publication BMJ 2019;366:l5107
GPs should be able to prescribe to improve access, NICE says
Ellen C G Grant
Physician and medical gynaecologist
Cannabinoid epigenetics and human development
The UK National Institute for Health and Care Excellence has proposed GPs and other prescribers such as pharmacists and nurses should be able to take on prescribing of cannabis based medicinal products once initiated by specialists in expert centres.
This enthusiasm might be tempered by reading the recently published review by Albert Stuart Reece and Gary Kenneth Hulse on the impacts of cannabinoid epigenetics on human development which is very alarming. Cannabis use increases hyper-and hypo DNA methylation of sperm in rats and in humans which may provide a vector for the transmission of transgenerational instability. Cannabis-related teratology includes effects on the neuraxis, cardiovasculature, immune stimulation, secondary genomic instability and carcinogenesis related to paediatric and adult cancers. Trends in the USA, Hawaii, Colorado, Canada, France and Australia relate to mental retardation, and inheritable carcinogenesis.
The outlook for future generations is bleak when fathers have sperm with epigenetic cannabinoid-induced damage and mothers have uncorrected biochemical perturbations caused by years of contraceptive progestogen and oestrogen use before conception.
1 NICE. Cannabis-based medicinal products: draft guidance for consultation. Aug 2019. https://www.nice.org.uk/guidance/indevelopment/gid-ng10124/consultation/....
2 Reece AS, Hulse GK. Impacts of cannabinoid epigenetics on human development: reflections on Murphy et. al. 'cannabinoid exposure and altered DNA methylation in rat and human sperm' epigenetics 2018; 13: 1208-1221. Epigenetics 2019 Jul 11:1-16. Epub 2019 Jul 11.
3 Grant ECG. The pill, hormone replacement therapy, vascular and mood over-reactivity, and mineral imbalance. J Nutr Environ Med 1998;8:105-116.
Competing interests: No competing interests