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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The National Institute for Health and Care Excellence (NICE) has issued draft guidance for the use of cannabis-based medicines considering the evidence for their use in intractable nausea and vomiting; chronic pain; spasticity and epilepsy.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Read the draft guidance here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: nhs.uk/conditions/medical-cannabis/.

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