Evidence-based CBD Oil Review Process

The square data markers indicate odds ratios ORs from primary studies, with sizes reflecting the statistical weight of the study using random-effects meta-analysis. The square data markers indicate mean differences from primary studies, with sizes reflecting the statistical weight of the study using random-effects meta-analysis. All review stages were conducted independently by 2 reviewers. Where possible, data were pooled using random-effects meta-analysis.

Benefits and harms of medical cannabis: a scoping review of systematic reviews

Metrics details. There has been increased interest in the role of cannabis for treating medical conditions. The availability of different cannabis-based products can make the side effects of exposure unpredictable. We sought to conduct a scoping review of systematic reviews assessing benefits and harms of cannabis-based medicines for any condition.

A protocol was followed throughout the conduct of this scoping review. A protocol-guided scoping review conduct.

Searches of bibliographic databases e. Two people selected and charted data from systematic reviews. Categorizations emerged during data synthesis. The reporting of results from systematic reviews was performed at a high level appropriate for a scoping review. After screening citations, 72 systematic reviews were included. The reviews covered many conditions, the most common being pain management.

Several reviews focused on management of pain as a symptom of conditions such as multiple sclerosis MS , injury, and cancer. An assessment of review findings lends to the understanding that, although in a small number of reviews results showed a benefit for reducing pain, the analysis approach and reporting in other reviews was sub-optimal, making it difficult to know how consistent findings are when considering pain in general.

Minor adverse effects e. Overall, safety data was generally reported study-by-study, with few reviews synthesizing data. Results from the included reviews were mixed, with most reporting an inability to draw conclusions due to inconsistent findings and a lack of rigorous evidence.

Mild harms were frequently reported, and it is possible the harms of cannabis-based medicines may outweigh benefits. Peer Review reports. Interest in medical applications of marijuana Cannabis sativa has increased dramatically during the past 20 years. A report from the National Academies of Sciences, Engineering, and Medicine supported the use of marijuana in medicine, leading to a number of regulatory medical colleges providing recommendations for its prescription to patients [ 1 ].

An updated report in called for a national research agenda, improvement of research quality, improvement in data collection and surveillance efforts, and strategies for addressing barriers in advancing the cannabis agenda [ 2 ].

Proponents of medical cannabis support its use for a highly varied range of medical conditions, most notably in the fields of pain management [ 3 ] and multiple sclerosis [ 4 ]. Marijuana can be consumed by patients in a variety of ways including smoking, vaporizing, ingesting, or administering sublingually or rectally. The plant consists of more than known cannabinoids, the main ones of relevance to medical applications being tetrahydrocannabinol THC and cannabidiol CBD [ 5 ].

Synthetic forms of marijuana such as dronabinol and nabilone are also available as prescriptions in the USA and Canada [ 6 ]. Over the last decade, there has been an increased interest in the use of medical cannabis products in North America. It is estimated that over 3. The number of Canadian residents with prescriptions to purchase medical marijuana from Health Canada—approved growers tripled from 30, in to near , in [ 8 ]. With the legalization of recreational-use marijuana in parts of the USA and in Canada in October , the number of patients using marijuana for therapeutic purposes may become more difficult to track.

The likely increase in the numbers of individuals consuming cannabis also necessitates a greater awareness of its potential benefits and harms. Plant-based and plant-derived cannabis products are not monitored as more traditional medicines are, thereby increasing the uncertainty regarding its potential health risks to patients [ 3 ].

While synthetic forms of cannabis are available by prescription, different cannabis plants and products contain varied concentrations of THC and CBD, making the effects of exposure unpredictable [ 9 ]. While short-lasting side effects including drowsiness, loss of short-term memory, and dizziness are relatively well known and may be considered minor, other possible effects e.

