MCLEAN HOSPITAL, THE LARGEST psychiatric affiliate of Harvard Medical School, has received a $500,000 gift that funds their new Marijuana Investigations for Neuroscientific Discovery (MIND) Program. The donation, announced on October 6, comes from best-selling crime novelist Patricia Cornwell.
Most studies on medical marijuana to date have focused on its efficacy, or on patients’ symptoms. MIND head researcher Staci A. Gruber, director of the Cognitive and Clinical Neuroimaging Core at McLean and associate professor of psychiatry at Harvard Medical School, hopes that the new initiative, the first of its kind, will begin to answer questions about whether medical marijuana affects cognitive function, positively or negatively—and why—by gathering empirical data about change over time within patients.
The initial phase of the program is expected to run for approximately two years. Researchers will collect data from subjects who, suffering from conditions including pain, anxiety, and post-traumatic stress disorder, have been certified to take medical marijuana but have no substantial history of recreational use, and have not yet begun this course of treatment. Participants will take a number of cognitive tests, on paper and on the computer, and will undergo brain scans. The studies will also gather clinical information on the patients’ perceptions about how they feel, and about their quality of life. After a baseline is established, the subjects will maintain weekly contact with the researchers, checking in physically with the hospital at the three-month, six-month, and one-year mark for more extensive tests, including some using multi-modal imaging equipment. If the program were to grow, Gruber says, the next phase would use the collected data to design and conduct clinical trials, administering the drug to individuals.
Though marijuana has been used medicinally, spiritually, and recreationally around the globe for some 5,000 years—and American doctors had, since the mid-nineteenth century, used it to treat conditions ranging from asthma to insomnia—the federal government classified it as a Schedule 1 drug in 1970 (grouping it with heroin and LSD), with profound effects on criminal justice in the United States. Recent years have seen dramatic cultural shifts in attitudes toward marijuana, accompanied by legal change. California was the first state to legalize medical cannabis, in 1996, and now 35 states permit some form of medical marijuana use. Medical marijuana clinics operate in 20 states and in Washington, D.C. The resulting rift between state and federal law—and the often conflicting policies of employers, health-insurance providers, and other parties—has caused confusion about the terms of legal medical use.
Yet those legal gaps find their match in scientific uncertainties, meaning that lawmakers deciding which conditions qualify patients for marijuana treatment currently make those decisions based on very little hard clinical knowledge. As Gruber puts it, “Policy has outpaced science.” For example, though patients have a variety of methods for taking medical marijuana, including as vapor, oil, tincture, or smoke, these substances bear little resemblance to the manufactured, standardized cannabinoids—the chemical compound patients need from the marijuana—studied in many trials; most of these synthetic versions have yet to reach end-users. (Gruber hopes to gather and analyze samples of what her subjects are using.) A June 2014 literature review in the New England Journal of Medicine, surveying the gaps in current knowledge, singled out what it called “the need to improve our understanding of how to harness the potential medical benefits of the marijuana plant without exposing people who are sick to its intrinsic risks.”
In a press release, Gruber stated that marijuana, which has “shown promise in alleviating a range of symptoms, could potentially improve cognitive performance” of patients suffering from severe medical disorders that disrupt their cognitive function and mood. “Equally critical,” she added, is that “Data showing a loss or impairment of cognitive function following the use of medical marijuana could inform alternative courses of treatment and prevent unjustified exposure to harm, especially in vulnerable populations.”
Gruber’s previous research into the subject has focused on the impact of heavy recreational marijuana use on the developing brain—a question increasing in urgency as use has begun to climb among high-school students after more than a decade of decline (even as cigarette smoking and alcohol use continue to drop). Her studies have found that the drug alters white-matter connections in the brain and reduces inhibitions, resulting in more impulsive behavior. On MRI scans taken while participants completed cognitive tests, early-onset marijuana smokers activated a different part of the brain region controlling inhibition, attention, and error processing than did late smokers. (Gruber has appeared on ABC’s Nightline and on the Dr. Sanjay Gupta’s CNN documentary Weed to speak about her findings, and will moderate a conversation with Gupta on medical marijuana at Harvard’s Institute of Politics tonight, October 8, at 6 P.M.)
Patricia Cornwell, who funded the program, is also a supporter of the Harvard Art Museum: she endowed the position of Cornwell Conservation Scientist at the Straus Center, and has donated collections of works by James McNeill Whistler, Augustus Edwin John, and Walter Sickert, in addition to advanced technological equipment. Her relationship with McLean coincides with her relationship with Gruber: they met when Cornwell visited McLean, on the recommendation of her contact at the Fogg Museum, to learn about brain imaging for a book project. “She asked incredibly good questions,” Gruber recalls. They married in 2005.