Marijuana Law, Policy & Reform

Editor: Douglas A. Berman
Moritz College of Law

Monday, April 2, 2018

Two new papers provide further evidence of marijuana reform aiding with opioid crisis

180402-imd-ec-800As reported via this CNN article, headlined "Marijuana legalization could help offset opioid epidemic, studies find," this weeks bring the publication of notable new research suggesting a link between marijuana access and reduced use of opioids. Here are the basics:

Experts have proposed using medical marijuana to help Americans struggling with opioid addiction. Now, two studies suggest that there is merit to that strategy. The studies, published Monday in the journal JAMA Internal Medicine, compared opioid prescription patterns in states that have enacted medical cannabis laws with those that have not. One of the studies looked at opioid prescriptions covered by Medicare Part D between 2010 and 2015, while the other looked at opioid prescriptions covered by Medicaid between 2011 and 2016.

The researchers found that states that allow the use of cannabis for medical purposes had 2.21 million fewer daily doses of opioids prescribed per year under Medicare Part D, compared with those states without medical cannabis laws. Opioid prescriptions under Medicaid also dropped by 5.88% in states with medical cannabis laws compared with states without such laws, according to the studies....

In order to evaluate whether medical marijuana could function as an effective and safe alternative to opioids, the two teams of researchers looked at whether opioid prescriptions were lower in states that had active medical cannabis laws and whether those states that enacted these laws during the study period saw reductions in opioid prescriptions.

Both teams, in fact, did find that opioid prescriptions were significantly lower in states that had enacted medical cannabis laws. The team that looked at Medicaid patients also found that the four states that switched from medical use only to recreational use -- Alaska, Colorado, Oregon and Washington -- saw further reductions in opioid prescriptions, according to Hefei Wen, assistant professor of health management and policy at the University of Kentucky and a lead author on the Medicaid study. "We saw a 9% or 10% reduction (in opioid prescriptions) in Colorado and Oregon," Wen said. "And in Alaska and Washington, the magnitude was a little bit smaller but still significant."...

The details of the medical cannabis laws were found to have a significant impact on opioid prescription patterns, the researchers found. States that permitted recreational use, for example, saw an additional 6.38% reduction in opioid prescriptions under Medicaid compared with those states that permitted marijuana only for medical use, according to Wen.

The method of procurement also had a significant impact on opioid prescription patterns. States that permitted medical dispensaries -- regulated shops that people can visit to purchase cannabis products -- had 3.742 million fewer opioid prescriptions filled per year under Medicare Part D, while those that allowed only home cultivation had 1.792 million fewer opioid prescriptions per year.

"We found that there was about a 14.5% reduction in any opiate use when dispensaries were turned on -- and that was statistically significant -- and about a 7% reduction in any opiate use when home cultivation only was turned on," Bradford said. "So dispensaries are much more powerful in terms of shifting people away from the use of opiates."...

This is not the first time researchers have found a link between marijuana legalization and decreased opioid use. A 2014 study showed that states with medical cannabis laws had 24.8% fewer opioid overdose deaths between 1999 and 2010. A study in 2017 also found that the legalization of recreational marijuana in Colorado in 2012 reversed the state's upward trend in opioid-related deaths.

Here are links to the JAMA Internal Medicine articles referenced here, as well as a companion commentary:

Medical and Adult-Use Marijuana Laws and Opioid Prescribing for Medicaid Enrollees by Hefei Wen & Jason Hockenberry

Association Between US State Medical Cannabis Laws and Opioid Prescribing in the Medicare Part D Population by Ashley C. Bradford et al

The Role of Cannabis Legalization in the Opioid Crisis by Kevin Hill & Andrew Saxon

 

Some (of many) prior related posts:

April 2, 2018 in Medical community perspectives, Medical Marijuana Commentary and Debate, Medical Marijuana Data and Research, Medical Marijuana State Laws and Reforms, Recreational Marijuana Data and Research | Permalink | Comments (0)

Wednesday, March 28, 2018

Notable efforts to expand reach and application of New Jersey's medical marijuana program

Nj-mmj-e1522187420449The great state of New Jersey has been the focal point for a lot of interesting debate over recreational marijuana reform this year.  But as that debate continues, the state's new Governor has announced here a new effort to "expands patient access to medical marijuana."  Here are some details:

Governor Phil Murphy [Tuesday] announced major reforms to New Jersey’s Medicinal Marijuana Program. Reforms include the addition of medical conditions, lowered patient and caregiver fees, allowing dispensaries to add satellite locations, and proposed legislative changes that would increase the monthly product limit for patients, and allow an unlimited supply for those receiving hospice care.

“We are changing the restrictive culture of our medical marijuana program to make it more patient-friendly,” Governor Murphy said. “We are adding five new categories of medical conditions, reducing patient and caregiver fees, and recommending changes in law so patients will be able to obtain the amount of product that they need. Some of these changes will take time, but we are committed to getting it done for all New Jersey residents who can be helped by access to medical marijuana.”

More than 20 recommendations are outlined in a report that New Jersey Department of Health Commissioner Dr. Shereef Elnahal submitted to Governor Murphy in response to Executive Order 6, which directed a comprehensive review of the program within 60 days. “As a physician, I have seen the therapeutic benefits of marijuana for patients with cancer and other difficult conditions,” said Dr. Elnahal. “These recommendations are informed by discussions with patients and their families, advocates, dispensary owners, clinicians, and other health professionals on the Medicinal Marijuana Review Panel. We are reducing the barriers for all of these stakeholders in order to allow many more patients to benefit from this effective treatment option."

In the report, the Department submitted three categories of recommendations: those that are effective today, regulatory changes that will go through the rulemaking process, and proposals that require legislation. In addition, there are recommendations for important future initiatives to allow home delivery, develop a provider education curriculum, and expedite the permitting process. Effective today, five new categories of medical conditions (anxiety, migraines, Tourette’s syndrome, chronic pain related to musculoskeletal disorders, and chronic visceral pain) will be eligible for marijuana prescription. Currently, 18,574 patients, 536 physicians, and 869 caregivers participate in the program – a far smaller number than comparably populated states. The Commissioner will also be able to add additional conditions at his discretion.

