Cannabidiol (CBD) and Cannabis for Pain, PTSD, & Nausea: 47 Recent Studies & Articles




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Effects of Cannabidiol (CBD) & Cannabis on Pain, PTSD, & Nausea:

47 Recent Studies & Articles (2018-2021)

Ken Pope, Ph.D. ABPP

PLEASE NOTE: I created this site to be fully accessible for people with disabilities; please follow this link to change text size, color, or contrast; please follow this link for other accessibility functions for those with visual, mobility, and other disabilities.

The purpose of the web page is to help patients, clinicians, caregivers, families, researchers, and others to keep abreast of the evolving research on
the role, effectiveness, risks, and side-effects of cannabidiol (CBD), cannabis, and varying forms of those substances in addressing pain, nausea, or PTSD.

I gathered the following  citations for and excerpts from 47 recent studies and articles on the effects of cannabidiol (CBD) & cannabis on pain, nausea, and PTSD published during the last 4 years (2018-2021):

Almog, S., et al. (2020). "The pharmacokinetics, efficacy, and safety of a novel selective-dose cannabis inhaler in patients with chronic pain: A randomized, double-blinded, placebo-controlled trial." European Journal of Pain 24(8): 1505-1516.

EXCERPT: "trial demonstrated that a metered-dose cannabis inhaler delivered precise and low THC doses, produced a dose-dependent and safe analgesic effect in patients with neuropathic pain/ complex-regional pain syndrome (CRPS). Thus, it enables individualization of medical cannabis regimens that can be evaluated pharmacokinetically and pharmacodynamically by accepted pharmaceutical models.... Evidence suggests that cannabis-based medicines are an effective treatment for chronic pain in adults. The pharmacokinetics of THC varies as a function of its route of administration. Pulmonary assimilation of inhaled THC causes rapid onset of analgesia. However, currently used routes of cannabinoids delivery provide unknown doses, making it impossible to implement a pharmaceutical standard treatment plan. A novel selective-dose cannabis inhaler delivers significantly low and precise doses of THC, thus allowing the administration of inhaled cannabis-based medicines according to high pharmaceutical standards. These low doses of THC can produce safe and effective analgesia in patients with chronic pain."


Bachhuber, M., et al. (2019). "Use of cannabis to relieve pain and promote sleep by customers at an adult use dispensary." Journal of Psychoactive Drugs: Published online in advance of print publication.

EXCERPT: “Between August 2016 and October 2016, store staff asked customers if they wanted to participate and, if so, provided an electronic survey link. All customers reporting medical certification were excluded. Of 1,000 adult-use only customer respondents, 65% reported taking cannabis to relieve pain and 74% reported taking cannabis to promote sleep. Among respondents taking cannabis for pain, 80% reported that it was very or extremely helpful, and most of those taking over-the-counter pain medications (82%) or opioid analgesics (88%) reported reducing or stopping use of those medications. Among respondents taking cannabis for sleep, 84% found it very or extremely helpful, and most of those taking over-the-counter (87%) or prescription sleep aids (83%) reported reducing or stopping use of those medications. De facto medical use of cannabis for symptom relief was common among adult-use dispensary customers and the majority reported that cannabis decreased their medication use. Adult use cannabis laws may broaden access to cannabis for the purpose of symptom relief.”


Becker, W. C., et al. (2021). "Cannabis use, pain interference, and prescription opioid receipt among persons with hiv: A target trial emulation study." AIDS Care.

EXCERPT:"Adjusting for demographic and clinical factors, cannabis use in any of 4 longitudinal patterns was not associated with resolved pain interference over 12- to 24-month follow-up. Among 153 participants receiving LTOT [Long Term Opiod Therapy] at baseline, cannabis use at both baseline and follow-up was negatively associated with LTOT dose reduction compared to no use at both baseline and follow-up. These findings support other observational studies finding no association between cannabis use and improved chronic pain or LTOT reduction among PWH."


Bitencourt, R. M. and R. N. Takahashi (2018). "Cannabidiol as a Therapeutic Alternative for Post-traumatic Stress Disorder: From Bench Research to Confirmation in Human Trials." Frontiers of Neuroscience 12: 502.

EXCERPT: “Since the discovery of the involvement of the endocannabinoid (eCB) system in emotional memory processing, pharmacological manipulation of eCB signaling has become a therapeutic possibility for the treatment of PTSD. Cannabidiol (CBD), a phytocannabinoid constituent of Cannabis sativa without the psychoactive effects of Delta(9)-tetrahydrocannabinol, has gained particular attention.… The goal of this review was to highlight the potential of CBD as a treatment for disorders related to inappropriate retention of aversive memories, by assessing evidence from preclinical to human experimental studies.”


Bobitt, J., et al. (2020). "Use of cannabis and opioids for chronic pain by older adults: Distinguishing clinical and contextual influences." Drug and Alcohol Review: published onine in avane of print publication.

EXCERPT: "When comparing drug users to non-drug users, pain was significantly associated with using cannabis and/or opioids when controlling for other covariates. However, when we compared cannabis users to opioid users, pain was no longer a determining factor. Instead, other contextual factors such as sex, personal beliefs and physician attitudes influenced an individual's choice between cannabis or opioids.... This study showed that contextual factors appear to have more influence on an individual's decision to use cannabis as an alternative to opioids than individual need or characteristics."


Boehnke, K. F., et al. (2019). "Cannabis use preferences and decision-making among a cross-sectional cohort of medical cannabis patients with chronic pain." The Journal of Pain Published online in advance of print publication.

