Marijuana Law, Policy & Reform

Editor: Douglas A. Berman
Moritz College of Law

Tuesday, February 13, 2018

"How will cannabis legalization affect alcohol consumption?"

UntitledThe question in the title of this post is the headline of this notable new commentary authored by Beau Kilmer and Rosanna Smart.  Like many thoughtful commentaries in this arena, the authored highlight that a seemingly simple question does not have a simple answer.  Here are excerpts:

How will legalization affect alcohol consumption?  Will drinking go down because people substitute cannabis for alcohol, or will drinking go up because cannabis and alcohol complement each other?  These questions have important implications for the health consequences of legalization, and for tax revenues.  Unfortunately, we don’t have the answers, yet.

A 2015 RAND Corporation study about cannabis legalization for the state of Vermont concluded that the evidence was mixed about whether cannabis and alcohol were substitutes or complemented each other.  A 2016 University of Washington literature review about changing cannabis polices and alcohol use concluded the relationship was complex.

Much research has relied on evidence of how laws that increase access to medical cannabis affect alcohol use.  The findings are mixed, possibly because the studies examine different age groups, measures of alcohol consumption and time periods.  The alcohol-cannabis relationship may differ across population subgroups — teens may treat these substances differently than adults. Also, some studies consider only effects on whether people drink, but not effects on how often or how much they drink.

Different studies also examine different time periods, and the laws have been changing over time.  Early state laws (such as the medical cannabis legislation California passed in 1996) tend to allow broader qualifying patient conditions, legal home cultivation and less oversight of dispensaries.  Differences in policies may lead to different effects on cannabis use, and possibly alcohol use. And the laws’ impact may evolve over time as the market expands or as federal enforcement shifts.

A recent working paper out of the University of Connecticut and Georgia State University has received a fair bit of attention as the latest in this series of attempts to shed light on the issue of whether alcohol and cannabis are substitutes or complements based on evidence from medical cannabis laws.  The authors examined changes in alcohol sales at grocery and convenience stores and other outlets.  They found that cannabis and alcohol are strong substitutes, with medical cannabis implementation being associated with a 15 percent reduction in monthly alcohol sales.

That is a surprisingly large effect, equivalent to what we would predict if the price of alcohol increased on the order of 30 percent.  The effect seems especially large considering that during the study period of 2006 to 2015, the newer state medical cannabis programs that drive the main result were more restrictive and had low participation rates, typically involving less than 1 percent of the population.  Of course, these medical laws could have effects that reach beyond the registered patient population if they made it easier and cheaper for non-patients to access cannabis, or if the laws caused the public to change its attitudes about cannabis and alcohol use more broadly.  Much more needs to be learned about what’s driving the results in this working paper.

Even if a consensus developed about the effect of medical cannabis laws on alcohol use, it would be unwise to simply assume that the same relationship applies to legalizing cannabis sales and advertising for recreational purposes....

These questions about legalization and alcohol consumption will not be resolved anytime soon.  In the meantime, California’s policymakers are making decisions about whether to license stores and lounges, and if so, where and how many.  They would be wise to build flexibility into their regulatory systems and not lock into decisions they may regret as they gain more information.

February 13, 2018 in History of Alcohol Prohibition and Temperance Movements, History of Marijuana Laws in the United States, Medical Marijuana Data and Research, Recreational Marijuana Data and Research | Permalink | Comments (1)

Monday, February 5, 2018

Still more research "suggesting broader access to medical marijuana facilitates substitution of marijuana for powerful and addictive opioids"

S01676296The March 2018 issue of the Journal of Health Economics includes this new research article that provides still further support for a claim that greater access to marijuana may be able to play a role in reducing use and abuse of opioids.  The new article is authored by David Powell, Rosalie Liccardo Pacula and Mireille Jacobson under the title "Do medical marijuana laws reduce addictions and deaths related to pain killers?".  Here is its abstract:

Recent work finds that medical marijuana laws reduce the daily doses filled for opioid analgesics among Medicare Part-D and Medicaid enrollees, as well as population-wide opioid overdose deaths.  We replicate the result for opioid overdose deaths and explore the potential mechanism.  The key feature of a medical marijuana law that facilitates a reduction in overdose death rates is a relatively liberal allowance for dispensaries.  As states have become more stringent in their regulation of dispensaries, the protective value generally has fallen.  These findings suggest that broader access to medical marijuana facilitates substitution of marijuana for powerful and addictive opioids.

Some (of many) prior related posts:

February 5, 2018 in Medical community perspectives, Medical Marijuana Data and Research | Permalink | Comments (0)

Thursday, January 18, 2018

New Maryland report details basis for marijuana measures to "remediate discrimination affecting minority- and women-owned businesses"

Maryland-Medical-Marijuana_thumbnailAs reported in this local article, headlined "State consultant finds grounds to consider race in awarding medical marijuana licenses," a notable report focused on the Maryland business arena was released yesterday. Here are the basics and context:

A state consultant has determined that there are grounds to conclude that minorities are at a disadvantage in Maryland's fledgling medical marijuana industry.

The state’s medical marijuana commission has awarded 15 licenses to growers, but none of them to a minority-owned business.  The General Assembly is considering a bill that would create five new licenses and require the commission to consider the race of applicants.

The consultant’s finding, released by Gov. Larry Hogan’s office Wednesday, is a key legal step toward allowing officials to weigh race when awarding any new licenses. Hogan ordered the study in April.  “Today’s findings are clear and unequivocal evidence that there is a disparity in the medical cannabis industry,” said Shareese Churchill, a spokeswoman for the Republican governor.  “This study is an important part of the process to allow for increased minority participation in our state.”

