Prescribing for chronic pain: opioids and medical cannabis (Part One)

As trends have continued to shift over recent years in how chronic pain treatment is managed, opioids remain one of the major drug families which are considered as an element of a treatment plan. However, this drug class carries with it a highly addictive nature, which means they’re not recommended for integration into long-term plans, which are often required as a part of chronic pain treatment. The inherent risk of prescription of this particular type of drug class is evident in the ongoing opioid epidemic in the US, which claims many lives on a daily basis through misuse. Thankfully, we have the opportunity to learn from the mistakes made by pharmaceutical and medical industries in their contributions to this ongoing national crisis. As the Australian patient population is largely aware of the issues that correlate to opioid prescription, the need for pain-relieving alternatives is evident.

Medical professionals can attest to the fact that managing chronic pain doesn’t occur via an isolated or simple diagnosis. Treatment plans will often include multidisciplinary practices in the process of providing a patient with as much pain relief and pain management as possible, with highly individualised plans allowing for a custom approach to be shaped for each patient. This can include trial-and-error solution processes, where the appropriate drug dosage and combination is shaped through a narrowing down of options – a long list which can include anticonvulsants, antidepressants, NSAIDs, muscle relaxants, corticosteroids and topical medicines. While each of these drugs do vary in their effectivity and the associated side effect spectrum, this can be a long journey with many frustrations for the patient, who are required to have patience throughout the trial-and-error process, while also dealing with the impact of chronic pain on an everyday basis. As cancer survival rates continue to increase and Australia’s aging popularity faces associated aging comorbidities, there’s an urgent need for effective chronic pain control that provides a more optimal solution than mixed results that require weeks, months and years to see any lasting difference.

The most legal shift around medical cannabis is as recent as December 2020 [1] and regulations only continue to adjust at a relatively fast pace. The ongoing patient-driven demand for access to medical cannabis means that medical practitioners must be well equipped to address frequent questions that arise in the course of consultations.

While the evidence base for medical cannabis is currently behind in comparison to that of other drugs which may present as pain treatment alternatives, this is in part due to the complexity of the plant itself (along with a compounding mix of social, cultural, historical, political and financial issues). Alongside THC and CBD, hundreds of cannabinoids and other compounds provide a wide array of potential interactions, producing further still active ingredients. This means that purification methods are central to the ongoing process of improving our collective, scientific, medical and societal understanding as to how cannabis can be effectively utilised for medical purposes. However, when it comes to chronic pain, THC is a major compound of interest. With a number of clinical trials already underway, practitioners in the field have already begun prescribing the drug for their patients on the back of current research findings and the results of many case studies.

In part two, we’ll examine how medical cannabis compares to opioids, unpacking areas of concern and uncertainty that you, or your patients, may have without access to current information.

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