Cannabis touted as opi­oid op­tion, more data needed

Seek­ing clar­ity ‘on ef­fi­cacy as well as safety’

National Post (Latest Edition) - - CANNABIS POST - DAVID DIAS

As doc­tors strug­gle to con­tain the opi­oid cri­sis in Canada, a new study on chronic pain sug­gests that medic­i­nal cannabis may of­fer al­ter­na­tive re­lief.

Funded by Toronto-based Apollo Ap­plied Re­search, it tracked the ex­pe­ri­ences of more than 300 chronic pain pa­tients over a pe­riod of three years.

More than one- third of par­tic­i­pants had been pre­scribed a reg­i­men of opi­oids, such as oxy­codone and fen­tanyl, which come with a high risk of ad­dic­tion and po­ten­tially fa­tal over­dose.

Dosages and de­liver y mech­a­nisms var­ied for each pa­tient, but sur­veys of par­tic­i­pants in Apollo’s study — ob­ser­va­tional in na­ture rather than ex­per­i­men­tal — found that 45 per cent of opi­ate users re­duced their dos- age af­ter start­ing cannabis treat­ment, and an­other 35 per cent stopped tak­ing opi­ates al­to­gether.

Medic­i­nal cannabis, which gen­er­ally lacks the “high” of recre­ational pot be­cause of lower lev­els of THC, is most of­ten pre­scribed for low-level pain man­age­ment, par­tic­u­larly for pa­tients with chronic pain. The drug is also pre­scribed for glau­coma, post­trau­matic stress dis­or­der ( PTSD), Parkin­son’s- re­lated tre­mors and for pain stem­ming from ir­ri­ta­ble bowel syn­drome and Crohn’s dis­ease.

But Health Canada only ap­proved its first ex­per­i­men­tal trial in 2015 — a ran­dom­ized, dou­ble- blind study by re­searchers at McGill Univer­sity on the ef­fi­cacy of cannabis treat­ment for os­teoarthritic knee pain.

Last month, a group of 10 med­i­cal pro­fes­sion­als pub­lished a peer-re­viewed guide­line in the jour­nal Canadian Fam­ily Physi­cian, sug­gest­ing lim­ited med­i­cal cannabi­noid use be­cause of “a lack of high­level re­search.”

“I think we’re in a des­per­ate need for in­for­ma­tion at the mo­ment,” says Mark Ware, a renowned pain spe­cial­ist and as­so­ciate pro­fes- sor at McGill who took part in the os­teoarthri­tis study. “Ob­vi­ously, we need in­for­ma­tion on both ef­fi­cacy as well as safety. Does the drug work for a par­tic­u­lar con­di­tion? Is it safe for pa­tients to use?”

Long-term overuse of mar­i­juana has been linked to de­creased mem­ory ca­pac­ity and im­paired cog­ni­tive func­tions, as well as bron­chi­tis. Rig­or­ous sci­en­tific ev­i­dence is still needed around po­ten­tial health benefits.

For Apollo’s study, each par­tic­i­pant was given a treat­ment plan by their own doc­tor. Re­searchers then had them fill out stan­dard­ized sur­veys (cre­ated us­ing cer­ti­fied method­olo­gies for scor­ing sub­jec­tive ex­pe­ri­ence) to see whether they had any re­duc­tions in the in­ten­sity and fre­quency of pain, as well as other im­prove­ments to qual­ity of life.

Over­all, par­tic­i­pants re­ported a 20 per cent re­duc- tion in the sever­ity of symp­toms, and a dra­matic re­duc­tion in opi­ate use. “In to­tal it was close to about 75 per cent to 80 per cent of (opi­oid users) that stopped or re­duced their opi­oid use,” says Ge­nane Lo­heswaran, the com­pany’s di­rec­tor of clin­i­cal re­search.

Apollo’s re­searchers have also been look­ing into cannabis ef­fects among pa­tients suf­fer­ing from post-trau­matic stress dis­or­der, and Lo­hes- waran says the results there are sim­i­larly promis­ing.

But nei­ther study has been pub­lished by a peer-re­viewed jour­nal at this stage. And Apollo Ap­plied Re­search, which has spent in ex­cess of $1 mil­lion on this study, earns a profit from its re­la­tion­ship with li­censed cannabis pro­duc­ers — it’s the sci­ence di­vi­sion of Apollo Cannabis Clin­ics, which runs a na­tional re­fer­ral ser­vice for med­i­cal mar­i­juana and two ded­i­cated clin­ics in Toronto.

Com­pany pres­i­dent Bryan Hendin, who be­gan re­search­ing cannabis ef­fi­cacy in 2013 as a way of bring­ing le­git­i­macy to the field, doesn’t shy away from per­ceived con­flict of in­ter­est: “If you look at it for Pfizer, to get a med­i­ca­tion out, they’re not ask­ing some­one else to pay for their clin­i­cal trial,” he says. “At the end of the day, this data will speak for it­self.”

Ware’s own re­search on os­teoarthri­tis pain was funded 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 find­ings are sub­mit­ted for peer re­view within a cred­i­ble jour­nal.

Apollo has sub­mit­ted its chronic pain study for 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 in­flu­ence opi­oid use pat­terns in chronic pain.

“I think we still have got a long way to go be­fore we can make rec­om­men­da­tions,” he says, “but it’s an area that de­serves very se­ri­ous and very care­ful at­ten­tion.”

I THINK WE STILL HAVE GOT A LONG WAY TO GO BE­FORE WE CAN MAKE REC­OM­MEN­DA­TIONS, BUT IT’S AN AREA THAT DE­SERVES VERY SE­RI­OUS AND VERY CARE­FUL AT­TEN­TION.

— MARK WARE, PAIN SPE­CIAL­IST AND AS­SO­CIATE PRO­FES­SOR AT McGILL UNIVER­SITY

GRAEME ROY / THE CANADIAN PRESS

Pre­scrip­tion pills con­tain­ing oxy­codone and ac­etaminophen.

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