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Marijuana Science

Reformers To JAMA: Don’t Generalize All Cannabinoid Data To Medical Cannabis

strawberry satori panacea portland medical marijuana greenwise gardens 2By Allen St. Pierre, NORML Executive Director

We read with interest the recent review of medical use of cannabinoids (1). As the authors attempt to emphasize, they focus on a heterogeneous collection of experiments that employed a range of treatments, including synthetic THC, CBD, and THC-mimicking drugs.

 

Lay readers might inappropriately generalize these results specifically to whole plant medical cannabis  But few (only two) of these experiments were conducted using medical cannabis; most of the studies reviewed focused on outcome measures that do not address the plant’s potential advantages over a single, compound agent in pill form.

For example, the authors conclude that evidence of individual, synthetic cannabinoids to help nausea and vomiting due to chemotherapy was low in quality. Within hours of the publication of the paper, mainstream media coverage applied these conclusions to medical cannabis per se, not just medical cannabinoids (2). In fact, as the authors emphasize, only 6 of the 28 studies assessing nausea and vomiting used THC, and none of these actually employed vaporized or inhaled botanical cannabis. The dependent measures were also not sensitive to the key advantage of medical cannabis for nausea: speed of onset. (Inhaled medicines can work within seconds. Sprayed extracts require at least a half hour while cannabinoids in pill form can take multiple hours.)  The authors were generally careful about these caveats, but the disparate and inaccurate media coverage suggests that flagship journals in all fields now have to be even more diligent when cautioning readers about the inappropriate generalization of results. Despite increasing popularity, medical cannabis remains controversial and, apparently, newsworthy. As reviews of the effects of cannabinoids proliferate, authors, editors, journal staff, and journalists might welcome a reminder that cautions about interpretation need to be spelled out in more effusive, detailed, and thorough ways.

Mitch Earleywine, Ph.D.
University at Albany
Department of Psychology
Chair, NORML Board of Directors

Paul Armentano
National Organization for the Reform of Marijuana Laws (NORML)

Amanda Reiman, Ph.D.
Drug Policy Alliance

1) Whiting PF, Wolff RF, et al. Cannabinoids for Medical Use: A Systematic Review and Meta-analysis. JAMA, 2015: 313(24):2456-2473

2) Seaman, AM. Medical marijuana: good evidence for some diseases, weak for others. Reuters. June 24, 2015. http://www.reuters.com/article/2015/06/23/us-marijuana-medical-evidence-idUSKBN0P31WT20150623

Source: NORML - make a donation

  • PhDScientist

    The guy who put together the JAMA report had an anti-medical-marijuana agenda. The real issue is this. A key part of the use of Marijuana as a medicine is the ability to self-titrate due to its incredibly wide therapeutic index. There’s a lot of “bad science” from the anti-medical-marijuana crowd. Some intentionally. Some unintentionally. The simplest way to get more people the benefits of what’s working for peope who are getting results is to let more patients use Medical Marijuana in exactly the same way those people are.

    • Don’t forget the entourage effect.

  • PhDScientist

    Its taking way too long to make Medical Marijuana safely and legally available to American patients who need it in all 50 states. 82% of Oncologists want to be able to prescribe it for their Cancer patients. Newsweek had a good article titled “Marijuana is a Wonder Drug for the Horrors of Chemo” and it is — ask any Cancer patient that’s used it. For America’s Cancer patients its a Wonder Drug for more than just the horrors of Chemo, it helps then with Cancer’s pain, gives them their appetite back, and does wonders for the depression that goes along with Cancer — and having Cancer is very, very, depressing.

    Americans are sick and tired of the fact that Americas Cancer patients, American kids dying of seizures, American Veterans with PTSD and Americans with chronic pain are being used as “political footballs”

    Medical Marijuana is safe and effective — much more safe than “over the counter” pain relievers such as NSAIDS much, much safer than Tylenol, and infinitely safer than Opiates.

    Its long past time for the federal government to get its act together on this issue.

    Americans, including American Children, are suffering and dying — needlessly.

  • Ambrose Bierce

    The JAMA review also cited “high quality evidence”, from the same “studies”, indicating utility in treating neuropathic & chronic pain. I can attest to the efficacy of Dronabinol in controlling “neuralgia”.

