Marijuana Law, Policy & Reform

Editor: Douglas A. Berman
Moritz College of Law

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)

Friday, May 19, 2017

"New potential for marijuana: Treating drug addiction"

The title of this post is the headline of this lengthy CNN piece.  Here are excerpts:

Most European countries and Canada have embraced the idea of harm reduction, designing policies that help people with drug problems to live better, healthier lives rather than to punish them. On the front lines of addiction in the United States, some addiction specialists have also begun to work toward this end.

Joe Schrank, program director and founder of High Sobriety, is one of them. He says his Los Angeles-based treatment center uses medicinal cannabis as a detox and maintenance protocol for people who have more severe addictions, although it's effectiveness is not scientifically proven. "So it's a harm-reduction theory," he said. "With cannabis, there is no known lethal dose; it can be helpful for certain conditions."

"Some say it's hypocritical because, you know, you're supposed to go to rehab to get off drugs," said Schrank, who recently celebrated 20 years of sobriety from alcohol and all drugs. "And cessation of drug use can be a goal for some people, but pacing is also important." Some patients want to gradually move into abstinence, weaning themselves off drugs over time. Others want to maintain sobriety from a drug by using a less harsh drug, such as cannabis.

Others, including Todd Stumbo, CEO of Blue Ridge Mountain Recovery Center in Georgia, do not favor using marijuana as treatment for addiction. "I'm all about adding interventions and therapeutic techniques that have proven to be significantly profound in the changes to somebody's life and treatment. Unfortunately, I don't know that there's evidence to substantiate that marijuana's had that effect," says Stumbo. "Our take is abstinence based and we use every tool or intervention we can that's been proven effective in the past."

Still, harm reduction is gaining acceptance in the wider field of addiction specialists in the U.S. "In principle, what we have aimed for many years is to find interventions that would lead to complete abstinence," said Dr. Nora Volkow, director of the National Institute on Drug Abuse. Practically, though, that has been very difficult to achieve with relapsing addictions.

"One of the things is, we don't have any evidence-based medication that has proven to be efficacious for the treatment of cocaine addiction," Volkow said. "So we currently have no medicine to intervene, and it can be a very severe addiction and actually quite dangerous."...

"We have started to explore the extent to which interventions that can decrease the amount of drug consumed can have benefits to the individual," Volkow said, adding that she'd make this same argument for opioids and heroin. "It would be valuable to decrease the amount of drug consumed."...

Schrank, who readily concedes there are possible health and addiction risks with marijuana, says he offers his cannabis detox and maintenance protocol to people addicted to crack cocaine as well as those trying to kick opioids. Through the years, he says, he's treated about 50 people with this technique and expects to see "more people wanting to try to have a voice in their recovery rather than just plug into systems telling them what to do." Marijuana "can really help people with pain management and other health issues, or it can help them be safer," Schrank said.

Yasmin Hurd, director of the Addiction Institute at Mount Sinai School of Medicine, says generally, cannabidiol is the more important compound when it comes to marijuana as a treatment for addiction. It is one of the two primary cannabinoids, along with Δ9-tetrahydrocannabinol (THC), found in the cannabis plant. In terms of the wider scope of medical marijuana research, this is the "same cannabidiol being looked at for the kids with epilepsy," Hurd said.

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

Thursday, May 18, 2017

Minnesota health department reports "perceptions of a high degree of benefit for most patients" in state's medical marijuana program

Rsz-minnesota-patients-with-chronic-pain-now-qualify-for-medical-marijuana-640x401Minnesota's medical marijuana program has garnered some headlines this week in part because of reports of big economic losses being suffered by industry players.   As this local article details, "Minnesota's medical marijuana manufacturing companies have lost $11 million in just two years of sales."  But the story emerging from the state this week that seems greater potential import and impact concerns a state study of patients noted this AP piece headlined  "Study: Minnesota medical marijuana patients report benefits."

The study comes from the Minnesota Department of Health and is titled "Minnesota Medical Cannabis Program: Patient Experiences from the First Program Year."  The complete report is due to to be released next month, but this Executive Summary was released this week and includes these passages:

Between July 1, 2015 and June 30, 2016 a total of 1660 patients enrolled in the program and 577 health care practitioners registered themselves in order to certify that patients have a medical condition that qualifies them for the program. The most common qualifying conditions were severe and persistent muscle spasms (43%), cancer (28%), and seizures (20%). Each of the remaining six qualifying conditions during the first year – Crohn’s Disease, Terminal illness, HIV/AIDS, Tourette Syndrome, glaucoma, and ALS – accounted for less than 10% of patients. Ten percent (167 patients) were certified for more than one qualifying condition. Most patients were middle-aged (56% between ages 36-64), 11% were <18, and 11% were ≥65. Distribution by race/ethnicity generally matched the state’s demographics, with 90% of patients describing themselves as white....

