Marijuana Law, Policy & Reform

Editor: Douglas A. Berman
Moritz College of Law

Wednesday, April 8, 2020

"Charlotte Figi, 13-year-old Coloradan whose CBD journey inspired medical marijuana reform, dies of COVID-19"

This is really sad

Charlotte Figi, the young Colorado Springs girl whose battle with Dravet syndrome inspired changes to medical marijuana laws, has died of complications from the coronavirus, according to a nonprofit organization co-founded by her mother. She was 13 years old.

Realm of Caring, the nonprofit that focuses on medical cannabis research and education, attributed Figi’s death to “COVID-19 complications” in a Facebook post. A message posted to the Facebook page of Charlotte’s mother, Paige Figi, on behalf of the Figi family says, “Charlotte is no longer suffering. She is seizure-free forever.”

Neither El Paso County nor state health officials have publicly announced the death of a 13-year-old Coloradan due to COVID-19; Charlotte would be the youngest person to date to die in Colorado in connection with the coronavirus.

Charlotte was one of Colorado’s many medical marijuana refugees, whose family moved to the state following the legalization of cannabis. From the time she was an infant, she suffered from frequent and severe seizures because of Dravet syndrome, including many that required hospitalization. But at age 5, Paige Figi gave her cannabidiol, the non-psychoactive compound in cannabis known more commonly as CBD, and Charlotte’s condition changed overnight.

 

April 8, 2020 in History of Marijuana Laws in the United States, Medical Marijuana Commentary and Debate | Permalink | Comments (0)

Friday, March 27, 2020

"Cannabis finds its moment amid coronavirus outbreak"

CoronavirusandcannabisgraphicThe title of this post is the title of this notable new Politico piece.  Here are excerpts:

Cannabis is turning out to be the one thing the coronavirus can’t destroy.

Marijuana sales are booming, with some states seeing 20 percent spikes in sales as anxious Americans prepare to be hunkered down in their homes potentially for months. Weed sellers are staffing up too, hiring laid-off workers from other industries to meet demand. And in the midst of a historic market meltdown, stock prices for cannabis companies have surged, in some cases doubling since the public health crisis began.

“We are hiring because we are having to shift our business a bit,” said Kim Rivers, CEO of Trulieve, which is valued at $1 billion. The company is staffing up its delivery fleet, retail workers, and people to handle increased inventory shipments. “Now is a great time [to apply], particularly if you’re in a business that has seen layoffs.”

Nearly all of the 33 states with legal medical or recreational markets have classified marijuana businesses as an essential service, allowing them to remain open even as vast swaths of the retail economy are shuttered. San Francisco and Denver initially announced plans to shut down dispensaries, but immediately backpedaled after a public furor.

Weed shops are essentially being treated the same as pharmacies, reflecting a dramatic shift in cultural perceptions about the drug over the last decade. “It is a recognition that it has taken on much greater significance around the country,” said Rep. Earl Blumenauer (D-Ore.), a longtime Capitol Hill champion for cannabis. “This is something that makes a huge difference to the lives of hundreds of thousands of people every day. I do think that this might be part of a turning point.“

Concerns about whether smoking pot is the smartest response to a pandemic that’s causing severe lung injuries in tens of thousands of Americans have been largely drowned out. "Public opinion has pushed lawmakers to think about cannabis — and particularly medical cannabis — in different ways than they used to," said John Hudak, a cannabis policy expert at the Brookings Institution, and author of Marijuana: A Short History. "A lot of state policymakers are trying to get this right and they obviously see the risk of shutting down a dispensary to be higher than the rewards of shutting down a dispensary."...

The burgeoning industry does face some stiff financial headwinds: The massive stimulus package moving through Congress this week to help beleaguered businesses shuts out cannabis companies from taking advantage of its benefits, reflecting the continued federal illegality of marijuana. Prior to the recent boom in sales, the industry had been in financial turmoil, with many companies laying off workers and scuttling acquisitions as they ran short on cash. “I'm frustrated Senate Republicans refused to allow us to include them in this legislation, but we aren't giving up," Sen. Patty Murray (D-Wash.) said Wednesday.

In addition, some medical experts question the wisdom of allowing uninhibited access to marijuana during a massive public health crisis. They worry that customers flocking to pot shops could spread the virus, that stoned customers will engage in risky behavior and that smoking pot will worsen the lung damage for people who do become infected. “If you keep the pot stores open, you're just adding fuel to the fire,” said Karen Randall, an emergency room doctor in Colorado. “You're having a whole bunch of people who are trashing their lungs.”...

The federal government said Thursday that a staggering 3.3 million people applied for unemployment benefits last week. While the cannabis industry can’t do much to remedy that bloodletting, some companies are looking to hire people who have recently lost their jobs. Harborside — which operates three shops in the Bay Area — found itself suddenly understaffed as delivery requests increased by 45 percent and phone calls exploded from around 100 to 8,000 per day.... Harborside has hired 10 employees in the last few weeks — some of whom were directly laid off as a result of the coronavirus — and plans to hire at least six more. The largest increase was in their delivery fleet, going from four drivers to 10.

And they’re not alone. “Two and a half weeks ago, our sales just exploded,” said Zachary Pitts, CEO of California cannabis delivery service Ganja Goddess. “People are leaning on delivery more now … even though storefronts are still open in California.” Pitts estimated that he’s increased his workforce by about 15 percent in recent weeks, and is working on hiring more. The company has suspended normal vetting processes and is instead relying on trusted referrals....

As states move to declare marijuana an essential business, the gulf between state and federal policy has never been wider. Congress is poised to enact a $2 trillion stimulus package this week, but the cannabis industry will not see a cent. “In the same way that cocaine dealers in the United States who are suffering under Covid-19 are not going to be eligible for relief under the stimulus bill, cannabis companies won't either,” said Hudak of the Brookings Institution. “Illegal businesses do not access legal funding.”

