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Authors:Petter Grahl Johnstad Abstract: Drug Science, Policy and Law, Volume 9, Issue , January-December 2023. The world has a long-standing system of drug control intended to suppress the use of a range of psychoactive drugs on the basis that such use is very harmful both to the users themselves and to their social surroundings. This perception of harmfulness has a long medical history, but recent research indicates that many forms of illicit drug use are not more harmful than the use of alcohol and tobacco. This article analyzes the historical and normative background for the apparently exaggerated assessments of drug harms on which the regime of drug control is founded. Starting from the observation that the drugs that have been exempted from this criminalization regime are those that were integrated in European cultures during the early modern era whereas the drugs criminalized under this regime lack such a history of European acceptance, the article discusses racial and cultural (especially religious) prejudice as a foundation for the exaggerated perceptions of drug harms. It finds that such prejudice is well-attested in the historical literature and seems to have contributed substantially to the formation of the international drug control regime. In sum, this article argues that drug prohibition was first introduced in the early modern era on racial and religious grounds and that the influence of these prohibition motives can be traced, directly and indirectly, all the way to the present day. This influence may explain why the health risks associated with illicit drug use are still often exaggerated in contemporary drug harms research. Citation: Drug Science, Policy and Law PubDate: 2023-09-07T06:29:33Z DOI: 10.1177/20503245231198526 Issue No:Vol. 9 (2023)
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Authors:Octavian Dixon Ritchie, Cameron N Donley, Gabrielle Dixon Ritchie Abstract: Drug Science, Policy and Law, Volume 9, Issue , January-December 2023.
Citation: Drug Science, Policy and Law PubDate: 2023-09-07T06:28:34Z DOI: 10.1177/20503245231198472 Issue No:Vol. 9 (2023)
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Authors:Zakaria Belrhiti, Fatima Zohra Serghini Abstract: Drug Science, Policy and Law, Volume 9, Issue , January-December 2023. BackgroundWorldwide, approximately there are 15.6 million people who inject drugs. Recently, a rising prevalence of hepatitis C virus among the people who inject drugs community (8.2 million, 40 to 80% of people who inject drugs) urged governments to implement targeted preventive and structural interventions. Yet, social stigma, poor interaction with health workers, and limited health literacy are critical challenges to equitable access to care. This study explores the perceived barriers and facilitators of people who inject drugs access to hepatitis C virus care in Morocco.MethodsWe adopted an explorative qualitative single-embedded case study design. We conducted 19 semi-structured interviews and a focus group discussion with people who inject drugs, health workers, and social community health workers. We performed an inductive qualitative data analysis using thematic analysis. We coded data using NVivo software. We summarized our findings using a causal loop diagram of critical barriers and facilitators.ResultsMulti-layered and interdependent factors constrain access to care for people who inject drugs. People who inject drugs are considered a vulnerable population experiencing irregular housing, lack of family support, gender-based stigmatization, and incarcerations. Individual factors include limited hepatitis C virus health literacy, mistrust in health workers, and poor interaction with health workers within healthcare facilities. Both individual and structural elements decrease their perceived self-worth and self-esteem and reinforce their perceived social stigmatization. This leads to a lack of motivation to engage in hepatitis C virus care delivery. We found that peer educators are perceived as trustworthy and credible sources of hepatitis C virus health-related knowledge.DiscussionPoor access to hepatitis C virus treatment for people who inject drugs involved an intertwined set of individual factors (level of knowledge, perceived social stigma, reduced self-esteem, and self-worth) and structural factors such as poor interaction with health workers and mistrust in healthcare institutions. More attention needs to be paid to alleviate structural barriers by integrating peer education, multiagency collaboration, community engagement, and capacity building of health workers for equitable access of people who inject drugs to hepatitis C virus care. Citation: Drug Science, Policy and Law PubDate: 2023-09-01T07:25:11Z DOI: 10.1177/20503245231199163 Issue No:Vol. 9 (2023)
