Marijuana Law, Policy & Reform

Editor: Douglas A. Berman
Moritz College of Law

Thursday, June 14, 2018

"The Politics of Passing and Implementing Medical Marijuana in Ohio"

The title of this post is the title of this notable new paper just posted to SSRN authored by A. Lee Hannah.  Here is its abstract:

Why did the state of Ohio adopt a medical marijuana policy? And why did it do so in 2016?  This article addresses these questions by examining the diffusion of medical cannabis policy across the U.S., by describing the evolution of images related to the policy, and by exploring the content of the law.

Using evidence from legislators’ remarks on the floor of the Ohio General Assembly and interviews with activists and analysts, I show that the direct initiative helped push members of the Ohio General Assembly to write and adopt a medical marijuana law (MML) when they were unlikely to do so. Next, I analyze trends in media coverage of medical marijuana to demonstrate that the spread of the policy has also been aided by shifting images related to the beneficiaries of medical cannabis programs.  Turning to the content of the law, I find that Ohio’s MML is written similarly to later adopters in the Midwest – where laws are more restrictive and medicalized. Finally, I assess how the characteristics of the law and looming elections will affect the implementation of Ohio’s Medical Marijuana Control Program.

June 14, 2018 in History of Marijuana Laws in the United States, Medical Marijuana Commentary and Debate, Medical Marijuana State Laws and Reforms | Permalink | Comments (0)

Saturday, June 9, 2018

Mapping out Oklahoma positions with approaching medical marijuana reform initiative vote

OK-Yes-788

This recent article from Religion News Service, headlined "In red-state Oklahoma, marijuana ballot question splits people of faith," provides a great look at the range of perspectives on marijuana reform in Oklahoma with only weeks before a big initiative vote. Here are snippets from an article worth reading in full:

As Presbyterian minister Bobby Griffith sees it, legalizing medical marijuana in Oklahoma could help arthritis sufferers with chronic pain and veterans with post-traumatic stress disorder.

The 41-year-old husband and father has a personal reason, too, for supporting State Question 788 — a pro-marijuana initiative that the Bible Belt state’s voters will decide June 26. “For myself, I would be interested in a prescription for it to see if it works better than my anxiety and depression medications,” said Griffith, co-pastor of a Presbyterian church near downtown Oklahoma City and a member of the national group Clergy for a New Drug Policy.

As Griffith characterizes it, the Oklahoma ballot measure’s potential to improve health outcomes and reduce dependence on addictive opioid painkillers makes it a “moral issue.”

Religious opponents counter that backing the issue would be immoral. Sen. James Lankford, R-Okla., an ordained Southern Baptist pastor, blasts the ballot measure as a “recreational marijuana vote disguised as medical marijuana.”

“The moral issue to me is really a family issue,” Lankford, who directed a Baptist youth camp before his 2010 election to Congress, told Religion News Service. “The best thing for our state is not to get more parents and grandparents to smoke marijuana,” added the senator, who filmed a commercial urging voters to reject State Question 788. “To have our communities more drug-addicted and distracted, that doesn’t help our families. It doesn’t make us more prosperous. It doesn’t make our schools more successful.”...

[F]aith arguments are prominent in a state where three out of four residents describe themselves in Gallup polling as “moderately religious” or “very religious.” The vote — which will take place on the state’s primary day for governor and other state and federal offices — resulted from a petition signed by nearly 68,000 voters and presented to state officials two years ago.

If State Question 788 passes, Abner warns, Oklahoma could follow the nine states that have authorized recreational use of marijuana. “The key thing is that it’s not medical,” he said. “This is something that’s hiding behind that (terminology) to bring recreational marijuana to Oklahoma. And from a spiritual standpoint, none of us can sustain the sound minds and healthy bodies God desires us to have when we place ourselves under the controlling influence of something other than the Holy Spirit.”

Other religious opponents include top officials of the Baptist General Convention of Oklahoma — representing the state’s roughly 577,000 Southern Baptists — and the Catholic Conference of Oklahoma, the public policy arm of the state’s Roman Catholic dioceses, comprising roughly 288,000 parishioners. “My hope is that Oklahoma will vote down marijuana legalization and continue to put legal barriers between addiction and the communities it devastates,” Russell Moore, president of the Southern Baptist Convention’s Ethics and Religious Liberty Commission, said in a statement published by The Baptist Messenger, an Oklahoma newspaper.

