Cannabinoids and treatment of chronic pain

Can cannabinoids be used in the treatment of chronic pain?

Kevin P. Hill, MD: Cannabis absolutely can be used in the treatment of chronic pain. And I want to be clear: I am not advocating for medical cannabis as a first-line treatment for chronic pain, perhaps not even a second-line treatment for chronic pain; however, the patients that I see frequently will come in and have a laundry list of treatments that they have already used, medications, injections for chronic pain. For that patient I think it is a legitimate potential treatment.

The evidence is pretty strong at this point. Hypothetically, I think when you think about the cannabinoid receptors and the opioid receptors, they are collocated in certain parts of the brain, so it makes sense that cannabis could be useful to treat pain that is associated with the opioid receptors. And then, certainly, anecdotal evidence has been growing for years. The patients say that when they are prescribed opioids for pain, for example, and then they start using medical cannabis, they use fewer opioids.

At the end of the day, I think there is a lot of promise there. I certainly would push strongly for more research. But we already have a fair amount of research. And so, as a third-line treatment, for example, for a patient that has exhausted many first- and second-line options, I think medical cannabis makes a lot of sense in some cases.