Medical marijuana patient counseling points for health care professionals based on trends in the medical uses, efficacy, and adverse effects of cannabis-based pharmaceutical drugs

Research in Social and Administrative Pharmacy

Volumn 12, Issue 4, 2016, Pages 638-654

  Parmar, Jayesh R ^a   Forrest, Benjamin D ^a   Freeman, Robert A ^a  

^a UNIVERSITY OF MARYLAND EASTERN SHORE   (United States)

Author keywords

Appetite; Cancer; Cannabis; Dronabinol; Efficacy; Glaucoma; Marijuana; Multiple sclerosis; Nabilone; Nabiximols; Nausea; Pain; Side effects; Smoke; Toxicity; Vomiting

Indexed keywords

DRONABINOL; MEDICAL CANNABIS;

ADVERSE EFFECTS; CANNABIS SMOKING; COUNSELING; HEALTH CARE PERSONNEL; HUMAN; LEGISLATION AND JURISPRUDENCE; PATIENT EDUCATION; PROCEDURES;

COUNSELING; DRONABINOL; HEALTH PERSONNEL; HUMANS; MARIJUANA SMOKING; MEDICAL MARIJUANA; PATIENT EDUCATION AS TOPIC;

EID: 84945936223     PISSN: 15517411     EISSN: None     Source Type: Journal    
DOI: 10.1016/j.sapharm.2015.09.002     Document Type: Note

References (80)

