Doctors Get New Clinical Guidelines for Managing Chronic Pain With Cannabis, Courtesy of Canadian Researchers
by Bethan Rose
Clinical trials into cannabis’ potential as an opioid replacement are well underway in South Africa. Based on the details of a June 21 press release, the trials—which are taking place in Johannesburg—are the first ethically approved studies exploring the suitability and safety of using cannabis as a substitute for opioid pain relievers.
According to the announcement, Biodata—a subsidiary of Labat Africa—“is the brainchild of Dr. Shiksha Gallow, a cannabis clinician, and the principal investigator in the trials, which took over 18 months to get official clearance.” Dr. Gallow prides himself on his work as a South African cannabis advocate and leader in the international medical cannabis research field. Alongside a team of researchers, he will assess 1,000 participants who have been actively consuming opioids for pain relief for a minimum of three months. Study subjects must be willing and ready to substitute opioids with cannabis.
“We are currently recruiting patients, and data-capturing all the questionnaires and feedback from the patients for the live study. It has been fairly slow,” explained Dr. Gallow. “However, more options have been introduced in the live study as suggested by the patients in the pilot study. The pilot results of the study were very promising, as it showed 98% of the patients have some sort of pain relief from cannabis.”
Quite frankly, the clinical trials couldn’t have come at a better time. The opioid epidemic has lingered for decades, with the seriousness of the health crisis hitting a worrying stage within the last few years—a problem that has been largely stimulated by the improper prescribing of opioids to patients.
According to the 2019 National Survey on Drug Use and Health, an estimated 10.1 million people aged 12 and above had abused opioids in the past year. The survey results showed that 9.7 million people misused prescription painkillers and approximately 745,000 people used the illegal drug heroin. Some of the most common legal and illegal opioids include buprenorphine, codeine, fentanyl, hydrocodone, methadone, morphine, oxymorphone, and oxycodone.
Exodus and Tallyman are the names of the two chemovars, or strains, being used for this study into cannabis as an opioid replacement. A third strain, 9 Pound Hammer, is also expected to be introduced at some stage in the near future.
According to the South African researchers, 9 Pound Hammer’s potent CBG (cannabigerol) and THC (tetrahydrocannabinol) content made it an appealing choice. What’s more, the soon-to-be-introduced strain is laden with myrcene and beta-caryophyllene terpenes.
The cannabis strains are being sourced from Labat’s Eastern Cape-based Sweetwaters Aquaponics facility, which is SAHPRA-licensed. Unlike traditional methods of cannabis cultivation, aquaponics is a food production system that merges aquaculture (raising aquatic animals in tanks) with hydroponics (growing plants in water). This process involves feeding the nutrient-dense aquaculture water to hydroponically cultivated plants.
After providing the study subjects with Exodus and Tallyman in both flower and oil form, researchers successfully managed to wean patients off their former opioid medicines. The flower contained high levels of THC in the range of 15-25 milligrams, with CBD content resting on the lower end of the spectrum at 0.5 milligrams. Oil, on the other hand, contained a balanced ratio (1:1) of THC and CBD at 15-20 milligrams.
Patients below the age of 55 who participated in the pilot group generally preferred smokable flower, whereas those aged 55 and above preferred the oil. However, the effects of cannabis oil surfaced much slower than the smokable flower.
Dr. Peter Grinspoon, a Harvard Medical School instructor and medical marijuana specialist at Massachusetts General Hospital, shared his thoughts on the study with reporters. Grinspoon’s devotion to cannabis stems from his father Lester Grinspoon’s longtime advocacy efforts.
“First of all, I think cannabis is really good for mild to moderate pain,” Dr. Grinspoon told High Times reporters. “I don’t think it works for severe pain. So I think it depends a little bit on what the patient’s conditions are and how severe their pain is, and it’s not just a question of being on cannabis and opiates or off cannabis and opiates. Together, they work very well. Synergistically, they co-work on some of the same receptors.”
Grinspoon went on to say that people who have exhausted opioid treatment options with little relief and/or unwanted side effects could enjoy an enhanced quality of life by switching to cannabis. Additionally, he noted that cannabis use can contribute to a major opioid dose reduction which, he says, is a “huge harm reduction benefit.” “There’s no reason for a pain specialist to view [cannabis] as the enemy,” he added. “We don’t really know how effective opiates are.”
To sum up, cannabis consumption is undoubtedly a safer alternative to opiates and may also be safer than non-steroidal treatments, such as Advil. These types of medications can prove dangerous, with many incidents of gastric ulcers, heart attacks, and kidney damage being reported after frequent use.
This leaves medical professionals to speculate on the answer to the question: “What is the least harmful medication to use as a treatment for chronic pain?”
It goes without saying that all types of medications carry certain side effects…even cannabis. While some medications might work for one person, they may be a poor choice for someone else. For this reason, it really is a case of trial and error for people living with chronic pain.
Since Dr. Gallow’s group of South African researchers have renewed the study for an extra year, we are sure to discover more about cannabis’ potential as a pain management tool in the foreseeable future.
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Cherish Masters-Pedraza says:
August 22, 2022 at 5:23 pm
If there is anything I can do to help disseminate factual information about cannabis, please contact me. I am also interested in any career positions available in the field. Thank you for this well-written article!