Where are we with medical cannabis research?
How far has medical cannabis research come? What are the challenges today?
There has been a dramatic uptick in cannabis research in recent years, but this field is still in its infancy because research was halted around the world half a century ago. So we are just scratching the surface. It is difficult to get federal approval to study cannabis, and researchers are limited in what types of cannabis they can study. The stigma of cannabis has alienated a lot of researchers who don’t want be associated with it.
But the biggest challenge is the lack of funding for researching the medical use of cannabis. It is incredibly difficult to get federal funding to study the medical use of cannabis because it is classified as a Schedule I drug, and Schedule I drugs are defined by the government as having “no currently accepted medical use.” Moreover, pharmaceutical companies only want to fund research into their proprietary cannabinoids, and universities also can’t take funding from federally illegal cannabis companies. So for our researchers at the UCLA Cannabis Research Initiative who want to study the medical use of naturally occurring cannabis compounds, we really have only one option—private donors.
Can you give us a rundown of the recent Medical Cannabis Research Act and how that affects your work?
The bill does two things: It forces the federal government to increase the number of federally licensed producers of cannabis. Currently there is only one, the University of Mississippi, and it’s been the sole licensed producer for half a century.
The second thing it does is allow VA health care providers to inform their patients about federally approved clinical trials of cannabis. Previously, federally approved clinical trials of cannabis that involved veterans—such as Dr. Sue Sisley and Dr. Bonn-Miller’s clinical trial of smoked cannabis for post-traumatic stress disorder—had difficulty recruiting veterans because the VA would not allow their employees to advertise the study to veterans.
What are the misconceptions surrounding medical cannabis?
The biggest misconception is that you have to get “high” to get a medicinal benefit. In many studies of cannabis or cannabinoids for pain, folks were getting pain relief with minimal to no psychoactivity. In fact, at high doses, THC can actually make pain worse.
What current research are you focusing on? What are you excited about?
We have more than a dozen studies looking at the impacts of cannabis on the aging brain, how to treat adolescents who are abusing cannabis, how CBD can treat pediatric neurologic diseases, how cannabinoids can treat autoimmune diseases like lupus, etc. We are also developing some of the world’s first human studies on the use of cannabis and cannabinoids to treat opioid use disorder, to prevent or slow Alzheimer’s disease, and to increase survival in cancer patients. However, again, locating funding to launch these studies has been difficult.
One area that we are particularly excited about is understanding how cannabis compounds may be able to reduce opioid use in chronic-pain patients, reduce opioid withdrawal symptoms, and prevent relapse in folks who are recovering from opioid use disorder. We realize we are in our nation’s worst opioid epidemic in history, and it’s incredibly urgent and important that we apply modern science to cannabis and understand if it could play a role in helping the opioid epidemic.
What do we know about medical cannabis so far?
First off, there have been no randomized placebo-controlled studies of cannabis done in humans for most of the conditions that people anecdotally use cannabis for. Right now, the state of the evidence is largely limited to animal studies and observational studies, neither of which are reliable. Time and time again, what we see in animal studies doesn’t pan out for humans. And the results from observational studies are subject to large placebo effects, which are even stronger for cannabis because of its “miraculous” reputation.
The conditions we do have good human data for benefit are chronic pain, nausea and vomiting related to chemotherapy, muscle spasticity in multiple sclerosis, and certain pediatric epilepsy conditions. Yes, cannabis is addictive (both psychologically and physically), although most people who use cannabis do not develop addiction or cannabis use disorder. And the data we have on the abuse potential and health risks of cannabis are largely drawn from studies looking at recreational use of high-THC cannabis that was combusted and inhaled. What we don’t know is if those risks are similar or different for other types of cannabis and ingestion methods—for example, someone who is medically using a high-CBD cannabis product that is orally ingested.
What do we know about the side effects of cannabis when taken with other medications?
Both THC and CBD may interact with other medications. For example, THC may decrease blood levels of antipsychotics or antidepressants and decrease their effectiveness. On the other hand, CBD may boost blood levels of benzodiazepines, antidepressants, antipsychotics, blood-thinning medication, etc., which could increase toxicity and side effects from these medications. Thus, it’s important to tell your doctor about the cannabis products you are using so they can monitor for any potential interactions with your other medication.
How does your research help guide regulation and policy?
Regulation and policy are intended to maximize public benefit while minimizing risk, so our research provides the data for informed decisions. Unfortunately, because research has been stymied for half a century, right now there isn’t a lot of good data to guide cannabis policy and regulation.
What does the future of medical cannabis look like? Do you think it will ever be fully studied and understood?
This plant can be understood, but it will take considerable time because of the hundreds of compounds within it and the multitude of ways to consume it. The future of cannabis is where we understand what types of cannabis or combinations of cannabinoids, at what dosage, using which consumption method, for what type of person, with which disease, could provide benefit or could harm them. We are particularly concerned about the risks of cannabis to certain vulnerable populations, like folks with mental health issues, adolescents with developing brains, and pregnant woman.
We've commonly heard the comment that marijuana is a plant and therefore can’t be dangerous. What’s your response to this?
There are lots of dangerous and poisonous plants. Heroin is made from the poppy plant. Nightshade can kill you. Cannabis is not harmless, but its harms have been overstated in the past, like in the movie Reefer Madness.