Medical Marijuana

Two Reviews Find Substantial Evidence That Marijuana Relieves Pain, Nausea, and Spasticity

The authors say the evidence supporting most other applications is weak.

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Jacob Sullum

The current issue of The Journal of the American Medical Association includes two articles that review studies of marijuana's medical utility and come to similar conclusions about the applications that are best supported by the existing evidence: treatment of chronic pain, neuropathic pain, and spasticity. There is also substantial evidence that THC, marijuana's main active ingredient, is effective at relieving nausea and restoring appetite.

In a review commissioned by the Swiss Federal Office of Public Health, Penny Whiting, a senior research fellow at the University of Bristol, and her co-authors consider 79 randomized clinical trials of cannabinoids involving about 6,500 subjects. Only two of the studies assessed marijuana itself; the others involved marijuana-based medications such as Marinol (synthetic THC in capsules) and Sativex (an oral spray containing cannabis extract). Per the Swiss government's instructions, Whiting et al. looked for evidence of cannabinoids' effectiveness in treating nausea and vomiting due to chemotherapy, loss of appetite associated with HIV/AIDS, chronic pain, spasticity due to multiple sclerosis or paraplegia, depression, anxiety disorder, sleep disorder, psychosis, glaucoma, and Tourette syndrome.

"There was moderate-quality evidence to support the use of cannabinoids for the treatment of chronic pain and spasticity," the researchers conclude. "There was low-quality evidence suggesting that cannabinoids were associated with improvements in nausea and vomiting due to chemotherapy, weight gain in HIV, sleep disorders, and Tourette syndrome." Where evidence was deemed inadequate, the main issues were a lack of statistical significance and possible sample bias due to subjects who dropped out of the studies before they were completed.

Whiting et al.'s conclusions regarding nausea, vomiting, and appetite loss are rather surprising, since the Food and Drug Administration (FDA) deemed the evidence strong enough to approve synthetic THC as a treatment for these symptoms. In fact, the author of the other medical marijuana review in this issue of JAMA, Kevin Hill, a psychiatrist who runs the Substance Abuse Consultation Service at McLean Hospital, does not include studies of these applications, apparently viewing them as well established in light of FDA approval. Based on 28 randomized clinical trials of cannabinoids and applying somewhat different criteria than Whiting et al., Hill concludes that "use of marijuana for chronic pain, neuropathic pain, and spasticity due to multiple sclerosis is supported by high-quality evidence."

Hill seems to agree with Whiting et al. that the evidence supporting marijuana as a treatment for glaucoma, anxiety, depression, sleep disorders, and Tourette syndrome is markedly weaker. In addition to those, qualifying conditions listed by various state medical marijuana laws include epilepsy, hepatitis C, lupus, fibromyalgia, Crohn's disease, Alzheimer's disease, Parkinson's disease, Huntington's disease, amyotrophic lateral sclerosis, and post-traumatic stress disorder. Some laws allow the use of marijuana to treat additional conditions beyond those listed, either based on a determination by state health officials or at the discretion of doctors who write recommendations.

In an editorial accompanying the JAMA review articles, Yale psychiatrists Deepak Cyril D'Souza and Mohini Ranganathan express dismay at the proliferation of conditions that cannabis supposedly can be used to treat. "There is some evidence to support the use of marijuana for nausea and vomiting related to chemotherapy, specific pain syndromes, and spasticity from multiple sclerosis," they write. "However, for most other indications that qualify by state law for use of medical marijuana, such as hepatitis C, Crohn disease, Parkinson disease, or Tourette syndrome, the evidence supporting its use is of poor quality." They argue that the conditions recognized by state laws are determined by politics rather than science and that marijuana-based medicines should be subject to the same FDA approval process as any other pharmaceutical, which requires double-blind, randomized clinical trials.

"If the states' initiative to legalize medical marijuana is merely a veiled step toward allowing access to recreational marijuana," D'Souza and Ranganathan say, "then the medical community should be left out of the process, and instead marijuana should be decriminalized. Conversely, if the goal is to make marijuana available for medical purposes, then it is unclear why the approval process should be different from that used for other medications."

There are various possible rejoinders to this argument, based on marijuana's remarkable safety compared to most pharmaceuticals, the long history of its use as a medicine, and the federal government's obstruction of research aimed at verifying the plant's therapeutic potential (which the Obama administration is only now beginning to address). But D'Souza and Ranganathan have a point: Medical marijuana advocates are asking for special treatment of cannabis, something that offends the technocratic sensibilities of organized medicine. Then again, all they are seeking is the right to treat themselves with a plant they find useful, regardless of whether rigorous research has confirmed what they believe they have learned from their own experience. That is a basic human right, although exercising it may entail a lot of trial and error, not to mention unscientific conclusions. There is nothing wrong with pointing out the latter, as long you don't insist on using force to prevent people from acting on them.

NEXT: Jacob Sullum on Magical Thinking After the Charleston Massacre

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  1. This is why I have always wanted to try marijuana – because I am spastic as fuck.

