My opinion about medical marijuana has been fairly consistent. First, the claims made by its advocates for it far exceed the evidence for its benefit, which is why I’ve referred to it as the “new herbalism.” Of course, it’s not really very new, but it is herbalism in that medical marijuana advocates make grandiose claims for using their favorite “drug” in its plant form rather than doing the standard thing that modern medicine does with natural products and try to isolate the active compounds, in this case a class of molecules known as cannabinoids. Second, although medical marijuana might have some minor utility in relieving the symptoms of chemotherapy in cancer patients, contrary to the claims of people like Rick Simpson promoting hemp oil as a cancer cure, his believers who provide anecdotes, and a large number of advocates who believe it is the next big thing in treating cancer, cannabis does not cure cancer. The bottom line: Purified cannabinoids have some promise for medicinal uses, but medical marijuana itself has little evidence to support its use and serves mainly as a politically palatable “foot in the door” for advocates to get their favorite drug legalized, and I say this as someone who thinks that marijuana should be legalized for recreational use.

I hate to say, “I told you so,” but I told you so. No, wait. I love to say “I told you so,” at least when the evidence is on my side. This time, it comes in the form of a systematic review and meta-analysis hot off the presses yesterday in JAMA looking at medical marijuana. Not surprisingly, the story’s made the national news, including NPR, New Scientist, and Reuters. Amusingly, the headlines and emphasis varied rather widely. For instance, NPR’s story was entitled Review Raises Troubling Question About Marijuana’s Safety, Effectiveness while livescience reported Medical Marijuana: Review Shows Pot Helps These Conditions. This latter headline is known as looking at the glass as half full (possibly through a haze of pot smoke) while the former was perhaps a more accurate statement of the studies findings. Even The Cannabist produced a headline Study: Medical pot unproven for many illnesses OK’d by state law.

Let’s dig in.

The study is by Penny Whiting and colleagues at the University of Bristol and entitled (appropriately enough) Cannabinoids for Medical Use: A Systematic Review and Meta-analysis. Let’s just say that Whiting et al failed to find much in the way of compelling evidence supporting the use of medical marijuana for most indications, and, even for the indications for which there was positive evidence, it wasn’t the sort of evidence that would exactly blow most doctors away. Overall, they examined 79 randomized clinical trials found through the following schema using the guidance published by the Centre for Reviews and Dissemination and the Cochrane Collaboration looking at either medical marijuana or various cannabinoids, such as dronabinol and nabilone, for a variety of indications. These trials compared cannabinoids with either usual care, placebo, or no treatment for the following indications: nausea and vomiting due to chemotherapy, appetite stimulation in HIV/AIDS, chronic pain, spasticity due to multiple sclerosis (MS) or paraplegia, depression, anxiety disorder, sleep disorder, psychosis, intraocular pressure in glaucoma, or Tourette syndrome. These indications were prespecified. If no RCTs were available for a particular indication or outcome (eg, long-term AEs such as cancer, psychosis, depression, or suicide), nonrandomized studies including uncontrolled studies (such as case series) with at least 25 patients were eligible.

If you want to get an idea of just how crappy the evidence base is, take a look at the description of the methods and characterization of the studies:

The searches identified 23,754 hits (records) of which 505 were considered potentially relevant, based on title and abstract screening, and obtained as full-text studies. A total of 79 studies (6462 participants), available as 151 reports, were included; 3 studies (6 reports) were included in multiple indication categories (Figure 1). Thirty-four studies were parallel-group trials (4436 participants), and 45 were crossover trials (2026 participants). Four studies were available only as an abstract, a further 3 were available only as abstracts but with additional details available on trial registries including full results in one, and details of 2 trials (including full trial results) were available only as trial registry entries; all other trials were reported in full-length journal articles. Where reported, the proportion of participants who were men ranged from 0% to 100% (median, 50% [57 studies]), and the proportion of white participants ranged from 50% to 99% (median, 78% [18 studies]). Publication dates ranged from 1975 to 2015 (median, 2004 [with one-third of trials published before 1990]). Studies were conducted in a wide range of countries. A variety of cannabinoids were evaluated and compared with various different active comparators or placebos; most active comparators were included in the nausea and vomiting indication …

Four (5%) trials were judged at low risk of bias, 55 (70%) were judged at high risk of bias, and 20 (25%) at unclear risk of bias (eAppendix 13 in Supplement 2). The major potential source of bias in the trials was incomplete outcome data. More than 50% of trials reported substantial withdrawals and did not adequately account for this in the analysis. Selective outcome reporting was a potential risk of bias in 16% of trials. These studies did not report data for all outcomes specified in the trial register, protocol, or methods section or changed the primary outcome from that which was prespecified. Most studies reported being double blinded but only 57% reported that appropriate methods had been used for participant blinding and only 24% reported that outcome assessors had been appropriately blinded.

In other words, the vast majority of the trials were not RCTs of sufficient rigor to be included in the meta-analysis. Of course, this is typical for most meta-analyses, which often start with hundreds of studies and end up with a few dozen at most. However, in this case, only a tiny minority of studies were sufficiently well-designed to be at low risk for bias, and over 2/3 of the studies were at high risk of bias for a wide variety of reasons, including sloppy double blinding (a huge problem). Just as bad are selective outcome reporting and potentially even worse is changing the primary outcome from the prespecified outcome, which is all too often used to “massage” the data to produce a positive result when the result for the prespecified primary outcome turns out negative.

There’s a lot of information in the meta-analysis, but it can be fairly quickly summarized thusly. The authors basically looked at various indications for cannabinoids and then rated them according to GRADE (Grading of Recommendations Assessment, Development and Evaluation) to evaluate the overall quality of the evidence for risk of bias, publication bias, imprecision, inconsistency, indirectness, and magnitude of effect. GRADE ratings include very low–, low-, moderate-, or high-quality evidence reflect the extent to which the authors are confident that the effect estimates are correct. Interventions were further subdivided into different cannabinoids tested. Most of the studies examined isolated cannabinoids.

Overall, most studies showed some improvement of symptoms with cannabinoid use compared to control groups, but most didn’t reach statistical significance and the effect sizes tended to be small to moderate. For example, here are some of the findings:

  1. Nausea and vomiting due to chemotherapy: OR 95% confidence level, 3.82 (1.55 to 9.42) for nausea and vomiting, complete response; GRADE: Low.
  2. HIV/AIDS weight gain: OR 95% confidence level, 2.2 (0.68 to 7.27) for greater than 2 kg weight gain over six weeks; GRADE: Low.
  3. Chronic pain (neuropathic and cancer): Low to moderate evidence of efficacy by GRADE.
  4. Spasticity due to multiple sclerosis or paraplegia: Low to moderate evidence of efficacy by GRADE.
  5. Depression: Evidence favors placebo, but GRADE is very low.
  6. Anxiety disorder: Evidence favors cannabinoids, but GRADE is very low.
  7. Psychosis Evidence favors cannabinoids, but GRADE is low.
  8. Tourette’s syndrome: Evidence favors cannabinoids, but GRADE is low.

Just to give you an idea, here is a graphical summary of the effect of cannabinoids on pain. If the error bars overlap zero, then the effect is not statistically significant.

Improvement in Pain Odds indicate 30% or greater improvement in pain with cannabinoid compared with placebo, stratified according to cannabinoid. The square data markers indicate odds ratios (ORs) from primary studies, with sizes reflecting the statistical weight of the study using random-effects meta-analysis. The horizontal lines indicate 95% CIs. The blue diamond data markers represent the subtotal and overall OR and 95% CI. The vertical dashed line shows the summary effect estimate, the dotted shows the line of no effect (OR = 1).

Improvement in Pain
Odds indicate 30% or greater improvement in pain with cannabinoid compared with placebo, stratified according to cannabinoid. The square data markers indicate odds ratios (ORs) from primary studies, with sizes reflecting the statistical weight of the study using random-effects meta-analysis. The horizontal lines indicate 95% CIs. The blue diamond data markers represent the subtotal and overall OR and 95% CI. The vertical dashed line shows the summary effect estimate, the dotted shows the line of no effect (OR = 1).

In other words, the evidence is reasonable, but by no means a slam dunk, given the methodological difficulties with the studies.

It was also noted that, like all drugs, cannabinoids have a risk of adverse events (AE):

There was an increased risk of short-term AEs with cannabinoid use, including serious AEs. Common AEs included asthenia, balance problems, confusion, dizziness, disorientation, diarrhea, euphoria, drowsiness, dry mouth, fatigue, hallucination, nausea, somnolence, and vomiting. There was no clear evidence for a difference in association (either beneficial or harmful) based on type of cannabinoids or mode of administration. Only 2 studies evaluated cannabis.59,77 There was no evidence that the effects of cannabis differed from other cannabinoids.

Again, cannabinoids, be they isolated and purified by a pharmaceutical company or as part of a burned plant being inhaled, are drugs and can thus cause adverse events. There is nothing magical about cannabinoids or medical marijuana, but, all too frequently, in the heartbreaking anecdotes used to support the legalization of medical marijuana, the weed (or the oil extract thereof) is portrayed as a miracle cure. Witness the case of Stefanie LaRue, for example, or the case of Charlotte Figi.

In an accompanying editorial, Deepak Cyril D’Souza and Mohini Ranganathan ask if medical marijuana is “putting the cart before the horse.” They point out that for most of the indications that states are legalizing medical marijuana for there is little or no evidence that cannabinoids are efficacious in relieving symptoms and virtually no high quality evidence. In addition, they observe that the FDA requires evidence from at least two well-designed randomized clinical trials before it will approve a drug for a given indication and that for the vast majority of the conditions for which states have legalized medical marijuana the evidence doesn’t come close ot meeting that standard, being mostly anecdotal.

Indeed, to that I’d add that usually it’s seemingly compelling testimonials, far more than anything, that drive legislators’ approval of medical marijuana. Another problem is that, unlike most FDA-approved drugs, whose active components are well-characterized and few in number (usually one), marijuana is “a complex of more than 400 compounds including flavonoids and terpenoids and approximately 70 cannabinoids other than Δ9-tetrahydrocannabinol (THC),” that “results of studies with individual cannabinoids (eg, THC or CBD) cannot be extrapolated to marijuana and vice versa,” and that “unlike FDA-approved medications that have a relatively uniform composition, the composition of cannabis preparations can vary substantially in its content of THC and CBD, such that precise dosing may be difficult.” As I said, it’s the same problem that herbalism has compared to purified natural products. D’Souza and Ranganathan rightly wonder why there is a double standard, with medical marijuana being held to a much lower (practically nonexistent) standard of evidence. If that standard of evidence that would provoke howls of outrage—and rightly so—if applied to approval of drugs produced by big pharma.

None of this is to say that there might not be indications for which cannabinoids will be safe and efficacious. Arguably, this meta-analysis suggests two of them, chronic pain and spasticity, and as I’ve discussed before there is some evidence for epilepsy. However, as is the case with much advocacy-based, rather than science-based medicine, the claims far outweigh the actual scientific and medical promise. Then, as D’Souza and Ranganathan note, there’s this:

In conclusion, if the states’ initiative to legalize medical marijuana is merely a veiled step toward allowing access to recreational marijuana, then the medical community should be left out of the process, and instead marijuana should be decriminalized. Conversely, if the goal is to make marijuana available for medical purposes, then it is unclear why the approval process should be different from that used for other medications.

