Medical cannabis education: general considerations on treatments with cannabis and cannabinoid based medicines

An Editorial by Dr. Raquel Peyraube

Given that endocannabinoid system (ECS) receptors are distributed throughout the body, the effects and therapeutic uses of cannabis and cannabinoids on our body can be diverse. As a physician with experience treating patients with cannabis and cannabinoid medicines, I have witnessed firsthand the impact that these treatments can have on a patient’s clinical outcomes and quality of life. However, it is important to remember that such treatments are not a panacea drug and several factors must be considered at every patient encounter to ensure optimal safety and efficacy.

Here are some general considerations about cannabis and cannabinoid treatments that I keep front of mind when I work with my patients:

1. At present, there is no scientific evidence to indicate that cannabis and cannabinoid treatments are curative to any disease. We must think of them in the same way that we view chronic disease treatments. For example, it is often said that cannabis and cannabinoid compounds cure cancer, but that is a false statement. What has been demonstrated is that they have an antitumor effect, which is not the same as cure.
2. Although cannabis and cannabinoid treatments have shown to provide benefit in many diseases, they do not serve to treat all pathologies. For example, arrythmias are not an indication for these products, and in some situations, they can even be worsened.
3. In general terms, cannabis and cannabinoid treatments can improve an individual’s quality of life by improving mood, sleep quality, appetite, reducing nausea and vomiting, and sometimes calming pain and providing a feeling of well-being.
4. The safety profile of cannabis and cannabinoid treatments is very high. Adverse effects are usually mild to moderate and generally reversible. It is important to avoid unnecessary risks by ensuring cannabis and cannabinoid treatments are:

• Prescribed and monitored by a qualified physician;
• Contraindications with other health conditions are evaluated prior to use;
• Interactions with other medicines are considered; and
• Cannabis and cannabinoid products being used have a proven composition and are of high-quality.

5. Like other medicines, not all patients will experience the same effects of the same treatments in a similar way; there are variations from one patient to another. For example, there are some people who respond favorably to low doses and other patients require higher cannabinoid titrations to experience the desired effect. Unfortunately, there are no indicators to anticipate who will require high, low or average doses. Therefore, treatment efficacy and efficiency must be tested and monitored in each patient. Further, it is advisable to start with a low dose and slowly increase according to the patient’s response and tolerance.
6. Often, the decision to start cannabis and cannabinoid treatments is based on the desire to achieve better treatment outcomes and quality of life, in addition to the desire to reduce the use of other medications and their adverse effects. Conventional medication should not be suspended abruptly without medical recommendation and knowledgeable support to guide the process. The general recommendation is that doses of other medications can be reduced as the dose of cannabinoids is increased. This approach works to avoid unnecessary suffering or aggravation for the patient.

Taking these considerations into account at every patient encounter is important to ensure optimal impact and satisfaction for patients taking, or considering taking, cannabis and cannabinoid medicines.