“There was moderate-quality evidence to support the use of cannabinoids for the treatment of chronic pain and spasticity. There was low-quality evidence suggesting that cannabinoids were associated with improvements in nausea and vomiting due to chemotherapy, weight gain in HIV infection, sleep disorders, and Tourette syndrome,” Dr. Wilsey told Clinical Pain Advisor.

Moreover, cannabinoids were linked to an increased risk of short-term adverse events,” Dr. Wilsey pointed out. These were most commonly related to CNS, cardiovascular, and respiratory effects.


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Although medical marijuana may be beneficial for selected medical conditions, further research is warranted, Dr. Parmar said, noting that he and his team are currently reviewing data and developing guidelines for marijuana use in CINV and pain relief.

A number of legal and regulatory issues also need to be addressed before marijuana use can be established in clinical practice. Federal laws still view marijuana as an illegal substance, although enforcement is low in states that have approved access to cannabis-ingested products, Dr. Parmar noted.

Benefits of Marijuana Treatment Agreement

It is important that clinical practitioners communicate with patients regarding the goals of marijuana therapy and associated potential risks and benefits. Patients should be made aware that in contrast with recreational use, medical marijuana is intended for delivery in low, cumulative, therapeutic doses.

According to Dr. Wilsey, a treatment agreement might be the best way to convey treatment goals and improve patient understanding and compliance.3,4 As with prescribed opioids, written agreements between prescriber and patient can help deter misuse and abuse by delineating patient responsibilities with respect to dosing, random drug screens, and appointments.

Dosing Strategies Remain Unclear

Optimal dosing strategies for cannabis-based medications and ingested marijuana remain unclear, highlighting the importance of clinical counseling guidelines.