1. Management of Substance Abuse 2014, World Health Organization, Available at:, Accessed 27.08.15. http://www.who.int/substance:abuse/facts/cannabis/en/.
2. Cannabis and Cannabinoids. National Cancer Institute at the National Institutes of Health. Available at: Accessed 27.08.15. http://www.cancer.gov/about-cancer/treatment/cam/patient/cannabis-pdq#section/all.
3. Cannabinoid Compounds 2014, GW Pharmaceuticals, Available at:, Accessed 27.08.15. http://www.gwpharm.com/types-compounds.aspx.
4. 10 Pharmaceutical drugs based on cannabis. Pros and Cons. Available at: Accessed 27.08.15. http://medicalmarijuana.procon.org/view.resource.php?resourceID=000883.
5. Summary of the Evidence for cannabis and cannabinoids. National Cancer Institute at the National Institutes of Health. Available at: Accessed 27.08.15. http://www.cancer.gov/about-cancer/treatment/cam/hp/cannabis-pdq#section/all.
6. Hernandez S.L., Sheyner I., Stover K.T., Stewart J.T. Dronabinol treatment of refractory nausea and vomiting related to peritoneal carcinomatosis. Am J Hosp Palliat Care 2013, 10.1177/1049909113504240.
7. Lutge E.E., Gray A., Siegfried N. The medical use of cannabis for reducing morbidity and mortality in patients with HIV/AIDS. Cochrane Database Syst Rev 2013 Apr 30, 4:CD005175. 10.1002/14651858.CD005175.pub3.
8. Zajicek J., Ball S., Wright D., et al. Effect of dronabinol on progression in progressive multiple sclerosis (CUPID): a randomized, placebo-controlled trial. Lancet Neurol 2013, 12(9):857-865. 10.1016/S1474-4422(13)70159-5.
9. Woodward M.R., Harper D.G., Stolyar A., Forester B.P., Ellison J.M. Dronabinol for the treatment of agitation and aggressive behavior in acutely hospitalized severely demented patients with noncognitive behavioral symptoms. Am J Geriatr Psychiatry 2013, pii: S1064-7481(12)00094-2. 10.1016/j.jagp.2012.11.022.
10. Wilsey B., Marcotte T., Deutsch R., Gouaux B., Sakai S., Donaghe H. Low-dose vaporized cannabis significantly improves neuropathic pain. J Pain 2013, 14:136-148. 10.1016/j.jpain.2012.10.009.
11. Toth C., Mawani S., Brady S., et al. An enriched-enrollment, randomized withdrawal, flexible-dose, double-blind, placebo-controlled, parallel assignment efficacy study of nabilone as adjuvant in the treatment of diabetic peripheral neuropathic pain. J Pain 2012, 153:2073-2082. 10.1016/j.pain.2012.06.024.
12. Serpell M.G., Notcutt W., Collin C. Sativex long-term use: an open-label trial in patients with spasticity due to multiple sclerosis. J Neurol 2013 Jan, 260:285-295. 10.1007/s00415-012-6634-z.
13. Zajicek J.P., Hobart J.C., Slade A., Barnes D., Mattison P.G. Multiple sclerosis and extract of cannabis: results of the MUSEC trial. J Neurol Neurosurg Psychiatry 2012, 83:1125-1132. MUSEC Research Group. 10.1136/jnnp-2012-302468.
14. Portenoy R.K., Ganae-Motan E.D., Allende S., et al. Nabiximols for opioid-treated cancer patients with poorly-controlled chronic pain: a randomized, placebo-controlled, graded-dose trial. J Pain 2012, 13:438-449. 10.1016/j.jpain.2012.01.003.
15. Pickering E.E., Semple S.J., Nazir M.S., et al. Cannabinoid effects on ventilation and breathlessness: a pilot study of efficacy and safety. Chron Respir Dis 2011, 8:109-118. 10.1177/1479972310391283.
16. Lynch M.E., Campbell F. Cannabinoids for treatment of chronic non-cancer pain; a systematic review of randomized trials. Br J Clin Pharmacol 2011 Nov, 72(5):735-744. 10.1111/j.1365-2125.2011.03970.x.
17. Bestard J.A., Toth C.C. An open-label comparison of nabilone and gabapentin as adjuvant therapy or monotherapy in the management of neuropathic pain in patients with peripheral neuropathy. Pain Pract 2011, 11:353-368. 10.1111/j.1533-2500.2010.00427.x.
18. Duran M., Perez E., Abanades S., et al. Preliminary efficacy and safety of an oromucosal standardized cannabis extract in chemotherapy-induced nausea and vomiting. Br J Clin Pharmacol 2010, 70:656-663. 10.1111/j.1365-2125.2010.03743.x.
19. Ware M.A., Wang T., Shapiro S., et al. Smoked cannabis for chronic neuropathic pain: a randomized controlled trial. CMAJ 2010, 182:E694-E701. 10.1503/cmaj.091414.
