Reformers To JAMA: Don’t Generalize All Cannabinoid Data to Medical Cannabis

We read with interest the recent review of medical use of cannabinoids (1). As the authors attempt to emphasize, they focus on a heterogeneous collection of experiments that employed a range of treatments, including synthetic THC, CBD, and THC-mimicking drugs.


Lay readers might inappropriately generalize these results specifically to whole plant medical cannabis  But few (only two) of these experiments were conducted using medical cannabis; most of the studies reviewed focused on outcome measures that do not address the plant’s potential advantages over a single, compound agent in pill form.

For example, the authors conclude that evidence of individual, synthetic cannabinoids to help nausea and vomiting due to chemotherapy was low in quality. Within hours of the publication of the paper, mainstream media coverage applied these conclusions to medical cannabis per se, not just medical cannabinoids (2). In fact, as the authors emphasize, only 6 of the 28 studies assessing nausea and vomiting used THC, and none of these actually employed vaporized or inhaled botanical cannabis. The dependent measures were also not sensitive to the key advantage of medical cannabis for nausea: speed of onset. (Inhaled medicines can work within seconds. Sprayed extracts require at least a half hour while cannabinoids in pill form can take multiple hours.)  The authors were generally careful about these caveats, but the disparate and inaccurate media coverage suggests that flagship journals in all fields now have to be even more diligent when cautioning readers about the inappropriate generalization of results. Despite increasing popularity, medical cannabis remains controversial and, apparently, newsworthy. As reviews of the effects of cannabinoids proliferate, authors, editors, journal staff, and journalists might welcome a reminder that cautions about interpretation need to be spelled out in more effusive, detailed, and thorough ways.

Mitch Earleywine, Ph.D.
University at Albany
Department of Psychology
Chair, NORML Board of Directors

Paul Armentano
National Organization for the Reform of Marijuana Laws (NORML)

Amanda Reiman, Ph.D.
Drug Policy Alliance

1) Whiting PF, Wolff RF, et al. Cannabinoids for Medical Use: A Systematic Review and Meta-analysis. JAMA, 2015: 313(24):2456-2473

2) Seaman, AM. Medical marijuana: good evidence for some diseases, weak for others. Reuters. June 24, 2015.


14 thoughts

  1. This reminds me of a paper I did in college years ago in the 70’s. It was about the advantages of natural vitamins and supplements opposed to synthesized I argued that although nutritional science has progressed greatly in the medical field. There are possible nutritional elements in the natural forms that not yet recognized. Therefore, the natural ones would have the elements regardless of our lack of knowledge of them. Furthermore, the synthesized supplements would lack the yet undiscovered elements. Hence I would prefer the natural supplements.

  2. Seems to me the people that write these summary word bits for the media always do this kind of stuff. It’s not their area of expertise. They want to sell papers or magazine, or whatever.

    It appears it falls to organizations like NORML to present a clearer, more realistic assessment.

  3. These medical organizations need to send the study FIRST to reform organizations like NORML, MPP, and DPA so that we can write the press releases. I realize everyone is working hard already, already overworked, but someone needs to be tasked to do that and get back to AMA, JAMA, whomever. AMA, JAMA, she’s a bad mama jama, whoever, need to have a person of contact assigned who does that, who sends it to the reform group’s person so that the cannabis community gets to frame the perspective and sort through the facts, etc.

  4. Please do not disrespect the orchestration and interaction different cannabinoids do when the whole plant is consumed. True science will someday allow the cannabis therapeutic professionals to determine customized efforts to use medication that does not kill you when mismanaged or abused.

  5. @Richard K., thanx for citing that 2011 E B Russo article, I think he was the first to mention three terpenoids, myrcene, pinene and beta-caryophyllene, which can relieve the craving for Nicotine $igarettes!

    Imagine if our experts soon breed a Cannabis strain that “entourages” these particular three especially well, and this collapses someone’s Trillion-dollar-a-year Nicotine $lave Drug industry worldwide… can we find all those experienced predators and their $-dependant employees ethically upstanding replacement jobs, say in the reforestation industry (yes, hemp plays a role in that)?

    Re “synthetic cannabinoids”– would it be advisable henceforth to signal more forcefully the fact that they are not true cannabinoids, or that true cannabinoids are not guilty of the dangers these may represent, by referring to them conventionally as “pseudo-cannabinoids”?

  6. In a JAMA article it said marijuana is a medicine for ms. Shouldn’t it at least be legalized for people with ms? How come I have to move to another state to see if it helps?
    Why can’t my wife’s doctor prescribe medical cannabis to see if it helps her stage 4 cancer? It’s the only thing she hasn’t been put on. “I mean that literally” she has been through all the standard chemo and the trials.
    It’s all or nothing isn’t working. The states that are unsure about medical cannabis need to see its medicinal purposes. The people who say “they only want to get high” let them tell that to the 3 and 4 year old kids it’s also helping.

  7. This is the reason I support NORML, and the DPA. Logical reform based in fact, free from contemptuous mentality driven by corporate gain. Cannabis law reformation is about patients, safe access, deflating crime, and making the US safer with legalization, and appropriate education. America must move past the idea that THC is bad. If you like to have a glass of wine with dinner, please understand it is safer for you to responsibly enjoy cannabis instead. And, just like wine, if you don’t want it, don’t partake.

    On another note, I would like to say that any scientific organization, or governmental entity seeking to launch a research campaign regarding medical cannabis should turn to the people with extensive experience; the patients, and caregivers. California cannabis patients have been learning how to appropriately medicate, titrate, create safe access, and heal using medical cannabis for decades. This experience is where you look for facts, not in limited studies launched at the bequest of pharmaceutical interests.

