Therapeutic use of cannabis and cannabinoids: A review
jamanetwork.comThe abstract of the review is interesting and honestly reflects my (negative) experience with cannabis.
I admit, I really like cannabis, and when I was a 20 year old occasionally smoking with friends at parties it was a "healthier" alternative to getting wasted on alcohol. Share few joins with friends, have fun, laugh a lot.
Then as I got financially independent and I started solo consumption (mostly to get rid of stress) I really started appreciating the cons: lack of energy, disruption of sleep, negative impact of my cognitive abilities, increase in anxiety. I'm glad the study confirms those to be statistically common.
I was very lucky to have a SO who really disliked me smoking and made me realize that I was just doing it to "not think", and it had really 0 positive effects on me. I'm sure I would've quitted eventually anyway, but support and criticism sped up the reality check.
Eventually this is all anecdotal experience, and I'm sure there might be occasional users who can have a mostly positive experience, but the fact that a review points out how statistically common are the negatives and how uncommon are the positives honestly reflects what I've seen on myself and friends.
>The abstract of the review is interesting and honestly reflects my (negative) experience with cannabis.
The abstract doesn’t say anything about recreational cannabis usage.
>lack of energy, disruption of sleep, negative impact of my cognitive abilities, increase in anxiety. I'm glad the study confirms those to be statistically common.
>I was very lucky to have a SO who really disliked me smoking and made me realize that I was just doing it to "not think"
This study about the clinical outcomes of physician-directed cannabis usage for specific conditions doesn’t really get into musing about how weed is just sort of generally bad. The only part of the study that seems to sort of touch on what you’re talking about is the section about Cannabis Use Disorder
https://jamanetwork.com/journals/jama/fullarticle/2842072?gu...
At no point in this study does it say that “share a few joints with friends, have fun, laugh a lot” has common negatives and uncommon positives. It is not in the purview of the analysis.
The study directly discusses the negatives of >10mg thc doses including anxiety and insomnia.
For some patients, sometimes. There is no part of this study that says that “positives are uncommon and negatives are common” to cannabis/cannabinoid use overall as the comment I was responding to said. You would have to only read “these are some negative effects some people have experienced” and not read anything else in the study to conclude “the authors of this study that repeatedly points out the efficacy of Nabiximols are trying to tell you that cannabinoids are Actually Bad And Not Good”
Confirmation bias
Denial
Denial of confirmation bias
I'm of the opinion that the claimed negative effects of cannabis are correlations, not causations. I've yet to read a study that empirically proves cannabis causes health issues beyond those caused by e.g. smoke inhalation.
I subscribe to the r/leaves subreddit, and the vast majority of posters clearly struggle with mental and physical health, and have abused the substance for years. If you consume anything daily in high dosages it's a sign that you're using the substance as a coping mechanism for other problems in your life, which you should probably address first. And then they wonder why they feel even worse after quitting cannabis... Well, yeah, you stopped relying on something that you thought helped you, without addressing the underlying problems.
The fact that there have been no recorded deaths directly caused by cannabis in all of human history[1] should be enough indication that this is the least harmful substance we enjoy. Especially when compared to alcohol, tobacco, and most other drugs. If it helps reduce stress, boost creativity, and makes life fun, there's nothing wrong with using it responsibly. The negative symptoms you mention are highly subjective, and will depend on the person's existing health and habits.
Kurzgesagt recently published a video strongly critical of cannabis[2], and it's full of anecdata and scare tactics, similar to what you often read from personal reports. As a fan of their content, this video has significantly reduced my confidence in their research and reporting.
[1]: I'm aware of recent reports of "THC overdoses", but those have all been caused by side-effects and poor judgment.
> The fact that there have been no recorded deaths directly caused by cannabis in all of human history[1] should be enough indication that this is the least harmful substance we enjoy.
Also 0 from LSD:
"LSD at typical recreational doses (~50–250 μg) is considered to be very safe in terms of toxicity, with not a single toxicity-related death having been reported at such doses despite many millions of exposures" https://en.wikipedia.org/wiki/LSD#Overdose
2 from psylocybin which edges on statistical error, but also:
"In reality, the 2016 Global Drug survey found that psilocybin mushrooms are the safest recreational drug. Of 12,000 people who reported using magic mushrooms, just 0.2% sought emergency medical attention, at least five times less than the rate for cocaine, LSD, and MDMA." https://recovered.org/hallucinogens/psilocybin/can-you-overd...
