medical marijuana

Importance: Approximately 27% of adults in the US and Canada report having ever used cannabis for medical purposes. An estimated 10.5% of the US population reports using cannabidiol (CBD), a chemical compound extracted from cannabis that does not have psychoactive effects, for therapeutic purposes.

Observations: Conditions for which cannabinoids have approval from the US Food and Drug Administration include HIV/AIDS-related anorexia, chemotherapy-induced nausea and vomiting, and certain pediatric seizure disorders. A meta-analysis of randomized clinical trials reported a small but significant reduction in nausea and vomiting from various causes (eg, chemotherapy, cancer) when comparing prescribed cannabinoids (eg, dronabinol, nabilone) with placebo or active comparators (eg, alizapride, chlorpromazine; standardized mean difference [SMD], -0.29 [95% CI, -0.39 to -0.18]). A meta-analysis of randomized clinical trials among patients with HIV/AIDS reported that cannabinoids had a moderate effect on increasing body weight compared with placebo (SMD, 0.57 [95% CI, 0.22 to 0.92]). Evidence-based guidelines do not recommend the use of inhaled or high-potency cannabis (≥10% or 10 mg Δ9-tetrahydrocannabinol [Δ9-THC]) for medical purposes. High-potency cannabis compared with low-potency cannabis use is associated with increased risk of psychotic symptoms (12.4% vs 7.1%) and generalized anxiety disorder (19.1% vs 11.6%). A meta-analysis of observational studies reported that 29% of individuals who used cannabis for medical purposes met criteria for cannabis use disorder. Daily inhaled cannabis use compared with nondaily use was associated with an increased risk of coronary heart disease (2.0% vs 0.9%), myocardial infarction (1.7% vs 1.3%), and stroke (2.6% vs 1.0%). Evidence from randomized clinical trials does not support the use of cannabis or cannabinoids for most conditions for which it is promoted, such as acute pain and insomnia. Before considering cannabis or cannabinoids for medical use, clinicians should consult applicable institutional, state, and national regulations; evaluate for drug-drug interactions; and assess for contraindications (eg, pregnancy) or conditions in which risks likely outweigh benefits (eg, schizophrenia or ischemic heart disease). For patients using cannabis or cannabinoids for treatment of medical conditions, clinicians should discuss harm reduction strategies, including avoiding concurrent use with alcohol or other central nervous system depressants such as benzodiazepines, using the lowest effective dose, and avoiding use when driving or operating machinery.

Conclusions and relevance: Evidence is insufficient for the use of cannabis or cannabinoids for most medical indications. Clear guidance from clinicians is essential to support safe, evidence-based decision-making. Clinicians should weigh benefits against risks when engaging patients in informed discussions about cannabis or cannabinoid use.

Author/s:

Michael Hsu, Arya Shah, Ayana Jordan, Mark S Gold, Kevin P Hill

Review of systemic and syndromic complications of cannabis use: A review

Aubrey Delammermore — Mon, 19 Dec 2022 06:00:00 +0000

Date Added:

December 19, 2022

Journal/Publication:

Medicine

Publisher:

Wolters Kluwer Health

Publication Date:

December 9, 2022

Issue:

Volume:

101

Pages:

e32111

URL:

Review of systemic and syndromic complications of cannabis use: A review

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1097/MD.0000000000032111

Keywords

complications of cannabis use

MeSH

A review of some of the complications of cannabis abuse. James W. Mold, MD, MPH

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Purpose of review: Prescribed and non-prescribed cannabis use is common. Providers in specialties treating chronic pain – primary care, pain management, and neurology–will be coming across medical cannabis as a treatment for chronic pain, regardless of whether they are prescribers. It is important to be aware of the systemic and syndromic complications of acute and chronic cannabis use in the differential diagnosis of cardiac, cardiovascular, cerebrovascular, gastrointestinal, and psychiatric disorders.

Recent Findings: Medical cannabis is legal in 36 states. Studies have shown several potentially serious adverse effects associated with cannabis use.

Summary: Cannabis use has the potential to cause several complications that can be easily overlooked without a preexisting high index of suspicion.

Author/s:

Shah, J., Fermo, O.

