Marijuana Law, Policy & Reform

Editor: Douglas A. Berman
Moritz College of Law

Wednesday, September 30, 2015

"The Wonder Drug: Inside the medical marijuana industry's wild new frontier"

The title of this post is the headline of this must-read New Republic article, which is mostly about the current crazy "wild west" world of CBD medicines.  There are many parts of the article that make it must-read in full, and here are passages that I especially wanted to highlight for commentary:

Today, dozens of companies produce CBD in an array of forms. CBD can be inhaled through vape pens, applied in topical salves, ingested in edibles, or swallowed in oil-based tinctures.  Oil has become the dominant CBD delivery method for kids with epilepsy, since it is easy to administer and ingest, and there is no shortage of it available for sale online.  There are dozens of companies boasting names like Healthy Hemp Oil, Dose of Nature, and Natural Organic Solutions, each of them selling CBD products at prices ranging from trivial to dizzyingly steep.  You don’t have to look hard to find them. If you have a PayPal account and $100 to spare, you could have a vial of hemp oil delivered to your doorstep....

In February, as part of an investigation into the marketing claims of six hemp oil companies, the FDA analyzed 18 CBD products.  What it found was disturbing: Many of these supposed CBD products were entirely lacking in CBD.  Of the products tested, six contained no cannabinoids whatsoever.  Another 11 contained less than 1 percent CBD.  The product that tested highest in CBD, at 2.6 percent, was a capsule for dogs. In states that have legalized CBD, regulations can require CBD products to contain at least 5 percent CBD, more often 10 or 15 percent....

In the end, companies like HempMedsPx are asking consumers simply to trust them. CBD oils are never subjected to systematic testing by any U.S. regulatory body.  The FDA regulates all pharmaceutical labs in the country.  But cannabis labs like the ones that HempMedsPx and others use are not, because cannabis is not federally recognized as a legal drug.

All of this makes CBD remarkably difficult for even the most dedicated health care providers to manage safely. Dr. Kelly Knupp, an associate professor of pediatrics and neurology at the University of Colorado, and the director of the Dravet Syndrome program at Children’s Hospital Colorado, said families of epileptic children have tried to bring CBD oils to the hospital for testing.  “They’re just concerned that they don’t know exactly who’s growing [the hemp],” Knupp said.  “They know it’s not being regulated.”  But because CBD is a Schedule I controlled substance, high-tech, regulated laboratories, like those at the University of Colorado, can’t accept, store, or test CBD oils, lest they risk prosecution.  “There is no such lab that can take that product,” Knupp said, which leaves any testing up to the unregulated testing centers that cater to the cannabis industry....

To this point, CBD oil has existed in a kind of liminal space — at once an illegal drug, a legal medication, and some kind of “dietary” supplement. It’s possible this could change in the coming years, however. GW Pharmaceuticals, a U.K.-based firm, has developed a “pure CBD” medication called Epidiolex that has shown promising test results. It is currently on a fast-track to receive FDA clearance. For some patients, Epidiolex could be a miracle cure. This summer, in Wired magazine, writer Fred Vogelstein chronicled his family’s own struggles to find an effective treatment for his son’s epilepsy — including experiments with hemp oil — and the immense hurdles they overcame to gain access to Epidiolex prior to its FDA approval.  The drug could be for sale on pharmacy shelves in the near future, though exactly how near is hard to say.

For the sake of all the individuals and families struggling with seizure disorders, I sincerely hope that all the emerging CBD treatments being promoted by private industry are much more than snake oil. But I find especially remarkable the sad reality that the blanket prohibition of marijuana in any form at the federal level means that it is near impossible for a person to even have access to a credible lab in order to try to research whether a CBD oil marketed to suffering persons is even what it claims to be. What a sad mess, and one that I hope will get cleared up before too long at the federal level by efforts to move marijuana off Schedule I of the Controlled Substances Act.

September 30, 2015 in Federal Marijuana Laws, Policies and Practices, Medical community perspectives, Medical Marijuana Commentary and Debate, Medical Marijuana Data and Research, Medical Marijuana State Laws and Reforms, Who decides | Permalink | Comments (0)

Friday, September 11, 2015

"The Worst of Both Worlds: The Wild West of the 'Legal' Marijuana Industry"

The title of this post is the title of this notable new article by Luke Scheuer available via SSRN.  Here is the abstract:

As states have legalized marijuana, they have created a booming industry that operates in violation of the federal Controlled Substances Abuse Act.  Like the tobacco and alcohol industries, this new legal marijuana industry has the potential to do great harm to American consumers and communities if it is not disciplined and restrained in how it sells and develops its products.  Unfortunately the federal government has not yet stepped in to regulate the industry and state governments have imposed only limited controls.  In addition, because of the increased threat of criminal and civil liability hanging over the industry, it has been largely shut out from attracting professional stakeholders including banks, venture capital firms, and professional managers which could help impose market discipline.

In order to achieve the policy goals behind legalization of marijuana it is important that states do everything they can in the short term to regulate this industry so that it develops in a responsible manner. One of the things states can do is promote the integration of professional stakeholders into this industry. This essay explores what it means to be a “professional” in the marijuana industry and how more professionals could help mitigate some of the harm this industry poses to the public. 

September 11, 2015 in Medical Marijuana Commentary and Debate, Recreational Marijuana Commentary and Debate, Who decides | Permalink | Comments (0)

Thursday, September 10, 2015

Two extended (and effective) reviews of Ohio's distinct marijuana reform dynamics

With election day 2015 now less than eight weeks away (and the start of early voting less than four weeks away), I am pleased to see that some national and local media are starting to engaging in deeper dives into the doctrines and debates surrounding the Ohio marijuana reform proposal now before Buckeye voters.  Of particular note are these two lengthy new pieces about what is now known in Ohio as Issue 3:

  • From the International Business Times here, "Marijuana Legalization 2015: Ohio’s Push To Legalize Pot Creates Rifts Within Pro-Pot Movement"

  • From the Cincinnati Enquirer here, "Parents of ill children question whether Issue 3 will meet medical marijuana needs"

September 10, 2015 in Campaigns, elections and public officials concerning reforms, Initiative reforms in states, Medical Marijuana Commentary and Debate, Medical Marijuana State Laws and Reforms, Recreational Marijuana Commentary and Debate, Recreational Marijuana State Laws and Reforms, Who decides | Permalink | Comments (0)

Monday, September 7, 2015

"Are 'Legal' Marijuana Contracts 'Illegal'?"

The title of this post is the title of this new paper by Luke Scheuer now available via SSRN. Here is the abstract:

America is currently in the midst of a “legal” marijuana business boom.  In states which have legalized marijuana thousands of businesses have been created and are being openly operated despite the continued prohibition on their main product by the federal Controlled Substances Abuse Act.  As a regular part of their business, these companies enter into contracts which violate the CSA, for example, every time they sell their main product.  

These businesses, and their stakeholders, rely upon the enforceability of these contracts in order to regulate their relationships.  However, under the “illegality” or public policy defense to the enforcement of contracts these contracts are arguably all void and unenforceable.   Under the traditional understanding of this defense not only will an illegal contract not be enforced but any consideration paid will not even be returned.  This defense is grounded in the public policy against encouraging illegal behavior and is a product of state law.  Should courts apply it to the marijuana industry which has been legalized also under state law when it clearly is not against the public policy of states which have legalized marijuana to allow for the sale of marijuana?

This article explores the effects of the conflict between federal and state marijuana laws on these businesses’ ability to enter into legally enforceable contracts.  This article argues that marijuana contracts do not in fact violate public policy and therefore should be enforced despite their illegality.  Nevertheless, courts should exercise restraint in enforcing these agreements, particularly in applying equitable remedies such as specific performance, so as to avoid forcing individuals to violate federal law.

