Marijuana Law, Policy & Reform

Editor: Douglas A. Berman
Moritz College of Law

Sunday, November 19, 2017

Still more talk, from notable conservative outlets, about possible benefits of marijuana reform amidst opioid crisis

Regular readers know that many proponents of marijuana reform have been eager in recent years to talk up the possible benefits of marijuana reform as one useful response to the on-going opioid crisis.   Indeed, since I have blogged many stories and commentaries on this front, it is not really big news to see more new advocacy along these lines.  But that said, this past week I have seen these two notable commentaries in this vein appearing in notable conservative or right-leaning outlets:

From the American Conservative here by Jeffrey Singer, "Can Marijuana Help Addicts Kick Opioids?: Research shows this once maligned 'gateway' drug could be an off-ramp."

From the Wall Street Journal here by Richard Boxer, "Can Marijuana Alleviate the Opioid Crisis?: The federal government should stop blocking research into the drug’s medical potential."

Some (of many) prior related posts:

November 19, 2017 in Medical community perspectives, Medical Marijuana Commentary and Debate | Permalink | Comments (0)

Thursday, November 16, 2017

"Pediatric Death Due to Myocarditis After Exposure to Cannabis"

Advocates of marijuana reform are often quick to assert that nobody dies from an overdose of marijuana.  But this new clinical report from two Colorado doctors, which has the same title as this post, discusses a case of an 11-month child who may have died as a direct result of marijuana exposure.   The paper is authored by Thomas Nappe and Christopher Hoyte, and here is the paper's abstract:

Since marijuana legalization, pediatric exposures to cannabis have increased.  To date, pediatric deaths from cannabis exposure have not been reported.  The authors report an 11-month-old male who, following cannabis exposure, presented with central nervous system depression after seizure, and progressed to cardiac arrest and died.  Myocarditis was diagnosed post-mortem and cannabis exposure was confirmed.  Given the temporal relationship of these two rare occurrences – cannabis exposure and sudden death secondary to myocarditis in an 11-month-old – as well as histological consistency with drug-induced myocarditis without confirmed alternate causes, and prior reported cases of cannabis-associated myocarditis, a possible relationship exists between cannabis exposure in this child and myocarditis leading to death. In areas where marijuana is commercially available or decriminalized, the authors urge clinicians to preventively counsel parents and to include cannabis exposure in the differential diagnosis of patients presenting with myocarditis.

UPDATE: Unsurprisingly, this clinical report links a death to marijuana exposure has created a stir, and this new Washington Post piece headlined "The truth behind the ‘first marijuana overdose death’" provides some context for the controversy.

November 16, 2017 in Medical community perspectives, Medical Marijuana Data and Research, Recreational Marijuana Data and Research | Permalink | Comments (2)

Monday, November 13, 2017

A reasonable accounting of public health realities surrounding marijuana and alcohol

ALCOHOL-VS-MARIJUANA-INFO-CROPThis new Business Insider article, headlined "We took a scientific look at whether weed or alcohol is worse for you — and there appears to be a winner," provides a pretty reasonable review of basic public health research concerning marijuana and alcohol. Here is how the article starts, its main boldheadings, and it conclusion:

Which is worse for you: weed or whiskey? It's a tough call, but based on the science, there appears to be a clear winner.

Keep in mind that there are dozens of factors to account for, including how the substances affect your heart, brain, and behavior, and how likely you are to get hooked. Time is important, too — while some effects are noticeable immediately, others only begin to shape up after months or years of use.

The comparison is slightly unfair for another reason: While scientists have been researching the effects of alcohol for decades, the science of cannabis is a lot murkier due to its mostly illegal status.

30,722 Americans died from alcohol-induced causes in 2014. There have been 0 documented deaths from marijuana use alone. ...

Marijuana appears to be significantly less addictive than alcohol. ...

Marijuana may be harder on your heart; while moderate drinking could be beneficial....

Alcohol is strongly linked with several types of cancer; marijuana is not....

Both drugs may be linked with risks while driving, but alcohol is worse. ...

Several studies link alcohol with violence, particularly at home. That has not been found for cannabis. ...

Both drugs negatively impact your memory, but in different ways. These effects are the most common in heavy, frequent, or binge users. ...

Both drugs are linked with an increased risk of psychiatric disease. For weed users, psychosis and schizophrenia are the main concern; with booze, it's depression and anxiety....

Alcohol appears to be linked more closely with weight gain than marijuana, despite weed's tendency to trigger the munchies. ...

All things considered, alcohol's effects seem markedly more extreme — and risky — than marijuana's.

When it comes to their addiction profile and their risk of death or overdose combined with their ties to cancer, car crashes, violence, and obesity, the research suggests that marijuana may be less of a health risk than alcohol.

Still, because of marijuana's largely illegal status, long-term studies on all of its health effects have been limited — meaning that more research is desperately needed.

November 13, 2017 in Food and Drink, Medical community perspectives, Medical Marijuana Commentary and Debate, Recreational Marijuana Commentary and Debate | Permalink | Comments (0)

Saturday, November 11, 2017

Lots of headlines (and prior posts) about veterans having access to medical marijuana ... but work remains in Trump era

Veterans-day-thank-you-quotesRegular readers know I have, since starting this blog more than four years ago, regularly blogged about a range of issues relating to veterans and their access to marijuana (a dozen of my more recent posts on this topic are linked below).  I feel a genuine and deep debt to anyone and everyone who serves this nation through the armed forces, and I feel  strongly that veterans should be able to have safe and legal access to any and every form of medicine that they and their doctors reasonably believe could help them with any ailments or conditions.

Notably, this White House release from a few days ago touts "President Donald J. Trump is Putting Our Veterans First," and it quotes Prez Trump sating that "we will not rest until all of America’s great veterans can receive the care they so richly deserve."  But current federal law essentially puts veterans last, not first, when it comes to access to medical marijuana because doctors with the Veterans Administration are legally barred from providing the recommendations that patients needs to obtain medical marijuana under state laws.

Perhaps unsurprisingly, on this Veterans Day 2017, issues relating to veterans and their access to marijuana are getting ever more attention.  Here are a few recent press pieces that caught my eye on this topic, followed by a lot of prior posts:

Some recent prior related posts:

November 11, 2017 in Federal Marijuana Laws, Policies and Practices, Medical community perspectives, Medical Marijuana Commentary and Debate, Who decides | Permalink | Comments (0)

Wednesday, October 11, 2017

"The use of cannabis in response to the opioid crisis: A review of the literature"

Cov200hThe title of this post is the title of this notable short literature review on a topic that regular readers know I find very interesting.  The article by multiple authors appears in Nursing Outlook, which is the official journal of the American Academy of Nursing.  Here is its abstract:

Background

A staggering number of Americans are dying from overdoses attributed to prescription opioid medications (POMs).  In response, states are creating policies related to POM harm reduction strategies, overdose prevention, and alternative therapies for pain management, such as cannabis (medical marijuana).  However, little is known about how the use of cannabis for pain management may be associated with POM use.

