Thread by @ProudyMan1

Recently, @Peter_Grinspoon of Harvard / MGH provided a lecture to physicians, researchers & Oz public touching on:

“The Top 5 Ways in Which Cannabinoids Supplement Opiates in #CNCP Patients”

A🧵:

CC:

@RACGP @ANZCA_FPM @TGAgovau @ChooseWiselyAU (your advices out of date)

Before the big 5 he qualifies comments:
a) threshold question- Is Cannabis less harmful or risky than alternative ?
b) is it safer in the particular indication?
c) communications between doctor & patient key
d) real world evidence (Eg insurance claims data) - v important

e) community becoming more rotund and arthritic- answer to this ≠ opiates; cannabinoids even cbd more readily indicated in inflammatory conditions
f) cannabinoids can be good for patients (HRQoL, sleep & pain) & helps doctors save time, help more folks via less appointments

g) it’s not a medication of last resort .
h) real risk of two care systems developing and not talking to each other: those doctors that understand the endocannabinoid system & cannabis and those that don’t = unethical and dangerous

i) doctors do and prescribe tonnes of things that haven’t been validated by RCTs and this medication has been used safely in human health and disease for Millenia
j) WHO PAYS? Big issue no health plan coverage in US (Australians reimbursed via pharmacy benefits on certain PHI)

k) adult use and medical use exists on a continuum - it’s basic harm reduction to encourage GMP legal access pathways for quality control & safety @AlexWodak
l) we need to stabilise the precursor acids and make minority cannabinoid preparations like CBG and THCV more available

So what’s his top 5?

(1) Start new CNCP patients on cannabis based medicinal products (CBMPs) instead of opiates - especially for arthritic conditions

(2) Transition patients on opiates for CNCP to cannabis: but … it must be voluntary and affordable in the jurisdiction

(3) Used wisely in conjunction with Opiates (noting synergistic activity on certain receptors), it will lower the dose of opiates by circa 30% for the same or better pain control (1+1=3).

(4) to manage the side effects of opiate withdrawal - unethical to kick people out of pain treatment programs for using cannabis

(5) Controversial - as an indication for OUD like Bupe or Methodone … notes higher threshold of proof may be required before this accepted in this one given these have 50-80%drop in OD / Death .

If you got this far - thanks for reading and feel free to comment share your thoughts ! @Peter_Grinspoon please qualify anything if I have misinterpreted aspects of or add to . Cheers.