Therapeutic use of cannabis and cannabinoids: A review
jamanetwork.com
jamanetwork.com
I admit, I really like cannabis, and when I was a 20 year old occasionally smoking with friends at parties it was a "healthier" alternative to getting wasted on alcohol. Share few joins with friends, have fun, laugh a lot.
Then as I got financially independent and I started solo consumption (mostly to get rid of stress) I really started appreciating the cons: lack of energy, disruption of sleep, negative impact of my cognitive abilities, increase in anxiety. I'm glad the study confirms those to be statistically common.
I was very lucky to have a SO who really disliked me smoking and made me realize that I was just doing it to "not think", and it had really 0 positive effects on me. I'm sure I would've quitted eventually anyway, but support and criticism sped up the reality check.
Eventually this is all anecdotal experience, and I'm sure there might be occasional users who can have a mostly positive experience, but the fact that a review points out how statistically common are the negatives and how uncommon are the positives honestly reflects what I've seen on myself and friends.
The abstract doesn’t say anything about recreational cannabis usage.
>lack of energy, disruption of sleep, negative impact of my cognitive abilities, increase in anxiety. I'm glad the study confirms those to be statistically common.
>I was very lucky to have a SO who really disliked me smoking and made me realize that I was just doing it to "not think"
This study about the clinical outcomes of physician-directed cannabis usage for specific conditions doesn’t really get into musing about how weed is just sort of generally bad. The only part of the study that seems to sort of touch on what you’re talking about is the section about Cannabis Use Disorder
https://jamanetwork.com/journals/jama/fullarticle/2842072?gu...
At no point in this study does it say that “share a few joints with friends, have fun, laugh a lot” has common negatives and uncommon positives. It is not in the purview of the analysis.
I subscribe to the r/leaves subreddit, and the vast majority of posters clearly struggle with mental and physical health, and have abused the substance for years. If you consume anything daily in high dosages it's a sign that you're using the substance as a coping mechanism for other problems in your life, which you should probably address first. And then they wonder why they feel even worse after quitting cannabis... Well, yeah, you stopped relying on something that you thought helped you, without addressing the underlying problems.
The fact that there have been no recorded deaths directly caused by cannabis in all of human history[1] should be enough indication that this is the least harmful substance we enjoy. Especially when compared to alcohol, tobacco, and most other drugs. If it helps reduce stress, boost creativity, and makes life fun, there's nothing wrong with using it responsibly. The negative symptoms you mention are highly subjective, and will depend on the person's existing health and habits.
Kurzgesagt recently published a video strongly critical of cannabis[2], and it's full of anecdata and scare tactics, similar to what you often read from personal reports. As a fan of their content, this video has significantly reduced my confidence in their research and reporting.
[1]: I'm aware of recent reports of "THC overdoses", but those have all been caused by side-effects and poor judgment.
Also 0 from LSD:
"LSD at typical recreational doses (~50–250 μg) is considered to be very safe in terms of toxicity, with not a single toxicity-related death having been reported at such doses despite many millions of exposures" https://en.wikipedia.org/wiki/LSD#Overdose
2 from psylocybin which edges on statistical error, but also:
"In reality, the 2016 Global Drug survey found that psilocybin mushrooms are the safest recreational drug. Of 12,000 people who reported using magic mushrooms, just 0.2% sought emergency medical attention, at least five times less than the rate for cocaine, LSD, and MDMA." https://recovered.org/hallucinogens/psilocybin/can-you-overd...
So, even though cannabis does seem to be very safe, it's not necessarily _the least harmful_.
Also, synthetic compounds such as LSD and MDMA which have only been around for a ~century don't have the historical record of cannabis, psilocybin, and other substances found in nature, which humans have consumed for thousands of years. So to me those are intuitively less "safe".
Also the weed we smoke today is absolutely nothing like historical cannabis. The potency is hundreds of times higher, depending on what they're breeding for.
Microdosing is not the same as recreational usage. Not many people take LSD or psilocybin recreationally that often. Cannabis recreational usage is much more common, with far lower health risks.
