Canada’s First Med­i­cal Cannabis Trial Seeks New Op­tions for Arthri­tis Pa­tients

National Post (Latest Edition) - - BONE & JOINT HEALTH - By San­dra MacGre­gor

Once maligned as a haz­ardous illegal drug, cannabis’ cred­i­bil­ity has risen over the last few decades as the med­i­cal com­mu­nity be­gan to ex­plore its pos­si­ble medic­i­nal ap­pli­ca­tions. This year marked yet another mile­stone in the quest for phar­ma­ceu­ti­cal le­git­i­macy when Health Canada ap­proved a Phase II clin­i­cal trial in­volv­ing med­i­cal cannabis.

The CAPRI Trial (Cannabi­noid Pro­file In­ves­ti­ga­tion of Va­por­ized Cannabis in Pa­tients with Os­teoarthri­tis of the Knee), which be­gins in the next few weeks, is over­seen by one of the coun­try’s most es­tab­lished med­i­cal cannabis pro­duc­ers, as well as re­searchers at McGill Univer­sity Health Cen­tre and Dal­housie Univer­sity. The ran­dom­ized, dou­ble-blind, placebo-con­trolled study will ex­am­ine the safety and anal­gesic dosage re­sponses to va­por­ized cannabis of adults over 50 with os­teoarthri­tis of the knee. The re­search will con­sist of sev­eral va­ri­eties of med­i­cal mar­i­juana, with dif­fer­ent con­cen­tra­tions of the two ma­jor ac­tive com­pounds, delta-9-tetrahy­dro­cannabi­nol (THC; a mood-al­ter­ing in­gre­di­ent) and cannabid­iol (CBD; a pos­si­ble anti-in­flam­ma­tory).

“Though it’s a pre­lim­i­nary study, this clin­i­cal trial is sig­nif­i­cant be­cause we’re look­ing at two im­por­tant things,” ex­plains Dr. Mark Ware, one of the trial’s pri­mary in­ves­ti­ga­tors and as­so­ciate pro­fes­sor in Fam­ily Medicine and Anes­the­sia at McGill Univer­sity. “We’re study­ing how pa­tients re­spond to the de­liv­ery sys­tem of va­por­ized cannabis and we’ll see if there’s a par­tic­u­lar ra­tio of the two ma­jor com­pounds most likely to give an anal­gesic re­sponse. It’s ground­break­ing in many ways. The study and peo­ple in­volved will help build our knowl­edge base. We’re acutely aware of how lit­tle in­for­ma­tion there is out there to help physi­cian make de­ci­sions with re­spect to med­i­cal cannabis.”

The trial de­cided to tar­get those who suf­fer from arthri­tis of the knee for a va­ri­ety of rea­sons, in­clud­ing sub­stan­tial re­search from an­i­mal mod­els that cannabi­noids could pos­i­tively af­fect the symp­toms of os­teoarthri­tis. Another com­pelling rea­son to fo­cus on os­teoarthri­tis was that “…arthritic pain is one of the most sin­is­ter ones, and it doesn’t seem to go away easily,” says Brent Zettl, pres­i­dent and CEO of Prairie Plant Sys­tems and CanniMed. He notes that in the com­pany’s ten­ure as a sanc­tioned med­i­cal mar­i­juana sup­plier for Health Canada, they found that about 37 per­cent of the pa­tients un­der the orig­i­nal pro­gram were us­ing med­i­cal cannabis to treat some kind of arthri­tis.

Though there are med­i­ca­tions for arthri­tis pa­tients, Zettl points out that they are not with­out their is­sues: “There’s such a strong de­mand from peo­ple who need to man­age pain and the op­tions they have aren’t so great. There are a lot of chal­lenges with the neg­a­tive side ef­fects of opi­ates like oxy­codone.” Dr. Ware also high­lights the lim­i­ta­tions of cur­rent med­i­ca­tions, “the stan­dard anal­gesics cur­rently avail­able can be very ef­fec­tive but can also have sig­nif­i­cant side ef­fects which can ac­tu­ally limit a pa­tient’s abil­ity to use them.”

The CAPRI trial is an im­por­tant step in ed­u­cat­ing peo­ple and doc­tors about the pos­si­ble ben­e­fits of mar­i­juana and al­lay­ing deeply rooted fears. “One of the ma­jor bar­ri­ers to the wide­spread us­age and ac­cep­tance of med­i­cal mar­i­juana is a fear of pa­tient abuse,” says Dr. Ware. “Many physi­cians are wor­ried that pa­tients who ask for med­i­cal cannabis want to use it for recre­ational pur­poses. Yet we hear re­peat­edly from pa­tients that they’re try­ing to con­trol se­vere symp­toms and cannabis ap­pears to be help­ing them. They want to achieve a qual­ity of life they can’t have with other med­i­ca­tion. By study­ing med­i­cal cannabis we’re try­ing to strike a bal­ance be­tween what pa­tients tell us and ad­dress physi­cians’ con­cerns. The hope is to find a happy medium, a dose pa­tients can safely use that min­i­mizes side ef­fects but helps them live with less pain.”

“The hope is to find a happy medium, a dose pa­tients can safely use that min­i­mizes side ef­fects but helps them live with less pain.” “Volup­taquam en­d­est ex­ce­pel igeni­hiti reribusam, ut a nos que nis qui de­lest hil­len­dant.”

The Pro­duc­tion Process Can­niMed Fa­cil­i­ties. Photo: Can­niMed

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