Purpose

The purpose of this article is to examine state medical cannabis (MC) use laws and policies and their potential association with POM use and related harms.

Methods

A systematic literature review was conducted to explore United States policies related to MC use and the association with POM use and related harms. Medline, PubMed, CINAHL, and Cochrane databases were searched to identify peer-reviewed articles published between 2010 and 2017. Using the search criteria, 11,513 records were identified, with 789 abstracts reviewed, and then 134 full-text articles screened for eligibility.

Findings

Of 134 articles, 10 articles met inclusion criteria. Four articles were cross-sectional online survey studies of MC substitution for POM, six were secondary data analyses exploring state-level POM overdose fatalities, hospitalizations related to MC or POM harms, opioid use disorder admissions, motor vehicle fatalities, and Medicare and Medicaid prescription cost analyses.  The literature suggests MC laws could be associated with decreased POM use, fewer POM-related hospitalizations, lower rates of opioid overdose, and reduced national health care expenditures related to POM overdose and misuse.  However, available literature on the topic is sparse and has notable limitations.

Conclusions

Review of the current literature suggests states that implement MC policies could reduce POM-associated mortality, improve pain management, and significantly reduce health care costs. However, M C research is constrained by federal policy restrictions, and more research related to MC as a potential alternative to POM for pain management, MC harms, and its impact on POM-related harms and health care costs should be a priority of public health, medical, and nursing research.

Some (of many) prior related posts:

October 11, 2017 in Medical community perspectives, Medical Marijuana Commentary and Debate, Medical Marijuana Data and Research | Permalink | Comments (0)

Tuesday, September 26, 2017

"Seniors Turn To Medical Marijuana For What Ails Them"

The title of this post is the title of this effective 5+ minute segment that aired today on the NPR midday show Here & Now.  Here is how the program's website sets up the segment:

With 29 states allowing medical marijuana, senior citizens have been increasingly seeking its curative powers. But there are many obstacles, ranging from paying for the herb to finding a doctor who is licensed to prescribe.

In New York, considered an especially restrictive medical marijuana state, reporter Karen Michel explores some of the benefits and difficulties for seniors seeking legal pot.

September 26, 2017 in Medical community perspectives, Medical Marijuana Commentary and Debate, Medical Marijuana Data and Research, Who decides | Permalink | Comments (0)

Monday, September 25, 2017

"Cannabis use among patients at a comprehensive cancer center in a state with legalized medicinal and recreational use"

CoverThe title of this post is the title of this intriguing new research paper in the journal Cancer.  Here is the paper's abstract (with key points emphasized):

BACKGROUND

Cannabis is purported to alleviate symptoms related to cancer treatment, although the patterns of use among cancer patients are not well known.  This study was designed to determine the prevalence and methods of use among cancer patients, the perceived benefits, and the sources of information in a state with legalized cannabis.

METHODS

A cross-sectional, anonymous survey of adult cancer patients was performed at a National Cancer Institute–designated cancer center in Washington State. Random urine samples for tetrahydrocannabinol provided survey validation.

RESULTS

Nine hundred twenty-six of 2737 eligible patients (34%) completed the survey, and the median age was 58 years (interquartile range [IQR], 46-66 years).   Most had a strong interest in learning about cannabis during treatment (6 on a 1-10 scale; IQR, 3-10) and wanted information from cancer providers (677 of 911 [74%]).  Previous use was common (607 of 926 [66%]); 24% (222 of 926) used cannabis in the last year, and 21% (192 of 926) used cannabis in the last month.  Random urine samples found similar percentages of users who reported weekly use (27 of 193 [14%] vs 164 of 926 [18%]).  Active users inhaled (153 of 220 [70%]) or consumed edibles (154 of 220 [70%]); 89 (40%) used both modalities.  Cannabis was used primarily for physical (165 of 219 [75%]) and neuropsychiatric symptoms (139 of 219 [63%]).  Legalization significantly increased the likelihood of use in more than half of the respondents.

CONCLUSIONS

This study of cancer patients in a state with legalized cannabis found high rates of active use across broad subgroups, and legalization was reported to be important in patients' decision to use. Cancer patients desire but are not receiving information about cannabis use during their treatment from oncology providers.

September 25, 2017 in Medical community perspectives, Recreational Marijuana Data and Research, Recreational Marijuana State Laws and Reforms | Permalink | Comments (0)

Monday, September 11, 2017

Spotlighting concerns over increases in heavy marijuana use

In this recent post, I noted that last week the federal Substance Abuse and Mental Health Services Administration (SAMHSA) released here some key data from its 2016 National Survey on Drug Use and Health (NSDUH).  The SAMSHA data showing decreases in teen marijuana use garnered considerable attention, and rightly so because so many are concerned about when marijuana reforms might mean for marijuana activity by those with still developing brains.  

The SAMSHA data covers a lot more than teen usage, and Christopher Ingraham has this new Washington Post piece about a trend in the data concerning adult marijuana use.  His piece is headlined "Here’s one marijuana trend you should actually be worried about," and here are excerpts:

[NSDUH has data on] the number of people who are getting high all the time — heavy users who smoke on a daily or near-daily basis. The federal data shows that those numbers are increasingly precipitously.

In 2016, nearly 19 percent of people who used marijuana that year used it at least 300 days out of the year.  That figure's up by roughly 50 percent from 2002, when 12 percent of marijuana users consumed the drug daily or near-daily.

Again, this on its own is not necessarily cause for concern. It's possible to smoke marijuana moderately on a daily basis — half a joint to wind down after a day of work, akin to the ubiquitous glass of wine with dinner, for instance. But the comparison with alcohol is instructive here. According to the federal survey data, marijuana users are far more likely to use daily than drinkers are to drink daily.... In a given year, lots of people drink — but relatively few of them drink every day. That's not true for marijuana. Marijuana users are nearly three times as likely as drinkers to consume their drug of choice daily.

Some of that daily marijuana use is probably inherently moderate and nothing to be concerned about. But public health researchers worry that much of it is a result of problematic use — drug dependency. "While alcohol is more dangerous in terms of acute overdose risk, and also in terms of promoting violence and chronic organ failure, marijuana — at least as now used in the United States — creates higher rates of behavioral problems, including dependence, among all its users," as Carnegie Mellon University researcher Jonathan Caulkins wrote for the magazine National Affairs earlier this year.