But Jon Middendorf, senior pastor of Oklahoma City First Church of the Nazarene, said he favors “whatever can bring relief to folks who are in chronic pain.”

“I’m just exhausted of conspiracy theories that always seem to emanate from the Christian right,” said Middendorf, who stressed that he was speaking personally and not on behalf of his congregation. “There’s always some sinister story behind it all,” he added. “It really might be that somebody who’s in pain just needs something that hasn’t been tried just yet, that offers some help for relief and quality of life, that they would not have had otherwise.”...

Typically, Oklahomans rank among the most conservative voters in the nation.... But on the medical marijuana issue, recent polling shows State Question 788 enjoying support from 57.5 percent of voters and seeming likely to pass, reported Bill Shapard, CEO of SoonerPoll.com.

“We’ve polled this issue multiple times over the last five years, and we continue to see that certain groups, who one might think would be opposed to SQ788, continue to support it,” Shapard said in a statement. “Thirty years ago, these groups would have opposed it, but roughly half have changed their minds since then.”

Griffith, whose congregation is affiliated with the Presbyterian Church in America, said some of his most conservative friends support State Question 788. “A very conservative person I know — I mean, she loves President Trump but she also wants medical marijuana,” he said. “She has rheumatoid arthritis and wants to have something that helps relieve the pain and has some healing qualities about it without the addiction.”

Notably, this article was published before Prez Trump's comments this past Friday suggesting he would support a federal marijuana reform bill that would formally respect state marijuana reform laws.   I suggested in this post a few months ago that proponents of Question 788 likely could benefit greatly, given that 65% of the state voted for Prez Trump, if they could claim he was supportive of state marijuana reform efforts.   interesting times.

Some prior related posts:

June 9, 2018 in Campaigns, elections and public officials concerning reforms, Initiative reforms in states, Medical Marijuana Commentary and Debate, Medical Marijuana State Laws and Reforms, Religion, Who decides | Permalink | Comments (0)

Friday, June 8, 2018

Rounding-up some notable and thoughtful reactions to the new STATES Act approach to federal marijuana reform

As noted in this prior post, President Donald Trump this morning seemingly indicated support for the new marijuana reform law proposed yesterday by Senators Cory Gardner (R-Colo.) and Elizabeth Warren (D-Mass.) and Representatives David Joyce (R-Ohio) and Earl Blumenauer (D-Ore.).  The proposal, knows as Strengthening the Tenth Amendment Through Entrusting States Act (STATES Act), has already drawn reactions both political and academic.  Here is a round up:

Tom Angell has collected a lot of notable reactions at Marijuana Moment under the heading, "Lawmakers And Advocates React To Bipartisan Trump-Supported Marijuana Bill"

For more detailed and academic perspectives, I highly recommend:

Prior related posts:

June 8, 2018 in Federal Marijuana Laws, Policies and Practices, History of Marijuana Laws in the United States, Medical Marijuana Commentary and Debate, Recreational Marijuana Commentary and Debate, Who decides | Permalink | Comments (0)

Monday, June 4, 2018

Medical marijuana news nationwide, in states large and small, developing and debated

There are so many interesting developments, some small and some big, in medical marijuana states that I cannot come close to keeping track of it all.  Having seen a lot of notable stories in a lot of states in recent days, I figured it might be time to do a round-up of stories that caught my eye.  So, though this is not in any sense comprehensive, here goes in alphabetical order:

From Arkansas here, "Arkansas Supreme Court to hear dispute over medical marijuana rollout"

From Connecticut here, "With booming medical marijuana program, some fear shortages"

From Georgia here, "Georgia couple loses custody of son after giving him marijuana to treat seizures"

From Florida here, "As marijuana dispensaries open their doors, Florida registers 5,400 new users per week"

From Maryland here, "Overwhelmed computer system stalls medical marijuana sales over weekend in Maryland

From Ohio here, "Ohio announces 56 sites where medical marijuana will be sold"

