What conditions is marijuana used to treat?

Medical Uses of Marijuana

Marijuana is primarily used to treat chronic pain, chemotherapy-induced nausea and vomiting, spasticity associated with multiple sclerosis, epilepsy, and appetite stimulation in HIV/AIDS and cancer patients, though evidence quality varies significantly across these conditions. 1

FDA-Approved Cannabis-Based Medications

• Epidiolex (CBD): FDA-approved for:

  • Lennox-Gastaut syndrome
  • Dravet syndrome
  • Tuberous sclerosis complex 1

• Dronabinol (synthetic THC):

  • Treatment of nausea and vomiting from chemotherapy
  • Appetite stimulation in HIV/AIDS patients 1

• Nabilone (synthetic cannabinoid):

  • Approved as an antiemetic for chemotherapy patients 1

Evidence-Based Medical Applications

Strong Evidence (High Quality)

• Epilepsy: Cannabidiol (CBD) improves seizure reduction by 50% and reduces seizure events 2
• Chronic Pain: Cannabis-based medicines may increase the number of people achieving 30% or greater pain relief compared to placebo 3, 2
• Multiple Sclerosis: Nabiximols (THC/CBD combination) approved in several countries for MS-related spasticity 1, 2

Moderate Evidence

• Chemotherapy-Induced Nausea and Vomiting: Cannabinoids can be effective when other antiemetics fail 1
• Appetite Stimulation: Beneficial in HIV/AIDS and cancer patients with cachexia/wasting 1
• Inflammatory Bowel Disease: Cannabinoids may improve quality of life 2

Limited or Inconclusive Evidence

• Cancer Pain: Research ongoing but current evidence is inconclusive 1
• Osteoarthritis: Research ongoing but current evidence is inconclusive 1
• Opioid Weaning: Being investigated but evidence remains limited 1
• Fibromyalgia: Potential benefit but requires more research 1
• Obstructive Sleep Apnea: Potential benefit but requires more research 1

Important Clinical Considerations

Adverse Effects

• Central Nervous System: Cognitive impairment, anxiety, psychosis, memory issues 4
• Cardiovascular: Tachycardia, arterial hypertension, increased risk of myocardial ischemia 4, 5
• Psychiatric: Increased risk of psychiatric disorders (17% vs 5% with placebo) 3
• Tolerance and Dependence: Cannabis use disorder affects approximately 10% of chronic users 4
• Cannabinoid Hyperemesis Syndrome: Paradoxical vomiting syndrome in chronic users 1

High-Risk Populations

• Pregnant and Breastfeeding Women: Should avoid cannabis due to potential negative effects on fetal brain development 1
• Adolescents and Young Adults: Higher risk of developing cannabis use disorder with early initiation 1, 4
• Elderly: May experience more severe sedation, obtundation, and cardiovascular effects 1
• Patients with Mental Health Conditions: May exacerbate existing psychiatric conditions 4

Potency Considerations

• Average THC concentration has increased from 9% in 2008 to 17% in 2017 4
• Cannabis concentrates can contain up to 70% THC 4
• Higher potency is associated with greater risk of adverse effects 4

Legal Status and Accessibility

• Cannabis remains a Schedule I controlled substance under federal law 1
• 38 states and Washington, DC have legalized medical use 1
• 24 states and Washington, DC have legalized recreational use 1
• Legal status creates challenges for research, prescribing, and patient guidance 1

Clinical Decision-Making Algorithm

1. Evaluate if patient's condition has evidence-based support for cannabis use

   • High-quality evidence: Epilepsy, chronic pain, MS spasticity
   • Moderate evidence: Chemotherapy-induced nausea/vomiting, appetite stimulation

2. Consider FDA-approved options first

   • Epidiolex for epilepsy conditions
   • Dronabinol for chemotherapy nausea/vomiting and appetite stimulation
   • Nabilone for chemotherapy nausea/vomiting

3. Assess patient risk factors

   • Age (adolescents and elderly at higher risk)
   • Psychiatric history (avoid in patients with psychosis or severe anxiety)
   • Cardiovascular health (caution with pre-existing conditions)
   • Pregnancy status (contraindicated)
   • History of substance use disorders

4. Discuss potential benefits versus risks

   • Emphasize limited evidence for many conditions
   • Review common adverse effects
   • Discuss legal implications based on state laws

5. If proceeding with treatment:

   • Start with lowest effective dose
   • Monitor for adverse effects
   • Regularly reassess efficacy and continued need
   • Consider discontinuation if inadequate benefit or problematic side effects

Despite growing acceptance and legalization, clinicians should approach medical marijuana with caution, recognizing both its therapeutic potential and significant risks.