Cannabis is one of the oldest and widely used substances in the world. Cannabinoids within the cannabis plant, known as phytocannabinoids, mediate cannabis’ effects through interactions with the body’s endogenous cannabinoid system. This endogenous system, the endocannabinoid system, has important roles in physical and mental health. These roles point to the potential to develop cannabinoids as therapeutic agents while underscoring the risks related to interfering with the endogenous system during nonmedical use. This scoping narrative review synthesizes the current evidence for both the therapeutic and adverse effects of the major (i.e., Δ9-tetrahydrocannabinol and cannabidiol) and lesser studied minor phytocannabinoids, from nonclinical to clinical research. We pay particular attention to the areas where evidence is well established, including analgesic effects after acute exposures and neurocognitive risks after acute and chronic use. In addition, drug development considerations for cannabinoids as therapeutic agents within the United States are reviewed. The proposed clinical study design considerations encourage methodological standards for greater scientific rigor and reproducibility to ultimately extend our knowledge of the risks and benefits of cannabinoids for patients and providers.

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大麻素作为治疗药物在美国的发展


大麻是世界上最古老且广泛使用的物质之一。大麻植物中的大麻素（称为植物大麻素）通过与人体内源性大麻素系统的相互作用来介导大麻的作用。这种内源性系统，即内源性大麻素系统，对身心健康具有重要作用。这些作用表明了开发大麻素作为治疗剂的潜力，同时强调了在非医疗用途期间干扰内源系统的相关风险。这篇范围叙述综述综合了主要植物大麻素（即 Δ9-四氢大麻酚和大麻二酚）和研究较少的次要植物大麻素从非临床到临床研究的治疗和不良反应的当前证据。我们特别关注证据充分的领域，包括急性暴露后的镇痛作用以及急性和慢性使用后的神经认知风险。此外，还审查了美国境内大麻素作为治疗剂的药物开发考虑因素。拟议的临床研究设计考虑因素鼓励采用更高科学严谨性和可重复性的方法标准，最终扩展我们对大麻素对患者和提供者的风险和益处的了解。