Medical cannabis: strengthening evidence in the face of hype and public pressure

Cannabis and public health—a need to reclaim the narrative

“…Apart from the use of cannabidiol in the treatment of severe forms of childhood epilepsy, the evidence that cannabisrelated products have therapeutic properties is extremely weak [12][13][14]. A recent scoping review of 72 systematic reviews found no good evidence that cannabis-related products have therapeutic efficacy for management of pain, spasticity, or nausea and vomiting and indeed found that they may be more likely to produce adverse effects [15].…”

“…This is a slippery slope to legalization, as those with non-qualifying conditions, especially chronic pain, will insist that they too are added. Despite the lack of scientific evidence for efficacy [14,15], chronic pain is by far the most common reason for dispensing of cannabis-based products in other countries [18].…”

“…In addition, campaigners will demand an end to the current restriction which limits "prescribing" to specialists as the experience in Canada and elsewhere was that most doctors did not wish to prescribe plants such as cannabis [19]. The regime in Canada became so loose after decades of campaigning and litigation that any doctor could recommend these products to any patient for any reason [13,14,19]. Such regimes have been described in USA as "an aggressively commercialized, quasi-recreational cannabis industry" [18].…”

Evidence shows that cannabis has fewer relative harms than opioids

“…2 We take particular issue with the authors' assertions that the relative lower harms of cannabinoids as compared with opioids are merely public "perception" and that without more cannabis research, we may see "a potential disaster similar to the opioid epidemic in North America." 1 We agree that more high-quality research is needed on the possible health benefits and acute and chronic harms of cannabis use. We are one of many research groups in Canada planning or conducting experimental trials into cannabinoidbased therapies.…”

Translational hurdles with cannabis medicines

“…In addition to the chemical complexity of some cannabis medicines, there is also off‐label use of standardised formulations, medicinal cannabis programs and self‐prescribed use with medicinal intent. Some of these formulations do not fit well with the usual RCT framework, 2 whereas others have been subjected to RCT evaluation for certain indications.…”