Marijuana Law, Policy & Reform

Editor: Douglas A. Berman
Moritz College of Law

Thursday, April 18, 2019

Terrific coverage of all sorts of issues via Reason's "Weed Week"

As a general matter, I am not too keen on all the marijuana buzz devoted to 4/20.  But, as a specific matter, I really like what folks at Reason have a put together in a "Weed Week" series of pieces.  Here are the pieces posted to date: 

April 18, 2019 in History of Marijuana Laws in the United States, Medical Marijuana Commentary and Debate, Political perspective on reforms, Recreational Marijuana Commentary and Debate | Permalink | Comments (0)

Friday, April 12, 2019

"The Canna(business) of Higher Education"

The title of this post is the title of this paper just posted to SSRN and authored by Shelby Slaven, who is a student at The Ohio State University Moritz College of Law. Here is the paper's abstract:

While the idea of legalizing cannabis for adult use is gaining on acceptance among the public, the past and current policies on both, the state and federal level, have resulted in dearth of research on the efficacy of cannabis for therapeutic purposes as well as possible societal and health consequences of recreational use.  Institutes of higher education are best positioned not only to reform research on the substance, but to train a generation of cultivators, distributors, and healthcare professionals, and while doing so address some of the historical harms perpetrated by the policies of the War on Drugs.  Students are seeking out ways to capitalize on a growing market and remedying past discrimination should be a top priority.  This paper first provides an overview of cannabis legalization as it stands today, the political efforts that got it here, and those that will move it forward.  It then discusses institutes of higher education and the efforts to bring cannabis into the classroom.  Lastly, this paper argues that Historically Black Colleges and Universities can provide education, training, and a foot in the door for Black individuals who have suffered harsher criminal penalties in the name of the war on crime.

April 12, 2019 in Business laws and regulatory issues, Employment and labor law issues, History of Marijuana Laws in the United States, Medical Marijuana Commentary and Debate, Race, Gender and Class Issues, Recreational Marijuana Commentary and Debate, Who decides | Permalink | Comments (0)

Spotlighting racial and regional differences in modern marijuana reform dynamics

I am very sad that presentations in my my Marijuana Law, Policy & Reform seminar have wrapped up, but that reality gives me a bit more time and space here to catch up on the marijuana law, policy and reform stories that most catch my eye.  One such important story that I missed a few weeks ago comes here from Stateline under the headline "African-Americans Missing Out on Southern Push for Legal Pot."  I recommend the extended article in full, and here are some excerpts:

Medical cannabis laws typically lay out the conditions for which the drug may be prescribed. But the laws in Arkansas and Florida — the only Southern states that have legalized medical cannabis — don’t cover sickle cell disease, which causes acute pain and disproportionately affects African-Americans. The bills advancing in Tennessee and Kentucky also exclude that condition. Three states that have legalized medical but not recreational cannabis — Connecticut, Ohio and Pennsylvania — allow sickle cell disease patients to use it....

Black legalization advocates also fear that even if medical cannabis becomes legal, white politicians won’t regulate licensing and permitting in a way that ensures equitable opportunities for people of color. “Without that, it’ll be more of the same,” said Dr. Felecia Dawson, a board-certified physician who closed her Georgia-based OB-GYN practice to focus on advocating for medical cannabis. “Legislators will keep people of color ... from the benefits of cannabis.”

Nationally, research suggests that medical marijuana use is more common among whites with high incomes, perhaps in part because of the long history of racial disparity in drug enforcement....

Every Southern state by 2016 had legalized the treatment of a limited number of conditions using CBD oil. As public support increased, so did lawmakers’ willingness to expand the list of eligible conditions. But some conditions that affect minority populations at higher rates than white ones — such as sickle cell disease, which affects 73 in 1,000 African-Americans at birth compared with 3 whites, according to federal estimates — are not included in proposals currently making their way through several Southern statehouses.

In a 2017 hearing co-hosted by the Arkansas Medical Marijuana Commission, following a ballot initiative that had legalized medical cannabis, advocates wore “Diversity for All” T-shirts to emphasize the drug’s importance to minority residents. “We know that such diseases as hypertension, sickle cell, neuropathy and so on are more predominant in blacks,” Casey Caldwell, a black cannabis advocate, said at the hearing.

“It is safe to say that African-American communities would benefit the most,” she added. “In the past, pharmaceutical drugs have been priced so high that [we] have to make a decision whether or not they should eat or whether they should purchase medication.”

Those concerns echoed what Dee Dawkins-Haigler, a former Democratic Georgia representative who headed the state’s Black Caucus, said in 2015 about the initial absence of black people among the state’s 17 appointees to the Commission on Medical Cannabis. The Black Caucus eventually fought to get sickle cell disease added to the list of conditions eligible for CBD oil....

In Florida, black farmers initially cried foul at being shut out of the state’s multibillion-dollar cannabis trade over policies that required license holders to have operated for 30 straight years. According to Roz McCarthy, founder of the Florida-based advocacy group Minorities for Medical Marijuana, the state’s law lacked the teeth needed to ensure that medical cannabis license holders adhered to requirements to ensure diversity in hiring. A spokesperson for the Florida Department of Health said that state law “does not require medical marijuana treatment centers to report the race or ethnicity of its owners.”

McCarthy said, “We’re trying to push lawmakers to understand that they have the ability and the power to ensure exclusionary practices don’t happen. Barriers are there. But the opportunity to reduce barriers is also there.”

