Two patients in Sweden received prescriptions for cannabis for chronic pain after sustaining back injuries. Doctors applied through the Medical Products Agency, (MPA) or the Swedish Läkemedelsverket to prescribe cannabis.
TT the local spoke to Karl Mikael Kälkner from MPA, who said the approval of cannabis for these two patients doesn’t mean government approves of cannabis in general.
The Swedish government granted the right to use herbal cannabis for chronic pain. Dr. Fredrik von Kieseritzky, organic and medicinal chemist advised the doctors to prescribe medicinal cannabis. He says he is happy the MPA approved the use of cannabis in these cases since no other medication could relieve the pain the two patients experienced.
Formal permission granted on a case-by-case basis
In Sweden, authorities grant permission on a case-by-case basis. A Dutch company that supplies the Swedish government with cannabis for medical use and research will supply these patients.
Dr. von Kieseritzky said he recommends that the patients add their cannabis to butter to make edibles. He advises patients not to smoke cannabis because he would like to keep a clear distinction between medicinal use and recreational use.
The MPA emphasized that people shouldn’t see the authorization of these two prescriptions as the approval of medical cannabis. There is a high likelihood of abuse, and cannabis possession and use is still illegal in Sweden, Kälkner said. He added that other medications used in clinical settings are also classed as narcotics, but if people follow the rules, abuse would be unlikely.
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Obstacles to research hamper progress
Studies on cannabis for chronic pain were difficult in the past because standardized material of pharmaceutical standard isn’t freely available.
Finding a delivery method acceptable to modern medicine also presented a problem. Health professionals would not accept smoking in a clinical trial because of possible health risks.
Patients complaining of irritation to the larynx or throat membranes could have difficulty with using an oil extract. Taking cannabis orally is a possible solution, but the onset of the effect is slow, and absorption varies from person to person. It is difficult to collect accurate data, and for patients with chronic pain, this means of delivery is too slow. However, if patients have stabilized and require a constant intake of cannabinoids, edibles could work very well.
Sublingual route is measurable
Drops under the tongue, or the sublingual route, has become widely accepted because it provides rapid absorption and a measurable route of administration.
GW Pharmaceuticals was the first to investigate pain management with Cannabis Based Medicinal Extracts (CBMEs) for sublingual use. The company developed a cannabis-based medicine for Multiple Sclerosis in 2000. Trials found that the cannabis-based drops performed well in terms of their efficacy, safety, and tolerability.
This led to the development of Sativex®, a cannabis-derived oromucosal spray, prescribed for the treatment of central neuropathic pain in multiple sclerosis and in 2007 for intractable cancer pain.
More work on cannabis for Chronic pain needed
The fact that governments around the world are allowing people to use cannabis for chronic pain and other conditions without what the medical establishment would see as sufficient research evidence doesn’t point to a situation in which prohibition would be the best answer.
Instead, we should see it as proof that progressive governments such as that of Sweden can’t deny the usefulness of the herb. It’s time research caught up with the ways people already use cannabis.