20. Ware M.A., Fitzcharles M.A., Joseph L., Shir Y. The effects of nabilone on sleep in fibromyalgia: results of a randomized controlled trial. Anesth Analg 2010, 110:604-610. 10.1213/ANE.0b013e3181c76f70.
21. Johnson J.R., Burnell-Nugent M., Lossignol D., Ganae-Motan E.D., Potts R., Fallon M.T. Multicenter, double-blind, randomized, placebo-controlled, parallel-group study of the efficacy, safety, and tolerability of THC: CBD extract and THC extract in patients with intractable cancer-related pain. J Pain Symptom Manage 2010, 39:167-179. 10.1016/j.jpainsymman.2009.06.008.
22. Curtis A., Clarke C.E., Rickards H.E. Cannabinoids for Tourette's syndrome. Cochrane Database Syst Rev 2009 Oct 7, (4):CD006565. 10.1002/14651858.CD006565.pub2.
23. Haroutiunian S., Rosen G., Shouval R., Davidson E. Open-label, add-on study of tetrahydrocannabinol for chronic nonmalignant pain. J Pain Palliat Care Pharmacother 2008, 22:213-217.
24. Machado Rocha F.C., Stefano S.C., De Cassia Haiek R., Rosa Oliveira L.M., Da Silveira D.X. Therapeutic use of cannabis sativa on chemotherapy-induced nausea and vomiting among cancer patients: systematic review and meta-analysis. Eur J Cancer Care 2008, 17:431-443. 10.1111/j.1365-2354.2008.00917.x.
25. Frank B., Serpell M.G., Hughes J., Matthews J.N., Kapur D. Comparison of analgesic effects and patient tolerability of nabilone and dihydrocodeine for chronic neuropathic pain: randomized, crossover, double blind study. BMJ 2008 Jan 26, 336(7637):199-201. 10.1136/bmj.39429.619653.80.
26. Wallace M., Schulteis G., Atkinson J.H., et al. Dose-dependent effects of smoked cannabis on capsaicin-induced pain and hyperalgesia in healthy volunteers. Anesthesiology 2007, 107:785-796.
27. Rog D.J., Nurmikko T.J., Young C.A. Oromucosal delta-9-tetrahydrocannabinol/cannabidiol for neuropathic pain associated with multiple sclerosis: an uncontrolled, open-label, 2-year extension trial. Clin Ther 2007, 29:2068-2079.
28. Haney M., Gunderson E.W., Rabkin J., et al. Dronabinol and marijuana in HIV-positive marijuana smokers. Caloric intake, mood, and sleep. J Acquir Immune Defic Syndr 2007, 45:545-554.
29. Wilson M.M., Philpot C., Morley J.E. Anorexia of aging in long term care: is dronabinol an effective appetite stimulant? A pilot study. J Nutr Health Aging 2007, 11:195-198.
30. Meiri E., Jhangiani H., Vredenburgh J.J., 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, 23:533-543.
31. Collin C., Davies P., Mutiboko I.K., Ratcliffe S. Randomized controlled trial of cannabis-based medicine in spasticity caused by multiple sclerosis. Eur J Neurol 2007, 14:290-296. Sativex Spasticity in MS Study Group.
32. Iskedjian M., Bereza B., Gordon A., Piwko C., Einarson T.R. Meta-analysis of cannabis based treatments for neuropathic and multiple sclerosis-related pain. Curr Med Res Opin 2007, 23:17-24.
33. Wissel J., Haydn T., Muller J., et al. Low dose treatment with the synthetic cannabinoid nabilone significantly reduces spasticity-related pain: a double-blind placebo-controlled cross-over trial. J Neurol 2006, 253:1337-1341.
34. Brady C.M., DasGupta R., Dalton C., Wiseman O.J., Berkley K.J., Fowler C.J. An open-label pilot study of cannabis-based extracts for bladder dysfunction in advanced multiple sclerosis. Mult Scler 2004, 10:425-433.
35. Vaney C., Heinzel-Gutenbrunner M., Jobin P. Efficacy, safety and tolerability of an orally administered cannabis extract in the treatment of spasticity in patients with multiple sclerosis: a randomized, double-blind, placebo-controlled, crossover study. Mult Scler 2004, 10:417-424.
36. Attal N., Brasseur L., Guirimand D., Clermond-Gnamien S., Atlami S., Bouhassira D. Are oral cannabinoids safe and effective in refractory neuropathic pain?. Eur J Pain 2004, 8:173-177.
37. Buggy D.J., Toogood L., Maric S., Sharpe P., Lambert D.G., Rowbotham D.J. Lack of analgesic efficacy of oral delta-9-tetrahydrocannabinol in postoperative pain. Pain 2003, 106:169-172.