From Oklahoma here, "Oklahoma's medical marijuana law would be unique"

From Utah here, "Unofficially, many Utah law enforcement groups are lining up to oppose the medical marijuana initiative"

June 4, 2018 in Medical community perspectives, Medical Marijuana Commentary and Debate, Medical Marijuana Data and Research, Medical Marijuana State Laws and Reforms | Permalink | Comments (1)

Friday, June 1, 2018

Brookings debuts short documentary: "The Life She Deserves: Medical Marijuana in the United States"

Regular readers have often seen me use this space to sing the praises of various writings from various folks at Brookings on various marijuana reform topics.  This Brookings feature highlights that their work in this space has taken on a new dimension:

For 100 years, Brookings has been known for its in-depth public policy research, primarily shared through reports, books, and events. This year, the Institution has added a new medium to its canon of work: narrative film.

On May 29, Brookings and Variety co-hosted the Washington, D.C. premiere of the Institution’s first documentary-short film, “The Life She Deserves.” The film is an intimate portrait of Virginia teenager Jennifer Collins and her family’s struggle to find a treatment to control her debilitating epilepsy and their fight to change medical marijuana laws. Following the screening of the film—a culmination of more than two years of work between Senior Fellow John Hudak and the Institution’s creative video team — John Hudak, Jennifer Collins, her mother and medical cannabis advocate Beth Collins, and George Burroughs, the film’s director, discussed the role of film in influencing policy and the current picture of state-level marijuana legalization and federal restrictions on the use and clinical research into medical cannabis. Ted Johnson, a senior editor at Variety, moderated the conversation....

“The Life She Deserves” is available to watch online at www.lifeshedeserves.com.

June 1, 2018 in Federal Marijuana Laws, Policies and Practices, Medical Marijuana Commentary and Debate, Medical Marijuana State Laws and Reforms | Permalink | Comments (0)

Monday, May 28, 2018

"PTSD & Pot: Veterans making Memorial Day push for legal marijuana"

The title of this post is the title of this lengthy new Fox News article. Regular readers know I have, since starting this blog more nearly five years ago, regularly blogged about a range of issues relating to veterans and their access to marijuana (a dozen of recent posts on this topic are linked below). As I have said before and will say again, I feel a genuine and deep debt to anyone and everyone who serves this nation through the armed forces, and I feel especially strongly on a day like Memorial Day that veterans should be able to have safe and legal access to any and every form of medicine that they and their doctors reasonably believe could help them with any ailments or conditions. Here is part of the start of the Fox News piece:

Veterans from across the country will be gathering in our nation's capital on Memorial Day this year to not only honor those who made the ultimate sacrifice, but to advocate for a cause that isn't typically associated with our nation's heroes -- the legalization of marijuana.

The veterans and advocates taking part in the Memorial Day Veterans Rally DC hope to change the stigma that surrounds cannabis, the preferred term for marijuana among advocates, by arguing that this alternative medicine is already helping some vets treat issues like PTSD, chronic pain and depression -- all without the use of dangerous & addictive prescription drugs like opioids. One of their rallying cries is "plants over pills," and they're not just coming from the usual legal pot hot-spots like Colorado....

Beyond a lack of access in all 50 states, advocates say one of the biggest problems is that veterans are forced to pay for this alternative treatment out of pocket, despite what they say are life-saving results. That's due to Department of Veterans Affairs regulations which stipulate VA doctors still cannot prescribe medicinal marijuana to patients, despite the fact that they are allowed to "discuss marijuana use with veterans as part of comprehensive care planning."

Some recent prior related posts:

May 28, 2018 in Medical Marijuana Commentary and Debate, Medical Marijuana State Laws and Reforms, Who decides | Permalink | Comments (0)

Sunday, May 27, 2018

"Could medical marijuana help fight opioid abuse? It’s complicated"

MarijuanavopioidsThe title of this post is the thoughtful headline of this article from Illinois thoughtfully discussing the issues surrounding the relationship between opioid use and marijuana access.  Here are excerpts:

Tom Utley says medical marijuana allowed him to reduce his use of prescription painkillers by 98 percent over the past year and a half. “It has given me control of my life,” said Utley, 42, a Mason County resident whose chronic pain after a car crash 27 years ago used to require him to swallow Vicodin and OxyContin pills four times a day.  Now he takes prescription opioids only a few times each month.

