A recent thought-provoking op-ed in the Baltimore Sun caught my eye, as it focused on an assumption that is routinely accepted as fact: Marijuana is safe and effective for treating a wide range of serious medical conditions. This belief has helped pro-pot forces legalize medical marijuana in 37 states—compared with 19 states that have legalized adult-use recreational cannabis—and convince many states that already permit it to significantly expand the number of conditions for which a physician may certify or recommend (not prescribe) its use. For example, when New York legalized recreational marijuana earlier this year, it added Alzheimer’s disease to the list, despite the Alzheimer’s Society affirming that “there are no research studies that prove cannabis, or products such as CBD oil can stop, slow, reverse or prevent the diseases that cause dementia.”
As the op-ed points out, just because a state allows that cannabis is a medicine doesn’t mean it actually is one in the same way a medication is sold in a pharmacy by a licensed pharmacist, in a plain bottle, and with clear indications about interactions and potential side effects based on clinical trials. By comparison, colorfully packaged and whimsically named marijuana products (including Sour Diesel, Skunk Plus and Gorilla Glue) are sold in dispensaries by “budtenders” who often recommend medical cannabis products based on “personal and coworker experience” rather than any scientific knowledge or insight into a patient’s medical history, according to a recent study published in JAMA Network. What’s more, few budtenders mention possible cannabis-related risks such as psychotic episodes, cannabis-use disorder, or cannabis withdrawal symptoms, the study reported.
There are several FDA-approved cannabis-derived medications, such as Marinol to treat severe nausea caused by cancer chemotherapy, and Epidiolex for two rare forms of epilepsy. Preliminary studies along with anecdotal evidence suggest that medical cannabis products may help patients with chronic pain, insomnia, and symptoms of PTSD, depression, and anxiety. Yet the efficacy of the vast majority of the products currently on sale is not yet known. Each state has come up with its own list of approved conditions for medical marijuana, ranging from anorexia and arthritis to migraines, Crohn’s disease, and hepatitis C. State health departments make these decisions, although the criteria and approval processes vary—and these officials also regularly come under pressure from the powerful cannabis industry to add ailments in order to expand their market.
Once again, commercialization is racing ahead of science. We are at a very early stage researching medical marijuana. Long-term clinical studies are required to determine the potential benefits—and harms—of these drugs, and this would be easier if federal laws were modified to allow such studies to go ahead. Physicians need more information about these products before they counsel patients (most states only require that they take a special course). And finally, to protect consumers as legalization continues and more and more patients seek relief through medical cannabis, we need clear marketing guidelines, industry oversight, and testing procedures that are just as rigorous as for other medicines.