Marijuana Law, Policy & Reform

Editor: Douglas A. Berman
Moritz College of Law

Thursday, April 27, 2017

"Drug-Impaired Driving: A Guide for States"

DUIDinfographic_web1The 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.

April 27, 2017 in Assembled readings on specific topics, Medical Marijuana Data and Research, Recreational Marijuana Data and Research | Permalink | Comments (0)

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."

April 26, 2017 in Medical Marijuana Data and Research, Medical Marijuana State Laws and Reforms | Permalink | Comments (0)

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.

April 26, 2017 in Medical Marijuana Data and Research, Medical Marijuana State Laws and Reforms | Permalink | Comments (0)

Friday, April 21, 2017

Heading out to speak at 2017 World Medical Cannabis Conference & Expo

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.

April 20, 2017 in Federal Marijuana Laws, Policies and Practices, Medical Marijuana Data and Research | Permalink | Comments (0)

Wednesday, March 29, 2017

Yet another serious study finds link between medical marijuana reforms and reduced opioid problems

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."

March 29, 2017 in Medical community perspectives, Medical Marijuana Commentary and Debate, Medical Marijuana Data and Research | Permalink | Comments (0)

Sunday, March 12, 2017

"Medical marijuana business in New York is a bust so far"

NEW-YORKThe 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

"Can this man successfully treat opioid addiction with marijuana?"

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:

March 9, 2017 in Medical Marijuana Data and Research | Permalink | Comments (0)

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:

Overarching Study:

National Academies of Science

——————————————————————————————————————————

Studies on the application of CBD to neurological disorders:

Cannabinoids in experimental stroke: a systematic review and meta-analysis

Cannabidiol and endogenous opioid peptide-mediated mechanisms modulate antinociception induced by transcutaneous electrostimulation of the peripheral nervous system

Medical Marijuana in Certain Neurological Disorders

——————————————————————————————————————————

Studies on the Application of THC to psychological disorders:

Cognitive and clinical outcomes associated with cannabis use in patients with bipolar I disorder.

Chronic Stress Impairs α1-Adrenoceptor-Induced Endocannabinoid-Dependent Synaptic Plasticity in the Dorsal Raphe Nucleus

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)

March 6, 2017 in Assembled readings on specific topics, Medical community perspectives, Medical Marijuana Commentary and Debate, Medical Marijuana Data and Research | Permalink | Comments (0)

Sunday, March 5, 2017

Examining connections between marijuana reform and opioid epidemic

Tuesday, February 28, 2017

Aggregating evidence on marijuana's role in curbing opioid abuse after AG Sessions expresses skepticism

Attorney General Sessions today took more shots at marijuana reform, which included criticism of the suggestion marijuana could help curb the nation's opioid problems.  In response, Christopher Ingraham has this lengthy Washington Post piece assembling all the recent research supporting the notion that marijuana could help curb the nation's opioid problems. The piece is headlined "Attorney General Sessions wants to know the science on marijuana and opioids. Here it is." Here is the start of the article and its main bold headings that set up discussions of recent research (readers should click through for a bunch of links):

Speaking this morning before the National Association of Attorneys General, U.S. Attorney General Jeff Sessions expressed doubt that marijuana could help mitigate the opioid abuse epidemic.

“I see a line in The Washington Post today that I remember from the '80s,” Sessions said. "'Marijuana is a cure for opiate abuse.' Give me a break. This is the kind of argument that's been made out there to just — almost a desperate attempt to defend the harmlessness of marijuana or even its benefits. I doubt that's true. Maybe science will prove I'm wrong.”

The stakes are pretty high here. After all, opioids killed 33,000 people in 2015, up from around 8,000 in 1999. As the head of the Department of Justice, Attorney General Sessions oversees the Drug Enforcement Administration, which just last year reaffirmed its belief that marijuana has no medical value and hence should remain illegal (which makes it substantially more difficult for researchers to conduct studies).

Here's a run-down of where the evidence on marijuana and opiates stands.

Marijuana is great at treating chronic pain....

States with medical marijuana laws see fewer opiate deaths....

Medical marijuana is associated with fewer opiate-induced car crashes....

