An Israeli clinic has followed 1,000 people with chronic lower back pain over ten years who were treated with medical cannabis. Opioid doses dropped by almost 90 percent among remaining patients, while pain scores fell by more than 80 percent. These numbers are making waves in the field. Less attention is being paid to a caveat from the authors themselves: the effects are so large that bias from the study design likely plays a role.
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The 10-Year Study on Back Pain and Medical Cannabis
The study was published on September 14 in the European Spine Journal. It comes from the orthopedic department of Rabin Medical Center in Petach Tikwa, with Muhammad Khatib as lead author. The analysis examined 1,000 consecutive patients from a registry who had not used cannabis before starting treatment. All suffered from chronic lower back pain.
The primary measure was opioid consumption, converted to morphine milligram equivalents (MME) per day. Additional metrics included pain severity on a 0-10 scale, functional limitation using the Oswestry Disability Index, and data on concomitant medications and adverse effects. While the findings have circulated in cannabis media, we consulted the original publication to provide a thorough review.
The Results: Less Opioids, Less Pain
Of the 1,000 participants, 638 remained in the study at the ten-year mark—63.8 percent. In this group, opioid consumption fell from 62.8 to 6.4 MME per day, a reduction of 89.8 percent. Pain severity dropped from 8.71 to 1.37 points on the pain scale. The disability index improved from 52.9 to 36.8 percent, a gain of roughly 16 points.
Other medications were also used less frequently. The proportion of patients taking tramadol or tapentadol fell by 84 percentage points, benzodiazepines by 73.5, and SSRI antidepressants by 71.9 percentage points. Gabapentinoids showed a 30.7 percentage point decline. Adverse effects related to tolerability occurred in 11.4 percent of clinic visits. Serious psychiatric events were documented in just 0.02 percent of visits.
This study joins a series of registry data pointing in the same direction. Earlier this year, we reported on a larger analysis of 3,500 patients titled Medical Cannabis Instead of Opioids. Israel has long been a pioneer in cannabis research. The path there was not politically straightforward, as our earlier reports on decriminalization during the CannaTech conference and initial decriminalization plans show.
Why the Authors Themselves Call for Caution
The researchers place their findings in an unusually critical light. The study has no control group. The measured effects far exceed results from randomized trials. The authors cite a recent Phase 3 trial where the difference from placebo was only 0.6 points on the pain scale. In the registry study, by contrast, pain fell by more than seven points—but this was a before-after comparison without a placebo group.
From this, the authors conclude that bias from the observational design likely contributed to the results. Several factors are plausible. More than one-third of participants dropped out before the ten-year mark. Those who discontinue treatment because it isn’t working disappear from the final analysis. Additionally, pain often improves over such a long period even without treatment. The authors therefore characterize their data as hypothesis-generating and call for randomized trials.
What This Means for Back Pain Patients in Germany
For patients in Germany, this study arrives at a difficult moment. Since July 30, statutory health insurance has stopped covering cannabis flower. There is no transition period for ongoing therapy, as the Frankfurt Social Court confirmed in emergency proceedings. Before reimbursement for extracts is approved, a six-month trial with an authorized pharmaceutical product is now required.
For chronic back pain, that product has been Exilby since June. We reported on its approval as Europe’s first cannabis medicine for chronic back pain. The reimbursement amount is still being negotiated; details are in our article on the Exilby pricing and AMNOG process. The Israeli registry data do not change this legal situation in Germany. However, they provide support for precisely the controlled studies that the authors themselves demand.
Frequently Asked Questions
What did the Israeli study examine?
It followed 1,000 people with chronic lower back pain over ten years who received medical cannabis treatment. The study tracked opioid consumption, pain severity, functional limitation, concomitant medications, and adverse effects.
How much did opioid use decline?
Among the 638 participants who completed the study, daily opioid doses fell from 62.8 to 6.4 MME. This represents a reduction of roughly 90 percent. This figure says nothing about those who dropped out.
Does the study prove that cannabis works for back pain?
No. This is an observational study without a control group. The authors explicitly acknowledge that bias from the study design is likely and call for randomized trials to verify the findings.
How often did adverse effects occur?
Adverse effects affecting tolerability were documented in 11.4 percent of clinic visits. Serious psychiatric events were rare at 0.02 percent of visits.
Does health insurance in Germany cover cannabis for back pain?
Cannabis flower has not been covered since July 30, 2026. For extracts, a six-month trial with an approved pharmaceutical product must first be completed; for chronic back pain, this is Exilby. The specifics are discussed between the treating physician and the insurance company.
Note: This article reflects the status as of September 17, 2026, and is not legal or medical advice. It does not replace medical consultation and makes no therapeutic claims. The reported results come from an uncontrolled observational study.
Hast du selbst Erfahrung mit Cannabis gegen chronische Schmerzen?
Sources: Khatib M, Robinson D, Lavon E et al.: Ten-year outcomes of medical cannabis for chronic low back pain: opioid reduction, pain relief, and functional improvement in 1,000 patients. European Spine Journal (2026), DOI 10.1007/s00586-026-10290-y (PubMed 42734834). Hanfjournal, September 15, 2026.
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