Hoch E, Volkow N D, Friemel C M, Lorenzetti V, Freeman T P, Hall W
Department of Psychiatry and Psychotherapy, LMU University Hospital, LMU Munich, Munich, Germany.
IFT Institut für Therapieforschung, Centre for Mental Health and Addiction Research, Munich, Germany.
Eur Arch Psychiatry Clin Neurosci. 2025 Mar;275(2):281-292. doi: 10.1007/s00406-024-01880-2. Epub 2024 Sep 19.
The legalization of cannabis for medical and recreational purposes has progressed internationally. Cannabis and cannabinoids are advocated for a plethora of medical indications. An increasing number of medical and nonmedical users regularly consume large doses of delta-9-Tetrahydrocannabinol (THC), the main active component of cannabis. Aim: to summarize the evidence on (1) risks of recreational cannabis use and (2) effectiveness and safety of medicinal cannabis. Findings on recreational use: Cannabis is mostly used to experience its acute rewarding effects. Regular use of high THC products can produce addiction (cannabis use disorder or CUD). Acute consumption of high THC doses (including unintentionally) can cause time-limited mental, gastrointestinal, and cardiovascular problems and motor vehicle accidents. Chronic patterns of cannabis use have been associated with multiple adverse outcomes that are of particular concern among adolescents and young adults, such as, disrupted learning, impaired cognitive performance, reduced educational attainment and an increased risk of CUD, psychosis/schizophrenia, mood and anxiety disorders and suicidal behaviors. There is debate about the extent to which cannabis use is a cause of these adverse outcomes. Physical health risks (e.g., respiratory and cardiovascular, prematurity and restricted fetal growth, hyperemesis syndrome among others) have also been linked with repeated consumption of cannabis with a high THC content. Findings on medical cannabis use: Herbal cannabis, medicines from extracted or synthetized cannabinoids-often used as adjuvants to standard medicines-may produce small to modest benefits. This is primarily the case in treating chronic pain, muscle spasticity, chemotherapy-induced nausea and vomiting, and refractory epilepsy (in the case of cannabidiol, CBD). The evidence is inconclusive on their value in treating mental disorders and other medical conditions. Safety: Cannabis-based medicine is generally well tolerated. There is a risk of mild to moderate adverse effects and CUD.
大麻用于医疗和娱乐目的的合法化在国际上已取得进展。大麻和大麻素被主张用于多种医学适应症。越来越多的医疗和非医疗使用者经常大量食用大麻的主要活性成分δ-9-四氢大麻酚（THC）。目的：总结关于（1）娱乐性使用大麻的风险以及（2）药用大麻的有效性和安全性的证据。娱乐性使用的研究结果：大麻主要用于体验其急性奖赏效应。经常使用高THC产品会导致成瘾（大麻使用障碍或CUD）。急性大量食用THC剂量（包括意外情况）会导致限时性的精神、胃肠道和心血管问题以及机动车事故。长期使用大麻的模式与多种不良后果相关，这些后果在青少年和年轻人中尤为令人担忧，例如学习中断、认知能力受损、教育程度降低以及CUD、精神病/精神分裂症、情绪和焦虑障碍以及自杀行为的风险增加。关于大麻使用在多大程度上是这些不良后果的原因存在争议。身体健康风险（例如呼吸和心血管、早产和胎儿生长受限、妊娠剧吐综合征等）也与反复食用高THC含量的大麻有关。药用大麻使用的研究结果：草药大麻、从提取或合成的大麻素制成的药物——通常用作标准药物的佐剂——可能产生小到中等程度的益处。主要体现在治疗慢性疼痛、肌肉痉挛、化疗引起的恶心和呕吐以及难治性癫痫（就大麻二酚，CBD而言）。关于它们在治疗精神障碍和其他医疗状况方面的价值，证据尚无定论。安全性：基于大麻的药物一般耐受性良好。存在轻度至中度不良反应和CUD的风险。
