Marijuana Law, Policy & Reform

Editor: Douglas A. Berman
Moritz College of Law

Saturday, December 9, 2017

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

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

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

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

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

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

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

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

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

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

Some (of many) prior related posts:

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

Friday, December 8, 2017

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

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

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

Tuesday, November 28, 2017

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

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

Background

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

Purpose

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

Methods

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

Results

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

Conclusions

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

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

Thursday, November 16, 2017

"Pediatric Death Due to Myocarditis After Exposure to Cannabis"

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

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

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

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

Monday, November 13, 2017

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

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

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

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

Thursday, November 2, 2017

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

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

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

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

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

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

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

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

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

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

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

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

Here are some highlights from the survey:

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

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

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

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

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

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

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

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

Sunday, October 29, 2017

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

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

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

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

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

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

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

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

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

Tuesday, October 24, 2017

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

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

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

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

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

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

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

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

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

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

Wednesday, October 18, 2017

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

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

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

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

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

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

Wednesday, October 11, 2017

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

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

Background

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

Purpose

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

Methods

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

Findings

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

Conclusions

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

Some (of many) prior related posts:

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

Wednesday, October 4, 2017

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

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

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

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

Tuesday, September 26, 2017

"Seniors Turn To Medical Marijuana For What Ails Them"

The title of this post is the title of this effective 5+ minute segment that aired today on the NPR midday show Here & Now.  Here is how the program's website sets up the segment:

With 29 states allowing medical marijuana, senior citizens have been increasingly seeking its curative powers. But there are many obstacles, ranging from paying for the herb to finding a doctor who is licensed to prescribe.

In New York, considered an especially restrictive medical marijuana state, reporter Karen Michel explores some of the benefits and difficulties for seniors seeking legal pot.

September 26, 2017 in Medical community perspectives, Medical Marijuana Commentary and Debate, Medical Marijuana Data and Research, Who decides | Permalink | Comments (0)

Tuesday, September 12, 2017

"The Effects of Marijuana Liberalizations: Evidence from Monitoring the Future"

The title of this post is the title of this notable new working paper from the National Bureau of Economic Research authored by Angela Dills, Sietse Goffard and Jeffrey Miron. Here is its abstract:

By the end of 2016, 28 states had liberalized their marijuana laws: by decriminalizing possession, by legalizing for medical purposes, or by legalizing more broadly.  More states are considering such policy changes even while supporters and opponents continue to debate their impacts.  Yet evidence on these liberalizations remains scarce, in part due to data limitations.

We use data from Monitoring the Future’s annual surveys of high school seniors to evaluate the impact of marijuana liberalizations on marijuana use, other substance use, alcohol consumption, attitudes surrounding substance use, youth health outcomes, crime rates, and traffic accidents.  These data have several advantages over those used in prior analyses.

We find that marijuana liberalizations have had minimal impact on the examined outcomes.  Notably, many of the outcomes predicted by critics of liberalizations, such as increases in youth drug use and youth criminal behavior, have failed to materialize in the wake of marijuana liberalizations.

September 12, 2017 in Medical Marijuana Commentary and Debate, Medical Marijuana Data and Research, Recreational Marijuana Commentary and Debate, Recreational Marijuana Data and Research | Permalink | Comments (0)

Friday, September 8, 2017

Competing takes on the latest SAMHSA data concerning marijuana use

Earlier this week, the federal Substance Abuse and Mental Health Services Administration (SAMHSA) released here some key data from its 2016 National Survey on Drug Use and Health (NSDUH). Like many careful and important data reports, this report has a number of intricacies that should defy simple spins and encourage thoughtful and reflective review. But, as these headlines and press release titles review, folks concerned about marijuana reform were quick to provide their points of emphasis ASAP: 

  • From SAM here, "New National Report Shows Rise in Prevalence and Intensity of Marijuana Use"

  • From Christopher Ingraham at Wonkblog of The Washington Post here, "Teen marijuana use falls to 20-year low, defying legalization opponents’ predictions"

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

Sunday, August 27, 2017

Interesting look at job-creation aspects of Arkansas medical marijuana reform (with a notable developing national story)

BLS-LogoThis local new article form Arkansas, headlined "Medical marijuana industry expected to bring new jobs to Arkansas," provides an effective and thorough accounting of an important economic development element of marijuana reform. For that reason, I recommend the piece in full, and the excerpt below includes a bit of extra national news highlighted below that strikes me as especially notable:

A one-man testing lab in Greenbrier is poised to add up to seven employees, spend more than $1 million on equipment and buy several vehicles to capitalize on the coming sale of medical marijuana in Arkansas.  Kyle Felling, the owner of F.A.S.T. Laboratories, is one part of a burgeoning medical marijuana industry that's expected to create hundreds of jobs in Arkansas, according to industry experts and representatives....

