Medical Cannabis for Treatment of Chronic Pain and Other Medical and Psychiatric Problems

Importance: As of March 2015, 23 states and the District of Columbia had medical Cannabis laws in place. Physicians should know both the scientific rationale and the practical implications for medical Cannabis laws. Objective: To review the pharmacology, indications, and laws related to medical Cannabis use. Evidence Review: The medical literature on medical Cannabis was reviewed from 1948 to March 2015 via MEDLINE with an emphasis on 28 randomized clinical trials of cannabinoids as pharmacotherapy for indications other than those for which there are 2 US Food and Drug Administration-approved cannabinoids (dronabinol and nabilone), which include nausea and vomiting associated with chemotherapy and appetite stimulation in wasting illnesses. Findings: Use of Cannabis for chronic pain, neuropathic pain, and spasticity due to multiple sclerosis is supported by high-quality evidence. Six trials that included 325 patients examined chronic pain, 6 trials that included 396 patients investigated neuropathic pain, and 12 trials that included 1600 patients focused on multiple sclerosis. Several of these trials had positive results, suggesting that Cannabis or cannabinoids may be efficacious for these indications. Conclusions And Relevance: Medical Cannabis is used to treat a host of indications, a few of which have evidence to support treatment with Cannabis and many that do not. Physicians should educate patients about medical Cannabis to ensure that it is used appropriately and that patients will benefit from its use.