Pubdate: Sun, 09 Aug 2015
Source: Gazette, The (Colorado Springs, CO)
Copyright: 2015 The Gazette
Contact: http://www.gazette.com/sections/opinion/submitletter/
Website: http://www.gazette.com/
Details: http://www.mapinc.org/media/165
Author: Christine Tatum

Q&A: DIRECTOR OF THE NATIONAL INSTITUTE ON DRUG ABUSE

Dr. Nora Volkow represents a lot of inconvenient truths about 
marijuana that just don't square with industry claims and popular 
opinion that the drug is medicine, "safer than alcohol" - or even on 
its way to being adequately regulated by states that have sanctioned its use.

The director of the National Institute on Drug Abuse in Bethesda, 
Md., Volkow is one of the world's top experts on the use and abuse of 
cannabis and research of the drug's impacts on individual and public health.

Volkow's command of the science was on display when she appeared in 
Denver alongside Gov. John Hickenlooper and Ricardo Lagos, former 
president of Chile, at the Biennial of the Americas, a festival that 
brought together leaders from North, Central and South America to 
address shared interests. Volkow recently spoke with The Gazette:

Question: What do you most want Americans to understand about how 
marijuana legalization affects public health?

Answer: It is important to remember that it is the legal drugs, in 
other words, nicotine and alcohol, that are, by far, the main drivers 
of drug-induced morbidity and mortality in our country. That is not 
because they are more dangerous, but because their legal status makes 
them much more accessible to people, increasing the overall number of 
individuals exposed to them and facilitating their regular use. That, 
in turn, leads to a much greater number of people affected negatively 
by them. Even when compared to the most dangerous illegal drugs, such 
as methamphetamine and heroin, there are many more people dying from 
the use of legal drugs. We should keep this simple fact in mind when 
discussing legalizing a third drug: the unintended consequences could 
be equally far reaching and hard to reverse once they are discovered.

Q: Which marijuana-related health problems do you think are most 
underreported or most inaccurately reported - and, therefore, most 
misunderstood by the general public?

A: One of the effects most challenging to explain to the public 
relates to the effects of chronic marijuana use on cognition, 
particularly when use begins early, during adolescence or even 
childhood. When use starts early, the known effects of marijuana on 
brain physiology and experience-driven brain adaptations interact 
with developmental processes that make the young brain particularly 
sensitive to these toxic effects, which can result in long-term 
changes to the brain.

Another issue that is grossly misunderstood or underappreciated is 
that, like other drugs of abuse, marijuana can be addictive.

  Q: Is cannabis medicine? If so, what for, and in what form?

A: Cannabis in smoked form is unlikely to be an ideal medicine due to 
its effects on the lungs and the difficulty of achieving reproducible dosing.

We can say with certainty is that cannabis contains active 
ingredients with potential therapeutic properties. In fact, the FDA 
has already approved medicines based on THC for the treatment of 
wasting syndrome and to control nausea in chemotherapy patients. And 
there is preliminary evidence suggesting THC may have therapeutic 
efficacy in the treatment of pain. There is also a great deal of 
interest in developing medications based on another constituent of 
the cannabis plant called cannabidiol (CBD). CBD, which does not give 
users the classic 'high,' has shown some promise in controlling 
seizures in children with severe forms of epilepsy (including Dravet 
and Lennox-Gastaut syndromes), and preliminary trials of a CBD-based 
drug are underway by GW Pharmaceuticals. There are likely many more 
applications for these other cannabinoids that are supported by a 
scientific rationale and some intriguing preliminary results that 
warrant more research.

Q: How do you respond to the assertion that marijuana is safer than 
alcohol, other drugs?

A: Most drug abuse researchers are reluctant to draw simple 
comparisons between the harms of different classes of drugs - and for 
good reasons. Substances can affect the body and brain in different 
ways, and there is so much variability in how different individuals 
respond to them that comparisons between drugs - or statements about 
'what drug is worst for you' - are of little use in predicting 
outcomes for a given individual. A drug that proves relatively benign 
for one person's life and health may have a disastrous effect on 
another person for reasons ranging from differences in age and 
genetic vulnerability to countless variables in life experience. If 
you are addicted to a drug, that is the one that is worst for you.

