prescribing cannabis for harm reduction处方大麻减轻危害.pdf

Collen Harm Reduction Journal 2012, 9:1 /content/9/1/1 COMMENTARY Open Access Prescribing cannabis for harm reduction Mark Collen Abstract Neuropathic pain affects between 5% and 10% of the US population and can be refractory to treatment. Opioids may be recommended as a second-line pharmacotherapy but have risks including overdose and death. Cannabis has been shown to be effective for treating nerve pain without the risk of fatal poisoning. The author suggests that physicians who treat neuropathic pain with opioids should evaluate their patients for a trial of cannabis and prescribe it when appropriate prior to using opioids. This harm reduction strategy may reduce the morbidity and mortality rates associated with prescription pain medications. Keywords: cannabis, cannabinoids, opioids, neuropathic pain, chronic pain, harm reduction, ethics Neuropathic pain (NP) is defined as pain caused by a or buprenorphine to replace heroin, [11] prescribing lesion or disease of the central or peripheral somatosen- nicotine patches to be used instead of smoking tobacco, sory nervous system [1]. NP affects between 5% and 10% [12] and prescribing intranasal naloxone to patients on of the US population [2] and examples include diabetic opioid therapy to be utilized in case of overdose [13]. neuropathy, complex regional pain syndrome, radiculo- Substituting cannabis for prescribed opioids may be con- pathy, phantom limb pain, HIV sensory neuropathy, mul- sidered a harm reduction strategy. tiple sclerosis-related pain, and poststroke pain [3]. Under the Federal Controlled Substance Act “mari- Neuropathic pain is difficult to treat and opioid analge- huana” is illegal and classified as a schedule I substance- s