Cannabinoid pharmacotherapy: past, present and future

Cannabinoids are medically interesting, but the available data are still weak scientifically and overwhelming anecdotally. In the management of pain, cannabinoids have been shown to have antinociceptive properties in animal models of pain, with non-opiate mechanisms appearing to predominate. A widely cited meta-analysis suggested that cannabinoids offer moderate pain relief, similar to codeine, and limited by side effects. Further research, particularly into modes of delivery, to assess their therapeutic potential are needed. Any successful future clinical development of cannabinoid pharmacotherapy depends upon a dosage form that is reliable, rapidly titratable to effect, non-smoked, and preferably parenteral to avoid hepatic first pass metabolism.