April 12, 2019 in Campaigns, elections and public officials concerning reforms, History of Marijuana Laws in the United States, Medical Marijuana Commentary and Debate, Medical Marijuana Data and Research, Medical Marijuana State Laws and Reforms, Race, Gender and Class Issues, Who decides | Permalink | Comments (0)

Wednesday, April 10, 2019

Critically and skeptically examining the claims in support of medical marijuana

The third planned presentations from a student in my Marijuana Law, Policy & Reform seminar this coming week will, in his words, "marshal the tools of critical thinking and scientific skepticism against the mounting claims about medical marijuana."  Here is how this student explains his plans and suggested background reading:

I have noticed worrying signs in the medical cannabis industry that bear all the hallmarks of pseudoscience and “alternative medicine.” For example, how many ailments fall under the ever-broadening curative umbrella of CBD? The ability to think critically and skeptically is the most useful skill we have as humans for discerning the truth, and it is most important to engage such skills when our biases most threaten our steady course. Remember the frequent allusions this semester to those who embrace medical legalization as a stepping stone to recreational use? Such people may be more inclined to jettison their critical thinking capabilities when it comes to scrutinizing claims in whose outcome one holds an interest.

I will provide a brief primer on thinking critically and skeptically, and then describe the signs of pseudo-scientific reasoning. Then, armed with this toolkit of sorts, I will explore the various claims about the benefits of cannabis as a medicine, including the current research, its blind spots, and its shortcomings. I will then critically explore the ethics and policy behind prohibition, comparing and contrasting cannabis with prescription drugs and alcohol; we shall see how the claimed justifications for cannabis prohibition stand up to critical scrutiny.

Links to Reading Matter

It is not vital that people read anything prior to the presentation, but here are some useful links for those wishing to get ahead of the game:

  • Steven Novella et al., The Skeptics’ Guide to the Universe 57–140 (2018).

Of course, I understand that people might not have access to the above-mentioned book, in which case the following website will suffice (although I commend the book highly in its entirety to anyone interested in how we get at the truth of things).

April 10, 2019 in Assembled readings on specific topics, Medical Marijuana Commentary and Debate, Medical Marijuana Data and Research | Permalink | Comments (0)

Wednesday, March 27, 2019

Rounding up just some (of so many) stories about CBD

There is so much talk and so many stories about CBD, I know I can barely scratch the surface on this topic.  But it seems this past week I have seen an especially notable number of notable stories on this front.  Below I provide a partial round-up, and suggested particular attention to the first linked piece for its science and thoughtfulness:

March 27, 2019 in Assembled readings on specific topics, Business laws and regulatory issues, Medical Marijuana Commentary and Debate, Medical Marijuana Data and Research, Recreational Marijuana Commentary and Debate | Permalink | Comments (0)

Monday, March 25, 2019

"The Effect of Marijuana Use on American Veterans with PTSD, and How the U.S. Department of Veterans Affairs Ought to Respond"

The title of this post is the title of a presentation to be made by one of my students in my Marijuana Law, Policy & Reform seminar this coming week.  Here is part of his explanation of his topic and links to some background reading:

Because the U.S. Department of Veterans Affairs (VA) is required to follow all federal laws, the VA is prohibited from prescribing, recommending, or assisting veterans in obtaining marijuana.  While veterans may discuss marijuana use with VA providers, VA doctors cannot help their patients participate in a state medical marijuana program and veterans cannot obtain reimbursement funding through the VA when they seek medical marijuana from state programs.

The inability of the VA to prescribe or recommend marijuana to American veterans with PTSD denies former service members an opportunity to receive treatment that many veterans not only want, but which also has the potential to be safer than the VA’s history of doling out addictive prescription drugs such as opioids, antidepressants, and anti-anxiety pills.  PTSD is a serious disease that is relatively common among combat veterans — it causes varying symptoms such as flashbacks, nightmares, severe anxiety, and uncontrollable thought about a triggering event.

The medical research in this arena has reached mixed findings.  While some researchers have found that the use of medical marijuana by veterans with PTSD has positive results, other studies suggest that marijuana use by those with PTSD may actually make symptoms worse.  There simply has not been enough controlled studies to conclusively state whether marijuana is beneficial for those with PTSD.  Nonetheless, there is plenty of anecdotal evidence by veterans suggesting that their use of marijuana has improved, or in some cases eliminated, symptoms associated with their PTSD.  Fortunately, the first clinical trial of marijuana for American veterans with PTSD is currently underway in Colorado.  My presentation will suggest that we need more controlled clinical trials such as this to further identify whether marijuana could (or should) truly be used as a remedy for veterans with PTSD.

* Medical journal article, "Post-Traumatic Stress Disorder" (discussing what PTSD is and various treatment options, including cannabis).

* Medical journal article, "Use and effects of cannabinoids in military veterans with posttraumatic stress disorder"(reviewing several studies and noting that while there is a need for more randomized and controlled studies, some PTSD patients report benefits in terms of reduced anxiety and insomnia and improved coping ability).

* Medical journal article, "Posttraumatic Stress Disorder and Cannabis Use Characteristics among Military Veterans with Cannabis Dependence" (exploring the negative effects of treating PTSD with marijuana and finding that individuals with PTSD may have a particularly difficult experience when attempting to quit marijuana).

* Medical journal article, "Marijuana and other cannabinoids as a treatment for posttraumatic stress disorder: A literature review" (explaining that conclusions cannot yet be drawn about the therapeutic effects of marijuana and related cannabinoids for PTSD; suggesting that rapidly changing legal landscape will permit promising clinical research).

* Medical journal article, "A review of medical marijuana for the treatment of posttraumatic stress disorder: Real symptom re-leaf or just high hopes?" (finding some positive data for use of marijuana for PTSD but also noting conflicting findings and limits of studies conducted thus far).

* Report on study, "Marijuana for Symptoms of PTSD in U.S. Veterans" (first clinical trial of marijuana for PTSD in American veterans underway).

