Medical Cannabis?


#64

And since there is no codified data regarding whether a statistically significant number of those people were using the modern diabetes meds, or how much, or for how long, or what results they may or may not have reported to anyone, or whether they are still living . . . that means essentially zero.

I’ll say it another way. There isn’t any freakin’ data because the controlled studies have not been done or reputably reported.

And now, I guess, we really have arrived in the arena of individual judgement calls. You’re clearly willing to bet that all is benign. I’m not.

If there’s a bright note in all of this, it’s that now cannabis is becoming accepted for medical uses, maybe somebody will begin doing those much needed studies.


#65

I look forward, as a scientist, to seeing such studies. Short of some debilitating pain/nausea and a lot more evidence that cannabis is effective and safe, I don’t see myself ever using it either recreationally or medically, but I’m all for more studies.

That being said, there are plenty of studies on medical cannabis. I linked to a PDF earlier in this thread from the World Health Organization that is, among other things, a good source of peer-reviewed science on the topic. While there hasn’t been as much study into drug interactions (which this thread has gotten sidetracked onto somehow), there have been a lot of studies on efficacy. And this is where I think people are missing the boat: most of the studies to date show negative or only very weak positive support (if any at all) that cannabis is useful outside of already known therapeutic applications. In other words, we already know that cannabis is effective at suppressing nausea and increasing appetite in chemo patients and those with advanced AIDS, comorbidities, and that horribleness. And that’s about it.

If you delve into the literature, for example, you’ll find that many studies have been conducted on whether cannabis (or cannabis-derived compounds) is useful in treating various types of neuropathy, including diabetic neuropathy. The results are pretty conclusive so far: it doesn’t have any greater success at reducing pain than placebos. Those same studies also showed that many patients wanted to continue to use it to treat the condition that it didn’t actually help treat. There is a good reason for this: whole cannabis treatment is highly pleasurable to most people, so plenty of people want to keep using it even when not effective. Any data on the efficacy of preparations (from whole plant to compounds) which include THC is likely to be confounded by many patients wanting to continue use regardless of efficacy. It’s kind of like laudanum in that sense :slight_smile:

I am not suggesting anything about whether people should or should not use marijuana or other preparations of various chemicals isolated from cannabis. People will clearly make up their own minds, regardless of what the science says. As a scientist, though, I’m fascinated by the data. And so far, the data can be summarized pretty simply:

  1. Cannabis is fun to smoke;

  2. It has very limited and well-documented therapeutic uses, although side-effects and drug interactions are not well documented yet;

  3. There are a lot of people that think it’s a miracle drug and cures everything from warts to cancer;

  4. The science doesn’t agree with them;

  5. People are going to smoke it anyways, because it’s now legal in many places and people will do what people will do…

More power to 'em, I say. Just don’t go trying to tell me it’s going to cure my diabetes.


#66

I don’t dispute the existence of studies focused on efficacy; they are well reported. My issue is safety; and I don’t consider that a “sidetrack” but rather a critical factor in the total equation. It’s no accident that drug trials are divided into stages, and that safety is tested first, then efficacy. I contend that they are of at least equal importance; one without the other will always cause me to take a “pass” until the blanks are filled in.


#67

Well, yeah. I’m with you on that one, but the “safety-first” in drug trials only happens after discovery. That’s the phase where there is an attempt to discover whether a drug, compound, plant, or crystal ball is actually going to help treat a symptom, disease, or disorder.

And my point is simpler than what you’re suggesting: before we even worry about safety of using cannabis, it’s important to realize it doesn’t actually treat that many conditions very well, according to the science. Medical marijuana is interesting in that the legalization of it has led to what would be considered “off-label” use with any other drug: there are really only two or three known therapeutic uses of cannabis, but people get prescriptions to treat everything from anxiety to neuropathy to constipation. And they believe it works. But when controlled studies are performed, they almost invariably conclude that it is no more effective at treating most conditions than a placebo.

So, safety is part of it, for sure. I want to know that my drugs are safe. But I also want to know that they actually work and do what the companies selling them say they do. In the case of cannabis, the claims of efficacy are almost always exaggerated or based on wishful-thinking. Ultimately, safety and efficacy are both critical factors to me. Having one without the other makes any given drug completely useless, for me.


#68

We’re really saying the same thing: safety without efficacy, or efficacy without safety, is a nonstarter.

