As the number of local governments legalizing marijuana continues to grow, society must come to grips with the legal and ethical ramifications of these new laws. While some patients with rheumatological and other disorders already avail themselves of cannabinoids for modification of their disease and complaints, the role that legalized marijuana does and will have in our society, as well as in the practice of evidence-based medicine, has yet to be clearly defined.
During the ARHP Concurrent Session Cannabis in Society & Medical Practice, experts will appraise the ramifications of legalization of marijuana use, both medical and recreational, and evaluate the evidence supporting the efficacy of cannabinoids in medical practice. The session will take place from 4:30 – 6:00 pm Monday in Room 5 B.
Rosalie Pacula, PhD, will discuss the legal process and debates behind the legalization movement, including concerns that current legalization efforts are driven more by economics and public opinion than evidence-based science. Dr. Pacula is Senior Economist at the RAND Corporation and a Professor at the Pardee RAND Graduate School in Santa Monica, CA. She also serves as Director of RAND’s BING Center for Health Economics and is co-director of the RAND Drug Policy Research Center.
“To date, the medical marijuana laws that have been passed have been only about providing access without paying any attention to things like dosage standards, proper methods for dosing, and reporting of adverse events, which are standard elements of the process with any FDA-approved medication,” Dr. Pacula said. “While there is clear clinical evidence that the cannabis plant has properties of therapeutic value, the state regulatory environment making cannabis available to patients has not approached this in a standard medical way.”
That has allowed dispensaries to offer an array of cannabis products with different levels of THC and other cannabinoids, she said, which raises legitimate questions about which products should be recommended to patients, what the potential side effects are of each, and whether certain products have greater risks than others.
“I think there is a real and immediate need for people in the medical community to get educated very quickly about the hundreds of products that now come out of the cannabis plant and get engaged in the regulatory process,” Dr. Pacula said. “The innovation of the cannabis industry and the potential for tax revenue are what drives the policy today; science has simply not caught up to it.”
Daniele Piomelli, PhD, Louise Turner Arnold Chair in Neurosciences and Professor of Anatomy and Neurobiology, Pharmacology and Biological Chemistry at the University of California, Irvine, will review the central and peripheral effects of cannabinoids and what the current science says about the potential for cannabinoids as therapeutic agents.
“Cannabis is currently used by people for a variety of medical indications, not just for its classical psychoactive effects,” Dr. Piomelli said. “Indeed, the vast majority of people who use cannabis as a medicine use it because of chronic back pain or some other form of neuropathic type of pain, and they typically use it because nothing else has worked.”
Dr. Piomelli said side effects and inefficacy with traditional pain and anti-inflammatory treatments are what lead many people to experiment with cannabis as a therapeutic option. He echoes Dr. Pacula’s concerns, though, about the dearth of information — and abundance of misinformation — about the medical use of cannabis.
“For treating pain, I think the evidence for the use of cannabis is pretty good, and it’s clear that you don’t need very high doses to achieve fairly decent pain control, particularly in neuropathic forms of pain,” Dr. Piomelli said. “When it comes to inflammation, the information is a lot less clear and more study needs to be done, but there is hope that there might be a place for cannabis and cannabis-based medicines in relieving inflammation and alleviating chronic pain.”