7 ms·

Therapeutic use of cannabis and cannabinoids: A review

60 points by bookofjoe 11mo ago

larodi 11mo ago
it is very important to also remind - no amount of alcohol is ever prescribed or sold in the pharmacies. the alcohol was legalized in order to a) reverse the ill effects of prohibition which led to birth of large-scale organized crime; b) to allow regulation of substances innit, as people were dying from bad booze. likewise, nations may have to legalize in order to regulate the contents of whatever-white-powder users may stumble upon on the street. and let us be honest - no bombs can stop the Fentanil (or rat poison for all I care) from being mixed in.
- loeg 11mo ago
  Sure, sure. But this is an argument that we shouldn't have special licensing schemes subsidizing some use via tax exemption ("medical").
- edgineer 11mo ago
  Doctors sometimes prescribe alcohol and in these cases pharmacies do fill these orders.
  - lucketone 11mo ago
    Example. Poisoning by methyl alcohol. Ethyl alcohol is ok’ish (the regular stuff), while methyl alcohol can make you blind or dead even in small amounts.
    - A1kmm 11mo ago
      I believe ethanol is not actually often given as an antidote for methanol poisoning in modern times. It does work as a competitive inhibitor of alcohol dehydrogenase (i.e. occupying the enzyme to convert ethanol to acetaldehyde, slowing the conversion of methanol to formaldehyde and on to formic acid, which is not eliminated quickly and causes metabolic acidosis) - allowing the methanol time to leave the body through excretion, and limiting formic acid levels. However, other drugs like fomepizole also inhibit alcohol dehydrogenase with lower toxicity than ethanol.
  - vkou 11mo ago
    Yes, because if you're a hardcore liver-failure-in-three-years alcoholic, quitting cold turkey will kill you, and if you're in the hospital for some other issue, they will make sure you get some alcohol. Doctors don't prescribe it to people who aren't already putting away 50 drinks a week.
    - jrflowers 11mo ago
      I like your point that doctors prescribe things that are necessary to patients, alcohol is one of those things, and there are clear and well-understood examples of when it is medically necessary for a doctor to prescribe and administer alcohol to a patient.
  - larodi 11mo ago
    I can bet they quite more often prescribe marijuana, or if you like - CBD or even THC in some cases. And historically, I've been told, the amount of morphine prescribed quite outpaces the alcohol prescriptions, right?
- IAmBroom 11mo ago
  > the alcohol was legalized in order to a) reverse the ill effects of prohibition which led to birth of large-scale organized crime This statement is historically incomplete, and geographically myopic. Alcohol in the US was initially fully legal, then prohibited for a short period, then legalized again. Elsewhere, laws differ, but alcohol is largely regulated but legal for adults in most (non-Islamic) countries.
readthenotes1 11mo ago
The sad thing to me, because of how it has affected, several family members, is that some smoke dope or take CBD to treat anxiety only to make things worse. Because of how marijuana has been made nearly sacrosanct in some circles, they will not look at that THC or CBD as a contributing factor : (
- op00to 11mo ago
  Cannabis works great for stress for a week, then it makes things worse for me. A few weeks off, and I can take advantage again.
- nurettin 11mo ago
  It is all fun and games "defending" legalization of weed online until you get a substance abuser in your family.
  - loeg 11mo ago
    Alcoholics have family members, too, but we aren't going to criminalize alcohol.
    - spoiler 11mo ago
      As someone who was raised by aggressive alcoholics, and I have myself struggled with weed addiction in the past (and seen weed addiction in others), it's really difficult to compare the substances. Yes, weed dependence is bad and people need to be aware of it, but alcohol (and I'd even say nicotine, but that's a different subject) are far more insidious than weed
      - squigz 11mo ago
        Could you elaborate on the nicotine thing? I would say alcohol is far, far, far more insidious than both nicotine and cannabis; I would also say nicotine is less insidious than cannabis.
an0malous 11mo ago
> Evidence from randomized clinical trials does not support the use of cannabis or cannabinoids for most conditions for which it is promoted, such as acute pain and insomnia. I once slept in a hoodie with the hood under my back and woke up with horrible back pain, I could not sit still or focus on anything but the pain, 800mg of ibuprofen did nothing. I was about to go to the ER or urgent care when a doctor friend suggested trying cannabis, I took one small hit and was immediately pain free. I have never experienced such a dramatic medical effect in my life, one second I was writhing in pain and the next I was completely fine. I’ve also seen videos of epileptics calming their seizures from cannabis. The autism community often speaks highly of it, how it makes them feel “normal” or more regulated. I’ve heard of stories of people getting off opioids by using cannabis. I think the people who get anxiety from it or no relief from insomnia are often taking far too much because there aren’t any good guidelines for self medicating and the guidelines they do get are from recreational users. All I have are anecdotes, but given how obvious the effects were, I find it hard to believe there’s no medicinal value to cannabis.
