重新安排大麻——医学还是政治?

IF 17.1 1区 医学 Q1 PSYCHIATRY
Bertha K Madras, Paul J Larkin
{"title":"重新安排大麻——医学还是政治?","authors":"Bertha K Madras, Paul J Larkin","doi":"10.1001/jamapsychiatry.2025.1116","DOIUrl":null,"url":null,"abstract":"<p><strong>Importance: </strong>In 2023, the US Department of Health and Human Services (HHS) issued a letter to the administrator of the Drug Enforcement Administration (DEA) recommending rescheduling of cannabis (marijuana) from Schedule I to Schedule III under the Controlled Substances Act (CSA). This recommendation marked a significant departure from previous, consistent, and long-standing federal decisions on cannabis scheduling.</p><p><strong>Objective: </strong>To critique the arguments made by HHS for recommending marijuana rescheduling.</p><p><strong>Evidence: </strong>The HHS secretary (advisor) and US attorney general (decision maker) must consider 8 factors and a 5-part test when deciding whether to reschedule a controlled substance. CSA classification criteria include whether a drug has currently accepted medical use, whether it has abuse potential, and whether use is safe under medical supervision. HHS undermined these established legal scheduling criteria by introducing new, untested criteria.</p><p><strong>Findings: </strong>HHS failed to adequately address the adverse effects of cannabis use, including the high prevalence of cannabis use disorder among users, risks associated with youth consumption, growing evidence linking cannabis to psychosis, and other significant concerns. HHS asserted that cannabis is widely accepted as a legitimate form of medicine, despite the reality that only a small fraction of patient-care physicians recommend it for symptom relief, in practices that often diverge from the norms of medical practice. Finally, the US Food and Drug Administration has not approved cannabis as a medicine, as evidence is deficient in several key areas, including data from high-quality clinical trials, standardized cannabis formulations, established purity, defined routes of administration, dosing guidelines, and specific frequencies of use.</p><p><strong>Conclusions and relevance: </strong>The HHS rationale for reclassifying cannabis in myriad forms (edibles, smokables, drinkables, vaping products, suppositories) and potencies relies on a questionable selection of comparator drugs, downplays distinctive adverse events among cannabis users, and claims, unconvincingly, that cannabis has wide acceptance in medical practice supported by scientific evidence.</p>","PeriodicalId":14800,"journal":{"name":"JAMA Psychiatry","volume":" ","pages":"934-939"},"PeriodicalIF":17.1000,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Rescheduling Cannabis-Medicine or Politics?\",\"authors\":\"Bertha K Madras, Paul J Larkin\",\"doi\":\"10.1001/jamapsychiatry.2025.1116\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Importance: </strong>In 2023, the US Department of Health and Human Services (HHS) issued a letter to the administrator of the Drug Enforcement Administration (DEA) recommending rescheduling of cannabis (marijuana) from Schedule I to Schedule III under the Controlled Substances Act (CSA). This recommendation marked a significant departure from previous, consistent, and long-standing federal decisions on cannabis scheduling.</p><p><strong>Objective: </strong>To critique the arguments made by HHS for recommending marijuana rescheduling.</p><p><strong>Evidence: </strong>The HHS secretary (advisor) and US attorney general (decision maker) must consider 8 factors and a 5-part test when deciding whether to reschedule a controlled substance. CSA classification criteria include whether a drug has currently accepted medical use, whether it has abuse potential, and whether use is safe under medical supervision. HHS undermined these established legal scheduling criteria by introducing new, untested criteria.</p><p><strong>Findings: </strong>HHS failed to adequately address the adverse effects of cannabis use, including the high prevalence of cannabis use disorder among users, risks associated with youth consumption, growing evidence linking cannabis to psychosis, and other significant concerns. HHS asserted that cannabis is widely accepted as a legitimate form of medicine, despite the reality that only a small fraction of patient-care physicians recommend it for symptom relief, in practices that often diverge from the norms of medical practice. Finally, the US Food and Drug Administration has not approved cannabis as a medicine, as evidence is deficient in several key areas, including data from high-quality clinical trials, standardized cannabis formulations, established purity, defined routes of administration, dosing guidelines, and specific frequencies of use.</p><p><strong>Conclusions and relevance: </strong>The HHS rationale for reclassifying cannabis in myriad forms (edibles, smokables, drinkables, vaping products, suppositories) and potencies relies on a questionable selection of comparator drugs, downplays distinctive adverse events among cannabis users, and claims, unconvincingly, that cannabis has wide acceptance in medical practice supported by scientific evidence.</p>\",\"PeriodicalId\":14800,\"journal\":{\"name\":\"JAMA Psychiatry\",\"volume\":\" \",\"pages\":\"934-939\"},\"PeriodicalIF\":17.1000,\"publicationDate\":\"2025-09-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"JAMA Psychiatry\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1001/jamapsychiatry.2025.1116\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"PSYCHIATRY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"JAMA Psychiatry","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1001/jamapsychiatry.2025.1116","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"PSYCHIATRY","Score":null,"Total":0}
引用次数: 0

