Saturday, February 9, 2019
Though Ohio enacted its medical marijuana law, HB 523, way back in June 2016, the state took quite some time getting its rules and regulations and licenses in place to make the program operational. But starting about a month ago, a few medical marijuana dispensaries were open for business and a system for registering doctors and patients in the program has been operational for a few months.
This past week, the Ohio Medical Marijuana Control Program Advisory Committee had a meeting at which this powerpoint presentation was shared showing all sorts of interesting data about how this program is now operating. Though I do not think the data is all too dissimilar to what we see in other states recently bringing a medical marijuana programs on-line, I still found these early facts from these PPT slides notable:
Medical Marijuana Sales Figures (from January 16 – February 3, 2019) had total sales of $502,961, with total volume of 68.22 pounds
Total Patient Recommendations were 17,077, along with 472 Total Caregivers
Patients with Veteran Status were 1,284, with Indigent Status were 405, and with a Terminal Diagnosis were 83
10% of Registered patients are aged 18-29, 21% are aged 30-39, 22% are aged 40-49, 22% are aged 50-59, 19% are aged 60-69, and 6% are over 70
Registered patients have twenty-one different conditions, with the top five being Spinal cord disease or injury (998 patients), Cancer (1,082), Fibromyalgia (1,973), Post-traumatic stress disorder (2,622), and Pain that is either chronic and severe or intractable (10,910)
There are 374 active Certificates To Recommend (CTRs) among physicians, but only 177 physicians have so far issued recommendations for patients
Tuesday, February 5, 2019
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.
Tuesday, January 29, 2019
"Impact of Medical Marijuana Legalization on Opioid Use, Chronic Opioid Use, and High-risk Opioid Use"
The 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:
To determine the association of medical marijuana legalization with prescription opioid utilization.
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.
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).
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.
Saturday, January 26, 2019
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 16, 2019
Speculating about impact on the opioid crisis as Ohio finally sees its first legal medical marijuana sale
Here is a silly trivia question: How did some people in Ohio celebrate the 100-year anniversary of the ratification of the alcohol prohibition amendment?
Answer: By finally being able to purchase medical marijuana in the state legally.
Remarkably, it has taken more than 30 months form the Buckeye State to go from the passage of a medical marijuana law to the opening up of the first legal dispensaries. And, not surprisingly, this new NBC News piece is already asking whether this development will help with the state's opioid problems. Here are excerpts:
Leaning on her cane, Joan Caleodis stepped gingerly into history on Wednesday as one of the first people to legally purchase medical marijuana in the state of Ohio.
Caleodis, who is 55 and suffers from multiple sclerosis, paid $150 for three containers, each holding 2.83 grams of dried cannabis flowers, at the CY + Dispensary in the town of Wintersville.
“I’m feeling ecstatic,” Caleodis told reporters as other pain sufferers waiting in line applauded. “The patients no longer have to wait for relief. We can get rid of this opioid issue we have in this country.” Caleodis said she felt even better when she got home and tried out her purchase. “I was curious and I am very happy with the quality,” she told NBC News. “Some days are worse than others, but I am pretty much in constant pain and right now I am not.”
A former state worker who went on disability after 27 years on the job, Caleodis said she was prescribed opioids for pain after she was diagnosed with multiple sclerosis more than eight years ago. “I found myself taking double the amount prescribed and told myself, ‘I’m not going that route’,” she said. “This is definitely better.”
While medical marijuana is now available in the Buckeye State, it is unclear if the change will put a dent into the state's opioid epidemic. Ohio is one of “the top five states with the highest rates for opioid-related overdose deaths,” according to the National Institute on Drug Abuse.
Medical marijuana dispensaries are regulated in Ohio by the state Board of Pharmacy. When asked if the state views legal pot as a potential weapon in the battle against the deadly opioid epidemic, a Board spokesman replied, “The state has no official policy on this.”
The same question was posed to newly-installed Gov. Mike DeWine, who as attorney general sued the pharmaceutical companies for flooding his state with prescription painkillers. His team referred a reporter to the state Board of Pharmacy....
“There’s some suggestive evidence that marijuana may help to reduce opioid use,” Dr. Caleb Alexander, co-founder of the Center for Drug Safety and Effectivenesss at the Bloomberg School posted. “There’s also some evidence to the contrary.”
