The Leaf THE LEAF November-December 2019 | Page 10

Initially, 34% of the cohort experienced side
effects. However, after adjusting the dose,
only 21% reported side effects.
The most common side effects were
sleepiness (13%), balance problems (7%), and
gastrointestinal disturbances (7%).
Three percent discontinued use because of
adverse events.
Interestingly, the results showed a decrease in
opioid use in 32% of participants.
"Our findings are promising and can help fuel
further research into medical marijuana as an
additional option for this group of people who
often have chronic conditions," the
investigators note.
Limitations of the study were its retrospective
design and its reliance on self-report with
respect to symptom relief.
Additional randomised, placebo-controlled
studies are needed, said Mechtler.
"Future research should focus on symptoms
like sleepiness and balance problems, as well
as efficacy and optimal dosing," he said.
Rapid Uptick in the Elderly
Commenting on the findings for Medscape
Medical News, Mark Wallace, MD, professor
of clinical anaesthesiology and chief of the
Division of Pain Medicine, University of
California, San Diego, who has extensive
experience researching and treating pain
patients with medical cannabis, said the study
is unique in that it involved a geriatric
population.
He noted that in his clinical practice,
geriatric patients are the fastest growing
group of medical cannabis users.
This rapid uptick of use among the elderly is
not surprising, he
said.
"These patients are looking for alternatives.
The medications we currently have on the
market [for the treatment of neuropathic
pain] probably reduce pain by no more than
30% in no more than 50% of the patients
— that's pretty low."
In addition,
evidence to
opioids, and
crisis, many
medications.
he said, there is very limited
support the long-term use of
in view of the current opioid
patients want to get off these
Because cannabis is a Schedule 1 substance,
no head-to-head studies have compared it to
other currently available agents for chronic
pain, so "these types of retrospective studies
are actually very important," Wallace said.
The study's finding that cannabis may help
reduce chronic opioid use, he added, mirrors
the clinical experience at his centre.
Reduced Opioid Use
"These patients come to me on high-dose
opioids, and we are able to get them off
opioids [by using medical cannabis]," he
said.
"Patients who are taking high-dose opioids
are constantly looking at the clock, waiting
for the time when they can take their next
dose, and are constantly monitoring their
supply.
When supply goes down, anxiety goes up.
It completely controls their life. But when you
put them on medical cannabis, that behaviour
completely goes away and they feel they have
their lives back," Wallace added.
Determining the ratio of CBD to THC is a
challenge and requires an individualised
approach.
However, said Wallace, for daytime use, it
appears that a CBD-to-THC ratio of 20:1 may
be best.
At night, a 1:1 ratio appears most effective.
"Even in patients where [medical cannabis]
doesn't help their pain, many — I would say