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No evidence that cannabinoids are effective in the improvement of disturbed behaviour in dementia or in the treatment of other symptoms of dementia

Cannabinoids are compounds derived from the cannabis plant (Cannabis sativa). Laboratory studies have indicated that cannabinoids may regulate some of the processes that lead to neurodegeneration. This suggests that cannabinoids could be useful in the treatment of neurodegenerative dementias such as Alzheimer's disease. So far, only one small randomized controlled trial has assessed the efficacy of cannabinoids in the treatment of dementia. This study had poorly presented results and did not provide sufficient data to draw any useful conclusions.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Cannabinoids for Tourette syndrome

Cannabinoid medication might be useful in the treatment of the symptoms in patients with Tourette's syndrome. At the present time only two relevant studies have been conducted. Both studies used tetrahydrocannabinol (Δ9THC). In both studies Δ9THC was associated with tic reduction. However the sample size was small and a large number of multiple comparisons were made . There were only 28 participants in total, since eight participants took part in both studies. Possibly the patients who derived the greatest benefit and experienced the least adverse effects would be the most inclined to participate in further studies. There were a high number of drop outs/exclusions in the six week study and it is unclear whether intention to treat analysis (ITT) was performed. The results that are reported are analyses done on the patients who remained in the study on the study medication at the correct dose. In reality, patients do opt not to continue treatment if there is limited efficacy or unpalatable side effects. This introduces attrition bias. Whilst there were some significant results, the authors themselves accept that very few of these results are significant if a Bonferroni correction is performed. It is possible that cannabinoid medication has a beneficial effect which is too weak to be detected using ITT and such a small sample size. There is some weak evidence that cannabinoid medication may have an effect on obsessive compulsive behaviour but the measure used was an addition to the TSSL which has not been validated.There were no data on the effect of Δ9THC on quality of life.There is not enough evidence to support the use of cannabinoids in treating tics and obsessive compulsive behaviour in people with Tourette's syndrome.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Nabilone for non-chemotherapy associated nausea and weight loss due to medical conditions: a review of the clinical effectiveness and guidelines

Bibliographic details: Canadian Agency for Drugs and Technologies in Health.  Nabilone for non-chemotherapy associated nausea and weight loss due to medical conditions: a review of the clinical effectiveness and guidelines. Ottawa (ON), Canada: Canadian Agency for Drugs and Technologies in Health. Rapid Response Report. 2014

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2014

Improving Antibiotic Prescribing for Uncomplicated Acute Respiratory Tract Infections [Internet]

To assess the comparative effectiveness of interventions for improving antibiotic use for acute respiratory tract infections (RTIs) in adults and children.

Comparative Effectiveness Reviews - Agency for Healthcare Research and Quality (US).

Version: January 2016
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Psychosis with Coexisting Substance Misuse: Assessment and Management in Adults and Young People

This clinical guideline covers the assessment and management of adults and young people (aged 14 years and older) who have a clinical diagnosis of psychosis (schizophrenia, bipolar disorder or other affective psychosis) and coexisting substance misuse (harmful use of any psychotropic substance including alcohol and legal or illicit drugs).

NICE Clinical Guidelines - National Collaborating Centre for Mental Health (UK).

Version: 2011
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Long-term Nabilone Use: A Review of the Clinical Effectiveness and Safety [Internet]

The purpose of this Rapid Response report is to summarize the evidence of clinical efficacy and harms associated with evidence of efficacy and safety of long-term nabilone use in adult populations with post-traumatic stress disorder (PTSD) and other chronic conditions.

Rapid Response Report: Summary with Critical Appraisal - Canadian Agency for Drugs and Technologies in Health.