So, even though cannabis does seem to be very safe, it's not necessarily _the least harmful_.
While that's true, I don't consider psychedelics to be within the same realm of safety as cannabis. Cannabis does have psychoactive effects, of course, but it doesn't induce visual and auditory hallucinations with the intensity that LSD, psilocybin, or even MDMA do. I do think that cannabis can make mental disorders such as anxiety worse in people who are already prone to them, but psychedelics are far more dangerous in that sense, especially with higher dosages. These effects can sometimes persist long after the effects of the substance wear off.
Also, synthetic compounds such as LSD and MDMA which have only been around for a ~century don't have the historical record of cannabis, psilocybin, and other substances found in nature, which humans have consumed for thousands of years. So to me those are intuitively less "safe".
Dosage matters. Lots of folks take psilocybin and lsd on a daily basis.
Also the weed we smoke today is absolutely nothing like historical cannabis. The potency is hundreds of times higher, depending on what they're breeding for.
> Dosage matters. Lots of folks take psilocybin and lsd on a daily basis.
Microdosing is not the same as recreational usage. Not many people take LSD or psilocybin recreationally that often. Cannabis recreational usage is much more common, with far lower health risks.
> Also the weed we smoke today is absolutely nothing like historical cannabis.
It's much stronger, but I wouldn't say it's "absolutely nothing" like historical cannabis. The way we consume it (concentrates, edibles, etc.) also makes it much more potent. But even that pales in comparison with the effects of moderate doses of psychedelics, which can have lasting psychological effects.
So, sure, dosage matters, but these substances have fundamentally different psychoactive effects.
Anecdata
This paper is very much a case of read past the abstract, especially the limitations of the study. As always it’s important for a clinician to explain the risks and current evidence when prescribing, no matter the substance. A lot of medicines have limited evidence, but they still work for some people.
Personally I use prescribed pharmacutical cannabis oils as I have much lower levels of a couple of important enzymes than most people which renders opioids mostly ineffective, even intravenous morphine as I recently found out after surgery. High CBD cannabis oil works, as does paracetamol but that’s way more dangerous.
> Evidence from randomized clinical trials does not support the use of cannabis or cannabinoids for most conditions for which it is promoted, such as acute pain and insomnia.
I think that’s the key message do the paper.
In this context, "does not support" means "the evidence is of low quality", not "the evidence says it probably doesn't work". Per the quotations in my other comment here, the paper and its references conclude that the best available RCT evidence is favorable to cannabis for those conditions. They're just not impressed with the statistical power and methodological rigor of those studies.
It's unfortunately common to report that situation of favorable but low-quality evidence as "does not support", despite the confusion that invariably results. This confusion has been noted for literally decades, for example in
https://pmc.ncbi.nlm.nih.gov/articles/PMC351831/
I'm sad to see it repeated here, and I hope we can avoid propagating it further.
>I'm sad to see it repeated here, and I hope we can avoid propagating it further.
Science educators have been fighting the scientific theory vs vernacular theory fight for decades without much progress, so I wouldn't hold my breath.
I think at some point, the scientific community needs to accept that many of the formal and precise ways they are taught to write in order to avoid ambiguity, have the exact opposite effect on everybody else. Unless we adjust the terminology so that the scientific and casual definitions more closely align, we're just going up have to keep explaining.
What would you want to write instead?
The acute pain paper they cited (linked in other comment) said "low-quality evidence [...] for a small but significant reduction", which seems clear and correct to me. If these authors think that's too favorable, then the paper I linked above suggests "insufficient evidence to confirm or exclude an important difference".
Either of those distinguishes "strong evidence this doesn't work, and more studies are probably wasted effort" vs. "weak evidence, more studies required". I don't see any benefit to a single phrase covering both cases unless the goal is to deliberately mislead.
it is very important to also remind - no amount of alcohol is ever prescribed or sold in the pharmacies. the alcohol was legalized in order to a) reverse the ill effects of prohibition which led to birth of large-scale organized crime; b) to allow regulation of substances innit, as people were dying from bad booze.
likewise, nations may have to legalize in order to regulate the contents of whatever-white-powder users may stumble upon on the street. and let us be honest - no bombs can stop the Fentanil (or rat poison for all I care) from being mixed in.
