It’s Time to Stop Treating Medicinal Cannabis Like Candy

The question of whether cannabis-based products are legitimate medications has been answered. No less of an authority than the Institute of Medicine documented research evidence supporting the following medicinal properties of cannabis in its 2017 report[i]:

  • There is conclusive or substantial evidence that cannabis or cannabinoids are effective: For the treatment of chronic pain in adults; As anti-emetics in the treatment of chemotherapy-induced nausea and vomiting; For improving patient-reported multiple sclerosis spasticity symptoms.
  • There is moderate evidence that cannabis or cannabinoids are effective for improving short-term sleep outcomes in individuals with sleep disturbance associated with obstructive sleep apnea syndrome, fibromyalgia, chronic pain, and multiple sclerosis.

Cannabis-based products have been used for a variety of illnesses beyond this report, including FDA-approved medications such as Epidiolex for rare forms of childhood epilepsy and a host of preparations used by hundreds of thousands of military veterans to treat symptoms of PTSD. Cannabis is not just the basis for legitimate medications, it is the basis for strong medications. As a result, it is time we begin applying the same standards to medicinal cannabis products that we apply to other pharmaceuticals.

First, I suggest we start by requiring transparency about potential side effects. I am probably as tired as everyone else of hearing long lists of mild to devastating side effects recited with every medication advertisement. Even drug treatments for skin ailments end up listing life-threatening warnings. In the long run, it is important to be reminded that there is no free lunch. No medications are free of side effects. None. Even aspirin can cause painful gastritis, ulcers, and excessive bleeding.

Cannabis is no different. Every advertisement and packaging for medical cannabis should be required to provide warnings of drowsiness, increased appetite, altered perceptions and consciousness, anxiety, difficulty concentrating, memory lapses, psychosis, and addiction. Perhaps uncontrolled laughter and joy could also be included. If you think cannabis is a legitimate medication, you should post warnings about its potential side effects the same way we do for penicillin and antidepressants.

Second, although the Cannabis Community and drug-policy reform advocates had to fight to re-legalize medical cannabis, the fight is essentially over. Its acceptance is not yet complete in the medical profession, but researchers have been convinced. It is only a matter of time before a much wider range of cannabinoid-based medications become standard treatments for many other, if not most, diseases.

Meanwhile, free-enterprise entrepreneurs are lining up to make as much money as possible from a boom in medical cannabis. Traditional pharmaceutical companies, and their eager stockholders, are getting into the action. Their huge research budgets will enable them to develop proprietary cannabis varieties and analogues of the plant’s chemistry that offer more effective and safer forms of medication. At what point will people realize that their skeptical, even cynical, attitude toward Big Pharma companies is equally warranted toward Big Marijuana? Does it really make sense to trust medical cannabis entrepreneurs more than traditional pharmaceutical entrepreneurs? They are all trying to make as much money as possible. The bottom line is that it is time to question the competence and practices of medical cannabis companies the same way we do those of the rest of the pharmaceutical industry.

Third, and bringing me to the event that stimulated this post, is the impact of Big Marijuana on scientific research and public policy. I was recently invited to be interviewed on a podcast focused on PTSD and military veterans. This is a complex issue and one I am eager to bring some scientific research to. But then I learned the show was being broadcast in partnership with a “chocolate cannabis company” that offers free medication to vets. The image of chocolate-covered medicine led to the title of this post. How would we react to learning that chocolate-coated Prozac was being offered to depressed people like an M&M-flavored SSRI? I could not appear on a show in league with a company invested in glowing descriptions of cannabis for PTSD without supplying warnings of potential side effects.

Big Marijuana’s impact on scientific research and policy is documented in a study that challenges naïve acceptance of research funded by the cannabis industry[ii]. The study found evidence of a “funding effect” on research integrity, research agendas, and the evidence base available for decision-making. This “funding effect” is like that documented with research funding by the pharmaceutical, tobacco, alcohol, and food industries. In addition, corporations also seek to shape evidence and policy environments through financial relationships with key opinion leaders—for example, chocolate cannabis companies partnering with medical cannabis podcasters to elevate their profile.

None of these marketing efforts are illegal; they are simply good business promotion. They represent free enterprise freely seeking financial reward. If an ethical line is crossed anywhere, it occurs when efforts to influence scientific research and public opinion are purposely hidden from public scrutiny. However, the public shares in the blame by naively permitting itself to be easily manipulated. Vigilance is required to avoid uncritical acceptance of information about cannabis. Caveat emptor.

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