Painkiller prescriptions fall sharply after medical marijuana laws are introduced....

Among chronic pain patients, marijuana use is associated with less opiate use....

The scientific evidence available so far indicates marijuana holds great promise for mitigating the effects of the opiate epidemic. Researchers desperately want to know more, but as long as the Drug Enforcement Administration considers marijuana a Schedule 1 controlled substance, they'll have a hard time getting more answers.

February 28, 2017 in Federal Marijuana Laws, Policies and Practices, Medical Marijuana Data and Research, Who decides | Permalink | Comments (0)

Wednesday, February 22, 2017

New report projects extraordinary job growth in US marijuana industry

This new Forbes article, headlined "Marijuana Industry Projected To Create More Jobs Than Manufacturing By 2020," highlights some of the economic development potential that is forecast by some in the marijuana arena. Here are the details:

Jobs. That is what the marijuana industry hopes will keep the Trump administration from cracking down on cannabis companies.

A new report from New Frontier data projects that by 2020, the legal cannabis market will create more than a quarter of a million jobs. This is more than the expected jobs from manufacturing, utilities or even government jobs, according to the Bureau of Labor Statistics. The BLS says that by 2024 manufacturing jobs are expected to decline by 814,000, utilities will lose 47,000 jobs and government jobs will decline by 383,000. This dovetails with data that suggests the fastest growing industries are all healthcare related.

The legal cannabis market was worth an estimated $7.2 billion in 2016 and is projected to grow at a compound annual growth rate of 17%. Medical marijuana sales are projected to grow from $4.7 billion in 2016 to $13.3 billion in 2020. Adult recreational sales are estimated to jump from $2.6 billion in 2016 to $11.2 billion by 2020. New Frontier bases these projections on the markets that have already passed such legal initiatives and don't include additional states that could come on board by 2020....

“These numbers confirm that cannabis is a major economic driver and job creation engine for the U.S. economy,” said Giadha Aguirre De Carcer, Founder and CEO of New Frontier Data. “While we see a potential drop in total number of U.S. jobs created in 2017, as reported by Kiplinger, as well as an overall expected drop in GDP growth, the cannabis industry continues to be a positive contributing factor to growth at a time of potential decline. We expect the cannabis industry’s growth to be slowed down to some degree in the next three to five years, however with a projected total market sales to exceed $24 billion by 2025, and the possibility of almost 300,000 jobs by 2020, it remains a positive economic force in the U.S.”

New Frontier based its projections on analysis from the Marijuana Policy Group which was hired by Colorado for an economic analysis. According to annual surveys of cannabis professionals by the Marijuana Business Daily, the industry already employs 100,000 to 150,000 workers and nearly 90,000 are in plant-touching companies....

Many employees in the industry seem thankful for their jobs and are genuinely happy with their employment. The alternative culture appeals to many who have no interest in cubicle jobs or working for a big corporate giant. It is increasingly pulling professionals from more traditional industries who are looking for new challenges and different work environments. “The governments and the programs that they've instilled into these (legalized) states have created great job opportunities and excellent business opportunities for entrepreneurs,” said Mark Lustig, Chief Executive Officer of CannaRoyalty. “They've created the right competition.”

February 22, 2017 in Business laws and regulatory issues, Medical Marijuana Commentary and Debate, Medical Marijuana Data and Research, Recreational Marijuana Commentary and Debate, Recreational Marijuana Data and Research | Permalink | Comments (0)

Wednesday, February 15, 2017

"Joint Culpability: The Effects of Medical Marijuana Laws on Crime"

The title of this post is the title of this notable new article posted to SSRN authored by Yu-Wei Luke Chu and Wilbur Townsend. Here is the abstract:

Most of the U.S. states have passed medical marijuana laws. In this paper, we study the effects of these laws on violent and property crime.  We first estimate models that control for city fixed effects and flexible city-specific time trends.  To supplement this regression analysis we use the synthetic control method which can relax the parallel trend assumption and better account for heterogeneous policy effects. 

Both the regression analysis and the synthetic control method suggest no causal effects of medical marijuana laws on violent or property crime at the national level.  We also find no strong effects within individual states, except for in California where the medical marijuana law reduced both violent and property crime by 20%.

