Skip to main content

Main menu

  • Home
  • COVID-19
    • Articles & podcasts
    • Blog posts
    • Collection
    • News
  • Content
    • Current issue
    • Past issues
    • Early releases
    • Collections
    • Sections
    • Blog
    • Infographics & illustrations
    • Podcasts
  • Authors
    • Overview for authors
    • Submission guidelines
    • Submit a manuscript
    • Forms
    • Editorial process
    • Editorial policies
    • Peer review process
    • Publication fees
    • Reprint requests
  • CMA Members
    • Overview for members
    • Earn CPD Credits
    • Print copies of CMAJ
    • Career Ad Discount
  • Subscribers
    • General information
    • View prices
  • Alerts
    • Email alerts
    • RSS
  • JAMC
    • À propos
    • Numéro en cours
    • Archives
    • Sections
    • Abonnement
    • Alertes
    • Trousse média 2021
  • CMAJ JOURNALS
    • CMAJ Open
    • CJS
    • JAMC
    • JPN

User menu

Search

  • Advanced search
CMAJ
  • CMAJ JOURNALS
    • CMAJ Open
    • CJS
    • JAMC
    • JPN
CMAJ

Advanced Search

  • Home
  • COVID-19
    • Articles & podcasts
    • Blog posts
    • Collection
    • News
  • Content
    • Current issue
    • Past issues
    • Early releases
    • Collections
    • Sections
    • Blog
    • Infographics & illustrations
    • Podcasts
  • Authors
    • Overview for authors
    • Submission guidelines
    • Submit a manuscript
    • Forms
    • Editorial process
    • Editorial policies
    • Peer review process
    • Publication fees
    • Reprint requests
  • CMA Members
    • Overview for members
    • Earn CPD Credits
    • Print copies of CMAJ
    • Career Ad Discount
  • Subscribers
    • General information
    • View prices
  • Alerts
    • Email alerts
    • RSS
  • JAMC
    • À propos
    • Numéro en cours
    • Archives
    • Sections
    • Abonnement
    • Alertes
    • Trousse média 2021
  • Visit CMAJ on Facebook
  • Follow CMAJ on Twitter
  • Follow CMAJ on Pinterest
  • Follow CMAJ on Youtube
  • Follow CMAJ on Instagram
Practice

Medical cannabinoids

Scott A. McLeod and Jean-François Lemay
CMAJ July 31, 2017 189 (30) E995; DOI: https://doi.org/10.1503/cmaj.161395
Scott A. McLeod
Department of Pediatrics (McLeod, Lemay), Cumming School of Medicine, University of Calgary, Alberta Children’s Hospital, Calgary, Alta.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • For correspondence: scott.mcleod2@ahs.ca
Jean-François Lemay
Department of Pediatrics (McLeod, Lemay), Cumming School of Medicine, University of Calgary, Alberta Children’s Hospital, Calgary, Alta.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Figures & Tables
  • Related Content
  • Metrics
  • Responses
  • PDF
Loading

This article has a correction. Please see:

  • Medical cannabinoids - August 28, 2017

The principal cannabinoids, cannabidiol and tetrahydrocannabinol, have different medical effects

Cannabidiol is nonpsychoactive, may reduce seizure frequency in refractory epilepsy and has preclinical evidence as a potential anxiolytic agent.1 Tetrahydrocannabinol (THC) and pharmaceutical combinations of THC and cannabidiol (nabiximols) show moderate evidence of benefit for chronic neuropathic pain.2 Tetrahydrocannabinol may induce memory deficits and psychotic symptoms; these symptoms may be reduced by combining THC with cannabidiol.1

Despite widespread availability, medical cannabinoids are still experimental

Most clinical trials use pharmaceutical cannabinoids rather than smoked THC.2 Although about 40% of the strains from licensed producers contain a potency of more than 15% THC, 9.4% is the highest percentage that has been studied to date.3 Smoked THC as a mode of delivery is not superior to oromucosal sprays based on current evidence, and may result in dose variability and unforeseen individual responses.2

Cannabinoids can increase the risk of motor vehicle collisions4

Road test trials have shown increased lane-position variability related to dosage.4 Combining cannabinoids with alcohol has been found to delay reaction times and increase time spent outside of lane.4 Effective strategies for driver education are needed to dispel false perceptions that cannabinoid-impaired driving is less of a risk than driving after alcohol use.

Cannabinoids should be titrated slowly with low initial dosing

Selection of dosages is individualized and experimental. Inquiring about quality of life and activity after cannabinoid use can help guide dosing. Appropriate selection of patients is important: patients with chronic pain and multiple sclerosis reported slightly improved quality of life with use of cannabinoids, whereas small declines were reported in patients with HIV.5 Dosage should be reduced if sedation or intoxication occur.

