How physicians should respond to the new cannabis regulations

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The new Health Canada regulations on medical marihuana would allow patients to purchase dried cannabis from a licensed distributer with a medical prescription. Yet available evidence does not support the safety and efficacy of smoked cannabis as an analgesic. The controlled trials on smoked cannabis were very brief and had small sample sizes. The subjects had severe neuropathic pain syndromes, whereas most medical marihuana users have fibromyalgia, low back pain and other conditions commonly seen in primary care. None of these trials compared smoked cannabis to oral cannabinoids, which may be as or more effective than smoked cannabis for chronic pain. Oral cannabinoids are also far safer than smoked cannabis, which produces very high plasma THC levels, and toxic chemicals that are carcinogenic and atherogenic.

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