A recently published case study documents one chronic pain patient’s reduction of prescribed pain medication after being referred to a medical cannabis registry. Prescribed cannabis-based medicinal products (CBMPs) have been legal in the UK since 2018.
The study was published on March 14, 2023 in the United Kingdom (UK) journal Drug Science, Policy and Law, the official journal of Drug Science, which is the UK’s leading independent scientific body on drugs (1). The case study follows a 61-year-old woman who was prescribed a medication for chronic pain and though her pain was well-controlled by the medication, she reported side effects such as hearing loss, sleepiness, tinnitus, confusion, and worsening anxiety (2).
“Prescribed cannabinoids are legal in the UK and are increasingly being used for a variety of conditions, with one of the most frequent conditions being chronic pain,” read the abstract of the study (2). “Here we present a case study of a 61-year-old woman with idiopathic small fibre neuropathy, who was prescribed the gabapentinoid pregabalin, in combination at different times with various other agents…over a 17-year period for the associated neuropathic pain.”
After attempts to decrease the dose of pregabalin had failed, in 2021 she enrolled in Project Twenty21, the UK's first medical cannabis registry (2). “She was prescribed full plant extract delta-9-tetrahydrocannabinol 10 mg: cannabidiol 15 mg/mL of oil, prescribed at a dose range of 0.1–0.5 mL twice daily,” the abstract said. “As a result, the patient managed to reduce her pregabalin down to 37.5 mg total daily dose.”
“Launched in August 2020, Project Twenty 21 (T21) is a multi-centre, observational patient registry for patients seeking treatment with prescribed cannabinoids,” the study explained (2). “The over-arching goal of T21 is to collect prospective data from substantial numbers of people who receive CBMPs for a variety of conditions, in order to contribute to both the scientific literature and regulatory aspects on the safety and effectiveness of these products in real-world settings.” In this way, T21 also allows medical cannabis patients to obtain CBPMs at a discounted price (1).
“The patient now feels she has ‘been given a second chance at life’ and her husband describes her as ‘a new woman’,” the abstract concluded (2). “This patient feels that she is in a position to finally stop treatment with pregabalin, as a result of medical cannabis controlling her pain. Highlighting the potential benefits of cannabis-based medicinal products to treat chronic pain, our case study indicates the value of including real-world evidence when assessing the benefits and safety of cannabis-based medicinal products.”
The study outlined the current recommendation from UK’s National Institute for Health and Care Excellent (NICE) for neuropathic pain, and noted that NICE does not recommend the prescription of CBMPs for chronic pain due to a variety of complex reasons (2). “Medical cannabis offers clinicians another treatment option and should be considered especially once all recommended treatments have failed or are only achieving partial pain management,” the study continued. “As with other drugs, CBMPs need to be embedded in a multimodal treatment plan, with appropriate safeguarding support, and ongoing pharmacovigilance such as provided by T21.”
As a final note, the study included the patient’s testimonial. “I have had peripheral neuropathy for over 17 years and I have tried all sorts of medications and treatments, (traditional and alternative), too many to mention but include ketamine infusions and I even twice trialed a spinal cord stimulator. Nothing has come anywhere close to the pain relief I gain from the prescription cannabis that I have been taking whilst on the Twenty21 Trial,” it read in part (2). “I am so very grateful that Peter Sunderland, the pharmacist at my GP's surgery, persuaded me to go on the trial. My family and friends have all remarked on how well and happy I am now.”