Over the last 20 years, scientific research on marijuana has grown tremendously due to increased curiosity on its therapeutic potential and its effect on population health. Nonetheless, in spite of the regulatory challenges, a virtually growing literature base currently serves to guide our perception of the pharmacology,
therapeutics, harms, and socio-behavioral consequences of cannabis. Nevertheless, there are numerous topics that are still under-researched,
and it can be explained by the federal Schedule I status of marijuana in the United States,
which restrictedaccess to it by researchers in the past.
Therapeutic Efficacy: Evidence-Based Usage
There is great evidence that cannabinoids should be used on precise medical indication. For instance:
A 2017 report by the National Academies of Sciences, Engineering,
and Medicine (NASEM) determined that cannabinoids have a role in chronic pain, mostly neuropathic pain,
and that oral cannabinoids are effective antiemetics in chemotherapy-induced nausea and vomiting.
The use of CBD in epilepsy, particularly in rare and severe childhood forms of Dravet syndrome and Lennox-Gastaut syndrome, also has high-quality evidence.
- The use of cannabis in the enhancement of spasticity and sleep disorders linked to multiple sclerosis (MS) in chronic illnesses has moderate evidence.
The rest of the potential therapeutic uses, such as cannabis to treat anxiety, PTSD, depression, or inflammatory diseases,
are mostly in the exploratory stage, with conflicting results or small clinical trials. To prove these possible applications, standardization of cannabis products,
better dosing methodologies and big randomized controlled trials (RCTs) are needed.
Risks and Adverse Effects: Scientific Consensus
Of equal importance is the accumulating evidence with regard to the dangers of habitual or high-concentration cannabis use,
especially among susceptible groups:
- Neurodevelopmental risks: Longitudinal designs link early cannabis use with modifications in brain structure and functionality, especially in the prefrontal cortex and hippocampus regions, which are crucial in memory and executive functioning.
- Mental health implications: Evidence is coherent in the existence of a relation between heavy cannabis consumption and the increased risk of psychosis, particularly in cases of individuals with a genetic vulnerability or in those populations who consume high-THC strains. The links with depression and anxiety are less clear, may be bidirectional and are under further study.
- Dependence and withdrawal: Some studies have established the presence of Cannabis Use Disorder (CUD) which is composed of compulsive use, tolerance, and withdrawal symptoms which include irritability, sleep disorders, and craving.
Cannabis Constituents and the “Entourage Effect”
The direction of modern studies is also toward a more phytochemically comprehensive outlook by investigating the importance of minor cannabinoids (e.g., CBG, CBC, THCV) and terpenes in the regulation of the effects of cannabis. The theory of the entourage effect suggests that compounds in cannabis can have a synergistic effect in relation to their therapeutic effects,
producing a greater effect than the individual compounds, THC or CBD, alone. Although this theory is promising, it needs further and more rigorous testing using controlled studies.