Monday, June 26, 2017
The title of this post is the title of this notable new article by multiple authors to soon appear in the American Journal of Public Health. Here is the abstract:
Background. Cannabis use is common in North America, especially among young people, and is associated with a risk of various acute and chronic adverse health outcomes. Cannabis control regimes are evolving, for example toward a national legalization policy in Canada, with the aim to improve public health, and thus require evidence-based interventions. As cannabis-related health outcomes may be influenced by behaviors that are modifiable by the user, evidence-based Lower-Risk Cannabis Use Guidelines (LRCUG) — akin to similar guidelines in other health fields — offer a valuable, targeted prevention tool to improve public health outcomes.
Objectives. To systematically review, update, and quality-grade evidence on behavioral factors determining adverse health outcomes from cannabis that may be modifiable by the user, and translate this evidence into revised LRCUG as a public health intervention tool based on an expert consensus process.
Search methods. We used pertinent medical search terms and structured search strategies, to search MEDLINE, EMBASE, PsycINFO, Cochrane Library databases, and reference lists primarily for systematic reviews and meta-analyses, and additional evidence on modifiable risk factors for adverse health outcomes from cannabis use.
Selection criteria. We included studies if they focused on potentially modifiable behavior-based factors for risks or harms for health from cannabis use, and excluded studies if cannabis use was assessed for therapeutic purposes.
Data collection and analysis. We screened the titles and abstracts of all studies identified by the search strategy and assessed the full texts of all potentially eligible studies for inclusion; 2 of the authors independently extracted the data of all studies included in this review. We created Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow-charts for each of the topical searches. Subsequently, we summarized the evidence by behavioral factor topic, quality-graded it by following standard (Grading of Recommendations Assessment, Development, and Evaluation; GRADE) criteria, and translated it into the LRCUG recommendations by the author expert collective on the basis of an iterative consensus process.
Main results. For most recommendations, there was at least “substantial” (i.e., good-quality) evidence. We developed 10 major recommendations for lower-risk use: (1) the most effective way to avoid cannabis use–related health risks is abstinence; (2) avoid early age initiation of cannabis use (i.e., definitively before the age of 16 years); (3) choose low-potency tetrahydrocannabinol (THC) or balanced THC-to-cannabidiol (CBD)–ratio cannabis products; (4) abstain from using synthetic cannabinoids; (5) avoid combusted cannabis inhalation and give preference to nonsmoking use methods; (6) avoid deep or other risky inhalation practices; (7) avoid high-frequency (e.g., daily or near-daily) cannabis use; (8) abstain from cannabis-impaired driving; (9) populations at higher risk for cannabis use–related health problems should avoid use altogether; and (10) avoid combining previously mentioned risk behaviors (e.g., early initiation and high-frequency use).
Authors’ conclusions. Evidence indicates that a substantial extent of the risk of adverse health outcomes from cannabis use may be reduced by informed behavioral choices among users. The evidence-based LRCUG serve as a population-level education and intervention tool to inform such user choices toward improved public health outcomes. However, the LRCUG ought to be systematically communicated and supported by key regulation measures (e.g., cannabis product labeling, content regulation) to be effective. All of these measures are concretely possible under emerging legalization regimes, and should be actively implemented by regulatory authorities. The population-level impact of the LRCUG toward reducing cannabis use–related health risks should be evaluated.
Public health implications. Cannabis control regimes are evolving, including legalization in North America, with uncertain impacts on public health. Evidence-based LRCUG offer a potentially valuable population-level tool to reduce the risk of adverse health outcomes from cannabis use among (especially young) users in legalization contexts, and hence to contribute to improved public health outcomes.
Wednesday, June 21, 2017
The question in the title of this post is prompted by this notable new New York Daily News article headlined "Science: Regular consumption of marijuana keeps you thin, fit and active." I am not sure the article that follows entire backs up the implication of this headline, but here are excerpts from the article that are still encouraging:
An apple a day keeps the doctor away. Here’s a new health-related adage to consider: Regular consumption of marijuana keeps you thin and active. According to researchers at Oregon Health and Science University, people who use marijuana more than five times per month have a lower body mass index (BMI) than people who do not marijuana.
The researchers concluded: “Heavy users of cannabis had a lower mean BMI compared to that of never users, with a mean BMI being 26.7 kg/m in heavy users and 28.4 kg/m in never users.”
The study also suggested that people who consume marijuana on a regular basis are more physically activity than those that use it sporadically or not at all.
Of course, this is not the first time scientific studies have reached this conclusion: A study published last year in the Journal of Mental Health Policy and Economics suggests that regular consumers of cannabis have a lower BMI than those who do not use the drug.
A 2013 study published in the American Journal of Medicine found that cannabis consumers have 16 percent lower levels of fasting insulin and 17 percent lower insulin resistance levels than non-users. The research found “significant associations between marijuana use and smaller waist circumferences.”
And data published in British Medical Journal in 2012 reported that cannabis consumers had a lower prevalence of type 2 diabetes and a lower risk of contracting the disease than did those with no history of cannabis consumption.
In the 2016 study, lead author Isabelle C. Beulaygue from the University of Miami concluded: “There is a popular belief that people who consume marijuana have the munchies, and so [THEY]are going to eat a lot and gain weight, and we found that it is not necessarily the case.”
Researchers have not identified the reason behind the findings. But some suggest that those who consume cannabis regularly may be able to more easily break down blood sugar, which may help prevent weight gain.
Thursday, June 15, 2017
As reported in this new Roll Call article, a "bipartisan group of senators and representatives have reintroduced legislation that would enable states to set their own medical marijuana policies." Here are the basics:
Senators Cory Booker, D-N.J., and Kirsten Gillibrand, D-N.Y., joined by Rep. Steve Cohen, D-Tenn., made the announcement on Thursday....
The legislation reintroduced Thursday would protect patients, doctors and businesses participating in state medical-marijuana programs from federal prosecution. The Compassionate Access, Research Expansion and Respect States (CARERS) Act would not legalize medical marijuana in all 50 states. Instead, it would ensure that people in the states where medical cannabis is legal can use it without violating federal law.
In addition to Booker and Gillibrand, co-sponsors of the CARERS Act include Senators Rand Paul, R-Ky., Mike Lee, R-Utah, Lisa Murkowski, R-Alaska, and Al Franken, D-Minn.