- smohare 11mo ago
  A substance can have pharmacological effects and still not be recommended for therapeutic use. As a hyperbolic example, suppose a substance relieved all pain for 1% of the population but caused death in everyone else. Even with a highly precise screening process this substance likely would not be administered in medicinal contexts.
  - tripletao 11mo ago
    That's true, but I believe the authors' complaint here is efficacy rather than safety. (I also think they're using terms of art from evidence-based medicine to make a statement the general public is likely to misinterpret, per my other comment here.) Safety is barely discussed in this paper, probably because the available RCT evidence is favorable to cannabis. I'm not sure that means it's actually safe, since RCTs of tobacco cigarettes over the same study periods probably wouldn't show signal either. This again shows the downside of ignoring all scientific knowledge except RCT outcomes, just in the other direction.
- 11mo ago
ursAxZA 11mo ago
Different countries still treat cannabis very differently, and that alone shows how unsettled the whole topic is. I don’t know the full historical reasoning behind the bans, but there must have been perceived downsides at the time. It feels like society just keeps swinging back and forth on this.
- rusk 11mo ago
  The UK actually did a report into drug use a number of years ago. Professor David Nutt identified the root causes of the phenomenon you identified and was sacked for it. https://en.wikipedia.org/wiki/David_Nutt https://en.wikipedia.org/wiki/David_Nutt
- lucketone 11mo ago
  > there must have been perceived downsides at the time. I also don’t know, but I seriously doubt there was cost benefit analysis. My two bets would be: - church/priests had power and they condemned most things, except for preying. - it became widely known that opium is really obviously bad for you, after a bit of mental juggling that became “drugs are bad”, and then wholesale bans followed.
  - rusk 11mo ago
    World War 1 and 2 were drug fueled. Americans saw the carnage after WW1 and instituted prohibition and then entered WW2 as the only sober participants. The Chinese 100 years of humiliation at the hands of the Brits, was down to Opium The fall of the medieval European dynasties was all down to Luandanum Time and again, the unhealthy, and unregulated use of drugs has toppled empires and led to social upheaval. Makes perfect sense if you ran a country you would be scared of it.
    - lucketone 11mo ago
      Looked up: Luandanum is opium dissolved in alcohol (for next clueless reader)
    - IAmBroom 11mo ago
ynab6 11mo ago
Weed is just cringe nowadays.
epolanski 11mo ago
The abstract of the review is interesting and honestly reflects my (negative) experience with cannabis. I admit, I really like cannabis, and when I was a 20 year old occasionally smoking with friends at parties it was a "healthier" alternative to getting wasted on alcohol. Share few joins with friends, have fun, laugh a lot. Then as I got financially independent and I started solo consumption (mostly to get rid of stress) I really started appreciating the cons: lack of energy, disruption of sleep, negative impact of my cognitive abilities, increase in anxiety. I'm glad the study confirms those to be statistically common. I was very lucky to have a SO who really disliked me smoking and made me realize that I was just doing it to "not think", and it had really 0 positive effects on me. I'm sure I would've quitted eventually anyway, but support and criticism sped up the reality check. Eventually this is all anecdotal experience, and I'm sure there might be occasional users who can have a mostly positive experience, but the fact that a review points out how statistically common are the negatives and how uncommon are the positives honestly reflects what I've seen on myself and friends.
- rusk 11mo ago
  Anecdata
- jrflowers 11mo ago
