PAIN: CANCER: Edited by Anthony H. Dickenson and Paul Farquhar-SmithCannabis and cannabinoids in cancer pain managementMeng, Howarda; Dai, Tianyangb; Hanlon, John G.a,c; Downar, Jamesd,e; Alibhai, Shabbir M.H.f; Clarke, Hancea,g,h Author Information aDepartment of Anesthesiology and Pain Medicine, University of Toronto bDepartment of Family and Community Medicine cDepartment of Anesthesia, St, Michael's Hospital, Toronto, Ontario dDivision of Palliative Care, University of Ottawa eDepartment of Palliative Care, Bruyere Continuing Care, Ottawa, Canada fDepartment of Medicine, University Health Network gDepartment of Anesthesia, Anesthesia Pain Research Unit, Toronto General Hospital hTransitional Pain Service, Toronto General Hospital, Toronto, Ontario, Canada Correspondence to Hance Clarke, MD, PhD, Department of Anesthesia, Anesthesia Pain Research Unit, Toronto General Hospital, 200 Elizabeth Street, Eaton North 3 EB 317, Toronto, ON M5G 2C4, Canada. Tel: +416 340 4800 ext 5679; fax: +1 416 340 3698; e-mail: [email protected] Current Opinion in Supportive and Palliative Care 14(2):p 87-93, June 2020. | DOI: 10.1097/SPC.0000000000000493 Buy Metrics Abstract Purpose of review An increasing number of patients are turning to cannabis and cannabinoids for management of their palliative and nonpalliative cancer pain and other cancer-related symptoms. Canadians have a legal framework for access to medical cannabis, which provides a unique perspective in a setting lacking robust clinical evidence. This review seeks to delineate the role of cannabis and cannabinoids in cancer pain management and offers insight into the Canadian practice. Recent findings A cohort study using nabiximols on advanced cancer pain in patients already optimized on opioids, over 3 weeks, demonstrated improved average pain score. A large observational study of cancer patients using cannabis over 6 months demonstrated a decreased number of patients with severe pain and decreased opioid use, whereas the number of patients reporting good quality of life increased. Summary Good preclinical animal data and a large body of observational evidence point to the potential efficacy of cannabinoids for cancer pain management. However, there are relatively weak data pointing to clinical efficacy from clinical trial data to date. In Canada, the burgeoning cannabis industry has driven the population to embrace a medicine before clinical evidence. There remains a need for high-quality randomized controlled trials to properly assess the effectiveness and safety of medical cannabis, compared with placebo and standard treatments for cancer-related symptoms. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.