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Has marijuana been shown to be an effective medicine for any one of these medical conditions: pain, glaucoma, cancer, HIV/AIDS, Alzheimer's disease, or multiple sclerosis?

For purposes of this question:

  • "effective" means that marijuana works as well as or better than available alternatives and with comparable or fewer negative side effects; or it works nearly as well as available alternatives, but with fewer negative side effects; or it can successfully treat a condition for which there are no alternative treatments.

  • "marijuana" means any unpurified parts of cannabis plants (as opposed to purified extracts such as THC).

Following are some examples of claims that marijuana can be used to effectively treat a variety of serious medical conditions:

There is a subpopulation of people suffering from cancer, HIV/AIDS, amyotrophic lateral sclerosis (ALS), chronic pain and other debilitating illnesses for whom existing medications are ineffective or cause dangerous side effects. For many of these patients, medical marijuana can provide a superior treatment alternative.

-- Massachusetts Patient Advocacy Alliance

The evidence is overwhelming that marijuana can relieve certain types of pain, nausea, vomiting and other symptoms caused by such illnesses as multiple sclerosis, cancer and AIDS -- or by the harsh drugs sometimes used to treat them. And it can do so with remarkable safety. Indeed, marijuana is less toxic than many of the drugs that physicians prescribe every day.

-- Dr. Joycelyn Elders, former U.S. Surgeon General

Supporters of medical cannabis argue that cannabis does have several well-documented beneficial effects. Among these are: the amelioration of nausea and vomiting, stimulation of hunger in chemotherapy and AIDS patients, lowered intraocular eye pressure (shown to be effective for treating glaucoma), as well as gastrointestinal illness. Its effectiveness as an analgesic has been suggested—and disputed—as well.

-- Wikipedia article on Medical Marijuana

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Dan Moulding
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    @DanMoulding - Can you call out a specific treatment (e.g. glaucoma) and a couple sites that are saying that it is an effective treatment? Including a couple different conditions is what is making things too broad as a treatment can be effective for one but not for others (e.g. aspirin is effective for headaches, but not so much for digestive upset). If you call out a specific condition and provide a couple links this should be a solid question. – rjzii Nov 05 '12 at 15:12
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    @RobZ: I am hesitant to call out just one specific condition. The reason is because it is claimed that marijuana is an effective treatment for a broad range of conditions, not simply one or two. It would not serve the interest of the question to restrict it to only one condition. What if I pick the wrong one, for which no strong evidence exists? Perhaps there is another commonly cited condition for which marijuana **has** been shown to be effective. I think listing some of the most commonly cited conditions is a good compromise between just one condition and leaving it open to any condition. – Dan Moulding Nov 05 '12 at 15:18
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    @DanMoulding The trouble is if you ask a vague, unsatisfying question you will get a vague unsatisfying answer. If you pick a condition, you'll get an answer for that condition. You can always pick another and ask another question. – DJClayworth Nov 05 '12 at 18:00
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    @DJClayworth: While I partly agree, I have to ultimately disagree because I don't believe that dozens of "Is marijuana an effective treatment for X?" questions will serve anyone well. Lumping the most commonly claimed ailments treatable by marijuana into a single question is, I think, much more practical. Note also that an answer needn't address every condition in the question. Any acceptable answer could address just *one* of them and would adequately answer the question. – Dan Moulding Nov 05 '12 at 18:24
  • Also, are you OK with the quote from the former surgeon general as to the "evidence is overwhelming" for the conditions she lists? Are you only skeptical of other conditions? – DJClayworth Nov 05 '12 at 18:43
  • @DJClayworth: I am skeptical of the former surgeon general's claim that the "evidence is overwhelming" for all of the conditions she lists. She made that claim without citing any references. My attempts to verify her claim have been, so far, unsatisfactory; hence this question. – Dan Moulding Nov 05 '12 at 18:53
  • @Chad there is no claim that marijuana is a better medicament than other medicines... – Sklivvz Nov 06 '12 at 20:47
  • @Chad: I've relaxed the way I'm defining "effective". Do you find the new definition more acceptable? – Dan Moulding Nov 08 '12 at 21:37
  • @Sklivvz: Good point. I added another claim that makes this more explicit. I think taken together they show that there is a strong belief that marijuana can, for at least some conditions, be better than any alternatives. – Dan Moulding Nov 08 '12 at 21:39
  • I downvoted because I think the referenced claims are good source material but the wording of the question doesn't match what is being said in the claims. – going Nov 08 '12 at 22:07
  • @Chad: I got that definition of (medical) marijuana from an NIH paper on the subject. – Dan Moulding Nov 08 '12 at 22:48
  • @xiaohouzi79: The first claim says that marijuana can be used where other medications are ineffective, which can only mean that marijuana must be effective in those cases. The other claims also imply that marijuana is effective (reasonable patients and doctors would avoid medicines that are ineffective). In order to assess the veracity of this claim, we need to settle on a reasonable definition of "effective". I can attest that this is not easy to do; but I think with some help I've arrived at a pretty reasonable definition. Or do you object with some other wording of the question? – Dan Moulding Nov 08 '12 at 23:04
  • @DanMoulding - The claims I see: less toxic; amelioration of nausea; stimulation of hunger; lowered intraocular eye pressure. Actually, the first claim quoted is not that good because it also makes a broad claim of "superior treatment" but doesn't provide something to test against. Good questions should match the claims provided and the claims should provide something to test against. The other 2 claims provide this, you could stick to those claims or find other references. Good question, I just think it needs some work. – going Nov 08 '12 at 23:38
  • @xiaohouzi79: If high quality, placebo-controlled, double-blind clinical trials have been performed, and they conclude that marijuana provides "superior" or "inferior" treatment, I think that is a way that we can test that claim. – Dan Moulding Nov 09 '12 at 02:35

