Saturday, January 23, 2016
The question in the title of this post is prompted by this local article from Maine, headlined "Sales of medical marijuana jumped 46 percent in Maine last year: The state's pot dispensaries took in $23.6 million as the social stigma faded and more patients seeking relief from chronic pain tried the drug." Here are excerpts:
Mainers spent $23.6 million on medical marijuana from dispensaries last year, a 46 percent increase driven by multiple factors, including patients seeking alternatives to prescription painkillers and more doctors certifying people to use the drug, according to dispensary operators.
Operators say the increase in sales illustrates the growing willingness of patients and doctors to consider alternatives to traditional medicine, and a reduction in the social stigma surrounding the use of medical marijuana.
But an official for the Maine Medical Association said Wednesday the big jump also shows why the medical community has resisted opening the program to more patients with different medical conditions, citing a lack of research that demonstrates medical marijuana is effective in treating them.
The $23.6 million in 2015 dispensary sales generated $1.29 million in sales tax, according to Maine Revenue Services. In 2014, the dispensaries sold $16.2 million worth of medical marijuana products and collected more than $892,000 in sales tax, a 40 percent increase over the previous year and more than triple the tax revenue collected in 2013. The sales figures from Maine Revenue Services do not include numbers from the state’s 2,255 caregivers, who are small-scale growers authorized to sell marijuana to up to five patients.
“There are a number of factors at play here. The first would be that Mainers are becoming more used to the idea of therapeutic cannabis,” said Becky DeKeuster, director of education for Wellness Connection, which operates four of Maine’s eight dispensaries. “We’ve had a very successful dispensary program for five years now and people are becoming used to this option.”
Maine is one of 34 states that allow some form of medical cannabis. Maine legalized medical uses in 1999, and the state’s first dispensaries opened in 2011. Last year, Maine’s program was voted the best medical marijuana program in the country by Americans for Safe Access, a national group that advocates for legal access to the drug.
The state cannot provide an exact number of patients because it does not keep a registry, but doctors have printed more than 35,000 certificates required under state regulations to certify patients. That number could include duplicates and replacement certificates and is likely higher than the actual number of patients, said Samantha Edwards, spokeswoman for the state Department of Health and Human Services, which oversees the medical marijuana program.
About 340 medical providers certified patients to obtain medical marijuana. Patients qualify for certification if they have one of a dozen specific conditions, including cancer, glaucoma, chronic pain and Crohn’s disease. Tim Smale, operator of the Remedy Compassion Center in Auburn and president of the Maine Dispensary Operators Association, believes there has been about a three-fold increase in the number of doctors certifying patients in the past couple of years. Maine law has been amended so that nurse practitioners and physician’s assistants also can certify patients....
Gordon Smith, spokesman for the state medical association, said the large increase in sales illustrates why the association has lobbied against efforts to expand the medical marijuana program to include more qualifying conditions or eliminate them altogether. “We don’t want to put Maine’s medical community in a position where it’s being asked to be a front for recreational use of marijuana,” Smith said. “We acknowledge marijuana helps a small number of medical conditions and there is good evidence of that, but for many of the (conditions) on the list, there’s not scientific data to establish marijuana is helpful.”
One condition that has been debated is post-traumatic stress disorder, which Maine added to the list of qualifying conditions in 2013. The Mayo Clinic defines post-traumatic stress disorder as a mental health condition that’s brought on when a person sees or experiences a severely traumatic event. A person suffering from PTSD may have uncontrollable thoughts about the event and also experience flashbacks, nightmares and severe anxiety.
Although several other states have authorized medical marijuana sales to people with PTSD, the U.S. Department of Veterans Affairs describes the practice as a growing concern because some veterans are using the drug to relieve symptoms of PTSD, yet there is a lack of medical evidence of its effectiveness.
DeKeuster said Wellness Connection, which serves about 11,000 patients across the state, is seeing more patients who want to use medical cannabis as a first option for treatment instead of as a last resort. The top three qualifying conditions among Wellness Connection patients are chronic pain, post-traumatic stress disorder and cancer. “Physicians and patients both are looking for a pain relief solution that is natural,” DeKeuster said....
Another factor contributing to the rise in the use of medical marijuana is that dispensaries have dozens of strains, as well as pills, tinctures and edible forms that make taking the drug easier, DeKeuster said. Smale said dispensary operators across the state report similar trends among all their patients, including seeing more elderly people who want to use medical cannabis for treatment of chronic pain. The Remedy Compassion Center, which Smale owns and operates in Auburn, now primarily serves patients between ages 50 and 70, he said. “The other things we’re finding is folks are looking for an alternative to their opiates,” he said. “We hear many anecdotal reports of people reducing or eliminating opiate use through medical cannabis.”
In addition to anecdotally answering some questions about what is going on with medical marijuana in Maine, it raised for me a bunch of questions about whether these developments in the Pine Tree State are also playing out in a bunch of other medical marijuana states. In particular, I would love to know if dispensary sales are up similarly in a number of other states and also whether there is any reliable data about "people reducing or eliminating opiate use through medical cannabis."
Monday, October 19, 2015
The title of this post is the title of this effective piece from Stateline, the news service of the Pew Charitable Trusts that provides reporting and analysis on trends in state policy. Here is an excerpt:
Montana is among several vanguard states whose voters eagerly legalized medical cannabis by passing broad ballot initiatives as many as 19 years ago, but left lawmakers struggling to regulate an industry that grew quickly with few rules.
Today, states like California, Montana and Michigan are still attempting to clean up their laws with bills that would develop licensing systems for growers, create a fee structure for providers and product, or legalize all marijuana use.
It’s a legislative and regulatory pitfall that lawmakers warn other states they could face as public demand for legal medical and recreational marijuana grows, and more states allow it.
Maryland opened the door to medical use last year, and Georgia, Oklahoma, Texas and Wyoming passed laws legalizing access to less-potent medical cannabis products for certain patients this year. At least 20 initiatives to legalize medical or recreational marijuana could be on the ballot in 16 states next year. And in November, voters in Ohio will decide whether recreational marijuana should be legal in that state.
Proponents of using marijuana as medicine say ingesting the drug can ease chronic pain, stimulate appetites for the very ill, soothe nausea caused by cancer treatments and prevent seizures in children with epilepsy. Detractors say the research surrounding medical marijuana isn’t conclusive, the drug poses significant public health risks and those who advocate for it use medical marijuana to trick voters into sanctioning an illegal drug for recreational use....
And unless state lawmakers get ahead of their constituents on legalization, they face a potential regulatory nightmare, said Washington state Sen. Ann Rivers. Rivers, a Republican, should know. Medical marijuana was legalized in Washington by voter initiative in 1998, leaving gaping regulatory holes and hazards that lawmakers like her have spent years trying to fix.
