Photo by Ted Kinsman via STEM cannabisevidence.org
Scanning electron microscope image of female cannabis flower
Scanning electron micrograph (SEM) of mature female Cannabis bud showing globular trichomes.
Teaming up with Oregon Health and Science University (OHSU), the Veterans Health Administration launched a new website dedicated to science-based communication and information regarding marijuana. It is intended as a continuously updating synthesis of scientific consensus on marijuana research, easily searchable by the public although intended as a professional resource for healthcare workers.
Even in states where marijuana is fully legal, physicians providing services for the U.S. Department of Veterans Affairs (VA) cannot legally prescribe medical marijuana or assist a patient in obtaining legal marijuana products. That is because marijuana is still a Schedule I drug, which is federally illegal. VA doctors are legally allowed to discuss marijuana with patients, and veterans cannot be denied benefits for participating in state-legal marijuana programs, but many doctors and patients still fear consequences for bringing up the subject of cannabis regardless. VA workers can be fired for legal marijuana use in their own time, and possession of cannabis at any VA medical center is still strictly prohibited even if adult-use marijuana is legal in that state.
To promote a healthier approach to marijuana discussion for veterans, the website called Systematically Testing the Evidence on Marijuana, or STEM, was launched to share non-judgmental, evidence-based information about cannabis. The site systematically gathers studies and presents a compilation of their findings, their methodologies and gaps in evidence.
The site does not seem to take a stand on whether cannabis should be legal or banned. It reliably relayed information when two studies concluded that cannabis compound cannabidiol (CBD) was found to prevent COVID-19 infections, for instance, or when reporting that 68% of Americans believe pot should be legal. It also recognizes that the criminalization of cannabis has been thoroughly proven to drive up racial inequalities.
The website hosts a state-by-state breakdown of marijuana’s status, legally and practically. It lists rates of cannabis use and dependence, as well as each state’s MCLaSS score (medicalization of cannabis laws standardized scale), which determines to which extent medical marijuana is treated similarly to traditional pharmaceutical medications. Ohio has the highest MCLaSS score, followed by New York. Vermont and Oregon have the most cannabis use, with nearly 19% of the population having consumed weed in the last month according to STEM’s information.
What Evidence Is Published
Several “evidence syntheses” are available on topics such as cannabis use during pregnancy and its efficiency for post-traumatic stress disorder (PTSD).
Cannabis use in pregnancy, according to 48 studies, seems to increase odds of preterm births, and there seems to be a tenuous link between a marijuana-smoking pregnant mother and underweight newborns, although certainty of evidence is low. There does not seem to be studies linking cannabis edible or tincture consumption and pregnancy issues. STEM concludes, “High quality studies that consider formulation and dosing of cannabis, as well as the timing and duration of use, are needed to help elucidate the associations between prenatal cannabis exposure and perinatal outcomes.”
Regarding chronic pain, the compilation of findings highlights the chemical composition of different cannabis products to show the correlation between THC (tetrahydrocannabinol, the psychoactive component of cannabis), CBD (cannabinol, a non-psychoactive but major component of the plant) and pain. High-THC formulas led to the highest painkilling effects (as well as the highest rate of dizziness, which can be expected of a psychoactive drug), while a comparable quantity of THC and CBD offered the second-best results.
STEM points out that “whole plant formulations and CBD-predominant formulations remain unstudied,” which severely limits how much we can know about the real consequences of patients self-medicating with homemade remedies based on actual cannabis plants. “Most studies included patients with neuropathic pain. The effects of cannabis for people with other forms of chronic pain (such as low back pain or arthritis) have not been well studied,” the site warns.
STEM’s understanding of the effect of cannabis on PTSD relies on only seven studies, which show little to no effects either way. The lack of direct research is a huge hindrance, given that PTSD is one of the main conditions leading to the prescription of medical marijuana. “There is no evidence on cannabis’ effects on quality of life,” STEM reports. “There is a need for high quality, randomized studies of cannabinoids to determine whether cannabis has any effects on PTSD symptoms.”
Population studies show that states with legal medical cannabis “have lower mean annual opioid overdose mortality compared with states without medical cannabis laws; a reduction in opioid-related deaths; a reduction in opioid prescriptions funded by Medicare,” writes Benjamin J. Morasco, PhD.
The one consistent find of researchers from Oregon Health and Science University is the damning lack of diversity and completeness in cannabis research, which is riddled with gaps hiding vital bits of knowledge. Medical marijuana might be already prescribed on a large scale by physicians and used for self-medicating by large swathes of the U.S. population, but formal scientific research in cannabis’ effectiveness for most issues it is associated with is profoundly lacking. Even when a topic was studied, such as chronic pain, it lacks research focusing on different chronic conditions or using different methods of cannabis ingestion, or different dosages, or CBD-dominant formulations, or whole plant medications.
Research into cannabis has been practically banned in the U.S. for the past 50 years. While it was technically legal to study the cannabis plant for most of America’s recent history, researchers were forced to go through countless legal hoops, sometimes requiring years to obtain the authorization to study anything. Only cannabis grown by the University of Mississippi, the only federally approved research-grade producer of marijuana, could be legally studied due to roadblocks installed by the Drug Enforcement Administration (DEA). The University of Mississippi’s cannabis has repeatedly been found to be subpar, barely psychoactive, closer to industrial hemp than commercial marijuana.
Whether cannabis is truly harmful or medically useful is an important bit of knowledge that humanity needs to obtain. Allowing scientific research is harmless and would give compelling arguments to anti-cannabis individuals and factions, if science could actually find evidence of harm. Regardless of reality, more scientific data being gathered on marijuana is a net positive for all.
