This overview covers a wide range of cannabis topics, initially examining issues in dispensaries and self-administration, plus regulatory requirements for production of cannabis-based medicines, particularly the Food and Drug Administration “Botanical Guidance.” The remainder pertains to various cannabis controversies that certainly require closer examination if the scientific, consumer, and governmental stakeholders are ever to reach consensus on safety issues, specifically: whether botanical cannabis displays herbal synergy of its components, pharmacokinetics of cannabis and dose titration, whether cannabis medicines produce cyclo-oxygenase inhibition, cannabis-drug interactions, and cytochrome P450 issues, whether cannabis randomized clinical trials are properly blinded, combatting the placebo effect in those trials via new approaches, the drug abuse liability (DAL) of cannabis-based medicines and their regulatory scheduling, their effects on cognitive function and psychiatric sequelae, immunological effects, cannabis and driving safety, youth usage, issues related to cannabis smoking and vaporization, cannabis concentrates and vape-pens, and laboratory analysis for contamination with bacteria and heavy metals. doi: 10.1016/j.jpain.20 Pub Med Abstract | Cross Ref Full Text | Google Scholar Press, C.
The answer is clear, inasmuch as it has already commenced. The first preparation to fulfill these criteria, currently in 27 nations around the globe, is nabiximols (US Adopted name, also known as Sativex), an oromucosal spray produced from whole cannabis extracts whose effects begin in 15–40 min, allowing a therapeutic window for control of symptoms without intoxication. In reality, patients are not seeking altered states from their medicine, but rather relief of pain or other complaints. Short of a biochemical analysis by a certified laboratory employing verified phytocannabinoids standards, the cannabis consumer can have no real idea of the composition or consistency of the product that they purchase. “Strain names” are eminently malleable, and are as simple to alter as writing a new label to change one to match the most desirable chemovar du jour. doi: 10.1097/010000125688.05091.8f Pub Med Abstract | Cross Ref Full Text | Google Scholar Notcutt, W., Langford, R., Davies, P., Ratcliffe, S., and Potts, R. A placebo-controlled, parallel-group, randomized withdrawal study of subjects with symptoms of spasticity due to multiple sclerosis who are receiving long-term Sativex(R) (nabiximols). Garden variety cannabis as bought on the street cannot meet these criteria nor gain regulatory approval in most nations of the world. The Cannabis sativa versus Cannabis indica debate: an interview with Ethan Russo, MD.