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Study: Cannabis Not Associated With Higher Risk of Motor Vehicle Accident

Portland, OR: The use of alcohol, but not cannabis, is associated with greater odds of suffering a motor vehicle crash requiring emergency care, according to case-control data published in the journal Accident Analysis and Prevention.

A team of investigators from universities in California, Colorado, and Oregon examined the relationship between cannabis and alcohol use and incidences of motor vehicle collisions (MVC) among patients admitted to emergency departments.

They determined that those who either self-reported or tested positive for the use of alcohol alone possessed a crash risk that was more than twice (OR = 2.50) that of controls (those who tested negative). By contrast, those who either self-reported or tested positive for cannabis possessed a lower risk of accident (OR = .80) than controls.

Those patients who either self-reported or tested positive for the use of both alcohol and cannabis in some instances possessed a higher risk of accident than those who used either substance alone. That finding that is consistent with several prior studies, but others have failed to report this outcome.

Authors concluded: “This was a cross-sectional study of visits to EDs [emergency departments] in Denver, CO, Portland, OR, and Sacramento, CA by drivers who were involved in MVCs and presented with injuries (cases) and non-injured drivers (controls) who presented for medical care. … Our study supported an increased risk for MVC among those with acute alcohol and combined alcohol and cannabis use. Some of our findings suggested an absence of added odds or even reduced odds for MVC among those using cannabis alone prior to driving. … Overall, our study reinforces that in this era of increased liberalization of cannabis, emphasis on actual driving behaviors and clinical signs of intoxication, rather than specific drug-level thresholds, to determine driving under the influence has the strongest rationale.”

NORML has long opposed the imposition of per se THC thresholds for motorists and has alternatively called for the expanded use of mobile performance technology like DRUID to determine whether someone is under the influence.

Full text of the study, “Risk of vehicle collision associated with cannabis and alcohol use among patients presenting for emergency care,” appears in Accident Analysis and Prevention.

Clinical Trial: Cannabis Consumption Associated With Reduced Anxiety

Boulder, CO: The use of state-legal cannabis products is associated with reduced levels of anxiety, according to clinical trial data published in the journal Cannabis and Cannabinoid Research.

Investigators affiliated with the University of Colorado at Boulder assessed subjects’ use of three distinct cannabis chemovars on symptoms of anxiety. Study participants consumed cannabis flower that was either high in THC, high in CBD, or that contained equal levels of THC and CBD ad libitum for four weeks.

Use of all three cannabis varieties was associated with improvements in anxiety symptoms. Those who consumed cannabis that was high in CBD reported the most significant improvements.

The study’s authors concluded: “This quasi-randomized study showed that individuals with generalized anxiety symptoms who used cannabis 3–4 days per week reported reduced anxiety and improved symptoms over the study. The CBD-dominant strain was associated with the greatest reduction in anxiety-related states both acutely and over a period of four weeks. [These] findings extend data on the anxiolytic effects of CBD to naturalistic use and real-world setting and suggest that these effects over a relatively short time frame may translate into longer-term anxiety reductions.”

In January, British scientists writing in the journal Neuropsychopharmacology Reports similarly reported that patients with generalized anxiety disorder exhibit sustained improvements following the use of cannabis products.

Full text of the study, “Acute and extended anxiolytic effects of cannabidiol in cannabis flower: A quasi-experimental ad libitum use study,” appears in Cannabis and Cannabinoid Research.

Poll: Likely Voters Say That Marijuana Should Be Legal for Adults Nationwide

Alexandria, VA: Nearly six in ten likely voters believe that the use of marijuana should be legal in all 50 states, according to nationwide polling data compiled by the Republican-leaning polling firm The Tarrance Group.

Fifty-seven percent of respondents favored a policy of nationwide legalization. Support was strongest among Democrats under the age of 55 (74 percent); however, a majority (55 percent) of Republicans under age 55 also supported legalization.

Regardless of political party, sixty-seven percent of younger voters (ages 18 to 44) backed legalization.

“Majority support exists for marijuana legalization, driven by Democratic and younger voters, as well younger independents and a majority of younger Republicans,” pollsters concluded.

The poll is the latest in a long line of nationwide surveys showing majority support among Americans for ending marijuana criminalization.

The Politics and Advocacy Poll data is available from the Tarrance Group.

