Highlights
- •Twenty-three U.S. states permit cannabis for clinical use but it remains illegal under federal law.
- •Cannabis strains have variable content of >100 different cannabinoids.
- •U.S. regulatory hurdles result in most cannabis research being done elsewhere.
- •Cannabidiol may be anti-inflammatory, anxiolytic, and anti-seizure with no euphoria.
- •Cannabis addiction develops in approximately 9% of nonmedical users.
Abstract
Perspective
Key words
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to The Journal of PainReferences
- Cannabinoid-opioid interaction in chronic pain.Clin Pharmacol Ther. 2011; 90: 844-851
- Cannabis in painful HIV-associated sensory neuropathy: A randomized placebo-controlled trial.Neurology. 2007; 68: 515-521
- Physician self-referral: Regulation by exceptions.JAMA. 2015; 313: 457-458
American Medical Association: H-95.952 Cannabis for Medicinal Use. Available at: https://www.ama-assn.org/ssl3/ecomm/PolicyFinderForm.pl?site=www.ama-assn.org&uri=/resources/html/PolicyFinder/policyfiles/HnE/H-95.952.HTM. Accessed January 14, 2016
American Medical Association: Opinion 8.08 Informed Consent. Available at: http://www.ama-assn.org/ama/pub/physician-resources/medical-ethics/code-medical-ethics/opinion808.page. Accessed July 21, 2015
- Inhaled cannabis for chronic neuropathic pain: A meta-analysis of individual patient data.J Pain. 2015; 16: 1221-1232
- The epidemiology of cannabis dependence.in: Roffman R.A. Stephens R.S. Cannabis Dependence: Its Nature, Consequences and Treatment. Cambridge University Press, Cambridge2006: 58-105
Arizona Department of Health Services. University of Arizona, College of Public Health: Contract No: ADHS12–017291. Report to Arizona Department of Health Services: First Annual Medical Marijuana Report A.R.S. §36-2809. Available at: http://archive.azcentral.com/ic/pdf/MM-annual-final-report.pdf. Accessed March 28, 2015
- Acute cannabis consumption and motor vehicle collision risk: Systematic review of observational studies and meta-analysis.BMJ. 2012; 344: e536
Azcentral. Billeaud J: 24 Doctors certify most in Ariz.'s pot program. Available at: http://www.azcentral.com/news/free/20121109arizona-marijuana-program-doctors.html. Accessed July 21, 2015
- Medical cannabis laws and opioid analgesic overdose mortality in the United States, 1999-2010.JAMA Intern Med. 2014; 174: 1668-1673
- The pharmacological management of post-stroke muscle spasticity.Drugs Aging. 2012; 29: 941-947
Beaver WT, Buring J, Goldstein A, Johnson K, Jones R, Kris MC, Mooney K, Palmberg P, Phair J: Report to the Director, National Institutes of Health. Available at: http://www.sky.org/data/laaketiede/MedicalMJ.html. Accessed July 21, 2015
- Preliminary assessment of the efficacy, tolerability and safety of a cannabis-based medicine (Sativex) in the treatment of pain caused by rheumatoid arthritis.Rheumatology (Oxford). 2006; 45: 50-52
Bureau voor Medicinale Cannabis [Office for Medicinal Cannabis]: Available at: https://www.cannabisbureau.nl/english. Accessed July 21, 2015
- Cannabinoid analgesia as a potential new therapeutic option in the treatment of chronic pain.Ann Pharmacother. 2006; 40: 251-260
- Medical marijuana laws in 50 states: Investigating the relationship between state legalization of medical marijuana and marijuana use, abuse and dependence.Drug Alcohol Depend. 2012; 120: 22-27
ClinicalTrials.gov. Available at: https://clinicaltrials.gov. Accessed March 29, 2016
ClinicalTrials.gov: Vaporized Cannabis and Spinal Cord Injury Pain. Available at: https://clinicaltrials.gov/ct2/show/NCT01555983. Accessed July 21, 2015
