CBD Report UK💚

Consumer interest in cannabidiol (“CBD”)


CBD in the UK – further update 

CMC Confirms All its Member’s Products That Were Tested as Part of Their Groundbreaking UK CBD Market Study Had A CBD Content That Was Within 10% Of The Stated Content On The Label.

The Centre for Medicinal Cannabis (CMC) today reveals more details of the results from their blind-testing of 30 major UK CBD products that can be purchased from the UK high street or bought online the findings of which were widely reported in the UK press. 

All products were CBD oils and were anonymously tested

CMC can confirm that all CMC member’s CBD products were within 10% of the CBD content indicated on the label 

All products were tested for residual solvents and heavy metals. No results from any product tested from any manufacturer were found to be a hazard to public health

The following CMC members products were tested; DragonflyCBD, George Botanicals, and Charlotte’s Web 

For members of the public who are concerned as to the validity of CBD products they have purchased, the CMC advises them to contact the product seller for further details on their individual analysis if tested or their independent batch test results. It would help the manufacturer to assist you if you identify the batch number and/or sell by date of your product and have this to hand for reference. The batch number and/or the sell by date should be indicated on the packaging

Further analysis of these results is ongoing and we will be published as part of a fuller analysis of the data in a peer reviewed journal within three months 


The size of the UK CBD market is between 3-6
times larger than previous well quoted estimates
(£300M per year vs £100M (Brightfield report)
and 1.3 M users vs 250K users (CTA) depending
on which measure you take; value or users. This is
larger than the total UK Vitamin D (£145M) and
Vitamin C market (£119M) combined.

The analysis for this report suggests the prospects
for the UK’s CBD market are strong, with rising
demand and a willingness among British consumers
to try CBD products and spend significant sums on a
regular wellness routine that encompasses CBD.


There are a number of future trends for the CBD
sector in the UK and globally, and some fundamental
market developments that the British CBD sector
can expect to encounter in the next three years.


The market is currently growing at double digits
and expected to be just short of £1B in 2025.
This would be equivalent to the entire UK herbal
supplement market in 2016.

There is an absence of comprehensive clinical education and prescription guidelines

Despite the rescheduling of cannabis-based medicinal products (CBMPs) in November 2018, which theoretically allowed British patients access to such medications, only very limited numbers of patients have been able to benefit. While many patients and families believe that CBMPs are now available, this is simply not the case and it is worrying that this has has soured patient-clinician relationships.

Last week, Parliament’s Health and Social Care Committee (HSSC) published Drugs policy: medicinal cannabis, summarizing how the rescheduling of cannabis-based medicinal products has affected clinical practice and providing an overview of current obstacles in accessing CBMPs through the UK health system. Here we discuss those barriers.

CBMPs are not licensed and CCGs are reluctant pay for them

For a medicine to be widely prescribed on the NHS, there must be randomised, double-blinded placebo-controlled trials (RCTs) showing strong evidence of efficacy for the Medicines and Healthcare products Regulatory Agency (MHRA) to licence the drug, then further evidence of cost-effectiveness for NICE to recommend its use. No CBMPs in the UK market are yet to achieve both.

As unlicensed ‘specials,’ CBMPs have not achieved the regulatory requirements to be approved by the MHRA so can only be prescribed by specialist physicians on a named-patient basis. Unlicensed drugs are paid for by local NHS budgets managed by Clinical Commissioning Groups (CCGs). But without a clear indication of cost-effectiveness from NICE, CCGs are reluctant to approve CBMP prescriptions, which cost £25-30,000 per patient per year.

There is insufficient clinical evidence available and medicinal cannabis isn’t well suited to conventional studies  

The Committee evaluated the evidence-base for CBMPs. Last year the Chief Medical Officer published a report supporting the use of CBMPs in four conditions: chronic pain in adults; chemotherapy-induced nausea and vomiting; multiple sclerosis spasticity syndromes; and intractable epilepsy. Yet a number of clinical bodies submitted testimony cautioning that the evidence is mixed or lacking.  

The UK has a global reputation for clinical excellence and won’t accept the widespread introduction of a new class of medicines without demanding the same rigor of evidence for safety and efficacy that other new medicines must achieve. To do so may set a dangerous precedent and it is right that we require robust evidence and proper regulatory oversight of any new drug.

However, patients, patient advocacy groups, families and prescribing clinicians told the Inquiry that conventional RCTs do not lend well to assessing CBMPs. The RCT design attempts to control for outside factors in order to understand the specific therapeutic action of the study drug. Specific, standardised cannabinoid-based medicines (such as Sativex) are tested in this way, but plant-based cannabis products represent a staggering diversity of molecular combinations not readily reduced to a single standardised trial drug. While a single preparation can be put through the standard pharmaceutical evidence-gathering process, the results won’t necessarily provide clarity on the potential efficacy of preparations with different cannabinoid profiles. Out of countless possible combinations of 150-or-so known cannabinoids from thousands of strains of cannabis, where should research start?

There are always methodological difficulties with psychoactive medicines, not least because it is difficult to ‘blind’ them. If a study drug makes you feel high, it’s a safe bet that you didn’t get the placebo. Researchers have developed clever ways of overcoming these blinding difficulties and, despite the apparent impracticality of pushing CBMPs through traditional RCTs, there is no reason to think that new or adapted methodologies won’t emerge to address the problem. We need to see trials that permit combinations of multiple formulations, for instance.  These methodologies must be rigorous enough to build the evidence base, satisfy the requirements of the MHRA and facilitate access for British patients.

The National Institute for Health Research have issued calls for funding applications for clinical trials and the Committee urges the prioritisation of resources for studies assessing CBMPs in the treatment of intractable epilepsy in children. The Committee notes that data from other countries should be used to inform guidance in the UK. Multi-centre, pan-European trials could be of great benefit and the Committee asks Government to ensure that Brexit won’t limit this opportunity.

NICE are due to release guidelines for prescribing clinicians towards the end of this year. The British Paediatric Neurology Association (BPNA), Association of British Neurologists (ABN) and the Royal College of Physicians (RCP) have released guidelines in advance. Yet patients, families and prescribing clinicians claim these initial guidelines are a barrier to prescribing. Neurologist Prof Mike Barnes criticized the guidelines as “too restrictive” and “rather negative.” The BPNA, ABN and RCP say the guidelines are based on the available evidence. Again, new methodologies better suited to assessing the evidence of cannabis-based medicines would help to break this impasse.

