Position on Research into the Use of Cannabinoids for Medical Purposes

A Position Statement from the American Academy of Pain Medicine

The American Academy of Pain Medicine (AAPM) supports regulatory rescheduling of cannabinoids from Schedule I to Schedule II to facilitate research into the medical effectiveness, substance toxicity, and overall safety of these products for the treatment of pain. The Academy is calling for this change so that a broader assessment can be made of risks and benefits related to cannabinoids as a medical option.

Major systematic reviews on the use of cannabinoids for chronic pain have yielded conflicting conclusions regarding their effectiveness and safety.^1-7 The lack of high quality clinical research leaves both physicians and patients at a disadvantage when considering the potential risks and benefits of cannabinoids as medicine.

Additionally, the current disparity in some areas between state and federal laws relating to the use of marijuana for the delivery of cannabinoids results in these substances not being sufficiently regulated.⁸ These factors place physicians in a difficult ethical and legal position when contemplating recommending cannabinoids for their patients. Accordingly, the American Academy of Pain Medicine urges federal agencies to reschedule medical cannabis in order to encourage research leading to responsible regulation.

References

1. Amato, L., Minozzi, S., Mitrova, Z., Parmelli, E., Saulle, R., Cruciani, F., . . . Davoli, M. (2017). Systematic review of safeness and therapeutic efficacy of cannabis in patients with multiple sclerosis, neuropathic pain, and in oncological patients treated with chemotherapy. Epidemiol Prev, Sep-Dec(41), 5-6, 279-293. doi:10.19191/EP17.5-6.AD01.069
2. Aviram, J., & Samuelly-Leichtag, G. (2017). Efficacy of Cannabis-Based Medicines for Pain Management: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Pain Physician, Sep 20(6), E755-E796.
3. Campbell, G., Stockings, E., & Nielsen, S. (2019). Understanding the evidence for medical cannabis and cannabis-based medicines for the treatment of chronic non-cancer pain. European Archives of Psychiatry and Clinical Neuroscience, 269(1), 135-144. doi:10.1007/s00406-018-0960-9.
4. Mücke, M., Phillips, T., Radbruch, L., Petzke, F., & Häuser, W. (2018). Cannabis-based medicines for chronic neuropathic pain in adults. Cochrane Database of Systematic Reviews. doi:10.1002/14651858.cd012182.pub2
5. The health effects of cannabis and cannabinoids: The current state of evidence and recommendations for research. (2017). Washington, DC: The National Academies Press.
6. Walitt, B., Klose, P., Fitzcharles, M., Phillips, T., & Häuser, W. (2016). Cannabinoids for fibromyalgia. Cochrane Database of Systematic Reviews. doi:10.1002/14651858.cd011694.pub2
7. Whiting, P. F., Wolff, R. F., Deshpande, S., Nisio, M. D., Duffy, S., Hernandez, A. V., . . . Kleijnen, J. (2015). Cannabinoids for Medical Use. Jama, 313(24), 2456-73. doi:10.1001/jama.2015.6358
8. Piomelli, D., Solomon, R., Abrams, D., Balla, A., Grant, I., Marcotte, T., & Yoder, J. (2019). Regulatory Barriers to Research on Cannabis and Cannabinoids: A Proposed Path Forward. Cannabis and Cannabinoid Research, 4(1), 21-32. doi:10.1089/can.2019.0010

Approved by the AAPM Board on May 30, 2019