Research Arguably the most comprehensive scientific review of medical cannabis research - free PDF!

[herbivore21]

Many of you may have noticed my relatively lower number of posts lately. I have been very busy with my scientific work at present and have not had a lot of time to post and respond to all of the correspondence that I receive from our community. I greatly appreciate the understanding that I've had from folks here while I've been busy and wanted to share a great big scholarly study that looks at the current state of cannabis research to keep you all busy!

The following is a book published by the National Academies of Science, Engineering and Medicine. These are large scale, peer-review meta-analyses of the bulk of the scholarly cannabis research out there on a variety of topics.

This is a fucking gargantuan book, but wonderfully, it is available in its entirety for free! Please use the following link, click the blue 'download free PDF' button and download this as a 'guest':

https://www.nap.edu/catalog/24625/the-health-effects-of-cannabis-and-cannabinoids-the-current-state

Please understand that the overall crux of many of the findings in these studies is that cannabis research is far too scant, and at present, there is not a large enough body of literature to do more than gauge the strength of statistical correlations between cannabis use and health effects. However, this publication also debunks a variety of myths about cannabis dangers.

Please understand that the absence of clinical research in a great many of these areas owes to research regulations, and that these are actually cited as a major barrier to better research in this book. This book is not saying that Cannabis does not provide any benefits for the conditions it considers, but in many cases, it will say that we do not have enough scientifically collected information of a large enough scale to make broad judgements about efficacy that we can be sure will extrapolate beyond individual cases. This data could still come of course!

Remember that broad scale population based medical science requires better controlled, systematically gather and altogether much larger scale information than many of us would personally seek to make a personal medical decision. Medical cannabis research in much of the West is still in its infancy.

This is all said to highlight that while we don't have enough information yet by scientific standards, this does not preclude the possibility of that information eventually coming. At the moment, the early state of much cannabis research means that most of what we have are correlations and pre-clinical findings: the broad data that will allow us to more accurately predict and manipulate clinical outcomes is still to come.

I'll start to unpack some of the findings of this study in this thread as I get the opportunity, but if any of you guys are interested in discussing or clarifying anything in these studies, please put all such comments here! This review of the scholarly literature breaks down the findings by different kinds of health conditions, so many of you may like to review the findings relating to your own medical situation.

 

[ddave]

a fucking gargantuan book

At first, after reading this, I thought I would find these guys listed within the pages.... Didn't godzilla fight them a few times?

Maybe I'm just thinking of Gorosaurus or Ghidorah?

Many of you may have noticed my relatively lower number of posts lately. I have been very busy with my scientific work at present and have not had a lot of time to post and respond to all of the correspondence that I receive from our community. I greatly appreciate the understanding that I've had from folks here while I've been busy and wanted to share a great big scholarly study that looks at the current state of cannabis research to keep you all busy!

The following is a book published by the National Academies of Science, Engineering and Medicine. These are large scale, peer-review meta-analyses of the bulk of the scholarly cannabis research out there on a variety of topics.

This is a fucking gargantuan book, but wonderfully, it is available in its entirety for free! Please use the following link, click the blue 'download free PDF' button and download this as a 'guest':

https://www.nap.edu/catalog/24625/the-health-effects-of-cannabis-and-cannabinoids-the-current-state

Please understand that the overall crux of many of the findings in these studies is that cannabis research is far too scant, and at present, there is not a large enough body of literature to do more than gauge the strength of statistical correlations between cannabis use and health effects. However, this publication also debunks a variety of myths about cannabis dangers.

Please understand that the absence of clinical research in a great many of these areas owes to research regulations, and that these are actually cited as a major barrier to better research in this book. This book is not saying that Cannabis does not provide any benefits for the conditions it considers, but in many cases, it will say that we do not have enough scientifically collected information of a large enough scale to make broad judgements about efficacy that we can be sure will extrapolate beyond individual cases. This data could still come of course!

Remember that broad scale population based medical science requires better controlled, systematically gather and altogether much larger scale information than many of us would personally seek to make a personal medical decision. Medical cannabis research in much of the West is still in its infancy.

This is all said to highlight that while we don't have enough information yet by scientific standards, this does not preclude the possibility of that information eventually coming. At the moment, the early state of much cannabis research means that most of what we have are correlations and pre-clinical findings: the broad data that will allow us to more accurately predict and manipulate clinical outcomes is still to come.

