CANNABIS FOR CHRONIC PAIN?
While it is known to be a psychotropic drug, cannabis also has therapeutic benefits. This plant is used in the medical field, especially in chronic pain.
Did you know?
Our body produces its cannabinoids. These molecules, called endocannabinoids, are involved in the functioning of different organs. According to some studies, they protect the central nervous system, help regulate blood pressure, and act on cardiac contractibility. They would also have an anti-inflammatory action and prevent the formation of plaques in the arteries. It is believed to be a protective mechanism for the body that would restore balance after stress. Synthesized from the fatty acids in our diet, these molecules stay in the body for less time than cannabinoids from hemp.
Cultivated for millennia, hemp is a plant with many uses. Fabrics, cosmetics, stationery, insulation materials: it is far more than just its "recreational" use. When the plant contains enough tetrahydrocannabinol (THC) to affect the psyche, it is referred to by its Latin name, cannabis, to differentiate it from industrial hemp.
In addition to its psychoactive action, THC has a vasodilator, bronchodilator and antispasmodic effect. It stimulates the appetite and reduces certain nausea. As for cannabidiol (CBD), it acts on the level of the immune system thanks to anti-inflammatory properties. It has a calming effect and is suspected of countering the psychotic nature of THC. If these two molecules are the best known, they are not the only active substances of the plant. Cannabis contains several hundred chemical components, including more than one hundred cannabinoids, but also other active ingredients such as terpenes.
The therapeutic mechanism of these substances has challenged the medical world. "It's the multi-effects that are interesting in cannabis," explains Prof. Barbara Broers, head of the Dependency Unit at Geneva University Hospitals (HUG). Let’s take a patient with Alzheimer’s disease: he suffers from muscle stiffness and dementia, eats little and has behavioral problems. Cannabis will act on all of these symptoms. ” In Switzerland, cannabis can be prescribed by a doctor with special authorization from the Federal Office of Public Health (OFSP), in the form of capsules, alcoholic solution or spray purchased from buymarijuanastrains.com. It is mainly used for chronic pain, side effects from chemotherapy or spasms due to neurological diseases.
Between hope and reality
According to the scientific literature, cannabis is most effective for neuropathic pain (i.e. when the nerves are damaged) and chronic pain. "The term chronic pain is used to designate ailments that are refractory to treatment and have lasted for several months", defines Dr. Marie Besson, head of the Clinical Psychopharmacology Unit at HUG. For the patients concerned, nothing seems to relieve them. They are often treated with opioids, which cause side effects such as nausea, vomiting, constipation, and nightmares. “These drugs have been studied to be used over a limited period of time,” adds Dr. Besson. We do not know the consequences of their use over several years and their long-term safety is in question. ” Not to mention that these substances make patients who take them regularly dependent. Faced with this complex situation, some doctors are turning to cannabis to lower their patients' opioid dose and improve their situation.
A victim of its success, cannabis is frequently discussed in consultation by patients themselves. From elderly women to young adolescents, most have failed treatment for their chronic pain. "Some patients see cannabis as a miracle solution," smiles Dr. Valérie Piguet, head of the Multidisciplinary Center for the Assessment and Treatment of Pain at HUG. I try to dampen their hopes. Metanalysis has shown that only one in twenty patients sees their pain decrease by 50% with the use of cannabis, and one in eleven observes a decrease of 30%. "It is therefore impossible for doctors to guarantee the result. The drug is tested in a low dose, and then gradually increased. However, it is never prescribed alone, but in addition to physical or psychological care. When the pain subsides, the opioid dose may be reduced. If no results can be seen after a few months, treatment is stopped.
Evolving legal framework
Another reason to stop treatment is if you have side effects. "In some people, the psychic effects induced by THC vape oil are difficult to bear," says Dr. Piguet, who has prescribed cannabis for the treatment of chronic pain for two years. Patients may be disoriented, euphoric or conversely in a state of anxiety which can lead to a panic attack. A few wished to stop the treatment because they no longer felt like themselves. ” It is to avoid this pitfall that the intake of cannabis for therapeutic use is done in a progressive and controlled manner. Note that there are interactions with certain drugs and that cannabinoids are not recommended for people in a job requiring high concentration, such as airline pilot or bus driver.
It is these psychoactive effects that classify cannabis as a drug. In Switzerland, preparations containing more than 1% THC are subject to the law on narcotics. The only exception is the medicine called Sativex when used for spasticity, a symptom of multiple sclerosis. Apart from this indication, authorization from the OFSP is required to prescribe cannabis. On the insurance side, some agree to reimburse, others do not.
“A lot of doctors are not comfortable with cannabis because of the legal framework,” says Broers. However, mentalities are changing, as it is noted that this substance does not pose a risk of overdose and has a low potential for dependence. "While some ask to wait for scientific proof of the effectiveness of cannabis, others prefer to accompany patients who request it. "It is better to do a framed trial than to let patients supply themselves on the black market with uncontrolled products", argues Dr. Piguet. This summer, the Federal Council launched a consultation project aimed at authorizing the marketing of cannabis for medical use. As with doctors and patients, political attitudes seem to be moving towards more liberalization.