Clinical Data for the Use of Cannabis-Based Treatments: A Comprehensive Review of the Literature

Abstract

Objective: To compile and synthesize the available literature describing medical cannabis use across various disease states. Data Sources: PubMed, EBSCO, and Google Scholar searches were conducted using MeSH and/or keywords. Study Selection and Data Extraction: Studies were included if they described the use of cannabis-based products and medications in the treatment of a predefined list of disease states in humans and were published in English. The extraction period had no historical limit and spanned through April 2019. Data Synthesis: Evidence was compiled and summarized for the following medical conditions: Alzheimer disease, amyotrophic lateral sclerosis, autism, cancer and cancer-associated adverse effects, seizure disorders, human immunodeficiency virus, inflammatory bowel disease, multiple sclerosis (MS), nausea, pain, posttraumatic stress disorder, and hospice care. Relevance to Patient Care and Clinical Practice: Based on identified data, the most robust evidence suggests that medical cannabis may be effective in the treatment of chemotherapy-induced nausea and vomiting, seizure disorders, MS-related spasticity, and pain (excluding diabetic neuropathy). Overall, the evidence is inconsistent and generally limited by poor quality. The large variation in cannabis-based products evaluated in studies limits the ability to make direct comparisons. Regardless of the product, a gradual dose titration was utilized in most studies. Cannabis-based therapies were typically well tolerated, with the most common adverse effects being dizziness, somnolence, dry mouth, nausea, and euphoria. Conclusions: As more states authorize medical cannabis use, there is an increasing need for high-quality clinical evidence describing its efficacy and safety. This review is intended to serve as a reference for clinicians, so that the risks and realistic benefits of medical cannabis are better understood.

Anti-Cancer Potential of Cannabinoids, Terpenes, and Flavonoids Present in Cannabis

“…Inglet et al [133] recently comprehensively outlined clinical data supporting the use of cannabis-based treatments in a variety of disease states, including cancer. Afrin et al [27] also presented completed, ongoing, and recruiting clinical trials looking at the effects of cannabis-based treatment in cancer patients.…”

Cannabinoid Formulations and Delivery Systems: Current and Future Options to Treat Pain

“…Nabiximols has undergone larger and more robust clinical trials than other cannabis-based products or medication for use in pain [ 280 ]. Nevertheless, head-to-head trials comparing the safety and efficacy of types of medical cannabis are still expected.…”

Nutraceuticals and Enteric Glial Cells

“…Similar results were obtained in the cultured rectal human biopsies, which were reversed by the PPARγ antagonist GW9662, confirming the involvement of this receptor in the anti-enterogliosis effect of CBD (although, to the best of our knowledge, this receptor has not been described so far to be expressed in EGCs). Thus, CBD may be useful in IBD patients, but high-quality clinical trials that may clearly determine the efficacy and safety of this compound, used as either a nutraceutical supplement or as part of medical cannabis, are still needed [ 115 , 116 , 117 ].…”