Long-term and serious harms of medical cannabis and cannabinoids for chronic pain

Long-term and serious harms of medical cannabis and cannabinoids for chronic pain

Use of cannabis for chronic pain:

• delta-9-tetrahydrocannabinol (THC)
  • THC binds to cannabinoid receptors types 1 and 2, is an analogue to the endogenous cannabinoid, anandamide and has shown psychoactive, analgesic, anti-inflammatory, antioxidant, antipruritic, antispasmodic and muscle-relaxant activities.
• cannabidiol (CBD)
  • CBD directly interacts with various ion channels to produce analgesic, anti-inflammatory, anticonvulsant and anxiolytic activities, without the psychoactive effects of THC

In an analysis of data involving 12143 adult patients the authors conclude that:

• 26% (95%CI: 13.2 to 41.2%) of patients experience adverse drug reactions (ADR) of which over half are psychiatric (13.5% -2.6% to 30.6%) and about 1 in 20 patients experience serious ADRs (1)
• ".. is very low certainty evidence that adverse events are common among people living with chronic pain who use medical cannabis or cannabinoids, but that few patients experience serious adverse events.."

Reference:

• Zeraatkar D, Cooper MA, Agarwal A, et al. : a systematic review of non-randomised studies.BMJ Open 2022;12:e054282. doi: 10.1136/bmjopen-2021-054282.