Tuesday, October 16, 2018
The title of this post is the title of this interesting new article in the journal Population Health Management authored by Yulia Treister-Goltzman, Tamar Freud, Yan Press, and Roni Peleg. Here is its abstract:
Widespread use of cannabis as a drug and passage of legislation on its use should lead to an increase in the number of scientific publications on cannabis. The aim of this study was to compare trends in scientific publication for papers on medical cannabis, papers on cannabis in general, and all papers between the years 2000 and 2017. A search of PubMed and Web of Science was conducted.
The overall number of scientific publications in PubMed increased 2.5-fold. In contrast, the number of publications on cannabis increased 4.5-fold and the number of publications on medical cannabis increased almost 9-fold. The number of publications on medical cannabis in Web of science increased even more (10-fold). The most significant number of publications was in the field of psychiatry. In the fields of neurology and cancer treatment there was a significant increase in the years 2011–2013. There was a rise in the number of publications on children and the elderly after 2013. The specific indications with the largest number of publications were HIV (261), chronic pain (179), multiple sclerosis (118), nausea and vomiting (102), and epilepsy (88). More than half of the publications on medical cannabis originated from the United States, followed by Canada. More than 66% of the publications were original studies.
The spike in the number of scientific publications on medical cannabis since 2013 is encouraging. In light of this trend the authors expect an even greater increase in the number of publications in this area in coming years.
Wednesday, September 26, 2018
The title of this post is the title of this interesting new FiveThirtyEight piece by Christie Aschwanden. Here is how it gets started:
As marijuana is legalized in more and more states, the wellness world has whipped itself into a frenzy over a non-intoxicating cannabis derivative called cannabidiol. CBD products can be found on the internet and in health-food stores, wellness catalogs and even bookstores. (A bookstore in downtown Boulder, Colorado, displays a case of CBD products between the cash register and the stacks of new releases.) Celebrities like Gwyneth Paltrow, disgraced cyclist Floyd Landis and former Denver Broncos quarterback Jake Plummer are all touting CBD products, and according to Bon Appétit, CBD-infused lattes have become “the wellness world’s new favorite drink.”
But, uh, what is it that CBD is supposed to do? I visited a cannabis dispensary in Boulder to find out what the hype was all about. After passing an ID check, I was introduced to a “budtender” who pointed me to an impressive array of CBD products — tinctures, skin patches, drink powders, candies, salves, massage oil, lotions, “sexy time personal intimacy oil” and even vaginal suppositories to treat menstrual cramps.
Most of these products promised to relieve pain or otherwise enhance well-being, and none of it was cheap. (Prices started at about $30.) But I wanted to know: Does any of this stuff really work? After a deep dive into the scientific research, I learned that the answer was a big fat maybe.Although there’s enticing evidence that good ol’ cannabis can ease chronic pain and possibly treat some medical conditions, whether CBD alone can deliver the same benefits remains an open question. What is clear, at this point, is that the marketing has gotten way ahead of the science.
Wednesday, September 12, 2018
The latest issue of the International Review of Psychiatry has a collection of interesting looking articles with titles like "Marijuana matters: reviewing the impact of marijuana on cognition, brain structure and function, & exploring policy implications and barriers to research" and "Sweet flowers are slow, and weeds make haste: leveraging methodology from research on tobacco, alcohol, and opioid analgesics to make rapid and policy-relevant advances in cannabis science." There are too many interesting looking pieces to cite them all here, but I can quote the start of the editorial introduction:
The allowance of cannabis to be used as a medicine in the absence of adequate data to inform basic clinical decision-making is rooted in compassion for individuals with life-threatening illness, or substantially debilitating illness, and no other course for treatment. However, this relatively simple tenet has now morphed into a large-scale for-profit industry that is fraught with public health concerns. Access to cannabis has been expanded to include treatment for a multitude of health conditions, many of which are neither life-threatening nor debilitating, and for which effective alternative treatments exist. Data from which to determine the risk-benefit for an individual considering the use of cannabis is sparse at best. Quality control issues abound in this industry as there are no established standards for cultivating, processing, testing, or labeling cannabis products. There is also concern over advertisements and product labeling that include misleading or unsubstantiated health claims, as these products have not been vetted by traditional drug development methods. The speed in which cannabis policies are changing is rapid, and the fact that these are happening as a direct result of legislation or by voter referendum is reckless given the absence of consensus standards and, in many cases, appropriate regulatory oversight. The impact of revised cannabis laws, both with respect to medicinal use for a variety of health conditions, and for non-medicinal (aka ‘recreational’) use of cannabis by adults, will likely have a substantial impact on psychiatry.
