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8am. Boston. It’s predictably freezing outside. I’m trying to get my scalding morning concoction of equal parts caffeine and sugar down my gullet, so I’m able to absorb the knowledge that my medical school professor is about to drop on me. It’s day one and my first lecture of Pharmacology. He began, “Marijuana is the world’s most effective anti-emetic known to man. Anti-emetic means anti-nausea.” If it was the professor’s intent to ensure that he got our attention he succeeded.
As an author of an article on Cannabis Abuse for Medscape, I’m responsible for updating the article. As I began to update the article, I began with a literature search via PubMed. As I started to write the article and consider the topic, I started to reflect on my clinical experience and the countless discussions I’d had with clients over the years covering marijuana use. While some clients had reported negative experiences associated with using marijuana, primarily consisting of panic attacks induced by smoking, in the client population I work with the vast majority of clients reported using marijuana as a salve, self-medicating for a range of ailments including anxiety, poor sleep, irritability, lack of appetite, pain and grief to name a few. The most significant unintended and undesirable negative side effects reported by my clients has generally consisted of apathy and an increased appetite, aka the munchies.
When I first wrote the article a few years ago, the scientific literature supporting the benefits of marijuana was incredibly limited. Yet as of today, 21 states and DC have legalized marijuana for medical purposes and Colorado has become the first state to end the prohibition of marijuana. As the cultural context has shifted in the US and the legalization of marijuana seems more a question of when as opposed to if, I started to consider my experience with marijuana and thought an investigation of the benefits of marijuana was warranted.
When reviewing the literature, it’s always important to consider a variety of factors when determining how much value to place on one paper vs another. An evidence based systematic review is considered a very reliable source. Published fairly recently, the Report of the Guideline Development Subcommittee of the American Academy of Neurology provides us a Systematic review: Efficacy and safety of medical marijuana in selected neurologic disorders. You can access the paper by clicking here: Neurology-2014-Koppel-1556-63. The key takeaway from this review was that medical marijuana was found to be effective for treating MS- related pain or painful spasms. A significant number of other potential benefits were not confirmed. The takeaway from this recent review confirmed the significant dearth of substantive evidenced based research regarding the benefits of marijuana.
This begs several questions. Is there other rigorous evidence that supports the benefits of marijuana, that my brief search did not elicit? And importantly, what is entailed with conducting research on marijuana for medicinal benefit? How difficult is it really to conduct meaningful research on marijuana in today’s conflicted federal and state regulatory environment? These are just some of the questions for followup…