Which is what I’ve been saying all along. If pot should be legalized, just legalize it, and stop the charade that it’s all for medical indications.

Coincidentally, the other day I was involved in a discussion where a graduate student described a lecture in ethics and law she attended in which the professor said that the law always follows the science. That’s not true at all. The law frequently puts the cart before the horse, as it has done in many states with mandatory breast density reporting laws and as it is doing with medical marijuana laws, both cases where the law has gone far beyond what the science can support. Unfortunately, although D’Souza and Ranganathan recommend putting the horse back in front of the cart, once the law goes beyond the science it’s rare that it can be put back. That’s because, more often than not, in politics a heart-rending anecdote will trump cold science.

Comments

  1. #1 c0nc0rdance
    June 24, 2015

    Two argument I am especially tired of:

    1. The conflation of therapeutic use and recreational use for the purposes of making an argument for legalization. We allow hydrocodone to be used therapeutically, but still restrict the sale and use for recreation. Even if cannabinoid drugs or cannabis itself is approved for medical use, that’s independent of the question of whether it should be legal to manufacture, sell for recreational use.

    2. The comparison of cannabis to alcohol and tobacco, both of which are legal but cause more illness/injury. We didn’t legalize alcohol and tobacco because we realized they were harmless substances: we just no longer have the capacity to do anything about them. They represent a huge disease burden and cost us billions per year in medical costs, life years lost.

  2. #2 Stella B
    June 24, 2015

    I predict that there will be a lot of angry responses to this post.

    My observation has always been the same. People who enjoy cannabis recreationally find that it helps their back spasms, social anxiety and the like. People who don’t use it recreationally, but try it for chemo nausea or chronic pain always complain that it has “too many side effects”.

    It should be decriminalized for recreational use with the understanding that there are dangers associated with it. However, it’s not a potential medical miracle.

  3. #3 Horatio
    Toronto
    June 24, 2015

    There has to be a more eloquent way of expressing it, but the proponents and opponents of legalization of marijuana are absolutely right about each other in a roundabout way.

    Proponents of legalization favour medicalization because they know it’s the most effective backdoor method for legalization for recreational use.

    Opponents of legalization oppose medicalization because they know it’s the most effective backdoor method for legalization for recreational use.

  4. #4 Eric Lund
    June 24, 2015

    We didn’t legalize alcohol and tobacco because we realized they were harmless substances: we just no longer have the capacity to do anything about them.

    In the case of alcohol, we tried the experiment (it was called Prohibition). It was a spectacular failure, and one of the major arguments in favor of legalizing cannabis for recreational use is that cannabis prohibition has been failing similarly for several decades now. There are countries which prohibit or severely restrict alcohol consumption (mostly in the Muslim world; the Quran forbids Muslims from drinking wine, and implicitly other alcoholic beverages), but from what I can see, many people in these countries who might otherwise be alcoholics find other ways to get high (khat, tobacco, etc.)

    Tobacco in the US is a different story. We haven’t prohibited tobacco in this country, but sales and use have become increasingly restricted. More importantly, smoking tobacco is no longer considered cool in the US, in contrast to marijuana (many musicians have been famous users) and alcohol (many consider US drinking age policy to be counterproductive, but that’s a separate rant). A big part of this is the public recognition that using tobacco is harmful, and the upside in social terms is less than one gets with alcohol or, presumably, marijuana. Tobacco is more of a problem in other countries, where it is still considered cool.

  5. #5 Dangerous Bacon
    June 24, 2015

    While pot’s medical benefits have been way overstated, I wish more drugs listed “euphoria” as a side effect.

  6. #6 Mike
    June 24, 2015

    Coincidentally, one of my friends is at Senate hearing today on “Cannabidiol: Barriers to Research and Potential Medical Benefits”.

  7. #7 GregH
    June 24, 2015

    Concordance: “2. The comparison of cannabis to alcohol and tobacco, both of which are legal but cause more illness/injury. We didn’t legalize alcohol and tobacco because we realized they were harmless substances: we just no longer have the capacity to do anything about them. They represent a huge disease burden and cost us billions per year in medical costs, life years lost.”

    The same is the case for Cannabis, we have no capacity to do anything about its recreational use. The difference being that it has a much lower disease burden compared to alcohol and tobacco. So comparing them actually makes perfect sense. In each case we are talking about a substance where the costs of prohibition are unacceptably high and said prohibition is/would be exceptionally ineffective. The differences that do exist, lower disease burden and lower addiction potential, work to illustrate that by the logic under which tobacco and alcohol are legal, cannabis for recreational use should be as well. Indeed, those differences demonstrate that if you had to choose just one of the three to have be legal and to ban both of the other two (starting with a societal blank slate, i.e. starting from a position of no current users), cannabis would be the legal one.

  8. #8 shay
    June 24, 2015

    I wish more drugs listed “euphoria” as a side effect.

    Is chocolate a drug?

  9. #9 Orac
    June 24, 2015

    I predict that there will be a lot of angry responses to this post.

    Oddly enough, after the last few days of 100+ comments/post, there don’t seem to be very many responses at all to this post. I must admit, I’m somewhat surprised. I guess pot isn’t as interesting as vaccines, the Nation of Islam, Scientology, trying to insinuate religion into medicine, etc.

  10. #10 c0nc0rdance
    June 24, 2015

    @Orac
    This has become a “10 foot pole” issue in our community because support for legalization is high among progressives, but many skeptics can sniff the propaganda coming from both sides, and don’t want to charge into a debate that is largely free of reliable facts. What I have read from the peer-reviewed literature lines up very well with what you discuss here.

  11. #11 Orac
    June 24, 2015

    OTOH, my e-mail load is much lighter today. (I get an e-mail notification every time someone posts a comment.) 🙂

  12. #12 Dave W.
    June 24, 2015

    I’ve generally been in favor of legalization, while recognizing that there are legitimate concerns about some of the possible social consequences (which I acknowledge, I just think that the known consequences of the status quo are really bad.) One advantage of this sort of “half-legalization” as an intermediate step/social experiment is that it provides the rest of us with an idea of what the social consequences of legalization might be without having to adopt full-fledged “anything goes” legalization that would be hard to take back if it turned out to have really bad consequences. If people can gather at that nice medical dispensary down the street for their daily joint without causing problems for the neighbors, maybe we can scale that up to “anyone who wants to” instead of just people with prescriptions.

    So far, it looks like most of the social problems associated with dispensaries are related to distribution still being primarily a cash-only business (and hence a target for criminals), which could be addressed by clarifying legal status for distributors and giving them better access to the banking system. I still don’t want to see pot corporations advertising like cigarette companies, but it looks like most of the potential problems with legalization are solvable if there is the political will to do it.

  13. #13 Denice Walter
    June 24, 2015

    ” My e-mail load is much lighter today”

    So I imagine that marijuana has become less controversial and/ or supporters are much too mellowed out to respond.

    At any rate, whilst I do not partake ( and I only did so when university friends offered- rarely afterwards), I would hope that it becomes legal as a recreational drug, taxed, regulated, sold in shops, stimulating local economies and enriching proprietors. Then if some people find it ‘helps’ them, they can use it as they will. Unfortunately, the TMs believe in its medicinal effects for autistic children and lobby for medical use: one, Tex, is currently very active in changing laws in Texas.

    HOWEVER as one who has traipsed around various international hipster/ hippie enclaves for at least 3 decades, I find that I am intrigued by the continuously evolving culture surrounding the magical weed amongst creative folk and their admirers. There’s that certain * je ne sais quoi* that announces, ” Cannabis is prevalent here” whether it involved rock music in the seventies or Back-to-Nature folk today- I can just TELL. Nothing medical about that part of it.

    ACTUALLY I believe that many of Orac’s minions/ readers have visited these havens and have as many tales to tell as I have. And right, I’ve been to Potter Valley in Mendocino.

  14. #14 Tim
    a place with a name that supposedly means "We can rest here" -- They keep using that word; I do not think it means what they think.
    June 24, 2015

    I guess pot isn’t as interesting as vaccines, the Nation of Islam, Scientology, trying to insinuate religion into medicine, etc.

    Well it is interesting to me but there is this horrible feeling of ‘too little too late’ in basing the prision-industrial complex on something besides cannabis prohibition.

    I feel ‘Moses-like’ in not being able to enter the promised land because I was bitter and thrashed and trashed about beforehand.

    I “threw it all away” over peeking behind the curtain and subsequently not being able to function in a society which ran on ‘reefer madness’ lies — Corrupted institutions interning the able, the meek, the thinker, the pot smoker. It’s what was good for DuPont. It’s what was good for wood pulp-based paper companies and the publishing houses that held stock there, drug companies, centralized energy conglomerates, and synthetic-based textiles. It is what was good for the petro dollar —

    …They poured a bucket of tar on top of a flower; Somehow, I knew they’d try it…

    — Drivin’ ‘n’ Cryin’
    https://www.youtube.com/watch?v=9I0dknDTnTk

    Tying cannabis as ‘medicine’ will only lock it away behind a prescription paywall/sign-your-soul-away for access. Dosages will be ‘standardized’. The pigs will be scanning your trash and stash to make sure it only contains Eli Lilly approved strains.

    ‘SBM’? It needs to be disassociated with Big Pharma, Big red states, and Big blue states.

    It is a trust issue now again. Science based, or not, at the end of the day, I don’t want authoritarians to tell me what I can not put into my body while telling me what I must put there. It is just not good medicine.

    p.s. 400 chemicals in cannabis? There are 600 in your average cup-o-Joe.

  15. #15 Mike Callahan
    Lake Tahoe
    June 24, 2015

    Interesting, like acupuncture, you can’t do a double blind placebo controlled cannabis experiment.
    Caution… Anecdote coming…. I used dronobinal after chemotherapy and feeling stoned was unavoidable. I came to prefer Zofran for nausea.
    Now I have chronic neuropathic pain from the drugs I take post stem cell transplant. To help enable me to walk I tried a lot of different pain meds and opioids worked the best. The constant increase in dosage to achieve the same effect was discouraging and I eventually tapered off opioids.
    Drugs that are used for pain seem to be the ones that get the most peoples panties in a bunch when used for recreation. Just my opinion but I think cannabis was originally discovered for it’s use for pain. It is not as effective as opioids but there is an effect. The problem is the euphoria that goes with it. Not all of us enjoy being stoned. I do though. The side effects for me are talkativeness and giddiness. The pain relief so far can’t be separated from the euphoria. The good thing is that the dosage does not have to be constantly elevated to reach the same effect.
    Another good thing about cannabis is that no one has ever overdosed and died from cannabis. I searched the LD50 for cannabis and you would need to smoke about a truckload in 15 minutes to die from it.

  16. #16 Jen Phillips
    Twelve hippies high
    June 24, 2015

    Full disclosure: I’m writing this from Eugene, Oregon, where medical marijuana ‘clinics’ are on every block and recreational use will be officially legal in one week’s time. I doubt we’ll notice much of a difference, to be honest.

    I agree completely with what Concordance said @#1. Those are the things that have rankled me greatly about the legalization efforts that attempt to legitimize having the stuff around for useful therapeutic reasons. I welcome recreational legalization precisely because it will, hopefully, deemphasize that message to some degree.