Utley, who works part time running a gymnastics tumbling program, has found relief in marijuana-infused topical lotions and patches, as well as smokable cannabis, from Springfield’s HCI Alternatives dispensary. Unlike prescription opioids, marijuana doesn’t come with the unwanted side-effects of constipation, cravings and cloudy thinking, he said....

Utley is among those who see expanded access to medical marijuana for people in pain as one solution for the nationwide epidemic of addiction to legal opioid painkillers and illegal opioids such as heroin and fentanyl.  There were about 2,000 fatal and 14,000 nonfatal opioid overdoses in Illinois last year. “I think it would be a way-better alternative,” Utley said of medical cannabis....

The Illinois General Assembly is considering a bill that could vastly expand the number of people qualifying for the state’s medical marijuana pilot program.  Senate Bill 336 would allow people who have been or could be prescribed opioids to apply for acceptance into the program.  The science surrounding the therapeutic benefits of marijuana is far from conclusive. But those shades of gray are missing from descriptions of both the benefits of cannabis from supporters of SB 336, and the drawbacks cited by opponents.

“Public policy is light years ahead of the science right now,” said Ziva Cooper, a research scientist who is associate professor of clinical neurobiology in psychiatry at Columbia University in New York. “There seems to be this nationwide experiment on the effects of cannabis that is happening in the absence of rigorous studies.”

SB 336 passed the Illinois Senate on a 44-6 vote April 26.  The bill is expected to receive a vote from the full House by the end of the week....  A spokeswoman for Gov. Bruce Rauner, a Republican, didn’t respond when asked the likelihood that Rauner would sign the bill into law if it reaches his desk.

Supporters of the legislation cite studies that have documented a correlation between a reduction in opioid-related fatalities and opioid prescriptions in states that allow the use of marijuana for medical or recreational purposes.  “The science is generally supportive of the concept,” said state Sen. Don Harmon, D-Oak Park, the bill’s chief Senate sponsor. “People don’t die from cannabis. I don’t feel like we’re doing much harm.”

But those studies, as well as numerous anecdotal reports from patients, don’t necessarily prove that expanding medical marijuana use leads to positive outcomes for the general population, Cooper said.  Results also aren’t conclusive when it comes to the negative implications of cannabis use reported in other legitimate but non-definitive studies, she said.  Those studies, publicized by Springfield-based Illinois Church Action on Alcohol and Addiction Problems, suggest marijuana is associated with an increased risk of prescription opioid misuse and addiction, and actually may contribute to the opioid epidemic....

Cooper said, “There is correlational evidence on both sides of the argument.” ...  The studies do make a compelling argument that more and more-rigorous follow-up studies are needed, she said while declining to comment on SB 336. “It’s just going to take time for us to do the studies that will yield the actual data that support some of these things we’re hearing about in the media,” she said.

Cooper was a member of a committee convened by the National Academies of Sciences, Engineering and Medicine that issued a report in January 2017 on the current state of evidence surrounding the health effects from cannabis and chemicals in cannabis known as cannabinoids.  The report said there is “conclusive” or “substantial” evidence that cannabis or cannabinoids are effective for the treatment of chronic pain in adults. “But there are a couple of caveats,” she said.  For example, she said, the report didn’t say there’s conclusive evidence that cannabis is more effective than opioids in helping patients deal with pain....

Data from the state indicate that 3 million Illinoisans obtained an opioid prescription in 2016, according to Chris Stone, chief executive officer of HCI Alternatives.  Even if just 10 percent of those patients sought temporary access to the state’s medical marijuana program under the provisions of SB 336, up to 300,000 people would join a program currently serving 36,800 people, he said....

Illinois, unlike most states with medical marijuana programs, doesn’t allow a general diagnosis of pain to qualify patients for the program, Cassidy said.  The Illinois Department of Public Health is appealing a Cook County judge’s January ruling ordering the department to add “intractable pain” to the list of qualifying conditions for medical marijuana.

