Abstract

Background: Chronic low back pain (CLBP) is a leading cause of disability, often managed with opioids despite risks. Cannabis, containing tetrahydrocannabinol (THC) and cannabidiol, offers a potential alternative, but long-term data are limited.
Objective: To evaluate the efficacy, safety, and opioid-sparing effects of cannabis therapy over 10 years in CLBP patients.

Methods: In a prospective study (2013–2023), 168 adults (135 males, mean age 47 ± 19 years) with CLBP (≥1 year) and anatomical abnormalities (e.g., disc herniation, 83%) received cannabis (20% THC, 50 ± 10 g/month) at a specialized orthopedic clinic. Baseline treatments included opioids (91%) and surgery (47%). Outcomes—pain (Visual Analogue Scale, VAS), disability (Oswestry Disability Index, ODI), quality of life (SF-12), and opioid use—were assessed at baseline, 1, 3, 12, 24, 60, and 120 months. Statistical analysis used ANOVA, t-tests, and Kruskal–Wallis; missing data were imputed via Last Observation Carried Forward.

Results: At 10 years (n = 159), VAS decreased from 84.6 ± 14.8 to 7.0 ± 11.0 (p < 0.0001), ODI from 61.7 ± 13.7 to 4.0 ± 6.0 (p < 0.0001), and SF-12 Physical and Mental Component Summaries improved by 21.1 points each (p < 0.0001). Opioid use dropped from 91% to 8.2% (morphine equivalent dose: 30 ± 12 to 1 ± 3 mg, p < 0.001). Six patients (3.6%) discontinued due to adverse effects; nine died.

Conclusions: Long-term cannabis therapy significantly reduced pain, disability, and opioid dependence in CLBP, with sustained quality-of-life gains, supporting its role in chronic pain management.