September 7, 2015 in Business laws and regulatory issues, Medical Marijuana Commentary and Debate, Recreational Marijuana Commentary and Debate | Permalink | Comments (0)

Friday, September 4, 2015

Senator Elizabeth Warren "open" to full legalization and urges more marijuana research

As highlighted in this posting at Marijuana Politics, headlined "Progressive Icon Elizabeth Warren is Now Open to Marijuana Legalization," Massachusetts Senator Elizabeth Warren had a number of interesting things to say about marijuana reform and marijuana research during an interview this past week.  Here is the video:

September 4, 2015 in Campaigns, elections and public officials concerning reforms, Federal Marijuana Laws, Policies and Practices, Medical Marijuana Commentary and Debate, Recreational Marijuana Commentary and Debate | Permalink | Comments (0)

"Trademark Laundering, Useless Patents, and Other IP Challenges for the Marijuana Industry"

The title of this post is the title of this notable new paper authored by Sam Kamin and Viva Moffat now available via SSRN.  Here is the abstract:

Marijuana law is changing rapidly in the United States today – since 1996, 23 states and the District of Columbia have legalized medical marijuana and five jurisdictions have made marijuana legal for all adults.  Because marijuana remains a prohibited substance under federal law, however, the states are significantly limited in their ability to control marijuana policy within their borders.  For example, because banking is regulated by the federal government, state-licensed marijuana businesses cannot gain full access to banking services; because bankruptcy is a federal benefit, it is unavailable to those involved in the business of violating federal law.

This article examines the implications for marijuana businesses of another area of federal regulation that has heretofore escaped academic commentary: federal intellectual property law.  The continuing federal marijuana prohibition means that the most relevant federal intellectual property protections – trademark and patent – are largely unavailable for most marijuana businesses.  While they are bound to comply with the dictates of trademark and patent law in their own affairs, marijuana businesses cannot acquire the rights and benefits of those laws or invoke those doctrines against others.

We discuss the ways in which these businesses attempt to circumvent the unavailability of patent and trademark rights, often through reliance on state law doctrines which generally prove insufficient to meet their needs.  We also discuss the unexpected natural experiment that the current conflict between state and federal law creates.  It is often asserted that intellectual property protections are necessary to foster creativity and investment.  Yet the marijuana industry has seen extraordinary innovation and capital formation, even as these ostensibly necessary protections have proven unavailable.  We conclude by discussing the implications of this observation for federal intellectual property law and policy more generally.

September 4, 2015 in Business laws and regulatory issues, Medical Marijuana Commentary and Debate, Recreational Marijuana Commentary and Debate, Web/Tech | Permalink | Comments (0)

Could (and will) women executives become dominant leaders in the marijuana industry?

20150828coverweed1800-x-2400The question in the title of this post is prompted by this recent lengthy Newsweek article headlined "Women in Weed: How Legal Marijuana Could Be the First Billion-Dollar Industry Not Dominated by Men." Here are excerpts:

It seems fitting that a plant called Mary Jane could smash the patriarchy. After all, only female marijuana flowers produce cannabinoids like the potent THC chemical that gets users buzzed. Pot farmers strive to keep all their crops female through flowering female clones of one plant, called the Mother. And women are moving into the pot business so quickly that they could make it the first billion-dollar industry that isn’t dominated by men....

During the past few years, hundreds of women have been ... propriety in the newly regulated marijuana industry. Indeed, many female entrepreneurs are striking Acapulco Gold. Though the industry is still predominantly male and employment statistics are somewhat vaporous, the power and influence of women are, by all signs, on the upswing. In the summer of 2014, Women Grow — a professional marijuana women’s networking group—launched with just 70 people; today, the monthly chapter meetings in 30 cities attract more than 1,000 women nationwide. The two-year-old Marijuana Business Association, a Seattle-based B2B trade group, started a Women’s Alliance in 2014 that now boasts 500 members. In just two years, Women of Weed, a private social club in Washington, has seen its membership swell from eight to 300.

Drug reform activist attorney Shaleen Title runs a marijuana recruitment agency, THC Staffing, entirely owned and run by women. She says half of the employment placements her company makes are women. “I am especially seeing more women with corporate ‘mainstream’ experience looking to join the marijuana industry,” she says. “With time, there will be more women with marijuana experience.”

Just like in Washington, women in Colorado were important players in the crafting and implementation of the legalization measure amendment. Title joined the Amendment 64 campaign in the summer of 2012. “As a senior staffer, I worked with several other women on the campaign,” she says. Most notably, attorney Tamar Todd, now the director of marijuana law and policy for the Drug Policy Alliance; Betty Aldworth, the primary spokeswoman and now executive director of Students for Sensible Drug Policy, which supports other young women activists; and Rachelle Yeung, now an attorney with Vicente Sederberg, a marijuana-focused law firm. Title says women were chosen deliberately in order to reach women. “Betty had a particular ability to relate to the mainstream. I had previously helped with California’s Prop 19 campaign in 2010, where we had trouble securing women's votes before the initiative ultimately failed. We knew that women's votes were crucial.”

In Colorado and Washington, the key demographic in the legalization movements were 30- to 50-year-old women, according to a study by the Wales-based Global Drug Policy Observatory. “I think women can help demonstrate that it's a reasonable choice for a lot of people,” Title adds. “And it's not going to turn you into Cheech or Chong.”...

Despite its illegal federal status, the marijuana business is one of the nation’s newest and fastest-growing industries. Regulated weed (medical and recreational) made $2.7 billion in nationwide revenue in 2014 alone, up from $1.5 billion in 2013 (medical only, the first recreational shops weren’t open in Washington and Colorado until January 2014). By 2019, the pot sold in all states and districts with legalization is projected to reach nearly $11 billion yearly, according to estimates by ArcView Market Research, an Oakland, California-based pot-focused investor network and market research company.

As pot legalization spreads, women are taking over more roles in the industry. There are female cannabis doctors, nurses, lawyers, chemists, chefs, marketers, investors, accountants and professors. The marijuana trade offers women a shortcut to get ahead in many avenues, and women in turn are helping to organize it as a viable business. Mary Lynn Mathre founded and is president of the American Cannabis Nurses Association (ACNA), a national organization with 315 members — 271 of whom are women. ACNA board member and director Eloise Theisen in Lafayette, California, created her own medical cannabis treatment clinic, Green Health Consultants. Emily Paxhia analyzes the cannabis financial marketplaces as a founding partner at the marijuana investment firm Poseidon Asset Management. Meghan Larson created Adistry, the first digital video advertising platform for marijuana. Olivia Mannix and Jennifer DeFalco founded Cannabrand, a Colorado-based pot marketing company. In Berkeley, California, three female lawyers—Shabnam Malek, Amanda Conley and Lara Leslie DeCaro—started the National Cannabis Bar Association, and Conley and Malek also started Synchronicity Sisters, which hosts Bay Area “Tupperware parties” to sample pot products made by women for women.

Among the most successful pot pioneers are the women who spot a void in the marketplace and fill it.... Maureen McNamara is starting a statewide certification program in Denver for people in the pot business. Many marijuana edible chefs take her Food Safety classes and her Sell Smart program is popular among marijuana retailers. She has been working directly with Colorado’s Marijuana Enforcement Division, and her curriculum has been approved to become the first certified responsible vendor program, much like those in the bar and alcohol business.

Cannabis science seems to be where women are making the most progress the fastest. Genifer Murray, a scientist who runs a Colorado cannabis testing facility called CannLabs, says she employs mostly women with advanced science degrees. “In a typical science, like environmental or medical, it would take them 20 to 30 years to become something,” she says. “We’re in the infancy. My scientists are going to be cannabis experts — some already are.”

