Perspective | Published:

Cannabis conundrum

Spinal Cord Series and Casesvolume 4, Article number: 68 (2018) | Download Citation

Abstract

As there is a high prevalence of cannabis use in the population of people with spinal cord injury (SCI), it is important for clinicians to understand the positive and negative consequences of cannabis use in order to have educated and constructive discussions with their patients. The recent National Academies of Sciences, Engineering, and Medicine (NASEM) report provided an excellent summary of current cannabis research and touted clinical efficacy for cannabis for neuropathic pain and spasticity, two common secondary conditions after SCI. However, it is important to consider the limitations of the studies examined and the shortcomings of the meta-analysis methodology. We will discuss the fallacies in evidence supporting cannabis use by identifying limitations of current cannabis research that lead to limited generalizeability of the results, including short duration of the studies, small sample sizes, lack of statistical significance, inability to conduct blinded trials, non-standardization of delivery systems and lack of defined dosing, and small clinical benefits. The number of negative side effects associated with cannabis use, including risk of injury, overdose injuries, impairment of cognition, and increased risk of depression and suicide, are a strong argument for more rigorous studies of the efficacy of cannabis, especially in an already vulnerable population.

Access optionsAccess options

Rent or Buy article

Get time limited or full article access on ReadCube.

from$8.99

All prices are NET prices.

References

  1. 1.

    Hawley L, Ketchum J, Morey C, Collins K, Charlifue S. Cannabis use in individuals with moderate/severe traumatic brain injury or spinal cord injury in Colorado. Arch Phys Med Rehabil. 2018. https://doi.org/10.1016/j.apmr.2018.02.003

  2. 2.

    National Academies of Sciences Engineering and Medicine. The health effects of cannabis and cannabinoids: the current state of evidence and recommendations for research. Washington, DC: The National Academies Press; 2017.

  3. 3.

    Whiting PF, Wolff RF, Deshpande S, Di Nisio M, Duffy S, Hernandez AV, et al. Cannabinoids for medical use: a systematic review and meta-analysis. JAMA. 2015;313:2456–73.

  4. 4.

    Leung L. Cannabis and its derivatives: review of medical use. J Am Board Fam Med. 2011;24:452–62.

  5. 5.

    McLaren J, Swift W, Dillon P, et al. Cannabis potency and contamination: a review of the literature. Addiction. 2008;103:1100–9.

  6. 6.

    Leafly. Cannabis Strain Explorer. 2018 [04/19/2018]. https://www.leafly.com/explore/sort-alpha.

  7. 7.

    Ehrler MR, Deborah EC, Yurgelun-Todd D. Subjective and cognitive effects of Cannabinoids in marijuana smokers. In: Campolongo P, Fattore L, editors. Cannabinoid modulation of emotion, memory, and motivation. New York, NY: Springer; 2015. p. 159–81.

  8. 8.

    Meier MH, Caspi A, Ambler A, Harrington H, Houts R, Keefe RSE, et al. Persistent cannabis users show neuropsychological decline from childhood to midlife. Proc Natl Acad Sci USA. 2012;109:E2657–E64. https://doi.org/10.1073/pnas.1206820109.

  9. 9.

    Cougle JR, Hakes JK, Macatee RJ, Zvolensky MJ, Chavarria J. Probability and correlates of dependence among regular users of alcohol, nicotine, cannabis, and cocaine: concurrent and prospective analyses of the National Epidemiologic Survey on Alcohol and Related Conditions. J Clin Psychiatry. 2016;4:444–50.

  10. 10.

    Curran HV, Freeman TP, Mokrysz C, Lewis DA, Morgan CJ, Parsons LH. Keep off the grass? Cannabis, cognition and addiction. Nat Rev Neurosci. 2016;17:293.

  11. 11.

    Solowij N, Stephens R, Roffman RA, Babor T. Does marijuana use cause long-term cognitive deficits? JAMA. 2002;287:2653–4.

  12. 12.

    Vangsness L, Bry BH, LaBouvie EW. Impulsivity, negative expectancies, and marijuana use: a test of the acquired preparedness model. Addict Behav. 2005;30:1071–6.

  13. 13.

    Volkow N, Baler R, Compton W. Adverse health effects of marijuana. N Engl J Med. 2014;370:2219.

  14. 14.

    Wang T, Collet J, Shapiro S, et al. Adverse effects of medical cannabinoids: a systematic review. CMAJ. 2008;178:1669–78.

  15. 15.

    Colorado Department of Public Safety. Marijuana legalization in Colorado: early findings. A Report Pursuant to Senate Bill 13-283. Denver, CO2016 [04/18/2018]. http://cdpsdocs.state.co.us/ors/docs/reports/2016-SB13-283-Rpt.pdf.

  16. 16.

    Heard K, Marlin MB, Nappe T, et al. Common marijuana-related cases encountered in the emergency department. Am J Health-Syst Pharm. 2017;74:499–503.

  17. 17.

    Hall W, Degenhardt l. Adverse health effects of non-medical cannabis use. Lancet. 2009;374:1383–91.

  18. 18.

    Hasin DS, Saha TD, Kerridge BT, Goldstein RB, Chou SP, Zhang H, et al. Prevalence of marijuana use disorders in the United States between 2001-2002 and 2012-2013. JAMA Psychiatry. 2015;72:1235–42.

  19. 19.

    Schauer GL, King BA, Bunnell RE, et al. Toking, vaping, and eating for health or fun: marijuana use patterns. Am J Prev Med. 2016;50:1–8.

Download references

Author information

Affiliations

  1. Craig Hospital, Englewood, CO, USA

    • Jeffrey Berliner
    • , Kathleen Collins
    •  & Jennifer Coker

Authors

  1. Search for Jeffrey Berliner in:

  2. Search for Kathleen Collins in:

  3. Search for Jennifer Coker in:

Conflict of interest

The authors declare that they have no conflict of interest.

Corresponding author

Correspondence to Jennifer Coker.

About this article

Publication history

Received

Accepted

Published

DOI

https://doi.org/10.1038/s41394-018-0097-0

Further reading