USA Marijuana: A Changing Legal and Research Environment

Marijuana: A Changing Legal and Research Environment   

Although this Report does not examine the issue of marijuana legalization, its continually evolving legal status is worth mentioning because of implications for both research and policy. As mentioned elsewhere, marijuana is the most commonly used illicit drug in the United States, with 22.2 million people aged 12 or older using it in the past month.3 In recent years marijuana use has become more socially acceptable among both adults and youth, while perceptions of risk among adolescents of the drug’s harms have been declining over the past 13 years.

As use of marijuana and its constituent components and derivatives becomes more widely accepted, it is critical to strengthen understanding of the effects and consequences for individual users and for public health and safety. 

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Conducting such research can be complex as laws and policies vary significantly from state to state. For example, some states use a decriminalization model, which means production and sale of marijuana are still illegal and no legal marijuana farms, distributors, companies, stores, or advertising are permitted. Through ballot initiatives, other states have “legalized” marijuana use, which means they allow the production and sales of marijuana for personal use. Additionally, some states have legalized marijuana for medical purposes, and this group includes a wide variety of different models dictating how therapeutic marijuana is dispensed. The impacts of state laws regarding therapeutic and recreational marijuana are still being evaluated, although the differences make comparisons between states challenging.

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As of June 2016, 25 states and the District of Columbia have legalized medical marijuana use. Four states have legalized retail sales; the District of Columbia has legalized personal use and home cultivation (both medical and recreational), with more states expecting to do so. None of the permitted uses under state laws alters the status of marijuana and its constituent compounds as illicit drugs under Schedule I of the federal Controlled Substances Act.93 It should also be noted that use for recreational purposes has not been legalized by any jurisdiction for people under age 21, and few jurisdictions have legalized medical marijuana for young people. While laws are changing, so too is the drug itself with average potency more than doubling over the past decade (1998 to 2008).94 The ways marijuana is used are also changing – in addition to smoking, consuming edible forms like baked goods and candies, using vaporizing devices, and using high-potency extracts and oils (e.g., “dabbing”) are becoming increasingly common.95 Because these products and methods are unregulated even in states that have legalized marijuana use, users may not have accurate information about dosage or potency, which can lead and has led to serious consequences such as hospitalizations for psychosis and other overdose-related symptoms.95 Marijuana use can also impair driving skills and, while estimates vary, is linked to a roughly two-fold increase in accident risk.96-98 The risk is compounded when marijuana is used with alcohol.96,99 

There is a growing body of research suggesting the potential therapeutic value of marijuana’s constituent cannabinoid chemicals in numerous health conditions including pain, nausea, epilepsy, obesity, wasting disease, addiction, autoimmune disorders, and other conditions.

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Potencial terapéutico del cannabis y los cannabinoides.

Given the possibilities around therapeutic use, it is necessary to continue to explore ways of easing existing barriers to research. Marijuana has more than 100 constituent cannabinoid compounds, with cannabidiol (CBD) and tetrahydrocannabinol (THC, the chemical responsible for most of marijuana’s intoxicating effects) being the most well-studied. Evidence collected so far in clinical investigations of the marijuana plant is still insufficient to meet PAGE | 1-22 FDA standards for a finding of safety and efficacy for any therapeutic indications.

However, the FDA has approved three medications containing synthetically derived cannabinoids: Marinol capsules and Syndros oral solution (both containing dronabinol, which is identical in chemical structure to THC), and Cesamet capsules (containing nabilone, which is similar in structure to THC) for severe nausea and wasting in certain circumstances, for instance in AIDS patients.

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Medical Marijuana...gran negocio.

Recognizing the potential therapeutic importance of compounds found in marijuana, the FDA has granted Fast Track designation to four development programs of products that contain marijuana constituents or their synthetic equivalents. The therapeutic areas in which products are being developed granted Fast Track by FDA include the treatment of pain in patients with advanced cancer; treatment of Dravet syndrome (two programs), a rare and catastrophic treatment-resistant form of childhood epilepsy; and treatment of neonatal hypoxic ischemic encephalopathy, brain injury resulting from oxygen deprivation during birth. 

Additionally, there are clinical investigations for the treatment of refractory seizure syndromes, including Lennox Gastaut Syndrome, and for treatment of post-traumatic stress disorder (PTSD). However, further exploration of these issues always requires consideration of the serious health and safety risks associated with marijuana use. Research shows that risks can include respiratory illnesses, dependence, mental health-related problems, and other issues affecting public health such as impaired driving. Within this context of changing marijuana policies at the state level, research is needed on the impact of different models of legalization and how to minimize harm based on what has been learned from legal substances subject to misuse, such as alcohol and tobacco. Continued assessment of barriers to research and surveillance will help build the best scientific foundation to support good public policy while also protecting the public health. (Más)

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