Medical marijuana is a booming industry in this country. A recent estimate puts industry growth at 74 percent from 2013 to 2014, with over 2.5 billion in sales in 2014 alone. This is incredible when you factor in that just under half the states allow its sale. From coast to coast there is a lot of action and excitement over the legalization of medical marijuana.
In Massachusetts, where sales are legal (since 2012) but have yet to begun, the anticipation of the opening of the first dispensary later this summer is palatable and in September, Boston will be hosting Canna Con a celebration and showcase of medical marijuana merchandise. In DC, President Obama is expected to announce today that several federal hurdles to scientific research on marijuana will be removed and in Florida a group is campaigning to get a medical marijuana on the ballot for the 2016 election. At its current pace, eventually medical marijuana will be legal in all 50 states, so it's important to ask what if anything medicinal pot does.
Medical marijuana has been reported to have positive effects for patients with a diverse range of conditions: ALS, multiple sclerosis, sleep disorders, Tourette's Syndrome and many more. None of these ailments are reported to be cured by marijuana, but the reported reduction in the debilitating symptoms of these conditions poses a significant value to patients in need. For example, the efficacy of marijuana in treating chemotherapy associated nausea or helping HIV/AIDS patients gain weight are ideas that are generally accepted today. However, scientifically they may not be as valid as commonly thought.
A new study published today in JAMA evaluated the efficacy and safety of medical marijuana and the results are not so rosy. The researchers compiled data from over 6,000 patients from 79 studies to use in their meta-analysis. They found that although most studies found an association between improved symptoms and cannabinoids (the class of chemicals that contains THC the active ingredient in marijuana), taken altogether these associations were not statistically significant.
The researchers did find that there was moderate quality evidence that suggested cannabinoids have some beneficial effects for patients suffering from complications due to multiple sclerosis and chronic neuropathic or cancer pain.
Furthermore, there was also low quality evidence to suggest cannabinoids ease the nausea and vomiting associated with chemotherapy, help HIV/AIDs patients gain weight, and benefit patients with sleep disorders and Tourette's syndrome. There was also low quality evidence it has no effect on psychosis. They also found very low quality evidence that cannabinoids were not helpful to patients with depression but there was very low quality evidence for beneficial effects for anxiety.
The authors also found there was significant evidence of an increase in adverse effects associated with cannabinoids. These included dizziness, dry mouth, nausea, fatigue, somnolence, euphoria, vomiting, disorientation, drowsiness, confusion, loss of balance, and hallucination.
Despite the fact this study is fairly comprehensive it does not mean we need to cease all sales at the local dispensary immediately. However, it does mean we may need to begin a dialogue on the goals of the medicinal marijuana movement. Forty-four percent of doctors are skeptical of marijuana as a pharmacological aid and believe the movement as a whole is a front for the drug to achieve recreational legalization.
In an editorial released with today s study, Deepak Cyril D'Souza, M.B.B.S., M.D., and Mohini Ranganathan, M.D., of the Yale University School of Medicine, New Haven, Conn. said If the states' initiative to legalize medical marijuana is merely a veiled step toward allowing access to recreational marijuana, then the medical community should be left out of the process, and instead marijuana should be decriminalized.
This begs the question: is the medical marijuana movement really just a front for recreational use? There is data to back that claim up. A large study in the journal Pain found that more than half of chronic pain sufferers are female. Yet, data from the states with legal medical marijuana show that 64-74 percent of patients receiving a marijuana prescription for pain were male. Another study in the Journal of Drug Policy Action found that the average profile of a medical marijuana recipient was a 32 year old male. The lack of a demographic match supports the idea that medicinal marijuana might just be a backdoor to legal recreational usage.
D'Souza and Ranganathan also take issue with how the US is handling medical marijuana, saying that 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. Evidence justifying marijuana use for various medical conditions will require the conduct of adequately powered, double-blind, randomized, placebo/active controlled clinical trials to test its short- and long-term efficacy and safety.
The message from doctors is clear: if marijuana is to be treated as a medical therapy than it should go through the same testing (i.e. clinical trials, FDA approval), same as any other drug. But if the endgame is from legalization of recreational usage, then medical community should be left out of it.
