Examining the roles of cannabinoids in pain and other therapeutic indications: a review.
BACKGROUND
In recent times, our knowledge of cannabinoids and the endocannabinoid system has greatly advanced. With expanding knowledge, synthetic cannabinoids - including nabilone, dronabinol and a combination of synthetic Delta9-THC and cannabidiol - have been developed and tested for benefit in a variety of therapeutic indications.


METHODS
The aim of this article is to provide a summative review of the vast amount of clinical trial data now available on these agents.


RESULTS
To locate clinical trials for review, a literature search was performed using PubMed between the dates of 25 May and 30 June 2009. Search parameters were set to isolate only human randomized controlled trials (RCTs) published between 1990 and 2009. Keywords consistently used for each search include: cannabinoids, marijuana, THC, nabilone and dronabinol. Preferential selection was given to the best-designed trials, focusing on placebo-controlled, double-blind RCTs with the largest patient populations, if available.


CONCLUSIONS
As efficacy and tolerability of these agents remain questionable, it is important that cannabinoids not be considered 'first-line' therapies for conditions for which there are more supported and better-tolerated agents. Instead, these agents could be considered in a situation of treatment failure with standard therapies or as adjunctive agents where appropriate.
Turcotte
Dana
D
University of Manitoba, Faculty of Pharmacy, 750 McDermot Avenue, Winnipeg, Manitoba, R3E 0T5 Canada. danaruhlen@hotmail.com
Le Dorze
Josée-Anne
JA
Esfahani
Farid
F
Frost
Emma
E
Gomori
Andrew
A
Namaka
Mike
M
D000203:Activities of Daily Living; D002186:Cannabinoids / Q000627:therapeutic use*; D002188:Cannabis / Q000009:adverse effects* / Q000737:chemistry; D003131:Combined Modality Therapy / Q000379:methods*; D004311:Double-Blind Method; D013759:Dronabinol / Q000031:analogs & derivatives / Q000494:pharmacology / Q000627:therapeutic use; D006801:Humans; D006967:Hypersensitivity; D010146:Pain / Q000188:drug therapy*; D010147:Pain Measurement / Q000379:methods*
D002186:Cannabinoids; C011941:nabilone; D013759:Dronabinol