California’s Big Daddy Jesse Unruh often intoned, “money is the mother’s milk of politics,” yet today we can say “money is the mother’s milk of medicine.” Any industry which takes up 17-18% of the economy leaves a lot of cash slashing around. And the latest entrant to the giant cash prize of $3.3 trillion a year is the medical marijuana market. Beyond it’s traditional relaxation properties, marijuana is now touted as the effective treatment of everything from pain to depression, essential tremor to PTSD, a list of dozens of syndromes marketers increase by the week.
Perhaps its biggest public use will come in chronic pain, where an opioid epidemic is now claimed in some quarters to lead to more than 60,000 overdose deaths a year. How many of these deaths occur in chronic pain patients who cannot find or afford treatments like buprenorphine or methadone, and die using fentanyl and carfentanil laced heroin, is not often highlighted by politicans and media. But with millions of people physically dependent on pain pills, the rush shifting from opioids to cannabinoids may prove irresistible to many policy makers. There are at least two reasons this will happen: it is hard to kill people with cannabinoids, especially if you only look at immediate overdoses rather than effects on driving, accidents, and other public health mortality. Secondly, state governments stand to make billions of dollars taxing the sale of marijuana products, many of which will be sold to treat pain.
A giant experiment is now getting tried on the public, driven by political passion and fabulous profits – three Exchange traded funds already exist for stocks of marijuana companies. Before jumping where angels will not tread, where is the data on marijuana’s effectiveness? What do we know?
Evidence or Not?
A good place to start is the National Academy of Sciences, Engineering and Technologies report on Cannabis and Cannabinoids use that appeared in 2017. Bias is everywhere, but these national reports tend to try far harder than most to extricate probable fact from near fiction.
Regarding the therapeutic uses of cannabis and cannabinoids, the Academy report found evidence they worked to prevent chemotherapy induced GI problems; in reducing chronic pain in adults; and decreased patient reported spasticity in MS.
Yet the report emphasized these three effects were modest, and then wrote “for all other conditions evaluated there is inadequate information to assess their effects.”
Answer regarding the medical effectiveness of marijuana – we don’t know. Not surprising when the substances involved have been deemed illegal for decades, and are still considered illegal by the Federal government. It’s not easy to do proper clinical trials when the drugs involved get you jailed. It’s even harder when cannabis is now fractionated into hundreds of unstandardized “treatments” now being sold to the public.
The Academy report is not particularly happy reading. Its findings – though there’s little evidence of cancer risk, cannabis increases the risk of motor vehicle accidents and unintentional overdoses in children. Cannabis in pregnancy produces lower birth weight in offspring. It impairs learning, memory and attention, particularly in the group with the greatest percentage use, teenagers and young adults, where these effects appear permanent on future education and employment. Cannabis increases the risk of schizophrenia, increases suicidal thoughts, and augments the risk of social anxiety disorder, without increasing rates of overall anxiety disorders or depression. About a fifth of present users qualify for the diagnosis cannabis use disorder. Cannabis use increases the risk of developing addiction to other substances – in other words, the Academy defines it a gateway drug.
Yet the clearest point of the National Academy study is that so much more is unknown than known. Often the data is described as “elusive.” Is it really true, as the New York Times reported, that 9% of cannabis users become “hooked” and dependent on the drugs? What if any is the addictive risk of cannabinoids without THC (tetrahydrocannabinol,) a major psychoactive ingredient? Are all those clinical reports claiming marijuana use led to panic disorder untrue?
What’s needed is evidence. That requires money.
A Research Tax
California expects to soon obtain one billion dollars in annual tax revenue from marijuana sales. Even one percent of that, $10 million, could go a long way to aiding nationally sponsored research to determine what cannabinoids do and do not do to medical conditions and overall public health.
The price of this research is not comparatively high, and numerous academic and government institutes could produce high quality data regarding efficacy. The cost of inaction is much greater. If 9% of marijuana users become dependent, and are also more prone to addiction to other substances, the public health cost will prove daunting.
For marijuana marketers to tout their wares as side effect free medical treatments they should prove their worth, just as other pharmaceuticals need prove their effectiveness in controlled clinical trials. With so much money at stake, company supported research is sadly suspect. Other governments, like Britain with their National Institute of Clinical Effectiveness, do such clinical testing routinely.
Why can’t we?