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Chapter 32 - Cannabinoids as Medicines

What the Evidence Says and What It Does Not Say

from Part VIII - Special Topics

Published online by Cambridge University Press:  12 May 2023

By
Marco De Toffol ,
Elena Dragioti ,
Andre Ferrer Carvalho  and
Marco Solmi
Edited by
Deepak Cyril D'Souza ,
David Castle  and
Sir Robin Murray
Deepak Cyril D'Souza
Affiliation:
Staff Psychiatrist, VA Connecticut Healthcare System; Professor of Psychiatry, Yale University School of Medicine
David Castle
Affiliation:
University of Tasmania, Australia
Sir Robin Murray
Affiliation:
Honorary Consultant Psychiatrist, Psychosis Service at the South London and Maudsley NHS Trust; Professor of Psychiatric Research at the Institute of Psychiatry
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Summary

Cannabis and cannabinoids are widely used, both as recreational substances with potential for addiction, and as treatments for a number of disorders. A large body of literature has investigated the harmful and/or beneficial effects of cannabis and/or cannabinoids employing observational and interventional methodologies. These individual studies have been pooled in many meta-analyses. Further, Mendelian Randomization (MR) studies have reported on a causal association between cannabis use and certain outcomes. This chapter reviews existing meta-analyses that pooled observational and interventional studies, and MR studies reporting on health outcomes after exposure to cannabis and/or cannabinoids in the general population, and selected clinical populations. We show that evidence from observational, interventional, and MR studies point towards an association between cannabis and psychosis. Several additional detrimental effects of cannabis emerged, including other psychiatric symptoms, cognitive impairment, and risk of motor vehicle accident (MVA). In terms of therapeutic benefits, cannabidiol seems to be effective for certain types of epilepsy, notably in children. Also, cannabis-based medicines can be effective in improving muscle spasticity in multiple sclerosis, ameliorating chronic pain syndromes, and reducing nausea/vomiting in palliative care settings. Risk–benefit ratios should be discussed with individual patients.

Keywords

cannabismarijuanaTHCcannabidiolcannabis-based medicineumbrella reviewevidence synthesis
Type
Chapter
Information
Marijuana and Madness , pp. 346 - 356
Publisher: Cambridge University Press
Print publication year: 2023

