Correspondence (letter to the editor): Scientific Data Are Lacking

Using a substance that has been used as a medicinal remedy for millennia to treat cancer, immunodeficiency syndrome, and muscle spasms seems an obvious thing to do.

It does, however, seem completely unscientific to initiate a study of smoking cannabis in chronically ill patients because it seems to cause greater damage to the bronchi than does tobacco.

It's not new for a potentially hallucinogenic plant-derived drug to have found its way into treatment, but, in my view, more potent treatment options are available for patients with cachexia, pain, and nausea—including options gained from sufficient experience in the combination with opiates.

The problem in treating muscle spasms in underlying neurological disorders—and the authors indirectly point this out in their table—lies in the induction of neurological adverse effects, including delirium.

To assign responsibility for the risks to the patient alone is common practice only for self-medication.

It is entirely possible to remain below the hallucinogenic threshold, especially for single doses, but the pharmacodynamics cannot be reproduced without blood concentration monitoring. The article is lacking scientific data about this. As long as these data are not available, the only option for treatment-refractory symptoms is dosage adjustment in an in-patient setting.

In that scenario it seems likely that drug monitoring would be decided on, because in view of the efficacy-safety profile it seems entirely feasible that a therapeutic effect would be achieved.