This special issue of the International Review of Psychiatry is focused on cannabis science, but with a very targeted theme of cannabis regulatory science. Recently in the US, the Food and Drug Administration (FDA) was granted regulatory authority over all nicotine and tobacco products. This was a landmark event, and has engendered a bolus of thoughtful, policy-oriented research that has already resulted in tobacco regulations which are likely to positively impact public health in the US and abroad. Studies have included careful scientific evaluation of the impact of nicotine on cigarette reinforcement and self-administration, packaging and flavoring on youth initiation, the harm reduction effects associated with nicotine delivery devices other than cigarettes, and other important topics. The parallel need for a cannabis regulatory science is urgent. Novel products and cannabis delivery devices are rolling onto the shelves of dispensaries at a rapid rate, product development appears to be geared towards high potency/high dose products, and it is all being carefully marketed to increase consumption. Contributions in this issue highlight lessons learned from tobacco, alcohol, and opioid regulatory science that are relevant to cannabis, detail important factors surrounding tobacco and cannabis co-use, and detail the potential impacts of regulatory changes on cannabis use in the workplace.
September 12, 2018 in Medical Marijuana Commentary and Debate, Medical Marijuana Data and Research, Recreational Marijuana Commentary and Debate, Recreational Marijuana Data and Research | Permalink | Comments (0)
Tuesday, August 28, 2018
Has anyone tracked how many times and how many ways state medical marijuana programs have been expanded after inception?
The question in the title of this post was my first reaction to the latest reports on the latest states to expand access to medical marijuana. This piece from Connecticut on this front is headlined "State Approves Use Of Medical Marijuana For Stubborn Headaches, 7 Other Conditions," and here are the basics:
Medical marijuana may now be prescribed in Connecticut to treat medication-resistant headaches, severe rheumatoid arthritis and several other new conditions, the Department of Consumer Protection announced Tuesday.
The state legislature’s Regulation Review Committee has updated the state’s medical marijuana program regulations to include eight new conditions for adults and two new conditions for patients under 18.
Today, also brings this similar news from Illinois, under the headline "Rauner signs medical marijuana expansion bill allowing drug as painkiller alternative," starting this way:
A measure that could dramatically expand access to medical marijuana in Illinois — making it available as an opioid painkiller replacement and easing the application process for all who qualify — was signed into law by Gov. Bruce Rauner on Tuesday....
No longer will any applicants have to be fingerprinted and undergo criminal background checks. And those who complete an online application with a doctor’s authorization will get a provisional registration to buy medical cannabis while they wait for state officials to make a final review of their request.
My sense is that this is a common reality that has found expression perhaps multiple time in multiple states: over time, states add qualifying conditions or reduce restriction on access to medical marijuana. I suspect someone somewhere is tracking these developments nationwide, and I think the pace and scope of amendments to state medical marijuana regimes would tell an interesting and significant modern reform story.
August 28, 2018 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 | Permalink | Comments (0)
Monday, August 13, 2018
The title of this post is the title of this notable new research article forthcoming in the October 2018 issue of the International Journal of Drug Policy. Here is its abstract:
The aim of this research was to determine the association between legalizing medical marijuana and workplace fatalities.
Repeated cross-sectional data on workplace fatalities at the state-year level were analyzed using a multivariate Poisson regression.
To date, 29 states and the District of Columbia have legalized the use of marijuana for medicinal purposes. Although there is increasing concern that legalizing medical marijuana will make workplaces more dangerous, little is known about the relationship between medical marijuana laws (MMLs) and workplace fatalities.
All 50 states and the District of Columbia for the period 1992–2015.
Workplace fatalities by state and year were obtained from the Bureau of Labor Statistics. Regression models were adjusted for state demographics, the unemployment rate, state fixed effects, and year fixed effects.
Legalizing medical marijuana was associated with a 19.5% reduction in the expected number of workplace fatalities among workers aged 25–44 (incident rate ratio [IRR], 0.805; 95% CI, .662–.979). The association between legalizing medical marijuana and workplace fatalities among workers aged 16–24, although negative, was not statistically significant at conventional levels. The association between legalizing medical marijuana and workplace fatalities among workers aged 25–44 grew stronger over time. Five years after coming into effect, MMLs were associated with a 33.7% reduction in the expected number of workplace fatalities (IRR, 0.663; 95% CI, .482–.912). MMLs that listed pain as a qualifying condition or allowed collective cultivation were associated with larger reductions in fatalities among workers aged 25–44 than those that did not.
The results provide evidence that legalizing medical marijuana improved workplace safety for workers aged 25–44. Further investigation is required to determine whether this result is attributable to reductions in the consumption of alcohol and other substances that impair cognitive function, memory, and motor skills.
Monday, July 30, 2018
This local Florida article, headlined "Marijuana booming as state nears 2-year mark," reports on (unsurprising?) medical marijuana realities in the Sunshine State. Here are highlights from the lengthy piece:
More than 100,000 Floridians now can legally take marijuana for medicinal purposes. This milestone, reached in April, is one of many signs that Florida’s young marijuana industry is booming as the state approaches the two-year anniversary of voters legalizing medical pot.
