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1.
BMJ ; 374: n1034, 2021 09 08.
Artigo em Inglês | MEDLINE | ID: mdl-34497047

RESUMO

OBJECTIVE: To determine the benefits and harms of medical cannabis and cannabinoids for chronic pain. DESIGN: Systematic review and meta-analysis. DATA SOURCES: MEDLINE, EMBASE, AMED, PsycInfo, CENTRAL, CINAHL, PubMed, Web of Science, Cannabis-Med, Epistemonikos, and trial registries up to January 2021. STUDY SELECTION: Randomised clinical trials of medical cannabis or cannabinoids versus any non-cannabis control for chronic pain at ≥1 month follow-up. DATA EXTRACTION AND SYNTHESIS: Paired reviewers independently assessed risk of bias and extracted data. We performed random-effects models meta-analyses and used GRADE to assess the certainty of evidence. RESULTS: A total of 32 trials with 5174 adult patients were included, 29 of which compared medical cannabis or cannabinoids with placebo. Medical cannabis was administered orally (n=30) or topically (n=2). Clinical populations included chronic non-cancer pain (n=28) and cancer related pain (n=4). Length of follow-up ranged from 1 to 5.5 months. Compared with placebo, non-inhaled medical cannabis probably results in a small increase in the proportion of patients experiencing at least the minimally important difference (MID) of 1 cm (on a 10 cm visual analogue scale (VAS)) in pain relief (modelled risk difference (RD) of 10% (95% confidence interval 5% to 15%), based on a weighted mean difference (WMD) of -0.50 cm (95% CI -0.75 to -0.25 cm, moderate certainty)). Medical cannabis taken orally results in a very small improvement in physical functioning (4% modelled RD (0.1% to 8%) for achieving at least the MID of 10 points on the 100-point SF-36 physical functioning scale, WMD of 1.67 points (0.03 to 3.31, high certainty)), and a small improvement in sleep quality (6% modelled RD (2% to 9%) for achieving at least the MID of 1 cm on a 10 cm VAS, WMD of -0.35 cm (-0.55 to -0.14 cm, high certainty)). Medical cannabis taken orally does not improve emotional, role, or social functioning (high certainty). Moderate certainty evidence shows that medical cannabis taken orally probably results in a small increased risk of transient cognitive impairment (RD 2% (0.1% to 6%)), vomiting (RD 3% (0.4% to 6%)), drowsiness (RD 5% (2% to 8%)), impaired attention (RD 3% (1% to 8%)), and nausea (RD 5% (2% to 8%)), but not diarrhoea; while high certainty evidence shows greater increased risk of dizziness (RD 9% (5% to 14%)) for trials with <3 months follow-up versus RD 28% (18% to 43%) for trials with ≥3 months follow-up; interaction test P=0.003; moderate credibility of subgroup effect). CONCLUSIONS: Moderate to high certainty evidence shows that non-inhaled medical cannabis or cannabinoids results in a small to very small improvement in pain relief, physical functioning, and sleep quality among patients with chronic pain, along with several transient adverse side effects, compared with placebo. The accompanying BMJ Rapid Recommendation provides contextualised guidance based on this body of evidence. SYSTEMATIC REVIEW REGISTRATION: https://osf.io/3pwn2.


Assuntos
Dor do Câncer/tratamento farmacológico , Canabinoides/efeitos adversos , Dor Crônica/tratamento farmacológico , Maconha Medicinal/administração & dosagem , Adulto , Canabinoides/administração & dosagem , Feminino , Humanos , Masculino , Maconha Medicinal/efeitos adversos , Diferença Mínima Clinicamente Importante , Medição da Dor , Ensaios Clínicos Controlados Aleatórios como Assunto , Sono/efeitos dos fármacos
2.
BMJ ; 374: n2040, 2021 09 08.
Artigo em Inglês | MEDLINE | ID: mdl-34497062

