Friday, April 12, 2019
This local article spotlights the (surprising?) popularity of medical marijuana in the Sooner State under the headline "Oklahoma Medical Marijuana Authority estimated licensing 80,000 patients in year one. It's on track for 150,000." Here are excerpts:
The Oklahoma Medical Marijuana Authority last year projected licensing 40,000 to 80,000 patients in its first year of operations. But in a surprise to OMMA personnel, the agency surpassed the 80,000-patient mark last week and could reach 150,000 by its first anniversary if the current pace of applications remains steady.
"We're probably averaging just over 5,000 a week," OMMA Director Adrienne Rollins said Thursday, which represents an increase of about 1,000 applications per week since early February, when OMMA shuttered its call center to free up time for application reviews. "We thought we would really be hammered in the very beginning and then it would start to level out. But as the number of physicians who are getting on board as far as recommending has increased, we've seen our numbers drastically increase," Rollins said. "I think at this point we're on track to have potentially 150,000."...
OMMA Communications Director Melissa Miller provided documentation to the Tulsa World showing the number of licensed patients in Oklahoma this week is more than 20 percent higher than it was the week of March 18. Miller said about 150 business license requests are submitted each week on average in recent weeks. Rollins said five OMMA employees specialize in reviewing those types of applications....
Rollins, who became the OMMA's director in October, said her department received about 3,500 patient applications between Aug. 26 and the first week of September. The number of submissions remained manageable until the winter holiday season, which is when Rollins said she noticed a "big jump" ahead of the expected widespread opening of dispensaries across the state.
By February, the OMMA closed its customer service call center, reassigning those five employees to review applications at least on a temporary basis. The move, Rollins said, means the OMMA can make decisions on up to 500 more patient applications per weekday. Of continuing to keep the call center shuttered, she said it was a "drastic change" from the OMMA's desires but maintained it was necessary to ensure applications are reviewed within the 14-day limit provided in State Question 788.
The House Rules Committee on Thursday passed a heavily amended version of Senate Bill 1030, which has a clause that if signed into law would expand the business applicant decision time to 90 days.
I am very sad that presentations in my my Marijuana Law, Policy & Reform seminar have wrapped up, but that reality gives me a bit more time and space here to catch up on the marijuana law, policy and reform stories that most catch my eye. One such important story that I missed a few weeks ago comes here from Stateline under the headline "African-Americans Missing Out on Southern Push for Legal Pot." I recommend the extended article in full, and here are some excerpts:
Medical cannabis laws typically lay out the conditions for which the drug may be prescribed. But the laws in Arkansas and Florida — the only Southern states that have legalized medical cannabis — don’t cover sickle cell disease, which causes acute pain and disproportionately affects African-Americans. The bills advancing in Tennessee and Kentucky also exclude that condition. Three states that have legalized medical but not recreational cannabis — Connecticut, Ohio and Pennsylvania — allow sickle cell disease patients to use it....
Black legalization advocates also fear that even if medical cannabis becomes legal, white politicians won’t regulate licensing and permitting in a way that ensures equitable opportunities for people of color. “Without that, it’ll be more of the same,” said Dr. Felecia Dawson, a board-certified physician who closed her Georgia-based OB-GYN practice to focus on advocating for medical cannabis. “Legislators will keep people of color ... from the benefits of cannabis.”
Nationally, research suggests that medical marijuana use is more common among whites with high incomes, perhaps in part because of the long history of racial disparity in drug enforcement....
Every Southern state by 2016 had legalized the treatment of a limited number of conditions using CBD oil. As public support increased, so did lawmakers’ willingness to expand the list of eligible conditions. But some conditions that affect minority populations at higher rates than white ones — such as sickle cell disease, which affects 73 in 1,000 African-Americans at birth compared with 3 whites, according to federal estimates — are not included in proposals currently making their way through several Southern statehouses.
In a 2017 hearing co-hosted by the Arkansas Medical Marijuana Commission, following a ballot initiative that had legalized medical cannabis, advocates wore “Diversity for All” T-shirts to emphasize the drug’s importance to minority residents. “We know that such diseases as hypertension, sickle cell, neuropathy and so on are more predominant in blacks,” Casey Caldwell, a black cannabis advocate, said at the hearing.