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Authors:Anoek S van Vugt, Josjan Zijlmans, Ramon Lindauer, Levi van Dam Abstract: Drug Science, Policy and Law, Volume 9, Issue , January-December 2023. BackgroundPTSD in adolescence causes much suffering and has substantial health-care costs. Many patients with severe PTSD do not respond to psychotherapy or continue to have symptoms despite trauma-focused psychotherapies and psychopharmacological treatment. A recent alternative in the search for cost-effective treatments for PTSD in adults is 3,4-methylenedioxymethamphetamine-assisted psychotherapy (MDMA-assisted psychotherapy). However, no research has yet been conducted on the therapeutic potential of MDMA for adolescents.Aims of the studyThe purpose of this study is to investigate the perspectives of adolescents, parents, and clinicians about the possible clinical application of MDMA-assisted psychotherapy for adolescents with PTSD.MethodWe performed focus groups in three samples: (a) 16–24-year-olds who had undergone trauma therapy (N = 9), (b) parents of traumatized children (N = 4), and (c) trauma clinicians (N = 6). Focus group topics included: perception of and associations with MDMA, opinions on MDMA-assisted psychotherapy, risks/benefits, and precautions to take prior to possible adolescent clinical trials with MDMA-assisted psychotherapy.ResultsIn all groups, initial participant attitudes towards MDMA were predominantly unfavorable, except for several adolescents who had conducted preliminary research on the subject. After a standardized explanation of MDMA-assisted psychotherapy, provided in each group, all but one participant changed their minds and supported the idea of implementing MDMA-assisted psychotherapy for adolescents. They all emphasized the importance of conducting research first.ConclusionOur findings suggest that when provided with information on what MDMA-assisted psychotherapy entails, adolescents, parents, and clinicians are open to the idea of exploring this type of treatment for adolescents. Citation: Drug Science, Policy and Law PubDate: 2023-09-01T07:24:12Z DOI: 10.1177/20503245231198477 Issue No:Vol. 9 (2023)
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Authors:Benjamin A. Korman Abstract: Drug Science, Policy and Law, Volume 9, Issue , January-December 2023. Rising international migration, paired with increasing public support for far-right political parties, poses a growing challenge to the countries tasked with successfully integrating immigrants into their society. Further complicating this matter is the fact that the acculturation process which immigrants undergo to fully integrate into their host society can be long, difficult, and taxing to their mental health, physical health, and sense of belonging. A better understanding of how the unique burdens faced by immigrants might be alleviated or more easily processed is therefore vital for the success of both immigrants and their host countries. Drawing on initial findings suggesting that classic psychedelics can help individuals process incidents of discrimination, make healthier decisions, and experience deeper feelings of connectedness to others, this literature review presents a roadmap for determining what classic psychedelics may offer immigrants, a large and rapidly growing international minority group. Citation: Drug Science, Policy and Law PubDate: 2023-08-01T06:24:29Z DOI: 10.1177/20503245231191400 Issue No:Vol. 9 (2023)
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Authors:Antonio Metastasio, Silvio Mignogna, Riccardo Paci, Milena Mancini, Fabio Melelli, Enrico Lando, Ornella Corazza, Giovanni Stanghellini Abstract: Drug Science, Policy and Law, Volume 9, Issue , January-December 2023. Since its discovery in 1943, LSD has been used by artists, scientists, and intellectuals, amongst others, to stimulate their creative insights. Federico Fellini, one of the most important film directors in the XX century, used LSD when it was still legal under the guidance of his psychoanalyst during a phase of personal and creative crisis. This article proposes a phenomenological analysis of how his filmmaking and his creativity was enhanced after using LSD in such controlled therapeutic settings, according to four main domains: (a) time, (b) space, (c) body and others and (d) perception of the self. In particular, time flows irregularly and is punctuated by disorienting flashbacks, colours become supernaturally brilliant and detached from objects, sounds pop up independently from any visible source, and human bodies become often deformed, grotesque and caricatural. The boundaries between dream- and reality-worlds also collapses. His films became so distinctive and original that an adjective was coined felliniesque. Citation: Drug Science, Policy and Law PubDate: 2023-08-01T06:23:50Z DOI: 10.1177/20503245231186723 Issue No:Vol. 9 (2023)
