The Medicinal Cannabis Treatment Agreement: Providing Information to Chronic Pain Patients Through a Written Document.
The Medicinal Cannabis Treatment Agreement: Providing Information to Chronic Pain Patients Through a Written Document.
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DOI：
10.1097/ajp.0000000000000145
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发表时间：
2015-12
期刊：
影响因子：
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通讯作者：
Grant I
中科院分区：
文献类型：
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作者：
Wilsey B;Atkinson JH;Marcotte TD;Grant I
现在有20多个州批准了医用大麻的一长串“适应症”，在不久的将来，更多的州可能会允许使用医用大麻。调查表明，疼痛是医用大麻最常见的指征。随着越来越多的人通过州投票倡议和立法授权获得这种植物产品，疼痛专家可能会遇到患者，要么在允许的情况下寻求这种治疗，要么询问其潜在的益处和危害，以及含有大麻素的替代药物。无论是否有权开医用大麻处方，疼痛医生似乎都有义务了解并告知患者大麻素疗法证据基础的关键问题。履行这一义务的一种方法可能是借鉴阿片类药物处方中形成的概念：使用书面协议来描述和尽量减少风险。令人遗憾的是，阿片类药物的广泛使用是在尽量减少有害影响的同时进行的；显然，没有人想重蹈覆辙。本文描述了一种以类似于其他治疗协议的方式教育患者的方法。毫无疑问，随着我们对长期使用药用大麻的了解越来越多，有关风险的知识库将是一个反复的过程。但我们现在应该开始这个过程，这样病人就可以了解我们目前对使用医用大麻的概念。
Over 20 states now approve medical marijuana for a long list of "indications," and more states may well offer access in the near future. Surveys have demonstrated that pain is the most common indication for medical use of cannabis. As more individuals gain access to this botanical product through state ballot initiatives and legislative mandate, the pain specialist is likely to be confronted by patients either seeking such treatment where permitted, or otherwise inquiring about its potential benefits and harms, and alternative pharmaceuticals containing cannabinoids. Whether or not they are in the position to prescribe medical cannabis, pain physicians would seem to have an obligation to understand and inform their patients on key issues of the evidence base on cannabinoid therapeutics. One way to fulfill this obligation might be to borrow from concepts developed in the prescription of opioids: the use of a written agreement to describe and minimize risks. Regrettably, the widespread adoption of opioids was undertaken while harmful effects were minimized; obviously, no one wants to repeat this misstep. This article describes a method of educating patients in a manner analogous to other treatment agreements. Undoubtedly, the knowledge base concerning risks will be an iterative process as we learn more about the long-term use of medicinal cannabis. But we should start the process now so that patients may be instructed about our current conception of what the use of medicinal cannabis entails.