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Medical cannabis in chronic pain management and its relationship to opioid use

The second issue of the American Journal of Endocannabinoid Medicine (AJEM) examines the role of medical cannabis in chronic pain management and its relationship to opioid use. The cover art shows an opioid molecule interacting with compounds found in the cannabis plant. The image represents the heart of the current issue and can be interpreted to reflect the role that cannabis and opioids may play in chronic pain management.

Additionally, you will find coverage of drug interactions associated with cannabis and cannabidiol related products, articles on cannabis policy, and a department called Practice Spotlight. Practice Spotlight focuses on medical cannabis practices around the country that have an on-site physician. Our first article spotlights the work of Leslie Apgar, MD, in Ellicott City, Maryland. AJEM welcomes Dr. Apgar to our peer review board and we recommend reading the Practice Spotlight article as well as the case report she authored on opioid weaning.

Additionally, we have some new faces in this issue, including heavy hitters from the research field—Margaret Haney, PhD, and Phillipe Lucas, PhD(c). If you don’t know where to start, I encourage you to read articles by Drs. Apgar, Haney, and Lucas’ for high-quality, thought-provoking discussions.

Although Drs. Haney and Lucas are both involved with clinical research, they provide different perspectives on cannabis and its relation to substance use the therapeutic benefits as well as the risk for substance use disorders. Thanks to the hard work of researchers like them, we may see cannabis products being developed into pharmaceutical standard therapies. However, that pathway to drug development of cannabis is fraught with concerns.

The legal and policy issues surrounding cannabis are causing considerable delays in research advances. AJEM reports on this topic, examining potential pathways for cannabis market approvals. If cannabis is rescheduled or de-scheduled, research activities could expand and the FDA may be able to exert greater regulation and oversight. However, there does not seem to be a viable approval pathway for the vast majority of the products in the cannabis and hemp market today. Rob Dhoble of HAVAS ECS jumps on his hemp box and makes a case for a dual path federal regulatory framework for prescription and nonprescription cannabis. Mr. Dhoble’s article peers into a turbid crystal ball, where a canna- bis rescheduling hearing and federal legalization are inevitable.

A quote from Shakespeare’s Hamlet sums it up: “there is nothing either good or bad, but thinking makes it so” or cannabis is neither good or bad, but thinking about the data makes it so. As a peer-reviewed medical education journal, we must be able to discuss the good and the bad. This discussion is ongoing and must be conducted with equal passion and consideration so that medical cannabis policies and drug development can move forward. There is a lot of data out there to address the good and the bad. Some is old, much is new.

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