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  • Writer's pictureDr. Dan Jin

Sex Differences in Medical Cannabis-Related Adverse Effects

Based on the FDA Adverse Event Reporting System, in general, adverse effects (AE) from conventional drugs are more frequent and severe in women than in men. These differences may be due to pharmacokinetic or pharmacodynamic factors, polypharmacy, or differences in reporting patterns. For now, very few studies evaluated sex-dependent AE from medical cannabis treatment. 

Recently, one group of researchers from Israel investigated the differences of medical cannabis-related AEs between women and men in patients with chronic noncancer pain (CNCP). In total 429 patients (64% males) with a diagnosis of CNCP participated and reported fully on the treatment and cannabis cultivar information in the form of self-reported questionnaires. Cannabinoids and terpenoids were identified and quantified in a total of 41 distinct cannabis cultivars consumed by the patients. Comparative statistics were used to evaluate differences between men and women.   

The results showed that although the weight-adjusted doses (gram/kg/month) were similar between men and women (0.48 [0.33-0.6] for men and 0.47 [0.34-0.66] for women), women reported more than men on medical cannabis related AEs. Further analysis revealed that women consumed different cannabis cultivar combinations than men, with significantly higher monthly doses of CBD and CBC and significantly lower monthly doses of the one cannabinoid labelled 373-15c and one terpenoid linalool. The higher rates of reported AEs in women may also be due to physiological differences as reported by several studies that the metabolism of THC is different between male and female rats, and the drug plasma concentrations could also be affected by sex, in addition to dose, administration route, frequency of consumption, drug-drug interaction, age, body weight, etc.  

The study concluded that women are more susceptible to medical cannabis-related AEs, presumably due to both the inherent sex effect and the consumption of different cannabinoids and terpenoids profile in different cannabis cultivars. The understanding of these differences may be crucial for planning medical cannabis treatments with safer cannabinoid and terpenoid profiles and to better inform patients of expected AEs. 


  1. Aviram, J. et al. Sex differences in medical cannabis-related adverse effects. PAIN (2021) doi:10.1097/j.pain.0000000000002463. 

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