02-23-2022 Primetime Living - Flipbook - Page 23
A Special Advertising Section of Baltimore Sun Media Group | Wednesday, February 23, 2022 23
Medical marajuana, continued
from previous page
Cannabis Sativa plant with THC and are
pyschotropic.
Industrial Hemp: Cannabis sativa plants
with very little Delta-9-THC, mandated to be
0.3 percent or less. It still has other cannabinoids, mainly CBD.
Cannabis v. Hemp: They are the same
plant. But if there is more than 0.3 percent
THC, it’s usually called marijuana and is
federally illegal whereas hemp is no longer a
controlled substance in the U.S.
The products you find in dispensaries –
edibles, oils, topicals, beauty products and
even dog treats – contain THC or CBD, or
sometimes both.
“As of May 2021,” according to National
Conference of State Legislators, “36 states
and four territories allow for the medical
use of cannabis products.” Several other
sources say it’s 39 states plus the District
of Columbia. Five states have legalized the
use of CBD oil only. And, as of November
29, 2021, 18 states, two territories and the
District of Columbia have enacted legislation to regulate cannabis for nonmedical use
(a.k.a. adult “recreational use”).
In the Drug Enforcement Administration’s
(DEA) handout on marijuana, it says,
“Marijuana is a Schedule I substance under
the Controlled Substances Act, meaning
that it has a high potential for abuse, no
currently accepted medical use in treatment
in the United States, and a lack of accepted
safety for use under medical supervision.”
In other words, it’s classified the same
as heroin. But unlike heroin, it says, “No
deaths from overdose of marijuana have
been reported.”
It adds, “To date, the FDA (U.S. Food
and Drug Administration) has not approved
a marketing application for cannabis for the
treatment of any disease or condition. It has,
however, approved one cannabis-derived
and three cannabis-related drug products.
These approved products are only available
with a prescription from a licensed healthcare provider.”
NCCIH says, “Drugs containing cannabinoids may be helpful in treating certain
rare forms of epilepsy, nausea and vomiting
associated with cancer chemotherapy, and
loss of appetite and weight loss associated
with HIV/AIDS. In addition, some evidence
suggests modest benefits of cannabis or
cannabinoids for chronic pain and multiple
sclerosis symptoms.”
So much for “no current medical use.” At
least the potential benefits are being studied
and evaluated by many researchers including Vandrey at Johns Hopkins.
Vandrey clarifies the status of all these
different substances. “Yes, THC has scientific evidence of a benefit. But there are still
issues. The FDA approved gelatin capsules
(gelcaps) with synthetic THC in them to treat
nausea or vomiting that often occur as a
side effect of chemotherapy. However, the
effect of THC is impacted by how it gets in
your body. If you inhale it, there’s an immediate effect. If you swallow it, it can take anywhere from 30 minutes to two hours to have
an effect, but the effect lasts longer.
“So, if you are feeling sick or throwing
up, there may be an advantage of being
able to inhale the drug for faster relief. But,
conversely, having a formulation that can
be swallowed, and lasts longer, may be
more effective for long-term relief. The big
issue right now is that the synthetic THC
you can swallow in a pill is legal and can be
prescribed to you, but the THC in cannabis
that can be inhaled is not, even though there
is no difference between synthetic THC or
THC derived from the cannabis plant. This
is problematic for cancer patients as well
as the multitude of individuals with other illnesses that report a therapeutic benefit from
THC. And we haven’t looked at patches for
transdermal absorption, but those products
exist in states that have legalized medical
cannabis use. The variability in rates of how
THC gets into a body have to be assessed
and there needs to be science to help
patients and providers determine how to
approach the use of THC as a medicine.
“Moving on to CBD or cannabidiol,”
Vandrey continues, “that chemical is
approved by the FDA to treat three types
of rare seizure disorders. People are using
CBD for a lot of other reasons though. In
one of our studies, people taking CBD products reported significant reductions in anxiety and depression, and improved sleep,
but these people were using lots of different
products and doses; there are no controlled
studies yet. Also, many “CBD” products
also contain small amounts of THC. We
don’t really know whether it is the CBD, the
THC, the combination, or other substances
in these products that drive these positive
health outcomes.
“Thus, there’s increasing evidence that
THC and CBD can be helpful, but so far
there are so many different products available with no good guidance to steer people
on what they should use, how much they
should use, or how often to use.”
Vandrey’s study about the content of
cannabis edibles raised a lot of questions. It
looked at 75 different edible cannabis products, purchased legally, representing 47 different brands. It found only 13 products, or
17%, were accurately labeled with respect
to the amount of THC in them. Twenty-three
percent contained more THC than advertised and 60% had less.
When the team tested for CBD, another
active ingredient, it showed 44 products
(59%) contained very low detectable levels. There is some research that suggests
a benefit to both the ingredients being
present – fewer side effects and improved
clinical benefit – but only one product had
a 1-to-1 ratio.
What all this shows is that quality control
is uncertain at best and there’s almost no
way for consumers to know what they’re
getting. When the I-Team of WNBC (Channel
4) in New York City tested products, it found
the same inconsistencies. One product even
included lead.
Vandrey recommends you look at it
this way. “Picture it as a tiered structure
for cannabis products. Those that the FDA
approved have exactly what is required and
you can only get it with a prescription. The
next level down are consumer products
you get from state regulated dispensaries. Dispensaries in Maryland are regulated by the Maryland Medical Cannabis
Commission (MMCC).
“Below that, you’re at the mercy of the
various manufacturers and have to figure
out who is reputable, doing the best job, and
is most consistent. Look at companies that
have published information. Some put their
certificates of analysis on their websites.
This can be helpful, but unfortunately there
is no current industry standard for how to
analyze all the different cannabis products.
One producer told me that they once sent
their products to three different labs and got
back three different results. It remains to be
determined if these differences were due to
different laboratory methods, product consistency problems, or both.”
Where do we go from here? Most adults
in the U.S. live in areas where cannabis
has been legalized and are in favor of federal legalization. At the same time, Vandrey
warns, it’s already a public health concern.
“It is important to keep in mind that cannabis, and THC in particular, is a drug of
abuse,” Vandrey explains, “just like alcohol,
cocaine and tobacco. Long-term use can
result in addiction and be difficult to quit.
People sometimes lose sight of problems
related to cannabis because an overdose on
THC does not result in death but taking too
much of it can result in adverse effects such
as vomiting, anxiety, panic attacks, hallucinations or even short periods of psychosis.”
Because of this, it’s important to maintain
the safety of users, ensure accuracy in labeling so purchasers know what they’re getting. The FDA can control that. Legislating
pharmaceutical control for supplements as
well as cannabis products would eliminate
these concerns, because supplements face
the same quality control problems. And
other studies like Vandrey’s are finding contaminants included, not a good result.
In publications by the FDA and the DEA,
both federal agencies use marijuana and
cannabis almost interchangeably, an indication that this subject should be revisited and
updated. Maybe it’s time the federal government took control of overseeing supplements and, when the time comes, cannabis
products. That will ensure consistency in
all the states, not just those that have put
regulations in place.
Consequently, we need to change this
conversation because there is much more
to the debate. Even the terminology needs
to be better defined so everyone knows
what we’re talking about. Right now, cannabis use can mean inhaling a very high
dose of THC or rubbing a CBD-containing
lotion on your skin. These have very different risks and benefits, plus very different
compositions.
Given that most states have legalized
cannabis and most adults support legalization, it makes sense for the federal government to take regulatory control over this
booming industry and support the research
needed to ensure the safety of cannabis
users in this country.
