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Media release
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Interest in the use of cannabis for medicinal purposes has been increasing worldwide and chronic non-cancer pain is the most common reason cited for medicinal use. There has been increasing speculation that using cannabis for pain may also allow people to reduce their prescribed opioid use. To date however, long-term evidence is limited: randomised control trials of cannabis for pain typically have short durations of generally 3 months and tend to exclude patients with complex physical and mental health problems; and controlled studies of potential “opioid sparing” effects have been lacking.
Now a group of researchers at UNSW Sydney has conducted one of the world’s longest in- depth community studies, of 1,500 people prescribed opioids for non-cancer pain over a four-year period, and examined the effect of cannabis on their pain, on the extent to which pain interfered with their everyday life, and on their prescribed opioid use.
The results, published in Lancet Public Health, suggest that there is a need for caution given no strong findings supporting a clear role for cannabis for these reasons. At each assessment, participants who were using cannabis had greater pain and anxiety, were coping less well with their pain, and reported that pain was interfering more in their life. There was no clear evidence that cannabis reduced pain severity or pain interference or led participants to reduce their opioid use or dose.
Hear from the lead author of the study Dr Gabrielle Campbell. Recording now available below.
Speakers:
- Dr Gabrielle Campbell, an NHMRC Australian Public Health Early Career Fellow at the National Drug and Alcohol Research Centre (NDARC) at UNSW Sydney and co-ordinator of Pain and Opioids IN Treatment (POINT) study.
- Professor Michael Farrell is Director National Drug and Alcohol Research Centre at UNSW Sydney and Investigator on the Pain and Opioids IN Treatment (POINT) study
Date: Friday 29 June 2018
Start Time: 11:30am AEST
Duration: 30 min
Venue: Online
RECORDING NOW AVAILABLE BELOW.
Expert Reaction
These comments have been collated by the Science Media Centre to provide a variety of expert perspectives on this issue. Feel free to use these quotes in your stories. Views expressed are the personal opinions of the experts named. They do not represent the views of the SMC or any other organisation unless specifically stated.
I acknowledge the important contribution this work has made to the information available around the perceived and objective harms and benefits of recreational cannabis to treat non-cancer pain.
This study provides a helpful base to undertake future double-blind randomised placebo-controlled clinical trials to investigate in more depth the benefits and risks for treating non-cancer pain with medicinal cannabis.
This will be one of the important project areas for Australian Centre for Cannabinoid Clinical and Research Excellence and it’s Clinical Advisory Group to tackle.
Dr Gabrielle Campbell is an NHMRC Australian Public Health Early Career Fellow at the National Drug and Alcohol Research Centre (NDARC) at UNSW Sydney and co-ordinator of Pain and Opioids IN Treatment (POINT) study. She is the lead author on this study.
In one of the world’s longest in-depth community studies on pharmaceutical opioids and chronic non-cancer pain, the Pain and Opioids IN Treatment (POINT) study, the researchers examined the effect of cannabis on their pain, on the extent to which pain interfered with their everyday life, and on their prescribed opioid use.
Participants were recruited through community pharmacies and completed comprehensive assessments of their pain, physical and mental health, medication and cannabis use annually. Approximately 80% of the sample completed each assessment. Participants had been in pain for a median of 10 years and taken prescribed opioids for their pain for a median of four years. There were very high rates of physical and mental health problems. At each assessment, participants who were using cannabis reported greater pain and anxiety, were coping less well with their pain, and reported that pain was interfering more in their life, compared to those not using cannabis. There was no clear evidence that cannabis led to reduced pain severity or pain interference or led participants to reduce their opioid use or dose
While this is a large prospective study with high retention over four years, there are a number of caveats to keep in mind. The participants were most likely accessing illicit cannabis, as legislation for medicinal cannabis only came in December 2016, and some of the most common reasons for stopping cannabis use was legal concerns and access difficulties (reported by approximately 20% of participants who reported stopping cannabis use). In our cohort, CNCP patients who used cannabis reported significantly greater pain severity than those not using cannabis. Those using cannabis with the intent of relieving their pain may comprise 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 may be that in the absence of cannabis use, pain severity and interference may have been worse. It is difficult to disentangle this based on the current study.
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