Patients use medical cannabis to treat the symptoms of a wide variety of ailments—but only some of those uses are actually backed up by science. A new study out Monday, however, suggests the vast majority of patients are prescribed medical pot for conditions like chronic pain and multiple sclerosis, for which there is good research supporting the use of cannabis.
In light of their findings, the authors say it’s high time that cannabis be downgraded from its federal status as a Schedule I drug, and it should be better tracked and regulated as a medical treatment.
In the U.S., 33 states and the District of Columbia currently permit people to use medical cannabis. These users need a special license, which can only be obtained if a doctor agrees that they have a qualifying condition. But until now, according to the authors, there hasn’t been an attempt to quantify, on a national level, why people are getting medical cannabis.
In the new study, published in Health Affairs, the authors looked at data from patient registries in D.C. and 20 states, including Alaska, Illinois, and New York. They also looked at a 2017 report from the National Academies of Sciences, Engineering, and Medicine, which reviewed the available evidence for weed’s health benefits. The report was used as a baseline to establish which qualifying conditions were well-supported by the science.
All in all, they found, 85.5 percent of patients reported conditions that passed muster, with “substantial or conclusive evidence” of a therapeutic effect from medical cannabis. The most common condition, by far, was chronic pain, with nearly 65 percent of patients reporting it as a qualifying condition in 2016. The other two well-supported conditions were chemotherapy-induced nausea and vomiting, along with spasms caused by multiple sclerosis.
Other qualifying conditions reported in 2016 included cancer, epilepsy, arthritis, Parkinson’s disease, post-traumatic stress disorder, and irritable bowel syndrome.
Despite the overall positive findings, the authors said, there are less rosy implications from the study.
For one, there was no available data from many states, including California, the state where medical pot has been legal the longest (since 1996). Some states, even if they had patient registries, didn’t include data on qualifying conditions, while others had some years where no data was published. And of course, 15 percent of patients were able to get medical cannabis for health problems that it might not be effective for.
There’s at least limited but decent evidence showing that cannabis could work to alleviate symptoms of some of these conditions, such as anxiety or Tourette syndrome. For some conditions, like epilepsy, there was inconsistent evidence of its effectiveness (that said, a drug made from cannabis was recently approved to treat certain forms of the seizure disorder). But there were also conditions on the list, such as glaucoma and dementia, where the evidence has actually pointed to cannabis being worthless.
One major reason for these inconsistencies is the slapdash nature of weed legalization. The U.S. government has long classified cannabis a Schedule I drug, meaning it’s considered to have no relevant medicinal use on the federal level. Advocates have been able to work around this restriction by slowly convincing states to adopt individual laws, but it’s left us in a confusing system where different states have different standards for legalization and regulation (some states, for instance, require doctors to be specially trained before they can prescribe cannabis). The Schedule I classification has also slowed down efforts by researchers to better study pot’s claimed benefits.
In New York, for instance, it is now legal for cannabis to be used as a treatment for people struggling with opioid addiction or as a replacement therapy for people using opioids for their chronic pain. But while some indirect research has found that opioid overdose deaths go down in states following medical cannabis legalization, there is no concrete evidence—such as from randomized clinical trials—that cannabis should be widely recommended as an addiction treatment or as a replacement for pain patients already stable on opioid therapy. That doesn’t mean it can’t work in these situations, it just means we don’t know yet.
One fix for these problems, the authors said, is the creation of a “nationwide database of medical cannabis users to evaluate the risks and benefits of using medical cannabis for different medical conditions and symptoms.” But because more states are likely to legalize cannabis for recreational use, it’s also possible that more people will decide to self-medicate without going through the hassle of getting a permit. And that’ll throw a few more wrenches into the mix.
“If legal cannabis use is increasingly decoupled from medical need or oversight at the state level, then a larger role for federal government oversight—for instance, by the Food and Drug Administration—regarding product safety and information may be warranted,” the authors said.
All of these complications, they concluded, make the strong case that not only should cannabis lose its status as a Schedule I drug, “but also that state and federal policy makers should begin evaluating evidence-based ways for safely integrating cannabis research and products into the health care system.”