For decades federal officials have largely stymied
large-scale clinical trial research into marijuana’s therapeutic
benefits. Now a coalition of United States Senators is saying it’s time
for a change.
Eight Democrat senators, led by Massachusetts Sen. Elizabeth Warren, fired off a letter
this month to representatives of the US Department of Health and Human
Services, the Office of National Drug Control Policy and the US Drug
Enforcement Administration demanding to know why the federal government
is not doing more to facilitate medical cannabis science.
The
letter, which the senators cc-ed to the head of the US National
Institute on Drug Abuse and the Commissioner of the US Food and Drug
Administration, states: “Currently, twenty-three states and the District
of Columbia have passed laws allowing for medical marijuana use, and an
additional fifteen states have laws specifically allowing access to
cannabidiol (CBD). While the federal government has emphasized research
on the potential harms associated with the use of marijuana, there is
still very limited research on the potential health benefits of
marijuana – despite the fact that millions of Americans are now eligible
by state law to use the drug for medical purposes. … With the pool of
medical marijuana users growing in the United States, we believe that
federal agencies have both an opportunity and a responsibility to craft a
sensible research and public health strategy that allows us to generate
meaningful data and conclusions from this ongoing natural experiment.”
Specifically,
the senators are asking federal health officials to conduct
“large-scale clinical trials” involving patients residing in legal
medical cannabis states. The senators also request that the feds to
provide better support, including financial support, to “independent
scientists” who are interested in studying the plant.
Under
federal law, all clinical protocols involving cannabis must meet the
approval of the FDA, DEA and the NIDA. Until recently, such trials also
required the additional approval from the US Public Health Service, but
that hurdle was removed
by the administration last month. Moreover, all federally approved
studies must utilize marijuana grown and provided by the US government’s
lone,
federally licensed provider, the University of Mississippi. Testifying
before Congress in late June, NIDA director Nora Volkow acknowledged
that this monopoly limits scientists’ access cannabis and hinders
research. Her conclusion is similar to that of the DEA’s own
administrative law judge Mary Ellen Bittner, who in 2007 ruled
that licensing additional cannabis cultivators “would be in the public
interest.” But in 2009 former DEA director Michele Leonhart set aside
the ruling. The agency issued its final rejection in 2011.
As
a result, Senator Warren and her colleagues are calling on the DEA and
other federal agencies to once again consider the prospect of licensing
private manufacturers of cannabis for research purposes.
Their
letter concludes: “Many states and localities are moving forward with
policies that facilitate the availability of medical marijuana to a
greater proportion of the population than ever before. All participants
in this important debate will benefit from rigorous, scientific research
into the impact of these policies on American public health. Relevant
federal agencies must play a leadership role in coordinating and
facilitating that research if we are to ensure that public policy in
this area is supported by our best science. We look forward to your
response on this matter … no later than August 31, 2015.”
Senators
Booker (D-NJ), Boxer (D-CA), Gillibrand (D-NY), Markey (D-MA), Merkley
(D-OR), Mikulski (D-MD), and Wyden (D-OR), co-signed the letter. Yet
these Senators are not the only ones now publicly pushing for further
research, Last week, Senators Diane Feinstien (D-CA) and Charles
Grassley (R-IA) – two longtime opponents of marijuana a law reform –
penned an op-ed in Time Magazine calling on the Feds to “break down barriers to medical marijuana research.”
Specifically,
the senators called on regulators at the US Department of Justice and
HHS to “definitively determine whether CBD has scientific and medical
benefits, and if so the proper schedule for it.”
They added: “We
need to cut red tape and streamline the licensing and regulatory
processes so research can move ahead. In addition, we must also find
ways to ensure that researchers have access to the quantity and quality
of marijuana that they need. Finally, we need to look at expanding
compassionate access programs where possible, to benefit as many
children as possible.”
Yet, while lawmakers’ calls for
additional research are welcome, it belies the fact that ample
scientific evidence already exists – and has for some time -- to
validate cannabis’ therapeutic utility and to support its removal from
its schedule I classification.
Unlike modern pharmaceuticals,
the marijuana plant possesses an extensive history of human use dating
back thousands of years, thus providing society with ample empirical
evidence as to its relative safety and efficacy. Moreover, cannabis and
its compounds are among some of the most well studied biologically
active substances of modern times. A search on PubMed,
the repository for all peer-reviewed scientific papers, using the term
“marijuana” yields more than 21,000 scientific papers referencing the
plant and/or its constituents, nearly half of which have been published
just within the past decade. While it is true that most of these studies
do not fall into the category of gold-standard Phase III
placebo-controlled clinical trials, hundreds of methodologically valid studies assessing cannabis’s safety, efficacy, and mechanism of action exist in the available literature.
For instance, there are well over 100 randomized controlled studies,
involving thousands of subjects, evaluating the relative safety and
therapeutic efficacy of either whole-plant cannabis or individual
cannabinoids. A review
of a recent series of clinical trials evaluating whole-plant cannabis,
sponsored by the University of California, concluded, “Based on evidence
currently available the Schedule I classification (for cannabis) is not
tenable; it is not accurate that cannabis has no medical value, or that
information on safety is lacking.”
Twenty-three states and
Washington, DC now permit physicians to recommend marijuana therapy.
Some of these state-sanctioned programs have now been in place for
nearly two decades. So while more clinical study is welcome, it is not
necessary in order to precipitate a change in federal law. We already
know enough about cannabis, as well as the failures of cannabis
prohibition, to allow people the option to consume a botanical product
that is objectively safer than the litany of pharmaceutical drugs it
could replace.
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