Cannabis Helps Woman to Reduce Medication Use for Nerve Pain, Case Study Reports
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Medical cannabis could help patients to reduce their use of other prescription drugs, a new case study suggests.
The case study follows a 61-year-old woman who was able to significantly reduce the dose of prescription medication she was taking to control her neuropathic pain after being prescribed a THC-containing cannabis oil. This reduction in medication use also significantly reduced the severity of side effects she had been experiencing, she reported.
The case study was published earlier this month in the open-access journal Drug Science, Policy and Law, which is the official journal of Drug Science. Drug Science is the UK’s leading independent scientific body on drugs and the overseer of Project Twenty21 (T21), Europe’s largest medical cannabis patient registry, in which the woman was enrolled.
Medical cannabis helps woman reduces prescription drug use
The focus of this new case study is a 61-year-old woman who developed idiopathic small fiber neuropathy following a tendonitis surgery more than 20 years ago. To treat her nerve pain, she was prescribed the drug pregabalin at a twice-daily dose of 300 milligrams (mg).
Although her pain was well-controlled by the pregabalin, the woman visited her doctor in early-2021 with concerns over hearing loss, tinnitus, sleepiness, and worsening anxiety. She believed that this could be linked to her prolonged use of pregabalin, which has been linked to cases of reversible hearing loss in the past.
After attempts to reduce her dose of pregabalin to below 350 mg per day failed, the woman was referred to T21 by her doctor and was quickly enrolled in the chronic pain arm of the T21 treatment initiative.
In T21, she was prescribed a cannabis oil containing 10 mg/milliliter (mL) THC and 15 mg/mL CBD to take alongside her current pregabalin dose. Over the course of the next few months, the woman titrated up to and settled on a cannabis oil dose of approximately 0.3 mL twice daily. In the same time period, she was able to reduce her total daily dose of pregabalin to just 37.5 mg.
According to the case study, the woman now feels that she has “been given a second chance of life”. The woman’s husband described her as a “new woman” after four months of treatment.
“It is a possibility that this patient will be able to finally stop treatment with pregabalin, after over 17 years, as a result of medical cannabis controlling her pain,” the researchers wrote in the case study.
“This case supports the growing RWE [real world evidence] for the clinical utility of medical cannabis in pain syndromes, and also contributes to the developing literature indicating that CBMPs [cannabis-based medicinal products] may function as a substitute for other prescription drugs.”
Medical cannabis, chronic pain, and prescription drug use
Current UK guidance for the prescription of CBMPs set out by the National Institute for Health and Care Excellent (NICE) does not recommend the use of CBMPs for chronic pain outside of clinical trials.
However, a recent Rapid Recommendation put out by the British Medical Journal advises that people living with chronic pain should be offered a trial of non-inhalable medical cannabis products where all other interventions have failed.
The experts constructing the Rapid Recommendation drew on data from four systematic reviews covering 32 randomized trials exploring the benefits and harms of using cannabis for chronic pain. Based on this, the experts made a “weak recommendation” supporting the ability of cannabis to improve pain and sleep quality in those with chronic pain. However, the panel was less confident about the ability of cannabis to reduce concomitant opioid use.
While there is fairly mixed evidence on whether cannabis encourages or reduces opioid use, other studies have suggested that medical cannabis could reduce the use of other prescription drugs.
In a 2019 survey from researchers at the University of Michigan and the University of Buffalo, 44% of respondents reported substituting prescription drugs for medical cannabis. Other studies on the effects of cannabis legalization in the United States have found that legalization appears to lessen demand for prescription medications including sleep aids, pain medications, and antidepressants.
Drug Science’s T21 is Europe’s largest observational medical cannabis patient registry, and allows medical cannabis patients in the UK to access CBPMs at a discounted price while the researchers collect real-world data on the effects of cannabis.
So far, the project has suggested that medical cannabis can significantly improve patient quality of life, as well as improving their ability to manage other secondary conditions such as anxiety and insomnia.
The first publication from the chronic pain arm of the project was published last year, describing the demographic characteristics of those enrolling in the trial. The researchers found that around half of the total number of patients enrolled in T21 reported chronic pain, with an average age of 42. Around 15% said they had never used cannabis previously, while nearly two-thirds said they were currently using cannabis for pain management.
“Our patient population comprises a huge age range, more or less from 18 to 80 years old,” Dr Anne Katrin Schlag, head of research at Drug Science, previously told Analytical Cannabis. “Their consistently high rates of comorbidity and low quality of life demonstrate just how unwell many of them are. As such, we can reject the stereotypes of medical cannabis patients as being 20-something, healthy, recreational users looking for a legal source.”
“With these high rates of comorbidity, many of our patients would have automatically been excluded from formal randomized controlled trials, highlighting the importance of a large-scale observational registry such as T21,” she added.