Mapping cannabis potency in medical and recreational programs in the United States
Mary Catherine Cash, Katharine Cunnane, Chuyin Fan, E. Alfonso Romero-Sandoval
PLoS ONE, 2020, 15, (3), e0230167.
Doi : 10.1371/journal.pone.0230167
Opinion d’expert: Les allégations sur l’infaisabilité du cannabis avec des concentrations élevées de THC à des fins médicales ne sont pas étayées par la science
En mars 2020, le conseil d’administration de l’IACM a décidé d’installer une nouvelle catégorie dans le Bulletin de l’IACM, qui encourage à rédiger des opinions et des déclarations de chercheurs sur les rapports scientifiques actuels et des déclarations de collègues. Ces avis visent à stimuler la discussion sur des questions controversées. L’avis d’aujourd’hui est celui du Dr Franjo Grotenhermen, directeur exécutif de l’IACM, qui dirige un cabinet médical en Allemagne axé sur les traitements à base de cannabis. Il s’agit d’une allégation sur la puissance du cannabis pour le soulagement de la douleur faite par le Dr Alfonso Edgar Romero-Sandoval et ses collègues du Département d’anesthésiologie, École de médecine de l’Université de Wake Forest à Winston-Salem, États-Unis.
Selon le rapport d’une agence de presse, le Dr Romero-Sandoval a déclaré: “Nous savons que les produits à haute concentration ne devraient pas avoir leur place dans le domaine médical en raison du risque élevé de développer des troubles liés à la consommation de cannabis, qui sont liés à l’exposition à des produits contenant du THC”. Le Dr Romero-Sandoval et ses collègues ont analysé la puissance du cannabis dans 8505 échantillons de cannabis provenant de 653 dispensaires légaux aux États-Unis. Il a été annoncé qu’environ 70% des échantillons à usage médical contenaient plus de 15% de THC. Dans l’article de recherche publié dans Plos One, les auteurs affirment que ” les patients qui consomment ces produits peuvent être à risque d’intoxication aiguë ou d’effets secondaires à long terme”. Romero-Sandoval a déclaré que plusieurs études ont montré que les produits à base de cannabis contenant jusqu’à 5% de THC sont suffisants pour réduire la douleur chronique avec des effets secondaires minimes.
“Dans les pharmacies allemandes, plus de 30 variétés de fleurs de cannabis sont disponibles, dont la majorité dépassent les concentrations de 15% de THC et souvent 20%. Cela a du sens, car avec des concentrations élevées de THC, vous avez besoin de doses plus faibles de fleurs de cannabis, ce qui réduit les coûts pour les patients. Ils devraient bien sûr continuer à avoir leur place dans le traitement moderne avec des médicaments à base de cannabis. Dans un contexte médical, il n’y a aucune base scientifique pour l’hypothèse selon laquelle les produits avec une teneur en THC plus élevée sont plus dangereux que ceux avec une teneur en THC plus faible “, a déclaré le Dr Grotenhermen. “Je n’ai jamais vu de patient dont le produit du cannabis était trop puissant. Vous devez commencer par des doses très faibles, puis augmenter lentement jusqu’à la dose tolérée et nécessaire, quel que soit le produit que vous utilisez. Si vous commencez trop haut, même un produit contenant 2% de THC sera trop élevé chez les patients inexpérimentés. Nous devrions avoir un nombre pertinent de variétés de fleurs de cannabis avec des teneurs différentes en THC, CBD et autres composants du cannabis dans les pharmacies et les dispensaires.”
