Last week, an international task force released guidelines on using cannabis to treat pain. Consisting of 20 health care professionals, the guide offers clinicians three protocols when recommending cannabis to patients for neuropathic, inflammatory, nociplastic, and mixed pain. This includes a routine protocol for most circumstances, a conservative protocol for more vulnerable populations, and a rapid protocol for patients with severe functional impairment and/or familiarity with medical cannabis.
The routine protocol advises:
Start with a 5 mg oral dose of a product that is CBD dominant twice per day. Titrate as needed by 10 mg (total daily amount) every 2 or 3 days until reaching either the treatment goal or 40 mg (total daily amount).
Add, as needed per dose, 2.5 mg of a product that is THC dominant. Titrate doses by 2.5 mg every 2 to 7 days until reaching either the treatment goal or 40 mg total daily dose.
The conservative protocol advises:
Start with a 5 mg oral dose of a product that is CBD dominant once per day. Titrate as needed by 10 mg every 2 or 3 days until reaching either the treatment goal or 40 mg.
Add, as needed, 1 mg of a product that is THC dominant. Titrate doses by 1 mg every 2 to 7 days until reaching either the treatment goal or 40 mg total daily dose.
The rapid protocol advises:
Begin with a once- or twice-daily oral dose of a product that contains between 2.5 mg and 5 mg of each cannabinoid—CBD and THC. Titrate doses of each cannabinoid by 2.5 mg to 5 mg every 2 to 3 days until reaching either the treatment goal or 40 mg THC total daily dose.
Should patients feel that 40 mg THC is inadequate, clinicians are advised to refer them to an expert. Additionally, the task force advised clinicians to consider potential drug interactions with concurrent medications like clobazam, anticoagulants, and immunotherapies.
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