cannabinoids

A compound derived from marijuana decreases seizure frequency in children with Dravet syndrome, and there's nothing "miraculous" about it

oracknows — Fri, 26 May 2017 01:01:41 +0000

A compound derived from marijuana decreases seizure frequency in children with Dravet syndrome, and there's nothing "miraculous" about it

When I first started to take an interest in medical marijuana, I was struck by how much it reminded me of herbalism. Although herbalism is scientifically the most plausible of modalities commonly associated with "complementary and alternative medicine" (CAM), the use of herbal medicines still involve a number of problems, the biggest of which is what I like to call either the delivery problem or the bioavailability problem. In brief, herbs, when they work, are adulterated drugs. The active ingredient is often a relatively small, embedded in thousands of other constituents that make up herbs, and it’s very difficult to control lot-to-lot consistency with respect to content or active ingredients given how location, weather, soil conditions, rainfall, and many other factors can affect how the plants from which the medicines are extracted grow and therefore their chemical composition. To demonstrate the concept, I frequently point out that it’s much safer and more predictable to administer digoxin to a patient who needs its activity on the heart than it would be for the patient to chew on some foxglove leaves, given that the therapeutic window (the difference between the doses needed to produce therapeutic effects and the lowest dose that will cause significant toxicity) is narrow.

I have nothing against recreational marijuana use and have come around to the view that it should be legalized, taxed, and regulated, just like alcohol and tobacco. Unfortunately, medical marijuana has been co-opted as a "foot in the door" to try to legalize marijuana. The problem with this approach is that it necessitated massively overblown claims for marijuana's health benefits, up to and including claims that it is a great treatment for autism and that it can cure cancer. It isn't and can't. Nor does it stop exaggerated miraculous claims. Basically, the bottom line in terms of scientific evidence for medical marijuana is that it mostly doesn't do what it's claimed to be able to do.

None of this is to say that it might not have some value in some conditions. One condition for cannabinoids isolated from marijuana have shown some promise is in seizure disorders. That's why I learned with interest of a study published in the New England Journal of Medicine (NEJM). This study is a randomized, placebo-controlled clinical trial of a candidate drug isolated from marijuana on severe drug-resistant seizures in children that made the national news Wednesday night. To be honest, the study's gotten less press coverage than I thought it would, but it is an interesting study nonetheless. Medical marijuana proponents frequently misrepresent the skeptic position as being unalterably opposed to the idea that marijuana might have value as a medication. I can't speak for anyone else, but what I've always objected to are the exaggerated, evidence-free claims so many advocates make, and the veritable cult that has sprung up around it. I actually like evidence, which is why this study caught my attention. (Indeed, I would have written about it yesterday, except that the night before I fell asleep on the couch before I got one paragraph in.)

So let's look at the study by Dr. Orrin Devinsky, a neurologist at New York University Langone Medical Center, and colleagues, Trial of Cannabidiol for Drug-Resistant Seizures in the Dravet Syndrome. The first thing I can't help but note is that this is not really medical marijuana, but rather an oral solution of cannabidiol (CBD), Investigational Medicinal Product GWP42003-P, manufactured by GW Pharmaceuticals under the trade name Epidiolex®. GWP42003-P is formulated from extracts prepared from Cannabis sativa L. plants that contain consistent levels of CBD as the principal phytocannabinoid. Extracts from these plants are processed to yield pure (>95%) CBD that contains less than 0.5% (w/w) THC. This pure CBD is subsequently dissolved in excipients with added sweetener and flavoring. So basically, it's a drug isolated from a plant, as many drugs are isolated from plants (and sometimes chemically modified).

Another thing that's important to note is that this trial was to test whether CBD was useful against drug-resistant seizures due to a specific genetic disorder, Dravet syndrome, also known as severe myoclonic epilepsy in infancy (SMEI). Dravet syndrome is due to a mutation in the voltage-gated sodium channel α1 subunit gene SCN1A, which encodes the pore-forming subunit of the NaV1.1 voltage-gated sodium. channel. There are currently more than 700 known SCN1A mutations, and 90% of them occur in DS patients. Two-thirds of these mutations give rise to truncations in the protein while the remaining third are missense mutations that are predicted to severely impair channel function. In patients with Dravet syndrome, the severity of the epilepsy can vary, but myoclonic seizures are the defining feature of Dravet syndrome, and can be massive, contributing to a mortality rate as high as 20% by age 20. The syndrome is also associated with developmental delay. The most devastating aspect of Dravet syndrome is that the epilepsy associated with it is among the most drug resistant forms, and most anti-epilepsy drugs provide inadequate relief.

This trial was pretty straightforward. Basically, it was a multi-institution phase II study carried out in the US and Europe with the following protocol, summarized by this flow sheet (click to embiggen)

The baseline characteristics of the two groups were well matched, ranging in age from 2 to 18, and patients had previously tried a median of 4 antiepileptic drugs, with a range from 0 to 26(!). Subjects were randomized to receive either placebo or CBD, and the primary end point measured was frequency of convulsive seizures. The CBD solution contained 100 mg/ml, and the placebo solution was identical except for the absence of CBD. Before the intervention began, there was a four week baseline period in which investigators trained caregivers to record daily seizure information. Then CBD or placebo was added to the subjects' regular anti-seizure regimen. This is actually a very important point that most reporting of the trial I've seen misses. This trial does not show that CBD has anti-seizure activity as a single agent, only that, when added to other regimens of anti-seizure medications, CBD can further decrease seizure frequency. We don't know from this trial whether CBD alone would be a useful treatment for Dravet syndrome seizures.

But back to the trial design. The dose was escalated up to 20 mg/kg per day with the use of a 14-day dosing regimen of twice daily administration. At the end of the treatment period, the cannabidiol and placebo solutions were tapered (10% each day) over a period of 10 days. After trial completion, all patients could enter a long-term open-label study. Each day, patients or caregivers recorded the number and type of seizures (tonic, clonic, tonic–clonic, or atonic) for the primary end point. Laboratory assessments were carried out at baseline and after 2, 4, 8, and 14 weeks of the trial regimen, as well as at the end of the taper period for those patients who did not enter the open-label extension study or who withdrew early and tapered the trial agent.

The results were encouraging. In the CBD group, the median frequency of seizures decreased from 12.4 to 5.9 per month, compared with a decrease from 14.9 to 14.1 in the placebo group. The percentage of patients with at least a 50% reduction on convulsive seizure frequency was 43% with CBD and 27% with placebo. The percentage of patients who became seizure-free was 5% in the CBD group, and 0% in the placebo group, but neither of these results achieved statistical significance (p=0.08 for both). I must admit that the way NBC reported Devinsky saying, ""Quite remarkably, 5 percent of the children in the active treatment group with CBD were completely seizure free during the 14 weeks of the trial but neglecting to point out that the result didn't achieve statistical significance. I understand that there were some children who had dramatic remissions, but this observation does have to be put into context.

There were some adverse events due to the CBD, including diarrhea, vomiting, fatigue, fever, somnolence, and abnormal liver-function tests. There were more withdrawals from the trial in the cannabidiol group. Indeed, nine out of the 61 subjects in the CBD group withdrew from the study, compared to only three from the placebo group. Overall, serious adverse events were more common in the cannabidiol group than in the placebo group (16% vs. 5%)

One interesting aspect of this trial is that the mechanism of CBD against seizures in patients with Dravet syndrome is not known. The clinical manifestations of Dravet syndrome are due to a single gene, SCN1A. In an accompanying editorial, Dr. Samuel Berkovic notes:

A major aim in the field of the Dravet syndrome and other genetic encephalopathies is to develop precision therapies — treatments directed at the specific genetic defect. Because the Dravet syndrome has a single-gene basis, it is an attractive target for precision medicine. However, cannabidiol is not a precision treatment for the syndrome, because there is no established link of the cannabinoid receptors with the inhibitory interneuron pathology of the Dravet syndrome, and the response across the cohort of the current study was not uniform.

He also notes:

Devinsky et al. found a significantly greater reduction in seizure frequency among patients who received cannabidiol than among those who received placebo, and the seizure-free rate was 5% with the active drug as compared with 0% with placebo. Thus, anecdote has been confirmed by data, and one might ask whether a controlled trial was really necessary. The answer is absolutely yes. Perhaps counterintuitively, the rate of response to placebo in clinical trials is higher among children than among adults. Moreover, parents who go to enormous efforts to get cannabis for their children report a higher response rate than those who can easily obtain it. Cannabidiol is not without side effects. The dropout rate in the active-treatment group was appreciable, and common side effects included vomiting, loss of appetite, and diarrhea. With additional experience, perhaps these effects can be modified with dose adjustment and other strategies.

I would quibble again here. If you look at Table 3, you'll see that the difference between placebo and control didn't achieve statistical significance for reaching 100%, 75%, and 50% decreases in seizure frequency. Now, I'm not so dogmatic that I won't accept that this difference is probably real, failure to achieve a p-value less than 0.05 notwihstanding, but if you're going to use frequentist statistics and define statistically significant as 0.05, then you should at least be consistent. That quibble aside, I do agree with Dr. Berkovic that absolutely a clinical trial was indicated. I would also add a further quibble that "anecdote has been confirmed by data" is overstating it a bit, given the tiny percentage of patients who were seizure free. However, some patients do apparently have fairly dramatic responses.

Another interesting aspect is that, counterintuitively, seizure frequency did decrease in the placebo group by 13.3%, compared to the CBD group, where seizure frequency decreased by 38.9%. This should be a lesson as to why placebo controls are necessary, even for seemingly objective measures. Of course, given that these were either self-reported or caregiver-reported measures, they are not completely objective; so it is not surprising that there was a slight decrease in seizure frequency, even in the placebo control group.

Finally, I can't help but note that medical marijuana advocates, the ones who will be flogging this study as vindication that marijuana is a miracle drug (even though what this study shows is much more modest) tend also to be very much anti-pharma and pro-alternative medicine. That's why I want to draw attention to this part of the methods section:

The funding source, GW Pharmaceuticals, was responsible for the trial design (with input from investigators and other experts), trial management, site monitoring, trial pharmacovigilance, data analysis, and statistical analysis. GW Pharmaceuticals prepared and provided the active treatment and placebo. Trial procedures were reviewed at multisite investigator meetings. Services were used for clinical laboratory testing; bioanalytical laboratory testing; design of the case-report form; data management; trial-agent distribution, returns, and destruction; the interactive voice-response system; diagnosis of the Dravet syndrome and seizure classification; and translation of documents. The authors vouch for the accuracy and completeness of the reported data and analyses and for the adherence of the trial to the protocol (available with the full text of this article at NEJM.org). The authors affirm that they approved the final draft of the manuscript.

This is, of course, a not uncommon practice for a drug company doing a clinical trial upon which it wants to base an application for FDA approval for its drug, and that's exactly what GW Pharmaceuticals is doing. Nothing wrong with that. It's what a drug company needs to do, and GW Pharmaceuticals is a drug company. It's a good idea to be a little more skeptical about the results of this study than most medical marijuana advocates I've seen gloating over it as total vindication are doing. This is a positive study, but not as strongly positive as it's being spun, and there are issues with CBD and adverse events. As Dr. Berkovic puts it:

This trial represents the beginning of solid evidence for the use of cannabinoids in epilepsy. It requires replication. Future trials may answer further questions about the applicability of cannabinoids to the many other syndromes of childhood epilepsy and to treatment in adults. After an era dominated by anecdote and obfuscated by medicolegal issues and emotionally infused debate, more scientific studies are under way. Much more research is needed to understand the basic science, benefits, and risks of cannabinoids in epilepsy.

Correct. This is a study that demonstrates that one chemical that can be isolated from marijuana has promise as a treatment for the epilepsy assocaited with Dravet syndrome. The mechanism by which it appears to work is not clear, as the relationship between cannabinoid receptor and SCN1A is not clear. It's thus not clear whether this result is generalizable to other forms of seizure disorders, but it's worth investigating. In other words, CBD is just like any other drug. It appears to have reasonable activity against the epilepsy due to Dravet syndrome, but it also has significant side effects, just like a lot of other antiepileptic drugs. It's no miracle, but it could be a step forward, particularly if its study leads to a greater understanding of the role of cannabinoid receptors in seizure disorders.

oracknows Thu, 05/25/2017 - 21:01

Categories

Medicine

This a drug combination trial on a constituent of Cannabis sativa L. (not an "ingredient" of the plant because ingredients are items of cake mixes and sundry other inventions rather than nature-made products). What we don't know is whether the results would have been significantly different had the subjects not taken their "regular anti-seizure regimen" in addition to cannabidiol or placebo. We also don't know if that would extend to the adverse events, among which "diarrhea, vomiting, fatigue, pyrexia, somnolence, and abnormal results on liver-function tests" were more frequent among those in the cannabidiol group compared to the placebo group. The fact that more subjects in the cannabidiol group withdrew from the trial than among those who received placebo is at least suggestive of adverse drug interactions. A further question (one I don't expect to be answered any time soon) is what, if any, medications could be dropped from a regular anti-seizure drug regimen without unacceptable harm to a patient with Dravet syndrome receiving cannabidiol?

