From the Guidelines
In Australia, the most effective medicinal cannabis products for cancer pain management, based on the latest evidence, are Nabiximols (Sativex), THC-dominant oral oil formulations like Tilray 25:0, and balanced THC:CBD oral oils such as Althea 12:12, with Nabiximols having moderate certainty of evidence for cancer pain relief 1. These products can be prescribed by authorized prescribers through the Special Access Scheme or Authorized Prescriber pathway. The dosing for these products typically starts low and is gradually increased as needed and tolerated, with Nabiximols starting at 1-2 sprays per day, Tilray 25:0 at 0.5-1ml once or twice daily, and Althea 12:12 at 0.2-0.5ml once daily. They work by interacting with the endocannabinoid system to modulate pain perception and may offer additional benefits like improved sleep and reduced anxiety, as suggested by studies on their effects in advanced cancer patients 2, 1. Side effects can include dizziness, drowsiness, and dry mouth, so patients should start with low doses and increase gradually under medical supervision. It's also important to consider the potential benefits and risks of these formulations, as well as the specific regulations and guidelines in place for their use in Australia, such as those outlined in the ASCO guideline for the use of cannabis and cannabinoids in adults with cancer 1. Key considerations for their use include:
- Starting with low doses and gradually increasing as needed and tolerated
- Monitoring for side effects such as dizziness, drowsiness, and dry mouth
- Considering the potential for drug-drug interactions and contraindications
- Following specific state regulations and guidelines for access to medical cannabis or cannabinoids.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Medicinal Cannabis Products for Cancer Pain in Australia
There are several medicinal cannabis products available in Australia for the treatment of cancer pain. The following are three options:
- Nabiximols (oromucosal spray) containing tetrahydrocannabinol (THC) and cannabidiol (CBD) 3, 4
- THC oil capsules 3
- Synthetic THC analogues, such as nabilone 4
Key Considerations
When considering these options, it is essential to note that:
- The efficacy of these products in reducing cancer pain is still being researched, with some studies showing moderate-certainty evidence of no clinically relevant benefit 4
- The optimal dosage and efficacy of different cannabis-based therapies are still being established 3
- Potential side effects, such as drowsiness, hypotension, mental clouding, and nausea and vomiting, should be considered 3
- Medicinal cannabis products should only be used under the guidance of a healthcare professional, as they may interact with other medications or have adverse effects 5, 6, 7