Cannabis: another painful decision

Many countries are relaxing their restrictions on cannabis. It’s been a long time since a psychoactive drug based on a plant and already widely used illicitly has been regulated. That is not surprising, given the trajectories of use and abuse of three of the older regulated products – opioids, tobacco and alcohol.

Can THC help?

When a substance become legal after a long period of illegality, there is a rush by interested parties to prove something about it – either good or bad. Better than good or bad would be to understand whether cannabis is helpful or dangerous – and in what situations. One of the main problems is that cannabis is not one entity. The cannabis sativa extract consists of more than 144 differing cannabinoids. The most frequently prescribed medical cannabinoids are a combination of cannabidiol (CBD) and delta-9-tetrahydrocannabinol (Δ9-THC) which has been shown to provide benefit treating conditions including chronic pain, multiple sclerosis-related spasticity, cancer-related nausea and childhood treatment-resistant epilepsy. In most of these preparations the non-psychoactive component CBD is the main ingredient.

Not so in the non-medical market. The most popular forms of street marijuana, such as cannabis and hashish, have been evolving upwards from a ratio of less than 4% THC. Skunk contains an average of 16% THC and a trace amount of CBD. Nederwiet, the Dutch product, contains up to 60% THC and is legally permitted to be used to make cannabis wax, which contains around 90% THC.

With two different uses emerging, a major rift is developing between the medical/scientific community and the community-at-large about the positioning of cannabis. It is always the mission of clinicians to do no harm. At best that means cure, at worst to minimise the additional suffering that the adverse effects of prescribed products can cause. So it is no wonder that without substantive supportive evidence, certain medical bodies have warned against cannabis use. For example, a leading journal of obstetricians and gynaecologists has sounded the alarm that using cannabis when pregnant could be harmful to both mom and baby. Without evidence, they incite fear. For example, the article warns that “THC passes into breast milk and then enters the baby’s brain and fat cells, where it can remain for weeks. Just as in the case of youth, there may be structural brain impacts.” This statement lacks any supporting citation.

In this epidemic ridden 21st century, fear is the dominant emotion driving on the one hand caution, and on the other recklessness and anger. It cannot be treated with more fear. Unfortunately, most research funding is heading that way. The federal government has awarded approximately $1.49 billion to scientists for cannabis research. Most of the funds focus on drug abuse and adverse mental effects with little focus on possible positive effects. 

It is time that we accepted that some of the psychoactive effects of cannabis (through THC) may be beneficial, and we start to research how, if possible, cannabis can help, not hinder  existential angst. Many non-medical users already seem to think so.

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