Cannabis as a Prescription Opioid Substitute for Adults with Chronic Pain: A Systematic Literature Review

Objective: To determine whether the use of cannabis improves pain control and/or reduces the amounts of opioids needed to control pain in adults with chronic pain. Methods: A systematic literature review of research conducted from the past five years. Five databases were searched, resulting in 14 peer-reviewed articles relevant to the objective. Results: The majority of the literature reviewed demonstrated the use of cannabis by adults with chronic pain resulted in better pain control and/or fewer opioids required to control pain in this population. The two articles which contradicted these findings only evaluated illicit, not medical, cannabis use by individuals with chronic pain. Conclusions: Cannabis should be considered as an alternative or adjunct to opioid therapy in adults with chronic pain. Changes in patient and provider education about cannabis as a therapy for chronic pain are necessary. The classification of cannabis as a Schedule I controlled substance by the federal government complicates research, public perception, and patient access and should be re-evaluated. Further research is indicated in determining the specific types, strains, and methods of ingestion that are most effective in this population; the sub-types of pain that are improved with cannabis; what the adverse effects of cannabis use in this population are; and what barriers exist for providers in recommending cannabis as a treatment option. Evidence from RCTs, particularly comparing cannabis to opioids, is lacking yet difficult to obtain due to federal and ethical limitations