Friday, April 20, 2018
The title of this post is the title of this effective new WonkBlog piece by Keith Humphreys, which makes these important points:
Studies conducted at the state level show that expanding access to medical marijuana is correlated with lower rates of opioid misuse and overdose. Yet studies of individuals show that using medical cannabis is correlated with higher rates of using and misusing opioids. This set of conflicting research has revealed less about the relationship between marijuana and opioids than it has about how science is misunderstood and misused in political debates....
The math underlying why many such apparent contradictions exist across scientific research areas is complicated, but the underlying point is simple: We can’t know what’s happening to individuals by looking just at state data (or county or city data), and we can’t know what is happening to states just by looking at individuals. Thus there isn’t any logical contradiction between marijuana and opioid use having opposite relationships at the state and individual level.
The other statistical point of relevance here is more widely understood: Just because two things are correlated doesn’t prove there’s a causal relationship between them. However, in this particular domain, people tend to apply that rule only to the subset of studies that conflict with their views on marijuana. Sometimes this is a conscious decision by people who want to spin the evidence, but more often it reflects unconscious, built-in flaws in human reasoning that make us more prone to attend to and trust evidence that confirms what we already believe or deeply want to believe. That is, people who hold anti-marijuana views will be more likely to accept the individual correlational studies as proving that medical cannabis is harmful and dismiss the state-level studies as “merely correlational.” Those with positive views of marijuana will do the reverse. (If you want to see this phenomenon in action, watch how this article is discussed on Twitter today!)
Being human, scientists also sometimes fall prey to the same problem, being too critical of marijuana studies that don’t accord with their beliefs and not critical enough of those that do. But at their best, scientists design rigorous studies of important questions and then accept the answers whether they (or anyone else) likes them or not.
Solving the puzzle of whether and how medical cannabis and opioids interact will require laboratory experiments and randomized clinical trials in which researchers can control exposure to both drugs rather than relying on correlational data. In one recent such study, Ziva Cooper of Columbia University found initial evidence that marijuana may modify both the pain-relieving effects and abuse liability of oxycodone.
More studies like Cooper’s are needed and should become more common if Congress is wise enough to loosen restrictions on medical marijuana research. In the meantime, the medical marijuana debate will rage on, with many people on each side citing as authoritative whichever study suits their purposes.
Tuesday, April 17, 2018
The sports website SBNation has this big new series of articles under the banner "Sports in the age of cannabis." Here is how the site sets up its coverage along with links to more than a half-dozen article of note:
We, as a nation, are changing the way we feel about cannabis.
Gone are the days of Reefer Madness, the hysteria of the War on Drugs. As more and more states decriminalize and legalize cannabis, we are seeing a new American attitude that views it as much a business opportunity as something to be feared or banned.
These attitudes are making their way into the sporting world as well. Some professional leagues still test for weed, though how eager they are to actually bust athletes is a matter of debate. And athletes are now seriously turning toward cannabis as a pain-management solution — as we learn more about the dangers of opioid abuse, weed appears more and more like a safer option.
While the changing stigmas around cannabis present exciting opportunities for some, it’s not all that simple. We still live in a country where people, too often people of color, are being arrested for selling and using a product that is already making entrepreneurs, in the sporting world and outside of it, tons of money.
We wanted to look at it all, from the mountains of Colorado to the streets of Atlanta, THC and CBD, oils and smoke, and all the rest. This is sports in the age of cannabis.
Thursday, April 12, 2018
Senators Orrin Hatch and Kamala Harris write to AG Jeff Sessions to push for more medical marijuana research
As reported in this new press release, "US Senators Orrin Hatch (R-UT) and Kamala Harris (D-CA), both members of the Senate Judiciary Committee, sent a letter today to US Attorney General Jeff Sessions urging the Drug Enforcement Administration (DEA) to cease efforts to slow medical marijuana research, following reports that the Department of Justice was blocking medical marijuana research efforts by delaying approvals for manufacturers growing research-grade medical marijuana." Here is more from the text of the letter:
Dear Attorney General Sessions:
We write to request that you enable the Drug Enforcement Administration (DEA) to fulfill its charter of lawfully registering manufacturers of the controlled substance of marijuana for research without delay. Research on marijuana is necessary to resolve critical questions of public health and safety, such as learning the impacts of marijuana on developing brains and formulating methods to test marijuana impairment in drivers.
To date, it has been federal practice that only one manufacturer — the University of Mississippi — is licensed to produce marijuana for federally-sanctioned research. Historically, as the DEA has noted, that single manufacturer could meet the minimal demand for research. However, the DEA changed its policy nearly two years ago because, as it explained, “There is growing public interest in exploring the possibility that marijuana or its chemical constituents may be used as potential treatments for certain medical conditions,” and the DEA — along with the Food and Drug Administration (FDA) and the National Institutes of Health (NIH) — “fully supports expanding research into the potential medical utility of marijuana and its chemical constituents.”
As of August 11, 2016, 354 individuals and institutions were approved by the DEA to conduct expansive research on marijuana and its related components. Those researchers needed access to a federally compliant expanded product line—they needed to study different types of marijuana and across various delivery mechanisms. Accordingly, a diverse, DEA-vetted market of suppliers of research-grade marijuana would be critical. Since the DEA’s Federal Register Notice on August 12, 2016, at least 25 manufacturers have formally applied to produce federally-approved research-grade marijuana....
We write this letter because research on marijuana is necessary for evidence-based decision making, and expanded research has been called for by President Trump’s Surgeon General, the Secretary of Veterans Affairs, the FDA, the CDC, the National Highway Safety Administration, the National Institute of Health, the National Cancer Institute, the National Academies of Sciences, and the National Institute on Drug Abuse. In order to facilitate such research, scientists and lawmakers must have timely guidance on whether, when, and how these manufacturers’ applications will be resolved.
The benefits of research are unquestionable. Research will give law enforcement guidance to do their jobs:protecting drivers on the roads, protecting kids in schools, and maintaining law and order. Ninety-two percent of veterans support federal research on marijuana, and the Department of Veterans’ Affairs is aware that many veterans have been using marijuana to manage the pain of their wartime wounds. America’s heroes deserve scientifically-based assessments of the substance many of them are already self-administering.
By allowing expanded research, the Department of Justice will aid legislators in making sound decisions, help law enforcement in developing critical public safety guidance, and ensure that citizens have the benefit of informed, evidence-based policy.