Rosalie Liccardo Pacula, co-director of the Drug Policy Research Center at the RAND Corporation said in the same forum that she was in favor of expanding medical marijuana programs, but added, “I do not believe that doing so will substantially impact the opioid epidemic. “
“Most people substituting cannabis for opioids are not using either drug medicinally,” she wrote. “Moreover, research does not suggest that cannabis is a substitute for heroin or fentanyl, the major drivers of the epidemic today.”
Mark Parrino of the American Association for the Treatment of Opioid Dependence said, “It is counterintuitive to advocate for the legalization of marijuana while our nation is struggling with an opioid use disorder epidemic.” “While medical use of marijuana may be beneficial in some cases, I do not think that it is reasonable to promote marijuana as a positive medical treatment,” he wrote.
Caleodis said anyone who thinks marijuana doesn’t help should take a walk in her shoes. She said she has used other “black market” cannabis products to easy her anguish over the years. “My symptoms are always there, I feel a burning in my feet just about all the time,” she said. “And at night it is way worse. Sometimes I just can’t sleep. But tonight I think I will.”
January 16, 2019 in History of Marijuana Laws in the United States, Medical Marijuana Commentary and Debate, Medical Marijuana Data and Research, Medical Marijuana State Laws and Reforms | Permalink | Comments (3)
Sunday, January 13, 2019
Maryland Medical Cannabis Commission report explores treatment of opioid use disorder by using medical cannabis
The debate over the relationship between the opioid crisis and marijuana reforms is so very interesting and, of course, so very important. Advocates for and against marijuana reform seem ever eager to leverage the opioid crisis (and everything else) to support their prior conclusions about the virtues or vices of marijuana reform. Against this backdrop, I think information from non-partisans is especially valuable, and thus I was pleased to see this notable new report from the Maryland Medical Cannabis Commission titled "Treatment of Opioid Use Disorder with Medical Cannabis." I recommend the full report, which mostly just reports on the state of the law in many jurisdictions and research on these topics. Here are excerpts:
Since 2016, at least nine states have considered legislation or regulations to allow medical cannabis as an opioid replacement therapy to help ease withdrawal symptoms and aid in relapse prevention.... In 2018, Pennsylvania, New Jersey, and New York became the first states to expressly allow medical cannabis for the treatment of OUD. Each state permits the use of medical cannabis to treat OUD, but with significant restrictions....
From 2016-2018, at least seven state legislatures considered bills that would expressly add OUD to the list of medical cannabis qualifying conditions. Of these, the majority rejected the legislation seeking to add OUD to the list of qualifying conditions. [T]hree states – Hawaii, Maine, and New Mexico – passed legislation authorizing the use of medical cannabis to treat OUD; however, the State’s Governor vetoed the legislation in each instance following significant pressure from health care providers, health care organizations, and addiction specialists....
Data suggest that cannabis legalization reduces prescription opioid use by serving as an alternative pain treatment. Medical cannabis laws may also have downstream policy effects on reducing opioid-related hospitalizations, overdose deaths, and traffic fatalities. The following section examines existing literature on the association between medical cannabis and opioid use, including as a treatment for opioid use disorder....
[But] a study was published in the “To the Editor” section of JAMA Internal Medicine in September 2018, which found that the opioid-related overdose death rate was accelerating in states where medical and/or adult use cannabis laws had been implemented. Moreover, the death rate surpassed that of nonlegalizing states. The study reviewed opioid-related overdose death data from 2010 to 2016, and determined that the age-adjusted death rate was higher in states with cannabis legalization and that the age-adjusted death rate was increasing at a faster rate than in non-legalizing states. While several researchers have challenged the methodology of this study – including the inaccurate assessment of states that have legalized medical and adultuse cannabis – the results call attention to the need for further investigation of the association between cannabis legalization and opioid-related overdose deaths....
In December 2018, the Commission received two petitions requesting the addition of OUD to the list of medical cannabis qualifying conditions. If the Commission determines that either or both of these petitions are “facially substantial” then it must conduct a public hearing within the next 12 months to evaluate whether the medical condition or disease should be included in the list of qualifying conditions. The Commission’s Research Committee, which includes two physicians, a scientist, addiction specialist, and horticulturist, is currently evaluating the petitions to determine whether they are facially substantial and require a public hearing. The Commission will provide the General Assembly with updates on the status of the OUD petitions, including information on any public hearings to consider adding OUD as a qualifying medical condition.
