DFCR Expert Mikhail Kogan Responds to New Guidelines for use of Medical Cannabis for Chronic Pain

Recently new guidelines were issued on medical cannabis for chronic pain.

An excerpt:

Chronic pain patients can be treated with medical cannabis following one of three protocols based on patient characteristics, according to an international task force at the virtual PAINWeek meeting.

  • Treat the majority of patients along the “routine” scale. This means starting patients with 5 mg of cannabidiol (CBD) twice daily. Tetrahydrocannabinol (THC) should only be introduced if patients do not respond to at least 40 mg of CBD daily, starting with 2.5-mg daily THC doses. THC doses should be capped at 40 mg daily.
  • Frail and elderly patients, and those with severe co-morbidity or polypharmacy should be treated via a conservative route. This means starting the THC dosses at 1 mg daily and titrating up the THC more slowly.
  • Patients suffering from severe pain and those who have significant prior cannabis consumption can follow the rapid protocol. This mean starting with a CBD-THC balanced dose of between 2.5-5 mg per each compound once or twice daily.

DFCR expert Mikhail Kogan, MD responded to these new guidelines.

The new guidelines on the use of Medical Cannabis is very timely and very welcomed. Now physicians who are not familiar with the topic of medical cannabis for pain can fall back on this. The start low and go slow dosing recommendation, especially in older adults practice, is also very important. However, recommendation of starting all patients with 5mg of CBD twice daily is in significant disagreement with clinical practice. This dose of CBD is not just too low but CBD with no THC is not highly evidenced for pain. In fact, all prior evidence on chronic pain including 2017 National Academy of Sciences report points toward using THC for pain as the main direction. While it is very true that some chronic pain patients can respond well to moderate doses of CBD (15-25mg twice daily) these patients are in the minority. Starting all patients on CBD and titrating up while waiting will leave most patients without adequate pain relief.

Dr. Kogan had discussed the MedPage report with Dr. Dustin Sulak, a well known medical cannabis expert, who provided additional important input to clarify several MedPage report inaccuracies: “To begin with, it doesn’t suggest CBD 5mg starting dose, it’s CBD-predominant formula up to THC:CBD 1:10. I know that’s still low, but the 0.5mg THC does make a difference in my opinion.” Dr. Kogan can’t agree more. It appears that MedPage original publication has misinterpreted the initial dosing recommendation. Additionally the consensus report is not guidelines but set of recommendations which have been already submitted for peer reviewed publication. We are looking forward to reading the publication in a near future.

Read the new guidelines at MedPage Today and Mikhail Kogan’s response in full at GW School of Medicine & Health Sciences

*Updated 10/6/20 to include additional comments by Dr. Kogan and Dr. Sulak.

The cannabis market already exists. Let’s regulate it.

DFCR Founder and President David Nathan co-authors an opinion piece with Paul Armentano regarding the upcoming vote to legalize cannabis in New Jersey.

Article excerpt:

Having spent many years working on marijuana policy, we’ve had ringside seats to the dramatic evolution of public opinion about cannabis legalization.

Today, 33 states have laws on the books regulating the production and dispensing of medical cannabis to qualified patients, while eleven states – encompassing one-quarter of the U.S. population – now regulate its non-medical use by adults. And more than two-thirds of Americans – including a majority of Democrats, Independents, and Republicans – favor making marijuana legal for those age 21 or older.

On Election Day, Garden State voters have the opportunity to make New Jersey the twelfth state to legalize, regulate, and tax the commercial marijuana market. It is critical that New Jerseyans vote YES on Question 1 in the interest of justice, public health, and fiscal responsibility.

Read the opinion piece by David Nathan and Paul Armentano at NJ.com