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MARIJUANA EFFECTIVE FOR CHRONIC
NEUROPATHIC PAIN RELIEF, STUDY FINDS
Smoking pot can make some of the pain go away, without the patient getting high.
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MARIJUANA EFFECTIVE FOR PAIN RELIEF, STUDY FINDS
Smoking pot can make some of the pain go away, without the patient getting high.
The finding comes from what researchers in Montreal believe to be the first
outpatient clinical trial of smoked cannabis, involving 21 people with chronic
neuropathic pain.
The results, which included improvements in mood and sleep, were published
Monday in the Canadian Medical Association Journal.
Dr. Mark Ware and colleagues at McGill University and McGill University
Health Centre got the ball rolling for the study almost a decade ago, but found
it was a long road to get all the necessary approvals and import a convincing
marijuana placebo from the United States.
But they plowed ahead, supported by a grant from the Canadian Institute for
Health Research, because they felt it was important to generate some scientific
data.
Marijuana is illegal in Canada but can be used medicinally in some
circumstances. In 2001, Health Canada brought in marijuana medical access
regulations outlining conditions for possessing, producing and using the herb
for medical purposes.
Despite the years that have passed, "the debate rages on about medical
marijuana," Ware said.
"We hear this a lot from policy makers and from regulatory colleges,
especially here in Canada ... there is very little evidence, and many of
them aren't aware of any evidence that smoked cannabis has any medical
value."
Marijuana with potencies of 2.5 per cent, six per cent and 9.4 per cent of the
active ingredient THC were obtained from Prairie Plant Systems, the company that
was given a government contract 10 years ago to produce a safe, standardized
supply of marijuana.
A placebo came from the U.S., where an alcohol extraction process was used to
remove the active ingredient, and the herb was reconstituted so it looked like a
green leafy material, Ware said.
There was a lot of paperwork and back-and-forth.
"Importing cannabis from the United States is not a trivial issue in this
environment," Ware noted.
Patients were given a special pipe bought on the Internet and 25-milligram
capsules of a substance to put in the pipe and light. The smoke was to be
inhaled once - three times a day for five days - and patients didn't know
whether they were getting a placebo or one of three different potencies of
active drug.
Participants used each strength of marijuana product for five days, separated by
nine days of washout without cannabis.
"They would inhale that in a slow, smooth, single inhalation, hold their
breath for 10 seconds," then exhale slowly, Ware said.
The first dose was in the hospital, under observation.
"Even with this kind of fixed dosing and limited exposure, we were able to
show in a blinded fashion that the patients did obtain some analgesia,
improvements in sleep quality and on one of the subscales of the quality-of-life
measure, we found that the anxiety was mildly improved as well," Ware said.
"This may help in developing policy, or improving policy, or improving
doctors' willingness to consider this as an approach when all else has
failed."
Side-effects - the euphoria associated with smoking pot - were "very, very
rare," Ware said.
"I think because the doses we used were very low," he explained.
"The plasma levels which we found, and which are reported in the trial,
show levels of THC in the blood of around ... 40 to 50 nanograms per
millilitre in the plasma. And we know that recreational users hit blood
levels of around 100 and 150 nanograms per millilitre."
Prairie Plant Systems now offers medical marijuana that is 12 per cent THC, Ware
observed.
"So would we get better results if we had slightly higher THC levels, would
we get better results if the patients could use it for longer periods, or if
they could use it more frequently during the day?" he asked. "I
think these are questions that we can't answer."
Prof. Henry McQuay, who works at a pain relief unit in Oxford, U.K., wrote
a commentary in the journal, saying that the researchers should be congratulated
for tackling the project given that the regulatory hurdles "must have been
a nightmare."
"The big picture here is a political one in a way, where Canada has decided
to legalize medicinal use of cannabis in this arena, but many other countries
have not," he said in an interview.
"It's another brick in that wall, that says here's evidence that some
people do indeed show some pain-relieving benefit from smoking cannabis."
Dr. Igor Grant, director of the Center for Medicinal Cannabis Research at
the University of California in San Diego, said the finding is consistent with
data reported from his centre, "and basically shows that there is a
beneficial effect of smoked cannabis on neuropathic pain."
"The potencies we have typically used have been around four per cent and as
high as seven per cent, so that ( 9.4 per cent ) is a higher potency than we're
experienced with," he said.
"But in reading the article, it seems like the patients tolerated it
reasonably well."
Neuropathic pain is a bit different than the pain of a broken leg, for instance,
and is a more chronic, burning, unpleasant sensation, he explained.
"Many patients don't respond completely to existing treatments, and so it's
useful to have another agent ... available, and I think there's good
evidence now cannabis may represent one of those additional agents."
The researchers say more studies are needed using higher potencies of marijuana,
longer duration and flexible dosing to see if pain levels can be reduced even
further.
Grant remarked that smoke inhalation raises several issues, and his centre is
completing two studies on pain using a vaporization form of cannabis.
"People who are non-smokers may have difficulty tolerating it ( smoke
)," he said. "Secondly, there's the issue of second-hand smoke,
which people may not like."
There are also the side-effects of smoking, and practical issues, such as
concerns about lighting up in a hospital where there are oxygen tanks, he added.
Author: Anne-Marie Tobin
Note: Download the study at http://mapinc.org/url/t4KIh82X
Pubdate: Mon, 30 Aug 2010
Source: Guelph Mercury (CN ON)
Copyright: 2010 Guelph Mercury Newspapers Limited
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