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UK: Patients to get cannabis in hospital

Sarah Boseley

The Guardian

Thursday 21 Aug 2003

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The medical research council is to spend £500,000 on a controversial
trial to see whether or not cannabis can relieve the pain of patients who
have undergone surgery, it was announced yesterday.

The trial will enroll 400 patients, in spite of a strongly worded and
critical review by eminent pain scientists published in the British Medical
Journal in July 2001.

The review looked at trials of synthetic cannabinoids derived from
cannabis. It found that the substances worked no better than codeine in
relieving post-operative pain. The cannabinoids also depressed the central
nervous system, limiting their use.

"Their widespread introduction into clinical practice for pain management
is therefore undesirable. In acute post-operative pain they should not be
used," the authors said.

Henry McQuay, professor of pain relief at the Nuffield department of
anaesthetics at Oxford's Churchill hospital, said yesterday that the review
team, of which he had been a member, stood by the findings and that he was
surprised at the MRC announcement.

"To get the analgesic equivalent to low-dose codeine you were taking a dose
[of cannabinoids] which gave you a lot of side effects. It didn't seem to
us that it was a good bet, to put it politely," he said.

Professor McQuay, who is clinical editor of the journal Pain, said that at
his clinic he found patients with neuropathic pain [from nerve damage] who
had smoked cannabis without relief.

"It's like alcohol. If you are lucky it makes you feel better, which is
slightly different from shifting the pain," he said.

But the leader of the MRC trial, Anita Holdcroft, of Imperial College and
the Chelsea and Westminster hospital, said that no comparison could be made
between the post-operative pain trials she would be conducting and those
that Prof McQuay and his colleagues had reviewed. "The studies [reviewed in
the BMJ] were looking at a synthetic cannabinoid, which is quite different
from using the cannabis plant material," she said. "You can't make broad
statements that all the drugs don't work when it only relates to one
particular type of drug.

"We don't have the evidence for cannabis; until we do the trial we won't
... There are no studies of cannabis in post-operative pain so to say it
cannot be used when nobody has ever done it is inappropriate."

Dr Holdcroft's involvement stems from the early 1990s when she wrote a
paper on cannabis use with a patient suffering acute to chronic pain.

The MRC trials will use a capsule holding a standardised extract of the
entire cannabis plant. Patients awaiting surgery in at least 36 British
hospitals will be invited to join the trial. Those tested will, randomly,
get either extracts of the cannabis plant, one of its active ingredients, a
standard pain-relieving drug, or a placebo. Neither they nor their doctors
will know what they have been given.

Turning cannabis into a medicine has become a political as well as
scientific issue, especially since the Lords' science and technology
committee urged trials to take place in 1998. Many multiple sclerosis
sufferers say smoking cannabis relieves their symptoms.

GW Pharmaceuticals has conducted the required three phases of trials on an
oral spray derived from cannabis. A spokeswoman for the multinational firm
Bayer, which has signed an agreement to help market the drug, said it was
not known whether it would be months or even a year or more before the
spray was approved or rejected.

GW Pharmaceuticals is also doing trials with cancer patients, but has not
pursued the area of post-operative pain.

Easing suffering: Potential uses

Multiple sclerosis Many patients have for years claimed their symptoms are
relieved by cannabis, which they smoke or eat. Some have been taken to
court for possession, which has caused an outcry. The House of Lords
science and technology committee took their part when it called for trials
of cannabis use in MS in 1998, and returned to the issue in 2001, demanding
urgent action to get cannabis products regulated for medicinal use. The MS
Society estimated that 1% of 35,000 people with the disease were using the
drug illegally.

Neuropathic pain There is evidence, particularly from animal studies, that
cannabis relieves pain from damaged nerves. Pains such as those from
amputation do not respond well to narcotics.

Anti-nausea Clinical trial evidence exists showing cannabis can suppress
the nausea and vomiting experienced by cancer patients as a result of
chemotherapy. Studies in the 1970s showed that nabilone, a synthetic
derivative, was as effective as other anti-nausea drugs and it was licensed
as a medicine, but it is little used.

Anorexia Cannabis has been used to tempt people with eating disorders and
lack of appetite. But in regular users the effect is thought to wear off.

 

 

 

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