For decades, opioids have been the most widely used medications for the treatment of pain. However, these drugs have exacted a heavy toll on society. For this reason, the health sector is in desperate need of other medications that can effectively treat pain.
Many researchers and physicians know that cannabidiol (CBD) and other cannabinoids may offer a solution to pain without the addictive nature of opioids. However, clinical trials into cannabis as a pain reliever is lacking (despite plenty of evidence from observational and prospective studies), and there have been little guidance for medical professionals in prescribing it for patients.
To address this problem, an international task force, known as the Global Task Force on Dosing and Administration of Medical Cannabis, has come up with protocols for the use of cannabis for pain relief. Arun Bhaskar, MD, of Imperial College Healthcare NHS Trust Pain Management Centre in London, led the panel of 20 physicians. The guidance was presented during PAINWeek, a live virtual conference held September 11-13, 2020.
“We as a task force believe it’s extremely important to bring [medical cannabis] to patients,” said Dr. Bell. “Our main focus was to provide directions to clinicians.”
The first protocol involves treating patients using a routine scale. It dictates beginning with 5mg of cannabidiol (CBD) two times each day. This dosage is to increase until pain relief is achieved. If pain relief is not achieved by 40mg a day of CBD, then tetrahydrocannabinol (THC) can be added to the mix in dosages starting at 2.5mg daily, which would be capped at 40mg daily.
For the frailest of patients who are elderly and/or have severe co-morbidities, THC is to be issued conservatively. The task force recommends beginning with 1mg per day and increasing it slowly if needed.
Finally, the task force addresses patients in severe pain and those with an extensive history of cannabis consumption. Patients in these categories can be given cannabis under a rapid protocol, which allows doctors to administer equal doses of CBD and THC containing between 2.5 and 5 mg of each cannabinoid once to two times per day.
Members of the task force favor starting with CBD because many have seen its sole use for pain as effective. Additionally, they recommended that all medicinal cannabis be administered orally for ease of use.
The task force advised that pregnant women and those who breastfeed should abstain from medicinal cannabis, as well as those with psychotic disorders.
Members of the task force included physicians from North America, Brazil, Africa, and Europe. Some had extensive experience using medicinal cannabis on their patients in a variety of fields of medicine, including, oncology, primary care, and pediatrics.
In their poster, the group emphasized: “Tailoring medical cannabis treatment to the individual is a critical component of successful treatment.”
As always, speak to your doctor before initiating use of any therapy, including cannabinoids.
Image Credit: Karolina Grabowska