Background
Methods
Literature search and process of study selection
Review selection criteria
Term | Definition |
---|---|
Medical marijuana (or marijuana for medical use) | The term medical marijuana refers to using the whole, unprocessed marijuana plant or its basic extracts to treat symptoms of illness and other conditions (https://www.drugabuse.gov/publications/drugfacts/marijuana-medicine) Whether marijuana is recognized as medicine varies from country to country. The US Food and Drug Administration (FDA) has not recognized or approved the marijuana plant as medicine, but a growing number of states have legalized marijuana for medical use. In Canada, it is legal to possess cannabis for medical purposes, and legalization for non-medical use is set to take place in 2018. |
Cannabis for therapeutic purposes (CTP) | A similar term to “medical marijuana,” CTP refers to legal access to cannabis for therapeutic purposes; this includes symptoms associated with health or mental disorders [19] |
Data collection and quality assessment
Evidence synthesis
Outcome data categorization | Definition |
---|---|
Favors intervention | Review authors conducted a meta-analysis and/or narrative synthesis (i.e., count data) which shows a beneficial effect for cannabis. |
Favors control | Review authors conducted a meta-analysis and/or narrative synthesis (i.e., count data) which shows a beneficial effect of control. |
Unclear efficacy/insufficient data | Review authors do not provide enough information to make a clear conclusion, or state that data from included studies is insufficient. |
No statistically significant difference between groups | Review authors conducted a meta-analysis and/or narrative synthesis (i.e., count data) which shows no significant difference between cannabis and control groups (precision with confidence interval [included null results] preferred over p value). |
Reported study-by-study (SBS) | Authors narratively review the primary study data, without providing an overall count of positive, negative, or no difference effects. Included studies are reviewed individually, with or without author’s final recommendations and conclusions |
Changes from the study protocol
Results
Search findings
Characteristics of included reviews
Author, year | Search dates; no. databases searched | Funding source | Nstudies | Illness/condition | Intervention/comparator* | Outcomes | Reported results | AMSTAR-2 rating |
---|---|---|---|---|---|---|---|---|
Herzog, 2017 [4] | Inception–mid-Dec 2016; 8 | No funding | 10 | Chronic illness (all included studies on MS) | I: Plant-derived cannabinoids C: Standard care (anti-spasticity drugs) | • Maintenance of treatment gains • QoL | Reported SBS | L |
Claflin, 2017 [23] | January 17, 2018; 1 | NR | 7 | MS | I: Plant-derived cannabinoids C: Placebo | • Pain • Incontinence • Spasticity • Muscle stiffness • VAS of most troublesome symptoms | Favors intervention for pain, incontinence, spasticity, and muscle stiffness; reported SBS for troublesome symptoms | L |
Behm, 2017 [24] | Until 30 Nov 2017; 5 | NR | 4 | MS | I: Plant-derived and synthetic cannabinoids C: Placebo; cannabis extract | • Gait speed | Reported SBS | L |
Youssef, 2017 [34] | 1 Jan 1946–11 Nov 2006; 4 | Non-profit | 3 | MS | I: Plant-derived cannabinoids C: Placebo | • Decrease in incontinence episodes • Decrease in number nocturia episodes • Daytime voids • Voids per 24 h • Urgency episodes/d • Withdrawal due to AEs | Favors intervention for decrease in incontinence episodes; reported SBS for nocturia episodes, daytime voids, voids per 24 h, urgency episodes, and withdrawal due to AEs | L |
Yadav, 2014 [92] | First search: 1970–Mar 2011; second search (Medline only): Mar 2011 to Sept 2013; 5 | Non-profit | 19 | MS | I: All types of cannabinoids C: Placebo | • Pain • Central NP • Spasticity • Tremor • Bladder symptoms • Balance • Posture • Cognition • Total/average AEs | Reported SBS | M |