I'll start to unpack some of the findings of this study in this thread as I get the opportunity, but if any of you guys are interested in discussing or clarifying anything in these studies, please put all such comments here! This review of the scholarly literature breaks down the findings by different kinds of health conditions, so many of you may like to review the findings relating to your own medical situation.

On a more serious note, THANKS for sharing this and for your contributions to the community! Very awesome!

 

[herbivore21]

At first, after reading this, I thought I would find these guys listed within the pages.... Didn't godzilla fight them a few times?

Maybe I'm just thinking of Gorosaurus or Ghidorah?



On a more serious note, THANKS for sharing this and for your contributions to the community! Very awesome!

Happy to contribute in any way that I can brother! I look forward to sharing studies that dwarf the research linked above, in what I'm sure will not be too distant of a future

 

[Killick]

This is freaking brilliant info! While it's kinda wishy-washy due to regulations, it's opening peoples minds to more and better research.

Apparently there is a new Red Dwarf coming out... Please let The Cat stay pretty, and put wronkles on Rimmers Heytch.

 

[herbivore21]

This is freaking brilliant info! While it's kinda wishy-washy due to regulations, it's opening peoples minds to more and better research.

That's real science bro. Complicated, contingent and long answers to life's questions are what science usually gives us. Given that there is very little clinical, representative and therefore extrapolatable (that is definitely not a word) research available, this report is exactly as it should be.

Nonetheless, this paper is clear that a number of the negative associations with cannabis have no evidence to support them, but also that a lot of positive claims about cannabis don't have enough evidence or the amount of scientific research that exists is not yet large enough to allow for certainty when extrapolating to different cases. It is a also a very loud and timely message to scientists that cannabis is most assuredly a medicine, and that researchers and those institutions that fund them need to get off their asses and carry out more research. It clearly identifies exactly which aspects of cannabis are not sufficiently understood too, which is invaluable to a scientist looking to get a research project approved.

This study also does researchers the favor of having a scientific source that can be cited which points out that they need to do more of these specific kinds of research. You would be surprised how effective that kind of message from an academic source can be in persuading those who fund researchers to let them do this sort of research!

 

[herbivore21]

I wanted to take a moment to give a little run-down of one incredibly frequent criticism of cannabis in mental healthcare:

That Cannabis use can cause the development of schizophrenia and other psychotic illness.

Now the article that I linked above deals with this topic, but if you were to read this following claim from the National Institute's findings:

CONCLUSION 12-1 There is substantial evidence of a statistical association between cannabis use and the development of schizophrenia or other psychoses, with the highest risk among the most frequent users.

You'd be forgiven for thinking that this is suggestive of that nasty old anti-cannabis trope that I mention above at #1.

However, this is why you should not just read the summaries of each section when reading a large publication like this. I am hopeful that this post will assist people in understanding and engaging with research literature like this:

First of all, the above claim is talking about a statistical association. What that means is simply co-occurence. The two things are observed together at the same time, but we cannot yet say why that is (if we knew this information; that very knowledge would constitute a causal explanation, which is much more highly regarded in science than a correlation/statistical association).

Moreover, the qualifier of 'substantial evidence' is defined within the study (page 7) as follows:

"For this level of evidence, there are several supportive findings from good quality studies with very few or no credible opposing findings. A firm conclusion can be made, but minor limitations, including chance, bias, and confounding factors,
cannot be ruled out with reasonable confidence." (page 7 of study linked in OP)

What we can see is that the reviewers of all of this research have found that there is enough high quality evidence to firmly state that the development of schizophrenia and cannabis use frequently co-occur together (and are more commonly observed in cases of heavier cannabis use than more moderate amounts). But (this is a big but that cannot lie!) precisely why this happens or whether there is any causal relationship is unknown.

The reviewers discuss why the causal relationship is not yet understood in the following excerpt:

"The association between cannabis use and the development of a psychotic disorder is supported by data synthesized in several good-quality systematic reviews. The magnitude of this association is moderate to large and appears to be dose-dependent, and it may be moderated by genetic factors. Factors contributing to the strength of the evidence derived from the cited systematic reviews include large sample sizes, the relative homogeneity of the findings, the presence of relationships between the dose/exposure and the risk, the studies having been controlled for confounders, and the systematic reviews having assessed for publication bias. The primary literature reviewed by the committee confirms the conclusions of the systematic reviews, including the association between cannabis use and psychotic outcome and the dose-dependency of the effects, further bolstering the overall strength of evidence for our conclusions.

