Investigators at the University of California, Davis Medical Center conducted a double-blind, placebo-controlled, crossover study evaluating the analgesic efficacy of vaporized cannabis in 39 subjects, the majority of whom were experiencing neuropathic pain despite traditional treatment. Subjects inhaled cannabis of either moderate THC (3.53 percent), low dose THC (1.29 percent), or zero THC (placebo). Subjects continued to take all other concurrent medications as per their normal routine during the 3- to 4-week study period. Spontaneous pain relief, the primary outcome variable, was assessed by asking participants to indicate the intensity of their current pain on a 100-mm visual analog scale (VAS) between 0 (no pain) and 100 (worst possible pain).
Researchers reported: “Both the low and medium doses proved to be salutary analgesics for the heterogeneous collection of neuropathic pain conditions studied. Both active study medications provided statistically significant 30% reductions in pain intensity when compared to placebo.”
They concluded: “Both the 1.29% and 3.53% vaporized THC study medications produced equal antinociception at every time point. … [T]he use of low doses could potentially be prescribed by physicians interested in helping patients use cannabis effectively while minimizing cognitive and psychological side effects. Viewed with this in mind, the present study adds to a growing body of literature supporting the use of cannabis for the treatment of neuropathic pain. It provides additional evidence of the efficacy of vaporized cannabis as well as establishes low-dose cannabis (1.29%) as having a favorable risk-benefit ratio.”
Previous clinical trials have indicated that inhaled cannabis can safety and effectively relieve various types of pain, particularly neuropathy — a hard-to-treat nerve condition often associated with cancer, HIV, spinal cord injury, diabetes, multiple sclerosis, and other conditions. These include the following double-blind, placebo-controlled (FDA gold-standard) studies:
Ware et al. 2010. Smoked cannabis for chronic neuropathic pain: a randomized controlled trial. CMAJ 182: 694-701.
Wilsey et al. 2008. A randomized, placebo-controlled, crossover trial of cannabis cigarettes in neuropathic pain. Journal of Pain 9: 506-521.
Ellis et al. 2008. Smoked medicinal cannabis for neuropathic pain in HIV: a randomized, crossover clinical trial. Neuropsychopharmacology 34: 672-80.
Abrams et al. 2007. Cannabis in painful HIV-associated sensory neuropathy: a randomized placebo-controlled trial. Neurology 68: 515-521.
Wallace et al. 2007. Dose-dependent Effects of Smoked Cannabis on Capsaicin-induced Pain and Hyperalgesia in Healthy Volunteers Anesthesiology 107: 785-796.
Separate clinical trial data also reports that inhaled “cannabis augments the analgesic effect of opioids” and therefore “may allow for opioid treatment at lower doses with fewer side effects.”
Since 1999, US sales of opiate drugs have tripled in number and in 2010, a record-setting 254 million prescriptions for opioids were filled in the United States — enough to medicate every American adult around the clock for a month. (In particular, the manufacturing of the drug Oxycodone has increased from 8.3 tons in 1997 to 105 tons in 2011, an increase of 1,200 percent.) Overdose deaths from the use of prescription painkillers are also now at record levels, totaling some 15,000 annually — more than triple the total a decade ago.
Full text of the study, “Low-dose vaporized cannabis significantly improves neuropathic pain,” appears in The Journal of Pain.
#1 Colorado and Washington Vote To Legalize Marijuana
Voters in Colorado and Washington made history by approving ballot measures allowing for the personal possession and consumption of cannabis by adults. Washington’s law, which removes criminal penalties for the possession of up to one ounce of cannabis for personal use (as well as the possession of up to 16 ounces of marijuana-infused product in solid form, and 72 ounces of marijuana-infused product in liquid form), took effect on December 6. Colorado’s law, which allows for the legal possession of up to one ounce of marijuana and/or the cultivation of up to six cannabis plants in private by those persons age 21 and over, took effect on December 10. Regulators in both states are now in the process of drafting rules to allow for state-licensed proprietors to commercially produce and sell cannabis.
#2 Most Americans Favor Legalization, Want The Feds To Butt Out
A majority of Americans support legalizing the use of cannabis by adults, according to national polls by Public Policy Polling, Angus Reid, Quinnipiac University, and others. A record high 83 percent of US citizens favor allowing doctors to authorize specified amounts of marijuana for patients suffering from serious illnesses. And nearly two-thirds of Americans oppose federal interference in state laws that allow for legal marijuana use by adults.
