Cannabinoids

Charles Pollack, M.D.

Medicinal Cannabis

Medicinal cannabis, or medicinal marijuana, refers to plant-derived preparations that include more than 100 chemicals —“cannabinoids”— along with many other compounds such as terpenoids and flavonoids. As more and more states legalize “medical pot,” the question of legitimate scientific and clinical use of cannabis has become more complex, burdened with controversies that include political, legal, ethical, and societal implications, as well as more mundane issues such as ensuring safe administration, packaging (and child-proofing), and dispensing; adverse health consequences; and therapeutic indications based on quite limited clinical data. Perhaps the biggest complexity of all is that marijuana remains classified by the U.S. Drug Enforcement Agency’s (DEA’s) Comprehensive Drug Abuse Prevention and Control Act (Controlled Substances Act) of 1970 as a Schedule I controlled substance, the definition of which is that is purportedly has a high potential for abuse, no currently accepted medicinal use in treatment in the United States, and a lack of accepted safety data for use of the treatment even under medical supervision.

Despite this draconian restriction, cannabis is the most commonly cultivated, trafficked, and abused illicit drug worldwide, and in the US, cannabis use, both for recreational and medicinal purposes, has garnered increasing acceptance across the country. This is the clear conclusion to be drawn from a multiplicity of legislative actions, ballot measures, and public opinion polls. While “recreational” use remains the primary mode of consumption of marijuana, the use and acceptance of medicinal cannabis continues to evolve. The problem is, we have very little rigorous science to support effective use, and a general acceptance by patients at large to at least try a botanical preparation that someone somewhere thinks might help them with their diseases or symptomatology.

The way forward is not so clear:

  • Do we focus on plant-derived cannabinoids, or on the increasing number of cannabinoid compounds that can now be synthesized in a laboratory?
  • Do we study individual cannabinoids (or man-made combinations of more than one), or do we study the entire plant
  • How do we design clinical trials to study cannabinoids when both licit and illicit use are already so prevalent, and, when THC is involved, with the difficulty of blinding?
  • How do we fund such trials?
  • How do we study cannabinoids as therapy—as first-line, as last-ditch? As a replacement for “conventional” therapy or as an add-on?

These and many related questions will doubtless continue to vex us for years to come. To help cut through the chatter, this page is a living resource for new and exciting developments in the potential therapeutic deployment of medicinal cannabinoids. Please feel free to submit entries both to catch us up and to keep us current. This is a multidisciplinary, truly interprofessional issue.

Questions or Comments about Cannabinoids?