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Authors:Jon Waldron, Meryem Grabski, Tom P Freeman, Margriet van Laar, H Valerie Curran Abstract: Drug Science, Policy and Law, Volume 9, Issue , January-December 2023. BackgroundCannabis was rescheduled in the UK in November 2018 so that it can now be prescribed as a treatment for certain medical conditions. It is not yet known whether this has had an impact on peoples’ perception of its risk or on their recreational use of cannabis.MethodsThis study used data from longitudinal and cross-sectional components of an online survey investigating drug use and nightlife behaviours, comparing data before and after rescheduling of cannabis in November 2018. Participants’ awareness of the change in policy and its impact on cannabis use were assessed for participants in both the cross-sectional and longitudinal arms. The perception of the risk of recreational cannabis use, past 12-month use and use frequency were assessed pre- and post-policy change among the longitudinal sample.Results414 longitudinal (57.3% response rate) and 2001 cross-sectional participants completed the online survey, resulting in a total sample size of 2415. Just over half the sample (53.5%) were aware of the change in policy to allow for the medical provision of cannabis, with almost 90% saying this would have no impact on their recreational and approximately 80% no impact on their medical use of cannabis, irrespective of prior awareness. No significant differences were found with respect to risk perception, past 12-month cannabis use, or use frequency pre- and post-policy change among the longitudinal sample.ConclusionsThe change in UK policy to allow for the medical provision of cannabis for some conditions had a limited impact on intentions to use cannabis, and was not associated with longitudinal changes in risk perception or temporal use patterns. Citation: Drug Science, Policy and Law PubDate: 2023-07-05T06:29:23Z DOI: 10.1177/20503245231168392 Issue No:Vol. 9 (2023)
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Authors:Sean M Viña, Amanda L Stephens Abstract: Drug Science, Policy and Law, Volume 9, Issue , January-December 2023. Although there is a growing support for the use of psychedelics to improve the health of marginalized groups, there are some critical gaps. First, no empirical studies have examined the effects of psychedelics on Black Americans. Second, there is little research on population effects of psychedelics. Third, little research has tested how cultural set and setting may affect the relationship between psychedelics and health. Specifically, how could economic inequality or the criminal justice system jeopardize the relationship between psychedelics and health for Black people. This study tests race and gender differences in multiple aspects of lifetime classic psychedelic use, specifically drug use, arrest history, economic inequality, and psychological distress. This project uses pooled data of Black and White respondents from the National Survey of Drug Use and Health (2008–2019) (N = 490,586). The analysis includes a series of logistic and ordinary least square regression models conducted in Stata 17. Results demonstrate that Black people are policed more even though they use less drugs than Whites. Higher class White men are more likely to use psychedelics, while class does not predict use among Black people. Finally, for White men and women, the positive association of psychedelics are enhanced by class, while the negative effect of arrest history on health are buffered by psychedelics. However, Black people do not gain health benefits from psychedelics regardless of class or arrest history. Results suggest that systemic inequality deters use and eliminates all health benefits of psychedelics for Black people. Citation: Drug Science, Policy and Law PubDate: 2023-06-23T07:04:12Z DOI: 10.1177/20503245231184638 Issue No:Vol. 9 (2023)
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Authors:Adriana D’Arienzo, Giorgio Samorini Abstract: Drug Science, Policy and Law, Volume 9, Issue , January-December 2023. In recent years, the historical record of psychedelic therapy in Europe and the Americas has undergone considerable revision. In this article, we contribute to this re-interpretation by sharing documentation relating to psychedelic therapy carried out in Italy during the period 1927–1966. Our library research has uncovered one hundred publications, documenting at least 60 clinical studies in which psychedelics were administered. There is evidence of some primacy regarding this psychedelic research: Italy has the world record, for the twentieth century, for having carried out the largest number of clinical studies on patients with psilocybin and with lysergic acid amide (LSA); humans first received the high dose of 500 mcg of lysergic acid diethylamide (LSD) in Italy; and LSD plus LSA, and LSD plus psilocybin, were administered simultaneously for the first time. The most successful Italian clinical