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  • Solmi, MarcoUniv Ottawa, Canada; Ottawa Hosp, Canada; Kings Coll London, England; Univ Southampton, England; NHS Trust, England; Charite Univ Med Berlin, Germany (författare)

Balancing risks and benefits of cannabis use: umbrella review of meta-analyses of randomised controlled trials and observational studies

  • Artikel/kapitelEngelska2023

Förlag, utgivningsår, omfång ...

  • BMJ PUBLISHING GROUP,2023
  • electronicrdacarrier

Nummerbeteckningar

  • LIBRIS-ID:oai:DiVA.org:liu-198687
  • https://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-198687URI
  • https://doi.org/10.1136/bmj-2022-072348DOI

Kompletterande språkuppgifter

  • Språk:engelska
  • Sammanfattning på:engelska

Ingår i deldatabas

Klassifikation

  • Ämneskategori:ref swepub-contenttype
  • Ämneskategori:for swepub-publicationtype

Anmärkningar

  • OBJECTIVE To systematically assess credibility and certainty of associations between cannabis, cannabinoids, and cannabis based medicines and human health, from observational studies and randomised controlled trials (RCTs). DESIGN Umbrella review. DATA SOURCES PubMed, PsychInfo, Embase, up to 9 February 2022. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Systematic reviews with meta-analyses of observational studies and RCTs that have reported on the efficacy and safety of cannabis, cannabinoids, or cannabis based medicines were included. Credibility was graded according to convincing, highly suggestive, suggestive, weak, or not significant (observational evidence), and by GRADE (Grading of Recommendations, Assessment, Development and Evaluations) (RCTs). Quality was assessed with AMSTAR 2 (A Measurement Tool to Assess Systematic Reviews 2). Sensitivity analyses were conducted. RESULTS 101 meta-analyses were included (observational=50, RCTs=51) (AMSTAR 2 high 33, moderate 31, low 32, or critically low 5). From RCTs supported by high to moderate certainty, cannabis based medicines increased adverse events related to the central nervous system (equivalent odds ratio 2.84 (95% confidence interval 2.16 to 3.73)), psychological effects (3.07 (1.79 to 5.26)), and vision (3.00 (1.79 5.03)) in people with mixed conditions (GRADE=high), improved nausea/vomit, pain, spasticity, but increased psychiatric, gastrointestinal adverse event, and somnolence among others (GRADE=moderate). Cannabidiol improved 50% reduction of seizures (0.59 (0.38 to 0.92)) and seizure events (0.59 (0.36 to 0.96)) (GRADE=high), but increased pneumonia, gastrointestinal adverse events, and somnolence (GRADE=moderate). For chronic pain, cannabis based medicines or cannabinoids reduced pain by 30% (0.59 (0.37 to 0.93), GRADE=high), across different conditions (n=7), but increased psychological distress. For epilepsy, cannabidiol increased risk of diarrhoea (2.25 (1.33 to 3.81)), had no effect on sleep disruption (GRADE=high), reduced seizures across different populations and measures (n=7), improved global impression (n=2), quality of life, and increased risk of somnolence (GRADE=moderate). In the general population, cannabis worsened positive psychotic symptoms (5.21 (3.36 to 8.01)) and total psychiatric symptoms (7.49 (5.31 to 10.42)) (GRADE=high), negative psychotic symptoms, and cognition (n=11) (GRADE=moderate). In healthy people, cannabinoids improved pain threshold (0.74 (0.59 to 0.91)), unpleasantness (0.60 (0.41 to 0.88)) (GRADE=high). For inflammatory bowel disease, cannabinoids improved quality of life (0.34 (0.22 to 0.53) (GRADE=high). For multiple sclerosis, cannabinoids improved spasticity, pain, but increased risk of dizziness, dry mouth, nausea, somnolence (GRADE=moderate). For cancer, cannabinoids improved sleep disruption, but had gastrointestinal adverse events (n=2) (GRADE=moderate). Cannabis based medicines, cannabis, and cannabinoids resulted in poor tolerability across various conditions (GRADE=moderate). Evidence was convincing from observational studies (main and sensitivity analyses); in pregnant women, small for gestational age (1.61 (1.41 to 1.83)), low birth weight (1.43 (1.27 to 1.62)); in drivers, car crash (1.27 (1.21 to 1.34)); and in the general population, psychosis (1.71 (1.47 to 2.00)). Harmful effects were noted for additional neonatal outcomes, outcomes related to car crash, outcomes in the general population including psychotic symptoms, suicide attempt, depression, and mania, and impaired cognition in healthy cannabis users (all suggestive to highly suggestive). CONCLUSIONS Convincing or converging evidence supports avoidance of cannabis during adolescence and early adulthood, in people prone to or with mental health disorders, in pregnancy and before and while driving. Cannabidiol is effective in people with epilepsy. Cannabis based medicines are effective in people with multiple sclerosis, chronic pain, inflammatory bowel disease, and in palliative medicine, but not without adverse events.

