Looking to Colorado for answers about cannabis

Cannabis: Last in a three-part series

Cannabis has been legal medically in Colorado since 2000 and recreationally since 2013. During this time, a booming industry has sprung up, complete with hundreds of dispensaries, tourism packages that lure visitors to the state, and more than $70 million worth of sales in medical and recreational cannabis reported for the month of March, according to the latest figures from the Colorado Department of Revenue.

Judgment aside, Colorado might have some answers about cannabis—especially its effects and properties—as legalization spreads and pharmacists become more drawn into the conversation.

This article is last in a three-part Pharmacy Today series examining the role of pharmacists around cannabis. Although marijuana is the more commonly known term, the proper scientific term, cannabis, is being used in this series.

A closer look

“Being Colorado, we are recognized as having some experience that we can share educationally about the patient use of marijuana, whether personal or medical,” Kari Franson, PharmD, PhD, Associate Dean for Professional Education at the University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, told Today.

Colorado is not allowed to perform cannabis research—that responsibility has only been given to the University of Mississippi, which has the only federally funded cannabis program in the country.

But Colorado can monitor and perform observational studies on different strains and components of cannabis. Cannabidiol (CBD) has been of interest because of its unique pharmacology, according to Franson. CBD is a nonpsychoactive cannabinoid that is believed to reduce the psychoactive effects of tetrhydrocannabinol (THC) and may hold promise for many serious conditions, such as central nervous system disorders, posttraumatic stress disorder, and epilepsy.

Colorado growers developed a high-CBD, low-THC cannabis oil called Charlotte’s Web, used to treat epilepsy.

“Now drug companies are looking at this and trying to go through [the] FDA process with it,” said Franson.

Similarly, local start-ups are looking to isolate and provide consistent dosage forms for recreational use of cannabis to determine which cannabinoids could be marketed for a specific experience—“relaxing” or “fun,” for instance.

“We can talk about 60 different cannabinoids, but when we start isolating things and giving super doses, that could lead to toxicity,” said Franson.

From a pharmacist’s perspective, understanding the risks is important. One example is knowing the difference between inhaled and ingested cannabis, which have dramatic pharmacokinetic differences, according to Franson, who was also part of the public safety and education task force on Gov. John Hickenlooper’s implementation task force to legalize recreational use of cannabis.

A recent study in the New England Journal of Medicine found that greater availability of cannabis, especially in edible products that have high intrapatient variability, increased the risk for young children. Since retail sales of cannabis began in 2014, the Rocky Mountain Poison and Drug Center has received more than 70% more calls related to cannabis exposure than it did in 2013.

Educating pharmacists

Samuel Johnson, PharmD, BCPS, FCCP, CPS, President-elect of the Colorado Pharmacists Society (CPS), told Today that CPS doesn’t take an official position on recreational or medical use of cannabis, but it monitors the legislation. Johnson said there’s high demand for continuing education on the topic.

Franson agrees. “We get calls to our continuing education office from all over the country asking about it,” she said.

Pharmacists also want to know about legal ramifications. Gina Moore, PharmD, MBA, Assistant Dean for Clinical and Professional Affairs at the University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, teaches an entire legal course on cannabis.

Colorado law does not permit pharmacists to dispense cannabis medicinally or recreationally. In addition, Moore said they tell student pharmacists they shouldn’t use cannabis just because it’s legal in the state.

“My advice is that this is still a Schedule I drug federally, so why would you spend the time and money to go through pharmacy school while this is still a gray area,” Moore told Today.