studies appear to have been those in which psilocybin was used in the treatment of depressive states, with the observed optimal dose being that of 3 mg administered intravenously every second or third day, alternated with placebo injections. Another therapeutic target that seems to have provided interesting results concerns the use of LSD and psilocybin for what was then called “neurosis.” Italian psychiatrists have also made useful contributions to theoretical aspects concerning psychedelic therapies, for example in the conflicting debate on the “psychotomimetic paradigm” and in the distinction between the “primary” and “secondary” effects of these substances. Citation: Drug Science, Policy and Law PubDate: 2023-06-07T05:37:44Z DOI: 10.1177/20503245231179687 Issue No:Vol. 9 (2023)
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Authors:Kylie O’Brien, Justin Beilby, Michelle Frans,
Michael Lynskey, Michael Barnes, Mihindu Jayasuriya, Alkyoni Athanasiou-Fragkouli, Philip Blair, David Nutt Abstract: Drug Science, Policy and Law, Volume 9, Issue , January-December 2023. BackgroundInternationally, one of the most common conditions for which people seek medicinal cannabis (MC) is chronic pain. However, relatively little is known about the effectiveness of cannabis for reducing pain in Australia. Medicinal cannabis was made legally available in Australia in 2016. Project Twenty21 Australia is an observational study that follows patients prescribed MC for chronic pain, anxiety, PTSD and multiple sclerosis for up to 12 months. It commenced recruitment in February 2022. This paper describes some preliminary findings for a cohort of patients with chronic pain.MethodParticipants seeking treatment for chronic pain are prescribed MC from within a Project Formulary, and complete questionnaires at baseline then three monthly for up to 12 months. Pain severity and interference are assessed using the Brief Pain Index while standardised measures of quality of life, mood and sleep quality are also applied.ResultsBy 30 November 2022, 55 participants with chronic pain had completed the first three-month follow-up. Patients reported a low quality of life and high levels of co-morbidity. Three-month data indicate that MC use was associated with significant reductions in self-reported pain intensity and pain interference (Effect sizes = 0.66 [95% CI = 0.34–0.98] and 0.56 [0.24–0.88], respectively). Additionally, there were significant improvements in quality of life, general health, mood/depression and sleep (Effect sizes = 0.53–0.63). One adverse reaction was reported which was mild in nature.ConclusionsPreliminary evidence suggests that MC may be effective in reducing both pain severity and pain interference while also improving quality of life, general health, mood and sleep in patients with chronic pain. Increasing uptake of MC coupled with growing evidence of both the effectiveness and safety of these medications indicate a need both to make MC more widely available and to reduce financial costs associated with its use. Citation: Drug Science, Policy and Law PubDate: 2023-05-25T08:28:12Z DOI: 10.1177/20503245231172535 Issue No:Vol. 9 (2023)
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Authors:Michael A White, Nicholas R Burns Abstract: Drug Science, Policy and Law, Volume 9, Issue , January-December 2023. This is the second of two closely related systematic literature reviews with meta-analyses by the same authors. The first concluded that there is no convincing epidemiological evidence that the prior use of cannabis (as indicated by the presence of THC in a body fluid) directly increases the risk of crashing. The purpose of this second review is to consider the possibility that the co-use of cannabis indirectly increases the risk of crashing by exacerbating the effect of alcohol on the risk of crashing. The starting point for both reviews is a systematic literature search that identifies seventeen epidemiological studies of the relationship between the prior use of cannabis and the risk of crashing. Twelve of those studies also investigated the joint effects of cannabis and alcohol on the risk of crashing. Although the authors of some studies claimed to have found an exacerbation (or equivalent) effect, the results of a meta-analysis of exacerbation odds ratios failed to support the claim. It is concluded that there is no credible evidence from the twelve epidemiological studies that the co-use of cannabis exacerbates the effect of alcohol on the risk of crashing. Citation: Drug Science, Policy and Law PubDate: 2023-05-25T08:27:40Z DOI: 10.1177/20503245231177334 Issue No:Vol. 9 (2023)
