Evidence map›Paper›PMID 33249713›Full record

ArticleInternational journal of clinical practice2021

Consensus-based recommendations for titrating cannabinoids and tapering opioids for chronic pain control.

Aaron Sihota, Brennan K Smith, Sana-Ara Ahmed, Alan Bell, Allison Blain, Hance Clarke, Ziva D Cooper, Claude Cyr, Paul Daeninck, Amol Deshpande and 13 more

Open access · hybridAbstract readConsensus Statement
PubMed Full text at PMC Publisher
In one paragraph

Article in International journal of clinical practice, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 19 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
19citing papers in PubMed, 1 pooled it
6.1field-weighted citation impact, top 3% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

19 citing papers in PubMed, 1 synthesis or guideline pooled it, 45 citations in OpenAlex.

  1. Pooled it
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  12. Cannabis and cannabinoid research · 2022
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

23 authors at 15 institutions in 2 countries.

Aaron SihotaFaculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada.
Brennan K SmithMedical Division, CTC Communications, Mississauga, ON, Canada.ORCID https://orcid.org/0000-0002-4162-0682
Sana-Ara AhmedMedical Director, Anesthesiology and Interventional Chronic Pain, Ahmed Institute for Pain and Cannabinoid Research, Calgary, AB, Canada.
Alan BellDepartment of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.
Allison BlainDepartment of Anesthesia, Michael G DeGroote Pain Clinic, Hamilton Health Sciences, McMaster University, Hamilton, ON, Canada.
Hance ClarkeDepartment of Anesthesia and Pain Medicine, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada.
Ziva D CooperDepartment of Psychiatry and Biobehavioral Science, UCLA Cannabis Research Initiative, Jane and Terry Semel Institute for Neuroscience and Human Behavior University of California, Los Angeles, CA, USA.
Claude CyrDepartment of Family Medicine, McGill University, Montreal, QC, Canada.
Paul DaeninckMax Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, and CancerCare Manitoba, Winnipeg, MB, Canada.
Amol DeshpandeComprehensive Interdisciplinary Pain Program, Division of Physical Medicine, Toronto Rehabilitation Institute, Toronto, ON, Canada.
Karen EthansDepartment of Medicine, Section of Physical Medicine and Rehabilitation, University of Manitoba, Winnipeg, MB, Canada.
David FluskFaculty of Medicine, Memorial University of Newfoundland, St John's NL, Canada.
Bernard Le FollTranslational Addiction Research Laboratory, Centre for Addiction and Mental Health, Toronto, ON, Canada.
M-J MilloyBritish Columbia Centre on Substance Use, Vancouver, BC, Canada.
Dwight E MoulinDepartments of Clinical Neurological Sciences and Oncology, Earl Russell Chair in Pain Medicine, Western University, London, ON, Canada.
Vernon NaidooGeneral Practitioner, Lloydminster, AB, Canada.
May OngDepartment of Medicine, University of British Columbia, Vancouver, BC, Canada.
Jordi PerezDepartment of Anesthesia, McGill University, Montreal, QC, Canada.
Kevin RodFCFP Director Toronto Poly Clinic, Lecturer DFCM University of Toronto, Toronto, ON, Canada.
Robert SealeyCannabinoid Medicine Specialist, Victoria, BC, Canada.
Dustin SulakIntegr8 Health, Falmouth, ME, USA.
Zachary WalshDepartment of Psychology, University of British Columbia, Vancouver, BC, Canada.
Colleen O'ConnellDepartment of Physical Medicine and Rehabilitation, Stan Cassidy Centre for Rehabilitation, Fredericton, NB, Canada.
University of British Columbia · CAMcGill University · CAUniversity of Toronto · CACancerCare Manitoba · CACentre for Addiction and Mental Health · CACommunications Research Centre Canada · CAHamilton Health Sciences · CALloydminster Hospital · CAMemorial University of Newfoundland · CAStan Cassidy Foundation · CAToronto Rehabilitation Institute · CAUniversity Health Network · CAUniversity of California, Los Angeles · USUniversity of Manitoba · CAWestern University · CA

Funding

Spectrum Therapeutics
6 · The paper itself

Abstract

aimsOpioid misuse and overuse have contributed to a widespread overdose crisis and many patients and physicians are considering medical cannabis to support opioid tapering and chronic pain control. Using a five-step modified Delphi process, we aimed to develop consensus-based recommendations on: 1) when and how to safely initiate and titrate cannabinoids in the presence of opioids, 2) when and how to safely taper opioids in the presence of cannabinoids and 3) how to monitor patients and evaluate outcomes when treating with opioids and cannabinoids.

resultsIn patients with chronic pain taking opioids not reaching treatment goals, there was consensus that cannabinoids may be considered for patients experiencing or displaying opioid-related complications, despite psychological or physical interventions. There was consensus observed to initiate with a cannabidiol (CBD)-predominant oral extract in the daytime and consider adding tetrahydrocannabinol (THC). When adding THC, start with 0.5-3 mg, and increase by 1-2 mg once or twice weekly up to 30-40 mg/day. Initiate opioid tapering when the patient reports a minor/major improvement in function, seeks less as-needed medication to control pain and/or the cannabis dose has been optimised. The opioid tapering schedule may be 5%-10% of the morphine equivalent dose (MED) every 1 to 4 weeks. Clinical success could be defined by an improvement in function/quality of life, a ≥30% reduction in pain intensity, a ≥25% reduction in opioid dose, a reduction in opioid dose to <90 mg MED and/or reduction in opioid-related adverse events.

conclusionsThis five-stage modified Delphi process led to the development of consensus-based recommendations surrounding the safe introduction and titration of cannabinoids in concert with tapering opioids.

Indexed as

CannabinoidsChronic PainAnalgesics, OpioidHumansQuality of LifeAnalgesics, OpioidCannabinoids

Identifiers

PMID33249713
PMCPMC8365704
OpenAlexW3107147482

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.