> Also the weed we smoke today is absolutely nothing like historical cannabis.
It's much stronger, but I wouldn't say it's "absolutely nothing" like historical cannabis. The way we consume it (concentrates, edibles, etc.) also makes it much more potent. But even that pales in comparison with the effects of moderate doses of psychedelics, which can have lasting psychological effects.
So, sure, dosage matters, but these substances have fundamentally different psychoactive effects.
Personally I use prescribed pharmacutical cannabis oils as I have much lower levels of a couple of important enzymes than most people which renders opioids mostly ineffective, even intravenous morphine as I recently found out after surgery. High CBD cannabis oil works, as does paracetamol but that’s way more dangerous.
likewise, nations may have to legalize in order to regulate the contents of whatever-white-powder users may stumble upon on the street. and let us be honest - no bombs can stop the Fentanil (or rat poison for all I care) from being mixed in.
Poisoning by methyl alcohol.
Ethyl alcohol is ok’ish (the regular stuff), while methyl alcohol can make you blind or dead even in small amounts.
Doctors don't prescribe it to people who aren't already putting away 50 drinks a week.
This statement is historically incomplete, and geographically myopic.
Alcohol in the US was initially fully legal, then prohibited for a short period, then legalized again.
Elsewhere, laws differ, but alcohol is largely regulated but legal for adults in most (non-Islamic) countries.
I think that’s the key message do the paper.
It's unfortunately common to report that situation of favorable but low-quality evidence as "does not support", despite the confusion that invariably results. This confusion has been noted for literally decades, for example in
https://pmc.ncbi.nlm.nih.gov/articles/PMC351831/
I'm sad to see it repeated here, and I hope we can avoid propagating it further.
Science educators have been fighting the scientific theory vs vernacular theory fight for decades without much progress, so I wouldn't hold my breath.
I think at some point, the scientific community needs to accept that many of the formal and precise ways they are taught to write in order to avoid ambiguity, have the exact opposite effect on everybody else. Unless we adjust the terminology so that the scientific and casual definitions more closely align, we're just going up have to keep explaining.
Either of those distinguishes "strong evidence this doesn't work, and more studies are probably wasted effort" vs. "weak evidence, more studies required". I don't see any benefit to a single phrase covering both cases unless the goal is to deliberately mislead.
I once slept in a hoodie with the hood under my back and woke up with horrible back pain, I could not sit still or focus on anything but the pain, 800mg of ibuprofen did nothing. I was about to go to the ER or urgent care when a doctor friend suggested trying cannabis, I took one small hit and was immediately pain free. I have never experienced such a dramatic medical effect in my life, one second I was writhing in pain and the next I was completely fine.
I’ve also seen videos of epileptics calming their seizures from cannabis. The autism community often speaks highly of it, how it makes them feel “normal” or more regulated. I’ve heard of stories of people getting off opioids by using cannabis. I think the people who get anxiety from it or no relief from insomnia are often taking far too much because there aren’t any good guidelines for self medicating and the guidelines they do get are from recreational users.
All I have are anecdotes, but given how obvious the effects were, I find it hard to believe there’s no medicinal value to cannabis.
Safety is barely discussed in this paper, probably because the available RCT evidence is favorable to cannabis. I'm not sure that means it's actually safe, since RCTs of tobacco cigarettes over the same study periods probably wouldn't show signal either. This again shows the downside of ignoring all scientific knowledge except RCT outcomes, just in the other direction.
While I do agree, that:
- there is a chance of something other causing the instant relief AND matching the moment of cannabis use
- health policy for population, should be made based on studies of population
At the same time, we must accept also some limitations of medical trials.
Models that interpret gathered results always includes a random part. Why? World is quite deterministic, why the randomness? Because one can’t make all possible measurements (money, sample size, time), one must choose the most promising practical setup.
Imagine hypothetical situation:
- there are 30 genotypes in population
- drug is highly effective only for 1 of those
- study doesn’t make genetic testing (also, it’s a parallel group study)
Such setup inflates required sample size to get statistically significant results. And even if significance is found, it will say that effectiveness is only 1/30, so not that good of a drug.
