Table 2. Evidence supporting the use of marijuana/cannabinoids for selected conditionsa.
| Agitation in Alzheimer's disease | Small RCT (N = 12) showed a decrease in agitation from dronabinol treatment, though sedation was a common side effect, suggesting a nonspecific effect (25) Long-term safety of psychoactive cannabinoids in demented patients is potentially problematic and has not been thoroughly evaluated |
| Cachexia/anorexia | Dronabinol is approved by the FDA for the treatment of cachexia in HIV/AIDS (8, 9) Large RCT (N = 243) comparing oral THC, oral cannabis extract, and placebo for the treatment of cancer-related cachexia showed no difference between treatment groups (26). Another large RCT (N = 469) showed oral THC is inferior to megestrol in cancer-related cachexia (27) |
| Crohn's disease | Small RCT (N = 21) showed no difference in remission but suggested symptomatic improvement in the group receiving active cannabis cigarettes; no objective measures (i.e., endoscopic biopsies) were evaluated (28) Although preclinical evidence suggests a possible anti-inflammatory role of cannabinoids (23), large RCTs have not established the efficacy of marijuana in Crohn's disease |
| Epilepsy | Three small RCTs (total N = 36) suggest cannabidiol may be useful in the treatment of epilepsy (29–31), but this evidence is insufficient to draw definitive conclusions of cannabidiol's long-term safety and efficacy (32). Larger RCTs evaluating efficacy or safety of marijuana/cannabinoids in epilepsy have not been done |
| Nausea/vomiting | Nausea and vomiting were among the first indications for which cannabinoids were approved for use. Dronabinol (oral THC) and nabilone (an oral THC analog) are approved by the FDA for the treatment of chemotherapy-induced nausea and vomiting (10–13) |
| Pain | Large and moderately sized RCTs have demonstrated the efficacy of nabiximols or an oral cannabis extract to treat neuropathic pain (21, 33, 34), although not all trials have been positive (NCT01606202; NCT00710424) Smaller trials of limited duration (5 days) have suggested that smoked marijuana may be efficacious in treating neuropathic pain (18–20) Preliminary data exist for rheumatoid arthritis (35), although less evidence exists for non-neuropathic pain |
| Posttraumatic stress disorder (PTSD) | A small RCT (N = 10) suggested that nabilone may improve nightmares in PTSD (36). Larger RCTs evaluating efficacy and safety of marijuana/cannabinoids in PTSD have not been done |
| Spasticity | Nabiximols is approved by regulatory agencies in Europe and Canada for the treatment of spasticity related to MS (37, 38) At least two RCTs show that smoked marijuana or an oral extract may be efficacious in the treatment of MS-related spasticity (16, 17) |
Abbreviations: FDA, US Food and Drug Administration; MS, multiple sclerosis; RCT, randomized controlled trial; THC, tetrahydrocannabinol.
a
Randomized controlled trials (placebo- or active-controlled), but not open-label or observational studies, are included as evidence.