Marijuana Law, Policy & Reform

Editor: Douglas A. Berman
Moritz College of Law

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)

Monday, June 26, 2017

"Lower-Risk Cannabis Use Guidelines: A Comprehensive Update of Evidence and Recommendations"

Ajph-logoThe title of this post is the title of this notable new article by multiple authors to soon appear in the American Journal of Public Health.  Here is the abstract:

Background.  Cannabis use is common in North America, especially among young people, and is associated with a risk of various acute and chronic adverse health outcomes.  Cannabis control regimes are evolving, for example toward a national legalization policy in Canada, with the aim to improve public health, and thus require evidence-based interventions.  As cannabis-related health outcomes may be influenced by behaviors that are modifiable by the user, evidence-based Lower-Risk Cannabis Use Guidelines (LRCUG) — akin to similar guidelines in other health fields — offer a valuable, targeted prevention tool to improve public health outcomes.

Objectives. To systematically review, update, and quality-grade evidence on behavioral factors determining adverse health outcomes from cannabis that may be modifiable by the user, and translate this evidence into revised LRCUG as a public health intervention tool based on an expert consensus process.

Search methods. We used pertinent medical search terms and structured search strategies, to search MEDLINE, EMBASE, PsycINFO, Cochrane Library databases, and reference lists primarily for systematic reviews and meta-analyses, and additional evidence on modifiable risk factors for adverse health outcomes from cannabis use.

Selection criteria. We included studies if they focused on potentially modifiable behavior-based factors for risks or harms for health from cannabis use, and excluded studies if cannabis use was assessed for therapeutic purposes.

Data collection and analysis. We screened the titles and abstracts of all studies identified by the search strategy and assessed the full texts of all potentially eligible studies for inclusion; 2 of the authors independently extracted the data of all studies included in this review.  We created Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow-charts for each of the topical searches.  Subsequently, we summarized the evidence by behavioral factor topic, quality-graded it by following standard (Grading of Recommendations Assessment, Development, and Evaluation; GRADE) criteria, and translated it into the LRCUG recommendations by the author expert collective on the basis of an iterative consensus process.

Main results. For most recommendations, there was at least “substantial” (i.e., good-quality) evidence.  We developed 10 major recommendations for lower-risk use: (1) the most effective way to avoid cannabis use–related health risks is abstinence; (2) avoid early age initiation of cannabis use (i.e., definitively before the age of 16 years); (3) choose low-potency tetrahydrocannabinol (THC) or balanced THC-to-cannabidiol (CBD)–ratio cannabis products; (4) abstain from using synthetic cannabinoids; (5) avoid combusted cannabis inhalation and give preference to nonsmoking use methods; (6) avoid deep or other risky inhalation practices; (7) avoid high-frequency (e.g., daily or near-daily) cannabis use; (8) abstain from cannabis-impaired driving; (9) populations at higher risk for cannabis use–related health problems should avoid use altogether; and (10) avoid combining previously mentioned risk behaviors (e.g., early initiation and high-frequency use).

Authors’ conclusions. Evidence indicates that a substantial extent of the risk of adverse health outcomes from cannabis use may be reduced by informed behavioral choices among users.  The evidence-based LRCUG serve as a population-level education and intervention tool to inform such user choices toward improved public health outcomes.  However, the LRCUG ought to be systematically communicated and supported by key regulation measures (e.g., cannabis product labeling, content regulation) to be effective.  All of these measures are concretely possible under emerging legalization regimes, and should be actively implemented by regulatory authorities.  The population-level impact of the LRCUG toward reducing cannabis use–related health risks should be evaluated.

Public health implications. Cannabis control regimes are evolving, including legalization in North America, with uncertain impacts on public health.  Evidence-based LRCUG offer a potentially valuable population-level tool to reduce the risk of adverse health outcomes from cannabis use among (especially young) users in legalization contexts, and hence to contribute to improved public health outcomes.

June 26, 2017 in Medical community perspectives, Medical Marijuana Data and Research, Recreational Marijuana Data and Research | Permalink | Comments (0)

Wednesday, June 21, 2017

Might marijuana reform help address the obesity epidemic?