February 15, 2017 in Criminal justice developments and reforms, Medical Marijuana Commentary and Debate, Medical Marijuana Data and Research, Medical Marijuana State Laws and Reforms | Permalink | Comments (0)

Monday, February 13, 2017

Interesting data and speculations concerning New York's (struggling) medical marijuana program

NymmjThe local article, headlined "Data: Only half of state's medical marijuana patients are repeat buyers," reports on some interesting patient data concerning New York's medical marijuana program. Here are excerpts:

More than three-quarters of the state's 13,000 or so medical marijuana-eligible patients have purchased the drug, but only half of the 13,000 are repeat buyers under the tightly regulated state program, according to Department of Health data provided to the Times Union.

Through late January, 12,933 patients had been certified by their doctors to participate in the state's medical marijuana program and 10,250 patients had been dispensed a medical marijuana product. But the number of patients who had been dispensed a product more than once was 6,403.  That data backs up anecdotal evidence about patients' purchasing habits over the first year of the program.  While the five companies authorized to sell medical marijuana products have had products to offer, demand has been on a slower growth curve than the businesses would like.

These less-than-robust sales have caused issues for patients, including prohibitive prices they must cover out of pocket because insurance does not cover medical marijuana.

Diagnosing why about half of all patients aren't returning to pick up a second round of medicine isn't an exact science. "If the implication is that only certain people are continuing on medical marijuana because they can afford it, there are probably lots of reasons for that besides just price," said Josh Vinciguerra, the Department of Health's Narcotic Enforcement Bureau director.  He pointed to the fact that medical marijuana remains a new area of treatment for a number of doctors and patients who might be willing to become certified for the program but are wary of actually taking advantage....

But Vinciguerra said cost does remain a focus for DOH moving forward, adding that the department believes opening the program up to more companies (only five are currently authorized to operate) could also assist with price issues by adding competition to the market.  The state has taken other actions to try to grow the program, including steps to allow nurse practitioners and physician assistants, not just doctors, to certify patients; the addition of chronic pain to the list of qualifying conditions; and a decision to allow companies to make home deliveries of their products.

Pricing reforms are happening on the company level, and some have turned to discounts in an effort build up their customer bases. Etain, which grows and produces products in Warren County and has an Albany dispensary, recently instituted a repeat buyer discount program.  Politico New York reported Wednesday that PharmaCann will drop prices on all of its products by 25 percent.

Still, one medical marijuana company executive said even if all 13,000 patients (as of Feb. 7, the number stood at 13,389) were purchasing products on a regular basis, they would constitute a market small enough for just one of the five current companies to handle. "But as you now see clearly from the data, we have never had 13,000 patients," Vireo Health of New York CEO Ari Hoffnung said. "We do not even have 6,400 patients, because 6,400 patients is essentially a data point of — over the past 12 or 13 months — how many people purchased twice. You can purchase twice and never purchase again. You may have purchased in January or February of 2016 and never came back. ... There's a lot of reasons patients don't come back."

February 13, 2017 in Medical Marijuana Data and Research, Medical Marijuana State Laws and Reforms | Permalink | Comments (0)

Friday, February 10, 2017

Colorado records another record high: state marijuana sales in 2016 hits $1.3 billion

This article from the Cannabist, headlined "Colorado sold $1.3 billion worth of marijuana in 2016," report on the latest notable sales numbers for the first state to have legalize recreational marijuana stores. Here are the details:

It’s a billion-dollar business — and then some. In 2016, Colorado’s dispensaries bagged $1.3 billion in recreational and medical cannabis sales, based on Colorado Department of Revenue tax data released Thursday.

To put the state’s third year of regulated recreational marijuana sales in perspective, Year One totaled $699.2 million (combined with medical sales) and Year Two jumped up to $996.2 million. The trend should continue in Year Four, but beyond that? It’s a murkier proposition.

“Colorado has had a really good run, being the first mover,” said Miles Light, an economist with the Marijuana Policy Group, which provides economic and market consulting services to legal cannabis markets. “Now, as other states legalize, some of these external benefits that are occurring are going to be eroded.”...

