Recent national policy changes have made cannabis increasingly available for medical purposes across numerous conditions. Yet a significant gap exists between what’s approved for cannabis therapeutic use and what scientific evidence actually supports. Understanding this distinction is crucial for public health and informed decision-making.
The FDA Approval Reality for Cannabis Therapeutic Use
Despite widespread availability of medical cannabis in dispensaries, the FDA has approved only three cannabis-related medications. Two are synthetic forms of delta-9-THC (dronabinol and nabilone), approved since the 1980s for treating nausea and appetite loss in AIDS and chemotherapy patients. The third, Epidiolex, contains highly purified cannabidiol (CBD) and treats severe childhood epilepsy.
These medications underwent rigorous randomised, placebo-controlled trials—the gold standard required of every prescription medicine. In contrast, the cannabis available at dispensaries has bypassed this scientific process entirely. Notably, even these FDA-approved medications have extremely narrow, specific applications and are not appropriate for the broad range of conditions for which dispensary cannabis is marketed.
Medical Cannabis Research: Significant Limitations
Dr Margaret Haney, director of Columbia University’s Cannabis Research Laboratory, highlights a critical problem: “Our societal changes have far exceeded placebo-controlled evidence.” Researchers face substantial barriers when studying cannabis therapeutic use due to its Schedule 1 classification, which requires extensive licensing and restricts available products for research.
This means scientists cannot simply purchase products from dispensaries to study their effectiveness. Instead, they’re limited to federally approved sources, creating a disconnect between what researchers can study and what patients actually use.
The Placebo Effect Challenge
Pain, anxiety, and sleep difficulties—the most common reasons people seek cannabis for medicinal purposes—are also the conditions most susceptible to placebo effects. When expectations are high, the brain can produce genuine symptom relief regardless of treatment content.
Studies examining cannabis therapeutic use consistently show this pattern. In one trial of women with chemotherapy-induced nerve pain, both the cannabis group and placebo group showed identical improvements. Pain ratings decreased significantly over eight weeks in both conditions, yet cannabis provided no additional benefit beyond placebo.
Cannabis Use Disorder: An Underestimated Risk
Approximately 5.8% of the population meets criteria for cannabis use disorder. When used daily for medical purposes, risk factors multiply. Users seeking cannabis therapeutic use develop higher rates of cannabis use disorder compared to those without chronic conditions, particularly when treating pain, anxiety, or depression.
Individuals with existing psychiatric diagnoses face double the risk of developing cannabis use disorder. Moreover, concurrent cannabis use worsens treatment outcomes for both the psychiatric condition and the substance use disorder itself—yet anxiety and depression remain leading reasons people seek medicinal cannabis despite minimal supporting evidence.
The therapeutic dose often produces intoxication, and repeated daily use increases dependency risk. Over 80% of medicinal cannabis users also use it recreationally, blurring the line between medical necessity and problematic use.
Cannabis Withdrawal: A Real Phenomenon
Daily cannabis users experience withdrawal symptoms when stopping, including:
- Severely disrupted sleep with increased nightmares
- Dramatic decrease in appetite
- Increased anxiety and irritability
- Depressed mood and restlessness
These symptoms can last weeks, with sleep disruption being particularly persistent. Many users believe they “need” cannabis to sleep or eat, when they’re actually experiencing withdrawal symptoms from dependency.
Anaesthesiologists report concerning patterns amongst daily cannabis users undergoing surgery. Patients arriving in acute withdrawal often experience heightened anxiety and increased pain sensitivity, requiring additional anxiolytic medication even before entering the operating theatre. Yet no evidence-based protocols exist for managing pre-surgical cannabis cessation—some physicians recommend stopping the morning of surgery, others suggest a month beforehand, but no data guides these decisions.
The State-by-State Confusion
Unlike other medications, cannabis regulations vary dramatically by state. The same condition deemed treatable with cannabis in one state may not qualify in a neighbouring state. This political approach to medicine means elected officials, rather than scientific evidence, determine what constitutes effective treatment for cannabis therapeutic use.
Healthcare providers face an impossible situation. They lack dosing guidelines, delivery method recommendations, or evidence-based protocols for different conditions. There’s no reliable information about THC-to-CBD ratios, appropriate concentrations, or how to address risks in vulnerable populations.
What We Actually Know
Whilst laboratory studies suggest cannabis may affect pain sensitivity and appetite under highly controlled conditions, these findings have consistently failed to translate into real-world clinical benefits.
The body possesses its own endocannabinoid system—natural cannabis-like compounds that regulate stress, pain, mood, and appetite. Cannabis overwhelms this delicate system in ways the body’s natural compounds never would. When people use cannabis daily, the brain attempts to adapt by reducing cannabinoid receptors, leading to tolerance.
Crucially, tolerance develops differently across effects. In studies with HIV patients, cannabis initially increased caloric intake significantly, but by day nine, this therapeutic benefit disappeared entirely—whilst intoxicating effects remained unchanged. This creates a troubling scenario where users must increase doses to maintain symptom relief, yet continue experiencing intoxication.
Some studies reveal cannabis worsening targeted symptoms. Research on obsessive-compulsive disorder found both high-THC and high-CBD cannabis increased anxiety rather than reducing it. The neuropathic pain trial showed sleep quality was actually worse in the cannabis group compared to placebo.
Route of administration significantly impacts risk. High-potency THC oils in vaporisers and “dabs” (over 85% THC) carry substantially greater dependency risk than traditional cannabis flower. When Dr Haney began her research, cannabis contained approximately 2% THC; today’s dispensary products reach 25-30% THC.
Sex differences also matter significantly. Women show greater sensitivity to cannabis’s pleasurable effects and withdrawal symptoms, yet demonstrate reduced pain relief compared to men at equivalent doses. This suggests optimal dosing may differ substantially between sexes, though current guidance doesn’t account for this.
The Path Forward
Evidence-based medicine requires randomised, placebo-controlled trials with products of known composition. Until such evidence exists, claims about cannabis therapeutic use effectiveness remain largely unsubstantiated.
The current situation represents a billion-dollar industry operating without the scientific foundation required of every other medication. Medical benefit has become whatever marketers claim it to be, with no obligation to prove effectiveness through controlled trials.
Much of what’s marketed as medicinal cannabis relies on expectation rather than pharmacology. The public deserves accurate information about both potential benefits and genuine risks, including cannabis use disorder, withdrawal symptoms, tolerance development, and the lack of dosing guidance. Making informed decisions about cannabis therapeutic use requires understanding what science has—and hasn’t—proven, and recognising that current evidence does not support the widespread medical claims being made.
(Source: WRD News)