The question in the title of this post is prompted by this notable new New York Daily News article headlined "Science: Regular consumption of marijuana keeps you thin, fit and active." I am not sure the article that follows entire backs up the implication of this headline, but here are excerpts from the article that are still encouraging:

An apple a day keeps the doctor away. Here’s a new health-related adage to consider: Regular consumption of marijuana keeps you thin and active. According to researchers at Oregon Health and Science University, people who use marijuana more than five times per month have a lower body mass index (BMI) than people who do not marijuana.

The researchers concluded: “Heavy users of cannabis had a lower mean BMI compared to that of never users, with a mean BMI being 26.7 kg/m in heavy users and 28.4 kg/m in never users.”

The study also suggested that people who consume marijuana on a regular basis are more physically activity than those that use it sporadically or not at all.

Of course, this is not the first time scientific studies have reached this conclusion: A study published last year in the Journal of Mental Health Policy and Economics suggests that regular consumers of cannabis have a lower BMI than those who do not use the drug.

A 2013 study published in the American Journal of Medicine found that cannabis consumers have 16 percent lower levels of fasting insulin and 17 percent lower insulin resistance levels than non-users. The research found “significant associations between marijuana use and smaller waist circumferences.”

And data published in British Medical Journal in 2012 reported that cannabis consumers had a lower prevalence of type 2 diabetes and a lower risk of contracting the disease than did those with no history of cannabis consumption.

In the 2016 study, lead author Isabelle C. Beulaygue from the University of Miami concluded: “There is a popular belief that people who consume marijuana have the munchies, and so [THEY]are going to eat a lot and gain weight, and we found that it is not necessarily the case.”

Researchers have not identified the reason behind the findings. But some suggest that those who consume cannabis regularly may be able to more easily break down blood sugar, which may help prevent weight gain.

June 21, 2017 in Food and Drink, Medical community perspectives, Medical Marijuana Data and Research, Recreational Marijuana Data and Research | Permalink | Comments (0)

Thursday, June 15, 2017

Bipartisan group introduces new version of CARERS Act to reform federal marijuana prohibition

CARERS-act-header-backgroundAs reported in this new Roll Call article, a "bipartisan group of senators and representatives have reintroduced legislation that would enable states to set their own medical marijuana policies."  Here are the basics:

Senators Cory Booker, D-N.J., and Kirsten Gillibrand, D-N.Y., joined by Rep. Steve Cohen, D-Tenn., made the announcement on Thursday....

The legislation reintroduced Thursday would protect patients, doctors and businesses participating in state medical-marijuana programs from federal prosecution. The Compassionate Access, Research Expansion and Respect States (CARERS) Act would not legalize medical marijuana in all 50 states. Instead, it would ensure that people in the states where medical cannabis is legal can use it without violating federal law.

In addition to Booker and Gillibrand, co-sponsors of the CARERS Act include Senators Rand Paul, R-Ky., Mike Lee, R-Utah, Lisa Murkowski, R-Alaska, and Al Franken, D-Minn. 

This press release from Senator Booker is titled "Lawmakers Reintroduce Bipartisan, Bicameral Medical Marijuana Bill: CARERS Act would ensure patients have access to lifesaving care without fear of federal prosecution." The press release includes quotes from all the sponsors and state that "the CARERS Act would:

(1) Recognize States’ Responsibility to Set Medical Marijuana Policy & Eliminate Potential Federal Prosecution

The CARERS Act amends the Controlled Substances Act so that states can set their own medical marijuana policies. The patients, providers, and businesses participating in state medical marijuana programs will no longer be in violation of federal law and vulnerable to federal prosecution.

(2) Allow States to Import Cannabidiol (CBD), Recognized Treatment for Epilepsy and Seizure Disorders

The CARERS Act amends the Controlled Substances Act to remove specific strains of CBD oil from the federal of definition of marijuana. This change will allow youth suffering from intractable epilepsy to gain access to the medicine they need to control their seizures.

(3) Provide Veterans Access

Current law prohibits doctors in Department of Veterans Affairs (VA) facilities from prescribing medical marijuana. The CARERS Act would allow VA doctors in states where medical marijuana is legal to recommend medical marijuana to military veterans.

(4) Expand Opportunities for Research

The CARERS Act removes unnecessary bureaucratic hurdles for researchers to gain government approval to undertake important research on marijuana and creates a system for the Secretary of the Department of Health and Human Services to encourage research.