RESUMO

CLINICAL QUESTION: What is the role of medical cannabis or cannabinoids for people living with chronic pain due to cancer or non-cancer causes? CURRENT PRACTICE: Chronic pain is common and distressing and associated with considerable socioeconomic burden globally. Medical cannabis is increasingly used to manage chronic pain, particularly in jurisdictions that have enacted policies to reduce use of opioids; however, existing guideline recommendations are inconsistent, and cannabis remains illegal for therapeutic use in many countries. RECOMMENDATION: The guideline expert panel issued a weak recommendation to offer a trial of non-inhaled medical cannabis or cannabinoids, in addition to standard care and management (if not sufficient), for people living with chronic cancer or non-cancer pain. HOW THIS GUIDELINE WAS CREATED: An international guideline development panel including patients, clinicians with content expertise, and methodologists produced this recommendation in adherence with standards for trustworthy guidelines using the GRADE approach. The MAGIC Evidence Ecosystem Foundation (MAGIC) provided methodological support. The panel applied an individual patient perspective. THE EVIDENCE: This recommendation is informed by a linked series of four systematic reviews summarising the current body of evidence for benefits and harms, as well as patient values and preferences, regarding medical cannabis or cannabinoids for chronic pain. UNDERSTANDING THE RECOMMENDATION: The recommendation is weak because of the close balance between benefits and harms of medical cannabis for chronic pain. It reflects a high value placed on small to very small improvements in self reported pain intensity, physical functioning, and sleep quality, and willingness to accept a small to modest risk of mostly self limited and transient harms. Shared decision making is required to ensure patients make choices that reflect their values and personal context. Further research is warranted and may alter this recommendation.


Assuntos
Canabinoides/administração & dosagem , Dor Crônica/tratamento farmacológico , Maconha Medicinal/administração & dosagem , Adolescente , Adulto , Canabinoides/efeitos adversos , Criança , Humanos , Maconha Medicinal/efeitos adversos , Adulto Jovem
5.
Front Public Health ; 9: 626853, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34095048

RESUMO

With the medical use of cannabis permitted in Canada since 2001, patients seek to use this botanical drug to treat a range of medical conditions. However, many healthcare practitioners express the need for further scientific evidence around the use of medical cannabis. This real-world evidence study aimed to address the paucity of scientific data by surveying newly registered medical cannabis patients, before beginning medical cannabis treatment, and at one follow up 6 weeks after beginning medical cannabis treatment. The goal was to collect data on efficacy, safety and cannabis product type information to capture the potential impact medical cannabis had on patient-reported quality of life (QOL) and several medical conditions over a 6-week period using validated questionnaires. The 214 participants were mainly male (58%) and 57% of the population was older than 50. The most frequently reported medical conditions were recurrent pain, post-traumatic stress disorder (PTSD), anxiety, sleep disorders [including restless leg syndrome (RLS)], and arthritis and other rheumatic disorders. Here we report that over 60% of our medical cannabis cohort self-reported improvements in their medical conditions. With the use of validated surveys, we found significant improvements in recurrent pain, PTSD, and sleep disorders after 6 weeks of medical cannabis treatment. Our findings from patients who reported arthritis and other rheumatic disorders are complex, showing improvements in pain and global activity sub-scores, but not overall changes in validated survey scores. We also report that patients who stated anxiety as their main medical condition did not experience significant changes in their anxiety after 6 weeks of cannabis treatment, though there were QOL improvements. While these results show that patients find cannabis treatment effective for a broad range of medical conditions, cannabis was not a remedy for all the conditions investigated. Thus, there is a need for future clinical research to support the findings we have reported. Additionally, while real-world evidence has not historically been utilized by regulatory bodies, we suggest changes in public policy surrounding cannabis should occur to reflect patient reported efficacy of cannabis from real-world studies due to the uniqueness of medical cannabis's path to legalization.


Assuntos
Cannabis , Maconha Medicinal , Canadá , Humanos , Masculino , Maconha Medicinal/efeitos adversos , Medidas de Resultados Relatados pelo Paciente , Qualidade de Vida , Inquéritos e Questionários
6.
Eur J Intern Med ; 89: 10-18, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34083092

