Global task force establishes protocols for medical cannabis use to treat pain
An international task force of 20 health care professionals developed protocols for using medical cannabis to treat neuropathic, inflammatory, nociplastic and mixed pain.
“There are limited randomized controlled trial data to guide clinicians on how to dose and administer medical cannabis,” Arun Bhaskar, MD, a pain medicine consultant with the Pain Management Centre at Imperial College Healthcare NHS Trust in London, said during a virtual PAINWeek presentation. “This evidence gap, coupled with the clinical reality that patients are receiving medical cannabis for chronic pain, highlights the demand for expert consensus guidance from experienced clinicians on how to safely and effectively dose and administer medical cannabis.”
The task force — which included health care professionals with backgrounds in oncology, anesthesia, pain management and psychiatry — developed a routine protocol that consists of:
- starting with a 5 mg oral dose of a CBD-predominant product twice daily;
- titrating as needed by 10 mg every 2 to 3 days until the patient reaches their treatment goal, or 40 mg daily;
- adding (if needed) 2.5 mg of THC; and
- titrating by 2.5 mg every 2 to 7 days until a maximum daily dose of 40 mg THC is reached.
A conservative protocol, designed for the frail and older adults and those with complex comorbidities, polypharmacy and/or mental health disorders, consists of:
- taking a 5 mg dose orally of a CBD-predominant product once daily;
- increasing as needed by 10 mg every 2 to 3 days until the patient reaches their treatment goal, or 40 mg daily;
- adding (if needed) 1 mg THC; and
- increasing by 1 mg every 2 to 7 days until a maximum daily dose of 40 mg THC is reached.
A rapid protocol, meant for patients with severe pain or functional impairment and/or have taken medical cannabis before, consists of:
- starting with once- or twice-daily oral doses of a THC-CBD product that contains 2.5 mg to 5 mg of each cannabinoid; and
- titrating by 2.5 mg to 5 mg of each cannabinoid every 2 to 3 days until the patient reaches treatment goals, or a maximum THC dose of 40 mg per day.
Regardless of protocol, the task force noted that if a patient needs more than 40 mg of THC daily to reach treatment goals, an expert should be consulted.
“Potential drug interactions should also be considered when coadministering anticoagulants, immunotherapies and clobazam with medical cannabis,” Bhaskar said, noting that randomized placebo-controlled trials are needed to confirm the “validity and applicability” of the protocols.