  >The abstract of the review is interesting and honestly reflects my (negative) experience with cannabis. The abstract doesn’t say anything about recreational cannabis usage. >lack of energy, disruption of sleep, negative impact of my cognitive abilities, increase in anxiety. I'm glad the study confirms those to be statistically common. >I was very lucky to have a SO who really disliked me smoking and made me realize that I was just doing it to "not think" This study about the clinical outcomes of physician-directed cannabis usage for specific conditions doesn’t really get into musing about how weed is just sort of generally bad. The only part of the study that seems to sort of touch on what you’re talking about is the section about Cannabis Use Disorder https://jamanetwork.com/journals/jama/fullarticle/2842072?guestAccessKey=a368e622-e374-4a0c-8d3b-22a976500305#jrv250033b2 https://jamanetwork.com/journals/jama/fullarticle/2842072?gu... At no point in this study does it say that “share a few joints with friends, have fun, laugh a lot” has common negatives and uncommon positives. It is not in the purview of the analysis.
sitharus 11mo ago
This paper is very much a case of read past the abstract, especially the limitations of the study. As always it’s important for a clinician to explain the risks and current evidence when prescribing, no matter the substance. A lot of medicines have limited evidence, but they still work for some people. Personally I use prescribed pharmacutical cannabis oils as I have much lower levels of a couple of important enzymes than most people which renders opioids mostly ineffective, even intravenous morphine as I recently found out after surgery. High CBD cannabis oil works, as does paracetamol but that’s way more dangerous.
baxtr 11mo ago
> Evidence from randomized clinical trials does not support the use of cannabis or cannabinoids for most conditions for which it is promoted, such as acute pain and insomnia. I think that’s the key message do the paper.
- tripletao 11mo ago
  In this context, "does not support" means "the evidence is of low quality", not "the evidence says it probably doesn't work". Per the quotations in my other comment here, the paper and its references conclude that the best available RCT evidence is favorable to cannabis for those conditions. They're just not impressed with the statistical power and methodological rigor of those studies. It's unfortunately common to report that situation of favorable but low-quality evidence as "does not support", despite the confusion that invariably results. This confusion has been noted for literally decades, for example in https://pmc.ncbi.nlm.nih.gov/articles/PMC351831/ https://pmc.ncbi.nlm.nih.gov/articles/PMC351831/ I'm sad to see it repeated here, and I hope we can avoid propagating it further.
  - bragr 11mo ago
    >I'm sad to see it repeated here, and I hope we can avoid propagating it further. Science educators have been fighting the scientific theory vs vernacular theory fight for decades without much progress, so I wouldn't hold my breath. I think at some point, the scientific community needs to accept that many of the formal and precise ways they are taught to write in order to avoid ambiguity, have the exact opposite effect on everybody else. Unless we adjust the terminology so that the scientific and casual definitions more closely align, we're just going up have to keep explaining.
  - baxtr 11mo ago
    What would you want to write instead?
    - tripletao 11mo ago
      The acute pain paper they cited (linked in other comment) said "low-quality evidence [...] for a small but significant reduction", which seems clear and correct to me. If these authors think that's too favorable, then the paper I linked above suggests "insufficient evidence to confirm or exclude an important difference". Either of those distinguishes "strong evidence this doesn't work, and more studies are probably wasted effort" vs. "weak evidence, more studies required". I don't see any benefit to a single phrase covering both cases unless the goal is to deliberately mislead.
nicolix 11mo ago
cannabis in many varieties and cannabinoids especially the most significant naturally made potentially cheaply sourceable receptors' agonist compound delta-9-thc, when taken not occasionally, in increasingly large quantities, in extracted purified forms, at high molar concentrations (up to and over 5-10 µM) have demostrated - albeit not in many clinical settings despite numerous studies since 1974 have confirmed such potential usage - a strong antiproliferative, antineoplastic, antitumor, anticancer activity.
renewiltord 11mo ago
The point of the studies was to establish a reason for people to use recreational drugs. Americans can’t be satisfied with “they’re fun” so people need to come up with a medical reason for it because “they’re suffering” is a get out of jail free card. Everything is obviously fabricated. You think the snail darter is real? But the scientific consensus…
- seec 11mo ago
  Yep, I completely agree. By the same standard, humans would never have started consuming alcohol, and it should be strictly forbidden. But of course we have tried that, and it's not very effective, but for some reason they seem to think it can work with something that is even easier to handle.
deleted 11mo ago
[deleted]
cluckindan 11mo ago
As an autistic person with ADHD and PTSD, this review heavily contradicts personal empirical evidence.
