MORGANTOWN – Following our report earlier this month on a proposal before the state Medical Cannabis Advisory Board to limit the THC content of dispensed cannabis products to 10%, board member Dr. James Berry reached out to The Dominion Post to offer a counterpoint to the industry view presented in that report.
Berry is chair of WVU’s Department of Behavioral Medicine and Psychiatry and director of addiction services at the WVU Rockefeller Neuroscience Institute and a member of the board’s Health and Medical Workgroup.
He proposed the cap and will be giving a presentation Saturday, Sept. 24, at the Appalachian Addiction and Prescription Drug Abuse Conference – at the Morgantown Marriott at Waterfront Place – titled “Avoiding Pot Holes: Navigating the Cautionary Trail of Cannabis.”
Berry said he has tried to impress upon the cannabis board and other physicians that states have initiated a nationwide experiment by increasing the amount of cannabis people are using and sanctioning it by giving it a medical label. “We’ve done that way ahead of any science that really is clear regarding both the benefits of cannabis for health conditions and the harms.”
Nationwide, he said, hospitals are seeing higher rates of people entering emergency departments related to cannabis use. A 2020 report said cannabis was the number two substance related to emergency department visits – more than alcohol, heroin and cocaine.
The report also said more people are going in with psychotic problems and more people are seeking addiction treatment related to cannabis use. Berry believes that trend will continue and they will see still more with psychotic problems – schizophrenia, depression and other issues. “Which is my greatest concern.”
Those statistics don’t distinguish between medical and recreational users, he said. But a study this year on people with cannabis cards and those on a card wait list indicated that those with cards are three times more likely to develop a cannabis addiction, and experience no improvement in their depression and anxiety conditions.
Berry explained the difference between dependence and addiction. Dependence is a psychological or biologic dependence; a person will notice withdrawal if they stop use.
The accepted term for addiction, he said, is cannabis use disorder. It means a person has developed a clinically significant problem related to a substance that has become unmanageable and can suffer psychological and potentially physical harms. The disorder may include dependence but that’s not always the case.
Another alarming trend, he said, and one that counters the stereotypical image of the mellow stoner, is increased violence across the nation associated with more frequent use and potentially higher potency of cannabis. It’s also linked with suicide, especially among youths and at-risk patients.
A recent study in England, he said, indicated the mostly likely substance in a psychotic episode leading to an emergency room visit is cannabis, and people who experience psychotic episodes have a 40% to 50% chance of developing schizophrenia or bipolar psychosis within three years.
“This should at least cause us maybe to consider what’s happening and what we can do to account for this and try to protect people.”
While states across the nation are legalizing medical and recreational cannabis, it remains federally illegal, on Schedule 1, defined by the U.S. DEA as “drugs with no currently accepted medical use and a high potential for abuse.”
Berry agrees with others on both sides of the cannabis debate that this hampers advancing knowledge of the drug.
“I would be in the camp that would be in favor of lessening the schedule,” he said. “Schedule 1 is way too restrictive. For those of us who truly want to learn about the plant and the potential therapeutic value and the harms, we really can’t do that in a way that we all agree we should be able to.”
It prohibits such things as placebo randomized control trials to understand dosing and frequency for particular conditions, he said. It will take Congress to change the Controlled Substance Act to deschedule it.
Berry said his 10% figure is based on existing research. He cited a Journal of the American Medical Association meta-analysis of various studies that showed the best results are achieved at THC concentrations around 10% or less. So his figure is a way to link concentration to the evidence.
Discussions are ongoing and he’s willing to compromise, he said. “To me it was important to start the discussion.” He would want to know what evidence would support a higher number. “If that could be supported I would be content with moving that number higher.”
The board last met Sept. 8 and will meet again Jan. 5. In the meantime, workgroup members are trying to gather evidence and understand that evidence to help facilitate a good decision. “Our first priority should be the safety of this compound.”
By charging ahead without thorough research, Berry said he believes is a mistake — the same mistake made with opioids in terms of overlooking the addictive potential and the harms.
“We’ve taken this plant and created a whole industry that’s become outside the area of medicine,” he said. “It sidestepped all the usual checks and balances to protect the public. And now it’s beyond any sort of true regulation to give physicians and patients confidence that these products are safe and effective and not going to cause problems. That’s not the way we should practice medicine.”
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