Information on patient benefits comes from the Patient Self-Evaluations (PSE) completed by patients prior to each medical cannabis purchase and from patient and health care practitioner surveys. Results of analysis of PSE and survey data indicate perceptions of a high degree of benefit for most patients....

Moderate to severe levels of non-disease-specific symptoms such as fatigue, anxiety, and sleep difficulties were common across all the medical conditions. And the reductions in these symptoms was often quite large. These findings support the understanding that some of the benefit perceived by patients is expressed as improved quality of life.

May 18, 2017 in Medical community perspectives, Medical Marijuana Commentary and Debate, Medical Marijuana Data and Research, Medical Marijuana State Laws and Reforms | Permalink | Comments (0)

Tuesday, April 25, 2017

"Marijuana may be a miracle treatment for children with autism"

Images (1)The title of this post is the headline of this notable new USA Today article.  I generally have a tendency to be skeptical of the tendency of some marijuana reform advocates to claim that marijuana is a "miracle plant" that can safely cure every possible ailment.  But I also generally have a tendency to believe there is a whole lot we still do not know about how the cannabis plant might impact brain functioning, and thus I do not wish to be immediately dismissive of serious research making serious claims about cannabis being helpful in dealing with a serious medical problem.   With that prelude, here are a few excerpts from the USA Today piece:

There is anecdotal evidence that marijuana’s main non-psychoactive compound — cannabidiol or CBD — helps children in ways no other medication has. Now this first-of-its-kind scientific study [in Israel] is trying to determine if the link is real.

Israel is a pioneer in this type of research. It permitted the use of medical marijuana in 1992, one of the first countries to do so. It's also one of just three countries with a government-sponsored medical cannabis program, along with Canada and the Netherlands. Conducting cannabis research is also less expensive here and easier under Israeli laws, particularly compared to the United States, which has many more legal restrictions.

Autism is one of the fastest-growing developmental disorders, affecting 1 in 68 children in the United States, according to the Centers for Disease Control and Prevention. Its debilitating symptoms include impaired communication and social skills, along with compulsive and repetitive behaviors. Autism typically emerges in infancy or early childhood. Advocates for combating the disorder are calling attention to it by declaring April National Autism Awareness Month....

Only two medications have been approved in the United States by the Food and Drug Administration to treat the symptoms of autism. Both are antipsychotic drugs that are not always effective and carry serious side effects....

Adi Aran, the pediatric neurologist leading the study, said nearly all the participants previously took antipsychotics and nearly half responded negatively. Yael desperately pushed Aran and other doctors to prescribe cannabis oil after a news report aired about a mother who illegally obtained it for her autistic son and said it was the only thing that helped him. “Many parents were asking for cannabis for their kids,” Aran said. “First I said, 'No, there’s no data to support cannabis for autism, so we can’t give it to you.'”

He said that changed about a year ago after studies in Israel showed that cannabis helped children with epilepsy by drastically reducing seizures and improving behavior for those who also have autism. Epilepsy afflicts about 30% of autistic children, Aran said. Mounting anecdotal reports of autistic children who benefited from cannabis also led Aran to pursue more scientific testing. After seeing positive results in 70 of his autistic patients in an observational study, Aran said, “OK we need to do a clinical trial so there will be data."...

Aran cautioned against premature conclusions about cannabis as a treatment for autism, but he said many children have shown significant improvements. Some no longer hurt themselves or throw tantrums. Some are more communicative. Others were able to return to classes after they had been suspended for behavioral problems....

Tamir Gedo, CEO of Breath of Life Pharma, which provides the cannabis oil for the study, said one mother reported, "My child is speaking relentlessly. … He never spoke before. And he's 12 years old.” One major concern is the long-term impact of prescribing cannabis to young patients, said Sarah Spence, co-director of the Autism Spectrum Center at Boston Children’s Hospital. “There certainly could be harm” to brain development, she said. But opioids and antipsychotic drugs currently prescribed to children are more harmful, said Gedo. “These families have no other hope.”

Notably, there is an advocacy group for treating autism with medical marijuana known as MAMMA, Mothers Advocating Medical Marijuana for Autism.

