Tuesday, December 14, 2021
The December 2021 issue of JNCI Monographs has a series of papers stemming from a symposium last year organized by the National Cancer Institute exploring cannabis policy, public health and research. Here are just some of the great-looking articles in the issue:
Here is a short excerpt from the first of these article:
Recent survey evidence suggests that one-quarter of cancer patients have used cannabis, often to manage common cancer symptoms or treatment side effects, such as anorexia, nausea, and pain, and there is some evidence of ameliorative effects. A majority of US oncologists engage in discussions about cannabis use with patients, and although almost one-half of them recommend it clinically, few oncologists feel sufficiently informed to make recommendations to their patients regarding the use of cannabis. In general, studies that replicate the effects of cannabis and its constituents are needed as are improvements in research quality and surveillance capacity.
Tuesday, November 23, 2021
"An Overview of Decriminalization Efforts in Regard to Psychedelic Plants in the United States, 2019-2020"
The title of this post is the title of this paper recently posted to SSRN and authored by Aaron Roberts, a student at The Ohio State University Moritz College of Law. (This paper is yet another in the on-going series of student papers supported by the Drug Enforcement and Policy Center.) Here is this paper's abstract:
This paper examines the recent developments made in psychedelic-related drug policy in the United States. The paper gives an overview of the decriminalization efforts made at the state and local levels. The paper also looks at the historical, cultural, political, and public health factors that have shaped psychedelic policy throughout American history and into the current day. Lastly, the paper shares some concerns about discrimination and unequal access present in psychedelic-assisted psychotherapy.
Tuesday, July 20, 2021
"Cannabis as Treatment for Chronic Pelvic Pain in Women: An Opportunity for the Cannabis Wellness Industry"
The title of this post is the title of this new paper recently posted to SSRN and authored by Jamie Feyko, a rising 3L at The Ohio State University Moritz College of Law. (This paper is yet another in the on-going series of student papers supported by the Drug Enforcement and Policy Center.) Here is this latest paper's abstract:
In a healthcare landscape that routinely ignores women’s pain, many women turn to cannabis to manage their otherwise debilitating chronic pelvic pain caused by conditions such as endometriosis and polycystic ovary syndrome. This paper explores how the Controlled Substances Act wrongly characterized cannabis as having “no medicinal value” and the effects this federal illegality still has on women seeking alternative pain management therapies for chronic pelvic pain. Additionally, this paper explains why and how cannabis helps relieve such pain through discussing the effects of cannabinoids like THC and CBD on the body’s inflammatory response and the body’s endocannabinoid system. Women, as the leading consumers in our society, have expressed a need and a desire for products that provide relief from chronic pelvic pain and increase sexual pleasure. The 2018 Farm Bill opened the doors to CBD businesses looking to break into the women’s sexual and reproductive wellness market. The market for women-centric CBD pain relief and sexual enjoyment is far from saturated, and this paper encourages those in the CBD industry (or those looking to enter the industry) to take note.
July 20, 2021 in Federal Marijuana Laws, Policies and Practices, Medical community perspectives, Medical Marijuana Commentary and Debate, Race, Gender and Class Issues, Who decides | Permalink | Comments (0)
Monday, April 12, 2021
The title of this post is the title of this notable new paper authored by Daniel Orenstein now available via SSRN. Here is its abstract:
States continue to legalize recreational cannabis, but most have heavily restricted where consumption of newly licit cannabis is permitted. Every legalizing state has thus far prohibited open, outdoor public use, either limiting lawful use to private property or allowing a small number of licensed indoor venues for consumption outside of public view, an approach borrowed from alcohol control. In contrast, some non-U.S. jurisdictions have adopted a tobacco control approach, allowing limited outdoor public use while prohibiting indoor public use. Each approach presents individual and population health risks that reflect the complex intersection of health, social inequities, and community norms.
Cannabis consumers face uncertain but potentially significant health risks from use, and the relative availability of use locations also implicates existing inequities in policing practices and housing. Those who do not use cannabis but are exposed to others’ use face possible harms from secondhand smoke and from intoxicated behavior, with such risks likely to be inequitably distributed due to existing employment and housing patterns. Communities as a whole also face risks, including that changing cannabis norms may increase use prevalence or intensity and that concentration of cannabis outlets in under-resourced communities may prove as detrimental as the concentration of other disfavored businesses has been.
Each public use approach carries attendant risks, but a regulatory framework based on the tobacco control model best balances the protection of public health and the promotion of equity and social justice. This model recognizes the parallels between cannabis and tobacco (in addition to those between cannabis and alcohol). This approach also provides a pathway to mitigating the public health risks of cannabis legalization by leveraging an approach that has proven effective at reducing secondhand exposures and denormalizing smoking behavior in the tobacco context.
April 12, 2021 in Business laws and regulatory issues, Medical community perspectives, Recreational Marijuana Commentary and Debate, Recreational Marijuana Data and Research, Recreational Marijuana State Laws and Reforms | Permalink | Comments (0)
Tuesday, June 30, 2020
The question in the title of this post is the headline of this effective new Leafly article, which builds off the research noted in this prior post about the "right" minimum age for legal access to recreational cannabis. Here are excerpts:
When it comes to legal cannabis, the random collection of ages across North America is curious. Every US state that allows recreational cannabis sales requires customers to be at least 21 years old. In Canada the minimum age is 19, except in Alberta (where it’s 18) and Québec (which started at 18 but raised it to 21 earlier this year).
In most jurisdictions, medical marijuana is legal for people age 18 and older, with a doctor’s recommendation.
