Cannabis ‘reasonable’ to try for chronic pain before resorting to opioids
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DESTIN, Fla. — Physicians can consider cannabis before opioids for chronic pain when other options have been exhausted, according to a speaker at the Congress of Clinical Rheumatology East.
“Non-opioid and non-cannabis approaches should be optimized first,” Jason W. Busse, DC, PhD, a professor of anesthesia at McMaster University, in Hamilton, Canada, told attendees. “But for patients who do not achieve a satisfactory result, it’s not unreasonable to offer a trial of oral cannabis products and, lastly, a trial of opioids.”
In his talk, Busse outlined the findings of various panels he has been involved with that have investigated the optimal uses of opioids and cannabis for chronic noncancerous pain.
“People seem to want to transition away from opioids,” he said. “There’s currently some enthusiasm about cannabis.”
Although head-to-head comparisons of opioids and cannabis are generally lacking, Busse and colleagues performed a systematic review and network meta-analysis of 90 randomized controlled trials evaluating these therapies. The analysis yielded “preliminary evidence” that their benefits “might be similar,” while “harms might be greater with opioids,” he said.
“We ended up coming up with low-to-moderate-certainty evidence that cannabis products, as used in these clinical trials — which were oral formulations, non-high-THC products — appear to be similarly effective for pain, sleep and physical function,” Busse said. “When we looked at dropouts due to adverse events, it was twice as high in the opioid groups.”
However, he additionally cautioned that when he says opioids and cannabis might be “similarly effective” for chronic pain, that still means “not that great.”
“Neither opioids nor cannabis for medical purposes are particularly effective,” Busse said. “They’re just not. However, they may provide important benefits for a minority of patients.”
Busse concluded that opioids and cannabis “are not first-line care, not second-line care, not third-line.”
“However, for individuals that have not responded and they’re looking for something else, it is reasonable to offer a trial of cannabis for therapeutic purposes before a trial of opioids,” he said. “At least, it looks as if you can reduce the harm profile.”
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Busse JW. Cannabis or Opioids for Chronic Pain: Do Either Have a Role? Presented at The Congress of Clinical Rheumatology East; May 9-12, 2024; Destin, Florida (hybrid meeting).
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