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Medical marijuana as the new herbalism, part 1: Science versus the politics of weed in New York and beyond

A while ago, I wrote about how the Cleveland Clinic had recently opened a clinic that dispensed herbal medicine according to traditional Chinese medicine (TCM) practice. As regular readers of the SBM blog might expect, I was not particularly impressed or approving of this particular bit of infiltration of quackademic medicine into a major academic medical center, particularly given some of the amazingly pseudoscientific treatments espoused by the naturopath who was running the clinic. I also pointed out that, although herbalism is the most plausible (or perhaps I should say the least implausible) of modalities commonly associated with “complementary and alternative medicine” (CAM) or “integrative medicine”, it still exhibits a number of problems, the biggest of which is what I like to call either the delivery problem or the bioavailability problem. In brief, herbs, when they work, are adulterated drugs. The active ingredient is usually a minor constituent, embedded in thousands of other constituents that make up herbs, and it’s almost impossible to control lot-to-lot consistency with respect to content or active ingredients given how location, weather, soil conditions, rainfall, and many other factors can affect how the plants from which the medicines are extracted grow and therefore their chemical composition. To demonstrate the concept, I pointed out that it’s much safer and more predictable to administer digoxin to a patient who needs its activity on the heart than it would be for the patient to chew on some foxglove leaves, given that the therapeutic window (the difference between the doses needed to produce therapeutic effects and the lowest dose that will cause significant toxicity) is narrow.

Which brings me to medical marijuana, a.k.a. medical cannabis.

Before I continue, let me just state my position on marijuana, which is different than it was, say, 20 years ago. Today, I believe there’s no reason why marijuana shouldn’t be legalized and treated by states the same way as tobacco products and alcoholic beverages are; they should be heavily regulated and taxed. Among physicians, this appears to be a common view, at least if you can believe a poll I saw a while back (for which I can’t find the link, alas). It’s also, these days, more and more of a mainstream view. In any case, medical marijuana has been a topic I’ve been meaning to write about for a while, now, but my “Dug the Dog” tendencies have kept popping up over squirrels topics like the Food Babe, Facebook, ketogenic diets for cancer, and a variety of other topics.

"Cannabis sativa plant (4)" by Chmee2 - Own work. Licensed under CC BY 3.0 via Wikimedia Commons.

Cannabis sativa plant (4)” by Chmee2Own work. Licensed under CC BY 3.0 via Wikimedia Commons.

Medical marijuana arrived in my state in 2008, when the voters approved a measure permitting it. After some time for the state to draft regulations, the law was implemented, and I had the strange (to me at the time) experience of receiving notices about state regulations, requirements, and documentation should I wish to prescribe medical marijuana. Indeed, more than twenty states, plus the District of Columbia, have legalized medical marijuana. They’ve done so on the basis of a political movement among patients that make pot sound like a miracle drug that can help when no other intervention can. And it’s more than that. Medical cannabis has been touted as a near-panacea for everything from pain to chemotherapy-induced nausea to HIV- and cancer-induced cachexia to even curing cancer itself. Yes, there’s a lot of hype out there, and there are a lot of claims that sometimes go viral on various social media, even though the evidence to support the claims is often, to put it mildly, less than rigorous.

medimarijuana

Indeed, the acceptance of medical marijuana appears to be far more driven by politics than it is by science, as was pointed out in a recent New York Times article about the impending legalization of medical cannabis in New York State:

New York moved last week to join 22 states in legalizing medical marijuana for patients with a diverse array of debilitating ailments, encompassing epilepsy and cancer, Crohn’s disease and Parkinson’s. Yet there is no rigorous scientific evidence that marijuana effectively treats the symptoms of many of the illnesses for which states have authorized its use.

Instead, experts say, lawmakers and the authors of public referendums have acted largely on the basis of animal studies and heart-wrenching anecdotes. The results have sometimes confounded doctors and researchers.

[Ed. Note: This post was written yesterday, which, as it turns out, was one day before New York State became the Cannabis Madness,” full of a lot of anecdotes and rhetoric about “policy against patients.” Again, I believe that marijuana should be legalized, regulated, and taxed, just like alcohol and tobacco. If marijuana is going to be approved for use as medicine rather than for recreational use, however, the standards of evidence it must meet should be no different than any other drug, and for the vast majority of indications for which it’s touted medical cannabis doesn’t even come close to meeting that standard.

The evidence

There are definitely compounds with potential medicinal use in the marijuana. No one, even the most die-hard drug warrior, denies that. These compounds are called cannabinoids, which is a term that describes a family of complex molecules that bind to cannabinoid receptors, which are proteins on the surface of cells. There are two types of cannabinoid receptors, type 1 (CB1) and type 2 (CB2). These receptors are seven transmembrane G-protein coupled receptors (so named for the seven protein domains that span the membrane), a class of receptor I’m pretty familiar with, because one of the receptors I study is of the same class, which looks like this:

Cb1 cb2 structure.png
Cb1 cb2 structure” by Esculapio at it.wikipediaOwn work (Original caption: “Immagine creata da –Esculapio”). Licensed under CC BY-SA 3.0 via Wikimedia Commons.

The details of how this happens aren’t essential for this post, but when these receptors are stimulated by the binding of cannabinoid molecules, including endocannabinoids (produced by mammals), plant cannabinoids (such as (−)-trans-Δ9-tetrahydrocannabinol, more commonly referred to by its abbreviation THC, produced by the cannabis plant) and synthetic cannabinoids (such as HU-210), downstream chemical signaling pathways are initiated from the receptor to the inside of the cell, thus producing the effects on the cell and organism. There is mounting evidence that there are more than two types of cannabinoid receptors. In any case, CB1 receptors are found widely in the central nervous system, where they modulate a variety of responses, and are also found in other parts of the body, for instance, the pituitary gland, thyroid gland, lungs, and kidney, as well as fat cells, muscle cells, liver cells, and in the digestive tract. CB2 receptors, on the other hand, are expressed primarily in the immune system, the gastrointestinal tract, and, to a much lesser extent than CB1 receptors, in the brain and have been implicated in modulation of immune responses. In particular, stimulating CB2 receptors cannabinoids could be potentially useful as anti-inflammatory drugs. Over the last couple of decades, endocannabinoids and cannabinoid receptors have been implicated a large variety of functions, including memory, pain, energy metabolism, and more. It is thus plausible that manipulation of cannabinoid signaling could have therapeutic effects in a variety of areas.

Unfortunately, one of the problems with medical marijuana, as noted in the NYT article is that enthusiasm for weed as a cure-all has far outstripped existing medical evidence. This disconnect between the existing evidence base ranges from thin to nonexistent, depending on the condition. One of the most frequent claims I see is that cannabis can be used to treat cancer. I’m not going to address that claim specifically in this post, except very briefly, because I think it’s a large enough topic to warrant its own post. Suffice to say that interesting preclinical studies have been exaggerated beyond all evidence, but nonetheless certain cannabinoids could have potential in the treatment of certain cancers. I might also review the evidence base for cannabinoids and autism, given how I’ve been seeing discussions of its use starting to pop up lately on the usual sites. In other words, stay tuned for parts two and three spread out over the next several weeks, whenever no squirrels distract Dug the Dog.

In all fairness, in this country, at least, studying the medicinal properties of marijuana and its constituents is not easy, given that it is currently an illegal drug, as was discussed in the NYT article. It’s not for lack of interest, but mainly because the law (and therefore the Drug Enforcement Agency) classifies it as a schedule 1 drug with “no currently accepted medical use.” Scientists who want to do research on marijuana and its constituents—particularly clinical trials—must register with the DEA and submit an investigational new drug (IND) application to the Food and Drug Administration for human trials. Moreover, the National Institute on Drug Abuse is the only supplier of legal, research-grade marijuana. On the other hand, while doing research on marijuana is difficult in this country, researchers in other countries that have long had much more lax laws and regulations should have an easier time of it.

Another issue is how to do a proper placebo control. Given that many of the conditions for which medical marijuana is touted are conditions with a large subjective symptomatic component, such as pain, nausea, fatigue, or lack of appetite, clinical studies of medical marijuana are going to require really good placebo controls. Given that at least one of the active components causes a high, it’s arguably even more difficult than in the case of, for instance, acupuncture, to design studies with adequate controls. That’s why most of the more rigorous studies have used specific purified cannabinoids. For example, in this study, a titanium pipe loaded with doses of THC varying potencies is used rather than plant, while this study of cannabis for neuropathic pain used high-dose cannabis, low-dose cannabis, and placebo cigarettes.

Be that as it may, let’s look at the evidence base for conditions for which medical marijuana might provide a benefit. Remember, again: I’m leaving out cancer and autism for another day. Leaving these aside, here are the potential medical uses for marijuana for which evidence exists that ranges from reasonably good to suggestive.

Chronic pain. It’s been known for a long time that cannabinoids modulate pain responses; so it’s plausible that either smoked marijuana or cannabinoids isolated from marijuana (or synthetic cannabinoids) could be useful for chronic pain. Fortunately, this is one of the more widely-studied uses for medical cannabis. For example, a recent review of uses of cannabinoids for the treatment of non-cancer pain concluded that there was evidence that cannabinoids are safe and modestly effective in neuropathic pain, citing preliminary evidence of efficacy in fibromyalgia and rheumatoid arthritis. As is the case with most reviews, more study was recommended. This particular review included smoked cannabis, oromucosal extracts of cannabis based medicine, nabilone (a synthetic cannabinoid), dronabinol (a synthetic delta-9-THC), and a novel THC analogue. Most studies have only been short term, and adverse events have tended not to be serious. The current general recommendation is that cannaboids should probably not be used as first line agents “for conditions for which there are more supported and better-tolerated agents,” and adverse effects are not well studied.

Appetite stimulation. I’ve never smoked marijuana, but those who have, have told me about the “munchies,” something that anyone who’s ever seen a comedy in which characters smoke post has likely seen used as fodder for jokes. Given its ability to stimulate appetite, it is therefore plausible that medical cannabis might be useful for appetite stimulation in patients with cachexia due to cancer or HIV/AIDS. (Cachexia is the “wasting” that can occur in advanced cases of malignancy and AIDS, among other diseases.) Unfortunately, a recent Cochrane review noted variable outcomes and concluded that the “efficacy and safety of cannabis and cannabinoids in this setting is lacking” and noting no good evidence of long-term effects on AIDS-related mortality and morbidity. Regarding cancer cachexia, Peter Lipson noted several years ago a study that failed to find any benefit from cannabis extract for cancer-related cachexia, speculating that maybe the mechanisms that cause appetite suppression in cancer are different than the mechanisms by which cannabinoids modulate appetite.

Currently, there are few controlled trials cited at the NCI website, which, taken together, find that oral THC has variable effects on appetite stimulation and weight loss in patients with advanced malignancies and human immunodeficiency virus (HIV) infection. A PubMed review by yours truly also found the evidence rather sparse. For instance, this randomized trial testing cannabis extract (CE), THC, and placebo (PL) reported that “no differences in patients’ appetite or quality of life were found either between CE, THC, and PL or between CE and THC at the dosages investigated.” Another randomized trial comparing megestrol acetate (Megase) and dronabinol found that “megestrol acetate provided superior anorexia palliation among advanced cancer patients compared with dronabinol alone” and that “combination therapy did not appear to confer additional benefit.” A more recent small randomized trial tested THC versus placebo and found that “THC may be useful in the palliation of chemosensory alterations and to improve food enjoyment for cancer patients.” To be honest, I was shocked at how sparse the literature is covering this particular indication. Indeed, as the NCI notes, there are no randomized controlled trials of smoked cannabis for this indication in cancer patients.

Nausea/antiemetic. Despite many advances in anti-emetics (anti-nausea and vomiting) agents, cancer-induced nausea and vomiting (CINV) is still among the most troubling symptoms cancer patients face. There are two FDA-approved cannabis products for this indication, dronabinol and the synthetic cannabinoid nabilone. The NCI cites several clinical trials and meta-analyses finding that these two drugs are efficacious against CINV, and the National Comprehensive Cancer Network guidelines recommend these drugs as treatment for breakthrough nausea and vomiting due to chemotherapy. One systematic review from 2001 found that cannabinoids were slightly more effective antiemetics than prochlorperazine, metoclopramide, chlorpromazine, thiethylperazine, haloperidol, domperidone, or alizapride, but were not more effective in patients already using large doses of antiemetic drugs. A more recent systematic review and meta-analysis found that cannabinoids were superior to conventional drugs but that “adverse effects were more intense and occurred more often among patients who used cannabinoids.” In children with cancer undergoing chemotherapy, a Cochrane systematic review concluded that “cannabinoids are probably effective but produce frequent side effects” and that the review “suggests that 5-HT(3) [seratonin] antagonists with dexamethasone added are effective in patients who are to receive highly emetogenic chemotherapy although the risk-benefit profile of additional steroid remains uncertain.”

Inflammatory bowel disease (IBD). Last fall, the first clinical trial of cannabis in IBD was reported by a group of Israeli researchers. It was a small trial (21 patients), in which subjects were assigned randomly to groups given cannabis, twice daily, in the form of cigarettes containing 115 mg of Δ9-tetrahydrocannabinol (THC) or placebo containing cannabis flowers from which the THC had been extracted. A clinical response was achieved in 10 of 11 patients receiving cannabis with THC and 4 of 10 in the placebo group. Overall, this was a small study, but intriguing. No difference in complete remissions between the groups was observed, but that could easily be because of the small numbers. As with many conditions, all one can conclude is that more research is needed.

There is, of course, a laundry list of other conditions. Cannabinoids have been shown to lower intraocular pressure, making them potentially useful for treating glaucoma, although using cannabis to treat glaucoma is impractical in the vast majority of patients (see below), and there exist better treatments. After that, other conditions for which medical cannabis is frequently recommended include schizophrenia, for which a Cochrane Review concludes that there is no good evidence for or against the use of cannabis for schizophrenia. For epilepsy, data from double-blind randomized controlled clinical trials is lacking, although clinical trials are finally being done.

Overall, the evidence base, from my interpretation, ranges from nonexistent (most indications) to suggestive (anti-inflammatory), to fairly good (ant-emetic). However, most of the good clinical trials didn’t use marijuana cigarettes as most patients get them, but rather either purified cannabinoids (or synthetic analogues) or cannabis cigarettes spiked with varying amounts of THC. Indeed, all of these studies tend to suggest that purified drugs from cannabis or synthetic drugs based on compounds designed to mimic either endocannabinoids or cannabinoids from marijuana will be the future. I realize that that’s not what medical marijuana activists want to hear. I also realize that it is likely I will be lambasted as a “pharma shill” or as so conventional that I can’t think outside the box, but I’ve endured those attacks before when I’ve criticized other forms of herbalism. In any case, mine, I believe, is a reasonable interpretation of the currently existing medical literature.

Moreover, contrary to what advocates will claim, cannabis, particularly smoked cannabis, is not without adverse health effects, as was recently reviewed in the New England Journal of Medicine. Potential medical effects reported in long time users include motor vehicle collisions (not unreasonable to expect because driving while high is not a good idea), chronic bronchitis (not surprising as a result of smoke inhalation), schizophrenia (one wonders whether correlation really suggests causation here), depression, and addiction to other drugs, although the risk for cancer due to marijuana smoke appears to be much lower than with tobacco cigarettes. True, drug warriors and moralists will frequently exaggerate the risks in order to promote their agendas, but that doesn’t mean that cannabis is perfectly safe and doesn’t produce significant side effects or complications.

Then there’s the delivery problem.

Delivery, purity, highs

Let’s consider, for a moment, a generic herb that has medicinal properties. I began this post by briefly discussing the problems with herbs as medicine, but I didn’t discuss delivery. If one were to come up with a delivery method for an effective herb, one would be hard pressed to come up with a worse method than burning it and inhaling it. Consider the case of tobacco. The combustion of dried tobacco leaves produces a toxic stew of gases with carcinogenic effects. Of course, the main reason tobacco is so addictive is because it does have an active drug in it, specifically nicotine, which rapidly reaches the circulation through the alveolar sacs in the lungs. However, that nicotine is mixed with numerous combustion products that can cause cancer and contribute to the numerous other diseases to which smoking tobacco has been linked.

