Marijuana Law, Policy & Reform

Editor: Douglas A. Berman
Moritz College of Law

Wednesday, August 24, 2016

New York Department of Health releases two-year report on "Medical Use of Marijuana Under the Compassionate Care Act"

ThI was pleased to find this big new data-rich report from the New York Department of Health titled simply "Medical Use of Marijuana Under the Compassionate Care Act: Two-Year Report."  For those really interested in really understanding how really serious medical marijuana programs are operating (as I am), this kind of official report is terrifically interesting and valuable.  Here is the 13-page report's introduction and some of its closing recommendations:

On July 7th, 2014, Governor Andrew M. Cuomo signed into law the Compassionate Care Act to establish a comprehensive Medical Marijuana Program (“program”). Just eighteen months after the Compassionate Care Act was signed into law, the first New Yorkers obtained medical marijuana. The program launched on time and statewide, providing access to a new treatment option for patients in a manner that protects public health and safety. Within the first six months of operation, over 5,000 patients were certified with the program. The program also registered more than 600 physicians across the State. In just six months, New York’s program has more physicians registered than other states whose programs have been in existence for significantly longer than New York’s. The program continues to oversee the manufacture and sale of medical marijuana to ensure that it is dispensed and administered in a manner that protects public health and safety.

Pursuant to Public Health Law (PHL) § 3367(3), this report provides an overview of Medical Marijuana Program activities since the signing of the Compassionate Care Act, as well as recommendations to the Governor and the Legislature. The data for this report was obtained on June 15, 2016, from the New York State Department of Health’s (NYSDOH) Medical Marijuana Data Management System (MMDMS) and the Prescription Monitoring Program Registry (PMPR)....

1.  NYSDOH recommends authorizing Nurse Practitioners (NPs) to certify New Yorkers for medical marijuana, consistent with their current authority to prescribe controlled substances (including opioids) for patients diagnosed with qualifying conditions covered in the Compassionate Care Act. Allowing NPs to issue certifications for medical marijuana would allow them to properly treat patients suffering from severe, debilitating or life threatening conditions, particularly in many rural counties where there are fewer physicians available to treat such ailments....

4.  NYSDOH recommends evaluating allowing distribution of Medical Marijuana to certified patients through home delivery services provided by registered organizations, and review of policies and procedures from other jurisdictions to help craft guidelines to provide for a safe and effective home delivery program.....

5.  NYSDOH recommends working with the registered organizations to make more brands of medical marijuana products available to patients....

7.  NYSDOH recommends a review of evidence be conducted for the medical use of marijuana in patients suffering from chronic intractable pain....

9.  To meet additional patient demand and increase access to medical marijuana throughout New York State, NYSDOH recommends registering five additional organizations over the next two years, using a phased-in approach to permit their smooth integration into the industry.

August 24, 2016 in Medical community perspectives, Medical Marijuana Data and Research, Medical Marijuana State Laws and Reforms | Permalink | Comments (0)

Friday, August 19, 2016

Timely new report on benefits of marijuana reform from West Virginia Center on Budget & Policy

This local article, headlined "Could legalizing marijuana be West Virginia's pot of gold?," reports on this interesting new policy brief released by the West Virginia Center on Budget & Policy suggests. The article summarizes the themes of the report, which is titled "Modernizing West Virginia's Marijuana Laws: Potential Benefits of Decriminalization, Medical Marijuana and Legalization." This summary comes directly from the first two pages of the full 27-page report:

Over the last two decades, states across the country have modernized their marijuana laws to reflect the growing evidence that doing so will help reduce criminal justice costs, help treat some medical conditions, and boost tax revenues and their state’s economy. As of 2016, four states and the District of Columbia have legalized the recreational use of marijuana for adults, 25 states (and DC) allow for marijuana to be used for medical purposes, and 21 states have decriminalized possession of small amounts of marijuana. With several states considering ballot measures this November and public support for legalization rapidly growing (53% of Americans support legalization) among all age groups, the number of states taking action to undo restrictions on marijuana is likely to grow.

While most states have taken at least one step toward modernizing their marijuana laws, West Virginia has not. However, bi-partisan legislation has been introduced in West Virginia over the last several years to legalize medical marijuana and tax marijuana for retail sales to adults. A 2013 poll found that a majority of West Virginians supports decriminalizing marijuana and legalizing it for medical use, while 46 percent supported regulating it like alcohol.

As West Virginia continues to be plagued by large budget deficits (a projected $300 million for FY 2018), an undiversified economy with a fading coal industry, and poor health outcomes, modernizing the state’s marijuana laws could be a step in addressing these problems and could help save the state money in the long run.

This report provides an overview of the states that have modernized their marijuana laws in recent years– including decriminalization, medical marijuana, and recreational use – and the implications for West Virginia if it decided to pursue a similar path. It provides an overview of federal and state marijuana laws (Section 1), an estimation of the potential tax revenue from legalizing recreational marijuana in West Virginia (Section 2), an evaluation of some potential benefits from modernizing West Virginia’s marijuana laws (Section 3), and recommendations on reforming West Virginia’s marijuana laws (Section 4).

KEY FINDINGS

  • If marijuana was legalized and taxed in West Virginia at a rate of 25 percent of its wholesale price the state could collect an estimated $45 million annually upon full implementation. If 10 percent of marijuana users who live within a 200-mile radius of West Virginia came to the state to purchase marijuana, the state could collect an estimated $194 million.

  • In 2010, it is estimated that West Virginia spent more than $17 million enforcing the state’s marijuana laws. Legalizing or decriminalizing marijuana in West Virginia could reduce the number of marijuana-related arrests, especially among African Americans, which in turn, could reduce criminal-justice-related costs.

  • The marijuana industry has the potential to add jobs both directly and indirectly. As of September 2015, Colorado had 25,311 people licensed to work in its marijuana industry and over 1,000 retail marijuana businesses. If marijuana were legal in West Virginia it could also have the effect of increasing tourism to the state, particularly in regions with outdoor recreational activities.

  • Marijuana may potentially have a positive impact on West Virginia’s opioid-based painkiller and heroin epidemic by offering another, less-addictive alternative to individuals who are suffering from debilitating medical conditions.

August 19, 2016 in Business laws and regulatory issues, History of Marijuana Laws in the United States, Medical Marijuana Commentary and Debate, Medical Marijuana Data and Research, Recreational Marijuana Commentary and Debate, Recreational Marijuana Data and Research, Taxation information and issues | Permalink | Comments (0)

Sunday, August 14, 2016

Highlighting myriad challenges for doctors in a world of widespread state medical marijuana reforms

Dt_160517_medical_marijuana_cannabis_800x600This recent USA Today piece, headlined "As states OK medical marijuana laws, doctors struggle with knowledge gap," puts a needed spotlight on what I think may be the most under-examined aspect of modern state medical marijuana reforms. Here are excerpts:

Medical marijuana has been legal in Maine for almost 20 years.  But Farmington physician Jean Antonucci says she continues to feel unprepared when counseling sick patients about whether the drug could benefit them.  Will it help my glaucoma?  Or my chronic pain?  My chemotherapy’s making me nauseous, and nothing’s helped.  Is cannabis the solution? Patients hope Antonucci, 62, can answer those questions.  But she said she is still “completely in the dark.”

Antonucci doesn’t know whether marijuana is the right way to treat an ailment, what amount is an appropriate dose or whether a patient should smoke it, eat it, rub it through an oil or vaporize it.  Like most doctors, she was never trained to have these discussions. And, because the topic still is not usually covered in medical school, seasoned doctors, as well as younger ones, often consider themselves ill-equipped.  Even though she tries to keep up with the scientific literature, Antonucci said, “it’s very difficult to support patients but not know what you’re saying.”

As the number of states allowing medical marijuana grows – the total has reached 25 plus the District of Columbia – some are working to address this knowledge gap with physician training programs.  States are beginning to require doctors to take continuing medical education courses that detail how marijuana interacts with the nervous system and other medications, as well as its side effects.

