The DEA Categorization of Marijuana as a Schedule I Substance Prevents Safe and Effective
Research on its Potential Medical and Therapeutic Properties
Abstract
The categorization of marijuana as a Schedule 1 substance
creates a barrier when it comes to researching the potential
medical benefits. With the current data available, is there
sufficient evidence that medical marijuana is a resource for pain
management? Should the research show therapeutic potential,
this is a direct contradiction to the categorization of marijuana as
a Schedule 1 substance. The type of research used within the
study of marijuana’s effects on pain control are both qualitative
and quantitative. Numerical and statistical analysis support
marijuana as a mechanism of pain reduction. Each systematic
review addresses the anomaly of marijuana as a Schedule 1
substance stating that for more conclusive results more studies
would be necessary. In conclusion cannabis, being a Schedule 1
substance, creates a barrier from legal and financial and to
finding results of the efficiency of cannabis with different medical
conditions.
History of Cannabis as Medicine
The first record of cannabis being used as medicine dates back
nearly 5000 years, when Chinese physicians found it useful in the
treatment of malaria, constipation, rheumatic pains and as an
analgesic in child birth. More recently in 1839 a European
physician published observations of cannabis's properties as a
muscle relaxant, anti-convulsant, antiemetic, and analgesic. Based
on these observations use spread widely and cannabis was listed
in the US Dispensatory in 1845. It was readily available for over
100 years in the UK but due to rising concerns over the
psychotropic effects it was removed from the the US
Pharmacopeia in 1941. In 1997 the White House office of National
Drug Control asked the Institute of Medicine to conduct a review to
assess the benefits and health risks of marijuana.
Currently, in the United States, 23 states and the District of
Columbia have in some manner legalized medical marijuana. It
still, however, remains illegal on a federal level.
(Jensen, Chen, Furnish, Wallace, p. 1, 2015)
Cannabinoids and Receptors
There are three types of cannabinoid compounds:
•Phytocannabinoids; derived from cannabis plants
•Endocannabinoids; endogenous compounds
•Synthetic cannabinoids
The primary cannabinoids found within the cannabis plant include
delta-9-tetrahydrocannabinol (THC), cannabidiol (CBD), and
cannabinol (CBN). THC is the primary psychoactive compound,
resulting is the scheduling of this substance. CBD is the second
most abundant compound in the plant and is minimally
psychoactive.
The two primary cannabinoid receptors are CB1 and CB2. They
are subtypes of G proteins and have complex signaling pathways.
Coupled negatively with adenylate cyclase, resulting in the
inhibition of cAMP, and positively to mitogen active protein kinase.
CB1 are in abundance in the brain and a variety of peripheral
tissues, the current believe in that CB1 receptors function in the
CNS to maintain homeostasis by inhibiting excessive neuronal
excitation and activity. CB2 receptors are predominantly expressed
in the immune and hematopoietic systems. (Jensen, Chen,
Furnish, Wallace, p. 2, 2015)
TEMPLATE DESIGN © 2008
www.PosterPresentations.com
Cedar Coleman, Sallie Davis, Dane Woodward
Westminster College School of Nursing
The Problem Summary and Analysis
Medical cannabis: considerations for the anesthesiologist and
The categorization by the DEA of marijuana as a Schedule pain physician
1 substance prevents safe and effective research on its Despite being categorized as a schedule 1 substance, which, in
part, states it has “no currently accepted medical use”, Beaulieu,
potential medical and therapeutic properties. Boulanger, Desroches, and Clark (2016) found that more attention
is brought to the potential therapeutic benefits of marijuana as
Question cannabinoid pharmacology advances. In their review, Beaulieu,
Boulanger, Desroches, and Clark (2016) found that depending on
Does the existing literature provide sufficient evidence to the type of pain being experienced, cannabis has differing
effects. In regards to acute pain they stated, “ A variety of
recommend medical marijuana for patients based on its compounds were used in these acute pain studies, including
potential therapeutic properties for pain management? marijuana, cannabis extracts, THC, nabilone, dronabinol, and
levonantradol. These cannabinoids are not very effective in
alleviating acute pain. This conclusion is based on studies
Methodology conducted in the postoperative setting (five studies) and in human
volunteers (13 studies) between 1977 and 2008”.