    1. Guys these jokes are not helpful, we need to get cannabis legalized. The Cheech and Chong crap needs to die along with the prohibition.

  2. There is also substantial evidence that THC, marijuana’s main active ingredient, is effective at relieving nausea and restoring appetite.

    Given that the thing most commonly associated with Marijuana use by both sides is ‘the munchies’ I’d hope there would be some basis in fact for such a universally recognized side effect.

      1. Maybe lay off the bong.

        1. I’m not a stoner!

          If I were going to ruin my life, I’d be more likely to choose amphetamines, as their primary effects counter what I hate most about being me.

          (At current the strongest drug in my system is caffiene, but that’s because I’m never without any in my system)

          1. …amphetamines, as their primary effects counter what I hate most about being me

            Fat?

            1. I’ve admitted to it before.

          2. Motionless?

            1. That was my guess also.

    1. So they didn’t study marijuana, they studied single compounds like marinol which would have been proven worthless in treating Charlotte’s seizures. Then they claim to find no evidence cannabis causes the munchies. Considering the source of the studies, I think they make a strong case for medicinal value.

  3. This article gave me a headache, made me want to throw up, and I started shaking like a leaf.

    AND I HAVE NO POT.

    THANKS FOR NOTHING, REASON

  4. all they are seeking is the right to treat themselves with a plant they find useful, regardless of whether rigorous research has confirmed what they believe they have learned from their own experience. That is a basic human right

    *** snorts ***

    Next, you’ll be claiming it’s a “basic human right” to drink one’s own urine.

    1. *puts down warm mug of urine*

      Wait wut!

      1. warm mug of urine

        Nice band name.

        At least for the fraternity Sippa Kuppa Kum.

      2. Where’s that guy that loves Ke$ha?

      3. Laughed so hard it caused spasms of pain.

  5. If that’s the same story I heard about on NPR this morning, this article has a totally different interpretation. The NPR story said all evidence was anecdotal, and that marijuana had no business being used as medicine.

    1. The NPR story said all evidence was anecdotal, and that marijuana had no business being used as medicine.

      Unlike acupuncture, yoga, color therapy, and psychoanalysis.

    2. NPR said what has business being a medicine? They must be quite smart and knowledgeable !

      But then all political liberal organizations consider themselves all-knowing.

    3. National Socialist Radio said THAT over the Public Brainwashing System? Surely you jest!

  6. There has NEVER been a good reason for pot to be a Schedule I drug.

    Ask a doctor about alcohol poisonings that they’ve seen. You’ll get some chilling stories.

    Then, ask about the marijuana overdoses they’ve seen. You’ll have a chance to listen to the crickets…

    1. “There was this one time this guy wandered into the ER stoned out of his mind. He had a fevered discussion with the fake ficus in the corner, then curled up on the waiting room chair like a big cat and snored through the night.”

      1. Actually, that sounds like he had the dose just about right.

        “Nurse! Get this man three chocolate chip cookies, a Gatorade, and a warm blanket! STAT!”

    2. In hospital detoxes its almost a universal rule to avoid loud noises, which can cause seizures in the patients withdrawing from alcohol dependence.

  7. I wish MD Gov. Larry Hogan great success in his cancer treatment. In particular I hope he endures puking his guts out every morning like an upstanding person, and doesn’t ever get tempted to use the devil weed, whose use for medical purposes he so vigilantly opposes in his rhetoric.

    1. Indeed. The devil weed is also a gateway drug to the use of pain-relieving opioids. Wouldn’t want a junkie governor.

  8. Dose MJ curb the urgeto use a wood chipper?

    1. Only blood sates that urge.

      1. True. I completely understand this. I go through the same thing every day. My cats just won’t leave. Me alone with their constant chatter until I bring home another Backpage whore and sacrifice her through exsanguination. This finally pleases them and I can go back to my crackpot libertarian online rantings.

  9. I wish I could use some MJ for my chronic pain issues… but any drug use, even with a medical marijuana card here in Michigan – will get me automatically fired from my job if I show positive on one of their random sweep drug tests.

    And case law – so far – supports the company on this.

    1. *”illegal” drug use

    2. Federal laws still manage to screw people here in Colorado regarding medical marijuana. My wife suffers from 3 life threatening diseases whose treatment requires 9 specialists and a GP, over 60 prescribed medications, 24/7 supplemental O2, a feeding tube and full time RN care (my job.) The pain specialist who prescribes her narcotics is only able to practice with the blessing of NIDA and the DEA. This translates into a 7 page, legally binding contract with the patient which bars them from using “recreational” drugs and requires their submission to random drug testing. A failed test means no more pain killers. Her doc would like to prescribe weed, which not only has promise to aid in her other conditions, but can help offset narcotic side effects which worsen her gastric motility and nausea. He is barred from prescribing weed and narcotics together except in cases of HIV or chemo therapy.

      1. I feel for you, my friend. A great injustice has befallen you and your wife. Stay strong — freedom might yet win the day; I hope for your sake, more-so then mine, that it does.

