Dr Mark Ware, Chief Medical Officer at Canopy Growth Corporation, discusses medical cannabis as a treatment for fibromyalgia.
Fibromyalgia, also referred to as fibromyalgia syndrome (FMS), is a long-term condition that causes pain all over the body. Whilst there are treatments which can ease the symptoms of fibromyalgia, there is currently no cure. Medications including painkillers and antidepressants are some of the most commonly prescribed treatments for the condition. However, these can have serious side effects.
The National Institute for Healthcare and Excellence (NICE) updated its guidelines in April this year to warn against the prescribing of opioid medications for extended use in England. With this considered, the search for alternative treatments for fibromyalgia is even greater.
Canopy Growth is a world-recognised cannabis and cannabinoid-based consumer product company, developed with the aim of improving lives and strengthening communities. Through its Spectrum Therapeutics brand, the company aims to improve the lives of patients around the world by giving them access to a variety of cannabis products for their medical needs.
To find out more about the company and its work with fibromyalgia sufferers, Health Europa spoke to Dr Mark Ware, Chief Medical Officer at Canopy Growth Corporation.
Can you summarise your research over the years and your experience of working with patients with fibromyalgia?
Prior to joining Canopy Growth as Chief Medical Officer, I was primarily carrying out research on the safety, efficacy, and effectiveness of cannabis and cannabinoids in pain and symptom management. In addition to my research, I spent over 20 years treating patients with chronic pain and saw first-hand how difficult these types of conditions can be for patients.
When looking at fibromyalgia more specifically, we would define this as a chronic condition involving the central nervous system which causes widespread pain. It is estimated to affect 1 in 20 people in the UK. However, because the condition is difficult to diagnose, these figures are quite likely higher.
Unfortunately, fibromyalgia is incurable and we see much higher rates in women than in men. We also see patients reporting poor sleep quality, mood disorders, and, really, they feel let down by treatments which have impacted their quality of life and often have troublesome side effects.
It is important to remember that, for people with fibromyalgia, it is not just a few weeks or months where they are living with pain and sometimes an unknown diagnosis – people will often have symptoms for years without adequate support or understanding the reason why. In addition to this, there is the added challenge of what they can do to manage the pain long-term once they receive a diagnosis.
What are the current treatments/therapies/healthcare services available for this condition?
While there is currently no cure, there are a number of different treatments used to manage symptoms of fibromyalgia which can include anticonvulsants, opioids, and antidepressants. Once patients receive a diagnosis, it may take some time to determine which variety of treatments work for their specific symptoms and overall condition. However, in many cases, patients do not find lasting relief from these options.
This is the point where medical cannabis enters the conversation, as we have seen encouraging results for its use in the management of chronic pain, as well as supporting sleep. It is worth noting here the inter-dependent relationship that pain, mood, and sleep have. When we can effectively manage one of these symptoms, we often see notable improvement or the elimination of the others.
Why are patients beginning to turn to medical cannabis?
Due to the nature of fibromyalgia, and chronic pain conditions more broadly, we know that they are notoriously difficult to diagnose and treat. Patients often go through testing for other conditions and, by the time they do receive a definitive diagnosis, these patients are experts in their condition. They have tried a variety of treatments and are heavily invested in their own care.
Because of this, many patients are becoming more and more interested in alternative treatments to strong painkillers to find relief from their pain and related symptoms. This is especially relevant as we know the use of opioids has produced a major health crisis, including in the UK, and that alternative treatments like medical cannabis – with fewer side effects and a superior safety profile to drugs like opioids – presents a valuable option worth exploring.
What is your understanding of how this medication can help these patients?
Our bodies naturally create pain relievers in the form of endorphins; however, they can also trigger pain relief via the endocannabinoid system (ECS). The ECS plays an important role in a range of biological functions like sleep, pain, and even memory, and we have known for many years now that cannabinoids directly interact with the ECS. Because of this, we see cannabis as a unique class of medicine, given its potential to provide relief for a wide spectrum of symptoms including pain, nausea, anxiety, and difficulties with sleep – all symptoms associated with fibromyalgia.
When we speak with patients, we often hear that, for them, medical cannabis is useful not only for pain control but to make the pain less unpleasant. They note it can help them sleep, improves their mood, and helps them regain a better quality of life and, while we know this is not a cure, and remains to be evaluated in large randomised controlled trials, it can be an important step forward in managing these difficult symptoms.
What more needs to be done to help both patients and clinicians to understand this condition?
Fibromyalgia is difficult to treat and recognise because it is invisible. There is currently no clear test for the condition and, as a result, it is very often misdiagnosed or left undiagnosed for many years.
When I worked as a pain management clinician, I saw the frustration and desperation of many people living with a condition that has been misdiagnosed or missed completely, resulting in patients being funnelled through seemingly endless tests and doctor visits. Factor in the added stigma of accessing medical cannabis and you get a very challenging treatment journey for these patients.
To help these people, we need healthcare professionals to be comfortable and able to talk to patients openly about whether they can try medicinal cannabis as a treatment option and, if so, how to access it. This is very much a journey that the health professional and patient must go on together, and while we are making positive strides, there is still a lot to be done to break down barriers when it comes to discussing medicinal cannabis as a therapeutic option. To address this, Spectrum is working hard to help facilitate these discussions through education programmes here in the UK and globally.
What further work is Spectrum doing to support those living with chronic conditions?
Given the patient-driven basis of medical cannabis acceptance, and the wide range of potential therapeutic uses, Spectrum believes real world evidence (RWE) and clinician education is critical for gathering insights into medical cannabis use and its potential applications.
We have recently published an RWE observational study of 600 participants to describe the impact medical cannabis can have in supporting sleep, pain management, and other mental health symptoms including anxiety and depression. What we found is that THC-dominant products were more frequently used for symptoms of pain and sleep, while CBD-dominant products were more frequently used for anxiety and depression. This research offers practical insights into how participants use and respond to cannabis products and suggests important avenues and opportunities for future clinical research.
In addition, as part of our work on demonstrating how medical cannabis can support those with chronic pain, we have published two consensus papers which provide practical guidance and suggestions on how clinicians can use medical cannabis to reduce opioid dependence and how medical cannabis can be used in the management of chronic pain.