Risks and Benefits of Cannabis and Cannabinoids in Psychiatry
Publication: American Journal of Psychiatry
Abstract
Objective:
The United States is in the midst of rapidly changing laws regarding cannabis. The increasing availability of cannabis for recreational and medical use requires that mental health clinicians be knowledgeable about evidence to be considered when counseling both patients and colleagues. In this review, the authors outline the evidence from randomized double-blind placebo-controlled trials for therapeutic use of cannabinoids for specific medical conditions and the potential side effects associated with acute and chronic cannabis use.
Methods:
Searches of PubMed and PsycInfo were conducted for articles published through July 2021 reporting on “cannabis” or “cannabinoids” or “medicinal cannabis.” Additional articles were identified from the reference lists of published reviews. Articles that did not contain the terms “clinical trial” or “therapy” in the title or abstract were not reviewed. A total of 4,431 articles were screened, and 841 articles that met criteria for inclusion were reviewed by two or more authors.
Results:
There are currently no psychiatric indications approved by the U.S. Food and Drug Administration (FDA) for cannabinoids, and there is limited evidence supporting the therapeutic use of cannabinoids for treatment of psychiatric disorders. To date, evidence supporting cannabinoid prescription beyond the FDA indications is strongest for the management of pain and spasticity.
Conclusions:
As cannabinoids become more available, the need for an evidence base adequately evaluating their safety and efficacy is increasingly important. There is considerable evidence that cannabinoids have a potential for harm in vulnerable populations such as adolescents and those with psychotic disorders. The current evidence base is insufficient to support the prescription of cannabinoids for the treatment of psychiatric disorders.
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History
Received: 27 March 2021
Revision received: 29 July 2021
Revision received: 14 September 2021
Accepted: 27 September 2021
Published online: 8 December 2021
Published in print: February 2022
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Competing Interests
This article is derived from work done on behalf of the American Psychiatric Association (APA) and remains the property of the APA.
Funding Information
Dr. Hill has served as a consultant to for Greenwich Biosciences and has received an honorarium from Wolters-Kluwer as an author. Dr. Nemeroff has served as a consultant for Acadia Pharmaceuticals, ANeuroTech (division of Anima BV), BioXcel Therapeutics, Corcept Therapeutics Pharmaceuticals Company, Intra-Cellular Therapies, EMA Wellness, Engrail Therapeutics, Magstim, Navitor Pharmaceuticals, Neuritek, Sage, Signant Health, Silo Pharma, SK Life Science, and XW Pharma and on scientific advisory boards for ANeuroTech, the Anxiety and Depression Association of America (ADAA), the Brain and Behavior Research Foundation, Heading Health, the Laureate Institute for Brain Research, Magnolia CNS, Skyland Trail, Signant Health, and TRUUST Neuroimaging; he serves on boards of directors for ADAA, Gratitude America, and Xhale Smart; he is a stockholder in Antares, BI Gen Holdings, Corcept Therapeutics Pharmaceuticals Company, EMA Wellness, Seattle Genetics, TRUUST Neuroimaging, and Xhale; and he holds patents on a method and devices for transdermal delivery of lithium (US 6,375,990B1) and on a method of assessing antidepressant drug therapy via transport inhibition of monoamine neurotransmitters by ex vivo assay (US 7,148,027B2). Dr. McDonald is a member of the American Psychiatric Association Council on Research representing ECT and Neuromodulation Therapies; he receives support from the Wounded Warrior Project as part of the Emory Veterans Program and has received funding from Cervel Neurotherapeutics, Neuronetics, NeoSync, the Stanley Foundation, and Soterix; he is chair of the data safety monitoring board for a National Institute on Aging multicenter study; he serves on the Board of Skyland Trail and 3Keys; he has served as a consultant for Parallel Georgia and Signant Health; he has an endowed chair funded by the JB Fuqua Foundation; and he receives royalties from Oxford University Press. Dr. Widge has received support from Minnesota’s Discovery, Research, and InnoVation Economy (MnDRIVE) initiative, the Minnesota Medical Discovery Team on Addictions, and NIH; he has received device donations from Medtronic; and he has multiple patent applications in the area of brain stimulation and circuit modification to improve cognition. Dr. Rodriguez serves as Deputy Editor at the American Journal of Psychiatry; disclosures of Editors’ financial relationships appear in the April 2021 issue of the Journal. Dr. Kraguljac has served as consultant for Neurocrine Biosciences. Dr. Carpenter has received research grant or clinical trials support from Affect Neuro, Janssen, NeoSync, and Neuronetics and has served as a consultant for Affect Neuro, Janssen, Neuronetics, Neurolief, Nexstim, Otsuka, Sage Therapeutics, and Sunovion. Dr. Krystal has served as a consultant for Aptinyx, Atai Life Sciences, AstraZeneca, Biogen Idec MA, Biomedisyn Corporation, Bionomics (Australia), Boehringer Ingelheim International, Cadent Therapeutics, Clexio Bioscience, COMPASS Pathways, Concert Pharmaceuticals, Epiodyne, EpiVario, Greenwich Biosciences, Heptares Therapeutics, Janssen Research and Development, Jazz Pharmaceuticals, Otsuka America Pharmaceutical, Perception Neuroscience Holdings, Spring Care, Sunovion Pharmaceuticals, Taisho Pharmaceutical, and Takeda Industries; he has served on scientific advisory boards for Biohaven Pharmaceuticals, BioXcel Therapeutics (clinical advisory board), Cadent Therapeutics (clinical advisory board), Cerevel Therapeutics, EpiVario, Eisai, Jazz Pharmaceuticals, Lohocla Research Corporation, Novartis Pharmaceuticals Corporation, PsychoGenics, RBNC Therapeutics, Tempero Bio, and Terran Biosciences and on the board of directors of Freedom Biosciences; he has stock or stock options in Biohaven Pharmaceuticals Medical Sciences, EpiVario, RBNC Therapeutics, Sage Pharmaceuticals, Spring Care, Tempero Bio, and Terran Biosciences; and he receives a stipend as the editor of Biological Psychiatry. The other authors report no financial relationships with commercial interests.
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