Murray insists that women are better suited for the cannabis industry and will keep flocking to it. “This is a compassionate industry, for the most part, especially if you're dealing with the medical side. The medical patients need time and consideration, and women are usually the better gender for that. The industry is flat-out geared for women.”

Some prior related posts:

September 4, 2015 in Business laws and regulatory issues, Medical Marijuana Commentary and Debate, Recreational Marijuana Commentary and Debate, Who decides | Permalink | Comments (0)

Thursday, August 20, 2015

Attention former Prez Carter: "Marijuana Is a Wonder Drug When It Comes to the Horrors of Chemo"

The title of this post is drawn from the headline of this Newsweek piece from last month that I just came across. Though it seems from this new news article that former President Jimmy Carter may not be getting a chemotherapy-based cancer treatment, this  Newsweek article seemed worth spotlighting on a day when a former US Prez is talking about his cancer diagnosis and coming treatments.  (In a coming post, I will highlight another newer Newsweek story on marijuana reform that I think merits even more attention.)  Here in a notable excerpt from the lengthy chemo piece:

A growing number of cancer patients and oncologists view the drug as a viable alternative for managing chemotherapy’s effects, as well as some of the physical and emotional health consequences of cancer, such as bone pain, anxiety and depression. State legislatures are following suit; medical cannabis is legal in 23 states and the District of Columbia, and more than a dozen other states allow some patients access to certain potency levels of the drug if a physician documents that it’s medically necessary, or if the sick person has exhausted other options. A large number of these patients have cancer, and many who gain access to medical marijuana report that it works.

“A day doesn’t go by where I don’t see a cancer patient who has nausea, vomiting, loss of appetite, pain, depression and insomnia,” says Dr. Donald Abrams, chief of hematology-oncology at San Francisco General Hospital and a professor of clinical medicine at the University of California, San Francisco. Marijuana, he says, “is the only anti-nausea medicine that increases appetite.”

It also helps patients sleep and elevates their mood — no easy feat when someone is facing a life-threatening illness.  “I could write six different prescriptions, all of which may interact with each other or the chemotherapy that the patient has been prescribed. Or I could just recommend trying one medicine,” Abrams says.

A 2014 poll conducted by Medscape and WebMD found that more than three-quarters of U.S. physicians think cannabis provides real therapeutic benefits. And those working with cancer patients were the strongest supporters: 82 percent of oncologists agreed that cannabis should be offered as a treatment option.

Dr. Benjamin Kligler, associate professor of family and social medicine at Albert Einstein College of Medicine, says there has been enough research to prove that at a bare minimum cannabis won’t actually harm a person.  In addition, “given what we've seen anecdotally in practice I think there's no reason we shouldn't see more integration of cannabis in the long run as a strategy,” he says.  “We have this extremely safe, extremely useful medicine that could potentially benefits a huge population.”

August 20, 2015 in Medical community perspectives, Medical Marijuana Commentary and Debate, Medical Marijuana Data and Research, Science | Permalink | Comments (0)

Sunday, August 16, 2015

Highlighting how and why the Deep South is warming up to marijuana reform

Images (11)This lengthy new article, headlined "Medical marijuana laws taking root across the South," provides an effective review of marijuana reform developments in a number of southern US states. The piece merits a full read, and here are a few excerpts:

She lives in the wooden house her grandfather built more than a century ago in Chester, South Carolina, a rural community about a two-hour drive southeast of the Blue Ridge Mountains. The cluttered home is dimly lit and not air-conditioned, with the low hum of floor fans filling in rare lulls in conversation. Two Chihuahuas, Cricket and Joe, scuttle around Ada Jones' feet as she peers down through her eyeglasses at the iPad in her hands....

If someone needs medical marijuana, they contact her over the Internet. Jones encourages those who reach out to her to purchase marijuana illegally and make their own cannabis oil. If they're unsuccessful, she puts them in contact with a supplier who can sell them a more refined product.

"It's almost like playing God," Jones said. "If somebody contacts me, I have to look at them and wonder. I wonder if that's police first, not if I can help their kid. I try not to do that, but you have to because you're scared."

Jones helps everyone she can, whether they be young mothers of epileptic children or older patients suffering from chronic pain. Her specific brand of civil disobedience, like so many other facets of Southern life, is captained by her faith. "They talk about the South being the Bible belt, and praise the Lord we are," Jones said. "I cannot not help somebody. I have to. As a Christian, that's what I'm here for."

Many Southern states have a long and failed history with medical marijuana, mired deep in forgotten statutes. Only recently, as the marijuana movement sweeps through statehouses, have those laws become political tinder for a new debate in the South....

South Carolina state Sen. Tom Davis first heard the name Mary Louise Swing in late January of last year. The opening month of the 2014 legislative session was just wrapping up, and the legislator was back from the capital city of Columbia to do some work at his law office in Beaufort, a scenic coastal city located on Port Royal Island.

Davis chatted briefly that Monday afternoon with a law partner who had just met a woman named Harriet Hilton at a local Rotary club lunch. Her granddaughter suffered from a severe form of epilepsy and was seeking a type of treatment not currently legal or particularly popular in the Palmetto State – medical marijuana. "Quite frankly, it wasn't even on my radar screen," Davis said. "It wasn't anything in terms of public policy that I thought about doing until I heard about that story."

About a week later, Hilton was sitting across from Davis in his Beaufort office, discussing her granddaughter, Mary Louise, now 7. With the help of senate staffers, Davis rifled through old statutes to clarify the current legality of marijuana in the historically conservative state. What they unearthed was an obscure, obsolete law that would come to play a greater role in 2014 than it ever did following its passage 35 years ago....

Republican Gov. Nikki Haley signed Davis' bill into law in June 2014, legalizing CBD oil for epilepsy patients in South Carolina. CBD oil is an extract with concentrated amounts of cannabidiol - the part of the cannabis plant anecdotally shown to treat seizures - and low amounts of tetrahydrocannabinol, or THC - marijuana's psychoactive component.

Though the final law allowed physicians to authorize, and patients to consume, CBD oil, it did not provide for its cultivation or dispensation. Parents, patients and advocates have grown increasingly frustrated with the current state of medical marijuana in South Carolina. A law was passed in Alabama last year to allow for limited use of CBD oil, although Alabama patients are running into the same inability to access the medicine and are also facing similar decisions about moving west....

Even today in states such as Alabama and South Carolina - where CBD oil is legal but there's no provision to grow or distribute the drug - patients are left to obtain medical marijuana on their own, often across state lines and in violation of federal law. "There is an underground network of parents who had been treating their children for a while in states where they had limited-access bills like we had," said Janel Ralph, a mother in Myrtle Beach, South Carolina, whose daughter suffers from a severe seizure disorder. "It was really an underground railroad."

You could call Ada Jones one of its many conductors. "The Jesus Christ that I know wouldn't want me to let anybody suffer," Jones said. "If it's in my ability to help them, then I'm going to help them."

Perhaps her favorite patient is her best friend, Beverly Love. A 55-year-old Chester native, Love was diagnosed with lupus at 31, and soon after, multiple sclerosis. Her doctor told her she probably had a maximum of two years to live. She needed to get her affairs in order and figure out who would be raising her 8-year-old son after she was gone.

"That was a scary thing. Not mainly for me – I worried about my son, my child," Love said. "But I'm still here, surprisingly. Even my doctors are surprised that I'm still living." Before Love met Jones, she didn't know what the word cannabis meant and had never smoked marijuana. She considered those who did drug addicts. "She could run for president and you couldn't find nothing on her. The girl is squeaky clean," Jones said. "She didn't want to do this. But she didn't want to die."

