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Medical benefis of cannabis have become widely accepted. In Obstetrics and
Gynecology, it was reported to be useful to alleviate nausea and vomiting from morning sickness
in pregnant women and in gynecologic cancer patients who received chemotherapy. It has also
been used as a pain killer during labor and menstruation. Some also claimed that the cannabis
may also prolong life of cancer patients or even cure cancer. Owing to the illegalization of the
cannabis in many countries for a long time, there has been no evidence-based data from clinical
study to support the use of cannabis for those aforementioned conditions except for chemotherapy
induced nausea/vomiting. Systematics reviews confimed that cannabis was signifiantly more
effective than placebo and at least as effective as various conventional antiemetics. However,
due to the availability of many potent new standard antiemetics (5-HT3 receptor antagonists,
and neurokinin-1-receptor-antagonists) without psychotropic effects, cannabis is not
recommended as a fist-line antiemetic agent. The exception is when the new standard
antiemetics cannot adequately control nausea and vomiting from chemotherapy. The cannabis
is contraindicated in pregnant women or lactating mother because of the possibility of adverse
fetal and neonatal outcomes. Once cannabis is legalized for medical use in more countries, its
efficacy in those aforementioned conditions can be tested and confimed in randomized controlled
2. Russell RJ. Therapeutic uses and toxic effects of Cannabis Indica. Lancet 1890;1:637-8.
3. Chuwiruch N. Thailand wants to have its (Hash) cake and eat it too. (July 17, 2018) Available from: https://www.bloomberg.com/news/articles/2018-07-16/thailand-looks-to-endorse-medical-pot-yet-keep-anti-drug-laws. Retrieved Nov 12, 2018.
4. International Opium Convention. Available from: https://en.wikipedia.org/wiki/International_Opium_Convention. Retrieved Nov 9, 2018.
5. NIH: National Institute on drug abuse. Is marijuana safe and effective as medicine?. Available from: https://www.drugabuse.gov/publications/research-reports/marijuana/marijuana-safe-effective-medicine. Retrieved Nov 9, 2018.
6. Overview of U.S. Medical marijuana law. Available from: https://www.medicalmarijuanainc.com/overview-of-u-s-medical-marijuana-law/. Retrieved Nov 9, 2018.
7. Anthony JC, Lopez-Quintero C, Alshaarawy O. Cannabis epidemiology: a selective review. Curr Pharm Des 2016; 22:6340–52.
8. Alcohol and drug abuse institute. What is Cannabis? Available from: http://learnaboutmarijuanawa.org/factsheets/whatiscannabis.htm. Retrieved Nov 9, 2018.
9. National institute of drug abuse. What is marijuana? Available from: https://www.drugabuse.gov/publications/research-reports/marijuana/what-marijuana. Retrieved Nov 12, 2018.
10. Curran HV, Freeman TP, Mokrysz C, Lewis DA, Morgan CJ, Parsons LH. Keep off the grass? Cannabis, cognition and addiction. Nat Rev Neurosci 2016;17:293-306.
11. Tishler J, Wedman B. Endocannabinoid system: master of homeostasis, pain control, & so much more. In: Wedman B, editor. Cannabis: a clinician’s guide. Boca Raton: CRC Press 2018;15-28.
12. Wedman B. Endocannabinoid system: regulatory function in health & disease. In: Wedman B, editor. Cannabis: a clinician’s guide. Boca Raton: CRC Press 2018;29-42.
13. Maida V, Daeninck PJ. A user’s guide to cannabinoid therapies in oncology. Curr Oncol 2016;23:398-406.
14. D’Souza DC, Perry E, MacDougall L, Ammerman Y, Cooper T, Wu YT, et al. The psychotomimetic effects of intravenous delta-9-tetrahydrocannabinol in healthy individuals: implications for psychosis. Neuropsychopharmacology 2004;29:1558-72.
15. Das RK, Kamboj SK, Ramadas M, Yogan K, Gupta V, Redman E, et al. Cannabidiol enhances consolidation of explicit fear extinction in humans. Psychopharmacology (Berl) 2013;226:781-92.
16. Leweke FM, Piomelli D, Pahlisch F, Muhl D, Gerth CW, Hoyer C, et al. Cannabidiol enhances anandamide signaling and alleviates psychotic symptoms of schizophrenia. Transl Psychiatry 2012;2:e94.
17. Bergamaschi MM, Queiroz RH, Chagas MH, de Oliveira DC, De Martinis BS, Kapczinski F, et al. Cannabidiol reduces the anxiety induced by simulated public speaking in treatment-naïve social phobia patients. Neuropsychopharmacology 2011;36:1219-26.
18. Morgan CJ, Schafer G, Freeman TP, Curran HV. Impact of cannabidiol on the acute memory and psychotomimetic effects of smoked cannabis: naturalistic study. Br J Psychiatry 2010;197:285-90.
19. Whiting PF, Wolff RF, Deshpande S, Di Nisio M, Duffy S, Hernandez AV, et al. Cannabinoids for medical use: a systematic review and meta-analysis. JAMA 2015; 313: 2456-73.
