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11 Articles in this Series
Introduction
A PAINWeek 2019 preview with EVP Debra Weiner
Comparing Marijuana and Hemp
Fibromyalgia: What’s New in Diagnosis and Pain Management
Life Hacks to Teach Patients with Chronic Pain
Managing Pain (and Function) in Osteoarthritis: Are Patients and Physicians on the Same Page?
Marijuana: How to Proceed When Controlled Substances are Involved
Menopause Comes with More than Mood Swings - It Deserves its Place Among Chronic Pain Conditions
More APPs Are Coming to the Forefront of Pain Care
Motivational Interviewing and Its Extension into Pain Management
Revisiting Documentation
Side Chat: Modern Analgesic Trials

Comparing Marijuana and Hemp

with Stephen J. Ziegler, PhD, JD

Stephen J. Ziegler, PhD, JD, professor emeritus at Purdue University and a former Task Force Officer for the DEA, led a PAINWeek panel on hemp, stating up front that he is neither for nor against marijuana.  “A lot of information out there is inaccurate and often used incorrectly on purpose to avoid federal scrutiny or attention,” he said. Cannabis sativa L is the genus and consists of both the marijuana plant and the hemp plant. Both plants can contain the most well-known cannabinoids, THC and CBD but at different concentrations ; these compounds must be extracted from the plants, which he noted is not an easy process (eg, steam, alcohol, or butane, may be involved). Marijuana is largely grown for its female plant and the resin that exists in the bud. Hemp looks different (and much taller) in its later life cycle, especially when grown for fiber.

Historically, hemp has been lumped in with marijuana and, until December 2018, was illegal at the federal level. Relaxations on hemp crop production began with the 2014 US Farm Bill, which invited universities to grow the plant under strict research guidelines. The 2018 Farm Bill then removed hemp from the Controlled Substances Act (it had been placed in Schedule I since the 1970s, after being prohibited earlier under the 1937 Marijuana Tax Act), making it legal after nearly a century. US regulators and scientists are therefore still trying to distinguish it from the marijuana plant.

Hemp has more than 25,000 uses; its analgesic capabilities are still being explored. (Image: 123RF)

What we do know, said Dr. Ziegler, is that hemp has more than 25,000 uses—the seeds can be eaten, the plant can remediate toxic soil, and fiber from the leaves can create paper products, to name a few. And, the chemical compounds/derivatives found in hemp (and in marijuana) can have medical uses, such as easing chemotherapy-induced nausea—but the jury is still out on whether these products may benefit pain and neurological disorders specifically.

Technically speaking, “hemp” means that its THC level is specifically at or below 0.3%. If the product has a THC of even 0.35%, it is no longer considered hemp and becomes marijuana, according to Section 10113 of the 2018 Agricultural Improvement Act. Why 0.3%? It was an arbitrary decision recommended by botanists Small and Cronquist in 1976, shared Dr. Ziegler. “This threshold recommendation made its way into policy but may be a concern as there is no medical or systematic reason for this number outside of the botanical context.”

Hemp: In a Regulatory Crossroads

Surprisingly, added Dr. Ziegler, there has not been too much questioning in the community around fact-checking the 0.3% THC threshold. Both Congress and FDA seem to be going with it, despite the lack of scientific or other evidence for the claim. “More research is needed on this number as well as on the interplay between CBD and THC, label accuracy, dosing, and testing mechanisms,” said Dr. Ziegler. For instance, “Is hemp’s anecdotal data simply a placebo effect? This finding will be all about the derivatives, such as CBD.”

Meanwhile, “Regulators are facing a tidal wave with the legalization of hemp after such a long period of it being prohibited, leading to significant confusion around its use.” Even if CBD is proven to be safe in the long term, FDA is concerned about labeling, claims, and what’s really going into individual products. In December 2018, the agency issued a release stating that therapeutic claims made about cannabis products, hemp-derived or otherwise, needed

FDA approval for intended use before being introduced to the market.

This announcement by the FDA led to a series of cannabis seizures and arrests, many of which seemed unfounded noted Dr. Ziegler, and then in February 2019, Congress asked FDA for clear answers. Unfortunately, FDA Commissioner Scott Gottlieb, MD, resigned two weeks later. In June 2019, FDA put out another release on what the public needs to know about cannabis but, as of now, we are still waiting for more clear guidance.

 

For a closer look at hemp's cousin - the marijuana plant - see how Jennifer Bolen, JD, and Douglas Gourlay, MD, answer key clinical questions, including the use of marijuana with controlled substance prescriptions.

 

 

 

 

 

Next summary: Fibromyalgia: What’s New in Diagnosis and Pain Management
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