Recent studies on the use of medical cannabis provide differing evidence regarding the benefits or risks of the drug in medicinal treatments and applications.
The discussion surrounding cannabis is becoming more prevalent within the medical field as its use recreationally and medicinally increases nationwide. At the University of Wisconsin, experts are examining the history, potential advantages and potential downsides of using cannabis as a treatment in a variety of patients.
One of the groups looking at these effects is UW’s Continuing Education Program for pharmacists, which includes a class called Cannabinoids as Medicines. The class is run by Faculty Director of the Carbone Cancer Center Natalie Schmitz and professor of pharmacy and neurology Barry Gidal.
Schmitz and Gidal’s course aims to address the knowledge gap that exists within the medical field when it comes to implementing medical cannabis as an option for patients, while giving students a combination of perspectives from experts on psychiatry, oncology and pharmacy.
Schmitz said the class is important given the current coalescence of cannabis’ increasing application and an undereducated sector of medical experts on the topic, shown through a survey recently done on Wisconsin pharmacists.
“With patients’ increasing use, it’s really important that providers, pharmacists, physicians, nurses — the full care team — is well educated on the topic, because there’s mixed results on the appropriate applications … the potential risks and drug interactions [and] what the appropriate doses are,” Schmitz said.
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According to the Alcohol and Drug Foundation, the benefits of medical cannabis can vary extensively based on the targeted application, along with the specific cannabinoid. There are around 120 different cannabinoids found in the cannabis plant, with the most commonly used being delta-9-tetrahydrocannabinol, or THC, and cannabidiol, or CBD.
Schmitz said CBD dominates as a treatment for different seizure disorders because of its FDA-approved medication, Epidiolex, whereas therapeutic applications of THC focus on pain and relief. Additionally, there is an FDA approved synthesized version of THC targeted for the symptoms of chronic wasting, a consequence commonly seen in patients with HIV or cancer.
According to Schmitz, there are still many unknowns when it comes to the different cannabinoids and each of their target applications, despite confirmed benefits.
“A lot of this hasn’t been rigorously studied and so that’s one of the things we really need to look into,” Schmitz said. “Better understanding the roles of each cannabinoid in different therapeutic indications and how, or if, they are working together in these therapeutic indications.”
Associate pharmacy professor Lucas Richert ties in the classification of cannabis within the Drug Enforcement Administration as Schedule I, categorizing drugs with no medical value and high potential for abuse.
Richert said despite changes being made at the state and national level over the past decade, cannabis is still within the most restrictive category.
“I guess the debate today within pharmacists or physicians is whether or not cannabis is appropriate for a certain mission,” Richert said. “How appropriate is it for a certain condition and how appropriate is it in the absence of randomized control trials?”
Research done in 2017 on the effects of medical cannabis at a national level aimed to answer these types of questions. Using all available and current research at the time, a committee synthesized a Consensus Study Report within the National Academies of Sciences, Engineering and Medicine to conclude which areas of medical cannabis application held promise.
According to the report, there is substantial evidence that cannabinoids are effective for treatments of chronic pain in adults and chemotherapy-induced nausea, along with improving patient-reported multiple sclerosis symptoms.
Furthermore, the study indicated no statistical association between cannabis smoking or use and incidence of lung cancer, head cancers and neck cancers — though all are common concerns that circulate through discussions of cannabinoid use.
When asked about the possible correlation between cancer and cannabinoid use, Schmitz concurred with the 2017 Consensus Study Report’s findings.
“Maybe there’s more research coming out, but typically, cancer isn’t at the forefront of my concerns,” Schmitz said. “The forefront of my concerns is mostly mental health. And if a patient has a history, or current unstable mental illness, if they have a familial history of schizophrenia, those are either contraindications or precautions to using some of these products.”
With cannabis still categorized as Schedule I at the national level and the state of Wisconsin has no laws that legalize it for either recreational or medicinal use, delta-8 THC products have shown a rapid peak in demand throughout the last year.
According to the FDA, Delta-8 Tetrahydrocannabinol is another psychoactive cannabinoid found in the cannabis plant. It occupies a legal grey area within legislative restrictions, allowing many businesses to sell products such as gummies and vaping devices infused with delta-8.
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Despite a limited amount of literature evaluating its therapeutic applications and risks, Schmitz said she expects its regulations to change soon.
“Dr. Heather Barkholtz, who is in forensic toxicology, and I have been talking about putting together a grant to try to evaluate the level of impairment from delta-8 … forensic toxicology labs have seen these THC isoforms show up in toxicology reports, suggesting there could be some level of impairment,” Schmitz said.
According to Richert, the future of medical cannabis and its different cannabinoids rely on a combination of factors at play within the medical community, state governments and private industries.
Some of the factors include whether or not medical cannabis will be covered by health insurance, if state and local governments plan on issuing licenses to medical cannabis companies and the kind of targeted advertising that might take place.
“I think that the mainstreaming of medical cannabis is going to depend a lot on state level industries’ ability to develop products that appeal to customer’s health needs and also whether or not companies are able to work with the government to enable further access,” Richert said.