This brings us back to delivery. People have been using marijuana for the high and for medicinal purposes for a very long time, but cannabinoids were only first isolated from the plant in the 1940s, and the main active ingredient, (−)-trans-Δ9-tetrahydrocannabinol (THC), wasn’t discovered until the 1960s. Now, like the case with cigarette smoke and its delivery of nicotine to the bloodstream, the THC and other active cannabinoids delivered to the bloodstream through smoking marijuana are mixed in a similarly toxic stew of combustion products. While it is probably true that marijuana smoke is less carcinogenic than tobacco smoke, it has the same potential for respiratory irritation and deposits four times as much tar into the lungs as a typical cigarette, mainly because marijuana is usually smoked unfiltered. However, occasional marijuana use appears not to have a significant effect on lung function up to seven joint-years of lifetime exposure. (I chuckled when I read that term; it means one joint a day for seven years or one joint a week for 49 years). Of course, this hardly compares to a typical tobacco smoker, who smokes anywhere from a half pack to two packs a day (10-40 cigarettes), and those using medicinal marijuana can be expected to be smoking at least a couple of times a day. Medical cannabis advocates even basically admit that this is true.

In any case, if one were going to decide on a drug delivery device for cannabinoids, one could hardly design a worse device than burning the leaf and inhaling the gases, where the active drug is just one of hundreds of products of combustion, all loaded with particulate matter and tar. Sure, toking one joint a day probably doesn’t do appreciable lung damage in the intermediate term, but smoking one cigarette a day probably doesn’t either. In the case of glaucoma patients, a condition for which there is some evidence of efficacy, it’s been noted that patients would have to be toking up several times a day:

Since at least 2009, for instance, the American Glaucoma Society has said publicly that marijuana is an impractical way to treat glaucoma. While it does lower intraocular eye pressure, it works only for up to four hours, so patients would need to take it even in the middle of the night to achieve consistent reductions in pressure. Once-a-day eye drops work more predictably.

Yet glaucoma qualifies for treatment with medical marijuana in more than a dozen states, and is included in pending legislation in Ohio and Pennsylvania. At one point, it appeared in New York’s legislation, too.

And:

What’s more, for some of the ailments, such as glaucoma, patients would have to toke up every three to four hours day and night to maintain therapeutic levels in the bloodstream or tissues. Routinely consuming that much weed would be incapacitating.

Clearly, even if marijuana is efficacious for some conditions, there are serious drawbacks to burning the plant and inhaling the smoke as a drug delivery system. Other problems exist, not the least of which are the psychoactive effects of THC, which cause much of the “high” that pot smoking produces. To paraphrase one of the ophthalmologists in the NYT, his 60-year-old patients with glaucoma don’t want to be stoned all the time to get the beneficial effect of medical marijuana. The high is a particular problem for children, but none of this has prevented parents with autistic children from claiming that pot can treat autism, complete with seemingly-heartwarming anecdotes. One can imagine the temptation to simply keep the child toking until he becomes mellow and more “manageable.”
Of course, medical marijuana being in essence herbalism, with the same claims for efficacy of the “whole plant” due to synergy of its ingredients and the same attitude that “natural is better,” it’s not surprising that the same problems exist that are routinely observed for any herb sold for medicinal purposes. These problems include as inconsistent potency and purity, adulteration with contaminants—or even questions of whether the plant being sold is actually what is being claimed. Indeed, a fascinating story that sounds very familiar to those of us who have been paying attention to adulterated herbs and supplements was published a month ago in The Seattle Times:

Tonani, 38, decided several years ago to try pot. And it has worked for her, she said, especially strains low in the psychedelic chemical THC and high in the non-psychoactive ingredient cannabidiol, known as CBD.

As a medical-marijuana patient, Tonani knows it can be hard to find the rare strains that don’t make you high — and it can be even harder to get the same kind of pot consistently.

Testing shows that some marijuana strains are not what they purport to be in name, chemical content and genetics. This is particularly concerning for patients seeking pot low in intoxicants and high in pain-relief or other therapeutic qualities.

One strain widely known for its high-CBD and popular among medical-marijuana patients is called Harlequin. But when Tonani and a leading Seattle pot-testing lab analyzed 22 samples of Harlequin from various growers and dispensaries, five of them were high in THC and had virtually no CBD, which means people trying to take medicine were just getting high instead.

Again, this is a very common problem with herbal medicines, and cannabis, when smoked or ingested as the plant, is an herbal medicine.

Medical cannabis: Politics versus science

There’s no doubt that what is driving the legalization of medical marijuana in so many states has far more to do with politics than with science. Right now, for all but a handful of conditions, the evidence is slim to nonexistent that cannabis has any use as a medicine, and those conditions, such as CINV and chronic pain, can often be treated more reliably with purified or synthesized active components. Moreover, for one condition for which there is reasonably good evidence for the efficacy of cannabis and/or cannabinoids, namely chronic pain, politicians are reluctant to approve medical marijuana, as described in the recent NYT article:

Often state legislators have been motivated not just by constituents in distress, but also by the desire to restrict access to limited patient populations so that legal marijuana does not become widely available as a recreational drug in their states.

For example, while there is research suggesting that marijuana alleviates certain kinds of chronic pain, Mr. Lang noted, legislators in Illinois were reluctant to legalize its use in such a broad patient population. The state’s list of qualifying conditions is lengthy partly because lawmakers tried instead to specify a number of diagnoses that result in pain, some quite rare.

“I’ll bet there are hundreds of conditions that cause pain, and now 30 are listed,” Karen O’Keefe, director of state policies at the Marijuana Policy Project, said of Illinois’s legislation.

So, for one indication for which there is reasonably good evidence for the use of cannabis, legislators in Illinois were reluctant to approve its use, while approving its use for a lot of indications for which there is no evidence to support them. Clearly, this is a policy area that cries out for better science, given how legislators are being swayed by anecdotes that do not demonstrate that cannabis is effective and stories of “persecution” for growing medical marijuana, rather than by well-designed randomized clinical trials. Add to that the conflict with currently existing federal law, which outlaws cannabis as a schedule I drug, and the political situation is a mess, making doing research to find out for what indications cannabinoids have efficacy much more difficult. Antidrug zealots hugely exaggerate the danger of pot smoking, while pro-medical marijuana zealots claim that “cannabis cures cancer.” (It doesn’t, as I will discuss in the next installment.)

Moreover, THC can have biphasic activity:

THC has what doctors and researchers know as biphasic activity. “At low doses it has certain effects, and at high doses it has opposite effects,” Dr. ElSohly explains. “Somebody using to get high at the right dose will be calm, happy, getting the munchies, and all of that,” Dr. ElSohly says. Someone using at the right dose could see medicinal benefits, too. But take in too much THC, and you can become irritable, even psychotic. “There are more emergency room admissions today than ever because of marijuana use,” Dr. ElSohly says. “That’s simply because of the psychoactive side effects of the high THC content that the public uses.”

This makes standardization and getting the dose right more important for medical cannabis than for most other drugs, which is why I’m not enamored of smoking pot as a THC/CBD delivery system. At the risk of being too personal and “anecdotal,” I couldn’t smoke pot if I wanted to, for recreational or medicinal uses, whatever my feelings about its legalization. I can’t smoke cigarettes, either, and have never tried either pot or cigarettes. The reason is simple. Inhaling just secondhand smoke sends me into fits of coughing—and has since I was a child. Inhaling smoke directly into my lungs has been and still is more or less unthinkable. And I’d bet I’m not alone, either.

"Cannabis 01 bgiu". Licensed under CC BY-SA 3.0 via Wikimedia Commons.

Cannabis 01 bgiu“. Licensed under CC BY-SA 3.0 via Wikimedia Commons.

My personal sensitivities aside (which are obviously not shared by most people), I see two critical unaddressed questions with respect to cannabis. The first issue is standardization. I’m sorry, herbalists and pot smokers, but smoking a dried plant just isn’t it, particularly given the relatively low doses of active compound needed for optimal effects. That means pharmaceutical-grade material. If cannabis is a therapeutic drug, it should be treated like every other therapeutic drug and be subject to clinical trials. The second issue is comparative effectiveness research. It’s not enough just to say cannabis (or whatever cannabinoid drug or derivative you might wish to use) is “efficacious” against this disease or this condition. We need to know how efficacious it is compared to the existing standard of care. In most cases, even for indications for which there is evidence of efficacy, the existing evidence base suggests that cannabis is less effective than existing treatments, with the possible exception of its use as an antiemetic. Yet none of this sways the zealots, just as similar evidence with respect to other herbs doesn’t sway believers in herbalism. Meanwhile, medical cannabis is rapidly becoming big business.

That’s because cannabis is the new herbalism. A more balanced, science-based approach is desperately needed.

Posted in: Cancer, Herbs & Supplements, Politics and Regulation

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219 thoughts on “Medical marijuana as the new herbalism, part 1: Science versus the politics of weed in New York and beyond

  1. Preston Garrison says:

    There seems to be some kind of typo or something missing in the paragraph on megestrol.

    I’m curious about your evaluation of the study in PNAS finding adverse effects on neurological function in people who became regular pot smokers as adolescents.

    Long-term effects of adolescent-onset and persistent use of cannabis
    http://www.pnas.org/content/109/40/15970.full?sid=a638864c-d272-4fb2-8138-401cb6ce733e

    1. Windriven says:

      “I’m curious about your evaluation of the study in PNAS finding adverse effects on neurological function in people who became regular pot smokers as adolescents.”

      I would imagine that most people are familiar with the label ‘stoner.’ One would assume neurological consequences to long term abuse of any intoxicant. The most interesting finding that I noted was that “that cannabis-associated deficits may recover with abstinence (rather than persist),” good news for stoners and for those who care about them. But as with alcohol, the abstinence part is where the difficulty arises.

    2. Angora Rabbit says:

      I’ve been following this work from the sidelines as a researcher, and it is something that States need to address as legislation moves forward. The evidence, such as the aforementioned PNAS paper, is finding that adolescent brain responds differently and more vigorously to alcohol, nicotine and cannabis (that would be separately). The adolescent brain is different (as any parent of teens can attest), neocortex and myelination are still developing. Their reward systems differ from the adults’ system – alcohol, nicotine, and cannabis reward harder and longer, with heightened sensitivity and elevated addiction risk as compared with adults. And then there’s the potential for long-term consequences due simply because the adolescent brain is still developing. I recently heard George Koob from NIAAA speak and adolescent drinking is a high priority area at NIH, and given the push for collaboration the parallel is likely also true at NIDA for cannabis and nicotine. We need to understand this better, and the data to date regarding risk for adolescents are definitely concerning. The risk to teens and to adults look very different.

      1. Jessica Collins says:

        http://faceofcannabis.wordpress.com/ Cannabis is doing WONDERS for children with neurological issues. When will the science catch up with common sense? When we get politics OUT.

        https://www.facebook.com/groups/416702921703509/ (Over 30K members)

        1. WilliamLawrenceUtridge says:

          When will the science catch up with common sense? When we get politics OUT.

          When the randomized controlled trials are done. While I am totally in favor of decriminalizing pot, that doesn’t mean it’s automatically an effective treatment, and shouldn’t be promoted as such until after the studies are done. All it may do for children with neurological issues is drug or sedate them, or it may be parents interpreting a placebo effect.

          I want marijuana to be safe and effective, because then it’s another potential treatment and they are always needed. But wanting doesn’t make it so.

  2. mike says:

    Politicians who legislate medical marijuana are anti-science quacks who need to be called out on their rejection of science aqnd reason. Their enshrining of anti-science into law needs to be condmened as such.

    Marijuana and other drugs should be legal as alcohol and tobacco are. But doing do by advocating an anti-scientific position is worse than having it illegal.

    1. WilliamLawrenceUtridge says:

      Drug legislation is only partly a scientific and medical issue. The larger and far more significant part of drug legislation is purely historical and cultural. From a pure harms perspective, pot is an amalgam of two currently legal drugs – alcohol and cigarettes. But culturally, it’s foreign and thus something to be resisted.

      1. stanmrak says:

        Sorry William, but pot is far less harmful than those other two COMBINED. How many users has pot killed? Please cite any statistics you find.

        1. WilliamLawrenceUtridge says:

          Actually, I’ll concede that point – pot is less harmful than alcohol and tobacco as far as I’m aware. I was more getting at it has the intoxicating effects of alcohol and the inhalation effects of cigarettes (but as Dr. Gorski notes above, you don’t smoke near so many, so it’s ulitmately less harmful).

          So yeah – legalize and tax marijauna, and dispense with the irrational cultural prejudices against it on the basis of its historical origins as “foreign”.

          1. Greg says:

            Legalization would push out all the small growers in favor of the corporations. It would be better if it were just de-criminalized.

            1. Windriven says:

              Not gonna happen, Greg. Like gambling gaming, pot isn’t about the sins of using, it is about the revenues gained through taxation. Our political class is all about righteous indignation until they smell cash and chant in unison: “tax it!”

            2. WilliamLawrenceUtridge says:

              Legalization would push out all the small growers in favor of the corporations. It would be better if it were just de-criminalized.

              Perhaps, but I kinda doubt it. In nearly every “consumptive” field (i.e. food) there are mass-produced and marketed items as well as small-scale entities producing premium, small-lot products. It would probably be harder to get weed from your local pot dealer, but you could almost certainly still get it if you worked harder and were willing to pay more.

              Think organic vineyards and farms, grass-fed beef, 100-mile markets, balsamic vinegar, etc.

              1. Jessica Collins says:

                Exactly. Decriminalization does NOTHING to stem the violent black market that is flourishing because of cannabis prohibition. It also doesn’t help people who want to grow it themselves. Only legalization does this.

            3. Daws says:

              Or they could just grow more now… Yes the business model would have to change, but look at the previous prohibition. I’m sure there were mom and pop operations then, but there was also the mob. And I’m willing to bet far more people have jobs related to alcohol now than did back then, and far more money circulates overall.

    2. rork says:

      To ask where the problem starts, note that there are no medical St. John’s Wort or medical Valerian laws being passed by states.

      1. David Gorski says:

        Heh. I should have said something like that. Of course there aren’t any medical St. John’s Wort laws. I don’t believe it’s possible to get high off of St. John’s Wort, although I suppose it’s possible I could be wrong.

        Perhaps the biggest tip-off that we’re dealing with magical thinking similar to that of herbalism when it comes to medical marijuana is the sheer number of conditions it’s touted for. Medical marijuana, if you believe its advocates, is good for everything that ails you. (It’s rather like acupuncture and reiki that way.) Moreover, while researching this post, I found many claims that the “whole plant” is better than isolated compounds because…well, just because. Maybe just because it’s “natural.”

        The biggest problem is that all the woo and quackery associated with medical marijuana, plus our draconian drug laws, have tainted the area of research so badly that a lot of doctors and scientists understandably stay away.

        1. WilliamLawrenceUtridge says:

          So…all the stoners out there are perfectly OK with grinding up and smoking the entire plant, roots and stalk included, along with the leaves and buds that contain much of the pyschoactive ingredients? I’d be in favour of that too :)

          1. Daws says:

            Lol that would be some pretty shwag stuff :P I think by “whole plant” what’s meant is that there is (it is claimed) a synergetic affect with the compounds that is more effective than when using the isolated ingredients alone. Something any cook can easily imagine being true. It could also just be that researchers went for isolating the wrong thing. Sure THC gives the effect of “getting high” but that doesn’t mean it’s going be the thing responsible for every medical effect. There’s dozens of cannabinoids to check out in there.

            1. WilliamLawrenceUtridge says:

              There’s a massive difference between trace amounts of flavouring compounds being synergistic towards a better taste, and trace amounts of pharmacologically active compounds being “synergistic”. There are very few examples of synergistic drugs or plant compounds that are well-supported in the scientific literature.

              1. Andrey Pavlov says:

                There’s a massive difference between trace amounts of flavouring compounds being synergistic towards a better taste, and trace amounts of pharmacologically active compounds being “synergistic”. There are very few examples of synergistic drugs or plant compounds that are well-supported in the scientific literature.

                This is indeed correct. As I said elsewhere I think that there is some evidence that there may indeed be some synergy in marijuana (meaning, enough to prompt investigating if there is, not enough to actually say there is). But even if there is, it is most certainly not necessary to be a “whole plant” synergy. It will likely be at best a few of the cannabinoid compounds, not all of them.

