Cannabis based medicines and cannabis dependence: a critical review of issues and evidence
Author(s)
Schlag, Anne K
Hindocha, Chandni
Zafar, Rayyan
Nutt, David J
Curran, H Valerie
Type
Journal Article
Abstract
Cannabis has been legalised for medical use in an ever-increasing number of countries. A growing body of scientific evidence supports the use of medical cannabis for a range of therapeutic indications. In parallel with these developments, concerns have been expressed by many prescribers that increased use will lead to patients developing cannabis use disorder. Cannabis use disorder has been widely studied in recreational users, and these findings have often been projected onto patients using medical cannabis. However, studies exploring medical cannabis dependence are scarce and the appropriate methodology to measure this construct is uncertain. This article provides a narrative review of the current research to discern if, how and to what extent, concerns about problems of dependence in recreational cannabis users apply to prescribed medical users. We focus on the main issues related to medical cannabis and dependence, including the importance of dose, potency, cannabinoid content, pharmacokinetics and route of administration, frequency of use, as well as set and setting. Medical and recreational cannabis use differs in significant ways, highlighting the challenges of extrapolating findings from the recreational cannabis literature. There are many questions about the potential for medical cannabis use to lead to dependence. It is therefore imperative to address these questions in order to be able to minimise harms of medical cannabis use. We draw out seven recommendations for increasing the safety of medical cannabis prescribing. We hope that the present review contributes to answering some of the key questions surrounding medical cannabis dependence.
Date Issued
2021-07-01
Date Acceptance
2021-02-01
Citation
Journal of Psychopharmacology, 2021, 35 (7), pp.773-785
ISSN
0269-8811
Publisher
SAGE Publications
Start Page
773
End Page
785
Journal / Book Title
Journal of Psychopharmacology
Volume
35
Issue
7
Copyright Statement
© The Author(s) 2021. Creative Commons License (CC BY 4.0) This article is distributed under the terms of the Creative Commons Attribution 4.0 License (https://creativecommons.org/licenses/by/4.0/) which permits any use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access page (https://us.sagepub.com/en-us/nam/open-access-at-sage).
License URL
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/33593117
Subjects
BLOOD CANNABINOIDS
cannabidiol
cannabis use disorder
Clinical Neurology
dependence
DOUBLE-BLIND
DRUG-USE
INHALED CANNABIS
Life Sciences & Biomedicine
Medical cannabis
MEDICAL MARIJUANA USERS
NEUROPATHIC PAIN
Neurosciences
Neurosciences & Neurology
ORAL DELTA(9)-TETRAHYDROCANNABINOL
OROMUCOSAL SPRAY
Pharmacology & Pharmacy
Psychiatry
Science & Technology
tetrahydrocannabinol
UNITED-STATES
USE DISORDER
Publication Status
Published
Coverage Spatial
United States
Article Number
0269881120986393
Date Publish Online
2021-02-17