Balancing risks and benefits of cannabis use: umbrella review of meta-analyses of randomised controlled trials and observational studies
Overview
Paper Summary
This umbrella review encompassing both observational studies and randomized controlled trials indicates that cannabis use, particularly high-THC cannabis, is linked to an elevated risk of psychosis and other mental health problems, while cannabidiol may be useful in treating certain types of epilepsy. Cannabis-based medicines can reduce seizures in some forms of epilepsy and may be beneficial for pain and spasticity in multiple sclerosis and chronic pain in other conditions, though they are not without adverse effects such as somnolence and visual impairment.
Explain Like I'm Five
Cannabidiol may help with epilepsy and some other conditions like chronic pain and multiple sclerosis, but using cannabis in general, especially with high THC, is associated with a higher risk of psychosis and other mental health issues.
Possible Conflicts of Interest
MS received honoraria/has been a consultant for AbbVie, Angelini, Lundbeck, Otsuka. DC has received grant monies and/or travel support and/or honoraria for talks and consultancy from Eli Lilly, Janssen Cilag, Roche, Allergen, Bristol-Myers Squibb, Pfizer, Lundbeck, Astra Zeneca, Hospira, Organon, Sanofi-Aventis, Wyeth, Hospira, Servier, and Seqirus. He is founder of the Optimal Health Program and part owner of Clarity Healthcare. He is on the scientific advisory of The Mental Health Foundation of Australia. EV has received grants and served as consultant, advisor, or CME speaker for numerous entities outside of the submitted work. CUC has been a consultant or advisor to or received honoraria from numerous pharmaceutical companies, has provided expert testimony, and is a stock option holder for several companies.
Identified Limitations
Rating Explanation
This is a well-conducted and informative umbrella review with some limitations. The inclusion of both RCTs and observational studies, quantitative criteria for grading evidence, and consideration of converging evidence are key strengths. However, the overreliance on observational studies, lack of recent evidence reflecting current cannabis products, and high heterogeneity in some analyses limit the generalizability and strength of some of the conclusions. Potential conflicts of interest among several authors are also noted.
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