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Cannabinoids for Health

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Cannabis is therapeutic in the treatment of chronic pain, does not cause lung cancer and is not linked to workplace accidents. These are among the conclusions of a comprehensive new report, “The Health Effects of Cannabis and Cannabinoids,” issued by the National Academies of Sciences, Engineering and Medicine (NAS) on Jan. 12.

This is the third such report from the NAS, a private society of more than 500 distinguished scholars who provide independent advice to the U.S. government regarding matters of science and technology. The group initially addressed the cannabis issue in 1982 with a report that concluded, “Cannabis and its derivatives have shown promise in the treatment of a variety of disorders,” particularly glaucoma, nausea, spasticity and seizures.

The NAS further challenged prohibitionist dogma in 1999 when it stated that marijuana is not a “gateway” to other illicit substances, has far less dependence liability than alcohol and possesses therapeutic compounds. The 2017 report, which summarizes the results of more than 10,000 scientific abstracts published since 1999, further pushes the envelope by acknowledging that “conclusive or substantial evidence” exists for the efficacy of whole-plant cannabis and its derivatives for people suffering from chronic pain, multiple sclerosis and other disorders.

“Patients who were treated with cannabis or cannabinoids are more likely to experience a clinically significant reduction of pain symptoms,” NAS experts found. “For adults with multiple sclerosis related muscle spasms, there was substantial evidence that short-term use of oral cannabinoids improved their reported symptoms. Furthermore, in adults with chemotherapy-induced nausea and vomiting, there was conclusive evidence that certain oral cannabinoids were effective in preventing and treating ailments.”

The NAS findings are at odds with the draconian federal classification of the cannabis plant as a Schedule I prohibited substance with “no currently accepted medical use in treatment in the United States” (the DEA upheld this designation in August). While the report’s authors refuse to make any explicit recommendations for regulatory changes, they note the “challenges and barriers in conducting research,” and that “the classification of cannabis as a Schedule I substance impede[s] the advancement of research.”

The report also addresses marijuana’s effects on overall health and safety. Not surprisingly, the authors (who include noted oncologist Dr. Donald I. Abrams) acknowledge that it may pose some potential risks for certain groups of people, such as adolescents, pregnant women and those with a family history of mental illness, and for those who drive shortly after ingesting cannabis.

A pair of recently published meta-analyses indicate that some of the NAS’ concerns may be overblown. A September 2016 article in Obstetrics & Gynecology that evaluated more than two dozen case-control studies assessing maternal drug use concluded that “maternal marijuana use during pregnancy is not an independent risk factor after adjusting for factors.” such as tobacco use.

And an article in the March 2016 issue of Addiction that assessed the culpability rates of THC-positive drivers in motor vehicle accidents determined that marijuana’s impact on accident rates is “low.” (A Jan. 16 article—“When Are You Too Stoned to Drive?”—posted at the-marshallproject.org posits that pot’s “impairment appears to be modest—akin to
driving with a blood alcohol level of between .01 and .05, which is legal in all states.”)

As to the validity of other health-related concerns, the NAS team found little or insufficient evidence to support claims that cannabis use is linked to lung cancer, chronic obstructive pulmonary disorder (COPD), heart attack, stroke, occupational accidents or injury, or over-all mortality—results commonly associated with the consumption of other licit substances, such as alcohol, tobacco and opioids.

NAS’ conclusions that cannabis possesses therapeutic utility and an acceptable safety profile when compared to other psychoactive substances are not surprising. Scientific evidence with regard to marijuana’s health and safety has been mounting for decades. Unfortunately, U.S. marijuana policy has largely been driven by political rhetoric and fear, not science and evidence.

A search on PubMed, the repository of peer-reviewed scientific papers, for the term “marijuana” yields more than 24,000 studies referencing the plant or its biologically active constituents—a far greater body of literature than exists for commonly consumed painkilling drugs like acetaminophen, ibuprofen or hydrocodone. Unlike modern pharmaceuticals, cannabis possesses an extensive history of human use dating back thousands of years, thus providing longstanding empirical evidence as to its relative safety and efficacy.

Currently, 29 states (and Washington, D.C.) permit physicians to recommend marijuana therapy. Some of these state-sanctioned programs have been in place for as long as two decades. At a minimum, it can be readily concluded that we as a society now know enough about cannabinoids—as well as the failures of cannabis prohibition—to regulate its consumption by adults, end its longstanding criminalization and remove it from its undeserved federal Schedule I status.

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