This press release from Senator Booker is titled "Lawmakers Reintroduce Bipartisan, Bicameral Medical Marijuana Bill: CARERS Act would ensure patients have access to lifesaving care without fear of federal prosecution." The press release includes quotes from all the sponsors and state that "the CARERS Act would:
(1) Recognize States’ Responsibility to Set Medical Marijuana Policy & Eliminate Potential Federal Prosecution
The CARERS Act amends the Controlled Substances Act so that states can set their own medical marijuana policies. The patients, providers, and businesses participating in state medical marijuana programs will no longer be in violation of federal law and vulnerable to federal prosecution.
(2) Allow States to Import Cannabidiol (CBD), Recognized Treatment for Epilepsy and Seizure Disorders
The CARERS Act amends the Controlled Substances Act to remove specific strains of CBD oil from the federal of definition of marijuana. This change will allow youth suffering from intractable epilepsy to gain access to the medicine they need to control their seizures.
(3) Provide Veterans Access
Current law prohibits doctors in Department of Veterans Affairs (VA) facilities from prescribing medical marijuana. The CARERS Act would allow VA doctors in states where medical marijuana is legal to recommend medical marijuana to military veterans.
(4) Expand Opportunities for Research
The CARERS Act removes unnecessary bureaucratic hurdles for researchers to gain government approval to undertake important research on marijuana and creates a system for the Secretary of the Department of Health and Human Services to encourage research.
The CARERS Act has the support of more than 20 health, veteran and policy organizations, including: American Civil Liberties Union, Americans for Safe Access, Compassionate Care NY, Coalition for Medical Marijuana NJ, Drug Policy Alliance, Housing Works, Law Enforcement Against Prohibition, Marijuana Policy Project, MS Resources of Central New York, Multidisciplinary Association for Psychedelic Studies, New Jersey Hospice and Palliative Care Organization, NY Physicians for Compassionate Care, Parents Coalition for Rescheduling Medical Cannabis, Patients Out of Time, Students for Sensible Drug Policy, The American Cannabis Nurses Association, The Breast Cancer Coalition of Rochester, Third Way, Veterans for Medical Cannabis Access, Veterans for Peace and Veterans for Safe Access and Compassionate Care."
June 15, 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 (1)
Monday, June 12, 2017
"Loose regulation of medical marijuana programs associated with higher rates of adult marijuana use but not cannabis use disorder"
The lengthy title of this post is the lengthy title of this new research to appearing in the journal Addiction. Here are the summary details via the abstract:
Background and Aims
Most U.S. states have passed medical marijuana laws (MMLs), with great variation in program regulation impacting enrollment rates. We aimed to compare changes in rates of marijuana use, heavy use, and Cannabis Use Disorder across age groups while accounting for whether states enacted medicalized (highly regulated) or non-medical MML programs.
Difference-in-differences estimates with time-varying state-level MML coded by program type (medicalized v. non-medical). Multilevel linear regression models adjusted for state-level random effects and covariates as well as historical trends in use. Setting Nationwide cross-sectional survey data from the U.S. National Survey of Drug Use and Health (NSDUH) restricted use data portal aggregated at the state level.
2004-2013 NSDUH respondents (N ~ 67,500/year); age groups 12-17, 18-25, and 26+ years. States had implemented 8 medicalized and 15 non-medical MML programs.
Primary outcome measures included 1) Active (past-month) marijuana use; 2) Heavy use (>300 days/year); and 3) Cannabis Use Disorder diagnosis, based on DSM-IV criteria. Covariates included program type, age group, and state-level characteristics across the study period.
Adults 26+ years of age living in states with non-medical MML programs increased past-month marijuana use 1.46% (from 4.13% to 6.59%, p=0.01) skewing toward greater heavy marijuana by 2.36% (from 14.94 to 17.30, p=0.09) after MMLs were enacted. However, no associated increase in the prevalence of Cannabis Use Disorder was found during the study period. Our findings do not show increases in prevalence of marijuana use among adults in states with medicalized MML programs. Additionally, there were no increases in adolescent or young adult marijuana outcomes following MML passage, irrespective of program type.
Non-medical marijuana laws enacted in US states are associated with increased marijuana use, but only among adults 26+ years.
Thursday, June 1, 2017
Bloomberg has this notable new article headlined "Trump Casts Cloud Over Cannabis, But Money Keeps Pouring In," and here are excerpts:
The Trump administration’s adversarial stance toward marijuana has brought jitters to the burgeoning cannabis industry, but money continues to pour in.
Pot-related companies raised more than $734 million between Jan. 1 and April 21, an almost sevenfold increase from $108 million in the same period last year, according to a report from New Frontier Data and Viridian Capital Advisors. That brings the total amount raised to $1.9 billion since the start of 2016.
The investment surge reflects optimism that President Donald Trump and Attorney General Jeff Sessions won’t crack down on the industry, even as those concerns weigh on stock prices this year. Since hitting a peak in February, the Bloomberg Intelligence Global Cannabis Index has dropped 36 percent.
For cannabis financiers, the industry’s growth potential outshines the political risk. Eight states voted to legalize cannabis in some form on Nov. 9, including the nation’s largest. Legal cannabis demand in California is set to grow by 50 percent in 2018, when recreational use is scheduled to come online, according to the report. The report’s authors forecast that national demand for legalized marijuana will almost quadruple by 2025.
“With each new state that legalizes, that need for capital is going to be there,” said John Kagia, New Frontier’s executive vice president of industry analytics and author of the report. “It will continue to represent a substantial investment opportunity for the foreseeable future.” As a result of competition for funding, seed capital is being raised in greater initial amounts and its cost is getting more expensive, New Frontier Chief Executive Officer Giadha Aguirre de Carcer said.
The boom has taken place amid an unclear policy outlook under Trump. Press Secretary Sean Spicer said in February that he expects the Department of Justice to increase enforcement of federal laws prohibiting recreational pot use, even in states where it’s allowed. While Spicer defended medical marijuana, Sessions indicated he dislikes anything to do with the plant....