Survey: Consumers of CBD Products Frequently Report Using Them in Place of Prescription Medications

Lawrence, KS: Many consumers of CBD products report that they use them as substitutes for prescription medications, according to survey data published in the journal Mental Health Clinician.

Researchers with the University of Kansas School of Pharmacy conducted a nationwide survey of Americans’ use of CBD products. Among those respondents who acknowledged using CBD, nearly one-third reported doing so to mitigate symptoms of anxiety. One-quarter of respondents said they used CBD products for depression and 22 percent said that they used them for pain management.

More than 70 percent of CBD consumers said that it helped alleviate their symptoms and 39 percent acknowledged having “discontinued a prescription medication in favor of CBD.”

Forty-five percent of respondents failed to inform their healthcare providers about their use of CBD products. Prior surveys of healthcare providers report that most providers are either “hesitant” or “uncomfortable” talking about CBD with their patients.

The study’s authors concluded: “[C]onsumers perceived CBD to be safe, effective, and adequately studied for medical purposes. … With the wide availability of CBD, HCPs [health care providers] should be knowledgeable and prepared to provide patients with evidence-based information about CBD.”

Survey data compiled by the National Consumers League reports that more than eight in ten voters desire federal regulatory oversight over the production and marketing of commercially available CBD products, which often contain inaccurate labeling and may contain impurities.

Full text of the study, “Consumer perception, knowledge, and uses of cannabidiol,” appears in Mental Health Clinician.

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CDC Analysis: Youth Cannabis Use Declining, Legalization Likely Responsible

Seattle, WA: Marijuana use by teens fell significantly in King County, Washington (population: 2.3 million) following the state’s adoption of adult-use legalization, according to data provided by the US Centers for Disease Control and Prevention.

Investigators reported that cannabis use fell 60 percent among males and 42 percent among females from 2012 to 2021. (Voters approved a ballot initiative legalizing the adult use market in 2012; retail cannabis sales began in 2014.)

The study’s authors suggested that legalization likely made it more difficult for teens to access cannabis.

“The observed overall decreases in cannabis use among students in grades 8, 10, and 12 might be associated with changes in the availability of cannabis among persons aged >=21 years as well as limited opportunities to engage in use,” they wrote. “The period 2012–2014 includes the legalization of nonmedical cannabis in Washington in 2012. Researchers studying the association of cannabis laws with cannabis use among high school students have observed similar declines in cannabis use after legalization of nonmedical cannabis. The legalization of nonmedical cannabis for adults aged >=21 years in Washington with licensed dispensaries requiring proof of age might have affected availability of cannabis to younger persons as well as their opportunities to engage in its use. This, in turn, might have had an impact on use prevalence.”

The authors’ findings are consistent with those of several other studies documenting declines in young people’s use of cannabis following states’ adoption of adult-use legalization laws.

Full text of the study, “Cannabis use among students in grades 8. 10, and 12, by sex: King County, Washington, 2008-2012,” is available from the Centers for Disease Control and Prevention.

Study: THC Blood Levels Not Correlated With Changes In Driving Performance

Toronto, Canada: The presence of THC in blood is not predictive of detriments in psychomotor performance, according to driving simulator data published in the journal JAMA Network Open.

Researchers affiliated with the University of Toronto assessed subjects’ simulated driving performance at baseline and then again 30 and 180 minutes after smoking cannabis. Participants were between the ages of 65 and 79 years old and smoked cannabis (mean THC potency: 19 percent) ad libitum prior to driving.

Subjects exhibited “small changes in SDLP [weaving]” 30 minutes after cannabis inhalation. Investigators described these changes as less pronounced than those associated with drivers with a BAC below 0.05 percent.

Consistent with the results of prior studies, participants decreased their speed after smoking and were more likely to self-assess their performance as “impaired.” Cannabis use did not impact participants’ reaction times.

Subjects’ simulated driving performance returned to baseline within three hours.

The study’s authors concluded: “The purpose of the present study was to investigate the association between cannabis and driving and blood THC levels in older adults. … There was no correlation between blood THC concentration and SDLP [standard deviation in lateral positioning] or MS [mean speed]. … The lack of correlation between driving and blood THC fits within emerging evidence that there is not a linear relationship between the two.”

That conclusion is consistent with numerous studies reporting that neither the detection of THC nor its metabolites in blood and/or other bodily fluids is predictive of impaired driving performance. As a result, NORML has long opposed the imposition of per se THC limits for motorists and has alternatively called for the expanded use of mobile performance technology like DRUID.

