Brief Commentary: Treating Pain—The Cannabis Conundrum
Authors: Chester B. Good, Natasha Parekh, Kavita Fischer, James Schuster, Chronis Manolis, William Shrank
Journal: Annals of Internal Medicine (2019)

Ideas and Opinions15 January 2019Brief Commentary: Treating Pain—The Cannabis ConundrumChester B. Good, MD, MPH, Natasha Parekh, MD, MS, Kavita Fischer, MD, James Schuster, MD, Chronis Manolis, RPh, and William Shrank, MD, MSHSChester B. Good, MD, MPHUPMC Health Plan, Pittsburgh, Pennsylvania (C.B.G., C.M., W.S.)Search for more papers by this author, Natasha Parekh, MD, MSUniversity of Pittsburgh, Pittsburgh, Pennsylvania (N.P.)Search for more papers by this author, Kavita Fischer, MDCommunity Care Behavioral Health Organization and UPMC Health Plan, Pittsburgh, Pennsylvania (K.F.)Search for more papers by this author, James Schuster, MDCommunity Care Behavioral Health Organization, Pittsburgh, Pennsylvania (J.S.)Search for more papers by this author, Chronis Manolis, RPhUPMC Health Plan, Pittsburgh, Pennsylvania (C.B.G., C.M., W.S.)Search for more papers by this author, and William Shrank, MD, MSHSUPMC Health Plan, Pittsburgh, Pennsylvania (C.B.G., C.M., W.S.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M18-3237 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Editors' Note: This commentary was selected for publication from among 100 submitted manuscripts in response to a call for readers' perspectives on prescribing or recommending marijuana.In April 2016, Pennsylvania legalized medical marijuana (1); 33 other states and the District of Columbia now allow use of various marijuana products for approved medical indications (2). The legalization of medical marijuana creates both opportunities and challenges. The need for adequate clinical substitutes for opioids has never been greater, and optimizing symptom relief for persons with debilitating diseases is a core function of the health care system. However, creating policies and providing insurance ...References1. Pennsylvania Department of Health. Medical marijuana patient and caregiver resources. 2018. Accessed at www.health.pa.gov/topics/programs/Medical%20Marijuana/Pages/Patients.aspx on 20 November 2018. Google Scholar2. Governing. State marijuana laws in 2018 map. 2018. Accessed at www.governing.com/gov-data/safety-justice/state-marijuana-laws-map-medical-recreational.html on 20 November 2018. Google Scholar3. Newton DE. Marijuana: A Reference Handbook. Santa Barbara, CA: ABC-CLIO; 2013. Google Scholar4. Nugent SM, Morasco BJ, O'Neil ME, Freeman M, Low A, Kondo K, et al. The effects of cannabis among adults with chronic pain and an overview of general harms: a systematic review. Ann Intern Med. 2017;167:319-31. [PMID: 28806817]. doi:10.7326/M17-0155 LinkGoogle Scholar5. Commonwealth of Pennsylvania. Wolf administration announces temporary regulations for research portion of medical marijuana program. 17 August 2018. Accessed at www.media.pa.gov/pages/Health-Details.aspx?newsid=525 on 20 November 2018. Google Scholar Author, Article, and Disclosure InformationAffiliations: UPMC Health Plan, Pittsburgh, Pennsylvania (C.B.G., C.M., W.S.)University of Pittsburgh, Pittsburgh, Pennsylvania (N.P.)Community Care Behavioral Health Organization and UPMC Health Plan, Pittsburgh, Pennsylvania (K.F.)Community Care Behavioral Health Organization, Pittsburgh, Pennsylvania (J.S.)Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M18-3237.Corresponding Author: Chester B. Good, MD, MPH, UPMC Health Plan, Center for Value-Based Pharmacy Initiatives, 600 Grant Street, Pittsburgh, PA 15219; e-mail, [email protected]edu.Current Author Addresses: Dr. Good: UPMC Health Plan, Center for Value-Based Pharmacy Initiatives, 600 Grant Street, Pittsburgh, PA 15219.Dr. Parekh: University of Pittsburgh, Division of General Internal Medicine, 200 Lothrop Street, Suite 933W, Pittsburgh, PA 15213.Dr. Fischer: Community Care Behavioral Health Organization, 339 Sixth Avenue, Suite 1300, Pittsburgh, PA 15222.Drs. Schuster and Shrank and Mr. Manolis: UPMC Health Plan, 600 Grant Street, U.S. Steel Building, Floor 55, Pittsburgh, PA 15219.Author Contributions: Conception and design: C.B. Good, N. Parekh, C. Manolis, W. Shrank.Analysis and interpretation of the data: K. Fischer, C. Manolis.Drafting of the article: C.B. Good, J. Schuster.Critical revision of the article for important intellectual content: N. Parekh, Knn. Fischer, J. Schuster, W. Shrank.Final approval of the article: C.B. Good, N. Parekh, K. Fischer, J. Schuster, C.v, W. Shrank.Administrative, technical, or logistic support: C.B. Good, W. Shrank.This article was published at Annals.org on 8 January 2019. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoBrief Commentary: Consequences of Marijuana—Observations From the Emergency Department Kennon Heard , Andrew A. Monte , and Christopher O. Hoyte Brief Commentary: Cannabinoid Dosing for Chronic Pain Management Kevin F. Boehnke and Daniel J. Clauw Brief Commentary: Marijuana and Cardiovascular Disease—What Should We Tell Patients? Tina M. Kaufman , Sergio Fazio , and Michael D. Shapiro Brief Commentary: Advocating for Blunt Policy Jan K. Carney Brief Commentary: Marijuana Use During Gestation and Lactation—Harmful Until Proved Safe Eli Y. Adashi Metrics Cited byCurrent state of evidence of cannabis utilization for treatment of autism spectrum disorders 15 January 2019Volume 170, Issue 2Page: 123KeywordsCannabisHealth careHealth insuranceMarijuanaMedical conditionsOilsOpioid use disorderOpioidsPatientsPrevention, policy, and public health ePublished: 8 January 2019 Issue Published: 15 January 2019 Copyright & PermissionsCopyright © 2019 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...