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Editorials |5 September 2017

Cannabis for Pain and Posttraumatic Stress Disorder: More Consensus Than Controversy or Vice Versa?

Sachin Patel, MD, PhD

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This article was published at Annals.org on 15 August 2017.
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The scientific evidence for the effectiveness and safety of cannabis and cannabinoid products in treating medical and psychiatric disease has recently come under substantial scrutiny. This surge in methodologically rigorous analysis of the evidence supporting cannabis-based therapeutics is driven in part by recent, dramatic, and ongoing changes in the accessibility of cannabis caused by U.S. state-level antiprohibition movements. In this context, clinicians, policymakers, and the public are increasingly interested in understanding the scientific evidence base underlying potential indications for medical cannabis use. This issue of Annals of Internal Medicine includes 2 such analyses, 1 focusing on pain and the other on posttraumatic stress disorder (PTSD). The systematic reviews highlight an alarming lack of high-quality data from which to draw firm conclusions about the efficacy of cannabis for these conditions, for which cannabis is both sanctioned and commonly used.
Nugent and colleagues (1) systematically reviewed data on the effects of cannabis for several types of pain and found only limited, low-strength evidence that cannabis alleviates neuropathic pain and insufficient evidence for other types of pain. Of importance, their conclusions were heavily based on studies using nabiximols (an oral mixture of tetrahydrocannabinol and cannabidiol) rather than smoked cannabis products (2). In addition, the authors comment that most available studies are small, have methodological pitfalls, and are of relatively short duration. These conclusions seem at odds with the fact that pain is one of the most common medical conditions for which cannabis is used and approved in many states...
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Patel S. Cannabis for Pain and Posttraumatic Stress Disorder: More Consensus Than Controversy or Vice Versa?. Ann Intern Med. [Epub ahead of print 15 August 2017]167:355–356. doi: 10.7326/M17-1713

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Published: Ann Intern Med. 2017;167(5):355-356.

DOI: 10.7326/M17-1713

Published at www.annals.org on 15 August 2017

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2017 American College of Physicians
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