INTRODUCTION RESEARCH

S — SEE → OBSERVATION

You begin by noticing a phenomenon in the world around you. OBSERVATION is about using your senses or tools to detect patterns, changes, or anomalies. It’s often the first moment of curiosity—something unusual or unexplained that prompts further investigation. This step frames what is worth studying.

Q — QUESTION → FORM A TESTABLE QUESTION

From your observation, you formulate a QUESTION that is specific, measurable, and testable. This should narrow the scope of your inquiry and guide the direction of your study. Good scientific questions often ask "how," "why," or "what effect."

Example: What is the effect of temperature on enzyme activity?

U — UNDERSTAND → RESEARCH EXISTING KNOWLEDGE

In the RESEARCH stage, you collect and evaluate prior knowledge. This could include academic journals, textbooks, databases, or expert interviews. Understanding existing literature helps ensure your investigation adds value, avoids duplication, and builds on what’s already known.

E — EXPECT → HYPOTHESIS

Now, develop a logical prediction—a HYPOTHESIS—based on your question and research. It must be testable and falsifiable, usually framed as an "If...then..." statement. This sets your expectation for what you believe the outcome will be under specific conditions.

Example: If enzyme temperature increases to 37°C, then the reaction rate will increase.

S — STUDY → EXPERIMENT

Design and carry out an EXPERIMENT to test your hypothesis. You manipulate one INDEPENDENT VARIABLE while measuring a DEPENDENT VARIABLE, and keep other variables constant (controls). This phase requires detailed protocols, materials, and repeatable procedures to ensure validity.

T — TRACK → DATA COLLECTION & ANALYSIS

Track results through DATA COLLECTION, followed by ANALYSIS. Data can be quantitative (numerical) or qualitative (descriptive). Use graphs, statistics, and models to interpret patterns, calculate averages or p-values, and determine significance.

Tools: Excel, Python, SPSS, GraphPad, etc.

D — DECIDE → CONCLUSION

Use your analysis to reach a CONCLUSION. Did the results support your hypothesis? Discuss what you discovered, note any limitations or anomalies, and suggest what could be improved or studied next. This step requires logical reasoning and may confirm or reject your original idea.

C — COMMUNICATE → SHARE RESULTS

Finally, COMMUNICATE your findings. This could include publishing in a journal, presenting at a conference, or creating an infographic. Peer review and open access to results allow others to replicate, validate, or expand upon your work. This is how science progresses.

🧭 1. ETHICS & INTEGRITY

• Informed Consent: Participants must know what the study involves and agree voluntarily.
  
  

• IRB Approval: Institutional Review Boards ensure research involving humans or animals is ethically conducted.
  
  

• Data Honesty: Fabricating or manipulating data is unethical and can invalidate results.
  
  

• Confidentiality: Protecting personal data is essential, especially in medical or social research.
  
  

📚 2. LITERATURE REVIEW SKILLS

• Knowing how to search databases (PubMed, JSTOR, etc.)
  
  

• Ability to critically analyze existing research
  
  

• Understanding gaps in the literature
  
  

• Synthesizing knowledge to support your hypothesis
  
  

🔢 3. STATISTICS & DATA LITERACY

• Knowing basic stats: mean, median, SD, p-values, confidence intervals
  
  

• Using tools: SPSS, R, Python, Excel
  
  

• Choosing the right test: t-test, ANOVA, chi-square, regression
  
  

• Understanding sample size, bias, and power
  
  

📐 4. EXPERIMENTAL DESIGN PRINCIPLES

• Use of controls, randomization, blinding
  
  

• Understanding variables (independent, dependent, confounding)
  
  

• Designing for replicability and reliability
  
  

• Pilot testing your design
  
  

🧠 5. CRITICAL THINKING & PROBLEM SOLVING

• Questioning assumptions
  
  

• Adjusting for unexpected outcomes
  
  

• Evaluating logical consistency
  
  

• Knowing when to revise hypotheses
  
  

🗃️ 6. DATA MANAGEMENT & RECORDKEEPING

• Maintaining accurate lab notebooks or digital records
  
  

• Using standardized data formats and labeling systems
  
  

• Version control and secure backups
  
  

• Following FAIR principles (Findable, Accessible, Interoperable, Reusable)
  
  

📊 7. COMMUNICATION & DISSEMINATION

• Writing abstracts, papers, and posters
  
  

• Presenting at conferences and seminars
  
  

• Publishing in peer-reviewed journals
  
  

• Using visualizations to explain data
  
  

🔄 8. REPLICATION & PEER REVIEW

• Importance of repeatability and reproducibility
  
  

• Participating in and responding to peer review
  
  

• Engaging in open science and sharing raw data when possible
  
  

🏛️ 9. FUNDING, GRANTS & COLLABORATION

• Writing grant proposals
  
  

• Navigating institutional funding and compliance
  
  

• Collaborating across disciplines and institutions
  
  

⚠️ 10. LIMITATIONS & BIAS AWARENESS

• Recognizing sampling bias, confirmation bias, or publication bias
  
  

• Stating limitations clearly in conclusions
  
  

• Designing to minimize confounding and maximize objectivity

🗣️ Subjective to Semi-Objective (Opinion / Interpretive)

1. Opinion Article (Op-Ed) = personal viewpoint

2. Editorial = organization’s official stance

3. Commentary / Perspective = expert interpretation of new data

4. Essay = reflective, philosophical, or narrative style

5. Letter to the Editor = short response or critique of a published article
   
   

📊 Balanced or Evidence-Interpreting (Applied / Analytical)

6. White Paper = evidence-based report with recommendations

7. Policy Brief = condensed summary of evidence for policymakers

8. Case Report / Case Study = detailed account of one subject or intervention

9. Technical Report = documentation of methods, systems, or pilot projects

10. Practice Guideline = consensus recommendations based on evidence review
    
    

🔬 Highly Objective (Empirical / Scholarly)

11. Research Article = original data, methods, and results

12. Systematic Review / Meta-Analysis = aggregated findings across studies

13. Clinical Trial Report = results from experimental or randomized studies

14. Data Paper = focuses on datasets, methodology, and reproducibility

15. Methodology Paper = describes or validates new scientific techniques

🧠 Educational or Translational (Knowledge-Sharing)

16. Review Article (Narrative) = explains current understanding for learners

17. Tutorial / How-To Paper = step-by-step guide for implementation

18. Conference Abstract / Proceedings Paper = summarizes presented research

19. Book Chapter / Monograph = extended, peer-reviewed work on one theme

20. Infographic Brief / Visual Summary = data translated into simplified visuals

Publication Type Title Abstract / Summary Body Sections Conclusion / End Matter Notes

Research Article / Clinical Trial 

✅ (150–300 words; structured)

Introduction, Methods, Results

Discussion, References

Most common PubMed format

Systematic Review / Meta-Analysis

✅ (structured summary: background → conclusion)

Search Strategy, Findings, Analysis

Discussion, References

Summarizes many studies

White Paper / Policy Brief

✅ (Executive Summary serves as abstract)

Background, Evidence, Recommendations

References, Resources

Targets policy/action audience

Case Report / Case Study

✅ (brief summary of case + significance)

Introduction, Case, Discussion

Conclusion, References

Common in clinical journals

Review Article / Commentary

✅ (overview of main themes)

Evidence Discussion

Summary, References

May not include raw data

Technical / Methodology Report

✅ (summary of innovations/results)

Methods, Results, Implementation

Discussion, Appendices

Emphasizes reproducibility

Editorial / Opinion Article

⚠️ (often omitted or replaced by opening paragraph)

Argument, Evidence

Call to Action

Abstract optional

Conference Abstract / Proceedings Paper

☑️ (published abstract is the paper)

—

—

Usually ≤300 words total

✅ Key Takeaway:
Abstract = snapshot of purpose, process, and outcomes.
It is mandatory for research and technical papers, optional for opinion/editorial, and functions as an executive summary in policy or white papers.

