Pub. Date:
National Academies Press
The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research

The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research


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Significant changes have taken place in the policy landscape surrounding cannabis legalization, production, and use. During the past 20 years, 25 states and the District of Columbia have legalized cannabis and/or cannabidiol (a component of cannabis) for medical conditions or retail sales at the state level and 4 states have legalized both the medical and recreational use of cannabis. These landmark changes in policy have impacted cannabis use patterns and perceived levels of risk.

However, despite this changing landscape, evidence regarding the short- and long-term health effects of cannabis use remains elusive. While a myriad of studies have examined cannabis use in all its various forms, often these research conclusions are not appropriately synthesized, translated for, or communicated to policy makers, health care providers, state health officials, or other stakeholders who have been charged with influencing and enacting policies, procedures, and laws related to cannabis use. Unlike other controlled substances such as alcohol or tobacco, no accepted standards for safe use or appropriate dose are available to help guide individuals as they make choices regarding the issues of if, when, where, and how to use cannabis safely and, in regard to therapeutic uses, effectively.

Shifting public sentiment, conflicting and impeded scientific research, and legislative battles have fueled the debate about what, if any, harms or benefits can be attributed to the use of cannabis or its derivatives, and this lack of aggregated knowledge has broad public health implications. The Health Effects of Cannabis and Cannabinoids provides a comprehensive review of scientific evidence related to the health effects and potential therapeutic benefits of cannabis. This report provides a research agenda—outlining gaps in current knowledge and opportunities for providing additional insight into these issues—that summarizes and prioritizes pressing research needs.

Product Details

ISBN-13: 9780309453042
Publisher: National Academies Press
Publication date: 05/01/2017
Pages: 486
Sales rank: 342,686
Product dimensions: 6.00(w) x 8.90(h) x 1.30(d)

Table of Contents

Preface vii

Summary 1

Study Context and Approach 3

Report Conclusions on the Association Between Cannabis Use and Health 7

Report Recommendations 9

References 12

Annex 13

Part I Introduction and Background

1 Introduction 25

Study Charge 26

Study Context and Approach 28

Report Organization 38

References 40

2 Cannabis 43

History of Cannabis 43

The Cannabis Plant 44

Cannabis-Derived Products 50

Clinical Features of Cannabis Intoxication 53

Cannabinoid-Based Medications 53

Synthetic Cannabinoids as Recreational Drugs 55

Cannabis Contaminants and Adulterants 56

References 56

3 Cannabis: Prevalence of Use, Regulation, and Current Policy Landscape 61

Prevalence of Cannabis Use in the United States (1975-2014) 61

Cannabis Regulation in the United States 65

Policy Landscape 73

Executive Branch Policies 76

Congressional Branch Policies 78

Public Opinion 78

Policy and Research 79

References 80

Part II Therapeutic Effects

4 Therapeutic Effects of Cannabis and Cannabinoids 85

Chronic Pain 87

Cancer 90

Chemotherapy-Induced Nausea and Vomiting 91

Anorexia and Weight Loss 94

Irritable Bowel Syndrome 98

Epilepsy 99

Spasticity Associated with Multiple Sclerosis or Spinal Cord Injury 101

Tourette Syndrome 103

Amyotrophic Lateral Sclerosis 105

Huntington's Disease 106

Parkinson's Disease 108

Dystonia 110

Dementia 111

Glaucoma 113

Traumatic Brain Injury/Intracranial Hemorrhage 115

Addiction 116

Anxiety 118

Depression 120

Sleep Disorders 121

Posttraumatic Stress Disorder 123

Schizophrenia and Other Psychoses 125

Research Gaps 126

Summary 127

References 128

Part III Other Health Effects

5 Cancer 141

Cancer 142

Research Gaps 156

Summary 156

References 158

6 Cardiometabolic Risk 161

Acute Myocardial Infarction 163

Stroke 166

Metabolic Dysregulation, Metabolic Syndrome, Prediabetes, and Diabetes Mellitus 170

Research Gaps 175

Summary 175

References 176

7 Respiratory Disease 181

Pulmonary Function 182

Chronic Obstructive Pulmonary Disease 186

Respiratory Symptoms, Including Chronic Bronchitis 189

Asthma 193

Research Gaps 194

Summary 195

References 196

8 Immunity 199

Immune Competence 200

Susceptibility to and Progression of Infectious Disease 204

Research Gap 211

Summary 212

References 213

9 Injury and Death 217

All-Cause Mortality 218

Occupational Injury 222

Motor Vehicle Crashes 227

Overdose Injuries and Death 230

Research Gaps 236

Summary 237

References 239

10 Prenatal, Perinatal, and Neonatal Exposure to Cannabis 245

Pregnancy Complications for the Mother 247

Fetal Growth and Development 249

Neonatal Conditions 253

Later Outcomes 254

Research Gaps 260

Summary 261

References 262

11 Psychosocial 267

Cognition 268

Academic Achievement 275

Employment and Income 280

Social Relationships and Other Social Roles 281

Research Gaps 283

Summary 285

References 286

12 Mental Health 289

Schizophrenia and Other Psychoses 291

Bipolar Disorder 303

Depression 307

Suicide 311

Anxiety 314

Posttraumatic Stress Disorder 320

Research Gaps 323

Summary 323

References 327

13 Problem Cannabis Use 333

Problem Cannabis Use 334

Research Gap 351

Summary 351

References 352

14 Cannabis Use and the Abuse of Other Substances 357

Abuse of Other Substances 358

Research Gaps 371

Summary 371

References 372

Part IV Research Barriers and Recommendations

15 Challenges and Barriers in Conducting Cannabis Research 377

Regulatory and Supply Barriers 378

Methodological Challenges 385

Summary 390

References 390

16 Recommendations to Support and Improve the Cannabis Research Agenda 395

Address Research Gaps 395

Improve Research Qualify 397

Improve Surveillance Capacity 399

Address Research Barriers 400


A Glossary 403

B Study Approach 409

C Systematic Reviews 443

D Public Session Agendas 453

E Biographical Sketches for Committee Members, Staff, Fellows, and Advisor 457

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