Living Systematic Review on Cannabis and Other Plant-Based Treatments for Chronic Pain - Quarterly Progress Report: May 2021

Bethie Seay — Tue, 06 Jul 2021 05:00:00 +0000

Date Added:

July 6, 2021

Type:

Meta-analyses, Reviews, and Guidelines

MeSH

Health Services Research

delivery of health care

medical marijuana

Plant-based analgesics appear to have relatively low efficacy and high rates of adverse effects.

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This is the third quarterly progress report for an ongoing living systematic review on
cannabis and other plant-based treatments for chronic pain. The first progress report was
published in January 2021 and the second in March 2021. The draft systematic review was
available for public comment from May 19 through June 15, 2021, on the Agency for Healthcare
Research and Quality (AHRQ) Effective Health Care website. The systematic review synthesizes
evidence on the benefits and harms of plant-based compounds (PBCs), such as cannabinoids and
kratom, used to treat chronic pain, addressing concerns about severe adverse effects, abuse,
misuse, dependence, and addiction.
The purpose of this progress report is to describe the cumulative literature identified thus far.
This report will be periodically updated with new studies as they are published and identified,
culminating in an annual systematic review that provides a synthesis of the accumulated
evidence.

Author/s:

M. S., Wagner, J., Ahmed, A. Y., Morasco, B., Kansagara, D., Chou, R.

Medical Marijuana, Recreational Cannabis, and Cardiovascular Health A Scientific Statement From the American Heart Association

Brian Desmarais — Mon, 10 Aug 2020 18:46:49 +0000

Date Added:

August 10, 2020

Publisher:

American Heart Association

Publication Date:

August 5, 2020

URL:

Medical Marijuana, Recreational Cannabis, and Cardiovascular Health A Scientific Statement From the American Heart Association

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1161/CIR.0000000000000883.

MeSH

public health

AHA Scientific Statements

cannabinoids

cannabis

medical marijuana

A fairly extensive review of the possible benefits and harms of recreational marijuana, with an emphasis on cardiovascular effects. James W. Mold, MD, MPH

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Cannabis, or marijuana, has potential therapeutic and medicinal properties related to multiple compounds, particularly Δ-9- tetrahydrocannabinol and cannabidiol. Over the past 25 years, attitudes toward cannabis have evolved rapidly, with expanding legalization of medical and recreational use at the state level in the United States and recreational use nationally in Canada and Uruguay. As a result, the consumption of cannabis products is increasing considerably, particularly among youth. Our understanding of the safety and ef cacy of cannabis has been limited by decades of worldwide illegality and continues to be limited in the United States by the ongoing classi cation of cannabis as a Schedule 1 controlled substance. These shifts in cannabis use require clinicians to understand conflicting laws, health implications, and therapeutic possibilities. Cannabis may have therapeutic bene ts, but few are cardiovascular in nature. Conversely, many of the concerning health implications of cannabis include cardiovascular diseases, although they may be mediated by mechanisms of delivery. This statement critically reviews the use of medicinal and recreational cannabis from a clinical but also a policy and public health perspective by evaluating its safety and ef cacy pro le, particularly in relationship to cardiovascular health.

Author/s:

Page 2nd, R.L., Allen, L.A., Kloner, K.A., Rana, J.S., Piano, R.S., Morris, A.A., Martel, C.

Therapeutic use of cannabis and cannabinoids: an evidence mapping and appraisal of systematic reviews

John Bayhi — Mon, 03 Feb 2020 19:39:52 +0000

Date Added:

February 3, 2020

Journal/Publication:

BMC Complementary Medicine and Therapies

Publisher:

Springer Nature

Publication Date:

January 15, 2020

Issue:

Volume:

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1186/s12906-019-2803-2

Keywords

Another summary of what we know about the therapeutic effects of cannabinoids. The figures appear to be useful. James W. Mold, MD, MPH

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Background

Although cannabis and cannabinoids are widely used with therapeutic purposes, their claimed efficacy is highly controversial. For this reason, medical cannabis use is a broad field of research that is rapidly expanding. Our objectives are to identify, characterize, appraise, and organize the current available evidence surrounding therapeutic use of cannabis and cannabinoids, using evidence maps.

Methods

We searched PubMed, EMBASE, The Cochrane Library and CINAHL, to identify systematic reviews (SRs) published from their inception up to December 2017. Two authors assessed eligibility and extracted data independently. We assessed methodological quality of the included SRs using the AMSTAR tool. To illustrate the extent of use of medical cannabis, we organized the results according to identified PICO questions using bubble plots corresponding to different clinical scenarios.

