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Medicinal cannabis: is current use clinically justified?

Russ J Scott1, Ian A Scott2

  • 1West Moreton Mental Health Service, Brisbane, Queensland, Australia.

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Summary

Medicinal cannabis (MC) is widely used for chronic non-cancer pain (CNCP), but evidence for its effectiveness and safety is limited and inconsistent. Healthcare professionals should inform patients about these limitations and potential harms.

Keywords:
cannabischronicefficacymedicinalnon‐cancerpain

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Area of Science:

  • Pharmacology
  • Pain Management
  • Public Health

Background:

  • Medicinal cannabis (MC) is increasingly marketed as a natural treatment for chronic non-cancer pain (CNCP).
  • Over one million Australians are prescribed MC monthly, with over 800 products available, yet only two are TGA-approved.
  • This highlights a gap between perceived benefits and regulatory approval.

Purpose of the Study:

  • To evaluate the evidence for the efficacy and safety of MC in treating CNCP.
  • To inform healthcare professionals and patients about the limitations of current MC research.
  • To address the discrepancy between industry promotion and scientific evidence.

Main Methods:

  • Systematic review of existing literature on MC for CNCP.
  • Analysis of evidence quality and consistency across multiple reviews.
  • Examination of regulatory approvals and product availability in Australia.

Main Results:

  • Evidence for MC efficacy in CNCP is inconsistent and of low quality, except for neuropathic pain.
  • Specific patient phenotypes benefiting from MC are not reliably identified.
  • Under-reported adverse effects include cognitive impairment, sedation, and psychosis, particularly in older adults.

Conclusions:

  • Current evidence does not support widespread or first-line use of MC for CNCP.
  • Healthcare professionals must counsel patients on the significant limitations in efficacy and safety data.
  • Resisting industry pressure for increased MC access is crucial given the evidence gaps.