Clinical trials and Indications

Randomised, placebo-controlled, and double-blinded clinicaltrials are the current gold standard for determining the efficacy and safety of medicines. Such studies are costly  and very time-consuming, but by weighing the benefits versus the risks, they help us decide where and when the use of a new medical treatment is appropriate and responsible. 

Clinical trials performed to determine the effects of cannabinoids often show significant limitations, such as a focus on isolated cannabinoids (e.g. Marinol) rather than on herbal cannabis, and the use of low doses because of fear of overdosing the patients. On top of that, clinical researchers often have a hard time obtaining the licenses needed to study cannabis, finding standardized cannabis products suitable for research, and dealing with practical problems related to studying unconventional preparations such as smoking, vaporising or edibles. 

In contrast, self-medicating patients can often choose from a wide range of cannabis products (even though this may be illegal), from which they pick the optimal cannabis variety, dose and administration form by a process of trial and error. Additional reasons that can explain why people choose medication with herbal cannabis over conventional therapy include cost issues, distrust in modern healthcare, or an interest in ‘green’ medicine. Many patients have heard about cannabis medicine from other patients or from recreational users. 

Sometimes cannabis is more effective than pharmaceutical drugs and/or people use cannabis to help them cope with the side effects of, or to replace, these medications. Because of all these reasons, experienced patients may actually know more about the advantages and disadvantages of treatment with cannabis than clinical researchers do. An important way of finding out the medicinal value of cannabis is therefore by performing surveys among large groups of patients. 

According to the most recent and largest-ever survey among 953 patients worldwide, the top 5 symptoms for using cannabis were chronic pain (29.2% of those surveyed), anxiety (18.3%), loss of appetite and/or weight (10.7%), depression (5.2%), and insomnia or sleeping disorder (5.1%). Several other studies have identified the same symptoms, specifically chronic pain, as leading reasons for using cannabis medicine.