January 13, 2019 in 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, January 10, 2019
The title of this post is the title of this notable new study just published in the journal Drug and Alcohol Dependence. Here is its abstract:
Driving under the influence of cannabis (DUIC) is a public health concern among those using medical cannabis. Understanding behaviors contributing to DUIC can inform prevention efforts. We evaluated three past 6-month DUIC behaviors among medical cannabis users with chronic pain.
Adults (N = 790) seeking medical cannabis certification or recertification for moderate/severe pain were recruited from February 2014 through June 2015 at Michigan medical cannabis clinics. About half of participants were male (52%) and 81% were White; their Mean age was 45.8 years. Participants completed survey measures of DUIC (driving within 2 h of use, driving while “a little high,” and driving while “very high”) and background factors (demographics, alcohol use, etc.). Unadjusted and adjusted logistic regressions were used to examine correlates of DUIC.
For the past 6 months, DUIC within 2 h of use was reported by 56.4% of the sample, DUIC while a “little high” was reported by 50.5%, and “very high” was reported by 21.1%. G reater cannabis quantity consumed and binge drinking were generally associated with DUIC behaviors. Higher pain was associated with lower likelihood of DUIC. Findings vary somewhat across DUIC measures.
The prevalence of DUIC is concerning, with more research needed on how to best measure DUIC. Prevention messaging for DUIC may be enhanced by addressing alcohol co-consumption.
Wednesday, January 9, 2019
The title of this post is the title of this new Civilized piece with an interesting factoid about employment in the marijuana industry. Here are the particulars (with links from the original to a notable infographic):
If there's any marker that the cannabis industry isn't slowing down, it's just how many people are now working in it.
In 2018 there were somewhere between 125,000 and 160,000 working in the legal cannabis industry, according to an infographic released by Cali Extractions using data from Statista and Marijuana Business Daily. That's no small jump up from just last year where there were only 90,000–110,000 cannabis industry workers.
That means there are more people working in state-legalized cannabis industries than there are pilots or librarians in America. And next year cannabis jobs look like they'll overtake the number of kindergarten teachers and bus drivers.
"Since 2016, revenue from cannabis has almost doubled—not many industries can show that kind of growth, even in the salad days," reads the a statement released with the infographic.
Friday, December 28, 2018
"Alcohol Use and Risk of Related Problems Among Cannabis Users Is Lower Among Those With Medical Cannabis Recommendations, Though Not Due To Health"
The title of this post is the headline of this encouraging article recently published in the Journal of Studies on Alcohol and Drugs authored by Meenakshi Subbaraman and William Kerr. Here is its abstract:
A small body of work has started developing cannabis use “typologies” for use in treatment and prevention. Two potentially relevant dimensions for classifying cannabis use typologies are medical versus recreational cannabis use and the co-use of cannabis and alcohol. Here we compare alcohol use and related problems between cannabis users with and without medical cannabis recommendations.
Data come from a larger general population study in Washington State conducted between January 2014 and October 2016. All participants in the analytic sample (n = 991) reported using both alcohol and cannabis in the past 12 months. The primary exposure was having a medical recommendation for cannabis. Outcomes were past-30-day drinking (drinks/day, frequency of 5+ drinks, and maximum number of drinks in a day) and past-12-month Alcohol Use Disorders Identification Test (AUDIT) scores.
Compared with those without medical cannabis recommendations, cannabis users with medical cannabis recommendations had 0.59 times fewer drinks/day, 0.44 times fewer occasions drinking 5+, and 0.78 times the average maximum number of drinks in one day (all ps < .05). Those with a recommendation also had 0.87 times lower AUDIT total scores (p < .05) and 0.57 times lower AUDIT problem scores (p < .01).
Cannabis users with medical cannabis recommendations drink less and have fewer alcohol-related problems than those without recommendations, even after adjusting for health status. Future studies should examine non-health reasons regarding how medical and non-medical users use cannabis differently.
