Gaps in evidence for the use of medically authorized cannabis: Ontario and Alberta, Canada

Abstract

Background With legal access to medical cannabis in Canada since 2001, there is a need to fully characterize its use at both the individual and population levels. We draw on data from Canada’s largest cohort study of medical cannabis to identify the primary reasons for medical cannabis authorization in Canada from 2014 to 2019 in two major provinces: Alberta (AB) and Ontario (ON), and review the extent that evidence supports each indication. Methods Self-reported baseline assessments were collected from adult patients in ON (n = 61,835) and AB (n = 3410) who were authorized medical cannabis. At baseline, sociodemographic, primary medical information, and validated clinical questionnaires were completed by patients as part of an individual assessment. Patients’ reasons for seeking medical cannabis were compared to published reviews and guidelines to assess the level of evidence supporting medical cannabis use for each condition. Results Medical cannabis use in both AB and ON was similar in both demographic and reason for authorization. The most common reasons for medical cannabis authorization were: (1) pain (AB = 77%, ON = 76%) primarily due to chronic musculoskeletal, arthritic, and neuropathic pain, (2) mental health concerns (AB = 32.9%, ON = 38.7%) due to anxiety and depression, and (3) sleep problems (AB = 28%, ON = 25%). More than 50 other conditions were identified as reasons for obtaining authorization. Conclusion In both AB and ON, the majority of reasons for medical cannabis authorization are not substantiated by clinical evidence to fully support its efficacy for long-term use. Ongoing epidemiological studies on medical cannabis on these treatments are warranted to fully outline its treatment benefits or risks.

Therapeutic benefits of cannabinoids in the treatment of chronic pain in cancer patients / Benefícios terapêuticos dos canabinoides no Tratamento da dor crônica em pacientes com câncer

“…21 Most studies on cannabis use patterns among cancer patients are limited to a single site lacking large-scale studies. 25 This result corroborates with the work of Noori A et al, 26 which showed that Colombian psychiatrists have a favorable attitude toward prescribing medical cannabis; however, there is a serious lack of legal knowledge. [23][24][25][26] An interesting finding in the study by Kaufmann et al,8 was that most physicians agreed with the use of (CM) to combat chronic cancer-related pain receiving the highest approval with 87.6%.…”

“…[23][24][25][26] An interesting finding in the study by Kaufmann et al,8 was that most physicians agreed with the use of (CM) to combat chronic cancer-related pain receiving the highest approval with 87.6%. [24][25] ,…”

“…The systematic review by Montero-Oleas 28 identified all randomized clinical trials (RCTs) of cannabinoids compared to placebo or other active agents for the treatment of cancer-related pain in adults to determine the efficacy of cannabinoids and evaluated the tolerability and safety of medical cannabis and cannabis-based medications for cancer pain, reported very low quality evidence for a non-significant 50% reduction in pain (p = 0.82). 25 The systematic review by Amato et al20 shows us the absolute change in mean pain intensity, which is a more sensitive outcome than a dichotomous outcome, for example the proportion of participants reporting pain relief of 50% or more from the beginning to the end of the study. 26 The study by Silva et al5 was conducted on five international databases and showed a higher risk of adverse events when compared to placebo, mainly drowsiness (OR 2.69 (1.54 to 4.71), p <0.001) and dizziness (OR 1.58 (0.99 to 2.51), p = 0.05).…”

Impacts of medical and non-medical cannabis on the health of older adults: Findings from a scoping review of the literature

“…Legalization of cannabis in many jurisdictions around the world has the potential to lead to greater availability and accessibility of cannabis products for all age groups [10]. As North American baby boomers born in the 1950s and 1960s age, attitudes toward cannabis use in the older adult cohort have changed, leading to higher rates of use in this demographic [2,116,168,169].…”

“…Older adults generally suffer from more chronic health conditions than younger adults (e.g., chronic pain, insomnia) [6,7] and, thus, may be attracted to cannabis for medical purposes [3,8] by marketing efforts that exaggerate the medical and "wellness" benefits of cannabis, while minimizing its harms [9], and by word-of-mouth anecdotal "evidence." Legalization, increased access, and non-evidence-based marketing may plausibly increase the proportion of older adults who consume cannabis for both medical and non-medical purposes [10]. Past work has suggested medical cannabinoids may offer certain benefits from consumption when conventional treatment does not help for conditions that include neuropathic pain, chemotherapy induced nausea and vomiting, spasticity (from multiple sclerosis and spinal cord injury), palliative and end-of-life pain [11].…”