(30 is not the limit, think of a case with 300 types or 3000 types)
Human body is amazingly complex. It is not a solved problem.
If OP experienced instant relief of pain after smoking cannabis, it would be a logical action for OP to try it second time if pain reappears. (Given that cost/risk of such personal experiment is relatively low)
You forgot about selection bias here
The point is not it's impossible to deduce. The point was that without randomization even simple passage of time gets equivalent support from that experience as cannabis. People make that mistake all the time with common cold, cause they drink some special tea on day 7, get the final relief, and think that was the tea.
But if my first sip of an herbal tea immediately punctuated the end of days of coughing (by example, because I've been coughing for days), I would be less inclined to think it's a lucky coincidence.
This contradicts "No it doesn't".
The effects are stunningly powerful, positive, and immediate.
Either those videos are all lies, or the drug is powerfully affecting the issue at hand. As said elsewhere in this thread, more "adult" conversations (and legal tests) are needed.
> Conclusions: There is low-quality evidence indicating that cannabinoids may be a safe alternative for a small but significant reduction in subjective pain score when treating acute pain, with intramuscular administration resulting in a greater reduction relative to oral.
https://dx.doi.org/10.1089/can.2019.0079
For insomnia, this paper itself says:
> meta-analysis of 39 RCTs, 38 of which evaluated oral cannabinoids and 1 administered inhaled cannabis, that included 5100 adult participants with chronic pain reported that cannabis and cannabinoid use, compared with placebo, resulted in a small improvement in sleep quality [...]
It goes on to criticize those studies, but we again see low-quality evidence in favor.
In the context of evidence-based medicine, "does not support" can mean the RCTs establish with reasonable confidence that the treatment doesn't work. It can also mean the RCTs show an effect in the good direction but with insufficient statistical power, so that an identical study with more participants would probably--but not certainly--reach our significance threshold. The failure to distinguish between those two quite different situations seems willful and unfortunate here.
It has an interesting conclusion that says more research in to CBD rather than THC is needed and cites some papers looking in to that.
For example, it's pretty widely agreed that it (anecdotally) causes anxiety at higher doses - how high of a dose?
That would require a grown up conversation and what if the results aren’t the one you want? Pretty hard for Bud, Pfizer etc to put that genie back in the bottle
Not for everyone. My understanding is that some people are more susceptible to experiencing anxiety when consuming, while others won’t even at high doses. I personally have pretty high anxiety in general, vaping <10mg of cannabis is really relaxing and makes my anxiety completely go away.
The only kind of bad experience I had was when I first tried a dry herb vape, it was maybe 1h after taking my ADHD meds and the combination resulted in the craziest out of body experience I’ve ever had (it wasn’t too bad, but pretty overwhelming at the time)
Small sampling even just for this one participant, but ... yeah, there's a lot more going on than just "smoking weed" when you partake. The biochemistry is complex, with multiple pathways.
I also don’t know, but I seriously doubt there was cost benefit analysis.
My two bets would be:
- church/priests had power and they condemned most things, except for preying.
- it became widely known that opium is really obviously bad for you, after a bit of mental juggling that became “drugs are bad”, and then wholesale bans followed.
The Chinese 100 years of humiliation at the hands of the Brits, was down to Opium
The fall of the medieval European dynasties was all down to Luandanum
Time and again, the unhealthy, and unregulated use of drugs has toppled empires and led to social upheaval.
Makes perfect sense if you ran a country you would be scared of it.
Not clear why you think the Hapsburgs and the Medicis lost their reigns due to alcoholic opium use. That's a new one to me.
Edit: Also, I was unaware the Allies were uniformly under the influence (aside from the Yanks). Citation?
> Not clear why you think
> Citation?
Are you okay?
The misspelling of "praying" is ironically on point.
It doesn't correlate with violent behaviors, unlike meth and alcohol. It isn't highly addictive like opioids. Users don't tend to spend their lives sedated beyond cognition, like residents of opium dens and absinthe parlors (without discussing what part of absinthe encouraged it).
