Cannabinoids in Clinical Practice

Components of Cannabis

Terpenes

Terpenes (pronounced tur-peens) are the fragrant essential oils found in all plants and are responsible for the different tastes and scents. The cannabis plant consists of a wide variety of chemicals and compounds. About 140 of these aromatic organic hydrocarbons are terpenes. Terpenes bind to receptors in the brain and give rise to various effects. Terpenes may also modulate the effects of cannabinoids such as THC and CBD concentrations.

Administering & Dosing

Government of Canada:

• Access to Cannabis for Medical Purposes Regulations – Daily Amount Fact Sheet (Dosage)

The College of Family Physicians of Canada:

• Authorizing Dried Cannabis for Chronic Pain or Anxiety

Other Articles & Research

Practical considerations in medical cannabis administration and dosing Dr. Caroline MacCallum, Dr. Ethan B. Russo (2018)

“Is medical cannabis safe for my patients?” A practical review of cannabis safety considerations Dr. Caroline MacCallum (2021)

Consensus recommendations on dosing and administration of medical cannabis to treat chronic pain: results of a modified Delphi process Dr. Caroline MacCallum (2021)

Tapering Medications

Opioids

The U.S Department of Health and Human Services, Centers for Disease Control and Prevention

• Pocket Guide: Tapering Opioids for Chronic Pain
• Prescription Opioids: What You Need to Know
• Promoting Safer and More Effective Pain Management
• Pregnancy and Opioid Pain Medications

US Department of Veterans Affairs and the Department of Defence

• Patient Information Guide: Long-term Opioid Therapy for Chronic Pain
• Clinical Practice Guideline for Opioid Therapy for Chronic Pain: Patient Summary

McMaster University

• McMaster Pain Centre patient handout
• Canadian Guidelines for Safe and Effective Use of Opioids for Chronic Non-Cancer Pain, Appendix B-4: Opioid Information for Patients

Harm Reduction Journal

• Medical cannabis patterns of use and substitution for opioids & other pharmaceutical drugs, alcohol, tobacco, and illicit substances; results from a cross-sectional survey of authorized patients

Other Articles & Research

Consensus-based recommendations for titrating cannabinoids and tapering opioids for chronic pain control Internation Journal of Clinical Practice (2021)

Potential Drug Interactions

Canadian Medical Association Journal (CMAJ)

• Drug interactions with cannabinoids

Canadian Centre on Substance Use and Addiction:

• Cannabis and Your Medications [Infographic]

Government of Canada:

• Health effects of cannabis 

Other Articles & Research

Potential Adverse Drug Events and Drug–Drug Interactions with Medical and Consumer Cannabidiol (CBD) Use Journal of Clinical Medicine (2019)