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Medical Cannabis Review Articles and Reports on Muscle Spasm and Spasticity

Assessment of efficacy and tolerability of medicinal cannabinoids in patients with multiple sclerosis: A systematic review and meta-analysis
Torres-Moreno MC, Papaseit E, Torrens M, Farre M. JAMA Network Open 2018;1(6):e183485.
This systematic review identified 17 randomized clinical trials of at least 4 weeks duration, including 3161 patients, for meta-analysis. Ten of the trials used nabiximols (Sativex – a cannabis extraction product containing approximately equal amounts of THC and CBD), five each used a variety of other extraction products and dronabinol (Marinol – synthetic THC), and one used nabilone, a synthetic THC analogue (two studies used two agents in comparison with placebo. Overall cannabinoids were significantly associated with efficacy for subjective spasticity, pain, and bladder dysfunction compared with placebo. Effect sizes varied somewhat by type of cannabinoid product, but were nearly all small, indicating a limited magnitude of efficacy. None of the interventions demonstrated clear efficacy for spasticity when evaluated in a more objective form (i.e. The Ashworth and modified Ashworth scales). Cannabinoids had a higher risk of adverse events and withdrawals due to adverse events, with no statistically significant differences found for serious adverse events. The authors’ summary: “Cannabinoids appear to be safe regarding serious adverse events, but their clinical benefit may be limited.”

The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research
A report published by the U.S. National Academies of Sciences, Engineering, and Medicine. 2017.
A rigorous review of relevant scientific research published since 1999, summarizing the current state of evidence regarding what is known about the health impacts of cannabis and cannabis-derived products, including effects related to therapeutic uses of cannabis and potential health risks related to certain cancers, diseases, mental health disorders, and injuries. Sections on evidence of therapeutic effects include: chronic pain, cancer treatment, chemotherapy-induced nausea and vomiting, anorexia and weight loss associated with HIV/AIDS, cancer-associated anorexia-cachexia syndrome, anorexia nervosa, irritable bowel syndrome, epilepsy, spasticity associated with multiple sclerosis or spinal cord injury, Tourette syndrome, amyotrophic lateral sclerosis, Huntington’s disease, Parkinson’s disease, dystonia, dementia, glaucoma, traumatic brain injury/intracerebral hemorrhage, substance addiction, anxiety, depression, sleep disorders, posttraumatic stress disorder, and schizophrenia and other psychoses. Chapters summarizing evidence of harms include: cancer, cardiometabolic risk, respiratory disease, immunity, injury and death, prenatal/perinatal/neonatal exposure, psychosocial, mental health, cannabis use problems, and abuse of other substances.

A Review of Medical Cannabis Studies relating to Chemical Compositions and Dosages for Qualifying Medical Conditions (PDF)
Office of Medical Cannabis.
Summary of clinical trials and prospective observational studies in humans, published in peer-reviewed journals, which focus on medical cannabis formulations consistent with Minnesota’s medical cannabis program.

Information for Health Care Professionals: Cannabis and the cannabinoids (PDF)
Health Canada. February, 2013.
Endocannabinoid system, clinical pharmacology, dosing, potential therapeutic uses (by condition), precautions, warnings, adverse effects, and overdose/toxicity.

Cannabinoids for Medical Use: A Systematic Review and Meta-analysis
Whiting PF, Wolff RF, Deshpande S, Di Nisio M, et al JAMA 2015;313(24):2456-2473.
Systematic review of the benefits and adverse effects of therapeutic use of cannabinoids. The study included randomized clinical trials of cannabinoids for the following indications: nausea and vomiting due to chemotherapy, appetite stimulation in HIV/AIDS, chronic pain, spasticity due to multiple sclerosis or paraplegia, depression, anxiety disorder, sleep disorder, psychosis, glaucoma, or Tourette syndrome.

Here is JAMA’s summary of the Whiting article, “In a systematic review, Whiting and colleagues identified 79 randomized trials, involving 6462 participants, that compared cannabinoid use with active comparators or placebo for the treatment of several medical conditions. The authors found moderate-quality evidence supporting cannabinoid treatment of chronic pain and spasticity due to multiple sclerosis or paraplegia. Low-quality evidence suggests cannabinoids may lessen nausea and vomiting due to chemotherapy, foster weight gain in patients with HIV infection, and improve symptoms of sleep disorders or Tourette syndrome. In an Editorial, D’Souza and Ranganathan discuss the need for high-quality evidence to guide decisions about medical marijuana use.”

Cannabis: The Evidence for Medical Use
Barnes MP, Barnes JC. Report published by Northumberland, Tyne & Wear NHS Foundation Trust, May 2016.
Literature review and discussion of strength of evidence of effectiveness for a wide variety of medical conditions. This report was commissioned by the All Party Parliamentary Group for Drug Policy Reform (UK). The authors note they received no renumeration other than a small grand from the APPG for Drug Policy Reform for their work and that they have no commercial interests in cannabis or cannabis products. The report includes good discussions of the evidence – or lack thereof – for long-term negative effects often ascribed to marijuana use: psychotic disorders, dependence, respiratory system cancer, cognition, amotivational syndrome, and decreased brain volume.

The pharmacologic and clinical effects of medical cannabis
Borgelt LM, Franson KL, Nussbaum AM, Wang GS.Pharmacotherapy 2013;33(2):195-209.
Pharmacodynamics and pharmacokinetics (smoked and orally ingested) of cannabis, clinical effects (focusing on pain and muscle spasm), adverse effects and drug interactions, psychiatric implications, and pediatric implications.

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