Results

A total of 44 SRs published between 2001 and 2017 were included in this evidence mapping with data from 158 individual studies. We extracted 96 PICO questions in the following medical conditions: multiple sclerosis, movement disorders (e.g. Tourette Syndrome, Parkinson Disease), psychiatry conditions, Alzheimer disease, epilepsy, acute and chronic pain, cancer, neuropathic pain, symptoms related to cancer (e.g. emesis and anorexia related with chemotherapy), rheumatic disorders, HIV-related symptoms, glaucoma, and COPD. The evidence about these conditions is heterogeneous regarding the conclusions and the quality of the individual primary studies. The quality of the SRs was moderate to high according to AMSTAR scores.

Conclusions

Evidence on medical uses of cannabis is broad. However, due to methodological limitations, conclusions were weak in most of the assessed comparisons. Evidence mapping methodology is useful to perform an overview of available research, since it is possible to systematically describe the extent and distribution of evidence, and to organize scattered data.

Author/s:

Montero-Oleas, N, Arevalo-Rodriguez, I, Nunez-Gonzalez, S, Viteri-Garcia, A, Simancas-Racines, D

Clinicians’ Guide to Cannabidiol and Hemp Oils

Brian Desmarais — Wed, 11 Sep 2019 21:41:17 +0000

Date Added:

September 18, 2019

Journal/Publication:

Mayo Clinic Proceedings

Publisher:

Mayo Foundation for Medical Education and Research

Publication Date:

September 1, 2019

Issue:

Volume:

Pages:

1840-1851

URL:

Clinicians’ Guide to Cannabidiol and Hemp Oils

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1016/j.mayocp.2019.01.003

Keywords

cannabidoil

cannabis

PMID (1):

31447137

MeSH

This is a review of what is known about cannabidiol and other hemp-related oils from the Mayo Clinic. James W. Mold, MD, MPH

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Cannabidiol (CBD) oils are low tetrahydrocannabinol products derived from Cannabis sativa that have become very popular over the past few years. Patients report relief for a variety of conditions, particularly pain, without the intoxicating adverse effects of medical marijuana. In June 2018, the first CBD-based drug, Epidiolex, was approved by the US Food and Drug Administration for treatment of rare, severe epilepsy, further putting the spotlight on CBD and hemp oils. There is a growing body of preclinical and clinical evidence to support use of CBD oils for many conditions, suggesting its potential role as another option for treating challenging chronic pain or opioid addiction. Care must be taken when directing patients toward CBD products because there is little regulation, and studies have found inaccurate labeling of CBD and tetrahydrocannabinol quantities. This article provides an overview of the scientific work on cannabinoids, CBD, and hemp oil and the distinction between marijuana, hemp, and the different components of CBD and hemp oil products. We summarize the current legal status of CBD and hemp oils in the United States and provide a guide to identifying higher-quality products so that clinicians can advise their patients on the safest and most evidence-based formulations. This review is based on a PubMed search using the terms CBD, cannabidiol, hemp oil, and medical marijuana. Articles were screened for relevance, and those with the most up-to-date information were selected for inclusion.

Author/s:

VanDolah H.J., Bauer, B.A., Mauck, K.F.

Medical Marijuana for Treatment of Chronic Pain and Other Problems

Brian Desmarais — Mon, 19 Aug 2019 14:41:38 +0000

Date Added:

August 19, 2019

Journal/Publication:

JN Learning

Publisher:

The American Medical Association

Publication Date:

August 23, 2015

URL:

Medical Marijuana for Treatment of Chronic Pain and Other Problems

Type:

Clinical Decision Aids

Format:

Web Page

Keywords

MeSH

This is a 27 ½ min. audiotaped interview with an expert on the medical uses and adverse effects of marijuana. James W. Mold, MD, MPH

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Interview with Kevin P. Hill, MD, MHS, author of Medical Marijuana for Treatment of Chronic Pain and Other Medical and Psychiatric Problems: A Clinical Review, and Deepak Cyril D'Souza, MBBS, MD, author of Medical Marijuana: Is the Cart Before the Horse?