Del. Cheryl D. Glenn, the chairwoman of the Legislative Black Caucus and a leading advocate for more minority participation in the state’s new marijuana industry, said the finding will help whatever legislation the General Assembly passes withstand a court challenge.  “I’m ecstatic Maryland can move forward and be a beacon of light and show it is a serious issue, that everyone should be concerned about having diversity in a multibillion-dollar industry,” the Baltimore Democrat said....

Such disparity studies are commonly used in government contracting to provide a justification for considering the race or gender of bidders for jobs.  Civil rights advocates found the commission’s failure to award any licenses to black-owned businesses especially galling because African-Americans have disproportionately faced consequences from marijuana being criminalized.

The full consultant report is available at this link, and here are key passages from its conclusion:

After reviewing and analyzing the information received from the State, and bearing in mind the 2017 Disparity Study’s finding that discrimination continues to adversely impact minority-owned and women-owned firms throughout the Maryland economy, I conclude, based upon the information available to me at this time, that the 2017 Disparity Study provides a strong basis in evidence, consisting of both quantitative and qualitative findings, that supports the use of race- and gender-based measures to remediate discrimination affecting minority- and women-owned businesses in the types of industries relevant to the medical cannabis business.

Moreover, the 2017 Disparity Study details a range of race- and gender-neutral activities that the State has already undertaken to address existing disparities. The 2017 Disparity Study found that, notwithstanding these race- and gender-neutral activities, many of which have been in place for a number of years, disparities continue to exist in both public and private contracting in the same geographic and industry markets in which medical cannabis licensees and independent testing laboratories are likely to operate. These disparities, in general, are large, adverse, and statistically significant. In addition, the 2017 Disparity Study contains both qualitative and quantitative evidence to suggest that economy-wide contracting disparities in Maryland’s relevant markets are even greater than disparities in the public sector. This difference may be due to the fact that the State has, for a number of years, operated an assertive MBE program in an attempt to remedy discrimination, which would tend to reduce, though it has not yet eliminated, the effects of discrimination in public procurement. Absent such affirmative remedial efforts by the State, I would expect to see evidence in the relevant markets in which the medical cannabis licensees will operate that is consistent with the continued presence of business discrimination.

January 18, 2018 in Medical Marijuana Data and Research, Medical Marijuana State Laws and Reforms, Race, Gender and Class Issues, Who decides | Permalink | Comments (0)

Friday, December 29, 2017

"Medical marijuana laws and adolescent use of marijuana and other substances: Alcohol, cigarettes, prescription drugs, and other illicit drugs"

Cov200hThe title of this post is the title of this new research to appear in print in the February 2018 issue of the journal Drug and Alcohol Dependence.  Here is its abstract:

Background

Historical shifts have taken place in the last twenty years in marijuana policy.  The impact of medical marijuana laws (MML) on use of substances other than marijuana is not well understood. We examined the relationship between state MML and use of marijuana, cigarettes, illicit drugs, nonmedical use of prescription opioids, amphetamines, and tranquilizers, as well as binge drinking.

Methods

Pre-post MML difference-in-difference analyses were performed on a nationally representative sample of adolescents in 48 contiguous U.S. states.  Participants were 1,179,372 U.S. 8th, 10th, and 12th graders in the national Monitoring the Future annual surveys conducted in 1991–2015.  Measurements were any self-reported past-30-day use of marijuana, cigarettes, non-medical use of opioids, amphetamines and tranquilizers, other illicit substances, and any past-two-week binge drinking (5+ drinks per occasion).

Results

Among 8th graders, the prevalence of marijuana, binge drinking, cigarette use, non-medical use of opioids, amphetamines and tranquilizers, and any non-marijuana illicit drug use decreased after MML enactment (0.2–2.4% decrease; p-values: <0.0001–0.0293).  Among 10th graders, the prevalence of substance use did not change after MML enactment (p-values: 0.177–0.938).  Among 12th graders, non-medical prescription opioid and cigarette use increased after MML enactment (0.9–2.7% increase; p-values: <0.0001–0.0026).

Conclusions

MML enactment is associated with decreases in marijuana and other drugs in early adolescence in those states.  Mechanisms that explain the increase in non-medical prescription opioid and cigarette use among 12th graders following MML enactment deserve further study. 

December 29, 2017 in Medical Marijuana Data and Research, Medical Marijuana State Laws and Reforms | Permalink | Comments (0)

Wednesday, December 27, 2017

Some new particulars on what West Virginia physicians think about medical marijuana

In this post last week, I noted the notable data from a survey of West Virginia physicians. The state's Department of Health and Human Resources found that, of "1,455 physicians who took the online survey, 82 percent of them indicated their interest in medical marijuana." Now I see this new local article, headlined "WV State Medical Association drills down on medical marijuana survey," reporting on a smaller survey conducted by the West Virginia State Medical Association. Here are a few details:

Medical Association President Dr. Brad Henry tells MetroNews the organization’s survey of its members show results not nearly as high as the state online survey that showed 82 percent of state doctors “interested” in medical marijuana.

In the WVSMA survey, in which approximately 75 doctors participated, only 31 percent said they were interested in becoming a certified physician for the state’s new medical marijuana law set to take effect in 2019. Henry said the issue continues to be the lack of research associated with the medicinal use of the drug. “Every time I read anything, anything that comes out, there’s some promise but there’s still aren’t good scientific studies to support marijuana use for anything,” Henry said. “There still isn’t that level of scientific information to at least give me confidence in the utility of it as a medicine.”

