Current role of cannabis in therapeutics: A critical perspective.

López Briz E.; Majem Tarruella M.; Pitarch Castellano I.; de Santiago Moraga J.; Smeyers Durá P. · Farmacia hospitalaria : organo oficial de expresion cientifica de la Sociedad Espanola de Farmacia Hospitalaria · 2026

**Background & Methods** This is a critical narrative review of cannabis and cannabinoid therapeutics following regulatory approval in Spain (Royal Decree 903/2025) for standardized compounded formulations. The authors systematically evaluated current evidence across multiple clinical indications to inform therapeutic decision-making in modern clinical practice. **Key Findings** • Cannabis demonstrates modest analgesic efficacy in chronic pain, particularly neuropathic pain, functioning as a third-line option for refractory cases. Its primary mechanism appears to modulate the affective-emotional dimension of pain perception rather than reduce nociceptive signaling directly. • Cannabidiol shows the strongest evidence base in refractory pediatric epilepsy (Dravet syndrome, Lennox-Gastaut syndrome, tuberous sclerosis complex), with the BECOME study demonstrating benefits extending beyond seizure reduction to include improvements in alertness, sleep quality, and family quality of life. • For chemotherapy-induced nausea and vomiting, cannabis is reserved for refractory cases only, with efficacy comparable to conventional antiemetics but a less favorable toxicity profile. Nabiximols for multiple sclerosis spasticity reduce symptom perception but show high discontinuation rates due to inadequate efficacy or adverse effects. **Dosage & Administration** Not reported. The review focuses on standardized compounded formulations approved under Spanish regulation but does not specify particular doses or administration routes. **Safety & Adverse Effects** The review indicates cannabis presents a less favorable toxicity profile compared to conventional antiemetics and contributes to high discontinuation rates in spasticity treatment. Specific adverse effects are not detailed in the abstract provided. **Evidence Quality** This review presents significant limitations inherent to narrative analysis: heterogeneous evidence quality across indications, variable study designs, and lack of systematic methodology. Evidence strength varies considerably—strongest for pediatric epilepsy, modest for chronic pain, comparable to standard therapy for chemotherapy-induced nausea, and weak or inconsistent for fibromyalgia, glaucoma, anorexia, and anxiety. The authors acknowledge the need for real-world use data to provide additional clinical insights. The regulatory context (recent Spanish approval) suggests evolving clinical integration rather than established standard-of-care status for most indications.

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