Orthopaedic patients are increasingly using cannabinoids for pain relief, but there is a lack of evidence-based data on this topic. In this episode, Marc and Mo are joined by special guest Jason Busse (Associate Professor in the Department of Anesthesia at McMaster University, Director of the National Pain Centre, and Associate Director of the Michael G. DeGroote Centre for Medicinal Cannabis Research) in an illuminating discussion on the issues, opportunities, and challenges related to orthopaedic research into the use of cannabinoids. Some of the questions covered during the discussion include: • What are the most popular claims among cannabis proponents? What evidence is there to support these claims? • Is there a causal relationship between cannabinoid use and decreased use of opioids and other prescription medications (i.e., a “substitution effect”)? • Much of the current evidence on cannabinoids is observational and anecdotal. What can we learn from this evidence, and how can such information inform future research? • What are the possible sources of funding for such research? • What legal and regulatory hurdles must be overcome in order to allow us to perform properly designed RCTs into this topic? • What challenges are faced by physicians when asked by patients about cannabinoids? • What research is being done from the patient perspective? • What is the roadmap for the future? How will we obtain quality evidence that will help clinicians and their patients to make decisions that are consistent with their values and preferences? OrthoJOE Mailbag: feedback, comments, and suggestions from our audience can be sent to email@example.com Links: • Yun C, Haleem MS, Jeong S, Oyer MA, Driscoll AJ, Chang KY, Yun J, Paul J, Lubbe RJ, Stock SR, Hsu WK, Hsu EL. Effect of Postoperative Analgesic Exposure to the Cannabinoid Receptor Agonist WIN55 on Osteogenic Differentiation and Spinal Fusion in Rats. J Bone Joint Surg Am. 2021 Jun 2;103(11):984-991. doi: 10.2106/JBJS.20.00573. PMID: 33759484. Link. • Devinsky O, Patel AD, Cross JH, Villanueva V, Wirrell EC, Privitera M, Greenwood SM, Roberts C, Checketts D, VanLandingham KE, Zuberi SM; GWPCARE3 Study Group. Effect of Cannabidiol on Drop Seizures in the Lennox-Gastaut Syndrome. N Engl J Med. 2018 May 17;378(20):1888-1897. doi: 10.1056/NEJMoa1714631. PMID: 29768152. Link. • Devinsky O, Cross JH, Laux L, Marsh E, Miller I, Nabbout R, Scheffer IE, Thiele EA, Wright S; Cannabidiol in Dravet Syndrome Study Group. Trial of Cannabidiol for Drug-Resistant Seizures in the Dravet Syndrome. N Engl J Med. 2017 May 25;376(21):2011-2020. doi: 10.1056/NEJMoa1611618. PMID: 28538134. Link. • Ng JY, Gilotra K, Usman S, Chang Y, Busse JW. Attitudes toward medical cannabis among family physicians practising in Ontario, Canada: a qualitative research study. CMAJ Open. 2021 Apr 13;9(2):E342-E348. doi: 10.9778/cmajo.20200187. PMID: 33849983; PMCID: PMC8084545. Link. • NICE Guidelines on cannabis-based medicinal products: https://www.nice.org.uk/guidance/ng144
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