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Acute pain isn't discussed in detail in this paper, but here's a paper they cited:

> 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.

The full text of the acute pain paper is available via EuropePMC https://europepmc.org/article/MED/33381643

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.

I fully accept there is pain relief value. What I wish were better studied is: what are the short, medium, long-term effects of using it at various dosages?

For example, it's pretty widely agreed that it (anecdotally) causes anxiety at higher doses - how high of a dose?

> For example, it's pretty widely agreed that it (anecdotally) causes anxiety at higher doses - how high of a dose?

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)

D8 and D9 cause anxiety in me (I have GAD to begin with). D10 does not.

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.

> short, medium, long-term effects of using it

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

I have a friend who was in a serious car accident years ago and had a broken hip. It still gives him daily pain. He has turned to cannabis to treat his pain long term and it seem to be working for him. He never describes it as "immediately eliminating the pain" or anything close to that. Really just takes the edge off so he's not as focused on his pain. It's easier to push to the background and ignore.

You do realize that your case has as much evidence that passage of time fixed your problem (or anything else that transpired) as it does for cannabis? And that is why people do randomized trials.

It feels too dismissive.

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)

> there is a chance of something other causing the instant relief AND matching the moment of cannabis use

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.

Yes, for subtle effects.

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.

Agreed, but... have you ever seen someone wracked by seizures taking a hit?

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.

No it doesn’t. One second I was in unbearable pain and about to go to the ER, and the next second I felt no pain. I am not the only person who has had success using cannabis for pain either.

> One second ... unbearable pain, ... next second ... no pain

This contradicts "No it doesn't".

They were stating "No it doesn't also support passage of time." An IMMEDIATE reversal of longtime conditions is rarely due to passage of time. One would quite naturally assume that something immediately prior was causative.

A substance can have pharmacological effects and still not be recommended for therapeutic use. As a hyperbolic example, suppose a substance relieved all pain for 1% of the population but caused death in everyone else. Even with a highly precise screening process this substance likely would not be administered in medicinal contexts.

That's true, but I believe the authors' complaint here is efficacy rather than safety. (I also think they're using terms of art from evidence-based medicine to make a statement the general public is likely to misinterpret, per my other comment here.)

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.