But issues remain: Some patients complain that the Florida Department of Health’s rules create unfair barriers for patients. They can’t smoke their marijuana or grow their own, for example. They also gripe about the patient approval process and the cost of medication. Companies eager to jump into the marijuana business are waiting for the state to issue additional licenses required by law upon passing the 100,000-patient mark....
In November 2016, 71 percent of Florida’s voters gave the green light to medical marijuana. The state still is issuing guidelines and battling lawsuits over how that should be done. But the direction is clear. Already, analysts are projecting a $1 billion medical marijuana market in Florida by 2020.
Fourteen companies have received licenses from the state. They’ve opened 43 dispensaries statewide, including offices in Summerfield and Lady Lake, to serve the growing number of approved patients, which has more than doubled since the start of the year. The coveted licenses are drawing attention from established marijuana businesses. In June, California-based MedMen paid $53 million to acquire the cultivation and distribution rights from Treadwell Nursery in Eustis....
[T]he process to become a qualifying doctor [initially meant] doctors were required to pay $1,000 for an eight-hour course. That requirement has since decreased to a two-hour course costing $250. More than 1,500 physicians now are able to recommend marijuana to patients, including more than 40 in Sumter, Lake and Marion counties.
Miami-Dade and Palm Beach counties have the most registered physicians, with more than 200 each. Demand for doctors persists, with 1,500 to 3,500 patients joining the registry every week....
Even as more and more people line up for treatment, criticism of the program continues. Companies and advocates of Amendment 2, which authorized medical marijuana, are challenging some of the rules laid out by the Department of Health. Attorney John Morgan sued the department over its rule banning smokeable cannabis, arguing it goes against the will of the voters who approved the amendment. Vaping is allowed. Tallahassee Circuit Judge Karen Gievers sided with Morgan, saying the restriction was unconstitutional. The state immediately appealed the decision, and Morgan tried to get the Florida Supreme Court to consider the case. He now is focusing on legalizing recreational use.
Morgan criticized Gov. Rick Scott, who had opposed the broad legalization of medical marijuana, for allowing the smoking ban. Scott defended following the law as it is written. He is not alone in voicing smoking opposition. The American Society of Addiction Medicine rejects smoking as a means of drug delivery for medical purposes. The American Cancer Society Cancer Action Network, the ACS’s advocacy group, has not taken a position on legalization of marijuana for medical purposes, citing a need for more scientific research on marijuana’s potential benefits and harms.
Thursday, July 26, 2018
The pro-marijuana reform website Marijuana Moment continues to provide effective coverage of all sorts of marijuana news and stories, and recently the site has spotlighted a lot of interesting new research results in these pieces:
Tuesday, July 24, 2018
Tom Angell reports here at Forbes on the introduction of a new piece of federal legislation that I consider long overdue. Here are the details:
The Marijuana Data Collection Act, introduced on Tuesday by Rep. Tulsi Gabbard (D-HI) and a bipartisan group of cosponsors, would direct the Department of Health and Human Services to partner with other federal and state government agencies to study "the effects of State legalized marijuana programs on the economy, public health, criminal justice and employment."...
If the legislation is enacted, the National Academy of Sciences would carry out the research and publish initial findings within 18 months, with follow-up reports to be issued every two years after that.
So far, the bill's backers seem to consist solely of those who support marijuana law reform, a situation that legalization advocates decried. “This is not a marijuana bill, it is an information bill," Justin Strekal, political director for NORML, said in an interview. "No member of Congress can intellectually justify opposition to this legislation. Our public policy needs to be based on sound data and science, not gut feelings or fear-mongering. Approving the Marijuana Data Collection Act would provide legislators with reliable and fact-based information to help them decide what direction is most beneficial to society when it comes to marijuana policy.”...
Gabbard held a Tuesday morning press conference with other supporters, including lead GOP cosponsor Rep. Carlos Curbelo (R-FL) and former U.S. Attorneys Barry Grissom of Kansas and Bill Nettles of South Carolina. Other original cosponsors of the bill include Reps. Don Young (R-AK), Darren Soto (D-FL), Beto O’Rourke (D-TX), Earl Blumenauer (D-OR), Dana Rohrabacher (R-CA), Matt Gaetz (R-FL), Peter DeFazio (D-OR), Eleanor Holmes Norton (D-DC), Dina Titus (D-NV), Charlie Crist (D-FL), Tom Garrett (R-VA), Lou Correa (D-CA), Barbara Lee (D-CA), Mark Pocan (D-WI) and Salud Carbajal (D-CA).
Here are the specific data points the bill directs federal officials to track:
REVENUES AND STATE ALLOCATIONS
The monetary amounts generated through revenues, taxes, and any other financial benefits. The purposes and relative amounts for which these funds were used. The total impact on the State and its budget.
MEDICINAL USE OF MARIJUANA
The rates of medicinal use among different population groups, including children, the elderly, veterans, and individuals with disabilities. The purpose of such use. Which medical conditions medical marijuana is most frequently purchased and used for.
