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Show HN: Meadow Education: A beginner's guide to medical marijuana

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Re: Show HN: Meadow Education: A beginner's guide to medical marijuana

#21

Post by phren0logy »

mohawk wrote: post #17
phren0logy wrote: post #3

Speaking as an MD, the evidence for medical marijuana is, uh, pretty thin . In fact, most people would decry the mismatch of research to marketing if it were a traditionally prescribed drug. The barriers to meaningful research are coming down, but the research just isn't there yet. I suspect that therapeutic targets will emerge, but no amount of enthusiasm changes the fact that high-quality research hasn't happened y…

Actually a lot of the data we have seen so far is quite good, here are some examples Medical Marijuana for Treatment of Chronic Pain and Other Medical and Psychiatric Problems: A Clinical Review https://jama.jamanetwork.com/article.aspx?articleid=2338266 Cannabidiol: Pharmacology and potential therapeutic role in epilepsy and other neuropsychiatric disorders http://onlinelibrary.wiley.com/doi/10.1111/epi.12631/full

The first article stalls out when I try to load it.

The from the second:

CBD has neuroprotective and antiinflammatory effects, and it appears to be well tolerated in humans, but small and methodologically limited studies of CBD in human epilepsy have been inconclusive. More recent anecdotal reports of high-ratio CBD:Δ9-THC medical marijuana have claimed efficacy, but studies were not controlled. CBD bears investigation in epilepsy and other neuropsychiatric disorders, including anxiety, schizophrenia, addiction, and neonatal hypoxic-ischemic encephalopathy. However, we lack data from well-powered double-blind randomized, controlled studies on the efficacy of pure CBD for any disorder. Initial dose-tolerability and double-blind randomized, controlled studies focusing on target intractable epilepsy populations such as patients with Dravet and Lennox-Gastaut syndromes are being planned. Trials in other treatment-resistant epilepsies may also be warranted.

This is not good evidence.

I want to be clear: I'm hopeful about the potential, but so far the enthusiasm for marijuana is not yet supported.

Re: Show HN: Meadow Education: A beginner's guide to medical marijuana

#22

Post by [deleted] »

kw71 wrote: post #16
phren0logy wrote: post #11

Earlier quoted context omitted.

To answer your first question, Cannabis Use Disorder specifically refers to a pattern of use that leads to health problems, disability, and failure to meet important responsibilities at work/school/home. So it's not defined by use but rather by consequences of use. Second, there are a number of large cohort studies looking at this question. Here's a recent one: http://www.ncbi.nlm.nih.gov/pubmed/26006253 Psychosocial…

Is it possible that the subjects who went to cannabis already had problems, are self-medicating, and would have achieved the adverse outcomes anyway?

[deleted]

Re: Show HN: Meadow Education: A beginner's guide to medical marijuana

#23

Post by phren0logy »

kw71 wrote: post #16
phren0logy wrote: post #11

Earlier quoted context omitted.

To answer your first question, Cannabis Use Disorder specifically refers to a pattern of use that leads to health problems, disability, and failure to meet important responsibilities at work/school/home. So it's not defined by use but rather by consequences of use. Second, there are a number of large cohort studies looking at this question. Here's a recent one: http://www.ncbi.nlm.nih.gov/pubmed/26006253 Psychosocial…

Is it possible that the subjects who went to cannabis already had problems, are self-medicating, and would have achieved the adverse outcomes anyway?

This was partially controlled for in their analysis, but it's a cohort study meaning that people weren't randomized into groups. So certainly there could be some of that happening, but the analysis minimizes (but doesn't totally eliminate) how much that influences the outcome.

Behavioral science is hard, and messy.

Re: Show HN: Meadow Education: A beginner's guide to medical marijuana

#24

Post by bryans »

phren0logy wrote: post #19
bryans wrote: post #18

Earlier quoted context omitted.