Sunday, October 18, 2015
The question in the title of this post is prompted by this provocative new Forbes commentary headlined "The NFL Should Be Investing In Marijuana If It Wants To Survive." Authored by Blake Yagman and Jason Belzer, here are excerpts:
The National Football League has survived more public relations crises in the past year than most multi-billion dollar organizations endure in a decade. Yet the greatest existential threat to the NFL, if not to the existence of football itself, still remains Chronic Traumatic Encephalopathy, or “CTE.”...
Terrifyingly, the vast prevalence of the disease may not have been known until fairly recently. Just this year, Boston University found the existence of CTE in the brains of 96% of 91 tested subjects, all of whom played football at some organized level. When the disease was first discovered in 2002 in the brain of former Pittsburgh Steeler Mike Webster by Dr. Bennet Omalu, the NFL initially tried to limit the fallout from the discovery. According to Omalu, “NFL doctors told me that if 10% of mothers in this country would begin to perceive football as a dangerous sport, that is the end of football.”
Last year, Harvard Medical School Professor Dr. Lester Grinspoon called attention to a neuro-protective agent that has the potential to render concussions obsolete – Marijuana. According to Grinspoon, a National Institute of Health study from 1998 revealed the neuro-protective qualities of Marijuana’s two main psycho-active ingredients, Cannabidiol and Delta-9 Tetrahudrocannabidol (THC). In 2008, a similar study in Spain revealed that the THC-receptors in the brain are involved in the healing process upon sustaining brain injury. Most recently, the National Institute of Health showed that THC significantly decreases the death rate of patients with physically sustained brain trauma. In 2013, a team of researchers in Brazil were able to prove that Cannabidiol has the ability to regenerate brain cells in mice. The study specifically showed a capacity to promote the growth of brain cells in the areas of the brain attributed to depression, anxiety, and chronic stress—the symptoms of CTE.
If components of Marijuana have been proven beneficial to patients with neurological injury, the natural conclusion would be to study the drug and develop a medication that could help prevent terrible effects of concussions and CTE. That being said, the barriers to begin this sort of endeavor — research that nevertheless could save the game of football — are high (no pun intended). Perhaps most obviously, the biggest issue is one of funding....
If the league were to finance this research, they would face an avalanche of cries of hypocrisy, as the league has a strict no-drug policy. Realistically, the program is often taken as seriously by its players as the league’s selection of the policy’s mandated testing date of April 20th (the unofficial holiday of recreational users of Marijuana).... Quite notoriously, players simply pass the annual test and continue to use the drug therapeutically for injuries during the season. Medical Marijuana is legal in 23 states, recreational use is legal in three states, and the drug has been decriminalized in many of the United States’major cities, yet the drug remains “illegal”for use by players.
Although the initial publicity for the NFL might be negative, the potential impact reaching into future generations is tremendous. Not only would the league attempt to cure a major medical question that plagues modern sports, but it could potentially set a precedent for major corporations to push Marijuana research forward to fully discover the drug’s potential. The looseness of the NFL’s current Marijuana policy, as well as Commissioner Goodell’s recent statement that the league is willing to support research into Marijuana’s medical uses specific to football, suggest that this partnership is a more than viable option.
Some prior related posts on NFL players and marijuana use:
Wednesday, September 30, 2015
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)
Tuesday, September 15, 2015
High Intensity Drug Trafficking Area Programs (HIDTAs) are, as explained here, a special kind of drug-enforcement task force that was "created by Congress with the Anti-Drug Abuse Act of 1988 [and] provides assistance to Federal, state, local, and tribal law enforcement agencies operating in areas determined to be critical drug-trafficking regions of the United States." Usefully, the Rocky Mountain HIDTA has been especially focused on marijuana reform, and the last three years it has produced a annual report around this time under the title "The Legalization of Marijuana in Colorado: The Impact." Volume Three of that report, which runs nearly 200 pages and was just release, can be accessed at this link.
Here is an excerpt from the report's executive summary highlighting its coverage:
Rocky Mountain High Intensity Drug Trafficking Area (RMHIDTA) is tracking the impact of marijuana legalization in the state of Colorado. This report will utilize, whenever possible, a comparison of three different eras in Colorado’s legalization history:
• 2006 – 2008: Early medical marijuana era
• 2009 – Present: Medical marijuana commercialization and expansion era
• 2013 – Present: Recreational marijuana era
Rocky Mountain HIDTA will collect and report comparative data in a variety of areas, including but not limited to:
• Impaired driving
• Youth marijuana use
• Adult marijuana use
• Emergency room admissions
• Marijuana-related exposure cases • Diversion of Colorado marijuana
This is the third annual report on the impact of legalized marijuana in Colorado. It is divided into eleven sections, each providing information on the impact of marijuana legalization. The sections are as follows:
Section 1 – Impaired Driving...
Section 2 – Youth Marijuana Use...
Section 3 – Adult Marijuana Use...
Section 4 – Emergency Room Marijuana and Hospital Marijuana-Related Admissions...
Section 5 – Marijuana-Related Exposure...
Section 6 – Treatment...
Section 7 – Diversion of Colorado Marijuana...
Section 8 – Diversion by Parcel...
Section 9 – THC Extraction Labs...
Section 10 – Related Data...
Section 11 – Related Material...
The nature and order of the sections in this big RMHIDTA "Impact" report help highlight that RMHIDTA is almost exclusively interested in emphasizing and lamenting any and all potential negative impacts from marijuana reform in Colorado and deemphasizing and mariginalizing any and all potential positive impacts.
This bias toward emphasizing the negative and ignoring positive impacts is most obvious in terms of the report's (almost non-existant) discussion of the economic development and tax revenues resulting from legalization. Jobs created by marijuana reform are not mentioned anywhere in the report, and a short discussion of tax revenues in the final sections of the report starts with this warning: "It will take years of data collection to complete an analysis of whether marijuana legalization is economically positive or an economic disaster."
Similarly, changes in overall crime rates are only briefly discussed in the final "related data" section of the report, probably because the news seems pretty positive: property crime rates seem to be going down since marijuana reform throughout Colorado while violent crimes rates seem flat. Of particular note, as this semi-official chart reveals, it appears Denver (which is sort-of ground-zero for marijuana reform relalities and likely impact) experienced a significant decrease in reported homicides, rapes and robbery in 2014 relative to 2013. I suspect that this RMHIDTA report would have made much of Colorado and/or Denver homicide rates if they had gone up, but instead this "impact" goes undiscussed.
Reporting biases notwithstanding, this is still an important report that assembles lots of data. And, perhaps in part because of its biases, this report now stands as the latest, greatest effort by the law enforcement community to make the case that marijuana reform in Colorado is a failed experiment. Any and all serious students of marijuana law and policy should take the time to review what this report says and how it is saying what it is saying.