The rates of overdoses with opioids and other painkillers. The rates of admission in health care facilities, emergency rooms, and volunteer treatment facilities related to overdoses with opioids and other painkillers. The rates of opioid-related and other painkiller-related crimes to one’s self and to the community. The rates of opioid prescriptions and other pain killers.
IMPACTS ON CRIMINAL JUSTICE
The rates of marijuana-related arrests for possession, cultivation, and distribution, and of these arrests, the percentages that involved a secondary charge unrelated to marijuana possession, cultivation, or distribution, including the rates of such arrests on the Federal level, including the number of Federal prisoners so arrested, disaggregated by sex, age, race, and ethnicity of the prisoners; and the rates of such arrests on the State level, including the number of State prisoners so arrested, disaggregated by sex, age, race, and ethnicity. The rates of arrests and citations on the Federal and State levels related to teenage use of marijuana. The rates of arrests on the Federal and State levels for unlawful driving under the influence of a substance, and the rates of such arrests involving marijuana. The rates of marijuana-related prosecutions, court filings, and imprisonments. The total monetary amounts expended for marijuana-related enforcement, arrests, court filings and proceedings, and imprisonment before and after legalization, including Federal expenditures disaggregated according to whether the laws being enforced were Federal or State. The total number and rate of defendants in Federal criminal prosecutions asserting as a defense that their conduct was in compliance with applicable State law legalizing marijuana usage, and the effects of such assertions.
The amount of jobs created in each State, differentiating between direct and indirect employment. The amount of jobs expected to be created in the next 5 years, and in the next 10 years, as a result of the State’s marijuana industry.
Because I cannot yet find the full text of the bill on-line, I cannot yet provide a full informed opinion on its particulars. I can say that I think a big, data-focused federal study of the impact of state marijuana reform is looooooooong overdue. I was hopeful, but not optimistic, that Prez Obama might see the wisdom and political value of pushing for this kind of study effort after the issuance of the 2013 Cole Memo and after the 2014 election brought more states and DC into the recreational marijuana column. But, sadly, we have been left largely with national number crunching by partisan advocates rather than government bean-counters for now two decades of ever-more-robust state-level reforms.
Based on Tom's description of the "Marijuana Data Collection Act," I am a bit concerned that there are not provisions likely to encourage pot prohibitionists to be supportive of this particular study effort. The folks at SAM are often eager to stress data on black markets, increased use of marijuana by workers, increased hospital visits, increased homelessness, increased drugged driving, increased use by youths and young adults, environmental impacts, and all sorts of other concerns (see, e.g., this SAM "lessons learned" report from March 2018). It is unclear if these kinds of potentially negative data are fundamental parts of the inquiry imagined by Marijuana Data Collection Act. If not, I doubt opponents of marijuana reform will want to sign on to this bill.
That said, even if the current version of the "Marijuana Data Collection Act" is in someway incomplete or one-sided, I hope a lot of folks on all sides of the marijuana reform debate will be inclined to try to make the bill better and get it passed. I sincerely hope nobody disagrees with the notion that sound data and science is needed in this arena, and I sense both sides of the debate sincerely believe that the data, if fairly collected, will be on their side. So maybe all can come together to really work toward trying to have all the data fairly collected (though I am not holding my breath).
July 24, 2018 in Campaigns, elections and public officials concerning reforms, Federal Marijuana Laws, Policies and Practices, Medical Marijuana Data and Research, Recreational Marijuana Data and Research, Who decides | Permalink | Comments (0)
Friday, July 20, 2018
"Medical cannabis legalization and state-level prevalence of serious mental illness in the National Survey on Drug Use and Health (NSDUH) 2008–2015"
The title of this post is the title of this new article in the International Review of Psychiatry. Here is its abstract:
Although research has established a link between cannabis legalization and use, and cannabis use and mental health, the relationship between medical cannabis legalization and mental health remains uncharacterized. This analysis investigated the relationship between state medical cannabis laws (restrictive, i.e. covering a narrow set of medical conditions; or liberal, i.e. covering a broad range of medical conditions), whether the law permits patients to petition their physician to approve medical cannabis use for specific medical conditions, and state prevalence of serious mental illness (SMI) in the National Survey of Drug Use and Health 2008–2015.
In a covariate-adjusted meta-regression, liberal laws were significantly associated with higher prevalence of SMI (Coeff = 0.003, SE = 0.001, p < .001). Restrictive laws (Coeff = 0.001, SE = 0.001, p = .285) and the ability to petition physician approval (Coeff = −0.001, SE = 0.001, p = .140) were non-significant. When added to the model, state past-year cannabis use was significantly associated with higher prevalence of SMI (Coeff = 0.037, SE = 0.015, p = .018), liberal laws remained significant (Coeff = 0.002, SE = 0.001, p = .015), and restrictive laws (Coeff = −0.0001, SE = 0.001, p = .945) and the ability to petition a physician (Coeff = 0.001, SE = 0.001, p = .290) remained non-significant. Medical cannabis laws are likely related to state mental health, and a higher prevalence of cannabis use partially explains this relationship.