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Authors:Michael T Lynskey, Anne K Schlag, Alkyoni Athanasiou-Fragkouli, David Badcock, David J Nutt Abstract: Drug Science, Policy and Law, Volume 9, Issue , January-December 2023. Medicinal cannabis has been legal in the UK since 2018 but there is limited information about characteristics of people seeking prescribed cannabis and the effectiveness of this treatment. This paper documents symptom patterns and quality of life among individuals seeking medicinal cannabis and examines changes in symptoms, quality of life and use of prescribed opioids using data from an observational registry study of patients (Project Twenty21). Self-report data, including condition-specific symptomatology and general health (quality of life, general health, mood and sleep), were available at treatment entry for 2833 patients seeking medicinal cannabis for any indication and also at 3-month follow-up for 1410 individuals seeking treatment for anxiety disorders, chronic pain or PTSD. Among chronic pain patients, dose and frequency of prescribed opioid use was available. There were consistent improvements in disease-specific symptomatology and in general health and quality of life 3 months after commencing treatment. Effect sizes, assessed using Cohen's d, ranged from 0.50 to 1.17. Among chronic pain patients using opioids at the start of treatment, there was a moderate reduction in Milligrams of Morphine Equivalents: from 22.5 to 8.3 mg/day (Cohen's d = 0.29, 95% CI = 0.19–0.38). Adverse events were rare (3.2% reported one or more adverse events) and were mostly assessed as either mild or moderate severity: the most common AEs were dry mouth (15 occurrences) and feeling drowsy or having red eyes (both reported 11 times). Despite limitations of observational research, including the lack of randomisation or a control group and potential selection bias, these results indicate that prescribed cannabinoids are associated with a reduction in condition-specific symptomatology, improvement in quality of life and a reduction in prescribed opioid use. While further research is needed to better understand who will most likely benefit from which prescribed cannabinoids, real-world evidence of their effectiveness and safety supports efforts to increase access to these medications. Citation: Drug Science, Policy and Law PubDate: 2023-05-02T11:00:27Z DOI: 10.1177/20503245231167373 Issue No:Vol. 9 (2023)
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Authors:Brian S. Barnett, Noah Wiles Sweat, Peter S. Hendricks Abstract: Drug Science, Policy and Law, Volume 9, Issue , January-December 2023. BackgroundRecent survey data indicate that some people report long-term improvement in color vision deficiency (CVD), also known as color blindness, following use of psychedelics such as lysergic acid diethylamide (LSD) and psilocybin. However, there are no objective data reported in the medical literature quantifying the degree or duration of CVD improvement associated with psychedelic use.Case presentationHere we present the case of a subject with red-green CVD (mild deuteranomalia) who self-administered the Ishihara Test to quantify the degree and duration of CVD improvement following the use of 5 g of dried psilocybin mushrooms. Self-reported Ishihara Test data from the subject revealed partial improvement in CVD peaking at 8 days and persisting for at least 16 days post-psilocybin administration. This improvement may have lasted longer, though the subsequent observations are confounded by additional substance use.ConclusionA single use of psilocybin may produce partial improvements in CVD extending beyond the period of acute effect, despite this condition typically resulting from a genetic defect. Systematic exploration of this possible phenomenon is needed to confirm our findings, gauge their generalizability, and determine the mechanism of action. Citation: Drug Science, Policy and Law PubDate: 2023-05-02T07:06:14Z DOI: 10.1177/20503245231172536 Issue No:Vol. 9 (2023)
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Authors:Jaden Brandt Abstract: Drug Science, Policy and Law, Volume 9, Issue , January-December 2023. The unprecedented progress in the science and clinical investigation of psychedelic medicine will require those in healthcare leadership and the legislative policy arena to conceptualize how future reforms, policy creation, and clinical practice should occur to broaden access to these agents while simultaneously maximizing effectiveness and mitigating harm. The pharmacy profession has surprisingly had little engagement on this front. This article provides a perspective commentary and overview of potential future strategies in legal reform, professional regulatory authority policy creation, and pharmacy operations regarding the psychedelic agents’ psilocybin and methylenedioxymethamphetamine, using Canada as a national case study. Citation: Drug Science, Policy and Law PubDate: 2023-04-26T05:58:22Z DOI: 10.1177/20503245231170340 Issue No:Vol. 9 (2023)
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Authors:David Nutt Abstract: Drug Science, Policy and Law, Volume 9, Issue , January-December 2023.
