Clinical Takeaway
In this phase 3 randomized controlled trial of 820 adults, the full-spectrum cannabis extract VER-01 was evaluated against placebo over 12 weeks for chronic low back pain, with long-term follow-up extending to approximately one year. This represents one of the most rigorously designed clinical investigations of a cannabis-based medicine for this condition to date. Results from this trial provide controlled evidence relevant to clinicians considering cannabis medicine as an option for patients with inadequately managed chronic low back pain.
#1 Full-spectrum extract from Cannabis sativa DKJ127 for chronic low back pain: a phase 3 randomized placebo-controlled trial.
Citation: Karst Matthias et al.. Full-spectrum extract from Cannabis sativa DKJ127 for chronic low back pain: a phase 3 randomized placebo-controlled trial.. Nature medicine. 2025. PMID: 41023483.
Design: 5 Journal: 4 N: 2 Recency: 2 Pop: 2 Human: 1 Risk: -2
This phase 3 trial addresses a critical clinical gap by providing rigorous evidence for a full-spectrum cannabis extract in chronic low back pain, a condition affecting over 500 million people globally where current pharmacologic options demonstrate limited efficacy and considerable safety concerns. The study’s large sample size (820 participants), double-blind design, and extended follow-up period strengthen the reliability of efficacy and safety data needed to inform clinical decision-making and potential regulatory approval. Given the opioid crisis and limitations of existing CLBP treatments, efficacious cannabis-based alternatives with favorable safety profiles could substantially improve treatment options for this prevalent condition.
- Preclinical only
Methodological Considerations:
- Open-label design — placebo effect not excluded
Abstract: Chronic low back pain (CLBP) affects over half a billion people worldwide. Current pharmacologic treatments offer limited efficacy and carry substantial risks, warranting the development of safe and effective alternatives. This multicenter, randomized, placebo-controlled phase 3 trial evaluated the efficacy and safety of VER-01 in CLBP. It enrolled 820 adults with CLBP (VER-01, n = 394; placebo, n = 426) and included a double-blind 12-week treatment phase (phase A), a 6-month open-label extension (phase B), followed by either a 6-month continuation (phase C) or randomized withdrawal (phase D). The primary endpoint of phase A was a change in mean numeric rating scale (NRS) pain intensity, with a change in total neuropathic pain symptom inventory (NPSI) score as a key secondary endpoint in participants with a neuropathic pain component (PainDETECT > 18). The primary endpoint for phase D was time to treatment failure. The study met its primary endpoint in phase A, with a mean pain reduction of -1.9 NRS points in the VER-01 group (mean difference (MD) versus placebo = -0.6, 95% confidence interval (CI) = -0.9 to -0.3; P < 0.001). Pain further decreased to -2.9 NRS points in phase B, with effects sustained through phase C. The study also met its key secondary endpoint of phase A, with a mean NPSI decrease of -14.4 (standard error, 3.3) points from baseline in the VER-01 arm (MD versus placebo = -7.3, 95% CI = -13.2 to -1.3; P = 0.017). Although phase D did not meet its primary endpoint (hazard ratio = 0.75, 95% CI = 0.44-1.27; P = 0.288), pain increased significantly more with placebo upon withdrawal (MD = 0.5, 95% CI = 0.0-1.0; P = 0.034). In phase A, the incidence of adverse events-mostly mild to moderate and transient-was higher with VER-01 than with placebo (83.3% versus 67.3%; P < 0.001). VER-01 was well-tolerated, with no signs of dependence or withdrawal. VER-01 shows potential as a new, safe and effective treatment for CLBP. ClinicalTrials.gov registration: NCT04
? This phase 3 trial of a full-spectrum cannabis extract for chronic low back pain represents an important addition to the evidence base, though several factors warrant careful interpretation in clinical practice. The 12-week double-blind design and relatively large sample size of 820 participants provide reasonable methodologic rigor, but the abstract’s incompleteness prevents assessment of critical outcomes such as the primary efficacy endpoint, effect sizes, and safety profiles that would inform real-world prescribing decisions. The open-label extension phase introduces potential bias and is less suitable for drawing efficacy conclusions compared to the blinded portion. Given that current CLBP treatments do carry risks and many patients seek cannabis alternatives, these results may eventually offer clinicians another option; however, practitioners should await the full publication to evaluate whether the magnitude of benefit justifies use, how results compare to existing first-line therapies like physical therapy and multimodal approaches, and which patient populations appear most likely to respond. Until complete safety and efficacy data are available, cautious interest is warran
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