Findings of cannabinoids on chronic pain show an analgesic
To give readers some background on the issue, effect. The review showed “a modest analgesic effect in patients
we provided information on the history, with chronic non-cancer-related ” as well as “ significant
physiology, and legality of cannabis. Using improvements in sleep, and there were no serious adverse events
reported”. Also significant was the effect cannabis had on opioid
Westminster’s Library website, we searched the analgesics. When patients on opioid medication inhaled vaporized
Medline database for peer-reviewed articles cannabis it “augmented the analgesic effects of opioids without
from academic journals. We wrote our significantly altering plasma opioid levels. This combination may
allow opioid treatment at lower doses with fewer side
summaries and analyses trying to answer the effects”. This is especially significant considering the topic of
question of marijuana managing pain and to opioid abuse is currently a major public health concern in this
address the problem of DEA scheduling. Medical marijuana and pain management
country.
Leslie Mendoza Temple addresses medical marijuana and pain
management. Background information was provided on behalf of gaining an
Legality and Schedule Categorization of Substances understanding of the synopsis of medical marijuana. In the mid 1800’s,
medical marijuana was recommended for various ways of medical
The Controlled Substances Act (CSA), which is management. This era came to a close when marijuana was outlawed
following the anti-alcohol legislation. The Controlled Substance act made
part of the Drug Abuse Prevention and Control
Act of 1970, is the legal cornerstone of
any type of possession of cannabis illegal. This law was made without
consideration of the benefits marijuana has on different medical conditions.
In the article, Temple states, “cannabinoids may have an opioid-sparing
prosecution and the government’s war on drugs. effect, providing analgesia while allowing the patient to use a lower dose of
The US Drug Enforcement Administration (DEA) opioids for overall pain control.” (Mendoza, p. 348, 2016)Both cannabinoids
and opioids share similar effects, but in combination cannabinoids allow for
has divided these substances into five categories,
use of smaller doses of opioids. Giving the patient cannabis in addition to
termed “schedules” based on the following: opioids enhances the effect of pain reduction. In a randomized, double-blind,
placebo study, patients with advanced cancer were given a low dose,
•1) Potential for abuse medium dose, or high dose of vaporized cannabis. The participants in the
•2) Safety low and medium dose category expressed a decrease in sleep disturbance
and pain compared to the placebo. Within 18 studies, 15 of the studies
•3) Addictive potential including 766 participants showed a telling amount of relief of pain with the
•4) Legitimate medical applications use of cannabinoids. Cannabis has many uses. Some of the common
conditions cannabis is used to treat are cancer, nausea related conditions,
multiple sclerosis, glaucoma and HIV/AIDS. (Mendoza, p. 349, 2016)
Schedule 1 (I): Defined by the federal Efficacy and adverse effects of medical marijuana for chronic
government as having no currently accepted noncancer pain
medical use and high potential for abuse. They In yet another systematic review, Deshpande, Mailis-Gagnon,
Zoheiry, and Lakha found that there was significant pain reduction
are the most dangerous with potentially severe in all studies involving delta-9-THC. Their review also showed no
psychological or physical dependence. evidence of serious adverse effects, and only short-term
psychoactive and neuropsychological effects. It was stated,
however, that the amount of THC patients were exposed to was
Schedule Examples significantly lower than what is available in the marketplace. Also,
1 (I) Heroin, Lysergic acid diethylamide (LSD), Marijuana,
three of the six studies showed a clinically significant outcome,
Methylenedioxymethamphetamine (ecstasy)
defined as a reduction in pain by two points on a ten point pain
2 (II) Cocaine, Methamphetamine, Methadone, Hydromorphone (Dilaudid),
Meperidine (Demerol), Oxycodone, Fentanyl, Adderall, Ritalin scale. Just as with every other review, the authors state that “The
3 (III) Vicodin, Tylenol with codeine, Ketamine, Anabolic steroids, testosterone generalizability of the results in CNCP is limited by factors such
as the quality of studies, small sample sizes, very short duration,
4 (IV) Xanax, Soma, Darvon, Darvocet, Valium, Ativan, Talwin, Ambien and dose and scheduling variability” as well as “the longer-term
consequences of medical marijuana still remain unknown ”
5 (V) Cough preparations with less than 200 mg of codeine or per 100 mL
Robitussin AC, Lomotil, Motofen, Lyrica, Parepectolin (Deshpande, Mailis-Gagnon, Zoheiry, and Lakha, p. 381,
2015). This is important because, “without additional evidence
United States Drug Enforcement Administration Drug Scheduling and a clear understanding as to the indications for and dosing of
cannabis, there remains a risk that clinicians might unwittingly
Accessed Dec. 1, 2017 Retrieved from
propagate similar issues that we now face with opioids in the
https://www.dea.gov/druginfo/ds.shtml management of CNCP” (Deshpande, et al., p. 381, 2015).
