School of Pharmacy, Department of Pharmaceutical Health Services Research, University of Maryland Baltimore, Baltimore, MD, 21201, USA.
Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
Curr Treat Options Oncol. 2020 Nov 19;22(1):1. doi: 10.1007/s11864-020-00803-2.
The use of medical cannabis is expanding in the USA. Due to conflicting, low-quality evidence, many oncologists may not feel confident to recommend it to patients. Given the potential for legal and financial risks when conducting clinical trials with medical cannabis, the use of observational data should be explored. Observational data that directly capture medical cannabis use in relation to prescription medications and track the prevalence and patterns of cannabis use is sparse. To gain insights into the role medical cannabis plays in the pharmaceutical landscape, proxies such as cannabis legislation need to be explored. In the context of recommendation-nonadherent antiemetic prescribing among patients experiencing chemotherapy-induced nausea and vomiting, medical cannabis may be a suitable alternative to an antiemetic in states that allow medical cannabis. Findings suggest that legislation may impact the use of certain antiemetics in states with cannabis legislation in place. The presence or absence of legislation regarding medical cannabis use may serve as an early, observable surrogate marker of medical cannabis use in the community. In light of the paucity of clinical trials and observational datasets that capture cannabis use, there remains a tremendous need for the development of methodologies or standardized datasets that appropriately and reliably capture the use of medical cannabis to facilitate research into its clinical application and effect on prescription medication use. Standardizing the reporting and destigmatizing use could eliminate the dependence upon proxy measures as a substitute for more extensive data and go a long way in improving data capture, thus allowing us to generate knowledge and hypotheses from observational data until research conditions improve and allow for expanded clinical trials involving medical cannabis.
医用大麻在美国的使用正在扩大。由于证据相互矛盾且质量不高，许多肿瘤医生可能对向患者推荐它没有信心。考虑到在临床试验中使用医用大麻可能带来法律和财务风险，应该探索使用观察性数据。直接捕捉与处方药物相关的医用大麻使用情况并跟踪大麻使用的流行率和模式的观察性数据很少。为了深入了解医用大麻在药物领域中的作用，需要探索诸如大麻立法等替代指标。在经历化疗引起的恶心和呕吐的患者中，在推荐不遵守止吐药处方的情况下，在允许使用医用大麻的州，医用大麻可能是止吐药的合适替代品。研究结果表明，立法可能会影响在实施大麻立法的州使用某些止吐药。医用大麻使用的立法的存在或不存在可能是社区中医用大麻使用的早期可观察替代指标。鉴于缺乏临床试验和观察性数据集来捕捉大麻的使用情况，仍然迫切需要开发方法或标准化数据集，以适当和可靠地捕捉医用大麻的使用情况，从而促进对其临床应用和对处方药物使用的影响的研究。通过标准化报告和消除使用污名化，可以消除对替代措施的依赖，这些替代措施是对更广泛数据的替代，并且在很大程度上改善了数据采集，从而使我们能够从观察性数据中生成知识和假设，直到研究条件改善并允许扩大涉及医用大麻的临床试验。