The cannabis industry generated $15 billion in sales last year and employs 340,000 people. Employers and workers pay federal taxes, and are required to comply with other coronavirus-related measures such as paid sick leave coverage. But for cannabis companies to access assistance made available through the stimulus package, Congress or the administration would need to dictate their inclusion. A spokesperson for Sen. Jeff Merkley (D-Ore.) said he wants to include such a provision in a future coronavirus aid package. Similarly, Murray said she is “exploring what can be done in the upcoming appropriations process to help them through this crisis and beyond."

March 27, 2020 in Business laws and regulatory issues, Campaigns, elections and public officials concerning reforms, Federal Marijuana Laws, Policies and Practices, Medical Marijuana Commentary and Debate, Political perspective on reforms, Recreational Marijuana Commentary and Debate | Permalink | Comments (0)

Wednesday, March 25, 2020

Advocacy groups urge governors to ensure "medical cannabis patients do not experience disrupted access to crucial medicine" during COVID crisis

I just saw that, earlier this week, an array of advocacy groups sent this short letter to the National Governors Association headed "Emergency Call To Action To Governors In States With Medical Cannabis Programs." Here is the heart of the letter (which also attaches a similar letter from last week from Americans for Safe Access):

In the midst of the COVID-19 pandemic, the undersigned national drug policy, HIV/AIDS, and public health organizations write to all U.S. governors and medical cannabis program directors to amplify a letter sent last week by the nation’s leading medical cannabis and patient advocacy group, Americans for Safe Access (ASA).  We are joining their call for necessary, immediate actions and safeguards to ensure that medical cannabis patients do not experience disrupted access to crucial medicine.

Thirty-three states and the District of Columbia have medical cannabis laws enacted and, cumulatively, these states serve over three million patients.  Medical cannabis patients often live with debilitating ailments, such as cancer, HIV/AIDS, and chronic pain that significantly affect quality of life.  It is critical that policymakers and other decision makers who are working to address the current COVID-19 pandemic are also considering the public health consequences that will follow the decision to abruptly interrupt the legal supply chain for medical cannabis patients.  We are especially worried about vulnerable patients being unintentionally pushed to the unregulated market, where there will not be access to lab-tested, tightly controlled products.  This could endanger the health of those who rely on cannabis as medicine.

The undersigned organizations -- who support research and access to medical cannabis -- join ASA in calls for the recognition of medical cannabis as necessary medicine and for the recommendations below to be implemented to ensure that patients’ access to medicinal cannabis will continue.

March 25, 2020 in Campaigns, elections and public officials concerning reforms, Medical Marijuana Commentary and Debate, Who decides | Permalink | Comments (0)

Tuesday, March 24, 2020

Just some of the latest headlines highlighting how COVID-19 is changing the marijuana reform world

I suspect regular readers have an inkling for why I have not blogged in this space for a few weeks.  For this blogger, the new coronavirus world has meant a lot more time spent rescuing kids from shuttered colleges, gearing up for online classes, and lots of blogging at Sentencing Law & Policy about the impact of the virus on our criminal justice systems.  Because a lot of organizations and journalists spend a lot of time covering marijuana news, I have not tried to keep up here with all the ways in which the COVID-19 is changing the marijuana reform world.

That all said, I think it useful to keep up with news in this space, if only to document how this historical moment is being captured in news stories and headlines.  So, as social distancing turns into lockdowns and as stimulus package proposals get closer to becoming law, here is a sampling:

From Boston.com, "Charlie Baker order lets medical marijuana shop stay open, but shuts down recreational sales"

From Business Insider, "Cannabis site Leafly just laid off nearly 40% of its workforce as coronavirus upends the marijuana industry"

From CNN Business, "Cannabis advocates to governors: Our businesses are 'essential'"

From Forbes, "Coronavirus Crisis Shows Marijuana Is ‘Essential’ And Mainstream"

From MLive, "Michigan is smoking more marijuana than any other state during coronavirus pandemic, survey says"

From Marijuana Business Daily, "Coronavirus outbreak could delay marijuana legalization along East Coast, other states"

From Marijuana Business Daily, "Adult-use cannabis sales plunge after briefly hitting new heights on coronavirus concerns"

From Marijuana Moment, "Marijuana Industry Pleads For Access To Federal Coronavirus Business Relief"

From Marijuana Moment, "Nebraska Medical Marijuana Campaign Suspended Due To Coronavirus"

From Westworld, "Ask a Stoner: Quarantining Proves We Should Grow Our Own"

UPDATEThese topics made the New York Times this afternoon: "Is Marijuana an ‘Essential’ Like Milk or Bread? Some States Say Yes"

March 24, 2020 in Business laws and regulatory issues, History of Marijuana Laws in the United States, Medical Marijuana Commentary and Debate, Recreational Marijuana Commentary and Debate, Who decides | Permalink | Comments (0)

Wednesday, March 4, 2020

Noting how blanket federal prohibition serves to thwart continued progress of medical marijuana reforms

This new Roll Call article, headlined "States turn to unenforced federal law to slow medical marijuana legalization," effectively reviews how federal prohibition still serves to impact medical marijuana reforms efforts in a number of states.  I recommend the lengthy article in full, and here are excerpts:

Since 2014, Congress has protected patients and cannabis programs from federal marijuana prosecutions in states that allow it for medical use. Medical marijuana’s unique legal status involves a little-known provision called the Rohrabacher-Farr amendment that Congress renews every year in spending laws. It says the Justice Department cannot use federal funds to prevent states from implementing their own medical marijuana laws.

Yet marijuana’s continued status as a Schedule I substance — the most severe drug category — remains fodder for those opposed to legalizing medical marijuana in other parts of the country.... In states considering the issue this year, including Alabama and Tennessee, opponents continue to cite the drug’s Schedule I status.