Though laws vary, they have common themes. They usually set up a process by which states establish marijuana dispensaries, where patients with qualifying medical conditions can obtain the drug.  The conditions are specified on a state-approved list. And the role of doctors is often to certify that patients have one of those ailments. But many say that, without knowing cannabis’ health effects, even writing a certification makes them uncomfortable.  “We just don’t know what we don’t know. And that’s a concern,” said Wanda Filer, president of the American Academy of Family Physicians and a practicing doctor in Pennsylvania.

This medical uncertainty is complicated by confusion over how to navigate often contradictory laws.  While states generally involve physicians in the process by which patients obtain marijuana, national drug policies have traditionally had a chilling effect on these conversations.  The Federation of State Medical Boards has tried to add clarity. In an Aug. 9 JAMA editorial, leaders noted that federal law technically prohibits prescribing marijuana and tasks states that allow it for medical use to “implement strong and effective ... enforcement systems to address any threat those laws could pose to public safety, public health and other interests.”  If state regulation is deemed insufficient, the federal government can step in.

That's why many doctors say they feel caught in the middle, not completely sure of where the line is now drawn between legal medical practice and what could get them in trouble. In New York, which legalized marijuana for medicinal purposes in 2014, the state health department rolled out a certification program last October. (The state’s medical marijuana program itself launched in January 2016.)  The course, which lasts about four hours and costs $249, is part of a larger physician registration process. So far, the state estimates 656 physicians have completed the required steps.  Other states have contacted New York’s Department of Health to learn how the training works.

Pennsylvania and Ohio are also developing similar programs.  Meanwhile in Massachusetts, doctors who wish to participate in the state medical marijuana program are required to take courses approved by the American Medical Association. Maryland doesn’t require training but encourages it through its Medical Cannabis Commission website, a policy also followed in some other states.

Physicians appear to welcome such direction.  A 2013 study in Colorado, for instance, found more than 80% of family doctors thought physicians needed medical training before recommending marijuana.  But some advocates worry that doctors may find these requirements onerous and opt out, which would in turn thwart patients’ access to the now-legal therapy, said Ellen Smith, a board member of the U.S. Pain Foundation, which favors expanded access to medical cannabis.

Education is essential, given the complexity of how marijuana interacts with the body and how little physicians know, said Stephen Corn, an associate professor of anesthesiology, perioperative and pain medicine at Harvard Medical School.  Corn also co-founded The Answer Page, a medical information website that supports the New York program and is also bidding to supply information for the Pennsylvania program, Corn said....

From a medical standpoint, the lack of information is troubling, Filer said. “Typically, when we’re going to prescribe something, you’ve got data that shows safety and efficacy,” she said.  With marijuana, the body of research doesn’t match what many doctors are used to for prescription drugs.

Still, Corn said, doctors appear pleased with the state training sessions. More than 80% of New York doctors who have taken his course said they changed their practice in response to what they learned.  But even now, whenever Corn speaks with doctors about medical marijuana, people ask him how they can learn more about the drug’s medical properties and about legal risks.  Those two concerns, he said, likely reduce the number of doctors comfortable with and willing to discuss marijuana’s place in medicine, even if it’s allowed in their states.

August 14, 2016 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 (2)

Friday, August 12, 2016

"7 Scientific Effects of Marijuana That Experts Want to Study"

The title of this is the headline of this new Time article that serves as a somewhat fitting follow-up to the (big?) news the DEA delivered this week about marijuana scheduling and research.   Here are excerpts:

On Thursday the U.S. government announced that marijuana would continue to be classified as a Schedule 1 drug, meaning it has a high potential for abuse.  However, the feds are allowing more research on marijuana’s medicinal uses by making it easier for researchers to grow it.

Many researchers, both those who view marijuana as beneficial and those who are skeptical, argue that the government’s stance still hinders research.  “I understand the cautious nature of the government, whose role is basically to protect its citizens, but it is disappointing that marijuana continues to be included on the DEA’s list of the most dangerous drugs,” says Dr. Yasmin Hurd of Mount Sinai, who studies the effects of marijuana on the brain.

Though more than 20 states have legalized marijuana for medicinal uses, there’s still a lot scientists don’t know about it.  “It’s actually quite amazing how little we really know about something that has been used for thousands of years,” says Sachin Patel of Vanderbilt University who studies cannabis.  “We desperately need well-controlled unbiased large scale research studies into the efficacy of cannabis for treating disease states, which we have very little of right now.  Without these studies we are basically flying blind with regard to medical marijuana in my opinion.”

Scientists argue that studying marijuana is safe, and researching it shouldn’t be such a difficult process.  “A question that is not on the lips of researchers is whether or not the consumption of cannabis-based medicines is safe,” says Gregory Gerdeman, an Assistant Professor of Biology at Eckerd College.  “In the biomedical research community, it is universally understood that cannabis is a very safe, well-tolerated medicine.”

Here’s what researchers tell TIME they want to know about marijuana.

Is marijuana an effective cancer therapy?...

What does it do to the brain?...

What dosage or strains have the best use in medicine?...

Can marijuana help brain and cognitive problems?...

What about anxiety?...

Can pot help end the opioid epidemic?...

Are there long term consequences of using pot?

August 12, 2016 in Federal Marijuana Laws, Policies and Practices, History of Marijuana Laws in the United States, Medical community perspectives, Medical Marijuana Commentary and Debate, Medical Marijuana Data and Research, Who decides | Permalink | Comments (0)

Thursday, August 11, 2016

DEA announces new policy "designed to increase the number of entities registered under the Controlled Substances Act (CSA) to grow (manufacture) marijuana to supply legitimate researchers in the United States"

As the DEA exaplins in this press release (which also notes its decision to deny petitions seeking rescheduling of marijuana under the CSA (discussed here)), the agency has "announced a policy change designed to foster research by expanding the number of DEA- registered marijuana manufacturers."  The formal announcement of the new policy can be found in this Federal Register document, and here is more about the policy change from the DEA press release:

This change should provide researchers with a more varied and robust supply of marijuana. At present, there is only one entity authorized to produce marijuana to supply researchers in the United States: the University of Mississippi, operating under a contract with NIDA.  Consistent with the CSA and U.S. treaty obligations, DEA’s new policy will allow additional entities to apply to become registered with DEA so that they may grow and distribute marijuana for FDA-authorized research purposes.

This change illustrates DEA’s commitment to working together with the FDA and NIDA to facilitate research concerning marijuana and its components. DEA currently has 350 individuals registered to conduct research on marijuana and its components.  Notably, DEA has approved every application for registration submitted by researchers seeking to use NIDA-supplied marijuana to conduct research that HHS determined to be scientifically meritorious. 

Encouragingly, John Hudak at Brookings, who understand the ins and outs of federal marijuana laws and regulations better than anyone, has this new commentary explainaing why he thinks this DEA marijuana research decision "is more important than rescheduling." Here is how he starts his must-read commentary:

Today the Drug Enforcement Administration is expected to announce its decision on a five-year-old marijuana rescheduling petition.  After a long wait and amid wild speculation about the agency’s intentions, DEA has decided to keep marijuana as a Schedule I substance, but to take the unexpected step of ending the monopoly on the production of research grade marijuana.

This move will certainly disappoint many in the marijuana reform community who hoped that DEA would change marijuana’s status.  Under current policy — and now continuing policy — marijuana is categorized along with heroin and LSD as a substance that has no medical value and that has a high potential for abuse.  Reformers hoped that the administration would accept the claim that marijuana has medical benefit and can be used safely in treatment.  Today, it is opting not to do so.

However, DEA, in a clear sign of the growing political complexity around cannabis policy in the United States, will strike a balance.  Rather than wholly maintaining the current policy, the administration nixed a different stumbling block to the study of marijuana and its efficacy as a medical product: the DEA mandated monopoly on the growth of marijuana for research (administered through the National Institutes on Drug Abuse).  The DEA-mandated NIDA monopoly was cited as a significant barrier to research by observers like myself, Mark Kleiman and many others, as well as clinical researchers themselves.

Despite reformers’ discontent, this decision may be more meaningful than the ultimate goal of rescheduling for both policy and political reasons.

