• regional anesthesia
• pain management
• chronic pain

The global use of cannabinoids for both recreational and medicinal purposes is accelerating at a remarkable pace. By 2026, the cannabinoid market capitalization is predicted to be approximately US$97 billion, which will far surpass that of the largest pharmaceutical company in the world.1 Political, professional and cultural conflict has emerged centered around the impact (good or bad) on the health and well-being of our society already suffering from epidemic levels of drug-related morbidity. Money, passion, hope, science, patients, pain, suffering, advocacy and politics—what could possibly go wrong?

I was in the audience at an acute pain medicine panel discussion about 2 years ago. The speaker, a world expert in cannabinoid pharmacology, deviated from the topic of acute pain and projected a slide summarizing the multitude of theoretical medicinal advantages offered by cannabinoid-based pharmaceuticals. The image was of the entire human body, and every organ system was displayed linked to text boxes declaring the nearly endless possible health benefits. This slide was enticing the audience to consider the potential for cannabinoid therapy to be able to improve a wide range of refractory and poorly understood human conditions—from autism to anxiety.

As a scientist, hobby historian, and editor, I am inherently skeptical of trending topics in medicine, especially with a market cap that would attract the attention of Warren Buffett and Jeff Bezos. The aforementioned expert panelist pointed out the relevance of audience members attending the cannabinoid session at the conference. He noted that, despite the lack of robust supporting scientific evidence, ‘The train had already left the station.’ I jotted down in my notebook (with an emoji) that perhaps one important detail was missing- this train was without an engineer. As it turns out, runaway trains are quite common in medicine and the major problem is that they often crash. In the 1980s, a multibillion dollar industry emerged advocating for the routine prescribing of hormonal replacement therapy (HRT) to healthy postmenopausal women in order to prevent such conditions as heart disease and dementia. In fact, the Journal of the American Medical Association published a calculator where women could determine how many years longer they would live based on starting HRT.2 Millions and millions of women were exposed to this drug to only learn later that it actually caused many of the diseases the drug was supposed to prevent—a major train crash! Given that roughly 40% of the evidence-based guidelines and expert opinions are found to be wrong or harmful within 10 years of their dissemination3 (ie, ‘tight’ glucose control, opioids for osteoarthritis, knee arthroscopy for osteoarthritis, etc), it seems reasonable for Regional Anesthesia & Pain Medicine (RAPM) readers and clinicians to ask tough questions of this journal, leadership societies and the cannabinoid advocating community.

RAPM anticipates that the cannabinoid discussion will consume a great deal collective energy and resources over the next decade in effort to establish what the best practices are for the perioperative, acute, and chronic pain medicine arenas. It is a medical imperative that the best information come to light clearly outlining the meaningful benefits and real-world harms of these complicated drugs. RAPM aspires to empower our readers so they can advocate and support patients who are suffering from pain and disability. We will provide a constructive forum to share opinions ranging from advocacy to resistance. We welcome and are recruiting all forms of research aimed at identifying the relationship between cannabinoid consumption and improvements in well-being, as well as the possibility for harm. In this month’s issue of RAPM we begin our coverage of this important topic with an outstanding systematic review/meta-analysis by Abdallah and colleagues.4 This review is accompanied by two Daring Discourses with drastically different perspectives on the role of cannabinoids as an adjunct therapy for acute pain medicine. We look forward to hearing from the community through our interactive media and meeting platforms!