Editor's Note
Recent state regulations (eg, in New York, Illinois) allow medical cannabis as an opioid substitute for chronic pain and addiction, but the authors of this article urge physicians to be cautious about recommending cannabis for these purposes due to the lack of evidence regarding safety, efficacy, and comparative effectiveness. The authors note that further research will likely yield useful results, but currently "neither recommendation meets the standards of rigor desirable for medical treatment decisions."

Cannabis and cannabis-derived medications merit further research, and such scientific work will likely yield useful results. This does not mean that medical cannabis recommendations should be made without the evidence base demanded for other treatments. Evidence-based therapies are available. For chronic pain, there are numerous alternatives to opioids aside from cannabis. Nonopioid medications appear to have similar efficacy, 3  and behavioral, voluntary, slow-tapering interventions can improve function and well-being while reducing pain.

For the opioid addiction crisis, clearly efficacious medications such as methadone and buprenorphine are underprescribed. Without convincing evidence of efficacy of cannabis for this indication, it would be irresponsible for medicine to exacerbate this problem by encouraging patients with opioid addiction to stop taking these medications and to rely instead on unproven cannabis treatment.