Practice Uncertainties Page

Should doctors prescribe cannabinoids?

BMJ 2014; 348 doi: https://doi.org/10.1136/bmj.g2737 (Published 23 April 2014) Cite this as: BMJ 2014;348:g2737
  1. Michael Farrell, professor and director1,
  2. Rachelle Buchbinder, director and professor2,
  3. Wayne Hall, professor, National Health and Medical Research Council Australia fellow, and deputy director (policy)3
  1. 1National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW 2031, Australia
  2. 2Monash Department of Clinical Epidemiology, Cabrini Hospital; Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia
  3. 3University of Queensland Centre for Clinical Research, Herston, Qld, Australia
  1. Correspondence to: M Farrell michael.farrell{at}unsw.edu.au

The medical use of cannabis was advocated in the United States in the 1970s and 1980s when clinical trials of oral synthetic tetrahydrocannabinol (THC) and other oral synthetic cannabinoids reported efficacy in controlling nausea in patients with cancer who were undergoing chemotherapy.1 Dronabinol (an oral synthetic THC) was approved by the Food and Drug Administration in 1985 for this indication,1 but it was not widely used because patients were unable to titrate doses or disliked its psychoactive effects.1 It is still available in the US, United Kingdom, and the rest of Europe.

Box 1 outlines the different formulations of cannabinoids, the term we use for the sake of clarity and convenience to refer to synthetic cannabinoids and drugs derived from the cannabis plant, such as nabiximols. Box 2 lists indications for which cannabinoids have been approved for medical use.

Box 1: Forms of cannabis and cannabinoids

  • Cannabis: Any product of the Cannabis sativa plant (such as marijuana or hash) that is smoked for its psychoactive effects

  • Cannabinoids: This term usually refers to a group of different chemical compounds that activate cannabinoid receptors in the body, including marijuana, endogenous neurotransmitters, and synthetic compounds. However, in this article, we use it to refer specifically to pharmaceutical drugs that are either:

    • Medical extracts from the cannabis plant, such as nabiximols (a patented formulation, trade name Sativex) or

    • Synthetic drugs that act on cannabinoid receptors, such as dronabinol and nabilone

  • Tetrahydrocannabinol (THC): The constituent of cannabis that by acting as an agonist on cannabinoid receptors is responsible for many of its psychoactive effects

  • Cannabinoid agonists: Cannabinoids that produce psychological effects similar to those produced by THC

Box 2: Approved medical uses for tetrahydrocannabinol and nabiximols

  • Controlling nausea and vomiting in cancer chemotherapy and radiotherapy (US)

  • Stimulating appetite in patients with AIDS related wasting (US)

  • Alleviating chronic neuropathic pain and muscle spasticity in multiple sclerosis (UK)

In the …

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