Jones inundated Love with countless articles on marijuana's medical benefits and personal testimonies to its effectiveness. "She just kept on," Love remembers. "And I'm thankful that she did. I'm really thankful that she did." Love first experimented with medical cannabis about a year and a half ago, spreading some medicated jam Jones had acquired for her on a piece of bread just before bedtime. Within two hours, Love said she experienced a relief she hadn't known in years.

She does not suffer from epilepsy, the only qualifying condition eligible to possess CBD oil in South Carolina. Even if she did, the oil she takes now is whole-plant – meaning it contains naturally high levels of THC in relation to CBD. She knows she could be arrested, but for her, the risk is worth it.

"If I started getting locked up now, I would move to a state where it was legal, because it's made such a difference in my day-to-day living," Love said. "I actually have quality of life now. And I didn't."

August 16, 2015 in Medical Marijuana Commentary and Debate, Medical Marijuana State Laws and Reforms | Permalink | Comments (0)

Monday, August 3, 2015

"Is it time to legalize marijuana in sports?"

Images (7)The question in the title of this post is the headline of this very lengthy San Diego Union-Tribune article spotlighting the arguments being made by a former NFL players about the relative advantages of marijuana as a means of pain relief.   Here are excerpts:

Kyle Turley's decade-long NFL career left the former San Diego State All-American offensive tackle with a multitude of health issues. Turley’s football injuries broke his body, but he’s also convinced that football did irreparable damage to his brain. He’s struggled with anxiety, headaches, depression and rage issues. In an interview with the Union-Tribune in 2013, he even admitted to having entertained suicide.

To help him deal with his ailments, Turley’s doctors have prescribed a multitude of painkillers, psych meds and muscle relaxants over the years. Depakote. Wellbutrin. Zoloft. Flexeril. Percocet. Vicodin. Toradol. Vioxx.

You don’t need to know what each of these drugs is designed to do. The point is that dating back to when he blew out his knee at SDSU in 1996, Turley has been on them all at some point, often in different prescribed combinations, over a period that spans almost 20 years.

That ended in February when Turley decided to free himself of all prescription medications and use only marijuana – a move he credits with saving his life.

The sports world appears to be waiting to see what happens politically in regard to marijuana, with the movement to legalize it gaining steam in the United States. 23 states have now legalized marijuana in some form, with four of those (Alaska, Washington, Oregon and Colorado) allowing for outright recreational use for adults aged 21 and older.

The drug is still illegal in all the major pro sports leagues and very restricted at the NCAA level. In the meantime, there’s a growing segment of athletes who believe the health benefits to be gained from the marijuana plant outweigh the risks – especially when compared to the opioids they’ve long been prescribed.

Experts in the field of pain medicine agree that everything is coming to a head. “We have 100 million Americans in chronic pain. We don’t have good, strong and safe therapies. We have a crisis with pain and opioids in this country,” said Dr. Lynn Webster, a past president of the American Academy of Pain Medicine. “We need to find better treatments for athletes and non-athletes, and cannabinoids may by one way.”...

A 1997 New York Times story estimated that “60 to 70 percent” of NBA players smoked marijuana, though this pre-dated the medicinal marijuana wave of the 2000s, and it appears that marijuana was used mostly as a recreational drug.

Around the turn of the decade, evidence suggests more athletes started using marijuana more to help manage pain from injuries, especially in the NFL. Running back Jamal Anderson, who played for the Atlanta Falcons from 1994 to 2001 recently told Bleacher Report that during his career about “40 to 50 percent of the league” used marijuana. San Diegan Ricky Williams, who played for the Saints, Dolphins and Ravens from 1999 to 2011, has also publicly talked about using marijuana during his career to help control pain and stress.

The focus on the issue sharpens when you consider that the NFL currently faces a lawsuit filed in May by a group of former players who allege that all 32 teams liberally dispensed large quantities of painkillers to injured players in a “conspiracy” to keep them on the field without fully educating them on the risks these medications present.

Anderson, Williams, Turley and former Denver Broncos tight end Nate Jackson are now part of a growing number of former players who believe that marijuana is a safer way to help athletes deal with pain. “It’s natural for football players to lean toward marijuana to deal with the violence and trauma of the game,” said Jackson, 36, who played for the Broncos from 2003-08, and who estimates that up to half his team might have used marijuana. “Teams will prescribe you bottles and injections that are really bad for you. Cannabis was what my teammates and I preferred.

“It was a supplement/recovery for me. (Opioids or marijuana), it was never a dilemma. It was a physical reaction to substances that I assessed after trying both and realizing that marijuana was better for my mind and body. I don’t like taking pills. They make me feel slow, sluggish and heavy.”...

The NFL only tests for marijuana between April and August, so it’s not difficult for players who use cannabis to work around that and stay under the radar while ensuring they pass the drug screening. Turley also used marijuana regularly when he played in the NFL because he said it helped him deal with some of his health issues – anxiety, sleeplessness and depression among them. Now, he’s returned to marijuana as a way to manage his ailments in his post-NFL life.

With California’s liberal medical marijuana policies, access to marijuana was one of the reasons Turley uprooted his family from Nashville, Tenn. back to his hometown of Riverside last April. Since weaning himself off all prescription drugs three months ago and transitioning solely to medicinal marijuana, Turley has noticed a “night and day difference in his psyche.” He no longer suffers from low testosterone, his libido is back, and his anxiety issues have improved.

“I don’t have as bad depression any more, that’s getting better. The cognitive impairment seems to be getting a little bit better. Life is more manageable, I have more energy and feel more alive,” Turley said. “I don’t think about killing myself any more. Suicidal thoughts and tendencies were part of my daily living. At the end of the day, I was losing hope with the synthetic drugs and now I feel better. It’s giving me hope again, helping with depression and anxiety.”

Some athletes also tout marijuana for its value as a neuro-protectant though scientific studies on the subject are still very preliminary. Some studies of the drug have found just the opposite – that it can actually lead to suicidal thoughts in some users. Like many medical issues, the anecdotes from true believers is increasingly at odds with the clinical evidence, stoking emotions on both sides.

More research could prove valuable for athletes looking for answers outside established medical practices that they have come to distrust – especially NFL players who have in the last five years become much more aware of how concussions and head trauma sustained during their football careers can cause long term brain damage or chronic traumatic encephalopathy (CTE) – the progressive, degenerative brain disease that results from multiple sub-concussive blows to the head.

Turley has been diagnosed with early onset dementia, and has had his brain scanned for damage. Scans yielded a “big blurred area that doctors are concerned about,” Turley said. Put together the results of the scans, his memory issues, depression and anxiety problems, and Turley believes he has CTE. Turley also thinks marijuana might be helping his brain to heal. “I believe that the answer lies in marijuana and I’m on that search to figure that out. … With marijuana I saw some pretty amazing things and how it can deal with brain injury and this disease I have,” Turley said. “From memory to function, there are some wonders in this medicine.

Yet, for all his praises of marijuana, even Turley admits that in terms of its properties as a medicine, it’s still very much an untested commodity. While he has no medical or scientific credentials, he is passionate about the subject and is anxious to learn more. “There’s no real science behind this yet,” Turley said. “I’m really looking forward to expanding on my experience with it now that it’s giving me relief.

Some prior related posts on NFL players and marijuana use:

August 3, 2015 in Medical community perspectives, Medical Marijuana Commentary and Debate, Medical Marijuana Data and Research, Medical Marijuana State Laws and Reforms, Sports | Permalink | Comments (0)

Sunday, August 2, 2015

A doctor's unique perspective on what doctors can learn from medical marijuana

I just got around to reading this fascinating New York Times op-ed piece authored by David Casarett, headlined "What I Learned at the Weed Dispensary."  I recommend the full piece, and here are passages that especially caught my attention:

I met Robin and many others like her at a California medical marijuana clinic where I was doing research for a book.  She was one of almost a dozen patients seeking recommendation letters that would let them buy marijuana at designated dispensaries. I asked how marijuana helped her.  “I can’t live without it,” she told me.  She said it helped her sleep, and it relieved the constant pain in her joints.

