Cannabinoids for Chronic Noncancer Pain Management: A Focused Literature Review
Dutton, Molly Annette
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The purpose of this literature review is to: 1. To determine if cannabinoid products are effective in treating chronic pain associated with HIV/AIDS, multiple sclerosis (MS), neuropathy, or other unspecified sources of chronic pain. 2. To ascertain if the form and route of administration of cannabinoid products is important in efficacy and safety (e.g. dronabinol versus whole-plant cannabis). 3. If efficacy has been established, are these medications available in a form that clinicians can safely recommend to their patients? 4. Lastly, to determine what the legal implications for clinicians and patients may be when working with a Schedule I drug. Evidence from this review indicate that cannabinoid products can be highly efficacious in managing chronic noncancer pain, including pain caused by multiple sclerosis, HIV, antiretroviral therapies used in treating HIV and other sources of chronic pain. Cannabinoid therapies that bypass hepatic metabolism are better tolerated by patients and are the preferred route of administration. Additional large-scale randomized controlled trials are essential to elucidate appropriate forms of administration (whole plant, synthetic sublingual, etc.) for safe clinical management of cannabinoid products. Regarding the legal implications of working with a tightly regulated medication, to date no patients, providers, dispensaries or caregivers have been prosecuted for practicing within the bounds of their state's legislation. Providers need to familiarize themselves with the forms of cannabinoid products available to patients within the state they practice in. Oral cannabinoids such as dronabinol (Marinol) can be helpful for many patients, but also have a side effect profile that limit therapeutic benefit for many more. Medical marijuana is available in 13 states at the time of this publication. It is the first time public initiative, rather than the FDA, is guiding the medications available to patients and preliminary research indicates that whole plant cannabis can be an effective analgesic for some patients. Consuming any product in a smoked form is never recommended, so clinicians should have conversations with patients regarding alternative methods of consumption (e.g. vaporization), or the harm versus benefit of smoking cannabis products.