Sunday, November 18, 2018
The title of this post is the title of this new paper I just saw posted to SSRN coming from multiple authors from the University of Florida and Regional Economic Models, Inc. (REMI). Here is its abstract:
In 2016, Florida Governor signed House Bill 307 that expanded the State's Right to Try Act to include medical marijuana. However, two years after this initiative, little is known about the economic impact of legal medical marijuana use (MMU) on the State of Florida. The goal of this research is to forecast the total economic impact arising from MMU on Florida, from 2017 to 2025, using a dynamic input-output model. Input data for the model were obtained from the Florida Office of Medical Marijuana Use.
The economic impact of MMU was measured in terms of gross state product, disposable personal income, migration, labor force, employment, and salaries and wages. The legalization of medical marijuana in Florida is associated with an increase in all the economic indicators in 2017. A positive trend for these indicators is observed from 2017 to 2025 except for migration with a negative trend starting in 2019.
Wednesday, November 7, 2018
The title of this post is the title of this interesting new NBER Working Paper authored by Michele Baggio, Alberto Chong and David Simon. Here is its abstract:
We study the behavioral changes due to marijuana consumption on fertility and its key mechanisms, as opposed to physiological changes. We can employ several large proprietary data sets, including the 1997 National Longitudinal Survey of Youth, Nielsen Retail Scanner database, as well as the Vital Statistics Natality files and apply a differences-in-differences approach by exploiting the timing of the introduction of medical marijuana laws among states. We first replicate the earlier literature by showing that marijuana use increases after the passage of medical marijuana laws. Our novel results reveal that birth rates increased after the passage of a law corresponding to increased frequency of sexual intercourse, decreased purchase of condoms and suggestive evidence on decreased condom use during sex. More sex and less contraceptive use may be attributed to behavioral responses such as increased attention to the immediate hedonic effects of sexual contact, delayed discounting and ignoring costs associated with risky sex. These findings are consistent with a large observational literature linking marijuana use with increased sexual activity and multiple partners. Our findings are robust to a broad set of tests.
Sunday, October 21, 2018
The title of this post is the title of this new paper on SSRN authored by Benjamin J. McMichael, R. Van Horn and W. Kip Viscusi. Here is its abstract:
While recent research has shown that cannabis access laws can reduce the use of prescription opioids, the effect of these laws on opioid use is not well understood for all dimensions of use and for the general United States population. Analyzing a dataset of over 1.3 billion individual opioid prescriptions between 2011 and 2017, which were aggregated to the individual provider-year level, we find that recreational and medical cannabis access laws reduce the number of morphine milligram equivalents prescribed each year by 6.9 and 6.1 percent, respectively. These laws also reduce the total days supply of opioids prescribed, the total number of patients receiving opioids, and the probability a provider prescribes any opioids net of any offsetting effects. Additionally, we find consistent evidence that cannabis access laws have different effects across types of providers and physician specialties.
Tuesday, October 16, 2018
The title of this post is the title of this interesting new article in the journal Population Health Management authored by Yulia Treister-Goltzman, Tamar Freud, Yan Press, and Roni Peleg. Here is its abstract:
Widespread use of cannabis as a drug and passage of legislation on its use should lead to an increase in the number of scientific publications on cannabis. The aim of this study was to compare trends in scientific publication for papers on medical cannabis, papers on cannabis in general, and all papers between the years 2000 and 2017. A search of PubMed and Web of Science was conducted.
The overall number of scientific publications in PubMed increased 2.5-fold. In contrast, the number of publications on cannabis increased 4.5-fold and the number of publications on medical cannabis increased almost 9-fold. The number of publications on medical cannabis in Web of science increased even more (10-fold). The most significant number of publications was in the field of psychiatry. In the fields of neurology and cancer treatment there was a significant increase in the years 2011–2013. There was a rise in the number of publications on children and the elderly after 2013. The specific indications with the largest number of publications were HIV (261), chronic pain (179), multiple sclerosis (118), nausea and vomiting (102), and epilepsy (88). More than half of the publications on medical cannabis originated from the United States, followed by Canada. More than 66% of the publications were original studies.
The spike in the number of scientific publications on medical cannabis since 2013 is encouraging. In light of this trend the authors expect an even greater increase in the number of publications in this area in coming years.