Other immediate changes include lowering the biennial patient registration fee from $200 to $100 and adding veterans and seniors -- 65 and older -- to the list of those who qualify for the $20 discounted registration fee. Those on government assistance, including federal disability, already receive the reduced fee.

The report prepared by the New Jersey Department of Health is available at this link.

March 28, 2018 in Medical community perspectives, Medical Marijuana Commentary and Debate, Medical Marijuana Data and Research, Medical Marijuana State Laws and Reforms | Permalink | Comments (0)

Thursday, March 22, 2018

Latest draft federal spending bill again includes protections for state-legal medical marijuana programs

As reported here by Tom Angell at Forbes, "medical marijuana patients and businesses that follow state laws will continue to be protected from U.S. Attorney General Jeff Sessions and the federal drug agents that work for him under a provision contained in new must-pass legislation revealed on Wednesday."  Here is more:

The policy, which has been federal law since 2014, bars the U.S. Department of Justice from spending money to interfere with the implementation of state medical marijuana laws. Its continuance was in question, however, after Sessions specifically asked Congress not to extend it and House leaders blocked a vote on the matter. But the rider, which cleared a key Senate panel last year, is now attached to a bicameral deal to fund the federal government's operations through the rest of Fiscal Year 2018, which ends on September 30....

The new bill, which the House is expected to vote on as soon as Thursday, also continues existing provisions shielding state industrial hemp research programs from federal interference.

In a related move, a bipartisan group of members of Congress is stepping up the push to include the medical marijuana protections in Fiscal Year 2019 spending legislation. "We believe such a policy is not only consistent with the wishes of a bipartisan majority of the members of the House, but also with the wishes of the American people," 62 lawmakers wrote in a letter to House appropriations leaders last week.

In January, U.S. Attorney General Jeff Sessions rescinded a separate Obama-era Justice Department memo that has generally cleared the way for states to implement their own marijuana laws without federal interference. Given that action, some members of Congress want to go even further than the current medical cannabis protections in spending legislation by adding a new provision that protects all state marijuana laws -- including those that allow recreational use and businesses -- from federal interference....

The existing medical marijuana rider was first approved by a House floor vote of 219-189 in 2014 and then again in 2015 by a margin of 242-186. The Senate Appropriations Committee has also adopted the language in a series of bipartisan votes, most recently last summer. The provision must be reapproved annually because it concerns restrictions on specific years' Justice Department spending legislation.

In negative news for cannabis law reform supporters, the new FY2018 omnibus spending bill extends a current ban on the Washington, D.C. using its own local funds to legalize and regulate marijuana sales. And, it does not include language approved by the Senate Appropriations Committee last year that would have allowed military veterans to receive medical cannabis recommendations through their U.S. Department of Veterans Affairs doctors. To avoid a government shutdown, Congress must pass, and President Trump must sign, the appropriations legislation by Friday at midnight.

March 22, 2018 in Federal Marijuana Laws, Policies and Practices, Medical Marijuana State Laws and Reforms | Permalink | Comments (0)

Sunday, March 11, 2018

New US Attorney for Southern District of West Virginia talking up efforts to "enforce laws against marijuana aggressively - AGGRESSIVELY"

I have just seen via my twitter feed this notable recent tweet posted by US Attorney Mike Stuart, the newly confirmed U.S. Attorney for the Southern District of West Virginia:

Without getting into the particulars of the gateway drug debate, I am eager here to highlight how easy it would be for this new US Attorney to ramp up federal marijuana enforcement relative to what has existed in recent years.  Based on some (too) quick research of US Sentencing Commission data, it seems that there have only been a handful of federal marijuana prosecutions each year in this district.  USA Stewart could "aggressively" increase the federal caseload just by bringing a few more cases each year.

It will be interesting to see if the Southern District of West Virginia does end up having many more marijuana prosecutions in the months ahead, though these statements likely are to be most significant with respect to West Virginia's development of its recently passed medical marijuana legislation.   This local article, headlined "Time runs out on bill making changes to WV's medical cannabis program," suggests that the rescission of the Cole Memo and related concerns about federal prohibition may already be slowing down the state's regulatory efforts.

March 11, 2018 in Campaigns, elections and public officials concerning reforms, Criminal justice developments and reforms, Federal Marijuana Laws, Policies and Practices, Medical Marijuana Commentary and Debate, Medical Marijuana State Laws and Reforms | Permalink | Comments (1)

Monday, March 5, 2018

Encouraging research from Minnesota on success of medical marijuana in the treatment of "intractable pain"

Download (9)This recent press release from the Minnesota Department of Health, headlined "Medical cannabis study shows significant number of patients saw pain reduction of 30 percent or more," provides a summary of this encouraging lengthy report titled "Intractable Pain Patients in the Minnesota Medical Cannabis Program: Experience of Enrollees During the First Five Months." Here is the start of the press release:

Forty-two percent of Minnesota’s patients taking medical cannabis for intractable pain reported a pain reduction of thirty percent or more, according to a new study conducted by the Minnesota Department of Health. “This study helps improve our understanding of the potential of medical cannabis for treating pain,” said Minnesota Health Commissioner Jan Malcolm. “We need additional and more rigorous study, but these results are clinically significant and promising for both pain treatment and reducing opioid dependence.”

The first-of-its-kind research study is based on the experiences of the initial 2,245 people enrolled for intractable pain in Minnesota’s medical cannabis program from August 1, 2016 to December 31, 2016. Of this initial group, 2,174 patients purchased medical cannabis within the study’s observation period and completed a required self-evaluation before each purchase.

As part of the self-evaluation, patients completed the PEG (pain, enjoyment and general activity) screening tool. On a scale of 0 to 10 (with 0 being no pain and 10 being the highest pain), patients rated their level of pain, how pain interfered with their enjoyment of life and how pain interfered with their general activity.

