When you get a bottle of pills, it clearly states on the label what is in them, the dosage, and how often you should take it. The same bottle also will include some warnings about side effects, and a number of the pharmacist to call if you have any questions or adverse reactions. Furthermore, before it was dispensed, the doctor and pharmacist both will check to make sure the drug is safe for the individual, and will not interact negatively with any other medications they are currently taking. So far, no such labeling guidelines are in place for medical cannabis despite 33 states allowing its sale.
Even for legal substances which do not have medical value, we have federal standards for labeling. Tobacco products and alcohol have warning labels that clearly alert users to the risks of consumption. There are also many public education programs surrounding these products which educate users as to their responsible use and dangers, but what programs exist for cannabis? Mostly what people know about cannabis comes from three sources: anti-drug propaganda, personal experience, and the internet. None of which are consistent, or necessarily factual. This was the topic covered by a new review published last week in the Journal of Cannabis Research which set out to evaluate the quality of the information being shared on the internet, and will be the topic of today’s article.
How the study was done?
It is quite clear that the anti-drug propaganda of the last century can hardly be considered evidence based, and is more likely a product of fear mongering and racism. Additionally, medical science rarely relies on the anecdotal evidence provided by users, who are suspect to bias and the placebo effect. So, the last remaining question is, what is the quality of the information being shared on the internet concerning medical cannabis and the diseases or ailments that it can treat?
To assess this, the authors performed extensive google searches at the end of 2019 using many terms related to medical cannabis use, they then documented and evaluated those sources. They wanted to know things like: where people being informed about the differences of CBD vs THC, are they informed about dosage, side effects, medication interactions, and were the claims backed up with citations. In the end, they compiled 344 pages from 179 unique websites which had been published between 2010 and 2019. It was then time to start analyzing the data to see if people getting their information about medical cannabis primarily from the internet is an effective means of educating the public.
Is medical cannabis info on the internet accurate?
While we all know that there is some great information on the internet, if you know how to find it, there is also a whole lot of misinformation, or even intentionally misleading sites our there. Anyone who has dealt with a serious medical diagnoses knows that this is the truth. Following a serious diagnoses, you have probably been exposed to by all your well-intentioned friends and family sending you links to juice cleanses, berries from the amazon, or other 'miracle cures.' These days, it seems that there is someone saying that cannabis can cure just about any problem you have. In the study reviewed, the authors found 151 different medical and health conditions for which claims about using cannabis were made. This is a whole lot more than the dozen or so for which ample scientific evidence is available for, including the pain and nausea associated with the effects of cancer/chemotherapy, Multiple sclerosis, and dementia. According to the author's own assessment (using only a single report from the NASEM ) only 11% of the uses proposed had any medical evidence, 9% had no evidence, and 6% had evidence to the contrary. The remaining 74% were not covered in the one source used by the authors to evaluate the websites. Interestingly, 78 of the website pages advocated cannabis use for medical conditions for which there where no studies available, and no other sites giving the same information. All of this implies that it can be very easy for less internet savvy researchers to be misled into using cannabis for conditions for which there is no evidence whatsoever.
Looking deeper into the data, most of the sites (66%) mentioned specific strains or products, and thus were likely in the category of native advertising, rather than relaying objective, factual information. Furthermore, most sites did not discuss CBD to THC ratios, dosage, or any other expected details relevant to medical cannabis users. Only a third of the sites mentioned any type of harmful effects, such as those brought about by smoking, or involving driving and operation of heavy machinery, and only 4% mentioned harm reduction techniques like vaping or oral consumption. To make matters worse, only 10% listed the credentials of the author, and possibly worst of all, only 6% listed citations and, of those, only 4% were peer-reviewed sources.
Can we trust what we read?
Clearly, this study has shown that the information people are receiving from the internet is no better, or arguably worse, than the anti-drug propaganda we have all been exposed to. Many readers might look at these findings with apathy, thinking "well, what do you expect? It's the internet." However, if medical cannabis patients are primarily getting their knowledge from the internet, then this is a big deal. Most doctors will not prescribe cannabis, and know very little about it to advise patients in any way. This means that there is a major void in the public's understanding of medical cannabis, for which there seems to be nobody at a high level of influence trying to fill. This may especially be true at the level of the cannabis dispensaries.
As a cancer patient, I expected that upon arriving to Colorado I would be met in the dispensaries with workers who had a high level of knowledge of both cannabis and the medical conditions it treats. After visiting more than 30 dispensaries and asking many questions, I never found one bud-tender who could provide me with accurate information. I have been told that vaping is the same risk as smoking, that I should buy edibles with only 10 mg of THC but more than 50 mg of sugar, and other falsehoods like CBD improves sleep at low doses. So, if we cannot trust the internet, and we cannot trust the dispensaries, who should we trust?
Well, unfortunately, this answer is not an easy one. Until the federal government starts to create public educations programs, standardized labeling, and regulates dispensaries more effectively – you can only trust yourself. In practice, this means only using reputable sites and vetting the information that you read or receive from friends. Here is a checklist of ways to scientifically vet information:
1) Does the author include citations to peer reviewed studies? Peer-review is the scientific process all researchers must go through before publishing an article, study, or review. Sources that are peer-reviewed will be published in a journal, and usually will include a DOI number which is searchable on google scholar or sci-hub.tw (for papers with a pay wall). If there are no sources, or all the hyperlinks or citations direct you to other news sources or websites, then the information is generally not valid.
2) If it sounds to good to be true, it usually is. Cannabis can cure cancer better than chemo you say? Well then why isn’t everybody doing that, and why do all the cancer survivors I met in person say they went through chemo, radiation, or surgery? If someone claims that cannabis or anything else can cure a disease, go directly to google scholar and search it, if there is evidence for that it will be there.
3) Not all studies are the same. When searching medical and scientific literature, be sure to look at what kind of study it was. Generally, medical breakthroughs go through several stages; testing in a petri dish, animal studies, preliminary human studies, double-blind placebo-controlled studies, and then metareviews. Their level of authority comes in the same order. Just because something works in a petri dish does not mean it will work the same in the body, understand that all studies are not equal, and that anytime you see the words "a new study has shown" in the media you should be very weary of whatever information comes after it.
4) Don’t become a victim of confirmation bias. If a friend tells you that 'dandelion roots kill cancer', don't just search for that phrase in google, also search for its opposite. Try adding words like debunked, disproven, or misleading at the end of your search and weigh those results against the positive ones. You can also check out sites which compile lists of disproven medical cures on sites like Wikipedia.
Hopefully this guide will assist you in making the right decisions concerning your medical cannabis use. At this point, anybody desiring to use cannabis for medical purposes should do their own research, follow the science as it progresses, talk with experts, and don't trust anyone trying to sell you something that seems to good to be true.