The CARERS Act has the support of more than 20 health, veteran and policy organizations, including: American Civil Liberties Union, Americans for Safe Access, Compassionate Care NY, Coalition for Medical Marijuana NJ, Drug Policy Alliance, Housing Works, Law Enforcement Against Prohibition, Marijuana Policy Project, MS Resources of Central New York, Multidisciplinary Association for Psychedelic Studies, New Jersey Hospice and Palliative Care Organization, NY Physicians for Compassionate Care, Parents Coalition for Rescheduling Medical Cannabis, Patients Out of Time, Students for Sensible Drug Policy, The American Cannabis Nurses Association, The Breast Cancer Coalition of Rochester, Third Way, Veterans for Medical Cannabis Access, Veterans for Peace and Veterans for Safe Access and Compassionate Care."

June 15, 2017 in Federal Marijuana Laws, Policies and Practices, Medical Marijuana Commentary and Debate, Medical Marijuana Data and Research, Medical Marijuana State Laws and Reforms, Who decides | Permalink | Comments (1)

Monday, June 12, 2017

"Loose regulation of medical marijuana programs associated with higher rates of adult marijuana use but not cannabis use disorder"

CoverThe lengthy title of this post is the lengthy title of this new research to appearing in the journal Addiction.  Here are the summary details via the abstract:

Background and Aims

Most U.S. states have passed medical marijuana laws (MMLs), with great variation in program regulation impacting enrollment rates.  We aimed to compare changes in rates of marijuana use, heavy use, and Cannabis Use Disorder across age groups while accounting for whether states enacted medicalized (highly regulated) or non-medical MML programs.

Design

Difference-in-differences estimates with time-varying state-level MML coded by program type (medicalized v. non-medical). Multilevel linear regression models adjusted for state-level random effects and covariates as well as historical trends in use. Setting Nationwide cross-sectional survey data from the U.S. National Survey of Drug Use and Health (NSDUH) restricted use data portal aggregated at the state level.

Participants

2004-2013 NSDUH respondents (N ~ 67,500/year); age groups 12-17, 18-25, and 26+ years. States had implemented 8 medicalized and 15 non-medical MML programs.

Measurements

Primary outcome measures included 1) Active (past-month) marijuana use; 2) Heavy use (>300 days/year); and 3) Cannabis Use Disorder diagnosis, based on DSM-IV criteria. Covariates included program type, age group, and state-level characteristics across the study period.

Findings

Adults 26+ years of age living in states with non-medical MML programs increased past-month marijuana use 1.46% (from 4.13% to 6.59%, p=0.01) skewing toward greater heavy marijuana by 2.36% (from 14.94 to 17.30, p=0.09) after MMLs were enacted. However, no associated increase in the prevalence of Cannabis Use Disorder was found during the study period. Our findings do not show increases in prevalence of marijuana use among adults in states with medicalized MML programs. Additionally, there were no increases in adolescent or young adult marijuana outcomes following MML passage, irrespective of program type.

Conclusions

Non-medical marijuana laws enacted in US states are associated with increased marijuana use, but only among adults 26+ years.

June 12, 2017 in Medical Marijuana Data and Research, Medical Marijuana State Laws and Reforms | Permalink | Comments (0)

Thursday, June 1, 2017

Following the ever-increasing monies being invested in marijuana industry

-1x-1Bloomberg has this notable new article headlined "Trump Casts Cloud Over Cannabis, But Money Keeps Pouring In," and here are excerpts:

The Trump administration’s adversarial stance toward marijuana has brought jitters to the burgeoning cannabis industry, but money continues to pour in.

Pot-related companies raised more than $734 million between Jan. 1 and April 21, an almost sevenfold increase from $108 million in the same period last year, according to a report from New Frontier Data and Viridian Capital Advisors. That brings the total amount raised to $1.9 billion since the start of 2016.

The investment surge reflects optimism that President Donald Trump and Attorney General Jeff Sessions won’t crack down on the industry, even as those concerns weigh on stock prices this year. Since hitting a peak in February, the Bloomberg Intelligence Global Cannabis Index has dropped 36 percent.

For cannabis financiers, the industry’s growth potential outshines the political risk. Eight states voted to legalize cannabis in some form on Nov. 9, including the nation’s largest. Legal cannabis demand in California is set to grow by 50 percent in 2018, when recreational use is scheduled to come online, according to the report. The report’s authors forecast that national demand for legalized marijuana will almost quadruple by 2025.