This a drug combination trial on a constituent of Cannabis sativa L. (not an “ingredient” of the plant because ingredients are items of cake mixes and sundry other inventions rather than nature-made products).hat we don’t know is whether the results would have been significantly different had the subjects not taken their “regular anti-seizure regimen” in addition to cannabidiol or placebo.

Well, yes. Most clinical trials these days involve adding experimental therapeutic or placebo to the standard treatment regimen, mainly because in a disease as severe as Dravet syndrome it would be unethical to take patients off of their anti-seizure medications because the placebo group could be subjected to harm. This is particularly true in what are considered vulnerable populations, such as children. A follow up trial in which it is tested whether CBD can allow the dose of other anti-seizure drugs to be reduced would be a logical next step, but it would be tricky to design in an ethical fashion.

It is written,

The dropout rate in the active-treatment group was appreciable, and common side effects included vomiting, loss of appetite, and diarrhea.

MJD says,

Kudos to the brave parents and children in this study.

Q. If the drug proves to be effective, safe, and profitable, will the pharmaceutical company financially compensate those (i.e. test subjects) who sacrificed the most.

In my opinion, medical research subjects should be provided special compensation for their participation similar to our brave soldiers in the armed forces.

@MJD:
While I understand the sentiment behind wanting to richly compensate research participants, it is profoundly unethical to do so. At least when you're talking about reasonable compensation for time, validated parking, and so on. Compensation that's sufficient to become enticing threatens informed consent, by becoming almost coercive to people who need money. That's most of us, but especially people of lower socioeconomic status. And those latter folks are precisely the ones who shouldn't be taken advantage of in medical trials.

Exactly. People will take risks for money that they wouldn't normally take if money isn't involved, and the more money the larger the risks they're willing to take.

In brief, herbs, when they work, are adulterated drugs.

No, they are "impure" drugs, but not "adulterated" because nobody added anything to make them impure. They grew that way from the start.

it’s very difficult to control lot-to-lot consistency with respect to content or active ingredients given how location, weather, soil conditions, rainfall, and many other factors can affect how the plants from which the medicines are extracted grow and therefore their chemical composition.
I take it ORAC is no fan of heirloom tomatoes. There is no toxicity known for a hemp (low THC sativa) plant. Use until desired effect. Millions of people every day have no problem dosing themselves (notably: arthritis, nausea, appetite, spastic colon) properly the old fashioned way. Herbalism indeed.

The adverse effects of loss of appetite and nausea are fixed with a little THC in the mix.

https://www.leafly.com/sativa/charlottes-web

https://www.youtube.com/watch?v=oxrKyjeClTk

they are “impure” drugs, but not “adulterated” because nobody added anything to make them impure

That distinction may matter in a legal context, but in a medical context, it's to-MAY-to vs. to-MAH-to. The patient is getting a drug in an unknown (to him) dose with unknown (to him) additional compounds that may or may not help with the delivery, and in some cases may interfere with it. If said patient ends up dead, it won't matter to him whether the product was represented to him as an herbal product or as a drug of claimed dosage and purity. The lawyers who take on any subsequent wrongful death case, of course, will care.

Thank you for giving this very, very careful and nuanced explanation. It really helps understands the strengths and limits of the trial.

Thanks for this! I watched the CBC coverage and nowhere was it explained that the CBD was in addition to the regular meds. It was presented as marijuana the saviour drug. And some irritating patient activists leading the way and science catching up narrative.
I'm not sure where the parents got CBD in Canada, my wife can only get Sativex here (a 50:50 CBD:THC med). If it is from the current medical marijuana dispensary world, who knows what they are giving their child.

No, they are “impure” drugs, but not “adulterated” because nobody added anything to make them impure. They grew that way from the start.

Now appears to be a good time to remind people how much I hate pedantry and how much it irritates the hell out of me. If the word "adulterated" bothers you so much, I'll just change it to "impure." The specific word used, as Eric points out, doesn't much matter for purposes of the idea, nor does it matter much in a medical context. The point is that there are hundreds, if not thousands, of compounds mixed in with the actual active ingredient of an herbal medicine.

abnormal results on liver-function tests” were more frequent among those in the cannabidiol group compared to the placebo group

It should be noted that only the kids who were also taking valproate (a seizure medication) showed elevated liver enzymes -- Something Vaproic acid can do all by itself.

And some irritating patient activists leading the way and science catching up narrative

What else would it be? Millions of people anecdotally know how it helps them. When a study is finally allowed it showed the users were right.

"counterintuitively, seizure frequency did decrease in the placebo group by 13.3%, compared to the CBD group, where seizure frequency decreased by 38.9%"

I agree this is a reminder of the importance of placebo groups, but I expect the placebo response in this case has more to do with trial participants stepping up their compliance with their usual meds during the trial as opposed to succumbing to bias on subjective symptom scores.

Gilbert @7: Speaking to the issues of lot-to-lot (or crop-to-crop) variability.
Are you a wine person? If so, are you familiar with the concept of terroir? (The idea that you can grow the same grapes in two different places and things like the mineral composition of the soil will affect the flavor of the wine.)
It's a lovely thing, in wine or in tomatoes or cheese. But you need to remember that while that variability is often wonderful, producing glorious vintages, it can also produce crap that's not even worth putting in a bottle.

If I gave you a glass of a clear beverage you'd want to know if it was pure water or pure ethanol or something in between. And if it's something where you can't tell the difference *before* ingesting it, then it's even more important to know how much you're getting.
And what's wrong with testing and labeling? In the recreational sphere it really broadens the market. Where some might say "I feel like a rose tonight" another might say "I'm feeling like a X% THC, Y% CBD tonight".

But medicine is all about precision.

It should be noted that only the kids who were also taking valproate (a seizure medication) showed elevated liver enzymes — Something Vaproic acid can do all by itself.

Where did you find this? Is it in the full paper?

I haven't seen the paper. but I assume that's where this comes from:

But some of the side effects may have been due to drug combinations, not CBD alone. For instance, kids in the CBD group who were also taking the epilepsy drug valproate were the only ones to experience liver problems as a side effect.

https://arstechnica.com/science/2017/05/marijuana-component-reduces-sei…

Some of those kids rotate amongst ten anti-seizure/epileptic drugs including phenobarbital -- None of which work. I'd think the next studies should be to treat those patients with only CBD and with a complementary inclusion of THC for suppression of nausea and increased appetite.

I would not be surprized if continuing the drugs hides the true effectiveness of the clean-acting CBD alone.

@ Gilbert,

Yes, valproate can raise liver function tests, and cause hepatic toxicity. That's why a baseline should be taken when you start it, and it should be monitored regularly for the first six months.

If you then add another drug and LFTs rise, it is more likely the second drug is the contributing factor. You have to consider if the problem comes from the second drug, or the fact the two drugs are combined before you decide how to change the treatment plan.

In this study, participants were in a four week baseline period before beginning the cannabinoid or placebo. In order to establish that baseline, and perform the regular checks during the trial itself, bloodwork is done. The LFTs of the patients who left the group (only 3, btw, with one from the placebo group) rose after starting the CBD treatment. The other nine patients completed the study in spite of the elevated liver enzymes.

What this means is there may be reason to believe that there is additional risk of adverse liver issues for patients taking CBD who are also taking valproate. The answer is dose adjustment. You cannot conclude that the problem is the valproate and not the CBD, or that CBD is automatically safe if the patient is not on valproate.

@Johnny: yes, the full paper does in fact note that the only patients who had elevated LFTs were on some form of valproate.

If said patient ends up dead, it won’t matter to him whether the product was represented to him as an herbal product or as a drug of claimed dosage and purity. The lawyers who take on any subsequent wrongful death case, of course, will care.

I take it, Eric Lund, that your statement is a generalization of all herbal medicine and not to intimate that could become the case with MMJ.

Otherwise, I challenge anyone to find one death attributed to cannabis** in ten thousand years of recorded history.

** Of course, not the synthetic 'legal high' THC which can be fairly deadly.

Orac, please, PLEASE cover this.

Open Access Journal, apparently 1.4 impact factor, case studies, alleging marijuana causing violence. ("Violence is a well-publicized, prominent risk from the more potent, current marijuana available. We present cases that are highly popularized storylines in which marijuana led to unnecessary violence, health risks, and, in many cases, both.")

The case studies include a handful of people who were shot by cops or others (Michael Brown, Trayvon Martin), the guy who shot up the Co. Planned Parenthood Center, the Boston marathon bombers, and OSAMA BIN LADEN.

One of their first sentences, "Marijuana intoxication results in panic reactions and paranoid feelings whose symptoms lead to violence " has a citation that turns out to be, something the NYPD Commissioner said. (something stupid).

I would tear this to bits, but I don't have the patience, stamina, nor knowledge to do it.
https://www.omicsonline.org/open-access/marijuana-violence-and-law-2155…

Can anyone explain why these studies, and everyone moving and getting in a queue to acquire charlotte's web, go after >95% cbd oil product offerings extracted from recreational marijuana strains vs the non-recreational strain, aka hemp, that naturally has that level of cbd. Currently you can buy 25-30% concentration cbd oil tubes produced from commercial hemp online w/o any medical marijuana referral/license required and for much less that equivalents produced by multiple solvent + other procedures applied to recreational marijuana.

Osama Bin Laden? What a bunch of maroons. You can't get marijuana in Pakistan or Afghanistan.

CJTX, if ORAC did a critical review of every dingbat article published in a pay to publish journal, he wouldn't have time for his day job, or sleep. All his blinking lights would burn out, leaving a dark void.

You can’t get marijuana in Pakistan or Afghanistan.

The lads at Wikipedia beg to differ

https://en.wikipedia.org/wiki/Cannabis_in_Pakistan
"Cannabis is widely used in Pakistan..."

https://en.wikipedia.org/wiki/Cannabis_in_Afghanistan
"Cannabis in Afghanistan has been cultivated for centuries..."

@Panacea - thanks for the info.

Johnny: Huh. I assumed it was forbidden, and also impossible to cultivate at high altitudes.

I would tear this to bits, but I don’t have the patience, stamina, nor knowledge to do it.

Author is a Professional Expert Witness grifter. Paper is basically an advertisement for his services. The litany of high-profile cases of police and vigilantes shooting black kids is so he can invent an encounter with marijuana for each of the victims, and argue that that encounter turned them violent and scary (and black) so that the police / vigilantes were compelled to shoot in self-defense. So the author is shamelessly self-whoring announcing his willingness to testify in the defense of uniformed lynchers in the future.

Any decent journal would only have published the piece with a label of "Advertisement", forcing him to resort instead to the negotiable standards of an OMICS dumpster.

CJTX:
We present cases that are highly popularized storylines

That is not a sentence intended to be read by scientists. The authors are writing for an audience of defense lawyers who need a simple narrative to absolve their clients (by blaming their client's victims).
I am going to hazard a guess that nine times out of ten, when someone is trying to pretend that marijuana causes violence, that person is an apologist for police violence or increased powers. The authors are advertising their services to cash in on future police violence.

You need to learn not to assume so much, grasshopper.

Given that there was a higher dropout rate for adverse events in the CBD group, how can researchers control for the possibility that the dropouts were somehow more likely to be unresponsive to the CBD treatment, thus making the average effect higher due to removal of low/no responders from the CBD group?
One scenario I can imagine is that those receiving a benefit from the CBD could be more likely to stay in the trial when experienceing side effects that those not receiving any benefit (I.e. Getting a treatment effect is "worth it" to stick it out, but if you're not seeing any benefit, you wouldn't consider it "worth it" to stay in the trial).
With the sample size, the difference between losing 9 patients in the CBD group versus 3 in the placebo group could make a difference.
Or is this something that researchers can control or account for?

"Unfortunately, medical marijuana has been co-opted as a “foot in the door” to try to legalize marijuana."

