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Letters to the Editor   |    
Research on Medical Marijuana
IGOR GRANT, M.D.; J. HAMPTON ATKINSON, M.D.; BEN GOUAUX, B.A.
Am J Psychiatry 2012;169:1119-1120. doi:10.1176/appi.ajp.2012.12060791
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Dr. Atkinson is a member of a scientific advisory board for Eli Lilly Pharmaceuticals, Inc. Mr. Gouaux is an employee of the Center for Medicinal Cannabis Research at the University of California, San Diego, funding of which is provided entirely by the State of California. Dr. Grant reports no financial relationships with commercial interests.

La Jolla, Calif.

Accepted July , 2012.

To the Editor: In the June 2012 issue, Drs. Kleber and DuPont (1) conclude that there is no place for medicinal cannabis based on a selected and incomplete review of the data. First, they suggest that evidence for marijuana’s efficacy is anecdotal. This is incorrect. There are results from at least five recent clinical trials reported in peer-reviewed publications (2–6); all of these indicate medicinal cannabis’ efficacy, particularly in the management of neuropathic pain and possibly for multiple sclerosis spasticity. Second, they suggest that medical marijuana laws may lead to increased marijuana abuse as a result of reduced perception of risk. Actually, recent epidemiologic studies concluded that, after adjustment for other factors, such laws had no effect on recreational marijuana consumption (7). Additionally, in their review of the situation in California following passage of Proposition 215, the authors, while correctly pointing to the problems of unregulated dispensaries that followed in its wake, failed to mention a more positive development: California established the Center for Medicinal Cannabis Research at the University of California, the first such center in the nation, to conduct clinical trials to shed light on this topic (http://www.cmcr.ucsd.edu/index.php). Recently, we provided an update on medicinal cannabis research along with a possible algorithm to guide evaluation and decision making by physicians who may be in a position to recommend medicinal cannabis (8).

It is timely to consider the state of the science in medicinal cannabis; however, this needs to be done with full awareness and balanced consideration of all the relevant facts. Hopefully, our letter will facilitate this process by addressing some issues that were missed in the commentary.

Kleber  HD;  DuPont  RL:  Physicians and medical marijuana.  Am J Psychiatry 2012; 169:564–568
[PubMed]
[CrossRef]
 
Abrams  DI;  Jay  CA;  Shade  SB;  Vizoso  H;  Reda  H;  Press  S;  Kelly  ME;  Rowbotham  MC;  Petersen  KL:  Cannabis in painful HIV-associated sensory neuropathy: a randomized placebo-controlled trial.  Neurology 2007; 68:515–521
[PubMed]
[CrossRef]
 
Ellis  RJ;  Toperoff  W;  Vaida  F;  van den Brande  G;  Gonzales  J;  Gouaux  B;  Bentley  H;  Atkinson  JH:  Smoked medicinal cannabis for neuropathic pain in HIV: a randomized, crossover clinical trial.  Neuropsychopharmacology 2009; 34:672–680
[PubMed]
[CrossRef]
 
Wilsey  B;  Marcotte  T;  Tsodikov  A;  Millman  J;  Bentley  H;  Gouaux  B;  Fishman  SA:  A randomized, placebo-controlled, crossover trial of cannabis cigarettes in neuropathic pain.  J Pain 2008; 9:506–521
[PubMed]
[CrossRef]
 
Ware  MA;  Wang  T;  Shapiro  S;  Robinson  A;  Ducruet  T;  Huynh  T;  Gamsa  A;  Bennett  GJ;  Collet  JP:  Smoked cannabis for chronic neuropathic pain: a randomized controlled trial.  CMAJ 2010; 182:E694–E701
[PubMed]
 
Corey-Bloom  J;  Wolfson  T;  Gamst  A;  Jin  S;  Marcotte  TD;  Bentley  H;  Gouaux  B:  Smoked cannabis for spasticity in multiple sclerosis: a randomized, placebo-controlled trial.  CMAJ 2012; 184:1143–1150
[PubMed]
 
Harper  S;  Strumpf  EC;  Kaufman  JS:  Do medical marijuana laws increase marijuana use? Replication study and extension.  Ann Epidemiol 2012; 22:207–212
[PubMed]
[CrossRef]
 
Grant  I;  Atkinson  JH;  Gouaux  B;  Wilsey  B:  Medical marijuana: clearing away the smoke.  Open Neurol J 2012; 6:18–25
[PubMed]
[CrossRef]
 
References Container
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References

Kleber  HD;  DuPont  RL:  Physicians and medical marijuana.  Am J Psychiatry 2012; 169:564–568
[PubMed]
[CrossRef]
 
Abrams  DI;  Jay  CA;  Shade  SB;  Vizoso  H;  Reda  H;  Press  S;  Kelly  ME;  Rowbotham  MC;  Petersen  KL:  Cannabis in painful HIV-associated sensory neuropathy: a randomized placebo-controlled trial.  Neurology 2007; 68:515–521
[PubMed]
[CrossRef]
 
Ellis  RJ;  Toperoff  W;  Vaida  F;  van den Brande  G;  Gonzales  J;  Gouaux  B;  Bentley  H;  Atkinson  JH:  Smoked medicinal cannabis for neuropathic pain in HIV: a randomized, crossover clinical trial.  Neuropsychopharmacology 2009; 34:672–680
[PubMed]
[CrossRef]
 
Wilsey  B;  Marcotte  T;  Tsodikov  A;  Millman  J;  Bentley  H;  Gouaux  B;  Fishman  SA:  A randomized, placebo-controlled, crossover trial of cannabis cigarettes in neuropathic pain.  J Pain 2008; 9:506–521
[PubMed]
[CrossRef]
 
Ware  MA;  Wang  T;  Shapiro  S;  Robinson  A;  Ducruet  T;  Huynh  T;  Gamsa  A;  Bennett  GJ;  Collet  JP:  Smoked cannabis for chronic neuropathic pain: a randomized controlled trial.  CMAJ 2010; 182:E694–E701
[PubMed]
 
Corey-Bloom  J;  Wolfson  T;  Gamst  A;  Jin  S;  Marcotte  TD;  Bentley  H;  Gouaux  B:  Smoked cannabis for spasticity in multiple sclerosis: a randomized, placebo-controlled trial.  CMAJ 2012; 184:1143–1150
[PubMed]
 
Harper  S;  Strumpf  EC;  Kaufman  JS:  Do medical marijuana laws increase marijuana use? Replication study and extension.  Ann Epidemiol 2012; 22:207–212
[PubMed]
[CrossRef]
 
Grant  I;  Atkinson  JH;  Gouaux  B;  Wilsey  B:  Medical marijuana: clearing away the smoke.  Open Neurol J 2012; 6:18–25
[PubMed]
[CrossRef]
 
References Container
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