The limitations of the summarized studies include their reliance of self-report for cannabis use, issues with study designs (e.g., a lack of randomization), a lack of information on the frequency of use, patterns of long-term use, and possible confounding polysubstance effects. In addition, for the primary studies cited, some are also limited in terms of their sample sizes and controlling for confounders. Overall, the accumulated evidence is suggestive that cannabis use is associated with an increase in psychosis-related outcomes, as made evident in the discussion of Auther et al. (2015) and Valmaggia et al. (2014) above.

[T]he relationship between cannabis use and cannabis use disorder, and psychoses may be multidirectional and complex. The committee found this to be consistent with their review of the summarized data demonstrating a strong and consistent association between cannabis use and the subsequent development of psychosis and psychotic disorders. In addition, it is noteworthy to state that in certain societies, the incidence of schizophrenia has remained stable over the past 50 years despite the introduction of cannabis into those settings (Kirkbride et al., 2012); however, the committee did not examine ecologic data (studies of concomitant time trends) to evaluate trends in cannabis consumption and diagnosis of psychosis over time. Multiple factors (including measurement of dose and frequency of cannabis consumption over decades, and patterns of diagnosis of psychosis) limit our ability to draw conclusions from such findings. Of note, future analysis of rates of psychosis in states with increased access to cannabis could be tracked to provide valuable information regarding potential causal relationships between cannabis use and psychosis."

So we can see that actually, there has never been a scientifically rigorous body of evidence to support the claim that Cannabis has a causal influence on the development of psychotic illnesses, including schizophrenia.

On the contrary, the data actually reports statistical relationships between cannabis use and more positive outcomes for people with psychotic illness in cognitive testing:

"There is moderate evidence that, among individuals with psychotic disorders, there is a statistical association between a history of cannabis use and better cognitive performance."

Again, this is talking about a statistical relationship, so the same caution as we take with the first statistical relationship discussed above should also be taken. Still, this research publication certainly could provide some peace of mind to many with psychotic conditions. I have known many who have had a lot of stress and anguish considering whether their cannabis use is positive or negative for their schizophrenia /other psychotic illness.

If you yourself are affected by such conditions and want to know more about cannabis and psychosis:
Please consider all of chapter 12 in the research above (feel free to text search the pdf for references to your condition too, some psychotic illnesses are referred to in other chapters throughout the book). Take care to read and understand all of the findings that are presented regarding your condition. Take note of whether there is a statistical, or causal relationship and the strength of that relationship. This will help you determine if cannabis use is a good idea or not in your case.

Most importantly: Please consult with your doctor/psychiatrist/psychologist and share this information with them if this is in any way possible in your locale (given local laws, cultural issues etc), when making decisions about cannabis use and your mental health.

Your healthcare providers will usually be happy to help you understand medical science as it applies to your health - as this is an important part of medical practice - if you can safely discuss this with a cannabis-friendly doctor or psych, don't be afraid to ask for assistance in explaining what something technical in the research means.

Asking your healthcare providers as many questions as you might have is the best way to understand how this research can relate to your health.

I hope that this has been helpful for some in understanding some of the very complicated ways that these articles can be written!

 

[Disrupt]

I signed up for this forum just to thank you for pointing me to this authoritative and scholarly report that so admirably strives for objectivity. I simply can't put it down!

The slow action of orally ingested cannabis is due to D9-THC being absorbed by the intestine and transported to the liver (hepatic first pass) where it is converted into 11-OH-THC, an equipotent and longer-lasting metabolite (Huestis et al., 1992).

Twenty-five years, and I never heard of 11-OH-THC.

This report is destined to become a textbook, if it hasn't already. Required reading!

 

[herbivore21]

I signed up for this forum just to thank you for pointing me to this authoritative and scholarly report that so admirably strives for objectivity. I simply can't put it down!



Twenty-five years, and I never heard of 11-OH-THC.

This report is destined to become a textbook, if it hasn't already. Required reading!

You are very, very welcome! I hope you'll stay with us! Check out the Research Labs (in my sig) for more threads like this