One thing the doctors are struggling with is the provision in the law that would have a doctor certify someone that has a diagnosis but there’s much else they can tell them because of the lack of research on the drug, Henry said. “You can’t look up (medical marijuana) in a textbook and say, ‘Okay, this is how much you should use. This is the side effects you should expect.’ Even over-the-counter (drugs) you can find what the usual dosages are and what the usual side effects are but with this substance (medical marijuana) that’s just not available,” Henry said....

Four of the questions in the medical association’s survey:

– Do you think there is scientific evidence to support marijuana use as a medical treatment?  Yes 65 percent

– Do you believe the legal access to medical marijuana will help patients?  Yes 64 percent

– Are you interested in becoming a certified physician?  Yes 31 percent

– Are you willing to receive the training required for the certification?  Yes 34 percent

December 27, 2017 in Medical community perspectives, Medical Marijuana Commentary and Debate, Medical Marijuana Data and Research, Who decides | Permalink | Comments (0)

Wednesday, December 20, 2017

Interesting review of big market growth in a small medical marijuana state

Rhode-island-medical-marijuanaAs hinted by this recent post, which asks "Are there 1.9 millions or 2.35 million or some other big number of medical marijuana patients?," I fear that states and the nation as a whole are doing insufficient data collection and analysis of medical marijuana regimes.  This view is indirectly enhanced by this recent article from Rhode Island, headlined "Medical marijuana cultivators, patients on rise in R.I.," reporting on some interesting data concerning its medical marijuana program. Here are excerpts:

More than 8,430 pounds of marijuana have been produced and sold through the state’s medical marijuana dispensaries and cultivators this year, translating into some $27 million in retail sales.  Nearly one-quarter of that marijuana was grown by the state’s new cultivators — licensed businesses only allowed to sell the drug to the state’s three dispensaries.  To date, 18 such businesses have been approved to operate in the the state, according to data from the state Department of Business Regulation.

Dozens more are waiting in the wings for their chance to get into the burgeoning industry. Forty applicants have passed the first stage of the process but are still awaiting a license, and another 53 applicants are behind them in the pipeline. The state has collected nearly $1 million in licensing and application fees from these new marijuana-growing businesses.

“It seems a large number of cultivators.  That’s always been my concern ... we’re setting up these cultivators for failure,” Rep. Scott Slater, D-Providence, said at a meeting of the state’s medical marijuana oversight commission Tuesday....  Greenleaf Compassionate Care Center in Portsmouth and Summit Medical Compassion Center in Warwick together have purchased roughly half of the medical marijuana sold this year from cultivators. The state’s largest dispensary, the Thomas C. Slater Center in Providence, has not purchased any marijuana from cultivators.

Norman Birenbaum, the state’s top medical marijuana regulator, said the state hopes that for safety and quality-control reasons eventually more patients will shift from growing marijuana in their homes to buying it from dispensaries.   There are currently more than 61,500 marijuana plants being grown in the state by medical marijuana patients and caregivers.

Meanwhile, the state now has 19,161 medical marijuana patients, a 17-percent increase from one year ago.  The number of patients in the program typically grows between 20 percent and 30 percent each year. Roughly 65 percent of patients qualify with severe, debilitating or chronic pain.

But Birenbaum agreed that many cultivators will potentially fail.  The state chose not to cap the number of cultivators, in part because doing so would require a competitive evaluation process for applications that almost inevitably would end up in court and could have resulted in shortages in the supply of medical marijuana.

Dr. Todd Handel, a physician who sits on the oversight panel, questioned what the state is doing to control the profit margins of the state’s dispensaries, which are state-registered nonprofits.  Birenbaum cautioned against making generalizations about the dispensaries’ profits.  He noted that the dispensaries cannot take many normal business deductions on their taxes because the federal government still considers selling marijuana to be illegal.  He also noted the significant costs of growing marijuana.

The average wholesale price of medical marijuana produced by the licensed cultivators is $4.16 a gram, according to state data.  An average retail price was not available because some marijuana flower is turned into other products such as edibles and oils that are not sold in a form measurable by grams.  Still, it’s clear there is a markup. On Tuesday, Greenleaf was offering three strains grown by cultivators for $15 a gram.

As this article reveals, Rhode Island has a lot of cultivators/growers but only three dispensary/sellers servicing its medical marijuana program.  That is distinct from some other states that have limited both growers and sellers and others that have no limits on growers or sellers. In addition, Rhode Island's medical marijuana regime allows for home grow, while other states do not (and, of course, nearly every state has at least slight variations on who qualifies to be a medical marijuana patient and/or caregiver). 

Though there are plenty of resources highlighting formal legal differences in different medical marijuana states, I am not aware of many objective analysis of whether and how different medical marijuana regulatory structures in different states impact the development and functionality of medical marijuana access and efficacy for patients.  In other words, while states are conducting a wide array of "laboratories of democracy" experiments  in this medical marijuana area, we need a lot more analysis of early lab results. 

December 20, 2017 in Business laws and regulatory issues, Medical Marijuana Commentary and Debate, Medical Marijuana Data and Research, Medical Marijuana State Laws and Reforms, Who decides | Permalink | Comments (0)

Monday, December 18, 2017

New data from West Virginia showing strong physician interest in state's developing medical marijuana program

As reported in this local article, headlined "Survey: 82 percent of WV doctors 'interested' in medical marijuana," a notably large percentage of surveyed physicians have expressed an interest in an emerging medical marijuana regime. Here are the basics:

An overwhelming majority of surveyed West Virginia physicians are “interested” in medical cannabis, according to the Department of Health and Human Resources.  Of 1,455 physicians who took the online survey, 82 percent of them indicated their interest in medical marijuana, which will be legal in the state in July 2019 thanks to a law passed during the last legislative session.

