Issue #5 December 2019

No, I don’t mean on therapeutic cannabis in the literal therapeutic sense – but rather, in the classic literary sense – as in sharing my perspective on the topic. Some people, who are less admiring of my work, have suggested that a regimen of a calming agent might not be a bad idea just to “mellow you out a bit’. Maybe.

After all, many countries across the globe including Canada have given cannabis some degree of official status as a medicine. While legalization for medical use has not occurred at the federal level in the US, it has been legalized as medicine in many states. Across those states, cannabis has been legally approved by state entities for no less than 300 conditions. No, that is not a typo involving 2, or even 1 unintended zero. Let’s be clear: three hundred conditions. Can anyone think of any other drug in science, or even in science fiction, that has been alleged to be such a prolific intervention? How feasible is this?

First, I’ll disclose my bias. I am a strong believer in randomized clinical trials. Yes, I recognize that they are not perfect. Replication results are too low to put one’s complete faith in any single clinical trial. So, I am also a strong believer in meta-analyses and review articles. These allow us to combine the results of multiple studies on the same topic – dozens of studies, involving potentially thousands of subjects. The big picture. The proverbial forest for the trees. Meta-analyses are not perfect either. But I believe they provide the best way to understand the enormously complex world around us.

So, what do meta-analyses have to say about cannabis for therapeutic use? I found 5 such meta-analyses which all issued the same take-home message: health care providers should exercise caution when recommending cannabis for therapeutic use – for any condition. I would suggest that this advice would apply to all three hundred of them.

That said, I would not want to be insensitive to, or dismissive of, individual claims of seemingly miraculous results from the use of cannabis for some conditions. Clearly, there are some people who experience some benefit from some use of cannabis for some conditions in some situations. But from a scientific perspective (and this is what makes it tricky) there are also people who report therapeutic benefit from a placebo when they believe they are receiving cannabis. And there are people who report no significant benefit from either. And then there are people whose condition worsens when they begin a regimen of cannabis. Those who experience substantial benefit have won the lottery. I am happy for them. I would not support any measure that would deny them access. Nor would I support an industry more committed to extracting money from desperate people than it is committed to extracting genuine medicine from a plant. But that’s another topic for another day.

So, at least for now, I am inclined to resist the advice of my critics and continue to suffer from, and inflict upon others, the unpleasantness of my objectionable disposition.

Before I close, I want to mention how grateful I am for those of you who have recently joined the list for these quarterly dispatches (despite my general unpleasantness). The intention is to be brief and not to provide comprehensive treatments of a topic – just to introduce a question, share some ideas, and leave the reader with some novel thoughts to consider. If, at any time, you decide that you already have too much to read, or too many novel thoughts to consider, don’t hesitate to ask to be removed from the list. Honestly, I get it.

Lately, I am encouraged and excited by increasing numbers of invitations to speak to classrooms of students in a variety of health-related disciplines. Hopefully a new generation of care providers, investigators, educators and policy analysts will help us get it right. But I’ll talk to anyone! Invite me. Attached is my list of presentations. Some might call them unpleasant. I prefer “provocative”.