Ethos Ho, BSc Pharm Candidate
A New Domain for Chronic Disease Management
As you may have heard, recreational use of marijuana will soon become legalized in July 2018, and with it will come new challenges and opportunities in healthcare. As the evidence for cannabis-use continues to grow, many clinical guidelines will soon incorporate cannabis as an option for various medical conditions including, but not limited to:
- Multiple Sclerosis
- Chronic pain
For today’s article, the evidence for the safety and effectiveness of cannabis-use will be evaluated for the management of chronic pain. For future articles, the treatment of other diseases will also be discussed to help get a better idea of where medical marijuana will fit in medical practice.
How Does Cannabis Work for Chronic Pain?
The leaf and flower of the marijuana plant contain substances belonging to the family known as cannabinoids. Among the cannabinoids in marijuana are several therapeutic components, perhaps the most well-known example being tetrahydrocannabinol (also known as THC, dronabinol).1 It’s currently believed that THC works to relieve pain by acting on cannabinoid receptors in the brain.1,2 This mechanism of action is similar that of opioid analgesics (e.g., morphine, codeine) which work by activating opioid receptors in the brain and body to affect the perception of pain.
How Safe is Cannabis?
Currently, there is only one marijuana product on the market with consistent, reliable safety evidence; a spray containing marijuana extract spray called Sativex ®. Sativex ® is sprayed directly into the mouth where it absorbs into the skin of the cheeks and tongue (instead of being swallowed) and is generally considered safe. On the other hand, there is currently not enough evidence to determine the safety of orally ingested marijuana or marijuana extracts.
Inhaled marijuana is considered possibly unsafe, as there have been cases of lung damage in individuals who have smoked using pipes, or rolled “joints” for several years. As well, one study found evidence that smoking marijuana can potentially increase the risk of lung cancer, however, it’s not currently clear if the risk is due to marijuana itself or contaminants associated with smoking.1,3
Marijuana use is not recommended in pregnant or breastfeeding women as it can pass through the placenta or breastmilk. This can lead to impaired fetal growth and delayed development.1
In terms of drug interactions, caution is advised when using cannabis with drugs that cause sedation, due to the risk of additive over-sedation. Theoretically, cannabis can also increase the risk of bleeding when taken with antiplatelet or anticoagulant medications such as aspirin and warfarin respectively. In two isolated cases, smoking marijuana was found to cause reversible hypomania (a mild form of mania) when combined with disulfiram (a drug for treating alcoholism) or fluoxetine (Prozac ®, an antidepressant).1
What Does the Evidence Say?
The evidence for the medical uses of cannabis continues to grow, and we’ll likely learn more about its clinical value once it becomes incorporated into modern medical practice. Recently, a new study has found promising results from using oral or vaporized cannabis for treating chronic pain. This has led to a growing belief that cannabis may be a viable option for treating chronic pain in addition to conventional medications.4
The researchers also found that medical cannabis was effective in the treatment of nerve pain, which has long been considered a complicated and difficult condition to treat by most clinicians – even with currently available medications. The results supported the safety and benefit of short-term, low-dose cannabis in vapour or spray form to reduce symptoms of nerve pain.2,6 Interestingly enough, cannabis for nerve pain was also shown to be as effective as current medications with similar tolerability.2
Although more high-quality studies are needed, cannabis-based medicinal extracts may be a viable option for treating cases of chronic nerve pain which have not responded to conventional medications.5 In addition, several individuals reported improvements in sleep and many did not experience serious side-effects.7 As well, there is preliminary evidence that cannabis may also be effective for treating fibromyalgia and rheumatoid arthritis.7
The Bottom Line
It’s still too early for a final verdict on the effectiveness and safety of medical cannabis for treating chronic pain. However, growing evidence suggests it may be a viable alternative for individuals who have exhausted all other treatment options. But until then, clinicians currently recommend using conventional medications first before considering alternative options such as cannabis.
As always, we hope you took away something valuable from this piece. If you have any questions or concerns regarding this article or others, feel free to reach out to us on Instagram, Facebook, or at firstname.lastname@example.org with your feedback. We’d love to hear from you.
- Natural Medicines
- Lee, G., Grovey, B., Furnish, T., & Wallace, M. (2018). Medical Cannabis for Neuropathic Pain. Current Pain And Headache Reports, 22(1). doi: 10.1007/s11916-018-0658-8
- ldington, S., Harwood, M., Cox, B., Weatherall, M., Beckert, L., & Hansell, A. et al. (2008). Cannabis use and risk of lung cancer: a case-control study. European Respiratory Journal, 31(2), 280-286. doi: 10.1183/09031936.00065707
- Fanelli, G., De Carolis, G., Leonardi, C., Longobardi, A., Sarli, E., Allegri, M., & Schatman, M. (2017). Cannabis and intractable chronic pain: an explorative retrospective analysis of Italian cohort of 614 patients. Journal Of Pain Research, Volume 10, 1217-1224. doi: 10.2147/jpr.s132814
- Boychuk, D., Goddard, G., Mauro, G., & Orellana, M. (2015). The Effectiveness of Cannabinoids in the Management of Chronic Nonmalignant Neuropathic Pain: A Systematic Review. Journal Of Oral & Facial Pain And Headache, 29(1), 7-14. doi: 10.11607/ofph.1274
- Wilsey, B., Marcotte, T., Deutsch, R., Gouaux, B., Sakai, S., & Donaghe, H. (2013). Low-Dose Vaporized Cannabis Significantly Improves Neuropathic Pain. The Journal Of Pain, 14(2), 136-148. doi: 10.1016/j.jpain.2012.10.009
- Lynch, M., & Campbell, F. (2011). Cannabinoids for treatment of chronic non-cancer pain; a systematic review of randomized trials. British Journal Of Clinical Pharmacology, 72(5), 735-744. doi: 10.1111/j.1365-2125.2011.03970.x
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