It is welcome that Health Education England are working on e-modules to train doctors to understand and prescribe CBMPs. NHS England are planning a process review to address bureaucratic barriers in prescribing. The report recommends issuing targeted guidance to practitioners and pharmacies following the review.

Limited UK supply of cannabis medicines means high costs while some patients resort to illegal access

There is no UK supply of CBMPs and prescriptions are made and imported on a named-patient basis. With each prescription requiring an individual importation license there is no economy of scale, significantly raising costs. The report recommends that the Department of Health and Social Care (DHSC) secure long-term international supply deals and DHSC is due to publish a review in early 2020.

The report strongly criticises industry for instances of being unwilling to supply their CBMPs for research to build the necessary evidence base and recommends “naming and shaming” such companies, calling for stronger industry involvement in medical research. In my own experience, companies producing CBMPs and looking to supply the future UK medical market are investing money and product in research. The report failed to consider incentivizing companies to further invest, which could be a more useful approach.

The lack of NHS access and high private prescription cost means some patients are illegally importing their CBMPs from abroad. The Select Committee says:

“We should not be treating patients or their families who are resorting to bringing medication here from abroad because they cannot obtain it on prescription here as if they are committing a criminal offence. Neither should patients have their medication confiscated… this cruel practice must not happen again.”

The Committee doesn’t recommend decriminalising other routes of access to cannabis products for patients unable to obtain prescriptions in the UK, such as self-cultivation. Not all patients have the physical, mental or financial ability to travel overseas to obtain prescriptions. The CDPRG recently featured the case of ‘Elizabeth’, an MS sufferer in her mid-fifties who was arrested and charged this year for cultivation and possession of 9 cannabis plants that she was growing to manage her condition. Elizabeth had attempted access of CBMPs through legal medical routes but could not sustainably afford a regular private prescription.

This omission may be due to a belief that cannabis produced by pharmaceutical companies is very different to cannabis cultivated or distributed illegally. The report is correct in saying that cannabis products on the unregulated market are of inconsistent quality, but street cannabis isn’t uniquely high in THC. The standardized medical cannabis product Bedrocan contains 22% THC and less than 1% CBD.  While non-standardised cannabis products from the unregulated market, including self-cultivation, are far from the consistent, sterile products on the medical market, patients who are unable to obtain NHS prescriptions, unable to afford private prescriptions and incapacitated from traveling abroad have little other option available. No patient should be treated as a criminal for trying to be well.

Meeting the urgent needs of British patients requires priority action

Meeting the urgent needs of British patients who can benefit from medicinal cannabis requires priority action. We need immediate resources for clinical research to provide children with intractable epilepsy the medications they require. Government must assure patients with evidence-based clinical needs for CBMPs that they will not be treated as criminals for doing what they must to access medicines that work for them, however they achieve it. We need more constructive collaborations between Government, clinical science and industry. We need assurance that, as promised by Health Secretary Matt Hancock, funding won’t be an obstacle to prescriptions. This might be achieved by the development of a central subsidy fund to reduce the economic burden of prescribing unlicensed CBMPs on local NHS trusts.

The report provides a balanced, if limited, assessment of the state of play regarding cannabis-based medical products on prescription in the UK. The CDPRG will be urging movement on each of these barriers. Patients deserve a robustly evidence-based yet compassionate and pragmatic approach to medical cannabis that achieves better health outcomes for Britain.

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AEA: anandamide, the first identified endogenous (made in our body) cannabinoid
Bioavailability: the ability of a medicine to get into our bloodstream
CB1: the first identified cannabinoid receptor
CB2: the second identified cannabinoid receptor
CBD: cannabidiol, phytocannabinoid that does not cause a high
CBMPs: cannabis-based medicinal products
Clinical trial: an investigation of the effectiveness of a medicine, usually in comparison to
placebo and/or standard care (controlled)
DDI: drug-drug interactions, when one medicine interferes with the action of another
Dronabinol: synthetic THC, licensed in the US
Epidiolex: pure CBD produced as a medicine licensed in epilepsy in the US
Nabilone: a structural analogue of THC, licensed in the US and UK
Primary endpoint: the main outcome of a clinical trial the investigators hypothesise will be
positively changed by a medicine (usually a pain rating in this subject area)
RCT:randomised controlled trial, the gold standard of clinical research
Sativex: CBD:THC in a 1:1 ratio licensed internationally for spasticity in MS, also known as
Secondary endpoint: additional supportive or important outcomes of a clinical trial the
investigators think will be positively changed by a medicine (often includes quality of life
Sublingually: a medicine taken under the tongue, common for CBMPs
-tetrahydrocannabinol, an abundant metabolite of the cannabis plant that causes
the ‘high

The Centre of Medicinal Cannabis (CMC) has
commissioned a series of reports on the therapeutic
potential of cannabis-based medicinal products
(CBMPs) in a range of disorders for which CBMPs
are commonly used, of which this report is the first.
The aim of this report is to be an educational tool
and resource for patients and their families, carers
and healthcare providers. To ensure we included
the right material, we sought the input and feedback
from relevant stakeholders (patients, scientists,
clinicians and charities) from the beginning and
throughout the process. As this is an evolving
research area, we plan to revise the report regularly.
We have set out the evidence for CBMPs use in
pain based on the published literature of scientific
research, survey data and clinical trials, covering the
key issues such as doses, bioavailability, side effects
and drug-drug interactions. The report concludes
with testimonies from patients and doctors on their
experiences with CBMPs in pain. If you would like
to input on feedback on the next version of this
report, please email pain@thecmcuk.org
The use of CBMPs for the treatment of pain is now
legal in the UK, although not recommended by the
Royal College of Physicians or the Faculty of Pain
Medicine of the Royal College of Anaesthetists
(with the potential exception of the palliative
care setting). Despite this, there is wide-spread
self-medication of pain sufferers with cannabisbased products to relieve pain and comorbidities
such as sleep problems and anxiety. Evidence
from clinical trial data suggests several products
appear to be beneficial including whole plant
and extracted phytocannabinoids, although
more robust evidence in large patient groups is
required, especially for any future positive National
Institute for Health and Care Excellence (NICE)
recommendation. Anecdotal and clinical trial data
suggest that the side-effects of CBD are usually
mild and tolerable, although potential drug-drug
interaction should be considered. Side-effects of
THC alone or THC-dominant products, especially
in higher concentrations, may be moderate or even
severe, and often leads to cessation of treatment.
International use of CBMPs in pain show emerging
evidence of opioid sparing effects. UK-based
research on the use of CBMPs in pain is limited to
date, but there is growing patient appetite, clinical
interest and industrial and government funding in
the potential of CBMPs, so the future looks positive.

