CANNABIS RESEARCH DATA

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Med J Aust || doi: 10.5694/mja17.01099 bPublished online: 12 November 2018

Although medicinal cannabis can now be prescribed for CINV, high quality clinical trial evidence is required to determine its efficacy and safety

Access to medicinal cannabis in Australia is a rapidly evolving and controversial field that is relevant to clinicians across a range of medical disciplines. There is widespread community interest in allowing access to medicinal cannabis for a variety of unapproved indications, despite a lack of high level evidence of efficacy.1 Legal and regulatory constraints make this access challenging; however, state and federal governments have now passed legislation enabling prescription by medical practitioners of medicinal cannabis in defined circumstances.2 In recognition of the lack of high level evidence supporting the use of medicinal cannabis for indications including but not limited to cancer pain, refractory paediatric epilepsy and palliative care, combined with the lack of formalised teaching in medical training programs, the Australian Government Therapeutics Goods Administration, in conjunction with state and territory governments, has commissioned a systematic review into the efficacy of medicinal cannabis, and has developed guidance documents for indications in which the evidence base is strongest to assist clinicians in appropriate prescribing of cannabis-based products.3 Despite these initiatives, willingness by medical practitioners to prescribe remains a significant barrier, with only 34 registered prescribers as of 31 July 2018.4

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What is COPD?

Symptoms of COPD can include wheezing, shortness of breath, and tightness in the chest. COPD describes a group of long-term lung diseases that includes bronchitis and emphysema. These diseases cause inflammation, which impairs airflow in and out of the lungs, making breathing difficult.

COPD is progressive, meaning that a person's symptoms tend to get worse over time. Cigarette smoking is the most common cause of COPD.

Symptoms of COPD can vary in severity but typically include:

• tightness in the chest
• shortness of breath
• wheezing
• fatigue
• unintentional weight loss
• low oxygen level

Smoking marijuana and COPD

A person's risk of developing COPD may increase due to heavy marijuana smoking.

The medical community is unsure whether smoking marijuana increases a person's risk of COPD. According to the American Thoracic Society, heavy marijuana smoking is likely to cause lung damage, which could increase a person's risk of developing COPD.

Many of the harmful and volatile chemicals in tobacco smoke are also present in marijuana smoke. Regardless of the source, smoke, ash, and heat are harmful to the lungs and can damage their lining. This seems to suggest that marijuana smoke is likely to cause COPD.

Also, the manner of smoking can increase the risk of lung damage. A person usually inhales marijuana smoke more deeply and holds it in the lungs for longer than cigarette smoke.

Long-term use may also lead to inflammation and swelling of the bronchial tubes, which can cause symptoms of chronic bronchitis, such as increased mucus production, coughing, and wheezing.

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After a nursing woman smokes marijuana once, her baby through her breast milk will consume traces of the drug's chief psychoactive element for at least six weeks and possibly longer, according to a soon-to-be-released study out of Colorado. 

For physicians who see cannabis-associated birth complications and long-term brain development concerns with children, the research is another step to try to square growing public nonchalance about marijuana with medical guidelines about use.

Researchers and clinicians have long warned women not to use marijuana while they are pregnant or nursing. They agree that infants' exposure to tetrahydrocannabinol, or THC, demonstrably changes their brain development. But their studies are limited. Legally, child protective services would have to step in if a child tests positive for the drug—a challenge for researchers who want to figure out how much THC infants absorb and what this means for them in the long term. 

Meanwhile, marijuana laws are loosening, and attitudes about cannabis have shifted. Physicians who witness the trends up close fear there will be another public health crisis that will hurt children. 

"We are in the opioid crisis due to expanding prescriptions for opioids with little thought to the consequences of widespread use, including use during pregnancy," said Dr. Lauren M. Jansson, director of pediatrics for the Johns Hopkins Center for Addiction and Pregnancy. "My fear is that we will see the same thing with marijuana. 

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J Clin Psychiatry 2018;79(6):17m11977m 10.4088/JCP.17m11977 © Copyright 2018 Physicians Postgraduate Press, Inc.

Objective: Associations between adolescent cannabis use and poor neurocognitive functioning have been reported from cross-sectional studies that cannot determine causality. Prospective designs can assess whether extended cannabis abstinence has a beneficial effect on cognition.

Conclusions: This study suggests that cannabis abstinence is associated with improvements in verbal learning that appear to occur largely in the first week following last use. Future studies are needed to determine whether the improvement in cognition with abstinence is associated with improvement in academic and other functional outcomes.

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