Dr Mikael Sodergren, Chief Medical Officer at Curaleaf International, discusses the challenges of developing and researching medical cannabis products and how the European medical cannabis ecosystem is well placed to overcome them.
In many European countries physicians can now prescribe medical cannabis for an array of chronic health conditions, including chronic pain, mental health disorders and neurological conditions.1,2 Yet the pace of adoption in Europe has notably lagged countries such as Canada, Australia and the US.1 In many countries, medical cannabis is only utilised as a therapy when licensed medications have proven ineffective.1,2 Moreover, except for countries such as Czechia, Denmark and Germany, the cost of these medications is borne by the patient, rather than national insurance or healthcare systems.1 Europe, however, is well placed to become a leader in driving the clinical translation of medications that display significant promise in laboratory-based studies.3
With established drug development pathways, we are accustomed to a rigid structure of translation from bench to bedside. While this is essential in the interrogation of novel compounds for which we know very little about their efficacy and safety, it is also true that some biomedical research is highly wasteful. It is estimated that only one in 10 drugs that enter Phase I trials are subsequently licensed by the US Food and Drug Administration (FDA).4 This is in addition to numerous compounds that are developed but either fail to demonstrate sufficient promise or pose potential health risks, meaning they never even enter Phase I trials.
Cannabis complications
There are notable complexities to researching medical cannabis using a linear approach to clinical translation.5 There is vast heterogeneity of products available to study owing to there being over 140 cannabinoids identified from the cannabis plant to date.5 These are each present at varying concentrations depending on underlying plant genetics and growing conditions.5 In addition, there is a vast range of flavonoids, terpenoids, phytols and other compounds present at lower concentrations within the cannabis flower.5 These compounds have been shown in pre-clinical studies to have an array of potential effects on the immune, nervous, cardiovascular, respiratory and endocrine systems.3 Moreover, some studies have suggested that co-administration of these compounds can modulate the effects of one another at a receptor level.6
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