Medical Assessment of Cannabis Efficacy and Side-effects Scale (MACESS©): a simple evidence-based scale to determine clinical benefits and adverse events following medical cannabis use


  • Peter H. Silverstone



Marijuana, Medical Cannabis, Safety, Clinical Study, Rating Scale


Medical cannabis has been proposed to benefit patients in a wide range of conditions, including chronic pain, psychological conditions including anxiety, and sleep issues. It is available via prescription in multiple countries, and in Canada it is available legally in both stores and on-line. The range of methods by which it can be consumed are large including (1) inhalation via smoking or using vapourizers, (2) swallowed as an oil or within a food or liquid, or (3) absorbed through the skin including as a patch.  As the range of products increases, a major problem is that there is no standardized scale to determine changes, both positive and negative, induced by medical cannabis products. This also means that there is no method to compare products, and the Medical Assessment of Cannabis Efficacy and Side-effects Scale (MACESS©) is specifically designed to address this issue. Following a comprehensive medical literature search and review, the most relevant clinical benefits and adverse events following the use of cannabis for medical purposes were determined. Following this key items were identified, with the scale being designed to measure these. The scale consists of 25 questions with each question being scored from 0 – 4, giving a range of total potential scores between 0 – 100. With the MACESS©a high score indicate a well tolerated and effective product, while a low scores indicates significant side-effects or adverse events and/or lack of positive clinical changes. It is available online and can be used for research, to measure change following prospective use in individuals or groups, and for cross-sectional information. It is intended to support both individual users and researchers examining benefits and problems with specific medical products, and can provide an easily understood single number for overall product comparisons. 


Abuhasira R, Shbiro L, Landschaft Y. Medical use of cannabis and cannabinoids containing products - Regulations in Europe and North America. Eur J Intern Med. 2018 Mar;49:2-6.

Abrams DI. The therapeutic effects of Cannabis and cannabinoids: An update from the National Academies of Sciences, Engineering and Medicine report. Eur J Intern Med. 2018 Mar;49:7-11.

Allan GM, Finley CR, Ton J, Perry D, Ramji J, Crawford K, Lindblad AJ, Korownyk C, Kolber MR. Systematic review of systematic reviews for medical cannabinoids: Pain, nausea and vomiting, spasticity, and harms. Can Fam Physician. 2018 Feb;64(2):e78-e94.

Andrade C. Cannabis and neuropsychiatry, 1: benefits and risks. J Clin Psychiatry. 2016 May;77(5):e551-4.

Bergamaschi MM, Queiroz RH, Zuardi AW, Crippa JA. Safety and side effects of cannabidiol, a Cannabis sativa constituent. Curr Drug Saf. 2011 Sep 1;6(4):237-49.

Bondallaz P, Favrat B, Chtioui H, Fornari E et al. Cannabis and its effects on driving skills. Forensic Sci Int. 2016 Nov;268:92-102.

Caulkins JP, Bao Y, Davenport S, Fahli I, Guo Y, Kinnard K, Najewicz M, Renaud L, Kilmer B. Big data on a big new market: Insights from Washington State's legal cannabis market. Int J Drug Policy. 2018 Jul;57:86-94.

Capler R, Walsh Z, Crosby K, Belle-Isle L, et al. Are dispensaries indispensable? Patient experiences of access to cannabis from medical cannabis dispensaries in Canada. Int J Drug Policy. 2017 Sep;47:1-8.

Cohen K, Weinstein A. The Effects of Cannabinoids on Executive Functions: Evidence from Cannabis and Synthetic Cannabinoids-A Systematic Review. Brain Sci. 2018 Feb 27;8(3). pii: E40.

D'Souza DC, Radhakrishnan R, Sherif M, Cortes-Briones J, et al. Cannabinoids and Psychosis. Curr Pharm Des. 2016;22(42):6380-6391.

Edwards P. Questionnaires in clinical trials: guidelines for optimal design and administration. Trials. 2010;11:2.