September 15, 2015 in Criminal justice developments and reforms, Medical Marijuana Data and Research, Medical Marijuana State Laws and Reforms, Recreational Marijuana Data and Research, Recreational Marijuana State Laws and Reforms, Who decides | Permalink | Comments (0)
Tuesday, September 1, 2015
Latest survey data shows marijuana use up, while other drug and alcohol use down, on college campuses
This news release from the University of Michigan, which reports on new data from its Monitoring the Future study, provides some evidence to support the notion that marijuana reform movements and other social factor may be lead college students to use more marijuana while also using less other illicit and licit drugs. Here is some of the interesting new data via the press release:
Daily marijuana use among the nation's college students is on the rise, surpassing daily cigarette smoking for the first time in 2014. A series of national surveys of U.S. college students, as part of the University of Michigan's Monitoring the Future study, shows that marijuana use has been growing slowly on the nation's campuses since 2006.
Daily or near-daily marijuana use was reported by 5.9 percent of college students in 2014 — the highest rate since 1980, the first year that complete college data were available in the study. This rate of use is up from 3.5 percent in 2007. In other words, one in every 17 college students is smoking marijuana on a daily or near-daily basis, defined as use on 20 or more occasions in the prior 30 days....
In sum, quite a number of drugs have been fading in popularity on U.S. college campuses in recent years, and a similar pattern is found among youth who do not attend college. Two of the newer drugs, synthetic marijuana and salvia, have shown steep declines in use. Other drugs are showing more gradual declines, including narcotic drugs other than heroin, sedatives and tranquilizers — all used non-medically — as well as inhalants and hallucinogens....
While 63 percent of college students in 2014 said that they have had an alcoholic beverage at least once in the prior 30 days, that figure is down a bit from 67 percent in 2000 and down considerably from 82 percent in 1981. The proportion of the nation's college students saying they have been drunk in the past 30 days was 43 percent in 2014, down some from 48 percent in 2006.
Occasions of heavy or binge drinking — here defined as having five or more drinks in a row on at least one occasion in the prior two weeks — have consistently had a higher prevalence among college students than among their fellow high school classmates who are not in college.
Still, between 1980 and 2014, college students' rates of such drinking declined 9 percentage points from 44 percent to 35 percent, while their non-college peers declined 12 percentage points from 41 percent to 29 percent, and high school seniors' rates declined 22 percentage points from 41 percent to 19 percent....
Cigarette smoking continued to decline among the nation's college students in 2014, when 13 percent said they had smoked one or more cigarettes in the prior 30 days, down from 14 percent in 2013 and from the recent high of 31 percent in 1999—a decline of more than half. As for daily smoking, only 5 percent indicated smoking at that level, compared with 19 percent in 1999 — a drop of nearly three fourths in the number of college students smoking daily.
Thursday, August 20, 2015
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.”
The science journal Nature has this effective new feature article discussing the notable challenges in doing good science in the marijuana reform space. The lengthy article is headlined "The cannabis experiment: As marijuana use becomes more acceptable, researchers are scrambling to answer key questions about the drug." Here are excerpts:
In 2013, Beau Kilmer took on a pretty audacious head count. Citizens in the state of Washington had just voted to legalize marijuana for recreational use, and the state's liquor control board, which would regulate the nascent industry, was anxious to understand how many people were using the drug — and importantly, how much they were consuming.
The task was never going to be straightforward. Users of an illicit substance, particularly heavy users, often under-report the amounts they take. So Kilmer, co-director of the RAND Drug Policy Research Center in Santa Monica, California, led a team to develop a web-based survey that would ask people how often they had used cannabis in the past month and year. To help them gauge the amounts, the surveys included scaled pictures showing different quantities of weed. The survey, along with other data the team had collected, revealed a rift between perception and reality. Based on prior data, state officials had estimated use at about 85 tonnes per year; Kilmer's research suggested that it was actually double that, about 175 tonnes. The take-home message, says Kilmer, was “we're going to have to start collecting more data”.
Scientists around the world would echo that statement. Laws designed to legalize cannabis or lessen the penalties associated with it are taking effect around the world. They are sweeping the sale of the drug out of stairwells and shady alleys and into modern shopfronts under full view of the authorities. In 2013, Uruguay became the first nation to legalize marijuana trade. And several countries in Europe — Spain and Italy among them — have moved away from tough penalties for use and possession. Thirty-nine US states plus Washington DC have at least some provisions for medicinal use of the drug. Washington, Colorado, Alaska and Oregon have gone further, legalizing the drug for recreational consumption. A handful of other states including California and Massachusetts are expected to vote on similar recreational-use measures by the end of 2016.
But the rapid shift has caught researchers on the back foot. “Broadly speaking, there's about 100 times as many studies on tobacco or alcohol as there are on illegal substances,” says Christian Hopfer, a psychiatry researcher at the University of Colorado School of Medicine in Denver. “I don't think it's the priority it should be.”
Despite claims that range from its being a treatment for seizures to a cause of schizophrenia, the evidence for marijuana's effects on health and behaviour is limited and at times conflicting. Researchers struggle to answer even the most basic questions about cannabis use, its risks, its benefits and the effect that legalization will have.
The quick shifts in policies should provide a plethora of natural experiments, but the window will not be open for long. “There's an opportunity here. Some of the most informative research we can do is right at the moment the market changes,” says Robert MacCoun, a social psychologist and public-policy researcher at Stanford Law School in California who worked with Kilmer on the research done in Washington....
As cannabis use becomes legal, the data may become easier to collect. But the drug's use is still low compared with alcohol and tobacco, says Wayne Hall, an addiction researcher at the University of Queensland in Brisbane, Australia, so it is hard to draw firm conclusions. Marijuana may be the most popular illegal drug, he says — about 44% of US adults have used it at some point in their lives according to one source — but only about one in ten have used it in the past year. By contrast, around 70% drank alcohol in that time. “The number of people who use it with any regularity for a long time is pretty small. The longer-term consequences are really understudied,” says Hall.
A major question for researchers — and a complication in interpreting the evidence — is dosing. There are more than 85 cannabinoid chemicals in pot. The one of most interest to researchers — and users — is tetrahydrocannabinol (THC). Growers have been able to breed high concentrations of the chemical into strains of the plant meant for recreational and medicinal use. A potency- monitoring programme run by the University of Mississippi for the US National Institute on Drug Abuse (NIDA) found that THC levels have steadily increased in the United States11, from 2–3% in 1985–95 to 4.9% in 2010. The increase is even starker for imported cannabis seized by law-enforcement officials. For these drugs, potency has gone from less than 4% in the late 1980s and early 1990s to more than 12% in 2013.
But it is hard to determine the amounts of THC being consumed by the average customer. It is unclear, for example, whether users 'titrate' their doses, adjusting their intake according to the potency. Nicotine users are known to do this with cigarettes, but nicotine does not impair judgement in the same way that cannabis does. And the effects of THC are less immediate, especially for edible forms.
The escalating potency raises questions about previous research because users in older studies may have been consuming lower-potency cannabis, and the effects may be different. A study published earlier this year, for example, linked high-potency cannabis to a threefold-increased risk of psychosis versus non-use but found no association with lower-potency forms. And many researchers have complained that the pot approved for study in experiments funded by NIDA is a poor match for what is used recreationally or medicinally....
