Guidelines Issued on the Use of Cannabis for Chronic Noncancer Pain Management

The American College of Physicians (ACP) has published new guidelines aimed at healthcare professionals regarding the use of cannabis and cannabinoids in treating chronic noncancer pain. This comprehensive advice, titled Cannabis or Cannabinoids for the Management of Chronic Noncancer Pain: Best Practice Advice From the American College of Physicians, is featured in the latest edition of the Annals of Internal Medicine.

The primary goal of the ACP's guidelines is to equip clinicians with evidence-based insights into the potential benefits and risks associated with cannabis use for chronic pain management. The increasing prevalence of medicinal cannabis usage among patients seeking relief from chronic pain has prompted the need for such guidance. As of 2024, cannabis has been legalized for adult recreational and medical use in 24 states and the District of Columbia, while an additional 14 states permit its use strictly for medical purposes.

In its advisory, the ACP emphasizes that healthcare providers should:

• Discuss with patients the various benefits and potential risks linked to cannabis and cannabinoids when considering their use for chronic noncancer pain.
• Specifically counsel certain groups of patients--such as young adults, those with a history of substance use disorders, individuals with severe mental health conditions, and frail patients--about the likelihood that the risks of cannabis use may outweigh any potential benefits.
• Advise against the initiation or continuation of cannabis use in pregnant or breastfeeding individuals or those who are trying to conceive.
• Discourage the inhalation of cannabis as a method for managing chronic noncancer pain.

According to the ACP, it is crucial for physicians to facilitate informed discussions with patients regarding the use of cannabis for chronic pain. The organization acknowledges the growing interest in medicinal cannabis but stresses the importance of understanding the associated risks. The potential for cannabis to be addictive poses additional concerns, especially as the potency of cannabis products available at dispensaries often exceeds that of products used in clinical studies.

Moreover, the ACP notes that many patients may acquire cannabis through dispensaries that lack the rigorous medical oversight typically associated with FDA-approved medications. Given these factors, the organization advocates for the prioritization of established treatment options and analgesics before considering cannabis or cannabinoid therapies.

The guidelines are informed by a thorough review of scientific literature, including a systematic analysis of cannabis and cannabinoid efficacy in treating chronic noncancer pain, as well as additional primary studies.

For further information, the full advisory can be accessed through the Annals of Internal Medicine.