                Perhaps the biggest tip-off that we’re dealing with magical thinking similar to that of herbalism when it comes to medical marijuana is the sheer number of conditions it’s touted for. Medical marijuana, if you believe its advocates, is good for everything that ails you. (It’s rather like acupuncture and reiki that way.)

                I missed this from when Dr. Gorski wrote it earlier, but he is at least partly correct here. There absolutely is a large group of… shall we say “ardent marijuana advocates” who try and claim it is a cure-all panacea. I’ve even had a few people tell me that the only smoke marijuana because they are healthy; that the smoke from tobacco will destroy your lungs but from marijuana is somehow magically harmless to lungs. Of course all of that is utter BS.

                However, it is important to realize there is a secondary reason for some of this panacea claiming – it is not stemming from credulity in stupidity like that. It is a means to an end to make an illegal drug de facto legal. As I’ve said before – the medical marijuana movement in California did have at least a grain of legitimate medicinal proponentry involved, but it was really at heart a stepping stone towards legalization. That is part of why there were intentionally staged situations to entice the DEA to raid little ol’ grannies with cancer toking up on a doob. Indeed a rather large part of the reason why there is so much advocacy for marijuana as a panacea is because both the herbalism loving hippies and the people who want to smoke recreationally benefit from having an endless number of “indications” for a prescription.

                The biggest problem is that all the woo and quackery associated with medical marijuana, plus our draconian drug laws, have tainted the area of research so badly that a lot of doctors and scientists understandably stay away.

                And this is indeed true. There have been a lot of politics getting in the way and it is only compounded by the crunchy hippie herbalist types.

        2. kev says:

          We already have such isolated compounds, Marinol is avoided by many of the people cannabis is supposed to help because it’s very difficult to titrate since it takes an hour to reach full effect, which means people are tend to get way too high and start freaking out/passing into lethargy, and end up smoking/vaporizing the buds anyway since that works much quicker and isn’t as finicky.

          The other, “better” kinds of available medicines are basically extracts/concentrates created by pouring solvent over the buds (not the “whole plant” of course), similar to how hash can be made.

          It seems inevitable that some group will create a product with a useful enough ratio of cannabinoids for a general population, right now things are pretty medieval.

  3. goodnightirene says:

    I have been waiting for this post for ages and have bugged some of the other contributors to no avail, so many thanks. I’ve sent this on to all the children and grandchildren as this subject has been at the bottom of more than a few family arguments. I keep telling my kids that they can’t be all science-y about everything else and then toss it out for pot.

    I’ve resigned myself to the coming legalization for recreational use, but I’m particularly happy to see you make the important distinction of that from “medical” use. (Recreation used to mean physical activity, now it seems to include getting high!)

  4. BobbyGvegas says:

    I have no science, only the anecdotal evidence of witnessing episodic pot use help my late daughter attenuate the effects of her brutal chemo and radiation tx’s. It worked. Period. Her Marinol Rx did not.

    1. KayMarie says:

      Yes, for some people in n of one experiments one modality may work better than another modality even when statistics show that both of them work for lets say 75% of the people in clinical trials. So even if you have two highly effective treatments one of them may not work for you, as an individual, at all.

      This does not mean that that one modality should be seen as the only effective one for all people. One of the reasons for having several of any particular drug class on the market is that people vary and no one thing is perfectly effective for all. I shouldn’t tell people to never ever use Claritin, it can’t do anything for anyone because my histamine receptors seem to have no affinity for it what-so-ever. The positive control we ran to see if I could get my allergy tests that day proves it. It works really well for a lot of people, but I might as well not take anything as try that. Now other antihistamines do seem to work for me, just that one doesn’t fit on my receptors.

      Now my pet hypothesis (or two) on why the pot from the dealer down the street works so much better for so many than the synthesized individual compounds.

      Distraction is a common Cognitive Behavioral Therapy technique for diminishing symptoms. Give the brain something to focus on other than exactly how miserable you feel and often the misery abates at least as long as the distraction is going on.

      I think this is sometimes why some very busy people manage to maintain their very business even while seriously ill with something that would make most of us miserable and focused only on our misery. They just don’t give the brain a second to focus on the pain and other discomforts so it actually doesn’t bother them as much as it bothers other people.

      I have never been high on pot, but I have spent a fair amount of time with people who routinely used pot for recreational purposes. Generally their brains were quite distracted by the various sensations and qualities of the high and did not seem particularly aware of other things that most of our brains focus on when sober.

      So I can believe that for some people the herb with all the gets you high and other compounds in it may very well be much more effective than a singular compound which may not have as many distracting effects.

      Then there is also some indication that for placebo effects how you get the placebo (inhaled vs pill vs what color the liquid is, etc) may trigger it more in some people than others. So sometimes I think that can be part of it for some herbs. All the ritual around the preparation of the dose may be more effective than just swallowing a pill for some people.

      And finally in an equal and opposite anecdote a friend of mine had pot recommended for nausea from chemo, brutal chemo, 2 full years of chemo. She found it did nothing for the nausea and she is also very sensitive to becoming paranoid when high on pot and becomes combative when she is paranoid. Thus when she toked up ahead of time she would then refuse to let the doctors give her a treatment that she would otherwise tolerate relatively well even with the side effects and misery.

      1. Greg says:

        There are hundreds of strains of marijuana, 2 distinct varieties and many hybrids, so to say it didnt’t work for your friend is not very meaningful without knowing about the particular strain(s) your friend tried.

        1. MadisonMD says:

          So, basically, you are saying it will be impossible to conclude that MJ has no medical benefits because, perhaps, it’s one of the many other varieties? Moreover, we cannot say it doesn’t work for any one individual for any one symptom for the same reason?

          1. Greg says:

            I’m saying that like pharmaceuticals (and other drugs), it is not a case of one-size fits all, so different strains will have different effects depending on the constitution of the individual (which I believe you well know).

            1. WilliamLawrenceUtridge says:

              Sounds like a good reason to take the plant out of the equation – test individual molecules rather than strains with variable growing seasons, growing conditions, stresses and so forth. Much like morphine, we don’t need poppies, we need a specific concentration of a particular molecule.

              Legalize, tax, research.

              1. Greg says:

                Sounds reasonable, but what do you do in a situation where the effects are the product of 2 or more molecules?

              2. KayMarie says:

                @Greg.

                That is what experimental designs to show that something is necessary and sufficient are all about.

                Do you need the compound to have an effect (so if you take it out of the mix does the effect go away). – Necessary

                Then if you give that compound in isolation can it do the job all by itself. – Sufficient

                My dad worked on a drug development program from a plant extract that had interesting effects. He was the organic chemist charged with synthesizing the individual compounds. They had a couple that were necessary, but none were sufficient on their own. so then they tested mixtures of the various compounds from the plant to see what was the right combination of compounds.

              3. WilliamLawrenceUtridge says:

                Sounds reasonable, but what do you do in a situation where the effects are the product of 2 or more molecules?

                You include a greater number of groups and control for multiple comparisons. If the effects are as profound as you say, then signal will rise from the noise.

                Despite claims by herbalism proponents, there are actually very few proven instances of actual “synergy” between similar plant molecules such that the impact on symptoms requires a delicate balance of a pinch of this and a pinch of that. And further – if that balance were so delicate that effects disappear in controlled conditions, you’re even worse off when it comes to using just the plant, which will be far more variable than anything you can produce in a steel vat.

          2. Daws says:

            To put it nicely, it’s rather to say that negative anecdotes are just as useful as positive ones ;)

        2. Thor says:

          We have virtually no database detailing the specific attributes of various cannabinoid configurations. Beyond the obvious excitement about isolating CBD, and creating high CBD strains to avoid psychoactive ‘side-effects’, relatively little documentation, other than anecdotal, is had differentiating between Indica and Sativa strains (species), let alone the countless hybrid varieties. I think too much is made of these differences—it is a major marketing tool, and it gives the appearance of medical authenticity/specificity. Sometimes it reminds me of all the fuss made about finding the ‘right’ homeopathic remedy, as if there are really all those options. By the way, most everyone I know who smokes, including myself, have rarely, if ever, noticed major differences in effect. It simply does what it does.

          1. Andrey Pavlov says:

            Indeed Thor and WLU are correct here. I actually happen to think that synergy is indeed a real thing and probably a little more common than WLU is intimating. But when I say “a little” I really do mean a little. Of all the plants out there, however, I think that marijuana is a solid candidate for such synergistic effects.

            What we found was that, to find the active ingredient, we would look for the fraction that had activity and we’d throw the other fraction away. We would keep fractionating down until we did our last fractionation and neither of them had activity. We put them back together again and they had activity. Then we took one of the fractions we’d thrown away earlier on and added it back to one of the ones that
            83 See, for example, Dunlop (1970). See also Tansey and Reynolds (eds) (1997b). It didn’t work, and we had activity again. It was absolutely clear that in a lot of biological processes, not just at a single molecular basis, you had clear synergy within these plants. Then, of course, some of the fractions of the plant, when you added them back in, took away the activity of a fraction that you knew had activity. So, the notion that there could be agonists and antagonists in the same plant was well understood.

            From The Medicalization of Cannabis (pp 30-31).

            Granted that is indeed preliminary and that chunk alone is not entirely sufficient, but there are other notable findings mentioned in that document which elucidate some rather complex and interesting interactions between the numerous bioactive molecules in cannabis and our physiology.

            All that said, I would aver that this effect is actually likely to be smallish or restricted to just a handful (at best) of the molecules involved. At least in terms of clinical utility. But I think there is some pretty decent evidence to strongly suggest it is there.

            But more to the point about Greg’s comment – the high involved is in and of itself something that can be useful and therapeutic. MadisonMD has correctly pointed out that for most people and in most situations it is a rather undesirable side effect. But for people who are not opposed to the feeling and in a situation like terminal cancer, the high alone can be extremely therapeutic.

            One thing to remember is that while the novice may be just as gorked after a joint as someone taking stuporous amounts of opioids, to more experienced individuals it is perfectly possible to function whilst under the influence. I’ve referenced my good friend John, whom my fiance calls “the mythical pot smoking monster” before. He is more intelligent, quick, witty, and higher functioning than just about anyone else I know and he is almost constantly stoned. My point being is that Greg’s anecdote is not necessarily reflecting the same sort of thing that folks like myself and MadisonMD may be referring to in terms of clinical utility and efficacy.

            I will close by adding that yet more evidence that there is some sort of synergy going on is that there is indeed a difference between at least the two major strains in terms of effect. I wish it were studied more rigorously to truly elucidate it and see if it actually exists, but based on past personal experience as well as that of many others, along with some basic science to give a reasonable prior to it I certainly think it is real. Whether there is any sort of big difference between all the hundreds of strains… I am much less convinced. I think that boils down to wine tasting and people finding “hints of cherry and tobacco” in their cabs (which is bollocks). But the differences between the two major strains I believe exist (though there is plenty of low hanging research fruit that could demonstrate that belief of mine wrong)

            1. brewandferment says:

              well, since there are so many very distinct flavor profiles in coffee beans, let alone roasting levels, it would certainly stand to reason that something similar would happen with weed.

              I suppose there might be some sort of weed strain equivalences to the differences between Arabica and Robusta coffee varietal.

            2. Greg says:

              Thanks for the thought-provoking responses. Similar to the passage quoted by Audrey, yesterday I was thinking about how one might synthesize a drug to have the exact same effects as MJ – that it might be accomplished through a process of elimination – reverse-engineering if you will. Granted I don’t enough about any investigation of the effects, to know whether or not this is a viable idea, so I’m just throwing it out there for comments.

              From personal experience, I notice a definite difference in the intoxicating effects of sativa versus indica strains and entirely different effect from ingestion. I think one of the best uses for MJ is as a sleep aid – works great for me! And I am someone who needs to ensure I get adequate sleep as deprivation can bring on mania – I’ve been diagnosed with bi-polar disorder, but I don’t take any meds for it, and really only experience it when I am sleep-deprived. Not that I am advocating MJ for bi-polar disorder – from my personal experience, it helps if I am only slightly manic, but in a full blown episode, it makes it worse as it causes paranoia and delusions.

              My brother’s GF who has fibromyalgia claims a particular sativa dominant strain – Jack Herrer – helps alleviate her symptoms much better than other strains.

            3. MadisonMD says:

              But for people who are not opposed to the feeling and in a situation like terminal cancer, the high alone can be extremely therapeutic.

              Hate to call you on this Andrey because you are one of the most careful and thought-provoking commenters on this site. But I think you have a bit of a blind spot for medical cannabis. Here goes: citation needed.

              And when you say:

              I will close by adding that yet more evidence that there is some sort of synergy going on is that there is indeed a difference between at least the two major strains in terms of effect…. but based on past personal experience…

              I mean you know better. Even if we were to admit your personal experience into evidence (which I do not–and you have not heretofore*) then there still no possibility of interpreting your experience as synergy. And differences in effects of two strains–which I do not dispute–would not provide evidence of synergy since it could merely be attributed to difference in THC dose or possibly the effects of two independently active molecules with distinct nonsynergistic effects.

              Anyways, still love ya buddy and hope you would do the same for me. I did enjoy the cite about synergy discovered by fractionation, by the way, although it would have been more satisfying as a scientific report than an oral history or even if it told what in the heck the assay was measuring.

              *On more than one occasion you have cited your personal experience of acupuncture and then refused to admit that as evidence of medical effectiveness.

              1. Andrey Pavlov says:

                Hate to call you on this Andrey because you are one of the most careful and thought-provoking commenters on this site. But I think you have a bit of a blind spot for medical cannabis. Here goes: citation needed.

                Don’t hate it. I certainly don’t don’t. I try my best to be thoughtful and objective but yes, we all have our biases and blind spots.

                I would counter you a bit by saying that you seem to have a bit of a bias against cannabis.

                I think we are probably not that far off from each other, but merely a few hash marks away from each other which each of us leaning a little more in the opposite direction from the other.

                That said, yes you are correct. I do not have any specific citations handy about that specific effect. And I do not have the time to dig through the literature right now (and even if I did I think we can both agree that it wouldn’t be hugely compelling evidence if I found any).

                I should have been more clear, but my point was more like how Gorski and Atwood view massage – if it feels good and improves the person’s mood that is good enough. And that is what I intended to mean by it. In other words, if a cancer patient enjoys the high and is better able to function with the use of cannabis, that is good enough. Would I like some more rigorous data on it? Yes. Is my assertion more tentative than usual and easily overturned should contrary evidence come to the fore? Absolutely. But I think it is not entirely ludicrous nor analogous to CAM apologetics to say that.

                Though I will be more clear that this falls more under the “expert opinion” type of evidence (and perhaps even less than expert, given who it is coming from) informed from many strands of low quality evidence and prior probability rather than robustly supported higher level evidence.

                Even if we were to admit your personal experience into evidence (which I do not–and you have not heretofore*) then there still no possibility of interpreting your experience as synergy.

                Here you are absolutely correct. There is other evidence that synergy is more likely in cannabis than average (which is to say both are rather low, but cannabis is less low). But that specific example does not offer evidence of synergy.

                Thanks for calling me out on that.

    2. kev says:

      Marinol is simply THC, CBD has been shown to have a lot of the more useful and expected effects that people associate with “medical cannabis”, perhaps one of the more obscure cannabinoids might be even more beneficial?

  5. Sullivanthepoop says:

    I also think there is no reason to keep marijuana illegal, but the medicinal marijuana thing is ridiculous and always has been. It is not a bad thing when treating any condition to have one or two active chemicals minus everything else a plant might contain at know and constant concentrations. People that eschew pharmaceuticals for marijuana or anything other alternative medicine are just fighting the modern world.

  6. Adam Morrison says:

    Great Post. The polarization of both sides of the MJ issue boggles my mind, it’s either the old ‘Marijuana is the devil’ or the new-age idiocy of it being ‘the magic cure all to everything’.

    The thing I almost never see addressed is the long term potential for health issues and side effects. Particularly from smoking it (as David mentions, there’s no control of amount, potency, etc). Not to mention regularly exposing your lungs to anything other than air, is generally a pretty bad idea. I don’t think it will quite be cigarette-level bad, but woodsmoke, cooking fires, all have associations with lung disease. Heck, on a recent jobsite I inspected there’s a mandatory dust-mask/respirator rule because the risk for long term inhalation of silica dust (sand) and they’ve had major concerns with worker lung health.

