Table 1.
Overview of studies on medical usage of marijuana
| Use of marijuana | Study | Type of study | Sample size | Comparator agent | Study parameters | Results | Level of evidence | Demerits |
|---|---|---|---|---|---|---|---|---|
| Nausea and Vomiting | 1) Risto Johansson (1982) | RCT | 27 | Prochlorperazine | Number of Vomiting ejections between Cannabis and Prochlorperazine groups | Lesser in Cannabis group as compared to Prochlorperazine, (P <0.001) | Ib | 1)Small sample size 2)Greater incidence of side effects with Cannabis |
| 2) Chan HS, 1987 | RCT | 30 | Prochlorperazine | Rate of Improvement in Vomiting between Cannabis and Prochlorperazine groups | Cannabis vs Prochlorperazine- 70% vs 30% (P=.003, chi 2 test) | Ib | 1)Small sample size 2)Greater incidence of side effects with Cannabis |
|
| 3) Pomeroy M, 1986 | RCT | 38 | Domperidone | Number of Vomiting episodes between Cannabis and Domperidone groups | Cannabis vs Domperidone, 4.76 vs 12.95 (P< 0.02) | Ib | 1)Small sample size 2)Greater incidence of side effects with Cannabis |
|
| 4) Niederle N, 1986 | RCT | 20 | Alizapride | Number of episodes of vomiting between Cannabis and Alizapride groups | Cannabis vs Alizapride, 1.1 vs 2.9 (P<0.01) | Ib | 1)Small sample size 2)Greater incidence of side effects with Cannabis |
|
| 5) Niiranen A, 1985 | RCT | 24 | Prochlorperazine | Number of episodes of vomiting between Cannabis and Prochlorperazine groups | Cannabis vs Prochlorperazine, 6.5 vs 11(P<0.05) | Ib | 1)Small Sample size 2)Cannabis use unpredictable 3)Greater incidence of side effects with Cannabis |
|
| 6) Salllan 1975 | RCT | 22 | Placebo | Response between the Cannabis and Placebo groups | Greater response in patients on Cannabis compared to Placebo Ib (p<0.001) Greater incidence of side effects with Cannabis | Ib | 1) Small sample size 2) Placebo controlled 3) No comparison between placebo and no placebo |
|
| 7) Stephen E. Jones, 1982 | RCT | 54 | Placebo | Mean episodes of Vomiting between Cannabis and Placebo groups. Severity of Nausea between both groups | Lesser number of Vomiting episodes and in patients receiving Cannabis over Placebo (P<0.001) Reduced Nausea in Cannabis group over placebo (P<0.001) | Ib | 1)Greater Incidence of side effects 2)Relatively small sample size |
|
| 8) Jerry K. Wada (1982) | RCT | 112 | Placebo | Incidence of Nausea and Vomiting between the Cannabis and Placebo groups | Nausea and Vomiting Reduced in Cannabis group as compared with placebo (P<0.001) | Ib | 1) Greater incidence and severe nature of side effects due to Cannabis | |
| 9) Duran M et al. 2010 | RCT | 16 | Placebo | Complete response in Vomiting between Cannabis and Placebo groups | Complete Response between Cannabis and Placebo groups - 71.4% of patients vs 22% of patients (95% CI 1%, 75%) | Ib | 1) Small sample size. 2) Placebo controlled |
|
| 10)Chang et al. | RCT | 15 | Placebo | Number of Vomiting and Retching episodes, Degree of Nausea, Duration of nausea and volume of emesis | Cannabis significantly more effective than placebo all parameters (P<0.001) | 1) Small sample size. 2) Placebo controlled |
||
| Appetite Stimulation | 1)Beal JE 1995 | RCT | 139 | Placebo | Improvement in appetite above basement between Cannabis and placebo groups | Increased appetite in Cannabis group as compared with Placebo (38% vs 8% for placebo, P=0.015) | Ib | 1)Placebo Controlled |
| 2) Struwe M, 1993 | RCT | 12 | Placebo | Increase in percentage of body fat and trend towards weight gain between Cannabis and placebo groups | Increased percent body fat in Cannabis group (one percent, P=0.04) Trends towards weight gain in cannabis group (0.5 kg, P=0.13) | Ib | 1)Small sample size 2)Placebo Controlled |
|
| Chronic Pain | 1)Jeremy R. Johnsn, 2010 | RCT | 177 | Placebo | In patients suffering from Cancer, Numerical Rating Scale (NRS) score were compared between the Cannabis and Placebo groups | Statistically significantly results in favor of Cannabis compared with placebo (improvement of −1.37 vs. −0.69, P<0.014) | Ib | 1)Placebo Controlled |
| 2) Ronald J Ellis, 2009 | RCT | 28 | Placebo | Pain relief in patients suffering from Neuropathic pain between the Cannabis and Placebo groups | Pain relief greater with cannabis than placebo (median difference in DDS pain intensity change, 3.3 points, effect size=0.60; P=0.016) | Ib | 1)Small Sample size 2)Placebo Controlled |
|
| 3)Skrabek RQ, 2008 | RCT | 40 | Placebo | Visual analogue scale(VAS) in patients suffering from fibromyalgia | Significant decrease in the VAS (-2.04, P < .02), in Cannabis group as compared to Placebo | Ib | 1)Comparatively small Sample size 2)Placebo Controlled |
