Professor David Finn, Co-director of the Centre for Pain Research and Professor of Pharmacology and Therapeutics in the School of Medicine at NUI Galway, has spoken in Dáil Éireann over the past two days (5-6 April 2017) and emphasised the need to consider people living with chronic pain in the ongoing debate on the status of medical cannabis and cannabinoids in Ireland.
Minister for Health, Simon Harris TD, has announced that he has decided to establish an access programme for cannabis-based treatments in Ireland. The announcement followed the publication of a report from the Health Products Regulatory Authority (HPRA) entitled Cannabis for Medical Use – A Scientific Review.
The HPRA report advised that, if a policy decision was taken to permit cannabis under an access programme, it should be for the treatment of patients with spasticity associated with multiple sclerosis resistant to all standard therapies and interventions whilst under expert medical supervision; intractable nausea and vomiting associated with chemotherapy, despite the use of standard medicine that is effective against vomiting and nausea whilst under expert medical supervision; and severe, treatment-resistant epilepsy that has failed to respond to standard anticonvulsant medications whilst under expert medical supervision.
The HPRA report also advised that patients accessing cannabis through the programme should be under the care of a medical consultant and that medical information and utilisation data should be kept on a central register. Controversially, the report recommended against the use of medical cannabis for the treatment of chronic pain, despite an acknowledgement within the report that chronic pain is the most researched indication for cannabinoids and despite the fact that the majority of clinical studies, meta-analyses and systematic reviews cited in the report conclude that cannabis or individual cannabinoids afford benefit to chronic pain patients.
Three of the most thorough and exhaustive scientific reviews to have been published on the subject in recent years all concluded that there is good or substantial, high-quality evidence that medical cannabis or cannabinoids are effective in treating chronic pain in adults (Hill, 2015; The National Academies of Sciences, 2017; Barnes & Barnes (UK Barnes Report), 2016). Chronic pain conditions that are responsive to cannabinoids include, but are not limited to, neuropathic pain and cancer pain.
The striking fact and reality is that despite the availability of current pharmacological and non-pharmacological treatments for chronic pain, 13 to 35 per cent of the population still suffer from chronic pain at a cost of €5.34 billion per year to the Irish economy, 2.86 per cent of GDP and, in the largest study ever to look at the prevalence and impact of chronic pain in Europe (46,394 patients), 40 per cent of patients reported that the management of their pain is inadequate (Breivik et al., 2006).
Professor David Finn from the Centre for Pain Research Centre at NUI Galway, said: “Chronic pain represents a very significant unmet clinical need, particularly conditions such as lower back pain, neuropathic pain, rheumatic conditions, post-surgical pain, arthritic pain and severe cancer pain. Chronic pain is the most researched indication for cannabinoids, and the majority of clinical studies, combined data analysis from multiple studies, and systematic reviews conclude that there is a good or substantial body of evidence that cannabis or cannabinoids afford benefit to patients with chronic pain. The evidence suggests that medical cannabis and cannabinoids, introduced in a careful, controlled, well-regulated manner as per the other three indications in the HPRA report, could alleviate some of the unmet clinical need in chronic pain.”
Importantly, the HPRA report was very supportive of further research within Ireland and internationally on medical cannabis and cannabinoids, including for chronic pain, and this support is welcomed by Professor Finn. Over the past 12 years, the Centre for Pain Research and Galway Neuroscience Centre at NUI Galway has developed a very active research group with a focus on cannabinoids and the endocannabinoid system.
In work funded from a variety of peer-reviewed grant sources including Science Foundation Ireland, the Health Research Board, the Irish Research Council, the International Association for the Study of Pain and others, the researchers have published over 50 peer-reviewed scientific publications demonstrating a key role for the endocannabinoid system in stress-induced modulation of pain, descending control of pain, cognitive and affective aspects of pain, and neuroimmune signalling and its relevance to pain, affective disorders and neurodegenerative disease.
Continued support of such research into cannabinoids and the endocannabinoid system alongside the careful, controlled and regulated introduction of medical cannabis in Ireland for chronic pain for which there is a strong evidence base, will be key to ensuring that we move forward in an informed manner and can lead internationally in this area.