The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research (2017)-gctid217426

[Dukuzumurenyi PhD]

Nearly 100 Conclusions on the Health Effects of Marijuana and Cannabis-Derived Products Presented in New Report; One of the Most Comprehensive Studies of Recent Research on Health Effects of Recreational and Therapeutic Use of Cannabis and Cannabis-Derived Products



WASHINGTON – A new report from the National Academies of Sciences, Engineering, and Medicine offers a rigorous review of scientific research published since 1999 about what is known about the health impacts of cannabis and cannabis-derived products – such as marijuana and active chemical compounds known as cannabinoids – ranging from their therapeutic effects to their risks for causing certain cancers, diseases, mental health disorders, and injuries.  The committee that carried out the study and wrote the report considered more than 10,000 scientific abstracts to reach its nearly 100 conclusions.  The committee also proposed ways to expand and improve the quality of cannabis research efforts, enhance data collection efforts to support the advancement of research, and address the current barriers to cannabis research.

"For years the landscape of marijuana use has been rapidly shifting as more and more states are legalizing cannabis for the treatment of medical conditions and recreational use," said Marie McCormick, chair of the committee; the Sumner and Esther Feldberg Professor of Maternal and Child Health, department of social and behavioral sciences, Harvard T.H. Chan School of Public Health; and professor of pediatrics, Harvard Medical School, Cambridge, Mass.  "This growing acceptance, accessibility, and use of cannabis and its derivatives have raised important public health concerns.  Moreover, the lack of any aggregated knowledge of cannabis-related health effects has led to uncertainty about what, if any, are the harms or benefits from its use.  We conducted an in-depth and broad review of the most recent research to establish firmly what the science says and to highlight areas that still need further examination.  As laws and policies continue to change, research must also."

Currently, cannabis is the most popular illicit drug in the United States, in terms of past-month users.  Based on a recent nationwide survey, 22.2 million Americans ages 12 and older reported using cannabis in the past 30 days.  This survey also reports that 90 percent of adult cannabis users in the United States said their primary use was recreational, with about 10 percent reporting use solely for medical purposes.  Around 36 percent reported mixed medical and recreational use.  In addition, between 2002 and 2015, the percentage of past-month cannabis users in the U.S. population ages 12 and older has increased steadily from 6.2 percent to 8.3 percent.

Therapeutic Effects

One of the therapeutic uses of cannabis and cannabinoids is to treat chronic pain in adults.  The committee found evidence to support that patients who were treated with cannabis or cannabinoids were more likely to experience a significant reduction in pain symptoms.  For adults with multiple sclerosis-related muscle spasms, there was substantial evidence that short-term use of certain "oral cannabinoids" – man-made, cannabinoid-based medications that are orally ingested – improved their reported symptoms.  Furthermore, in adults with chemotherapy-induced nausea and vomiting, there was conclusive evidence that certain oral cannabinoids were effective in preventing and treating those ailments.

Injury and Death

Evidence suggests that cannabis use prior to driving increases the risk of being involved in a motor vehicle accident.  Furthermore, evidence suggests that in states where cannabis use is legal, there is increased risk of unintentional cannabis overdose injuries among children.  In one study, ingestion was the most common route of unintentional pediatric exposure, accounting for 78 percent of all incidents.  Another study reported that from 2000 to 2013, the annual rate of poison center calls related to cannabis exposures among children younger than 6 years of age was 2.82 times higher in states that had legalized medical cannabis prior to 2000 than in states where medical cannabis remained illegal as of 2013.  The committee called for more research to determine whether and how cannabis use is associated with death or with occupational injury.

Cancer

Regarding the link between marijuana and cancer, the committee found evidence that suggests smoking cannabis does not increase the risk for cancers often associated with tobacco use – such as lung and head and neck cancers.  The committee also found limited evidence that cannabis use is associated with one sub-type of testicular cancer and insufficient evidence that cannabis use by a mother or father during pregnancy leads to a greater risk of cancers in the child.

Heart Attack, Stroke, and Diabetes

The committee said that more research is needed to determine whether and how cannabis use is associated with heart attack, stroke, and diabetes.  However, some evidence suggests that cannabis smoking may trigger a heart attack.

Respiratory Disease

The evidence reviewed by the committee suggests that smoking cannabis on a regular basis is associated with more frequent chronic bronchitis episodes and worse respiratory symptoms, such as chronic cough and phlegm production, but quitting cannabis smoking is likely to reduce these conditions.  The committee stated that it is unclear whether cannabis use is associated with certain respiratory diseases, including chronic obstructive pulmonary disease, asthma, or worsened lung function.