- Medical marijuana: The conflict between scientific evidence and political ideology. Part one of two.J Pain Palliat Care Pharmacother. 2009; 23: 4-25
- Medical marijuana: The conflict between scientific evidence and political ideology. Part two of two.J Pain Palliat Care Pharmacother. 2009; 23: 120-140
Colorado Department of Public Health & Environment: Approved medical marijuana research grants. Available at: https://www.colorado.gov/pacific/cdphe/approved-medical-marijuana-research-grants. Accessed July 21, 2015
Congressional Research Service. CRS Report for Congress. Eddy M: Medical Marijuana: Review and Analysis of Federal and State Policies. Available at: http://fas.org/sgp/crs/misc/RL33211.pdf. Accessed March 28, 2015
- Comparison of the analgesic effects of dronabinol and smoked marijuana in daily marijuana smokers.Neuropsychopharmacology. 2013; 38: 1984-1992
- Effects of chronic, heavy cannabis use on executive functions.J Addict Med. 2011; 5: 9-15
- Critical appraisal of the potential use of cannabinoids in cancer management.Cancer Manag Res. 2013; 5: 301-313
- The pharmacokinetics, efficacy, safety, and ease of use of a novel portable metered-dose cannabis inhaler in patients with chronic neuropathic pain: a phase 1a study.J Pain Palliat Care Pharmacother. 2014; 28: 216-225
- Smoked medicinal cannabis for neuropathic pain in HIV: A randomized, crossover clinical trial.Neuropsychopharmacology. 2009; 34: 672-680
ElSohly MA: National Institute on Drug Abuse, Quarterly Report: Potency Monitoring Project. Available at: https://www.ncjrs.gov/pdffiles1/ondcp/mpmp_report_104.pdf. Accessed March 28, 2015
- Shortening the Screener and Opioid Assessment for Patients with Pain-Revised (SOAPP-R): A proof-of-principle study for customized computer-based testing.Pain Med. 2015; 16: 2344-2356
- Cannabis sativa and the endogenous cannabinoid system: Therapeutic potential for appetite regulation.Phytother Res. 2011; 25: 170-188
- Phytocannabinoids beyond the Cannabis plant - do they exist?.Br J Pharmacol. 2010; 160: 523-529
- Universal precautions in pain medicine: A rational approach to the treatment of chronic pain.Pain Med. 2005; 6: 107-112
- Pharmacokinetics and pharmacodynamics of cannabinoids.Clin Pharmacokinet. 2003; 42: 327-360
- The endocannabinoid system and pain.CNS Neurol Disord Drug Targets. 2009; 8: 403-421
- Cannabis effects on driving skills.Clin Chem. 2013; 59: 478-492
- Evaluation of a vaporizing device (Volcano) for the pulmonary administration of tetrahydrocannabinol.J Pharm Sci. 2006; 95: 1308-1317
Health Canada: Licensed Producers. Available at: http://www.hc-sc.gc.ca/dhp-mps/marihuana/info/index-eng.php. Accessed July 21, 2015
- Acute subjective effects after smoking joints containing up to 69 mg Delta9-tetrahydrocannabinol in recreational users: A randomized, crossover clinical trial.Psychopharmacology (Berl). 2014; 231: 4723-4733
- The subjective psychoactive effects of oral dronabinol studied in a randomized, controlled crossover clinical trial for pain.Clin J Pain. 2014; 30: 472-478
- Cannabis, the pregnant woman and her child: Weeding out the myths.J Perinatol. 2014; 34: 417-424
- Marijuana and lung diseases.Curr Opin Pulm Med. 2014; 20: 173-179
- Marijuana and Medicine: Assessing the Science Base.National Academies Press, Washington, D.C.1999
- A positive association between anxiety disorders and cannabis use or cannabis use disorders in the general population–a meta-analysis of 31 studies.BMC Psychiatry. 2014; 14: 136
- Colorado family physicians' attitudes toward medical marijuana.J Am Board Fam Med. 2013; 26: 52-60
