As legal weed looms, barriers to research still standing
The scientists who study marijuana’s potential risks and therapeutic benefits have been frustrated by the barriers they must leap to do work that’s needed now more than ever.
BY: Kate Allen – The Star – April 9, 2017
After punching a string of numbers into a bolted-down, fireproof, alarm-protected safe — the location of which can’t be divulged for security reasons — Steven Laviolette pulls out a tiny vial. Inside that vial is an even tinier dab of dark tar. The tar is purified THC, the mind-altering compound in marijuana.
The street price for a gram of weed is about $10. A gram of this stuff costs about $2,000, not counting the cost of the researcher’s time acquiring it. Laviolette, a professor in the department of Anatomy and Cell Biology and Psychiatry at Western University’s Schulich School of Medicine & Dentistry, studies the effects of marijuana on the brain. His lab is investigating both some of the troubling brain changes associated with THC, and also — a rapidly growing avenue of research — the very different and perhaps protective brain changes associated with cannabidiol, or CBD, another compound found in the plant.
This week the government of Canada is expected to unveil legislation legalizing marijuana. As the country hurtles toward the end of nearly a century of prohibition on recreational pot, researchers of all stripes, from neurobiologists to clinicians to epidemiologists, say there are major gaps in our understanding of the drug.
Both the scientists who study its potential therapeutic effects and those who research its risks have been frustrated by the barriers they must leap to generate knowledge that fills those gaps — evidence that should be informing policy.
Researchers who want to access marijuana for experiments must apply for a special exemption from Health Canada for each individual compound from the plant they hope to study, of which there are hundreds — including those that have no known intoxicating effects, like CBD. If approved, they must navigate the opaque and expensive world of acquiring these compounds. And even though legalization seems certain to boost what is already one of the world’s highest national marijuana usage rates, scientists say there is not enough funding to study how the drug impacts health, behaviour and the brain — especially teenage brains.
“Now is when we need to be doing this research, and the money is just not there,” says Laviolette. “If we’re going to be the only North American country that has full legalization, there’s no reason that we shouldn’t become global leaders.”
The members of Canada’s small cannabis research community, many of whom have been collaborating in recent months to set a national research agenda, will be scrutinizing the new legislation.
“Really, science has been stuck for past 80 or 90 years or so, unable to do many of these tests,” says M-J Milloy, a professor in the Department of Medicine at the University of British Columbia and a research scientist at the B.C. Centre on Substance Use, who studies the effects of cannabis use among people living with HIV/AIDS.
“Hopefully when it is legalized many of those barriers will fall away.”
Cannabis is a complex plant. It contains over 100 different chemical compounds known as cannabinoids. The most well studied of these is THC, the “psychoactive” one: it gives users the feeling of being high. CBD is another actively investigated cannabinoid, though less well understood. Cannabis also contains hundreds of other compounds belonging to several other chemical families, like terpenes, the oils that give different varieties of weed — and conifers and citrus plants — different aromas.
Both THC and CBD have therapeutic effects. But the list of symptoms for which there is solid evidence that marijuana helps is very short.
In an exhaustive report published in January by the U.S. National Academies of Sciences, Engineering, and Medicine, cannabis and compounds derived from it were deemed an effective therapy backed by “conclusive or substantial evidence” for only three problems: chronic pain in adults, chemotherapy-induced nausea, and spasticity in multiple sclerosis.
The list of therapies for which there was limited, insufficient, or no evidence is much longer and includes Tourette’s syndrome, traumatic brain injury, epilepsy, anxiety disorders, ALS and addictions.
“I think at the end of the day everyone agrees that the best medical care is based in evidence. And unfortunately we just don’t have enough for many conditions to guide us,” says Milloy.
Patients, doctors, and their respective advocacy groups disagree on key issues related to medical marijuana. But “there is consensus on the need for more research aimed at understanding, validating and approving cannabis-based medicine,” the task force found. The CMA agrees, saying it will “continue to urge that Health Canada support development of rigorous research on the effects, both positive and adverse.”
“Unfortunately, cannabis has developed a bit of a reputation as a panacea in some groups,” says Milloy. “We need to really test cannabis, develop good medical evidence, so people know whether or not this hope and optimism is warranted.”
Medical marijuana may help individuals. But recreational use of the drug could have population-wide health benefits too, if users replace other more dangerous drugs with cannabis.
A curious theme emerges when interviewing scientists who study marijuana. At a certain point, some of them want to know when the media will finally address the overwhelming public health burden of alcohol.
The World Health Organization ranks alcohol use as the third leading risk factor globally in lost healthy years, ahead of tobacco. One in four Canadian drinkers engages in risky alcohol use, according to Statistics Canada, and the rates are rising. According to the Centre for Addiction and Mental Health (CAMH), alcohol-related problems, from health care to law enforcement to lost productivity, cost Ontario $5 billion a year.
As alcohol supplies a steady current of sickness and mayhem, prescription opioids have been a skyrocketing source of overdoses and deaths.
How many binge drinkers might replace alcohol with safe amounts of recreational weed if it was legal? How many sufferers of chronic pain might choose marijuana instead of highly addictive opioids, if the plant was easier to obtain?
In Colorado and Washington, the two U.S. states that voted to legalize marijuana in 2012, researchers have been tracking these types of questions. The Canadian Centre on Substance Abuse (CCSA), an agency that was created by Parliament to synthesize evidence and inform policy, led delegations to both states in 2015.
There are some hints from states where medical marijuana is legal that suggest patients are, in fact, choosing cannabis over opioids. The full picture is not yet clear. But in general, in both states, the CCSA delegation found that those trying to answer fundamental questions about the impacts of legalization were frustrated because they lacked data from before the changes were made for comparison. Both states devoted a portion of legal marijuana sales to research — money that didn’t start flowing until after sales began, when it was too late.
“The major take home message there, for Canada: make sure that you not only invest in research on an ongoing basis, but invest proactively in collecting baseline data,” says Rebecca Jesseman, Senior Policy Advisor for the CCSA.
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