First NZ study of cannabis use in people with spinal injury

(Jointly attributed to the University of Otago and the Burwood Academy of Independent Living.)

Using cannabis helps people with spinal cord injuries better tolerate almost constant and excruciating pain and participate in community and family life without feeling like ‘zombies’, a new study has found.

Participants in the joint University of Otago, Christchurch and Burwood Academy of Independent Living study found, on balance, the benefits of using cannabis outweighed the negatives. Negatives included risk of prosecution, an irregularity of supply and inconsistent quality and ingredients, due to the drug’s illegal status.

In the words of one participant, “I’m not wanting to get stoned all day, every day, because that’s not me, but I get to live every day. That’s the big difference.”

The study is an invaluable insight into the use of the illegal substance as a ‘last resort’ to ease almost constant pain, and highlights the vulnerability of patients in an unregulated market and an absence of professional advice on dosage or effect.

To understand cannabis use and its perceived impact on pain, researchers did in-depth interviews with eight people with spinal injuries who used cannabis for pain. They all chose to use cannabis after finding other pain management strategies, particularly prescription medicines, ineffective.

The study was done on condition of anonymity but the research paper, published recently in the Spinal Cord Case Studies journal, contains quotes from unidentified participants, many of which are included in this media release.

Dr Jo Nunnerley is a University of Otago, Christchurch research fellow and director of the Burwood Academy of Independent Living. She says one of the most common and debilitating complications of spinal cord injury is severe and chronic pain.

The research provides the first detailed understanding of how New Zealanders in often constant pain from spinal cord injuries use cannabis and perceive its effects.

“The research team felt it was important for these people’s voices to be heard and for this small but important study to provide evidence on the way the illegal substance is used to reduce chronic pain in this population.”

The study found cannabis was used to reduce pain often as a ‘last resort’ when other pain management strategies were ineffective or the negative side-effects of prescribed medications, such as drowsiness, fatigue, or being in a ‘zombie state’, became intolerable, Dr Nunnerley says.

Participants reported cannabis reduced their pain quickly and allowed them to engage in daily activities without the side effects of traditional pain medication, she says.

Participants all agreed there were drawbacks to using cannabis. Because they accessed it on the black market, participants had to ‘guess’ at best dosages and risked the substance interacting negatively with prescription medications. Their supply was also irregular and inconsistent in quality, and they risked prosecution in obtaining it.

Following are quotes from participants that illustrate the study’s six themes or conclusions:

Participants living in unbearable pain

“It just takes over … your life…when you have the pain you can’t do anything…you can barely talk… the pain overtakes everything.”

“Since day dot I’ve tried everything and you know nothing has seemed to work.”

The (prescribed) drugs don’t work

“All of the prescription medications…things like oxycodone, fentanyl patch…I find they make me drowsy and they do impair my cognitive ability to think clearly and…to be fully compos mentis.”

Choosing to use cannabis

From one participants using a high CBD/low THC oil: “I’ve got nothing to lose…and I’m not getting high from it…it does a better job than the stuff that’s legal.”

Another talked of the compromise between pain relief and the effect on the mind: “You can get paranoid…your body is relaxed but your mind is not quite with it …I don’t like that side of it, that’s what I hate…not feeling in control…like if I was to smoke it I wouldn’t want to go out into the community.”

A high degree of experimentation and underground research is needed: “I started to eat it raw. The leaves, the stalks, I started chopping it up and putting it into my salads and things like that… I don’t know exactly what I was doing then, but the pain would come and go, and the burning sensations were all starting to change, and with a mixture of eating it, the stalks, the leave and smoking …the pain started to subside.”

Negotiating an unfamiliar illegal context
“In my former life, if someone mentioned cannabis I would have thrown my arms up in horror. I think this is a last resort because you’re always waiting to see what will help.”

“Just make it legal so we don’t have to look over our shoulders all the time and think about what’s gonna happen and consequences.”

“The pain specialists don’t, won’t…endorse a marijuana-based product because …there’s not enough evidence-based research yet to warrant it.”

Free to pursue meaningful outcomes

“It’s helped my whole health and helped the pain everything, my mental pain, physical pain the whole lot you know, ever since I’ve been on it.”

“My whole family...don’t even care where I smoke weed… because they have seen the effects. They’ve seen the effects when I’m in pain… they cry. But compared to when I take weed, it’s totally different.”

“It gave me a better sleep, I guess, so I just was less disturbed by my pain when I was sleeping.”

“I just want to enjoy life and it seems to really help to do those things and enjoy my family.”

You can’t always get what you want

Participants described unpredictability, inconsistency, and lack of information due to the unregulated market.

“If you’re not going to grow it yourself, you’re then therefore left to buy it. Now when you buy it, you don’t know what you’re getting, you don’t know what strain it is, you don’t know what the product is. I’ve had instances where I’ve bought the wrong product. Where’s… the fairness in that?

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