> the alcohol was legalized in order to a) reverse the ill effects of prohibition which led to birth of large-scale organized crime
This statement is historically incomplete, and geographically myopic.
Alcohol in the US was initially fully legal, then prohibited for a short period, then legalized again.
Elsewhere, laws differ, but alcohol is largely regulated but legal for adults in most (non-Islamic) countries.
Sure, sure. But this is an argument that we shouldn't have special licensing schemes subsidizing some use via tax exemption ("medical").
Doctors sometimes prescribe alcohol and in these cases pharmacies do fill these orders.
Yes, because if you're a hardcore liver-failure-in-three-years alcoholic, quitting cold turkey will kill you, and if you're in the hospital for some other issue, they will make sure you get some alcohol.
Doctors don't prescribe it to people who aren't already putting away 50 drinks a week.
I like your point that doctors prescribe things that are necessary to patients, alcohol is one of those things, and there are clear and well-understood examples of when it is medically necessary for a doctor to prescribe and administer alcohol to a patient.
I can bet they quite more often prescribe marijuana, or if you like - CBD or even THC in some cases. And historically, I've been told, the amount of morphine prescribed quite outpaces the alcohol prescriptions, right?
Example.
Poisoning by methyl alcohol.
Ethyl alcohol is ok’ish (the regular stuff), while methyl alcohol can make you blind or dead even in small amounts.
I believe ethanol is not actually often given as an antidote for methanol poisoning in modern times. It does work as a competitive inhibitor of alcohol dehydrogenase (i.e. occupying the enzyme to convert ethanol to acetaldehyde, slowing the conversion of methanol to formaldehyde and on to formic acid, which is not eliminated quickly and causes metabolic acidosis) - allowing the methanol time to leave the body through excretion, and limiting formic acid levels. However, other drugs like fomepizole also inhibit alcohol dehydrogenase with lower toxicity than ethanol.
cannabis in many varieties and cannabinoids especially the most significant naturally made potentially cheaply sourceable receptors' agonist compound delta-9-thc, when taken not occasionally, in increasingly large quantities, in extracted purified forms, at high molar concentrations (up to and over 5-10 µM) have demostrated - albeit not in many clinical settings despite numerous studies since 1974 have confirmed such potential usage - a strong antiproliferative, antineoplastic, antitumor, anticancer activity.
> Evidence from randomized clinical trials does not support the use of cannabis or cannabinoids for most conditions for which it is promoted, such as acute pain and insomnia.
I once slept in a hoodie with the hood under my back and woke up with horrible back pain, I could not sit still or focus on anything but the pain, 800mg of ibuprofen did nothing. I was about to go to the ER or urgent care when a doctor friend suggested trying cannabis, I took one small hit and was immediately pain free. I have never experienced such a dramatic medical effect in my life, one second I was writhing in pain and the next I was completely fine.
I’ve also seen videos of epileptics calming their seizures from cannabis. The autism community often speaks highly of it, how it makes them feel “normal” or more regulated. I’ve heard of stories of people getting off opioids by using cannabis. I think the people who get anxiety from it or no relief from insomnia are often taking far too much because there aren’t any good guidelines for self medicating and the guidelines they do get are from recreational users.
All I have are anecdotes, but given how obvious the effects were, I find it hard to believe there’s no medicinal value to cannabis.
Acute pain isn't discussed in detail in this paper, but here's a paper they cited:
> Conclusions: There is low-quality evidence indicating that cannabinoids may be a safe alternative for a small but significant reduction in subjective pain score when treating acute pain, with intramuscular administration resulting in a greater reduction relative to oral.
https://dx.doi.org/10.1089/can.2019.0079
For insomnia, this paper itself says:
> meta-analysis of 39 RCTs, 38 of which evaluated oral cannabinoids and 1 administered inhaled cannabis, that included 5100 adult participants with chronic pain reported that cannabis and cannabinoid use, compared with placebo, resulted in a small improvement in sleep quality [...]
It goes on to criticize those studies, but we again see low-quality evidence in favor.
