“Do not prescribe currently available ‘medicinal cannabis’ products to treat chronic non-cancer pain (CNCP) unless part of a registered clinical trial”
So was just one of the unambiguous and evidence-based recommendations outlined in recent literature.
The ‘red flags’ on current therapeutic claims around cannabis and pain (and other pain/distress inducing ailments i.e., certain rare epilepsies) continue to grow.
As the Dalgarno Institute has intimated repeatedly, the decades long declaration on the promised ‘panacea of pot’ have not been actualized, even after repeated proclamations of potential, that it was ‘merely a matter of time and new science’.
Whilst the scientific process is not at an end, one would have thought that nearly 20 years of pursuit would have actualized just some of those remarkable claims. Yet, still promises failed, or any potentials for good, undermined or diminished by unintended consequences, side-effects, and harms.
Ah, but one thing that seems to emerge in the ‘benefits’ column of this purported plant panacea is the placebo effect. As we’ve stated previously, and here again, this emergence should be harnessed to give people Pot-placebos and allow those for who it works to be managed accordingly, without the toxicity of this now utterly engineered plant.
The Literature Speaks and Anecdotes Challenged?
The following is just some of the latest recommendations emerging in the latest literature
Cannabis-derived products are now available for use with therapeutic intentions in Australia and New Zealand. By far the most common reason for their use is chronic pain however there is a critical lack of evidence that it provides a consistent benefit for any type of chronic non-cancer pain. More than 90% of Special Access Scheme – Category B (SAS-B) approvals have been for chronic pain of various types.
The evidence available is either unsupportive of using cannabinoid products in chronic non-cancer pain (CNCP) or is of such low quality that no valid scientific conclusion can be drawn. Cannabidiol-only formulations have not been the subject of a published randomised controlled trial (RCT) for pain indications, yet they are the most commonly prescribed type of product.
In addition, evidence of harms does exist, particularly in relation to sedative effects, interactions with other medications and neuropsychiatric effects (for products which contain tetrahydrocannabinol (THC)).
Given the above, the clinical use of cannabinoid products cannot be ethically recommended outside a properly established and registered clinical trial environment until high-quality evidence for specific indications is published.
Recommendation 6: Draft guidance says patients with chronic pain should not be offered tetrahydrocannabinol (THC) or mixtures of cannabidiol and THC unless the treatment is part of a clinical trial.
Choosing Wisely Australia 19 March 2021 Faculty of Pain Medicine, ANZCA
International Association for the Study of Pain Presidential Task Force on Cannabis and Cannabinoid Analgesia position statement
Conclusion: Reviews of preclinical research and clinical safety and efficacy of cannabis and cannabinoids for pain relief have identified important research gaps. Due to the lack of high-quality clinical evidence IASP does not currently endorse general use of cannabis and cannabinoids for pain relief. International Association for the Study of Pain recognizes the pressing need for preclinical and clinical studies to fill the research gap, and for education on this topic.
Basic science advances are promising, but these are yet to be fully translated to efficacious and safe medicines. There is a need to increase our understanding of the biology of the endocannabinoid system. High-quality research is required to elucidate the types of pain, and characteristics of individuals, where there is benefit or harm from particular cannabinoid compounds (personalised medicine). Improved understanding of the clinical pharmacology of cannabis and cannabinoids in a pain relief setting is needed. Expansion in the range of chemical entities tested, elucidation of dose effects, and the optimisation of drug delivery is required.
As a global multidisciplinary organization of health and science professionals, IASP has a duty to protect public health, although IASP recognises that some jurisdictions already permit the use of cannabis and cannabinoids for pain relief, other medical indications, or recreational use. More research is required to elucidate the benefits and harms of therapeutic use of cannabis and cannabinoids for the treatment of pain. (A lay summary can be found on the IASP website at: https://www.iasp-pain.org/summarystatement)
‘Medical’ Cannabis Blacklisted by Australian Pain Specialists?
Dean of ANZCA’s pain medicine faculty Professor Michael Vagg said medicinal cannabis products on the market “are not even close” to showing they are effective in the management of patients with complex chronic pain.
“The research available is either unsupportive of using cannabinoid products in chronic non-cancer pain or is of such low quality that no valid scientific conclusion can be drawn,” the pain specialist and physician said.
The National Institute for Health and Care Excellence (NICE) has said it is currently unable to recommend cannabis-based medical products (CBMPs) for severe treatment-resistant epilepsy.
In draft guidance on the use of CBMPs, NICE said that more research into the use of CBMP for the treatment of a number of conditions was needed because “current research is limited and of low quality”, adding that clinical trials had shown a high level of adverse events.
The guidance said that patients with chronic pain should not be offered tetrahydrocannabinol (THC) or mixtures of cannabidiol (CBD) and THC unless the treatment is part of a clinical trial.
NICE also said there is no evidence that CBD in isolation is effective for chronic pain and that the potential benefits of CBPMs in all cases “were small compared with the high and ongoing costs, and the products were not an effective use of NHS resources”
The concern isn’t so much for the failed potential, or even the all to often negative attending issues of this product, but more, that this ‘medicinal’ smoke-screen is being used to promote the ‘harmlessness’ or worse, benefits of this product, all lending itself to ‘recreational’ release. The two popular, and of course, ‘heart string tugging’ uses are pain and epilepsy. After all, no-one, very much including us, wants those suffering to be deprived of properly trialled and tested pharmaceutical grade medicines that do no harm. Simply to have a product alleviate one symptom whilst causing other and often longer-lasting complications or damage, is not good medicine or best-practice at all.
It’s not about listening to ‘experts’ only, as we have seen with the over-prescribing of regulated opioids, but it certainly cannot simply be alleviating a ‘felt need’ at any cost.
We saw all this behaviour unleashed in the second half of the 19th Century with unregulated cocaine and opium employed by anyone making therapeutic claims, simply on the basis that; ‘if you ‘feel’ better, you must be better.’ That disastrous anecdotal prescribing led to (arguably) the greatest per capita addiction statistics the United Stats had ever seen, current opioid crisis included.
We must all ask, but particularly those charged with policy creation, the cautiously wise questions of our current process; are we advancing in our science to bring best health-care practice to the populace, or are we regressing to back-ward model and dressing it up in clinical terms?
Let’s not let science get in the way of a feel-good story, no matter how short lived.
For more articles, research and commentary see following…
- Doctors accuse Britain's first medical cannabis clinic of making unfounded claims over pain relief
- Medical cannabis products 'will drive patients to addiction and crime' and turn doctors into drug dealers, warn experts in scathing letter
- Cannabis and cannabinoids for the treatment of people with chronic noncancer pain conditions: a systematic review and meta-analysis of controlled and observational studies
- Pain response to cannabidiol (CBD) in induced acute nociceptive pain, allodynia, and hyperalgesia by using a model mimicking acute pain in healthy adults in a randomized trial
- Cannabis, NOT the answer to the Opioid Crisis! Yet again!
- Science vs Marketing: Addiction for Profit off the back of Peoples Grief - unconscionable!
- Cannabis as ‘Medicine?’: Pot Propaganda, Emotive Anecdote, Marketing Manipulation, and the Side Stepping of Science
By Research & Communications Team – Dalgarno Institute