    Have residual neuralgia owing to decortication via surgical thoracotomy. My rheumatologist, who’d upped the Neurontin (gabapentin) dose to the point where the “woozy/off kilter” side effects became the primary effects, decided to try the Marinol (Dronabinol) – synthetic analogue of the primary intoxicant in Cannabis (Delta Nine THC), and FDA/DEA approved med (went on market in 1985) that is currently a Schedule 3 substance – doc can write for 5 refills). Titrated dose up from 2.5mg qid, to 10 mg tid. At the latter dosage not only did the neuralgia become “background noise”, the arthritic “gnawing” in the shoulders and hips nearly vanished (not only did I cut back on the gabapentin – but on the Aspirin and Codeine, as well). Only “psychotropic” effect observed was that colors seemed slightly more saturated, the only side effect is dry mouth – haven’t had any increase in appetite, have been more active and eating less).

    My doc is more concerned about “trouble with the government” owing to his using the Dronabinol “off-label” for the neuralgia, than he is about writing me scripts for Schedule 2 narcotic analgesics (told me as much). As a patient who has had every sort of “latest and greatest” NSAID prescribed, over decades – only to find out by blind “misfortune”, i.e., nasty surgery followed by the perception that chest/abdomen had been “repacked” with frayed wiring and a doc with the guts to try “something different”, that a “nontoxic” medication can control both the neuralgia AND the arthritis? I’m more than P*SSED.

    Even if Cannabis “cures” no disease at all, its use as a nontoxic “palliative”, rather than relying on substances with less forgiving risk profiles, seems to argue for its immediate return to the USP, and into everyone’s garden – yesterday.

    I’d also like to point out that the patient insert that comes with Marinol/Dronabinol doesn’t forbid the patient from driving or operating machinery “under the influence”, it only cautions the patient not to do so until the patient understands & can accommodate for the effects, before doing so. (good enough for the FDA/DEA – how about employers & their drug testing and “roadside sobriety” testing, if one can pass a field sobriety test why “test” for marijuana?). I’ve been tooling around, for several months “under the influence”. That I have a valid script for D9THC is sufficient defense for “non-driving offense “testing”, as well as “positive” test by employer. It’s all about what “entity” controls the “source” of the D9THC.

  • Mooster75

    Welcome to the world of science reporting, Mr. Earleywine and all. There’s no scientific advance that can’t be screwed up by our fearless reporters.

  • Cleanslate

    The so-called “gold standard” of clinical trials and randomized
    double blind studies is not so golden as we have been led to believe.

    The Editors in Chief of Lancet and The New England Journal of Medicine have
    made serious charges about the reliability of such studies. Dr.
    Richard Horton of the Lancet: “The case against science is
    straightforward: much of the scientific literature, perhaps half, may
    simply be untrue. Afflicted by studies with small sample sizes, tiny
    effects, invalid exploratory analyses, and flagrant conflicts of
    interest, together with an obsession for pursuing fashionable trends of
    dubious importance, science has taken a turn towards darkness.”
    http://www.thelancet(dot)com/pdfs/journals/lancet/PIIS0140-6736%2815%2960696-1.pdf

    And

    Dr. Marcia Angell longtime Editor in Chief of the New England Journal
    of Medicine said: “It is simply no longer possible to believe much of
    the clinical research that is published, or to rely on the judgment of
    trusted physicians or authoritative medical guidelines. I take no
    pleasure in this conclusion, which I reached slowly and reluctantly over
    my two decades as an editor of the New England Journal of Medicine”

    On the other hand, cannabis as medicine, has a long empirical track record
    as a safe and beneficial medicine established by millennia of use by
    countless millions of people.

    The reason that 80% plus of Americans now recognize cannabis as a medicine and demand it be legalized for that use is not primarily due to scientific clinical
    studies but from first hand experience of the healing benefits of the
    plant or being witness to that healing power experienced by people they
    know and care about. So when you read these sort of headlines that
    continue to pass doubt and aspersions on the quintessential medicine
    that is cannabis, look carefully into the actual studies that are behind
    those headlines — for the devil is indeed in the details.

  • Sarijuana

    Many thanks to Dr. Earleywine, Dr Reiman and Paul Armentano for this official statement. As soon as I read about this JAMA report, and then saw the pickups in other media outlets, I was dismayed on how it was being perceived by so many unknowing and unsupportive reporters. We can guess that this statement reported here will not make it to “mainstream” anymore than the remarks mentioned in the post below by the Editors of Lancet or The New England Journal of Medicine. How sad is that?

  • D Kessler

    What a Fing joke this so called report is. When will these buttheads get with some real testing. Unfortunately it will end up being the people that have been using this wonderful plant to write the book on it. There are a lot of us out here doing just that and I say the more the merrier. We need people to do the research on there own but document, document, document. Be serious and do it well we all need the info no matter who it comes from. And the BS will get weeded out so to speak.