38. Neff G.W., O'Brien C.B., Reddy K.R., et al. Preliminary observation with dronabinol in patients with intractable pruritus secondary to cholestatic liver disease. Am J Gastroenterol 2002, 97:2117-2119.
39. Jatoi A., Windschitl H.E., Loprinzi C.L., et al. Dronabinol versus megestrol acetate versus combination therapy for cancer-associated anorexia: a North Central Cancer Treatment Group Study. J Clin Oncol 2002, 20:567-573.
40. Tramer M.R., Carroll D., Campbell F.A., Reynolds D.J., Moore R.A., McQuay H.J. Cannabinoids for control of chemotherapy induced nausea and vomiting: quantitative systematic review. BMJ 2001, 323:16.
41. Beal J.E., Olson R., Lefkowitz L., et al. Long-term efficacy and safety of dronabinol for acquired immunodeficiency syndrome-associated anorexia. J Pain Symptom Manage 1997, 14:7-14.
42. Lane M., Smith F.E., Sullivan R.A., Plasse T.F. Dronabinol and prochlorperazine alone and in combination as antiemetic agents for cancer chemotherapy. Am J Clin Oncol 1990, 13:480-484.
43. McCabe M., Smith F.P., Macdonald J.S., Woolley P.V., Goldberg D., Schein P.S. Efficacy of tetrahydrocannabinol in patients refractory to standard antiemetic therapy. Invest New Drugs 1988, 6:243-246.
44. Priestman S.G., Priestman T.J., Canney P.A. A double-blind randomized cross-over comparison of nabilone and metoclopramide in the control of radiation-induced nausea. Clin Radiol 1987, 38:543-544.
45. Niiranen A., Mattson K. Antiemetic efficacy of nabilone and dexamethasone: a randomized study of patients with lung cancer receiving chemotherapy. Am J Clin Oncol 1987, 10:325-329.
46. Svendsen K.B., Jensen T.S., Bach F.W. Does the cannabinoid dronabinol reduce central pain in multiple sclerosis? Randomized double blind placebo controlled crossover trial. BMJ 2004, 329:253.
47. DeJesus E. Use of dronabinol improves appetite and reverses weight loss in HIV/AIDS-infected patients. J Int Assoc Physicians AIDS Care 2007, 6:95-100.
48. Rog D.J., Nurmikko T.J., Friede T., Young C.A. Randomized, controlled trial of cannabis-based medicine in central pain in multiple sclerosis. Neurology 2005, 27(65):812-819.
49. Wade D.T., Makela P.M., House H., Bateman C., Robson P. Long-term use of a cannabis-based medicine in treatment of spasticity and other symptoms in multiple sclerosis. Mult Scler 2006, 12:639-645.
50. Aragona M., Onesti E., Tomassini V., et al. Psychopathological and cognitive effects of therapeutic cannabinoids in multiple sclerosis: a double-blind, placebo controlled, crossover study. Clin Neuropharmacol 2009, 32:41-47. 10.1097/WNF.0B013E3181633497.
51. Freeman R.M., Adekanmi O., Waterfield M.R., Waterfield A.E., Wright D., Zajicek J. The effect of cannabis on urge incontinence in patients with multiple sclerosis: a multicenter, randomized placebo-controlled trial (CAM-LUTS). Int Urogynecol J Pelvic Floor Dysfunct 2006, 17:636-641.
52. Issa M.A., Narang S., Jamison R.N., et al. The subjective psychoactive effects of oral dronabinol studied in a randomized, controlled crossover clinical trial for pain. Clin J Pain 2014, 30:472-478.
53. Adverse effects of cannabis. Prescrire Int 2011, 20:18-23.
54. Niederle N., Schutte J., Schmidt C.G. Crossover comparison of the antiemetic efficacy of nabilone and alizapride in patients with nonseminomatous testicular cancer receiving cisplatin therapy. Klin Wochenschr 1986, 64:362-365.
55. Pomeroy M., Fennelly J.J., Towers M. Prospective randomized double-blind trial of nabilone versus domperidone in the treatment of cytotoxic-induced emesis. Cancer Chemother Pharmacol 1986, 17:285-288.
56. Cooper Z.D., Comer S.D., Haney M. Comparison of the analgesic effects of dronabinol and smoked marijuana in daily marijuana smokers. Neuropsychopharmacology 2013, 38:1984-1992. 10.1038/npp.2013.97.
57. Woods J.A., Wright N.J., Gee J., Scobey M.W. Cannabinoid hyperemesis syndrome: an emerging drug-induced disease. Am J Ther 2014, [Epub ahead of print]. PMID: 24413371.
58. Joshi M., Joshi A., Bartter T. Marijuana and lung diseases. Curr Opin Pulm Med 2014, 20:173-179. 10.1097/MCP.0000000000000026.