August 11, 2016 in Federal Marijuana Laws, Policies and Practices, History of Marijuana Laws in the United States, Medical community perspectives, Medical Marijuana Data and Research, Who decides | Permalink | Comments (0)

Monday, August 8, 2016

Gallup reports that self-reports of marijuana use is up in United States ... though I wonder if numbers partially reflect more honest self-reporting

As reported in this new Gallup posting, "[t]hirteen percent of U.S. adults tell Gallup they currently smoke marijuana, nearly double the percentage who reported smoking marijuana only three years ago."  Here is more on what Gallup has found and has to say about its most recent findings:

Although use of the drug is still prohibited by federal law, the number of states that have legalized recreational marijuana use has grown from two in 2013, Colorado and Washington, to four today -- with the addition of Alaska and Oregon -- plus the District of Columbia.  Five states will vote on whether to legalize marijuana this November. Half of U.S. states (including the four above) have some variation of a medicinal marijuana law on the books, and four more will be voting this fall on whether to legalize marijuana for medicinal use.  Both major-party presidential candidates, Hillary Clinton and Donald Trump, have voiced support for medicinal marijuana but say they defer to the states in terms of policymaking on both recreational and medicinal marijuana use.

States' willingness to legalize marijuana could be a reason for the uptick in the percentage of Americans who say they smoke marijuana, regardless of whether it is legal in their particular state.  Gallup finds residents in the West -- home of all four states that have legalized recreational marijuana use -- are significantly more likely to say they smoke marijuana than those in other parts of the country....

To compare marijuana use among various subgroups, Gallup aggregated data from 2013, 2015 and 2016.  The results show that age and religiosity are key determinants of marijuana use. Almost one in five adults (19%) under the age of 30 report currently using it -- at least double the rate seen among each older age group. Only 2% of weekly churchgoers and 7% of less frequent attenders say they use marijuana, but this rises to 14% of those who seldom or never attend a religious service.

The pattern by age in ever having used marijuana does not show the same skew toward the young; instead, it peaks among the middle-aged. About half of adults between the ages of 30 and 49 (50%) and between 50 and 64 (48%) report having tried it.  Despite being less likely to currently smoke marijuana, these older Americans could be more likely than their younger peers to report having tried it because they've had more years to do so.  But this difference in their rates of experimentation could also reflect generational cultures and attitudes toward marijuana that have shifted over time....

Results for this Gallup poll are based on telephone interviews conducted July 13-17, 2016, with a random sample of 1,023 adults, aged 18 and older, living in all 50 U.S. states and the District of Columbia.

Though not discussed by Gallup, I cannot help but speculate that these latest results may reflect a greater willingness by marijuana consumers to admit to marijuana consumption (especially in states that have recreational or medical reforms in place) as well as a greater number of persons consuming marijuana. Just speaking for myself, I think I would be generally be much more willing to admit to a telephone interviewer my involvement with activities that are legal under state laws than to those that are illegal under state law. For this reason (and others), I always wonder whether changes in self-reported marijuana use primarily reflects changes in actual use rates or instead is impacted significantly by changes in self-reporting honesty.

August 8, 2016 in Medical Marijuana Data and Research, Polling data and results, Recreational Marijuana Data and Research | Permalink | Comments (0)

Tuesday, July 26, 2016

The latest government data on marijuana use and attitudes

This new USA Today article, headlined "Study examines evolving rates, perceptions of marijuana use," reports on some new data on marijuana consumption and related topics in the United States. Here are excerpts from the press report on the marijuana report:

A new study from the Substance Abuse and Mental Health Services Administration provides an in-depth examination of marijuana use in the United States, as well as data regarding the public’s perception of the risks associated with the drug.  Using data collected by the National Survey on Drug Use and Health from 2012 to 2014, SAMHSA analyzed various regions around the country and within states to determine the rates of marijuana use and “perceptions of risks of harm” associated with the drug’s use in different parts of the U.S.

“This report provides a very detailed understanding of marijuana use and perception patterns in communities across the nation,” said Fran Harding, Director of SAMHSA’s Center for Substance Abuse Prevention. “This information can help public health officials and others better gauge the marijuana-related prevention and treatment needs in their communities and fine-tune their programs and services to best address them....

According to the study, 20.3 million people age 12 or older used marijuana in the past month, or approximately 1 in 13 people over the age of 12.

Although the federal government still classifies marijuana as a Schedule I drug, many states have begun to make changes to their cannabis laws. Alaska, Colorado, Oregon, Washington and the District of Columbia are currently the only states with legalized recreational marijuana, but 23 states and the District of Columbia have legalized forms of medical marijuana while an additional 14 have taken measures to decriminalize the drug.

The report comes several months ahead of the November elections, where eight states will have the option to legalize either recreational or medical cannabis. Five states — Arizona, California, Maine, Massachusetts and Nevada — are pursuing recreational marijuana, while three more — Arkansas, Florida and Missouri — could legalize medicinal cannabis.

Breaking their study into several regions — West, Northeast, Midwest and South — SAMHSA identified several states with multiple high use substate regions. Among those identified were Alaska, California, Colorado, Maine, Massachusetts, Oregon, Rhode Island, Vermont, Washington and the District of Columbia. Rhode Island and Vermont are the only two of those states to have either not legalized recreational marijuana or not have it on the ballot in 2016.

In spite of the increasingly relaxed marijuana laws, the SAMHSA study also found that approximately 74.9 million people aged 12 or older “perceived great risk of harm” from using marijuana once a month, or approximately 2 out of every 7 people above the age of 12. The states with the highest percentages of perception of risk were all from the South — Alabama, Arkansas, Florida, Kentucky, Louisiana, Mississippi and Texas. Alabama, Louisiana and Texas were among the states with the lowest use rate. The states with the lowest perception of risk include high marijuana use areas like Oregon, Washington and the District of Columbia.

The SAMHSA 19-page "short report" that is the basis for this article is available at this link under the title "Marijuana Use and Perceived Risk of Harm from Marijuana Use Varies within and across States."  For anyone really interested in marijuana data, especially divided by regions, the particulars and graphics from this report will be really interesting.

July 26, 2016 in Medical Marijuana Data and Research, Recreational Marijuana Data and Research | Permalink | Comments (0)

Friday, July 22, 2016

Illinois judge orders reconsideration of making migraines an eligible condition for medical marijuana in the state

Migraines-spousesAs reported in this Chicago Tribune article, in Illinois "a judge has ordered state officials to reconsider adding migraine headaches to the list of conditions that qualify a patient to buy" marijuana.  Here is more about this significant ruling:

Cook County Circuit Court Associate Judge Rita Novak overturned Illinois Department of Public Health Director Dr. Nirav Shah's denial of a petition to add migraines to that list.  The judge ordered Shah to reconsider evidence presented to the Medical Cannabis Advisory Board before its members voted to recommend approval of marijuana to treat migraines.

The court ruling came in response to a suit filed by a man whose name was kept secret because he already has been using marijuana to treat his headaches, his attorneys said.  Since adolescence, the middle-age man has suffered migraines up to three times a week, lasting from several hours up to three days, attorney Robert Bauerschmidt said.

The man has tried triptans, the most common treatment for migraines, but they didn't work well.  He tried narcotic painkillers but had a bad reaction that keeps him from using them, the attorney said.  "He's been through everything," Bauerschmidt said. "Marijuana doesn't cure it, but he finds the pain less severe and believes the headaches are less frequent when he's using it."

Though federal law still prohibits marijuana possession, state law allows it for patients who have any of about 40 specific medical conditions, including cancer, AIDS or multiple sclerosis.  Patients may buy the pot only from state-approved dispensaries.

The latest ruling comes after another judge last month ordered the state to add post-traumatic stress disorder as a qualifying condition for medical pot.  That ruling has been rendered somewhat moot, since Gov. Bruce Rauner recently signed a law adding PTSD and terminal illness as qualifying conditions.  But taken together, the separate rulings by different judges suggest that judicial review may further expand the program.

Attorney Mike Goldberg, whose firm handled the two prior cases, has pending lawsuits asking to add six other conditions: irritable bowel syndrome, chronic postoperative pain, osteoarthritis, intractable pain, autism and polycystic kidney disease.  "It's a potential game-changer for the industry," Goldberg said.

But Annie Thompson, a spokeswoman for the Illinois attorney general's office, which represents the state in court, emphasized that the ruling does not require adding migraines to the list.  It instead orders the director to reconsider within the parameters of the law and the judge's findings.

