A question asked by some UCLA researchers might seem like an oxymoron for anyone raised on the now debunked “gateway” theory, the one that says using marijuana leads to using harder drugs:
Can cannabis play a role in easing the nation’s opioid epidemic?
That idea is one of many being explored at UCLA’s new Cannabis Research Initiative.
The university quietly launched the interdisciplinary research center four months ago, to study how cannabis impacts society. Experts are looking at everything from public health and the environment to the economy and the legal system.
“I think California is going to be a decisive area where we really learn about all of the potential positive and negative impacts of cannabis legalization,” said Dr. Jeff Chen, the institute’s executive director.
There are challenges. The federal illegality of cannabis, coupled with the stigma lingering from decades of prohibition, make it difficult to get permission and funding to research marijuana. In fact, Chen describes cannabis as “arguably the single-most difficult substance to study in America.”
That’s helped marijuana take on an almost mythical reputation. While a growing body of research suggests cannabis can help combat seizures, chronic pain and more, there’s a dearth of clinical studies to back much of the anecdotal evidence. And, with an emerging multi-billion-dollar industry backing studies that might push the benefits ahead of the overdue science, Chen said “it’s good to be skeptical.”
“We hear these miraculous stories, and we definitely have to discard some of it,” Chen said.
“But we can’t discard all of it.”
And the more researchers learn about how cannabis works in our bodies, Chen said the more it makes sense to him that the plant might have far-reaching impacts on a number of seemingly unrelated conditions.
Creating the center[hhmc]
Chen was a third year medical student at The David Geffen School of Medicine at UCLA when he noticed that a lot of patients were either already using cannabis or interested in using it as part of their treatment. But the potential benefits and risks of marijuana aren’t taught through standardized curriculum in medical schools, leaving Chen and his colleagues at a loss.
“We could never give them any answers,” he said. “California had legalized (medical) cannabis 20 years prior, (but) we still couldn’t tell patients whether cannabis could actually help them.”
Chen first thought about joining a research project on the topic. After all, UCLA professors have been doing their own studies involving cannabis for years.
But along with getting his medical degree, Chen was simultaneously pursuing an MBA at UCLA. So he started asking, “How can I build something that could actually do much more than I could ever do by myself?”
It was 2016. Proposition 64 was nearing a vote, and all the polls predicted it would pass. Chen started approaching faculty and administration at UCLA to pitch his idea for creating a cannabis research center that would allow them to collaborate and expand their work. And he couldn’t see any better place to do it than in the heart of Los Angeles.
Nearly half of all legal cannabis sales in the country are estimated to take place in California, Chen said. Perhaps two-thirds of that business happens in the L.A. area.
Southern California is also responsible for exporting culture to the rest of the world through the movies, TV shows, music and other entertainment that gets produced locally.
“What happens when cannabis becomes part of that content, and that is the narrative that is dispersed around the world?” he said.
We’re about to find out. Recreational cannabis sales started Jan. 1, with more than 200 stores throughout the state now licensed to sell marijuana to anyone 21 and older.
Chen graduated with his dual degree in June. In September, rather than start his residency at a hospital as his classmates were doing, he launched the university’s Cannabis Research Initiative.
There are now six full- or part-time staff members working with the center, which is part of UCLA’s Semel Institute for Neuroscience and Human Behavior. Nearly 30 other faculty members have signed on as contributors, with everyone anxious to create as tight a feedback loop as possible as California’s legalization scheme plays out.
The plan is for the center to one day be simultaneously coordinating studies in a broad range of fields, with interest in how legal marijuana affects every part of society. But Chen said their near-term priority is the health effects of cannabis.
Fortunately, UCLA has one of the highest-ranked medical centers in the state.
About two million patients come through the UCLA health system each year, Chen said. They’re all asked specific questions about tobacco and alcohol use, while cannabis is simply lumped in with all other drugs. If the center can get a new questionnaire in place that asks patients about cannabis use, Chen said it will allow them to do cohort studies over time, looking for trends related to marijuana and a range of health conditions.
