Much of the other data published this year regarding marijuana use has surrounded lack of safety, Dr. Schatman explained, but research into cannabidiol is showing some early positive therapeutic effects as well as carrying a strong evidence basis for safety.

Discussing safety of medicinal marijuana use, Dr. Schatman cited data demonstrating that smoking remains the most common route of administration,5 and a recent review showed that pulmonary effects may be worse than previously thought.6 These data are sometimes difficult to interpret, however, Dr. Schatman said, because many people who smoke marijuana also smoke tobacco.

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Although research into cannabidiol is “just starting,” Dr. Schatman cited several studies that show its safety has been established when coadministered with fentanyl,7 that it enhances fracture healing,8 and has been associated in animal models with protective effects on lesion-induced intervertebral disc degeneration.9 

Discussing research abroad, Dr. Schatman noted that nabiximols is now approved in 27 countries  but not in the United States. He said clinical efficacy has been established for spasticity associated with multiple sclerosis10 and neuropathic pain.11

“We need to look at isolated constituents–primarily cannabidiol–in order to maximize analgesia and functionality,” Dr. Schatman explained.  He added that based on the currently available data, there is no good way of predicting the impact of medical marijuana on specific patients, explaining that “any pill can do anything to any person at any time.”

Dr. Schatman expressed frustration with what he referred to as “medical marijuana neuromysticism,” whereby zealous proponents of the drug tend to ignore the existing empirical data, seeking to guide practice based upon what they simply want to believe.

Dr. Schatman concluded his presentation by directing clinicians to an article published ahead of print in the Clinical Journal of Pain that outlined a “medicinal cannabis treatment agreement,” calling it “absolutely brilliant.”

Highlights of these agreements are that they can help physicians address inappropriate utilization by the authorized patient and prompt discussion of the risk of marijuana generally and to specific populations.

This article originally appeared on MPR