Drexel professor Stephen Lankenau and his team of researchers have received the first National Institutes of Health grant for a large public health study, which started July 1, of medical marijuana use in young adults.
Lankenau, an associate professor in the Department of Community Health and Prevention, said he hopes that the study will provide data to help compare and contrast medical marijuana patients and nonmedical marijuana users.
The R01 grant awarded to the study, titled “Medical Marijuana, Emerging Adults & Community: Connecting Health and Policy,” will provide $3.3 million in funds over the course of the next five years. Lankenau will recruit 380 individuals from Los Angeles who are between the ages of 18 and 26, including both medical marijuana patients and nonmedical marijuana users, according to a Drexel news release.
Following an initial interview upon recruitment, participants will be tracked over the course of three more interviews. While the study will generate a sizable amount of quantitative data, Lankenau said he also plans to interview a subsample of 40 nonmedical marijuana users to gain insight into the qualitative aspects of the participants’ drug use. The data collected in Los Angeles will be relayed back to Drexel, where Lankenau and a group of graduate students will work on data analysis.
This study emerged as a line of investigation into the medical marijuana phenomenon that has swept the nation over the past few decades. The movement began in California, where Proposition 215 was passed in 1996, legalizing the use of medical marijuana. Today, 18 states and the District of Columbia have approved similar legislation, and still other states, including Pennsylvania, have legislation pending.
Lankenau explained that the National Institute of Drug Abuse (NIDA), a division of the NIH, has decided to investigate this topic further in order to better inform the public on the benefits and risks of marijuana use.
In 2010 NIDA put out a request for proposals for studies on medical marijuana. Lankenau responded and was granted the funds to carry out his study proposal.
This was a landmark event in the study of marijuana use because “[NIDA] wasn’t soliciting or encouraging investigators to do research on medical marijuana up until that point,” Lankenau said.
Lankenau developed an interest in the issue of marijuana use and misuse in a previous study that he had conducted in Los Angeles.
“We found some things that intrigued us and formed the basis of some hypotheses,” Lankenau said.
The current study that Lankenau leads is centered on similar foundational hypotheses, which he hopes will be proven or disproven by studying the two groups over the next five years.
“We’re going to be able to compare those two groups in a variety of different ways,” he said.
The first hypothesis is termed the legitimate patient hypothesis. Medical marijuana is typically prescribed to patients with chronic pains, anxiety, AIDS or any other health condition that cannot be treated pharmaceutically.
Opponents of marijuana use argue that patients could be faking ailments, so the study also hopes to compare the medical histories of the two groups in order to assess the legitimacy of the patients’ claims. Furthermore, the study aims to provide information on the use of marijuana as a medicine.
The interviews conducted in LA, headed by co-investigator Ellen Iverson, will ask patients about the efficacy of marijuana in relieving their symptoms in order to evaluate its properties as a medicine. Lankenau also predicts that the results of this study will offer insight into the gateway hypothesis.
Marijuana has been termed a gateway drug, suggesting that it leads users to harder drugs such as cocaine or heroin. Lankenau stated that this assumption is not necessarily true.
“The problem is that most people who use marijuana don’t usually transition into other drugs, but those who use harder drugs have also used marijuana,” Lankenau said. To tackle this debate, the study will compare the effects of marijuana use on each group.
Another hypothesis seeks to answer the question of the protective effect of legalized marijuana. Previous research in the Netherlands, where recreational marijuana use is legal, has suggested that the legalization of marijuana may convert the drug from a stepping stone to a stepping-off point.
“Once these individuals had regular access to marijuana, they stepped off harder drug use, so it served as a kind of a protective factor,” Lankenau said.
Applying this concept to his study, Lankenau said he hopes to determine if medical marijuana patients have lower rates of harder drug use compared to recreational marijuana users.
Though the participants enter the study as either medical marijuana patients or nonmedical marijuana users, Lankenau is interested in looking into the crossovers between the groups and determining the impetus behind the switch from legal to illegal use and vice versa.
For example, the closure of a local dispensary may prompt an individual with a physician’s recommendation to start buying his or her supply on the black market out of convenience. He said he hopes that data describing these conversions will help develop a natural history of marijuana use among both medical marijuana patients and nonmedical users.
The data collected in the course of the study may also lead to findings that were not previously anticipated.
“In the course of learning about one group, you learn about another,” Lankenau explained.
Historically, the subject of marijuana use has been a hotbed of controversy. Though there are studies that suggest marijuana has medicinal properties, the drug is currently classified as a Schedule I drug, meaning that it has no significant medical uses and presents a high risk of addiction. This categorization puts marijuana in the same class of drugs as ecstasy, LSD and heroin.
While physicians cannot prescribe Schedule I drugs, they can write a recommendation for patients that present a particular array of health problems. Patients likely to receive a recommendation for medical marijuana typically present issues that cannot be satisfied by normal pharmaceutical options. These recommendations are then taken to a dispensary, which serves as a legal storefront for marijuana.
California has more dispensaries than any other state that has approved the use of medical marijuana.
“Whereas the entire state of New Jersey has one dispensary, the city of Los Angeles alone has 500 to 1,000,” Lankenau said.
He added that the profusion of dispensaries has made it hard to gauge the number of existing dispensaries accurately. California put the issue out to voters, and Amendment D recently passed by a statewide referendum. The bill hopes to bring the number of dispensaries from the thousands to the hundreds, but Lankenau cautioned that this new legislation would be difficult to enforce.