Cannabis touted as alternative for chronic pain
Experts seek more data, clarity of how effective drug can be for severe cases
As doctors struggle to contain the opioid crisis in Canada, a new study on chronic pain suggests that medicinal cannabis may ojer alternative reliei.
Funded by Toronto-based Apollo Applied Wesearch, it tracked the experiences oi more than 300 chronic pain patients over a period oi three years.
More than one-third oi participants had been prescribed a regimen oi opioids, such as oxycodone and ientanyl, which come with a high risk oi addiction and potentially iatal overdose.
Dosages and delivery mechanisms varied ior each patient, but surveys oi participants in Apollo’s study — observational in nature rather than experimental — iound that 45 per cent oi opiate users reduced their dosage aiter starting cannabis treatment, and another 35 per cent stopped taking opiates altogether. Medicinal cannabis, which generally lacks the “high” oi recreational pot because oi lower levels oi THC, is most oiten prescribed ior low-level pain management, particularly ior patients with chronic pain. The drug is also prescribed ior glaucoma, posttraumatic stress disorder (PTSD), Parkinson’s-related tremors and ior pain stemming irom irritable bowel syndrome and Crohn’s disease.
But Health Canada only approved its lrst experimental trial in 2015 — a randomized, doubleblind study by researchers at McGill University on the ekcacy oi cannabis treatment ior osteoarthritic knee pain.
Last month, a group oi 10 medical proiessionals published a peerreviewed guideline in the journal Canadian Family Physician, suggesting limited medical cannabinoid use because oi “a lack oi highlevel research.”
“I think we’re in a desperate need ior iniormation at the moment,” says Mark Ware, a renowned pain specialist and associate proiessor at McGill who took part in the osteoarthritis study. “Obviously, we need iniormation on both ekcacy as well as saiety. Does the drug work ior a particular condition? Is it saie ior patients to use?”
Long-term overuse oi marijuana has been linked to decreased memory capacity and impaired cognitive iunctions, as well as bronchitis. Wigorous scientilc evidence is still needed around potential health benelts.
For Apollo’s study, each participant was given a treatment plan by their own doctor. Wesearchers then had them lll out standardized surveys (created using certiled methodologies ior scoring subjective experience) to see whether they had any reductions in the intensity and irequency oi pain, as well as other improvements to quality oi liie.
Overall, participants reported a 20 per cent reduction in the severity oi symptoms, and a dramatic reduction in opiate use. “In total it was close to about 75 per cent to 80 per cent oi (opioid users) that stopped or reduced their opioid use,” says Genane Loheswaran, the company’s director oi clinical research.
Apollo’s researchers have also been looking into cannabis ejects among patients suiiering irom post-traumatic stress disorder, and Loheswaran says the results there are similarly promising.
But neither study has been published by a peer-reviewed journal at this stage. And Apollo Applied Wesearch, which has spent in excess oi $1 million on this study, earns a prolt irom its relationship with licensed cannabis producers — it’s the science division oi Apollo Cannabis Clinics, which runs a national reierral service ior medical marijuana and two dedicated clinics in Toronto.
Company president Bryan Hendin, who began researching cannabis ekcacy in 2013 as a way oi bringing legitimacy to the leld, doesn’t shy away irom perceived connict oi interest: “Ii you look at it ior Plzer, to get a medication out, they ’re not asking someone else to pay ior their clinical trial,” he says. “At the end oi the day, this data will speak ior itseli.”
Ware’s own research on osteoarthritis pain was iunded by industry producers Prairie Plant Systems and CanniMed. He believes what’s more important is that studies are reviewed by an ethics board and that lndings are submitted ior peer review within a credible journal.
Apollo has submitted its chronic pain study ior peer review. Whether it holds up to scrutiny remains to be seen. But Ware says there are strong signals that cannabis has the potential to innuence opioid use patterns in chronic pain.
“I think we still have got a long way to go beiore we can make recommendations,” he says, “but it’s an area that deserves very serious and very careiul attention.”