RESUMO

Medical cannabis use is increasing worldwide. Clinicians are commonly asked by patients to provide guidance on its safety and efficacy. Although there has been an increase in research on the role of medical cannabis for a number of different conditions, we found that there was a paucity of clear safety guidance on its use. We aim to address this issue by answering two pertinent clinician safety questions: 1 Can medical cannabis be safely used in this patient? 2. What strategies can be used to ensure that any harms from medical cannabis are mitigated? To address these questions, we reviewed available evidence and provided expert clinical opinion to summarize the fundamental components for evaluating medical cannabis safety and strategies to reduce risk from its use. Our review resulted in a safety-focused framework for medical cannabis initiation and utilization. We provide clear recommendations for patients being considered for cannabis (e.g. precautions, contraindications and drug interactions). Risk mitigation strategies such as appropriate chemovar (strain) selection, routes of administration, and dosing are reviewed. As with any other pharmacotherapy, we review the key components of monitoring and address potential issues that may arise while using medical cannabis. We propose a structured assessment and monitoring strategy that can be used by clinicians recommending cannabis (CRC) to guide patients through each step of their cannabis journey. This framework can be used to ensure that medical cannabis utilization is associated with the lowest possible risk to the patient.


Assuntos
Canabidiol , Cannabis , Maconha Medicinal , Analgésicos , Interações Medicamentosas , Humanos , Maconha Medicinal/efeitos adversos
7.
CMAJ Open ; 9(2): E563-E569, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34021014

RESUMO

BACKGROUND: Cannabis is legal for recreational and medical use in Canada. Our aim was to explore family experiences using medical cannabis for children with severe conditions in the context of legalization. METHODS: We conducted a qualitative study using semistructured interviews between April and July 2019. Participants were parents of children attending BC Children's Hospital oncology or palliative care clinics, recruited through posters, emails or referral. Participants were included if they spoke English and their child used any type of cannabis for medical purposes. Interviews included open-ended questions about the child's cannabis use. Interviews were recorded and transcribed, and thematic analysis was performed using qualitative description. RESULTS: Ten interviews were completed with 9 mothers and 1 mother-father pair. The age range of the children was 22 months to 16 years. The primary reasons for cannabis use were epilepsy (6 children) or chemotherapy management (4 children). Five major themes were identified. 1) Child and family context, and cannabis as a last resort: children were seen as severely ill; parents sought cannabis out of desperation and responsibility to their child. 2) Varied information sources informed decision-making: parents lacked resources from health care providers and sought support from social media, industry and other families. 3) Cannabis as an ambiguous medicine: cannabis was viewed as both a serious drug that doctors should prescribe and as a natural alternative health product, safe to pursue alone. 4) Perceived effects: parents perceived medical benefits with few concerns about adverse effects. 5) Legal and financial challenges: parents were willing to obtain cannabis despite high costs and uncertain legality. INTERPRETATION: Parents of children with severe conditions pursued medical cannabis despite obstacles and needed unbiased information to access alone. Scientific investigation is needed to develop pediatric medical guidelines to inform decisions.


Assuntos
Epilepsia/tratamento farmacológico , Maconha Medicinal/uso terapêutico , Neoplasias/tratamento farmacológico , Cuidados Paliativos , Pais/psicologia , Percepção Social , Adulto , Atitude Frente a Saúde , Canadá/epidemiologia , Criança , Epilepsia/psicologia , Feminino , Humanos , Masculino , Maconha Medicinal/efeitos adversos , Maconha Medicinal/economia , Neoplasias/psicologia , Cuidados Paliativos/métodos , Cuidados Paliativos/psicologia , Psico-Oncologia/métodos , Pesquisa Qualitativa , Medição de Risco
9.
CMAJ Open ; 9(2): E342-E348, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33849983

RESUMO

BACKGROUND: Medical cannabis has been legally available in Canada since 2001, but its benefits and harms remain uncertain. We explored attitudes toward medical cannabis among family physicians practising in Ontario. METHODS: Between January and October 2019, we conducted a qualitative study of Ontario family physicians using semistructured telephone interviews. We applied thematic analysis to interview transcripts and identified representative quotes. RESULTS: Eleven physicians agreed to be interviewed, and 3 themes regarding medical cannabis emerged: reluctance to authorize use, concern over harms and lack of practical knowledge. Participants raised concerns about the limited evidence for, and their lack of education regarding, the therapeutic use of cannabis, particularly the harms associated with neurocognitive development, exacerbation of mental illness and drug interactions in older adults. Some participants thought medical cannabis was overly accessible and questioned their role following legalization of recreational cannabis. INTERPRETATION: Despite the increasing availability of medical cannabis, family physicians expressed reluctance to authorize its use because of lack of knowledge and concerns regarding harms. Family physicians may benefit from guidance and education that address concerns they have surrounding medical cannabis.