#3 Connecticut, Massachusetts Legalize Cannabis Therapy
Connecticut and Massachusetts became the 17th and 18th states to allow for the use of cannabis when recommended by a physician. Connecticut lawmakers in May approved Public Act 12-55, An Act Concerning the Palliative Use of Marijuana. The new law took effect on October 1. On Election Day, 63 percent of Massachusetts voters approved Question 3, eliminating statewide criminal and civil penalties related to the possession and use of up to a 60-day supply of cannabis by qualified patients. The law takes effect on January 1, 2013.
#4 Schedule I Prohibitive Status For Pot “Untenable,” Scientists Say
The classification of cannabis and its organic compounds as Schedule I prohibited substances under federal law is scientifically indefensible, according to a review published online in May in The Open Neurology Journal. Investigators at the University of California at San Diego and the University of California, Davis reviewed the results of several recent clinical trials assessing the safety and efficacy of inhaled or vaporized cannabis. They concluded: “Based on evidence currently available the Schedule I classification is not tenable; it is not accurate that cannabis has no medical value, or that information on safety is lacking.”
#5 Marijuana Arrests Decline, But Still Total Half Of All Illicit Drug Violations
Police made 757,969 arrests in 2011 for marijuana-related offenses, according to the Federal Bureau of Investigation’s annual Uniform Crime Report. The total marked a decline from previous years. Of those charged in 2011 with marijuana law violations, 663,032 (86 percent) were arrested for marijuana offenses involving possession only. According to the report, approximately 43 percent of all drug violations in 2011 were for cannabis possession.
#6 Long-Term Cannabis Exposure Not Associated With Adverse Lung Function
Exposure to moderate levels of cannabis smoke, even over the long-term, is not associated with adverse effects on pulmonary function, according to clinical trial data published in January in the Journal of the American Medical Association. Investigators at the University of California, San Francisco analyzed the association between marijuana exposure and pulmonary function over a 20-year period in a cohort of 5,115 men and women in four US cities. They concluded: “With up to 7 joint-years of lifetime exposure (e.g., 1 joint/d for 7 years or 1 joint/wk for 49 years), we found no evidence that increasing exposure to marijuana adversely affects pulmonary function. … Our findings suggest that occasional use of marijuana … may not be associated with adverse consequences on pulmonary function.”
#7 Cannabis Use Associated With Decreased Prevalence Of Diabetes
Adults with a history of marijuana use have a lower prevalence of type 2 diabetes and possess a lower risk of contracting the disease than do those with no history of cannabis consumption, according to clinical trial data published in the British Medical Journal. Investigators at the University of California, Los Angeles assessed the association between diabetes mellitus (DM) and marijuana use among adults aged 20 to 59 in a nationally representative sample of the US population of 10,896 adults. Investigators concluded, “Our analysis of adults aged 20-59 years … Showed that participants who used marijuana had a lower prevalence of DM and lower odds of DM relative to non-marijuana users.”
#8 Medical Cannabis Dispensaries Not Associated With Neighborhood Crime
The establishment of medical cannabis dispensaries does not adversely impact local crime rates, according to a federally funded study published in the July issue of the Journal of Studies on Alcohol and Drugs. Researchers reported: “There were no observed cross-sectional associations between the density of medical marijuana dispensaries and either violent or property crime rates in this study.”
#9 Rhode Island Becomes The 15th State To Decriminalize Pot Possession Penalties
Governor Lincoln Chafee signed legislation into law in June amending marijuana possession penalties for those age 18 or older from a criminal misdemeanor (punishable by one year in jail and a $500 maximum fine) to a non-arrestable civil offense — punishable by a $150 fine, no jail time, and no criminal record. The decriminalization law takes effect on April 1, 2013.
#10 Cannabis Reduces Symptoms In Patients With Treatment-Resistant MS
Cannabis inhalation mitigates spasticity and pain in patients with treatment-resistant multiple sclerosis (MS), according to clinical trial data published online in May in the Journal of the Canadian Medical Association. Investigators at the University of California, San Diego assessed the use of inhaled cannabis versus placebo in 30 patients with MS who were unresponsive to conventional treatments. “Smoked cannabis was superior to placebo in symptom and pain reduction in patients with treatment-resistant spasticity,” authors concluded.
Is it any wonder that the US government fights tooth-and-nail to hinder researchers’ attempts to conduct clinical trials assessing the therapeutic utility of cannabis as a medicine? After all, each and every time the federal government begrudgingly allows for such studies they’re faced with credibility-shattering results like this:
Marijuana relieves muscles tightness, pain of multiple sclerosis: Study
via the Toronto Star
Smoking marijuana can relieve muscle tightness, spasticity (contractions) and pain often experienced by those with multiple sclerosis, says research out of the University of California, San Diego School of Medicine.