Joe Wright, the former director of the state's medical cannabis program, agreed that the case is not a done deal. "I'm not sure that means you'd necessarily have to add it," he said.  "That means they have to look at it again in light of what the advisory board considered."  If migraines and other conditions are added, Wright said, "That would open up the patient population fairly sizably."...

If the director adds migraines as a qualifying condition, that could greatly enlarge the number of patients. Migraines are a widespread condition, occurring in about 16 percent of Americans, according to two surveys cited by the American Headache Society.  Because there is no widely accepted blood test or brain scan to verify migraines, they typically are diagnosed by medical history, symptoms and a physical and neurological examination, according to the Mayo Clinic.  Typically Migraines occur repeatedly to the same patient, involving moderate to severe head pain that last for hours or days, nausea or vomiting and sensitivity to noise and light.

July 22, 2016 in Court Rulings, Medical community perspectives, Medical Marijuana Data and Research, Medical Marijuana State Laws and Reforms, Who decides | Permalink | Comments (0)

Thursday, July 21, 2016

New psychology research suggests why we ought to consider encouraging adults to use more marijuana and less alcohol

15As highlighted by this Washington Post piece, headlined "Researchers got people drunk or high, then made a fascinating discovery about how we respond," some notable new research provide yet another reason why society might be better off encouraging marijuana use rather than alcohol use. Here are the basics from the WaPo piece:

[R]esearch on the link between marijuana and aggression has been mixed. Marijuana seems to make most people relaxed, but it can also cause anxiety and paranoia, conditions which can occasionally manifest themselves in violent ways....

So a recent study from the Netherlands, published in the journal Psychopharmacology, attempts to put this question to bed using the gold standard of scientific research: a random controlled trial. They recruited a group of 20 heavy alcohol users (three-plus drinks a day for men, two-plus for women), 21 heavy marijuana users who smoked at least three times a week, and 20 controls who didn't use either drug heavily at all.... Then they made all three groups complete a number of tests designed to get people riled up....

The researchers measured aggression, before and after the respondents took the test, by asking them how aggressive they felt on a 100-point scale. For good measure, they had the marijuana and alcohol users go through the whole thing again one week later, this time without getting high or drunk, as a kind of separate control. They found, first of all, that "alcohol intoxication increased subjective aggression in the alcohol group." The alcohol users, in other words, acted more aggressive when they were drunk than they did when they were sober. By contrast, the smokers became less aggressive when they were high.

These findings held through both the self-assessments — alcohol users rated themselves as more aggressive when drunk — and through the responses to the tests: The drinkers tried harder to undermine their computer opponents when they were drunk. But the smokers actually acted less aggressive toward their computer opponents when they were high. "The results in the present study support the hypothesis that acute alcohol intoxication increases feelings of aggression and that acute cannabis intoxication reduces feelings of aggression," the researchers conclude.

This is in line with other research. A study in 2014, for instance, found that marijuana use among couples was linked to lower rates of domestic violence. In a fun study from the 1980s, researchers gave undergraduates varying doses of marijuana and then asked them to administer electric shocks to people in another room. The more stoned the undergrads were, the less interested they were in zapping other people.

This multi-author research can be examined at this link and under the title "Subjective aggression during alcohol and cannabis intoxication before and after aggression exposure." And here is how the abstract of the article describes the results anf findings:

Results: Subjective aggression significantly increased following aggression exposure in all groups while being sober. Alcohol intoxication increased subjective aggression whereas cannabis decreased the subjective aggression following aggression exposure. Aggressive responses during the PSAP increased following alcohol and decreased following cannabis relative to placebo. Changes in aggressive feeling or response were not correlated to the neuroendocrine response to treatments.

Conclusions: It is concluded that alcohol facilitates feelings of aggression whereas cannabis diminishes aggressive feelings in heavy alcohol and regular cannabis users, respectively.

July 21, 2016 in Medical Marijuana Data and Research, Recreational Marijuana Data and Research | Permalink | Comments (1)

Wednesday, July 6, 2016

New study suggests medical marijuana is already saving millions in Medicare costs

Medicare-and-uncle-samThis new Boston Globe article, headlined "Medical marijuana changing prescription practices, study finds," reports on fascinating new research seeming to document another financial benefit from marijuana reform. Here are the interesting details:

The arrival of medical marijuana in Massachusetts and other states is changing the way doctors prescribe conventional medications, a study published Wednesday reports.

The study, one of the first to investigate whether medical marijuana laws alter prescribing patterns, analyzed data from 17 states and Washington, D.C. It found that after medical marijuana laws were adopted, doctors wrote fewer prescriptions for Medicare patients diagnosed with anxiety, pain, nausea, depression, and other conditions thought to respond to marijuana treatment.

That translated to about $165 million less spent on prescription drugs in just one year in the Medicare program, which provides health insurance for older adults, according to the study published in the journal Health Affairs. Analysts said the findings are especially significant coming amid the nation’s opioid crisis and campaigns to reduce the prescribing of potentially addictive painkillers.

W. David Bradford, a health economist at the University of Georgia and the study’s senior researcher, said an ongoing review of the government’s Medicaid database, which includes a younger population more likely to use marijuana, suggests an even stronger correlation between prescribing trends and medical marijuana laws. Medicaid insures mostly younger patients who are poor and disabled. “This research says there is evidence that physicians are responding as if marijuana is medicine, and as if there is clinical benefit,” Bradford said.

The researchers analyzed millions of drugs prescribed by physicians from 2010 through 2013 in the Medicare Part D database. They focused their analysis on drugs that treat conditions for which marijuana might be an alternative treatment, including anxiety, depression, glaucoma, nausea, pain, psychosis, seizures, sleep disorders, and a muscle control disorder known as spasticity. They found that for all conditions, except glaucoma and spasticity, fewer prescriptions were written when a medical marijuana law was in effect.

To confirm the link to marijuana laws, and not other factors, the researchers compared results from the states with medical marijuana to states that had not legalized it. They did not see a similar decline in prescribing in states without marijuana laws. As a further test, the researchers selected four drugs prescribed for conditions for which there are no studies suggesting benefit from marijuana treatment. Those drugs included blood-thinners, antibiotics, antivirals to treat the flu, and a drug used in dialysis. They found no decline in prescriptions for these drugs....

Avi Dor, a health economist and professor of health policy and management at George Washington University’s Milken Institute, called the study “impressive and timely,” given concerns about prescription opioid abuse. Opioids are often prescribed for many of the conditions the researchers studied. “We can’t be sure about the causality [in the study], but the evidence is strong in favor of the marijuana laws leading to the substitution away from certain drugs,” said Dor, who was not involved in the research. “We just don’t know if, over time, the effects they find will wash out or become amplified,” Dor said. “Physicians and their patients are only beginning to experiment with the new therapeutic alternative of medical marijuana.”

The Health Affairs study estimated that if medical marijuana had been available in all states in 2013, the Medicare prescription program would have saved about $468 million because of fewer prescriptions for just that year -- an amount equal to one-half of 1 percent of Medicare prescription spending that year. But the researchers acknowledged that savings for Medicare might translate into more costs for patients who pay for medical marijuana out of their own pockets, because insurance doesn’t cover the drug.

Dr. Kevin Hill, an assistant professor of psychiatry at McLean Hospital and Harvard Medical School who studies marijuana, said the Medicare savings are important. But he noted physicians remain reluctant to recommend marijuana to their patients because they feel the evidence supporting its use is insufficient, or they are concerned about legal ramifications if they suggest a drug the federal government classifies as dangerous. “Medical marijuana may reduce prescription costs in some cases, but there is a risk that medical marijuana may be used for conditions that are not supported by evidence,” Hill said.

July 6, 2016 in Federal Marijuana Laws, Policies and Practices, Medical community perspectives, Medical Marijuana Commentary and Debate, Medical Marijuana Data and Research, Who decides | Permalink | Comments (0)

Saturday, July 2, 2016

"Could Marijuana Help Treat Alzheimer's Disease?"