  10. There was moderate-quality evidence to support the use of cannabinoids for the treatment of chronic pain and spasticity JAMA

    the science is overwhelmingly clear that marijuana use is harmful to human health Bill Bennett

    Hey Bill, take a few of your favorite poker chips, your alcohol-induced cauliflower nose and a wood chipper and go out behind your house and do the world a favor you disgusting pig.

  11. This means I have to stop calling Epi a spazz. I has a sad.

    OK, off to drill his mom again. Later, peeps.

  12. That is all nice but the basic human right should be the right to catch a buzz by smoking pot in the privacy of one’s home.

    1. Liberty ought be considered the freedom to act in accordance with will and intention to not bring harm upon others. That’s what it should be, I’m not sure that’s what it is anymore (ever?), conventionally.

      1. This is why the. Progtards want health care in the public domain. So they can claim a vested interest in your health. So as to justify unlimited control of your life. From the same people that unlimited institutional infanticide a right.

  13. I’ve been fascinated by the pain relief. On the one hand, it kills some pain I have. But marijuana’s exaggerating effect *sometimes* amplifies it or a different pain.

    1. Totally agree, as a person with strong anecdotal experience with the green leaf, my experience has always been that it enhances sharp physical pain, e.g., cramps, banging the ole funny bone, that moment when the metal bat one is using to ‘Office Space’ a shit computer rebounds off the case into a weak kneecap, etc. Though to be fair sharp physical pains have a way of pervasively dominating consciousness in the agonized moments — so I don’t mean to claim herb increases pain rather then dulling it. Perhaps with certain types of chronic pain it does offer relief. When I’m actually sick and ill it always puts me in a better state no matter the symptoms.

  14. Calling into question the government’s lies about marijuana may be harmful to your health, however.

  15. There is substantial evidence that cannibdiols can relieve siezures. Moreover there is no evidence whatsoever , over the course of its use by humans for thousands of years , that marijuana or marijuana derivatives are toxic. Thus marijuana and marijuana derivatives should be classified as a generally regarded as safe herbal products and people should be able to see if helps them for a variety of ailments. Of course that would only be the case if the USA were a free country and its citizens able to act in their own interests without begging the permission of bureaucrats who could care less as to their well being.

  16. If they didn’t include high CBD cannabis the study is junk.

  17. I’m encouraged to see studies validating cannabis as a treatment for various medical conditions. However, we must understand that its likely the most promising cannabinoids present in cannabis are in such low concentrations in the flower that their effectiveness has yet to be explored due to what are now eroding regulations.

    We can extract the essential oils of the plant, but we only get the same ratios of cannabinoids out that we started with. We have had success breeding strains to be higher in CBD which is great because it has a ton of medicinal value. We need to the same for CBG, CBC, THCV as each compound has unique properties that can target a whole plethora of conditions; many of which have no viable treatments. And there are likely at least 60 other cannabinoids in trace amounts that we have not even properly identified!

    Then, there are the terpenes which are clearly acting in unison with the cannabinoids to affect the outcome of the medicine with their own established medicinal and therapeutic properties.

    When we talk about marijuana / cannabis in the medicinal realm, we already have the appropriate technology and know how to move beyond smoking flower and talk about oral and topical administration. We should really stop talking about smoking flower as a means of administration medically or at least talk about it after the more common sense forms.

    The science is finally starting to evolve! Now let’s keep the conversation evolving as the science does too!

  18. Of course Jacob is right, but since when is the law based on what is true and correct? For millennia hemp products treated not just corns but many other symptoms in competition with the addictive and highly poisonous opium and morphine. Barbiturates were developed to replace opium but preserved its noxious qualities. Finally, Big Pharma and Big Alcohol lobbyists waxing fat with new powers and income after the excesses of prohibitionism were reduced slightly, came up with another mild sedative and hypnotic drug Distaval at about the time JAMA spokesmen screamed for a ban on LSD, then a treatment for alcoholism. Distaval was experimentally exported to poorer countries under the brand name Thalidomide. If its victims only understood, they would file a class action suit against the exporters of superstitious prohibitionist legislation claiming damages for the horrible deformities visited upon them by government-backed corporations and their laws.

  19. My issue is simply freedom. I am an adult in a supposedly free country. The government has no right to tell me what I can or can’t do with my own body. Especially when the government chooses what drugs are illegal based on profit and little else. They have consistently lied about the harm these ‘illegal’ drugs cause. Especially regarding cannabis. They demonized cannabis and hemp solely due to profit even having to use the Mexican slang term ‘Marihuana’ when passing the ‘Marihuana Tax Act’ of 1937 to fly under the radar of physicians who had been prescribing cannabis for almost 100 years prior to the MTA. Why else would hemp be illegal too if not for profit. Hemp can replace plastic, fuel, paper, cloth, many chemicals and over 50000 other items yet it’s still illegal to grow in most states and countries. They say cannabis is as ‘dangerous’ as heroin and has no medical use yet morphine is basically heroin without the adulterants. One is no more addictive than the other but if none are illegal it’s hard to have a ‘War on Drugs’. Wake up people. The so called ‘War on Drugs is about racism, control of the people and empire building. Just follow the money…

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