Considerations for Cannabis Use to Treat Pain in Sickle Cell Disease

Abstract

Pain in Sickle Cell Disease (SCD) is a major comorbidity and unique with acute pain due to recurrent and episodic vaso-occlusive crises as well as chronic pain, which can span an individual’s entire life. Opioids are the mainstay treatment for pain in SCD. Due to recent health crises raised by adverse effects including deaths from opioid use, pain management in SCD is adversely affected. Cannabis and its products are most widely used for pain in multiple conditions and also by patients with SCD on their own. With the availability of “Medical Cannabis” and approval to use cannabis as medicine across majority of States in the United States as well as over-the-counter preparations, cannabis products are being used increasingly for SCD. The reliability of many of these products remains questionable, which poses a major health risk to the vulnerable individuals seeking pain relief. Therefore, this review provides up to date insights into available categories of cannabis-based treatment strategies, their mechanism of action and pre-clinical and clinical outcomes in SCD. It provides evidence for the benefits and risks of cannabis use in SCD and cautions about the unreliable and unvalidated products that may be adulterated with life-threatening non-cannabis compounds.

Psychiatric comorbidities in adults with sickle cell disease: A narrative review

“…High‐quality randomized controlled studies evaluating the effects of cannabis on patients with SCD have not yet been conducted 163 . Results have been mixed as it relates to care utilization and pain outcomes.…”

“…162 High-quality randomized controlled studies evaluating the effects of cannabis on patients with SCD have not yet been conducted. 163 Results have been mixed as it relates to care utilization and pain outcomes. A study of 72 patients' urine drug tests compared those who screened positive for cannabis (51%) with those who did not, and saw no difference in opioid use, fewer outpatient clinic appointments, but greater hospital admissions for VOC.…”

Is CBD ready for prime time in sickle cell disease?

“…Retrospective studies have shown that 31% to 51% of people living with SCD self-report using cannabis, and the majority endorse using it for pain relief. 3 One retrospective study showed that medical cannabis use was associated with a decrease in hospital admissions. 4 In contrast, the only randomized controlled study of inhaled cannabis in SCD failed to show a significant decrease in pain ratings; this small study, however, showed a promising improvement in mood with cannabis.…”

The Efficacy of Marijuana Use for Pain Relief in Adults With Sickle Cell Disease: A Systematic Review

“…The review focused on 15 studies: one RCT, two cross-sectional surveys, three retrospective studies, one observational study, one qualitative study, one prospective study, one survey study, three case studies, and two questionnaire-based studies. While sample sizes, demographics, and other parameters differed for almost all these studies, one commonality was that further data is needed as well as long term studies ideally with less interference from other drugs to make decisive proposals on whether marijuana use is efficacious for pain relief in SCD or not [ 18 ].…”