“With each new state that legalizes, that need for capital is going to be there,” said John Kagia, New Frontier’s executive vice president of industry analytics and author of the report. “It will continue to represent a substantial investment opportunity for the foreseeable future.” As a result of competition for funding, seed capital is being raised in greater initial amounts and its cost is getting more expensive, New Frontier Chief Executive Officer Giadha Aguirre de Carcer said.

The boom has taken place amid an unclear policy outlook under Trump. Press Secretary Sean Spicer said in February that he expects the Department of Justice to increase enforcement of federal laws prohibiting recreational pot use, even in states where it’s allowed. While Spicer defended medical marijuana, Sessions indicated he dislikes anything to do with the plant....

The uncertainty has made some investors more nervous about getting into the industry. “There’s a lot of fear,” said Rob Hunt, a founding partner of Tuatara Capital, which invests in cannabis companies and has more than $100 million under management. The silver lining, however, is that “it’s not very likely we’re ever getting someone further to the right on this issue than Sessions is.”...

Neither the political threats nor ongoing banking and tax difficulties will ultimately derail the industry, Viridian and New Frontier predict. Legal sales of cannabis products are expected to reach $24.1 billion in 2025, up from $6.6 billion in 2016. Investment will keep gaining too, particularly because interstate commerce is prohibited. That means every state that legalizes weed must create its own infrastructure....

“What we’ve also seen in the past 18 months or so is an increased number of more sophisticated companies entering the industry,” De Carcer said. And they’ve come with “more mature and experienced management teams,” she said.

June 1, 2017 in Business laws and regulatory issues, Medical Marijuana Data and Research, Recreational Marijuana Data and Research, Who decides | Permalink | Comments (0)

Wednesday, May 24, 2017

Encouraging new research about CBD as an effective treatment for Dravet syndrome

ImagesAs reported in this NBC News piece, headlined "Cannabis Drug Reduces Seizures in Severe Epilepsy Cases," some encouraging new research news was published in a major medical journal today. Here are the details:

A compound taken from marijuana greatly helped some children with a severe and often deadly form of epilepsy and completely stopped seizures in a very few, researchers reported Wednesday.  It's a rare success in a field suffused with more hope than facts — in which advocates clamor to have marijuana and compounds taken from the herb legalized for free use, while government rules limit use and researchers struggle to prove what works and what doesn't.

In this study, the researchers enrolled kids with Dravet syndrome, a very rare and often deadly form of epilepsy caused by a genetic mutation.  These kids have multiple, prolonged seizures that cause brain damage. There's no treatment. "It's hard to portray how serious and devastating this is," Dr. Orrin Devinsky, director of the New York University Comprehensive Epilepsy Center, told NBC News.

Devinsky and colleagues around the country tested a cannabis derivative called cannabidiol — CBD for short — on 120 Dravet syndrome patients.  Half took it for 14 weeks and half got a placebo.

"Seizure frequency dropped in the cannabidiol-treated group by 39 percent from nearly 12 convulsive seizures per month before the study to about six; three patients' seizures stopped entirely," the team wrote in the New England Journal of Medicine.  "In the placebo group, there was a 13 percent reduction in seizures from about 15 monthly seizures to 14," they added.

"Quite remarkably, 5 percent of the children in the active treatment group with CBD were completely seizure free during the 14 weeks of the trial," Devinsky said. "And these were kids who were often having dozens of seizures, if not many more than that per week."

The kids who got CBD were more likely to stop the trial because of side-effects. "Side-effects were generally mild or moderate in severity, with the most common being vomiting, fatigue and fever," Devinsky wrote.  But those who have been helped have been transformed, he added. "There's no doubt for some children this is just been an incredibly effective and game changing medication for them," Devinsky said.

"These are some of the children I care for [who] were in wheelchairs, were barely able to open their eyes in an office visit and really showed no emotion and … now they come in, they're walking, they're smiling, they're interactive. It's like a different human being in front of you."

He said it's not quite accurate to called CBD "medical marijuana."

"Cannabidiol is the major non-psychoactive compound present in cannabis or marijuana," Devinsky said.  "In this study, we were giving a compound CBD which has no high-producing or psychoactive properties."...

"The drug we gave was derived from cannabis or marijuana but it really should not be confused with the medical marijuana that would be obtained from dispensaries in the 44 U.S. states that have approved it. Those typically contain combinations of THC with CBD and many other compounds," Devinsky said.

