Cannabis for Fibromyalgia: The Great Green Elephant in the Room

Silviu Brill
Director of Institute of Pain Medicine, Tel Aviv Medical Center, Israel

In recent years, cannabis had been approved for medical use in more than 30 countries: from United States to Europe and Israel. Worldwide, cannabis is the third most commonly used substance after alcohol and tobacco.

The use Medicinal cannabis is highly controversial amongst doctors.
There are only a few studies in the literature on the use of cannabis by fibromyalgia patients. In these studies, the patients used unlicensed/illegal cannabis from different suppliers, and the studies contained no information on either the type or amount of cannabis used. 

The medical community needs to adheres to the principle that substances intended for therapeutic purposes be fully characterized chemically, pharmacologically and toxicologically. The use of medications, including medicinal cannabis, should not be the core component of therapy. 
Although herbal cannabinoids may offer some therapeutic effect, caution regarding any recommendation should be exercised pending clarification of general health and psychosocial problems and a clear follow-up program should be used.
At the present time, the scientific evidence for the efficacy of cannabinoids in the management of people with fibromyalgia patients is insufficient to justify endorsement of clinical guidelines. 
Specific concerns should address also risk of doctor shopping, risk of harms, media and public pressure and the emergence of a new industry, rather than on the foundation of robust evidence.