A new study led by researchers at the Center for Human Psychopharmacology at Swinburne University of Technology has made significant discoveries in the field of the medical use of cannabioids. Research suggests that medical cannabis, when used as prescribed for a chronic health condition, has a negligible impact on simulated driving performance.
There research was published in the Journal of Psychopharmacology in February 2024.
Medical cannabis has a negligible impact on simulated driving performance
The open-label study evaluated the influence of prescribed medical cannabis on simulated driving performance among 40 patients with a range of chronic health conditions. Participants were assessed on their driving ability in a simulator before and after consuming a standard dose of the prescribed drug.
The results revealed no noticeable deterioration in driving performance during a highway driving simulation at 2.5 hours after consumption, nor was there any residual deterioration in driving performance at 5 hours.
Brooke Manning, the lead author of the article, highlighted the study's crucial role in generating evidence on the safety and effectiveness of medical cannabis treatment.
“Our main finding was the absence of impairment in a simulated highway driving task. We noticed that patients taking the medications as prescribed drove at slightly higher highway driving speeds and reported a decrease in the perceived effort required to drive,” she said.
“It is critical to highlight that this study, while revealing, involved a relatively small sample size and its findings apply specifically to patients undergoing stable, long-term treatment with medical cannabis for refractory conditions.”
The use of medicinal cannabis is booming in Australia. Hundreds of thousands of people have accessed the treatment since it was legalized in 2016, with the most significant increase in uptake coming in the last 18 months, according to the Therapeutic Goods Administration (TGA).
Dr Thomas Arkell of Swinburne, who also contributed to the article, highlights the importance of rigorous scientific research to support this increase in medical cannabis prescriptions.
Dr Arkell is currently leading a major longitudinal study at Swinburne investigating the cognitive and health effects of medical cannabis for chronic pain, which is notoriously difficult to treat and is one of the main reasons why people are prescribed medical cannabis.
“People with chronic pain often say that medical cannabis has a positive impact on their daily life and helps them function normally, but we really need clinical evidence to support this,” Dr Arkell said. “We are focusing specifically on people with chronic pain who have never used cannabis before, and we are examining the impact of medical cannabis on quality of life and daily activities, such as driving, over a 12-week period.”
In all jurisdictions except Tasmania, patients prescribed medical cannabis containing THC are prohibited from driving, underlining the importance of this research in shaping future policies and guidelines for the use of medical cannabis.
According to research published today in the European Heart Journal, people who take medical cannabis for chronic pain have a slightly increased risk of arrhythmia. Arrhythmia is when the heart beats too slowly, too fast, or irregularly. Includes conditions such as atrial fibrillation.
Recreational cannabis use has been linked to cardiovascular disease, but very little research has been conducted on the side effects of medical cannabis.
The researchers say the new study is important as a growing number of countries now allow medical cannabis as a treatment for chronic pain.
The study was led by Dr Anders Holt of Copenhagen-Herlev and Gentofte University Hospital in Denmark. It included data on 5,391 Danish patients who had been prescribed cannabis for chronic pain. This included people with muscle, joint or bone pain, people with cancer and those suffering from nerve pain. The researchers compared this group to 26,941 patients who also suffered from chronic pain but were not receiving cannabis as treatment.
The data showed that patients receiving medical cannabis had a 0.8% risk of receiving a diagnosis of an arrhythmia requiring monitoring and possible treatment within 180 days of receiving cannabis. This risk was more than double the risk for chronic pain patients who did not take cannabis. The difference in risk between the two groups had narrowed when researchers looked at the first year of treatment.
Cannabis-taking patients aged 60 or older and those already diagnosed with cancer or cardiometabolic diseases, such as heart disease, stroke, and diabetes, had the greatest increases in arrhythmia risk.
The study showed no link between taking medical cannabis and the risk of acute coronary syndrome, which includes heart attack and unstable angina, stroke or heart failure.
