Look­ing af­ter we leap

Cosmos - - Editor's Note - EL­IZ­A­BETH FINKEL Editor-in- chief

IT MAY BE one of the world’s old­est drugs, but cannabis has caught the world un­pre­pared.

Af­ter 80 years of dra­co­nian pro­hi­bi­tion, the tide has sud­denly turned. Medic­i­nal cannabis is flood­ing in and over­whelm­ing the med­i­cal es­tab­lish­ment, as pa­tients clam­our for it, many con­vinced it is a harm­less cure-all to their ills. Some 2.3 mil­lion Amer­i­cans are al­ready us­ing it.

But its ef­fi­cacy is not based on data. There are barely any clin­i­cal tri­als to go with the long-asa-piece-of-rope claims for its med­i­cal ben­e­fits.

As with any drug, there are ben­e­fits and risks. You would think we know them all by now. Most of us have smoked a joint or two at some stage. The harms are cer­tainly lower than what we ac­cept from recre­ational drugs such as al­co­hol and to­bacco.

But we’re not talk­ing about oc­ca­sional recre­ational use by ro­bust peo­ple. We are talk­ing about some very sick mem­bers of the com­mu­nity: chil­dren with epilepsy, peo­ple in chronic pain, with cancer and con­di­tions like Crohn’s Dis­ease.

Is a doc­tor’s ad­vice go­ing to be: take a few tokes and call me in the morn­ing? Hardly.

So where is the clin­i­cal ev­i­dence for the ben­e­fits of cannabis treat­ments? As­ton­ish­ingly it doesn’t ex­ist. Cannabis has been so de­monised that it has been im­pos­si­ble in many places for re­searchers to study it. As a US Sched­ule 1 drug, it is held to be as dan­ger­ous as heroin and with no med­i­cal ben­e­fits.

So we find our­selves fac­ing this ab­surd state of af­fairs. Twenty-nine states have le­galised med­i­cal cannabis to be sold in dis­pen­saries, but a fed­er­ally funded re­searcher in Cal­i­for­nia who wishes to study its ef­fects risks be­ing raided by the author­i­ties.

Sort­ing out this mess is go­ing to be dif­fi­cult. It’s not just that we don’t have the clin­i­cal stud­ies; we don’t even re­ally know the ther­a­peu­tic in­gre­di­ent/s. Cannabis con­tains more than 100 unique cannabi­noids – each with medic­i­nal ef­fects. Com­pelling anecdotes sug­gest some­thing in cannabis helps chil­dren with autism. But is it the cannabid­iol, the THC, some­thing else, or a com­bi­na­tion?

Cannabis medicine needs a hefty in­jec­tion of good sci­ence.

Is­rael, with 30,000 med­i­cal cannabis users, has been forced to act. Re­searchers at the Tech­nion are car­ry­ing out a re­verse clin­i­cal trial, try­ing to match the pa­tients’ re­sponses, cap­tured via ques­tion­naires, to chem­i­cal fin­ger­prints of the cannabis ex­tract they re­ceived. Sci­en­tists are also push­ing ahead with small clin­i­cal tri­als for Crohn’s Dis­ease and autism.

Mean­while, Australia is en­ter­ing this brave new world with trep­i­da­tion. Pro­vid­ing phar­ma­ceu­ti­cally cer­ti­fied cannabis ex­tracts to pa­tients, as Australia plans to do, is ex­pen­sive – about $30,000 a year per pa­tient.

The fact is this dive into med­i­cal cannabis is driven more by hype and hope than sci­ence. Let’s hope it’s worth it.

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