    Hopefully when it does become an over-the-counter drug of pleasure like alcohol, which seems inevitable in North America, they have the sense to use some of the substantial tax revenue for H&S studies, and banked for future treatement. But I’m not naive enough to think that they’ll be that fiscally responsible.

    1. kev says:

      The “cannabis-as-panacea” thing isn’t new, it’s probably a result of backlash against all the very old propaganda about the “killer weed”. Of course there tends to be a least a a grain of truth within every lie…

      1. Richard Paul Steeb says:

        O’Shaughnessy pronounced Cannabis to be an “anti-convulsive remedy of the greatest value” about 170 years ago. It was prominent in the United States Pharmacopoeia from that time up until Anslinger’s day.

        If you think there is any substance on earth NEARER to a literal panacea, go browse “Storm Crow’s List” and get back to us, mmm-kay?

  7. Thor says:

    In California, anybody can get a script for any condition, at anytime. Why? Because marijuana is supposedly a panacea. There are presumably mostly only healthy people here because whatever ails you, pot can help or cure, lol. Most here use the law simply to be able to have a legal supply of recreational marijuana. From the start, medical marijuana allowance was a first-step ruse to get it legalized. It was always wink-wink,
    nudge-nudge. And everyone know this—consumers, politicians, medical establishment.
    Name your ailment and the good doctor okays the script, basically no questions asked. Man, those marijuana doctors are laughing all the way to the bank.
    Marijuana as medicine? Give me a break. I don’t know anyone who considers it a viable medicine. It is used to get high‚ not that there’s anything wrong with that, but let’s call a spade a spade.

    1. @GeekPharm says:

      your comments about medicinal marijuana in California reminds me of this article on Cracked trying to see exactly how hard it is to get medicinal marijuana legally (spoiler: not hard AT ALL):

      http://www.cracked.com/blog/how-fast-can-you-get-marijuana-prescription-in-california/

      However, in response to this statwement: “Marijuana as medicine? Give me a break. I don’t know anyone who considers it a viable medicine.” I have to say that there really are some people that really believe. Cannabis Oil (I think that’s what they call it) is apparently legal for treating epilepsy in Colorado. Here in Utah, right next door to CO, there are a TON of good little Mormon boys and girls that would never dream of using it recreationally because it is both illegal and against our religion’s Word of Wisdom, that recently very loudly petitioned the state government to approve its use here so they don’t have to take their epileptic kids to CO to get the treatment. When the local News channel posted about the story on their FB page asking for opinions on whether the state should legalize it. I voiced my dissent citing basically most of the reasons Dr. Gorski outlines here and the vitriol aimed towards me was incredible. I shouldn’t have been surprised by the response from the herbalism capital of the world (it seems) but it was still astounding.

      1. Thor says:

        I’m talking about people that don’t include “belief” as evidence. There are obviously tons of believers. Utah? Mormons? That’s easy. They already believe the most ridiculous of things. Will be interesting to see, in say ten years, what the science ends up showing. My hunch is it won’t show much.

        1. Andrey Pavlov says:

          @Thor:

          As I said in my longer stand-alone comment, pretty much nobody in California has ever thought it was really about medicinal use. It was nothing more than a politically tenable back door to de facto legalization. Back home you can literally walk into a “clinic” where a physician will charge you $200 to make a chart for you, give you a list of approved conditions for usage of marijuana, you pick the ones you like, get a script, and then walk literally next door to the dispensary, and then only one more door over to the head shop. And typically the dispensary will give you first time customer perks.

          Sure some people are those crunchy hippie folk that really think it is a panacea, but my friend started and is part of one of the largest (if not the largest) marijuana company in California (and probably the country). While he does support the medicinal aspects of it and works within those limits, nobody is kidding themselves that it isn’t really primarily for recreational use.

          1. Thor says:

            That’s what I’m talking about, bro. I’ve heard of your friend (in high places). They say the coming marijuana market may dwarf the venture capitalism of the dot.com era. Seems reasonable.

            Hey, way to be true to yourself, Andrey, and to have chosen to become someone first through hard work, instead of going the commercial route so early in your career. Admirable.

            1. Andrey Pavlov says:

              Thanks for the kind words Thor.

      2. David Gorski says:

        I voiced my dissent citing basically most of the reasons Dr. Gorski outlines here and the vitriol aimed towards me was incredible. I shouldn’t have been surprised by the response from the herbalism capital of the world (it seems) but it was still astounding.

        Hopefully this post will be useful to people like you to spread around to counter such arguments. We at SBM are here for our readers for just these situations. :-)

      3. kev says:

        Palliative medicine is still medicine! You can be pessimistic all you want, it won’t change the fact there are lots of people with AIDS/cancer/epilepsy/multiple sclerosis/chronic pain that benefit from such “recreation”.

        1. Missmolly says:

          So we should study it and prove it, Kev! Dying people don’t deserve to have any old shit thrown at them just because they’re dying! Enough of palliative medicine is anecdotal already. Playing the ‘fact there are lots of people…that benefit’ card without ponying up the evidence is bullshit. Now that marijuana is more available, it would be a crime not to study it and prove its efficacy or lack thereof.
          Personally, I hope it’s effective- one more good tool in the arsenal! But I won’t be recommending it to the kids I look after without seeing something well-designed suggesting that a) it usually helps above placebo and b) the side effects aren’t intolerable. Surely not too much to ask!

        2. Andrey Pavlov says:

          the fact there are lots of people with AIDS/cancer/epilepsy/multiple sclerosis/chronic pain that benefit from such “recreation”.

          I fully agree.

        3. Thor says:

          Again, so far it is really “only” the benefit of recreation. Literally.
          That’s why all people, patients included, mainly use marijuana. It makes one feel good. For patients, this enhanced feeling may make a difference in their ability to deal with their condition. As Missmolly says, let’s see what the evidence shows before jumping to definitive conclusions of benefit beyond the the recreational one. Not to diminish that purpose for usage.

          1. Greg says:

            Call it what you will but I saw a documentary, wherein an epileptic, who was so severely afflicted he could barely talk, smoked a joint and within minutes he was lucid, could speak normally and had no tremors to speak – he basically appeared normal. So I think there are undisputed medical benefits, which is why people who advocate it as medicine aren’t too concerned about it’s constituents – it helps and that’s all they care about. I agree that there are any number of people who have taken advantage of the situation but there are also many people who have legitimate reasons for using it.

            1. KayMarie says:

              Oh I don’t doubt there are some very interesting documentary clips on potential benefits.

              For a scientific anecdote (a case study) there would need to be more done than just that clip before I, personally, accept it as an effect that is probably caused by the thing that looks like it is helping. For instance did we do a trial run where the patient got either a joint sans active ingredients vs a joint with them and there was a difference in how much better he did when he didn’t know if he got an active ingredient. People sometimes react strongly to things they believe will work. For instance (at a party I was at) a juice made from wine grapes in a wine bottle had the effect of wine for those who didn’t know the hosts would not serve alcohol to anyone. BTW, it’s really good grape juice and can be paired with food just like a wine would.

              And one video clip does not a comparative effectiveness trial make, either. You can’t assume it will always work better than standard medical treatment, etc.

            2. MadisonMD says:

              Basically that’s a case report with a subjective endpoint cherrypicked and filtered through a documentary that is highly motivated to demonstrate medical benefit of MJ. It really doesn’t indicate whether MJ is likely to benefit the next person with epilepsy.

              I don’t think I would call that evidence of “undisputed medical benefits” of MJ, any more than I would call Merola’s documentary evidence of ANP benefits.

            3. MadisonMD says:

              KayMarie’s comment (and mine) demonstrate that the evidence is, in fact, disputed.

              1. Greg says:

                From an SBM perspective, I suppose that is true, from a user perspective, there is no doubt as to its’ effectiveness. And yes I realize film footage can be easily manipulated, however this was only 1 person out of several who appeared in the documentary extolling the beneficial effects MJ has on their particular affliction – I think it was called “Grass”.

              2. KayMarie says:

                Yes and there are plenty of individuals who have no doubt what-so-ever that thingy 1 has effect Z on them because every single time they know they took thingy 1 the get effect Z.

                Until you put them in a controlled situation where they have no idea if they took thingy 1 or thingy 2.

                People get all kinds of conditioned responses to things so that is why we often do the feed them a meal where person with big response can’t tell but you added thingy 1 to one plate on day one and thingy 2 to the next plate you feed them the next day.

            4. WilliamLawrenceUtridge says:

              So I think there are undisputed medical benefits, which is why people who advocate it as medicine aren’t too concerned about it’s constituents – it helps and that’s all they care about.

              Your anecdote doesn’t account for placebo effects (which can influence even siezures, not to mention speech and tremor), and there are considerable other problems here. For one, some people don’t want the high. For another, if something has effects, it will generally have side effects. For a third, when science investigates herbal remedies, it often reveals hitherto-unappreciated side effects that can be good and bad.

              Marijuana needs more research – hopefully it will get it with the relaxing of legal constraints.

              Legalize, tax and research.

              1. Greg says:

                I agree but isn’t “placebo effect” a bit of a non-starter? It is equally applicable to pharmaceuticals. How do clinical trials and studies of pharmaceuticals account for this in their findings?

              2. KayMarie says:

                @Greg,

                That is why you large randomized placebo (or sham when placebo isn’t the right alternative, like a sham surgery where you cut the holes but don’t fix anything inside) controlled experiments and study the effects in populations, not one individual.

                The FDA would never approve a drug because you gave it to one person one time and recorded an effect.

              3. WilliamLawrenceUtridge says:

                I agree but isn’t “placebo effect” a bit of a non-starter? It is equally applicable to pharmaceuticals. How do clinical trials and studies of pharmaceuticals account for this in their findings?

                Read Snake Oil Science or Ben Goldacre’s Bad Science, both explain the basic controls needed in a scientific investigation and why they are necessary.

                To be short and a lot less snarky than my original comment – yes, placebo effects apply to pharmaceuticals, and marijuana is such a pharmaceutical, semantics aside. You’ve never seen someone get waaaaaaayyyyy too high on skunk weed as satirized in this Adam Sandler sketch?

            5. Thor says:

              Undisputed? Your evidence bar is set pretty low. I recommend perusing this site some more to get a better understanding about what constitutes evidence. One can make a documentary about anything.

              1. Greg says:

                I suppose you could say that – I’m just basing it on observations, such as those in the documentary I mentioned and perusing various sites that offer reviews and comments of the effects people experience from the different strains. Regardless of the mechanism, can you deny that people experience medicinal effects from its’ usage? Even alcohol is purported to have medicinal effects.

              2. WilliamLawrenceUtridge says:

                People get stoned from marijuana. The decision regarding whether an effect is “medicinal” or not is a human value judgement. Pain relief and blood thinning are both effects of aspirin, the decision to call one a side effect depends on which you desire.

                Put another way – if you want to get high, reducing seizures is a side effect. If you want to reduce seizures, getting high is.

                And you really don’t know what most of the effects are until you do placebo-controlled trials, even for something with as long a history of use as pot.

              3. KayMarie says:

                @Greg,

                People get self-reported benefit (heck sometimes even objectively measurable benefit) from all kinds of things.

                Doesn’t prove cause and effect. Doesn’t prove efficacy. Doesn’t prove safety.

                No amount of self-reported anecdotes can do what scientific trials do. Part of the problem is even in well-designed experiments you have to control for the human mind’s ability to fool itself into believing all kinds of things. Also the mind’s ability to inject it’s bias into the data it is collecting.

                We don’t directly experience reality. We have found ways to get around that and reliably find out what reality is despite our brains best efforts to keep us locked into our biases and beliefs about what we think the reality we don’t experience might be.

              4. Daws says:

                That being said, I may have seen that documentary myself, and it seems to boil down to whether you suspect shenanigans or not. Sure it could be the most duplicit staged scene ever, but, if we do away with the possibility of shenanigans, that everyone’s being honest, it seems hard to argue against such and obvious change happening before your eyes. Placebos can only go so far, right?

        4. Bruce says:

          I think the focus should be on palliative CARE and that medicine only be given as with any other patient as and when required medically.

          Pot SHOULD be legalised for recreation and that means that someone with a terminal condition who enjoys it for recreational purposes should be allowed to use it just like any other person, but as soon as you give it to them as a medication you really need to be a lot more rigorous no matter what stage of care the patient is at.

          1. DW says:

            I would say this sums up the issue. _Prescribing_ pot is an entirely different ballgame, from the question of whether people should be allowed to legally use it recreationally. There seems to be a pretty broad consensus nowdays that the latter is the best route. I’m grateful to SBM for bringing up the former question – should it really be prescribed, and for what conditions, and all the many research routes this will open up. Apparently there’s no reason to prescribe it as far and wide as some would have you think – or at least, no evidence for this _yet_.

            That said, I am not sure when we consider mainly palliative measures that it makes much difference exactly in what manner the palliation is being achieved. If someone is suffering intensely from cancer pain or nausea from chemo etc., I don’t see why we would need to split hairs regarding whether it’s “really” treating their pain or just getting them high enough to care a little less. What’s the difference? A person in pain might be distracted by listening to music, or watching a stupid TV show, and we wouldn’t say OMG don’t prescribe it ‘cus it isn’t proven.

            But that’s all very different from touting MJ as a _cure_ for various things.

            1. Greg says:

              A person in pain might be distracted by listening to music

              After ORIF surgery to repair my collarbone, this worked for me when I was trying to get to sleep. Though I was taking percocet for pain, it wasn’t quite enough to enable me to sleep.

              1. Thor says:

                Greg, since Reply was closed up above, I’ll reply here.

                “From an SBM perspective, I suppose that is true, from a user perspective, there is no doubt as to its’ effectiveness.”

                This is an exaggerated statement. No Doubt!? All users are 100% convinced of marijuana’s medical properties? I can’t think of anyone I know who has experienced any medical benefit from it, although I’m not a health-care provider. Which doesn’t in the least mean that those people don’t exist, as I’m sure they do.

                On the other hand, I can’t count how many people I know who do find benefit from it recreationally, which has great value all on it’s own.

              2. Greg says:

                from the perspective of people who actually use it for medical purposes, not recreational users, which is probably 99% of users but for the other 1% the benefits are undeniable.

              3. MadisonMD says:

                I don’t thing Dr Gorskis post supports the assertion that benefits of medical marijuana are “undeniable.” Why are so many denying it if undeniable? Why are so many disputing what you call indisputable?

                Recall that bloodletting for fever and Perkins tractors for pain had the same type of anecdotal evidence that you characterize as undeniable and indisputable.

              4. WilliamLawrenceUtridge says:

                but for the other 1% the benefits are undeniable

                Much like alcohol, which is enjoyed primarily for its intoxicating effects and only slightly for its medicinal benefits, why not simply admit that for most people the medicinal benefits are irrelevant? If there are actual, medical benefits for the molecules involved, they will show up in clinical trials. Hopefully with ongoing medical use exemptions and decriminalization, they’ll eventually be able to conduct proper research on it (and tax the shit out of nonmedicinal use).

            2. KayMarie says:

              I suppose it means what you mean by undeniable.

              Sounds like to me, for you, undeniable = we have some observational data that a scientist would look at and say there might possibly be enough there to write a grant for a pilot project to see if there really is enough there to find out what parts may be supported.

              Observational data is great, but all too often in science we have seen way too many undeniable observations end up being something other than what believe them to be.

              I have undeniable data that raisins are a potent emetic, possibly more effective and powerful than syrup of ipecac. After all every single time I knew I ate one for the better part of 3 decades I vomited profusely and completely. I could eat all other dried fruit and I could eat all grapes. Now scientifically I know it is a conditioned response to being fed raisin bran for the first time on a day I happened to have a GI bug about to erupt. I finally broke it with an extended period of strict avoidance. No amount of explaining to my body that raisins could not possibly have this effect changed what happened every time I saw one in my food.

              1. Greg says:

                I thought I mentioned earlier that I based these comments on the observational experiences of users and conceded that from an SBM perspective there’s little evidence of efficacy as medicine. At this point, until more good-quality research is performed, the testimonials of users who feel they have benefited from it, are going to continue to influence the decisions of thousands if not millions of people who are looking for alternatives to pharmaceutical therapy and / or conventional medicine (EBM / SBM).