Dr. Rahul Gupta, state health officer and commissioner of the state Bureau for Public Health, said the high response volume gives the state a sound outlook on patient and physician views of the looming change.  “We found that to be compelling that there is a certain level of interest, not just from patients, but from the physician community,” he said.

Along with doctors, the bureau analyzed survey results from 6,003 West Virginians, as well as Public Employees Insurance Agency and Medicaid claim data to tease out what tweaks, if any, might be needed for the nascent program.  Of the patients who responded, 2,120 reported suffering from chronic pain, 1,579 reported suffering from post-traumatic stress disorder and another 980 reported suffering from a mental health disorder.

The Medicaid and PEIA data shows crossover between some of the most prevalent conditions in the state and the list of conditions whose victims qualify to obtain medical marijuana....

There is still work to be done and change for the organization to consider.  Among the questions Gupta said the board is considering: Should the state limit how many dispensaries can obtain a permit to sell?  Should the board approve the sale of marijuana in plant form?  Should patients be allowed to grow their own marijuana plants? Should patients be able to purchase any other forms of marijuana?

Marijuana will be available to certified patients in the form of a pill, oil, topical, via vaporization or nebulization, tincture, liquid, or dermal patch.  Gupta said the board is scheduled to meet again in February.

December 18, 2017 in Medical community perspectives, Medical Marijuana Data and Research, Medical Marijuana State Laws and Reforms, Who decides | Permalink | Comments (0)

Thursday, December 14, 2017

Less encouraging new data from Monitoring the Future study concerning teenager marijuana use (but good news regarding other drugs)

In this post earlier this week, titled "Encouraging new data from National Survey on Drug Use and Health concerning teenager marijuana use," I noted my personal skepticism of contentions that teen marijuana use would go down in the wake of marijuana legalization. But, as detailed in that prior post, some new numbers from the National Survey on Drug Use and Health suggests this could be the reality in at least some legalization states for now.

But, as detailed in this new press release, headed "Marijuana Use Edges Upward," another set of new data does not tell a story quite so rosy with respect to use of marijuana by youngsters. Here are the basics:

Marijuana use among adolescents edged upward in 2017, the first significant increase in seven years.  Overall, past-year use of marijuana significantly increased by 1.3% to 24% in 2017 for 8th, 10th, and 12th graders combined.  Specifically, in 8th, 10th, and 12th grades the respective increases were 0.8% (to 10.1%), 1.6% (to 25.5%) and 1.5% (to 37.1%).  The increase is statistically significant when all three grades are combined.

“This increase has been expected by many” said Richard Miech, the Principal Investigator of the study. “Historically marijuana use has gone up as adolescents see less risk of harm in using it.  We’ve found that the risk adolescents see in marijuana use has been steadily going down for years to the point that it is now at the lowest level we’ve seen in four decades.”

The results come from the annual Monitoring the Future study, now in its 43rd year.  About 45,000 students in some 380 public and private secondary schools have been surveyed each year in this U.S. national study, designed and conducted by research scientists at the University of Michigan’s Institute for Social Research and funded by the National Institute on Drug Abuse.  Students in grades 8, 10 and 12 are surveyed.

This increase in marijuana drove trends in any illicit drug use in the past year. In both 12th and 10th grade this measure increased (although the increase was not statistically significant), while use of any illicit drug use other than marijuana declined (although the decrease was not statistically significant). In 8th grade neither of these drug use measures significantly changed, although they both increased slightly.

As this blurb highlights, a decline in the use of other illicit drugs emerges from this 2017 data, and also "cigarette smoking by teens [for] all measures (lifetime, 30-day, daily, and half-pack/day) are at historic lows since first measured in all three grades in 1991." Though there is research to suggest an increase in marijuana use by teens is not a positive public health story, a reduction in the use of cigarettes and other illicit drugs certainly is. These stories may or may not be causally connected, but all these data reinforce for me how intricate (and perhaps conflicting) data may be about the impact of marijuana reforms on teen behaviors and public health.

Prior recent related post:

Encouraging new data from National Survey on Drug Use and Health concerning teenager marijuana use

 

December 14, 2017 in History of Marijuana Laws in the United States, Medical Marijuana Data and Research, Recreational Marijuana Data and Research | Permalink | Comments (0)

Tuesday, December 12, 2017

"Medical Marijuana and Crime: Substance Use and Criminal Behaviors in a Sample of Arrestees"

The title of this post is the title of this new article published in the Journal of Drug Issues and authored by Hyunjung Cheon, Scott Decker and Charles Katz. Here is its abstract:

After decades of prohibition, laws allowing marijuana use for medical and, in some cases, recreational purposes have been enacted across the country.  To date, however, little is known about medical marijuana use, particularly regarding its relationship to criminal offending and use by nonauthorized persons.  The current study bridges this gap by examining offending patterns in a sample of recent arrestees in Maricopa County, Arizona, identified and interviewed through the Arizona Arrestee Reporting Information Network (AARIN) project.

Findings suggest that medical users had a higher probability for committing Driving Under the Influendce (DUI) and drug selling/making than nonusers, and diverted medical marijuana users had a higher probability for involvement in property crime, violent crime, DUI, and drug selling/making than nonusers.  The results have important implications for developing marijuana decriminalization policies, criminal justice, and criminological theory.  Directions for future research are discussed.

