The cannabinoid system is just beginning to be explored and exploited in the pain world and neuropathic pain is what comes to mind a lot when people think of using medical marijuana. We have good data showing that an inhaled cannabinoid will help with pain, particularly neuropathic pain. It helps with nausea, helps with anxiety. We have some approved pharmaceutically elegant preparations that work on the cannabinoid system that people can take as pills. Also in Canada you can use Sativex as a sublingual spray. But smoking THC or marijuana does seem to have some benefits that you don’t always get with a pill. However, there are significant side effects, and generally speaking it’s not going to be a first-line treatment option. Most pharmacists have a big concern that this is being used as a medication but that there’s no standardization. Even in states like California that have dispensaries, these are not being done by licensed clinicians. If this is going to be used as a real clinical tool, then it has to meet the same standards as other clinical tools. It must be dispensed, procured, and given out in the same way that other clinical medications are being managed to keep patients safe, which is our first responsibility as clinicians.
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