* Recent Weedmaps article, "Marijuana Study Findings Could Hold Promise for Veterans With PTSD" (noting that MAPS study mentioned above could pave the way toward an FDA-approved prescription medicine; anecdotal evidence of veteran using black market rather than expensive medical marijuana program in CA)

March 25, 2019 in Federal Marijuana Laws, Policies and Practices, Medical community perspectives, Medical Marijuana Commentary and Debate, Medical Marijuana Data and Research, Medical Marijuana State Laws and Reforms, Who decides | Permalink | Comments (0)

Thursday, March 7, 2019

Latest polling data shows overwhelming support for medical marijuana reform and notable age gap in support for full legalization

The results of the latest Quinnipiac University national poll with questions on marijuana reform can be found at this link, and here is how the results on these questions are summarized:

Legalized Marijuana

American voters say 60 - 33 percent "the use of marijuana should be made legal in the U.S." There is a very small gender gap, but a wide age gap:

  • Voters 18 to 34 years old support legalized marijuana 85 - 12 percent;
  • Voters 35 to 49 years old support it 63 - 30 percent;
  • Voters 50 to 64 years old support it 59 - 35 percent;
  • Voters over 65 years old are divided on legalized marijuana as 44 percent support it, with 49 percent opposed.

Voters support medical marijuana, if a doctor prescribes it, 93 - 5 percent.

American voters support erasing criminal records for marijuana possession 63 - 29 percent.  Republicans are divided as 45 percent support erasing records, with 47 percent opposed. Every other listed party, gender, education, age and racial group supports erasing criminal records.

"The baby boomers say no to the drug that helped define an era, while the millennials say bring it on," [Tim] Malloy [assistant director of the Quinnipiac University Poll] said. "In between are enough voters to rubber stamp legalizing marijuana for recreation as well as medical reasons."

The results on these questions are here also broken down by gender, education levels and racial background.  Interestingly, there is no real gender gap on these questions in this latest poll, but there is a small racial gap on a few of the questions.

March 7, 2019 in Medical Marijuana Commentary and Debate, Polling data and results, Race, Gender and Class Issues, Recreational Marijuana Commentary and Debate, Who decides | Permalink | Comments (0)

Tuesday, February 26, 2019

"The Association between Cannabis Product Characteristics and Symptom Relief"

Download (5)I am grateful for a student in my marijuana reform seminar who made sure that I did not miss this new research in the journal Scientific Reports which share the title of this post and was authored by Sarah Stith, Jacob Vigil, Franco Brockelman, Keenan Keeling and Branden Hall. Here is the research article's abstract:

Federal barriers and logistical challenges have hindered measurement of the real time effects from the types of cannabis products used medically by millions of patients in vivo.  Between 06/06/2016 and 03/05/2018, 3,341 people completed 19,910 self- administrated cannabis sessions using the mobile device software, ReleafApp to record: type of cannabis product (dried whole natural Cannabis flower, concentrate, edible, tincture, topical), combustion method (joint, pipe, vaporization), Cannabis subspecies (C. indica and C. sativa), and major cannabinoid contents (tetrahydrocannabinol, THC; and cannabidiol, CBD), along with real-time ratings of health symptom severity levels, prior-to and immediately following administration, and reported side effects.  A fixed effects panel regression approach was used to model the within-user effects of different product characteristics. 
Patients showed an average symptom improvement of 3.5 (SD = 2.6) on an 11-point scale across the 27 measured symptom categories.  Dried flower was the most commonly used product and generally associated with greater symptom relief than other types of products.  Across product characteristics, only higher THC levels were independently associated with greater symptom relief and prevalence of positive and negative side effects.  In contrast, CBD potency levels were generally not associated with significant symptom changes or experienced side effects.

This public release about the article is headlined "THC found more important for therapeutic effects in cannabis than originally thought," and it provides a useful summary of the research methods and findings.

February 26, 2019 in Medical Marijuana Commentary and Debate, Medical Marijuana Data and Research | Permalink | Comments (0)

Two interesting new articles about the early operation of Ohio's medical marijuana program

OHIO-HERBAL-CLINIC-DOCTORS-OFFICE-OHIO-MEDICAL-MARIJUANA-CARD--300x300Two Ohio papers had two interesting new article about early developments in the operation of Ohio's still-new medical marijuana program.  Here are headlines, links and excerpts:

From the Akron Beacon Journal, "Ohio medical marijuana recommendations coming from clinics, not family doctors"

If you know someone who has received a recommendation to use medical marijuana, odds are the recommendation didn’t come from a family doctor or primary-care physician. The vast majority of recommendations in Ohio come from clinics that employ doctors solely to evaluate patients for medical marijuana, say people familiar with the industry....

“Marijuana-specific clinics fill a huge need,” said Dr. Joel Simmons, who runs the Ohio Herbal Clinic, a Near East Side cannabis clinic. While the clinics, many of which have out-of-state owners, have some critics, patient advocates say primary-care doctors are the ideal source for marijuana recommendations.

Those doctors better understand a patient’s needs and medical history, said Mary Jane Borden, co-founder of the Ohio Rights Group, which advocates for users of medicinal cannabis. When Ohio lawmakers wrote the state’s medical-marijuana law, they hoped that family physicians would be writing most recommendations, Borden said....

Clinics charge between $125 and $200 for an evaluation, which insurance won’t cover.  Because the clinics don’t negotiate with insurance companies, they clinics can charge whatever they want, said Emilie Ramach, founder and CEO of Compassionate Alternatives, a Columbus-based nonprofit agency that helps patients pay for medicinal cannabis.  Several clinic doctors, including Simmons, said they do their best to keep their prices reasonable.

From the Columbus Dispatch, "High prices keep many Ohioans out of legal cannabis market"

As Ohio’s medical marijuana industry finally takes off, some patients and advocates are griping about costs that put it out of reach for many people.  A steep price tag stems partly from the lack of competition, as Ohio only has seven dispensaries spread throughout the state, mostly in rural areas, experts said.  Costs are expected to drop as more dispensaries open and the industry finds its footing.

In the meantime, patients openly acknowledge buying the drug on the black market while they wait for prices to come down.  And without insurance to cover the expense, some worry that low-income people might never be able to afford medical cannabis....

