Researchers push past restrictions and stigmas to advance our understanding of cannabis
If you've read through several articles of Learn, you might have gathered that cannabis is not widely accepted or understood by the majority of the public. Some of this has to do with stigma, but the lack of education is also is attributed to some of the restrictions placed on cannabis research — despite growing interest in cannabis.
In August of 2016, the United States Drug Enforcement Agency (DEA) denied a petition to reclassify cannabis on the schedule of controlled substances. This announcement was actually the third time the DEA has denied such a petition and the decision was largely rooted in input from the Food and Drug Administration (FDA). In short, the FDA stated that there simply isn't enough evidence to support the safety and effectiveness of cannabis as a medicine.
Meanwhile, the National Academies of Sciences, Engineering, and Medicine (NASEM) was hard at work on an exhaustive review of the health risks and benefits of cannabis and cannabinoids. The team of experts that conducted this review combed through more than 10,000 studies in humans that had been conducted since 1999. In their report, researchers drew a number of important conclusions.
Cannabis does, indeed, have notable therapeutic effects. Cannabinoids are an effective antiemetic agent for people with chemotherapy-induced nausea and vomiting. Adults with chronic pain experience a significant reduction in pain symptoms when they use cannabis. Cannabinoids also improve muscle spasms for people that suffer from multiple sclerosis (MS). For all other health conditions, there isn't enough evidence to make an accurate assessment of cannabis' effectiveness. This is even true for Epidiolex, the pharmaceutical grade CBD oil that may soon be an FDA-approved drug for pediatric epilepsy. As of December 2017, 182 clinical studies are either actively underway or enrolling research participants. This body of work is evolving by the day and covers a wide range of health conditions from autism to post-traumatic stress.
The NASEM report also highlights some of the more notable risks of using cannabis. A number of poor outcomes are associated with cannabis smoke, including chronic coughing and low infant birth weight if mothers smoke during pregnancy. It's also an exceedingly bad idea to consume cannabis as an adolescent. Adolescent cannabis use is linked to psychosis (schizophrenic symptoms), substance use disorder, diminished academic performance, diminished employment, and income prospects, as well as impaired social relationships.
US-based clinical research on cannabis is exceedingly and unnecessarily difficult to conduct. Obtaining FDA approval for a clinical trial and obtaining a Schedule I license to possess and conduct research with cannabinoids takes an agonizing amount of time. Neither the DEA nor the FDA has any requirements on how quickly they must process requests for research, so the work regularly stagnates. Furthermore, the only legal source of whole-plant cannabis for research is the National Institute on Drug Abuse (NIDA). Even in recreationally legal states, it's still illegal for a licensed producer to provide cannabis products to scientists and doctors for research. Additionally, it's illegal to purchase or receive donated material, as this is considered trafficking of a Schedule I federally prohibited substance.
Not only does the NIDA monopoly create a bottleneck and unnecessary delay in carrying out research, the product itself in no way resembles what is available at a local dispensary in regulated markets. The potency is infamously low in terms of THC and CBD percentage and there are significant safety concerns over the mold and pathogens that are commonly found in the NIDA supply. In fact, NIDA cannabis would not pass the safety requirements to be sold on the shelves of cannabis retailers in the state of Oregon. Furthermore, there is currently no legal source of cannabis for large-scale Phase III clinical trials. Researchers are only able to complete Phase II under the current law. Without Phase III trials, the FDA will never have the level of evidence it requires to recommend rescheduling cannabis.
Fortunately, the research support from the Israeli and Canadian governments (among others) ensures that even while US science stalls, work continues worldwide.