OPINION: Can DNA testing balance sensible cannabis policies and evidence-based health strategies?

It’s not hard to imagine practical applications for these tests as they become mainstream, perhaps as soon as over the next year or two

By Dan Skilleter

December 17, 2018

In the lead-up to Canada’s near-historic legalization of cannabis—it was second, worldwide—the national conversation around so-called Weed Wednesday was dominated by speculation about the stock market and reports of an uncertain retail environment. To be fair, some of that talk remains, particularly around availability and delivery times, but a new legalized regime is beginning to stabilize.

As this foundation sets, there is a real opportunity for all concerned to shift the dialogue back toward safety—ensuring that Canadians are consuming cannabis responsibly and that everyone, especially youth, are protected from potential risks.

Can DNA identify risk factors for cannabis users?

The recent increase in direct-to-consumer (DTC) genetic testing—a method of discovering genetic variations that can determine vulnerability to inherited diseases—is already beginning to energize that discussion. For example, the number of people who have had their DNA analyzed with DTC genetics genealogy tests more than doubled in 2017 and now exceeds 12 million. Additionally, market research from Technavio indicates the growing awareness about DTC genetic is one of the key factors triggering growth of the market.

In the cannabis context, DNA can expose underlying genetic risk factors associated with consumption.

The idea is that genetics could help empower doctors to tailor their recommended treatments based on relevant genetic data that informs how a patient is likely to respond to certain drugs or experience adverse effects. It may also be possible to predict whether or not an individual is at greater risk of developing a certain disease, thereby allowing time for proactive steps to be taken.

The possibilities seem to have appeal. In a medical setting, BIS Research forecasts the global industry could grow from $43.59 billion in 2016 to $141.17 billion by 2026.

Research has identified relatively common genetic variations that put those who regularly use cannabis at a higher risk of triggering psychotic disorders. For example, research has shown that approximately 20 percent to 25 percent of the population can carry AKTI or COMT gene variants that could increase their risk of psychosis with cannabis use and short-term memory loss following consumption, respectively.

Genetics can also help determine how quickly a person metabolizes THC—research indicates that 15 percent to 20 percent of the population break down THC at a slower rate based on their DNA—which can often lead to an increased risk of adverse reactions, including anxiety, sedation and paranoia.

 Tests can offer a helping hand

It’s not hard to imagine practical applications for these tests as they become mainstream, perhaps as soon as over the next year or two. Doctors could benefit significantly from having this information at their fingertips as they weigh whether or not to prescribe cannabis to a patient and work on determining an appropriate dosage.

As it stands, DNA cannot recommend a precise dosage, but it can alert a person to sensitivities and offer insights that can help start with dosages better tailored to individuals.

So, too, could DNA information be useful to the parents of tweens and teens looking to spark that first difficult conversation with their children about cannabis use and its potential risks. A genetic test could further prove useful for those in the baby-boomer cohort who are starting to experience some degree of chronic pain, and are cautiously interested in trying cannabis for relief, despite limited or no prior experience.

There’s good reason for Canadians to consider the merits of DNA testing alongside more traditional harm prevention tools, including public health campaigns, places of use regulations, advertising regulations, driving prohibitions when high, cannabis curriculum in student classes and promotion of consumption by only adults.

Qualitative research shows that Canadian youth commonly believe cannabis is safe or doesn’t have significant harms—an attitude that may help explain why their consumption rates are among the highest in the world. Other informationalso suggests early and regular cannabis use increases the risk of developing a primary psychotic illness, such as schizophrenia, in those who are already vulnerable.

 Acknowledge, learn and adjust

Genetic testing is not a silver bullet. The industry needs to acknowledge limitations where they exist, such as additional factors that contribute to developing psychosis (like environmental and family history), and must work with healthcare stakeholders to ensure the information it provides to Canadians is responsible. As more research studies are done—proving correlations between specific gene variants and their interactions with cannabis use—companies are expected to be able to offer even more insights and with greater certainty.

When it comes to cannabis, DNA testing has the potential to complement the educational campaignssafe consumption deadlines and health programming that governments and healthcare organizations have already launched.

The primary hurdle is that DNA testing regarding cannabis consumption is very new and only now being commercialized. Healthcare organizations will take some time to decide whether or not to incorporate testing-related information into future guidelines and awareness campaigns.

Eyes on Canada

Around the world, all eyes are on Canada as this experiment with cannabis legalization unfolds—and the country has much to be proud of thus far. As the first G7 country to legalize cannabis, Canada has first-mover advantage with a hospitable regulatory environment and the ability to raise capital.

The right ingredients are present, but more work is needed. While a handful of small companies in Canada are playing in the space, they are either not yet commercialized or are brand new.

That said, first-mover status has already helped Canadian cannabis cultivators—such as Canopy, Tilray and Aurora—become globally recognized players. Now, innovative companies in fields like genetic testing are well-positioned to capitalize on them as well.

Timing, talent and tools are available for Canada to become a global model of how a country can balance sensible drug policies with strong, evidence-based health strategies.

Celine Chang