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The beneficial role of cannabinoids, or cannabis products, as medicinal substances has been identified since long times. However, the exact therapeutic potential was greatly improved since the discovery of the endocannabinoid system in the body, which entails specific receptors (CB1 and CB2) to the various cannabinoid compounds. Smoked cannabis has been associated with several side effects, including anxiety, euphoria, and dry mouth due to the effect of tetrahydrocannabinol (THC). Alternatively, cannabinoids can be given via the oral, topical, or sublingual routes, where THC and cannabidiol (CBD) are considered the main active therapeutic substances.
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Multiple countries approved the medical use of cannabinoids for chronically-ill patients, such as Canada, Netherlands, and 24 states in the United States. The present study reviewed the most recent evidence of the medical use of cannabinoids and their potential side effects.
Medical uses for diseases of the nervous and musculoskeletal systems
The use of cannabinoids showed a great efficacy for controlling chronic pain, including neuropathic pain, cancer pain, rheumatoid arthritis, and chronic pain due to fibromyalgia and HIV. Nonetheless, the greatest beneficial role was demonstrated after using smoked THC. Both THC and CBD were effective to manage the continuous muscular contraction (spasticity) due to multiple sclerosis. Cannabis extracts and synthetic cannabinoids have the potential to treat sleep disorders, depression and anxiety. In addition, THC capsules were efficiently used to alleviate locomotor disturbances in children with Tourette syndrome. Unfortunately, CBD was ineffective for the treatment of psychosis, which is characterized by a loss of contact with reality.
Other miscellaneous medical uses
Cannabinoids showed a promising medicinal role in the treatment of nausea and vomiting that may be associated with cancer treatment (chemotherapy). This effect was more apparent when the symptoms were compared to patients receiving other anti-emetic medications. Additionally, dronabinol (a synthetic form of THC) used successfully to stimulate appetite in HIV patients, since the patients would have an increase in body weight and greater percentage of body fat.
The role of cannabinoids was not clearly recognized in patients with glaucoma as they did not exert significant effects on decreasing the fluid pressure within the eyes (intraocular pressure) to relieve disease symptoms.
Adverse effects of cannabinoids
Generally, the use of cannabinoids was associated with adverse effects shortly after their use. The most commonly reported side effects were euphoria, drowsiness, hallucination, vomiting, sleepiness, confusion, and balance problems. Dry mouth and fatigue were also demonstrated elsewhere but in a less frequency. The adverse effects following the use of cannabis were similar to those after using other cannabinoids. Currently, no clinical trials have been conducted to investigate the long-term side effects based on the different routes of administration.
The medical uses of cannabinoids were efficiently demonstrated although their associated short-term side effects may limit their application in selected patients. The most useful indications were the treatment of chronic pain and spasticity whereas its use in sleep disorders, Tourette syndrome, and glaucoma was poorly identified.