Care and concern with cannabinoids used therapeutically [Editorial] (2018)

The last few years have witnessed a remarkable academic journey for cannabis with a ten-fold increase in annual publications from 1990 to 2017 and clinical trials now underway to understand its potential role in clinical practice. This humble plant, thought to have originated in Asia, has been used for around 3000 years for spiritual, industrial and medicinal purposes. It spread widely throughout the world as its psychoactive and medicinal properties were sought after. In the nineteenth and twentieth centuries, like heroin and cocaine, cannabis was publicly vilified as an illicit poison, made illegal in many countries. However, many people continued to use it particularly for recreational use and as an anxiolytic, despite known detrimental effects on brain development and function. Now, in the twenty-first century, cannabis has re?arrived, the latest 'super-therapy' in popular media, yet evidence to date suggests that for most symptoms, the data are mostly low quality and showing little benefit (evidence meta-analysed in 3). However, like benzodiazepines before it, and alcohol even earlier, it is touted as treatment for maladies of a wide range of chronic symptoms and diseases – ranging from anxiety, cancer treatment symptoms, post-traumatic stress disorder, seizures, spasticity to chronic pain syndromes and cachexia. Further, standard drug discovery and development for this experimental therapy, and clinical research to understand benefits and harms have lagged well behind the pressure from advocates and the political framework.
The reviews in this issue of BJCP summarize what is known about the properties and clinical applications of cannabis, exploring its history, chemistry, pharmacology and several common clinical applications and where the current limitations are, from a clinical pharmacology perspective. [Extract]