Overview

In a significant development for the medical community, the American College of Physicians (ACP) has released new Best Practice Advice concerning the use of cannabis and cannabinoids in managing chronic, noncancer pain. This pivotal document, unveiled during the ACP Internal Medicine Meeting 2025, aims to equip clinicians with the necessary insights regarding the benefits and risks of cannabis use among patients considering this alternative treatment.

Importance of Guidance

Dr. Isaac O. Opole, MD, PhD, the Ruth Cohan Teaching Professor of Medicine and president of the ACP, emphasized the importance of this guidance: "This Best Practice Advice is critical for physicians counseling patients about cannabis and cannabinoids for chronic noncancer pain. As medicinal cannabis use proliferates, we must engage in thorough discussions and review the emerging evidence surrounding its benefits and possible drawbacks. It's paramount that patients possess the information needed to make educated choices."

Current Legal Status

As of 2024, cannabis is legal for recreational and medical use in 24 states, with an additional 14 states permitting it solely for medical purposes. Research highlighted in the 2023 American Journal of Preventive Medicine showed a significant surge in medical cannabis use, with rates skyrocketing tenfold from 2013 to 2020. The study used data from the National Survey on Drug Use and Health, analyzing trends in medical cannabis consumption among residents of 39 states and the District of Columbia.

Research Findings

Key findings demonstrated that the proportion of U.S. adults using medical cannabis increased from 1.2% (2013-2014) to 2.5% (2019-2020), signifying a robust annual growth rate of 12.9%. This trend persisted across various demographic groups, indicating a widespread shift in attitudes and acceptance of medical cannabis.

ACP Recommendations

The ACP’s Best Practice Advice outlines four critical recommendations to assist clinicians in guiding their patients effectively:

1. Counseling on Benefits and Harms

Clinicians should thoroughly discuss the benefits and potential harms of cannabis or cannabinoids with patients contemplating initiation or continuation of treatment.

2. Special Populations Advisory

Certain patient groups, including adolescents, those with substance use disorders, individuals with serious mental illnesses, and frail patients, may face risks where the harms of cannabis use outweigh the benefits.

3. Pregnancy and Cannabis Use

Pregnant or breastfeeding patients, as well as those actively trying to conceive, should be cautioned against using cannabis or cannabinoids for chronic pain management.

4. Inhalation Risks

The use of inhaled cannabis is discouraged for managing chronic noncancer pain due to potential health risks.

Public Health Approach

In addition to these guidelines, the ACP has voiced its support for a public health approach to navigate the complexities of cannabis usage, advocating for the decriminalization of small amounts for personal use. They also call for research into the health implications of cannabis, regulations to limit youth access, and necessary oversight resources.

Insurance and Education

Moreover, the ACP recommends insurance coverage for cannabis use disorder treatment and emphasizes the incorporation of cannabis education into medical training. They have also highlighted the importance of protecting physicians who recommend or prescribe cannabis in accordance with state laws.

Final Thoughts

Are you or someone you know considering cannabis for chronic pain? This information is crucial for making informed choices! Stay informed and let’s keep the dialogue open on this emerging medical frontier!