Assuntos
Acesso aos Serviços de Saúde , Maconha Medicinal , Saúde Mental , Médicos de Família , Padrões de Prática Médica , Atitude do Pessoal de Saúde , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Acesso aos Serviços de Saúde/legislação & jurisprudência , Acesso aos Serviços de Saúde/estatística & dados numéricos , Humanos , Masculino , Maconha Medicinal/efeitos adversos , Maconha Medicinal/uso terapêutico , Saúde Mental/ética , Saúde Mental/tendências , Pessoa de Meia-Idade , Determinação de Necessidades de Cuidados de Saúde , Ontário/epidemiologia , Médicos de Família/educação , Médicos de Família/ética , Médicos de Família/psicologia , Padrões de Prática Médica/ética , Padrões de Prática Médica/normas , Pesquisa Qualitativa , Medição de Risco
10.
Exp Clin Psychopharmacol ; 29(2): 147-156, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33764103

RESUMO

Previous studies have demonstrated improvements in pain following short-term medical cannabis (MC) use, suggesting long-term MC treatment may alleviate symptoms associated with chronic pain. The goal of this observational and longitudinal study was to examine patients using MC to treat chronic pain pre versus post MC treatment. These interim analyses included 37 patients with chronic pain evaluated prior to initiation of MC treatment and following 3 and 6 months of MC use; pain, clinical state, sleep, quality of life, and conventional medication use were assessed. Correlation analyses examined the relationship between changes in pain and other clinical measures, assessed the impact of cannabinoid exposure on pain and clinical ratings, and assessed whether baseline cannabis expectancies influenced outcome variables. Additionally, a pilot group of treatment-as-usual patients (n = 9) who did not use MC were examined at baseline and 3 months later. Relative to baseline, following 3 and 6 months of treatment, MC patients exhibited improvements in pain which were accompanied by improved sleep, mood, anxiety, and quality of life, and stable conventional medication use. Reduced pain was associated with improvements in aspects of mood and anxiety. The results generally suggest increased THC exposure was related to pain-related improvement, while increased CBD exposure was related to improved mood. Cannabis expectancies were not related to observed improvements. Pilot analyses revealed that treatment-as-usual patients do not demonstrate the same pattern of improvement. Findings highlight the potential efficacy of MC treatment for pain and underscore the unique impact of individual cannabinoids on specific aspects of pain and comorbid symptoms. (PsycInfo Database Record (c) 2021 APA, all rights reserved).


Assuntos
Canabinoides/uso terapêutico , Dor Crônica/tratamento farmacológico , Maconha Medicinal/administração & dosagem , Adulto , Idoso , Ansiedade/tratamento farmacológico , Feminino , Humanos , Estudos Longitudinais , Masculino , Maconha Medicinal/efeitos adversos , Pessoa de Meia-Idade , Qualidade de Vida
11.
Nurs Outlook ; 69(4): 672-685, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33581859

RESUMO

BACKGROUND: Cancer survivors are vulnerable to Cannabis Use (CU) and at increased risk for depression. Yet, the relationship between CU and depression among cancer survivors is unknown. PURPOSE: The purpose of this study was to estimate the prevalence of daily/non-daily CU, investigate the association between CU and depression and evaluate CU reasons and methods of administration among cancer survivors. METHOD: Population-based, nationally representative sample of cancer survivors aged ≥18 (n = 10,799) from 2018 Behavioral Risk Factor Surveillance System Survey was used. Weighted descriptive statistics and multivariate logistic regression were conducted. FINDINGS: Overall, 4.2% reported daily and 4.1% non-daily CU. Those who self-reported depression had higher prevalence of daily and non-daily CU than those not reporting depression. Daily CU was associated with 120% increased odds of depression (odds ratio = 2.2, 95% confidence interval [1.3, 3.7]) compared with none-users. DISCUSSION: Efforts to improve open communications and evidence-informed discussions regarding benefits and risks of CU and reasons for using cannabis between clinicians and cancer survivors are imperative.


