MEDICINAL CANNABIS AND PERSISTENT PAIN


Key points | Is it marijuana or cannabis? | The power of cannabinoids | How is it taken? | Is there any evidence for its use? | Side effects | How do I access it? | Caution | Conclusion | Where to get help | How we can help | More to explore | References | Download PDF

Key points

  • There’s a lot of interest in the use of medicinal cannabis for many health conditions
  • At the moment there’s not enough evidence to support its use to treat persistent pain related to arthritis and musculoskeletal conditions
  • More research is needed

In 2017 the Australian Government granted the first license for an Australian company to grow and harvest medicinal cannabis. The aim was to improve access to legal, domestically produced, high quality cannabis for medicine and research.

Since then, medicinal cannabis prescriptions have taken off, with the Therapeutic Goods Administration (TGA) granting over 25,000 applications from doctors in 2019 to prescribe cannabis, mostly in the form of an oil.

This information will explore the use of medicinal cannabis in Australia – specifically in relation to musculoskeletal conditions and pain.

Is it marijuana or cannabis?

It’s both. Marijuana and cannabis are different names for the same plant – marijuana is the commonly used name, cannabis is the scientific name. The term medical marijuana is often used in the media, however medicinal cannabis is generally preferred to draw the distinction between medicinal use of cannabis and the illegal, recreational use of marijuana.

The power of cannabinoids

Cannabinoids are chemicals found in the cannabis plant. They bind onto specific receptors (CB1 and CB2) on the outside of our cells and can affect things such as our appetite, pain-sensation, mood, and memory.

Cannabis has more than 100 cannabinoids; the two major ones are tetrahydrocannabinol (THC) and cannabidiol (CBD). THC is the cannabinoid linked with the ‘high’ or ‘euphoria’ associated with recreational marijuana use.

Cannabinoids also occur naturally in our body (endocannabinoids) and can also be created artificially (synthetic cannabinoids).

How is it taken?

Medicinal cannabis, both plant-based and synthetic, can come in a range of forms including tablets, oils, vapours and tinctures. Smoking isn’t an approved preparation as it carries the same health risks as smoking cigarettes.

Is there any evidence for its use?

Evidence for the use of medicinal cannabis to treat pain associated with arthritis and musculoskeletal conditions is currently lacking. Cannabis has been illegal for so long that we just don’t have the thorough, scientific evidence we need about side effects or dosages, or the health conditions or symptoms it may be beneficial for. Some research is emerging, but much more is needed.

The Australian Rheumatology Association doesn’t currently support the use of medicinal cannabis for musculoskeletal conditions. Their concern is the lack of evidence from high quality research trials that cannabis is safe and effective for people with musculoskeletal conditions. “There is currently not enough supportive evidence to recommend medical cannabis as a clinical intervention for chronic musculoskeletal pain outside of a clinical trial setting”.1

The TGA has also stated that there’s “not enough information to tell whether medicinal cannabis is effective in treating pain associated with arthritis and fibromyalgia”.2

More research is also needed to determine the risks associated with long term use of medicinal cannabis. We just don’t have enough information at this stage to know what risks people may be exposed to if they use medicinal cannabis.

As with any treatment or intervention, you and your doctor will weigh up the risks and benefits for your specific situation.

Side effects

Medicinal cannabis is a medication, and like all medications it can have side effects. They can range from mild to severe, and may include: fatigue, nausea, vomiting, changes in appetite, hallucinations and psychosis.

The extent of side effects can vary with the type of medicinal cannabis product and between people.2

How do I access it?

If you think medicinal cannabis is something you’d like to try, it’s a bit complicated. We aren’t at the stage where a doctor can just write a prescription that you can fill at a chemist.

Talk with your doctor to find out whether it’s a possible option for you. If you decide to go ahead with medicinal cannabis, your doctor will need to apply for approval to prescribe it to you. Each state or territory has different rules relating to medicinal cannabis and whether it can be prescribed or not.

It’s important that you note that medicinal cannabis is not on the Pharmaceutical Benefits Scheme (PBS), so if you can access it, you’ll need to pay all the costs

Caution

Driving with any THC in your blood system is a criminal offence in Australia. You’ll need to check the product information for your medicinal cannabis to ensure it doesn’t contain THC. Talk with your doctor and/or pharmacist about possible side effects and whether they’ll affect your ability to drive.

We also don’t have enough information about how medicinal cannabis may interact with other medications or supplements you may be taking. If you experience any unusual symptoms, you need to discuss these with your doctor.

Conclusion

In reality, for most people the use of medicinal cannabis is a long way off. And unlike the way it’s often portrayed in the media, it won’t be a panacea or magic bullet that will cure all ills.

It will also not work in isolation – you’ll still need to do all of the other things you do to manage your condition and pain, including exercise, managing your weight, mindfulness, managing stress, pacing etc.

The important thing is to be as educated as you can and be open in your discussions with your doctor. And be aware that cannabis for non-medicinal purposes is still illegal in Australia.

Where to get help

  • Your doctor
  • Musculoskeletal Australia
    MSK Help Line: 1800 263 265

How we can help

Call our MSK Help Line and speak to our nurses. Phone 1800 263 265 or email helpline@msk.org.au

Watch our webinar

Medicinal cannabis in Australia: Weeding out the facts

Dr Richard di Natale, outgoing Senator and former leader of the Australian Greens, and Prof Iain McGregor, Lambert Initiative for Cannabinoid Therapeutics, University of Sydney discuss the use of medicinal cannabis in Australia – what it is, available forms, access issues in Australia and the current evidence for use.

More to explore

Download this information sheet (PDF).

References

  1. Australian Rheumatology Association. ARA Position Statement on the use of medicinal cannabis for musculoskeletal pain. 2016.
  2. Therapeutic Goods Administration. Medicinal cannabis products: Patient information. 2018.


Musculoskeletal Australia (or MSK) is the consumer organisation working with, and advocating on behalf of, people with arthritis, osteoporosis, back pain, gout and over 150 other musculoskeletal conditions.

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