April 25, 2017 in Medical community perspectives, Medical Marijuana Commentary and Debate | Permalink | Comments (2)

Wednesday, March 29, 2017

Yet another serious study finds link between medical marijuana reforms and reduced opioid problems

Regular readers might be getting a bit bored by regular posts here highlighting research showing reductions in opioid use and problems in states that have legalized medical marijuana.  But, especially with the Trump Administration reportedly about to create a new commission to tackle opioid problems, I do not think the research in this arena can be given too much attention.  And, perhaps especially helpful for purposes of influencing the Trump Administration, FoxNews Health here is discussing the latest research under the headline "Would legalizing medical marijuana help curb the opioid epidemic?". The article starts this way:

In states that legalized medical marijuana, U.S. hospitals failed to see a predicted influx of pot smokers, but in an unexpected twist, they treated far fewer opioid users, a new study shows.

Hospitalization rates for opioid painkiller dependence and abuse dropped on average 23 percent in states after marijuana was permitted for medicinal purposes, the analysis found. Hospitalization rates for opioid overdoses dropped 13 percent on average.

At the same time, fears that legalization of medical marijuana would lead to an uptick in cannabis-related hospitalizations proved unfounded, according to the report in Drug and Alcohol Dependence.  "Instead, medical marijuana laws may have reduced hospitalizations related to opioid pain relievers," said study author Yuyan Shi, a public health professor at the University of California, San Diego.

"This study and a few others provided some evidence regarding the potential positive benefits of legalizing marijuana to reduce opioid use and abuse, but they are still preliminary," she said in an email.

Dr. Esther Choo, a professor of emergency medicine at Oregon Health and Science University in Portland, was intrigued by the study's suggestion that access to cannabis might reduce opioid misuse.  "It is becoming increasingly clear that battling the opioid epidemic will require a multi-pronged approach and a good deal of creativity," Choo, who was not involved in the study, said in an email.  

"Could increased liberalization of marijuana be part of the solution? It seems plausible." However, she said, "there is still much we need to understand about the mechanisms through which marijuana policy may affect opioid use and harms."...

Shi analyzed hospitalization records from 1997 through 2014 for 27 states, nine of which implemented medical marijuana policies. Her study was the fifth to show declines in opioid use or deaths in states that allow medical cannabis.

Previous studies reported associations between medical marijuana and reductions in opioid prescriptions, opioid-related vehicle accidents and opioid-overdose deaths. In a 2014 study, Dr. Marcus Bachhuber found deaths from opioid overdoses fell by 25 percent in states that legalized medical marijuana.

The study referenced in this press article is available at this link and is titled "Medical marijuana policies and hospitalizations related to marijuana and opioid pain reliever."

March 29, 2017 in Medical community perspectives, Medical Marijuana Commentary and Debate, Medical Marijuana Data and Research | Permalink | Comments (0)

Monday, March 27, 2017

Analyzing risks, restrictions, and barriers for those providing medical marijuana recommendations

As readers know from recent posts, my Marijuana Law, Policy & Reform seminar students deep into their class presentations. And a student this coming week is "analyzing and comparing the risks, restrictions, and barriers providers face for providing recommendations." Here are the materials this student has prepared for background on this topic:

CNN article about physician medical marijuana education

ABA article about Malpractice Liability

Nurse Practitioner article about APRN recommendations

ACP article about Marijuana Hospital Policies

Ohio Medical Marijuana Control Program - Advisory Committee - Physician Rule Presentation - Notice and Comment Review on Proposed Rule

Ohio's Proposed Rule for Physicians (draft as of 03/21)

March 27, 2017 in Business laws and regulatory issues, Medical community perspectives, Medical Marijuana Commentary and Debate, Medical Marijuana State Laws and Reforms, Who decides | Permalink | Comments (0)

Friday, March 24, 2017

Terrific Harvard School of Public Health panel on "Marijuana: The Latest Scientific Findings and Legalization"

Marijuana-web-missed-1-636x358Though other commitments prevented me from watching the event live, I am grateful to have been able to find (and find the time) to watch an hour-long panel discussion on marijuana research and reform today as part of as The Harvard T.H. Chan School of Public Health.  I watched the full video via this page at The Huffington Post, which provides this "preview":

Twenty-eight states and the nation’s capital allow for the legal use of medical marijuana.  The drug is legal for recreational use in eight states and Washington, D.C. But with a new administration in office signaling a crackdown on recreational use, including an attorney general personally opposed to the drug, states are gearing up for a marijuana war.

