Margaret-Ann Tait, PhD candidate
University of Sydney
According to the Australian Institute of Health and Welfare, 3.6 million people in Australia suffer with chronic pain, impacting their quality of life. Legislation changes in 2016 allowed clinicians to prescribe medicinal cannabis to patients for whom conventional therapies had failed. However, as medical cannabis is still regarded as an unauthorised medicine in Australia, clinicians have limited guidance on which cannabinoids, cannabidiol (CBD) and/or delta9-tetrahydrocannabinol (THC), to prescribe for different conditions. We wanted to explore current prescribing patterns in Australia and compare this with patient-reported outcomes across the different types of chronic pain conditions and different cannabinoid combinations.
This study was part of a larger project called the QUEST initiative, in which we followed patients across Australia who had been prescribed medicinal cannabis oil for any chronic health condition. We found that over the first three months of medicinal cannabis therapy, participants reported improvements in their health related quality of life and fatigue, and reported improvements in health conditions associated with anxiety, depression, insomnia, and pain. More information about the 3-month follow-up observational study is available here in PLOS One.
Of 2,353 participants in the QUEST study, 1,609 had chronic pain diagnosed by clinicians according to ICD-10 defined types: neuropathic / musculoskeletal / visceral / widespread or fibromyalgia / headache / cancer-related / and post-traumatic (or post-surgery). Patients completed the PROMIS Pain intensity and Pain interference questionnaires before starting therapy, then at regular intervals over the following 12-months. (Learn more about the PROMIS roadmap here.) We collected data on total daily dose of CBD and THC, categorized into active ingredient combinations of: CBD-only, CBD-dominant, CBD-THC-balanced, and THC-dominant. We looked at change in pain scores after commencing therapy compared with baseline, and differences between cannabinoid combinations for each of the different types of chronic pain.
We found clinically important improvements in pain intensity and pain interference across all cannabinoid categories and pain types. Our full manuscript on the study, titled “Improvements in health-related quality of life are maintained long-term in patients pre-scribed medicinal cannabis in Australia: The QUEST Initiative 12-month follow-up observational study,” is currently under review.
Overall, CBD-only was most often prescribed, however, we found that for musculoskeletal, headache, and cancer-related pain intensity, improvements were significantly better with CBD-dominant, which typically contained 30mg CBD and 3mg THC. Pain interference improvements were similar across the cannabinoid categories.
Our findings contribute to the ongoing evidence that clinicians and patients can consider when deciding whether to try medicinal cannabis after conventional treatments have failed.
This newsletter editorial represents the views of the author and does not necessarily reflect the views of ISOQOL.
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