According to a National Academies report released this month, more and more Americans are using cannabis both for recreational and medical purposes, however, scientists still don’t know very much about the drug’s effects on human physiology. Part of this knowledge gap owes to the fact that marijuana is classified as a Schedule I drug under the US Controlled Substances Act. In the eyes of the federal government, cannabis is a dangerous drug that “has no currently accepted medical use in treatment in the United States.” However, researchers in Canada are not far ahead of their United States counterparts, even though marijuana has since 2001 been functionally legal for medical use at the federal level there.

Mark Ware, a McGill University pain management physician who has researched the safety and efficacy of cannabinoids for the past 18 years stated, “I wish I could say that [legalizing medical marijuana] had led to more research. I think there’s certainly a willingness to be able to document real world use of cannabis under a legal framework.” Ware added that while there are several public registries that track the legal use of marijuana among Canadians, experimental evidence on the effects of that use are lacking. He said, “The clinical trials, I think for most people that’s an expensive undertaking. There are still questions around who owns the intellectual property, who’s going to sponsor the trials, those remain barriers even in a legal framework as to the cost of that kind of research and the drug development piece of it.”

Michael Bostwick, a psychiatrist at the Mayo Clinic in Rochester, Minnesota, has also published extensively on the therapeutic effects of marijuana. He agreed that although federal illegality is a primary obstacle to studying cannabis in the United States, there are other factors that make understanding the basic science behind the drug’s potential therapeutic effects a daunting prospect. “I’m not sure that the research can catch up with the social use, meaning this: that, at least within the current [US Food and Drug Administration] approaches to medication, which is how every other medication in our country is approved, there is no precedent and no model for, first, smoking a substance and, second, using a substance that is not pure but contains many, many different compounds in varying amounts.”

The Food and Drug Administration (FDA) has only approved three drugs for human use that contain active ingredients present in or similar to those in botanical cannabis. These are Syndros and Marinol, which contain a synthetic version of delta-9-tetrahydrocannabinol (THC, the main psychoactive component of marijuana), and Cesamet, which contains a synthetic cannabinoid that has a chemical structure similar to THC.

Ware suggested that instead of seeking to study smoked cannabis, researchers should shift to studying the therapeutic potential of extracts or derivatives of the plant or otherwise conduct research on alternative ingestion mechanisms, such as vaporization. He states, “There’s obviously a lot of non-scientific development in the recreational market in some of these areas, with edibles and vaping, and all that sort of thing, but I think if we can align some of that with therapeutic delivery systems, we could get away from the smoking. I think that’s a positive direction, more of those studies showing that it mimics the smoked route but it’s clearly less dangerous than smoking.”

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