20. Atakan Z. Cannabis, a complex plant: different compounds and different effects on individuals. Ther Adv Psychopharmacol 2012;2:241-54.
21. MacCallum CA, Russo EB. Practical considerations in medical cannabis administration and dosing. Eur J Intern Med 2018;49:12-9.
22. Buddy T. How Is marijuana used? (Sep 30, 2018) available from: https://www.verywellhealth.com/how-is-marijuana-used-63522. Retrieved Nov 20, 2018.
23. Tramer MR, Carroll D, Campbell FA, Reynolds JM, Moore RA, McQuay HJ. Cannabinoids for control of chemotherapy induced nausea and vomiting: quantitative systematic review. BMJ 2001;323:16–21.
24. Bridgeman MB, Abazia DT. Medicinal cannabis: history, pharmacology, and implications for the acute care setting. P T 2017;42:180-8.
25. Russo E. Cannabis treatments in obstetrics and gynecology: a historical review. J Cannabis Ther 2002; 2:5-35.
26. Curry WL. Hyperemesis gravidarum and clinical cannabis: to eat or not to eat? J Cannabis Ther 2002; 2:63-83.
27. Westfall RE, Janssen PA, Lucas P, Capler R. Survey of medicinal cannabis use among childbearing women: patterns of its use in pregnancy and retroactive self-assessment of its efficacy against ‘morning sickness’. Complement Ther Clin Pract 2009;15:242-6.
28. Allen JH, de Moore GM, Heddle R, Twartz JC. Cannabinoid hyperemesis: cyclical hyperemesis in association with chronic cannabis abuse. Gut 2004;53: 1566-70.
29. Richards JR, Gordon BK, Danielson AR, Moulin AK. Pharmacologic treatment of cannabinoid hyperemesis syndrome: a systematic review. Pharmacotherapy 2017; 37:725-34.
30. Sorensen CJ, DeSanto K, Borgelt L, Phillips KT, Monte AA. Cannabinoid hyperemesis syndrome: diagnosis, pathophysiology, and treatment-a systematic review. J Med Toxicol 2017;13:71-87.
31. Schmid S, Lapaire O, Huang DJ, Jurgens FE, Güth U. Cannabinoid hyperemesis syndrome: an underreported entity causing nausea and vomiting of pregnancy. Arch Gynecol Obstet 2011;284:1095–7.
32. Ohle M. Cannabis and pain: can marijuana really manage pregnancy pain? Available from: https://potstocknews.com/can-cannabis-ease-labor-pains%3F. Retrieved Nov 7, 2018.
33. Mothers in labor are using cannabis to manage pain during birth. Available from: https://420intel.com/articles/2018/06/22/mothers-labor-are-using-cannabis-manage-pain-during-birth. Retrieved Nov 7, 2018.
34. Hutchings DE, Martin BR, Gamagaris Z, Miller N, Fico T. Plasma concentrations of delta 9-tetrahydrocannabinol in dams and fetuses following acute or multiple prenatal dosing in rats. Life Sci 1989;44:697-701.
35. Hayatbakhsh MR, Flenady VJ, Gibbons KS, Kingsbury AM, Hurrion E, Mamun AA, et al. Birth outcomes associated with cannabis use before and during pregnancy. Pediatr Res 2012;71:215-9.
36. Fried PA, Watkinson B, Willan A. Marijuana use during pregnancy and decreased length of gestation. Am J Obstet Gynecol 1984;150:23-7.
37. Gray TR, Eiden RD, Leonard KE, Connors GJ, Shisler S, Huestis MA. Identifying prenatal cannabis exposure and effects of concurrent tobacco exposure on neonatal growth. Clin Chem 2010;56:1442-50.
38. Hingson R, Alpert JJ, Day N, Dooling E, Kayne H, Morelock S, et al. Effects of maternal drinking and marijuana use on fetal growth and development. Pediatrics 1982;70:539-46.
39. Varner M, Silver R, Rowland Hogue C, Willinger M, Parker C, Thorsten V, et al. Eunice Kennedy Shriver National Institute of Child Health and Human Development Stillbirth Collaborative Research Network. Association between stillbirth and illicit drug use and smoking during pregnancy. Obstet Gynecol 2014;123: 113-25.
40. Shiono P, Klebenoff M, Nugent R, Cotch M, Wilkins D, Rollins D, et al. The impact of cocaine and marijuana use on low birth weight and preterm. Am J Obstet Gynecol 1995;172:19-27.
41. Van Gelder M, Reefhuis J, Cayton A, Weirler M, Druschel C, Roeleveld N. National Birth Defects Prevention Study. Characteristics of pregnant illicit drug users and associations between cannabis use and perinatal outcome in a population-based study. Drug Alcohol Depend 2010;109:243–7.
42. Huizink AC. Prenatal cannabis exposure and infant outcomes: overview of studies. Prog Neuropsychopharmacol Biol Psychiatry 2014; 3:45–52.
