This project will review the evidence for the medicinal use of cannabis and cannabinoid products for a number of key medical conditions. We will examine the evidence base for delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD) in particular, alone or in combination, in the major conditions for which cannabinoids have been advocated with a focus on assessments in either RCTs or observational studies.
Professor Wayne Hall
University of Queensland
Associate Professor Suzanne Nielson
Professor Nicholas Buckley
University of Sydney
Professor Jan Copeland
From October 31 2016, locally-cultivated and manufactured cannabis and cannabinoid products will be able to be provided under a system of regulation overseen by the Commonwealth Department of Health (see https://www.tga.gov.au/medicinal-cannabis-products-overview-regulation; and https://www.tga.gov.au/access-medicinal-cannabis-products-questions-and-answers). A small number of commercial cannabis-derived and synthetic products are available globally, but it is likely that in Australia there will be an increase in the coming years in availability of cannabinoid products derived from locally-grown plants. This will include both extracts and oils, which will contain defined levels of delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD).
The purpose of this project is to provide a shared point of reference for individual clinicians, State and Territory health departments and the Commonwealth Department of Health. For clinicians, it will inform decisions about whether to seek permission from government to prescribe medicinal cannabis products; and it will inform governments in making decisions about whether such authorisations should be granted.
To support decision making, draft guidance documents will be developed that summarise the evidence base for cannabinoid products for particular conditions.
Through a process to be managed and coordinated by states and territories and the Commonwealth, clinical experts will review the draft guidance documents, including the provision of commentary on the appropriate place in therapy of the cannabinoid-based products relative to alternative pharmacological (and where appropriate, non-pharmacological) interventions.
To complete systematic reviews to inform policy and clinical practice in relation to the use of cannabis and cannabinoids for medicinal purposes.
This project will involve the conduct of a staged process of review of the evidence for the medical use of cannabis and cannabinoid products for a number of key medical conditions.
Activity 1: Review of critical reviews of evidence and of clinical guidance documents
The first stage will involve a “review of reviews” approach which will summarise the existing evidence based upon the review conclusions. It will focus upon Cochrane and other key reviews that have been recently completed. Other reviews will be searched for in the peer-reviewed literature.
In this piece of work, the focus will be centred initially upon the following conditions:
- Epilepsy (children and adults)
- Palliative care (for control of pain and improving appetite)
- Pain (including cancer or AIDS related, neuropathic pain and chronic non-cancer pain)
- Nausea and vomiting (cancer or AIDS related)
- Multiple sclerosis
Activity 2: Development of draft clinical guidance
A “draft clinical guidance document” for the use of cannabinoids will be drafted for each condition described above in activity 1. These drafts will be reviewed and further developed by Australian clinical experts through a process separately managed and coordinated by the Commonwealth and States and Territories.
Activity 3: Systematic review and synthesis of evidence
This stage will use a standard systematic review approach to evidence. In undertaking these reviews, the results of the literature search will be used to make decisions about whether a full new systematic review and meta-analysis is warranted, based upon the number of studies identified that have not been included in previous reviews, and extent to which they or studies current underway could provide evidence that would change conclusions of earlier reviews.
Study-level details will be extracted from existing Cochrane and other systematic reviews, and additional RCT and observational-level evidence sought from systematic searches of the peer-reviewed literature, clinical trial websites and from contacting companies marketing cannabinoid products.
Reviews of reviews commenced in October 2016.
Published review of review protocols:
- Cannabis and cannabinoids for medical purposes: a review of reviews for pain
Prospero registration number: CRD42016049475
- Cannabis and cannabinoids for medical purposes: a review of reviews for epilepsy.
PROSPERO registration number CRD42016050974
- Cannabis and cannabinoids for medical purposes: a review of reviews for nausea and vomiting.
PROSPERO registration number CRD42016050975
- Cannabis and cannabinoids for medical purposes: a review of reviews for palliative care
PROSPERO registration number CRD42016051240
- Cannabis and cannabinoids for medical purposes: a review of reviews for multiple sclerosis
PROSPERO registration number CRD42016051264
- Black, N., Stockings, E., Campbell, G., Tran, L. T., Zagic, D., Hall, W. D., ... & Degenhardt, L. (2019). Cannabinoids for the treatment of mental disorders and symptoms of mental disorders: a systematic review and meta-analysis. The Lancet Psychiatry.
- Stockings, E., Zagic, D., Campbell, G., Weier, M., Hall, W. D., Nielsen, S., ... & Degenhardt, L. (2018). Evidence for cannabis and cannabinoids for epilepsy: a systematic review of controlled and observational evidence. J Neurol Neurosurg Psychiatry, 89(7), 741-753.
- Stockings, E., Campbell, G., Hall, W. D., Nielsen, S., Zagic, D., Rahman, R., ... & Degenhardt, L. (2018). Cannabis and cannabinoids for the treatment of people with chronic noncancer pain conditions: a systematic review and meta-analysis of controlled and observational studies. Pain, 159(10), 1932-1954.