Characteristics of and 3-month health outcomes for people seeking treatment with prescribed cannabis: Real-world evidence from Project Twenty21

Summary & key facts

Project Twenty21 collected real-world data from people in the UK who sought prescribed medicinal cannabis. Data at treatment start were available for 2,833 patients and 1,410 had 3-month follow-up for anxiety, chronic pain or PTSD. On average, patients reported improvements in condition-specific symptoms and in general health and quality of life after three months, and prescribed opioid doses fell for chronic pain patients. The study was observational, so the findings show associations but cannot prove that cannabis caused the improvements.

Key facts:

• Data at treatment start were available for 2,833 people seeking prescribed medicinal cannabis.
• Three-month follow-up data were available for 1,410 people treated for anxiety disorders, chronic pain, or PTSD.
• Measures of symptoms and quality of life showed consistent improvement at 3 months. Effect sizes (Cohen's d) for these changes ranged from 0.50 to 1.17.
• Among chronic pain patients who were using prescribed opioids at the start, average daily morphine-equivalent dose fell from 22.5 mg to 8.3 mg (Cohen's d = 0.29; 95% CI = 0.19–0.38).
• Adverse events were uncommon: 3.2% of participants reported one or more adverse events. Most were rated mild or moderate.
• The most common reported adverse events were dry mouth (15 reports), feeling drowsy (11 reports), and red eyes (11 reports).
• The study is observational, with no randomisation or control group, and may have selection bias. These limits mean the results show associations but do not prove cause and effect.

Abstract

Medicinal cannabis has been legal in the UK since 2018 but there is limited information about characteristics of people seeking prescribed cannabis and the effectiveness of this treatment. This paper documents symptom patterns and quality of life among individuals seeking medicinal cannabis and examines changes in symptoms, quality of life and use of prescribed opioids using data from an observational registry study of patients (Project Twenty21). Self-report data, including condition-specific symptomatology and general health (quality of life, general health, mood and sleep), were available at treatment entry for 2833 patients seeking medicinal cannabis for any indication and also at 3-month follow-up for 1410 individuals seeking treatment for anxiety disorders, chronic pain or PTSD. Among chronic pain patients, dose and frequency of prescribed opioid use was available. There were consistent improvements in disease-specific symptomatology and in general health and quality of life 3 months after commencing treatment. Effect sizes, assessed using Cohen's d, ranged from 0.50 to 1.17. Among chronic pain patients using opioids at the start of treatment, there was a moderate reduction in Milligrams of Morphine Equivalents: from 22.5 to 8.3 mg/day (Cohen's d = 0.29, 95% CI = 0.19–0.38). Adverse events were rare (3.2% reported one or more adverse events) and were mostly assessed as either mild or moderate severity: the most common AEs were dry mouth (15 occurrences) and feeling drowsy or having red eyes (both reported 11 times). Despite limitations of observational research, including the lack of randomisation or a control group and potential selection bias, these results indicate that prescribed cannabinoids are associated with a reduction in condition-specific symptomatology, improvement in quality of life and a reduction in prescribed opioid use. While further research is needed to better understand who will most likely benefit from which prescribed cannabinoids, real-world evidence of their effectiveness and safety supports efforts to increase access to these medications.

Topics

Cannabis and Cannabinoid Research Homelessness and Social Issues Substance Abuse Treatment and Outcomes

Categories

Health Sciences Medicine Pharmacology

Tags

Addiction Adverse effect Anxiety Cannabis Chronic pain Feeling Internal medicine Medicine Mood Nursing Observational study Opioid Psychiatry Psychology Quality of life (healthcare) Receptor Social psychology