- Systematic review: Efficacy and safety of medical marijuana in selected neurologic disorders: Report of the Guideline Development Subcommittee of the American Academy of Neurology.Neurology. 2014; 82: 1556-1563
- A comment on the “amotivational syndrome” in marijuana smokers.Am J Psychiatry. 1973; 130: 1319-1322
- Can oral fluid cannabinoid testing monitor medication compliance and/or cannabis smoking during oral THC and oromucosal Sativex administration?.Drug Alcohol Depend. 2013; 130: 68-76
- Effects of smoking cannabis on lung function.Expert Rev Respir Med. 2011; 5 (quiz: 547): 537-546
- Impact of age at onset of cannabis use on cannabis dependence and driving under the influence in the United States.Accid Anal Prev. 2015; 76: 1-5
- Marijuana use and motor vehicle crashes.Epidemiol Rev. 2012; 34: 65-72
- Probability and predictors of transition from first use to dependence on nicotine, alcohol, cannabis, and cocaine: Results of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC).Drug Alcohol Depend. 2011; 115: 120-130
- Cannabis and adolescent brain development.Pharmacol Ther. 2015; 148: 1-16
- Cannabinoids for treatment of chronic non-cancer pain; a systematic review of randomized trials.Br J Clin Pharmacol. 2011; 72: 735-744
- Cannabinoids for the treatment of chronic non-cancer pain: An updated systematic review of randomized controlled trials.J Neuroimmune Pharmacol. 2015; 10: 293-301
- Therapeutic use of Cannabis sativa on chemotherapy-induced nausea and vomiting among cancer patients: Systematic review and meta-analysis.Eur J Cancer Care (Engl). 2008; 17: 431-443
Marijuana Policy Project: State Policy. Available at: http://www.mpp.org/states. Accessed July 21, 2015
- Cannabinoids and hallucinogens for headache.Headache. 2013; 53: 447-458
- A random walk through a cannabis field.Pharmacol Biochem Behav. 1991; 40: 461-464
- Potency trends of Delta9-THC and other cannabinoids in confiscated cannabis preparations from 1993 to 2008.J Forensic Sci. 2010; 55: 1209-1217
- Cannabis for inflammatory bowel disease.Dig Dis. 2014; 32: 468-474
National Institutes of Health. Department of Health and Human Services: Notice of Availability of Additional Marijuana Strains through NIDA's Drug Supply Program. Available at: http://grants.nih.gov/grants/guide/notice-files/NOT-DA-15-064.html. Accessed July 21, 2015
National Medical Marijuana Growers Association: About Us. Available at: http://www.medicalmarijuanagrowersassociation.org/#/about-us/4579354785. Accessed July 21, 2015
NIH. National Institute on Drug Abuse: NIDA Research on the Therapeutic Benefits of Cannabis and Cannabinoids. Available at: http://www.drugabuse.gov/drugs-abuse/marijuana/nida-research-therapeutic-benefits-cannabis-cannabinoids. Accessed July 21, 2015
- Long-term marijuana users seeking medical cannabis in California (2001-2007): Demographics, social characteristics, patterns of cannabis and other drug use of 4117 applicants.Harm Reduct J. 2007; 4: 16
O'Connor A: Israeli Medical Marijuana Creates Buzz But No High—Will It Go Global? Available at: https://www.washingtonpost.com/world/middle_east/israeli-medical-marijuana-creates-buzz-but-no-high-will-it-go-global/2015/01/31/558fe072-a19a-11e4-9f89-561284a573f8_story.html. Accessed March 28, 2015
- Mitigation of post-traumatic stress symptoms by Cannabis resin: A review of the clinical and neurobiological evidence.Drug Test Anal. 2012; 4: 649-659
- Recommendations for urine drug monitoring as a component of opioid therapy in the treatment of chronic pain.Pain Med. 2012; 13: 886-896
