A review of the evidence surrounding the safety of medical marijuana authorization for adults with neuropathic pain in primary care

Chronic neuropathic pain (NeP) is a complex condition that is commonly seen in primary care and is often refractory to current recommended treatments. Novel approaches to pain management are increasingly being studied to address this issue including the use of cannabis, a plant that has been used medicinally for thousands of years. The aim of this project was to review the current literature to determine if medical marijuana can be authorized safely by primary care providers (PCPs) to treat NeP in adults. Rational prescribing guidelines were used as the foundation for determining safety. Background knowledge of pain, chronic pain, neuropathic pain, analgesia, the history of medical marijuana, marijuana licensing, pharmacology of cannabis, including what is known about the efficacy of NeP, medical marijuana and society, nurse practitioner prescriptive authority and safe prescribing practices formed the basis of this review. The 12 studies utilized in this review do not provide enough data to support the safe use of medical marijuana for NeP in adults. It may be considered after guideline recommended prescription treatments have failed in specific clients taking into account the limitations of the evidence and associated risks. For those PCPs who are considering authorizing dried cannabis for their clients recommendations for practice will be discussed. Areas for future research and limitations of the review will also be acknowledged. --Leaf v.