Questions that need answers: research needs to keep pace with escalating cannabis issues

As a seasoned researcher in the field of cannabis and cannabinoid pharmacology, there are a few key areas where the current lack of information and knowledge gaps raise concerns. Some of these gaps in knowledge have been the topic of research for decades, while others have emerged much more recently. The changing and evolving landscape of cannabis use has intensified the need for answers and has raised new questions. Discussing both the established and emerging areas where research data is either lacking or still accumulating, is complicated by the informational milieu, which includes real-world experience, anecdotes, advertorials, academic research, industry marketing, and educational material from diverse sources. The situation is further convoluted by a variety of conflicts of interest. This is exacerbated by the blurring of dichotomy between non-medical and medical use, whereby a perceived “harm” in the former case may be a manageable side-effect in the latter. So, from the perspective of a pharmacology prof, what are the most critical gaps in our knowledge? I would highlight three pressing questions for which we need to the research data to keep pace with these rapidly evolving and, in some cases, escalating issues. Are the effects of cannabis different in females and males? All compounds, whether natural or synthetic, are processed by the body so they can be safety excreted. Emerging data indicates that there are very striking differences in how the females and males metabolize and excrete cannabis constituents—with potential implications for the impacts on health and in illnesses. This also influences the potential for different effects of inhaled and edible cannabis in females and males. The fact that studies of effectiveness, side-effects, and dose were largely conducted in males, remains one of the most alarming historical errors in pharmaceutical drug development. Numerous cases have highlighted serious consequences discovered after the fact. For example, the case of a widely used sleeping medication, where blood levels were found to be roughly 30 per cent higher in females leading to greater impairment, or a diabetes medication where almost 70 per cent of the cases of acute liver failure associated with the drug were in females. We must make every effort to avoid such errors in relation to cannabis, especially as use in women is now increasing. What are the effects of chronic use of high dose CBD? The use of CBD as a wellness product for a plethora of health indications has rapidly escalated over the last number of years. This is especially the case in women, where product marketing is often being targeted. While there is good data on the use of CBD as a medicine for epilepsy in children, these trials and others have highlighted potential effects of CBD on the liver and in modifying the levels of other medications that patients may be taking. Use of CBD in high doses is a relatively new phenomenon and we do not have any information of the long-term consequences—be they good or ill or neutral. Claims of effectiveness of CBD products in anxiety and sleep are not yet backed by robust research data. This does not mean that CBD does not have health benefits, it means that we simply do not know for sure, and we do not know if there are side-effects over the long-term. Patients desperately need good quality information. What are the consequences of use of high doses of THC, particularly in young adults? We have many decades of population data on the effects of lower doses of THC. However, the doses used have dramatically increased over the last decade, with many of the legal products now being above 20 per cent THC. From a pharmacologist perspective, this is a very high dose of THC, at least five times higher than the kinds of doses contained in the epidemiological data previously used to assess any long-term impacts of use of THC. We would never use data on a low dose of a drug and claim to make any projections about the effects of a dose that is many multiples higher. The fact that 20 per cent is a very high dose of THC, for which we currently have limited data on safety and health consequences, should be front and centre at the point of sale of cannabis products. This is especially the case for young adults (aged 18-25). Recent research shows that the human brain does not reach full maturity until at least the mid-20s, with continuing adjustment until at least 25. Young adults aged 15-25 are more likely to experience mental illness and/or substance use disorders than any other age group. There are good reasons for concern. These questions are priority for many cannabis researchers. It is important to track the emerging data and rapidly communicate and implement any recommendations to consumers, patients, and physicians. Professor Ruth Ross is chair of the Department of Pharmacology and Toxicology and a senior scientist at the Centre for Addiction and Mental Health. The Hill Times

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Questions that need answers: research needs to keep pace with escalating cannabis issues

The changing and evolving landscape of cannabis use has intensified the need for answers and has raised new questions.

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