IDPH director Dr. Nirav Shah has said there was a lack of “high-quality data” to justify adding pain to the list of more than 30 conditions, which include cancer, AIDS, spinal cord injury, seizures and fibromyalgia. SB 336 isn’t designed to add pain patients to the program for the rest of their lives. “This is really about folks who are looking at a six-month period of time of needing these medications or a three-month time period — for those folks who are very much at risk of addiction,” Cassidy said.

Some (of many) prior related posts:

May 27, 2018 in Medical community perspectives, Medical Marijuana Commentary and Debate | Permalink | Comments (0)

Tuesday, May 22, 2018

"Cities should restrict marijuana businesses to the same areas as junkyards and strip clubs"

The title of this post is the (catchy?) subheadline of this new provocative Bloomberg commentary authored by economist Tyler Cowen under the main headline "Legalize Pot, But Don’t Normalize It." Here are excerpts:

I think it is the proper province of government to regulate the use of public spaces in ways that encourage order and utility.  Private shopping malls won’t let you walk through the halls snorting heroin or smoking marijuana, and there is nothing outrageous about that decision.  The property owners have decided that they want a particular kind of experience and image for their venue, and they regulate its use and access accordingly.  Municipal governments should make and enforce comparable decisions.

Cities and towns already face these trade-offs when it comes to zoning.  Even if you believe, as I do, that most zoning regulations are far too restrictive, it’s legitimate for a local government to decide that a waste dump, an auto junkyard or a strip club cannot simply set up shop anywhere in a city, hang out a sign and attract attention.  We ought to treat marijuana the same way.

I propose that cities and suburbs restrict the sale and usage of marijuana to the same areas we use for garbage disposal and other “zoned out of sight” enterprises.  We needn’t throw anyone in jail: If people or businesses violate these strictures, keep hitting them with the equivalent of parking tickets or injunctions, much as you would for an out-of-place repair shop.  It should be possible to visit Colorado without knowing that marijuana is legal there.  If someone is determined to ingest it, they can either drive to an industrial zone or order it online, and smoke it at home or up away in the mountains.

You might wonder why we should be so worried about public marijuana use.  To put it bluntly, I see intelligence as one of the ultimate scarcities when it comes to making the world a better place, and smoking marijuana does not make people smarter.  Even if you think there is no long-term damage, right after smoking a person is less able to perform most IQ-intensive tasks (with improvisational jazz as a possible exception).  By having city streets filled with pot, pot stores and the odor of pot, we are sending a signal that our society isn’t so oriented toward the intellect or bourgeois values.  Even if that signal is reflecting a good bit of truth, it would be better not to acknowledge it too openly, just as most advocates of legalized prostitution don’t want to allow brothels on Main Street....

Marijuana advocates commonly counter that the drug is no worse or more dangerous than alcohol.  I agree, but you nonetheless might still believe that alcohol has acquired too prominent a place in the American public sphere, even if that state of affairs is no longer reversible.  There is no reason we should compound that mistake with marijuana.

May 22, 2018 in Business laws and regulatory issues, Medical Marijuana Commentary and Debate, Recreational Marijuana Commentary and Debate | Permalink | Comments (0)

Wednesday, May 2, 2018

"Medical Marijuana Users are More Likely to Use Prescription Drugs Medically and Nonmedically"

Download (10)The title of this post is the title of this notable new research authored by Theodore Caputi and Keith Humphreys being published in the Journal of Addiction Medicine. Here is its abstract:

Objectives

Previous studies have found a negative population-level correlation between medical marijuana availability in US states, and trends in medical and nonmedical prescription drug use. These studies have been interpreted as evidence that use of medical marijuana reduces medical and nonmedical prescription drug use. This study evaluates whether medical marijuana use is a risk or protective factor for medical and nonmedical prescription drug use.

Methods

Simulations based upon logistic regression analyses of data from the 2015 National Survey on Drug Use and Health were used to compute associations between medical marijuana use, and medical and nonmedical prescription drug use. Adjusted risk ratios (RRs) were computed with controls added for age, sex, race, health status, family income, and living in a state with legalized medical marijuana.

