As identified in the Discussion sections of chapter findings, there are common topics in the type of study limitations found in this evidence base. The most common are limitations in research design (p. E.g., the lack of appropriate control groups, the lack of long-term follow-up), small sample sizes and research gaps in investigating the potential therapeutic benefits of different forms of cannabis (p. ex., cannabis plant). These restrictions emphasize the need for substantial research to provide comprehensive and conclusive evidence of the therapeutic effects of cannabis and cannabinoids. This chapter describes the committee’s efforts to review the current evidence for the potential efficacy of cannabis or cannabinoids in prioritized health conditions. The committee has drawn up a series of research conclusions regarding these health endpoints; however, it is important that the conclusions of the chapter are interpreted in the context of the limitations discussed in the discussion sections of previous results.
A 2007 study investigated cannabinoid therapy compared to the current generation of serotonin antagonistic anti-emetics, as opposed to the dopamine D2 receptor antagonists used in previous studies. This study in 64 patients evaluated anti-emetic ondansetron versus commonly used dronabinol versus the combination of both nausea and vomiting caused by late chemotherapy (Meiri et al. 2007). The two agents seemed similar in effectiveness, without additional benefit from the combination. Therefore, in this most recent study, the cannabinoid once again performed well as the current standard anti-emetic. Most pain studies cited in Whiting et al. nabiximoles evaluated outside the United States.
The committee has not identified a good quality primary literature that reports on cannabis or cannabinoids for cancer treatment and has been published after the data collection period of the most recently published good or fair quality systematic review dealing with the issue of research. In general, the report suggests that for therapeutic benefits, marijuana is a robust treatment for multiple symptoms related to chronic pain, chemotherapy-induced nausea and vomiting and multiple sclerosis. Everything else, from epilepsy to HIV / AIDS, needs more research before marijuana has proven to be effective or ineffective. The use of cannabinoids has been proposed to help control neurological and non-neurological disorders. Clinical studies of cannabis as an EP treatment performed did not use the gold standard of the clinical trial of a double-blind, placebo-controlled study design. Several cannabis / cannabinoid preparations for symptoms of multiple sclerosis have been studied, including dronabinol, nabilone, cannabis extract, nabiximoles (Sativex brand; an oral spray with THC and CBD approved in more than 25 countries outside the United States.) And smoked cannabis.
Whiting et al. included RCTs that compared cannabinoids with usual care, a placebo or no treatment for 10 conditions. When RCTs were not available for a condition or outcome, non-randomized studies, including uncontrolled studies, were considered. This information was supplemented by a search Cultivation trends in cannabis 2021 in the primary literature from April 2015 to August 2016, as well as with an additional context by Andreae et al. that was specific to the effects of inhaled cannabinoids. And there is “limited evidence” of a correlation between marijuana and better results after traumatic brain injury.
There are indications that oral cannabinoids may arrive in patients with HIV-associated emaciation syndrome and anorexia nervosa. No benefit has been demonstrated in cancer-related anorexia cachexia syndrome. Studies are generally small and short-lived and may not have investigated the optimal dose of cannabinoid. In a study in HIV patients, both dronabinol and inhaled cannabis were significantly compared to placebo dronabinol.