Using the PEG scale data, 42 percent of the patients who scored moderate to high pain levels at the beginning of the measurement achieved a reduction in pain scores of 30 percent or more, and 22 percent of patients both achieved and maintained a reduction of 30 percent or more over four months. The 30 percent reduction threshold is often used in pain studies to define clinically meaningful improvement. Health care practitioners caring for program-enrolled patients suffering from intractable pain reported similar reductions in pain scores, saying 41 percent of patients achieved at least a reduction of 30 percent or more.

The study also found that of the 353 patients who self-reported taking opioid medications when they started using medical cannabis, 63 percent or 221 reduced or eliminated opioid use after six months. Likewise, the health care practitioner survey found that 58 percent of patients who were on other pain medications were able to reduce their use of these medications when they started taking medical cannabis. Thirty-eight percent of patients reduced opioid medication (nearly 60 percent of these cut use of at least one opioid by half or more), 3 percent of patients reduced benzodiazepines and 22 percent of patients reduced other pain medications.

The safety profile of medical cannabis products available through the Minnesota program continues to appear favorable. No serious adverse events (life threatening or requiring hospitalization) were reported for this group of patients during the observation period. 

Here is a portion of the executive summary from the full report:

Among respondents to the patient (54% response rate) and health care practitioner (40% response rate) surveys, a high level of benefit was reported by 61% and 43%, respectively (score of 6 or 7 on a seven-point scale). Little or no benefit (score of 1, 2, or 3) was reported by 10% of patients and 24% of health care practitioners.

The benefits extended beyond reduction in pain severity, though that was the benefit mentioned most often (64%). The benefit described second most often was improved sleep (27%), which likely has a synergistic relationship with reduction in pain severity. In some cases improved sleep, reduction of other pain medications and their side effects, decreased anxiety, improved mobility and function, and other quality of life factors were cited as being the most important benefit. The pattern of described benefits was similar in the patient and the health care practitioner survey results....

A large proportion (58%) of patients on other pain medications when they started taking medical cannabis were able to reduce their use of these meds according to health care practitioner survey results. Opioid medications were reduced for 38% of patients (nearly 60% of these reduced at least one opioid by ≥50%), benzodiazepines were reduced for 3%, and other pain medications were reduced for 22%. If only the 353 patients (60.2%, based on medication list in first Patient Self-Evaluation) known to be taking opioid medications at baseline are included, 62.6% (221/353) were able to reduce or eliminate opioid usage after six months.

March 5, 2018 in Medical community perspectives, Medical Marijuana Commentary and Debate, Medical Marijuana Data and Research, Medical Marijuana State Laws and Reforms | Permalink | Comments (0)

Wednesday, February 28, 2018

Americans for Safe Access releases its latest analysis and report card on medical marijuana programs across United States

Asa_default_social_thumbnail2The advocacy group Americans for Safe Access regularly produces reports on the state of state medical marijuana laws, and this latest 2018 version of ASA's “Medical Marijuana Access in the United States: A Patient-Focused Analysis of the Patchwork of State Laws” now runs almost 200 pages.  I recommend the report in full for everyone interested in medical marijuana information, and here is part of the report's preface:

For over fifteen years, Americans for Safe Access (ASA) has engaged state and federal governments, courts, and regulators to improve the development and implementation of state medical cannabis laws and regulations.  This experience has taught us how to assess whether or not state laws meet the practical needs of patients. It has also provided us with the tools to advocate for programs that will better meet those needs. Passing a medical cannabis law is only the first step in a lengthy implementation process, and the level of forethought and advance input from patients can make the difference between a well-designed program and one that is seriously flawed.  One of the most important markers of a well-designed program is whether or not all patients who would benefit from medical cannabis will have safe and legal access to their medicine without fear of losing any of the civil rights and protections afforded to them as American citizens....

Today, we have a patchwork of medical cannabis laws across the United States.  Thirty states, the District of Columbia, Guam, and Puerto Rico have adopted laws that created programs that allow at least some patients legal access to medical cannabis.  Most of those thirty states provide patients with protections from arrest and prosecution as well as incorporate a regulated production and distribution program.  Several programs also allow patients and their caregivers to cultivate a certain amount of medical cannabis themselves.  While it took a long time for states to recognize the importance of protecting patients from civil discrimination (employment, parental rights, education, access to health care, etc.), more and more laws now include these explicit protections.

However, as of 2017, none of the state laws adopted thus far can be considered ideal from a patient’s standpoint.  Only a minority of states currently include the entire range of protections and rights that should be afforded to patients under the law, with some lagging far behind others.  Because of these differences and deficiencies, patients have argued that the laws do not function equitably and are often poorly designed, implemented, or both.  As production and distribution models are implemented, hostile local governments have found ways to ban such activity, leaving thousands of patients without the access state law was intended to create. Minnesota, for example, despite setting up a regulatory system for the production, manufacturing, and distribution of cannabis oil extracts, prohibits qualified patients from using the actual plant.  These laws include sanctions for qualified patients who seek to use their medicine in whole plant form, unnecessarily eliminating clinically validated routes of administration used by hundreds of thousands of patients.  Some states have taken years to implement their medical cannabis laws leaving patients waiting years before their medicine is available. 

February 28, 2018 in History of Marijuana Laws in the United States, Medical community perspectives, Medical Marijuana Commentary and Debate, Medical Marijuana Data and Research, Medical Marijuana State Laws and Reforms | Permalink | Comments (0)

Tuesday, February 27, 2018

Highlighting the perspectives of governors in dynamic marijuana reform times

News-8Rolling Stone has this lengthy new article on modern state marijuana reforms focused on how governors are reacting to Attorney General Jeff Sessions' latest policy directives to federal prosecutors.  The piece is  headlines "Sorry, Jeff Sessions – Governors Are Moving Ahead with Pot: At their annual meeting, pro-pot governors say the AG isn't stopping them from advancing plans for medical and recreational legalization." Here are excerpts:

Over the past few days, most of the nation's governors descended on Washington for their annual meeting with administration officials and the president. As the governors mingled about and chatted in between sessions, many of them were exchanging ideas and best practices on how to roll out a successful regulatory regime on marijuana. But hanging over their talks was the specter of Attorney General Jeff Sessions who would like to clamp down on the nation's burgeoning, though disparate, marijuana industry.

