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- Page navigation anchor for RE: Physician decisions about medical cannabis should be based on evidence, not hype or public pressureRE: Physician decisions about medical cannabis should be based on evidence, not hype or public pressure
We appreciate the interest that our commentary on medical cannabis has generated, and agreement of our stance by Dr. Holbrook and Dr. Yu. Similar to Dr. Yu, we note that the CBD “wellness” industry is burgeoning with health claims for many conditions, but with paltry evidence for most conditions. Our concern is further heightened as CBD products are nonregulated raising issues about molecular content and contaminants that could adversely affect patient health.
In this highly charged and often polarized environment of medical cannabis, it is more than ever critical that the medical community adhere to the standards of evidence-based medicine that were diligently developed in the last decades. The literature pertaining to cannabis is voluminous and abounds with publications of varying quality, requiring critical reading and need to question some published conclusions. Almost any hypotheses about cannabis can at this time be bolstered by some published report.
We applaud the efforts of Dr Lake and colleagues to further the evidence for the helps and harms of cannabis-based medicines. Dr. Lake challenges our conclusion that there is limited evidence for the effect of cannabinoids in pain relief based on the often-quoted publication of the National Academies of Science, Engineering, and Medicine [1]. On scrutiny, the statements of the National Academies regarding effects in chronic pain are mostly based on the conclusions of 2 meta-analyses, Whiting et al and...
Show MoreCompeting Interests: None declared. - Page navigation anchor for RE: Medical cannabis: Strengthening evidence in the face of hype and public pressureRE: Medical cannabis: Strengthening evidence in the face of hype and public pressure
Fitzcharles and colleagues raise a number of important concerns stemming from the need for more rigorous research into therapeutic applications of cannabinoids. Unfortunately, their arguments are undermined by their unsubstantiated claims about the relative risks of cannabis compared to opioids.
The authors acknowledge there are several symptoms and conditions for which cannabis has shown to be effective (e.g., severe childhood epilepsy, chemotherapy-induced nausea, palliation at end-of-life) and suggest that the evidence is not sufficient to support other conditions that are commonly thought to improve with cannabis, including chronic non-cancer pain. This conclusion is debatable, especially in light of the recent consensus reached by the United States’ National Academies of Science, Engineering, and Medicine that there is substantial evidence to support cannabinoids for the treatment of chronic pain.[1] We take particular issue with the authors’ assertions that the relative lower harms of cannabinoids as compared to 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.”
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 cannabinoid-based therapies. However, suggesting cannabis migh...
Show MoreCompeting Interests: UBC has received an unstructured gift to support Dr. Milloy's research from NG Biomed, Ltd, an applicant to the Canadian federal government for a license to produce medical cannabis. Dr. Milloy is the Canopy Growth Professor of cannabis science at the University of British Columbia, a position created by an unstructured gift to the university from Canopy Growth, a licensed producer of cannabis, and the Government of British Columbia’s Ministry of Mental Health and Addictions. The other authors do not have any conflicts of interest to declare. - Page navigation anchor for RE: Medical CannabisRE: Medical Cannabis
This is an excellent commentary. The burgeoning of cannabis use without any good evidence of efficacy or safety, is alarming. It is particularly concerning in Ontario where our current government strives to increase the availability and use of alcohol, also ignoring best evidence on predictors of unhealthy use and healthcare burden.
Competing Interests: None declared. - Page navigation anchor for RE: "...the evidence base remains weak."RE: "...the evidence base remains weak."
Thanks for your cogent article. I agree with you completely. As there is little profit in funding unbiased research; the evidence will likely remain weak until great harm is done. I read in Wikipedia, “..in vitro studies indicate CBD may interact with different biological targets, including cannabinoid receptors and other neurotransmitter receptors, as of 2018 the mechanism of action for its biological effects has not been determined...It is an allosteric modulator of the μ- and δ-opioid receptors as well.”
While I have no clue how CBD actually works, it being both a potent psychotropic and analgesic suggests to me of it’s potential as a dangerous substitute or quick fix solution for dealing with physical pain and mental suffering.
While I suspect there will soon be research on CBD safety and benefits eagerly and earnestly shared by producers and promoters; I am hesitant to abandon all caution. I read not all that long ago Valium was promoted as safe and a way to safeguard the virtues of college girls who might otherwise succumb to crumbling moral standards. More recently Oxycontin was prophetically promoted as the “one to start with and the one to stay with”.Thanks again for your work.
Competing Interests: None declared.