But Robin was most eager to talk about how medical marijuana put her in charge.  She can decide whether to use it, when to use it and how much she needs.  She doesn’t have to rely on a doctor.  “I’m in control,” she said....

Many people with serious illnesses turn to medical marijuana because they’re not getting the careful, comprehensive treatment they need for symptoms like pain or nausea or anxiety.  That was certainly true for Robin, whose physicians didn’t seem to have the time or the skills to help her.  

As a palliative care physician, every day I see firsthand the suffering my patients have experienced, and the lengths to which they’ve gone to manage their symptoms and control their lives.  They stockpile medications in case their pain increases.  And some buy illegal drugs on the street because their physicians won’t prescribe opioids.  So is it any wonder that people like Robin with serious illnesses want to take matters into their own hands?

Yet it seems that many of my physician colleagues haven’t considered the possibility that patients are turning to medical marijuana because the health care system has failed them.  In general, their reaction to medical marijuana has been one of detached amusement, tinged with avuncular concern.  And when they recognize the challenges that patients like Robin face, they point out that they don’t have enough time in a typical 15­-minute visit to deliver the kind of personalized care that Robin needed.

Fortunately, Robin’s story offers solutions. I’ve identified at least three lessons the medical marijuana industry holds for our health care system. And none of them require doctors to spend any more time with patients.

First, we should give patients a chance to learn from one another....

Second, if physicians can’t spend more time with patients — and, in general, they can’t — we should give patients more time with other office staff members....

Third, we should give patients more ability to manage their treatment. What Robin wanted was a chance to treat her symptoms in her own way, using strategies that worked for her. She wanted to try, and maybe fail, and try again. She wanted to be in charge.

August 2, 2015 in Medical community perspectives, Medical Marijuana Commentary and Debate, Who decides | Permalink | Comments (0)

Saturday, August 1, 2015

Could medical marijuana developments in Nevada and New York be game-changers?

New_York_New_York_Casino_Las_Vegas_Nevada_1280x960Marijuana reform advocacy groups and many others tend to focus these days particularly on the handful of jrisdictions experimenting with full legalization of marijuana.  But I continue to think that the broad spread of state medical marijuana reform and the varied regulatory regimes in many states has the greatest short-term potential to encourage Congress to back off its steadfast commitment to blanket marijuana prohibition.  Consequently, I think it especially notable and important that this week two notable and important states had, as the articles below highlight, big medicial marijuana  reform developments:

Here is the news story from Nevada (a notable swing state with a popular Republican governor and a major tourism industry), "Historic day in Nevada: First medical marijuana sales after 15-year wait": 

Fifteen years after Nevadans voted to legalize it, medical marijuana was sold legally in the state for the first time Friday at a dispensary in a strip mall about 5 miles east of downtown Reno.

Dressed in polo shirts, tie-dyes and button-downs, about 75 people with medical marijuana cards lined up outside Silver State Relief, between a sub shop and pizza place in Sparks, to be among the first to buy as much as a half-ounce of pot for $195. “It smells good in there,” said Dana Metz, 64, a retired General Motors worker who said he suffers from back pain, insomnia and anxiety. He was the first in line two hours before the doors opened just after 10 a.m....

Unless the next Legislature takes action sooner, Nevadans will consider another ballot measure in 2016 to legalize recreational use of marijuana. They approved medical pot in 2000, but the law lacked language to establish a system to sell or distribute the drug until 2013. Before that, anyone authorized had to grow their own — up to 12 plants per person — or find it some other way.

“The politicians just didn’t have the will to do what the people wanted,” said state Sen. Tick Segerblom, a major proponent of marijuana legislation. “Why the Legislature could not get behind this blows my mind.”...

On average it takes nine to 18 months for stores to open following legislative approval, said Karmen Hanson, marijuana analyst for the National Conference of State Legislatures. Of the 25 states and territories that approved medical pot, most are up and operational. “By two years, there’s usually something,” Hanson said....

Nevada already has distributed many of its 66 marijuana dispensary licenses, but it’s unclear how soon Las Vegas or other parts of the state will see shops open. The process was complicated when Clark County gave preliminary clearance to eight applicants, and the state later gave preliminary clearance to eight others. The state deferred to the county’s list, but the future of the state-approved entities is uncertain.

Nevada Medical Marijuana Association Executive Director Will Adler said the state’s strict rules — based on Colorado’s system — will stave off problems once dispensaries get off the ground and become a model for other states. “We tried to write the law that would be the gold standard for the country,” he said.

Nevada’s regulations include “seed-to-sale” tracking to trace marijuana to the source — a measure aimed at preventing black market marijuana from seeping into the system, or thieves from taking pot out. The Department of Agriculture also is working to finalize a pesticide testing process that screens for 30 to 40 different chemicals, the first such system in the nation.

Here is the news story from New York (a notable liberal state which is also the unofficial capitol of capitalism), "New York State Awards 5 Medical Marijuana Licenses":

Mirroring a national trend toward an acceptance of marijuana, the New York State Health Department on Friday named the five organizations that will be allowed to grow and sell the drug for medical use in the state, including in New York City.

The organizations will be registered with the state, and each plans to open four dispensaries statewide. They are required to be doing business within six months, meaning medical marijuana could be on sale in New York by the end of the year.

The marijuana outlets were authorized by the Compassionate Care Act signed by Gov. Andrew M. Cuomo, a Democrat, in July 2014, and the decision on the registrations was issued after what the Health Department called a “rigorous and comprehensive” review of prospective purveyors of the drug, and amid criticism that state regulations for such businesses are too restrictive....

Despite the rules and a list of precise regulations announced this spring, the bidding for the registrations was intense, with 43 companies submitting applications. And while that meant dozens of losers on Friday, at least one lawmaker offered some hope for the future. “To those who did not make the cut, stick around,” said State Senator Diane Savino, a Staten Island Democrat who sponsored the 2014 bill. “New York is a very big state.”

August 1, 2015 in Medical Marijuana Commentary and Debate, Medical Marijuana State Laws and Reforms | Permalink | Comments (1)

Friday, July 31, 2015

Is Congress in the midst of a "summer fling with marijuana"?

The question in the title of this post is prompted by this lengthy new Politico article, headline "Congress’ Summer Fling With Marijuana:How Congress turned on the DEA and embraced weed." Here is an excerpt from the first part of the article:

In May, the Senate made history by voting in favor of the first pro-marijuana measure ever offered in that chamber to allow the Veterans Administration to recommend medical marijuana to veterans. Then when June rolled around, it was time for the House to pass its appropriations bill for Commerce, Justice and Science. That’s when things got interesting. The DEA got its budget cut by $23 million, had its marijuana eradication unit’s budget slashed in half and its bulk data collections program shut down. Ouch.

In short, April was a bad month for the DEA; May was historically bad; but June was arguably the DEA’s worst month since Colorado went legal 18 months ago — a turn of events that was easy to miss with the news crammed with tragic shootings, Confederate flags, Obamacare, gay marriage, a papal encyclical and the Greece-Euro drama. July hasn’t been any different, with the legalization movement only gaining steam in both chambers of Congress.

The string of setbacks, cuts and handcuffs for the DEA potentially signals a new era for the once untouchable law enforcement agency — a sign that the national reconsideration of drug policy might engulf and fundamentally alter DEA’s mission. “The DEA is no longer sacrosanct,” Rep. Steve Cohen (D-Tenn.) tells Politico.

