Is Cannabis Any Good Medically?

047081331-cannabis-leafAnecdotal reports abound about the ability of cannabis or marijuana to relieve chronic pain and the anxiety associated with post traumatic stress disorder, or PTSD, but do these claims have any basis in fact? On PodMed this week, Rick and I examine two studies in Annals of Internal Medicine, and agree with the authors that the evidence is lackluster at best. What did they do?

Both studies are meta-analyses, so admittedly hypothesis generating rather than conclusive.  With regard to chronic pain, the study notes the fact that 28 states and DC have legalized marijuana for medical purposes. Some of those same places have also done so for recreational purposes as well, yet the strength of the evidence that cannabis provides effective pain relief from 27 pain trials cited is of low quality. The harm side of cannabis use appears to be robust: 11 reviews and 32 primary studies indicate increased motor vehicle accidents, cognitive impairment and psychotic symptoms.

What of PTSD? This review states that more than one-third of those seeking cannabis in states where it is legal list this condition as their reason for doing so. With regard to evidence for its use, only two reviews and three observational studies were found, with no randomized trials. The authors conclude that our best hope is ongoing trials currently underway that are examining cannabis use in a more rigorous fashion.

Other topics this week include ABIM Maintenance of Certification: Randomized Trial of Open-Book Versus Closed-Book Examination, also from Annals, and two from NEJM:Five-Year Outcomes for
On-Pump vs. Off-Pump CABG
 and Cognitive Function in a Trial of Evolocumab. Until next week, y'all live well.

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