Cannabis (marijuana) products are widely used. Cannabis is now fully legal in 24 states, legal if medically prescribed in 15 and partially legal (depending on the composition) in seven. In only four states is it still completely illegal.

            Among 176,000 primary-care patients in a Los Angeles clinic, 17% reported regular use. Not surprisingly, use was commoner in younger people than older ones: 31% of those 18-29 used cannabis, while only 8.5% of those 60 and older reported use.

            A large percentage of cannabis users say they do so to treat symptoms, largely stress, insomnia and pain.

            Cannabis can be inhaled or eaten. Smoking gets the active ingredients into you faster, but the effects of edible (“gummies”) products are similar.

            Do cannabis products help? Our evidence base is flimsy. The fact that cannabis is still classified at the federal level as “Class 1,” with no approved medical use, means funding for large, well-done studies is limited.

            Many of the studies of the benefits rely on self-reported use and are uncontrolled. An analysis of the use of cannabis for chronic pain found seven large studies, including 13,000 patients, that were “observational” (uncontrolled) and 18 randomized, placebo-controlled trials – but these were very small, averaging fewer than 100 subjects in each trial.

            What we can gather from studies to date is that some cannabis products do help with insomnia, but this is countered by deterioration in sleep if use is stopped.

            The evidence seems to show that cannabis has moderate effectiveness for chronic pain, but the benefit is countered by sedation and a marked increase in dizziness and falls.

            What about the risks? Cannabis use by women during pregnancy results in increased likelihood of low birthweight, preterm birth and need for intensive care by the newborns.

            Regular long-term use starting in adolescence and continued into middle age was accompanied by a fall in IQ and evidence of shrinkage of the part of the brain known as the hippocampus.

            Participants in the United Kingdom Biobank (a large, respected observational trial) who were regular, heavy cannabis users, followed for an average of 12 years, had a higher mortality, both overall and from cancer and heart disease.

            Older people should be particularly cautious, as side-effects such as dizziness and sedation are more likely. After cannabis was legalized in Ontario, Canada, the number of older adults treated in emergency departments for cannabis side-effects rose four-fold.

            My take-aways? First, cannabis should be strongly discouraged in adolescents and young adults, whose brains are still developing, and in pregnant women.

            It should be discouraged in older adults, where side-effects are more common and more likely to lead to falls and injury.

            In the middle? Be cautious and minimize your use.

            Finally, I do support the removal of cannabis from Class 1 to a lower class, so that proper studies can be done with federal funding. Only large, randomized, placebo-controlled trials can determine whether cannabis has a role in treating symptoms.

            Edward Hoffer MD is Associate Professor of Medicine, part-time, at Harvard.

What Does The Doctor Say?

By Dr. Edward Hoffer

            One of my favorite songs is “Smile” by Charlie Chaplin. Ya, that Charlie Chaplin who, to people of a certain age, was known as the “Litte Tramp,” a character he portrayed in the movies.

            Chaplin wrote the music in 1936 for his film “Modern Times” (John Turner and Geoffrey Parsons added the lyrics in 1954). Despite the title, the tune is not a happy one. The first line is “Smile, though your heart is aching …” but goes on to advise that there will always be a better tomorrow if you just smile.

            It might be a good anthem for modern times. We certainly can use more smiles in the world, don’t you agree? Smiling has become an issue in our current election cycle with one candidate suggesting the other team smiles too much, and the other saying their opponent rarely smiles.

            There are many kinds of smiles. There are laughs, giggles, cackles, guffaws, smirks, sneers, chuckles and grins. Dr. Paul Ekman, a professor at the University of California, is an expert on smiles … er, nonverbal communication. (Why do we have to complicate everything?)

            He has determined that there are 18 different kinds of smiles. I won’t list them all, but some may be familiar to you, such as the sadistic smile which, he says, “exudes jealously.”   Another is the ecstatic smile, which says life is wonderful. There is the contemptuous smile, the worried smile and the fake smile. Dare I say we see the latter in all political campaigns.

            A real sense of humor used to be a prerequisite for running a successful campaign. Ronald Reagan smiled a lot and used it to his advantage. I recall when he told his opponent Walter Mondale in a debate he would not “exploit, for political purposes, my opponent’s youth and inexperience.” Reagan was 73 and Mondale was 56 years old. They both shared a hearty laugh as did the audience. Reagan won the election.

            Abraham Lincoln was known to tell homespun stories full of ribald humor during meetings to lighten the mood. He also claimed humor helped him to deal with the stress of the office.

            Some say President Jimmie Carter had the best smile. According to Dr. Jack Ragsdale, a dentist … naturally, who studies presidential smiles (really?), his toothy grin was genuine. (Imagine cooling your heels in the doctor’s office waiting for him while he studies all the presidents’ smiles.)

            Newer research at Aston University in the UK suggests that a smile can be contagious and has been linked to “higher levels of trust.” I don’t think it worked so well for old Jimmie while he was in office. He was not reelected.

            Harvey Ball, of Worcester, then a graphic designer at State Mutual Insurance, was asked to come up with a symbol that would raise the morale of the employees. (A pay raise might have worked.) Harvey drew the iconic happy face, now known as the Smiley Face. It took him 10 minutes and he received $45 for his efforts. (That would be $454.06 in today’s dollars. Not such a bad deal.) He never trademarked the symbol and never received another penny. Mr. Ball later started the nonprofit charity Harvey Ball World Smile Foundation to support children’s causes.

            Now that is something to smile about.

            Mattapoisett resident Dick Morgado is an artist and happily retired writer. His newspaper columns appeared for many years in daily newspapers around Boston.

Thoughts on…

By Dick Morgado