A broad review of cannabinoid pharmacology found therapeutic potential across multiple conditions including MS spasticity, neuropathic pain, nausea, epilepsy, psychosis, and addiction.
Read this if you want a comprehensive overview of what conditions cannabinoid medicines may treat.
ECS modulates immune response, appetite, cognition, emotion, motor coordination, sleep, and bone metabolism
What the researchers found
The review covers the endocannabinoid system's role in immune response, appetite, cognition, emotion, perception, motor coordination, body temperature, sleep, and bone metabolism. THC and CBD have contrasting pharmacological profiles: THC activates cannabinoid receptors producing both therapeutic and intoxicating effects, while CBD modulates the system without intoxication.
The strongest clinical evidence existed for MS spasticity (Sativex), chronic neuropathic pain, and chemotherapy-induced nausea and vomiting. Emerging areas of research included epilepsy, psychosis, addiction, and metabolic disorders.
The review also considers the risks of drugs that inhibit the endocannabinoid system (like the withdrawn weight-loss drug rimonabant, which caused serious psychiatric side effects), demonstrating that both enhancing and suppressing this system carries therapeutic potential and risk.
Why it matters
This review provides a comprehensive overview of the state of cannabinoid medicine as of 2014, capturing a critical inflection point when cannabis-based medicines were transitioning from fringe therapies to regulated pharmaceuticals. It frames the therapeutic landscape that would continue to develop over the following decade.
The numbers in context
Indications reviewed: MS spasticity, neuropathic pain, nausea/vomiting, appetite/weight (cancer/AIDS), psychosis, epilepsy, addiction, metabolic disorders. Key contrast: THC (intoxicating, receptor agonist) vs. CBD (non-intoxicating, modulatory).
How the study worked
This is a narrative review of clinical research on cannabinoid medicines. It covers the pharmacology of THC and CBD, the endocannabinoid system, and clinical evidence across multiple indications. The review was published alongside related papers on cannabis cultivation and pharmaceutical development.
What this study cannot tell us
This is a narrative review that predates many of the definitive clinical trials in cannabinoid medicine. The evidence base was still developing for most indications. The review was published in a journal focused on drug testing, and the selection of evidence may not be comprehensive.
How to read the evidence
This is a narrative review covering a wide range of indications with varying levels of evidence, from well-established (MS spasticity) to highly preliminary (metabolic disorders).
When this study was published
Published in 2014. Significant clinical advances have occurred since, including FDA approval of Epidiolex for epilepsy in 2018.
The bigger picture
The endocannabinoid system's involvement in so many physiological processes explains both the broad therapeutic potential and the broad side effect profile of cannabinoid medicines. The contrast between THC and CBD pharmacology has become the central organizing principle for cannabinoid medicine development.
Questions still open
- Which indications will produce the strongest clinical evidence for cannabinoid medicines? Can the therapeutic effects of THC be achieved without its intoxicating properties? What new cannabinoid compounds beyond THC and CBD will prove therapeutically useful?
Common questions
What is the difference between THC and CBD?
What happened with rimonabant?
Read the original research
Therapeutic potential of cannabinoid medicines.
Drug testing and analysis, 6(1-2), 24-30
Citation
Robson, P J. (2014). Therapeutic potential of cannabinoid medicines.. Drug testing and analysis, 6(1-2), 24-30. https://doi.org/10.1002/dta.1529
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