    Interestingly, the legalization vote and enactment thereof has preceded any sort of structure for distribution or taxation. Come July 1st, you’re allowed to possess a reasonable ‘personal use’ amount, and/or up to 4 plants, but you’re not allowed to buy or sell it *unless* you have a medical card/license to dispense by Rx.

  17. #17 c0nc0rdance
    June 24, 2015

    The LD50, inhaled, rat of THC is 42 mg/kg (Merck Manual). For a 75 kg adult, a scaled LD50 is therefore 3.15 grams. That’s less than a teaspoon of THC. Cannabis ranges from 1% to 25% THC content, but 5% is a round mid-range figure. At 5% THC, a scaled lethal dose is 63 grams, or 2 ounces of plant material.

    If ingested orally or eaten, the LD50 is around 500 mg/kg, so 75 kg adult scaled LD50 is 37 grams of THC which would be 740 grams of cannabis at 5% THC, or 22 ounces.

    Not exactly a truckload. This also assumes 5% THC content. No, you don’t have to smoke it in 15 minutes, either. THC is 100% converted to active metabolite over the course of an hour, and clearance of the active metabolite may take more than 4 hours in normal, healthy users.

  18. #18 palindrom
    June 24, 2015

    c0nc0rdance @17 — It’s good to have the numbers, but I think Mike @15’s larger point was that the lethal dose of cannabis is so large that there’s essentially no danger of overdosing in practice.

  19. #19 Kiiri
    June 24, 2015

    I think that if you want pot to be medicine, then it needs to be studied like, well, medicine. Which means isolated purified compounds and thorough studies. It seems there are some indications that cannabinoids can have a therapeutic effect for some conditions. I prefer my medicine to come in a standardized format personally rather than a pile of leaves that may or may not contain the active ingredient desired in the desired quantity. As for legalization, I think it should be legal for personal use. I find it less objectionable in many ways than alcohol and tobacco. I have met many obnoxious drunks, and very few obnoxious stoners. If people want a glass of wine on the weekend or a joint hey who am I to judge? I like a good glass of wine myself, and if legal would probably have a joint occasionally as well.

  20. #20 JustaTech
    June 24, 2015

    Jen @16: Hey there southern neighbor! Up here in Washington we did pretty much the same thing. Legalize, then figure out all of those pesky regulations.

    The recreational shop that opened up a neighborhood over has really improved the whole intersection. Now there are food trucks and nice lighting, where there was a fire-bombed quick-food joint and creeps. They might even sell *less* weed on that corner now.

  21. #21 Panacea
    June 24, 2015

    Considering doing any kind of marijuana research is difficult because permission is rarely granted, and all marijuana for testing must be obtained from a single farm in Alabama (IIRC), it’s hardly surprising that the results are what they are. The pot generally available for sale is considered more potent (though what compound makes it so is up for debate).

    So my question is, did the studies in the meta analysis control for that?

    I certainly agree much, much more research is needed. But I don’t think what we have is enough to make any conclusion one way or another.

    I also think the side effects and risks are way understated by its proponents. Those risks should be made clear, and use of marijuana as medicine should not be a back door for recreational use.

    And while I know this is mere anecdote, I’ll share it anyway. My sister has horrible fibromyalgia. One minute she’s fine, but if she overexerts herself the slightest bit she can hardly move after that, and is in terrible pain.

    She didn’t want to take opioids because she doesn’t want to sleep her life away or be in a stupor, and she doesn’t want to get addicted. NSAIDs weren’t working. Acetaminophen doesn’t work. So I suggested she discuss Marinol with her doctor. He agreed to write the prescription.

    It works for her. So she got curious about what kind of effect pot would have on her.

    I discouraged it, mostly because I think smoking pot is just as dangerous as smoking tobacco. She persisted. Finally I told her, fine if you gotta try it, then at least vaporize it! Don’t smoke it. And for God’s sake don’t get caught!

    She decided to wait until a planned trip to Spain, where it is legal. According to her, she gets a better effect from marijuana than Marinol. But she has to be careful about potency. Too strong and she sleeps all day, which she doesn’t want. Too old or weak, and it doesn’t work as well as the Marinol.

    She’s actually a big advocate of the scientific method, and not at all into woo. Her feeling on the matter is medicine needs to do more research on to the wide variety of pot strains to figure out what works and why so it can be synthesized into a medication that will have consistent and predictable effects. She believes it’s one of the other compounds than THC that is responsible.

    In the meantime, she keeps some pot on hand for the days when the Marinol doesn’t quite work for her pain. And I continue to pray she doesn’t get caught.

  22. #22 JustaTech
    June 24, 2015

    Panacea @21: I’m pretty sure that the review looked at studies from all over the world, so that might start to address the single-source problem.

    The University of Washington has several researchers who would like to do some rigorous testing of pot, but they’re waiting on pre-approval from the federal government (Justice Department). The university can’t risk losing their federal funding, which is a big part of why there isn’t a lot of independent research in the US yet.

  23. #23 Tim
    June 24, 2015

    and all marijuana for testing must be obtained from a single farm in Alabama (IIRC)

    You did not recall correctly sir. All the ‘marijuana’ for research is from Mississippi.

  24. #24 MarkN
    June 24, 2015

    Why must the mighty Orac kill my research buzz, man…

  25. #25 Panacea
    June 24, 2015

    Close but no cigar. Knew it was in the Deep South. 🙂

  26. #26 Garou
    Québec, Canada
    June 25, 2015

    I don’t get all this dancing around the issue of legalizing recreational use of marijuana. There are literally no arguments to justify keeping it illegal.

    Funny thing is you can talk with someone who is for the legalization of marijuana for recreational use who will happily make comparisons to what the prohibition did for alcohol, but when you start talking about legalizing anabolic steroids for recreational use, then they go on the defensive and say “woa that’s not right mang, that’s not good for your health blblblblblbl”.

  27. #27 llewelly
    June 25, 2015

    c0nc0rdance:

    We didn’t legalize alcohol and tobacco because we realized they were harmless substances: we just no longer have the capacity to do anything about them.

    This is not true. Regulation to reduce drunk driving and many other under-the-influence uses of heavy equipment has been highly successful, if imperfect.

    Likewise, heavy regluation of smoking advertisements have greatly reduced smoking.

    Allowing recreational use does not mean “we lack the capacity do anything”. There are many other potential approaches.

  28. #28 has
    June 25, 2015

    Stella B@2:

    I predict that there will be a lot of angry responses to this post.

    I AM ANGRY THAT YOU ARE COMPLETELY RIGHT AND THAT I TOTALLY AGREE WITH YOU TOO!!!!1!1!!

  29. #29 Gray Squirrel
    June 25, 2015

    Orac, not to sound critical or anything, but if that picture is what you think of as modern marijuana, no wonder you haven’t gotten 100 replies!;-) For a look at the “good stuff,” get on Ixquick.com and click Picture search and type in the phrase “fluffy green buds.”

    Seriously though:

    I agree with you that herbal marijuana is basically a form of herbal medicine with all the shortcomings of variable quality and dosage. That said, people rapidly become proficient at finding strains and dosages that provide their desired results, so it’s hardly in the same league as Maoist herbs that contain lead and arsenic.

    As one of the key medical claims is alleviation of nausea, and another is relief from cluster headaches where every second counts, pills are out of the question for many patients. Pharmaceutical cannabinoids should be produced in an inhalable form, and this should be a goal for Big Pharma after recreational marijuana is legalized nationwide so there are no further barriers to research.

    Re. blinding of studies: Would require very naive Ss and an active placebo such as a phenothiazine tranquilizer. I would add the step of having every S guess whether s/he got the cannabinoids or the phenothiazine, and run a second analysis where the Ss who guessed right were factored out. At that point we’re talking N = large, so someone is going to have to write one heck of a check to pay for that study. Not to mention all the hoop-jumping to get permissions.

    Anecdotes != data, but I know of two people who have used marijuana successfully to deal with nausea from chemo, and one for whom it’s the only thing that stops his cluster headaches, which it does in _seconds_. The latter person occasionally smoked it recreationally once in a while, so he did not need a medical basis as an “excuse.”

    What I’d do about all this:

    Uniform age of 18 for access to all legal recreational drugs: alcohol, tobacco, cannabis, and yes, caffeine.

    The age-21 experiment for alcohol has failed miserably by causing a pandemic of binge-drinking on college campuses, and a commensurate increase in hospitalizations and deaths from overt alcohol overdose. Age 18 enables parental socialization of substance use, which will reduce collegiate alcohol abuse to its earlier (lower) level and prevent an outbreak of marijuana abuse.

    The fact that caffeine is added to sodas that are promoted to children is frankly insane, as are the coffee shop drinks that look (and presumably taste) like milkshakes, and I have no doubt it is the real “gateway drug.” (But let the kids have chocolate, as the quantity of caffeine in it is low enough to not be noticed amidst the sugar buzz. Alternately, put all high-sugar foods on the over-18 list of social drugs as well.)

    Restrict advertising of all social drugs to the interior pages of adult print media including internet. Allow sales of all legal social drugs over the internet and delivery via common carriers. Last I checked it was illegal to sell alcohol this way, which is also crazy: people in remote areas should be able to order their preferred brands of beverages, typically high-grade wines and craft beers, and this activity will not contribute substantially to abuse. The requirement to pay via credit card will prevent under-age access.

    If a person is found driving under the influence, prohibit them from using that substance for X number of years. A person who provides a substance to someone who is restricted, or to someone under-age, would also be restricted themselves. That puts the incentive where it counts, and would solve the DUI problem overnight, solve the under-age problem fairly quickly, and would also make a decent dent in alcoholism and marijuana abuse.

    If you agree, elect me to Congress, OK?;-)

  30. #30 Gray Squirrel
    June 25, 2015

    Oops, I screwed up: factoring out the Ss who guess right, would take out those for whom cannabis did provide relief of nausea, pain, or whatever. Good Grief!, what a stupid mistake.

    OK, so, what can we do to blind these studies effectively? Any ideas?

  31. #31 Marry Me, Mindy
    June 25, 2015

    I am actually a pretty strong advocate for legalization, but the “medical marijuana” crap is really disgusting. It’s complete garbage.

    And don’t think anyone is fooled. I’ve said the same thing about the hemp crowd. Don’t give me all this crap about how hemp is so great for the economy etc. It would mean a lot more if it didn’t come from major stoners, like Woody Harrelson.

    You aren’t fooling anyone.

  32. #32 James M. Barber
    June 25, 2015

    Considering how common chronic pain, and chemo side effects are, wouldn’t you say the medical marijuana is a valid medication. I know this is meant to be a retort to the woonatics, but this article also manages to marginalize its more notable uses. I would like to think anyone looking to back evidence based living would support decriminalization, and also ending stigma attached to taking certain medications.

  33. #33 Tim
    June 25, 2015

    And don’t think anyone is fooled. I’ve said the same thing about the hemp crowd. Don’t give me all this crap about how hemp is so great for the economy etc.

    Marry Me, Mindy .. It sounds as though you have been fooled. Cannabis ‘hemp’ only contains trace psycoactive substances.. if that. It was ages of selective breeding to bring out the latent ‘peace’.

    Industrial hemp would make outdoor ‘medicinal’ grows very nearly impossible — crossbreeding would lead back to rope-dope in just a few generations.

