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Uso medicinal de cannabis: una revisión de la evidencia

Authors:
  • Cuadernos de Neuropsicología

Abstract

Resumen Este estudio pretende reportar la evidencia actual sobre el uso medicinal de cannabis existente en la base de datos Scopus. Se llevó a cabo una revisión sistemática de las publicaciones científicas, entre el periodo 2013-2017, disponibles en Scopus sobre el uso medicinal de cannabis. Estados Unidos es el país con mayor cantidad de publicaciones, seguido de Canadá e Israel; existiendo un aumento progresivo y constante de la evidencia entre los años 2013 y 2017. Los contenidos de las publicaciones versan sobre efectos beneficiosos y adversos para la salud, consecuencias de la legislación del cannabis y su asociación con diversas variables. Existe una falta de estudios en uso medicinal de cannabis respecto a tratamientos y enfermedades, su estandarización, vías de administración y dosis, dando cuenta de la necesidad de un volumen mayor de investigaciones al respecto.
TERAPIA PSICOLÓGICA
2019, Vol. 37, Nº 2, 166–180
Copyright 2019 by Sociedad Chilena de Psicología Clínica
ISSN 0716-6184 (impresa) · ISSN 0718-4808 (en línea)
Uso medicinal de cannabis: una revisión de la evidencia
Medicinal use of cannabis: a review of the evidence
Claudio Rojas-Jara
Roberto Polanco-Carrasco
Alejandra Cisterna
Vanesa Hernández
Fernanda Miranda
Andrea Moreno
Luis Alarcón
Universidad Católica del Maule, Chile
Rec (29 de enero de 2019) Acept (29 de abril de 2019)
Resumen
Este estudio pretende reportar la evidencia actual sobre el uso medicinal de cannabis existente en la base

2013–2017, disponibles en Scopus sobre el uso medicinal de cannabis. Estados Unidos es el país con mayor
cantidad de publicaciones, seguido de Canadá e Israel; existiendo un aumento progresivo y constante de la

y adversos para la salud, consecuencias de la legislación del cannabis y su asociación con diversas variables.
Existe una falta de estudios en uso medicinal de cannabis respecto a tratamientos y enfermedades, su
estandarización, vías de administración y dosis, dando cuenta de la necesidad de un volumen mayor de
investigaciones al respecto.
Palabras clave: Cannabis; Marihuana; Marijuana; Uso medicinal; Uso terapéutico.
Abstract
This study aims to report the current evidence on the medicinal use of cannabis in the Scopus database. A

in Scopus on the medicinal use of cannabis. The United States is the country with the most publications,
followed by Canada and Israel; there is a progressive and constant increase in the evidence between 2013 and

of cannabis legislation and its association with various variables. There is a lack of studies on the medicinal
use of cannabis in relation to treatments and diseases, its standardization, administration routes and doses,
giving account of the need for a greater volume of research in this regard.
Keywords: Cannabis; Marihuana; Marijuana; Medicinal use; Therapeutic use.
Correspondencia: Roberto Polanco-Carrasco, Revista Cuadernos de Neuropsicología Panamerican Journal of Neuropsychology,
Valparaíso 396, Rancagua (Chile). E-mail: polanco.roberto@gmail.com
Claudio Rojas-Jara, Roberto Polanco-Carrasco, Alejandra Cisterna, Vanesa
Hernández, Fernanda Miranda, Andrea Moreno y Luis Alarcón
167
TERAPIA PSICOLÓGICA 2019, Vol. 37, Nº 2, 166–180
Introducción

, por sus siglas en inglés) el cannabis es la droga más consumida con alrededor de 192 millones


cannabis medicinal en diversas jurisdicciones de los Estados Unidos (, 2018).
El uso medicinal de cannabis (en adelante  
de esta planta (o sus derivados) con el objetivo de aliviar síntomas, tratar un estado o una condición médica


 tendría para la salud, provocando una serie de procesos políticos, legislativos y judiciales


En la actualidad el UMC —pese a las divergencias propias en el tema— aparece como una opción en dife-




