To Your Health: NLM update Transcript

Medical marijuana's legalization:

Is the cart before the horse?: 08/03/2015

Greetings from the National Library of Medicine and MedlinePlus.gov

Regards to all our listeners!

I'm Rob Logan, Ph.D., senior staff, U.S. National Library of Medicine (NLM).

Here is what's new this week in To Your Health, a consumer health oriented podcast from NLM, that helps you use MedlinePlus to follow up on weekly topics.

The dearth of evidence about marijuana's therapeutic value raises concerns about its legalization for medical use, suggests a comprehensive assessment and an accompanying editorial recently published in the Journal of the American Medical Association.

Currently, marijuana for medical use is legalized in 21 U.S. states and the District of Columbia. Nineteen U.S. states recently decriminalized or eliminated jail time for possession of small amounts of marijuana. Colorado and Washington also have approved the retail sale of marijuana.

In a pioneering meta-analysis of 79 clinical trials, the study's 13 authors found there is some evidence to support the use of medical marijuana for nausea and vomiting during chemotherapy, pain reduction, and spasticity from multiple sclerosis.

However, the comprehensive meta-analysis (encompassing more than 6,400 participants) found insufficient evidence to support the use of marijuana to treat: hepatitis C, Crohn disease, Parkinson's disease, and Tourette syndrome. An editorial accompanying the study notes the treatment of these specific diseases were seen as rationales to legalize medical marijuana in several states.

Moreover, the editorial notes the study found the clinical trials to determine marijuana's clinical efficacy and safety reported an array of serious side effects (called adverse events).

Some of these adverse events included: anxiety, drowsiness, diarrhea, dry mouth, dizziness, nervous system disorders, psychosis, musculoskeletal and connective tissue disorders, as well as blood disorders.

The editorial explains (and we quote): 'approval (of medical marijuana) has relied on low-quality scientific evidence, anecdotal reports, individual testimonies, legislative initiatives, and public opinion. Imagine if other drugs were approved through a similar approach' (end of quote).

The editorial's authors urge federal and state governments to support marijuana therapy research so (and we quote) 'high-quality evidence can be generated to guide decisions' (end of quote) especially for use in medical conditions where current evidence is insufficient or flimsy.

The editorial's authors continue that new research is especially needed to assess the inconsistent medical conditions specified among states to justify the availability of medical marijuana. For example, the editorial's authors note in Connecticut medical marijuana is available to treat psoriasis and sickle cell disease. Unlike some states, medical marijuana is not available in Connecticut to treat Tourette syndrome. Yet, the editorial's authors explain the supporting evidence for all three conditions (and we quote) 'is uniformly of very low quality' (end of quote).

Finally, the editorial's authors note states that legalize medical marijuana should establish follow-up programs to assess long-term outcomes.

The editorial's authors note these programs might assess the impact of repeated marijuana use over time, such as whether doses need to be increased to achieve the same clinical effect. In addition, the authors note long-term outcome research should monitor the side effects associated with repeated marijuana use, such as an increase in psychosis cases.

Overall, the editorial's title summarizes the challenge of marijuana's legalization in advance of clinical evidence about its therapeutic value. The editorial's writers ask regarding medical marijuana, is the cart before the horse?

Meanwhile, an easy-to-read guide to understand the risks of marijuana use (from the National Institute on Drug Abuse) is available in the 'start here' section of MedlinePlus.gov's marijuana health topic page. The National Institute on Drug Abuse also provides information whether marijuana is medicine within the 'related issues' section of MedlinePlus.gov's marijuana health topic page.

MedlinePlus.gov's marijuana health topic page additionally provides links to the latest pertinent journal research articles, which are available in the 'journal articles' section. Links to relevant clinical trials that may be occurring in your area are available in the 'clinical trials' section. You can sign up to receive updates about marijuana as they become available on MedlinePlus.gov.

To find MedlinePlus.gov's marijuana health topic page type 'marijuana' in the search box on MedlinePlus.gov's home page, then, click on 'marijuana (National Library of Medicine).'

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