The legalization of medical marijuana in numerous states across the United States has led to an increase in its usage for various health conditions. However, the clinical evidence supporting the effectiveness of its active ingredients, THC and CBD, remains limited.
In a recent study published in JAMA Network Open, Thomas Arkell, Ph.D., a postdoctoral research fellow at Swinburne University of Technology, emphasized the need for a stronger evidence base to determine optimal doses, administration methods, and reasons for treatment discontinuation due to lack of symptom improvement.
The study conducted by Arkell and his team, which can be considered one of the largest in its field, involved the analysis of data from 3,148 patients. Approximately two-thirds of the participants were using medical cannabis to alleviate chronic noncancer pain, with other conditions including cancer pain, insomnia, and anxiety. The researchers utilized a standardized questionnaire to measure health-related quality of life, covering domains such as general health, physical and emotional health problems, pain, energy, and social activities. The questionnaire’s scores range from 0 to 100, with lower scores indicating greater disability.
Benefits of Medical Cannabis Use
Following the initiation of medical cannabis treatment, patients reported significant improvements in all eight domains of the questionnaire compared to their baseline scores. Moreover, these improvements were generally sustained over time. After accounting for potential confounders such as other medications, comorbid diseases, age, gender, and employment status, medical cannabis use was associated with a 6 to 18 point improvement in various domains. Dr. Arkell noted that the findings suggest a genuine enhancement in physical and mental health, as well as day-to-day functioning, which is particularly crucial for individuals with chronic illnesses.
Comparison of Medical Marijuana Access
Dr. Arkell highlighted the differences in medical cannabis access between Australia and the United States. In Australia, the process resembles obtaining a prescription drug, where doctors prescribe a specific dose and product that can be obtained from a pharmacy. In contrast, the U.S. requires individuals to qualify for a medical marijuana card to purchase products from a dispensary, providing them with more autonomy in their selection. The more controlled approach in Australia, including regulation of THC dose and frequency, may contribute to better clinical outcomes.
Potential Side Effects and Study Limitations
The study revealed a total of 2,919 reported adverse events, with 86 classified as severe. Dr. Arkell emphasized the need for caution regarding the risks associated with THC prescribing and potential side effects. Although most adverse events were mild and transient, it is important to consider the patient’s existing medication regimen when determining the appropriate THC dosage.
Critique of Study Design
Keith Humphreys, Ph.D., a professor at Stanford University, identified two flaws in the study design. Firstly, the study excluded individuals who did not return for follow-up visits, potentially biasing the results by excluding those who did not respond positively to the treatment. Secondly, the absence of a placebo control group limits the ability to ascertain whether the reported improvements are specifically due to medical marijuana use.
While the study provides valuable insights into the potential benefits of medical marijuana for chronic pain and overall quality of life, it is essential to acknowledge the limitations and need for further research. Rigorous clinical trials incorporating placebo controls and larger sample sizes are necessary to establish a more robust evidence base. Additionally, transparency regarding financial disclosures and funding sources is crucial for maintaining scientific integrity.