UK legislative context
In the summer of 2018, Home Secretary Sajid Javid
announced the UK would be making medicinal
cannabis available after receiving advice from
Professor Dame Sally Davies, Chief Medical Officer
for England and Chief Medical Adviser to the
UK government, that cannabis-based medicinal
products should be moved out of a Schedule 1
classification where compounds have no medicinal
value. On November 1, 2018, cannabis-based
medicinal products (CBMPs) were rescheduled to
allow lawful prescription as unlicensed medicines by
specialist doctors (consultants)1
. The Home Office
definition of a CBMP is as follows:
• the product is or contains cannabis, cannabis
resin, cannabinol or cannabinol derivatives
• the product must be produced for medicinal use
in humans
• it must be a product that is regulated as
a medicinal product or an ingredient of a
medicinal product
Current guidelines for CBMPs in Pain
After the change in law, the UK government
asked for interim guidance on the medicinal use
of CBMPs. One report was jointly produced by
the Royal College of Physicians (RCP), the Royal
College of Radiologists (RCR) in liaison with the
Faculty of Pain Medicine of the Royal College of
Anaesthetists. The summary of their research was
that ‘There is limited research available from which
to create guidance on the effect of CBMP on pain in
palliative care patients, including those with cancer.
Studies show mixed results or statistically significant
results of uncertain clinical significance. In view of
this and the adverse effects associated with CBMP,
their place in the treatment of pain in palliative care
patients is unclear and not recommended in routine
clinical practice. There is no robust evidence for the
use of CBMP in chronic pain and their use is not
recommended2.’ The NHS website states ‘There is
some evidence medical cannabis can help certain types
of pain, though this evidence is not yet strong enough to
recommend it for pain relief3.’ For these reasons, it is
likely to be extremely challenging to access CBMPs
for pain management under the NHS.
The National Institute for Health and Care
Excellence (NICE) is currently defining the final
guidelines which will be published no later than
October 20194. Chronic pain has been listed as
a key area that will be covered in their research.
Within this, specific considerations will be given
to young and older people, those with learning
disability or mental health problems, and pregnant
or breastfeeding women.

Introduction to cannabis and cannabinoids
The cannabis sativa plant produces hundreds of
chemicals which are concentrated in structures
called glandular trichomes on the flower of the
plant. These chemicals are known as cannabinoids;
or more specifically, phytocannabinoids, because
they come from the plant. Usually, the most
abundant phytocannabinoid found in cannabis
flowers is Δ9-tetrahydrocannabinol (THC). THC
normally comprises about 10-18% of the
chemicals depending on the cannabis plant strain.
This is the psychotropic (mood altering) chemical
that produces the responses in our body that you
might be familiar with; euphoria (feeling high),
increased appetite, effects on memory and
analgesia (the ability to relieve pain). Normally, the
next most abundant cannabinoid is cannabidiol
(CBD). CBD is the chemical that makes you feel
mellow and reduces anxiety5
, and is evidenced to
be useful
in a wide range of disorders such as epilepsy,
schizophrenia, post-traumatic stress disorder
(PTSD) and stroke6
The definition of a cannabinoid can include
chemicals that are similar to phytocannabinoids
and that bind to the cannabinoid receptors in our
body. This includes synthetic cannabinoids that are
manufactured artificially (these may be structurally
similar or identical to phytocannabinoids or
structurally diverse such as street “spice”) and
endocannabinoids, chemicals that are produced
within our bodies (see below) to control a range of
Introduction to the endocannabinoid system
Initial scientific thinking was that cannabis had a
non-specific effect on the function of cells in our
body. However, approximately 30 years ago, it was
discovered that there are particular proteins (called
receptors) on the surface of our cells that recognise
and bind cannabinoids, resulting in a change in the
function of these proteins. This leads to the effects
we recognise when people consume cannabis
preparations. The first receptor discovered was
called the cannabinoid receptor 1 (CB1). Activation
of CB1 is the way THC brings about most of its
biological effects such as euphoria, appetite
stimulation and analgesia. The CB1 receptor is
found all over the body, but has particularly high
levels across the brain. The second cannabinoid
receptor, called cannabinoid receptor 2 (CB2) was
discovered a couple of years later. It is expressed
particularly in cells of the immune system, but levels
of this receptor are increased in many tissues
whenever there is damage or infection.
After the discovery of cannabinoid receptors in our
body, people began to investigate whether
we produce chemicals within our body that
bind to these receptors, and quickly discovered
a molecule derived from fatty acids called
arachidonoylethanolamine (also known as
anandamide, AEA). AEA is similar to THC in that it
can activate both CB1 and CB2. A second
compound called 2-arachidonoylglycerol (2-AG,
also activates CB1 and CB2) was also found soon
afterwards. These compounds were termed
‘endocannabinoids’ and we now know that these
represent two families of endocannabinoids which
are formed through independent pathways in our
5 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5595771/
6 https://www.sciencedirect.com/science/article/pii/S1043661816000396?via%3Dihub
The use of cannabis-based medicinal products (CBMPs) in pain 7
7 http://www.mhra.gov.uk/home/groups/par/documents/websiteresources/con2033379.pdf
8 https://bnf.nice.org.uk/drug/nabilone.html
9 http://marinol.com/
10 https://www.epidiolex.com/
11 https://www.upalliance.org/2018-upa-patient-survey-results
The endocannabinoid system is involved in
almost every biological function in the body, and
particularly in the central nervous system, which
is why there is a role for cannabinoids in the
modulation of pain.
Currently licensed CBMP medicines
The Home Office definition of a CBMP represents
an incredibly broad potential range of products
which potentially complicates clinical decision
making. We recommend that there are four types
of CBMPs for which we have clinical trial evidence:
• Whole flower products (such as Bedrocan
Flos or similar flower products) which can be
purchased with specific ratios of THC:CBD
according to the patient’s preference.
• Products that have a CBD:THC ratio of 1:1 (such
as Sativex7, which is licensed internationally
for spasticity in MS. However, it should also be
recognised that Sativex also contains other plant
products in small quantities).
• THC only products (such as nabilone8 (a
molecular similar to THC, licensed in the US
and UK) and dronabinol9 (a synthetic version of
THC, licensed in the US), which are licensed for
HIV/AIDS induced anorexia and chemotherapy
induced nausea and vomiting).
• CBD only products (such as Epidiolex10, which
is licensed in the US for seizure reduction in
Evidence exists in the form of clinical trial data and
patient testimonies that each of these

