Abstract
BackgroundMedicinal cannabis has received increased research attention over recent years due to loosening global regulatory changes. Medicinal cannabis has been reported to have potential efficacy in reducing pain, muscle spasticity, chemotherapy-induced nausea and vomiting, and intractable childhood epilepsy. Yet its potential application in the field of psychiatry is lesser known.MethodsThe first clinically-focused systematic review on the emerging medical application of cannabis across all major psychiatric disorders was conducted. Current evidence regarding whole plant formulations and plant-derived cannabinoid isolates in mood, anxiety, sleep, psychotic disorders and attention deficit/hyperactivity disorder (ADHD) is discussed; while also detailing clinical prescription considerations (including pharmacogenomics), occupational and public health elements, and future research recommendations. The systematic review of the literature was conducted during 2019, assessing the data from all case studies and clinical trials involving medicinal cannabis or plant-derived isolates for all major psychiatric disorders (neurological conditions and pain were omitted).ResultsThe present evidence in the emerging field of cannabinoid therapeutics in psychiatry is nascent, and thereby it is currently premature to recommend cannabinoid-based interventions. Isolated positive studies have, however, revealed tentative support for cannabinoids (namely cannabidiol; CBD) for reducing social anxiety; with mixed (mainly positive) evidence for adjunctive use in schizophrenia. Case studies suggest that medicinal cannabis may be beneficial for improving sleep and post-traumatic stress disorder, however evidence is currently weak. Preliminary research findings indicate no benefit for depression from high delta-9 tetrahydrocannabinol (THC) therapeutics, or for CBD in mania. One isolated study indicates some potential efficacy for an oral cannabinoid/terpene combination in ADHD. Clinical prescriptive consideration involves caution in the use of high-THC formulations (avoidance in youth, and in people with anxiety or psychotic disorders), gradual titration, regular assessment, and caution in cardiovascular and respiratory disorders, pregnancy and breast-feeding.ConclusionsThere is currently encouraging, albeit embryonic, evidence for medicinal cannabis in the treatment of a range of psychiatric disorders. Supportive findings are emerging for some key isolates, however, clinicians need to be mindful of a range of prescriptive and occupational safety considerations, especially if initiating higher dose THC formulas.
Highlights
The Cannabaceae family is a comparatively small family of flowering plants encompassing 11 genera and approximately 170 different species, a small number of which elicit a range of varying psychoactive effects [1]
The most promising evidence is for CBD as an adjunctive treatment in schizophrenia, with an additional isolated study showing efficacy in social anxiety, and weak data suggesting a potential effect for attention deficit/hyperactivity disorder (ADHD) symptoms
The evidence tentatively suggests that a role exists for cannabinoids in post-traumatic stress disorder (PTSD), and in reducing insomnia, which may commonly occur in chronic pain
Summary
The Cannabaceae family is a comparatively small family of flowering plants encompassing 11 genera and approximately 170 different species, a small number of which elicit a range of varying psychoactive effects [1]. Several medical applications have been studied over the past decades, with the National Academies of Sciences, Engineering and Medicine (NASEM) recently holding the position that cannabis and cannabinoids demonstrate conclusive or substantial evidence for chronic pain in adults, chemotherapy-induced nausea and vomiting and spasticity in multiple sclerosis, with limited evidence for use in increasing appetite in HIV/AIDS patients and improving symptoms of post-traumatic stress disorder (PTSD) [2]. With respect to modern use, contemporary consumers of cannabis report (as assessed via meta-analysis of patient usage data) that pain (64%), anxiety (50%), and depression/mood (34%) are the most common reasons [9]. Medicinal cannabis has been reported to have potential efficacy in reducing pain, muscle spasticity, chemotherapy-induced nausea and vomiting, and intractable childhood epilepsy. Its potential application in the field of psychiatry is lesser known
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