Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Systematic Reviews
Published in: Systematic Reviews 1/2019

Open Access 01-12-2019 | Multiple Sclerosis | Research

Benefits and harms of medical cannabis: a scoping review of systematic reviews

Authors: Misty Pratt, Adrienne Stevens, Micere Thuku, Claire Butler, Becky Skidmore, L. Susan Wieland, Mark Clemons, Salmaan Kanji, Brian Hutton

Published in: Systematic Reviews | Issue 1/2019

Login to get access

Abstract

Background

There has been increased interest in the role of cannabis for treating medical conditions. The availability of different cannabis-based products can make the side effects of exposure unpredictable. We sought to conduct a scoping review of systematic reviews assessing benefits and harms of cannabis-based medicines for any condition.

Methods

A protocol was followed throughout the conduct of this scoping review. A protocol-guided scoping review conduct. Searches of bibliographic databases (e.g., MEDLINE®, Embase, PsycINFO, the Cochrane Library) and gray literature were performed. Two people selected and charted data from systematic reviews. Categorizations emerged during data synthesis. The reporting of results from systematic reviews was performed at a high level appropriate for a scoping review.

Results

After screening 1975 citations, 72 systematic reviews were included. The reviews covered many conditions, the most common being pain management. Several reviews focused on management of pain as a symptom of conditions such as multiple sclerosis (MS), injury, and cancer. After pain, the most common symptoms treated were spasticity in MS, movement disturbances, nausea/vomiting, and mental health symptoms. An assessment of review findings lends to the understanding that, although in a small number of reviews results showed a benefit for reducing pain, the analysis approach and reporting in other reviews was sub-optimal, making it difficult to know how consistent findings are when considering pain in general. Adverse effects were reported in most reviews comparing cannabis with placebo (49/59, 83%) and in 20/24 (83%) of the reviews comparing cannabis to active drugs. Minor adverse effects (e.g., drowsiness, dizziness) were common and reported in over half of the reviews. Serious harms were not as common, but were reported in 21/59 (36%) reviews that reported on adverse effects. Overall, safety data was generally reported study-by-study, with few reviews synthesizing data. Only one review was rated as high quality, while the remaining were rated of moderate (n = 36) or low/critically low (n = 35) quality.

Conclusions

Results from the included reviews were mixed, with most reporting an inability to draw conclusions due to inconsistent findings and a lack of rigorous evidence. Mild harms were frequently reported, and it is possible the harms of cannabis-based medicines may outweigh benefits.

