Clearing the air: Healio launches special report on medical cannabis

Healio has launched a new special report on medical cannabis that summarizes the current scientific research and incorporates expert opinion.

The report focuses on several of the most common indications for medical cannabis: pain, sleep, anxiety, depression and seizure disorders. It offers easy access to information that busy clinicians need to answer important questions from their patients, along with expert insight from Kari L. Franson, PharmD, PhD, BCPP, senior associate dean for academic and student affairs and professor of clinical pharmacy at the University of Southern California Alfred E. Mann School of Pharmacy and Pharmaceutical Sciences, who provides important take-home messages for clinicians.

Readers can access the report for free here.

Informing patients

Cannabis and its potential use in health care has long been one of the hottest topics in medicine.

Many think the words “marijuana” and “cannabis” are interchangeable, but this is incorrect, according to the National Center for Complementary and Integrative Health (NCCIH), which is part of the NIH. Cannabis refers broadly to all products that come from the cannabis plant, while marijuana specifically refers to plants that contain “substantial amounts of tetrahydrocannabinol (THC)” — the primary substance that creates the well-known “high” and other effects on one’s mental state.

Research often evaluates the effect of popular cannabinoids, a substance group found in cannabis. The most common are cannabidiol (CBD) and THC, but at least 100 more have been identified, according to NCCIH.

Despite anecdotal evidence that cannabis use can improve pain, nausea, mental health symptoms and more, the FDA has not approved the cannabis plant for medical use. But it has greenlit several drugs containing individual cannabinoids, according to the NCCIH.

“We’re well aware that there are components of the cannabis plant that have pharmacological activity,” Franson told Healio. “With any pharmacological intervention, you're trying to figure out, ‘What can we harness for good?’ and ‘What is a risk to anybody who would use this?’”

Roughly 2.5% of the world’s population — about 147 million people — use cannabis (for comparison, 0.2% use opiates and 0.2% use cocaine), according to WHO. However, Franson said other recent estimates have put that number nearer to 200 million people, and this prevalence means health care workers have a responsibility to their patients.

“It's up to us as health care providers to monitor and document who is benefiting and who is not, and who is at risk for adverse events, so that we can do a better job of informing people what their likely outcomes are based on our knowledge,” Franson said.

The 2018 passage of the Farm Bill removed hemp, which can include CBD, from its status as a Schedule I drug. Since then, CBD’s popularity has skyrocketed and there has been a frenzy of interest in its potential medicinal properties.

“CBD has many, many different mechanisms that it interacts with,” Franson said.

Like cannabis in general, patients anecdotally report using CBD for a variety of reasons. According to a 2019 Gallup poll, 14% of people in the United States said they used CBD products. The top three reasons were pain (40%), anxiety (20%) and sleep (11%).

However, use of CBD and people’s familiarity with it also varied widely by age. Among those aged younger than 30 years, 20% said they used CBD, but among those aged 65 years and older, nearly half were unfamiliar with CBD and only 8% reported using it.

Many health care workers are regularly asked about cannabis, and Franson said they should explore these conversations when a patient brings it up.

“If somebody's asking about cannabis use, it's my belief that they have hope that the product is (maybe) going to treat something that their current medication regimen is not addressing,” she said. “Or they simply have hope that cannabis will do better, it will be super therapeutic. I think clinicians need to explore that underpinning hope and recognize that a lot of patients will continue to pursue it and try it because of that hope. So, it's up to that clinician to guide that patient into safe use of cannabis.”

References:

• Cannabis (marijuana) and cannabinoids: What you need to know (NCCIH). https://www.nccih.nih.gov/health/Cannabis-marijuana-and-cannabinoids-what-you-need-to-know. Accessed March 13, 2024.
• Megan B. Gallup. 14% of Americans say they use CBD products. https://news.gallup.com/poll/263147/americans-say-cbd-products.aspx. Published Aug. 7, 2019.
• WHO. Alcohol, drugs and addictive behaviors unit. Cannabis. https://www.who.int/teams/mental-health-and-substance-use/alcohol-drugs-and-addictive-behaviours/drugs-psychoactive/Cannabis. Accessed March 18, 2024.