Some Democratic governors say they were denied a private meeting with Sessions to discuss his anti-marijuana stance. And besides attending the formal Governors' Ball on Sunday night, the attorney general only made one appearance to the group, at a White House briefing on opioids. Some say they're frustrated they couldn't pick his brain on his controversial move to rescind an Obama-era memo that directed the nation's top prosecutors to prioritize other offenses over marijuana in states where it's legal. "I tried, but I couldn't get called on," Gov. John Hickenlooper (D-CO) tells Rolling Stone. "He only took about six questions. There were probably 40 governors in the room."

Even though there's fear that Sessions wants to go after legal marijuana business owners, many states are moving ahead with efforts to either launch a new medicinal marijuana industry, expand an existing one or to legalize weed for recreational purposes. And governors say so far Sessions' opposition hasn't had an impact on the ground. "It has not impacted us and we believe it will not, although that doesn't mean we're not paying attention," Gov. Phil Murphy (D-NJ) tells Rolling Stone.

Murphy, who was elected last year, campaigned aggressively on marijuana legalization. For him, it's a criminal-justice issue because his state has the largest racial disparity in its prison population of any state in the nation, and many of those convicts are serving terms for nonviolent drug offenses. While he's received some pushback from his legislature on his plan to legalize pot, he's moving ahead on expanding medicinal marijuana because currently there are only five dispensaries in a state with nine million people. "We're proceeding apace, again, beginning to make sure we get the medical piece right because it's life or death," Murphy says. "And then we will deliberately and steadily get to the recreational side."

The nation's other newly seated governor, Ralph Northam (D-VA), also campaigned on marijuana. He faces more headwinds from Republicans who control his state's House of Delegates, but he's still calling for marijuana decriminalization. As a physician, Northam is also vocal about the medicinal benefits of weed, though he says more research is needed. For that he's calling on Congress to reclassify pot, since it's currently listed as a Schedule I narcotic, making it extremely difficult to study in any official capacity. "I think that it would be great if at the federal level they could change the schedule of marijuana so that we can get more data on it – do more research," Northam tells Rolling Stone. "I remind people all the time that probably over 100 medicines that we use routinely in health care come from plants, so let's be a little bit more open minded and look at potential uses for medicinal marijuana."...

While the movement on medical marijuana is steadily picking up steam in red and blue states alike, the recreational effort is going more slowly but some governors say there's starting to be an air of certainty that eventually marijuana will be viewed as the same as alcohol in most every state.

Back in 2011, Gov. Dan Malloy (D-CT) moved to decriminalize marijuana and set up a medicinal marijuana regime. While he hasn't come down one way or another on recreational marijuana, he says it's just a matter of time before it happens in Connecticut because efforts to legalize weed are sweeping the entire northeast corridor. "As Canada moves in that direction, as Massachusetts and Vermont, it's going to be a neighborhood thing, and I understand that," Malloy tells Rolling Stone. While he remains lukewarm on recreational marijuana, he did pen a blunt letter to Sessions on it.

"I told him to stop messing around with marijuana, because it really isn't important," Malloy says. "I have not taken the opportunity to endorse marijuana, but that's very different than spending resources trying to combat marijuana use. And, quite frankly, if you're going to be serious about opioids, you can't be screwing around with marijuana."

While many governors are now rushing out new marijuana regulations, they're still keeping one eye on Jeff Sessions. Gov. Jay Inslee (D-WA) says during this visit he was rebuffed when he asked for a private meeting with the attorney general to discuss his state's recreational marijuana marketplace, but he says his offer for Sessions to come out west and tour his state's pot businesses still stands. "It's a shame that he has a closed mind, and he's much more attentive to his old ideology than to the new facts," Inslee tells Rolling Stone. "The fears that he might have had 30 years ago have not been realized, and we wish he would just open his eyes to the reality of the situation. If he did, I think he would no longer try to fight an old battle that the community and the nation is moving very rapidly forward on."

February 27, 2018 in Campaigns, elections and public officials concerning reforms, Federal Marijuana Laws, Policies and Practices, History of Marijuana Laws in the United States, Medical Marijuana Commentary and Debate, Medical Marijuana State Laws and Reforms, Recreational Marijuana Commentary and Debate, Recreational Marijuana State Laws and Reforms | Permalink | Comments (0)

Friday, February 23, 2018

"Medical marijuana laws and adolescent marijuana use in the United States: A systematic review and meta-analysis"

CoverThe title of this post is the title of this notable new article by multiple authored in the journal Addiction.  Here is the abstract:

Aims

To conduct a systematic review and meta-analysis of studies in order to estimate the effect of US medical marijuana laws (MMLs) on past-month marijuana use prevalence among adolescents.

Methods

A total of 2999 papers from 17 literature sources were screened systematically.  Eleven studies, developed from four ongoing large national surveys, were meta-analyzed.  Estimates of MML effects on any past-month marijuana use prevalence from included studies were obtained from comparisons of pre–post MML changes in MML states to changes in non-MML states over comparable time-periods.  These estimates were standardized and entered into a meta-analysis model with fixed-effects for each study.  Heterogeneity among the study estimates by national data survey was tested with an omnibus F-test.  Estimates of effects on additional marijuana outcomes, of MML provisions (e.g. dispensaries) and among demographic subgroups were abstracted and summarized.  Key methodological and modeling characteristics were also described. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed.

Results

None of the 11 studies found significant estimates of pre–post MML changes compared with contemporaneous changes in non-MML states for marijuana use prevalence among adolescents. The meta-analysis yielded a non-significant pooled estimate (standardized mean difference) of −0.003 (95% confidence interval = −0.012, +0.007). Four studies compared MML with non-MML states on pre-MML differences and all found higher rates of past-month marijuana use in MML states pre-MML passage. Additional tests of specific MML provisions, of MML effects on additional marijuana outcomes and among subgroups generally yielded non-significant results, although limited heterogeneity may warrant further study.

