FDA and Marijuana: Questions and Answers

http://www.fda.gov/NewsEvents/PublicHealthFocus/ucm421168.htm



1. How is marijuana therapy being used by some members of the medical community?

A. The FDA is aware that marijuana or marijuana-derived products are being used for a number of medical conditions including, for example, AIDS wasting, epilepsy, neuropathic pain, treatment of spasticity associated with multiple sclerosis, and cancer and chemotherapy-induced nausea. To date, the FDA has not approved a marketing application for a drug product containing or derived from botanical marijuana and has not found any such product to be safe and effective for any indication.

2. Why hasn’t the FDA approved marijuana for medical uses?

A. To date, the FDA has not approved a marketing application for marijuana for any indication. The FDA generally evaluates research conducted by manufacturers and other scientific investigators. Our role, as laid out in the Federal Food, Drug, and Cosmetic (FD&C) Act, is to review data submitted to the FDA in an application for approval to assure that the drug product meets the statutory standards for approval.

The FDA has approved Marinol for therapeutic uses in the United States, including for the treatment of anorexia associated with weight loss in AIDS patients. Marinol includes the active ingredient dronabinol, a synthetic delta-9- tetrahydrocannabinol (THC) which is considered the psychoactive component of marijuana. Another FDA-approved drug, Cesamet, contains the active ingredient nabilone, which has a chemical structure similar to THC and is synthetically derived.

3. Is marijuana safe for medical use?

A. The FDA has not approved any product containing or derived from botanical marijuana for any indication. This means that the FDA has not found any such product to be safe or effective for the treatment of any disease or condition. Study of marijuana in clinical trial settings is needed to assess the safety and effectiveness of marijuana for medical use.

The FDA will continue to facilitate the work of companies interested in appropriately bringing safe, effective, and quality products to market, including scientifically-based research concerning the medicinal uses of marijuana.

4. How does FDA’s role differ from NIH and DEA’s role when it comes to the investigation of marijuana for medical use?

A. Conducting clinical research using marijuana involves interactions with several federal agencies. This includes: a registration administered by the Drug Enforcement Administration (DEA); obtaining the marijuana for research from the National Institute on Drug Abuse (NIDA) within the National Institutes of Health; and review of an investigational new drug (IND) application and research protocol by the FDA. Additionally:

As a Schedule I controlled substance under the Controlled Substances Act, DEA provides researchers with a special registration and has certain requirements at the site marijuana will be studied.
NIDA provides research-grade marijuana for scientific study. The agency is responsible for overseeing the cultivation of marijuana for medical research and has contracted with the University of Mississippi to grow marijuana for research at a secure facility. Marijuana of varying strengths and potencies is available.
Researchers work with the FDA and submit an IND application.

5. Does the FDA object to the clinical investigation of marijuana for medical use?

A. No. The FDA believes that scientifically valid research conducted under an IND application is the best way to determine what patients could benefit from the use of drugs derived from marijuana. The FDA supports the conduct of that research by:

Providing information on the process needed to conduct clinical research using marijuana.
Providing information on the specific requirements needed to develop a drug that is derived from a plant such as marijuana. In June 2004, the FDA finalized its Guidance for Industry: Botanical Drug Products, which provides sponsors with guidance on submitting IND applications for botanical drug products.
Providing specific support for investigators interested in conducting clinical research using marijuana and its constituents as a part of the IND process through meetings and regular interactions throughout the drug development process.
Providing general support to investigators to help them understand and follow the procedures to conduct clinical research through the FDA Center for Drug Evaluation and Research’s Small Business and Industry Assistance group.

6. What kind of research is the FDA reviewing when it comes to the efficacy of marijuana?

A. The FDA reviews applications to market drug products to determine whether those drug products are safe and effective for their intended indications. The FDA reviews scientific investigations, including adequate and well-controlled clinical trials, as part of the FDA’s drug approval process.

The FDA relies on applicants and scientific investigators to conduct research. Our role, as outlined in the Federal Food, Drug, and Cosmetic Act, is to review data submitted to the FDA in a marketing application to determine whether a proposed drug product meets the statutory standards for approval. Additional information concerning research on the medical use of marijuana is available from the National Institutes of Health, particularly the National Cancer Institute (NCI) and NIDA.

7. How can patients get into expanded access program for marijuana for medical use?

A. Manufacturers may be able to make investigational drugs available to individual patients in certain circumstances through expanded access, as described in the FD&C Act and implementing regulations. For example, GW Pharmaceuticals disclaimer icon is currently making a drug product that contains cannabidiol and that is being developed for seizure disorders available through expanded access. Information about this program can be obtained from the company.

8. Does the FDA have concerns about administering a cannabis product to children?

A. We understand that parents are trying to find treatments for their children’s medical conditions. However, the use of untested drugs can have unpredictable and unintended consequences. Caregivers and patients can be confident that FDA-approved drugs have been carefully evaluated for safety, efficacy, and quality, and are monitored by the FDA once they are on the market. The FDA continues to support sound, scientifically-based research into the medicinal uses of drug products containing marijuana or marijuana constituents, and will continue to work with companies interested in bringing safe, effective, and quality products to market.

9. What is FDA’s reaction to states that are allowing marijuana to be sold for medical uses without the FDA’s approval?

A. The FDA is aware that several states have either passed laws that remove state restrictions on the medical use of marijuana and its derivatives or are considering doing so. In particular, we know that a number of states are interested in allowing access to cannabinoid oil, or cannabidiol, in an attempt to treat childhood epilepsy. It is important to conduct medical research into the safety and effectiveness of marijuana products through adequate and well-controlled clinical trials. We welcome the opportunity to talk with states who are considering support for medical research of marijuana and its derivatives to provide information on Federal and scientific standards.

10. What is the FDA’s position on state “Right to Try” bills?

A. The FDA has not taken a position on any particular state “Right to Try” bill. The FDA works with companies to provide patients access to experimental therapies through enrollment in clinical trials or through the expanded access provisions described in the FDA’s statute and regulations. The FDA may permit the use of an experimental therapy, but the sponsor company ultimately decides whether or not to provide experimental therapies to patients.

These channels help to protect patients while also allowing for the collection of data necessary to support the FDA approval of safe and effective therapies for use in the broader population. The FDA is strongly supportive of appropriate use of expanded access protocols and stands ready to work with companies that are interested in providing access to experimental drugs.

11. Has the agency received any adverse event reports associated with marijuana for medical conditions?

A. The agency has received reports of adverse events in patients using marijuana to treat medical conditions. The FDA is currently reviewing those reports and will continue to monitor adverse event reports for any safety signals attributable to marijuana and marijuana products, with a focus on serious adverse effects associated with the use of marijuana.

Information from adverse event reports regarding marijuana use is extremely limited; the FDA primarily receives adverse event reports for approved products. General information on the potential adverse effects of using marijuana and its constituents can come from clinical trials using marijuana that have been published, as well as from spontaneously reported adverse events sent to the FDA. Additional information about the safety and effectiveness of marijuana and its constituents is needed. Clinical trials of marijuana conducted under an IND application could collect this important information as a part of the drug development process.

12. Can products that contain cannabidiol be sold as dietary supplements?

A. No. Based on available evidence, FDA has concluded that cannabidiol products are excluded from the dietary supplement definition under section 201(ff)(3)(B)(ii) of the FD&C Act. Under that provision, if a substance (such as cannabidiol) has been authorized for investigation as a new drug for which substantial clinical investigations have been instituted and for which the existence of such investigations has been made public, then products containing that substance are outside the definition of a dietary supplement. There is an exception if the substance was "marketed as" a dietary supplement or as a conventional food before the new drug investigations were authorized; however, based on available evidence, FDA has concluded that this is not the case for cannabidiol. For more information on this provision, including an explanation of the phrase "marketed as," see Draft Guidance for Industry: Dietary Supplements: New Dietary Ingredient Notifications and Related Issues.

FDA is not aware of any evidence that would call into question its current conclusion that cannabidiol products are excluded from the dietary supplement definition under section 201(ff)(3)(B)(ii) of the FD&C Act. Interested parties may present the agency with any evidence that they think has bearing on this issue.

13. How did the FDA determine that cannabidiol products are excluded from the dietary supplement definition?

Based on available evidence, FDA has concluded that cannabidiol products are excluded from the dietary supplement definition under section 201(ff)(3)(B)(ii) of the FD&C Act. Under that provision, if an article (such as cannabidiol) has been authorized for investigation as a new drug for which substantial clinical investigations have been instituted and for which the existence of such investigations has been made public, then products containing that substance are outside the definition of a dietary supplement. There is an exception if the substance was “marketed as” a dietary supplement or as a conventional food before the new drug investigations were authorized; however, based on available evidence, FDA has concluded that this is not the case for cannabidiol.

The existence of substantial clinical investigations regarding cannabidiol has been made public. For example, two such substantial clinical investigations include GW Pharmaceuticals’ investigations regarding Sativex and Epidiolex. (See Sativex Commences US Phase II/III Clinical Trial in Cancer Pain disclaimer icon and disclaimer iconGW Pharmaceuticals Receives Investigational New Drug (IND) from FDA for Phase 2/3 Clinical Trial of Epidiolex in the Treatment of Dravet Syndrome). FDA considers a substance to be "authorized for investigation as a new drug" if it is the subject of an Investigational New Drug application (IND) that has gone into effect. Under FDA’s regulations (21 CFR 312.2), unless a clinical investigation meets the limited criteria in that regulation, an IND is required for all clinical investigations of products that are subject to section 505 of the FD&C Act.

14. Will FDA take enforcement action regarding cannabidiol products that are marketed as dietary supplements?

A. When a product is in violation of the FD&C Act, FDA considers many factors in deciding whether or not to initiate an enforcement action. Those factors include, among other things, agency resources and the threat to the public health. FDA also may consult with its federal and state partners in making decisions about whether to initiate a federal enforcement action.

15. What does the FDA think about making cannabidiol available to children with epilepsy?

A. The FDA understands the interest in making investigational products available to patients while they are being studied for approval, and there are expanded access provisions in both the FDA’s statute and its regulations to make this possible.

16. What should I do if my child eats something containing marijuana?

A. It is important to protect children from accidental ingestion of marijuana and its derivative products. FDA recommends that these products are kept out of reach of children to reduce the risk of accidental ingestion.

If the parent or caregiver has a reasonable suspicion that the child ingested products containing marijuana, the child should be taken to a physician or emergency department, especially if the child acts in an unusual way or is/feels sick.

17. I’ve seen marijuana products being marketed for pets. Are they safe?

A. FDA has recently become aware of some marijuana products being marketed to treat diseases in animals. We want to stress that FDA has not approved marijuana for any use in animals, and the agency cannot ensure the safety or effectiveness of these products. For these reasons, FDA cautions pet-owners against the use of such products.

18. Can I give my pet marijuana products for medical purposes, such as to relieve the pain of a sick or dying pet?

A. Marijuana needs to be further studied to assess the safety and effectiveness for medical use in animals. To date, FDA has not approved marijuana for any use in animals. If your pet is in pain, we urge you to talk with your veterinarian about appropriate treatment options.

19. I gave my pet marijuana and I’m concerned my pet is suffering adverse effects. What should I do?

A. Signs that your pet may be suffering adverse effects from ingesting marijuana may include lethargy, depression, heavy drooling, vomiting, agitation, tremors, and convulsions. If you have concerns that your pet is suffering adverse effects from ingesting marijuana or any substance containing marijuana, consult your veterinarian, local animal emergency hospital or an animal poison control center immediately.

20. Has the agency received any adverse event reports associated with marijuana for animals?

A. While the agency is aware of reports of pets consuming various forms of marijuana, to date, FDA has not directly received any adverse event reports associated with giving marijuana to animals via our safety reporting portals. However, adverse events from accidental ingestion are well-documented in scientific literature. If you feel your animal has suffered from ingesting marijuana, we encourage you to report the adverse event to the FDA. Please visit Reporting Information about Animal Drugs and Devices to learn more about how to report an adverse event related to an animal food or drug.

21. What is FDA doing about marijuana products currently on the market for pets?

A. FDA is currently collecting information about marijuana and marijuana-derived products being marketed for animals. FDA reminds consumers that these products have not been evaluated by FDA for safety and effectiveness, and we recommend that you talk with your veterinarian about appropriate treatment options for your pet.