Marijuana: A Medical Update
A Study Looking at Efficacy to Side Effects
When I suggested writing about this topic, I was primarily wanting it to coincide with marijuana’s new legal status in Oregon, but another bounty has appeared! Just this week marijuana made the medical news in a systematic review and meta-analyses of cannabinoids for medical use, in the prestigious Journal of the American Medical Association (JAMA, for short, and IMHO, about the only good thing to be associated with the AMA.) Meaning that these researchers looked for every good bit of medical research they could find on the topic and synthesized the information into one report. Good timing, surely, but what about the information itself?
The researchers reviewed 79 trials involving over 6000 participants, studying the efficacy of medical cannabis for nausea and vomiting from chemotherapy, appetite stimulation in AIDS patients, chronic pain, spasticity due to multiple sclerosis or nerve injury, depression, anxiety, insomnia, psychosis, glaucoma or Tourette’s syndrome.
Cannabis is one of the most popular recreational drugs around the world, with an estimated 178 million people aged 15 to 64 years indulging at least once in the year 2012. Actually that number is lower than I would have thought: going to college at UC Berkeley in the 1960s I would have thought more. Ah, look at that age spread: all those folks at college with me are now older than 64! And they’re not talking. Either way, lots of folks use the drug recreationally, what about medically?
Medical cannabis was approved by Oregon voters in 1998 and there are now (more so since we voted to legalize non-medical use of marijuana) dispensaries where one can show your medical card and purchase marijuana in the form of leaf, tea, tincture or edibles. Medical use is growing both in the US and around the world —what’s the evidence for it?
Overall the studies in the meta-analysis were not found to be of the highest quality, lacking adequate data collection or guilty of some bias evident to the reviewers. Although most studies suggested that cannabinoids (the active ingredient in marijuana, either intoxicating THC or not-intoxicating CBD) were associated with improvement in symptoms, the degree of benefit was not deemed sufficient to be conclusive. The analysis of the data did not reach what we like to see: statistical significance, which gives us confidence that the results weren’t just due to chance. The best evidence seemed to be for chronic pain and spasticity, with less satisfying evidence for nausea and vomiting, appetite stimulation (what were those brownies all about in 1967 anyway?), sleep disorders, or Tourette’s. Even less satisfying was any benefit for anxiety or depression. There were, unfortunately, some adverse events, none of them surprising: balance problems, confusion, dizziness, fatigue, hallucination and more, all of them thankfully transient.
So bottom line, nothing is proven that would indicate general or widespread medical usefulness of cannabis, leaving us with anecdotal evidence. Know anyone with relief of symptoms from cannabis in some form? I do. Relief of neurological symptoms, pain, and sleeplessness have been reported to me with sufficiently compelling heartiness to encourage me to try it myself, with no effect other than some troubling dreams. So it’s not for me, but perhaps it’s right for you?
Which brings me to what I consider an absolutely important point: anecdotal evidence counts. In medicine, we call that an N of 1 (one subject) study, a type of study gaining in general respect. Whenever I dispense medical advice, I await the patient’s response, no matter what the evidence says. If my fave Paleo Diet makes you feel awful, it’s not for you! If marijuana puts you to sleep like a baby, how great for you! If antibiotics make you feel like—well, you know—I believe you and try to help you recover. Kind of how all medical advice should be given, right? I do my best to make a sound recommendation, but the proof of the pudding is all about your experience.
(Off topic, but incredibly relevant to your health and fresh news, please note that the US government has partially come to its dietary senses. The new guidelines have removed, REMOVED, any concern about dietary cholesterol or fat consumption. You are right to eat all the eggs you want to, and choose good fat, and enjoy yourself. Very exciting news, now wait for the apologies for 40 years of bad advice.)
Read more of Dr. Deborah’s healthy insights at www.DrDeborahMD.com.