Canadian real-world evidence: observational 24-week outcomes for health care practitioner authorized cannabis
Brian Yanga,b, Calvin Diepc, Sonalben Thakerc, Ted Jacksond, Aly Lakhanie,f, Carolina Landoltg,Elena Popeb,h, Irene Lara-Corralesb,h, Henry Cortes Pradillai, Hai Chuan Yuj, Gretchen Mae Gabrielc,k,Rasheeda Darvillec,k, Ken Weisbrodl, Keriann Tinglinga, Kiritpaul Nandrab,c, Praveen Ganty b,c,k,Joseph Fiorellinob,c,k, Alexander Huangb,c,k, Leeping Taob,k, Mandeep Singhc,m, Peter Chung Tain,Peter Carlenn,o, Karim Ladhac,p, and Hance Clarke
a Department of Anesthesia and Pain Management, Pain Research Unit, Toronto, Ontario, Canada; bTemerty Faculty ofMedicine, University of Toronto, Toronto, Ontario, Canada; cDepartment of Anesthesiology and Pain Medicine, Universityof Toronto, Ontario, Canada; dDepartment of Emergency Medicine, Georgetown Hospital, Halton Healthcare, Georgetown,Ontario, Canada; eDepartment of Medicine, General Internal Medicine Division, Western Hospital, Toronto, Ontario,Canada; fNewmarket Pain Clinic, Newmarket, Ontario, Canada; gIndependent Health Facility, Headwaters Health Care,Orangeville, Ontario, Canada; hDivision of Dermatology, Department of Pediatrics, The Hospital for Sick Children, Toronto,Ontario, Canada; iIndependent Health Facility, Interventional Pain Clinic Hospital Don Benito Villanueva de la Serena,Badajoz, Spain; jDepartment of Anesthesiology, Perioperative and Pain Medicine, University of Calgary, Calgary, Alberta,Canada; kTransitional Pain Service, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada; lTelusHealth, Toronto, Ontario, Canada; mUniversity Health Network, Toronto Western Hospital, Toronto, Ontario, Canada;nDivision of Neurology, Toronto Western Hospital, Toronto, Ontario, Canada; oDivision of Fundamental Neurobiology,Toronto Western Research Institute, Toronto, Ontario, Canada; pDepartment of Anesthesia, St. Michael’s Hospital, Toronto,Ontario, Canada
Affiliationer
Background
With the increasing use of medical cannabis (MC), there is growing evidence suggesting that MC may be an effective therapeutic for chronic sleep, pain, and anxiety conditions. However, further evaluation is warranted to evaluate the heterogeneous patient outcomes of authorized cannabis treatment.
Aims
To assess the effectiveness of authorized cannabis on pain, sleep duration, anxiety, and depression in patients presenting to clinics over a 6-month time period.
Methods
This long-term prospective observational multicenter study utilized data from adult Canadian patients in the Medical Cannabis Real-World Evidence study. With physician guidance, patients were able to choose from Health Canada–verified MC products via a national pharmacy platform. Validated questionnaires were administered at Weeks 0, 6, 12, and 24 to assess pain interference (PROMIS, 6–30), pain score (NPRS, 0–10), sleep duration, anxiety (GAD-7, 0–21), depression (PHQ-9, 0–27), and quality of life (EQ-5D-3 L, 0–10). Outcomes were analyzed using descriptive statistics and generalized estimating equations models as both a per-protocol and intention-to-treat basis.
Results
Improvements in pain, anxiety, depression, and QoL were observed from Baseline to Week 24. Decreases were observed in PROMIS Pain Interference – 4.6 (CI – 6.02 to – 3.17, n = 137), Numeric Pain Rating Scale – 1.19 (CI – 1.7 to −0.68, n = 137), General Anxiety Disorder-7 – 2.24 (CI – 3.5 to – 0.99, n = 139), Patient Health Questionnaire-9 depression −2.79 (CI – 4.29 to −1.3, n = 141), and EQ-5D-3 L – 0.56 (CI −0.96 to −0.16, n = 139).
Conclusions
At Week 24, outcomes in chronic pain, anxiety, depression, and quality of life improved. Although 85% of patients in our study had an MC indication for pain, no outcomes met their minimal clinically significant thresholds at Week 24. These observations align with existing evidence, yet there remains some discrepancies in the current literature. Our findings highlight the need for future studies to characterize MC administration, dose, and specific product relationships.
