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Not solid evidence that weeds work … at least not yet.
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Aside from the lack of evidence of effectiveness, however, there is evidence that there is potential harm, “particularly in terms of sedative effects, drug interactions, and neuropsychiatric effects” for products containing THC, the recommendation says.
What is really needed, the group argues, is “evidence from gold standard studies showing that cannabinoid products are effective in treating the suffering of these patients,” reports the Sydney Morning Herald.
Professor Michael Vagg, dean of the ANZCA School of Pain Medicine, wrote in The Conversation this week that both the International Association for Pain Studies and ANZCA have “recommended against medical cannabis for people with persistent pain without cancer”.
While some may view the recommendations as controversial, Vagg noted that some misconceptions about the effectiveness of marijuana for chronic pain persist.
“There is not a single published randomized controlled trial of a CBD-only product for chronic pain of any kind,” wrote Vagg. This is key for Australia as the country often only allows CBD marijuana medicines.
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Regarding the study results on THC-containing products and pain: “One way or another, clinical studies do not provide a reliable picture because they affect too few participants, have major technical flaws in the design or were rated as unacceptably high risk of obtaining biased results “, Emphasized Vagg.
He also pushed back on the idea that medicinal cannabis could help alleviate the opioid crisis.
A 2017 study by the University of New Mexico found that the association between enrollment in a medical cannabis program and cessation and reduction of opioid prescriptions and improved quality of life requires further research into cannabis as a potential alternative to prescription opioids for the treatment of chronic pain. ”
Another study published in 2017 included “preliminary evidence that cannabis-consuming chronic pain patients can benefit from an interdisciplinary chronic pain program.”
Vaggs advice? “People looking for an alternative to opioid treatment for persistent pain should seek treatment from a professional team of experts rather than substituting cannabis for opioids,” he wrote in The Conversation.
Evidence of the effectiveness of medical marijuana in relieving chemotherapy-induced nausea or treating epilepsy in children seems more convincing than it is for persistent pain, he suggested.
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Still, the Sydney Morning Herald reports that the Therapeutic Goods Administration (TGA) allows doctors to request special access to prescribe medicinal cannabis products, suggesting that the substances should be given the benefit of the doubt.
Iain McGregor, academic director of the Lambert Cannabinoid Therapeutics Initiative at the University of Sydney, admitted that evidence is still developing, the paper reports. Nonetheless, McGregor pointed out, “This is a galloping horse heading into the future, with many patients already being prescribed medical cannabinoids and even more self-medication.”
To date, around 64,000 patients have been prescribed cannabis-related substances by 2,500 prescribing doctors, TGA chief Professor John Skerritt reports. Most of the uses have been in chronic pain, including arthritis, neck or back pain, fibromyalgia, and migraines.
Vagg told the Sydney Sunday Herald that patients with chronic pain would benefit most from multidisciplinary pain management clinics used as part of their basket pain management, physical reconditioning, biomechanical assessment, occupational therapy, and proven assisted procedures or medical treatments.
Medicinal Cannabis Industry Australia has set up an advisory board to, among other things, “enable improved patient access supported by evidence-based decision-making and a community of appropriately trained physicians”.
“Because of its promising results in animal models, its relative safety, its non-psychoactive properties, and its low potential for abuse, CBD is an attractive candidate for pain relief,” said a Harvard Medical School blog.
“Unfortunately, there is a lack of human studies on the effectiveness of CBD,” the information adds.
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