Therapeutic Potential of Cannabis - for multiple conditions and or suggestions for incorporating medical cannabis into clinical practice

Therapeutic Potential of Cannabis (for multiple conditions and/or suggestions for incorporating medical cannabis into clinical practice)

A survey of the attitudes, beliefs and knowledge about medical cannabis among primary care providers
Philpot LM, Ebbert JO, Hurt RT. A survey of the attitudes, beliefs and knowledge about medical cannabis among primary care providers. BMC Family Practice 2019;20:17.
Survey of Mayo Clinic primary care clinicians carried out in January/February, 2018 with a 31% response rate (62/199). A majority believed medical cannabis was a legitimate medical therapy (58.1%) and ≥50% believed that medical cannabis was helpful for treating three of the Minnesota medical cannabis program’s qualifying conditions: cancer, terminal illness, and intractable pain. A majority did not know if medical cannabis was effective for managing nearly one-half of the program’s other qualifying conditions. Few believed that medical cannabis improved quality of life domains. One-half were not ready to or did not want to answer patients’ questions about medical cannabis and the majority wanted to learn more about it.

The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research
A report published by the U.S. National Academies of Sciences, Engineering, and Medicine.  2017. 
A rigorous review of relevant scientific research published since 1999, summarizing the current state of evidence regarding what is known about the health impacts of cannabis and cannabis-derived products, including effects related to therapeutic uses of cannabis and potential health risks related to certain cancers, diseases, mental health disorders, and injuries.  Sections on evidence of therapeutic effects include: chronic pain, cancer treatment, chemotherapy-induced nausea and vomiting, anorexia and weight loss associated with HIV/AIDS, cancer-associated anorexia-cachexia syndrome, anorexia nervosa, irritable bowel syndrome, epilepsy, spasticity associated with multiple sclerosis or spinal cord injury, Tourette syndrome, amyotrophic lateral sclerosis, Huntington’s disease, Parkinson’s disease, dystonia, dementia, glaucoma, traumatic brain injury/intracerebral hemorrhage, substance addiction, anxiety, depression, sleep disorders, posttraumatic stress disorder, and schizophrenia and other psychoses.  Chapters summarizing evidence of harms include: cancer, cardiometabolic risk, respiratory disease, immunity, injury and death, prenatal/perinatal/neonatal exposure, psychosocial, mental health, cannabis use problems, and abuse of other substances.

A Review of Medical Cannabis Studies relating to Chemical Compositions and Dosages for Qualifying Medical Conditions (PDF)
Office of Medical Cannabis.
Summary of clinical trials and prospective observational studies in humans, published in peer-reviewed journals, which focus on medical cannabis formulations consistent with Minnesota’s medical cannabis program.

Information for Health Care Professionals: Cannabis and the cannabinoids (PDF)
Health Canada. February, 2013.
Endocannabinoid system, clinical pharmacology, dosing, potential therapeutic uses (by condition), precautions, warnings, adverse effects, and overdose/toxicity.

Handbook of Cannabis
Roger G Pertwee, Oxford University Press, 2014. 747 pages.

  • Constituents, History, International Control, Cultivation, and Phenotypes of Cannabis
  • Pharmacology, Pharmacokinetics, Metabolism, and Forensics
  • Medical Cannabis and Cannabinoids: Clinical Data
  • Approved Therapeutic Targets for Phytocannabinoids: Preclinical Pharmacology
  • Some Potential Therapeutic Targets for Phytocannabinoids
  • Recreational Cannabis: Sought-After Effects, Adverse Effects, Designer Drugs, and Harm Minimization

Cannabinoids for Medical Use: A Systematic Review and Meta-analysis
Whiting PF, Wolff RF, Deshpande S, Di Nisio M, et al JAMA 2015;313(24):2456-2473.
Systematic review of the benefits and adverse effects of therapeutic use of cannabinoids.  The study included randomized clinical trials of cannabinoids for the following indications: nausea and vomiting due to chemotherapy, appetite stimulation in HIV/AIDS, chronic pain, spasticity due to multiple sclerosis or paraplegia, depression, anxiety disorder, sleep disorder, psychosis, glaucoma, or Tourette syndrome.

