Consensus recommendations on dosing and administration of medical cannabis to treat chronic pain: results of a modified Delphi process

Summary & key facts

A group of 20 international experts used a step-by-step group method to agree on how doctors might start and change medical cannabis doses for people with long-term pain. They made three practical plans—conservative, routine, and rapid—that explain starting doses, how quickly to increase them, and when to add THC. The experts said these are guidance because there are still few high-quality trials proving exact doses work best.

Key facts:

• Twenty experts from nine countries used a structured group process to create consensus recommendations on dosing medical cannabis for chronic pain.
• The experts agreed medical cannabis may be considered for several types of pain: neuropathic pain, inflammatory pain, nociplastic pain (pain from changes in how the nervous system processes signals), and mixed pain.
• They created three treatment plans: a routine plan, a conservative plan, and a rapid plan to help clinicians choose how to start and increase doses.
• Routine plan: start with a CBD-predominant product at about 5 mg of CBD twice a day. Increase CBD by about 10 mg every 2 to 3 days until goals are met or up to about 40 mg per day. Once at 40 mg of CBD per day, clinicians may add about 2.5 mg of THC and increase THC by about 2.5 mg every 2 to 7 days up to about 40 mg of THC per day.
• Conservative plan: start with about 5 mg of CBD once a day. Increase CBD by about 10 mg every 2 to 3 days until goals are met or up to about 40 mg per day. Once at 40 mg of CBD per day, clinicians may add about 1 mg of THC and increase THC by about 1 mg every 7 days up to about 40 mg of THC per day.
• Rapid plan: start with a balanced product that has both THC and CBD at about 2.5–5 mg of each once or twice a day. Increase both THC and CBD by about 2.5–5 mg every 2 to 3 days until goals are met or until THC reaches about 40 mg per day.
• The recommendations are expert opinion to guide clinicians because there are few randomized controlled trials that test exact doses and schedules.

Abstract

BACKGROUND: Globally, medical cannabis legalization has increased in recent years and medical cannabis is commonly used to treat chronic pain. However, there are few randomized control trials studying medical cannabis indicating expert guidance on how to dose and administer medical cannabis safely and effectively is needed. METHODS: Using a multistage modified Delphi process, twenty global experts across nine countries developed consensus-based recommendations on how to dose and administer medical cannabis in patients with chronic pain. RESULTS: There was consensus that medical cannabis may be considered for patients experiencing neuropathic, inflammatory, nociplastic, and mixed pain. Three treatment protocols were developed. A routine protocol where the clinician initiates the patient on a CBD-predominant variety at a dose of 5 mg CBD twice daily and titrates the CBD-predominant dose by 10 mg every 2 to 3 days until the patient reaches their goals, or up to 40 mg/day. At a CBD-predominant dose of 40 mg/day, clinicians may consider adding THC at 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. A conservative protocol where the clinician initiates the patient on a CBD-predominant variety at a dose of 5 mg once daily and titrates the CBD-predominant dose by 10 mg every 2 to 3 days until the patient reaches their goals, or up to 40 mg/day. At a CBD-predominant dose of 40 mg/day, clinicians may consider adding THC at 1 mg/day and titrate by 1 mg every 7 days until a maximum daily dose of 40 mg/day of THC. A rapid protocol where the clinician initiates the patient on a balanced THC:CBD variety at 2.5-5 mg of each cannabinoid once or twice daily and titrates by 2.5-5 mg of each cannabinoid every 2 to 3 days until the patient reaches his/her goals or to a maximum THC dose of 40 mg/day. CONCLUSIONS: In summary, using a modified Delphi process, expert consensus-based recommendations were developed on how to dose and administer medical cannabis for the treatment of patients with chronic pain.

Topics

Cannabis and Cannabinoid Research Pain Management and Placebo Effect Psychedelics and Drug Studies

Categories

Health Sciences Medicine Pharmacology

Tags

Analgesic Anesthesia Cannabis Chronic pain Dosing Medicine Neuropathic pain Pharmacology Psychiatry Tramadol

Substances

Cannabis

Conditions & symptoms

Chronic Pain Chronic pain