WASHINGTON — Healthcare providers don’t know enough about cannabis to talk with patients about the potential risks and benefits, witnesses said at a mid-January House Energy and Commerce Health Subcommittee hearing.
“We need to have much more education with respect to how the use of marijuana products can negatively impact or help someone,” said Nora Volkow, MD, director of the National Institute on Drug Abuse (NIDA). “The problem is we do not have sufficient evidence that could help us mount those programs in a way that’s actually required. At this point, I don’t feel the evidence is sufficient to say, ‘We’re going to recommend that this product should be used by this patient.'” For example, elderly patients who take marijuana-containing products may be on a lot of other medications, and little is known about potential interactions between marijuana and prescription drugs. “So I do believe in the importance of expanding our knowledge so we can develop educational training programs that are based on knowledge, not on anecdote.”
Making it Easier to Research Cannabis
Rep. John Sarbanes (D-Md.) noted that a 2015 survey of healthcare providers concluded that the providers “perceive a knowledge gap related to cannabis dosing, treatment plans, and different areas related to cannabis products, so providers themselves realize the need for research and expertise to be developed in this area.”
The hearing was held to discuss six bills on cannabis, several of which were aimed at making it easier for researchers to obtain cannabis for research purposes. Currently, the only cannabis legally available for research comes from a single farm housed at the University of Mississippi, and researchers who want to use it must get permission from three agencies: the FDA, the Drug Enforcement Administration (DEA), and the NIH. “We need to figure out a way to take advantage of different producers of cannabis plants to evaluate the diversity of products out there, as opposed to limiting us to the Mississippi farm,” said Volkow.
Rep. Kurt Schrader (D-Ore.) agreed. “The sad part is we’re not testing the right stuff,” he said. “I fail to understand why we have one bloody facility that is the sole nexus for research and analysis of CBD [cannabidiol] products. It seems to me we ought to be testing products on the marketplace.” Subcommittee chairman Anna Eshoo (D-Calif.) agreed. “I don’t understand why the three agencies before us can’t get this done,” she said, referring to NIDA, the FDA, and the DEA, which all had officials testifying at the hearing.
The Cannabis Research “Catch-22”
Several subcommittee members expressed frustration over what they called the “Catch 22” problem that cannabis researchers face. “They can’t conduct cannabis research until they can show cannabis has a medical use, but they can’t demonstrate cannabis has a medical use until they conduct research. It doesn’t make sense,” said Eshoo.
“You’ve got to help us figure out how we’re going to get out of this Catch 22,” Rep. Debbie Dingell (D-Mich.) said to the witnesses at the hearing. “This lack of knowledge poses a public health risk.”
One issue with conducting research on marijuana is its classification as a Schedule 1 drug; these are substances deemed to have no medical value and have a high potential for abuse, and their availability is highly restricted. Several bills the subcommittee is considering, including the Legitimate Use of Medicinal Marijuana Act, the Marijuana Freedom and Opportunity Act, and the Marijuana Opportunity Reinvestment and Expungement (MORE) Act, would either downgrade marijuana from a Schedule 1 drug to a Schedule 2 drug, which has fewer restrictions, or remove it from the drug schedule altogether.
Rep. Michael Burgess, MD (R-Texas), the subcommittee’s ranking member, said the latter “is going too far,” adding that “using our congressional authority to override this may be a dangerous move, especially given the lack of research.”
So far, only one marijuana-related drug has been approved by the FDA: Epidiolex, which contains cannabidiol, was approved in June 2018 for treating a rare seizure disorder in patients ages 2 and over.
Diverse Testimony from Both Sides of the Aisle
Both the witnesses and the subcommittee members seemed divided on marijuana’s potential harms and benefits for patients. Volkow mentioned research showing that cannabis exposure during pregnancy was associated with low birthweight and preterm delivery, and added that it was also linked with episodes of psychosis. She also said that there was some evidence that cannabis may be useful in treating spasticity, multiple sclerosis, and pain, “but otherwise there is little benefit for other indications for which patients are using it.”
Rep. Morgan Griffith (R-Va.) said that his support of medical marijuana began some years ago when he learned that people were smuggling marijuana into a Virginia hospital to help a terminally ill father who wanted to be feeling well enough to spend time with his 2-year-old son. Years later, when he told that story at a high school town hall, one student raised his hand and said, “They did that for my daddy too.”
“These communities were 20 years apart, 30 years apart, yet doctors were turning a blind eye to allow marijuana to be brought into the hospital because they recognized that for those patients who are dying, that was the only way they would get relief and get the nutrients they needed to spend a little more time with their children,” Griffith said.
Rep. Greg Gianforte (R-Mont.) said he was opposed to efforts to “make any Schedule 1 drug legal without adequate research.” Instead, “we should focus on combating addiction,” he said.
by Joyce Frieden, News Editor, MedPage Today
Originally published in MedPage Today
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