Medical Cannabis: State of the Artand Clinical Applications

Abstract

Medical cannabis has gained increasing relevance across multiple therapeutic fields, particularly in the management of chronic neuropathic pain, multiple sclerosis–related spasticity, chemotherapy-induced nausea and vomiting, cachexia associated with chronic diseases, and selected forms of drug-resistant epilepsy. In recent years, scientific and clinical interest has grown substantially, supported by evolving regulatory frameworks—especially in Switzerland—which have significantly improved prescription accessibility.
This article provides a practical, clinician-oriented overview of medical cannabis, primarily addressed to non-specialist physicians who are increasingly confronted with patient requests for cannabinoid-based therapies.
Emphasis is placed on medical cannabis as a complementary treatment integrated into standard care, rather than as a substitute for evidence-based therapies. After a brief historical overview, the paper outlines the pharmacology of cannabinoids, focusing on THC and CBD, and describes the endocannabinoid system, including CB1 and CB2 receptors and their role in pain modulation, inflammation, mood regulation, and neurophysiology. Pharmacokinetic differences between inhaled, oral, and sublingual administration routes are discussed, highlighting their clinical implications for dosing and titration.
The article reviews current evidence for established clinical indications such as neuropathic pain, multiple sclerosis spasticity, chemotherapy-related nausea, appetite stimulation, epilepsy, and sleep disorders as well as emerging applications in psychiatry, including anxiety disorders, PTSD, mood disorders, and adult ADHD. Special attention is given to patients on chronic opioid therapy, where cannabinoids
may exert an opioid-sparing effect, improve pain control, and enhance overall quality of life.
Finally, safety considerations, drug–drug interactions, and the Swiss legal and regulatory context are addressed, including reimbursement issues under mandatory health insurance. The article concludes that medical cannabis represents a valuable and evolving therapeutic option when prescribed judiciously, titrated individually, and
integrated within a structured clinical framework.