Thursday, July 12, 2018
"Medical Cannabis Legalization and Opioid Prescriptions: Evidence on US Medicaid Enrollees during 1993‐2014"
The title of this post is the title of this new research published on-line this week from the journal Addiction. Here is its abstract:
Background and Aims
While the US has been experiencing an opioid epidemic, 29 states and Washington DC have legalized cannabis for medical use. This study examined whether statewide medical cannabis legalization was associated with reduction in opioids received by Medicaid enrollees.
Secondary data analysis of state‐level opioid prescription records from 1993‐2014 Medicaid State Drug Utilization Data. Linear time‐series regressions assessed the associations between medical cannabis legalization and opioid prescriptions, controlling for state‐level time‐varying policy covariates (such as prescription drug monitoring programs) and socioeconomic covariates (such as income).
Drug prescription records for patients enrolled in fee‐for‐service Medicaid programs that primarily provide healthcare coverage to low income and disabled people.
The primary outcomes were population‐adjusted number, dosage, and Medicaid spending on opioid prescriptions. Outcomes for Schedule II opioids (e.g., Hydrocodone, Oxycodone) and Schedule III opioids (e.g., Codeine) were analyzed separately. The primary policy variable of interest was the implementation of statewide medical cannabis legalization.
For Schedule III opioid prescriptions, medical cannabis legalization was associated with a 29.6% (p=0.03) reduction in number of prescriptions, 29.9% (p=0.02) reduction in dosage, and 28.8% (p=0.04) reduction in related Medicaid spending. No evidence was found to support the associations between medical cannabis legalization and Schedule II opioid prescriptions. Permitting medical cannabis dispensaries was not associated with Schedule II or Schedule III opioid prescriptions after controlling for medical cannabis legalization. It was estimated that, if all the states had legalized medical cannabis by 2014, Medicaid annual spending on opioid prescriptions would be reduced by 17.8 million dollars.
Statewide medical cannabis legalization appears to have been associated with reductions in both prescriptions and dosages of Schedule III (but not Schedule II) opioids received by Medicaid enrollees in the US. Supporting Information
Saturday, July 7, 2018
The title of this post is the headline of this recent Reason piece by Mike Riggs, which gets started this way:
It's been almost two years since the Drug Enforcement Administration (DEA) began accepting applications for new growers of research cannabis, and two dozen applicants are still in regulatory limbo.
Since the DEA announced in August 2016 that it would end the federal monopoly on producing cannabis for scientific research in the United States, growers, investors, researchers, applicants, and even members of Congress have sought to understand why a relatively simple licensing review process has stretched on for nearly two years. The answer is pretty straightforward: Attorney General Jeff Sessions, for reasons he has not publicly disclosed, decided to intervene in a process that has historically not involved the attorney general in order to stop the DEA from issuing licenses to growers.
While the Controlled Substances Act gives the attorney general regulatory authority over scheduled drugs, that authority has historically been delegated to the DEA, which is part of the Justice Department. The DEA has a whole division, in fact, dedicated to "investigat[ing] the diversion of controlled pharmaceuticals and listed chemicals from legitimate sources while ensuring an adequate and uninterrupted supply for legitimate medical, commercial, and scientific needs."
Members of Congress are not happy with Sessions' obstruction of the licensing process. In April, Sens. Orrin Hatch (R–Utah) and Kamala Harris (D–Calif.) sent the attorney general a letter in which they asked him to provide the Senate with a timeline for processing applications from potential manufacturers of research marijuana. They also asked the DOJ to update applicants on the review process. Both actions, Hatch and Harris suggested, should be completed by May 15, 2018. Not only did the DOJ miss that deadline, but it doesn't seem interested in playing catch-up.
Four license applicants I interviewed in late June told me they've received no official updates from either the DEA or the DOJ in months. Applicants who have spoken to congressional offices working on this issue say their contacts are equally frustrated by Sessions' obstruction of the DEA's licensing process.
Friday, July 6, 2018
The title of this post is the title of this notable new article authored by Eric Sevigny which will appear in the September 2018 issue of the journal Accident Analysis & Prevention. Here is its abstract:
This study uses data from the Fatality Analysis Reporting System and a differences-in-differences model to examine the effect of state medical marijuana laws (MMLs) on cannabis-involved driving among U.S. drivers involved in a fatal crash between 1993–2014. Findings indicate that MMLs in general have a null effect on cannabis-positive driving, as do state laws with specific supply provisions including home cultivation and unlicensed or quasi-legal dispensaries.
Only in jurisdictions with state-licensed medical marijuana dispensaries did the odds of marijuana-involved driving increase significantly by 14 percent, translating into an additional 87 to 113 drivers testing positive for marijuana per year. Sensitivity analyses reveal these findings to be generally robust to alternate specifications, although an observed spillover effect consistent with elevated drugged driving enforcement in bordering states weakens a causal interpretation. Still, reasonable policy implications are drawn regarding drugged driving prevention/enforcement and regulations governing dispensary delivery services and business siting decisions.
