An Ounce of Hope

Proposition 64 passed in November, legalizing recreational marijuana use in California. When it goes into full effect Jan. 1, 2018, UCLA students and anyone 21 or older will be able to buy marijuana from stores with retail licenses. Currently, patients have used medical marijuana to treat a variety of conditions, including nausea, pain and seizures.

The Daily Bruin spoke to physicians and parents familiar with using medical marijuana as treatment for illness and investigated the potential for research into the plant, despite federal policy barriers.

The Pot Potential

Rashmi Mullur and Ravi Aysola watched helplessly as their infant son seized again in their arms.

“There were days where I would hold my son and have that seizure happen 50 times in a row, incessantly, for hours and hours during the day,” said Aysola, a pulmonologist and sleep doctor at UCLA. “All I could do as a father – as a physician – was to hold him and say, ‘I’m here.’”

Just four and a half months after he was born with a congenital brain malformation, Siddharth Aysola began contracting infantile spasms. Mullur and Aysola immediately drove their son to the Ronald Reagan UCLA Medical Center emergency room. Within a week, Sidd started to experience seizures.

Mullur and Aysola spend their weekends looking after and playing with their children at home. (Jintak Han/Assistant Photo editor)

“I think one of the only good things about being a physician and a special needs parent is that you are more aware of what to look for,” said Mullur, an endocrinologist at UCLA. “So when we were warned that seizures could develop, we knew to look for it – there was no long delay.”

At the inaugural 2017 UCLA cannabis symposium April 20, Mullur and Aysola shared their son’s story with about 250 in-house audience members and 10,000 viewers online.

Mullur said after her son went on steroids and other medications, the seizures disappeared for a little while. However, by the time of Sidd’s first birthday, the epilepsy had returned.

His debilitating condition forced him to live his life in a wheelchair, unable to walk or speak.

Mullur tried a number of medications and nonpharmacological alternative therapies, such as ketogenic dieting, acupuncture, chiropractic care and cranial sacral therapy, but her son did not respond well to any of these treatments. He remained unaware and aloof, even at his preschool graduation.

“I started to look up maybe if there were herbal supplements that might help with seizures,” Mullur said. “I didn’t find a lot of anything until we found medical cannabis.”

In summer 2013, she discovered medical cannabis through a small Facebook group called Pediatric Cannabis Therapy.

“There were some parents in there who had kids with brain cancers and they really needed something for pain control,” Mullur said. “There were some parents in there who had kids with epilepsy.”

Soon afterward, Sidd started on medical cannabis at the recommendation of a local physician, Mullur said.

Within six months, Sidd went from being an inattentive and unresponsive boy in a wheelchair, to being cognitively aware and alert, walking with a walker and holding his head up.

Sidd plays with his father, Ravi Aysola, pulmonologist and sleep doctor at UCLA. Before he started medical cannabis treatment, Sidd had been heavily sedated by his antiepileptic medication. (Jintak Han/Assistant Photo editor)

“I don’t know if we could have seen that without medical cannabis,” Mullur said.

She said the biggest difficulty she and her husband have encountered has been obtaining access to the most effective type of cannabis for their child.

“You can’t find it in a dispensary, if you’re looking for a high quality CBD product,” she said.

The entourage effect, or chemical combination of terpenes that gives each strain of cannabis its unique flavor, has made a big difference for Sidd. These terpenes, or oils in the CBD Sidd consumes, are largely responsible for the therapeutic effects of the medication on her son, Mullur said.

However, many people are still biased because they do not understand the therapeutic effects cannabis can bring to people like Sidd. Aysola said he feels grateful that he lives in a time and academic community that values his son, seeks to help him and is willing to take risks.

Aysola added that as an intensive care unit physician, he often treats patients with epilepsy professionally. But he also has to go home and do the same thing for his son. He said he hopes that by sharing his experiences as a physician and a father, more people can be aware of the potential value cannabis has as a medication and overcome their biases.

“I know we are held to the highest standard at this institution, which is why I’m thankful that we are here,” he said. “I hope that what we do here helps establish the legitimacy of a scientific approach that will lead to a rational application of thoughtful, compassionate medicine.”

The Cannabis Campaign

For Siddharth Aysola, Christian and Connor Kramme and many other patients, cannabis, although ineffectively studied, provides relief and treatment for their illnesses.

They attribute the efficacy of the medication specifically to a compound called cannabidiol, or CBD, one of many cannabinoids in the cannabis plant.

Unlike THC, CBD is nonpsychoactive and acts on the body by binding allosterically to cannabinoid receptors, which are mostly located in the central nervous system. This changes the ability of THC and other endocannabinoids to bind to the same receptor and activates the endocannabinoid system to release neurotransmitters that induce therapeutic effects.

CBD has been widely recognized as having the potential to treat conditions like arthritis, multiple sclerosis, schizophrenia, epilepsy and other neurological disorders. Currently, researchers in the United States are investigating its possible anti-cancer properties.