              2. KayMarie says:

                Yet you say undeniable as if observational data has always in every case been proven to be true when the science came in. Scientists know you can’t tell from the early observations what cannot be denied and what is totally and completely a false interpretation of what you think you are seeing.

                I can’t call it undeniable with merely some observational data no matter how impressive it appears at first glance or how it was collected.

                Scientists are trained to look for those observational tidbits (as often great discoveries come from them) but we are also trained to not go all undeniable we should change all the laws and policies based on a few observations no matter how impressive they may appear. We have seen too many promising observations fall apart when you do more research.

                It is normal human brain chemistry to see a few observations and make it into something undeniable, but that device in your head is indiscriminate. We believe we have it because it works more often than not. But no scientist is ever going to rely on it for the “undeniable”. A lot of good experimental design is to try to get past the evolutionary brain chemistry that has us leap to undeniability and proof way too soon.

                Like I said may be enough to prompt the start of something, but it isn’t the proof you said it was even with a few disclaimers. For me, the ratio to see I have absolute undeniable evidence that will change the paradigm proof to disclaimer is way off. Everyone has a different set point on that. You aren’t going to change mine with a great anecdote. I’ll change my mind when the undeniable experiments come in. Happily, and with great enthusiasm. The proof that proteins without DNA all by themselves can cause disease was spectabulous and rewrote a lot of what we now about biology and infectious disease. But see that is where undeniability comes in, not from a few observations made in non-systematic ways (documentaries rarely use good systematic objective observational technique, as they usually rely more on subjective methods better suited for persuasion than proof).

                And I do believe some people have subjective experiences they interpret as pot doing them some good. I’m not saying the experiences are not as people feel them. I’m just saying our very humanness often gets in the way of knowing what is really going on. Now policy is more often than not made on those subjective experiences rather than the science. Doesn’t mean I have to elevate anything to undeniable before its time.

                FWIW my main arguments for legalizing pot have to do with dismantling criminal organizations and better regulation of additives (a regulated shop is less likely to use dangerous fillers than the criminal on the street). The dangers of the pot itself seem much less than the dangers of the criminal enterprise built to supply it or the dangers of whatever all else they lace the pot with for all the various reasons they adulterate it. I generally don’t trust criminals to follow strict QA/QI protocols. And I realize exactly how based on subjective information that bias is.

              3. Greg says:

                Sorry, I don’t know how better to express the many positive experiences people report from cannabis usage. I understand your points about observational data and appreciate the explanation.

              4. Andrey Pavlov says:

                Sorry, I don’t know how better to express the many positive experiences people report from cannabis usage. I understand your points about observational data and appreciate the explanation.

                Greg, you’ve hit an important point in your sceptical life. I know you are rather new here and I haven’t been reading everything in detail since I am in my intern year right now and rather busy, so forgive me if I make some incorrect assumptions.

                But it seems to me you are rather new to this arena of more rigorous science and skepticism. And you have made some very good strides in a very short time! Kudos to you! (Seriously)

                But this is one of those times that you are butting up against something that to you seems so obvious and clear that it must be so. We all have those. The thing to learn from this is that other people who make claims that you find ridiculous feel the exact same way you do right now.

                I’m not saying you are being unreasonable or woo-ey or anything. I’m just taking a moment to point out one of the most important lessons I learned as a budding skeptic. That This feeling is what we are actually combatting. In ourselves and in others. This gives you a real taste of what needs to be done to achieve goals. And to always be ready to be wrong.

                Like Sam Harris and his fireplace delusion

    2. oldebabe says:

      Right, Thor. This article makes too much out of what is just getting `high’, and having it feel good.

    3. lagaya1 says:

      I agree. marijuana as medicine is just an excuse to get high. If it was legal to use, there would be FAR fewer people going to clinics for made-up symptoms. But since having pain is the only way to get it, everyone’s got some kind of pain. Just legalize it already. By now, everyone’s in on the joke.

      1. Roadstergal says:

        “Just legalize it already. By now, everyone’s in on the joke.”

        Yes. This. Exactly. I know that at least in my group of acquaintances, nobody thinks it will actually cure what ails them, and if it were legal, they wouldn’t be pretending it would.

        https://www.youtube.com/watch?v=U4r1hUXeRA0

      2. stanmrak says:

        Players in the NFL, who need pain relievers regularly, have access to any prescription pain medication in existence, as much as they want, courtesy of the club physician. About half of them opt for marijuana instead.

        1. WilliamLawrenceUtridge says:

          What’s your point? One can’t tell from your comment whether they do so because they believe it provides superior pain management or just want to get high (or have recieved bad advice from the club physician).

          1. stanmrak says:

            They opt for marijuana for PAIN RELIEF instead of (not in addition to) the opiates and other narcotics offered by the team doctors, even tho they could face suspensions and fines from the NFL. Why would they risk their careers this way if it didn’t work? HBO did a documentary piece on this.

            1. WilliamLawrenceUtridge says:

              May I point out that while the NFL players may have said they were opting for marijuana for pain relief, they may actually have wanted to get high. Or both.

              Also, as other comments have alluded to – MJ isn’t necessarily a panacea for pain, or even particularly effective for some people and types of pain. Sometimes narcotics are necessary, but yes they are also abused.

            2. MadisonMD says:

              Why would they risk their careers this way if it didn’t work?

              Dumb question. Why would they risk careers by carrying guns, running dogfights, groping underage women, and driving drunk?

              Maybe rest, stretching, ice or heating pads, massage, ibuprofen and naproxen would be the best bets for football player’s pain relief, depending on its underlying cause.

  8. Ian Mitchell says:

    Hi:

    I am a physician-prescriber of cannabis and write a blog about the evidence on clinical cannabis (It doesn’t contain any posts that say that cannabis cures cancer).

    I would love to see more research done, however you noted the heavy restrictions that are placed on research in your country. That is why it is so surprising that you would refer to Dr. Volkow’s New England Journal of Medicine article on the Adverse effects of marijuana. She is hardly likely to render an unbiased report, given that she is the head of NIDA. I’ve gone through this article in depth here: http://clinicalcannabisincontext.tumblr.com/post/89779954835/commentary-on-adverse-health-effects-of-marijuana-use

    As a physician, I don’t recommend smoking cannabis either for medical or recreational usage. Vaporizers are widely available, improve the extracted yield of THC from plant material and are a standard harm reduction method for those using cannabis. Vaporizing happens at a lower temperature than combustion and significantly lowers the amount of products of combustion inhaled. They can also be used in an institutional setting, most recently approved for a hospital in Sherbrooke, Quebec.

    Overall, it makes much more sense to move away from dried plant material and change to concentrates, which are easier to standardize and control quality for contaminants.

    1. KayMarie says:

      There seem to be an endless supply of websites claiming it cures cancer, manying claiming they have science on their side. Add to that the celebrities claiming they only got cancer when they stopped smoking pot and will cure it by smoking pot again, it isn’t surprising most of my wooier friends all believe it is the one true cure for cancer.

    2. Thor says:

      A wise recommendation to use a vaporizer for “medical” usage as the potential harm to the lungs is minimized. But, for getting high, a vaporizer just isn’t as effective as smoking. For many, the effect appears to be thinner, weaker and flatter, if you will. Something seems to be missing from just the vapor.

  9. Scott Hurst says:

    A correction re “in marijuana leaves”

    There is little THC in the leaves and they are usually not smoked/consumed but thrown away.

    The flower/bud of the female plant is what is processed/kept.

    1. Thor says:

      Marijuana leaves have plenty of THC, especially in high vegetative phase, not in glandular trichomes (there are none yet), but the leaf itself.
      Later, after harvest, leaves on the branches of flowers are rarely discarded except for the fan leaves. Leaves in the flowering phase, especially the smaller ones closer to the buds, are loaded with trichomes, although much less than the flowers. Indeed, the trim is usually not smoked but processed, especially into kief, which is the trichomes separated from the leaf material by screening. That can be pressed into hash. Or hash can be made directly from the leaf trim by using the ice-water processing method. Or butter and edibles can be made. And more.
      NO! Not thrown away.

      1. n brownlee says:

        Or, you can just keep the least resinous trimmings in a box under your bed, for those lean times. Remember: “Dope will get you though times of no money better than money will get you through times of no dope.”

        1. Thor says:

          I know someone who prefers trim because it is less potent.
          1967! You young whipper-snapper, you.

          1. n brownlee says:

            I’m 67. I smoked grass the first time about 1965- but infrequently, until the freewheeling days of the late ‘sixties. About mid 1970, I started thinking it was boring me and making me stupid. Sure enough, a couple of weeks after I stopped, I felt a lot livelier. After that, intoxicants in general have been uninteresting.

            I should be clear, though- I really do not regret a minute of it, even the fairly intensive experiments in psychedelia.

            1. Thor says:

              Was kidding, thought you were a few years older than me.
              I’m envious because you got to partake in most of the full period, even ’65. I was a tad too young then and began smoking in ’68. I missed the days of legal LSD, but it was still available as candy.
              Unfortunately, even though intoxicants are mostly uninteresting to me, and even though I have terrible cognitive dissonance surrounding smoking, I’m unable, even after all this time, to make a final break. I think it has severely impacted my life. It’s a love/hate relationship.

              1. n brownlee says:

                I have quite a few friends who still toke up regularly- I mean, folks my own age. They are all people who, at the first experience with pot, knew they had found their ‘drug of choice’. I’ve even had some people tell me that they immediately felt like they were ‘supposed to feel’. I never felt that way. I mostly enjoyed the high, but sometimes felt like, “Crap, now I have to be stoned for an hour”.

                And it definitely knocks about 20 points off my IQ. Or more. I don’t need that.

  10. passionlessDrone says:

    Great article.

    The issues on potency are very real; regulation would probably help this quite a bit. To some extent, the free market helps inform you on this where it is still technically illegal; i.e., you pay more for the good stuff. Of course, you’ve got to know the right people sometimes or you’re trapped with whatever you can get.

    The potency issue with edible cannabis are far, far worse; you can’t really tell what you’ve gotten yourself into until an hour or two in, and by that time, you might have taken more, or a lot more, than you wanted. You’ll never accidentally smoke seven joints in a row, but you can easily eat that much and not know until you are pot committed, so to speak, and then you can be in for a long and shitty ride.

    1. Andrey Pavlov says:

      The potency issue with edible cannabis are far, far worse; you can’t really tell what you’ve gotten yourself into until an hour or two in, and by that time, you might have taken more, or a lot more, than you wanted. You’ll never accidentally smoke seven joints in a row, but you can easily eat that much and not know until you are pot committed, so to speak, and then you can be in for a long and shitty ride.

      You are absolutely correct, which is why the Maureen Dowd story is kind of hilarious.

      As I’ve said in previous comments, I have a friend in the industry and he works to standardize the doses and they are pretty good at it. The problem, of course, is twofold. Firstly people need to actually follow the directions. But secondly not everyone knows hey they will react. Even if they are not marijuana naive, if they are edible marijuana naive it is a very different experience. I had a friend who ate a half of pan of brownies because he didn’t know it would take so long to kick in (and he is a chocolate fiend and they were tasty brownies). He became one with his couch for a solid 12 hours.

      The one upside is that at least an OD on that is not at all likely to be fatal. Maureen Dowd ate 16 times the recommend dose. If she’d had an equivalent amount of alcohol she would most likely be dead now. Granted trauma or aspiration of vomit or something else can happen (what we in medicine call “misadventure”) but one is not going to die from the marijuana directly.

      So a society in which we can regulate it properly, educate people accurately (just like we do with alcohol), and deliver it consistently will ameliorate a lot of the problems you correctly point out.

  11. Nell on Wheels says:

    You are not alone in your reaction to inhaling smoke–most asthmatics have that reaction. However, I’m surprised that you didn’t bring up pot allergies. I discovered during my freshman year in college that, for me, smoking pot triggered hay fever-like symptoms of rhinitis, itchy eyes and occasionally shortness of breath, followed by a killer migraine, If I took an antihistamine and kept my inhaler handy, I could smoke, but that didn’t always prevent the migraine. People kept telling me to try brownies, but I decided it just wasn’t worth it.

    cite=”http://www.medicaldaily.com/are-marijuana-allergies-real-deal-how-negative-reactions-cannabis-may-even-spur-food-allergies”>
    According to a recent study published in the journal Revue Française d’Allergologie, allergic reactions to marijuana when smoking, inhaling, or chewing the plant are starting to emerge, drawing the attention of researchers.

    “Allergy to illicit drugs and narcotics has rarely been reported in the medical literature. Nevertheless, in the past few years there appears to be a considerable increase in the prevalence of this allergy, in particular, allergy to Cannabis sativa (Indian hemp) is growing,” wrote the team of Belgian researchers in their report. The literature available on the allergic reactions to marijuana provides some insight as to the potential of cross-reactivity with other pollens and foods. It also makes clear that marijuana can be an allergen not only by inhalation but also by ingestion.
    Medical Daily, April 10, 2014

    1. CC says:

      I also discovered in university that not only did I have (very mild) asthma, while campfire smoke irritated me and cigarettes made me cough, pot smoke makes me cough so hard I feel like I’m about to either cough up a lung or crack a rib. (Some, but not all, cigars also affect me this way.) Oh, and this wasn’t from trying to smoke the stuff, this was from being downwind of somebody who was smoking pot.

      If the actual medicinal ingredient is isolated, purified, and delivered in some form that doesn’t involve pot smoke, I’m all for it (for those conditions where it is shown to help).

      Legalizing smoked pot for recreational use the same way cigarettes and alcohol are legal? Well, I can walk away from cigarette smoke, with a bit of coughing and stinging eyes. I have been doubled over coughing so hard I couldn’t even stagger away when exposed to pot smoke. So no, I’m opposed to that, for purely selfish reasons. I like my lungs where they are.

  12. Harriet Hall says:

    Cocaine is an illegal drug, but the evidence for its efficacy is far greater than that for marijuana; it is still used by doctors for specific purposes. Heroin is also supported by strong evidence of efficacy for many indications and is available as a prescription drug in the UK and elsewhere. No, I’m not advocating their legalization in the US; but this illustrates Dr. Gorski’s point that the laws are not based on scientific merit but on political and social considerations.

    David, thank you for writing about this; I had tried to research the subject but had given up in despair because everything I could find seemed to be contaminated by bias pro or con marijuana. You have done a good job of keeping your pro-legalization stance separate from an objective review of the evidence.

    1. Volteric says:

      Still really wish you’d weigh in. Always appreciate your POV.

  13. R Miller says:

    On one hand, it’s certainly frustrating to see medical marijuana be used as a ‘backdoor’ to legalization and be given a “separate-but-equal” approach to scientific and clinical scrutiny. It’s a mockery of medical care, with so many ‘prescribers’ being pretend physicians and the clinical knowledge held by the average dispensary manager being below that of even a first year pharmacy student (admittedly anecdotal, I haven’t met all of them of course). It’s especially frustrating to have clinical opinions ignored, because I think most non-dinosaur health professionals are accepting of legalization within reason.

    At the same time, although deceptive, it’s a strategy that has worked for them and I cannot entirely blame them for following it. A direct path to legalization would probably not be politically workable without the “it’s my medicine, why do you want to take away my medicine” stories that are so captivating to politicians; and in my experience most advocates are sincere that medicalization is only intended as a temporary foot-in-the-door until full legalization. I certainly feel the history of marijuana criminalization has been an embarrassment to the country, and should be critically examined; so I give them credit for playing the hand they’ve been dealt.

  14. Stella B. says:

    If it sounds too good to be true…

    My experience has been that non-recreational MJ users who try it for chemo nausea, for example, find it to have too many side effects (i.e. they don’t like getting high). People who have enjoyed it recreationally, find that it may be useful for diminishing some of their symptoms, but at least one has admitted that it didn’t lower her pain level, just raise her tolerance for pain. I’ve never tried MJ, but I don’t really like the “side effects” of wine, so I doubt that I would tolerate weed.

    1. Thor says:

      Using marijuana as pain medication is sketchy at best. What kind of pain? A dull,
      low-back ache? Sharp tooth pain? Ask anyone if it ameliorates tooth pain and the answer will mostly be, NO it increases this pain. In fact, all pain can be enhanced with marijuana use, as one of the main psychoactive effects is increasing and magnifying sensation. Using it for neuropathic pain isn’t medically justified. If one has pain, marijuana can bring it to the fore, even exaggerate it. There are many better options for pain control. Mainly, the reason for using weed for pain control is that one gets so stoned that it becomes, perhaps and sometimes, more tolerable (because one cares less?).
      And we all know how subjective perception of pain is, and prone to the placebo effect.