I appreciate that you have clarified your reasoning, and I certainly don't intend to insult, but I really feel there is some amount of cognitive dissonance going on here. For example, from your original comment and new comment: > but no amount of enthusiasm changes the fact that high-quality research hasn't happened yet. > I didn't say that all positive evidence is low quality You are now conceding that there is high…

You are right to point this out as contradictory, and I'm happy to clarify. It's more a product of trying to reply quickly. Often in medical research, we see early high-quality studies purporting an effect. As a recent example, fish oil for hyperlipidemia. Positive studies (meaning ones that show an effect beyond placebo) are more likely to get picked up for publication, and ones that show new/interesting findings ev…

I think we are on the same page now.

Re: Show HN: Meadow Education: A beginner's guide to medical marijuana

#25

Post by delluminatus »

phren0logy wrote: post #11
delluminatus wrote: post #8

Earlier quoted context omitted.

It sounds like you are reasonably well informed in this field, whereas I can barely parse the abstract for the linked paper. I was hoping you could give me an educated opinion about negative effects of cannabis use in non-adolescents. It seems like papers are mostly finding negative effects for adolescents only. Also, the particular paper you mention seems to be studying adolescents with "Cannabis Use Disorder (CUD)"…

To answer your first question, Cannabis Use Disorder specifically refers to a pattern of use that leads to health problems, disability, and failure to meet important responsibilities at work/school/home. So it's not defined by use but rather by consequences of use. Second, there are a number of large cohort studies looking at this question. Here's a recent one: http://www.ncbi.nlm.nih.gov/pubmed/26006253 Psychosocial…

Thank you for the reply. I am beginning to understand what you mean about how there is not enough research to make general statements about side effects or medical efficacy, because there are just so many potential factors that could have an influence on how cannabis affects an individual.

I can see why one would hesitate to make recommendations, especially as a doctor, when it's simply uncertain if a user would get medical benefits, or whether they would have negative side-effects. As unlikely as side effects may be on average, for people with specific conditions a negative effect might be predictable if that condition and its interaction with cannabis was isolated in a study.

Re: Show HN: Meadow Education: A beginner's guide to medical marijuana

#26

Post by sehugg »

phren0logy wrote: post #21
mohawk wrote: post #17

Earlier quoted context omitted.

Actually a lot of the data we have seen so far is quite good, here are some examples Medical Marijuana for Treatment of Chronic Pain and Other Medical and Psychiatric Problems: A Clinical Review https://jama.jamanetwork.com/article.aspx?articleid=2338266 Cannabidiol: Pharmacology and potential therapeutic role in epilepsy and other neuropsychiatric disorders http://onlinelibrary.wiley.com/doi/10.1111/epi.12631/full

The first article stalls out when I try to load it. The from the second: CBD has neuroprotective and antiinflammatory effects, and it appears to be well tolerated in humans, but small and methodologically limited studies of CBD in human epilepsy have been inconclusive. More recent anecdotal reports of high-ratio CBD:Δ9-THC medical marijuana have claimed efficacy, but studies were not controlled. CBD bears investigati…

The first article stalls out when I try to load it.

Here you go:

Use of marijuana for chronic pain, neuropathic pain, and spasticity due to multiple sclerosis is supported by high-quality evidence. Six trials that included 325 patients examined chronic pain, 6 trials that included 396 patients investigated neuropathic pain, and 12 trials that included 1600 patients focused on multiple sclerosis. Several of these trials had positive results, suggesting that marijuana or cannabinoids may be efficacious for these indications.

Re: Show HN: Meadow Education: A beginner's guide to medical marijuana

#27

Post by simoncion »

kw71 wrote: post #14
phren0logy wrote: post #3

Speaking as an MD, the evidence for medical marijuana is, uh, pretty thin . In fact, most people would decry the mismatch of research to marketing if it were a traditionally prescribed drug. The barriers to meaningful research are coming down, but the research just isn't there yet. I suspect that therapeutic targets will emerge, but no amount of enthusiasm changes the fact that high-quality research hasn't happened y…

I think you're right that the research isn't up to par. But I also think there's a lot of empirical evidence to show that there are some use cases. I don't expect any scientist, chemist or doctor to recommend that I burn plant material and inhale the combustion products. But what about a hospice, end of life situation, to improve quality of life? You mention psychotic disorders and concentration. I have PTSD and norm…

> I know I am risking cancer and two lungs full of thick tar by smoking.

