Medical Cannabis
The number of registered medical marijuana users in Canada has tripled every year since 2014. Compared to the general population, marijuana users score four times worse on a functional assessment (World Health Organization Disability Assessment Schedule).
While a growing number of medical marijuana users self-medicate anxiety and sleep disorders, coping with chronic pain is the most common justification for use.
Unfortunately, cannabinoids are ineffective for most types of pain and marijuana (smoked, oils or edibles) is not an appropriate therapy for anxiety or insomnia. Cannabis oil prescriptions have mushroomed of late, but these preparations have not been shown to be more effective or safer than dried medical marijuana.
Only three conditions have modest evidence to support cannabinoid prescribing. They are:
1. Neuropathic pain (nerve pain, NOT osteoarthritis, NOT back pain, NOT fibromyalgia), or palliative pain (in cancer and end-of-life care);
2. Spasticity in multiple sclerosis or spinal cord injury, and
3. Chemotherapy-induced nausea and vomiting
In our clinic, we DO NOT prescribe medical marijuana (smoked, oils or edibles) as they are inadequately studied. If considering a medical cannabinoid, we prescribe nabilone only under the following circumstances:
1. Failure of ≥3 standard medications for neuropathic pain (or ≥2 for palliative pain);
2. Failure of standard therapies for chemotherapy-induced nausea/vomiting or spasticity in multiple sclerosis (or spinal cord injury).
Medical Cannabinoids Pt Brochure
Neuropathic Pain Pharmacotherapy Treatment
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