Column: Medical marijuana needs more study – Honolulu Star-Advertiser
Sunday, February 15, 2026 76° Today’s Paper
By Dr. Michael Jaffe
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I arrived at the Hawaii Cannabis Expo before I bought an entrance ticket.
The moment I opened my car door, the unmistakable scent of marijuana wrapped itself around me — an aroma I usually associate with my 7 a.m. runs down Ocean Boulevard in Pacific Beach in my hometown of San Diego.
As a pain management physician who prescribes Hawaii’s 329 medical marijuana card, it’s my professional duty to stay fluent in the ever-expanding alphabet soup of cannabinoids: THC, CBD, and their extended family — CBC, CBG, CBGA, CBNA, CBN, delta-8 THC, CBL, CBLA. At this point, I half expect new letters to appear before I left he expo.
Despite its ubiquitous vibe, marijuana — known locally as pakalolo — is still not legal for recreational use in Hawaii, if you can believe that. Meanwhile, 24 other states have embraced recreational cannabis with open arms and well-stocked dispensaries.
The expo itself leaned heavily toward marijuana seed sales, a booming $44-billion industry in the U.S. Between booths, I waded through racks of cannabis-themed clothing, stickers and an impressive assortment of chocolates, gummies, tinctures, lotions and potions — essentially Bath and Body Works meets Willy Wonka, with a horticultural twist.
Marijuana legislation has been politically charged since the 1990s, and today, 40 states allow medicinal use. But when you look closely at the data — particularly retrospective studies on pain — the benefit is … modest. Cannabis shows about a 21% statistically significant improvement, while placebo clocks in at 17%. That’s a lot of legislation, lobbying and cultural debate over a very slim benefit. Personally, I suspect the original push for medicinal marijuana had less to do with neuropathic pain and more to do with my little brother wanting to smoke at home without getting arrested.
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That said, cannabis isn’t without merit. During a rotation on an inpatient rehab service, I cared for a 19-year-old collegiate basketball player who became quadriplegic after a devastating neck injury. When I took over her case, she was severely underweight and had failed no fewer than eight appetite-stimulating medications. I prescribed marijuana. The next morning, I walked into her room to find a giant bag of Doritos on her bedside table. I quietly thought, problem solved.
But the story doesn’t end there. A sobering 2023 review in the New England Journal of Medicine highlighted rising rates of cannabis-related disorders: intoxication, addiction (affecting up to 40% of adolescent users), anxiety, psychosis, withdrawal, and the particularly cruel phenomenon of cannabis hyperemesis syndrome. Most concerning, adolescents who use cannabis more than four days a week show permanent brain changes associated with lower academic performance, reduced socioeconomic outcomes, and — tragically — more time playing video games in their parents’ basements.
From a judicial standpoint, the cart was clearly placed before the horse when marijuana was legalized. We need higher-powered, well-designed medical studies to determine where cannabis truly fits in evidence-based care. Hopefully, the FDA will soon reclassify marijuana from a Schedule I drug to Schedule III, allowing it to be studied — and prescribed — more responsibly.
One final observation: most of my patients requesting medical marijuana cards don’t come with clean slates. Their urine drug screens often reveal a cornucopia of substances — benzodiazepines, sleep medications, stimulants like Adderall, alcohol and, of course, opioids.
While medicinal marijuana likely has a role in treating pain and suffering — and while I ultimately support federal legalization — my deeper concern remains unchanged. We continue to be a society that reaches for substances to feel better, rather than asking why we feel so bad in the first place.
Michael Jaffe, D.O., is a Kailua physician, board-certified in both physical medicine/rehabilitation and pain management.
500 Ala Moana Blvd. #2-200
Honolulu, HI 96813
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