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Cannabinoid Medicines: Good or Bad

Cannabis, or marijuana, has been used by many people for over 3000 years to treat different ailments. However, most medical associations, including the Food and Drug Administration, do not consider cannabis to be safe or effective in the treatment of any medical condition. Nevertheless, cannabidiol, a substance present in cannabis, did receive approval to be used as a treatment for some types of epilepsy in June 2018.(1, 2, 3)

The debate between a widely popular belief that cannabis can be an effective treatment for many types of illnesses, and a lack of scientific data on its exact effects, has recently come to the forefront as the drive to legalize cannabis gains ground. In the United States, 29 states plus the District of Columbia gave the approval to use cannabis for medical purposes, while some states have also given the approval to use cannabis for recreational purposes.

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A recently published study in the Addiction Journal showed that the use of cannabis is rapidly increasing all across the United States, though this increase may not necessarily be linked to the legalization of cannabis in some of the participating states.(4) Nevertheless, this increase in the use of cannabinoid medicines has prompted significant public health concerns.

Let us look at some of the scientific evidence in favor of the medical benefits of cannabinoid medicines against any health risks in order to understand if cannabinoid medicines are good or bad.

Benefits of Cannabinoid Medicines

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Over many years, research has found many results to indicate that cannabis might be beneficial in the treatment of several conditions. Some of the conditions in which cannabinoid medicines may help include:

  1. Chronic Pain

    In 2017, an extensive review was undertaken by the National Academies of Sciences, Engineering, and Medicine. Over 10,000 scientific studies were assessed to look at the  medical benefits and harmful effects of cannabis.(5)

    One particular area that the report analyzed closely was the use of medical cannabis in the treatment of chronic pain. Chronic pain is one of the biggest causes of disability, and it is estimated to affect over 25 million adults in the US alone. In fact, many studies have estimated that the prevalence of chronic pain globally ranges from 11 to 40 percent. Chronic pain is also one of the most common reasons why adults seek medical care, and it is also a reason behind the dependence on opioids in the world.(6, 7, 8, 9)

    The review found that cannabis or products containing cannabinoids, which are active ingredients found in cannabis, or even any other compounds that act on similar receptors in the brain as cannabis, are pretty effective at relieving chronic pain.

  2. Drug Addiction and Alcoholism

    Another in-depth review was published in 2017 in the journal Clinical Psychology Review. It found that the use of cannabis may help people who have opioid or alcohol dependencies to battle their addictions.(10)

    However, this finding is believed to be debatable since the National Academies of Sciences review suggests that the use of cannabis actually drives an increased risk of abuse and further becoming dependent on other substances.(5)

    Additionally, the more someone uses cannabinoid medicines, the more likely they are to develop an addiction to using cannabis. People who began to use this drug at a very young age are known to be at a greater risk of developing a problem of addiction to cannabis use.

  3. Cancer

    Evidence has shown that oral cannabinoid medicines are effective against nausea and vomiting that are typically caused by chemotherapy and radiation therapy, and many small studies have also found that smoking cannabis can also help relieve these symptoms.(11, 12, 13)

    Some studies done on cancer cells have suggested that cannabinoids can help in either slowing down the growth or even killing some forms of cancer. However, earlier studies that also tested this hypothesis in humans found that even though cannabinoids were a safe form of treatment, they are not very effective at controlling or curing cancer.(14, 15)

  4. Depression, Social Anxiety, and Post-Traumatic Stress Disorder

    A study published in Clinical Psychology Review looked at all the published scientific literature that investigates the use of cannabis in the treatment of mental illness symptoms.(16) The researchers of the study found some evidence that supported the use of cannabis in relieving the symptoms of depression and post-traumatic stress disorder.

    However, the study authors also cautioned that cannabis might not be the proper treatment for some mental health conditions, such as psychosis and bipolar disorder.(17) The review suggested that while some proof is there that shows cannabis helps relieve the symptoms of social anxiety but, once again, this evidence is contradicted by the National Academies of Sciences, Engineering, and Medicine review.(5) The National Academies review found that regular usage of cannabis may actually increase the risk of social anxiety.

  5. Epilepsy

    The Food and Drug Administration (FDA) approved the use of a medication containing cannabidiol (CBD) in June 2018 for the treatment of two rare and severe types of epilepsy, known as the Dravet Syndrome and Lennox Gastaut Syndrome. These two forms of epilepsy are challenging to control with other forms of medications. This FDA-approved cannabinoid medication is named Epidiolex.(18, 19, 20, 21)

    CBD is one of the many substances that are present in cannabis, and it is not psychoactive. This means it does not cause the high commonly associated with cannabis use. The drug that was approved for treating the two types of epilepsy contains a purified form of CBD. The approval was based on thorough research and many clinical trials.

