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National Academies: More and Better Cannabis Research Needed

— Schedule 1 designation called a major barrier

MedpageToday

Public and private entities should fund and otherwise support cannabis research, while barriers to this research should be removed, according to a Health and Medicine division report published Thursday.

The report also called the Drug Enforcement Administration's (DEA) classifying cannabis as a Schedule 1 drug "a regulatory barrier" impeding research, and issued evidence-based conclusions about the plant's medicinal benefits and harms on 11 "groups of health endpoints," in the Academies' first comprehensive cannabis assessment since 1999.

"The growing acceptance, accessibility, and use of cannabis raise important public health concerns," according to committee chair , "and there is a clear need to establish what is known and what needs to be known about the health effects of cannabis use."

The 395-page report -- titled "The Health Effects of Cannabis and Cannabinoids: Current State of Evidence and Recommendations for Research" -- included a summary of findings by McCormick's . The panel was charged with updating national health-related information on cannabis.

The report came with with four broad recommendations:

  • Develop a comprehensive evidence base on the beneficial and harmful health effects of cannabis use in the short and long term, with funding and support for "a national cannabis research agenda that addresses key gaps in the evidence base."
  • Improve federal and state public health surveillance efforts.
  • Hold a workshop to develop research standards and benchmarks, including a minimum data set for observational and clinical studies, adapting existing reporting standards to cannabis research, creating uniform terminology for clinical and epidemiological research, and developing standardized and evidence-based question banks for surveillance instruments.
  • Convene an expert committee to produce a report "that fully characterizes the impacts of regulatory barriers to cannabis research" and that proposes strategies "to conduct a comprehensive cannabis research agenda."

Among the latter committee's charges should be opening new marijuana growth and storage facilities to expand access to research-grade cannabis, and improving its quality, diversity, and external validity.

The 11 health endpoints that should be addressed in cannabis research included: therapeutic effects; cancer risk; cardiometabolic risk; respiratory disease risk; immunological effects; injury and death; issues with pre-, peri- and post-natal exposure; psychosocial effects; mental health; and problem use and abuse of other substances.

Within those realms, the report assessed current knowledge on cannabis' impact on specific health conditions, with ratings ranging from "conclusive" to "no evidence to refute or support."

Among the "conclusive or substantial" findings: Cannabis can treat chronic pain in adults, and nausea and vomiting from chemotherapy, and improve patient-reported multiple sclerosis spasticity symptoms.

The committee found "substantial" evidence that smoking cannabis is associated with worse respiratory symptoms and more frequent chronic bronchitis, and increased risk of motor vehicle crashes. Smoking cannabis is also associated with pregnant women having children born at a lower weight. Cannabis use is associated with developing schizophrenia or other psychoses, especially among frequent users, and use at an "earlier" age is a risk factor for problem use.

"No evidence" findings included associations with depressive disorders and post-traumatic stress disorder. "Limited" findings included associations with impaired academic performance and social functioning, and with increased rates of unemployment or low income.

The report concluded with a section outlining research barriers and challenges, specifically calling out the . It noted the difficulty for researchers "to gain access to the quantity, quality, and type of cannabis product necessary to address specific research questions on the health effects," and the needs for a diverse network of funders, and to improve and standardize research methodology examining cannabis' impact on short- and long-term health outcomes.

The committee reviewed research dating back to 1999, "giving primacy to recently published systematic reviews (since 2011) and high-quality primary research for eleven groups of health endpoints."

"The study was conducted in a limited time frame in order to respond to a quickly moving landscape, but," McCormick wrote, "the amount of work that this report entailed and the volume of literature reviewed clearly indicates the substantial effort involved and the importance of this issue."

Report include CDC, FDA, and National Institute on Drug Abuse, as well as Truth Initiative and the Robert W. Woodruff Foundation.