Marijuana Law, Policy & Reform

Editor: Douglas A. Berman
Moritz College of Law

Monday, August 13, 2018

"Medical marijuana laws and workplace fatalities in the United States"

1-s2.0-S0955395918X00061-cov150hThe title of this post is the title of this notable new research article forthcoming in the October 2018 issue of the International Journal of Drug Policy. Here is its abstract:

Aims

The aim of this research was to determine the association between legalizing medical marijuana and workplace fatalities.

Design

Repeated cross-sectional data on workplace fatalities at the state-year level were analyzed using a multivariate Poisson regression.

Setting

To date, 29 states and the District of Columbia have legalized the use of marijuana for medicinal purposes. Although there is increasing concern that legalizing medical marijuana will make workplaces more dangerous, little is known about the relationship between medical marijuana laws (MMLs) and workplace fatalities.

Participants

All 50 states and the District of Columbia for the period 1992–2015.

Measurements

Workplace fatalities by state and year were obtained from the Bureau of Labor Statistics.  Regression models were adjusted for state demographics, the unemployment rate, state fixed effects, and year fixed effects.

Findings

Legalizing medical marijuana was associated with a 19.5% reduction in the expected number of workplace fatalities among workers aged 25–44 (incident rate ratio [IRR], 0.805; 95% CI, .662–.979).   The association between legalizing medical marijuana and workplace fatalities among workers aged 16–24, although negative, was not statistically significant at conventional levels.   The association between legalizing medical marijuana and workplace fatalities among workers aged 25–44 grew stronger over time.  Five years after coming into effect, MMLs were associated with a 33.7% reduction in the expected number of workplace fatalities (IRR, 0.663; 95% CI, .482–.912).   MMLs that listed pain as a qualifying condition or allowed collective cultivation were associated with larger reductions in fatalities among workers aged 25–44 than those that did not.

Conclusions

The results provide evidence that legalizing medical marijuana improved workplace safety for workers aged 25–44.   Further investigation is required to determine whether this result is attributable to reductions in the consumption of alcohol and other substances that impair cognitive function, memory, and motor skills.

August 13, 2018 in Medical Marijuana Data and Research, Medical Marijuana State Laws and Reforms | Permalink | Comments (0)

Monday, July 30, 2018

Notable review of Florida’s "booming" medicial marijuana industry

Florida-medical-marijuana-program-rules

This local Florida article, headlined "Marijuana booming as state nears 2-year mark," reports on (unsurprising?) medical marijuana realities in the Sunshine State.  Here are highlights from the lengthy piece:

More than 100,000 Floridians now can legally take marijuana for medicinal purposes.  This milestone, reached in April, is one of many signs that Florida’s young marijuana industry is booming as the state approaches the two-year anniversary of voters legalizing medical pot.

But issues remain: Some patients complain that the Florida Department of Health’s rules create unfair barriers for patients. They can’t smoke their marijuana or grow their own, for example.  They also gripe about the patient approval process and the cost of medication.  Companies eager to jump into the marijuana business are waiting for the state to issue additional licenses required by law upon passing the 100,000-patient mark....

In November 2016, 71 percent of Florida’s voters gave the green light to medical marijuana.  The state still is issuing guidelines and battling lawsuits over how that should be done.  But the direction is clear.  Already, analysts are projecting a $1 billion medical marijuana market in Florida by 2020. 

Fourteen companies have received licenses from the state.  They’ve opened 43 dispensaries statewide, including offices in Summerfield and Lady Lake, to serve the growing number of approved patients, which has more than doubled since the start of the year.  The coveted licenses are drawing attention from established marijuana businesses.  In June, California-based MedMen paid $53 million to acquire the cultivation and distribution rights from Treadwell Nursery in Eustis....

[T]he process to become a qualifying doctor [initially meant] doctors were required to pay $1,000 for an eight-hour course. That requirement has since decreased to a two-hour course costing $250. More than 1,500 physicians now are able to recommend marijuana to patients, including more than 40 in Sumter, Lake and Marion counties.

Miami-Dade and Palm Beach counties have the most registered physicians, with more than 200 each.  Demand for doctors persists, with 1,500 to 3,500 patients joining the registry every week....

Even as more and more people line up for treatment, criticism of the program continues.  Companies and advocates of Amendment 2, which authorized medical marijuana, are challenging some of the rules laid out by the Department of Health.  Attorney John Morgan sued the department over its rule banning smokeable cannabis, arguing it goes against the will of the voters who approved the amendment.  Vaping is allowed.  Tallahassee Circuit Judge Karen Gievers sided with Morgan, saying the restriction was unconstitutional.  The state immediately appealed the decision, and Morgan tried to get the Florida Supreme Court to consider the case.  He now is focusing on legalizing recreational use.

Morgan criticized Gov. Rick Scott, who had opposed the broad legalization of medical marijuana, for allowing the smoking ban. Scott defended following the law as it is written. He is not alone in voicing smoking opposition. The American Society of Addiction Medicine rejects smoking as a means of drug delivery for medical purposes. The American Cancer Society Cancer Action Network, the ACS’s advocacy group, has not taken a position on legalization of marijuana for medical purposes, citing a need for more scientific research on marijuana’s potential benefits and harms.

