gms | German Medical Science

G-I-N Conference 2012

Guidelines International Network

22.08 - 25.08.2012, Berlin

Problematic guidance for politically controversial treatments – the case of medical marijuana

Meeting Abstract

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  • D. Indyk - Mount Sinai School of Medicine, New York, NY, USA

Guidelines International Network. G-I-N Conference 2012. Berlin, 22.-25.08.2012. Düsseldorf: German Medical Science GMS Publishing House; 2012. DocP053

doi: 10.3205/12gin165, urn:nbn:de:0183-12gin1654

Veröffentlicht: 10. Juli 2012

© 2012 Indyk.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen ( Er darf vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.



Background: Guidelines should synthesize available data about indication and therapy, risk/benefit and cost-effectiveness based on best available evidence. Ideology and political interests may interfere with guideline development for cannabis. Data from randomized clinical trials suggest that cannabis, which is legal in some jurisdictions, is effective for neuropathic pain, affecting 30–40% of HIV-infected individuals. This is our litmus test for evidence based recommendations.

Objectives: We searched and compared practice guidelines worldwide for medical marijuana to investigate if they are evidence based, disclose stakeholders and conflicts of interests (COI) and patients were involved.

Methods: We searched the literature, guideline clearinghouses and the internet for guidance on medical marijuana with a combination of free text and controlled vocabulary search.

Results: We found more than 30 pertinent guidelines, statements or advisories from professional bodies, regulatory and government agencies and other interested parties; we tabulated clinical recommendations, stakeholders and COI statements. Most state guidelines address legal issues, but do not provide clinical advice. The majority of clinical guidelines on neuropathy do not include recent evidence on smoked Cannabis for neuropathy. Advice on medical marijuana on the internet by Cannabis dispensaries or political pressure groups mostly did not disclose process, stakeholders, and COI.

Discussion: The available guidelines for politically controversial treatments like Cannabis seem biased, and lack transparency and complete disclosure.

Implications for guideline developers/users: Lack of evidence based, impartial advice useful for providers considering smoked cannabis for neuropathic pain is problematic considering the legal controversies and the lack of effective treatment alternatives.