Not All Marijuana-Based Treatments Are Created Equal

Medical Evidence Is Limited
The lack of reliable studies on medical marijuana use has been a considerable problem, Dr. Patel acknowledged. A 2014 Cochrane review examined cannabinoids as monotherapy or add-on treatment for people with epilepsy. The review authors found that the reports were of low quality; none included details of randomization or assessed the primary outcome of seizure freedom. Of the secondary outcomes, only severe adverse effects were analyzed; none were found.

A 2014 systematic review by the AAN is a “well-written” paper that attempts to provide guidance, according to Dr. Patel. “Smoked preparations were found to be of no benefit,” he said. “Oral extracts may be effective for spasms, and THC and other synthetic derivatives may be effective for treating spasms related to MS and to bladder dysfunction.” The report also indicates that oral extracts are probably ineffective for treating levodopa-induced dyskinesias in patients with Parkinson’s disease and are of unknown efficacy in non–chorea-related symptoms of Huntington’s disease, Tourette syndrome, cervical dystonia, and epilepsy.

The AAN also issued a position statement in 2014, which Dr. Patel coauthored, on medical marijuana. In essence, the organization supports the reclassification of marijuana-based products from their current Schedule 1 status so that they will be available for study under research protocols approved by institutional review boards.

“We adamantly support rigorous research and evidence-based trials … so that we can get the answers to the questions that so many of us have,” he stated. “However, at this point, as an organization, we do not advocate legalization.” As noted in the statement, the effect that these products may have on patients with neurologic disorders and on children, whose developing brains may be susceptible to marijuana’s toxic effects, is of paramount concern.

Proceed With Caution
“The take-home point is, do not do anything that’s going to get you in trouble legally or medically. Do not think that state laws are adequate to protect you. The federal government trumps all, and as long as you follow their mandates, you’re going to be fine,” Dr. Patel said.

“Right now, there are no substantial data on the efficacy of medical marijuana, but we’re working as hard as we can to make sure that your patients will soon get the best information about benefits and safety.”

—Adriene Marshall