
Show HN: Meadow Education: A beginner's guide to medical marijuana - rickharrison
https://getmeadow.com/education/how-is-marijuana-medicine
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phren0logy
Speaking as an MD, the evidence for medical marijuana is, uh, _pretty thin_.
In fact, most people would decry the mismatch of research to marketing if it
were a traditionally prescribed drug.

The barriers to meaningful research are coming down, but the research just
isn't there yet. I suspect that therapeutic targets will emerge, but no amount
of enthusiasm changes the fact that high-quality research hasn't happened yet.
On the other hand, there are real problems associated with use, such as an
increased risk of psychotic disorders, problems with concentration, etc.

I consider it part of my job to look at the evidence and remain free of bias,
because most marketing is put together by those who stand to make a lot of
money off of what they are selling. If I apply those same criteria I use for
other drugs I prescribe to marijuana, the outlook is not so good.

Recreation marijuana, on the other hand, suffers from no such pretense. People
use it to get high, and understand the risk. This, to me, seems like a much
more honest system for the use most people want.

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TelmoMenezes
So research is too thin to assume any therapeutic use, but strong enough to
claim real problems such as an increased risk of psychotic disorders and
problems with concentration?

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phren0logy
Yes. Each individual paper covers a very narrow topic. For example, here's a
recent paper - _White matter fractional anisotropy over two time points in
early onset schizophrenia and adolescent cannabis use disorder: A naturalistic
diffusion tensor imaging study_

This paper tells me nothing about headache relief, or nausea related to
chemotherapy.

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delluminatus
It sounds like you are reasonably well informed in this field, whereas I can
barely parse the abstract for the linked paper. I was hoping you could give me
an educated opinion about negative effects of cannabis use in non-adolescents.
It seems like papers are mostly finding negative effects for adolescents only.

Also, the particular paper you mention seems to be studying adolescents with
"Cannabis Use Disorder (CUD)". Is this just a roundabout way of saying they
are a pot smoker, or is there a difference between cannabis use and "cannabis
use disorder"?

For example, consider a non-adolescent who uses cannabis sporadically but does
not have a "disorder" (i.e. no addictive tendencies). Do you have an opinion
about cannabis use for that individual?

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phren0logy
To answer your first question, Cannabis Use Disorder specifically refers to a
pattern of use that leads to health problems, disability, and failure to meet
important responsibilities at work/school/home. So it's not defined by use but
rather by consequences of use.

Second, there are a number of large cohort studies looking at this question.
Here's a recent one:
[http://www.ncbi.nlm.nih.gov/pubmed/26006253](http://www.ncbi.nlm.nih.gov/pubmed/26006253)
_Psychosocial sequelae of cannabis use and implications for policy: findings
from the Christchurch Health and Development Study._

It followed a group of 1200+ kids in New Zealand for all kinds of stuff, but
in this particular paper they looked at cannabis use.

Their conclusion: In general, the findings of the CHDS suggest that
individuals who use cannabis regularly, or who begin using cannabis at earlier
ages, are at increased risk of a range of adverse outcomes, including: lower
levels of educational attainment; welfare dependence and unemployment; using
other, more dangerous illicit drugs; and psychotic symptomatology. It should
also be noted, however, that there is a substantial proportion of regular
adult users who do not experience harmful consequences as a result of cannabis
use.

In conclusion, it seems that some adults can use occasionally, or even
regularly, without a problem on one of the outcomes they looked at. Those with
a personal or family history of addiction or a psychiatric disorder are
probably at higher risk for a problem.

But, it comes back the same problem mentioned before: Every study can only
answer the narrow questions they have considered, How does cannabis impact the
risk for vascular disease, or dementia? Perhaps it helps, perhaps it
hurts.This study does not answer that question.

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kw71
Is it possible that the subjects who went to cannabis already had problems,
are self-medicating, and would have achieved the adverse outcomes anyway?

~~~
phren0logy
This was partially controlled for in their analysis, but it's a cohort study
meaning that people weren't randomized into groups. So certainly there could
be some of that happening, but the analysis minimizes (but doesn't totally
eliminate) how much that influences the outcome.

Behavioral science is hard, and messy.

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oneeyedpigeon
That's a very professional looking site and just goes to show how far medical
marijuana has come ... in the US. As a UK citizen, I'm full of jealousy and
saddened by the fact that we're probably further away from legalisation than
ever. This petition [1] shows that there is at least some demand for a change
in the law, but it seems unlikely to occur anytime soon with the current
government in power.

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Ivanov
So, err, when are we gonna get medical MDMA and medical LCD?

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beowulfey
Very nice site. Slight typo under the CBN explanation tab -- you have
"oxides", which is a noun; I believe you'd want "oxidizes" there.

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eonw
Washington State just did way with medical marijuana. At a marijuana industry
convention I recently attended it seemed more and more are starting to turn
their back on the current medical claims and just hoping to get in as a
capitalist in the recreational market. Given the industry is getting more and
more attention on the federal level, might be a good move for other states to
just go recreational and skip the medical farce.