It's not clear precisely how CBD works. It appears to attach to brain cells, he said. "The CBD binds with a novel receptor in the brain and thereby dampens down too much electrical activity," he said. "It seems to be a relatively unique mechanism of action that's not shared by any of the existing seizure medications."

Doctors are interested in trying CBD on autism, anxiety, inflammatory and autoimmune disorders, Devinsky said.  It may help people with other types of seizures, as well....

Australian epilepsy expert Dr. Samuel Berkovic said much more testing is needed. "This trial represents the beginning of solid evidence for the use of cannabinoids in epilepsy," Berkovic, who works at the University of Melbourne, wrote in a commentary.

May 24, 2017 in Medical community perspectives, Medical Marijuana Commentary and Debate, Medical Marijuana Data and Research | Permalink | Comments (0)

Sunday, May 21, 2017

American Legion, the largest US vets' organization, pressing Trump Administration on medical marijuana reform

LegionemblemThis new Politico article, headlined "American Legion to Trump: Allow marijuana research for vets," reports on a notable new push by a notable organization to seek a notable change in federal marijuana laws with the new administration. Here are excerpts from an article which strikes me as pretty big news:

One of the nation’s most conservative veterans’ groups is appealing to President Donald Trump to reclassify marijuana to allow large-scale research into whether cannabis can help troops suffering from post-traumatic stress disorder . The change sought by The American Legion would conflict with the strongly anti-marijuana positions of some administration leaders, most vocally Attorney General Jeff Sessions.

Under current rules, doctors with the Department of Veterans Affairs cannot even discuss marijuana as an option with patients.  But the alternative treatment is gaining support in the medical community, where some researchers hope pot might prove more effective than traditional pharmaceuticals in controlling PTSD symptoms and reducing the record number of veteran suicides.

"We are not asking for it to be legalized," said Louis Celli, the national director of veterans affairs and rehabilitation for the American Legion, which with 2.4 million members is the largest U.S. veterans’ organization.  "There is overwhelming evidence that it has been beneficial for some vets.  The difference is that it is not founded in federal research because it has been illegal."

The Legion has requested a White House meeting with Jared Kushner, Trump's son-in-law and close aide, "as we seek support from the president to clear the way for clinical research in the cutting edge areas of cannabinoid receptor research," according to a recent letter shared with POLITICO.

The request marks a significant turn in the debate over medical marijuana by lending an influential and unexpected voice.  The Legion, made up mostly of Vietnam and Korean War-era veterans, is breaking with other leading vets’ groups such as the Veterans of Foreign Wars in lobbying for the removal of the major roadblock in pursuing marijuana treatment.  But it also comes as the new administration, led by Sessions, is sending strong signals of its desire to thwart marijuana decriminalization and legalization efforts.  Expectations are growing in Congress that DOJ may even try to roll back medical marijuana laws in 29 states....

"We desperately need more research in this area to inform policymakers," said Sue Sisley, a psychiatrist at the Scottsdale Research Institute in Arizona who is running one of the only cannabis studies underway focused on vets suffering from PTSD.  "I really want to see the most objective data published in peer reviewed medical journals.” She added that she isn’t prejudging what the outcome of the research will be.

“I don't know if cannabis will turn out to be helpful for PTSD,” Sisley said.  “I know what veterans tell me but until we have rigorous controlled trials, all we have are case studies that are not rigorous enough to make me, medical professionals, health departments or policymakers convinced."

Some veterans’ activists are angry at the federal government’s continued resistance to even studying cannabis, even as an average of 20 vets kill themselves every day. "We need solutions," said Nick Etten, a former Navy SEAL who runs the Veterans Cannabis Project, a health policy organization. "We need treatment that works. We need treatment that is not destructive.  The VA has been throwing opiates at veterans for almost every condition for the last 15 years.  You are looking at a system that has made a problem worse the way they have approached treatment."...

The VA declined to address whether it is reconsidering its stance on the issue, citing the illegality of marijuana in all its forms under federal law....  Most leading veterans’ groups are toeing that line, including Veterans of Foreign Wars.  "The VFW has no official position regarding this ongoing debate because marijuana is illegal under federal law," said Joe Davis, the group's spokesman.

