The therapeutic effects of Cannabis and cannabinoids: An update from the National Academies of Sciences, Engineering and Medicine report

Published:January 09, 2018DOI:https://doi.org/10.1016/j.ejim.2018.01.003

      Abstract

      The National Academies of Sciences, Engineering and Medicine conducted a rapid turn-around comprehensive review of recent medical literature on The Health Effects of Cannabis and Cannabinoids. The 16-member committee adopted the key features of a systematic review process, conducting an extensive search of relevant databases and considered 10,000 recent abstracts to determine their relevance. Primacy was given to recently published systematic reviews and primary research that studied one of the committee's 11 prioritized health endpoints- therapeutic effects; cancer incidence; cardiometabolic risk; respiratory disease; immune function; injury and death; prenatal, perinatal and postnatal outcomes; psychosocial outcomes; mental health; problem Cannabis use; and Cannabis use and abuse of other substances. The committee developed standard language to categorize the weight of evidence regarding whether Cannabis or cannabinoids use for therapeutic purposes are an effective or ineffective treatment for the prioritized health endpoints of interest. In the Therapeutics chapter reviewed here, the report concluded that there was conclusive or substantial evidence that Cannabis or cannabinoids are effective for the treatment of pain in adults; chemotherapy-induced nausea and vomiting and spasticity associated with multiple sclerosis. Moderate evidence was found for secondary sleep disturbances. The evidence supporting improvement in appetite, Tourette syndrome, anxiety, posttraumatic stress disorder, cancer, irritable bowel syndrome, epilepsy and a variety of neurodegenerative disorders was described as limited, insufficient or absent. A chapter of the NASEM report enumerated multiple barriers to conducting research on Cannabis in the US that may explain the paucity of positive therapeutic benefits in the published literature to date.
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      References

