Table Of ContentTherapeutic
uses o f
cannabis
Therapeutic
uses o f
cannabis
British Medical A ssociation
O
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Contents
List of tables
XI
List of f igures XII
1 Introduction 1
Cannabis s ativa 2
The l egal situation 3
International d evelopments 4
Prescription o f unlicensed medicines in the UK 5
Scope and p urpose o f the report 6
2 Pharmacology 7
Constituents o f cannabis; natural a nd s ynthetic
cannabinoids 7
Pharmacokinetics 11
Absorption 12
Distribution 12
Metabolism and e xcretion 15
Pharmacodynamics 16
Cannabinoid r eceptors 16
Endogenous c annabinoids anandamide & o thers 17
Mechanism o f action 17
Actions of cannabis in man 18
v
3 Therapeutic uses 21
Nausea a nd v omiting a ssociated w ith c ancer
chemotherapy 21
Existing p harmacological t reatments 21
Cannabis a nd c annabinoids i n v omiting d ue t o
anti-cancer d rugs 23
Research needed 25
Conclusions 27
Muscle spasticity 27
Existing p harmacological t reatments 28
Cannabis a nd c annabinoids i n s pastic d isorders 30
Research needed 37
Conclusions 38
Pain 39
Existing p harmacological t reatments 40
Cannabis a nd c annabinoids a s a nalgesics 41
Research needed 44
Conclusions 45
Anorexia ( Loss of appetite) 45
Effects of cannabis a nd c annabinoids o n a ppetite 45
Research needed 48
Conclusions 49
Epilepsy 49
Existing p harmacological treatments 49
Cannabis a nd c annabinoids i n e pilepsy 51
Research needed 52
Conclusions 53
Glaucoma 53
Existing p harmacological t reatments 54
Effects of cannabis a nd c annabinoids o n i ntraocular
pressure 55
Research needed 58
Conclusions 59
Bronchial A sthma 59
Existing p harmacological treatments 59
Cannabis a nd c annabinoids i n a sthma 60
Research needed 62
Conclusions 63
Mood d isorders, psychiatric c onditions 63
Hypertension 64
vi
4 Adverse effects of cannabis and
cannabinoids in clinical use 65
Acute e ffects c ommonly o bserved i n c linical settings 65
Other a cute e ffects o f cannabis r elevant t o therapeutic u se 66
Effects of chronic d osage w ith c annabinoids r elevant t o
therapeutic u se 67
Precautions f or p rescribing c annabinoids 70
5 Dosage and routes of a dministration 73
6 Future prospects 75
7 Summary and recommendations 77
Appendix I: Glossary 83
Appendix II: Anecdotal evidence 89
Apendix III: Summary of research studies 1 01
References 119
Index 131
vii
Editorial Board
A p ublication o f t he BMA Science Department
Chairman. Board o f
Science and E ducation Professor J B L Howell
Head o f P rofessional Resources
and R esearch Group Professor V ivienne Nathanson
Editor Dr D avid R M organ
Written b y Professor C H Ashton,
Emeritus Professor of C linical
Psychopharmacology,
University of N ewcastle
Contributing a uthors Dr A nita Holdcroft
Sarah Mars
Professor T ony Moffat
Dr Roger Pertwee
Professor Patrick W all
Editorial S ecretariat Dawn Bedwell
Lisa Davies
Sallie Robins
Hayley Todd
Indexer Richard J ones
Design Hilary Glanville
viii
Board of S cience and Education
This report w as prepared u nder t he auspices of the Board o f
Science and E ducation o f t he British Medical A ssociation. The
members o f the Board w ere as follows:
Sir Donald A cheson President, BMA
Dr S J R ichards Chairman o f t he Representative Body,
BMA
DrAW M acara Chairman o f Council, BMA
Dr W J A ppleyard Treasurer, BMA
Professor J B L Howell Chairman, Board o f Science and
Education
Dr P Dangerfield Deputy C hairman, Board o f Science
and E ducation
Dr J M C undy
Dr H WK F ell
Miss C E F ozzard
Dr E Harris
Dr N J O lsen
Ms S S omjee
Dr P Steadman
Dr S T aylor
Dr D Ward
ix