The question, then, becomes how best to address the risks of chronic, heavy marijuana use. Keeping pot illegal is not likely to solve things — after all, the charts above show that daily marijuana use was rising well before the first states legalized the drug in 2014. Legalization advocates say that bringing the drug out in the open and regulating it is the best way to go. They point to tobacco as an example: Tobacco use, including heavy use, has fallen precipitously in the past two decades as a result of public health campaigns and greater stigma around use of the drug — all of which was accomplished without throwing people in jail for using it.

Public-health experts, meanwhile, are increasingly calling for a balance between the extremes of prohibition and commercialization — "grudging toleration," as New York University professor Mark Kleiman puts it. As a Rand Corp. report outlined last year, there are a whole host of options for dealing with the marijuana market, from allowing people to grow marijuana but not sell it, to giving the government a monopoly in marijuana sales, to more esoteric options like allowing nonprofit co-ops to control the supply of the drug.

The good news is that as laws relax around marijuana use, we're running real-world experiments in how some of those options actually work. In the United States, we have a handful of fully commercial markets, like the ones in Colorado and Washington. We also have noncommercial legalization for homegrown marijuana in the District. In Canada, meanwhile, it appears that the province of Ontario will experiment with implementing a government monopoly on the drug starting in July of next year.

September 11, 2017 in Medical community perspectives, Recreational Marijuana Commentary and Debate, Recreational Marijuana Data and Research | Permalink | Comments (1)

Sunday, September 10, 2017

"A Safer Way To Legalize Marijuana"

The title of this post is the headline of this notable extended commentary appearing at the Heath Affairs Blog authored by Rebecca Haffajee, Alex Liber, and Kenneth Warner. Here are excerpts:

Those crafting marijuana laws can draw upon lessons learned about the harms of combusted tobacco and the smoking control policies that followed. Given what we already know about the health hazards of combusted marijuana and the difficulty of controlling the sale of commercially established products, policy makers should capitalize on this opportunity to create a legal marijuana market that mitigates potentially significant harms associated with inhaling combusted marijuana while still facilitating desired benefits of recreational marijuana....

Combustible marijuana likely poses similar risks to those of combustible tobacco, while vaporizing or eating marijuana products offers a “cleaner” delivery mechanism. Why repeat the devastating public health harms of smoking tobacco when policy makers can reasonably mitigate similar consequences of smoking marijuana?...

In a recent comprehensive review of the scientific literature, the National Academies of Sciences, Engineering, and Medicine concluded that “smoked marijuana…is a crude THC delivery system that also delivers harmful substances.” The report and other reviews found strong evidence linking combusted marijuana to increased risk for chronic bronchitis....

Edible and vaporized marijuana products offer the potential to deliver therapeutic and euphoric benefits of marijuana while avoiding cardiopulmonary-related harms of combustion. Although precise estimates of the decreased risks associated with this substitution are not available, by analogy the health risks for smokeless and vaporized tobacco products are estimated to be roughly 90 percent less than those of combusted tobacco.

Valid concerns have been raised about the potential health harms from commercially marketed edibles, especially their attractiveness to, accessibility by, and increasing exposure and overdoses among children. We strongly support prohibitions on the sale of marijuana products — including edibles — to minors, clearly labeling product THC content and requiring child-proof packaging. Additionally, if marijuana is only legally available for sale in forms that do not resemble cigarettes, children may be less likely to cross over between products....

Policy makers in jurisdictions considering legalization are not bound by custom to make available all forms of marijuana for recreational use. Little prior interstate commerce of legal marijuana products exists, and most states have yet to legalize recreational use. The environment is ripe to experiment with different types of markets, and entrepreneurial policy makers could embark on implementing a safer legal marijuana market that omits combustibles, based on our current and developing knowledge.

While uncertainty still exists regarding the relative harms of different marijuana products and robust research is warranted, waiting for perfect scientific consensus about the scope and nature of harms related to marijuana combustion is unwise. The evidence base around marijuana combustion harms is already strong, and growing. Arriving at total consensus will take decades — as it took to link cigarettes to lung cancer — and waiting to embark on an alternative, very likely safer policy regime has real costs, measured in disease and death. Permitting the sale of THC extracts for consumption in edible or vaporized form will neither compromise therapeutic nor euphoric benefits of recreational marijuana use. In addition, creating variation in recreational marijuana policy regimes — between those already enacted that permit marijuana combustion and those enacted in the future that don’t — would create natural experiments ripe to study the differential effects and quantify harms versus benefits. Policy makers in favor of legalization should seize the opportunity to design a new market that permits recreational sale of marijuana only in edible or vaporized form, to minimize the potential for the kind of disease burden associated with smoked tobacco.

September 10, 2017 in History of Marijuana Laws in the United States, Medical community perspectives, Recreational Marijuana Commentary and Debate, Recreational Marijuana Data and Research, Recreational Marijuana State Laws and Reforms | Permalink | Comments (1)

Friday, September 1, 2017

"Make Pot Legal for Veterans With Traumatic Brain Injury"

The title of this post is the headline of this notable op-ed in today's New York Times authored by Thomas James Brennan, a former sergeant in the Marine Corps. Here is much of what he has to say: 

The explosion that wounded me during a Taliban ambush in Afghanistan in 2010 left me with a traumatic brain injury and post-traumatic stress. In 2012 I was medically retired from the Marine Corps because of debilitating migraines, vertigo and crippling depression. After a nine-year career, I sought care from the Department of Veterans Affairs.

At first, I didn’t object to the pills that arrived by mail: antidepressants, sedatives, amphetamines and mood stabilizers. Stuff to wake me up. Stuff to put me down. Stuff to keep me calm. Stuff to rile me up. Stuff to numb me from the effects of my wars as an infantryman in Iraq and Afghanistan. Stuff to numb me from the world all around.  The T.B.I. brings on almost daily migraines, and when they come, it’s as if the blast wave from the explosion in Afghanistan is still reverberating through my brain, shooting fresh bolts of pain through my skull, once again leaving me incapacitated. Initially the prescriptions helped — as they do for many veterans. But when I continued to feel bad, the answers from my doctors were always the same: more pills. And higher dosages. And more pills to counteract the side effects of those higher dosages. Yet none of them quite worked.

One thing did. In 2013, a friend rolled a joint and handed it to me, urging me to smoke it later. It will relieve your symptoms, he promised. That night I anxiously paced around my empty house. I hesitated to light it up because I’d always bought into the theory of weed as a “gateway drug.” But after a few tokes, I stretched out and fell asleep. I slept 10 hours instead of my usual five or six. I woke up feeling energized and well rested. I didn’t have nightmares or remember tossing or turning throughout the night, as I usually did. I was, as the comedian Katt Williams puts it, “hungry, happy, sleepy.”