There remains a considerable degree of clinical equipoise as to the benefits and harms of marijuana use for medical purposes [ 10 , 11 , 12 , 13 ]. We located and mapped systematic reviews to summarize research that is available for consideration for practice or policy questions in relation to medical marijuana. An experienced medical information specialist developed and tested the search strategy using an iterative process in consultation with the review team.

We performed the searches on November 3, The search strategy incorporated controlled vocabulary e. Vocabulary and syntax were adjusted across the databases and where possible animal-only and opinion pieces were removed, from the search results.

Gray literature searching was limited to relevant drug and mental health databases, as well as HTA Health Technology Assessment and systematic review databases.

We performed searches between January and February Reference lists of overviews were searched for relevant systematic reviews, and we searched for full-text publications of abstracts or protocols. New York: Thomson Reuters , and then uploaded to Distiller. The review team used Distiller for Levels 1 titles and abstracts and 2 full-text screening.

Pilot testing of screening questions for both levels were completed prior to implementation. All titles and abstracts were screened in duplicate by two independent reviewers MT and MP using the liberal accelerated method [ 17 ]. This method requires only one reviewer to assess an abstract as eligible for full-text screening, and requires two reviewers to deem the abstract irrelevant.

Two independent reviewers MT and MP assessed full-text reports for eligibility. Disagreements during full-text screening were resolved through consensus, or by a third team member AS. Reviews of solely observational designs were included only in relation to adverse effects data, in order to focus on the most robust evidence available.

We considered studies to be systematic reviews if at least one database was searched with search dates reported, at least one eligibility criterion was reported, the authors had assessed the quality of included studies, and there was a narrative or quantitative synthesis of the evidence. Reviews assessing multiple interventions both pharmacological and complementary and alternative medicine CAM interventions were included if the data for marijuana studies was reported separately.

Published and unpublished guidelines were included if they conducted a systematic review encompassing the criteria listed above. We excluded overviews of systematic reviews, reviews in abstract form only, and review protocols. The form was pilot tested on three included reviews by three people. One reviewer MP or CB independently extracted all data, and a second reviewer MT verified all of the items collected and checked for any omitted data. Disagreements were resolved by consensus and consultation with a third reviewer if necessary.

A data extraction form with the list of included variables is provided in Additional file 4. All collected data has also been made available in the online supplemental materials associated with this report. The tool consists of 16 items in total, with four critical domains and 12 non-critical domains. The AMSTAR-2 tool is not intended to generate an overall score, and instead allows for an overall rating based on weaknesses in critical domains.

We used a directed content analytic approach [ 21 ] with an initial deductive framework [ 22 ] that allowed flexibility for inductive analysis if refinement or development of new categorization was needed.

The framework used to categorize outcome data results is outlined in Table 2. Where reviews had a mix of narrative and quantitative data, results from meta-analyses were prioritized over count data or study-by-study data.

The extraction and reporting of data results was performed at a high level and did not involve an in-depth evaluation, which is appropriate for a scoping review [ 14 ]. For feasibility, we decided to limit the inclusion of systematic reviews of only observational study designs to those that addressed adverse events data. All other steps of the review were performed as planned.

After duplicates were removed, the search identified a total of titles and abstracts, of which 47 references were located through the gray literature search. Of the total citations assessed during Level 1 screening, were deemed irrelevant. We reviewed full-text reports for the reviews of potential relevance, and of these, were subsequently excluded, leaving a total of 72 systematic reviews that were included; the associated data collected are provided in Additional file 5.

A listing of the reports excluded during full-text review is provided in Additional file 6. Five reviews reported that they did not receive any funding for the systematic review. Tables 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , and 13 provide an overview of the characteristics of the 72 included systematic reviews. Figure 2 illustrates the different cannabis-based interventions covered by the included reviews.

Plant-based cannabis consists of whole plant products such as marijuana or hashish. Synthetic cannabinoids are manufactured rather than extracted from the plant and include drugs such as nabilone and dronabinol. Twenty-seven reviews included solely interventions from plant-derived cannabinoids, 10 studied solely synthetic cannabinoids, and eight included solely studies on plant-based cannabis products.