🧭 Publication Structure Hierarchy

🔬 1. Research Article / Clinical Trial Report

Title
→ Abstract (150–300 words summary)
→ Introduction / Background
→ Methods / Materials
→ Results
→ Discussion / Conclusion
→ References
→ (Appendices / Figures / Tables optional)

📚 2. Systematic Review / Meta-Analysis

Title
→ Abstract (structured: background, methods, results, conclusion)
→ Introduction
→ Search Strategy & Inclusion Criteria
→ Findings / Statistical Analysis
→ Discussion
→ References

🧾 3. White Paper / Policy Brief

Title Page
→ Executive Summary or Abstract (policy equivalent of abstract)
→ Background & Problem Statement
→ Evidence / Data / Analysis
→ Recommendations / Action Steps
→ References / Resources

🩺 4. Case Report / Case Study

Title
→ Abstract (brief summary of case, findings, and relevance)
→ Introduction
→ Case Presentation
→ Discussion
→ Conclusion
→ References

🧠 5. Review Article / Commentary

Title
→ Abstract (summary of main themes or arguments)
→ Introduction
→ Main Discussion / Evidence Review
→ Conclusion
→ References

🧾 6. Technical Report / Methodology Paper

Title
→ Abstract / Summary (key findings or innovations)
→ Introduction
→ Methods / Implementation
→ Results / Validation
→ Discussion
→ References / Appendices

✅ Summary Insight:
An abstract = universal gateway that provides readers with a snapshot of why the paper exists, what was done, what was found, and why it matters.

🗣️ Subjective to Semi-Objective (Opinion / Interpretive)

1. Opinion Article (Op-Ed) = personal viewpoint
   
   

2. Editorial = organization’s official stance
   
   

3. Commentary / Perspective = expert interpretation of new data
   
   

4. Essay = reflective, philosophical, or narrative style
   
   

5. Letter to the Editor = short response or critique of a published article
   
   

📊 Balanced or Evidence-Interpreting (Applied / Analytical)

6. White Paper = evidence-based report with recommendations
   
   

7. Policy Brief = condensed summary of evidence for policymakers
   
   

8. Case Report / Case Study = detailed account of one subject or intervention
   
   

9. Technical Report = documentation of methods, systems, or pilot projects
   
   

10. Practice Guideline = consensus recommendations based on evidence review
    
    

🔬 Highly Objective (Empirical / Scholarly)

11. Research Article = original data, methods, and results
    
    

12. Systematic Review / Meta-Analysis = aggregated findings across studies
    
    

13. Clinical Trial Report = results from experimental or randomized studies
    
    

14. Data Paper = focuses on datasets, methodology, and reproducibility
    
    

15. Methodology Paper = describes or validates new scientific techniques
    
    

🧠 Educational or Translational (Knowledge-Sharing)

16. Review Article (Narrative) = explains current understanding for learners
    
    

17. Tutorial / How-To Paper = step-by-step guide for implementation
    
    

18. Conference Abstract / Proceedings Paper = summarizes presented research
    
    

19. Book Chapter / Monograph = extended, peer-reviewed work on one theme
    
    

20. Infographic Brief / Visual Summary = data translated into simplified visuals

CAREGIVERS

1. Case Study / Case Report = illustrates real patient outcomes and caregiving impact; practical and relatable.

2. White Paper = explains problems (e.g., burnout, pain, cannabis access) and proposes realistic solutions.

 Goal: education, empathy, and applied insight.

DOCTORS

1. Research Article / Clinical Trial Report = provides empirical, peer-reviewed data for evidence-based practice.

2. Systematic Review / Meta-Analysis = consolidates large bodies of evidence for clinical decision-making.

 Goal: validate interventions and refine treatment guidelines.

NURSES

1. Review Article (Narrative) = summarizes complex information in an accessible, practical way.

2. Case Study / Case Report = shows real-world nursing assessment and intervention.

 Goal: clinical education and practice improvement.

PHARMACISTS

1. Technical Report / Methodology Paper = explains dosing methods, formulation, or interaction models.

2. Review Article = interprets pharmacologic and mechanistic evidence across multiple studies.

 Goal: optimize therapeutic use and safety monitoring.

POLICY MAKERS

1. White Paper = synthesizes data, economics, and recommendations for public policy decisions.

2. Policy Brief = short, action-oriented summary of key findings and recommendations.

 Goal: translate science into legislation and funding priorities.

The Journal Impact Factor (JIF) is a widely used metric that reflects the yearly mean number of citations to recent articles published in a specific academic journal. 

Publishing & Writing Metrics

Page & Word Counts

• 500 words per single-spaced page

• 1200 approximate maximum words for two single-spaced pages

• 250 double-spaced manuscript pages (equivalent for a full novel)

• 70000 minimum words for a full novel

• 4000 minimum words per scientific article

Reading Speed

• 300 maximum words per minute (WPM)

Scientific Publishing

• 30 days for peer review

• 35 percent average acceptance rate

• 1600 dollar average Article Processing Charge (APC)

• 2 year window for Impact Factor calculation

RECOMMENDATIONS FOR GEORGIA LOW-THC PROGRAM | TEREL NEWTON MD | TRULIEVE FL MED DIR 

Ga Program - https://dph.georgia.gov/low-thc-oil-registry 

1)  Removal of “end stage” language 

Georgia’s Low THC Oil Registry requires several (8 of 17 = about ½) conditions to be “severe or end stage” before patients qualify: cancer, ALS, multiple sclerosis, Parkinson’s, sickle cell, Alzheimer’s, AIDS, and peripheral neuropathy. Other conditions (e.g., intractable pain, PTSD, seizures) have no such qualifier.

Problem

This restriction denies earlier access even when evidence supports benefit in non–end stage disease:

• Multiple sclerosis: Nabiximols and oral THC/CBD reduce spasticity and pain and improved sleep; many of these patients had  moderate MS, not only end-stage [1].

• Parkinson’s disease: Cannabis reduced tremor and dyskinesia in outpatient studies of moderate-stage patients [2].

• Alzheimer’s disease: Low-dose THC reduced agitation and improved appetite in patients at mild-to-moderate stages [3].

• HIV/AIDS: Cannabis reduced neuropathic pain in ambulatory patients, not just at terminal stages [4]. 

Policy recommendation 

• Eliminate “end stage” as a requirement.

• Allow physicians to certify when the disease causes clinically significant symptoms or when standard therapies have failed.

• This mirrors how “intractable pain” is already handled in Georgia law, and it aligns with states like New York, where physician discretion governs eligibility.

References for Section 1
[1] Chan, A., & Silván, C. V. (2022). Evidence-based Management of Multiple Sclerosis Spasticity With Nabiximols Oromucosal Spray in Clinical Practice: A 10-year Recap. Neurodegenerative Disease Management, 12(3), 141–154. https://doi.org/10.2217/nmt-2022-0002

 [2] Lotan I et al. Cannabis (medical marijuana) treatment for motor and non-motor symptoms of Parkinson disease. Clin Neuropharmacol (2014). https://pubmed.ncbi.nlm.nih.gov/24614667/
[3] Shelef A et al. Safety and efficacy of medical cannabis oil for behavioral and psychological symptoms of dementia: an open label study. J Alzheimers Dis (2016). https://pubmed.ncbi.nlm.nih.g 

[4] Abrams DI et al. Neurology (2007). https://pubmed.ncbi.nlm.nih.gov/17296917/

2) Expansion of qualifying conditions

Georgia currently covers cancer, ALS, multiple sclerosis, Parkinson’s disease, Alzheimer’s disease, AIDS, peripheral neuropathy, epilepsy/seizures, Crohn’s disease, mitochondrial disease, autism spectrum disorder (with severity), Tourette’s syndrome (severe), PTSD (adults), intractable pain, and terminal illness.

Problem: This excludes conditions with strong or emerging evidence: fibromyalgia, ulcerative colitis, insomnia, opioid use disorder, and anxiety disorders.

Evidence:

• Fibromyalgia: THC/CBD lowered symptom burden by 44% [1].

• IBD: Cannabis reduced CDAI by >100 points; 45% remission [2].   [ 8 factors | 0-600 

• Insomnia: THC/CBD spray shortened sleep latency by 30–40 minutes, added ~1.2 hrs/night [3].

• Opioid use disorder: Cannabis laws linked to 17–31% lower opioid prescribing [4].

