As of last June, more than one fifth of Americans live in states that have voted to legalize recreational marijuana use. A majority live in states that allow access to medical marijuana. Many say that cannabis oil is amazing for debilitating pains of neuropathy. Weed’s more legally accessible now than it has been since the “Reefer Madness” era; the varieties available now, created with the aid of modern botany and chemistry, are unparalleled in history. With that in mind you might think that scientific researchers would have a pretty good handle on exactly how regular or casual marijuana use affects humans, how medical marijuana should be best used, and what potential risks there may be to cannabis use. But if you thought that the recent warming towards marijuana is fully backed by scientific understanding, you might be surprised. “There are so many basic questions that need to be addressed,” says Ryan Vandrey, an associate professor of psychiatry who researches marijuana at Johns Hopkins Medicine. “The practical use and legalization of these things is happening faster than the science can keep up.” Vandrey and a number of other experts say that even though we know far more about marijuana than we did just a few decades ago, there are important topics — ranging from questions about how marijuana affects the brains of different users to questions about how to make use of medical cannabis — where the legal policy has far outpaced the science. It’s not about being anti- or pro-marijuana, it’s simply that scientists want to know more — especially now, when it’s such an important topic because of the wave of legalization. The Drug Enforcement Agency (DEA) considers marijuana a drug with no medical value, so it’s hard to get approval to research it and impossible to study the cannabis products most people use says sarasota marijuana doctors, since researchers can only give study participants cannabis grown at DEA-approved facilities. “It’s pretty amazing” that we have so many unanswered questions, says Staci Gruber, an associate professor of psychiatry at Harvard Medical School and director of the Marijuana Investigations for Neuroscientific Discovery program at McLean Hospital. “It ain’t new, it’s been around for thousands and thousands of years, it’s not like we just made this in a lab.” Many of the most common inquiries fit into three categories: questions about how recreational marijuana will affect users both young and old; questions about how medical marijuana affects patients; and questions about the marijuana plant itself. And while marijuana is still distressingly hard to research, there are a number of ongoing studies that should help answer some of the most pressing questions. Here’s what we’re learning from that research and what we still need to know. The cannabis plant itself is a fascinating organism, one that humanity has used for thousands of years for reasons ranging from religious rituals to performance enhancement to just plain partying says marijuana doctors in florida. But within that plant there are somewhere around 400 chemical compounds, more than 60 of which are special compounds known as cannabinoids. These bond with a relatively recently discovered system in our brain that interacts with naturally-produced cannabinoids. In every animal, these natural (endogenous) cannabinoids play multiple roles, affecting mood, appetite, memory, consciousness, pain response, blood pressure, and more. The cannabinoids from marijuana tap into that same system, which is why the plant has such wide-ranging effects. We’re pretty far from fully understanding how that system works and even further from understanding all the compounds in fort lauderdale marijuana doctors. The most famous cannabinoid, THC, is largely responsible for marijuana’s ability to get users high. Cannabidiol, CBD, is the next best known — it seems to be important for many medical uses of marijuana. In one of the studies that Gruber’s team is working on at the Marijuana Investigations for Neuroscientific Discovery (MIND) center at McLean Hospital in Massachusetts, researchers are testing to see if CBD can help reduce anxiety. It also plays a role in pain relief and several of the other known medical uses of tampa marijuana doctors. Further complicating this question is the fact that growers create numerous strains of cannabis with different characteristics. We see this most frequently now with high THC strains of marijuana. The data on this isn’t perfect, but it is true you can get stronger pot now than ever before, largely because of innovations in growing practices. Every tweak is going to change the health effects of the plant. High THC plants tend to have low CBD, for example, according to Krista Lisdahl, an associate professor of psychology and director of the Brain Imaging and Neuropsychology Lab. In general, THC potency keeps going up. Lisdahl says this could be worrisome, since there is some research indicating that some of the brain changes seen in heavy marijuana smokers are not present in smokers who smoke higher CBD, lower THC strains. This could make the trend away from CBD a negative for some medical users. At present, that’s hard to study. The marijuana that researchers can give people