Canadian real-world evidence: observational 24-week outcomes for health care practitioner authorized cannabis

With the increasing use of medical cannabis (MC), there is growing evidence suggesting that MC may be an effective therapeutic for chronic sleep, pain, and anxiety conditions. However, further evaluation is warranted to evaluate the heterogeneous patient outcomes of authorized cannabis treatment.

To assess the effectiveness of authorized cannabis on pain, sleep duration, anxiety, and depression in patients presenting to clinics over a 6-month time period.

This long-term prospective observational multicenter study utilized data from adult Canadian patients in the Medical Cannabis Real-World Evidence study. With physician guidance, patients were able to choose from Health Canada-verified MC products via a national pharmacy platform. Validated questionnaires were administered at Weeks 0, 6, 12, and 24 to assess pain interference (PROMIS, 6-30), pain score (NPRS, 0-10), sleep duration, anxiety (GAD-7, 0-21), depression (PHQ-9, 0-27), and quality of life (EQ-5D-3 L, 0-10). Outcomes were analyzed using descriptive statistics and generalized estimating equations models as both a per-protocol and intention-to-treat basis.

Improvements in pain, anxiety, depression, and QoL were observed from Baseline to Week 24. Decreases were observed in PROMIS Pain Interference - 4.6 (CI - 6.02 to - 3.17, n = 137), Numeric Pain Rating Scale - 1.19 (CI - 1.7 to -0.68, n = 137), General Anxiety Disorder-7 - 2.24 (CI - 3.5 to - 0.99, n = 139), Patient Health Questionnaire-9 depression -2.79 (CI - 4.29 to -1.3, n = 141), and EQ-5D-3 L - 0.56 (CI -0.96 to -0.16, n = 139).

At Week 24, outcomes in chronic pain, anxiety, depression, and quality of life improved. Although 85% of patients in our study had an MC indication for pain, no outcomes met their minimal clinically significant thresholds at Week 24. These observations align with existing evidence, yet there remains some discrepancies in the current literature. Our findings highlight the need for future studies to characterize MC administration, dose, and specific product relationships.