South Africa’s first ethically-approved cannabis clinical trials have begun in Johannesburg with the goal to determine if cannabis can replace opioids for pain management, according to a June 21 press release. Cannabis is increasingly being recognized as a potential alternative to opioids in certain forms of pain management.

Biodata, subsidiary of Labat Africa, “is the brainchild of Dr. Shiksha Gallow, a cannabis clinician, and the principal investigator in the trials, which took over 18 months to get official clearance,” the announcement reads. South African medical cannabis researcher Dr. Shiksha Gallow has been a pioneer.

Researchers will follow 1,000 people who have used opioids to manage their pain for at most three months. Participants must be willing to try cannabis. Two chemovars currently being used are Tallyman and Exodus—sourced from Labat’s Sweetwaters Aquaponics SAHPRA-licensed facility in the Eastern Cape. Aquaponics can be used to grow cannabis with greater benefits. The third strain to be introduced shortly, 9 Pound Hammer, will be next—chosen because of its high THC and CBG profile, and being rich in beta caryophyllene and myrcene.

“We are currently recruiting patients, and data-capturing all the questionnaires and feedback from the patients for the live study,” Dr. Gallow said. “It has been fairly slow. As suggested by patients, the pilot study showed that there are more options in the live trial. The pilot results of the study were very promising, as it showed 98% of the patients have some sort of pain relief from the cannabis.”

The researchers were able wean opioid-treated patients from their treatment. High levels of THC were found in the flower, between 15 and 25 mg THC. The oil also contained approximately 0.5mg of CBD. A balanced oil (1:1) contained 15-20mg THC and 20-20m CBD. The pilot study showed that patients aged 55 and under preferred cannabis smoking, while older patients preferred oil. Smoking cannabis provided relief in a matter of minutes, but the oil was more time-consuming.

Peter Grinspoon, a Massachusetts General Hospital medical cannabis specialist and Harvard Medical School instructor, is the son of Lester Grinspoon (long-time advocate for cannabis) and psychiatrist. You can watch him discuss America’s opioid crisis on HarvardX or similar topics on TEDx.

“First of all, I think cannabis is really good for mild to moderate pain,” Dr. Grinspoon tells Chronic News. “I don’tI believe it is effective for extreme pain. So I think it depends a little bit on what the patient’s conditions are and how severe their pain is, and it’s not just a question of being on cannabis and opiates or off cannabis and opiates. Both work together very well. Synergistically, they co-work on some of the same receptors.”

Grinspoon stated that cannabis has many benefits and is more safe than opioids. “But I think for Other people they’ll probably achieve a dose reduction, which will also be a huge harm reduction [benefit]. So again, it’s not really binary, like off opiates or not off opiates.”

There’s evidence showing other people have reduced opioid use with the help of cannabis—which is what makes it incredibly stupid to test people on opiates for cannabis because it is probably helping them.

“There’s no reason for a pain specialist to view it as the enemy,” he said.

“We don’t really know how effective opiates are,” Dr. Grinspoon added, since there are people under withdrawal symptoms who have pain that’s hard to separate from chronic pain. There are also people who have severe pain, such as phantom or severe limb pain, and absolutely require opioids.

“It’s either opiates non-steroidals which, you know, like your Advil, your Motrin, and those aren’t safe either,” Dr. Grinspoon says.

“Those things are really dangerous, and can cause heart attacks, gas, ulcers, and a lot of kidney damage. The question here is: What is the most harmful treatment for chronic pain? There’s no free lunch. All medications have side effects, cannabis certainly have side effects, but I always ask myself, ‘what is the least dangerous thing to use and often?’”

Cannabis is definitely safer than opiates, he said, and he wonders if in some cases it’s safer than the non-steroidals.

Research is showing cannabis’ true potential in pain management. Dr. Gallow’s team of researchers in South Africa renewed this study for another year.