July 30, 2018 in Medical Marijuana Commentary and Debate, Medical Marijuana Data and Research, Medical Marijuana State Laws and Reforms, Who decides | Permalink | Comments (0)

Thursday, July 26, 2018

Lots of new reports on lots of new research on lots of marijuana topics

Tuesday, July 24, 2018

Hooray for the proposed new "Marijuana Data Collection Act" ... but ...

Images (2)Tom Angell reports here at Forbes on the introduction of a new piece of federal legislation that I consider long overdue.   Here are the details:

The Marijuana Data Collection Act, introduced on Tuesday by Rep. Tulsi Gabbard (D-HI) and a bipartisan group of cosponsors, would direct the Department of Health and Human Services to partner with other federal and state government agencies to study "the effects of State legalized marijuana programs on the economy, public health, criminal justice and employment."...

If the legislation is enacted, the National Academy of Sciences would carry out the research and publish initial findings within 18 months, with follow-up reports to be issued every two years after that.

So far, the bill's backers seem to consist solely of those who support marijuana law reform, a situation that legalization advocates decried.  “This is not a marijuana bill, it is an information bill," Justin Strekal, political director for NORML, said in an interview.  "No member of Congress can intellectually justify opposition to this legislation. Our public policy needs to be based on sound data and science, not gut feelings or fear-mongering.  Approving the Marijuana Data Collection Act would provide legislators with reliable and fact-based information to help them decide what direction is most beneficial to society when it comes to marijuana policy.”...

Gabbard held a Tuesday morning press conference with other supporters, including lead GOP cosponsor Rep. Carlos Curbelo (R-FL) and former U.S. Attorneys Barry Grissom of Kansas and Bill Nettles of South Carolina. Other original cosponsors of the bill include Reps. Don Young (R-AK), Darren Soto (D-FL), Beto O’Rourke (D-TX), Earl Blumenauer (D-OR), Dana Rohrabacher (R-CA), Matt Gaetz (R-FL), Peter DeFazio (D-OR), Eleanor Holmes Norton (D-DC), Dina Titus (D-NV), Charlie Crist (D-FL), Tom Garrett (R-VA), Lou Correa (D-CA), Barbara Lee (D-CA), Mark Pocan (D-WI) and Salud Carbajal (D-CA).

Here are the specific data points the bill directs federal officials to track:

REVENUES AND STATE ALLOCATIONS

The monetary amounts generated through revenues, taxes, and any other financial benefits. The purposes and relative amounts for which these funds were used. The total impact on the State and its budget.

MEDICINAL USE OF MARIJUANA

The rates of medicinal use among different population groups, including children, the elderly, veterans, and individuals with disabilities. The purpose of such use. Which medical conditions medical marijuana is most frequently purchased and used for.

SUBSTANCE USE

The rates of overdoses with opioids and other painkillers. The rates of admission in health care facilities, emergency rooms, and volunteer treatment facilities related to overdoses with opioids and other painkillers. The rates of opioid-related and other painkiller-related crimes to one’s self and to the community. The rates of opioid prescriptions and other pain killers.

IMPACTS ON CRIMINAL JUSTICE

The rates of marijuana-related arrests for possession, cultivation, and distribution, and of these arrests, the percentages that involved a secondary charge unrelated to marijuana possession, cultivation, or distribution, including the rates of such arrests on the Federal level, including the number of Federal prisoners so arrested, disaggregated by sex, age, race, and ethnicity of the prisoners; and the rates of such arrests on the State level, including the number of State prisoners so arrested, disaggregated by sex, age, race, and ethnicity. The rates of arrests and citations on the Federal and State levels related to teenage use of marijuana. The rates of arrests on the Federal and State levels for unlawful driving under the influence of a substance, and the rates of such arrests involving marijuana. The rates of marijuana-related prosecutions, court filings, and imprisonments. The total monetary amounts expended for marijuana-related enforcement, arrests, court filings and proceedings, and imprisonment before and after legalization, including Federal expenditures disaggregated according to whether the laws being enforced were Federal or State. The total number and rate of defendants in Federal criminal prosecutions asserting as a defense that their conduct was in compliance with applicable State law legalizing marijuana usage, and the effects of such assertions.

EMPLOYMENT

The amount of jobs created in each State, differentiating between direct and indirect employment. The amount of jobs expected to be created in the next 5 years, and in the next 10 years, as a result of the State’s marijuana industry.

Because I cannot yet find the full text of the bill on-line, I cannot yet provide a full informed opinion on its particulars.  I can say that I think a big, data-focused federal study of the impact of state marijuana reform is looooooooong overdue.  I was hopeful, but not optimistic, that Prez Obama might see the wisdom and political value of pushing for this kind of study effort after the issuance of the 2013 Cole Memo and after the 2014 election brought more states and DC into the recreational marijuana column.  But, sadly, we have been left largely with national number crunching by partisan advocates rather than government bean-counters for now two decades of ever-more-robust state-level reforms.

Based on Tom's description of the "Marijuana Data Collection Act," I am a bit concerned that there are not provisions likely to encourage pot prohibitionists to be supportive of this particular study effort.   The folks at SAM are often eager to stress data on black markets, increased use of marijuana by workers, increased hospital visits, increased homelessness, increased drugged driving, increased use by youths and young adults, environmental impacts,  and all sorts of other concerns (see, e.g., this SAM "lessons learned" report from March 2018).  It is unclear if these kinds of potentially negative data are fundamental parts of the inquiry imagined by Marijuana Data Collection Act.  If not, I doubt opponents of marijuana reform will want to sign on to this bill.

