Medical cannabis: From research breakthroughs to shifting public perceptions and ensuring safe use

The Regulatory Environment Surrounding Cannabis Medicines in the EU, the USA, and Australia

Background/Objectives: Recent evidence supporting the medicinal use of cannabis has brought significant regulatory changes regarding its legal status, cultivation, and use. Several countries have adopted regulatory strategies enabling access to cannabis-based medicinal products; however, the regulation and availability of high-quality cannabis products differs globally. This work aimed to explore the regulatory pathways available for cannabis-based medicinal products, particularly those regulated as medicines, and establish the current landscape of those approved. Methods: The public repositories of the European Medicines Agency, U.S. Food and Drug Administration, and Therapeutic Goods Administration were searched. A consumer website, Amazon, was searched to provide illustrative examples of cannabis products readily available to consumers. Finally, clinical trial data were collected to evaluate trends in medicinal cannabis research. Results: Only Epidyolex™ has been approved by these three agencies. Whilst topical cannabinoid consumer products are popular, no topical cannabis-based medicines have been approved by regulators, despite being the focus of several clinical trials. There are few regulator-approved cannabis-based medicines available and, evidence supporting the therapeutic use of consumer products is very limited. A complex regulatory and legislative scenario hinders research on and development of cannabis-based medicines, leaving a market gap filled with unregulated products that are potentially misleading regarding their therapeutic claims.

Renal Outcomes and Other Adverse Effects of Cannabinoid Supplementation

This narrative review explores the benefits and risks of cannabinoids in kidney health, particularly in individuals with pre-existing renal conditions. It discusses the roles of cannabinoid receptor ligands (phytocannabinoids, synthetic cannabinoids, and endocannabinoids) in kidney physiology. The metabolism and excretion of these substances are also highlighted, with partial elimination occurring via the kidneys. The effects of cannabinoids on kidney function are examined, emphasizing both their potential to offer nephroprotection and the risks they may pose, such as cannabinoid hyperemesis syndrome and ischemia-reperfusion injury. These complexities underscore the intricate interactions between cannabinoids and renal health. Furthermore, this review highlights the association between chronic synthetic cannabinoid use and acute kidney injury, stressing the need for further research into their mechanisms and risks. This article also highlights the growing prevalence of edible cannabis and hemp seed consumption, emphasizing their nutritional benefits, legal regulations, and challenges such as inconsistent labeling, potential health risks, and implications for kidney health. The review delves into the roles of CB1 and CB2 receptors in diabetic nephropathy, chronic kidney disease, and obesity-related kidney dysfunction, discussing the therapeutic potential of CB2 agonists and CB1 antagonists. Additionally, it examines the potential diuretic and anti-inflammatory effects of cannabinoids in preventing kidney stones, suggesting that cannabinoids could reduce crystal retention and lower the risk of stone formation. Cannabinoids' effects on kidneys depend heavily on the characteristics of individual substances, as synthetic cannabinoids pose a major threat to the health of users. Cannabinoids offer therapeutic potential but require more research to confirm their benefits. Distinguishing between therapeutic cannabinoids and harmful synthetic variants is crucial for safe clinical application.