The question in the title of this post is the headline of this local article reporting on new research that could be a profound "game-changer" if confirmed by additional future findings.  Here are the basics and why:

Researchers said Thursday marijuana may help treat Alzheimer's disease after discovering a new connection with an active ingredient.  Researchers at the The Salk Institute for Biological Studies in La Jolla said the connection has to do with THC, which is found in marijuana.

Five million Americans suffer with Alzheimer's disease, and it is a number that is expected to grow substantially as baby boomers move into what were supposed to be their golden years.

July 2, 2016 in Medical community perspectives, Medical Marijuana Commentary and Debate, Medical Marijuana Data and Research | Permalink | Comments (0)

Monday, June 20, 2016

Bipartisan Medical Marijuana Research Act of 2016 gets support from most vocal opponents and supporters of reform

Capitolpot-largeAs reported in this WonkBlog posting via the Washington Post, two members of Congress known to marijuana reformers for different reasons are now teaming up to support new federal laws to advance marijuana research.  The piece is headlined "Marijuana’s biggest adversary on Capitol Hill is sponsoring a bill to research … marijuana," and here are excerpts:

Rep. Andy Harris (R-Md.) is Congress's most vocal opponent of legal marijuana, having single-handedly spearheaded a provision blocking legal pot shops in the District of Columbia in 2014. Rep. Earl Blumenauer (D-Ore.), on the other hand, was recently named Congress's "top legal pot advocate" by Rolling Stone.

The two lawmakers couldn't be farther apart on marijuana policy, but they're teaming up this week to introduce a significant overhaul of federal marijuana policy that would make it much easier for scientists to conduct research into the medical uses of marijuana.

As Harris described it in an interview, the bipartisan Medical Marijuana Research Act of 2016 would "cut through the red tape" that currently makes it exceedingly difficult for researchers to obtain and use marijuana in clinical trials. As federal law currently stands, only one facility in Mississippi is allowed to produce marijuana used for research. "Because of this monopoly, research-grade drugs that meet researchers’ specifications often take years to acquire, if they are produced at all," Brookings Institution researchers wrote last year.

Beyond those difficulties, researchers wanting to work with the drug need to have their work approved by the Drug Enforcement Administration, the Food and Drug Administration and, in some cases, the National Institutes on Health. Those hurdles, and the amount of time it takes to jump over all of them, deter many researchers from doing work on marijuana. In one typical case, it took a team of scientists seven years to get full approval to conduct research into using marijuana to treat post-traumatic stress disorder among veterans.

But the bill sponsored by Harris, Blumenauer, Rep. Sam Farr (D-Calif.) and Rep. H. Morgan Griffith (R-Va.) would allow many more growers to produce marijuana for research. It would also remove levels of federal review for marijuana research projects and specify shorter windows for federal approval of the projects.

Crucially, it would also change the criteria by which the federal government allows marijuana research to proceed. "The federal government must grant an application for [approval] unless it's not in the public interest, rather than assuming it's not," Blumenauer said in an interview. "Reversing that presumption is huge."

Marijuana is currently listed under Schedule 1 of the federal Controlled Substances Act, the most stringent category of regulation. This bill would not change the schedule status of marijuana, but it would essentially create a "carve-out" within Schedule 1 for marijuana research, according to Harris. "Marijuana's actually different from other things in Schedule 1, which are all discrete chemicals," he said in an interview. "The plant is a combination of hundreds of compounds, so it needs to be treated separately from the other drugs in Schedule 1."

In a separate action, the DEA is currently considering whether to keep marijuana in Schedule 1, move it to a lower schedule, or de-schedule it entirely. But Harris says that process doesn't affect his thinking on this bill. "I'm not going to wait for the DEA to figure out what's going on," he said.

John Hudak, who studies marijuana policy at the Brookings Institution, calls the bill "a really creative approach by Congressman Blumenauer and his colleagues to effectively reschedule marijuana without having to reschedule it." He added, "It forces the government to make it easier for qualified legitimate researchers to get access to product and conduct that research."

Marijuana advocates used to tussling with Harris over his opposition to legal weed may be surprised to see him coming out forcefully in support of improved research. But as a doctor himself, Harris says researchers tell him that they can't do their jobs on account of federal red tape. "It's a Catch-22 that the research is difficult because of the strict rules, and the rules are strict because of the lack of research," he said. His thinking on the drug hasn't changed, he says: "I think medical marijuana should be much more strictly controlled than it is now." But, he adds, "as a physician I would never want to deny a medicine to a patient that has been shown, with scientific rigor, to help them."

June 20, 2016 in Federal Marijuana Laws, Policies and Practices, Medical community perspectives, Medical Marijuana Commentary and Debate, Medical Marijuana Data and Research, Who decides | Permalink | Comments (0)

Thursday, June 16, 2016

New Drug Policy Alliance report highlights problems with access and data in New York medical marijuana program

DownloadEarlier this week the Drug Policy Alliance this notable new report detailing and lamenting that New York's medical marijuana program is too restrictive and that information about the program is not readily available.  This DPA press release reports on some of the report's findings, and here are excerpts from the press release:

The Drug Policy Alliance issued a report assessing the first four months on the state’s medical marijuana program.  The report is in response to demand for information in the face of the absence of all but the most limited public information from the New York State Department of Health.  The report, the first systematic assessment of the program so far and its impact on patient access, found patients and caregivers face significant barriers to accessing medical marijuana.

On January 7th 2016, New York became the 23rd state to rollout its medical marijuana program. The law, which was passed in June of 2014, took eighteen months to implement and has been criticized as being one of the most restrictive and burdensome programs in the country.  Since the program was launched, patients and advocates have been frustrated by numerous barriers to accessing the program, including difficulty finding participating physicians, trouble accessing dispensaries and medication, and affordability.

The Department of Health has released only limited data about how the program is performing, offering little more than updates on the number of patients and doctors who have completed registration applications. Working with Compassionate Care NY, the state’s largest grassroots organization of patients and caregivers, the Drug Policy Alliance surveyed 255 people who had sought to access the state’s medical marijuana program.

According to the report, one of most pressing problems is that patients are struggling to find health care providers who are participating in the program.  According to DOH, as of June 9th, only 593 physicians New York physicians registered to certify patients for medical marijuana – less than 1% of all physicians in New York. Because there is no publicly available list of participating physicians, patients are forced to cold-call doctors in hopes of finding one or go through social media or other potentially unreliable sources.

More than half of patients and caregivers surveyed in the DPA report had not yet found a doctor to certify them, and among those, 3 out of 5 have been trying for 3 to 4 months to locate a registered physician.

Geographic inaccessibility is another barrier compounding problems of patient access to medicine.  Under the law, only five producers are licensed to grow medical marijuana in New York, and each can only operate 4 dispensaries.  This means that for a state of almost 20 million people and 54,000 square miles, there are only 20 dispensaries allowed (of which only 17 dispensaries have opened, to date). Patients, many of whom are very sick and disabled, must travel hours in some cases to get to a dispensary.  According to findings from the survey, 27% of registered patients/caregivers travelled for 1 to 5 hours to access a dispensary, while nearly 2 out of 5 reported that the dispensary they visited did not carry the specific kind of medical marijuana that was recommended to them by their physician.

Another major finding of the report is the unaffordability of medicine.  For respondents who had obtained medicine, 70% indicated that their monthly cost would be $300 and above, and more than 3 in 4 patients and caregivers who purchased medicine from a dispensary, stated that they would not be able to afford the monthly cost of medicine.

DPA’s report calls on the New York State legislature to pass bills currently pending in Albany that would amend the Compassionate Care Act, New York’s medical marijuana law, and improve access to medicine for those in need....  “New Yorkers deserve more transparency and information about how the state’s medical marijuana program is performing,” said Julie Netherland, PhD, of the Drug Policy Alliance and Compassionate Care NY. “Our data confirms what we have heard from patients and caregivers for months – New York’s program is not easily accessible, and even for patients who manage access the program, most cannot afford the medication.  We urge the legislature to act quickly and pass these bills to improve the program so patients in need can get relief.”