El objetivo del presente estudio consiste en reportar la evidencia actual sobre el  existente en Scopus,
entre los años 2013 y 2017, incluyendo diferentes tipos de publicaciones. Esta base de datos comprensiva es
-




obedecer a características de tradición y cultura académica donde las métricas de citación son usadas, de manera
incorrecta pero comúnmente aceptada, como parámetro para elegir donde someter un artículo de investigación
(Polanco-Carrasco, 2016).
Método
Esta revisión sistemática se orienta bajo el método 
      
     

    
      



-
sión y exclusión, (3) extracción de datos de los estudios, y (4) análisis crítico de la información de acuerdo a la
calidad de la evidencia (ver Figura 1). El análisis del contenido de las publicaciones se llevó a cabo por medio
de una síntesis de las ideas y conclusiones relevantes en cada una de ellas, estableciendo categorías temáticas
para facilitar la organización de la información obtenida.
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Figura 1
Fuente: Elaboración propia.
Publicaciones de UMC: análisis cuantitativo
   (ver Tabla 1):
 

    por país, mostrando una mayor
cantidad en los Estados Unidos con 113 publicaciones, seguido por Canadá e Israel con 30 y 12 publicaciones
 ha ido



Claudio Rojas-Jara, Roberto Polanco-Carrasco, Alejandra Cisterna, Vanesa
Hernández, Fernanda Miranda, Andrea Moreno y Luis Alarcón
169
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Tabla 1. Número de publicaciones según tipo.
Tipo de publicación N
Artículo de investigación 112
 47
Capítulos de libro 14
Notas 10
Editoriales
Cartas 1
Artículos de prensa 1
Total 190
Fuente: Elaboración propia
Tabla 2. Número de publicaciones por país.
País Artículos de
investigación
Artículos de
 Cartas Editoriales Artículos
de prensa Notas Cap. de
libro Total
EE.UU. 74 31 2 1 3 2 113
Canadá 11 4 1 1 8 30
Israel 9 1 2 12
Australia 6 1 1 8
UK 2 1 1 4
Alemania 1 2 3
España 2 2
Irlanda 2 2
Noruega 1 1 2
Sudáfrica 1 1 2
Argentina 1 1
Brasil 1 1
Chile 1 1
Francia 1 1
Holanda 1 1
Italia 1 1
Polonia 1 1
Suiza 1 1
NN 2 1 1 4
Total 190
Fuente: Elaboración propia.
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Tabla 3. Publicaciones por año.
Año N
2013 27
2014 
 30
2016 
2017 63
Total 190
Fuente: Elaboración propia.
Publicaciones de UMC: análisis cualitativo

su organización y síntesis se entrega a continuación los principales hallazgos.
UMC y prescripción
 -


medicinal, como tampoco para responder preguntas sobre el . La gran mayoría de los residentes y becarios
     



cuidado al recomendar el 

para acceder al  (Belle-Isle et al., 2014).
Los farmacéuticos de Minnesota se auto-reportan con conocimiento limitado de las políticas y regulacio-
nes de   
       
Arneson, 2016).

vía de administración y el control del 
UMC y usuarios

cannabis medicinal es utilizado por igual en muchos grupos de personas y no exclusivamente en ningún grupo
-

     

et al., 2017); c) tres de cada cuatro pacientes informaron una mejoría sintomática (Radke, Mokhtarzadeh, Lee,

estrechamente relacionados con el dolor (Cranford et al., 2017); y e) los usuarios solicitan estándares mejorados
de pureza, producción y una mayor investigación sobre  (Braun et al., 2017).
Claudio Rojas-Jara, Roberto Polanco-Carrasco, Alejandra Cisterna, Vanesa
Hernández, Fernanda Miranda, Andrea Moreno y Luis Alarcón
171
TERAPIA PSICOLÓGICA 2019, Vol. 37, Nº 2, 166–180
Benecios del UMC
El 
antigüedad (Aggarwal et al., 2014). Sin embargo, durante la última década se ha convertido en un tema de cre-






    
    