Wednesday, September 26, 2018
The title of this post is the title of this interesting new FiveThirtyEight piece by Christie Aschwanden. Here is how it gets started:
As marijuana is legalized in more and more states, the wellness world has whipped itself into a frenzy over a non-intoxicating cannabis derivative called cannabidiol. CBD products can be found on the internet and in health-food stores, wellness catalogs and even bookstores. (A bookstore in downtown Boulder, Colorado, displays a case of CBD products between the cash register and the stacks of new releases.) Celebrities like Gwyneth Paltrow, disgraced cyclist Floyd Landis and former Denver Broncos quarterback Jake Plummer are all touting CBD products, and according to Bon Appétit, CBD-infused lattes have become “the wellness world’s new favorite drink.”
But, uh, what is it that CBD is supposed to do? I visited a cannabis dispensary in Boulder to find out what the hype was all about. After passing an ID check, I was introduced to a “budtender” who pointed me to an impressive array of CBD products — tinctures, skin patches, drink powders, candies, salves, massage oil, lotions, “sexy time personal intimacy oil” and even vaginal suppositories to treat menstrual cramps.
Most of these products promised to relieve pain or otherwise enhance well-being, and none of it was cheap. (Prices started at about $30.) But I wanted to know: Does any of this stuff really work? After a deep dive into the scientific research, I learned that the answer was a big fat maybe.Although there’s enticing evidence that good ol’ cannabis can ease chronic pain and possibly treat some medical conditions, whether CBD alone can deliver the same benefits remains an open question. What is clear, at this point, is that the marketing has gotten way ahead of the science.
Wednesday, September 12, 2018
The latest issue of the International Review of Psychiatry has a collection of interesting looking articles with titles like "Marijuana matters: reviewing the impact of marijuana on cognition, brain structure and function, & exploring policy implications and barriers to research" and "Sweet flowers are slow, and weeds make haste: leveraging methodology from research on tobacco, alcohol, and opioid analgesics to make rapid and policy-relevant advances in cannabis science." There are too many interesting looking pieces to cite them all here, but I can quote the start of the editorial introduction:
The allowance of cannabis to be used as a medicine in the absence of adequate data to inform basic clinical decision-making is rooted in compassion for individuals with life-threatening illness, or substantially debilitating illness, and no other course for treatment. However, this relatively simple tenet has now morphed into a large-scale for-profit industry that is fraught with public health concerns. Access to cannabis has been expanded to include treatment for a multitude of health conditions, many of which are neither life-threatening nor debilitating, and for which effective alternative treatments exist. Data from which to determine the risk-benefit for an individual considering the use of cannabis is sparse at best. Quality control issues abound in this industry as there are no established standards for cultivating, processing, testing, or labeling cannabis products. There is also concern over advertisements and product labeling that include misleading or unsubstantiated health claims, as these products have not been vetted by traditional drug development methods. The speed in which cannabis policies are changing is rapid, and the fact that these are happening as a direct result of legislation or by voter referendum is reckless given the absence of consensus standards and, in many cases, appropriate regulatory oversight. The impact of revised cannabis laws, both with respect to medicinal use for a variety of health conditions, and for non-medicinal (aka ‘recreational’) use of cannabis by adults, will likely have a substantial impact on psychiatry.
This special issue of the International Review of Psychiatry is focused on cannabis science, but with a very targeted theme of cannabis regulatory science. Recently in the US, the Food and Drug Administration (FDA) was granted regulatory authority over all nicotine and tobacco products. This was a landmark event, and has engendered a bolus of thoughtful, policy-oriented research that has already resulted in tobacco regulations which are likely to positively impact public health in the US and abroad. Studies have included careful scientific evaluation of the impact of nicotine on cigarette reinforcement and self-administration, packaging and flavoring on youth initiation, the harm reduction effects associated with nicotine delivery devices other than cigarettes, and other important topics. The parallel need for a cannabis regulatory science is urgent. Novel products and cannabis delivery devices are rolling onto the shelves of dispensaries at a rapid rate, product development appears to be geared towards high potency/high dose products, and it is all being carefully marketed to increase consumption. Contributions in this issue highlight lessons learned from tobacco, alcohol, and opioid regulatory science that are relevant to cannabis, detail important factors surrounding tobacco and cannabis co-use, and detail the potential impacts of regulatory changes on cannabis use in the workplace.
