Cannabinoids produce a variety of actions by activating CB1 and CB2 receptors and through
other possible effects in the central nervous system. The pharmacologic and pharmacodynamics
effects of cannabis can vary widely based on patient and drug characteristics, which can make
it difficult to use effectively and safely. Various cannabis-derived pharmaceuticals are available.
Dronabinol and nabilone are oral agents available in the United States as schedule III and II
medications, respectively. Nabiximols is an oromucosal spray containing a 1:1 mixture of THC:
CBD, which is available in 10 countries and will be evaluated this year by the FDA for approval
in the United States. Medical cannabis containing hundreds of various cannabinoids is available in 18 U.S. states and the District of Columbia and will most likely be made more widely available in the next legislative year.
Medical cannabis has been evaluated for many different purposes, and medical cannabis
registrants are using it particularly for pain and muscle spasms. Data indicate medical cannabis
may be effective for these conditions, especially when standard therapy has failed. However,
common adverse effects involving the central nervous system and gastrointestinal system may
not make this an appropriate option in many patients. Extreme caution should be used in
patients with a history of cardiovascular disease or mental disorders and in adolescents. Just as
is recommended with other medications, patients using medical cannabis should minimize the risk of accidental pediatric ingestion by securing the drug in a safe place with childproof locks. Although dronabinol and nabilone are regulated in the United States and have demonstrated sufficient efficacy and safety, evidence for medical cannabis is still lacking; thus, the drug should be used with caution in