And this is why most medical marijuana legislation is bogus, it is not written correctly, if proven in clinical trials anywhere in the world it should be available to patients. Your doctor likely won't ever suggest marijuana for spasticity, so bypass them in legal states or Canada.
Systematic review of systematic reviews for medical cannabinoids
Pain, nausea and vomiting, spasticity, and harms
Abstract
Objective To determine the effects of medical cannabinoids on pain, spasticity, and nausea and vomiting, and to identify adverse events.
Data sources MEDLINE, the Cochrane Database, and the references of included studies were searched.
Study selection
Systematic reviews with 2 or more randomized controlled trials (RCTs)
that focused on medical cannabinoids for pain, spasticity, or nausea and
vomiting were included. For adverse events, any meta-analysis for the
conditions listed or of adverse events of cannabinoids was included.
Synthesis
From 1085 articles, 31 relevant systematic reviews were identified
including 23 for pain, 5 for spasticity, 6 for nausea and vomiting, and
12 for adverse events. Meta-analysis of 15 RCTs found more patients
taking cannabinoids attained at least a 30% pain reduction: risk ratio
(RR) of 1.37 (95% CI 1.14 to 1.64), number needed to treat (NNT) of 11.
Sensitivity analysis found study size and duration affected findings
(subgroup differences, P ≤ .03), with larger and longer RCTs
finding no benefit. Meta-analysis of 4 RCTs found a positive global
impression of change in spasticity (RR = 1.45, 95% CI 1.08 to 1.95, NNT =
7). Other results were not consistently statistically significant, but
when positive, a 30% or more improvement in spasticity had an NNT of 10.
Meta-analysis of 7 RCTs for control of nausea and vomiting after
chemotherapy found an RR of 3.60 (95% CI 2.55 to 5.09) with an NNT of 3.
Adverse effects caused more patients to stop treatment (number needed
to harm [NNH] of 8 to 22). Individual adverse events were very common,
including dizziness (NNH = 5), sedation (NNH = 5), confusion (NNH = 15),
and dissociation (NNH = 20). “Feeling high” was reported in 35% to 70%
of users. The GRADE (Grading of Recommendations Assessment, Development
and Evaluation) evaluation reduced evidence ratings of benefit to low or
very low.
Conclusion
There is reasonable evidence that cannabinoids improve nausea and
vomiting after chemotherapy. They might improve spasticity (primarily in
multiple sclerosis). There is some uncertainty about whether
cannabinoids improve pain, but if they do, it is neuropathic pain and
the benefit is likely small. Adverse effects are very common, meaning
benefits would need to be considerable to warrant trials of therapy.
Medical cannabinoids have been advocated for an extensive variety of conditions, from glaucoma to cancer.1
Unfortunately, bias is pervasive throughout the medical cannabinoid
literature, including in randomized controlled trials (RCTs).2
This is compounded by poor reporting in the media, with 79% of medical
cannabinoid newspaper stories providing inappropriate information, most
of which was sensationalism.3
The interest in medical cannabinoids has varied broadly among prescribers, from enthusiasm4 to reluctance.5
A survey found that about one-quarter of physicians in a region of
Quebec prescribed medical cannabinoids, primarily (about 90%) nabilone,
but they thought more education on prescribing would be helpful.6
A needs assessment survey found that Canadian physicians wanted more
information about the risks and potential therapeutic uses of medical
cannabinoids.7 While Canadian organizations have responded by providing guidance documents8 and patient information,9
these documents lack numeric information and GRADE (Grading of
Recommendations Assessment, Development and Evaluation) evaluation10 regarding risks and benefits to adequately promote shared, informed decision making.
Two large and comprehensive reviews have examined the use of cannabinoids for various medical conditions.1,2
If cannabinoids are effective, the evidence suggests that they are most
likely to work for chronic pain, nausea and vomiting associated with
chemotherapy, and spasticity associated with chronic neurologic
conditions like multiple sclerosis.1,2
However, a key consideration for any medical intervention is the
potential adverse events or harms that could arise from the therapy.
Our
purpose was to complete a systematic review to provide evidence for a
medical cannabinoid prescribing guideline. We focused on the conditions
for which medical cannabinoids have the best evidence base and the
highest likelihood of having medical advantages. Therefore, our
objective was to complete 4 distinct systematic reviews of systematic
reviews on medical cannabinoids for pain, nausea and vomiting,
spasticity, and adverse events. On completion, we hoped to have clear
guidance for prescribers and their patients, as well as to provide
adequate information to promote shared, informed decision making.
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