In Tennessee, House Speaker Cameron Sexton, a Republican, said in January that he won’t take up medical marijuana because “it’s against federal law.” A commission created by the Alabama Legislature to advise lawmakers on cannabis policy last year recommended that the state adopt a medical marijuana plan this session, and it published draft legislation to do so. But opponents on the commission said the top reason for their objections was “the fact that marijuana remains a Class I Controlled Substance under state and federal law.”

Alabama Attorney General Steve Marshall inflamed debate further in January when he wrote a letter in opposition to legislators. “State laws that allow any use of marijuana, medical or recreational, are in direct conflict with duly enacted and clearly constitutional law,” Marshall wrote. “Thus, state marijuana statutes enacted in violation of the law are damaging to the law itself.”...

Such arguments underscore why Congress is considering a number of bills to deschedule marijuana entirely or reschedule it in order to better study it. They face long odds in the Senate, which has yet to move on a House-passed bill that is limited to offering protections for banks that do business with marijuana companies.

But advocates for legalization say federal prohibition is a red herring, and that states shouldn’t have to comply with a federal drug law the Drug Enforcement Administration is barred from enforcing. “States are authorizing conduct that is prohibited under federal law, so at first blush, I can see how this could be confusing and surprising, but at this point, two-thirds of the country have implemented comprehensive medical marijuanalaws,” says Karen O’Keefe, state policy director for the Marijuana Policy Project, a pro-legalization advocacy group that lobbied for the Rohrabacher-Farr amendment. The rider halted most raids involving medical marijuana in states with legalization.

The patients and providers who cultivate, process and dispense the cannabis these patients rely on in these states for the treatment of debilitating illness do not have to fear federal charges as long as they are in compliance with state law, says Sean Khalepari, regulatory affairs coordinator for the pro-medical marijuana group Americans for Safe Access.

But the unusual nature of the provision is not well understood, some say.... Although the amendment serves as a shield against federal prosecution, “I think it can be misunderstood that this rider does not in and of itself legalize medicinal marijuana at the federal level,” says Jeffrey Vanderslice, who worked as an aide to Rohrabacher in 2014. Since the Justice Department technically retains the ability to prosecute medical marijuana — even in states that have legalized it, if a business or individual doesn’t comply with state law — advocates are hoping for more certainty on the federal level eventually.

Meanwhile, the Trump administration’s interpretations and actions have contributed to the confusion. In 2018, the administration rescinded guidance by the Obama administration known as the Cole memorandum, which directed Justice to deprioritize prosecuting state-legal marijuana businesses. Trump’s reversal stoked worry and confusion among supporters of legalization.

The office of the attorney general has since turned over from Jeff Sessions, a severe critic of marijuana, to William Barr. Barr said during a Senate hearing in 2019 that he operates under the Cole memo, but leaves significant discretion to U.S. attorneys in each state. Meanwhile, the White House has sought the repeal of Rohrabacher-Farr in each of its budgets, including in Trump’s fiscal 2021 budget proposal. Congress has always bucked that recommendation.

March 4, 2020 in Federal Marijuana Laws, Policies and Practices, Medical Marijuana Commentary and Debate, Medical Marijuana State Laws and Reforms, Who decides | Permalink | Comments (0)

Thursday, February 13, 2020

Spitballing metrics that might be important when evaluating medical marijuana programs

As noted in prior posts here and here, this week I have asked students in my marijuana reform seminar to reflect on how policymakers should assess the efficacy of medical marijuana programs.  Potentially important to this inquiry is figuring out just what basic metrics should matter — metrics related both to  the operation of medical marijuana programs and to the program's potential impact on individual and community well-being. 

Reflecting on these questions always lead me back to a range of challenging (and useful) policy questions about what fundamental values are of greatest importance as we consider and operationalize any form of marijuana reform.  Of course, there are always going to be plenty of basic medical research questions (and uncertainty) about whether and for whom marijuana might provide health benefits (after all, this article suggests medical science cannot conclusively answer whether adults should be drinking milk).  But beyond (or intertwined with) uncertainty about the medical use of marijuana, how should policy makers approach these (or many other) potentially important metrics:

-- Is the raw number of patients in medical marijuana programs, or the number of a particular type of patients, fundamental to judging the success of medical marijuana programs?

-- Should self-reports or health-care worker reports of patient satisfaction or the cost of this form of health care relative to others be central to assessing efficacy?

-- Should reductions (or increases) in opioid overdoses or other salient community health problems be a central consideration? 

-- How about potential health care cost savings (or cost increases) for the state?

-- How about other possible public health and safety concerns ranging from increased marijuana use by teens, or more reports of substance use disorders, or more accidents involving impaired drivers or even increased crimes around dispensaries?

-- How about tax revenues or number of jobs created as an important metric for medical marijuana programs (since we see this often discussed for recreational programs)?

-- How should social equity and social justice concerns impact these issues: e.g., should we worry if only privileged people have access to and profit from medical marijuana and/or if arrest rates for low-level marijuana possession go up after a state implements a medical marijuana program?

I am sure I am leaving out lots of other important issues in this spitballing of metrics that might be important when evaluating medical marijuana programs. I eagerly welcome feedback and suggestions on this front from all readers.

A few recent related posts:

February 13, 2020 in Medical Marijuana Commentary and Debate, Medical Marijuana Data and Research, Medical Marijuana State Laws and Reforms, Who decides | Permalink | Comments (0)

Wednesday, February 12, 2020

Does official public data about Ohio's Medical Marijuana Control Program show its efficacy? Its ineffectiveness?

In a post from few days ago, I asked "How should policymakers assess the efficacy of medical marijuana programs? What are key metrics?".   I have asked students in my marijuana reform seminar to reflect on these questions, and I am wondering if official data on Ohio's "Medical Marijuana Control Program" can help answer these question in the Buckeye State. 

