Lack of guidelines for use of medical marijuana for HIV neuropathic pain

Background: Painful HIV-associated sensory polyneuropathy affects 30-40% of HIV- infected individuals, and current treatments are unsatisfactory. Systematic reviews and meta-analyses pooling data from several randomized clinical trials suggest that smoked cannabis is effective for chronic neuropathic pain. Medical marijuana is legal in 16 of the United States, Washington DC and several jurisdictions in Europe, Latin America and Asia, but concerns about potential harm remain. We searched, scrutinized and compared practice guidelines worldwide for the medicinal use of marijuana. Methods: We searched the literature and the internet for practice guidelines on peripheral neuropathy and/or medical marijuana with a combination of free text search and a controlled vocabulary search. Results: We found more than 30 guidelines from professional bodies, regulatory and government agencies and other interested parties; only two mentioned cannabis as effective treatment for HIV neuropathy. Most medical marijuana guidelines only address legal issues or called for more research. Existing guidelines do not discuss clinical indications, drug interactions or side effects, potential benefits and harms, appropriate marijuana administration or dosing; they are therefore unhelpful for providers or patients considering cannabis for the treatment of chronic neuropathic pain. Conclusion: Existing guidelines provide little or no clinically useful information to patients or providers. Evidence-based consensus guidelines on medicinal use of marijuana could help both to improve the treatment of painful conditions and to reduce abuse. Guidelines should list clinical indications supported by data from randomized clinical trials and weigh proven benefits against documented risks and harms associated with cannabis use.