Science vs. policy: examining the clash over cannabis
As marijuana becomes more socially accepted, scientists say federal regulations put an unnecessary strain on medical research
Travis Welsh spends several hours a day attending his information technology classes and working. But by the end of his day, the pain from the arthritis in his knee begins to bother him.
To treat his pain, Welsh, 22, retires to his room where he plants himself on his tattered leather chair and takes his medicine — a pipe-full of Blissful Wizard, his favorite strain of marijuana.
“I’ll feel better in 15 minutes,” he said. “It seems very immediate compared to other (medications).”
Welsh applied and received his medical marijuana card in May 2016 for a diagnosis of chronic knee pain from arthritis in his joints. Smoking marijuana and “dabbing” concentrates are his preferred method of treatment.
It’s entirely legal for him to possess his medication under Michigan’s Medical Marihuana Act, signed into law in 2008.
Michigan is among most states in the U.S. with laws authorizing medical cannabis. Medical use of the plant and its flower buds to treat chronic pain and mental health disorders is legal in 28 states. Another 17 states allow limited uses, such as permitting less psychoactive varieties of marijuana for cases of epilepsy.
While marijuana is still illegal by federal standards, researchers continue to suggest that cannabis provides strong pain and nausea relief for people with chronic disorders. They also propose its pain-killing elements can reduce opioid use and addiction, improve quality of life and may even promote efficient thinking for patients.
Researchers are also disclosing discoveries that the plant could benefit patients with muscle spasms and mental health disorders such as anxiety, PTSD and depression.
The U.S. Department of Justice categorizes cannabis as a Schedule I controlled substance, the most restricted class of drugs on record. That means U.S. policy makers have determined that marijuana has no medicinal value and is considered as deadly and addictive as heroin and MDMA.
With a Schedule 1 classification, research is difficult to conduct in America, which is falling behind in scientific advancements compared to other countries, said Yannick Marchalant, a neuroscience professor and researcher at CMU.
“It’s very hard to get licensed to do (research) with it,” he said.
With these breakthroughs in mind, cannabis researchers from around the nation are making an argument for federal changes in the restriction and regulation of marijuana. While researchers agree there is a clear medicinal value of cannabis, they are unsure of its extent. As the drug’s popularity continues to skyrocket, they maintain that more research is needed to benefit the patients and recreational users who will undoubtedly continue to smoke.
BENEFITS AND DOWNFALLS, ACCORDING TO SCIENCE
Its taboo status in America stems from a century’s worth of misinformation and dueling economic and political influences, many of which are based in unscientific explanations of the benefits and downfalls of pot.
In order to show any conclusive results of medical benefit, research has to be separated from political influence to observe its actual effects on the body.
For starters, studies show that marijuana affects users by fluctuating excitation in certain areas in the brain. One area, Marchalant describes, is an axon in the brain stem that is responsible for sensing toxins in the body. Smoking cannabis “tampers with the sensation of toxicity” by making the region less active.
“(Users) will tolerate toxins more,” Marchalant said. “It’s very good for patients that (need) drugs that are fairly aggressive for their treatment, but have side effects that are making them sick.”
Sometimes the science surrounding medical marijuana gets misrepresented by activists seeking a scientific sword to wield in the battle for legalization.
Most researchers steadfastly believe medical cannabis does not treat illness. It can, however, be an effective form of temporary relief, Marchalant said. While it is beneficial to have a natural substance that alleviates pain, promoting it as a treatment for conditions is not based in fact.
“A lot of people think it does everything, it’s a miracle drug,” Marchalant said. “Then you have the opposite where people think it’s not doing anything (and) has no medicinal value. Of course, the truth is probably right in the middle.”
For example, there is a clear medicinal value for cancer and AIDS patients, Marchalant said. Marijuana is also an antiemetic, which can be used to help these patients eat when they lose their appetites.
Due to its powerful pain relieving properties, patients and casual users will often self-medicate with marijuana, said Staci Gruber, an associate professor of psychiatry at Harvard Medical School.
Gruber’s research is focused on the effects of cannabis on patients, specifically considering quality of life and executive functioning — the mental skill that enables people to do tasks and make conscious decisions.
After three months of observation, Gruber found that patients were experiencing significant improvements in their quality of life. They reported feeling less general depression and improved sleep habits, along with greater social functioning.
Her lab also found that patients using cannabis were improving in executive functioning abilities, being able to think more clearly, solving complicated puzzles and making faster decisions.
She attributes these findings to symptom relief.
“This is important because, with regard to what we know about recreational users, this is an area where we’ve seen (reductions in functioning),” Gruber said.
Recreational users are known to smoke with intentions to get “high” at the expense of smooth thinking, Gruber explained. So, she finds these results especially intriguing.
Gruber was one of three researchers presenting on current cannabis research at the American Association for the Advancement of Science conference from February 16-20 in Boston. For now, she and other researchers strongly support medical marijuana for symptom relief purposes only.
However, the “research remains in its infancy,” Gruber said, and further exploration of the plants medicinal value is critical.
THE PATIENT EXPERIENCE ON MEDICAL CANNABIS
For Laingsburg senior Mitchell Brown, legal medical marijuana concentrates help him feel less nauseas in the morning, preparing him for a day on campus. Brown, 22, uses weed to treat irritable bowel syndrome, chronic headaches and depression.
He also said the symptom relief offered by cannabis makes him a better student overall.
“If I had to go to school and be uncomfortable all day, then I wouldn’t be as into it,” Brown explained. “I feel like I have a better learning experience than I would if didn’t (use cannabis).”
Before Brown became a cannabis patient, his doctor prescribed him an array of pills to treat his ailments. Ultimately, Brown was unhappy with the side effects of other drugs — particularly those prescribed for his bouts of depression.
