#201 Any Other “Doobie”ous Effects of Medical Cannabinoids?
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- Glaucoma: One Randomized Controlled Trial (RCT) (6 patients): No benefit.1,2
- Anxiety: One RCT (24 patients) on simulated public speaking: More improvement on mood scale.2
- Meta-analyses for control of nausea/vomiting.1,5,7
- Versus placebo:3 47% versus 13%, Number Needed to Treat (NNT)=3.
- Versus neuroleptic:3 31% versus 16%, NNT=7.
- Others find similar.1,5,7
- Patient preference exceeds effectiveness: NNT=2 versus placebo and NNT=3 versus neuroleptic.6,8
- Suggests something other than effectiveness influences preference.
- Not chemotherapy-related:
- Palliative care (cancer/HIV): One SR, symptoms unchanged.6
- Post-Op: One RCT (60 patients), nabilone versus metoclopramide: No difference.9
- No clear difference between nabilone or dronabinol.5,7
- Meta-analysis of meaningful change in symptoms:3 50% versus 35%, NNT=7.
- Others find similar.1,10
- ≥30% improvement in spasticity:10 35% versus 25%, NNT=10.
- Four meta-analyses of mean change in scale:
- Two meta-analyses:1,10 1.3 versus 0.97 placebo (clinical significance ~1.1).10
- Two meta-analyses: Not statistically significant.1,13
- Quality often poor.1
- Many studies small/short.1,8
- Blinding not possible: Example, 85-95% of patients and clinicians know who’s on cannabinoids.8,14
- Approved indication:
- Nabilone (Cesamet™): Chemotherapy-induced nausea/vomiting.
- Nabiximol (Sativex™): Adjunctive therapy for spasticity of multiple sclerosis and pain from multiple sclerosis or cancer.
- For pain15 and adverse events16 see Tools for Practice #199 and #200.
- Although evidence for seizure is sparse, one RCT suggests potential in children with Dravet epilepsy.17