That said, even if the current version of the "Marijuana Data Collection Act" is in someway incomplete or one-sided, I hope a lot of folks on all sides of the marijuana reform debate will be inclined to try to make the bill better and get it passed.  I sincerely hope nobody disagrees with the notion that sound data and science is needed in this arena, and I sense both sides of the debate sincerely believe that the data, if fairly collected, will be on their side.  So maybe all can come together to really work toward trying to have all the data fairly collected (though I am not holding my breath).

July 24, 2018 in Campaigns, elections and public officials concerning reforms, Federal Marijuana Laws, Policies and Practices, Medical Marijuana Data and Research, Recreational Marijuana Data and Research, Who decides | Permalink | Comments (0)

Friday, July 20, 2018

"Medical cannabis legalization and state-level prevalence of serious mental illness in the National Survey on Drug Use and Health (NSDUH) 2008–2015"

The title of this post is the title of this new article in the International Review of Psychiatry. Here is its abstract:

Although research has established a link between cannabis legalization and use, and cannabis use and mental health, the relationship between medical cannabis legalization and mental health remains uncharacterized.  This analysis investigated the relationship between state medical cannabis laws (restrictive, i.e. covering a narrow set of medical conditions; or liberal, i.e. covering a broad range of medical conditions), whether the law permits patients to petition their physician to approve medical cannabis use for specific medical conditions, and state prevalence of serious mental illness (SMI) in the National Survey of Drug Use and Health 2008–2015.

In a covariate-adjusted meta-regression, liberal laws were significantly associated with higher prevalence of SMI (Coeff = 0.003, SE = 0.001, p < .001). Restrictive laws (Coeff = 0.001, SE = 0.001, p = .285) and the ability to petition physician approval (Coeff = −0.001, SE = 0.001, p = .140) were non-significant.  When added to the model, state past-year cannabis use was significantly associated with higher prevalence of SMI (Coeff = 0.037, SE = 0.015, p = .018), liberal laws remained significant (Coeff = 0.002, SE = 0.001, p = .015), and restrictive laws (Coeff = −0.0001, SE = 0.001, p = .945) and the ability to petition a physician (Coeff = 0.001, SE = 0.001, p = .290) remained non-significant.  Medical cannabis laws are likely related to state mental health, and a higher prevalence of cannabis use partially explains this relationship.

July 20, 2018 in Medical Marijuana Data and Research, Recreational Marijuana Data and Research | Permalink | Comments (0)

Thursday, July 12, 2018

"Medical Cannabis Legalization and Opioid Prescriptions: Evidence on US Medicaid Enrollees during 1993‐2014"

DownloadThe title of this post is the title of this new research published on-line this week from the journal Addiction. Here is its abstract:

Background and Aims

While the US has been experiencing an opioid epidemic, 29 states and Washington DC have legalized cannabis for medical use.  This study examined whether statewide medical cannabis legalization was associated with reduction in opioids received by Medicaid enrollees.

Design

Secondary data analysis of state‐level opioid prescription records from 1993‐2014 Medicaid State Drug Utilization Data.  Linear time‐series regressions assessed the associations between medical cannabis legalization and opioid prescriptions, controlling for state‐level time‐varying policy covariates (such as prescription drug monitoring programs) and socioeconomic covariates (such as income).

Setting

United States.

Participants

Drug prescription records for patients enrolled in fee‐for‐service Medicaid programs that primarily provide healthcare coverage to low income and disabled people.

Measurements

The primary outcomes were population‐adjusted number, dosage, and Medicaid spending on opioid prescriptions.  Outcomes for Schedule II opioids (e.g., Hydrocodone, Oxycodone) and Schedule III opioids (e.g., Codeine) were analyzed separately.   The primary policy variable of interest was the implementation of statewide medical cannabis legalization.

Findings

For Schedule III opioid prescriptions, medical cannabis legalization was associated with a 29.6% (p=0.03) reduction in number of prescriptions, 29.9% (p=0.02) reduction in dosage, and 28.8% (p=0.04) reduction in related Medicaid spending.  No evidence was found to support the associations between medical cannabis legalization and Schedule II opioid prescriptions.  Permitting medical cannabis dispensaries was not associated with Schedule II or Schedule III opioid prescriptions after controlling for medical cannabis legalization.  It was estimated that, if all the states had legalized medical cannabis by 2014, Medicaid annual spending on opioid prescriptions would be reduced by 17.8 million dollars.

Conclusion

Statewide medical cannabis legalization appears to have been associated with reductions in both prescriptions and dosages of Schedule III (but not Schedule II) opioids received by Medicaid enrollees in the US. Supporting Information

July 12, 2018 in Medical Marijuana Data and Research | Permalink | Comments (0)

Saturday, July 7, 2018

"Defying Congress, Jeff Sessions Keeps Blocking Medical Marijuana Research"

The title of this post is the headline of this recent Reason piece by Mike Riggs, which gets started this way:

It's been almost two years since the Drug Enforcement Administration (DEA) began accepting applications for new growers of research cannabis, and two dozen applicants are still in regulatory limbo.

