HerbalEGram: Volume 10, Number 9, September 2013

Editor’s Note: We were keenly interested in Dr. Sanjay Gupta’s one-hour CNN special called WEED that aired in August. We asked Lindsay Stafford Mader, who covers medicinal cannabis and related issues at the American Botanical Council, to view the documentary, compose a report on its contents, and to offer a response, if warranted, regarding the factual accuracy of CNN’s information as well as to what extent the coverage was adequate. We present her critique below.

Having researched and written about medicinal cannabis (Cannabis sativa) for more than four years for the American Botanical Council and its journal HerbalGram, I watched CNN’s recent TV documentary WEED with a heavy dose of skepticism. While I am well aware of the plant’s promising medicinal properties, I did not fully expect Sanjay Gupta, MD, to “get it right.” Others in the medicinal cannabis community understandably expected much from WEED, considering the media hype leading up to its premier, which was stimulated by Dr. Gupta’s preceding and much-publicized editorial stating that he had reversed his position to be in favor of medicinal cannabis.

Dr. Gupta’s WEED documentary gave an interesting and often touching overview of the situation and left many viewers enlightened on how effective cannabis can be for treating conditions such as young Charlotte Figi’s Dravet Syndrome. Other sources and I agree that WEED, which admirably attempted to cover significant ground, was better than most everything else the mainstream media has produced on cannabis. Unfortunately, Dr. Gupta disappointed in many areas by failing to investigate important issues at the heart of the medicinal cannabis discussion and quietly perpetuating false details on cannabis to the Americans who have grown to trust his expertise. 

Filling in Gupta’s Gaps

In the beginning of WEED, Dr. Gupta skimmed over the history of cannabis in the United States, and noted that it became illegal in 1937 and is currently considered a Schedule I drug as “the government was saying it had no medicinal value and a high potential for abuse.”¹ For context, Dr. Gupta could have listed other substances classified as Schedule I, such as heroin and LSD.² To exemplify the inappropriateness of cannabis’s current scheduling, he additionally should have mentioned that the American Medical Association (AMA) has called for cannabis’s Schedule I status to be reviewed,³ and that the US government seemingly recognized cannabis as medicine in 2003, when scientists for the US Department of Health and Human Services (HHS) wrote in a patent abstract that cannabinoids are useful as antioxidants and neuroprotectants (patent no. 6630507).⁴  And that, in 2011, the US National Cancer Institute’s PDQ Complementary and Alternative Medicine (CAM) Editorial Board acknowledged medicinal uses of cannabis by publishing an online summary of cannabis and cannabinoids as CAM treatments for cancer patients.⁵

The rarity of these two conditions, however, could have alienated many viewers, considering the multitude of more common conditions that cannabis has been shown to help, such as cancer symptoms, glaucoma, multiple sclerosis, post-traumatic stress disorder, and more.⁶ Unfortunately, Dr. Gupta spoke with just two uncommon patients out of the many who are benefiting from cannabis through US state-based programs.

“He has these two bizarre conditions that may be benefited by CBD, not THC, and then in the last five minutes, he goes off to Israel and shows cancer patients benefiting,” said Donald Abrams, MD, chief of oncology at San Francisco General Hospital, professor of clinical medicine at the University of California at San Francisco (UCSF), and an integrative oncologist at the UCSF Osher Center for Integrative Medicine (oral communication, August 13, 2013). “You certainly don’t have to go to Israel to find cancer patients that benefit. That’s what I do and see all day long.”

Dr. Gupta noted that despite encouraging reports from families like the Figis, the Miami Children’s Hospital and American Society of Pediatrics still do not condone the usage of cannabis for epileptic treatment. But, again, that is not the whole story. It would have been equally as interesting and important to mention that AMA has recognized the medicinal potential of cannabis for certain conditions,³ and that the nonprofit Institute of Medicine concluded in 1999 that some patients can benefit from cannabis.⁶ Instead of giving an overview of the variety of conditions that can be improved with cannabis, and the corresponding government and NGO-issued reports on these usages, Dr. Gupta oversimplified the medicinal impact of cannabis by focusing on children with epilepsy.

Misleading Portrayal of Science

Upon hearing Dr. Gupta’s most erroneous statement that “marijuana is made up of two ingredients,”¹ I had concerns for the accuracy of his reporting on cannabis science and research. (Anybody with basic knowledge of cannabis science knows that, in fact, THC and CBD are just two of the more than 100 different cannabinoids and approximately 400 other chemicals in the plant.⁷) Indeed, Dr. Gupta made the most mistakes when discussing cannabis’s effects on the brain, particularly its effects on the child brain and on addiction. And when the subjects he interviewed made sweeping or inaccurate statements, he failed to follow-up with appropriate questions and investigation.