  15. Jopari says:

    http://www.upworthy.com/think-marijuana-is-for-stoners-meet-a-6-year-old-girl-who-might-just-disagree-with-you-on-that?c=reccon1

    Anyone mind helping me dissect this?
    I would like to know if legislatures prevent use of chemicals derived from illegal substances, and also if these Cannabinoids can be synthesized otherwise.

    Much appreciated.

    1. MadisonMD says:

      Dissect what? It seems fairly convincing anecdotal evidence that cannibidiol can quell seizures in Dravet Syndrome.

      I would like to know if legislatures prevent use of chemicals derived from illegal substances, and also if these Cannabinoids can be synthesized otherwise.

      Well, thanks for asking. Not really. It would be nice if it could be standardized, pharmacology discerned, and tested on other cases, right? The work is in progress here. Then we will know how to dose the drug in other children and the likelihood it will work on other children with this disease.

      1. Jopari says:

        What I meant by the questions was basicly:
        1) It’s not allowed outside that one state, is it because the active ingredient is derived from cannabis or because it hasn’t been tested?
        2) If it is because it’s derived from cannabis, then can the cannabinoids be synthesized?

        1. MadisonMD says:

          (1) Possibly both. (a) Not tested– we do not know that all patients with Dravet’s would have these results. However, it might not be tested already, in part, because of restrictions on cannabis research in U.S. as doctor Gorski said. I don’t think this is insurmountable; after all, we already have pharamaceutical grade THC.

          (2) Chemical synthesis is not likely to overcome legal hurdles to making this into a medicine. The primary hurdle is demonstrating that DHC can be dosed reliably, safely, and is effective at treating more than one case of Dravet’s. The studies on GWP42003-P linked by me above will test this. If it is always as effective as that one young patient, I would not be surprised to see accelerated FDA approval based on a small non-randomized study.

          1. Jopari says:

            Thanks.

  16. Mike Callahan says:

    Just anecdotal….I had a nasty case of AML that had a grim prognosis and required an allogeneic hematopoietic stem cell transplant. I tried lots of anti emetics including dronobinol during and after chemotherapy. For that feeling you get of intense nausea just before projectile vomiting I came to prefer a good dose of Zofran IV over anything. Dronobinol didn’t help me at all compared to Zofran.
    Now as a side effect of the chemo or the drugs I take to stay alive I have a bad case of peripheral neuropathy. Walking is very painful. I tried lots of different drugs like gabapentin, lyrica and cymbalta with no effect. I saw a DO at the local cannabis recommendation mill and tried smoking pot. I got really stoned but the pain was still there. If it helps relieve pain it’s only because being stoned helps you forget about it for a little while. The only thing that really dampened the pain was a Vicodin. My feet still felt numb but without the pain. The problem was when the Vicodin wore off the pain came back pretty intense. I used Vicodin for two years before tapering off because I have to drive a lot. Now I just endure and don’t walk much.
    I think cannabis should be legal but not for medicinal reasons.

    1. Greg says:

      I had some intense pain following shoulder surgery and found that smoking cannabis seemed to intensify the pain-relieving effect of Percocet. After taking Percocet I would wait 45 minutes to an hour have some smoke and I would be good until the next dose. However, thinking about it now, it was more likely that the combination of the intoxicating effects of both drugs took my focus off the pain more so than alleviating it.

  17. brewandferment says:

    Somewhat tangential but I wonder if you would comment on the synthetic marijuana issue. It always seemed to me as a good illustration of the unintended consequences, in that there are always inventive people who want to get high and will find something else. Thanks to Reason magazine (yeah I know there are also issues with them but still) I’ve become duly suspicious of the anti-pot element. Now it seems you see some of the same rhetoric about synthetic pot. Is this more anti-mind altering substances propaganda or is synthetic pot actually more dangerous as they would have you believe?

    BTW, never tried the stuff, real or synthetic–second hand pot smoke gave me a headache and I’ve never liked being loopy, whether from medical applications or being drunk, so it was no difficulty steering clear. But I just don’t like the social impacts of trying to stamp out something so easily grown. I mean, you could make a legit argument against the potential harms of manufacturing various illegal drugs, like explosive and fire risk, etc, without having to bring in moral arguments against mind alteration–but growing a plant doesn’t come anywhere close.

  18. Mals says:

    Having written permission to purchase marijuana will mean permanent denial of a pistol permit by states.

    1. Windriven says:

      ?

      Where is this coming from? In CO and WA, pot is legal. So are concealed carry arms with a permit.

      1. Daws says:

        Partly right, it’s done by the Feds though, sort of… for a permit in some states (maybe all?) you need to sign something saying you are in compliance with federal law. Likely the last place it will still be illegal is under federal law. Because of this, technically people that use pot can’t have a gun permit.

        Worse yet, mandatory minimums increase your sentence automatically by 5 years if a gun is found on the same property where weed is seized. A way for places to get around this and still have security is to outsource to security guard companies. That way their guns cannot be said to be in your (or the dispensary you own’s) control, it belongs to the security company.

  19. Frederick says:

    Thank you! AT LAST somebody here covers that subject. I got some friends who post meme all the time about how pot is great and do X or Z and can cure Y. But to me smoking it always seems like a worst way ever do have the effect needed. I did use Pot , and still do from time to time, but now, at 35, I prefer the light buzz from beer or wine to the buzz from Pot. But in my early 20′s I used to smoke a lot more, not as much as some pothead out there, but still a lot.

    I have a good friend of mine who have blood clot problems, is now on medication for life, and he smoke pot a lot for decades now. He told me that his Doctor recommended that he continue. Despite him not being able to have medical pot permission. Does cannabis really help for that? it was not covered in this article.

    I’m totally in legalization for recreational usage too. with regulation and taxes for it too. I’m also totally in favor of decriminalization of usage of all drug, even the hard ones, junkies are not criminals, they are victims.

    Anyway it was good read, Thank Dr. Gorski I’ll share that on facebook ( with a warning : interesting but Long article ahead :-) )

  20. dozr says:

    even if its hocus pocus bullshit on the medical benefits, we are adults, we should be able to make decisions about our consciousness for ourselves. you(anyone/government) has no right to tell me what I can or can’t do as long as its not hurting others.

  21. Lytrigian says:

    I’m reasonably confident that medical marijuana is primarily a foot in the door toward legalizing recreational use. I live in a county in California where pot has been effectively legal for quite a while now, with a good portion of county officials (including many in the DAs office) known to enjoy some herb from time to tile. You have to do something very stupid to get arrested for it, and a ballot measure passed a few years ago to officially make marijuana the lowest law enforcement priority. Naturally, every small town has at least two medical marijuana “clinics”. If this were really about medicine, we clearly have some kind of epidemic on our hands.

  22. Andrey Pavlov says:

    Thanks for this Dr. Gorski. This is more or less in complete concordance with my own knowledge of the topic. I found this plenary meeting on this history of cannabis research to be extremely informative and interesting.

    As I have mentioned before one of my friends is a multi-millionaire from the cannabis industry. In fact, after her famed weed chocolate bar incident, Maureen Dowd interviewed him and called him “the Phillip Morris of pot.” He is not one of those nutters that claims to marijuana is a panacea and actually does want to get the science and medicine of it right. He has offered me a job being the science and medicine advisor for his company. I have given him some off the record information based on questions raised in a YouTube channel he runs, and he appreciates the rigorous science. The problem is, that thanks to the political situation of it all, I simply can’t be in a position to have my name and face plastered all over an industry like his. Not until I am an attending at least, and even then I’d have to be reasonably well established (and well liked). Which is a shame, because I could make a fair bit of money doing nothing by advising him on the state of medical science on the topic.

    But I digress. The thing with the medical laws is that they were never really anything more than a politically tenable back door to legalization. Nobody – and I mean nobody – in California thinks that a medical marijuana card is anything more than a small speed bump on the way to getting your recreational cannabis. My friend recognizes this and they don’t really hide it. Obviously, for legal reasons, they focus on the medicinal aspects of it, but it is pretty clear that isn’t really the point.

    The real problem is that the political history of the drug has indeed made research on it rather scarce (as that plenary lays out in fascinating detail). So you get the hardcore anti-druggies (like those Fox News idiots who are so worried about people “getting all potted up on weed”) and then the crunchy hippie morons who (I swear I’ve heard this numerous times) argue that somehow, magically, the smoke from marijuana is actually good for your lungs. I can’t even begin to tell you how many facepalms I’ve had when someone realizes my background and that I support the legalization of marijuana. They take that to mean that I also agree with all their ridiculous magical ideas surrounding it. And it annoys me, because there are legitimate reasons to use marijuana medicinally (albeit few), there are legitimate reasons to legalize it independent of any medicinal benefit (I mean really, does ethanol have more medicinal value than weed?), but these morons are actually losing the case for it because well, they make moronic claims about the stuff.

    And stuck in the middle is my friend. Who is an MBA (his thesis project was a marijuana company that he later sold for $25 million), not a scientist. But he has a physician on his board and wants to do it right. But there isn’t terribly much to go on. Most of what is out there is bench science molecular receptor type stuff. Which is nigh impossible for a guy like him to parse and difficult to explain by people who can (which is why he wants to hire me – I’ve explained it to him in a way that he gets it and can then utilize in his business). Obviously he leans more towards the crunchy hippie types but he is legitimately interested in offering a good product, with a standardized potency and consistent delivery method, while offering legitimate science based advice on it.

    Which brings me to my last point, Dr. Gorski. You wrote a lot about smoking it and the problems and harms with that. However, there are many more ways to ingest it as well. And in fact, if my friend’s business is any indicator, a large part of the market is moving away from smoking the dried plant. Nowadays there are e-cig fills that have a standardized content, sublingual sprays, and this stuff called “dabs” which is gaining popularity in California. Dabs are basically a highly concentrated and somewhat purified hashish (hash typically tops out at around 40-45% THC, dabs start at 70%). You take a very small amount and instantly vaporize it for effect. Given that my friend’s company tests and standardizes the THC content (and even sells pure CBD wax – which is what they call the stuff) all that is necessary is a more accurate measuring device to dose it more properly. Heck there is even a company that is starting to make sex lube with THC in it!

    Ultimately it is certainly one of our safer drugs (legal or otherwise). It has effects that many people enjoy in addition to the strictly medicinal benefits (the “high”). It has some indications for use in people medicinally. And we have a paucity of evidence to guide it’s use, a huge amount of possible research to develop its active compounds pharmaceutically, and a politicolegal situation that makes standardization and regulation in its potency, delivery, and availability spotty (for example, I would be willing to bet that unlike the story you told about the people searching for CBD strains and getting some with THC my friend’s company would not do that; they are pretty darned rigorous about their products). Basically, it seems to me that, legal thoughts aside, it seems much better to spend money on medical research of cannabis and its derivates than on all the other CAM herb BS we keep flogging. Stop research which formulation of echinacea is good for what kind of common cold and use that money for something that actually holds some promise.

    1. Frederick says:

      “However, there are many more ways to ingest it as well”

      Like Smoking it, then having the munchies on a Cannabis-lasagna, and some pot-cake? is that what you meant, or just me having memories flash back?

      Lol sorry for the silly comments, food is a another way. And it is more potent that way, Of course people who want pain relief from cannabis do not want the High most of the time, I like to be high, but If i had to use Pot as a pain killer, I would want to be high all the time. I have a life. So I think that isolating THC and make a pill without the high-inducing effect the best option. Of course all this need lot of research.

      And you have a really good point, They should take all the money they put in NCCAM and use it for serious research on THC and CDB.

    2. CHotel says:

      As more and more new formulations of cannibas are developed by all these dispensaries, the more and more my inner compounding-pharmacist gets scared. I’m not sure if these places have personel trained in sterile-products manufacturing, if they could meet USP standards for compounding, or if they’re even aware of what any of those things are with how loose some of the regulations are. One of these days someone will have the genius idea to make an injectable, and something very bad is gonna happen from there. Or even with all these various solutions for vapourizers, there is a very, very slim but still real possibility of contaminated product causing a big batch of bacterial or fungal pneumonias. I don’t want the West Coast to have their own Mary Jane-inspired New England Compounding Center type scenario.

  23. Irreducibly simplex says:

    Tincture of cannabis used to be available in Australia for insomnia and loss of appetite.
    Followed by 2 packs of Tim Tams and falling asleep on the lounge.

  24. gina says:

    Thank you for finally writing about this. I was just wondering today what SBM thinks of medical marijuana and lo and behold, i load the website and there it is!!!

    So, I am going to offer some insight into this issue from a lay person’s view.

    I am a musician and spend a lot of time in the hippie festival scene. A great number of my close personal friends and also fans of the band that I talk to regularly are pro-medical marijuana, and constantly post graphics and articles on their Facebook walls about cannabis oil for cancer treatment among other extraordinary claims. Half the time I roll my eyes at it, because, yes it is absolutely the naturalistic fallacy at work.

    Another reason I’d like to propose that a lot of these people want to believe pot is a cureall is this. 1) they are already comfortable with the high feeling (it takes some getting used to.) and 2) their access to it is arguably better than their access to conventional medical care.

    Many of my friends and fans of my band live below the poverty line. They also trend towards anti-establishment views such as distrust of the government and the medical profession. They hold these beliefs I think due to a mixture of negative personal experiences with low-quality small town doctors that are common in poor communities, lack of science literacy, and a belief-based ideological upbringing. They are typically not insured, even under the affordable care act, because they still do not have the money for even the cheapest marketplace plans. Health insurance is not a priority for them, because they are living paycheck to paycheck and mainly trying to make rent and keep their electric turned on. As a result they are not actively connected with modern medicine. They don’t have a primary care doctor that they consult for health advice. It’s not on their radar. But they do have an internet connection and a heaping distrust for authority. They already buy pot for recreation. It’s a perfect storm. It seems completely logical to me that they would gravitate toward the naturalistic fallacy of pot medicine.

    It’s really difficult to convince them otherwise. I sometimes wonder if it’s even my place because I come from such a different background. I come from a family that prioritizes modern health care, insurance, and regular doctor visits. I went to college and became science literate. I teach biology to community college students. But the people I am close to, that I relate to on an emotional level, are among the “poor pennsylvania redneck hippie” variety. I don’t know why I love them so much, but I do. Kindest people on earth….not a shred of pretension or judgement in their bodies. But, they all really love pot and really hate the establishment. When i figure out a way to get my friends to accept science, I’ll let you know. I think this particular population is a hard sell for reasons that run so much deeper than just a need for science literacy.

    You have to ask so many questions…
    1) why do they prioritize smart phones and internet connections over health insurance and doctor visits? Why do they feel the need to “take matters into their own hands” ?
    2) why don’t they build a relationship with a qualified physican they trust? Are those kinds of doctors even available? Here in Central PA, there’s a chiropractor on every street corner but good MDs are hard to find.
    3) Why can’t my friends distinguish between good internet sources and lowsy ones ? (For example, PubMed searches or Mayo Clinic articles versus “the Libtard Show” facebook group or Natural News?)

    There’s just so much to understand about what makes a person believe what they believe.

    Sorry that was too long….I will stop now.

    Good night!

    1. Volteric says:

      Seems like many illicit drugs are the pharmaceuticals of the poor. Why is that?

      Having been prescribed many drugs for anxiety/panic disorder/depression I was surprised by how well Cannabis worked. On the one hand it works well like an anti-anxiety medication (sedation and sleep!) but it offered something that no anti-depressant did for me, namely feel well! Yes, the high, albeit slight, introduced me to states of happiness and well being–not something a depressed person is currently familiar with–and something none of the antidepressants did for me. At best they made me neutral/without emotion/zombie like. Every drug has a risk/benefit profile and I think Cannabis compared to Xanax and alcohol is relatively safe. I’ll exchange short term memory loss? (What?) for sleep and well being any day of the week!

  25. DW says:

    The comments are amusing for how many people insist they’ve never smoked it …

    1. Windriven says:

      I did. Inhaled, too. Just found it wasn’t my thing. The really good stuff made me sleepy and the rest just made me cough.