  8. Empirically, a wide study should be engaged to survey the effects of various strains of cannabis on medical patients. From an informal survey of about 100 medical users, there is clearly discernible differences in effect and relief from the available strains at their dispensary.
    This is strong empirical evidence that the greater than 70 cannabinoids and terpenes in marijuana.

    A broad study would verify my suspicion, and help validate the points being made within this comments thread.

    A good resource:

  9. @ Gary
    I recommend a vaporizer. Keep it concealed and there’s no noticeable odor like smoked cannabis to alert authorities. Get the help you and your wife need quickly and as discreetly as possible. It’s called non-violent civil disobedience. And don’t buy any hydroponics. The receipts are tagged to the DEA, who will introduce you to civil asset forfeitures.

    Thank you Allen for another on topic article. It is hard to believe that when California passed the first medicinal marijuana law back in 1996, it was also the first time that JAMA published anything about the endocannabinoid system even existing!

    Let’s pause for a moment and soak that in a little… our most educated medical trainers in the United States couldn’t even SPEAK about the endocannabinoid system until recently… or risk having what happened to Dr. Sisley before she attained FDA approval of her medical marijuan research on PTSD when the University of Arizona fired her under pressure form the DEA. I mean, Israel and Iran have made more advances in medical marijuana over the last four decades until very recently in U.S. history. Iran!! I’ve likened the suppression of publication and study of the endocannabinoid system to ripping the diagnostics pages out of the manual of an auto mechanic’s shop, and placing said mechanic under arrest if he or she dares to download or publish any information about how to diagnose the vehicle under repair. Except were talking about human lives, over a 75 year period of prohibition and medical suppression of one of our most vital, basic systems of the human body, that evolved with us since we were nothing but sea-squirts in the ocean. (That’s right, if the lack of legal study of the endocannabinoid system by modern medical science throughout the 20th century didn’t blow your mind, I just said we evolved from sea quirts).
    While NIDA is showing signs of caving on CBD and patentable synthetics, have ANY of our Congressman read one of National Geographic’s recent issues on WEED? The whole subject of the “entourage effect” was covered… there’s even a picture of Dr. Mechoulam, the Bulgarian Jew who had to research various cannabinoids and plant-based studies on humans for the last 50+ years in Israel, because NIDA (albeit for the last 45 years) has used OUR U.S. tax dollars to DENY the medical efficacy of marijuana, as ordained by the treasonous, unconstitutional Controlled Substances Act of 1970.

    We can’t emphasize this fact enough. In fact, John Oliver, if your researchers are reading this, we need an entire segment on how NIDA and the C.S.Act has supressed the research , publication and existence of the human endocannabinoid system!

    Oh well, at least I can settle for his latest segment and elementary school song on DC Statehood and Weed…

    🙂 “Give them Weed…”

  10. It is a MORAL IMPERATIVE that Medical Marijuana be immediately legalized in all 50 states.

    For Cancer patients, for kids suffering from Seizures, and for so many others, safe, legal, access to Medical Marijuana is a matter of life and death.

    Ask any American who’s gone through Chemotherapy who’s used it.
    There’s a great article in the July 22nd special issue of Newsweek on CANCER, titled
    “Marijuana is a Wonder Drug for when it comes to the horrors of Chemo”
    According to a 2014 poll, 82% of Oncologists felt that Medical Marijuana should be included as a treatment option.

    Ask the parents of any American kid with a seizure disorder who’s life its saved.

    They need a special kind of Marijuana oil that’s impossible to get in the 27 states that don’t have Medical Marijuana, and for their kids, its a matter of life and death.

    We need the President to cut through the red tape and take personal action on this issue right now. We need Congress to pass the CARERS act too. Americans are suffering and dying — needlessly!

    Please call the whitehouse comment line at (202) 456-1111 and ask that the President have Marijuana removed from Schedule 1, You can email the President by going to and clicking on “contact us”

    Call and email your Senators and Representative, and ask that they pass the CARERS act — IMMEDIATELY.

    Call and email every day, and ask everyone you know to call and email every day, and to keep calling, and keep emailing, for however long it takes, until the President, Congress or both take action.

    Please do everything you can to get as many people as possible to call and email and to keep on calling and emailing, every single day.

    Do everything you can to help with this effort.

    Pass it on.

    With luck the effort will go viral.

    The lives of countless Americans depend on it.

  11. We’re facing a humanitarian crisis of epic proportions.
    Marijuana is “a rain forest in a single plant”
    Its not just a “Wonder Drug” its a whole bunch of them.
    There’s no other medicine that has shown so much promise in such a wide variety of diseases or has such a wide therapeutic index.
    We should be deploying it in a wide range of large scale clinical trials and it should be available to anyone and everyone who can benefit from it.
    Its ironic that its been safely used around the world for over 5,000 years but that people are claiming that they need more research on it before removing it from Schedule 1. Ask any Cancer patient that’s used it. Ask the parent of any kid with Seizures its helped save the life of. We don’t need any more evidence to de-schedule it and make it over the counter or able to be prescribed on the same basis as every other medication. It should be over the counter. Its safer than NSAIDS and much safer than Tylenol.

  12. It’s so good to see that “watchful eyes” are on the guard. Cannabis belongs to the people. It is the answer to what troubles almost every living creature. We should all defend it this strongly always. I wil.

  13. @Richard,
    Double thanks on the link… I believe that
    Sounds much more descriptive than the “entourage effect.”

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