Monday, April 2, 2018
As reported via this CNN article, headlined "Marijuana legalization could help offset opioid epidemic, studies find," this weeks bring the publication of notable new research suggesting a link between marijuana access and reduced use of opioids. Here are the basics:
Experts have proposed using medical marijuana to help Americans struggling with opioid addiction. Now, two studies suggest that there is merit to that strategy. The studies, published Monday in the journal JAMA Internal Medicine, compared opioid prescription patterns in states that have enacted medical cannabis laws with those that have not. One of the studies looked at opioid prescriptions covered by Medicare Part D between 2010 and 2015, while the other looked at opioid prescriptions covered by Medicaid between 2011 and 2016.
The researchers found that states that allow the use of cannabis for medical purposes had 2.21 million fewer daily doses of opioids prescribed per year under Medicare Part D, compared with those states without medical cannabis laws. Opioid prescriptions under Medicaid also dropped by 5.88% in states with medical cannabis laws compared with states without such laws, according to the studies....
In order to evaluate whether medical marijuana could function as an effective and safe alternative to opioids, the two teams of researchers looked at whether opioid prescriptions were lower in states that had active medical cannabis laws and whether those states that enacted these laws during the study period saw reductions in opioid prescriptions.
Both teams, in fact, did find that opioid prescriptions were significantly lower in states that had enacted medical cannabis laws. The team that looked at Medicaid patients also found that the four states that switched from medical use only to recreational use -- Alaska, Colorado, Oregon and Washington -- saw further reductions in opioid prescriptions, according to Hefei Wen, assistant professor of health management and policy at the University of Kentucky and a lead author on the Medicaid study. "We saw a 9% or 10% reduction (in opioid prescriptions) in Colorado and Oregon," Wen said. "And in Alaska and Washington, the magnitude was a little bit smaller but still significant."...
The details of the medical cannabis laws were found to have a significant impact on opioid prescription patterns, the researchers found. States that permitted recreational use, for example, saw an additional 6.38% reduction in opioid prescriptions under Medicaid compared with those states that permitted marijuana only for medical use, according to Wen.
The method of procurement also had a significant impact on opioid prescription patterns. States that permitted medical dispensaries -- regulated shops that people can visit to purchase cannabis products -- had 3.742 million fewer opioid prescriptions filled per year under Medicare Part D, while those that allowed only home cultivation had 1.792 million fewer opioid prescriptions per year.
"We found that there was about a 14.5% reduction in any opiate use when dispensaries were turned on -- and that was statistically significant -- and about a 7% reduction in any opiate use when home cultivation only was turned on," Bradford said. "So dispensaries are much more powerful in terms of shifting people away from the use of opiates."...
This is not the first time researchers have found a link between marijuana legalization and decreased opioid use. A 2014 study showed that states with medical cannabis laws had 24.8% fewer opioid overdose deaths between 1999 and 2010. A study in 2017 also found that the legalization of recreational marijuana in Colorado in 2012 reversed the state's upward trend in opioid-related deaths.
Here are links to the JAMA Internal Medicine articles referenced here, as well as a companion commentary:
Medical and Adult-Use Marijuana Laws and Opioid Prescribing for Medicaid Enrollees by Hefei Wen & Jason Hockenberry
Association Between US State Medical Cannabis Laws and Opioid Prescribing in the Medicare Part D Population by Ashley C. Bradford et al
The Role of Cannabis Legalization in the Opioid Crisis by Kevin Hill & Andrew Saxon
Some (of many) prior related posts:
- Given latest opioid death data, should Ohio officials be fast-tracking access to medical marijuana?
- "The Case for Pot in the Age of Opioids: Legalizing medical marijuana could save lives that may otherwise be lost to opioid addiction."
- "Can medical marijuana be used to treat heroin addiction?"
- Yet another study suggests link between medical marijuana availability and decreased opioid use
- "Could medical marijuana solve Ohio's opioid problem?"
- "Legalize marijuana and reduce deaths from drug abuse"
- "Obama’s Opioid Offensive Again Ignores the Cannabis Solution"
- "Is marijuana a secret weapon against the opioid epidemic?"
- "Cannabis as a Substitute for Opioid-Based Pain Medication: Patient Self-Report"
- "The use of cannabis in response to the opioid crisis: A review of the literature"
- Still more talk, from notable conservative outlets, about possible benefits of marijuana reform amidst opioid crisis
April 2, 2018 in Medical community perspectives, Medical Marijuana Commentary and Debate, Medical Marijuana Data and Research, Medical Marijuana State Laws and Reforms, Recreational Marijuana Data and Research | Permalink | Comments (0)
Wednesday, March 28, 2018
The great state of New Jersey has been the focal point for a lot of interesting debate over recreational marijuana reform this year. But as that debate continues, the state's new Governor has announced here a new effort to "expands patient access to medical marijuana." Here are some details:
Governor Phil Murphy [Tuesday] announced major reforms to New Jersey’s Medicinal Marijuana Program. Reforms include the addition of medical conditions, lowered patient and caregiver fees, allowing dispensaries to add satellite locations, and proposed legislative changes that would increase the monthly product limit for patients, and allow an unlimited supply for those receiving hospice care.
“We are changing the restrictive culture of our medical marijuana program to make it more patient-friendly,” Governor Murphy said. “We are adding five new categories of medical conditions, reducing patient and caregiver fees, and recommending changes in law so patients will be able to obtain the amount of product that they need. Some of these changes will take time, but we are committed to getting it done for all New Jersey residents who can be helped by access to medical marijuana.”
More than 20 recommendations are outlined in a report that New Jersey Department of Health Commissioner Dr. Shereef Elnahal submitted to Governor Murphy in response to Executive Order 6, which directed a comprehensive review of the program within 60 days. “As a physician, I have seen the therapeutic benefits of marijuana for patients with cancer and other difficult conditions,” said Dr. Elnahal. “These recommendations are informed by discussions with patients and their families, advocates, dispensary owners, clinicians, and other health professionals on the Medicinal Marijuana Review Panel. We are reducing the barriers for all of these stakeholders in order to allow many more patients to benefit from this effective treatment option."
In the report, the Department submitted three categories of recommendations: those that are effective today, regulatory changes that will go through the rulemaking process, and proposals that require legislation. In addition, there are recommendations for important future initiatives to allow home delivery, develop a provider education curriculum, and expedite the permitting process. Effective today, five new categories of medical conditions (anxiety, migraines, Tourette’s syndrome, chronic pain related to musculoskeletal disorders, and chronic visceral pain) will be eligible for marijuana prescription. Currently, 18,574 patients, 536 physicians, and 869 caregivers participate in the program – a far smaller number than comparably populated states. The Commissioner will also be able to add additional conditions at his discretion.