for experiments has to come from approved facilities and tends to be far weaker than what people actually use. A few lakeland marijuana doctors can walk into a store and buy marijuana but they can’t get approval to give that product to participants in a study. Some states have started to require that marijuana products be tested for potency and to make sure they are free of contaminants Rules that recreational and medical products be tested & started to require testing after approving recreational marijuana, for example. However, it’s not clear that a fully accurate means of testing cannabis products exists yet. One analysis of 75 medical marijuana products purchased in Los Angeles, San Francisco, and Seattle found that only 17% were accurately labeled. Some sort of national standard might require devising more accurate tests. The unknowns about what various cannabinoids do and how they interact with each other create plenty of questions about the best ways to use medical marijuana. But that doesn’t mean we know nothing. The aforementioned NASEM report did find that cannabis (both regular marijuana and various products derived from it) can effectively treat chronic painalong with other conditions, with pain being the reason most people seek it out. Researchers have good reasons to think that in states where people switch from opioids to marijuana to manage pain, overdose and addiction rates are dropping. Even though there’s much to be learned about what sort of cannabis best treats what condition, there are reasons to think it’s effective. “You have to kind of respect the fact that there seem to be people who have very serious health problems and have found positive effects from the use of cannabis,” says Vandrey. “It’s up to us to try to figure out how and why and to develop very specific targeted therapeutics based on what we can find out.” She stresses that it’s really early to draw conclusions from this ongoing work. But one of the first studies to come out of this particular project had an encouraging finding. Their preliminary results showed that three months into their medical marijuana treatment, a group of users (24 people, still relatively small) showed significant improvement in tests of cognitive function. Tests of heavy recreational smokers in the past have shown worse cognitive function. This was the opposite. One research effort that Lisdahl is involved in right now could help change uncover some of these mysteries. The ABCD Study is “extremely exciting, not just for marijuana — there are hundreds of things we can look at,” she says. ABCD is a research effort that will follow 10,000 kids around the country — starting when they are 9 or 10 years old— for 10 years. It’s coordinated out of UCSD and there are 21 different sites around the country. For instance, a lot of baby boomers have started smoking pot regularly since it was legalized — or started smoking again — and we don’t know much about the effects that might have. It’s important to learn how safe marijuana is for pregnant women. There are connections between marijuana use, low birth weight, and time spent in the NICU for infants, so we certainly can’t say it’s safe, even if some women are already using it to control nausea.
A new drug derived from marijuana just became the first of its kind to get the green light from the US government.
Called Epidiolex, the drug is designed to treat two rare forms of childhood epilepsy using a cannabis compound called cannabidiol (or CBD).
British-based GW Pharmaceuticals makes the drug. It does not contain THC, the well-known psychoactive component of marijuana responsible for the drug’s characteristic high.
The federal thumbs-up comes on the heels of several months of promising research results and a positive preliminary vote from the Food and Drug Administration this spring. Experts are hopeful that the approval will unleash a wave of new interest in the potential medical applications of CBD and other marijuana compounds.
“This approval serves as a reminder,” Scott Gottlieb, the FDA commissioner, said in a statement on Monday, “that advancing sound development programs that properly evaluate active ingredients contained in marijuana can lead to important medical therapies.”
In three large clinical trials which the FDA considered before giving Epidiolex the official green light, researchers presented strong evidence that the pharmaceutical-grade CBD in the medicine had the power to significantly curb some of the worst symptoms of two of the hardest-to-treat forms of epilepsy, known as Lennox-Gastaut syndrome and Dravet syndrome.
“This is clearly a breakthrough drug for an awful disease,” John Mendelson, a panel member and senior scientist at the Friends Research Institute, said at a public FDA meeting this spring that was called to discuss the scientific merits of the drug.
But although the green light means that patients will soon be able to access Epidiolex with a doctor’s prescription, many will also likely turn to less expensive sources of CBD, such as those sold in marijuana dispensaries. Researchers and advocates cautioned against this, however, with the caveat that it’s impossible to verify that what’s in those products is actually pharmaceutical-grade CBD.