Conclusions

Synthesis of the current evidence does not support the hypothesis that US medical marijuana laws (MMLs) until 2014 have led to increases in adolescent marijuana use prevalence. Limited heterogeneity exists among estimates of effects of MMLs on other patterns of marijuana use, of effects within particular population subgroups and of effects of specific MML provisions.

February 23, 2018 in Medical Marijuana Commentary and Debate, Medical Marijuana Data and Research, Medical Marijuana State Laws and Reforms | Permalink | Comments (0)

Saturday, February 10, 2018

Latest spending stopgap extends limit on DOJ funding for medical marijuana prosecutions though March 23, 2018

As reported here under the headline "Federal medical cannabis protection extended again," the stop-gap federal funding approach to stopping possible federal prosecution of state-compliant medical marijuana providers:

The only federal law formally preventing the U.S. Department of Justice from prosecuting medical marijuana businesses has once more been given a new lease on life.  This time, the Rohrabacher-Blumenauer Amendment – formerly known as Rohrabacher-Farr – has been extended until March 23 under the budget deal passed by Congress and signed Friday morning by President Donald Trump....

Rohrabacher-Blumenauer prohibits the DOJ from using federal funds to interfere with state-legal MMJ laws and companies.  The measure does not protect recreational marijuana businesses....

It’s possible the amendment will be included in a larger spending package that is expected to be approved by March 23.  But there’s no guarantee at this point, given a change in procedural rules in the House of Representatives last year that has prevented amendments like Rohrabacher-Blumenauer from being added to the budget.

February 10, 2018 in Federal Marijuana Laws, Policies and Practices, Medical Marijuana State Laws and Reforms, Who decides | Permalink | Comments (0)

Thursday, January 18, 2018

New Maryland report details basis for marijuana measures to "remediate discrimination affecting minority- and women-owned businesses"

Maryland-Medical-Marijuana_thumbnailAs reported in this local article, headlined "State consultant finds grounds to consider race in awarding medical marijuana licenses," a notable report focused on the Maryland business arena was released yesterday. Here are the basics and context:

A state consultant has determined that there are grounds to conclude that minorities are at a disadvantage in Maryland's fledgling medical marijuana industry.

The state’s medical marijuana commission has awarded 15 licenses to growers, but none of them to a minority-owned business.  The General Assembly is considering a bill that would create five new licenses and require the commission to consider the race of applicants.

The consultant’s finding, released by Gov. Larry Hogan’s office Wednesday, is a key legal step toward allowing officials to weigh race when awarding any new licenses. Hogan ordered the study in April.  “Today’s findings are clear and unequivocal evidence that there is a disparity in the medical cannabis industry,” said Shareese Churchill, a spokeswoman for the Republican governor.  “This study is an important part of the process to allow for increased minority participation in our state.”

Del. Cheryl D. Glenn, the chairwoman of the Legislative Black Caucus and a leading advocate for more minority participation in the state’s new marijuana industry, said the finding will help whatever legislation the General Assembly passes withstand a court challenge.  “I’m ecstatic Maryland can move forward and be a beacon of light and show it is a serious issue, that everyone should be concerned about having diversity in a multibillion-dollar industry,” the Baltimore Democrat said....

Such disparity studies are commonly used in government contracting to provide a justification for considering the race or gender of bidders for jobs.  Civil rights advocates found the commission’s failure to award any licenses to black-owned businesses especially galling because African-Americans have disproportionately faced consequences from marijuana being criminalized.

The full consultant report is available at this link, and here are key passages from its conclusion:

After reviewing and analyzing the information received from the State, and bearing in mind the 2017 Disparity Study’s finding that discrimination continues to adversely impact minority-owned and women-owned firms throughout the Maryland economy, I conclude, based upon the information available to me at this time, that the 2017 Disparity Study provides a strong basis in evidence, consisting of both quantitative and qualitative findings, that supports the use of race- and gender-based measures to remediate discrimination affecting minority- and women-owned businesses in the types of industries relevant to the medical cannabis business.

Moreover, the 2017 Disparity Study details a range of race- and gender-neutral activities that the State has already undertaken to address existing disparities. The 2017 Disparity Study found that, notwithstanding these race- and gender-neutral activities, many of which have been in place for a number of years, disparities continue to exist in both public and private contracting in the same geographic and industry markets in which medical cannabis licensees and independent testing laboratories are likely to operate. These disparities, in general, are large, adverse, and statistically significant. In addition, the 2017 Disparity Study contains both qualitative and quantitative evidence to suggest that economy-wide contracting disparities in Maryland’s relevant markets are even greater than disparities in the public sector. This difference may be due to the fact that the State has, for a number of years, operated an assertive MBE program in an attempt to remedy discrimination, which would tend to reduce, though it has not yet eliminated, the effects of discrimination in public procurement. Absent such affirmative remedial efforts by the State, I would expect to see evidence in the relevant markets in which the medical cannabis licensees will operate that is consistent with the continued presence of business discrimination.

January 18, 2018 in Medical Marijuana Data and Research, Medical Marijuana State Laws and Reforms, Race, Gender and Class Issues, Who decides | Permalink | Comments (0)

Tuesday, January 9, 2018

Louisiana Gov writes directly to Prez Trump urging him to urge Congress to preserve medical marijuana spending limit

I have been lately wondering if, when and how President Donald Trump might have something to say about federal marijuana policy in the wake of Attorney General Sessions' recent decision to rescinding the Cole Memo (basics here and here).   Though we have still not heard from the Prez on this matter, today I see that Louisiana Gov John Bel Edwards has written directly to Prez Trump to discuss medical marijuana in the Bayou State and to seemingly ask Prez Trump to push Congress to preserve the soon-to-expire spending limitation that prohibits the Justice Department from using government funds to go after state medical marijuana programs.