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There are details, with a list of more than 250 references/citations, at Information for Health Care Professionals: Marihuana (marijuana, cannabis) [Health Canada, 2010] (hyperlink).

It talks about the following clinical uses:

4.1 Nausea and vomiting
4.2 Wasting syndrome and loss of appetite in AIDS and cancer patients
4.2.1 To stimulate appetite and produce weight gain in AIDS patients
4.2.2 To stimulate appetite and produce weight gain in cancer patients
4.2.3 Anorexia nervosa
4.3 Multiple sclerosis, amyotrophic lateral sclerosis, spinal cord injury
4.3.1 Multiple sclerosis
4.3.2 Amyotrophic lateral sclerosis
4.3.3 Spinal cord injury
4.4 Epilepsy
4.5 Pain
4.5.1 Cancer pain
4.5.2 Non-cancer pain
4.5.2.1 Postoperative pain
4.5.2.2 Neuropathic pain
4.5.2.3 Rheumatoid arthritis
4.5.2.4 Headache
4.5.2.5 Fibromyalgia
4.6 Other diseases and symptoms
4.6.1 Movement disorders
4.6.1.1 Dystonia
4.6.1.2 Huntington's disease
4.6.1.3 Parkinson's disease
4.6.1.4 Tourette's syndrome
4.6.2 Glaucoma
4.6.3 Asthma
4.6.4 Hypertension
4.6.5 Psychiatric disorders
4.6.6 Alzheimer's disease
4.6.7 Inflammation
4.6.7.1 Inflammatory bowel disease
4.6.7.2 Inflammatory skin diseases
4.6.8 Bladder dysfunction
4.6.9 Anti-neoplastic properties

I can't quote it all, but to pick one sentence:

While cannabinoids present clear advantages over placebo in the control of CINV, the evidence from randomized trials shows cannabinoids to be clinically only slightly better than conventional dopamine D2-receptor antagonist anti-emetics (114,115).

So the answer is yes to the first two parts of our question:

  1. It is comparably effective
  2. For cancer (e.g. for controlling chemotherapy-induced nausea)

The third part of your question was, "marijuana means any unpurified parts of cannabis plants (as opposed to purified extracts such as THC)".

It says things like,

The ability of marihuana to stimulate appetite and food intake has been applied to clinical situations where weight gain is deemed beneficial such as in HIV-associated muscle wasting and weight loss. One study showed that experienced HIV+ marihuana smokers with clinically significant muscle mass loss benefited from both dronabinol (4-8 times the standard 2.5 mg b.i.d dose or 10-20 mg daily) and smoked marihuana (3 puffs at 40 sec intervals, 1.3-3.9% THC). Both drugs produced substantial and comparable increases in food intake and body weight, as well as improvements in mood and sleep (130,131). The marihuana-associated increase in body weight appeared to result from an increase in body fat rather than lean muscle mass (132,133).

It goes on to say,

Oral synthetic THC, dronabinol, administered as capsules (Marinol®) is an approved indication in Canada for AIDS-related anorexia associated with weight loss.

They previously said that smoked marijuana is effective.

I expect that synthetics (purified extracts) are prescribed, not because they're more effective but because they have fewer adverse side-effects, for example smoking tar etc.

ChrisW
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  • Thanks for the answer. For the first about control of CINV, looking at the actual studies that were referenced, we find that a) only cannabinoids were used, no patients smoked marijuana; b) cannabinoids were most effective at treating nausea, but with a "number needed to treat" of 6, it's not really especially effective; c) they conclude "Harmful side effects also occurred more often with cannabinoids" and "Potentially serious adverse effects, even when taken short term orally or intramuscularly, are likely to limit their widespread use." So this fails to show that marijuana is effective, IMO. – Dan Moulding Mar 09 '15 at 23:05