- smugtrain 11mo ago
  That’s because the goal of these psychiatrists that wrote the study is to scare people, by using technically correct scientific terms that mislead people into thinking that their hesitation to accept “low-quality” studies is the same as their being evidence that cannabis does not work.
  - IAmBroom 11mo ago
    Or, that clinical terms like "low-quality studies" and "does not support" can be easily understood by laypeople browsing summaries of the paper by other laypeople.
deleted 11mo ago
[deleted]
tsoukase 11mo ago
[flagged]
- deleted 11mo ago
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- leoh 11mo ago
  You live in Greece. You are a physician. It’s a free country. Yet you have chosen to blame a “Jewish company.” You also probably have confirmation bias. Given your specialty, you likely have a lot of patients that suffer from neuropathic pain. It’s your job to support them. Is cannabis best for your patients? Perhaps not always as used. It’s your job to help. I live in California and cannabis is used here too. Blaming a “Jewish company” is beyond absurd.
  - nataliste 11mo ago
    >You live in Greece. You are a physician. It’s a free country. Yet you have chosen to blame a “Jewish company.” From August, 2025: https://businessofcannabis.com/as-canada-floods-europe-with-cannabis-greek-producer-pushes-local-high-quality-alternative https://businessofcannabis.com/as-canada-floods-europe-with-... >Currently, only three medical cannabis flower strains are available to Greek patients, all produced by Tikun Olam Europe. From: https://tikuneurope.com/en/ https://tikuneurope.com/en/ >The pioneer for his time, Tzahi Cohen, decides to start growing cannabis, with the aim of offering its therapeutic properties non-profit to specific groups of patients: cancer patients, people addicted to opiate drugs and war veterans with post-traumatic stress disorder syndrome (PTSD) >Israel’s Ministry of Health has granted the world’s first government license to Tikun Olam to produce medical cannabis products >Founded in Israel, its verticalized production units have expanded across the world: USA, Canada, Asia and Europe (based in Greece) So, uh, how is this a conspiracy and not a factual statement?
    - leoh 11mo ago
      The issue here is the insinuation that it’s a “Jewish” company that is responsible for unhealthy use of cannabis in Greece.
nataliste 11mo ago
You can tell what the paper is going to argue just by reading the author affiliations. They're all part of a group whose funding lines all lead back to NIDA. NIDA’s mandate is harm. Not cognition, not performance, not any of the reasons people actually use cannabis. So of course the study leans hard on CUD and psychosis as those are the two outcomes that guarantee grant renewals. A proposal about cannabis and creative problem-solving will get immediately buried. But if you emphasize risk (especially adolescent risk, ideally with "first-episode psychosis" somewhere in the aims) then suddenly everyone’s interested. They do the usual maneuver with FDA-approved derived substances: carve them out as clean, respectable, and clinically manageable, while treating the whole-plant as this murky, unstable mass the medical system can’t "trust." That distinction is purely commercial, not scientific. The plant itself is chaotic, but the extract with an SKU number is pure, controlled, and therefore "clinical." It’s not hard to see what this protects. It's the exact same thing Cargill, Coca-Cola, and PepsiCo did against stevia (Rebiana) and Merck did against red rice koji (Lovastatin). The form you can just grow or make yourself cheaply is dangerous to consumers. But this patented recombination passed solely through greased palms is just dandy. This study is just another vehicle for the same move against cannabis. Most of the authors work in addiction medicine. Their entire professional world assumes SUD as the governing model. If cannabis doesn’t sit inside that model (as in patients can just go buy it without passing through the psychiatric gate) then they lose money and clients. The conclusion section basically spells out the anxiety: clinicians must provide guidance, clinicians must set the boundaries, clinicians must interpret the evidence. That’s jurisdictional language. Meanwhile, the practical reality is that patients get contradictory instructions: a doctor says "try cannabis" but a follow-up psychiatrist says "chronic cannabis use is a disorder." They're trying to patch that incoherence by building a moat around medicalized (and patented) cannabinoids and burning everything outside it. The only cannabis that counts is the kind that runs through the FDA and, by extension, the institutions tied into that pipeline. Everything outside that channel is going to be treated as dangerous and destructive on purpose.
- IAmBroom 11mo ago
  > NIDA’s mandate is harm. That's an impressive take. In general, or were they institutionally created to destroy all people?

