Cannabis advocate Steve DeAngelo took to Twitter on Tuesday to share with his followers the latest in scientific research promoting marijuana’s myriad benefits for elderly users. The findings he posted were written up in Health Impact News, which, in the pantheon of medical literature, is one step above the New England Journal of Bullshit.
“The evidence keeps mounting,” DeAngelo wrote alongside a link to an article titled ‘More Seniors Rejecting Pharmaceutical Drugs for Medical Cannabis.’ “Cannabis is the most effective medicine for most Elder health complaints. And most other health complaints for every age group. One natural medicine more effective than all the pharmaceuticals combined w/o horrific side effects.”
According to a survey of 2700 elderly patients aged 65 and over, medical cannabis was deemed to be “safe and efficacious” and may, in fact, decrease the need for opioids. As many as 97 percent of respondents cited a decrease in symptoms, with pain and cancer being the most commonly reported ailments — a panacea for everything from stubbed toes to brain tumors.
“Our study finds that the therapeutic use of cannabis is safe and efficacious in the elderly population,” concluded the authors in one of the few select quotes presented by Health Impact News. “Cannabis use may decrease the use of other prescription medicines, including opioids.”
The study, of course, was self-report and suffered from the reliability and validity issues common to such research. As Dr. Francis Keefe, of Duke University Medical Center’s Pain Management Program noted almost 20 years ago, pain perception is influenced by mitigating factors, including psychological, social, and cultural norms.
According to the Association for Psychological Science, it’s not a “simple sensory event” equally defined by all.
Moreover, when it comes to the conclusions of the study in question, a mere 18 percent of respondents reported either stopping or decreasing their use of opioids after six months — decreasing by how much, it doesn’t say. Nor does it specifically say whether or not cannabis was the reason for quitting the use of opioids altogether.
Two-thousand, two-hundred and forty-four respondents out of 2700 people surveyed continued to use opioids as prescribed. But 90 likes and 50 re-tweets laters, and Steve DeAngelo’s message had begun to spread like presidential propaganda from a Russian troll farm.
“It is, in fact, irresponsible to substitute a proven treatment…”
Cannabis advocates have a science problem, or, perhaps, an anti-science one; a cognitive dissonance on par with climate-change deniers, anti-vaxxers, flat-earthers, and the folks who think Jesus rode on dinosaurs.
It’s not that they don’t believe the science, it’s that they pick and choose which science to accept.
A comprehensive report published by the National Academies of Sciences, Engineering and Medicine in 2017 reviewed over 10,000 studies on medical cannabis to attempt to determine what science has conclusively learned about the drug. In the end, researchers determined that there’s not much hard data to back up many of the claims being made today. And while much of that is due to the fact that the U.S. continues to ban research on Schedule I substances, the fact remains that evidence-based research is hard to come by.
“Even scientists appear to think we know more than we know,” Richard Saitz, MD, professor and chair of the department of community health sciences, Boston University School of Public Health told PotNetwork News via email. “The reason is that there are systematic reviews by high-level scientific bodies, but those reviews [are] summarized across cannabis in general and draw preliminary conclusions about likely effects, both risks, and benefits.”
He continued: “But what there is little known about, is specific doses and dosage forms of specific cannabinoids for specific conditions, in placebo-controlled trials. Those are what we need to know the same level of information that we have for things like aspirin and blood pressure medicines and even opioids.”
Dr. Saitz, along with his co-author Keith Humphreys, Ph.D., professor of psychiatry and behavioral sciences at Stanford University, recently published an article asking whether or not physicians should recommend cannabis as an opioid replacement to patients for both pain and addiction.
Based on the available research the two concluded that not only shouldn’t doctors be doing so — something that a slew of cannabis companies and several state governments have pushed for in recent years — but that such a move would be “irresponsible.”
“The suggestion that patients should self-substitute a drug (i.e., cannabis) that has not been subjected to a single clinical trial for opioid addiction is irresponsible and should be reconsidered,” the two wrote in their article. “There are no randomized clinical trials of substituting cannabis for opioids in patients taking or misusing opioids for treatment of pain, or in patients with opioid addiction treated with methadone or buprenorphine.”
Asked to elaborate, Saitz made clear to PotNetwork News that opioid use disorder is a deadly problem of epidemic proportions. But he also noted that medically-assisted treatment with methadone or buprenorphine works to reduce mortality rates.
“We know this from high-quality studies,” he said. “It is, in fact, irresponsible to substitute a proven treatment for a fatal disease with something that is not proven to be effective.”
When it comes to pain, the data available is middling at best. According to Saitz, medical cannabis may indeed result in pain patients lowering their opioid intake in some cases — which he agreed merits further scientific study. However, the data available to-date shows that cannabis is primarily used as an add-on, not a substitution for opioids in pain management, according to Saitz.
Unsurprisingly, the denizens of the internet have disagreed with Saitz and Humphreys vociferously; hundreds of commenters used anecdotal evidence and Wikipedia degrees to dispute the evidence in hand.
“Who hasn’t paid this Saitz individual ‘personal fees’ (in my mind just code for payola),” wrote one accusing internet virtuoso. “Here we go again with a supposed expert making pronouncements about pain, pain management, etc. when I’m certain that they have never experienced chronic pain. If so they would be singing an entirely different tune.”
“At this point, there are two conclusions…”
In mid-April cannabis advocacy website Marijuana Moment published a report on a seemingly promising but scientifically worthless study linking cannabis oil to decreased seizures in canines. The investigation, another self-reported survey that used owner’s observations of their dogs had a sample size of three, which is about as statistically significant as voting third-party — it sounds good, but makes absolutely no difference in the end.
To their credit, Marijuana Moment did not hide the details of this study from their readers, even if they did present a biased view of its findings.
