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Published: 30 November 2022

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Researchers say despite the lack of symptom relief, more trials are needed to focus on the targeted use of medicinal cannabis
Melissa Davey 29/11 2022

The first high quality study looking at the impact of cannabidiol oil on palliative care patients with advanced cancer found it did not improve their pain, depression, anxiety, or quality of life.

Palliative care is one of the conditions for which medicinal cannabis has been approved in Australia.

The trial, led by the Mater hospital and the University of Queensland, studied the effects of cannabidiol oil, also known as CBD, on the relief of pain, depression, anxiety and quality of life on 144 patients receiving palliative care for cancer. The trial was double-blinded, which meant neither the researchers nor the participants knew whether they were getting medicinal cannabis or a placebo.

All patients also received standard palliative care throughout the trial period.

“The trial found there was no detectable effect of CBD on change in physical or emotional functioning, overall quality of life, fatigue, nausea and vomiting, pain, dyspnoea or appetite loss,” lead author of the study and the director of palliative and supportive care at Mater, Prof Janet Hardy, said.

Hardy said the study aimed to fill the gap in scientific evidence supporting the use of medicinal cannabis for pain relief and symptom distress due to cancer.
“The best way to describe the uptake of medicinal cannabis following its legalisation was as a social phenomenon,” she said.

“Everyone wanted it, but there was little evidence to guide its usage. Usually, new products entering the market have gone through extensive pre-clinical studies regarding best dosage and usage, however medicinal cannabis entered the market with very little guidance.”

The findings have been published in the Journal of Clinical Oncology.

For complete story

Also see

• Cannabis & Pain – Media Hype & the Placebo Reality?
• Academic concerns around Cannabis and Pain Management – #ScienceMatters
• NICE will not recommend medical cannabis for epilepsy and chronic pain
• Medicinal cannabis blacklisted by Australian pain specialists
• Cannabis and cannabinoids for the treatment of people with chronic noncancer pain conditions: a systematic review and meta-analysis of controlled and observational studies

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Published: 30 November 2022

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(Why not exploit the placebo effect of Cannabis, placebo’s will not addict!)
There are numerous examples of the relationship between treatment expectations and placebo responses. If a person thinks they will experience relief from their pain by using a certain product or treatment, this can change the way they end up perceiving incoming pain signals – making them think their pain is less severe. Recent evidence suggests that the placebo effect may work even if we’re presented with evidence that contradicts our initial expectations.
We cannot say with 100% certainty that media coverage is responsible for the high placebo response observed in our review. But given placebos were shown to be just as good as cannabis for managing pain, our results show just how important it is to think about the placebo effect and how it can be influenced by external factors – such as media coverage. For treatments, such as cannabinoids, that receive a lot of media attention, we need to be extra rigorous in our clinical trials. (For complete article https://theconversation.com/cannabis-is-no-better-than-a-placebo-for-treating-pain-new-research-195394 )

Research: Placebo Response and Media Attention in Randomized Clinical Trials Assessing Cannabis-Based Therapies for PainA Systematic Review and Meta-analysis
JAMA Netw Open. 2022;5(11):e2243848. doi:10.1001/jamanetworkopen.2022.43848
Question  What is the size of the placebo response in cannabinoid trials for clinical pain, and is the magnitude of placebo response associated with media attention on the trials?
Findings  This meta-analysis of 20 studies of 1459 individuals found a significant pain reduction in response to placebo in cannabinoid randomized clinical trials. Media attention was proportionally high, with a strong positive bias, yet not associated with the clinical outcomes.
Meaning  These findings suggest that placebo has a significant association with pain reduction as seen in cannabinoid clinical trials, and the positive media attention may shape placebo responses in future trials.
Abstract
Importance  Persistent pain is a common and disabling health problem that is often difficult to treat. There is an increasing interest in medicinal cannabis for treatment of persistent pain; however, the limited superiority of cannabinoids over placebo in clinical trials suggests that positive expectations may contribute to the improvements.
Objective  To evaluate the size of placebo responses in randomized clinical trials in which cannabinoids were compared with placebo in the treatment of pain and to correlate these responses to objective estimates of media attention.
Conclusions and Relevance  Placebo contributes significantly to pain reduction seen in cannabinoid clinical trials. The positive media attention and wide dissemination may uphold high expectations and shape placebo responses in future trials, which has the potential to affect the outcome of clinical trials, regulatory decisions, clinical practice, and ultimately patient access to cannabinoids for pain relief.

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Published: 24 November 2022

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Association of Recreational Cannabis Legalization With Alcohol Use Among Adults in the US, 2010 to 2019
JAMA Health Forum. 2022;3(11):e224069. doi:10.1001/jamahealthforum.2022.4069

Abstract
Importance  In the US, cannabis use has nearly doubled during the past decade, in part because states have implemented recreational cannabis laws (RCLs). However, it is unclear how legalization of adult-use cannabis may affect alcohol consumption.
Objective  To estimate the association between implementation of state RCLs and alcohol use among adults in the US.
Exposures  States with RCLs, as reported by the RAND−University of Southern California Schaeffer Opioid Policy Tools and Information Center.
Main Outcomes and Measures  Past-month alcohol use, binge drinking, and heavy drinking.
Results  Of 4.2 million respondents (median age group, 50-64 years; 2 476 984 [51.7%] women; 2 978 467 [58.3%] non-Hispanic White individuals) in 2010 through 2019, 321 921 individuals lived in state-years with recreational cannabis laws. Recreational cannabis laws were associated with a 0.9 percentage point (95% CI, 0.1-1.7; P = .02) increase in any alcohol drinking but were not significantly associated with binge or heavy drinking. Increases in any alcohol use were primarily among younger adults (18-24 years) and men, as well as among non-Hispanic White respondents and those without any college education. A 1.4 percentage point increase (95% CI, 0.4-2.3; P = .006) in binge drinking was also observed among men, although this association diminished over time.
Conclusions and Relevance  This cross-sectional study and difference-in-differences analysis found that recreational cannabis laws in the US may be associated with increased alcohol use, primarily among younger adults and men.

For complete research

Also see

• Cannabis Vs Alcohol:  A Population-Based Analysis of the Relationship Between Substance Use and Adolescent Cognitive Development
• Dual Use of Alcohol & Cannabis a Real Problem for Young Adults – Greater Risk of Alcohol Use Disorder? Dual use of alcohol and cannabis appears to be associated with adverse behavioral and psychological consequences and is a rapidly growing public health concern.

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Published: 22 November 2022

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The Disastrous Californian Cannabis Legalization Experiment – More than promises ‘Up in Smoke’!

Also see ‘Then There Were Three – Marijuana Markets, That Is!’

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