Article

Medical Cannabis Effective for Chronic Pain, Other Indications

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Abstract

According to this study: Moderate-quality evidence supports the use of cannabinoids for the treatment of chronic pain and for the spasticity related to multiple sclerosis. Low-quality evidence suggests that cannabinoids may be effective for chemotherapy-induced nausea and vomiting and other indications.

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Objective: Changes to national and some state’s policy on the cultivation and prescription of cannabis for medicinal purposes will soon directly impact Australian medical practitioners. We investigate differences in demographics, use patterns and the perceptions held by individuals who use cannabis for medicinal or recreational purposes and non-users. Method: Online survey advertised on the newsfeed of Australian Facebook users aged 18 years or over between March and May of 2016. A total sample of 1578 completed the survey, 199 (12.61%) were non- cannabis users, 489 (31.99%) were recreational-only users, 82 (5.20%) were medicinal-only users, and 808 (51.20%) used both recreationally and medicinally. Detailed questions regarded demographics, health, substance use, and knowledge and perceptions of medicinal cannabis use and policy in Australia. Results: The sample most commonly perceived cannabis to effectively treat pain and mental health conditions. Most medicinal users also reported frequently smoking cannabis for non-medicinal purposes. Overall, participant knowledge did not accurately reflect the current evidence base for medicinal cannabis. Differences by cannabis use motivation are discussed. Conclusions: This survey highlights important differences between non-users and current medicinal and non-medicinal cannabis users in demographics, patterns of cannabis use and regarding knowledge and perceptions of medicinal cannabis. The mismatch between the state of evidence to inform safe and effective clinical practice and beliefs of medicinal cannabis users must be addressed and may negatively impact clinical rapport and patient outcomes.
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Full-text available
Cannabis and cannabinoid drugs are widely used to treat disease or alleviate symptoms, but their efficacy for specific indications is not clear. To conduct a systematic review of the benefits and adverse events (AEs) of cannabinoids. Twenty-eight databases from inception to April 2015. 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. Study quality was assessed using the Cochrane risk of bias tool. All review stages were conducted independently by 2 reviewers. Where possible, data were pooled using random-effects meta-analysis. Patient-relevant/disease-specific outcomes, activities of daily living, quality of life, global impression of change, and AEs. A total of 79 trials (6462 participants) were included; 4 were judged at low risk of bias. Most trials showed improvement in symptoms associated with cannabinoids but these associations did not reach statistical significance in all trials. Compared with placebo, cannabinoids were associated with a greater average number of patients showing a complete nausea and vomiting response (47% vs 20%; odds ratio [OR], 3.82 [95% CI, 1.55-9.42]; 3 trials), reduction in pain (37% vs 31%; OR, 1.41 [95% CI, 0.99-2.00]; 8 trials), a greater average reduction in numerical rating scale pain assessment (on a 0-10-point scale; weighted mean difference [WMD], -0.46 [95% CI, -0.80 to -0.11]; 6 trials), and average reduction in the Ashworth spasticity scale (WMD, -0.36 [95% CI, -0.69 to -0.05]; 7 trials). There was an increased risk of short-term AEs with cannabinoids, including serious AEs. Common AEs included dizziness, dry mouth, nausea, fatigue, somnolence, euphoria, vomiting, disorientation, drowsiness, confusion, loss of balance, and hallucination. There was moderate-quality evidence to support the use of cannabinoids for the treatment of chronic pain and spasticity. There was low-quality evidence suggesting that cannabinoids were associated with improvements in nausea and vomiting due to chemotherapy, weight gain in HIV infection, sleep disorders, and Tourette syndrome. Cannabinoids were associated with an increased risk of short-term AEs.