Other immediate changes include lowering the biennial patient registration fee from $200 to $100 and adding veterans and seniors -- 65 and older -- to the list of those who qualify for the $20 discounted registration fee. Those on government assistance, including federal disability, already receive the reduced fee.
The report prepared by the New Jersey Department of Health is available at this link.
The title of this post is the title of this new Viewpoint commentary authored by Lawrence Gostin, James Hodge, and Sarah Wetter published earlier this week on line at JAMA. Here is how it concludes:
Toward Rational Medical Marijuana Policies
Although public opinion and state action have trended strongly toward permitting use of marijuana, especially for medical purposes, controversy continues to exist. The specter of federal prosecution could refrain physicians, patients, and dispensaries from providing marijuana in states where the drug is lawful and dissuade additional jurisdictions from legalizing marijuana. Public policy formed and implemented in the context of inconsistent federal and state laws, unpredictable legal enforcement, and insufficient scientific evidence is unsustainable. Rational policies should follow a 3-pronged agenda.
A Solid Research Foundation
Sound policy requires a strong evidence base. Scientific studies could quell ongoing disagreements about marijuana’s medical effectiveness, harms, and status as a gateway drug. Yet limited funding and restrictive access to uniformly high-quality cannabis have sharply curtailed longitudinal studies on a drug already in wide use. Physicians require rigorous evidence to inform prescribing practices and counseling of patients. At present, wide regional variations in prescribing practices exist, and patients do not have access to consistently high-quality, uncontaminated cannabis — where the purity, potency, and dosage can be ensured. Health officials, moreover, rarely conduct careful surveillance of marijuana use incidence, prevalence, and outcomes. Public policy on a potentially hazardous psychotropic drug is difficult when short- and long-term effects across populations are underreported, insufficiently studied, and poorly funded.
A Harmonized Legal Environment
Substantial variability of legal approaches to marijuana use exists across jurisdictions and between states and the federal government. Individuals in certain jurisdictions can lawfully access marijuana for medical use, recreational use, or both, whereas individuals in other jurisdictions cannot do so. Conditions under which physicians can prescribe (or patients can access) marijuana fluctuate extensively. Federal law is inconsistent with policy in virtually all states. The CSA should be revised to operate harmoniously with prevailing state law. Model legislation for medical use of marijuana, based on scientific evidence, could help reconcile activities across jurisdictions.
Federal Law Enforcement Respectful of States’ Sovereignty
Under US constitutional design, states and localities are laboratories for innovation, with state sovereignty and local home rule respected and preserved. This requires federal prosecutorial discretion to hew to the legal environment of states that have legalized marijuana use. Respecting marijuana laws is essential in states where cannabis is prescribed and used for medical purposes. On an issue as consequential as marijuana, the nation needs consistent legal norms based on the best available scientific evidence.
March 28, 2018 in Criminal justice developments and reforms, Federal Marijuana Laws, Policies and Practices, Medical community perspectives, Medical Marijuana Commentary and Debate | Permalink | Comments (0)
Sunday, March 25, 2018
"Unique treatment potential of cannabidiol for the prevention of relapse to drug use: preclinical proof of principle"
The title of this post is the title of this notable new research just published on-line from the journal Neuropsychopharmacology. Here is the abstract:
Cannabidiol (CBD), the major non-psychoactive constituent of Cannabis sativa, has received attention for therapeutic potential in treating neurologic and psychiatric disorders. Recently, CBD has also been explored for potential in treating drug addiction. Substance use disorders are chronically relapsing conditions and relapse risk persists for multiple reasons including craving induced by drug contexts, susceptibility to stress, elevated anxiety, and impaired impulse control. Here, we evaluated the “anti-relapse” potential of a transdermal CBD preparation in animal models of drug seeking, anxiety and impulsivity. Rats with alcohol or cocaine self-administration histories received transdermal CBD at 24 h intervals for 7 days and were tested for context and stress-induced reinstatement, as well as experimental anxiety on the elevated plus maze.
Effects on impulsive behavior were established using a delay-discounting task following recovery from a 7-day dependence-inducing alcohol intoxication regimen. CBD attenuated context-induced and stress-induced drug seeking without tolerance, sedative effects, or interference with normal motivated behavior. Following treatment termination, reinstatement remained attenuated up to ≈5 months although plasma and brain CBD levels remained detectable only for 3 days. CBD also reduced experimental anxiety and prevented the development of high impulsivity in rats with an alcohol dependence history. The results provide proof of principle supporting potential of CBD in relapse prevention along two dimensions CBD: beneficial actions across several vulnerability states, and long-lasting effects with only brief treatment. The findings also inform the ongoing medical marijuana debate concerning medical benefits of non-psychoactive cannabinoids and their promise for development and use as therapeutics.
I found this research via this press article with a headline that provides a crisp accounting of what this research means: "Cannabis drug may help alcohol and cocaine addicts overcome their cravings, study finds." Here is how one of the researchers explained the findings in the press account:
Speaking of the findings, lead author Dr Friedbert Weiss said: 'The efficacy of the CBD to reduce reinstatement in rats with both alcohol and cocaine -- and, as previously reported, heroin -- histories predicts therapeutic potential for addiction treatment across several classes of abused drugs.
'The results provide proof of principle supporting the potential of CBD in relapse prevention along two dimensions: beneficial actions across several vulnerability states and long-lasting effects with only brief treatment.
'Drug addicts enter relapse vulnerability states for multiple reasons. Therefore, effects such as these observed with CBD that concurrently ameliorate several of these are likely to be more effective in preventing relapse than treatments targeting only a single state.'
Results further suggest CBD is completely cleared from such rats' brains just three days after the treatment ends.
Friday, March 23, 2018
Estimates of extraordinary health-care savings in research paper on medical marijuana laws and tobacco use
I just saw this notable research paper authored by Anna Choi, Dhaval Dave and Joseph Sabia under the title "Smoke Gets in Your Eyes: Medical Marijuana Laws and Tobacco Use." The last line of the abstract merits placement in bold because it is such a bold finding:
The public health costs of tobacco consumption have been documented to be substantially larger than those of marijuana use. This study is the first to investigate the impact of medical marijuana laws (MMLs) on tobacco cigarette consumption . First, using data from the National Survey of Drug Use and Health (NSDUH), we establish that MMLs induce a 2 to 3 percentage-point increase in adult marijuana consumption, likely for both recreational and medicinal purposes. Then, using data from the NSDUH, the Behavioral Risk Factor Surveillance System (BRFSS), and the Current Population Survey Tobacco Use Supplements (CPS-TUS), we find that the enactment of MMLs leads to a 1 to 1.5 percentage-point reduction in adult cigarette smoking. We also find that MMLs reduce the number of cigarettes consumed by smokers, suggesting effects on both the cessation and intensive margins of cigarette use. Our estimated effect sizes imply substantial MML-induced tobacco-related healthcare cost savings, ranging from $4.6 to $6.9 billion per year.
