The National Academies of Sciences, Engineering, and Medicine has released a major US government-funded report entitled "The Health Effects of Cannabis and Cannabinoids: The Current States of Evidence and Recommendations for Research" (the "Report") outlining benefits and harms associated with cannabis on a range of public health and safety issues. Cannabis scientific and medical research has historically been impeded because of its illegality, stigma, and related challenges, so the report represents a major positive step towards providing guidance and evidence-based research for physicians, researchers, and patients alike.
A key finding of the Report was that in adults with chronic pain, patients who were treated with cannabis or cannabinoids are more likely to experience a clinically significant reduction in pain symptoms (Report, page 69). This is a significant conclusion in itself, but may also have implications for the potential systemic reduction of opioid use. Opioid use and abuse has become a significant epidemic in Canada and worldwide, and some studies have shown that the use of medical cannabis in pain patients is associated with a reduction in opioid use and the prescription of conventional pain medications (Report, page 70-71). As a result, the conclusion that cannabis may be an effective treatment for chronic pain, may have farther reaching implications.
Another significant finding of the Report was that there is conclusive evidence that oral cannabinoids are effective antiemetics in adults with chemotherapy induced nausea and vomiting (Report, page 75). Additionally, in adults with multiple sclerosis related spasticity, there is substantial evidence that short-term use of oral cannabinoids improves patient-reported spasticity symptoms (Report, page 83).
The effect of cannabis on a number of other diseases and symptoms was reviewed in the study, but the general conclusion was that more research is needed. Ultimately, the recommendations of the Report were as follows:
1. Address Research Gaps
Public agencies, philanthropic and professional organizations, private companies, and clinical and public health research groups should provide funding and support for a national cannabis research agenda that addresses key gaps in the evidence base in order to develop a comprehensive evidence base on the short- and long-term health effects of cannabis use (both beneficial and harmful effects).
2. Improve Research Quality
Agencies of the United States Department of Health and Human Services, including the National Institutes of Health and the Centers for Disease Control and Prevention should jointly fund a workshop to develop a set of research standards and benchmarks to guide and ensure the production of high-quality cannabis research in order to promote the development of conclusive evidence on the short- and long-term health effects of cannabis use (both beneficial and harmful effects).
3. Improve Surveillance Capacity
The Centers for Disease Control and Prevention, the Substance Abuse and Mental Health Services Administration, the Association of State and Territorial Health Officials, National Association of County and City Health Officials, the Association of Public Health Laboratories, and state and local public health departments should fund and support improvements to federal public health surveillance systems and state-based public health surveillance efforts in order to ensure that sufficient data are available to inform research on the short- and long-term health effects of cannabis use (both beneficial and harmful effects).
4. Address Research Barriers
The Centers for Disease Control and Prevention, National Institutes of Health, Food and Drug Administration, industry groups, and nongovernmental organizations should fund the convening of a committee of experts tasked to produce an objective and evidence-based report that fully characterizes the impacts of regulatory barriers to cannabis research and that proposes strategies for supporting development of the resources and infrastructure necessary to conduct a comprehensive cannabis research agenda.
The full Report can be accessed at: https://www.nap.edu/read/24625/chapter/1
This article was written with the helpful contribution of Michael Garbuz (Articling Student).