Wednesday, September 12, 2018
The latest issue of the International Review of Psychiatry has a collection of interesting looking articles with titles like "Marijuana matters: reviewing the impact of marijuana on cognition, brain structure and function, & exploring policy implications and barriers to research" and "Sweet flowers are slow, and weeds make haste: leveraging methodology from research on tobacco, alcohol, and opioid analgesics to make rapid and policy-relevant advances in cannabis science." There are too many interesting looking pieces to cite them all here, but I can quote the start of the editorial introduction:
The allowance of cannabis to be used as a medicine in the absence of adequate data to inform basic clinical decision-making is rooted in compassion for individuals with life-threatening illness, or substantially debilitating illness, and no other course for treatment. However, this relatively simple tenet has now morphed into a large-scale for-profit industry that is fraught with public health concerns. Access to cannabis has been expanded to include treatment for a multitude of health conditions, many of which are neither life-threatening nor debilitating, and for which effective alternative treatments exist. Data from which to determine the risk-benefit for an individual considering the use of cannabis is sparse at best. Quality control issues abound in this industry as there are no established standards for cultivating, processing, testing, or labeling cannabis products. There is also concern over advertisements and product labeling that include misleading or unsubstantiated health claims, as these products have not been vetted by traditional drug development methods. The speed in which cannabis policies are changing is rapid, and the fact that these are happening as a direct result of legislation or by voter referendum is reckless given the absence of consensus standards and, in many cases, appropriate regulatory oversight. The impact of revised cannabis laws, both with respect to medicinal use for a variety of health conditions, and for non-medicinal (aka ‘recreational’) use of cannabis by adults, will likely have a substantial impact on psychiatry.
This special issue of the International Review of Psychiatry is focused on cannabis science, but with a very targeted theme of cannabis regulatory science. Recently in the US, the Food and Drug Administration (FDA) was granted regulatory authority over all nicotine and tobacco products. This was a landmark event, and has engendered a bolus of thoughtful, policy-oriented research that has already resulted in tobacco regulations which are likely to positively impact public health in the US and abroad. Studies have included careful scientific evaluation of the impact of nicotine on cigarette reinforcement and self-administration, packaging and flavoring on youth initiation, the harm reduction effects associated with nicotine delivery devices other than cigarettes, and other important topics. The parallel need for a cannabis regulatory science is urgent. Novel products and cannabis delivery devices are rolling onto the shelves of dispensaries at a rapid rate, product development appears to be geared towards high potency/high dose products, and it is all being carefully marketed to increase consumption. Contributions in this issue highlight lessons learned from tobacco, alcohol, and opioid regulatory science that are relevant to cannabis, detail important factors surrounding tobacco and cannabis co-use, and detail the potential impacts of regulatory changes on cannabis use in the workplace.