Summary and Analysis
Medical Marijuana and Chronic Pain: a Review of Basic
Science and Clinical Evidence
In this systematic review Jensen, Chen, Furnish, and Wallace of
the Center for Pain Medicine at UCSD examine the positive and
negative effects of marijuana for use in pain management. Stated
in the abstract of this particular article is the overarching issue;
“Gold standard clinical trials are limited..” (Jensen, Chen, Furnish,
Wallace, p. 1, 2015) This directly relates to the question regarding
the problem at hand; why is marijuana categorized as a Schedule I
substance? In terms of the pathophysiology, the CB1 cannabinoid
receptor functions on a level of the central nervous system and
maintains homeostasis by inhibition of excessive neuronal
excitation. In a review of studies done on patients with cancer pain
promising results were found. Cancer patient studies provide a
unique opportunity for data collection as this area provides highest
concentration of human trials. One study found that pain relief was
improved at 15 and 20 mg of THC doses, side effects were
sedation and confusion. Another study illustrated that a synthetic
analog of THC, benzopyranoperidine, was found to be superior
than the placebo for a method of pain management. Patients with
neuropathic pain have also been subjects of study, a randomized
double-blind, placebo-controlled trial in 66 patients with MS and
central pain found nabiximols to be superior to placebo in pain
reduction and sleep disturbance. In conclusion this review found
that there are promising results for patients experiencing chronic,
cancer, and neuropathic pain but due to limitations in, high-quality,
placebo-controlled clinical studies more definitive conclusions
cannot be reached. This theme is found within all of the articles
summarized in this poster. Were the DEA to re-categorize
marijuana as even a Schedule II, defining it as having some
potential for therapeutic use, there would likely be more research
done on its potential.
Nursing Implications
A huge aspect of nursing care is pain management, healing is best facilitated
when patient pain is under control. Many pain medications have concerning side
effects that the nurse must monitor for, i.e., respiratory depression with an
overdose of an opioid, medical marijuana is no exception as many trial patients
experienced some degree of sedation, however when compared to death by
respiratory depression sedation is of minimal concern. Should the DEA re-
categorize, the nurse will be tasked with the job of patient education; this will be
of great importance as the marijuana plant has been assigned morality and has
been historically stigmatized negatively within our society. For the nurse,
providers, and policymakers to effectively implement medical marijuana in care
plans and the therapeutic regime more research is necessary, but unfortunately
limited by current scheduling. Nurses are held to a certain standard as
individuals, members of the healthcare field, and as members of the community, it
is the job of nurses to present as a united front with the task of patient care.
Should the scheduling be changed and the research become conclusive as
beneficial nurses will be looked to in all aspects of their lives to explain the risks
and benefits of medical marijuana just as they do with all other prescription drugs.
Conclusion
The article cited within the research found therapeutic benefits in regards to pain
management. Each article also concluded that more research was needed and
important topics such as long-term risks can not be addressed. This can be directly
attributed to the DEA scheduling of marijuana. Additional review may lead to the
opportunity of using cannabis for even more medical purposes.
References
Temple, L. M. (2016). Medical marijuana and pain management. Disease-A-Month: DM, 62(9), 346-352. doi:10.1016/j.disamonth.2016.05.014
Jensen, B., Chen, J., Furnish, T., & Wallace, M. (2015). Medical Marijuana and Chronic Pain: a Review of Basic Science and Clinical Evidence. Current Pain And Headache Reports, 19(10), 50.
doi:10.1007/s11916-015-0524-x
Deshpande, A., Mailis-Gagnon, A., Zoheiry, N., & Lakha, S. F. (2015). Efficacy and adverse effects of medical marijuana for chronic noncancer pain: Systematic review of randomized controlled
trials. Canadian Family Physician Medecin De Famille Canadien, 61(8), e372-e381.
Shi, Y. (2017). Medical marijuana policies and hospitalizations related to marijuana and opioid pain reliever. Drug And Alcohol Dependence, 173144-150. doi:10.1016/j.drugalcdep.2017.01.006
Beaulieu, P., Boulanger, A., Desroches, J., & Clark, A. J. (2016). Medical cannabis: considerations for the anesthesiologist and pain physician. Canadian Journal Of Anaesthesia = Journal
Canadien D'anesthesie, 63(5), 608-624. doi:10.1007/s12630-016-0598-x
Kim, P. S., & Fishman, M. A. (2017). Cannabis for Pain and Headaches: Primer. Current Pain And Headache Reports, 21(4), 19. doi:10.1007/s11916-017-0619-
United States Drug Enforcement Administration Drug Scheduling Accessed Dec. 1, 2017 Retrieved from https://www.dea.gov/druginfo/ds.shtml