With the help of my civilian psychiatrist, I began trading my pill bottles for pipes and papers. I also began to feel less numb. I started to smile more often. I thought I had found a miracle drug. There was just one problem: That drug was illegal. In 21 states, including North Carolina, where I live, any use of marijuana is forbidden under state law. The current punishments for those who possess or cultivate cannabis — even for medical purposes — may include a felony conviction and imprisonment, loss of child custody and permanent damage to their livelihood. The V.A. encourages veterans to discuss their cannabis use with their doctors, but because cannabis is also prohibited under federal law, the V.A. cannot prescribe it in any form — thereby denying countless veterans relief to many mental health symptoms and other service-connected disabilities.

The medical benefits of marijuana for the more than 360,000 post-Sept. 11 veterans who have brain injuries are not universally recognized. (As many as one in five veterans are thought to have post-traumatic stress.) But medical experts like Dr. Frank Ochberg, a psychiatrist and former associate director of the National Institute of Mental Health, believe that “medical marijuana absolutely belongs in the pharmacy for post-traumatic stress and brain injury treatment.” The V.A., Dr. Ochberg said, “is failing veterans by not making cannabis a treatment option.”...

Most of the major veterans groups, including the American Legion, Iraq and Afghanistan Veterans of America, Veterans of Foreign Wars and Disabled American Veterans, support regulated research into the medical uses of cannabis. But the research is slow in coming: Since 1968, the University of Mississippi has been home to the only licensed facility to produce cannabis for clinical research. In March it was reported that the university’s cannabis was contaminated with lead, yeast and mold — substances that jeopardize research efficacy and patient safety.

What I know is that it works for me. If I hadn’t begun self-medicating with it, I would have killed myself. The relief isn’t immediate. It doesn’t make the pain disappear. But it’s the only thing that takes the sharpest edges off my symptoms. Because of cannabis, I’m more hopeful, less woeful. My relationship with my wife is improving. My daughter and I are growing closer. My past is easier to remember and talk about. My mind is less clouded. More than anything, it feels good to feel again. My migraines and depression don’t control my life. Neither do pills.

But I live in fear that I will be arrested purchasing an illegal drug. I want safe, regulated medical cannabis to be a treatment option. Just like the sedatives and amphetamines the V.A. used to send me by mail. And the opioids they still send to my friends.

September 1, 2017 in Federal Marijuana Laws, Policies and Practices, Medical community perspectives, Medical Marijuana Commentary and Debate, Who decides | Permalink | Comments (1)

Tuesday, August 15, 2017

US Justice Department reportedly blocking marijuana research requests supported by DEA

The Washington Post has this notable new article reporting that "The Justice Department under Attorney General Jeff Sessions has effectively blocked the Drug Enforcement Administration from taking action on more than two dozen requests to grow marijuana to use in research." Here is more:

A year ago, the DEA began accepting applications to grow more marijuana for research, and as of this month, had 25 proposals to consider.  But DEA officials said they need the Justice Department’s sign-off to move forward, and so far, the department has not been willing to provide it.  “They’re sitting on it,” said one law enforcement official familiar with the matter. “They just will not act on these things.”

As a result, said one senior DEA official, “the Justice Department has effectively shut down this program to increase research registrations.’’  DEA spokesman Rusty Payne said the agency “has always been in favor of enhanced research for controlled substances such as marijuana.’’  Lauren Ehrsam, a Justice Department spokeswoman, declined to comment....

[Attorney General Jeff] Sessions frequently speaks harshly about marijuana use, and Justice Department officials have been reviewing the policy of his predecessor when it comes to enforcing federal laws on marijuana in states where the drug is legal.  Sessions, too, has called medical marijuana “hyped, maybe too much,” and signaled that he is skeptical about benefits of smoking it.  “Dosages can be constructed in a way that might be beneficial, I acknowledge that, but if you smoke marijuana, for example, where you have no idea how much THC you’re getting, it’s probably not a good way to administer a medicinal amount.  So forgive me if I’m a bit dubious about that,” Sessions said earlier this year.

The DEA is no shrinking violet when it comes to marijuana enforcement.  Last year, Rosenberg declined to lessen restrictions on its use, maintaining its classification as a Schedule 1 controlled substance — which means it has no accepted medical use and a high potential for abuse.  But Rosenberg wrote at the time that the DEA would “support and promote legitimate research regarding marijuana and its constituent parts.”  The DEA, he wrote, already had approved such research, registering 354 people and institutions to study marijuana and related components, including the effects of smoked marijuana on humans.

The DEA indicated at the time it was willing to see those studies expand, asking for applications from people who wanted to grow marijuana to be used for research.  The only source of marijuana for researchers then was — and is — the University of Mississippi, which has permission to grow and distribute the drug for research.

One still-waiting applicant is Lyle Craker, a professor at the University of Massachusetts at Amherst.  Craker has spent years seeking approval to do research into whether other parts of marijuana plants have medicinal value.  “I’ve filled out the forms, but I haven’t heard back from them. I assume they don’t want to answer,’’ said Craker. “They need to think about why they are holding this up when there are products that could be used to improve people’s health . I think marijuana has some bad effects, but there can be some good and without investigation we really don’t know.’’  Craker submitted his latest application Feb. 14, and after getting additional questions from the DEA in March, supplied additional information in April.

Brad Burge, spokesman for the Multidisciplinary Association for Psychedelic Studies, said the federal government for years has prevented important research into marijuana.  “That’s a sad state of affairs,’’ he said, adding, “if the DEA is now asking for permission to say yes, then the resistance is now further up the chain of command.’’

Rosenberg indicated in a call with The Washington Post that he still would support more marijuana research.  “I stand by what I wrote,” he said.  Tension between Rosenberg and Trump is perhaps unsurprising.  Rosenberg was appointed during the Obama administration, and he had served as chief of staff and senior counselor to James B. Comey, who was the FBI director until Trump fired him earlier this year.

The Justice Department has not rejected any of the 25 people whose applications to grow marijuana the DEA is considering. Rather, the department is not taking any action at all, officials said.  Before approving such applications, DEA officials have to assess each applicant and determine whether their facility is secure and whether they had previously been complying with federal law.

August 15, 2017 in Federal Marijuana Laws, Policies and Practices, Medical community perspectives, Medical Marijuana Commentary and Debate, Who decides | Permalink | Comments (0)

Sunday, July 9, 2017

"Is marijuana a secret weapon against the opioid epidemic?"