Full text of the study, “Cannabis and driving in older adults,” appears in JAMA Network Open.

Analysis: Cannabis Use In Adolescence Not Independently Linked To Poorer Educational Outcomes

Helsinki, Finland: The use of alcohol, but not cannabis, in adolescence is independently associated with poorer educational attainment, according to longitudinal data published in the journal BMC Public Health.

Finnish investigators assessed the relationship between the use of cannabis and alcohol by adolescents and lifetime educational attainment in a cohort of more than 6,500 subjects.

They reported that the frequent use of alcohol during adolescence was significantly associated with poorer lifetime educational attainment after controlling for confounders. By contrast, early-onset cannabis use was not a statistically significant risk factor after researchers controlled for other variables.

The study’s authors concluded: “In this large birth cohort study with a 17-year follow-up, younger age at first intoxication, higher frequency of alcohol intoxication, and high self-reported alcohol tolerance at age 15/16 years were associated with poorer educational outcomes by the age of 33 years. These adverse associations were evident regardless of a range of potential confounders, such as behavioral/emotional problems at age 7/8 years and parental education level. The association between adolescent lifetime cannabis use and educational attainment in adulthood was no longer statistically significant after adjusting for potential confounders including alcohol use. Our finding that inherent alcohol tolerance in adolescence was associated with subsequent educational attainment has not been previously reported.”

Full text of the study, “Adolescent alcohol and cannabis use in early adulthood educational attainment in the 1986 Finland birth cohort study,” appears in BMC Public Health.

New Jersey: Regulators Finalize Plans For Opening Cannabis Cafes

Trenton, New Jersey: State regulators have signed off on rules governing the operation of cannabis consumption lounges. Regulators are expected to review business applications in the coming months.

Under the plan, dispensary owners would be eligible to open no more than one café. Patrons must be 21 to enter and sales of food or alcohol are prohibited.

Fewer than half of legal cannabis states permit on-site cannabis consumption facilities.

New Jersey legalized the adult-use cannabis market in 2021.

Additional information is available from the New Jersey Cannabis Regulatory Commission.

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Study: Medical Cannabis Associated With Symptom Improvements In Patients With Major Depressive Disorder

Essen, Germany: The use of medical cannabis products is associated with reduced levels of depression, according to data published in the journal Pharmacopsychiatry.

German investigators assessed medical cannabis use in a cohort of 59 outpatients suffering from major depressive disorder (MDD). (Plant cannabis and cannabinoid treatments, such as dronabinol, were legalized by prescription use in Germany in 2017; however, such products are typically only authorized when patients are unresponsive to traditional therapies.) Study participants used cannabis products for 18 weeks.

“Mean severity of depression decreased from 6.9 points at entry to 3.8 points at week 18,” they reported. “A treatment response (>50 percent reduction of the initial score) was seen in 50.8 percent [of study subjects] at week 18.”

The study’s authors concluded: “Medical cannabis was well-tolerated and [the] dropout rate was comparable to those in clinical trials of antidepressant medication. Patients reported a clinically significant reduction of depression severity. Further research on the effectiveness of medical cannabis for MDD seems warranted.”

The study’s findings are consistent with recently published data from the United Kingdom, which determined, “Medicinal cannabis was associated with improvements in depression and anxiety symptoms, as well as health-related quality of life, and sleep quality after 1, 3, and 6 months of treatment.”

Full text of the study, “Effectiveness of medical cannabis for the treatment of depression: A naturalistic outpatient study,” appears in Pharmacopsychiatry.

Analysis: Cannabis Use Plays Little Role In Cardiovascular Deaths Related To Substance Use

Jackson, MS: The use of alcohol is implicated in the majority of substance use-related cardiovascular deaths, according to data published in the Journal of the American Heart Association.

Researchers affiliated with the University of Mississippi Medical Center analyzed substance use-related mortality trends from 1999 to 2019.

They reported that alcohol likely played a role in 65 percent of all cardiovascular deaths related to substance use. Opioids were implicated in 14 percent of deaths and cocaine was linked to just under ten percent of deaths. Cannabis was associated with fewer than one percent of all substance use-related cardiovascular deaths.