Assuntos
Sobreviventes de Câncer/psicologia , Depressão/induzido quimicamente , Depressão/epidemiologia , Maconha Medicinal/efeitos adversos , Maconha Medicinal/uso terapêutico , Neoplasias/tratamento farmacológico , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Sobreviventes de Câncer/estatística & dados numéricos , Estudos Transversais , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Vigilância da População , Prevalência , Inquéritos e Questionários , Estados Unidos/epidemiologia , Adulto Jovem
12.
Toxins (Basel) ; 13(2)2021 02 05.
Artigo em Inglês | MEDLINE | ID: mdl-33562446

RESUMO

For thousands of years, Cannabis sativa has been utilized as a medicine and for recreational and spiritual purposes. Phytocannabinoids are a family of compounds that are found in the cannabis plant, which is known for its psychotogenic and euphoric effects; the main psychotropic constituent of cannabis is Δ9-tetrahydrocannabinol (Δ9-THC). The pharmacological effects of cannabinoids are a result of interactions between those compounds and cannabinoid receptors, CB1 and CB2, located in many parts of the human body. Cannabis is used as a therapeutic agent for treating pain and emesis. Some cannabinoids are clinically applied for treating chronic pain, particularly cancer and multiple sclerosis-associated pain, for appetite stimulation and anti-emesis in HIV/AIDS and cancer patients, and for spasticity treatment in multiple sclerosis and epilepsy patients. Medical cannabis varies from recreational cannabis in the chemical content of THC and cannabidiol (CBD), modes of administration, and safety. Despite the therapeutic effects of cannabis, exposure to high concentrations of THC, the main compound that is responsible for most of the intoxicating effects experienced by users, could lead to psychological events and adverse effects that affect almost all body systems, such as neurological (dizziness, drowsiness, seizures, coma, and others), ophthalmological (mydriasis and conjunctival hyperemia), cardiovascular (tachycardia and arterial hypertension), and gastrointestinal (nausea, vomiting, and thirst), mainly associated with recreational use. Cannabis toxicity in children is more concerning and can cause serious adverse effects such as acute neurological symptoms (stupor), lethargy, seizures, and even coma. More countries are legalizing the commercial production and sale of cannabis for medicinal use, and some for recreational use as well. Liberalization of cannabis laws has led to increased incidence of toxicity, hyperemesis syndrome, lung disease cardiovascular disease, reduced fertility, tolerance, and dependence with chronic prolonged use. This review focuses on the potential therapeutic effects of cannabis and cannabinoids, as well as the acute and chronic toxic effects of cannabis use on various body systems.


Assuntos
Canabinoides/uso terapêutico , Cannabis , Maconha Medicinal/uso terapêutico , Sistema Nervoso/efeitos dos fármacos , Plantas Tóxicas , Animais , Canabinoides/efeitos adversos , Canabinoides/isolamento & purificação , Cannabis/efeitos adversos , Humanos , Abuso de Maconha/metabolismo , Abuso de Maconha/fisiopatologia , Abuso de Maconha/psicologia , Maconha Medicinal/efeitos adversos , Sistema Nervoso/metabolismo , Sistema Nervoso/fisiopatologia , Síndromes Neurotóxicas/metabolismo , Síndromes Neurotóxicas/fisiopatologia , Síndromes Neurotóxicas/psicologia , Plantas Tóxicas/efeitos adversos , Receptores de Canabinoides/efeitos dos fármacos , Receptores de Canabinoides/metabolismo , Transdução de Sinais
13.
Mult Scler Relat Disord ; 48: 102708, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33387864

