Why we don’t know much about pot

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To fully grasp the absurdity of U.S. marijuana policy, step into one of the two Dodge Sprinter vans that University of Colorado at Boulder researchers have equipped as mobile research labs — tiny desks mounted to the floor, outfitted with syringes, heart rate monitors, cognition games and binders to track hundreds of volunteer research subjects.

Although pot is fully legal in 10 states, effectively so in 22 others that permit some form of medical marijuana, and consumed by nearly half of American teens and adults at some time in their lives, there is surprisingly little information about its effects on users. Nor has science determined when, where, how or how much marijuana might be safe to use.

That’s because while it’s perfectly legal and easy to smoke pot in states like Colorado, studying the drug is another matter.

While marijuana use explodes around the nation and more states experiment with liberalizing cannabis policies, the federal government hasn’t budged an inch toward legalization.

Marijuana remains fully illegal at the federal level, and strict federal access policies tie the hands of researchers like UC’s Angela Bryan and Kent Hutchison, who aren’t allowed to bring the drug on campus or be present when it’s consumed. The only way they can study Boulder’s plentiful potheads, they’ve discovered, is by parking their “Cannavan” outside a home while its residents use the drug inside. They then ask them to come outside to the van for tests of how its active ingredients, called cannabinoids, have affected them.

The federal government continues to classify marijuana as a Schedule I drug, a product with “no currently accepted medical use and a high potential for abuse,” along with heroin and LSD. As a result, even legitimate researchers at labs and universities across the country must wade through restrictions on the clinical trials they run, which marijuana they can use and how it is shipped and stored.

This means states that have legalized cannabis for adult use are doing so in an information vacuum, with less understanding of what it is and what it does than virtually any nutritional supplement currently on the market, and with far less information than they have on legal substances that are easily abused, such as alcohol or tobacco. Law enforcement officers don’t even know at what point it is unsafe for marijuana users to drive.

“We suddenly have this huge influx of people who are able to buy cannabis, able to use it in all its various formulations,” Bryan said. “And we know nothing.”

The questions they and members of their 20-member research team want to answer are far-ranging. Many volunteers are being assessed for the basic impact of cannabis on body chemistry and cognition, factors that could help policymakers set legal driving limits, or aid doctors in treatment of conditions that many believe marijuana can ease, such as PTSD. Other studies carried out with the vans focus on how cannabis can be used to treat anxiety, cancer pain and chemotherapy side effects. Bryan is finalizing a study on how cannabis can affect body weight, blood glucose and diabetes. Hutchison also hopes to study whether cannabis can help reduce opioid dependence.

For years, Bryan and Hutchison — who are a married couple as well as research partners — struggled to make headway in their research. Hutchison first tossed out the van idea as a joke, Bryan recalled. The university had nixed all their other ideas, which included an off-campus laboratory. But the “Cannavan” idea passed legal muster.

But the Cannavans are not a perfect solution. For one, using a mobile lab is time-consuming. The researchers can only visit two vape- or smoke-using volunteers each day, at most. Researching edible forms of marijuana, like candy or cookies — is even harder. Edibles take more time to digest and take effect, so the researchers can spend hours in the van waiting to administer blood tests and cognition assessments, or to pose questions about pain, anxiety and other feelings.

Moreover, the methodology isn’t ideal. The gold standard in medical research is a randomized controlled trial using a well-defined drug. Bryan and Hutchison can only estimate the potency and chemical components of the products employed in their research, since they rely on volunteers to buy and administer their own pot. The researchers try to control the real-world factors by instructing patients to send them photos of the product they buy. By Colorado law, dispensaries must label products with the percentages of the chemicals in marijuana, including THC, CBD and a few other cannabinoids — that makes studies in that state a bit easier to standardize.

The recent marijuana vaping scare has shown the tragedy of federal foot-dragging, Hutchison said. More than 500 people, most of them using vapes containing THC, came down with serious lung disease over the summer that resulted in at least 12 deaths. But even UC Boulder chemists could not test the mysterious marijuana vapes in university labs because of drug-free school laws. The Colorado group would not even be able to run animal studies, a key step in determining safety.

“We can work with humans in the van,” Hutchison said. But “our best chemists are not allowed to bring any cannabis product on campus to test the purity and the safety of that product. And that’s just crazy.”

Under federal law, the only other option for Bryan and researchers nationwide would be to obtain marijuana grown especially for research by the federal government at a single authorized facility, based at the University of Mississippi. That marijuana stock, first acquired more than 30 years ago and never updated, bears little resemblance to the marijuana consumed today; scientists around the country have described it as “brown, muddy garbage.” It’s also much weaker than marijuana strains used now and doesn’t enable researchers to examine whether, say, high-THC pot affects patients’ health differently than a less intense varietal. Plus, it’s often moldy, according to a recent lawsuit.

Even getting the maligned Mississippi weed comes with a host of barriers. Researchers need approval from the Food and Drug Administration for proposed studies. And they also need to pass muster with the Drug Enforcement Agency, which treats marijuana like the dangerous Schedule I drug federal law says it is and therefore requires costly safeguards like a limited-access room and a specific storage safe for the weed.

