Mayo Clinic Proceedings Home
MCP Digital Health Home
Perspectives and controversies| Volume 93, ISSUE 6, P689-692, June 2018

Medical Cannabis for Obstructive Sleep Apnea: Premature and Potentially Harmful

      In the United States, currently 29 states and the District of Columbia have enacted laws that allow for the medical use of cannabis. The list of conditions that qualify a patient for the use of medical cannabis varies from state to state. Recently, the medical cannabis citizens' review panel at the Minnesota Department of Health (MDH) added obstructive sleep apnea (OSA) to the list of qualifying conditions for medical cannabis, making Minnesota the first state to approve the use of cannabis for OSA. This decision followed a petition that rightly identified OSA as a public health concern associated with sleepiness and substantial cardiovascular consequences.
      • Minnesota Department of Health
      Minnesota Medical Cannabis Program petition to add a medically qualifying condition.
      The petition referenced continuous positive airway pressure (CPAP) as the primary treatment option for OSA and proceeded to list alternative therapeutic modalities including medications, acupuncture, upper airway stimulation, and surgeries. The “brief of support” issued by the MDH in November 2017 allows patients certified as having OSA to enroll in the medical cannabis program from July 1, 2018, and obtain medical cannabis beginning August 1, 2018.

      Abbreviations and Acronyms:

      AASM (American Academy of Sleep Medicine), AHI (apnea-hypopnea index), CPAP (continuous positive airway pressure), DEA (Drug Enforcement Agency), FDA (Food and Drug Administration), MDH (Minnesota Department of Health), OSA (obstructive sleep apnea), THC (tetrahydrocannabinol)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Mayo Clinic Proceedings
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Minnesota Department of Health
        Minnesota Medical Cannabis Program petition to add a medically qualifying condition.
        • Calik M.W.
        • Radulovacki M.
        • Carley D.W.
        Intranodose ganglion injections of dronabinol attenuate serotonin-induced apnea in Sprague-Dawley rat.
        Respir Physiol Neurobiol. 2014; 190: 20-24
        • Calik M.W.
        • Carley D.W.
        Effects of cannabinoid agonists and antagonists on sleep and breathing in Sprague-Dawley rats.
        Sleep. 2017; 40
        • Prasad B.
        • Radulovacki M.G.
        • Carley D.W.
        Proof of concept trial of dronabinol in obstructive sleep apnea.
        Front Psychiatry. 2013; 4: 1
        • Carley D.W.
        • Prasad B.
        • Reid K.J.
        • et al.
        Pharmacotherapy of apnea by cannabimimetic enhancement, the PACE clinical trial: effects of dronabinol in obstructive sleep apnea.
        Sleep. 2018; 41
        • Epstein L.J.
        • Kristo D.
        • Strollo Jr., P.J.
        • et al.
        Adult Obstructive Sleep Apnea Task Force of the American Academy of Sleep Medicine. Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults.
        J Clin Sleep Med. 2009; 5: 263-276
      1. Ramar K, Rosen IM, Kirsch DB, et al; American Academy of Sleep Medicine Board of Directors. Medical cannabis and the treatment of obstructive sleep apnea: an American Academy of Sleep Medicine position statement [published online ahead of print March 30, 2018]. J Clin Sleep Med.

        • Nicholson A.N.
        • Turner C.
        • Stone B.M.
        • Robson P.J.
        Effect of delta-9-tetrahydrocannabinol and cannabidiol on nocturnal sleep and early-morning behavior in young adults.
        J Clin Psychopharmacol. 2004; 24: 305-313
      2. Marinol (dronabinol) capsules.
        • Li M.C.
        • Brady J.E.
        • DiMaggio C.J.
        • Lusardi A.R.
        • Tzong K.Y.
        • Li G.
        Marijuana use and motor vehicle crashes.
        Epidemiol Rev. 2012; 34: 65-72
        • Bosker W.M.
        • Kuypers K.P.
        • Theunissen E.L.
        • et al.
        Medicinal delta(9)-tetrahydrocannabinol (dronabinol) impairs on-the-road driving performance of occasional and heavy cannabis users but is not detected in Standard Field Sobriety Tests.
        Addiction. 2012; 107: 1837-1844
        • Badowski M.E.
        • Perez S.E.
        Clinical utility of dronabinol in the treatment of weight loss associated with HIV and AIDS.
        HIV/AIDS (Auckl). 2016; 8: 37-45
        • Guyatt G.H.
        • Oxman A.D.
        • Vist G.E.
        • et al.
        • GRADEWorking Group
        GRADE: an emerging consensus on rating quality of evidence and strength of recommendations.
        BMJ. 2008; 336: 924-926

      Linked Article

      • Comment on Medical Cannabis for Obstructive Sleep Apnea: Premature and Potentially Harmful
        Mayo Clinic ProceedingsVol. 93Issue 11
        • Preview
          We recently read with interest “Medical cannabis for obstructive sleep apnea: premature and potentially harmful” by Kolla et al1 competently summarizing the current evidence for the recent approval of obstructive sleep apnea as a certifying condition for the use of medical cannabis in the state of Minnesota. We share the authors’ doubt to the scientific validity of this recent action. It would be helpful for the readers of Mayo Clinic Proceedings to know additional background relating to the evolving medical and legislative landscape of medical cannabis.
        • Full-Text
        • PDF