Specifically, here is link to a graphic that compares some data on Ohio's medical marijuana program from January 2019 and January 2020.  Because the 2019 data is from the "first day of sales," we see great growth in listed number over the course of a year (e.g., registered patients grew from 12,721 to 73,967).  Is this a mark of success for a program that became law in mid 2016?  Or does this show how slowly (or poorly) the program got launched?

Or consider this page of cumulative data as of Feb 7, 2020 

Dispensaries
  • 57 Provisional licenses
    • 49 Provisional licensees have received a Certificate of Operation
Patients & Caregivers (as of 12/31/2019)
  • 83,857 Recommendations
  • 78,376 Registered patients
    • 5,617 Patients with Veteran Status
    • 4,398 Patients with Indigent Status
    • 449 Patients with a Terminal Diagnosis
  • 55,617 Unique patients who purchased medical marijuana (as reported to OARRS by licensed dispensaries)
  • 8,259 Registered Caregivers
Physicians
  • 590 Certificates to Recommend
Sales Figures (as of 2/3/2020)
  • 8,174 lbs. of plant material
  • 393,726 units of manufactured product
  • 68.1 million in product sales
  • 534,913 total receipts
  • Historical Sales Data

Are any of these numbers especially important in judging the success of Ohio's medical marijuana program? What other metrics would be important to judging the success of Ohio's medical marijuana program?

February 12, 2020 in Medical Marijuana Commentary and Debate, Medical Marijuana Data and Research, Medical Marijuana State Laws and Reforms | Permalink | Comments (0)

Sunday, February 9, 2020

How should policymakers assess the efficacy of medical marijuana programs? What are key metrics?

The question in the title of this post are questions I have asked students in my marijuana reform seminar to be considering this week.  I am not sure I have good answers to these questions, so I am hoping my students can help answer them.

Notably, the group Americans for Safe Access (ASA) produces an annual report that gives letter grades to all states based on various criteria relating to medical marijuana programs.  (The 2019 version of  this lengthy and informative report  is summarized in this ASA blog post.)  But ASA is a medical marijuana advocacy group that grades states based primarily on how accessible marijuana is to individuals who want access -- i.e., ASA is focused on whether programs "ensure that all patients have access to the medicine they need" -- and it is not a given that all policymakers would be keen to adopt the ASA's grading criteria. (Tellingly, in these ASA reports, states with recreational marijuana programs consistently get the highest grades).

The Drug Enforcement & Policy Center last Fall released this survey report that "revealed immense dissatisfaction with the Ohio medical marijuana system" among likely medical marijuana consumers.  But again, the views of likely consumers may not be the best metric for assessing the efficacy of a medical marijuana program.  In some coming posts, I will focus on some existing data related to Ohio's and (some other states') medical marijuana program to further explore just what metrics ought to be key to assessing the virtues (and vices?) of these programs.

February 9, 2020 in Medical Marijuana Commentary and Debate, Medical Marijuana Data and Research, Medical Marijuana State Laws and Reforms | Permalink | Comments (0)

Monday, January 20, 2020

Highlighting another troublesome spot at the intersection of marijuana reform and criminal justice systems

Regular readers know that, because of my work in the criminal justice arena, I often come to marijuana reform stories with an extra focus on how marijuana law and policy impact criminal justice system.  Though I am particularly interested in topics covered in my Federal Sentencing Reporter article, "Leveraging Marijuana Reform to Enhance Expungement Practices," regarding how marijuana reform efforts may be impacting criminal record expungement efforts, there are so many other interesting (and troublesome) spots where marijuana reform intersects with criminal law and practice.

This recent Marshall Project piece looks at one of these spots in a piece headlined "People on Probation and Parole Are Being Denied Perfectly Legal Medical Weed: Despite statewide legalization, some counties ban probationers and parolees from using medical marijuana. So the chronically ill turn to less effective and more addictive prescription drugs."  Here are excerpts:

Following years of research demonstrating that marijuana can be a life-changing treatment for people with cancer, Alzheimer’s, multiple sclerosis, PTSD, eating disorders, nausea and epilepsy, and that it is neither physically addictive nor an evident danger to public safety, the drug has been legalized for medical use in 33 states and for adults over 21 to smoke recreationally in 11.  Yet for most people on probation or parole — even in precisely these same states — drug testing remains the rule, and jail time the potential punishment.

The argument that many parole and probation authorities make for this seeming contradiction is that regardless of whether marijuana has been legalized in their state, it remains illegal at the federal level, and that if you’re under government supervision for committing a crime, you should at the very least have to follow all state and federal laws.  Some parole and probation officials also point out that they drug-test their own officers, so the people they oversee should be held to at least the same standard.

“I don’t know of any paroling authorities who are casual about marijuana — it’s part of their institutional culture, and old habits are hard to break,” said Edward E. Rhine, a former corrections official in multiple states and an expert on parole at the Robina Institute of Criminal Law and Criminal Justice at the University of Minnesota Law School.  “Obviously most people couldn’t conceive of marijuana being allowed inside a prison, even if that prison is in a state where it has been legalized.”

A handful of states where marijuana is now legal, though, have taken action to make it available to people on probation or parole.  Arizona’s supreme court ruled in 2015 that medical marijuana patients cannot be arrested or jailed for taking their medication, even if they are under court supervision.  An Oregon appeals court in 2018 issued a similar decision.  Within Pennsylvania, where there isn’t yet any such ruling statewide, different counties have different policies....  In other states where there haven’t been major court cases, county courts and even individual probation officers are often responsible for deciding whether to drug-test — and possibly jail — those under their control. Some do so only when marijuana or drugs were related to someone’s underlying crime.

