Medicinal cannabis use has increased rapidly in recent years in Australia. Since access pathways were expanded in 2016, more than 700,000 prescription approvals have been issued.

The vast majority of medicinal cannabis products on the market have not been registered on the Australian Register of Therapeutic Goods. But medical practitioners can apply to the Therapeutic Goods Administration (TGA) for approval to prescribe them to patients.

Data shows the three most common conditions for which scripts are approved are chronic pain, anxiety and sleep disorders.

Although many patients report benefits, professional bodies and regulators have raised concerns about whether prescribing is outpacing the evidence.

So what does the evidence actually say? Does medicinal cannabis work for the conditions for which it’s most commonly prescribed?

Medicinal cannabis for pain

Medicinal cannabis refers to cannabis products that are legally prescribed to treat a medical condition. This can be the plant itself, or natural compounds extracted from the plant. Some compounds similar to or the same as those found in cannabis (for example, dronabinol and nabilone) are made in a lab.

Two of the most common compounds in the plant are THC (tetrahydrocannabinol) and CBD (cannabidiol), known as cannabinoids.

These are commonly found at various concentrations in medicinal cannabis products which come in forms including oils, capsules, dried flower (used in a vaporiser), sprays and gummies.

Chronic pain is the most common reason for medicinal cannabis use. But as we’ve written in a previous article, research shows only modest benefits, with limited improvements in pain and physical functioning.

The TGA says there’s limited evidence medicinal cannabis provides clinically significant pain relief for many conditions, and should only be tried if other standard therapies haven’t helped.

Does medicinal cannabis work for anxiety?

Beside chronic pain, a growing number of people are now turning to medicinal cannabis for anxiety.

Multiple reviews have examined whether it works for this purpose and have come to similar conclusions. For THC-based products the evidence is mixed, with some patients finding relief, while others report their symptoms are worse.

There is emerging evidence for CBD, however it’s too soon to recommend medical cannabis as a first-line treatment for anxiety. So far, studies of CBD in anxiety have been small, only measured effects under experimental conditions designed to induce stress, had no comparison group, or only tested a one-off dose. Because of these limitations, the studies can’t tell us if CBD is effective for ongoing anxiety management.

A recent review found CBD had positive effects on anxiety, but these effects were seen in studies deemed to have problems with their methods, and not in studies that were more rigorously designed and conducted.

Similarly, a small Australian study (with no control group) demonstrated positive effects of CBD in young people with anxiety who had already tried other treatments. However, the authors stated more rigorous trials were still needed.

What’s more, there are recent case reports of acute psychosis arising from medicinal cannabis use. Taken together with the ambiguous evidence, the role for cannabinoids for anxiety remains far from clear.

How about sleep disorders?

The evidence for cannabis in the treatment of sleep disorders and insomnia is perhaps even more limited, with neither CBD or THC having shown clear benefits reducing the number of awakenings or time spent awake during the night, or improved sleep quality. That said, some people do report they have fewer symptoms of insomnia when using medicinal cannabis.

Similar to anxiety, many of the studies have major weaknesses in their study design which make it difficult to draw strong conclusions. There are also few studies that compare medicinal cannabis to proven treatments for sleep disorders and insomnia. This makes it hard to make recommendations for treatment based on the current research evidence.

THC can make you drowsy, and in the short term, may help people fall asleep, or feel like they’re getting more sleep. But there are some important downsides to consider, too.

For example, if you take medicinal cannabis regularly to fall asleep your body can get used to it, making it harder to fall asleep without it. In the long term, medicinal cannabis can also affect the amounts of light and deep sleep a person will have, which can result in poorer sleep quality.

There is good evidence for some conditions

Some of the strongest evidence for medicinal cannabis products are for rare forms of epilepsy that don’t respond to existing treatments, and for treating symptoms associated with multiple sclerosis.

The only TGA-approved medicinal cannabis products are for these conditions.

There’s also evidence medicinal cannabis can help with chemotherapy-induced nausea and vomiting. Though as newer medications with fewer side effects are now available, medicinal cannabis products are not considered first-line treatments.

Risks and side effects

Common side effects with THC in the short term include drowsiness, anxiety, dry mouth, nausea, vomiting and appetite changes. For some people, these effects reduce over time.

Some people with preexisting health conditions such as schizophrenia, psychosis or heart conditions may be more prone to experiencing side effects.

An estimated one in four people using medical cannabis meet the criteria for dependence (known as cannabis use disorder). In the longer term, dependence appears more common with medical use, particularly when combined with non-medical use.

If you are suffering with anxiety, sleep problems or chronic pain, and are wondering what treatments might be most effective for you, speak to your regular GP.