EXCERPT: “Female, MED, and novice users were less likely to smoke or vaporize (all P < .0001), but more likely to rank edibles, tinctures, and topicals as a first-choice administration route than their counterparts. Female and MED users also preferred low THC: high cannabidiol ratios significantly more than their counterparts. Overall, only 2.6% of participants selected cannabis products with input from a medical professional, although 54.9% relied on advice from dispensary employees. More male, MEDREC, and experienced users selected products based on factors that reflected greater comfort with cannabis (eg, smell, visual properties, cannabis variety)…. Medical cannabis users with chronic pain show distinct differences in cannabinoid preferences and administration associated with user sex, intentions behind use, and experience with cannabis.”


Boehnke, K. F., et al. (2019). "High-frequency medical cannabis use is associated with worse pain among individuals with chronic pain." The Journal of Pain: Published online in advance of print publication.

EXCERPT: “ Cannabis is widely used for chronic pain. However, there is some evidence of an inverse dose–response relationship between cannabis effects and pain relief that may negatively affect analgesic outcomes. In this cross-sectional survey, we examined whether daily cannabis use frequency was associated with pain severity and interference, quality of life measures relevant to pain (eg, anxiety and depressive symptoms), and cannabis use preferences (administration routes and cannabinoid ratio). Our analysis included 989 adults who used cannabis every day for chronic pain. Participant use was designated as light, moderate, and heavy (1–2, 3–4, and 5 or more cannabis uses per day, respectively). The sample was also subgrouped by self-reported medical-only use (designated MED, n = 531, 54%) versus medical use concomitant with a past-year history of recreational use (designated MEDREC, n = 458, 46%). …. Our findings suggest that lower daily cannabis use frequency is associated with better clinical profile as well as lower risk cannabis use behaviors among MED participants.”


Bonaccorso, S., et al. (2019). "Cannabidiol (CBD) use in psychiatric disorders: A systematic review." Neurotoxicology 74: 282-298.

EXCERPT: “Cannabidiol (CBD) and Delta9-tetrahydrocannabinol (THC) are the most represented phytocannabinoids in Cannabis sativa plants. However, CBD may present with a different activity compared with the psychotomimetic THC. Most typically, CBD is reported to be used in some medical conditions, including chronic pain. Conversely, the main aim of this systematic review is to assess and summarise the available body of evidence relating to both efficacy and safety of CBD as a treatment for psychiatric disorders, alone and/or in combination with other treatments. Eligible studies included randomized controlled trials (RCT) assessing the effect of CBD in a range of psychopathological conditions, such as substance use; psychosis, anxiety, mood disturbances, and other psychiatric (e.g., cognitive impairment; sleep; personality; eating; obsessive-compulsive; post-traumatic stress/PTSD; dissociative; and somatic) disorders. For data gathering purposes, the PRISMA guidelines were followed. The initial search strategy identified some n=1301 papers; n=190 studies were included after the abstract's screening and n=27 articles met the inclusion criteria. There is currently limited evidence regarding the safety and efficacy of CBD for the treatment of psychiatric disorders. However, available trials reported potential therapeutic effects for specific psychopathological conditions, such as substance use disorders, chronic psychosis, and anxiety.”


Bonar, E. E., et al. (2019). "Driving under the influence of cannabis among medical cannabis patients with chronic pain." Drug and Alcohol Dependence 195: 193-197.

EXCERPT: “For the past 6 months, DUIC within 2 h of use was reported by 56.4% of the sample, DUIC while a “little high” was reported by 50.5%, and “very high” was reported by 21.1%. Greater cannabis quantity consumed and binge drinking were generally associated with DUIC behaviors. Higher pain was associated with lower likelihood of DUIC.… The prevalence of DUIC is concerning, with more research needed on how to best measure DUIC. Prevention messaging for DUIC may be enhanced by addressing alcohol co-consumption.”


Botsford, S. L., et al. (2019). "Cannabis and cannabinoids in mood and anxiety disorders: Impact on illness onset and course, and assessment of therapeutic potential." The American Journal on Addictions: Published online in advance of print publication.

EXCERPT: “Forty-seven studies were included: 32 reported on illness onset, nine on illness course, and six on cannabinoid therapeutics. Cohort studies varied significantly in design and quality. The literature suggests that cannabis use is linked to the onset and poorer clinical course in bipolar disorder and PTSD, but this finding is not as clear in depression and anxiety disorders (ADs). There have been few high-quality studies of cannabinoid pharmaceuticals in clinical settings.”


Bruce, D., et al. (2019). "Perceived efficacy of medical cannabis in the treatment of co-occurring health-related quality of life symptoms." Behavioral Medicine: Published online in advance of print publication.

EXCERPT: “For persons living with chronic conditions, health-related quality of life (HRQoL) symptoms, such as pain, anxiety, depression, and insomnia, often interact and mutually reinforce one another. There is evidence that medical cannabis (MC) may be efficacious in ameliorating such symptoms and improving HRQoL. As many of these HRQoL symptoms may mutually reinforce one another, we conducted an exploratory study to investigate how MC users perceive the efficacy of MC in addressing co-occurring HRQoL symptoms…. Pain was the most frequently reported HRQoL treated by MC, followed by anxiety, insomnia, and depression. A large majority of our sample (75%) reported treating two or more HRQoL symptoms. In general, perceived efficacy of MC in relieving each HRQoL symptom category increased with the number of co-occurring symptoms also treated with MC. Perceived efficacy of MC in relieving pain, anxiety, and depression varied significantly by number of total symptoms experienced…. Our results suggest that co-occurring pain, anxiety, and depression may be particularly amenable to treatment with MC.”