Galgatte UC, Jamdae VR, Aute PP, Chaudhair PD. Study on requirements of bioequivalence for registration of pharmaceutical products in USA, Europe, and Canada. Saudi Pharm J. 2014 Nov;22(5):391-402 Grof CPL. Cannabis, from plant to pill. Br J Clin Pharmacol. 2018 Apr 27.

Gauthier S, Reisberg B, Zaudig M, Petersen RC, Ritchie K, et al. Mild Cognitive Impairment. Lancet. 2006; Apr;3679518;1262-1270

Hall W, Degenhardt L. The adverse health effects of chronic cannabis use. Drug Test Anal. 2014 Jan-Feb;6(1-2):39-45.

Iffland K, Grotenhermen F. An Update on Safety and Side Effects of Cannabidiol: A Review of Clinical Data and Relevant Animal Studies. Cannabis Cannabinoid Res. 2017 Jun 1;2(1):139-154.

Ivy SP, Siu LL, Garrett-Mayer E, Rubinstein L, Approaches to Phase 1 Clinical Trial Design Focused on Safety, Efficiency, and Selected Patient Populations: A Report from the Clinical Trial Design Task Force of the National Cancer Institute Investigational Drug Steering Committee Clin Cancer Res. 2010 Mar 15;16(6):1726-36.

Jikomes N, Zoorob M. The Cannabinoid Content of Legal Cannabis in Washington State Varies Systematically Across Testing Facilities and Popular Consumer Products. Sci Rep. 2018 Mar 14;8(1):4519.

Kelly BF, Nappe TM. Toxicity, Cannabinoids. StatPearls Publishing; Treasure Island (FL): 2018.

Ko GD, Bober SL, Mindra S, Moreau JM. Medical cannabis - the Canadian perspective. J Pain Res. 2016 Sep 30;9:735-744.

Lim K, See YM, Lee J. A Systematic Review of the Effectiveness of Medical Cannabis for Psychiatric, Movement and Neurodegenerative Disorders. Clin Psychopharmacol Neurosci. 2017 Nov 30;15(4):301-312.

MacCallum CA, Russo EB. Practical considerations in medical cannabis administration and dosing. Eur J Intern Med. 2018 Mar;49:12-19.

Mahvan TD, Hilaire ML, Mann A, Brown A, et al. Marijuana Use in the Elderly: Implications and Considerations. Consult Pharm. 2017 Jun 1;32(6):341-351.

Miller RJ, Miller RE. Is cannabis an effective treatment for joint pain? Clin Exp Rheumatol. 2017 Sep-Oct;35 Suppl 107(5):59-67.

Minto C, Vriz GB, Martinato M, Gregori D. Electronic questionnaires design and implementation. Open Nurs J. 2017; 11: 157–202.

Mücke M, Phillips T, Radbruch L, Petzke F, Häuser W. Cannabis-based medicines for chronic neuropathic pain in adults. Cochrane Database Syst Rev. 2018 Mar 7;3:CD012182.

Murray RM, Englund A, Abi-Dargham A, Lewis DA, Di Forti M, Davies C, Sherif M, McGuire P, D'Souza DC. Cannabis-associated psychosis: Neural substrate and clinical impact. Neuropharmacology. 2017 Sep 15;124:89-104.

Pacher P, Steffens S, Haskó G, Schindler TH, Kunos G. Cardiovascular effects of marijuana and synthetic cannabinoids: the good, the bad, and the ugly. Nat Rev Cardiol. 2018 Mar;15(3):151-166.

Park JY, Wu LT. Prevalence, reasons, perceived effects, and correlates of medical marijuana use: A review. Drug Alcohol Depend. 2017 Aug 1;177:1-13.

Perucca E. Cannabinoids in the Treatment of Epilepsy: Hard Evidence at Last? J Epilepsy Res. 2017 Dec 31;7(2):61-76.