Dr. Gupta stated in the WEED documentary that there is a clear effect of marijuana on the young brain, although the evidence is anything but conclusive. Stacy Gruber, PhD — director of the Cognitive and Clinical Neuroimaging Core at McLean Hospital’s Brain Imaging Center — claimed that brain white matter is impaired and white matter highways are more disrupted in those who start smoking before age 16. But Dr. Gruber’s work has looked at the brains of a small number of heavy, chronic cannabis smokers — not the brains of patients using therapeutic dosages.

Dr. Gupta then went on to say, “Preliminary research shows that early onset smokers are slower at tasks, have lower IQs later in life, higher risk of strokes, and increased risk of psychotic disorders, and while these studies are inconclusive, some scientists are still concerned” because 35% of high school seniors have used cannabis and many fear “a generation of kids with damaged brains” as well as “a generation of marijuana addicts.”¹

Although he recognized that “studies are inconclusive,” Dr. Gupta then referred to this information as “the truth and the science” of a growing epidemic. In contrast, however, an expert peer reviewer of this article noted that these statements seem to have been largely based on animal research,⁸ that many studies on cannabis and white matter within the last 30 years have had flawed methodology,⁹ and that heavy recreational cannabis usage has more cognitive impact than measured and monitored therapeutic usage. Indeed, research has shown that “some cognitive deficits appear detectable at least seven days after heavy cannabis use but appear reversible and related to recent cannabis exposure rather than irreversible and related to cumulative lifetime use.”¹⁰ So, while adolescence is a very sensitive time for the brain, the notion of permanent cognitive impairment simply has not been substantiated.^8,10

Later, Dr. Gupta accurately stated that there have been zero cannabis overdoses, initially leading many to believe the widely held understanding that cannabis is safe. But he then interviewed Christian Thurstone, MD — a psychiatrist and director of one of Colorado’s largest youth substance-abuse treatment clinics — who told Dr. Gupta, “There is no longer any scientific debate that marijuana is not just psychologically addictive, but also physically addictive.”¹ Dr. Thurstone’s statement was an exaggeration at best, considering the very low risk for physical and psychic dependency on cannabis.¹¹ In fact, while many cannabis and addiction experts agree that psychological dependence is possible, physical dependence “is much less convincing on the basis of the published literature,” according to the book The Medicinal Uses of Cannabis and Cannabinoids (Pharmaceutical Press, 2004).¹²

Dr. Gupta did compare the lower risk of cannabis addiction with that of other drugs, citing a figure that 9% of marijuana users become addicted, while 23% of heroin users do, 17% of cocaine users, and 15% of alcohol users. But these numbers are misleading as they are based on a 1994 epidemiological study consisting of interviews with participants asked to gauge their self-description of dependence symptoms.¹³ A peer reviewer of this article similarly noted that the 9% rate was likely much too high as many individuals are in court-mandated cannabis-abuse treatment programs, and others who find it difficult to stop smoking are often using cannabis to self-treat an underlying condition, such as depression; thus, when the depression improves, so does the dependence on cannabis. Thankfully, this segment was somewhat balanced by a clip, although much too short, of psychopharmacologist and editor of The Pot Book (Park Street Press, 2010), Julie Holland, MD, clarifying that cannabis withdrawal is nowhere near as serious as withdrawal from alcohol dependence and is more about learning new behaviors.¹

As an additional disappointment, Dr. Gupta traveled some 5,000 miles to Israel to discuss human research and ignored all of the clinical studies on cannabis that have been carried out in the United States, conducted by researchers such as Dr. Abrams and Barth L. Wilsey, MD. The Center for Medicinal Cannabis Research (CMCR) in California, for example, completed 13 human studies on whole-plant cannabis, which found that the plant benefited conditions such as neuropathic pain, spasticity in multiple sclerosis, pain in HIV patients, and more.¹⁴

In fact, Dr. Gupta ignored the vast majority of human research on medicinal cannabis. According to a 2010 review of clinical studies, “In the period from 1975 to current, at least 110 controlled clinical studies have been published, assessing well over 6,100 patients suffering from a wide range of illnesses.”¹⁵ Dr. Gupta failed to mention, for example, the work that has been done in Canada, Austria, and in the United Kingdom, the majority of which has been led by GW Pharmaceuticals on its product Sativex^®, a cannabis whole plant extract oromucosal spray containing predominantly THC and CBD that has been approved as a medicine for multiple sclerosis spasticity in the United Kingdom, Spain, Germany, Denmark, the Czech Republic, Sweden, New Zealand, and Canada.¹⁶ (Sativex for cancer pain is currently in Phase III clinical trials in the United States.) Although WEED makes it seem as if the Stanley Brothers in Colorado were the first to produce high-CBD cannabis, GW has had similar material since 1998,¹⁷ and even they were not the first to create high-CBD strains.

