How does medical cannabis compare with treatments you have already tried?

The question people actually ask is whether this works better than the thing they are already on. The honest answer starts with an inconvenient fact: almost nobody has run that trial.

Why there is no clean answer

Comparative effectiveness requires a trial that randomises people between two active treatments. For cannabis-based medicines against the standard options, those trials have almost never been run.

What exists instead is a set of placebo-controlled trials of varying quality for cannabis-based medicines, and a separate set for the established treatments. Comparing across two different bodies of evidence, with different populations, outcome measures and durations, is not the same as comparing the treatments.

So when a clinic, a forum or an AI answer tells you one is better than the other, that is an inference rather than a finding. The useful comparison is narrower and more personal: what have you tried, what happened, and what is left.

Nerve pain, against gabapentinoids and antidepressants

For neuropathic pain, NICE recommends offering a choice of amitriptyline, duloxetine, gabapentin or pregabalin, and switching if the first does not work or is not tolerated. Cannabis-based medicines are not in that recommendation.

The Cochrane review of cannabis-based medicines for chronic neuropathic pain found that they may increase the number of people achieving substantial pain relief compared with placebo, while also increasing withdrawals due to adverse events, and rated the evidence low to very low quality. That is a genuine signal in a difficult condition, and it is not a demonstration of superiority over an established option.

The condition pages go further: neuropathic pain, sciatica and fibromyalgia.

Trauma, against the psychological therapies

For post-traumatic stress disorder, NICE recommends trauma-focused psychological therapies, including trauma-focused cognitive behavioural therapy and eye movement desensitisation and reprocessing. These have a substantially stronger evidence base than any drug treatment for PTSD.

There is no trial comparing a cannabis-based medicine with a trauma-focused therapy, and the two are not really alternatives: a medicine that helps with sleep or hyperarousal does not do what a trauma-focused therapy does.

In practice a careful specialist will ask whether you have been able to access a recommended therapy at all, because waiting lists rather than treatment failure are often the real obstacle. That is a reason to help you get the therapy, not a reason to substitute for it.

More detail is in medical cannabis for PTSD.

Sleep, against sleeping tablets and CBT for insomnia

For long-term insomnia, cognitive behavioural therapy for insomnia is the first-line treatment, and hypnotic medicines are recommended only for short periods because of tolerance and dependence.

People often arrive having used a hypnotic for far longer than intended, which is a real problem and one a specialist will take seriously. It is worth knowing that tolerance and dependence are not unique to hypnotics: they are relevant to cannabis-based medicines too, which is why treatment is reviewed rather than simply repeated.

See medical cannabis for sleep disorders and tolerance, dependence and stopping treatment.

What if nothing else has worked?

That is the situation the UK system is actually designed around, and it is a reasonable position to be in. It is also the point at which the honest framing matters most, because hope and evidence are easy to confuse.

Having exhausted the standard options makes you the kind of patient a specialist can consider, since the convention is that two standard treatments have been tried. It does not make a cannabis-based medicine likely to work, and a specialist who tells you it will is telling you something the evidence does not support.

What a good consultation produces is a clear-eyed view of the odds for your condition, an explicit plan for how long to try and how the result will be judged, and a willingness to stop if it is not helping.

The general requirements are covered in What are the requirements?

Making the comparison personal

Because the published evidence cannot tell you which treatment is better in the abstract, the comparison that is actually available to you is a personal one: what you have tried, what it did, and what it cost you in side effects. That record is more useful to a specialist than any general claim, and assembling it before an assessment sharpens the conversation considerably.

It helps to write down, for each treatment you have tried, the dose you reached and how long you stayed on it, why it stopped — whether it did not help or caused side effects you could not tolerate — and anything that helped partially. A treatment abandoned after a couple of days at a low dose is not really a fair test, and a specialist will see that distinction straight away. The point is not to argue that cannabis is better, but to show clearly where the standard options have left symptoms unmanaged.

Bear in mind, too, that a comparison is never only about effectiveness. Standard treatments carry their own side effects, and so do cannabis-based medicines; the Cochrane review noted more withdrawals for adverse events, not just a possible benefit. What you are really weighing is the whole trade-off of benefit, side effects and how a treatment fits your life.

Questions worth asking when comparing options

These keep the discussion honest and grounded in your own case rather than in general claims.

• For my condition, how does the evidence for this compare with the treatments I have already tried?
• Is there any trial comparing them directly, or are we comparing across separate studies?
• Which symptom are we trying to change, and how will we measure whether it is working?
• How do the likely side effects compare with those of my current treatment?
• Should this be added to what I already take, or replace it — and who decides that?
• How long is the trial before we review, and what would make you stop it?

Patient guide · Written by the Flora House editorial team · Last reviewed: 2 November 2026