60 points by bookofjoe 11mo ago

larodi 11mo ago

it is very important to also remind - no amount of alcohol is ever prescribed or sold in the pharmacies. the alcohol was legalized in order to a) reverse the ill effects of prohibition which led to birth of large-scale organized crime; b) to allow regulation of substances innit, as people were dying from bad booze. likewise, nations may have to legalize in order to regulate the contents of whatever-white-powder users may stumble upon on the street. and let us be honest - no bombs can stop the Fentanil (or rat poison for all I care) from being mixed in.

loeg 11mo ago
Sure, sure. But this is an argument that we shouldn't have special licensing schemes subsidizing some use via tax exemption ("medical").
edgineer 11mo ago
Doctors sometimes prescribe alcohol and in these cases pharmacies do fill these orders.
- lucketone 11mo ago
  Example. Poisoning by methyl alcohol. Ethyl alcohol is ok’ish (the regular stuff), while methyl alcohol can make you blind or dead even in small amounts.
  - A1kmm 11mo ago
    I believe ethanol is not actually often given as an antidote for methanol poisoning in modern times. It does work as a competitive inhibitor of alcohol dehydrogenase (i.e. occupying the enzyme to convert ethanol to acetaldehyde, slowing the conversion of methanol to formaldehyde and on to formic acid, which is not eliminated quickly and causes metabolic acidosis) - allowing the methanol time to leave the body through excretion, and limiting formic acid levels. However, other drugs like fomepizole also inhibit alcohol dehydrogenase with lower toxicity than ethanol.
- vkou 11mo ago
  Yes, because if you're a hardcore liver-failure-in-three-years alcoholic, quitting cold turkey will kill you, and if you're in the hospital for some other issue, they will make sure you get some alcohol. Doctors don't prescribe it to people who aren't already putting away 50 drinks a week.
  - jrflowers 11mo ago
    I like your point that doctors prescribe things that are necessary to patients, alcohol is one of those things, and there are clear and well-understood examples of when it is medically necessary for a doctor to prescribe and administer alcohol to a patient.
- larodi 11mo ago
  I can bet they quite more often prescribe marijuana, or if you like - CBD or even THC in some cases. And historically, I've been told, the amount of morphine prescribed quite outpaces the alcohol prescriptions, right?
IAmBroom 11mo ago
> the alcohol was legalized in order to a) reverse the ill effects of prohibition which led to birth of large-scale organized crime This statement is historically incomplete, and geographically myopic. Alcohol in the US was initially fully legal, then prohibited for a short period, then legalized again. Elsewhere, laws differ, but alcohol is largely regulated but legal for adults in most (non-Islamic) countries.

readthenotes1 11mo ago

The sad thing to me, because of how it has affected, several family members, is that some smoke dope or take CBD to treat anxiety only to make things worse. Because of how marijuana has been made nearly sacrosanct in some circles, they will not look at that THC or CBD as a contributing factor : (

op00to 11mo ago
Cannabis works great for stress for a week, then it makes things worse for me. A few weeks off, and I can take advantage again.
nurettin 11mo ago
It is all fun and games "defending" legalization of weed online until you get a substance abuser in your family.
- loeg 11mo ago
  Alcoholics have family members, too, but we aren't going to criminalize alcohol.
  - spoiler 11mo ago
    As someone who was raised by aggressive alcoholics, and I have myself struggled with weed addiction in the past (and seen weed addiction in others), it's really difficult to compare the substances. Yes, weed dependence is bad and people need to be aware of it, but alcohol (and I'd even say nicotine, but that's a different subject) are far more insidious than weed
    - squigz 11mo ago
      Could you elaborate on the nicotine thing? I would say alcohol is far, far, far more insidious than both nicotine and cannabis; I would also say nicotine is less insidious than cannabis.

