Cannabis in Medicine: Evidence Base Approachch

Editor: Finn, Kenneth (Ed.)

Legalization of marijuana is becoming increasingly prominent in the United States and around the world. While there is some discussion of the relationship between marijuana and overall health, a comprehensive resource that outlines the medical literature for several organ systems, as well as non-medical societal effects, has yet to be seen. While all physicians strive to practice evidence-based medicine, many clinicians aren’t aware of the facts surrounding cannabis and are guided by public opinion.
This first of its kind book is a comprehensive compilation of multiple facets of cannabis recommendation, use and effects from a variety of different perspectives. Comprised of chapters dedicated to separate fields of medicine, this evidence-based guide outlines the current data, or lack thereof, as well as the need for further study. The book begins with a general overview of the neurobiology and pharmacology of THC and hemp. It then delves into various medical concerns that plague specific disciplines of medicine such as psychiatry, cardiology, gastrointestinal and neurology, among others. The end of the book focuses on non-medical concerns such as public health and safety, driving impairment and legal implications.

Comprised of case studies and meta-analyses, Cannabis in Medicine:  An Evidence-Based Approach provides clinicians with with a concise, evidence-based guide to various health concerns related to the use of marijuana. By addressing non-medical concerns, this book is also a useful resource for professionals working in the public health and legal fields.

IS MARIJUANA A TRUE MEDICINE?

True medicine approved by the FDA undergoes rigorous trials and research. Due to potential complications noted during those trials, many new medications do not make it to the market. A drug that becomes available for prescription purposes comes with a dosage guideline. For example, amoxicillin (a commonly prescribed antibiotic) has a dosing guideline for adults – 500 mg three times a day and a weight-based calculated dosing guideline for children. The medical marijuana products comes with no standardized drug content recommendations and no dosing guidelines. An exception is the FDA-approved medication – Epidiolex (3), but it comes from pharmacies, not the marijuana shops.

Because of clever marketing, the public believes in many “treatments” or “cures” from the use of CBD and or THC products. Side effects and drug interactions occur with every drug on the market. The cannabis industry hasn’t informed the general public of the potential consequences, drug interactions and side effects of these products called medications. 

by Emergency Room doctor, Dr. Karen Randall

“No such thing as Medical Marijuana”

U.S. Surgeon General’s Advisory: Marijuana Use and the Developing Brain

You Can Take Action

No amount of marijuana use during pregnancy or adolescence is known to be safe. Until and unless more is known about the long-term impact, the safest choice for pregnant women and adolescents is not to use marijuana.  Pregnant women and youth–and those who love them–need the facts and resources to support healthy decisions. It is critical to educate women and youth, as well as family members, school officials, state and local leaders, and health professionals, about the risks of marijuana, particularly as more states contemplate legalization.

Science-based messaging campaigns and targeted prevention programming are urgently needed to ensure that risks are clearly communicated and amplified by local, state, and national organizations. Clinicians can help by asking about marijuana use, informing mothers-to-be, new mothers, young people, and those vulnerable to psychotic disorders, of the risks. Clinicians can also prescribe safe, effective, and FDA-approved treatments for nausea, depression, and pain during pregnancy. Further research is needed to understand all the impacts of THC on the developing brain, but we know enough now to warrant concern and action. Everyone has a role in protecting our young people from the risks of marijuana.

Cannabinoid Drug-Drug Interactions

Delta-9-Tetrahydrocannabinol (∆9-THC) & Cannabidiol (CBD) Drug-Drug Interactions

Cannabinoid (as Precipitant) Drug-Drug Interactions

   Although regulatory agency approved prescribing information is often the initial source of information when identifying potential drug-drug interactions, it may only provide for a limited number of exemplars or only reference a class of medications without providing any specific medication examples.  However, with the recent deregulation of CBD oil (hemp oil) and the steady increase in states and countries that have legalized recreational and medical marijuana, these products are often not associated with regulatory agency approved prescribing information.

Penn State College of Medicine, Dept of Pharmacology

   One of the objectives of this website, and associated journal article, is to develop a comprehensive and detailed cannabinoid drug-drug interaction list aligned with regulatory approved prescribing information.  Also, as newer medications are approved, and real-world evidence accumulates, another objective is to routinely update this drug-drug interaction list.

   The following cannabinoid drug-drug interaction information is predicated on regulatory agency approved cannabinoid manufacturer prescribing information, and then supplemented with the FDA Drug Development and Drug Interactions: Table of Substrates, Inhibitors and Inducers’ online document and the DrugBank database.

Penn State College of Medicine, Dept of Pharmacology