In-state dispensaries and cultivation facilities are expected to provide the bulk of the jobs.  However, other services, like lab testing, are essential for the medical marijuana market to function.  Storm Nolan, president of the Arkansas Cannabis Industry Association, said he expects between 500 and 600 people to be employed where marijuana is grown and sold in the near term....

David Couch, the Little Rock lawyer who sponsored the Arkansas Medical Marijuana Amendment that was approved by voters in November, said he eventually expects 1,500 jobs or more in dispensaries and cultivation facilities.  Nolan and Couch said hundreds more jobs are expected in ancillary businesses, like F.A.S.T. Laboratories....

The accuracy of job estimates is expected to improve with time.  The federal Bureau of Labor Statistics will begin releasing data Sept. 6 under an updated jobs classification system that details marijuana wholesalers, stores and grower employment, David Hiles, an economist with the bureau, said in an email. ...

Specialty companies will be needed to ship, test, market, enforce, track, insure, construct, lobby, inspect, secure and bank in the industry.  However, it's an open question whether many of the businesses will be locally owned.  While the Arkansas Medical Marijuana Commission mandated that dispensaries and cultivation facilities be majority owned by Arkansans, there's no similar requirement for the businesses that will serve them.

James Yagielo, chief executive of Florida-based HempStaff, said many end up being from out of state.  "There are always some ancillary businesses," he said.  "A lot of them -- like us -- are national, but you do get some that pop up."  Nolan said he expects more ancillary businesses to enter the market as the Arkansas Medical Marijuana Commission develops licenses for transportation, distribution and processing.  Those licenses remain on the to-do list of the commission, which currently is taking applications for dispensaries and growers....

Michael Pakko, chief economist at the Arkansas Economic Development Institute at the University of Arkansas at Little Rock, said the nature of the marijuana business -- highly regulated with dispensaries and cultivation facilities required to each have unique ownership -- is costly, but can also provide additional employment....

Entry-level jobs include trimming marijuana at around $10 an hour.  Assistant growers, who plant and nourish marijuana, will earn $15 to $20 per hour.  Master growers, who manage operations, will make between $40 to $60 per hour....  Most dispensaries start with around five employees....  Each store's general manager will earn around $20 per hour. Dispensary agents, who interact with patients, will make $12 to $15 per hour.

While hundreds of jobs are expected to be created in the medical marijuana industry -- on par with a large state economic development project -- Arkansans may not feel the same impact because the jobs will be spread throughout the state, Pakko said.  "Five hundred to 600 jobs -- that would be a pretty good economic development project, but in the overall scheme of things, that's not a very large percentage of Arkansas' workforce or employment base," he said.  "Now in the local communities where those jobs are going to be, it can be a big deal.  It can be a significant impact."

In this MassRoots posting back in February, Tom Angell reported that the "U.S. Bureau of Labor Statistics (BLS) revealed to MassRoots that it will soon begin tracking cannabis sector employment ... [but] added that it won’t necessarily release any numbers."  It would now appear that BLS has data it is prepared to release in only a matter of weeks.  That strikes me as a very interesting and important development that will, among other things, make it much easier for the mainstream media to see and report on the seemingly significant job-creation realities of the emerging marijuana industry.

August 27, 2017 in Employment and labor law issues, Federal Marijuana Laws, Policies and Practices, Medical Marijuana Data and Research, Medical Marijuana State Laws and Reforms | Permalink | Comments (0)

Friday, August 18, 2017

NHTSA releases "Marijuana-Impaired Driving A Report to Congress"

Download (1)Though dated July 2017, I believe the National Highway Traffic Safety Administration (NHTSA) has only just this week released this lengthy report titled "Marijuana-Impaired Driving A Report to Congress." The report's introduction explains that it "has been prepared in response to a requirement in Section 4008 (Marijuana-Impaired Driving) of the Fixing America’s Surface Transportation Act (FAST Act)," and it highlights the limited research on marijuana-impaired driving and continued challenges:

Unlike alcohol, marijuana is classified as a Schedule I substance under the Controlled Substances Act. A much smaller number of studies have looked at the impairing effects of marijuana use on driving-related skills.  Less is known about these effects due in part to the typical differences in research methods, tasks, subjects and dosing that are used. A clearer understanding of the effects of marijuana use will take additional time as more research is conducted.  The extra precautions associated with conducting research on a Schedule I drug may contribute to this relative lack of research. For example, these include the need for a government license to obtain, store and use marijuana, the security requirements for storage, and documentation requirements and disposal requirements.

