Minimal evidence, ‘distortion of the facts’ complicate cannabis use in medicine
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DESTIN, Fla. — Significantly more research into the risks and benefits of cannabinoids is necessary to keep pace with both medicinal and recreational use in the U.S., noted a presenter at the 2023 Congress of Clinical Rheumatology-East.
“Your patients are already using these compounds,” Kevin P. Hill, MD, MHS, director in the division of addiction psychiatry at Beth Israel Deaconess Medical Center, told attendees. “Hopefully, they are talking to you about it, but maybe not. If you talk about it, only good things can happen.”
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Hill stressed that regardless of any given clinician’s personal opinions about cannabinoids, engaging with patients about their use will reduce the likelihood that the patient will make a poor decision on their own. “If you do engage with them, that is going to increase the likelihood that you will get them on a regimen that is going to help their condition,” he said.
But helping a patient find the right cannabinoid regimen is rife with obstacles, according to Hill. He noted that some 22 million Americans used cannabis last year, but only 10% used it medicinally. Moreover, policy on both medicinal and recreational use is changing daily and varies dramatically from state to state.
A further confounding factor is that patients may not be receiving messages from their health care provider about cannabinoid use. Rather, they are learning from the internet, celebrities or other unverified sources. “There is a ton of distortion of the facts,” he said.
The medical and research communities are at least partially to blame, according to Hill. “We are electing not to do the research that we could be doing,” he said.
That said, Hill noted that there is some high-quality evidence supporting the use of various CBD products for chronic and neuropathic pain. But more evidence is needed to inform both clinical and regulatory decision-making, as current data has not been sufficient to expand the rate and nature of FDA approvals.
Hill noted that while 37 states and three territories have medical cannabis laws, the indications for those laws are generally the same.
“The rate and scale of the science has not kept pace with interest,” Hill said. “It is easier for states just to copy what other states have done. Most states are just checking a box to say, ‘We are doing some research’.”
States should be trying to “maximize” research and conduct “meaningful” studies to inform the next wave of cannabis laws, but that is not happening, according to Hill.
“We need research on medical cannabis efficacy so that physicians and patients can make informed choices about whether medical cannabis should be a part of their treatment plans,” he said. “There is some evidence, but it is dwarfed by the amount of interest.”
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Hill K. Therapeutic use of cannabinoids in 2023. Presented at: Congress of Clinical Rheumatology-East annual symposium; May 4-7, 2023.
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