PM10 2019: Medicinal cannabis for chronic pain



·         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


Possible indications:

·         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


Recommendations if prescribing it:

·         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


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