Systematic review registration

The protocol for this scoping review was posted in the Open Access (https://​ruor.​uottawa.​ca/​handle/​10393/​37247).
Appendix
Available only for authorised users
Literature
1.
Watson SJ, Benson JA, Joy JE. Marijuana and medicine: assessing the science base: a summary of the 1999 Institute of Medicine report. Arch Gen Psychiatry. 2000;57:547–52.PubMedCrossRef
2.
National Academies of Sciences, Engineering, and Medicine, Health and Medicine Division, Board on Population Health and Public Health Practice & Committee on the Health Effects of Marijuana: An Evidence Review and Research Agenda. The health effects of cannabis and cannabinoids: the current state of evidence and recommendations for research. US: National Academies Press; 2017.
3.
Häuser W, Petzke F, Fitzcharles MA. Efficacy, tolerability and safety of cannabis-based medicines for chronic pain management - an overview of systematic reviews. Eur J Pain Lond Engl. 2018;22:455–70.CrossRef
4.
Herzog S, et al. Systematic review of the costs and benefits of prescribed cannabis-based medicines for the management of chronic illness: lessons from multiple sclerosis. Pharmacoeconomics. 2017.
5.
Aizpurua-Olaizola O, et al. Evolution of the cannabinoid and terpene content during the growth of Cannabis sativa plants from different chemotypes. J. Nat. Prod. 2016;79:324–31.PubMedCrossRef
6.
Canadian Agency for Drugs and Technologies in Health. Nabilone for chronic pain management: a review of clinical effectiveness, safety, and guidelines. Rapid Response Rep. 2011.
7.
8.
9.
Colizzi M, Bhattacharyya S. Does cannabis composition matter? Differential effects of delta-9-tetrahydrocannabinol and cannabidiol on human cognition. Curr Addict Rep. 2017;4:62–74.PubMedPubMedCentralCrossRef
10.
DuPont RL. Examining the debate on the use of medical marijuana. Proc Assoc Am Physicians. 1999;111:166–72.PubMedCrossRef
11.
Cohen PJ. Medical marijuana: the conflict between scientific evidence and political ideology. Part one of two. J Pain Palliat Care Pharmacother. 2009;23:4–25.PubMedCrossRef
12.
Cohen PJ. Medical marijuana: the conflict between scientific evidence and political ideology. Part two of two. J Pain Palliat Care Pharmacother. 2009;23:120–40.PubMedCrossRef
13.
14.
Arksey H, O’Malley L. Scoping studies: towards a methodological framework. Int J Soc Res Methodol. 2005;8:19–32.CrossRef
15.
Tricco AC, et al. PRISMA Extension for scoping reviews (PRISMA-ScR): Checklist and Explanation. Ann Intern Med. 2018;169:467–73.PubMedCrossRef
16.
McGowan J, et al. PRESS peer review of electronic search strategies: 2015 guideline statement. J Clin Epidemiol. 2016;75:40–6.PubMedCrossRef
17.
18.
Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med. 2009;151:264–9, W64.PubMedCrossRef
19.
Walsh Z, et al. Medical cannabis and mental health: a guided systematic review. Clin Psychol Rev. 2017;51:15–29.PubMedCrossRef
20.
Shea BJ, et al. AMSTAR 2: a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both. BMJ. 2017;358:j4008.PubMedPubMedCentralCrossRef
21.
Hsief H, Shannon S. Three approaches to qualitative content analysis. Qual Health Res. 2005;15.
22.
23.
Claflin SB, van der Mei IAF, Taylor BV. Complementary and alternative treatments of multiple sclerosis: a review of the evidence from 2001 to 2016. J Neurol Neurosurg Psychiatr. 2017.
24.
Behm K, Morgan P. The effect of symptom-controlling medication on gait outcomes in people with multiple sclerosis: a systematic review. Disabil Rehabil. 2017:1–12.
25.
Lim K, See YM, Lee J. A systematic review of the effectiveness of medical cannabis for psychiatric, movement and neurodegenerative disorders. Clin Psychopharmacol Neurosci Off Sci J Korean Coll Neuropsychopharmacol. 2017;15:301–12.CrossRef
26.
Aviram J, Samuelly-Leichtag G. Efficacy of cannabis-based medicines for pain management: a systematic review and meta-analysis of randomized controlled trials. Pain Physician. 2017;20:E755–96.PubMed
27.
da Rovare VP, et al. Cannabinoids for spasticity due to multiple sclerosis or paraplegia: a systematic review and meta-analysis of randomized clinical trials. Complement Ther Med. 2017;34:170–85.PubMedCrossRef
28.
