Many people feel secure in a medical setting, which has opened the door for cannabis clinics staffed by physicians who are savvy about cannabis. Yet the concept of a physician focusing treatment strategies on a single product is peculiar and contrary to medical care standards. The notion that a “cannabis expert” can identify the ideal strain or molecular content for a specific condition for a specific patient is not backed by concrete evidence. Furthermore, the accuracy of the labelling of cannabis products is questionable, and regulations regarding both quality control and labelling are insufficient. 9 To save costs, many patients may choose to access cannabis illegally, compounding risks related to unknown molecular content, quality and safety, especially since the concentration of THC offered as a medicinal product by Canadian growers has reportedly increased in recent years. 10 Despite advocacy, politics and commerce having outpaced sound clinical evidence regarding the use of medical cannabis, physicians must provide advice based on valid science, not pseudo science or hype. Therefore, there is an urgent need to generate better evidence about the benefits and risks of medical cannabis. Preclinical study should be used as a guide to identify molecular compositions of cannabis that may be effective for a specific indication and warrant further testing in the clinical setting. The gold standard of RCTs may, however, be less realistic for accumulating evidence for using medical cannabis for reasons that include variability in molecular content (even within specific strains of the plant product), current prevalent use by many patients, issues of effective blinding and the need for longterm study.

Observational studies involving cohorts of patients being managed in usual clinical care, but not those conducted by cannabis growers or in cannabis clinics or dispensaries, will generate real-world information. Investigator-initiated studies that are financially supported by the cannabis industry should adhere to the regulatory standards required for pharmaceutical products. Governments and regulators worldwide have a moral obligation to support the scientific study of cannabis to protect the well-being of patients and avert a potential disaster similar to the opioid epidemic in North America. Although some patients may benefit from cannabis in the short term, long-term consequences of its use are not yet known. 11 Until the evidence base is strong enough to support sound decisions about the use of cannabis as a medical treatment, the well-being of patients will continue to come second to profit-motivated parties.