Recent state regulations (eg, in New York, Illinois) allow medical cannabis as a substitute for opioids for chronic pain and for addiction. Yet the evidence regarding safety, efficacy, and comparative effectiveness is at best equivocal for the former recommendation and strongly suggests the latter—substituting cannabis for opioid addiction treatments is potentially harmful. Neither recommendation meets the standards of rigor desirable for medical treatment decisions.
Recent systematic reviews1,2 identified low-strength evidence that plant-based cannabis preparations alleviate neuropathic pain and insufficient evidence for other types of pain. Studies tend to be of low methodological quality, involve small samples and short-follow-up periods, and do not address the most common causes of pain (eg, back pain). This description of evidence for efficacy of cannabis for chronic pain is similar to how efficacy studies of opioids for chronic pain have been described (except that the volume of evidence is greater for opioids with 96 trials identified in a recent systematic review3).
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Humphreys K, Saitz R. Should Physicians Recommend Replacing Opioids With Cannabis? JAMA. Published online February 01, 2019321(7):639–640. doi:10.1001/jama.2019.0077
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