This article [BCMJ 2019;61:14-19] would be the first in the literature to establish different clinical effects from C. sativa and C. indica strains. While Dr Ocana insists that clinical research supports separating these strains because of their different effects (stimulating vs sedating), the reference he provided does not support this or even use these differing strain names. Recent chemical analysis of cannabis strains from Washington State argues against differences in CBD and THC between these strains. Other cannabis scientists are in agreement that these terms are better suited to marketing than clinical use: “There are biochemically distinct strains of Cannabis, but the sativa/indica distinction as commonly applied in the lay literature is total nonsense and an exercise in futility.”
In Dr Ocana’s article, results are presented from a cohort interviewed about their experiences with different strains; however, the results should be viewed more as those of the placebo effect in combination with observer bias, especially given the lack of quantification of the cannabis used.
Dr Ocana also states that deaths have increased with cannabis legalization. The cited reference mentions only one death, that of a child who died of myocarditis. This case was controversial enough for the case report’s authors to publicly clarify, “We are absolutely not saying that marijuana killed that child.”
As Dr Ocana notes, it can be difficult to deal with misinformation; this is magnified when it is published in a medical journal. The three most commonly held misbeliefs among physicians are that cannabis overdose can be fatal, that cannabis is often contaminated with fentanyl, and that there are differences in effect between C. indica and C. sativa strains.
—Ian Mitchell, MD, FRCP
Clinical Associate Professor, UBC Department of Emergency Medicine
Site Scholar, Kamloops Family Medicine Residency Program
This letter was submitted in response to “Cannabis use by adolescents: Practical implications for clinicians.”
1. Jikomes N, Zoorob M. The cannabinoid content of legal cannabis in Washington State varies systematically across testing facilities and popular consumer products. Scientific Reports. Accessed 26 February 2019. www.nature.com/articles/s41598-018-22755-2.
3. Silverman E. The truth behind the ‘first marijuana overdose death’ headlines. The Washington Post. Accessed 26 February 2019. www.washingtonpost.com/news/to-your-health/wp/2017/11/17/the-truth-behind-the-first-marijuana-overdose-death/.
Above is the information needed to cite this article in your paper or presentation. The International Committee
of Medical Journal Editors (ICMJE) recommends the following citation style, which is the now nearly universally
accepted citation style for scientific papers:
Halpern SD, Ubel PA, Caplan AL, Marion DW, Palmer AM, Schiding JK, et al. Solid-organ transplantation in HIV-infected patients. N Engl J Med. 2002;347:284-7.
About the ICMJE and citation styles
The ICMJE is small group of editors of general medical journals who first met informally in Vancouver, British Columbia, in 1978 to establish guidelines for the format of manuscripts submitted to their journals. The group became known as the Vancouver Group. Its requirements for manuscripts, including formats for bibliographic references developed by the U.S. National Library of Medicine (NLM), were first published in 1979. The Vancouver Group expanded and evolved into the International Committee of Medical Journal Editors (ICMJE), which meets annually. The ICMJE created the Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals to help authors and editors create and distribute accurate, clear, easily accessible reports of biomedical studies.
An alternate version of ICMJE style is to additionally list the month an issue number, but since most journals use continuous pagination, the shorter form provides sufficient information to locate the reference. The NLM now lists all authors.
BCMJ standard citation style is a slight modification of the ICMJE/NLM style, as follows:
- Only the first three authors are listed, followed by "et al."
- There is no period after the journal name.
- Page numbers are not abbreviated.
For more information on the ICMJE Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals, visit www.icmje.org