A recent survey published in the journal Obstetrics & Gynecology took a closer look at symptom management pertaining to cannabis and endometriosis, finding that patients often turn to cannabis to alleviate their symptoms despite ongoing barriers to access. Endometriosis is a condition where tissue similar to the lining of the uterus grows outside of the uterus, generally resulting in severe pelvic pain and inflammation. The tissue acts in the same way as the lining inside the uterus, thickening, breaking down and bleeding with each menstrual cycle.

Endometriosis involving the ovaries can also result in cysts, causing surrounding tissue irritation and formation of scar tissue. Endometriosis can start at the time of a person’s first menstrual period and last until menopause. We still don’t know what causes endometriosis, there is no way to prevent it and there is no cure. However, there are a number of treatments to help ease the related symptoms. Some opt for surgery to remove lesions, while many embrace hormonal intrauterine devices, birth control methods, opioid-based pain medications and more for ongoing relief.

That said, we can safely add cannabis to the list of modern-day treatments given its prevalence of use. In the survey, Australian researchers examined the perspectives of 192 people with a history of cannabis use and endometriosis. Noting it as a “very expensive disease, with substantive out of pocket costs for pain and symptom management,” researchers reference cost and accessibility to cannabis-based medicinal products (CMBPs) as a primary focus of the survey. They also cite the lack of information surrounding ideal products, modes of administration and efficacy in current research.

Researchers gathered data through an online survey of Australian and New Zealand residents, via social media and community-based advocacy platform Cannareviews.co. Respondents included those using either illicit cannabis or legal CMBPs prescribed by a doctor to manage endometriosis and chronic pelvic pain-related symptoms. However, the published report only includes data from Australian respondents.  The survey found that THC-dominant CBMPs are most commonly prescribed to Australians with endometriosis, noting multi-product use as a common trend with most people reporting the use of at least two products.

For those with only one prescription (23%), it was almost always a THC-dominant product.  Most respondents (59.4%) said they used cannabis recreationally and for endometriosis symptom management, though many exclusively used cannabis to manage symptoms (40.1%). Patients reported improvements in common endometriosis symptoms through the use of legal CBMPs, specifically sleep (68.9%), chronic pelvic pain (44.5%), nausea (47.9%), anxiety/depression (45.4%) and menstrual pain (38.7%).  They also reported a reduction in the use of opioids, hormonal treatments, non-steroidal inflammatory drugs, neuroleptics and illicit cannabis.

  Oils and flower were the most common product types, illicit or legal. The results also pointed to legal, THC-dominant cannabis medications being more expensive than illicit “equivalents” and that the extra cost for legal access often led to people underdosing (76.1%) or resorting to illicit cannabis to “bridge the gap” and easen cost burdens (42.9%). Researchers note that relying upon illicit cannabis products can lead to inadequate symptom management, using products that have not been tested for safety and quality and of course associated legal ramifications.

Nearly all (96.3%) respondents said that their cost burden would be substantially reduced if CBMPs were a Pharmaceutical Benefits Scheme (PBS) listed and subsidized product.  The bulk of respondents said they would consider moving insurers if they found out their private health insurance would not reimburse the cost of cannabis medicine as well — 60.9% said maybe, depending on other factors; 20.3% said yes, so long as the premium was the same price or less; 11.7% said yes, even if the premium was higher; only 7% said no.

Researchers said that patients’ willingness to switch insurers based on this variable “speaks to the pivotal nature of cost concerns (and perceived effectiveness) relating to affordable access to cannabinoids.” Additionally, they state that the results suggest a need for a greater response from insurers in the country. “Given the lack of well-tolerated alternatives for medical management of endometriosis, this is an equity issue that urgently needs addressing,” they add. Researchers note that self-reported nature of cost, diagnosis and product consumption as a limitation.

They also cited the potential for their recruitment methods — through social media and Cannareviews’ patient base — to produce recall and selection bias, as participants may have either had more severe impacts to quality of life or a more positive experience with illicit or medicinal cannabis than the broader population. Still, the data affirms that many are already finding relief and relying on cannabis treatments for endometriosis, highlighting the need for better access. “Given major issues with symptom management and the self-reported reductions in pain and other symptoms, improving access to medicinal cannabis for this population is important and timely,” authors conclude.

“Reductions in cost of both product and consultations, as well as coverage by insurance are areas which need addressing.” Read less