Without a doubt, there is an unprecedented amount of knowledge available regarding cannabis; more than 3,500 scholarly studies were published on the subject in just 2020. All of this information affects how we see, consider, and hear about the plant and its consequences. Research funding is also rising. These assertions have an impact on things like cannabis purchases by consumers and doctor-patient interactions. But what if our perceptions of cannabis, which appear to be supported by a wealth of scientific evidence, are incorrect? What if cannabis marketing teams and media sources mislead us into thinking that most of it is founded on the level of scientific certainty they claim it is?
The issue with cannabis research
Despite the enormous number of research publications that are released annually, many of these studies include one or more design flaws. The sample size, uniform materials and methods, or statistical significance are some of the most frequent areas of weakness.
The number of subjects (or “sample size”) in a study. The more study groups there are, the easier it will be for researchers to spot differences between them, and the better the outcome will be at representing a larger community of people (called generalizability). Any abnormalities or exceptional participant variable can significantly affect the outcome when the sample size is very small.
The value associated with a study’s findings known as statistical significance (p) denotes how likely it is that the findings are the result of chance. The likelihood that the outcome is not random increases with decreasing p values. However, a finding could be statistically significant but not clinically significant, which means that while a study might find a difference on paper, it might not actually show up in the real world. In addition, there are dishonest “p-hacking” techniques that allow researchers to modify data using various statistical tests in quest of statistically meaningful results.
To guarantee that every participant has the precise same product formulation and dosage, standardized materials and processes are essential in a study. With a natural product like cannabis, whose chemistry varies from plant to plant and within the same plant, this is challenging to do. Inconsistent scientific findings have been produced as a result of this plant variability and the absence of standardized techniques, such as chemical studies of cannabinoids or terpenes. The main problem with these diverse study methodologies is that it might be difficult to compare and contrast the findings of studies conducted using various methodologies.
What exactly qualifies as an excellent research study?
We receive many kinds of information from different kinds of research investigations. In contrast to interventional studies, which include the researchers performing a specific activity and observing the consequence, observational studies involve watching the patient and documenting results like a reporter. Preclinical research involves administering treatments to cells and animals to check for any signs that the procedure would be worthwhile testing on humans. To learn how people respond to a treatment, clinical investigations are conducted on living subjects and can be managed in a number of different ways.
The main categories of scientific study are shown in the table below. The placebo controlled, double blind, randomized clinical trial is the greatest caliber of scientific study, in terms of whether the findings have predictive power (which is what science is all about). This is because the most variables are controlled in these research to make sure that the trial’s findings are as accurate as feasible.
Due in significant part to legal concerns, the great majority of cannabis research is often either preclinical or observational in nature. Furthermore, a significant portion of study has been on cannabinoids of synthetic pharmaceutical quality created by pharmaceutical firms. On the other hand, there hasn’t been as much controlled clinical study on cannabis extracts or herbal cannabis.
The issue with cannabis
Cannabis research encounters special challenges in addition to the standard research design constraints that we would expect to discover in any research study. Cannabis is still strictly prohibited in many nations, making it very difficult for researchers to get resources, funding, and openings for research in the first place.
An investigational review board must always provide its consent before a researcher can carry out any study with people or animals (IRB). Due to cannabis’ legal status and the mind-altering properties of THC, many IRBs won’t accept an interventional study with it.
Furthermore, even if a researcher does receive permission to conduct a study, they still need to locate funds. Anyone wishing to handle cannabis is not guaranteed banking in jurisdictions where it is still prohibited. Further, financing for non-cannabis programs may be impacted by cannabis research in unrelated ways. Universities, for instance, are frequently dependent on funding from governmental as well as philanthropic institutions; these organizations may very well withhold their support if they find out that the school is involved in illegal activity, even if it is housed in a state, territory, or nation where cannabis has been legalized.
