by E. Mironchik-Frankenberg, DVM.
There is a growing crisis in our country that most people are unaware of. It disproportionately affects the elderly, but more and more children, and indeed pets, are becoming victims of this predicament. I’m referring to polypharmacy, a situation that doctors and pharmacists are beginning to consider a public health emergency.
Polypharmacy is generally accepted to mean the use of several (usually five or more) medications on a daily basis, with the possibility that these may not all be clinically necessary.1 In many patients, including our pets, it can develop slowly and insidiously from visits to multiple doctors or specialists, from the need to treat multiple conditions, or as the result of what is referred to as the “prescribing cascade.” This is the phenomenon in which a medication-related side effect leads to the prescription of additional medications, and so on….2
This situation can rapidly get out of hand, leading to the risk of drug interactions, unintentional overdose, excessive costs, and side effects. In addition, the added difficulty in medicating our pets, combined with the challenges in dosing and timing schedules can lead to unintended consequences. Overall, multiple studies have shown the correlation between polypharmacy and poor quality of life. 2
Many patients and pet owners are realizing that there must be a better way…
Cannabis advocates argue that in certain circumstances, there is a natural solution. They propose that the ‘complex and variable nature of cannabis’ could be exactly what makes it a potential solution for combatting the polypharmacy crisis.3 This is partly due to the fact that many diseases are multifactorial; where a variety of receptors need to be targeted to produce a therapeutic effect. A botanical medicine may better achieve this than a single synthetic compound, because its inherent components can act synergistically.6
Let’s take the common example of a pet with chronic pain. This is a condition that many patients suffer from (both humans and their pets). Unfortunately, a large portion of those being treated for their painful conditions may be taking multiple medications, and yet, still do not attain adequate relief. Traditional treatment for a dog with severe, chronic pain may include multiple types of pain relievers, possibly including different combinations of NSAIDs or steroids, opiates, gabapentin, etc. All these medications have side effects which may also require medications to offset, such as stomach ulceration, diarrhea, vomiting, inappetence, etc. When faced with a traditional regimen of several of these drugs, multiple times per day, why wouldn’t a pet owner consider a single herbal remedy that may be safer and free from the risk of drug-drug interactions, because all the therapeutic effects are contained within one synergistic, plant-based medicine?3 Conversely, if a patient is already on multiple medications, the addition of cannabis may increase the effectiveness of treatment, but more importantly, allow the patient to be weaned off of the other prescription medicines.
In fact, a 2016 study concluded that “overall, since the initiation of medical cannabis use, chronic pain (CP) patients reported significant decreases in medication side effects that affected their daily functioning (including opioids), decreases in total number of medications being taken, and improvements in quality of life.4
In a recent veterinary study of CBD in dogs with chronic osteoarthritis pain, one of the objectives was to observe any potential effects on the doses of pain-related medications already in place for the dogs.5 The results showed that almost all of the subjects were able to reduce their gabapentin dose or eliminate the drug completely, thereby potentially providing a “gabapentin-sparing effect” for dogs with chronic maladaptive pain.
Finally, in many cases, patients using medical cannabis may be better managing their symptoms, while simultaneously reducing the number of prescription drugs they are taking. If this is an option you are considering, talk to your veterinarian. Ultimately, minimizing the stress involved in managing chronic disease can result in a better quality of life for both pets and their families.
REF:
1. US Pharm. 2017;42(6):13-14. https://www.uspharmacist.com/article/polypharmacy
2.Schenker, Y., Park, S.Y., Jeong, K. et al. Associations Between Polypharmacy, Symptom Burden, and Quality of Life in Patients with Advanced, Life-Limiting Illness. J GEN INTERN MED 34, 559–566 (2019). https://doi.org/10.1007/s11606-019-04837-7
3.https://www.projectcbd.org/medicine/cannabis-instead-polypharmacy
4. Boehnke KF, Litinas E, Clauw DJ. Medical cannabis use is associated with decreased opiate medication use in a retrospective cross-sectional survey of patients with chronic pain. J Pain. 2016;17(6):739–744 https://www.omofmedicine.org/wp-content/uploads/2018/05/um-om-pain-study.pdf
5. Kogan, L., Hellyer, P., & Downing, R. 2020. The Use of Cannabidiol-Rich Hemp Oil Extract to Treat Canine Osteoarthritis-Related Pain: A Pilot Study. AHVMA Journal. Vol 58. 35-45. https://www.ahvma.org/wp-content/uploads/Use-of-Cannabidiol-Rich-Hemp-Oil-Sample-Article.pdf
6.Brian A. Whittle, Geoffrey W. Guy & Philip Robson (2001) Prospects for New Cannabis-Based Prescription Medicines, Journal of Cannabis Therapeutics, 1:3-4, 183-205, DOI: 10.1300/J175v01n03_12 https://www.researchgate.net/publication/247286973_Prospects_for_New_Cannabis-Based_Prescription_Medicines