Lakhan, 2009 [56] | 1999–Apr 2009; 3 | NR | 6 | MS | I: Plant-derived cannabinoids C: Placebo; THC | • Decreased spasticity • Mobility • Efficacy • Ashworth score • Walk time • Spasticity (VAS scores) • RMI score • Spasticity (subjective) | Favors intervention for decreased spasticity, mobility, spasticity (VAS scores), and subjective spasticity. No statistically significant difference between groups for efficacy, Ashworth score, and RMI score. Unclear efficacy for walk time. | M |
Mills, 2007 [63] | MEDLINE 1966, EMBASE 1988, and Cochrane to Jun 2006; 4 | NR | 3 | MS | I: Plant-derived and synthetic cannabinoids C: Placebo | • Tremor • Pain (VAS) • Arm and hand function • Ataxia • Disability outcomes | No statistically significant difference between groups for tremor. Reported SBS for all other outcomes | L |
Shakespeare, 2003 [64] | MEDLINE 1966, EMBASE 1988 and Cochrane to Jun 2003; 4 | NR | 2 | MS | I: Plant-derived cannabinoids C: Placebo | • Ashworth score • Brainstem functioning • MS functional composite score • Subjective global rating • Spasms and spasticity • Spasticity (NRS) • Spasm frequency | No statistically significant difference between groups for Ashworth score. Only one study included for all other outcomes | CL |
Kuspinar, 2012 [71] | Start search date varies by database to Sept 2011; 4 | Non-profit | 1 | MS | I: Plant-derived cannabinoids C: Placebo | • Number of incontinence episodes • QoL (incontinence questionnaire) | Reported SBS | L |
NICE, 2014 [91] | Search updated on Feb 3, 2014; 6 | Government | 6 | MS | I: Plant-derived cannabinoids C: Placebo | • Spasticity (Ashworth score) • Spasticity (NRS score) • Activities of daily living • Spasm severity (NRS) • Spasm severity (30% improvement in NRS) • Timed 10 min walk • Global impression of improvement • Motricity • QoL • Guys neurological disability scale • Adverse events | Favors intervention for spasticity (NRS score), spasm severity (30% improvement in NRS), and global impression of improvement. No statistically significant difference between groups for spasticity (Ashworth score), spasm severity (NRS), motricity, QoL, and most adverse effects. Favors control for activities of daily living and Guys neurological disability scale | M |
da Rovare, 2017 [27] | Up to Mar 20, 2017; 4 | NR | 16 (24 pubs) | MS or paraplegia | I: Cannabinoids (not specified) C: placebo | • Spasticity • Spasm • Cognitive function • Daily activities • Motricity • Pain • Bladder function • Dizziness • Somnolence • Headache • Nausea • Dry mouth | No statistically significant differences between groups for spasticity, spasm, pain, cognitive function, daily activities, motricity, and bladder function. Favors placebo for dizziness, somnolence, nausea, and dry mouth | M |
Author, year | Search dates; # databases searched | Funding source | Nstudies | Illness/condition | Intervention/comparator | Outcomes | Conclusions from data | AMSTAR-2 rating |
---|---|---|---|---|---|---|---|---|
Koppel, 2014 [85] | Inception–Nov 2013; 5 | Non-profit | 34 | MS, HD, PD, cervical dystonia, Tourette syndrome, epilepsy | I: All types of cannabinoids C: Placebo | • Spasticity • Central NP • Bladder symptoms • Tremor • Symptomatic HD treatment • Levodopa-induced dyskinesias • Tic severity • Cervical dystonia • Seizure frequency • Discontinuation of medication due to AEs | Reported SBS for all outcomes except discontinuation of medication due to AEs (favors placebo) | L |
Mestre, 2009 [75] | Start search date varies by database to Dec 2007; 4 | Non-profit | 1 | HD | I: Plant-derived cannabinoids C: placebo | • Chorea severity • Functional capacity • HD staging system • Motor function (SCL-90R) • Cognition (SCL-90R) • Psychological distress (SCL-90R) | Only one study included | M |
Chung, 2006 [78] | Searched in Jul 2005; 11 | Non-profit | 1 | PD | I: Plant-based cannabis C: placebo | • Therapeutic effect on L-dopa induced dyskinesia • Unified PD rating scale • QoL • Total AEs | Only one study included | L |
