Therapeutic use of cannabis and cannabinoids: an evidence mapping and appraisal of systematic reviews

Abstract

Background: Although cannabis and cannabinoids are widely used with therapeutic purposes, their claimed efficacy is highly controversial. For this reason, medical cannabis use is a broad field of research that is rapidly expanding. Our objectives are to identify, characterize, appraise, and organize the current available evidence surrounding therapeutic use of cannabis and cannabinoids, using evidence maps. Methods: We searched PubMed, EMBASE, The Cochrane Library and CINAHL, to identify systematic reviews (SRs) published from their inception up to December 2017. Two authors assessed eligibility and extracted data independently. We assessed methodological quality of the included SRs using the AMSTAR tool. To illustrate the extent of use of medical cannabis, we organized the results according to identified PICO questions using bubble plots corresponding to different clinical scenarios. Results: A total of 44 SRs published between 2001 and 2017 were included in this evidence mapping with data from 158 individual studies. We extracted 96 PICO questions in the following medical conditions: multiple sclerosis, movement disorders (e.g. Tourette Syndrome, Parkinson Disease), psychiatry conditions, Alzheimer disease, epilepsy, acute and chronic pain, cancer, neuropathic pain, symptoms related to cancer (e.g. emesis and anorexia related with chemotherapy), rheumatic disorders, HIV-related symptoms, glaucoma, and COPD. The evidence about these conditions is heterogeneous regarding the conclusions and the quality of the individual primary studies. The quality of the SRs was moderate to high according to AMSTAR scores. Conclusions: Evidence on medical uses of cannabis is broad. However, due to methodological limitations, conclusions were weak in most of the assessed comparisons. Evidence mapping methodology is useful to perform an overview of available research, since it is possible to systematically describe the extent and distribution of evidence, and to organize scattered data.

A description of self-medication with cannabis among adults with legal access to cannabis

“…Main conditions treated by participants in our sample are similar to those reported in previous survey of patients seeking cannabis to treat a health condition (8,11,12). These treated conditions were consistent with the potential pharmacologic effects of cannabis and cannabinoids in the literature (13,14). The high number of conditions treated per participant is problematic and suggest that cannabis may be perceived as effective for a wide range of conditions, which is not supported by current literature.…”

Consensus recommendations on dosing and administration of medical cannabis to treat chronic pain: results of a modified Delphi process

“…Upon recruitment, the task force participants completed a practice patterns survey (Additional file 1) to gain insights into how clinicians around the world were treating patients with medical cannabis. After the practice profile was completed, nine recent articles were provided to the task force (Habib and Artul 2018;Banerjee and McCormack 2019;Crawley et al 2019;Maher et al 2019;Boyaji et al 2020;Johal et al 2020;Montero-Oleas et al 2020;Wong et al 2020;Gulbransen et al 2020). An initial draft of 37 consensus questions was developed based on the practice patterns survey and reviewed for rationale and applicability to clinical practice by a nine-member scientific committee.…”

Cannabinoids in disorders of gut-brain interaction and gastrointestinal motility

“…There has been an increasing development of systematic reviews and meta-analyses in the past 5 years to verify the efficacy of cannabinoid-based medicines in various clinical settings 47 . Despite limitations of randomized controlled trials, the most significant and conclusive evidence regarding safety and efficacy of cannabinoid-based medicines has been demonstrated for the treatment of chronic neuropathic pain, CINV, drug-resistant epilepsy, and spasticity in MS.…”