Consensus recommendations on dosing and administration of medical cannabis to treat chronic pain: results of a modified Delphi process
Background: Globally, medical cannabis legalization has increased in recent years and medical cannabis is commonly used to treat chronic pain. However, there are few randomized control trials studying medical cannabis indicating expert guidance on how to dose and administer medical cannabis safely and effectively is needed.
Methods: Using a multistage modified Delphi process, twenty global experts across nine countries developed consensus-based recommendations on how to dose and administer medical cannabis in patients with chronic pain.
Results: There was consensus that medical cannabis may be considered for patients experiencing neuropathic, inflammatory, nociplastic, and mixed pain. Three treatment protocols were developed. A routine protocol where the clinician initiates the patient on a CBD-predominant variety at a dose of 5 mg CBD twice daily and titrates the CBD-predominant dose by 10 mg every 2 to 3 days until the patient reaches their goals, or up to 40 mg/day. At a CBD-predominant dose of 40 mg/day, clinicians may consider adding THC at 2.5 mg and titrate by 2.5 mg every 2 to 7 days until a maximum daily dose of 40 mg/day of THC. A conservative protocol where the clinician initiates the patient on a CBD-predominant variety at a dose of 5 mg once daily and titrates the CBD-predominant dose by 10 mg every 2 to 3 days until the patient reaches their goals, or up to 40 mg/day. At a CBD-predominant dose of 40 mg/day, clinicians may consider adding THC at 1 mg/day and titrate by 1 mg every 7 days until a maximum daily dose of 40 mg/day of THC. A rapid protocol where the clinician initiates the patient on a balanced THC:CBD variety at 2.5-5 mg of each cannabinoid once or twice daily and titrates by 2.5-5 mg of each cannabinoid every 2 to 3 days until the patient reaches his/her goals or to a maximum THC dose of 40 mg/day.
Conclusions: In summary, using a modified Delphi process, expert consensus-based recommendations were developed on how to dose and administer medical cannabis for the treatment of patients with chronic pain.
Keywords: CBD; Cannabidiol; Chronic pain; Delphi process; Medical cannabis; THC; Tetrahydrocannabinol.
Conflict of interest statement
All authors declare that they have received compensation from Spectrum Therapeutics.
Everything To Know About Cannabis in South Africa
In 2018, South Africa decriminalized the use, possession, and growth of marijuana. This made it, at the time, one of the most lenient countries in the world when it comes to cannabis. The new laws didn’t go so far as to open South Africa to cannabis tourism like the legalization in Canada and select parts of the United States. It is, however, possible to enjoy cannabis while traveling through South Africa. But before trying South Africa’s top strains like Durban Poison or Swazi Gold, you need to brush up on local laws and customs.
Here’s everything you need to know about cannabis consumption in South Africa.
Is cannabis legal in South Africa?
The rules regarding cannabis (also known as dagga) in South Africa are slightly contradictory. First and foremost, smoking in public around non-consenting adults and minors is not allowed, and could result in a hefty fine or imprisonment. However, the personal use of marijuana in South Africa is legal. In September 2018, the Constitutional Court ruled that it’s no longer a criminal offense for an adult to use, possess, or grow cannabis in private for personal consumption. The judge ruled that due to the Bill of Rights section 4, which dictates that South Africans are entitled to live a life that’s not interfered with by private or government institutions, the ban on personal use of cannabis was unconstitutional. South Africa joins its neighbors Lesotho and Zimbabwe as the third African country to legalize the personal use of marijuana.
What is the legal amount of weed you’re allowed to have in South Africa?
The Constitutional Court did not give a quantity of cannabis for personal use. However, in February 2020, South Africans got a look at the laws being considered in a preview of the Regulation of Cannabis Bill. The bill, which is the first since decriminalization in 2018, states that South Africans can possess up to 600 grams per person, with a maximum of 1,200 grams per household. Public possession is limited to a maximum of 60 grams, though it’s important to always remember that public consumption is illegal.
The bill is currently awaiting Cabinet approval before it goes to Parliament and is put out for public comment by September 2020. Until the provisions are law, South Africa’s law enforcement officials have the discretion to decide if the amount of cannabis in a person’s possession is above what is necessary for private use.
Can you fly with weed in South Africa?
Yes! According to a directive issued to police offers, it is no longer a criminal offense to travel with small amounts of cannabis or edibles on domestic flights, but there are restrictions. You need to make sure the amount is consistent with personal consumption, and that your dagga is well concealed — in other words, keep it to yourself, just like you would when traveling anywhere else in public in the country. Things change if the flight is international. If you fly with any amount of cannabis outside of South Africa’s borders or into the country, it falls under drug dealing and is a criminal offense.
What you need to know about South Africa’s cannabis cafes
After the landmark ruling in 2018, cannabis cafes began springing up in Johannesburg and Cape Town. One establishment, Cannapax, started selling franchise opportunities using a loophole in South African law. Canapax founder Russell de Beer said he is legally allowed to sell dagga as medicine because he is a traditional healer, and it falls under the Traditional Health Practitioners Act.
Much like the cafes in Amsterdam, the Cannpax cafes let you choose from a variety of strains, edibles, and other cannabis-infused products and paraphernalia. While these cafes have existed for well over a year, there has been a recent crackdown from the South African Police Service. In December 2019, Cannapax was raided, and the founder arrested. At the time of his arrest, there were 70 of these dispensaries operating countrywide.
If you do come across a cannabis cafe in South Africa, it’s an unlawful establishment since buying and selling weed in South Africa is still illegal and owners can no longer use the traditional healer loophole. The only way to legally get your hands on cannabis in South Africa is to grow it yourself or find someone who will share with you.
What are the laws around CBD products in South Africa?
CBD, or cannabidiol, is legal in South Africa. The Department of Health announced in May 2019 that CBD products can be legally purchased as long as it doesn’t exceed the maximum daily dose of 20 milligrams and sellers don’t claim to treat or cure any specific condition. You can buy a range of CBD products from online dispensaries like Zootly and Good Leaf, as well as physical stores like Puff Puff Pass.
The road to full cannabis legalization in South Africa
While buying and selling cannabis is illegal, there is a possibility that full legalization is around the corner. South Africa’s finance minister, Tito Mboweni, regularly updates his 10,000 Twitter followers about his giant pot plant, and is a firm proponent of full legalization.
With South Africa entering its second recession in a decade, and Prohibition Partners valuing the country’s cannabis market at 27 billion South African rands ($1.6 billion) by 2023, the tax revenue the South African government can claim from the plant could fast track its full legalization.
While consuming cannabis in South Africa sounds risky, there’s nothing to worry about as long as you abide by the personal use laws and don’t buy or sell it.