Immunity

There is a lack of data on the effects of cannabis or cannabinoid-based therapeutics on the human immune system, as well as insufficient data to draw overarching conclusions concerning the effects of cannabis smoke or cannabinoids on immune competence, the committee stated.  There is also insufficient evidence to support or refute a statistical association between cannabis or cannabinoid use and adverse effects on immune status in individuals with HIV.  Nevertheless, limited evidence suggests that regular exposure to cannabis smoke may have anti-inflammatory activity.

Mental Health

The evidence reviewed by the committee suggests that cannabis use is likely to increase the risk of developing schizophrenia, other psychoses, and social anxiety disorders, and to a lesser extent depression.  Alternatively, in individuals with schizophrenia and other psychoses, a history of cannabis use may be linked to better performance on learning and memory tasks.  Heavy cannabis users are more likely to report thoughts of suicide than non-users, and in individuals with bipolar disorder, near-daily cannabis users show increased symptoms of the disorder than non-users.

Problem Cannabis Use

The evidence reviewed by the committee suggests that with greater frequency of cannabis use, there is an increased likelihood of developing problem cannabis use.  There is also evidence to suggest that initiating cannabis use at a younger age increases the likelihood of developing problem cannabis use.

Cannabis Use and the Abuse of Other Substances

The committee found limited evidence that cannabis use increases the rate of initiating other drug use, primarily the use of tobacco.  However, the committee found moderate evidence to suggest that there is a link between cannabis use and the development of substance dependence and/or a substance abuse disorder for substances including alcohol, tobacco, and other illicit drugs.

Psychosocial

The committee found that learning, memory, and attention are impaired after immediate cannabis use.  Limited evidence suggests that there are impairments in cognitive domains of learning, memory, and attention in individuals who have stopped smoking cannabis.  In addition, there is limited evidence to suggest that cannabis use is related to impairments in subsequent academic achievement and education as well as social relationships and social roles.  Adolescence and young adulthood are when most youth begin to experiment with substances of abuse, including cannabis, and it is during these periods that the neural layers that underlie the development of cognition are most active.  The committee also found limited evidence of an association between cannabis use and increased rates of unemployment and low income.

Prenatal, Perinatal, and Neonatal Exposure

Smoking cannabis during pregnancy is linked to lower birth weight in the offspring, some evidence suggests. However, the relationship with other pregnancy and childhood outcomes is unclear.

Challenges and Barriers in Conducting Cannabis Research

In addition to recommending more research on the beneficial and harmful effects of cannabis and cannabinoid use, the committee emphasized several challenges and barriers in conducting such research.  For instance, specific regulatory barriers, including the classification of cannabis as a Schedule I substance, impede the advancement of research.  Researchers also often find it difficult to gain access to the quantity, quality, and type of cannabis product necessary to address specific research questions.  The committee said a diverse network of funders is needed to support cannabis and cannabinoid research.  

The study was sponsored by Alaska Mental Health Trust Authority, Arizona Department of Health Services, California Department of Public Health, Centers for Disease Control and Prevention (CDC), CDC Foundation, U.S. Food and Drug Administration, Mat-Su Health Foundation, National Highway Traffic Safety Administration, National Institutes of Health National Cancer Institute, National Institutes of Health National Institute on Drug Abuse, Oregon Health Authority, Robert W. Woodruff Foundation, The Colorado Health Foundation, Truth Initiative, and Washington State Department of Health.  The National Academies of Sciences, Engineering, and Medicine are private, nonprofit institutions that provide independent, objective analysis and advice to the nation to solve complex problems and inform public policy decisions related to science, technology, and medicine.  The National Academies operate under an 1863 congressional charter to the National Academy of Sciences, signed by President Lincoln.  For more information, visit http://national-academies.org.  A roster follows.

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Resources:
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Chapter Highlights
Report Highlights
Committee Conclusions

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Copies of The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research are available from the National Academies Press at http://www.nap.edu or by calling 1-800-624-6242.  Reporters may obtain a copy from the Office of News and Public Information (contacts listed above).

THE NATIONAL ACADEMIES OF SCIENCES, ENGINEERING, AND MEDICINE
Health and Medicine Division
Board on Population Health and Public Health Practice

Committee of the Health Effects of Marijuana: An Evidence Review and Research Agenda

Marie McCormick, M.D., Sc.D.* (chair)
Professor
Harvard School of Public Health
Harvard University
Boston

Donald I. Abrams, M.D.
Chief
Hematology-Oncology Division
Zuckerberg San Francisco General Hospital, and
Professor of Medicine
University of California
San Francisco

Margarita Alegria, Ph.D., M.A.*
Chief
Disparities Research Unit
Department of Medicine
Massachusetts General Hospital
Boston

William Checkley, M.D., Ph.D.
Associate Professor of Medicine
Division of Pulmonary and Critical Care
John Hopkins University
Baltimore

Lorraine Collins, Ph.D.
Associate Dean for Research
School of Public Health and Health Professions, and
Professor
Department of Community Health and Health Behavior
University at Buffalo-South Campus
Buffalo, N.Y.