The findings, just published in the Canadian Medical Association Journal, included a controlled trial with 30 participants to understand whether inhaled cannabis would help complicated cases where existing pharmaceuticals are ineffective or trigger adverse side effects.
MS is an unpredictable, often disabling disease of the central nervous system, which is made up of the brain and spinal cord.
The disease attacks the myelin, the protective covering wrapped around the nerves of the central nervous system, and — among other symptoms — can cause loss of balance, impaired speech, extreme fatigue, double vision and paralysis.
The average age of the research participants was 50 years with 63 per cent of the study population female.
More than half the participants needed walking aids and 20 per cent used wheelchairs.
Rather than rely on self-reporting by patients regarding their muscle spasticity — a subjective measure — health professionals rated each patient’s joints on the modified Ashworth scale, a common objective tool to evaluate intensity of muscle tone.
The researchers found that the individuals in the group that smoked cannabis experienced an almost one-third decrease on the Ashworth scale — 2.74 points from a baseline score of 9.3 — meaning spasticity improved, compared to the placebo group.
As well, pain scores decreased by about 50 per cent.
“We saw a beneficial effect of smoked cannabis on treatment-resistant spasticity and pain associated with multiple sclerosis among our participants,” says Dr. Jody Corey-Bloom of the university’s department of neuroscience.
To those familiar with medicinal cannabis research, the results are hardly surprising. After all, Sativex — an oral spray containing plant cannabis extracts — is already legal by prescription to treat MS-related symptoms in over a dozen countries, including Canada, Germany, Great Britain, New Zealand, and Spain. Further, long-term assessments of the drug indicate that in addition to symptom management, cannabinoids may also play a role in halting the course of the disease.
Nevertheless, the National MS Society — like the US government — shares little enthusiasm for cannabis medicine, stating, “Studies completed thus far have not provided convincing evidence that marijuana or its derivatives provide substantiated benefits for symptoms of MS.”
Patient advocacy organizations, like the MS Society, have a responsibility to represent the interests of their constituents and to advise practitioners regarding best treatment practices. Why then does this responsibility not extend to patients who use cannabis as an alternative treatment therapy or to those that might one day potentially benefit from its use?
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This week in weed: a recent study further illustrates marijuana’s effectiveness in treating chronic pain and a federal judge dismisses the NORML Legal Committee lawsuit against the federal government.
Over Two-Dozen Controlled Trials Demonstrate Cannabinoids’ “Statistically Significant Pain Relieving Effects”March 7, 2012
[Editor's note: This post is excerpted from this week's forthcoming NORML weekly media advisory. To have NORML's news alerts and legislative advisories delivered straight to your in-box, sign up here.]
Cannabis and its active constituents appear to be safe and modestly effective treatments in patients suffering from a variety of chronic pain conditions, including neuropathy (pain due to nerve damage), according to a literature review to be published in The Clinical Journal of Pain.
An investigator from New York University, Department of Physical Medicine and Rehabilitation, conducted a PubMed search to survey the percentage of positive and negative published randomized controlled trials (RCTs) assessing cannabinoids as treatments for pain. Of the 56 hits generated, 38 published RCTs met inclusion criteria. Of these, “71 percent (27) concluded that cannabinoids had empirically demonstrable and statistically significant pain relieving effects, whereas 29 percent (11) did not.”
Cannabinoids appeared to be most effective in treating hard-to-treat neuropathic pain conditions. “[F]or notoriously difficult to treat conditions such as HIV neuropathy, … cannabinergic pain medicines, particularly inhaled cannabinoid botanicals, are one of the only treatments that have been shown to be safe and effective with the highest levels of evidence,” the review states.
Five to ten percent of the US population is estimated to suffer from neuropathic pain at some point during their lives.
The study concludes, “Overall, based on the existing clinical trials database, cannabinergic pain medicines have been shown to be modestly effective and safe treatments in patients with a variety of chronic pain conditions. … Incorporating cannabinergic medicine topics into pain medicine education seems warranted and continuing clinical research and empiric treatment trials are appropriate.”
A separate paper, published in January in the Harm Reduction Journal, concluded: “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.”
Full text of the study, “Cannabinergic pain medicine: A concise clinical primer and survey of randomized controlled trial results,” will appear in The Clinical Journal of Pain.