products may
be useful in the management of pain.
CBMP use in pain management
The use of CBMPs for pain in the UK
The United Patients Alliance (UPA) carried out a
survey on UK medicinal cannabis users in 201811
This self-administered questionnaire investigated
the extent and range of consumption of cannabis
for medicinal purposes and was conducted from
July to August 2018. The UPA survey found the
largest primary reason that patients were using
cannabis was for the relief of pain (10.7%). arthritis
(3.8%), fibromyalgia (3.5%), migraines (3.1%),
headaches (2.7%), sciatica (2.5%) and neuropathy
(2.5%) were listed separately as primary reasons for
medicinal cannabis use. Together, this suggests that
nearly 29% of medicinal cannabis users in the UK
do so for the primary relief of pain, or 65% if you
combine patients who use CBMPs for pain as the
primary and also secondary reason. The other
primary reasons for CBMP use in the UK according
to the survey were depression, anxiety, insomnia,
arthritis, muscle spasms and gut disorders. The
2018 UPA data is in agreement with an older UK
survey from 2005 of 2969 medical cannabis users
where 25% reported using for chronic pain, 21%
reported using for arthritis and 19% reported using
for neuropathy.

Surveys from other countries
A survey carried out in north-eastern US and
published in 2017 found that 64% (of 1,513
patients) were using cannabis for chronic pain. In
Canada, a survey of 628 consumers of cannabis for
therapeutic purposes in 2013 showed that 82%
were using for pain symptoms. A 2005 survey of
128 patients in Australia found 57% were using
medical cannabis for chronic pain and 35% were
using for arthritis.
Together, these surveys show that pain is the main
indication for which CBMPs are used in patient
groups across the globe.
Which cannabis-based products are preferred for
pain management?
The UPA survey of medicinal cannabis users in the
UK found similar use of CBD-dominant or THCdominant products for the treatment of pain as the
primary condition (17% versus 20%). However,
more patients appeared to use CBD-dominant
products in the treatment of fibromyalgia (16%
versus 6%) and arthritis (8% versus 3%). A survey by
the Brightfield Group12 questioned 2,400 HelloMD
medicinal cannabis community members about
their medicinal cannabis use. They found roughly
equal numbers of THC-dominant users compared
with CBD only users when looking at joint pain,
migraines, arthritis of chronic pain. In a recent selfselected survey of 2490 CBD users in the US13, the
top three medical conditions reported were chronic
pain, arthritis/joint pain, and anxiety. Almost 36%
of respondents reported that CBD treated their
medical condition ‘‘very well by itself’’.
Together, this suggests there is no major preference
amongst patients for either THC-dominant or
CBD-dominant products in the treatment of pain.
In UK patients, CBD seems to be preferred in the
treatment of fibromyalgia and arthritis, although it
should be noted that this might also reflect easier
access to CBD products in the UK.
Scientific evidence
Animal data and mechanisms of action
The analgesic properties of the cannabis plant
have been utilised for centuries in Western and
Eastern medicine. However, the understanding of
the analgesic effects of cannabis did not begin to be
investigated scientifically until the active chemicals of
the plant were discovered in the 1960s, and until the
cannabinoid receptors were identified in the 1990s.
It is worth noting that other phytocannabinoids
such as cannabinol (CBN) and cannabichromene
(CBC) can also reduce pain in animal models, but
these have been less studied than THC or CBD, and
have not been explored clinically in patients. From
the scientific literature, it has been shown that THC
and CBD have different mechanisms of action, and
several studies have shown that combined treatment
with THC and CBD is more effective than either
compound alone14.
Δ9-tetrahydrocannabinol has been shown to be an
effective analgesic in a wide range of animal models
of pain since the 1970s. The mechanism of action
of THC in pain mainly involves activation of the

CB1 receptor, causing inhibition of the transmission
of pain signals. The pain-relieving effects of
THC can also involve CB2 activation, for example
in inflammatory pain conditions. Additionally,
interactions occur between cannabinoid and opioid
receptors such that THC enhances the pain relieving
effects of opioids (a process discussed further in
the section on cannabinoids and opioids). THC has
also been recently shown to enhance the function of
glycine receptors which modulate nociception (the
perception of pain) in animal studies.
In animal models, the analgesic effect of CBD is
thought to involve the activation of serotonin
receptors and ion channels (pores through the cell
membrane that allow the transport of ions) called
TRPV1 and TRPA1. Like THC, animal studies have
shown that some of the analgesic effects of CBD
are partly brought about by the ability of CBD to
affect glycine receptor function. There does not
appear to be a role for CB1 or CB2 activation by
CBD in pain models other than the suggestion that
CBD can increase the levels of endocannabinoids,
and thus indirectly cause cannabinoid receptor
activation. Recent animal studies also suggest
that CBD enhances the pain-relieving effects of
morphine (an opioid).
Clinical Evidence
Summary of published human clinical trials
When the clinical evidence base for the use of
CBMPs in patients with pain was considered, a total
of 69 clinical trials published between 1975 and
2018 were identified. A full reference list of all the
clinical trials included in this analysis can be found at
the end of the report by CBMP type.
The majority of these studies were small in size,
and only 11 of these trials involved more than 100
patients. In general, large patient numbers are required
to sufficiently establish the effectiveness of a drug,
especially when the outcome measure is subjective.
Nine of these larger trials reported positive effects of
CBMPs in reducing pain. It is on the basis of multiple
small studies that the evidence base for CBMPs in pain
is largely held to be inadequate. It is also very difficult
to judge how effective CBMPs are in pain based on
this clinical trial data because of the different types
of CBMPs tested, by different routes of administration,
carried out in very different patient populations across
trials. Of the CBMPs tested in randomised controlled
clinical trials, only Sativex has been examined in large
patient numbers. The data from these trials with
Sativex support its licensing for the symptomatic relief
of neuropathic pain in Multiple Sclerosis in Canada.
Effective products in the pain setting
Because different CBMPs have different
pharmacological properties, we divided the 69
studies into those that examined the effects of
the whole plant, pure CBD, pure THC, or a ratio of
THC:CBD (Sativex). In general, trials examining
the effects of the whole plant (77% of trials positive
for their primary endpoint) or Sativex (65% of trials

