The ACP advises clinicians to discuss cannabis benefits and harms with chronic pain patients, while warning against use in youth, pregnant patients, those with substance use disorders, and recommending against inhaled forms.
Patients with chronic pain considering cannabis, clinicians counseling patients about cannabis options
Advises against inhaled cannabis for all chronic pain patients
What the researchers found
The ACP developed best practice advice based on systematic reviews, recommending clinicians counsel patients about cannabis for chronic noncancer pain while identifying specific subgroups where harms likely outweigh benefits: young adults and adolescents, patients with substance use disorders, those with serious mental illness, and frail patients at risk for falls.
Why it matters
This represents one of the first major U.S. medical society guidelines specifically addressing cannabis for chronic pain. Rather than a blanket endorsement or rejection, it takes a nuanced position that acknowledges potential benefits while drawing clear lines around higher-risk populations.
The numbers in context
The guidance identifies four subgroups where harms likely outweigh benefits and advises against inhaled cannabis across all patient groups.
How the study worked
Clinical guidance developed by the ACP Population Health and Medical Science Committee based on living systematic reviews and primary studies on cannabis and cannabinoid treatments for chronic noncancer pain.
What this study cannot tell us
Best practice advice is based on available evidence, which remains limited in quality and quantity. The guidance acknowledges uncertainty in many areas and relies on systematic reviews that may not capture the full range of cannabis products and formulations patients actually use.
How to read the evidence
Clinical guidance from a major medical society based on systematic review evidence, though underlying studies are often limited in quality.
When this study was published
2025 guidance reflecting current evidence base
The bigger picture
As cannabis legalization expands, clinicians increasingly face questions about its role in pain management. Having guidance from a major medical society gives practitioners a framework for these conversations rather than relying on anecdotal evidence or patient self-direction.
Questions still open
- How will this guidance affect prescribing patterns in states with legal cannabis?
- What specific cannabis formulations and doses show the most favorable risk-benefit profiles for chronic pain?
Common questions
What does the ACP recommend about cannabis for chronic pain?
Who should avoid using cannabis for chronic pain according to this guidance?
Read the original research
Cannabis or Cannabinoids for the Management of Chronic Noncancer Pain: Best Practice Advice From the American College of Physicians.
Annals of internal medicine, 178(5), 714-724
Citation
Kansagara, Devan; Hill, Kevin P; Yost, Jennifer; Humphrey, Linda L; Shaw, Beth; Obley, Adam J; Haeme, Ray; Akl, Elie A; Qaseem, Amir; Dunn, Andrew S; Jackson, Christopher D; Jokela, Janet A; Lee, Rachael A; Mackey, Katherine; Saini, Sameer D; Tschanz, Mark P; Wilt, Timothy J; Etxeandia-Ikobaltzeta, Itziar; Shamliyan, Tatyana; Vigna, Chelsea. (2025). Cannabis or Cannabinoids for the Management of Chronic Noncancer Pain: Best Practice Advice From the American College of Physicians.. Annals of internal medicine, 178(5), 714-724. https://doi.org/10.7326/ANNALS-24-03319
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