Some recent (of many) prior related posts:
- "Drug-Impaired Driving: Marijuana and Opioids Raise Critical Issues for States"
- "Driving While Stoned: Issues and Policy Options"
- NHTSA releases "Marijuana-Impaired Driving A Report to Congress"
- "Too Stoned to Drive? The question is trickier than you’d think for police and the courts to answer."
- "Drug-Impaired Driving: A Guide for States"
Tuesday, July 3, 2018
The huge 2017 National Academies of Sciences report titled "The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research" came to this encouraging conclusion in Chapter 4 of the report concerning the medicinal potential of marijuana: "There is substantial evidence that cannabis is an effective treatment for chronic pain in adults."
A big new study out of Australia, however, now throws some cold water on anyone getting to hot about marijuana's potential as an effective pain reliever. This Business Insider Australia article reports on the study under the headline "A 4-year Australian study of 1500 people finds no evidence that cannabis helps to treat pain." Here are excerpts:
A long term study by the University of NSW — one of the world’s longest in-depth community studies on pharmaceutical opioids and non-cancer pain — has found little evidence to support the use of cannabis in the treatment of chronic pain.
The four-year study of more than 1,500 Australians prescribed opioids for non-cancer pain suggest that there is a need for caution in using medicinal cannabis. Those in the study who used cannabis, and there were many among those with chronic non-cancer pain who had been prescribed opioids, actually had greater pain, anxiety and were coping less....
“Chronic non-cancer pain is a complex problem,” says Dr Gabrielle Campbell at the University of NSW, the lead author in the latest study. “For most people, there is unlikely to be a single effective treatment. In our study of people living with chronic non-cancer pain who were prescribed pharmaceutical opioids, despite reporting perceived benefits from cannabis use, we found no strong evidence that cannabis use reduced participants’ pain or opioid use over time.”
The Pain and Opioids IN Treatment (POINT) study, published today in the journal Lancet Public Health, looked at the effect of cannabis on pain, on the extent to which this interfered with everyday life, and on prescribed opioid use.
In the study, funded by the National Health and Medical Research Council and led by the National Drug and Alcohol Research Centre at UNSW Sydney, participants were recruited through community pharmacies and completed comprehensive assessments of their pain, physical and mental health, medication and cannabis.
Participants had been in pain for a median of 10 years and taken prescribed opioids for for four years. There were very high rates of physical and mental health problems. At each assessment, participants who were using cannabis reported greater pain and anxiety, were coping less well with their pain, and reported that pain was interfering more in their life, compared to those not using cannabis.
There was no clear evidence that cannabis led to reduced pain severity or pain interference or led participants to reduce their opioid use or dose. However, the users thought otherwise. Those who used cannabis, despite the study finding no evidence, reported that cannabis was effective (mean score of 7 out of 10). One possibility is that cannabis improves sleep, which in turn improves well-being, say the researchers.
The researchers say double-blind randomised placebo-controlled clinical trials are needed to better understand the impact of cannabis.
The full study being reported on is titled "Effect of cannabis use in people with chronic non-cancer pain prescribed opioids: findings from a 4-year prospective cohort study," and it is available at this link. Reading the abstract makes clearer that this study was entirely observational in that participants were acquiring and using marijuana on their own and reporting that use rather than being giving marijuana in a controlled setting.
Among other reactions, this new study reinforces my sense that we need a lot more studies to really get a handle on the possible value of marijuana to help address the "complex problem" of chronic pain. I am also struck by the line I emphasized above that indicate that a significant majority of marijuana users in the study believed that they were helped by marijuana when the evidence suggested otherwise. A real interesting philosophical issue arises, for the medical profession and for governments, if it turns out that marijuana does not really help many chronic pain problems, but many users think that it does and are eager to have access to the drug because others report that it provides them relief.
Thursday, June 28, 2018
The title of this post is the title of this notable new paper now available via SSRN authored by R. Vincent Pohl. Here is its abstract:
Mortality due to opioid overdoses has been growing rapidly in the U.S., with some states experiencing much steeper increases than others. Legalizing medical cannabis could reduce opioid-related mortality if potential opioid users substitute towards cannabis as a safer alternative. I show, however, that a substantial reduction in opioid-related mortality associated with the implementation of medical cannabis laws can be explained by selection bias. States that legalized medical cannabis exhibit lower pre-existing mortality trends. Accordingly, the mitigating effect of medical cannabis laws on opioid-related mortality vanishes when I include state-specific time trends in state-year-level difference-in-differences regressions.