December 12, 2017 in Criminal justice developments and reforms, Medical Marijuana Data and Research | Permalink | Comments (0)

Saturday, December 9, 2017

"Medical Pot Is Our Best Hope to Fight the Opioid Epidemic"

Images (3)The title of this post is the headline of this new Rolling Stone article. Here are excerpts (with some links from the original preserved):

The pain-relieving properties of cannabis are no longer hypothetical or anecdotal. At the beginning of the year, the National Academies of Science, Medicine and Engineering released a landmark report determining that there is conclusive evidence that cannabis is effective in treating chronic pain.  What's even more promising is that early research indicates that the plant not only could play a role in treating pain, but additionally could be effective in treating addiction itself – meaning marijuana could actually be used as a so-called "exit drug" to help wean people off of pills or heroin.

"We're not just saying opioids make you feel good and so does cannabis, and now you're addicted to cannabis. There are direct reasons why this could actually help people get off of opioids," says Jeff Chen, director of UCLA's new Cannabis Research Initiative.  "If there is a chronic pain component, the cannabis can address the chronic pain component. We also find opioid addicts have a lot of neurological inflammation, which we believe is driving the addictive cycle. We see in preliminary studies that cannabinoids can reduce neurological inflammation, so cannabis could be directly addressing the inflammation in the brain that's leading to opioid dependency."

The theory that cannabinoids could decrease cravings for opioids is further supported by a small 2015 study published in the journal Neurotherapeutics, which found that the non-psychoactive cannabinoid CBD was effective in reducing the desire for heroin among addicts, and remained effective for an entire week after being administered. Similar effects have long been observed in animal studies.

Cannabis, in fact, may be exactly the kind of opioid replacement that politicians and pharmaceutical executives claim to be searching for. "I will be pushing the concept of non-addictive painkillers very, very hard," President Trump said in October, when declaring opioid abuse a national public health emergency.  The CEO of Purdue Pharma, which makes OxyContin, recently referred to the possibility of a drug that helps with pain but isn't physically addictive as the "Holy Grail."...

But already, many Americans seem to be replacing their pills with pot. A survey of pain patients in Michigan, published in 2016 in the journal of the American Pain Society, found medical cannabis use was associated with a 64 percent decrease in opioid use.  A 2016 study published in the health policy journal Health Affairs found that states with medical marijuana saw a drop in Medicare prescriptions and spending for conditions that are commonly treated with cannabis, including chronic pain, glaucoma, seizures and sleep disorders. And a 21-month study of 66 chronic pain patients using prescription opioids in New Mexico found that those enrolled in the state's medical cannabis program were 17 times more likely to quit opioids than those who were not.

At the same time, opioid-related deaths and overdose treatment admissions appear to be declining by nearly 25 percent in states where patients have access to legal marijuana. That number comes primarily from a 2014 study in the Journal of the American Medical Association, and has been supported by additional data from the American Journal of Public Health, the American Academy of Nursing, and the Journal of Drug and Alcohol Dependence.

However, more research is sorely needed. Stanford professor and drug policy expert Keith Humphreys described the studies concerning cannabis legalization and the decrease in opioid-related deaths and hospital admissions as falling victim to a form of logical error known as ecological fallacy. "It's correlation, not causation," he told me, because you cannot use statistical information about entire populations to understand individual behavior.

And researchers are eager for more solid evidence.  The Cannabis Research Initiative at UCLA is working on establishing one of the first studies that will directly administer cannabis to patients addicted to opioids, potentially providing a much more comprehensive understanding of how this all works. Chen, the initiative director, says he has scientists, clinics and a study design all lined up, but funding has been a struggle. "You're forced to go an extra ten miles with zero gas in the tank when it comes to cannabis research," he says. Between the lack of support from the federal government and pharmaceutical companies, Chen says he is "pretty much dependent on philanthropy."

Some (of many) prior related posts:

December 9, 2017 in Medical community perspectives, Medical Marijuana Commentary and Debate, Medical Marijuana Data and Research, Medical Marijuana State Laws and Reforms | Permalink | Comments (0)

Friday, December 8, 2017

Are there 1.9 millions or 2.35 million or some other big number of medical marijuana patients?

The question in the title of this post was prompted by this new article reporting that New Frontier Data has determined that, in the medical marijuana arena, the "total U.S. patient population (not including CBD states) is 1,914,767."  This accounting led me to check out the latest patient head-count at Marijuana Policy Project, and this MPP page reports an estimate of "all state-legal patients" to be 2,354,403.   Hmmm.

December 8, 2017 in Medical Marijuana Data and Research, Who decides | Permalink | Comments (0)

Tuesday, November 28, 2017

"Associations between medical cannabis and prescription opioid use in chronic pain patients: A preliminary cohort study"

The title of this post is the title of this small research report emerging from New Mexico that a helpful reader made sure I did not miss.  The article has multiple authors and here is its abstract:

Background

Current levels and dangers of opioid use in the U.S. warrant the investigation of harm-reducing treatment alternatives.

Purpose

A preliminary, historical, cohort study was used to examine the association between enrollment in the New Mexico Medical Cannabis Program (MCP) and opioid prescription use.

Methods

Thirty-seven habitual opioid using, chronic pain patients (mean age = 54 years; 54% male; 86% chronic back pain) enrolled in the MCP between 4/1/2010 and 10/3/2015 were compared to 29 non-enrolled patients (mean age = 60 years; 69% male; 100% chronic back pain).  We used Prescription Monitoring Program opioid records over a 21 month period (first three months prior to enrollment for the MCP patients) to measure cessation (defined as the absence of opioid prescriptions activity during the last three months of observation) and reduction (calculated in average daily intravenous [IV] morphine dosages).  MCP patient-reported benefits and side effects of using cannabis one year after enrollment were also collected.