While fewer studies have examined the relationship between THC blood levels and degree of impairment, in those studies that have been conducted the consistent finding is that the level of THC in the blood and the degree of impairment do not appear to be closely related.  Peak impairment does not occur when THC concentration in the blood is at or near peak levels.  Peak THC level can occur when low impairment is measured, and high impairment can be measured when THC level is low.  Thus, in contrast to the situation with alcohol, someone can show little or no impairment at a THC level at which someone else may show a greater degree of impairment....

There is a need to improve data collection regarding the prevalence and effects of marijuana-impaired driving.  NHTSA has collected some data on the prevalence of marijuana use by drivers on a national basis, though NHTSA has been prohibited from continuing to collect this information.  In contrast, there is little State level data about the prevalence of use of marijuana by drivers being collected.  As States continue to change their laws regarding marijuana use in general and as it relates to driving, this lack of State level data prevents evaluation of the effect of policy changes on driver behavior, including willingness to drive while under the influence of marijuana, as well as the effect of marijuana on crashes, deaths and injuries.

August 18, 2017 in Business laws and regulatory issues, Federal Marijuana Laws, Policies and Practices, Medical Marijuana Data and Research, Recreational Marijuana Data and Research | Permalink | Comments (1)

Wednesday, July 12, 2017

"Mapping medical marijuana: State laws regulating patients, product safety, supply chains and dispensaries, 2017"

CoverThe title of this post is the title of this useful new article in the publication Addiction authored by numerous researchers.  Here is the article's abstract:

Aims

1) To describe open source legal datasets, created for research use, that capture the key provisions of U.S. state medical marijuana laws. The data document how state lawmakers have regulated a medicine that remains, under federal law, a Schedule I illegal drug with no legitimate medical use. 2) To demonstrate the variability that exists across states in rules governing patient access, product safety, and dispensary practice.

Methods

Two legal researchers collected and coded state laws governing marijuana patients, product safety, and dispensaries in effect on February 1, 2017, creating three empirical legal datasets. We used summary tables to identify the variation in specific statutory provisions specified in each state's medical marijuana law as it existed on February 1, 2017. We compared aspects of these laws to the traditional Federal approach to regulating medicine. Full datasets, codebooks and protocols are available through the Prescription Drug Abuse Policy System (http://www.pdaps.org/ ; http://www.webcitation.org/6qv5CZNaZ).

Results

Twenty-eight states (including the District of Columbia) have authorized medical marijuana. Twenty-seven specify qualifying diseases, which differ across states. All but two protect patient privacy; only 14 protect patients against discrimination. Eighteen states have mandatory product safety testing before any sale. While the majority have package/label regulations, states have a wide range of specific requirements. Most regulate dispensaries (25 states), with considerable variation in specific provisions such as permitted product supply sources (23 states), number of dispensaries per state (18 states) and restricting proximity to various types of location (21 states).

Conclusions

The federal ban in the USA on marijuana has resulted in a patchwork of regulatory strategies that are not uniformly consistent with the approach usually taken by the Federal government and whose effectiveness remains unknown.

July 12, 2017 in History of Marijuana Laws in the United States, Medical Marijuana Commentary and Debate, Medical Marijuana Data and Research, Medical Marijuana State Laws and Reforms, Who decides | Permalink | Comments (0)

Sunday, July 9, 2017

"Is marijuana a secret weapon against the opioid epidemic?"

Regular readers may already be tired of posts here exploring whether marijuana reform may be an important element of modern responses to the modern opioid epidemic.  But until that epidemic is over, I am going to keep posting on this topic.  And the title of this post is the headline of this PRI article is based on an interview that aired on PRI's Science Friday. Here are excerpts:

“Really, if we stopped medical marijuana programs that are now in place in 29 states and Washington, DC … the science suggests we would worsen the opioid epidemic,” says Dina Fine Maron, a medicine and health editor at Scientific American, who wrote a recent story on the subject.

She explains that states with medical marijuana programs have fewer opioid overdose-related deaths than states without medical marijuana — 25 percent fewer, according to a 2014 study cited in her article. “The reality is that the literature right now suggests that if anyone is using an opioid — whether it be a prescription painkiller or something like heroin — a prescription painkiller is more likely [than marijuana] to lead to drug abuse,” she says, “because it’s more addictive and obviously can be more lethal.”...

University of Georgia public policy professor W. David Bradford has studied how legal medical marijuana impacts prescription use by enrollees of Medicare, the federal health insurance program for seniors and the disabled. “What we found … was significant reductions in prescription use, most notably among pain medications, and the largest plurality of those would be opiates,” he says.

