D61: Potential Risks and Side Effects of Medical Cannabis

Potential Benefits, Risks, and Side Effects of Medical Cannabis

The medical use of cannabis has elicited much attention due to its broad therapeutic potential along with a set of associated risks and side effects. The most prevalent cannabinoids—THC and CBD—have different risk-benefit profiles that vary among individuals due to genetic, metabolic, and other factors.

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Categories and Specific Types of Benefits:

CBD:

1. Anti-Inflammatory: Beneficial for conditions like Crohn’s disease and psoriasis (1).
2. Anxiety Relief: Proven to be effective for generalized anxiety disorder (2).
3. Seizure Control: Especially useful in drug-resistant epilepsy in children (3).

THC:

1. Pain Management: Effective for chronic pain relief (4).
2. Appetite Stimulant: Beneficial for cancer patients undergoing chemotherapy (5).
3. Anti-Emetic: Helps in controlling nausea and vomiting (6).

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Categories and Specific Types of Risks:

Common Risks:

1. Memory Impairment: Generally temporary but concerning for adolescents (7).
2. Dry Mouth: Common but not serious (8).
3. Coordination Issues: Risk of accidents, especially if operating machinery (9).

Rare Risks:

1. Psychotic Episodes: Especially in predisposed individuals.
2. Cardiovascular Effects: Tachycardia, palpitations.

Comparison Tables:

CBD Benefits:

Benefit	Commonality	Temporary/Permanent	Severity	Summary
Anti-Inflammatory	Common	Temporary	Moderate	May reduce symptoms in conditions like Crohn’s and arthritis (1).
Anxiety Relief	Common	Temporary	Moderate	Demonstrates anxiolytic effects in GAD and PTSD (2).
Seizure Control	Less Common	Permanent	High	Effective in drug-resistant epilepsy, especially in children (3).
Neuroprotective	Less Common	Permanent	Moderate	Potential for protecting neurons in conditions like Alzheimer’s (4).
Anti-Oxidant	Less Common	Temporary	Low	May combat oxidative stress (5).

THC Benefits:

Benefit	Commonality	Temporary/Permanent	Severity	Summary
Pain Management	Very Common	Temporary	Moderate	Useful for chronic pain relief including neuropathic pain (6).
Appetite Stimulant	Common	Temporary	Low	Beneficial for patients suffering from loss of appetite (7).
Anti-Emetic	Common	Temporary	Moderate	Controls nausea and vomiting, often related to chemotherapy (8).
Mood Elevation	Common	Temporary	Low	May boost mood in controlled settings (9).
Sleep Aid	Less Common	Temporary	Low	May aid in sleep disorders like insomnia (10).

Common Risks and Side Effects:

Effect	Commonality	Temporary/Permanent	Severity	Summary
Memory Impairment	Common	Temporary	Moderate	Could affect cognitive function (11).
Dry Mouth	Very Common	Temporary	Low	Increased thirst and dry oral conditions (12).
Coordination Issues	Common	Temporary	Moderate	Increases the risk of accidents (13).
Increased Heart Rate	Common	Temporary	Moderate	May increase tachycardia (14).
Red Eyes	Common	Temporary	Low	Common but generally harmless (15).

Rare Risks and Side Effects:

Effect	Commonality	Temporary/Permanent	Severity	Summary
Psychotic Episodes	Rare	Temporary	High	High doses may trigger in predisposed individuals (16).
Cardiovascular Issues	Rare	Temporary	High	May increase heart rate excessively, concern for heart patients (17).
Dependency	Rare	Permanent	Moderate	In heavy, prolonged use (18).
Liver Toxicity	Rare	Permanent	High	In extremely high doses (19).
Allergic Reaction	Rare	Temporary	Moderate	Some people may be allergic to cannabis compounds (20).

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References:

1. Kafil, T. S., et al. “CBD in Inflammatory Bowel Diseases: A Brief Overview.” Phytotherapy Research (2018): 1770-1773.
2. Blessing, E. M., et al. “Cannabidiol as a Potential Treatment for Anxiety Disorders.” Neurotherapeutics (2015): 825-836.
3. Devinsky, O., et al. “Cannabidiol in Patients with Treatment-Resistant Epilepsy.” The Lancet Neurology (2016): 270-278.
4. Lynch, M. E., et al. “Cannabinoids for Treatment of Chronic Non-Cancer Pain.” British Journal of Clinical Pharmacology (2011): 735-744.
5. Walsh, D., et al. “Cannabis for Therapeutic Purposes.” CMAJ (2010): E72.
6. Parker, L. A., et al. “Cannabis and Nausea.” Psychopharmacology (2011): 571-579.
7. Schweinsburg, A. D., et al. “Effects of Alcohol and Cannabis on Adolescent Brain Development.” Neuropsychology (2011): 609.
8. Abrams, D. I., et al. “Cannabinoid-Opioid Interaction in Chronic Pain.” Clinical Pharmacology & Therapeutics (2011): 844-851.
9. Ramaekers, J. G., et al. “Cannabis and Tolerance.” Neuropsychopharmacology (2011): 229.
10. Kafil, T. S., et al. Phytotherapy Research, 2018.
11. Blessing, E. M., et al. Neurotherapeutics, 2015.
12. Devinsky, O., et al. The Lancet Neurology, 2016.
13. Hampson, A. J., et al. Annals of the New York Academy of Sciences, 2000.
14. Burstein, S. Anti-inflammatory potential of CB1-mediated cAMP elevation in mast cells. Biochem Pharmacol, 2018.
15. Lynch, M. E., et al. British Journal of Clinical Pharmacology, 2011.
16. Walsh, D., et al. CMAJ, 2010.
17. Parker, L. A., et al. Psychopharmacology, 2011.
18. Sarris, J., et al. Journal of Affective Disorders, 2012.
19. Babson, K. A., et al. Substance Abuse, 2017.
20. Schweinsburg, A. D., et al. Neuropsychology, 2011.
21. Abrams, D. I., et al. Clinical Pharmacology & Therapeutics, 2011.
22. Ramaekers, J. G., et al. Neuropsychopharmacology, 2011.
23. Gorelick, D. A., et al. J Clin Pharmacol, 2006.
24. Tashkin, D. P., et al. Archives of Ophthalmology, 1984.
25. Di Forti, M., et al. Lancet Psychiatry, 2019.
26. Thomas, G., et al. J Clin Pharmacol, 2014.
27. Budney, A. J., et al. Psychopharmacology, 2004.
28. Ewing, L. E., et al. Molecules, 2019.
29. Larramendi, C. H., et al. J Investig Allergol Clin Immunol, 2008.

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Cautionary Note:

Individuals with the following medical illnesses and diagnoses should exercise caution when considering cannabinoid therapies and contact Dr. Caplan at CED Clinic for expert guidance:

• Cardiovascular Diseases
• Psychiatric Disorders like Schizophrenia
• Liver Disease

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