2016 was the year in which the $100-million-month became a baseline and heralded a record-breaking summer: The combined sales for July, August and September were $376.6 million. Monthly sales topped $100 million in eight of the 12 months. In December, which is typically a strong month for cannabis transactions, pot shops’ sales were a little more than $114.7 million, a 13 percent increase from the $101.3 million recorded in December 2015....

The Colorado Department of Revenue’s tax data don’t provide information about transactions, so it’s difficult to know the impact of price declines on the overall sales totals. The data do show that recreational marijuana accounted for an $875 million share of that haul while medical sales accounted for roughly $438 million.

They also show that Colorado brought in about $199 million in tax and fees revenue for the calendar year. Marijuana tax revenue is put toward areas such as school construction projects, public health and law enforcement.

It’s the visitor demand that drives a lot of this incremental growth in Colorado’s marijuana industry, Light said. That includes the tourist who buys an eighth for a ski trip here and that’s also the visitors who come into the state to purchase product to illegally supply to other markets, he said. The Denver Post reported in January that research commissioned by the Colorado Tourism Office found interest in legal weed waning among visitors. “2016 represented a return to the more usual Colorado traveler,” tourism director Cathy Ritter said.

February 10, 2017 in History of Marijuana Laws in the United States, Medical Marijuana Data and Research, Recreational Marijuana Data and Research, Taxation information and issues | Permalink | Comments (0)

Tuesday, February 7, 2017

"The Effect of Medical Marijuana Laws on the Labor Supply of Older Adults: Evidence from the Health and Retirement Study"

The title of this post is the title of this intriguing paper available via SSRN authored by Lauren Hersch Nicholas and Johanna Catherine Maclean. Here is the abstract:

We study the effect of state medical marijuana laws on labor supply among older adults; the demographic group with the highest rates of many health conditions for which marijuana may be an effective treatment.  We use the Health and Retirement Study to study this question and estimate differences-in-differences regression models.  We find that passage of a state medical marijuana law leads to increases in labor supply among older adults. These effects should be considered as policymakers determine how best to regulate access to medical marijuana.

February 7, 2017 in Business laws and regulatory issues, Medical Marijuana Data and Research | Permalink | Comments (0)

Friday, February 3, 2017

New Textbook on Marijuana Law, Policy, and Authority

I’m happy to announce that my first-of-its-kind textbook on Marijuana Law, Policy, and Authority will soon be published by Aspen. It will be out in April (in e form) and May (in print). The teacher’s manual and a companion website will be available soon thereafter. Many thanks to Doug and others who have provided helpful feedback on this book over the last 2.5 years!

The book covers a lot of ground, befitting a field that implicates so many different areas of law. The first chapter of the book is now available on SSRN. That chapter provides more details about the book’s coverage and approach, and it also explains why this is such an interesting and worthwhile area of law to study – and not just for those who are interested in practicing in this burgeoning field.

Not coincidentally, I will be posting more this month (both here and at Prawfsblawg) on topics drawn from the book. My first post at Prawfsblawg briefly laid out the case for teaching and writing about marijuana law. Even though most people who read this blog are already sold on the subject, I’ll copy the relevant passage here:

“For one thing, state marijuana reforms and the federal response to them have sparked some of the most challenging and interesting legal controversies of our day. May the states legalize a drug while Congress forbids it? Even so, are state regulations governing marijuana preempted by federal law? Does anyone (besides the DOJ) have a cause of action to challenge them as such? Can the President suspend enforcement of the federal ban? Do state restrictions on marijuana industry advertising violate the First Amendment? These are just a handful of the intriguing questions that are now being confronted in this field.

Just as importantly, there is a large and growing number of people who care about the answers to such questions. Forty-three (43) states and the District of Columbia have legalized possession and use of some form of marijuana by at least some people. These reforms – not to mention the prohibitions that remain in place at the federal level – affect a staggering number of people. Roughly 40% of adults in the U.S. have tried marijuana, and more than 22 million people use the drug regularly. To supply this demand, thousands of people are growing and selling marijuana. In Colorado alone, for example, there are more than 600 state licensed marijuana suppliers. There are also countless third parties who regularly deal with these users and suppliers, including physicians who recommend marijuana to patients, banks that provide payment services to the marijuana industry, firms that employ marijuana users, and lawyers who advise all of the above.

