Mixed results for cannabis in pain and nausea therapy
Cannabinoids might be useful for controlling chemotherapy
induced sickness, but serious side affects are likely to limit their use,
say researchers in this week’s BMJ. In a separate study, researchers examined
the evidence for using cannabinoids to treat pain and say that they are
no more effective than codeine (2001;323:16 and 13).
The first study by Dr Martin Tramèr, University
hospital, Geneva, and colleagues, reviewed 30 randomised trials in which
cannabis had been compared with placebo or antiemetics. Across all trials
cannabinoids showed some antiemetic efficacy. The authors of the reveiw
say that patients “overwhelmingly” preferred them over conventional antiemetics
even though the incidence of side effects was higher, and more of them
withdrew from the trials because of intolerable adverse effects.
The authors of the review conclude that selected
patients might find cannabinoids useful as mood-enhancing adjuvants for
the control of chemotherapy-related sickness. They add that priority should
go to trials of cannabinoids for indications where there are few competing
drugs, such as spasticity in multiple sclerosis.
The second reveiw by Dr Fiona Campbell of Queen’s
Medical Centre, Nottingham, and colleagues looked at nine randomised trials
that had compared the efficacy and safety of cannabinoids with those of
conventional analgesics. In eight of the nine trials the authors found
that cannabinoids were no more effective than oral codeine 60–120mg. In
addition, adverse effects with cannabinoids were common and sometimes
severe.
The authors conclude that they found insufficient
evidence to support the introduction of cannabinoids into widespread clinical
practice but note that the absence of evidence does not necessarily mean
an absence of effect.
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