Medicinal cannabis in Australia, 2016: the Cannabis as Medicine Survey (CAMS‐16)

Lintzeris, Nicholas; Driels, Jessica; Elias, Natalie; Arnold, Jonathon C.; McGregor, Iain S.; Allsop, David

doi:10.5694/mja17.01247

Cited by 76 publications

(95 citation statements)

References 12 publications

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“…movement disorders [25]. A further motive for this paper focusing solely on psychiatric disorders, concerns cannabis users noting that self-reported anxiety, insomnia, and depression symptoms are amongst the most common reasons for usage [26].…”

Section: Introductionmentioning

confidence: 99%

Medicinal cannabis for psychiatric disorders: a clinically-focused systematic review

et al. 2020

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Background: Medicinal cannabis has received increased research attention over recent years due to loosening global regulatory changes. Medicinal cannabis has been reported to have potential efficacy in reducing pain, muscle spasticity, chemotherapy-induced nausea and vomiting, and intractable childhood epilepsy. Yet its potential application in the field of psychiatry is lesser known. Methods: The first clinically-focused systematic review on the emerging medical application of cannabis across all major psychiatric disorders was conducted. Current evidence regarding whole plant formulations and plant-derived cannabinoid isolates in mood, anxiety, sleep, psychotic disorders and attention deficit/hyperactivity disorder (ADHD) is discussed; while also detailing clinical prescription considerations (including pharmacogenomics), occupational and public health elements, and future research recommendations. The systematic review of the literature was conducted during 2019, assessing the data from all case studies and clinical trials involving medicinal cannabis or plant-derived isolates for all major psychiatric disorders (neurological conditions and pain were omitted). Results: The present evidence in the emerging field of cannabinoid therapeutics in psychiatry is nascent, and thereby it is currently premature to recommend cannabinoid-based interventions. Isolated positive studies have, however, revealed tentative support for cannabinoids (namely cannabidiol; CBD) for reducing social anxiety; with mixed (mainly positive) evidence for adjunctive use in schizophrenia. Case studies suggest that medicinal cannabis may be beneficial for improving sleep and post-traumatic stress disorder, however evidence is currently weak. Preliminary research findings indicate no benefit for depression from high delta-9 tetrahydrocannabinol (THC) therapeutics, or for CBD in mania. One isolated study indicates some potential efficacy for an oral cannabinoid/ terpene combination in ADHD. Clinical prescriptive consideration involves caution in the use of high-THC formulations (avoidance in youth, and in people with anxiety or psychotic disorders), gradual titration, regular assessment, and caution in cardiovascular and respiratory disorders, pregnancy and breast-feeding. Conclusions: There is currently encouraging, albeit embryonic, evidence for medicinal cannabis in the treatment of a range of psychiatric disorders. Supportive findings are emerging for some key isolates, however, clinicians need to be mindful of a range of prescriptive and occupational safety considerations, especially if initiating higher dose THC formulas.

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Section: Introductionmentioning

confidence: 99%

Medicinal cannabis for psychiatric disorders: a clinically-focused systematic review

et al. 2020

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“…Vaporization of cannabis is an increasingly common route of administration among both medicinal and recreational cannabis users; [21][22][23] however, only a small number of studies have described oral fluid concentrations 24,25 and POCT device performance 20 following vaporized cannabis. Moreover, these studies have been limited to THC-dominant cannabis.…”

Section: Introductionmentioning

confidence: 99%

Detection of Δ⁹ THC in oral fluid following vaporized cannabis with varied cannabidiol (CBD) content: An evaluation of two point‐of‐collection testing devices

