Abstract:There is a great deal of interest in the use of cannabis-based products including medically authorized marijuana for the treatment of almost any pain condition including low back pain. There are many anecdotal reports of patients who found it an effective treatment for chronic low back pain, one that has allowed them in some cases to discontinue other treatments such as continuing opioid therapy. There is now easy legal access to cannabis-based preparations in Canada with or without medical authorization. However, with some notable exceptions, the evidence that would allow physicians to have a high degree of confidence in selecting this treatment modality is lacking.
Key Words: cannabis; chronic pain; low back pain; evidence.
Members of the College of Family Physicians of Canada may claim MAINPRO-M2 Credits for this unaccredited educational program.
1. Compared to medically authorized cannabis, street sourced products are at high risk of contamination including insect remains, fungi, chemical fertilizers and herbicides.
2. Unlike most plant-sourced medications, the active ingredients are located on the cannabis leaf, which raises the risk of contaminant exposure.
3. Cannabis leaves by themselves are inert until heated in a process known as decarboxylation.
4. While inhaled cannabis has a rapid onset of action, ingested products have a delayed onset producing a risk of overdose if continuing to consume while waiting for an expected effect.
5. Little is yet known about potential drug interactions with cannabis use.
Cannabis authorizing physicians will often recommend a higher THC:CBD ratio product for evening or bedtime use, and a higher CBD:THC ratio or pure CBD for daytime use.
As is true for any potential intoxicant, patients need to be cautioned about the risks of operating a motor vehicle or any machinery while under the influence of cannabinoids, especially higher THC ratio products.
Because it is a lipid soluble chemical, urine, blood, or hair tests can detect THC for many days after use.
Standardized tools and principles exist for the appraisal of credible eHealth resources.
Physicians in Canada provide medical "authorization" for cannabis use, verifying that the patient has a medical condition for which cannabis could be a valid therapeutic option. This authorization then allows the patient to purchase from a licensed producer up to a recommended quantity in grams per day. Although the basic patient demographics and birthday are required, unlike a prescription, the exact component percentage and potency, method of ingestion, and frequency are not components of the authorization.
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What Physicians Should Know about Herbal Medicines
Edzard Ernst, MD, PhD, FRCP, FRCPEd, Complementary Medicine, Peninsula Medical School, Universities of Exeter and Plymouth, Exeter, UK.
Many patients use herbal medicines, often without telling their physicians. In order for doctors to advise their patients responsibly, they should know the basics of efficacy, safety, and quality of herbal medicines. As one herbal medicine is different from another, there can be no generalizations. Key words: herbal medicine, efficacy, safety, quality, evidence.