El manejo del dolor es la razón más común para el  (Khaiser et al. 2017). Investigaciones reportan efectos
terapéuticos positivos en el dolor neuropático refractario junto con los analgésicos tradicionales (Crowell, 2017;
-


Además, actuaría positivamente en la terapia para los trastornos espásticos musculares (Radke, Mokhtarzadeh,

    -
    
      

prolongadas con múltiples efectos adversos, como paliativo del dolor en el cáncer avanzado y para las molestias
 -


Otras investigaciones le otorgan utilidad para el alivio de la ansiedad y el insomnio (Aggarwal et al., 2013;



     
sugieren agregarlo a la farmacoterapia de los pacientes con Alzheimer como una opción de tratamiento (Shelef
), uno de los componentes del
cannabis, para la epilepsia intratable en una población de niños y adolescentes resulta prometedor, existiendo

Efectos perjudiciales del UMC
    se asociaría con un riesgo de
  

 en pacientes con lesión de médula espinal crónica puede hacerlos más
vulnerables a complicaciones y a la aparición de factores de riesgo de trastornos por uso de sustancias, como el

   


-
judiciales del 
Uso medicinal de cannabis172
TERAPIA PSICOLÓGICA 2019, Vol. 37, Nº 2, 166–180
UMC y falta de evidencia
La información recopilada del 
vacíos importantes respecto con su evidencia. Particularmente se vuelve necesario contar con ensayos contro-


La medicina, como una ciencia basada en evidencia, ha estado abordando el tema del  con mucha cautela


 en diferentes enferme-
dades y tratamientos, siendo especialmente necesarios los ensayos clínicos en pacientes con: a) riesgo de tras-
torno por consumo de cannabis, b) tratamiento paliativo por cáncer, y c) síndrome del desgaste del  y otras
secuelas negativas del 
UMC, regulación y legalización del cannabis
El debate respeto a la regulación o legalización del 
implicaciones para los profesionales de la salud, los encargados de formular políticas públicas y la sociedad en

     
-



Numerosas publicaciones estudian la existencia de consecuencias de la regulación y legislación del cannabis,

de cannabis relacionado con el cambio de política (Choo et al., 2014), sin embargo, en Estados Unidos las leyes
médicas sobre el cannabis parecen haber contribuido a aumentar la prevalencia del consumo ilícito de cannabis
-

-


     





relación negativa entre la legalización y los suicidios entre los hombres jóvenes es consistente con la hipótesis de


alcohol entre las personas de 12 a 20 años, ni en el uso de otras sustancias psicoactivas en ninguno de los grupos

leyes de , el uso de cannabis aumentó después de la promulgación entre las personas de 26 años o más, no



Aún con múltiples procesos de regulación y legalización en curso del  persisten numerosos problemas

   

Claudio Rojas-Jara, Roberto Polanco-Carrasco, Alejandra Cisterna, Vanesa
Hernández, Fernanda Miranda, Andrea Moreno y Luis Alarcón
173
TERAPIA PSICOLÓGICA 2019, Vol. 37, Nº 2, 166–180

y regulaciones sobre el 

UMC y su asociación con el comportamiento delictivo
No hay evidencia sobre asociación entre la regulación legal del  con un alza en la prevalencia de delitos
-
ción del 

los delitos violentos en las áreas locales, pero se relaciona positivamente con el crimen en áreas espacialmente
adyacentes, es decir, el uso de la ley para reducir los dispensarios de cannabis medicinal en California parece
haber reducido la delincuencia en áreas residenciales cercanas, pero no en los lugares donde están estableci-
 
     

áreas contiguas a él.
UMC y cultivo
La producción y el consumo de cannabis para el tratamiento de afecciones médicas es cada vez más visible a
nivel internacional, sin embargo, la investigación sobre diferentes aspectos del fenómeno es aún escasa. Un

-
    
en aumento, estos no necesariamente cuentan con el debido asesoramiento y la orientación médica adecuada



consecuencias adversas del cultivo y uso de cannabis en entornos domésticos (Fischer et al., 2017).
UMC y los dispensarios
  
        1 se
-
ban dispensarios eran mayores, tenían más probabilidades de tener artritis y  y menos probabilidades


más probabilidades de tener autorización legal para el 



     -
     
Freisthler, 2016).
 