June 16, 2016 in Medical Marijuana Commentary and Debate, Medical Marijuana Data and Research, Medical Marijuana State Laws and Reforms | Permalink | Comments (0)

Thursday, June 9, 2016

Notable CDC survey data showing no changes in youth marijuana use despite massive state changes in marijuana law and policy

Via Tom Angell, the founder of Marijuana Majority, I just saw this interesting data report from the Center For Desease Control under the heading "Trends in the Prevalence of Marijuana, Cocaine, and Other Illegal Drug Use, National YRBS: 1991—2015." For those who do not know, the YRBS refers to the nation Youth Risk Behavior Survey which "monitors priority health risk behaviors and "is conducted every two years during the spring semester and provides data representative of 9th through 12th grade students in public and private schools throughout the United States."

The first three lines of data from this link will be of greatest interest to marijuana reform advocate, as it reports from the last 25 years the survey results on the issues of how many high-schoolers have "Ever used marijuana (one or more times during their life)" and have "Tried marijuana before age 13 years (for the first time)" and "Currently used marijuana (one or more times during the 30 days before the survey)."  Though I am simplifying the particulars, for all these survey questions, it appears that teen use of marijuana as reported via these surveys generally increased some in the 1990s and generally decreased over the last 15 years. And, of particular note, the CDC report that from 2013 to 2015, these was essentially and statistically speaking "No change." (Also, encouragingly, it appears that use of harder drugs by teens is also either not changing or even "decreasing" in recent years.)

Long story short, while adult use of marijuana is being legalize recreationally in a few states and medically in many more, it appears that so far we are seeing no obvious impact on teen use of marijuana.   I am not confident that these trends will persist over a long period of time if marijuana is legalized for recreational use by adults nationwide, but for now there is preliminary data to contradict assertions by opponents that marijuana reform that reform will be leading to significant increases in use by underage populations.

June 9, 2016 in History of Marijuana Laws in the United States, Medical Marijuana Data and Research, Recreational Marijuana Data and Research | Permalink | Comments (0)

Tuesday, June 7, 2016

Minnesota Dept of Health survey shows patients and health-care providers report benefits from medical marijauna including reduced opioid use

Download (20)This local article, headlined "Most Minnesota medical marijuana patients, and their practitioners, find treatment beneficial," reports on some positive results from early surveys of participants in Minnesota's medical marijuana program. Here are basics from the press report (with links from the original, and my emphasis added):

Almost all patients participating in Minnesota’s medical marijuana program say they are benefiting from the treatment, according to the results of a Minnesota Department of Health (MDH) survey released Monday.  Most of the patients’ health-care providers agree, although they tend to be more modest with their assessment of the treatment’s therapeutic benefits, the survey also found.

“This was certainly not a clinical trial.  It can’t answer questions about effectiveness,” said Dr. Thomas Arneson, research manager for the MDH’s Office of Medical Cannabis, in a phone interview with MinnPost.  “But I was impressed by the high level of benefit reported,” he added.  “We heard from 55 percent of the patients, which is pretty good. So even if it was a lower presumption of benefit among the others who didn’t respond, it was still pretty substantial.”

In Minnesota, marijuana (cannabis) in liquid or oil form can be prescribed by certified health-care practitioners to patients with nine qualifying medical conditions: cancer (to help treat the disease’s symptoms or the side effects of cancer therapies), glaucoma, HIV/AIDS, Tourette syndrome, amyotrophic lateral sclerosis (ALS), seizures (such as those characteristic of epilepsy), severe and persistent muscle spasms (such as those characteristic of multiple sclerosis), Crohn’s disease and terminal illness.   Starting July 1, patients with intractable pain will also be able to participate in the state’s medical marijuana program....

MDH sent the survey to the 435 patients who purchased medical marijuana during the first three months of the state’s program (July 1 to Sept. 30, 2015) and to the 345 health-care practitioners, including physicians, physician assistants and nurse practitioners, who certified them as being eligible for the treatment. The survey asked the patients and the practitioners to rate the level of benefit received from the use of medical marijuana on a scale of 1 (no benefit) to 7 (a great deal of benefit). 

Surveys were completed by 241 (55 percent) of the patients and by 94 (27 percent) of the health-care practitioners.  The perception of benefit was high in both groups. Almost 88 percent of the patients and 68 percent of the health-care practitioners reported at least some benefit to the patient (a score of 4 or higher) from the treatment.  A “significant” level of benefit (a score of 6 or 7) was reported by 66 percent of the patients and 46 percent of the practitioners.

The top three conditions for which the patients surveyed had been prescribed medical marijuana were severe muscle spasms, seizures and cancer. Although benefits were reported for all of those conditions, patients with cancer reported the highest scores, while the practitioners indicated that they had observed the greatest benefit from the treatments among their patients with muscle spasms.

The practitioners’ reports of benefit for all the conditions were generally more conservative than those of the patients.   “The patients were a little bit higher on the more subjective quality-of-life benefits than the healthcare practitioners were,” said Arneson. “The clinicians tended to respond more with things that were measurable, that were objective,” he added.

One interesting benefit reported by the practitioners was a reduction in the need for other pain medications.  Twelve said their patients were able to reduce their pain medication dosage as a result of the marijuana, including at least six who were able to decrease their use of prescription opioids.

About 20 percent of the surveyed patients and 16 percent of the surveyed practitioners reported patient side effects from the marijuana treatment — a finding that mirrors what has been observed in research conducted elsewhere, said Arneson.  In the MDH survey, the side effects included hives, stomach pains, dizziness, fatigue, a burning sensation in the mouth and paranoia. None of the side effects were life-threatening, although four patients (2 percent) reported an increase in seizures.

Despite the survey's overall positive results, not everybody who receives medical marijuana treatment for one of the qualifying conditions is going to benefit from it, Arneson emphasized.  “How much of this is the placebo factor, we don’t know, although it’s probably quite a bit of it,” he said.  “Cannabis is not a miracle drug,” he added.

Still, the survey suggests that whether or not the placebo effect is in play, many patients believe medical marijuana is helping to ease their symptoms.   “These are individual persons, individual lives, many of whom are having great difficulties in their lives because of their medical conditions,” said Arneson. ... 

FMI:  The MDH’s report on the survey was published online in the June issue of Minnesota Medicine magazine, where it can be read in full.  The complete survey results — including specific comments from patients about the effects of the treatment on their medical condition — can be found on MDH’s Office of Medical Cannabis website.

June 7, 2016 in Medical community perspectives, Medical Marijuana Commentary and Debate, Medical Marijuana Data and Research, Medical Marijuana State Laws and Reforms | Permalink | Comments (0)

Monday, June 6, 2016

Louisiana universities and businesses now clearly think the Bayou State is a serious medical marijuana reform jurisdiction

Medical-marijuana-mms-titlepng-a8616304bffdd15cThere has been some enduring debate and uncertainty as to whether Louisiana should "count" as one of the two-dozen-plus states that have enacted significant medical marijuana reforms.  For a number of reasons, and especially since recent legislative reforms to the state's medical marijuana rules, I think Louisiana should count in any accounting of such states.  And this recent local article, headlined "Louisiana gearing up for marijuana business: How much might LSU, Southern, companies profit? How will it be distributed?," suggests that now shortage of Louisiana officials and institutions are now considering the state's work in this space very seriously. Here are highlights from the interesting article:

Growing up on a cotton farm in Missouri in the 1950s, Bill Richardson didn’t know a thing about marijuana. Nobody talked about it, he never saw it and he certainly never smoked it. “I didn’t inhale,” Richardson, LSU’s 71-year-old vice president for agriculture and dean of the College of Agriculture, said with a smile in a recent interview.

Richardson has become the unlikely leader of an effort to get LSU into the pot business. Last month, the Louisiana Legislature approved a bill that legalizes the use of marijuana for people suffering from a specific list of debilitating diseases. The so-called medical marijuana legislation authorizes LSU and Southern University to grow and produce cannabis to be consumed in a liquid form. (Hold the “Cheech and Chong” jokes — it cannot be smoked, and no, they won’t be offering samples.)

The boards of both universities appear likely to give the go-ahead for pot cultivation. It’s not clear yet, however, who will provide the $10 million to $20 million needed to produce the drug, which will be sold at 10 standalone pharmacies designated by a state agency. None of the people wanting to be treated by pot will have access to it for at least 18 months.

