November 22, 2024

By: Toni Shears

 

Cannabis is America’s most popular self-prescribed herbal medicine. There is substantial evidence that it’s an effective treatment for chronic pain. It can reduce nausea in chemotherapy and spasticity in multiple sclerosis.  

 

There is moderate evidence that it can help with sleep issues. It has long been used for increasing appetite and reducing weight loss in AIDS and cancer patients, and it may help with anxiety, post-traumatic stress, and the symptoms of Tourette’s syndrome. 

 

And yet, officially under US drug laws, it’s a Schedule 1 controlled substance with no accepted medical use. 

 

That status may be changing. Federal agencies are considering the possible reclassification of marijuana. Meanwhile, across the nation, drug laws have loosened to legalize the medical or recreational use of cannabis and its active ingredient, cannabidiol (CBD). Millions of Americans are now self-medicating with gummies and edibles—and that means pharmacists and other health care providers need to understand what cannabis does and how it can aid patients.

 

Gus Rosania, Professor of Pharmaceutical Sciences, has created a Medical Cannabis course (Pharm Sci. 420) to prepare the next generation of pharmacists to understand CBD and other cannabis-derived products. Offered for the first time in the 2025 winter term, the course will cover medical, pharmaceutical, social, political, legal, and public health perspectives. Rosania has invited physicians, scientists, lawyers, growers, and others to share their relevant experiences. 

 

The curriculum includes the biology and genomics of the cannabis plant and the pharmacology and dosing of cannabinoids. It explores the industrial extraction of CBD and the importance of standards in hemp-derived products.

 

At its root, however, “the course is actually an old-fashioned pharmacognosy class – a dinosaur-era term for studying the active principles of herbs — so students can understand how this ancient medicine works,” says Rosania. 

 

The Path to Rescheduling

Cannabis was widely available in pharmacies until 1937, when it was prohibited for commercial—not medical—reasons, Rosania explains. It could still be used legally as a medicine until 1971, when the Controlled Substance Act classified it as a Schedule 1 drug. This law set out strict scientific criteria a drug must meet to qualify for medical use. 

 

Science has moved on; today, 50 years later, “we have about 50 FDA-approved cell and gene therapies that do not conform to these strict criteria for drugs,” Rosania says, yet cannabis remains restricted. 

 

Two cannabis-based drugs are approved for medical use. First, Marinol (dronabinol) is a synthetic compound that is chemically identical to Delta-9 THC, the psychoactive component that is in the cannabis plants. Marinol has been extensively tested and is effective as an antinausea and weight gain agent in patients with AIDS. 

 

Second, Epidiolex, a purified, crystalized form of plant-based CBD, was approved in 2018 to treat children with an extreme form of seizure disorder.  Children with the condition had such frequent seizures that they couldn’t eat and would die without treatment. CBD calmed the seizures enough for children to eat and ultimately outgrow the disease. 

 

Pursuing the Unanswered Questions

Meanwhile, there are plenty of unanswered questions about how cannabis works in the body. Rosania and his research team have been pursuing them for years. The general focus of his research studies the distribution of drugs within the body. Side effects arise when drugs impact cells and tissues beyond the intended target, but we don’t always know where a drug is going besides the target. Rosania investigates the off-target impacts to better understand — and potentially control — those side effects. 

 

Safety and efficacy trials for the first two FDA-approved drugs based on synthetic or cannabis showed extensive bioaccumulation in the body. That makes CBD an attractive candidate for studying drug distribution. 

 

“Because these compounds are lipophilic, or fat loving, people think it accumulates in fatty tissue,” Rosania says. “The brain has the highest share of fat in the body. When CBD is used to treat epilepsy, it interacts with neuronal signaling in the brain. It would be natural to think it’s probably accumulating in the brain, but nobody has really looked at that. We don’t know where CBD is going and how it’s accumulating.”

 

“We would like to know the answers to these questions so we can understand what the drug is doing and how it’s working,” Rosania said. “If you use it for a long time for a chronic condition, you want to know if it will bioaccumulate and where. So that’s what got us into CBD.” 

 

Rosania and his team are pioneering and deploying high-tech tools and techniques to trace drugs at microscopic levels in cells throughout the body. His interest in studying cannabis is driven by empathy for the patients who can be helped.

 

He speaks with obvious passion about cases where patients have gone through chemotherapy, experienced the brutal side effects and reached a point where there is little chance of any further clinical improvement.

 

“And then these patients may take cannabis oil, and for one reason or another, they begin to improve,” he says.

 

“When you interact with people and hear their stories, you want to work with them. You want to give them answers and relief,” Rosania says. “I care for patients. I probably have an exaggerated sense of empathy, but for me, empathy is my foremost guiding factor in terms of what I decide to study.” 

 

Learning how CBD may accumulate in the body with long-term use will help scientists develop safe, standardized, targeted forms for specific use. Helping future pharmacists and clinical teams understand the uses and potential benefits of cannabis will bring relief for many conditions. In these ways, Rosania and his team are paving the path for this “ancient herb” to safely benefit patients.