Results

By the end of the 21 month observation period, MCP enrollment was associated with 17.27 higher age- and gender-adjusted odds of ceasing opioid prescriptions (CI 1.89 to 157.36, p = 0.012), 5.12 higher odds of reducing daily prescription opioid dosages (CI 1.56 to 16.88, p = 0.007), and a 47 percentage point reduction in daily opioid dosages relative to a mean change of positive 10.4 percentage points in the comparison group (CI -90.68 to -3.59, p = 0.034).  The monthly trend in opioid prescriptions over time was negative among MCP patients (-0.64mg IV morphine, CI -1.10 to -0.18, p = 0.008), but not statistically different from zero in the comparison group (0.18mg IV morphine, CI -0.02 to 0.39, p = 0.081).  Survey responses indicated improvements in pain reduction, quality of life, social life, activity levels, and concentration, and few side effects from using cannabis one year after enrollment in the MCP (ps<0.001).

Conclusions

The clinically and statistically significant evidence of an association between MCP enrollment and opioid prescription cessation and reductions and improved quality of life warrants further investigations on cannabis as a potential alternative to prescription opioids for treating chronic pain.

November 28, 2017 in Medical Marijuana Data and Research, Medical Marijuana State Laws and Reforms | Permalink | Comments (0)

Thursday, November 16, 2017

"Pediatric Death Due to Myocarditis After Exposure to Cannabis"

Advocates of marijuana reform are often quick to assert that nobody dies from an overdose of marijuana.  But this new clinical report from two Colorado doctors, which has the same title as this post, discusses a case of an 11-month child who may have died as a direct result of marijuana exposure.   The paper is authored by Thomas Nappe and Christopher Hoyte, and here is the paper's abstract:

Since marijuana legalization, pediatric exposures to cannabis have increased.  To date, pediatric deaths from cannabis exposure have not been reported.  The authors report an 11-month-old male who, following cannabis exposure, presented with central nervous system depression after seizure, and progressed to cardiac arrest and died.  Myocarditis was diagnosed post-mortem and cannabis exposure was confirmed.  Given the temporal relationship of these two rare occurrences – cannabis exposure and sudden death secondary to myocarditis in an 11-month-old – as well as histological consistency with drug-induced myocarditis without confirmed alternate causes, and prior reported cases of cannabis-associated myocarditis, a possible relationship exists between cannabis exposure in this child and myocarditis leading to death. In areas where marijuana is commercially available or decriminalized, the authors urge clinicians to preventively counsel parents and to include cannabis exposure in the differential diagnosis of patients presenting with myocarditis.

UPDATE: Unsurprisingly, this clinical report links a death to marijuana exposure has created a stir, and this new Washington Post piece headlined "The truth behind the ‘first marijuana overdose death’" provides some context for the controversy.

November 16, 2017 in Medical community perspectives, Medical Marijuana Data and Research, Recreational Marijuana Data and Research | Permalink | Comments (4)

Monday, November 13, 2017

"Helping Settle the Marijuana and Alcohol Debate: Evidence from Scanner Data"

The title of this post is the title of this intriguing new empirical article authored by Michele Baggio, Alberto Chong and Sungoh Kwon now available via SSRN. Here is the abstract (with the key finding emphasized):

We use data on purchases of alcoholic beverages in grocery, convenience, drug, or mass distribution stores in US counties for 2006-2015 to study the link between medical marijuana laws and alcohol consumption and focus on settling the debate between the substitutability or complementarity between marijuana and alcohol. To do this we exploit the differences in the timing of the of marijuana laws among states and find that these two substances are substitutes. Counties located in MML states reduced monthly alcohol sales by 15 percent. Our findings are robust to border counties analysis, a placebo effective dates for MMLs in the treated states, and falsification tests using sales of pens and pencils.

November 13, 2017 in History of Alcohol Prohibition and Temperance Movements, History of Marijuana Laws in the United States, Medical Marijuana Data and Research, Medical Marijuana State Laws and Reforms | Permalink | Comments (0)

Thursday, November 2, 2017

New American Legion survey documents strong support among veteran households for medical marijuana

ThThis new posting from The American Legion, the nation’s largest wartime veterans service organization, reports on a notable new survey showing notable support for marijuana reform from a notable population.  The posting is headed "Survey shows veteran households support research of medical cannabis," and here is how is starts (with links from the original):

An independent public opinion research company conducted a nationwide survey about the opinions of veterans, their family members and caregivers on the issue of medical cannabis. See the survey results here.Learn more about The American Legion's push for research into medical cannabis here.

The results are significant and reinforce The American Legion’s continued efforts, under Resolution 11, to urge Congress to amend legislation to remove marijuana from Schedule I of the Controlled Substances Act and reclassify it, at a minimum, as a drug with potential medical value.

According to the survey – which included more than 1,300 respondents and achieved a +/- 3.5 percent margin of error at a 95 percent confidence level – 92 percent of veteran households support research into the efficacy of medical cannabis for mental and physical conditions.

Eighty-three percent of veteran households surveyed indicated that they believe the federal government should legalize medical cannabis nationwide, and 82 percent indicated that they would want to have medical cannabis as a federally-legal treatment option, the survey says.

In January 2017, the National Academy of medicine released a review of more than 10,000 scientific abstracts and found substantial evidence to support the idea that cannabis was effective in treating chronic pain, reducing spasticity in Multiple Sclerosis patients, and reducing symptoms of chemotherapy-induced nausea. The American Legion calls on the federal government to confirm or deny the validity of these studies.

In August during the Legion’s national convention in Reno, Nev., Resolution 28 was passed, which calls on the federal government to allow medical providers within the Department of Veterans Affairs (VA) to discuss medical cannabis as a treatment option in states where medical marijuana is legal.

VA officials report that about 60 percent of veterans returning from combat deployments and 50 percent of older veterans suffer from chronic pain compared to 30 percent of Americans nationwide.

