Regarding the position statement on medical cannabis by the American Academy of Sleep Medicine (AASM),1 the opportunity cost of banning cannabis program referrals and attacking the Minnesota state law that establishes obstructive sleep apnea (OSA) as an allowable medical condition treatable by cannabis should be recognized by members as self-interested, not credible and too expensive for patients to shoulder. It also suffices as a recipe for conflict of interest inquiries at the organizational level since the AASM directive alleges patient endangerment by medical cannabis and extends the fear to dronabinol by including substitutes or medical synthetic extracts/derivatives as unstudied and therefore contraindicated.
There is evidence that cannabinoids improve the sleep apnea-hypopnea index,2 which led to the recommendation by the National Academies of Sciences that there is “moderate evidence suggesting that cannabinoids…improve short-term sleep outcomes in patients…with obstructive sleep apnea.”3 To argue that because it hasn't been studied long-term it should be banned is shortsighted.
The AASM position statement authors also confuse their assertions by mixing concerns for unregulated cannabis products and their potential for variable delivery methods with those of regulated medical cannabis, placing this directive at odds with the truth. Using the organizational pulpit for position statements not ground in solid evidence is a defensive tactic to maintain the expensive (yet not well tolerated) device-driven continuous positive airway pressure management monopoly in OSA without allowing consideration for less expensive treatment options.
The AASM directive also swings too early to exclude (OSA eligibility began in July 2018 for Minnesota) medical cannabis and dronabinol, which were lumped together in a sloppy fashion. Ideologically it makes little sense that dronabinol available for off-label prescription by doctors would be dispensed without a prescription by medical cannabis programs anyway. Moreover, there is evidence the dronabinol works4 and no evidence the medical cannabis harms.
Even a cursory read of the Minnesota law, the only state to explicitly allow OSA to be a medical condition in 2017, progressively includes a caution regarding the evolving scientific evidence concerning medical safety, efficacy and tolerability research.5 But no change of approved delivery methods was granted, thus the 2017 petitions for infused edibles, vaporizing or smoking cannabis flowers were refused requests. All patients, after giving special scrutiny and care to their medical condition, should be provided with the full spectrum of treatment alternatives.
The author has seen and approved the manuscript. The author reports no conflicts of interest.
Takakuwa KM. Stop the attack on Minnesota's courageous stance to allow its residents to sleep safely. J Clin Sleep Med. 2018;14(10):1813.
Ramar K, Rosen IM, Kirsch DB, et al. Medical cannabis and the treatment of obstructive sleep apnea: an American Academy of Sleep Medicine position statement. J Clin Sleep Med. 2018;14(4):679–681. [PubMed Central][PubMed]
Whiting PF, Wolff RF, Deshpande S, et al. Cannabinoids for medical use: a systematic review and meta-analysis. JAMA. 2015;313(24):2456–2473. [PubMed]
National Academies of Science, Engineering, and Medicine. The Health Effects of Cannabis and Cannabinoids: The Current State of the Evidence and Recommendations for Research. Washington, DC: The National Academies Press; 2017.
Carley DW, Prasad B, Reide KJ, et al. Pharmacotherapy of apnea by cannabimimetic enhancement, the PACE clinical trial: effects of dronabinol in obstructive sleep apnea. Sleep. 2018;41(1)
Medical cannabis program to add autism and obstructive sleep apnea as qualifying conditions. Minnesota Department of Health website. http://www.health.state.mn.us/news/pressrel/2017/cannabis113017.html. Published November 30, 2017. Accessed May 28, 2018.