‘Weak’ proof helps utilizing medical hashish to deal with power ache

16.09.2021

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Disclosure:
Busse reports as a consultant for Health Canada, Health Quality Ontario, Veterans Affairs Canada; Providing expert evidence to the House of Commons Veterans Affairs Standing Committee; Received scholarships from the American College of Physicians and the Canadian Institutes of Health Research; Presentations to the Canadian Pain Society, the McMaster Center for Medicinal Cannabis Research, and various hospitals; and receipt of travel and accommodation expenses from Veterans Affairs Canada. Dionne and Kröger do not report any relevant financial information. Please see the referral article for all relevant financial information from the other authors.

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An international panel of experts reported that uninhaled medicinal cannabis or cannabinoids are associated with modest benefits in patients with chronic pain.

So far, most research has focused on the effects of recreational cannabis use, Jason Busse, DC, PhD, a panel member and assistant director of the Michael G. DeGroote Center for Medicinal Cannabis Research at McMaster University in Ontario, Canada, and associate professor of anesthesia, said in a press release.

Reference: Busse J, et al. BMJ. 2021; doi: 10.1136 / bmj.n2040.

“The increasing legalization of medical cannabis around the world, increasing patient consumption, lack of training in the use of medical cannabis or cannabinoids during formal medical training, and inconsistent guidelines from professional associations and federal agencies have all created confusion about the role of medical cannabis in medicine Treatment of chronic pain, ”wrote Busse and colleagues at the BMJ.

Researchers used the GRADE approach to analyze a linked series of four systematic reviews that examined benefits, harm, patient scores, and preferences related to medicinal cannabis or cannabinoids. The review included 32 randomized clinical trials.

After evaluating the data, panel members wrote that they were “confident” that the use of non-inhaled cannabis or cannabinoids led to the following:

  • “A small increase in the proportion of people living with chronic pain who experience significant improvements in pain and sleep quality”;
  • “A very small increase in the proportion of people with chronic pain who experience significant improvements in physical functioning”;
  • a lack of improvement in “emotional functions, role functions, or social functions”; and
  • “A small to very small increase in the proportion of people with chronic pain who suffer from cognitive impairment, vomiting, drowsiness, attention deficit disorder, and nausea, and a modest increase in the proportion of people with dizziness, which increased with longer follow-up.”

Based on the evidence, the panel made a weak recommendation to consider a study of non-inhaled medicinal cannabis or cannabinoids for people with chronic pain when standard care and treatment were inadequate. The recommendation applies to patients with cancer and non-cancer pain, neuropathic pain, nociceptive pain, and nociplastic pain.

“Therapeutic studies should begin with low-dose, non-inhaled cannabidiol products, with the dose and THC level gradually increasing (e.g. 3 days up to a maximum daily dose of 40 mg) depending on the clinical response and tolerability,” the panel wrote . “If the response is not satisfactory, clinicians can consider adding 1 mg to 2.5 mg of THC per day and titrating 1 mg to 2.5 mg every 2 to 7 days to a maximum of 40 mg / day.”

In the absence of sufficient evidence, Busse and colleagues found that the recommendations for pediatric patients, veterans, patients with simultaneous mental illness, disability pensioners and those involved in litigation “may or may not apply”. The recommendations do not apply to people in palliative care.

The panel also stressed that their recommendations do not apply to recreational use of cannabis or cannabinoids, nor to inhaled versions of these substances.

In terms of safety, Busse and colleagues reported that “serious adverse events are unlikely to occur with medicinal cannabis or cannabinoids and patients cannot have a fatal overdose”.

“Dizziness is the most common non-serious side effect of medical cannabis treatment,” they wrote. “The evidence for the side effects of medicinal cannabis or cannabinoids during pregnancy or breastfeeding is inconclusive: pregnant women or women contemplating pregnancy should be encouraged to stop using medicinal cannabis in favor of alternative therapy. Cannabis use during breastfeeding should be discouraged. ”

In a related editorial Edeltraut Kröger and Clermont E.. Dionne, Prof.

“Clinics should highlight the harm associated with vaporizing or smoking cannabis and, as recommended in other guidelines, propose products with known compositions such as nabilone or nabiximol, discourage self-medication, and pay special attention to particularly vulnerable populations,” write Kröger and Dionne.

References:

Busse J, et al. BMJ. 2021; doi: 10.1136 / bmj.n2040.

Kroeger E, Dionne C. BMJ. 2021; doi: 10.1136 / bmj.n.1942.

News wise. Medical cannabis can provide modest benefits for chronic pain. www.newswise.com/articles/medical-cannabis-may-give-modest-benefits-for-chronic-pain?ta=home. Accessed September 13, 2021.

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