The short but still interesting letter from Gov Edwards to Prez Trump is available at this link.  The letter's concluding substantive paragraph reads:

Mr. President, for many people in my state, access to this treatment means a person could return to the workforce, return to school or simply lead a normal life.  Simply put, we would be failing the people we represent if we allow any funding bill to move through Congress without the Rohrabacher-Blumenauer language included.  This issue is critically important in Louisiana, and I hope we can partner together to ensure the safe distribution of this life-changing form of treatment.

January 9, 2018 in Campaigns, elections and public officials concerning reforms, Federal Marijuana Laws, Policies and Practices, Medical Marijuana State Laws and Reforms, Who decides | Permalink | Comments (0)

Friday, January 5, 2018

Oklahoma medical marijuana initiative set for June vote

As reported in this press release, Oklahoma Governor Mary Fallin yesterday "set a June election date for the medical marijuana ballot measure." Here is more from the release:

Fallin filed an executive proclamation placing State Question 788 on the June 26 primary election ballot. The governor’s other option was to place the issue on the November general election ballot.

Supporters of an initiative petition asking voters to legalize medical marijuana gathered enough signatures in 2016 to schedule a statewide referendum on the measure. “Backers of this proposal to legalize medical marijuana followed procedures and gathered the more than 66,000 required signatures to submit the issue to a vote of the people,” said Fallin. “I’m fulfilling my duty as governor to decide when that election will occur this year.”

If approved by voters, the measure would permit doctors to recommend a patient, who is at least 18 years old, for a state-issued medical marijuana license. A license holder would be allowed to legally possess up to 3 ounces of the drug, six mature plants and six seedlings. These limits can be increased by individual counties or cities. 

Primary elections, typically, will bring out many fewer voters than general elections. But it seems elections involving marijuana ballot issues will bring out, sometime, at least a few more than the usual voters. It will be interesting to watch the turn out dynamics, as well as of course the outcome, in the Sooner State now that the Governor has called for a sooner vote.

January 5, 2018 in Campaigns, elections and public officials concerning reforms, Initiative reforms in states, Medical Marijuana State Laws and Reforms, Who decides | Permalink | Comments (0)

Friday, December 29, 2017

"Medical marijuana laws and adolescent use of marijuana and other substances: Alcohol, cigarettes, prescription drugs, and other illicit drugs"

Cov200hThe title of this post is the title of this new research to appear in print in the February 2018 issue of the journal Drug and Alcohol Dependence.  Here is its abstract:

Background

Historical shifts have taken place in the last twenty years in marijuana policy.  The impact of medical marijuana laws (MML) on use of substances other than marijuana is not well understood. We examined the relationship between state MML and use of marijuana, cigarettes, illicit drugs, nonmedical use of prescription opioids, amphetamines, and tranquilizers, as well as binge drinking.

Methods

Pre-post MML difference-in-difference analyses were performed on a nationally representative sample of adolescents in 48 contiguous U.S. states.  Participants were 1,179,372 U.S. 8th, 10th, and 12th graders in the national Monitoring the Future annual surveys conducted in 1991–2015.  Measurements were any self-reported past-30-day use of marijuana, cigarettes, non-medical use of opioids, amphetamines and tranquilizers, other illicit substances, and any past-two-week binge drinking (5+ drinks per occasion).

Results

Among 8th graders, the prevalence of marijuana, binge drinking, cigarette use, non-medical use of opioids, amphetamines and tranquilizers, and any non-marijuana illicit drug use decreased after MML enactment (0.2–2.4% decrease; p-values: <0.0001–0.0293).  Among 10th graders, the prevalence of substance use did not change after MML enactment (p-values: 0.177–0.938).  Among 12th graders, non-medical prescription opioid and cigarette use increased after MML enactment (0.9–2.7% increase; p-values: <0.0001–0.0026).

Conclusions

MML enactment is associated with decreases in marijuana and other drugs in early adolescence in those states.  Mechanisms that explain the increase in non-medical prescription opioid and cigarette use among 12th graders following MML enactment deserve further study. 

December 29, 2017 in Medical Marijuana Data and Research, Medical Marijuana State Laws and Reforms | Permalink | Comments (0)

Wednesday, December 20, 2017

Interesting review of big market growth in a small medical marijuana state

Rhode-island-medical-marijuanaAs hinted by this recent post, which asks "Are there 1.9 millions or 2.35 million or some other big number of medical marijuana patients?," I fear that states and the nation as a whole are doing insufficient data collection and analysis of medical marijuana regimes.  This view is indirectly enhanced by this recent article from Rhode Island, headlined "Medical marijuana cultivators, patients on rise in R.I.," reporting on some interesting data concerning its medical marijuana program. Here are excerpts:

More than 8,430 pounds of marijuana have been produced and sold through the state’s medical marijuana dispensaries and cultivators this year, translating into some $27 million in retail sales.  Nearly one-quarter of that marijuana was grown by the state’s new cultivators — licensed businesses only allowed to sell the drug to the state’s three dispensaries.  To date, 18 such businesses have been approved to operate in the the state, according to data from the state Department of Business Regulation.

Dozens more are waiting in the wings for their chance to get into the burgeoning industry. Forty applicants have passed the first stage of the process but are still awaiting a license, and another 53 applicants are behind them in the pipeline. The state has collected nearly $1 million in licensing and application fees from these new marijuana-growing businesses.

“It seems a large number of cultivators.  That’s always been my concern ... we’re setting up these cultivators for failure,” Rep. Scott Slater, D-Providence, said at a meeting of the state’s medical marijuana oversight commission Tuesday....  Greenleaf Compassionate Care Center in Portsmouth and Summit Medical Compassion Center in Warwick together have purchased roughly half of the medical marijuana sold this year from cultivators. The state’s largest dispensary, the Thomas C. Slater Center in Providence, has not purchased any marijuana from cultivators.

Norman Birenbaum, the state’s top medical marijuana regulator, said the state hopes that for safety and quality-control reasons eventually more patients will shift from growing marijuana in their homes to buying it from dispensaries.   There are currently more than 61,500 marijuana plants being grown in the state by medical marijuana patients and caregivers.