In the case of alcohol-versus-marijuana comparisons, the difficulty 
is compounded by an imbalance in the available data. Because alcohol 
is legal, its use is much more widespread and often continues 
throughout the lifespan. As a result, its adverse health effects and 
its impact on personal and public safety - for example, fetal alcohol 
syndrome or driving risk - are well understood. Scientists cannot yet 
speak with the same degree of confidence about some of the health and 
safety effects of marijuana. For instance, its contribution to 
pulmonary and cerebrovascular function, or the exact degree to which 
it harms a developing fetus or impairs driving. What data we do have 
on marijuana's effects are occasionally difficult to interpret 
because marijuana users frequently use alcohol as well - whereas the 
reverse is less likely to be true, making it difficult to separate 
the effects of the two substances.

Q: What kind of research do you want to see more of? Which recent 
and/or ongoing research do you want the public to know about?

A: There is a significant need for more research following up on 
promising preclinical and early clinical research findings related to 
the potential therapeutic value of some of the components of 
marijuana, including THC and CBD. NIDA specifically is working to 
understand the potential therapeutic value of these compounds for the 
treatment of substance use disorders as well as pain. Other NIH 
institutes are studying the value of these compounds for other 
disorders relevant to their missions.

Additionally, from NIDA's perspective, it is important to continue 
research related to the changing landscape of marijuana use, 
including strains of higher THC potency; new routes of administration 
- - for example, vaping and consuming edibles; new drug combinations; 
and a culture of rapidly changing norms and perceptions. For example, 
what are the consequences of long-term use of 'medical marijuana' 
among vulnerable populations, such as patients with AIDS, cancer, 
cardiovascular disease, multiple sclerosis or other neurodegenerative 
diseases or elderly persons? And the impact of in-state marijuana 
policies and related market forces - for example, youth-targeted 
advertising, pricing wars, and the emergence of FDA-approved 
cannabis-based medicines - on use and related public health and 
safety outcomes?

One of the most important questions we need to answer is whether and 
to what extent the association between early marijuana use and 
long-term, adverse effects on aspects of life - such as IQ, academic 
achievement, well-being and mental health - reflects a causal 
relationship. This is why NIDA is coordinating a 10-year study that 
will follow the trajectory of 10,000 children. We call this the 
Adolescent Brain Cognitive Development (ABCD) study, which is about 
to be launched jointly by several NIH Institutes. By gathering 
neuro-imaging data as well as a broad range of data regarding 
substance use, mental health and other outcomes - including IQ and 
cognition - the study will clarify the impact of marijuana use on 
development, reveal the effects of multiple substance exposures and 
disentangle the effects of marijuana and other drugs from various 
confounding factors - particularly prior exposure to substances.

Q: What ideas do you have about ways to speed medical research of 
cannabis and cannabis use disorder treatment and the dissemination of 
those findings to practice?

A: As mentioned before, THC and other chemicals in the marijuana 
plant have a wide range of potential medicinal properties, and thus 
the possible therapeutic uses of marijuana are a subject of 
increasingly intense interest. The challenge is to learn how to 
encourage research but keep research subjects safe. We want to 
optimally harness the potential medical benefits of marijuana's 
chemical constituents without exposing healthy or sick people to the 
various intrinsic risks of smoking or otherwise ingesting marijuana 
in its crude form, particularly when product quality, composition, 
purity and dosing are inconsistently standardized - as may be the 
case with 'medical marijuana.'

We think the U.S. Department of Health and Human Services' recent 
removal of one level of review (by the Public Health Service 
committee) that has been necessary for approval for non-NIH-funded 
studies should help. In addition, we think that consideration should 
be given to reducing other barriers to research, including the 
administrative and regulatory burden associated with doing research 
on Schedule I drugs, the restriction of marijuana produced for 
research purposes to a single source, and issues related to the 
disparity between federal and state laws.

The medical cannabis research portfolio is potentially very vast, so 
it must be said that most of this portfolio falls outside of NIDA's 
defined mission. However, NIDA does have a natural interest in 
exploring at least two major applications for cannabis-based 
medications: the treatment of substance use disorders, including 
cannabis use disorders, and the development of alternative - meaning 
non-opioid-based - approaches for pain management.
- ---
MAP posted-by: Jay Bergstrom