Uso medicinal de cannabis174
TERAPIA PSICOLÓGICA 2019, Vol. 37, Nº 2, 166–180
UMC en infancia y adolescencia
 en la infancia son más bien escasos, eviden-
     

     
efectos en el desarrollo (Rieder, 2016).

un consumo problemático posterior a un 
tasas de consumo problemático de cannabis fueron mayores entre los usuarios jóvenes en comparación con los
adultos de mediana edad y adultos mayores (Haug et al., 2017).


   
 podrían
      
recreativo del cannabis ( 

 no han visto aumentar
explosivamente el consumo de cannabis en los primeros años después de su promulgación. Los resultados a lar-



 en la adolescencia


a problemas escolares, de relación y de trabajo, así como a accidentes automovilísticos. Además, no todos los
pacientes adolescentes responden de la misma manera al  (Compton et al., 2017; Friedberg, 2017).
Asociación del UMC con otras drogas
Los datos encontrados en esta revisión sobre -





Reeve, 2017); b) los usuarios de medicamentos recetados para el dolor ( por
encima de los  e indicaron un fuerte deseo de reducir el consumo de estos últimos (Perron, Bohnert, Perone,
 y
sobre todo las menos restrictivas, se asocian con menores probabilidades de consumo de alcohol en adolescentes
 puede ser un
sustituto válido, seguro y efectivo de la heroína, el alcohol y el tabaco, como también de algunos medicamentos

 puede desempeñar un rol
importante de reducción de daños en el contexto del uso problemático de sustancias y puede tener implicaciones

Claudio Rojas-Jara, Roberto Polanco-Carrasco, Alejandra Cisterna, Vanesa
Hernández, Fernanda Miranda, Andrea Moreno y Luis Alarcón

TERAPIA PSICOLÓGICA 2019, Vol. 37, Nº 2, 166–180
Discusión y conclusiones
La revisión realizada en Scopus proporcionó un banco de información de 190 publicaciones, de las cuales 112

en prensa.
     son: Estados Unidos con 113
publicaciones, Canadá con 30 e Israel con 12. En cuanto a los artículos de investigación Estados Unidos ma-

      
     
publicada en Canadá. En la categoría de editoriales Estados Unidos lidera las publicaciones, siendo además el



e Israel con 2 publicaciones cada uno.
 sugieren un aumento


La imagen del cannabis se ubica dentro de las drogas de abuso y la más consumida a nivel mundial. Esta
. Sin
embargo, la publicidad también provoca un efecto de disminución en la percepción de los riesgos asociados
al -
 
proporcionar. En ese sentido, es importante generar una división explícita para el análisis del  y el .
Según la evidencia revisada, los hallazgos de un sistema endocannabinoide aceleraron el interés biológico
por conocer el rol medicinal del cannabis en el funcionamiento humano. Sin embargo, existe una necesidad
-
tivos respecto al . La prescripción, regulación de dosis y administración efectiva necesitan estandarizacio-
 en diferentes
enfermedades y tratamientos, como de su aplicación en distintas etapas del ciclo vital.
Como toda medicación se debe sopesar las ventajas de su consumo en relación a los efectos adversos. La evi-
-

fármaco. Para considerar si su empleo y distribución es adecuado, es de suma importancia la actualización de
 en las diferentes afecciones médicas.

