Larger-scale research, better regulation needed

By Ryan Basen for Medpage Today

WASHINGTON -- Medicinal cannabis industry officials and scholars here touted potential breakthroughs to treat health problems and questioned why cannabidiol (CBD) is not mandatory for athletes to address traumatic brain injury (TBI). Others, meanwhile, cautioned the field needs much more research and regulation.

"The whole concept of cannabis as medicine is very new," Stuart Titus, PhD, told MedPage Today during an interview at the Americans for Safe Access (ASA) annual meeting on medical cannabis last week. "Everything is at such a ground-floor state."


Medical professionals including Titus, a former physiotherapist working with athletes, cited cannabis medicines being developed (including these by Axim Biotech) for heath problems including:

  • Chronic pain
  • Cancer-induced pain and nausea
  • Irritable bowel syndrome and irritable bowel disease
  • Psoriasis and dermatitis
  • Multiple sclerosis

"It is the herbal medicine, it should be the paradigm," Ethan Russo, MD, a neurologist and pharmacology researcher said.

Medicinal development is stalling, he noted: "The problem is those guys," he said of federal and state politicians, "who make the rules, those rapacious bastards who are ruining our lives."

Cannabis is not undergoing the randomized controlled trials needed in academic settings, said Christina Marrongelli, PharmD, an independent industry consultant and former University of Mississippi researcher in natural products.

"It's not like a bunch of [pharmaceutical companies] are waiting to get in. This is a harder thing to develop," she said. Marrongelli suggested advocates encourage more companies to test the plant.

"How do you take a tree and make it into an FDA approved drug?" she wrote later in an email to MedPage Today. "Development of a botanical drug substance is an enormous task to begin with." Ultimately, she said, large trials must confirm dosages and efficacy in specific conditions.

Better regulation is also needed, said Nic Easley, CEO of Comprehensive Cannabis Consulting. Regulations vary too much between states, he noted, and between states and the federal government. "It's medicine, but (without regulation) to some it's really dangerous," he said. "We're fighting over a dandelion and it's ridiculous."

CBD has shown enough promise to treat TBI in young athletes, said Titus, president of Medical Marijuana Inc. (which sells CBD products); he asserted that all high school and college athletes should use botanical hemp oil that includes CBD and other compounds from the hemp-cannabis plant.

"Hopefully at some point this will be mandated for the NFL [National Football League]" and other levels of football, he added, a position already advocated by former NFL player Eugene Monroe and Dallas Cowboys owner Jerry Jones.

Titus cited studies including UCLA research published in 2014 showing cannabis consumption (in this case tetrahydrocannabinol, or THC) was "associated with decreased mortality in adult patients sustaining TBI"; he also cited pre-clinical and animal studies he said positively tested cannabis as a neuroprotectant -- including protection against chronic traumatic encephalopathy.

Two recent review articles -- a systematic review of clinical literature on neuroprotection and one of preclinical cannabis work -- also suggested cannabis may have neuroprotective properties to treat TBI.

But: "While studies have demonstrated neuroprotective properties of marijuana (and other cannabinoid analogs) in animal models," the authors of the systematic review wrote, "more studies are needed to ascertain the potential benefits (if any exist) of cannabinoids in humans with TBI."

CBD has also yielded positive results controlling epileptic seizures in children, Titus said, citing two other recent studies showing botanical CBD was effective . "You'd normally expect better results with the pharmaceutical version (of treatment)," he said. But: "This CBD hemp-cannabis botanical has a pretty profound effect," perhaps because of the entourage effect.

"We are in the very early stage with informational studies," Titus cautioned. "But the best therapy at the moment seems to be on the botanical side."