The potential use of medicinal cannabis for pain management in people with endometriosis is being explored by Victorian and NSW researchers in two separate studies. The upcoming Australian Medicinal Nursing Symposium being held 11 August will explore the rising use of medicinal cannabis for patients with a range of conditions, including endometriosis.

The ‘EndoCannED’ trial conducted by Deakin University researchers in Victoria is looking at whether prescribing medicinal cannabis instead of opioids can reduce emergency department presentations among people living with the condition.

“Women with endometriosis have a four times greater risk of chronic opioid use compared to women without,” said Deakin’s Centre for Social and Early Emotional Development (SEED) Professor Antonina Mikocka-Walus.

“Opioids are often ineffective in managing pain from endometriosis and are not suitable for the long-term treatment required by those with the condition.

“Despite substantial use of these medications most people with endometriosis in Australia report poor pain and symptom control.”

Insufficient pain control can lead to people presenting to emergency departments with breakthrough pain, Professor Mikocka-Walus said. Endometriosis affects one in nine women and currently has no cure.

The three-month Deakin project involves 63 patients, living in Victoria, monitored by researchers to learn whether the use of medicinal cannabis reduces the need for them to present to emergency departments.

A recent poll undertaken in January 2022 on social media by Instagram account ‘theendojournal’ reported that 78% of more than 650 responses had presented to an emergency department at least once in the previous two years due to their endometriosis symptoms, with almost one in five (18%) presenting more than five times in the past two years.

A recently announced Sydney based trial is also looking at the potential for medicinal cannabis to relieve endometriosis pain.

Western Sydney University has secured funding to study the use of medicinal cannabis for endometriosis over the next three years. Researchers will investigate the endocannabinoid system (ECS) and inflammatory markers, as well as exploring potential cost-benefits of medicinal cannabis for treating endometriosis.“The purpose of this double-blind randomised controlled trial is to determine if medicinal cannabis, either a cannabidiol (CBD) isolate or a balanced oil containing both CBD and delta-9-tetrahydrocannabinol (THC), can reduce pelvic pain and other symptoms of endometriosis when compared to a placebo oil, which we believe is the first time this has been done,” said principal investigator of the study, Associate Professor Mike Armour, NICM Health Research Institute, Western Sydney University.Previous research has shown that people living with endometriosis in Australia and New Zealand are using cannabis, mostly from illicit sources, to manage their pain and other associated symptoms, Professor Armour said.

“These people self-reported positive experiences with cannabis use including reduction in pain, improvements in sleep, mood and gastrointestinal functions and credited it with allowing them to effectively manage their endometriosis symptoms and live a better quality of life.

“However, there is still a lot we don’t know about how or why cannabis may affect endometriosis symptoms and possibly slow lesion progression. The trial will allow us to determine the effective dosage range, ideal THC to CBD ratio, duration of treatment and so forth.

Endometriosis sufferers have welcomed the research.

“As a person living with endometriosis and the impact it has left on my body, I know all too well how often we struggle to find effective treatment options,” said long-time endometriosis advocate and co-founder and Director of Endometriosis Australia Donna Ciccia.

“Using medicinal cannabis under the care of my GP, I’ve found it has helped me manage some of my symptoms. This study has the potential to provide a safe and accessible alternative for the community.”

The Victorian study will also examine participants’ pelvic pain severity, general symptom severity, analgesic usage, fatigue, and health-related quality of life changes.

Previous research has found that the potential for cognitive impairment was a concern to people who wish to use medicinal cannabis to manage menstrual symptoms.

“We’ll be testing an oral cannabidiol (CBD) isolate as a daily treatment as it allows people to undertake the normal activities of daily life while providing a potential pain reduction,” Professor Mikocka-Walus said.

The Victorian project is being supported by the state government and NICM Health Research Institute and results are expected to be delivered by April 2024. For further information on the project please contact endocanned@deakin.edu.au

The Australian Nursing Medicinal Cannabis Conference sponsored by The Australian Nursing & Midwifery Federation (ANMF) is being held on 11 August. The one-day nursing program is part of the 3-day United in Compassion Australian Medicinal Cannabis Symposium with presentations from around the globe and Australia.