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Consensus-based recommendations for titrating cannabinoids and tapering opioids for chronic pain control
Aaron Sihota1, Brennan K Smith2, Sana-Ara Ahmed3
1Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada.
International Journal of Clinical Practice
|November 29, 2020
Summary
Medical cannabis may help patients taper off opioids for chronic pain. Consensus recommendations guide safe initiation of cannabinoids (CBD, THC) and opioid reduction, improving function and quality of life.
Area of Science:
- Pain Management
- Pharmacology
- Cannabinoid Science
Background:
- Opioid misuse crisis necessitates alternative pain management strategies.
- Medical cannabis is explored for chronic pain and opioid tapering.
- Physician and patient interest in cannabinoids for opioid reduction is growing.
Purpose of the Study:
- Develop consensus-based recommendations for using cannabinoids with opioids.
- Guide safe initiation and titration of cannabinoids during opioid tapering.
- Establish protocols for patient monitoring and outcome evaluation.
Main Methods:
- A five-step modified Delphi process was employed.
- Expert consensus was sought on cannabinoid-opioid management.
- Recommendations cover initiation, titration, tapering, and monitoring.
Main Results:
- Cannabinoids can be considered for chronic pain patients with opioid complications.
- Initiate with cannabidiol (CBD)-predominant extract, then add tetrahydrocannabinol (THC) cautiously.
- Opioid tapering begins with functional improvement or optimized cannabinoid dosage, with gradual reductions.
Conclusions:
- Consensus recommendations were developed for safe cannabinoid use alongside opioid tapering.
- The guidelines address the complex interplay between cannabinoids and opioids in pain management.
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