Marijuana Science and Links for Lawyers 002: Commissioned Review & Position Statements
Thank you for your interest in the “cannabis” part of cannabis law. Post 002 of the Marijuana Science and Links for Lawyers series offers additional information about the current state of the science of marijuana. This information should capture the attention of interested citizens, parents, teachers, lawyers, judges, legislators, and cannabis-law policy researchers.
This post provides links to a comprehensive commissioned research review and summaries and a sampling of selected formal position statements about medical and recreational marijuana from various medical, psychological science or psychiatric, and public health and policy organizations. These statements reflect a range including broad and narrow views. Most urge caution. Many call for research. Patient benefit and product safety and efficacy rank overall as the top concerns reflected by the following position statements.
Broad Public Health Implications – Current Evidence & Research Recommendations. The most substantial review of evidence about the health effects of marijuana and its related compounds appears in the work by the National Academies of Sciences, Engineering, and Medicine published in 2017. This 450+ page report, The health effects of cannabis and cannabinoids: The current state of evidence and recommendations for research, Washington, DC: The National Academies Press. doi: 10.17226/24625 electronic copy here, resulted from review of recently published systematic reviews (since 2011) and high-quality primary research organized and considered around 11 groups of health endpoints, e.g. injury and death, immunity, pregnancy and childhood, cancer, schizophrenia.
The report sets out nearly 100 different research conclusions related to cannabis or cannabinoid use and health…. This report addresses concerns raised by shifting public sentiment, conflicting and impeded scientific research, and legislative battles which have fueled the debate about what, if any, harms or benefits can be attributed to the use of cannabis or its derivatives. The report fills a void created by a lack of aggregated knowledge. It has broad public health implications. The Health Effects of Cannabis and Cannabinoids provides a comprehensive review of scientific evidence related to the health effects and potential therapeutic benefits of cannabis. This report provides a research agenda—outlining gaps in current knowledge and opportunities for providing additional insight into these issues—that summarizes and prioritizes pressing research needs.”) Download PDF copy here)
Pregnancy and Lactation – The American College of Obstetricians and Gynecologists. Marijuana use during pregnancy and lactation. Committee Opinion No. 637. American College of Obstetricians and Gynecologists. Obstet Gynecol 2015;126:234–8. electronic copy available here cites over 40 references, sets forth recommendations, and discusses the nature and properties of marijuana, its self-reported use, effects of marijuana use on pregnancy, effects of marijuana use on lactation, and medical marijuana.
In pertinent part, the College’s position statement provides “Because of concerns regarding impaired neurodevelopment, as well as maternal and fetal exposure to the adverse effects of smoking, women who are pregnant or contemplating pregnancy should be encouraged to discontinue marijuana use. Obstetrician–gynecologists should be discouraged from prescribing or suggesting the use of marijuana for medicinal purposes during preconception, pregnancy, and lactation. Pregnant women or women contemplating pregnancy should be encouraged to discontinue use of marijuana for medicinal purposes in favor of an alternative therapy for which there are better pregnancy-specific safety data. There are insufficient data to evaluate the effects of marijuana use on infants during lactation and breastfeeding, and in the absence of such data, marijuana use is discouraged.” Download PDF copy here.
American Academy of Pediatrics – Children & Adolescents Ages 0 – 21 Years. The Impact of Marijuana Policies on Youth: Clinical, Research, and Legal Update, COMMITTEE ON SUBSTANCE ABUSE, COMMITTEE ON ADOLESCENCE Pediatrics Mar 2015, 135 (3) 584-587; DOI: 10.1542/peds.2014-4146 electronic copy available here provides the position of the American Academy of Pediatrics on the issue of marijuana legalization.
The position statement reviews history of legislation, effects of marijuana, concerns about impacts on children and adolescents with legalization for recreational and medical uses, adverse effects of marijuana, decriminalization efforts and effects, conclusions about behavioral and health risks, and makes ten (10) recommendations, including opposing medical marijuana outside of Federal oversight and legalization of marijuana (PDF download available here).
A technical report electronic copy of technical report here (citing over 100 sources) accompanies the position statement. It discusses the epidemiology of marijuana use and youth, notes functional definitions, outlines marijuana biology, discusses several aspects of cannabinoid therapeutics, legalization of marijuana, decriminalization of marijuana, arguments for and against legalization or decriminalization of marijuana, possible effects of legalization or decriminalization of marijuana, comparisons between marijuana, alcohol, and tobacco, acknowledges and discusses society and social justice concerns, and concludes with results from a survey of teen use of marijuana before and after passage of a medical marijuana law (PDF download of technical report available here). See also American Academy of Pediatrics Key Resources and Information on Substance Abuse and Marijuana here.
American Academy of Neurology – Position Statement: Use of Medical Marijuana for Neurologic Disorders. The American Academy of Neurology (AAN) describes itself as a professional organization of over 28,000 practicing neurologists and neuroscientists. Its members have “an interest in providing the best possible care for all patients with all types of neurological disorders.”
