PM10 2019: Medicinal cannabis for chronic pain

List:

· Summary

· Indications

· Pharmaceutics

· Pharmacokinetics

· Recommendations if prescribing

· Use is prevalent in chronic pain patients (12-15%)

· Use often associated with psychiatric illness

· Definite harms: lung damage, psychosis, cognitive impairment

· Unclear benefits: no improvement in physical function, emotional state

· MS: pain, spasticity

· Cancer: pain, chemotherapy-induced nausea

· Epilepsy

· Weight loss (AIDS, anorexia nervosa)

· Fibromyalgia

· Natural: ∆9-tetrahydrocannabinol, cannabidiol, cannabinol

· Synthetic THC: dronabinol, nabilone

· Oral: bioav 10%, slow onset, difficult to titrate

· Pulmonary: bioav 20%, rapid onset, short duration

· Expect patch form to be developed

· Assess social, psychological and biological factors first

· Beware difficulty dosing

· Assess therapeutic and adverse effects after 1 month

· Suggest involving the patient in a research project or audit