Cannabinoids for pain in palliative care

Boland, 2020Fallon, 2018IASP Presidential Task Force on Cannabis Cannabinoid Analgesia, 2021National Institute for Health and Care Excellence (NICE), 2019 Updated 2021Therapeutic Goods Administration (TGA), 2017Therapeutic Goods Administration (TGA), 2017

Although cannabinoids are increasingly used in palliative care, there is insufficient evidence to support their use as standard therapy:

  • In randomised placebo-controlled trials, cannabinoids have not demonstrated a clinically significant reduction in pain and have been associated with adverse effects (eg dizziness, nausea, sedation1).
  • The dose for efficacy and safety is unknown, as is dose equivalence between medicinal cannabis products.
  • Pharmacokinetic and pharmacodynamic data are limited; however, the limited data available indicate that cannabinoids may have drug interactions with drugs commonly used in this patient group (eg benzodiazepines).

For these reasons, cannabinoids are not approved for use for pain in Australia and are only available via the Special Access Scheme and Authorised Prescriber Scheme (see Accessing unapproved medications)2; cost may be a significant barrier. If a cannabinoid is considered, seek expert advice. Ideally, cannabinoids should only be prescribed as part of a clinical trial.

For management of refractory pain, see Refractory pain in palliative care.

1 Cannabinoid use may affect fitness to drive. Return
2 At the time of writing, 2 cannabinoid products are approved for use in Australia; Sativex (nabiximols) for certain patients with multiple sclerosis, and Epidyolex (cannabidiol) for patients with certain epileptic conditions.Return