    YES #3 – Thomas Jefferson: In addition to farming hemp, Jefferson was Ambassador to France during the hashish era there. At risk of imprisonment if caught, Jefferson smuggled hemp seeds from China known for their potency to America. However, as far as our research takes us, he never said or wrote, “Some of my finest hours have been spent sitting on my back veranda, smoking hemp and observing as far as my eye can see.”

    YES #1 – George Washington: The father of our country kept meticulous diaries, wherein he noted “Sowed hemp at muddy hole by swamp” away from the hemp he grew for fiber. “Began to separate the male from female plants at do [sic –rather too late” and “Pulling up the (male) hemp. Was too late for the blossom hemp by three weeks or a month” indicates he was going for female plants with higher THC content. There is also indication he used hemp preparations to deal with his toothaches.

    http://www.hightimes.com/read/11-us-presidents-who-smoked-marijuana

    Hemp is good for farmers. Hemp turns sunlight into something man can burn (cellulose) pretty efficiently — There have been times (such as with war) when farms were run on gassification of hemp hurds yeilding mainly methanol.

    Ethanol has it’s place as a specialty fuel but biological fermentation for a sustainable ‘green’ fuel has “got a long way to go, baby!” Ethanol subsidies have proven disasterous and only further spreads that pernicious monocrop crap with its obligatory attendant Monsanto Fu*kUp™.

    You know? Shortly after the defacto banning of cannabis under the ‘Marijuana Tax Act’ came a little skirmish — WWII (IIRC). Then, every farmer became required to watch a film, Hemp for Victory, and though they were not forced to grow hemp they were nonetheless strongly encouraged to do so; They had to sign a form declaring that they had patriotically viewed the film.

    It is often claimed that it was only necessary for ‘nautical rope’ as imports were somewhat curtailed when we started dropping bombs on the importers and they, in kind, responded by flying themselves into everyone else’s merchant ships. This is only partially true as hemp proved an invaluable replacement for lubricating fluids, solvent, and methanol fuel; Interestingly, these were the things it was used for before the ban. Nonetheless, it is a superior fiber which resists rot and salt water — Hemp rope is a ‘static’ line — nylon on the boat has always been a big no no as it can stretch and release a nasty lot of energy all over yur face when it gets all brokedick. The rigging for George Herbert Walker (Opium Poppy) Bushs’ parachute was of Hemp.

    Cotton is the fiber of choice? I’ve heard tell that a cotton shirt was $200 dollars while a hemp one was a dollar. Those damn slave owners sure liked to flaunt their inferior Izods.

    Its just a little disconcearting how *coal tar manufacturing patents* popped up right before cannabis was banned — Very suddenly paint bases, lubricants, and synthetic fibers (there were already cellulose based ‘synthetic’ fibers) became all derived from petroleum. Hmm. Rayon, Dacron, Nylon, and the ‘natural’ alternative, cotton, which needs all DuPonts’ fertilizer and pesticides. Hmm.

    Good for the economy? It depends on which cog one plays — It does seem prohibition has been a boon for ‘certain’ interests. “… Fool MM,M once and …. the point is she was not alone.”

    Hemp for Victory:

  34. #34 Jason Brown
    United States
    June 25, 2015

    Small point… in your text just above your graph, I think you mean “if the error bars overlap 1, then the effect is not statistically significant”. They’re reporting odds ratios.

  35. #35 Sam
    June 25, 2015

    Two things really why I’m skeptical about this article that leads me to believe Orac is another bias anti-weed crusader unfortunately in a situation where he/she can use some level of media to get people to join his/her cause… or he/she could simply be another one of these “political spam bots” perhaps?
    1) The arguably and incredibly bias nature of the article itself; the context of the headline is a dead giveaway, and;
    2) The fact that among the millions of marijuana photos on the internet that could have been obtained without paying for them, they’ve chosen one that actually isn’t weed… -_-
    I can therefore deduce there’s a decent likelihood my initial assumptions are correct as:
    1) The writer might not know what chopped weed actually looks like combined with the bias nature of the writing is sending my modern day anti-weed fascist detector to never before seen readings thus greatly increasing chances of A.W.N. (Anti-Weed Nazism). Yes I made that up but that’s no overstatement; some people actually believe all people who use marijuana should be removed from existence. Hitler vs. Jew style.
    or
    2.1) Expenditure on marijuana photos wasn’t included in the budget perhaps? Therefore somebody is paying for the article and, lets be honest, paid opinion’s are rarely neutral and almost always selectively edited again increasing my skepticism, or;
    2.2) The article was slapped together quickly as 1 in 30 articles that needed to be written as a part of some sort of “keep weed hate alive” propaganda campaign, again I can’t believe the readings I’m getting from my trusty A.W.F.D!

    • #36 Orac
      June 25, 2015

      Sam, since the photo I chose to feature for the post so offended your delicate sensibilities, I found a better one! Budget? Seriously? You clearly have no clue. I have no budget.

      As for the rest, one notes that you haven’t come up with a single substantive criticism of my post, its arguments, or the study upon which I based the post. Your sole criticism seems to be that I picked a bad picture and therefore I must be some sort of anti-weed Nazi. Do I smoke the evil weed? No, I do not, but not because I have some sort of desire to ban it, but rather because, as I’ve said before (and as you would have known if you clicked upon a couple of the links to my previous posts on the subject), I can’t. I can’t stand to be in a smoky room be it tobacco or marijuana smoke. I break out into a coughing jag. So I’m sure as hell not going to inhale into my lungs. Also, being a physician, I really can’t afford even a minor drug arrest; so I’ve never even had much of a desire to try pot. There’s just not enough of an allure to tempt me to break the law; so as long as it is illegal for recreational use I am highly unlikely ever even to try it.

      Finally, I think pot should be legalized, regulated, and heavily taxed, just like tobacco and alcohol.

  36. #37 Sam
    June 25, 2015

    @c0nc0rdance

    The maths is unarguably correct with those figures you’re reporting… however it’s not justifying your apparent argument of “weed is dangerous” as have you seen 22 ounces of weed? Hell dude! Not even Snoop Dogg could smoke that in a day by himself…
    So therefore I’m led to believe you’re just another passionate weed hater who’s never even smoked it before who feels the need to voice one’s opinions regarding a topic they actually know nothing about hiding this fact by using some level of statistical analysis to make you sound smart.
    Thing is – you’re not fooling the smart ones…

  37. #38 Bruce Scott
    United States
    June 25, 2015

    I’m in favor of legalization for recreational use (subject to regulation and taxation).

    I’m also in favor of expanded permissions to study medical uses.

    I very much believe that these two should be cleanly separated and that it is entirely consistent to be in favor of medical use but not recreational use.

    I’m theoretically in favor of medical use, but quite unhappy about how that has gone in practice. Seems to be way too easy to prescribe. The fears expressed by medical marijuana opponents (that it would be a backdoor way to recreational legalization) seem to have been warranted.

    In a palliative care specialty role, I’ve conditionally advised use of non-smoked (tincture) form in perhaps 5 cases (3 nausea and 2 multiple sclerosis central pain, in all cases poorly or incompletely responsive to multiple other approaches). Anecdotally successful in two of those five (one chemotherapy nausea and one severe gastroparesis). One of the unsuccessful ones was MS pain where she said it helped the pain but she didn’t like the way it made her feel.

  38. #39 Narad
    June 25, 2015

    The writer might not know what chopped weed actually looks like combined with the bias nature of the writing is sending my modern day anti-weed fascist detector to never before seen readings thus greatly increasing chances of A.W.N.

    The grass doesn’t seem to be doing much for your writing skills, which some might say correlate with thinking skills.

    Just sayin’.

    • #40 Orac
      June 25, 2015

      I refrained from making pothead jokes…this time. Perhaps I shouldn’t have shown such amazing restraint. 🙂

  39. #41 goblinbox
    June 25, 2015

    I take issue with the “lower disease burden” statement in the comments.

    Pot is addictive.

    It’s linked to testicular cancer.

    It may be linked to head and neck cancers.

    Research shows that kids aged 12 to 17 who smoke marijuana weekly are three times more likely than nonusers to have suicidal thoughts.

    As far as lung cancer and COPD, so many pot smokers also smoke tobacco that it make take a long time to really know the results of pot smoking, but due to the components of the smoke itself — it can contain four times the amount of tar as cigarette smoke, for starters — it’s highly unlikely that the stuff is safe, especially for chronic, life-long smokers.

    Users’ risk for a heart attack is four times higher within the first hour after smoking marijuana, compared to their general risk of heart attack when not smoking.

    Research indicates that THC impairs the body’s immune system from fighting disease.

    In other words, lack of evidence is not evidence of lack — the longer we look at the stuff, the more we find it’s not a panacea.

  40. #42 Narad
    June 25, 2015

    I take issue with the “lower disease burden” statement in the comments.

    Pot is addictive.

    When the “withdrawal syndrome” is – in my experience – thinking “gee, I wish I had some grass” for two or three days, I’m not particularly impressed.

    One might also note that the rest of your assertions are wholly unsourced.

  41. #43 Johnny
    127.0.0.1
    June 25, 2015

    Tim@33

    Washington and Jefferson – see
    http://www.straightdope.com/columns/read/2912/did-george-washington-and-thomas-jefferson-grow-marijuana

    Money quote –

    Despite the above, I couldn’t find any contemporary accounts suggesting either Washington or Jefferson ever indulged in, advocated, or even mentioned smoking pot. The National Organization for the Reform of Marijuana Laws, an organization dedicated to being a voice for “responsible marijuana smokers,” simply notes that Washington and Jefferson grew hemp for economic reasons.

    Hemp, the economic miracle – see
    http://www.straightdope.com/columns/read/1116/is-hemp-nonpharmacological-marijuana-the-answer-to-our-environmental-problems

    Money quote –

    The suppression of hemp wasn’t, as some have alleged, the result of an unholy conspiracy between federal narcotics commissioner Harry Anslinger, the Du Pont corporation, and William Randolph Hearst. No question, Anslinger was a zealot who thought marijuana was a menace to society, and Hearst’s newspapers had done their best to whip up antihemp hysteria. But so had everybody else in the press. Lurid antimarijuana stories appeared in the New Yorker, for God’s sake.

    The hemp industry didn’t pose a significant threat to Du Pont and its new synthetic product, nylon. The most widely publicized early use of nylon was for women’s stockings. Hemp wasn’t used for this purpose.

    Hemp has a lot of uses, true enough, and can be made into a bunch of products. But none of those products are particularly good, and better alternatives exist for all of them.

    As far as legalization, I’m of two minds. Sure, pot is no worse than alcohol and or tobacco, and those two are legal. On the other hand, alcohol and tobacco cause enough problems by themselves, and we really don’t need another problem commodity.

    But one thing I feel strongly about is that this half-a$$ed illegal, but sorta legal status has to end. Make it legal, or make it illegal, I don’t care.

    I’ve no objection to studies to see if pot has any medical uses, in fact I would encourage them. But if you are going to sell it as medicine, you should get FDA approval.

  42. #44 jacob
    los angeles
    June 25, 2015

    There is relatively little evidence because studies are outlawed, not because the drug is ineffectual. In some cases there is no western drug that does better than marijuana, such as with glaucoma, nausea from cancer treatments, and colitis.

