title: Evaluation of herbal cannabis characteristics by medical users: a randomized trial.
abstract: BACKGROUND
  Cannabis, in herbal form, is widely used as self-medication by patients with diseases such as HIV/AIDS and multiple sclerosis suffering from symptoms including pain, muscle spasticity, stress and insomnia. Valid clinical studies of herbal cannabis require a product which is acceptable to patients in order to maximize adherence to study protocols.
  
  
  METHODS
  We conducted a randomized controlled crossover trial of 4 different herbal cannabis preparations among 8 experienced and authorized cannabis users with chronic pain. Preparations were varied with respect to grind size, THC content and humidity. Subjects received each preparation on a separate day and prepared the drug in their usual way in a dedicated and licensed clinical facility. They were asked to evaluate the products based on appearance (smell, colour, humidity, grind size, ease of preparation and overall appearance) and smoking characteristics (burn rate, hotness, harshness and taste). Five-point Likert scores were assigned to each characteristic. Scores were compared between preparations using ANOVA.
  
  
  RESULTS
  Seven subjects completed the study, and the product with highest THC content (12%), highest humidity (14%) and largest grind size (10 mm) was rated highest overall. Significant differences were noted between preparations on overall appearance and colour (p = 0.003).
  
  
  CONCLUSIONS
  While the small size of the study precludes broad conclusions, the study shows that medical cannabis users can appreciate differences in herbal product. A more acceptable cannabis product may increase recruitment and retention in clinical studies of medical cannabis.
authors.affiliation: Department of Anesthesia, McGill University, Montreal, Quebec, Canada. mark.ware@muhc.mcgill.ca
authors.forename: Mark A
authors.initials: MA
authors.lastname: Ware
authors.forename: Thierry
authors.initials: T
authors.lastname: Ducruet
authors.forename: Ann R
authors.initials: AR
authors.lastname: Robinson