Meanwhile, the state now has 19,161 medical marijuana patients, a 17-percent increase from one year ago.  The number of patients in the program typically grows between 20 percent and 30 percent each year. Roughly 65 percent of patients qualify with severe, debilitating or chronic pain.

But Birenbaum agreed that many cultivators will potentially fail.  The state chose not to cap the number of cultivators, in part because doing so would require a competitive evaluation process for applications that almost inevitably would end up in court and could have resulted in shortages in the supply of medical marijuana.

Dr. Todd Handel, a physician who sits on the oversight panel, questioned what the state is doing to control the profit margins of the state’s dispensaries, which are state-registered nonprofits.  Birenbaum cautioned against making generalizations about the dispensaries’ profits.  He noted that the dispensaries cannot take many normal business deductions on their taxes because the federal government still considers selling marijuana to be illegal.  He also noted the significant costs of growing marijuana.

The average wholesale price of medical marijuana produced by the licensed cultivators is $4.16 a gram, according to state data.  An average retail price was not available because some marijuana flower is turned into other products such as edibles and oils that are not sold in a form measurable by grams.  Still, it’s clear there is a markup. On Tuesday, Greenleaf was offering three strains grown by cultivators for $15 a gram.

As this article reveals, Rhode Island has a lot of cultivators/growers but only three dispensary/sellers servicing its medical marijuana program.  That is distinct from some other states that have limited both growers and sellers and others that have no limits on growers or sellers. In addition, Rhode Island's medical marijuana regime allows for home grow, while other states do not (and, of course, nearly every state has at least slight variations on who qualifies to be a medical marijuana patient and/or caregiver). 

Though there are plenty of resources highlighting formal legal differences in different medical marijuana states, I am not aware of many objective analysis of whether and how different medical marijuana regulatory structures in different states impact the development and functionality of medical marijuana access and efficacy for patients.  In other words, while states are conducting a wide array of "laboratories of democracy" experiments  in this medical marijuana area, we need a lot more analysis of early lab results. 

December 20, 2017 in Business laws and regulatory issues, Medical Marijuana Commentary and Debate, Medical Marijuana Data and Research, Medical Marijuana State Laws and Reforms, Who decides | Permalink | Comments (0)

Monday, December 18, 2017

New data from West Virginia showing strong physician interest in state's developing medical marijuana program

As reported in this local article, headlined "Survey: 82 percent of WV doctors 'interested' in medical marijuana," a notably large percentage of surveyed physicians have expressed an interest in an emerging medical marijuana regime. Here are the basics:

An overwhelming majority of surveyed West Virginia physicians are “interested” in medical cannabis, according to the Department of Health and Human Resources.  Of 1,455 physicians who took the online survey, 82 percent of them indicated their interest in medical marijuana, which will be legal in the state in July 2019 thanks to a law passed during the last legislative session.

Dr. Rahul Gupta, state health officer and commissioner of the state Bureau for Public Health, said the high response volume gives the state a sound outlook on patient and physician views of the looming change.  “We found that to be compelling that there is a certain level of interest, not just from patients, but from the physician community,” he said.

Along with doctors, the bureau analyzed survey results from 6,003 West Virginians, as well as Public Employees Insurance Agency and Medicaid claim data to tease out what tweaks, if any, might be needed for the nascent program.  Of the patients who responded, 2,120 reported suffering from chronic pain, 1,579 reported suffering from post-traumatic stress disorder and another 980 reported suffering from a mental health disorder.

The Medicaid and PEIA data shows crossover between some of the most prevalent conditions in the state and the list of conditions whose victims qualify to obtain medical marijuana....

There is still work to be done and change for the organization to consider.  Among the questions Gupta said the board is considering: Should the state limit how many dispensaries can obtain a permit to sell?  Should the board approve the sale of marijuana in plant form?  Should patients be allowed to grow their own marijuana plants? Should patients be able to purchase any other forms of marijuana?

Marijuana will be available to certified patients in the form of a pill, oil, topical, via vaporization or nebulization, tincture, liquid, or dermal patch.  Gupta said the board is scheduled to meet again in February.

December 18, 2017 in Medical community perspectives, Medical Marijuana Data and Research, Medical Marijuana State Laws and Reforms, Who decides | Permalink | Comments (0)

Friday, December 15, 2017

Applicant Sues to Block Ohio from Using Racial Preferences in the Award of Commercial Marijuana Licenses

Over at my blog, I've just posted some details about a new lawsuit challenging Ohio's purported use of a "racial quota" in the award of its large-scale marijuana cultivation licenses. Check out the post here. The suit could have some far-reaching ramifications for state efforts to boost minority participation in the state licensed marijuana industry.

December 15, 2017 in Current Affairs, Medical Marijuana State Laws and Reforms, Race, Gender and Class Issues | Permalink | Comments (0)

Saturday, December 9, 2017

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

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

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

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

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

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

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

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

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

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

Some (of many) prior related posts:

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

Thursday, December 7, 2017

Intriguing review of latest banking realities for marijuana businesses

MarijuanaBanks_FStateline has this interesting new piece on banking in the marijuana sector under the headline "Why It’s Getting Easier for Marijuana Companies to Open Bank Accounts." Here are excerpts:

State and local officials in places that recently legalized marijuana are bracing for the arrival of a sector that largely runs on cash. They’re anxiously envisioning burglars targeting dispensaries and business owners showing up at tax offices with duffel bags full of money. But the marijuana industry’s banking problems may be more manageable than many officials realize.

Just ask Washington state, which last year successfully pushed almost all legal marijuana businesses to open bank accounts and pay their taxes with a check or other non-cash method. Or Hawaii, which earlier this year announced a “cashless” system for buying medical marijuana, reliant on a technology analogous to PayPal.

“We’re definitely seeing more businesses in the industry getting banked every day,” said Aaron Smith, executive director of the National Cannabis Industry Association, a trade group. Despite the legal risk involved in serving the cannabis industry, almost 400 banks and credit unions now do, according to the U.S. Treasury — a number that has more than tripled since 2014.