But grassroots support is growing among veterans — both young and older — and in Congress to reconsider the current approach.  Much of that is because of growing anecdotal evidence that marijuana helps some veterans with PTSD control their symptoms when approved drugs do not, such as ridding them of nightmares and helping them sleep.  And that is what is driving the efforts of the American Legion.  Celli said the group's Veterans Affairs & Rehabilitation Commission, which represents veterans from World War II to the wars in Iraq and Afghanistan, recently gave the Legion "overwhelming support" to advocate changes....

In addition to cannabis, the organization is advocating for more research on so-called Quantitative EEG neurometrics, which measures the brain's electrical activity.  "The American Legion believes these two areas alone can help cut the amount of veteran suicides and cases of chemically addicted veteran by more than half," the letter to the White House says.  "The American Legion respectfully requests a meeting with President Trump as soon as possible and looks forward to partnering with this administration in the fight against narcotics addiction and reducing the veteran suicide rate from the tragic loss of 20 warriors per day, to zero."

May 21, 2017 in Federal Marijuana Laws, Policies and Practices, Medical Marijuana Commentary and Debate, Medical Marijuana Data and Research, Who decides | Permalink | Comments (1)

Friday, May 19, 2017

"New potential for marijuana: Treating drug addiction"

The title of this post is the headline of this lengthy CNN piece.  Here are excerpts:

Most European countries and Canada have embraced the idea of harm reduction, designing policies that help people with drug problems to live better, healthier lives rather than to punish them. On the front lines of addiction in the United States, some addiction specialists have also begun to work toward this end.

Joe Schrank, program director and founder of High Sobriety, is one of them. He says his Los Angeles-based treatment center uses medicinal cannabis as a detox and maintenance protocol for people who have more severe addictions, although it's effectiveness is not scientifically proven. "So it's a harm-reduction theory," he said. "With cannabis, there is no known lethal dose; it can be helpful for certain conditions."

"Some say it's hypocritical because, you know, you're supposed to go to rehab to get off drugs," said Schrank, who recently celebrated 20 years of sobriety from alcohol and all drugs. "And cessation of drug use can be a goal for some people, but pacing is also important." Some patients want to gradually move into abstinence, weaning themselves off drugs over time. Others want to maintain sobriety from a drug by using a less harsh drug, such as cannabis.

Others, including Todd Stumbo, CEO of Blue Ridge Mountain Recovery Center in Georgia, do not favor using marijuana as treatment for addiction. "I'm all about adding interventions and therapeutic techniques that have proven to be significantly profound in the changes to somebody's life and treatment. Unfortunately, I don't know that there's evidence to substantiate that marijuana's had that effect," says Stumbo. "Our take is abstinence based and we use every tool or intervention we can that's been proven effective in the past."

Still, harm reduction is gaining acceptance in the wider field of addiction specialists in the U.S. "In principle, what we have aimed for many years is to find interventions that would lead to complete abstinence," said Dr. Nora Volkow, director of the National Institute on Drug Abuse. Practically, though, that has been very difficult to achieve with relapsing addictions.

"One of the things is, we don't have any evidence-based medication that has proven to be efficacious for the treatment of cocaine addiction," Volkow said. "So we currently have no medicine to intervene, and it can be a very severe addiction and actually quite dangerous."...

"We have started to explore the extent to which interventions that can decrease the amount of drug consumed can have benefits to the individual," Volkow said, adding that she'd make this same argument for opioids and heroin. "It would be valuable to decrease the amount of drug consumed."...

Schrank, who readily concedes there are possible health and addiction risks with marijuana, says he offers his cannabis detox and maintenance protocol to people addicted to crack cocaine as well as those trying to kick opioids. Through the years, he says, he's treated about 50 people with this technique and expects to see "more people wanting to try to have a voice in their recovery rather than just plug into systems telling them what to do." Marijuana "can really help people with pain management and other health issues, or it can help them be safer," Schrank said.

Yasmin Hurd, director of the Addiction Institute at Mount Sinai School of Medicine, says generally, cannabidiol is the more important compound when it comes to marijuana as a treatment for addiction. It is one of the two primary cannabinoids, along with Δ9-tetrahydrocannabinol (THC), found in the cannabis plant. In terms of the wider scope of medical marijuana research, this is the "same cannabidiol being looked at for the kids with epilepsy," Hurd said.

May 19, 2017 in Medical community perspectives, Medical Marijuana Commentary and Debate, Medical Marijuana Data and Research | Permalink | Comments (0)