Campbell, G., et al. (2019). "Understanding the evidence for medical cannabis and cannabis-based medicines for the treatment of chronic non-cancer pain." European Archives of Psychiatry and Clinical Neuroscience 269(1): 135-144.

EXCERPT: “In this paper, we outline the current evidence for medical cannabis and cannabis-based medicines in the treatment and management of chronic non-cancer pain. We discuss limitations of the current evidence, including limitations of randomised control trials in the field, limits on generalisability of previous findings and common issues such as problems with measurements of dose and type of cannabinoids. We discuss future directions for medicinal cannabinoid research, including addressing limitations in trial design; developing frameworks to monitor for use disorder and other unintended outcomes; and considering endpoints other than 30% or 50% reductions in pain severity.”


Casarett, D. J., et al. (2019). "Benefit of tetrahydrocannabinol versus cannabidiol for common palliative care symptoms." Journal of Palliative Medicine 22(10): 1180-1184.

EXCERPT: “A total of 2,431 patients participated…. Of the six symptoms, response was associated with increased THC:CBD ratio for neuropathic pain (odds ratio [OR]: 3.58; 95% CI: 1.32–9.68; p = 0.012), insomnia (OR: 2.93; 95% CI: 1.75–4.91; p p = 0.022). Increased THC:CBD ratio was not associated with a greater response of post-traumatic stress disorder (PTSD)-related flashbacks (OR: 1.43; 95% CI: 0.60–3.41; p = 0.415) or anorexia (OR: 1.61; 95% CI: 0.70–3.73; p = 0.265). The response for anxiety symptoms was not significant (OR: 1.13; 95% CI: 0.77–1.64; p = 0.53), but showed an inverted U-shaped curve, with maximal benefit at a 1:1 ratio (50% THC).”


Chan, C. J. (2020). Efficacy of plant based cannabis in reducing pain in patients with chronic pain: A meta analysis. US, ProQuest Information & Learning. 81.

EXCERPT: "Pre and post means and standard deviations of subjective pain intensity were used to determine confidence intervals and effect sizes in order to get an overall grand effect size. Magnitude of effect sizes were determined by Cohen's Q and homogeneity was determined by P values.The seven articles included in this meta-analysis (see Appendix) were used to determine the efficacy of plant-derived cannabis for decreasing pain according to the 10cm VAS or NPRS. The results support the use of cannabis for decreasing pain. Despite these results, the heterogeneity of the studies based on vast differences in research design and protocol, make it difficult to conclude that cannabis is an effective and safe option for relief of chronic pain."


Chayama, K. L., et al. (2021). "The role of cannabis in pain management among people living with hiv who use drugs: A qualitative study." Drug and Alcohol Review.

EXCERPT: "Most participants reported that using cannabis for pain management helped improve daily functioning. Some participants turned to cannabis as a supplement or periodic alternative to prescription and illicit drugs (e.g. benzodiazepines, opioids) used to manage pain and related symptoms. Nonetheless, participants' access to legal cannabis was limited and most continued to obtain cannabis from illicit sources, which provided access to cannabis that was free or deemed to be affordable.... Cannabis use may lead to reduced use of prescription and illicit drugs for pain management among some people living with HIV who use drugs. Our findings add to growing calls for additional research on the role of cannabis in pain management and harm reduction, and suggest the need for concrete efforts to ensure equitable access to cannabis."


Cooper, Z. D. and D. Abrams (2019). "Considering abuse liability and neurocognitive effects of cannabis and cannabis-derived products when assessing analgesic efficacy: A comprehensive review of randomized-controlled studies." The American Journal of Drug and Alcohol Abuse: Published online in advance of print publication.

EXCERPT: “Thirty-eight studies were reviewed; 29 assessed cannabis and CDPs for chronic pain, 1 for acute pain, and 8 used experimental pain tests. Most studies ascertained adverse effects through self-report (N = 27). Fewer studies specifically probed abuse liability (N = 7) and cognitive and psychomotor effects (N = 12). Many studies related to chronic and experimental pain (N = 18 and N = 5, respectively) found cannabis and CDPs to reduce pain. Overall, adverse effects were mild to moderate, and dose-related. Studies investigating the impact of cannabis and CDPs on abuse liability and neurocognitive endpoints were mostly limited to inhaled administration and confirmed dose-related effects.”


Coughlin, L. N., et al. (2021). "Progression of cannabis withdrawal symptoms in people using medical cannabis for chronic pain." Addiction.

EXCERPT: "A three-class LCA model including a mild (41%), moderate (34%) and severe (25%) symptom class parsimoniously represented withdrawal symptoms experienced by people using medical cannabis. Stability of withdrawal symptoms using a three-class LTA at 12 and 24 months ranged from 0.58 to 0.87, with the most stability in the mild withdrawal class. Younger age predicted greater severity and worsening of withdrawal over time.... Adults with chronic pain seeking medical cannabis certification or re-certification appear to experience mild to severe withdrawal symptoms. Withdrawal symptoms tend to be stable over a 2-year period, but younger age is predictive of worse symptoms and of an escalating withdrawal trajectory."