  43. #45 JP
    June 25, 2015

    As far as legalization, I’m of two minds. Sure, pot is no worse than alcohol and or tobacco, and those two are legal. On the other hand, alcohol and tobacco cause enough problems by themselves, and we really don’t need another problem commodity.

    The way lives are ruined by the ridiculous “War on Drugs” is a pretty good argument for legalization, I think. (One might note that selling weed while black is particularly, uh, frowned upon.)

    If one is not sympathetic to such claims, it can also be noted that marijuana prohibition and the huge prison population it has in part engendered costs a lot of money.

  44. #46 Roadstergal
    June 25, 2015

    @has 28: “I AM ANGRY THAT YOU ARE COMPLETELY RIGHT AND THAT I TOTALLY AGREE WITH YOU TOO!!!!1!1!!”

    Yep, pretty much.

    I am aware of two people in my life who are honestly using it for medical purposes – a gentleman with Parkinson’s who finds the main side effect, euphoria, a good balance to the lack of euphoria that Parkinsonian medications and the disease itself bring, and a friend with chronic pain from sports injuries who wants an alternative to opiates for pain relief to reduce the chances of addiction while she works with her doc to try to repair the damage as much as possible. The rest of us use our medical cards to enjoy outdoor music festivals more now and then.

    As far as blinded studies go – you don’t have to smoke it. The peddlers have wised up to the idea that a lot of folk hate smoking, and edibles are good business*. How you would mask the distinctive taste and smell would be another matter, but if you’re studying components in isolation, as you should, that problem should go away.

    *As is vaping, which the vaping activists have given me a knee-jerk negative reaction to.

  45. #47 JustaTech
    June 25, 2015

    James M Barber @32: But that’s just the thing! What this article discusses is that there is not enough evidence to know *if* pot is a good treatment for either chronic pain or chemo side effects.

    You say we should use it, but we don’t know if it is actually working!

  46. #48 Curtis
    Kitchen Table
    June 25, 2015

    From the actual study: “There was moderate-quality evidence to support the use of cannabinoids for the treatment of chronic pain and spasticity. There was low-quality evidence suggesting that cannabinoids were associated with improvements in nausea and vomiting due to chemotherapy, weight gain in HIV infection, sleep disorders, and Tourette syndrome. ” So, that’s a qualified “yes”.
    I’d also like to point out that these researchers studied Marinol, a single molecule drug derivative of Cannabis. They did not study “Medical Marijuana” at all. Cannabis has over two hundred cannbinoid and terpenoid components, some of which modify the effects of THC, some that are possibly active in and and of themselves.
    That’s like studying the chemical Atropine, and claiming you studied the poisonous nightshade. not even CLOSE to the same thing.

  47. #49 Mite B Mee
    Australia
    June 25, 2015

    …”marijuana might have some minor utility in relieving the symptoms of chemotherapy in cancer patients…”

    As someone who went through a heavy chemo program, I can tell you that it is nit minor. It was THE ONLY thing that brought the neausea under control. Without it, I would have stopped my treatment.

    Whilst an interesting article, it’s coloured by your own bias

  48. #50 George
    Oregon
    June 25, 2015

    I liked your post and while some of your verbiage was inflammatory towards the negative side, I feel like your position was accurate based off the published study. A friend of mine who is in favor of MJ medically referenced this study

    http://jama.jamanetwork.com/Mobile/article.aspx?articleid=2338266

    By Hill which was contemporary with yours, but more positive in its outcome and more inclusive in the studies. What were your thoughts on Hill’s analysis?

  49. #51 ct150
    June 25, 2015

    “might have some minor utility in relieving the symptoms of chemotherapy in cancer patients”
    Minor? End-of-life pain care is not “minor” and I have seen significant pain palliation with the use of marijuana in terminally ill cancer patients. I invite you to be the one to tell people that this should not be an option compared to things like morphine.

  50. #52 Everything
    In Moderation
    June 25, 2015

    I agree with Orac (and felt a little sad for him and his lack of comments). I am all for the legalisation of recreational marijuana but that is separate from medicinal use, and as a medicine, it should be subject to the same standards as any other medicine.

    Goblinbox – citations please? Even if all of what you stated is true – which I doubt – the disease burden of marijuana pales in comparison to that of alcohol and tobacco.

    Orac, I’m sorry you feel your lungs aren’t up to trying it but you could eat it (though I understand why you wouldn’t publicly announce it if you did). Around these parts it is a common experience when first trying pot to have others present look at you sympathetically while you cough your ring up and wisely intone: You gotta cough to get off.

  51. #53 JustaTech
    June 25, 2015

    Gah! This meta-analysis shows that the existing data for the use of marijuana-derived compounds for several indications is not definitive. That is not saying, no, it doesn’t work, and it’s not saying, yes, it does work. It says: we do not know. We need more studies.

    And if anyone thinks that conducting studies on people with cancer is easy, think again. People with serious, life-threatening conditions must be strongly protected because their condition makes them vulnerable. So there are (or should be) extra layers of ethical investigation applied to any research on these groups.

    So while your personal experience is paramount to you, ethical researchers must have more hard evidence before they can even consider recommending *any* treatment to the very ill. Regardless of the source of the treatment, pot or Big Pharma.

    Separately ct150: The “minor” in that sentence means that the researchers found that the treatment did not have a strong effect, not that the pain was minor. Also, “symptoms of chemotherapy” are generally not the same as “end-of-life pain care”.

  52. #54 Everything
    In Moderation
    June 25, 2015

    Mite B Mee and ct150 – come on! The statements that marijuana might have some minor utility in chemo nausea and palliation is the bottom line of the available research, not Orac’s personal opinion. No one is trivialising chemo nausea or end of life pain, nor is anyone saying it shouldn’t be available as an option. In fact, Orac says he feels it should be a legal option for everyone. If you’re not happy that the evidence isn’t strong then either lobby for more research or lobby for legalisation, but don’t shoot the messenger and accuse him of bias.

  53. #55 Narad
    June 25, 2015

    I am aware of two people in my life who are honestly using it for medical purposes – a gentleman with Parkinson’s who finds the main side effect, euphoria, a good balance to the lack of euphoria that Parkinsonian medications and the disease itself bring….

    Yah, I know one who’d I’d include, a neighbor with a degenerative condition that has robbed her of most of her eyesight and mobility. (The criteria in these parts are reasonably stringent. And I don’t think there are even any dispensaries yet. None of the other claimants to the status that I’ve met has bothered to apply.)

  54. #56 KayMarie
    June 25, 2015

    And “minor” utility may be more about the number of people it helps than how much help that small percentage of people get.

    Some things are very effective IF they happen to work for you. Problem is when placebo works reasonably well for 35% of people and the medication works quite well for 40% of people you can’t call the effect any word indicating it is majorly effective, you have to indicate it’s general usefulness is really not something you should expect. Especially if other things work for 75% of patients.

  55. #57 Bob
    June 25, 2015

    Thanks for writing this piece and your previous articles on “medical” marijuana. I think many skeptics have been embarrassingly silent on the herbalism propaganda that has been spewed out on MM and I’m glad to see someone taking a stand against anecdotal science that’s been used to support MM laws in this country.

  56. #58 Tim
    June 25, 2015

    I’d also like to point out that these researchers studied Marinol, a single molecule drug derivative of Cannabis.

    ^^ Is this the ‘straight-dope’ Orac?? That would explain alot. You see? A pharmaceutical company can’t get a patent on a natural molecule — Like the knockoff key in the lock, they must change it up a little bit; I’ve heard that ‘spice’, the synthetic and legal alternative to marijuana does cause psycotic breaks.
    —————————
    Sam #35, there do seem to be a lack of actual psycoative plant part picks here (the flower/buds). Here is some Alaskan Thunderfuck shots for your viewing edification:
    http://www.medicaljane.com/review/alaskan-thunder-fuck-strain-review/

    http://www.icmag.com/gallery/data/500/13511bluedancer_dryin2.JPG <– note the perfect timing of harvest with distinct concordant white opacity of the stalk-like glandular trichomes…

    http://www.medicalmarijuanastrains.com/?s=alaskan+thunderfuck&x=0&y=0

    Oh yea, another benifit of hemp is that it is nutritious food. When raised for seed, 70% of the weight of the plant is seed. Didya know that the Carrier pidgeon's staple food was hempseed? Didya know when they went extinct? Prohibition was good for the US postal service and 'man-in-the-middle' injections between communicating parties.

    I would like to suggest that it is an atrocity to suggest that there should be any restriction, monitoring, taxing, licsensing, or inspections of one's home garden whatsoever. Otherwise, people may be tempted to do horrendous things to conceal it like grafting cannabis to hops, figs, breadfruit, or mullberry trees. Yep, they are all of the same family… all of the biblical 'fruits'.

    As far as people concerned about 'smoking'.. It is a bronchodilator and has expectorant action; It cleans your lungs out.

    Research indicates that THC impairs the body’s immune system from fighting disease.

    goblinbox #41, I think ‘moderates’ would be a better word. It immediately moderates the immune system so that it is not wasting resources reacting to every dustmite and pollen grain… It is this property that sometimes stops asthma attacks mid-puff.

    “Cough.. cough! Tast that? It is Strawberry cough…”

  57. #59 R
    California
    June 25, 2015

    I hate the smell and taste of pot and most of the effects of pot. I experimented in high school with it but it wasn’t something for me. That said, after colorectal cancer surgery, a friend suggested it for pain relief when the narcotics and over the counter meds didn’t help. It seemed to work for pain relief for me in that circumstance. I haven’t used it since, but I’m not averse to it. To each their own.

  58. #60 Jeff
    In the war zone.
    June 25, 2015

    I agree 100% with you and I’m a strong MM supporter. As someone who has spinal stenosis which causes sever back spasms and pain, I started using MJ in ’08 to allow me to move my arm. My nerosurgeon said and I quote “well, it is a power muscle relaxant” as he handed me a prescription for Oxy and a debilitating surgery. I’ve done neither, I’ve upped my cannabis intake to include concentrated oils (hash.)

    My last back spasm was in 2013, prior to 2008 I averaged 3 or so a month, sever ones laid me out on the bed for 2 weeks unable to move. The last one in 2013 threw me down a flight of stairs, I couldn’t move my arms to catch the railing and I hit full force on my lower spine. It scared the hell out of my wife and me.

    I never once believed it cured cancer, and given that I lived in pain for a decade before using cannabis says something about my skepticism.

    The problem is, it is illegal for no logical reason. The “adverse effects” you mention are comedic at best, dry mouth? euphoria? hallucinations? (really for first timers maybe.) I won’t do a who’s more evil comparison, but no one will argue it’s “therapeutic effects.” Muscle relaxation, paid reduction (really I hurt less because my muscles are less tense and I’m not on opiates.)

    The only argument I have is don’t get too judgemental too fast on the MM movement, until the US has resigned that it should be legal and it shouldn’t be a profit center for prisons, institutionalized rasism, and the war on the poor, then we can call the BS the BS that it is. Rick Simpson, in my opinion has done more damage to the legalization effort than good.

    We need research into the harm it does not do, since we have all the confined lab rats going insane from asphyxiation and starvation in then 70’s and 80’s that must be undone.