RESUMO

INTRODUCTION: The use of cannabis as medical therapy to treat chronic pain and spasticity in patients with multiple sclerosis (MS) is increasing. However, the evidence on safety when initiating treatment with medical cannabis oils is limited. The aim of this study was to investigate the safety of sublingual medical cannabis oils in patients with MS. METHODS: In this prospective observational safety study 28 patients with MS were treated with medical cannabis oils (THC-rich, CBD-rich and THC+CBD combined products) and were followed during a titration period of four weeks. Patients were evaluated at treatment start (Visit 1) and after four weeks treatment (Visit 2). At each visit neurological examination (Expanded Disability Status Scale - EDSS), ambulation (Timed 25-Foot Walk Test - T25FWT), routine blood tests, plasma cannabinoids, dexterity (9-Hole Peg Test - 9-HPT) and processing speed (Symbol Digit Modalities Test - SDMT) were tested. Adverse events (AEs) and tolerability were reported at Visit 2. Secondary, efficacy of medical cannabis on pain, spasticity and sleep disturbances were measured by numeric rating scale (NRS-11) each day during the 4-week treatment period. RESULTS: During treatment with cannabis preparations containing 10-25 mg/mL THC, the most common AEs were dry mouth, drowsiness, dizziness and nausea of mild to moderate degree. Two patients experienced pronounced symptoms with excessive dreaming and drowsiness, respectively, which led to treatment stop during the titration. Three serious adverse events (SAE) were reported but were not associated with the treatment. Mean doses of THC and CBD were 4.0 mg and 7.0 mg, respectively, and primarily administered as a once-daily evening dose. Furthermore, pain decreased from a median NRS score of 7 to 4, (p = 0.01), spasticity decreased from a median NRS score of 6 to 2.5 (p = 0.01) and sleep disturbances decreased from a median NRS score of 7 to 3 (p < 0.001). No impairment in disability, ambulation, dexterity or processing speed was observed. CONCLUSION: Treatment with medical cannabis oils was safe and well tolerated, and resulted in a reduction in pain intensity, spasticity and sleep disturbances in MS patients. This suggests that medical cannabis oils can be used safely, especially at relatively low doses and with slow titration, as an alternative to treat MS-related symptoms when conventional therapy is inadequate.


Assuntos
Canabidiol , Cannabis , Maconha Medicinal , Esclerose Múltipla , Canabidiol/efeitos adversos , Cannabis/efeitos adversos , Dronabinol/efeitos adversos , Humanos , Maconha Medicinal/efeitos adversos , Esclerose Múltipla/complicações , Esclerose Múltipla/tratamento farmacológico , Espasticidade Muscular/tratamento farmacológico , Óleos
14.
Transplantation ; 105(2): 291-299, 2021 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-32413017

RESUMO

Cannabis, or marijuana, comprises many compounds with varying effects. It has become a treatment option for chronic diseases and debilitating symptoms, and evidence suggests that it has immunomodulatory and antiinflammatory properties. Transplant centers are more frequently facing issues about cannabis, as indications and legalization expand. As of February 2020, 33 states and the District of Columbia have legalized medical cannabis, and 14 have legalized recreational cannabis. Moreover, 8 states have passed legislation prohibiting the denial of transplant listing solely based on cannabis use. Studies demonstrate the potential for significant pharmacokinetic and pharmacodynamic interactions between cannabis and immunosuppression. Additionally, safety concerns include increased risk of myocardial infarction, ischemic stroke, tachyarrhythmias, malignancy, neurocognitive deficits, psychosis, other neuropsychiatric disorders, cannabis use disorder, respiratory symptoms, and infection. A recent retrospective database study found a negative association between documented cannabis use disorder and graft survival, but little additional evidence exists evaluating this relationship. In the absence of robust clinical data, transplant centers need a clear, reasoned, and systematic approach to cannabis. The results of our national survey, unfortunately, found little consensus among institutions. As both recreational and medicinal cannabis become more ubiquitous nationwide, transplant centers will need to develop comprehensive policies to address its use.


Assuntos
Imunossupressores/farmacocinética , Abuso de Maconha/complicações , Fumar Maconha/efeitos adversos , Maconha Medicinal/efeitos adversos , Transplante de Órgãos , Tomada de Decisão Clínica , Interações Medicamentosas , Humanos , Imunossupressores/administração & dosagem , Imunossupressores/efeitos adversos , Abuso de Maconha/imunologia , Fumar Maconha/imunologia , Fumar Maconha/legislação & jurisprudência , Transplante de Órgãos/efeitos adversos , Transplante de Órgãos/legislação & jurisprudência , Formulação de Políticas , Medição de Risco , Fatores de Risco , Resultado do Tratamento
15.
JBI Evid Synth ; 19(5): 1251-1258, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33165173