All of these people need help navigating a thicket of complicated and oftentimes conflicting laws governing marijuana. Colorado, for example, has promulgated more than 200 pages of regulations to govern its $1 billion a year licensed marijuana industry. Among many other things, Colorado’s regulations require suppliers to carefully track their inventories, test and label their products, and limit where and how they advertise. These regulations are complicated enough but doubts about their enforceability (highlighted in the questions above) only add to the confusion and the need for informed legal advice.”

In the coming weeks, I will blog about some of the questions noted above. In the meantime, if you are interested in teaching a course or a unit on any aspect of marijuana law, contact me – robert<dot>mikos<at>vanderbilt<dot>edu -- I would be happy to chat.

February 3, 2017 in Assembled readings on specific topics, Books, Business laws and regulatory issues, Current Affairs, Federal Marijuana Laws, Policies and Practices, Medical Marijuana Commentary and Debate, Medical Marijuana Data and Research, Medical Marijuana State Laws and Reforms, Political perspective on reforms, Recreational Marijuana Commentary and Debate, Recreational Marijuana Data and Research, Recreational Marijuana State Laws and Reforms, State court rulings, Who decides | Permalink | Comments (2)

Thursday, February 2, 2017

"Patients Are Ditching Opioid Pills for Weed"

The title of this post is the headline of this notable new Atlantic article, and here are excerpts:

James Feeney, a surgeon in Connecticut, heard it from his patients. A few actually turned down his prescription for oxycodone, the popular opioid painkiller that has also gained notoriety with the opioid epidemic. His patients, Feeney recalls, would say, “Listen, don’t give me any of that oxycodone garbage. … I’m just going to smoke weed.”

“And you know what?” says Feeney. “Every single one of those patients doesn’t have a lot of pain, and they do pretty well.” Marijuana has worked well enough, anecdotally at least, that Feeney is following his patients’ lead and conducting a trial at Saint Francis Hospital and Medical Center in Hartford, CT. The state-funded study will compare opioids and medical marijuana for treating acute pain, such as that from a broken rib.

That distinction — acute pain from an injury — is also an important one. A small body of evidence suggests that medical marijuana is effective for chronic pain, which persists even after an injury should have healed and for which opioids are already not a great treatment. But now Feeney wants to try medical marijuana for acute pain, where opioids have long been a go-to drug.

“The big focus from my standpoint is that this is an attempt to end the opioid epidemic,” he says. Overdoses from opioids, which includes heroin as well as prescription painkillers like oxycodone and morphine, killed more than 30,000 people in 2015.

Marijuana might have a bigger role in curbing this drug abuse than previously thought. Its potential uses are actually threefold: to treat chronic pain, to treat acute pain, and to alleviate the cravings from opioid withdrawal. And it has the advantages of being much less dangerous and addictive than opioids.... Yasmin Hurd, a neuroscientist at Mount Sinai who has a license to study marijuana and its derivatives...in a small pilot study ... has found that cannabidiol can reduce the cravings of people addicted to heroin. “They relapse because they are in conditions that induce craving,” says Hurd. By controlling their anxiety, cannabidiol also seems to be controlling their cravings.

Hurd is now running a larger trial to investigate if the substance could help people addicted to heroin, and she published a recent review on cannabidiol’s role in curbing substance abuse....

Interestingly, patients already seem to be replacing opioids with marijuana for chronic pain. A handful of observational studies have also found correlations between states legalizing medical marijuana and a drop in painkiller prescriptions, opioid use, and deaths from opioid overdose. And in 2016, Dan Clauw and his colleagues published a survey of patients with chronic pain who started patronizing a medical marijuana dispensary. They cut their previous opioid use by two-thirds....

Clauw, who runs a pain lab at University of Michigan, says he would to like understand how marijuana quells pain on a molecular level, but getting the license has proved too big a hurdle.