Norton C, Czuber-Dochan W, Artom M, Sweeney L, Hart A. Systematic review: interventions for abdominal pain management in inflammatory bowel disease. Aliment Pharmacol Ther. 2017;46:115–25.PubMedCrossRef
29.
Snedecor SJ, et al. Systematic review and comparison of pharmacologic therapies for neuropathic pain associated with spinal cord injury. J Pain Res. 2013;6:539–47.PubMedPubMedCentralCrossRef
30.
Goldenberg M, Reid MW, IsHak WW, Danovitch I. The impact of cannabis and cannabinoids for medical conditions on health-related quality of life: a systematic review and meta-analysis. Drug Alcohol Depend. 2017;174:80–90.PubMedCrossRef
31.
Meng H, Johnston B, Englesakis M, Moulin DE, Bhatia A. Selective cannabinoids for chronic neuropathic pain: a systematic review and meta-analysis. Anesth Analg. 2017;125:1638–52.PubMedCrossRef
32.
Nugent SM, et al. The effects of cannabis among adults with chronic pain and an overview of general harms: a systematic review. Ann Intern Med. 2017;167:319–31.PubMedCrossRef
33.
O’Neil ME, et al. Benefits and harms of plant-based cannabis for posttraumatic stress disorder: a systematic review. Ann Intern Med. 2017;167:332–40.PubMedCrossRef
34.
Abo Youssef N, et al. Cannabinoids for treating neurogenic lower urinary tract dysfunction in patients with multiple sclerosis: a systematic review and meta-analysis. BJU Int. 2017;119:515–21.PubMedCrossRef
35.
Mehta S, et al. Systematic review of pharmacologic treatments of pain after spinal cord injury: an update. Arch Phys Med Rehabil. 2016;97:1381–91.PubMedCrossRef
36.
Fitzcharles M-A, Baerwald C, Ablin J, Häuser W. Efficacy, tolerability and safety of cannabinoids in chronic pain associated with rheumatic diseases (fibromyalgia syndrome, back pain, osteoarthritis, rheumatoid arthritis): a systematic review of randomized controlled trials. Schmerz Berl Ger. 2016;30:47–61.CrossRef
37.
Tateo S. State of the evidence: Cannabinoids and cancer pain-a systematic review. J Am Assoc Nurse Pract. 2017;29:94–103.PubMed
38.
Stevens AJ, Higgins MD. A systematic review of the analgesic efficacy of cannabinoid medications in the management of acute pain. Acta Anaesthesiol Scand. 2017;61:268–80.PubMedCrossRef
39.
Walitt B, Klose P, Fitzcharles MA, Phillips T, Hauser W. Cannabinoids for fibromyalgia. Cochrane Database Syst Rev. 2016;7:CD011694.PubMed
40.
Smith LA, Azariah F, Lavender VTC, Stoner NS, Bettiol S. Cannabinoids for nausea and vomiting in adults with cancer receiving chemotherapy. Cochrane Database Syst Rev. 2015:CD009464.
41.
Deshpande A, Mailis-Gagnon A, Zoheiry N, Lakha SF. Efficacy and adverse effects of medical marijuana for chronic noncancer pain: systematic review of randomized controlled trials. Can Fam Physician Med Fam Can. 2015;61:e372–81.
42.
Andreae MH, et al. Inhaled cannabis for chronic neuropathic pain: a meta-analysis of individual patient data. J Pain Off J Am Pain Soc. 2015;16:1221–32.CrossRef
43.
Whiting PF, et al. Cannabinoids for medical use: a systematic review and meta-analysis. JAMA. 2015;313:2456–73.PubMedCrossRef
44.
Langhorst J, et al. Systematic review of complementary and alternative medicine treatments in inflammatory bowel diseases. J. Crohns Colitis. 2015;9:86–106.PubMedCrossRef
45.
McLoughlin BC, et al. Cannabis and schizophrenia. Cochrane Database Syst Rev. 2014:CD004837.
46.
Gates PJ, Albertella L, Copeland J. The effects of cannabinoid administration on sleep: a systematic review of human studies. Sleep Med Rev. 2014;18:477–87.PubMedCrossRef
47.
van den Elsen GAH, et al. Efficacy and safety of medical cannabinoids in older subjects: a systematic review. Ageing Res Rev. 2014;14:56–64.PubMedCrossRef
48.
Lutge EE, Gray A, Siegfried N. The medical use of cannabis for reducing morbidity and mortality in patients with HIV/AIDS. Cochrane Database Syst Rev. 2013:CD005175.
49.
Fitzcharles M-A, et al. Efficacy, tolerability, and safety of cannabinoid treatments in the rheumatic diseases: a systematic review of randomized controlled trials. Arthritis Care Res. 2016;68:681–8.CrossRef
50.
Baldinger R, Katzberg HD, Weber M. Treatment for cramps in amyotrophic lateral sclerosis/motor neuron disease. Cochrane Database Syst Rev. 2012:CD004157.
51.
Richards BL, Whittle SL, Buchbinder R. Neuromodulators for pain management in rheumatoid arthritis. Cochrane Database Syst Rev. 2012;1:CD008921.PubMed