When the Legislature legalized marijuana for patients suffering from 10 specific diseases, lawmakers told emotional stories about the children and loved ones who stood to benefit. Opponents, meanwhile, warned darkly that Louisiana was heading down a slippery slope toward legalizing a dangerous drug. Lost in the debate is what the measure will mean for LSU and Southern — and the private companies that are now emerging to try to profit from the new industry by partnering with the universities.

The legislation by state Sen. Fred Mills, R-Parks, gave LSU and Southern no money to launch this new venture, meaning they will have to rely on private companies to buy the seeds, hire scientists, rent or build growing facilities and pay for all the other costs. “All of the money would have to come from venture capitalists, or you’d have to sell bonds,” said Adell Brown, the point person at Southern as the university’s interim chancellor for its Agricultural Research and Extension Center. Neither Brown nor Richardson can say yet how much it will cost to get the business running at full speed, but both agree that it probably will take at least $10 million.

Brown and Richardson both report getting calls from representatives of companies that want to rent or sell land or provide a growing facility. Others are inquiring about financing the entire venture with the expectation of earning a profit. “It’s a money-making venture,” Brown said.

Neither he nor Richardson knows yet where they might grow the pot, but the universities are not likely to do it together. (The Legislature has authorized them to cultivate the marijuana because of federal laws prohibiting the transport of marijuana across state lines.) The University of Mississippi grows marijuana for research under a special federal license on the edge of its campus, in a field surrounded by two fences and armed guards, said an Ole Miss spokesman. “My recommendation is that it not be grown on campus, for the PR,” Richardson said.

He expects that LSU’s Board of Supervisors will authorize the growing of marijuana at its June 24 meeting. “It’s something we can do,” Richardson said, adding that he sees this as an opportunity for the university to duplicate its pioneering work with rice and other crops. Besides, “over the past year, I’ve heard enough testimonials of the medicinal effects to believe that the benefits outweigh the negatives. Plus, there may be some opportunities to create an income stream to help us balance our budget.”

Brown said he expects Southern’s board to approve the venture at either its June or July meeting. “It will be a highly sophisticated and self-controlled facility with the proper protocols for security,” he said. “We have faculty members who have done work with a lot of different crops that are of the same family.”...

While LSU and Southern are gearing up, several state entities are working to provide the regulatory framework for everyone who wants to be involved. The Louisiana State Board of Medical Examiners already has drafted its rules for doctors who want to apply to treat patients suffering from cancer, multiple sclerosis, epilepsy and seven other diseases, including HIV and AIDS. No doctor can treat more than 100 patients, said Eric Torres, the executive director of the medical board. Mills’ legislation, Senate Bill 271, requires doctors to “recommend,” not “prescribe,” the drug, to get around federal laws.

The state Department of Agriculture and Forestry is drafting rules that will govern the growing and production of the medical marijuana. The Legislature has authorized money for the agency to hire outside labs to make sure the marijuana is free of pesticides and heavy metals and has the least possible THC — the active ingredient that makes people high — and to hire staff to regulate the new business. “We have to make sure that end product is safe,” Agriculture Commissioner Mike Strain said in an interview.

The end product is what the patients actually will buy. “The marijuana cannot be inhaled,” said Jesse McCormick, of the Louisiana Cannabis Association, who lobbied to pass SB271. “It could be a cream. It could be in liquid form — tincture. It could be a gel cap. It could be a vitamin gummy. If you’re going to a dispensary to find ‘bud’ — well, you won’t.” The Louisiana Board of Pharmacy will decide on the drug’s final form and is leaning in favor of allowing LSU and Southern to make that decision. “Let the producers be as creative as they wish,” said Malcolm Broussard, the executive director of the board.

The 17 members of this Baton Rouge-based board — who are appointed by the governor to six-year terms — also will decide who will operate the 10 pharmacies throughout Louisiana that will sell the medical marijuana. Under state law, they cannot be part of a normal drugstore, although Broussard said it’s possible that the therapeutic drug could be sold in a convenience store. That store could not also sell prescription drugs, but it could offer over-the-counter drugs, he said.

Next year’s licensing decision will put a spotlight on a board so obscure that Broussard said he had never before been interviewed by an Advocate reporter during 17 years as executive director.

June 6, 2016 in Business laws and regulatory issues, Medical community perspectives, Medical Marijuana Commentary and Debate, Medical Marijuana Data and Research, Medical Marijuana State Laws and Reforms | Permalink | Comments (0)

Wednesday, June 1, 2016

Seeking any new quantitative or qualitative research on physician engagement with state medical marijuana programs

Image_doctor-marijuana-leaf-001Among the many issues that seem to me to be woefully under-explored in discussions of marijuana reform and policies is the role being played (or not played) by doctors in states with functioning medical marijuana programs.  Ergo, I am seeking, as the title of this post reveals, information from anyone who can help me determine if any new (and rigorous) research is being done in this arena these days. 

I have seen press reports that relatively few doctors are signing up to be a part of formal programming in a number of states.  Those kinds of reports give credence  to complaints I hear from advocates in Ohio that the new bill for medical marijuana in the state will not function well because of the regulatory rules and burdens it will be placing on doctors in order to be able to make a medical marijuana recommendation.  

But I suspect various reports of physician disaffinity for medical marijuana programming may reflect long-enduring beliefs and concerns, especially among old and more "traditional" physicians, that many past claims about marijuana as a wonder drug are based in "snake-oil" type promotion.  Now though, especially with so many states and studies starting to take seriously the potential medical benefits of marijuana (especially in non-smoked forms), I am wondering if doctors, especially younger ones, are becoming more open to considering being involved in medical marijuana programs.

I would be grateful is anyone can point me to any new significant research in this space.

June 1, 2016 in Medical Marijuana Commentary and Debate, Medical Marijuana Data and Research, Who decides | Permalink | Comments (0)

Saturday, May 28, 2016

Calling out Leg/Reg, Ad Law scholars to start looking seriously at pros/cons of structures of state (and eventually federal) medical marijuana reforms

Download (19)As explained in this prior post, this past week the Ohio General Assembly passed a massive medical marijuana bill that creates a remarkable regulatory structure for the development and application of rules and regulations for medical marijuana in the Buckeye State.  Specifically,  the 126-page(!) Ohio medical marijuana bill (available here; detailed summary/analysis here), creates three enduring regulatory bodies in charge of various parts the state's marijuana programming: the Department of Commerce, the board of pharmacy, and the medical board.

In addition, the bill also creates for, a five-year period, a multi-member "medical marijuana advisory committee" which "may develop and submit to the department of commerce, state board of pharmacy, and the state medical board any recommendations related to the medical marijuana control program."  In my prior post, I suggested that Ohio-based lobbyists would surely love this regulatory structure; this post is my effort to encourage fellow LawProfs who follow closely the work of legislators and adminstrative regulators to love looking closely not only this Ohio legislation, but also the broader set of fascinating "leg/reg" and administrative law issues that are swiftly emerging at the local, state and federal level concerning medical marijuana reform.

For a range of understandable reasons, the traditional press and most marijuana/drug policy advocates spend a lot more time talking and thinking about recreational marijuana reforms than about (much more prevalent) medical marijuana reforms.  Serious followers of the work of state legislatures and thoughtful legal scholars should realize, however, that medical marijuana reform efforts at the local, state and federal level is where the most significant (and diverse) action is now to be found and observed.   Only five jurisdictions have enacted recreational marijuana reforms and all of those were the result of voter initiatives.  But more than two dozen states have now enacted major medical marijuana reforms, and another dozen-and-half  states have enacted limited-CBD-oil type reforms.  

Moreover, and perhaps even more importantly, state legislatures have played a significant role in all of the most recent medical marijuana reform efforts in a number of big diverse states ranging from California to Louisiana to New York to Illinois to Pennsylvania to Ohio.   In addition, even at the federal level where blanket prohibition is the law of the land, we have seen lots of notable bills proposed (and some provisions passed) that directly impacts how federal agencies and agents are to engage with state medical marijuana reforms.  And, of course, there is ever-growing discussions of whether, when and how marijuana's placement on Schedule 1 of the Controlled Substantive Act might get changed.

