AAFP Releases Marijuana, Cannabinoids Position Paper

Research Into Safety, Health Effects Sorely Needed, Says FP Expert

September 20, 2019 09:55 am Chris Crawford

The World Health Organization reports(www.who.int) that about 2.5% of the global population uses cannabis annually, making it the most commonly used drug worldwide.

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The AAFP's new position paper on this topic, Marijuana and Cannabinoids: Health, Research and Regulatory Considerations, describes marijuana and related substance misuse as "complex issues impacting family medicine, patient health and public health."

In the position paper, the Academy acknowledges that preliminary evidence indicates marijuana and cannabinoids "may have potential therapeutic benefits," but they may also have a negative impact on health.

"Family physicians can help inform their patients about the complex interplay and emerging evidence surrounding the potential benefits and harms of marijuana and cannabinoid use, helping them to make healthy decisions about its use," said Beth Anne Fox, M.D., M.P.H., of Kingsport, Tenn., who, as a member of the AAFP's Commission of the Health of the Public and Science, led development of the position paper.  

Story Highlights
  • The AAFP's new marijuana and cannabinoids position paper describes marijuana and related substance misuse as "complex issues impacting family medicine, patient health and public health."
  • The AAFP recognizes that there is support for the medical use of marijuana and cannabinoids but advocates that usage be based on high-quality, evidence-based public health policy and patient-centered research, including investigation of its impact on vulnerable populations.
  • On Aug. 29, the surgeon general released an advisory on marijuana use and the developing brain that highlighted issues regarding how marijuana affects adolescents and pregnant women and their unborn children.  

Position Paper Notes

The AAFP recognizes there is support for the medical use of marijuana and cannabinoids, Fox told AAFP News, but advocates that usage be based on high-quality, evidence-based public health policy and patient-centered research, including investigation of its impact on vulnerable populations.

The Academy's policy on marijuana possession for personal use opposes the recreational use of marijuana.

"However," the policy notes, "the AAFP supports decriminalization of possession of marijuana for personal use. The AAFP recognizes the benefits of intervention and treatment for the recreational use of marijuana, in lieu of incarceration, for all individuals, including youth."

The policy also states that the Academy "recognizes that several states have passed laws approving limited recreational use and/or possession of marijuana. Therefore, the AAFP advocates for further research into the overall safety and health effects of recreational use, as well as the effects of those laws on patient and societal health."

As for the regulatory environment surrounding research on cannabis, marijuana and cannabinoids, the position paper said Schedule I classification of these substances by the Drug Enforcement Administration "creates barriers detrimental to facilitating meaningful medical, public health, policy and public safety research."  

"This has led to a lack of empirical evidence regarding a myriad of health-related issues, including potential therapeutic benefits of cannabis, public health impact, health economics and short- and long-term health effects from cannabis use," Fox said. "While there are some anecdotal reports and some studies that seem to indicate marijuana may be effective in the management of pain, the evidence is weak and inconclusive at this time."

Therefore, the AAFP encourages a reclassification of marijuana to facilitate rigorous clinical research.

It should also be noted that to date, the majority of states, along with the District of Columbia, Guam and Puerto Rico, have legalized or decriminalized cannabis in various forms.

NIH to Investigate Cannabinoids' Pain Relief Potential

NIH's National Center for Complementary and Integrative Health announced Sept. 19(www.nih.gov) it will award nine research grants totaling about $3 million to investigate the potential pain-relieving properties and mechanisms of action of various phytochemicals in cannabis, including minor cannabinoids and terpenes.

The goal, according to the NCCIH, is to strengthen the evidence regarding cannabis components and whether they have potential roles in pain management.

"The treatment of chronic pain has relied heavily on opioids, despite their potential for addiction and overdose and the fact that they often don't work well when used on a long-term basis," said Helene Langevin, M.D., director of NCCIH. "There's an urgent need for more effective and safer options."
 

Cannabidiol, more widely known as CBD, is the most abundant cannabinoid in cannabis and is largely non-psychoactive.

"There are some studies that suggest CBD may have health benefits, such as in the management of treatment-resistant seizure disorders in children and adolescents with Dravet syndrome and Lennox Gastaut syndrome; however, as with marijuana, in general, there is a paucity of high-quality studies on its potential benefits and uses," Fox said. "Potential long-term harms with its use are also largely unknown. The CBD products sold over-the-counter are not regulated so the content can be variable, as well."

Surgeon General Advisory

On Aug. 29, the surgeon general released an advisory on marijuana use and the developing brain(www.hhs.gov) that highlighted issues regarding how marijuana affects adolescents and pregnant women and their unborn children.

The advisory recommended that health care professionals, including family physicians, integrate marijuana education into prenatal visits and when speaking with adolescents.

"Exploring substance use and misuse are common practices when caring for adults and children, especially during preventive health visits and during times of heightened concern," Fox said.

During the first and subsequent prenatal care visits, pregnant women are routinely educated about the effects of many substances that can adversely affect the developing fetus, in keeping with the overall goals of maintaining and improving maternal health and delivering a healthy infant, she added.

What Family Physicians Can Do

When addressing marijuana, cannabinoids or cannabis products with patients, Fox recommended family physicians do the following:

  • Discuss inappropriate use of marijuana, cannabinoids and cannabis products.
  • Discuss safe storage of all cannabis products with patients who live with or serve as primary caregivers for children to prevent exposure.
  • Discuss the developmental and other potential negative impacts of marijuana and cannabis on individuals who are or who could become pregnant.
  • Emphasize the serious consequences of marijuana intoxication and impaired driving.

"The landscape regarding marijuana and cannabinoids is rapidly changing," Fox said. "Marijuana use continues to be an important public health issue. While its use may have deleterious health impacts, positive health impacts are beginning to be identified, and its status of being illegal has also had a negative public health impact.

"It is important to thoughtfully weigh the benefits and costs to patient care and public health in order to make good policy decisions in this changing landscape."

Related AAFP News Coverage
Surgeon General Issues Advisory on Risks of Marijuana Use
Youth, Pregnant Women Encouraged to Stop Using
(9/12/2019)

USPSTF Recommends Screening Adults for Illicit Drug Use
Evidence Remains Insufficient to Recommend Screening in Adolescents
(8/27/2019)

More From AAFP
Familydoctor.org: Medical Marijuana(familydoctor.org)

American Family Physician: Editorial: Counseling Parents and Adolescents About Marijuana
(7/15/2018)