However, despite the passage of Proposition 64, marijuana is listed as a Schedule I drug by the federal government. As a Schedule I drug, it is deemed as having a high potential for abuse and lacking safety for use under medical supervision, according to the Drug Enforcement Administration. Because of this, research into CBD has been scarce without sufficient funding.

Nevertheless, many researchers at UCLA claim that research into cannabis holds much potential for clinical treatment. One student is even changing the course of his career in an effort to help researchers investigate how these exogenous cannabinoids can affect the human body.

A Hazy Horizon

Jeff Chen takes off his white coat after a long day at the hospital – and may never put it back on again.

Chen, a graduating medical student and business administration student, is forgoing residency after medical school to pursue a business career in cannabis. He recently created the UCLA Cannabinoid Affinity Group, which aims to help researchers obtain funding for cannabis projects and eventually build a world-class cannabis research center on campus.

“As human beings and scientists, we want the truth,” he said. “I can have a broader impact at the systems level if I can help accelerate the research and understanding (of cannabis).”

Chen hopes to establish a world-class cannabis research center on campus. (Jintak Han/Assistant Photo editor)

The UCLA Cannabinoid Affinity Group is comprised of a growing list of UCLA physicians and researchers who support research into cannabis to discover its potential risks and benefits as a treatment for illnesses.

“There is a hypothesis that cannabis could represent a cheap, safe and effective alternative to many currently used drugs,” Chen said. “(We) desperately need to study its therapeutic effects.”

Previously, Chen took a leave of absence from his dual studies to create a nonprofit organization, the National Institute of Cannabinoid Research, which aimed to share information about marijuana’s health benefits and harms with the public.

All drugs have harms, but he said he thinks cannabis’ toxicities in particular have been overstated.

Chen said after watching Sanjay Gupta’s CNN documentary “Weed,” which highlighted the health benefits of marijuana, he was inspired to study its medicinal effects. He talked to many patients who had benefited from this treatment and decided he could use his passion for medicine and entrepreneurship to impact health care at a larger level.

“Our health care system is in a crisis,” he said. “We are spending more and getting less. If cannabis can reverse that, it deserves a serious conversation that we haven’t had.”

Before Californians passed Proposition 64, about 1 million people in the state had legal access to cannabis. Now, 27 million Californians have legal access.

With the addition of Measure M, which passed in March to allow the city to regulate the marijuana industry in Los Angeles, Chen predicts there will be an accelerated need to research the drug because of increased consumption.

Chen said Proposition 64 has increased legal access to marijuana by 2,700 percent in California. Cannabis is estimated to bring in $50 billion in legal annual sale by 2026. (Jintak Han/Assistant Photo editor)

However, many barriers still hinder the advancement of cannabis research.

Since cannabis is still labeled as a Schedule I drug by the federal government, researchers must obtain a Schedule I drug license and approval from the Drug Enforcement Administration to conduct studies, Chen said. In addition, he said the University of Mississippi has monopolized all federal cannabis cultivation available for research, which makes it difficult for other universities to conduct studies.

“We need laws and policies guided by research and not by archaic politics,” he said. “Since 1970, I’d like to say things have changed, but unfortunately nothing has.”

In August, however, the DEA announced an end to the monopoly and will begin allowing public universities to grow cannabis for research purposes, which Chen said he thinks is a step in the right direction.

Chen added he thinks UCLA has the infrastructure needed to grow cannabis on campus, noting the success of the medicinal herb garden next to the Ronald Reagan UCLA Medical Center, the greenhouses on Tiverton Avenue and the botanical gardens across the street from the School of Dentistry.

“California is now the largest legal cannabis market on the planet, (and) cannabis is the fastest growing industry in America,” Chen said. “If we don’t catch up, we’re going to be left behind as other countries jump on (medical marijuana research).”

Starting in 2018, California will provide $10 million in state funding to study the impacts of cannabis legalization. It will be one of the largest population health experiments because of this unprecedented access, Chen said.

With large-scale crowdsourcing, private and corporate philanthropy, and support from research foundations, Chen said he is hopeful a center focused on cannabis research on campus will become a reality.

“It’s definitely with a heavy heart that I’m delaying residency,” he said. “Eleven years (after I first decided to pursue medicine), I’m finally a doctor but not practicing. But we’re all working toward the same goal: improving people’s lives – that’s why it’s not a waste of 11 years.”

Contact Chiu at [email protected] or tweet @k4456395.

Past the Joint

Marijuana’s popularity keeps growing, but the sprouting knowledge surrounding its dangers and benefits are nipped at the bud by a lack of research funding.

Daily Bruin Opinion columnist Jasmine Aquino explores the hazy future of cannabis research and Proposition 64’s effects on its obstacles, arguing that there are innovate resources for these efforts. The Daily Bruin spoke to physicians and parents familiar with using medical marijuana as treatment for illness and investigated the potential for research into the plant, despite federal policy barriers.

Drugs are everywhere.

Maybe it’s the alcohol in a glass of wine over dinner. Or the caffeine in a cup of coffee to start the day. Or maybe it’s the marijuana in a joint or edible.

For the record, I do not drink coffee or dark soda. But to me, smoking a joint is a lot like having a glass of wine to relax at the end of the day.