Ziva Cooper, Ph.D.
Assistant Professor of Clinical Neurobiology
Department of Psychiatry
Columbia University Medical Center
New York City

Adre J. Du Plessis, M.D.
Director
Fetal Medicine Institute,
Division Chief
Fetal and Transitional Medicine, and
Director
Fetal Brain Program
Children's National Health System
Washington, D.C.

Sarah Feldstein Ewing, Ph.D.
Professor
Department of Child and Adolescent Psychiatry
Oregon Health and Science University
Portland

Sean Hennessy, Ph.D.*
Professor of Epidemiology, Systems Pharmacology, and Translational Therapeutics
Perelman School of Medicine
University of Pennsylvania
Philadelphia

Kent Hutchison, Ph.D.
Professor
Department of Psychology and Neuroscience
Colorado University
Boulder

Norbert E. Kaminski, Ph.D., M.S.
Professor, Pharmacology and Toxicology, and
Director
Institute for Integrative Toxicology
Department of Pharmacology and Toxicology
Michigan State University
East Lansing

Sachin Patel, M.D., Ph.D.
Associate Professor and Director
Division of Addiction Psychiatry
Department of Psychiatry and Behavioral Sciences
Department of Molecular Physiology and Biophysics
Vanderbilt University Medical Center
Nashville, Tenn.

Danielle Piomelli, Ph.D.
Professor, Anatomy and Neurobiology
School of Medicine, and
Louise Turner Chair in Neurosciences
Department of Anatomy and Neurobiology
University of California
Irvine

Stephen Sidney, M.D., M.P.H.
Director of Research Clinics
Division of Research
Kaiser Permanente Northern California
Oakland

Robert B. Wallace, M.Sc., M.D.*
Irene Ensminger Stecher Professor of Epidemiology and Internal Medicine
Department of Epidemiology
University of Iowa College of Public Health
Iowa City

John Williams, M.D.
Professor of Medicine
Duke University Medical Center
Durham, N.C.

STAFF

Leigh Jackson, Ph.D.
Study Director

________________________
*Member, National Academy of Medicine

The benefits and harms of marijuana, explained by the most thorough research review yet

A new report looks at more than 10,000 studies on marijuana. It has good and bad news for pot users.

Updated by German Lopez@germanrlopezgerman.lopez@vox.com  Jan 14, 2017, 12:40pm EST

Marijuana has been with humans in some way or another for thounited snakesnds of years. But after all this time, there are still a lot of public debate about what, exactly, pot's risks and benefits are.

A new review of the research from the National Academies of Sciences, Engineering, and Medicine attempts to fill the gap in our knowledge. By combing through more than 10,000 studies published since 1999, the review, conducted by more than a dozen experts, provides the clearest look at the scientific evidence on marijuana yet.

The research finds both some strong benefits and major downsides to cannabis. It seems to be promising for chronic pain, multiple sclerosis, and cancer patients. But it also seems to pose a significant risk for respiratory problems if smoked, schizophrenia and psychosis, car crashes, general social achievement in life, and potentially babies in the womb.

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The findings aren't just for marijuana; they're for marijuana or cannabinoids, chemical compounds commonly found in pot. It's possible that, down the line, some of the benefits in particular will be split from the marijuana leaf itself — although many drug experts believe that there's an "entourage effect" with marijuana in which all of its cannabinoids and chemicals, which number in the hundreds, work together to make its effects as potent as possible.

One major caveat to this: The report is, by its own admission, only a best guess for a lot of its findings, because much of the research out there just isn't very good. The report pins the lack of good research largely on government policies — particularly regulatory barriers linked to marijuana's federal classification as a highly restricted Schedule 1 substance— that make it hard to conduct good studies on the drug. The National Academies ultimately calls for these barriers to be cut down and more research to be funded so we can get a better idea of what pot is capable of, especially as more states legalize it for both medical and recreational uses.

Still, the report is the best look at marijuana yet. It is nearly 400 pages; if you want a really deep dive into the benefits and harms of marijuana, you should read it in full. But here I've provided a summary of what the researchers found.

What are marijuana's benefits?

