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Cannabis has not been shown to be effective for the treatment of common disorders such as back pain, sciatica, nerve pain and many other chronic and acute pain conditions, according to a new medical practice guideline developed by researchers at the University of Utah and the Rocky Mountain Center for Occupational and Environmental Health (RMCOEH), while high-quality evidence demonstrates that cannabis users are at risk of numerous harmful effects.

The Journal of Occupational and Environmental Medicine published the practice guideline Monday. The guideline, developed through a comprehensive review of peer-reviewed research, specifically addresses the use of cannabis for treating common health conditions and is one of more than two dozen evidence-based practice guidelines from the American College of Occupational and Environmental Medicine (ACOEM).

Kurt Hegmann, MD, a professor within the University of Utah Spencer Fox Eccles School of Medicine and the director of RMCOEH, is editor-in-chief of the ACOEM Guidelines. He said the guideline underscores that cannabis is not a wonder drug that carries no risk of ill effects.

“We were surprised to uncover these findings, which run counter to the popular narrative among the public regarding cannabis use,” Hegmann said. “There is a prevailing attitude among some that cannabis is a cure-all and that there are not serious risks associated with its use. Based on the body of evidence from dozens of peer-reviewed studies that we examined, both of those notions are simply not true.”

Underpinning the guideline are systematic reviews and analyses of more than 50 peer-reviewed studies, most of them randomized trials, that address the use of cannabis for treating common medical disorders. A University of Utah-RMCOEH research team gathered the studies and performed initial analyses, then a panel of 16 medical experts from more than a dozen specialties reviewed the research findings and developed the recommendations in the guideline. The complete guideline underwent external peer review prior to publication.

Based on the analyses of the research base, the guideline recommends against the use of cannabis for treating chronic pain, acute pain, and postoperative pain. It also warns that people who perform safety-critical jobs, from truck drivers to forklift operators, should avoid both medicinal and recreational cannabis. The literature, meanwhile, includes evidence that cannabis use is associated with harmful effects such as dependency, cancer, cardiovascular disease, motor vehicle fatalities, psychosis and schizophrenia.

“At the beginning of the process of developing this guideline, I thought we’d find a more mixed bag with at least a few studies supporting treatment of some common disorders,” Hegmann said. “Frankly, I was surprised by how one-sided the data are across studies regarding the medical benefits of cannabis — or, in this case, the lack of demonstrated medical benefits. As well, it’s concerning that the population-based data on adverse effects are looking a bit like a combination of the early stages of the smoking and opioid epidemics combined with a three-fold risk of schizophrenia added in.”

While covering common disorders, the guideline is not comprehensive. For instance, it did not explore cannabis for the treatment of multiple sclerosis, Parkinson’s disease, or amyotrophic lateral sclerosis. The guideline also notes that cannabis’ classification in the U.S. as a Schedule I drug has limited research into its medical effectiveness, meaning additional studies are needed.

Nonetheless, Matthew Thiese, PhD, a University of Utah and RMCOEH professor involved in the development of the guideline, said the findings from the studies that formed the basis of the guideline are compelling enough to prompt concern, particularly given increasing rates of cannabis usage in recent years as more states have legalized medicinal or recreational marijuana.

“We hope that people beyond just health care providers, who are typically the targets for practice guidelines, sit up and pay attention,” he said. “People need to understand the benefits and risks associated with cannabis use. As far as the research that we explored, it turns out that the benefits are very few while the risks include serious harms.”