Cannabidiol (CBD) - What we know and what we don't

Jeffrey Wilson — Wed, 24 Apr 2019 15:32:45 +0000

Date Added:

April 24, 2019

Journal/Publication:

Harvard Health Blog

Publisher:

Harvard University

Publication Date:

August 24, 2018

URL:

Cannabidiol (CBD) - What we know and what we don't

Type:

Patient Education Materials

Format:

Web Page

Keywords

MeSH

sleep initiation and maintenance disorders

chronic pain

This patient-friendly review of what we currently know about CBD includes a warning that CBD oil reduces the metabolism of warfarin and other drugs metabolized by the CYP450 enzyme system (the same system affected by grapefruit juice) causing elevation of the INR and increased risk of bleeding. James W. Mold, MD, MPH

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Cannabidiol (CBD) has been recently covered in the media, and you may have even seen it as an add-in booster to your post-workout smoothie or morning coffee. What exactly is CBD? Why is it suddenly so popular?

Author/s:

Grinspoon, Peter

Medical Marijuana Overview: Patient Care Considerations for all Primary Care Physicians

Jeffrey Wilson — Tue, 19 Mar 2019 19:38:20 +0000

Date Added:

March 19, 2019

Publication Date:

March 13, 2019

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Slides

Keywords

MeSH

This GR presented by one of your primary care colleagues is a review of the current status of medical marijuana. James Mold, MD, MPH

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Objectives:

Recognize the difference between recommending and prescribing medication in regard to medical marijuana
Summarize components of the Oklahoma Medical Marijuana Rules and Regulations in regard to patient licensing and physician recommendations
Recognize that marijuana is still a Schedule I Controlled Dangerous Substance at the Federal level
Differentiate the pharmacology and toxicology of the cannabinoids THC and cannabidiol
Recognize potential drug-drug interactions of medical marijuana
Implement appropriate counseling of patients who are considering or currently using medical marijuana

Author/s:

Douglas, Chad

Lack of evidence for cannabis in adults with chronic neuropathic pain

Jeffrey Wilson — Tue, 04 Dec 2018 23:10:18 +0000

Date Added:

December 4, 2018

Journal/Publication:

Pearls

Issue:

597

Type:

Meta-analyses, Reviews, and Guidelines

Keywords

MeSH

There is so far no high quality evidence to support the use of cannabinoids for relief of chronic neuropathic pain.

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Bottom Line:

There was no high-quality evidence for the efficacy of any CBM (herbal cannabis, plant-derived tetrahydrocannabinol (THC) (dronabinol), synthetic THC (nabilone), plant-derived THC/cannabidiol (CBD) com bination) in any condition with chronic neuropathic pain. The studies were two to 26 weeks long and compared an oromucosal spray with a plant-derived combination of THC and CBD (10 studies), a synthetic cannabinoid mimicking THC (nabilone) (two studies), inhaled herbal cannabis (two studies) and plant-derived THC (dronabinol) (two studies) against placebo (15 studies) and an analgesic (dihydrocodeine) (one study). Herbal cannabis was not different from placebo in reducing pain and the number of people who dropped out due to side effects. Some adverse events (particularly somnolence or sedation, confusion, psychosis) might limit the clinical usefulness of cannabis-based medicines.

Author/s:

McAvoy, Brian R.

Oklahoma Medical Marijuana Authority: Rules, Risks, and Strategies

Jeffrey Wilson — Wed, 31 Oct 2018 15:11:34 +0000

Date Added:

October 31, 2018

Publisher:

Oklahoma Medical Marijuana Authority

Publication Date:

October 26, 2018

Type:

Meta-analyses, Reviews, and Guidelines, Public Health Announcements

Format:

Slides

Keywords

MeSH

Legislation, rules, and licensing pertaining to medical marijuana in Oklahoma.

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Overview

State Question 788
Oklahoma Medical Marijuana Authority
Emergency Rules Approved
Food Safety Standards Board
Contact Information

Author/s:

Bates, Tom

Don't Get Burned! Legal Issues Associated with Medical Marijuana

Jeffrey Wilson — Wed, 31 Oct 2018 14:57:07 +0000

Date Added:

October 31, 2018

Publisher:

Christensen Law Group

Type:

Meta-analyses, Reviews, and Guidelines, Public Health Announcements

Keywords

MeSH

Legal issues with prescription of medical marijuana.

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In Conclusion

Evaluate carefully whether recommending medical marijuana is something you want to do and the risks and requirements associated with it.
Prepare and use appropriate informed consent forms and treatment agreements.
Notify your medical liability insurance carrier.
Check with your employer or facilities at which you have privleges.

Author/s:

Loomis, Cori H.