    A study from 2017 found that the use of CBD can actually cause far fewer seizures in children who had Dravet syndrome as compared to a placebo.(22) In this study, 120 children and teenagers having Dravet syndrome took part. All of them were aged between 2 and 18 years and were randomly given an oral CBD solution or a placebo for a period of 14 weeks, along with continuing their usual medication. The research team found that the children who were given the CBD solution went from experiencing at least 12 seizures every month to an average of six seizures in the month. Three children receiving CBD did not have any seizures at all. Meanwhile, the children who were given the placebo also saw a slight reduction in seizures.

    Their average number of seizures reduced from 15 every month before the study to just 14 seizures each month during the period of the study. This 39 percent reduction in seizure activity provided the researchers with strong evidence that the CBD solution can dramatically help people living with Dravet syndrome. However, the study also had a high rate of side effects that were linked to the CBD solution.

    More than nine in ten children treated with the CBD experienced many side effects, commonly including fatigue, vomiting and fever.

    Dravet syndrome is characterized by prolonged, repetitive, and potentially fatal seizures. It is estimated that one in five children with Dravet syndrome does not reach past the age of 20 years.(23)

    Even the patient information pamphlet for Epidiolex does issue a warning of side effects like sedation, liver damage, and even thoughts of suicide.

Are There Risks of Cannabinoid Medicines?

While there are many benefits of taking cannabis-based medicines, many studies have also found some adverse side effects between cannabis use and health. Some of these are given below.

Mental Health Problems: Daily use of cannabis is believed to aggravate existing symptoms of bipolar disorder in people who already have this mental health problem. In people with no history of the condition, though, there is minimal evidence to show a link between cannabis use and actually developing bipolar disorder. Moderate evidence shows that regular users of cannabis are more likely to experience suicidal thoughts and a small risk of depression.(24)

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Testicular Cancer: While there is no evidence to show any connection between cannabis use and a higher risk of most cancers, there is some evidence to show a slightly higher risk for the slow-growing seminoma subtype of testicular cancer.(25)

Respiratory disease: Regular smoking of cannabis is linked to a greater risk of developing a chronic cough. However, it is still unclear whether smoking cannabis increases the risk of developing asthma or chronic obstructive pulmonary disease or it worsens lung function. A study from 2014 looked at the relationship between lung disease and cannabis use. The study suggested that smoking cannabis could be a contributing factor in the development of lung cancer, though there is no conclusive link between the two as of yet.(26)

Conclusion: Are Cannabinoid Medicines Good or Bad?

There is evidence to show that there are both benefits and harms of using cannabis. However, the emergence of some very in-depth and up-to-date reviews that evaluated the drug’s benefits determined that more research is still needed to fully confirm the health implications of cannabis use for treating medical conditions. If you live in a state where medical use of cannabis is legalized, you can consult your doctor if you are interested in trying out cannabinoid medicines for conditions like chronic pain, depression, epilepsy, or other such disorders. However, it is always necessary to speak to your doctor before you start taking any new medicine.

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References:

  1. U.S. Food and Drug Administration. 2022. FDA Regulation of Cannabis and Cannabis-Derived Products: Q&A. [online] Available at: <https://www.fda.gov/news-events/public-health-focus/fda-regulation-cannabis-and-cannabis-derived-products-including-cannabidiol-cbd#:~:text=To%20date%2C%20the%20agency%20has,from%20a%20licensed%20healthcare%20provider.> [Accessed 13 August 2022].
  2. U.S. Food and Drug Administration. 2022. FDA and Cannabis: Research and Drug Approval Process. [online] Available at: <https://www.fda.gov/news-events/public-health-focus/fda-and-cannabis-research-and-drug-approval-process> [Accessed 13 August 2022].
  3. U.S. Food and Drug Administration. 2022. Cannabis Policies For the New Decade. [online] Available at: <https://www.fda.gov/news-events/congressional-testimony/cannabis-policies-new-decade-01152020> [Accessed 13 August 2022].
  4. Kerr, W.C., Lui, C. and Ye, Y., 2018. Trends and age, period and cohort effects for marijuana use prevalence in the 1984–2015 US National Alcohol Surveys. Addiction, 113(3), pp.473-481.
  5. National Academies of Sciences, Engineering, and Medicine, 2017. The health effects of cannabis and cannabinoids: the current state of evidence and recommendations for research.
  6. Nahin, R.L., 2015. Estimates of pain prevalence and severity in adults: United States, 2012. The Journal of Pain, 16(8), pp.769-780.
  7. Fayaz, A., Croft, P., Langford, R.M., Donaldson, L.J. and Jones, G.T., 2016. Prevalence of chronic pain in the UK: a systematic review and meta-analysis of population studies. BMJ open, 6(6), p.e010364.
  8. Schopflocher, D., Taenzer, P. and Jovey, R., 2011. The prevalence of chronic pain in Canada. Pain research and management, 16(6), pp.445-450.
  9. Ospina, M. and Harstall, C., 2002. Prevalence of chronic pain: an overview (Vol. 28). Edmonton, Alberta: Alberta Heritage Foundation for Medical Research.
  10. Walsh, Z., Gonzalez, R., Crosby, K., Thiessen, M.S., Carroll, C. and Bonn-Miller, M.O., 2017. Medical cannabis and mental health: A guided systematic review. Clinical psychology review, 51, pp.15-29.
  11. Blake, A., Wan, B.A., Malek, L., DeAngelis, C., Diaz, P., Lao, N., Chow, E. and O’Hearn, S., 2017. A selective review of medical cannabis in cancer pain management. Ann Palliat Med, 6(Suppl 2), pp.S215-S222.
  12. Macari, D.M., Gbadamosi, B., Jaiyesimi, I. and Gaikazian, S., 2020. Medical cannabis in cancer patients: a survey of a community hematology oncology population. American journal of clinical oncology, 43(9), pp.636-639.
  13. Cancer.org. 2022. Marijuana and Cancer. [online] Available at: <https://www.cancer.org/treatment/treatments-and-side-effects/treatment-types/complementary-and-integrative-medicine/marijuana-and-cancer.html> [Accessed 13 August 2022].
  14. Sarfaraz, S., Adhami, V.M., Syed, D.N., Afaq, F. and Mukhtar, H., 2008. Cannabinoids for cancer treatment: progress and promise. Cancer research, 68(2), pp.339-342.
  15. Dariš, B., Verboten, M.T., Knez, Ž. and Ferk, P., 2019. Cannabinoids in cancer treatment: Therapeutic potential and legislation. Bosnian journal of basic medical sciences, 19(1), p.14.
  16. Walsh, Z., Gonzalez, R., Crosby, K., Thiessen, M.S., Carroll, C. and Bonn-Miller, M.O., 2017. Medical cannabis and mental health: A guided systematic review. Clinical psychology review, 51, pp.15-29.
  17. Orsolini, L., Chiappini, S., Volpe, U., De Berardis, D., Latini, R., Papanti, G.D. and Corkery, J.M., 2019. Use of medicinal cannabis and synthetic cannabinoids in post-traumatic stress disorder (PTSD): a systematic review. Medicina, 55(9), p.525.
  18. U.S. Food and Drug Administration. 2022. FDA Approves First Drug Comprised of an Active Ingredient Derived from Marijuana to Treat Rare, Severe Forms of Epilepsy. [online] Available at: <https://www.fda.gov/newsevents/newsroom/pressannouncements/ucm611046.htm> [Accessed 13 August 2022].
  19. Reddy, D.S. and Golub, V.M., 2016. The pharmacological basis of cannabis therapy for epilepsy. Journal of Pharmacology and Experimental Therapeutics, 357(1), pp.45-55.
  20. Sekar, K. and Pack, A., 2019. Epidiolex as adjunct therapy for treatment of refractory epilepsy: a comprehensive review with a focus on adverse effects. F1000Research, 8.
  21. Abu-Sawwa, R., Scutt, B. and Park, Y., 2020. Emerging use of epidiolex (cannabidiol) in epilepsy. The Journal of Pediatric Pharmacology and Therapeutics, 25(6), pp.485-499.
  22. Devinsky, O., Cross, J.H., Laux, L., Marsh, E., Miller, I., Nabbout, R., Scheffer, I.E., Thiele, E.A. and Wright, S., 2017. Trial of cannabidiol for drug-resistant seizures in the Dravet syndrome. New England Journal of Medicine, 376(21), pp.2011-2020.
  23. Kalume, F., 2013. Sudden unexpected death in Dravet syndrome: respiratory and other physiological dysfunctions. Respiratory physiology & neurobiology, 189(2), pp.324-328.
    Delforterie, M.J., Lynskey, M.T., Huizink, A.C., Creemers, H.E., Grant, J.D., Few, L.R.,
  24. Glowinski, A.L., Statham, D.J., Trull, T.J., Bucholz, K.K. and Madden, P.A., 2015. The relationship between cannabis involvement and suicidal thoughts and behaviors. Drug and alcohol dependence, 150, pp.98-104.
  25. Gurney, J., Shaw, C., Stanley, J., Signal, V. and Sarfati, D., 2015. Cannabis exposure and risk of testicular cancer: a systematic review and meta-analysis. BMC cancer, 15(1), pp.1-10.
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