Medical Marijuana: Need for Robust Clinical Evidence to Shape the Market Future

calendar_today 05 December, 2022 person_outline Growth Plus Reports

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Emerging from the Cannabaceae (Marijuana) family, Cannabis is a genus of herbaceous plants that is found widely in Asia. The genus comprises three species, including Cannabis sativa, Cannabis indica, and Cannabis ruderalis. However, C. sativa and C. indica represent the most popular species of the Cannabis genus, producing Marijuana and Hemp.

Cannabinoids and Marijuana Vs Hemp:
Research shows that all Cannabis species contain Cannabinoids - a set of over 100 compounds with variable degrees of psychoactive properties that can be obtained/extracted from Cannabis flowers, leaves and stalks.
 
However, the most popular pair of cannabinoids are Cannabidiol (CBD) and Tetrahydrocannabinol (THC) - two widely researched chief compounds with similar chemical structures.

It is worth noting that Marijuana, obtained from C. sativa, contains higher THC (vs CBD) while Hemp, obtained from C. indica, is richer in CBD. In most legal settings, the THC concentration of a sample/specimen decides whether it would be considered Marijuana.

Cannabinoids, Medicine and Recreation:
It is of particular interest to Medicine and Recreation that some cannabinoids interact with the human body’s endocannabinoid system to produce a range of effects (including calmness, highs, pain relief and relaxation). 

While both THC and CBD interact with the human body’s endocannabinoid system, each compound seems to have a distinct effect upon consumption. THC (or Delta – 9 THC), which is present in richer quantities in the Cannabis sativa plant, has psychoactive properties, typically resulting in a “high” upon consumption (think Marijuana) while CBD, which is extracted from Cannabis indica (think Hemp), helps in inducing calmness and relaxation. However, in 2017, CBD was shown to have a biphasic effect. Lower doses (below 15 mg) caused alertness while higher doses led to sedation with significant variations based on individual responses.  

Medical Marijuana – an emerging picture:

For medical use, Cannabis sativa (as Cannabis extract & THC products incl. Marijuana or CEPMs) may be smoked, inhaled through a vaporizer, eaten, used as a topical solution or taken orally as a few drops of liquid. Reported side-effects include depression, dizziness, hallucinations, or tachycardia.

Medical Marijuana - the case for use in Pain and Cancer:
Over the past two decades, there has been a steady increase in interest and research for the use of Marijuana (CEPMs) across areas like Cancer. 

Several small-scaled clinical studies have evaluated the effect on pain associated with chemotherapy besides suggesting that THC (tetrahydrocannabinol) and CBD (cannabidiol) could slow or cause death in a few types of cancer cells. 

Further, CEPMs were reported to be helpful in managing nausea and vomiting - a major concern during chemotherapy with the USFDA approving two man-made cannabinoid medicines (Dronabinol and nabilone) for the treatment of nausea and vomiting from chemotherapy.  

Apart from cancer, CEPMs showed promise in chronic pain through preclinical studies where CEPMs bound to and blocked pain receptors on peripheral nerves. Besides, results from an online survey that featured in the Journal of Alternative and Complimentary Medicine in 2014 reported that Cannabis indica seemed to be effective for pain management against non-migraine headaches, neuropathy and joint pain. 

In 2018, the USFDA also approved a cannabidiol (Epidiolex) for the management of seizures associated with two rare forms of epilepsy.

Medical Marijuana – the controversy:

However, despite the above successes, there is an ongoing controversy around the use and legalization of CEPMs.  

This is because of two reasons which are as follows:
1.Benefit: Research has shown that though high THC (as in Marijuana) can cause a “high”, it is very powerful in the management of “breakthrough pain”. This makes it a high potential therapy for patients suffering from chronic pain (severe trauma and specific diseases like RA and Cancer), with advocates demanding access by prescription and through regulated channels.
2.Harm: Research has also shown that the unprescribed or unethical consumption of CEPMs results in sundry challenges including the slowing of brain development, respiratory problems and potentially life-threatening issues.

This coexistence of benefit and harm from CEPMs has given rise to both controversy and debate on the scope and ethics of legalising usage.

While CEPMs have seen legalization in some parts of the world (including Canada and over 35 states in the USA), they remains illegal in 137 countries that are still suspicious and reluctant. Favorable consideration of CEPMs is adversely affected by multiple factors including US consumer updates which stated safety concerns regarding the harm from CBD use, including drug-drug interactions resulting in inhibition of P450 enzymes (CYP1A2, 2D6, 2C19, & 3A4), suicidal behavior, long-term memory loss and cannabinoid hyperemesis syndrome (CHS).

Closing thoughts:
CEPMs have shown strong benefit in select individuals and populations, forcing them to push for change in current restrictions. However, since data is low and individual results tend to vary, it is difficult for regulators to take decisions (even though independent usage of CEPMs continues to rise).

Right now, CEPMs are a subjective choice and not an approved treatment and individual users must decide if consuming Cannabis is good or bad.