“Substances evaluated in our analysis, including alcohol, cannabis, cocaine, opioids, and stimulants, have multiple cardiovascular effects and are associated with the development of cardiomyopathy, arrhythmias, microvascular disease, and coronary artery disease, particularly in the case of cocaine and stimulants,” the study’s authors concluded. “Among the substances evaluated in our study, alcohol was the most common to be associated with SU [substance use] + CVD [cardiovascular disease]‐related death, more than four times opioids, the second‐highest substance. … [C]annabis had the lowest SU + CVD-related absolute AAMR [age adjusted mortality rate].”

Data assessing cannabis’ potential role in adverse cardiovascular events, such as heart attack and stroke, has yielded inconsistent results. For instance, the findings of a meta-analysis published in May concluded, “Cannabis use insignificantly predicts all major cardiovascular adverse events,” including myocardial infarction and stroke. By contrast, data published more recently in the journal Addiction reported that adults engaged in problematic cannabis use possess an elevated risk of adverse cardiovascular outcomes.

Similarly, data published this month in the European Heart Journal reported that pain patients using medical cannabis products possessed a slightly increased risk of atrial fibrillation (AFib), whereas longitudinal data reported just days earlier in the journal Heart Rhythm identified no elevated risk.

Full text of the study, “Temporal trends in substance use and cardiovascular disease-related mortality in the United States,” appears in the Journal of the American Heart Association.

Analysis: Cannabis Products Provide Sustained Improvements In Patients With Generalized Anxiety Disorder

London, United Kingdom: Patients with generalized anxiety disorder (GAD) exhibit sustained improvements in their symptoms following the use of cannabis products, according to data published in the journal Neuropsychopharmacology Reports.

British investigators assessed the safety and efficacy of plant-derived cannabis products (either oils, flower, or a combination of both) in over 300 patients enrolled in the UK Medical Cannabis Registry. Cohort participants possessed a doctor’s authorization to access cannabis products. (Since 2018, specialists have been permitted to prescribe cannabis-based medicinal products to patients unresponsive to conventional medications.) Authors assessed the efficacy of cannabis at one, three, six, and 12 months.

Consistent with prior studies, cannabis treatment was associated with persistent improvements in patients’ anxiety, sleep, and health-related quality of life. Patients presenting with severe baseline anxiety were most likely to experience a clinically significant improvement in anxiety symptoms at 12 months.

Researchers concluded: “The findings from this cohort study demonstrate that treatment with CBMPs [cannabis-based medicinal products] is associated with statistically significant improvements across anxiety-, sleep-, and HRQoL-specific PROMs [patients-reported outcome measures] after 12 months in patients with GAD. … Results also indicated CBMPs were well tolerated throughout the study. … Patients were prescribed either oils, dried flower, or a combination of both, and this study identified no difference in outcomes at 12 months between treatment groups.”

Other studies assessing the use of cannabis products in patients enrolled in the UK Cannabis Registry have reported them to be effective for those suffering from chronic pain, post-traumatic stress, depression, migraine, inflammatory bowel disease, and other afflictions.
Full text of the study, “A cohort study comparing the effects of medical cannabis for anxiety patients with and without comorbid sleep disturbance,” appears in Neuropsychopharmacology Reports.

Survey: Cannabis Use Is “Widespread” Among Cancer Survivors

Houston, Texas: Nearly half of US cancer survivors report having used cannabis, according to survey data published in the journal Cancers.

Investigators affiliated with the University of Texas, Anderson Cancer Center and John Hopkins University surveyed 1,886 cancer survivors from 41 states.

Just under half (48 percent) of respondents acknowledged having experience with cannabis. Approximately one-third of them reported using cannabis following their cancer diagnosis. Patients were most likely to report inhaling cannabis flower or consuming oil extracts.

“Many cancer survivors use cannabis as a palliative while undergoing cancer treatment, and this usage tends to rise following cancer diagnosis,” the study’s authors reported. “This suggests that cancer survivors often turn to cannabis to cope with their diagnosis or manage treatment-related symptoms.”

They concluded: “Cannabis use is widespread among cancer patients; therefore, regulatory guidance is even more critical at this time. As cannabis becomes more accessible for medicinal and recreational use, it is important to strengthen the regulatory framework for its use to minimize the untoward effects of cannabis use in cancer management.”

