Q: Did you see cannabis is actually better for pain relief than opioids?
A: Not convinced.
Q: But 92%97% of patients said they preferred it! Even if they’d tried opioids! You’re not saying you know better than them, are you?
A: Imagine you had a survey of people who cycle to work, including lots of people who own cars.
Q: Ok.
A: What proportion of those people would say they’d choose to cycle to work instead of driving?
Q: I don’t know, I don’t drive.
A: Imagine you had a survey of people who cycle to work, including lots of people who have perfectly good bus routes as alternatives.
Q: Ok.
A: What proportion of those people would say they’d choose to cycle to work instead of driving or taking the bus?
Q: A lot.
A: Maybe even 92%97%?
Q: Maybe.
A: The survey was of about 2000 current medical cannabis users. It’s not surprising they say it works.
Q: So it’s not true?
A: No, I think it quite like is true, or at least partly true — not for everyone, but for a lot of people.
Q: Then what’s the problem?
A: The survey provides almost no additional evidence that it’s true. I already thought it was plausible, but anyone who didn’t think that shouldn’t have had their mind changed by the survey.
Q: Ok, what would convince you? Do we need randomised trials?
A: That would be nice.
Q: And a pony?
A: Ok, ok. More realistically, a cohort study that follows up a group of people starting to use cannabis for pain relief to find out what they end up preferring, rather than starting with people who prefer cannabis. You could set that up somewhere were medical use was just being legalised, and it wouldn’t cost that much.