The ACLU of Pennsylvania [is] challenging the court rule in Lebanon County that prohibits parolees and probationers who have a prescription for medical marijuana from using it....   The ACLU’s position is that these counties’ rules contradict the letter and intent of Pennsylvania’s 2016 medical marijuana law, which protected medical marijuana patients from any criminal sanction.  The legislation expressly prohibited people in prison from possessing pot, but did not expressly exclude those on parole or probation. The lawyers also point out that people under court supervision can still use opioids with a prescription — which is far more of a public health concern in this day and age, especially in Pennsylvania....

In Colorado, where anyone can smoke a joint freely, a parolee named Mark Paulsen is still being tested for marijuana — even though he is about to die.  In 2009, Paulsen, a former mechanic who is an alcoholic, blacked out while drinking and attacked two acquaintances with a knife (neither was killed).  He was sentenced to prison for a decade, records show.  There, his hepatitis of the liver worsened, becoming end-stage cirrhosis by the time he was released last year.

Paulsen, 64, is now on parole outside Denver.  He is visibly ill, jaundiced and constantly bleeding.  He has peach-sized tumors in his abdomen, which he says make walking around feel like jumping up and down with heavy, jagged rocks in his belly.  And his nausea is so severe that he has at times gone weeks without eating solid food. “The always-there-ness” of the stomach pain, he said, “is what gets you.”

As he waits to die, there have been all the challenges familiar to people on parole.  He got out of prison with no money or health insurance, and has to go to the emergency room instead of to a specialist because he’s in such immediate pain, he says.  There, he has racked up insurmountable medical debt.

The only things that would ease his symptoms are opioids or medical marijuana, but the former is something that doctors have been wary to prescribe, amid a nationwide epidemic.  The latter, Paulsen believes, would seem the solution. (He also has been sober ever since his crime and is not “drug-seeking,” he emphasizes.)  Yet every morning, he has to call his parole office, he says.  If he is randomly selected that day, he must ride the bus an hour and a half, those sharp rocks in his stomach jostling, to take a drug test.  And if he fails one, he could be sent back to prison for whatever time he has left before dying.

A spokeswoman for the Colorado Department of Corrections said that if a parolee has a prescription for medical marijuana, the agency in most instances is willing to “work with” that person to avoid being sanctioned for using it.  She later added, “Our parole team is going to reach out directly to Mr. Paulsen to see what assistance they can provide.”

January 20, 2020 in Criminal justice developments and reforms, Medical Marijuana Commentary and Debate, Medical Marijuana State Laws and Reforms | Permalink | Comments (0)

Thursday, January 16, 2020

"From Reefer Madness to Hemp Utopia: CBD, Hemp and the Evolving Regulation of Commoditized Cannabis"

Jan-24-Cannabis-Roundtable_for-email-600x400The title of this post is the title of this exciting event taking place next week put on by the Drug Enforcement and Policy Center at The Ohio State University.  Here are all the essential details and some background from this page where you can also find a registration link: 

When: Friday, January 24 from 7:30-9:30 a.m.
Where: 2nd Floor Rotunda, Mason Hall, 250 W Woodruff Avenue, Columbus Ohio

Join the Drug Enforcement and Policy Center and the Center for Innovation Strategies for From Reefer Madness to Hemp Utopia: CBD, Hemp and the Evolving Regulation of Commoditized Cannabis.  The latest Cannabiz Roundtable discussion will feature a panel of experts as they discuss the challenges of regulating the unusual agricultural commodity that is hemp and the myriad products infused with one of its derivatives, CBD.

With the passage of the 2018 Farm Bill, the world of the cannabis plant has undergone a seismic shift allowing for its legal cultivation as long as its THC content remains below 0.3%.  A year later, the federal and state governments, including the state of Ohio, are in the process of creating regulations that would allow the agricultural sector to take advantage of this new crop while at the same time addressing numerous concerns about public health and law enforcement.

 

Speakers

Benton Bodamer, DEPC Adjunct Faculty, Dickinson Wright PLLC, Columbus


Donnie Burton, Owner and CEO, The Harvest Foundation


David E. Miran, Jr. Esq., Executive Director, Hemp Program, Ohio Department of Agriculture


Anthony Seegers
, Director of State Policy, Ohio Farm Bureau


Patricia Zettler, DEPC Assistant Professor of Law, Moritz College of Law

 

Moderator: Douglas Berman, Executive Director, DEPC


Schedule

7:30 – 8:00 a.m. | registration
8:00 – 9:00 a.m. | panel
9:00 – 9:30 a.m. | follow up conversation and networking

January 16, 2020 in Business laws and regulatory issues, Federal Marijuana Laws, Policies and Practices, Medical Marijuana Commentary and Debate, Recreational Marijuana Commentary and Debate, Who decides | Permalink | Comments (0)

Monday, January 13, 2020

US House Subcommittee to hold hearing on Jan 15, 2020 on "Cannabis Policies for the New Decade"

Ccc_SQUAREAs detailed on this US House committee webpage, the "Subcommittee on Health of the Committee on Energy and Commerce will hold a legislative hearing on Wednesday, January 15, 2020, at 10 a.m. in the John D. Dingell Room, 2123 of the Rayburn House Office Building. The hearing is entitled, 'Cannabis Policies for the New Decade'."  Interestingly, the hearing page provides a list and links to six House bills with varying approaches to marijuana reform as well as the names and titled of the three government officials now scheduled to testify:

Legislation

H.R. 171, the "Legitimate Use of Medicinal Marihuana Act" or the "LUMMA"

H.R. 601, the "Medical Cannabis Research Act of 2019"

H.R. 1151, the "Veterans Medical Marijuana Safe Harbor Act"

H.R. 2843, the "Marijuana Freedom and Opportunity Act"

H.R. 3797, the "Medical Marijuana Research Act of 2019"

H.R. 3884, the "Marijuana Opportunity Reinvestment and Expungement Act of 2019" or the "MORE Act of 2019"

 

Witnesses

Matthew J. Strait
Senior Policy Advisor, Diversion Control Division
Drug Enforcement Administration

Douglas Throckmorton, M.D.
Deputy Director for Regulatory Programs, Center for Drug Evaluation and Research
Food and Drug Administration

Nora D. Volkow, M.D.
Director, National Institute on Drug Abuse
National Institutes of Health

 

Also listed on the website is a "Key Document" in the form of a "Memorandum from Chairman Pallone to the Subcommittee on Health."  This memo runs six pages and provides a nice primer on the basics of federal cannabis law as well as a very brief accounting of the six bills listed above.