Then he researched the effect on enrollees in Medicaid, the federal-state program that helps the poor and people with disabilities pay for health care. “We redid the study for Medicaid just this past month in Health Affairs and, again, found large reductions in the use of prescription pain medications when states turned on medical cannabis laws.”...

Legal medical marijuana isn’t a silver bullet for the complex US opiate crisis, Bradford says. But while dozens of people in the US die each day from opioids, there has never been a fatal overdose documented from marijuana alone. “The National [Academies] of Sciences, Engineering, and Medicine just this past January issued a comprehensive report where they said there is conclusive evidence that cannabis can be effective at managing pain,” he says. “So, to the extent we can divert people from initially starting on opiates through legitimate prescriptions, we divert them from the path of abuse and then the path of death,” he adds. “And it does seem that cannabis could be one tool in the arsenal to do that.”

Some prior related posts:

July 9, 2017 in Medical community perspectives, Medical Marijuana Data and Research | Permalink | Comments (1)

Wednesday, July 5, 2017

"Cannabis use and psychotic-like experiences trajectories during early adolescence: the coevolution and potential mediators"

OlalertbannerThe title of this post is the title of this notable new article appearing in the Journal of Child Psychology and Psychiatry authored by Josiane Bourque, Mohammad H. Afzali, Maeve O'Leary-Barrett, and Patricia Conrod. Here is the abstract:

Background

The authors sought to model the different trajectories of psychotic-like experiences (PLE) during adolescence and to examine whether the longitudinal relationship between cannabis use and PLE is mediated by changes in cognitive development and/or change in anxiety or depression symptoms.

Methods

A total of 2,566 youths were assessed every year for 4-years (from 13- to 16-years of age) on clinical, substance use and cognitive development outcomes. Latent class growth models identified three trajectories of PLE: low decreasing (83.9%), high decreasing (7.9%), and moderate increasing class (8.2%). We conducted logistic regressions to investigate whether baseline levels and growth in cannabis use were associated with PLE trajectory membership. Then, we examined the effects of potential mediators (growth in cognition and anxiety/depression) on the relationship between growth in cannabis use and PLE trajectory.

Results

A steeper growth in cannabis use from 13- to 16-years was associated with a higher likelihood of being assigned to the moderate increasing trajectory of PLE [odds ratio, 2.59; 95% confidence interval (CI), 1.11–6.03], when controlling for cumulative cigarette use. Growth in depression symptoms, not anxiety or change in cognitive functioning, mediated the relationship between growth in cannabis use and the PLE moderate increasing group (indirect effect: 0.07; 95% CI, 0.03–0.11).

Conclusions

Depression symptoms partially mediated the longitudinal link between cannabis use and PLE in adolescents, suggesting that there may be a preventative effect to be gained from targeting depression symptoms, in addition to attempting to prevent cannabis use in youth presenting increasing psychotic experiences.

July 5, 2017 in Medical community perspectives, Medical Marijuana Data and Research, Recreational Marijuana Data and Research | Permalink | Comments (3)

Wednesday, June 28, 2017

"Cannabis as a Substitute for Opioid-Based Pain Medication: Patient Self-Report"

The title of this post is the title of this new original research by Amanda Reiman, Mark Welty, and Perry Solomon. Here is the abstract:

Introduction: Prescription drug overdoses are the leading cause of accidental death in the United States. Alternatives to opioids for the treatment of pain are necessary to address this issue. Cannabis can be an effective treatment for pain, greatly reduces the chance of dependence, and eliminates the risk of fatal overdose compared to opioid-based medications. Medical cannabis patients report that cannabis is just as effective, if not more, than opioid-based medications for pain.

 

Materials and Methods: The current study examined the use of cannabis as a substitute for opioid-based pain medication by collecting survey data from 2897 medical cannabis patients.

 

Discussion: Thirty-four percent of the sample reported using opioid-based pain medication in the past 6 months. Respondents overwhelmingly reported that cannabis provided relief on par with their other medications, but without the unwanted side effects. Ninety-seven percent of the sample ‘‘strongly agreed/agreed’’ that they are able to decrease the amount of opiates they consume when they also use cannabis, and 81% ‘‘strongly agreed/agreed’’ that taking cannabis by itself was more effective at treating their condition than taking cannabis with opioids. Results were similar for those using cannabis with nonopioid-based pain medications.

 

Conclusion: Future research should track clinical outcomes where cannabis is offered as a viable substitute for pain treatment and examine the outcomes of using cannabis as a medication assisted treatment for opioid dependence.

June 28, 2017 in Medical Marijuana Commentary and Debate, Medical Marijuana Data and Research | Permalink | Comments (0)