This is a logical consequence of (wrongly) classifying Cannabis as drug with no medical uses or benefits and using this in a legal circle jerk to justify its prohibition.

"The problem with this approach is that it necessitated massively overblown claims for marijuana’s health benefits..."

In a hypothetical sane world, one demonstrated medical use would be enough to trash that wrong classification. This didn't happen, so now you have Anslinger's Devil Weed with flipped sign.

Just a note: Sorry to all the regulars who got stuck in automoderation because they had been impersonated by a certain sock puppeteer and I have to make sure it's you before letting you post. I had visitors yesterday, and I was away from the computer for nearly 16 hours, which means a bunch of you didn't get your comments posted until just now. I'll try to keep a better eye out.

I will, however, mention that I'll be on vacation in early June. I haven't decided yet how much (if at all) I'll be blogging or whether I'll be posting "reruns" or a mix, but the time is fast approaching for me to make up my mind...

Can anyone explain why these studies, and everyone moving and getting in a queue to acquire charlotte’s web

It touches on JustaTech's "lot-to-lot (or crop-to-crop) variability".

The Stanley brothers' Charlottes Web is pretty standardized: It is tested, it is grown in a controlled environment, and propagation is through cloning.

Please have some good vacation time Dr Orac :)

Alain

madder (#4) says,

... but especially people of lower socioeconomic status. And those latter folks are precisely the ones who shouldn’t be taken advantage of in medical trials.

MJD says,

Q. Can monetary awards for trial participation increase the placebo effect (e.g., placebo currency) in people having a lower socioeconomic status.

If the answer is YES, placebo currency may be a confounding variable and should be eliminated to control the validity of the experiment.

Alternatively, if placebo currency (i.e., integrative medicine) has efficacy it may be a useful supplemental treatment for needy individuals having lower socioeconomic status.

Alternatively, if placebo currency (i.e., integrative medicine) has efficacy it may be a useful supplemental treatment for needy individuals having lower socioeconomic status.

Are you suggesting, like Chairman Mao, that sometning like acupuncture is good enough for the peasants? Because I thought you were just an idiot and a loon, but this would move you into the 'evil SOB' category.

PGP @24

I assumed

Go figure.

Could you try to learn from this one, please ?

Sorry to all the regulars who got stuck in automoderation

I WANT MY MONEY BACK.

@ Gilbert #16: What you posted in reply to my comment (which got moved to #17 because of the posts that went into automoderation) is called "shifting the goalposts."

That some of these kids rotate among a variety of anti-seizure medications has ZERO bearing on my response to you, or on the 3 kids who dropped out of the study due to increased LFTs. It only matters what the kids were on AT THE TIME.

And you can't wave your magic wand and say phenobarbital doesn't work when in fact it does, or that even if it actually didn't (which is a falsehood) that somehow magically means CBD is safe.

Citing an Ars Technical review of this paper which essentially says similar things to what Orac says without the insolence doesn't support your point in the least.

This study hasn't proven CBD can control seizures by itself. It only showed a reduction in the number of seizures the child had. Considering that seizures can be life threatening, simply jumping to a CBD only study as you suggest is premature. It is unethical to withhold treatment that works just to test a pet theory.

The authors believed the increased LFTs were due to a drug to drug interaction with valproate. They also believed since most of the kids taking valproate remained in the study, and also based further blood work, that this interaction was temporary. That needs more research; if so it simply means that most kids would be able to remain on valproate while taking CBD.

Odds are if these study findings are confirmed, CBD might become an adjuvant therapy for kids with Dravet syndrome who are not as well controlled on other drugs as they could be. We're years away from proving it works on its own and can be a primary therapy.

Also, we have no long term safety data on CBD alone, as the authors acknowledge (and you ignore). If something pops up with chronic use over time, that will limit its usefulness.

@ Gilbert #16: What you posted in reply to my comment (which got moved to #17 because of the posts that went into automoderation) is called “shifting the goalposts.”

I was not replying to your comment as I commented first. That's what #16 comes before #17 means. Though I saw your comment well before my moderation kicked out -- ORAC's tiered moderation methods to 'slow you down' I take it.

Moving goalposts. Hmm. I seem to recall that Charlotte Figi went from 300 seizures a week to one and that they had stopped all the other meds -- It was 2013 when I heard the story so I may be wrong.

Johnny (#34) writes,

Because I thought you were just an idiot and a loon, but this would move you into the ‘evil SOB’ category.

MJD says,

My comment about "placebo currency" was intended to bring transparency to the potential benefit of a post therapeutic-intervention for test subjects. :-)

Your respectful insolence is like holding a skunk by the tail, it's always unpleasant.

@ Alain (#32),

What's a nice person like you doing in a place like this?

Understand, you'll always be a pseudo-minion in Orac's dominion.

@ Orac,

If your VACATION, in the month of June, takes you to a foreign country will you be fully vaccinated?

In the absence of a response, we will assume that you are a closet antivaxxer.

@Gilbert: I can't help it if you don't pay attention. My #17 was posted before your #16. Perhaps you were replying to Johnny but you didn't make that clear. You still shifted the goal posts.

Charlotte Figi's ONE case isn't evidence of anything. What it did was spark interest in real research on the subject, which is now being done. Her case is still anecdote, not data, though if true I'm certainly delighted to hear she is doing better.

MJD: we don't understand completely why the placebo effect happens. Lying to patients is unethical, and right now we have to lie to patients to deliberately trigger the placebo effect. The effectiveness of doing that is dubious at best, and allows people to continue suffering at worst which is not cool.

But then again, you've proven time and again that ethics don't really concern you, so I'm not really surprised you'd advocate this.

Poking the bear is not funny. Better watch out he doesn't bite your head off.

@MJD:
The potential confounding factor presented by financial incentives to trial participation is a good reason to continue avoiding those incentives. And while I won't respond with quite the vitriol as Johnny did, I do wonder if you've thought through the ethics of your proposal to focus placebo treatments on the less fortunate, coupled with financial incentives for them to participate in clinical trials. You can't possibly be serious, can you?

I mean, just wow, dude.

Panacea (#40) writes,

But then again, you’ve proven time and again that ethics don’t really concern you, so I’m not really surprised you’d advocate this.

MJD says,

The other day an unhealthy-looking homeless man asked me for $ to get a smoke.

His teeth appeared like buttered corn as he smiled and gave a hearty thanks for the $.

In my opinion, the placebo currency-effect is real.

I can’t help it if you don’t pay attention. My #17 was posted before your #16

And I can't help it if you don't know how moderation works, I was replying to Johnny. Though I did see your comment was published first shortly after I subitted mine; I doubt you were ever in moderation.

Perhaps you were replying to Johnny but you didn’t make that clear.

Ohh. my bad. comment #15 was

Where did you find this? Is it in the full paper?

To which I replied

I haven’t seen the paper. but I assume that’s where this comes from:

I guess that is a little bit ambiguous to you. Again, #16 was submitted before #17 was posted. Silly.

Have a great and well deserved holiday, Orac.

MJD - If you are indeed proposing 'placebos for the poor', then yes, I stand by my statement that you are an evil sumbitch, and I've a feeling I won't be alone.

I really don't understand your post #33, and #39 didn't really help.

Well, fine. You got me Gilbert. I misunderstood who you were posting you.

Enjoy it. Everything else you said is flat out wrong.

You can’t get marijuana in Pakistan or Afghanistan.

I assumed it was forbidden, and also impossible to cultivate at high altitudes.

This is why you can't get kif in Morocco, either.

I've heard tell that some of the best and smoothest cannabis comes from arid conditions at moderate elevations. The plants thrive with plenty of water but the dry air reduces degredation of the cannabonoids as they are formed and the elevation increases UV which also enhance cannabonoid production. All and all, the same strain will come out better in Afganistan than in the muggy conditions of the southeastern US or even mexico.

Also, we have no long term safety data on CBD alone

Everything else you said is flat out wrong.

Panacea, you qualify for the *find a death after ten thousand years of recorded history challenge*.

According to one frequently cited study, a marijuana smoker would have to consume 20,000 to 40,000 times the amount of THC in a joint in order to be at risk of dying.

http://www.huffingtonpost.com/2013/09/03/marijuana-deaths_n_3860418.html

And that ^ is from carbon monoxide poisoning.

The answer is dose adjustment.

The "dose adjustment" is use until the desired effect is achieved as there is no toxic dose from the constituants of cannabis.

MJD,

this place, i enjoy.

Orac, that's a job requirement that he be fully vaccinated according to the standard of care. Never mind travelling (which may carry some recommendations).

Gilbert: while no one has died directly from an overdose of cannibis . . . yet . . . they have died from being under the influence, often while driving or some other mishap where they would not have died had they been sober.

I say yet because with the increasing levels of THC in the cannabis being produced today, once of these days we will find out what the lethal dose is . . . probably the hard way. Too much of anything is bad for you, even water.

And even the milder forms of pot our grandparents used in the 60's still had side effects. We know that chronic marijuana use in teenagers has adverse impacts on brain development. In sort, cannabis may be "safer" than many other drugs people use, but it is by no means benign.

I support legalization, by the way. The reasons for making it illegal were always bogus to begin with, and even with its known problems, alcohol and tobacco are worse in many ways.

But we're talking about using cannabis as medicine. A different standard applies. What I said about dose adjustment still stands; your blather about toxicity doesn't change the fact that we already know from the study under question that combining CBD and valproate can raise LFTs. That's worth knowing about cannabis, since many people combine it with other drugs. The likelihood that people who take it for medical purposes while taking zero other drugs is pretty low.

And this study still hasn't proven CBD safe or effective for anything, not even Dravet Syndrome. It's proven it may be effective . . . safe is still an open question, and only in a limited circumstance. More research is needed, especially since so many other studies of cannabis have been unconvincing.

Alain (#51) writes,

...that’s a job requirement that he be fully vaccinated according to the standard of care.

MJD says,

In an article from Lexology (2013) titled, Firing employees who don't get flu shots: what risks do hospitals face?, author Mark D. Nelson writes, "Hospitals, of course, have reached different decisions on how to balance the interests of patients and employees. As such, policies vary in the flexibility given to employees regarding non-vaccination and the resulting consequences:

Vaccination mandated with exemptions for medical contraindication, religious beliefs (discipline/other adverse consequences for non-exempted employees).

http://www.lexology.com/library/detail.aspx?g=d47d4235-8619-4bbe-aa16-e…

Q. Why are non-exempted employees singled out for punishment/other adverse consequences.

@ Orac,

Are you a non-exempt employee at the hospital?

My apology for the off topic question(s) about vaccination but it seems particularly-relevant knowing that Orac may be taking a vacation in early June, 2017.

@ Orac,

In the hypothetical:

If you are going to Mexico for some R&R, is it your responsibility, as a cancer surgeon, to protect your patients and determine the flu risk from the World Health Organization (WHO) before departing?

http://www.who.int/influenza/surveillance_monitoring/updates/latest_upd…

Please advise...

@Panacea #52

I suppose those are some good points.

MJD- you really are a bulldozer in a china shop - i assume Orac is intelligent enough to get any shots required for an overseas vacation like every sane person. He might be enjoying a "staycation". He might be going to Lost Wages or some other US tourist attraction. What business is it of yours?

You seem to be suffering from a fantasy that you can weasel out a confession that he hasn't had his shots (and therefore is a secret antivaxxer and hypocrite) . Not going to happen. Give it a rest.

Pretty pathetic.

Jane: not to mention MJD doesn't seem to know what non-exempt means.

Jane O. (#55) writes,

What business is it of yours?

MJD says,

It's none of my business, although, in the spirit of full disclosure it would behoove Orac to come clean about his vaccine history before any of us jump on his bandwagon.

Personally, I want to believe that Orac practices what he preaches.

@ Orac,

What say you?

Note: Verification of vaccinations, including those based on foreign travel, for the past 10-years will be adequate.

You seem to be suffering from a fantasy that you can weasel out a confession that he hasn’t had his shots (and therefore is a secret antivaxxer and hypocrite)

One might recall that this was a favorite of ol' Gerg's, as well.

Chemmom :Ok, ok. I'll stop commenting and lurk here quietly Right after this.

Narad: I wouldn't know about the drug scene in Morocco. Never been,and I'd be more interested in the wildlife.(Heck, I can barely tolerate tobacco.)