Since the DEA announced in August 2016 that it would end the federal monopoly on producing cannabis for scientific research in the United States, growers, investors, researchers, applicants, and even members of Congress have sought to understand why a relatively simple licensing review process has stretched on for nearly two years. The answer is pretty straightforward: Attorney General Jeff Sessions, for reasons he has not publicly disclosed, decided to intervene in a process that has historically not involved the attorney general in order to stop the DEA from issuing licenses to growers.

While the Controlled Substances Act gives the attorney general regulatory authority over scheduled drugs, that authority has historically been delegated to the DEA, which is part of the Justice Department. The DEA has a whole division, in fact, dedicated to "investigat[ing] the diversion of controlled pharmaceuticals and listed chemicals from legitimate sources while ensuring an adequate and uninterrupted supply for legitimate medical, commercial, and scientific needs."

Members of Congress are not happy with Sessions' obstruction of the licensing process.  In April, Sens. Orrin Hatch (R–Utah) and Kamala Harris (D–Calif.) sent the attorney general a letter in which they asked him to provide the Senate with a timeline for processing applications from potential manufacturers of research marijuana. They also asked the DOJ to update applicants on the review process.  Both actions, Hatch and Harris suggested, should be completed by May 15, 2018.  Not only did the DOJ miss that deadline, but it doesn't seem interested in playing catch-up.

Four license applicants I interviewed in late June told me they've received no official updates from either the DEA or the DOJ in months.  Applicants who have spoken to congressional offices working on this issue say their contacts are equally frustrated by Sessions' obstruction of the DEA's licensing process.

July 7, 2018 in Federal Marijuana Laws, Policies and Practices, Medical Marijuana Commentary and Debate, Medical Marijuana Data and Research, Who decides | Permalink | Comments (0)

Friday, July 6, 2018

"The effects of medical marijuana laws on cannabis-involved driving"

X00014575The title of this post is the title of this notable new article authored by Eric Sevigny which will appear in the September 2018 issue of the journal Accident Analysis & Prevention. Here is its abstract:

This study uses data from the Fatality Analysis Reporting System and a differences-in-differences model to examine the effect of state medical marijuana laws (MMLs) on cannabis-involved driving among U.S. drivers involved in a fatal crash between 1993–2014. Findings indicate that MMLs in general have a null effect on cannabis-positive driving, as do state laws with specific supply provisions including home cultivation and unlicensed or quasi-legal dispensaries.

Only in jurisdictions with state-licensed medical marijuana dispensaries did the odds of marijuana-involved driving increase significantly by 14 percent, translating into an additional 87 to 113 drivers testing positive for marijuana per year. Sensitivity analyses reveal these findings to be generally robust to alternate specifications, although an observed spillover effect consistent with elevated drugged driving enforcement in bordering states weakens a causal interpretation. Still, reasonable policy implications are drawn regarding drugged driving prevention/enforcement and regulations governing dispensary delivery services and business siting decisions.

Some recent (of many) prior related posts:

July 6, 2018 in Medical Marijuana Data and Research | Permalink | Comments (0)

Tuesday, July 3, 2018

Big new Australian study throws cold water on marijuana as an effective pain reliever

Download (18)The huge 2017 National Academies of Sciences report titled "The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research" came to this encouraging conclusion in Chapter 4 of the report concerning the medicinal potential of marijuana: "There is substantial evidence that cannabis is an effective treatment for chronic pain in adults."

A big new study out of Australia, however, now throws some cold water on anyone getting to hot about marijuana's potential as an effective pain reliever. This Business Insider Australia article reports on the study under the headline "A 4-year Australian study of 1500 people finds no evidence that cannabis helps to treat pain." Here are excerpts:

A long term study by the University of NSW — one of the world’s longest in-depth community studies on pharmaceutical opioids and non-cancer pain — has found little evidence to support the use of cannabis in the treatment of chronic pain.

The four-year study of more than 1,500 Australians prescribed opioids for non-cancer pain suggest that there is a need for caution in using medicinal cannabis. Those in the study who used cannabis, and there were many among those with chronic non-cancer pain who had been prescribed opioids, actually had greater pain, anxiety and were coping less....

“Chronic non-cancer pain is a complex problem,” says Dr Gabrielle Campbell at the University of NSW, the lead author in the latest study. “For most people, there is unlikely to be a single effective treatment. In our study of people living with chronic non-cancer pain who were prescribed pharmaceutical opioids, despite reporting perceived benefits from cannabis use, we found no strong evidence that cannabis use reduced participants’ pain or opioid use over time.”

The Pain and Opioids IN Treatment (POINT) study, published today in the journal Lancet Public Health, looked at the effect of cannabis on pain, on the extent to which this interfered with everyday life, and on prescribed opioid use.

In the study, funded by the National Health and Medical Research Council and led by the National Drug and Alcohol Research Centre at UNSW Sydney, participants were recruited through community pharmacies and completed comprehensive assessments of their pain, physical and mental health, medication and cannabis.

