Map of life expectancy at birth from Global Education Project.

Tuesday, June 23, 2015

The weed with roots in hell

A few items in the new JAMA concerning medical marijuana. As usual, I'm not sure how much you worthless rabble are allowed to read, but if you want to give it a shot, there's an opinion piece by a guy named Deepak, but fortunately not the quantum woo guy. Actually his last name is D'Souza but equally fortunately his first name is not Dinesh. Anyway, he doesn't think we know enough about it yet to be prescribing.

A systematic review by Deepak and a multitude does not, it seems to me, entirely support his editorial opinion. There's reasonably good evidence that the herb or cannabinoids are beneficial for the major indications for which they are usually touted, e.g. nausea from chemotherapy, spasticity from MS and paralysis, HIV-related appetite loss, chronic pain. Other indications are lacking in good evidence but maybe it does some good. The main problem is that we don't have much in the way of long-term follow-up data. There can be short-term adverse effects, of course -- not everybody likes the evil whoopee weed at first try. But these are not serious and go away if you stop toking (or swallowing). But we don't know what might happen long term. Well, that's true, but from a couple of millennia of observational data there doesn't appear to be any obvious major worry.

Well yeah, but that also happens to be true for most of the pharmaceuticals on the market. The FDA approves them after trials with 6 month follow up, on evidence no better than the evidence for ganja. The real problem, as I see it, is that as a bunch of chemists discovered, you don't know what you're buying. They copped a whole lot of medical marijuana products from legal dispensaries in California and Washington and found the labeling of THC content was just completely unreliable. So the obvious answer for that is to eliminate the federal prohibition so the FDA can regulate manufacture and assure quality.

Based on everything I've read, if you have any of the problems for which there is reasonable evidence, and the alternatives aren't working for you, it's reasonable to give it a try. However, it is something adolescents should stay away from, I am increasingly convinced. Also, too, obviously a lot of people who get medical marijuana prescriptions may or may not have a real medical need, but they also want to get high. That's okay with me if you don't have work or driving obligations that make it counter-indicated.

So I think this is much better than criminalizing people who are legitimately trying to get relief from very unpleasant symptoms, and have an option that just might work for them. I'm also in favor of legalization and regulation of recreational Mary Jane, because people can make their own decisions about it and 99% of the adverse consequences are caused by prohibition.


kathy a. said...

I read in the commoner press about a couple of things -- that rules had been changed to make it easier to do scientific studies of medical marijuana and its effectiveness; and also that bit about no regulation, who knows what you're getting.

And both scientific studies and quality control seem like issues we should get to, already.

Not sure if I mentioned that a relative who has been on some meds for serious behavioral and mood symptoms is currently doing well on an experiment of MM in candy form -- and they have been able to reduce some heavier drugs, so her balance is better, she is more engaged, not anxious 24/7, etc. MM is legal in my state, and she's being overseen by the weed psychiatrist. But unlike other medications, we had no studies to look at; and we don't have any idea about quality of "the stuff." Also, zip in the way of insurance coverage.

The deciding factor really was that we couldn't see that trying it would cause any harm. The doctors and staff were getting to the end of their ropes, and there were no other medication options; placement options are VERY problematic for someone like her. Relieved to see improvement!

But it would really be good to have studies, and to have oversight and regulation.

Cervantes said...

Yes. As I say, my view is that current evidence for some indications is at least as good as the evidence for some FDA-licensed pharmaceuticals. But cannabis is used for a much wider range of indications than we have good evidence for. Legalization at the federal level is necessary in order to do this right.