There is no disputing that cannabis provides medicinal relief to scores of people. However, federal regulations limit the scope of testing for marijuana recommended for patients, unlike the rigorous testing standards held for other medicines. As such, only a few cannabis-esque medicines have been able to reach the U.S. market to date. With a handful of medications and dispensary options to choose from, one could argue that medical cannabis, in its current form, is a misnomer to some degree.
Moreover, a lack of conclusive data prevents the community from fully understanding the functions of the plant itself. Without proper insights, medical professionals lack needed information on critical plant compounds like cannabinoids and terpenes. “We know that there are almost 150 different phytocannabinoids in cannabis with some new cannabinoids being discovered as recently as two months ago,” said Sarah Dakar, vice president of product development at Jay Pharma. “Very few of these cannabinoids have been isolated and studied, and the ones that have been studied have only undergone very limited studies.”
As such, current patients are primarily left to the best guesses of themselves and the staff at their dispensary. Doing their best to go beyond guesswork, physicians make evidence-based decisions in place of clinical trials. However, evidence-based decisions relying on small lab samples and anecdotal findings can only carry medical cannabis so far. Without data from clinical studies to support such decisions, medical professionals and patients alike are left without complete certainty.
As medical cannabis markets advance and mature, a lack of data is growing from a gap to a chasm. With much left to understand about the plant and its medicinal effects, many hope that regulatory change will come soon enough. However, as often the case in cannabis, uncertainty lies ahead.
Uncertainty in Today’s Medical Cannabis Market
“We are in the initial phase of understanding the medical benefits and risks associated with each cannabinoid,” said Dakar. “We are far from understanding the complex relationship that exists when there are multiple cannabinoids combined.”
Six countries, Canada, Uruguay, Israel, the Netherlands, Spain, and the Czech Republic, currently lead the way in lab studies regarding medical cannabis and other areas of interest. Federal regulations limit the United States from taking part in advancing the understanding of the plant and its compounds. This limitation is due to cannabis being a Schedule I drug. With the government’s view that cannabis provides no medical value, the plant cannot be studied in America at this time.
Scant lab research to date has resulted in limited data in critical areas of study, Dakar reported. In particular, Jay Pharma’s VP singled out cannabinoid treatments. For example, CBN is believed to aid in appetite stimulation and sleep. However, further research must be conducted to account for each person’s endocannabinoid system, explained the medical researcher.
A Lack of Conclusive Data Impacts the Medical Marijuana Market
A burgeoning market saddled by a knowledge gap creates pain points no other medication in the U.S. currently faces. “As of right now, it’s up to the patient to ideally find which chemovar and consumption method works best for them,” Dakar said of the patient’s plight. This situation is often brought on by the physicians’ lack of education and confidence in the current data available. “Physicians not only don’t have enough data to inform their decisions, but many of those physicians aren’t properly educated on the data that does exist.”
Both patients and practitioners face the ongoing ramifications of federal regulations stemming from the drug war. Speaking of drugs, the approval of cannabis-based medications won’t happen in the current regulatory climate. As such, only a few marijuana-based options have reached American markets to date. So far, the FDA has approved one cannabis-derived prescription drug, Epidiolex, as well as three synthetic cannabis-related prescription drugs, Cesamet, Marinol, and Syndros.
With the approved options treating just a few conditions, most patients remain without a legal medical cannabis option that has gone through FDA trials. Regardless of its tests, many patients want answers. This includes hundreds of Washington State residents, where a poll found that 74% wanted information from cancer providers about cannabis treatment options. The research noted the high interest is likely boosted by being in a legalized state. However, the report went on to state that “cancer patients desire but are not receiving information about cannabis use during their treatment from oncology providers.”
Where Does America’s Medical Cannabis Go From Here?
With the previously mentioned six nations leading the way, research regarding marijuana and specific phytocannabinoids will develop in time. Even if the U.S. were to reschedule the plant and allow for testing, studies may not focus on specific compounds for some time, according to Jeff Zucker, president of cannabis strategy firm Green Lion Partners. While such reviews are ideal, Zucker advised people not to hold their breath. “The FDA is used to analyzing individual chemical compounds, so a plant that has hundreds of those is something they’re in no rush to tackle.”
Meanwhile, CannaMD’s Dakar and her team are working in Israel. They’re preparing for Phase I and II trials to assess a synthetic strain of CBD and its effect on malignant Glioblastoma multiforme brain tumors. The company expects the start date to begin the second half of 2020.
Back in the U.S., the FDA has voiced its support of what it calls sound scientific research. The FDA says it supports research efforts by providing information on the clinical research process and specific requirements to develop a drug for humans. Additionally, it claims to provide support for investigators and their clinical trials and other procedural matters.
The efforts of the FDA indicate that the U.S. may be interested in helping close the information gaps in the cannabis market. However, without substantial regulatory changes on the federal level, a lack of U.S. research will continue to hamper the progress of the country’s medical cannabis market. While the nation can rely on outside data, America’s inability to study the plant itself will likely continue to impact its market and the globe for some time.
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