Contemporary Routes of Cannabis Consumption

I would first like to commend Peters and Chien on the concise information they provided regarding the modalities, forms, and dosing of cannabis in their February 2018 article on cannabis. I agree with the authors that cannabis use will become even more omnipresent in medicine than it already is. However, I strongly disagree and even refute their statement that “Physicians have little reason to advocate for cannabis use, as data are limited on its beneficial effects.” I am a cannabis clinician in Ohio, which means that I have a certificate to recommend medical marijuana in the state. Medical marijuana legislation was passed in Ohio in 2016, and the state is currently in the early stages of rollout: patient registries opened December 2018, in-state grown cannabis greenhouses have cultivated their first harvests, and the first dispensaries opened in February 2019. It is a very exciting time for cannabis in Ohio, so I was disheartened when this article came across my desk. I agree that there is limited evidencebased literature regarding cannabis currently, but existing data coupled with current ongoing research are more than positive. The National Institutes of Health have been funding Israeli cannabis research since the early 1960s. In a 2018 review, Tashkin concluded that smoking marijuana habitually did not increase the likelihood of lung cancer, possibly because of the immunoprotectant properties of cannabis. Additionally, evidence has shown that cannabis is a safer alternative to opioids; in the face of the ongoing opioid epidemic, this news is welcoming. Cannabis has also been shown to be beneficial in acute opioid withdrawal and as a harm reduction tool in opioid use disorder. Furthermore, in June 2018, Epidiolex (GW Pharmaceuticals plc) was the first drug approved by the Food and Drug Administration that contains a purified substance derived from cannabis to treat patients with seizures associated with Lennox-Gastaut and Dravet syndromes. The evidence is growing, but we must be vigilant in our search and not be blinded by long-antiquated societal views. Yes, clinicians will have the challenge of keeping up with the ever-evolving use of cannabis, both medically and recreationally, but this challenge is one I gladly accept. (doi:10.7556/jaoa.2019.087)