“It is safe to say that African-American communities would benefit the most,” she added. “In the past, pharmaceutical drugs have been priced so high that [we] have to make a decision whether or not they should eat or whether they should purchase medication.”
Those concerns echoed what Dee Dawkins-Haigler, a former Democratic Georgia representative who headed the state’s Black Caucus, said in 2015 about the initial absence of black people among the state’s 17 appointees to the Commission on Medical Cannabis. The Black Caucus eventually fought to get sickle cell disease added to the list of conditions eligible for CBD oil....
In Florida, black farmers initially cried foul at being shut out of the state’s multibillion-dollar cannabis trade over policies that required license holders to have operated for 30 straight years. According to Roz McCarthy, founder of the Florida-based advocacy group Minorities for Medical Marijuana, the state’s law lacked the teeth needed to ensure that medical cannabis license holders adhered to requirements to ensure diversity in hiring. A spokesperson for the Florida Department of Health said that state law “does not require medical marijuana treatment centers to report the race or ethnicity of its owners.”
McCarthy said, “We’re trying to push lawmakers to understand that they have the ability and the power to ensure exclusionary practices don’t happen. Barriers are there. But the opportunity to reduce barriers is also there.”
April 12, 2019 in Campaigns, elections and public officials concerning reforms, History of Marijuana Laws in the United States, Medical Marijuana Commentary and Debate, Medical Marijuana Data and Research, Medical Marijuana State Laws and Reforms, Race, Gender and Class Issues, Who decides | Permalink | Comments (0)
Wednesday, April 10, 2019
The third planned presentations from a student in my Marijuana Law, Policy & Reform seminar this coming week will, in his words, "marshal the tools of critical thinking and scientific skepticism against the mounting claims about medical marijuana." Here is how this student explains his plans and suggested background reading:
I have noticed worrying signs in the medical cannabis industry that bear all the hallmarks of pseudoscience and “alternative medicine.” For example, how many ailments fall under the ever-broadening curative umbrella of CBD? The ability to think critically and skeptically is the most useful skill we have as humans for discerning the truth, and it is most important to engage such skills when our biases most threaten our steady course. Remember the frequent allusions this semester to those who embrace medical legalization as a stepping stone to recreational use? Such people may be more inclined to jettison their critical thinking capabilities when it comes to scrutinizing claims in whose outcome one holds an interest.
I will provide a brief primer on thinking critically and skeptically, and then describe the signs of pseudo-scientific reasoning. Then, armed with this toolkit of sorts, I will explore the various claims about the benefits of cannabis as a medicine, including the current research, its blind spots, and its shortcomings. I will then critically explore the ethics and policy behind prohibition, comparing and contrasting cannabis with prescription drugs and alcohol; we shall see how the claimed justifications for cannabis prohibition stand up to critical scrutiny.
Links to Reading Matter
It is not vital that people read anything prior to the presentation, but here are some useful links for those wishing to get ahead of the game:
Steven Novella et al., The Skeptics’ Guide to the Universe 57–140 (2018).
Of course, I understand that people might not have access to the above-mentioned book, in which case the following website will suffice (although I commend the book highly in its entirety to anyone interested in how we get at the truth of things).
"Logical Fallacies," The Skeptics Guide to the Universe (last visited Apr. 7, 2019).