Several local patients said using marijuana has improved their quality of life, but they must stretch their budgets to pay for it or buy it on the street.  “I’m not using as much as I probably need to be using,” said Mary Alleger, 31, of Reynoldsburg, who said she uses cannabis to treat post-traumatic stress disorder (PTSD) and ongoing pain from a botched medical procedure.

Katherin Cottrill, 33, of Newark, has worked with the patient advocacy organization Ohio Rights Group to acquire a medical marijuana card, but said current costs keep her from even getting started.  “I would have to pay $200 to $250 (just to get a recommendation),” Cottrill said.  “And then I have to drive to a dispensary and pay $50. It’s unreasonable for me to even try.”...

Just under 3 grams of medical marijuana costs about $50. Cannabis clinics charge between $125 and $200, and the state charges $50 in fees.  Marijuana is cheaper on the street, patients said.

“On the black market you can buy an ounce for $200,” said Robert Doyle, 61, of Newark, who has a medical marijuana card but still buys the drug on the street due to the cost.  There are about 28 grams in an ounce.  Doyle said he’s visited dispensaries in Michigan with prices comparable to the black market, making him confident that Ohio’s costs will eventually fall....

But even if prices drop, clinic costs and fees will remain a barrier for some, Cottrill said.  “What about low-income people who are desperately seeking medication?” she said. “They can’t even afford to pay $50 to get their card registered.”

February 26, 2019 in Business laws and regulatory issues, Medical community perspectives, Medical Marijuana Commentary and Debate, Medical Marijuana Data and Research, Medical Marijuana State Laws and Reforms, Who decides | Permalink | Comments (1)

Thursday, February 21, 2019

"Growing Marijuana Industry Struggles To Attract Employees Of Color"

The title of this post is the headline of this notable new NPR piece.  Here are excerpts:

As marijuana becomes legal around the country, blacks and Latinos are often left out of new business opportunities. Advocates say people of color are often reluctant to join the growing legal marijuana economy because they were targeted far more often than whites during the war on drugs. Studies show members of such communities were arrested and jailed for illegal marijuana use far more often than whites.

As Massachusetts developed laws for legal marijuana, officials wrote what they claimed was a first-in-the-nation Social Equity Program explicitly to give members of those communities a leg up. But this part of the state law isn't working — next to no black or Latino candidates have applied for licenses in Massachusetts.

They're scared of the government. "They're scared of the government, man," said Sieh Samura, an outspoken cannabis activist. "This is still a new thing. And there's taxes, there's the government, there's all kinds of things, you know. Just because people say it's legal ... it's not welcoming for everybody."

Studies show that blacks and Latinos nationwide have been arrested and incarcerated for cannabis and other drug crimes at at least four times the rate of whites. The long-term effects of the war on drugs launched in the 1970s are still evident in many communities of color.

So, the city of Somerville, Mass., passed an ordinance requiring that 50 percent of recreational marijuana licenses go to black and Latino applicants. "We want to make sure that everyone has a real authentic opportunity to participate in that economy in the future," said Somerville Mayor Joe Curtatone. "If not, we start to lose the fabric and soul of our community. And then social inequity becomes greater, becomes vaster, and we can't allow that to happen. We're a pro-growth community, but we want to make sure regular folks are able to participate in that."...

To be a model for others, Samura and his wife Leah created a recreational marijuana business called 612 Studios. For months they've been coming to a massive marijuana cultivation facility in Milford, Mass., to participate in The Sira Accelerator, a 12-week program designed to get more people of color into the industry by doing everything from raising money, to helping with marketing, packaging and distribution.

This program is run by Sira Naturals, which grows marijuana and creates products for its own medical dispensaries and some other recreational businesses. Mike Dundas, Sira Naturals' CEO, said the company wants to help longtime marijuana advocates, like the Samuras, or folks who have been dabbling in the illegal pot market. "We see our program, the Sira Accelerator, as sort of offering a hand to those who've been operating — and have skill and passion and dedication to cannabis products — in the illicit marketplace, to come to the regulated side, to get on the books and help facilitate the start of their businesses," said Dundas.

In return for the advice and counsel, Sira takes just under a 10 percent stake in the new company. Sira also hopes the accelerator will help it open a recreational shop in Somerville, where it already runs one of three medical dispensaries. The company can't get a recreational license until black or Latino entrepreneurs do because of the city's ordinance. Dundas, who is white, admits he's scrambling to find and mentor people of color who want to open businesses in Somerville to ensure that his company can open a retail shop of its own.

Karen O'Keefe, director of state policies with the Washington, D.C.-based Marijuana Policy Project, said there have been lots of attempts around the country to help candidates from black and Latino communities, but none have worked. "None of the states have the kind of diversity that we would like to see in the cannabis industry," she said....

"States moving forward are going to look at what happened in Massachusetts," O'Keefe said, "why such good intentions didn't end up bearing as much fruit and as much diversity in the industry as was intended."

UPDATE: Not long after this posting I saw that USA Today has an even fuller discussion of these issues in this new article headlined "Drug laws have historically been racist. Marijuana activists are helping minority dealers go legal." Here is a small piece of a long article worth reading in full:

The war on drugs has for decades disproportionately devastated minority communities by punishing people like Blunt and creating a cycle of poverty, incarceration and limited employment options, legal and social justice experts say.

Now, lawmakers and legalization advocates across the country are demanding not just cannabis legalization but remedies to address decades of demonstrably racist policing, from laws that automatically expunge criminal records for marijuana dealing and possession to policies that would give minority communities assistance in building cannabis businesses....

For many marijuana legalization activists, it's now up to local governments to diversify the legal pot industry by clearing conviction records and handing out subsidies. If white men have unfairly benefited from marijuana legalization, then it's only fair that minority communities be given extra help now because they suffered more, the thinking goes.

