“By far the most common cause of medical cannabis use in this country is chronic pain. However, there is a critical lack of evidence that it provides a consistent benefit for any type of chronic non-cancer pain, especially when compared to the treatments we are already trying to care for in pain clinics, ”Vagg said.

“The research available either does not support the use of cannabinoid products for chronic, non-cancer pain, or is of such poor quality that no valid scientific conclusions can be drawn. Cannabidiol-only formulations have never been the subject of a published randomized controlled trial for the treatment of chronic pain, but they are the most widely prescribed type of cannabis product. ”

Vagg also said there is a lack of research into how cannabinoids react with drugs, particularly in terms of their calming and psychiatric side effects.

“Hypothesis” of analgesia

ANZCA’s new guidelines came just days after the International Association for Pain Studies (IASP) issued a statement disapproving the use of cannabinoids to treat pain. According to the IASP, there were preliminary studies that supported the “cannabinoid analgesia hypothesis” but were insufficient to overcome the lack of evidence of the safety and effectiveness of cannabinoids.

“While IASP is currently in no position to endorse the general use of cannabinoids to treat pain, we do not want to disapprove of the experiences of people with pain who have benefited from their use,” said Andrew Rice, MD, chair of the IASP Presidential Task Force for cannabis and cannabinoid analgesia.

“This is not a closing door on the matter, but a call for more rigorous and robust research to better understand the potential benefits and harms associated with the potential uses of medicinal cannabis, cannabis-based drugs and synthetic cannabinoids for pain relief, ensuring patient safety and pain the public through official standards and protective measures. “

Rice said IASP was concerned that laws allowing the use of medical marijuana would be passed without the same rigorous and regulatory procedures that are followed for pharmaceutical products. Patients who treat their pain themselves with cannabis are also at risk, according to Rice, as their doctors often have no knowledge of their cannabis use.

“The IASP also calls for a comprehensive research agenda to be made available. One of the priorities is to identify those patients with pain who may benefit most from cannabis or cannabinoids and who are at risk of most harm, ”said former IASP President Lars Arendt-Nielsen, MD, who chairs the Cannabis Task Force held.

Medical cannabis advocates deny the claim that there is insufficient evidence to support the use of cannabis for pain.

“These recommendations are political and not scientific. Several peer-reviewed studies have found that inhaled cannabis is safe and effective for treating various types of pain, particularly neuropathic pain, ”said Paul Armentano, NORML’s associate director, in an email to PNN.

Armentano cited a 2017 study by the US National Academy of Sciences that found “conclusive or substantial evidence” that cannabis is an effective treatment for chronic pain.

“In the real world, therapeutic use of cannabis is increasing in patients with chronic pain, many of whom are replacing opioids. In countries where cannabis is legally available, chronic pain is the most suitable condition for medical cannabis patients participating in country-specific access programs. Deliberately ignoring this data suggests that political rather than scientific considerations influenced the decision of this group, ”said Armentano.