Medical Cannabis Review: Pain and Spasticity Have the Best Evidence, but Safety Concerns Remain

What the researchers 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.

Why it 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 numbers in context

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 the study worked

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.

What this study cannot 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 Rapidly evolving legal landscape may have made some observations outdated quickly.

How to read the evidence

Narrative review synthesizing clinical evidence across multiple cannabis formulations; moderate evidence base.

When this study was published

Published in 2013. The medical cannabis evidence base has grown substantially since, with additional clinical trials and more states legalizing.

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.

Questions still open

• 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?

Common questions

Read the original research

The pharmacologic and clinical effects of medical cannabis.

Pharmacotherapy, 33(2), 195-209

Citation

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

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