Version: October 16, 2015
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Nabilone for Non-chemotherapy Associated Nausea and Weight Loss due to Medical Conditions: A Review of the Clinical Effectiveness and Guidelines [Internet]

Cannabis has been used medically for its antiemetic, sedative, and analgesic effects and for its ability to stimulate appetite. The major psychoactive ingredient of cannabis is delta-9-tetrahydrocannabinol (THC). Nabilone is a synthetic cannabinoid analog of THC and is approved for use in Canada for the treatment of severe nausea and vomiting associated with chemotherapy in adults over the age of 18 years. For its approved indication, nabilone (1 mg to 2 mg) is used short-term, administered the night before and one to three hours prior to chemotherapy and can be continued up to 24 hours following chemotherapy. A systematic review of randomized controlled trials (RCTs) found that 70% of patients undergoing chemotherapy who received cannabinoids had complete control of nausea compared to 57% of placebo patients (RR 1.21; 95% CI 1.03 to 1.42). As well, 66% of patients had complete control of vomiting with cannabinoids compared to 36% of patients treated with placebo (RR 1.84; 95% CI 1.42 to 2.38).

Rapid Response Report: Summary with Critical Appraisal - Canadian Agency for Drugs and Technologies in Health.

Version: September 12, 2014
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Appetite stimulants in cystic fibrosis: a systematic review

This review aimed to assess the benefits of appetite stimulants in cystic fibrosis-related anorexia and concluded that megesterol acetate may be a useful adjunct for treatment for cystic fibrosis patients who had difficulty maintaining their weight. This conclusion may not be reliable given the overall poor quality of the included studies.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2007

Medical use of cannabis in patients with HIV/AIDS.

The use of cannabis (marijuana), its active ingredient or synthetic forms such as dronabinol has been advocated in patients with HIV/AIDS, in order to improve the appetite, promote weight gain and lift mood. Dronabinol has been registered for the treatment of AIDS‐associated anorexia in some countries. However, the evidence for positive effects in patients with HIV/AIDS is limited, and some of that which exists may be subject to the effects of bias. Those studies that have been performed have included small numbers of participants and have focused on short‐term effects. Longer‐term data, and data showing a benefit in terms of survival, are lacking. There are insufficient data available at present to justify wide‐ranging changes to the current regulatory status of cannabis or synthetic cannabinoids.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Cannabis and Cannabinoids (PDQ®): Health Professional Version

Expert-reviewed information summary about the use of Cannabis and cannabinoids in the treatment of cancer-related side effects, such as nausea and vomiting.

PDQ Cancer Information Summaries [Internet] - National Cancer Institute (US).

Version: May 27, 2016

Nausea and Vomiting (PDQ®): Health Professional Version

Expert-reviewed information summary about nausea and vomiting as complications of cancer or its treatment. Approaches to the management of nausea and vomiting are discussed.

PDQ Cancer Information Summaries [Internet] - National Cancer Institute (US).

Version: January 4, 2016

Neuropathic Pain: The Pharmacological Management of Neuropathic Pain in Adults in Non-specialist Settings [Internet]

This short clinical guideline aims to improve the care of adults with neuropathic pain by making evidence-based recommendations on the pharmacological management of neuropathic pain outside of specialist pain management services. A further aim is to ensure that people who require specialist assessment and interventions are referred appropriately and in a timely fashion to a specialist pain management service and/or other condition-specific services.

NICE Clinical Guidelines - Centre for Clinical Practice at NICE (UK).

Version: November 2013
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Cannabis and Cannabinoids (PDQ®): Patient Version

Expert-reviewed information summary about the use of Cannabis and cannabinoids in the treatment of cancer-related side effects, such as nausea and vomiting.

PDQ Cancer Information Summaries [Internet] - National Cancer Institute (US).

Version: May 27, 2016

Nutrition in Cancer Care (PDQ®): Health Professional Version

Expert-reviewed information summary about the causes and management of nutritional problems that occur in patients with cancer.

PDQ Cancer Information Summaries [Internet] - National Cancer Institute (US).

