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Consensus‐based recommendations for titrating cannabinoids and tapering opioids for chronic pain control
AIMS: Opioid misuse and overuse have contributed to a widespread overdose crisis and many patients and physicians are considering medical cannabis to support opioid tapering and chronic pain control. Using a five‐step modified Delphi process, we aimed to develop consensus‐based recommendations on: 1...
Autores principales: | , , , , , , , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
John Wiley and Sons Inc.
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8365704/ https://www.ncbi.nlm.nih.gov/pubmed/33249713 http://dx.doi.org/10.1111/ijcp.13871 |
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author | Sihota, Aaron Smith, Brennan K. Ahmed, Sana‐Ara Bell, Alan Blain, Allison Clarke, Hance Cooper, Ziva D. Cyr, Claude Daeninck, Paul Deshpande, Amol Ethans, Karen Flusk, David Le Foll, Bernard Milloy, M‐J Moulin, Dwight E. Naidoo, Vernon Ong, May Perez, Jordi Rod, Kevin Sealey, Robert Sulak, Dustin Walsh, Zachary O’Connell, Colleen |
author_facet | Sihota, Aaron Smith, Brennan K. Ahmed, Sana‐Ara Bell, Alan Blain, Allison Clarke, Hance Cooper, Ziva D. Cyr, Claude Daeninck, Paul Deshpande, Amol Ethans, Karen Flusk, David Le Foll, Bernard Milloy, M‐J Moulin, Dwight E. Naidoo, Vernon Ong, May Perez, Jordi Rod, Kevin Sealey, Robert Sulak, Dustin Walsh, Zachary O’Connell, Colleen |
author_sort | Sihota, Aaron |
collection | PubMed |
description | AIMS: Opioid misuse and overuse have contributed to a widespread overdose crisis and many patients and physicians are considering medical cannabis to support opioid tapering and chronic pain control. Using a five‐step modified Delphi process, we aimed to develop consensus‐based recommendations on: 1) when and how to safely initiate and titrate cannabinoids in the presence of opioids, 2) when and how to safely taper opioids in the presence of cannabinoids and 3) how to monitor patients and evaluate outcomes when treating with opioids and cannabinoids. RESULTS: In patients with chronic pain taking opioids not reaching treatment goals, there was consensus that cannabinoids may be considered for patients experiencing or displaying opioid‐related complications, despite psychological or physical interventions. There was consensus observed to initiate with a cannabidiol (CBD)‐predominant oral extract in the daytime and consider adding tetrahydrocannabinol (THC). When adding THC, start with 0.5‐3 mg, and increase by 1‐2 mg once or twice weekly up to 30‐40 mg/day. Initiate opioid tapering when the patient reports a minor/major improvement in function, seeks less as‐needed medication to control pain and/or the cannabis dose has been optimised. The opioid tapering schedule may be 5%–10% of the morphine equivalent dose (MED) every 1 to 4 weeks. Clinical success could be defined by an improvement in function/quality of life, a ≥30% reduction in pain intensity, a ≥25% reduction in opioid dose, a reduction in opioid dose to <90 mg MED and/or reduction in opioid‐related adverse events. CONCLUSIONS: This five‐stage modified Delphi process led to the development of consensus‐based recommendations surrounding the safe introduction and titration of cannabinoids in concert with tapering opioids. |
format | Online Article Text |
id | pubmed-8365704 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | John Wiley and Sons Inc. |
record_format | MEDLINE/PubMed |
spelling | pubmed-83657042021-08-23 Consensus‐based recommendations for titrating cannabinoids and tapering opioids for chronic pain control Sihota, Aaron Smith, Brennan K. Ahmed, Sana‐Ara Bell, Alan Blain, Allison Clarke, Hance Cooper, Ziva D. Cyr, Claude Daeninck, Paul Deshpande, Amol Ethans, Karen Flusk, David Le Foll, Bernard Milloy, M‐J Moulin, Dwight E. Naidoo, Vernon Ong, May Perez, Jordi Rod, Kevin Sealey, Robert Sulak, Dustin Walsh, Zachary O’Connell, Colleen Int J Clin Pract Consensus AIMS: Opioid misuse and overuse have contributed to a widespread overdose crisis and many patients and physicians are considering medical cannabis to support opioid tapering and chronic pain control. Using a five‐step modified Delphi process, we aimed to develop consensus‐based recommendations on: 1) when and how to safely initiate and titrate cannabinoids in the presence of opioids, 2) when and how to safely taper opioids in the presence of cannabinoids and 3) how to monitor patients and evaluate outcomes when treating with opioids and cannabinoids. RESULTS: In patients with chronic pain taking opioids not reaching treatment goals, there was consensus that cannabinoids may be considered for patients experiencing or displaying opioid‐related complications, despite psychological or physical interventions. There was consensus observed to initiate with a cannabidiol (CBD)‐predominant oral extract in the daytime and consider adding tetrahydrocannabinol (THC). When adding THC, start with 0.5‐3 mg, and increase by 1‐2 mg once or twice weekly up to 30‐40 mg/day. Initiate opioid tapering when the patient reports a minor/major improvement in function, seeks less as‐needed medication to control pain and/or the cannabis dose has been optimised. The opioid tapering schedule may be 5%–10% of the morphine equivalent dose (MED) every 1 to 4 weeks. Clinical success could be defined by an improvement in function/quality of life, a ≥30% reduction in pain intensity, a ≥25% reduction in opioid dose, a reduction in opioid dose to <90 mg MED and/or reduction in opioid‐related adverse events. CONCLUSIONS: This five‐stage modified Delphi process led to the development of consensus‐based recommendations surrounding the safe introduction and titration of cannabinoids in concert with tapering opioids. John Wiley and Sons Inc. 2020-12-18 2021-08 /pmc/articles/PMC8365704/ /pubmed/33249713 http://dx.doi.org/10.1111/ijcp.13871 Text en © 2020 The Authors. International Journal of Clinical Practice published by John Wiley & Sons Ltd https://creativecommons.org/licenses/by-nc/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes. |
spellingShingle | Consensus Sihota, Aaron Smith, Brennan K. Ahmed, Sana‐Ara Bell, Alan Blain, Allison Clarke, Hance Cooper, Ziva D. Cyr, Claude Daeninck, Paul Deshpande, Amol Ethans, Karen Flusk, David Le Foll, Bernard Milloy, M‐J Moulin, Dwight E. Naidoo, Vernon Ong, May Perez, Jordi Rod, Kevin Sealey, Robert Sulak, Dustin Walsh, Zachary O’Connell, Colleen Consensus‐based recommendations for titrating cannabinoids and tapering opioids for chronic pain control |
title | Consensus‐based recommendations for titrating cannabinoids and tapering opioids for chronic pain control |
title_full | Consensus‐based recommendations for titrating cannabinoids and tapering opioids for chronic pain control |
title_fullStr | Consensus‐based recommendations for titrating cannabinoids and tapering opioids for chronic pain control |
title_full_unstemmed | Consensus‐based recommendations for titrating cannabinoids and tapering opioids for chronic pain control |
title_short | Consensus‐based recommendations for titrating cannabinoids and tapering opioids for chronic pain control |
title_sort | consensus‐based recommendations for titrating cannabinoids and tapering opioids for chronic pain control |
topic | Consensus |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8365704/ https://www.ncbi.nlm.nih.gov/pubmed/33249713 http://dx.doi.org/10.1111/ijcp.13871 |
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