• Anxiety: Observational studies show significant acute reduction in GAD-7 scores post-cannabis use [5].

Recommendation: Add these conditions, or adopt a physician-discretion model (as in FL/VT/MN) to allow certification for any conditions similar to the qualified conditions and any debilitating illness.

References for Section 2
[1] Habib G, Artul S. Clin Exp Rheumatol (2018). https://pubmed.ncbi.nlm.nih.gov/29511842/
[2] Naftali T et al. Clin Gastroenterol Hepatol (2013). https://pubmed.ncbi.nlm.nih.gov/23648372/
[3] Suraev A et al. Sleep (2021). https://pubmed.ncbi.nlm.nih.gov/34009777/
[4] Bradford AC, Bradford WD. JAMA Intern Med (2018). https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2676999
[5] Cuttler C et al. J Affect Disord (2018). https://pubmed.ncbi.nlm.nih.gov/30197194/

Notes: CDAI scores range from 0 to 600. A score of less than 150 corresponds to relative disease quiescence (remission); 150 to 219, mildly active disease; 220 to 450, moderately active disease; and greater than 450, severe disease. 

3) THC cap adjustment

Georgia law caps THC content at 5%, which prevents therapeutic dosing.

Problem: Patients requiring more than trace THC must consume impractically large amounts, raising cost, adherence issues, and risk of illicit use.

Evidence: Nabiximols (1:1 THC:CBD) is typically titrated to 8–12 sprays/day (~20–30 mg THC), achieving 25–34% spasticity reduction [1]. Long-term extensions permitted up to 48 sprays/day (~130 mg THC) [2]. Cancer pain trials used 20–40 mg THC/day with significant analgesia [3]. Experts recommend regulating high-THC products with labeling and taxation instead of blanket low caps [4].

Recommendation: Raise or remove the 5% THC cap, adopting targeted regulation for ultra-high potency products.

References for Section 3
[1] Patti F et al. Expert Rev Neurother (2022). https://pmc.ncbi.nlm.nih.gov/articles/PMC9539865/
[2] Langford RM et al. J Neurol (2013). https://pmc.ncbi.nlm.nih.gov/articles/PMC3437528/
[3] Blake A et al. Ann Palliat Med (2022). https://apm.amegroups.org/article/view/16199/html
[4] Hall W et al. Addiction (2023). https://doi.org/10.1111/add.16135

4) Addition of product forms and routes (revised)

Georgia law currently permits low-THC oil, tinctures, transdermal patches, lotions, and capsules.  

Problem: Forms like inhalation, vaporization, whole flower, and edibles are still prohibited. These forms can offer much faster onset (in minutes rather than hours), better options for acute symptom relief, and greater flexibility for patients who cannot swallow or want more precisely titratable doses.

Evidence:

• Inhaled cannabis peaks in 3–10 minutes, useful for breakthrough pain, nausea, or spasticity [1,2].

• Many patients prefer inhalation when available due to rapid onset and adjustability 

• In jurisdictions where inhalation is allowed, patient satisfaction and adherence improve, and some patients reduce their use of other symptom-relief medications.

Recommendation: Amend Georgia law to authorize inhalation and vaporization, and consider pilot authorization for whole flower or edibles with potency / safety regulation.

References for Section 4
[1] Chayasirisobhon S. Pharmacokinetics of cannabis. Neurol Int (2020). https://pmc.ncbi.nlm.nih.gov/articles/PMC8803256/
[2] Lucas CJ et al. Cannabinoid PK/PD. Clin Pharmacokinet (2018). https://pmc.ncbi.nlm.nih.gov/articles/PMC6177698/ 

5) Compassionate “Right-to-Try” access (corrected again)

Georgia law already lists Crohn’s disease, cancer, and epilepsy as qualifying conditions. The true policy gap is that the law has a closed list, leaving out other debilitating conditions with supporting evidence.

Problem: Patients with serious, refractory illnesses not on Georgia’s list  such as fibromyalgia, ulcerative colitis, refractory migraine, anxiety disorders, and insomnia  remain ineligible even when conventional therapies fail.

Evidence:

• Fibromyalgia: THC/CBD improved symptom scores by 44% [1].

• Ulcerative colitis: Pilot RCTs show cannabis improved disease activity and quality of life compared to placebo [2].

• Refractory migraine/anxiety: Observational data show acute reductions in migraine intensity and significant decreases in GAD-7 anxiety scores after cannabis use [3].

Recommendation: Keep Georgia’s existing list intact but add a compassionate-use or physician-discretion pathway for conditions outside the list, aligning with models in New York and Minnesota.

References for Section 5
[1] Habib G, Artul S. Medical Cannabis for Fibromyalgia. Clin Exp Rheumatol (2018). https://pubmed.ncbi.nlm.nih.gov/29461346/
[2] Naftali T et al. Cannabis is associated with clinical improvement in ulcerative colitis. Dig Dis Sci (2011). https://pubmed.ncbi.nlm.nih.gov/33571293/
[3] Cuttler C et al. Short- and long-term effects of cannabis on headaches and migraine. J Pain (2019). https://pubmed.ncbi.nlm.nih.gov/31715263/ 

6) Direct patient delivery 

Georgia currently requires in-person dispensary pickup.

Problem: This requirement disproportionately burdens patients in rural areas, low-income communities, and those with limited mobility or disability. Many patients travel long distances, incur travel costs, or are unable to get to a dispensary at all. This contributes to healthcare disparities, especially for minority populations and those with chronic illness who already face barriers in accessing care.

Evidence:

• In 2025  more than 25 U.S. states + Puerto Rico allow some form of medical cannabis delivery, enabling access especially for those living far from dispensaries or without reliable transportation. 

• In many of those states, delivery programs have been cited in patient surveys as reducing missed doses, reducing travel burden, and improving treatment adherence among rural or homebound populations. (While specific empirical data from Georgia isn’t yet published, national data shows patients in states with delivery laws report fewer disruptions in care. )   

Recommendation: Georgia should authorize licensed home delivery by certified dispensaries or registered couriers under a regulated model. Key features should include:

• Track-and-trace systems to ensure accountability.

• Statewide availability, not limited only to urban areas.

• Priority provisions for underserved communities (e.g., rural counties, low-income areas, elderly or disabled patients).

• Reasonable delivery fees / subsidies to offset cost burdens.

References for Section 6
[1] “Cannabis Delivery Service by State: March 2025 Update.” CannabusinessPlans. 2025. https://cannabusinessplans.com/cannabis-delivery-service-by-state/ Cannabusiness Plans
[2] Ebling T., et al. “US State Recreational and Medical Cannabis Delivery Laws, 2024.” American Journal of Public Health. 2025. https://doi.org/10.2105/AJPH.2024.307874 American Journal of Public Health
[3] “Here’s Every State Where Marijuana Delivery Is Allowed as of April 2025.” The Marijuana Herald. April 2025. https://themarijuanaherald.com/2025/04/heres-every-state-where-marijuana-delivery-is-allowed-as-of-april-2025/

Title: Cannabis & Pain Management: Exploring Clinical Alternatives to Opioids  [ final ] 

Author:  Terel S. Newton, M.D.    

Board-Certified Anesthesiologist, Diplomat Interventional Pain Fellowship, Florida Medical Director, Trulieve  

Certifications in Artificial Intelligence & Business and Healthcare x3, Founder, Total Pain Relief, LLC 

Abstract 

Background:  The United States faces a quadruple crisis of chronic pain, escalating opioid mortality, comorbid mental health crisis and aging related disease burden. Over 50 million adults live with chronic pain (CDC, 2021), and more than 80,000 die annually from opioid overdoses (CDC, 2023). At the same time, depression, anxiety, and opioid use disorder (OUD) rates continue to climb, especially among older adults burdened by polypharmacy. Medical cannabis offers multimodal therapeutic benefits; analgesic, anti-inflammatory, anxiolytic, and neuromodulatory, via CB1 and CB2 receptor pathways. The National Academies of Sciences, Engineering, and Medicine (2017) concluded there is substantial evidence of efficacy for chronic and neuropathic pain. Importantly, the introduction of medical cannabis laws has also been linked to significant reductions in Medicare prescription spending (1), reflecting both therapeutic and economic benefits. 

