A comprehensive review published in the BMJ revealed that cannabis use can be especially harmful during adolescence, among people with mental health disorders, during pregnancy and while driving.
On the other hand, the review also highlights the effectiveness of cannabidiol, a compound in cannabis, in the treatment of epilepsy and the usefulness of cannabis-based medicines for multiple sclerosis, chronic pain, inflammatory bowel disease and palliative care.
The recommendations are based on an “overall review” of 101 meta-analyses on cannabis and health, synthesizing previous meta-analyses and providing a high-level summary of evidence on a specific topic.
The researchers noted that a growing number of studies have examined the effects of cannabinoids on health and other outcomes, but most results are observational and prone to bias, making it difficult to draw firm conclusions.
To address this question, the international team assessed the credibility and certainty of over 500 reported associations between cannabis and health in 50 meta-analyses of observational studies and 51 meta-analyses of randomized clinical trials, pooling data from hundreds of individual published studies. from 2002 to 2022.
Evidence was classified as high, moderate, low, or critically low certainty in randomized trials, and as convincing, highly suggestive, suggestive, weak, or not significant in observational studies, based on quantitative criteria.
Increased risk of psychosis
Investigators found an increased risk of cannabinoid-associated psychosis in the general population, based on at least suggestive-level evidence from observational studies and moderate-certainty evidence from trials.
Specifically, cannabis use was associated with psychosis in adolescents (when brain development is still ongoing) and psychosis relapse in people with a psychotic disorder, the study found. This suggests that cannabis use increases the risk of psychotic disorders and worsens clinical outcomes after onset.
Increased psychotic symptoms
The study also found an association between cannabis use and general psychiatric symptoms, including depression and mania, as well as detrimental effects on memory, verbal and visual recall based on weak to suggestive observational evidence and high to moderate quality experimental evidence. .
These associations are particularly concerning given that the peak age of onset for mental health disorders coincides with the age pattern for cannabis use disorders, from mid-teens to early 20s, when adolescents and young adults are still in their early teens. education.
Weak to convincing observational evidence has suggested a link between cannabis use and car accidents. Convincing observational evidence has also linked cannabis use during pregnancy to the risk of having a small, low-birth-weight baby.
However, the study concluded that cannabidiol is beneficial in reducing seizures in certain types of epilepsy, while cannabis-based medications were beneficial for pain and muscle stiffness (spasticity) in multiple sclerosis, chronic pain in various conditions and care. palliative care, though not without adverse events.
The comprehensive review is the first to bring together observational and interventional studies on the effects of cannabinoids in humans. However, investigators noted that most outcomes associated with cannabis use are supported by weak evidence, have low to very low certainty, or are not significant.
Other limitations include differences in the cannabis content of products, the fact that not all individuals experience the same effects of cannabis use on their mental health and cognition, and that randomized trials may not be representative of the real-world population.
Regulation of cannabis use
However, the researchers recommend that policymakers and public health researchers consider this synthesis of evidence when making policy decisions about regulating cannabinoid use and when planning a future epidemiological or experimental research agenda.
Experts also call for future guidance to translate current results into clinical practice, involving stakeholders in the process.
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