52.
Lynch ME, Campbell F. Cannabinoids for treatment of chronic non-cancer pain; a systematic review of randomized trials. Br J Clin Pharmacol. 2011;72:735–44.PubMedPubMedCentralCrossRef
53.
Phillips TJC, Cherry CL, Cox S, Marshall SJ, Rice ASC. Pharmacological treatment of painful HIV-associated sensory neuropathy: a systematic review and meta-analysis of randomised controlled trials. PloS One. 2010;5:e14433.PubMedPubMedCentralCrossRef
54.
Phillips RS, et al. Antiemetic medication for prevention and treatment of chemotherapy induced nausea and vomiting in childhood. Cochrane Database Syst Rev. 2010:CD007786.
55.
Meyer MJ, et al. Acute management of acquired brain injury part II: an evidence-based review of pharmacological interventions. Brain Inj. 2010;24:706–21.PubMedCrossRef
56.
57.
Curtis A, Clarke CE, Rickards HE. Cannabinoids for Tourette’s syndrome. Cochrane Database Syst Rev. 2009:CD006565.
58.
Martin-Sanchez E, Furukawa TA, Taylor J, Martin JL. Systematic review and meta-analysis of cannabis treatment for chronic pain. Pain Med Malden Mass. 2009;10:1353–68.CrossRef
59.
Krishnan S, Cairns R, Howard R. Cannabinoids for the treatment of dementia. Cochrane Database Syst Rev. 2009:CD007204.
60.
Machado Rocha FC, Stefano SC, De Cassia Haiek R, Rosa Oliveira LMQ, Da Silveira DX. Therapeutic use of Cannabis sativa on chemotherapy-induced nausea and vomiting among cancer patients: systematic review and meta-analysis. Eur J Cancer Care (Engl). 2008;17:431–43.CrossRef
61.
Wang T, Collet JP, Shapiro S, Ware MA. Adverse effects of medical cannabinoids: a systematic review. Can Med Assoc J. 2008;178:1669–78.CrossRef
62.
Iskedjian M, Bereza B, Gordon A, Piwko C, Einarson TR. Meta-analysis of cannabis based treatments for neuropathic and multiple sclerosis-related pain. Curr Med Res Opin. 2007;23:17–24.PubMedCrossRef
63.
Mills RJ, Yap L, Young CA. Treatment for ataxia in multiple sclerosis. Cochrane Database Syst Rev. 2007:CD005029.
64.
Shakespeare DT, Boggild M, Young C. Anti-spasticity agents for multiple sclerosis. Cochrane Database Syst Rev. 2003:CD001332.
65.
Campbell FA, et al. Are cannabinoids an effective and safe treatment option in the management of pain? A qualitative systematic review. BMJ. 2001;323:13–6.PubMedPubMedCentralCrossRef
66.
67.
Merlin JS, Bulls HW, Vucovich LA, Edelman EJ, Starrels JL. Pharmacologic and non-pharmacologic treatments for chronic pain in individuals with HIV: a systematic review. AIDS Care Psychol Socio Med Asp AIDSHIV. 2016;28:1506–15.CrossRef
68.
Lynch ME, Ware MA. Cannabinoids for the treatment of chronic non-cancer pain: an updated systematic review of randomized controlled trials. J Neuroimmune Pharmacol. 2015;10:293–301.PubMedCrossRef
69.
70.
Snedecor SJ, et al. Systematic review and meta-analysis of pharmacological therapies for painful diabetic peripheral neuropathy. Pain Pract. 2014;14:167–84.PubMedCrossRef
71.
Kuspinar A, Rodriguez AM, Mayo NE. The effects of clinical interventions on health-related quality of life in multiple sclerosis: a meta-analysis. Mult Scler J. 2012;18:1686–704.CrossRef
72.
Gloss D, Vickrey B. Cannabinoids for epilepsy. Cochrane Database Syst Rev Online. 2012;6:CD009270.
73.
Macfarlane GJ, et al. Evidence for the efficacy of complementary and alternative medicines in the management of rheumatoid arthritis: a systematic review. Rheumatology. 2011;50:1672–83.PubMedCrossRef
74.
75.
Mestre T, Ferreira J, Coelho MM, Rosa M, Sampaio C. Therapeutic interventions for symptomatic treatment in Huntington’s disease. Cochrane Database Syst Rev. 2009:CD006456.
76.
Wheaton P, Mathias JL, Vink R. Impact of early pharmacological treatment on cognitive and behavioral outcome after traumatic brain injury in adults: a meta-analysis. J Clin Psychopharmacol. 2009;29:468–77.PubMedCrossRef
77.
78.
Chung V, et al. Efficacy and safety of herbal medicines for idiopathic Parkinson’s disease: a systematic review. Mov Disord. 2006;21:1709–15.PubMedCrossRef
79.
Yavuzsen T, Davis MP, Walsh D, LeGrand S, Lagman R. Systematic review of the treatment of cancer-associated anorexia and weight loss. J Clin Oncol. 2005;23:8500–11.PubMedCrossRef
80.