What difference does it really make if someone is 18, 19 or 21? A research team at Memorial University in Newfoundland, Canada, recently investigated the question. Instead of looking at the immediate health and safety of young adults, they assessed later life outcomes — namely educational attainment, lifetime cigarette smoking habits, and general physical and mental health. In their study, the Memorial University team concluded that the ideal minimum legal age for cannabis was 19....
Health experts cite THC exposure in adolescents causes changes to the brain’s folding patterns, decreased neural connectivity, thinning of the cortex and lower white matter, among other symptoms. However, one recent study suggests any changes to brain structure caused by cannabis use in adolescence cleared up by the time subjects were in their 30s.
Another ongoing study in the Saguenay region of Quebec took MRI scans of over 1,000 adolescent brains in 2002, and the same subjects are currently being re-evaluated as adults — results pending.
If the serious nature of brain health is such a risk, why not just make cannabis illegal until a person’s mid-20s? In the real world, policymakers have to weigh human nature’s penchant for the forbidden with appropriate rules and consequences. In an ideal world, sure — and in this ideal world underage kids never go looking for cannabis from illicit sources, either. In the real world, though, policymakers have to weigh human nature’s penchant for the forbidden with appropriate rules and consequences. In an ideal world, alcohol would also be outlawed for health reasons, but we all know how Prohibition worked out.
Prior to the Oct. 2018 opening of legal cannabis sales in Canada, a government task force took a hard look at the best-legal-age question. That group found that the higher the minimum legal age, the more likely adolescents will seek out unregulated sources, risking both consumption of potentially more dangerous products and also incarceration.
Prior related post:
June 30, 2020 in Business laws and regulatory issues, International Marijuana Laws and Policies, Medical community perspectives, Medical Marijuana State Laws and Reforms, Recreational Marijuana State Laws and Reforms | Permalink | Comments (0)
Tuesday, June 23, 2020
The JAMA Internal Medicine journal has this week published online notable new original research and commentary on roadway fatalities in some states that have legalized marijuana use by all adults (called RCL in the works). Here is the main piece and its main results and conclusions from its abstract:
Implementation of RCLs was associated with increases in traffic fatalities in Colorado but not in Washington State. The difference between Colorado and its synthetic control in the post-RCL period was 1.46 deaths per 1 billion vehicle miles traveled (VMT) per year (an estimated equivalent of 75 excess fatalities per year; probability = 0.047). The difference between Washington State and its synthetic control was 0.08 deaths per 1 billion VMT per year (probability = 0.674). Results were robust in most sensitivity analyses. The difference between Colorado and synthetic Colorado was 1.84 fatalities per 1 billion VMT per year (94 excess deaths per year; probability = 0.055) after excluding neighboring states and 2.16 fatalities per 1 billion VMT per year (111 excess deaths per year; probability = 0.063) after excluding states without MCLs. The effect was smaller when using the enactment date (24 excess deaths per year; probability = 0.116).
Conclusions and Relevance
This study found evidence of an increase in traffic fatalities after the implementation of RCLs in Colorado but not in Washington State. Differences in how RCLs were implemented (eg, density of recreational cannabis stores), out-of-state cannabis tourism, and local factors may explain the different results. These findings highlight the importance of RCLs as a factor that may increase traffic fatalities and call for the identification of policies and enforcement strategies that can help prevent unintended consequences of cannabis legalization.
And here are two follow-up pieces published with this main piece:
June 23, 2020 in Criminal justice developments and reforms, Medical community perspectives, Recreational Marijuana Commentary and Debate, Recreational Marijuana Data and Research | Permalink | Comments (1)
Thursday, April 23, 2020
The last of a big group of student presentations in my Marijuana Law, Policy & Reform seminar will focus on "CBD and its efficacy as a sleep aid." Here some background readings he has provided:
- "CBD & Parkinson's Disease"
- "Is CBD legal? Here’s what you need to know, according to science"
- "Cannabidiol can improve complex sleep‐related behaviours associated with rapid eye movement sleep behaviour disorder in Parkinson's disease patients: a case series"
- "Is CBD legal in your state? Check this chart to find out"
- "Cannabidiol (CBD) — what we know and what we don’t
- "Every Question You Have About CBD—Answered"
- "The State of Sleep"
- "What to know about sleep deprivation"
- "Prescription sleeping pills: What's right for you?"
- "Are Sleeping Pills Safe?"
- "1 in 3 adults don’t get enough sleep"
FDA Approved MJ derived medicine
Thursday, January 23, 2020
Should the public health community applaud shifts from alcohol to marijuana (and support cannabis beverages)?
The question in the title of this post is prompted by this interesting recent Forbes piece headlined "Cannabis Taking A Larger Share Of Alcohol Industry Amid Concern Over Calories And Hangovers." Here are excerpts:
The growing concern over calories and hangovers is driving more millennials to replace alcohol with cannabis in their social life — a trend that pushes investors to increasingly eye the infused beverage industry as an opportunity.
A recent Monitoring the Future research found US millennials drink far less alcohol than previous generations: The percentage of college students who drink alcohol daily declined from 6.5% in 1980 to 2.2% in 2017. By contrast, there was a significant increase in daily marijuana use among young US adults, especially during 2019, the research further revealed, resonating with the gradual legalization of medical and recreational marijuana across the country....
