Medicinal cannabis in the treatment of chronic pain

Henderson, Luke A.; Kotsirilos, Vicki; Cairns, Elizabeth A.; Ramachandran, Alister; Peck, Chris; McGregor, Iain S.

doi:10.31128/ajgp-04-21-5939

Cited by 20 publications

(14 citation statements)

References 49 publications

(63 reference statements)

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“…To date, little systematic analysis of these TGA datasets have been undertaken (although see Benson and Cohen, 2019 ; Arnold et al, 2020 ; Henderson et al, 2021 ). The purpose of the current study was to provide more detailed analysis of these datasets to allow insights into current trends in MC prescribing in Australia, including indications, patient demographics, and product categories.…”

Section: Introductionmentioning

confidence: 99%

Medicinal Cannabis Prescribing in Australia: An Analysis of Trends Over the First Five Years

et al. 2022

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A regulatory framework allowing legal access to medicinal cannabis (MC) products has operated in Australia since November 2016. MC prescribing by healthcare practitioners (HCPs) is primarily conducted through the Special Access Scheme - Category B (SAS-B) pathway, through which prescribers apply to the Therapeutic Goods Administration (TGA–the federal regulator) for approval to prescribe a category of product to an individual patient suffering from a specific indication. The dataset collected by the TGA provides a unique opportunity to examine MC prescribing trends over time in the Australian population. Here we analysed this TGA SAS-B dataset since inception with respect to age, gender, product type (e.g., oil, flower, etc.), CBD content, indication treated, and prescriber location. Results are presented descriptively as well as being analysed using non-linear regression models. Relationship between variables were explored via correspondence analyses. Indications were classified with reference to the International Statistical Classification of Diseases and Related Health Problems (10th Revision). As of 31 August 2021, a total of 159,665 SAS-B approvals had been issued for MC products, 82.4% of were since January 2020. Leading indications for approvals were for pain, anxiety, and sleep disorders. Oil products were the most popular product type, while CBD-dominant products (≥98% CBD) accounted for 25.1% of total approvals. Approvals for flower products increased markedly during 2020–2021, as did approvals involving younger age groups (18–31 years old), male patients, and non-CBD dominant products. A disproportionate number of SAS-B MC applications (around 50%) came from HCPs in the state of Queensland. Associations between patient gender and age and/or indication with product type were found. For example, approvals for oil products were commonly associated with approvals for pain. While, overall prescribing increased dramatically over the last 2 years of analysis, stabilization of approval numbers is evident for some indications, such as pain. Current prescribing practices do not always reflect provided TGA guidance documents for MC prescribing. While acknowledging some limitations around the SAS-B dataset, it provides a unique and valuable resource with which to better understand current prescribing practices and utilisation of MC products within Australia.

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Section: Introductionmentioning

confidence: 99%

Medicinal Cannabis Prescribing in Australia: An Analysis of Trends Over the First Five Years

et al. 2022

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“…Medicines containing THC and/or CBD have been approved for the treatment of nausea, spasticity associated with multiple sclerosis, chronic pain, and epilepsy in a number of countries (Sholler et al, 2020). In regions with legal medicinal Cannabis programmes, available evidence suggests patients consume Cannabis preparations predominantly to alleviate pain, spasticity, nausea, and other neurological conditions such as posttraumatic stress disorder and epilepsy (Henderson et al, 2021; Oregon Health Authority, OMMP Statistics, 2022). It seems likely that THC activity at CB 1 receptors contributes significantly to the reported therapeutic efficacy of Cannabis in people, but this has not been directly examined, and agonist actions at CB 1 receptors cannot explain the effects of cannabidiol.…”

Section: Introductionmentioning

confidence: 99%

Inhibition of human recombinant T‐type calcium channels by phytocannabinoids in vitro

Mirlohi

Bladen

Santiago

et al. 2022

British J Pharmacology

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Background and Purpose: T-type Ca channels (I Ca ) regulate neuronal excitability and contribute to neurotransmitter release. The phytocannabinoids Δ 9 -tetrahydrocannabinol and cannabidiol effectively modulate T-type I Ca , but effects of other biologically active phytocannabinoids on these channels are unknown. We thus investigated the modulation of T-type I Ca by low abundance phytocannabinoids. Experimental Approach: A fluorometric (fluorescence imaging plate reader [FLIPR]) assay was used to investigate modulation of human T-type I Ca (Ca V 3.1, 3.2 and 3.3) stably expressed in FlpIn-TREx HEK293 cells. The biophysical effects of some compounds were examined using whole-cell patch clamp recordings.

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“…Participating GPs who were MC prescribers had prescribed MC most often for chronic pain and anxiety (Supplementary Table 2 ). However, prescribing for these indications is supported by relatively sparse evidence [ 32 – 35 ]. Indeed, participating GPs were clearly aware of the limited evidence for clinical efficacy of MC, as has been noted in previous surveys [ 13 , 16 , 17 , 31 ].…”

Section: Discussionmentioning

confidence: 99%

Knowledge, experiences, and attitudes of Australian General Practitioners towards medicinal cannabis: a 2021–2022 survey

Bawa

McCartney

Manocha³

et al. 2022

BMC Prim. Care

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Background Medicinal cannabis (MC) products have been available on prescription in Australia for around six years. General practitioners (GPs) are at the forefront of MC prescribing and recent years have seen substantial increases in prescription numbers. This study examined the current knowledge, experiences, and attitudes of Australian GPs around MC. We also compared our findings to those of an earlier 2017 investigation. Method We conducted a cross-sectional study using a 42-item on-line questionnaire adapted from our earlier 2017 survey. The current survey was completed by GPs attending an on-line, multi-topic educational seminar. Australian GPs (n = 505) completed the survey between November 2021 and February 2022. Data were synthesised using descriptive statistics. MC ‘prescribers’ and ‘non-prescribers’ responses were compared using Pearson’s χ2 tests. Results While most GPs (85.3%) had received patient enquiries about MC during the last three months, only half (52.3%) felt comfortable discussing MC with patients. Around one fifth (21.8%) had prescribed a MC product. GPs strongly supported MC prescribing for palliative care, cancer pain, chemotherapy-induced nausea and vomiting, and epilepsy, more so than in our 2017 survey. Prescribing for mental health conditions (e.g., depression, anxiety) and insomnia received less support. Opioids, benzodiazepines, and chemotherapy drugs were rated as more hazardous than MC. GPs correctly endorsed concerns around Δ9-tetrahydrocannabinol-related driving impairment and drug-seeking behaviour. However, additional concerns endorsed around cannabidiol causing addiction and driving impairment do not agree with current evidence. Consistent with this, many GPs (66.9%) felt they had inadequate knowledge of MC. Conclusion Acceptance of MC as a treatment option has increased among Australian GPs since 2017. However, there is a clear need for improved training and education of GPs around cannabis-based medicines to provide increased numbers of skilled prescribers in the community.

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Medicinal cannabis in the treatment of chronic pain

Cited by 20 publications

References 49 publications

Medicinal Cannabis Prescribing in Australia: An Analysis of Trends Over the First Five Years

Medicinal Cannabis Prescribing in Australia: An Analysis of Trends Over the First Five Years

Inhibition of human recombinant T‐type calcium channels by phytocannabinoids in vitro

Knowledge, experiences, and attitudes of Australian General Practitioners towards medicinal cannabis: a 2021–2022 survey

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