Department of Anesthesiology, Pain Mechanisms Laboratory, Wake Forest University School of Medicine, Winston-Salem, North Carolina.
Department of Pharmaceutical and Administrative Sciences, Presbyterian College School of Pharmacy, Clinton, South Carolina.
Pharmacotherapy. 2018 Jun;38(6):651-662. doi: 10.1002/phar.2115. Epub 2018 May 16.
The National Academies of Sciences, Engineering, and Medicine has found substantial evidence that cannabis (plant) is effective for the treatment of chronic pain in adults, and moderate evidence that oromucosal cannabinoids (extracts, especially nabiximols) improve short-term sleep disturbances in chronic pain. The paradoxical superiority of the cannabis plant over cannabinoid molecules represents a challenge for the medical community and the established processes that define modern pharmacy. The expanding and variable legalization of cannabis in multiple states nationwide represents an additional challenge for patients and the medical community because recreational and medicinal cannabis are irresponsibly overlapped. Cannabis designed for recreational use (containing high levels of active ingredients) is increasingly available to patients with chronic pain who do not find relief with current pharmacologic entities, which exposes patients to potential harm. This article analyzes the available scientific evidence to address controversial questions that the current state of cannabis poses for health care professionals and chronic pain patients and sets the basis for a more open discussion about the role of cannabis in modern medicine for pain management. A critical discussion on these points, the legal status of cannabis, and considerations for health care providers is presented.
美国国家科学院、工程院和医学院发现大量证据表明大麻（植物）可有效治疗成人慢性疼痛，有中等质量证据表明口溶大麻素（提取物，特别是纳比昔莫）可改善慢性疼痛患者的短期睡眠障碍。大麻植物相对于大麻素分子的矛盾优越性，对医学界和定义现代药学的既定流程构成了挑战。全国多个州大麻的不断扩大和多样化合法化，给患者和医学界带来了额外的挑战，因为娱乐性和药用大麻被不负责任地重叠。用于娱乐用途的大麻（含有高水平的活性成分）越来越多地提供给慢性疼痛患者，而这些患者无法从现有药物实体中得到缓解，这使患者面临潜在的伤害。本文分析了现有的科学证据，以解决当前大麻对医疗保健专业人员和慢性疼痛患者带来的有争议的问题，并为更开放地讨论大麻在现代医学疼痛管理中的作用奠定基础。本文还就这些问题、大麻的法律地位以及医疗保健提供者的注意事项进行了批判性讨论。