an0malous 11mo ago

> Evidence from randomized clinical trials does not support the use of cannabis or cannabinoids for most conditions for which it is promoted, such as acute pain and insomnia. I once slept in a hoodie with the hood under my back and woke up with horrible back pain, I could not sit still or focus on anything but the pain, 800mg of ibuprofen did nothing. I was about to go to the ER or urgent care when a doctor friend suggested trying cannabis, I took one small hit and was immediately pain free. I have never experienced such a dramatic medical effect in my life, one second I was writhing in pain and the next I was completely fine. I’ve also seen videos of epileptics calming their seizures from cannabis. The autism community often speaks highly of it, how it makes them feel “normal” or more regulated. I’ve heard of stories of people getting off opioids by using cannabis. I think the people who get anxiety from it or no relief from insomnia are often taking far too much because there aren’t any good guidelines for self medicating and the guidelines they do get are from recreational users. All I have are anecdotes, but given how obvious the effects were, I find it hard to believe there’s no medicinal value to cannabis.

smohare 11mo ago
A substance can have pharmacological effects and still not be recommended for therapeutic use. As a hyperbolic example, suppose a substance relieved all pain for 1% of the population but caused death in everyone else. Even with a highly precise screening process this substance likely would not be administered in medicinal contexts.
- tripletao 11mo ago
  That's true, but I believe the authors' complaint here is efficacy rather than safety. (I also think they're using terms of art from evidence-based medicine to make a statement the general public is likely to misinterpret, per my other comment here.) Safety is barely discussed in this paper, probably because the available RCT evidence is favorable to cannabis. I'm not sure that means it's actually safe, since RCTs of tobacco cigarettes over the same study periods probably wouldn't show signal either. This again shows the downside of ignoring all scientific knowledge except RCT outcomes, just in the other direction.
11mo ago

ursAxZA 11mo ago

Different countries still treat cannabis very differently, and that alone shows how unsettled the whole topic is. I don’t know the full historical reasoning behind the bans, but there must have been perceived downsides at the time. It feels like society just keeps swinging back and forth on this.

rusk 11mo ago
The UK actually did a report into drug use a number of years ago. Professor David Nutt identified the root causes of the phenomenon you identified and was sacked for it. https://en.wikipedia.org/wiki/David_Nutt https://en.wikipedia.org/wiki/David_Nutt
lucketone 11mo ago
> there must have been perceived downsides at the time. I also don’t know, but I seriously doubt there was cost benefit analysis. My two bets would be: - church/priests had power and they condemned most things, except for preying. - it became widely known that opium is really obviously bad for you, after a bit of mental juggling that became “drugs are bad”, and then wholesale bans followed.
- rusk 11mo ago
  World War 1 and 2 were drug fueled. Americans saw the carnage after WW1 and instituted prohibition and then entered WW2 as the only sober participants. The Chinese 100 years of humiliation at the hands of the Brits, was down to Opium The fall of the medieval European dynasties was all down to Luandanum Time and again, the unhealthy, and unregulated use of drugs has toppled empires and led to social upheaval. Makes perfect sense if you ran a country you would be scared of it.
  - lucketone 11mo ago
    Looked up: Luandanum is opium dissolved in alcohol (for next clueless reader)
  - IAmBroom 11mo ago

ynab6 11mo ago

Weed is just cringe nowadays.

epolanski 11mo ago

The abstract of the review is interesting and honestly reflects my (negative) experience with cannabis. I admit, I really like cannabis, and when I was a 20 year old occasionally smoking with friends at parties it was a "healthier" alternative to getting wasted on alcohol. Share few joins with friends, have fun, laugh a lot. Then as I got financially independent and I started solo consumption (mostly to get rid of stress) I really started appreciating the cons: lack of energy, disruption of sleep, negative impact of my cognitive abilities, increase in anxiety. I'm glad the study confirms those to be statistically common. I was very lucky to have a SO who really disliked me smoking and made me realize that I was just doing it to "not think", and it had really 0 positive effects on me. I'm sure I would've quitted eventually anyway, but support and criticism sped up the reality check. Eventually this is all anecdotal experience, and I'm sure there might be occasional users who can have a mostly positive experience, but the fact that a review points out how statistically common are the negatives and how uncommon are the positives honestly reflects what I've seen on myself and friends.

