Editor's Note
The author of this editorial concludes that the time has passed when it is justifiable for pain clinics in cannabis legal jurisdictions to discharge patients for the appearance of THC metabolites in their urine. He urges clinicians to educate themselves on cannabis, cannabinoids, and the endocannabinoid system, to understand that cannabis is a variable botanical with distinct pharmacological differences between chemovars with attendant preparation-specific effects, and to engage their patients in substantive discussions of the impact that cannabis may have on their quality of life.
September 14, 2019
Pain Medicine

This editorial is occasioned by the publication in  Pain Medicine  of two quite distinct articles on the topical subject of cannabis and pain. As a point of departure, it is necessary to define terms. Cannabis sativa L. is a highly variable biochemical and morphological plant frequently termed “marijuana,” an obsolete and pejorative terminology for an ancient Old World species that has been utilized as an analgesic for millennia. The cannabis of commerce is frequently divided into two categories termed “sativa” and “indica” that purport to refer to differences that are neither taxonomically nor pharmacologically defensible. Similarly, one may refer to “strains” of cannabis, a label that is properly applied to bacteria or viruses, but not plants. Rather, what is scientifically relevant is the biochemical profile of a given cannabis variety, prompting the more appropriate terminology of chemical varieties or “chemovars.”

The first entry documents the contents of a 2016 pain symposium encompassing contributions of several experts on pain, addiction, and drugs of abuse. ...

The second entry in this issue on cannabis and pain is provided by a team in Israel with many years of experience in treatment with cannabis. I can imagine my colleagues scoffing at the concept of accepting as evidence a series of anecdotal interviews in an era where the randomized controlled trial is the sine qua non of medical proof.

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