Rohleder C, Müller JK, Lange B, Leweke FM. Cannabidiol as a Potential New Type of an Antipsychotic. A Critical Review of the Evidence. Front Pharmacol. 2016 Nov 8;7:422. eCollection 2016.

Romero-Sandoval EA, Kolano AL, Alvarado-Vázquez PA. Cannabis and Cannabinoids for Chronic Pain. Curr Rheumatol Rep. 2017 Oct 5;19(11):67.

Rong C, Carmona NE, Lee YL, Ragguett RM, Pan Z, Rosenblat JD, Subramaniapillai M, Shekotikhina M, Almatham F, Alageel A, Mansur R, Ho RC, McIntyre RS. Drug-drug interactions as a result of co-administering Δ9-THC and CBD with other psychotropic agents. Expert Opin Drug Saf. 2018 Jan;17(1):51-54.

Russell C, Rueda S, Room R, Tyndall M, et al. Routes of administration for cannabis use - basic prevalence and related health outcomes: A scoping review and synthesis. Int J Drug Policy. 2018 Feb;52:87-96.

Russo EB. Current Therapeutic Cannabis Controversies and Clinical Trial Design Issues. Front Pharmacol. 2016 Sep 14;7:309.

Sanford AM. Mild Cognitive Impairment. Clinics in Geriatric Med. 2017 Aug;33(3);325-337.

Schachtsiek J, Warzecha H, Kayser O, Stehle F. Current Perspectives on Biotechnological Cannabinoid Production in Plants. Planta Med. 2018 Mar;84(4):214-220.

Shram MJ. Differences in the in vitro and in vivo pharmacokinetic profiles of once-daily modified-release methylphenidate formulations in Canada: examination of current bioequivalence criteria. Clinical Therapeutics. 2012, 34 (5), 1170–1181.

Silverstone PH. Concise assessment for depression (CAD): a brief screening approach to depression in the medically ill. J Psychosom Res. 1996 Aug;41(2):161-70.

Solowij N, Broyd SJ, Beale C, Prick JA et al. Therapeutic Effects of Prolonged Cannabidiol Treatment on Psychological Symptoms and Cognitive Function in Regular Cannabis Users: A Pragmatic Open-Label Clinical Trial. Cannabis Cannabinoid Res. 2018 Mar 1;3(1):21-34.

Turna J, Patterson B, Van Ameringen M. Is cannabis treatment for anxiety, mood, and related disorders ready for prime time? Depress Anxiety. 2017 Nov;34(11):1006-1017..

Wakim PG, Rosa C, Kothari P, Michel ME. Relation of study design to recruitment and retention in CTN trials. Am J Drug Alcohol Abuse. 2011 Sep;37(5):426-33.

Walsh Z, Gonzalez R, Crosby K, S Thiessen M et al. Medical cannabis and mental health: A guided systematic review. Clin Psychol Rev. 2017 Feb;51:15-29.

Whiting PF, Wolff RF, Deshpande S, Di Nisio M, Duffy S, Hernandez AV, Keurentjes JC, Lang S, Misso K, Ryder S, Schmidlkofer S, Westwood M, Kleijnen J. Cannabinoids for Medical Use: A Systematic Review and Meta-analysis. JAMA. 2015 Jun 23-30;313(24):2456-73.

Wilsey B, Marcotte TD, Deutsch R, Gouaux B, Sakai S, Donaghe H. Low dose vaporized cannabis significantly improves neuropathic pain. J Pain. 2013 Feb; 14(2): 136-148.

Zou S, Kumar U. Cannabinoid Receptors and the Endocannabinoid System: Signaling and Function in the Central Nervous System. Int J Mol Sci. 2018 Mar 13;19(3). pii: E833.




How to Cite

Silverstone, P. H. (2018). Medical Assessment of Cannabis Efficacy and Side-effects Scale (MACESS©): a simple evidence-based scale to determine clinical benefits and adverse events following medical cannabis use. Advances in Social Sciences Research Journal, 5(12).