Participants had been in pain for a median of 10 years and taken prescribed opioids for for four years. There were very high rates of physical and mental health problems. At each assessment, participants who were using cannabis reported greater pain and anxiety, were coping less well with their pain, and reported that pain was interfering more in their life, compared to those not using cannabis.

There was no clear evidence that cannabis led to reduced pain severity or pain interference or led participants to reduce their opioid use or dose. However, the users thought otherwise. Those who used cannabis, despite the study finding no evidence, reported that cannabis was effective (mean score of 7 out of 10). One possibility is that cannabis improves sleep, which in turn improves well-being, say the researchers.

The researchers say double-blind randomised placebo-controlled clinical trials are needed to better understand the impact of cannabis.

The full study being reported on is titled "Effect of cannabis use in people with chronic non-cancer pain prescribed opioids: findings from a 4-year prospective cohort study," and it is available at this link.  Reading the abstract makes clearer that this study was entirely observational in that participants were acquiring and using marijuana on their own and reporting that use rather than being giving marijuana in a controlled setting.

Among other reactions, this new study reinforces my sense that we need a lot more studies to really get a handle on the possible value of marijuana to help address the "complex problem" of chronic pain.  I am also struck by the line I emphasized above that indicate that a significant majority of marijuana users in the study believed that they were helped by marijuana when the evidence suggested otherwise.  A real interesting philosophical issue arises, for the medical profession and for governments, if it turns out that marijuana does not really help many chronic pain problems, but many users think that it does and are eager to have access to the drug because others report that it provides them relief.

July 3, 2018 in Medical community perspectives, Medical Marijuana Data and Research | Permalink | Comments (0)

Thursday, June 28, 2018

"Time Trends Matter: The Case of Medical Cannabis Laws and Opioid Overdose Mortality"

The title of this post is the title of this notable new paper now available via SSRN authored by R. Vincent Pohl.  Here is its abstract:

Mortality due to opioid overdoses has been growing rapidly in the U.S., with some states experiencing much steeper increases than others.  Legalizing medical cannabis could reduce opioid-related mortality if potential opioid users substitute towards cannabis as a safer alternative.  I show, however, that a substantial reduction in opioid-related mortality associated with the implementation of medical cannabis laws can be explained by selection bias.  States that legalized medical cannabis exhibit lower pre-existing mortality trends.  Accordingly, the mitigating effect of medical cannabis laws on opioid-related mortality vanishes when I include state-specific time trends in state-year-level difference-in-differences regressions.

June 28, 2018 in Medical Marijuana Data and Research, Recreational Marijuana Data and Research | Permalink | Comments (0)

Saturday, June 16, 2018

"High on Crime? Exploring the Effects of Marijuana Dispensary Laws on Crime in California Counties"

The title of this post is the title of this notable new research now available via SSRN authored by Priscillia Hunt, Rosalie Liccardo Pacula and Gabriel Weinberger. Here is its abstract:

Regulated marijuana markets are more common today than outright prohibitions across the U.S. states.  Advocates for policies that would legalize marijuana recreational markets frequently argue that such laws will eliminate crime associated with the black markets, which many argue is the only link between marijuana use and crime.  Law enforcement, however, has consistently argued that marijuana medical dispensaries (regulated retail sale and a common method of medical marijuana distribution), create crime in neighborhoods with these store-fronts.

This study offers new insight into the question by exploiting newly collected longitudinal data on local marijuana ordinances within California and thoroughly examining the extent to which counties that permit dispensaries experience changes in violent, property and marijuana use crimes using difference-in-difference methods.  The results suggest no relationship between county laws that legally permit dispensaries and reported violent crime.  We find a negative and significant relationship between dispensary allowances and property crime rates, although event studies indicate these effects may be a result of pre-existing trends.  These results are consistent with some recent studies suggesting that dispensaries help reduce crime by reducing vacant buildings and putting more security in these areas.  We also find a positive association between dispensary allowances and DUI arrests, suggesting marijuana use increases in conjunction with impaired driving in counties that adopt these ordinances, but these results are also not corroborated by an event study analysis.

June 16, 2018 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 | Permalink | Comments (0)

Monday, June 4, 2018

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

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

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

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

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

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

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

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

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

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

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

Thursday, May 17, 2018

"Planting the seed for marijuana use: Changes in exposure to medical marijuana advertising and subsequent adolescent marijuana use, cognitions, and consequences over seven years"

Download (14)The title of this post is the title of this notable new research now appearing in the journal Drug and Alcohol Dependence.  Here is its highlights and abstract:

Highlights

• Many adolescents are exposed to medical marijuana (MM) advertising.

• MM advertising exposure may contribute to increased marijuana use and consequences.

• Regulations for marijuana advertising are needed, similar to tobacco and alcohol.

Abstract

Background

Marijuana use during adolescence is associated with neurocognitive deficits and poorer functioning across several domains.  It is likely that more states will pass both medical and recreational marijuana legalization laws in the coming elections; therefore, we must begin to look more closely at the longitudinal effects of medical marijuana (MM) advertising on marijuana use among adolescents so that we can better understand effects that this advertising may have on their subsequent marijuana use and related outcomes.

Methods

We followed two cohorts of 7th and 8th graders (mean age 13) recruited from school districts in Southern California from 2010 until 2017 (mean age 19) to examine effects of MM advertising on adolescents’ marijuana use, cognitions, and consequences over seven years.  Latent growth models examined trajectories of self-reported exposure to medical marijuana ads in the past three months and trajectories of use, cognitions, and consequences.