Results

Medical marijuana users were significantly more likely (RR 1.62, 95% confidence interval [CI] 1.50–1.74) to report medical use of prescription drugs in the past 12 months. Individuals who used medical marijuana were also significantly more likely to report nonmedical use in the past 12 months of any prescription drug (RR 2.12, 95% CI 1.67–2.62), with elevated risks for pain relievers (RR 1.95, 95% CI 1.41–2.62), stimulants (RR 1.86, 95% CI 1.09–3.02), and tranquilizers (RR 2.18, 95% CI 1.45–3.16).

Conclusions

Our findings disconfirm the hypothesis that a population-level negative correlation between medical marijuana use and prescription drug harms occurs because medical marijuana users are less likely to use prescription drugs, either medically or nonmedically. Medical marijuana users should be a target population in efforts to combat nonmedical prescription drug use.

May 2, 2018 in Medical Marijuana Commentary and Debate, Medical Marijuana Data and Research | Permalink | Comments (0)

Monday, April 30, 2018

Lots of new medical marijuana coverage via CNN

Last night CNN aired the fourth installment of Chief Medical Correspondent Dr. Sanjay Gupta's programming about marijuana.  This Special Report was titled "Weed 4: Pot vs. Pills," and CNN has has a number of stories in recent days related to its work in this space.  Here are links to just some of its recent coverage:

April 30, 2018 in History of Marijuana Laws in the United States, Medical community perspectives, Medical Marijuana Commentary and Debate, Medical Marijuana Data and Research | Permalink | Comments (0)

Sunday, April 29, 2018

Zimbabwe becomes second country in Africa to legalize medical marijuana

MapAs reported in this article, headlined "Zimbabwe legalises marijuana for medicinal use: Decision is a step away from the country's traditionally tough stance on drugs," a notable nation on a notable continent is the latest to join the ranks of marijuana reformers:

Zimbabwe has made it legal to produce marijuana for medicinal and scientific uses.

It follows in the footsteps of Lesotho, the tiny nation which last year became the first in Africa to issue a license for medical marijuana.

Zimbabwe has been considering legalising the drug for a number of months, and will now become one of the few countries able to turn it into a source of revenue. Previously, production and possession of the drug could bring up to 12 years in prison, although recreational use remains illegal.

The move is a step away from Zimbabwe's traditionally tough stance on drugs. In the past, members of parliament in the largely conservative country who had advocated for legalisation were often mocked.

Much of Africa still criminalises the production and use of marijuana but countries including Malawi and Ghana are reportedly exploring ways they too can legalise it.

A South African court last year ruled that private use of marijuana was legal but the government appealed against the ruling at the constitutional court.

April 29, 2018 in International Marijuana Laws and Policies, Medical Marijuana Commentary and Debate, Who decides | Permalink | Comments (0)

Wednesday, April 25, 2018

Making a case for the FDA as the main federal agency on marijuana reform

Download (13)Paul J. Larkin Jr., a senior legal research fellow in The Heritage Foundation’s Meese Center for Legal and Judicial Studies, has this interesting new Fox News commentary headlined "On marijuana, let the Food and Drug Administration make the decisions." Here are excerpts:

Reports about the Trump-Gardner deal and Schumer proposal [to reform federal marijuana laws and policies] raise several additional questions:

· Will the federal government pursue an entirely new policy regarding marijuana regulation?

· If so, will that new direction leave decision-making entirely up to the states?

· If not, will the federal government still play a role?

· Will that change lead to a net social plus or minus?

The answer to each of those questions is the same: “Maybe yes, maybe no.” That’s because there is another possible option lying between “absolute federal ban” and “complete state freedom.”...

In 1962, Congress also prohibited the distribution of new drugs unless the FDA commissioner first found them to be both “safe” and “effective.” Since then, Congress has consistently reiterated that the FDA should be responsible for making those decisions – not Congress, not the states, not the public. It’s an important matter. We do not decide by plebiscite which drugs should be sold to the public. America has resolved that experts should make that decision because the average person lacks the education, training and experience to answer the medical question of whether a particular drug is safe and effective.

Why should we treat marijuana differently? For more than two decades, states have decided to reconsider their marijuana laws and permit people to use marijuana for medical or recreational purposes even though the distribution of marijuana is forbidden under federal law. Three presidents – Bill Clinton, George W. Bush, and Barack Obama – each failed to force Congress to decide whether federal law should also be re-examined.