- Combined cannabinoid therapy via an oromucosal spray.Drugs Today (Barc). 2006; 42: 495-503
- Use of prescription pain medications among medical cannabis patients: Comparisons of pain levels, functioning, and patterns of alcohol and other drug use.J Stud Alcohol Drugs. 2015; 76: 406-413
- Marijuana correlates with use of other illicit drugs in a pain patient population.Pain Physician. 2010; 13: 283-287
- Nabiximols for opioid-treated cancer patients with poorly-controlled chronic pain: A randomized, placebo-controlled, graded-dose trial.J Pain. 2012; 13: 438-449
- New insights into antimetastatic and antiangiogenic effects of cannabinoids.Int Rev Cell Mol Biol. 2015; 314: 43-116
- Therapeutic aspects of cannabis and cannabinoids.Br J Psychiatry. 2001; 178: 107-115
- Cannabinoid receptor 2: Potential role in immunomodulation and neuroinflammation.J Neuroimmune Pharmacol. 2013; 8: 608-620
- Potential cannabis synergy and phytocannabinoid-terpenoid entourage effects.Br J Pharmacol. 2011; 163: 1344-1364
- Trends in fatal motor vehicle crashes before and after marijuana commercialization in Colorado.Drug Alcohol Depend. 2014; 140: 137-144
Sanchez YW: Medical marijuana purity under a microscope. Available at: http://www.usatoday.com/story/news/nation/2014/01/06/medical-marijuana-purity-laboratories/4336123. Accessed July 21, 2015
- Effect of illicit recreational drugs upon sleep: Cocaine, ecstasy and marijuana.Sleep Med Rev. 2008; 12: 381-389
- Temporal trends in marijuana attitudes, availability and use in Colorado compared to non-medical marijuana states: 2003-11.Drug Alcohol Depend. 2014; 140: 145-155
- Prescription opioid abuse in chronic pain: A review of opioid abuse predictors and strategies to curb opioid abuse.Pain Physician. 2012; 15: ES67-ES92
- Cannabinoid hyperemesis: A case series of 98 patients.Mayo Clin Proc. 2012; 87: 114-119
- Nabilone for the treatment of pain in fibromyalgia.J Pain. 2008; 9: 164-173
State of Oregon: Control, Regulation, and Taxation of Marijuana and Industrial Hemp Act. Available at: http://media.oregonlive.com/mapes/other/SP-2014-051.pdf. Accessed March 28, 2015
The University of Mississippi, National Center for Natural Products Research: Cannabis Research. Available at: http://pharmacy.olemiss.edu/ncnpr/research-programs/cannabis-research. Accessed July 21, 2015
- Adverse cardiovascular, cerebrovascular, and peripheral vascular effects of marijuana inhalation: What cardiologists need to know.Am J Cardiol. 2014; 113: 187-190
- An enriched-enrolment, randomized withdrawal, flexible-dose, double-blind, placebo-controlled, parallel assignment efficacy study of nabilone as adjuvant in the treatment of diabetic peripheral neuropathic pain.Pain. 2012; 153: 2073-2082
Ubelacker S: Quebec Cannabis Registry To Collect Data From Patients Using Medical Marijuana. Available at: http://www.huffingtonpost.ca/2015/05/11/quebec-registry-will-trac_n_7259620.html. Accessed July 21, 2015
United States Department of Justice, Drug Enforcement Administration, Office of Diversion Control: Controlled Substance Schedules. Available at: http://www.deadiversion.usdoj.gov/schedules/index.html#define. Accessed July 21, 2015
United States Department of Justice, Office of Public Affairs: Justice Department Announces Update to Marijuana Enforcement Policy. Available at: http://www.justice.gov/opa/pr/justice-department-announces-update-marijuana-enforcement-policy. Accessed July 21, 2015
Clinicaltrials.gov: Vaporized Cannabis for Chronic Pain Associated With Sickle Cell Disease (Cannabis-SCD). Available at: https://clinicaltrials.gov/ct2/show/NCT01771731. Accessed July 21, 2015