|
| 4) B Frank, 2008 | RCT | 96 | Dihydrocodiene | Pain compared using Visual Analogue Scale (VAS) between Cannabis group and Dihydrocodeine group | Mean score on VAS scale was 6.0 mm longer for Cannabis than for Dihydrocodeine (95% confidence interval 1.4 to 10.5) | Ib | 1)Greater side effects associated with Cannabis | |
| Multiple Sclerosis | 1) Zajicek, 2012 | RCT | 279 | Placebo | Spasticity compared using change in Ashworth score from baseline to 12 months between Cannabis group, Cannabis extract group and placebo | Change in Ashworth score from baseline to 12 months in Cannabis=1·82 (n = 154, 95% confidence interval (CI) 0.53 to 3.12), cannabis extract=0.10 (n = 172, 95% CI −0.99 to 1.19), placebo=0.23 (n = 176, 95% CI −1.41 to 0.94); (P = 0.04) | Ib | 1)Placebo Controlled |
| 2) Corey-Bloom, 2012 | RCT | 37 | Placebo | Muscle spasticity between Cannabis and Placebo groups compared using modified Ashworth scale | Reduction in patient scores on the modified Ashworth scale by an average of 2.74 points with Cannabis more than placebo (P < 0.0001) | Ib | 1)Small Sample size 2)Placebo controlled |
|
| 3) C. Collins 2006 | RCT | 189 | Placebo | Muscle spasticity compared between Cannabis and Placebo group | primary efficacy analysis on the intention to treat (ITT) population (n=184) showed the Cannabis to be significantly superior to Placebo (P=0.048) | Ib | 1)Placebo Controlled 2)Greater incidence of adverse effects with Cannabis |
|
| Epilepsy | 1) Devinsky et al. 2017 | RCT | 120 | Placebo | Median frequency of convulsive seizures in Children and young adults with the Dravet syndrome between Cannabis group or Placebo group | median frequency of convulsive seizures per month decreased from 12.4 to 5.9 with Cannabis, as compared with a decrease from 14.9 to 14.1 with placebo (adjusted median difference between the Cannabis group and the placebo group in change in seizure frequency, −22.8 percentage points; 95% confidence interval [CI], −41.1 to −5.4; P=0.01) | Ib | 1)Placebo Controlled 2)Greater incidence of Adverse effects with Cannabis |
| 2) Thiele et al., 2018 | RCT | 171 | Placebo | Percentage change from baseline in monthly frequency of drop seizures during the treatment period in patients suffering from Lennox-Gastaut syndrome. | median percentage reduction in monthly drop seizure frequency from baseline was 43·9% (IQR −69·6 to −1·9) in the cannibidiol group and 21·8% (IQR −45·7 to 1·7) in the placebo group The median percentage reduction in monthly drop seizure frequency from baseline was 43·9% (IQR −69·6 to −1·9) in the cannabis group and 21·8% (IQR −45·7 to 1·7) in the placebo group. The estimated median difference between the treatment groups was −17·21 (95% CI −30·32 to −4·09; P=0.0135) | Ib | Placebo controlled Statistically not significant results | |
| Crohn’s Disease | 1)Naftali T, 2013 | RCT | 20 | Placebo | Complete remission in symptoms were compared between Cannabis and placebo group | Complete remission (CDAI score, <150) was achieved by 5 of 11 subjects in the cannabis group (45%) and 1 of 10 in the placebo group (10%; P=.43) | Ib | 1)Small sample size 2)Placebo controlled |
| Glaucoma | 1)Tomida et al. 2006 | RCT | 6 | Placebo | Cannabis group and placebo groups were compared for Intraocular pressure | Intraocular pressure in Cannabis group significantly lower than after placebo (23.5 mm Hg vs. 27.3 mm Hg, P=0.026) | Ib | 1)Small sample size 2)Placebo controlled |
| Tourrette Syndrome | 1) Muller Vahl, 2003 | RCT | 20 | Placebo | Memory span was compared between Cannabis and placebo group using the German version of auditory verbal learning test (VLMT) | Cannabis group was superior to the Placebo group (P<0.039) | Ib | 1)Small sample size 2)Placebo controlled |
| 2) Muller Vahl, 2003 | RCT | 24 | Placebo | Cannabis and placebo groups were compared using various scales such as Tourette Syndrome Clinical Global Impressions scale (TS-CGI), Shapiro Tourette-Syndrome Severity Scale (STSSS), Yale Global Tic Severity Scale (YGTSS), Self-rated Tourette Syndrome Symptom List (TSSL), Videotape-based rating scale. | On various scales such as Significant difference (P <.05) or a trend toward a significant difference (P <.10) between Cannabis and placebo groups at visits 2, 3, and/or 4 | Ib | 1)Small sample size 2)Placebo controlled |
|
| 3) Muller Vahl, 2002 | RCT | 12 | Placebo | Tics ad obsessive compulsive behavior (OCB) between Cannabis and placebo group. | Significant improvement of tics (P=0.015) and obsessive-compulsive behavior (OCB) (P=0.041 in Cannabis vs Placebo | Ib | 1)Small sample size 2)Placebo controlled |