Abstract
Safety issues are a major barrier to the use of cannabis and cannabinoid medications for clinical purposes. Information on the safety of herbal cannabis may be derived from studies of recreational cannabis use, but cannabis exposure and effects may differ widely between medical and recreational cannabis users. Standardized, quality-controlled cannabinoid products are available in Canada, and safety profiles of approved medications are available through the Canadian formulary. In the present article, the evidence behind major safety issues related to cannabis use is summarized, with the aim of promoting informed dialogue between physicians and patients in whom cannabinoid therapy is being considered. Caution is advised in interpreting these data, because clinical experience with cannabinoid use is in the early stages. There is a need for long-term safety monitoring of patients using cannabinoids for a wide variety of conditions, to further guide therapeutic decisions and public policy.
Highlights
Safety issues are a major barrier to the use of cannabis and cannabinoid medications for clinical purposes
Because herbal cannabis has been used recreationally for many years and has been extensively studied, information on the safety concerns may be obtained by extrapolating results from epidemiological studies
Safety information about medicinal cannabinoid use may be obtained from preparations of single cannabinoid compounds, which have been approved by regulatory agencies and have been prescribed for more than 20 years
Summary
Safety issues are a major barrier to the use of cannabis and cannabinoid medications for clinical purposes. The evidence behind major safety issues related to cannabis use is summarized, with the aim of promoting informed dialogue between physicians and patients in whom cannabinoid therapy is being considered. The use of cannabis by patients with diseases such as HIV/AIDS, epilepsy, chronic noncancer pain, glaucoma and multiple sclerosis gives rise to potential safety concerns that are not addressed in observational research on recreational users. Examples of such concerns are potential drug-drug interactions, alterations in the immune functions of immunocompromised patients, and the risk of developing dependency disorders when cannabis is used in a medical context. The aim is to promote a meaningful and informed dialogue between patients and health care providers regarding cannabis use
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