Many veterans suffering from post-traumatic stress disorder and chronic pain – especially those of the Iraq and Afghanistan generation – have told The American Legion that they have achieved improved health care outcomes by foregoing VA-prescribed opioids in favor of medical cannabis. While the stories of these wartime veterans are compelling, more research must be done in order to enable lawmakers to have a fact-based debate on future drug policy.

The survey also showed that 22 percent of veterans are currently using cannabis to treat a medical condition.

The opioid crisis in America is having a disproportionate impact on our veterans, according to a 2011 study of the VA system, as they contend with the facts that poorly-treated chronic pain increases suicide risk, and veterans are twice as likely to succumb to accidental opioid overdoses. Traumatic brain injury and PTSD remain leading causes of death and disability within the veteran community, according to Lou Celli, director of the Legion's Veterans Affairs and Rehabilitation Division.

Here are some highlights from the survey:

  • 92 percent of all veterans support research into medical cannabis.

  • 83 percent of all veteran households support legalizing medical cannabis.

  • Support for medical cannabis research is consistent nationwide, across ages, gender, political affiliation and geography.

  • 60 percent of respondents do not live in states where medical cannabis is currently legal.

  • 79 percent of respondents aged 60+ supported federally legalized medical cannabis.

  • 22 percent of veterans stated they are currently using cannabis to treat a medical condition.

  • 40 percent of caregivers stated they know a veteran who is using medical cannabis to alleviate a medical condition.

November 2, 2017 in Medical Marijuana Commentary and Debate, Medical Marijuana Data and Research, Polling data and results, Who decides | Permalink | Comments (0)

Sunday, October 29, 2017

"A Well-Kept Secret: How Vets And Their Doctors Are Getting Around The VA’s Medical Marijuana Policy"

Download (4) title of this post is the headline of this lengthy article from Task & Purpose, a website that seeks to "provide authentic and unfiltered perspectives on military and veterans issues in the post-9/11 era." I recommend the article in full, and here are some excerpts:

In states where medical marijuana is legal, the VA’s existing policy allows for veterans and their care providers to candidly discuss cannabis use as part of their overall treatment plan, and in some cases, even test positive on a urinalysis for the drug without consequence — many of the same official changes to VA policy that veteran service organizations have been aggressively advocating for in 2017.

Under VA policy, veterans who participate in state-approved marijuana programs won’t lose access to VA health care, however, due to the drug’s Schedule 1 classification, the VA doesn’t allow physicians to prescribe pot; fill out forms for veterans seeking to participate in state weed programs; or pay for the drug. Nor is its use permitted on VA grounds....

What leaves VA guidelines open to interpretation is what they don’t address. The VA doesn’t explicitly bar patients from discussing their medicinal weed use with their doctors. The policy even leaves room for physicians to alter a veteran’s treatment plan to account for their pot use, but stops short of stating exactly what that entails. When it comes to specifics on how this all plays out in a doctor’s office, the policy at large, and the VA in particular, are quite vague....

Advocates of medicinal marijuana use for veterans — and those simply in favor of more research into its potential benefits — often point to its effectiveness in treating chronic pain, especially compared to highly addictive medications, like opioids. Its efficacy has been well-documented, with one observational study indicating a marked dip in opiate-related deaths in states where medicinal weed is legal, The Washington Post reported earlier this year. Still, when it comes to pot as a treatment option for veterans with PTSD and TBI, hard results are less readily available.

One of the consequences of the VA’s reliance on results from state-run studies and its lack of involvement in an ongoing federal study near a major VA hospital in Phoenix, Arizona, is that much of the research needed to further this conversation at the federal level, in any direction, remains out of reach, and it could stay that way for quite some time.

Currently, the marijuana PTSD study, the only federally approved research into the effects of herb on PTSD, has stagnated, with just 26 veterans enrolled out of the required 76 needed to be viable as of Sept. 19, and the hang-up stems from the VA’s refusal to recommend veteran patients for the study, due to the drug’s classification as Schedule 1. The lack of VA involvement, coupled with the study’s strict requirements — roughly 99% of applicants fail to meet the standards — has limited its recruitment pool. The federal research was further stymied by substandard pot — it had a low concentration of THC, but high levels of mold and lead — provided to the researchers by the federal government’s official grow operation at the University of Mississippi.

October 29, 2017 in Federal Marijuana Laws, Policies and Practices, Medical Marijuana Commentary and Debate, Medical Marijuana Data and Research, Medical Marijuana State Laws and Reforms, Who decides | Permalink | Comments (0)

Tuesday, October 24, 2017

What should we make of the data on teen substance use from Massachusetts?

The question in the title of this post is one I have been thinking about a lot since seeing this press report on new data from a survey done of teenagers in Western Massachusetts.  Here are the details:

Marijuana and e-cigarette usage among some Western Massachusetts teenagers appear to be on the up while fewer smoke tobacco, drink alcohol and use other drugs, according to a recent survey.   About 31 percent of 16- to 18-year-olds surveyed reported using marijuana in the past month, up four percent over 2016, the 2017 Massachusetts Prevention Needs Assessment Survey says.

The survey also showed kids, for the first time ever, reporting being exposed to marijuana advertising, and trying other forms of marijuana consumption, such as edibles, dabs and vapor pens.   

Meanwhile, the survey reported a modest dip of several percentage points in the use of alcohol among the same age groups.  In 2017, 28 and 48 percent of surveyed 16- and 18-year-olds, respectively, reported using alcohol in the past 30 days, versus 31.5 and 50.5 in 2015 and 35 and 51.3 in 2013. 