Snip20151020_1In addition to seeing a whole lots of legislative and regulatory action at all levels, there is an extraordinary diversity in regulatory structures being put in place and starting to operate in various ways in various states.  The Ohio legislation, for good of for bad, highlights the problematic reality that still nobody is yet sure at all what could or should be the best structure for developing sound on-going medical marijuana rules and regulations: is sound reform really about "medical/patient" issues for agencies like pharmacy/medical boards; is it really about "business/consumer" issues for agencies like a Department of Commerce or Taxation; or is medical marijuana its own special, strange, unique space that call for its own special, strange, unique regulatory body.

For the record, especially right now when blanket federal marijuana prohibition is still the basic law of the land, I consider medical marijuana reform and regulation to occupy its own special, strange, unique space calling for its own special, strange, unique regulatory body.  For that reason and others, I am encouraged that the new Ohio law has created a diverse, multi-member "medical marijuana advisory committee," and I am hopeful that this body ends up staffed with a motivated and informed group of quasi-policy-makers who will take a leadership role in the months and years ahead as Ohio moves forward with its marijuana reform efforts.  

That all said, and as this post is meant to highlight, my perspectives on these critical legislative/regulatory issues would be greatly informed and enhanced by having legal scholars who study these issues actively providing their informed perspective on the good, the bad and the ugly of sound regulatory reforms.  I know these folks know a lot about topics relating to regulatory (in)efficiency and agency capture and all sort of other important topics, and I want to start better understanding what I know that I now do not know on these next forteirs for marijuana reform.

Long story short:  I am putting you on notice Chris Walker, and I am eager to see some comments!

Some prior related posts about Ohio's recent legislative and regulatory medical marijuana activity:

May 28, 2016 in Business laws and regulatory issues, Federal Marijuana Laws, Policies and Practices, Medical Marijuana Commentary and Debate, Medical Marijuana Data and Research, Medical Marijuana State Laws and Reforms | Permalink | Comments (0)

Tuesday, May 24, 2016

"As more states legalize marijuana, adolescents' problems with pot decline: Fewer adolescents also report using marijuana"

Journal-american-academy-childThe title of this post is the headline of this notable Science Daily release that reports on this notable newly published research in the Journal of the American Academy of Child & Adolescent Psychiatry that surely should be getting lots and lots of attention from marijuana reform advocates.  Here are the basics via the Science Daily:

A survey of more than 216,000 adolescents from all 50 states indicates the number of teens with marijuana-related problems is declining. Similarly, the rates of marijuana use by young people are falling despite the fact more U.S. states are legalizing or decriminalizing marijuana use and the number of adults using the drug has increased.

Researchers at Washington University School of Medicine in St. Louis examined data on drug use collected from young people, ages 12 to 17, over a 12-year span. They found that the number of adolescents who had problems related to marijuana -- such as becoming dependent on the drug or having trouble in school and in relationships -- declined by 24 percent from 2002 to 2013.

Over the same period, kids, when asked whether they had used pot in the previous 12 months, reported fewer instances of marijuana use in 2013 than their peers had reported in 2002. In all, the rate fell by 10 percent. Those drops were accompanied by reductions in behavioral problems, including fighting, property crimes and selling drugs. The researchers found that the two trends are connected. As kids became less likely to engage in problem behaviors, they also became less likely to have problems with marijuana.

The study's first author, Richard A. Grucza, PhD, an associate professor of psychiatry, explained that those behavioral problems often are signs of childhood psychiatric disorders. "We were surprised to see substantial declines in marijuana use and abuse," he said. "We don't know how legalization is affecting young marijuana users, but it could be that many kids with behavioral problems are more likely to get treatment earlier in childhood, making them less likely to turn to pot during adolescence. But whatever is happening with these behavioral issues, it seems to be outweighing any effects of marijuana decriminalization."

The new study is published in the June issue of the Journal of the American Academy of Child & Adolescent Psychiatry. The data was gathered as part of a confidential, computerized study called the National Survey on Drug Use and Health. It surveys young people from different racial, ethnic and income groups in all 50 states about their drug use, abuse and dependence.

In 2002, just over 16 percent of those 12 to 17 reported using marijuana during the previous year. That number fell to below 14 percent by 2013. Meanwhile, the percentage of young people with marijuana-use disorders declined from around 4 percent to about 3 percent.

At the same time, the number of kids in the study who reported having serious behavior problems -- such as getting into fights, shoplifting, bringing weapons to school or selling drugs -- also declined over the 12-year study period. "Other research shows that psychiatric disorders earlier in childhood are strong predictors of marijuana use later on," Grucza said. "So it's likely that if these disruptive behaviors are recognized earlier in life, we may be able to deliver therapies that will help prevent marijuana problems -- and possibly problems with alcohol and other drugs, too."

May 24, 2016 in History of Marijuana Laws in the United States, Medical Marijuana Data and Research, Recreational Marijuana Data and Research, Science | Permalink | Comments (0)

Wednesday, May 11, 2016

AAA study properly highlights challenge of assessing marijuana impairment for highway safety laws

As reported in this press piece, headlined "Legal limits for driving on pot not backed by science, study shows," the folks at AAA have released a valuable new report on marijuana impairment and driving. Here are the basics via the press report:

Legal blood limits for marijuana are not an accurate way to measure whether someone was driving while impaired, and can lead to unsafe drivers going free while others are wrongfully convicted, according to a new study.

The study released Tuesday by the AAA Foundation for Traffic Safety found that drivers can have a low level of THC, the active ingredient in marijuana, in their blood and be unsafe behind the wheel, while others with relatively high levels may not be a hazard.

Marijuana is not metabolized in the system in the same way as alcohol. So while a person with a blood-alcohol level of .08 or higher is considered too drunk to drive, it's not possible to say the same thing absent other evidence about a person testing at 5 nanograms per milliliter of blood of THC — the level used to find impairment by Colorado, Montana and Washington, the study found.

The difference matters, because Illinois and 11 other states have laws that forbid any level of marijuana in the system while driving. A pot decriminalization bill being considered in the Illinois legislature would raise the level to 5 ng/ml. The bill faces opposition from law enforcement and anti-pot advocates.

Efforts to legally measure marijuana impairment have become a major concern for lawmakers as more states move to legalize cannabis, either for medical use or adult recreational use. Four states have legalized pot for recreational use by adults, and 24 states — including Illinois, plus Washington, D.C. — allow medical use, according to the Marijuana Policy Project, a D.C.-based advocacy group.

"It's an attempt to try to do an apples-to-apples comparison with blood alcohol concentration," said Chris Lindsey, senior legislative analyst for the Marijuana Policy Project. He noted that the AAA findings echo earlier research. "They found out that these things can't really be compared."

Another problem is that high THC levels may drop before a test is administered, because the average time to collect blood from a suspect driver is often two hours, the AAA study found. Frequent pot users can exhibit high levels of the drug long after use, while levels can decline rapidly among occasional users, so it is difficult to develop fair guidelines, the study found.

Because of the problem in measuring whether someone is impaired with a blood test, AAA urged states to also look at behavioral and physiological evidence through field sobriety tests, such as seeing whether a driver has bloodshot eyes or is able to stand on one leg. "That kind of testing has proved effective in court," said J.T. Griffin, chief government affairs officer for Mothers Against Drunk Driving, or MADD.

He pointed to a 2015 study by the National Highway Traffic Safety Administration that found no big crash risk associated with people driving with marijuana in their system but says more study is needed. Alcohol remains the biggest drug problem on the highways, he said. "We know that almost one-third of all traffic deaths are caused by alcohol," Griffin said.

AAA released a second study Tuesday that showed fatal crashes involving drivers who recently used marijuana had doubled in Washington after that state legalized the drug in December 2012 — the percentage of drivers involved in fatal crashes who had used marijuana jumped to 17 percent from 8 percent between 2013 and 2014. Most drivers who had THC in their systems also had alcohol or other drugs in their blood at the time of the crash, the study found. The study noted that the drivers who had THC in their blood were not necessarily impaired nor were they necessarily at fault in the crashes.

Much of the work by AAA in this space can be found at this link.

May 11, 2016 in Criminal justice developments and reforms, Medical Marijuana Data and Research, Recreational Marijuana Data and Research | Permalink | Comments (1)