    The claims maid by the MM movement are extravagant and at times outright lies. That’s politics for you. We can’t move this decrepit, controling government with “you all are wrong in your demonization of this.” We have to put mothers bawling about their dying babies on TV, otherwise the boomers will keep putting those damn potheads in the pen where they belong.

  59. #61 Narad
    June 25, 2015

    @Jeff:

    The “adverse effects” you mention are comedic at best, dry mouth? euphoria? hallucinations? (really for first timers maybe.)

    I don’t think Orac (or anyone else) has mentioned these.

    I do think that there are pragmatic questions that need to be addressed prior to wholesale legalization (including a serious cui bono regarding qualification as a legitimate supplier) by means of popularity contest, but slapdash laundry lists such as goblinbox’s don’t cut it from where I sit.

  60. #62 Narad
    June 25, 2015

    ^ I should also mention that Leon Gussow’s The Poison Review covers the topic from a literature perspective, as well.

    He doesn’t really tag stuff all that helpfully, but if one looks around, there’s a good deal to suggest that the synthetic cannabinoid channel is really just a dumb idea to encourage. (I realize that I’ve just invited a which slope? retort, but I’m not interested in random legalize-everything arguments.)

  61. #63 Gadfly
    June 26, 2015

    @c0nc0rdance

    If the LD50 is in fact 3.15 grams, the gentleman in this video should be dead four times over. Watch him complete a 22.5 gram dab of pure BHO: http://youtu.be/VA8ZYalgXpA

  62. #64 your mom
    June 26, 2015

    Learn about your endocannabinoid system and how phytocannabinoids help maintain it which is a messenging system to your vital organs. Cannabis helps especially when ingested. This is partly why cannabis cures cancer and should kd be researched further. Saying it doesnt without any evidence is doing more harm dicktree. Cannabis is as important to healthy humans as water is

  63. #65 Nopioids
    June 26, 2015

    Whatever it’s worth, if you’re opioid tolerant like I am, marijuana can help with chronic pain. Unfortunately, only certain strains are worth a damn, and living somewhere that it isn’t legal means it’s a crapshoot for me as to whether or not I get the “right” kind, and I don’t even know which one that is.

    Anyway, in my opinion, which is worth the paper it’s written on, they’d need to test several different strains against the list of things marijuana is supposed to treat in different studies to see if that’s just bias or real. Until they do that, I’ll continue to be optimistic that there may be better results to be had than what they’ve gotten thus far.

  64. #66 Joe Bergin
    Cambridge
    June 26, 2015

    This back door route to legalization pays off one potential source of problems.
    The doctors involved in writing the prescriptions may themselves be no longer allowed operating priveledges (due to their own problems, drug or psychiatric). Thus this method of approaching legalization should be expected in countries where the medical profession is in a position above their patients ( the USA, certainly) but unlikely in countries where doctors are salaried public servants.
    If you are an AMA duke welfare is like $300/ hour…sigh. I support honest legalization because free people should not be bothered over trivial pastimes.

  65. #68 MI Dawn
    June 26, 2015

    Uh, Tim – we all know you are a huge marijuana user. But come on! The passenger pigeon went extinct because THEY WERE TOO DARN EASY TO KILL!!! People would go out and shoot them in the thousands, and not even eat all the birds. AND, they were extinct in the wild LONG before hemp growing was banned. Learn a little history before you mouth off, especially when it has to do with your favorite stuff.

  66. #69 Gray Squirrel
    June 26, 2015

    Aack!, an Oz video. I don’t have the stomach to watch that, so I’ll take your word for it that Oz is anti-pot with scare tactics about The Children.

    Mindy @31: “medical MJ is complete garbage” is also an extremist position. Any given instance of relief from symptoms might be a placebo response or might be pure coincidence, or it might be that e.g. someone’s degree of nausea caused by chemo would have been mild and receded quickly without any pot. But that is not the same thing as asserting that any medical claim is deliberately fraudulent, which assertion IMHO borders on paranoia.

    A person who already occasionally smokes pot recreationally, does not fake a cluster headache complete with curling up in the fetal position and rigidly clenched hands, in order to scare or impress a couple of close personal friends to get one of them to offer him some pot. To assert that the person is faking it for ulterior reasons, is just f—ing nuts. Placebos and coincidences are one thing, but attribution of deliberate intent to lie, in the absence of any evidence supporting that contention, is evidence of a bias that impairs your own objectivity and credibility.

    That said, I agree that a lot of the strong proponents of medical MJ and industrial hemp are stoners engaged in rationalization and a backdoor approach to legalization. On the other hand, industrial hemp really does have a few viable uses. As with most things, facts and supported hypotheses are not likely to be found at the extremes.

    And, frankly, even if you assume that medical MJ and industrial hemp are nothing more than a vast left-wing conspiracy, it’s a pretty benign one compared to most of what goes on in the political arena these days. Bottom line is that pot is less harmful than alcohol on a number of axes of measurement that are important for health and for societal impact, prohibition has not worked, and people have a right to amuse themselves as long as they aren’t harming anyone else in the process.

    And it’s also a good thing that a lot of folks here (Orac et.al.) who don’t use it in any form, are supporting legalization based on the rational case.

    Now let’s all kick back and mellow out, whether our preferred method is a glass of wine, a pipe of pot, a porn video, or our imagination. Personally I prefer my imagination. Ahh, visions of mellow. Much better!;-)

  67. #70 has
    June 26, 2015

    Narad@39

    The writer might not know what chopped weed actually looks like combined with the bias nature of the writing is sending my modern day anti-weed fascist detector to never before seen readings thus greatly increasing chances of A.W.N.

    The grass doesn’t seem to be doing much for your writing skills, which some might say correlate with thinking skills.

    It does seem to be doing marvels for his attitude though.

    Also related: the shakedown merchants are having a field day. (Maybe best avoid the comments tho’ as they’re a tad embarrassing by Ars standards.)

  68. #71 goblinbox
    June 26, 2015

    Opinions about withdrawal syndrome are unlikely to have any impact on whether or not a substance is considered addictive. Apparently measurable effects can exist for up to six months after quitting marijuana.

    Sure, giving up pot is demonstrably less life-threatening than, say, cold-turkeying your horrific heroin habit, but I can tell you, (anecdote!) having lived with some big ol’ fat stoners, that being around them when they’re out of dope is evidence enough of deep dependence.

    Unsourced? Uh, yeah, because I assumed you could use the internet. In other words, LMGTFY:

    “Pot is addictive.” – http://www.drugabuse.gov/publications/research-reports/marijuana/marijuana-addictive

    “It’s linked to testicular cancer.” – http://www.cancer.org/cancer/news/study-links-marijuana-use-to-testicular-cancer

    “It may be linked to head and neck cancers.” – http://www.ncbi.nlm.nih.gov/pubmed/12412843

    “Research shows that kids aged 12 to 17 who smoke marijuana weekly are three times more likely than nonusers to have suicidal thoughts.” – http://www.elementsbehavioralhealth.com/addiction/marijuana-dependency-linked-to-depression-suicidal-thoughts/

    “Users’ risk for a heart attack is four times higher within the first hour after smoking marijuana, compared to their general risk of heart attack when not smoking.” – http://circ.ahajournals.org/content/103/23/2805.full

    …and so on.

    Obviously it’s early days and the research is of varying qualities, but it’s so easy to find nascent evidence of pot’s negative effects on users that I don’t think it’s a strain to assume it’s probably not good for you under a lot of circumstances, and that, in fact, it’s probably actively bad for you in even more.

    Especially the way lifers use it, which is six to ten times a day, every day, for decades. There’s no way that’s harmless, let alone beneficial. And as for the assumed lower burden, we have evidence that drinking booze — even a lot of booze, really — appears to reduce mortality compared to teetotalers, which is weird and counter-intuitive until you remember that drunks more often than not have friends.

    – – –
    Hemp has a lot of uses, true enough, and can be made into a bunch of products. But none of those products are particularly good, and better alternatives exist for all of them.

    Isn’t it weird how that Occam’s razor free market argument never seems to work with hemp enthusiasts? “IT’S THE MAN, KEEPING US DOWN!!1!” makes ’em much happier than “People stopped using your beloved hemp mainly because it’s mediocre compared to other solutions.”

  69. #72 Jon H
    June 26, 2015

    “1. The conflation of therapeutic use and recreational use for the purposes of making an argument for legalization. We allow hydrocodone to be used therapeutically, but still restrict the sale and use for recreation. Even if cannabinoid drugs or cannabis itself is approved for medical use, that’s independent of the question of whether it should be legal to manufacture, sell for recreational use.”

    On the other hand, that *is* an argument for why the “abuse potential” of pot should not be an obstacle to being able to use it in research.

    I’m pretty sure abused prescription opiates have caused far more trouble than abused pot, but you’d think the opposite were true. Pot is politically radioactive but companies are developing stronger and stronger prescription opiates.

  70. #73 Jon H
    June 26, 2015

    goblin box, that “pot is addictive” piece is a bit shifty.

    “According to the 2013 NSDUH, marijuana accounted for 4.2 million of the estimated 6.9 million Americans dependent on or abusing illicit drugs.”

    This bit of crafty wording blurs the distinction between dependency and “abuse”. I’m guessing they consider any use of pot or other illegal drugs to be abuse.

    Also, the “withdrawal symptoms” listed aren’t exactly a junkie’s nightmare:

    “Marijuana addiction is linked to a mild withdrawal syndrome. Frequent marijuana users often report irritability, mood and sleep difficulties, decreased appetite, cravings, restlessness, and/or various forms of physical discomfort that peak within the first week after quitting and last up to 2 weeks.14,15”

  71. #74 Dangerous Bacon
    June 26, 2015

    Wow, the potheads have shown up in force.

    I hope Orac left out plenty of Doritos for them.

  72. #75 Mike Callahan
    Lake Tahoe
    June 26, 2015

    Hey Orac. You changed the photo. I think the original photo looked a lot like some of that Columbian I used to smoke back in the early 70s. It was a little comical because that is what pot really did used to look like.
    These days the pot is astoundingly more potent. I have gone through the process a few times for my , ahem, “reccomendation”. It was either a retired physician or a DO. The waiting room was full and I doubt anyone was being turned down. The plea for MM is just the foot in the door for legalization.
    The use of pot for pain or nausea is very likely overrated. Hemp is an inferior fiber because it is not very comfortable and it wears out quickly compared to cotton. Pot cures cancer? I’d be dead if I believed that. No one pleas for the real reason it should be legal. That is that it can make a life full of constant sh!tty feelings from disabilities and pain a little better. “Feeling better” is a dubious argument but I bet anyone dying from cancer who smokes a little pot would agree that feeling better is a real thing. I like to think of it as a quality of life issue. People smoke pot because it makes them feel better and that is what infuriates the opposition. If Jesus multiplied a joint instead of wine to stoke the party then a lot less people would be against it. It’s a cultural thing. As a former Catholic it is not good I was told to not endure suffering. The old adage, “What doesn’t kill you makes you stronger” is total BS. Cancer almost killed me and instead of stronger I’m having a rough time with lingering cachexia. Just a tiny bit of modern pot is enough to soothe the rough edges and help me laugh and engage with my friends. It’s not escaping reality like opponents like to think. To invoke Thomas Jefferson, I believe it is a part of my right to a “pursuit of happiness”.