There are various reasons to enjoy it. The American Medical Association reported that marijuana may help people manage pain, control appetite and mood, and manage other chronic symptoms.

(Kelly Brennan/Daily Bruin senior staff)

But many people, including myself, use marijuana without full knowledge of its effect. Anyone turning 21 or over by 2018 can obtain and continue to consume marijuana in California. And one in eight people smoke cannabis in the United States, so it should not come as a surprise that you may interact with at least one person a day who has used marijuana.

The current marijuana scene is very much like a major health experiment: People are using it without complete knowledge of what it does – almost as if testing its effects. That’s an image Jeff Chen, co-director of the UCLA Cannabinoid Affinity Group and a medical student at UCLA’s David Geffen School of Medicine, agrees with.

The question is no longer about whether marijuana prohibition should continue, but about what its effects are on the millions of people using it each day. And this presents a stark reality: We need to give more funding for academic initiatives aiming to studying marijuana’s effects.

There are couple of things we already know about marijuana. Cannabis, like all drugs, affects the brain. Its tetrahydrocannabinol, or THC, induces sedation, increases heart rate, lowers blood pressure and stimulates the appetite.

But this is about as much as any report or researcher will tell you. The reason: We just don’t know enough.

For example, at the inaugural 2017 UCLA Cannabis Research Symposium on April 20 – the coincidence was clearly too good to pass over – more than 12 researchers, professors and doctors presented their limited knowledge on the physiological and psychological effects of cannabis. However, many of their presentations mentioned legal limitations, such as restricted federal funding, inhibiting their research.

Audience members listen to limited research findings from around the country about the effects of cannabis on the brain and body. A question-and-answer section followed each presentation. (Jintak Han/Assistant Photo editor)

The most common answer in the Q&A portion following every presentation was a flattering, “We don’t know.”

The fact that the federal government still considers marijuana illegal slows or prevents much of the research. Marijuana’s Schedule I drug classification under the 1970 Controlled Substances Act restricts academic research of marijuana. In order to study its effects, approval from three different agencies are required: the Food and Drug Administration, the National Institute on Drug Abuse and the Drug Enforcement Administration. Approval from each can take years to receive.

This means that few researchers are able to obtain and renew the needed Schedule I drug license and DEA approval to perform research.

But the barriers do not stop there.

Researchers are required to follow special storage and handling policies. And the only cannabis used for federally funded research, like that at UCLA, comes from a farm at the University of Mississippi. The strains can be different from the ones grown in California, so the regulations don't allow for an accurate representation of what our population is actually consuming.

Clearly, any research on this cannabis comes with limitations on its external validity, especially considering many people also consume marijuana in edible or wax form. But different forms can have vastly different effects.

“The industry has more knowledge than academia in certain domains,” Chen said.

Jeff Chen, a graduating medical and business administration student, co-hosted the cannabis research symposium as co-director of the UCLA Cannabinoid Affinity Group. (Jintak Han/Assistant Photo editor)

Chen is right. Sixty-two percent of the U.S. population lives with medical-marijuana-only laws and 21 percent lives with legalized medical and recreational marijuana. But while the market is is growing and catering to consumers’ demands, health care providers and policymakers are not able to make their own informative decisions. Furthermore, research on the herb moves slowly while the cannabis industry keeps creating products without fully understanding their effects.

For example, Timothy Fong, a doctor at the David Geffen School of Medicine and a UCLA associate clinical professor of psychiatry, said at his recent “Addiction and Cannabis” presentation that the percentage of THC in “street” cannabis has increased from single digit percentages in the 1970s to double digit percentages today. In other words, the drug continues to change because of consumer demand, but the research is lagging.

I’ve seen this change myself as a medical marijuana patient. I have seen wax, edibles, topicals and even syrups with over 70 percent THC concentrate – a surprisingly high amount for a drug with effects that are not well understood.

But there are very clear and potential avenues for research that can start now for an academia dry of funds.

The cannabis industry keeps good track of its patients, considering its members need to meticulously work with a federally illegal drug. Dispensaries can facilitate participant recruitment and data collection for research purposes.

Dispersing this information would not come as an inconvenience to the industry. Since dispensaries already keep track of patient records, it would be easy to transfer data for the possibility of bettering their product.

And since federal funding is a current obstacle for researchers given the federal government's stance, private or corporate philanthropic donations may instead be able to provide for the resources researchers need to carry out investigation. For example, Barry and Joy Lambert donated $33.7 million to Sydney University for cannabis research. Given cannabis’ general popularity in today’s culture, crowdsourcing this funding should not be difficult.

Additionally, now that California is the largest legal cannabis market in the world, the estimated $50 billion in legal annual sale of marijuana will provide for some funds to aid research. People, including investors, are bound to jump on the growing industry – potential donors, in other words.

Cannabis – and its millions of smokers, for that matter – is not going anywhere. The potential benefits marijuana presents are themselves enough reason to pursue more understanding of the drug. Giving cannabis researches the necessary funding just might help the drug answer that higher calling.

Contact Aquino at [email protected] or tweet @aquinojasmineee.