MJ is not intended to be used as first line therapy for pain relief, either smoked or as a medible. Before cannabis is recommended for this indication, physicians should ensure their patients have an adequate trial of standard analgesics for pain control. Multimodal approaches for chronic pain management appropriately include antidepressants, anticonvulsants, NSAIDs like ibuprofen, topical analgesics, and TENS units, in addition to narcotics.
In general, there seems to be an increasing trend toward public acceptance of medical MJ as a treatment option for severe nausea and vomiting associated with chemotherapy, weight loss associated with cancer and HIV, spasticity secondary to multiple sclerosis, and glaucoma, in addition to neuropathic pain.
Patients using medical MJ are advised to follow all appropriate state laws including possession limits in the state where they reside as well as to refrain from public use. Dried cannabis should be titrated to a dose that is effective while minimizing intoxication and cognitive impairment.
Evidence of MJ use must be held in strictest professional confidence, and all medical and business records should comply with the requirements of the Health Insurance Portability and Accountability Act of 1996. In addition, physicians and pharmacists should:
Keep up with state and federal laws regarding medical MJ use (some states require a pharmacist be involved in the delivery of MJ)
Ensure patients using MJ for medical purposes are under continuous medical supervision with a physician and have met their statutory state requirements
Develop a professional knowledge of the risk/benefit of medical MJ based on the published literature
MJ is here to stay for the foreseeable future. It’s time to get our heads out of the sandbox and get educated. It takes a village to keep us safe.