  73. #76 Narad
    June 26, 2015

    Unsourced? Uh, yeah, because I assumed you could use the internet. In other words, LMGTFY

    Get the stick out of your ass. You make the claims, you cite them. The cancer data is weaksauce. Your characterization of the MI paper was as follows:

    Users’ risk for a heart attack is four times higher within the first hour after smoking marijuana, compared to their general risk of heart attack when not smoking.

    Maybe you should have read the paper, in all its N = 6 glory:

    “In summary, smoking marijuana is a rare trigger of acute myocardial infarction and may pose a health risk to patients with established coronary artery disease and perhaps to individuals with multiple coronary risk factors.”

    I have to be somewhere shortly, so I’m not going to be able to do the rest at the moment.

  74. #77 Narad
    June 26, 2015

    Sure, giving up pot is demonstrably less life-threatening than, say, cold-turkeying your horrific heroin habit

    Opiate withdrawal isn’t life-threatening.

  75. #78 Johnny
    127.0.0.1
    June 27, 2015

    As far as legalization, I’m of two minds. Sure, pot is no worse than alcohol and or tobacco, and those two are legal. On the other hand, alcohol and tobacco cause enough problems by themselves, and we really don’t need another problem commodity.

    The way lives are ruined by the ridiculous “War on Drugs” is a pretty good argument for legalization, I think. (One might note that selling weed while black is particularly, uh, frowned upon.)

    If one is not sympathetic to such claims, it can also be noted that marijuana prohibition and the huge prison population it has in part engendered costs a lot of money.

    I don’t disagree with any particular point.

    However, I think most of the problem is the half a$$ed way we have made the possession and use of pot legal, but not the distribution. It’s very much like Prohibition, which made the production, transport and sale of alcohol illegal but not the consumption or private possession. That didn’t turn out well.

    Pot has put a lot of people in prison, but seldom does anyone go to prison for possession. According to
    http://www.bjs.gov/content/pub/pdf/fjs09st.pdf
    of the total federal prison population of 185,273 as of 30 SEP 2009, the number for drug trafficking was 97,062 vs 177 for possession (table 7.9). As many states have made possession a non-crime, I suspect (but no cite) that the state prision population ratios will be about the same. When there is a demand for a product, someone will step up and fill the demand, and when filling the demand is illegal, someone is going to jail.

    Sure, there are a lot of arrests for possession, but that isn’t even grounds to deny a security clearance (continued use is, however).

    Yes, selling weed while black is ‘frowned upon’. Unfortunately in this country, driving while black, and even waking down the street with your hands in your pockets while black is grounds for the police to stop and frisk. The problem is pure bigotry, not the fact that we have any particular law (well, maybe the crack vs powdered cocaine laws).

    So, yeah, I maintain that if pot is going to be legal to have, it should be legal to buy and sell, and if it’s illegal to sell, it should be illegal to have, and I really don’t care which way it goes. But the current system is madness.

  76. #79 JP
    June 27, 2015

    Yes, selling weed while black is ‘frowned upon’. Unfortunately in this country, driving while black, and even waking down the street with your hands in your pockets while black is grounds for the police to stop and frisk. The problem is pure bigotry, not the fact that we have any particular law (well, maybe the crack vs powdered cocaine laws).

    Well, African Americans are 10 times more likely (PDF) to go to prison for drug offenses than whites. Obviously that has to do with bigotry, but when it comes to marijuana-related offenses, I’m pretty sure that if marijuana weren’t illegal, people wouldn’t be going to prison for selling it.

    When there is a demand for a product, someone will step up and fill the demand, and when filling the demand is illegal, someone is going to jail.

    Yeah, but the demand is going to be there whether it’s legal to posses marijuana or not. In fact, drugs use among teenagers was higher in the 1990s, when it was totally illegal, than it is now. (Kids these days!)

    So I don’t really see much argument for continued marijuana prohibition, even if one finds it to be a problematic substance; legalizing it seems to make it less popular, even.

  77. #80 JP
    June 27, 2015

    ^ Sorry, wrong study in my second link; just a second.

  78. #81 JP
    June 27, 2015

    ^ Here. (PDF) Key findings in chap. 2.

    I suppose I should clarify that increasing, if confused, legality of marijuana most likely doesn’t make it less popular among the kiddies, but it is correlated with a downward, rather than upward, trend in use.

  79. #82 JP
    June 27, 2015

    I suppose I should highlight this quote from the study:

    We expected a continued increase into 2012 and later years, in part because of the ongoing
    trend toward increased use and in part because of the movement by some states to legalize the
    medical use of marijuana. Publicity around legalizing medical, and in some cases recreational, use
    may serve to normalize use of marijuana, the most widely used of all illicit substances. However,
    this anticipated rise has yet to pick up momentum, and in 2014 illicit drug use actually showed
    non-significant declines in all three grades for lifetime, annual, and 30-day use. Whether we will
    see the expected future increase in illicit drug use is a matter to be clarified with continued
    monitoring.

    So apparently it was assumed that “[p]ublicity around legalizing medical, and in some cases recreational, use
    may serve to normalize use of marijuana,” but the data don’t support that assumption. Even though it is apparently such a common-sensical assumption that it is still assumed that the data will eventually back it up.

  80. #83 Narad
    June 27, 2015

    However, I think most of the problem is the half a$$ed way we have made the possession and use of pot legal, but not the distribution.

    As I alluded to above, I think there’s one more step in constructing well thought out legalization policy, which is not rewarding extant organized crime.

    Large-scale distribution of high-test grass is not a happy-go-lucky affair.

  81. #84 JP
    June 27, 2015

    ^ Sorry about the formatting fail.

  82. #85 Johnny
    127.0.0.1
    June 27, 2015

    … I’m pretty sure that if marijuana weren’t illegal, people wouldn’t be going to prison for selling it.

    I’m not sure that’s completly true. Mostly true, sure, but the numbers aren’t going to zero.

    Nobody (except maybe Tim and a few others like him) is proposing that all sales of any quantity between anybody should be legal. Legal pot sales will be restricted, limited, and taxed.

    But there will continue to be a demand among the young (less than 21), those looking for a quantity discount (wanting pounds, not ounces) or to save on taxes. There is a black-market for alcohol and tobacco, and there will continue to be a black-market for pot. The corner dealers aren’t going away, their supply chain isn’t going away, and the police are still going to go after them. There will still be arrest and prison time involved, and, yes, most of the arrest will be blacks. Fewer to be sure, but still thousands nation wide.

  83. #86 George
    Oregon
    June 27, 2015

    Other studies – what did you think of Hill’s coverage of the same studies? It seems more positive in its outlook than your linked study.

    http://jamanetwork.altmetric.com/details/4201819

  84. #87 Mephistopheles O'Brien
    June 27, 2015

    I have seen someone argue against legalization of marijuana because it would drive the subsistence pot dealers out of business, depriving them of a necessary source of income.

  85. #88 Marcel
    Holland
    June 28, 2015

    I think the issue isn’t so much if it actually helps people, but whether they think it helps them or not. If you’re in a shitty situation that has little to no prospects of improving and you take some marijuana to feel better (be it mentally or physically), what does that matter?
    I don’t see how anyone could be against that. Period.

  86. #89 Vicki
    June 28, 2015

    I envy the person who dismissed dry mouth as a “trivial” side effect. I got that as a side effect from a prescription drug, at a level that caused me to bite my tongue or the inside of my mouth multiple times every day, even when I was using an OTC spray to reduce the effect.

    Stopping the drug has helped, but I still need the spray, and I still have some problems with tongue-biting.

  87. #90 JP
    June 28, 2015

    But there will continue to be a demand among the young (less than 21), those looking for a quantity discount (wanting pounds, not ounces) or to save on taxes. There is a black-market for alcohol and tobacco, and there will continue to be a black-market for pot. The corner dealers aren’t going away, their supply chain isn’t going away, and the police are still going to go after them. There will still be arrest and prison time involved, and, yes, most of the arrest will be blacks. Fewer to be sure, but still thousands nation wide.

    OK, there might still be some arrests for illegal sales, as there are some here and there for illegal alcohol sales, but not nearly on the level that exists now. I’m pretty sure broad, federal legalization would entail decriminalization also, which means that black-market marijuana dealing would be an offense on the same level as black-market alcohol dealing. Dealing in a Schedule I substance is a different beast altogether.

    I mean, really, though, “there will still be a black market even if it’s way smaller” doesn’t strike me as an argument against legalization, any more than “seat belts don’t save all of the lives all of the time, and they can even cause harm sometimes” is an argument against seat belts.

    Which is kind of a weird metaphor, but I’m kind of tired after hanging out and staying up late with ma teachin’ pardner.* Korean food, bowling, and a review of the hundreds of CDs I was just given by my advisor** (he’s got them all “in the cloud” now.)

    *The Zhenya and Zhenya Show is officially over for the summer, though.

    **I’m not sure he realizes the danger of even greater ontological entanglement that this presents.

  88. #91 Rick Wingate
    June 28, 2015

    12 years ago diagnosed with glaucoma, for real, maaaaan. Treated with drops and weed for most of that time and pressure was manageable but disease was still there. Stopped using the drops after a check up a year ago. Six months ago tests were clear. Last week tests still clear. I freaked My eye Doc out. Told Her from the beginning I was using both, She kinda disapproved. I changed Her mind. I won’t say it cured Me, it may have just kept it under control well.

  89. #92 Rick Wingate
    June 28, 2015

    JP just yesterday a state made unlimited hemp production legal anywhere, even Yer backyard. Think it was Maine.

  90. #93 Horatio
    Toronto
    June 28, 2015

    It has been pointed out above that none of the products you can make from hemp are actually particularly good.

    Even 200 years ago, in the age of sailing ships, hemp was not particularly highly regarded. Linen canvas sails were much stronger and easier to maintain.

    Coir (coconut husk fibre), not hemp, was the go-to material for ropes. Coir is light, strong, relatively water resistant and is not damaged by saltwater. In contrast, hemp ropes absorbed water readily, becoming very heavy in the process and were extremely prone to rot. Sailors had to dip them in hot pitch to prevent this, hence the nickname “Jack Tar”

  91. #94 Dead
    June 29, 2015

    “In other words, the evidence is reasonable”

    Neat. So, the evidence for the efficacy of the drug reasonable. And yet, the evidence is also on your side when you say that that cannabis doesn’t have medicinal value? You really do love to say “I told you so”. So much so that you don’t really seem to care if you’re right or not.

  92. #95 Dead
    United States
    June 29, 2015

    Oh, and I’m just gonna leave this here. In case anyone didn’t care to be proselytized to by a biased blogger and instead would like to examine some evidence for themselves.

    http://medicalmarijuana.procon.org/view.resource.php?resourceID=000884

    And I encourage actually looking at the meta-analysis that the author so heroically interprets and distorts. It’s a much more even read without the spin.