In the context of evidence-based medicine, "does not support" can mean the RCTs establish with reasonable confidence that the treatment doesn't work. It can also mean the RCTs show an effect in the good direction but with insufficient statistical power, so that an identical study with more participants would probably--but not certainly--reach our significance threshold. The failure to distinguish between those two quite different situations seems willful and unfortunate here.
The full text of the acute pain paper is available via EuropePMC https://europepmc.org/article/MED/33381643
It has an interesting conclusion that says more research in to CBD rather than THC is needed and cites some papers looking in to that.
I fully accept there is pain relief value. What I wish were better studied is: what are the short, medium, long-term effects of using it at various dosages?
For example, it's pretty widely agreed that it (anecdotally) causes anxiety at higher doses - how high of a dose?
> For example, it's pretty widely agreed that it (anecdotally) causes anxiety at higher doses - how high of a dose?
Not for everyone. My understanding is that some people are more susceptible to experiencing anxiety when consuming, while others won’t even at high doses. I personally have pretty high anxiety in general, vaping <10mg of cannabis is really relaxing and makes my anxiety completely go away.
The only kind of bad experience I had was when I first tried a dry herb vape, it was maybe 1h after taking my ADHD meds and the combination resulted in the craziest out of body experience I’ve ever had (it wasn’t too bad, but pretty overwhelming at the time)
D8 and D9 cause anxiety in me (I have GAD to begin with). D10 does not.
Small sampling even just for this one participant, but ... yeah, there's a lot more going on than just "smoking weed" when you partake. The biochemistry is complex, with multiple pathways.
> short, medium, long-term effects of using it
That would require a grown up conversation and what if the results aren’t the one you want? Pretty hard for Bud, Pfizer etc to put that genie back in the bottle
I have a friend who was in a serious car accident years ago and had a broken hip. It still gives him daily pain. He has turned to cannabis to treat his pain long term and it seem to be working for him. He never describes it as "immediately eliminating the pain" or anything close to that. Really just takes the edge off so he's not as focused on his pain. It's easier to push to the background and ignore.
You do realize that your case has as much evidence that passage of time fixed your problem (or anything else that transpired) as it does for cannabis? And that is why people do randomized trials.
Agreed, but... have you ever seen someone wracked by seizures taking a hit?
The effects are stunningly powerful, positive, and immediate.
Either those videos are all lies, or the drug is powerfully affecting the issue at hand. As said elsewhere in this thread, more "adult" conversations (and legal tests) are needed.
It feels too dismissive.
While I do agree, that:
- there is a chance of something other causing the instant relief AND matching the moment of cannabis use
- health policy for population, should be made based on studies of population
At the same time, we must accept also some limitations of medical trials.
Models that interpret gathered results always includes a random part. Why? World is quite deterministic, why the randomness? Because one can’t make all possible measurements (money, sample size, time), one must choose the most promising practical setup.
Imagine hypothetical situation:
- there are 30 genotypes in population
- drug is highly effective only for 1 of those
- study doesn’t make genetic testing (also, it’s a parallel group study)
Such setup inflates required sample size to get statistically significant results. And even if significance is found, it will say that effectiveness is only 1/30, so not that good of a drug.
(30 is not the limit, think of a case with 300 types or 3000 types)
Human body is amazingly complex. It is not a solved problem.
If OP experienced instant relief of pain after smoking cannabis, it would be a logical action for OP to try it second time if pain reappears. (Given that cost/risk of such personal experiment is relatively low)
> there is a chance of something other causing the instant relief AND matching the moment of cannabis use
You forgot about selection bias here
The point is not it's impossible to deduce. The point was that without randomization even simple passage of time gets equivalent support from that experience as cannabis. People make that mistake all the time with common cold, cause they drink some special tea on day 7, get the final relief, and think that was the tea.
Yes, for subtle effects.
But if my first sip of an herbal tea immediately punctuated the end of days of coughing (by example, because I've been coughing for days), I would be less inclined to think it's a lucky coincidence.
No it doesn’t. One second I was in unbearable pain and about to go to the ER, and the next second I felt no pain. I am not the only person who has had success using cannabis for pain either.
> One second ... unbearable pain, ... next second ... no pain
This contradicts "No it doesn't".