Arkell

Kevin

Stuart

et al. 2019

Drug Testing and Analysis

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Point‐of‐collection testing (POCT) for Δ9‐tetrahydrocannabinol (THC) in oral fluid is increasingly used to detect driving under the influence of cannabis (DUIC). However, previous studies have questioned the reliability and accuracy of two commonly used POCT devices, the Securetec DrugWipe® 5 s (DW5s) and Dräger DrugTest® 5000 (DT5000). In the current placebo controlled, double‐blind, crossover study we used liquid chromatography‐tandem mass spectrometry (LC–MS/MS) to accurately quantify cannabinoid concentrations in the oral fluid of 14 participants at various timepoints (10, 60, 120, and 180 minutes) following vaporization of 125 mg of THC‐dominant (11% THC; <1% CBD), THC/CBD equivalent (11% THC; 11% CBD) and placebo (<1% THC; <1% CBD) cannabis. At each timepoint, oral fluid was also screened using the DW5s (10 ng/mL THC cut‐off) and DT5000 (10 ng/mL THC cut‐off). LC–MS/MS analysis showed peak oral fluid THC concentrations at the 10 minute timepoint with a rapid decline thereafter. This trajectory did not differ with THC dominant and THC/CBD equivalent cannabis. With a 10 ng/mL confirmatory cut‐off, 5% of DW5s test results were false positives and 16% false negatives. For the DT5000, 10% of test results were false positives and 9% false negatives. Neither the DW5s nor the DT5000 demonstrated the recommended >80% sensitivity, specificity and accuracy. Accuracy was lowest at 60 minutes, when THC concentrations were often close to the screening cut‐off (10 ng/mL). POCT devices can be useful tools in detecting recent cannabis use; however, limitations should be noted, and confirmatory LC–MS/MS quantification of results is strongly advisable.

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“…A different set of challenges is posed for clinicians and government regulators by patients who wish to treat medical conditions for which there is limited or no evidence of the efficacy of cannabis products. These challenges are highlighted in this issue by the results of a survey of the experiences of 1748 Australians who reported using illicit cannabis for medical purposes in 2016 7 …”

mentioning

confidence: 99%

“…These challenges are highlighted in this issue by the results of a survey of the experiences of 1748 Australians who reported using illicit cannabis for medical purposes in 2016. 7 The authors undertook an anonymous online survey to minimise respondents' concerns about disclosing an illegal activity, primarily recruiting respondents from medical cannabis websites and Facebook groups. This approach has a number of limitations that the authors acknowledge.…”

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confidence: 99%

The challenges in providing safe, effective, affordable cannabis‐based medicines for unapproved indications

Hall

Farrell

2018

Medical Journal of Australia

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Medicinal cannabis in Australia, 2016: the Cannabis as Medicine Survey (CAMS‐16)

Abstract: Illicitly sourced cannabis is used to treat a broad range of medical conditions in Australia. Future models of prescribed medical cannabis take consumer patterns of use and demand into consideration.

Cited by 76 publications

References 12 publications

Medicinal cannabis for psychiatric disorders: a clinically-focused systematic review

Medicinal cannabis for psychiatric disorders: a clinically-focused systematic review

Detection of Δ⁹ THC in oral fluid following vaporized cannabis with varied cannabidiol (CBD) content: An evaluation of two point‐of‐collection testing devices

The challenges in providing safe, effective, affordable cannabis‐based medicines for unapproved indications

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Medicinal cannabis in Australia, 2016: the Cannabis as Medicine Survey (CAMS‐16)

Abstract: Illicitly sourced cannabis is used to treat a broad range of medical conditions in Australia. Future models of prescribed medical cannabis take consumer patterns of use and demand into consideration.

Cited by 76 publications

References 12 publications

Medicinal cannabis for psychiatric disorders: a clinically-focused systematic review

Medicinal cannabis for psychiatric disorders: a clinically-focused systematic review

Detection of Δ9 THC in oral fluid following vaporized cannabis with varied cannabidiol (CBD) content: An evaluation of two point‐of‐collection testing devices

The challenges in providing safe, effective, affordable cannabis‐based medicines for unapproved indications

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Detection of Δ⁹ THC in oral fluid following vaporized cannabis with varied cannabidiol (CBD) content: An evaluation of two point‐of‐collection testing devices