positive for their primary endpoint) were more likely
to show an improvement in pain ratings (both patient
and clinician reported) across a range of pain settings
compared to THC alone (46% of trials positive for
their primary endpoint). Patient testimony to this
effect can be found here15. Only three, small clinical
trials examining the effects of CBD in pain have been
published to date, but all were positive.
Total number of studies
Positive trials
Negative trials
Mixed results
Positive trials with >100 patients
Pain conditions improved in
positive trials
Route of administration
Whole plant
11 (79%)
1/1 (100%)
Chronic pain,
neuropathic pain,
fibromyalgia, spinal
cord injury, diabetic
neuropathy, pain
associated with
Multiple sclerosis,
Tea, smoked,
11 (65%)
6/8 (75%)
Pain associated
with Multiple
sclerosis, cancerrelated pain,
pain, diabetic
neuropathy, pain
due to rheumatoid
Sublingual spray
16 (44%)
1/2 (50%)
Multiple sclerosis,
chest pain, diabetic
neuropathic pain,
pain, chronic pain,
cancer-related pain
Oral (tablets,
capsules, solution,
sublingual spray)
3 (100%)
pain, dysautonomic
neuropathic pain
Sublingual spray
or oil
Positive trials saw a significant change in the
primary outcome of the trial (usually a pain rating
score) and negative trials did not show a change in
the primary outcome. Mixed trials failed to change
the primary outcome, but showed positive effects in
some of the secondary outcomes.
Secondary (non-pain) endpoints
For many pain studies where a cannabis-based
medicine has been tested, it has often been
found that there is a significant improvement for
patients in secondary measures/endpoint (other
than pain). Some examples of other aspects of
chronic pain conditions that have been significantly
improved by CBMPs in various clinical trials include
anxiety, depression, mood, sleep, daily functioning,
social functioning, range of spine motion, global
The use of cannabis-based medicinal products (CBMPs) in pain 11
impression of change and quality of life. This data
is in agreement with the anecdotal evidence and
testimonies from CBMP-using pain patients who
feel that CBMPs holistically improves many aspects
of their condition.
Effective doses and delivery mechanisms in
pain disorders
Sativex: Clinical trials that have demonstrated
Sativex to be effective in pain settings have used on
average between 6 and 12 sprays per day with the
guidance of a maximum of 8 sprays per 3-hour period
and 24 sprays within a 24 hour period. Each spray of
Sativex contains 2.7 mg of THC and 2.5 mg CBD and
is delivered sublingually (under the tongue).
THC: Clinical trials that have demonstrated THC
to be effective in pain settings have used a dose of
between 3mg and 20mg, two or three times a day,
with a maximum dose not exceeding 30 mg/day
to avoid side effects. It is recommended to start
low and use a step up phase; ‘Start low and go slow!’
In clinical trials, THC was usually given orally (by
tablet, capsule or in a solution).
CBD: Clinical trials that have demonstrated CBD
to be effective have used between 150-300mg
per day, and CBD was given sublingually or by oral
Whole plant: It is more difficult to tell the exact
dose of cannabinoids administered in whole plant
studies. Usually the THC content is detailed,
ranging from 1-7% in plant material, and this is
delivered as leaf, in a cannabis cigarette or vaped/
inhaled. It should be remembered that when the
whole plant is administered, it will contain small
quantities of many other phytocannabinoids,
terpenes and flavonoids16 that may have additive
or synergistic effects (known as the entourage
hypothesis) compared to isolated compounds.
Smoking CBMPs is not allowed under the new
UK legislation.
Phytocannabinoids have low oral bioavailability
(which means that they don’t easily get into our
bloodstream when taken orally) because they
are highly lipophilic (fat loving) compounds. This
may have played a factor in some of the negative
findings in trials if insufficient quantities of relevant
compounds enter the bloodstream. Alternative
methods of administration (which many researchers
and companies are trying to achieve) may prove
to be more successful in future pain trials if better
delivery of cannabinoids into the bloodstream
can be achieved. Some suggested mechanisms to
improve cannabinoid drug delivery are via nano-or
ionised particles, or using carriers to aid absorption
in the gut. Alternatively, cannabinoids could be
delivered via vaping, the transdermal (across the
skin) route (including gels and patches), intranasal
(through the nose) administration and transmucosal
(across the lining of the mouth) absorption.
These routes are all commonly used with existing
medications for pain. Future studies are required
to establish if this will enhance the effectiveness of
phytocannabinoids in pain conditions.
Several studies suggest that CBMPs are better
absorbed in the body when taken after food, and are
therefore usually recommended to be taken with
food when administered orally17
16 https://www.fundacion-canna.es/en/flavonoids
17 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6223703/
The use of cannabis-based medicinal products (CBMPs) in pain 12
In pain studies, the majority of side-effects of
CBMPs were mild to moderate, but tolerable and
reversible i.e. stop when the medication is stopped
(see the below tables for more details). Typical
side-effects include dizziness, dry mouth, nausea,
palpitations, cough, fatigue and gastrointestinal
related effects. Moderate side-effects were
associated with the psychoactive effects of CBMPs
(euphoric or dysphoric effects, mild sedation and
drowsiness) and tended to be associated with
higher THC doses (15-20mg). The withdrawal rates
from clinical trials were higher in trials that tested
THC only medicines.
Using CBD with THC appears to reduce the sideeffects of THC, and mild side-effects were observed
in response to Sativex and whole plant extracts.
For studies that used CBD only, nausea, dry
mouth, dizziness, and drowsiness were reported as
common side-effects. The reported side effects of
Sativex18 are dizziness, which occurs mainly during
the initial titration period, nausea and fatigue. These
reactions are usually mild to moderate and resolve
within a few days even if treatment is continued.
Rare, but more severe, reactions to CBMPs
can include psychosis, paranoia, depression,
hyperemesis and diarrhoea, and are usually related
to high THC levels. There is some animal model
evidence to suggest, especially relating to the
developing brains of children, that some of these
THC-related side effects may not be reversible.
It is worth noting that traditional analgesics are
fraught with side effects (some life threatening),
