Interest in medicinal cannabis continues to grow, with patients and clinicians seeking to understand its potential role in managing various health conditions. As the body of scientific evidence expands, it is important to consider both the reported benefits and the associated risks. The evolving landscape of medicinal cannabis research highlights the need for a balanced perspective, grounded in scientific inquiry and clinical experience.
The Evolving Landscape of Medicinal Cannabis Research
Established Uses and Emerging Evidence
Currently, the Food and Drug Administration (FDA) in the United States has approved a limited number of cannabis-derived or synthetic cannabinoid medications for specific conditions. These include options for chemotherapy-induced nausea, a wasting syndrome related to AIDS, and certain types of seizures, as reported by GN: medicinal cannabis. Beyond these, preliminary evidence suggests a role for cannabis in chronic pain relief.
Dr. Ali John Zarrabi, an internist and palliative care physician and researcher at the Winship Cancer Institute at Emory University, noted that while actual pain intensity may not change significantly, patients often report improved mood, better sleep, and an enhanced quality of life. However, medical societies such as the International Association for the Study of Pain recommend against cannabis as a primary treatment due to limited data and potential side effects like dizziness, drowsiness, and nausea.
For older patients, medicinal cannabis use is reportedly increasing rapidly, with some finding it may help manage symptoms associated with aging. An excerpt published by MedPage Today highlights that older adults may experience relief from chronic pain, anxiety, and insomnia, potentially reducing reliance on multiple conventional pharmaceuticals. A 2018 Israeli study of over 2,700 medical cannabis patients aged 65 and older observed that 93.7% reported improvement in their condition after six months, with a notable reduction in reported pain levels. Common adverse events in this study were dizziness (9.7%) and dry mouth (7.1%), and 18.1% of participants reduced or stopped opioid analgesics.
Areas Requiring Further Research
Despite anecdotal reports and some preliminary findings, robust scientific evidence remains limited for many conditions for which medicinal cannabis is sometimes considered. Almut Gertrud Winterstein, director of the Consortium for Medical Marijuana Clinical Outcomes Research at the University of Florida, indicates that there is little or no strong evidence for conditions such as post-traumatic stress disorder (PTSD), Parkinson’s disease, glaucoma, and amyotrophic lateral sclerosis (ALS), according to GN: medicinal cannabis.
Similarly, the American Psychiatric Association opposes the medical use of cannabis for psychiatric illness, citing insufficient evidence of effectiveness and a strong association between cannabis use and the onset or exacerbation of psychiatric disorders, particularly in younger individuals. Evidence for cannabis supporting sleep is also limited, with sleep medicine societies generally discouraging its use.
Important Safety Considerations and Risks
Potency, Dependence, and Adverse Effects
Modern cannabis products often contain significantly higher concentrations of THC, the psychoactive component, compared to those available decades ago. Analyses by the National Institute on Drug Abuse (NIDA) found that THC content in illegal cannabis products quadrupled between 1995 and 2022, as reported by GN: medicinal cannabis. Higher potency products are associated with an increased likelihood of developing cannabis use disorder, characterised by an inability to stop using cannabis despite experiencing harm.
Dr. Smita Das, clinical professor of psychiatry and behavioral sciences at Stanford University School of Medicine, noted that the misconception of cannabis being non-addictive may stem from experiences with lower potency products of the past. Individuals at heightened risk for cannabis use disorder include men, those who begin use as teenagers, individuals with a family history of substance abuse, and those with mental health conditions who use cannabis for self-medication. Studies have also linked cannabis use to an increased risk of cardiovascular disease, strokes, and heart attacks, particularly with weekly use and higher THC levels. Chronic use has been associated with an increased risk of schizophrenia and other psychotic disorders, with the highest risk observed in frequent users. Long-term smoking of cannabis has also been linked to worsening respiratory symptoms and more frequent episodes of bronchitis and wheezing. Some heavy users may also develop cannabinoid hyperemesis syndrome, which causes abdominal pain, nausea, and vomiting.
Dosing Challenges and Vulnerable Populations
A challenge for clinicians considering medicinal cannabis is the variability in product formulations and inconsistent dosing. Dr. Samer Narouze, chief of the pain medicine division at University Hospitals in Cleveland, highlighted that it can be difficult to ensure patients receive a consistent and known dose. Older studies that indicated benefits for pain often used lower THC products, raising concerns that today’s higher potency options may carry more adverse effects, particularly for vulnerable populations like elderly patients.
Certain groups are particularly susceptible to potential harms. The American College of Obstetricians and Gynecologists (ACOG) advises pregnant and breastfeeding women to avoid cannabis due to links with poor birth outcomes, including low birth weight and potential neurocognitive and behavioral problems in children. Dr. Melissa Russo, a maternal-fetal medicine physician and ACOG guidance author, emphasised that cannabinoids can cross the placenta and enter the baby’s system. Adolescents are also uniquely vulnerable due to ongoing brain development, with regular cannabis use potentially impairing cognition and increasing the risk of dependence and psychosis, as noted by Dr. Kevin Gray, professor of psychiatry and behavioral sciences at the Medical University of South Carolina. It is crucial for patients to discuss any cannabis use with their doctor, as it can interact with other prescription medications, including blood thinners, antidepressants, and pain medications.
Disclaimer: This article is for informational purposes only and does not constitute medical advice. Hemp Gazette does not provide medical recommendations, diagnoses, or treatment plans. Always consult a qualified healthcare practitioner before making any decisions regarding your health or any medical condition. Statements concerning the therapeutic uses of hemp, cannabis, or cannabinoid-derived products have not been evaluated by Australia’s Therapeutic Goods Administration (TGA). Medicinal cannabis products in Australia are accessed via prescription pathways under TGA regulation.
