Last month, the Journal of American Medicine (JAMA) Internal Medicine released a study claiming Nabiximols successfully “reduced illicit cannabis use in patients with cannabis dependence.” The study was poorly designed and meaningless, and the subsequent article was short on logic and facts. Let’s review them.
Nabiximols, or GW Pharmaceuticals’ Sativex, is a standardized cannabis tincture with an equal dose of CBD and THC. It is essentially a whole plant cannabis extract. Nabiximols is replacing “illicit”, or illegal, cannabis use only by the default of it being in the early stages of FDA approval, versus botanical cannabis which is a federally illegal drug and cannot be approved as a medicine. It is a tautology.
As an expert with over 50 years working in drug abuse treatment and prevention, the suggestion that there needs to be a pharmaceutical drug to treat “cannabis dependence” is not helpful to those who need help and stigmatizing to those that cannabis is helping.
I venture to say that the majority of the subjects in the JAMA study were suffering from ADD and/or PTSD and both Nabiximols use as well as “illicit” cannabis are treating the symptoms of these two conditions. The only difference is that Nabiximols is $1,400 a month while in some states you can grow your own cannabis for the cost of seed, water and fertilizer. If you buy the equivalent of Nabiximols at a dispensary, the cost would be between $350 to $500 a month. Clearly patients using cannabis medically would not be considered dependent or an addict any more than a diabetic who uses insulin.
Way back in 1972 even the Nixon Marijuana Commission said that it was obvious dependency from cannabis was rarely a problem since the natural history of recreational cannabis use is to start in the teens and end in young adulthood. This is done voluntarily.
As we know from the work of Drs. Henningfeld and Benowitz; of the most common social use, including alcohol, tobacco, opiates, cocaine, coffee and cannabis, cannabis has the least risk dependency. So, where are the drugs to treat coffee dependency?
It is the law, not the substance, that makes the cannabis use illicit.