Financial services company Cowen predicts the sales of recreational cannabis in the US will increase more than 700% from $6 billion in 2016 to $50 billion in 2026, prompting beverage companies of all sizes, such as Ceria, to tap into the space to grow their profits. Keith Villa, the creator of Blue Moon Brewing Company, launched Ceria in 2018 – a company produces a cannabis-infused and non-alcoholic craft beer brand Grainwave. Breweries that manufactures similar products include Colorado-based New Belgium Brewing and Dad & Dude’s Breweria, as well as SweetWater Brewing Co. of Georgia. Several mainstream CPG heavyweights, including Coca-Cola, PepsiCo and Mondelēz, also reportedly consider launching infused food products, but nothing so far has materialized.
These existing infused beverages in the market, however, do not appeal widely to consumers who are already frequent cannabis users, at least according to Jake Bullock, co-founder of cannabis-infused social tonic startup Cann. Cann produces cannabis-infused beverage products that are low in calories. “As a result, the mainstream consumer is not entering the market as quickly,” he wrote me via email, stressing the cannabis industry has lagged the growth projections many analysts and companies have made. “It is clear that cannabis is here to stay and will only continue to penetrate existing markets and new states over time,” Bullock added....
The other element that prevents more people from exploring THC-added food is their confusion with CBD products. The other co-founder of Cann, Luke Anderson, notes many consumers who are curious about cannabis turn to CBD to explore the plant, but often time, they don’t know the difference between the cannabinoids. “This has created a lot of confusion in the market, with people thinking they would 'feel something' after trying a CBD-only product and not being able to tell what was physiologically happening versus a placebo effect,” he said.
“This experience may have discouraged people from exploring micro doses of THC, which are quite safe but give you a very palpable buzz. While CBD products play in a crowded health and wellness segment of grocery aisles.”
Anderson said his company has aimed to reshape the alcohol industry with a small amount of THC in each can since it was first launched about a year ago. Cann prides itself in balancing 2 mg of sativa-dominant hybrid THC and 4mg of CBD to provide a “sessionable experience” without high calories and the hangover.
When the modern marijuana reform movement got started, I was often in the habit of saying that it would likely be a "public health win" if a lot of alcohol use was replaced by marijuana use. This article suggest this is already happening, and I presume a growing cannabis beverage market would enhance the number of folks who might substitute cannabis for alcohol. But, as the question in this post title reveals, I am not knowledgeable enough about the public health literature to say for sure that these trends ought to be applauded.
Tuesday, January 7, 2020
The title of this post is the title of this Hill commentary authored by Elizabeth Long and Diana Fishbein. Here are excerpts:
Despite the billions of dollars, marijuana prohibition has cost society; this strategy has failed to protect communities. Instead, it has caused great harm, particularly for marginalized populations. These adverse outcomes are rooted in policies enacted to tackle this public health problem that has little to do with public health. Marijuana possession continues to be treated as a criminal matter, even though, historically, there are no examples of criminal law solving a public health matter....
While decriminalization of marijuana is projected to have many economic and social benefits, legislation must balance decriminalization with the need to prevent teenage use. Teenage marijuana use can alter the course of brain development and increase risk for dependence and possibly addiction. Heavy use in adolescence has been associated with several developmental delays. Importantly, when teenagers believe using a drug is not harmful, they are more likely to use it....
A substantial body of research justifies reallocating resources from criminal justice to public health policies. A public health approach focuses on the implementation and enforcement of regulations to manage health risks through policy changes, such as taxation, regulation of advertising, and age limits. Several policy recommendations are offered here for consideration:
- Support a detailed, comprehensive, scientific evaluation of the impacts from current laws surrounding both medical marijuana and adult-use to guide future legislation.
- Re-categorize marijuana from Schedule I to Schedule III or IV to be more consistent with its known pharmacological properties and effects.
- Update the regulatory structure by applying uniform standards to the types of products that can be sold or marketed to the public.
- Invest prevention resources in delaying the age of initiation of marijuana use past the period when the brain is still developing (around age 25) to reduce the impact on neurodevelopment.
- Support screening, early detection, and intervention. Focus both on at-risk youth who have not yet initiated to avert pathways to use in adolescence and youth who have already begun using marijuana to avoid negative consequences.
Wednesday, November 20, 2019
The title of this post is the title of this notable new Washington Post commentary. I am not keen on the headline, but I am keep on the contents, especially because a Democratic Prez Candidate Debate scheduled for tonight makes this piece is a timely must-read. But that is true primarily because it is authored by Keith Humphreys, who I always consider to be a timely must-read. Here are excerpts:
When former vice president Joe Biden asserted over the weekend that marijuana shouldn’t be legal because it might be a “gateway” to hard drug use, pro-legalization critics were quick to paint him as an out-of-touch codger still fighting the last drug war. But the reaction isn’t entirely fair: Yes, the marijuana gateway theory that was omnipresent in the 1980s was at best distorted and at worst dishonest. Nevertheless, gateways between marijuana and other addictive substances are real — and they swing in both directions.
During the heyday of anti-marijuana sentiment in America, fear-based prevention programs warned adolescents that a huge percentage of adults who experienced some horrible drug-related outcome (e.g., becoming addicted to heroin) had used marijuana when they were younger. These statistics were technically accurate, but even as teenagers, most of my classmates and I could see the logical flaws in the implication that marijuana was inevitably a road to ruin. Just because most people who used heroin had previously used marijuana didn’t prove that most people who used marijuana would go on to use heroin.
But strip away that era’s ideological agenda, designed to assign marijuana a unique and powerful role in ruining lives, and a more nuanced underlying truth about gateways reveals itself. People who become users of almost any addictive substance are at higher risk of subsequently using and having problems with other substances. A recent National Academies of Sciences, Engineering, and Medicine report found moderate evidence that this is the case for cannabis, but it’s also true of other drugs, including legal ones such as alcohol and tobacco. At least three causal forces can create such gateways.