Although states are starting to ease restrictions on recreational use of marijuana, what got the ball rolling in changing public perceptions and the legal landscape for pot were the arguments for its medical use.
Colorado introduced its rules allowing medical marijuana more than a decade before it allowed recreational use. The amendment to the state's constitution listed eight conditions for which marijuana was approved: cancer, glaucoma, HIV/AIDS, cachexia (a progressive wasting syndrome), persistent muscle spasms, seizures, severe nausea and severe pain. But, says Larry Wolk, executive director and chief medical officer of the CDPHE, “those are dictated by the constitution and not necessarily by medical research”.
Although there is a huge amount of anecdotal evidence — and well-organized advocacy groups that campaign for easier access to medical marijuana — there is little conclusive scientific evidence for many of the claimed medical benefits. One of the reasons for this dearth of evidence is that money generally has been obtainable only for research on the negative effects of cannabis. That is beginning to change.
When Colorado first legalized the drug, its public-health department began collecting fees from patients who applied to purchase pot at medical dispensaries. By 2014, the state had amassed more than US$9 million, most of which was ploughed back into a medical marijuana research programme selected by the CDPHE. Among the projects funded by the Colorado millions, there are two investigating whether cannabinoids can help to mitigate seizures in childhood epilepsy. Similar research is being pursued in the United Kingdom and elsewhere in the United States....
One of the biggest questions is how legalization will change usage patterns. One place in which researchers are looking for answers is Europe, where cannabis regulation tends to be much lighter than it is in the United States (see 'Reefer madness'). In the United Kingdom, some police forces overlook cannabis use and small-scale growing operations. Spain allows private consumption, but still has restrictions on sales.
The most extreme and long-standing example is the Netherlands, which decriminalized the possession and sale of small quantities of cannabis in 1976. But although some streets of Amsterdam have been transformed into pungent tourism hotspots, the country as a whole has not changed its habits much.
Although hard data on cannabis use in Europe is patchy, the Netherlands does not have hugely more users than other nations. Data aggregated by the United Nations Office on Drugs and Crime put use in the Netherlands at about 7%. That is more than in Germany (5%) and Norway (5%), about the same as in the United Kingdom and less than in the United States (15%). Nor has the Netherlands seen a huge spike in use of harder drugs, dampening fears that marijuana serves as a gateway to more-dangerous substances such as heroin and cocaine. The message from the Netherlands, says Franz Trautmann, a drugs-policy researcher at the Trimbos Institute in Utrecht, the Netherlands, is that “a very liberal policy doesn't lead to a skyrocketing prevalence”. Rather, cannabis is endemic, he says. “We can't control this through prohibition. This is something which more and more is recognized.”
But the lesson from the Netherlands may be limited because the drug is still illegal, and growing and selling large quantities is still punishable by law. Colorado has gone further by legalizing not merely the drug's use, but the whole production chain, and that could have fundamentally different effects on the economics of pot. “Legalized production really raises the prospect of a dramatic drop in price,” says MacCoun. “It's conceivable marijuana prices could drop 75–80% in a fully legalized model.” (Although Uruguay legalized the drug in 2013, it reportedly has struggled to regulate production and to set up working dispensaries.)
The effects of a sharp drop in cost are unknown. Taxation may also have unintended consequences. If states tax by weight, users might look to higher-potency strains to save money. And once cannabis is a business, it gains a business lobby. Cannabis researchers already talk of being bombarded with e-mails from pro-cannabis groups if they make negative comments about the drug. “Marijuana research is like tobacco research in the '60s,” says Hopfer. “Any study about harms is challenged. It's really something.” Many fear that the big money now to be found in cannabis will drive attempts to obfuscate the risks. “If the commercial interests are too big, then the profit interest is prevailing above the health interest. This is what I'm afraid of,” says Trautmann.
Legalization provides an opportunity to answer some important questions. In a few years, Colorado, Washington and others will know (if only roughly) how legalization affects usage patterns, the number of car crashes and the number of people seeking help for drug dependency. The CDPHE-funded programmes will have added to the knowledge of beneficial effects. And continuing long-term studies of large groups of users will provide more evidence for statisticians who are attempting to disentangle correlation and causation on the negative impacts.
“When a jurisdiction changes its marijuana laws, that provides an opportunity for greater leverage on the questions of cause and effect,” says MacCoun. But, he adds, the signals will only really be clear if the laws result in a dramatic increase in use — something that is neither a given, nor necessarily desirable. “Obviously, we don't want marijuana use to rise just to allow us to answer our questions, but if it does, we'll be poring over all the data.”
Thursday, August 13, 2015
International Centre for Science in Drug Policy releases "State of the Evidence: Cannabis Use and Regulation"
I am very pleased to see that the International Centre for Science in Drug Policy (ICSDP), a group of scientists and academics who seek to "ensure that policy responses to the many problems posed by illicit drugs are informed by the best available scientific evidence," has released this effective and timely new report titled "State of the Evidence: Cannabis Use and Regulation." Here is the report's introduction:
The regulation of recreational cannabis markets has become an increasingly important policy issue in a number of jurisdictions. Colorado and Washington State made headlines in 2012 when they became the first jurisdictions in the world to legalize and regulate the adult use and sale of cannabis for non-medical purposes. In 2013, Uruguay became the first country to legalize and regulate recreational cannabis markets. Momentum towards regulation continued in the United States in 2014 with successful ballot initiatives in Alaska, Oregon, and the District of Columbia. Globally, the issue of cannabis regulation is front and center in a growing number of jurisdictions, including Canada, Jamaica, Italy, Spain, several Latin American countries, and a number of additional U.S. states, including California, set to vote on legalization initiatives in 2016.
Unsurprisingly, given the robust global conversation around the regulation of recreational cannabis markets, claims about the impacts of cannabis use and regulation are increasingly part of the public discourse. Unfortunately, though, these claims are often unsupported by the available scientific evidence. Another reoccurring problem in the public discourse is the selective inclusion of research studies based on their support for a predetermined narrative. The intentional exclusion of studies with contradictory findings does not allow for an objective review and analysis of all the evidence. This “cherry picking” of the evidence is a routine practice that distorts public understanding. By outlining the current state of all the scientific evidence on common cannabis claims, State of the Evidence: Cannabis Use and Regulation strives to ensure that evidence, rather than rhetoric, plays a central role in policymaking around this important issue.
The harms of misrepresenting the scientific evidence on cannabis should not be overlooked. Given that policy decisions are influenced by public opinion and media reports, public discourse needs to be well informed. By addressing knowledge gaps with scientific findings, the ICSDP hopes to dispel myths about cannabis use and regulation, and ensure that the scientific evidence on these topics is accurately represented. Only then can evidence-based policy decisions be made.
Readers of this report will notice three repeating themes emerge through the discussion of the scientific evidence on common cannabis claims.