Here is JAMA’s summary of the Whiting article, “In a systematic review, Whiting and colleagues identified 79 randomized trials, involving 6462 participants, that compared cannabinoid use with active comparators or placebo for the treatment of several medical conditions.  The authors found moderate-quality evidence supporting cannabinoid treatment of chronic pain and spasticity due to multiple sclerosis or paraplegia.  Low-quality evidence suggests cannabinoids may lessen nausea and vomiting due to chemotherapy, foster weight gain in patients with HIV infection, and improve symptoms of sleep disorders or Tourette syndrome.  In an Editorial, D’Souza and Ranganathan discuss the need for high-quality evidence to guide decisions about medical marijuana use.” 

Medical Marijuana for Treatment of Chronic Pain and Other Medical and Psychiatric Problems: A Clinical Review
Hill KP. JAMA 2015;313:2474-2483.
A literature review and case presentation based on a Grand Rounds conference at Beth Israel Deaconess Medical Center, Boston, in May, 2014.  The patient discussed is a 60 year old with back pain since a fall 19 years ago and extensive surgical and medical treatment for pain since then.  From the FINDINGS section of the abstract, “Use of marijuana for chronic pain, neuropathic pain, and spasticity due to multiple sclerosis is supported by high-quality evidence.  Six trials that included 325 patients examined chronic pain, 6 trials that included 396 patients investigated neuropathic pain, and 12 trials that included 1600 patients focused on multiple sclerosis.  Several of these triials had positive results, suggesting that marijuana or cannabinoids may be efficacious for these indications.”  Of particular note is the clinical approach to evaluation of a patient for medical cannabis certification, beginning on page 2478 and summarized in a box on page 2480.

Therapeutic potential of cannabinoid medicines
Robson PJ. Drug Test Anal 2014 Jan-Feb;6(1-2):24-30.
Overview of endocannabinoid system, pharmacoactive components of cannabis and clinical conditions where there is some evidence of therapeutic potential for cannabis.  The author is associated with GW Pharmaceuticals, a public company that is researching and developing a portfolio of cannabinoid medicines.

The pharmacologic and clinical effects of medical cannabis
Borgelt LM, Franson KL, Nussbaum AM, Wang GS. Pharmacotherapy 2013;33(2):195-209.
Pharmacodynamics and pharmacokinetics (smoked and orally ingested) of cannabis, clinical effects (focusing on pain and muscle spasm), adverse effects and drug interactions, psychiatric implications, and pediatric implications.

Cannabinoids in Medical Practice
Strouse TB. Cannabis and Cannabinoid Research 2016: Vol 1:1. DOI: 10.1089/can.2015.0010. 
Perspective piece defining the types of cannabinoid products now in use, evidence of efficacy and safety, and suggestions for a responsible approach to patients’ use of cannabinoids in clinical practice.

Cannabis: The Evidence for Medical Use
Barnes MP, Barnes JC. Report published by Northumberland, Tyne & Wear NHS Foundation Trust, May 2016.
Literature review and discussion of strength of evidence of effectiveness for a wide variety of medical conditions.  This report was commissioned by the All Party Parliamentary Group for Drug Policy Reform (UK).  The authors note they received no renumeration other than a small grand from the APPG for Drug Policy Reform for their work and that they have no commercial interests in cannabis or cannabis products.  The report includes good discussions of the evidence – or lack thereof – for long-term negative effects often ascribed to marijuana use: psychotic disorders, dependence, respiratory system cancer, cognition, amotivational syndrome, and decreased brain volume.

Cannabis in Pain Treatment: Clinical and Research Considerations
Savage SR, Romero-Sandoval A, Schatman M, Wallace M, Fanciullo G, McCarberg B, Ware M. J Pain 2016;17:654-668. 
Though there is some focus on pain, most of this article is relevant to all therapeutic use of cannabis products.  It includes sections on risks, regulatory and professional considerations, research constraints, and responsible incorporation of medical cannabis into clinical practice.

Medical Board Expectations for Physicians Recommending Marijuana
Chaudhry HJ, Hengerer AS, Snyder GB. JAMA 2016;316:577-578. 
This two page opinion piece from the Federation of State Medical Boards summarizes 10 recommendations about marijuana for patient care.  The content for the ten recommendations is a slightly condensed version of nine recommendations in a report referenced in the article, “Model Guidelines for the Recommendation of Marijuana in Patient Care” plus a recommendation that physicians be advised to abstain from the use of marijuana for medical or recreational purposes while actively engaged in the practice of medicine, and that practicing medicine under the influence of marijuana may constitute unprofessional conduct or incompetence. Both the article and the report are meant as policy recommendations for state medical boards.

 

Updated Friday, May 29, 2020 at 04:42PM