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Pot-pourri: Cannabis Preparations for Pain

Recent surveys conducted in people with multiple sclerosis (MS) and epilepsy suggest that many people with these diseases are using marijuana to treat pain, stress and other symptoms associated with their conditions. While little research is being done on the medical uses of marijuana, a new study suggests that a drug modeled on a cannabinoid chemical in marijuana may help ease the pain associated with multiple sclerosis (MS) and perhaps provide a safer alternative to smoked marijuana for people with chronic pain conditions.

Treating Pain in Multiple Sclerosis
The MS study, published in the June 16th online edition of the British Medical Journal (BMJ), evaluated 24 people with MS between the ages of 23 and 55 who had central pain. Up to 80 percent of people with multiple sclerosis experience pain, including pain generated in the central nervous system known as central pain.

The researchers, of the University Hospital of Aarhus in Denmark, divided the participants into two groups, giving one a placebo and the other group dronabinol (Marinol). Dronabinol contains a synthetic form of THC, which is believed to be the primary active ingredient in marijuana, or cannabis. Dronabinol, a prescription medication that is given as a capsule, is the only cannabinoid approved by the U.S. Food and Drug Administration (FDA). It is currently indicated for loss of appetite in people with AIDS and for the treatment of nausea and vomiting associated with chemotherapy for cancer.

The Danish researchers found that dronabinol reduced pain intensity and improved pain relief in participants, and concluded it should be offered to people with MS whose pain is not severe enough to be treated with medications such as anticonvulsants, antidepressants or opioids. Some side effects, such as dizziness, were associated with dronabinol.

Marinol and Marijuana: What’s the Difference?
Dronabinol contains just one of the more than 60 cannabinoids in the marijuana plant, many of which may contribute to its beneficial effects. But unlike marijuana, which is illegal under U.S. federal law, dronabinol provides a standardized THC concentration and is free of impurities such as leaves, bacteria and mold spores. In addition to the quality control concerns, there is still a need for randomized trials of medical marijuana to establish its therapeutic value.

Surveys, however, suggest that people with MS, for example, are smoking marijuana for medical purposes regardless. Of the 220 people with MS interviewed for a Canadian survey that was published in June in the journal Neurology, 29 said they used marijuana regularly for symptom relief. About half of these patients said marijuana eased pain and spasticity.

"I think the survey findings point to the reality that a proportion of patients with MS are using cannabis." says Mark Ware, MBBS, MSc, an assistant professor of anesthesia and family medicine at McGill University in Montreal who conducted the survey. "If physicians don’t ask their patients about cannabis, the use may go undetected by the physicians, and cannabis may not be totally beneficial; it may cause harm and interact with other medications."

While Dr. Ware does not advocate the use of medical marijuana at this time, he thinks that its use among patients points to a need for pain to be taken seriously. He and other physicians who treat people with painful conditions say that more research on dronabinol and marijuana is needed for this reason. "I think that clinical trials such as the one recently published in the BMJ add significantly to the body of evidence suggesting that cannabis, and products based on cannabis, have a role to play in the management of painful chronic diseases like MS." Dr Ware says.