rusk 11mo ago
Anecdata
jrflowers 11mo ago
>The abstract of the review is interesting and honestly reflects my (negative) experience with cannabis. The abstract doesn’t say anything about recreational cannabis usage. >lack of energy, disruption of sleep, negative impact of my cognitive abilities, increase in anxiety. I'm glad the study confirms those to be statistically common. >I was very lucky to have a SO who really disliked me smoking and made me realize that I was just doing it to "not think" This study about the clinical outcomes of physician-directed cannabis usage for specific conditions doesn’t really get into musing about how weed is just sort of generally bad. The only part of the study that seems to sort of touch on what you’re talking about is the section about Cannabis Use Disorder https://jamanetwork.com/journals/jama/fullarticle/2842072?guestAccessKey=a368e622-e374-4a0c-8d3b-22a976500305#jrv250033b2 https://jamanetwork.com/journals/jama/fullarticle/2842072?gu... At no point in this study does it say that “share a few joints with friends, have fun, laugh a lot” has common negatives and uncommon positives. It is not in the purview of the analysis.

sitharus 11mo ago

This paper is very much a case of read past the abstract, especially the limitations of the study. As always it’s important for a clinician to explain the risks and current evidence when prescribing, no matter the substance. A lot of medicines have limited evidence, but they still work for some people. Personally I use prescribed pharmacutical cannabis oils as I have much lower levels of a couple of important enzymes than most people which renders opioids mostly ineffective, even intravenous morphine as I recently found out after surgery. High CBD cannabis oil works, as does paracetamol but that’s way more dangerous.

baxtr 11mo ago

> Evidence from randomized clinical trials does not support the use of cannabis or cannabinoids for most conditions for which it is promoted, such as acute pain and insomnia. I think that’s the key message do the paper.

tripletao 11mo ago
In this context, "does not support" means "the evidence is of low quality", not "the evidence says it probably doesn't work". Per the quotations in my other comment here, the paper and its references conclude that the best available RCT evidence is favorable to cannabis for those conditions. They're just not impressed with the statistical power and methodological rigor of those studies. It's unfortunately common to report that situation of favorable but low-quality evidence as "does not support", despite the confusion that invariably results. This confusion has been noted for literally decades, for example in https://pmc.ncbi.nlm.nih.gov/articles/PMC351831/ https://pmc.ncbi.nlm.nih.gov/articles/PMC351831/ I'm sad to see it repeated here, and I hope we can avoid propagating it further.
- bragr 11mo ago
  >I'm sad to see it repeated here, and I hope we can avoid propagating it further. Science educators have been fighting the scientific theory vs vernacular theory fight for decades without much progress, so I wouldn't hold my breath. I think at some point, the scientific community needs to accept that many of the formal and precise ways they are taught to write in order to avoid ambiguity, have the exact opposite effect on everybody else. Unless we adjust the terminology so that the scientific and casual definitions more closely align, we're just going up have to keep explaining.
- baxtr 11mo ago
  What would you want to write instead?
  - tripletao 11mo ago
    The acute pain paper they cited (linked in other comment) said "low-quality evidence [...] for a small but significant reduction", which seems clear and correct to me. If these authors think that's too favorable, then the paper I linked above suggests "insufficient evidence to confirm or exclude an important difference". Either of those distinguishes "strong evidence this doesn't work, and more studies are probably wasted effort" vs. "weak evidence, more studies required". I don't see any benefit to a single phrase covering both cases unless the goal is to deliberately mislead.

nicolix 11mo ago

cannabis in many varieties and cannabinoids especially the most significant naturally made potentially cheaply sourceable receptors' agonist compound delta-9-thc, when taken not occasionally, in increasingly large quantities, in extracted purified forms, at high molar concentrations (up to and over 5-10 µM) have demostrated - albeit not in many clinical settings despite numerous studies since 1974 have confirmed such potential usage - a strong antiproliferative, antineoplastic, antitumor, anticancer activity.

renewiltord 11mo ago

The point of the studies was to establish a reason for people to use recreational drugs. Americans can’t be satisfied with “they’re fun” so people need to come up with a medical reason for it because “they’re suffering” is a get out of jail free card. Everything is obviously fabricated. You think the snail darter is real? But the scientific consensus…

seec 11mo ago
Yep, I completely agree. By the same standard, humans would never have started consuming alcohol, and it should be strictly forbidden. But of course we have tried that, and it's not very effective, but for some reason they seem to think it can work with something that is even easier to handle.

deleted 11mo ago

[deleted]

cluckindan 11mo ago

As an autistic person with ADHD and PTSD, this review heavily contradicts personal empirical evidence.

