Queen Victoria was prescribed cannabis for period pains, and 19th-century American doctors used it for everything from anorexia to sexual problems. And now the US is embracing medicinal cannabis again – it’s legally available in 25 states for conditions such as Aids, anorexia, arthritis, cachexia, cancer, chronic pain, glaucoma, migraine, muscle spasms from multiple sclerosis, seizures and severe nausea. The list is for comparison: in the UK, the only indication for medical cannabis is for painful, tightening muscle spasms (spasticity) in multiple sclerosis. Sativex, an oral spray that uses two chemical extracts from the cannabis plant – delta-9 tetrahydrocannabinol (THC) and cannabidiol (CBD) – was the first medicinal cannabis licensed in the UK. Medicinal cannabis, you see, does not mean treating yourself by smoking weed. Cannabis comes as a proper drug – Sativex costs too much for the health watchdog Nice to recommend and only a handful of specialist doctors will prescribe it.
The solution
Last week’s report from the all-party parliamentary group for drug policy reform recommended medicinal cannabis for chronic pain, spasticity, nausea and vomiting after chemotherapy and for anxiety. There is good evidence to use cannabis products or “natural” cannabis, they said, for all these conditions – and moderate evidence for use in sleep disorders, fibromyalgia and post-traumatic stress disorder. The evidence came from a review based on 20,000 references – although, in places, they were quite generous in their rating of the evidence.
A systematic review of the same question – the benefits and adverse effects of medicinal marijuana – was published in the Journal of the American Medical Association (JAMA) last year with similar conclusions – but found the evidence overall to be weaker, and not there at all for anxiety.
The evidence shows that cannabis does relieve chronic pain, but the Home Office has already said in response to this latest report that cannabis “is a harmful drug which can damage people’s mental and physical health”. Yet Nice says it works in the treatment of MS. And the JAMA review, which had higher standards of evidence than the latest report, says that cannabis benefits people with chronic pain or spasticity due to MS. It adds that there is some evidence it helps to improve weight gain in HIV infection, and relieves insomnia, nausea and vomiting due to chemotherapy. There is no data on long-term side-effects – psychosis is the most feared. Typical side-effects include drowsiness, nausea, paranoia, sweating and euphoria. There is no solid research comparing “natural” with “medicinal” cannabis, but the research suggests similar benefits for pain and spasticity. So it does work – but the law says you can’t take it.
