The oral cannabinoid dronabinol has similar psychoactive effects to smoking marijuana.

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• Mohammed A Issa, Sanjeet Narang, Robert N Jamison, Edward Michna, Robert R Edwards, David M Penetar, and Ajay D Wasan.
• Departments of *Anesthesiology, Perioperative, and Pain Medicine ‡Psychiatry, Brigham and Women's Hospital §Behavioral Psychopharmacology Research Laboratory, McLean Hospital †Harvard Medical School, Boston, MA.
• Clin J Pain. 2014 Jun 1; 30 (6): 472-8.

BackgroundMany cannabinoid medications are approved in North America or in phase III trials, such as dronabinol, nabilone, or nabiximols. Little is known about their subjective psychoactive effects when used for pain management. We hypothesized that when used for pain, dronabinol has psychoactive effects in a dose-response relationship, whose peak effects are comparable with smoking marijuana.MethodsThis was a randomized controlled trial of single dose placebo, 10 or 20 mg dronabinol in 30 chronic noncancer pain patients taking opioids and not using marijuana. Participants completed the Addiction Research Center Inventory (ARCI) hourly for 8 hours during 3 monitored sessions. Comparison sample was the ARCI ratings in participants with no pain (N=20), monitored every 30 minutes after smoking a 1.99% THC (low) and a 3.51% (high strength) marijuana cigarette.ResultsThe 10 and 20 mg dronabinol doses had significantly elevated scores over time on 4/5 subscales versus placebo (P<0.05). Average daily morphine use, total pain relief (TOTPAR), age, sex, and baseline pain level were not significant covariates. ARCI peak effects at 2 hours were similar to peak effects of smoked marijuana at 30 minutes (P=0.80, 10 mg=low strength, 20 mg=high strength).ConclusionsIn pain patients, oral dronabinol has similar psychoactive effects to smoking marijuana. This risk must be considered in any decision to prescribe cannabinoid medications for pain.

This article appears in the collection: Chronic pain.

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