In a recent study JAMA Network OpenResearchers have investigated whether cannabis treatment can improve health-related quality of life (QoL) over time in Australia.
Background
Medical cannabis includes a wide range of products, including dried flowers, oils, and edibles, that contain bioactive compounds such as cannabidiol (CBD) and delta-9-tetrahydrocannabinol (THC).
Medical cannabis was legalized in Australia in November 2016 and is approved to treat chronic pain, anxiety, insomnia and sleep disorders. In addition, medical cannabis can be used to treat chemotherapy-induced vomiting and multiple sclerosis-related spasticity.
Given the many medical conditions being treated with medical cannabis, and the wide range of products and dosages available, cannabis has become increasingly popular as a medicine.
However, data from randomized controlled trials (RCTs) regarding the therapeutic benefits of cannabis use are limited, and studies evaluating patient-reported outcomes using validated QoL measures are limited. Effectiveness and informs policy making and strategy development to improve the safety and health-related QoL of patients using cannabis.
About the study
In the current retrospective cohort study, researchers examined the medical benefits of cannabis use among Australians in relation to health-related QoL.
The study was conducted at Emerald Clinics located across the Australian continent. Participants received treatment at the clinics for any medical condition from December 2018 to May 2022 and were followed up for 15 follow-ups every 45 days (on average). The study exposure was medical cannabis, with cannabinoid content and product type determined by the treating physician.
The primary study outcome was improvement in health-related QoL, assessed using the 36-item Short Form Health Survey (SF-36) questionnaire.
The use of cannabis has been clinically validated, including the Australian Therapeutic Goods Register as inappropriate for treatment and depletion of other treatments for clinical indications.
For carboxy-THC (THC-COOH)-positive urine samples, pregnant and/or lactating individuals and individuals with severe cardiovascular disease or severe mental health problems, including psychotic history and/or suicidal ideation, were not provided with cannabis.
Data has been collected since December 2018 and is ongoing, with each finding recorded as of May 5, 2022. Ordinary ordinary least squares regression modeling was performed adjusting for covariates such as medication, comorbidities, age, sex, and work status.
Results
Among the 3,148 participants, the average age was 56 years. 1,688 (54%) were female and 820 (30%) were employed. Individuals frequently received cannabis treatment for chronic pain (n=2,160, 69%), cancer pain (n=190, 6.0%), anxiety (n=132, 4.2%), and insomnia (n=152, 4.8%).
After the start of treatment, patients reported significant improvements from baseline in all domains of the SF-36, most of which were sustained over time.
After controlling for potential confounders in the regression model, treatment with medical cannabis was associated with a 6.6 to 18 point improvement in SF-36 scores.
Effect sizes were small to moderate, ranging from 0.2 to 0.7. On average, the participants used 6.6 drugs per day before the cannabis treatment.
The most commonly used pain relievers (n=1,703, 54%), opioid analgesics (n=1,523, 48%), antidepressants (n=1,401, 45%), benzodiazepines (n=1,084, 34%) and gamma- aminobutyric acid (GABA) analog (n=693, 22%).
Before cannabis treatment, mean scores for all SF-36 domains were below the 50% mark on their respective scales, with the exception of the mental well-being domain (mean 54): 40, 30, 41, 14, 28, 37, and 30 for general health, physical pain, and physical fitness. Activity, role-physical, role-emotional, social function and importance, respectively.
Regarding monthly prescriptions, CBD-rich treatments, balance treatments and THC-dominant treatments accounted for 80%, 7.50% and 13% of prescriptions, respectively. Most of the patients were taken orally in cannabis oil (90%, 14,779 individuals) and capsules (3.8%, 631 individuals).
Only 244 people inhaled dried flowers, while 168 were given a combination of dried flower inhalation and oil treatment.
For balanced treatment, equivalent CBD and THC doses of 19 mg (average) daily are prescribed. For cannabidiol-dominant therapy, the average CBD and THC dose is 97 mg and 9.0 mg, and tetrahydrocannabinol-dominant therapy, the corresponding dose is 5.0 mg and 36 mg, respectively.
The average daily dose of cannabidiol increased from 51 mg at baseline to 72 mg at follow-up and continued thereafter.
In contrast, the daily amount of tetrahydrocannabinol increased steadily, from 7.0 mg at the first follow-up to 26 mg at the last follow-up, after 675.0 days of treatment. Except for the SF-36 questionnaire domains role-physical and physical functioning, balance products were more effective than THC and CBD-dominant products.
CBD-based products most effectively improved role-physical outcomes, whereas THC-based products were most effective in improving physical performance. 2,919 adverse events (AEs) were recorded, of which 1,905, 922, and 86 were mild, moderate, and severe, respectively, and two serious AEs were reported.
The most common AEs are somnolence and/or sedation, xerostomia, fatigue and/or lethargy, dizziness, concentration problems, nausea, diarrhea, hyperactivity, increased appetite, anxiety, and headache.
Summary
Overall, the findings of the study showed that medical cannabis use resulted in improvements in all SF-36 domains assessing health-related QoL.
AEs were common but not serious, suggesting that medical cannabis should be prescribed with caution based on patient profiles.
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Toshniwal Paharia, Pooja Toshniwal Paharia. (2023, May 11) Is medical cannabis treatment associated with improvements in health-related quality of life? News-Medical. Retrieved May 11, 2023, from https://www.news-medical.net/news/20230511/Is-medical-cannabis-treatment-associated-with-improvements-in-health-related-quality-of-life.aspx.
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Toshniwal Paharia, Pooja Toshniwal Paharia. “Is medical cannabis treatment associated with improvements in health-related quality of life?” News-Medical. May 11, 2023.
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Toshniwal Paharia, Pooja Toshniwal Paharia. “Is medical cannabis treatment associated with improvements in health-related quality of life?” News-Medical. https://www.news-medical.net/news/20230511/Is-medical-cannabis-treatment-associated-with-improvements-in-health-related-quality-of-life.aspx. (Accessed May 11, 2023).
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Toshniwal Paharia, Pooja Toshniwal Paharia. 2023. Is medical cannabis treatment associated with improvements in health-related quality of life?. News-Medical, accessed 11 May 2023, https://www.news-medical.net/news/20230511/Is-medical-cannabis-treatment-associated-with-provements-in-health-related-quality-of- life .aspx.