Federal Health Agency Seeks Public Input on Pain and Cannabinoids

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Can plant-based medicines help patients with pain management?

The Agency for Healthcare Research and Quality (AHRQ), within the Department of Health and Human Services, is asking for public submissions of scientific literature on cannabinoids, among other plant-based products, for a systematic review on pain. Cannabis plants contain dozens of cannabinoids, the most well-known of which are THC and CBD. 

The mission of the AHRQ is to “produce evidence to make health care safer, higher quality, more accessible, equitable, and affordable.” Specifically, the AHRQ is asking for the public’s help in providing studies, published or unpublished, to “inform” their Living Systematic Review on Plant-Based Treatment for Chronic Pain, according to a notice filed on the Federal Register. 

The systematic review will ask a number of key questions, some of which involve non-cannabis plant substances like kratom. One question will ask: In adults with chronic pain, what are the benefits of cannabinoids? And, conversely, in adults with chronic pain, what are the harms of cannabinoids? Research will cover a variety of forms of cannabinoid delivery, including inhaled, oral, topical, and buccal vehicles, and it will also include synthetic cannabinoids. Reviewers will be looking for specific “efficacy outcomes” related to pain, and adverse effects like nausea, dizziness, or development of a cannabis use disorder. 

The Evidence-based Practice Centers, the Federal Register filing noted, is “dedicated to identifying as many studies as possible” on plant-based treatment for chronic pain, “including those that describe adverse events.” To increase the number of studies included, the agency is supplementing database searches with this public request. 

Once the AHRQ notice is posted on December 2, a four week public comment window will open.  

It appears that federal agencies are focusing more on the intersection of pain and cannabinoids, and the potential that the cannabis plant might play in treatment of pain, and in reducing use of opioids. 

This month, Colorado State University, Pueblo hosted David Shurtleff, deputy director of the National Center for Complementary and Integrative Health (NCCIH) at the National Institutes of Health (NIH). Shurtleff’s presentation focused on funding for cannabis research and areas of interest. On this note, Shurtleff said that in 2000, 4.1 million adults were treated with opioids, but a decade later, that number jumped to well over 10 million adults.

“Given the current opioid epidemic, it’s really important that we invest more research to find alternatives to opiate analgesics that are less addictive, certainly less harmful,” Shurtleff said. 

The “overwhelming reason” that patients seek medical cannabis, Shurtleff said, is to help treat chronic pain, followed by muscle spasms, nausea, and post traumatic stress disorder. To illustrate this point, he discussed a study of 2,700 participants that had used medical cannabis at least once in the past three months. When asked what the medical cannabis replaced, Shurtleff said, respondents reported “extra opioids.”

“We’re very excited about the research we’re doing. We think that you will have an important impact on the public health crisis of opioid use,” Shurtleff said, referencing cannabis researchers. 

Cannabichromene (CBC) and cannabigerol (CBG) are of particular interest to NCCIH, because preliminary data suggests that “they have an affinity” for the receptors known to be important targets for pain perception and for the treatment of pain.  

“We’re very excited about looking more into these minor cannabinoids as possible analgesics,” Shurtleff said. 

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