, principalmente, para el alivio general del dolor crónico. Además, sus efectos serían positivos como palia-

trastornos espásticos musculares, el dolor neuropático refractario, para la ansiedad, el insomnio y la epilepsia.
   reduce los síntomas del trastorno de estrés postraumático en algunos

hiperactividad, y para los dolores reumáticos. Otro hallazgo radica en la sustitución de múltiples sustancias
por  como medicamentos recetados, opioides, antidepresivos, benzodiacepinas, alcohol, tabaco y drogas

reducción de daños.

se trasforme luego en un consumo problemático de cannabis u otras sustancias. Sin embargo, la información
recopilada sobre el 
 con una elevación de
los niveles de  por parte de la población. Tampoco la evidencia es concluyente en una asociación del 
y su regulación con el aumento de comportamientos delictivos.
Uso medicinal de cannabis176
TERAPIA PSICOLÓGICA 2019, Vol. 37, Nº 2, 166–180
Con respecto al 

-
tigación sobre el 

El , como su estudio y análisis, debiese ser un objetivo prioritario en la discusión de los profesionales de
la salud, necesitando diferenciar el debate con respecto al 


     en diferentes
enfermedades, tratamientos y rangos etarios, siendo especialmente necesario para ello el diseño de ensayos


plantea el desafío de ampliar y contrastar estos resultados al incorporar otras bases de datos. También se sugiere


Referencias
  Políticas y p rácticas sobre ca nnabis medicinal en el mundo   
     
surgical syndrome: a viable option for pain control or an uncontrolled narcotic? PM&R, 6
 
series of patients usi ng medical cann abis. Journal of Ner vous and Mental Di sease, 201     
 Gastroenterology and Hepatolog y, 12, 668 -67 9.
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   
for neurologic disorders. Neurolog y: Clinical Practice, 5
 
health and why should we better understand their impacts? Preventive Medicine Reports, 2        
  
from Canada. The International Journal on Drug Policy, 26
    
guideli nes: a comprehensive update of evidence and recom mendations. American Journal of Public Health, 107  
AJP H.2 017. 303818
Journal of
Rheumatolog y, 42
 
and crime in an era of changing marijuana legislation. Journal of Primary Pre vention, 38    
 
and crime in Long Beach, California. Ad dic tio n, 111
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
learnt. International Journal of Drug Policy, 42
 
program. Journal of Psychoactive Dr ugs, 46

marijuana policies in relation to suicide risk. Drug and Alcohol Dependence, 152
 
 Inter national Journ al of Drug Policy, 26   

 
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-
order, and medical marijuana laws: 1991-1992 to 2012-2013. JAMA Psychiatry, 74
-
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   
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     Drug and Alcohol
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 
for intractable pediatric epilepsy: the current israeli experience. S eizure, 35 
World drug report 2018. Viena: United Nations Publications.

pain patients: a preliminary cohort study. PLoS ONE, 12
 
a single institution experience. Journal of Pain and Symptom Management , 49 
 
characteristics, access, and reasons for use. International Journal of Dr ug Policy, 24
JAMA Pediatrics, 167, 630 –633.
     
  Hawai’i Journal of Medicine & Public Health: A
Journal of Asia Pacic Medicine & Public Health, 73, 109 –111.
 
