Posts Tagged ‘drug policy’
By: Kseniya Golovnina, PhD
On November 8th 2016, nine states voted on legalizing recreational and medical marijuana (Cannabis L.). All US presidential candidates supported relaxing current restrictions on marijuana use. Since 2011, more than 50% of Americans consistently show positive attitudes towards legalizing marijuana. It is estimated that marijuana industry tax revenues for federal, state and local governments could total up to $28 billion. In addition to tax revenues, the non-profit advocacy group the Drug Policy Alliance highlights that marijuana legalization will reduce harm to young people and people of color, create new jobs, save money on law enforcement, and promote development of tests for drug impairment.
One of the challenges in marijuana regulation is how it is generally perceived—either as a drug or as a harmless recreation. On the one hand, it is a central component of the long standing ‘war on drugs’ that is a primary part of US law enforcement. According to the legal system, marijuana remains classified as a Schedule I substance under the Comprehensive Drug Abuse Prevention and Control Act of 1970, along with heroin. On the other, prominent thinkers argue that it is a drug of choice, without a known lethal case, which helps produce serenity and insight, and should be regulated as alcohol and tobacco. Recent policy shifts will strike a new balance between these views.
While prohibited at the Federal level, marijuana decriminalization laws have been passed in several states by lawmakers, and often through public ballot measures. In 25 states, Cannabis is legal for medical use and in 5 states, for recreational use. Out of the 9 states that voted on Nov 8, only Arizona hasn’t supported marijuana initiatives. In 2013, the Obama administration clarified Federal marijuana enforcement to deemphasize some criminal behavior, and remain in harmony with new and evolving state laws. The US Congress is acting as well, with a petition introduced (the CARERS Act) intended to remove conflicts between state and federal laws.
Marijuana in science
Shown clearly by these recent political trends, the public attitude has been shifting rapidly, and legalization appears to be only an issue of time. From a scientific point of view, legalization of Cannabis will open the door for robust federally approved research on marijuana’s therapeutic value. The reasonable scientific question now is whether and to what degree Cannabis can be a real new frontier of therapeutics?
Marijuana chemical science started from the identification of THC (delta-9-tetrahydrocannabinol) as the main active ingredient. Today, more than 460 chemicals are known to be Cannabis ingredients, more than 60 of which are grouped under the name cannabinoids. In the early 1990s, cannabinoid (CB) receptors were discovered and cloned. Cannabinoids, along with their receptors, make up the endocannabinoid (EC) system, which participates in the regulation of neurotransmission. Surprisingly, a number of chocolate-derived chemicals can activate the human cannabinoid system, both directly and indirectly, suggesting that chocolate and marijuana can have overlapping effects. The identification of natural agonists anandamide and 2-arachidonylglycerol, which also act on CB receptors, has stimulated interest in the medical uses of Cannabis. On PubMed the number of publications with the term “cannabis” has increased from 71 in 1990 to 1195 in 2016, revealing both the unexpected Cannabis therapeutic horizons and warnings about its effect on adolescent brain.
A 2003 review on cannabinoids as potential anticancer agents reported, “cannabinoids have favorable drug-safety profiles and do not produce the generalized toxic effects of conventional chemotherapies.” Thirteen years later in 2016, cancer therapy using cannabinoids is still paradoxical but evident. In 2006, based on the analysis of 72 controlled studies evaluating the therapeutic effects of cannabinoids, it was shown that “cannabinoids present an interesting therapeutic potential as antiemetics, appetite stimulants in debilitating diseases (cancer and AIDS), analgesics, and in the treatment of multiple sclerosis, spinal cord injuries, Tourette’s syndrome, epilepsy and glaucoma”. A potential antipsychotic effect of cannabidiol was also reported in 2012. At the 2015 AAAS Annual Meeting, researcher Mark Ware from McGill University Health Centre in Montreal, Canada, reported, “it’s clear that the weight of evidence now is such that cannabinoids are analgesic drugs,” while also emphasized that more studies are needed to understand the best dosing and delivery methods for medical use.
A search on the website ClinicalTrials.gov, maintained by the National Institutes of Health shows 557 clinical trials with ‘known status’ for the term “cannabis” as of October 26, 2016. More than one hundred of them are open now. Topics for these studies relate to Cannabis abuse as well as new treatments for a variety of medical conditions such as schizophrenia, cancer, autoimmune diseases, epilepsy, musculoskeletal diseases, and others. For example, GW Pharmaceuticals Ltd. was conducting clinical trials with Nabiximols (trade name Sativex) to investigate its safety in treating cancer pain. However, out of ten cannabis-related drugs on the world market, only three (including Sativex) are approved for medical use in the US.
Legalization, public interest and scientific research on Cannabis has promoted regulatory agencies such as the Food and Drug Administration (FDA) to develop new policies and guidance. It is stated on the official FDA website that “the FDA supports researchers who conduct adequate and well-controlled clinical trials which may lead to the development of safe and effective marijuana products to treat medical conditions.” Non-profit US Pharmacopeial Convention (USP), a known leader in developing and controlling drug standards, has organized a Cannabis expert committee to develop USP Standards for medical Cannabis. Their aim is to control quality specifications for the Cannabis used in clinical studies.
While the frontier of science appears to be opening for Cannabis in the US, the regulatory regime will need to keep pace. As medical use legalization proliferates, there will be a strong, even urgent need to revamp regulation to accommodate and emphasize research and best uses. Until the regulations are properly developed there will be some uncomfortable unknowns from a public health perspective, leading to greater risks and missed benefits.
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