Chen’s team also just applied for seed funding to launch what would likely be a $3 million study on how cannabis might help patients who are using opioids to treat chronic pain.
The plan is to administer vaporized cannabis to patients who’ve been using opioids for at least three months to treat chronic pain. They would monitor these patients over time to see how the treatment impacts their pain, mental health and overall quality of life.
Cannabis by all accounts has fewer side effects and a much lower addiction rate than opioids. So if patients with chronic pain are able to substitute medical marijuana for at least some of the painkillers they’re taking, that alone would be considered a good thing.
But there might be more to the theory. Chen said limited studies suggest there’s interaction between the system in our bodies that reacts to cannabis and the system that reacts to opioids, which may make the two drugs work synergistically.
Cannabis is also believed to have anti-inflammatory properties. And since swelling is often a contributing factor in chronic pain, Chen said any reduction in inflammation could reduce the amount of opioids patients need to take.
A federally funded study released Tuesday by the Rand Corporation and UC Irvine suggests states with ready access to medical marijuana had lower rates of opioid deaths. And an August 2017 study published in the American Journal of Public Health showed recreational cannabis legalization may be tied to a drop in opioid deaths in Colorado.
Those population studies are intriguing, Chen said. But he said they can’t actually prove causation, since other factors could be affecting the declines in opioid use. Also, conditions are so different from one state to the next that what’s true in one state with legal cannabis might not prove true in another.
Having clinical research to support such studies should help to clear up some of the confusion surrounding cannabis and opioids, Chen said, giving both patients and doctors more reliable information when they’re considering treatment options.
Some other early areas of interest UCLA’s cannabis research center hopes to pursue are connections to cancer, diabetes and whether people are adjusting their use of alcohol and other recreational drugs as they turn toward cannabis.
While the interest and need for more cannabis research are high, so are the barriers.
Marijuana remains classified by the Drug Enforcement Administration alongside heroin as a Schedule I controlled substance – a designation reserved for highly addictive drugs with no proven medical use. That means anyone who wants to research the drug must jump through so many hoops that it’s impossible for many to move forward.
Also, though there are multiple state-licensed cannabis dispensaries within 1,000 feet of UCLA Medical Center, federal laws says the university would need to get marijuana for its study from the University of Mississippi.
Since 1968, Ole Miss has had a monopoly on growing cannabis to supply researchers doing studies on people. But Chen said that supply is not reflective of what people are buying in legal markets, without the range of concentrations, strains and preparations available at any licensed shop.
The DEA agreed in 2016 to let other organizations grow cannabis for sanctioned research. UCLA has not applied to be a licensed cultivator given the real estate challenges in the area, Chen said. More than 100 other universities or organizations have applied. None have yet been given a permit to proceed.
The federal status of cannabis also makes it tough for researchers to get funding, with very few pots of money available for research on the therapeutic benefits of marijuana.
“Nearly all of federal funding related to cannabis over the past 50 years has gone into research toward (its) harms,” Chen said.
Under Proposition 64, up to $10 million a year for the next 10 years will be dedicated to California universities to research the impact of legalization. But competition for those funds will be stiff.
UC San Diego has had a Center for Medicinal Cannabis Research since 2000. Humboldt State University created its Institute for Interdisciplinary Marijuana Research nearly six years ago. And UC Irvine is in the process of trying to create an interdisciplinary cannabis research center.
Chen said he expects much of the funding to advance cannabis research at UCLA and beyond will have to come from philanthropists and from companies in the industry.
Two studies are underway at the university now on how cannabis might reduce spasticity in children with epilepsy. Both are being funded by GW Pharmaceutical, a British company that’s close to securing FDA approval for Epidiolex, which would be the first drug derived from real cannabis plants that could be prescribed through a pharmacy.
Developments like that have Chen optimistic, despite the challenges ahead.
“I get out of bed now so excited… to be able to uncover all this knowledge that we’ve been overlooking.”