Questioning assumptions about the abuse potential of medical cannabis and cannabinoids: narrative review and commentary

Aims and method There is a pressing need for standardised and comprehensive research frameworks to evaluate both the therapeutic benefits and risks of dependency and misuse associated with medical cannabis. We address the issue of abuse potential or misuse liability by examining research data and what amounts to existing clinical dogma for validity and generalisability. We undertook a broad scoping approach to exploring recent literature, focusing on clinical studies that investigated abuse/misuse and dependence among users of medical and/or recreational cannabis and cannabinoids. The search provided over 350 articles, mostly (∼90%) dated post 2002. Abstract analysis narrowed the selection to under 50 papers, according to their relevance as judged by the authors, an experienced clinician and a public health toxicologist. Results We identified and commented upon some broad assumptions within the abuse liability literature that included (a) a standard cannabis formulation; (b) standard routes of administration and standard potency dosing; (c) a standard pattern of use; (d) a standard user or patient; and (e) a standard vulnerability to misuse or dependence. Clinical implications Unpacking and questioning these assumptions leads to the conclusion that far more rigorous language and research design are needed to address the question of cannabis abuse definitively but, based on the best available evidence, it appears that the abuse liability of medically supervised cannabis is comparable to any other class of widely used and well-regulated pharmaceutical agents.