I don't personally enjoy it, but ... did banning it include some reasoning beyond "Drugs are immoral!"?
Because of how marijuana has been made nearly sacrosanct in some circles, they will not look at that THC or CBD as a contributing factor : (
I guess what I mean is, nicotine is more self-contained than the others.
The problem is that it's a slow burn because it's consumed by smoking, and this is really the most pleasant way to consume it. People don't like the externalities associated with it, and that's pretty much it.
Perhaps the reason you don't see that is it is more difficult for teenagers to get alcohol. At one point in my life it was actually more difficult for teenagers to get alcohol than it was for them to get marijuana
Every honest therapist looks at all components of a patient's life, and the patient, too, has a responsibility to identify what is helping and what is hurting them, or in which situations a trade-off is justified.
We will never be able to arrive at a complete and perfect answer for everyone because people happen to be individuals. However the medical profession (including therapy professions) lean heavily on generalizations to avoid the overhead of having to deal with a living, breathing individual with a history and family context, where possible.
NIDA’s mandate is harm. Not cognition, not performance, not any of the reasons people actually use cannabis. So of course the study leans hard on CUD and psychosis as those are the two outcomes that guarantee grant renewals. A proposal about cannabis and creative problem-solving will get immediately buried. But if you emphasize risk (especially adolescent risk, ideally with "first-episode psychosis" somewhere in the aims) then suddenly everyone’s interested.
They do the usual maneuver with FDA-approved derived substances: carve them out as clean, respectable, and clinically manageable, while treating the whole-plant as this murky, unstable mass the medical system can’t "trust." That distinction is purely commercial, not scientific. The plant itself is chaotic, but the extract with an SKU number is pure, controlled, and therefore "clinical." It’s not hard to see what this protects.
It's the exact same thing Cargill, Coca-Cola, and PepsiCo did against stevia (Rebiana) and Merck did against red rice koji (Lovastatin). The form you can just grow or make yourself cheaply is dangerous to consumers. But this patented recombination passed solely through greased palms is just dandy. This study is just another vehicle for the same move against cannabis.
Most of the authors work in addiction medicine. Their entire professional world assumes SUD as the governing model. If cannabis doesn’t sit inside that model (as in patients can just go buy it without passing through the psychiatric gate) then they lose money and clients. The conclusion section basically spells out the anxiety: clinicians must provide guidance, clinicians must set the boundaries, clinicians must interpret the evidence. That’s jurisdictional language.
Meanwhile, the practical reality is that patients get contradictory instructions: a doctor says "try cannabis" but a follow-up psychiatrist says "chronic cannabis use is a disorder." They're trying to patch that incoherence by building a moat around medicalized (and patented) cannabinoids and burning everything outside it.
The only cannabis that counts is the kind that runs through the FDA and, by extension, the institutions tied into that pipeline. Everything outside that channel is going to be treated as dangerous and destructive on purpose.
That's an impressive take. In general, or were they institutionally created to destroy all people?
Anyway, I don't think the research can have the effect you think it has. Cannabis will be available in the black market regardless of whatever the research ends up saying. Whoever really wants to try to see if it works better for them than conventional medicine/treatment can definitely do so and choose for themselves if it's worth it.
I have consumed quite a decent amount of cannabis myself and have friends who are regular users (this is how I access it, basically). I wouldn't be so quick to dismiss the bad effects of cannabis; they are very real. And the older I get, the more I think that the good part isn't really worth the bad part unless we are talking about some more extreme situations like cancer treatment, tetraplegia, or basically anything where life outcomes are so fucked there is almost no way to make it worse.
It's probably better to avoid it entirely before 25 yo, until the brain is fully stabilized. But that's very much true of alcohol, nicotine, and even most likely caffeine, but they still get used, so whatever, I guess.
Everything is obviously fabricated. You think the snail darter is real? But the scientific consensus…
By the same standard, humans would never have started consuming alcohol, and it should be strictly forbidden. But of course we have tried that, and it's not very effective, but for some reason they seem to think it can work with something that is even easier to handle.