Pringsheim, 2012 [86] | MEDLINE 1950 and EMBASE 1980 to Oct 2010; 2 | Government | 2 | Tic disorders | I: Plant-derived cannabinoids C: Placebo | • Tic frequency and severity • Total AEs | Favors intervention | L |
Curtis, 2009 [57] | Start search date varies by database and runs “to date”; 8 | Government | 2 | Tourette syndrome | I: Plant-derived cannabinoids C: Placebo | • Tic reduction • Tic severity • STSSS • YGTSS • TSSL • Obsessive Compulsive disorder (TSSL) • TS–CGI • Video rating • Total AEs | Favors intervention for tic reduction; reported SBS for total AEs; only one study included for all other outcomes | M |
Author, year | Search dates; # databases searched | Funding source | Nstudies | Illness/condition | Intervention/comparator* | Outcomes | Conclusions from data | AMSTAR-2 rating |
---|---|---|---|---|---|---|---|---|
Chronic pain, any kind | ||||||||
Martin-Sanchez, 2009 [58] | To Feb 2008; 3 | Government | 18 | Chronic pain | I: Plant-derived and synthetic cannabinoids C: Placebo | • Pain • Euphoria • Dysphoria • Events linked to alterations in perception • Events affecting motor function • Events that altered cognitive function | Favors intervention for pain, euphoria, events linked to alternations in perception, events affecting motor function, and events that altered cognitive function. No statistically significant difference between groups for dysphoria. | M |
Nielsen, 2017 [80] | No date limits; search run on Oct 29, 2015; 4 | Government | 9 | Chronic pain | I: Plant-derived or synthetic cannabinoids alone or with opioids C: Placebo + opioids | • Analgesia • Pain intensity • Experimental pain • Opioid-sparing effect • Sleep • Energy • Social functioning | Favors intervention for analgesia. Favors control for opioid-sparing effect, but analysis of high-quality studies for this outcome shows unclear efficacy. Only one study included for all other outcomes | M |
Nugent, 2017 [32] | Inception–Mar 2017; 5 | Government | 75 | Chronic pain in various conditions | I: Plant-derived cannabinoids C: Placebo or NR | • Central NP • NP • Cancer pain • Risk of short-term non-serious AEs • Lung function • Pulmonary effects • Cardiovascular events | No statistically significant difference for NP in MS or cancer pain; favors intervention for NP in other conditions; reported SBS for risk of short-term AEs, lung function, pulmonary effects, cardiovascular events | M |
Deshpande, 2015 [41] | Searched in April 2014; 3 | NR | 6 | Chronic non-cancer pain | I: Plant-derived cannabinoids C: placebo | • Pain relief • Pain reduction • Effect on dose of other analgesics • QoL | Favors intervention for NP; only one study included on dose of other analgesics; no statistically significant difference between groups for QoL | L |
Lynch, 2015 [68] | 2010–Oct 2014; 10 | NR | 11 | Chronic non-cancer pain: FM, medication overuse, MS, OA, diabetic and chemotherapy-induced neuropathy | I: All types of cannabinoids C: Unclear for one analysis (placebo, ibuprofen, o ramitriptyline); placebo; ibuprofen; amitriptyline | • Analgesia • Pain intensity • Pain • Analgesic intake and dependence • Sleep • Anxiety • Sleep quality • VAS and patient global assessment of change • NP • Muscle stiffness pain • Serious AEs | Favors intervention for analgesia (cannabinoids vs. placebo.) Reported SBS for serious AEs. Only one study included for all other outcomes | L |
Aviram, 2017 [26] | 1975–Jul 2015; 2 | No funding | 43 | Chronic or postoperative pain | I: Plant-derived and synthetic cannabinoids C: placebo | • NP • Peripheral NP • Chronic pain • Postoperative pain • Acute postoperative pain | Favors intervention for all types of pain except acute postoperative pain (favors control) | M |
Meng, 2017 [31] | To Mar 11, 2016; 6 | Non-profit | 11 | Chronic NP | I: Plant-derived and synthetic cannabinoids C: Placebo; dihydrocodeine | • NP • Central NP • Peripheral NP • QoL • Anxiety • Satisfaction of participants • QST profile • Withdrawal due to AEs | Favors intervention for NP, QoL, satisfaction, and QST profile; reported SBS for central NP and withdrawal due to AEs (vs. placebo); no statistically significant difference between groups for peripheral NP (vs. placebo.) Reported SBS for mixed central and peripheral NP (vs. dihydrocodeine) | M |
