Medical cannabis is a safe and effective treatment for pain relief and should be integrated into current clinical practice, according to a new evidence overview. Benefits also include reduced spasticity in multiple sclerosis patients.
The overview, titled “Special Issue: Cannabis in Medicine,” was published in the European Journal of Internal Medicine. It presents current data supporting the use of cannabis in medicine and calls for more research to provide increased evidence of its benefits.
“We feel it is absolutely imperative to not only present the current state of affairs, but also propose the development of the scientific research program within the paradigm of evidence-based medicine,” Victor Novack, an MD and PhD, the special issue’s guest editor and a professor of medicine at Ben-Gurion University of the Negev, in Israel, said in a press release.
“Our ultimate aim should be to scientifically establish the actual place of medical cannabis-derived products in the modern medical arsenal,” Novack added.
Despite cannabis’ historical use to relieve pain and improve sleep, among other purposes, legal restrictions have limited research on its safety and effectiveness, and has led to doctors having little to no understanding of its use. However, the number of studies on cannabis has greatly increased in recent years.
The special issue includes two studies in cancer patients and the elderly, as well as a review of the evidence, practical use, regulations, and ethics related to cannabis use.
“This Medical Cannabis special issue covers everything you wanted to know about medical cannabis,” Novack said.
“We hope that it will provide physicians with a contemporary summary of different aspects related to the medical cannabis and guide the choice of an appropriate [use] for the indications where the evidence is sufficient to initiate the treatment. We also hope the articles will facilitate the conversation on the future of medical cannabis research and its accommodation into mainstream medicine,” he added.
The study with cancer patients, “Prospective analysis of safety and efficacy of medical cannabis in large unselected population of patients with cancer,” addressed the safety and efficacy of medical cannabis in palliative treatment of cancer symptoms.
The research, which had Novack as a senior author, analyzed data from 2,970 cancer patients treated with medical cannabis from 2015 to 2017.
The most frequent types of cancer were breast (20.7%), lung (13.6%), pancreatic (8.1%) and colorectal (7.9%).
The main symptoms requiring treatment were sleep problems (78.4%), pain (77.7%), weakness (72.7%), nausea (64.6%), and lack of appetite (48.9%).
Results showed that 95.9% of the patients who completed the six-month follow-up (1,211 patients) reported an improvement in their condition.
“In an age where a physician often prescribes a different medication for each symptom, cannabis, as a comprehensive treatment that affects several symptoms, becomes a desirable therapeutic option,” the researchers wrote.
The same team conducted a similar study, “Epidemiological characteristics, safety and efficacy of medical cannabis in the elderly,” in older patients, who received medical cannabis for a variety of issues, the most common being pain and cancer.
After a six-month treatment period, 93.7% of respondents reported an improvement in their condition and reduced pain. Of note, 18.1% of patients stopped using opioid analgesics or decreased their dose.
“Our study finds that the therapeutic use of cannabis is safe and efficacious in the elderly population. Cannabis use may decrease the use of other prescription medicines, including opioids,” the investigators wrote.
However, the team emphasized the need to collect more evidence from studies in the elderly, especially through double-blind clinical trials.
The special issue also contains a review study, “The therapeutic effects of Cannabis and cannabinoids: An update from the National Academies of Sciences, Engineering and Medicine report,” from Donald Abrams, MD, a professor of clinical medicine at the University of California San Francisco.
It covers the recent review of medical literature, “The Health Effects of Cannabis and Cannabinoids” by the National Academies of Sciences, Engineering and Medicine.
The report considered 10,000 recent scientific abstracts and “concluded that there was conclusive or substantial evidence that Cannabis or cannabinoids are effective for the treatment of pain in adults; chemotherapy-induced nausea and vomiting; and spasticity associated with multiple sclerosis.”
However, the report also emphasized the barriers to research on cannabis in the U.S., which may help explain the limited amount of data backed up by scientific evidence. The scarcity of research also represents an ethical obstacle to medical prescriptions, because many doctors lack the knowledge to properly advise dosage and use.
A Canadian and Czech study also present in the special issue, “Practical considerations in medical cannabis administration and dosing,” offers guidance for doctors, with data on cannabis drug interactions, patient monitoring, and standards of care.
