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What are Oral Cannabinoids?
 
Marijuana is a complex drug containing some 500 chemicals. About 100 of these are cannabinoids, chemicals unique to the cannabis (marijuana) plant.  
 
Last week, the National Academies of Sciences (NAS) issued a report on the therapeutic and harmful health effects of marijuana. A committee of top scientists evaluated 10,000 study abstracts to assess what we know about this drug and its cannabinoids.
 
For therapeutic effects, the committee found only three conditions for which cannabinoids are effective.
 
The three conditions, all in adults, are chemotherapy induced nausea and vomiting, multiple sclerosis (MS) related spasticity, and chronic pain. In the first two conditions, only oral cannabinoids were given to patients in the studies. In the pain condition, most of the studies administered oral cannabinoids; a handful administered smoked or inhaled marijuana.  
 
Pictured above are oral cannabinoids.
 
Dronabinol (scientific name) is at upper left. Marinol®, a capsule, is a commercial version of dronabinol. Not pictured is Syndros®, dronabinol in mouth spray form. A similar drug is nabilone (scientific name) at lower right, trade name Cesamet®, a capsule.

Dronabinol and nabilone are synthesized THC. To avoid contaminants often found in the marijuana plant, scientists made these drugs using pure chemicals to produce a “carbon copy” of THC found in marijuana. These products were approved by the Food and Drug Administration (FDA) to treat chemotherapy induced nausea and vomiting and AIDS wasting in people who don’t respond to standard medications.
 
Epidiolex®, upper right, and Sativex, lower left, are cannabinoids scientists extracted from marijuana and purified to remove any contaminants. Epidiolex is 98% cannabidiol (CBD) and is seeking FDA approval to treat epilepsy. Sativex is equal parts CBD and THC and small amounts of minor cannabinoids. It has been approved in several countries to treat multiple sclerosis-related spasticity and is seeking FDA approval here for the same purpose. Not pictured is a German drug, Cannador, a capsule containing two parts THC to one part CBD, to treat MS symptoms.
 
The National Academies of Medicine committee says, “For these conditions [chemotherapy induced nausea and vomiting, MS spasticity, and pain] the effects of cannabinoids are modest; for all other conditions evaluated there is inadequate information to assess their effects (emphasis added).”
 
States are not legalizing oral cannabinoids; they are legalizing marijuana, the whole plant. The committee found no evidence to support giving marijuana to anyone with any condition except pain. Given how many different forms of marijuana – whole plant extracts, hash oils, edibles, elixirs, body creams, etc. -- are being marketed to patients in states that legalize the drug for medical use, the committee calls for more research to determine whether these products are helping or hurting patients.
 
Coming next week: The NAS committee’s assessment of marijuana’s harmful effects.

The Marijuana Report is a weekly e-newsletter published by National Families in Action in partnership with SAM (Smart Approaches to Marijuana). Visit our website, The Marijuana Report.Org, to learn more about the marijuana story unfolding across the nation.
 
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About National Families in Action (NFIA)
NFIA consists of families, scientists, business leaders, physicians, addiction specialists, policymakers, and others committed to protecting children from addictive drugs. Our vision is:
  • Healthy, drug-free kids
  • Nurturing, addiction-free families
  • Scientifically accurate information and education
  • A nation free of Big Marijuana
  • Smart, safe, FDA-approved medicines developed from the cannabis plant (and other plants) 
  • Expanded access to medicines in FDA clinical trials for children with epilepsy 
About SAM (Smart Approaches to Marijuana)
SAM is a nonpartisan alliance of lawmakers, scientists and other concerned citizens who want to move beyond simplistic discussions of "incarceration versus legalization" when discussing marijuana use and instead focus on practical changes in marijuana policy that neither demonizes users nor legalizes the drug. SAM supports a treatment, health-first marijuana policy.  SAM has four main goals:
  • To inform public policy with the science of today's marijuana.
  • To reduce the unintended consequences of current marijuana policies, such as lifelong stigma due to arrest.
  • To prevent the establishment of "Big Marijuana" - and a 21st-Century tobacco industry that would market marijuana to children.
  • To promote research of marijuana's medical properties and produce, non-smoked, non-psychoactive pharmacy-attainable medications.
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