Citation: Drug Science, Policy and Law PubDate: 2023-04-17T06:31:26Z DOI: 10.1177/20503245231170039 Issue No:Vol. 9 (2023)
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Authors:Alfred Balston, Kuljit Hunjan, Michael J Kelleher Abstract: Drug Science, Policy and Law, Volume 9, Issue , January-December 2023. BackgroundVarious detoxification regimens are used for gamma-hydroxybutyrate (GHB) and gamma-butyrolactone (GBL), including diazepam, barbiturates, baclofen and GHB itself. However, these regimens are primarily derived from inpatient units, and literature on outpatient GBL detoxification is sparse with no previous reports on chlordiazepoxide. We describe the characteristics of outpatient GBL detoxification using chlordiazepoxide.MethodsObservational study of all patients who attended a community outpatient addiction service in South London between August 2015 and November 2017 seeking detoxification from GBL. The outpatient caseload is predominantly patients with alcohol, opioid and stimulant dependence. Routine clinical data including patient demographics, GBL usage, daily chlordiazepoxide dose and Clinical Institute Withdrawal Assessment for Alcohol-revised (CIWA-Ar) score were recorded.ResultsIn the study period there were 17 attendances for GBL detoxification, 14 of which were undertaken in the outpatient setting. Twelve (86%) patients who had an outpatient detoxification were male, all of whom were men who have sex with men. Of 14 outpatient GBL detoxifications managed with chlordiazepoxide, 10 were successfully completed. One of the four patients that did not complete detoxification required inpatient treatment in an acute hospital. The average successful detoxification took 10 ± 3.1 days. For patients who completed a detoxification, the median maximum CIWA-Ar score on day one of the detoxification was 11 (range 2–17), with the mean dose of chlordiazepoxide used on day one being 140 mg (range 80–225 mg).ConclusionsChlordiazepoxide can be used for outpatient GBL detoxification in combination with a provision for crisis admission to hospital. CIWA-Ar score can be applied to GBL withdrawal to measure severity and inform a reducing regimen of chlordiazepoxide. Citation: Drug Science, Policy and Law PubDate: 2023-04-06T07:55:11Z DOI: 10.1177/20503245231167544 Issue No:Vol. 9 (2023)
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Authors:Kellen Russoniello, Sheila P. Vakharia, Jules Netherland, Theshia Naidoo, Haven Wheelock, Tera Hurst, Saba Rouhani Abstract: Drug Science, Policy and Law, Volume 9, Issue , January-December 2023. In November 2020, Oregon voters approved Measure 110, a ballot initiative that decriminalized possession of small quantities of all drugs and allocated hundreds of millions of dollars annually to health services for people who use drugs. Implementation of Measure 110 is ongoing, but several effects are noticeable in the first two years since the measure passed. Among these are substantial decreases in possession of controlled substances arrests and an infusion of funding into harm reduction services that have not traditionally enjoyed a sustainable funding source. This paper analyzes the provisions of Measure 110, examines its early impacts, successes, and challenges, and outlines lessons that jurisdictions contemplating decriminalizing drug possession in the U.S. and globally should consider. Citation: Drug Science, Policy and Law PubDate: 2023-04-06T07:23:11Z DOI: 10.1177/20503245231167407 Issue No:Vol. 9 (2023)
