In May this year, the first analysis from the UK Medical Cannabis Registry found that for 129 patients in its study, researchers saw statistically significant improvements in chronic pain symptoms. Study authors wrote that subsequent studies will analyse effectiveness and safety of cannabis-based medicinal products for chronic pain patients. Readers were advised to note that several of the study authors have an interest in the privately operated Sapphire Medical Clinics; that said, a non-profit research organisation in New Zealand found similar results about chronic pain in a similar-sized study.
Research into pain can be challenging, he adds. Although typical standards of evidence for clinical trials, double-blind randomised control trials (RCTs), are still the right ones to use when studying chronic pain treatment, research into chronic pain can be difficult to quantify. That’s because pain reporting relies on more subjective measures (namely pain scores) rather than objective quantitative measurement (such as changes in size, weight or blood pressure).
Many people have tried CBD to treat problems such as mild pain (such as period pain) or poor sleep. Anecdotally, some have seen a benefit. The problem for consumers is that there is not yet a recognised standard for CBD products, so it is impossible to know the efficacy of a product, or the amount of CBD it contains.
CBD for chronic pain
Noel is not alone. According to a survey from 2014, one in five people with MS report using cannabis to help with symptoms. MS Society, who conducted the survey, says that people with MS often report using cannabis to treat pain.
As doctors well know, people who use medical cannabis have developed their own approaches to law and policy prohibitions. Patient advocacy groups have crystallised around services like CanCard, a privately run membership system that offers people with certain diagnoses a form of ID to say so. The ID is a ‘mitigating factor’ that the scheme says may prevent or reduce the risk of arrest for possession, but it does not ‘legalise’ cannabis for the cardholder.
Guidance to doctors
Neil has told his doctors that he smokes cannabis and says that apart from warnings about the dangers of smoking, he has felt that his doctors haven’t hassled him to stop.
Leo*, 49, was diagnosed with MS in 2003, and has sensory pain in his hands and feet with pain and stiffness in his calf muscles. He has been using a first-line treatment for his leg pain and stiffness for a while, but hopes to discuss Sativex with his MS nurse when they meet again soon.
“I suspect many doctors are afraid of cannabis after years of fear-mongering and just want to be spoon-fed by the pharmaceutical industry,” he said.
She has received just one reply so far, from the foreign secretary, Dominic Raab, who, in a letter addressing her as “Bridget”, began by saying that cannabis use was detrimental to the mental and physical health of communities.
On the NHS, full-extract cannabis oil imported from the Netherlands has continued to be prescribed to just two children with rare forms of epilepsy, Alfie Dingley and Sophia Gibson, who both received emergency interim licences from the Home Office in summer 2018 following high-profile campaigning.
Experts say that, despite the drug’s legality, rigid prescribing guidelines for doctors set by the British Paediatric Neurological Association – which cite a lack of clinical research and reference disputed theories about the mental health effects of cannabis – make getting hold of the medicine on the NHS difficult in practice.
Full-extract oil contains both THC, the psychoactive part of cannabis that remains illegal for recreational use, and CBD, which is now commonly sold on high streets. Many believe oils including both cannabinoids are most effective in vastly reducing, and even precluding, seizures due to a synergetic so-called entourage effect.
“Since the law changed, two cannabis-based medicines have been made available for prescribing on the NHS for patients with multiple sclerosis or hard-to-treat epilepsies, where clinically appropriate. This follows clear demonstrated evidence of their safety, clinical and cost effectiveness. We have also changed how we regulate imports to improve supply and reduce costs.
“Unless some kind of bespoke regulatory framework can be found that reduces barriers to access, the more risky scenario of unregulated self-medication with illegally sourced supplies will continue,” he said.