"Medical Cannabis and Pain Management: How Might the Role of Cannabis Be Defined in Pain Medicine?" is an insightful editorial set to appear in the January 2018 Journal of Applied Laboratory Medicine. The two authors—medical professionals with the Toronto Rehabilitation Institute and the Pain and Wellness Centre, respectively—articulated one of the more thoughtful arguments for research into cannabis-based pain management. The following are eight lines from the editorial that stand out as particularly pertinent.
1. Imagine if science could harness medical cannabis, with its myriad of biologically active compounds, to produce chemotypes tailored to the physical and mental presentation of each pain patient.
2. Many clinicians might have thought it equally unimaginable, if asked a decade ago, to ever envisage a peer-reviewed editorial such as this one discussing the medicinal merits of cannabis.
3. With every passing day, the din surrounding the inappropriateness of cannabinoids in pain medicine grows quieter.
4. The endocannabinoid system (ECS), as we refer to it now, is a novel neurotransmitter pathway, with ubiquitous reach involving peripheral and central pain pathways, mood and sleep.
5. The journey over the next decade or more to exploit the impact of medicinal cannabis as an analgesic … will be determined by the willingness to reconsider several currently well-established tenets of pain and cannabis.
6. Although grounded in simplicity, it may be presumptuous to assume that the major clinical effects of cannabis are derived solely from THC and cannabidiol (CBD).
7. What becomes lost in the rhetoric is the importance of associated compounds found in the whole plant; in particular, the putative analgesic effects of terpenes and flavonoids.
8. While not a panacea, cannabis stands ready at the vanguard of precision pain medicine.
The authors then finished the editorial by stating the following: "Disappointed patients, frustrated clinicians and eager scientists have been empowered to seek a new solution to an old problem. The real debate is whether there is enthusiasm to meaningfully participate to create a pioneering role for cannabis by embracing interindividual variability, shunning reductionism and employing bold new methodological tools that depart from traditional scientific inquiry. Is there an alternative? Absolutely; remain on the sidelines and let patients find their own path."
The options moving forward are clear, and inaction itself is a choice that entails real consequences for a patient's health and quality of life.