Isaac Opole, MD, PhD
Credit: UCI School of Medicine
The American College of Physicians (ACP) has announced new Best Practice Advice for use of cannabis or cannabinoids for managing chronic, noncancer pain.
Published during the ACP Internal Medicine (IM) Meeting 2025, the document is intended to inform clinicians whose patients are considering cannabis or cannabinoids on the benefits and harms for use in the management of chronic noncancer pain.1,2
“This Best Practice Advice is important for practicing physicians when counseling our patients on the potential use of cannabis and cannabinoids to treat their chronic noncancer pain,” said Isaac O. Opole, MD, PhD, the Ruth Cohan Teaching Professor of Medicine and president of the ACP.2 “As the use of cannabis for medicinal purposes grows it’s critical to open that dialogue and review the emerging evidence related to benefits and harms. We need to raise awareness and get the word out to ensure that patients have the information they need to make informed decisions.”
As of 2024, a total of 24 states had legalized cannabis for recreational and medical purposes, with an additional 14 legalizing for medical use only. According to a 2023 study in the American Journal of Preventive Medicine, the prevalence of cannabis use for medical purpose increased 10-fold from 2013 to 2020.1,2
The study, which used National Survey on Drug Use and Health survey data 2013 through 2020, examined temporal trends and correlates of medical cannabis use among US residents in 39 states and the District of Columbia. Medical cannabis use was assessed based on self-reported past-year cannabis consumption recommended by a healthcare provider. Using a modified Poisson model, investigators calculated the average annual percentage change in medical cannabis use and performed subgroup analyses across key sociodemographic and clinical characteristics.3
Results of the study indicated the prevalence of medical cannabis use in the U.S. increased significantly from 1.2% in 2013 to 2014 to 2.5% in 2019 to 2020, representing an average annual percentage increase of 12.9% (95% CI, 10.4 to 15.5). Investigators noted this upward trend was consistent across many subgroups evaluated.3
The Best Practice Advice document from the ACP was created by the Population Health and Medical Science Committee (PHMSC) and is based on a living systematic review on cannabis and cannabinoid treatments for chronic noncancer pain and a series of living systematic reviews and primary studies. The document highlights 4 pieces of advice:1,2
Best Practice Advice 1a:
Clinicians should counsel patients about the benefits and harms of cannabis or cannabinoids when patients are considering whether to start or continue to use cannabis or cannabinoids to manage their chronic noncancer pain.Best Practice Advice 1b:
Clinicians should counsel the following subgroups of patients that the harms of cannabis or cannabinoid use for chronic noncancer pain are likely to outweigh the benefits: young adult and adolescent patients, patients with current or past substance use disorder, patients with serious mental illness, and frail patients and those at risk for falling.Best Practice Advice 2:
Clinicians should advise against starting or continuing to use cannabis or cannabinoids to manage chronic noncancer pain in patients who are pregnant or breastfeeding or actively trying to conceive.Best Practice Advice 3:
Clinicians should advise patients against the use of inhaled cannabis to manage chronic noncancer pain.
In 2024, the ACP also published a position paper outlining a public health approach to address the legal, medical, and social complexities of cannabis use. In this position paper, the ACP outlined their stance in support of decriminalizing small amounts of cannabis for personal use and calls for evidence-based policies, recommend research on cannabis’s health effects, regulation to prevent youth access and unsafe use, and adequate resources for oversight.4
The organization also expressed support for insurance coverage for cannabis use disorder treatment and incorporating cannabis education into medical training. ACP also backs research into cannabis’s therapeutic benefits and protections for physicians who recommend or prescribe cannabis under state law.4
Reference:
Kansagara D, Hill KP, Yost J, et al. Cannabis or Cannabinoids for the Management of Chronic Noncancer Pain: Best Practice Advice From the American College of Physicians. Annals of Internal Medicine. Published online April 4, 2025. doi: 10.7326/annals-24-03319
American College of Physicians. ACP’s Best Practice Advice Addresses Use of Cannabis, Cannabinoids for Chronic Noncancer Pain | ACP Online. Acponline.org. Published April 4, 2025. Accessed April 5, 2025. https://www.acponline.org/acp-newsroom/acps-best-practice-advice-addresses-use-of-cannabis-cannabinoids-for-chronic-noncancer-pain.
Taeho Greg Rhee, Rosenheck RA. Increasing Use of Cannabis for Medical Purposes Among U.S. Residents, 2013–2020. American Journal of Preventive Medicine. 2023;65(3):528-533. doi: 10.1016/j.amepre.2023.03.005
Crowley R, Cline K, Hilden D, Beachy M. Regulatory Framework for Cannabis: A Position Paper From the American College of Physicians. Annals of Internal Medicine. Published online July 23, 2024. doi: 10.7326/m24-0638
The Best Practice Advice is aimed at detailing benefits and harms of cannabis or cannabinoids in the management of chronic noncancer pain. Read More