Andreae, 2015 [42] | Searched Apr 23, 2014;4 | Mixed | 5 | Chronic NP | I: Plant-based cannabis C: placebo | • Peripheral NP • Withdrawal due to AEs | Favors intervention for peripheral NP. Reported SBS for withdrawal due to AEs. | M |
Pain | ||||||||
Campbell, 2001 [65] | MEDLINE 1966, EMBASE 1974, and Cochrane to Oct 1999; Oxford pain database: 1950–1994; 4 | NR | 9 | Pain | I: All types of cannabinoids C: Placebo; codeine | • Nociceptive pain • Postoperative pain • Cancer pain • Abdominal pain • NP • Spasticity • Subjective improvement of MS symptoms • Balance • Withdrawal due to AEs | Favors intervention for nociceptive pain and postoperative pain (cannabinoids vs. placebo). No statistically significant difference between groups for nociceptive pain, postoperative pain, and cancer pain (cannabinoids vs. codeine). Reported SBS for withdrawal due to AEs (compared with both placebo and codeine.) Only one study included for all other outcomes | M |
Finnerup, 2015 [69] | Jan 1966–to Jan 31 2014; 5 | Non-profit | 9 | Pain in MS, diabetes, allodynia, SCI, | I: Plant-derived cannabinoids C: placebo | • NP (NNT for 30–50% pain reduction) | No statistically significant difference between groups | M |
Iskedjian, 2007 [62] | Inception to end of June 2006; 4 | Industry | 7 | NP | I: Plant-derived cannabinoids C: Placebo | • Pain • Withdrawals due to AEs • Dizziness • Somnolence • Headache • Nausea • Diarrhea • Fatigue | Favors intervention for pain; unclear/indeterminate for all adverse effects | CL |
NICE, 2013 [90] | Searches conducted between Jul 17 and 31st and Aug 23rd and 29th of August; 10 | NR | 4 | NP | I: Plant-derived cannabinoids C: Placebo; “other drugs”; amitriptyline; pregabalin | • Pain • Continuous pain • Burning pain • Patient reported global improvement • Sleep • Withdrawal due to adverse effects • Dizziness or vertigo • Drowsiness • Fatigue • Nausea • Vomiting • Burning pain • Cognitive impairment • Mood disturbance • Dry mouth | Favors intervention for pain, continuous pain, withdrawal due to adverse effects, sleep, dizziness, or vertigo (cannabinoids vs. placebo). Favors control for pain (cannabinoids vs. other drugs). No statistically significant difference between groups for withdrawal due to adverse effects and dizziness or vertigo (cannabinoids vs. amitriptyline), drowsiness, fatigue, nausea, vomiting, burning pain, cognitive impairment, mood disturbance, dry mouth, 30% pain relief, global improvement. Reported SBS for sleep (vs. placebo or pregabalin). | M |
Acute pain | ||||||||
Stevens, 2017 [38] | To Aug 20, 2016; 3 | No funding | 7 | Acute pain | I: Cannabinoids (not specified) C: Placebo | • Acute pain • Total/average AEs • Withdrawal due to AEs | No statistically significant difference between groups; AEs reported SBS | M |
Author, year | Search dates; # databases searched | Funding source | Nstudies | Illness/condition | Intervention/comparator* | Outcomes | Conclusions from data | AMSTAR-2 rating |
---|---|---|---|---|---|---|---|---|
van den Beuken-van Everdingen, 2017 [84] | Jan 2005–May 2014; 3 | NR | 3 | Cancer | I: Plant-derived cannabinoids C: placebo; THC alone | • Cancer pain: nociceptive pain, NP, and chemotherapy-induced pain • Rate of adverse events | Only one study included | CL |
Tateo, 2017 [37] | NR; 4 | NR | 8 | Cancer | I: Plant-based and plant-derived cannabinoids C: Placebo; codeine; secobarbital; THC | • Pain • Sleep disruption • QoL • Impression of global change • Sensory function • Withdrawal due to AEs | Favors intervention for pain with nabiximols (vs. placebo); reported SBS for all other interventions and outcomes. | M |
