Therapeutic use of cannabis and cannabinoids: A review
30 comments
·December 14, 2025sitharus
This paper is very much a case of read past the abstract, especially the limitations of the study. As always it’s important for a clinician to explain the risks and current evidence when prescribing, no matter the substance. A lot of medicines have limited evidence, but they still work for some people.
Personally I use prescribed pharmacutical cannabis oils as I have much lower levels of a couple of important enzymes than most people which renders opioids mostly ineffective, even intravenous morphine as I recently found out after surgery. High CBD cannabis oil works, as does paracetamol but that’s way more dangerous.
baxtr
> Evidence from randomized clinical trials does not support the use of cannabis or cannabinoids for most conditions for which it is promoted, such as acute pain and insomnia.
I think that’s the key message do the paper.
ursAxZA
Different countries still treat cannabis very differently, and that alone shows how unsettled the whole topic is. I don’t know the full historical reasoning behind the bans, but there must have been perceived downsides at the time. It feels like society just keeps swinging back and forth on this.
lucketone
> there must have been perceived downsides at the time.
I also don’t know, but I seriously doubt there was cost benefit analysis.
My two bets would be:
- church/priests had power and they condemned most things, except for preying.
- it became widely known that opium is really obviously bad for you, after a bit of mental juggling that became “drugs are bad”, and then wholesale bans followed.
rusk
World War 1 and 2 were drug fueled. Americans saw the carnage after WW1 and instituted prohibition and then entered WW2 as the only sober participants.
The Chinese 100 years of humiliation at the hands of the Brits, was down to Opium
The fall of the medieval European dynasties was all down to Luandanum
Time and again, the unhealthy, and unregulated use of drugs has toppled empires and led to social upheaval.
Makes perfect sense if you ran a country you would be scared of it.
rusk
The UK actually did a report into drug use a number of years ago. Professor David Nutt identified the root causes of the phenomenon you identified and was sacked for it.
larodi
it is very important to also remind - no amount of alcohol is ever prescribed or sold in the pharmacies. the alcohol was legalized in order to a) reverse the ill effects of prohibition which led to birth of large-scale organized crime; b) to allow regulation of substances innit, as people were dying from bad booze.
likewise, nations may have to legalize in order to regulate the contents of whatever-white-powder users may stumble upon on the street. and let us be honest - no bombs can stop the Fentanil (or rat poison for all I care) from being mixed in.
edgineer
Doctors sometimes prescribe alcohol and in these cases pharmacies do fill these orders.
lucketone
Example.
Poisoning by methyl alcohol.
Ethyl alcohol is ok’ish (the regular stuff), while methyl alcohol can make you blind or dead even in small amounts.
loeg
Sure, sure. But this is an argument that we shouldn't have special licensing schemes subsidizing some use via tax exemption ("medical").
an0malous
> Evidence from randomized clinical trials does not support the use of cannabis or cannabinoids for most conditions for which it is promoted, such as acute pain and insomnia.
I once slept in a hoodie with the hood under my back and woke up with horrible back pain, I could not sit still or focus on anything but the pain, 800mg of ibuprofen did nothing. I was about to go to the ER or urgent care when a doctor friend suggested trying cannabis, I took one small hit and was immediately pain free. I have never experienced such a dramatic medical effect in my life, one second I was writhing in pain and the next I was completely fine.
I’ve also seen videos of epileptics calming their seizures from cannabis. The autism community often speaks highly of it, how it makes them feel “normal” or more regulated. I’ve heard of stories of people getting off opioids by using cannabis. I think the people who get anxiety from it or no relief from insomnia are often taking far too much because there aren’t any good guidelines for self medicating and the guidelines they do get are from recreational users.
All I have are anecdotes, but given how obvious the effects were, I find it hard to believe there’s no medicinal value to cannabis.
tripletao
Acute pain isn't discussed in detail in this paper, but here's a paper they cited:
> Conclusions: There is low-quality evidence indicating that cannabinoids may be a safe alternative for a small but significant reduction in subjective pain score when treating acute pain, with intramuscular administration resulting in a greater reduction relative to oral.
https://dx.doi.org/10.1089/can.2019.0079
For insomnia, this paper itself says:
> meta-analysis of 39 RCTs, 38 of which evaluated oral cannabinoids and 1 administered inhaled cannabis, that included 5100 adult participants with chronic pain reported that cannabis and cannabinoid use, compared with placebo, resulted in a small improvement in sleep quality [...]