And while your point about the limited efficacy of cannabis is true and valid, consider this: limited effectiveness or not, people are going to use it anyway. That train has left the station. Therefore it would be a really good idea to make sure it is safe.


#69

I intend to smoke your share too then, starting when I retire and don’t have to figure out whether it’s actually legal or not.


#70

I’m pretty sure in Alaska you can grow your own and smoke it for whatever purpose you like. Your employer might not care for it, but…


#71

Nor do the Feds who issue my professional license and mandate my periodic drug testing


#75

I’m fascinated by the turn this thread took.

Thanks, everyone, for your contribution. It’s always interesting to hear what others have experienced and think about a topic.

I come into every interaction with the understanding that all of us are subject to perceptual bias–even scientists…and even studies. So, I sift through all of it and make my own decisions based on what “feels right” to me. Not a system valued by many contributing to this topic, but I am ok with that. My system works for me.

I appreciate those of you who shared your experience.

Since the thread has moved to from my interest into other things, I’m going to move on. Again, thanks everyone.


#76

Smoking Cannabis is fun?!? Where did this ignorant idea stem from? It’s absurd, really. Medical Cannabis is often not smoked at all. There are many users who can’t smoke it. Your list has lots of absurdities. Where on earth are these “lots of people that think it’s a miracle drug”?!? No person I’ve encountered has ever suggested MC or any kind of marijuana cures anything. Certainly not diabetes.

Oh, and I’m a pirate!!


#78

You’ve clearly never ventured into social media or read in the popular literature. In efforts to support legalization (which I support, by the way), claims have been made that marijuana (smoked, eaten, taken in tinctures, and etc.) are useful in all kinds of absurd cases. So far, science isn’t backing that.

I honestly think you should smoke, eat, drink, or rub on your toes whatever you personally feel like. And if it makes you feel better, fantastic! I was just weighing in here because the question was repeatedly raised about what the science has to say about efficacy and safety of medical cannabis use. Turns out, people don’t want to hear what the science says :slight_smile: No skin off my back.


#79

You know, I think the n=1 experiment is the key idea here. People are going to be waiting a long time for validated marijuana studies that are double-blinded and randomized. Given who’s in power and who’s been appointed for HHS and Atty Gen’l positions, I think it’s unlikely that widespread legalization of marijuana is going to be a priority, and until it’s no longer schedule 1, trials are going to be so tough to arrange.

Because marijuana has a decently short half-life, though, I think it would be pretty easy to design an n of 1 trial for an individual that would produce validated results for that individual – especially for something like neuropathic pain. There are more unknowns and more variability than with an industrially manufactured substance, but you’d probably have a pretty good idea within about 100 days if you just set up an alarm on your phone to randomly quiz you on how you feel, and set up some alternating day of use system. Hard to blind of course and pain is one of those biggies with a huge placebo effect, but still, probably better than taking someone else’s ancedata as evidence.


#80

Yep, I agree with everything you’ve said. Given what research has been done, scientifically, I’d be wary of claims made by proponents, but people are going to do what they’re going to do. And if I’m honest, there are circumstances where I’d even try such things myself. If I were suffering from a condition where I couldn’t get any relief from the best medical science has to offer, I’d surely look into alternative treatments.

The recent election makes widespread legalization at the Federal level unlikely, but I think testing by scientists will continue in states where it is legal. There is too much money involved in medical marijuana for the research to go nowhere. I have colleagues at other universities who have been offered massive sums to undertake studies, and I myself in my previous work as a plant ecologist had (unsolicited) offers from Washington to come help grow the good stuff. Where there is money, there will be research, trust me :slight_smile:


#81

All of sudden, the thread got interesting for me again… looks like I’m back :stuck_out_tongue:

What I would say is that the list provides several broad brush stroke statements without any evidence that they are facts… making them sound like strong opinions. There is ample evidence that proves the efficacy of CBD in relieving seizures in childhood epilepsy, plenty of evidence that shows CBD reduces the sizes of tumors in test tubes and test animals, as well as many clinical studies on the use of MC for PTSD. Just depends on where the researcher researches. Perceptual bias.

In my personal experience over the past few weeks with using CBD for nerve pain, I’ve taken 10mg at the onset of nerve pain as an infused oil and, within a few minutes, the pain is gone. As long as I maintain a dose of 150 mg or higher over a 24 period, I don’t have debilitating muscle cramps. I don’t need a study to corroborate that it works.

