Cyr Claude, Arboleda Maria Fernanda, Aggarwal Sunil Kumar, Balneaves Lynda G, Daeninck Paul, Néron Andrée, Prosk Erin, Vigano Antonio
Department of Family Medicine, McGill University, Montreal, Canada.
Department of Oncology, McGill University, Montreal, Canada; Clinique Santé Cannabis, Montreal, Canada.
Ann Palliat Med. 2018 Oct;7(4):463-477. doi: 10.21037/apm.2018.06.04. Epub 2018 Jun 28.
Pain and symptom control challenges are common in palliative care, and the search for other therapeutic strategies is ongoing. Unfortunately, patients and their caregivers are receiving little information or support from healthcare providers regarding the increasingly popular cannabinoid-based medicines (CBM). Clinicians, meanwhile, feel understandably perplexed by the discrepancy between the available evidence and the rapid interest in which patients and their families have demonstrated for CBM. There is an urgent need to address the many challenges that are delaying the appropriate integration of CBM into clinical practice, notwithstanding the obvious need for a solid general knowledge of pharmacology, mechanism of action and available clinical evidence supporting its use. The authors will address these challenges and provide practical recommendations regarding patient assessment for the use of CBM. The authors will also make suggestions regarding patient expectations in order to define clear objectives, review the necessary precautions prior to initiating treatment, aid in selecting the appropriate strain and route of administration as well as establishing proper titration and monitoring protocols. The authors will also discuss the lesser known but potentially therapeutic psychoactive effects of cannabis. As this class of therapeutic agents are likely to play a major role in palliative medicine in the near future, clinicians would benefit from familiarizing themselves with CBM and we can expect that patients and their caregivers will appreciate receiving support in their search for safe and effective therapeutic alternatives.
疼痛和症状控制挑战在姑息治疗中很常见，对其他治疗策略的探索也在持续进行。不幸的是，患者及其护理人员从医疗保健提供者那里获得的关于日益流行的基于大麻素的药物（CBM）的信息或支持很少。与此同时，临床医生对现有证据与患者及其家属对CBM表现出的迅速兴趣之间的差异感到困惑，这是可以理解的。尽管显然需要扎实掌握药理学、作用机制以及支持其使用的现有临床证据等常识，但迫切需要解决许多阻碍CBM适当融入临床实践的挑战。作者将应对这些挑战，并就使用CBM的患者评估提供实用建议。作者还将就患者期望提出建议，以明确目标，在开始治疗前审查必要的预防措施，协助选择合适的品种和给药途径，以及建立适当的滴定和监测方案。作者还将讨论大麻鲜为人知但可能具有治疗作用的精神活性效应。由于这类治疗药物在不久的将来可能在姑息医学中发挥重要作用，临床医生熟悉CBM将受益匪浅，并且我们可以预期患者及其护理人员会感激在寻找安全有效的治疗替代方案方面得到支持。
