CRNA Professor and Student Collaborate on Medical Cannabis Presentation

As the prominence of medical marijuana continues to grow in the public eye, the ability to perform effective research on cannabis and cannabis extracts remains extremely difficult. Many barriers exist, and the gap continues to grow between the knowledge of cannabis and practical applications with scientific evidence to support its clinical use.

USF nurse anesthesia student Liz Rayburn and professor John Maye, PhD, hope to advance this discussion when they present “Exploring Cannabis and Cannabinoids as Integrative Strategies for Pain Management” at the Florida Association of Nurse Anesthetists conference in Orlando on October 5. The pair have framed their lecture around key points of interest to the nurse anesthesia community — the history of cannabis for medicinal purposes, political influences, and therapeutic benefits.

Rayburn and Maye see growing interest in medical cannabis within their community, but recognize that “a lot of people actually know very little about it,” Maye said. The regulations regarding research are strict and cumbersome, so the ability to conduct clinical studies can be difficult, Rayburn adds.

In 1970, the federal Controlled Substances Act classified cannabis as a Schedule 1 drug, meaning it holds “no medical use.” As a result, there are extensive regulations related to its procurement and utilization for research purposes.

According to Rayburn, even if a potential researcher does meet all the criteria to obtain permission from the needed governmental agencies, such as the National Institute on Drug Abuse (NIDA) or the Food and Drug Administration (FDA), those institutions then must inspect the researchers’ facilities. It must be proven that the site complies with a long list of requirements for safe handling of the product before it can be distributed.

There also exists a quality issue. Cannabis used for federally funded research is sourced from the University of Mississippi, the lone government-approved cannabis supplier for medical researchers.

“It is not considered to be high-quality cannabis,” said Rayburn. “It has sticks, stems, and nothing to do with what is actually on the market and being marketed as medical cannabis. They are not even remotely the same. The product has been frozen, often for years, so you do not know how efficacious the cannabinoids that remain actually are. So, you’re doing research with a really subpar product, and attempting to show that these results will correlate to how people are going to react to what is out on the market, which is not true at all.”

USF CRNA student Liz Rayburn

Rayburn worries that nurse anesthetists are falling behind in terms of understanding the current state of research related to the clinical application of medical cannabis. In some studies, cannabidiol, or CBD, is shown to reduce seizures, alleviate pain, and can be used to curb post-op nausea. Yet, some trials have also shown additional bleeding in some cases when cannabis is used, presenting potential perioperative-surgical complications.

Despite the potential benefits of cannabis and cannabinoids being well documented, researchers still do not have the volume of research to identify and isolate each cannabinoid compound to a specific clinical effect.

After the passage of the 2018 Farm Bill, which de-scheduled hemp as a controlled substance, common misconceptions remain about what the sweeping legislation changed in terms of CBD legality. CBD, the main constituent of hemp is also found in other cannabis species that are classified as “marijuana,” which is listed on the Controlled Substance Act. Furthermore, marijuana derivatives are still listed on the CSA as well. 

Because CBD is also a marijuana extract, it remains illegal as an ingredient in food, dietary supplements or animal food. No testing can determine if the CBD was isolated from hemp or from marijuana after the fact, Rayburn said. Therefore, CBD products currently being marketed are not always advertised in good faith, and their online sale resides in a legal gray area.  The ability to source both CBD and other cannabinoids from both marijuana and hemp also confuses the issue of legality for research purposes.

With research more accessible in countries like Canada, Australia and Israel, Rayburn says researchers from the U.S. often need to rely on findings coming from those regions to stay abreast of the latest research in the field.

Meanwhile, Rayburn and Maye will also look at the problem of perception toward cannabis in America. Prior to 1936, cannabis was considered a medicinal plant and listed in the U.S. Pharmacopeia, a medical guide for botanicals. That changed in the late-1930s with “Reefer Madness,” an anti-marijuana propaganda film that declared marijuana “the worst drug corrupting the youth of America.”

The film, followed by the categorization of the plant as illegal, contributed to a large portion of Americans only knowing a time where marijuana has had a negative connotation, Rayburn says. She estimates that the perception and classification of the drug has led to a large majority of studies concentrating on the negative impact related to abuse and addiction, skewing knowledge toward that idea rather than towards the efficacy or therapeutic effects of cannabis.

“Now you have multiple generations of people who have lived their entire lives through this time of (marijuana being illegal),” Rayburn said. “They’ve been lied to their entire lives, told this is a demonizing thing, it’s a schedule one drug, it is just like LSD, it is just like heroin. Now your young kid is coming and sitting here telling you, ‘No it’s not, it has medical benefits.’ Who do you believe?”

What remains is a need to break down the barrier of understanding, accompanied by well-designed research studies to back it up to a scientific community that needs those data points.

“We’re kind of going on faith here,” Rayburn added. “Someone has to give us a chance.”

She believes significant progress is being made on the issue, and thinks cannabis will be de-scheduled within 10 years. Until then, Rayburn and Maye each consider cannabis law the “Wild, wild west.”

Story by Alex Hooper, USF College of Nursing