| One-Minute Clinician

Taking the Confusion out of Cannabinoids

What is medical marijuana? It depends on who you ask. If you ask heavy marijuana users, all marijuana is medical. If you ask the Food and Drug Administration, no marijuana is medical. It’s a very complex question because marijuana has 100-some odd constituents and the attention seems to be all about the THC or the delta-9-tetrahydrocannabinol, which is what makes you high, but doesn’t seem to have much medical value. Cannabidiol is the real medical piece of medical marijuana. We know in terms of safety profile generally, the more THC and the less cannabidiol that you have, the greater the risks. This is particularly true for mental health issues, such as the development of psychosis in those who are predisposed to it. But there is a dearth of quality research, and the biggest problem is that all the marijuana used in the United States in studies has to come from the University of Mississippi School of Agriculture. The highest THC content that they provide is 7%. About 30% of cannabis available from dispensaries now is 80-90% THC. So any research on something that is maybe 8- 9% percent of what’s really being used becomes automatically invalid. So bottom line is that data are not particularly good now, they’re all over the place. A lot of these studies are showing up in very lousy journals. And with a little statistical manipulation you can come up with something that a journal that does not aggressively vet methodology will publish, and if it’s published it must be true. As a scientist, I struggle with this because again we’re supposed to be informing practice, and around medical cannabinoids we’re not doing a very good job of it.

My advice to frontline practitioners is to obtain education. Right now, Florida which is a relatively new medical marijuana state, requires 2 CMEs if a doctor is going to authorize. I’ve been commissioned by an education company to put together a 4-hour module that’s going to be used in Pennsylvania when their marijuana law takes effect. You can also come to PAINWeek and PAINWeekEND because we have so much education around cannabinoids that is up to date and state of the art, where we talk not only about medical marijuana generally, but about the science and oftentimes the lack thereof.

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