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Ideas and Opinions |16 May 2017

What We Do (and Don't) Know About the Health Effects of Cannabis and Whether Marijuana Is Medicine

Sachin Patel, MD, PhD; John W. Williams Jr., MD, MHS; Robert B. Wallace, MD

Article, Author, and Disclosure Information
Author, Article, and Disclosure Information
This article was published at Annals.org on 4 April 2017.
  • From Vanderbilt University Medical Center, Nashville, Tennessee; Duke University and Center of Innovation for Health Services Research in Primary Care at the Durham Veterans Affairs Medical Center, Durham, North Carolina; and University of Iowa, Iowa City, Iowa.

    Disclosures: Dr. Patel reports grants from H. Lundbeck A/S outside the submitted work. Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M17-0501.

    Requests for Single Reprints: Sachin Patel, MD, PhD, Vanderbilt Psychiatric Hospital, 1601 23rd Avenue South, Nashville, TN 37232; e-mail, Sachin.patel@vanderbilt.edu.

    Current Author Addresses: Dr. Patel: Vanderbilt Psychiatric Hospital, 1601 23rd Avenue South, Nashville, TN 37232.

    Dr. Williams: Duke University School of Medicine, 411 West Chapel Hill Street, Suite 500, Durham, NC 27701.

    Dr. Wallace: University of Iowa College of Public Health, 145 Riverside Drive, Iowa City, IA 52242.

    Author Contributions: Conception and design: S. Patel, J.W. Williams.

    Analysis and interpretation of the data: S. Patel, J.W. Williams, R.B. Wallace.

    Drafting of the article: S. Patel.

    Critical revision for important intellectual content: S. Patel, J.W. Williams, R.B. Wallace.

    Final approval of the article: S. Patel, J.W. Williams, R.B. Wallace.

    Collection and assembly of data: S. Patel, J.W. Williams, R.B. Wallace.

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The political and cultural landscapes surrounding the therapeutic and recreational use of cannabis and related products have changed dramatically in the past decade. In contradistinction to federal law, 28 states and the District of Columbia have legalized cannabis for medicinal use; moreover, recreational use is legal in 7 states and the District of Columbia. Indeed, cannabis use in the general population increased 45% between 2007 and 2014, and 22.2 million Americans aged 12 years or older reported using cannabis in the past month (1). Given the increasing rates of use, internists must be familiar with the scientific evidence regarding the benefits and harms of cannabis and cannabinoid products in order to counsel their patients.
To date, more than 104 cannabinoid compounds have been identified in the cannabis plant, the most studied of which are tetrahydrocannabinol (THC) and cannabidiol (CBD). Tetrahydrocannabinol, the primary psychoactive component of cannabis, exerts its biological effects via activation of 2 G protein–coupled receptors (CB1 and CB2). During the past 30 years or so, the THC concentration in cannabis plant products increased substantially and the types of products (inhalable and edible cannabis, cannabis oil) became more diverse (2). The change in THC concentration and the wider variety of available cannabis-derived products complicate the evaluation of potential harms and benefits. Moreover, the biological and health effects of the purified or synthetic THC or CBD in medications approved by the U.S. Food and Drug Administration, such as dronabinol (oral synthetic THC), nabiximols (oral purified THC–CBD...
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Patel S, Williams Jr. JW, Wallace RB. What We Do (and Don't) Know About the Health Effects of Cannabis and Whether Marijuana Is Medicine. Ann Intern Med. 2017;166:747–748. [Epub ahead of print 4 April 2017]. doi: https://doi.org/10.7326/M17-0501

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Published: Ann Intern Med. 2017;166(10):747-748.

DOI: 10.7326/M17-0501

Published at www.annals.org on 4 April 2017

©
2017 American College of Physicians
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