First, people can become habituated to particular routes of administering drugs....
Social networks are the second force behind drug gateways. Drug use, like many other behaviors, is very commonly a social activity. This creates gateway effects between drugs in part because classes of behavior (e.g., playing sports, traveling to exotic locales, collecting antiques or, yes, taking drugs) come to seem more normal when your friends all engage in them....
Gateways can also result from users’ desire to combine the effect of a new drug with a familiar one. Established cocaine users sometimes become heavy drinkers (and vice versa) because they find the cocaethylene produced in the body by this drug combination particularly euphoric. Similarly, the fact that many people take the trouble to carve out cigars and fill them with marijuana (known as smoking “blunts”) demonstrates that tobacco and marijuana combined is uniquely reinforcing to some users.
So those who mocked Biden’s claim that marijuana could be a gateway to other drugs thus got the science wrong. There are plenty of ways using the drug can make people more likely to use other substances.
But research also shows that singling out marijuana is wrong; the gateway effect is in fact shared by many substances. If Biden continues to oppose the legalization of marijuana on the grounds that marijuana could lead to other drugs, it is only fair that he should answer another question: Why have we made alcohol and tobacco legal and often subjected them to insufficient restrictions when they are powerful gateways, too?
November 20, 2019 in Campaigns, elections and public officials concerning reforms, Medical community perspectives | Permalink | Comments (0)
The title of this post is the title of this new paper recently posted to SSRN and authored by Kathryn Foust, a recent graduate The Ohio State University Moritz College of Law. This paper is the sixteenth paper in an on-going series of student papers supported by the Drug Enforcement and Policy Center. (The fifteen prior papers in this series are linked below.) Here is this latest paper's abstract:
The intersection between marijuana and parenting is both highly controversial and largely unexplored. Despite the trend of legalization (medicinal and recreational) across the country, there is a widening discrepancy between criminal laws and child welfare policies. Even in states where marijuana is recreationally legal, a parent might still be charged with child abuse or neglect as a result of his or her marijuana use. Although second-hand marijuana smoke has proven to be a relatively low risk of harm to children, other areas of concern have not been adequately studied, such as the effects of marijuana use during pregnancy and/or breastfeeding. Despite the lack of reliable scientific studies on the impact of ingestion by children, some initial studies have shown a marked increase in frequency of accidental ingestions and resulting hospital treatment in states that have legalized marijuana. The palatability and attractiveness of “edibles” is likely the cause of this measurable and dramatic increase. Overall, parental marijuana use has been inadequately studied by science, but some reliable data is available which could be used overhaul existing children’s services policies.
Prior student papers in this series:
- "The Canna(business) of Higher Education"
- "Marijuana Banking in New York and Around the US: 'Swim at Your Own Risk'"
- "Intellectual Property Survey: Cannabis Plant Types, Methods of Extraction, IP Protection, and One Patent That Could Ruin It All"
- "Marijuana in the Workplace: Distinguishing Between On-Duty and Off-Duty Consumption"
- "An Argument Against Regulating Cannabis Like Alcohol"
- "The State of Marijuana in The Buckeye State and Fiscal Policy Considerations of Legalized Recreational Marijuana"
- "Race Based Statutes at Play with Cannabis: Cultivating a Process for Weeding Out the Competition"
- "Tribal Cannabis: Balancing Tribal Sovereignty and Cooperative Enforcement"
- "Land of the Free, Home of the (Disgruntled) Brave: The Case for Allowing Veterans Access to Medical Marijuana"
- "Cannabidiol (CBD) in the Therapeutics Industry"
- "The Good, the Bad, and the Ugly: Why IRC § 280E Is Not the Industry Killer It Is Portrayed to Be"
- "Achieving Diversity in the Marijuana Industry: Should States Implement Social Equity into Their Regimes?"
- "Cannabis Legalization: Dealing with the Black Market"
- "Pop Culture's Influence on Recreational Marijuana Use & Legislation: A Case Study on Snoop Dogg"
- "Going Green in American Professional Sports: Why Marijuana Usage Should Be Allowed and What Policy Changes Should Ensue"
November 20, 2019 in Medical community perspectives, Medical Marijuana Commentary and Debate, Medical Marijuana Data and Research, Recreational Marijuana Commentary and Debate, Recreational Marijuana Data and Research | Permalink | Comments (0)
Tuesday, November 12, 2019
The question in the title of this post is the headline if this notable new editorial in the journal Drug Discovery Today authored by Patricia Zettler and Erika Lietzan. (Disclosure/humble brag: Professor Zettler is on the Ohio State College of Law faculty and a member of our Drug Enforcement and Policy Center.) Here are excerpts from the start and end of the piece:
In the last two years the cannabidiol (CBD) market has exploded. Consumers can purchase CBD-containing oils, lotions, gummies, tea, coffee, water, popcorn, and cereal, on store shelves and online. Celebrities and athletes are touting the benefits of these products, and sales are forecast to exceed $20 billion in the next five years. This market explosion has coincided with the U.S. Food & Drug Administration (FDA)’s 2018 approval of the first CBD drug (Epidiolex), for treating seizures associated with two rare and severe forms of epilepsy in children, as well as the 2018 Farm Bill, which removed cannabis with low levels of delta-9-tetrahydocannabinol (THC) — “hemp” — from the federal list of controlled substances. And it comes on the heels of nearly 40 states enacting comprehensive laws to legalize cannabis for medical use (and sometimes recreational use) within their borders.