Scott Gavura, "Medical Marijuana: Where’s the Evidence?," Science-Based Medicine (Jan. 11, 2018)
Steven Novella, "Marijuana Beliefs Outstrip Evidence," Science-Based Medicine (July 25, 2018)
Salomeh Keyhani, MD, MPH; Stacey Steigerwald, MSSA; Julie Ishida, MD, MAS; Marzieh Vali, MS; Magdalena Cerdá, DrPH; Deborah Hasin, PhD; Camille Dollinger, BS; Sodahm R. Yoo, BS; Beth E. Cohen, MD, MAS, "Risks and Benefits of Marijuana Use: A National Survey of U.S. Adults," American College of Physicians: Annals of Internal Medicine (Sept. 4, 2018)
Peter Grinspoon, "Cannabidiol (CBD) — what we know and what we don’t," Harvard Health Publishing: Harvard Health Blog (Aug. 24, 2018)
Sunday, March 31, 2019
The second of four student presentation this coming week in my Marijuana Law, Policy & Reform seminar will focus on federal scheduling under the Controlled Substances Act and the research and market realities impacted by the placement of marijuana in Schedule I. Here is how my student has summarized his topic, along with the background readings he has provided:
The placement of cannabis in Schedule I practically prevents comprehensive and meaningful research into its medical applications and potential harms. The federal government cites cannabis' placement in Schedule I as the reason rigorous research must be conducted before it can be rescheduled, but places restrictions on its research, because of its schedule, that are nearly impossible to overcome. Is there an alternative pathway to federal cannabis legalization, or at least rescheduling, so that more meaningful research can be conducted?
My presentation will examine U.S. drug scheduling, looking at the criteria and examples of substances in each schedule. I will then provide an overview of the FDA research model by which new drugs come to market, contrast it with the type of research conducted on cannabis, and discuss why meaningful, rigorous research into cannabis is so difficult. With this background, I will discuss the findings of a former UK drug-policy adviser that suggests substantial rescheduling is necessary, and how these findings helped initiate research into other Schedule I drugs. Finally, I will provide an overview of research into other Schedule I substances, particularly psychedelics, and how this research may accelerate the rescheduling or federal legalization of cannabis so that its impact on health may be studied more effectively.
March 31, 2019 in Assembled readings on specific topics, Federal Marijuana Laws, Policies and Practices, Medical Marijuana Data and Research, Recreational Marijuana Data and Research, Who decides | Permalink | Comments (1)
Wednesday, March 27, 2019
There is so much talk and so many stories about CBD, I know I can barely scratch the surface on this topic. But it seems this past week I have seen an especially notable number of notable stories on this front. Below I provide a partial round-up, and suggested particular attention to the first linked piece for its science and thoughtfulness:
From Politico, "Flood of products containing marijuana extract puts FDA in a bind"
From Rolling Stone, "CBD Expected to Have Explosive Growth In European Union"
From CNN, "Suddenly, CBD is everywhere. Here's what's next"
From NBC News, "CVS to sell CBD products in 800 stores in 8 states"
From CNBC, "Walgreens to sell CBD products in 1,500 stores"
March 27, 2019 in Assembled readings on specific topics, Business laws and regulatory issues, Medical Marijuana Commentary and Debate, Medical Marijuana Data and Research, Recreational Marijuana Commentary and Debate | Permalink | Comments (0)
Monday, March 25, 2019
"The Effect of Marijuana Use on American Veterans with PTSD, and How the U.S. Department of Veterans Affairs Ought to Respond"
The title of this post is the title of a presentation to be made by one of my students in my Marijuana Law, Policy & Reform seminar this coming week. Here is part of his explanation of his topic and links to some background reading:
Because the U.S. Department of Veterans Affairs (VA) is required to follow all federal laws, the VA is prohibited from prescribing, recommending, or assisting veterans in obtaining marijuana. While veterans may discuss marijuana use with VA providers, VA doctors cannot help their patients participate in a state medical marijuana program and veterans cannot obtain reimbursement funding through the VA when they seek medical marijuana from state programs.
The inability of the VA to prescribe or recommend marijuana to American veterans with PTSD denies former service members an opportunity to receive treatment that many veterans not only want, but which also has the potential to be safer than the VA’s history of doling out addictive prescription drugs such as opioids, antidepressants, and anti-anxiety pills. PTSD is a serious disease that is relatively common among combat veterans — it causes varying symptoms such as flashbacks, nightmares, severe anxiety, and uncontrollable thought about a triggering event.