Dr Holt said: “Medical cannabis is now permitted as a treatment for chronic pain in 38 US states and several European countries – such as Spain, Portugal, the Netherlands and the UK – and other parts of the world. This means more and more doctors will find themselves prescribing cannabis, despite the lack of evidence about its side effects.
“I don't think this research should lead chronic pain patients to refrain from trying medical cannabis if other treatments have been inadequate. However, these findings suggest that better monitoring may be advisable initially, especially in patients who are already at increased risk of cardiovascular disease.”
Researchers say this is the first national study of its kind investigating the cardiovascular effects of medical cannabis for chronic pain. However, they caution that this is an observational study.
Dr. Holt explained: “Despite our best efforts to make a balanced comparison, it can never be assumed that patients who have been prescribed medical cannabis do not differ from patients who h
ave not been prescribed medical cannabis, and this could influence the results”.
In an accompanying editorial, Prof. Robert L. Page of the University of Colorado, USA, said: “The strict pharmacovigilance of cannabis, as well as its safety and efficacy, have been limited by decades of worldwide illegality and by the ongoing classification of cannabis as a Schedule 1 controlled substance in the United States. However, with the increasing decriminalization and legalization of cannabis worldwide, the association between cannabis exposure and incident cardiovascular events has emerged as an important safety signal.
“From a therapeutic perspective, these findings suggest that medical cannabis may not be a one-size-fits-all treatment option for certain medical conditions and should be contextualized based on patient comorbidities and potential vulnerability to side effects.
Cannabis is generally referred to as recreational and 'medical' or 'medicinal'. The latter terminology has been carefully scrutinized as it includes both phytochemically derived cannabis products and also those prescription cannabinoids approved in the EU. Additionally, the term “medical” implies that the product may have clinical monitoring along with safety and efficacy data, which is not true at all with cannabis. To this end, I would argue that “medical cannabis” would be a more appropriate terminology rather than “medical”.
Australian patients with chronic health conditions who were prescribed medical cannabis showed significant improvements in overall health-related quality of life and fatigue in the first three months of use, along with improvements in anxiety, depression and pain .
Interestingly, cannabis therapy does not appear to improve reported sleep disturbances, according to a study published in the open-access journal PLOS ONE by Margaret-Ann Tait of the University of Sydney, Australia, and colleagues.
Since 2016 in Australia, medical cannabis has been approved for prescription to patients with health conditions that do not respond to other treatments. Tait and colleagues surveyed a group of Australians with chronic health conditions who were prescribed medical cannabis to better understand any changes in patient-reported outcomes following cannabis treatment in this population.
The authors used survey responses from 2,327 Australian patients with chronic health conditions who were prescribed medical cannabis (THC and CBD dissolved in a medium-chain triglyceride (MCT) carrier oil between November 2020 and December 2021. The patients They were interviewed about their self-reported health problems such as quality of life, pain, sleep, anxiety and depression before starting cannabis therapy, after two weeks of treatment, then once a month for three months.
Of the patients interviewed, 63% were women, with a mean age of 51 years (range 18-97 years). The most reported conditions under treatment were chronic pain (69%); insomnia (23%); anxiety (22%); and anxiety/depression (11%); half of the patients were being treated for more than one condition.
Patients reported significant and clinically meaningful improvements in health-related quality of life and fatigue measures over the three months examined. Patients also reported clinically significant reductions in pain and significant improvements in anxiety and moderate to severe depression. However, although many patients have been prescribed cannabis for insomnia, no overall improvements have been found in patient-reported sleep disturbances.
The authors did not measure adverse effects as part of the study, although 30 patients formally withdrew from the study due to “unwanted side effects.” Regardless, these findings suggest that medical cannabis may be effective in helping manage previously incurable chronic conditions. The authors also note that further research and development of the cannabis oil products used in this study may be needed to successfully treat patients with insomnia and sleep disorders.
The authors add: “Within the first three months of medical cannabis therapy, participants reported improvements in quality of life, fatigue, and health conditions associated with anxiety, depression, and pain.”
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