They were stating "No it doesn't also support passage of time." An IMMEDIATE reversal of longtime conditions is rarely due to passage of time. One would quite naturally assume that something immediately prior was causative.
A substance can have pharmacological effects and still not be recommended for therapeutic use. As a hyperbolic example, suppose a substance relieved all pain for 1% of the population but caused death in everyone else. Even with a highly precise screening process this substance likely would not be administered in medicinal contexts.
That's true, but I believe the authors' complaint here is efficacy rather than safety. (I also think they're using terms of art from evidence-based medicine to make a statement the general public is likely to misinterpret, per my other comment here.)
Safety is barely discussed in this paper, probably because the available RCT evidence is favorable to cannabis. I'm not sure that means it's actually safe, since RCTs of tobacco cigarettes over the same study periods probably wouldn't show signal either. This again shows the downside of ignoring all scientific knowledge except RCT outcomes, just in the other direction.
Different countries still treat cannabis very differently, and that alone shows how unsettled the whole topic is. I don’t know the full historical reasoning behind the bans, but there must have been perceived downsides at the time. It feels like society just keeps swinging back and forth on this.
> there must have been perceived downsides at the time.
I also don’t know, but I seriously doubt there was cost benefit analysis.
My two bets would be:
- church/priests had power and they condemned most things, except for preying.
- it became widely known that opium is really obviously bad for you, after a bit of mental juggling that became “drugs are bad”, and then wholesale bans followed.
World War 1 and 2 were drug fueled. Americans saw the carnage after WW1 and instituted prohibition and then entered WW2 as the only sober participants.
The Chinese 100 years of humiliation at the hands of the Brits, was down to Opium
The fall of the medieval European dynasties was all down to Luandanum
Time and again, the unhealthy, and unregulated use of drugs has toppled empires and led to social upheaval.
Makes perfect sense if you ran a country you would be scared of it.
Correction: "laudanum", not "Luandanum". And there's no reason to capitalize that, nor opium.
Not clear why you think the Hapsburgs and the Medicis lost their reigns due to alcoholic opium use. That's a new one to me.
Edit: Also, I was unaware the Allies were uniformly under the influence (aside from the Yanks). Citation?
> there's no reason to capitalize that
> Not clear why you think
> Citation?
Are you okay?
Looked up: Luandanum is opium dissolved in alcohol (for next clueless reader)
> church/priests had power and they condemned most things, except for preying.
The misspelling of "praying" is ironically on point.
Unintentional.
Understood, but it's still a gem.
Honestly, the whole thing feels too complex to trace cleanly. Even if you try to connect the history in a linear story, any missing piece makes the rest fall apart. If people have managed to live without using these substances so far, the only safe choice is to continue not using them until we understand more. Like with CFCs, there are many things we can only evaluate clearly in hindsight.
if you honestly cannot comprehend why people might legitimately consider the use of cannabis to be a social ill (for reasons other than “they only think people should pray all the time”), you might want to stop using it for a while and reevaluate some things
OK, I'll bite.
It doesn't correlate with violent behaviors, unlike meth and alcohol. It isn't highly addictive like opioids. Users don't tend to spend their lives sedated beyond cognition, like residents of opium dens and absinthe parlors (without discussing what part of absinthe encouraged it).
I don't personally enjoy it, but ... did banning it include some reasoning beyond "Drugs are immoral!"?
You implied that I am regular user, which I am not.
The UK actually did a report into drug use a number of years ago. Professor David Nutt identified the root causes of the phenomenon you identified and was sacked for it.
As an autistic person with ADHD and PTSD, this review heavily contradicts personal empirical evidence.
That’s because the goal of these psychiatrists that wrote the study is to scare people, by using technically correct scientific terms that mislead people into thinking that their hesitation to accept “low-quality” studies is the same as their being evidence that cannabis does not work.
Or, that clinical terms like "low-quality studies" and "does not support" can be easily understood by laypeople browsing summaries of the paper by other laypeople.
You can tell what the paper is going to argue just by reading the author affiliations. They're all part of a group whose funding lines all lead back to NIDA.
