March 20th, 2015

Last Saturday, the Baltimore City Medical Society held an all-day conference on medical cannabis. Interest was high; the room was filled to its capacity of 100, and a waiting list had been created. In addition to the many physicians in attendance, about 40 people of other backgrounds were also there. One was the mother of child with a seizure disorder, while others had business interests in medical cannabis.

I gave the opening presentation for the Baltimore City Medical Society event — an overview of the history of cannabis use and misuse as well as its neuropharmacology —and then sat back to listen to a series of enlightening talks. I wanted to share some of the information that I found particularly interesting:

  • Access. Repeated efforts — all unsuccessful — have been made in recent years on a federal level to move cannabis from Schedule I to II to make research on medical possibilities more feasible. The FDA was involved in these rejections, but it was clear that the DEA had the final say. A classic “Catch 22” was described wherein the DEA objected to “medical cannabis” on the basis of insufficient information being available, while itself having created substantial barriers to obtaining that necessary information. As a result research access to cannabis is more restricted than for any other Schedule I substance.
  • Experience. Some people have argued that the issue of medical cannabis was being used as a “Trojan horse” for recreational legalization. The California medical marijuana program has been managed so loosely that a considerable amount of de facto recreational use occurs. In Colorado, by contrast, the program is being managed more tightly, and physicians are being monitored more carefully. The situation in Colorado, however, has been complicated by the recent legalization of cannabis for recreational use. Problems have arisen particularly around the use of oral forms of cannabis, known as “edibles.” Packaging has been confusing with inaccurate representations of THC content. This was something I explained to the Baltimore City Medical Society.
  • Research. Despite all the barriers, some good research on cannabis is being done. One area of interest is its relationship to sleep. While people with sleep difficulties sometimes use it to induce sleep, there is evidence that although in the short run this can work, in the long run cannabis can make the problem worse. I plan in the future to pay more attention to the sleep difficulties of my cannabis addicted patients; quality of sleep is an important factor in the overall success of addiction treatment.

During the question and answer session for the Baltimore City Medical Society event that concluded the conference, many people expressed puzzlement about the continued barriers to researching this complex and important substance. The conference confirmed my belief that the intransigency of the responsible federal government agencies in general and the DEA in particular bear the brunt of the responsibility for this situation. I believe that the progress that we have seen on this front will only continue if pressure is brought from the outside — perhaps from our community of professionals treating people with substance abuse disorders.

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