"We actually do have to overcorrect," said Kassandra Frederique, 32, the New York state director of the Drug Policy Alliance, which is lobbying to legalize marijuana in the Empire State. "People from our communities, black and brown communities, were the one first ones to be criminalized. Why shouldn’t we be the first ones to benefit?"

February 21, 2019 in Medical Marijuana Commentary and Debate, Race, Gender and Class Issues, Recreational Marijuana Commentary and Debate, Recreational Marijuana State Laws and Reforms, Who decides | Permalink | Comments (2)

Friday, February 8, 2019

Notable new lobbying group, National Cannabis Roundtable, to be chaired by former US House Speaker John Boehner

LogoWhen Acreage Holdings last year announced that former Speaker of the US House of Representatives John Boehner was now on its board of advisors, I was unsure whether Boehner was really interested in being a serious advocate for marijuana reform or was mostly to be a high-profile figurehead in this space. But in November, as noted here, Boehner penned a Wall Street Journal commentary headlined "Washington Needs to Legalize Cannabis." And today comes news that John Boehner is to be the Chair of a new industry lobbying ground calling itself the National Cannabis Roundtable.

This new local press piece and this National Cannabis Roundtable website is all I can find about this new group right now, but the press piece provides a flavor of the group's commitments:

The former lawmaker will also serve as an advisor, not a registered lobbyist, for the roundtable, Boehner said during a phone call with reporters Friday. Boehner said the roundtable will promote changes to federal law that make it easier to research cannabis and for regulated cannabis businesses to operate. Federally, marijuana is an illegal Schedule 1 controlled substance, alongside heroin and LSD, is not a top priority for the group....

But Boehner said removing cannabis from Schedule I of the U.S. Controlled Substances Act is not the group's top priority. "It would clearly be a big goal, but I think there are other steps that need to be taken along the way before we get to that," he said....

Boehner said the roundtable's members represent every aspect of the cannabis supply chain, including growers, processors, retailers, wellness centers, investors, entrepreneurs, and publicly traded companies.

The National Cannabis Roundtable website has the following sentences under the heading "Our Mission"

The legal cannabis boom promises to contribute billions of dollars to the US economy over the next decade - creating jobs, advancing new health science and adding momentum to criminal justice reform.

The National Cannabis Roundtable promotes common sense federal regulation, tax equality and financial services reform and supports changing federal law to acknowledge states’ rights to regulate and manage cannabis policy.

I like the reference to "adding momentum to criminal justice reform" in the first sentence, though the second sentence and other factors leads me to suspect that National Cannabis Roundtable will not have criminal justice reform as a focal point of its work.

Prior related posts:

February 8, 2019 in Business laws and regulatory issues, Campaigns, elections and public officials concerning reforms, Medical Marijuana Commentary and Debate, Recreational Marijuana Commentary and Debate, Who decides | Permalink | Comments (0)

Thursday, February 7, 2019

More on the forces that have shaped views on marijuana

Download (6)In this post last month, I blogged  this interesting new paper, titled ""How and why have attitudes about cannabis legalization changed so much?", which was recently published in Social Science Research and was authored by Jacob Felson, Amy Adamczyk and Christopher Thomas. I am not pleased to see that the authors of this research have this new piece at The Conversation under the headline "Why do so many Americans now support legalizing marijuana?". Here are excerpts (with links from the original) from this reader-friendly account of their interesting research:

American views on marijuana have shifted incredibly rapidly. Thirty years ago, marijuana legalization seemed like a lost cause. In 1988, only 24 percent of Americans supported legalization.

But steadily, the nation began to liberalize. By 2018, 66 percent of U.S. residents offered their approval, transforming marijuana legalization from a libertarian fantasy into a mainstream cause. Many state laws have changed as well. Over the last quarter-century, 10 states have legalized recreational marijuana, while 22 states have legalized medical marijuana.

So why has public opinion changed dramatically in favor of legalization? In a study published this February, we examined a range of possible reasons, finding that the media likely had the greatest influence....

What has likely made the biggest difference is how the media has portrayed marijuana. Support for legalization began to increase shortly after the news media began to frame marijuana as a medical issue....

In the 1980s, the vast majority of New York Times stories about marijuana were about drug trafficking and abuse or other Schedule I drugs. At that time, The New York Times was more likely to lump marijuana together in a kind of unholy trinity with cocaine and heroin in discussions about drug smuggling, drug dealers and the like.

During the 1990s, stories discussing marijuana in criminal terms became less prevalent. Meanwhile, the number of articles discussing the medical uses of marijuana slowly increased. By the late 1990s, marijuana was rarely discussed in the context of drug trafficking and drug abuse. And marijuana had lost its association with other Schedule I drugs like cocaine and heroin in the New York Times. Gradually, the stereotypical persona of the marijuana user shifted from the stoned slacker wanting to get high to the aging boomer seeking pain relief....

As Americans became more supportive of marijuana legalization, they also increasingly told survey researchers that the criminal justice system was too harsh.

In the late 1980s, the “war on drugs” and sentencing reform laws put a large number of young men, often black and Latino, behind bars for lengthy periods of time. As Americans started to feel the full social and economic effects of tough-on-crime initiatives, they reconsidered the problems with criminalizing marijuana.

Because support for the legalization of marijuana and concerns about the harshness of the criminal justice system changed at about the same time, it’s difficult to know what came first. Did concern about the harshness of the criminal justice system affect support for legalization – or vice versa?

By contrast, the cause and effect is clearer with respect to the media framing of marijuana. The news media’s portrayal of marijuana began to change shortly before the public did, suggesting that the media influenced support for the legalization of marijuana.

Prior related post:

"How and why have attitudes about cannabis legalization changed so much?"