Regular readers may already be tired of posts here exploring whether marijuana reform may be an important element of modern responses to the modern opioid epidemic.  But until that epidemic is over, I am going to keep posting on this topic.  And the title of this post is the headline of this PRI article is based on an interview that aired on PRI's Science Friday. Here are excerpts:

“Really, if we stopped medical marijuana programs that are now in place in 29 states and Washington, DC … the science suggests we would worsen the opioid epidemic,” says Dina Fine Maron, a medicine and health editor at Scientific American, who wrote a recent story on the subject.

She explains that states with medical marijuana programs have fewer opioid overdose-related deaths than states without medical marijuana — 25 percent fewer, according to a 2014 study cited in her article. “The reality is that the literature right now suggests that if anyone is using an opioid — whether it be a prescription painkiller or something like heroin — a prescription painkiller is more likely [than marijuana] to lead to drug abuse,” she says, “because it’s more addictive and obviously can be more lethal.”...

University of Georgia public policy professor W. David Bradford has studied how legal medical marijuana impacts prescription use by enrollees of Medicare, the federal health insurance program for seniors and the disabled. “What we found … was significant reductions in prescription use, most notably among pain medications, and the largest plurality of those would be opiates,” he says.

Then he researched the effect on enrollees in Medicaid, the federal-state program that helps the poor and people with disabilities pay for health care. “We redid the study for Medicaid just this past month in Health Affairs and, again, found large reductions in the use of prescription pain medications when states turned on medical cannabis laws.”...

Legal medical marijuana isn’t a silver bullet for the complex US opiate crisis, Bradford says. But while dozens of people in the US die each day from opioids, there has never been a fatal overdose documented from marijuana alone. “The National [Academies] of Sciences, Engineering, and Medicine just this past January issued a comprehensive report where they said there is conclusive evidence that cannabis can be effective at managing pain,” he says. “So, to the extent we can divert people from initially starting on opiates through legitimate prescriptions, we divert them from the path of abuse and then the path of death,” he adds. “And it does seem that cannabis could be one tool in the arsenal to do that.”

Some prior related posts:

July 9, 2017 in Medical community perspectives, Medical Marijuana Data and Research | Permalink | Comments (1)

Friday, July 7, 2017

University of Maryland pharmacy school partnering with Americans for Safe Access on medical marijuana instruction

Download (2)As an academic working at a large state university believing in the importance of training students about marijuana law, policy and reform, I am always extra interested hearing about academics at other large state universities working in this space.  One such story is covered in this new AP article with the sub-headline "The University of Maryland School of Pharmacy will begin offering training to prepare prospective workers for the medical marijuana industry." Here are some of the notable details:

The University of Maryland School of Pharmacy will begin offering training to prepare prospective workers for the medical marijuana industry. The move puts the Baltimore school in league with few other established universities and colleges, including the University of Vermont College of Medicine's Department of Pharmacology, seeking to bring educational standards to a growing national industry that grapples with evolving science and uncertain legal standing.

"We wanted to be there as a resource," said Magaly Rodriguez de Bittner, a pharmacy professor and executive director of the school's Center for Innovative Pharmacy Solutions, which began signing up potential workers for training June 29.  "If you're going to be dispensing," she said, "let's make sure your staff in trained in best practices to do it safely and effectively."

The pharmacy school will offer classes through its online platform toward certifications required under the state's medical marijuana law for those involved in the business.  It's partnering with the advocacy group Americans for Safe Access on the certification program. That organization will provide the instructors and the curriculum, which the school vetted and adjusted.

Training doesn't mean an endorsement of using marijuana by the school, a well-regarded institution founded in 1841, Rodriguez de Bittner said.  Medical marijuana is not approved by the U.S. Food and Drug Administration. The school had an online platform to offer the training and a mission to provide education to health care providers, even if the science and government regulation has yet to catch up with demand, she said.

Few universities even support research into medical uses for cannabis, largely because accessing the plant is restricted by federal law that categorizes it the same as heroin and LSD.  And though Maryland, 28 other states and the District of Columbia have made medical marijuana legal, the administration of President Donald Trump has signaled it could increase enforcement efforts.

Some large health systems in Maryland are concerned enough to ask their doctors not to recommend the drug, including LifeBridge Health and MedStar Health.  Johns Hopkins Medicine and the University of Maryland Medical System still are formulating policies.  Maryland's medical marijuana rules don't obligate doctors to get specific training before prescribing cannabis, but like other states it does require growers, processors, dispensaries and laboratories to be "certified," said Patrick Jameson, executive director of the Maryland Medical Cannabis Commission....

The pharmacy school's partnership with Americans for Safe Access gives the nonprofit advocacy group "immediate legitimacy" for its courses, said Shad Ewart, a professor at Anne Arundel Community College, who teaches a course about the marijuana industry for credit but not yet industry certification.  He said the school also benefits because officials there had to do little legwork in developing a curriculum that could have taken months or years to produce on their own. (University officials said they reviewed the content and made it conform to educational norms.)

Still, Ewart understands many colleges and universities don't want to jeopardize federal funding for research, student loans or other programs by wading into the medical marijuana arena.  He said there was a need, and in his case, demand particularly from students who wanted to launch their own businesses.  He said he steers students to focus on ancillary operations such as security, marketing, accounting and retail. "If the legislation says you must have fencing with video surveillance, well, that's good for the fencing and video industries," he said.

Jahan Marcu, chief science officer for Americans for Safe Access, said the group has been offering training since 2002 when there were approximately 11 dispensaries around the country. Instruction initially focused only on "survival," which meant how to handle law enforcement.  Now that there are several thousand businesses, the training has evolved to match what's required by states that allow medical marijuana for each type of operation from growing and processing to retailing and laboratory testing, he said.  Courses offer instruction about laws and regulations; the latest evidence on uses for medical marijuana; plant and product consistency; pesticides; sanitation; operating procedures; labeling, inventory control and record keeping; and other relevant information....

Marcu said his group is not the largest marijuana educator, though it's not clear anyone is keeping track. Among others offering instruction are Cannabis Training Institute, THC University and Green Cultured. In addition to such new "universities" dedicated to medical marijuana certification, there are some medical societies and health departments offering training. The university affiliation, Marcu hopes, will bring some accountability and possibly standards that others could adopt.

Rodriguez de Bittner said since launch of the training site, there has been interest from potential workers in Maryland, West Virginia, California and the District of Columbia. "There is so much out there," she said. "We're trying to partner and provide courses based on the best evidence — as it develops."