Sunday, March 11, 2018
New US Attorney for Southern District of West Virginia talking up efforts to "enforce laws against marijuana aggressively - AGGRESSIVELY"
I have just seen via my twitter feed this notable recent tweet posted by US Attorney Mike Stuart, the newly confirmed U.S. Attorney for the Southern District of West Virginia:
Have visited many treatment facilities. Every single treatment professional - EVERY SINGLE ONE- has told me “Marijuana is a gateway drug.” My office is preparing to enforce laws against marijuana aggressively - AGGRESSIVELY.— US Attorney Mike Stuart (@USAttyStuart) March 9, 2018
Without getting into the particulars of the gateway drug debate, I am eager here to highlight how easy it would be for this new US Attorney to ramp up federal marijuana enforcement relative to what has existed in recent years. Based on some (too) quick research of US Sentencing Commission data, it seems that there have only been a handful of federal marijuana prosecutions each year in this district. USA Stewart could "aggressively" increase the federal caseload just by bringing a few more cases each year.
It will be interesting to see if the Southern District of West Virginia does end up having many more marijuana prosecutions in the months ahead, though these statements likely are to be most significant with respect to West Virginia's development of its recently passed medical marijuana legislation. This local article, headlined "Time runs out on bill making changes to WV's medical cannabis program," suggests that the rescission of the Cole Memo and related concerns about federal prohibition may already be slowing down the state's regulatory efforts.
March 11, 2018 in Campaigns, elections and public officials concerning reforms, Criminal justice developments and reforms, Federal Marijuana Laws, Policies and Practices, Medical Marijuana Commentary and Debate, Medical Marijuana State Laws and Reforms | Permalink | Comments (1)
Wednesday, March 7, 2018
The title of this post is the headline of this notable lengthy new Bloomberg Businessweek article. I am tempted to politicize this post by saying that a true "America First" President ought to be quite concerned about the sub-headline of this piece: "Why? Because the feds are bogarting the weed, while Israel and Canada are grabbing market share." I recommend the piece in full, and here are excerpts:
Lyle Craker is an unlikely advocate for any political cause, let alone one as touchy as marijuana law, and that’s precisely why Rick Doblin sought him out almost two decades ago. Craker, Doblin likes to say, is the perfect flag bearer for the cause of medical marijuana production—not remotely controversial and thus the ideal partner in a long and frustrating effort to loosen the Drug Enforcement Administration’s chokehold on cannabis research. There are no counterculture skeletons in Craker’s closet; only dirty boots and botany books. He’s never smoked pot in his life, nor has he tasted liquor. “I have Coca-Cola every once in a while,” says the quiet, white-haired Craker, from a rolling chair in his basement office at the University of Massachusetts at Amherst, where he’s served as a professor in the Stockbridge School of Agriculture since 1967, specializing in medicinal and aromatic plants. He and his students do things such as subject basil plants to high temperatures to study the effects of climate change on what plant people call the constituents, or active elements....
In June 2001, Craker filed an application for a license to cultivate “research-grade” marijuana at UMass, with the goal of staging FDA-approved studies. Six months later he was told his application had been lost. He reapplied in 2002 and then, after an additional two years of no action, sued the DEA, backed by MAPS. By this point, both U.S. senators from Massachusetts had publicly supported his application, and a federal court of appeals ordered the DEA to respond, which it finally did, denying the application in 2004.
Craker appealed that decision with backing from a powerful bench of allies, including 40 members of Congress, and finally, in February 2007, a DEA administrative law judge ruled that his application for a license should be granted. The decision was not binding, however; it was merely a recommendation to the DEA leadership. Almost two years later, in the last week of the Bush administration, the application was rejected. Craker threw up his hands. He firmly believed marijuana should be more widely grown and studied, but he’d lost any hope that it would happen in his lifetime. And he had basil to attend to.
Then, in August 2016, during the final months of the Obama presidency, the DEA reversed course. It announced that, for the first time in a half-century, it would grant new licenses. Doblin, who has seemingly endless supplies of optimism and enthusiasm, convinced the professor there was hope—again. So Craker submitted paperwork, again, along with 25 other groups. The university’s provost co-signed his application, and Senator Elizabeth Warren (D–Mass.) wrote a letter to the DEA in support of his effort. He’s still waiting to hear back. “I’m never gonna get the license,” Craker says.
Pessimism isn’t surprising from a man who’s been making a reasonable case for 17 years to no avail. Studies around the world have shown that marijuana has considerable promise as a medicine. Craker says he spoke late last year at a hospital in New Hampshire where certain cannabinoids were shown to facilitate healing in brain-damaged mice. “And I thought, ‘If cannabinoids could do that, let’s put them in medicines!’ ” He sighs. “We can’t do the research.”
Another sigh. “I’m naive about a lot about things,” he says. “But it seems to me that we should be looking at cannabis. I mean, if it’s going to kill people, let’s know that and get rid of it. If it’s going to help people, let’s know that and expand on it. … But there’s just something wrong with the DEA. I don’t know what else to say. … Somehow, marijuana’s got a bad name. And it’s tough to let go of.”....
Many people expect the Republican-controlled Congress to follow its recent tax overhaul by looking for ways to slash costs in Medicaid and Medicare. Legitimate research into the medicinal properties of marijuana could help. Studies show that opioid use drops significantly in states where marijuana has been legalized; this suggests people are consuming the plant for pain, something they could be doing more effectively if physicians and the FDA controlled chemical makeup and potency. A study published in July 2016 in Health Affairs showed that the use of prescription drugs for which marijuana could serve as a clinical alternative “fell significantly,” saving hundreds of millions of dollars among users of Medicare Part D....
Among those who’ve advised Craker is Tony Coulson, a former DEA agent who retired in 2010 and works as a consultant for companies developing drugs. Coulson was vehemently antimarijuana until his son, a combat soldier, came home from the Middle East with post-traumatic stress disorder and needed help. “For years I was of the belief that the science doesn’t say that this is medicine,” he says. “But when you get into this curious history, you find the science doesn’t show it primarily because we’re standing in the way. The NIDA monopoly prevents anyone from getting into further studies.”