Even if all these obstacles are cleared, the placebo effect still poses a challenge to researchers. Patients may experience relief after receiving treatment, even if it involves an inert material like a sugar pill or a salt water injection. And when it comes to the distinct mental-altering effects of THC and herbal cannabis, how can patients be properly “blinded” so they don’t know whether they are receiving a real medication or a placebo?
Noting that prohibitionist cannabis laws have frequently cited the absence of controlled, blinded clinical cannabis research over time to support them is also important. Given the established safety profile of the plant and its components, do we genuinely need more randomized double-blind scientific trials to support legal reforms that would allow for broader access to cannabis as a medicine? Non-clinical research has a very strong ability to provide answers to safety and risk-related problems. Simply put, herbal cannabis has been used by humans for a very long time, and a wealth of observational data supports its widely acknowledged safety profile.
Another issue is literacy and communication in science.
The public’s inability to critically assess scientific material as well as fundamental issues with how scientific research is disseminated constitute the other glaring difficulty facing cannabis research. Only 28% of US adults qualify as “scientifically literate” in the country, an increase from 10% since the 1990s. Public scientific literacy is extremely low in the US. According to recent data, US science literacy is comparable to the rest of the world. Even though the majority of American individuals can only read at a 7th grade level, the majority of scientific articles are prepared for readers with advanced college degrees.
Additionally, the situation is complicated by the marketing demands placed on news reporting, which encourage publishers to create provocative and shocking headlines that overstate the results of research studies, both positive and bad.
Publishers, reporters, and science communicators frequently spread false information to a public that lacks the scientific literacy necessary to evaluate what they are reading in the first place as a result of these two dynamics.
Examples of Cannabis Research that is False
First: Cannabis and schizophrenia
It was one of the theories that surfaced from the 1970s to the 1990s that cannabis contributed to schizophrenia. This was a slightly altered version of an old 1930s allegation that marijuana caused craziness in users (also known as “reefer madness”). These assertions are based on research that has in fact consistently shown a connection between cannabis usage and schizophrenia or psychosis.
It is true that high THC doses, depending on the user’s tolerance, may result in severe experiences that may qualify as acute psychosis or a dissociation from reality. The endocannabinoid system is tightly confined to the same regions of the brain that are frequently out of balance in psychosis, and it plays a significant role in how we perceive reality, time, space, and balance. In other words, specific portions of a schizophrenia patient’s brain have changed functions, and these same regions have strong connections to the ECS. But assertions that cannabis causes schizophrenia directly are a distortion of the available scientific data. The reality is more nuanced.
Only a very small percentage of the general population exposed to cannabis experiences psychotic disorder, according to a 2009 analysis on the topic. Cannabis exposure is probably a “component cause” that interacts with other factors to “create” schizophrenia or a psychotic disease, but it neither makes something happen on its own nor is necessary for it to.
This consensus was most recently supported by a 2019 study that also showed no causal link between marijuana and schizophrenia. Simply said, if the THC dose is high enough, cannabis has the ability to briefly send most people into a psychotic break. Cannabis carries hazards for hastening onset or aggravating symptoms in persons at risk for schizophrenia, but it most definitely does not cause schizophrenia in the ordinary person.
- The mysterious entourage effect
In the late 1990s, the phrase “entourage effect” was originally used to refer to an observation in which the body appeared to create both endocannabinoids and “endocannabinoid-like” molecules at the same time. The effects of the endocannabinoid 2-AG were shown to be influenced by these endocannabinoid-like compounds, which acted as a “entourage” and protected it from deterioration despite not binding to CB1 or CB2 receptors. Researchers began referring to broad synergistic effects amongst components in the cannabis plant using this word later in the 2000s, which is a significantly different meaning of the original term.
Additionally, research was performed in the early 2000s to determine whether the concentration of key cannabinoids like THC and CBD may account for the variations in effects that patients were reporting from various strains of cannabis. When it was discovered that there were no clear relationships between the ratios of THC and CBD and the effects that users described, it was hypothesized that terpenes—the other main constituents of cannabis resin—were the likely culprits.