The national tide is clearly not in the DEA’s favor. Since Colorado legalized recreational marijuana in January 2014, three additional states have followed suit with full legal weed; the District of Columbia’s fight to legalize continues; the number of medical marijuana states has grown to 23; 14 states have legalized nonpsychoactive CBD oil; and 13 states have legalized industrial hemp, spurring a rapidly expanding legal market for a plant long demonized by the DEA.

At the same time, a national debate about the high costs of sending millions of people — many of them young black and Hispanic men — to prison for nonviolent marijuana offenses has led to increasing questions about whether the zero-tolerance enforcement favored by DEA is the right way to proceed.

That marijuana reform is moving along in Congress at all is a sign of just how far — and fast — the landscape has shifted. Much of the recent uptick of reform voices are actually coming from Republicans, long tough-on-crime legislators who were stalwart opponents of marijuana. In a sign of just how far the sands have shifted, Sen. Lindsay Graham, a Republican candidate for president, tells Politico that he believes, “Medical marijuana holds promise.”

It’s no longer political suicide to be seen on Capitol Hill as backing drug reform. “There clearly is momentum, absolutely,” says Rep. Ted Lieu (D-Calif.), a former Air Force JAG officer who replaced Henry Waxman as the congressman from Beverly Hills. “It’s the first time we’ve ever been able to show momentum in Congress,” Dan Riffle of the Marijuana Policy Project tells Politico.

The looming cuts has the Justice Department issuing dire warnings: “If enacted, the House budget would cause DEA to experience a significant shortfall in their FY16 budget that would severely inhibit their ability to carry out their mission of stopping the manufacture and distribution of illicit drugs,” says Patrick Rodenbush, a spokesman for DOJ. But unlike such dire warnings in the past, when Congress could be assured of protecting funding for a law enforcement agency seen for decades as key to winning the War on Drugs, the shine has now clearly come off DEA — and that means the agency’s problems might just be beginning.

July 31, 2015 in Federal Marijuana Laws, Policies and Practices, Medical Marijuana Commentary and Debate, Recreational Marijuana Commentary and Debate, Who decides | Permalink | Comments (0)

Wednesday, July 22, 2015

"Seniors Are Seeking Out States Where Marijuana is Legal"

The title of this post is the headline of this intriguing new Reuters article.  Here are excerpts:

When choosing retirement locales, a few factors pop to mind: climate, amenities, proximity to grandchildren, access to quality healthcare. Chris Cooper had something else to consider – marijuana laws.

The investment adviser from Toledo had long struggled with back pain due to a fractured vertebra and crushed disc from a fall. He hated powerful prescription drugs like Vicodin, but one thing did help ease the pain and spasms: marijuana.

So when Cooper, 57, was looking for a place to retire, he ended up in San Diego, since California allows medical marijuana. A growing number of retirees are also factoring in the legalization of pot when choosing where to spend their golden years. “Stores are packed with every type of person you can imagine,” said Cooper who takes marijuana once or twice a week, often orally. “There are old men in wheelchairs, or women whose hair is falling out from chemotherapy. You see literally everybody.”

Cooper, who figures he spends about $150 on the drug each month, is not alone in retiring to a marijuana-friendly state.... Figuring out how many people are retiring to states that let you smoke pot is challenging since retirees do not have to check off a box on a form saying why they chose a particular location to their final years.

But “there is anecdotal evidence that people with health conditions which medical marijuana could help treat, are relocating to states with legalized marijuana,” said Michael Stoll, a professor of public policy at University of California, Los Angeles who studies retiree migration trends.

He cited data from United Van Lines, which show the top U.S. moving destinations in 2014 was Oregon, where marijuana had been expected to be legalized for several years and finally passed a ballot initiative last November. Two-thirds of moves involving Oregon last year were inbound. That is a 5 percent jump over the previous year, as the state “continues to pull away from the pack,” the moving company said in a report.

The Mountain West – including Colorado, which legalized medical marijuana in 2000, and recreational use in 2012 – boasted the highest percentage of people moving there to retire, United Van Lines said. One-third of movers to the region said they were going there specifically to retire....

Many of the health afflictions of older Americans push them to seek out dispensaries for relief. “A lot of the things marijuana is best at are conditions which become more of an issue as you get older,” said Taylor West, deputy director of the Denver-based National Cannabis Industry Association. “Chronic pain, inflammation, insomnia, loss of appetite: All of those things are widespread among seniors.”

Since those in their 60s and 70s presumably have no desire to be skulking around on the criminal market in states where usage is outlawed, it makes sense they would gravitate to states where marijuana is legal. “In Colorado, since legalization, many dispensaries have seen the largest portion of sales going to baby boomers and people of retirement age,” West said.

July 22, 2015 in 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)

Senators Feinstein and Grassley: "remove barriers to research" on medical marijuana

Feinstein-grassleyThe title of this post is drawn from this notable new Time commentary authored by US Senators Dianne Feinstein and Chuck Grassley. The piece is headlined "Break Down Barriers to Medical Marijuana Research," and here are excerpts:

After years of failed treatments [for debilitating seizures, Mallory Minahan's] parents decided to try cannabidiol oil in October 2013. This product is derived from the marijuana plant, administered orally, and has a very low level of tetrahydrocannabinol, or THC, the component of marijuana that makes users high. According to Tom Minahan, Mallory’s father and an ER doctor in Colton, Calif., it took just 36 hours to see profound changes.

But the process hasn’t been easy. A one-month supply of cannabidiol oil, commonly referred to as CBD oil, can cost up to $2,500. Because CBD oil is not approved by the Food and Drug Administration (FDA), there’s no guarantee that the formulation of each batch will be the same, or that each bottle actually contains CBD oil, rather than some other unknown substance.

In fact, the FDA recently sent warning letters to six companies marketing unapproved products that they claim contain CBD, but don’t. This is why Mallory’s parents are forced to spend up to $100 per bottle of oil if they want to have it tested to verify the contents. And even how much of the oil to administer was a mystery. Dr. Minahan and his wife, Carrin, arrived at the proper dosage for Mallory through trial and error.

This isn’t how modern medicine should work. For Mallory, who wasn’t responding to any other treatments or medications, the results were spectacular. Her seizures have decreased by 90%. Yet CBD oil hasn’t been effective for everyone. Many questions remain about its long-term effects and how it interacts with other medications.

Simply put, we need to know more about CBD, and the only way to gain that knowledge is to remove barriers to research. Research will shed light on critical safety issues as well as how effective CBD oil is and the proper formulations and dosages for patients.

After hearing from constituents, we asked the Justice Department (DOJ) and the Department of Health and Human Services (HHS) in October 2014 to clarify their positions on CBD research and what it would take to ensure research could move forward. After some back-and-forth with the two departments, we’re pleased to report that both have taken significant steps to ensure that CBD research can proceed. The DOJ agreed to initiate what is known as an “eight-factor analysis” to definitively determine whether CBD has scientific and medical benefits, and if so the proper schedule for it.

Another key step was HHS’s decision that privately-funded researchers are no longer required to submit research proposals for additional review. It is also allowing Epidiolex, a purified form of CBD currently in clinical trials, to be administered to 400 children under a compassionate use program that allows sick patients to access medicines before they are approved by the FDA.

While these are important developments, they’re not enough.... We need to cut red tape and streamline the licensing and regulatory processes so research can move ahead. In addition, we must also find ways to ensure that researchers have access to the quantity and quality of marijuana that they need. Finally, we need to look at expanding compassionate access programs where possible, to benefit as many children as possible.

Patients like Mallory have helped draw attention to this issue. Now, the federal government should step up, continue to reduce research barriers and help the many patients who could benefit from this treatment.