Yet significant questions remain about the legal status of these widely available CBD products. Most sales of CBD-containing foods and supplements violate the “drug exclusion rules” in the Federal Food, Drug, and Cosmetic Act (FDCA). But FDA has yet to enforce those rules, apart from sending warning letters to a few sellers. The agency is instead considering what approach to take. Several former agency officials — including former Commissioner Scott Gottlieb — have urged FDA to create a sensible, science-based path forward for consumer products. The time is ripe for the agency, lawmakers, health care providers, the drug discovery community, and the public to consider the purpose of the drug exclusion rules and what a different approach — exempting CBD — might mean for consumer and patient access and safety, as well as innovation incentives....
As a practical matter, CBD-containing foods and supplements may be here to stay. Lawmakers or FDA may decide that the drug exclusion rules are unwarranted for CBD, given the federal descheduling of hemp, state legalization of cannabis products, and (eventually) rigorous evidence that CBD products are relatively safe. But FDA should not default into this position simply because a robust, albeit unlawful, market has already emerged. A decision to give CBD special treatment should be made thoughtfully and with public participation, accounting for possible gains in consumer access and choice, as well as the lost opportunity to learn, and harness, CBD’s full therapeutic potential.
November 12, 2019 in Business laws and regulatory issues, Federal Marijuana Laws, Policies and Practices, Medical community perspectives, Medical Marijuana Commentary and Debate, Recreational Marijuana Commentary and Debate, Who decides | Permalink | Comments (1)
Wednesday, October 30, 2019
The title of this post is the title of this notable new article authored by Elena Andreyeva and Benjamin Ukert published in the Forum for Health Economics & Policy. Here is its abstract:
Growing evidence suggests that medical marijuana laws have harm reduction effects across a variety of outcomes related to risky health behaviors. This study investigates the impact of medical marijuana laws on self-reported health using data from the Behavioral Risk Factor Surveillance System from 1993 to 2013. In our analyses we separately identify the effect of a medical marijuana law and the impact of subsequent active and legally protected dispensaries.
Our main results show surprisingly limited improvements in self-reported health after the legalization of medical marijuana and legally protected dispensaries. Subsample analyses reveal strong improvements in health among non-white individuals, those reporting chronic pain, and those with a high school degree, driven predominately by whether or not the state had active and legally protected dispensaries. We also complement the analysis by evaluating the impact on risky health behaviors and find that the aforementioned demographic groups experience large reductions in alcohol consumption after the implementation of a medical marijuana law.
"Cannabinoids for the treatment of mental disorders and symptoms of mental disorders: a systematic review and meta-analysis"
The title of this post is the title of this notable new article by multiple authors published in The Lancet Psychiatry. Here is its "Summary":
Medicinal cannabinoids, including medicinal cannabis and pharmaceutical cannabinoids and their synthetic derivatives, such as tetrahydrocannabinol (THC) and cannabidiol (CBD), have been suggested to have a therapeutic role in certain mental disorders. We analysed the available evidence to ascertain the effectiveness and safety of all types of medicinal cannabinoids in treating symptoms of various mental disorders.
For this systematic review and meta-analysis we searched MEDLINE, Embase, PsycINFO, the Cochrane Central Register of Controlled Clinical Trials, and the Cochrane Database of Systematic Reviews for studies published between Jan 1, 1980, and April 30, 2018. We also searched for unpublished or ongoing studies on ClinicalTrials.gov, the EU Clinical Trials Register, and the Australian and New Zealand Clinical Trials Registry. We considered all studies examining any type and formulation of a medicinal cannabinoid in adults (≥18 years) for treating depression, anxiety, attention-deficit hyperactivity disorder (ADHD), Tourette syndrome, post-traumatic stress disorder, or psychosis, either as the primary condition or secondary to other medical conditions. We placed no restrictions on language, publication status, or study type (ie, both experimental and observational study designs were included). Primary outcomes were remission from and changes in symptoms of these mental disorders. The safety of medicinal cannabinoids for these mental disorders was also examined. Evidence from randomised controlled trials was synthesised as odds ratios (ORs) for disorder remission, adverse events, and withdrawals and as standardised mean differences (SMDs) for change in symptoms, via random-effects meta-analyses. The quality of the evidence was assessed with the Cochrane risk of bias tool and Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. This study is registered with PROSPERO (CRD42017059372, CRD42017059373, CRD42017059376, CRD42017064996, and CRD42018102977).
83 eligible studies (40 randomised controlled trials, n=3067) were included: 42 for depression (23 randomised controlled trials; n=2551), 31 for anxiety (17 randomised controlled trials; n=605), eight for Tourette syndrome (two randomised controlled trials; n=36), three for ADHD (one randomised controlled trial; n=30), 12 for post-traumatic stress disorder (one randomised controlled trial; n=10), and 11 for psychosis (six randomised controlled trials; n=281). Pharmaceutical THC (with or without CBD) improved anxiety symptoms among individuals with other medical conditions (primarily chronic non-cancer pain and multiple sclerosis; SMD −0·25 [95% CI −0·49 to −0·01]; seven studies; n=252), although the evidence GRADE was very low. Pharmaceutical THC (with or without CBD) worsened negative symptoms of psychosis in a single study (SMD 0·36 [95% CI 0·10 to 0·62]; n=24). Pharmaceutical THC (with or without CBD) did not significantly affect any other primary outcomes for the mental disorders examined but did increase the number of people who had adverse events (OR 1·99 [95% CI 1·20 to 3·29]; ten studies; n=1495) and withdrawals due to adverse events (2·78 [1·59 to 4·86]; 11 studies; n=1621) compared with placebo across all mental disorders examined. Few randomised controlled trials examined the role of pharmaceutical CBD or medicinal cannabis.