Coulson blames the Obama administration for not acting sooner, creating a situation in which the decision on granting new growing licenses was passed down to Attorney General Jeff Sessions, who has publicly declared his belief in the dangers of marijuana. The NIDA monopoly is now his to change. “Sessions has a 1930s Reefer Madness view of the marijuana world,” Coulson says. “It’s not realistic, and it’s not what rank-and-file DEA really are concerned about. DEA folks have moved beyond this.”
“I guess I take a nationalist approach here,” says Rick Kimball, a former investment banker who’s raising money for a marijuana-related private equity fund and is a trustee for marijuana policy at the Brookings Institution. “We have a huge opportunity in the U.S.,” he says, “and we ought to get our act together. I’m worried that we’re ceding this whole market to the Israelis.”
March 7, 2018 in Business laws and regulatory issues, Federal Marijuana Laws, Policies and Practices, Medical community perspectives, Medical Marijuana Commentary and Debate, Medical Marijuana Data and Research, Who decides | Permalink | Comments (0)
Monday, March 5, 2018
Encouraging research from Minnesota on success of medical marijuana in the treatment of "intractable pain"
This recent press release from the Minnesota Department of Health, headlined "Medical cannabis study shows significant number of patients saw pain reduction of 30 percent or more," provides a summary of this encouraging lengthy report titled "Intractable Pain Patients in the Minnesota Medical Cannabis Program: Experience of Enrollees During the First Five Months." Here is the start of the press release:
Forty-two percent of Minnesota’s patients taking medical cannabis for intractable pain reported a pain reduction of thirty percent or more, according to a new study conducted by the Minnesota Department of Health. “This study helps improve our understanding of the potential of medical cannabis for treating pain,” said Minnesota Health Commissioner Jan Malcolm. “We need additional and more rigorous study, but these results are clinically significant and promising for both pain treatment and reducing opioid dependence.”
The first-of-its-kind research study is based on the experiences of the initial 2,245 people enrolled for intractable pain in Minnesota’s medical cannabis program from August 1, 2016 to December 31, 2016. Of this initial group, 2,174 patients purchased medical cannabis within the study’s observation period and completed a required self-evaluation before each purchase.
As part of the self-evaluation, patients completed the PEG (pain, enjoyment and general activity) screening tool. On a scale of 0 to 10 (with 0 being no pain and 10 being the highest pain), patients rated their level of pain, how pain interfered with their enjoyment of life and how pain interfered with their general activity.
Using the PEG scale data, 42 percent of the patients who scored moderate to high pain levels at the beginning of the measurement achieved a reduction in pain scores of 30 percent or more, and 22 percent of patients both achieved and maintained a reduction of 30 percent or more over four months. The 30 percent reduction threshold is often used in pain studies to define clinically meaningful improvement. Health care practitioners caring for program-enrolled patients suffering from intractable pain reported similar reductions in pain scores, saying 41 percent of patients achieved at least a reduction of 30 percent or more.
The study also found that of the 353 patients who self-reported taking opioid medications when they started using medical cannabis, 63 percent or 221 reduced or eliminated opioid use after six months. Likewise, the health care practitioner survey found that 58 percent of patients who were on other pain medications were able to reduce their use of these medications when they started taking medical cannabis. Thirty-eight percent of patients reduced opioid medication (nearly 60 percent of these cut use of at least one opioid by half or more), 3 percent of patients reduced benzodiazepines and 22 percent of patients reduced other pain medications.
The safety profile of medical cannabis products available through the Minnesota program continues to appear favorable. No serious adverse events (life threatening or requiring hospitalization) were reported for this group of patients during the observation period.
Here is a portion of the executive summary from the full report:
Among respondents to the patient (54% response rate) and health care practitioner (40% response rate) surveys, a high level of benefit was reported by 61% and 43%, respectively (score of 6 or 7 on a seven-point scale). Little or no benefit (score of 1, 2, or 3) was reported by 10% of patients and 24% of health care practitioners.
The benefits extended beyond reduction in pain severity, though that was the benefit mentioned most often (64%). The benefit described second most often was improved sleep (27%), which likely has a synergistic relationship with reduction in pain severity. In some cases improved sleep, reduction of other pain medications and their side effects, decreased anxiety, improved mobility and function, and other quality of life factors were cited as being the most important benefit. The pattern of described benefits was similar in the patient and the health care practitioner survey results....
A large proportion (58%) of patients on other pain medications when they started taking medical cannabis were able to reduce their use of these meds according to health care practitioner survey results. Opioid medications were reduced for 38% of patients (nearly 60% of these reduced at least one opioid by ≥50%), benzodiazepines were reduced for 3%, and other pain medications were reduced for 22%. If only the 353 patients (60.2%, based on medication list in first Patient Self-Evaluation) known to be taking opioid medications at baseline are included, 62.6% (221/353) were able to reduce or eliminate opioid usage after six months.
Friday, March 2, 2018
The title of this post is the headline of this notable lengthy Atlantic piece, with the subheadline: "In states where weed is legal, new mild cannabis products are catching on with parents." Here is how it gets started:
Many a meme has been made about “wine moms”—mothers who joke online about their love for a relaxing glass of cabernet, or three. But a new drug is gaining popularity with the playgroup circuit. As it becomes more socially acceptable, more moms are using marijuana and its various incarnations to deal with everything from the daily aches and stresses of motherhood, to postpartum depression and anxiety, to menstrual cramps. And forget the simple bongs and pipes of the past; as the industry expands, it’s creating a whole new world of sprays, drinks, drops, and oils. The needs of this market of marijuana-friendly mothers have inspired a new crop of cannabis products.
In her recent High Times article, Jessica Delfino discusses the changing social attitudes toward motherhood and marijuana: “Mothers and women who use medical marijuana…are often put into a position in which they feel they have to explain themselves and what their condition is, and then steel themselves for the judgment that will inevitably follow,” she writes.
But also, Delfino tells me: “I think cannabis use in moms is becoming more widespread because it’s becoming more legal, and so people feel more willing and able to discuss it.”
Adam Grossman, the CEO of the cannabis company Papa and Barkley, has also noticed a burgeoning interest in marijuana from moms. “In the last month alone, we have seen the emergence of cannabis-and-parenthood workshops, new ‘parenting and cannabis’ publications like Splimm, and Facebook groups," he says. “More and more parents are starting to have the conversation about cannabis and breastfeeding, cannabis and pregnancy, and cannabis and parenting.”
But according to those in the pot industry, one new product in particular is spreading fast in mom circles: sublingual spray, a convenient, THC-infused ingestible liquid.
