Cannabis based medicines and cannabis dependence: A critical review of issues and evidence

Abstract

Cannabis has been legalised for medical use in an ever-increasing number of countries. A growing body of scientific evidence supports the use of medical cannabis for a range of therapeutic indications. In parallel with these developments, concerns have been expressed by many prescribers that increased use will lead to patients developing cannabis use disorder. Cannabis use disorder has been widely studied in recreational users, and these findings have often been projected onto patients using medical cannabis. However, studies exploring medical cannabis dependence are scarce and the appropriate methodology to measure this construct is uncertain. This article provides a narrative review of the current research to discern if, how and to what extent, concerns about problems of dependence in recreational cannabis users apply to prescribed medical users. We focus on the main issues related to medical cannabis and dependence, including the importance of dose, potency, cannabinoid content, pharmacokinetics and route of administration, frequency of use, as well as set and setting. Medical and recreational cannabis use differs in significant ways, highlighting the challenges of extrapolating findings from the recreational cannabis literature. There are many questions about the potential for medical cannabis use to lead to dependence. It is therefore imperative to address these questions in order to be able to minimise harms of medical cannabis use. We draw out seven recommendations for increasing the safety of medical cannabis prescribing. We hope that the present review contributes to answering some of the key questions surrounding medical cannabis dependence.

More than just smoke: Psychopharmacology of cannabinoids

“…Addiction and all attendant issues are rarely ever entirely removed from consideration in clinical psychopharmacology. Schlag et al (2021) critically review cannabis-based medicines and cannabis dependence. Interestingly, their narrative review concludes that medical and recreational cannabis use differs in significant ways thus highlighting the challenges of extrapolating findings from the recreational cannabis literature to medical use.…”

Digital Medical Cannabis as Market Differentiator: Second-Generation Artificial Intelligence Systems to Improve Response

“…The increase in strength of THC-plants composition is related to legalization, globalization, pharmaceutical-related factors ( 3 , 4 ). The increased use of medical cannabis for multiple diseases and legalization of its use in many countries have led to the increase in variety of products available.…”

“…Cannabis tolerance models imply neurobiological or behavioral adaptation following repeated cannabis exposure ( 25 ). A review of studies examining the single or repeated cannabis administration effect as a function of previous exposure showed the acute single cannabinoid administration effect less acute in chronic users compared to non-regular users ( 3 ). Repeated cannabinoid administration is associated with decreased effectiveness upon repeated exposure, mainly for cognitive functions.…”

“…Regular exposure is associated with reduced acute intoxicating, psychotomimetic, and cardiac effects, or partial tolerance. Some chronic users showed full tolerance, with complete absence of acute effect ( 3 , 26 ).…”

Online survey into developing a model for a legal cannabis market in the United Kingdom

“…However, as of 11th November 2019 NICE released new guidelines allowing GPs to prescribe Sativex (Nabiximols) on the NHS in England and Epidiolex to patients with two rare forms of epilepsy: Lennox-Gastaut Syndrome and Dravet Syndrome (Bezinga, 2020). With the aforementioned exception of Sativex, an oromucosal spray containing 1:1 THC:CBD licensed for the treatment of spasticity in multiple sclerosis, Epidiolex and dronabinol, most CBMPs are currently considered unlicensed medicines (Freeman et al, 2019;Schlag et al, 2020).…”