This year, the federal farm shipped marijuana to just 14 researchers by Aug. 30, 2019, according to the National Institute on Drug Abuse, which manages the Mississippi contract; just 20 researchers received it in all of 2018.

Yet efforts to bring more approved growers — and ideally, better pot — into federal research have stalled. Three years ago, in the final months of the Obama administration, the DEA promised to approve more growers for medical marijuana but refused to reschedule the drug at the same time — and applications have since languished. Many accused the subsequent Attorney General Jeff Sessions, a longtime critic of marijuana legalization, of engineering the application freeze while peeling back protections for states legalizing pot and pushing harsher penalties for illicit drug-related crimes, including marijuana. Advocates celebrated his departure last year, but applications for new federal pot farmers were still parked on DEA’s desk. Under court order, the agency promised in August to review 33 new applicants — but only after it issued new ground rules, for which it gave no timeline.

Meanwhile, bills in Congress have failed to make it past committee markup as more hot-button issues crowd legislative calendars. The pot-related legislation ranges from efforts to simply force the DEA to approve more grow facilities to the more ambitious goal of moving marijuana out of the most restricted drug class.

The National Institutes of Health has funded multiple health studies by the Colorado group and wants answers too, but it has to play by the rules set by the DEA.

Sue Sisley, an Arizona researcher whose petition spurred DEA to take its nominal first step in August, wants to study the drug’s impact on PTSD in veterans. She said she hesitantly turned to the courts after years of attempts to access higher-quality marijuana for trials at the Scottsdale Research Institute.

The Mississippi facility’s pot is inadequate for her studies and it doesn’t make products like vapes or edibles, which many veterans would prefer, Sisley said. She’s gotten tired of accepting “vague reassurance from the current administration that they are going to act, finally.”

“I was trying to ignite a national conversation about the harms of monopolies in general, but especially when it comes to research,” she said. “It’s really detrimental to science when you have one drug supply for all of the U.S.”

Licensing more growers would only be a partial fix for the inundation of marijuana products on the market, scientists say. Unless the federal government reschedules marijuana, research—especially on publicly funded campuses like UC Boulder — would still be hampered by other federal laws.

If he had a magic wand, Hutchison said, his first step would be to take marijuana out of Schedule I status while empowering the FDA to “issue some rules about how to fast-track” research on the drug. Without that groundwork, he and others worry that pot will remain in a scientific black hole.

The urgency of learning more about cannabis has been underlined by the national decriminalization of one of its components, cannabidiol, or CBD, an apparently non-intoxicating component. The 2018 farm bill enabled producers to grow low-potency marijuana, known as hemp, and to extract CBD from it.

But the fact that CBD is decriminalized doesn’t mean it’s legal, exactly. Although the FDA has approved one cannabis-related drug for the treatment of epilepsy in children, pretty much all other medical claims for CBD use remain technically illegal. None the less, the cannabinoid has boomed in popularity as an unproven cure-all. States have issued a patchwork of regulations while federally, regulators are racing to build a legal framework for the slew of CBD-infused products, putting the cannabinoid in legal limbo even as people buy it off the shelves.

Congressional efforts have largely swerved around the thorny problem of rescheduling marijuana and instead focused on lowering barriers and building incentives for research. This summer, longtime marijuana research advocate Sen. Brian Schatz (D-Hawaii) joined forces with Senate Finance Chair Chuck Grassley (R-Iowa) and Dianne Feinstein (D-Calif.) to couple his bill, the MEDS Act, with legislation to encourage CBD and cannabis research. The bill would give the DEA a hard deadline to respond to applicants, require the Department of Health and Human Services to draw up a report on the potential benefits and risks of cannabis components, and address barriers pot-legal states face on regulation.

In theory, learning more about marijuana should be welcomed by opponents and supporters of legalization, since unbiased research could end up supporting either side. And indeed, anti-legalization advocates such as Smart Approaches to Marijuana have supported creating a special breakout of the Schedule I category just for marijuana research. Pot proponents oppose that position, however, seeing it as an attempt to slow momentum for nationwide legalization.

Back in Colorado, Bryan and Hutchison are looking to expand their mobile operation. They’re talking about getting a third van and setting their sights past Boulder — to Colorado Springs, Denver and Ft. Collins. They’re also hoping to get a grant soon to study marijuana’s impact on a fast-growing set of users: seniors.

More than 600 study participants have been tested in the Cannavans, and the team expects to publish some findings soon on questions such as CBD’s medical efficacy alone or in combination with THC. In coming years, they hope to help shape the best formulation of the two for pain management.

“We’re in this world where we have unfettered access to these products for all these different conditions and we can’t tell people what to do,” Bryan said.

Hutchison said that every year that passes without better research on marijuana, the greater the gap between how much cannabis is being used and how little is known about it.

“It takes time — that’s the thing, Hutchison said. “I feel like we’re so far behind.”

This report first appeared on The Agenda on Oct. 14, 2019.