Why the Media Can't Get Its Story Straight About the Amazing Medical Potential of Cannabis
Judging from the disparate media headlines, last week’s meta-analysis of cannabinoid research published in the Journal of the American Medical Association (JAMA) contained something for everyone.
Here’s a sampling of the mainstream media’s seemingly schizophrenic coverage:
Toledo Blade: Studies support marijuana’s role for medical needs
Los Angeles Times: Most uses of medical marijuana wouldn’t pass FDA review, study finds
So what was the review’s actual takeaway message in regard to the efficacy, or lack thereof, of medical marijuana? That’s hard to say because its authors said little at all about cannabis.
Of the 79 total randomized controlled trials (involving nearly 6,500 total participants) reviewed by the authors, only two explicitly assessed the safety and efficacy of whole-plant cannabis. By contrast, most of the trials reviewed evaluated the oral administration of a synthetic cannabinoids such as dronabinol (synthetic THC) and nabilone (a synthetic THC derivative that mimics THC).
But such isolated synthetic compounds are hardly analogous to whole-plant cannabis. Specifically, the marijuana plant contains multiple therapeutic components, many of which are presumed to promote healing in a synergistic manner (the so-called entourage effect). Further, herbal cannabis is typically inhaled, a method that results in rapid onset of drug effect and allows for more precise self-titration. By contrast, oral cannabinoid administration is associated with delayed onset, increased bioavailbility, and a greater likelihood of adverse side- effects such as dysphoria.
Although researchers distinguished between whole-plant cannabis and man-made, single cannabinoids, most media outlets made no such distinction. They should have. In fact, the authors’ conclusions never speak of medical cannabis. Rather, they conclude, “[T]here was moderate-quality evidence to suggest that cannabinoids may be beneficial for the treatment of chronic neuropathy or cancer pain (smoked THC and nabiximols) and spasticity due to MS (nabiximols, nabilone, THC/CBD capsules, and dronabinol).” (Nabiximols is an oralmuscosal spray, typically marketed under the brand name Sativex, that contains both CBD and THC extracts; its use is approved by prescription in various countries, such as Canada and the United Kingdom, for treatment of symptoms specific to multiple sclerosis.)
Researchers were less enthused in regard to the use of synthetic cannabinoids for the treatment of nausea, vomiting, and weight gain citing only “low quality evidence” that cannabinoid administration improved these indications. This finding is perplexing because the FDA has approved both dronabinol (marketed as Marinol) and nabilone (marketed as Cesamet) explicitly for the treatment of these conditions.
But while it is common for researchers suggest only the most stringent methods (adequately powered, randomized, placebo/active controlled clinical trials) be used to evaluate cannabinoids’ potential health benefits, they do not demand such rigor in regard to evidence of the plant’s supposed deleterious risks. Predictably, an accompanying review in the same issue regurgitates often-repeated, but well-refuted claims that marijuana use lowers IQ and/or “doubles” the risk of motor vehicle accident. Such claims of cannabis’ adverse effects, though disputed (or in some cases, debunked) in the available literature, are nonetheless cited as if they are well-established fact. Scientific studies showing the potential efficacy and relative safety of cannabis are almost never portrayed in such a definitive manner.
Consequently, it comes as little surprise that an accompanying editorial suggests that states’ decision to permit therapeutic cannabis is putting “the cart before the horse.” But it is only because of the rapidly changing political landscape that JAMA and others are even engaging in this discussion. And it is only because of the rapidly changing political landscape that the federal government is only now beginning to open the door to legitimate research. Nonetheless authors advise, “Since medical marijuana is not a life-saving intervention, it may be prudent to wait.” News flash: patients have been waiting for decades already. And they likely be waiting for decades more if they heed JAMA’s advice.