Therapeutic use of cannabis and cannabinoids: benefits and risks.

Abstract

The international popularity of cannabis and the shifting legal landscape have propelled conversations around medical and recreational use to the forefront of public discussion. Clinicians face increased questions from patients, though there is a lack of clear medical consensus on several conditions for which cannabis is commonly used. As of 2025, key indications for cannabis and cannabinoid use are nausea and vomiting induced by chemotherapy, loss of appetite induced by HIV / AIDS, Dravet syndrome, Lenox Gastaut syndrome, seizures associated with tuberous sclerosis, and multiple sclerosis spasticity. However, cannabis and cannabinoids are used to treat additional conditions, which we discuss in this update of Hill and Palastro's 2017 review of medical cannabis. We review current evidence for cannabis and cannabinoid treatment of chronic non-cancer pain, insomnia, psychiatric and neurologic disorders. We also consider current inconclusive evidence for cannabis to treat opioid use disorder and neurological disorders. Risks associated with cannabis and cannabinoid use include addiction, decreased neurocognitive function, particularly in adolescents, cannabinoid hyperemesis syndrome, psychosis, perinatal complications, cardiovascular, pulmonary and physical injury risks such as falls and motor vehicle accidents. As public and clinical interest in cannabis grows, clinicians must evaluate potential harms alongside benefits relevant to the medical condition for which cannabis is being considered. Anecdotal experiences and commercial claims, whether positive or negative, and however compelling, must be eschewed in favor of research findings and fact to guide clinical decision-making.