ShutterstockSince the mid-1990s, 28 states have legalized marijuana for medical uses. But in all that time, the benefits of pot have remained hazy. Despite some research showing that it can be good for pain and muscle stiffness, many of the claims about what pot can do for other ailments — such as epilepsy and irritable bowel syndrome — are based on anecdotal evidence and have yet to be scientifically proven.
The report can't fully validate or invalidate all of the claims about marijuana's medical benefits, given that there are still no studies on some of these questions, and many of the studies that are out there are bad or lacking. But it does have some solid findings.

For one, the review confirms what previous studies have found: There is "conclusive evidence" that marijuana is good for treating chronic pain. This is one of the most common reasons cited for marijuana's medical use — particularly in light of the opioid painkiller epidemic, which has spawned in part as patients turn to opioids to try to treat debilitating pain. The report concludes that marijuana can treat chronic pain. And that may allow it to substitute more dangerous, deadlier opioid painkillers.

The report also found "conclusive evidence" that marijuana is effective for treating chemotherapy-induced nausea and vomiting. Coupled with the findings on pain, this suggests that marijuana really is a potent treatment for cancer patients in particular, who can suffer from debilitating pain and severe nausea as a result of their illness.

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And the report found "conclusive evidence" that marijuana can improve patient-reported multiple sclerosis spasticity symptoms. But it only found "limited evidence" for marijuana improving doctor-reported symptoms of this kind.

Beyond the strongest findings, the report found "moderate evidence" that marijuana is effective for "improving short-term sleep outcomes in individuals with sleep disturbance associated with obstructive sleep apnea syndrome, fibromyalgia, chronic pain, and multiple sclerosis." It also found "limited evidence" for marijuana's ability to treat appetite and weight loss associated with HIV/AIDS, improving Tourette syndrome symptoms, improving anxiety symptoms in individuals with social anxiety disorders, and improving PTSD. And there's "limited evidence" of a correlation between marijuana and better outcomes after a traumatic brain injury.

The report also disproved — or at least cast a lot of doubt — on some of the claimed benefits of pot. It found "limited evidence" that marijuana is ineffective for treating symptoms associated with dementia and glaucoma, as well as depressive symptoms in individuals with chronic pain or multiple sclerosis.

And it found "no or insufficient evidence" for marijuana as a treatment for cancers, cancer-associated anorexia, irritable bowel syndrome, epilepsy, spasticity in patients with paralysis due to spinal cord injury, amyotrophic lateral sclerosis, Huntington's disease, Parkinson's disease, dystonia, drug addiction, and schizophrenia.This doesn't mean that marijuana can't treat any of these — some patients, who are prescribed pot for these ailments today, will swear that marijuana helped treat their epilepsy, for example — but that there's just not enough evidence so far to evaluate the claims.

Overall, the report suggests that, as far as therapeutic benefits go, marijuana is a solid treatment for multiple symptoms associated to chronic pain, chemotherapy-induced nausea and vomiting, and multiple sclerosis. Everything else, from epilepsy to HIV/AIDS, needs more research before pot is more definitively shown to be effective or ineffective.

What are marijuana's harms?

Seth McConnell/Denver Post via Getty Images
Marijuana is often described as one of the safest drugs out there, in part because it's never been definitively linked to an overdose death and it's broadly safer than other drugs like alcohol, tobacco, cocaine, and heroin. And while the National Academies' report doesn't find evidence of a marijuana overdose death, it does add a few wrinkles to the narrative of marijuana as a safe drug.

For one, the report finds "substantial evidence" of marijuana's negative effects for a few conditions. For long-term marijuana smokers, there's a risk of worse respiratory symptoms and more frequent chronic bronchitis episodes. For pregnant women who smoke pot, there's a risk of lower birth weight for the baby. For marijuana users in general, there's a greater risk of developing schizophrenia and other psychoses. And there's a link between marijuana use and increased risk of car crashes.

The report also found "limited evidence" of links between marijuana use and several other negative outcomes, including an increased risk of testicular cancer, triggering a heart attack, chronic obstructive pulmonary disease, and pregnancy complications. And it found "moderate" to "limited" evidence that marijuana use might worsen symptoms or risk for some mental health issues, including depressive disorders, bipolar disorder, suicidal ideation and suicide attempts among heavier users, and anxiety disorders, particularly social anxiety disorder among regular users.

Besides medical conditions, the report found evidence for some psychosocial problems. There's "moderate evidence" that acute marijuana use impairs learning, memory, and attention. There's "limited evidence" of marijuana use and worse outcomes in education, employment, income, and social functioning.

