One of the difficulties for people who are inexperienced at reading scientific research papers and studies is not knowing how to validate sources. This article will explain why that’s important with one crucial example.
Did you know that as of 2019, the only legal grower for cannabis research in the United States is the University of Mississippi and that their “research-grade” cannabis (available only through the National Institute of Drug Abuse) is dramatically different from what is commercially available in dispensaries and the illicit market? This means that any Randomized Controlled Trials (RTCs) on cannabis conducted in the USA will generate results that are not generalizable (i.e. useless) to American cannabis patients and consumers. In America, we like to believe that our medical system is the best of the best, despite research that says otherwise.
If you didn’t know that, you might think their research was useful. Clinicians and researchers who do know that however, typically look outside of the USA for better studies. They know that despite the Drug Enforcement Agency’s (DEA’s) 2016 announcement[1,5] that other growers would be allowed to grow cannabis for research, they didn’t do anything to actually make it happen until a lawsuit applied pressure on them to follow through in 2019[1,6].
On their website, the National Institute on Drug Abuse says “Our mission is to advance science on the causes and consequences of drug use and addiction and to apply that knowledge to improve individual and public health”. This clearly shows their bias IF you know how to look for it — which many patients don’t. They say they’re studying drug “use” but their name shows their real focus is drug “abuse.” If you lump drug “use” and “abuse” into the same category, you’re essentially saying there’s no use that isn’t abuse. If their institutional values match their words, that is moralizing (rather than objective science) and will skew their interpretation of the results based on their paradigm that all drug use is misuse (or abuse).
Anti-cannabis groups don’t need to use research to back up their claims because they capitalize on years of unscientific policy, stigma, and fear-mongering. They can make their claims because, as a society, we bought into those old ideas and fears. Pro-cannabis groups are required to cite their sources because they need to back up claims that seem unbelievable based on our history of propaganda.
Because of all this, I believe part of our job as clinicians in a field that is still getting its footing (in terms of public acceptance and understanding) is to help our clients understand how to review research and critically examine its sources. It can be overwhelming for a new patient to learn all about cannabis and its use and then also have to figure out how to critically read the research. The therapeutic relationship should help establish trust, but since many of our clients still face stigma outside the therapeutic relationship it would be helpful if we taught them how to read and analyze the research.
Now that you know you can’t take research at face value…
HOW do you critically examine the evidence?
Carey Clark, PHD, RN, AHN-BC, RYT, FAAN has written two fantastic articles walking you through how to examine medical research. Even more interesting to you, dear reader, is that she examines an article from the Lancet Psychiatry journal (a well-respected, peer-reviewed British medical journal) looking at the correlation (meaning how frequently 2 phenomena occur together) between early cannabis use and psychosis.
1. Kennedy, B. (2019, September 30). Wasn’t the DEA going to let others grow research-grade cannabis? Leafly. https://www.leafly.com/news/science-tech/wasnt-the-dea-going-to-let-others-grow-research-grade-cannabis
2. Schwabe, A. L., Hansen, C. J., Hyslop, R. M., & McGlaughlin, M. E. (2019). Research grade marijuana supplied by the National Institute on Drug Abuse is genetically divergent from commercially available cannabis. Author Manuscript, 1–21. https://doi.org/10.1101/592725
3. Generalizable is a research term that means that the results of a study can be applied generally across an unstudied group of people with similar demographics. If a result is NOT generalizable, that means that the results are only valid in the people who were studied and that the results will not likely be repeated if you did the study again with different participants. While you might learn valuable information, studies that are not generalizable are essentially worthless when it comes to taking a small portion of a population and applying what you’ve learned to the population as a whole.
4. Schneider, E. C., Sarnak, D. O., Squires, D., Shah, A., & Doty, M. M. (2017, July). Mirror, mirror 2017: International comparison reflects flaws and opportunities for better U.S. health care. The Commonwealth Fund. https://interactives.commonwealthfund.org/2017/july/mirror-mirror/
5. Franz, J. (2016, August 19). What Will More Research-Grade Marijuana Mean for Medical Studies? Science Friday. https://www.sciencefriday.com/segments/what-will-more-research-grade-marijuana-mean-for-medical-studies/
6. United States Drug Enforcement Administration. (2019, August 26). DEA announces steps necessary to improve access to marijuana research. https://www.dea.gov/press-releases/2019/08/26/dea-announces-steps-necessary-improve-access-marijuana-research
7. National Institute on Drug Abuse. (n.d.). National Institute on Drug Abuse: About NIDA. Retrieved July 23, 2020, from https://www.drugabuse.gov/about-nida
8. Satterlund, T. D., Lee, J. P., & Moore, R. S. (2015). Stigma among California’s Medical Marijuana Patients. Journal of Psychoactive Drugs, 47(1), 10–17. https://doi.org/10.1080/02791072.2014.991858
9. Clark, C. S. (2019a, March 21). Evaluating the Evidence: Cannabis and Psychosis, Part I. NurseManifest. https://nursemanifest.com/2019/03/21/evaluating-the-evidence-cannabis-and-psychosis-part-i/
10. Clark, C. S. (2019b, March 26). Evaluating the Evidence: Cannabis and Psychosis, Part II. NurseManifest. https://nursemanifest.com/2019/03/26/evaluating-the-evidence-cannabis-and-psychosis-part-ii/