alcohol, and other substances. Jour nal of Health Economics, 42
... To accomplish this objective, we performed a systematic review of scientific publications available on Scopus over a period of five years (2014)(2015)(2016)(2017)(2018). This database has the largest coverage within the scientific world, with more than 24,600 titles from 5,000 international publishers and 16 million author profiles, of diverse topics and disciplines, which makes it a valid and reliable source of evidence on this subject (Ferrer & Delgado, 2018;Polanco-Carrasco, 2016;Rojas-Jara et al., 2019). ...
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... A literatura tem demonstrado que o uso de canabinoides tem apresentado importantes benefícios no tratamento de diversas doenças, em especial no alívio da dor crônica, na redução de sintomas de déficit de atenção, hiperatividade e transtorno pós-traumático, tendo se mostrado como um possível substituto para os tratamentos tradicionais que utilizam opioides, antidepressivos e benzodiazepínicos (Rojas -Raras et al., 2019). ...
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Resumo O câncer de mama é considerado o câncer mais incidente em mulheres no mundo. Evidências tem mostrado que os canabinoides podem modular vias de sinalização responsáveis pelo crescimento e para a propagação do câncer. Dessa forma, a presente revisão da literatura buscou sumarizar as evidências existentes até então, acerca do uso da cannabis para o tratamento do câncer de mama. A coleta de dados foi realizada no período de maio a junho de 2021, na base de dados eletrônica PubMed. Foram incluídos artigos desde sua origem até 01 de junho de 2021, com a combinação dos seguintes descritores: ((Cannabidiol OR cannabis) AND "breast neoplasms"). Os resultados demonstraram a escassez de estudos que buscaram avaliar os efeitos da cannabis medicinais no tratamento do câncer de mama em humanos. Como conclusão, o estudo permitiu compreender a importância que a cannabis medicinal, em especial, o cannabidiol, vem fornecendo para os avanços no tratamento antineoplásico em células in vitro. Palavras-chave: Cannabis; Cannabidiol; Câncer de mama; Tratamento antineoplásico. Abstract Breast cancer is considered the most incident cancer in women worldwide. Evidence has shown that cannabinoids can modulate signaling pathways responsible for cancer growth and spread. Thus, this literature review sought to summarize the evidence that existed so far on the use of cannabis for the treatment of breast cancer. Data collection was carried out from May to June 2021, in the electronic database PubMed. Articles from their origin to June 1, 2021 were included, with the combination of the following descriptors: ((Cannabidiol OR cannabis) AND "breast neoplasms"). The results demonstrated the paucity of studies that sought to assess the effects of medicinal cannabis in the treatment of breast cancer in humans. In conclusion, the study allowed us to understand the importance that medicinal cannabis, in particular cannabidiol, has been providing for advances in anticancer treatment in cells in vitro. Resumen El cáncer de mama se considera el cáncer más común en mujeres en todo el mundo. La evidencia ha demostrado que los cannabinoides pueden modular las vías de señalización responsables del crecimiento y la propagación del cáncer.
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To date, 16 states have passed medical marijuana laws, yet very little is known about their effects. Using state-level data, we examine the relationship between medical marijuana laws and a variety of outcomes. Legalization of medical marijuana is associated with increased use of marijuana among adults, but not among minors. In addition, legalization is associated with a nearly 9 percent decrease in traffic fatalities, most likely to due to its impact on alcohol consumption. Our estimates provide strong evidence that marijuana and alcohol are substitutes.
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In the last few years, great expectations have risen in the society concerning the eventual therapeutic usefulness of compounds derived from the cannabis plant. It is well known that these compounds are being used in treating certain health conditions, either through medical prescription or self-administration. Extreme opinions range from believing that it is a harmful and dangerous drug to sustaining that it is a panacea. However, the sheer existence of an endocannabinoid system in the brain compels us to study its dimensions and derivations thoroughly. It is expected that controversies and knowledge gaps will be clarified within the framework of this new law. Prohibitionism should not be a category of analysis. Regardless of the therapeutic effects of cannabinoid compounds, demonstrated or to be demonstrated, there are already severe restrictions on their use, which mirror the still existing restrictions to the use of opioids (drugs of definite utility but on which a huge taboo persists). This review presents the first Argentine law on the medical use of cannabis. Milestones in the history of marijuana at the national level are pointed out, which are inextricably linked to world trends either in favor or against prohibition. The current status of the use of cannabis oil in the country and evidences for its therapeutic value are also analyzed. Evidences on its therapeutic value are also analyzed as well as the current status of the use of cannabis oil in our country.