First, many of the claims confuse correlation and causation. Although scientific evidence may find associations between two events, this does not indicate that one necessarily caused the other. Put simply, correlation does not equal causation. This is a commonly made mistake when interpreting scientific evidence in all fields, and is unsurprisingly a recurring source of confusion in the discourse on cannabis use and regulation.
Second, for several of these claims, the inability to control for a range of variables (“confounders”) means that in many cases, we cannot conclude that a particular outcome was caused by cannabis use or regulation. Unless scientists can remove all other possible explanations, the evidence cannot conclusively say that one specific explanation is true.
Third, many of the claims cannot be made conclusively as there is insufficient evidence to support them. Findings from a single study or a small sample cannot be generalized to entire populations. This is especially pronounced for claims related to cannabis regulation, as not enough time has passed since the regulation of recreational cannabis in Colorado, Washington State, and Uruguay to examine many of the impacts of these policy changes.
These three common pitfalls are important to take into account when reading media reports and advocacy materials that suggest scientists have conclusively made some finding related to cannabis use or regulation. In many cases, due to the reasons outlined above, this will actually result in a misrepresentation of the scientific evidence.
State of the Evidence: Cannabis Use and Regulation is comprised of two sections: Common Claims on Cannabis Use and Common Claims on Cannabis Regulation.
Common Claims on Cannabis Use presents evidence on frequently heard claims about cannabis use, including claims on the addictive potential of cannabis, cannabis as a “gateway” drug, the potency of cannabis, and the impact of cannabis use on the lungs, heart, and brain (in terms of IQ, cognitive functioning, and risk of schizophrenia).
Common Claims on Cannabis Regulation presents evidence on frequently heard claims about the impacts of cannabis regulation, including the impact of regulation on cannabis availability, impaired driving, the use of cannabis, drug crime, drug tourism, and “Big Marijuana.”
For each claim, the relevant available scientific evidence is presented and the strength of the scientific evidence in support of the claim is determined. Readers will notice that none of the claims are strongly supported by the scientific evidence, reinforcing the significant misrepresentation of evidence on cannabis use and regulation.
We hope that the evidence contained in this report meaningfully contributes to the global conversation around cannabis policy and helps policymakers, as well as general readers, separate scientific evidence from conjecture.
Friday, August 7, 2015
The title of this post is partially the headline of this local article and partially my spin on why I think the potential economic developments of a lawful marijuana marketplace could be of greatest long-term political and social importance. Here is how the interesting article gets started:
Washington County is a proudly conservative place. Voters here haven’t backed a Democrat for president since 1964, and same-sex marriage lost by a landslide in a referendum three years ago.
But when Chicago-based Green Thumb Industries pitched a proposal to put a medical-marijuana production plant here, the county’s five county commissioners — Republicans all — passed a resolution unanimously supporting the plan.
Residents of Hagerstown, the county seat, seem to be taking the news in stride. The consensus: yes to marijuana for relieving pain, no to recreational use. “I think it’s all right as long as it’s only for medical. I don’t want a lot of potheads,” said Leo Myers, 61, a security worker at the Mack Truck plant.
It isn’t just compassion for suffering patients that is driving the acceptance of medical marijuana in Washington County, although that is one factor. Here and in other rural counties from Western Maryland to the Eastern Shore, officials are looking at cannabis grower-processors as sources of jobs rather than purveyors of vice.
Unemployment in this county has eased since it soared into double digits during the recession. But at 6.1 percent, the rate remains higher than the statewide average of 5.6 percent. And many residents have to commute 90 minutes or more to jobs in or near the District. Decent-paying jobs closer to home are much in demand.
“Out in Western Maryland, we’ve been deprived and depressed a lot,” said Commissioner John Barr. That history has helped shape reaction to the possibilities created by Maryland’s legalization of marijuana for medical purposes. “We view it as an economic-development opportunity,” Barr said.
Green Thumb representatives who briefed the commissioners before last month’s vote said the facility would employ 30 to 50 employees in its first year and predicted that it would expand to 200 workers in a new 175,000-square-foot plant in two to four years. They predicted the venture would give a $4 million-to- $7 million boost to the local economy.
That is hardly an economic panacea, but it represents a significant lift for a county still reeling from 650 layoffs at a Citigroup mortgage-servicing center and the closing of Unilever’s Good Humor ice cream plant, with its 450 jobs, in recent years.
The board’s action illustrates how quickly attitudes are changing across Maryland about the medicinal use of cannabis — the industry’s preferred term and one that was written into state law this year. “There’s a lot of interest all over the state,” said Hannah Byron, executive director of Maryland’s Medical Cannabis Commission.
August 7, 2015 in Business laws and regulatory issues, Employment and labor law issues, Medical Marijuana Data and Research, Medical Marijuana State Laws and Reforms, Political perspective on reforms | Permalink | Comments (0)
Monday, August 3, 2015
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)
Wednesday, July 22, 2015
The 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.
Thursday, July 16, 2015
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
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.
A 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.
Wednesday, July 8, 2015
The 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.
The question in the title of this post is prompted by this notable new and lengthy Politico magazine piece headlined "The Senate's experiment with cannabis: Hardliners on Judiciary open up to research on medical pot." Here are excerpts:
Congress has resolutely opposed the state-level movements toward legalizing marijuana, keeping it a Schedule I controlled substance on par with heroin, LSD and peyote. But now some of the nation’s toughest law-and-order senators just might be opening the window to cannabis, at least a crack.
Sens. Chuck Grassley (R-Iowa), Orrin Hatch (R-Utah) and Dianne Feinstein (D-Calif.) have all begun speaking up about the need for more clinical research on the marijuana plant compound known as cannabidiol, or CBD. The three sit on the powerful Judiciary Committee, which has a key voice in setting the federal government’s firm stance on pot in all its different forms.
They sent a clear signal in a packed hearing room last week, when the senators took on the tricky issue of CBD, a compound derived from an illegal drug but which many scientists and public health officials believe could treat conditions including cancer, diabetes, chronic pain, and alcoholism. Some parents and doctors have already turned to CBD as an anti-seizure medicine for children who suffer from rare and extreme types of intractable epilepsy.
Grassley, the chairman of the powerful Judiciary panel, told the audience at a narcotics caucus meeting that it's not an “inconsistent position" to embrace the beneficial components of the pot plant even while rejecting pretty much everything else about the drug, adding that doctors prescribe morphine but don’t recommend their patients go out and smoke opium or heroin. Feinstein and Hatch also spoke about the potential benefits from CBD, and complained that current drug laws impede the parents of sick children from access to what appears to be a helpful medicine.
At the same time, the senators went through elaborate motions to explain they weren’t softening their stance against recreational pot. “I have deep concern that [pot] does more harm than anything else,” Feinstein said in an interview. “But in terms of the medical aspects of it, it’s a totally different picture. It’s like any other plant. I’m sure there are other plants that if you ate you’d hallucinate or something. But if you can get the beneficial parts out, get them researched, be able to standardize it, regulate it, you may have something very good.”