      1. Joy J.E. Watson S.J. Benson J.A. Marijuana and Medicine: Assessing the Science Base. National Academy Press, Washington, DC1999
        • National Academies of Sciences, Engineering and Medicine
        The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research.
        National Academies Press, Washington, DC2017
        • Sexton M.
        • Cuttler C.
        • Finnell J.S.
        • Mischley L.K.
        A cross-sectional survey of medical Cannabis users: patterns of use and perceived efficacy.
        Cannabis Cannabinoid Res. 2016 Jun 1; 1: 131-138
        • Whiting P.F.
        • Wolff R.F.
        • Deshpande S.
        • Di Nisio M.
        • Duffy S.
        • Hernandez A.V.
        • et al.
        Cannabinoids for medical use: a systematic review and meta-analysis.
        JAMA. 2015 Jun 23; 313: 2456-2473
        • Andreae M.H.
        • Carter G.M.
        • Shaparin N.
        • Suslov K.
        • Ellis R.J.
        • Ware M.A.
        • et al.
        Inhaled Cannabis for chronic neuropathic pain: a meta-analysis of individual patient data.
        J Pain. 2015 Dec 31; 16: 1221-1232
        • Nugent S.M.
        • Morasco B.J.
        • O'Neil M.E.
        • Freeman M.
        • Low A.
        • Kondo K.
        • et al.
        The effects of Cannabis among adults with chronic pain and an overview of general harms: a systematic review.
        Ann Intern Med. 2017 Sep 5; 167: 319-331
        • Phillips R.S.
        • Friend A.J.
        • Gibson F.
        • Houghton E.
        • Gopaul S.
        • Pizer B.
        Antiemetic medication for prevention and treatment of chemotherapy-induced nausea and vomiting in childhood.
        Cochrane Database Syst Rev. 2016; CD007786https://doi.org/10.1002/14651858.CD007786.pub3
        • Phillips R.S.
        • Friend A.J.
        • Gibson F.
        • Houghton E.
        • Gopaul S.
        • Craig J.V.
        • et al.
        Antiemetic medication for prevention and treatment of chemotherapy-induced nausea and vomiting in childhood.
        Cochrane Database Syst Rev. 2016; 2CD007786
        • Hesketh P.J.
        • Kris M.G.
        • Basch E.
        • Bohlke K.
        • Barbour S.Y.
        • Clark-Snow R.A.
        • et al.
        Antiemetics: American Society of Clinical Oncology clinical practice guideline update.
        J Clin Oncol. 2017 Jul 31; 35: 3240-3261
        • Meiri E.
        • Jhangiani H.
        • Vredenburgh J.J.
        • Barbato L.M.
        • Carter F.J.
        • Yang H.M.
        • et al.
        Efficacy of dronabinol alone and in combination with ondansetron versus ondansetron alone for delayed chemotherapy-induced nausea and vomiting.
        Curr Med Res Opin. 2007 Mar 1; 23: 533-543
        • Tanasescu R.
        • Rog D.
        • Constantinescu C.S.
        A drug discovery case history of ‘delta-9-tetrahydrocannabinol, cannabidiol’.
        Expert Opin Drug Discovery. 2011 Apr 1; 6: 437-452
        • Koppel B.S.
        • Brust J.C.
        • Fife T.
        • Bronstein J.
        • Youssof S.
        • Gronseth G.
        • et al.
        Systematic review: efficacy and safety of medical marijuana in selected neurologic disorders: report of the guideline development Subcommittee of the American Academy of Neurology.
        Neurology. 2014; 82: 1556-1563
        • Leocani L.
        • Nuara A.
        • Houdayer E.
        • Schiavetti I.
        • Del Carro U.
        • Amadio S.
        • et al.
        Sativex® and clinicalneurophysiological measures of spasticity in progressive multiple sclerosis.
        J Neurol. 2015; 262: 2520-2527
        • Russo E.B.
        Cannabidiol claims and misconceptions.
        Trends Pharmacol Sci. 2017 Mar 31; 38: 198-201
        • Abrams D.I.
        • Hilton J.F.
        • Leiser R.J.
        • Shade S.B.
        • Elbeik T.A.
        • Aweeka F.T.
        • et al.
        Short-term effects of cannabinoids in patients with HIV-1 Infection. A randomized, placebo-controlled clinical trial.
        Ann Intern Med. 2003 Aug 19; 139: 258-266
        • Jatoi A.
        • Windschitl H.E.
        • Loprinzi C.L.
        • Sloan J.A.
        • Dakhil S.R.
        • Mailliard J.A.
        • et al.
        Dronabinol versus megestrol acetate versus combination therapy for cancer-associated anorexia: a North Central Cancer Treatment Group study.
        J Clin Oncol. 2002 Jan 15; 20: 567-573
        • Jetly R.
        • Heber A.
        • Fraser G.
        • Boisvert D.
        The efficacy of nabilone, a synthetic cannabinoid, in the treatment of PTSD-associated nightmares: a preliminary randomized, double-blind, placebo-controlled cross-over design study.
        Psychoneuroendocrinology. 2015 Jan 31; 51: 585-588
        • O'neil M.E.
        • Nugent S.M.
        • Morasco B.J.
        • Freeman M.
        • Low A.
        • Kondo K.
        • et al.
        Benefits and harms of plant-based Cannabis for posttraumatic stress disorder: a systematic review.
        Ann Intern Med. 2017 Sep 5; 167: 332-340
        • Müller-Vahl K.R.
        Treatment of Tourette syndrome with cannabinoids.
        Behav Neurol. 2013; 27: 119-124
        • Kanaan A.S.
        • Jakubovski E.
        • Müller-Vahl K.
        Significant Tic reduction in an otherwise treatment-resistant patient with Gilles de la Tourette syndrome following treatment with Nabiximols.
        Brain Sci. 2017 Apr 26; 7: 47
        • Rocha F.C.
        • dos Santos Júnior J.G.
        • Stefano S.C.
        • da Silveira D.X.
        Systematic review of the literature on clinical and experimental trials on the antitumor effects of cannabinoids in gliomas.
        J Neurooncol. 2014 Jan 1; 116: 11-24
        • Guzman M.
        • Duarte M.J.
        • Blazquez C.
        • Ravina J.
        • Rosa M.C.
        • Galve-Roperh I.
        • et al.
        A pilot clinical study of Δ9-tetrahydrocannabinol in patients with recurrent glioblastoma multiforme.
        Br J Cancer. 2006 Jul 17; 95: 197-203
        • Marcu J.P.
        • Christian R.T.
        • Lau D.
        • Zielinski A.J.
        • Horowitz M.P.
        • Lee J.
        • et al.
        Cannabidiol enhances the inhibitory effects of Δ9-tetrahydrocannabinol on human glioblastoma cell proliferation and survival.
        Mol Cancer Ther. 2010 Jan 1; 9: 180-189
        • Ladin D.A.
        • Soliman E.
        • Griffin L.
        • Van Dross R.
        Preclinical and clinical assessment of cannabinoids as anti-cancer agents.
        Front Pharmacol. 2016; 7
        • Gloss D.
        • Vickrey B.
        Cannabinoids for epilepsy.
        Cochrane Database Syst Rev. 2014; CD009270https://doi.org/10.1002/14651858.CD009270.pub3
        • Rosenberg E.C.
        • Tsien R.W.
        • Whalley B.J.
        • Devinsky O.
        Cannabinoids and epilepsy.
        Neurotherapeutics. 2015 Oct 1; 12: 747-768
        • Devinsky O.
        • Marsh E.
        • Friedman D.
        • Thiele E.
        • Laux L.
        • Sullivan J.
        • et al.
        Cannabidiol in patients with treatment-resistant epilepsy: an open-label interventional trial.
        Lancet Neurol. 2016 Mar 31; 15: 270-278
        • Tzadok M.
        • Uliel-Siboni S.
        • Linder I.
        • Kramer U.
        • Epstein O.
        • Menascu S.
        • et al.
        CBD-enriched medical Cannabis for intractable pediatric epilepsy: the current Israeli experience.
        Seizure. 2016 Feb 29; 35: 41-44
        • Wong B.S.
        • Camilleri M.
        • Eckert D.
        • Carlson P.
        • Ryks M.
        • Burton D.
        • et al.
        Randomized pharmacodynamic and pharmacogenetic trial of dronabinol effects on colon transit in irritable bowel syndrome-diarrhea.
        Neurogastroenterol Motil. 2012 Apr 1; 24: 358
        • Naftali T.
        • Mechulam R.
        • Marii A.
        • Gabay G.
        • Stein A.
        • Bronshtain M.
        • et al.
        Low-dose cannabidiol is safe but not effective in the treatment for Crohn's disease, a randomized controlled trial.
        Dig Dis Sci. 2017 Jan 1; : 1-6
        • Boehnke K.F.
        • Litinas E.
        • Clauw D.J.
        Medical Cannabis use is associated with decreased opiate medication use in a retrospective cross-sectional survey of patients with chronic pain.
        J Pain. 2016 Jun 30; 17: 739-744
        • Morgan C.J.
        • Das R.K.
        • Joye A.
        • Curran H.V.
        • Kamboj S.K.
        Cannabidiol reduces cigarette consumption in tobacco smokers: preliminary findings.
        Addict Behav. 2013 Sep 30; 38: 2433-2436