Results

Higher average exposure to MM advertising was associated with higher average use, intentions to use, positive expectancies, and negative consequences.  Similarly, higher rates of change in MM advertising exposure were associated with higher rates of change in use, intentions, expectancies, and consequences over seven years.

Conclusions

Results suggest that exposure to MM advertising may not only play a significant role in shaping attitudes about marijuana, but may also contribute to increased marijuana use and related negative consequences throughout adolescence.  This highlights the importance of considering regulations for marijuana advertising, similar to regulations in place for the promotion of tobacco and alcohol in the U.S.

This RAND press release provides an account of the research behind this new article, and it begins this way:

Adolescents who view more advertising for medical marijuana are more likely to use marijuana, express intentions to use the drug and have more-positive expectations about the substance, according to a new RAND Corporation study.

The findings—from a study that tracked adolescents' viewing of medical marijuana ads over seven years—provides the best evidence to date that an increasing amount of advertising about marijuana may prompt young people to increase their use of the drug. The study was published by the journal Drug and Alcohol Dependence.

May 17, 2018 in Business laws and regulatory issues, Medical Marijuana Data and Research, Recreational Marijuana Data and Research | Permalink | Comments (0)

Wednesday, May 2, 2018

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

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

Objectives

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

Methods

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

Results

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

Conclusions

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

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

Monday, April 30, 2018

Lots of new medical marijuana coverage via CNN

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

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

Wednesday, April 25, 2018

Does the new Medical Cannabis Research Act now have a real shot at becoming law?

DownloadThe question in the title of this post is prompted by this notable new Bloomberg article headlined "Medical Marijuana Bill Gains Backing of Key Republican in House." Here are the interesting details from the piece:

House Judiciary Chairman Bob Goodlatte has agreed to co-sponsor a Florida Republican’s bipartisan bill to make medical marijuana research easier, his office confirmed on Wednesday.

That backing by the conservative Virginia Republican potentially bolsters the bill’s chances in the House. Representative Matt Gaetz started circulating a handout Tuesday night explaining his Medical Cannabis Research Act, with Goodlatte listed as a co-sponsor. "I can confirm that the chairman will co-sponsor," said Kathryn Rexrode, a spokesman for Goodlatte, who is not running for re-election, in an email.

A spokesman for Gaetz said the measure was to be introduced on Wednesday or Thursday, with its sponsors set to hold a news conference on Thursday.... A draft of the legislation was also obtained Tuesday by Bloomberg News -- as well as a separate summary Gaetz was circulating outside the House chamber.

That summary listed current co-sponsors as Goodlatte and fellow Republicans Dana Rohrabacher of California and Karen Handel of Georgia; as well as Democrats Alcee Hastings and Darren Soto of Florida; Steve Cohen of Tennessee and Earl Blumenauer of Oregon.

The measure, as described would increase the number of federally approved manufacturers of cannabis for research purposes, and it would also provide a "safe harbor" for researchers and patients in clinical trials so that institutions such as universities would not risk losing federal funding.  The bill makes it clear that the Department of Veterans Affairs could refer patients for clinical trials, and eligible researchers at the VA could perform research on medical cannabis.

Clear standards on federally approved growers would be imposed.  At the same time, the measure was described as fostering innovation, making it easier for industry leaders to work with researchers to develop new scientific breakthroughs.

Even so, the chances that most of Gaetz’s Republican colleagues will help him pass the bill in an election year are slim.  And the odds of Sessions reversing course are also long....

Asked if he’s talked to the attorney general about his new bill, Gaetz said he has not. He joked of Sessions, "doesn’t call or visit me anymore." Gaetz is among House conservatives who have been criticizing the Justice Department in unrelated battles over providing Congress documents tied to the FBI’s handing of its investigations of Hillary Clinton’s emails, and the Russia inquiry led by Special Counsel Robert Mueller.

Trump offered qualified support for legalization while on the presidential campaign trail, saying that medical marijuana “should happen” and that laws regarding recreational usage should be left in the hands of the states. Trump made his assurances this month after Republican Senator Cory Gardner of Colorado, a state that has legalized marijuana, had held up Justice Department nominees.

This article is right to suggest that the odds of any marijuana reform making it through Congress these days are slim. But because the Medical Cannabis Research Act sounds like a very modest proposal that has the backing of a key Committee Chair, this bill would seems to at least have some chance. Indeed, because there are a number of other more robust federal marijuana reform proposals gaining attention and sponsors, it strikes me as even possible that AG Jeff Sessions might not oppose this proposal as actively as he may be inclined to oppose others making the rounds.  That all said, I still think the most likely answer to the question in the title of this post is "no."

UPDATE: Over here at Marijuana Moment, Tom Angell has more details on the provisions of the Medical Cannabis Research Act.

April 25, 2018 in Federal Marijuana Laws, Policies and Practices, History of Marijuana Laws in the United States, Medical Marijuana Data and Research, Who decides | Permalink | Comments (0)

Friday, April 20, 2018

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

The title of this post is the title of this effective new WonkBlog piece by Keith Humphreys, which makes these important points:

Studies conducted at the state level show that expanding access to medical marijuana is correlated with lower rates of opioid misuse and overdose.  Yet studies of individuals show that using medical cannabis is correlated with higher rates of using and misusing opioids.  This set of conflicting research has revealed less about the relationship between marijuana and opioids than it has about how science is misunderstood and misused in political debates....

