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Quality of Life and Health Status in Patients with Chronic Diseases Using Cannabis

28.02.2020

The number of patients using cannabis for therapeutic purposes is increasing worldwide. Many patients find relief from its effects, especially those patients suffering from chronic diseases for which there is no effective treatment. This involves living with disabling and persistent symptoms related to inflammatory processes, pain or other conditions that end up making a person’s daily activities difficult and directly impacting on their quality of life.

While there are an increasing number of studies on the treatment of certain diseases/disorders with both cannabis and some isolated cannabinoids, few longitudinal studies have assessed the medium or long-term effects of the use of medical cannabis on psychological variables and quality of life. In order to fill this gap, ICEERS’ Science & Innovation department conducted a longitudinal study, sponsored by Fundación CANNA and Fundació Alchimia, in which a sample of about 70 patients with chronic diseases using cannabis as a treatment for their symptoms was followed for 12 months. The results of this study have recently been published in the journal Phytotherapy Research.

Cannabis and chronic diseases: a growing reality

More than thirty states in the United States and dozens of countries in Europe and Asia have implemented medical cannabis programs in recent years (see the Cannabmed website map for current legal status worldwide). These programs allow a legal and safe access to different cannabis products, with which people with pathologies susceptible to obtain some improvement (glaucoma, some types of epilepsy, chronic pain, etc.) can make use of this therapeutic resource. However, in those countries where no medical cannabis program exists yet, patients are using this plant as well for the treatment of different symptoms. This is the case of Spain, for example, where only patients with multiple sclerosis can access Sativex (a drug with a 1:1 ratio of THC and CBD, and with added terpenes and flavonoids from the plant) as a second-line treatment for spasticity. In this context, patients with other diseases use cannabis within a dangerous regulatory framework, exposing themselves to different risks: those associated with a product manufactured and distributed within an informal market; a lack of expert medical advice; social stigma for using a plant considered an illegal drug; the absence of a legal framework, which implies possible repercussions such as administrative sanctions, among others.

One resource that some patients have been using to acquire the cannabis flower or similar products is the cannabis social clubs. These spaces, born in a grey area of the Spanish legislation, have allowed for years that cannabis users could safely go to a specific place to buy and consume this plant. Initially devised by activists with an anti-prohibitionist ideology and aimed basically at users in general as a response to the legal situation of cannabis in Spain, progressively a sub-group of “therapeutic users” also made use of these clubs to obtain their medication.

In order to carry out this study, different clubs were contacted and those members using cannabis for therapeutic purposes were invited to participate. Participants completed questionnaires on quality of life, personality, mental health and neuropsychological performance. They were also asked about their patterns of cannabis use (amounts used, routes of administration, etc.). These questionnaires were administered every 4 months for one year.

Chronic diseases and cannabis: results found

Firstly, the main diseases for which users were making therapeutic use of cannabis were Human Immunodeficiency Virus or HIV, fibromyalgia, chronic pain and epilepsy. One third of the participants in the survey started using cannabis as soon as they were diagnosed with the disease and not before, indicating that a significant proportion of therapeutic cannabis users make their debut in this use only after receiving the diagnosis.

With regard to variables related to health status, it should first be noted that the main objective of this study was not to describe potential benefits associated with the use of cannabis. This is because the participants included in our sample had already been using cannabis for therapeutic purposes for a long time (an average of 6 years), and in such a situation it is difficult to observe changes and attribute them to cannabis use. However, by following this sample over a 12-month period, some variables related to quality of life or neuropsychiatric status can be analysed and it can be assessed whether cannabis use is having any relevant detrimental effects.

Regarding quality of life, very low scores were obtained at the beginning of the study as compared with the general population average, however, this is a generalized situation among patients suffering from chronic diseases. Moreover, generally the quality of life of patients with chronic diseases tend to worsen over time. However, in this case, despite not reporting improvements in any of the assessments, no progressive worsening was recorded either, suggesting that cannabis may in part contribute to maintaining a relatively stable quality of life.

No deterioration in cognitive performance, psychiatric status, or sleep status was recorded over the 12 months of the study. This is especially relevant considering the main consequences that have been observed in the recreational use of cannabis, basically memory loss. This study, along with others conducted previously, shows how therapeutic users are not exposed to these risks and that the use of medical cannabis is safe from a neuropsychiatric point of view. In addition, many studies report a reduction in the use of prescription drugs from cannabis use. This reduction would be related to a higher quality of life, given the profuse side effects of most drugs prescribed for the treatment of pain or anxiety.

[Patients] are systematically fighting against an inefficient and extremely slow system when it comes to providing access to medical cannabis, when they need some remedy urgently.

Conclusions and future challenges

With this study we obtained more information about the profile and situation of those patients who use cannabis for therapeutic purposes in a context where this practice is not regulated. This scenario poses several short and long term challenges that users, but also health professionals, researchers, activists and policy makers have to deal with in order to ensure a dignified life and access to all possible treatment options. This complicated situation was materialised in the Human Rights Agora that was organized by ICEERS, where we also observed some of the challenges that patients continually have to face, since they are systematically fighting against an inefficient and extremely slow system when it comes to providing access to medical cannabis, when they need some remedy urgently. 

Other studies will ideally have to start making assessments just before patients start cannabis treatment with the aim of being able to establish some association between therapeutic improvements and the use of the plant. However, in parallel to the design and implementation of these studies, much work is also needed to improve the situation of patients who have legitimately decided to stop waiting for scientific and political developments and to use cannabis on their own. For example, it seems that the provision of expert medical advice is necessary to accompany this self-consumption, since the majority of our sample (84%) used the smoked route to consume cannabis, however, other routes such as vaporized may be more indicated in the case of therapeutic users, since they limit the possible physical consequences that this consumption may entail, thus adding another symptomatology to the complicated situation of an established chronic disease.

 

Authors: Genís Oña, MSc, José Carlos Bouso, PhD

Categories: NEWS , Cannabis , Others , RESEARCH & INNOVATION
Tags: cannabis , health , psychoactive plants , quality of life

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