July 7, 2017 in Business laws and regulatory issues, Medical community perspectives, Who decides | Permalink | Comments (0)

Wednesday, July 5, 2017

"Cannabis use and psychotic-like experiences trajectories during early adolescence: the coevolution and potential mediators"

OlalertbannerThe title of this post is the title of this notable new article appearing in the Journal of Child Psychology and Psychiatry authored by Josiane Bourque, Mohammad H. Afzali, Maeve O'Leary-Barrett, and Patricia Conrod. Here is the abstract:

Background

The authors sought to model the different trajectories of psychotic-like experiences (PLE) during adolescence and to examine whether the longitudinal relationship between cannabis use and PLE is mediated by changes in cognitive development and/or change in anxiety or depression symptoms.

Methods

A total of 2,566 youths were assessed every year for 4-years (from 13- to 16-years of age) on clinical, substance use and cognitive development outcomes. Latent class growth models identified three trajectories of PLE: low decreasing (83.9%), high decreasing (7.9%), and moderate increasing class (8.2%). We conducted logistic regressions to investigate whether baseline levels and growth in cannabis use were associated with PLE trajectory membership. Then, we examined the effects of potential mediators (growth in cognition and anxiety/depression) on the relationship between growth in cannabis use and PLE trajectory.

Results

A steeper growth in cannabis use from 13- to 16-years was associated with a higher likelihood of being assigned to the moderate increasing trajectory of PLE [odds ratio, 2.59; 95% confidence interval (CI), 1.11–6.03], when controlling for cumulative cigarette use. Growth in depression symptoms, not anxiety or change in cognitive functioning, mediated the relationship between growth in cannabis use and the PLE moderate increasing group (indirect effect: 0.07; 95% CI, 0.03–0.11).

Conclusions

Depression symptoms partially mediated the longitudinal link between cannabis use and PLE in adolescents, suggesting that there may be a preventative effect to be gained from targeting depression symptoms, in addition to attempting to prevent cannabis use in youth presenting increasing psychotic experiences.

July 5, 2017 in Medical community perspectives, Medical Marijuana Data and Research, Recreational Marijuana Data and Research | Permalink | Comments (3)

Tuesday, July 4, 2017

Can marijuana help dogs enjoy holiday fireworks?

FourthThe somewhat silly question in the title of this post is prompted by this not-so-silly new NPR article headlined "Some Marijuana-Derived Treatments Aim To Soothe Skittish Pets." As a pet owner with a dog who really dislikes fireworks, I could not resist blogging about what some folks think could be a Fourth of July tonic for freaked out Fidos.  Here is an excerpt from the lengthy article:

Along with picnics and barbecues, the Fourth of July brings a less pleasant yearly ritual for many dog lovers: worrying about a family pooch who panics at the sound of firecrackers.

Betsy and Andy Firebaugh of Santa Cruz, Calif., have reason for concern. They live on a mountain ridge overlooking the Pacific Ocean — a usually peaceful scene, except at this time of year, when people illegally set off firecrackers at local beaches. The explosive booms send their otherwise happy Australian shepherd — Seamus — into a frenzy....

But to quell the dog's nerves this year, they say, they may try something new: giving him a squirt of an extract of marijuana that's mostly cannabidiol (CBD), a component of the cannabis plant that, unlike a better-known component, THC, doesn't induce a high. CBD has drawn a lot of attention in recent years from neurologists and other researchers intrigued by hints that the chemical might prove helpful to people; there's been preliminary study of possible benefits in reducing chronic pain, anxiety and seizures in humans, for example. So it's probably no surprise that some folks are interested in CBD's therapeutic potential for Fido or Fluffy, too.

Betsy initially got a prescription for medical marijuana to help with her own joint pain. While at the medical marijuana dispensary, she also picked up a vial of CBD oil designed for pets, on the advice of the manager. The supplement has already yielded good results in their other dog, Angus — a sweet blue merle Aussie who was abused as a puppy by previous owners, and still sometimes "becomes Frankendog" around canine strangers, Betsy says. Occasional doses of the cannabis extract in high-stress situations, she says, help to mellow him out.

The Firebaughs aren't the only ones exploring marijuana-based therapies for man's best friend. A growing number of firms are marketing CBD for noise anxiety and other ailments in companion animals. Denver-based Therabis specifically advertises one of its hemp-derived CBD supplements as an aid to help dogs get through the Fourth of July. And the Los Angeles-based makers of VetCBD oil say that early July, along with New Year's Eve, is one of their busiest sales periods. Animal shelters tend to see an increased influx of runaway pets around the two holidays — because of fireworks, notes VetCBD's founder Tim Shu, who is also a veterinarian.

Still, cannabis therapies for pets fall into a legal gray zone. While numerous states, including California, have legalized medical marijuana and/or recreational pot for people, cannabis remains federally illegal, and the U.S. Drug Enforcement Administration recently clarified that it considers CBD extracts unlawful too. None of the cannabis-derived products for pets are approved by the Food and Drug Administration, and state licensing agencies, such as the California Veterinary Medical Board, don't allow veterinarians to prescribe them.

Shu says marijuana has long had a bad reputation in the veterinary community, which has seen many ER cases of dogs suffering toxic effects from gobbling down their owners' marijuana stash or edibles. Large doses of THC, the chemical that produces pot's intoxicating effects, can cause wobbliness, disorientation, vomiting and loss of bladder control in canines.

But the premise of companies selling cannabis-derived products for pets is that non-psychoactive CBD, in combination with a small amount of THC, can be beneficial. For instance, Shu's VetCBD oil contains a 20:1 ratio of CBD to THC, a formulation he says he developed in a quest to aid his own elderly dog, Tye, a mixed pit bull breed. Tye has arthritic pain and fireworks anxiety, the veterinarian says, but can't handle the side effects of standard veterinary medications.

By experimenting with Tye and other patients in his practice, Shu came up with his cannabidiol concoction — which is extracted from organic cannabis flowers — and a variety of specific dosages for pets of different sizes. Tye's mobility has since improved, Shu says, and "I can actually walk her outside during Fourth of July fireworks. For a lot of owners, it's a night-and-day difference."

Such anecdotes may sound compelling, but some other vets say they'd like to see scientific evidence. Brennen McKenzie, a veterinarian in Los Altos, Calif., writes the SkeptVet blog and is on the board of the Evidence-Based Veterinary Medicine Association. In regards to CBD, McKenzie says, "we have virtually no research in pets, so we are guessing and extrapolating."