MJD: Do you understand seasons? Flu is more prevalent and virulent in winter and fall. Orac is travelling in summer. Even during 1918, there were very few outbreaks during summer-well, until late August-early September. So you're chicken littling about a very tiny risk to his patients and Orac himself. Not to mention that hospitals provide free flu vaccinations every year. Why do you assume Orac is too dumb to take care of himself?

This 'I am the only intelligent lifeform on the blog' posture of yours is getting beyond stale. It's even staler than Gilly's hippy-dippy 'I want all the drugs' policy.

OK, Panacea, an earlier study suggests the combination can be a problem. Maybe it does act like grapefruit does with some drugs:

The other major issue is the possibility of drug interactions—because CBD is a potent liver enzyme inhibitor it can increase the concentration of other drugs in the body. This means that when administered with other compounds, consequent effects on patients may be due to the increased exposure to those other drugs rather than the CBD itself.

https://www.scientificamerican.com/article/can-cannabis-treat-epileptic…

PgPig (#60) writes,

So you’re chicken littling about a very tiny risk to his patients and Orac himself.

MJD says,

I would never downplay a flu virus and recommend regular flu vaccinations, when available, independent of the season.

I'm surprised to read your comments, PgPig (#60).

I hope Chemmom doesn't put you back on a short leash after that outburst and/or effort. :-)

MjD - Think about it - why would anyone in their right mind waste one second of their time rummaging through their files to verify to a stranger in the "interwebs" that they have had their vaccinations?

I believe in Pap smears, but i wouldn't feel the need to prove to some random jerk that I've had mine regularly.

I assumed [Marijuana] was forbidden, and also impossible to cultivate at high altitudes.

I guess that rules out the usual explanation for the name of Hassan-i Sabbah's group, the Hashshashin.

I'm not our host, but challange accepted. Copied direct from my HMO website. True, honest and complete, you have my word on it, but, of course, how do you know? And just what exactly is this suppose to prove?

Immunization
Date
INFs 3yrs-adult (Influenza)
10/10/2009, 10/7/2007, 10/21/2006, 11/6/2005
INFs 4yrs-adult (influenza)
10/4/2008
INFs pres free 3yrs-adult (FLUARIX Quadrivalent) (Influenza, split virus)
9/9/2016, 9/17/2015
INFs pres free 3yrs-adult (Influenza)
10/17/2013, 9/14/2012, 10/11/2011
INFs pres free 4yrs-adult (FLUVIRIN) (Influenza)
10/21/2014
INFs pres free 9yrs-adult (AFLURIA) (Influenza)
10/19/2010
Tdap (ADACEL) (Tetanus, diphtheria, acellular pertussis)
7/27/2010
ZOS (Zostervirus live, shingles)
11/29/2016

Jane O. (#62) writes,

- why would anyone in their right mind waste one second of their time rummaging through their files to verify to a stranger in the “interwebs” that they have had their vaccinations?

MJD says,

Understood, let's all agree that Orac has and will always be vaccinated.

@ Orac,

If you miss one or many vaccines hereafter, you'll still have my/our full support.

Johnny (~#64) writes,

And just what exactly is this suppose to prove?

MJD says,

Good character from you Johnny and if Orac made such an effort we would all benefit knowing he's doing the right thing.

Gilbert: The possibility of a drug to drug interaction is present with every combination of drugs that exists.

Jane: regarding MJD. Agreed. he tries to come across as funny, and only manages to present himself as smarmy.

If Orac posted his vaccination information like Johnny, no, we would not all benefit. How is that information a benefit to any stranger? I assume he has done everything sensible and necessary (like normal people who are not antivaccine nuts) and i don't need to have this verified.

Christ you are paranoid.

Good character from you Johnny and if Orac made such an effort we would all benefit knowing he’s doing the right thing.

I disagree. I would suggest that if this quote reflects your actual belief, it proves you have a very low bar for persuasive evidence (which I believe everyone here already knows).

While my post above is a true and accurate copy of my shot records for the last few years, there is no way you could know that. If you accept it a face value, you are a foolish person (and no, I will not post my HMO login info so you can check up on me).

To answer my own question, all it proves is that I can look up which shots were given in a particular year and make up a few dates. If our host was to post his 'records', it wouldn't prove a darn thing either.

Your challange was a silly thing, and you should feel bad for posting it.

Jane O. (#69) writes,

Christ you are paranoid.

MJD says,

Having been publicly flogged by Orac as an "Anti-vaccine Zealot" and thereafter regularly placed in auto-moderation, it is my intent to provide personal comments that do away with such anti-vaccine rhetoric (i.e., judgmental insolence).

A respectful and productive conversation on the risk/benefit ratio of vaccines can only be accomplished in the absence of any form of insolence.

@ Orac,

Please consider renaming the much frequented Scienceblogs Respectful Insolence to "Respectful Judgment".

A smidgen of harmony and cooperation MAY ensue thereafter.

I don't know how many of those making comments here have any personal experiences with seizures or epilepsy,but I have lived with recurring/relapsing seizures for decades.In the last few years,they have been mostly atonic,and have gotten worse.I have several underlying genetic and medical issues,involving multiple systems.metabolic,autoimmune,and neurological.

In complex cases like mine,it can be very difficult to say what is the underlying cause of the seizures can be.Standard antiepileptic drugs can often cause more seizures, or make existing seizures worse.As with other conditions,such as MS or cancer,I think there is a lot in favor of a right to try here.Especially if we are talking about CBD oil derived from cannabis,with the THC removed,something I very much do want to try.

We all know there are too many scammers out there who just want to get high,and too many enabling doctors,with questionable credentials,that will gladly create a phony PTSD diagnosis for these scammers,but there can be legitimate reasons to try products derived from cannabis.Whether or not this is actual medical marijuana,is debatable.

Yes, it was first *assumed* that the infected machines were probably XP because, as it is no longer supported, it did not get an update.

Since then, analysis has shown the vast majority of infections were win 7 machines. Though they finally did roll out an update for XP. In fact, I'm suspicious -- NSA lost some tools; They want to implant new ones.

It should be noted that WannaCry was just the current payload of the exploit ETERNALBLUE. It may be that win XP is off the radar because they bluescreened before the implant could activate.

Meanwhile, EternalRocks—a separate self-replicating exploit also developed by the NSA and released in last month's Shadow Brokers release—is also being repackaged in active attacks.

https://arstechnica.com/security/2017/05/windows-7-not-xp-was-the-reaso…

And the beat goes on.....

Oh man, is my face red. I just commented on the wrong website; please ignore.

As for pot, "CBD is a potent liver enzyme inhibitor it can increase the concentration of other drugs in the body. This means that when administered with other compounds, consequent effects on patients may be due to the increased exposure to those other drugs rather than the CBD itself." (#61) -- makes sense then that there were side effects because the patients may have been effectively overdosed on their regular meds.

No worries Tim - I actually liked both of your comments.

e marijuana in Afghanistan and Pakistan

Whilst I have NO idea about it...
I'm sure that they have other more lucrative drugs sources to plant that bring in REAL MONEY

Hi, Tim: In essence, yes. Dosing and frequency of medications is based on the goal of maintaining a steady therapeutic serum level. If a drug to drug interaction causes something to take longer to metabolize, then it can cause a higher (or lower) than desired serum level, with the accompanying additive effects.

This is why people on coumadin shouldn't take St. John's Wort.

In this case, though, the issue is the effect on metabolism. Valproate is metabolized in the liver. So is CBD. In addition to potentially increasing the action and effect of valproate, the combination is stressing the liver somewhat, to the point where three participants in the study had to drop out, while nine others were able to continue.

So it begs the question; is the action of CBD in the liver somehow complimenting the action of the other anti seizure medications in a desirable way (making it useful as an adjuvant therapy), would it be useful on its own as a treatment, or is it simply going to complicate current therapies. The answers to those questions aren't answered by this study. More research is needed.

@Roger: my sister suffers from a very odd form of a focal seizure that causes arm, shoulder, and neck spasms, always the same side and direction. Overstimulation is a trigger; she often gets these when she is tired, when we've been to the movies or is under some other kind of stress. She also has fibro myalgia. She uses pot (medical marijuana is legal in our state, with a vaporizer, as I warned her not to smoke it) when she has a "fibro flare up" to deal with the pain. It works for that quite well, but puts her out like a light so she only does it at night when she's home.

It's had no impact on her focal seizures that we can see . . . and she keeps up with the research into medical marijuana (and is a skeptic herself) because of how the subject impacts her directly. She's well aware of the claims, doesn't think it helps her for that.

MJD @3: Clearly you have never taken a bioethics course, because pretty much lesson 1 is that you can not give anything of real value to study participants because it interferes with/negates their consent.
(Example: "I'm not sure about this study, but I really need to make rent this week." That's coercion.)

Too many parents who gave their children CBD oil which is in hemp and pot; stopped all their seizures and many stopped using their normal medications.

But if CBD is not POT then why did the DEA ban hemp and CBD oil?

If you're taking this site serious, consider a new source of information. You're being lied to; special interest have many interest in only curing symptoms and not disease.

It's the basis of corporate greed and crony capitalist. Why are you going to run yourself out of business? Money always wins; greed always wins.

The truth will remain elusive for the majority who rely on centralized sources of information. 90% of media is controlled by 6 corporations.

"Earth"

Are you sure? Have another look around you.

Does medical marijuana work? The answer is (mostly) "no" and "we don't know"

oracknows — Wed, 24 Jun 2015 07:32:11 +0000

Does medical marijuana work? The answer is (mostly) "no" and "we don't know"

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:

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.
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.
Chronic pain (neuropathic and cancer): Low to moderate evidence of efficacy by GRADE.
Spasticity due to multiple sclerosis or paraplegia: Low to moderate evidence of efficacy by GRADE.
Depression: Evidence favors placebo, but GRADE is very low.
Anxiety disorder: Evidence favors cannabinoids, but GRADE is very low.
Psychosis Evidence favors cannabinoids, but GRADE is low.
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).

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.

oracknows Wed, 06/24/2015 - 03:32

Categories

Medicine

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.

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.

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.

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.

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

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

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.

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

Is chocolate a drug?

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.

@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.

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

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.

" 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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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

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

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".

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.

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!!

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?;-)

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?

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.

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.

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:
https://www.youtube.com/watch?v=a1oFcgLfgV0

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.

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!

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.

@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...

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.

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'.

I refrained from making pothead jokes...this time. Perhaps I shouldn't have shown such amazing restraint. :-)

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.

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.

Tim@33

Washington and Jefferson - see
http://www.straightdope.com/columns/read/2912/did-george-washington-and…

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-nonpharmacologica…

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.

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.

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.

@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.

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!

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.

..."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

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?

"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.

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.

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".

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.

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.)

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.

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.

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..."
https://www.youtube.com/watch?v=LZo1T7KOgs4

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.

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.

@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.

^ 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.)

@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

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

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.

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.

Oh, wow. How did I miss this:

http://www.doctoroz.com/episode/dark-side-legalized-marijuana-edible-po…

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.

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!;-)

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.)

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/mariju…

"It’s linked to testicular cancer." - http://www.cancer.org/cancer/news/study-links-marijuana-use-to-testicul…

"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-…

"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."

"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.

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"

Wow, the potheads have shown up in force.

I hope Orac left out plenty of Doritos for them.

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".

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.

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

Opiate withdrawal isn't life-threatening.

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.

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.

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

^ 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.

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.

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.

^ Sorry about the formatting fail.

... 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.

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

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.

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.

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.

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.

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.

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

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"

"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.

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.

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.

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-wor…

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

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....

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.

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.

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.

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.

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.

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.

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.

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.

“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.

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.

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?

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.

@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.

Medical marijuana and the new herbalism, part 2: The cult of "cannabis cures cancer"

oracknows — Mon, 18 Aug 2014 05:00:29 +0000

Medical marijuana and the new herbalism, part 2: The cult of "cannabis cures cancer"

About five weeks ago a month ago, I finally wrote the post I had been promising to write for months before about medical marijuana. At the time, I also promised that there would be follow-up posts. Like Dug the Dog seeing a squirrel, I kept running into other topics that kept me from revisiting the topic. However, recently the New York Times gave me just the little nudge I needed to come back and revisit the topic, first by openly advocating the legalization of marijuana, then by vastly overstating the potential medical benefits of pot (compare the NYT coverage with my post from last month), and finally a week ago by running a story lamenting the federal law that makes research into medical marijuana difficult in this country.