Objective:  To evaluate peer-reviewed evidence supporting medical cannabis as a harm-reduction, opioid-sparing, and cost-saving therapy across chronic, neuropathic, and cancer-related pain, with emphasis on its role in mitigating the interconnected crises of opioid mortality, mental health/OUD, and geriatric polypharmacy. 

Methods:  A narrative review of > 25 peer-reviewed studies (2014–2025), including randomized controlled trials, cohort studies, and meta-analyses, was conducted. Primary outcomes included pain relief, opioid-sparing effects, and secondary metrics such as sleep, anxiety, quality of life, and cost impact. Findings were considered and integrated with Dr. Newton’s clinical expertise; fellowship training, clinical teaching experience, interventional pain practice (>15,000 image guided procedures) and medical cannabis expertise.  

Results:  Medical cannabis use was associated with 14–47% reductions in opioid consumption (1–3) and a 25% lower opioid overdose mortality in medical cannabis-law (MCL) states (4). Inhaled cannabinoids produced significant analgesia in neuropathic pain (NNT ≈ 5.6) (5). For fibromyalgia, 81% reported improvement and 60% discontinued opioids (6). Migraine frequency decreased by ≈ 55% (7). Among older adults, 93.7% reported moderate-to-major improvement, with 18% discontinuing opioids (8). Palliative oncology data demonstrated enhanced appetite, improved sleep, and a trend toward prolonged survival (9). From a cost perspective, Medicare Part D expenditures declined by $165 million annually following cannabis-law enactment, primarily due to reduced prescribing of pain and anxiety medications (1). Adverse effects were mild (somnolence, dry mouth); no lethal toxicity reported. 

Conclusion:  Medical cannabis addresses 4 converging crises, opioid overdose mortality, mental health/OUD burden, and senior polypharmacy, while producing measurable reductions in healthcare costs and opioid utilization. Integration into interventional and rehabilitative pain programs, coupled with clinician training and payer reform, could significantly reduce morbidity, mortality, and Medicare expenditures associated with chronic pain and opioid dependence. 

Cannabis & Pain Management: Exploring Clinical Alternatives to Opioids Background Chronic pain is a prevalent and debilitating condition affecting roughly 20–30% of adults worldwide[1][2]. In the United States, the latest national survey data indicate that about 51.6 million adults (20.9%) experienced chronic pain in 2021[3], a figure that rose to 24.3% of adults by 2023[4]. Chronic pain is not only a leading cause of health-related years lived with disability globally (with low back pain ranked as the top cause)[5], but it is also tightly intertwined with mental health and opioid use challenges. Approximately 40% of chronic pain patients concurrently suffer from clinically significant depression or anxiety[2][3], underscoring the psychological toll of unmanaged pain. This comorbidity contributes to diminished quality of life and complicates treatment, as pain can exacerbate mood disorders and vice versa[6][7]. For decades, opioid analgesics have been a mainstay for treating moderate-to-severe chronic pain, especially in non-cancer populations. However, widespread opioid prescribing starting in the 1990s precipitated a public health crisis. 

Opioid misuse and opioid use disorder (OUD) became alarmingly common – an estimated 5.6 million Americans (2.0% of those ≥12 years old) had an OUD in 2021[8] – and overdose deaths surged. In 2022, over 107,000 drug overdose deaths occurred in the U.S., and in 2023 drug fatalities climbed to ~105,000, of which nearly 80,000 (about 76%) involved opioids[9]. This translates to roughly 217 opioid overdose deaths every single day in 2023[10]. Cumulatively, the U.S. has lost over 800,000 lives to opioid overdoses since 1999[11]. The crisis has evolved in waves – from prescription opioids to heroin to potent synthetics like fentanyl – and continues to exact a heavy toll[12][13]. Globally, opioid misuse is likewise a dire concern: according to the WHO, about 600,000 drug-related deaths occurred in 2019, nearly 80% of which were attributed to opioids (approximately 125,000 deaths from opioid overdose alone in 2019)[14][15]. Beyond mortality, chronic opioid therapy carries risks of tolerance, dependence, opioid-induced hyperalgesia, endocrine and immune effects, and side effects that impair function (e.g. sedation, constipation). The magnitude of chronic pain’s burden and the harms of opioid over-reliance have prompted urgent exploration of safer, yet effective, analgesic alternatives. In particular, medical cannabis (cannabinoid-based therapy) has re-emerged in the 21st century as a promising option for pain management. 

Cannabis and its derivatives (e.g. Δ9-tetrahydrocannabinol [THC] and cannabidiol [CBD]) engage the endogenous cannabinoid system to modulate pain and inflammation, which presents a biological rationale for their use as analgesics[16]. Importantly, cannabis is not associated with lethal respiratory depression as opioids are, and real-world data suggest it may carry lower addiction potential and address dimensions of pain (such as neuropathic pain and affective distress) that opioids do not[17]. Patients and clinicians have reported that cannabis can reduce pain and concurrently help with insomnia, anxiety, and mood – a “monotherapy” approach in contrast to opioid-centric polypharmacy[18]. This is especially relevant for older adults, who often contend with multiple chronic conditions and medications. Polypharmacy in the elderly is linked to increased frailty and adverse events[19]. Notably, 36% of U.S. seniors (65+) report chronic pain (versus ~12% of young adults)[20], putting them at risk for high cumulative opioid exposure and drug–drug interactions. Medical cannabis has been proposed as a strategy to “break the pill cycle” – substituting or reducing opioids and other analgesics in favor of a single, broader-spectrum therapy[21]. 

Early evidence is encouraging: a multi-site prospective study of patients over age 50 found that nearly half were able to reduce or discontinue other medications after initiating medical cannabis, with significant improvements in quality of life over 6 months and no serious adverse events[22][23]. Likewise, many states with medical cannabis programs have observed decreases in opioid prescribing and opioid-related harms in parallel with increased cannabis access[24][25]. For instance, each additional dispensary opening at the county level has been associated with an estimated 17% reduction in opioid overdose mortality rates[24]. These epidemiologic signals, combined with patient-driven demand (as of early 2025, nearly 50 countries worldwide and 42 U.S. states have legalized medical cannabis access[26][27], with Florida alone registering over 900,000 medical cannabis patients)[28], underscore the importance of rigorously evaluating cannabis as a clinical alternative to opioids. Objective: This expanded abstract aims to review and synthesize clinical evidence from the past decade (2014–2025) on the role of medical cannabis in chronic pain management, especially as an alternative or adjunct to opioid analgesics. We integrate updated epidemiological data on chronic pain and opioid outcomes, summarize the pharmacological mechanisms of cannabinoids in pain modulation, and examine findings from high-quality peer-reviewed studies (including randomized trials, systematic reviews, and cohort studies) regarding the efficacy, safety, and opioid-sparing effects of cannabis. 

The goal is to provide clinicians, policymakers, and researchers a concise but comprehensive overview of whether and how cannabis can contribute to pain management strategies that reduce reliance on opioids, in the context of patient health and public health (e.g. impacts on opioid misuse, overdose, and societal burden). We also address current policy and regulatory considerations and highlight areas where further research or technology (such as AI-driven data analysis) may facilitate evidence-based integration of cannabis into pain care. Methods We conducted a thorough literature search and critical review of publications from 2014 through 2025 focusing on medical cannabis/cannabinoids for chronic pain and opioid reduction. Sources included PubMed/MEDLINE, Cochrane Library, and major journals in pain, medicine, and policy. Keywords used in various combinations were: “cannabis,” “cannabinoids,” “chronic pain,” “neuropathic pain,” “opioids,” “opioid-sparing,” “opioid use disorder,” “analgesic efficacy,” “endocannabinoid system,” “medical marijuana,” and “opioid overdose.” We prioritized high-quality evidence such as randomized controlled trials (RCTs), systematic reviews and meta-analyses, large observational cohort studies, and authoritative reports or guidelines. Over 30 peer-reviewed studies were included, emphasizing recent data (2018–2025) and clinically relevant outcomes. 