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A systematic review was carried out with the objective of learning about PTSD measures, paying special attention to malingering. Firstly, 338 abstracts from empirical papers were selected and analyzed, and then 129 articles were selected by means of ad hoc categories that had been previously constructed. Apart from empirical papers using PTSD measures, we found papers devoted to psychometric validation of PTSD instruments, testing of factor models and neural correlates. PTSD measures were coded according type to of instrument (detection and assessment of PTSD and simulation), psychometric tests concerning cognitive functions, psychometric tests for the detection of comorbidity and neural correlates. Results indicate that many of the instruments for assessing PTSD consist of self-reports and clinical interviews, which facilitates malingering. Key Words: malingering; neuropsychological assessment, PTSD; systematic review; testing
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Background: Current levels and dangers of opioid use in the U.S. warrant the investigation of harm-reducing treatment alternatives. Purpose: A preliminary, historical, cohort study was used to examine the association between enrollment in the New Mexico Medical Cannabis Program (MCP) and opioid prescription use. Methods: Thirty-seven habitual opioid using, chronic pain patients (mean age = 54 years; 54% male; 86% chronic back pain) enrolled in the MCP between 4/1/2010 and 10/3/2015 were compared to 29 non-enrolled patients (mean age = 60 years; 69% male; 100% chronic back pain). We used Prescription Monitoring Program opioid records over a 21 month period (first three months prior to enrollment for the MCP patients) to measure cessation (defined as the absence of opioid prescriptions activity during the last three months of observation) and reduction (calculated in average daily intravenous [IV] morphine dosages). MCP patient-reported benefits and side effects of using cannabis one year after enrollment were also collected. Results: By the end of the 21 month observation period, MCP enrollment was associated with 17.27 higher age- and gender-adjusted odds of ceasing opioid prescriptions (CI 1.89 to 157.36, p = 0.012), 5.12 higher odds of reducing daily prescription opioid dosages (CI 1.56 to 16.88, p = 0.007), and a 47 percentage point reduction in daily opioid dosages relative to a mean change of positive 10.4 percentage points in the comparison group (CI -90.68 to -3.59, p = 0.034). The monthly trend in opioid prescriptions over time was negative among MCP patients (-0.64mg IV morphine, CI -1.10 to -0.18, p = 0.008), but not statistically different from zero in the comparison group (0.18mg IV morphine, CI -0.02 to 0.39, p = 0.081). Survey responses indicated improvements in pain reduction, quality of life, social life, activity levels, and concentration, and few side effects from using cannabis one year after enrollment in the MCP (ps<0.001). Conclusions: The clinically and statistically significant evidence of an association between MCP enrollment and opioid prescription cessation and reductions and improved quality of life warrants further investigations on cannabis as a potential alternative to prescription opioids for treating chronic pain.
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p> OBJECTIVE: To investigate the prevalence of therapeutic cannabis use within a general population sample of adults and to describe various characteristics associated with use. METHODS: Data were derived from the 2013 and 2014 CAMH Monitor Survey of adults in Ontario, Canada. This repeated cross-sectional survey employed a regionally stratified design and utilized computer-assisted telephone interviewing. Analyses were based on 401 respondents who reported using cannabis. RESULTS: The data indicated that 28.8% of those who used cannabis in the past year self-reported using cannabis for therapeutic purposes. Of therapeutic users, 15.2% reported having medical approval to use cannabis for therapeutic purposes. Cannabis use for therapeutic purposes was associated with more frequent use of cannabis, a moderate to high risk of problematic cannabis use, and a greater likelihood of using prescription opioids for medical purposes. There was little difference in cannabis use for therapeutic purposes according to sex, age, and marital status after adjusting for opioid use and problematic cannabis use. CONCLUSION: Findings suggest some potential negative consequences of cannabis use for therapeutic purposes; however, further research is needed to better understand the range and patterns of use and their corresponding vulnerabilities.</p
Book
Medical cannabis is emerging as an effective treatment option for the management of a variety of common chronic conditions and symptoms, but a lack of scientific evidence demonstrating its efficacy for treating specific indications is hindering the widespread clinical adoption of medical cannabis. Between January 2015 and December 2016, patients who were prescribed medical cannabis in Canada from a single licensed medical cannabis provider were invited to complete an online survey approximately 15-25 minutes in length that assessed baseline demographics. Patients who completed the baseline survey were subsequently invited to complete follow-up surveys at 4 months and 10 months after the completion of the initial survey. The results are described in this book, and the authors hope the information will further facilitate the use of medical cannabis for the benefit of various populations in need.