43. Gunn JK, Rosales CB, Center KE, Nuñez A, Gibson SJ, Christ C, et al. Prenatal exposure to cannabis and maternal and child health outcomes: a systematic review and meta-analysis. BMJ Open 2016;6:1-8.
44. Barrow B. A case of dysmenorrhoea in which the tincture of Cannabis Indica was employed, with some observations upon that drug. Prov Med Surg J 1847;11:122-4.
45. Eitzel E. How medical cannabis can help with severe dysmenorrhea. (Apr 04, 2018) Available from: https://thefreshtoast.com/rx/medical-cannabis-helps-severe-dysmenorrhea. Retrieved Nov 7, 2018.
46. Wetsman N. Does weed actually work for period cramps? (Apr 19, 2018) Available from: https://tonic.vice.com/en_us/article/d35ewy/does-weed-actually-work-for-period-cramps. Retrieved Nov 7, 2018,
47. Russel M. I tried 7 cannabis products for cramps & here’s what worked.(Dec 22, 2016) Available from: https://www.bustle.com/articles/200937-i-tried-7-cannabis-products-for-cramps-heres-what-worked. Retrieved Nov 7, 2018.
48. Badowski ME. A review of oral cannabinoids and medical marijuana for the treatment of chemotherapy induced nausea and vomiting: a focus on pharmacokinetic variability and pharmacodynamics. Cancer Chemother Pharmacol 2017;80:441–9.
49. Tafelski S, Häuser W, Schäfer M. Efficacy, tolerability, and safety of cannabinoids for chemotherapy-induced nausea and vomiting--a systematic review of systematic reviews. Schmerz 2016;30:14–24.
50. Parker LA, Rock EM, Limebeer CL. Regulation of nausea and vomiting by cannabinoids. Br J Pharmacol 2011;163:1411–22.
51. Rock EM, Sticht MA, Limebeer CL, Parker LA. Cannabinoid regulation of acute and anticipatory nausea. Cannabis Cannabinoid Res 2016;1.1:113-21.
52. Hesketh PJ, Kris MG, Basch E, Bohlke K, Barbour SY, Clark-Snow RA, et al. Antiemetics: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol 2017;35:3240-61.
53. Meiri E, Jhangiani H, Vredenburgh, Barbato LM, Carter FJ, Yang HM, et al. Efficacy of dronabinol alone and in combination with ondansetron versus ondansetron alone for delayed chemotherapy-induced nausea and vomiting. Curr Med Res Opin 2007;23:533-43.
54. Velasco G, Sánchez C, Guzmán M. Anticancer mechanisms of cannabinoids. Curr Oncol 2016;23: S23-S32.
55. BogdanovicV, Mrdjanovic J, Boris I. A review of the therapeutic antitumor potential of cannabinoids. J Am Chem Soc 2017;23:831-6.
56. Simpson R. Phoenix Tears Rick Simpson Oil Nature’s Answer For Cancer. Den Beauvais. 2012. p.1-129. available from: http://www.milkaclarkestrokefoundation.org/uploads/2/4/5/9/2459046/rick_simpson_natures_answer_for_cancer.pdf. Retrieved Oct 9, 2018
57. Meetam T, Panyalimpanun T. Cannabis: evil plant or alternative herb. (January 20, 2018). Available from: https://www.bbc.com/thai/thailand-42748753. Retrieved Oct 9, 2018.
58. Parker LA. Cannabinoids and the brain. Cambridge: The MIT Press 2017;79-96.
59. Freeman TP, Winstock AR. Examining the profile of high-potency cannabis and its association with severity of cannabis dependence. Psychol Med 2015;45:3181-9.
60. Hasin DS, Saha TD, Kerridge BT, Goldstein RB, Chou SP, Zhang H, et al. Prevalence of marijuana use disorders in the United States between 2001-2002 and 2012-2013. JAMA Psychiatry 2015;72:1235-42.
61. Flórez-Salamanca L, Secades-Villa R, Hasin DS, Cottler L, Wang S, Grant BF, et al. Probability and predictors of transition from abuse to dependence on alcohol, cannabis, and cocaine: results from the National Epidemiologic Survey on Alcohol and Related Conditions. Am J Drug Alcohol Abuse 2013;39:168-79.
62. Lopez-Quintero C, Pérez de los Cobos J, Hasin DS, Okuda M, Wang S, Grant BF, et al. Probability and predictors of transition from first use to dependence on nicotine, alcohol, cannabis, and cocaine: results of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Drug Alcohol Depend 2011;115: 120-30.
63. Grotenhermen F, Müller-Vahl K. The therapeutic potential of cannabis and cannabinoids. Dtsch Arztebl Int 2012;109:495-501.
64. Budney AJ, Hughes JR, Moore BA, Vandrey R. Review of the validity and significance of cannabis withdrawal syndrome. Am J Psychiatry 2004;161:1967-77.
65. Bonnet U, Preuss UW. The cannabis withdrawal syndrome: current insights. Subst Abuse Rehabil 2017; 8:9-37.
66. Wang T, Collet JP, Shapiro S, Ware MA. Adverse effects of medical cannabinoids: a systematic review. CMAJ 2008;178:1669-78.