Suzanne Nielsen, Professor and Deputy Director, Monash Addiction Research Centre, Monash University and Myfanwy Graham, NHMRC Postgraduate Scholar and Fulbright Alumna in Public Health Policy, Monash University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Recovering from an eating disorder can be long and complex.

Treatment typically focuses on reducing the unhelpful behaviours and thoughts that characterise these disorders. These include extreme dieting, binge eating, purging, negative body image, and – in some (but not all) cases – having a very low body weight.

But when recovery focuses on a clinical checklist of symptoms, such as reaching a healthy weight, it may ignore other important aspects of getting better.

Eating disorders are not just physical. They are complex mental health conditions that severely disrupt people’s relationship with themselves, their bodies and other people. So the psychological aspects of recovery, and the way people feel about it, also plays an important role.

Our new research shows when people’s broader wellbeing improves – such as developing a sense of self-acceptance or hope – they are more likely to report a “personal” recovery from an eating disorder, even if they still have some clinical symptoms.

How is recovery measured?

There is no one definition of eating disorder recovery.

But most research has focused on clinical symptoms. This means an absence of diagnostic criteria (for example, no binge eating or purging) over a specific timeframe, such as a 12-month period, to meet the definition of recovery.

Emerging research points to the importance of “personal recovery” meaning that dimensions of psychological wellbeing are essential.

For example, a 2020 review of studies focusing on perspectives of people with eating disorders showed supportive relationships, hope, identity, meaning and purpose, empowerment, and self-compassion were central to their recovery process.

People with eating disorders also report that including these as goals (rather than just focusing on clinical symptoms) feels relevant and empowering, while emerging research shows this can improve long-term outcomes and improve quality of life, meaning people may be less likely to relapse.

But there still hasn’t been much research on how both personal and clinical aspects can be incorporated into treatment and recovery.

Understanding how to include these aspects in treatment is urgent, given eating disorders are among the most life-threatening psychiatric disorders, and recovery is often slow.

What we did and what we found

Our new study surveyed 234 adults who have lived through or are currently experiencing an eating disorder. Most identified as female (89%), and the average age was 28.

Overall, we found less than a quarter of participants (22.6%) met the criteria for clinical improvement, meaning many were still dieting or preoccupied with food and body image.

But more than half (52.1%) felt they had achieved personal recovery. This included experiencing self-acceptance, positive relationships, personal growth, reduced eating disorder behaviours, resilience and greater autonomy.

Clinical improvement in symptoms did make personal recovery more likely. But nearly two-thirds (63.9%) of those who self-identified as personally recovered did not meet the clinical definition, meaning they still experienced some eating disorder symptoms.

This points to a possible disconnect between definitions of recovery that focus on symptoms and what recovery actually means to the people living it.

We also explored whether personal recovery looked different depending on someone’s eating disorder diagnosis.

All participants had a past or current diagnosis of anorexia nervosa (68.4%), bulimia nervosa (8.5%) or binge eating disorder (8.1%).

But, we found no meaningful differences in personal recovery rates across these diagnoses. This suggests the experience of personal recovery may be broadly similar regardless of the specific eating disorder a person has faced.

Why does this matter?

When treatment success is measured almost entirely through symptom checklists and clinical criteria, we risk missing – and failing to celebrate – the progress that may matter the most to the person in front of us.

We suggest people seeking recovery from an eating disorder should be asked early on about what recovery looks like to them, not just what the clinical guidelines say it should look like. This might also improve the currently low rates of people seeking help for eating disorders. It may help clinicians set goals that are meaningful and better reflect the psychological nature of eating disorders, not just the physical aspects.

If there’s something that feels important to your recovery, it’s worth raising with your treatment team. Recovery can look different for everyone, and your personal goals matter.

For example, wellbeing goals could involve reconnecting with relationships, rebuilding a sense of identity, or simply feeling more in control of daily life, alongside improving clinical symptoms.

This is also significant because funding for eating disorder services and policy decisions still often lean heavily on clinical benchmarks. If these don’t capture aspects of personal recovery, we are likely underestimating how many people are getting better, and potentially designing services around a narrower picture of recovery than the evidence actually supports.

If you have a history of an eating disorder or suspect you may have one, you can contact the Butterfly Foundation’s national helpline on 1800 334 673, or via online chat.

Catherine Houlihan, Senior Lecturer in Clinical Psychology, University of the Sunshine Coast; Andrew Allen, Senior Lecturer in Clinical Psychology, University of the Sunshine Coast; Dan Fassnacht, Associate Professor in Psychology, University of the Sunshine Coast, and Kathina Ali, Senior Lecturer in Clinical Psychology, University of the Sunshine Coast

This article is republished from The Conversation under a Creative Commons license. Read the original article.