Smith, 2015 [40] | Inception–Jan 2015; 5 | Non-profit | 23 | Cancer | I: Synthetic cannabinoids C: Placebo; prochlorperazine; domperidone; metoclopramide | • Absence of nausea • Absence of vomiting • Absence of both nausea and vomiting • participant preference • Dysphoria • Feeling high • Sedation • Withdrawal due to adverse events • Dizziness • Euphoria • Hallucinations • Postural hypotension • Depression • Withdrawal due to lack of efficacy | No statistically significant differences between groups for: absence of nausea, dysphoria, sedation, hallucinations, hypotension, depression, withdrawal due to lack of efficacy. Favors intervention for absence of vomiting, absence of nausea and vomiting, feeling high, withdrawal due to adverse events, dizziness, dysphoria, euphoria, patient preference Note: mixed results based on several subgroup analyses | M |
Phillips, 2010 [54] | Inception to Feb or Mar 2008; 11 | Non-profit | 4 | Cancer | I: Plant-derived and synthetic cannabinoids C: Prochlorperazine and metoclopramide; domperidone; prochlorperazine | • Nausea and vomiting | Only one study included | M |
Machado Rocha, 2008 [60] | Inception to Dec 2006; 5 | NR | 30 | Cancer | I: Synthetic cannabinoids C: Placebo; neuroleptic drugs | • Anti-emetic efficacy • Preference for drug | No statistically significant difference for anti-emetic effect of dronabinol vs. placebo, and nabilone or levonantradol vs. neuroleptics. Favors intervention for anti-emetic effect of dronabinol vs. neuroleptic and preference of drug. | M |
Yavuzsen, 2005 [79] | Start search date varies by database to Oct 2004 | NR | 1 | Cancer | I: Plant-based cannabis alone or in combination with megestrol acetate C: Megestrol acetate | • Weight • Appetite • QoL | Only one study included | CL |
The Belgian Health Care Knowledge Centre (KCE), 2012 [89] | Dec 2011 to Aug 2012; 6 | NR | 4 | Chemotherapy-related adverse events | I: Plant-based cannabis and synthetic cannabinoids + chemo C: Placebo (+ chemo) | • Complete response to anti-emetic therapy • Absence of delayed nausea • Significant delayed nausea • Absence of delayed emesis • QoL • Nausea absence • Vomiting and/or retching (mean number of episodes per week) • Patient’s wellness • At least one AE • Severe AEs • At least one treatment emerging AE • At least one serious AE | Only one study narratively described for each outcome, except for AEs. No statistically significant difference between groups for at least one AE and severe AEs (cannabis vs. placebo.) Favors dronabinol for at least one treatment emerging AE. Favors placebo for at least one serious AE. | M |
American Society of Clinical Oncology, 2016 [88] | Searched on Nov 5, 2014; 1 | Non-profit | 4 | Cancer | I: Plant-derived cannabinoids C: Placebo | • Pain (NRS score) • Worsening of nausea and vomiting | Only one study included | L |
SIGN, 2008 [87] | 1997 to Jun 2007; 8 | Government | 3 | Cancer | I: Plant-based cannabis and plant-derived cannabinoids C: Placebo | • NP • Central NP | Favors intervention for NP (types of cannabis combined). Only one study included for NP (smoked cannabis) and central NP | M |
Author, year | Search dates; # databases searched | Funding source | Nstudies | Illness/condition | Intervention/comparator* | Outcomes | Conclusions from data | AMSTAR-2 rating |
---|---|---|---|---|---|---|---|---|
Walitt, 2016 [39] | To Apr 26, 2016; 3 | No funding | 2 | Fibromyalgia | I: Synthetic cannabinoids C: Placebo; Amitriptyline | • Pain • Anxiety • QoL • Fatigue • Depression • Insomnia • Mood states • Withdrawal due to AEs | Reported SBS for all outcomes (vs. placebo or amitriptyline) | M |
Fitzcharles, 2016 [49] | Sept 2013 (updated Jan 2015); 11 | NR | 4 | Rheumatic diseases (inflammatory arthritis, OA, soft tissue rheumatism, and FM) | I: Plant-derived and synthetic cannabinoids C: Placebo; amitriptyline | • Pain • Sleep quality • Disease activity score • QoL • Sleep measures • Withdrawal due to AEs • Total AEs | Reported SBS for pain, sleep, disease activity, and withdrawal due to adverse events (vs. placebo); reported SBS for QoL, sleep measures, withdrawal due to adverse events, and total adverse events (vs. amitriptyline) | M |
