2023-09-08 07:18:53
by Elena Meli
Benefits of medicinal preparations based on cannabinoids confirmed for those with chronic pain, multiple sclerosis, epilepsy and in palliative care, but the expert underlines: «Only with medical prescription»
Judging by the abundance of shops selling it, legal cannabis could almost be considered a consumer good. Yet these products, as well as medicines that contain some active ingredients of cannabis, cannabidiol and cannabinoids, and even more so the derivatives for use as recreational substances and drugs of abuse, can be risky for some categories of people: this is underlined by largest study ever carried out on the effects of cannabis and derivatives, recently published in the British Medical Journal a few days after an Italian ministerial decree which allows the inclusion of cannabidiol among narcotic substances.
Categories most at risk
The newly published research is an “umbrella review”, that is, a study for which previous reviews of research on the topic have been analysed: in practice it is the highest level of evidence that can be reached, a review of reviews that helps to clarify with the strength of numbers. Well, the results show that during adolescence, early adulthood and pregnancy, cannabis use can be risky and the same goes for people at high risk or with mental disorders; use is equally dangerous for those who have to drive, because it can increase the probability of road accidents.
Damages in young people
In very young people, the consumption of cannabis and derivatives is associated with a worsening of cognitive functions and mental health: for example, it leads to an increased risk of psychotic symptoms and is related to psychiatric disorders such as depression and mania, as well as memory performance. poorer. «Moreover», the authors specify, «cannabis can be the “gateway” to the use of other substances of abuse: the recommendation to avoid it in all forms is therefore strong». Similarly, pregnant women should stay away from it: cannabis is associated with lower birth weight of the baby and preterm births.
Cannabidiol-based medicines
The authors also examined the effects of medicines based on cannabidiol and cannabinoids, which together with tetrahydrocannabinol are among the most important active ingredients of cannabis: tetrahydrocannabinol is responsible for the psychotropic effects sought when used as a substance of abuse, Cannabidiol and cannabinoids have demonstrated some interesting properties in medicine. The new study confirms a possible usefulness of medicines containing cannabidiol in reducing episodes in some patients with epilepsy, as well as a decrease in pain in various chronic pain conditions and in palliative care thanks to the use of other cannabinoids, which also have antispasmodics in multiple sclerosis and help cancer patients against insomnia. However, all this, as the authors specify, «is not without adverse events: in addition to low tolerability, cannabidiol and cannabinoid-based medicines are also associated with psychiatric side effects. These results must therefore be considered in a clinical perspective and compared with available alternatives.”
More options
In other words, it is often likely that there are better options for the management of patients and the evaluation of a possible use must be careful, case by case, and always include close medical supervision. Not to mention that, as the authors conclude, «most of the health effects associated with cannabinoids are supported by weak evidence or are not significant, while convincing and converging evidence recommends avoiding the use of cannabis in adolescence, in young adults, in pregnancy, in those who are at risk or have mental disorders and every time you drive.”
The new decree
These indications from science arrive a few days after the publication in the Official Journal, on August 21, of a decree revoking the suspension of a previous 2020 decree, allowing the inclusion of cannabidiol in the table of narcotic substances. «Before this decree», explains Matteo Balestrieri, co-president of the Italian Society of Neuropsychopharmacology (SINPF), «cannabis-based medicines approved by the regulatory authorities were also subject to the provisions of the “Consolidated Law on Narcotic Substances” (DPR 309/1990) only if they contain tetrahydrocannabinol, the substance with a psychotropic effect; the same did not apply to cannabidiol-based drugs, which was not considered a psychotropic substance by current legislation in line with what was stated by the World Health Organization. Therefore, the implementation of the decree, while allowing its pharmacological use, would also include drugs with an exclusive cannabidiol content, for example an oral solution for the treatment of specific forms of epilepsy, within the provisions of Presidential Decree 309/1990″.
The effects on «cannabis light»
The decree will not change the methods of medical prescription of cannabis-based products and master preparations not approved by the regulatory authorities but used in support of standard treatments (so-called medical cannabis), however it will have an impact on the sale of consumer products based on of cannabidiol, the “cannabis light”. As Balestrieri explains, «based on the directives that allow the cultivation of cannabis varieties with tetrahydrocannabinol equal to or less than 0.2 percent, the sale of these products has seen exponential growth. They do not have the authorization to be placed on the market either as foods or as medicines, on the basis of ministerial decrees, European regulations and AIFA authorization, but in the absence of explicit provisions on their marketing they are proposed as “technological products”, i.e. as a collector’s item not intended to be smoked or ingested. However, the data confirms the use of these preparations instead of drugs usually prescribed for conditions such as chronic pain, anxiety, insomnia, with a reduction in the number of packages of drugs dispensed of up to 10 percent; furthermore, it emerged that light cannabis-based preparations may lack adequate safety by declaring quantities of compounds, including tetrahydrocannabinol, significantly divergent from those subsequently found. Beyond its scientific appropriateness, therefore, the recent decision of the Ministry of Health seems to drastically fill a gap in the legislation regarding the oral use of cannabidiol, limiting it only to pharmacological use, understood as subject to medical prescription”, concludes the ‘expert.
September 8, 2023 (modified September 8, 2023 | 07:17)
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