February 7, 2019 in Campaigns, elections and public officials concerning reforms, History of Marijuana Laws in the United States, Medical Marijuana Commentary and Debate, Recreational Marijuana Commentary and Debate, Who decides | Permalink | Comments (3)

Tuesday, February 5, 2019

"Qualifying Conditions Of Medical Cannabis License Holders In The United States"

The title of this post is the title of this notable new article appearing the jounral Health Affairs and authored by Kevin Boehnke, Saurav Gangopadhyay, Daniel Clauw, and Rebecca Haffajee. Here is its abstract:

The evidence for cannabis’s treatment efficacy across different conditions varies widely, and comprehensive data on the conditions for which people use cannabis are lacking.  We analyzed state registry data to provide nationwide estimates characterizing the qualifying conditions for which patients are licensed to use cannabis medically.  We also compared the prevalence of medical cannabis qualifying conditions to recent evidence from the National Academies of Sciences, Engineering, and Medicine report on cannabis’s efficacy in treating each condition.  Twenty states and the District of Columbia had available registry data on patient numbers, and fifteen states had data on patient-reported qualifying conditions.

Chronic pain is currently and historically the most common qualifying condition reported by medical cannabis patients (64.9 percent in 2016).  Of all patient-reported qualifying conditions, 85.5 percent had either substantial or conclusive evidence of therapeutic efficacy.  As medical cannabis use continues to increase, creating a nationwide patient registry would facilitate better understanding of trends in use and of its potential effectiveness.

February 5, 2019 in History of Marijuana Laws in the United States, Medical Marijuana Commentary and Debate, Medical Marijuana Data and Research | Permalink | Comments (0)

Monday, February 4, 2019

A month's worth of interesting headlines and stories ... from just last week

"Should Physicians Recommend Replacing Opioids With Cannabis?"

Download (3)The title of this post is the title of this short new "Viewpoint" piece authored by Keith Humphreys and Richard Saitz and published in the Journal of the American Medical Association.  I recommend the full piece, and here are excerpts:

Recent state regulations (eg, in New York, Illinois) allow medical cannabis as a substitute for opioids for chronic pain and for addiction.  Yet the evidence regarding safety, efficacy, and comparative effectiveness is at best equivocal for the former recommendation and strongly suggests the latter — substituting cannabis for opioid addiction treatments is potentially harmful.  Neither recommendation meets the standards of rigor desirable for medical treatment decisions.

Recent systematic reviews identified low-strength evidence that plant-based cannabis preparations alleviate neuropathic pain and insufficient evidence for other types of pain.  Studies tend to be of low methodological quality, involve small samples and short-follow-up periods, and do not address the most common causes of pain (eg, back pain).  This description of evidence for efficacy of cannabis for chronic pain is similar to how efficacy studies of opioids for chronic pain have been described (except that the volume of evidence is greater for opioids with 96 trials identified in a recent systematic review).

The evidence that cannabis is an efficacious treatment for opioid use disorder is even weaker.  To date, no prospective evidence, either from clinical trials or observational studies, has demonstrated any benefit of treating patients who have opioid addiction with cannabis.

Substituting cannabis for opioids is not the same as initiating opioid therapy.  There are no randomized clinical trials of substituting cannabis for opioids in patients taking or misusing opioids for treatment of pain, or in patients with opioid addiction treated with methadone or buprenorphine.  In addition to surveys of patients who use medical cannabis, the other types of studies prompting a move to cannabis to replace opioids are population-level reports stating that laws allowing medical cannabis use are followed by fewer opioid overdose deaths than expected.  The methodological concern with such studies is that correlation is not causation.  Many factors other than cannabis use may affect opioid overdose deaths, such as prescribing guidelines, opioid rescheduling, Good Samaritan laws, incarceration practices, and availability of evidence-based opioid use disorder treatment and naloxone....

For opioid use disorder, there is concern that the New York State Health Commissioner has defined opioid addiction to include people being treated with US Food and Drug Administration – approved, efficacious, opioid agonist medications, as a qualifying condition for medical cannabis.  Methadone and buprenorphine treatment reduces illicit opioid use, blood-borne disease transmission, criminal activity, adverse birth outcomes, and mortality.  Discontinuing such medications increases the risk of return to illicit opioid use, overdose, and death.  The suggestion that patients should self-substitute a drug (ie, cannabis) that has not been subjected to a single clinical trial for opioid addiction is irresponsible and should be reconsidered....

Cannabis and cannabis-derived medications merit further research, and such scientific work will likely yield useful results.  This does not mean that medical cannabis recommendations should be made without the evidence base demanded for other treatments. Evidence-based therapies are available.  For chronic pain, there are numerous alternatives to opioids aside from cannabis.  Nonopioid medications appear to have similar efficacy, and behavioral, voluntary, slow-tapering interventions can improve function and well-being while reducing pain.

For the opioid addiction crisis, clearly efficacious medications such as methadone and buprenorphine are underprescribed.  Without convincing evidence of efficacy of cannabis for this indication, it would be irresponsible for medicine to exacerbate this problem by encouraging patients with opioid addiction to stop taking these medications and to rely instead on unproven cannabis treatment.

February 4, 2019 in Medical community perspectives, Medical Marijuana Commentary and Debate, Medical Marijuana State Laws and Reforms, Who decides | Permalink | Comments (0)

Tuesday, January 29, 2019

"Impact of Medical Marijuana Legalization on Opioid Use, Chronic Opioid Use, and High-risk Opioid Use"

1The title of this post is the title of this notable new article recently published in the Journal of General Internal Medicine and authored by Anuj Shah, Corey Hayes, Mrinmayee Lakkad, and Bradley Martin.  Here is the abstract:

Objective

To determine the association of medical marijuana legalization with prescription opioid utilization.

