The future of medical cannabis is quite promising yet requires the leveraging of best practices and knowledge assets of the following industries: cannabis, technology, traditional Western medicine and pharmaceutical. In May 2019, CannabizMD hosted a panel discussion “Cannabis + Innovation”. The discussion with cannabis industry leaders focused on the need for ongoing application of cutting-edge technology with high-level science, data capture and its analysis. One year later and one more year in the cannabis industry including graduate studies in the science of medical cannabis, I recognize that the pharmaceutical industry’s best practices and knowledge assets are necessary to drive substantive growth and success for the medical cannabis industry which will happen.
Many believe federal prohibition of cannabis in the US will end in the next few years but when, is dependent upon US politics. Cannabis (marijuana) has been in therapeutic use for thousands of years. Relative “modern medicine” cannabis was used by physicians for therapeutic patient treatment from the mid-19th century in Europe and made its way to the US Pharmacopeia in 1851. It became illegal in the US in 1937 when President Franklin D. Roosevelt signed the Marihuana Tax Act of 1937 (the spelling of the time was racially biased against minorities), the first federal marijuana law which effectively banned possession and required a stamp for purchase. The stamp basically banned possession requiring purchasers to obtain a tax stamp, they couldn’t purchase without providing details about the amount and location of their cannabis purchase. Essentially, stamp purchasers incriminated themselves in illegal activity.
The future of medical cannabis is a hot topic for debate among industry professionals. Hypotheses include:
- The medical cannabis industry will disaggregate and evolve.
- Medical cannabis will remain but gain advantages over adult-use cannabis.
- Medical cannabis will disappear with the introduction of adult use (recreational).
Leveraging Assets and Best Practices
My hypothesis is a fourth and a combination of hypothesis 1 and 2: First, industry will evolve into three lanes: wellness; adult use and medical cannabis. Second, medical cannabis will thrive and revenues will exceed those of the other two lanes but not without the inclusion of pharma and that will assuredly happen. Leveraging the best practices and knowledge assets of the existing cannabis industry, technology, traditional healthcare with those of the pharmaceutical industry in the development and application of phytocannabinoids (the chemical compounds found in the cannabis plant, e.g. CBD and THC) with the gold standard of evidence-based medicine for clinical study, there will be new effective plant-based drug formulations and new drug delivery systems.
The Prospect for Revenue Will Drive the End Prohibition
The pharmaceutical industry will be a big player in the global end of federal prohibition. There’s tremendous economic opportunity to drive it into the space. In the US, medical cannabis annual sales are projected to grow to an estimated $13.1 billion by 2025 and that’s without pharma. The US pharmaceutical industry sales are projected to be $685.45 billion by 2023. A number of pharmaceutical companies already have new cannabinoid drug formulations in different stages of development. Two synthetic (man-made) cannabinoid drugs have been in the market for several years, Marinol and Cesamet – both are used to treat severe nausea and vomiting due to chemotherapy – and Sativex, used to treat MS-related symptoms.
Epidiolex, manufactured by UK-based GW Pharmaceuticals, is the first plant-based cannabinoid medication which was formulated to treat the severe seizure disorders. Epidiolex was recently declassified by the DEA and removed from the list of controlled substances which classifies drugs into five distinct categories based upon acceptable medical use and drug abuse potential. Cannabis is classified by the DEA as a Schedule 1 drug, offering no accepted medical use and high potential for drug abuse. Of note, Epidiolex does not contain THC which does have psychotropic effects, it’s a CBD oral solution. In the US, medical cannabis is now legal in 33 states, Washington, DC and Puerto Rico. Yet, it is federally illegal classified as a Class 1. Most countries apply similar standards to cannabis.
The cannabis industry is actually three industries in one and each is referred to as a vertical: agricultural/cultivation; manufacturing/processing and retail/dispensaries. Each vertical has its own set of complex rules and regulations. There’s tremendous value in knowing how to successfully navigate through them. The knowledge assets of the traditional cannabis industry are necessary, delivering time and cost savings to move into the future. Of course, these regulations will change when pharma becomes more involved but the experience is adaptable and valuable.
The Value of Legacy
The medical cannabis industry needs the pharmaceutical industry’s knowledge assets and best practices of standardized Good Manufacturing Practices (GMP – no standardized GMP exist in the cannabis industry), standardized research, randomized controlled trials and meta-analysis. Many pharmaceutical drug formulators have already transitioned to the cannabis industry bringing with them innovation that will transition clinical application away from combustion-based consumption, e.g. smoking and vaping, to more innovative formulations and delivery methods. These formulations will allow for a prescribed time of onset, duration of action, bioavailability, and dose consistency which all synthetic drugs have.
The traditional cannabis industry is founded upon a legacy of experience of best growing techniques and a more recent focus of strain development including the incorporation of terpenes (plant-based essential oils which have medicinal value). These strains have demonstrated success in treating a multitude of disease and disorder symptoms. Several medical cannabis companies across the globe have launched their own studies focused on patient experience and efficacy, delivering valuable insight and data for a faster track for new formulations.
Perhaps the most famous cannabis strain is Charlotte’s Web which was developed by seven brothers in Colorado and was originally known as Hippies Disappointment for its lack of psychotropic effects – a high CBD strain that doesn’t get the user “high”. The strain was renamed Charlotte’s Web for Charlotte Figgi who died in April 2020 at age 14, possibly due to complications of COVID 19. Charlotte’s parents successfully treated her severe form of a seizure disorder from a toddler with Charlotte’s Web. An entire new industry was built upon the success of Charlotte’s treatment.
Technologic innovation which impacts the ability to accurately dose medical cannabis with newer delivery methods to optimize the balance between therapeutic effects and psychoactive events does exist. They’re missing acceptance by conservative and traditional healthcare providers since they the gold standard FDA clinical trial because of Schedule 1 classification. Application from the pharmaceutical industry’s drug delivery methods and innovation will benefit the optimization and patient safety.
Universal application of blockchain technology in the cannabis industry does not yet exist. Blockchain delivers the ability to maintain strain purity with accurate analysis of data on strains and product formulations most effective for specific disease and disorder symptoms as well as the capture of dosage data and the origins of the product.
Lastly, an important quality of the legacy of upon which today’s cannabis industry is built includes an almost universal passion for safe and effective therapies that do not deliver unpleasant side effects common to most pharmaceutical products. The future is quite bright and exciting for medical cannabis. It gets there even faster with mindful integration of respective industry knowledge assets … and passion.
Jacquie Cohen Roth, MS is Founder/CEO of CannabizMD and Tea Pad. She’s in the 2021 cohort of MS in Medical Cannabis Science and Therapeutics at the University of Maryland, Baltimore School of Pharmacy.