Draft — pending COA review. Rette derived these criteria from the ACOEM guidelines adopted into the MTUS. They are not COA documents and have not been signed off by a COA physician reviewer.

MTUS Treatment ChecklistbyRette

Utilization Review Checklist

Cannabinoids for Pain

Derived from the ACOEM Cannabis Guideline, edition 28 January 2025, as adopted into the California MTUS 1 June 2025. ICD-10 G89.18, G89.29, M54.5, M25.50.

Draft — not reviewed or approved by COA. Prepared by Rette from the ACOEM guideline named above. This is not a COA document and does not reproduce COA’s own checklists.

Patient name: Claim #:

CriteriaCheck if documented

Contraindications and Cautions

Required

  • Whether the patient performs safety-critical work has been established and recorded

    “Acute or chronic cannabinoid use is not recommended for individuals who perform safety-critical jobs. These jobs include the operation of motor vehicles, forklifts, overhead cranes, heavy equipment, or other modes of transportation; sharps work (e.g., knives); work with injury risks (e.g., heights)” — p. 15

Procedures — the guideline treats each separately

Cannabinoids for postoperative pain

Moderately Not Recommended. Cannabinoids are not recommended for the treatment of postoperative pain.

Strength of Evidence — Moderately Not Recommended, Evidence (B) · confidence moderate · p. 14

Indications — required:

  • Postoperative pain

    “Cannabinoids are not recommended for the treatment of postoperative pain.” — p. 14

Moderately NOT recommended on Evidence (B) — the strongest negative in this guideline, and the one most relevant after orthopaedic surgery.

Cannabinoids for chronic pain

Not Recommended. Cannabinoids are not recommended for the treatment of chronic pain.

Strength of Evidence — Not Recommended, Evidence (C) · confidence low · p. 11

Indications — required:

  • Chronic pain

    “Cannabinoids are not recommended for the treatment of chronic pain.” — p. 11

Not recommended. The guideline notes the longest quality study runs to 3 months and no long-term placebo-controlled trial supports efficacy.

Cannabinoids for acute or subacute pain

Not Recommended. Cannabinoids are not recommended for treatment of acute or subacute pain.

Strength of Evidence — Not Recommended, Evidence (C) · confidence low · p. 13

Indications — required:

  • Acute or subacute pain

    “Cannabinoids are not recommended for treatment of acute or subacute pain.” — p. 13

Not recommended for acute or subacute pain.

Reviewing this for COA, or think a criterion is wrong?