The lawmakers’ comments, coming on the heels of two recent Obama administration moves to expand medical-marijuana research, marked another pointed moment in the country’s shifting views on drug policy. What was once an absolute red line in the “Just Say No” era is now a more porous border. Twenty-three states and Washington D.C. have legalized medical marijuana; Alaska, Colorado, Oregon, Washington state and the District of Columbia have also legalized recreational use, despite the clash with federal drug laws.
Congress, so far, has made no moves at all to relax recreational marijuana laws, and in Washington D.C. – where it effectively holds veto powers over the local government’s affairs – it prohibited the city from spending money to implement its voter initiative on recreational use. As a result, the nation’s capital considers marijuana legal but doesn’t have any sales and taxation system....
Utah, Hatch noted, was “certainly no redoubt of hippie liberalism,” but in March 2014 became the first of 15 states to legalize use of the CBD oil. Now, he's pushing the Senate to pass a bipartisan bill that would remove CBD from the definition of marijuana under federal law, giving parents a green light to buy the medicine without the threat of DEA agents busting them.
One sticky issue on the cannabis front has been that its outlaw status makes it more difficult to carry out both government and privately funded research. While it’s technically legal to study the medical aspects of pot, researchers must go through a rigorous DEA and FDA approval process, and can only obtain their marijuana from the government’s sole authorized U.S. supplier, located at the University of Mississippi.
While Grassley rarely has praise for Team Obama, he applauded the Democratic administration for two moves it made in June on the medical-research front: the Department of Health and Human Services got rid of what it called a duplicative 16-year old paperwork review requirement for private researchers studying the drug; and separately, the Justice Department and HHS moved to study whether CBD should be classified on a less stringent level than the entire marijuana plant. “This is a significant breakthrough and I commend these agencies for agreeing to take this step,” Grassley said.
The feds are in part playing catch-up with the black market, where parents using the oil extracts for their children say they’ve spent as much as $2,500 for a month’s supply. Feinstein said she hears complaints from constituents in California and around the country that they have bought CBD without labels, factory seals or clear dosage amounts. “This is an untenable situation. It is not how medicine should work,” Feinstein said. Her goal, she said, was "to get this process expanded, and get it legitimized and get it regulated. And I think those are the things we have to do and do as quickly as we can.”...
Despite their interest, Feinstein and her colleagues were circumspect still about how far Congress will go this session. The House in June included several pot-related amendments to a spending bill funding the Commerce, Justice and State departments; one measure adopted on a 297-130 vote allows states that have legalized cannabidiol to do it without federal interference; another prohibits the federal government from blocking states from implementing their own medical marijuana laws. (President Barack Obama signed a similar provision into law in last year's "CRominbus" spending bill, but the language lapses at the end of the fiscal year.) The House also narrowly rejected an amendment – on a 206-222 vote – that would have told the feds to butt out in the implementation of any state marijuana laws, either recreational or medical.
In the Senate, Cory Booker (D-N.J.), Kirsten Gillibrand (D-N.Y.) and Rand Paul (R-Ky.) are leading an effort for a broader medical marijuana bill that would help make the drug available for a range of conditions, including cancer, glaucoma and for children via the CBD extract. Their legislation would block the federal government from halting state medical marijuana laws; permit doctors at the Department of Veterans Affairs to prescribe the drug to military veterans; allow banks to do business with medical marijuana dispensaries and let states import the CBD oils for treatments. The senators also want to change how marijuana is classified under the Controlled Substances Act – moving it from the most restrictive Schedule 1 category that limits its use for research and defines it as having no accepted medical benefits into the Schedule 2 category that comes with fewer requirements before it can be studied.
In an interview, Gillibrand said it was a "huge deal" to have Grassley, Hatch and Feinstein supportive of expanding cannabis research. “I think it’s the first step toward a fuller conversation on how important medical marijuana is to so many patients across the country," she said.
But Gillibrand still has work in front of her if she wans to pick up their support for many of the specifics in her bill. Grassley, who has been a high-profile partner with Gillibrand on legislation tackling sexual assault crimes in the military and on college campuses, said he wasn't ready to ally with the Democrat yet on medical marijuana legislation.... And when asked if she backed the push to reclassify marijuana as a Schedule 2 controlled substance, Feinstein – who represents a state that legalized medical marijuana nearly 20 years ago – replied: “I’m not there yet.”
Personally, I have a "deep concern" that Senator Feinstein may do "more harm than anything else" if she is still clinging to a refeer madness view of marijuana as the most hamful of all drugs. But, especially if Senator Feinstein still does have a unsupportable view as to the harms of marijauana, the fact that even she is now talking up the importance of some medical marijuana reform perhaps is a great sign for the overall reform movement.
Sunday, July 5, 2015
This recent lengthy article about marijuana research struck me as especially worth highlighting as we close out a weekend of patriotic celebrations. The piece is headlined "PTSD And Cannabis -- Can Researchers Cut Through The Politics To Find Out Whether Weed Works?" and here are excerpts:
After steadily accumulating anecdotes about how veterans use cannabis to treat their war wounds that understanding might finally be on the way. Following years of bureaucratic hurdles, the first Food and Drug Administration (FDA)-approved, randomized controlled trial on cannabis and PTSD is set to begin this summer. Many believe the study will spur increased acceptance of veterans using marijuana, a political shift that’s already led more and more states to add PTSD to their lists of conditions that qualify for medical marijuana.
But that key study still faces roadblocks, the latest being a VA hospital’s refusal to let one of the trial’s researchers recruit patients at its facility. It’s just one more example of the political and scientific obstacles that remain before cannabis is embraced as a viable option for soldiers. While the idea of veterans becoming medical marijuana patients has proven to be a powerful political leveraging tool, the concept gives some people pause. Amid reports of skyrocketing substance abuse among veterans, overworked VA doctors and increasingly potent marijuana offerings, some worry that exposing the nation’s wounded warriors to cannabis might in some instances do more harm than good -- and in extreme cases, lead to even more violence and tragedy.
More than for any other potential medical use for marijuana, the clock is ticking to nail down the science behind cannabis and PTSD. According to a 2014 report by the RAND Corporation’s Center for Military Health Policy Research, approximately 300,000 of the 1.64 million service members who deployed to Iraq or Afghanistan as of October 2007 were suffering from PTSD or major depression. Only about half of that number had sought treatment in the previous year, and of those who did, just over half received a "minimally adequate treatment." And with hundreds, if not thousands, of these struggling veterans killing themselves each year, advocates argue that if marijuana can help reduce the death toll there’s not a minute to lose....
But while veterans helped jumpstart recognition of cannabis’ potential medical benefits, many of them have limited access to medical marijuana themselves. Because cannabis is still illegal under federal law, federal employees such as VA doctors can’t recommend the substance as treatment....
