Delivery dilemma for medical marijuana
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On Fifth Avenue, a few steps from New York City’s Bryant Park, is a storefront with an aesthetic more akin to an Apple outlet than a marijuana dispensary. But its presence in Manhattan hints at a business going mainstream.
The store, MedMen, offers five products — though no marijuana is on display in keeping with New York laws — with combinations of cannabidiol, one of several compounds in the cannabis plant, and tetrahydrocannabinol, or THC, the psychoactive compound that gives marijuana users a high. Products with names like Wellness, Harmony, Awake, Calm and Sleep come in the form of pens, drops and gels.
While drops and lotions have been popularised by celebrities, many still smoke or vape the drug, which experts say comes with the risk of lung disease and makes it hard to recommend a dosage. Thus, companies are experimenting with the most effective ways of consuming cannabis-derived medications.
“One of the most important aspects of cannabinoid research is and will be delivery systems,” says Dr George Anastassov, chief executive of Axim Biotech, which last month secured a patent for a suppository it developed to treat gastrointestinal conditions. He says the challenge for companies would be finding delivery platforms that are “just as predictable as smoking but that don’t use any combustive energy and will have similar bioavailability profiles”.
Axim’s pipeline includes cannabinoid-based products in the form of chewing gums, suppositories, topical applications and eye drops aimed at conditions ranging from irritable bowel syndrome and psoriasis to Parkinson’s disease and dry eye. The products are either in phase one or two of clinical research studies or are pre-clinical.
Growth is expected to be driven by applications in areas such as pain management in neurology, cancer, HIV/Aids, seizures, muscle spasms and inflammatory conditions. Innovation will be fuelled by access to capital markets — Tilray in July became the first cannabis producer to make its public debut in the US — and from deals, as countries begin easing restrictions on medicinal and recreational marijuana.
Canada last month became the second country to legalise marijuana for recreational use, following Uruguay, which decriminalised the drug in 2013. Canada authorised medical use in 2001.
UK doctors can prescribe medical pot on the National Health Service after a case of a 12-year-old epileptic boy who had his supply of cannabis oil confiscated at Heathrow airport this year. Other countries such as Australia and Germany have joined the bandwagon.
More than 30 US states and the District of Columbia have legalised medical cannabis and 10, plus DC, allow recreational use. It is outlawed at federal level. The departure of Jeff Sessions — the former US attorney-general who rescinded an Obama-era policy instructing federal prosecutors not to take action against marijuana in states where it had been legalised — has raised hopes that a key obstacle for the industry has been removed, though it remains unclear what policies his successor will pursue. About six in 10 Americans support legalisation, says a Pew survey, about double that in 2000.
The worldwide medical marijuana market could be worth more than $55bn by 2024, says Global Market Insights — from $7bn last year. PI Financial has a slightly more modest projection for the market to swell to about $50bn by 2025.
The strict regulatory environment around the drug can be blamed in part for the immature market and the paucity of data on its use and efficacy.
A 1961 UN convention labelled cannabis a “schedule 1” drug — considered to have a high potential for abuse and the potential to create severe dependence.
By comparison, GW Pharmaceuticals’ Epidiolex — derived from cannabidiol to treat childhood epilepsy and which this summer became the first medicine derived from cannabis to be approved for sale in the US — is now a schedule 5 drug, considered to have a lower potential for abuse and ranked alongside cough medicines such as Robitussin.
Value of the world market for medical marijuana in 2017
“The lack of data is a critical barrier to the adoption of medical marijuana,” says Dr Randi Schuster, at Massachusetts General Hospital’s Center for Addiction Medicine. “As with all other approved medications, clinical trials are sorely needed to demonstrate efficacy and test appropriate dosing. No insurance company will cover the cost of medical marijuana without knowing that it works.”
There is concern that cannabis’s benefits are overstated — with advocates arguing for its application in everything from managing chronic pain and muscle spasms to post-traumatic stress disorder — while side-effects from long-term exposure are not well understood. “Cannabis is often touted as a panacea, which I doubt will be supported scientifically,” Dr Schuster says.
Critics raise questions about its addictive potential, particularly in strains high in THC.
Global Market Insights’ estimate of the market’s value by 2024
“For historical reasons, marijuana escaped the typical phases of a clinical study,” says Dr Gabriella Gobbi of the Faculty of Medicine at McGill University. “This is why we have medical cannabis but we don’t know its side effects.” Whether there is interaction with anti-depressants, she adds, “we don’t know.”
To help understand the effects of medical pot, some researchers are teaming up with cannabis producers. McGill University is working with Aurora Cannabis to examine cannabidiol as a therapy for chronic pain, anxiety and depression. Researchers and companies hope to find more effective ways of administering it to patients.
“To my knowledge, there is no other medication that is smoked. Combustion comes with its own health risks and smoking makes dosing nearly impossible,” Dr Schuster says.
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