September 12, 2018 in Medical Marijuana Commentary and Debate, Medical Marijuana Data and Research, Recreational Marijuana Commentary and Debate, Recreational Marijuana Data and Research | Permalink | Comments (0)
Tuesday, August 28, 2018
Has anyone tracked how many times and how many ways state medical marijuana programs have been expanded after inception?
The question in the title of this post was my first reaction to the latest reports on the latest states to expand access to medical marijuana. This piece from Connecticut on this front is headlined "State Approves Use Of Medical Marijuana For Stubborn Headaches, 7 Other Conditions," and here are the basics:
Medical marijuana may now be prescribed in Connecticut to treat medication-resistant headaches, severe rheumatoid arthritis and several other new conditions, the Department of Consumer Protection announced Tuesday.
The state legislature’s Regulation Review Committee has updated the state’s medical marijuana program regulations to include eight new conditions for adults and two new conditions for patients under 18.
Today, also brings this similar news from Illinois, under the headline "Rauner signs medical marijuana expansion bill allowing drug as painkiller alternative," starting this way:
A measure that could dramatically expand access to medical marijuana in Illinois — making it available as an opioid painkiller replacement and easing the application process for all who qualify — was signed into law by Gov. Bruce Rauner on Tuesday....
No longer will any applicants have to be fingerprinted and undergo criminal background checks. And those who complete an online application with a doctor’s authorization will get a provisional registration to buy medical cannabis while they wait for state officials to make a final review of their request.
My sense is that this is a common reality that has found expression perhaps multiple time in multiple states: over time, states add qualifying conditions or reduce restriction on access to medical marijuana. I suspect someone somewhere is tracking these developments nationwide, and I think the pace and scope of amendments to state medical marijuana regimes would tell an interesting and significant modern reform story.
August 28, 2018 in History of Marijuana Laws in the United States, Medical Marijuana Commentary and Debate, Medical Marijuana Data and Research, Medical Marijuana State Laws and Reforms | Permalink | Comments (0)
Monday, August 13, 2018
The title of this post is the title of this notable new research article forthcoming in the October 2018 issue of the International Journal of Drug Policy. Here is its abstract:
The aim of this research was to determine the association between legalizing medical marijuana and workplace fatalities.
Repeated cross-sectional data on workplace fatalities at the state-year level were analyzed using a multivariate Poisson regression.
To date, 29 states and the District of Columbia have legalized the use of marijuana for medicinal purposes. Although there is increasing concern that legalizing medical marijuana will make workplaces more dangerous, little is known about the relationship between medical marijuana laws (MMLs) and workplace fatalities.
All 50 states and the District of Columbia for the period 1992–2015.
Workplace fatalities by state and year were obtained from the Bureau of Labor Statistics. Regression models were adjusted for state demographics, the unemployment rate, state fixed effects, and year fixed effects.
Legalizing medical marijuana was associated with a 19.5% reduction in the expected number of workplace fatalities among workers aged 25–44 (incident rate ratio [IRR], 0.805; 95% CI, .662–.979). The association between legalizing medical marijuana and workplace fatalities among workers aged 16–24, although negative, was not statistically significant at conventional levels. The association between legalizing medical marijuana and workplace fatalities among workers aged 25–44 grew stronger over time. Five years after coming into effect, MMLs were associated with a 33.7% reduction in the expected number of workplace fatalities (IRR, 0.663; 95% CI, .482–.912). MMLs that listed pain as a qualifying condition or allowed collective cultivation were associated with larger reductions in fatalities among workers aged 25–44 than those that did not.
The results provide evidence that legalizing medical marijuana improved workplace safety for workers aged 25–44. Further investigation is required to determine whether this result is attributable to reductions in the consumption of alcohol and other substances that impair cognitive function, memory, and motor skills.
Monday, July 30, 2018
This local Florida article, headlined "Marijuana booming as state nears 2-year mark," reports on (unsurprising?) medical marijuana realities in the Sunshine State. Here are highlights from the lengthy piece:
More than 100,000 Floridians now can legally take marijuana for medicinal purposes. This milestone, reached in April, is one of many signs that Florida’s young marijuana industry is booming as the state approaches the two-year anniversary of voters legalizing medical pot.