Key epidemiological statistics (prevalence of chronic pain, opioid mortality, etc.) were obtained from official sources like the CDC, WHO, and national surveys, to ensure the review reflects up-to-date context. Data on endocannabinoid system mechanisms were drawn from pharmacology reviews. Given the multidisciplinary nature of the topic, we also reviewed policy analyses and consensus reports (e.g. the National Academies 2017 report on cannabis) to understand regulatory and public health implications. Each selected study was analyzed for results pertaining to: (1) pain relief outcomes with cannabis (magnitude of analgesia, responder rates, etc.); (2) changes in opioid consumption or dosage when cannabis is introduced; (3) incidence of adverse events or safety issues; (4) any effects on psychological outcomes or functional status; and (5) any population-specific considerations (such as older adults or patients with certain pain conditions). We extracted numerical results (e.g. pain score reductions, odds ratios for opioid discontinuation) when available, and noted the strength of evidence (e.g. sample sizes, bias risk, and confidence in estimates per GRADE or similar evaluations reported in reviews). The findings were then synthesized in a narrative form under Results, structured to cover mechanistic rationale, analgesic efficacy, opioid-sparing effects, safety, and broader impacts. Citations are provided in American Medical Association (AMA) style, and a reference list is included at the end. 

Results Role of the Endocannabinoid System in Pain Modulation: The endocannabinoid system (ECS) is now recognized as a critical neuromodulatory network in pain processing[16][29]. Cannabinoid receptors are densely distributed in pain pathways: CB₁ receptors are abundant in the central nervous system (brain and dorsal spinal cord) as well as peripheral nerve terminals, whereas CB₂ receptors are expressed primarily on immune cells and peripheral tissues (with low levels in microglia and some central regions)[30][31]. Endogenous cannabinoids (anandamide and 2-AG) are released in response to noxious stimuli to help regulate pain perception. Phytocannabinoids (plant-derived cannabinoids) like THC and CBD can exogenously augment this system. THC is a partial agonist at CB₁ and CB₂ receptors, while CBD has more complex indirect effects on the ECS and other targets (e.g. TRPV1, serotonin receptors). The net effect of cannabinoid activation is a reduction of pain signaling and inflammation through multiple mechanisms. Preclinical studies and reviews indicate that cannabinoids produce analgesia by inhibiting the release of neurotransmitters and neuropeptides (e.g. glutamate, substance P, calcitonin gene-related peptide) from presynaptic nerve endings, modulating postsynaptic neuronal excitability, and activating descending inhibitory pain pathways in the brainstem[16]. 

Additionally, CB₂ receptor activation on immune cells attenuates the release of pro-inflammatory mediators, thereby reducing peripheral and central sensitization of pain[32][33]. This multifaceted modulation means that cannabinoids can target both the nociceptive aspects of pain and its inflammatory and affective components. For example, in models of neuropathic pain, upregulation of CB₁ and CB₂ receptors in injured nerve tissue and spinal cord has been observed, suggesting the body’s natural response is to increase cannabinoid signaling; providing external cannabinoids can further reduce hyperalgesia and allodynia[34][29]. Clinically, these mechanisms translate into analgesic and anti-hyperalgesic effects across a variety of pain conditions. It is noteworthy that unlike opioids, which primarily act on mu-opioid receptors to blunt pain but also depress respiration and have high abuse potential, cannabinoids act on a different receptor family and have no direct effect on the brainstem respiratory centers, making fatal overdose from cannabinoids extremely unlikely. Cannabinoids also engage reward pathways far less potently than opioids, which may explain the significantly lower physical dependence liability. However, they are not risk-free: CB₁ activation underlies cannabis’s psychoactive effects (euphoria, cognitive changes) and some side effects like dizziness or dysphoria, and chronic heavy use can lead to cannabis use disorder in a subset of individuals. CBD, by contrast, is not intoxicating and may even mitigate some THC side effects, while contributing anti-inflammatory and anxiolytic effects. In summary, the ECS offers a distinct pharmacological target for analgesia, and cannabis-based therapies leverage this system to potentially achieve pain relief with a different safety profile than opioids[35][36]. Analgesic Efficacy of Cannabis in Chronic Pain: A substantial body of clinical evidence now indicates that cannabinoids can provide modest but clinically meaningful analgesia in certain chronic pain populations, particularly those with neuropathic pain. 

The National Academies of Sciences, Engineering, and Medicine (NASEM) convened a committee that comprehensively reviewed over 10,000 studies; in their landmark 2017 consensus report, the committee concluded there is “substantial evidence that cannabis or cannabinoids are effective for the treatment of chronic pain in adults,” especially neuropathic pain (e.g. painful diabetic neuropathy, postherpetic neuralgia)[35]. Since then, multiple high-quality reviews have refined our understanding. For example, a 2018 meta-analysis by Vučković et al. examined dozens of RCTs and found that cannabis-based therapies were associated with significant pain reduction compared to placebo, with an emphasis on neuropathic pain improvement[16]. More recently, an updated systematic review (2022, 18 trials, n=1,740) reported that THC-rich cannabis products yield moderate short-term pain relief in chronic pain: in pooled analyses, patients using high-THC preparations were more likely to achieve ≥30% improvement in pain intensity than those on placebo[37]. The analgesic effect size was generally in the small-to-moderate range (often on the order of a 0.5-point reduction on a 0–10 pain scale beyond placebo)[38], which is comparable to or slightly less than typical opioids or other adjuvant pain medications. Notably, THC-dominant extracts (with THC:CBD ratios > 10:1) appeared most effective for pain relief[39]. In the 2022 Annals of Internal Medicine review by McDonagh et al., oral synthetic THC analogues (dronabinol or nabilone) and other high-THC products showed a “moderate” improvement in pain severity (on average, about 0.5–0.8 points better than placebo on 0–10 scales) and a higher likelihood of pain response (defined as ≥30% pain reduction)[40][37]. By contrast, products with balanced THC:CBD content (e.g. nabiximols oromucosal spray with ~1:1 ratio) tended to produce smaller pain reductions[41] – still better than placebo in some studies, but with more mixed results on significance. In conditions like cancer-related pain or rheumatic pain, evidence has been less robust or more variable, but some patients do report benefit. Fibromyalgia trials, for instance, have shown improvements in pain and sleep with synthetic cannabinoids (nabilone) or herbal cannabis, though often as secondary outcomes. In head-to-head comparisons, how does cannabis efficacy stack up against opioids for chronic pain? There have been few direct trials, but a 2023 systematic review and network meta-analysis by Jeddi et al. (2024) aggregated data from 90 trials (22,000 patients) on either opioids or medical cannabis in chronic non-cancer pain[42][43]. It found that both classes produce statistically small improvements in pain versus placebo, and importantly cannabis was not inferior to opioids in terms of pain relief[44]. 

The estimated difference in pain reduction between cannabis and opioids was tiny and non-significant (weighted mean difference ~0.23 cm on a 10 cm visual analog scale)[43]. Similarly, improvements in physical and emotional functioning were comparable. This suggests that for many chronic pain patients, a trial of cannabis could potentially offer pain relief in the same ballpark as a trial of an opioid – a remarkable finding as it challenges the traditional view that opioids are the “strongest” analgesics. The authors rated the evidence as moderate certainty for equivalence in function and low-moderate for pain, acknowledging some imprecision[44]. An equally notable result of this analysis was that patients on medical cannabis were significantly less likely to discontinue treatment due to adverse events than those on opioids (odds ratio ~0.55, meaning the cannabis group had about half the odds of drop-outs for side effects)[44]. This hints at better tolerability for many patients. Common side effects of cannabis (in studies up to ~6 months) include sedation, dizziness, dry mouth, nausea, and cognitive effects, but these were mostly mild to moderate and transient[36][45]. In contrast, opioids often cause constipation, hormonal suppression, and carry risks of misuse or overdose with long-term use. That said, high-THC cannabis can cause acute psychoactive effects (e.g. anxiety, confusion) in some individuals, and around 10% can’t tolerate even low-dose THC due to such effects[46][47]. This underscores the need to tailor cannabinoid selection (THC vs CBD content) and dosing for each patient. 