Once you spritz the liquid under your tongue, it activates quickly (within 60 seconds), it’s hard to overdo, and the high doesn't last very long, says Leslie Siu, the CMO and cofounder of cannabis company Mother and Clone. “After a minute you’ll start to feel this uplifting euphoric feeling, almost like a gentle rush,” Siu says of her sublingual nano-sprays. (Nano-sprays are a form of microdosing — Mother and Clone bottles deliver a metered dose of the drug.) By the five-minute mark, she says, you’ll know just how strong the effects will be for the next hour and you can decide to re-up and spray some more — in the industry this is called “stacking.”
Siu was moved to start Mother and Clone after she experienced postpartum depression. “Everything felt dark,” she recalls of that first “ominous” year after having her daughter Veda. Siu started searching for ways to ease the overwhelming, stressful feelings she was having. “Then a few things happened that got me back on track,” Siu says. "Time, therapy, running, and weed.”
Siu wanted to create a cannabis product that would be easy and safe for mothers in similar situations to use, and she landed on sublingual sprays. Because it’s easier to control the dose with sublingual spray, Siu says that it’s ideal for parents (her products also have child-resistant bottles). The sprays can also help with sleep, she says. “A lot of [postpartum depression and postpartum anxiety] sufferers develop terrible insomnia even if the baby starts to sleep through the night.”
Wednesday, February 28, 2018
Americans for Safe Access releases its latest analysis and report card on medical marijuana programs across United States
The advocacy group Americans for Safe Access regularly produces reports on the state of state medical marijuana laws, and this latest 2018 version of ASA's “Medical Marijuana Access in the United States: A Patient-Focused Analysis of the Patchwork of State Laws” now runs almost 200 pages. I recommend the report in full for everyone interested in medical marijuana information, and here is part of the report's preface:
For over fifteen years, Americans for Safe Access (ASA) has engaged state and federal governments, courts, and regulators to improve the development and implementation of state medical cannabis laws and regulations. This experience has taught us how to assess whether or not state laws meet the practical needs of patients. It has also provided us with the tools to advocate for programs that will better meet those needs. Passing a medical cannabis law is only the first step in a lengthy implementation process, and the level of forethought and advance input from patients can make the difference between a well-designed program and one that is seriously flawed. One of the most important markers of a well-designed program is whether or not all patients who would benefit from medical cannabis will have safe and legal access to their medicine without fear of losing any of the civil rights and protections afforded to them as American citizens....
Today, we have a patchwork of medical cannabis laws across the United States. Thirty states, the District of Columbia, Guam, and Puerto Rico have adopted laws that created programs that allow at least some patients legal access to medical cannabis. Most of those thirty states provide patients with protections from arrest and prosecution as well as incorporate a regulated production and distribution program. Several programs also allow patients and their caregivers to cultivate a certain amount of medical cannabis themselves. While it took a long time for states to recognize the importance of protecting patients from civil discrimination (employment, parental rights, education, access to health care, etc.), more and more laws now include these explicit protections.
However, as of 2017, none of the state laws adopted thus far can be considered ideal from a patient’s standpoint. Only a minority of states currently include the entire range of protections and rights that should be afforded to patients under the law, with some lagging far behind others. Because of these differences and deficiencies, patients have argued that the laws do not function equitably and are often poorly designed, implemented, or both. As production and distribution models are implemented, hostile local governments have found ways to ban such activity, leaving thousands of patients without the access state law was intended to create. Minnesota, for example, despite setting up a regulatory system for the production, manufacturing, and distribution of cannabis oil extracts, prohibits qualified patients from using the actual plant. These laws include sanctions for qualified patients who seek to use their medicine in whole plant form, unnecessarily eliminating clinically validated routes of administration used by hundreds of thousands of patients. Some states have taken years to implement their medical cannabis laws leaving patients waiting years before their medicine is available.
February 28, 2018 in History of Marijuana Laws in the United States, Medical community perspectives, Medical Marijuana Commentary and Debate, Medical Marijuana Data and Research, Medical Marijuana State Laws and Reforms | Permalink | Comments (0)
Tuesday, February 27, 2018
Rolling Stone has this lengthy new article on modern state marijuana reforms focused on how governors are reacting to Attorney General Jeff Sessions' latest policy directives to federal prosecutors. The piece is headlines "Sorry, Jeff Sessions – Governors Are Moving Ahead with Pot: At their annual meeting, pro-pot governors say the AG isn't stopping them from advancing plans for medical and recreational legalization." Here are excerpts:
Over the past few days, most of the nation's governors descended on Washington for their annual meeting with administration officials and the president. As the governors mingled about and chatted in between sessions, many of them were exchanging ideas and best practices on how to roll out a successful regulatory regime on marijuana. But hanging over their talks was the specter of Attorney General Jeff Sessions who would like to clamp down on the nation's burgeoning, though disparate, marijuana industry.
Some Democratic governors say they were denied a private meeting with Sessions to discuss his anti-marijuana stance. And besides attending the formal Governors' Ball on Sunday night, the attorney general only made one appearance to the group, at a White House briefing on opioids. Some say they're frustrated they couldn't pick his brain on his controversial move to rescind an Obama-era memo that directed the nation's top prosecutors to prioritize other offenses over marijuana in states where it's legal. "I tried, but I couldn't get called on," Gov. John Hickenlooper (D-CO) tells Rolling Stone. "He only took about six questions. There were probably 40 governors in the room."
Even though there's fear that Sessions wants to go after legal marijuana business owners, many states are moving ahead with efforts to either launch a new medicinal marijuana industry, expand an existing one or to legalize weed for recreational purposes. And governors say so far Sessions' opposition hasn't had an impact on the ground. "It has not impacted us and we believe it will not, although that doesn't mean we're not paying attention," Gov. Phil Murphy (D-NJ) tells Rolling Stone.
Murphy, who was elected last year, campaigned aggressively on marijuana legalization. For him, it's a criminal-justice issue because his state has the largest racial disparity in its prison population of any state in the nation, and many of those convicts are serving terms for nonviolent drug offenses. While he's received some pushback from his legislature on his plan to legalize pot, he's moving ahead on expanding medicinal marijuana because currently there are only five dispensaries in a state with nine million people. "We're proceeding apace, again, beginning to make sure we get the medical piece right because it's life or death," Murphy says. "And then we will deliberately and steadily get to the recreational side."
