Not all research is created equal: Cannabis and chronic pain

Not all research is created equal. A new study published in The Lancet medical journal suggests that cannabis is not effective at treating chronic, non-cancer pain. This study is flawed on a number of levels.

Take a look at what I, and other physicians treating patients with cannabinoid medicine across North America, have to say in the article here.

From a clinical perspective, I have successfully treated hundreds of patients with non-cancer, chronic pain with cannabis therapy. It does not work for everyone and it is not a panacea, but for many, many patients it can be life-changing and is the only medicine that works to relieve their pain.

However, until we have more prospective, randomized controlled trials that can prove causality, we will continue to go around in circles with the cannabis as medicine debate. To legitimize cannabis as medicine and improve access for patients around the world who could benefit, more quality research is imperative.

U.S. Senate committee slams marijuana's federal classification, saying Schedule I blocks research: Forbes

Forbes reporter, Tom Angell reports: "A key U.S. Senate committee says that marijuana's current federal classification blocks scientific research on its effects -- something that legalization advocates have long argued." 

Canadians, and indeed patients from around the world, cannot underestimate the impact that the U.S. classification of marijuana has on the pace of advancement within the field of cannabinoid medicine. 

Angell explains: "Schedule I is the most restrictive category under federal law, and is supposed to be reserved for drugs with a high potential for abuse and no medical value. Researchers wishing to study substances classified there must overcome procedural hurdles that don't exist for other drugs."

"The committee's criticism of Schedule 1 roadblocks to marijuana research provides more momentum to the effort to reclassify cannabis under federal law." 

Read full article here.

FDA approves first ever drug comprised of an active ingredient derived from marijuana

On June 25, 2018, the U.S. Food and Drug Administration (FDA) made history by granting approval for the first drug comprised of an active ingredient derived from marijuana, to treat rare, severe forms of epilepsy.

This impact of this decision on the advancement of cannabinoid medicine cannot be understated. Currently, marijuana is listed as a Schedule 1 drug in the U.S., which is defined as drugs with no currently accepted medical use and a high potential for abuse. Schedule 1 drugs currently include Heroine, LSD, Ecstasy and Marijuana, among others. The scheduling of marijuana in the U.S. has undoubtedly hindered research and development into cannabis as medicine and so the FDA's approval of Epidiolex - an oral solution made from cannabidiol (CBD) - could have a profound impact on the advancement and acceptance of cannabinoid medicine.

Read the FDA's full statement here.

 

 

Trust medical marijuana, N.J.'s top health official asks doctors and medical students: NJ.com

NJ.com reports: New Jersey's top doctor Tuesday encouraged physicians and medical students to embrace cannabis as another tool to help their patients, despite acknowledging that rigorous scientific research is lacking.

Here are a few highlights of his message but be sure to click on the full story to read the full article and watch a video from the day's event:

  • "At the end of the day, this is about patients. The Department of Health is pushing this because...many times it is the best therapy you can give them."
  • "I want this to be in physicians' and other providers' heads as a therapeutic option -- not something separate, not sort of in a different category like alternative medicine. This really is reaching a level of relevance and importance to patients,"

Cannabis versus Cancer: Scientific American

Scientific American reports: "Countless scientific studies have shown that medical cannabis offers palliative care benefits, including appetite stimulationpain relief and more. But early research indicates that cannabinoids can do so much more. Data is showing that medical marijuana has antitumor effects and may one day be used as a cancer treatment, not just as a drug to ease symptoms of the disease." Full article. 

Research: Anticancer effects of phytocannabinoids used with chemotherapy in leukaemia cells, International Journal of Oncology (May 27, 2017)

Early research is providing cancer patients with new hope.

From Abstract: "Phytocannabinoids possess anticancer activity when used alone, and a number have also been shown to combine favourably with each other in vitro in leukaemia cells to generate improved activity. We have investigated the effect of pairing cannabinoids and assessed their anticancer activity in cell line models. Those most effective were then used with the common anti-leukaemia drugs cytarabine and vincristine, and the effects of this combination therapy on cell death studied in vitro. Results show a number of cannabinoids could be paired together to generate an effect superior to that achieved if the components were used individually." Full study here.

Is there a double-standard when it comes to off-label pharmaceuticals and medical cannabis?

In Canada, all prescription pharmaceuticals (“drugs”) must be approved for sale by Health Canada. When Health Canada approves a drug for sale the approval stipulates, among other things; the population for whom the drug can be prescribed, the indication(s) 
the drug can treat, and the dosage(s) that can be administered. The use of an approved drug beyond the criteria set out in the product’s approval is referred to as “off-label” use. 

1 in 9 drugs are used off label: 99.2% of gabapentin is used off label and 75% of pediatric medications are used off label. According to a Health Canada report (below), 79% of off-label prescriptions were not supported by strong scientific evidence. (Strong evidence was described as at least one randomized, controlled clinical trial {RCT}.) Yet, when it comes to medical uses for cannabis, the same rules do not apply and the standards for evidence are so much more rigorous. As a physician seeing the positive impacts of cannabinoid therapy on my patients every day, I really question this double-standard — especially given cannabis’ excellent safety profile. 

Check out the Senate of Canada Standing Senate Committee on Social Affairs Science and Technology on Prescription Pharmaceuticals in Canada - Off Label Use.

Research: Opioid use lower in states that eased medical marijuana laws, JAMA (April 2, 2018)

On Monday, the Journal of the American Medical Association published two studies investigating whether access to medical cannabis reduces opiate use and abuse. This article from NPR provides a solid, balanced overview.

NPR reports: 

Medical marijuana appears to have put a dent in the opioid abuse epidemic, according to two studies published Monday.

The research suggests that some people turn to marijuana as a way to treat their pain, and by so doing, avoid more dangerous addictive drugs. The findings are the latest to lend support to the idea that some people are willing to substitute marijuana for opioids and other prescription drugs.

Many people end up abusing opioid drugs such as oxycodone and heroin after starting off with a legitimate prescription for pain. The authors argue that people who avoid that first prescription are less likely to end up as part of the opioid epidemic.

"We do know that cannabis is much less risky than opiates, as far as likelihood of dependency," says W. David Bradford, a professor of public policy at the University of Georgia. "And certainly there's no mortality risk" from the drug itself.

Read full article here.