Opioid-Sparing Effects and Impact on Opioid Use/Misuse: One of the most clinically significant aspects of integrating medical cannabis into pain management is its potential to reduce patients’ reliance on opioid analgesics – the so-called “opioid-sparing” effect. A growing number of observational studies and patient surveys consistently report that when chronic pain patients start using cannabis, many are able to lower their opioid doses or even discontinue opioids entirely[48][49]. For example, a 2016 cross-sectional survey of pain patients in Michigan found 64% of patients on medical cannabis were able to reduce their opioid use, with an average 44% reduction in opioid dose, and a significant number reported improved side effect profiles and quality of life on cannabis compared to opioids[50]. More rigorously, a 2018 prospective cohort study in Canada (Ware et al.) demonstrated that over one year, cannabis use was associated with sustained pain control and was not linked to increasing opioid use – in fact, participants had stable or reduced opioid consumption. Compelling evidence comes from a 2025 Australian cohort study by Finch et al., which prospectively followed two groups of chronic non-cancer pain patients over 12 months[51][52]. One group (n=102) was prescribed adjunctive medicinal cannabis (THC/CBD oil) in addition to their baseline opioid therapy, while a control group (n=53) continued on opioids alone[53]. Both cohorts started with a median opioid dose of ~40 morphine milligram equivalents (MME) per day[54]. After one year, results were striking: the cannabis cohort’s median opioid dosage plummeted to just 2.7 mg/day, essentially an approximate 93% reduction[54]. By contrast, the opioid-only group remained at a median of 42.3 mg/day[54]. In other words, patients who had access to cannabis were able to almost entirely wean off opioids on average, whereas those without cannabis showed no improvement. 

This opioid-sparing was accompanied by improvements in secondary outcomes – the cannabis group reported better physical functioning and sleep quality, and decreases in pain-related disability scores[52][46]. It should be noted that about half of the cannabis group did drop out or stop cannabis due to side effects or insufficient benefit, indicating that not every patient will tolerate or respond to cannabinoids. But those who did tolerate it achieved major opioid reduction. This “real-world” study aligns with a broader literature trend: patients often describe cannabis as enabling them to manage pain with fewer opioids. Indeed, a 2023 survey published by the American Medical Association found one in three chronic pain patients in states with medical cannabis had used cannabis as a substitute for pain medications; of those, the majority specifically substituted it for opioids and reported equal or better pain relief with cannabis[50]. At the population level, the introduction of medical cannabis laws (MCLs) in various U.S. states since the mid-1990s has provided a natural experiment to observe effects on opioid use and harms. Early ecological studies noted a correlation between state MCL enactment and lower opioid overdose death rates: a well-known 2014 study found states with MCLs had a 24.8% lower annual opioid overdose mortality rate on average compared to states without such laws[55]. However, this association has been complex to interpret and evolved over time. Some later analyses (through 2017) yielded mixed results, with certain data suggesting the initial benefit attenuated as the opioid epidemic shifted to illicit fentanyl (and as almost all states eventually passed MCLs)[56]. More granular analyses have looked at medical cannabis utilization rather than just laws. A 2021 BMJ study (Hsu & Kovács) focusing on the number of active dispensaries per county found a dose-dependent inverse relationship: counties that went from 1 to 2 dispensaries saw a 17% reduction in opioid mortality, and those going from 2 to 3 saw an additional ~8.5% reduction[24][57]. Interestingly, this effect was strongest for synthetic opioid (fentanyl) deaths[25]. Such findings bolster the idea that greater access to legal cannabis (both medical and adult-use) is associated with people choosing cannabis over more dangerous opioids, thereby reducing overdose risk. Complementary to mortality data, studies have also examined opioid prescribing. 

Multiple analyses of Medicare and Medicaid populations showed significant declines in opioid prescription rates (and doses filled) after states legalized medical cannabis[58][24]. For instance, Medicaid enrollees in states with MCLs had nearly 6% fewer opioid prescriptions than those in prohibition states, and states with adult-use (recreational) legalization saw even larger decreases in Schedule II opioid dispensing[59]. A recent 2022 health economics study found that legalizing recreational cannabis was associated with a ~3.5 per 100,000 reduction in opioid overdose death rates and also a drop in opioid prescriptions to pain patients[60][61]. Additionally, pain doctors in medical cannabis states receive fewer opioid-related pharmaceutical payments, implying a shift in treatment paradigms away from opioid-centric approaches[62][63]. While these epidemiological patterns are encouraging, they cannot prove a causal “replacement” effect, and some caution is warranted. Patients who choose to use medical cannabis may be systematically different or have different support than those who do not. Furthermore, not all studies are uniformly positive – a few analyses did not find significant changes in opioid overdose rates with cannabis laws, and at least one suggested a lag in benefit or other confounding factors. Nonetheless, the consistency of patient-level and community-level data pointing to opioid sparing lends credibility to the idea that cannabis can be an “exit drug” for those dependent on opioids (contrary to the old notion of cannabis as a gateway into hard drugs)[48][60]. Indeed, a 2023 longitudinal study of people who use illicit opioids found those who used cannabis daily were more likely to cease opioid use over time, highlighting cannabis’s potential as a harm reduction tool in OUD populations[48]. Safety Profile and Adverse Effects: In evaluating cannabis as an alternative to opioids, safety considerations are paramount. The short-to-medium term safety of medical cannabis in controlled trials has been fairly well characterized. Common adverse effects of cannabinoids include dizziness, somnolence, fatigue, dry mouth, nausea, and cognitive effects (short-term memory impairment, difficulty concentrating)[45]. In pooled analyses, dizziness was significantly more frequent with cannabis than placebo (with high-THC products conferring the greatest risk)[37]. There is also a dose-dependent relationship: higher THC content tends to produce more psychoactive effects and side effects. Importantly, serious adverse events are rare in the pain trials and typically no different than placebo in incidence[36]. Unlike opioids, cannabis does not cause respiratory depression, so even if over-used it does not typically cause death (except indirectly, e.g. impaired driving). 

That said, over-sedation or acute psychiatric distress can occur with excessive dosing. Notably, the 2022 systematic review found that sedation was moderately increased with high-THC cannabis (and comparable to what is seen with opioids)[39]. Psychotomimetic effects (e.g. acute anxiety, paranoia) were not prominent in most pain studies, likely because doses were kept moderate; however, real-world use of high-potency cannabis can precipitate such effects in susceptible individuals. One challenge is tolerability: as seen in Finch et al.’s study, a significant subset (up to ~45%) of patients could not continue medical cannabis due to side effects or lack of efficacy[52][46]. This attrition emphasizes that cannabis is not universally effective or acceptable – individualized titration and careful patient selection are important (for instance, patients with a history of psychotic disorder are usually advised against THC). From a long-term safety perspective, data are still accruing. Chronic daily use of high-THC cannabis may carry risks such as cannabinoid hyperemesis syndrome (a rare vomiting illness), subtle cognitive changes, or dependence in about 9% of users (rising to ~17% if use starts in adolescence). However, these rates of addiction are significantly lower than those for opioids (OUD occurs in an estimated 20-30% of chronic opioid patients). Observational studies up to 1-2 years have not flagged major organ toxicity from cannabis. In fact, large cohort studies of medical cannabis patients (e.g. in Israel) have reported stable or improved measures of pain and function with few discontinuations due to harms[22][23]. By contrast, long-term opioid therapy is associated with development of tolerance, hyperalgesia, hormonal suppression, constipation, overdose risk, and high addiction potential. Thus, the risk-benefit calculus may favor trying cannabis over escalating opioid doses, particularly in younger patients with chronic pain who face decades of analgesic needs. Clinical Applications and Specific Pain Conditions: Medical cannabis has been applied across a spectrum of chronic pain conditions. 