The medical research in this arena has reached mixed findings. While some researchers have found that the use of medical marijuana by veterans with PTSD has positive results, other studies suggest that marijuana use by those with PTSD may actually make symptoms worse. There simply has not been enough controlled studies to conclusively state whether marijuana is beneficial for those with PTSD. Nonetheless, there is plenty of anecdotal evidence by veterans suggesting that their use of marijuana has improved, or in some cases eliminated, symptoms associated with their PTSD. Fortunately, the first clinical trial of marijuana for American veterans with PTSD is currently underway in Colorado. My presentation will suggest that we need more controlled clinical trials such as this to further identify whether marijuana could (or should) truly be used as a remedy for veterans with PTSD.
* Medical journal article, "Post-Traumatic Stress Disorder" (discussing what PTSD is and various treatment options, including cannabis).
* Medical journal article, "Use and effects of cannabinoids in military veterans with posttraumatic stress disorder"(reviewing several studies and noting that while there is a need for more randomized and controlled studies, some PTSD patients report benefits in terms of reduced anxiety and insomnia and improved coping ability).
* Medical journal article, "Posttraumatic Stress Disorder and Cannabis Use Characteristics among Military Veterans with Cannabis Dependence" (exploring the negative effects of treating PTSD with marijuana and finding that individuals with PTSD may have a particularly difficult experience when attempting to quit marijuana).
* Medical journal article, "Marijuana and other cannabinoids as a treatment for posttraumatic stress disorder: A literature review" (explaining that conclusions cannot yet be drawn about the therapeutic effects of marijuana and related cannabinoids for PTSD; suggesting that rapidly changing legal landscape will permit promising clinical research).
* Medical journal article, "A review of medical marijuana for the treatment of posttraumatic stress disorder: Real symptom re-leaf or just high hopes?" (finding some positive data for use of marijuana for PTSD but also noting conflicting findings and limits of studies conducted thus far).
* Report on study, "Marijuana for Symptoms of PTSD in U.S. Veterans" (first clinical trial of marijuana for PTSD in American veterans underway).
* Recent Weedmaps article, "Marijuana Study Findings Could Hold Promise for Veterans With PTSD" (noting that MAPS study mentioned above could pave the way toward an FDA-approved prescription medicine; anecdotal evidence of veteran using black market rather than expensive medical marijuana program in CA)
March 25, 2019 in Federal Marijuana Laws, Policies and Practices, Medical community perspectives, Medical Marijuana Commentary and Debate, Medical Marijuana Data and Research, Medical Marijuana State Laws and Reforms, Who decides | Permalink | Comments (0)
Saturday, March 9, 2019
This story at Leafy, headlined "As of 2019, Legal Cannabis Has Created 211,000 Full-Time Jobs in America," reports on Leafy's effort to account for job creation in the legal marijuana industry. Here is how the article starts:
How many jobs are there in the legal cannabis industry? It’s a common question — and one the government refuses to answer. Because cannabis remains federally illegal, employment data agencies such as the Bureau of Labor Statistics ignore all jobs related to the industry.
Over the past three months Leafly’s data team, working in partnership with Whitney Economics, has gone state-by-state to tally the total number of direct, full-time jobs in the state-legal cannabis industry.
There are now more than 211,000 cannabis jobs across the United States.
The Leafy accounting is set forth in this relatively short document titled "Special Report: Cannabis Jobs Count." Here is an excerpt:
In early 2017, roughly 120,000 Americans worked in the legal cannabis industry. At that time, 29 states allowed medical marijuana. Four states and the District of Columbia had legalized the adult use of cannabis. National sales in legal markets topped $6.7 billion.
Today, two years later, 34 states have legalized medical marijuana. Ten states and the District of Columbia have legalized cannabis for adult use. Annual sales nationwide are nearing the $11 billion mark. And the number of Americans directly employed in this booming industry has soared to more than 211,000.
When indirect and ancillary jobs — think of all the lawyers, accountants, security consultants, media companies, and marketing firms that service the cannabis industry — are added, along with induced jobs (local community jobs supported by the spending of cannabis industry paychecks), the total number of full-time American jobs that depend on legal cannabis rises to a whopping 296,000.