1) Why not use a vaporizer?

2) AIUI, tar isn't a byproduct of marijuana combustion. (But I may very well be misinformed about this.)

Re: Show HN: Meadow Education: A beginner's guide to medical marijuana

#28

Post by phren0logy »

sehugg wrote: post #26
phren0logy wrote: post #21

Earlier quoted context omitted.

The first article stalls out when I try to load it. The from the second: CBD has neuroprotective and antiinflammatory effects, and it appears to be well tolerated in humans, but small and methodologically limited studies of CBD in human epilepsy have been inconclusive. More recent anecdotal reports of high-ratio CBD:Δ9-THC medical marijuana have claimed efficacy, but studies were not controlled. CBD bears investigati…

The first article stalls out when I try to load it. Here you go: Use of marijuana for chronic pain, neuropathic pain, and spasticity due to multiple sclerosis is supported by high-quality evidence. Six trials that included 325 patients examined chronic pain, 6 trials that included 396 patients investigated neuropathic pain, and 12 trials that included 1600 patients focused on multiple sclerosis. Several of these tria…

That is starting to look like real evidence. Thanks.

Re: Show HN: Meadow Education: A beginner's guide to medical marijuana

#29

Post by kw71 »

simoncion wrote: post #27
kw71 wrote: post #14

Earlier quoted context omitted.

I think you're right that the research isn't up to par. But I also think there's a lot of empirical evidence to show that there are some use cases. I don't expect any scientist, chemist or doctor to recommend that I burn plant material and inhale the combustion products. But what about a hospice, end of life situation, to improve quality of life? You mention psychotic disorders and concentration. I have PTSD and norm…

> I know I am risking cancer and two lungs full of thick tar by smoking. 1) Why not use a vaporizer? 2) AIUI, tar isn't a byproduct of marijuana combustion. (But I may very well be misinformed about this.)

1. is a good idea but I don't own the equipment. I'm not "that committed" to smoking and will stop if we come across another medication that works. I would really prefer to find something else: smoking brings some restrictions such as not being able to drive for the rest of the day after I smoke (although I feel fine and in charge, safety & respect for others lives trumps all)... so I don't want to spend the money on 'durable equipment' that I hope I don't need for much longer.

2. I don't know if there's some specific definition for "smoking tar" like what's advertised for tobacco products. I consider it to be any residue, but with mj it's characteristically a gooey solid or liquid when left to accumualte on equipment. It is not water soluble but a good solvent for it is isopropanol. If you examine the ends of smoked cigarettes rolled with tobacco and mj, I think you will agree that the stains on the paper used for the mj cigarette will be heavier and may even show through the paper. Whatever this is, it goes in the user's lungs and is likely not easily removed.

Re: Show HN: Meadow Education: A beginner's guide to medical marijuana

#30

Post by simoncion »

kw71 wrote: post #29
simoncion wrote: post #27

Earlier quoted context omitted.

> I know I am risking cancer and two lungs full of thick tar by smoking. 1) Why not use a vaporizer? 2) AIUI, tar isn't a byproduct of marijuana combustion. (But I may very well be misinformed about this.)

1. is a good idea but I don't own the equipment. I'm not "that committed" to smoking and will stop if we come across another medication that works. I would really prefer to find something else: smoking brings some restrictions such as not being able to drive for the rest of the day after I smoke (although I feel fine and in charge, safety & respect for others lives trumps all)... so I don't want to spend the money on…

> (although I feel fine and in charge, safety & respect for others lives trumps all)

+1 and props for that.

> ...with mj it's characteristically a gooey solid or liquid...

Fuck me, I had forgotten about resin. Yeah, you're totally right.

Well, if -after a while- you don't find anything that works, you might consider purchasing (or causing to be purchased) a vaporiser. Hope you find something that works with fewer side effects, though! :D

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