Every patient’s pain is unique, making it difficult to find an effective treatment plan that exclusively solves chronic pain.¹ Medical cannabis is a potential outlet for chronic pain relief; however, it can be a controversial topic due to the limited existing evidence and associated risks. Here, we consider the legalities of medical cannabis and its possible use as a last-resort treatment for managing chronic pain.

There are various gaps in the clinical benefits of medical cannabis and its potential harm in the long term. Cannabis carries certain risks which must be acknowledged in the judgment of legalisation for this drug, alongside the positive pain relief it provides for patients with chronic pain. Due to the risks associated with cannabis in general, being more relaxed with the prescription of medical cannabis may cause more harm than good.²

Continue reading to find out the common controversies and ethical considerations towards medical cannabis and whether it is truly effective towards managing chronic pain.

Introducing medical cannabis

Medical cannabis is a broad term often used for any cannabis-related medication to manage symptoms of various conditions.² Medical cannabis has had increased interest recently in its potential to assist in pain management alternatives for chronic pain.³ Chronic pain is a substantially difficult sector to treat, where typical therapies and medications, such as opioids, offer temporary pain relief with various connotated side effects.⁴

Chronic pain influences approximately 1 in 5 Americans and roughly 25% of the Canadian population, leading to a substantial economic cost for treatment and care.^3,4 Not only does chronic pain manifest as physical discomfort, but it has various comorbidities, including emotional distraught, mental stress, and large impairments in quality of life.³

Cannabis is a complex drug, encompassing a variety of active compounds known as cannabinoids, which promptly act in our body by interacting with our endocannabinoid system.³ Pain relievers typically work by blocking pain signals in our body or by reducing inflammation, unlike medical cannabis, where the endocannabinoid system plays a distinct role in monitoring pain and other vital processes.¹ While both pain medications and medicinal cannabis have side effects, this has prompted discussions on whether cannabis can be utilised as an alternative for treating chronic pain.¹

Legal considerations: medical cannabis in the UK and the USA

In 2018, medical cannabis was legalised in the UK, however, it remains tightly regulated and is only prescribed under specific conditions.¹ This includes medical cannabis being the last resort of choice if other treatments have failed, where it is only prescribed by doctors under the title of ‘Specialist Register’, which they are a part of the General Medical Council (GMC).¹ On the other hand, in the United States, legalisation of cannabis has skyrocketed over the years, where 36 states have legalised the usage of marijuana for medical purposes, including treating those with chronic pain.3 Despite this, cannabis is still in the Schedule 1 category through federal law, where it is not FDA-approved and has a high risk for abuse.³ This has caused increased political debate on whether it should be legalised and whether the benefits of these drugs outweigh the significant potential public health risks.⁵

However, establishing solid evidence on medicinal cannabis remains pivotal to expanding legal access soon.⁶ The NHS in the UK initiated the Medicinal Cannabis Patient Registry in 2022 to track patient outcomes over time and hopefully discover the trends of medical cannabis on health outcomes.⁶ This system has the potential to shift existing policies and influence medical cannabis regulations worldwide. But for now, the UK government has no intention of legalising cannabis for non-medical use anytime soon, with tight regulations surrounding medical cannabis prescription.²

Public safety concerns 

Medical cannabis has many adverse effects that may make states reluctant to legalise this drug.³ This includes impaired coordination and attention, short-term memory, dry mouth, dizziness and even affects driving performance.^1,3 Hence, patients with a history of psychiatric disorders should avoid the use of medical cannabis.³ It is illegal in England to drive with legal drugs in your body if they affect your driving, including medicinal cannabis.¹

There are various risks associated with utilising medical cannabis due to its content of tetrahydrocannabinol (THC)- a chemical known to get people high.² There are higher risks due to the content of THC, including obtaining psychotic illnesses or alterations in behavioural health ^[2]. However, this is only for a small percentage of the population and can be avoided when solely prescribed by a specialist doctor.^2,5 Age consideration is crucial, where the younger the individual, the greater the risk for addiction or side effects from medical cannabis.⁵

The legality of medical cannabis may be further complicated by the existence of synthetic cannabinoid products, including Dronabinol, which mimic THC’s effects, although they remain unlicensed in the UK.⁷ This could potentially be a gateway to further therapeutic options for treating chronic pain.

Evaluation of the effectiveness of medical cannabis

The efficacy of medical cannabis is still under ongoing research.¹ However, it may be a supportive treatment for patients with chronic pain who have had unsuccessful primary medications.¹

Most studies have reported patients feeling relief from their typical chronic pain when taking medical cannabis.³ Pain relief was the number one reported symptom from patients, followed closely by improved sleep.³

Medical cannabis may be more effective for some than others. Some studies reveal medical cannabis has positive effects on managing chronic neuropathic pain, but not enough evidence is present to support treating patients with Crohn’s disease, fibromyalgia and rheumatoid arthritis.⁴

Controversies and debates regarding the legality of medical cannabis 

Multiple controversies and uncertainties surround the logistics of implementing medical cannabis as a treatment method.⁴

Despite patients having reported noticeable relief from chronic pain with medical cannabis, current evidence on its positive effects is still incomplete.⁷ The necessity for clinical trials before the prescription of medical cannabis limits its accessibility and is generally not considered a safe drug to be provided to any appropriate patient.² Further controlled trials with a larger cohort of patients are required to dictate the potential long-term impact of this drug and its true efficacy on relieving chronic pain.⁷ Hence, until the evidence is more concrete, further cannabis-based medical products have the potential to become licensed.⁷

How is it prescribed?

Getting access to medical cannabis is considered difficult in the UK, where prescriptions are only available through a licensed pharmacy.^1,2 It is mainly given for those experiencing severe epilepsy, vomiting or nausea symptoms from chemotherapy, or muscle stiffness from multiple sclerosis.² Hence, it can only be prescribed for unusual conditions when other treatments are ineffective or unsuitable for that patient.²

Medical cannabis can be prescribed in various forms; the most common variations in the UK are as oils, cannabis flowers, or a combination of both.¹ The outbreak of vaping and its strong correlation with lung-related illnesses highlights the need to monitor how medicinal cannabis is administered.⁵

Ethical and social considerations

Ethical considerations indicate that healthcare providers should recommend medical cannabis for conditions that have the most substantial evidence towards symptom relief.⁵ However, using medical cannabis or possessing cannabis in general without a prescription is still classified as illegal.²

Summary

Overall, while medical cannabis may help relieve chronic pain, the risks associated make it a reluctant approach until further research is done. It is important to understand that no medication is perfect and risk-free.⁷ While some medicines are safer than others, medical cannabis should only be considered as the last resort, with extra caution for vulnerable populations.⁷ Where the legalisations vary internationally, UK policies emphasise caution with prescriptions due to its limited evidence.⁷

FAQs

Are the side effects of medical cannabis worse than those of pain relievers?

While medical cannabis does have side effects such as impaired coordination, dry mouth, and dizziness, they may be less severe than many pain medications, depending on the individual. Assessing age, medical history, and low responsiveness to pain medications can lead to the consideration of medical cannabis as an alternative.¹

How can I be prescribed medical cannabis?

Prescriptions can only be given for rare cases, under the direction of a specialised doctor of the General Medical Council, ensuring increased safety for patients. Medical cannabis can be considered for prescription after proof of failed responses to other primary treatment plans.