The uncertainty has made some investors more nervous about getting into the industry. “There’s a lot of fear,” said Rob Hunt, a founding partner of Tuatara Capital, which invests in cannabis companies and has more than $100 million under management. The silver lining, however, is that “it’s not very likely we’re ever getting someone further to the right on this issue than Sessions is.”...
Neither the political threats nor ongoing banking and tax difficulties will ultimately derail the industry, Viridian and New Frontier predict. Legal sales of cannabis products are expected to reach $24.1 billion in 2025, up from $6.6 billion in 2016. Investment will keep gaining too, particularly because interstate commerce is prohibited. That means every state that legalizes weed must create its own infrastructure....
“What we’ve also seen in the past 18 months or so is an increased number of more sophisticated companies entering the industry,” De Carcer said. And they’ve come with “more mature and experienced management teams,” she said.
Wednesday, May 24, 2017
As reported in this NBC News piece, headlined "Cannabis Drug Reduces Seizures in Severe Epilepsy Cases," some encouraging new research news was published in a major medical journal today. Here are the details:
A compound taken from marijuana greatly helped some children with a severe and often deadly form of epilepsy and completely stopped seizures in a very few, researchers reported Wednesday. It's a rare success in a field suffused with more hope than facts — in which advocates clamor to have marijuana and compounds taken from the herb legalized for free use, while government rules limit use and researchers struggle to prove what works and what doesn't.
In this study, the researchers enrolled kids with Dravet syndrome, a very rare and often deadly form of epilepsy caused by a genetic mutation. These kids have multiple, prolonged seizures that cause brain damage. There's no treatment. "It's hard to portray how serious and devastating this is," Dr. Orrin Devinsky, director of the New York University Comprehensive Epilepsy Center, told NBC News.
Devinsky and colleagues around the country tested a cannabis derivative called cannabidiol — CBD for short — on 120 Dravet syndrome patients. Half took it for 14 weeks and half got a placebo.
"Seizure frequency dropped in the cannabidiol-treated group by 39 percent from nearly 12 convulsive seizures per month before the study to about six; three patients' seizures stopped entirely," the team wrote in the New England Journal of Medicine. "In the placebo group, there was a 13 percent reduction in seizures from about 15 monthly seizures to 14," they added.
"Quite remarkably, 5 percent of the children in the active treatment group with CBD were completely seizure free during the 14 weeks of the trial," Devinsky said. "And these were kids who were often having dozens of seizures, if not many more than that per week."
The kids who got CBD were more likely to stop the trial because of side-effects. "Side-effects were generally mild or moderate in severity, with the most common being vomiting, fatigue and fever," Devinsky wrote. But those who have been helped have been transformed, he added. "There's no doubt for some children this is just been an incredibly effective and game changing medication for them," Devinsky said.
"These are some of the children I care for [who] were in wheelchairs, were barely able to open their eyes in an office visit and really showed no emotion and … now they come in, they're walking, they're smiling, they're interactive. It's like a different human being in front of you."
He said it's not quite accurate to called CBD "medical marijuana."
"Cannabidiol is the major non-psychoactive compound present in cannabis or marijuana," Devinsky said. "In this study, we were giving a compound CBD which has no high-producing or psychoactive properties."...
"The drug we gave was derived from cannabis or marijuana but it really should not be confused with the medical marijuana that would be obtained from dispensaries in the 44 U.S. states that have approved it. Those typically contain combinations of THC with CBD and many other compounds," Devinsky said.
It's not clear precisely how CBD works. It appears to attach to brain cells, he said. "The CBD binds with a novel receptor in the brain and thereby dampens down too much electrical activity," he said. "It seems to be a relatively unique mechanism of action that's not shared by any of the existing seizure medications."
Doctors are interested in trying CBD on autism, anxiety, inflammatory and autoimmune disorders, Devinsky said. It may help people with other types of seizures, as well....
Australian epilepsy expert Dr. Samuel Berkovic said much more testing is needed. "This trial represents the beginning of solid evidence for the use of cannabinoids in epilepsy," Berkovic, who works at the University of Melbourne, wrote in a commentary.
Sunday, May 21, 2017
American Legion, the largest US vets' organization, pressing Trump Administration on medical marijuana reform
This new Politico article, headlined "American Legion to Trump: Allow marijuana research for vets," reports on a notable new push by a notable organization to seek a notable change in federal marijuana laws with the new administration. Here are excerpts from an article which strikes me as pretty big news:
One of the nation’s most conservative veterans’ groups is appealing to President Donald Trump to reclassify marijuana to allow large-scale research into whether cannabis can help troops suffering from post-traumatic stress disorder . The change sought by The American Legion would conflict with the strongly anti-marijuana positions of some administration leaders, most vocally Attorney General Jeff Sessions.
Under current rules, doctors with the Department of Veterans Affairs cannot even discuss marijuana as an option with patients. But the alternative treatment is gaining support in the medical community, where some researchers hope pot might prove more effective than traditional pharmaceuticals in controlling PTSD symptoms and reducing the record number of veteran suicides.
"We are not asking for it to be legalized," said Louis Celli, the national director of veterans affairs and rehabilitation for the American Legion, which with 2.4 million members is the largest U.S. veterans’ organization. "There is overwhelming evidence that it has been beneficial for some vets. The difference is that it is not founded in federal research because it has been illegal."
The Legion has requested a White House meeting with Jared Kushner, Trump's son-in-law and close aide, "as we seek support from the president to clear the way for clinical research in the cutting edge areas of cannabinoid receptor research," according to a recent letter shared with POLITICO.
The request marks a significant turn in the debate over medical marijuana by lending an influential and unexpected voice. The Legion, made up mostly of Vietnam and Korean War-era veterans, is breaking with other leading vets’ groups such as the Veterans of Foreign Wars in lobbying for the removal of the major roadblock in pursuing marijuana treatment. But it also comes as the new administration, led by Sessions, is sending strong signals of its desire to thwart marijuana decriminalization and legalization efforts. Expectations are growing in Congress that DOJ may even try to roll back medical marijuana laws in 29 states....
"We desperately need more research in this area to inform policymakers," said Sue Sisley, a psychiatrist at the Scottsdale Research Institute in Arizona who is running one of the only cannabis studies underway focused on vets suffering from PTSD. "I really want to see the most objective data published in peer reviewed medical journals.” She added that she isn’t prejudging what the outcome of the research will be.
