Cannabis-based medicine as a treatment for advanced cancer pain

Sam Jole, Senior Research Nurse, and Dr Iain Lawrie seen holding the Sativex® spray

The Pennine Acute Hospitals NHS Trust has won a global race and signed up the first patient for a worldwide commercial study looking at the use of Sativex® - a cannabis-based medicine for pain management in advanced cancer patients.

The study is part of the SPRAY III research programme, which is being sponsored by GW Pharmaceuticals. SPRAY III is looking at the use of Sativex® for relieving chronic pain in patients with advanced cancer who have not obtained adequate pain relief from opioid therapy. It is being carried out at two of the Trust’s hospitals – North Manchester General Hospital and Fairfield General Hospital in Bury.

As it stands, Pennine Acute Trust is to date the lead hospital trust in the world for the SPRAY III programme, with eight patients already recruited into the main studies and four into the extension study. It is hoped that another 32 will join the group over the next two years.

Sativex® is a medicine derived from the cannabis plant and contains Delta-9-Tetrahydro-cannabinol (THC) and Cannabidiol (CBD) as its primary active ingredients. The medicine is delivered by an oromucosal spray (sprayed into the mouth either onto the inside of the cheek or under the tongue). Sativex® is already available on prescription in the UK as a treatment for spasticity due to Multiple Sclerosis.

In a move which will hopefully show a quantifiable and demonstrable improvement in the pain and suffering of all palliative cancer patients, along with academic recognition for the Trust, the principal investigators for the trial at Pennine Acute Trust are Dr Iain Lawrie, Consultant & Honorary Clinical Senior Lecturer in Palliative Medicine at North Manchester General Hospital, and Dr Paul O’Donnell, Consultant in Respiratory and Palliative Medicine, at Fairfield General Hospital.

Sam Jole, Senior Research Nurse at Pennine Acute Trust, has been involved in setting up the trials and identifying, recruiting and monitoring patients. He said: “Research in palliative care, especially looking at new drug treatments is rare. Cancer research in the Trust has progressed significantly in recent years and the cancer research team recognised the opportunity for the Trust to be involved in a new palliative care research trial.

”The majority of cancer research is focused on curing disease. Palliative care is an under-researched medical specialty and the SPRAY III studies are genuinely ground-breaking. I’ve been a research nurse for years and have never come across anything like it.

“It is very important to point out that patients using the spray do not experience the euphoria associated with the illegal recreational use of cannabis.

“Sativex is a medicine which is licensed in the UK and several other European countries. It has passed strict tests for quality, safety and efficacy and doctors are already prescribing it for Multiple Sclerosis patients for the relief of spasticity (muscle stiffness).”

Patients involved in the study, and who have been recruited from a number of cancer specialties, visit the clinic four times over a five week period. They are required to complete a two minute phone call each evening to report their pain scores and usage of painkillers. Neither the patients nor study team know whether the patient is using the active drug or a placebo. The patients also have the option of entering a long term extension study, which allows them continued access to Sativex®.

Dr Iain Lawrie added: “This study is an exciting development in the field of cancer pain management. Initial clinical observations suggest that Sativex® will have an important role to play in this complex area of palliative care.”