I stated my position on marijuana last time, which is that marijuana should be at least decriminalized or, preferably, legalized, taxed, and regulated, just like tobacco and alcohol. I also likened the cult of medical marijuana to the "new herbalism," because it (1) vastly inflates the potential of medicinal uses of marijuana and (2) ascribes near-mystical powers to smoking or making extracts out of marijuana, rather than identifying and isolating constituents of the plant that might have medicinal value. All of this is very much like herbalism in alternative medicine. Indeed, promoting laws legalizing medicinal marijuana is such an obvious ploy to open the door to full legalization that some advocates don’t even bother to disingenuously deny it any more. Given that I tend to support legalization, as a physician this sort of deception irritates me. It also has consequences, particularly when overblown claims are made for what cannabis can do. Perhaps the best example of this is the claim that cannabis cures cancer, which pops up all over the Internet in memes such as the one in the image above.

Don’t believe me? Just Google "cannabis cures cancer" or "marijuana cures cancer." To my relief, you’ll find the National Cancer Institute’s page on cannabis and cannabinoids, which, as I discussed last time, dwells more on whether cannabinoids are useful for pain relief, nausea, and cancer cachexia than on whether they can be used to treat cancer directly. However, you’ll also find pages like 20 Medical Studies That Prove Cannabis Can Cure Cancer, a Facebook page Cannabis Cures Cancers!, and articles like Rick Simpson’s Hemp Oil Medicine, which resembles a lot of articles for various alternative medicine and quackery in terms of providing lots of testimonials of cures for skin cancer, diabetic ulcers, and other skin diseases and conspiracy mongering but no hard evidence. Indeed, a commenter by the ‘nym of "Danman" showed up here and proceeded to make hilariously bad arguments for the healing power of cannabis and how my original post was a "prohibitionist hit piece," even though it expressed the opinion that marijuana should be legalized. Meanwhile, others are recommending hash oil for gliomas with a near-religious fervor, touting the same sort of evidence that Stanislaw Burzynski uses to claim he can cure gliomas with antineoplastons.

So what is the story, really?

Cannabinoids versus cancer: Hype versus science

The first problem one encounters when examining the evidence concerning the effect of cannabinoids on cancer is that the vast majority of studies touted by advocates claiming that "cannabis cures cancer" are either in vitro or animal studies. In vitro and animal studies are what we in the biz call "preclinical data," meaning data obtained before trying a treatment in the clinic. As the American Cancer Society put it:

More recently, scientists reported that THC and other cannabinoids such as CBD (cannabidiol) slow growth and/or cause death in certain types of cancer cells growing in laboratory dishes. Some animal studies also suggest certain cannabinoids may slow growth and reduce spread of some forms of cancer. However, these substances have not been tested in humans to find out if they can lower cancer risk. There is no available scientific evidence from controlled studies in humans that cannabinoids can cure or treat cancer.

This basically says it all, and it’s tempting to wind up this post right there, but, as Han Solo said after being urged to be quiet while taking out some storm troopers, "Hey, it’s me." Besides, you, our SBM readers, expect science in addition to my self-absorbed blather, as amusing as it might sometimes be. So you shall have it. As good a place as any to start is, as you might imagine, 20 Medical Studies That Prove Cannabis Can Cure Cancer. After all, I assume that Arjun Walia, the person who put this list together, wanted to provide the very best evidence that could be found, particularly given the emphasis that "this is a short list." I perused the papers in the list and was—shall we say?—underwhelmed. I’ll divide my discussion into tumor types, the way the list does. First, you have to understand that CBD, one of the cannabinoids found in marijuana, is viewed as particularly promising because it does not produce the same psychotropic effects as Δ9-tetrahydrocannabinol (THC), making it a particularly attractive for developing treatments whose side effects don’t involve being stoned all the time.

Glioma. The first thing that jumped out at me is that one of these papers has nothing to do with cancer, specifically this study that suggested that cannabinoids could protect the brain against neurodegeneration in neonatal rats caused by the toxin ouabain (an Na⁺/K⁺-ATPase inhibitor). The vast majority of the other studies were in human cell lines, such as this one studying the effect of cannabidiol, a nonpsychoactive cannabinoid, on glioma cell lines. As a cancer researcher, I noted that the IC₅₀ (the concentration that produces 50% of maximal inhibition of the parameter being measured), was 25 μM, which is a bit higher than we like for an anticancer compound. I was thus not particularly impressed, although in fairness subcutaneous injection of CBD was able to inhibit the growth of glioma xenografts implanted subcutaneously in athymic nude mice, although no dose-response was demonstrated, and a dose of 0.5 mg per mouse is a pretty generous dose (25 mg/kg for a typical 20 g mouse). So while there does appear to be antitumor effect against the glioma cell lines tested, it was, at best, modest. Certainly it wasn’t the sort that would knock my socks off as a cancer researcher. A different study, which combined THC and temozolomide, produced more impressive results, not for the THC, which produced at best modest antitumor effect, but for the combination, which looked a bit more promising. Of course, one also must note that this is not hash oil or smoked pot, but the purified THC component. That THC might be useful against glioma does not tell us that hemp oil or smoking the weed will be useful against glioma any more than the fact that digoxin works in congestive heart failure tells us that it would be a good idea to ingest foxglove leaves.

Skeptical Raptor puts it in perspective:

In one study, the researchers determined that it would take a concentration of cannabinoids of approximately 10 µmol/L to cause the death breast cancer cells in cell culture. This converts to around 3.14mg/L of THC. So, you’d have to assume that to kill any breast cancer cells, you’d need at least a blood level of 3.14 mg/L to achieve breast cancer cell death. So how close to that 3.14 mg/L can we get by just smoking a joint or two? According to research, smoking one joint will give you a blood level of THC of around 1.3-6.4 ng/mL serum, or about .00013-.00064 mg/L. In other words, to get an anti-cancer effect, you need to light up around 1000 joints per day.

The IC₅₀ values in these studies were higher than 10 μM.

Finally, there was one human study in the list of glioma papers. Basically, this was a phase I trial testing a method of administering THC. This was also some strange science in that nine patients with recurrent glioma had their tumors resected, but a catheter was left in the cavity left behind after surgery, and then:

Each day an aliquot of the THC solution (100 mg ml⁻¹ in ethanol) was dissolved in 30 ml of physiological saline solution supplemented with 0.5% (w v−1) human serum albumin, and the resulting solution was filtered and transferred to an opaque syringe. This process was performed at the Department of Pharmacy of the Hospital Universitario de Canarias. Owing to the high hydrophobicity of THC, we controlled by gas chromatography/mass spectrometry (see below) the actual concentration of THC in the final solution. The THC solution was administered to the patients for different times starting at days 3–6 after surgery at a rate of 0.3 ml min−1 with a syringe pump connected to the subcutaneous reservoir. In the case of Patients 1 and 2, who received THC for 30 and 26 days, respectively, biopsies were also taken after the THC-treatment period and various tumour-cell parameters were evaluated.

As you can see, this is very different from smoking marijuana or ingesting hash oil. It involves directly infusing THC solution at a high concentration directly into the brain cavity where the tumor had been, in the hope of killing off any remaining tumor cells surrounding the cavity. Let’s just put it this way. There’s a reason why direct intratumoral injection of any drug is generally frowned upon, and that’s because it’s invasive and rarely works. Moreover, no one generally bothers with intratumoral infusion of a drug unless it requires a very high concentration to work. Mean survival was 24 weeks, and two patients survived approximately a year. The authors try (rather like Stanislaw Burzynski, actually) to argue that this is better than would be expected based on other studies and controls, and to claim that some patients responded. I find no convincing evidence of this in the paper, and in a cohort of nine patients though, it’s pretty darned hard to conclude this. I agree with Harriet. There is nothing "earth shattering" about these results. They could be consistent with an antitumor effect, but they could just as easily be consistent with no effect. Worse, this was not simply ingesting, smoking, or being injected with cannabinoids. The study involved having catheters sticking out of the subjects’s heads and having THC infused directly into the brain.

Breast cancer. I’m a breast cancer surgeon; so I’m going to go out of order here. There are four breast cancer studies listed. The first study examines CBD activity against a mouse breast cancer cell line 4T1 (another cell line I’m quite familiar with, having used it in my lab and because it was a cell line developed by a now retired investigator whom I know), and the breast cancer cell line MDA-MB-231 (which I’m more familiar with than I’d like to be). Basically, the study showed a modest effect against these two cell lines in vitro and in mouse models using 1 mg/kg and 5 mg/kg CBD. The second study looked at five different cannabinoids and found that CBD was the most potent inhibitor of breast cancer cell growth in vitro (IC₅₀ between 6.0 and 10.5 μM) and that CBD and "CBD-rich oil" could inhibit the growth of MDA-MB-231 tumor xenografts. In this study, the effects of THC on cancer cell growth were weak (IC₅₀ between 14.2 and over 25 μM, depending on the cell line). The third study showed similar results for HER2/neu(+) tumor cell lines using THC and specific synthetic agonists (activators) of cannabinoid receptors CB1 and CB2 (Win55,212-2 and JWH-015, which activate CB1 and CB, respectively) except that THC was not as weak. The fourth study didn’t look at marijuana cannabinoids at all, but rather the endogenous cannabinoid anandamine, with similar results.

Lung cancer. The next set of three studies look at lung cancer. The first study used a cell line with which I’m quite familiar, A549 lung cancer cells, using both cell culture and mouse xenograft models. I must say that I was singularly unimpressed with the effect sizes, at least in the in vitro studies, which also required fairly high concentrations (15 μM) of THC. In a mouse tail vein injection model of lung metastases, 5 mg/kg of THC decreased metastases by 50%, which is not bad, and in a straightforward xenograft model resulted in a 50% growth delay of the tumors, which is also not bad. The next study found similar results testing CBD against lung cancer cell lines and tumor cells from a patient in cell culture and mouse models. The third study showed that stimulation of cannabinoid receptors (CB1 and CB2) with synthetic agonists, Win55,212-2 and JWH-015, which activate CB1 and CB2, respectively, inhibited the growth and invasion of A549 lung cancer cells in vitro and their growth and metastases in mouse models.

And so it goes. Nearly all of these studies look at purified cannabinoids, usually either THC or CBD, but sometimes the endogenous cannabinoid anandamine (which isn’t even in marijuana), as with the breast cancer study above and this prostate cancer study. Some use synthetic agonists, such as the breast cancer and lung cancer studies above, or this study of mantle cell lymphoma that tested R(+)-methanandamide in addition to Win55,212-2, or this study of non-Hodgkin’s lymphoma, which also used R(+)-methanandamide. With the exception of the glioma study, all were preclinical studies looking at cell culture models and mouse models. One was a review article. One, as I pointed out above, had nothing to do with cancer, and I suspect the author included it to round up his list of studies to 20.

Unfortunately, it’s a highly intellectually dishonest list of studies if your goal is to provide evidence that "cannabis" (as in the plant or extracts from the plant) can cure cancer. Unfortunately, this is not the first time Arjun Walia has constructed such a list. Last year, Liz Ditz nailed him for constructing a similarly intellectually dishonest list of studies that "show vaccines cause autism." Let’s just put it this way. In 2013, Walia was still citing some highly discredited studies, such as studies by Mark and David Geier.

The intellectual dishonest of representing this list of studies as evidence that cannabis cures cancer aside, it is a group of moderately interesting papers that suggest that purified cannabinoid receptor agonists can produce reasonable, albeit by no means spectacular, antitumor effects in preclinical models. As a whole, they suggest that some of these purified cannabinoid agonists, whether naturally occurring, such as THC, CBD, or synthetic, such as R(+)-methanandamide, or specific to CB1 or CB2, such as Win55,212-2 and JWH-015, might be worth investigating further. Again, we’re talking about pharmacology, isolating active substances and purifying or chemically modifying them to improve their activity and safety profile, not smoking weed or using hash oil. Cancer Research UK concludes:

But claims that this body of preclinical research is solid "proof" that cannabis or cannabinoids can cure cancer is highly misleading to patients and their families, and builds a false picture of the state of progress in this area.

