Physicians who prescribe opioid drugs to patients with neuropathy (nerve pain) ought to consider recommending cannabis as an alternative therapy, according to a peer-reviewed paper published online this week in the Harm Reduction Journal.

“There is sufficient evidence of safety and efficacy for the use of (cannabis/cannabinoids) in the treatment of nerve pain relative to opioids,” the commentary states. “In states where medicinal cannabis is legal, physicians who treat neuropathic pain with opioids should evaluate their patients for a trial of cannabis and prescribe it when appropriate prior to using opioids. … Prescribing cannabis in place of opioids for neuropathic pain may reduce the morbidity and mortality rates associated with prescription pain medications and may be an effective harm reduction strategy.”

The author notes that between the years 1999 and 2006, “approximately 65,000 people died from opioid analgesic overdose.” By contrast, he writes “[N]o one has ever died from an overdose of cannabis.”

In clinical trials, inhaled cannabis has been consistently shown to reduce neuropathic pain of diverse causes in subjects unresponsive to standard pain therapies.

In November, clinical investigators at the University of California, San Francisco reported that vaporized cannabis augments the analgesic effects of opiates in subjects prescribed morphine or oxycodone. Authors of the study surmised that cannabis-specific interventions “may allow for opioid treatment at lower doses with fewer [patient] side effects.”

Neuropathy affects between five percent and 10 percent of the US population. The condition is often unresponsive to conventional analgesic medications such as opiates and non-steroidal anti-inflammatory drugs.

Full text of the paper, “Prescribing cannabis for harm reduction” is available online here.

Cannabis inhalation and the administration of cannabinoids are both associated with “significant analgesic effects” in the treatment of chronic non-cancer pain, according to a systemic review of randomized controlled trials to be published in the British Journal of Clinical Pharmacology.

Investigators from the University of Toronto, Hospital for Sick Children, conducted a literature review regarding the efficacy of cannabinoids in the treatment of chronic pain, including neuropathic pain, fibromyalgia, rheumatoid arthritis, and mixed chronic pain. Eighteen randomized controlled trials published between 2003 and 2010 involving a total of 766 participants met inclusion criteria. Four of the trials assessed inhaled cannabis, while other studies assessed the analgesic properties of either plant-derived cannabinoids or synthetic cannabinoids.

“Overall the quality of trials was excellent,” authors wrote. “Fifteen of the eighteen trials that met inclusion criteria demonstrated a significant analgesic effect of cannabinoid as compared to placebo, several reported significant improvements in sleep. There were no serious adverse effects.”

Researchers noted that all four trials involving inhaled cannabis “found a positive effect with no serious adverse side effects.” They added: “Of special importance is the fact that two of the trials examining smoked cannabis demonstrated a significant analgesic effect in HIV neuropathy, a type of pain that has been notoriously resistant to other treatments normally used for neuropathic pain. In the trial examining cannabis based medicines in rheumatoid arthritis a significant reduction in disease activity was also noted, this is consistent with pre-clinical work demonstrating that cannabinoids are anti-inflammatory.”

Investigators concluded, “[C]annabinoids are a modestly effective and safe treatment option for chronic non-cancer (predominantly neuropathic) pain. Given the prevalence of chronic pain, its impact on function and the paucity of effective therapeutic interventions, additional treatment options are urgently needed. More large-scale trials of longer duration reporting on pain and level of function are required.”

NORML has additional information on the analgesic properties of cannabinoids in its handbook, Emerging Clinical Applications for Cannabis and Cannabinoids, here.

Updated and revised for 2011, this report reviews approximately 200 newly published scientific studies assessing the safety and efficacy of marijuana and its compounds in the treatment and management of nineteen clinical indications: Alzheimer’s disease, Amyotrophic Lateral Sclerosis (ALS), chronic pain, diabetes mellitus, dystonia, fibromyalgia, gastrointestinal disorders, gliomas and other cancers, hepatitis C, human immunodeficiency virus (HIV), hypertension, incontinence, methicillin-resistant Staphyloccus aureus (MRSA), multiple sclerosis, osteoporosis, pruritus, rheumatoid arthritis, sleep apnea, and Tourette’s syndrome.

Explains the report’s lead author, NORML Deputy Director Paul Armentano: “The conditions profiled in this report were chosen because patients frequently inquire about the therapeutic use of cannabis to treat these disorders. In addition, many of the indications included in this report may be moderated by cannabis therapy. In several cases, preclinical data and clinical data indicates that cannabinoids may halt the progression of these diseases in a more efficacious manner than available pharmaceuticals.”

The updated report also features a new section, authored by osteopath and medical cannabis specialist Dr. Dustin Sulak, highlighting the significance of the endocannabinoid system and its role in maintaining mental and physiological health.

“As we continue to sort through the emerging science of cannabis and cannabinoids, one thing remains clear: a functional cannabinoid system is essential for health,” writes Dr. Sulak. “From embryonic implantation on the wall of our mother’s uterus, to nursing and growth, to responding to injuries, endocannabinoids help us survive in a quickly changing and increasingly hostile environment. As I realized this, I began to wonder: can an individual enhance his/her cannabinoid system by taking supplemental cannabis? Beyond treating symptoms, beyond even curing disease, can cannabis help us prevent disease and promote health by stimulating an ancient system that is hard-wired into all of us? I now believe the answer is yes.”

Full text of the report is now available online here. Hard copies will be available for purchase shortly. Print copies of the third edition of this report will be made available at a reduced rate for those seeking bulk orders. (Please e-mail NORML for further details.)

Researchers worldwide have performed 37 separate clinical trials assessing the therapeutic safety and efficacy of inhaled cannabis and marijuana-based medicines since 2005, according to a review published online last week in the journal Cannabinoids: The Journal of the International Association for Cannabinoid Medicines (IACM).

