Elena Stains
Geisinger Commonwealth School of Medicine
Co-Authors: Amy Kennalley1, Alexander Bachir1, Brian J. Piper1
1Geisinger Commonwealth School of Medicine
Background
The National Academies of Sciences, Engineering, and Medicine (NAS) published a report in 2017 of conclusions on the therapeutic effects of cannabis for over 20 conditions based on the highest quality studies available[1]. Our objective was to compare each state’s current qualifying conditions (QCs) with the NAS findings.
Methods
We collected the QCs of each of the 36 states where medical cannabis is legal in 2023[2]. These conditions were divided into the NAS-established categories into which they fit: substantial evidence of effectiveness (chronic pain), moderate or limited evidence of effectiveness (PTSD), limited evidence of ineffectiveness (glaucoma), and no/insufficient evidence to support effectiveness (epilepsy).
Results
The number of QCs for medical cannabis varied widely between states, with South Dakota having the fewest (5) and Illinois the most (52). While 91.7% of states had at least one QC with substantial evidence, on average, only 9.3% of a state\’s QCs met this standard. In contrast, 88.9% of states had one or more QCs with limited evidence of ineffectiveness or no/insufficient evidence, and 41.7% of states had more than three of such conditions.
Twelve states allowed physicians to recommend medical cannabis at their discretion–while three left the decision entirely up to the physician, requiring no specific QCs whatsoever. Of any state’s list of QCs, South Dakota had the highest percentage (20.0%) with substantial evidence, while Massachusetts the lowest (0.0%). Illinois had the highest percentage (53.9%) of QCs not included in the NAS report, while Maryland, Oregon, and South Dakota tied for the lowest percentage (0.0%).
Conclusion
We found that most states are condoning medical cannabis use for conditions that have not been appropriately studied–ALS symptoms, Parkinson’s, opioid dependence—or are known to some degree to be ineffective–dementia symptoms and depression. Thirty states listed one or more QCs that were not included in the NAS report. Overall, these data show: 1) a large gap between state-level recommendations for medical cannabis and the quality evidence to support them, and 2) the need for more randomized controlled trials using the products currently available in dispensaries.
References
1) National Academies of Sciences, Engineering, and Medicine 2017. The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research. Washington, DC: The National Academies Press. https://doi.org/10.17226/24625.
2) “Medical Marijuana Laws.” NORML, The NORML Foundation, 2 Feb. 2023, https://norml.org/laws/medical-laws/.
Disclosures
BJP’s research is supported by the Pennsylvania Academic Clinical Research Center. The other authors have no disclosures.