Medicinal Cannabis for Pain Relief
You may be surprised to learn that the drug causing the most overdoses in New Zealand is not an illegal drug, and it’s not opioids. It is paracetamol, as sold in supermarkets, dairies and service stations, and there is no prescription required.
Paracetamol and Ibuprofen are important drugs and they are used by most of us for mild to intermediate pain management at various stages in our lives. Doctors tend to prescribe them for most types of pain as they are not addictive like opioids.
Opioids, on the other hand, are a class of drug that includes heroin at the illegal end and Fentanyl, Morphine, Oxycontin, Codeine as well as the artificial opioid Tramadol at the legal end. These drugs all vary in strength, but all aim to relieve pain. However, some people abuse them to get a high and as such are highly addictive. Of special note here is Tramadol that was approved on the basis it was not addictive, but that proved not to be the case.
There are other pain relief specialty drugs available, but those classes of drugs cover most of the pain relief medicines available and prescribed in New Zealand.
So why do we need research into medicinal cannabis for pain relief? Because the drugs listed above are failing many New Zealanders who suffer from chronic pain and we need new treatments to fill the gaps in pain relief.
Dr Willem Van Der Merwe, an Emergency Department doctor at Auckland Hospital stated that he thought that there should be further research into cannabis pain relief products. Over the years he has noticed many patients that have been discharged from the Emergency Department representing themselves for pain relief. First line medications often have little to no effect on these patients and he believes further research is warranted into other options.
He also stated that in the Emergency Department they get overwhelmed with alcohol related harm - but not cannabis related harm. Surprisingly, when asked what the drug was that caused the most overdoses, he stated that in his experience it was paracetamol. People in pain often accidentally overdose by taking a sheet of paracetamol pills and end up in the Emergency Department with liver damage – up to three to four people per day. Liver failure can be terminal, as there are not a lot of transplantable livers available. Paracetamol can cause liver damage at doses just over the maximum recommended dose per day so its an extremely fine line that unfortunately gets crossed by desperate people suffering chronic pain, the fatigue of which often leads to mental health issues as well. NSAID’s, such as Ibuprofen have their own set of problems, some people are allergic to this class of painkillers and long term or heavy use can lead to kidney disease.
The problems are exacerbated by the (understandably) cautious nature of NZ doctors when prescribing opioids. The death toll in the USA due to legally prescribed opioids is over 50,000 people per year. The problem is that while opioids are effective, they can cause respiratory failure and death.
I have had personal experience of this. Last year, I had a close relative pass away while on opioid pain relief. This person had a genuine need for strong pain management due to surgery but unfortunately, along with other factors, this led to a tragic outcome.
Medicinal cannabis for pain relief needs further research to see if it can provide an alternative to Paracetamol and Ibuprofen or the highly addictive opioids. People seeking pain relief should be offered the best researched products for their wellbeing.
Daniel King MSc is a scientist and co-founder of Plantonin Ltd that is currently pursuing a research license for medicinal cannabis for pain relief.
Dr Willem Van Der Merwe is a senior medical advisor to Plantonin Limited and works at the Emergency Department, Auckland Hospital.