“Earlier in life, I didn’t like the way antidepressants and anti-anxiety (medications) were (working) in my system,” Brown said. “I felt like it dulled me to the world and didn’t make me a better person.”
Brown was able to significantly reduce his use of pharmaceutical drugs. He no longer uses prescription pills every day and only takes them as needed.
This is a common claim for people who use medical marijuana. Cannabis has been shown to help decrease use of pharmaceuticals in areas with legal regulation.
Several researchers have reported that because the plant contributes to pain management, it can help reduce opioid use.
Mark Ware is the director of clinical research at the Alan Edwards Pain Management Unit of the McGill University Health Centre. He also presented at the AAAS conference earlier this year. Ware said research shows that in areas with forms of legalized cannabis, opioid-based mortality decreased by 25 percent.
“This is suggesting that patients who are using cannabis are able to or seem to be willing to, reduce their other medications,” Ware said.
Gruber expounded on this point at the conference. Her research found a 15 percent decrease in antidepressant use in patients and 42.8 percent decrease in opioid use.
Welsh said it’s important for medical cannabis to be accessible to all people. His argument is that patients should have options when seeking a treatment regimen that works best for them.
Specifically, Welsh believes marijuana is a natural remedy with relatively mild side effects compared to pharmaceutical medications used to treat the same conditions.
“When taking (pharmaceuticals), it could do so much more to you than you really want it to,” Welsh said. “With cannabis, you really know what you’re getting into.”
The trouble in promoting marijuana as a medicinal substance comes from its psychoactive properties, or “high” feeling. Marchalant said this is the most concerning side effect of cannabis for legislators considering reducing the Schedule I classification.
Simply put, the high is never a “good thing” when marketing medication, he added. Getting high is associated with consuming THC, the strongest and most present cannabinoid, a chemical compound found in the plant.
Ryan Vandrey, an associate professor of psychiatry and behavioral sciences at John Hopkins Bayview Medical Center, presented research at AAAS about the effects of different dosages and consuming habits.
The negative consequences associated with marijuana include sleepiness, increased heart rate, hunger, paranoia, dizziness and nausea. Vandrey said these symptoms rarely occur and are often a direct product of higher THC content found in certain strains of marijuana.
For Welsh, cannabis only negatively affects him when he smokes too much.
“It’s like any medication, in moderation it’s fine,” Welsh said.
Considering the effects of THC content, Vandrey said it’s important for cannabis users to have control of the dose while medicating. However, because the state and federal governments have implemented inconsistent policies, plant quality is poorly regulated.
After testing products at dispensaries and comparing results to the labels, Vandrey’s research found that only 17 percent of legally sold marijuana products were accurately labeled. False labels were often lower than the actual THC content.
“There’s concern over the lack of quality control and oversight of cannabis in the U.S.” he stressed. “I think that’s something that needs to be addressed.”
WHEN POLICY HINDERS SCIENTIFIC ADVANCEMENTS
Most states have legalized some form of medical marijuana, but because research is so restricted in the U.S., drug policy is outpacing the science.
Brown said he doesn’t understand why the government isn’t more supportive of marijuana research, but does understand the contentious history of prohibition and propaganda shaping attitudes toward marijuana.
Brown thinks the government should prioritize testing so it can take a definitive stance.
Regulations tend to endorse cannabis products more if it emphasizes other cannabinoids such as CBD I and CBD II. However, while there is less of a psychoactive element in CBD, the medical benefits are also much more mild, Marchalant added.
“The only way we can find out how good or poor it is for health in general is to try it out on the population,” he said.
As more states pass medical legislation, the doors are opening for researchers interested in the observational effects of marijuana on behavior, Marchalant said. However, investigating the physical and medical components of the plant is much more difficult.
If a researcher wanted to work with a marijuana plant, they would need to apply for various approvals and licenses. They can only get the product from one growing facility in the country, at the University of Mississippi.
The process can take years to complete.
“We live in a very pragmatic world,” Marchalant said. “If you take three years to conduct your research, your research will probably be dead by then.”
Most researchers use synthetic THC in their labs in part because it is more easily accessible, Marchalant said. He suspects synthetic THC may be more impactful as a medication anyways, because it utilizes the benefit of one cannabinoid as opposed to the collective effect of 400 cannabinoids that are found in the plant naturally.
Still, Vandrey maintains that marijuana is becoming increasingly popular and more widely accepted for recreational use, too. That said, there needs to be a healthy push in momentum toward studying the plant in whole.
The disparity between federal policy and societal practices hinders research in a way that is disadvantageous to both users and science. Vandrey describes the struggles of cannabis research as a “Catch-22.”
Efficient studies to understand the effects of cannabis and how to properly prescribe it cannot be done until it is removed from the Schedule 1 category, he said.
Yet, it cannot be removed until more research is done to support its benefits.
“Efforts to try and reconcile this and to help put science in line with policy is important,” he said.
Gruber agreed, and emphasized that need more research on dosages, long-term effects and cognitive abilities is drastically needed for both medical and recreational users.
“Research is knowledge and knowledge is power,” Gruber concluded at the conference. “I would always underscore the importance of more research in each of these areas.”
Because marijuana is widely supported by the public and helps so many people with medical conditions, Welsh said it’s the government’s responsibility to let science happen.
He hopes that science showing the benefits of medical cannabis will help continue the journey toward full legalization. Because the drug is becoming so socially accepted, he believes legalization is bound to happen eventually.
“It’s not as big of a deal as it’s been made out to be in the past and people are finally realizing it,” Welsh said. “Trying to resist or advocate against it is a waste of time because legalization is inevitable. It’s only slowing the process.”