The new JAMA review doesn’t say cannabis is useless. It says something more uncomfortable: we’ve been wildly overpromising on thin evidence. FDA-approved cannabinoid medicines have real, documented benefits for a short list of conditions—chemotherapy-related nausea, HIV-related wasting, a few catastrophic seizure disorders. They are standardized, dosed, monitored, and studied. By contrast, dispensary products are a chemical lottery: shifting THC levels, inconsistent CBD content, edibles that peak hours later, concentrates that deliver a psychoactive shock. That chaos makes both benefits and harms harder to predict—and much easier to underestimate.

Across chronic pain, insomnia, anxiety, and everyday “wellness” use, the review finds small, inconsistent gains shadowed by clear risks: psychotic symptoms tied to high-potency THC, cannabis use disorder in nearly a third of medical users, and worrying cardiovascular signals in daily smokers. The message is not prohibitionist; it is clinical. Cannabis is a drug, not a miracle. It demands screening, dose limits, explicit stop rules, and the courage—from both patients and clinicians—to walk away when the numbers don’t justify the hope.