Many Americans have at least tried cannabidiol (CBD) and tetrahydrocannabinol (THC) products within the past 12 months, according to a 2023 cross-sectional survey, 21.1% and 11.9% respectively.
While some decide to use these substances on their own, a different survey found 24% of the respondents initiated the use of medical cannabis for pain upon the advice of their healthcare provider.
What do you say if a patient asks for your advice about CBD or the use of a THC-containing product to help ease their chronic pain? Researchers from the University of Michigan Medical Center, New York’s Hospital for Special Surgery and Weill Cornell Medicine offer three principles that can help inform your response, providing you the ability to thoughtfully integrate these products into a patient’s treatment plan.
#1. Start the conversation (and patient education)
The first principle presented in the January 2024 article in Anesthesia and Analgesia involves maintaining a therapeutic partnership or alliance with patients.
DCs can open the door to conversations about using CBD for pain by being willing to support patients when they express a desire to pursue it as a pain management options. Through these discussions, patients can become more educated about health and feel empowered as partners in their treatment. This fosters trust and communication between provider and patient, strengthening this alliance.
#2. Reduce harm while maximizing benefits
The second principle of dispensing CBD use advice is to reduce patient harm while maximizing benefits. This requires focusing on four key concepts and providing guidance in each area. These concepts and the recommended guidance are:
- Route of administration. When administering CBD products, use tinctures for breakthrough symptoms, capsules for chronic symptoms and vaporizing is preferred to smoking (although inhalation isn’t recommended, if possible).
- Cannabinoid content. In addition to THC leading to psychoactive effects, products containing this cannabinoid may not be legal in that particular state. CBD products containing less than 0.3% THC are not illegal federally and therefore more available.
- Titration. Start with CBD products first and at a low dose, 5-10 mg twice a day (BID). If increases are needed, increase slowly, adding 1-2 milligrams of THC per increase if the therapeutic effect is not being achieved.
- Timing of use. Time CBD use according to the symptoms experienced, such as taking it 30 minutes before bed if the patient has trouble sleeping. Avoid THC products during work or when driving.
#3. Offer pragmatic and patient-centered care
The final principle provided is centered around being pragmatic, patient-centered and using your best clinical judgment. The authors acknowledge that research on the use of CBD is insufficient, due to both methodology issues and barriers associated with this drug’s legal status. This forces practitioners to rely on their best judgment until more definitive answers can be learned.
When sharing your best judgment, consider the patient’s needs and preferences. Work together to create shared goals and measures of the treatment’s effectiveness. Continue this cooperation when deciding if the dosage should be increased or if the use of cannabis for pain is impacting the patient in other ways.
Final thoughts
Until research provides more definitive answers about the effectiveness of cannabis for pain, following these three principles can help practitioners prescribe the best advice possible for individual patients. It also keeps the lines of communication open, further enhancing the patient-provider relationship.