“I don't know if cannabis will turn out to be helpful for PTSD,” Sisley said. “I know what veterans tell me but until we have rigorous controlled trials, all we have are case studies that are not rigorous enough to make me, medical professionals, health departments or policymakers convinced."
Some veterans’ activists are angry at the federal government’s continued resistance to even studying cannabis, even as an average of 20 vets kill themselves every day. "We need solutions," said Nick Etten, a former Navy SEAL who runs the Veterans Cannabis Project, a health policy organization. "We need treatment that works. We need treatment that is not destructive. The VA has been throwing opiates at veterans for almost every condition for the last 15 years. You are looking at a system that has made a problem worse the way they have approached treatment."...
The VA declined to address whether it is reconsidering its stance on the issue, citing the illegality of marijuana in all its forms under federal law.... Most leading veterans’ groups are toeing that line, including Veterans of Foreign Wars. "The VFW has no official position regarding this ongoing debate because marijuana is illegal under federal law," said Joe Davis, the group's spokesman.
But grassroots support is growing among veterans — both young and older — and in Congress to reconsider the current approach. Much of that is because of growing anecdotal evidence that marijuana helps some veterans with PTSD control their symptoms when approved drugs do not, such as ridding them of nightmares and helping them sleep. And that is what is driving the efforts of the American Legion. Celli said the group's Veterans Affairs & Rehabilitation Commission, which represents veterans from World War II to the wars in Iraq and Afghanistan, recently gave the Legion "overwhelming support" to advocate changes....
In addition to cannabis, the organization is advocating for more research on so-called Quantitative EEG neurometrics, which measures the brain's electrical activity. "The American Legion believes these two areas alone can help cut the amount of veteran suicides and cases of chemically addicted veteran by more than half," the letter to the White House says. "The American Legion respectfully requests a meeting with President Trump as soon as possible and looks forward to partnering with this administration in the fight against narcotics addiction and reducing the veteran suicide rate from the tragic loss of 20 warriors per day, to zero."
Friday, May 19, 2017
The title of this post is the headline of this lengthy CNN piece. Here are excerpts:
Most European countries and Canada have embraced the idea of harm reduction, designing policies that help people with drug problems to live better, healthier lives rather than to punish them. On the front lines of addiction in the United States, some addiction specialists have also begun to work toward this end.
Joe Schrank, program director and founder of High Sobriety, is one of them. He says his Los Angeles-based treatment center uses medicinal cannabis as a detox and maintenance protocol for people who have more severe addictions, although it's effectiveness is not scientifically proven. "So it's a harm-reduction theory," he said. "With cannabis, there is no known lethal dose; it can be helpful for certain conditions."
"Some say it's hypocritical because, you know, you're supposed to go to rehab to get off drugs," said Schrank, who recently celebrated 20 years of sobriety from alcohol and all drugs. "And cessation of drug use can be a goal for some people, but pacing is also important." Some patients want to gradually move into abstinence, weaning themselves off drugs over time. Others want to maintain sobriety from a drug by using a less harsh drug, such as cannabis.
Others, including Todd Stumbo, CEO of Blue Ridge Mountain Recovery Center in Georgia, do not favor using marijuana as treatment for addiction. "I'm all about adding interventions and therapeutic techniques that have proven to be significantly profound in the changes to somebody's life and treatment. Unfortunately, I don't know that there's evidence to substantiate that marijuana's had that effect," says Stumbo. "Our take is abstinence based and we use every tool or intervention we can that's been proven effective in the past."
Still, harm reduction is gaining acceptance in the wider field of addiction specialists in the U.S. "In principle, what we have aimed for many years is to find interventions that would lead to complete abstinence," said Dr. Nora Volkow, director of the National Institute on Drug Abuse. Practically, though, that has been very difficult to achieve with relapsing addictions.
"One of the things is, we don't have any evidence-based medication that has proven to be efficacious for the treatment of cocaine addiction," Volkow said. "So we currently have no medicine to intervene, and it can be a very severe addiction and actually quite dangerous."...
"We have started to explore the extent to which interventions that can decrease the amount of drug consumed can have benefits to the individual," Volkow said, adding that she'd make this same argument for opioids and heroin. "It would be valuable to decrease the amount of drug consumed."...
Schrank, who readily concedes there are possible health and addiction risks with marijuana, says he offers his cannabis detox and maintenance protocol to people addicted to crack cocaine as well as those trying to kick opioids. Through the years, he says, he's treated about 50 people with this technique and expects to see "more people wanting to try to have a voice in their recovery rather than just plug into systems telling them what to do." Marijuana "can really help people with pain management and other health issues, or it can help them be safer," Schrank said.
Yasmin Hurd, director of the Addiction Institute at Mount Sinai School of Medicine, says generally, cannabidiol is the more important compound when it comes to marijuana as a treatment for addiction. It is one of the two primary cannabinoids, along with Δ9-tetrahydrocannabinol (THC), found in the cannabis plant. In terms of the wider scope of medical marijuana research, this is the "same cannabidiol being looked at for the kids with epilepsy," Hurd said.
Thursday, May 18, 2017
Minnesota health department reports "perceptions of a high degree of benefit for most patients" in state's medical marijuana program
Minnesota's medical marijuana program has garnered some headlines this week in part because of reports of big economic losses being suffered by industry players. As this local article details, "Minnesota's medical marijuana manufacturing companies have lost $11 million in just two years of sales." But the story emerging from the state this week that seems greater potential import and impact concerns a state study of patients noted this AP piece headlined "Study: Minnesota medical marijuana patients report benefits."
The study comes from the Minnesota Department of Health and is titled "Minnesota Medical Cannabis Program: Patient Experiences from the First Program Year." The complete report is due to to be released next month, but this Executive Summary was released this week and includes these passages:
Between July 1, 2015 and June 30, 2016 a total of 1660 patients enrolled in the program and 577 health care practitioners registered themselves in order to certify that patients have a medical condition that qualifies them for the program. The most common qualifying conditions were severe and persistent muscle spasms (43%), cancer (28%), and seizures (20%). Each of the remaining six qualifying conditions during the first year – Crohn’s Disease, Terminal illness, HIV/AIDS, Tourette Syndrome, glaucoma, and ALS – accounted for less than 10% of patients. Ten percent (167 patients) were certified for more than one qualifying condition. Most patients were middle-aged (56% between ages 36-64), 11% were <18, and 11% were ≥65. Distribution by race/ethnicity generally matched the state’s demographics, with 90% of patients describing themselves as white....