Meanwhile, Feeney’s hospital trial for acute pain is able to get around the logistics issue of marijuana as a scheduled substance. Medical marijuana is legal in the state of Connecticut, but neither Feeney nor his hospital provides it directly to patients. Rather, a doctor certifies a patient to use marijuana, and the patient then picks it up at a dispensary or pharmacy. “The strains I have to select from are so pure and so potent that the stuff they get from the University of Mississippi pales in comparison,” says Feeney.

The trial, which was just got started, will enroll 60 patients with rib injuries in total—30 on marijuana, 30 on opioids. The doctors chose rib injuries to study because the pain lasts a predictable six weeks. Because of the study’s design, patients get to choose whether they use opioids and marijuana to control pain. So far, the hospitals has enrolled a handful of patients. They’ve all chosen marijuana.

Some prior related posts:

February 2, 2017 in Medical community perspectives, Medical Marijuana Commentary and Debate, Medical Marijuana Data and Research | Permalink | Comments (0)

Monday, January 30, 2017

Minnesota facing the high costs of highly regulating its medical marijuana program

This new AP article, headlined "Minnesota's Medical Marijuana Program Needs More Money," provides an interesting report on the state of the medical marijuana program in the Gopher State. Here are the particulars:

Minnesota's medical marijuana program needs extra state funding to cover the costs of its patient database and inspections of drug manufacturers, just a few of the regulations that make it one of the most restrictive such laws in the country. It's the latest reminder of the financial constraints on the program borne from the heavy restrictions on Minnesota's 2014 law.

The plant form of marijuana remains banned under the law, requiring the state's two medical manufacturers to concoct marijuana oils, pills and vapors with routine state inspections and secondary lab testing. Just 10 severe conditions such as cancer and epilepsy qualify for the program, a number that has grown in recent years with a few additions.

The state's manufacturers combined to lose more than $5 million in the first year of legal medical marijuana sales in 2015. And patient count hasn't met projections, exacerbating high prescription costs for patients that the two companies who cultivate and sell medication have only recently begun to address with modest price decreases.

The Office of Medical Cannabis' request for more than $500,000 over the next two years is just a fraction of the $40 billion-plus budget Minnesota's Legislature will assemble this year. But state regulators say that money is critical to cover the higher-than-expected costs for maintenance of their around-the-clock patient registry and the costs of performing 120 inspections or more each year....

The state already provides about $1.4 million a year to help cover operating costs, and regulators can cover their oversight costs by charging manufacturers, LeafLine Labs and Minnesota Medical Solutions, an annual registration fee. But after increasing the manufacturers' annual fee from $94,000 to $146,000 last year, Gov. Mark Dayton's budget proposal says additional state funding is essential to help avoid an "increase the cost of medical cannabis to program participants."

Those costs range from software licensing and fixing bugs on their patient registry — where the state tracks each patient's progress with the new medications — to the travel bills that come from visiting every distribution site, from Rochester in southern Minnesota to Moorhead, near its northwestern corner. "I don't think anyone thought about us having eight cannabis centers statewide," said Michelle Larson, the director of the state program. "Our annual cost is a little bit more than folks thought it would be."

Garofalo also has a different approach: He's proposing legislation that would allow manufacturers to write off business expenses on their Minnesota tax filings. That's impossible at the federal level while it's still considered a Schedule I drug, subjecting marijuana-related businesses to some of the highest effective tax rates.

LeafLine Labs chief executive Andrew Bachman said his company will likely lose money again in 2017, and he wasn't sure whether the tax break would help it break even. But by treating the business just as any other Minnesota company, he said it would help cement medical marijuana as just another type of medicine. "It's about normalization. Cannabis is medicine is thousands for Minnesotans now," Bachman said.

January 30, 2017 in Medical Marijuana Commentary and Debate, Medical Marijuana Data and Research, Medical Marijuana State Laws and Reforms | Permalink | Comments (0)

Wednesday, January 25, 2017

"Can medical marijuana be used to treat heroin addiction?"