often much less tolerable than those experienced
by patients taking CBMPs. Patient testimonials
suggest to us that for some people, the side effect
profile of CBMPs is considerably better.
CBMP effectiveness by pain disorder
Pain represents a large area of unmet clinical need,
and there are many types and generators of pain.
Pain is also a variable symptom that can be daily or
seasonally affected and therefore requires flexible
medication. A number of common types and causes
of pain that have been best explored in clinical
trials using CBMPs are detailed below to identify
whether particular pain conditions respond better
to CBMPs.
– Multiple sclerosis (MS)-related pain
11 trials were identified examining a CBMP in
MS-related pain, which are presented below
in chronological order. Five have been carried
out using Sativex, of which four studies showed
significant reductions in MS-related pain and sleep
disturbances. Sativex is licensed for MS–related
pain in Canada. Five studies have examined THC
alone, although only one of these was in large
patient numbers. The smaller THC trials all showed
a significant decrease in pain in MS patients,
although the larger trial with dronabinol (240
patients) failed to show a significant change in pain
intensity from baseline.
18 http://www.mhra.gov.uk/home/groups/par/documents/websiteresources/con2033379.pdf
The use of cannabis-based medicinal products (CBMPs) in pain 13
Positive trials (green) saw a significant change in the
primary outcome of the trial. Mixed trials (orange)
failed to change the primary outcome, but showed
positive effects in some of the secondary outcomes.
– Cancer-related pain
Eight trials to date have examined the use of
CBMP in cancer-related pain, presented below
in chronological order. Three of these trials
were carried out in larger patient numbers, all
investigating Sativex. Of these, two were positive
and one was negative (although the negative trial
did see improvements in quality of life and sleep
disruption in patients).
A summary of the clinical trials examining the effects of CBMPs in MS-related pain.
The use of cannabis-based medicinal products (CBMPs) in pain 14
Positive trials (green) saw a significant change in the
primary outcome of the trial. Mixed trials (orange)
failed to change the primary outcome, but showed
positive effects in some of the secondary outcomes.
Red trials did not find a beneficial effect of CBMP
– Neuropathic pain
Cannabinoids may provide effective analgesia
in chronic neuropathic pain conditions that are
refractory to other treatments. 15 clinical trials
were identified which examined a CBMP in
neuropathic pain, presented below in chronological
order. In general (12/15), the outcome of these
studies tended to show a positive effect of CBMPs.
Three of these trials were in larger patient numbers
and all showed a positive effect of Sativex in
reducing neuropathic pain. Seven studies examined
the inhalation, smoking or vaporisation of whole
plant extracts, and six of these studies were positive,
but these studies were in much smaller patient
numbers. CBD alone has not been tested in any
neuropathic pain trials.
A summary of the clinical trials examining the effects of CBMPs in cancer-related pain.
The use of cannabis-based medicinal products (CBMPs) in pain 15
A summary of the clinical trials examining the effects of CBMPs in neuropathic pain.
Positive trials (green) saw a significant change in the
primary outcome of the trial. Mixed trials (orange)
failed to change the primary outcome, but showed
positive effects in some of the secondary outcomes.
A recent Cochrane review in this area19 examined
clinical trial data from 1,750 participants and found
19 https://www.ncbi.nlm.nih.gov/pubmed/29513392
The use of cannabis-based medicinal products (CBMPs) in pain 16
that cannabis-based medicines may increase the
number of people achieving 50% or greater pain
relief compared with placebo. However, it should
be noted that more participants receiving cannabisbased medicines withdrew from the studies due to
adverse events (including psychiatric disorders).
They concluded that the potential benefits of
cannabis-based medicine in neuropathic pain might
be outweighed by their potential harms.
– Fibromyalgia
Our research identified five trials examining a
CBMP in fibromyalgia, which are presented below in
chronological order. All trials showed some positive
effects either in pain (with Sativex or whole plant),
sleep (Sativex, THC), anxiety (Nabilone), although only
Sativex has been tested in large patient numbers.
Potential drug-drug interactions (DDIs)
As with all medicines, the potential for drug-drug
interactions (DDI) is present with CBMPs, and
warnings are present in the patient information
sheets for Epidiolex and Sativex regarding this.
Dose adjustment of other co-administered drugs
may be required because of the ability of CBMPs
to interfere with the metabolism (breakdown) of
medicines in the liver.
A summary of the clinical trials examining the effects of CBMPs in fibromyalgia.
The use of cannabis-based medicinal products (CBMPs) in pain 17
In epilepsy, DDIs have been reported between CBD
(Epidiolex) and medicines that are metabolised by
the liver enzymes CYP2C19 and CYP3A4, where
CBD inhibits the metabolism of anti-epileptic
medicines normally broken down by these enzymes.
On occasion dose reductions of other medications
that have been inhibited by CBD have been
necessary, this is most common with Clobazam.
It is thought that some of the adverse effects
observed with CBD medications may actually
result from concurrent medication whose plasma
concentrations are raised due to the inhibition of
metabolism by CBD. There is also one case report
of a DDI between CBD and warfarin, possibly
because of competitive inhibition at CYP2C9 or
CYP3A4. In clinical trials with Sativex, no clinically
apparent DDIs have been observed.
Cannabis-based medicines and driving
It is an offence to drive whilst impaired through
drugs (whether due to non-medical use of drugs
or due to legitimate use of medicines) in Section
4 of the Road Traffic Act 1988. There is also a
new offence which refers to driving, attempting to
drive or being in charge of a vehicle with a specified
controlled drug in the body, in excess of a specified
limit (Section 5A of the Road Traffic Act 1988 as
amended in April 2013), which includes THC set
at a very low limit. It is a driver’s responsibility
to decide whether they consider their driving is,
or they believe might be, impaired on any given
occasion. Based on existing best practice, current
advice given to patients about issues related
to ‘medicines and driving’ typically covers the
following points, as relevant to each case:

Not to drive if any symptoms or signs develop
suggesting that their driving may be impaired,
such as experiencing sleepiness, poor
coordination, impaired or slowed thinking,
dizziness, or visual problems.

Not to drive at certain times when the risk may
be temporarily increased, for example, when first
starting, or when first increasing or reducing the
dose of a medicine that may potentially impair
their driving.

To take particular care in circumstances that may
increase the risk of their driving being impaired
whilst taking their medicine, and to avoid driving
if this occurs.

To be aware that alcohol taken in combination
with other impairing drugs can substantially
increase the risk of accidents.
It should be remembered that while THC is the
most likely compound to cause impairments
in driving, some of the side-effects of CBD are
dizziness and drowsiness, so patients should take
care with CBD products. If you are stopped by the
police, a new ‘medical defence’ can be raised for the
offence if drivers are taking medication as directed
and found to be over the limit and not impaired20.
20 https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/325275/healthcare-profs-drug-driving.pdf
The use of cannabis-based medicinal products (CBMPs) in pain 18
21 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5520783/
22 https://www.ncbi.nlm.nih.gov/pubmed/30690169
23 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5690609/
24 https://www.ncbi.nlm.nih.gov/pubmed/30691503
Cannabinoids and opioid-sparing effects
Cannabinoid and opioid receptors are expressed
in several brain regions involved in the regulation
of pain, and have been shown to co-localise (be
expressed next to each other on the cell membrane).
For this reason, scientists have researched whether
cannabinoids and opioids can influence each other’s
activity and ability to reduce pain. Numerous animal
studies have now shown that there is a synergistic
effect from opioid and cannabinoid
To establish whether this is also true in the
treatment of patients, a number of studies have
investigated the effects of medical cannabis on
opioid use within pain patients. A study in 2016
showed that medical cannabis use is associated
with 64% lower opioid use in 244 patients with
chronic pain. A more recent study from Michigan
published in 2019 showed that approximately 80%
of 1,321 chronic pain patients reported substituting
cannabis for traditional pain medications (53% for
opioids, 22% for benzodiazepines), citing fewer
side effects and better symptom management as
their rationale for doing so22. A 2017 study found
that 37 chronic pain patients who enrolled in a
Medical Cannabis Program were more likely to
stop or reduce their opioid prescriptions compared
to 29 non-enrolled patients23. Data from Canada
published in 2019 also suggests that patients report
they are using less opioids and other analgesic
drugs, alcohol, tobacco, and illicit substances24.
Together, this suggests that cannabis use for chronic
pain may lead to reductions in opioid usage, a theory
which should be tested more rigorously through
further clinical trials.
Upcoming clinical trials in the pain setting
There are 29 trials active registered on clinicaltrials.
gov investigating CBMPs in pain. The majority of
these trials are all located in the US, Canada and
Israel, which is reflective of the fact the cannabis
use for medicinal reasons has been legal in these
countries for many years.
Phase 2 trials
Phase 3 trials
1 Chronic
non-cancer pain
1 Arthritis
1 Low back pain
1 Medical abortion
THC:CBD (1:1)
1 Chronic
non-cancer pain
1 Chronic pain
other ratios
1 Pancreatic cancer
1 Cancer pain
1 Chronic pain
Whole plant
2 Cancer pain
1 osteoarthritis
1 Low back pain
1 HIV neuropathic
1 Cancer pain
The use of cannabis-based medicinal products (CBMPs) in pain 19
Patient testimonies
Carly Jayne Barton
‘I was diagnosed with neuropathy and fibromyalgia following a stroke in my twenties. Alongside hundreds
of neurological symptoms; my most dominant pain experiences were: Allodynia throughout all of my
upper torso, chronic widespread and intractable neuropathic pain, involuntary movements and prolonged
spasticity. These were often triggered by very benign and sometimes undetectable sensory events, such
as certain types of lighting, sounds, smells, stress, hormones, temperature etc. The pain was constant and
never dipped below a 7/10.
I was initially given Barbiturates, Gabapentinoids, Benzodiazepines, mild Opiates and sleeping tablets.
None of these treatments helped my symptoms and so stronger doses of opiates were prescribed, this
eventually led to high doses of Morphine and Fentynal being introduced. For every increase in dose I
got some mild relief, however after a period of eight weeks the pain levels were just as bad, if not worse
than before. I felt increasingly depressed, my pain was getting worse, I was not able to function and the
side effects were intolerable. These included: opioid induced hyperalgesia, feelings of worthlessness,
depression, cognitive decline, seizures, absences, lack of motor control, visual disturbances, speech issues,
memory loss, apathy, dizziness, drowsiness, weight loss etc.
My body also became very quickly dependent on the opiates and I would have terrible withdrawal
symptoms if I forgot to change a patch or missed a few doses.
The experience of cannabis was totally different. Rather than feel that my cognitive functioning was
being impaired by treatment, I found that when I would consume cannabis my memory would be better,
as would my word recall and ability to process language. Whereas with opiates I could bring pain down
from an 9/10 to a 5/10 within a quarter of an hour, inhaled cannabinoids have the ability to bring that
same pain down to a 2/10 in the space of 3-4 minutes. Regular dosing means that I can mostly escape
the likelihood of my pain extending over 6/10 on most days. Maintaining homeostasis for me means my
Central Nervous System is less likely to be reactive. In that sense Cannabis is both a preventative and a
rescue treatment for me. In terms of side effects, when I Initially began consuming I would feel a change
in mood quite soon after consumption, I experience a dry mouth, which means that I naturally drink more
fluids throughout the day. I sometimes feel drowsy with certain strains, which can be helpful to sleep – this
is easily rectified by making the right strain choices at the right time of day.’
The use of cannabis-based medicinal products (CBMPs) in pain 20
Julie Durrans
‘Three years ago I was so unwell I had to sell my travel agency business. At that time, I was taking
prescribed Gabapentin, diazepam, codeine, naproxen, fluoxetine and lansoprazole. I was in severe pain,
couldn’t walk far, used crutches when I did and had no energy plus severe brain fog. I began using cannabis
to treat pain symptoms and found relief enough to begin physio and Pilates plus swimming. My health
slowly improved. I moved two years ago to an area with a cannabis club and started to educate myself
into everything I could to do with weed. I made oils and tinctures, edibles and learnt what strains work
and what didn’t.
A year ago I began reducing my pharmaceuticals. Today I just take half the dose I was on of fluoxetine
and I have codeine for emergency use but rarely take. I still have pain flare-ups but mostly I can control
them quickly and keep them at bay. Exercise is easier. I’ve reduced my weight by three stone. The brain
fog is massively reduced. My love for cannabis as medicine has become my passion. I feel well enough
to consider a return to work. I’m researching starting up a new business-a small tour operator to take
patients to Jamaica to learn how cannabis might help them using legal and prescribed cannabis.’
Stephen Spencer
‘First had problems with my right shoulder (right handed) four weeks after the birth of my first child. This
