Cannaboids and chronic pain

A friend recently mentioned this article in The Lancet about an Australian study into cannabis use in people with chronic pain prescribed opiods.

Firstly a disclaimer: I find statistical analysis interesting. I’m not a medical professional, so take everything you read from me with the appropriate pinch of salt, and if you’re affected by any issues raised here, go and see your doctor.

A few thoughts, having now read the paper in full…

• “participants recruited from those already taking Schedule 8 opioids”. Schedule 8 is similar to UK Class A drugs, so we’re talking things like morphine, oxycodone, fentanyl, etc. – i.e. *seriously* strong painkillers. We’re way beyond a couple of tramadol or cocodamol here.

This is significant because, as I understand it, cannaboids are alleged to be effective at reducing mild to moderate pain – the sort of thing people self-medicate by taking OTC or ‘light’ prescription opiods to address – things like low-strength codeine, possibly up to and including tramadol.

Prescribing of the stronger opiods is quite carefully regulated and a medical practitioner needs to be fairly convinced the pain is severe before going down that route, at least outside the US.

• “Participants were asked about lifetime and past 12-month use of cannabis”. This is *not* a double-blind, or indeed a blind trial. Participants are being asked about their use of cannabis vs. S8 opiods in the preceding 3 month period, and are fully aware of the difference between them.

This is significant because participants are already ‘used to’ the pain relief effects of their prescribed (very strong) S8 opioid, and as Hazel has already said, that can effect perceived effectiveness of an alternative (even if that alternative were a ‘different’ opioid).

• “The funder of the study had no role in study design, data collection, data analysis, data interpretation, or writing of the report”

I’m not overly concerned by the funding of the study – they do seem to have taken reasonable precautions to keep corporate interests away from the data itself.

• Much of the study period pre-dates the legalisation of cannabis for medical use (in Australia). This is important because, for a significant period of the trial, participants have been using illicitly obtained cannabis, with the various quality control issues that usually involves (short of growing it oneself). That means that measuring the exact amount of active ingredient is nigh on impossible.

In conclusion – more research needed, especially for those at the lower end of the chronic pain scale, and in a DBT if at all possible.