Abstract
Cannabis related online searches are associated with positive attitudes toward medical cannabis, particularly when information is obtained from dispensaries. Since pain is the main reason for medicinal cannabis use, information from dispensary websites has the potential to shape the attitude of pain patients towards cannabis. This is relevant because cannabis has demonstrated efficacy in neuropathic pain with low tetrahydrocannabinol (THC) concentrations (< 5–10%), in contrast to potent cannabis (>15% THC), which is highly rewarded in the recreational realm. The role of CBD in pain is not clear, however it has gained popularity. Thus, we hypothesize that the potency of medical cannabis that is advertised online is similar to the cannabis advertised for recreational purposes, which would potentially create a misconception towards medical cannabis. The current lack of knowledge surrounding advertised potencies in the legal cannabis market limits the ability to generate clear policies regarding online advertising to protect patients that are willing to use cannabis for their condition. Thus, we evaluated the advertised THC and CBD content of cannabis products offered online in dispensaries in the United States to determine products’ suitability to medicinal use and compare the strength of products offered in legal medical and recreational programs. We recorded THC and CBD concentrations for all herb cannabis products provided by dispensary websites and compared them between or within states. Four Western states (CA, CO, NM, WA) and five Northeastern states (ME, MA, NH, RI, VT) were included. A total of 8,505 cannabis products across 653 dispensaries were sampled. Despite the clear differences between medicinal and recreational uses of cannabis, the average THC concentration advertised online in medicinal programs was similar (19.2% ±6.2) to recreational programs (21.5% ±6.0) when compared between states with different programs, or between medicinal and recreational programs within the same states (CO or WA). Lower CBD concentrations accompanied higher THC products. The majority of products, regardless of medicinal or recreational programs, were advertised to have >15% THC (70.3% – 91.4% of products). These stated concentrations seem unsuitable for medicinal purposes, particularly for patients with chronic neuropathic pain. Therefore, this information could induce the misconception that high potency cannabis is safe to treat pain. This data is consistent with reports in which THC and CBD in products from legal dispensaries or in nationwide products from the illegal market were actually measured, which indicates that patients consuming these products may be at risk of acute intoxication or long-term side effects. Our study offers grounds to develop policies that help prevent misconceptions toward cannabis and reduce risks in pain patients.
Introduction
The practice of pain management has come under scrutiny in recent years with the rise of the opioid epidemic in the United States (U.S.). Physicians continue to search for alternatives when opioids, anticonvulsants, or antidepressants provide no relief or result in adverse effects. Cannabis offers an alternative to pain management. While it is challenging to determine a cause and effect relationship between the implementation of cannabis legislation and a decline in opioid prescribing practices given the concurrent rise of legislation aimed at restricting and monitoring opioid prescribing, states with legalized medical cannabis programs have witnessed a decline in the number of opioid prescriptions and prescribed doses, particularly among younger cohorts and for schedule III opioids[1–4]. Interestingly, recreational cannabis legislation has not demonstrated a significant impact on opioid prescribing in privately insured adults [5].
Pain is the foremost reason patients visit cannabis dispensaries across the U.S. [1, 6] As of October 2019, 39 states and Washington D.C. have legalized cannabis for medical use in the U. S. Of those, 10 states and Washington D.C. have also legalized cannabis for recreational use. Thirty-four states list pain as a qualifying condition and six have approved only the use of CBD oils for medical purposes. Thus, the U.S. represents a largely populated geographical area in which cannabis is becoming rapidly legal and accessible in a non-uniformly regulated market in contrast to other countries such as Uruguay, which has slowly implemented its cannabis policies in order to address challenges and insure the safe and successful implementation of a nation-wide cannabis program. This tendency towards rapid cannabis legalization in the U.S. has been accompanied with robust dissemination of information using new technologies, namely online advertisements. In fact, marijuana or cannabis online searches have grown exponentially during the last decade across the U.S. [7]. Interestingly, online presence of cannabis products is associated with positive attitudes towards the medicinal properties of cannabis [8]. More importantly, it has been demonstrated that information provided by dispensaries is highly regarded by patients as safe and reliable [9]. Providing wrong information via online advertisements represents a high risk for public health, as evidenced by the recent concern expressed by the Federal Drug Administration (FDA) towards online offers and claims about cannabis products [10]. Therefore, understanding what information is provided online by dispensaries will provide a better understanding on how this shapes the attitude of pain patients towards cannabis products for medical purposes.
(…)
journal.pone.0230167