Methods

A 10% sample of a nationally representative database of commercially insured population was used to gather information on opioid use, chronic opioid use, and high-risk opioid use for the years 2006–2014.  Adults with pharmacy and medical benefits for the entire calendar year were included in the population for that year.  Multilevel logistic regression analysis, controlling for patient, person-year, and state-level factors, were used to determine the impact of medical marijuana legalization on the three opioid use measures.  Sub-group analysis among cancer-free adults and cancer-free adults with at least one chronic non-cancer pain condition in the particular year were conducted.  Alternate regression models were used to test the robustness of our results including a fixed effects model, an alternate definition for start date for medical marijuana legalization, a person-level analysis, and a falsification test.

Results

The final sample included a total of 4,840,562 persons translating into 15,705,562 person years.  Medical marijuana legalization was found to be associated with a lower odds of any opioid use: OR = 0.95 (0.94–0.96), chronic opioid use: OR = 0.93 (0.91–0.95), and high-risk opioid use: OR = 0.96 (0.94–0.98).  The findings were similar in both the sub-group analyses and all the sensitivity analyses.  The falsification tests showed no association between medical marijuana legalization and prescriptions for antihyperlipidemics (OR = 1.00; CI 0.99–1.01) or antihypertensives (OR = 1.00; CI 0.99–1.01).

Conclusions

In states where marijuana is available through medical channels, a modestly lower rate of opioid and high-risk opioid prescribing was observed.  Policy makers could consider medical marijuana legalization as a tool that may modestly reduce chronic and high-risk opioid use.  However, further research assessing risk versus benefits of medical marijuana legalization and head to head comparisons of marijuana versus opioids for pain management is required.

January 29, 2019 in Medical Marijuana Commentary and Debate, Medical Marijuana Data and Research | Permalink | Comments (0)

AG-nominee Bill Barr reiterates (with nuance) commitment to non-enforcement of federal marijuana prohibition in reform states

AG-Candidate-William-Barr-Just-Stated-His-Position-on-Marijuana__FocusFillWzExNzAsNjU4LCJ5Iiw2MV0Tom Angell has this effective Forbes report, headlined "Trump Attorney General Pick Puts Marijuana Enforcement Pledge In Writing," spotlighting that the next US Attorney General has made clear his inherent commitment to respecting state-level marijuana reforms. Here are the details:

William Barr, President Trump's nominee to serve as the next U.S. attorney general, made headlines earlier this month when he pledged during his Senate confirmation hearing not to "go after" marijuana companies that comply with state laws.

Now, in response to written questions from senators, Barr is putting that pledge on paper, in black and white. He's also calling for the approval of more legal growers of marijuana for research, and is acknowledging that a recent bill legalizing hemp has broad implications for sale of cannabis products.

"As discussed at my hearing, I do not intend to go after parties who have complied with state law in reliance on the Cole Memorandum," he wrote, referring to Obama-era cannabis enforcement guidance that then-Attorney General Jeff Sessions rescinded last year.

That said, Barr isn't committing to formally replacing the Cole Memo, which generally directed federal prosecutors not to interfere with state marijuana laws, with new guidance reiterating the approach. "I have not closely considered or determined whether further administrative guidance would be appropriate following the Cole Memorandum and the January 2018 memorandum from Attorney General Sessions, or what such guidance might look like," he wrote in response to a question from Sen. Cory Booker (D-NJ). "If confirmed, I will give the matter careful consideration."

And Barr, who previously served as attorney general under President George H. W. Bush, says it would be even better if Congress got around to addressing the growing gap between state and federal marijuana laws. "I still believe that the legislative process, rather than administrative guidance, is ultimately the right way to resolve whether and how to legalize marijuana," he wrote in a compilation of responses delivered to the Senate Judiciary Committee on Sunday.

But even as Barr reiterated that he wouldn't go after people and businesses that benefited from the Cole memo, he voiced criticism of policy directives like it and of the idea of legalization in general. "An approach based solely on executive discretion fails to provide the certainty and predictability that regulated parties deserve and threatens to undermine the rule of law," Barr wrote in response to a question from Sen. Dianne Feinstein (D-CA). "If confirmed, I can commit to working with the Committee and the rest of Congress on these issues, including any specific legislative proposals. As I have said, however, I do not support the wholesale legalization of marijuana."

Nonetheless, legalization advocates were happy to see the nominee reiterating his non-enforcement pledge when it comes to state-legal businesses. "It’s positive to see Barr make the same commitments on marijuana enforcement in writing as he did in the hearings," Michael Collins, director of national affairs for the Drug Policy Alliance, said. "My hope is that he sends this message to all federal prosecutors so that states are given space to reform their outdated, broken, racist marijuana laws, and the country can turn the page on prohibition."

January 29, 2019 in Campaigns, elections and public officials concerning reforms, Criminal justice developments and reforms, History of Marijuana Laws in the United States, Medical Marijuana Commentary and Debate, Recreational Marijuana Commentary and Debate, Who decides | Permalink | Comments (0)

Saturday, January 26, 2019

Reviewing the now "mainstream" and "trendy" (and still uncertain) new world of CBD products

Download (3)NBC News has this new article, headlined "CBD goes mainstream as bars and coffee shops add weed-related drinks to menus," that is worth a read, and I especially liked its closing paragraph. Here are excerpts:

Coffee. Cocktails. Lotion. Dog treats. You name it, CBD is probably in it.

CBD, short for cannabidiol, is a compound found in the cannabis plant.  It promises to deliver the calming benefits of marijuana without the high that comes from THC.  Companies are adding CBD to just about everything — a trend set to accelerate as regulations ease and consumer interest grows.

Most CBD is now federally legal thanks to the farm bill President Donald Trump signed in December. Companies still aren't supposed to add CBD to food, drinks and dietary supplements, but many are doing it anyway.  The Food and Drug Administration has said it plans to continue enforcing this ban but will also look into creating a pathway for such products to legally enter the market.