      Scotch. Single malt, neat. Now there is the one true cure for all that ails you. Not the Islays though. Too peaty. Taste like used dressings from a gangrene ward.

      1. n brownlee says:

        I smoked grass several times a day from 1967 through 1970. On the weekends I took psychedelics. The first few times I did acid, it wasn’t even illegal.

        Told you I’m old.

        1. Windriven says:

          Acid always scared the crap out of me. I don’t like feeling too far out of control. So I never did it. Sorry that I didn’t, actually. But I guess not sorry enough to make up for lost opportunities.

          1. Andrey Pavlov says:

            Sam Harris has some good stuff on his experiences with psychedelics.

            Not everyone who takes them completely loses control and all grip on reality. I don’t think there is any data as to whether it is more or less common to have a trip where all touch with reality is lost or not, but I’d imagine it has to do with the dose.

            1. Windriven says:

              It isn’t the immediate shift in perception of reality as much as the fear of a flashback at an inopportune time. And apparently some people never experience the flashback phenomenon. But then one doesn’t know until one knows, do they?

              1. DW says:

                I really wonder if much of the “flashback” lore is mythological, too (like Reefer Madness). Practically everyone I knew in college took acid, and I have never in all the (many) years since heard _anyone_ ever report having “flashbacks.” I kind of think that was just something adults were trying to scare us with … I read “Go Ask Alice” as a teenager and believed every word of it (years later it was revealed to be fictional). That was the sort of thing she described – going happily along on a summer day without a care in the world and then suddenly flipping out and waking up in the closet screaming because she thought she had maggots coming out of every orifice – that sort of thing – I just kinda think that stuff wasn’t true.

    2. Andrey Pavlov says:

      I’ve smoked it as well. In fact that stats show that a rather large percentage of Americans have at least once in their past.

      And I myself have been to the Netherlands 3 times as I have good friends there. The first time I went, they showed me around the house, told me where my room was, the bathroom, towels for me to use, the food, how to make myself coffee, and where the weed and the rolling papers were. Mind you these were both full professors at the University of Maastricht. The culture there is just very different about it. Just like how many of us enjoy relaxing with an extra glass or two of our alcohol of choice from time to time, so to the Dutch with their weed. Or to go out and enjoy it with friends. Or before dinner out.

      Interestingly it is not legal in the Netherlands. It is tolerated. Meaning that if you are being disruptive you can get busted for possession. Which is probably part of why it is so responsibly enjoyed out there (and probably also because they ride bikes a lot and have good public transportation).

      1. Thor says:

        I grew up in Germany and many summers as a teen we’d hop on a train and go to Amsterdam, mainly to smoke hash and bring some back (this was way before the marijuana boom). At age 14, on my very first acid trip, I saw Pink Floyd at the Paradiso! I slept in the small strip of green across the street. Those were heady times, to say the least. Walking into Vondelpark, one would pass the countless dealers along the entrance pathway calling out their wares, which included almost every drug imaginable. The following summer, I bought some pleasure in the Red Light District. Ahh, the halcyon days of youth.

    3. WilliamLawrenceUtridge says:

      Twice. OK, but if I’m going to get intoxicated, I’d prefer wine for the flavour. Scotch is balls BTW WD.

      My plan for my death, assuming no accident, is a massive heroin overdose at a time and place of my choosing. But I sure will miss this amazing, interesting, frustrating world. There’s so much mystery and wonder to be found.

      1. DW says:

        Good grief – I don’t think I’ve ever heard anyone with a plan of that nature for their own death … are you all right?!

        1. Windriven says:

          It strikes me as foolish not to have a plan for the eventuality of terminal debilitating disease. My wife and I even have quite specific plans for the eventuality that one of us becomes substantially incapable of acting on our own or mentally incompetent to do so.

          Should one leave such decisions to the winds of fate and circumstance?

          1. DW says:

            ok, I see.

        2. WilliamLawrenceUtridge says:

          Oh, I’m fine. But I’ve seen and heard of people locked into horrible lives that are both unpleasant and difficult for themselves and the people who take care of them. In addition, having a plan (a legitimate out essentially) actually makes people less prone to suicide because they gain a sense of control.

          No, I quite like life, and I eat well and exercise so I can prolong it in good health as much as I can. But health isn’t always good, and if I can’t die peacefully in my bed while still retaining most of my faculties and mobility, then massive heroin overdose seems like a much better way to go than a long and agonizing (or long and boring) life immobilized in a hospital bed with someone else wiping my ass while I eat through a tube.

          I also have a great plan for dealing with Alzheimer’s and the like – an implanted poison capsule with a ‘dead man switch’ that you deactivate every day. If you go a week without activating it, the assumption is you no longer know how (i.e. your cognitive decline has progressed to the point that you are not aware of context, location or time) and it busts open, killing you peacefully. You put it in when you’re coherent and are in a position to make such a decision, because by the time you’re just an empty meat sack who doesn’t know their own identity or the identity of their loved ones and just makes everyone around you sad, you’re no longer cognitively or legally in a position to commit suicide the way you would if “coherent you” were still around.

          I think it’s brilliant.

          1. DW says:

            Egads, downright diabolical. But I see the advantages. I would worry though, about some other situation where you weren’t conscious for a week, perhaps as the result of an accident? You’d better wear some kind of medical bracelet alerting emergency personnel to the presence of this capsule and asking them to deactivate it for you in such an event … Or what if you had amnesia, or were somehow physically unable to deactivate it, and you were alone and couldn’t tell anyone? If you really do this be sure your friends and family know all about it!

            1. DW says:

              Though I suppose if you were really cognitively impaired, with dementia for instance, and they put you in a nursing home, if the staff knew of it they would immediately deactivate it anyway.

            2. WilliamLawrenceUtridge says:

              I would worry though, about some other situation where you weren’t conscious for a week, perhaps as the result of an accident?

              That’s one of the first objections people raise, but think about it – if you’re in a situation where you can’t reach it for a week, chances are you’re dead anyways. If it became common, doctors would look for it as part of their routine checks when you enter the ER (some kind of mark, like a tattoo or something, could be used to indicate its presence). Same if you’ve got amnesia – you’re going to go to a doctor anyway, and they’d look for it.

              Though I suppose if you were really cognitively impaired, with dementia for instance, and they put you in a nursing home, if the staff knew of it they would immediately deactivate it anyway.

              Why? It’s like a DNR, but for cognitive impairment rather than physical injury. Ideally any nursing home that violated the terms of use for the device would, in my deathtopia, be charged for impairing patient autonomy.

              Having seen family members experience cognitive declines, having seen seriously-impaired sufferers of AD, I see this as a tremendously important unmet need. Society does not benefit from having to take care of a body whose mind has been scooped out from the inside. Family members do not benefit from visiting this empty shell. The shell itself spends its time unaware of its surroundings, unable to take care of itself, lacking dignity and often presenting a hazard to others, locked into a life it can’t enjoy or even understand. It places control in the hands of a conscious person at a time where they can make real, informed, well-thought-out decisions.

              It’s not going to happen in my lifetime, most countries can’t even have an intelligent discussion about assisted suicide, let alone premeditated death with dignity. Which is too bad. And all to what end? Who benefits from the ongoing life of someone who doesn’t know who, where or why they are?

              There’s always the possibility to cite ever-more-elaborate examples of improbable events by which it could be abused, but given the “target market” you are talking about, the same thing could be said of cars, stoves, scissors, drugs, whatever. Ever see Momento? One could argue that the example of Sammy Jankis should prevent the sale of insulin.

              1. DW says:

                I completely agree with you, but just saying, in the real world if you went into a nursing home and the staff became aware of this, trust me they would deactivate it in a heartbeat. Maybe some day we will be where this sort of thing would be respected, but at present, most nursing homes would NOT respect that. They are too afraid of being held liable if they withhold ANY form of treatment. They probably wouldn’t even admit you if they knew upfront that you basically had a built-in suicide button ready to push. From their POV, it would be more or less like letting you keep a gun under your pillow, or cyanide tablets in the bedside drawer. Granted, with this thing you could only hurt yourself, but they simply couldn’t allow it.

            3. WilliamLawrenceUtridge says:

              Also:

              Egads, downright diabolical.

              Thank you, I accept and appreciate the compliment.

              I only wish I could have worked giant mecha into it somehow.

      2. Windriven says:

        I haven’t decided mine. Horrific diseases are not common in my family so it may be moot. Most of us eventually succumb to terminal superannuated ennui and just wake up dead one morning. But in the event, Mrs. Windriven has absolutely forbade the Hemingway exit. Heroin would probably be fine but purity is never certain. Fentanyl would probably be my choice.

        1. WilliamLawrenceUtridge says:

          Obviously my first choice is on my 120th birthday, at the moment of orgasm, with Mrs. Utridge, while deatonating a nuclear warhead to prevent an asteroid from colliding with the Earth. But the vagaries of life being what they are, I’ll settle for “in my sleep in good health” if possible, followed by heroin overdose.

          Or immortality, that’s another solid option.

          1. Windriven says:

            You are welcome to my immortality lottery ticket. I love my life. But I have no desire to live forever. Besides, think about a world populated by crotchety geezers milling around the salad bar at Golden Corral when they aren’t busy chasing punks off their lawns. Pass.

            1. WilliamLawrenceUtridge says:

              In my scenario, I am an eternal young Adonis with a library card and no need for sleep. I would happily stab even you dear Windriven, in the face for a shot at being a Barbara Hambly-style vampire.

              1. Windriven says:

                No need to stab, William. I’ll happily give you my lottery ticket. With my luck I’d end up as a 57 year old Marty Feldman with dyslexia and hemorrhoids.

              2. CHotel says:

                Well hopefully the dyslexia kicks in first so that when the MD writes “hemorrhoids” on the prescription you’ll think that he’s instructing the pharmacist to “Order Him Hos”

                (Yes, I used an anagram finder)

          2. Jim Borgman says:

            Funny you mention heroine OD. I’ve heard that referenced three times in the past two weeks as a preferred method of voluntary demise. Being unfamiliar with heroine, why?

            1. WilliamLawrenceUtridge says:

              Imagine the happiest day of your life. Distill that down into a chemical extract that can flood your brain with that happiness, but multiplied thousand-fold. Heroin is pretty much literally pure chemical bliss. That’s why I only want to use it as a suicide method, because I don’t want to end up providing $5 blowjobs under a bridge to afford my next bump of a substance that provides me with an undiluted form of happiness that no real-life experience will ever match up to.

              Heroin combines this undiluted happiness with a relatively predictable and guaranteed lethality which is also pretty peaceful – it supresses breathing, so you don’t convulse to death, or bleed out, or blow your brains over a wall, or endanger others through carbon monoxide build-up (my option in the case of an apocalypse where I have no access to heroin). You basically get really, really happy, slip into unconsciousness, stop breathing and die without drama.

            2. DW says:

              I do believe heroine overdose would be a bit different from heroin overdose :)

      3. CHotel says:

        I have a similar plan, but I’ve got the place picked out already: by the open door of a skydiving plane. Do some flips and shit before slipping from consciousness and becoming a version of one of my favourite breakfast foods.

        1. Windriven says:

          Good thought, CHotel. Essentially zero chance of a failed attempt, lots of fun along the way, and a rather abrupt termination. And if one chooses the jump zone wisely, nearly zero chance of collateral damage.

          1. CHotel says:

            Yeah, safe jump zone, that’s totally part of the plan, it’s not going to be a final act of revenge at all….

        2. brewandferment says:

          be sure the aircrew are people who share your feelings about suicide then, because otherwise you are unfairly traumatizing them and using them, however tangentially. And even if they did, the actual event might still be pretty upsetting, not to mention tarnishing their sport and/or company.

          1. WilliamLawrenceUtridge says:

            Indeed, I think this approach would tend to underestimate the last-minute terror experienced. I’m going for a quiet, peaceful death as I generally avoid strong emotions as a rule.

            Except for smugness. I own the shit out of smugness.

            1. CHotel says:

              The heroin should take care of the terror.

              I guess I should have been more clear, I meant that I was going to take a ton of heroin a la WLU, but my place had been picked out as the open door of a plane. Shoot up, fall down.

              1. WilliamLawrenceUtridge says:

                Not to pick at nits, he said while nitpicking pedantically, but what would the airplane add? You’re high, so basically numb to the experience on the way down.

                I’ll stick with my nice, comfortable bed, with no prospect of watermeloning at the end.

          2. Windriven says:

            What we need are suicide booths like those on Futurama. No muss, no fuss, no cleanup on aisle 9.

      4. Thor says:

        The glorious ‘golden shot’……what a way to go!
        Interesting discussion on the thread.

        1. WilliamLawrenceUtridge says:

          That…I’d be careful about googling that particular term, you might not get quite what you expect. The exact term I’m thinking of involves more plumbing, but it might be horseshoes and handgrenades close enough to make you shut your browser really quickly.

  26. strayan says:

    Medicinal cannabis can quite easily meet stringent pharmaceutical requirements:

    https://www.youtube.com/watch?v=hE60il2pI_k&feature=youtu.be

  27. Windriven says:

    “I bought some pleasure in the Red Light District. Ahh, the halcyon days of youth.”

    And before the advent of widespread HIV. You couldn’t get me into a bordello these days with anything less substantial that a radiator hose for a condom.

    1. Thor says:

      Maybe outside of Europe, but in Amsterdam, for example, prostitution is legal.
      It is a licensed business. All prostitutes are mandated to have a monthly inspection by a medical doctor; then their card is stamped and good to go for another month.
      Your hose (flattering yourself? lol) isn’t really necessary there. Perhaps just a normal rubber.

      1. Windriven says:

        “All prostitutes are mandated to have a monthly inspection by a medical doctor; then their card is stamped and good to go for another month.”

        A month is about 30 days too long an interval for me ;-)

        ” (flattering yourself? lol)”

        The hose has thick walls but a tiny little bore. Sort of like a transformer for the modestly endowed :-)

  28. R says:

    Your post comes just in time for this ridiculous development:

    http://www.nationalreview.com/corner/381906/new-berkeley-law-will-require-free-weed-low-income-homeless-patients-molly-wharton

    “Basically, the city council wants to make sure that low-income, homeless, indigent folks have access to their medical marijuana, their medicine,” Berkeley City Council member Darryl Moore told CBS. “We think this is the responsible thing to do for those less fortunate in our community.”

  29. Jason says:

    Cannabis cancer cure is all over Facebook this week.
    http://www.lifeadvancer.com/cannabis-oil-cures-8-month-old-infant-of-cancer-dissolving-large-inoperable-tumor-in-8-months

    Just one of the dozen or so articles claiming it cures all types of cancer through apoptosis.

  30. Jason says:

    This is the other one:
    34 studies showing marijuana oil cures cancer.
    http://themindunleashed.org/2013/12/34-medical-studies-proving-cannabis-cures-cancer.html

    It’s been all over Facebook today and yesterday. Others include a father saying his baby was cured of brain cancer with it.

  31. BA says:

    There is one unquestioned source of empirical evidence for the effectiveness of access to marijuana as medicine. It cures the anxiety that comes with running out of pot.

  32. KayMarie says:

    *clicks first link in list of 34*

    Safety study (so not designed to prove cure).

    Abstract says “Median survival of the cohort from the beginning of cannabinoid administration was 24 weeks”

    Um is that what constitutes a cure these days?

    1. MadisonMD says:

      Um is that what constitutes a cure these days?

      If you are high or exceptionally credulous like Jason, then yeah sure…. after all it’s 34 studies of 24-week cures!

      1. Jason says:

        Woah woah I didn’t say I believed. All I said was my Facebook feed is swamped with this.
        Many are also in vitro studies.
        Be right back, drinking bleach because it kills cancer cells in a petri dish so it must work when I drink it too.
        I was simply giving an example of the recent surge in marijuana cure alls.

        1. KayMarie says:

          More a comment on those who post the memes mindlessly than those that report that memes are going around.

        2. MadisonMD says:

          Sorry I leaped to that conclusion, Jason. Usually such links are posted by true believers. Mea culpa.

  33. Joey says:

    You guys are hilarious. CBD marijuana clearly treats certain seizure disorders more effectively than anything else, period.

    http://www.cnn.com/2013/08/07/health/charlotte-child-medical-marijuana/

    There’s a disinfo campaign out there to promote medical marijuana as primarily a cancer treatment, which is why you highlighted it.