July 22, 2015 in Federal Marijuana Laws, Policies and Practices, Medical Marijuana Commentary and Debate, Medical Marijuana Data and Research, Who decides | Permalink | Comments (0)

Thursday, July 16, 2015

Colorado board refuses to add PTSD to conditions included in medical marijuana laws

As reported in this new Denver Post piece, the "Colorado Board of Health voted 6-2 — amid shouts, hisses and boos from a packed house — not to add post-traumatic stress disorder to the medical conditions that can be treated under the state's medical marijuana program." Here is the backstory for this notable regulatory decision:

A dozen of the veterans who testified said cannabis has saved their lives. Many said drugs legally prescribed to them for PTSD at veterans clinics or by other doctors — antidepressants, antipsychotics, opioids and others — nearly killed them or robbed them of quality of life.  "It is our brothers and sisters who are committing suicide every day. We know cannabis can help. We're not going to go away," said John Evans, director of Veterans 4 Freedoms.

"We've legalized it," Evans said.  "We'll take the tax dollars from our tourists (for recreational marijuana) before we'll help our vets."

The president of the nine-member board, Tony Cappello, an epidemiologist, said he could not vote to approve pot's use for PTSD because scientific evidence does not support it.  Most board members agreed that mountains of anecdotal evidence aren't enough.  One board member was absent.  "I'm struggling with the science piece," board member Dr. Christopher Stanley said.

The American and Colorado psychiatric associations do not support it, said board member Dr. Ray Estacio, an internist at Denver Health and associate professor in medicine at the University of Colorado Denver.

But board member Joan Sowinski, an environmental and occupational health consultant, said the testimony from veterans and other PTSD sufferers was so persuasive — as was recent research about symptoms reduction — that she could support it. Jill Hunsaker-Ryan, an Eagle County commissioner, was the only other yes vote.

"Blood is on your hands," one audience member shouted after the board voted not to make Colorado the 10th state to allow medicinal marijuana use for PTSD.

The state's chief medical officer, Dr. Larry Wolk, director of the Colorado Department of Public Health and Environment, recommended the state add the condition.  He suggested a provision that would cause the issue to be re-examined in four years, after two state-funded studies produced results.  Wolk said listing PTSD as a treatable condition would increase transparency and reveal actual usage, shedding light on its effectiveness and reinforcing a physician-patient relationship for many users.

Many veterans are self-medicating with recreational marijuana or using medical marijuana ostensibly as pain treatment, although it is really for PTSD, he said. Currently allowed uses of marijuana include pain (93 percent of recommendations), cancer, epilepsy, glaucoma, muscles spasms, multiple sclerosis, severe nausea and wasting disease (cachexia).

Dr. Doris Gundersen, a psychiatrist who spoke at the meeting, said only 4 percent to 5 percent of the state's physicians recommend medical marijuana to patients.  About 15 physicians make 75 percent of the recommendations, she said. The state has roughly 14,000 licensed doctors.  "Why are so few getting on board? (Because) there is a lack of quality evidence that it is safe and effective ... and does no harm," Gundersen said.

One of the state-funded medical marijuana investigators, Sue Sisley, who is looking at effects on veterans' PTSD, said federal policy on marijuana is a prime reason research is scant.  It will take at least four years for her study, she said, because the team has been delayed in getting the study drug, still illegal under federal law, from the authorized supplier — the U.S. government.

A few of the roughly 30 public speakers noted that what patients want — not hard science — is driving demand for expanded medicinal uses of marijuana.  That's not a bad thing, advocates said. "It is very important patients become part of this discussion," said Teri Robnett, director of the Cannabis Patients Alliance and member of the state's advisory council.  "Patients are getting enormous relief." 

July 16, 2015 in Medical community perspectives, Medical Marijuana Commentary and Debate, Medical Marijuana Data and Research, Medical Marijuana State Laws and Reforms, Who decides | Permalink | Comments (0)

Tuesday, July 14, 2015

"How medical marijuana could literally save lives"

The title of this post is the headline of this notable new Washington Post Wonkblog entry that reports on a notable new study about the relationship between marijuana reform and reduction in the harms from opiate addictions and overdoses.  Here is how the piece gets started (with links from the original):

Medical marijuana opponents recently pounced on a big new analysis published in the Journal of the American Medical Association showing that there isn't good evidence that marijuana works for many of the conditions, like glaucoma, anxiety, or Parkinson's disease, that it's often prescribed for.  The JAMA study was based on a meta-analysis of the findings of 79 previously-published studies.

Now, the study did not say pot isn't helpful for people suffering from those ailments; it said there was no evidence to that effect, as German Lopez noted at Vox.  Importantly, however, the JAMA study found solid evidence that marijuana is effective at treating one big condition: chronic pain.  The JAMA review found "30% or greater improvement in pain with cannabinoid compared with placebo," across the 79 studies it surveyed.

new NBER working paper out today is a helpful reminder of why that finding is so important.  Pain management -- especially chronic pain management -- is a tricky business.  Prescription painkillers are highly addictive and deadly -- they killed more than 16,000 people in 2013, according to the Centers for Disease Control and Prevention's's latest numbers.  In the U.S., drug overdoses kill more people than suicide, guns or car crashes.  The CDC now calls prescription painkiller abuse an "epidemic."

The researchers on the NBER paper, however, found that access to state-sanctioned medical marijuana dispensaries is linked to a significant decrease in both prescription painkiller abuse, and in overdose deaths from prescription painkillers.  The study authors examined admissions to substance abuse treatment programs for opiate addiction as well as opiate overdose deaths in states that do and do not have medical marijuana laws.

They found that the presence of marijuana dispensaries was associated with a 15 to 35 percent decrease in substance abuse admissions.  Opiate overdose deaths decreased by a similar amount. "Our findings suggest that providing broader access to medical marijuana may have the potential benefit of reducing abuse of highly addictive painkillers," the researchers conclude.

July 14, 2015 in Medical community perspectives, Medical Marijuana Commentary and Debate, Medical Marijuana Data and Research, Medical Marijuana State Laws and Reforms | Permalink | Comments (0)

Saturday, July 11, 2015

Terrific on-going coverage of marijuana reform issues via International Business Times

I recently had the pleasure of speaking at length to a terrific reporter covering marijuana reform issues for International Business Times, and I told the reporter that I was quite impressed with the extent and sophistication of IBT's on-going coverage of these issues.  Thereafter, it dawned on me that I have not consistently highlighted these realities on this blog space.  But here is just an abridged review of some of the great IBT pieces from various reporters in just the last few weeks:

"Rand Paul Courts Marijuana Investors, But Why Aren’t More Presidential Candidates Embracing Pot?"

"PTSD And Cannabis -- Can Researchers Cut Through The Politics To Find Out Whether Weed Works?"

"Oregon Hopes Legal Weed Will End Race-Based Arrests, But Advocates Wary"

"Marijuana Legalization No Longer ‘Political Suicide’ For Presidential Candidates"

"Chile’s Lower House Of Congress Approves Marijuana Bill"

Researchers Find That Medical Marijuana Laws Increase Recreational Marijuana Use Among Juveniles

Marijuana Legalization In Oregon: Portland Airport Allows Travelers To Bring Weed On In-State Flights

July 11, 2015 in Assembled readings on specific topics, Current Affairs, Medical Marijuana Commentary and Debate, Recreational Marijuana Commentary and Debate | Permalink | Comments (0)

Wednesday, July 8, 2015

"Is Marijuana A Benefit Or A Bad Idea For Autism And Schizophrenia?"

DownloadThe question in the title of this post is the headline of this notable and informative new Forbes article.  Here are excerpts:

When Jim Carrey co-opted the image of a distressed boy with tuberous sclerosis complex (TSC) in an effort to reinforce the actor’s views about vaccines, he inadvertently brought attention to TSC, which is, unlike vaccines, associated with autism. In using the image of Alex Echols, for which he later apologized, Carrey may also have brought attention to another topic of discussion in autism circles: the use of marijuana as a therapeutic.

