MedicalResearch.com Interview with:
Daniel J. Kruger, PhD
Research Assistant Professor
University of Michigan
MedicalResearch.com: What is the background for this study?
Response: We study health-related behaviors, such as diet and the consumption of caffeine and alcohol.
Given the recent trends in legalization of cannabis for medical and even recreational purposes, we were concerned with the narrow focus of current public health efforts regarding cannabis. Although some in the field take a harm-reduction approach to substance use, too many efforts focus solely on abstinence. These programs are a legacy from the era of prohibition, and we know that there are disadvantages to such a restricted scope in public health.
For example, municipalities that eliminated or blocked accurate and effective sex education had increases in teenage pregnancy rates. There are so many public health-related aspects of cannabis, beyond risks and adverse effects, which need to be addressed by systematic scientific research. Because of the legal history of cannabis, there is little integration with the mainstream health care system.
The focus of the current study was investigating how medical cannabis users perceived medical cannabis in comparison to pharmaceutical drugs and other aspects of the mainstream health care system and how they navigated they relationships between these currently separate systems
MedicalResearch.com: What are the main findings?
Response: Medical cannabis users had higher levels of both trust in and a higher level of use of medical cannabis compared to mainstream healthcare (a medical doctor or hospital). Medical cannabis users rated cannabis better on effectiveness, side effects, safety, addictiveness, availability, and cost compared to pharmaceutical drugs. About half of participants stopped taking a pharmaceutical drug or used less of a pharmaceutical drug due to the medical use of cannabis.
At the same time, only about half (56%) reported that their mainstream healthcare provider knew that they used medical cannabis. Also, participants had very little knowledge of the psychoactive content (levels of THC, CBD, etc.) in the cannabis they were using. Imagine a physician handing patients bags of unlabeled assorted pills and saying, “take a few of these until you start feeling better.” The physician would quickly loose her or his license.
MedicalResearch.com: What should readers take away from your report?
Response: Cannabis needs to be rescheduled at the federal level, as soon as possible, to enable systematic scientific research. The current classification (Schedule 1) is the most restrictive and prevents the kind of double-blind placebo controlled trials that are standard practice for pharmaceutical drugs. Although prevention-focused public health efforts may be valuable for minors and aspects such as driving while intoxicated, the field would greatly benefit by shifting towards an evidence-based harm reduction model.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: We have come full circle back to the 19th Century when cannabis was included in “cure-all” tinctures that were used for a very broad range of purposes. Considerable efforts are needed to maximize benefits and minimize harm to users and society.
This includes systematic research on the effective dosage levels for the numerous cannabinoids; effectiveness ranges for the treatment of various health conditions; standardized testing, systematic assessment, and accurate and informative labeling of cannabis products; and consumer education on cannabinoid properties, effective dosage levels, and administration schedules.
In addition, systematic research is needed on risk assessment for developing policies and guidelines for levels of cannabis intoxication during behaviors such as driving automobiles and operating other machinery.
MedicalResearch.com: Is there anything else you would like to add?
Response: As in all domains, an evidence-based approach is needed to shape policies and practices. Without this, the medicinal use of cannabis will be slouching towards alchemy.
J Psychoactive Drugs. 2019 Jan 8:1-6. doi: 10.1080/02791072.2018.1563314.
[Epub ahead of print]
Kruger DJ1, Kruger JS2.
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