Rings of Smoke

The circular discussion of medical cannabis and its value in science and medicine has been going on for some time. It is going to continue on until, as a country, we determine to take a risk in one direction or the other, and finally make some federal regulation changes. Cannabis, as a topic, is controversial. That is not news. The background noise and barriers to this once reviled plant are growing less obtrusive. What does capture attention and bring concerns is the continued cycle of discussion and action, or lack thereof. The lack of clinical research and data to evaluate therapeutic efficacy makes advocacy and change more difficult.

The history of the cannabis plant and its use dates back 12,000 years. According to AncientOrigins.net, the first recorded use of cannabis for medicinal purposes was in 2737 BC by the Chinese emperor Shen Nung for rheumatism and gout. Both hemp and marijuana were used through ancient China. Cultivation of the plant grew and spread. Early Egyptians have recorded use of medicinal cannabis as far back as 2000 BC for sore eyes and cataracts. This plant has been used by cultures and people all over the world for centuries. Historians have evaluated evidence of its historical use medicinally across the globe; regardless of the stance you take, we can agree this plant has been around and provided solutions for people for a long time.

The challenge is how to generate the kind of research that scientists, clinicians, and lawmakers can point to and make educated conclusions. Anecdotal evidence and observations outside of a controlled research study are helpful and provide strong stories for value therapeutically and medically. However, that type of information cannot answer some of the greater questions surrounding societal benefit, perceived or actual risk, and generalization for broader application; that information has not yet convinced the skeptics. A January 2018 editorial published in the Journal of Applied Laboratory Medicine touched on this very issue. “A recent cursory PubMed literature search in May 2017 revealed approximately 12 randomized control trials published over the past 5 years contributing to new evidence in the field. Over the same time span, the search identified an incredible 11 systematic reviews published in English all appraising similar sets or subsets of clinical traisl on cannabinoids and pain.” We need continued research to push forward. The biggest barrier to additional research is the Schedule I classification for marijuana. Funding, organization, implementation, and evaluation for research trials is limited while cannabis remains an illegal substance.

This brief article has gone in a ring, like many current debates on this topic. There isn’t sufficient research to make decisions so additional research is called for; however, clinical research is challenging due to marijuana’s illegal status. So now what? Maybe the next step is not additional discussion but action. We take leaps of faith because we want to move forward into the unknown; the AMA amended policy calling for the review of marijuana’s Schedule I drug status to allow study of its medical value. One of the main factors in classifying a substance as Schedule I is that there is no medical value. Would a change in drug classification be enough to start the medicinal cannabis research ball rolling? What are the true and imagined risks to changing that classification to make marijuana less restricted on the federal level? Do those risks outweigh the potential benefits? Epistemologically speaking, is there a difference between what each of us have historically held as truth versus what has been studied and demonstrated on the topic of cannabis as a therapeutic agent?