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Narrative review of the safety and efficacy of marijuana
for the treatment of commonly state-approved medical and psychiatric disorders

Authors: Katherine A Belendiuk1, Lisa L Baldini2 and Marcel O Bonn-Miller345*

Conclusion:

The reviewed literature highlights the dearth of rigorous research on the effects of marijuana for the most common conditions for which it is currently recommended. It is paramount that well-designed RCTs with larger sample sizes be conducted to determine the actual medical benefits and adverse effects of marijuana for each of the above conditions. Indeed, recent reviews [4,132] comprehensively discuss adverse events associated with marijuana use, and while it is beyond the scope of the current paper to review these effects in-depth, they are important to consider when evaluating whether or not to recommend marijuana for a medical or psychiatric disorder in place of other existing treatment options. Given the extensive literature speaking to the harms associated with marijuana use, research on the comparative safety, tolerability, efficacy, and risk of marijuana compared to existing pharmacological agents is needed. The present literature also illuminates the need for research into the effects of isolated cannabinoids (e.g., THC, CBD) as well as species of smoked marijuana (e.g., indica and sativa), as the majority of medical marijuana users ingest marijuana by smoking the marijuana plant [133,134], which contains a wide variety of phytocannabinoids at varying potencies [135,136]. Furthermore, improved and objective measurement of clinical outcomes should be implemented in clinical trials to determine treatment efficacy. Finally, little research has considered the issues of dose, duration, and potency. If research identifies a therapeutic effect of marijuana for medical or psychiatric conditions, there will need to be revisions in marijuana policy to increase quality control so that dose and potency are valid and reliable. Additionally, risk of abuse and diversion can be decreased by developing prescribing practices with continued supervision of a medical professional, creating prescription monitoring programs to reduce the risk of “doctor shopping” and identifying provisions for the safe disposal of unused cannabinoids. In sum, the current literature does not adequately support the widespread adoption and use of marijuana for medical and psychiatric conditions at this time.

For complete paper go to  http://www.ascpjournal.org/content/10/1/10/abstract  © Addiction Science & Clinical Practice 2015, 10:10  doi:10.1186/s13722-015-0032-7

Published: 21 April 2015

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Introduction:

During the past three decades, drug testing of employees and job applicants has become a crucial part of employers’ efforts to maintain drug-free workplaces. Drug use is a significant threat to workplace
health, safety and productivity. In addition to testing, drug-free workplace programs typically include education about the risks of drug use, especially in the workplace, and employee assistance programs to support treatment and long-term recovery of employees with substance use and other medical and behavioral health problems. Workplace drug testing programs identify those who need assistance in addressing their drug use problems, reinforce prevention messages, and deter workers from using drugs.

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Epigenetic Regulation of Immunological Alterations Following Prenatal Exposure to Marijuana Cannabinoids and its Long Term Consequences in Offspring.
Zumbrun EE1, Sido JM, Nagarkatti PS, Nagarkatti M.
Abstract
Use of marijuana during pregnancy is fairly commonplace and can be expected increase in frequency as more states legalize its recreational use. The cannabinoids present in marijuana have been shown to be immunosuppressive, yet the effect of prenatal exposure to cannabinoids on the immune system of the developing fetus, its long term consequences during adult stage of life, and transgenerational effects have not been well characterized. Confounding factors such as co-existing drug use make the impact of cannabis use on progeny inherently difficult to study in a human population. Data from various animal models suggests that in utero exposure to cannabinoids results in profound T cell dysfunction and a greatly reduced immune response to viral antigens. Furthermore, evidence from animal studies indicates that the immunosuppressive effects of cannabinoids can be mediated through epigenetic mechanisms such as altered microRNA, DNA methylation and histone modification profiles. Such studies support the hypothesis that that parental or prenatal exposure to cannabis can trigger epigenetic changes that could have significant immunological consequences for offspring as well as long term transgenerational effects.

For further information go to http://www.ncbi.nlm.nih.gov/pubmed/25618446

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Associations between cigarette smoking and cannabis dependence: A longitudinal study of young cannabis users in the United Kingdom.

Cigarette smoking is related to concurrent cannabis dependence independently of cannabis use frequency. Cigarette smoking also mediates the relationship between cannabis use and cannabis dependence suggesting tobacco is a partial driver of cannabis dependence in young people who use cannabis and tobacco.

Authors: Hindocha C1, Shaban ND2, Freeman TP2, Das RK2, Gale G2, Schafer G2, Falconer CJ3, Morgan CJ4, Curran HV2.
For further info go to… http://www.ncbi.nlm.nih.gov/pubmed/25622777