Medical MarijuanaIs the Cart Before the Horse?

Deepak Cyril D'Souza, MBBS, MD1,2,3; Mohini Ranganathan, MD1,2,3

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JAMA. 2015;313(24):2431-2432. doi:10.1001/jama.2015.6407.

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This Editorial discusses some of the medical and legal considerations surrounding use of medical marijuana and cannabinoid drugs.

There is a pressing need to develop new medications for many debilitating conditions. Novel approaches based on marijuana or its constituent cannabinoids, if proven, could be added to the armamentarium of available treatments. In this issue of JAMA, reviews by Whiting et al1 and Hill2 provide detailed assessment of the pharmacology, indications, benefits, adverse effects, and laws related to medical marijuana and the cannabinoids, and the results and conclusions are consistent. There is some evidence to support the use of marijuana for nausea and vomiting related to chemotherapy, specific pain syndromes, and spasticity from multiple sclerosis. However, for most other indications that qualify by state law for use of medical marijuana, such as hepatitis C, Crohn disease, Parkinson disease, or Tourette syndrome, the evidence supporting its use is of poor quality. State laws vary widely regarding conditions for which marijuana is approved and the dispensable legal limit. Both reviews raise important issues worthy of further discussion