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Review: cannabinoids and codeine have similar effects on pain relief, but cannabinoids commonly cause psychotropic adverse effects

Data sources
Full publications of studies were identified by searching Medline (1966 to 1999), EMBASE/Excerpta Medica (1974 to 1999), the Oxford Pain Database (1950 to 1994), and the Cochrane Library (1999, Issue 3) with the terms marijuana, marihuana, mariuana, cannabis, cannabinoids, tetrahydrocannabinol (THC), delta-9-THC, nabilone, pain, analgesia, and random. Bibliographies of relevant studies were scanned.

Study selection
Studies were selected if they were randomised controlled trials (RCTs) that compared cannabis or cannabinoids with an analgesic agent or placebo for pain management. Studies of experimental pain were excluded.

Data extraction
Data were extracted on study quality, interventions, and outcomes.

Main results
20 RCTs were identified, 9 of which met the selection criteria (222 patients). The types of cannabinoids used were oral delta-9-THC 5 to 10 mg; an oral synthetic nitrogen analogue of THC 4 mg; oral benzopyranoperidine 2 to 4 mg; and intramuscular levonantradol 1.5 to 3 mg. No study assessed cannabis or other inhaled or smoked cannabinoids. The . . . [Full text of this article]

Barry M Kinzbrunner, MD

Vitas Healthcare Corporation, Miami, Florida, USA