Cunetti, L., et al. (2018). "Chronic Pain Treatment With Cannabidiol in Kidney Transplant Patients in Uruguay." Transplant Proc 50(2): 461-464.

EXCERPT: “Chronic pain is a major therapeutic problem in kidney transplant patients owing to nephrotoxicity associated with nonsteroidal antiiflammatory drugs. Benefits in chronic pain treatment with cannabidiol (CBD) have been reported. This study assesses the effect, safety, and possible drug interactions in kidney transplant patients treated with CBD for chronic pain…. We assessed patients who asked to receive CBD for pain treatment. Doses were increased from 50 to 150 mg twice a day for 3 weeks. Creatinine, blood count, liver function, liver enzymes, and drug levels were determined every 48 hours the first week and then once a week thereafter… Two patients had total pain improvement, 4 had a partial response in the first 15 days, and in 1 there was no change…. During this follow-up, CBD was well-tolerated, and there were no severe adverse effects.”


De Aquino, J. P., et al. (2020). "Impact of cannabis on non-medical opioid use and symptoms of posttraumatic stress disorder: A nationwide longitudinal va study." The American Journal of Drug and Alcohol Abuse: Published online in advance of print publication.

EXCERPT: "Of 1,413 veterans with current non-medical opioid use, 438 (30.3%) also used cannabis, and 985 (69.7%) did not. At baseline, veterans with concurrent non-medical opioid and cannabis use had slightly fewer days of non-medical opioid use (p < .005; d = −0.16), greater use of other substances (p < .0001) and more PTSD symptoms (p = .003; d = 0.16), compared to veterans who used non-medical opioids but not cannabis. At follow-up, substance use or PTSD symptoms did not significantly differ. Conclusion Cannabis use was not associated with a substantial reduction of non-medical opioid use, or either improvement or worsening of PTSD symptoms in this population. Hence, these data do not encourage cannabis use to treat either non-medical opioid use or PTSD."


do Nascimento, G. C., et al. (2020). "Cannabidiol increases the nociceptive threshold in a preclinical model of Parkinson's disease." Neuropharmacology 163.

EXCERPT: “6-hydroxydopamine- induced parkinsonism decreases the thermal and mechanical nociceptive threshold, whereas CBD (acute and chronic treatment) reduces this hyperalgesia and allodynia evoked by 6-hydroxydopamine. Moreover, ineffective doses of either FAAH inhibitor or TRPV1 receptor antagonist potentialized the CBD-evoked antinociception while an inverse agonist of the CB1 and CB2 receptor prevented the antinociceptive effect of the CBD. Altogether, these results indicate that CBD can be a useful drug to prevent the parkinsonism-induced nociceptive threshold reduction. They also suggest that CB1 and TRPV1 receptors are important for CBD-induced analgesia and that CBD could produce these analgesic effects increasing endogenous anandamide levels.”


Elms, L., Shannon, S., Hughes, S., & Lewis, N. (2019). Cannabidiol in the treatment of post-traumatic stress disorder: a case series. The Journal of Alternative and Complementary Medicine, 25(4), 392-397.

EXCERPT: “Patients taking daily oral CBD over an 8-week period demonstrated an overall decrease in PTSD symptom severity as measured by continual decreases in mean PCL-5 scores. CBD was well tolerated and no patients discontinued it due to side effects, although a minority of patients did report fatigue and gastrointestinal discomfort. It is unclear whether the fatigue caused by CBD is due to a sedative effect, and further information should be obtained about the safety profile of CBD. Doses of CBD used in this study were generally lower than those used in prior preclinical and clinical research. Patients did generally report greater improvement in symptoms with higher doses of CBD. Further investigation into the optimal dosing of CBD for PTSD is warranted. Patients also received liquid spray and oral capsular forms of CBD, and it is unknown whether there is a difference in response between the two routes of administration. CBD is commercially available in many different forms, and further studies should be done to determine the most effective form of CBD. A surprising number of patients with significant symptomatology related to PTSD nightmares reported subjective improvement in these symptoms.”


Frohe, T., et al. (2019). "Perceived health, medical, and psychiatric conditions in individual and dual-use of marijuana and nonprescription opioids." J Consult Clin Psychol 87(10): 859-871.

EXCERPT: “We used the National Epidemiologic Survey of Alcohol and Related Conditions (NESARC) Wave 1 (W1; N = 43,093), Wave 2 (W2; N = 34,653), and the more recent NESARC-III (N3; N = 36,171) to compare nonuse with use of marijuana, nonprescription opioids, or both. We examined perceived health, pain interference, pain-related medical conditions, psychiatric conditions, and suicidality…. Individual use and dual-use were more common in N3 than in W1. W1 dual-use and nonprescription opioid-only use predicted worse outcomes for most variables prospectively and cross-sectionally, including pain interference and poorer general health. Associations between marijuana-only use and outcomes were not as strong; however, marijuana was associated with depression and suicidal ideation.”


Gruber, S. A., et al. (2021). "No pain, all gain? Interim analyses from a longitudinal, observational study examining the impact of medical cannabis treatment on chronic pain and related symptoms." Experimental and Clinical Psychopharmacology 29(2): 147-156.

EXCERPT: "Relative to baseline, following 3 and 6 months of treatment, MC patients exhibited improvements in pain which were accompanied by improved sleep, mood, anxiety, and quality of life, and stable conventional medication use. Reduced pain was associated with improvements in aspects of mood and anxiety. The results generally suggest increased THC exposure was related to pain-related improvement, while increased CBD exposure was related to improved mood. Cannabis expectancies were not related to observed improvements.... Findings highlight the potential efficacy of MC treatment for pain and underscore the unique impact of individual cannabinoids on specific aspects of pain and comorbid symptoms."