President Trump may be willing to do what his three predecessors should have done. It is time for Congress to take up this subject once again. Great nations, like great people, always must be willing to reconsider their laws in light of new developments. It makes sense for Congress to revisit this issue.

But that does not mean senators and representatives should act in a vacuum, without regard for the nation’s designated authority on food and drug safety. Nor should members of Congress simply act according to polling results. We do not let the public decide which antibiotic, antiviral, antifungal, or chemotherapy drugs can be marketed. There is no reason to treat marijuana differently.

Congress has never let the FDA decide this issue, because federal law has treated marijuana as contraband since the year before the FDCA became law. Maybe we should treat marijuana in the same way that we treat any other new drug that someone argues should be used therapeutically.

No healthy democracy can afford to glibly disregard the opinions of experts on matters within their expertise. Since 1962, the United States has decided to trust the FDA with the responsibility to resolve any debate, either within or beyond the scientific community, over a drug’s safety and efficacy. That decision is entitled to no less respect today than it was 50 years ago.

So maybe Congress will re-examine the treatment of marijuana under federal law and send the nation in a new direction. But maybe that new direction will be to leave the decision how to treat marijuana in the hands of the person we trust to make other, similar decisions: the commissioner of food and drugs. And maybe that approach will be a net social plus. We certainly think so with respect to other drugs. Perhaps, it’s time to enlist the FDA commissioner to make a scientific judgment about this issue too.

April 25, 2018 in Campaigns, elections and public officials concerning reforms, Federal Marijuana Laws, Policies and Practices, Food and Drink, History of Marijuana Laws in the United States, Medical Marijuana Commentary and Debate, Recreational Marijuana Commentary and Debate, Who decides | Permalink | Comments (0)

Friday, April 20, 2018

"Does medical marijuana decrease opioid use or boost it?"

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.

April 20, 2018 in Medical community perspectives, Medical Marijuana Commentary and Debate, Medical Marijuana Data and Research | Permalink | Comments (0)

Tuesday, April 17, 2018

SBNation takes big look at "Sports in the age of cannabis"

DownloadThe 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.

ATHLETES ARE LEADING CANNABIS INTO THE MAINSTREAM

WEED AND SPORTS: A TIMELINE

CANNABIS IS FUELING ONE OF THE BEST RUNNERS IN AMERICA

WHICH WEED IS RIGHT FOR ATHLETES?

HOW ATHLETES BEAT WEED TESTS

THE GENDER DOUBLE STANDARD OF WEED IN SNOWBOARDING

WEED STIGMAS ARE CHANGING, BUT NOT FOR PEOPLE OF COLOR

April 17, 2018 in Medical Marijuana Commentary and Debate, Race, Gender and Class Issues, Recreational Marijuana Commentary and Debate, Sports, Who decides | Permalink | Comments (0)

Thursday, April 12, 2018

Senators Orrin Hatch and Kamala Harris write to AG Jeff Sessions to push for more medical marijuana research

53352_lgAs 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.

April 12, 2018 in Federal Marijuana Laws, Policies and Practices, Medical Marijuana Commentary and Debate, Medical Marijuana Data and Research, Who decides | Permalink | Comments (0)

Monday, April 2, 2018

Two new papers provide further evidence of marijuana reform aiding with opioid crisis

180402-imd-ec-800As 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:

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

Notable efforts to expand reach and application of New Jersey's medical marijuana program

Nj-mmj-e1522187420449The 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.

March 28, 2018 in Medical community perspectives, Medical Marijuana Commentary and Debate, Medical Marijuana Data and Research, Medical Marijuana State Laws and Reforms | Permalink | Comments (0)

"Enforcing Federal Drug Laws in States Where Medical Marijuana Is Lawful"

Jama-logoThe 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"

Npp201754f1The 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.

March 25, 2018 in Medical community perspectives, Medical Marijuana Commentary and Debate, Medical Marijuana Data and Research | Permalink | Comments (0)

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.

March 23, 2018 in Medical community perspectives, Medical Marijuana Commentary and Debate, Medical Marijuana Data and Research | Permalink | Comments (0)