Cannabis works better than opioids for back pain, in two European studies : Shots

Should I try cannabis for back pain?

This is a spine surgeon question. Richard Price says he hears at least several times a day from patients who come to his clinic.

When Price finally immersed in evidence several years ago he discovered that there was not much high quality research, although chronic pain was one of the most common reasons people are turning to medical marijuana.

“Oddly enough, [people] they say cannabis works great,” says Price, an assistant professor of neurological surgery at the University of California, Davis. “It's the only thing that helps them sleep at night, the only thing that relieves stress.”

That's why the results of two large clinical studies in Europe that assessed the effectiveness of cannabis for low back pain: leading cause disabilities around the world—has caught the attention of Price and others who are exploring the plant's potential for treating pain.

First published in the magazine Natural medicine, showed that A cannabis oil blend containing the psychoactive compound THC, as well as CBD and other natural compounds from the plant, outperformed a placebo.

Another compared the same patented cannabis tincture to opioids. There were patients here much less likely to have gastrointestinal side effects such as constipation and cannabis provided better relief over 6 months than their pain medications.

Price believes the new research is “groundbreaking” and will be a “cornerstone” of the growing evidence base on cannabis and chronic pain.

Because cannabis remains a Schedule 1 drug—a category reserved for substances that have no approved medical use—and tightly regulatedthis type of large-scale clinical trial hard make it to the USA

Vertanical, the German company that funded the trial, hopes to receive approval to sell its full-spectrum cannabis oil, called VER-01, to patients in several European countries within a few months.

Meanwhile, the Food and Drug Administration is requiring the company to repeat that study in the U.S., meaning it could be years before the drug has a chance of gaining approval here.

“If politicians or the FDA want to speed up the process, we are ready,” says Dr. Clemens Fischerfounder of Vertanical.

The FDA doesn't comment on the future of VER-01, but a spokesperson told NPR in a statement that it supports “robust, science-based studies to evaluate these products.”

Alternative to pain relief

The results from European trials are “remarkable,” especially the fact that cannabis is superior to opioids in terms of pain relief and sleep, he says. Kevin Behnke, is an assistant professor of anesthesiology at the University of Michigan who studies cannabis and chronic pain.

The opioid study included about 400 participants—about half as many as another study comparing cannabis to a placebo—and patients knew which drug they were taking.

While these are limitations, Boehnke says the study is also more “reflective” of the real world and confirms previous research indicating that “many people intentionally use cannabis instead of opioids” because they find it more effective and don't have the same side effects.

While Vertanical's cannabis tincture may not be available in the U.S. anytime soon, Boehnke says, for people seeking treatment for low back pain, the study suggests it may be worth trying a similar cannabis product instead of opioids.

“It may not be exactly the same,” he says. “But I think it provides a lot of useful evidence.e for patients.”

However, other experts in this field are more cautious.

This is the type of rigorous research that is desperately needed, says Simon Harutunyanwho has many years of experience in this field and directs research at the Washington University Pain Center in St. Louis.

But he believes the results are specific to this particular compound that was tested.

In the placebo study, participants in the cannabis group experienced an average reduction in pain of about 30% after 12 weeks compared to baseline. When the placebo effect is taken into account, Harutunian says only about 10% of this reduction can be attributed to the actual treatment.

In other words: the number of people who need to take the drug for one person to get clinically significant pain relief is about seven.

“Most of the medications we have for chronic pain are in this range,” says Harutunian. “So this is not a panacea or a drug that can cure any chronic pain.”

Proponents of medical cannabis are quick to point out that the drug's safety profile is a clear advantage. Unlike opioids, it does not raise the same concerns about overdose and addiction.

Vertanical's Fisher notes that there were no signs of dependence or withdrawal. In fact, he said, participants usually didn't feel a high, especially if they took it for a long period of time.

“You’re not high,” he says. “They go to work, drive cars, use technology – everything that is possible and legal in Europe.”

However, in the study, those taking opioids and cannabis experienced roughly the same rate of side effects, and 17% ultimately dropped out of the study, which Harutunian said should not be overlooked.

Over the years, Harutunian, a clinical pharmacist, has seen success and failure in his patients.

One patient suffered a horrific motorcycle accident and ended up quitting opioids with cannabis. On the other hand, he recalls the case of an elderly woman who tried cannabis for knee pain.

“After the first dose, she felt dizzy. She fell and broke her hip,” he says. “She spent the next six months in and out of hospital.”

Pain patients want to be able to use cannabis

Currently, there is only one medicine derived from cannabis. with FDA approvalthe seizure medication Epidiolex, and it does not contain THC.

While it's not entirely clear, experts like Boehnke say THC appears to be one of the “main” compounds responsible for reducing pain and improving sleep.

“There's no one-size-fits-all cure for chronic pain, for virtually nothing,” he says. “Oftentimes you can say, 'Oh, I got a little benefit here and a little bit there,' you're kind of putting the puzzle together.”

Although most Americans live in a state where marijuana is legal, either recreationally or medicallyThere is well documented concerns O quality and the consistency of these products.

Ellen Lenox Smithwho works for the US Pain Foundation, says FDA approval of a cannabis product will not only make it available in all states, but will also give chronic pain patients confidence in what they are consuming.

“I wish our country would be the one to come out with this right now,” she says.

Patient advocates are frustrated that there isn't a better study they can refer others to.

“It's unfortunate because a lot of people are living on their own,” said Lenox Smith, who has been using medical marijuana to treat her own pain for nearly two decades.

Her condition, known as Ehlers-Danlos syndrome, has led to more than two dozen surgeries, including on her neck and spine. However, a spoonful of homemade cannabis oil brings her relief and helps her sleep through the night.

UC Davis surgeon Richard Price thinks it's a reasonable option for his patients who don't have surgery, although he'd like to see the results found in Europe replicated in the U.S. before he promotes cannabis more widely.

“It's very difficult to tell someone, 'I know you're hurting, but there's nothing I can do for you, and a lot of patients don't want to take opioids,'” he says.