The nation's other newly seated governor, Ralph Northam (D-VA), also campaigned on marijuana. He faces more headwinds from Republicans who control his state's House of Delegates, but he's still calling for marijuana decriminalization. As a physician, Northam is also vocal about the medicinal benefits of weed, though he says more research is needed. For that he's calling on Congress to reclassify pot, since it's currently listed as a Schedule I narcotic, making it extremely difficult to study in any official capacity. "I think that it would be great if at the federal level they could change the schedule of marijuana so that we can get more data on it – do more research," Northam tells Rolling Stone. "I remind people all the time that probably over 100 medicines that we use routinely in health care come from plants, so let's be a little bit more open minded and look at potential uses for medicinal marijuana."...
While the movement on medical marijuana is steadily picking up steam in red and blue states alike, the recreational effort is going more slowly but some governors say there's starting to be an air of certainty that eventually marijuana will be viewed as the same as alcohol in most every state.
Back in 2011, Gov. Dan Malloy (D-CT) moved to decriminalize marijuana and set up a medicinal marijuana regime. While he hasn't come down one way or another on recreational marijuana, he says it's just a matter of time before it happens in Connecticut because efforts to legalize weed are sweeping the entire northeast corridor. "As Canada moves in that direction, as Massachusetts and Vermont, it's going to be a neighborhood thing, and I understand that," Malloy tells Rolling Stone. While he remains lukewarm on recreational marijuana, he did pen a blunt letter to Sessions on it.
"I told him to stop messing around with marijuana, because it really isn't important," Malloy says. "I have not taken the opportunity to endorse marijuana, but that's very different than spending resources trying to combat marijuana use. And, quite frankly, if you're going to be serious about opioids, you can't be screwing around with marijuana."
While many governors are now rushing out new marijuana regulations, they're still keeping one eye on Jeff Sessions. Gov. Jay Inslee (D-WA) says during this visit he was rebuffed when he asked for a private meeting with the attorney general to discuss his state's recreational marijuana marketplace, but he says his offer for Sessions to come out west and tour his state's pot businesses still stands. "It's a shame that he has a closed mind, and he's much more attentive to his old ideology than to the new facts," Inslee tells Rolling Stone. "The fears that he might have had 30 years ago have not been realized, and we wish he would just open his eyes to the reality of the situation. If he did, I think he would no longer try to fight an old battle that the community and the nation is moving very rapidly forward on."
February 27, 2018 in Campaigns, elections and public officials concerning reforms, Federal Marijuana Laws, Policies and Practices, History of Marijuana Laws in the United States, Medical Marijuana Commentary and Debate, Medical Marijuana State Laws and Reforms, Recreational Marijuana Commentary and Debate, Recreational Marijuana State Laws and Reforms | Permalink | Comments (0)
Friday, February 23, 2018
"E.U. Regulation Will Revolutionize Global Data Privacy. How Will This Affect The Regulated Cannabis Sector?"
In prior posts here and here, I spotlighted articles published at the Cannabis Law Report discussing federal tax treatment of cannabis businesses authored by Chris Nani, a student in my Marijuana Law & Policy seminar last semester. I am now pleased and proud to spotlight that Chris Nani has branched out by authoring this new piece with the title that serves as the title of this post. Here is how it starts and ends:
A European Union regulation may soon shape the way U.S. cannabis companies create their privacy policies and standards. The European Union will fully implement the General Data Protection Regulation (GDPR) by May 25, 2018....
Data security is tantamount to consumers and companies that comply with the GDPR will have an advantage over others and their clients will appreciate the additional security.
American Legion continues to push federal government for more research on how marijuana can help veterans
This new article from The Cannabist, headlined "Veterans group ratchets up pressure on White House and Congress to support medical marijuana research: The American Legion wants the federal government to focus on cannabis as potential treatment for PTSD and other ailments," reports on notable new comments from a notable old advocate for medical marijuana research and reform. Here is how the article begins:
Top officials at of The American Legion, the nation’s largest veterans organization, on Friday stepped up their calls for the federal government to legitimize and invest in medical marijuana research. In a speech to the National Press Club in Washington, D.C., the Legion National Commander Denise Rohan outlined how the White House and Congress could improve the delivery of benefits to the nation’s 20 million-plus veterans. Medical cannabis was on the list. In fulfilling its mission to make sure veterans are taken care of, “we have to find replacements for the opioid epidemic we have in this nation,” Rohan said.
The organization’s call for additional research into cannabis as a potential treatment for post traumatic stress disorder (PTSD), pain and other ailments was reiterated by Louis Celli, National Director Veterans Affairs & Rehabilitation at the Legion. “We just need to know that the American government is focused on trying to find cures for not only veterans but for all Americans,” he said. “And if cannabis, which is a drug, is something that can help (then) they have to do the research to do that.”
The Legion has passed several resolutions on cannabis over the past two years. A 2016 measure calls on the Drug Enforcement Agency to license privately-funded medical marijuana operations, ensuring “safe and efficient” research into cannabis. It also asks for the rescheduling of cannabis from its current, decades-long classification as a Schedule 1 drug into a category that, “at a minimum, will recognize cannabis as a drug with a potential medical value.”
The other resolution, passed last year, calls on the Veterans Administration (VA) to allow its medical advisors to openly discuss the use of medical cannabis with veterans for medical purposes – as well as to recommend medicinal cannabis where it is legal.
Last November, a Legion-commissioned national survey showed strong support for medical cannabis research and legalization within the military veteran community. In December, the VA issued a directive, allowing its doctors and pharmacists to discuss cannabis with veterans taking part in state-approved medical marijuana programs. However, the Weed for Warriors Project, a pro-cannabis legalization veterans group, warned that vets who choose to talk about marijuana use with doctors might be identified by the VA as having a substance abuse disorder, which would in turn curtail their access to other medicines.
The Legion’s Celli also addressed that issue Friday, when asked if he was seeing any pushback to the organization’s stance on cannabis due to the stigmas still surrounding marijuana. “I wouldn’t say we’re getting pushback,” he responded. “What we’re getting is…stories from veterans who live in states that have legal cannabis programs, and they’re participating in those programs with a feeling of inner guilt.”
Ambivalence about medical cannabis, he said, comes from years of being told that marijuana is bad and immoral. Veterans in those state-legal cannabis programs, he added, see pot as a valid treatment but still feel like they could be on “the wrong side of the law.”
Prior related posts:
- American Legion, the largest US vets' organization, pressing Trump Administration on medical marijuana reform
- New American Legion survey documents strong support among veteran households for medical marijuana
"Medical marijuana laws and adolescent marijuana use in the United States: A systematic review and meta-analysis"
The title of this post is the title of this notable new article by multiple authored in the journal Addiction. Here is the abstract:
To conduct a systematic review and meta-analysis of studies in order to estimate the effect of US medical marijuana laws (MMLs) on past-month marijuana use prevalence among adolescents.