The most robust evidence supports its use in neuropathic pain (peripheral or central). Multiple RCTs (e.g. in painful diabetic neuropathy, HIV-associated neuropathy, and multiple sclerosis-related pain) demonstrated that inhaled cannabis or oromucosal THC/CBD sprays yield significant pain relief compared to placebo, often with a twofold higher odds of a clinically significant pain reduction[35]. For example, in a pivotal trial in central neuropathic pain due to MS, nabiximols (1:1 THC:CBD) led to ≥30% pain improvement in 50% of patients vs 24% on placebo. Cancer pain: Trials here are mixed – some positive signals when cannabis is added to opioids for refractory cancer pain, but results haven’t been uniformly positive, and dosing issues remain. Arthritis and inflammatory pain: Preclinical data suggest cannabinoids have anti-inflammatory effects via CB₂; small trials in rheumatoid arthritis found reductions in pain and morning stiffness with cannabis extracts. Fibromyalgia: Patients with fibromyalgia often self-report cannabis helps with diffuse pain and sleep; a 2019 prospective trial showed nabilone improved fibromyalgia symptoms modestly. Visceral pain: Emerging data (e.g. in endometriosis or irritable bowel syndrome) indicate potential benefit, likely through both peripheral CB₁/CB₂ and central pathways reducing visceral pain signaling[64][65]. Notably, the psychoactive properties of cannabis might confer an advantage in treating the affective-emotional component of pain. Dr. Terel Newton, the author of the original abstract and a pain specialist, has pointed out that unlike opioids – which do not address the emotional distress of pain and may even worsen it – cannabis can alleviate anxiety and improve mood in tandem with physical pain relief[66][67]. Chronic pain often entails significant psychological burden (fear, depression, insomnia); a single agent that can target both nociception and mental anguish is potentially very valuable. Patients frequently report improved sleep and reduced anxiety on cannabis therapy[68][49], which in turn can augment overall pain control.

Opioids, on the other hand, can disrupt sleep architecture and create mood instability over time. This holistic effect of cannabinoids aligns with the goal of multimodal pain management – attacking pain on multiple fronts (physical, psychological, functional). It also dovetails with non-pharmacologic strategies: for example, cannabis might enable a patient to engage more in physical therapy or exercise by reducing pain and improving sleep, thereby breaking a cycle of pain and inactivity[69]. Policy and Public Health Implications: The shift toward cannabis in pain care raises important policy considerations. Many professional organizations (e.g. the American Academy of Neurology, which supports cannabis for MS spasticity and pain) and even government agencies acknowledge the need for a balanced approach that facilitates research and allows patient access under medical supervision. As of 2025, most U.S. states and dozens of countries have some form of legal medical cannabis, yet federal-level policy (in the U.S.) still classifies cannabis as Schedule I (high abuse potential, no accepted medical use), which hampers large-scale research funding and standardization of products. Policymakers are increasingly interested in cannabis as a tool to combat the opioid crisis – some states have enacted laws explicitly permitting doctors to recommend medical cannabis in lieu of opioids for pain, or even as a treatment for OUD (to ease withdrawal or cravings). Early evidence from such initiatives is encouraging, with states seeing reductions in opioid prescriptions and patients reporting better pain management. However, experts urge caution in overstating cannabis’s capabilities. An editorial accompanying the 2021 BMJ study[70][71] stressed that while the associations are promising, cannabis “cannot be regarded as a remedy to the opioid crisis” in the absence of definitive evidence of causality – randomized trials and longitudinal studies are needed to truly establish whether cannabis access reduces opioid overdose rates on a causal pathway, or if both are influenced by other factors[71]. There are also public safety concerns: with greater cannabis availability, one must consider risks like impaired driving and youth access. Effective policy will require education on responsible use (especially avoiding combining cannabis with other CNS depressants or driving under influence), monitoring outcomes, and possibly regulating product composition (to ensure patients have access to balanced THC/CBD formulations if desired, not only high-THC products). From a health systems perspective, incorporating medical cannabis might involve retraining clinicians (many of whom were never taught about the ECS or cannabinoid pharmacotherapy), establishing dosing guidelines, and creating a framework for monitoring efficacy and side effects, much as we do for opioids (e.g. follow-up assessments, treatment agreements). Insurance coverage is another hurdle – currently, patients often pay out of pocket for cannabis, whereas opioids are usually covered and inexpensive, which can bias choices. Policymakers and payers will need to address this if they want to encourage a shift to cannabis where appropriate. Emerging Technologies and Research Directions: The coming years hold opportunities to optimize the use of cannabis in pain management further. For example, AI-driven analytics on large patient datasets (from electronic health records or registries) can help identify which sub-populations of pain patients benefit most from cannabis versus opioids, and predict responders based on genetics or pain phenotype. 

Machine learning models might also assist in personalizing cannabinoid therapy (e.g. recommending an ideal THC:CBD ratio or dose titration schedule for a given patient profile) and in monitoring for signs of misuse or adverse effects in real time. Additionally, pharmaceutical development is underway for next-generation cannabinoids or modulators of the ECS that aim to maximize analgesia while minimizing psychoactive or adverse effects – such as peripherally restricted CB₁ agonists (which target CB₁ on peripheral nerves but not in the brain, to avoid intoxication)[72], or selective CB₂ agonists for inflammatory pain[32]. These novel agents, along with non-invasive routes of delivery (topical gels, transdermal patches, sublingual tablets), could broaden the therapeutic applicability of cannabinoids. Finally, an interdisciplinary approach is essential. Medical cannabis should be viewed not as a standalone silver bullet, but as one component in a multimodal pain management plan that includes physical therapy, psychological support, and other non-opioid medications. By doing so, we can address the multifactorial nature of chronic pain and reduce opioid exposure from multiple angles. The encouraging data on cannabis’s ability to improve pain and reduce opioid dose lend hope that a significant number of patients can achieve adequate pain control with far less opioid risk. As the population ages and the burden of chronic pain and comorbid disease grows, such alternatives will be crucial. Ongoing clinical trials (including large RCTs of cannabis for low back pain, osteoarthritis, and OUD) will further clarify optimal practices. In parallel, policy reforms – informed by evidence – are likely to continue, potentially reclassifying cannabis to facilitate prescribing and research. The trajectory of both the opioid epidemic and cannabis legislation makes this a rapidly evolving field. The evidence to date suggests that medical cannabis is a viable adjunct or alternative for certain patients: it can produce modest analgesia (particularly in neuropathic and centralized pain syndromes), improve associated symptoms like sleep and anxiety, and enable significant opioid dose reduction in many cases, all with an acceptable safety profile under medical oversight. Harnessing this potential responsibly could improve patient outcomes and contribute to mitigating the opioid overdose crisis, but it demands continued research, education, and sensible regulation. Conclusion Chronic pain remains a pervasive clinical and public health challenge, closely linked with the ongoing opioid crisis and intertwined with mental health burdens. In this context, medical cannabis has emerged as a promising clinical alternative or adjunct to opioids for pain management. Our extensive review of recent evidence (2014–2025) finds that cannabinoid-based therapies can achieve meaningful pain relief in a range of chronic pain conditions – especially neuropathic pain – with efficacy roughly comparable to that of opioids in many cases[44]. Moreover, cannabis demonstrates an opioid-sparing effect: integrating medical cannabis allows many patients to significantly reduce or even eliminate opioid use, without loss of pain control[54][50]. This opioid reduction, observed in both individual-level studies and population-level analyses, is associated with improvements in function and quality of life and potentially with fewer opioid-related overdose deaths[24][60]. The underlying mechanisms involve the endocannabinoid system (via CB₁ and CB₂ receptors) modulating pain signaling and emotional processing of pain in ways distinct from opioid mechanisms[16][73]. From a safety standpoint, short-term adverse effects of cannabis are generally mild to moderate (dizziness, sedation being the most common[37]), and there is no risk of fatal respiratory depression as seen with opioids. Long-term risks (cannabis use disorder, cognitive effects) do exist and necessitate caution, but appear manageable in a medical setting. 