Some users swear by it, saying it relieves their anxiety, helps them sleep and eases their pain.  And forget stoner stereotypes when thinking about CBD. Moms and even pets are experimenting with it.  One research firm, Brightfield Group, expects the CBD market to reach $22 billion by 2022.

However, most of our current understanding of CBD is anecdotal — not proven through scientific studies.  And because CBD products aren't yet regulated, the quality can vary widely. "There's a lot of interest and excitement, for good reason, but I think people are pushing it too hard, too fast and are overgeneralizing things," said Ryan Vandrey, a professor at Johns Hopkins who studies the behavioral pharmacology of cannabis.

We don't know what exactly CBD interacts with in the brain or the body, but researchers do know that CBD tends to turn down abnormal signaling in the brain, said Ken Mackie, a psychological and brain sciences professor at Indiana University.  That's why CBD may help with epilepsy, anxiety and sleep. CBD and other cannabis compounds tweak systems in the body, a process he compares to lowering the volume. Other compounds, like opioids, ketamine and nicotine, simply turn them on and off.

There isn't much clinical research on the safety and efficacy of CBD. Studying cannabis has been challenging because it's technically illegal under federal law, meaning researchers must overcome a number of hurdles in order to study it.  We don't know anything about indications like sleep, anxiety or pain, Vandrey said.

We do know it's safe and effective in treating seizures in children with Lennox-Gastaut syndrome or Dravet syndrome. GW Pharma studied its CBD-derived drug, Epidiolex, in numerous clinical trials.  After reviewing the company's science, the Food and Drug Administration approved Epidiolex in June.

The lack of clinical evidence hasn't stopped consumers from trying it — and raving about it.  "It's always nice to have strong proof in placebo controlled trials, but if someone's taking a drug and feeling any benefit, more power to them," Mackie said....

The farm bill signed in December legalized hemp. Most CBD hitting shelves is derived from the hemp plant, which contains less than 0.3 percent THC, the psychoactive chemical in weed. Hemp's close cousin, marijuana, can contain upwards of 10 percent THC. So you can't get high from CBD products if the proper dosage is followed, but the industry isn't regulated on a federal level so the amount of THC can vary.

Doses can vary, too. Some shops recommend six milligrams of CBD when taken as a tincture or added to food. Others recommend at least 30. Again, since there isn't much clinical research on CBD, most of the recommendations are based on trial and error.

As more people dabble with CBD, more people are following the money, worrying some that bad products will enter the market and taint CBD's allure. Or worse, harm consumers. "There does need to be some sort of regulatory framework for overall product safety and to protect the customer from purchasing products that contain false advertisements or make unsubstantiated claims," said Pamela Hadfield, co-founder of HelloMD, a medical cannabis company, while cautioning against strict regulations that would be "too difficult for most manufacturers to comply."

Joe Masse, beverage director at The Woodstock bar, added a CBD cocktail to the menu in September. Called The White Rabbit, the drink is made with Bombay Dry Gin, sage simple syrup, honey, fresh lemon juice and 1 milligram of CBD oil.... "It's trendy right now, so I don't know how it will be in six months when we redo the menu," Masse said. "A year ago, activated charcoal was popular and now you can't find it anywhere."

Because I am not hip enough to know that "sctivated charcoal" was once, and now is no longer, a big deal, I am not the right person to be predicting the trend lines on the CBD trend.  But I do know how important and likely unpredictable it will be to see the FDA and/or state regulatory players take on CBD products and marketing in the wake of the new Farm Bill.  Just another important front to watch in the coming months and years and marijuana products and industry players continue to emerge from prohibition's shadow.

January 26, 2019 in Business laws and regulatory issues, Federal Marijuana Laws, Policies and Practices, Food and Drink, History of Marijuana Laws in the United States, Medical Marijuana Commentary and Debate, Medical Marijuana Data and Research, Medical Marijuana State Laws and Reforms | Permalink | Comments (0)

Wednesday, January 23, 2019

Reserve a seat at the Ohio State Cannabiz Roundtable on January 31

Qualtrics-header-800x292I am so very pleased to be able to be a part of an exciting panel discussion taking place next week, the "Ohio State Cannabiz Roundtable."  The event is described at this website, where one can and should register ASAP.  Here is the event description and expected participants:

With cannabis being illegal at the federal level but many states moving to legalize it for both medical and recreational purposes, how does one navigate this new emerging market properly? The birth of this new multi-billion industry is being accompanied by a lot of unusual challenges, risks, and opportunities. Please join us for a discussion of the various aspects of this market – dealing with regulations and legal questions, raising funds, working through a financial system that is disinclined to serve them, and running a new business in an unchartered territory. After our panel discussion, students and attendees will have a chance to speak to each panelist in a small group setting to ask questions and network. This is a unique opportunity to better understand the rapidly rising market of cannabis, don’t miss out!

Hosts: Center for Innovation Strategies and Drug Enforcement and Policy Center

January 31, 2019 at 9am -- 2nd Floor Rotunda, Mason Hall

Panelists

 

January 23, 2019 in Business laws and regulatory issues, Medical Marijuana Commentary and Debate, Recreational Marijuana Commentary and Debate | Permalink | Comments (0)

Tuesday, January 22, 2019

Still more commentary pushing back on efforts to link marijuana, psychosis and violence

In  prior posts, I have noted here and here commentaries by the author of the new book by Alex Berenson, "Tell Your Children: The Truth About Marijuana, Mental Illness, and Violence," as well as the lengthy Malcolm Gladwell New Yorker essay about the book.   And in this post, I rounded up some of the major commentaries expressing concerns about Berenson's claims that more marijuana use is leading to more mental illness and more violence.  In addition to collecting all these posts via links below, I also wanted to spotlight a few more notable commentaries in this space:

Prior related posts:

January 22, 2019 in Criminal justice developments and reforms, Medical Marijuana Commentary and Debate, Recreational Marijuana Commentary and Debate | Permalink | Comments (1)