Richards, 2012 [51] | Inception to Nov 2010; 4 | Non-profit | 1 | RA | I: Plant-derived cannabinoids C: Placebo | • Movement and morning pain • Total intensity of pain • Pain at present • Sleep • Withdrawal due to adverse events • Total adverse events | Favors intervention for movement and morning pain, sleep NRS, and total adverse events. No statistically significant difference between groups for total intensity of pain, pain at present, and withdrawal due to adverse events | M |
Macfarlane, 2011 [73] | Start search date varies by database to Aug 2010; 7 | Non-profit | 1 | RA | I: Plant-derived cannabinoids C: Placebo | • Pain • Quality of sleep • 28-joint disease activity score | Only one study included | L |
Author, year {refid} | Search dates; # databases searched | Funding source | Nstudies | Illness/condition | Intervention/comparator | Outcomes | Conclusions from data | AMSTAR-2 rating |
---|---|---|---|---|---|---|---|---|
Snedecor, 2013 [29] | To Dec 2011; 5 | Industry | 1 | NP associated with spinal cord injury | I: Synthetic cannabinoids C: Placebo | • NP • All-cause discontinuation | Favors control for NP; no statistically significant different between groups for all-cause discontinuation | CL |
Mehta, 2016 [35] | 2009–Sept 2015; 4 | NR | 2 | Spinal cord injury | I: Plant-derived and Synthetic cannabinoids C: diphenhydramine | • NP • Spastic pain | Reported SBS | L |
Meyer, 2010 [55] | 1980–2008; 4 | NR | 2 | Acquired brain injury | I: Synthetic cannabinoids C: Placebo | • Intercranial pressure • Glasgow outcome scale • Disability rating scale • Mortality rates • Activities of daily living • QoL | Reported SBS | M |
Wheaton, 2009 [76] | Jan 1980 to May 2008; 2 | Non-profit | 2 | Traumatic brain injury | I: Synthetic cannabinoids C: placebo | • Global outcome score (3 and 6 months) | No statistically significant difference between groups | CL |
Author, year {refid} | Search dates; # databases searched | Funding source | Nstudies | Illness/condition | Intervention/comparator | Outcomes | Conclusions from data | AMSTAR-2 rating |
---|---|---|---|---|---|---|---|---|
Walsh, 2017 [19] | 1960–Sept 2015; 2 | Government | 31 | Mental health | I: Plant-derived cannabinoids C: Cannabinoid with no THC | • Improvement in anxiety and depression | Only one RCT included (combined with cross-sectional data) | CL |
O’Neil, 2017 [33] | Inception–Mar 2017; 6 | Government | 5 | PTSD | I: All types of cannabinoids C: Different dose or different duration of dose of cannabinoids | N/A observational data | N/A observational data | M |
McLoughlin, 2014 [45] | To Aug 12, 2013; 6 | Non-profit | 1 | Schizophrenia | I: Plant-derived cannabinoids C: Amisulpride | • Mental state outcomes | Only one study included | H |
Author, year {refid} | Search dates; # databases searched | Funding source | Nstudies | Illness/condition | Intervention/comparator | Outcomes | Conclusions from data | AMSTAR-2 rating |
---|---|---|---|---|---|---|---|---|
Lutge, 2013 [48] | 1980–Jul 2012; 7 | NR | 7 | HIV/AIDS | I: Plant-based and synthetic cannabinoids C: Placebo | • Change in body fat • Appetite • Food/caloric intake • Nausea and vomiting • Performance • Mood • Subjective experience of drug • Peripheral NP • Effect on pharmacokinetics of protease inhibitors • Viral load and CD4 count • Resting heart rate • Skin temperature • Withdrawal due to adverse events | Reported SBS for all outcomes except change in mood, which found no statistically significant difference between groups | M |
Phillips, 2010 [53] | Search on Jun 20, 2008 and updated Feb 22, 2010; 4 | Non-profit | 2 | HIV | I: Plant-based cannabis C: placebo | • NP | Favors intervention | CL |
Merlin, 2016 [67] | Inception to Jan 2015; CENTRAL: Jun 2014; 5 | Government | 1 | HIV | I: Plant-based cannabis C: Placebo | • NP | Reported SBS | CL |
Author, year {refid} | Search dates; # databases searched | Funding source | Nstudies | Illness/condition | Intervention/comparator | Outcomes | Conclusions from data | AMSTAR-2 rating |
---|---|---|---|---|---|---|---|---|