Since then, however, research has mainly fallen short of substantiating how terpenes might influence cannabis users’ experiences. The popular debate on terpenes and how they might affect cannabis effects is heavily influenced by preclinical studies using isolated terpenoids, which appears to go against the “entourage effect” concept’s original intent.
Despite all of this complexity and ambiguity surrounding the entourage effect, more papers, blog posts, and social media posts are published every day claiming that people may use it to treat a variety of ailments. Products are designed to engage the entourage effect in some way. The “entourage effect” is not scientifically well-defined, and the majority of the study on it has produced contradictory and muddled findings. Cannabis polypharmacy (or synergistic effects) is genuine, but it is simply untrue to assert that we have a complete understanding of it at this point. The science is not yet advanced enough to quantify the “entourage effect,” though we might be able to do so in the future. 19
3: Consumable absorption
Rapid-acting technology has been the topic of much discussion in the cannabis market, so one company decided to back up what they were saying by conducting a clinical research comparing their fast-acting edible items against Wana Brands’ rapid-acting and conventional acting sour gummies. The Ripple brand of THC and CBD infused edibles is sold by Stillwater Brands. This study, which was funded by Stillwater Brands, discovered that subjects who consumed particular edibles appeared to have greater average circulation THC levels than those who consumed others.
This research was subsequently utilized to create marketing materials suggesting that Ripple goods are superior to Wana products, claiming that clinical research has proven that Ripple’s fast-acting gummies act up to 2.3 times faster than the Wana gummies.
Although this is not exactly what the study discovered, this example does show a number of problems with research study design and the incentives that firms have to conflate science with marketing. The researchers did discover that the Ripple product increased THC absorption into the blood at minutes 20 and 30, a finding that appeared remarkable but held up under statistical analysis. However, the objective of the statistical analyses performed was to identify differences rather than to estimate “how many times faster” a substance was absorbed. Here marketing interferes with science communication and shows how some dubious findings can be presented as superior.
Only seven participants were included in the study’s final analysis, which constituted a serious flaw in the study’s sample size.
A low sample size increases the likelihood of error in the study because any bias or anomalies will be amplified in the outcome due to the sparse number of data points.
Although the study’s findings were statistically significant, this does not necessarily imply that consumers will experience any clinically significant differences or be able to tell the difference. One gummy may feel stronger and have a faster onset than another, but perhaps no one will notice. How do the variations in experience and blood THC levels correlate? Even while THC levels in some products may be lower, might there be additional substances working in concert to produce effects? We have very little understanding of that. You only need to look at studies that attempt to link THC blood levels to driving impairment to see how challenging such kinds of studies may be.
Last but not least, this study has not yet been reproduced, a critical stage in the scientific method, like many previous cannabis studies. This study should be repeated, but with a considerably bigger sample size and with goods from more producers. Thanks to the Ripple team for bringing much-needed and much too infrequent actual research to the cannabis market. However, making 2.3x faster onset claims based on the study’s findings is not being honest with the customer or the salesperson. The research just did not support that.
So how do we address these problems with cannabis research?
The state of cannabis research has to be improved in a number of different ways. To make it simpler for researchers to get financing and complete their work correctly, legal obstacles to research must be addressed. Replicating previous cannabis studies is necessary in order to confirm or refute any preconceptions we may have about the drug. Studies need to be improved upon in addition to being duplicated. There is an urgent need for studies with larger sample numbers and better data collecting.
There is currently a strong urge to push boundaries in order to create new discoveries or contributions. Going back, however, to support or refute what has already been investigated, has great significance. For instance, researchers can now examine hundreds of chemicals in cannabis products using readily available analytical methods, when a decade ago they might have only been able to analyze a few dozen.
Publishers and science communicators need to be more accountable for their contributions to increasing public scientific literacy. We must examine scientific material critically and repress the impulse to inflate or overstate the significance of study findings. As new data arises and challenged previous data, we must be willing to adjust our ideas and receptive to criticism.