Prior surveys find that cancer patients commonly report consuming cannabis to aid with sleep and to “improve their ability to cope with their illness.” Nonetheless, many healthcare providers acknowledge that they are unprepared to discuss cannabis therapy with cancer patients.

Full text of the study, “Cannabis use among cancer survivors: Use pattern, product type, and timing of use,” appears in Cancers.

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Twin Study: Lifetime Cannabis Exposure Not Linked To Significant Changes In Mental Health Or Other Psychosocial Outcomes

Minneapolis, MN: The cumulative use of cannabis over several decades is not associated with a significantly elevated risk of either psychiatric disorders, cognitive decline, or other adverse psychosocial outcomes, according to longitudinal data published in the Journal of Psychopathology and Clinical Science.

Investigators affiliated with the University of Minnesota and the University of Colorado assessed the long-term impact of cannabis use on psychiatric and psychosocial outcomes in a sample of more than 4,000 adult twins. Subjects were assessed from 1994 to 2021.

“This study suggests that lifetime exposure to cannabis has few persistent effects on mental health and other psychosocial outcomes,” researchers reported. “We did not identify within-pair differences in cognitive ability. … Cannabis consumption did not predict within-pair differences in psychoticism.”

Researchers cautioned that heavy cannabis use could elevate the risk of so-called ‘cannabis use disorder,’ tobacco use, and experimentation with other controlled substances.

The study’s authors concluded: “Broadly speaking, our results do not support a causal relationship between lifetime average cannabis frequency and most of the substance use, psychiatric, and psychosocial outcomes assessed here. Rather, genetic and familial confounding most likely explain the relationships between cannabis use and the negative outcomes associated with it. ... The lack of within-pair effects, or small effects for those existing within-pair differences, in our primary outcome suggest that cumulative cannabis use does not have large, or lasting effects on many psychosocial outcomes.”

Full text of the study, “Limited psychological and social effects of lifetime cannabis use frequency: Evidence from a 30-year community study of 4,078 twins,” appears in the Journal of Psychopathology and Clinical Science.

Survey: Pain Patents Report That Cannabis Is “More Effective” Than Conventional Medications

Berlin, Germany: Patients with chronic pain and other conditions report that cannabis is often more effective than conventional treatments, according to survey data published in the journal Frontiers in Medicine.

German researchers surveyed patients’ experiences with cannabis products. (Plant cannabis and cannabinoid treatments, such as , were legalized by prescription use in Germany in 2017; however, such products are typically only authorized when patients are unresponsive to traditional therapies.) Over 200 patients participated in the survey. Most respondents suffered from chronic pain and over two-thirds of the survey’s participants consumed cannabis flowers or plant-derived extracts.

Consistent with numerous other studies, patients reported reductions in their daily pain following cannabis therapy. Patients also said that they were less likely to be either anxious or depressed while using cannabis. Participants reported “greater satisfaction” with cannabis and said that it was “more effective” than their prior therapies. Ninety-four percent of those surveyed reported holding more positive attitudes toward cannabis following treatment.

“The results of this cross-sectional survey suggest that most surveyed outpatients treated with prescription cannabinoids in Germany subjectively experience health benefits and symptom reduction associated with these therapies,” the study’s authors concluded.

Full text of the study, “Patients’ perspectives on prescription cannabinoid therapies: A cross-sectional, exploratory, anonymous, one-time web-based survey among German patients,” appears in Frontiers in Medicine.

Study: Cannabis/opioid Co-administration Effective For Hospice Patients

New Haven, CT: Hospice patients administered plant-derived CBD-dominant capsules experience significant pain relief and reduce their daily opioid intake, according to data published in the American Journal of Hospice & Palliative Care.

Researchers affiliated with Yale University assessed the efficacy of the adjunctive use of cannabis products in a cohort of 66 hospice patients. Subjects in the study were administered oral capsules containing either 40mg CBD/1.5mg THC or 80mg CBD/3mg THC. All patients enrolled in the study were taking opioids for pain management.

Investigators reported: “Combination therapy led to a statistically significant reduction in pain intensity over time, aligning with previous research suggesting that cannabinoids … can modulate pain pathways and enhance the analgesic effects of opioids.”

They further acknowledged, “The average opioid dose used in combination with medical cannabis in our study decreased over time – while patients simultaneously showed statistically significant improved pain scores. While the decrease in opioid dose did not reach statistical significance, this trend may support a stabilizing effect of combination therapy on opioid dose.”