- Efficacy and safety of medical cannabinoids in older subjects: A systematic review.Ageing Res Rev. 2014; 14: 56-64
- Cannabinoid dose and label accuracy in edible medical cannabis products.JAMA. 2015; 313: 2491-2493
- Adverse health effects of marijuana use.N Engl J Med. 2014; 370: 2219-2227
- Adolescent marijuana use from 2002 to 2008: Higher in states with medical marijuana laws, cause still unclear.Ann Epidemiol. 2011; 21: 714-716
- Efficacy of inhaled cannabis on painful diabetic neuropathy.J Pain. 2015; 16: 616-627
- Pediatric marijuana exposures in a medical marijuana state.JAMA Pediatr. 2013; 167: 630-633
- Adverse effects of medical cannabinoids: A systematic review.CMAJ. 2008; 178: 1669-1678
- The effects of nabilone on sleep in fibromyalgia: Results of a randomized controlled trial.Anesth Analg. 2010; 110: 604-610
- COMPASS study team: Cannabis for the Management of Pain: Assessment of Safety Study (COMPASS).J Pain. 2015; 16: 1233-1242
- Smoked cannabis for chronic neuropathic pain: A randomized controlled trial.CMAJ. 2010; 182: E694-E701
- Marijuana and medicine: Assessing the science base: A summary of the 1999 Institute of Medicine report.Arch Gen Psychiatry. 2000; 57: 547-552
WebMD: MARINOL Side Effects. Available at: http://www.webmd.com/drugs/2/drug-9308/marinol-oral/details/list-sideeffects. Accessed July 21, 2015
- A comparison of an opioid abuse screening tool and prescription drug monitoring data in the emergency department.Drug Alcohol Depend. 2016; 159: 152-157
- The opioid renewal clinic: A primary care, managed approach to opioid therapy in chronic pain patients at risk for substance abuse.Pain Med. 2007; 8: 573-584
- The central role of glia in pathological pain and the potential of targeting the cannabinoid 2 receptor for pain relief.ISRN Anesthesiol. 2011; 593894: 2011
- Impact of cannabis use on the development of psychotic disorders.Curr Addict Rep. 2014; 1: 115-128
- The medicinal cannabis treatment agreement: Providing information to chronic pain patients via a written document.Clin J Pain. 2015; 31: 1087-1096
- Low-dose vaporized cannabis significantly improves neuropathic pain.J Pain. 2013; 14: 136-148
- A randomized, placebo-controlled, crossover trial of cannabis cigarettes in neuropathic pain.J Pain. 2008; 9: 506-521
World first: Launch of Quebec Registry for Cannabis Users. Press release of McGill University Health Centre. Available at: https://registrecannabisquebec.com/en/world-first-launch-quebec-registry-users-medical-cannabis. Accessed March 29, 2016
- Cannabis smoking and lung cancer risk: Pooled analysis in the International Lung Cancer Consortium.Int J Cancer. 2015; 136: 894-903
Article info
Publication history
Footnotes
The authors report the following relevant relationships: Alfonso Romero-Sandoval is a consultant for Otsuka Pharmaceuticals and Valley Agriceuticals; Mark Wallace reports research funding from University of California Center for Medicinal Cannabis Research and GW Pharmaceuticals, consultant to Zynerba; Gilbert Fanciullo is the Chief Medical Officer Prime Wellness of Connecticut and Prime Alternative Treatment Centers of New Hampshire; Bill McCarberg is an advisor to Iroko, Pfizer, Collegium, Millennium, Mallinckrodt, Inspirion, Salix, Takeda, Depomed, Janssen, Kaleo, and AstraZeneca, and has stock holdings in Johnson & Johnson, Protein Design Labs, Biospecifics Technologies, Nektar Therapeutics, Galena, and Collegium; Mark Ware reports research funding from CanniMed. Seddon R. Savage and Michael Schatman have no conflicts of interest to declare.