July 4, 2017 in Medical community perspectives, Medical Marijuana Commentary and Debate | Permalink | Comments (2)

Monday, June 26, 2017

"Lower-Risk Cannabis Use Guidelines: A Comprehensive Update of Evidence and Recommendations"

Ajph-logoThe title of this post is the title of this notable new article by multiple authors to soon appear in the American Journal of Public Health.  Here is the abstract:

Background.  Cannabis use is common in North America, especially among young people, and is associated with a risk of various acute and chronic adverse health outcomes.  Cannabis control regimes are evolving, for example toward a national legalization policy in Canada, with the aim to improve public health, and thus require evidence-based interventions.  As cannabis-related health outcomes may be influenced by behaviors that are modifiable by the user, evidence-based Lower-Risk Cannabis Use Guidelines (LRCUG) — akin to similar guidelines in other health fields — offer a valuable, targeted prevention tool to improve public health outcomes.

Objectives. To systematically review, update, and quality-grade evidence on behavioral factors determining adverse health outcomes from cannabis that may be modifiable by the user, and translate this evidence into revised LRCUG as a public health intervention tool based on an expert consensus process.

Search methods. We used pertinent medical search terms and structured search strategies, to search MEDLINE, EMBASE, PsycINFO, Cochrane Library databases, and reference lists primarily for systematic reviews and meta-analyses, and additional evidence on modifiable risk factors for adverse health outcomes from cannabis use.

Selection criteria. We included studies if they focused on potentially modifiable behavior-based factors for risks or harms for health from cannabis use, and excluded studies if cannabis use was assessed for therapeutic purposes.

Data collection and analysis. We screened the titles and abstracts of all studies identified by the search strategy and assessed the full texts of all potentially eligible studies for inclusion; 2 of the authors independently extracted the data of all studies included in this review.  We created Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow-charts for each of the topical searches.  Subsequently, we summarized the evidence by behavioral factor topic, quality-graded it by following standard (Grading of Recommendations Assessment, Development, and Evaluation; GRADE) criteria, and translated it into the LRCUG recommendations by the author expert collective on the basis of an iterative consensus process.

Main results. For most recommendations, there was at least “substantial” (i.e., good-quality) evidence.  We developed 10 major recommendations for lower-risk use: (1) the most effective way to avoid cannabis use–related health risks is abstinence; (2) avoid early age initiation of cannabis use (i.e., definitively before the age of 16 years); (3) choose low-potency tetrahydrocannabinol (THC) or balanced THC-to-cannabidiol (CBD)–ratio cannabis products; (4) abstain from using synthetic cannabinoids; (5) avoid combusted cannabis inhalation and give preference to nonsmoking use methods; (6) avoid deep or other risky inhalation practices; (7) avoid high-frequency (e.g., daily or near-daily) cannabis use; (8) abstain from cannabis-impaired driving; (9) populations at higher risk for cannabis use–related health problems should avoid use altogether; and (10) avoid combining previously mentioned risk behaviors (e.g., early initiation and high-frequency use).

Authors’ conclusions. Evidence indicates that a substantial extent of the risk of adverse health outcomes from cannabis use may be reduced by informed behavioral choices among users.  The evidence-based LRCUG serve as a population-level education and intervention tool to inform such user choices toward improved public health outcomes.  However, the LRCUG ought to be systematically communicated and supported by key regulation measures (e.g., cannabis product labeling, content regulation) to be effective.  All of these measures are concretely possible under emerging legalization regimes, and should be actively implemented by regulatory authorities.  The population-level impact of the LRCUG toward reducing cannabis use–related health risks should be evaluated.

Public health implications. Cannabis control regimes are evolving, including legalization in North America, with uncertain impacts on public health.  Evidence-based LRCUG offer a potentially valuable population-level tool to reduce the risk of adverse health outcomes from cannabis use among (especially young) users in legalization contexts, and hence to contribute to improved public health outcomes.

June 26, 2017 in Medical community perspectives, Medical Marijuana Data and Research, Recreational Marijuana Data and Research | Permalink | Comments (0)

Wednesday, June 21, 2017

Might marijuana reform help address the obesity epidemic?

The question in the title of this post is prompted by this notable new New York Daily News article headlined "Science: Regular consumption of marijuana keeps you thin, fit and active." I am not sure the article that follows entire backs up the implication of this headline, but here are excerpts from the article that are still encouraging:

An apple a day keeps the doctor away. Here’s a new health-related adage to consider: Regular consumption of marijuana keeps you thin and active. According to researchers at Oregon Health and Science University, people who use marijuana more than five times per month have a lower body mass index (BMI) than people who do not marijuana.

The researchers concluded: “Heavy users of cannabis had a lower mean BMI compared to that of never users, with a mean BMI being 26.7 kg/m in heavy users and 28.4 kg/m in never users.”

The study also suggested that people who consume marijuana on a regular basis are more physically activity than those that use it sporadically or not at all.

Of course, this is not the first time scientific studies have reached this conclusion: A study published last year in the Journal of Mental Health Policy and Economics suggests that regular consumers of cannabis have a lower BMI than those who do not use the drug.

A 2013 study published in the American Journal of Medicine found that cannabis consumers have 16 percent lower levels of fasting insulin and 17 percent lower insulin resistance levels than non-users. The research found “significant associations between marijuana use and smaller waist circumferences.”

And data published in British Medical Journal in 2012 reported that cannabis consumers had a lower prevalence of type 2 diabetes and a lower risk of contracting the disease than did those with no history of cannabis consumption.

In the 2016 study, lead author Isabelle C. Beulaygue from the University of Miami concluded: “There is a popular belief that people who consume marijuana have the munchies, and so [THEY]are going to eat a lot and gain weight, and we found that it is not necessarily the case.”

Researchers have not identified the reason behind the findings. But some suggest that those who consume cannabis regularly may be able to more easily break down blood sugar, which may help prevent weight gain.

June 21, 2017 in Food and Drink, Medical community perspectives, Medical Marijuana Data and Research, Recreational Marijuana Data and Research | Permalink | Comments (0)

Monday, June 12, 2017

Noting some interesting new data on modern trends in marijuana addiction treatment

ImrsKeith Humphreys has this interesting new piece at the Washington Post's Wonkblog headlined "More people are voluntarily seeking help for marijuana addiction." Here, along with the reprinted graph, is the interesting data story he is reporting on:

As marijuana has been increasingly liberalized and decriminalized, fewer people are finding themselves in court-mandated programs for marijuana addiction treatment.  This is not particularly surprising: With fewer people landing in court for using marijuana, it follows that fewer would be sentenced to treatment for it.  But while mandatory treatment is falling, evidence suggests that the number of people voluntarily seeking treatment is rising.

