It’s not so much the claims made about the magic qualities of cannabinoids that prick up the ears — curing tuberculosis, anxiety, chronic pain, liver disease. Pretty standard hype in a world of consumers slathering themselves inside and out with anything labeled CBD or THC.
It’s the year.
The advertising hype about miraculous treatment of “general debility” and “nervous excitement” plaguing the populace came in 1857.
Skip to the now, and the Food and Drug Administration is sending warning letters to cannabinoid marketers in Colorado and other states ordering them to cease claiming they can alleviate everything from autism to hepatitis to cancer and Tourette’s syndrome.
It’s been 163 years — have we learned anything scientific about the medical properties of marijuana products?
Colorado, California and a small handful of other states are trying to lead the way by steering funds derived from marijuana legalization toward controlled, peer-approved studies assessing the medical effectiveness of cannabis compounds. Colorado began in 2014 with a $7 million commitment from medical marijuana registration fees, and the state health director saying it was time to move from the “anecdotal” toward “good science.”
When it comes to marijuana and two of its key components, THC and CBD, “there are a lot of claims, and like anything people are using or consuming there needs to be the research behind it to validate those claims,” said Chad Kinney, director of the state-funded Institute of Cannabis Research and professor of chemistry at Colorado State University Pueblo.
What pre- and post-legalization studies have pinpointed is that THC, the psychoactive compound from marijuana that produces a “high” for users, is medically effective for a few conditions including chronic neuropathic pain, muscle spasticity from multiple sclerosis and nausea and weight loss in cancer patients.
CBD, short for cannabidiol, has no psychoactive effects, and is being studied for a number of “plausible” if as-yet unproven claims, said Dr. Igor Grant, director of the state-funded Center for Medicinal Cannabis Research at the University of California San Diego. The only truly proven area so far for CBD is for severely debilitating epilepsy seizures in young children, research that grew out of a cluster of Colorado cases and treatments.
Other areas for CBD are “promising,” though years and multiple studies away from getting medical sanction, Grant said, including rheumatoid or inflammatory arthritis, anxiety disorders and inflammatory bowel disease.
Post-traumatic stress disorder was one of the proposed medically qualified treatments that prompted Colorado’s move into state-sponsored research six years ago. Advocates had sought approval for such prescriptions for years. Some state officials and medical researchers wanted to see credible evidence marijuana was effective for PTSD before expanding allowed conditions.
Though the state legislature in 2017 added PTSD to the list of qualifying conditions, Grant currently places the disorder in the plausible, yet unproven, category begging for more research. There is evidence that the THC in marijuana affects memory, with a negative connotation of fuzziness or “burnout.” But softening or blurring memory may be a useful approach to neutralizing PTSD, which can be described as “hyper-memory,” Grant noted.
“I’m not one to throw something away just because it’s anecdotal,” Grant said. “Anecdotal can be a clue. Our job as researchers and physicians is to figure out what is true and what isn’t.”
Advocates have been hoping for medical studies to prove out positive theories on health impacts, but safety and efficacy studies often prove out negatives as well, Grant noted. Many over-the-counter potions advertise CBD as a rub-on ingredient for pain treatment, but researchers have little idea what dosage of CBD is being put in many materials, or how much of that gets absorbed through skin.
The child epilepsy studies, meanwhile, have found positive impacts on seizures at dosages of 600 milligrams of CBD or greater, while many CBD supplements come at 10 milligram levels, Grant noted. At higher does, CBD can interfere with liver function.
The mythology of marijuana and its products as the harmless, fun drugs full of promise needs to be filtered through better science.
“They’re not magical. They can have some bad effects,” Grant said.
Who’s in charge here?
Over the years, Colorado has moved control of state marijuana research money from the public health department to the institute in Pueblo. Research grants are now intended to be divided between medical studies, on subjects such as bowel disease or sleep disorders, and agriculture or product development, such as growing conditions or uses of hemp.
When the state put marijuana research at Pueblo four years ago, funding began at $900,000 a year, then doubled to $1.8 million, all funded by marijuana-derived taxes and fees. Budget woes have now cut that to $1 million a year, Kinney said, hardly enough to fund credible clinical trial-category studies that take place at multiple sites and last for years.
Some states have separate pools of money for more social science-oriented research related to marijuana, such as surveys on changes in rate of use among different age groups after legalization, or seeking accurate legal standards for driving under the influence of THC.
A few other states, their university systems and some philanthropists have joined the push for credible marijuana research. Grant and Kinney mentioned the Oregon Global Hemp Innovation Center; Louisiana State University in agriculture; Pennsylvania’s Thomas Jefferson University Lambert Center for Medicinal Cannabis; the Pennsylvania Department of Health; and Washington State University-Pullman.
Emily Lindley, an assistant professor in the Department of Orthopedics at the University of Colorado School of Medicine, received $742,000 in Colorado money to study cannabis as a treatment for chronic back and neck pain.
“We are almost done with the clinical trial, no results to report yet,” Lindley wrote in an email. “Well-designed clinical trials are critical in determining the clinical relevance of cannabis for back and neck pain. Without such clinical trials, physicians cannot make clear, evidence-based recommendations to their chronic spine patients on the use of cannabis.”
At CSU-Pueblo, Kinney said, researchers are using some of the grant money to attempt to prove hemp’s potential for environmental remediation, among other experiments. In another lab, Sang Hyuck Park, a molecular biologist at Pueblo, and graduate assistants grow new strains in greenhouses in search of higher CBD content that would boost agricultural enterprises. Isolating and boosting CBD will help other researchers study the most useful applications of the chemicals, Park said.
Asked what he would do with the money if he suddenly was handed $10 million more for marijuana research, UC San Diego’s Grant said he would focus on population subsets where risks are different, and on longitudinal studies showing long-term impacts of cannabis use.
For example, neuropathic pain. This is not acute, post-trauma pain, but chronic nerve damage not always located at the site of an injury. You break a small foot bone, for example, and for years afterward suffer nerve pain and hot flashes up and down your leg or back.
Credible studies have proven short-term benefits of cannabis for that pain, Grant said. “What we don’t know is if in three years, is it still helpful? Do you have to take more and more? We need some longer term outcome studies if we’re going to prescribe these as medicines.”
In the elderly, antipsychotic drugs used in nursing homes for Alzheimer’s or dementia are “really hard on older people,” Grant said. Studies using THC or CBD in that population are long overdue.
Delivery methods are also in dire need of study, Grant said. Many medical uses suggest smoking, where chemicals are quickly absorbed into the bloodstream. An oral dose, by contrast, can take an hour to digest, depends on other foods consumed and is metabolized differently among patients. But “most people don’t want to smoke joints or vape, so we need to look at the oral form more,” or whether it can absorb through skin, Grant said.
A new FDA study reported this month in Hemp Industry Daily underlined the problems with dosing in the thinly-regulated world of CBD miracle claims. “Of the 102 products tested this year that were labeled as having CBD, 18 had less than 80% of the amount indicated, while another 46 were within 20% of the amount advertised. Thirty-eight products had more than 120% of the CBD indicated,” the publication said.
While various product-boosters are making claims they can’t back up with science, the researchers involved with cannabis are more confident than ever they are dealing with a plant hosting a uniquely broad and effective array of compounds. There truly is great promise, and that’s why basic science needs running room, they said.
“We’ve just started to scratch the surface with cannabis,” Kinney said.