JAMA Psychiatry. Published online May 3, 2023. doi:10.1001/jamapsychiatry.2023.0731
Abstract: Currently, only 4 cannabis products are approved for medicinal use. However, cannabis and cannabis products are widely promoted as therapeutic agents, placing potential burdens on physicians and other clinicians to recommend them, in the absence of sufficient clinical evidence, as treatments. The main aim of this Viewpoint is to communicate that it is important that practitioners, particularly addiction physicians, be educated about harmful and beneficial effects of cannabis and related products before making therapeutic recommendations. (Source: JAMA Psychiatry https://jamanetwork.com/journals/jamapsychiatry/article-abstract/2804266 )
(The imperative of thorough clinical trials is need before cannabis can be called a ‘medicine’)
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The Viewpoint article by Potenza, Bunt and Khalsa 1 is an important call that cannabis be held to similar regulatory standards as all other drugs notwithstanding the special status which has been granted to it by the combined leverage of heavy advertising campaigns and ballot box fiat.We concur with the many concerns cited by the authors. We wish also to underscore the implications of the cited cautions for cannabis use by pregnant women. This is because cannabinoid genotoxicity has been well described since at least 1969 2. Not only have numerous birth defects been linked with prenatal cannabis exposure in animals 2 but also in large multidecadal studies in both USA and Europe 3,4. Moreover it has been convincingly shown that cannabinoid genotoxicity extends well beyond teratogenicity and includes carcinogenesis 5,6 and epigenetic and syndromic organismal aging 7-9.Combined with the seriously disordered brain development mentioned by the authors now linked to numerous mental disorders and even the exponentiating autism epidemic 10, it is hard for us to imagine a more serious multifaceted public health disaster than a community wide escalation of neurotoxicity, teratogenicity, carcinogenicity and aging driven by cannabinoids. Indeed the implications of the sponsorship of such widespread and serious problems at the whole of community level are literally mind boggling and to our knowledge have not been subject to serious public health modelling. Given that the cannabis industry remains in positive growth phase it is important that leading public health institutions conduct such robust modelling including econometric studies so that communities can be well informed about the now well-defined risks of increasing cannabinoid genotoxic exposure. To fail to do so is to risk repeating the well-known mistakes of the 1950’s in relation to tobacco, an error which should be otherwise completely avoidable.The implication of cannabinoid epigenotoxicity by many studies 3-10 clearly indicates that not only are the present exposed populations at risk but also that several generations to come may also be deleteriously affected. This important multigenerational component also needs to be factored into more advanced and comprehensive public health models.References
1. Potenza MN, Bunt G, Khalsa JH. Addiction Medicine Physicians and Medicinal Cannabinoids. JAMA Psychiatry. 2023;doi:10.1001/jamapsychiatry.2023.0731
2. Geber WF, Schramm LC. Teratogenicity of marihuana extract as influenced by plant origin and seasonal variation. Arch Int Pharmacodyn Ther. Jan 1969;177(1):224-30.
3. Reece A.S., Hulse G.K. Effects of Cannabis on Congenital Limb Anomalies in 14 European Nations: A Geospatiotemporal and Causal Inferential Study. Environmental Epigenetics. 2022;8(1):1-34.
4. Reece AS, Hulse GK. Geotemporospatial and causal inference epidemiological analysis of US survey and overview of cannabis, cannabidiol and cannabinoid genotoxicity in relation to congenital anomalies 2001–2015. BMC Pediatrics. 2022/01/19 2022;22(1):47-124. doi:10.1186/s12887-021-02996-3
5. Reece A.S., Hulse G.K. Epidemiological Overview of Multidimensional Chromosomal and Genome Toxicity of Cannabis Exposure in Congenital Anomalies and Cancer Development Scientific Reports. 2021/07/06 2021;11(1):13892-13912. doi:10.10389/s41598-021-93411-5
6. Reece A.S., Hulse G.K. Geotemporospatial and Causal Inferential Epidemiological Overview and Survey of USA Cannabis, Cannabidiol and Cannabinoid Genotoxicity Expressed in Cancer Incidence 2003–2017: Part 1 – Continuous Bivariate