It’s also noted that the best results in the lab have come from using a combination of highly purified THC and CBD, but that there have also been positive results with synthetic cannabinoids, such as a molecule called JWH-133, just as I’ve described, through mechanisms that include:

Triggering cell death, through a mechanism called apoptosis
Stopping cells from dividing
Preventing new blood vessels from growing into tumors
Reducing the chances of cancer cells spreading through the body, by stopping cells from moving or invading neighbouring tissue
Speeding up the cell’s internal ‘waste disposal machine’ – a process known as autophagy – which can lead to cell death

Unfortunately, as good as that sounds, it’s not all good. There is also evidence that cannabinoids, under some circumstances, can stimulate cancer cell growth and possibly contribute to tumor progression. They can also have different effects depending on dose and the level of cannabinoid receptors on the tumor cells being treated. For instance, this study suggests that cannabinoids only induce apoptosis in cells that express low levels of receptors that couple to a signaling pathway called ERK1/2 but don’t induce apoptosis in cells that have high levels of receptors because they then couple through a survival pathway known as AKT. Interestingly, cannabinoids also seem able to induce cell death through pathways that don’t involve cannabinoid receptors. In other words, it’s complicated, because cancer is complicated, and cancer drugs tend to work only against certain cancers. If cannabinoids do have anticancer effects in humans, it will likely only be against certain cancers, most likely combined with existing chemotherapy and targeted drugs. We also know from the preclinical work that has been done that it will take purified THC and/or CBD and/or synthetic cannabinoid receptor agonists to produce even the modest effects observed thus far, effects that are too modest to expect cannabinoids to be any sort of cure for cancer on their own. Smoking weed or using hash oil just isn’t going to cut it.

But what about the anecdotes?

On that other blog that you all hopefully know and love, one of the commenters, Justin Kander, cited a case report that’s been going around social media as "proof" that cannabis cures cancer. This case report describes a 14-year-old girl, PK, who presented with symptoms of "weakness, shortness of breath and bruising when she was taken to the Hospital for Sick Children, Toronto, Canada, on the 10th March 2006." She was diagnosed with acute lymphoblastic leukemia (ALL) and underwent standard chemotherapy for ALL for six months. Upon analysis, she was found to be positive for a mutation in the Philadelphia chromosome, which is found in 2-10% of pediatric ALL cases. Philadelphia chromosome-positive ALL tends to have a poorer prognosis than other ALL. PK underwent a bone marrow transplant but was noted to have blast cells six months after treatment and therefore underwent aggressive chemotherapy along with a tyrosine kinase inhibitor. After more recurrences and more treatment (such as radiation therapy to the brain for a presumed, but never completely documented, infiltration of the brain by leukemia, it was stated in the case report:

On the 4th February 2009, blood was noted in the patient's stools and a blood cell count revealed the presence of blast cells. As a result, all treatment including the disatinib was suspended and the patient's medical staff acknowledged failure in treating her cancer. It was charted by the patient's hematologist/oncologist that the patient ‘suffers from terminal malignant disease. She has been treated to the limits of available therapy… no further active intervention will be undertaken’. She was placed in palliative home care and told to prepare for her disease to overwhelm her body and from which she would suffer a stroke within the next 2 months.

The family found articles on how cannabis supposedly cures cancer, and found their way to Rick Simpson, who has been featured in utterly credulous articles in High Times and SF Weekly (the latter of whose editors really should have known better) as the man who can cure cancer with hemp oil, who provided her with hemp oil mixed with honey (because of the bitter taste and viscous nature of hemp oil). This was administered in daily doses. It is claimed in this case report that there was a strong correlation between increasing dose of the hemp oil and decreases in PK’s blast count (a measure of leukemia cells in the blood), but looking at Figures 1, 2, 3, and 4, I have a hard time seeing it. Figure 1 shows increasing doses of hemp oil from what was called the "chronic" strain. That’s the closest we see to decreasing blast counts correlating with hemp oil dose. By day 15, the chronic strain was gone, and PK started taking Hemp Oil #2 from an outside source. In actuality in Figure 2, we see the blast count increasing with increasing dose until day 27, when it starts falling. Figure #3 shows Hemp Oil #3 (Afghan/Thai strain) from days 44 to 49. Given that the blast count stayed the same one can’t say much about this. Then Hemp Oil #4 was tried from day 50 to day 67, and her blast counts started rising. Finally, Hemp Oil #5 was tried and PK’s blast count fell between days 69 and 78. During that time, PK suffered the psychotropic effects of the hemp oil, including euphoria, disoriented memory, and the like.

Unfortunately, PK developed gastrointestinal bleeding and bowel perforation with peritonitis on day 78 and passed away. So, basically, she lived two and a half months after being placed on hospice. The authors assert that a dose-response curve was achieved, but to my eye I really don’t see it, except perhaps at the beginning, nor do I really buy the claim that the bumps in blast counts correlate with using "lower potency" strains. They also assert because PK was treated for tumor lysis syndrome (a syndrome in which the waste products of tumor breakdown, often seen after intense chemotherapy in hematopoietic malignancies, injure organs such as the kidneys), it must mean that the hemp oil was effective.
Unfortunately, even if a mild dose-response effect was observed that would not rule out spontaneous remission. Spontaneous remission is known to occur in ALL, although it is usually temporary, and spontaneous tumor lysis syndrome has been reported, although it is rare. In any case, one has to wonder whether the patient’s bone marrow was petering out near the end, something that is hard to determine because almost no laboratory values other than blast counts are presented, except at the end, when she had a very low platelet count (8K; normal 150K to 450K), a low white blood cell count (1.4, normal 4.5-13.0), and severe anemia (hemoglobin 8.2; normal: 13 to 16). It wasn’t established how the diagnosis of tumor lysis syndrome was made other than that the patient had elevated urate levels. Indeed, the entire case report seemed to have been written with the belief that it was the hemp oil that accounted for the decrease in blasts. A lot of information has been left out about the patient’s clinical course. All we know is that, after being placed in hospice, she was fortunate to have her blast count fall, developed a central line infection, and was treated for tumor lysis syndrome. We can also infer that she was still having considerable issues with her gut because she was on total parenteral nutrition (being fed by vein) and had trouble when they started to try to feed her orally again.

It should also be remembered that, whether or not hemp oil was responsible for the decline in blasts (which is possible but not convincingly demonstrated by this case study) or whether it was "burnout" of the bone marrow in the terminal phase of the disease or even spontaneous remission, the patient still died. She still developed GI bleeding and a GI perforation with peritonitis and died of it only 78 days after going on hospice. There’s no way of knowing whether hemp oil prolonged her life. Probably it did not, as a two to three month survival after going into hospice after being declared terminal for leukemia is well within what is expected. In other words, this case report is mighty thin gruel indeed.

Of course, the sad story of PK and the treatment of her terminal relapsed ALL with hemp oil is probably the highest quality cancer cure testimonial out there, and unfortunately its quality is not that high at all. The rest of the anecdotes I ran into tended to be about as convincing to someone familiar with cancer as nearly all the other alternative cancer cure testimonials I’ve found; i.e., not very. If you don’t believe me, take a look at this article, in which Rick Simpson claims his success rate for patients with terminal cancer is around 70% and says:

"The ones that can’t be saved are usually the ones who’ve had the most chemotherapy and radiation, or wait too long to start the treatment," he says. "They have to be able to stay alive long enough for the oil to start to work." In fact, most patients who undergo chemotherapy die from the treatment, not the disease.

No, it is not a "fact" that most patients who undergo chemotherapy die from the treatment, not the disease. It’s a lie. In any case, Rick Simpson is just like cancer quacks the world over, who have no firm evidence to back up their miraculous-sounding cure rates and excuse their failures by claiming that the treatment patients had before prevented the quackery from working. Quacks like Rick Simpson do those who think that cannabinoids have promise in treating cancer no favors.

Conclusions

There’s a lot of interesting research about the role of cannabinoid receptors in cancer and whether targeting them with cannabinoid agonists from marijuana or other natural sources, synthetic agonists, or endocannibinoids will be a useful tool to add to the armamentarium of anticancer therapies. From what we know now, it is quite clear that cannabis does not cure cancer, at least not by itself and certainly not ingested or smoked as marijuana or ingested or applied topically as hemp oil. Even in purified form, naturally-derived or synthetic cannabinoid agonists show relatively modest antitumor activity in preclinical models, which means that they will have to be combined with existing chemotherapeutic regimens. If they do find their way into the routine clinical treatment of cancer, it will be through rigorous pharmacological studies and rigorous clinical trials, the latter of which, in particular, are painfully lacking. Indeed, if you search ClinicalTrials.gov, you’ll quickly find lots of trials of cannabinoids to treat cancer-related symptoms and side effects, but precious few to treat cancer itself. There’s this phase I trial of Dexanabinol in Patients With Advanced Solid Tumors, which has been open two years and is still accruing patients, as well as this one of Dexanabinol against brain cancers. It’s not a lot, and suggests that there is not much interest in even synthetic cannabinoids as a treatment for cancer. After all, there are so many other promising avenues that a class of drugs that show the modest effects that the cannabinoids I’ve discussed do just don’t excite researchers that much.

In any event, the claims of advocates that "cannabis cures cancer" are nothing more than herbalism infused with the magical thinking of the naturalistic fallacy. Just because it’s "natural" does not make it better. In the case of cannabis for cancer, the only potentially promising way forward is to isolate the active components and figure out which of the hundreds of different cancers in which these components have activity against.

Finally, I have no objection to lobbying for the legalization of marijuana for recreational use. I would support such measures myself. However, trying to use hugely exaggerated claims of medicinal benefit as a back door path to legalization gets my skeptical antennae all a’twitchin’ about all the other claims made by advocates and provides ammunition for critics whose real goal is prohibition.

Next: More testimonials analyzed.

oracknows Mon, 08/18/2014 - 01:00

Categories

Social Sciences

"In any event, the claims of advocates that “cannabis cures cancer” are nothing more than herbalism infused with the magical thinking of the naturalistic fallacy."

...and driven in many instances by the idea that the suffering of cancer patients can be used to get pot legalized for the benefit of recreational users.

**Sigh** And so reason becomes another another casualty of The Drug Wars, or, lack-of-reason in one direction begets lack-of-reason in the opposite.

"Indeed, promoting laws legalizing medicinal marijuana is such an obvious ploy to open the door to full legalization that some advocates don’t even bother to disingenuously deny it any more." True, but this has been the only SUCCESSFUL ploy against draconian policies. It's not just a question of 'prohibition' but of the forms and levels of punishment meted out to violators.

As annoying as cannabis-cures-cancer herbalism may be to an oncologist, I'd hope Orac could find some comfort in the thought that many if not most of the folks advancing such claims are being disingenuous, and it's mostly a nudge-nudge, wink-wink we're-all-in-on-the-joke-down-here-at-the-dispensary ruse. And to any extent that anyone who's not already into herbalist woo gets sucked into that by cannabis claims (which I'm thinking is improbable, not that I have any real knowledge thereof) it's a small social price to pay if it keeps one poor schmuck from getting 20 years of hard time for weed possession (and of course we're actually talking about thousands of people, marked out mostly by Racism and Classism, sacrificed to the prison-industrial complex every year.)

If any other form of woo has even a scintilla of either a similar degree of self-awareness of its own BS, or a corresponding social good, I can't think of one.

As to Orac's point that exaggerated medical claims provide ammunition for the prohibitionists, I suppose that's true, but I wonder how effective that ammo actually is. Sometimes a rhetorical or political position is strengthened by more reasonable advocates being able to point to irrational advocates on the extremes, and saying "Hey! We're not them!"

(NB: My only 'dog in this fight' is actually the best interests of the sober, as I have never used recreational intoxicants of any kind. I am not only familiar with the statistics that show a high correlation between alcohol intoxication and violent crime, but I have had people I know killed by drunk drivers; personally witnessed a drunk run a red light and crash into an innocent motorist causing serious injury; and been the victim of verbal aggression by drunks on too many occasions to count. In contrast, I have never been hassled by a stoner, nor am I aware of any stats indicating pot-heads are unusually prone to settling disputes with their Significant Others with firearms. Thus, from my POV, every toke that REPLACES a shot of booze or yet-another-brewski is a social good.)

many if not most of the folks advancing such claims are being disingenuous, and it’s mostly a nudge-nudge, wink-wink we’re-all-in-on-the-joke-down-here-at-the-dispensary ruse

Do you have any evidence for this or is it an opinion? I've encountered many, many true believers on the 'net. I suspect only a matter of time before some show up here. In fact, there were so many true believers here in Seattle that they almost killed I-502 (which legalized marijuana) because it didn't go far enough: http://boycotti502.com/

As annoying as cannabis-cures-cancer herbalism may be to an oncologist, I’d hope Orac could find some comfort in the thought that many if not most of the folks advancing such claims are being disingenuous, and it’s mostly a nudge-nudge, wink-wink we’re-all-in-on-the-joke-down-here-at-the-dispensary ruse.