Hasin, D. S., et al. (2020). "U.S. adults with pain, a group increasingly vulnerable to nonmedical cannabis use and cannabis use disorder: 2001–2002 and 2012–2013." The American Journal of Psychiatry 177(7): 611-618.

EXCERPT: "Any nonmedical cannabis use was more prevalent in respondents with than without pain (2001–2002: 5.15% compared with 3.74%; 2012–2013: 12.42% compared with 9.02%), a risk difference significantly greater in the 2012–2013 data than in the 2001–2002 data. The prevalence of frequent nonmedical cannabis use did not differ by pain status in the 2001–2002 survey, but was significantly more prevalent in those with than without pain in the 2012–2013 survey (5.03% compared with 3.45%). Cannabis use disorder was more prevalent in respondents with than without pain(2001–2002: 1.77% compared with 1.35%; 2012–2013: 4.18% compared with 2.74%), a significantly greater risk difference in the data from 2012–2013 than from 2001–2002.... The results suggest that adults with pain are a group increasingly vulnerable to adverse cannabis use outcomes, warranting clinical and public health attention to this risk. Psychiatrists and other health care providers treating patients with pain should monitor such patients for signs and symptoms of cannabis use disorder."


Hill, K. P., et al. (2019). "Therapeutic cannabis use in 2018: Where do we stand?" The Lancet Psychiatry 6(2): 88-89.

EXCERPT: “As of November 2018, 30 countries have initiated policies that allow the use of cannabis or cannabinoids for the treatment of specific medical conditions…. Cannabinoids have previously been approved for chemotherapy-induced nausea, vomiting, and appetite stimulation. Additionally, the efficacy of cannabis as a pharmacotherapy is best shown for three conditions: chronic pain, neuropathic pain, and muscle spasticity associated with multiple sclerosis.”


Hjorthøj, C., et al. (2021). "Cannabis-based medicines and medical cannabis for patients with neuropathic pain and other pain disorders: Nationwide register-based pharmacoepidemiologic comparison with propensity score matched controls." European Journal of Pain.

EXCERPT: "Among both patient groups, users of THC used more opioids during follow-up than controls. Among patients with neuropathic pain, however, users of either CBD, THC, or combined CBD + THC used less gabapentin than controls. Users of all three classes of CBM/MC were hospitalized fewer days than controls among neuropathic-pain patients but not among patients with other or unspecified pain disorders. Conclusions CBM/MC were generally safe and even displayed some positive effects among patients with neuropathic pain. We conclude that CBM/MC are safe and possibly efficacious for patients with neuropathic pain but not patients with other pain disorders.... Patients with neuropathic pain may benefit from treatment with cannabis-based medicines or medical cannabis (CBM/MC), particularly in terms of reduced use of gabapentin and fewer days admitted to hospitals, compared with propensity score matched controls. CBM/MC did not, however, reduce the use of opioids. We did not find evidence that CBM/MC were effective for patients with other pain disorders."


Kenyon, J., et al. (2018). "Report of Objective Clinical Responses of Cancer Patients to Pharmaceutical-grade Synthetic Cannabidiol." Anticancer Research 38(10): 5831-5835.

EXCERPT: “The aim of this study was to assess the effects of pharmaceutical-grade synthetic cannabidiol on a range of cancer patients…. We analysed the data routinely collected, as part of our treatment program, in 119 cancer patients over a four-year period…. Clinical responses were seen in 92% of the 119 cases with solid tumours including a reduction in circulating tumour cells in many cases and in other cases, a reduction in tumour size, as shown by repeat scans. No side-effects of any kind were observed when using pharmaceutical grade synthetic cannabidiol…. Pharmaceutical-grade synthetic cannabidiol is a candidate for treating breast cancer and glioma patients."


Kim, A., et al. (2019). "Patterns of medical cannabis use among cancer patients from a medical cannabis dispensary in New York State." Journal of Palliative Medicine 22(10): 1196-1201.

EXCERPT: “There were a total of 11,590 individuals with 1990 (17.2%) having cancer who used at least one cannabis product. Patients with cancer using cannabis were older and more likely to be female. The most common qualifying symptom for both cancer and noncancer patients was severe or chronic pain. Cancer patients were more likely to use the sublingual tincture form of cannabis (n = 1098, 55.2%), while noncancer patients were more likely to use the vaporization form (n = 4222, 44.0%). Over time, across all patients, there was an increase in the THC daily dose by a factor of 0.20 mg/week, yielding a corresponding increase in the THC:CBD daily ratio. Compared with noncancer patients, these trends were not different in the cancer group for THC daily dose, but there were less pronounced increases in the THC:CBD daily ratio over time among cancer patients.”


Kosiba, J. D., et al. (2019). "Patient-reported use of medical cannabis for pain, anxiety, and depression symptoms: Systematic review and meta-analysis." Social Science & Medicine 233: 181-192.

EXCERPT: “Meta-analytic results indicated that pain (64%), anxiety (50%), and depression/mood (34%) were common reasons for medical cannabis use.”


Kosiba, J. D., et al. (2019). "A preliminary study of associations between discomfort intolerance, pain severity/interference, and frequency of cannabis use among individuals with chronic pain." Addiction Research & Theory Published online in advance of print publication.

