Title: Novel approaches in clinical development of cannabinoid drugs
A pamphlet has recently been published that highlights new approaches in the clinical development of cannabinoid-based therapies. The pamphlet begins with a look into how current cannabinoids affect patients based on gender, stress, physiological variations, and also delves into how cannabis works on the body in general.
A novel therapy that features an oral version of tetrahydrocannabinol (THC) and a synthetic activator of cannabinoid-receptor-1 (CB1) is explored in this piece and frames it to be a promising future therapy. The pharmacological properties of these two novel therapies were optimized during development after various analysis techniques, forming medications that the authors hope to see in future clinical trials.
Although the authors remain hopeful that their cannabis-based therapies will reach clinical trials soon, trials featuring cannabinoids are difficult to test in a formal setting because of a dire lack of funding. The federal government still lists cannabis as a Schedule I substance, under the Controlled Substances Act, meaning that the federal government does not support the idea that cannabis has any medical use. Considering the legal status of cannabis, only privately-funded studies are able to take place, and unfortunately, that leaves cannabis research in an area of complete bias and prohibitively underfunded. Considering the massive literature supporting a myriad of novel therapeutic benefits, this is a costly reality to the health and well-being of millions.
In yesterday’s blog post, the discrepancies in the number of medical cannabis users were discussed and the suggestion arose that perhaps medical cannabis use may need stricter regulations. The author of the piece that inspired the letter featured in the post responded, highlighting the possibility that recreational cannabis is being used for medical purposes rather than users obtaining cannabis from more nefarious sources. The author points out that renewing medical licenses can be a hassle and in states where recreational cannabis has been legalized patients may just be obtaining their cannabis, used for medical purposes, from recreational dispensaries. Surveys that delve into this issue are needed to confirm the author’s hypothesis.
Describing the medical process of obtaining a cannabis license as a hassle is, unfortunately, reported by many consumers. State governments are forced to run the regulatory processes, in the absence of federal support, and conservative politicians and opposition groups often create difficulty around opening dispensaries in their districts. On top of the expenses of renewing or obtaining a medical license, it may seem almost less confrontational for people who reside in a state or have access to recreational marijuana (from a state-regulated dispensary) simply to purchase recreational cannabis, rather than take the time to obtain a license.
Of note, Massachusetts is one of the few states that has anticipated this circumstance and has codified protections and advantages of the medical program, into law. In Massachusetts, medical patients are incentivized through robust discounts (totaling greater than $2000 in discounts, and 20% cost reduction because of the absence of state taxation for medical patients.) Further, there are legal protections available only to medical patients, and the opportunity for delivery, which are not available to recreational consumers.
Benjamin Caplan, MDAuthor’s Response to Discrepancies in Medical Cannabis Use
A recent letter to the editor exposes the large discrepancy between the number of registered medical marijuana patients and those who self-reported medical cannabis use. Estimates given by the National Survey on Drug Use and Health (NSDUH) suggest that 2.5% of Americans over the age of 12 used medical cannabis in 2013-2015 but a study from 2016 found that only 641,176 people were licensed to receive medical cannabis, a prevalence of 0.4%. If the numbers published by the NSDUH are accurate then states may need to delve into how so many people are accessing medical cannabis without proper licensing in order to better regulate the supply. If the numbers are extrapolated to 2019 and include all states where medical cannabis use in legal then more than 6.2 million people should be licensed but may not be.
Medical cannabis can be difficult to acquire due to its cost, post-legalization. Although medical cannabis in Massachusetts is readily available with a large number of dispensaries across the state, the cost of obtaining a doctor’s recommendation, complying with state fees, and then paying for the cannabis at a dispensary can be too much for some patients. Although MA will soon be waving the state fee, to obtaining a license, clinicians are still expensive and without the support of the federal government allowing national insurance companies to cover medical cannabis the costs still add up quickly. Fortunately, some dispensaries are designed to cater to those who need financial support.
“Among all surveyed consumers, 49% reported reducing their over-the-counter painkiller use since starting cannabis, and 52% reduced prescription drug use. Another 37% said they’ve reduced alcohol consumption since starting cannabis”
Medical marijuana is legal in 33 states, and recreational marijuana is legal in 11. But on a federal level, the use and possession of marijuana is illegal for any purpose. The illegal status of cannabis prohibits research opportunities and hinders the safety of cannabis sales.
Watch this video for 4 reasons to legalize marijuana on a federal level
Benjamin Caplan, MDVideo: Legalization of Cannabis?
Smoking cannabis brings toxins and unhealthy combustion byproducts into the body. With temps in the ~2000’F range for flame, burning flower incinerates a large portion of the product being consumed. As the distance from the point of flame grows, temperatures are lower, and cannabinoids are vaporizing, in addition to being burned by the flame. Over time, as heating technology has improved, there is no longer a need for blasting temperatures way beyond what the material can safely sustain before turning to tar and ash.
Beyond developed habits of consumption, social familiarity, and simplicity of use, one of the reasons many enjoy combustion is the other effects of heat. As with any human contact with extreme heat, blood rushes to the source of heat, and this may present a platform, through which cannabinoids may enter the bloodstream more quickly. The extravagant heat is also aerosolizing many more cannabis compounds than vaporization temperatures typically support, so the effect of flame is often felt to be more intense.
Vaporizing cannabis, however, is less likely to introduce mutations in the polyphenol compounds found in abundance within cannabis, and some of the mutations create terrible molecules known to be caustic and destructive.
If the medical rationale for vaporizing (over combustion) is not convincing, please consider the financial argument: Though purchasing a vaporizer may be costly, it’s a smart investment that could save money in the long run. Learn more by watching this video:
Benjamin Caplan, MDCannabis: Vaporizing vs Smoking
In Colorado, medical patients are losing priority and rights at dispensaries due to expiring laws, and dispensaries are focusing on rec. cannabis for fiscal purposes. Up to legislation to maintain focus on medical cannabis, which would be the path to federal legalization of cannabis. http://bit.ly/2Ylmamw
Benjamin Caplan, MDColorado Medical Patients losing priority & Rights
MA effectively outlawed the sale of any food products with CBD or products which make therapeutic claims. This is the result of FDA saying that CBD cannot be added to food or dietary supplements. In a state where cannabis is legally accessible, consumers and hemp farmers are very unhappy. What do you think? http://bit.ly/2IOtTRm
Benjamin Caplan, MDIn MA, despite being state-legal, FDA says CBD cannot be added to food or dietary supplements. What now?