title: Cannabis in Pain Treatment: Clinical and Research Considerations.
abstract: Cannabinoids show promise as therapeutic agents, particularly as analgesics, but their development and clinical use has been complicated by recognition of their botanical source, cannabis, as a substance of misuse. Although research into endogenous cannabinoid systems and potential cannabinoid pharmaceuticals is slowly increasing, there has been intense societal interest in making herbal (plant) cannabis available for medicinal use; 23 U.S. States and all Canadian provinces currently permit use in some clinical contexts. Whether or not individual professionals support the clinical use of herbal cannabis, all clinicians will encounter patients who elect to use it and therefore need to be prepared to advise them on cannabis-related clinical issues despite limited evidence to guide care. Expanded research on cannabis is needed to better determine the individual and public health effects of increasing use of herbal cannabis and to advance understanding of the pharmaceutical potential of cannabinoids as medications. This article reviews clinical, research, and policy issues related to herbal cannabis to support clinicians in thoughtfully advising and caring for patients who use cannabis, and it examines obstacles and opportunities to expand research on the health effects of herbal cannabis and cannabinoids.
  
  
  
  Herbal cannabis is increasingly available for clinical use in the United States despite continuing controversies over its efficacy and safety. This article explores important considerations in the use of plant Cannabis to better prepare clinicians to care for patients who use it, and identifies needed directions for research.
authors.affiliation: Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; Silver Hill Hospital, New Canaan, Connecticut. Electronic address: seddon.savage@dartmouth.edu.
authors.forename: Seddon R
authors.initials: SR
authors.lastname: Savage
authors.affiliation: Presbyterian College School of Pharmacy, Clinton, North Carolina.
authors.forename: Alfonso
authors.initials: A
authors.lastname: Romero-Sandoval
authors.affiliation: U.S. Pain Foundation, Bellevue, Washington and Middletown, Connecticut.
authors.forename: Michael
authors.initials: M
authors.lastname: Schatman
authors.affiliation: University of California San Diego School of Medicine, La Jolla, California.
authors.forename: Mark
authors.initials: M
authors.lastname: Wallace
authors.affiliation: Geisel School of Medicine at Dartmouth, Hanover, New Hampshire.
authors.forename: Gilbert
authors.initials: G
authors.lastname: Fanciullo
authors.affiliation: University of California San Diego School of Medicine, La Jolla, California.
authors.forename: Bill
authors.initials: B
authors.lastname: McCarberg
authors.affiliation: McGill University Faculty of Medicine, Montreal, Quebec, Canada.
authors.forename: Mark
authors.initials: M
authors.lastname: Ware
mesh_terms: D000818:Animals; D035843:Biomedical Research; D002186:Cannabinoids / Q000627:therapeutic use*; D002986:Clinical Trials as Topic; D006801:Humans; D010146:Pain / Q000188:drug therapy* / Q000503:physiopathology; D059408:Pain Management / Q000379:methods*; D014481:United States
chemical_list: D002186:Cannabinoids
keywords: Cannabis; marijuana