Characteristics of People Seeking Prescribed Cannabinoids for the Treatment of Chronic Pain: Evidence From Project Twenty 21

Abstract

BackgroundPrescribed cannabinoids are now legal in the UK and increasingly being used for a variety of conditions, with one of the most frequent conditions being chronic pain. This paper describes the characteristics of individuals seeking prescribed cannabinoids for the treatment of chronic pain in Project Twenty 21, a UK based real world data registry of prescribed cannabis patients.MethodBy 1st November 2021 data were available for 1,782 people who had sought treatment with medical cannabis as part of Project Twenty 21. The most common diagnosis among this cohort was chronic pain with 949 (53.5%) of the cohort reporting a primary condition related to chronic pain. Medical and self-report data on the characteristics of these patients, their health status and type/s of cannabinoid/s prescribed are summarized in this report.ResultsOf the 949 people reporting chronic pain as a primary condition 54.7% were male and their average age was 42.0 years (range = 18–84). Patients reported a low quality of life and high levels of comorbidity: people reported an average of 4.6 comorbid conditions with the most common comorbid conditions including anxiety, depression, insomnia and stress. A range of cannabinoid products were prescribed with the most common products being classified as high THC flower (48.5%). The majority of patients also reported using at least one other prescribed medication (68.7%).ConclusionsConsistent with findings in other national and international databases, chronic pain was the most common primary condition in this real world study of prescribed cannabinoids. There was considerable variation in the types of chronic pain, comorbid pathology and in the characteristics of products being prescribed to treat these conditions. Together, this evidence supports the utility of real world evidence, as opposed to clinical trial approaches to studying the potential benefits of prescribed cannabinoids in treating chronic pain.

The value of real world evidence: The case of medical cannabis

“…International evidence indicates that large numbers of people seek treatment with medicinal cannabis once it has been legalised for medical use and, recognising the importance of generating evidence on the uses of and potential effectiveness of medicinal cannabis, Project Twenty21 (T21) was established as an observational registry to collect information on medicinal cannabis use in the United Kingdom and most recently set up in Australia as well. This study became operational in August 2020 and initial findings from the study are available ( 32 , 33 ). By March 2022 data on the characteristics of people seeking treatment with medicinal cannabis were available for in excess of 2,000 individuals.…”

Raising awareness: The implementation of medical cannabis and psychedelics used as an adjunct to standard therapy in the treatment of advanced metastatic breast cancer

“…In addition to psilocybin, both CBD and THC are anxiolytic, and cannabis-based medicinal products (CBMPs) are increasingly being used by patients to treat various anxiety disorders. Within Project Twenty21, the largest UK registry of medical cannabis patients, about a third of patients are prescribed a range of CBMPs to treat anxiety, the most common condition treated after chronic pain in this registry (Schlag et al, 2022b).…”

“Flower Power”: Controlled Inhalation of THC-Predominant Cannabis Flos Improves Health-Related Quality of Life and Symptoms of Chronic Pain and Anxiety in Eligible UK Patients

“…Participants were patients registered in Project Twenty21 (T21), the first UK multi-center registry seeking to develop a body of real-world evidence (RWE) to inform on the effectiveness and safety of medical cannabis. Full information relating to T21 procedures is outlined elsewhere [ 23 , 25 ]. In brief, patients receiving CBPMs for a variety of conditions are entered into the registry by invitation and monitored for data collection as part of their standard of care.…”

“…Prescribing physicians partnering with T21 use a product formulary that includes a wide range of CBPMs including oral extracts and flos of differing CBD and THC ratios. To date, THC-predominant flos remains the most prescribed CBPM in the project [ 23 ]. To reduce the inherent variability associated with the chemical composition of cannabis dried flowers, we decided to include in our data review only those patients receiving at their initial appointment a prescription for KHIRON 20/1, the most frequently prescribed THC-predominant flos in T21.…”

“…Authors reported significant improvements in health-related quality of life, pain interference and sleep quality, accompanied by a 30% incidence of side effects of mild or moderate intensity [ 22 ]. Following a similar rationale and experimental design, in the present work we aimed at investigating the efficacy and safety of the inhalation of THC-predominant cannabis flowers on a treatment-resistant cohort of patients enrolled in Project Twenty21 (T21), the first multi-center registry of patients receiving bespoke CBPMs in the UK [ 23 , 24 ]. We analyzed clinical outcome measures, collected prospectively through validated questionnaires [ 25 ], reported by patients receiving treatment with KHIRON 20/1, the most frequently prescribed chemotype I cannabis flower in T21.…”