AMA Calls for More Research into Medical Use of Marijuana

The federal government should consider moving marijuana out of Schedule I of the Controlled Substances Act in order to facilitate clinical research and development of cannabinoid-based medications, the American Medical Association (AMA) said in a new policy statement.

In adopting the policy on Nov. 10 (PDF), the AMA’s House of Delegates backed away from the group’s long-standing opinion that marijuana should remain in Schedule I as a drug with no accepted medical uses, with a report from the group’s Council on Science and Public Health stating that smoked cannabis has been shown in short-term controlled trials to be effective in reducing neuropathic pain and improving appetite, and may also alleviate symptoms among patients with multiple sclerosis.

The Council’s report noted that the future of cannabinoid-based medicine lies in the botanical-drug development as well as the design of molecules targeting the endocannabinoid system. “To the extent that rescheduling marijuana out of Schedule I will benefit this effort, such a move can be supported,” the report said.

In February 2008, the American College of Physicians similarly called for an “evidence-based review of marijuana’s status as a Schedule I controlled substance to determine whether it should be reclassified to a different schedule.”

“This [AMA policy] shift, coming from what has historically been America’s most cautious and conservative major medical organization, is historic,” said Aaron Houston, director of government relations for the Marijuana Policy Project, which advocates for medical use of marijuana and has backed many of the state medical-marijuana campaigns in the U.S.


No Endorsement of State Medical-Marijuana Laws

However, the panel’s report also called the patchwork of state-based medical-marijuana programs “woefully inadequate in establishing even rudimentary safeguards that normally would be applied to the appropriate clinical use of psychoactive substances,” and the AMA resolution stated that the new policy “should not be viewed as an endorsement of state-based medical cannabis programs, the legalization of marijuana, or that scientific evidence on the therapeutic use of cannabis meets the current standards for a prescription drug product.”

The Obama administration reacted cautiously to the new AMA policy, restating the FDA’s assessment that raw marijuana “has not met the standards for identity, strength, quality, purity, packaging and labeling required of medicine.”

“The Office of National Drug Control Policy agrees with the AMA that the safety and efficacy of drug products should continue to be determined by scientific and regulatory review, and not by ballot initiatives or state legislative action,” the White House agency said in a press statement.


A Dearth of Research

AMA officials said that research into the medical uses of marijuana has been lacking, and the AMA policy urges the National Institutes of Health to “implement administrative procedures to facilitate grant applications and the conduct of well-designed clinical research into the medical utility of marijuana,” including assisting researchers on developing research protocols and safeguards, providing research funding, and providing adequate supplies of “marijuana of various and consistent strengths and/or placebo” via the National Institute on Drug Abuse (NIDA).

“Despite more than 30 years of clinical research, only a small number of randomized, controlled trials have been conducted on smoked cannabis,” noted AMA board member Edward Langston, M.D.

Rick Doblin, Ph.D., executive director of the Multidisciplinary Association for Psychedelic Studies (MAPS), said the AMA policy shift demonstrates that there is  “clearly more interest in medical marijuana in the medical community than ever before.”

However, Doblin — who has long contended that NIDA has worked to block medical-marijuana research through its gatekeeping role over supplies of marijuana for research — said the policy will have “zero effect in getting NIDA out of the loop.” Doblin said that a unique and open-ended Public Health Service (PHS) review process for medical-marijuana research, coupled with NIDA’s monopoly on the drug supply, has prevented most basic research studies on smoked marijuana from getting off the ground.

Steve Gust, Ph.D., a special assistant to NIDA Director Nora Volkow, M.D., countered that the agency “has been and continues to be open to applications” for medical-marijuana research, but added that the agency has seen “no groundswell of interest from researchers” wanting to study the drug’s medical uses. (NIDA funds research on drug abuse and addiction, not medical uses of drugs, so medical-marijuana studies, if approved, would be funded by other institutes within NIH.)

“The criticism about the so-called NIDA resistance to such research is completely unfounded, always comes from the same source, and in fact seems to be based on either a single example of a 10-year-old grant application to NIH or a request by MAPS that has reviewed by the PHS several times but has been technically deficient,” said Gust. “The fact is that there has been more clinical research on medical marijuana in the last five years than the previous 20 — almost all conducted by the Center on Medicinal Cannabis Research at the University of California at San Diego (UCSD), and with mostly positive results.”

Gust noted that the marijuana for the UCSD studies was provided by NIDA. “I really don’t understand why the critics are not celebrating this increase in research and positive findings rather than continually harping on the falsehoods about NIDA blocking research,” he said.

This news feature has been revised to reflect the following correction:

Correction, Nov. 23, 2009: The original headline and first paragraph of this article incorrectly said that the policy adopted by the AMA stated that limited research has shown that marijuana has medicinal value. This conclusion was not part of the resolution adopted by the House of Delegates. It was included only in the advisory report from the AMA’s Council on Science and Public Health, which stated, “Results of short term controlled trials indicate that smoked cannabis reduces neuropathic pain, improves appetite and caloric intake especially in patients with reduced muscle mass, and may relieve spasticity and pain in patients with multiple sclerosis.”