Saturday, June 16, 2018
The title of this post is the title of this notable new research now available via SSRN authored by Priscillia Hunt, Rosalie Liccardo Pacula and Gabriel Weinberger. Here is its abstract:
Regulated marijuana markets are more common today than outright prohibitions across the U.S. states. Advocates for policies that would legalize marijuana recreational markets frequently argue that such laws will eliminate crime associated with the black markets, which many argue is the only link between marijuana use and crime. Law enforcement, however, has consistently argued that marijuana medical dispensaries (regulated retail sale and a common method of medical marijuana distribution), create crime in neighborhoods with these store-fronts.
This study offers new insight into the question by exploiting newly collected longitudinal data on local marijuana ordinances within California and thoroughly examining the extent to which counties that permit dispensaries experience changes in violent, property and marijuana use crimes using difference-in-difference methods. The results suggest no relationship between county laws that legally permit dispensaries and reported violent crime. We find a negative and significant relationship between dispensary allowances and property crime rates, although event studies indicate these effects may be a result of pre-existing trends. These results are consistent with some recent studies suggesting that dispensaries help reduce crime by reducing vacant buildings and putting more security in these areas. We also find a positive association between dispensary allowances and DUI arrests, suggesting marijuana use increases in conjunction with impaired driving in counties that adopt these ordinances, but these results are also not corroborated by an event study analysis.
June 16, 2018 in Criminal justice developments and reforms, Medical Marijuana Data and Research, Medical Marijuana State Laws and Reforms, Recreational Marijuana Data and Research, Recreational Marijuana State Laws and Reforms | Permalink | Comments (0)
Monday, June 4, 2018
There are so many interesting developments, some small and some big, in medical marijuana states that I cannot come close to keeping track of it all. Having seen a lot of notable stories in a lot of states in recent days, I figured it might be time to do a round-up of stories that caught my eye. So, though this is not in any sense comprehensive, here goes in alphabetical order:
From Arkansas here, "Arkansas Supreme Court to hear dispute over medical marijuana rollout"
From Connecticut here, "With booming medical marijuana program, some fear shortages"
From Georgia here, "Georgia couple loses custody of son after giving him marijuana to treat seizures"
From Florida here, "As marijuana dispensaries open their doors, Florida registers 5,400 new users per week"
From Maryland here, "Overwhelmed computer system stalls medical marijuana sales over weekend in Maryland
From Ohio here, "Ohio announces 56 sites where medical marijuana will be sold"
From Oklahoma here, "Oklahoma's medical marijuana law would be unique"
From Utah here, "Unofficially, many Utah law enforcement groups are lining up to oppose the medical marijuana initiative"
Thursday, May 17, 2018
"Planting the seed for marijuana use: Changes in exposure to medical marijuana advertising and subsequent adolescent marijuana use, cognitions, and consequences over seven years"
The title of this post is the title of this notable new research now appearing in the journal Drug and Alcohol Dependence. Here is its highlights and abstract:
• Many adolescents are exposed to medical marijuana (MM) advertising.
• MM advertising exposure may contribute to increased marijuana use and consequences.
• Regulations for marijuana advertising are needed, similar to tobacco and alcohol.
Marijuana use during adolescence is associated with neurocognitive deficits and poorer functioning across several domains. It is likely that more states will pass both medical and recreational marijuana legalization laws in the coming elections; therefore, we must begin to look more closely at the longitudinal effects of medical marijuana (MM) advertising on marijuana use among adolescents so that we can better understand effects that this advertising may have on their subsequent marijuana use and related outcomes.
We followed two cohorts of 7th and 8th graders (mean age 13) recruited from school districts in Southern California from 2010 until 2017 (mean age 19) to examine effects of MM advertising on adolescents’ marijuana use, cognitions, and consequences over seven years. Latent growth models examined trajectories of self-reported exposure to medical marijuana ads in the past three months and trajectories of use, cognitions, and consequences.
Higher average exposure to MM advertising was associated with higher average use, intentions to use, positive expectancies, and negative consequences. Similarly, higher rates of change in MM advertising exposure were associated with higher rates of change in use, intentions, expectancies, and consequences over seven years.
Results suggest that exposure to MM advertising may not only play a significant role in shaping attitudes about marijuana, but may also contribute to increased marijuana use and related negative consequences throughout adolescence. This highlights the importance of considering regulations for marijuana advertising, similar to regulations in place for the promotion of tobacco and alcohol in the U.S.
This RAND press release provides an account of the research behind this new article, and it begins this way:
Adolescents who view more advertising for medical marijuana are more likely to use marijuana, express intentions to use the drug and have more-positive expectations about the substance, according to a new RAND Corporation study.
The findings—from a study that tracked adolescents' viewing of medical marijuana ads over seven years—provides the best evidence to date that an increasing amount of advertising about marijuana may prompt young people to increase their use of the drug. The study was published by the journal Drug and Alcohol Dependence.
Wednesday, May 2, 2018
The title of this post is the title of this notable new research authored by Theodore Caputi and Keith Humphreys being published in the Journal of Addiction Medicine. Here is its abstract:
Previous studies have found a negative population-level correlation between medical marijuana availability in US states, and trends in medical and nonmedical prescription drug use. These studies have been interpreted as evidence that use of medical marijuana reduces medical and nonmedical prescription drug use. This study evaluates whether medical marijuana use is a risk or protective factor for medical and nonmedical prescription drug use.
