Key Points

Cannabis is a plant that contains cannabinoids, which are agents that act on the endocannabinoid system; an ancient, evolutionary conserved system that regulates our bodies in many ways, most of them still poorly understood.

Legal cannabis production, use, and distribution for medical and recreational use is regulated in Canada. Production, distribution and use of synthetic forms of cannabis are highly regulated and approved for medical uses only. In many parts of the world recreational and/or medical use of cannabis may be illegal or restricted.

THC and CBD are two common cannabinoids. THC is psychoactive, and though CBD is not, it seems to modulate the psychoactive effects of THC.

Cannabis may be inhaled, ingested, or applied topically. The effects and risks vary depending on the mode of administration, the cannabis type, amount, and dosage.

Current scientific literature is insufficient to inform specific dose regimens for SCI and for most other conditions.

Cannabis may have a small positive effect on pain and spasticity management in people with SCI.

Quality of evidence on other effects of cannabis in non-SCI populations limits generalizability or application of findings

Most short-term side effects are mild to moderate and dose-dependent.

Dry mouth, fatigue, and hunger are the most common side effects in the SCI population.

Autonomic, cardiovascular, and respiratory side effects may not be common in SCI patients using cannabis, but more research is needed.

Where autonomic, cardiovascular, and respiratory functions are important prognostic factors, people with SCI who use cannabis should be regularly monitored for changes in these functions.

Cannabis use may lead to depressive and anxious symptoms, though these are not commonly reported by SCI patients in studies conducted to date.

Long-term use of cannabis is associated with tolerance, dependence, and symptoms of withdrawal when discontinued. Lifetime risk of developing cannabis dependence syndrome has been documented as 9% for cannabis users in general.

Long-term use of cannabis is associated with chronic psychotic illness with youngers adults, though causality is unclear.

Naïve cannabis users may experience acute intoxication symptoms including feelings of anxiety and panic, combined with nausea, vomiting, or fainting as well as symptoms of misperception and distortion of time and space.