4 ms·

> (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

by 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
    >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)? In cases in which the active agent is THC or a similarly psychoactive agent, patients are indeed more likely to report positive overall effects simply because they know they're receiving the active agent; i.e. the placebo effect. This would apply whether they've used cannabis before or not. You don't have this problem with trials of the non-psychoactive cannabis chemicals, which fortunately is most trials.
    - mmt 8y ago
      That certainly makes sense with THC, and ties back to your earlier remark about clinically significant quantities of it. For some studies, I've seen reference to using an active placebo (so the placebo group feels something), but I realize that can pollute the side effects data, and it may be useless for psychoactives where the effect is publically well-known.

by mmt 8y ago

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
  >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)? In cases in which the active agent is THC or a similarly psychoactive agent, patients are indeed more likely to report positive overall effects simply because they know they're receiving the active agent; i.e. the placebo effect. This would apply whether they've used cannabis before or not. You don't have this problem with trials of the non-psychoactive cannabis chemicals, which fortunately is most trials.
  - mmt 8y ago
    That certainly makes sense with THC, and ties back to your earlier remark about clinically significant quantities of it. For some studies, I've seen reference to using an active placebo (so the placebo group feels something), but I realize that can pollute the side effects data, and it may be useless for psychoactives where the effect is publically well-known.