There is scarce evidence to suggest that cannabinoids improve depressive disorders and symptoms, anxiety disorders, attention-deficit hyperactivity disorder, Tourette syndrome, post-traumatic stress disorder, or psychosis. There is very low quality evidence that pharmaceutical THC (with or without CBD) leads to a small improvement in symptoms of anxiety among individuals with other medical conditions. There remains insufficient evidence to provide guidance on the use of cannabinoids for treating mental disorders within a regulatory framework. Further high-quality studies directly examining the effect of cannabinoids on treating mental disorders are needed.
Tuesday, October 1, 2019
"Contribution of Marijuana Legalization to the U.S. Opioid Mortality Epidemic: Individual and Combined Experience of 27 States and District of Columbia"
The title of this post is the title of this new forthcoming research article authored by Archie Bleyer and Brian Barnes. Here is its abstract:
Prior studies of U.S. states as of 2013 and one state as of 2015 suggested that marijuana availability reduces opioid mortality (marijuana protection hypothesis). This investigation tested the hypothesis with opioid mortality trends updated to 2017 and by evaluating all states and the District of Columbia (D.C.).
Opioid mortality data obtained from the U.S. Centers for Disease Control and Prevention were used to compare opioid death rate trends in each marijuana-legalizing state and D.C. before and after medicinal and recreational legalization implementation and their individual and cumulative aggregate trends with concomitant trends in non-legalizing states. The Joinpoint Regression Program identified statistically-significant mortality trends and when they occurred.
Of 23 individually evaluable legalizing jurisdictions, 78% had evidence for a statistically-significant acceleration of opioid death rates after medicinal or recreational legalization implementation at greater rates than their pre-legalization rate or the concurrent composite rate in non-legalizing states. All four jurisdictions evaluable for recreational legalization had evidence (p <0.05) for subsequent opioid death rate increases, one had a distinct acceleration, and one a reversal of prior decline. Since 2009-2012, when the cumulative-aggregate opioid death rate in the legalizing jurisdictions was the same as in the non-legalizing group, the legalizing group′s rate accelerated increasingly faster (p=0.009). By 2017 it was 67% greater than in the non-legalizing group (p<0.05).
The marijuana protection hypothesis is not supported by recent U.S. data on opioid mortality trends. Instead, legalizing marijuana appears to have contributed to the nation′s opioid mortality epidemic.
Thursday, September 5, 2019
The title of this post is the headline of this AP article, which started this way:
Public health officials in Oregon said Wednesday that a person who recently died of a severe respiratory illness had used an electronic cigarette containing marijuana oil from a legal dispensary, the second death linked to vaping nationwide and the first tied to a vaping product bought at a pot shop.
Officials have not determined what sickened the middle-aged adult, whether the product was contaminated or whether they may have added something to the liquid in the device after buying it, said Dr. Ann Thomas with the Oregon Health Authority.
Thomas declined to name the brand of the product or the dispensary during the investigation and said it's the only case of vaping-related illness or death in Oregon that authorities know about. "Our investigation has not yielded exactly what it is in this product," Thomas said. "At this point, some of the other states have more data than us."
As of last week, 215 possible cases of severe lung disease associated with the use of e-cigarettes had been reported by 25 states, according to the federal Centers for Disease Control and Prevention. The battery-powered vaping devices can be used to inhale a flavored nicotine solution or a solution infused with marijuana oil.
Illinois officials on Friday reported what they consider the first death in the nation linked to vaping after the person contracted a serious lung disease. They didn't say if the e-cigarette contained marijuana oil or just nicotine. Health officials in some states have said a number of people who got sick had vaped products containing THC, the compound that gives marijuana its high.
That's a critical distinction in the Oregon case, according to the American Vaping Association, which has blamed the recent spate of lung illnesses on illegal vape pens that contain THC.
Wisconsin public health officials said late last month that 89% of the people they interviewed who became sick reported using e-cigarettes or other vaping devices to inhale THC.
In New York state, 32 cases of vaping-related illness have been reported, with a "vast majority" involving people who vape illicit marijuana. None has involved medical marijuana products sold in compliance with state law.
New York officials are focusing their investigation on an additive used in black-market vape oils made from vitamin E. A state health department spokeswoman said a lab has found "high levels" of vitamin E acetate in "nearly all" the marijuana samples involved.
Thursday, August 29, 2019
This morning, the federal government weighed in on the health risks of marijuana reforms through this new extended US Surgeon General advisory headed "Marijuana Use and the Developing Brain." Here is how it gets started and some key passages (with lots of cites to research removed):
I, Surgeon General VADM Jerome Adams, am emphasizing the importance of protecting our Nation from the health risks of marijuana use in adolescence and during pregnancy. Recent increases in access to marijuana and in its potency, along with misperceptions of safety of marijuana endanger our most precious resource, our nation’s youth.
Marijuana, or cannabis, is the most commonly used illicit drug in the United States. It acts by binding to cannabinoid receptors in the brain to produce a variety of effects, including euphoria, intoxication, and memory and motor impairments. These same cannabinoid receptors are also critical for brain development. They are part of the endocannabinoid system, which impacts the formation of brain circuits important for decision making, mood and responding to stress....