Alex’s parents have a blog where they’ve written about Alex and his needs for many years. Among those needs, they argue, is therapeutic marijuana, which they say helps Alex with his self-injurious behaviors. They have published their clear agenda for accomplishing this for their son, who currently lives in a group home.

The Echols are not alone in their belief in and urgency about marijuana as an intervention for neurological conditions. Many other parents, some autistic adults, and some clinicians also have suggested that the plant—and its active compounds—might offer an effective treatment for some of the intense behaviors related to autism and for schizophrenia, as well. But what do we really know about marijuana and its therapeutic possibilities?

Like so many sources of neuroactive compounds, pot has dual potential to be beneficial or damaging, depending on which ingredient is the focus. One of its active compounds, delta-9-tetrahydrocannabinol, or THC, acts through a signaling system that involves some of the same components associated with atypical signaling in schizophrenia. According to Tori Rodriguez, writing at Psychiatry Advisor, studies have shown interesting parallels between altered brain function measures in people with schizophrenia and people who were marijuana intoxicated.

Thus, THC, it seems, is ‘pro-psychotic’ (although that’s controversial), and there’s a chicken-egg question about whether or not it contributes to the development or onset of psychosis-related conditions like schizophrenia or if people with such conditions might be more prone to reach out for it as self-medication. The age at which one reaches for it might also be a factor, but studies show a “consistent” association between pot use during the teens and risk for developing a psychotic disorder....

But marijuana is one of those two-faced offerings from nature that can help or hinder. Now that pot has become legal in various parts of the US, these issues of help or hinder become more critical and will start to settle into some form of commonly accepted wisdom that likely belies the complexities.

As an example of that complexity, another physiologically active compound in marijuana (there are dozens) is cannabidiol, which might act as an antipsychotic, in contrast to its pot-plant partner THC. Plants, you see, are complicated organisms just like we are, and banning the entire plant ends up banning every possibility each of its hundreds of active compounds might hold.

So far, the studies of cannabidiol in schizophrenic populations are small, but at least one suggests head-to-head effectiveness against one atypical antipsychotic with less in the way of negative side effects compared to the approved drug. Cannabidiol is one of the target substances that the Echols want to be able to give to their son to reduce his distress and distressing episodes of self-injurious behaviors. Parents of children with epilepsy and other neurological conditions also would like cannabidiol oil to be available as a treatment for their sons and daughters....

And what about marijuana for autism? Compared to the studies done for schizophrenia, which number more than 1,000, autism and marijuana has gotten almost no research attention. That hasn’t stopped a grassroots movement from growing up around using pot as an autism therapeutic, with one Facebook group, MAMMAS (Mothers Advocating Medical Marijuana for Autism), boasting almost 5,000 followers, and one writer and autism parent advocating for its use from a public pulpit.

But as the authors of a recent review note — and PubMed searches bear out — no studies exist suggesting clinical benefit for autism. Indeed, in a news release publicizing the review, the first author, Scott Hadland of Boston Children’s Hospital, is quoted as saying: "in using medicinal marijuana (parents) may be trading away their child’s future for short-term symptom control." These authors also call for more research into cannibidiol’s effects and more emphasis on developing high-cannabidiol/low-THC products.

July 8, 2015 in Medical community perspectives, Medical Marijuana Commentary and Debate, Medical Marijuana Data and Research | Permalink | Comments (0)

Thursday, July 2, 2015

Louisiana now with broadest (and least functional?) medical marijuana laws in South

ImagesAs effectively reported in this local article, headlined "One word could render Louisiana's medical marijuana law useless, advocates say," there is big marijuana reform news in the Bayou.  But, as the article also explains, the real-world effectiveness of the reform is uncertain because of a critical term used in the reforms:

Louisiana now has a law in place authorizing the growth, prescription and dispensary of medical marijuana to certain patients.  But advocates of medical marijuana who lobbied this year at the Louisiana State Capitol for the bill's passage worry a last-minute word change could essentially render the new law useless.

In the 23 other states where medical marijuana is legal, the laws refer to a "recommendation" for medical marijuana, not a "prescription."  David Brown, the director of a group called Sensible Marijuana Policy for Louisiana, said changing out "prescription" for "recommendation" allows doctors and pharmacists to get marijuana to patients without risking their federal license with the Drug Enforcement Agency....

The sponsor of the bill (SB 143), state Sen. Fred Mills, R-New Iberia, is aware of the concerns of Brown and other advocates.  He said, however, that Louisiana Board of Pharmacy Director Malcolm Broussard has assured him the issue of prescription versus recommendation could be "worked through" during the rule-making process.

Jacob Irving, a medical marijuana advocate and recent graduate of LSU, suffers from spastic quadriplegia -- a rare form of cerebral palsy that causes chronic muscle stiffness and has been effectively treated with marijuana.  If the law in its current form is properly enacted, his disease is on the list of those that would quality for medical marijuana.  Irving was the one who convinced a House panel to change the wording to "recommendation," before it was stripped out of the bill on the House floor.

The Louisiana Family Forum, the state's most influential conservative Christian group, requested the word "prescription" be put back into the bill before it reached the House floor.  Even the Louisiana Sheriff's Association, who had expressed strong opposition to the bill last year, were OK with "recommendation," Fred Mills said.  Family Forum Director Gene Mills said early this month he told Fred Mills putting the prescription language in the bill was a requirement for his group to remain neutral on the bill.

Opposition from the Family Forum could have hurt the bill's chance of passing and might have drawn a veto from Gov. Bobby Jindal, who closely follows Mills' guidance on social policies.  Jindal, too, had requested the term prescription be used.  Gene Mills said the prescription requirement keeps the proposed law in the realm of medical practice, subjecting it to the oversight and "necessary safeguard."

"That's why we're in the neutral zone," said Gene Mills, days after the House passed the version of the bill with "prescription" included.

Brown said the Louisiana Family Forum and Jindal's hardline position on calling it a prescription provides more evidence that the wording neuters the bill. "Why on earth would you insist so hard on that language being included (in the bill) unless you were fully aware, like we are, that by including it you've essentially gutted the bill?" he said.

While Irving is hopeful the wording won't cause a problem as the bill's sponsor has suggested, he can't ignore the potential threat it has to thwart access to patients. "If a doctor writes a prescription, he may go to jail or lose his DEA license," Irving said.

Brown said there's no pharmacist willing to put his or federal license at risk by signing off on dispensing a schedule I substance. By doing so, they would be "risking their whole livelihood -- for just that one prescription that they write." Broussard, however, acknowledged in an email provided by Mills that the use of the word "recommendation" has been suggested by other states to reduce risk to doctors and pharmacists. But he also indicated it made little difference.

"The outcome of the process -- whether it is a 'recommendation' or a 'prescription' -- remains the same," Broussard said. "It is an order generated by the physician for filling at the pharmacy." Irving still worries the seemingly minor wording problem could lead to another empty medical marijuana law that doesn't actually get the drug in the hands of patients who need it.

It's happened before: Louisiana technically legalized medical marijuana in 1978 and again in 1991, but those statutes didn't provide legal structure to allow for legal access to the drug -- from the ground to the patient. The law signed Monday (June 30) by Jindal was supposed close those loopholes.

Irving, who is 22, said he has been waiting his whole life for structural flaws in Louisiana's current medical marijuana law to be sorted out. "I just don't want to see a whole second generation pass (before) this bill is set up (to work)," he said. "It's needless suffering that can end."

July 2, 2015 in Medical Marijuana Commentary and Debate, Medical Marijuana State Laws and Reforms, Who decides | Permalink | Comments (0)