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Cannabis and Pain

November 18, 2019

A recent editorial published in 2019 in Pain Medicine comments on the use of medical cannabis in pain management.

The editorial is entitled ‘Cannabis and Pain’ and was written by Ethan Russo, MD, Director of Research and Development for the International Cannabis and Cannabinoids Institute, Prague, Czech Republic. Dr Russo has dedicated much of his career to conducting medical research with cannabis. His research interests have included correlations of historical uses of cannabis with modern pharmacological mechanisms, and bringing attention to the benefits of cannabis.

Dr Russo’s editorial can be accessed via the following link: https://doi.org/10.1093/pm/pnz227

Dr Russo proffers the following messages in his editorial:

Certain basic truths must be advanced:

  1. We are facing an opioid crisis with attendant unacceptable iatrogenic mortality;
  2. Our nonopioid alternatives are minimally effective adjuncts in the treatment of chronic pain and often harbor their own prominent comorbidities and sequelae;
  3. There are no data that support the safety or efficacy of long-term opioids in chronic noncancer pain;
  4. Little is on the drug development horizon that portends to alter this landscape;
  5. Whether anyone likes it or not, increasing millions of people around the globe are utilizing cannabis to treat their pain, and observational studies and surveys repeatedly demonstrate that pain is the top medical indication for cannabis usage, in the range of 70% of all patients;
  6. No medicine is successful commercially or otherwise unless the patient perceives that they are improved through its usage; and
  7. As we lack objective measurement of pain on the clinical front (the putative “pain-o-meter”), we have only the patients’ opinions and those of their caregivers to guide measures of efficacy.

Dr Russo concludes with, “I urge clinicians to educate themselves on cannabis, cannabinoids, and the endocannabinoid system, to understand that cannabis is a variable botanical with distinct pharmacological differences between chemovars with attendant preparation-specific effects, and to engage their patients in substantive discussions of the impact that cannabis may have on their quality of life.”

The importance of education and public discussion rounds out a poignant editorial that highlights the need for quality use of medicines and harm minimisation.

References:
Russo, E. (2019). Cannabis and Pain. Pain Medicine.