Evidence map›Paper›PMID 38171632›Full record

SynthesisBMJ open2024

Cannabis for medical use versus opioids for chronic non-cancer pain: a systematic review and network meta-analysis of randomised clinical trials.

Haron M Jeddi, Jason W Busse, Behnam Sadeghirad, Mitchell Levine, Michael J Zoratti, Li Wang, Atefeh Noori, Rachel J Couban, Jean-Eric Tarride

Open access · goldAbstract readComparative StudySystematic ReviewNetwork Meta-Analysis
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in BMJ open, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 26 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
26citing papers in PubMed, 1 pooled it
18.8field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

26 citing papers in PubMed, 1 synthesis or guideline pooled it, 42 citations in OpenAlex.

  1. Pooled it
  2. Trial
  3. Ten-year outcomes of medical cannabis for chronic low back pain: opioid reduction, pain relief, and functional improvement in 1,000 patients.European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2026
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  9. A Scoping Systematic Review of Cannabis Use in Endometriosis.The Australian & New Zealand journal of obstetrics & gynaecology · 2026
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors at 4 institutions in 1 country.

Haron M JeddiDepartment of Health Research Methods, Evidence, and Impact (HEI), Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Ontario, Canada markjeddi@me.com.ORCID 0000-0003-2018-9376
Jason W BusseDepartment of Health Research Methods, Evidence, and Impact (HEI), Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Ontario, Canada.ORCID 0000-0002-0178-8712
Behnam SadeghiradDepartment of Health Research Methods, Evidence, and Impact (HEI), Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Ontario, Canada.ORCID 0000-0001-9422-5232
Mitchell LevineDepartment of Health Research Methods, Evidence, and Impact (HEI), Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Ontario, Canada.
Michael J ZorattiDepartment of Health Research Methods, Evidence, and Impact (HEI), Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Ontario, Canada.
Li WangDepartment of Anesthesia, McMaster University, Hamilton, Ontario, Canada.
Atefeh NooriDepartment of Health Research Methods, Evidence, and Impact (HEI), Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Ontario, Canada.
Rachel J CoubanDepartment of Anesthesia, McMaster University, Hamilton, Ontario, Canada.
Jean-Eric TarrideDepartment of Health Research Methods, Evidence, and Impact (HEI), Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Ontario, Canada.
Impact · CAMcMaster University · CAPrograms for Assessment of Technology in Health Research Institute · CAUniversity Health Network · CA

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveThe objective of this study is to evaluate the comparative benefits and harms of opioids and cannabis for medical use for chronic non-cancer pain.

designSystematic review and network meta-analysis. DATA SOURCES: EMBASE, MEDLINE, CINAHL, AMED, PsycINFO, PubMed, Web of Science, Cannabis-Med, Epistemonikos and the Cochrane Library (CENTRAL) from inception to March 2021. STUDY SELECTION: Randomised trials comparing any type of cannabis for medical use or opioids, against each other or placebo, with patient follow-up ≥4 weeks. DATA EXTRACTION AND SYNTHESIS: Paired reviewers independently extracted data. We used Bayesian random-effects network meta-analyses to summarise the evidence and the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach to evaluate the certainty of evidence and communicate our findings.

resultsNinety trials involving 22 028 patients were eligible for review, among which the length of follow-up ranged from 28 to 180 days. Moderate certainty evidence showed that opioids provide small improvements in pain, physical functioning and sleep quality versus placebo; low to moderate certainty evidence supported similar effects for cannabis versus placebo. Neither was more effective than placebo for role, social or emotional functioning (all high to moderate certainty evidence). Moderate certainty evidence showed there is probably little to no difference between cannabis for medical use and opioids for physical functioning (weighted mean difference (WMD) 0.47 on the 100-point 36-item Short Form Survey physical component summary score, 95% credible interval (CrI) -1.97 to 2.99), and cannabis resulted in fewer discontinuations due to adverse events versus opioids (OR 0.55, 95% CrI 0.36 to 0.83). Low certainty evidence suggested little to no difference between cannabis and opioids for pain relief (WMD 0.23 cm on a 10 cm Visual Analogue Scale (VAS), 95% CrI -0.06 to 0.53) or sleep quality (WMD 0.49 mm on a 100 mm VAS, 95% CrI -4.72 to 5.59).

conclusionsCannabis for medical use may be similarly effective and result in fewer discontinuations than opioids for chronic non-cancer pain. PROSPERO REGISTRATION NUMBER: CRD42020185184.

Indexed as

CannabisChronic PainAnalgesics, OpioidBayes TheoremCannabinoid Receptor AgonistsHumansRandomized Controlled Trials as TopicAnalgesics, OpioidCannabinoid Receptor AgonistsBack painNeurological painPain managementPAIN MANAGEMENT

Identifiers

PMID38171632
PMCPMC10773353
OpenAlexW4390595288

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.