Information on patient benefits comes from the Patient Self-Evaluations (PSE) completed by patients prior to each medical cannabis purchase and from patient and health care practitioner surveys. Results of analysis of PSE and survey data indicate perceptions of a high degree of benefit for most patients....
Moderate to severe levels of non-disease-specific symptoms such as fatigue, anxiety, and sleep difficulties were common across all the medical conditions. And the reductions in these symptoms was often quite large. These findings support the understanding that some of the benefit perceived by patients is expressed as improved quality of life.
Thursday, May 11, 2017
In a post last month, I asked "Is the Trump Administration driving a 2017 spike in Colorado marijuana sales?" based on data showing increased marijuana sales in Colorado the first two months of this year. Now, via this new Cannabist piece, headlined "Colorado marijuana sales top $131M, set record in March 2017," we have additional data on ever-increasing sales, though there is no way to tell from basic sales data if the market is experiencing general growth or if folks in Colorado may be stocking up on marijuana in light of uncertainty concerning federal marijuana policies under a new administration. Speculations about reasons aside, here are the basic sales details along with some perspectives via The Cannabist:
The Colorado cannabis industry’s unbridled growth hasn’t waned — in fact, it’s still setting records. The state’s licensed marijuana shops captured nearly $132 million of recreational and medical cannabis sales in March, according to The Cannabist’s extrapolations of state sales tax data made public Tuesday.
The monthly sales haul of $131.7 million sets a new record for Colorado’s relatively young legal marijuana industry, besting the previous high of $127.8 million set last September, The Cannabist’s calculations show. It’s the tenth consecutive month that sales have topped $100 million.
Sales tax revenue generated for the state during March was $22.9 million, according to the Colorado Department of Revenue. March’s sales totals were 48 percent higher than those tallied in March 2016, according to The Cannabist’s calculations. The month closes out a quarter in which sales were up nearly 36 percent from the first three months of last year.
In 2016, the year-over-year quarterly growth rate ranged between 29 percent and 39.6 percent. The Cannabist also found that March 2017’s year-over-year percentage growth outpaced much of what was seen on a monthly basis last year. Monthly growth rates from calendar year 2015 to 2016 averaged nearly 34 percent.
It was this continued rate of growth that caught the attention of some analysts and economists contacted by The Cannabist. Andrew Livingston, director of economics and research for cannabis law firm Vicente Sederberg, separately calculated out the year-over-year monthly growth rate for Colorado cannabis sales and saw a trend emerge.
“The year-over-year rates of growth have continued at a steady pace, which to me indicates that we have not yet reached the point at which we are starting to cap out the market,” he said. At that point, he added, the growth rates would start to decline.
If the current growth rates keeps up, April 2017 should be another record month, and the summer of 2017 should set new highs, Livingston predicted. And by the end of the year, that could add up to an industry boasting $1.6 billion in sales, he said.
“We’re surprised that sales continue to grow so quickly,” said Miles Light, an economist with the Marijuana Policy Group, a Denver-based financial, policy, research and consulting firm focused on the marijuana industry. “We are not surprised that almost all of the sales growth is in the retail marijuana space.” Adult-use sales, which hit a new monthly high of $93.3 million, accounted for the lion’s share of the March totals. Medical cannabis transactions totaled $38.4 million.
Light and other economists have previously projected that Colorado’s marijuana market would eventually hit a ceiling as the draw from the black market becomes more complete, regular economic cycles take hold and other states implement adult-use sales. It’s hard to predict when that plateau may occur, but the license and application fees in the March 2017 report were telling, Light said.
Ten months into Colorado’s fiscal year (the latest report for March sales show tax revenue remitted in April), the license and application fees for medical marijuana businesses and retail marijuana businesses were down 25.4 percent and 8.5 percent, respectively, according to the Colorado Department of Revenue report. “This shows that fewer new firms are entering and, I believe, shows that … sales should be tapering off or declining,” he said.
Whatever the particular reasons for the strong and steady sales growth in Colorado, there numbers seem certain to keep investors and other business players "bullish" on the marijuana industry at least for the time being. And such business bullishness will likely continue to fuel various efforts in various jurisdictions to continue moving forward with or expand the reach of marijuana reform.
Prior related post:
May 11, 2017 in Business laws and regulatory issues, Medical Marijuana Data and Research, Medical Marijuana State Laws and Reforms, Recreational Marijuana Data and Research, Recreational Marijuana State Laws and Reforms, Taxation information and issues | Permalink | Comments (0)
Wednesday, May 10, 2017
The question in the title of this post is prompted by this new Scientific American piece headlined "Marijuana May Boost, Rather Than Dull, the Elderly Brain." Here are excerpts:
Picture the stereotypical pot smoker: young, dazed and confused. Marijuana has long been known for its psychoactive effects, which can include cognitive impairment. But new research published this week in Nature Medicine suggests the drug might affect older users very differently than young ones—at least in mice. Instead of impairing learning and memory as it does in young people, the drug appears to reverse age-related declines in the cognitive performance of elderly mice.
Researchers led by Andreas Zimmer of the University of Bonn in Germany gave low doses of delta 9-tetrahydrocannabinol, or THC, marijuana’s main active ingredient, to young, mature and aged mice. As expected, young mice treated with THC performed slightly worse on behavioral tests of memory and learning. For example, after THC young mice took longer to learn where a safe platform was hidden in a water maze, and they had a harder time recognizing another mouse to which they had previously been exposed. Without the drug, mature and aged mice performed worse on the tests than young ones did. But after receiving THC the elderly animals’ performances improved to the point that they resembled those of young, untreated mice. “The effects were very robust, very profound,” Zimmer says.
Other experts praised the study but cautioned against extrapolating the findings to humans. “This well-designed set of experiments shows that chronic THC pretreatment appears to restore a significant level of diminished cognitive performance in older mice, while corroborating the opposite effect among young mice,” Susan Weiss, director of the Division of Extramural Research at the National Institute on Drug Abuse who was not involved in the study, wrote in an e-mail. Nevertheless, she added, “While it would be tempting to presume the relevance of these findings [extends] to aging humans…further research will be critically needed.”...