was later diagnosed as mild FSH Muscular Dystrophy. I was prescribed the following but all had side
effects I could not live with:
Naproxen and Lansoprazole – cause abdominal cramps and stomach tenderness.
Co Codamol (highest strength) – made me zombie like and gave me terrible constipation which
was very painful.
Amitriptyline – this made me have suicidal thoughts.
PreGabalin – this messed with my head, I didn’t know where I was or why I was there, complete
zombie. Plus just dropping 10mg caused me to have three days of flu like symptoms from
Tramadol – Made me snappy and irritable when not using it, caused an anxiety attack, I would see
double, I was not connecting with life at all, couldn’t remember anything.
Baclofen – after suffering the side effects of the other drugs I read about this one first and decided
it was too dangerous and did not take it.
After going through all of these over the course of a year. I had a car crash when we were six weeks
pregnant with our second child. I then developed Fibromyalgia (FM) which affects my right arm, both
hands, my lower back, my hips, my legs and my feet. I waited seven months for a pain clinic appointment,
but when I got there he did not care about my FM he was only bothered about my shoulder, offered me a
steroid injection which I refused because my shoulder wasn’t the issue at the time. I asked about Sativex
The use of cannabis-based medicinal products (CBMPs) in pain 21
but no one would discuss it. That is when I decided to use cannabis. I have now used cannabis to treat ALL
of my symptoms every day for the past four and a half years. Use about one gram a day, I vaporise it, use
RSO and make canna butter. It has saved my life; I can sleep, eat, pain is bearable, my mobility is better
and most importantly I can feel like and be me. Pain can be gone or manageable in seconds to minutes,
I can wipe out any bouts of fatigue in seconds, I eat, (without it I have zero appetite) and I sleep, on
cannabis insomnia is not an issue. Which means everything else is easier to deal with. But I have to be a
criminal to use it and it is very costly. My illnesses have taken my life away, I can’t work, I can barely walk,
but cannabis gives me hope of some sort of a normal life without persistent torture.’
Georgina Downs
‘I have had a diagnosis of Fibromyalgia, Osteoarthritis, Osteoporosis, Ehlers-Danlos Syndrome, Migraine,
Morton’s Neuroma, Plantar Fasciitis, Degenerative Spine Disease, Depression and Diverticulitis, amongst
others. In this time my doctors have tried to treat my pain with Amitriptyline, Nortriptyline, Gabapentin,
Duloxetine, 30/500 Co-codamol, Immigran, Morphine patches, Voltarol patches and many, many more.
Taking the above pharmaceutical medication has given me many unwanted and serious side effects and
some of them have made me feel extremely ill. Not to mention the cost to the NHS. I remain in constant
debilitating pain, bedridden at times and unable to enjoy even simple things like making a cup of tea or
sitting in an armchair to watch TV.
Last year I have tried CBD with some degree of success. For the past six months, I have been able to try
some pastes with combinations of THC/CBD. These have helped a great deal, they calm my pain down
so that my first thought isn’t “I want a cup of tea but I can’t bear the thought of the pain it would cause,
to get up and make one”. Using the THC I can get out of bed, wash my hair, get downstairs and sit in a
chair! It doesn’t make me high, but it does uplift my mood. It makes me feel like continuing my hobbies
like watercolour painting. It also helps me to get a good restful night’s sleep, essential for Fibromyalgia
sufferers, and in addition to that, I have been able to cope with the nausea caused by weaning myself off
of the Duloxetine.
At the moment I am recovering from an operation to my foot and I have found that the THC has helped
me cope with the postsurgery pain. Relieving my pain with THC has meant that I am breaking the law
for the first time in my life! I have a constant worry that I will run out and have to resort to the opiate
painkillers that I have prescribed for me, and suffer the side effects of constipation, drowsiness, painful
stomach aches etc.
I am unable to work, I cannot afford the cost of sourcing my THC pastes from abroad, but I don’t want to
put myself at risk of trying to find “Street Weed” of which I would have no idea of what I am getting or how
it will affect me. I need safe, legal access to my choice of pain relief, I want to be able to relieve my pain
without causing harmful side effects. I don’t want to dread running out of my pain killing THC.’
The use of cannabis-based medicinal products (CBMPs) in pain 22
Mrs June Wray
‘I write about my experience of CBD… I have been down the path of prescribed medicines for pain, all of
which went on to give me other medical problems mainly severe constipation, severe tiredness and, on
one occasion, a really bad experience. All of the prescribed medications do have a serious side effect on
other organs of your body too.
With CBD I have not suffered further problems to my health, in fact had an amazing experience after its
first use. I used the flowers of CBD after they were ‘treated’ by heat. I mixed them with chocolate. I am
a non-smoker. The reason I used it was to see if it would help my ‘mesh injured body’ with pain it is in as
a result of two implants. I have also suffered two strokes in 2013/4 the last one cost me my short call
memory and the loss of some long term too to some extent.
After my first use of trying the chocolate I had made I had an amazing result not as much to my pain but
to the effect on my memory…It was amazing how the ‘cotton wool’ feeling I had had in my head ‘lifted.’
It was unbelievable to be honest. I have tried twice stopping its use only to go back to the ‘cotton wool’
effect again. My memory is in a better state too. I think it is both cruel and evil to deny a person any help
with this herb. I am using 18% strength of CBD it helps my body relax too thus helping with pain but not
completely freeing my body to live a better life of which I wish it could.
I do believe that it may need a higher element of THC to aid this. But that is not allowed but it should be
looked into. I have discussed this with my doctor too. As a result of this I no longer take prescribed pain
relief-the medications I was talking were harming my body rather than help it; my pain was not helped
by legal medication. The only thing in my experience that has helped me has been the CBD but it needs
an element of THC or if there’s a higher element of CBD I would be willing to try it. I have suffered no side
effects with CBD.’
‘I suffer from chronic pain due to osteoarthritis of my hips having been prescribed various drugs over
the past few years eg Dichlorfenac, Nefopam, Codeine all of them have very serious side effects as you
should know. For the past three years I have been prescribed Tramadol but only use it very sparingly in
the evening if pain becomes intense. I have found that by using a very small amounts of cannabis I can go
weeks or months without using Tramadol at all and only taking paracetamol. Cannabis seems to facilitate
joint movement rather than dulling the pain, it also has its drawbacks and I have had to experiment using
myself as the guinea pig due to the lack of truthful advice available. Luckily it is not possible to overdose
on cannabis and it is not highly addictive. I would love to have a reasoned discussion about how this could
fit into a pain management program but I have felt uneasy about openly giving any information about
dosages, delivery methods, sources etc. My subjective view is that cannabis could replace opiates for
many cases of chronic pain but the main obstacle at the moment is the threat of arrest and prosecution
which kills any attempts to develop innovative solutions by sharing information openly.