The math underlying why many such apparent contradictions exist across scientific research areas is complicated, but the underlying point is simple: We can’t know what’s happening to individuals by looking just at state data (or county or city data), and we can’t know what is happening to states just by looking at individuals. Thus there isn’t any logical contradiction between marijuana and opioid use having opposite relationships at the state and individual level.

The other statistical point of relevance here is more widely understood: Just because two things are correlated doesn’t prove there’s a causal relationship between them. However, in this particular domain, people tend to apply that rule only to the subset of studies that conflict with their views on marijuana.  Sometimes this is a conscious decision by people who want to spin the evidence, but more often it reflects unconscious, built-in flaws in human reasoning that make us more prone to attend to and trust evidence that confirms what we already believe or deeply want to believe.  That is, people who hold anti-marijuana views will be more likely to accept the individual correlational studies as proving that medical cannabis is harmful and dismiss the state-level studies as “merely correlational.”  Those with positive views of marijuana will do the reverse.  (If you want to see this phenomenon in action, watch how this article is discussed on Twitter today!)

Being human, scientists also sometimes fall prey to the same problem, being too critical of marijuana studies that don’t accord with their beliefs and not critical enough of those that do.  But at their best, scientists design rigorous studies of important questions and then accept the answers whether they (or anyone else) likes them or not.

Solving the puzzle of whether and how medical cannabis and opioids interact will require laboratory experiments and randomized clinical trials in which researchers can control exposure to both drugs rather than relying on correlational data. In one recent such study, Ziva Cooper of Columbia University found initial evidence that marijuana may modify both the pain-relieving effects and abuse liability of oxycodone.

More studies like Cooper’s are needed and should become more common if Congress is wise enough to loosen restrictions on medical marijuana research. In the meantime, the medical marijuana debate will rage on, with many people on each side citing as authoritative whichever study suits their purposes.

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

Thursday, April 12, 2018

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

53352_lgAs reported in this new press release, "US Senators Orrin Hatch (R-UT) and Kamala Harris (D-CA), both members of the Senate Judiciary Committee, sent a letter today to US Attorney General Jeff Sessions urging the Drug Enforcement Administration (DEA) to cease efforts to slow medical marijuana research, following reports that the Department of Justice was blocking medical marijuana research efforts by delaying approvals for manufacturers growing research-grade medical marijuana."  Here is more from the text of the letter:

Dear Attorney General Sessions:

We write to request that you enable the Drug Enforcement Administration (DEA) to fulfill its charter of lawfully registering manufacturers of the controlled substance of marijuana for research without delay. Research on marijuana is necessary to resolve critical questions of public health and safety, such as learning the impacts of marijuana on developing brains and formulating methods to test marijuana impairment in drivers.

To date, it has been federal practice that only one manufacturer — the University of Mississippi — is licensed to produce marijuana for federally-sanctioned research. Historically, as the DEA has noted, that single manufacturer could meet the minimal demand for research. However, the DEA changed its policy nearly two years ago because, as it explained, “There is growing public interest in exploring the possibility that marijuana or its chemical constituents may be used as potential treatments for certain medical conditions,” and the DEA — along with the Food and Drug Administration (FDA) and the National Institutes of Health (NIH) — “fully supports expanding research into the potential medical utility of marijuana and its chemical constituents.”

As of August 11, 2016, 354 individuals and institutions were approved by the DEA to conduct expansive research on marijuana and its related components. Those researchers needed access to a federally compliant expanded product line—they needed to study different types of marijuana and across various delivery mechanisms. Accordingly, a diverse, DEA-vetted market of suppliers of research-grade marijuana would be critical. Since the DEA’s Federal Register Notice on August 12, 2016, at least 25 manufacturers have formally applied to produce federally-approved research-grade marijuana....

We write this letter because research on marijuana is necessary for evidence-based decision making, and expanded research has been called for by President Trump’s Surgeon General, the Secretary of Veterans Affairs, the FDA, the CDC, the National Highway Safety Administration, the National Institute of Health, the National Cancer Institute, the National Academies of Sciences, and the National Institute on Drug Abuse. In order to facilitate such research, scientists and lawmakers must have timely guidance on whether, when, and how these manufacturers’ applications will be resolved.

The benefits of research are unquestionable. Research will give law enforcement guidance to do their jobs:protecting drivers on the roads, protecting kids in schools, and maintaining law and order. Ninety-two percent of veterans support federal research on marijuana, and the Department of Veterans’ Affairs is aware that many veterans have been using marijuana to manage the pain of their wartime wounds. America’s heroes deserve scientifically-based assessments of the substance many of them are already self-administering.

By allowing expanded research, the Department of Justice will aid legislators in making sound decisions, help law enforcement in developing critical public safety guidance, and ensure that citizens have the benefit of informed, evidence-based policy.