The percentages using other drugs such as amphetamines, cocaine, sedatives, tranquilizers and other narcotics -- always in the low single-digits in previous surveys -- also fell across the board in the 2017 survey. 

Massachusetts voters' 2016 Election vote to legalize marijuana for people over 21 likely contributed to the survey's result showing fewer teenagers perceiving the drug to be a serious risk.   Additionally, fewer of the surveyed teens felt their parents strongly opposed the drug, either. 

The most explosive growth seen in any of the survey's results appeared in the usage of electronic cigarettes.   Whereas virtually no 16- to 18-year-olds reported using e-cigs in 2015, 13 and 21 percent, respectively, had used the devices within the past month in 2017.

Sponsored by the Strategic Planning Initiative for Families and Youth, the annual survey hit 3,320 county youths before the results were published in late August. 

October 24, 2017 in Medical Marijuana Data and Research, Recreational Marijuana Data and Research | Permalink | Comments (0)

Wednesday, October 18, 2017

Senator Orrin Hatch questions Attorney General Jeff Sessions about medical marijuana research

As this report from The Cannabist details,  there were a few minutes of discussion of medical marijuana during an oversight hearing in the US Senate today with Attorney General Jeff Sessions.  Here are the basic details:

In testimony before the Senate Judiciary Committee on Wednesday morning, U.S. Attorney General Jeff Sessions said there should be “more competition” among growers who supply marijuana for federally approved research, though he said he thought the current applicant pool of 26 was too many.

His statement came in response to a question from Sen. Orrin Hatch, a Republican from Utah.  Hatch referred to legislation he recently co-sponsored with Sen. Brian Schatz, D-Hawaii, known as the MEDS Act. “I believe that scientists need to study the potential benefits and risks of marijuana,” said Hatch, though clarifying that “I remain opposed to the broad legalization of marijuana.”

Hatch said he was “very concerned” with reports that the Drug Enforcement Administration and the Justice Department “are at odds” over granting additional applications for cultivating marijuana for research purposes.  In August, DEA officials said they had been waiting for the Justice Department’s sign-off to move forward on 25 applications, and expressed frustration that the Justice Department had not been willing to provide that sign-off.

October 18, 2017 in Federal Marijuana Laws, Policies and Practices, Medical Marijuana Data and Research, Who decides | Permalink | Comments (0)

Wednesday, October 11, 2017

"The use of cannabis in response to the opioid crisis: A review of the literature"

Cov200hThe title of this post is the title of this notable short literature review on a topic that regular readers know I find very interesting.  The article by multiple authors appears in Nursing Outlook, which is the official journal of the American Academy of Nursing.  Here is its abstract:

Background

A staggering number of Americans are dying from overdoses attributed to prescription opioid medications (POMs).  In response, states are creating policies related to POM harm reduction strategies, overdose prevention, and alternative therapies for pain management, such as cannabis (medical marijuana).  However, little is known about how the use of cannabis for pain management may be associated with POM use.

Purpose

The purpose of this article is to examine state medical cannabis (MC) use laws and policies and their potential association with POM use and related harms.

Methods

A systematic literature review was conducted to explore United States policies related to MC use and the association with POM use and related harms. Medline, PubMed, CINAHL, and Cochrane databases were searched to identify peer-reviewed articles published between 2010 and 2017. Using the search criteria, 11,513 records were identified, with 789 abstracts reviewed, and then 134 full-text articles screened for eligibility.

Findings

Of 134 articles, 10 articles met inclusion criteria. Four articles were cross-sectional online survey studies of MC substitution for POM, six were secondary data analyses exploring state-level POM overdose fatalities, hospitalizations related to MC or POM harms, opioid use disorder admissions, motor vehicle fatalities, and Medicare and Medicaid prescription cost analyses.  The literature suggests MC laws could be associated with decreased POM use, fewer POM-related hospitalizations, lower rates of opioid overdose, and reduced national health care expenditures related to POM overdose and misuse.  However, available literature on the topic is sparse and has notable limitations.

Conclusions

Review of the current literature suggests states that implement MC policies could reduce POM-associated mortality, improve pain management, and significantly reduce health care costs. However, M C research is constrained by federal policy restrictions, and more research related to MC as a potential alternative to POM for pain management, MC harms, and its impact on POM-related harms and health care costs should be a priority of public health, medical, and nursing research.

Some (of many) prior related posts:

October 11, 2017 in Medical community perspectives, Medical Marijuana Commentary and Debate, Medical Marijuana Data and Research | Permalink | Comments (0)

Wednesday, October 4, 2017

"The Impact of State Medical Marijuana Laws on Social Security Disability Insurance and Workers' Compensation Benefit Claiming"

The title of this post is the title of this interesting new empirical paper available via SSRN authored by Catherine Maclean, Keshar Ghimire and Lauren Hersch Nicholas. Here is the abstract:

We study the effect of state medical marijuana laws (MMLs) on Social Security Disability Insurance (SSDI) and Workers' Compensation (WC) claiming.  We use data on benefit claiming drawn from the 1990 to 2013 Current Population Survey coupled with a differences-in-differences design.  We find that passage of an MML increases SSDI, but not WC, claiming on both the intensive and extensive margins.  Post-MML the propensity to claim SSDI increases by 0.27 percentage points (9.9%) and SSDI benefits increase by 2.6%. We identify heterogeneity by age and the manner in which states regulate medical marijuana.  Our findings suggest an unintended consequence of MMLs: increased reliance on costly social insurance programs among working age adults.

October 4, 2017 in Medical Marijuana Commentary and Debate, Medical Marijuana Data and Research, Medical Marijuana State Laws and Reforms | Permalink | Comments (1)