LYPHE on medical cannabis: the hype is strong but what does the evidence say?
As cannabis medicalisation rolls out across the globe, there’s an active debate over standards of evidence and how these standards are interpreted to allow for regulated guidance on medical cannabis therapies.
Different national regulators have actually broadly arrived at a similar set of conclusions, enabling medical cannabis prescribing for at least some conditions and symptoms. While some regulators are notably more conservative than others, it’s clear the needle is moving towards increased access to medical cannabis.
So let’s make a quick assessment of the evidence. Contrary to some outlying views, cannabis is not and will likely not be a panacea. Through research, we have only established so many clear areas in which medical cannabis can help. The Medical Cannabis Clinics are already consulting and prescribing in these areas (neurological, psychiatric and pain-related areas) with success.
Across different national regulators, the most common set of conditions and symptoms approved for the use of medical cannabis include:
Many regulators have found sufficient evidence to allow for the treatment of chronic pain conditions. While there are probably sufficient emerging findings to support medical use for a range of mental health disorders such as PTSD, there are no current clear recommendations for the use of medical cannabis in this case.
Understanding the issue of evidence-based medicine is critical in understanding why current clinical activity is more limited than the overall body of research may imply. While a regulator like NICE can start with a study set of over 20,000 cannabinoid studies, inclusion criteria that demands the highest standards of study quality reduces this study set to, on average, fewer than 20 studies per condition under investigation. This is a striking degree of exclusion, with evidence-based resources like The Academy of Medical Cannabis identifying several hundred studies that meet a reasonable evidentiary standard.
Randomised control trials are the gold standard in clinical decision making. While large volumes of non-human clinical trials, and to a lesser degree some volume of Phase I and II human trials, have illustrated pathways for further research, this research is still yet to be undertaken.
While there is a field of academic debate that discusses challenges within EBM practices, the simple fact is that governing bodies for healthcare matters generally cleave towards more conservative findings. Although this can be frustrating for patients that see value in medicines they struggle to access, the EBM system is a vital standard for removing unintended harms in medical practice.
There is also a separate concern with EBM that applies particularly to cannabis, focussing on some important differences between isolated molecular pharmaceuticals versus this complex organic substance, but again this remains an academic debate.
The clearest way to establish the evidentiary standards that will sustainably support the prescribing of medical cannabis for a range of conditions is to drive hard at the necessary standards of research. While this is no easy feat, with fully fledged human RCTs requiring substantial funding, organisation and time, there is clearly the impetus to do so.
Medical cannabis already represents a potentially life-changing treatment for some patients, and by developing our understanding it’s likely we can uncover and actualise even more of its potential. At LYPHE GROUP, we are committed to developing understanding around cannabis and cannabis-based medicinal products so that doctors can eventually prescribe and improve the lives of patients. Stay up to date with how we’re changing the medical cannabis landscape by following us on twitter: @lyphegroup