But issues remain: Some patients complain that the Florida Department of Health’s rules create unfair barriers for patients. They can’t smoke their marijuana or grow their own, for example. They also gripe about the patient approval process and the cost of medication. Companies eager to jump into the marijuana business are waiting for the state to issue additional licenses required by law upon passing the 100,000-patient mark....
In November 2016, 71 percent of Florida’s voters gave the green light to medical marijuana. The state still is issuing guidelines and battling lawsuits over how that should be done. But the direction is clear. Already, analysts are projecting a $1 billion medical marijuana market in Florida by 2020.
Fourteen companies have received licenses from the state. They’ve opened 43 dispensaries statewide, including offices in Summerfield and Lady Lake, to serve the growing number of approved patients, which has more than doubled since the start of the year. The coveted licenses are drawing attention from established marijuana businesses. In June, California-based MedMen paid $53 million to acquire the cultivation and distribution rights from Treadwell Nursery in Eustis....
[T]he process to become a qualifying doctor [initially meant] doctors were required to pay $1,000 for an eight-hour course. That requirement has since decreased to a two-hour course costing $250. More than 1,500 physicians now are able to recommend marijuana to patients, including more than 40 in Sumter, Lake and Marion counties.
Miami-Dade and Palm Beach counties have the most registered physicians, with more than 200 each. Demand for doctors persists, with 1,500 to 3,500 patients joining the registry every week....
Even as more and more people line up for treatment, criticism of the program continues. Companies and advocates of Amendment 2, which authorized medical marijuana, are challenging some of the rules laid out by the Department of Health. Attorney John Morgan sued the department over its rule banning smokeable cannabis, arguing it goes against the will of the voters who approved the amendment. Vaping is allowed. Tallahassee Circuit Judge Karen Gievers sided with Morgan, saying the restriction was unconstitutional. The state immediately appealed the decision, and Morgan tried to get the Florida Supreme Court to consider the case. He now is focusing on legalizing recreational use.
Morgan criticized Gov. Rick Scott, who had opposed the broad legalization of medical marijuana, for allowing the smoking ban. Scott defended following the law as it is written. He is not alone in voicing smoking opposition. The American Society of Addiction Medicine rejects smoking as a means of drug delivery for medical purposes. The American Cancer Society Cancer Action Network, the ACS’s advocacy group, has not taken a position on legalization of marijuana for medical purposes, citing a need for more scientific research on marijuana’s potential benefits and harms.
Thursday, July 26, 2018
The pro-marijuana reform website Marijuana Moment continues to provide effective coverage of all sorts of marijuana news and stories, and recently the site has spotlighted a lot of interesting new research results in these pieces:
Tuesday, July 24, 2018
Tom Angell reports here at Forbes on the introduction of a new piece of federal legislation that I consider long overdue. Here are the details:
The Marijuana Data Collection Act, introduced on Tuesday by Rep. Tulsi Gabbard (D-HI) and a bipartisan group of cosponsors, would direct the Department of Health and Human Services to partner with other federal and state government agencies to study "the effects of State legalized marijuana programs on the economy, public health, criminal justice and employment."...
If the legislation is enacted, the National Academy of Sciences would carry out the research and publish initial findings within 18 months, with follow-up reports to be issued every two years after that.
So far, the bill's backers seem to consist solely of those who support marijuana law reform, a situation that legalization advocates decried. “This is not a marijuana bill, it is an information bill," Justin Strekal, political director for NORML, said in an interview. "No member of Congress can intellectually justify opposition to this legislation. Our public policy needs to be based on sound data and science, not gut feelings or fear-mongering. Approving the Marijuana Data Collection Act would provide legislators with reliable and fact-based information to help them decide what direction is most beneficial to society when it comes to marijuana policy.”...
Gabbard held a Tuesday morning press conference with other supporters, including lead GOP cosponsor Rep. Carlos Curbelo (R-FL) and former U.S. Attorneys Barry Grissom of Kansas and Bill Nettles of South Carolina. Other original cosponsors of the bill include Reps. Don Young (R-AK), Darren Soto (D-FL), Beto O’Rourke (D-TX), Earl Blumenauer (D-OR), Dana Rohrabacher (R-CA), Matt Gaetz (R-FL), Peter DeFazio (D-OR), Eleanor Holmes Norton (D-DC), Dina Titus (D-NV), Charlie Crist (D-FL), Tom Garrett (R-VA), Lou Correa (D-CA), Barbara Lee (D-CA), Mark Pocan (D-WI) and Salud Carbajal (D-CA).
