Cannabinoids in pain management

BMJ 2001; 323 doi: https://doi.org/10.1136/bmj.323.7323.1249 (Published 24 November 2001) Cite this as: BMJ 2001;323:1249

Study was bound to conclude that cannabinoids had limited efficacy

  1. Ethan Russo, clinical assistant professor, University of Washington School of Medicine (erusso@blackfoot.net)
  1. Montana Neurobehavioral Specialists, 900 North Orange Street, Missoula, MT 59802, USA
  2. Department of Pharmacology, University of Oxford, Oxford OX3 9DU
  3. Arlington, VA 22209, USA
  4. nova-Institut, D-50354 Hürth, Germany
  5. Pain Management Centre, Queen's Medical Centre, Nottingham NG7 2UH
  6. Pain Research, Nuffield Department of Anaesthetics, The Churchill, Oxford Radcliffe Hospital, Oxford OX3 7LJ
  7. Division d'Anesthésiologie, Département APSIC, Hôpitaux Universitaires, CH-1211 Genève 14, Switzerland
  8. Department of Clinical Pharmacology, Radcliffe Infirmary, Oxford OX2 6HE

    EDITOR—Campbell et al's paper on whether cannabinoids are effective and safe in the management of pain purports to be qualitative and systematic,1 but it is neither. Because it focused on two clinically questionable synthetic cannabinoids and oral delta-9-tetrahydrocannabinol (THC) without providing any focus on the synergistic components of herbal cannabis, and examined only certain facets of the broad topic of pain, it ensured that a conclusion of limited efficacy was reached. That is not news.

    What is surprising, in contrast, is that the authors chose to broaden the alleged impact of their limited investigation to relegate the use of cannabis and cannabinoids to a back seat in future analgesic applications. This contention is not supported by their limited data.

    I see nothing published about pioneering British doctors and their clinical successes with cannabis extracts in a myriad of painful conditions between 1840 and 1940.2-4 I see virtually nothing of modern scientific studies showing the multifactorial benefits of cannabis on a range of neurotransmitter systems, which I have reviewed.5 No mention is made of bureaucratic and political obstructions to clinical research into cannabis; one cannot show results when the requisite studies are not permitted. Thus until recently we have been left with an overwhelming (but ignored) body of anecdotal evidence from patients and their doctors.

    What is truly newsworthy here is that the BMJ has ignored peer review and editorial standards in a scandalous manner. The popular media have seized the opportunity, and in the process valuable laboratory and clinical research, and their funding, in analgesia and pain control have been severely compromised. Great shame accrues to the journal as a result. Instead of …

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