Ämnesord och genrebeteckningar

Biuppslag (personer, institutioner, konferenser, titlar ...)

  • De Toffol, MarcoASL Lecce, Italy (författare)
  • Kim, Jong YeobYonsei Univ, South Korea (författare)
  • Choi, Min JeYonsei Univ, South Korea (författare)
  • Stubbs, BrendonKings Coll London, England; South London & Maudsley NHS Fdn Trust, England (författare)
  • Thompson, TrevorUniv Greenwich, England (författare)
  • Firth, JosephUniv Manchester, England; Greater Manchester Mental Hlth NHS Fdn Trust, England (författare)
  • Miola, AlessandroUniv Padua, Italy (författare)
  • Croatto, GiovanniAULSS 3 Serenissima, Italy (författare)
  • Baggio, FrancescaAULSS 3 Serenissima, Italy (författare)
  • Michelon, SilviaAULSS 7 Pedemontana Veneto, Italy (författare)
  • Ballan, LucaAULSS 7 Pedemontana Veneto, Italy (författare)
  • Gerdle, BjörnLinköpings universitet,Avdelningen för prevention, rehabilitering och nära vård,Medicinska fakulteten,Region Östergötland, Smärt och rehabiliteringscentrum(Swepub:liu)bjoge88 (författare)
  • Monaco, FrancescoAsl Salerno, Italy; European Biomed Res Inst Salerno, Italy (författare)
  • Simonato, PierluigiUniv Hertfordshire, England; ULSS 6 Euganea, Italy (författare)
  • Scocco, PaoloULSS 6 Euganea, Italy (författare)
  • Ricca, ValdoUniv Florence, Italy (författare)
  • Castellini, GiovanniUniv Florence, Italy (författare)
  • Fornaro, MicheleUniv Sch Med Federico II, Italy (författare)
  • Murru, AndreaUniv Barcelona, Spain (författare)
  • Vieta, EduardUniv Barcelona, Spain (författare)
  • Fusar-Poli, PaoloKings Coll London, England; Univ Pavia, Italy (författare)
  • Barbui, CorradoUniv Verona, Italy (författare)
  • Ioannidis, John P. A.Stanford Univ, CA USA; Charite Univ Med Berlin, Germany; Stanford Univ, CA USA; Stanford Univ, CA USA; Stanford Univ, CA USA; Stanford Univ, CA USA (författare)
  • Carvalho, Andre F.Deakin Univ, Australia (författare)
  • Radua, JoaquimUniv Barcelona, Spain (författare)
  • Correll, Christoph U.Charite Univ Med Berlin, Germany; Zucker Hillside Hosp, NY USA; Donald & Barbara Zucker Sch Med Hofstra Northwell, NY USA (författare)
  • Cortese, SamuelUniv Southampton, England; Solent NHS Trust, England; Univ Nottingham, England; NYU, NY USA (författare)
  • Murray, Robin M.Kings Coll London, England (författare)
  • Castle, DavidUniv Tasmania, Australia; Ctr Mental Hlth Serv Innovat, Australia (författare)
  • Il Shin, JaeYonsei Univ, South Korea; Yonsei Univ, South Korea (författare)
  • Dragioti, ElenaLinköpings universitet,Avdelningen för prevention, rehabilitering och nära vård,Medicinska fakulteten,Region Östergötland, Smärt och rehabiliteringscentrum,Univ Ioannina, Greece(Swepub:liu)eledr71 (författare)
  • Univ Ottawa, Canada; Ottawa Hosp, Canada; Kings Coll London, England; Univ Southampton, England; NHS Trust, England; Charite Univ Med Berlin, GermanyASL Lecce, Italy (creator_code:org_t)

Sammanhörande titlar

  • Ingår i:BMJ. British Medical Journal: BMJ PUBLISHING GROUP3820959-81460959-535X

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