The cannabis industry, in its quest to sell ever more products, is working hard to confuse the national conversation with parallels to over-the-counter medication (OTC) and supplements.  Not only are these two product categories really quite different and the way they are sold has a huge impact on people’s health, but neither are a good model for cannabis products.  Let us take a look at the realities of these products and the ways in which this discussion is not appropriate for cannabis sales. 

What Are Over-The-Counter Medications?

First, let’s define some terms.  Over-the-counter medications like Advil or Robitussin are medicines that are comprised of one or more active ingredients that were previously controlled by prescription.  Advil is Ibuprofen at a reduced dose compared to the prescription strength.  Robitussin comes in many formulas but contains decongestants and cough suppressants that were available by prescription.  These medications were made available to the general public for use without immediate physician supervision because they were felt to be safe enough for short-term use.  Part of that safety comes from the general public understanding of these medications after years of use by prescription only.  It also comes from a reduced dose and from clear instructions on the package.  

Even with all of that safety background, over-the-counter medications cause harm and illness for some people, largely when the instructions are not followed and medical care is not sought.  For example, not only is Advil reduced in dose but comes with instructions to use it only in very specific ways – and only for a certain number of days at a time.  It clearly warns that if symptoms persist, people should see their doctor.  Sadly, a large number of people (but a very small percentage of the population) develop life-threatening bleeding ulcers from using Ibuprofen too much. 

Cannabis Doesn’t Fit Over-The-Counter Medication

Cannabis medications, at least at present, do not come with any such warnings, dose recommendations, or really any other information.  Sources of information about cannabinoid medications include the salespeople at the store or articles on the internet – neither of which are reliable and trustworthy.  The only good source of information is your doctor, many of whom are still learning about cannabinoid medications. 

What Are Supplements?

Supplements, like Black Cohosh, Ginko, or vitamin K, are very different from over-the-counter medications.  These are substances that have never been medications, never properly evaluated by the FDA, and have no proven benefit in general use.  In fact, the United States Preventive Services Taskforce reviews medications and supplements on a regular basis and has published for decades that supplements are at best useless and in some cases actually harmful.  Their recommendation is that supplements not be used unless a physician finds a measurable deficiency.  Nonetheless, the supplement industry sells 16 billion dollars per year in the US.

As you can see, cannabis-based medications don’t adequately fit into either category.  There is no standardization, decades of clinical experience, adequate general wisdom, nor appropriate warnings as we would expect for OTC meds.  Further, cannabis is typically used long-term, not briefly as OTC medications are. 

FDA Has Approved Cannabinoids

On the other hand, cannabinoids have been evaluated by the FDA and found to be safe and effective when used as a medication (even though cannabis, itself, is not an approved medication), proving not only that they work, but are only safe and effective when used under a specific regimen.  This makes them inappropriate for the unproven, unmonitored supplement category.  

If cannabis is, in fact, a worthwhile medication, why is the industry trying so hard to sell it under various less well-regulated channels?  You guessed it!  Money.  

I’ve encountered this time and again:  companies come to me wanting to prove that their cannabis product is the best but, when confronted with the cost of that process, they balk.  Why would you spend $100M to prove that your product is safe and effective if you can simply go to market with it and say what you like?  You wouldn’t.  

This is what the FDA does in the pharmaceutical arena.  Surely FDA and drug companies are worthy of some criticism, but overall the role of the FDA is to ensure that drug companies do the homework to prove safety and efficacy.  This costs a ton of money, but without spending that money, pharma companies cannot take their product to market.  While this does drive up the cost of medications, and that is another serious problem in need of a solution, at least the drugs are proven. 

The Only Way Forward for Cannabis and Cannabinoids

In the end, the only approach to the regulation of cannabis that makes sense to me as a physician is to have two paths:  recreational and medical/pharmaceutical.  The recreational path should sell lower potency products for the purpose of having fun – like alcohol – but without any pretext of medical use.  These products should still be regulated for safety.  On the medical side, products need to transition from unproven to proven, which will require a regulatory mandate.  Companies should be given a transitional period of time in which to either complete the research process to become a pharmaceutical company with pharmaceutical products or move into the recreational-only market. 

Consult with a Qualified Boston Medical Marijuana Expert Today

Those considering using THC, CBD, or any type of medicine found in cannabis to help manage their condition should consider speaking to a trained medical expert who is knowledgeable about using cannabis therapeutically. Massachusetts medical marijuana doctor Jordan Tishler, M.D. sits on the faculty of Harvard Medical School and has years of experience helping patients treat pain and other ailments using cannabis. He and the team at InhaleMD stand ready to assist patients in determining whether medical marijuana is right for them.

For more information, or to set up a virtual consultation with the team at InhaleMD, call us at (617) 477-8886 today.

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