January 13, 2020 in Campaigns, elections and public officials concerning reforms, Federal Marijuana Laws, Policies and Practices, Medical Marijuana Commentary and Debate, Recreational Marijuana Commentary and Debate, Who decides | Permalink | Comments (0)

Monday, December 30, 2019

Reviewing the year that was 2019 with a round-up of reviews of the year (and decade) in marijuana reform

2019-marijuana-snowflake-ldThis holiday season has brought not only the usual "year in review" pieces, but also a number of "decade in review" accountings of big changes since the start of 2010.  Interestingly, I have not seen too many "decade in review" pieces focused on marijuana reform developments even though so much has happened in this space since 2010.  This new NBC News piece by Zachary Siegel, headlined "Opioids, pot and criminal justice reform helped undermine this decade's War on Drugs," covers some of this ground in a broader context.  Here is an excerpt:

If shame was a potent force in fighting against the company that oversold opioids, it was the shedding of stigmas that characterized the massive shift in public opinion toward marijuana in the past decade — which transformed more than that on just about any other policy across the American landscape.  In 2000, 63 percent of Americans said the use of marijuana should be illegal, according to polling from Pew Research Center.  By 2010, that number had dropped to 52 percent, and for the last 10 years it continued to plunge, shifting the balance in favor of marijuana. In 2019, a full two-thirds of Americans believed cannabis should be legal.

There is no way to characterize this but as a loss for the so-called War on Drugs.  Marijuana not only continued to be consumed — with nearly 55 million people who indulge, it’s one of the most widely used drugs — but now, thanks to the legalization drive, there’s a chance to right wrongs of the past.  For instance, once legalization goes into effect in Illinois on Jan 1, 2020, the city of Evanston will use tax revenue on cannabis to fund reparations for black residents....

So how did 80-year-old cannabis laws finally begin to crumble this past decade?  Though very different in properties and ill effects, marijuana’s image shifted for some of the same reasons that opioids changed the drug conversation in America: White people being criminalized, the medical industry having a role in how to calibrate use of the drug, and a feeling among both liberals and conservatives that filling up jails with users was a waste of lives and money.

Cannabis laws didn’t change all by themselves, and it’s important to recognize the role that grass-roots advocacy played.  “The remarkable progress of marijuana legalization over the past decade was driven not by for-profit interests but by people and organizations who care first and foremost about freedom, justice, compassion and human rights,” said Ethan Nadelmann, the founder and former director of the Drug Policy Alliance, the nonprofit that helped get cannabis on the ballot in numerous states.

There is, of course, so much more to say about the past decade in marijuana reform, way too much to say in a single book, let alone a single blog post.  Rather than try to cover all that ground, I will be content here to just link to a number of 2019 "year in review" pieces about marijuana reform:

From the National Law Review, "Puff, Puff, Passed: 2019 Marijuana Laws in Review and 2020 Projections"

From MG Magazine, "The Evolving Cannabis Industry: a 2019 Year-End Review"

From The Hill, "2019 was a historic year for marijuana law reform — here's why"

From JD Supra, "The Year in Weed: 2019 Edition"

From NORML, "2019 Year in Review: NORML's Top Ten Events in Marijuana Policy"

And from the Dayton Daily News, "Ohio medical marijuana: What happened in the first year"

December 30, 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 | Permalink | Comments (0)

Tuesday, December 24, 2019

Alabama Medical Cannabis Study Commission recommends legislation to create medical marijuana program for Yellowhammer State

Alabama-cannabis-and-hemp-reform-act-of-2013As reported in this local article, "Friday, the Alabama Medical Cannabis Study Commission voted to recommend legislation that would legalize marijuana for persons with diagnosed medical conditions."  Here is more:

The commission voted twelve in favor and three against. Three members abstained. State Health Office Scott Harris voted against the bill.

The proposed bill would allow farmers to grow marijuana, doctors to prescribe marijuana for certain listed conditions, transporters to transport the product, dispensaries to sell the product, and would designate a state testing lab to perform the tests on the product sold on the state.

A new state agency, the Alabama Medical Cannabis agency would regulate cannabis in Alabama.  The commission would strictly regulate the product from planting to sell so that all product would be accounted for and limited to grown and produced within the state of Alabama.... The draft did not allow for a smokable products or for edible products such as marijuana gummies and brownies.  There is no provision for the legalization of home gardeners to grow marijuana for their own use....

The Commission is chaired by State Senator Tim Melson, R-Florence.  Melson is a physician who introduced medical marijuana legislation during the last legislative session. That bill passed the state Senate; but ran into fierce opposition in committee in the Alabama House of Representatives.  Senator Melson will introduce this bill, which was recommended by the Commission, in the 2020 Alabama legislative session.

Some marijuana advocates are arguing for a much broader legalization of cannabis in Alabama, including the legalization of recreational marijuana.  They have also criticized the ban on edible marijuana products and smokable product as well as the ban on the sell of marijuana plant material.  They have also questioned the legality of the ban on importing marijuana products into the state.