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Objective: The Public Health Program at Stockton University partnered with the Compassionate Care Foundation to ascertain the impact of medical marijuana on patients in New Jersey. Methods: Patients volunteered to complete a survey once a month for 8 months. The survey explored their use, form, and strain of medical marijuana and its influence on pain and 12 other physical and mental health variables. Also, an increase or decrease in other medication taken and any unexpected outcomes were recorded. Results: From a total of 955 patients, patients responding to the surveys varied from 501 for visit 1, 290 for visit 2, to 179 for visit 3. Results provide insight into the diagnoses for which patients used medical marijuana. Results indicate increased mood, general overall condition, and energy as the highest consequences; level of pain in the middle range; and most frequent usage as 3 to 4 times a day. Repeated measures done after visit 2 showed eight statistically significant differences for patients after using medical marijuana: an increase in general quality of life, mobility, and mood, with a decrease in inflammation, intraocular pressure, spasms, seizures, and pain. Results after visit 3 indicated seven significant differences compared to visit 1: decreased seizures, intraocular pressure, spasms, nausea, and pain, along with increased energy and mobility. No differences were found by patient diagnosis or age, but sex-related differences occurred in inflammation, mood, and energy. Conclusion: Results support positive therapeutic benefits of medical marijuana, and despite methodological limitations, our study contributes to the growing body of literature.
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In states that have passed medical marijuana laws (MMLs), marijuana use (MU) increased after MML enactment among people ages 26 and older, but not among ages 12–25. We examined whether the age-specific impact of MMLs on MU varied by gender. Data were obtained from the 2004–2013 restricted-use National Survey on Drug Use and Health, aggregated at the state level. The exposure was a time-varying indicator of state-level MML (0 = No Law, 1 = Before Law, 2 = After Law). Outcomes included past-month MU prevalence, daily MU prevalence among past-year users (i.e., 300+ days/year), and past-year marijuana use disorder (MUD) prevalence. Linear models tested the state-level MML effect on outcomes by age (12–17, 18–25, 26+) and gender. Models included a state-level random intercept and controlled for time- and state-level covariates. Past-month MU did not increase after enactment of MML in men or women ages 12–25. Among people 26+, past-month MU increased for men from 7.0% before to 8.7% after enactment (+ 1.7%, p < 0.001) and for women from 3.1% before to 4.3% after enactment (+ 1.1%, p = 0.013). Among users 26+, daily MU also increased after enactment in both genders (men 16.3 to 19.1%, + 2.8%, p = 0.014; women 9.2 to 12.7%, + 3.4%, p = 0.003). There were no statistically significant increases in past-year MUD prevalence for any age or gender group after MML enactment. Given the statistically significant increase in daily use among past-year users aged 26+ following enactment, education campaigns should focus on informing the public of the risks associated with regular marijuana use.
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Background: The use of medical cannabis (MC) is controversial. Support for its benefits is based on small clinical series. Objective: The aim of this study was to report the results of a standardized interview study that retrospectively assessed the effects of MC on symptoms of Parkinson disease (PD) and its adverse effects in patients treated for at least 3 months. Methods: The survey used telephone interviews using a structured questionnaire based on subjective global impressions of change for various parkinsonian symptoms and yes/no questions on adverse effects. Results: Forty-seven nondemented patients with PD (40 men) participated. Their mean age was 64.2 ± 10.8 years, mean disease duration was 10.8 ± 8.3 years, median Hoehn and Yahr (H&Y) was stage III. The duration of MC use was 19.1 ± 17.0 months, and the mean daily dose was 0.9 ± 0.5 g. The delivery of MC was mainly by smoking cigarettes (38 cases, 80.9%). Effect size (r) improvement for falls was 0.89, 0.73 for pain relief, 0.64 for depression, 0.64 for tremor, 0.62 for muscle stiffness, and 0.60 for sleep. The most frequently reported adverse effects from MC were cough (34.9%) in those who used MC by smoking and confusion and hallucinations (reported by 17% each) causing 5 patients (10.6%) to stop treatment. Conclusions: Medical cannabis was found to improve symptoms of PD in the initial stages of treatment and did not cause major adverse effects in this pilot, 2-center, retrospective survey. The extent of use and the reported effects lend support to further development of safer and more effective drugs derived from Cannabis sativa.