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AMA Calls for More Research into Medical Use of Marijuana

The federal government should consider moving marijuana out of Schedule I of the Controlled Substances Act in order to facilitate clinical research and development of cannabinoid-based medications, the American Medical Association (AMA) said in a new policy statement.


In adopting the policy on Nov. 10 (PDF), the AMA's House of Delegates backed away from the group's long-standing opinion that marijuana should remain in Schedule I as a drug with no accepted medical uses, with a report from the group's Council on Science and Public Health stating that smoked cannabis has been shown in short-term controlled trials to be effective in reducing neuropathic pain and improving appetite, and may also alleviate symptoms among patients with multiple sclerosis.


The Council's report noted that the future of cannabinoid-based medicine lies in the botanical-drug development as well as the design of molecules targeting the endocannabinoid system. “To the extent that rescheduling marijuana out of Schedule I will benefit this effort, such a move can be supported,” the report said.


In February 2008, the American College of Physicians similarly called for an “evidence-based review of marijuana's status as a Schedule I controlled substance to determine whether it should be reclassified to a different schedule.”


“This [AMA policy] shift, coming from what has historically been America's most cautious and conservative major medical organization, is historic,” said Aaron Houston, director of government relations for the Marijuana Policy Project, which advocates for medical use of marijuana and has backed many of the state medical-marijuana campaigns in the U.S.



No Endorsement of State Medical-Marijuana Laws


However, the panel's report also called the patchwork of state-based medical-marijuana programs “woefully inadequate in establishing even rudimentary safeguards that normally would be applied to the appropriate clinical use of psychoactive substances,” and the AMA resolution stated that the new policy “should not be viewed as an endorsement of state-based medical cannabis programs, the legalization of marijuana, or that scientific evidence on the therapeutic use of cannabis meets the current standards for a prescription drug product.”


The Obama administration reacted cautiously to the new AMA policy, restating the FDA's assessment that raw marijuana “has not met the standards for identity, strength, quality, purity, packaging and labeling required of medicine.”


“The Office of National Drug Control Policy agrees with the AMA that the safety and efficacy of drug products should continue to be determined by scientific and regulatory review, and not by ballot initiatives or state legislative action,” the White House agency said in a press statement.



A Dearth of Research


AMA officials said that research into the medical uses of marijuana has been lacking, and the AMA policy urges the National Institutes of Health to “implement administrative procedures to facilitate grant applications and the conduct of well-designed clinical research into the medical utility of marijuana,” including assisting researchers on developing research protocols and safeguards, providing research funding, and providing adequate supplies of “marijuana of various and consistent strengths and/or placebo” via the National Institute on Drug Abuse (NIDA).


“Despite more than 30 years of clinical research, only a small number of randomized, controlled trials have been conducted on smoked cannabis,” noted AMA board member Edward Langston, M.D.


Rick Doblin, Ph.D., executive director of the Multidisciplinary Association for Psychedelic Studies (MAPS), said the AMA policy shift demonstrates that there is  “clearly more interest in medical marijuana in the medical community than ever before.”


However, Doblin — who has long contended that NIDA has worked to block medical-marijuana research through its gatekeeping role over supplies of marijuana for research — said the policy will have “zero effect in getting NIDA out of the loop.” Doblin said that a unique and open-ended Public Health Service (PHS) review process for medical-marijuana research, coupled with NIDA's monopoly on the drug supply, has prevented most basic research studies on smoked marijuana from getting off the ground.


Steve Gust, Ph.D., a special assistant to NIDA Director Nora Volkow, M.D., countered that the agency “has been and continues to be open to applications” for medical-marijuana research, but added that the agency has seen “no groundswell of interest from researchers” wanting to study the drug's medical uses. (NIDA funds research on drug abuse and addiction, not medical uses of drugs, so medical-marijuana studies, if approved, would be funded by other institutes within NIH.)


“The criticism about the so-called NIDA resistance to such research is completely unfounded, always comes from the same source, and in fact seems to be based on either a single example of a 10-year-old grant application to NIH or a request by MAPS that has reviewed by the PHS several times but has been technically deficient,” said Gust. “The fact is that there has been more clinical research on medical marijuana in the last five years than the previous 20 — almost all conducted by the Center on Medicinal Cannabis Research at the University of California at San Diego (UCSD), and with mostly positive results.”


Gust noted that the marijuana for the UCSD studies was provided by NIDA. “I really don't understand why the critics are not celebrating this increase in research and positive findings rather than continually harping on the falsehoods about NIDA blocking research,” he said.


This news feature has been revised to reflect the following correction:


Correction, Nov. 23, 2009: The original headline and first paragraph of this article incorrectly said that the policy adopted by the AMA stated that limited research has shown that marijuana has medicinal value. This conclusion was not part of the resolution adopted by the House of Delegates. It was included only in the advisory report from the AMA's Council on Science and Public Health, which stated, “Results of short term controlled trials indicate that smoked cannabis reduces neuropathic pain, improves appetite and caloric intake especially in patients with reduced muscle mass, and may relieve spasticity and pain in patients with multiple sclerosis.”

Leave a Reply

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