Mikhail Kogan, MD:
Last week during the virtual PAINWeek meeting, the international task force shared the guidelines for dosing and administrating on medical cannabis. Allan Bell, MD, one of the members of the task force, explained that their main focus was to provide directions to clinicians. Though medical cannabis has been suggested to treat chronic pain, there is a huge knowledge gap about its use in the clinical field. Many providers still do not use it because there are no accepted guidelines about dosing and administration. Others prescribe medical cannabis without knowing about proper dosage.
“This guideline is very timely and very welcomed! Now physicians who are not familiar with the topic of medical cannabis for pain can fall back on this. The start low and go slow, especially in older adults practice is also very important. However, there is unfortunately one major problem with this guidelines. While it is very true that some chronic pain patients can respond well to CBD these are in minority and starting all patients on CBD and titrating up while waiting does not make sense. Patients should have options of starting low dose of THC containing products, ideally in balanced 1:1 THC:CBD ratios as soon as possible. While safety wise this guideline makes good sense unfortunately it misses to mention that there is no data comparing THC:CBD mixes to CBD alone. This gap in knowledge is critical to address. The guidelines also fail to state that CBD total oral dose should be kept under 100mg since high doses of CBD can and likely will interact with other pain medications including opioids. In summary, since this is first Medical Cannabis for chronic pain guideline it is very welcomed as first crucial step in increasing prescribers awareness.”