The findings raise the intriguing possibility THC and other “cannabinoids” might act as anti-aging molecules in the brain. Cannabinoids include dozens of biologically active compounds found in the Cannabis sativa plant. THC, the most highly studied type, is largely responsible for marijuana’s psychoactive effects. The plant compounds mimic our brain’s own marijuanalike molecules, called endogenous cannabinoids, which activate specific receptors in the brain capable of modulating neural activity. “We know the endogenous cannabinoid system is very dynamic; it goes through changes over the lifespan,” says Ryan McLaughlin, a researcher who studies cannabis and stress at Washington State University and was not involved in the current work. Research has shown the cannabinoid system develops gradually during childhood, “and then it blows up in adolescence—you see increased activity of its enzymes and receptors,” McLaughlin says. “Then as we age, it’s on a steady decline.”
That decline in the endogenous cannabinoid system with age fits with previous work by Zimmer and others showing cannabinoid-associated molecules become more scant in the brains of aged animals. “The idea is that as animals grow old, similar to in humans, the activity of the endogenous cannabinoid system goes down—and that coincides with signs of aging in the brain,” Zimmer says. “So we thought, what if we stimulate the system by supplying [externally produced] cannabinoids?”...
The researchers don’t suggest seniors should rush out and start using marijuana. “I don’t want to encourage anyone to use cannabis in any form based on this study,” Zimmer says. Older adults looking to medical cannabis to relieve chronic pain and other ailments are concerned about its side effects, Ware says. “They want to know: Does this cause damage to my brain? Will it impair my memory? If this data holds up in humans…it may suggest that [THC] isn’t likely to have a negative impact if you’re using the right dose. Now the challenge is thrown down to clinical researchers to study that in people,” Ware says. Zimmer and his colleagues plan to do just that. They have secured funding from the German government, and after clearing regulatory hurdles they will begin testing the effects of THC in elderly adults with mild cognitive impairments.
Thursday, April 27, 2017
The title of this post is the title of this notable newly updated report with newly updated statistics about the road-safety problems created by drugged driving. Here is a part of the report's introduction and background:
This report, originally released in September 2015, was prepared by Dr. James Hedlund under contract with the Governors Highway Safety Association (GHSA), the national association of state and territorial highway safety offices that address behavioral highway-safety issues, including drugimpaired driving. An open forum on drugged driving at GHSA’s 2014 Annual Meeting noted the need for this type of resource. Funding was provided by the Foundation for Advancing Alcohol Responsibility (Responsibility.org).
This revision, also prepared by Dr. Hedlund, updated the report to April 2017. It includes 34 additional citations, drug-impaired driving data from 2015, state laws as of April 2017, and 15 state programs.
The report was guided by an advisory panel of experts from the states, the research community, and several organizations concerned with impaired driving. It provides references to research and position papers, especially papers that summarize the research on drugs and driving that have appeared in the last 20 years. It includes information obtained by GHSA from a survey of state highway safety offices. It does not attempt to be a complete review of the extensive information available on drugs and driving.
Drug-impaired driving is an increasingly critical issue for states and state highway safety offices. In 2015, the most recent year for which data are available, NHTSA’s Fatality Analysis Reporting System (FARS) reported that drugs were present in 43% of the fatally-injured drivers with a known test result, more frequently than alcohol was present (FARS, 2016). NHTSA’s 2013–2014 roadside survey found drugs in 22% of all drivers both on weekend nights and on weekday days (Berning et al., 2015).
In particular, marijuana use is increasing. As of April 2017, marijuana may be used for medical purposes in 29 states and the District of Columbia (NCSL, 2017a). The most recent is West Virginia, which authorized medical marijuana in April 2017, with use to begin in July 2019. Recreational use is allowed in Alaska, California, Colorado, Maine, Massachusetts, Nevada, Oregon, Washington and the District of Columbia and 13 other states have decriminalized possession of small amounts of marijuana (NCSL, 2016). Congress identified drug-impaired driving as a priority in the Fixing America’s Surface Transportation (FAST) Act of 2015 (https://www.fhwa.dot.gov/fastact/). This multi-year highway bill directed NHTSA to develop education campaigns to increase public awareness about the dangers associated with drugged driving. The Act also required the Department of Transportation to study the relationship between marijuana use and driving impairment and to identify effective methods to detect marijuana-impaired drivers. Legislatures, law enforcement, and highway safety offices in many states are urged to “do something” about drug-impaired driving, but what to do is far from clear.
Wednesday, April 26, 2017
Pennsylvania receives "flood of applications" seeking one of a few dozen medicial marijuana licenses
This local report from Pennsylvania highlights the large number of applications received by state officials from businesses looking to get in on the ground floor of the state's medical marijuana industry. Here are the basic details:
Hundreds of applicants have asked for licenses to grow or sell medical marijuana in Pennsylvania, including dozens in the state's southeastern corner.
In their first accounting of the flood of applications, Health Department officials said Wednesday that they received more than 500 packages by the March 20 deadline, and have sifted through 258 applications. Among those have been 31 applications to grow medical marijuana in Philadelphia or its surrounding suburbs.
But officials wouldn't release the names of the principals behind the company names — or divulge the locations where they propose to grow or sell the drug. More company names will be released after additional applications have been reviewed.
Still, the data suggests the frenzied interest in getting in on the ground floor of the potentially lucrative medical marijuana industry, which some advocates hope will be the first step toward broader legalization of the drug.
Only 12 growing permits will be granted statewide. The state has been moving swiftly to implement a law passed last year with support from both parties in the Republican-controlled Legislature. The law aims to supply cannabis to seriously ill patients who have any one of 17 qualifying ailments.
March 20 was the deadline for all materials for people vying for one of 12 initial grower licenses. The state also received applications for would-be operators seeking one of 27 permits that would allow up to 81 dispensaries, where prescriptions could be filled, across the state.
The permit applications that are pending represent just the first phase of the bidding process. The state also is preparing to offer clinical registrant licenses, which would attach medical marijuana to existing hospitals that also serve as academic medical institutions. That credential would allow eight academic medical centers to select investor partners to establish research, growing, and dispensary networks of their own. Health systems have been soliciting potential suitors for months....