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References

Allan, G. M., Finley, C. R., Ton, J., et al. (2018). Systematic review of systematic reviews for medical cannabinoids. Can Fam Physician, 64, e78–e94.Google Scholar
Andreae, M. H., Carter, G. M., Shaparin, N., et al. (2015). Inhaled cannabis for chronic neuropathic pain: A meta-analysis of individual patient data. J Pain, 16, 1221–1232.Google Scholar
Asbridge, M., Hayden, J. A., and Cartwright, J. L. (2012). Acute cannabis consumption and motor vehicle collision risk: Systematic review of observational studies and meta-analysis. BMJ, 344, e536.Google Scholar
Aviram, J., and Samuelly-Leichtag, G. (2017). Efficacy of cannabis-based medicines for pain management: A systematic review and meta-analysis of randomized controlled trials. Pain Physician, 20, E755–E796.Google Scholar
Bhattacharyya, S., Morrison, P. D., Fusar-Poli, P., et al. (2010). Opposite effects of Δ-9-tetrahydrocannabinol and cannabidiol on human brain function and psychopathology. Neuropsychopharmacology, 35, 764–774.CrossRefGoogle ScholarPubMed
Blest-Hopley, G., Giampietro, V., and Bhattacharyya, S. (2019). Regular cannabis use is associated with altered activation of central executive and default mode networks even after prolonged abstinence in adolescent users: Results from a complementary meta-analysis. Neurosci Biobehav Rev, 96, 45–55.CrossRefGoogle ScholarPubMed
Borges, G., Bagge, C. L., and Orozco, R. (2016). A literature review and meta-analyses of cannabis use and suicidality. J Affect Disord, 195, 63–74.Google Scholar
Conner, S. N., Bedell, V., Lipsey, K., et al. (2016). Maternal marijuana use and adverse neonatal outcomes: A systematic review and meta-analysis. Obstet Gynecol, 128, 713–723.Google Scholar
Corsi, O., and Peña, J. (2017). Are cannabinoids effective for the management of chemotherapy induced nausea and vomiting? Medwave, 17, e7119.CrossRefGoogle Scholar
Esmaeelzadeh, S., Moraros, J., Thorpe, L., et al. (2018). Examining the association and directionality between mental health disorders and substance use among adolescents and young adults in the U.S. and Canada: A systematic review and meta-analysis. J Clin Med, 7, 543.CrossRefGoogle Scholar
Farooqui, M. T., Khan, M. A., Cholankeril, G., et al. (2019). Marijuana is not associated with progression of hepatic fibrosis in liver disease: A systematic review and meta-analysis. Eur J Gastroenterol Hepatol, 31, 149–156.Google Scholar
Foglia, E., Schoeler, T., Klamerus, E., et al. (2017). Cannabis use and adherence to antipsychotic medication: A systematic review and meta-analysis. Psychol Med, 47, 1691–1705.Google Scholar
Fu, X., Wang, Y., Wang, C., et al. (2018). A mixed treatment comparison on efficacy and safety of treatments for spasticity caused by multiple sclerosis: A systematic review and network meta-analysis. Clin Rehab, 32, 713–721.CrossRefGoogle ScholarPubMed
Gibbs, M., Winsper, C., Marwaha, S., et al. (2015). Cannabis use and mania symptoms: A systematic review and meta-analysis. J Affect Disord, 171, 39–47.Google Scholar
Grant, I., Gonzalez, R., Carey, C. L., et al. (2003). Non-acute (residual) neurocognitive effects of cannabis use: A meta-analytic study. J Int Neuropsychol Soc, 9, 679–689.Google Scholar
Gunn, J. K., Rosales, C. B., Center, K. E., et al. (2016). Prenatal exposure to cannabis and maternal and child health outcomes: A systematic review and meta-analysis. BMJ Open, 6, e009986.Google Scholar
Gurney, J., Shaw, C., Stanley, J., et al. (2015). Cannabis exposure and risk of testicular cancer: A systematic review and meta-analysis. BMC Cancer, 15, 897.Google Scholar
Häuser, W., Welsch, P., Klose, P., et al. (2019). Efficacy, tolerability and safety of cannabis-based medicines for cancer pain. Der Schmerz, 33, 424–436.Google Scholar
Hindley, G., Beck, K., Borgan, F., et al. (2020). Psychiatric symptoms caused by cannabis constituents: A systematic review and meta-analysis. Lancet Psychiatry, 7, 344–353.CrossRefGoogle ScholarPubMed
Hostiuc, S., Moldoveanu, A., Negoi, I., et al. (2018). The association of unfavorable traffic events and cannabis usage: A meta-analysis. Front Pharmacol, 9, 99.Google Scholar
Johnson, E. C., Hatoum, A. S., Deak, J. D., et al. (2021). The relationship between cannabis and schizophrenia: A genetically informed perspective. Addiction, 116, 3227–3234.CrossRefGoogle ScholarPubMed
Kiburi, S. K., Molebatsi, K., Ntlantsana, V., et al. (2021). Cannabis use in adolescence and risk of psychosis: Are there factors that moderate this relationship? A systematic review and meta-analysis. Subst Abuse, 42, 527–542.CrossRefGoogle ScholarPubMed
Kraan, T., Velthorst, E., Koenders, L., et al. (2016). Cannabis use and transition to psychosis in individuals at ultra-high risk: review and meta-analysis. Psychol Med, 46, 673–681.Google Scholar
Lattanzi, S., Brigo, F., Cagnetti, C., et al. (2018a). Efficacy and safety of adjunctive cannabidiol in patients with Lennox–Gastaut Syndrome: A systematic review and meta-analysis. CNS Drugs, 32, 905–916.Google Scholar
Lattanzi, S., Brigo, F., Trinka, E., et al. (2018b). Efficacy and safety of cannabidiol in epilepsy: A systematic review and meta-analysis. Drugs, 78, 1791–1804.Google Scholar