Users of medical cannabinoids may be vulnerable to psychosis

Dose-dependent associations exist between THC, psychosis risk and the earlier development of psychotic symptoms.1,2 Lower THC concentrations or balanced THC–cannabidiol content may optimize benefits while reducing harms for patients.3

CMAJ invites submissions to “Five things to know about …” Submit manuscripts online at http://mc.manuscriptcentral.com/cmaj

Footnotes

  • Competing interests: None declared.

  • This article has been peer reviewed.

References

  1. ↵
    1. Abramovici H
    . Information for health care professionals: cannabis (marihuana, marijuana) and the cannabinoids. Ottawa: Health Canada; 2013.
  2. ↵
    1. Whiting PF,
    2. Wolff RF,
    3. Deshpande S,
    4. et al
    . Cannabinoids for medical use: a systematic review and meta-analysis. JAMA 2015;313:2456–73.
    OpenUrlCrossRefPubMed
  3. ↵
    1. Mammen G,
    2. De freitas L,
    3. Rehm J,
    4. et al
    . Cannabinoid concentrations in Canada’s regulated medical cannabis industry. Addiction 2017;112:730–2.
    OpenUrl
  4. ↵
    1. Bondallaz P,
    2. Favrat B,
    3. Chtioui H,
    4. et al
    . Cannabis and its effects on driving skills. Forensic Sci Int 2016;268:92–102.
    OpenUrl
  5. ↵
    1. Goldenberg M,
    2. Reid MW,
    3. Ishak WW,
    4. et al
    . The impact of cannabis and cannabinoids for medical conditions on health-related quality of life: a systematic review and meta-analysis. Drug Alcohol Depend 2017;174:80–90.
    OpenUrl
PreviousNext
Back to top

In this issue

Canadian Medical Association Journal: 189 (30)
CMAJ
Vol. 189, Issue 30
31 Jul 2017
  • Table of Contents
  • Index by author

Article tools

Respond to this article
Print
Download PDF
Article Alerts
To sign up for email alerts or to access your current email alerts, enter your email address below:
Email Article

Thank you for your interest in spreading the word on CMAJ.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Medical cannabinoids
(Your Name) has sent you a message from CMAJ
(Your Name) thought you would like to see the CMAJ web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
Medical cannabinoids
Scott A. McLeod, Jean-François Lemay
CMAJ Jul 2017, 189 (30) E995; DOI: 10.1503/cmaj.161395

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
‍ Request Permissions
Share
Medical cannabinoids
Scott A. McLeod, Jean-François Lemay
CMAJ Jul 2017, 189 (30) E995; DOI: 10.1503/cmaj.161395
Digg logo Reddit logo Twitter logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Jump to section

  • Article
    • The principal cannabinoids, cannabidiol and tetrahydrocannabinol, have different medical effects
    • Despite widespread availability, medical cannabinoids are still experimental
    • Cannabinoids can increase the risk of motor vehicle collisions4
    • Cannabinoids should be titrated slowly with low initial dosing
    • Users of medical cannabinoids may be vulnerable to psychosis
    • Footnotes
    • References
  • Figures & Tables
  • Related Content
  • Responses
  • Metrics
  • PDF

Related Articles

  • Medical cannabinoids
  • PubMed
  • Google Scholar

Cited By...

  • Analgesic efficacy of cannabinoids for acute pain management after surgery: a systematic review and meta-analysis
  • Lignes directrices simplifiees en matiere de prescription de cannabinoides medicaux en soins de premiere ligne
  • Simplified guideline for prescribing medical cannabinoids in primary care
  • Medical cannabinoids
  • Google Scholar

More in this TOC Section

  • Tocilizumab for hospitalized patients with COVID-19
  • A 59-year-old man with persistent fever, aphasia and leg pain
  • Gelatinous pseudocysts in cryptococcal infection of the central nervous system
Show more Practice

Similar Articles

Content

  • Current issue
  • Past issues
  • Collections
  • Sections
  • Blog
  • Podcasts
  • Alerts
  • RSS
  • Early releases

Information for

  • Advertisers
  • Authors
  • Reviewers
  • CMA Members
  • Media
  • Reprint requests
  • Subscribers

About

  • General Information
  • Journal staff
  • Editorial Board
  • Governance Council
  • Journal Oversight
  • Careers
  • Contact
  • Copyright and Permissions

Copyright 2021, CMA Joule Inc. or its licensors. All rights reserved. ISSN 1488-2329 (e) 0820-3946 (p)

All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association or its subsidiaries.

To receive any of the resources on this site in an accessible format, please contact us at cmajgroup@cmaj.ca.

Powered by HighWire