Simulations based upon logistic regression analyses of data from the 2015 National Survey on Drug Use and Health were used to compute associations between medical marijuana use, and medical and nonmedical prescription drug use. Adjusted risk ratios (RRs) were computed with controls added for age, sex, race, health status, family income, and living in a state with legalized medical marijuana.
Medical marijuana users were significantly more likely (RR 1.62, 95% confidence interval [CI] 1.50–1.74) to report medical use of prescription drugs in the past 12 months. Individuals who used medical marijuana were also significantly more likely to report nonmedical use in the past 12 months of any prescription drug (RR 2.12, 95% CI 1.67–2.62), with elevated risks for pain relievers (RR 1.95, 95% CI 1.41–2.62), stimulants (RR 1.86, 95% CI 1.09–3.02), and tranquilizers (RR 2.18, 95% CI 1.45–3.16).
Our findings disconfirm the hypothesis that a population-level negative correlation between medical marijuana use and prescription drug harms occurs because medical marijuana users are less likely to use prescription drugs, either medically or nonmedically. Medical marijuana users should be a target population in efforts to combat nonmedical prescription drug use.
Monday, April 30, 2018
Last night CNN aired the fourth installment of Chief Medical Correspondent Dr. Sanjay Gupta's programming about marijuana. This Special Report was titled "
April 30, 2018 in History of Marijuana Laws in the United States, Medical community perspectives, Medical Marijuana Commentary and Debate, Medical Marijuana Data and Research | Permalink | Comments (0)
Wednesday, April 25, 2018
The question in the title of this post is prompted by this notable new Bloomberg article headlined "Medical Marijuana Bill Gains Backing of Key Republican in House." Here are the interesting details from the piece:
House Judiciary Chairman Bob Goodlatte has agreed to co-sponsor a Florida Republican’s bipartisan bill to make medical marijuana research easier, his office confirmed on Wednesday.
That backing by the conservative Virginia Republican potentially bolsters the bill’s chances in the House. Representative Matt Gaetz started circulating a handout Tuesday night explaining his Medical Cannabis Research Act, with Goodlatte listed as a co-sponsor. "I can confirm that the chairman will co-sponsor," said Kathryn Rexrode, a spokesman for Goodlatte, who is not running for re-election, in an email.
A spokesman for Gaetz said the measure was to be introduced on Wednesday or Thursday, with its sponsors set to hold a news conference on Thursday.... A draft of the legislation was also obtained Tuesday by Bloomberg News -- as well as a separate summary Gaetz was circulating outside the House chamber.
That summary listed current co-sponsors as Goodlatte and fellow Republicans Dana Rohrabacher of California and Karen Handel of Georgia; as well as Democrats Alcee Hastings and Darren Soto of Florida; Steve Cohen of Tennessee and Earl Blumenauer of Oregon.
The measure, as described would increase the number of federally approved manufacturers of cannabis for research purposes, and it would also provide a "safe harbor" for researchers and patients in clinical trials so that institutions such as universities would not risk losing federal funding. The bill makes it clear that the Department of Veterans Affairs could refer patients for clinical trials, and eligible researchers at the VA could perform research on medical cannabis.
Clear standards on federally approved growers would be imposed. At the same time, the measure was described as fostering innovation, making it easier for industry leaders to work with researchers to develop new scientific breakthroughs.
Even so, the chances that most of Gaetz’s Republican colleagues will help him pass the bill in an election year are slim. And the odds of Sessions reversing course are also long....
Asked if he’s talked to the attorney general about his new bill, Gaetz said he has not. He joked of Sessions, "doesn’t call or visit me anymore." Gaetz is among House conservatives who have been criticizing the Justice Department in unrelated battles over providing Congress documents tied to the FBI’s handing of its investigations of Hillary Clinton’s emails, and the Russia inquiry led by Special Counsel Robert Mueller.
Trump offered qualified support for legalization while on the presidential campaign trail, saying that medical marijuana “should happen” and that laws regarding recreational usage should be left in the hands of the states. Trump made his assurances this month after Republican Senator Cory Gardner of Colorado, a state that has legalized marijuana, had held up Justice Department nominees.
This article is right to suggest that the odds of any marijuana reform making it through Congress these days are slim. But because the Medical Cannabis Research Act sounds like a very modest proposal that has the backing of a key Committee Chair, this bill would seems to at least have some chance. Indeed, because there are a number of other more robust federal marijuana reform proposals gaining attention and sponsors, it strikes me as even possible that AG Jeff Sessions might not oppose this proposal as actively as he may be inclined to oppose others making the rounds. That all said, I still think the most likely answer to the question in the title of this post is "no."
UPDATE: Over here at Marijuana Moment, Tom Angell has more details on the provisions of the Medical Cannabis Research Act.