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Safety Considerations in Cannabinoid-Based Medicine

Authors Gottschling S, Ayonrinde O, Bhaskar A, Blockman M, D’Agnone O, Schecter D, Suárez Rodríguez LD, Yafai S, Cyr C

Received 1 August 2020

Accepted for publication 5 October 2020

Published 1 December 2020 Volume 2020:13 Pages 1317—1333

DOI https://doi.org/10.2147/IJGM.S275049

Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Scott Fraser


Sven Gottschling,1 Oyedeji Ayonrinde,2 Arun Bhaskar,3 Marc Blockman,4 Oscar D’Agnone,5 Danial Schecter,6 Luis David Suárez Rodríguez,7 Sherry Yafai,8 Claude Cyr9

1Universitätsklinikum des Saarlandes, Homburg (Saar), Germany; 2Queen’s University, Kingston, Ontario, Canada; 3Imperial College Healthcare NHS Trust, London, UK; 4University of Cape Town and Groot Schuur Hospital, Cape Town, South Africa; 5The OAD Clinic, London, UK; 6Spectrum Therapeutics, Smiths Falls, Ontario, Canada; 7Centro de Medicina Integrativa Sanar, Playa del Carmen, Mexico; 8The Releaf Institute, Santa Monica, CA, USA; 9McGill University, Montreal, Quebec, Canada

Correspondence: Claude Cyr
McGill University, 3500 DeMaisonneuve Boulevard, Suite 1520, Montreal, Quebec H3Z3C1, Canada
Tel +1-514-264-9657
Email [email protected]

Abstract: Cannabinoids are a diverse class of chemical compounds that are increasingly recognized as potential therapeutic options for a range of conditions. While many studies and reviews of cannabinoids focus on efficacy, safety is much less well reported. Overall assessment of the safety of cannabinoid-based medicines is confounded by confusion with recreational cannabis use as well as different study designs, indications, dosing, and administration methods. However, clinical studies in registered products are increasingly available, and this article aims to discuss and clarify what is known regarding the safety profiles of cannabinoid-based medicines, focusing on the medical and clinical safety evidence and identifying areas for future research. The two most well-studied cannabinoids are Δ9-tetrahydrocannabinol (THC), or its synthetic variants (dronabinol, nabilone), and cannabidiol (CBD). Across diverse indications, dizziness and fatigue are generally the most common adverse events experienced by patients receiving THC or combined THC and CBD. Patients receiving THC may experience adverse cognitive effects and impairment in psychomotor skills, with implications for driving and some occupations, while CBD may help to lower the psychotropic effects of THC when used in combination. Studies on dependency and addiction in a medical context are limited, but have shown inconsistent findings regarding misuse potential. Generally, the recommended route of administration is oral ingestion, as smoking medicinal cannabinoid products potentially releases mutagenic and carcinogenic by-products. There are several potential drug–drug interactions and contraindications for cannabinoid-based medicines, which physicians should account for when making prescribing decisions. The available evidence shows that, as with any other class of pharmaceuticals, cannabinoid-based medicines are associated with safety risks which should be assessed in the context of potential therapeutic benefits. Each patient should be assessed on an individual basis and physicians must rely on informed, evidence-based decision-making when determining whether a cannabinoid-based medicine could be an appropriate treatment option.

Keywords: cannabis, cannabinoid, safety, cannabidiol, Δ9-tetrahydrocannabinol

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