A total of 2999 papers from 17 literature sources were screened systematically. Eleven studies, developed from four ongoing large national surveys, were meta-analyzed. Estimates of MML effects on any past-month marijuana use prevalence from included studies were obtained from comparisons of pre–post MML changes in MML states to changes in non-MML states over comparable time-periods. These estimates were standardized and entered into a meta-analysis model with fixed-effects for each study. Heterogeneity among the study estimates by national data survey was tested with an omnibus F-test. Estimates of effects on additional marijuana outcomes, of MML provisions (e.g. dispensaries) and among demographic subgroups were abstracted and summarized. Key methodological and modeling characteristics were also described. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed.
None of the 11 studies found significant estimates of pre–post MML changes compared with contemporaneous changes in non-MML states for marijuana use prevalence among adolescents. The meta-analysis yielded a non-significant pooled estimate (standardized mean difference) of −0.003 (95% confidence interval = −0.012, +0.007). Four studies compared MML with non-MML states on pre-MML differences and all found higher rates of past-month marijuana use in MML states pre-MML passage. Additional tests of specific MML provisions, of MML effects on additional marijuana outcomes and among subgroups generally yielded non-significant results, although limited heterogeneity may warrant further study.
Synthesis of the current evidence does not support the hypothesis that US medical marijuana laws (MMLs) until 2014 have led to increases in adolescent marijuana use prevalence. Limited heterogeneity exists among estimates of effects of MMLs on other patterns of marijuana use, of effects within particular population subgroups and of effects of specific MML provisions.
Thursday, February 22, 2018
The title of this post is the amusing headline of this amusing story about a little bit of misinformation delivered by law enforcement officers to teens in Canada. Here are the details:
Don't smoke marijuana, boys, or you'll develop breasts. That's the message that an officer for Canada's York Regional Police shared with high school boys last week during a drug-awareness talk in which the officer claimed that smoking marijuana would make boys develop breasts.
“There are studies that marijuana lowers your testosterone,” drug recognition officer Nigel Cole told students during a panel held at the York District School Board headquarters. “We call it ‘doobies make boobies,’ we are finding that 60 percent of 14-year-olds are developing ‘boobies.’”
Health experts quickly responded to dismiss the bogus claim. “Smoking marijuana does not give you breasts,” said Dr. John Harrison, Chief Scientific Officer for the healthcare company TeamMD. “Marijuana does impact hormones but by no means does it give anyone breasts. That’s what you call knowledge going the wrong way. There’s no scientific basis that I know of.”...
The police agree. Yesterday, the official Twitter account for the York Regional Police released an apology for spreading misinformation. "We’re no health experts," YPR wrote, "but we’re pretty sure getting high does not cause enhanced mammary growth in men. We are aware of the misinformation about cannabis that was unfortunately provided to the community by our officers. We’re working to address it."
The York Regional Police should certainly be given credit for forthrightly apologizing for spreading misinformation rather than for trying to deny this happened. But this incident serves to provide another reminder of the enduring challenges of ensuring that only sound information is part of needed efforts to educate the community about the array of potential pros and cons of marijuana use.
Tuesday, February 20, 2018
The title of this post is the title of this notable new Rand commentary authored by Eric Pedersen. Here are excerpts:
Young adults between the ages of 18 and 25 have been shown to be the most prevalent and problematic users of marijuana. And now with laws for recreational marijuana sales emerging in multiple states, there is a need to understand how the potential for harm can be minimized among young adults who choose to use the drug.
My colleagues and I at RAND and other research institutions have developed a Protective Behavioral Strategies Scale for Marijuana that helps identify some practices young adults can use to help limit their use of marijuana and avoid negative consequences....
We are still learning about the effects of legalization on marijuana consumption, but young adults between the ages of 18 and 25 represent the drug's most prevalent users and 5 percent of those in that age category meet criteria for cannabis use disorder — more than double the percentage of individuals in any other age category. Given that young adults are using the drug, and it is becoming increasingly more available for medical and recreational use, there is a need to understand whether the potential for harm can be minimized among those who choose to use marijuana.
One of my mentors in graduate school at the University of Washington, the late Alan Marlatt, was instrumental in challenging the notion that misuse of alcohol could only be controlled by abstinence, as in never using it again. He demonstrated that “harm-reduction techniques” could help individuals limit their use so that they experience few to no harms from use. Any step toward reduced risk, such as drinking one less day per week or limiting oneself to two drinks per day, was a step in the right direction. This proved to be an effective approach for some people and has been particularly attractive to young adults. That is, if young people chose to drink, they were provided with strategies for how to moderate their drinking in a way to minimize associated harms.
Using Marlatt's principles, my colleagues and I developed a list of strategies that young people can turn to before, during, after — or instead of — using marijuana to help protect themselves from experiencing negative consequences. In multiple studies we have shown that to be true: College students who use these strategies were at significantly less risk for heavily using the drug and experiencing negative consequences from use. And we came to a similar conclusion in another study with young veterans.
We have developed 36-item and 17-item versions of our list of strategies — the Protective Behavioral Strategies Scale for Marijuana (or the PBSM) — that researchers and clinicians can use in their research studies and in practice. Items on the list relate to a variety of situations and practices, and include strategies that may be helpful to try if someone desires to cut down use, wants to limit use around certain times of the day, and avoid or limit use in particularly risky situations, such as when everyone else around them is using. Some examples of items on the list are:
Avoid using marijuana before work or school.
Keep track of your costs to get an accurate picture of how much you spend on marijuana.
Avoid situations that you anticipate being pressured to use marijuana.
Use marijuana only among trusted peers.
Avoid using marijuana to cope with emotions such as sadness or depression.
Use a little and then wait to see how you feel before using more.
Limit use to weekends.
Sunday, February 18, 2018
The title of this post is the title of this short paper recently posted to SSRN authored by Ian Stewart and Francis Joseph Mootz. Here is its abstract:
Legal adult-use marijuana is associated with risks that may cause bodily injury and property damage. Many of these risks have been well documented and widely discussed in the media, including theft, fire, motor vehicle accidents and consumption-related injuries. T he potential for an increase in the number and value of cannabis-related product liability claims and lawsuits, however, is of particular concern to the cannabis and insurance industries. The production, distribution and sale of an ingestible product that has psychoactive effects – accompanied by a wide range of anticipated labeling and marketing representations – will certainly result in robust product liability litigation.