Lattanzi, S., Brigo, F., Trinka, E., et al. (2020a). Adjunctive cannabidiol in patients with Dravet Syndrome: A systematic review and meta-analysis of efficacy and safety. CNS Drugs, 34, 229–241.CrossRefGoogle ScholarPubMed
Lattanzi, S., Trinka, E., Striano, P., et al. (2020b). Cannabidiol efficacy and clobazam status: A systematic review and meta‐analysis. Epilepsia, 61, 1090–1098.Google Scholar
Lev-Ran, S., Roerecke, M., Le Foll, B., et al. (2014). The association between cannabis use and depression: A systematic review and meta-analysis of longitudinal studies. Psychol Med, 44, 797–810.Google Scholar
Lorenzetti, V., Chye, Y., Silva, P., et al. (2019). Does regular cannabis use affect neuroanatomy? An updated systematic review and meta-analysis of structural neuroimaging studies. Eur Arch Psychiatry Clin Neurosci, 269, 59–71.Google Scholar
Marchand, G., Masoud, A. T., Govindan, M., et al. (2022). Birth outcomes of neonates exposed to marijuana in utero: A systematic review and meta-analysis. JAMA Netw Open, 5, E2145653.Google Scholar
McCartney, D., Arkell, T. R., Irwin, C., et al. (2021). Determining the magnitude and duration of acute Δ9-tetrahydrocannabinol (Δ9-THC)-induced driving and cognitive impairment: A systematic and meta-analytic review. Neurosci Biobehav Rev, 126, 175–193.Google Scholar
Meza, R., Peña, J., García, K., et al. (2017). Are cannabinoids effective in multiple sclerosis? Medwave, 17, e6865.Google Scholar
Moore, T. H., Zammit, S., Lingford-Hughes, A., et al. (2007). Cannabis use and risk of psychotic or affective mental health outcomes: a systematic review. Lancet, 370, 319–328.Google Scholar
Mücke, M., Phillips, T., Radbruch, L., et al. (2018). Cannabis-based medicines for chronic neuropathic pain in adults. Cochrane Database Syst Rev, 3, CD012182.Google Scholar
Myles, N., Nielssen, O., and Large, M. (2012). The association between cannabis use and earlier age at onset of schizophrenia and other psychoses: Meta-analysis of possible confounding factors. Curr Pharm Des, 18, 5055–5069.CrossRefGoogle ScholarPubMed
Noori, A., Miroshnychenko, A., Shergill, Y., et al. (2021). Opioid-sparing effects of medical cannabis or cannabinoids for chronic pain: A systematic review and meta-analysis of randomised and observational studies. BMJ Open, 11, e047717.Google Scholar
Power, E., Sabherwal, S., Healy, C., et al. (2021). Intelligence quotient decline following frequent or dependent cannabis use in youth: A systematic review and meta-analysis of longitudinal studies. Psychol Med, 51, 194–200.Google Scholar
Rabin, R. A., Zakzanis, K. K., and George, T. P. (2011). The effects of cannabis use on neurocognition in schizophrenia: A meta-analysis. Schizophr Res, 128, 111–116.CrossRefGoogle ScholarPubMed
Rocchetti, M., Crescini, A., Borgwardt, S., et al. (2013). Is cannabis neurotoxic for the healthy brain? A meta-analytical review of structural brain alterations in non-psychotic users. Psychiatry Clin Neurosci, 67, 483–492.CrossRefGoogle Scholar
Rogeberg, O. (2019). A meta-analysis of the crash risk of cannabis-positive drivers in culpability studies: Avoiding interpretational bias. Accid Anal Prev, 123, 69–78.Google Scholar
Sainsbury, B., Bloxham, J., Pour, M. H., et al. (2021). Efficacy of cannabis-based medications compared to placebo for the treatment of chronic neuropathic pain: A systematic review with meta-analysis. J Dental Anesthesia Pain Med, 21, 479.CrossRefGoogle ScholarPubMed
Sánchez-Gutiérrez, T., Fernandez-Castilla, B., Barbeito, S., et al. (2020). Cannabis use and nonuse in patients with first-episode psychosis: A systematic review and meta-analysis of studies comparing neurocognitive functioning. Eur Psychiatry, 63, e6.Google Scholar
Schoeler, T., Kambeitz, J., Behlke, I., et al. (2016a). The effects of cannabis on memory function in users with and without a psychotic disorder: Findings from a combined meta-analysis. Psychol Med, 46, 177–188.CrossRefGoogle ScholarPubMed
Schoeler, T., Monk, A., Sami, M. B., et al. (2016b). Continued versus discontinued cannabis use in patients with psychosis: A systematic review and meta-analysis. Lancet Psychiatry, 3, 215–225.Google Scholar
Scott, J. C., Slomiak, S. T., Jones, J. D., et al. (2018). Association of cannabis with cognitive functioning in adolescents and young adults A systematic review and meta-analysis. JAMA Psychiatry, 75, 585–595.CrossRefGoogle Scholar
Stockings, E., Zagic, D., Campbell, G., et al. (2018). Evidence for cannabis and cannabinoids for epilepsy: A systematic review of controlled and observational evidence. J Neurol Neurosurg Psychiatry, 89, 741–753.Google Scholar
Torres-Moreno, M. C., Papaseit, E., Torrens, M., et al. (2018). Assessment of efficacy and tolerability of medicinal cannabinoids in patients with multiple sclerosis. JAMA Netw Open, 1, e183485.Google Scholar
Wang, L., Hong, P. J., May, C., et al. (2021). Medical cannabis or cannabinoids for chronic non-cancer and cancer related pain: A systematic review and meta-analysis of randomised clinical trials. BMJ, 374, n1034.Google Scholar
Wong, S. S. C., Chan, S. C., and Cheung, C. W. (2020). Analgesic effects of cannabinoids for chronic non-cancer pain: A systematic review and meta-analysis with meta-regression. J Neuroimmune Pharmacol, 15, 801–829.Google Scholar

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