Position of the European Pain Federation EFIC® on appropriate use of cannabis‐based medicines and medical cannabis for chronic pain management

Bart Morlion, MD, PhD University of Leuven, Belgium
Recently, cannabis‐based medicines have been approved for pain management in several European countries. Due to the uncertainties and controversies concerning the role and appropriate use of cannabis‐based medicines, and after many enquiries by stakeholders, EFIC® put forward a position to empower and inform specialist and nonspecialist prescribers on appropriate use of cannabis‐based medicines for chronic pain. This position paper is freely available (https://europeanpainfederation.eu/advocacy/position-papers/).
In summary, therapy with cannabis‐based medicines should only be considered by experienced clinicians in properly selected and supervised patients as part of a multidisciplinary treatment and preferably as adjunctive medication. This step should only be considered if guideline‐recommended first‐ and second‐line therapies have not provided sufficient efficacy or tolerability. The quantity and quality of evidence are such that cannabis‐based medicines may be reasonably considered for chronic neuropathic pain. For all other chronic pain conditions (cancer, non‐neuropathic non-cancer pain), the use of cannabis‐based medicines should be regarded as an individual therapeutic trial.
Realistic goals of therapy have to be defined. All patients must be kept under close clinical surveillance. As with any other medical therapy, if the treatment fails to reach the predefined goals and/or the patient is additionally burdened by an unacceptable level of adverse effects and/or there are signs of abuse and misuse of the drug by the patient, therapy with cannabis‐based medicines should be terminated.
A dedicated working group of experts in the framework of the research committee of EFIC® will continue to evaluate evolving data and advise the executive board timely on the necessity of a revision of this position.
Reference: Häuser W. et al. EUROPEAN JOURNAL OF PAIN, 22 (9), 1547-1564