RESUMO

OBJECTIVE: The objective of this scoping review is to map and identify the symptoms, adverse events, and outcomes in the use of medicinal cannabis in children and adolescents with autism spectrum disorder. INTRODUCTION: Autism spectrum disorder is a neurodevelopmental disorder that impacts social communication and social interaction, and is associated with restrictive and repetitive behaviors and interests. Medicinal cannabis has become a potential area of interest for parents for the treatment of autism spectrum disorder symptoms in their children. There is some evidence that cannabinoids may be involved in autism spectrum disorder, laying a potential foundation for medicinal cannabis utility; however, previous reviews did not identify any clinical research on this topic. INCLUSION CRITERIA: This scoping review will consider all published and unpublished studies that investigate the use of medicinal cannabis in autism spectrum disorder, where at least 50% of the participants have a diagnosis of autism spectrum disorder and at least 50% of the study population is 0 to 18 years of age, or where pediatric data are reported separately. Studies undertaken in any context (hospital or community) and in any geographic location will be included. METHODS: We will search MEDLINE, Embase, CINAHL, PsycINFO, Web of Science, and Google Scholar, and the gray literature sources for studies. Two independent team members will screen titles and abstracts, review full texts for potential inclusion, and extract data for all studies. The results will be presented as a narrative synthesis and in tabular form.


Assuntos
Transtorno do Espectro Autista , Maconha Medicinal , Adolescente , Transtorno do Espectro Autista/tratamento farmacológico , Criança , Atenção à Saúde , Humanos , Maconha Medicinal/efeitos adversos , Pais , Literatura de Revisão como Assunto
16.
Am J Med ; 134(2): 182-193, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33186596

RESUMO

Utilization of marijuana as a medicinal agent is becoming increasingly popular, and so far, 25 states have legalized it for medical purposes. However, there is emerging evidence that marijuana use can result in cardiovascular side effects, such as rhythm abnormalities, syncope/dizziness, and myocardial infarction, among others. Further, there are currently no stringent national standards or approval processes, like Food and Drug Administration (FDA) evaluation, in place to assess medical marijuana products. This review includes the largest up-to-date pooled population of patients with exposure to marijuana and reported cardiovascular effects. Although purported as benign by many seeking to advance the use of marijuana as an adjunctive medical therapy across the country, marijuana is associated with its own set of cardiovascular risks and deserves further definitive study and the same level of scrutiny we apply in research of all other types of medications. When used as a medicinal agent, marijuana should be regarded accordingly, and both clinical providers and patients must be aware of potential adverse effects associated with its use for early recognition and management.


Assuntos
Doenças Cardiovasculares/induzido quimicamente , Maconha Medicinal/efeitos adversos , Humanos , Estados Unidos
17.
J Altern Complement Med ; 27(3): 198-213, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33337931

RESUMO

Background: Fibromyalgia (FMS) is a complex condition that is characterized by various pain syndromes and fatigue, among other symptoms experienced. Current medical treatment of FMS involves both pharmacological and nonpharmacological approaches, but often with ineffective outcomes. Medicinal cannabis has the potential to be a therapeutic option for patients with FMS due to the positive research in chronic pain management. In addition, it has been found to have fewer adverse effects compared with currently available pain medications. This literature review aims at answering whether medicinal cannabis is reported to be safe and effective for the treatment of pain and symptomology experienced by people with FMS. Methods: A systematic review was conducted on human trials utilizing cannabis in FMS. MEDLINE, Embase, CINAHL, AMED, Scopus, and Cochrane CENTRAL were used for databases search, and mesh terms were used for cannabis and FMS. The search was limited to studies conducted from 2000 to 2020. Results: From the 181 citations identified, 10 studies were included after title, abstract, and full text screening occurred. A total of 1136 of patients (intervention n = 945, control n = 108, crossover n = 83) participated in the 10 studies ranging from 9 to 383 patients (mean = 114, median = 36). Of these studies, there were three randomized controlled trials, six observational studies, and one study that compared the management of chronic pain patients with FMS patients. Cannabis was found to be safe and well tolerated in FMS. The main adverse events identified included feeling "high," dizziness/vertigo, dry mouth, cough, red eyes, and drowsiness with no serious adverse events reported. Conclusions: This literature review identified that medical cannabis may be beneficial for some people with FMS. Further studies are required to confirm its efficacy, what type of cannabis is the most effective form to use, and what assessment tools need to be utilized to understand how to quantify clinical outcomes.


Assuntos
Fibromialgia/tratamento farmacológico , Maconha Medicinal , Dor Crônica/tratamento farmacológico , Humanos , Maconha Medicinal/efeitos adversos , Maconha Medicinal/uso terapêutico
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