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Authors:Kylie O’Brien, Justin Beilby, Michelle Frans, Michael Lynskey, Michael Barnes, Mihindu Jayasuriya, Alkyoni Athanasiou-Fragkouli, Philip Blair, David Nutt Abstract: Drug Science, Policy and Law, Volume 9, Issue , January-December 2023. BackgroundSince medical access to medicinal cannabis (MC) was legalised in Australia in 2016, numbers of people prescribed MC have increased exponentially. There is a need for safety and effectiveness data on the longer-term use of MC in real-world settings. This paper describes the methodology of Project Twenty21 Australia, an observational study that commenced early in 2022 and its preliminary findings.MethodThis study tests whether medicinal cannabis is effective in four primary conditions: chronic pain, anxiety, posttraumatic stress disorder and multiple sclerosis (MS). Participants are prescribed MC from within a Project Formulary, completing questionnaires at baseline then 3 monthly for up to 12 months.ResultsBetween the start of the study in February and 30 August 2022, 278 participants had been recruited into the study: 50.7% female, 48.2% male and 1.1% non-binary with average age 39.2 years (18–77). Patients reported a low quality of life and high levels of co-morbidity. Three-month data, available for 71 participants, indicate that MC was associated with substantial improvements in self-reported quality of life, general health, mood/depression and sleep with standardised effect size estimates ranging from 0.57 to 0.93. Three adverse reactions were reported.ConclusionsThis paper describes the protocol used for an observational study conducted in Australia assessing the effectiveness of MC in four main conditions. We have established the feasibility of collecting real-world data on symptoms and quality of life in people receiving treatment with MC. Preliminary evidence suggests that MC may be effective in improving quality of life, general health, mood and sleep. Citation: Drug Science, Policy and Law PubDate: 2023-03-21T05:54:53Z DOI: 10.1177/20503245231164718 Issue No:Vol. 9 (2023)
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Authors:Peter Sunderland, David J Nutt, Anne Katrin Schlag Abstract: Drug Science, Policy and Law, Volume 9, Issue , January-December 2023. Prescribed cannabinoids are legal in the UK and are increasingly being used for a variety of conditions, with one of the most frequent conditions being chronic pain. Within this cohort, there is developing evidence that cannabis-based medicinal products are associated with opioid and other medication sparing. However, at present, the National Institute for Health and Care Excellence (NICE) does not recommend the prescription of cannabis-based medicinal products to treat chronic pain due to the lack of randomised controlled trial evidence for this condition. Here we present a case study of a 61-year-old woman with idiopathic small fibre neuropathy, who was prescribed the gabapentinoid pregabalin, in combination at different times with various other agents including amitriptyline, duloxetine, lamotrigine, meloxicam and topical capsaicin, over a 17-year period for the associated neuropathic pain. Although her pain was relatively well controlled, the patient reported hearing loss, sleepiness, tinnitus, confusion and worsening anxiety possibly as a result of prolonged pregabalin use. Efforts were made to reduce the pregabalin dose but any attempts to reduce below a total daily dose of 350 mg resulted in unacceptable pain for the patient. In 2021, the patient was enrolled in Project Twenty21, the UK's first medical cannabis registry, and prescribed full plant extract delta-9-tetrahydrocannabinol 10 mg: cannabidiol 15 mg/mL of oil, prescribed at a dose range of 0.1–0.5 mL twice daily. As a result, the patient managed to reduce her pregabalin down to 37.5 mg total daily dose. The patient now feels she has ‘been given a second chance at life’ and her husband describes her as ‘a new woman’. This patient feels that she is in a position to finally stop treatment with pregabalin, as a result of medical cannabis controlling her pain. Highlighting the potential benefits of cannabis-based medicinal products to treat chronic pain, our case study indicates the value of including real-world evidence when assessing the benefits and safety of cannabis-based medicinal products. Citation: Drug Science, Policy and Law PubDate: 2023-03-14T07:20:03Z DOI: 10.1177/20503245231157489 Issue No:Vol. 9 (2023)
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