Smoke and Mirrors – and Red Tape
Knowledge lags behind practice on medical marijuana. Cutting back on excessive bureaucracy for researchers is likely to help us all catch up.
In August 2016, the US Drug Enforcement Agency (DEA) lifted rules that restricted scientists to a single, government-run source of marijuana for medical research. With medical marijuana legalized in 25 US states, the DEA accepts that an expanded supply and greater variety of marijuana for research is needed.
However, cannabis remains a Schedule I substance in the US, and researchers wishing to study the drug have a number of regulatory hoops to jump through. Funders and review boards are wary of research involving marijuana, creating a somewhat contradictory situation – patients can access marijuana in many states, while medical researchers wishing to carry out clinical trials often cannot. The drug remains Schedule I in part because there is a lack of evidence to justify medical use, but the classification makes it an uphill slog for researchers to generate such evidence – classic catch-22.
Despite the hurdles, there is evidence to suggest that cannabis and its active ingredients are effective in a number of therapeutic areas (1). There are two FDA-approved cannabinoid drugs (Marinol and Syndros) containing one of the main psychoactive ingredients of marijuana, tetrahydrocannabinol (THC), which are used to stimulate appetite in AIDS or cancer patients (2)(3). Sativex, approved in Canada, New Zealand, and several European countries to treat multiple sclerosis-related spasticity, mainly contains THC and non-psychoactive cannabidiol (CBD) (4). CBD is also showing promise in some hard-to-treat epilepsies (5).
The most common reason for a medical marijuana prescription is pain relief. It is thought that cannabinoids may help control chronic neuropathic pain, which – as we learnt in our March feature “The Problem with Pain” (6) – often fails to respond to existing therapies. We need more and larger studies if we’re to determine whether cannabis is an effective painkiller – but research is being held back by the polarized nature of the debate. Meanwhile, patients prescribed medical marijuana are exposed to the risk of an untested product of variable strength and quality.
Though some of those in favor of legalization like to present the drug as a 100 percent safe “cure all”, cannabis – like all drugs – is not without side effects, which makes it all the more important that unbiased, controlled studies are conducted. Only rigorous research can clarify the benefit and harm of medical marijuana – as well as allowing doctors, patients, and governments to make informed decisions.
Read more about the challenges of cannabis research in “The Cannabis Scientist”, a supplement to The Analytical Scientist.
Charlotte Barker
Editor
- PF Whiting et al., “Cannabinoids for medical use: a systematic review and meta-analysis”, JAMA, 313, 2456–2473 (2015). PMID: 26103030.
- Abbvie, “Marinol”, Available at: www.marinol.com, (2016). Accessed September 7, 2016.
- Insys Therapeutics, “Insys therapeutics announces fda approval of Syndros™”, (2016) Available at: www.syndros.com. Accessed September 7, 2016.
- GW Pharmaceuticals, “Sativex”, (2016) Available at: www.gwpharm.com/sativex.aspx. Accessed September 7, 2016.
- O Davinsky et al., “Cannabidiol in patients with treatment-resistant epilepsy: an open-label interventional trial”, Lancet Neurol, 15, 270–278 (2016). PMID: 26724101.
- C Barker, “The Problem with Pain”, The Translational Scientist, 3, 18–27 (2016). Available at: tts.txp.to/0316/pain
“As Editor of The Translational Scientist, I’m working closely with our audience to create vibrant, engaging content that reflects the hard work and passion that goes into bringing new medicines to market. I got my start in biomedical publishing as a commissioning editor for healthcare journals and have spent my career covering everything from early-stage research to clinical medicine, so I know my way around. And I can’t think of a more interesting, challenging or important area to be working in.”