A recent report published in the Journal “Lancet Public Health” titled “The effect of cannabis use in people with chronic non-cancer pain prescribed opioids-A four year prospective cohort study” from the National Drug and Alcohol Research Centre at the University of New South Wales, made the conclusions that cannabis use in this group actually appeared to make the pain experienced by these people worse and increased their general level of anxiety.

Reports were released in the media suggesting that this was a blow to the Medical Cannabis industry by proving that cannabis has no benefits in this group of people. Firstly, I would like to make the point that I do have a significant conflict of interest in writing this article. I am on the board of the company MGC pharmaceuticals who are researching and developing medical cannabis in Australia and Internationally and will soon be releasing a pill for refractory epilepsy known as Cannepil.

But, precisely for this reason, it would be irresponsible of me and other people involved in the Medical Cannabis industry not to address the concerns raised by this article. It is important to realise that the gold standard of research in medical science is the randomised controlled clinical trial (RCT), where a large group of participants are split into two age & demographically matched groups where half are given the active, standardised pharmaceutical grade substance, whilst the other half is given a placebo and, in the best possible trials, both researchers and patients are blinded as to whom receives which, the active or placebo drug.

This trial was a prospective cohort study purely looking at the use of the illegal, non-standardised marijuana and compared  use in people with chronic pain who did not use marijuana. I have said for years that I believe illegal marijuana should stay  illegal because of the pervasive side effects of this drug including an increased risk for a variety of mental health disorders, including schizophrenia and anxiety. It is certainly not comparable with Medical Cannabis, which has either no or much less (non-psychotropic) concentrations of THC.

THE STUDY

This study examined the use of illegal cannabis in people who were already taking prescribed opioids. The studied group of people obtained their opioids from pharmacies. They initially enrolled 1,514 people throughout Australia and at the end of four years, 1,217 completed a final questionnaire. Twenty percent of the group had discontinued use of opioids after four years. There was a marginal though statistically significant increase in the severity of pain especially with high users of illegal cannabis and an increase in anxiety disorder.

To quote the authors of this study, “In our cohort, patients with chronic non-cancer pain who used cannabis reported significantly greater pain severity than those not using cannabis, consistent with surveys of medicinal users who report using cannabis because of a failure of conventional treatments. Those using cannabis with the intent of relieving their pain might represent a patient population with more distress and poorer coping mechanisms, as evidenced in our study by the lower pain self-efficacy scores for people who used cannabis. It could be that in the absence of cannabis use, pain severity and interference might have been worse. However, our study supports recent research that suggests cannabis use is associated with reduced self-efficacy in managing depression and anxiety”.

Again, this direct quote from the paper reinforces the point I made about the use of illegal drugs. They are unregulated with varying doses & contaminants with none of the rigorous controls mandated by scientific clinical trials.

All this study is saying, in my opinion, is that people with chronic non-cancer pain should not be using illegal substances such as marijuana in the false belief that it will help their symptoms. Illegal marijuana is completely unregulated (that is the reason it is illegal) and untested for any medical condition, despite the strong notion amongst some users that it does give them relief for a number of medical conditions.

FINDING ANSWERS

This is precisely the reason responsible companies around the world, including MGC pharmaceuticals, are performing well conducted, randomised controlled clinical trials of pharmaceutical grade medical cannabis to determine whether there are any benefits for a variety of conditions such as refractory epilepsy, cancer associated conditions such as pain, nausea and vomiting associated with chemotherapy and cachexia from the cancer itself. Medical cannabis is also been trialled for chronic non-cancer pain with some preliminary data suggesting a benefit. Also, there are some papers suggesting benefits treating the spasticity associated with multiple sclerosis, chronic degenerative neurological conditions such as Alzheimer’s disease, Parkinson’s disease and motor neurone disease, along with a variety of autoimmune conditions.

My company has conducted a series of successful trials using topical medical cannabis for psoriasis and eczema.

Thus, when the media sensationalises well conducted observational, cohort trials such as this, examining the use of illegal drugs in ubiquitous states of chronic pain and draws conclusions from questionnaires filled in by these people, it is my opinion that this is irresponsible reporting. Not on the part of the researchers, but certainly by some in the media.

With the well-reported fact that there are now more deaths in modern society from prescription opioids than deaths from heroin overdose, we certainly need a better approach to managing chronic pain, because opioid use is clearly not the answer.

Whether medical cannabis is useful for the management of chronic non-cancer pain is as yet unanswered. But the preliminary data to this point do appear promising. Trials such as this are irrelevant as to the efficacy of medical cannabis. This report purely strengthens the notion that illegal drugs should stay where they are - illegal.