Baldinger, 2012 [50] | To Jan 2011 and Cochrane specialized register to Feb 14, 2011; 4 | Non-profit | 1 | ALS/motor neuron disease | I: Plant-derived cannabinoids C: Placebo | • Muscle cramps • Muscle cramps as AEs | No statistically significant difference between groups | L |
Gloss, 2014 [72] | Searched on Sept 9, 2013; 6 | NR | 4 | Epilepsy | I: Plant-derived cannabinoids C: placebo | • Seizure freedom for 12 months | No studies assessed primary outcome in this review | M |
Krishnan, 2009 [59] | Dec 2005–Apr 2008; 6 | NR | 1 | Dementia | I: Synthetic cannabinoids C: Placebo | • Body weight • Triceps skinfold thickness • Disturbed behavior • Affect | Only one study included | L |
Hanson, 2011 [74] | Jan 1990 to Oct 2009; 5 | Government | 1 | Dementia | I: Synthetic cannabinoids C: placebo | • Weight • Negative affect • Disruptive behavior | Only one study included | L |
CADTH, 2018 [83] | Jan 1 2012 to Nov 29, 2017; 6 | No funding | 4 | Dementia | I: Plant-derived cannabinoids C: Placebo | • Static balance • Dynamic balance • Stride length • Total AEs • Dizziness • Somnolence • Balance disorders • Falls • Severe AEs | Only one study included | CL |
Author, year | Search dates; # databases searched | Funding source | Nstudies | Illness/condition | Intervention/comparator* | Outcomes | Conclusions from data | AMSTAR-2 rating |
---|---|---|---|---|---|---|---|---|
Kim, 201797 | Inception–apr 2017; 3 | Non-profit | 24 | Dystonia, HD, PD, Tourette syndrome, AD, dementia, ALS, psychosis, schizophrenia, anxiety | I: Plant-derived and synthetic cannabinoids C: Placebo; diazepam; amisulpride | • Weight gain • Anti-anxiety • CGI-C • Clinical improvements • Disturbed behavior • Sleep outcomes • Chorea outcomes • Dyskinesia • Motor symptoms • QoL • Tics • OCD behavior • Withdrawal due to adverse effects | Favors intervention for anti-anxiety effects; reported SBS for all other outcomes (vs. diazepam, placebo or amisulpride) | M |
Goldenberg, 2017 [30] | To 2015; 4 | No funding | 20 | Fibromyalgia, HIV, IBD, pain, MS, headache, cramps, cancer-related anorexia, traumatic brain injury | I: Plant-based and plant-derived cannabinoids C: Various combined (non-users, placebo, ibuprofen) | • QoL | No statistically significant difference between groups | L |
Fitzcharles, 2016 [36] | To Apr 30, 2015; 2 | NR | 4 | Various conditions (chronic spinal pain, rheumatoid arthritis, osteoarthritis, or fibromyalgia) | I: All types of cannabinoids C: Placebo or amitriptyline | • Pain • Anxiety • QoL • Fatigue • Depression • Withdrawal due to AEs • Total AEs | Favors intervention for pain (vs. placebo); no statistically significant difference between groups for anxiety, QoL, fatigue, and depression; reported SBS for withdrawal due to AEs and total AEs. Only a single study included comparing cannabinoids to amitriptyline. | M |
Whiting, 2015 [43] | Inception to between Apr 2014 and Apr 2015; 8 | Government | 79 | Various conditions: cancer (chemo-induced nausea and vomiting), appetite stimulation for HIV/AIDS, chronic pain, spasticity in MS or paraplegia, depression, anxiety disorder, sleep disorder, psychosis, intraocular pressure in glaucoma, Tourette syndrome | I: All types of cannabinoids C: Placebo | • NP • Cancer pain • Nausea and vomiting • QoL • Spasticity • Walking speed • Activities of daily living • CGI-C • Spasticity (various measures) • Sleep outcomes • Any AEs • Serious AEs • Withdrawal due to AEs | Mixed results based on how pain is measured (3 MAs favor intervention for NRS scores, patients CGI-C, and NP Scale and 2 show no statistically significant difference between groups for pain reduction ≥ 30% NRS or VAS and BPI-S); favors intervention for nausea and vomiting, spasticity (NRS or VAS), sleep quality, and CGI-C; no statistically significant difference between groups for QoL, 30% or 50% reduction in spasticity NRS, Ashworth score, ADL, sleep disturbance, any AEs, serious AEs, and withdrawal due to AEs | M |