Gupta’s Failure to Investigate Stalled Research in US

Although some human research has been conducted in the United States, all parties agree that more needs to be carried out, a point that was expressed throughout WEED. But what many Americans do not know is that there is an intricate federal roadblock preventing much of this research from happening. In WEED, Dr. Gupta visited the University of Mississippi to interview Mahmoud ElSohly, PhD, a research professor of pharmaceutical sciences, about the Marijuana Potency Project. But viewers would have been better served if Dr. Gupta also had discussed the contract between Ole Miss’s National Center for Natural Products Research (NCNPR) and the National Institute on Drug Abuse (NIDA) to produce cannabis for all research in the United States. Although NIDA puts the contract up for bid every five years, it has awarded this contract solely to Ole Miss since 1968. NCNPR is thus the only federally permitted source of cannabis, and before a cannabis researcher can proceed with a study, NIDA must first decide that it has sufficient cannabis available — a situation frequently referred to as a monopoly.¹⁸

Additionally, cannabis research proposals must receive scientific merit approval from the Public Health Service (PHS), although research protocols for no other controlled substance require PHS review.¹⁸ Oftentimes, cannabis studies — especially those that seek to produce prescription medicines — approved by the US Food and Drug Administration (FDA) and by relevant institutional review boards are then rejected by PHS or have difficulty in obtaining the material from NIDA. (As an alleged conflict of interest, Dr. ElSohly and NCNPR have a separate DEA permit to grow cannabis for producing the generic version of the synthetic THC-containing drug Marinol^®, which makes him the only person in the country who can legally grow marijuana for commercial purposes.)¹⁸

The documentary did feature Dr. Holland noting that, although FDA has approved many medicinal cannabis studies, NIDA has stonewalled therapeutic research. But the Director of NIDA — Nora Volkow, MD — later appeared, quickly dismissing this accurate assertion and claiming that they deal only with studies looking to investigate drug abuse. Although it is true that NIDA reviews studies that deal with drug abuse, it still has the power to reject any kind of cannabis research proposal based on supposed unavailability of NCNPR material. Instead of investigating the truth and the involvement of NIDA/PHS, Dr. Gupta took Dr. Volkow’s word at face value and chocked it up to “bureaucratic hoops that researchers simply don’t want to jump through.” To the contrary, researchers desperately want to study cannabis, and many have attempted to, but have become overwhelmingly frustrated with the NIDA/PHS process or they have been rejected. Although Dr. Gupta seemed to have touched very lightly on this subject in his online editorial,¹⁹ he failed to give it anything near adequate time and effort in his special report.

Impact

While many medicinal cannabis advocates were pleased with Dr. Gupta’s WEED documentary, others have expressed more satisfaction with his public apology and editorial, “Why I Changed my Mind on Weed,”¹⁹ which CNN published online just a few days before the documentary aired. As only a couple of weeks have passed since the documentary’s airing, its potential impact is uncertain.

Dr. Abrams noted that it probably will not have much of an impact on the average American, as the majority of the country already supports legalizing cannabis,²⁰ and it is the Obama Administration that needs to be persuaded. But when asked if the President (who several years ago was rumored to have selected Dr. Gupta as one of his top choices for US Surgeon General) had a response to Dr. Gupta’s essay, Deputy Press Secretary Josh Earnest said he hadn’t read it and couldn’t comment.²¹ A day later, Earnest told reporters that the President does not currently advocate a change in cannabis laws.

Nonetheless, Dr. Gupta’s prominence as one of the country’s most respected and well known physicians could be important for the medicinal cannabis movement.

“Dr. Gupta is very influential and perhaps his endorsement will lend moral strength to physicians who are often reluctant, even in medical states, to recommend [cannabis] to their patients,” said Mariann Wizard, who frequently writes about cannabis for ABC’s HerbClip publication. “That's really the most positive thing that I hope the documentary may achieve!”

Although these parties have not said what encouraged their recent decisions, New Jersey Governor Chris Christie, considered a potential Republican candidate for the 2016 Presidential election, issued a decision allowing cannabis prescriptions for children just several days after the documentary aired,²² and on August 26, US Senate Judiciary Chairman Patrick J. Leahy (D-VT) announced a Congressional hearing on the conflict between state and federal medical cannabis laws. In a breaking news press release, Steph Sherer, the executive director of patient organization Americans for Safe Access, described this as a “big deal” as it could “be a springboard for new legislation and a turning point for federal policy.”²³

More discussion of Dr. Gupta’s WEED documentary, including responses from some of those interviewed in WEED, is available at this Google Hangout YouTube video from Americans for Safe Access.