Current evidence does not support prescription cannabinoids for psychiatric disorders

Available evidence does not sufficiently support prescription cannabinoids for treating psychiatric disorders, according to results of a review published in American Journal of Psychiatry.

“Cannabis policies continue to change in the U.S. and around the world,” Kevin P. Hill, MD, MHS, of the department of psychiatry at Harvard Medical School in Boston, told Healio Psychiatry. “In the context of constant policy discussions, patients often wonder about the benefits and risks of cannabis and cannabinoids like cannabidiol (CBD). Mental health clinicians must be well-versed on the evidence related to the therapeutic use of cannabis and cannabinoids, particularly in relation to psychiatric disorders.”

According to Hill, many patients have interest in using cannabis and cannabinoids or are already doing so, whether or not clinicians like it. In the current study, the researchers aimed to summarize the latest evidence in this area and offer clinicians guidance. To do so, they searched two databases for articles published through July that reported on cannabis, cannabinoids or medicinal cannabis. They used the reference lists of published reviews to find additional articles. They excluded articles without the terms “clinical trial” or “therapy” in the title or abstract, after which 841 articles met inclusion criteria and were reviewed.

Hill and colleagues noted the FDA has not approved any psychiatric indications for cannabinoids. Evidence is limited regarding support for the therapeutic use of cannabinoids for psychiatric disorder treatment. Thus far, management of pain and spasticity have the strongest evidence supporting cannabinoid prescription beyond the FDA indications.

“The three cannabinoids (dronabinol, nabilone and cannabidiol) available by prescription in the U.S. are not approved by the FDA to treat psychiatric conditions,” Hill said. “Overall, there is little data suggesting that cannabinoids are useful in treating psychiatric illness, while the potential for harm in vulnerable populations is considerable. Unfortunately, the rate and scale of the cannabinoid research has not kept pace with the incredible levels of interest.”