smugtrain 11mo ago
That’s because the goal of these psychiatrists that wrote the study is to scare people, by using technically correct scientific terms that mislead people into thinking that their hesitation to accept “low-quality” studies is the same as their being evidence that cannabis does not work.
- IAmBroom 11mo ago
  Or, that clinical terms like "low-quality studies" and "does not support" can be easily understood by laypeople browsing summaries of the paper by other laypeople.

deleted 11mo ago

[deleted]

tsoukase 11mo ago

[flagged]

deleted 11mo ago
[deleted]
leoh 11mo ago
You live in Greece. You are a physician. It’s a free country. Yet you have chosen to blame a “Jewish company.” You also probably have confirmation bias. Given your specialty, you likely have a lot of patients that suffer from neuropathic pain. It’s your job to support them. Is cannabis best for your patients? Perhaps not always as used. It’s your job to help. I live in California and cannabis is used here too. Blaming a “Jewish company” is beyond absurd.
- nataliste 11mo ago
  >You live in Greece. You are a physician. It’s a free country. Yet you have chosen to blame a “Jewish company.” From August, 2025: https://businessofcannabis.com/as-canada-floods-europe-with-cannabis-greek-producer-pushes-local-high-quality-alternative https://businessofcannabis.com/as-canada-floods-europe-with-... >Currently, only three medical cannabis flower strains are available to Greek patients, all produced by Tikun Olam Europe. From: https://tikuneurope.com/en/ https://tikuneurope.com/en/ >The pioneer for his time, Tzahi Cohen, decides to start growing cannabis, with the aim of offering its therapeutic properties non-profit to specific groups of patients: cancer patients, people addicted to opiate drugs and war veterans with post-traumatic stress disorder syndrome (PTSD) >Israel’s Ministry of Health has granted the world’s first government license to Tikun Olam to produce medical cannabis products >Founded in Israel, its verticalized production units have expanded across the world: USA, Canada, Asia and Europe (based in Greece) So, uh, how is this a conspiracy and not a factual statement?
  - leoh 11mo ago
    The issue here is the insinuation that it’s a “Jewish” company that is responsible for unhealthy use of cannabis in Greece.

nataliste 11mo ago

You can tell what the paper is going to argue just by reading the author affiliations. They're all part of a group whose funding lines all lead back to NIDA. NIDA’s mandate is harm. Not cognition, not performance, not any of the reasons people actually use cannabis. So of course the study leans hard on CUD and psychosis as those are the two outcomes that guarantee grant renewals. A proposal about cannabis and creative problem-solving will get immediately buried. But if you emphasize risk (especially adolescent risk, ideally with "first-episode psychosis" somewhere in the aims) then suddenly everyone’s interested. They do the usual maneuver with FDA-approved derived substances: carve them out as clean, respectable, and clinically manageable, while treating the whole-plant as this murky, unstable mass the medical system can’t "trust." That distinction is purely commercial, not scientific. The plant itself is chaotic, but the extract with an SKU number is pure, controlled, and therefore "clinical." It’s not hard to see what this protects. It's the exact same thing Cargill, Coca-Cola, and PepsiCo did against stevia (Rebiana) and Merck did against red rice koji (Lovastatin). The form you can just grow or make yourself cheaply is dangerous to consumers. But this patented recombination passed solely through greased palms is just dandy. This study is just another vehicle for the same move against cannabis. Most of the authors work in addiction medicine. Their entire professional world assumes SUD as the governing model. If cannabis doesn’t sit inside that model (as in patients can just go buy it without passing through the psychiatric gate) then they lose money and clients. The conclusion section basically spells out the anxiety: clinicians must provide guidance, clinicians must set the boundaries, clinicians must interpret the evidence. That’s jurisdictional language. Meanwhile, the practical reality is that patients get contradictory instructions: a doctor says "try cannabis" but a follow-up psychiatrist says "chronic cannabis use is a disorder." They're trying to patch that incoherence by building a moat around medicalized (and patented) cannabinoids and burning everything outside it. The only cannabis that counts is the kind that runs through the FDA and, by extension, the institutions tied into that pipeline. Everything outside that channel is going to be treated as dangerous and destructive on purpose.

IAmBroom 11mo ago
> NIDA’s mandate is harm. That's an impressive take. In general, or were they institutionally created to destroy all people?