5 ms·

It turns out that cannabis is, and has been, extensively researched for years, in Canada and elsewhere (researchers could apply for special access). Thanks to t

It turns out that cannabis is, and has been, extensively researched for years, in Canada and elsewhere (researchers could apply for special access). Thanks to this work, we know that there is one, exactly one robust, reliable clinical application of a cannabis chemical that stands out: to treat otherwise hard-to-treat childhood epilepsies. The chemical responsible for this is cannabidiol, which is the most abundant non-psychoactive molecule found in the cannabis plant. The other tested clinical applications include pain relief (works great for some people against some types of pain, continually fails clinical trials in most types of pain, not better than the standard of care), nausea relief (not better than the standards of care), sleep (very variable and low quality clinical data from multiple trials), inflammation (very variable and low quality clinical data from multiple trials) and headache (very variable data, etc). Most of this work has been done on the various non-psychoactive chemicals in cannabis, popular and otherwise, since tetrahydrocannabinol is kind of useless at clinically-relevant doses. I think we'll find out in a few years that most of the hype around cannabis is just, well, hype.

mmt 8y ago
> (researchers could apply for special access) I'm aware of the special access, and I'm even aware that it has resulted in actual pharmaceuticals. The problem with special access is that it has a huge chilling effect. I suspect only the very most motivated (and funded? or just politically protected?) would attempt it. What about semi-synthetics? I have to imagine it's easier to experiment with synthesis if there's a robust, commercial market for the raw materials, instead of just the special government hothouse (or however it works in the particular jurisdiction). > not better than the standard of care I don't think I'd characterize that as a failure, if it's approximatey as good. Even if it's worse but significantly better than placebo, that doesn't seem like anything approaching a research dead-end. Besides semi-synthetics, which would be a long and hard road, there's also adjunct therapy, or did those studies actually include using cannabis chemicals in addition to the standard ones? > very variable and low quality clinical data from multiple trials Any possibility that this was affected by actual or perceived stigma surrounding the source of the chemical being studied? Participants worrying about failing a drug test? (Does this law address that at all?) > I think we'll find out in a few years that most of the hype around cannabis is just, well, hype. That's an easy prediction to make about any hype, and I certainly agree. I just think there's more to learn, even if it confirms the null hypothesis, and this will take the foot off the brake in Canada.
- gwerbret 8y ago
  To answer some of your questions, one reason why the area has seen so much active research in the past 30 years -- and there's been a lot -- is that the human cellular pathways that respond to cannabis are extremely far-reaching and far more interesting. To this end, there has indeed been a great deal of synthetic chemistry to experiment with and manipulate these pathways. >Besides semi-synthetics, which would be a long and hard road, there's also adjunct therapy, or did those studies actually include using cannabis chemicals in addition to the standard ones? Interestingly, you can find examples of both adjunct and comparator studies, which are usually blinded in some way to reduce stigma or bias. (If anything, the bias tends to favor cannabis-consuming patients, since it's hard to hide the fact that the pill you just took in a "blinded" clinical trial is making you high.) A decent summary of some of the clinical data is here: https://www.cancer.gov/about-cancer/treatment/cam/hp/cannabis-pdq https://www.cancer.gov/about-cancer/treatment/cam/hp/cannabi... .
  - mmt 8y ago
    >A decent summary of some of the clinical data is here Thanks! That looks extremely informative, and I only had a chance to skim through it so far. I couldn't help but notice how many (at least half) of the referenced studies were in the past 10 years. That does suggest to me that changing attitudes have more to do with it than legalization. > Interestingly, you can find examples of both adjunct and comparator studies, which are usually blinded in some way to reduce stigma or bias. (If anything, the bias tends to favor cannabis-consuming patients, since it's hard to hide the fact that the pill you just took in a "blinded" clinical trial is making you high.) I'm a bit confused by what you mean by "favors" here. Do you mean that an otherwise/previously cannabis-using patient would report more favorable results (and/or fewer negative side effects)? Or that such a patient would more likely receive actually better benefits? Or that they would be more likely to be in the trial in the first place? Are there clinical trials where the participants don't know what (potential) active therapy they could get is? The ones I've looked at in the US have always said, but I've only looked at a couple very specific conditions.
    - gwerbret 8y ago

mmt 8y ago

> (researchers could apply for special access) I'm aware of the special access, and I'm even aware that it has resulted in actual pharmaceuticals. The problem with special access is that it has a huge chilling effect. I suspect only the very most motivated (and funded? or just politically protected?) would attempt it. What about semi-synthetics? I have to imagine it's easier to experiment with synthesis if there's a robust, commercial market for the raw materials, instead of just the special government hothouse (or however it works in the particular jurisdiction). > not better than the standard of care I don't think I'd characterize that as a failure, if it's approximatey as good. Even if it's worse but significantly better than placebo, that doesn't seem like anything approaching a research dead-end. Besides semi-synthetics, which would be a long and hard road, there's also adjunct therapy, or did those studies actually include using cannabis chemicals in addition to the standard ones? > very variable and low quality clinical data from multiple trials Any possibility that this was affected by actual or perceived stigma surrounding the source of the chemical being studied? Participants worrying about failing a drug test? (Does this law address that at all?) > I think we'll find out in a few years that most of the hype around cannabis is just, well, hype. That's an easy prediction to make about any hype, and I certainly agree. I just think there's more to learn, even if it confirms the null hypothesis, and this will take the foot off the brake in Canada.

gwerbret 8y ago
To answer some of your questions, one reason why the area has seen so much active research in the past 30 years -- and there's been a lot -- is that the human cellular pathways that respond to cannabis are extremely far-reaching and far more interesting. To this end, there has indeed been a great deal of synthetic chemistry to experiment with and manipulate these pathways. >Besides semi-synthetics, which would be a long and hard road, there's also adjunct therapy, or did those studies actually include using cannabis chemicals in addition to the standard ones? Interestingly, you can find examples of both adjunct and comparator studies, which are usually blinded in some way to reduce stigma or bias. (If anything, the bias tends to favor cannabis-consuming patients, since it's hard to hide the fact that the pill you just took in a "blinded" clinical trial is making you high.) A decent summary of some of the clinical data is here: https://www.cancer.gov/about-cancer/treatment/cam/hp/cannabis-pdq https://www.cancer.gov/about-cancer/treatment/cam/hp/cannabi... .
- mmt 8y ago
  >A decent summary of some of the clinical data is here Thanks! That looks extremely informative, and I only had a chance to skim through it so far. I couldn't help but notice how many (at least half) of the referenced studies were in the past 10 years. That does suggest to me that changing attitudes have more to do with it than legalization. > Interestingly, you can find examples of both adjunct and comparator studies, which are usually blinded in some way to reduce stigma or bias. (If anything, the bias tends to favor cannabis-consuming patients, since it's hard to hide the fact that the pill you just took in a "blinded" clinical trial is making you high.) I'm a bit confused by what you mean by "favors" here. Do you mean that an otherwise/previously cannabis-using patient would report more favorable results (and/or fewer negative side effects)? Or that such a patient would more likely receive actually better benefits? Or that they would be more likely to be in the trial in the first place? Are there clinical trials where the participants don't know what (potential) active therapy they could get is? The ones I've looked at in the US have always said, but I've only looked at a couple very specific conditions.
  - gwerbret 8y ago