Funny you should mention this, as my next post will definitely show that there are a lot of people out there for which this is most definitely not true.

I'm not sure which of these I'm more comfortable with, personally:

- People who overestimate the value of research because it fits their belief patterns; or
- People who know that the research doesn't support what they say but cite it anyway to support their agenda.

In the first case they're being insufficiently skeptical; in the second they're claiming the ends justify the means.

In contrast, I have never been hassled by a stoner

Based on my experience, I wouldn't generalize from your experience.

First, you have to understand that CBD ... is viewed as particularly promising because it does not produce the same psychotropic effects as Δ9-tetrahydrocannabinol (THC), making it a particularly attractive for developing treatments whose side effects don’t involve being stoned all the time.

Does this originate with Cunha? It's long been standard lore that high-CBD strains (viz., "indica") produce a more stoned than "high" state as compared with low-CBD strains ("sativa").

There are obviously ways in which this could be a complete artifact (one of which would be straightforwardly settled by having experienced users go through a washout period and offering their opinions), but were it to hold, CBD would at least be exerting a modulatory effect on psychoactivity, and one that some people don't find interesting at all.

Instead, I'm now seeing an awful lot of cut-and-paste of this bit about CBD "counter[ing] the the psychoactive effects of THC."

It’s long been standard lore that high-CBD strains (viz., “indica”) produce a more stoned than “high” state as compared with low-CBD strains (“sativa”).

Anecdotally, this has always been true for me. You'll often see this expressed as 'body high' (indica) vs. 'head high' (sativa). 'Couch-lock' is another slang term used to describe the intense body high associated with a good indica.

Check out Leafly, which has done a great initial job trying to quantify these various effects for most strains currently on the marketplace.

I've been waiting for this post. :)
To the writer who thinks there's a nudge-nudge/wink-wink inside joke, I'm afraid not. The pro-cannabis people have undertaken a massive guerrilla marketing campaign, hitting up every cancer site they can with their cancer cure 'research' and anecdotal evidence. In addition to these gunja warriors there are facebook groups and youtube pages. It's hard not to find them if you're doing any research about cancer on the web. There's not a hint of irony in their claims, no wink, no nudge. The terminally ill aren't typically appreciative of inside jokes about cancer cures. I can't tell if the goal is to legalize marijuana in all 50 states or to set themselves up to be bazillionaires off the future sale of cannabis oil. Who knows? Maybe it's both.

MOB #5: I would have to find the second more objectionable, as it's intentional dishonesty, as opposed to ignorance. End justify the means people manipulate and use others, especially the ignorant ones who may not have as many resources as the manipulators do.

Can Orac address the apparent theraputic effect of some cannabis therapy on certain types of siezures? Those claims seem at least plausible in the context of the cannabinoids psychoative effects.

The other question that arises to my mind is where is the reasearch that shows negative effects of using cannabinoids recreationally? As an example we are seeing a number of claims about addiction to cannabis now. Is there any evidence at all that cannabis is addictive other than in the context of some psychological dependency?

I think the whole debate is rather pointless and useless. There is no doubt at all that cannabis has been a major boon to law enforcement selectivity and fear mongering.
There also seems to be some confusion in this thread with respect to the two species of cannabis and their relative potency. Indica is the species of choice to my understanding for recreational users because it is naturally higher in content of THC. Sativa is commonly referred to as rope dope, good for fiber, almost useless for "getting stoned". However, it is possible due to the magic of organic chemistry to extract most of the cannabinoids from any version of the plant and with some
isomerization and treatment with HCL greatly increase the proportion of THC. All of this is actually available in published literature.

For the record, other than in the possible case of mitigating idiopathic siezures I don;t think cannabis has any medicinal qualities beyond those of a mild sedative or relaxant. I suppose it is possible that it can mitigate nausea in patients undergoing chemo-therapy but I have never seen any evidence that that is true. As to increasinging appetite, that also is wholly ancecdotal so far as I know. It might possibly increase one's awareness of appetite given its psychoactive effects.

In contrast, having observed for decades the adverse effects of people who indulged in too much alchohol and the extent to which that drug impairs both judgement and motor relexes with respect to such behaviors as driving, it seems to me that the prohibition of recreational use of cannabis is irrational and counter productive.

I favor its legalization. The police have more serious crimes to investigate and the prisons, though counter productive in and of themselves, would have far less fodder for the cultivation of serious anti-social behavior.

I'll STFU now regarding the issues of science and human behavior because there are obviously a lot of people who do not understand science and who assume that behaivor is something magical. It can't be argued with. But like the issue of global warming, sooner or later, reality will impose itself on the delusional and the ignorant. And yes,
it can be cruel.

I am glad that I am old.

Fare forward....

Krubozumo Nyankoye,

There also seems to be some confusion in this thread with respect to the two species of cannabis and their relative potency. Indica is the species of choice to my understanding for recreational users because it is naturally higher in content of THC. Sativa is commonly referred to as rope dope, good for fiber, almost useless for “getting stoned”.

You appear to be confused yourself. Sativa strains (subspecies, not a separate species) tend to be higher in THC, indica strains higher in cannabidiol. Sativa strains are most certainly not almost useless for "getting stoned" (Thai and Durban Poison are both sativa strains, for example), unless you are making a distinction between THC "highs" and CBD "stone". Perhaps you are thinking of strains that are bred to have low levels of psychoactive components. These do tend to be sativa strains because they are better for producing fiber, being taller.

Other than that, I tend to agree with you.

I too would like to see more analysis of the anti-cannabis material. I've seen some of the propaganda from early to mid 20th century that makes me more than a little suspicious of the claims of the prohibitionists, but I'd sure like a rational review of their claims as well. My two younger kids are 13 and 10; I'd really like to have a source that I can trust for discussions so I don't have to rely on dubious claims from either side. Managed ok with eldest kid (at least I think so) but nothing had been legalized for general consumption yet.

Autism Speaks published an article about a small study using hemp oil for the treatment of intractable-to-treatment seizures in children specifically diagnosed with Dravet Syndrome and Lennox Gastaut seizures.

http://www.autismspeaks.org/blog/2014/07/11/can-hemp-oil-reduce-seizure…

I posted a comment and look at who else posted comments...He-Who-Must-Not-Be-Named and Katie Wright. (As far as I know, Ms. Wright's child has not been diagnosed with Dravet Syndrome and does not have Lennox Gastaut seizures).

I was wondering the other day about something related to this...

Why does it have to be cancer? Why don't they study it for anorexia? There's prior plausibility all over the hypothesis that it would work, since we're talking about a condition characterized by emotional anxiety and lack of appetite, and a potential treatment known for mellowing people out and giving them the munchies.

Of course, the proposition that "there are a lot of people out there" who buy into cannabis-cures-cancer claims for realz is not at all inconsistent with the claim that "most of the folks advancing such claims are being disingenuous" since the domain of people who advocate for legalized access to weed by-any-means-necessary is really, really big. (Anecdotal, yes, but as a Californian I know a LOT of people who have medical prescriptions for weed, and every single one of them is winking.)

But that's trivia, really. The 'argumentation fail' in response to my comment above is the absence of response to the larger points about 1) the massive racist and classist injustices inflicted via anti-marijuana laws 2) the various 'medical' arguments being the only rhetorical/political strategies that have actually been effective in reversing these draconian laws 3) the slippery-slope fallacies that conflate reasonable advocates with nutters, and fail to acknowledge that nutters perform the strategic value of making the reasonable advocates appear sane.

Bottom-line: It only makes sense to prioritize your targets, and focus fire on the woo-scams that do the most harm, and have no countervailing pro-social 'side-effects'. (E.g. Right-To-Try, which is all about the anti-social 'side-effects' of dismantling the FDA, to great harm, as Orac will explain in the next post...)

"My two younger kids are 13 and 10; I’d really like to have a source that I can trust for discussions so I don’t have to rely on dubious claims from either side."

I do hope someone can point you to that, as "what about the kids" and "what do I tell them" are serious questions. Given the wide circulation of so many dubious claims, I don't know how any 10-13 year old could sort out what's trustworthy and what's not. Ultimately, you-as-parent will be the source of Ethos for whatever you might pass on to them, and adolescents are pretty-much hard-wired to do whatever adults tell them not to do. (Of course, your kids may be a different story. I was...FWIW.) That being the case, I'm guessing the most traction would come from being different from the other Voices of Authority on one hand, and Peer Pressure or Rebellion for the Hell of It on the other. As the voices on both sides are more than a bit hyperbolic, you have the happy coincidence of 'difference' correlating to measured reason and objectivity.

What that would consist of exactly is pretty hard to say, I'll admit, though it's probably very context dependent on the nature of your family (especially whether the adults drink, how much, how often, to what ends...) and the school/neighborhood environment...

Anyway, though childless myself, I can feel the dilemma, and I wish you and yours the best.

brewandferment: "I too would like to see more analysis of the anti-cannabis material."

There was an article today in the NY Times that addressed that issue: http://well.blogs.nytimes.com/2014/08/18/marijuana-teens-health-risks/

I have been honest with my kids about the one week I tried smoking marijuana. Essentially I did not continue because I did not like the way it made me stupid, plus I can't stand the smell.

I guess it worked. When we visited Copenhagen my teenage daughter refused to go into Freetown Christiana. Also both kids were not happy with the smells from some pubs in Amsterdam.

sadmar, Chris,

Thanks! Those ideas are pretty much where I'm going. I've been frank in giving them my opinion about prohibition: I think criminalizing anything that's easily grown or made is a fool's errand. If it's production is inherently dangerous (is crack production really as bad as popularly portrayed? who knows?) then that's the reason it ought not be permitted, just like baking explosives in your apartment is a really stupid idea. I like the comment I saw either here or SBM about how pot can trigger schizophrenia and you are most vulnerable in teens/early 20s. My husband didn't like it and I don't like the smell although I never tried it, and the few times I got really and truly blotto drunk got less and less worth the pain the next day. Haven't discussed that with the younger two yet, we still have a fair amount of control over their opportunities. So yeah, I try to steer a middle ground too, and keep current with terminology. Just want to have a good science based knowledge of pot (and other psychoactive substances for that matter) that's accurate and it's not easy to find one that doesn't demonize or sing praises.

ebrillblaiddes: Now that you mention it, that does seem odd. I think that since most patients treated for anorexia are teens, physicians are reluctant to suggest controlled substances for treatment. Also, most anorexics tend to have symptoms of depression- I don't know how marijauna interacts with ssris.

bandf: I'd suggest you watch Reefer Madness with the kids, even though it's ludicrous. It's on Netflix, and I'd be really surprised if you couldn't get it at the library. It's a propaganda piece, admittedly, but it might be a good jumping off point.

For the sake of balance, I think it's important to emphasize that the research continues to support long-term effects on brain development, progression to psychoses, and some rare but potentially lethal events (stroke, heart attack). The role of cannabis in promoting cancer is still uncertain, but biological plausibility is high. There is little doubt that smoking cannabis is bad for respiratory health, cardiovascular health, and particularly bad for normal brain development in younger people. Cannabis does produce a dependency syndrome comparable to cigarette smoking.

I would join Orac in supporting some form of decriminalization that included treatment and rehab, but I remain unconvinced that full legalization is the best route to take.

Am J Cardiol. 2014 Jan 1;113(1):187-90.
"Adverse cardiovascular, cerebrovascular, and peripheral vascular effects of marijuana inhalation: what cardiologists need to know."
http://www.ncbi.nlm.nih.gov/pubmed/24176069

Lancet. 2009 Oct 17;374(9698):1383-91.
"Adverse health effects of non-medical cannabis use."
http://www.ncbi.nlm.nih.gov/pubmed/19837255

Front Psychiatry. 2014 May 22;5:54.
"Gone to Pot - A Review of the Association between Cannabis and Psychosis."
http://www.ncbi.nlm.nih.gov/pubmed/24904437

Neuropsychol Rev. 2013 Jun;23(2):117-37.
"Effects of cannabis on neurocognitive functioning: recent advances, neurodevelopmental influences, and sex differences."
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3593817/

Respirology. 2014 Jul;19(5):655-62.
"Cannabis smoking and respiratory health: consideration of the literature."
http://onlinelibrary.wiley.com/doi/10.1111/resp.12298/full

Why does it have to be cancer? Why don’t they study it for anorexia? There’s prior plausibility all over the hypothesis that it would work, since we’re talking about a condition characterized by emotional anxiety and lack of appetite, and a potential treatment known for mellowing people out and giving them the munchies.