EXCERPT: “Participants (N = 109; 44% male; Mage = 27) endorsed chronic pain and at least one instance of lifetime cannabis use. Most participants characterized their chronic pain as high intensity and low disability, and the two most commonly reported frequencies of cannabis use were “less than monthly” (n = 38), and “daily/almost daily” (n = 32). Results indicated that discomfort avoidance (but not discomfort intolerance), pain severity, and pain-related interference were each independently and positively associated with frequency of cannabis use.”


Krediet, E., et al. (2020). "Experiences with medical cannabis in the treatment of veterans with PTSD: Results from a focus group discussion." European Neuropsychopharmacology 36: 244-254.

EXCERPT: "Five overarching themes were identified. The first four themes related to the different phases of medical cannabis use – namely, 1) Consideration; 2) Initiation; 3) Usage; and 4) Discontinuation. The fifth theme related to several general aspects of medical cannabis use. Patients used medical cannabis to manage their symptoms and did not experience an urge to “get high.” They used a variety of different cannabis strains and dosages and reported several therapeutic effects, including an increased quality of sleep. Furthermore, discussions about the experienced stigma surrounding cannabis generated insights with implications for the initiation of medical cannabis use. These results underscore the value of qualitative research in this field and are relevant for the design of future clinical trials on the use of medical cannabis for the treatment of PTSD."


LaFrance, E. M., et al. (2020). "Short and long-term effects of cannabis on symptoms of post-traumatic stress disorder." J Affect Disord 274: 298-304.

EXCERPT: "All symptoms were reduced by more than 50% immediately after cannabis use. Time predicted larger decreases in intrusions and irritability, with later cannabis use sessions predicting greater symptom relief than earlier sessions. Higher doses of cannabis predicted larger reductions in intrusions and anxiety, and dose used to treat anxiety increased over time. Baseline severity of all symptoms remained constant across time.... Cannabis provides temporary relief from PTSD-related symptoms. However, it may not be an effective long-term remedy as baseline symptoms were maintained over time and dose used for anxiety increased over time, which is indicative of development of tolerance."


Metrik, J., et al. (2020). "Cannabis use and posttraumatic stress disorder: Prospective evidence from a longitudinal study of veterans." Psychological Medicine: Published online in advance of print.

EXCERPT: "Results from the two-wave CLPM reveal a significant effect from baseline PTSD to 12-month CUD...,but not from baseline CUD to 12-month PTSD (β = 0.12, 95% CI −0.022 to 0.262)....Strong prospective associations capturing within-person changes suggest that cannabis use is linked with greater severity of trauma-related intrusion symptoms over time. A strong person-level directional association between PTSD and CUD was evident. Findings have significant clinical implications for the long-term effects of cannabis use among individuals with PTSD."


Millar, S. A., et al. (2019). "A systematic review of cannabidiol dosing in clinical populations." Br J Clin Pharmacol 85(9): 1888-1900.

EXCERPT: A total of 1038 articles were retrieved, of which 35 studies met inclusion criteria covering 13 medical contexts. Twenty-three studies reported a significant improvement in primary outcomes (e.g. psychotic symptoms, anxiety, seizures), with doses ranging between <1 and 50 mg/kg/d. Plasma concentrations were not provided in any publication. CBD was reported as well tolerated and epilepsy was the most frequently studied medical condition, with all 11 studies demonstrating positive effects of CBD on reducing seizure frequency or severity (average 15 mg/kg/d within randomised controlled trials). There was no signal of positive activity of CBD in small randomised controlled trials (range n = 6-62) assessing diabetes, Crohn's disease, ocular hypertension, fatty liver disease or chronic pain. However, low doses (average 2.4 mg/kg/d) were used in these studies.”


Nitecka-Buchta, A., et al. (2019). "Myorelaxant Effect of Transdermal Cannabidiol Application in Patients with TMD: A Randomized, Double-Blind Trial." J Clin Med 8(11).

EXCERPT: “In this study, we aimed to evaluate the efficiency of the myorelaxant effect of CBD after the transdermal application in patients with myofascial pain. (2) Methods: The Polish version of the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD Ia and Ib) was used. A total of 60 patients were enrolled in the study and were randomly divided into two groups: Group1 and Group2. The average age in Group1 was 23.2 years (SD) = 1.6 years) and in Group2, it was 22.6 years (SD = 1.86). This was a parallel and double-blind trial. Group1 received CBD formulation, whereas Group2 received placebo formulation for topical use. The masseter muscle activity was measured on days 0 and 14, with surface electromyography (sEMG) (Neurobit Optima 4, Neurobit System, Gdynia, Poland). Pain intensity in VAS (Visual Analogue Scale) was measured on days 0 and 14. (3) Results: in Group1, the sEMG masseter activity significantly decreased (11% in the right and 12.6% in the left masseter muscles). In Group2, the sEMG masseter activity was recorded as 0.23% in the right and 3.3% in the left masseter muscles. Pain intensity in VAS scale was significantly decreased in Group1: 70.2% compared to Group2: 9.81% reduction. Patients were asked to apply formulation twice a day for a period of 14 days…. The application of CBD formulation over masseter muscle reduced the activity of masseter muscles and improved the condition of masticatory muscles in patients with myofascial pain.”


Orr, M. F., et al. (2019). "Is there a relationship between cannabis use problems, emotion dysregulation, and mental health problems among adults with chronic pain?" Psychology, Health & Medicine: Published online in advance of print publication.