“Dogs Treated With Cannabis Oil Experience Less Frequent Seizures, Study Finds,” read a bastardized summary of the research at hand. Dispersed across social media, it was nestled above one out-of-context quote which read, “In this study, the seizure frequency improved considerably and owners reported a positive impression.”View image on Twitter
On Facebook, 95 people liked that post and 92 shared it with their friends; a digital game of whisper-down-the-lane for a society that can’t be bothered to read past the headlines.
Marijuana Moment is one of the most-read cannabis news websites on the internet, with a readership in the millions and an audience that includes some of the top pot politicos in the nation. And, to be fair, its coverage of the ongoing fight to legalize cannabis in the U.S. and abroad has been, at many times unparalleled in the post-High Times era of cannabis journalism.
But, like so many cannabis advocacy organizations before it, the Moment’s bias towards the plant has come at the expense of solid science journalism.
Earlier in April, the site joined a chorus of protestors taking former Vice President and current presidential candidate Joe Biden to task for his anti-cannabis past and, more recently, his silence on the subject. With over 40 years in Washington, Biden has a treasure trove of quotes and policy decisions to dissect, including his role as the architect of the 1994 crime bill — a particularly rancid piece of legislation that turned the War on Drugs on its head, decimating poor and minority communities in ways that are still being felt today.
The former Vice President has much to answer for as he seeks the Democratic nomination in 2020, but acceptance of scientific fact should not be top on that list.
The Moment took Biden to task for “enthusiastically” applauding an anti-cannabis screed at a forum in Philadelphia, daring to whisper to the guest next to him that “she’s right.” That screed, given by psychobiology professor Bertha Madras was in response to a question about the effectiveness of cannabis as an opioid alternative — an answer that mimics Dr. Saitz nearly word-for-word.
“At this point there are two conclusions,” began Madras, who also served as deputy director of demand reduction for the White House Office of National Drug Control Policy, according to Marijuana Moment. “Number one, the data does not show that cannabis is a substitute, because if you actually do longitudinal studies on an individual basis, you find that people are suffering as much pain if they’re taking marijuana, and their opioid use is not decreasing in most cases. In fact, they’re getting more and more in trouble, in terms of developing opioid use disorder and they’re misusing opioids.”
She went on to say that accepted treatments in the U.S. for any disease have always been evidence-based, with efficacy determined by longitudinal studies.
Cannabis advocates do have such studies, a golden calf of confirmational bias they trot out every time this argument comes up — and indeed the writers over at Marijuana Moment cited them like clockwork. Research originally published in JAMA Internal Medicine and others like it found that in states where medical cannabis is legal, opioid prescriptions dipped by as much as 6 percent.
But, summarizing single studies into digestible soundbites glosses over its flaws; it’s the reason for such substandard science writing in the media. For example, the authors of the JAMA study themselves noted that they couldn’t confirm whether or not medical marijuana was the cause of reduced opioid prescriptions in the states reviewed — a classic correlation doesn’t equal causation conundrum — but cannabis advocates rarely bring that up in discussion.
Joe Biden Applauds Anti-Marijuana Speech At Opioid Forum: Following the skeptical rant about cannabis’s benefits, the former VP seemed to whisper “she’s right.” https://www.marijuanamoment.net/joe-biden-applauds-anti-marijuana-speech-at-opioid-forum/ …106:25 AM – Apr 15, 2019See Marijuana Moment’s other TweetsTwitter Ads info and privacy
Moreover, and more importantly, as Dr. Humphreys noted in an article in The Washington Post last year, proponents on both sides generally have trouble understanding that two sets of studies may, in fact, be correct. There is not an inherent contradiction between state-level data that shows a decrease in opioid misuse when cannabis is introduced and individual-based studies that prove the opposite.
“Just because two variables have different relationships to each other at the individual level and at the aggregate level doesn’t mean that either finding is wrong,” wrote Humphreys in WaPo’s April 20 edition last year. “This set of conflicting research has revealed less about the relationship between marijuana and opioids than it has about how science is misunderstood and misused in political debates.”
“…completely separate issues from truth and science.”
Patients taking methadone are four times more likely to stay in treatment, according to one study, while at the same time produce 33 percent fewer positive drug screens. Buprenorphine was found to have a 75 percent success rate, compared in randomized trials to a placebo which resulted in relapse 100 percent of the time.
But access to these drugs are scarce in the U.S., and usually limited to large urban areas. In the case of buprenorphine, prescribing doctors are capped at 100 patients per practice, while burdensome prior authorizations and manufacturer backorders tend to send patients back to the streets.
But, lousy science continues to dominate the conversation. In many ways, big cannabis and front line advocates have joined together in a devil’s pact to push the opioid epidemic as their cause célèbre. They focus-grouped addiction, and it sells.
Far from zeroing in on any one person, or organization, or issue, bad science is pervasive throughout the cannabis space. Whether it’s former New Mexico governor and cannabis executive Gary Johnson claiming cannabis can treat Ebola, or everyone claiming that marijuana cures cancer, such misinformation diminishes valid arguments supporting the safety profile of cannabis as well as reasons for why it should be legalized.
Joe Biden may be president one day, and lobbying him on the bad science of cannabis as an opioid replacement won’t bring him to the cause.
“I think we need to separate discussions about legalization and regulation from efficacy, risks, and safety,” Dr. Saitz told PotNetwork News. “We should evaluate the latter dispassionately, so we get the right answers.”
He continued: “When a study comes out that says cannabis is ‘good’ the general reaction in the press and public is to not question the science; the opposite is true every time a study reveals some risks. Part of the reason is that people want to believe what they want to believe, like the purported health benefits of chocolate or alcohol. The other reason is that they fear that results will be used for or against legalization or regulation, but those are completely separate issues from truth and science.”