The risks of physical dependence, addiction, and other negative consequences increase with exposure to high concentrations of THC7 and the younger the age of initiation. Higher doses of THC are more likely to produce anxiety, agitation, paranoia, and psychosis. Edible marijuana takes time to absorb and to produce its effects, increasing the risk of unintentional overdose, as well as accidental ingestion by children and adolescents. In addition, chronic users of marijuana with a high THC content are at risk for developing a condition known as cannabinoid hyperemesis syndrome, which is marked by severe cycles of nausea and vomiting.
This advisory is intended to raise awareness of the known and potential harms to developing brains, posed by the increasing availability of highly potent marijuana in multiple, concentrated forms. These harms are costly to individuals and to our society, impacting mental health and educational achievement and raising the risks of addiction and misuse of other substances. Additionally, marijuana use remains illegal for youth under state law in all states; normalization of its use raises the potential for criminal consequences in this population. In addition to the health risks posed by marijuana use, sale or possession of marijuana remains illegal under federal law notwithstanding some state laws to the contrary.
Marijuana Use during Pregnancy
Pregnant women use marijuana more than any other illicit drug. In a national survey, marijuana use in the past month among pregnant women doubled (3.4% to 7%) between 2002 and 201712. In a study conducted in a large health system, marijuana use rose by 69% (4.2% to 7.1%) between 2009 and 2016 among pregnant women. Alarmingly, many retail dispensaries recommend marijuana to pregnant women for morning sickness.
Marijuana use during pregnancy can affect the developing fetus. THC can enter the fetal brain from the mother’s bloodstream and may disrupt the endocannabinoid system, which is important for a healthy pregnancy and fetal brain development. Moreover, studies have shown that marijuana use in pregnancy is associated with adverse outcomes, including lower birth weight. The Colorado Pregnancy Risk Assessment Monitoring System reported that maternal marijuana use was associated with a 50% increased risk of low birth weight regardless of maternal age, race, ethnicity, education, and tobacco use....
Marijuana Use during Adolescence
Marijuana is also commonly used by adolescents, second only to alcohol. In 2017, approximately 9.2 million youth aged 12 to 25 reported marijuana use in the past month and 29% more young adults aged 18-25 started using marijuana. In addition, high school students’ perception of the harm from regular marijuana use has been steadily declining over the last decade. During this same period, a number of states have legalized adult use of marijuana for medicinal or recreational purposes, while it remains legal under federal law. The legalization movement may be impacting youth perception of harm from marijuana.
The human brain continues to develop from before birth into the mid-20s and is vulnerable to the effects of addictive substances. Frequent marijuana use during adolescence is associated with changes in the areas of the brain involved in attention, memory, decision-making, and motivation. Deficits in attention and memory have been detected in marijuana-using teens even after a month of abstinence. Marijuana can also impair learning in adolescents. Chronic use is linked to declines in IQ, school performance that jeopardizes professional and social achievements, and life satisfaction. Regular use of marijuana in adolescence is linked to increased rates of school absence and drop-out, as well as suicide attempts.
Sunday, June 16, 2019
The title of this post is the headline of this new commentary in the New York Times authored by two doctors, Kenneth L. Davis and Mary Jeanne Kreek. Here are excerpts:
It’s tempting to think marijuana is a harmless substance that poses no threat to teens and young adults. The medical facts, however, reveal a different reality.
Numerous studies show that marijuana can have a deleterious impact on cognitive development in adolescents, impairing executive function, processing speed, memory, attention span and concentration. The damage is measurable with an I.Q. test. Researchers who tracked subjects from childhood through age 38 found a consequential I.Q. decline over the 25-year period among adolescents who consistently used marijuana every week. In addition, studies have shown that substantial adolescent exposure to marijuana may be a predictor of opioid use disorders.
The reason the adolescent brain is so vulnerable to the effect of drugs is that the brain — especially the prefrontal cortex, which controls decision making, judgment and impulsivity — is still developing in adolescents and young adults until age 25....
The risk that marijuana use poses to adolescents today is far greater than it was 20 or 30 years ago, because the marijuana grown now is much more potent. In the early 1990s, the average THC content of confiscated marijuana was roughly 3.7 percent. By contrast, a recent analysis of marijuana for sale in Colorado’s authorized dispensaries showed an average THC content of 18.7 percent.
The proposals for legalizing marijuana under consideration in New York and New Jersey allow for use starting at age 21. While society may consider a 21-year-old to be an adult, the brain is still developing at that age. States that legalize marijuana should set a minimum age of no younger than 25. They should also impose stricter limits on THC levels and strictly monitor them. Educational campaigns are also necessary to help the public understand that marijuana is not harmless.
Simply because society has become more accepting of marijuana use doesn’t make it safe for high school and college students. Cigarettes and alcohol, both legal, have caused great harm in society as well as to people’s health, and have ruined many lives. Marijuana may do the same. We must tightly regulate the emerging cannabis industry to protect the developing brain.
UPDATE: Interestingly, not long after blogging about this NY Times commentary, I came across this extended Washington Post piece headlined "Potent pot, vulnerable teens trigger concerns in first states to legalize marijuana." Here is a snippet:
As more than a dozen states from Hawaii to New Hampshire consider legalizing marijuana, doctors warn of an urgent need for better education — not just of teens but of parents and lawmakers — about how the products being marketed can significantly affect young people’s brain development.
The limited scientific research to date shows that earlier and more frequent use of high-THC cannabis puts adolescents at greater jeopardy of substance use disorders, mental health issues and poor school performance.
“The brain is abnormally vulnerable during adolescence,” said Staci Gruber, an associate professor of psychiatry at Harvard Medical School who studies how marijuana affects the brain. “Policy seems to have outpaced science, and in the best of all possible worlds, science would allow us to set policy.”
