nabilone and Pain--Intractable

Nabilone is a synthetic cannabinoid prescription drug approved in Canada since 1981 to treat chemotherapy-induced nausea and vomiting. In recent years, off-label use of nabilone for chronic pain management has increased, and physicians have begun to express concerns about nabilone becoming a drug of abuse. This study evaluates the evidence for abuse of nabilone, which is currently ill-defined.. Scientific literature, popular press and internet databases were searched extensively for evidence of nabilone abuse. Focused interviews with medical professionals and law enforcement agencies across Canada were also conducted.. The scientific literature and popular press reviews found very little reference to nabilone abuse. Nabilone is perceived to produce more undesirable side effects, to have a longer onset of action and to be more expensive than smoked cannabis. The internet review revealed rare and isolated instances of recreational use of nabilone. The database review yielded little evidence of nabilone abuse, although nabilone seizures and thefts have occurred in Canada in the past few years, especially in Ontario. Most law enforcement officers reported no instances of nabilone abuse or diversion, and the drug has no known street value. Medical professionals reported that nabilone is not perceived to be a matter of concern with respect to its abuse potential.. Reports of nabilone abuse are extremely rare. However, follow-up of patients using nabilone for therapeutic purposes is prudent and should include assessment of tolerance and dependence. Prospective studies are also needed to definitively address the issue of nabilone abuse.

Topics: Analgesics; Antiemetics; Canada; Cannabinoids; Dronabinol; Humans; Off-Label Use; Pain, Intractable; Substance-Related Disorders

Cannabinoids have been known for many centuries because of their various effects in healthcare. They are primarily effective in reducing nausea, vomiting, pain, anorexia, spasticity and depression. Some other effects are known, all seem to be mediated by cannabinoid receptors in the central nervous system. In the past years, medical use has been proven in several studies. Today, the therapeutical use of cannabinoids in medicine is increasing, and access was made easier. Especially in pain-management and palliative care, they seem to be a valuable therapeutic option.

Topics: Adenocarcinoma; Analgesics; Analgesics, Opioid; Dronabinol; Drug Therapy, Combination; Female; Humans; Middle Aged; Multiple Sclerosis; Pain, Intractable; Palliative Care; Quality of Life; Uterine Neoplasms

A prospective observational study assessed the effectiveness of adjuvant nabilone (Cesamet) therapy in managing pain and symptoms experienced by advanced cancer patients. The primary outcomes were the differences between treated and untreated patients at 30 days' follow-up, in Edmonton Symptom Assessment System (ESAS) pain scores, and in total morphine-sulfate-equivalent (MSE) use after adjusting for baseline discrepancies using the propensity-score method. Secondary outcomes included other ESAS parameters and frequency of other drug use. Data from 112 patients (47 treated, 65 untreated) met criteria for analyses.The propensity-adjusted pain scores and total MSE use in nabilone-treated patients were significantly lower than were those found in untreated patients (both P < 0.0001). Other ESAS parameters that improved significantly in patients receiving nabilone were nausea (P < 0.0001), anxiety (P = 0.0284) and overall distress (total ESAS score; P = 0.0208). The nabilone group showed borderline improvement in appetite (P = 0.0516). When compared with those not taking nabilone, patients using this cannabinoid had a lower rate of starting nonsteroidal anti-inflammatory agents, tricyclic antidepressants, gabapentin, dexamethasone, metoclopramide, and ondansetron and a greater tendency to discontinue these drugs.

Topics: Adjuvants, Pharmaceutic; Aged; Aged, 80 and over; Analgesics; Anti-Anxiety Agents; Antiemetics; Cancer Care Facilities; Dronabinol; Female; Humans; Karnofsky Performance Status; Male; Middle Aged; Neoplasms; Pain Measurement; Pain, Intractable; Palliative Care; Prospective Studies; Treatment Outcome