Here are the specific data points the bill directs federal officials to track:
REVENUES AND STATE ALLOCATIONS
The monetary amounts generated through revenues, taxes, and any other financial benefits. The purposes and relative amounts for which these funds were used. The total impact on the State and its budget.
MEDICINAL USE OF MARIJUANA
The rates of medicinal use among different population groups, including children, the elderly, veterans, and individuals with disabilities. The purpose of such use. Which medical conditions medical marijuana is most frequently purchased and used for.
The rates of overdoses with opioids and other painkillers. The rates of admission in health care facilities, emergency rooms, and volunteer treatment facilities related to overdoses with opioids and other painkillers. The rates of opioid-related and other painkiller-related crimes to one’s self and to the community. The rates of opioid prescriptions and other pain killers.
IMPACTS ON CRIMINAL JUSTICE
The rates of marijuana-related arrests for possession, cultivation, and distribution, and of these arrests, the percentages that involved a secondary charge unrelated to marijuana possession, cultivation, or distribution, including the rates of such arrests on the Federal level, including the number of Federal prisoners so arrested, disaggregated by sex, age, race, and ethnicity of the prisoners; and the rates of such arrests on the State level, including the number of State prisoners so arrested, disaggregated by sex, age, race, and ethnicity. The rates of arrests and citations on the Federal and State levels related to teenage use of marijuana. The rates of arrests on the Federal and State levels for unlawful driving under the influence of a substance, and the rates of such arrests involving marijuana. The rates of marijuana-related prosecutions, court filings, and imprisonments. The total monetary amounts expended for marijuana-related enforcement, arrests, court filings and proceedings, and imprisonment before and after legalization, including Federal expenditures disaggregated according to whether the laws being enforced were Federal or State. The total number and rate of defendants in Federal criminal prosecutions asserting as a defense that their conduct was in compliance with applicable State law legalizing marijuana usage, and the effects of such assertions.
The amount of jobs created in each State, differentiating between direct and indirect employment. The amount of jobs expected to be created in the next 5 years, and in the next 10 years, as a result of the State’s marijuana industry.
Because I cannot yet find the full text of the bill on-line, I cannot yet provide a full informed opinion on its particulars. I can say that I think a big, data-focused federal study of the impact of state marijuana reform is looooooooong overdue. I was hopeful, but not optimistic, that Prez Obama might see the wisdom and political value of pushing for this kind of study effort after the issuance of the 2013 Cole Memo and after the 2014 election brought more states and DC into the recreational marijuana column. But, sadly, we have been left largely with national number crunching by partisan advocates rather than government bean-counters for now two decades of ever-more-robust state-level reforms.
Based on Tom's description of the "Marijuana Data Collection Act," I am a bit concerned that there are not provisions likely to encourage pot prohibitionists to be supportive of this particular study effort. The folks at SAM are often eager to stress data on black markets, increased use of marijuana by workers, increased hospital visits, increased homelessness, increased drugged driving, increased use by youths and young adults, environmental impacts, and all sorts of other concerns (see, e.g., this SAM "lessons learned" report from March 2018). It is unclear if these kinds of potentially negative data are fundamental parts of the inquiry imagined by Marijuana Data Collection Act. If not, I doubt opponents of marijuana reform will want to sign on to this bill.
That said, even if the current version of the "Marijuana Data Collection Act" is in someway incomplete or one-sided, I hope a lot of folks on all sides of the marijuana reform debate will be inclined to try to make the bill better and get it passed. I sincerely hope nobody disagrees with the notion that sound data and science is needed in this arena, and I sense both sides of the debate sincerely believe that the data, if fairly collected, will be on their side. So maybe all can come together to really work toward trying to have all the data fairly collected (though I am not holding my breath).
July 24, 2018 in Campaigns, elections and public officials concerning reforms, Federal Marijuana Laws, Policies and Practices, Medical Marijuana Data and Research, Recreational Marijuana Data and Research, Who decides | Permalink | Comments (0)