Wednesday, June 5, 2019
The leading medical marijuana advocacy group, Americans for Safe Access, has this terrific new resource titled "Patient's Guide To CBD." Though the title of this nearly 50-page report is simple, the contents provide an intricate road-map to the complicated law and science surrounding the status and import of the cannabis-plant compound known as CBD. Here is a section of the publication's introduction:
The Patient’s Guide to CBD was created by Americans for Safe Access (ASA) for the benefit of patients, prospective patients, healthcare providers, consumers, and anyone interested in learning more about CBD. The goal of this guide is to be an informative and useful reference document that will be shared with others so that patients, doctors, and regulators can make informed decisions regarding CBD....
Patients and consumers should also be aware of the legal and regulatory status of CBD products. As of May 2019, 47 U.S. states have passed some type of legislation permitting the use of cannabis or cannabinoids such as CBD; nevertheless, cannabis with THC in excess of 0.3% by dry weight is a Schedule I controlled substance under U.S. Federal law. Therefore, CBD-containing products that were produced from cannabis plants that exceed the federal threshold on THC may be legal at the state level, but are federally illegal. Additionally, even CBD products that are derived from plants containing not more than 0.3% THC by dry weight may violate laws such as the Food, Drug and Cosmetics Act and create further legal challenges for patients and consumers.
The passage of the Agriculture Improvement Act of 2018 (also known as the 2018 Farm Bill) will make industrial hemp (i.e., cannabis with no more than 0.3% THC by dry weight), including CBD-rich industrial hemp, an agricultural commodity in the United States, but the U.S. Department of Agriculture has yet to promulgate federal regulations or approve state regulations regarding the cultivation and processing of industrial hemp. Further, the U.S. Food & Drug Administration has yet to provide a pathway for the introduction of hemp-derived CBD products into the marketplace. Therefore, it is not yet federally legal to market hemp-derived CBD as a drug, dietary supplement, food product, or cosmetic. Patients and consumers are encouraged to stay up to date on these changing regulations to ensure that they, and their products, are in compliance with applicable laws.
Globally, the use of products containing CBD has risen dramatically as more and more people seek alternative ways to improve their health and their lives. The data has shown an increase in the sales of products containing CBD every year, and sales are expected to continue to rise in the coming years.
June 5, 2019 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, May 21, 2019
Long-time readers know I have long been covering the (never-quite-clear) connection between modern marijuana reform and the modern opioid crisis. (Just some of many, many prior posts on this front are linked below.) Today brings notable research news on this front, which is already getting a lot of attention from the mainstream press in articles from CNN, from NBC News, from Newsweek, and from US News & World Report, among others. All these stories are about a new study published in The American Journal of Psychiatry from multiple authors under this catchy title: "Cannabidiol for the Reduction of Cue-Induced Craving and Anxiety in Drug-Abstinent Individuals With Heroin Use Disorder: A Double-Blind Randomized Placebo-Controlled Trial." Here is the study's abstract:
Despite the staggering consequences of the opioid epidemic, limited nonopioid medication options have been developed to treat this medical and public health crisis. This study investigated the potential of cannabidiol (CBD), a nonintoxicating phytocannabinoid, to reduce cue-induced craving and anxiety, two critical features of addiction that often contribute to relapse and continued drug use, in drug-abstinent individuals with heroin use disorder.
This exploratory double-blind randomized placebo-controlled trial assessed the acute (1 hour, 2 hours, and 24 hours), short-term (3 consecutive days), and protracted (7 days after the last of three consecutive daily administrations) effects of CBD administration (400 or 800 mg, once daily for 3 consecutive days) on drug cue–induced craving and anxiety in drug-abstinent individuals with heroin use disorder. Secondary measures assessed participants’ positive and negative affect, cognition, and physiological status.
Acute CBD administration, in contrast to placebo, significantly reduced both craving and anxiety induced by the presentation of salient drug cues compared with neutral cues. CBD also showed significant protracted effects on these measures 7 days after the final short-term (3-day) CBD exposure. In addition, CBD reduced the drug cue–induced physiological measures of heart rate and salivary cortisol levels. There were no significant effects on cognition, and there were no serious adverse effects.
CBD’s potential to reduce cue-induced craving and anxiety provides a strong basis for further investigation of this phytocannabinoid as a treatment option for opioid use disorder.
Some (of many) prior related posts:
- Two new papers provide further evidence of marijuana reform aiding with opioid crisis
- "The Case for Pot in the Age of Opioids: Legalizing medical marijuana could save lives that may otherwise be lost to opioid addiction."
- "Can medical marijuana be used to treat heroin addiction?"
- Yet another study suggests link between medical marijuana availability and decreased opioid use
- "Legalize marijuana and reduce deaths from drug abuse"
- "Obama’s Opioid Offensive Again Ignores the Cannabis Solution"
- "Is marijuana a secret weapon against the opioid epidemic?"
- "Cannabis as a Substitute for Opioid-Based Pain Medication: Patient Self-Report"
- "The use of cannabis in response to the opioid crisis: A review of the literature"
- Still more talk, from notable conservative outlets, about possible benefits of marijuana reform amidst opioid crisis
- "Could medical marijuana help fight opioid abuse? It’s complicated"
- "Impact of Medical Marijuana Legalization on Opioid Use, Chronic Opioid Use, and High-risk Opioid Use"
- "Should Physicians Recommend Replacing Opioids With Cannabis?"
- "The Impact of Cannabis Access Laws on Opioid Prescribing"
- Speculating about impact on the opioid crisis as Ohio finally sees its first legal medical marijuana sale