Medical Cannabis Use in Palliative Care: Review of Clinical Effectiveness and Guidelines – An Update

This report reviews the evidence and guidelines for the use of medical cannabis in the palliative care setting. From a systematic review of nine randomized controlled trials, in patients with cancer dronabinol (a synthetic cannabinoid) may be less effective than megestrol for improvement in appetite, weight gain and health-related quality of life, and may increase risk of withdrawal due to adverse events as compared to megestrol. Two evidence-based guidelines address the use of medical cannabis in a palliative care setting. The first evidence-based guideline (endorsed by the College of Family Physicians of Canada) explicitly recommends against the use of medical cannabis as a first or second line option for palliative cancer pain. The guideline suggests that it could be considered in the case of refractory symptoms and with careful consideration of potential risks. The second evidence-based guideline (developed by the Australian Government) similarly recommends that medical cannabis only be used in the palliative care setting when other treatments have failed, and after consideration of the potential for adverse events and drug interactions. The investigators of the systematic review concluded that they were unable to make recommendations surrounding use of cannabis in palliative care due to lack of quality and quantity of evidence suggesting further research is required.

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