Centre for Addiction and Mental Health, Toronto, Ontario.
Pain Res Manag. 2005 Autumn;10 Suppl A:38A-43A. doi: 10.1155/2005/512653.
The adequate cotreatment of chronic pain and addiction disorders is a complex and challenging problem for health care professionals. There is great potential for cannabinoids in the treatment of pain; however, the increasing prevalence of recreational cannabis use has led to a considerable increase in the number of people seeking treatment for cannabis use disorders. Evidence that cannabis abuse liability is higher than previously thought suggests that individuals with a history of substance abuse may be at an increased risk after taking cannabinoids, even for medicinal purposes. Smoked cannabis is significantly more reinforcing than other cannabinoid administration methods. In addition, it is clear that the smoked route of cannabis delivery is associated with a number of adverse health consequences. Thus, there is a need for pharmaceutical-grade products of known purity and concentration using delivery systems optimized for safety. Another factor that needs to be considered when assessing the practicality of prescribing medicinal cannabinoids is the difficulty in differentiating illicit from prescribed cannabinoids in urine drug testing. Overall, a thorough assessment of the risk/benefit profile of cannabinoids as they relate to a patient's substance abuse history is suggested.
慢性疼痛和成瘾障碍的适当联合治疗是医疗保健专业人员面临的一个复杂而具有挑战性的问题。大麻素在疼痛治疗中有很大的潜力；然而，娱乐性大麻使用的流行率不断上升，导致寻求治疗大麻使用障碍的人数显著增加。有证据表明，大麻滥用的可能性比以前认为的要高，这表明有药物滥用史的个体在服用大麻素后，即使是出于医疗目的，也可能面临更高的风险。吸食大麻比其他大麻素给药方法更具强化作用。此外，很明显，大麻的吸食途径与许多不良健康后果有关。因此，需要使用优化了安全性的给药系统来提供具有已知纯度和浓度的制药级产品。在评估开具药用大麻的实用性时，另一个需要考虑的因素是在尿液药物检测中区分非法和处方大麻素的困难。总之，建议对大麻素与患者药物滥用史相关的风险/效益情况进行全面评估。
