Medical Cannabis - My Thoughts and an Excerpt from The Journal of the American Medical Association

As a physician I receive many requests for cannabis use. I have not seen benefits outweigh side affects. I see articles in my medical journals on this subject regularly and keep up to date on this topic as new research and studies come out. Here is a summary from a September 2019 article in The Journal of the American Medical Association. Please read the following summary for more information.  
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Nearly 10% of all cannabis users in the United States report using it for medicinal purposes. As of August 2019, 33 states and the District of Columbia have initiated policies allowing the use of cannabis or cannabinoids for the management of specific medical conditions. Yet . the federal government still classifies cannabis as illegal. complicating its medical use and research into its effectiveness as a treatment for the various conditions purported to benefit from cannabis pharmacotherapy. Because of this conflict and restrictions on cannabis research, evidence of the efficacy of cannabis to manage various diseases is often lacking. 
 
Cannabis and Cannabinoids
A cannabinoid is any of a group of closely related compounds which include cannabinol and the active constituents of cannabis. Cannabinoids have unique pharmacologic profiles enabling drug development to manage various conditions without having the cognitive effects typically associated with cannabis. Only a few cannabinoids have high -quality evidence to support their use and are approved for medicinal use by the US Food and Drug Ad­ministration (FDA). 

Studies and A Lack of Credible Evidence for Effectiveness
A more recent meta-analysis of 91 publications found cannabinoids to reduce pain 30% more than placebo, but had a number needed to treat for chronic pain of 24 and a number needed to harm of 6. While a moderate level of evidence supports these recommendations, most studies of the efficacy of cannabinoids on pain are for neuropathic pain, with relatively few high-quality studies examining other types of pain . Taken together, at best, there is only inconclusive evidence that cannabinoids effectively manage chronic pain, and large numbers of patients must receive treatment with cannabinoids for a few to benefit, while not many need to receive treatment to result in harm.
 
Numerous other medical conditions. including Parkinson disease, posttraumatic stress disorder, and Tourette syndrome, have a hypothetical rationale for the use of cannabis or cannabinoids as pharmacotherapy based on cannabinoid effects on spasticity, anxiety, and density of cannabinoid receptors in areas implicated in development of tics, such as the basal ganglia and cerebellum . The strength of the evidence supporting the use of cannabinoids for these diseases is weak because most studies of patients with these diseases have been small, often uncontrolled. or crossover studies. Few pharmaceutical companies are conducting cannabinoid trials. Thus, it is not likely that additional cannabinoids will be approved by the FDA in the near future. Public interest in cannabis and cannabinoids as pharmacotherapy continues to increase, as does the number of medical conditions for which patients are utilizing cannabis and CBD, despite insufficient evidence to support this trend .
 
The Negatives and Reasons for Caution in Medical Use
 
Acute cannabis use is associated with impaired learning, memory, attention,
and motor coordination, areas that can affect important activities of daily living, such as driving. Acute cannabis use can also affect judgment. potentially resulting in users making risky decisions that they would not otherwise make. While there is consensus that acute
cannabis use results in cognitive deficits, residual cognitive effects persisting
after acute intoxication are still debated, especially for individuals who used cannabis regularly as adolescents. Chronic cannabis use is associated with an increased risk of psychiatric illness and addiction. There is a significant association possibly a causal relationship between cannabis use and the development of psychotic disorders, such as schizophrenia, part particularly among heavy users. Chronic cannabis use can lead to cannabis use disorder (CUD) and contributes to impairment in work, school, and
relationships in up to 31% of adult users. Regular cannabis use at levels associated with CUD (near-daily use of more than one eighth ounce of cannabis per week) is associated with worsening functional status, including lower income, greater need for socioeconomic
assistance, criminal behavior, unemployment, and decreased life satisfaction. Cannabis use is associated with adverse perinatal outcomes as well: a 2019 study showed the crude rate of preterm birth was 12.0% among cannabis users and 6.1% among nonusers.
 
Conclusions
Insufficient evidence exists for the use of medical cannabis for most conditions for which its use is advocated. Despite the lack of evidence, various US state governments have recommended cannabis for the management of more than 50 medical conditions. Physicians may be appropriately reticent to recommend medical cannabis for their patients because of the limited scientific evidence supporting its use or because cannabis remains illegal in federal law. Cannabis is useful for some conditions, but patients who
might benefit may not get appropriate treatment because of insufficient awareness regarding the evidence supporting its use or confusion from federal law deeming cannabis illegal.
 
Excerpt from The Journal of the American Medical Association | Medical Use of Cannabis in 2019 by Kevin P. Hill, MD, MHS, September 10, 2019 

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