Here are key takeaways from an episode of Kentucky Health discussing medical use of cannabis. Medicinal cannabis will become legal in the commonwealth on Jan. 1, 2025. Host Dr. Wayne Tuckson speaks with Dr. Shanna Babalonis, PhD, an associate professor in the Department of Behavioral Science and Center on Drug and Alcohol Research at the University of Kentucky College of Medicine and director of the UK Cannabis Center.
1) Research into medical uses for cannabis has ramped up in recent years, and some findings are promising. Dr. Babalonis says that for most of the 20th century, studies into the medical properties of the cannabis plant (or marijuana as more commonly called) were sparse due to its status as a Schedule 1 controlled substance. In August 2023, the Department of Health and Human Services recommended that cannabis/marijuana be reclassified as a less strictly controlled Schedule 3 substance.
In Kentucky, the UK Cannabis Center was established via an appropriation from the General Assembly in order to conduct high-quality research and clinical trials. “To really figure out problems that affect people in Kentucky – can cannabis help those people in those conditions, and what are the risks and benefits,” Babalonis says.
The UK Cannabis Center’s research focus is established by its board of directors, and focuses on potential treatments for cancer, metabolic disorders such as diabetes, and opioid use disorder, each of which affects tens of thousands of Kentuckians. In all three of these areas, preliminary research into the efficacy of cannabis as a treatment option is promising, Babalonis explains.
“For us, we’re looking very carefully, with controlled doses, in a very scientific way with double-blind placebo-controlled trials, for all of those conditions,” she says.
To use cancer as an example, Babalonis says her team at UK is conducting trials that aim to determine a more scientific and precise estimate of cannabis dose levels for cancer patients. “Our trial will look at three active doses and placebo to see which is the best dose for the general cancer population,” she explains, “and within those three active doses we’re also testing, what is the highest tolerated dose that someone could take? The whole goal of (this) study is to start to look at dosing. That is something that science has so little knowledge about.”
Babalonis says that there are dozens of cannabis compounds that will need to be researched in order to determine their medical effects, if any. Furthermore, studies will also need to be conducted into how cannabis is metabolized through different products – inhaling smoke or vapor vs. eating a marijuana brownie or gummy, for example.
2) Cannabis use is now legal in many states due to changes in social attitudes, even as scientific evidence about its medical efficacy is largely absent. As noted above, many state legislatures have enacted laws allowing patients to use cannabis, outpacing scientific knowledge that’s been hindered due to the drug’s Schedule 1 classification. Despite this restriction, Babalonis says that many states have been able to legalize cannabis either for medicinal use or recreational use, which has led to a growing number of people taking a drug that is still very much a mystery in a medicinal sense.
“Ahead of the trials that the FDA would use to typically approve a drug, we have seen medical cannabis (adopted) in roughly three-quarters of the United States now, it’s permissible,” Babalonis says. “Now we have this situation where cannabis is available in almost every state, it’s available to a large population of patients, but the studies aren’t there to back it up. If the studies were there to back it up, we’d have FDA approval for many different conditions, many different indications. But we’re not there yet.”
Babalonis forecasts more widespread legalization of marijuana for recreational use, noting that it has been proven to be far less dangerous than other Schedule 1 substances such as heroin. She anticipates that this trend toward legalization will enable the scientific community to conduct more intensive research studies such as the ones ongoing at the UK Cannabis Center.
“I’m hopeful that with loosening regulations, we can try to move forward cannabis medicine and make it a legitimate medicine if it’s warranted, if we do find out that it works for certain conditions,” Babalonis says.
3) Since cannabis research is still very much in a preliminary stage, medical providers should be cautious in their recommendations to patients. Babalonis says that many patients may be frustrated with the current lack of information about what diseases cannabis can help treat and what dose levels are appropriate, and that’s understandable.
But physicians should still take a cautious approach, she believes. Uncertainty is to be expected when drug research is in its initial phases, and she says the situation will improve greatly once more studies are conducted, findings are made, and regulations are established for medicinal cannabis.
“My hope is that, as the science progresses, as scientists and physicians can start to understand dosing, start to understand side effects, and start to understand therapeutic effects, we can move it through the channels that we trust, which is the FDA process,” Babalonis says.
“And so clinical trials are conducted, double blind placebo controlled trials like we talked about, and the FDA can rigorously review those, and then we’re using a product that’s safe, that’s sterile, ideally non-smoked and could be manufactured with good practices and would be safe for people to take – and then it would appear in pharmacies, and physicians could write prescriptions for it,” she adds.