It goes on to criticize those studies, but we again see low-quality evidence in favor.
In the context of evidence-based medicine, "does not support" can mean the RCTs establish with reasonable confidence that the treatment doesn't work. It can also mean the RCTs show an effect in the good direction but with insufficient statistical power, so that an identical study with more participants would probably--but not certainly--reach our significance threshold. The failure to distinguish between those two quite different situations seems willful and unfortunate here.
sitharus
The full text of the acute pain paper is available via EuropePMC https://europepmc.org/article/MED/33381643
It has an interesting conclusion that says more research in to CBD rather than THC is needed and cites some papers looking in to that.
mh-
I fully accept there is pain relief value. What I wish were better studied is: what are the short, medium, long-term effects of using it at various dosages?
For example, it's pretty widely agreed that it (anecdotally) causes anxiety at higher doses - how high of a dose?
rusk
> short, medium, long-term effects of using it
That would require a grown up conversation and what if the results aren’t the one you want? Pretty hard for Bud, Pfizer etc to put that genie back in the bottle
lostmsu
You do realize that your case has as much evidence that passage of time fixed your problem (or anything else that transpired) as it does for cannabis? And that is why people do randomized trials.
smohare
A substance can have pharmacological effects and still not be recommended for therapeutic use. As a hyperbolic example, suppose a substance relieved all pain for 1% of the population but caused death in everyone else. Even with a highly precise screening process this substance likely would not be administered in medicinal contexts.
tripletao
That's true, but I believe the authors' complaint here is efficacy rather than safety. (I also think they're using terms of art from evidence-based medicine to make a statement the general public is likely to misinterpret, per my other comment here.)
Safety is barely discussed in this paper, probably because the available RCT evidence is favorable to cannabis. I'm not sure that means it's actually safe, since RCTs of tobacco cigarettes over the same study periods probably wouldn't show signal either. This again shows the downside of ignoring all scientific knowledge except RCT outcomes, just in the other direction.
onionisafruit
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BoorishBears
Pretty simple sentence: a hoodie is a top (usually a sweatshirt) with a hood. The hood being a round cap-like piece of fabric that covers your head.
They went to sleep and that very same piece of fabric got jostled underneath their back and got stuck! The fabric, now constrained by a good portion of their body weight, either applied a great amount of pressure to a very small area of their body or caused them to get stuck in an unnatural sleeping position.
Either could conceivably lead to considerable localized pain.
(And I assume they don't know for sure since they were asleep as this occured)
readthenotes1
The sad thing to me, because of how it has affected, several family members, is that some smoke dope or take CBD to treat anxiety only to make things worse.
Because of how marijuana has been made nearly sacrosanct in some circles, they will not look at that THC or CBD as a contributing factor : (
op00to
Cannabis works great for stress for a week, then it makes things worse for me. A few weeks off, and I can take advantage again.
nurettin
It is all fun and games "defending" legalization of weed online until you get a substance abuser in your family.
loeg
Alcoholics have family members, too, but we aren't going to criminalize alcohol.
spoiler
As someone who was raised by aggressive alcoholics, and I have myself struggled with weed addiction in the past (and seen weed addiction in others), it's really difficult to compare the substances. Yes, weed dependence is bad and people need to be aware of it, but alcohol (and I'd even say nicotine, but that's a different subject) are far more insidious than weed
rusk
Wait til their substance abuser gets locked up that’s where the fun really begins
ynab6
Weed is just cringe nowadays.
The abstract of the review is interesting and honestly reflects my (negative) experience with cannabis.
I admit, I really like cannabis, and when I was a 20 year old occasionally smoking with friends at parties it was a "healthier" alternative to getting wasted on alcohol. Share few joins with friends, have fun, laugh a lot.
Then as I got financially independent and I started solo consumption (mostly to get rid of stress) I really started appreciating the cons: lack of energy, disruption of sleep, negative impact of my cognitive abilities, increase in anxiety. I'm glad the study confirms those to be statistically common.
I was very lucky to have a SO who really disliked me smoking and made me realize that I was just doing it to "not think", and it had really 0 positive effects on me. I'm sure I would've quitted eventually anyway, but support and criticism sped up the reality check.
Eventually this is all anecdotal experience, and I'm sure there might be occasional users who can have a mostly positive experience, but the fact that a review points out how statistically common are the negatives and how uncommon are the positives honestly reflects what I've seen on myself and friends.