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Randomized Controlled Trial
. 2013 Sep;38(10):1984-92.
doi: 10.1038/npp.2013.97. Epub 2013 Apr 22.

Comparison of the Analgesic Effects of Dronabinol and Smoked Marijuana in Daily Marijuana Smokers

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Free PMC article
Randomized Controlled Trial

Comparison of the Analgesic Effects of Dronabinol and Smoked Marijuana in Daily Marijuana Smokers

Ziva D Cooper et al. Neuropsychopharmacology. .
Free PMC article

Abstract

Recent studies have demonstrated the therapeutic potential of cannabinoids to treat pain, yet none have compared the analgesic effectiveness of smoked marijuana to orally administered Δ(9)-tetrahydrocannabinol (THC; dronabinol). This randomized, placebo-controlled, double-dummy, double-blind study compared the magnitude and duration of analgesic effects of smoked marijuana and dronabinol under well-controlled conditions using a validated experimental model of pain. Healthy male (N=15) and female (N=15) daily marijuana smokers participated in this outpatient study comparing the analgesic, subjective, and physiological effects of marijuana (0.00, 1.98, or 3.56% THC) to dronabinol (0, 10, or 20 mg). Pain response was assessed using the cold-pressor test (CPT): participants immersed their left hand in cold water (4 °C), and the time to report pain (pain sensitivity) and withdraw the hand from the water (pain tolerance) were recorded. Subjective pain and drug effect ratings were also measured as well as cardiovascular effects. Compared with placebo, marijuana and dronabinol decreased pain sensitivity (3.56%; 20 mg), increased pain tolerance (1.98%; 20 mg), and decreased subjective ratings of pain intensity (1.98, 3.56%; 20 mg). The magnitude of peak change in pain sensitivity and tolerance did not differ between marijuana and dronabinol, although dronabinol produced analgesia that was of a longer duration. Marijuana (1.98, 3.56%) and dronabinol (20 mg) also increased abuse-related subjective ratings relative to placebo; these ratings were greater with marijuana. These data indicate that under controlled conditions, marijuana and dronabinol decreased pain, with dronabinol producing longer-lasting decreases in pain sensitivity and lower ratings of abuse-related subjective effects than marijuana.

Figures

Figure 1
Figure 1
Pain sensitivity (left panels) and tolerance (right panels) as calculated by percent baseline latency (seconds) to report pain and withdraw the hand from the cold water. Data are presented as mean values for the group according to marijuana strength (top panels) or dronabinol dose (bottom panels) and time point. Refer to the Results section for explanation of significant differences between drug conditions.
Figure 2
Figure 2
Subjective ratings of the painfulness (left panel) and bothersomeness (right panel) as assessed immediately after the hand was withdrawn from the cold water. Data are presented as mean ratings for the group as a function of marijuana strength (top panels) or dronabinol dose (bottom panels) and time point. Refer to the Results section for explanation of significant differences between drug conditions.
Figure 3
Figure 3
Participant ratings of subjective drug effects ‘High,' ‘Good drug effect,' and ‘Stimulated' as measured by the subjective effect-visual analog scale (SE-VAS) (a) and ratings of marijuana strength, liking, and willingness to take again as measured by the Marijuana Rating Form (MRF) (b). Data are presented as mean group ratings as a function of drug condition and time point. Refer to the Results section for explanation of significant differences between drug conditions.
Figure 4
Figure 4
Cardiovascular effects of placebo, dronabinol, and marijuana presented as the average (±SEM) heart rate (beats per minute (b.p.m.)) for post-smoking time points for each drug condition. Significant differences between placebo and dronabinol or marijuana are indicated by *p⩽0.05, **p⩽0.01, and ***p⩽0.001.

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