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Cannabis. Just what you need.

Notes from SA FPM Lecture:


- Endocannabinoidome - Gut/brain axis - best described system


- Phytocannabinoids - THC, Cannabidiol (but there are Over 100 of these!)


- Synthetic cannabinoids not available in Aus


- Single dose may not be eliminated for up to 30 days due to its lipid solubility


- Now over 100 different options to purchase


- Doses and delivery systems are highly variable


Cohen, K., & Weinstein, A. M. (2018). Synthetic and Non-synthetic Cannabinoid Drugs and Their Adverse Effects-A Review From Public Health Prospective. Frontiers in public health, 6, 162. https://doi.org/10.3389/fpubh.2018.00162


- NNT = 22 for a 30% reduction in pain!

- NNT harm = 6 (though these are for more common effects)

- NNT Serious harm = 71


- Moderate confidence cannabinoids are just better than placebo for neuropathic pain


- For MSK pain - no benefit


Stockings, Emilya,*; Campbell, Gabriellea; Hall, Wayne D.b,c; Nielsen, Suzannea; Zagic, Dinoa; Rahman, Rakina; Murnion, Bridind,e; Farrell, Michaela; Weier, Megana; Degenhardt, Louisaa Cannabis and cannabinoids for the treatment of people with chronic noncancer pain conditions: a systematic review and meta-analysis of controlled and observational studies, PAIN: October 2018 - Volume 159 - Issue 10 - p 1932-1954

doi: 10.1097/j.pain.0000000000001293


Changes in brain regions mediating: reward, learning, memory, motivational circuits


Lorenzetti V, Chye Y, Silva P, Solowij N, Roberts CA. Does regular cannabis use affect neuroanatomy? An updated systematic review and meta-analysis of structural neuroimaging studies. Eur Arch Psychiatry Clin Neurosci. 2019 Feb;269(1):59-71. doi: 10.1007/s00406-019-00979-1. Epub 2019 Jan 31. PMID: 30706169.


Wide range of activity between <1 and 50 mg/kg/day but little available on pharmacokinetic properties


Millar SA, Stone NL, Bellman ZD, Yates AS, England TJ, O'Sullivan SE. A systematic review of cannabidiol dosing in clinical populations. Br J Clin Pharmacol. 2019 Sep;85(9):1888-1900. doi: 10.1111/bcp.14038. Epub 2019 Jul 19. PMID: 31222854; PMCID: PMC6710502.


Studies in this field have unclear or high risk of bias. We have little confidence in the estimates of effect in the management of pain.


RACGP - Use of medicinal cannabis products - 2019 update


FPM: Not current evidence to support its recommended use

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