https://doi.org/10.1177/2050313X20907015 SAGE Open Medical Case Reports Creative Commons Non Commercial CC BY-NC: This article is distributed under the terms of the Creative Commons Attribution- NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage). SAGE Open Medical Case Reports Volume 8: 1–3 © The Author(s) 2020 Article reuse guidelines: sagepub.com/journals-permissions DOI: 10.1177/2050313X20907015 journals.sagepub.com/home/sco Introduction Opioid use for pain has increased over the last decade. Rates of opioid-related deaths have also increased fourfold in this time frame. 1 This country-wide epidemic has even prompted the Centers for Disease Control and Prevention to put out new opioid-prescribing guidelines for primary care physi- cians. 2 In this case report, the patient is able to wean off her opioids safely using medical cannibus as an alternative to opioids for chronic pain. Case report This study describes a case of a 43-year-old female with a history of traumatic brain injury secondary to a motor vehi- cle accident in June 2004. The patient had no history of psy- chiatric illness. She sustained multiple fractures, including a right-sided occipital fracture, C2 fracture, right scapula frac- ture and multiple rib fractures. She presented to our outpa- tient clinic complaining of right-sided headaches and neck and shoulder pain. She complained of pain which was 8/10 on the visual analog scale (VAS) in her neck, right shoulder and right side of the head. She described pain as a tight vice like gripping with paresthesias. The pain was alleviated by heat and massage and aggravated by increased activity and sleep. She was taking morphine 30 mg two times per day. She was followed in our clinic for 14 years and was trialed on multiple medications such as Flexeril, gabapentin and Elavil, which did not give her relief. She was also increased on her narcotic pain medications. She was placed on MS Contin 45 mg two times per day and morphine immediate-release 30 mg two times per day for breakthrough pain. This was equal to 150 morphine milligram equivalents (MME) per day. The pain was controlled with narcotic pain medications for over 10 years. She states the medications decreased her pain from 8/10 on the VAS to 4/10 on the VAS. Over the years, the patient expressed her concerns about becoming addicted to narcotic pain medication. On 6 April 2016, the state of Pennsylvania legalized medical cannibus, and on 15 February 2018 medical cannibus became available for patients in Pennsylvania. The patient was educated on medical cannibus as an alternative to opioid medications. We came up with a weaning protocol. We first decreased the long-acting MS Contin by 15 mg per week until she was only on morphine immediate-release. She did complain of some increased pain and withdrawal symptoms such as chills and diarrhea but was able to wean off in 1 month. Once off the Medical cannibus as an alternative for opioids for chronic pain: A case report Franklin E Caldera Abstract Opioid medication–related deaths have increased to epidemic proportions in the last decade. This report describes a case of 43-year-old female with a traumatic brain injury who developed chronic pain and opioid dependence. The patient expressed concerns and wanted weaning off opioids. Recent legalization of medical marijuana in Pennsylvania allows us to try it as an alternative to opioids for chronic pain. Medical cannibus has risks associated with administration but is safer than opioids. Our patient was successfully weaned off her opioid medications with the help of medical cannibus and pain remained well controlled. More studies need to be done on using medical cannibus as an alternative to opioids. Keywords Orthopedics/rehabilitation/occupational therapy, anesthesia/pain, marijuana, opioid Date received: 29 October 2018; accepted: 18 January 2020 Hospital of the University of Pennsylvania, Philadelphia, PA, USA Corresponding Author: Franklin E Caldera, Hospital of the University of Pennsylvania, 1800 Lombard Street, Philadelphia, PA 19104, USA. Email: Franklin.Caldera@uphs.upenn.edu 907015SCO 0 0 10.1177/2050313X20907015SAGE Open Medical Case ReportsCaldera case-report 2020 Case Report