By comparison, there are currently about 52,000 coal mining jobs in the United States. American beer makers employ 69,000 brewery workers. And 112,000 people work in textile manufacturing.
Tuesday, February 26, 2019
I am grateful for a student in my marijuana reform seminar who made sure that I did not miss this new research in the journal Scientific Reports which share the title of this post and was authored by Sarah Stith, Jacob Vigil, Franco Brockelman, Keenan Keeling and Branden Hall. Here is the research article's abstract:
Federal barriers and logistical challenges have hindered measurement of the real time effects from the types of cannabis products used medically by millions of patients in vivo. Between 06/06/2016 and 03/05/2018, 3,341 people completed 19,910 self- administrated cannabis sessions using the mobile device software, ReleafApp to record: type of cannabis product (dried whole natural Cannabis flower, concentrate, edible, tincture, topical), combustion method (joint, pipe, vaporization), Cannabis subspecies (C. indica and C. sativa), and major cannabinoid contents (tetrahydrocannabinol, THC; and cannabidiol, CBD), along with real-time ratings of health symptom severity levels, prior-to and immediately following administration, and reported side effects. A fixed effects panel regression approach was used to model the within-user effects of different product characteristics.
Patients showed an average symptom improvement of 3.5 (SD = 2.6) on an 11-point scale across the 27 measured symptom categories. Dried flower was the most commonly used product and generally associated with greater symptom relief than other types of products. Across product characteristics, only higher THC levels were independently associated with greater symptom relief and prevalence of positive and negative side effects. In contrast, CBD potency levels were generally not associated with significant symptom changes or experienced side effects.
This public release about the article is headlined "THC found more important for therapeutic effects in cannabis than originally thought," and it provides a useful summary of the research methods and findings.
From the Akron Beacon Journal, "Ohio medical marijuana recommendations coming from clinics, not family doctors"
If you know someone who has received a recommendation to use medical marijuana, odds are the recommendation didn’t come from a family doctor or primary-care physician. The vast majority of recommendations in Ohio come from clinics that employ doctors solely to evaluate patients for medical marijuana, say people familiar with the industry....
“Marijuana-specific clinics fill a huge need,” said Dr. Joel Simmons, who runs the Ohio Herbal Clinic, a Near East Side cannabis clinic. While the clinics, many of which have out-of-state owners, have some critics, patient advocates say primary-care doctors are the ideal source for marijuana recommendations.
Those doctors better understand a patient’s needs and medical history, said Mary Jane Borden, co-founder of the Ohio Rights Group, which advocates for users of medicinal cannabis. When Ohio lawmakers wrote the state’s medical-marijuana law, they hoped that family physicians would be writing most recommendations, Borden said....
Clinics charge between $125 and $200 for an evaluation, which insurance won’t cover. Because the clinics don’t negotiate with insurance companies, they clinics can charge whatever they want, said Emilie Ramach, founder and CEO of Compassionate Alternatives, a Columbus-based nonprofit agency that helps patients pay for medicinal cannabis. Several clinic doctors, including Simmons, said they do their best to keep their prices reasonable.
From the Columbus Dispatch, "High prices keep many Ohioans out of legal cannabis market"
As Ohio’s medical marijuana industry finally takes off, some patients and advocates are griping about costs that put it out of reach for many people. A steep price tag stems partly from the lack of competition, as Ohio only has seven dispensaries spread throughout the state, mostly in rural areas, experts said. Costs are expected to drop as more dispensaries open and the industry finds its footing.
In the meantime, patients openly acknowledge buying the drug on the black market while they wait for prices to come down. And without insurance to cover the expense, some worry that low-income people might never be able to afford medical cannabis....
Several local patients said using marijuana has improved their quality of life, but they must stretch their budgets to pay for it or buy it on the street. “I’m not using as much as I probably need to be using,” said Mary Alleger, 31, of Reynoldsburg, who said she uses cannabis to treat post-traumatic stress disorder (PTSD) and ongoing pain from a botched medical procedure.