Twenty-four reviews covered a combination of different types of cannabis, and the remaining three systematic reviews did not report which type of cannabinoid was administered in the included studies. The systematic reviews covered a wide range of conditions and illnesses, the most notable being pain management. Seventeen reviews looked at specific types of pain including neuropathic [ 31 , 42 , 62 , 69 , 85 , 90 ], chronic [ 26 , 32 , 52 , 58 , 80 ], cancer [ 84 , 87 ], non-cancer [ 41 , 68 ], and acute [ 38 ] types of pain one review covered all types of pain [ 65 ].

In Fig. Some systematic reviews covered multiple diseases, and therefore the total number of conditions represented in Fig. Conditions or symptoms across reviews that were treated with cannabis. One review included a pediatric-only population, in the evaluation of marijuana for nausea and vomiting following chemotherapy [ 54 ]. Cannabis was prescribed for a wide range of medical issues. The indication for cannabis use is illustrated in Fig. Figure 5 summarizes the breadth of outcomes analyzed in the included reviews.

Many outcomes were reported using a variety of measures across reviews. For example, spasticity was measured both objectively using the Ashworth scale and subjectively using a visual analog scale [VAS] or numerical rating scale [NRS].

Similarily, outcomes for pain included VAS or NRS scales, reduction in pain, pain relief, analgesia, pain intensity, and patient assessment of change in pain. Only one review was rated as high quality [ 45 ]. Assessments for the domains deemed of critical importance for determining quality ratings are described below.

The remaining reviews did not report a comprehensive search strategy. The remaining reviews did not report a satisfactory technique for assessing ROB. The final critical domain for the AMSTAR-2 determines whether review authors accounted for ROB in individual studies when discussing or interpreting the results of the review. In some cases, reviews contributed to more than one comparison e.

As pain was the most commonly addressed outcome, we mapped this outcome separately from all other endpoints. This information is shown for all reviews and then restricted to reviews of moderate-to-high quality as determined using the AMSTAR-2 criteria : cannabis versus placebo Figs.

This review is based on a PubMed search using the terms CBD, cannabidiol, as well as hemp and cannabidiol (CBD) oils, with some evidence that access to of the amygdala during negative emotional processing and has been found to​. review for approval in the U.S. There is also preliminary evidence that There is unsanctioned medical use of CBD based products with oils, hemp plants through a multi-stage process into a crystalline powder (production.

Metrics details. There has been increased interest in the role of cannabis for treating medical conditions. The availability of different cannabis-based products can make the side effects of exposure unpredictable.

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Evidence-based CBD Oil Review Process

Cannabidiol oil has purported health benefits, including helping to relieve chronic pain. Cannabidiol CBD is an illegal drug with no redeeming value. It is also a useful prescription medicine for epilepsy, with considerable potential for treating numerous other conditions. Although contradictory, all three statements are true from different perspectives, and clinical researchers are frustrated. This flies in the face of current evidence.

The reality behind cannabidiol’s medical hype

Cannabis use has been shown to impair cognitive functions on a number of levels—from basic motor coordination to more complex executive function tasks, such as the ability to plan, organize, solve problems, make decisions, remember, and control emotions and behavior. These deficits differ in severity depending on the quantity, recency, age of onset and duration of marijuana use. Understanding how cannabis use impairs executive function is important. Individuals with cannabis-related impairment in executive functions have been found to have trouble learning and applying the skills required for successful recovery, putting them at increased risk for relapse to cannabis use. Here we review the research on the acute, residual, and long-term effects of cannabis use on executive functions, and discuss the implications for treatment. Consumption of cannabis for medical purposes is legal with a prescription in 15 states, and many states are in the process of decriminalizing non-medical marijuana use. More than However, evidence exists of significant harm for some individuals, with 1 in 10 users developing cannabis dependence SAMHSA,