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Cannabis and Chronic Pain

NICE guid­ance on cannabis-based med­i­cines out for consultation

The Nation­al Insti­tute for Health and Care Excel­lence (NICE) has issued draft guid­ance for the use of cannabis-based med­i­cines con­sid­er­ing the evi­dence for their use in intractable nau­sea and vom­it­ing; chron­ic pain; spas­tic­i­ty and epilep­sy. It cov­ers oth­er relat­ed top­ics, such as pre­scrib­ing, and the eco­nom­ic aspects. NICE guide­lines apply only to Eng­land unless adopt­ed by devolved gov­ern­ments. Doc­tors are expect­ed to take the guide­lines into account in their clin­i­cal prac­tice. How­ev­er, it is not manda­to­ry for doc­tors to fol­low them where they believe they are not in the best inter­ests of a par­tic­u­lar patient. The evi­dence review for chron­ic pain runs to near­ly 262 pages and reviews data from 20 tri­als. There are no head­line grab­bing conclusions.

The com­mit­tee not­ed that most of the tri­als were lim­it­ed in scope and of poor qual­i­ty. There is some evi­dence that some cannabis-based prod­ucts reduce chron­ic pain in some patients. How­ev­er, the ben­e­fit is small com­pared with the cost of the treat­ment. NICE not­ed that cannabis-based med­i­cines would have to be 10 times more effec­tive or 10 times cheap­er to have an accept­able cost/benefit. How­ev­er, the com­mit­tee acknowl­edged the many patient reports of ben­e­fit and has rec­om­mend­ed fur­ther research be done, par­tic­u­lar­ly in fibromyal­gia and per­sis­tent treat­ment-resis­tant neu­ro­path­ic pain in adults, and chron­ic pain in chil­dren and young peo­ple. Notes will keep an eye on developments.

Read the draft guid­ance here

What is Cannabidiol?

Cannabid­i­ol (CBD) is a nat­ur­al com­pound extract­ed from the cannabis plant. It is freely avail­able in the UK as a food sup­ple­ment and the mar­ket for it is grow­ing. The prod­ucts for sale do not claim any med­ical ben­e­fit and some prod­ucts do not con­tain a suf­fi­cient­ly high dose to be like­ly to have any ben­e­fit. They are not cheap. Cannabid­i­ol does not get you ‘high’, but some for­mu­la­tions avail­able on the inter­net (from US sites for exam­ple) con­tain tetrahy­dro­cannabi­nol (THC) which is the chem­i­cal that does make you high. Pos­ses­sion of for­mu­la­tions with THC is like­ly to be ille­gal in the UK. Syn­thet­ic cannabi­noids such as Nabix­i­mols are avail­able for some con­di­tions under med­ical pre­scrip­tion hav­ing been test­ed and shown to be both effec­tive and safe. For more infor­ma­tion, we rec­om­mend the NHS web­site: