Dr. Brooke Worster: Shaping The Future of Cannabis Medicine
For Dr. Brooke Worster, medical cannabis research is a professional passion driven by the very real needs and frustrations of her cancer pain management and palliative care patients.
“My work in [these areas] directly brought me into the cannabis space, because patients and their family members were constantly asking me about how it could help,” said Worster, an associate professor at Thomas Jefferson University, Philadelphia, and clinical researcher in Jefferson’s medical cannabis research program. “We need better answers, and the more I’m learning, the more unanswered questions I’m finding. I won’t sit around and wait for someone else to answer them.”
Initially, Worster found herself at a loss when patients would ask about how medical cannabis could help them. She knew some of her patients were introduced to cannabis by a friend or family member, but could not answer important questions about the plant as part of their symptom and side effect management.
“Years ago, this subject was very hush-hush — my patients would hear about cannabis from a neighbor, or a friend would bring back some products from California,” Worster said. “Cannabis as medicine is no longer a game of telephone. There are so many opportunities from educational, clinical care, and research perspectives in the space of cannabis medicine.”
These questions drove Worster to look into cannabis medicine further, and she was surprised to learn just how little she knew about the endocannabinoid system (ECS) and the role medical cannabis played in it.
“I had no exposure to cannabis in my medical training, and it felt like this huge, obvious hole in my knowledge,” Worster said. “I owed it to my patients to have better conversations. It’s in a physicians’ best interest to understand how and why a patient wants to try medical cannabis, and understand how it fits into their course of treatment.”
It became clear to Worster that medical cannabis was an obvious fit for her practice. Cannabis has been widely studied internationally for its ability to both relieve cancer pain and alleviate side effects of cancer therapies, most famously nausea and vomiting associated with chemotherapy. In fact, synthetic versions of the phytocannabinoid Tetrahydrocannabinol (THC) make up the basis of Dronabinol, one of the first FDA-approved pharmaceuticals to manage nausea and vomiting in cancer patients.
The emerging evidence was certainly promising, but the gap between the research, the medical community, and patients was still enormous. Worster observed that this deficit made patients hesitant to try medical cannabis altogether.
“Certain patients aren’t comfortable navigating their own way in a dispensary, which creates a barrier,” Worster said, adding that these findings are backed by her research. “When patients feel stuck for information, [they struggle to get] help at the dispensary, and when their doctor can’t talk about it, cannabis becomes this elephant in the room…. Every single patient [in our studies] said that they wished their regular doctors would talk about cannabis with them.”
As she set out to solve these problems, Worster realized just how high the barriers were to cannabis researchers in the U.S. First was the issue of funding: The National Institutes of Health (NIH) invests more than $41 billion each year into medical research, but almost none of that is allocated to studying cannabis. That’s because of cannabis’ status as a Schedule I drug according to the Controlled Substances Act (CSA), classifying the plant as a substance with no medical value and high risk for addiction.
This classification has a chilling effect on clinical research, making it nearly impossible for universities to access cannabis for study. Researchers can only obtain cannabis legally from one grower at the University of Mississippi, through a program which only grows one cultivar.
“All Schedule I substances, by definition, are not allowed without jumping through special hoops to get a special license to research them,” Worster said. “Scheduling cannabis created this space where this huge gap of no cannabis research [conducted in the U.S.] exists, and the federal government cannot fund any research for any of those therapeutics.”
To bypass these restrictions and create opportunities for much needed-research, Pennsylvania created a special class of dispensary license which requires the license holder to partner with a research institution, called an Academic Clinical Research Center (ACRC), for purposes of advancing medical cannabis research. Ethos Cannabis partners with Thomas Jefferson University’s Sidney Kimmel Medical College, providing that rare yet vital avenue for doctors, patients, and researchers to explore cannabis in a clinical setting.
“Jefferson stepped up with Ethos and other dispensaries to say, ‘why not break down some of these barriers and allow some funding to come through in a way where we can research cannabis without federal funding?’” Worster said. “Through this partnership, we are trying to change the culture and break barriers that will further integrate cannabis medicine into healthcare.”
For Worster, the opportunity to work with Ethos patients brings to life lab models that don’t tell the full story of why and how real people respond so well to cannabis therapeutics.
“We are diving into the science of cannabis therapy for patients — we’re not looking to understand the ECS pathways in a mouse model,” Worster said. “We want to further the science around cannabis therapy in real patients and understand more directly precisely what cannabis helps and how it helps. We want to know where cannabis is most effective, where it is most tolerated, what is safest, what conditions make it more complex to use as medicine, and the makeup of the cannabis product most effective for those situations.”
Ethos’ contribution of real world feedback from their daily interactions with patients helps researchers devise more effective studies, she said.
“Ethos helps us… shape the questions we ask patients,” Worster said. “As research and development occurs for different products, formulations, and delivery systems, we’re always going to [want] to learn more.”
Pennsylvania medical cannabis patients can apply to be considered for a forthcoming study with Ethos Cannabis and Thomas Jefferson University. Visit the Ethos website for more information about ongoing research opportunities or to sign up to be considered for a future study.