While medical marijuana has been scientifically proved to ease pain, but the jury is still out on the drug’s other health benefits. A recent study conducted by the National Academies of Sciences, Engineering and Medicine, led by Harvard T.H. Chan School of Public Health professor Marie McCormick, found as much.  Ryan Grim, Washington bureau chief for The Huffington Post, will be joined by McCormick and other policy and research experts for a panel discussion on marijuana’s health benefits and legalization. 

This page at the Harvard School of Public Health indicates that the video will be posted there soon as well, and it provides this additional summary of the event:

California, Massachusetts, Maine, and Nevada became the latest states to legalize recreational marijuana, bringing to 28 the number of states that have okayed the drug for medicinal use, recreational use, or both. Even more states have rules that allow certain kinds of cannabis extracts to be used for medical purposes. At the same time that state legalization is increasing, the Trump administration is signaling that it may ramp up enforcement of federal drug laws, even when they come into conflict with state laws allowing recreational marijuana use. State and local governments may find themselves on uncertain legal ground. Meanwhile, policymakers navigating this new landscape are also working largely without the benefit of a solid foundation of scientific evidence on the drug’s risks and benefits. In fact, a new National Academy of Medicine report describes notable gaps in scientific data on the short- and long-term health effects of marijuana. What do we know about the health impacts of marijuana, and what do we still need to learn? This Forum brought together researchers studying marijuana’s health impacts with policymakers who are working to implement new laws in ways that will benefit and protect public health.

March 24, 2017 in Medical community perspectives, Medical Marijuana Commentary and Debate, Recreational Marijuana Commentary and Debate, Science | Permalink | Comments (0)

Monday, March 6, 2017

Examining studies on marijuana and THC in the treatment of psychiatric diseases and CBD in the treatment of neurological disorders

As recent posts highlight, my Marijuana Law, Policy & Reform seminar is now deep into the part of the semester in which student are making presentation based on their selected marijuana-related research issue. One student this coming week is exploring "the use of THC in the treatment of psychiatric diseases, in comparison to the use of CBD in the treatment of neurological disorders." Here are the studies the student plans to discuss:

Overarching Study:

National Academies of Science

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Studies on the application of CBD to neurological disorders:

Cannabinoids in experimental stroke: a systematic review and meta-analysis

Cannabidiol and endogenous opioid peptide-mediated mechanisms modulate antinociception induced by transcutaneous electrostimulation of the peripheral nervous system

Medical Marijuana in Certain Neurological Disorders

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Studies on the Application of THC to psychological disorders:

Cognitive and clinical outcomes associated with cannabis use in patients with bipolar I disorder.

Chronic Stress Impairs α1-Adrenoceptor-Induced Endocannabinoid-Dependent Synaptic Plasticity in the Dorsal Raphe Nucleus

Antidepressant-like and anxiolytic-like effects of cannabidiol: a chemical compound of Cannabis sativa (illustrating that anxiety, typically thought to be reduced by THC, may experience greater reduction thorough CBD)

March 6, 2017 in Assembled readings on specific topics, Medical community perspectives, Medical Marijuana Commentary and Debate, Medical Marijuana Data and Research | Permalink | Comments (0)

Sunday, March 5, 2017

Examining connections between marijuana reform and opioid epidemic

Friday, March 3, 2017

What might marijuana law look like if we really treated marijuana like a medicine?

The question in the title of this post is the question being raised by a student presentation in in my Marijuana Law, Policy & Reform seminar next week. The student addressing this issue has assembled the following background reading:

1.  Press article: "11 key findings from one of the most comprehensive reports ever on the health effects of marijuana"

2.  Information from the FDA: "What is the approval process for a new prescription drug?"

3.  More from the FDA: "FDA and Marijuana"

4.  Press article: "Most uses of medical marijuana wouldn't pass FDA review, study finds"

5.  Press article: "When Your State Says Yes To Medical Marijuana, But Your Insurer Says No"

March 3, 2017 in Assembled readings on specific topics, Medical community perspectives, Medical Marijuana Commentary and Debate, Medical Marijuana State Laws and Reforms | Permalink | Comments (0)

Thursday, March 2, 2017

"Can we make cannabis safer?"

The title of this post is the title of this notable new piece from a group of doctors appearing in The Lancet Psychiatry.  Here is its summary:

Cannabis use and related problems are on the rise globally alongside an increase in the potency of cannabis sold on both black and legal markets.  Additionally, there has been a shift towards abandoning prohibition for a less punitive and more permissive legal stance on cannabis, such as decriminalisation and legalisation.  It is therefore crucial that we explore new and innovative ways to reduce harm.

