As cannabis finds its place back into modern human culture quickly, there is much still to be learned. As the science grows and adapts to modern need and expectations, the “can we” may be out-pacing the “should we.” On the other hand, there are circumstances where modern culture really “should be” and is handicapped by years of misinformed stigma.
Here, a few controversial questions about cannabis:
Should teachers be allowed to use cannabis around children?
Should spiritual leaders be allowed to use cannabis, as they have for millennia?
Should taxi drivers be allowed to use cannabis on the job?
Should pilots be allowed to use cannabis?
To explore related information, click the keywords below:
Benjamin Caplan, MDVideo: Controversial Questions in Cannabis Today
Title:Preferences for Medical Marijuana over Prescription Medications Among Persons Living with Chronic Conditions: Alternative, Complementary, and Tapering Uses
In a survey of 30 patients using medical cannabis for a range of diseases including rheumatoid arthritis, cancer, hepatitis C, PTSD, among others, patients reported an array of benefits they have reaped from cannabis use. Patients successfully used cannabis in several ways: as an alternative to prescription medication, complementarily with prescription medicine, and to gradually replace use of prescription medication.
Benefits described by participants included the effects of cannabis lasting longer than that of opioids, lower risk of addiction, fewer side-effects. Patients also saw their sleep, anxiety, appetite, and adverse reactions improve with the use of medical cannabis. Larger, more controlled studies may suggest cannabis more affirmatively as an alternative or complementary therapy with prescription medications.
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.
Title: Neuroanatomical alterations in people with high and low cannabis dependence
A recent article has been published revealing some volumetric alterations in specific brain regions in people who report dependence on cannabis. Magnetic resonance imaging revealed that the volume of certain regions, including the hippocampus, the cerebellum, and the caudate, in cannabis dependent users, were all reduced in size, relative to recreational cannabis users who did not use cannabis chronically. Future research will likely focus on the effects of the structural alterations on patients’ reward, stress, and addiction-relevant circuitry to examine the possible relevance of cannabis dependance on those circuits.
There are certainly possibilities that suggest this volume difference could be of concern, but there are also a great number of explanations (more than likely) whereby this is related to another variable that we have not yet fully appreciated.
Currently, cannabis use is thought to have a little-to-no risk of addiction (beyond any “normal” product of medical value, such as coffee or eyeglasses), because it does not act directly on the reward circuit. Opioids have a high risk of addiction, and therefore a concerning safety profile, in part because of the direct effect of the opioid system on the reward pathway of the central and peripheral nervous systems. While the endocannabinoid system has been observed to act directly up the reward circuit, it does so in subtle, soft ways, making it an ideal adjunct therapy for opioids to help with pain management. Current research provides inconsistent results and appropriately emphasizes a need for more testing to validate the possibility of cannabis as a recommended pain medication.
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
Impacts of cannabinoid epigenetics on human development- reflections on Murphy et. al. ‘cannabinoid exposure and altered DNA methylation in rat and human sperm’ epigenetics
An op-ed has praised the work published last year which exposed how pre-conception exposure to cannabis in males is related to alterations in epigenetic regulation of the central nervous and immune systems. Murphy et. al.’s paper ‘Cannabinoid exposure and altered DNA methylation in rat and human sperm,’ revealed that the sperm cells of men who have consumed cannabis are a key vector that may affect neuraxis, heart blood vessels, immune stimulation, secondary genomic instability, and carcinogenesis in the fetus offspring. The author of the response piece extrapolates the data collected by Murphy et. al. to conclude the genome-epigenome is extremely sensitive to environmental toxicants and that further research should examine the epigenomic toxicology of multiple cannabinoids.
The effect of prenatal exposure to cannabis on birth rates, birth outcomes, and the health of the mother is still uncertain. Studies focussing on cannabis use during pregnancy are limited, and what little has been reported, is inconsistent. The featured article now brings to light that bothparents may need to be cautious when attempting to conceive or when having unprotected sex as cannabis may affect both germ cells. Currently, governing bodies of obstetricians advise that pregnant mothers cease any cannabis use so if someone who needs cannabis for a medical purpose that improves their quality of life becomes pregnant they need to seek out alternative methods of treatment. Research is needed so that pregnant women can safely continue their medication or so that alternatives can be found so that women do not need to suffer for the duration of their pregnancy and possible breastfeeding period.