These findings carry significant implications. Clinically, they support offering medical cannabis as part of a multimodal pain management plan, particularly for patients who have inadequate relief or intolerable side effects from conventional analgesics, or those at high risk from opioids (e.g. history of substance misuse or severe adverse reactions). Policy-wise, the evidence encourages the expansion of safe access to medical cannabis, the removal of barriers to cannabis research, and the development of guidelines to help clinicians navigate cannabinoid prescribing (dosing, product selection, monitoring). The ultimate vision is a paradigm shift in which chronic pain is treated not with an “opioids or nothing” approach, but with a toolkit of alternatives – of which cannabis is a key component – to maximize pain relief while minimizing harm. In practical terms, this could mean a patient with refractory neuropathic pain might use a THC/CBD vaporizer or sublingual tincture at night to sleep and relieve pain, allowing them to cut their opioid pills from four per day to one per day, thus lowering risks and improving functionality. On a larger scale, if a substantial fraction of the millions of Americans on long-term opioids could safely transition to or incorporate cannabis, the downstream benefits might include fewer new OUD cases, fewer overdoses, and improved socio-economic productivity of those individuals. That said, cannabis is not a panacea. The effectiveness varies between individuals, and not everyone finds relief or tolerates it. Further, pain is a complex biopsychosocial phenomenon, and cannabis mainly addresses the biological and some psychological facets; comprehensive pain care should also involve physical rehabilitation and mental health support. More high-quality research is needed to determine optimal cannabinoid formulations, dosing regimens, and long-term outcomes, as well as to clarify any risks in special populations (such as adolescents, pregnant women, or those with severe mental illness). The current evidence base, while the strongest in history, still has gaps (for instance, very few RCTs beyond 6 months in duration). Healthcare providers require education to feel comfortable discussing and recommending cannabis, and patients need guidance to navigate the myriad products available in dispensaries (with widely varying potency and purity). In conclusion, cannabis-based therapy represents a viable and evidence-supported clinical alternative for managing chronic pain and mitigating opioid use. Its integration into practice could help “break the pill cycle” of polypharmacy and high-dose opioid dependence, as Dr. Newton’s work advocates, by providing a single agent that addresses pain, mood, and sleep simultaneously[18][66]. The impact of doing so could be substantial: improved patient outcomes, reduced healthcare utilization related to opioid complications, and progression toward a new standard of pain management that is safer and more holistic. 

As the medical and scientific community continues to explore this field, it will be crucial to balance enthusiasm with empirical rigor – ensuring that policy decisions and clinical recommendations remain grounded in solid evidence and patient well-being. With prudent implementation, medical cannabis can be a valuable tool in our arsenal against chronic pain and opioid morbidity, exemplifying a shift toward more personalized and safer pain care in the 21st century. Keywords: Chronic pain; Medical cannabis; Opioids; Opioid Use Disorder; Endocannabinoid System; Pain Management; Polypharmacy; Analgesic; Cannabinoids; Chronic Pain Policy References (AMA Style) 1. Lucas JW, Sohi I. Chronic pain and high-impact chronic pain in U.S. adults, 2023. NCHS Data Brief. 2024;(518):1-8. 2. Vaegter HB, Bruun KD, Bye-Møller L. High-Impact Chronic Pain (Fact Sheet). International Association for the Study of Pain (IASP); Published July 17, 2023. 3. Aaron RV, Dupont SR, Abrahao B, et al. Prevalence of depression and anxiety among adults with chronic pain: a systematic review and meta-analysis. JAMA Netw Open. 2025;8(3):e250268. doi:10.1001/jamanetworkopen.2025.0268. 4. Substance Abuse and Mental Health Services Administration (SAMHSA). Key Substance Use and Mental Health Indicators in the United States: Results from the 2021 National Survey on Drug Use and Health. Published 2023. Rockville, MD: Center for Behavioral Health Statistics and Quality, SAMHSA. (Table A.15B: 5.6 million with past-year opioid use disorder). 5. Centers for Disease Control and Prevention (CDC). Understanding the Opioid Overdose Epidemic. Published June 9, 2025. Atlanta, GA: National Center for Injury Prevention and Control, CDC. (Nearly 80,000 opioid-involved overdose deaths in 2023, first annual decline since 2018). 6. World Health Organization (WHO). Opioid Overdose (Fact Sheet). Published August 29, 2025. Geneva: WHO. (Approximately 600,000 drug-related deaths worldwide in 2019; ~80% related to opioids; ~125,000 due to opioid overdose). 7. National Academies of Sciences, Engineering, and Medicine. The Health Effects of Cannabis and Cannabinoids: Current State of Evidence and Recommendations for Research. Washington, DC: The National Academies Press; 2017. (Conclusion: substantial evidence for cannabis efficacy in chronic pain in adults). 8. Vučković S, Srebro D, Vujović KS, Vučetić Č, Prostran M. Cannabinoids and pain: new insights from old molecules. Front Pharmacol. 2018;9:1259. doi:10.3389/fphar.2018.01259. 9. Whiting PF, Wolff RF, Deshpande S, et al. Cannabinoids for medical use: a systematic review and meta-analysis. JAMA. 2015;313(24):2456-2473. doi:10.1001/jama.2015.6358. 10.McDonagh MS, Morasco BJ, Wagner J, et al. Cannabis-based products for chronic pain: a systematic review. Ann Intern Med. 2022;175(8):1143-1153. doi:10.7326/M21-4520. 11. Boehnke KF, Litinas E, Clauw DJ. Medical cannabis associated with decreased opiate medication use in chronic pain: a prospective cohort study. J Pain. 2016;17(6):739-744. doi:10.1016/j.jpain.2016.03.002. 12.Nugent SM, Morasco BJ, O’Neil ME, et al. The effects of cannabis among adults with chronic pain and an overview of general harms: a systematic review. Ann Intern Med. 2017;167(5):319-331. doi:10.7326/M17-0155. 13.Jeddi HM, Busse JW, Sadeghirad B, et al. Cannabis for medical use versus opioids for chronic non-cancer pain: a systematic review and network meta-analysis of randomized trials. BMJ Open. 2024;14(1):e068182. doi:10.1136/bmjopen-2022-068182. 14.Hsu G, Kovács B. Association between county-level cannabis dispensary counts and opioid-related mortality rates in the United States: panel data study. BMJ. 2021;372:m4957. doi:10.1136/bmj.m4957. 15.Finch PM, Price LM, Price TJ, Kent MJ, Drummond PD. Opioid reduction in patients with chronic non-cancer pain undergoing treatment with medicinal cannabis. Pain Manag. 2025;15(10):703-711. doi:10.1080/17581869.2025.2544511. 16.Bachhuber MA, Saloner B, Cunningham CO, Barry CL. Medical cannabis laws and opioid analgesic overdose mortality in the United States, 1999-2010. JAMA Intern Med. 2014;174(10):1668-1673. doi:10.1001/jamainternmed.2014.4005. 17.Shover CL, Davis CS, Gordon SC, Humphreys K. Association between medical cannabis laws and opioid overdose mortality has reversed over time. Proc Natl Acad Sci U S A. 2019;116(26):12624-12626. doi:10.1073/pnas.1903434116. 18.Wen H, Hockenberry JM. Association of medical and adult-use marijuana laws with opioid prescribing for Medicaid enrollees. JAMA Intern Med. 2018;178(5):673-679. doi:10.1001/jamainternmed.2018.1007. 19.National Institute on Drug Abuse (NIDA). Only 1 in 5 U.S. adults with opioid use disorder received medications to treat it in 2021 (Press Release). Published August 3, 2023. Bethesda, MD: NIDA, National Institutes of Health. (Prevalence of OUD and treatment gap). 20.Florida Office of Medical Marijuana Use (OMMU). OMMU Update: Qualified Patients Report. Tallahassee, FL: Florida Department of Health; March 2025. (Over 900,000 patients with active medical cannabis ID cards in FL). 21.Hill KP. Medical marijuana for treatment of chronic pain and other medical and psychiatric problems: a clinical review. JAMA. 2015;313(24):2474-2483. doi:10.1001/jama.2015.6199. 22.van de Donk T, Niesters M, Kowal MA, et al. An experimental randomized study on the analgesic effects of pharmaceutical-grade cannabis in chronic pain patients with fibromyalgia. Pain. 2019;160(4):860-869. doi:10.1097/j.pain.0000000000001464. 23.Häuser W, Petzke F, Fitzcharles MA. Efficacy, tolerability and safety of cannabis-based medicines for chronic pain management – An overview of systematic reviews. Eur J Pain. 2018;22(3):455-470. doi:10.1002/ejp.1118.