CBD and other cannabinoids in palliative care

    November 11, 2022 3 min read

    CBD and other cannabinoids in palliative care

    There is much (and justified) research interest in cannabis and cannabinoids in treatment of numerous medical disorders. We have written about many of them. Mechanisms of action are better and better understood, the overall safety profile of cannabinoids so far appears to be favorable, and use of some of these is becoming authorized in an increasing number of countries for particular ailments. Palliation of discomfort in disease toward the end of life is one of the research interests, and it is a reasonable application of cannabinoids to consider, given many of these compounds’ antinociception and anxiolytic effects. With some local restrictions, there is in fact a wide range of medicinal cannabis preparations now available for it, ranging through cultivars of medical cannabis, at varying ratios of THC to CBD, in varying formulations, and highly purified or synthetic single and combination cannabinoids. Reviews of their efficacy make it clear that not all pain is the same, but that generally speaking, cannabinoid pain research is well warranted at the clinical level. It appears as though they may work. To many people’s surprise, studies do not tend to support the expected entourage effect of other constituents of cannabis, like terpenoids, in management of long-term pain with cannabinoids. CBD is currently the cannabinoid of interest, because proof of its wide efficacy is establishing and because it does not intoxicate. Two large palliation studies are underway at the moment. Will CBD be of better use in pain and anxiety control than THC or other cannabinoids? At this point there has been no well-conducted head-to-head comparison among cannabis cultivars, pure cannabinoids, or extracts to know. Which cannabinoid is optimal for palliative care simply has not been determined. 

    There is one study just completed, published this year as the ‘UK Medical Cannabis Registry palliative care patients cohort: initial experience and outcomes’, in the Journal of Cannabis Research (2022 Jan 4;4(1):3. doi: 10.1186/s42238-021-00114-9), noting the paucity of high-quality evidence with regard to the optimal regimen in palliative care, and the limitation of trials so far by methodological heterogeneity, and aiming to summarize outcomes of at least one group of patients given adjunctive cannabinoid therapy in end-stage cancer. Changes in patient-reported outcome measures included EQ-5D-5L, General Anxiety Disorder-7 (GAD-7), Single-Item Sleep Quality Scale (SQS), Pain Visual Analog Scale (VAS) and the Australia-Modified Karnofsky Performance Scale, at 1 and 3 months compared to baseline. Secondary outcomes were the incidence and characteristics of adverse events. Sixteen patients were included in the analysis, with a mean age of 63.25 years. Median initial CBD and THC daily doses were 32.0 mg and 1.3 mg respectively. Changes in the outcome scales, unfortunately, were not statistically significant. There were 3 adverse events, all mild. It was a small study, the first exploration of its kind since the legalization of cannabis intervention in the UK. Patient toleration was good, so at least the intervention did no harm. Are cannabinoids efficacious in palliative care? Further study, larger cohorts, and comparison studies with routine palliative measures will tell. 

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    The foregoing is a report on trends and developments in the cannabinoid industry. No product described herein is intended to diagnose, treat, cure or prevent any disease or syndrome.