Each applicant was required to put up a non-refundable $10,000 fee, in addition to a $200,000 permit fee that will be returned only to the unsuccessful applicants. The ante for dispensary licenses, which will allow the winner to operate up to three storefronts, was $5,000, and those checks were accompanied by a refundable permit fee of $30,000 per storefront.
I am expecting that the same sort of "frenzied interest" will also be the medical marijuana story here in nearly Ohio when the has its license application process fully up and running in the coming months. (This short column from an Ohio business publication, headlined "Intense competition for state-issued medical marijuana licenses necessitates advance preparation," suggests I am not alone in that view.) The old "Field of Dreams" adage, "if you build it, they will come," seems fitting here. Though perhaps in this setting the adage should be tweaked to "if you build it, they will come with checks with lots of zeroes."
New research highlights increased "illicit cannabis use and cannabis use disorders" in medical marijuana states through 2013
JAMA Psychiatry has this notable new research published under the title "US Adult Illicit Cannabis Use, Cannabis Use Disorder, and Medical Marijuana Laws, 1991-1992 to 2012-2013." Here are parts of its abstract:
Over the last 25 years, illicit cannabis use and cannabis use disorders have increased among US adults, and 28 states have passed medical marijuana laws (MML). Little is known about MML and adult illicit cannabis use or cannabis use disorders considered over time....
Differences in the degree of change between those living in MML states and other states were examined using 3 cross-sectional US adult surveys: the National Longitudinal Alcohol Epidemiologic Survey (NLAES; 1991-1992), the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC; 2001-2002), and the National Epidemiologic Survey on Alcohol and Related Conditions–III (NESARC-III; 2012-2013)....
Overall, from 1991-1992 to 2012-2013, illicit cannabis use increased significantly more in states that passed MML than in other states (1.4–percentage point more; SE, 0.5; P = .004), as did cannabis use disorders (0.7–percentage point more; SE, 0.3; P = .03)....
Medical marijuana laws appear to have contributed to increased prevalence of illicit cannabis use and cannabis use disorders. State-specific policy changes may also have played a role. While medical marijuana may help some, cannabis-related health consequences associated with changes in state marijuana laws should receive consideration by health care professionals and the public.
Friday, April 21, 2017
Blogging in this space will be light over the next few days because I am about to travel to Pittsburgh to attend and participate in the 2017 World Medical Cannabis Conference & Expo. As this schedule details, I am speaking tomorrow afternoon (Saturday) on a panel titled "Higher Education & Its Role in the Industry." Here is how the panel is previewed:
The cannabis industry is set to create more jobs than established industries like manufacturing by 2020. However, there is still no clear path to getting involved in the industry or clear educational path. Students need more courses and curriculum that teaches the fundamentals of the industry. These include all areas of the industry including business, agriculture, research, etc. This panel will talk about what courses are currently available for students and what still needs to be offered as well as how higher education can translate their findings into commercial services and products the industry can use to advance itself.
April 21, 2017 in Business laws and regulatory issues, Employment and labor law issues, Medical Marijuana Commentary and Debate, Medical Marijuana Data and Research, Medical Marijuana State Laws and Reforms | Permalink | Comments (0)
Thursday, April 20, 2017
"Medical Marijuana Laws May Be Associated With A Decline In The Number Of Prescriptions For Medicaid Enrollees"
The title of this post is the title of this notable new study to be published in the journal Health Affairs. Here is the abstract (with one line emphasized):
In the past twenty years, twenty-eight states and the District of Columbia have passed some form of medical marijuana law. Using quarterly data on all fee-for-service Medicaid prescriptions in the period 2007–14, we tested the association between those laws and the average number of prescriptions filled by Medicaid beneficiaries. We found that the use of prescription drugs in fee-for-service Medicaid was lower in states with medical marijuana laws than in states without such laws in five of the nine broad clinical areas we studied. If all states had had a medical marijuana law in 2014, we estimated that total savings for fee-for-service Medicaid could have been $1.01 billion. These results are similar to those in a previous study we conducted, regarding the effects of medical marijuana laws on the number of prescriptions within the Medicare population. Together, the studies suggest that in states with such laws, Medicaid and Medicare beneficiaries will fill fewer prescriptions.
Wednesday, March 29, 2017
Regular readers might be getting a bit bored by regular posts here highlighting research showing reductions in opioid use and problems in states that have legalized medical marijuana. But, especially with the Trump Administration reportedly about to create a new commission to tackle opioid problems, I do not think the research in this arena can be given too much attention. And, perhaps especially helpful for purposes of influencing the Trump Administration, FoxNews Health here is discussing the latest research under the headline "Would legalizing medical marijuana help curb the opioid epidemic?". The article starts this way:
In states that legalized medical marijuana, U.S. hospitals failed to see a predicted influx of pot smokers, but in an unexpected twist, they treated far fewer opioid users, a new study shows.
Hospitalization rates for opioid painkiller dependence and abuse dropped on average 23 percent in states after marijuana was permitted for medicinal purposes, the analysis found. Hospitalization rates for opioid overdoses dropped 13 percent on average.
At the same time, fears that legalization of medical marijuana would lead to an uptick in cannabis-related hospitalizations proved unfounded, according to the report in Drug and Alcohol Dependence. "Instead, medical marijuana laws may have reduced hospitalizations related to opioid pain relievers," said study author Yuyan Shi, a public health professor at the University of California, San Diego.
"This study and a few others provided some evidence regarding the potential positive benefits of legalizing marijuana to reduce opioid use and abuse, but they are still preliminary," she said in an email.
Dr. Esther Choo, a professor of emergency medicine at Oregon Health and Science University in Portland, was intrigued by the study's suggestion that access to cannabis might reduce opioid misuse. "It is becoming increasingly clear that battling the opioid epidemic will require a multi-pronged approach and a good deal of creativity," Choo, who was not involved in the study, said in an email.
"Could increased liberalization of marijuana be part of the solution? It seems plausible." However, she said, "there is still much we need to understand about the mechanisms through which marijuana policy may affect opioid use and harms."...
Shi analyzed hospitalization records from 1997 through 2014 for 27 states, nine of which implemented medical marijuana policies. Her study was the fifth to show declines in opioid use or deaths in states that allow medical cannabis.