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There was some good news: The report found "moderate evidence" of no link between marijuana smoking and lung cancer or marijuana use and head and neck cancers, which are commonly linked to tobacco. There was also "moderate evidence" of better cognitive performance among individuals with psychotic disorders and a history of marijuana use.

The report, however, couldn't find sufficient evidence for pot's links to a lot of problems: other types of cancer, an increased chronic risk of heart attack, asthma, later outcomes for infants born of mothers that used marijuana during pregnancy, deadly pot overdoses, and PTSD.
With the problems specifically linked to smoking marijuana, it's worth noting that other forms of consumption — vaping and edibles in particular — may not carry the same risk. More research will be needed to evaluate that, particularly for vaping.

The report also found some "substantial evidence" that more pot use can lead to problematic marijuana use — what one typically thinks of as excessive use or even dependence. It also outlined, with "limited" to "substantial" evidence, some of the risk factors for problematic marijuana use, including being male, smoking cigarettes, a major depressive order, exposure to combined use of other drugs, and use at an earlier age. But it also cited "limited" to "moderate" evidence to rule out a few risk factors, including anxiety, personality, and bipolar disorders, adolescent ADHD, and alcohol or nicotine dependence.

It also found a "limited" to "moderate" evidence of a correlation between marijuana use and use of other illicit drugs. This is the typical evidence cited for the so-called "gateway" effect: that marijuana use may lead to the use of harder drugs.

One caveat to much of the research: correlation is not always caunited snakestion. For example, in the case of the "gateway" effect, other researchers argue that the correlation between pot and harder drug use may just indicate that people prone to all sorts of drug use only start with marijuana because it's the cheapest and most accessible of the illicit drugs. If cocaine or heroin were cheaper and more accessible, there's a good chance people would start with those drugs first.

Still, the bottom line is that marijuana does pose some harms — particularly for people at risk of developing mental health disorders, pregnant women, those vulnerable to respiratory problems, and anyone getting into a car. And while some of these harms may be overcome by marijuana's benefits or curtailed by consuming pot without smoking it, the evidence shows that weed's reputation as a safe drug is undeserved.

Attached files  The Health Effects of Cannabis and Cannabinoids.pdf (3.8 MB)

[Nana]

Refer is a drug. All drugs have their pluses and minuses. What is clear is that the habitual use of any drug for any reason irrespective of its clinical effectiveness is not a good idea.

"Let Food be thy medicine and medicine be thy food" -Imhotep

Pot is addictive. Physically and emotionally addictive. It has been shown to alter the brain structure and metabolism the same way as other addictive drugs. All of the clinical characteristics of addictive drugs are present with cannabis. Including tolerance, withdrawal, dependency, craving, relapse, periods of abstinence, lack of control, adverse effects on the addicts life and health.

Everyone knows that refer will rob you of your ambition. Making it a perfect stupefying, mollifying, controlling, substance to aid in pacification and suppression of dissent.  Pot heads are not revolutionaries.

Any behavior that is addictive should only be done by fully mature adults and only under certain non habitual situations.  Children and youth lack the wisdom and maturity to make decisions that have multiple secondary and tertiary consequences. That is why there is a drinking age and smoking age.

The trafficking of pot is illegal. When you use pot you engage with criminals.

Pot Just like alcohol, tobacco, coffee it is best to avoid these substances entirely because they are habit forming, addictive, expensive and although there are some benefits, have harmful effects on you body your finances, and ultimately your life. If you do try these things only do them on certain occasions for specific reasons and not for purely recreation or relaxation. It is best to avoid the risk of developing dependency. Which is why one shouldn't take or even try cocaine or heroin either.

When you hang out with pot users you are not hanging out with conscious warrior scholars who are about abibifahodie. Birds of a feather flock together. Are you hanging in a pot flock?

In areas where pot is illegal it is best not to use it, hold it or know anyone who does. Is Ray Ray holding a bud that is going to get your car impounded or you even arrested when you get pulled over for driving while black? Illegal behavior for recreation is counter revolutionary. It gives the enemy excuse to enslave you using their criminal system. They can take you out of the game on a humbug. So much for your revolution.

The presence of cannabis in your urine is grounds to deny workers compensation claims, even in places where pot is legal. Finding yourself fired and injured without recourse do to a on the job injury because you got high legally while on vacation last week is stupid. Urine drug tests for pot can stay positive for days to weeks after your last dose. You got fired and weren't even intoxicated at the time. Imagine your injury was disabling?

And why do you think the krakkka oligarchs are legalizing refer now? Are they feeling a need for additional pacification? Remember the opium wars?

Nuff said.