Medical Cannabis Review: Pain and Spasticity Have the Best Evidence, but Safety Concerns Remain
A comprehensive review found significant evidence for medical cannabis benefits in various pain types and muscle spasms, while highlighting safety concerns including schizophrenia risk in adolescents and memory impairment.
Quick Facts
What This Study Found
The review covered three types of cannabinoid medicines available in North America: dronabinol (Schedule III), nabilone (Schedule II), and medical cannabis (Schedule I). Pain and muscle spasms were the most common reasons for medical cannabis recommendations and had the most supporting evidence.
Studies showed significant improvement in various pain types and muscle spasticity. Adverse effects were typically not serious, with dizziness being the most common. Key safety concerns included increased schizophrenia risk with adolescent use, memory and cognitive impairments, accidental pediatric ingestion, and lack of standardized safety packaging.
Key Numbers
Three cannabinoid medicines reviewed. Dronabinol: Schedule III. Nabilone: Schedule II. Medical cannabis: Schedule I. Most common uses: pain and muscle spasms. Most common adverse effect: dizziness. Key risk: adolescent use and schizophrenia.
How They Did This
Narrative review of the pharmacology, dosage formulations, therapeutic benefits and risks, and safety concerns of medical cannabis products. Covered dronabinol, nabilone, nabiximols, and herbal medical cannabis.
Why This Research Matters
This review provided clinicians with a practical overview of the medical cannabis landscape at a time when state medical cannabis programs were expanding rapidly but clinical guidance was lacking. It balanced evidence of benefit with clearly articulated safety concerns.
The Bigger Picture
Published in 2013 as medical cannabis programs were proliferating, this review captured a moment when the evidence base was sufficient to identify genuine benefits for specific conditions while also recognizing that the unregulated nature of medical cannabis raised legitimate safety concerns.
What This Study Doesn't Tell Us
Narrative rather than systematic review. The evidence base was unevenly distributed across conditions. The comparison between pharmaceutical cannabinoids and herbal medical cannabis was complicated by different regulatory standards. Rapidly evolving legal landscape may have made some observations outdated quickly.
Questions This Raises
- ?Should medical cannabis products be held to the same regulatory standards as pharmaceutical cannabinoids?
- ?How should clinicians balance evidence of benefit with safety concerns?
- ?Would standardized dosing and packaging address the key safety issues?
Trust & Context
- Key Stat:
- Pain and muscle spasms: most common reasons for medical cannabis and most evidence
- Evidence Grade:
- Narrative review synthesizing clinical evidence across multiple cannabis formulations; moderate evidence base.
- Study Age:
- Published in 2013. The medical cannabis evidence base has grown substantially since, with additional clinical trials and more states legalizing.
- Original Title:
- The pharmacologic and clinical effects of medical cannabis.
- Published In:
- Pharmacotherapy, 33(2), 195-209 (2013)
- Authors:
- Borgelt, Laura M(8), Franson, Kari L, Nussbaum, Abraham M, Wang, George S
- Database ID:
- RTHC-00655
Evidence Hierarchy
Summarizes existing research on a topic.
What do these levels mean? →Frequently Asked Questions
What conditions has medical cannabis been shown to help?
The strongest evidence at the time of this review was for various types of pain (neuropathic, cancer-related, chronic) and muscle spasms, particularly in multiple sclerosis. Dronabinol and nabilone were FDA-approved for chemotherapy nausea and AIDS-related weight loss.
What are the main safety concerns with medical cannabis?
The review highlighted four key concerns: increased schizophrenia risk with adolescent use, impairments in memory and cognitive function, risk of accidental pediatric ingestion (especially with edibles), and the lack of standardized safety packaging for medical cannabis products.
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Cite This Study
https://rethinkthc.com/research/RTHC-00655APA
Borgelt, Laura M; Franson, Kari L; Nussbaum, Abraham M; Wang, George S. (2013). The pharmacologic and clinical effects of medical cannabis.. Pharmacotherapy, 33(2), 195-209. https://doi.org/10.1002/phar.1187
MLA
Borgelt, Laura M, et al. "The pharmacologic and clinical effects of medical cannabis.." Pharmacotherapy, 2013. https://doi.org/10.1002/phar.1187
RethinkTHC
RethinkTHC Research Database. "The pharmacologic and clinical effects of medical cannabis." RTHC-00655. Retrieved from https://rethinkthc.com/research/borgelt-2013-the-pharmacologic-and-clinical
Access the Original Study
Study data sourced from PubMed, a service of the U.S. National Library of Medicine, National Institutes of Health.
This study breakdown was produced by the RethinkTHC research team. We analyze and report published research findings without making health recommendations. All interpretations are based solely on the published abstract and study data.