A recent study published in The Journal of Headache and Pain suggests that cannabis may be a viable treatment for chronic pain.
Tilray, a medical cannabis research, cultivation, processing, and distribution company, surveyed 2032 patients who use cannabis to treat 21 various illnesses.
Daily Hive spoke with Philippe Lucas, Vice-President of Patient Research and Access at Tilray and the co-founder of the Vancouver Island Compassion Society, about the implications of the study and future of patient care in the wake of legalization.
Part one of a four-part study focused on cannabis use to treat pain associated with headaches and migraines, with 88% of patients responding “yes” to using cannabis as a headache therapy.
Aside from examining patterns of patient use of medical cannabis to treat pain, the study also gathered data on patient’s preferences of strains, and the reduction and substitution of prescription pain medications.
Patient reports indicate hybrid strains to be the most preferred, specifically OG Shark which has a high THC and low CBD ratio.
Terpene profiles were also evaluated, favouring beta-caryophyllene and beta-myrcene for their anti-inflammatory and analgesic effects.
Patients also reported using less or fully substituting their prescription pain medications (most commonly opiates/opioids) with medical cannabis.
The entourage effect
Results from the report “may point the way down the road to migraine or headache specific cannabis-based medication that would also have specific profiles in terms of preferred terpenes,” said Lucas over the phone.
“Terpenes themselves not only have therapeutic effects but it has been identified that one or two terpenes bind to the endocannabinoid receptors, so they may alter, displace, or otherwise modulate the effects of cannabinoids in our bodies.”
Lucas explained that other academics have suggested “a whole plant product” (when all the biochemical elements of the plant are used instead of filtered out) seems to lead to better tolerability and effects due to something called “the entourage effect.”
“With different cannabinoids and terpenes playing off each other, it both reduces some of the potentially negative side effects associated with cannabis use but also increases the efficacy.”
“It has also been suggested that through the entourage effect, terpene profiles in particular may help explain the subjective differences that patients site from one strain to the next that otherwise might look similar in their cannabinoid ratios.”
Lucas noted that there has been some research into terpenes, particularly in superfoods like blueberries and acai, but “there is a lack of cannabis-specific research in the area.”
The goal of the study was not specifically to get patients to change or substitute opioids but rather to track some of the trends of medical cannabis use to treat pain.
“Patients do self-report a very high rate of substitution of cannabis for prescription drugs and other drugs as well,” said Lucas, noting that about 70% of patients cited cannabis as a substitute, and one-third of the substitutions were for opioids.
“This suggests that cannabis can potentially interrupt the opioid overdose cycle by providing physicians and patients a potentially safer tool in addressing chronic pain.”
“We know a lot of patients were successfully using cannabis as an adjunct treatment to opioids in order to not have to increase their doses of opioids, and a great percentage of patients seem to be suggesting that they are using cannabis as a full-on replacement for opioid therapy.”
Consumption methods and patient access
Raw flower vaporization was the most popular method of cannabis consumption of patients surveyed, with an overall trend showing that 50% are vaping or taking edibles.
“If you look at black market trends of medical and recreational [cannabis use] there is an increased use and demand of oil-based vaporization,” said Lucas.
“Vape pens and cartridges are not legally available in Canada yet and I think it’s to the great detriment of patients who are seeking out this alternative to smoking because they want the rapid affects you get through inhalation but they don’t want to smoke their product.”
“Federal restrictions (on the production/sale of vape pens) are encouraging patients to seek these alternatives elsewhere or to continue to use smoke products instead of shifting to these potentially safer modes of inhalation.”
Although the Canadian government has committed to regulating extractions within 12 months of legalization, Lucas believes that “we really need to speed up access to alternative methods of ingestion.”
“In terms of priority of access for patients, I think I would put vape cartridges ahead of edibles and concentrates and I would certainly hope that the government makes them available before the 12 month time period they have given themselves.”
“The opportunity presented by C-45 (The Cannabis Act) is not only to reduce the potential harms associated with cannabis use by bringing it out of the black market and regulating its production and access, but also tracking the potential positive beneficial impacts of these changes associated with the legalization of cannabis and cannabis use itself.”
Lucas concluded by saying he “couldn’t be more pleased that we’re finally moving away from cannabis policies based on fear, prejudice and misinformation, and moving towards policies based on science, reason, and compassion.”