During the commission meetings, Melson said that he would join with Senators skeptical of his bill in fighting to defeat any effort to pass recreational marijuana.  Some opponents of medical marijuana have told the Alabama Political Reporter that they oppose passage of medical marijuana; because it is an incremental step towards the legalization of recreational marijuana.

Whether or not the state passes a medical marijuana bill will be decided in the Alabama legislature next year.

The full report is available at this link; it is short and reader-friendly.

December 24, 2019 in Campaigns, elections and public officials concerning reforms, Medical Marijuana Commentary and Debate, Medical Marijuana State Laws and Reforms | Permalink | Comments (1)

Tuesday, November 26, 2019

Highlighting how, even after "decriminalization," punitive marijuana criminalization persists for some

Drug_tests7The Philadelphia Inquirer has this notable new article under the headline "The Marijuana Paradox: Philadelphia Has Decriminalized Marijuana, But Those Who Get High On Probation Still Risk Incarceration." I recommend the lengthy article in full, and here are some excerpts:

District Attorney Larry Krasner announced his office would not charge people with marijuana possession, or seek to revoke probation for use of the drug.  Medical-use cannabis dispensaries are popping up across the city.  And the lieutenant governor, crisscrossing the state on a listening tour, reported that the Wolf administration and a majority of the public support legalizing recreational use.

Even as most Philadelphians are free to get high with impunity — facing at worst a $100 fine — judges and probation officers continue to punish people for using the drug, resulting in court-mandated treatment, extended probation, and even incarceration.

It’s one factor contributing to Philadelphia’s bloated levels of community supervision and of incarceration — which are among the highest of any big city and come at an enormous cost.  Philadelphia spends more than twice as much per capita as other cities on corrections, and nearly twice as much on judicial and legal costs.

And it is a significant factor, going by the results of 53,313 drug tests administered by the Philadelphia adult probation department in 2018.  The majority of those tests were negative for any drug — but among the failed screens, about half were positive for marijuana alone, according to court data. That’s more than 11,000 tests flagged just for weed.

Philadelphia City Council held a hearing in February to examine the possibility of ceasing testing, but city leaders have so far been reluctant to move ahead of state law. Probation-reform legislation proposed in the state House would not bar testing but would prohibit courts from violating people for using marijuana if they have medical authorization.

Philadelphia’s chief defender, Keir Bradford-Grey, called marijuana screening a waste of resources that doesn’t make the city any safer: “Many of them are using it for PTSD and trauma. Many of them are using it for pain.  So these reasons are benign in terms of our notion of public safety — and this is why we are creating an endless cycle of probation for people who are being tested this way.”

And, at a time when the opioid crisis is killing more than a thousand people each year in Philadelphia, the courts’ most intensive drug-treatment and diversion programs are squandered on marijuana users.  For instance, just 18% of those coming out of Philadelphia Drug Treatment Court in 2018 were opioid users; 75% were marijuana users....

One way some jurisdictions are avoiding such outcomes is to simply stop testing for marijuana. Among them, New York City this year enacted a law barring its probation department from testing for marijuana in almost all cases.  But in Pennsylvania, probation officials and judges continue to craft their own — often conflicting — responses to marijuana use.

In September, Lebanon County Probation prohibited use even for those with medical marijuana cards.  For people on probation who were managing health conditions with marijuana, the consequences were in some cases severe.  One woman, Melissa Gass, 41, stopped using the drug to manage her epilepsy after her probation officer told her continued use would put her in violation. Soon, she was experiencing six or seven seizures a day.

In October, the ACLU of Pennsylvania sued on behalf of Gass and two other people on probation, and the state Supreme Court agreed to exercise its extraordinary King’s Bench authority — a power reserved for matters of “immediate public importance” — to review the case and temporarily bar Lebanon County from implementing its policy.  “We are reading this as a statewide injunction,” said Vic Walczak, legal director of the ACLU of Pennsylvania, which has identified six other counties — Elk, Forest, Indiana, Jefferson, Lycoming, and Northampton — that ban medical marijuana for those on probation.

But there’s no immediate relief for people like Jacob Makaravitz, 29, who are already incarcerated on probation violations.  This fall, he went to a doctor and obtained a medical marijuana card to manage his nerve pain, but failed to get his probation officer’s permission.  In October, a Lackawanna County judge sentenced him to one to three years in state prison for the unauthorized use.

James McGurl, 31, who was in drug court with Makaravitz, learned of his friend’s incarceration with alarm.  “It’s just pure insanity. You can sentence someone one to three years for a medical marijuana card prescribed to him by a doctor,” McGurl said. McGurl himself is a former heroin user who got clean through a 12-step program. “Marijuana has been a great help and aid to me in my recovery,” he said — but it was a marijuana charge that saddled him with a felony conviction and a sentence to intermediate punishment.  “Oddly, after I finally got clean, I ended up in jail and on drug court,” he said.  “Where were they when I was robbing people’s houses and being a total scumbag?”

In Philadelphia, the court accepts medical marijuana cards, but probation administrators and judges have conflicting ideas about how to deal with those who use marijuana without authorization, according to Laurie Corbin of the Public Health Management Corp., which holds an $8 million contract with the city to provide assessment and treatment for court-ordered clients.  “There’s a real concerted effort not to be bringing people in [to jail] with charges related to marijuana,” she said, “but then there are other behaviors related to marijuana use, where [they’re] breaking and entering or doing other kinds of crime.”....

Nationwide, more people receive court-ordered referrals into drug treatment for marijuana than any other kind of drug — 126,000 of them in 2017, according to the U.S. Substance Abuse and Mental Health Treatment Administration.  More than half of all marijuana users in treatment are forced to go there by the criminal justice system. Notably, while just 13% of those in drug treatment in Pennsylvania are African American, 29% of those in treatment for marijuana are black.