  93. […] Does medical marijuana work? The answer is (mostly) “no” and “we don’t know” [Via Respectful Insolence] […]

  94. #97 Darren
    Australia
    July 3, 2015

    My Friends have talked me into a months trial on medical oil for my cancer I agreed as long as they under stood there is no cure for cancer they said its the only cure so take it kills all cancer cells and types.?
    My friends are great working class people not medical scientists/
    Any way as I rejected chemo and radio after surgery-after being given only 1,3 % chance of being alive at 1 year I said no thanks lousey odds ill hike till the cancer comes back my surgeon said he cannot tell me what to do but winked and nodded in the afirmitive at my decision-
    Any way the medical oil was so good at pain relief-even though I had little to no pain before I started the oil but it was strong relif-anti nausea was fantastic as was bile and stomach type pain-heaps better than somac-and zantac and maxalon.
    It realy takes away the fear of cancer and the stress of it all.so that was a positive but the danger I fore seen was is it realy masking the symptoms of the cancer-
    Being stoned all the time was not for me whilst on the oil I could not pray or read the old/new testament-this was the kicker for me so I said the oil had to go it blighted my channel to the divine and so I stopped the oil.
    When my friends found out they went ballistic got very angry at me for throwing away my only shot at a cure-I was shocked as it was me with the death sentence not them
    Deep down I suspected all along they were selling the oil for a good profit 300 for a 10ml syringe full mates rates they said
    I felt like they were dealing to me as well as having all faith in their product to cure me.
    So if the oil does kill all cancerous cells deep in the human body for good as they claim-then I have made a huge miscalculation in rejecting their oil
    On the other hand the positives pain relief nausea anti anziety were very good,
    ii told my friends at a later date i may wish to use the oil pallativily but not for now.

  95. #98 Tim
    July 4, 2015

    Nobody (except maybe Tim and a few others like him) is proposing that all sales of any quantity between anybody should be legal.

    I said nothing about ‘sales’ Johnny #85. My endorsement is for unfettered production:

    I would like to suggest that it is an atrocity to suggest that there should be any restriction, monitoring, taxing, licsensing, or inspections of one’s home garden whatsoever.

    http://scienceblogs.com/insolence/2015/06/24/does-medical-marijuana-work-the-answer-is-mostly-no-and-we-dont-know/#comment-405142

    There is one caveat: Does *barter* count as sales?

    and he provides that no one will be able to buy or to sell, except the one who has the mark, either the name of the beast or the number of his name.

    — Revelation 13:17

  96. #99 JakeFelice
    July 7, 2015

    Marijuana works for pain. Nobody disputes that. And marijuana is by far the least toxic of all of the pain medications. Why is nobody talking about its amazingly low toxicity when compared with the alternatives? Sounds like more propaganda dressed up in science. Science, the new propaganda….

  97. #100 michael shenk
    california
    July 20, 2015

    the human body has natural cannabinoid receptor sites. the medicinal herb, marijuana, binds to these sites as needed.not all patients with illness respond to marijuana or like the feeling. more people are finding it helpful in easing symptoms:pain, suffering, seizures,anxiety. if your MD approves, always start with less amount than friends recommend.especially tincture.less is always more.

  98. #101 michael shenk
    california
    July 20, 2015

    the greatest achievement I have witnessed after 30 years of RN work in pediatric and adult oncology departments, is return of hunger via marijuana, to a wasting patient. this is mandatory for life. replacing intravenous synthetic hyperalimentation/IV fats with genuine food salvages the human liver.
    true, it is difficult to determine doses of cannabis because of the entourage of other plant chemicals smoked, vaporized or ingested. this collection of plant chemicals,together, may be why marijuana is unique among herbs or medicines in history. nobody has ever metabolically crashed and died from temporary marijuana use.

  99. #102 michael shenk
    Ukiah,California
    July 20, 2015

    encouraging the demise of federal schedule one research restrictions is necessary to continue objective, non-biased research. punitive laws can impede a non experienced cannabis attempt with innate pressure of fear. historically dramatic drug war propaganda can prevent a suffering patient from responding appropriately to cannabis.
    I emphasize marijuana use, in these comments, only to stimulate hunger and relieve symptoms. in no way do I, a retired RN of 30 years experience, recommend this plant as a cure for any disease.

  100. #103 michael shenk
    Ukiah,California
    July 20, 2015

    the author of the study summarizes his opinion on data. this is different from mothers who cry tears of joy after their daughter or son uses cannabis and begins to eat again. [after weeks of weekly, sometimes daily blood draws to determine if intravenous chemical feedings are adding damage to a liver stressed from chemotherapy]. data does not reflect the folks who thank God that painful daily muscle spasms ceased for the first day in years. after marijuana use. etc.

  101. #104 pawheels
    home
    July 27, 2015

    Marijuana has been around before all of us and will always exist. even M.D Anderson cancer center admits it presents possibilities for positive medical results. I have lewy body dementia, and my doctor cant understand why I am not getting worse. Thank you cannabis oil. No thanks to you cigarette smoking and/or booze drinking anti pot hypocrites.

  102. #105 Calli Arcale
    http://fractalwonder.wordpress.com
    July 27, 2015

    I am absolutely open to the idea that marijuana could have helpful medicinal effects. Quite a lot of plants do. But for all the near miraculous claims, why is it that so far studies have shown results that were equivocal at best? I realize the DEA puts a lot of fairly pointless obstacles in the way of a lot of trials, but even so, if it was really so profoundly powerful, you’d think at least *something* would show up by now.

  103. […] Indeed, in my previous posts in this series on medical marijuana, one theme has emerged, which is that cannabis—specifically, a class of active chemicals in marijuana known as cannabinoids—has potential for some diseases but is not the panacea claimed by its proponents. It does not cure cancer, for instance, contrary to glowing testimonials promoted by people like Rick Simpson. For other conditions, the evidence is either not particularly compelling or only mildly promising. The answer to the question of whether medical marijuana is good medicine is, as far as I’m concerned, mostly “no” and “we don’t know.” […]

  104. #107 Robert ireland
    Maryland
    August 12, 2015

    Not medicine. Over 500 essential nutrients which keep us from disease and give back up to at least 70% more longevity, just in limited numbers of terpenoids, which cannabinoids and terpenes fall under, making far more.compounds, over 340 vs 119 vs 49 nutrients were told to believe is all we need as essential nutrients, yet disease across an entire encyclopedia of diseases and disorders, every one of which improves, engances, slows progression of, stops, reverses, repairs, crea tree s, destroys or at least improves quality of life when used after the fact of deficiency led disease factor. Terpenoids are newly being discovered over the past 40 and more years as interacting in multiple manners, singularly and in endless combinations provoking the cells to function in a. Vastly more healthy way and when consumed in the normal diet as a core element of that diet not only renders a population virtually disease factor free AND living upwards and beyond at least 40 to 70% longevity increases. The evidence is in micro communities worldwide if you all care to do real research. I have. I’ve pored over at least over 27,000 research abstracts and reports in the past 35 months and I don’t see a single medicine or drug in this entire plant. Not onr. What I do see is nutrients, over 500 and when you eat them 3 very day you do not disease and if average is 70, then you stand a pretty good chance of reaching over 110 in good health and with vitality. Even over 120! And that just in low doses and limited compounds. Medicine my arse. Nutrients behave this way and are identified this wat. All this lunacy over not just a vegetable. A vegetable with not just most of the accepted 49 essential nutrients, 10 times MORE than we have been yet told. Do the research. I have.and it’s more amazing than they dare tell and most even know for want of having ever read the full compendium of available research from reputable international and national laboratories and institutions. Make them all go read. They’re all out in left field with this issue
    All for personal gains. Mine? We heal the world. Tikun Olam. Heal the world in light of love. Go look. It’s all there in front of your faces. I know. I went there. I awoke. This IS the Tree of Life. Kaneh Bos, the key ingredient of the holy Anointing oil. I’m actually appalled that only a tiny number of scientists actually even see a hint of this when it’s so obvious. Smh appalled.

  105. #108 Dave Campbell
    http://www.buymyweedonline.ca
    August 14, 2015

    Yes the most answers of medical marijuana works is “no” and “we don’t know” but these are not true answers. As we have find that many of researches and studies has proven it medical marijuana work in many problems in very good manner. Also many people have found its benefits in chronic pain. And secondly in Canada it is legalized that means there are some benefit are true that was it happen.

  106. #109 DdC
    Central Coast, CA
    August 16, 2015

    “From time to time, I say that the suppression of medical marijuana is murder. This is not quite correct. It is actually mass murder. It has caused the deaths of countless thousands of people.”
    ~ the Financial Times Limited, 1998

    Cannabis Shrinks Tumors: Government Knew in 74
    http://endingcannabisprohibition.yuku.com/topic/588
    ☛ The DEA shut down all cannabis/tumor research.
    ☛ Gerald Ford ended all public research.

    ☛ List of brain tumor patients who died due to opinions based on gossip.
    http://en.wikipedia.org/wiki/List_of_brain_tumor_patients

    Drug Worriers preferred methods of treatment…
    http://endingcannabisprohibition.yuku.com/topic/1945
    Epileptic seizures: Aptiom (eslicarbazepine acetate)

    Who’s Really Fighting Legal Weed
    http://endingcannabisprohibition.yuku.com/topic/1974
    ☛ 3/4th of a Century of Gossip and Gutter Science
    ☛ A Very Lucrative Evil Hoax
    ☛ Only 13% of the medical schools surveyed
    mention the endocannabinoid science to our future doctors.

    Note that’s “mention” GanjaRx. None of the Med Schools teach students, future doctors. Censorship is the same result as illiteracy.

  107. #110 Factoid
    USA
    August 18, 2015

    Concordance wrote : ”

    The LD50, inhaled, rat of THC is 42 mg/kg (Merck Manual). For a 75 kg adult, a scaled LD50 is therefore 3.15 grams. That’s less than a teaspoon of THC. Cannabis ranges from 1% to 25% THC content, but 5% is a round mid-range figure. At 5% THC, a scaled lethal dose is 63 grams, or 2 ounces of plant material.

    If ingested orally or eaten, the LD50 is around 500 mg/kg, so 75 kg adult scaled LD50 is 37 grams of THC which would be 740 grams of cannabis at 5% THC, or 22 ounces.

    Not exactly a truckload. This also assumes 5% THC content. No, you don’t have to smoke it in 15 minutes, either. THC is 100% converted to active metabolite over the course of an hour, and clearance of the active metabolite may take more than 4 hours in normal, healthy users.”

    The problem here is you, like many others, think/assume/believe that the % of THC on the bud is based on the weight of the plant material. IT IS NOT. The % of THC is base on all cannabinoids on the bud. Not the weight of the bud.

  108. #111 JGC
    August 18, 2015

    What I do see is nutrients, over 500 and when you eat them 3 very day you do not disease and if average is 70, then you stand a pretty good chance of reaching over 110 in good health and with vitality.

    Robert, your evidence that if you consume these nutrients diet you will not ‘get disease’, and that theaverage life span of people who consume these nutrients daily approaches 110 would be…well, what exactly?

    I mean, you have some–right?

  109. #112 Narad
    August 18, 2015

    oblem here is you, like many others, think/assume/believe that the % of THC on the bud is based on the weight of the plant material. IT IS NOT. The % of THC is base on all cannabinoids on the bud. Not the weight of the bud.

    That would be more of a floptoid.

  110. #113 Mephistopheles O'Brien
    August 18, 2015

    @Dave Campbell,

    As we have find that many of researches and studies has proven it medical marijuana work in many problems in very good manner.

    Could you please provide a link to the most convincing study? Thanks.

  111. […] the state of the evidence supporting the use of medical marijuana for almost anything is, at best, weak and contradictory. That’s not to say that cannabinoids, the active compounds in cannabis, don’t have some […]

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