Physicians strive to provide guidance as patients increasingly ask about treatment
As medical cannabis gains more mainstream acceptance, and as physicians increasingly encounter patient questions about its use, doctors are developing more clinical resources to guide those who decide to prescribe it.
At this year’s PAINWeek in September, Alan Bell, MD, of the University of Toronto, and colleagues presented recommendations for using medical cannabis to treat chronic pain. The same month, two physicians published a book aimed at helping colleagues treat patients, and the previous month a pain medicine specialist published a similar book.
Though evidence from gold-standard randomized controlled trials has been severely limited, authors of the publications told MedPage Today that it’s important to start somewhere.
“We are trying to advocate for more physicians to provide better care,” said Kevin Hill, MD, of Beth Israel Deaconess Medical Center in Boston, a co-author of one of the new clinical textbooks. “We wanted to present exactly where things stand now — understanding we have a long way to go in some areas.”
The group met via video calls to develop the guidelines, setting the bar at 75% agreement to include any recommendations, and touting the use of a modified Delphi process.
Ultimately their recommendations included: stratifying patients into conservative, routine, or rapid treatment protocols based on level of need; following a regimen heavy on cannabidiol (CBD), introducing tetrahydrocannabinol (THC) in small doses only when CBD alone cannot yield desired patient outcomes; and starting with 2.5-mg doses of THC and 5-mg CBD doses and increasing dosages by 1-5 mg.