Mirtazapine on line 2.

The pro-cannabis people have undertaken a massive guerrilla marketing campaign, hitting up every cancer site they can with their cancer cure ‘research’ and anecdotal evidence. In addition to these gunja warriors there are facebook groups and youtube pages. It’s hard not to find them if you’re doing any research about cancer on the web.

Last night I was having a few beers with an old university friend who's been on chemo for his colon-cancer metastases, and that is exactly what he reports, i.e. a phenomenal level of marijuana-as-cancer-cure propaganda in circulation. Facebook pages proliferating, and sent to him by well-intended friends with poor research skills. Enough to leave my friend wondering whether Philip Morris or BAT is behind it all and hoping to profit from new markets.

ebrillblaiddes,

I was wondering the other day about something related to this…
Why does it have to be cancer? Why don’t they study it for anorexia?

I think it is has been studied as an appetite stimulant, but anorexia is a far bigger can of worms than a simple lack of appetite. Anecdotally, most serious stoners I have known have been skinny rather than plump, something I have wondered about, given the drug's notorious effects on appetite.

Narad,
I was prescribed Mirtazepine for depression several years ago, and I still haven't completely lost the 30 pounds I gained, without any noticeable increase in appetite or food consumption, oddly. This rapid weight gain actually made my feet and legs hurt when walking, which was a strange experience for someone who has always been on the edge of underweight. It didn't help the depression either, probably because, as now seems clear, my symptoms were being caused by a chronic sinus infection.

concordance,

Thanks for the authoritative links, that's the sort of stuff I was looking for. My Pubmed skills are nonexistent presently--especially for such a complex question--so much appreciated.

I have to second c0nc0rdance's concerns about usage of MJ by youngsters ( primarily because interference with executive functioning development) and add that there can be serious repercussions in people at risk for SMI or who experience SMI regardless of age

OT- but seriously, how often is it that ALL of the woo-drenched swamps of un-reason that I blithely survey tap into the same identical keg of swill within 48 hours- which would never be truly OT @ R -btw-?
In fact, AFAICT, it might even be some sort of a record.

Both Mikey and Gary feature Focus Autism's/ Brian Hooker's interview with Deep Throat and his 'analysis' of "fixed" CDC data ( @ NaturalNews and @ PRN, yesterday's noontime show tape / previously @ Jake's place/ 2 articles @ AoA / TMR/ video with Andy and David Lewis).

AND, as promised, Dan delivers his first interview detailing a parent's observation of "vaccine injury". ( AoA). Which is exactly what you would expect.

@ Denice Walter: I'm seeing that press release about Hooker's study all over the internet. Secret anonymous "whistleblower"?
I think I'll wait for the movie.

Dan's new feature, interviewing parents of "vaccine-injured" children, leaves me underwhelmed.

I still haven’t completely lost the 30 pounds I gained, without any noticeable increase in appetite or food consumption, oddly.

My shrink at the time swore up and down that the 25 pounds I put on were almost certainly due to increased caloric intake. I definitely did seem to be sleep-eating, judging by the weird messes discovered on the counter in the morning.

Several years down the line, I find it to be somewhat helpful in controlling my non-entrained sleep rhythm. I've only trialed it during the day a few times, but I'm tempted to rank the sedative properties as more anxiolytic than benzodiazepines once the really heavy first wave passes.

Well, wouldn't you know that they sometimes prescribe mirtazapine to anorectic cats - but with you two especially I can totally understand the logic of feline meds.(I'm joking)

Cats who tear their own fur out may be prescirbed elavil as I learned when my late cat gave himself something resembling a Mohawk by pulling out most of the fur on his underside and sides ( perhaps precipitated by steroid treatment for asthma).

My current creature occasionally manically overgrooms his shoulder cloudy leopard** spot which I treat by giving him catnip. No MJ I'm afraid.

** which it resembles.

That would be CLOUDED

...Justin Kander? I've heard of that tool.

http://boards.straightdope.com/sdmb/showthread.php?t=707563

11 pages of banging my head against a brick wall. -.- His 100-page "report" is so incredibly asinine that it basically cost me brain cells to read.

Well, wouldn’t you know that they sometimes prescribe mirtazapine to anorectic cats

Hmph. A quick look suggests twice-a-week dosing. It seems odd, since it has more going on than H1. Then again, cyproheptadine also appears to be a choice on this front, and it's all over the map.

Denice,

My current creature occasionally manically overgrooms his shoulder cloudy leopard** spot which I treat by giving him catnip.

Our remaining rescue cat has developed a similar habit since we banned her from coming indoors. She has always jumped around in her sleep, often culminating in urinating, which was manageable when she restricted her sleeping to a couple of places. When she started moving to multiple locations it got too much, so I bought her some feline underwear, of which a surprising variety is available, and we dressed her in it along with an incontinence pad.

Sadly this traumatized her so much* she refuses to come indoors any more, which suits us just fine, but getting constantly bullied by other cats (she's small, and not a fighter) seems to have triggered overgrooming.

I'll try some catnip - she might still get bullied but may not care as much. Incidentally, most cats go similarly mad for valerian, the stinky herbal root that is sometimes used as a human sleeping aid, and seem to get high like they do from catnip.

No MJ I’m afraid.

Back in the mists of time I had a cat that loved to eat MJ fan leaves - I would fold one up and pop it in her mouth and she would gobble it up purring loudly. I sometimes wonder what the attraction was.

* She actually climbed inside my large bass speaker (I play bass guitar on occasion) and got stuck for a while, eventually emerging sans underwear which is still somewhere inside the cabinet.

She actually climbed inside my large bass speaker ... and got stuck for a while, eventually emerging sans underwear

That sounds like an anecdote about a groupie from the early days of The Who.

Saw this news report. Thoughts?
http://www.news24.com/Green/News/Dagga-lowers-deaths-due-to-painkillers…
Dagga is the South African term for cannabis.

Julian,
It wouldn't surprise me if that report is accurate, though obviously it is too early to say. It would be wonderful if it is accurate, as opiate addiction and overdose is a huge problem.

Autism cured by RSO? Please, no!!!!

Orac it seems that many people are getting their medical advice from facebook, so what exactly are the dangers of giving cannabinoids to children with seizure disorders related to autism? Particularly, what's the danger in using THC? Do other cannabinoids reduce any dangers from THC.
People aren't going to stop experimenting with cannabis for autism whether you confirm that it might work or not but really that's down to the individual. So which individuals are most at risk?

HOW MY FATHER LUNG CANCER WAS CURED WITH RICK SIMPSON CANNABIS OIL

My name is Jend and my father has been suffering from lung cancer and the doctor told us that there nothing he could do after doing 5 times chemotherapy and radiation and my father was not responding to treatment and not getting better.i was frustrated and confused and seeking advice from people until a friend told me about the Rick simpson cannabis oil and its fast curing ability of any kind of cancer and told me that her mother inlaw ovarian cancer was cured with the oil. I was desperate to save my father and contacted Rick simpson via ricksimpsoncannabisoil@gmx.com to get this miraculous oil. So far so good my father is responding to treatment of cannabis oil and the health condition have improved drastically for good.

Hey Kids, Some Drugs Are Good for You

milhayser — Sun, 29 Sep 2013 12:41:55 +0000

Hey Kids, Some Drugs Are Good for You

The U.S. "war on drugs," besides failing to meet its goals, has demonstrated a stubborn ignorance of the effects that different drugs have in the human body. Granted, some drugs cause degeneration and are properly outlawed. Opiates such as heroin and stimulants such as cocaine and methamphetamine take a harsh physical toll and leave users addicted to the chemical. But classified along with these truly dangerous drugs are some of nature's most mysterious medicines. New research shows how marijuana, psychedelics, MDMA and even ketamine have positive physiological and psychological effects that can persist even after the drug has worn off.

The marijuana flower, of course, is the nearest of these drugs to public and political acceptance, and the transformation of its image over the decades is very instructive. Stuck with a Spanish name in the 1930's to excite American xenophobia, marijuana has long been demonized as causing "reefer madness." In fact, new research shows that marijuana has potent neuroprotective and neuroplastic properties, in addition to its power as a non-addictive painkiller. Marijuana contains at least 85 cannabinoid chemicals, including the well-known THC, and the lesser known CBD. New research shows that CBD, administered thirty minutes after a devastating loss of oxygen in mice brains, totally circumvented brain damage. Cannabinoids are currently being studied for a wide range of therapeutic applications, including the fight against cancer. Their potency should come as no surprise since all mammals have cannabinoid receptors in their brains. According to Salon, these receptors evolved in animals 550 million years before the marijuana plant.

Psychedelic drugs are very different; the most popular ones are psilocybin, mescaline, and LSD. Psilocybin and mescaline occur naturally, in certain mushrooms and cacti, respectively. LSD must be made in a laboratory. These drugs have differing effects, but the psychedelic experience has many features in common. A new study in PLOS ONE showed no correlation between a lifetime of psychedelic use and negative mental health outcomes. In fact, "in several cases psychedelic use was associated with lower rate of mental health problems." Ongoing research on psilocybin suggests that it can help terminally ill patients come to terms with their mortality in healthy and beneficial ways. Meanwhile mescaline, in the form of peyote, is exempt from DEA regulation when taken under certain religious circumstances. Mescaline and psilocybin have been used in tribal cultures for thousands of years as tools for understanding the self and the world. If you try them just once your life can change drastically. After marijuana, magic mushrooms and peyote cactus should be decriminalized as natural, non-addictive, safe substances. LSD on the other hand can cause psychedelic effects for up to 16 hours (about twice as long as psilocybin) and may present a bigger danger to public health.

Similar in effect to psychedelics, but also demonstrating stimulant properties, is MDMA or Ecstasy. While conflicting research suggests that long term or heavy use of MDMA may cause brain damage, a 2011 study at UCLA "found that persons with autism using the drug often report an increase in socialization and strong feelings of empathy that last even after the drug has worn off." Perhaps one day this darling of dance culture will be available for therapeutic use by prescription.

Finally, there's a drug you may not have heard of: Ketamine, best known as a horse tranquilizer and club drug. In sub-anaesthetic doses "Special K" causes very strange psychological effects unlike those of pot or psychedelics. It's a type of drug known as a dissociative, along PCP and dextromethorphan. But while these latter drugs can cause psychosis and brain damage, Ketamine turns out to be pretty gentle, and may even have a future as an antidepressant. According to Scientific American, "the enthusiasm for ketamine is such that physicians, often working out of small clinics, have already started prescribing low doses of the generic anesthetic off-label [...] and drug companies are contemplating whether to get into the act by creating new drugs based on ketamine’s biochemistry."

A word of warning: these drugs are illegal for recreational use, they often have unpleasant effects, and it's always possible to get too much of a good thing. Many drugs are truly dangerous and deserve to remain tightly regulated or illegal. One needs only to read about the emergence of krokodil, a street form of mesomorphine cooked up from codeine and toxic chemicals, to be reminded of the horrors of drug addiction.

But the prohibition of safe, non-addictive, psychologically inspiring, and medically promising substances is not the answer.

milhayser Sun, 09/29/2013 - 08:41

Categories

Medicine

Many of the drugs who listed here, like LSD and horse tranquilizers, are going to have negative effects on young teens because of their psychedelic and damaging psychological properties. Sure, they might have a few minor benefits, like antidepressant, but it could also end up ruining kid's lives. Marijuana, on the other hand, is a drug you listed that I agree can have some benefits. Some researchers believe that its increase in availability is leading to a decrease in drinking among teens, which is a good thing because nobody has ever died directly from marijuana consumption and kids who drive while "high", god forbid, are likely to be more cautious then drunk drivers.

http://www.nytimes.com/2013/11/04/opinion/marijuana-and-alcohol.html

Drug addiction is a problem that has plagued humanity for many generations, however the USA recently made marijuana legal in some states. What is this hinting at? The fact that society is slowing building an acceptance towards "Natures medicine". The only problem with this is that it is mainly used for recreational use and not medical uses and we cannot yet predict the consequences of this misuse.

There's some good things here but meh.
So writer of this if krokodil was legal tommorow would you do it? No and 99% human race agrees with you.
War on drugs has always been about power, money and control
I'm sorry but it's a pretty stupid concept that this article perpetuates. You cannot protect people from themselves. Hey buddy were going to save yourself from ruining your life by ruining your life right now and throwing in in jail.

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I don't think it's a black and white ordeal. It's good if it's not hurting yourself, but bad if it's hurting the person.