Abstract
Objectives: To determine the relative contributions of tetrahydrocannabinol (THC) and cannabidiol (CBD) to patients' self-ratings of efficacy for common palliative care symptoms.Design: This is an electronic record-based retrospective cohort study. Model development used logistic regression with bootstrapped confidence intervals (CIs), with standard errors clustered to account for multiple observations by each patient.Setting: This is a national Canadian patient portal.Participants: A total of 2,431 patients participated.Main Outcome Measures: Self-ratings of efficacy of cannabis, defined as a three-point reduction in neuropathic pain, anorexia, anxiety symptoms, depressive symptoms, insomnia, and post-traumatic flashbacks.Results: We included 26,150 observations between October 1, 2017 and November 28, 2018. Of the six symptoms, response was associated with increased THC:CBD ratio for neuropathic pain (odds ratio [OR]: 3.58; 95% CI: 1.32–9.68; p = 0.012), insomnia (OR: 2.93; 95% CI: 1.75–4.91; p < 0.001), and depressive symptoms (OR: 1.63; 95% CI: 1.07–2.49; p = 0.022). Increased THC:CBD ratio was not associated with a greater response of post-traumatic stress disorder (PTSD)-related flashbacks (OR: 1.43; 95% CI: 0.60–3.41; p = 0.415) or anorexia (OR: 1.61; 95% CI: 0.70–3.73; p = 0.265). The response for anxiety symptoms was not significant (OR: 1.13; 95% CI: 0.77–1.64; p = 0.53), but showed an inverted U-shaped curve, with maximal benefit at a 1:1 ratio (50% THC).Conclusions: These preliminary results offer a unique view of real-world medical cannabis use and identify several areas for future research.
Highlights
The past 10 years have seen growing enthusiasm for medical cannabis in the United States, Canada, and in Europe, especially among patients with serious lifethreatening conditions.[1,2] That enthusiasm has been coupled with growing evidence to support the benefits for medical cannabis for a variety of symptoms
Response was associated with increased THC:CBD ratio for neuropathic pain, insomnia (OR: 2.93; 95% confidence intervals (CIs): 1.75–4.91; p < 0.001), and depressive symptoms (OR: 1.63; 95% CI: 1.07–2.49; p = 0.022)
Increased THC:CBD ratio was not associated with a greater response of post-traumatic stress disorder (PTSD)-related flashbacks (OR: 1.43; 95% CI: 0.60–3.41; p = 0.415) or anorexia (OR: 1.61; 95% CI: 0.70– 3.73; p = 0.265)
Summary
The past 10 years have seen growing enthusiasm for medical cannabis in the United States, Canada, and in Europe, especially among patients with serious lifethreatening conditions.[1,2] That enthusiasm has been coupled with growing evidence to support the benefits for medical cannabis for a variety of symptoms. There is inadequate evidence to guide clinicians and patients in choosing the optimal ratio of the two most common cannabinoids, tetrahydrocannabinol (THC) and cannabidiol (CBD). These molecules have different receptors, physiological effects, and potential medical benefits. THC is associated with psychoactive effects such as euphoria, anxiety symptoms, paranoia, and hallucinations, whereas CBD is not
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