Increasingly, cannabis and its supporters seem to be ruling the...

Increasingly, cannabis and its supporters seem to be ruling the joint. I think The Medical Journal of Australia has summed it up well

Medicinal cannabis has been the hottest of hot-button issues in medicine for some years now. It’s one the few medications where media hype and patient demand seem to have moulded – some would say muddied – the regulatory framework…...

Last month, Canada became the second nation (after Uruguay) to legalize cannabis. The United States appears to be inching towards the same outcome - recreational cannabis is already legalized in nine states and there are 30 states which permit cannabis for medical use. Using Californian legislation as an example, that means cannabis can be recommended by doctors for “appropriate conditions” such as cancer, chronic pain, anorexia, AIDS, spasticity, glaucoma, arthritis, migraine, insomnia, depression, anxiety, PTSD or “any other illness for which marijuana provides relief.”

Cannabis is being widely promoted as a key solution to America's opioid crisis. It has been claimed that cannabis provides superior pain relief to opioids, that it improves pain relief when used in conjunction with opioids and that it can decrease the use of opioids. A Fox News headline last month questioned whether opioids will be replaced by medical cannabis. If that came to pass, what would be the use of an opioid patch, even if it is abuse-deterrent?

Perhaps the hype about cannabis has run ahead of the reality. GW Pharma is currently the world leader in cannabis-derived drug development (that is, drug development seeking regulatory approval).  Last week, GW made history by gaining the first ever approval by the FDA for a cannabis-based prescription drug (Epidiolex, for the treatment of childhood epilepsy in disorders such as Dravet syndrome and Lennox-Gastaut syndrome). GW had already received approval in the UK, EU, Canada, New Zealand and Israel for another cannabis-derived drug, Sativex, for spasticity due to MS. But approval for cannabis-derived drugs in pain indications has been more elusive. In 2015, GW Pharma announced that Sativex had failed in three separate Phase 3 trials for the treatment of cancer pain. Sativex, an oromucosal spray, demonstrated no benefit over placebo. And last year, in a Phase 2 trial of its cannabis-derived topical gel, Zynerba Pharma failed to demonstrate reduction in knee pain caused by osteoarthritis compared with placebo.

Now, this week, Lancet has published the results of a 4 year study into the effect of cannabis use in people with chronic non-cancer pain who had been prescribed opioids. The 1514 participant study was conducted by the University of New South Wales. The study found no evidence to support the use of cannabis in the treatment of chronic pain and no evidence that cannabis use either reduced prescribed opioid use or increased rates of opioid discontinuation. On the other hand, evidence was found that those participants using cannabis had greater pain and anxiety, were coping less, and reported that pain was interfering more in their life.

It makes me think that an effective, abuse-deterrent opioid patch still holds relevance for the foreseeable future….