Version: January 8, 2016

Treatment for cramps in amyotrophic lateral sclerosis/motor neuron disease

A cramp is a sudden, involuntary painful contraction of a muscle. Many people with amyotrophic lateral sclerosis (ALS), also known as motor neuron disease (MND), experience cramps during the course of the disease. These range from mild cramps that do not affect daily activities and sleep, through to very severe, painful cramps. Some medications that are used to treat cramps in people with no medical condition or with conditions other than ALS have been tested in ALS clinical trials. These medicines include vitamin E, creatine, quinidine, and gabapentin. Other medications such as quinine sulfate, magnesium, lioresal, dantrolene, clonazepam, diphenylhydantoin, and gabapentin have been used to treat cramps in people with ALS but their effectiveness is unknown. In 2006 and 2010 the US Food and Drugs Administration issued warnings concerning the use of quinine sulfate, which was the previously most widely prescribed medication for cramps in the US. This review sought to find out how effective medications and physical treatments for cramps are for people with ALS. The reviewers identified 20 randomised controlled trials in people with ALS comprising a total of 4789 participants. Only one trial, of the drug tetrahydrocannabinol (THC), directly investigated the effectiveness of an intervention for cramps. Thirteen randomised controlled ALS trials investigated cramps secondarily among other variables. The medications comprised vitamin E, baclofen, riluzole, L‐threonine, xaliproden, indinavir, and memantine. Six randomised controlled ALS trials investigated cramps as adverse events. The medications comprised creatine, gabapentin, dextromethorphan, quinidine and lithium. None of the 20 studies could demonstrate any benefit, but the studies were small. Current evidence on the treatment of cramps in ALS is lacking and more research is needed.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Eating Disorders: Core Interventions in the Treatment and Management of Anorexia Nervosa, Bulimia Nervosa and Related Eating Disorders

This guideline has been developed to advise on the identification, treatment and management of the eating disorders anorexia nervosa, bulimia nervosa and related conditions. The guideline recommendations have been developed by a multidisciplinary group of health care professionals, patients and their representatives, and guideline methodologists after careful consideration of the best available evidence. It is intended that the guideline will be useful to clinicians and service commissioners in providing and planning high quality care for those with eating disorders while also emphasising the importance of the experience of care for patients and carers.

NICE Clinical Guidelines - National Collaborating Centre for Mental Health (UK).

Version: 2004
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Medications for the treatment of cannabis dependence

Cannabis is the most common illicit drug in the world. Demand by cannabis users for treatment has been increasing in most regions of the world. Currently there are no medications specifically for the treatment of cannabis use. This review sought to assess the effectiveness and safety of medications for the treatment of cannabis dependence.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Cannabis‐based medicine for nausea and vomiting in people treated with chemotherapy for cancer

As many as three‐quarters of people who receive chemotherapy experience nausea (feeling sick) and vomiting (being sick), which many find distressing. While conventional anti‐sickness medicines are effective, they do not work for everyone, all of the time. Therapeutic drugs based on the active ingredient of cannabis, known as THC (delta‐9‐tetrahydrocannabinol), have been approved for use as anti‐sickness medicines in some countries.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Pregnancy and Complex Social Factors: A Model for Service Provision for Pregnant Women with Complex Social Factors

This guideline aims to: identify and describe best practice for service organisation and delivery that will improve access, acceptability and use of services; identify and describe services that encourage, overcome barriers to and facilitate the maintenance of contact throughout pregnancy; describe additional consultations with and/or support and information for women with complex social factors, and their partners and families, that should be provided during pregnancy, over and above that described in the NICE guideline ‘Antenatal care: routine care for the healthy pregnant woman’ (2008) (clinical guideline 62); identify when additional midwifery care or referral to other members of the maternity team (obstetricians and other specialists) would be appropriate, and what that additional care should be.

NICE Clinical Guidelines - National Collaborating Centre for Women's and Children's Health (UK).

Version: September 2010
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Sleep Disorders (PDQ®): Health Professional Version

Expert-reviewed information summary about causes and management of sleep disorders in people with cancer.

PDQ Cancer Information Summaries [Internet] - National Cancer Institute (US).

Version: March 10, 2016

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