In some cases, veterans say their VA physicians wouldn’t just avoid talking about medical marijuana, but actively penalized them for using it. Jack Stiegelman, founder of the Florida-based organization Vets For Cannabis, says a 2004 deployment in Afghanistan left him with a serious back injury for which he was prescribed daunting amounts of morphine and muscle relaxants. There was also the PTSD that led him to wake up screaming in the middle of the night, threatening his squad leader with physical violence. “I said I was going to put my foot through his teeth,” says Stiegelman. “I felt it was their fault for not taking care of me.”...
VA spokeswoman Ndidi Mojay notes that federal law prohibits VA physicians from prescribing medical marijuana and from completing forms and paperwork necessary for patients to enroll in state marijuana programs. However, “VA does not administratively prohibit VA services to those veterans who participate in state marijuana programs," she says. "In some cases, participation in state marijuana programs may be inconsistent with treatment goals and therefore VA clinicians may modify treatment plans for the health of the patient.”
A major stumbling block is that there’s still little scientific research related to marijuana’s medical benefits, particularly when it comes to one of the signature injuries of modern veterans: PTSD. Arguments for using cannabis to treat PTSD got a boost last year when New Mexico psychiatrist George Greer published in the Journal of Psychoactive Drugs the results of a chart review of 80 veterans he worked with who had PTSD and used marijuana. He found that on average, patients using cannabis reported a 75 percent reduction in several of the main symptoms of PTSD, including hyperarousal and re-experiencing traumatic episodes. “This is a watershed,” says Greer. “You think of people being stoned on marijuana, you don’t think of them being more functional. It has to be a historical thing for marijuana to be found at least in anecdotal reports to be helpful for people for psychiatric conditions.”
But like all existing research on cannabis and PTSD, Greer’s study was based on anecdotal evidence, not the gold standard of scientific research: a randomized clinical trial. “We are at the point where self-report data is overwhelming and generally positive regarding medical marijuana and PTSD,” says Mitch Earleywine, a professor at SUNY Albany and chair of the National Organization for the Reform of Marijuana Laws (NORML)’s board of directors. “Unfortunately, there has never been a randomized clinical trial or anything like that.”...
Political momentum for linking PTSD and medical marijuana is growing. Of the 23 states that now allow for medical marijuana, nine include PTSD as a qualifying condition for the drug, and in three others doctors have broad discretion to recommend medical cannabis for PTSD or other ailments. In 2010, the VA published a directive stating veterans shouldn’t be punished for using medical marijuana in those states that allow it, but reiterated that its doctors can’t help veterans obtain the treatment. Now, even that restriction could be lifted. In May, a Senate committee passed a bipartisan amendment to a military spending bill that would allow VA doctors to recommend and fill out paperwork for medical marijuana in states where it’s legal; the final bill will be negotiated later this year.
But in many jurisdictions, PTSD and marijuana remains a political sticking point. In Colorado, which has some of the most liberal cannabis laws in the world, PTSD still doesn’t count as a qualifying condition for obtaining medical marijuana. And while PTSD is the No. 1 reason for which people obtain medical marijuana cards in New Mexico, there have been multiple initiatives to remove it from the state’s list of qualifying conditions.
Part of the problem is that PTSD is unique among medical marijuana conditions, since it is a psychiatric disorder, not a physical ailment. “One of the issues with PTSD with medical marijuana is it is the first mental condition to be considered,” says John Evans, founder of the organization Vets 4 Freedoms. He helped add PTSD to Michigan’s list of medical marijuana-approved conditions in 2014 and petitioned to add the condition to Colorado’s list earlier this year. The Colorado Board of Health will hold a hearing on the issue on July 15. “It bothers a lot of people in the psychiatric community and the prescription-drug world,” says Evans.
“It’s a catch-22,” says Dan Riffle, director of federal policies for the Marijuana Policy Project. “People want to have hard data on how medical marijuana works for PTSD. But you can’t say that and then actively block the research. And that’s what’s happening on a federal level.”
Monday, June 29, 2015
Senator Orrin Hatch has this notable new op-ed piece in the Washington Times headlined "The curative side of cannabis: A medical extract offers relief for epileptic children." Here are excerpts:
[Imagine] you hear about a new therapy that has shown remarkable success in treating children just like yours — children with intractable epilepsy. But there’s a problem: The therapy is made from a strain of the cannabis plant. The therapy doesn’t produce any sort of “high.” In fact, it’s made from a strain of cannabis that’s so low in THC — the active ingredient in marijuana — that it has no psychotropic effect even when ingested in large quantities. But because the therapy comes from the cannabis plant, it’s classified as marijuana under federal law and is therefore illegal.
As a devoted, loving parent, you’re faced with an impossible dilemma. Do you break the law to obtain a therapy that could cure or at the very least substantially reduce your child’s devastating seizures? Or do you allow your child to continue to suffer? Remember, the therapy produces no high, and it carries none of the dangerous side effects of traditional marijuana. It simply comes from the same source.
This hypothetical scenario is a reality for tens of thousands of parents. The therapy is called cannabidiol oil, or CBD for short. It’s administered by placing a small amount under the tongue, and has been shown to reduce seizures by more than 90 percent in children with intractable epilepsy. It is not addictive.
But because it’s made from the cannabis plant, CBD is illegal under federal law. To solve this problem, I’ve recently sponsored bipartisan legislation with Sens. Cory Gardner, Colorado Republican, Ron Wyden, Oregon Democrat, and others to exempt CBD from the definition of “marijuana” under federal law.
Our bill, S. 1333, will allow parents to obtain a life-changing therapy for their children without threat of federal prosecution. It’s colloquially known as the Charlotte’s Web Act, after Charlotte Figi, an eight-year-old girl who has seen extraordinary improvements from taking CBD. Prior to beginning treatment with CBD, Charlotte suffered as many as 300 grand mal seizures per week — seizures so violent that her parents put a do not resuscitate order in her medical records. After Charlotte started taking CBD, however, her seizures dropped dramatically. She now suffers, on average, less than three seizures per month and is able to engage in normal childhood activities. “Dateline NBC” and National Geographic recently highlighted the medical benefits of CBD for children with severe epilepsy.
CBD is not medical marijuana. It cannot be used to get high. Its only use is for epilepsy and other medical conditions. Nor is it a camel’s nose in the tent for advocates of full marijuana legalization. Fifteen states have now legalized CBD. These include some of the most rock-ribbed conservative states in the country, such as Alabama, South Carolina and Texas. In fact, my home state of Utah — certainly no redoubt of hippie liberalism — was the very first state to legalize CBD.
Throughout my entire Senate career, I’ve taken a strong stand against illegal drugs. The proliferation of cocaine, meth and other addictive, mind-altering substances has had a devastating effect on homes and communities. CBD is not like any of those substances. It is not addictive. To the contrary, it has shown promise in treating addiction. Rather than harming families, it can help make their lives better.