59. Owen K.P., Sutter M.E., Albertson T.E. Marijuana: respiratory tract effects. Clin Rev Allergy Immunol 2013, 10.1007/s12016-013-8374-y.
60. Callaghan R.C., Allebeck P., Sidorchuk A. Marijuana use and risk of lung cancer: a 40-year cohort study. Cancer Causes Control 2013, 24:1811-1820. 10.1007/s10552-013-0259-0.
61. Seamon M.J., Fass J.A., Maniscalco-Feichtl M., Abu-Shraie N.A. Medical marijuana and the developing role of the pharmacist. Am J Health Syst Pharm 2007, 64:1037-1044.
62. Storr M., Devlin S., Kaplan G.G., Panaccione R., Andrews C.N. Cannabis use provides symptom relief in patients with Inflammatory Bowel Disease but is associated with worse disease prognosis in patients with Crohn's Disease. Inflamm Bowel Dis 2014, 20(3):472-480. http://dx.doi.org/10.1097/01.MIB.0000440982.79036.d6.
63. Naftali T., Lev L.B., Yablecovitch D., Half E., Konikoff F.M. Treatment of Crohn's disease with cannabis: an observational study. Isr Med Assoc J 2011, 13:582.
64. Tzu-Chin W.U., Tashkin D.P., Djahed B., Rose J.E. Pulmonary hazards of smoking marijuana as compared with tobacco. N Engl J Med 1988, 318:347-351.
65. Notcutt W., Langford R., Davies P., Ratcliffe S., Potts R. A placebo-controlled, randomized withdrawal study of subjects with symptoms of spasticity due to multiple sclerosis who are receiving long-term Sativex (nabiximols). Mult Scler 2012, 18:219-228. 10.1177/1352458511419700.
66. Blake D.R., Robson P., Ho M., Jubb R.W., McCabe C.S. Preliminary assessment of the efficacy, tolerability and safety of a cannabis-bases medicine (Sativex) in the treatment of pain caused by rheumatoid arthritis. Rheumatology 2006, 45:50-52.
67. Kavia R.B., De Ridder D., Constantinescu C.S., Stott C.G., Fowler C.J. Randomized controlled trial of Sativex to treat detrusor overactivity in multiple sclerosis. Mult Scler 2010, 16(11):1349-1359. 10.1177/1352458510378020.
68. Wade D.T., Collin C., Stott C., Duncombe P. Meta-analysis of the efficacy and safety of Sativex (nabiximols) on spasticity in people with multiple sclerosis. Mult Scler 2010, 16(6):707-714. 10.1177/1352458510367462.
69. Flach A.J. Delta-9-tetrahydrocannabinol (THC) in the treatment of end-stage open-angle glaucoma. Trans Am Ophthalmol Soc 2002, 100:215-222. discussion 222-224.
70. Jarvinen T., Pate D.W., Laine K. Cannabinoids in the treatment of glaucoma. Pharmacol Ther 2002, 95:203-220.
71. Rhee D.J., Katz L.J., Spaeth G.L., Myers J.S. Complementary and alternative medicine for glaucoma. Surv Ophthalmol 2001, 46:43-55.
72. Green K. Marijuana smoking vs cannabinoids for glaucoma therapy. Arch Ophthalmol 1998, 116:1433-1437. 10.1001/archopht.116.11.1433.
73. Plange N., Arend K.O., Kaup M., et al. Dronabinol and retinal hemodynamics in humans. Am J Ophthalmol 2007, 143:173-174.
74. Gross D., Hamm J., Ashworth N., Quigley D. Marijuana use and Epilepsy. Prevalence in patients of a tertiary care epilepsy center. Neurology 2004, 62:2095-2097.
75. Porter B.E., Jacobson C. Report of a parent survey of cannabidiol-enriched cannabis use in pediatric treatment-resistant epilepsy. Epilepsy Behav 2013, 29:574-577.
76. Kogan N.M., Mechoulam R. Cannabinoids in health and disease. Dialogues Clin Neurosci 2007, 9:413-430.
77. Hill T.D., Cascio M.G., Romano B., et al. Cannabidivarin-rich cannabis extracts are anticonvulsant in mouse and rat via a CB1 receptor-independent mechanism. Br J Pharmacol 2013, 170:679-692.
78. The Use of Medical Marijuana for the Treatment of Epilepsy. Epilepsy foundation of Colorado. Available at: Accessed 27.08.15. http://www.epilepsycolorado.org/index.php?s=10784&item=5985.
79. Abrams D.I., Vizoso S.B., Shade S.B., Jay C., Kelly M.E., Benowitz N.L. Vaporization as a smokeless cannabis delivery system: a pilot study. Clin Pharmacol Ther 2007, 82(5):572-578. http://dx.doi.org/10.1038/sj.clpt.6100200.
80. Human/Clinical Studies. National Cancer Institute at the National Institutes of Health. Available at: Accessed 27.08.15. http://www.cancer.gov/about-cancer/treatment/cam/hp/cannabis-pdq#link/_82_toc.