Dt_150915_marijuana_leaf_pills_800x600The question in the title of this post is one that I wonder about a lot as more and more communities struggle for responses to the opioid epidemic.  The question is also the title of this new local article from New Hampshire, which discusses a legislative hearing about addiction and other conditions being added to the state's list of qualifying conditions for medical marijuana.  Here are excerpts: 

In the midst of a heroin and fentanyl crisis, New Hampshire lawmakers are considering a bill that would add opioid addiction to the list of qualifying conditions for the state’s therapeutic cannabis program.

That bill was one of five that could add chronic pain, opioid addiction, post-traumatic stress disorder, fibromyalgia and myelitis disorder to the list of conditions that qualify someone to use therapeutic cannabis in the state. New Hampshire lawmakers heard testimony on the bills Wednesday morning.

A number of patients testified in favor of the bills, but one doctor told legislators to proceed with caution on the bill that would allow doctors to treat drug addiction with marijuana.

Dr. Molly Rossignol, a family physician and addiction doctor at Concord Hospital, said there is not enough research to suggest cannabis is an effective treatment for addiction. “We’re going down a dark and potentially dangerous road,” Rossignol said. “In the past year, I’ve evaluated over 100 patients in our capital region. It is clear cannabis is not helping them stop or reduce their use of opioids.”

While medical marijuana is widely used in other states to treat chronic pain and other medical conditions, no state so far has approved therapeutic cannabis to treat addiction. However, at least one study showed a correlation between overdose deaths and medical marijuana laws. A 2014 study published in the Journal of the American Medical Association found opioid overdose deaths went down 25 percent in states that had medical marijuana laws.

State health officials in Maine considered the question of whether to add addiction as a qualifying condition last year, but ultimately their Department of Health and Human Services concluded there was not enough research or evidence to show it would be effective.

“Given the lack of rigorous human studies on the use of marijuana for the treatment of opioid addiction (only one clinical trial has been completed) and the lack of any safety or efficacy data, the Committee can not conclude that the use of medical marijuana for treatment of opioid addiction is safe,” wrote Dr. Siiri Bennett, the Maine state epidemiologist, and Dr. Christopher Pezzullo, the state health officer.

Rossignol said the issue of marijuana being used to treat addiction needed more time. “This has to be vetted, it has to be scientifically studied,” she said.

Rossignol said her experience with addicted patients has so far indicated marijuana is not helpful with addiction. She treats her addicted patients with Suboxone, a drug taken daily to keep cravings and withdrawal symptoms at bay. Suboxone, methadone and naltrexone are the three drugs approved by the Food and Drug Administration to treat addiction – Rossignol said when used with evidence-based therapies, many studies show they help with addiction.

She said she believed marijuana could do the opposite. “It is something that I see every day reducing their chances of getting into longterm recovery,” she said. “I think it is a very slippery slope.”

Several patients traveled to the State House to testify in favor of the five cannabis bills, including ones to add chronic pain and PTSD to the list of qualifying conditions. Stephen Boulter of North Conway told lawmakers that therapeutic cannabis had dramatically decreased his pain and increased his quality of life.

Boulter was able to qualify for medical marijuana due to a vertebrae injury. He said pain from that injury became debilitating. “It’s with you 24 hours a day, you always have pain,” he said. “The only thing that mitigated the pain were opiates, which I detested.”

When Boulter qualified for medical marijuana, he found it got rid of his pain and didn’t make him loopy. “It made a tremendous difference, it allows me to go to bed at night and go to sleep,” he said. “I firmly believe that anyone suffering with severe chronic pain working with a qualified provider can restore a normal, high quality standard of living.”

Former state Rep. Joe LaChance of Manchester, a disabled veteran, encouraged lawmakers to add PTSD to the list of qualifying conditions. “This is so important to us,” LaChance said. “This is near and dear to my heart.” LaChance briefly described his struggles with drugs and alcohol, crediting therapeutic cannabis with his recovery. “Cannabis saved my life,” he said. “The VA got me addicted to opioids. Add a bottle of Jack Daniels to that, I’m lucky to be here.”

Some prior related posts:

January 25, 2017 in Medical community perspectives, Medical Marijuana Commentary and Debate, Medical Marijuana Data and Research, Medical Marijuana State Laws and Reforms, Who decides | Permalink | Comments (0)