I continue to oppose marijuana and efforts to legalize its use. I remain unconvinced by claims that it is safe and that the side effects it causes are no big deal. Stories of children being rushed to the hospital for accidentally consuming marijuana edibles belie the notion that marijuana is a safe drug. In fact, I am currently working on legislation to help protect children from the dangers of edible marijuana products.
But I also believe that when a drug is safe and can improve people’s lives, Congress should not stand in the way. That CBD is derived from the cannabis plant does not mean we should be scared to have anything to do with it. Legalizing CBD is a compassionate, common-sense move that will bring relief to thousands of suffering children. I am glad to stand with my colleagues in supporting the Charlotte’s Web Act and look forward to helping it move through Congress and to the president’s desk.
Thursday, June 25, 2015
Members of the Senate are attempting to finish off where the White House started earlier this week, by calling for the removal of additional barriers still in place that they believe are limiting scientific study on the effects of marijuana.
At a hearing of the Senate Caucus on International Narcotics Control Wednesday, members challenged representatives from the Drug Enforcement Agency, Federal Drug Administration and the National Institute on Drug Abuse on the current process for approving marijuana studies. "I understand the desire for caution. We're Congress, we act slowly. But these are people who need the help, for who a five- to 10-month delay is a death sentence," said Sen. Orin Hatch, R-Utah.
The hearing specifically looked at the effects of cannabidiol, a derivative of marijuana, on patients. Many members and witnesses spoke of anecdotal evidence that the drug helped children with chronic epilepsy when nothing else would. However, large-scale studies on the link have been rare, largely in part of heavily controlled federal government approval of marijuana research.
The hearing came on the heels of White House action earlier this week that removed a key government hurdle blocking many scientific marijuana studies from moving forward. The White House action means scientists will no longer have to submit research proposals to the Public Health Service Review (PHS) at the Department of Health and Human Services to get a green light for marijuana research.
But while the move, which was announced Monday, signals a shift in federal policy, many caution that there remain significant barriers to studying the drug’s positive medical effects on humans. Marijuana advocates point out that the PHS was only one of three major hurdles limiting research. The other two -- the fact that researchers can only use marijuana from a single government-owned dispensary at the University of Mississippi and classifying marijuana as a Schedule I drug -- endure.
Senators Kirsten Gillibrand, D-NY, and Corey Booker, D-NJ, are two key members of Congress who are fighting for more studies on the effects of the drug. Earlier this year they introduced a bill, along with Sen. Rand Paul, R-KY, that in addition to getting rid of the now-defunct PHS review, would downgrade marijuana from a Schedule I drug, up there with heroin, to a Schedule II, in the line with opiates.
Both senators were guests at the caucus hearing and took no time to challenge witnesses from the various government agencies present. A fiery Gillibrand challenged NIDA and the National Institute for Health's strict control of cannabidiol. NIDA representatives said one drug company had a patent on cannabidiol. Many fear this control over the drug will limit future research options. Gillibrand shot back saying, "Let's be clear, we have to change the laws to remove the impediments so that we have research across the country."
Whether it be cannibidiol or marijuana in general, supporters say much still needs to be done to study the drug and get it available on markets where medical marijuana is legal. “Arguably the largest hurdle in this process still remains in place,” Paul Armentano, deputy director at the National Organization for the Reform of Marijuana Laws said. “That is that government policy … mandates that all clinical protocols must utilize government grown cannabis provided by NIDA.”...
While attitudes may be changing, led by President Obama himself, and including DEA efforts to expand the availability of marijuana for studies, progress remains slow. As a result, many members of Congress are getting in on efforts to streamline the regulatory process in hopes that it may make the drug available to those who need it.
Just last May, Reps. Earl Blumenauer, D-Ore., Morgan Griffith, R-Va., Jane Schakowsky, D-Ill., and Dana Rohrabacher, R-Calif., wrote a letter to the Secretary of HHS asking her to remove the PHS barrier. In a statement Monday, Blumenauer called the White House’s decision “a significant step toward improving an antiquated system that unfairly targets marijuana above and beyond other substances in research.” He said, however, there still remains a lot to be done and said he’s working on legislation to address the remaining blockades.
While more and more lawmakers’ acceptance of marijuana’s role in medicine might be a welcome surprise, some marijuana supporters are skeptical that additional marijuana studies will significantly change federal policy. “Ample scientific research already exists to contradict cannabis’ federal Schedule I status -- as a substance without medical utility, lacking acceptable safety, and possessing a high potential of abuse,” Armentano said. “More research is welcome, but unfortunately science has never driven marijuana policy. If it did, we would already have a very different policy in place.”
Tuesday, June 23, 2015
As explained in this helpful new Washington Post piece, a "long-standing bureaucratic obstacle to privately-funded medical marijuana research has just been removed, effective immediately." Here are the details
Until today if you wanted to conduct marijuana research, you'd need to do the following:
- Submit your study proposal to the Food and Drug Administration for a thorough review of its "scientific validity and ethical soundness."
- Submit your proposal to a separate Public Health Service (PHS) board, which performs pretty much the exact same review as the FDA.
- Get a marijuana permit from the Drug Enforcement Administration.
- Finally, obtain a quantity of medical marijuana via the Drug Supply Program run by the National Institute on Drug Abuse (NIDA), which maintains a monopoly on medical marijuana grown for research in the U.S.
As you might imagine, this can be a complicated, time-consuming process. Step 2, the PHS review, has been a subject of particular consternation among researchers and advocates. That step is not required for research into any other drug, including cocaine and heroin.
The PHS review is nearly identical to the one performed by the FDA. Sometimes, it can take months to complete. In recent years, advocates of overhauling marijuana laws, researchers, members of Congress, and even marijuana legalization opponents have called for the PHS review to be eliminated in the name of streamlining research.
This week, the Department of Health and Human Services agreed, determining that the PHS review process is redundant with the FDA review, and that it is "no longer necessary to support the conduct of scientifically-sound studies into the potential therapeutic uses of marijuana."
"The president has often said that drug policy should be dictated by unimpeded science instead of ideology, and it’s great to see the Obama administration finally starting to take some real action to back that up," said Tom Angell of the Marijuana Majority, a pro-legalization group.
Even those who oppose legalization agreed. "I think it's a sensible change; but people are being delusional if they think this will result in a flood of research on the drug," said Kevin Sabet of Smart Approaches to Marijuana, an anti-legalization group. "But it's a step in the right direction as the development of a non smoked cannabis medication goes forward."...
There are still more bureaucratic hurdles to marijuana research than to research in any other drug. NIDA's monopoly on legal marijuana production doesn't exist for any other drug, meaning that heroin and cocaine remain easier for researchers to work with. "The next step should be moving marijuana out of Schedule I to a more appropriate category, which the administration can do without any further Congressional action," said Angell. "Given what the president and surgeon general have already said publicly about marijuana’s relative harms and medical uses, it’s completely inappropriate for it to remain in a schedule that’s supposed to be reserved for substances with a high potential for abuse and no therapeutic value."
June 23, 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)