Yet, a national epidemiological survey found that, as marijuana use has proliferated, the prevalence of marijuana-use disorders, described as abuse of or dependence on the drug, remains below 3% of adults nationwide.  That represents about three out of 10 marijuana users.  Statewide, 22% of people in drug treatment courts are marijuana users, but that number rises to 57% in Chester County and 75% in Philadelphia.

These programs are seen as a means to keep people out of jail while enforcing treatment.  But in reality, about one in three participants in these diversionary programs will be incarcerated as a sanction for repeated positive drug tests, missed court dates, or failure to attend treatment, an Inquirer review of court data from Philadelphia and surrounding counties shows.  Six out of 10 people leaving drug court in Pennsylvania graduate successfully; those who fail can face sentences of probation, jail, or even state prison.

Despite the potential for harsh consequences, some are grateful for the counseling that judges and probation officers provide. They say they need other coping mechanisms besides dulling trauma with marijuana, and court-ordered counseling or treatment may provide those skills But to those who flounder under the strictures of drug treatment court, it feels like a trap.

November 26, 2019 in Criminal justice developments and reforms, Medical Marijuana Commentary and Debate, Race, Gender and Class Issues | Permalink | Comments (0)

Wednesday, November 20, 2019

"The Complicated Relationship Between Marijuana Use and Parenting"

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:

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

"A special exception for CBD in foods and supplements?"

X13596446The 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 (0)

Wednesday, November 6, 2019

"The Evolving Federal Response to State Marijuana Reforms"

The title of this post is the title of this new paper now available via SSRN authored by Rob Mikos.  Here is its abstract:

The states have launched a revolution in marijuana policy, creating a wide gap between state and federal marijuana law.  While nearly every state has legalized marijuana in at least some circumstances, federal law continues to ban the substance outright.  Nonetheless, the federal response to state reforms has been anything but static during this revolution.  This Essay, based on my Distinguished Speaker Lecture at Delaware Law School, examines how the federal response to state marijuana reforms has evolved over time, from War, to Partial Truce, and, next (possibly) to Capitulation.  It also illuminates the ways in which this shifting federal response has alternately constrained and liberated states as they seek to regulate marijuana as they deem fit.

November 6, 2019 in Federal Marijuana Laws, Policies and Practices, Medical Marijuana Commentary and Debate, Recreational Marijuana Commentary and Debate, Who decides | Permalink | Comments (0)

Tuesday, November 5, 2019

Notable new poll explores Americans' views on CBD and marijuana

This new Politico piece reports on this interesting new polling that seems to me to present the deepest accounting of (shallow?) views on a range of cannabis related issues.  Here is part of the Politico piece: 

Americans now think marijuana is much less harmful than alcohol, tobacco or e-cigarettes, according to new polling results from POLITICO and Harvard’s T.H. Chan School of Public Health released Monday. Just 1 in 5 Americans believe marijuana is very harmful to people who use it. Twice as many said the same about alcohol, 52 percent characterized e-cigarettes as very harmful and 80 percent said tobacco cigarettes are very harmful....

The poll shows marijuana largely has avoided a perception hit following nearly 2,000 cases of vaping-related lung illnesses, including at least 37 deaths. The most recent numbers from the Centers for Disease Control and Prevention show that more than 80 percent of vaping products linked to lung problems contained THC — the psychoactive component of marijuana. Most of the vaping products tied to the outbreak were bought on the black market, although a handful of deaths have been tied to products purchased through state-legal marijuana dispensaries. The poll was conducted in early October, at least a month after news broke of health issues associated with vaping....

The market for CBD products has exploded since hemp was legalized under the 2018 farm bill, with Americans using it to treat everything from back pain to cancer. But despite widespread use, many Americans don't know what it is.

Nearly half of respondents indicated they weren’t familiar with CBD. Yet CBD is widely seen by the general public as a benign substance. Only 8 percent of total adults polled and 5 percent of those familiar with CBD said they think it is very harmful.

A majority of people familiar with CBD said they want little to no interference or regulation by the federal government. Only half of those who knew what CBD was thought the Food and Drug Administration should regulate the safety of products that contain it. The FDA is wrestling with how it should regulate the rapidly growing industry.

Of consumers familiar with CBD, 55 percent said they should be able to buy it over the counter if they think it‘s effective for them — whether or not a clinical trial has proven that it actually is. And more than 3 out of every 5 CBD users say they’d consider using their favorite products even if the FDA found that the product doesn’t actually help in the way it claims to....

While 67 percent of Democrats and 69 percent of independents support federal marijuana legalization, only 45 percent of Republicans are on board. That translates to 62 percent of Americans supporting federal legalization, a huge leap from the 44 percent of Americans who thought legalization was a good idea in 2009...

But when it comes to CBD, there is no partisan divide. According to the Harvard poll, 13 percent of Republicans and Democrats indicated they use CBD products. In addition, 83 percent of Democrats and 73 percent of Republicans think it should be sold in drugstores like CVS or Walgreens. The real CBD divide is generational: 21 percent of adults under 30 use it, versus 11 percent of adults over 65.

November 5, 2019 in History of Marijuana Laws in the United States, Medical Marijuana Commentary and Debate, Polling data and results, Recreational Marijuana Commentary and Debate, Who decides | Permalink | Comments (0)

Wednesday, October 30, 2019

"The Impact of Medical Marijuana Laws and Dispensaries on Self-Reported Health"

S21946191The 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.

October 30, 2019 in Medical community perspectives, Medical Marijuana Commentary and Debate, Medical Marijuana Data and Research | Permalink | Comments (0)

"Cannabinoids for the treatment of mental disorders and symptoms of mental disorders: a systematic review and meta-analysis"

Download (6)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":

Background

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.

Methods

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).

Findings

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.

Interpretation

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.

October 30, 2019 in Medical community perspectives, Medical Marijuana Commentary and Debate, Medical Marijuana Data and Research | Permalink | Comments (0)