Katherin Cottrill, 33, of Newark, has worked with the patient advocacy organization Ohio Rights Group to acquire a medical marijuana card, but said current costs keep her from even getting started. “I would have to pay $200 to $250 (just to get a recommendation),” Cottrill said. “And then I have to drive to a dispensary and pay $50. It’s unreasonable for me to even try.”...
Just under 3 grams of medical marijuana costs about $50. Cannabis clinics charge between $125 and $200, and the state charges $50 in fees. Marijuana is cheaper on the street, patients said.
“On the black market you can buy an ounce for $200,” said Robert Doyle, 61, of Newark, who has a medical marijuana card but still buys the drug on the street due to the cost. There are about 28 grams in an ounce. Doyle said he’s visited dispensaries in Michigan with prices comparable to the black market, making him confident that Ohio’s costs will eventually fall....
But even if prices drop, clinic costs and fees will remain a barrier for some, Cottrill said. “What about low-income people who are desperately seeking medication?” she said. “They can’t even afford to pay $50 to get their card registered.”
February 26, 2019 in Business laws and regulatory issues, Medical community perspectives, Medical Marijuana Commentary and Debate, Medical Marijuana Data and Research, Medical Marijuana State Laws and Reforms, Who decides | Permalink | Comments (1)
Tuesday, February 19, 2019
The title of this post is the title of this notable new article just published in the journal Justice Quarterly and authored by Lorine Hughes, Lonnie Schaible & Katherine Jimmerson. Here is the paper's abstract:
Beginning with Colorado and Washington State in 2012, longstanding bans on the sale, possession, and use of marijuana for recreational purposes have been overturned in nine states and the nation’s capital. Consistent with the logic of routine activity theory and broken windows theory, critics of legalized marijuana argue that dispensaries are magnets for crime, attracting criminal offenders to the area with large sums of cash and valuable goods. The current study addresses this possibility by examining the effects of both medical and recreational marijuana dispensaries on yearly crime rates in N = 3981 neighborhood grid cells in Denver, Colorado, 2012–2015. Estimates from Bayesian spatiotemporal Poisson regression models indicate that, except for murder and auto theft, both types of dispensaries are associated with statistically significant increases in rates of neighborhood crime and disorder. The theoretical and policy implications of these findings are discussed.
This notice about the research provides additional background and findings. Here are excerpts therefrom:
"We found that neighborhoods with one or more medical or recreational dispensary saw increased crime rates that were between 26 and 1,452% higher than in neighborhoods without any commercial marijuana activity," notes Lorine A. Hughes, associate professor in the School of Public Affairs at the University of Colorado Denver, who led the study. "But we also found that the strongest associations between dispensaries and crime weakened significantly over time."...
The study found that except for murder, the presence of at least one medical marijuana dispensary was associated with a statistically significant increase in neighborhood crime and disorder, including robbery and aggravated assault. The study also found a relatively strong association between medical marijuana dispensaries and drug and alcohol offenses, with a decline in the strength of the link after recreational marijuana was legalized. The pattern of results was similar for recreational marijuana dispensaries, though the study found no direct relation to auto theft.
The authors caution that the results of the study, based only on information from Denver immediately after legalization and before market saturation, may not be generalizable to other geographic areas. They also note that because the study relied on official police data to measure crime and disorder, it's possible that police targeted neighborhoods with marijuana dispensaries, which would over-estimate the association between these facilities and crime and disorder.
"Our findings have important implications for the marijuana industry in Denver and the liberalization of marijuana laws nationwide," suggests Lonnie M. Schaible, associate professor in the School of Public Affairs at the University of Colorado Denver, who coauthored the study. "Although our results indicate that both medical and recreational marijuana dispensaries are associated with increases in most major crime types, the weak strength typical of these relationships suggests that, if Denver's experience is representative, major spikes in crime are unlikely to occur in other places following legalization."
The authors suggest that, rather than fighting to oppose legalized marijuana, which has become a multibillion-dollar industry and is expected to create more than a quarter of a million jobs by 2020, it may be more expedient to develop and support secure and legal ways for dispensaries to engage in financial transactions.
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.