and CBD to Δ9-THC alone, compared to placebo [15].
Both symptom score and distress thermometer showed
direction of improvement in all subgroups. The strongest
interaction was found to be with depression or anxiety level
at the first interview. The large improvement in physical
symptoms can be partially related to the cannabis-induced
euphoria, but, from a medical point of view, the general
improvement in the level of distress is important as an
end-point for palliative studies [16], and the cause is less
important. A slight reduction in the need for opioids and
antidepressant drugs was seen in the study group. In a study
that followed the trends of legal medicinal cannabis users in
TheNetherlands, the level ofmorphine usewas lowbut stable.
Theuse of nonopioid analgesics and antidepressants was very
fluctuating during the survey period