In this comprehensive clinical review published by JAMA, experts examine the current evidence for therapeutic cannabis and cannabinoid use, emphasizing implications for clinical practice, risk assessment, and addiction medicine. The authors underscore that while nearly one in four adults report using cannabis or cannabinoids for medical purposes, robust evidence supporting their benefit remains limited for most conditions routinely cited by patients and clinicians.
Approved indications include selected FDA-recognized uses such as treatment for HIV/AIDS–related anorexia, chemotherapy-induced nausea and vomiting, and specific pediatric seizure disorders; however, large meta-analyses reveal minimal, inconsistent clinical benefit for common patient concerns such as pain relief, sleep improvement, or generalized anxiety. Importantly, the review highlights that high-potency cannabis (≥10 mg Δ9-THC) is associated with increased risk for psychotic symptoms, anxiety disorders, and cannabis use disorder, signaling critical intersections between therapeutic intentions and addiction risk.
Observational evidence also links daily inhaled cannabis use to elevated risks of cardiovascular events including coronary heart disease, myocardial infarction, and stroke, reinforcing the need for cautious clinical guidance.
The authors advocate for harm-reduction strategies – such as screening for contraindications (e.g., schizophrenia), evaluating drug interactions, avoiding concurrent alcohol or CNS depressant use, and choosing the lowest effective dose when medically indicated. Clinicians are urged to engage in evidence-based discussions, balancing potential therapeutic benefits against risks of dependency and adverse outcomes.
This review sharpens clinical awareness around cannabis therapeutics and addiction prevalence, offering essential guidance for clinicians navigating complex patient care decisions amid evolving cannabis use landscapes.
Full Article: https://jamanetwork.com/journals/jama/article-abstract/2842072