    1. KayMarie says:

      One anecdote is not a comparative effectiveness trial and the data are not always in other studies as good as that news report might indicate.

      1. Jessica Collins says:

        ONE? NO. MANY. http://faceofcannabis.wordpress.com/ AND Over 30K members in this group for cannabis oil… https://www.facebook.com/groups/416702921703509/

        1. WilliamLawrenceUtridge says:

          Many anecdotes are not really much better than one. Anecdotes, by their nature, systematically distort memory and reasoning.

          I want marijuana to be legalized, taxed and researched – but until the final piece is complete, I strongly disagree with any efforts to promote it as medicine.

    2. WilliamLawrenceUtridge says:

      I really, really, really hope that some of the compounds in MJ can treat hitherto-untreatable seizure disorders, so they would no longer be untreatable. Yet another reason for it to be legalized, taxed and sold like alcohol, you could being testing it scientifically for much more broad applications, and in this case find out if it’s one idiosyncratic kid’s reaction or a systemic, broadly-applicable medication. Medicine always welcomes new treatments, another arrow in the quiver.

    3. MadisonMD says:

      CBD marijuana clearly treats certain seizure disorders more effectively than anything else, period.

      In this one case it sure seems to*. We will shortly find out if it works equally well for other people suffering from Dravet syndrome That’s really a great study because, if it succeeds, it will allow these poor kids to have good treatment without the vagaries of batch-batch variation of DHC content in their medicine, and what is the optimal dose and schedule. It will also allow them to avoid risk of THC exposure– since I’m guessing that most kids don’t want to be high for the remainder of their lives.

      ———————-
      *I notice that you seem to leap to rather sweeping conclusions from single cases. Are you unaware of biologic variation in genetics, environment, and disease?

      1. Jessica Collins says:

        https://www.facebook.com/groups/416702921703509/ Go here and see just how many people are being helped by cannabis oil. How many people need to be helped before science and modern medicine get some balls and call it like it is… Cannabis was prohibited a midst a climate of fear, uncertainty and intolerance. There is ZERO scientific evidence to support its Schedule I narcotic classification. And that’s after decades of the Government funding studied to try and prove their erroneous point. Instead, these studies often backfired and exposed the benefits of cannabis. It’s only a matter of time before enough sick people learn the truth, and that science will be forced to catch up on account of the corrupt involvement it has with politics.

        1. Woo Fighter says:

          “There is ZERO scientific evidence to support its Schedule I narcotic classification…”

          There is also zero scientific evidence that cannabis can cure or prevent anything. You REALLY think weed can cure cancer?

          Got any citations? And NO YouTube videos or anything from Rick Simpson.

        2. WilliamLawrenceUtridge says:

          How many people need to be helped before science and modern medicine get some balls and call it like it is…

          Not that many, they just need to be in a randomized, controlled trial.

          Schedule 1 narcotic classification is stupid, but that stupid classification doesn’t make it a panacea and your rhetoric is way, way too clost to the rhetoric of Gary Null and Mike Adams to be taken seriously here.

      2. Jessica Collins says:

        The MANY faces of cannabis, not just one. GET POLITICS OUT OF SCIENCE. http://faceofcannabis.wordpress.com/

  34. Here is a recent article I wrote in the BMJ which chimes with your article
    http://www.bmj.com/content/348/bmj.g2737

    or else at our web site
    https://ndarc.med.unsw.edu.au/blog/should-doctors-prescribe-cannabinoids

  35. free radical says:

    More reefer madness from a spokesperson for prohibition.

    If you are interested in opposing anti-science, then you need to oppose prohibition. Period. That policy is as anti-scientific as it gets.

    It is infuriating that you call for research before legalization, but research into cannabis’ benefits is all but impossible given the bureaucratic hurdles put up for cannabis and cannabis alone. It is a classic “catch 22″: we won’t let you research cannabis, until you do more research on cannabis, which is forbidden.

    Nora volkow Trotsky is an anti-scientist. She had the audacity to say that it is the legal status, not the chemical effects of alcohol and tobacco that cause them to kill millions of people. That is patently ridiculous. No true scientist could possibly recognize her as an authority.

    Arguing against medical cannabis simply because some people will use it recreationally is a prohibitionist talking point and leads to the prison overcrowding, loss of rights, and bloody border war that we now face.

    Warning against “big cannabis” is another prohibitionist talking point. How much are they paying you? The smuggling cartels are a bigger cannabis business than would ever exist under a system of legal regulation.

    1. WilliamLawrenceUtridge says:

      I think most people here would be quite comfortable with marijuana being legalized and taxed. Indeed, Dr. Gorski said so in his post:

      Before I continue, let me just state my position on marijuana, which is different than it was, say, 20 years ago. Today, I believe there’s no reason why marijuana shouldn’t be legalized and treated by states the same way as tobacco products and alcoholic beverages are; they should be heavily regulated and taxed. Among physicians, this appears to be a common view, at least if you can believe a poll I saw a while back (for which I can’t find the link, alas).

      I kinda wonder if legalization is opposed by the drug cartels, because I think most of them would stand to lose considerable amounts of money if their products could be sold in corner stores.

      1. Windriven says:

        William, I think it is safe to assume that neither drug dealers nor DEA types want to see legalization. Both have vested interests in the status quo. Legalization, properly managed, removes much of the profit incentive for dealers. And legalization means DEA storm troopers* have to turn in their ninja suits, armored personnel carriers, and bitchin’ weaponry.

        *Mrs. Windriven once worked in a building where DEA had a floor. She would ride in elevators with DEA agents from time to time. Her stories of eavesdropped snippets of conversations removed any illusions I might have held about them.

        1. Thor says:

          Even so far, many of the growers/dealers/middlemen here in CA, have dramatically seen income decline. The market is flooded; prices have dropped; access is ubiquitous. Thus, new out-of-state markets are sought after.
          Corporations and large companies will certainly provide the bulk of product
          when legalization occurs, as is already happening. But, there will always be a cottage industry for small-scale, hand-crafted product, and exotic strains. Similar to how we consume food from farmer’s markets even though a large grocery store might be just around the corner.
          And yeah, the DEA love the war on drugs! That’s what they do.
          Awww, too bad.

    2. DW says:

      I don’t think you read the article. He did not call for research before legalization.

      1. Jessica Collins says:

        How can you? The Feds have a monopoly on allowing anyone to research anything about it. And they’re hardly generous with research grants when it comes to cannabis. No one likes to be proven wrong though, and the corrupt Feds and DEA are certainly no exception. They are hanging on to that Schedule I (a sick joke) classification with everything they have! In fact, they stand to lose quite a bit of money if cannabis prohibition ever goes away vis a vie the courts and prison systems. So, lots of people suffer and are criminalized needlessly as a result. It’s pretty insane.

        1. WilliamLawrenceUtridge says:

          Do you see your foot? You’re kinda shooting yourself in it, a little bit.

  36. Seth Katzman says:

    I am a legal medical marijuana smoker in California. I have found pot to be effective for insomnia but not so for pain. The marijuana I’ve used for pain is often quite high in CBD and almost absent in THC. There’s just no high with no THC. So, if pot is used for pain, it can be done without the “side effect” of getting high.

    1. Daws says:

      Well that’s the trouble right there, much of the analgesic effect comes from THC, in fact it’s been said a one to one ratio of THC to CBD is best. So if yours is low in THC that’s probably the opposite ratio you want for treating pain. Try for a more 1:1 strain, and at least try to go for something indica dominant. For more info: http://norml.org/library/item/chronic-pain

      Also if it’s a localized pain the best to try is something topical, that also avoids getting psychoactive effects for some reason.

    2. Jessica Collins says:

      Seth, THC is for pain relief. CBD is for anxiety and neurological issues. They are both anti-inflammatory agents and work together to provide medicinal benefit. If your condition is more pain related in the body (like MS,) you need higher THC content. If you have neurological/behavioral issues (like seizures,) you need higher CBD. Illnesses that have both pain and behavioral effects do best with an even, moderate ratio of both. If our “well intended” leaders weren’t so blind and corrupt, perhaps there would be adequate research about all of this by now. But instead, people are left desperate and guessing on how they can use this plant to their benefit when illness strikes and modern industrialized medicine fails. There is a great FB group with over 35K members, all of whom are experienced with chronic illness and cannabis oil in one way or another. It’s a great resource when you’re sick and no pill is working. You should check it out if you’re not already a member. https://www.facebook.com/groups/416702921703509/

      1. WilliamLawrenceUtridge says:

        Please stop linking to facebook. Unless you have a pubmed-indexed journal as a starting point, you are actually hurting your cause among most readers here. Even if our leaders are blind and corrupt, that doesn’t mean marijuana cures anything. If it is actually effective, and as a powerful psychoactive there is a very good chance it has many effects, then they will show up clearly in the clinical trials.

  37. Windriven says:

    ” I have found pot to be effective for insomnia”

    They don’t have C-SPAN in California?

  38. CorrectionsPharmacist says:

    My experience of politically-motivated health care decision making: some years ago, we started receiving numerous inmates from the federal system who were taking nabilone for no reason, other than they were all HIV positive, but doing reasonably well, taking their ART, no opportunistic infections, not cachectic. So I contacted the feds, saying, this stuff is $6 per capsule, and why are they giving all this nabilone to people with no indication for it? Apparently, there was this physician (now retired) who believed nabilone had “benefits” for AIDS patients. When the pharmacy, in the interest of promoting evidence-based medicine and controlling drug costs, protested that this drug was expensive and the inmates had no indication, this doctor went running to the local newspaper proclaiming that CORRECTIONS CANADA WAS WITHHOLDING DRUGS FROM AIDS PATIENTS. So he got to prescribe nabilone to his little heart’s content. Upon his retirement, this practice stopped. No deleterious effect upon HIV positive inmates was noted.

    I notice a lot less drug-seeking behaviour around nabilone and Marinol compared with the opioids.

  39. @geekpharm says:

    Today’s Twitter chat for pharmacists, #rxchat, was on this very topic and I was grateful to be able to share this link with them all.

  40. Maggie says:

    My mother is a nurse who loves marinol, she says that nothing gets a patient’s appetite back faster.

    That said, I do want pot legalized, or at least decriminalized, not because I think it is a miracle drug but because I feel that prohibition has been a spectacular failure.

    I’m a big fan of this site by the way. Keep up the good work.

    1. Jessica Collins says:

      It IS a miracle drug, when you get the correct ratios and dosage, of course. Which is practically impossible to do in the current illegal market. Just think of how many people have suffered needlessly because there is only recently very limited and inconsistent legal access. It’s hard to get the science when the Government is blocking access to research at every turn.

      1. AdamG says:

        It IS a miracle drug, when you get the correct ratios and dosage, of course.

        You don’t actually know this though. All you have is anecdotal evidence.

      2. MadisonMD says:

        It IS a miracle drug, when you get the correct ratios and dosage, of course.

        If the research isn’t done because it is illegal to do so, then how do you know it is a miracle* drug? The no-true-Scotsman clause is slick: Hey, if it wasn’t a miracle for you, then you had the ratios and dosage wrong, because we don’t know how to dose this stuff especially with the batch-specific variances.

        Your point about restrictions on marijuana in the US is well taken. However, you overstate the case. Here is good evidence that this is not insurmountable:
        (1) It has not precluded US-based research and FDA approval of THC. Oh, and here’s another FDA-approved cannaboid, for multiple sclerosis.
        (2) U.S. law does not affect research in other countries. For example, GW pharmaceuticals has been developing cannabis-derived drugs since 1998.

        *Protip: If anyone calls any drug a “miracle“, then they are either ignorant or not fully honest. Perhaps penicillin, imatinib, and sofosbuvir are close, but it would be more accurate to describe their risk/benefit without invoking ‘miracle.’

        1. Windriven says:

          “*Protip: If anyone calls any drug a “miracle“, then they are either ignorant or not fully honest.”

          Miracles imply divine intervention. I haven’t seen any gods authoring journal articles or filing patents. Maybe he’s using an assumed name.

  41. Volteric says:

    Cannabis wasn’t prohibited for scientific reasons, but political ones. It remains prohibited not for scientific reasons but political ones. It was considered a medicine by evidence based Physicians along with the AMA. It is true that it fell out of favor because of a lack of consistency/ potency due to varying genetics, but no one questioned it’s medical value.

    Since it’s being scheduled a class one (with no medical value) activists have sought to get this re-scheduled 3 times unsuccessfully so that it CAN be researched. As you pointed out there are some dubious Federal roadblocks that make research difficult and near impossible. So while I am in full support of well designed, human studies the Science can’t vet this out until the politics gets behind it or out of it– so maybe the veiled attempts at recreational legal use is forcing the well needed research around it. Not a very traditional approach but one that should have science front and center to it. I read that $9 million of the Colorado tax has been designated for research.

    1. Jessica Collins says:

      I agree completely.

  42. Daws says:

    Great to see an article on this subject, however am somewhat disappointed with the outdated assumption that it’s just being smoked, or even that what’s being smoked is always simply a dried up plant…even thousands of years ago people had hash and kief -which, ideally, that basically IS an isolation of the active ingredient (ie the crystals). Sure it’s still a number of compounds at once but it’s not just a dried up plant.

    Aside from smoking, (be it of hash, kief, buds, or left over stems scraped off the floor), there’s also edibles, teas, topical oils, and vaporizing. Just firing up a bong is so last millennium (and FYI bongs are actually the least efficient use of your stuff). Though I’ve gotten doctor recommendations, I never had a doctor recommend simply smoking it. It’s easy so I do, but the advise I had myself was to grind the leaves up and mix em into yogurt.

  43. Daws says:

    On the question of rigor, I’d like to see more of specific studies be addressed if they have flaws. I know this has been touted as being of the double-blind, randomized, placebo-controlled, FDA “gold standard” clinical trial design:
    http://cmcr.ucsd.edu/images/pdfs/cmcr_report_feb17.pdf

    Might be worth a look, the story is in legal battles we Californians came up with thus specifically to address rigor concerns.

    Lots of other mention of randomized, placebo-controlled studies pop up in here as well, http://norml.org/library/recent-research-on-medical-marijuana. It would be good to get a run down of which seem crap and which actually look good. To norml’s credit they do seem to use cautious wording at times, saying even that it’s bad for some things, like hypertension.

    Seeing the author in person speaking on the subject, Paul Armentano, he does seem of the skeptical cloth, he told an audience member he doesn’t like anecdotal evidence, he mentioned that conspiracy theories about it are bs. Even touted animal studies as being good in that they at least help develop a scientific understanding of why things work if they do (ie that he seems to most favor science-based medicine!). Personally I think he’d be a great interview on SGU.

    1. WilliamLawrenceUtridge says:

      I don’t think I’d ever trust norml to have an honest take on the situation.

    2. Jessica Collins says:

      That study was mostly for smoked cannabis, one aspect was vapor, which is still inhaled even though combustion is no longer taking place. There is zero information about ingesting cannabis in various forms. Hardly the “gold standard” for determining the benefits of medicinal use, ha. The science on cannabis is so weak and limited because of our corrupt Government’s prohibitive stance on it, which stems from a period of racism, more corruption and social stigma in the early 1900s.

  44. Dashbrook says:

    Great article. As a sufferer of years of childhood cancer I was always told to smoke. It never helped with my awful symptoms, but some I knew claimed it helped them.
    As an adult, I suffer from severe stomach issues. It is legal in my state, so I started ingesting edible cannibis. I found that problems with dosage was high, but when it worked, it worked better than any medication in relaxing the stomach, reducing pain, and reducing inflammation.
    The problem was always getting it just right for the sweet spot of pain relief with no high. I hope in the future (now even recreation is legal in my state) scientist will figure out a way to help patients suffering with stomach ailments like mine. I don’t want to be high, but I hate taking harsh pain killers. And, yes, in my experience, too much cannibis does make pain worse…another huge problem. There was a study a few years back that showed this. I wish I remember where it is. Patients getting to the sweet spot were happy and pain free, but too often they had too little or too much– both not helping pain at all.

  45. Boombotti says:

    Soooo… never tried a weed brownie or heard of Vaporizing? Also there are these great little CBD chews that could helpful. And people in Colorado working to grow CBD concentrated weed!

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