m2d1605-chrisli

Evidence-based guidelines that support my capstone projects are medicinal cannabis for chronic pain. Kevin et al. (2017) reported approximately 100 million adults who live in the United States are burdened by chronic pain. Greater than 50% of all annual physician visits and recent estimates indicate a pain-related financial burden of over $600 billion in annual healthcare costs and lost productivity (Kevin et al., 2017). This burden exceeds the costs of sick leaves and early retirement combined. The increasingly prescribed and authorized medicinal cannabis or cannabinoids for chronic pain remains contentious for many healthcare providers because of the suspected dangers of cannabis use. Cannabis has been used around the world for centuries, and the purpose of its use varies. Many civilizations have used cannabis for various conditions, from joint pain, muscle spasms, gout, and malaria starting with the Chinese around 2900 B.C. (Kevin et al., 2017).

There was consensus that medical cannabis may be considered for patients experiencing neuropathic, inflammatory, and mixed pain. Arun et al. (2021), in a journal of cannabis research, the authors provide specific evidence-based guidelines that support treatment protocols. First, for a routine protocol, a clinician can initiate a patient on a cannabinoid predominant at a dose of 5 mg twice daily and titrate the dose by 10 mg every 2 to 3 days until a patient reaches his or her goals, or up to 40 mg/day. Second, at 40 mg/day, a clinician may consider adding tetrahydrocannabinol (THC) starts of 2.5 mg and titrate by 2.5 mg every 2 to 7 days until a maximum daily dose of 40 mg/day of THC. The third approach is a more conservative protocol where a clinician may initiate a cannabinoid at a dose of 5 mg once daily and titrate the dose by 10 mg every 2 to 3 days until a patient reaches his or her goals, or up to 40 mg/day. Arun et al. (2021) suggested a rapid protocol can start with the initiation of a balanced THC with cannabinoid combined at 2.55 mg once or twice daily and can titrate by 2.5mg to 5 mg until a patient reaches his or her goals or a maximum THC dose of 40 mg/day (Arun et al., 2021).

Implementation of the above guidelines can help a provider address chronic pain in patients who cannot use opioids. Kevin et al. (2017) have indicated that a lack of training in the use of medical cannabis or cannabinoids during formal medical education may create confusion. This lack of guidance from professional associations and federal agencies may confuse medical cannabis in the management of chronic pain. Some clinicians even mention and have criticized that medical cannabis is like substituting one addictive substance like opioids for another with the uncertain benefit of cannabis (Brian et al., 2017).