Cannabis and its derivatives are gaining attention in medical circles, but experts stress that their use must be cautious and evidence-driven. In India, clinicians say that while cannabinoids can help some patients, they are not a cure-all, and wider adoption in healthcare will require more research, regulation, and structured guidance.
While some see the therapeutic potential, many still wrestle with the stigma surrounding cannabis use, often viewing it as a fringe or controversial option. These stigma stems from historical perceptions of cannabis as an illegal and dangerous substance, and it is particularly pervasive in medical settings– leading to barriers in patient care and a reluctance for patients to disclose their use. While attitudes are slowly shifting with growing research, further education for healthcare professionals and transparent communication are crucial for integrating cannabis into mainstream medical practice.
Where cannabis has shown benefit
Cannabinoids have the clearest evidence in certain childhood epilepsies. Purified cannabidiol (CBD) has been shown to reduce seizures in syndromes such as Dravet and Lennox-Gastaut, particularly in children who do not respond to other treatments. “The strongest regulatory approval is for refractory epilepsy syndromes in children, where CBD reduces seizures,” says Vivek Iyer, senior consultant, neurology, SIMS Hospital, Chennai.
Cannabis can also help cancer patients experiencing chemotherapy-related nausea, vomiting, and loss of appetite. Some patients report relief from chronic or neuropathic pain that does not respond to standard medications. “Cannabis, though not a cure, works for some patients,” notes Vijay G., adult and paediatric haematology-oncologist, VS Hospitals, Chennai. He adds that the effect is often patchy and not different patients have different experiences.
Synthetic cannabinoids are also used in some settings. “They are FDA-approved for chemotherapy-induced nausea and vomiting in patients who do not respond to standard therapy,” says Rishab Bharadwaj, consultant, paediatric haematology-oncology, MGM Cancer Institute, Chennai.
Understanding the risks
While cannabinoids can help in certain situations, experts emphasise that the medicines carry risks. Short-term side effects include drowsiness, dizziness, dry mouth, increased appetite, mood changes, and forgetfulness. Some patients report anxiety, palpitations, or feeling “not themselves,” says Dr. Vijay.
Long-term or uncontrolled use can affect memory and concentration, and increase the risk of dependence. THC (delta-9-tetrahydrocannabinol) is the main psychoactive compound in cannabis that causes the “high” feeling, may affect mentally vulnerable individuals, while CBD may affect liver enzymes and interact with other medications, says Dr. Iyer.
Dr. Bharadwaj adds that fluctuations in blood pressure and other mild symptoms are common, depending on the dose and route of administration.
Studies published in The Lancet revealed that there needs to be more research into checking the efficacy of CBD since most of the positive clinical trials have been for childhood-onset, treatment-resistant epilepsy. Indeed, for people with other types of epilepsy, CBD might not be effective.
The report also emphasised that anecdotal evidence and trial results in rare childhood epilepsy disorders will continue spur patients on to try cannabis and its derivatives, and potentially risk exacerbation of their condition or dangerous interaction with their current medication
Prescription v/s recreational products
Experts highlight the key difference between regulated medical cannabis and recreational products available outside of medical use. Prescription medicines such as Epidiolex or Sativex have defined THC or CBD content, standardised dosing, and safety data from clinical trials. “In recreational products, you do not know the strength, what else is mixed in, or whether it is safe,” Dr. Vijay explains.
Recreational products vary widely in potency and may even be contaminated. They carry a higher risk of adverse events, making pharmaceutical-grade preparations the only safe option in clinical practice, the doctors say.
Cannabis is not suitable for everyone. Experts advise against use in pregnant or breastfeeding women, adolescents and young adults whose brains are still developing, people with psychiatric illnesses such as schizophrenia, patients with uncontrolled heart problems, and those with substance-use disorders. Careful patient selection, they say, is essential.
Need for research
The World Health Organization (WHO) notes that cannabinoids have shown therapeutic benefits, especially for treating nausea and vomiting in advanced illnesses like cancer and AIDS. Dronabinol (a form of THC) has been prescribed in the U.S. for over a decade. Research also suggests potential uses in treating asthma, glaucoma, depression, seizures, muscle spasms, and for boosting appetite.
Clinicians stress that more research is needed in India. “We need our own studies, not just western data,” says Dr. Vijay. Population genetics, lifestyle factors, co-morbidities, and local medical practice can all influence how effective or safe cannabis is in Indian patients.
Dr. Bharadwaj emphasises the role of government policy in standardising manufacture, distribution, and prescription to prevent misuse. Dr. Iyer adds that long-term studies on cognition, mental health, heart health, and metabolism are needed to fully understand the benefits and risks.
Physician training is also a priority. Many doctors are not confident in prescribing or monitoring cannabis. Structured guidelines and clinical protocols will be needed to ensure patients receive safe, evidence-based care. With careful research and policy support, India could integrate these medicines safely, but their use must always remain guided by evidence and clinical judgment.