The AAN issued its Position Statement: Use of Medical Marijuana for Neurologic Disorders in 2014 copy accessible here. The Position Statement concisely explains the official stand and reasoning of the AAN on legislative issues, includes background and the rationale, and references all supporting evidence. The AAN rejects anecdotal evidence which may engender public support of them, and offers its Position Statement, which calls for rigorous research to produce evidence which substantiates the safety and medical benefit of various forms of “marijuana-based products”, i.e. “marijuana and to products derived from it”. It offers it for the stated purpose to assist policymakers. The AAN described the “issue” as “The current medical marijuana legislation being passed by policymakers across the country, which promotes marijuana-based products as treatment options for various neurologic disorders, is not supported by high-level research.”
The AAN’s position statement involves two parts: (1) research and (2) benefits and safety. Regarding (1), in pertinent part, the AAN “supports all efforts to conduct rigorous research to evaluate the long-term safety and effectiveness of marijuana-based products.” Regarding (2), in pertinent part, the AAN “does not advocate for the legalization of marijuana-based products for use in neurologic disorders at this time, as further research is needed to determine the benefits and safety of such products. This is of paramount importance when marijuana-based products are used in patients with underlying neurologic disorders, or in children whose developing brains may be more vulnerable to the toxic effects of marijuana.”
The Rationale portion of the AAN position statement discusses the legal status of marijuana under Federal law and state schemes and aspects of the state laws and regulations, notes salient historical points and basic science of marijuana, and discusses issues of side-effects, safety, tolerance, and dependence from several case and clinical studies. While its position statement differentiates between smoked and non-smoked forms of marijuana-based products, and urges further research, particularly regarding non-smoked forms, the AAN states “Importantly, there is no evidence to support the use of smoked cannabis.”
American Lung Association – Lung Health & Marijuana. “For more than 110 years, the American Lung Association has led the fight for healthy lungs and healthy air.” As the leading organization working to save lives by improving lung health and preventing lung disease, it works on several strategic imperatives. Through research, education and advocacy, The American Lung Association seeks to defeat lung cancer; to improve the air we breathe; to reduce the burden of lung disease on individuals and their families; to eliminate tobacco use and tobacco-related diseases; and to accelerate fundraising and enhance organizational effectiveness to support the urgency of its mission.
The American Lung Association issued a Public Policy Position on lung health in October of 2015 electronic copy available here. Its policy principle states in pertinent part “The American Lung Association strongly supports measures to prevent lung disease, reduce the incidence and exacerbation of lung disease, improve the diagnosis and treatment of lung disease patients and increase their access to appropriate health care.” Generally, the organization supports research and programming which will support efforts to serve those ends.
Consistent with that guiding principle, the policy position states in pertinent part that “Since marijuana smoke harms lung health, the American Lung Association opposes the inhalation of smoke or aerosol of marijuana.” Regarding medical marijuana, the Association supports research into the effects, e.g. risks and any potential benefits, of medical marijuana use and lung health. And, “Medical marijuana should be subjected to the same Food and Drug Administration standards of efficacy and safety as any pharmaceutical agent promoted for purposes of alleviating the symptoms of disease.”
The American Association of Family Physicians (AAFP) Position Statement – Marijuana. The AAFP, a professional organization of over 125,000 members, represents primary care physicians – family doctors AAFP webpage here. Family physicians treat the whole person. According to the AAFP webpage, family physicians conduct approximately one in five office visits annually.
The AAFP developed a marijuana policy in 1989. The current policy, updated in 2016, covers medical marijuana and recreational marijuana electronic copy available here. See a related 2015 editorial, “Effectiveness, Adverse Effects, and Safety” electronic copy available here. This piece concerns medical marijuana in the context of family physicians’ increasing need to discuss the issue with their patients, cites 18 references, and discusses clinical effectiveness of cannabinoids and the adverse effects of marijuana.
The AAFP acknowledges that support exists for the medical use of marijuana. Its position states in pertinent part “The AAFP recognizes that there is support for the medical use of marijuana but advocates that usage be based on high quality, patient-centered, evidence-based research and advocates for further studies into the use of medical marijuana and related compounds.” The organization calls for re-scheduling marijuana to facilitate high quality research, and calls for adequate funding for that research. About legalization for medical use, the AAFP’s policy states “The AAFP also recognizes that some states have passed laws approving the medical use of marijuana; the AAFP does not endorse such laws.”
The AAFP also calls for “research into the overall safety and health effects of recreational use as well as the effects of those laws on patient and societal health.” But, “The AAFP opposes the recreational use of marijuana, however supports decriminalization of the possession and personal use of marijuana.”
American Psychiatric Association – Position Statement. Self-described as “the leading psychiatric organization in the world”, the American Psychiatric Association (APA) has some 37,000 members in academic, research, and psychiatric practice from over 100 countries.
The APA published in 2013 a position statement electronic copy available here about the use of medical marijuana for the treatment of post-traumatic stress disorder (PTSD). It states in pertinent part “Because of the lack of any credible studies demonstrating clinical effectiveness, the APA cannot endorse the use of medical marijuana for the treatment of posttraumatic stress disorder (PTSD).”
See related post on Psycholawlogy: Marijuana Science and Medicine Links for Lawyers
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