Therapeutic potential of medicinal marijuana: an educational primer for health care professionals

Abstract

With the proposed Canadian July 2018 legalization of marijuana through the Cannabis Act, a thorough critical analysis of the current trials on the efficacy of medicinal marijuana (MM) as a treatment option is necessary. This review is particularly important for primary care physicians whose patients may be interested in using MM as an alternative therapy. In response to increased interest in MM, Health Canada released a document in 2013 for general practitioners (GPs) as an educational tool on the efficacy of MM in treating some chronic and acute conditions. Although additional studies have filled in some of the gaps since the release of the Health Canada document, conflicting and inconclusive results continue to pose a challenge for physicians. This review aims to supplement the Health Canada document by providing physicians with a critical yet concise update on the recent advancements made regarding the efficacy of MM as a potential therapeutic option. An update to the literature of 2013 is important given the upcoming changes in legislation on the use of marijuana. Also, we briefly highlight the current recommendations provided by Canadian medical colleges on the parameters that need to be considered prior to authorizing MM use, routes of administration as well as a general overview of the endocannabinoid system as it pertains to cannabis. Lastly, we outline the appropriate medical conditions for which the authorization of MM may present as a practical alternative option in improving patient outcomes as well as individual considerations of which GPs should be mindful. The purpose of this paper is to offer physicians an educational tool that provides a necessary, evidence-based analysis of the therapeutic potential of MM and to ensure physicians are making decisions on the therapeutic use of MM in good faith.

Education and Attitudes on Medical Cannabis in Family Medicine Residency Programs

“…This is consistent with prior research showing knowledge deficits surrounding medical cannabis for practicing clinicians as well as in medical residents. [14][15][16][17][18][19] This has implications for a primary care workforce that is increasingly likely to encounter patients seeking clinical guidance regarding medical cannabis. Regardless of a particular state's legality of cannabis, the overall momentum of cannabis use in the United States is trending toward increased use and overall acceptance.…”

“…[11][12][13] Despite this, educational resources for family physicians are clearly lacking. [14][15][16][17][18][19] While one might assume that physicians in states with a longer history of available medical cannabis would have curriculum around this topic, this is currently unknown. To complicate decisions regarding educational needs, 43% of residents will practice in a state different to where they have completed their training, which may necessitate cannabis training despite local laws.…”

Pharmacodynamics of cannabinoids

“…For example, the international open access journal "Drug, Healthcare and Patient Safety" published a review dealing with the evidence-based analysis of the cannabinoid therapeutic potential; the authors stated that cannabinoids are a suitable alternative to classical treatments for patients suffering from epilepsy, movement disorders, and pain. As a further possible choice are mentioned patients with multiple sclerosis, digestive tract disorders, anorexia, and multiple myeloma [48].…”

CBD Reverts the Mesenchymal Invasive Phenotype of Breast Cancer Cells Induced by the Inflammatory Cytokine IL-1β

“…For several years cannabidiol, CBD, a constituent of Cannabis sativa without psychotropic effects, has been empirically used as an anti-inflammatory drug and modulator of cancer progression. Recent studies highlighted that CBD is toxic at different concentrations in diverse cells, making the results obtained in cell models and the clinic difficult to interpret and, therefore, for defining the proper dose for patients [8]. On the other hand, in vitro studies have shown that activation of the cannabinoid receptors modulates different steps of tumorigenesis in several types of cancer [9,10].…”

“…These reports have suggested that CBD has a potential role in the treatment of tumors and chronic inflammatory diseases. Therefore, a better understanding of the cellular and molecular mechanisms underlying CBD activities is imperative for its safe administration in patients, particularly when treatment is prolonged [8,13].…”