The American College of Physicians (ACP) has released new guidance for doctors whose patients are using or thinking about using cannabis or cannabinoid products to manage chronic pain not caused by cancer.
This advice was published in the Annals of Internal Medicine and reflects growing concern about the rising use of cannabis for medical purposes without enough understanding of its risks and limited benefits.
As of 2024, cannabis is legal for recreational and medical use in 24 U.S. states and Washington, D.C., and for medical use only in 14 more states. With this broader access, many patients with ongoing pain are turning to cannabis as a possible treatment—even though the medical evidence to support its use remains limited.
The ACP’s new Best Practice Advice gives doctors clear recommendations on how to talk with patients about cannabis for chronic noncancer pain:
- Discuss both the risks and the limited benefits of cannabis or cannabinoids with any patient who is thinking about starting or continuing its use for chronic pain.
- Warn specific groups that the risks likely outweigh any benefits:
- Young adults and teens
- People with current or past substance use issues
- Patients with serious mental health conditions
- Frail individuals or those at risk of falling
- Advise against use of cannabis or cannabinoids for pain in:
- Pregnant or breastfeeding patients
- Those actively trying to become pregnant
- Recommend against inhaling cannabis (such as smoking or vaping) as a way to manage chronic pain.
Dr. Isaac Opole, President of the ACP, emphasized the importance of open conversations between doctors and patients. “As the use of cannabis for medicinal purposes grows, it’s critical to open that dialog and review the emerging evidence related to benefits and harms,” he said.
The ACP’s review of available research shows that, for many patients, the harms of cannabis—including addiction and mental health effects—are likely greater than the small pain relief it may provide.
There is also concern about the strength of cannabis products sold in dispensaries, which often contain much higher levels of THC (the main psychoactive ingredient) than those tested in research studies. This makes it harder to apply research findings to real-world use.
Another major issue is the lack of medical oversight. Most patients using cannabis for pain buy it from dispensaries, not through a pharmacy with doctor supervision. Unlike FDA-approved medications, cannabis products may vary in strength and purity, which adds another layer of risk.
The ACP recommends that doctors start with proven pain treatments—such as physical therapy, over-the-counter pain relievers, or prescription drugs with a known safety record—before suggesting cannabis. In most cases, these traditional approaches are safer and more effective.
This advice is based on a thorough review of scientific evidence, including a living systematic review that continuously updates the latest research. The ACP also released a broader position paper calling for a public health approach to deal with the legal, medical, and social issues around cannabis use.
This new guidance reflects a cautious, patient-centered approach. While some people may feel better using cannabis for chronic pain, the evidence supporting its benefit is limited, and the risks—especially for vulnerable groups—are real.
The ACP is not completely against medical cannabis use, but it strongly encourages doctors to weigh each patient’s situation carefully and prioritize safer, more reliable treatments first.
The guidance also highlights a broader concern: in the U.S., cannabis use has grown faster than the science and medical systems supporting it.
The lack of consistent regulation and high-potency products create challenges for both patients and doctors. Until there is more solid evidence and better control over how cannabis is produced and sold, doctors will need to help patients make cautious, informed choices based on facts—not trends.
In short, cannabis might play a role in pain care for some people, but it’s far from a first-choice option. The ACP encourages a thoughtful, science-based approach—and honest conversations between patients and doctors—to guide safe decision-making.
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The research findings can be found in Annals of Internal Medicine.
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