EXCERPT: “Participants were 431 opioid-using adults with current moderate to severe chronic pain, 176 were current cannabis users, of which 30.20% reported cannabis use problems. Results indicated a significant indirect relationship between cannabis use problems and anxiety [95% CI (.03, .05)], depression [95% CI (.03, .06)], and suicidal ideation [95% CI (.01, .01)] via emotion dysregulation. Tests of specificity suggested potential for a bi-directional effect for suicidal ideation (p < .001).”


Perron, B. E., et al. (2019). "Mental health functioning and severity of cannabis withdrawal among medical cannabis users with chronic pain." Drug and Alcohol Dependence 194: 401-409.

EXCERPT: “Patients were included in the current study if they endorsed using cannabis at least weekly over the past three months. Of the persons in the baseline sample (N = 801), 83% endorsed using cannabis at this level of frequency and duration (N = 665). Findings: Approximately two-thirds of the sample (67.8%) reported at least one moderate or severe withdrawal symptom. The most commonly observed symptom was sleep difficulties (50.3%), followed by anxiety (27.8%), irritability (26.7%), and appetite disturbance (25.2%). Patients with low mental functioning had significantly higher rates of withdrawal symptom endorsement than patients with high mental functioning. However, no association was observed between physical functioning and withdrawal symptom endorsement. These patterns of association were consistent in multivariate analyses that controlled for other potentially confounding variables.”


Rehder, K. and S. Bowen (2019). "PTSD symptom severity, cannabis, and gender: A zero-inflated negative binomial regression model." Substance Use & Misuse: Published online in advance of print publication.

EXCERPT: “Gender predicted number of cannabis using days [incidence rate ratio (IRR) = 2.17; 95%CI = 1.41, 3.35; p < .001]. The probability of being a cannabis user was moderated by gender [odds ratio (OR) = 0.96; 95%CI= 0.93, 0.99; p = .026], such that for males, as PTSD symptom severity increased, likelihood of being a cannabis user increased. This relation was not supported in females, however.”


Schlag, A. K., et al. (2021). "Current controversies in medical cannabis: Recent developments in human clinical applications and potential therapeutics." Neuropharmacology 191.

EXCERPT: "We provide a high-level summary of current developments using findings from recent major reviews, as well as real world evidence (RWE), including global database registries and other patient reported outcomes (PROs). On the one hand, our strongest empirical data supports the use of cannabis-based medicinal products (CBMPs) for conditions with relatively small patient numbers. Yet on the other hand, the conditions, where the highest patient numbers present, often have debatable clinical evidence but good RWE, incorporating PROs of 1000s of patients. The discord between PROs and the respective strength of the evidence from randomised controlled trials (RCTs) highlights the urgent need for further research. The scientific literature examining the efficacy of medical cannabis for many conditions is still developing, whilst large numbers of patients globally have been successfully using medical cannabis to treat a broad range of conditions. We conclude on the importance of systematically developing RWE databases to supplement RCTs and to bridge the current evidence gaps."


Sznitman, S. R., et al. (2020). "Medical cannabis and cognitive performance in middle to old adults treated for chronic pain." Drug and Alcohol Review: Published online in advance of print.

EXCERPT: "Mean age was 63 ± 6 and 60 ± 5 years in the non-exposed and MC patients, respectively. Groups did not significantly differ in terms of cognitive performance measures. Furthermore, none of the MC use patterns were associated with cognitive performance.... These results suggest that use of whole plant MC does not have a widespread impact on cognition in older chronic pain patients. Considering the increasing use of MC in older populations, this study could be a first step towards a better risk–benefit assessment of MC treatment in this population. Future studies are urgently needed to further clarify the implications of late-life cannabis use for brain health."


van de Donk, T., et al. (2019). "An experimental randomized study on the analgesic effects of pharmaceutical-grade cannabis in chronic pain patients with fibromyalgia." Pain 160(4): 860-869.

EXCERPT: “In this experimental randomized placebo-controlled 4-way crossover trial, we explored the analgesic effects of inhaled pharmaceutical-grade cannabis in 20 chronic pain patients with fibromyalgia. We tested 4 different cannabis varieties with exact knowledge on their ??-tetrahydrocannabinol (THC) and cannabidiol (CBD) content: Bedrocan (22.4-mg THC, P = 0.01), with spontaneous pain scores correlating with the magnitude of drug high (ρ = −0.5, P P < 0.01). Cannabidiol inhalation increased THC plasma concentrations but diminished THC-induced analgesic effects, indicative of synergistic pharmacokinetic but antagonistic pharmacodynamic interactions of THC and CBD. This experimental trial shows the complex behavior of inhaled cannabinoids in chronic pain patients with just small analgesic responses after a single inhalation.”


VanDolah, H. J., et al. (2019). "Clinicians' Guide to Cannabidiol and Hemp Oils." Mayo Clin Proc 94(9): 1840-1851.

