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Review
. 2022 Aug;30(4):1167-1178.
doi: 10.1007/s10787-022-01020-z. Epub 2022 Jul 7.

Tetrahydrocannabinol and cannabidiol medicines for chronic pain and mental health conditions

Jeremy D Henson  1   2 , Luis Vitetta  3   4 , Sean Hall  5
Affiliations
Review

Tetrahydrocannabinol and cannabidiol medicines for chronic pain and mental health conditions

Jeremy D Henson et al. Inflammopharmacology. 2022 Aug.

Abstract

Combination tetrahydrocannabinol (THC)/cannabidiol (CBD) medicines or CBD-only medicines are prospective treatments for chronic pain, stress, anxiety, depression, and insomnia. THC and CBD increase signaling from cannabinoid receptors, which reduces synaptic transmission in parts of the central and peripheral nervous systems and reduces the secretion of inflammatory factors from immune and glial cells. The overall effect of adding CBD to THC medicines is to enhance the analgesic effect but counteract some of the adverse effects. There is substantial evidence for the effectiveness of THC/CBD combination medicines for chronic pain, especially neuropathic and nociplastic pain or pain with an inflammatory component. For CBD-only medication, there is substantial evidence for stress, moderate evidence for anxiety and insomnia, and minimal evidence for depression and pain. THC/CBD combination medicines have a good tolerability and safety profile relative to opioid analgesics and have negligible dependence and abuse potential; however, should be avoided in patients predisposed to depression, psychosis and suicide as these conditions appear to be exacerbated. Non-serious adverse events are usually dose-proportional, subject to tachyphylaxis and are rarely dose limiting when patients are commenced on a low dose with gradual up-titration. THC and CBD inhibit several Phase I and II metabolism enzymes, which increases the exposure to a wide range of drugs and appropriate care needs to be taken. Low-dose CBD that appears effective for chronic pain and mental health has good tolerability and safety, with few adverse effects and is appropriate as an initial treatment.

Keywords: Anxiety; Cannabidiol; Depression; Insomnia; Pain; Stress; Tetrahydrocannabinol.

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Conflict of interest statement

The authors are employees and shareholders of Medlab Clinical Ltd. (Sydney, Australia). Medlab Clinical funded the publication costs; however, had no role in the design of the review; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish.

References

    1. Abelev S, Warne LN, Benson M, Hardy M, Nayee S, Barlow J. Medicinal cannabis for the treatment of chronic refractory pain: an investigation of the adverse event profile and health-related quality of life impact of an oral formulation. Med Cannabis Cannabinoids. 2022;5:20–31. - PMC - PubMed
    1. ACMD (2020) Cannabis-based products for medicinal use (CBPMs) in humans. London: Home Office, pp 1–48
    1. Agarwal N, Pacher P, Tegeder I, Amaya F, Constantin CE, Brenner GJ, Rubino T, Michalski CW, Marsicano G, Monory K, Mackie K, Marian C, Batkai S, Parolaro D, Fischer MJ, Reeh P, Kunos G, Kress M, Lutz B, Woolf CJ, Kuner R. Cannabinoids mediate analgesia largely via peripheral type 1 cannabinoid receptors in nociceptors. Nat Neurosci. 2007;10:870–879. doi: 10.1038/nn1916. - DOI - PMC - PubMed
    1. Amaral C, Trouille FM, Almeida CF, Correia-Da-silva G, Teixeira N. Unveiling the mechanism of action behind the anti-cancer properties of cannabinoids in ER(+) breast cancer cells: Impact on aromatase and steroid receptors. J Steroid Biochem Mol Biol. 2021;210:105876. doi: 10.1016/j.jsbmb.2021.105876. - DOI - PubMed
    1. American Psychiatric Association . Diagnostic and statistical manual of mental disorders. 5. Washington D. C: American Psychiatric Association; 2013.

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