摘要

重要性:2023年,美国卫生与公众服务部(HHS)致信美国缉毒局(DEA)局长,建议根据《受控物质法案》(CSA)将大麻(大麻)从附表一重新列入附表三。这一建议与以往联邦政府关于大麻日程安排的一贯和长期决定有很大不同。目的:对美国卫生与公众服务部推荐大麻重新管制的论点进行批评。证据:卫生与公众服务部部长(顾问)和美国司法部长(决策者)在决定是否重新安排管制物质时必须考虑8个因素和5部分测试。CSA分类标准包括药物目前是否已被接受用于医疗用途,是否有滥用的可能,以及在医疗监督下使用是否安全。卫生与公众服务部通过引入新的、未经检验的标准,破坏了这些既定的法定调度标准。调查结果:卫生与公众服务部未能充分解决大麻使用的不利影响,包括使用者中大麻使用障碍的高发率、与青少年消费相关的风险、越来越多的证据表明大麻与精神病有关,以及其他重大问题。卫生与公众服务部声称,大麻被广泛接受为一种合法的药物,尽管现实情况是,只有一小部分病人护理医生建议用它来缓解症状,这种做法往往与医疗实践的规范不同。最后,美国食品和药物管理局尚未批准大麻作为一种药物,因为在几个关键领域缺乏证据,包括来自高质量临床试验的数据、标准化的大麻配方、确定的纯度、确定的给药途径、给药指南和特定的使用频率。结论和相关性:卫生与公众服务部将大麻重新分类为各种形式(可食用、可吸烟、可饮用、电子烟产品、栓剂)和效力的理由,依赖于对比较药物的选择存在问题,淡化大麻使用者中独特的不良事件,并声称大麻在医学实践中得到了科学证据的广泛接受,这一说法令人难以置信。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Rescheduling Cannabis-Medicine or Politics?

Importance: In 2023, the US Department of Health and Human Services (HHS) issued a letter to the administrator of the Drug Enforcement Administration (DEA) recommending rescheduling of cannabis (marijuana) from Schedule I to Schedule III under the Controlled Substances Act (CSA). This recommendation marked a significant departure from previous, consistent, and long-standing federal decisions on cannabis scheduling.

Objective: To critique the arguments made by HHS for recommending marijuana rescheduling.

Evidence: The HHS secretary (advisor) and US attorney general (decision maker) must consider 8 factors and a 5-part test when deciding whether to reschedule a controlled substance. CSA classification criteria include whether a drug has currently accepted medical use, whether it has abuse potential, and whether use is safe under medical supervision. HHS undermined these established legal scheduling criteria by introducing new, untested criteria.

Findings: HHS failed to adequately address the adverse effects of cannabis use, including the high prevalence of cannabis use disorder among users, risks associated with youth consumption, growing evidence linking cannabis to psychosis, and other significant concerns. HHS asserted that cannabis is widely accepted as a legitimate form of medicine, despite the reality that only a small fraction of patient-care physicians recommend it for symptom relief, in practices that often diverge from the norms of medical practice. Finally, the US Food and Drug Administration has not approved cannabis as a medicine, as evidence is deficient in several key areas, including data from high-quality clinical trials, standardized cannabis formulations, established purity, defined routes of administration, dosing guidelines, and specific frequencies of use.

Conclusions and relevance: The HHS rationale for reclassifying cannabis in myriad forms (edibles, smokables, drinkables, vaping products, suppositories) and potencies relies on a questionable selection of comparator drugs, downplays distinctive adverse events among cannabis users, and claims, unconvincingly, that cannabis has wide acceptance in medical practice supported by scientific evidence.

求助全文
通过发布文献求助,成功后即可免费获取论文全文。 去求助
来源期刊
JAMA Psychiatry
JAMA Psychiatry PSYCHIATRY-
CiteScore
30.60
自引率
1.90%
发文量
233
期刊介绍: JAMA Psychiatry is a global, peer-reviewed journal catering to clinicians, scholars, and research scientists in psychiatry, mental health, behavioral science, and related fields. The Archives of Neurology & Psychiatry originated in 1919, splitting into two journals in 1959: Archives of Neurology and Archives of General Psychiatry. In 2013, these evolved into JAMA Neurology and JAMA Psychiatry, respectively. JAMA Psychiatry is affiliated with the JAMA Network, a group of peer-reviewed medical and specialty publications.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:604180095
Book学术官方微信