Research has found cannabis with high concentrations of its main active ingredient, δ-9-tetrahydrocannabinol (THC), to be more harmful (in terms of causing the main risks associated with cannabis use, such as addiction, psychosis, and cognitive impairment) than cannabis with lower concentrations of THC.  By contrast, cannabidiol, which is a non-intoxicating and potentially therapeutic component of cannabis, has been found to reduce the negative effects of cannabis use.  Here, we briefly review findings from studies investigating various types of cannabis and discuss how future research can help to better understand and reduce the risks of cannabis use.

March 2, 2017 in Medical community perspectives, Medical Marijuana Commentary and Debate, Recreational Marijuana Commentary and Debate | Permalink | Comments (0)

Tuesday, February 21, 2017

"Can Marijuana Ease the Opioid Epidemic?"

The question in the title of this post is the headline of this new Stateline piece.  Regular readers may be tired of my repeated emphasis on the possible connections between the nation's opioid problems and marijuana reform, but I continue to consider the story very important and I am especially troubled to see so little attention seemingly given to these matters by those on the front-lines of the opioid epidemic.  Here are excerpts from the Stateline piece (which discusses medical marijuana more generally):

In the midst of an opioid crisis, some medical practitioners and researchers believe that greater use of marijuana for pain relief could result in fewer people using the highly addictive prescription painkillers that led to the epidemic.

A 2016 study by researchers at Johns Hopkins Bloomberg School of Public Health found that states with medical marijuana laws had 25 percent fewer opioid overdose deaths than states that do not have medical marijuana laws. And another study published in Health Affairs last year found that prescriptions for opioid painkillers such as OxyContin, Vicodin and Percocet paid for by Medicare dropped substantially in states that adopted medical marijuana laws.

In December, the New York Health Department said it would start allowing some patients with certain types of chronic pain to use marijuana as long as they have tried other therapies. The state’s original medical marijuana law, along with those in Connecticut, Illinois, New Hampshire and New Jersey, did not include chronic pain as an allowable condition for marijuana use, in part over concerns that such a broad category of symptoms could result in widespread and potentially inappropriate use of the controversial medicine.

Advocates for greater use of medical marijuana argue that including chronic pain as an allowable condition could result in even further reductions in dangerous opioid use. But some physicians remain cautious about recommending the botanical medicine as a pain management tool.

Dr. Jane Ballantyne, a pain specialist at the University of Washington and president of Physicians for Responsible Opioid Prescribing, which promotes the use of alternatives to opioids for chronic pain, said she does not recommend that her patients try marijuana. “There is no doubt marijuana is much safer than opiates. So we don’t discourage its use.” But in general, she said, “non-drug treatments are far more helpful than any drug treatment, and marijuana is a drug.”

At Mount Sinai Hospital here in the city, Dr. Houman Danesh, director of integrative pain management, suggests patients try physical therapy, yoga, acupuncture, stem cell therapy, nutrition counseling, hypnosis and behavioral health counseling before resorting to opioids or any other medications. He said lack of sufficient research to back up marijuana’s safety and efficacy has kept him from adding it to his pain management toolkit, but he doesn’t rule it out in the near future....

Dr. Howard Shapiro, started certifying patients for marijuana about a year ago and quickly became a believer. He’s one of only 371 doctors out of nearly 33,000 in [New York] City’s five boroughs registered to certify patients for medical marijuana. Statewide, only 863 out of roughly 96,000 physicians have signed up for the program....

As a primary care doctor who takes a holistic approach to medicine, Shapiro said trying medical marijuana was a natural for him. But he said he worried that “a bunch of druggies would start showing up.” Instead, he said the patients he began seeing were all very sick and none of them appeared to be seeking drugs for fun. The improvement he saw in those first patients was remarkable, he said. “I really think medical marijuana is the drug of the future,” Shapiro said. “We’re going to find out that it does a lot of things we already think it can do, but don’t have scientific studies to prove it.”

Out of 109 patients he’s seen over the past year, all but a handful reported substantial improvement in their pain and other symptoms within a month or two of using medical marijuana, he said. For Shapiro’s patients, the cost of marijuana treatment ranges from $300 to $400 a month, depending on their level of use.

February 21, 2017 in Medical community perspectives, Medical Marijuana Commentary and Debate, Medical Marijuana State Laws and Reforms | Permalink | Comments (1)