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Medicine Grand Rounds - Cannabis and Opioids in Pain Management: Alternatives? Complements? Pipe dream?

This presentation reviews the biological mechanisms that influence patients’ perceptions of pain and the implications for pain treatment strategies. Many types of interventions modulate the neurotransmission of pain, and optimal treatment plans typically combine healthy self-care and clinical care, often in the form of prescription medications. The presenters discuss the risks and benefits of cannabis and opiates, as well as the history of both in the pharmacopeia. Therapeutic applications of cannabis in clinical practice and demand from patients may be moving faster than the evidence base and infrastructure for safety and quality control, and much of the current research on cannabis in the treatment of pain is low quality. There is limited evidence of efficacy for oncologic and neuropathic pain management, and evidence of effective relief from nausea, anxiety and spasticity, which may occur concomitantly in painful conditions. The complex neurochemical interactions of cannabis and opioids are reviewed, including animal and human studies that have mixed results regarding opioid sparing when used in combination therapy.

Activity Details
Start Date: January 25, 2019
End Date: January 25, 2021

You may claim MOC points and/or CME credits for successful completion of this online course. In order to claim points/credits, you must follow these steps:

  1. Register for the learning activity by creating an account or logging in to your account.
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  3. Return to this Activity page.
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    Click Continue to navigate to the Post-Assessment tab; then click the Launch button to start the post-assessment.

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  5. For CME credit, click Continue to navigate to the Evaluation tab; then click the Launch button to start the evaluation.
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When the evaluation is submitted, you will be awarded CME credit. You may access your transcript for verification of participation at any time via Your Account. MOC points will be submitted to the ACCME at the end of each month; you can check with your accrediting board for point totals. Need help? Visit the Support Page, send an Email, or call the Center for Learning and Professional Development at (603) 653-1234, Option 1.

  • Kathleen Broglio, DNP, ANP-BC, ACHPN, CPE, FPCN
    Assistant Professor of Medicine
    Geisel School of Medicine at Dartmouth
    Section of Palliative Medicine
    Dartmouth-Hitchcock Medical Center
  • Seddon R. Savage, MD, MS
    Adjunct Associate Professor of Anesthesiology
    Geisel School of Medicine at Dartmouth
    Advisor, Substance Use and Mental Health Initiative
    Dartmouth-Hitchcock Health System

Learning Outcome

Participants will be able to discuss with patients the potential risks, benefits and unknowns of cannabis and cannabinoids for symptom control in chronic pain as well as rationally monitor and revise care for those who elect for a trial of cannabis, either as an alternative or in addition to opioids in the treatment of chronic pain.


Dartmouth-Hitchcock is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

Dartmouth-Hitchcock designates this enduring material for a maximum of 1 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

American Board of Internal Medicine (ABIM) - Maintenance of Certification

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 1.0 Medical Knowledge MOC points in the American Board of Internal Medicine's Maintenance of Certification program. It is the CME activity provider's responsibility to submit participant completion information to the ACCME for the purpose of granting ABIM MOC credit.

Learner participation information will be shared with the ABIM through the ACCME’s Program and Activity Reporting System.


In accordance with the disclosure policy of Dartmouth-Hitchcock/Geisel School of Medicine at Dartmouth as well as standards set forth by the Accreditation Council on Continuing Medical Education and the Nursing Continuing Education Council standards set forth by the American Nurses Credentialing Center Commission on Accreditation, continuing medical education and nursing education activity director(s), planning committee member(s), speaker(s), author(s) or anyone in a position to control the content have been asked to disclose any financial relationship* they have to a commercial interest (any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on patients). Such disclosure is not intended to suggest or condone bias in any presentation, but is elicited to provide participants with information that might be of potential importance to their evaluation of a given activity.

The following Activity Physician Director(s), planning committee member(s), speaker(s), author(s) or anyone in a position to control the content for Cannabis and Opioids in Pain Management: Alternatives? Complements? Pipe dream? (Medicine Grand Rounds) have reported the following financial interest or relationship* with various companies/organizations. The Activity Director and Planning Committee member roles were resolved by altering the individual’s control over content about the products or services of the commercial interest by the Associate Dean for CME and the Department of Medicine Chair. All potential conflict(s) were resolved.

* Kelly Kieffer, MD ~ her spouse is a consultant for OcculoBio. 

* Richard I. Rothstein, MD ~ has research support from Baranova (research grant to Dartmouth-Hitchcock Medical Center) and has other financial interest from Allurion. 

Other planning committee member(s), speaker(s), activity director(s), author(s) or anyone in a position to control the content for this program report no financial interest or relationship* with any company(ies) or organizations whose product may be germane to the content of their presentations.

*A “financial interest or relationship" refers to an equity position, receipt of royalties, consultantship, funding by a research grant, receiving honoraria for educational services elsewhere, or to any other relationship to a company that provides sufficient reason for disclosure, in keeping with the spirit of the stated policy.

Provider Contact Information

Provider contact information for questions regarding accreditation of the activity:

Center for Learning and Professional Development
Dartmouth-Hitchcock Medical Center

For more information on this topic, please go to: https://www.oplc.nh.gov/medicine/opioid-prescribing.htm

Type:     Internet Activity (Enduring Material)
317 Registered Users