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

Tuesday, April 3, 2018

"Marijuana use is associated with intimate partner violence perpetration among men arrested for domestic violence"

Tps-150The title of this post is the title of this notable new research published in Translational Issues in Psychological Science. Here is the article's abstract:

Intimate partner violence (IPV) is a serious public health problem. Substance use, particularly alcohol, is a robust risk factor for IPV.  There is a small but growing body of research demonstrating that marijuana use is positively associated with IPV perpetration.  However, research on marijuana use and IPV has failed to control for other known predictors of IPV that may account for the positive association between marijuana use and IPV perpetration.  Therefore, the current study examined whether marijuana use was associated with IPV perpetration after controlling for alcohol use and problems, antisocial personality symptoms, and relationship satisfaction, all known risk factors for IPV.

Participants were men arrested for domestic violence and court-referred to batterer intervention programs (N = 269). Findings demonstrated that marijuana use was positively and significantly associated with psychological, physical, and sexual IPV perpetration, even after controlling for alcohol use and problems, antisocial personality symptoms, and relationship satisfaction.  Moreover, marijuana use and alcohol use and problems interacted to predict sexual IPV, such that marijuana use was associated with sexual IPV at high, but not low, levels of alcohol use and problems.  These findings lend additional support to the body of research demonstrating that marijuana use is positively associated with IPV perpetration in a variety of samples.  Results suggest that additional, rigorous research is needed to further explore why and under what conditions marijuana is associated with IPV perpetration.

April 3, 2018 in Criminal justice developments and reforms, Medical Marijuana Data and Research, Recreational Marijuana Data and Research | Permalink | Comments (0)

Monday, April 2, 2018

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

180402-imd-ec-800As reported via this CNN article, headlined "Marijuana legalization could help offset opioid epidemic, studies find," this weeks bring the publication of notable new research suggesting a link between marijuana access and reduced use of opioids. Here are the basics:

Experts have proposed using medical marijuana to help Americans struggling with opioid addiction. Now, two studies suggest that there is merit to that strategy. The studies, published Monday in the journal JAMA Internal Medicine, compared opioid prescription patterns in states that have enacted medical cannabis laws with those that have not. One of the studies looked at opioid prescriptions covered by Medicare Part D between 2010 and 2015, while the other looked at opioid prescriptions covered by Medicaid between 2011 and 2016.

The researchers found that states that allow the use of cannabis for medical purposes had 2.21 million fewer daily doses of opioids prescribed per year under Medicare Part D, compared with those states without medical cannabis laws. Opioid prescriptions under Medicaid also dropped by 5.88% in states with medical cannabis laws compared with states without such laws, according to the studies....

In order to evaluate whether medical marijuana could function as an effective and safe alternative to opioids, the two teams of researchers looked at whether opioid prescriptions were lower in states that had active medical cannabis laws and whether those states that enacted these laws during the study period saw reductions in opioid prescriptions.

Both teams, in fact, did find that opioid prescriptions were significantly lower in states that had enacted medical cannabis laws. The team that looked at Medicaid patients also found that the four states that switched from medical use only to recreational use -- Alaska, Colorado, Oregon and Washington -- saw further reductions in opioid prescriptions, according to Hefei Wen, assistant professor of health management and policy at the University of Kentucky and a lead author on the Medicaid study. "We saw a 9% or 10% reduction (in opioid prescriptions) in Colorado and Oregon," Wen said. "And in Alaska and Washington, the magnitude was a little bit smaller but still significant."...

The details of the medical cannabis laws were found to have a significant impact on opioid prescription patterns, the researchers found. States that permitted recreational use, for example, saw an additional 6.38% reduction in opioid prescriptions under Medicaid compared with those states that permitted marijuana only for medical use, according to Wen.

The method of procurement also had a significant impact on opioid prescription patterns. States that permitted medical dispensaries -- regulated shops that people can visit to purchase cannabis products -- had 3.742 million fewer opioid prescriptions filled per year under Medicare Part D, while those that allowed only home cultivation had 1.792 million fewer opioid prescriptions per year.

"We found that there was about a 14.5% reduction in any opiate use when dispensaries were turned on -- and that was statistically significant -- and about a 7% reduction in any opiate use when home cultivation only was turned on," Bradford said. "So dispensaries are much more powerful in terms of shifting people away from the use of opiates."...

This is not the first time researchers have found a link between marijuana legalization and decreased opioid use. A 2014 study showed that states with medical cannabis laws had 24.8% fewer opioid overdose deaths between 1999 and 2010. A study in 2017 also found that the legalization of recreational marijuana in Colorado in 2012 reversed the state's upward trend in opioid-related deaths.

Here are links to the JAMA Internal Medicine articles referenced here, as well as a companion commentary:

Medical and Adult-Use Marijuana Laws and Opioid Prescribing for Medicaid Enrollees by Hefei Wen & Jason Hockenberry

Association Between US State Medical Cannabis Laws and Opioid Prescribing in the Medicare Part D Population by Ashley C. Bradford et al

The Role of Cannabis Legalization in the Opioid Crisis by Kevin Hill & Andrew Saxon

 

Some (of many) prior related posts:

April 2, 2018 in Medical community perspectives, Medical Marijuana Commentary and Debate, Medical Marijuana Data and Research, Medical Marijuana State Laws and Reforms, Recreational Marijuana Data and Research | Permalink | Comments (0)