That’s reassuring news for California, where sales of recreational pot start next month, as well as for Nevada, Maine and Massachusetts, where voters approved recreational marijuana sales last year, and Arkansas, Florida, Montana and North Dakota, where voters approved medicinal sales.

But the progress that has occurred in some legal markets remains fragile. The federal government still considers marijuana to be a dangerous, illegal drug. States can only permit marijuana sales — and financial institutions can only serve marijuana-related businesses — thanks to Obama-era guidelines that create wiggle room in federal law....

Local institutions that are chartered at the state level have been particularly willing to work with the industry. In Oregon, where sales of recreational marijuana began in 2015, Salem-based Maps Credit Union decided to serve marijuana businesses after audits revealed some of its members were already in the industry. “It didn’t really square with our philosophy to kick members out,” said Shane Saunders, chief experience officer.

Taking on the new line of business required investments in staff, anti-money laundering software, and extra security at bank branches, said Rachel Pross, the credit union’s chief risk officer. Under the current federal guidance, Maps has to send a report on each marijuana-related account to the U.S. Treasury every 90 days, plus a report each time an account experiences a cash transaction of over $10,000.

Maps staff run background checks on marijuana-related business owners who want to open an account. They conduct regular, in-person inspections of the businesses whose accounts they manage, and they require business owners to share their quarterly financial statements. Dispensaries that bank with Maps make most of their sales in cash, because credit- and debit-card processors typically won’t touch marijuana money. As of October, the credit union had handled $140 million in cash deposits from 375 marijuana-related accounts in 2017, Pross said. Some companies hold multiple accounts.

In neighboring Washington, where recreational marijuana sales began in 2014, several financial institutions are openly working with the industry. Washington has helped banks and credit unions monitor marijuana-related customers by collecting and publishing extensive data on monthly sales and legal violations to the liquor and cannabis control board’s website. State regulators last year nudged marijuana licensees to open deposit accounts, aware that banking services were available and worried that cash-based businesses threatened public safety....

In some states, such as Alaska and Hawaii, regulators say they’re not aware of any credit unions or banks that currently serve the industry. Recreational marijuana sales began in Alaska in 2015, and medical marijuana dispensaries opened in Hawaii in 2017. But Hawaii is pioneering a workaround. Regulators have given a Colorado-based credit union permission to serve the state’s medical marijuana dispensaries. The credit union, in turn, has partnered with CanPay, an app that allows patients to transfer money from their bank accounts directly to the dispensary’s account....

Seattle dispensary owner [John] Branch notes that stores with ATMs make money when they dispense cash, and store owners may not embrace an electronic payment system that instead will cost them 2 percent of each transaction, as CanPay’s service does.

A change in federal law would solve the cannabis industry’s banking problem and wipe away the need for services tailored to the industry, such as CanPay. But Congress has so far failed to pass — or even seriously consider — a law that would reclassify marijuana as a less dangerous substance or allow banks and credit unions to work with businesses without risking their charters. U.S. Rep. Ed Perlmutter, a Colorado Democrat who proposed a bill on the issue this year, says no action is expected anytime soon.

December 7, 2017 in Business laws and regulatory issues, Federal Marijuana Laws, Policies and Practices, Medical Marijuana State Laws and Reforms, Recreational Marijuana State Laws and Reforms | Permalink | Comments (0)

Tuesday, December 5, 2017

"Did Ohio hire a drug felon to score medical marijuana applications?"

The title of this post is the somewhat amusing headline of this somewhat amusing article in the Columbus Dispatch.  Here are excerpts:

A company that failed to win a state license to cultivate medical marijuana is criticizing the state for apparently hiring a man with a felony drug conviction to score the applications.  “The state of Ohio has a lot of explaining to do ... they hired a convicted drug dealer for $150,000 to score applications for the Ohio medical marijuana industry,” said Jimmy Gould, chairman of CannAscend Ohio, the rejected would-be cultivator.

Applicants to grow medical marijuana were required to undergo criminal background checks, Gould noted.  “Did the Department of Commerce not think it important to check and report the fact that at least one of the scorers of the medical marijuana control program had a criminal record for dealing drugs ... did they require a background check to get a license, but not to give a license?”  Gould asked in a statement.

Court records verified by The Dispatch show a Trevor C. Bozeman was convicted of manufacturing, delivering and possessing drugs, with intent to manufacture or deliver, in Middleburg, Pennsylvania, in 2005.   The records do not provide details of the offense.  They also show misdemeanor charges of use and possession of drug paraphernalia and possession of a small amount of marijuana for personal use, that were dismissed.

Bozeman, now age 33, of Brunswick, Maine, paid $2,131 in fines and costs and was placed on probation for three years, which court records show he successfully completed.  Ohio incorporation papers show a Trevor Bozeman formed ICANN Consulting, with a Dublin address, in late 2016, The Dispatch confirmed....  The company was one of three to receive a $150,000 state contract in June to score applications submitted by those seeking licenses to grow medical marijuana. Messages seeking comment from Bozeman were left Tuesday morning at two telephone numbers listed in his name.

Stephanie Gostomski, a spokeswoman for the Department of Commerce, said the agency is checking the allegation made by CannAscend. ICANN Consulting appeared to meet all the requirements to receive the state contract and its scoring appeared to be done professionally, she said.

CannAscend’s bid to win a medical marijuana cultivation contract was rejected after it scored poorly in evaluations and failed to meet requirements, Gostomski said. Gould said the situation reflected “significant irregularities” that should be investigated.  “This is the start of a billion dollar industry and the fact that the start is marred by arbitrary and capricious irregularities is troubling and deserves a thorough and deep review,” he said.

December 5, 2017 in Business laws and regulatory issues, Medical Marijuana State Laws and Reforms, Who decides | Permalink | Comments (0)

Tuesday, November 28, 2017

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

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

Background

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

Purpose

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

Methods

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

Results

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

Conclusions

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

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