Pain Matters Podcast Network · AAPM - American Academy of Pain Medicine

Navigating Cannabis in Pain Medicine [Part 1]

·27 min·1 clip

Dr. Wallace says THC followed an inverted U: low dose did nothing, medium dose helped, high dose worsened pain.

The discussion stays focused on medicinal cannabis. The speaker frames it as a pain-management tool and quickly separates medicinal doses from the much higher recreational doses that can change the clinical picture. Tolerance is the first big contrast. He says he has not seen the same dose escalation with cannabis that is common in opioid treatment, and describes patients often staying on the same dose for long stretches instead of constantly chasing a stronger effect. Supply behavior also differs. Rather than the anxiety cycle that can show up when an opioid prescription is getting low, he says cannabis patients usually wait until they can reach a dispensary and refill, and stop without withdrawal in his experience. Route of delivery matters too. Inhalation is presented as the most consistent way to deliver the drug because blood levels are steadier, but that reliability comes with a short duration of action, probably less than two hours. Edibles require more patience. Their onset can be delayed by one to four hours, and the effect is described as variable because THC is lipophilic and goes through an erratic first-pass effect that makes blood levels harder to predict. Patients are taught timing. The goal is to learn an individual absorption profile and use that knowledge to predict the peak more reliably, which is why some patients use edibles at night and inhalation during the day to titrate effects. Safety comes first. The speaker discourages smoking, vape pens, and inhaled extracts, saying the extraction process makes the contents less certain, while still allowing vaporization of organically grown flower in a small vaporizer. Topicals do not fare well. He says the evidence for topical products is weak and that it is hard to know how much of the drug is actually reaching the receptors. CBD gets treated skeptically. The conversation argues that any real effect would require very high and cost-prohibitive doses, and that many products marketed as pure CBD likely contain THC when patients report benefit. THC is the active center. The episode closes by pointing listeners toward part two, where the discussion continues into a study on car accidents and other medical-marijuana questions.

As heard by us

A clinical look at medicinal cannabis that stays with dose, delivery, and effect.

Pain medicine gets handled in a practical way here, with medicinal cannabis weighed against opioids and the focus kept on inhalation, edibles, topicals, THC, and CBD as they relate to dose, onset, and effect.

Read the full review in PlayNext →

Why you'd press play

When you want cannabis explained like a treatment plan, not a headline.

Read the full recommendation in PlayNext →

Listen to the show on

Apple Podcasts Spotify

Play clips from this episode More from Pain Matters Podcast Network