A University of Colorado Cancer Center study presented at the American Society for Clinical Oncology (ASCO) Annual Meeting 2019 shows that while 73 percent of surveyed oncology providers believe that medical marijuana provides benefits for cancer patients, only 46 percent are comfortable recommending it. Major concerns included uncertain dosing, limited knowledge of available products and where to get them, and possible interactions with other medications.

 

“I think in some cases we’re missing out on providing a useful tool. Providers think it has benefit, but aren’t comfortable recommending it,” says Ashley E. Glode, PharmD, assistant professor at the Skaggs School of Pharmacy and Pharmaceutical Sciences, and the study’s first author.

Survey respondents included 48 specialized oncologists, 47 physicians, 53 registered nurses, 17 pharmacists, and 7 “other” oncology providers. Seventy-nine percent reported that educational programs both during training and as continuing medical education courses could increase their comfort level with medical marijuana prescribing. Interestingly, 68 percent of providers reported receiving information about medical marijuana from their patients – the next most common sources of information were news media (accessed by 55 percent of providers), and other providers (53 percent).

“We asked and most providers didn’t train in a state where medical marijuana was legal. We need to adapt our healthcare education to include this, and also offer trainings on medical marijuana to current providers,” Glode says.

Providers also reported legal and regulatory concerns, especially providers working in academic medical centers who expressed uncertainty whether recommending medical marijuana could jeopardize federal funding (marijuana remains a U.S. Drug Enforcement Agency Schedule 1 drug). Providers felt as if additional clinical data describing the effectiveness of medical marijuana and endorsed guidelines describing the conditions and situations in which it should be used would increase their comfort in prescribing.

“Still, the biggest issue that providers saw is the lack of certainty in dosing,” Glode says. “The issue is it’s not regulated – a dispensary might say a product has this much THC and this much CBD, but no one is testing that for sure. Limited data suggest that patients should start low and slow, no more than 10mg of THC in a dose, but we don’t know that’s what patients are really getting. Then from a consumption perspective, inhalation and smoking is the least preferred due to possible damage to the lung. So many doctors recommend edibles, oils, and tinctures, but we still don’t have good data comparing dosage across these forms.”

Glode and study colleagues including Stephen Leong, MD, hope to expand the survey to gather a more nationally representative sample.

“Knowledge is an issue,” Glode says. “If we could do a better job educating our healthcare providers, it might be used more often and potentially more safely.”

Article by University of Colorado.

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The Transportation Security Administration (TSA) updated its policy on cannabis over the Memorial Day weekend, changing the medical marijuana section of its “What Can I Bring?” webpage from reading “no” to “yes” (with “special instructions”).

Specifically, the agency is clarifying that hemp-derived CBD products may now be carried on planes under certain circumstances.

Previously, TSA made no distinction between marijuana and hemp-derived preparations and warned on its website that cannabis products cannot be taken as carry-on items or in checked bags. But since the 2018 Farm Bill, that’s no longer the case.

Now the agency’s webpage specifies that possession of “certain” cannabis products are illegal under federal law, and TSA agents are required to report suspected violations such as possession of “certain” products to law enforcement.

It’s not clear how the agency plans to enforce the new policy, unless it intends to train agents to test CBD preparations for the presence of THC and maintain a database of products that are approved by the Food and Drug Administration.

A TSA spokesperson told Marijuana Moment in an email that the policy change was spurred by FDA’s approval of a cannabis-derived anti-seizure medication, Epidiolex.

“TSA was made aware of an FDA-approved drug that contains CBD oil for children who experience seizures from pediatric epilepsy,” the spokesperson wrote. “To avoid confusion as to whether families can travel with this drug, TSA immediately updated TSA.gov once we became aware of the issue.”

But FDA approved the CBD prescription drug nearly a year ago—calling into question the notion that TSA acted “immediately.”

And the representative was not immediately able to comment on part of the TSA website update that now references the broader legalization of hemp-derived CBD under the Farm Bill, which was enacted in December.

The rest of the TSA page on cannabis mostly retains language from the earlier version. The agency’s efforts are “focused on security and are designed to detect potential threats to aviation and passengers,” it says, so it doesn’t use resources to seek out illicit drugs.

However, “if any illegal substance is discovered during security screening, TSA will refer the matter to a law enforcement officer.”

TSA has gone back-and-forth on its marijuana policy as more states opt to legalize the plant for medical or adult use. In April 2017, the agency took advocates by surprise after it updated the medical marijuana section of the “What Can I Bring?” page to include a green “yes,” indicating that medical cannabis was permitted in carry ons or checked bags.

“TSA security officers do not search for marijuana or other drugs,” the page said at the time. “In the event a substance that appears to be marijuana is observed during security screening, TSA will refer the matter to a law enforcement officer.”

But shortly after the page started attracting press attention, TSA temporarily removed the medical cannabis section and tweeted that a “mistake was made in the database.”

The agency later posted an updated version of the page, which specified that marijuana was not in fact allowed on planes.

“Whether or not marijuana is considered legal under local laws is not relevant to TSA screening because TSA is governed by federal law,” TSA wrote. “Federal law provides no basis to treat medical marijuana any differently than non-medical marijuana.”

But with the legalization of industrial hemp and its derivatives, multiple federal agencies are now revisiting their policies to clarify what is and isn’t allowed.

Both the FDA and the USDA are in the process of developing broader regulatory guidelines for hemp and its derivatives, with the FDA set to hold a public hearing on the issue this Friday, May 31st, 2019.

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