The blue part of each bar in the chart is drawn from annual surveys assessing court-referred marijuana patients in public sector addiction-treatment programs, which have dropped 40 percent since 2011.   The orange part of each bar captures data from an annual national population survey that asks marijuana-using individuals about treatment they have received in the past year.  It covers a much broader range of settings than the survey of substance-use treatment programs, including help-seeking with physicians, psychologists, school nurses, urgent care clinic staff and self-help groups.  Most marijuana-treatment-seeking in these settings is voluntary, and court-mandated public sector addiction treatment has been excluded from the data reflected in the orange part of the bars.

The overall number of people receiving marijuana-addiction treatment is fairly stable.  This suggests that the decline in court-mandated treatment is being compensated for by an increase in voluntary treatment seeking.  The rise in voluntary admissions will likely surprise people who think marijuana is harmless and that, therefore, no one would seek treatment for it without legal pressure.  But marijuana-addiction treatment will probably be more rather than less widely sought as legalization spreads, for two reasons.

First, although marijuana has a benign reputation, about 9 percent of users report becoming addicted to it.  Because marijuana consumption is soaring, that 9 percent is becoming a larger absolute number of people, some of whom will seek treatment not because the legal system makes them but because they are genuinely experiencing problems with the drug.

Second, The Netherlands has long made marijuana legally available in licensed cafes with no legal pressure to seek treatment.  Yet the Dutch have the highest rate of seeking marijuana treatment in Europe.  The U.S. could very easily end up with a Dutch future: little legal pressure on marijuana users to seek treatment, but substantial desire among them to do so voluntarily.

June 12, 2017 in Medical community perspectives, Recreational Marijuana Data and Research | Permalink | Comments (0)

Wednesday, May 31, 2017

Head of Veterans Affairs acknowledges marijuana may be "helpful" to veterans

This notable new article from The Hill reports on notable new comments by the head of the federal Veterans Affairs department.  The piece is headlined "VA chief: Medical marijuana could help vets," and here are excerpts:

Veterans Affairs Secretary David Shulkin said Wednesday he's open to expanding the use of medical marijuana to help service members suffering from post-traumatic stress disorder (PTSD), but noted it’s strictly limited by federal law.  “There may be some evidence that this is beginning to be helpful and we’re interested in looking at that and learning from that,” Shulkin told reporters, pointing to states where medical pot is legal.

The VA has come under pressure from some influential veterans groups, including the American Legion, to reclassify marijuana to allow federal research into its effect on troops with PTSD or traumatic brain injuries....

“Right now, federal law does not prevent us at VA to look at that as an option for veterans,” said Shulkin, who is a trained physician. “I believe that everything that could help veterans should be debated by Congress and by medical experts and we will implement that law."

Relaxing enforcement of marijuana laws, however, would conflict with several top administration officials who take a hard-line approach on drugs, including Attorney General Jeff Sessions. Shulkin, who spoke at the White House about President Trump’s proposed reforms at the scandal-plagued agency, is a holdover from the Obama administration. The Senate confirmed him unanimously in February to lead the VA.

Some prior related posts:

May 31, 2017 in Campaigns, elections and public officials concerning reforms, Federal Marijuana Laws, Policies and Practices, Medical community perspectives, Medical Marijuana Commentary and Debate | Permalink | Comments (0)

Wednesday, May 24, 2017

Encouraging new research about CBD as an effective treatment for Dravet syndrome

ImagesAs reported in this NBC News piece, headlined "Cannabis Drug Reduces Seizures in Severe Epilepsy Cases," some encouraging new research news was published in a major medical journal today. Here are the details:

A compound taken from marijuana greatly helped some children with a severe and often deadly form of epilepsy and completely stopped seizures in a very few, researchers reported Wednesday.  It's a rare success in a field suffused with more hope than facts — in which advocates clamor to have marijuana and compounds taken from the herb legalized for free use, while government rules limit use and researchers struggle to prove what works and what doesn't.

In this study, the researchers enrolled kids with Dravet syndrome, a very rare and often deadly form of epilepsy caused by a genetic mutation.  These kids have multiple, prolonged seizures that cause brain damage. There's no treatment. "It's hard to portray how serious and devastating this is," Dr. Orrin Devinsky, director of the New York University Comprehensive Epilepsy Center, told NBC News.

Devinsky and colleagues around the country tested a cannabis derivative called cannabidiol — CBD for short — on 120 Dravet syndrome patients.  Half took it for 14 weeks and half got a placebo.

"Seizure frequency dropped in the cannabidiol-treated group by 39 percent from nearly 12 convulsive seizures per month before the study to about six; three patients' seizures stopped entirely," the team wrote in the New England Journal of Medicine.  "In the placebo group, there was a 13 percent reduction in seizures from about 15 monthly seizures to 14," they added.

"Quite remarkably, 5 percent of the children in the active treatment group with CBD were completely seizure free during the 14 weeks of the trial," Devinsky said. "And these were kids who were often having dozens of seizures, if not many more than that per week."

The kids who got CBD were more likely to stop the trial because of side-effects. "Side-effects were generally mild or moderate in severity, with the most common being vomiting, fatigue and fever," Devinsky wrote.  But those who have been helped have been transformed, he added. "There's no doubt for some children this is just been an incredibly effective and game changing medication for them," Devinsky said.

"These are some of the children I care for [who] were in wheelchairs, were barely able to open their eyes in an office visit and really showed no emotion and … now they come in, they're walking, they're smiling, they're interactive. It's like a different human being in front of you."

He said it's not quite accurate to called CBD "medical marijuana."

"Cannabidiol is the major non-psychoactive compound present in cannabis or marijuana," Devinsky said.  "In this study, we were giving a compound CBD which has no high-producing or psychoactive properties."...

"The drug we gave was derived from cannabis or marijuana but it really should not be confused with the medical marijuana that would be obtained from dispensaries in the 44 U.S. states that have approved it. Those typically contain combinations of THC with CBD and many other compounds," Devinsky said.

It's not clear precisely how CBD works. It appears to attach to brain cells, he said. "The CBD binds with a novel receptor in the brain and thereby dampens down too much electrical activity," he said. "It seems to be a relatively unique mechanism of action that's not shared by any of the existing seizure medications."

Doctors are interested in trying CBD on autism, anxiety, inflammatory and autoimmune disorders, Devinsky said.  It may help people with other types of seizures, as well....

Australian epilepsy expert Dr. Samuel Berkovic said much more testing is needed. "This trial represents the beginning of solid evidence for the use of cannabinoids in epilepsy," Berkovic, who works at the University of Melbourne, wrote in a commentary.

May 24, 2017 in Medical community perspectives, Medical Marijuana Commentary and Debate, Medical Marijuana Data and Research | Permalink | Comments (0)