Gates, 2014 [46] | NR; 8 | NR | 28 | Various (pain, MS, anorexia, cancer, immune deficiency) | I: Cannabinoids (not specified) C: NR; experimental drugs | • Impact on sleep • Subjective measures of sleep • Objective measures of sleep • Effect of dose on sleep | Favors intervention for impact on sleep, insufficient evidence for subjective measure of sleep (vs. experimental drugs), reported SBS for objective measures of sleep, and effect of dose on sleep | L |
van den Elsen, 2014 [47] | To Oct 7, 2013; 4 | Government | 5 | AD, PD, chemotherapy-induced nausea, and vomiting, COPD | I: Plant-based and synthetic cannabinoids C: Placebo; Prochlorperazine | • Dyskinesia • Breathlessness • Chemotherapy-induced nausea and vomiting • Behavioral problems • Weight gain • Triceps skinfold thickness | Reported SBS | M |
Lynch, 2011 [52] | Search run between Sept 7 and Oct 7 2010 and not limited by date; 11 | NR | 18 | Chronic pain, fibromyalgia, HIV, MS, rheumatoid arthritis, brachial plexus avulsion, spinal cord or brachial plexus injury, limb amputation | I: All types of cannabinoids C: Placebo; dihydrocodeine | • Central NP • Central pain • NP • Analgesia • Spasticity-related pain • FM pain • Allodynia • Hyperalgesia • Sensory Neuropathy • Spinal pain • Sleep • RA Disease Activity • Activities of daily living • FIQ | Favors intervention for all types of pain combined and sleep. Favors control for activities of daily living. Reported SBS for NP (vs. dihydrocodeine) | L |
Wang, 2008 [61] | MEDLINE: Jan 1966 to week 5 of Oct 2007; PsycINFO: Jan 1967 to week 5 of Oct 2007; and EMBASE: Jan 1980 to week 42 of 2007; 3 | Government | 31 | Various (looking at adverse events) | I: Plant-derived cannabinoids C: Placebo; standard care | • Serious adverse events • Death rate • Rate of non-serious adverse events • Average rate of non-serious adverse events | Favors intervention for rate and average rate of non-serious adverse events, except in the case of THC:CBD vs. standard care (no significant difference between groups). No statistically significant difference between groups for serious adverse events and death rate. | L |
CADTH, 2011 [6] | Jan 1 2010 to Sept 18, 2015; 4 | NR | 5 | PTSD, FM, chronic pain, spasticity-related pain, MS, peripheral NP, SCI | I: Synthetic cannabinoids C: Placebo, placebo + gabapentin | • Recurring/distressing dreams—PTSD scale • General wellbeing questionnaire • CGI-C • Pain • Peripheral NP • Quality of sleep • Spasticity | Only one study included | L |
Author, year {refid} | Search dates; # databases searched | Funding source | Nstudies | Illness/condition | Intervention/comparator* | Outcomes | Conclusions from data | AMSTAR-2 rating |
---|---|---|---|---|---|---|---|---|
Huntley, 2000 [66] | Inception to Dec 1999; 4 | NR | 1 | Asthma | I: Plant-derived cannabinoids C: Placebo | • Airway resistance (raw) | Only one study included | M |
Singh, 2007 [77] | Inception to Dec 2004; 6 | Non-profit | 4 | Asthma | I: Plant-based cannabis C: Placebo; isoproterenol; low-dose marijuana | • Pulmonary function test | Reported SBS | M |
Snedecor, 2013 [70] | To Jun 2011; 5 | Industry | 1 | Diabetes | I: Plant-derived cannabinoids C: placebo | • Peripheral NP (mean reduction in pain) • Peripheral NP (mean probability of 30% pain reduction) | Unclear efficacy (not enough information provided by authors) | L |
Norton, 2017 [28] | Inception–Feb 2016; 5 | NR | 3 | Inflammatory bowel disease | I: Plant-based cannabis C: No comparator (observational study) | N/A observational data | N/A observational data | CL |
Langhorst, 2015 [44] | Inception–Mar 12, 2014; 4 | Non-profit | 1 | Inflammatory bowel disease (Crohn's, ulcerative colitis, IBS) | I: Plant-based cannabis C: Placebo cigarettes (THC removed) | • Response rate • QoL • Remission rate | Only one study included | M |
CADTH, 2014 [81] | Jan 1, 1982 to Aug 8 2014; 5 | NR | 4 | Nausea and vomiting (non-chemotherapy-induced) | I: Synthetic cannabinoids C: Metoclopramide | • Postoperative nausea and vomiting • Patient rating of nausea and vomiting (VAS) | Only one study included | L |