There’s much work to be done to establish what works and what doesn’t in terms of all of the cannabinoids and terpenes in combination in different strains. It’s a frontier…like exploring the world was when people believed it was flat. I love learning new things so this appeals to me a lot.


#82

This, I think, is the bottom line.

I have two MDs lined up now–an internist from CA who works with MC in recommending strains and dosing and a local MD for lab testing what I grow and my body. Both to consult with me on results.

One step at a time–always learning. And never one to give my authority over to anyone else :wink:


#83

Yes, and personal experience is sometimes good enough, in my opinion. I learned long ago that studies are often skewed, biased, and inconclusive. And every study has a counter. Perceptual bias - talk about fascinating!

Another real life experience that is in my personal experience is that MC is a god send for folks who are in hospice just waiting for the peace carriage. Given a choice of MC or a bolus of morphine should be made available sooner rather than never.

I am glad you are able to get what you need. Nothing wrong with being a self study, and I wish you well, Ahnalira.


#84

[quote=“David_dns, post:64, topic:57691, full:true”]
I’ll say it another way. There isn’t any freakin’ data because the controlled studies have not been done or reputably reported.
[/quote]Untrue. There’s plenty of data. You just reject it because it doesn’t meet a standard you apply for validity.

I say that your standard sets an unreasonably high, and unrealistic bar. We rely on anecdotal and broadly experiential data across large populations to make judgments and draw conclusions all the time about the safety, efficacy, and utility of many things. You do this too.

In fact, this is the data from which we function for the vast majority of our judgements and decisions. Formal, scientifically acquired data through rigorous protocols is the tiniest fraction of the body of data that governs our choices and behavior.

Did you know there has never been a large-scale, formalized study done with randomized trials, placebo, etc. to determine the basic safety of aspirin (acetyl salicylic acid)? Sure, there have been plenty of studies of aspirin for more targeted modalities, but simple safety is not one of them. It would be a monumental waste of money and resources, because we already KNOW its safe.

How do we know that?

The scientific method, drug testing protocols, etc. are a very new phonomena in human behavior. There’s no arguing these methods haven’t added a great deal of certainty, and determinism to the accuracy of our understanding of anything being studied, but these methods are an addition to how we acquire useful data, not a complete replacement for existing means of data gathering. Indeed, the scientific method is in some cases the worst way to seek valid, accurate data.

Yet, human beings were not completely without “data” (in the form of experiential knowledge) before these methods were developed, nor was that data completely worthless and useless.

David, like you I prefer (strongly) data derived from rigorous scientific methods. Unlike you, however, I don’t reject completely information gathered through other means as having any validity. Rather, I examine the quality of the data, how it was gathered, etc. and include that in my evaluation.

As such, I have no concerns regarding the safety of aspirin. I have no concern NOT because there is some formal safety study I can point to that convinces me, but rather because Willow Bark has been used for thousands of years, safely, by billions of people. If it was unsafe, I’m confident I’d know about it – as would you, and everyone else.

I expect you too trust in the safety of aspirin, and I’d point out gazillions of other things you use every day without a second thought, for which we all accept the safety and efficacy simply because the use is so common and widespread that it would be silly to try and “establish” the safety by having a formal study.


#85

Precisely correct.


#86

Recreational drugs have an additional hurdle to surmount for any sort of legitimacy, and this deliberate lies and misinformation. This usually has the effect of discrediting the source and the concept, rather than convincing many in any significant numbers.

And this is very bad for objective, real information.

Is cannabis dangerous in any serious way (understanding that “serious” is a somewhat squishy term doesn’t detract from the point…)? At this point in the history, I personally don’t know for sure. But the information before me point in the direction of “not very if at all”, and that whatever detriment exist are no more worrisome than the problems with all sorts of things we use all the time.

To drive home the point of my first paragraph, anyone that has seen the classic “Reefer Madness” and also have actually gotten high from pot at least once knows exactly what I’m talking about.


#87

First, you misrepresent what I said. I didn’t “reject” anything. I said anecdote is not evidence, and in the case of cannabis, it’s not. No one has reported, even anecdotally, significant data on the interactions of cannabis with GLP-1 agonists, DPP-4 inhibitors, etc., etc., and certainly not with the Invokana type drugs because they’re just too bloody new. And that, if you read, way, way back, was my original point, which seems to have gotten lost in the mist.

Second, you have no way to examine the “quality” of that data because (a) there isn’t much, and (b) you don’t know anything about who reported it or under what circumstances. So your method falls down in this case.