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.
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Spinal Cord Series and Cases (2018)