NIDA’s mandate is harm. Not cognition, not performance, not any of the reasons people actually use cannabis. So of course the study leans hard on CUD and psychosis as those are the two outcomes that guarantee grant renewals. A proposal about cannabis and creative problem-solving will get immediately buried. But if you emphasize risk (especially adolescent risk, ideally with "first-episode psychosis" somewhere in the aims) then suddenly everyone’s interested.
They do the usual maneuver with FDA-approved derived substances: carve them out as clean, respectable, and clinically manageable, while treating the whole-plant as this murky, unstable mass the medical system can’t "trust." That distinction is purely commercial, not scientific. The plant itself is chaotic, but the extract with an SKU number is pure, controlled, and therefore "clinical." It’s not hard to see what this protects.
It's the exact same thing Cargill, Coca-Cola, and PepsiCo did against stevia (Rebiana) and Merck did against red rice koji (Lovastatin). The form you can just grow or make yourself cheaply is dangerous to consumers. But this patented recombination passed solely through greased palms is just dandy. This study is just another vehicle for the same move against cannabis.
Most of the authors work in addiction medicine. Their entire professional world assumes SUD as the governing model. If cannabis doesn’t sit inside that model (as in patients can just go buy it without passing through the psychiatric gate) then they lose money and clients. The conclusion section basically spells out the anxiety: clinicians must provide guidance, clinicians must set the boundaries, clinicians must interpret the evidence. That’s jurisdictional language.
Meanwhile, the practical reality is that patients get contradictory instructions: a doctor says "try cannabis" but a follow-up psychiatrist says "chronic cannabis use is a disorder." They're trying to patch that incoherence by building a moat around medicalized (and patented) cannabinoids and burning everything outside it.
The only cannabis that counts is the kind that runs through the FDA and, by extension, the institutions tied into that pipeline. Everything outside that channel is going to be treated as dangerous and destructive on purpose.
> NIDA’s mandate is harm.
That's an impressive take. In general, or were they institutionally created to destroy all people?
Weed is just cringe nowadays.
The sad thing to me, because of how it has affected, several family members, is that some smoke dope or take CBD to treat anxiety only to make things worse.
Because of how marijuana has been made nearly sacrosanct in some circles, they will not look at that THC or CBD as a contributing factor : (
The war on drugs and millions of non-violent offenders in prison does not exactly suggest to me the term "sacrosanct."
Every honest therapist looks at all components of a patient's life, and the patient, too, has a responsibility to identify what is helping and what is hurting them, or in which situations a trade-off is justified.
We will never be able to arrive at a complete and perfect answer for everyone because people happen to be individuals. However the medical profession (including therapy professions) lean heavily on generalizations to avoid the overhead of having to deal with a living, breathing individual with a history and family context, where possible.
Cannabis works great for stress for a week, then it makes things worse for me. A few weeks off, and I can take advantage again.
It is all fun and games "defending" legalization of weed online until you get a substance abuser in your family.
Alcoholics have family members, too, but we aren't going to criminalize alcohol.
As someone who was raised by aggressive alcoholics, and I have myself struggled with weed addiction in the past (and seen weed addiction in others), it's really difficult to compare the substances. Yes, weed dependence is bad and people need to be aware of it, but alcohol (and I'd even say nicotine, but that's a different subject) are far more insidious than weed
Could you elaborate on the nicotine thing? I would say alcohol is far, far, far more insidious than both nicotine and cannabis; I would also say nicotine is less insidious than cannabis.
What do you mean by "insidious"? To me the addictiveness plays a role, and nicotine outshines alcohol & THC completely in that dimension.
I guess I was considering the effects it has on other people. Sure, nicotine is far more addictive, but I've never heard of a parent being abusive because they had 1 too many cigarettes.
I guess what I mean is, nicotine is more self-contained than the others.
What's the difference? It takes years of ramping up to become an alcoholic. That's why you don't have many teenagers who are alcoholics. Weed? All it takes is one puff and you are hooked for life.
Ha ha ha ha ha! That's a good one. Now do "race music"!
Wait til their substance abuser gets locked up that’s where the fun really begins
The point of the studies was to establish a reason for people to use recreational drugs. Americans can’t be satisfied with “they’re fun” so people need to come up with a medical reason for it because “they’re suffering” is a get out of jail free card.
Everything is obviously fabricated. You think the snail darter is real? But the scientific consensus…