Starting last spring with a study presented at the American Academy of Neurology’s yearly meeting in Boston, GW Pharmaceuticals has consistently presented strong clinical studies that appear to support Epidiolex.
“There’s a boatload of evidence to show for this drug at this point,” Orrin Devinsky, a lead author on one of those studies and a neurologist at NYU Langone Health.
A month after the Neurology meeting, Devinksy and his colleagues published a positive study of the drug in children with Dravet syndrome in the New England Journal of Medicine. Roughly 43% of the children in that study who got the drug saw their number of seizures cut in half, and 5% stopped having seizures entirely. In comparison, children who got a placebo had barely any noticeable change in their symptoms.
Almost exactly a year later, Devinksy and his team followed up those results with another favorable study in the same journal using a smaller dose of the drug in patients with Lennox-Gastaut. Devinsky said that low dose might be “the sweet spot” where most patients can achieve relief from symptoms without any unwanted side effects, such as drowsiness.
Also, although Epidiolex is designed to treat only two types of epilepsy, medical professionals and Florida marijuana doctors can technically prescribe it “off-label” for other conditions as well. (The anesthetic ketamine, for example, is prescribed this way for some hard-to-treat forms of depression.)
“We would expect that once this is approved as a drug it’s quite likely this will be tried in other populations off-label so it has a big opportunity to affect others,” Lubbers said.
Epidiolex vs. other CBD products
Scientists and advocates representing families of patients with epilepsy are hailing Epidiolex’s arrival as a long-awaited treatment. But they are also aware that desperate patients — especially parents of young children — may actively seek alternate sources of CBD that may be cheaper and don’t require a doctor’s prescription.
In states where marijuana is legal (or in states with laws legalizing CBD on its own), oils and salves made with CBD are widely available. But experts caution that these products may not be what they seem.
“What’s different with [Epidiolex] is that this is a well-studied and well-controlled product,” Laura Lubbers, the chief scientific officer of a nonprofit called Cure that funds epilepsy research.
But most dispensary-grade CBD products are not well-studied or well-controlled.
For a 2017 study published in the Journal of the American Medical Association, researchers tested 84 products purchased from 31 different online CBD sellers. Roughly seven out of 10 items had different levels of CBD than what was written on the label. Of all of the items they tested, roughly half of the items had more CBD than was indicated; a quarter had less. And 18 of the samples tested positive for THC, despite it not being listed on the label.
“The main thing is that CBD as approved by the FDA is pharmaceutical-grade CBD. It’s manufactured under stringent standards, the same as other FDA-approved drugs,” Shlomo Shinnar, the president of the American Epilepsy Society and a professor of neurology and epidemiology at the Albert Einstein College of Medicine. “That’s not the same as when people tell you, ‘Oh, I’ve got marijuana and it’s high in CBD,’ or ‘Oh, I’ve got a CBD product.'”
Epidiolex’s approval could also be a powerful catalyst for deeper research into other marijuana-derived medicines. Cannabis has more than 400 compounds, of which CBD and THC are only two, and researchers think the others could hold promise as well.
The drug’s green light also means that the Drug Enforcement Agency now has 90 days to reschedule CBD, which it listed in January of last year as a “marijuana extract” separate from “marijuana” or THC.
That means instead of being listed alongside marijuana as a Schedule 1 drug with “no currently accepted medical use,” CBD will soon be categorized as either a Schedule 2 or 3 drug, much like the popular ADHD medication Adderall.
Once that happens, it’ll unleash what Carreno called a “sea change” for CBD manufacturers and the industry as a whole, which up until this point has existed in a legal grey area.
Apart from CBD, researchers are also actively studying THC and other marijuana compounds for a range of potential medical uses, from relieving pain to soothing severe nausea. Although Epidiolex is the first marijuana plant-based drug to land FDA approval, the agency has already given the green light to drugs whose active ingredient is a lab-made version of THC, for example.
In the meantime, experts look forward to seeing Epidiolex made available to patients in need.