Study: Most pain physicians in Israel prescribe cannabis

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A majority of Israel’s pain specialists prescribe cannabis in their practices, say opiates are more dangerous than cannabis, and find cannabis moderately to highly effective in pain relief, according to a new scientific study on the role of cannabis in pain medicine.

The study, published in the Journal of Pain Research, surveyed registered pain specialists in Israel on their personal experience with cannabis, the role of medical marijuana in pain medicine, and their attitudes toward cannabis medicalization and legalization.

Dr. Silviu Brill, director of the Chronic and Acute Pain Center at Tel Aviv Sourasky Medical Center and one of the study’s authors, told the Emerald Report that he was “moderately surprised” by the results that showed that cannabis is no longer considered a last-resort pain reliever.

“Cannabis is an effective treatment option for patients with chronic pain that does not respond to other treatments,” write the study’s authors. “Doctors’ answers show a change in the attitude of pain doctors to medical cannabis when more doctors are willing to try cannabis at an earlier stage and not only as a ‘last resort’ after the other treatments have failed.”

Fifty practicing pain specialists in Israel (64 percent of all board-certified pain physicians in the country) took part in the study.

Among the key findings: Pain doctors “experienced in prescribing cannabis over prolonged periods view it as an effective and relatively safe treatment for chronic pain, based on their own experience.”

In fact, 95 percent of those surveyed said they prescribe cannabis in their practice. Some 54 percent of those surveyed noted that they request cannabis for more than 20 patients per year. Survey results showed just 5 percent of Israel’s pain specialists have never prescribed cannabis for chronic pain.

The study’s authors say they set out to examine “the attitude, beliefs and knowledge of specialist physicians toward the clinical application of cannabis.” The authors note that earlier studies on the subject, surveying Irish, Canadian and Israeli doctors, asked their opinions on the “theoretical use of cannabis.”

Dr. Brill says one of the goals of the study is to offer “better understanding [of medical cannabis] and the possibility to build up a plan to teach the subject to students and doctors.”

Israel, the first country to legalize medical marijuana in the early 1990s, is considered a world leader in the study and application of cannabis for medical purposes. Raphael Mechoulam, a retired Hebrew University professor, is credited with leading Israel to the forefront of medical cannabis research in 1964, when he led a team that first isolated THC, the main psychoactive compound in cannabis.

This study is the first to include physicians with actual experience in the clinical use of cannabis, according to the authors.

Medical cannabis could help treat an array of chronic pain conditions including neuropathic pain (65 percent of responders), oncological pain (50 percent), joint pain related to rheumatic diseases (25 percent), and any pains not responding to conventional treatments (29 percent), according to the report.

As the United States continues its uphill battle against opioid overdoses — with 49,068 deaths in 2017, according to preliminary statistics released by the Centers for Disease Control and Prevention in August — the question of whether cannabis is more hazardous than opiates or not is already a public debate.

Nearly 90 percent of the Israeli pain specialists in the study reported that they believe opiates are more dangerous — or equally as dangerous — as cannabis. The exact breakdown: 43 percent of those surveyed said opiates are more hazardous than cannabis, 12 percent said cannabis was more dangerous, and 45 percent said they were equally risky.

“[The Israeli pain specialists’] responses arguably present a possible change of paradigm,” write the study’s authors. “Cannabis emerges as an effective treatment option for many patients with chronic pain who have failed previous treatments … Crucially, 45 percent of Israeli pain specialists state that they themselves would prefer to be treated with cannabis rather than opiates in case of chronic pain. While there still is a small opposing majority (55 percent), this can be seen as an overall vote of confidence in cannabis treatment.”

Perhaps most surprisingly, 54 percent of pain specialists who took part in the study say they would like to see cannabis legalized in Israel with an age restriction.

“As far as we know, this is the first survey of medical professionals reported thus far that shows such support,” write the authors.

Viva Sarah Press is a journalist and speaker. She writes and talks about the creativity and innovation taking place in Israel and beyond.