Nielsen S, et al. Opioid-sparing effect of cannabinoids: a systematic review and meta-analysis. Neuropsychopharmacol. 2017;42:1752–65.CrossRef
81.
Canadian Agency for Drugs and Technologies in Health. In: Canadian Agency for Drugs and Technologies in Health, editor. Nabilone for non-chemotherapy associated nausea and weight loss due to medical conditions: a review of the clinical effectiveness and guidelines; 2014.
82.
Long-term nabilone use: a review of the clinical effectiveness and safety. Canadian Agency for Drugs and Technologies in Health, 2015.
83.
Staples H, Adcock L. Cannabinoids for behavioural symptoms in adults with dementia: a review of clinical effectiveness and guidelines. CADTH. 2018.
84.
van den Beuken-van Everdingen M, et al. Pharmacological treatment of pain in cancer patients: the role of adjuvant analgesics, a systematic review. Pain Pract Off J World Inst Pain. 2017;17:409–19.CrossRef
85.
Koppel BS, 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;82:1556–63.PubMedPubMedCentralCrossRef
86.
Pringsheim T, et al. Canadian guidelines for the evidence-based treatment of tic disorders: pharmacotherapy. Can J Psychiatry Rev Can Psychiatr. 2012;57:133–43.CrossRef
87.
Scottish Intercollegiate Guidelines Network. Control of pain in adults with cancer: a national clinical guideline. SIGN. 2008.
88.
Paice JA, et al. Management of chronic pain in survivors of adult cancers: American Society of Clinical Oncology Clinical Practice Guideline. J Clin Oncol Off J Am Soc Clin Oncol. 2016;34:3325–45.CrossRef
89.
Verleye L, et al. Supportive treatment for cancer - part 2: prevention and treatment of adverse events related to chemotherapy and radiotherapy. Good Clin Pract GCP Bruss Belg Health Care Knowl Cent KCE KCE Reports. 2012;191C.
90.
Centre for Clinical Practice at NICE (UK). In: National Institute for Health and Care Excellence, editor. Neuropathic pain: the pharmacological management of neuropathic pain in adults in non-specialist settings. UK; 2013.
91.
National Clinical Guideline Centre. Multiple sclerosis: management of multiple sclerosis in primary and secondary care. NICE Clinical Guideline. 2014;186.
92.
Yadav V, et al. Summary of evidence-based guideline: complementary and alternative medicine in multiple sclerosis: report of the guideline development subcommittee of the American Academy of Neurology. Neurology, 2014;82:1083–92.PubMedPubMedCentralCrossRef
93.
Mücke M, et al. Cannabinoids in palliative care: systematic review and meta-analysis of efficacy, tolerability and safety. Schmerz Berl Ger. 2016;30:25–36.CrossRef
94.
Jawahar R, Oh U, Yang S, Lapane KL. A systematic review of pharmacological pain management in multiple sclerosis. Drugs. 2013;73:1711–22.PubMedCrossRef
95.
Jawahar R, Oh U, Yang S, Lapane KL. A systematic review of pharmacological pain management in multiple sclerosis. Database Abstr Rev Eff. 2018;2015.
96.
Metadata
Title
Benefits and harms of medical cannabis: a scoping review of systematic reviews
Authors
Misty Pratt
Adrienne Stevens
Micere Thuku
Claire Butler
Becky Skidmore
L. Susan Wieland
Mark Clemons
Salmaan Kanji
Brian Hutton
Publication date
01-12-2019
Publisher
BioMed Central
Published in
Systematic Reviews / Issue 1/2019
Electronic ISSN: 2046-4053
DOI
https://doi.org/10.1186/s13643-019-1243-x

Other articles of this Issue 1/2019

Systematic Reviews 1/2019 Go to the issue

Research

Usability and acceptability of four systematic review automation software packages: a mixed method design

Commentary

Toward systematic review automation: a practical guide to using machine learning tools in research synthesis

Protocol

The prevalence of phantom limb pain and associated risk factors in people with amputations: a systematic review protocol

Protocol

Ivabradine for coronary artery disease and/or heart failure—a protocol for a systematic review of randomised clinical trials with meta-analysis and Trial Sequential Analysis

Protocol

Effectiveness of treatments for acute and sub-acute mechanical non-specific low back pain: protocol for a systematic review and network meta-analysis

Protocol

Impact of interventions on work-related outcomes for individuals with musculoskeletal injuries after road traffic crash: a systematic review protocol