Dr Joshua Rein Discusses the Next Steps of Cannabis Treatment for Kidney Disease

The federal illegality and Schedule I listing of cannabis significantly impair our ability to conduct any kind of prospective clinical research, said Joshua L Rein, DO, FASN, a nephrologist at Mt. Sinai Hospital in New York City.

Transcript:

What are the next steps in understanding cannabis treatment for kidney disease?

Physicians are poorly educated on cannabis, and the endocannabinoid system during medical education, medical training. That's partially because of the the federal stigma against cannabis in the United States, which really started in the early 1900s and led up to the Controlled Substances Act in 1970. That has really limited any kind of research in the field, and is preventing teaching about the drug in medical education. So state legalized consumption of cannabis is in conflict with federal law, where it remains a Schedule I controlled substance without accepted medical use and a high potential for abuse. The federal illegality and the Schedule I listing significantly impair our ability to conduct any kind of prospective clinical research. I think this is really what's needed in order to have a better understanding of its effects on the kidney.

Also, it's important to have some better oversight. That federal illegality prevents some kind of larger oversight or some kind of organization or some kind of standards that have been created to oversee the production and the manufacturing of the product. Standardized labeling, standardized dosing, guidance, these are all things that I think would be very important in the future. Then lastly, more research is needed on studying the effects of cannabis use, but from evaluating the route of administration, because we know smoking has effects on the lungs, on the airway that edibles may not necessarily share that same side effect profile. It would be important in the future to better understand the effects of these cannabinoid formulations.

Do you have any final thoughts you'd like to share?

One aspect of nephrology that would be important in understanding the effects of cannabis would be of the field of kidney transplantation. Patients with kidney disease who use cannabis for medical uses may undergo an evaluation for a kidney transplant. Cannabis may have an effect on their transplant candidacy, either delaying the listing or exclusion from the candidacy. This varies depending on the transplant center, but it's something important that should be kept in mind when considering the use of cannabis and for people considering kidney transplantation. People with kidney disease tend to also have cardiovascular disease or pulmonary disease. The literature regarding the use of cannabis on heart and lung outcomes really has mixed evidence. Some studies suggest that there may be an increased risk of heart attacks or strokes, while some studies may show an increased risk of chronic bronchitis and cough. But some studies don't demonstrate this and we really don't understand the overall effects of cannabis on the body. Having said that, consistent with recommendations regarding the use of tobacco and cigarettes and other smoked substances among patients with kidney disease, people really shouldn't smoke cannabis if they have cardiovascular or pulmonary disease, and other routes of administration such as oral consumption may avoid some of these risks and that may be a reasonable alternative.