The Future of Cannabis in Psychiatry

Mark Viner, MD, has extensive experience in schizophrenia, clozapine, psychopharmacology, and suicide research. His expertise also extends to cannabis medicine, as a member of the Clinical Society of Cannabis Clinicians and the International Alliance of Medicinal Cannabinoids. He advocates for a closer relationship between psychiatry and cannabis research to enhance understanding and therapeutic applications.

The history of modern synthetic cannabis research has seen significant challenges. Notably, the rimonabant disaster, involving a CB1 antagonist, led to suicide cases—an area Viner actively studies in psychiatry. Another significant setback was the BA 10-2474 fatty acid amide hydrolase inhibitor study, where 6 patients died during a phase 1 trial investigating an enzyme that interacts with endocannabinoids in the body. These events highlight the risks associated with synthetic cannabis compounds.

However, plant-based cannabis medications have shown promise. Epidiolex, a pure plant derivative produced by GW Pharmaceuticals (now owned by Jazz Pharmaceuticals), has gained FDA approval. In 2023, Epidiolex generated $845 million in revenue, underscoring the growing acceptance and commercial success of plant-based cannabis treatments.

The pharmaceutical cannabis market is expanding rapidly, with at least 13 major companies involved. Projections indicate that the market size will increase 200-fold over the next decade. This growth presents a unique opportunity for psychiatry to collaborate more closely with cannabis research to better understand its effects on mental health conditions.

Viner emphasizes the importance of integrating psychiatric research with cannabis studies to explore its unique properties, target specific clinical conditions, and compare its effects with other psychoactive substances, including psychedelics. By fostering collaboration, the field can gain valuable insights into the therapeutic potential and risks of cannabis in mental health treatment.

In conclusion, psychiatry must play a crucial role in advancing cannabis research. As the market and scientific interest grow, ensuring evidence-based practices will be essential in optimizing the benefits of cannabis while mitigating risks. Viner’s insights highlight the need for continued exploration, collaboration, and responsible clinical application of cannabis in psychiatry.

This is part 5 of a 5 part series. You can view part 1 here, part 2 here, part 3 here, and part 4 here.

Dr Viner is a practicing physician who has been working with psychiatric patients in the state of Nevada for over 25 years. He served as a clinical professor of psychiatry and behavioral sciences at the University of Nevada School of Medicine.