EXCERPT: “Cannabidiol (CBD) oils are low tetrahydrocannabinol products derived from Cannabis sativa that have become very popular over the past few years. Patients report relief for a variety of conditions, particularly pain, without the intoxicating adverse effects of medical marijuana. In June 2018, the first CBD-based drug, Epidiolex, was approved by the US Food and Drug Administration for treatment of rare, severe epilepsy, further putting the spotlight on CBD and hemp oils. There is a growing body of preclinical and clinical evidence to support use of CBD oils for many conditions, suggesting its potential role as another option for treating challenging chronic pain or opioid addiction. Care must be taken when directing patients toward CBD products because there is little regulation, and studies have found inaccurate labeling of CBD and tetrahydrocannabinol quantities. This article provides an overview of the scientific work on cannabinoids, CBD, and hemp oil and the distinction between marijuana, hemp, and the different components of CBD and hemp oil products. We summarize the current legal status of CBD and hemp oils in the United States and provide a guide to identifying higher-quality products so that clinicians can advise their patients on the safest and most evidence-based formulations. This review is based on a PubMed search using the terms CBD, cannabidiol, hemp oil, and medical marijuana. Articles were screened for relevance, and those with the most up-to-date information were selected for inclusion.”


Weaver, M. S., et al. (2019). "Crossing the line: Care of a pediatric patient with intractable seizures and severe neuropathic pain in absence of access to medical marijuana." Journal of Palliative Medicine 22(10): 1232-1235.

EXCERPT: “We present the case of a six-year-old child with intractable seizures and severe neuropathic pain managed on medical marijuana (MM) in her home state of Colorado; where medicinal use of marijuana is authorized at the state level; traveling across state lines to access surgical care in Nebraska where MM is prohibited….The case report shares the communication and creativity invested in adequate symptom management for this child weaned off of MM perioperatively. The case recognizes the unique complexities of shared symptom management goals within state-specific care models.”


Wilson, M. M., et al. (2019). "Cannabis use among patients in a rural academic palliative care clinic." Journal of Palliative Medicine 22(10): 1224-1226.

EXCERPT: “Clinicians saw 299 unique patients during the four one-month time periods reviewed. Eighty-three patients (27%) reported use of any form of cannabis. The most common reasons for cannabis use were pain (n = 49, 59%), anorexia (n = 16, 19%), insomnia (n = 14, 17%), nausea (n = 13, 16%), anxiety (n = 8, 10%), and depression (n = 5, 6%). Twenty-six patients (31%) used cannabis for more than one symptom. Among the 83 patients using cannabis, 60 (72%) were also prescribed opioids with 32% on immediate-release only and 25% on both immediate- and extended-release opioids. These 60 patients on opioids and cannabis represent 33% of all patients prescribed opioids in this clinic. Tetrahydrocannabinol was present in 25% of the 73 urine drug screens.”


Xu, D. H., et al. (2019). "The Effectiveness of Topical Cannabidiol Oil in Symptomatic Relief of Peripheral Neuropathy of the Lower Extremities." Curr Pharm Biotechnol.

EXCERPT: “There was a statistically significant reduction in intense pain, sharp pain, cold and itchy sensations in the CBD group when compared to the placebo group. No adverse events were reported in this study…. Our findings demonstrate that the transdermal application of CBD oil can achieve significant improvement in pain and other disturbing sensations in patients with peripheral neuropathy. The treatment product was well tolerated and may provide a more effective alternative compared to other current therapies in the treatment of peripheral neuropathy.”


Yang, K. H., et al. (2021). "Cannabis: An emerging treatment for common symptoms in older adults." Journal of the American Geriatrics Society 69(1): 91-97.

EXCERPT: "Approximately 15% (N = 83) of survey responders reported using cannabis within the past 3 years. Half (53%) reported using cannabis regularly on a daily or weekly basis, and reported using cannabidiol-only products (46%). The majority (78%) used cannabis for medical purposes only, with the most common targeted conditions/symptoms being pain/arthritis (73%), sleep disturbance (29%), anxiety (24%), and depression (17%). Just over three-quarters reported cannabis “somewhat” or “extremely” helpful in managing one of these conditions, with few adverse effects. Just over half obtained cannabis via a dispensary, and lotions (35%), tinctures (35%), and smoking (30%) were the most common administration forms. Most indicated family members (94%) knew about their cannabis use, about half reported their friends knew, and 41% reported their healthcare provider knowing. Sixty-one percent used cannabis for the first time as older adults (aged ≥61 years), and these users overall engaged in less risky use patterns (e.g., more likely to use for medical purposes, less likely to consume via smoking).... Most older adults in the sample initiated cannabis use after the age of 60 years and used it primarily for medical purposes to treat pain, sleep disturbance, anxiety, and/or depression. Cannabis use by older adults is likely to increase due to medical need, favorable legalization, and attitudes."


Young-Wolff, K. C., et al. (2019). "Trends in marijuana use among pregnant women with and without nausea and vomiting in pregnancy, 2009–2016." Drug and Alcohol Dependence 196: 66-70.

EXCERPT: “Of 220,510 pregnancies, 38,831 (17.6%) had an NVP diagnosis. Prenatal marijuana use was elevated each year among women with NVP. The adjusted prevalence of use increased significantly from 2009 to 2016 at an annual rate of 1.086 (95%CI = 1.069–1.104) among women with NVP, from 6.5% (95%CI = 5.7%–7.2%) to 11.1% (95%CI = 0.2%–12.0%), and 1.069 (95%CI = 1.059–1.080) among women without NVP, from 3.4% (95%CI = 3.2%–3.7%) to 5.8% (95%CI = 5.5%–6.1%). Trends did not vary by NVP status…. The prevalence of prenatal marijuana use has remained elevated over time among women with NVP. Clinicians should ask pregnant patients about their reasons for marijuana use and treat NVP with evidence-based interventions.”


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