Investigators from Leiden University in the Netherlands and the nova-Institut in Germany conducted a systematic review of recent clinical trial data pertaining to the medical use of whole smoked marijuana and cannabinoids.

Authors identified 37 controlled studies since 2005 evaluating the therapeutic effects of cannabinoids. The trials involved a total of 2,563 subjects.

Of the 37 clinical trials that have been recently conducted, eleven assessed the drug’s impact on chronic neuropathic pain – a difficult to treat type of pain resulting from nerve damage. Other studies assessed the efficacy of cannabinoids to treat multiple sclerosis-associated spasticity (nine separate studies); HIV/AIDS (four); experimental pain (four); intestinal dysfunction (two); nausea/vomiting/appetite (two); schizophrenia (two); glaucoma (one); and ‘other indications (two).

Authors concluded, “Based on the clinical results, cannabinoids present an interesting therapeutic potential mainly as analgesics in chronic neuropathic pain, appetite stimulants in debilitating diseases (cancer and AIDS), as well as in the treatment of multiple sclerosis.”

Last Wednesday investigators from the California Center for Medicinal Cannabis Research released the results of a series of double-blind, placebo-controlled trials that determined that cannabinoids could be “a first-line treatment” for patients suffering from neuropathy.

Commenting on the review, NORML Deputy Director Paul Armentano said: “The safety and efficacy of marijuana as a medicine has now been established by the ‘gold standard’ of clinical study. Further, over 2,500 patients have used cannabinoids in controlled clinical trials over the past five years alone. This is a far greater total than the number of subjects that would likely be administered any other new drug pending United States FDA approval, and is a large enough population to once and for all establish marijuana’s objective value as a medicine.”

Oh, so this is why the Feds do everything they can to discourage any investigation into the safety and efficacy of inhaled cannabis.

Medicinal Marijuana Eases Neuropathic Pain in HIV
via The Washington Post

WEDNESDAY, Aug. 6 (HealthDay News) — Medicinal marijuana helps relieve neuropathic pain in people with HIV, says a University of California, San Diego, School of Medicine study.

It included 28 HIV patients with neuropathic pain that wasn’t adequately controlled by opiates or other pain relievers. The researchers found that 46 percent of patients who smoked medicinal marijuana reported clinically meaningful pain relief, compared with 18 percent of those who smoked a placebo.

The study, published online Aug. 6 in Neuropsychopharmacology, was sponsored by the University of California Center for Medical Cannabis Research (CMCR).

“Neuropathy is a chronic and significant problem in HIV patients as there are few existing treatments that offer adequate pain management to sufferers,” study leader Dr. Ronald J. Ellis, an associate professor of neurosciences, said in an UCSD news release. “We found that smoked cannabis was generally well-tolerated and effective when added to the patient’s existing pain medication, resulting in increased pain relief.”

The findings are consistent with and extend other recent CMCR-sponsored research supporting the short-term effectiveness of medicinal marijuana in treating neuropathic pain.

“This study adds to a growing body of evidence that indicates that cannabis is effective, in the short-term at least, in the management of neuropathic pain,” Dr. Igor Grant, a professor of psychiatry and director of the CMCR, said in the UCSD news release.   

By my count, this is the third clinical trial published in just over a year to conclude that inhaling cannabis significantly reduces neuropathic pain. (Read about the others here and here.) And that’s not even including this study that found that low doses of inhaled cannabis are more therapeutic for HIV-positive patients than Marinol (oral synthetic THC).

Kudos to The Washington Post for publicizing this important story. And an extra ‘shout out’ to the Post‘s editors for highlighting that this trial was sponsored by California’s Center for Medical Cannabis Research and not by the US government.

Antihyperalgesic effect of a Cannabis sativa extract in a rat model of neuropathic pain: mechanisms involved
via PubMed

This study aimed to give a rationale for the employment of phytocannabinoid formulations to treat neuropathic pain. It was found that a controlled cannabis extract, containing multiple cannabinoids, in a defined ratio, and other non-cannabinoid fractions (terpenes and flavonoids) provided better antinociceptive efficacy than the single cannabinoid given alone, when tested in a rat model of neuropathic pain.

On a separate but related note, am I the only one offended that most scientists appear to be more inclined to document pot’s healing powers in rats and mice than in, say, human beings?

Of course, if you want to enroll in clinical trials intent on documenting so-called “marijuana abuse,” you can take your pick here.

A funny thing happens when the US government begrudgingly allows for double-blind, placebo-controlled clinical trials evaluating the therapeutic efficacy of inhaled cannabis.  

Investigators discover time after time that it works! 

Here are the results from the latest study, conducted at California’s Center for Medical Cannabis Research.   

Low-dose pot eases pain while keeping mind clear
via Reuters News Wire

NEW YORK (Reuters Health) — Giving carefully calibrated doses of smoked marijuana to people with neuropathic pain, which can be difficult-to-treat and extremely painful, can ease their pain without clouding their minds, California researchers report.

Read the full story here. 

Unfortunately, according to recently released legal filings, fewer than 20 investigators in the United States currently possess federal approval to conduct legal clinical research on whole smoked cannabis. (Not surprisingly, most of these researchers are conducting trials that seek to assess the potential physical and mental harms allegedly associated with the drug.) In addition, state funding for the CMCR — which has backed virtually all of the medical cannabis research conducted over the past several years — has dried up and no new appropriations are likely.

Of course, federal officials could readily step in with grant money to keep this important clinical research going — after all, just last month the US National Institute on Drug Abuse announced that it would be spending millions to establish the first-ever ‘Center on Cannabis Addiction‘ — but, needless to say, I’m not holding my breath.