“Is medical cannabis safe for my patients?” A practical review of cannabis safety considerations
Open accessAbstract
Medical cannabis use is increasing worldwide. Clinicians are commonly asked by patients to provide guidance on its safety and efficacy. Although there has been an increase in research on the role of medical cannabis for a number of different conditions, we found that there was a paucity of clear safety guidance on its use. We aim to address this issue by answering two pertinent clinician safety questions: 1 Can medical cannabis be safely used in this patient? 2. What strategies can be used to ensure that any harms from medical cannabis are mitigated? To address these questions, we reviewed available evidence and provided expert clinical opinion to summarize the fundamental components for evaluating medical cannabis safety and strategies to reduce risk from its use. Our review resulted in a safety-focused framework for medical cannabis initiation and utilization. We provide clear recommendations for patients being considered for cannabis (e.g. precautions, contraindications and drug interactions). Risk mitigation strategies such as appropriate chemovar (strain) selection, routes of administration, and dosing are reviewed. As with any other pharmacotherapy, we review the key components of monitoring and address potential issues that may arise while using medical cannabis. We propose a structured assessment and monitoring strategy that can be used by clinicians recommending cannabis (CRC) to guide patients through each step of their cannabis journey. This framework can be used to ensure that medical cannabis utilization is associated with the lowest possible risk to the patient.
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The THC-related adverse effects include dizziness, cognitive impairment, dry mouth, tachycardia, anxiety, drowsiness, and fatigue.
“The THC-related adverse effects include dizziness, cognitive impairment, dry mouth, tachycardia, anxiety, drowsiness, and fatigue.116”
From Clinical Practice Guidelines for Cannabis and Cannabinoid-Based Medicines in the Management of Chronic Pain and Co-Occurring Conditions (2024) · cites this paper as [116]
The adverse effects that are the most commonly associated with cannabis are related to THC-dose and the route of administration.
“The adverse effects that are the most commonly associated with cannabis are related to THC-dose and the route of administration.116”
From Clinical Practice Guidelines for Cannabis and Cannabinoid-Based Medicines in the Management of Chronic Pain and Co-Occurring Conditions (2024) · cites this paper as [116]
Smoking cannabis is associated with respiratory adverse effects such as cough, an increase in phlegm, and bronchitis.
“Smoking cannabis is associated with respiratory adverse effects such as cough, an increase in phlegm, and bronchitis.116”
From Clinical Practice Guidelines for Cannabis and Cannabinoid-Based Medicines in the Management of Chronic Pain and Co-Occurring Conditions (2024) · cites this paper as [116]
Adverse effects can be mitigated when initiating CBM through low-dose initiation, slow titration and avoiding smoked cannabis.
“Adverse effects can be mitigated when initiating CBM through low-dose initiation, slow titration and avoiding smoked cannabis.116”
From Clinical Practice Guidelines for Cannabis and Cannabinoid-Based Medicines in the Management of Chronic Pain and Co-Occurring Conditions (2024) · cites this paper as [116]
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- Authors
- MacCallum, C. A., Lo, L. A., & Boivin, M.
- Affiliations
- University of British Columbia (CA)
- Queen's University (CA)
- Corresponding author
- MacCallum, Caroline A.
- Venue
- European Journal of Internal Medicine
- Publisher
- Elsevier BV
- Published
- 2021-07
- Volume
- 89
- Pages
- 10-18
- ISSN
- 0953-6205 (ISSN-L)
- OpenAlex
- W3164368172
- Cited by
- 71
- References
- 74
- Citations by year
- 2026: 6 · 2025: 13 · 2024: 17 · 2023: 21 · 2022: 12 · 2021: 2
- FWCI
- 1.65
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- European Journal of Internal Medicine (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Pharmacology › Cannabis and Cannabinoid Research
- Health Sciences › Medicine › Complementary and alternative medicine › Complementary and Alternative Medicine Studies
- Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Pharmacology › Pharmacy and Medical Practices
- Keywords
- medical cannabis, cannabis safety, risk mitigation, drug interactions, contraindications, route of administration, dosage, patient monitoring, cannabis initiation
- MeSH terms
- Analgesics, Cannabidiol, Cannabis, Drug Interactions, Humans, Medical Marijuana
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