Previous studies reported associations between medical marijuana and reductions in opioid prescriptions, opioid-related vehicle accidents and opioid-overdose deaths. In a 2014 study, Dr. Marcus Bachhuber found deaths from opioid overdoses fell by 25 percent in states that legalized medical marijuana.
The study referenced in this press article is available at this link and is titled "Medical marijuana policies and hospitalizations related to marijuana and opioid pain reliever."
Sunday, March 12, 2017
The title of this post is the headline of this lengthy new local article from Buffalo. Here are excerpts:
The state health commissioner last year declared New York’s medical marijuana program a success. But the five companies that the state selected in 2015 to get marijuana into the hands of people suffering from debilitating and sometimes terminal diseases such as cancer, AIDS and multiple sclerosis tell a different story.
“Our company is not close to break-even yet," said Ari Hoffnung, president of Vireo Health of New York, which has a marijuana-growing facility in Fulton County and dispenses its products in two downstate and two upstate locations. “And based on my understanding, no one has made a dime here in New York."
If other states were a guide, New York should be preparing for at least 200,000 patients enrolled in the program, the industry estimates. But since medical marijuana went on the market in New York State a little over a year ago, just over 14,000 patients have enrolled to buy the drug at one of the 20 dispensaries scattered around the state. Only half of those are regular customers. Many stopped taking the drug because of high costs, distances they must travel to get it or because they died, industry executives say. Fewer than 900 doctors signed on to certify patients to use the drug.
“There are two things the program is lacking: physicians and patients," said Sen. Diane Savino, author of the bill that opened up medical marijuana treatment in New York State. Now, while the five companies producing medical marijuana struggle to stay alive for lack of customers, the Cuomo administration wants to add five more grow-and-distribution licenses.
At the same time, the administration is not opening up a new bidding process. Instead, the Cuomo administration is turning to five companies – from the original 43 bidders – that lost in the application process two years ago. All of this is worrying the companies still trying to stay afloat. “Every single one of them is financially struggling," Savino said....
Instead of adding new grow facilities, the existing licensees say, New York should more aggressively attract physicians to participate and put dispensaries in more locations. Savino, the Staten Island senator who sponsored the legislation, said she is pushing the Cuomo administration to award new “retail license” dispensaries, but to bar the five existing grower/dispensary firms from owning them. She said the administration does not understand how the medical marijuana marketplace works and that adding new growers while supplies exceed demand is “a big mistake.”
Marijuana companies say they are not arguing more licenses should never be issued to grow and sell marijuana. “No one is making any money here. Twenty percent of us have already failed," said Hoffnung, president of Vireo Health, referring to one of the original licensees that sold out to a California company because of financial problems.
March 12, 2017 in Business laws and regulatory issues, Medical Marijuana Commentary and Debate, Medical Marijuana Data and Research, Medical Marijuana State Laws and Reforms | Permalink | Comments (0)
Thursday, March 9, 2017
The title of this post comes from this article from The Guardian discussing a controversial new addiction treatment facility that "uses cannabis as a a central part of its treatment plan." It begins:
When Joe Schrank got the call six years ago that his friend Greg Giraldo had been found unconscious after an overdose in a New Jersey hotel room, he was not surprised. Giraldo, a comedian, had cycled through the addiction loop for years, and Schrank had tried in vain to save him.
“Greg’s death really rattled me to the core,” says Schrank, a trained social worker who works with addicts. “He tried the abstinence route and it never really took root. I felt like rehab had failed him. It failed his family. It failed me. I kept thinking he could be smoking pot instead of dead. And that’s a big difference.”
Using pot instead of cocaine and Valium was something Schrank had suggested to his friend weeks before his death. Although it is an unpopular idea in the rehab world, where Schrank had made his career (first at the Malibu detox center Promises, then as head of a clean house in Brooklyn and founder of the The Fix, a website dedicated to addiction recovery), he nonetheless had a hunch marijuana could have helped his friend.
“There’s no lethal dose,” says Schrank who has collaborated with the addiction psychiatrist Scott Bienenfeld for the past decade on cases Bienenfeld oversees medically.
Indeed, page through the National Academy of Sciences’ latest 395-page report of 10,000 scientific abstracts on the health effects of cannabis, and you’d be pressed to find a single mention of death by marijuana overdose in adults. Yet because of its longtime classification as a Schedule 1 drug (right up there with heroin), research on marijuana’s impact on our health remains limited and largely inconclusive.
After Giraldo’s death, Schrank began working with Bienenfeld on treatment plans that incorporated marijuana as a crucial detox step. He also connected with Amanda Reiman, former head of marijuana law and policy at the Drug Policy Alliance, whose research at University of California, Berkeley, for more than a decade has focused on the use of cannabis as a viable substitute for prescription drugs.
This January, Schrank took another step and opened High Sobriety – a first-of-its-kind rehab center that uses cannabis as a central part of its treatment plan. Seen as a highly contentious move in the rehab world, High Sobriety has been met with skepticism and criticism for its use of marijuana in a field where success is traditionally measured by total abstinence.
Some prior related posts:
- Aggregating evidence on marijuana's role in curbing opioid abuse after AG Sessions expresses skepticism
- Examining connections between marijuana reform and opioid epidemic
- "Can Marijuana Ease the Opioid Epidemic?"
- "Patients Are Ditching Opioid Pills for Weed"
- "Can medical marijuana be used to treat heroin addiction?"
- Yet another study suggests link between medical marijuana availability and decreased opioid use
Monday, March 6, 2017
Examining studies on marijuana and THC in the treatment of psychiatric diseases and CBD in the treatment of neurological disorders
As recent posts highlight, my Marijuana Law, Policy & Reform seminar is now deep into the part of the semester in which student are making presentation based on their selected marijuana-related research issue. One student this coming week is exploring "the use of THC in the treatment of psychiatric diseases, in comparison to the use of CBD in the treatment of neurological disorders." Here are the studies the student plans to discuss:
Studies on the application of CBD to neurological disorders:
Studies on the Application of THC to psychological disorders:
Antidepressant-like and anxiolytic-like effects of cannabidiol: a chemical compound of Cannabis sativa (illustrating that anxiety, typically thought to be reduced by THC, may experience greater reduction thorough CBD)