NASEM Report:Removing Barriers to Cannabis Research
By
Dr.Ali Fourkan
Last
month, the National Academies of Science, Engineering, and Medicine (NASEM)
released a major new report on the health effects of cannabis and its
constituent compounds, based on a comprehensive assessment of research
conducted since 1999. The National Academy of Medicine, formerly the Institute
of Medicine (IOM), is a nonprofit organization of medical and health
professionals whose reports provide independent research reviews and recommendations
on pressing issues in the field. The Health Effects of
Cannabis and Cannabinoids is
its first report on the subject since 1999, when (as the IOM) the organization
reached the conclusion that "accumulated data indicate a potential
therapeutic value for cannabinoid drugs, particularly for symptoms such as pain
relief, control of nausea and vomiting, and appetite stimulation."
The
new report is based on reviews of research on both the cannabis plant itself
and its constituents, but its conclusions are substantially similar to the 1999
report: While cannabis use, particularly smoked cannabis, poses some long-term
health and safety risks, there is evidence that cannabis or cannabinoids can
treat certain medical conditions, which include nausea and vomiting from
chemotherapy, spasticity from multiple sclerosis, and pain. However, most
research to date on the therapeutic potential of cannabinoids has studied
individual cannabinoid chemicals, especially delta-9-tetrahydrocannabinol (THC)
and cannabidiol (CBD). And while the full report is highly detailed and
provides appropriate caveats for the limitations of the research, I have concerns
that the report summary and press coverage may give the impression that the
findings apply equally to the cannabis plant ("medical marijuana")
and to the cannabinoid formulations that have undergone rigorous clinical
trials. In addressing potential therapeutic benefits of the cannabis plant and
its constituents, it is important to explicitly identify the cannabinoid tested
to avoid mistakes such as ascribing the potential antiepileptic effects of CBD
to "marijuana," which usually contains less than 1 percent of this
cannabinoid.
Even
the existing evidence on cannabis and cannabinoids for pain, rated as
"strong" in the NASEM report, is based on research with limitations.
For studies using the cannabis plant (5 total), the sample sizes were small,
studies were short (with duration under 2 weeks, which is too short to assess
effectiveness for chronic pain), and they were subject to problems with
blinding. The strongest evidence comes from studies with isolated cannabinoid
compounds (e.g., THC), not the whole plant. Nevertheless, there are modest but
consistent positive findings reported for treating certain types of pain with
cannabis, suggesting a promising area for further therapeutic
development.
"Medical
marijuana" that has any appreciable THC content may have notable adverse
side effects, including impairment of judgment and motor function and the risk
of addiction. Unfortunately, there are currently no consistent quality
controls, no assurances that patients are informed about side effects, and
unclear recommendations about dosing and route of administration. It is
important for people to understand the range of effects produced by cannabis as
they weigh the risks and benefits for treating their health conditions with
products from state dispensaries.
Regarding
long-term psychosocial and mental health risks of marijuana use, the report
largely supports the conclusion that use during adolescence is associated with
various adverse outcomes and that it is associated with increased risk of
psychosis and psychotic disorder and can worsen symptoms of these disorders.
The report also found that cannabis use is associated with an increased risk
for developing substance dependence other than cannabis use disorder. However,
it did not find evidence that cannabis use raises risk of depression, anxiety,
or post-traumatic stress disorder (PTSD), and it found only moderate support
for links between cannabis use and poor academic achievement and educational
outcomes. The NIDA does not concur with the latter conclusion: While it is true
that the available data cannot establish causality of these adverse outcomes,
the statistical association is consistent, substantial, and dose-related,
especially for early and heavy use.
Regarding
physical health effects of marijuana use, the report found a lack of clear
evidence for any link to heart attack or stroke and lack of an association with
cancers of the lung, head, and neck. Our sister Institute, the National Cancer
Institute, does not concur with the strength of that conclusion, since
disentangling the effects of tobacco from cannabis can be challenging and some
data do suggest that a link to these cancers may exist. The report did
find a link to low birth weight in babies born to mothers who used cannabis
while pregnant but insufficient evidence at this point to draw strong
conclusions on other childhood outcomes of prenatal exposure.
The
NIDA strongly agrees with the report’s finding that there are impediments to
performing quality research on cannabis and cannabinoids and that there is a
need to address these impediments so that researchers can draw more confident
conclusions. The report makes four major recommendations:
Address
research gaps across the areas of basic and clinical research, policy, and
public health and safety.
Identify
strategies to improve the quality of research on cannabis, including better
research standards and benchmarks.
Strengthen
federal and state-based public health surveillance efforts to better track the
effects of new policies.
Address
regulatory barriers to cannabis research.
Although
a single report could not hope to address all the complexities of cannabis,
cannabinoids, and their health effects, NASEM is to be commended for tackling a
massive and often contradictory literature and for making a strong case for the
need for further research. We will have more confident conclusions about this
drug's benefits and its harms only when it is easier for qualified researchers
across the country to do high-quality research.
The
Writer Teacher & Columnist
8801611579267
Dr.fourkanali@gmail.com
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