The study’s authors concluded: “Our study highlights the potential benefit of medical cannabis co-administration with opioid therapy for pain management in hospice inpatients, demonstrating statistically significant pain reduction over time with minimal adverse events. These findings contribute to the growing body of evidence supporting the use of medical cannabis as an adjunctive treatment for pain management.”

The findings are consistent with those of other studies reporting that the co-administration of either smoked cannabis or oral cannabinoids augments the pain-relieving effects of opioids, even when both substances are administered at subtherapeutic doses.

Full text of the study, “Medical marijuana for pain management in hospice care as a complementary approach to scheduled opioids: A single arm study,” appears in the American Journal of Hospice & Palliative Care.

Survey: Some Physicians Endorse Cannabis-Based Treatments for Children with Cerebral Palsy

Bern, Switzerland: Physicians are recommending cannabis-based treatments for children suffering from cerebral palsy (CP), according to survey data published in the journal Children.

Swiss researchers surveyed 70 physicians with experience treating children with cerebral palsy. Physicians participating in the survey resided in Europe, North America, and Australia.

Forty-seven percent of respondents reported having authorized cannabis-based therapies (e.g., Dronabinol, Epidiolex, whole-plant cannabis extracts, or CBD) to their pediatric patients, typically as an adjunctive therapy. Doctors were most likely to recommend cannabinoids for treating seizures, spasticity, and pain. Sixty-nine percent of respondents reported that cannabis-based treatments provided either “strong” or “moderate” effects on CP symptoms.

The study’s authors concluded: “This international online survey assessed the prescribing practices of cannabinoids in children with CP by their treating physicians. The participating physicians acquired their knowledge about cannabinoids mainly outside their medical training. The physicians frequently prescribed differing formulas of cannabinoids for various indications in children with CP. The most common indications were epilepsy, spasticity, and pain, and treatment was initiated as co-medication or second-line treatment. Overall, physicians perceived a moderate efficacy of cannabinoids and no long-term side effects.”

Survey data published last year in the journal Orthopedics reported that 17 percent of US pediatric patients with CP are using CBD supplements to mitigate disease symptoms.

Full text of the study, “Prescription practices of cannabinoids in children with cerebral palsy worldwide -- A survey of the Swiss cerebral palsy registry,” appears in Children.

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Study: Cannabis Use Not Associated With Elevated Risk of Atrial Fibrillation

San Francisco, CA: Middle-aged adults with a history of cannabis consumption do not possess an increased risk of suffering from atrial fibrillation (AFib), according to longitudinal data published in the journal Heart Rhythm.

Investigators affiliated with the University of California, San Francisco assessed the relationship between cannabis and AFib (irregular heartbeat) in a cohort of more than 150,000 subjects between the ages of 40 and 69. The cohort included non-users, occasional users, and frequent users. Researchers tracked the study’s participants for six years.

Researchers found “no evidence” that subjects who used cannabis were more likely than non-users to suffer from atrial fibrillation.

“Among a large, prospective cohort, we were unable to find evidence that occasional cannabis use [defined as more than 100 times] was associated with a higher risk of incident AF,” the study’s authors concluded. “To our knowledge, this is the first longitudinal cohort study to assess such recreational use and the first to report an absence of a relationship between cannabis use and risk of AF.”

AFib is associated with an increased risk of stroke and other adverse cardiovascular events.

Data published in October reported that middle-aged cannabis consumers do not possess an elevated risk of atherosclerosis (hardening of the arteries) as compared to never users. The findings of a meta-analysis published in May concluded, “Cannabis use insignificantly predicts all major cardiovascular adverse events,” including myocardial infarction and stroke. By contrast, data published recently in the journal Addiction reported that adults engaged in problematic cannabis use possess an elevated risk of adverse cardiovascular outcomes.

Full text of the study, “Cannabis use and incident of atrial fibrillation in a longitudinal cohort,” appears in Heart Rhythm.

Analysis: Legalization Not Associated With Spikes in Incidences of Marijuana-Related Psychosis

London, Canada: The legalization of the Canadian marijuana market is not associated with increases in rates of cannabis-related psychosis, according to data published in the International Journal of Drug Policy.

A team of Canadian researchers examined regional changes in health services use and incidences of psychotic disorders during the months immediately following legalization. (Canada legalized marijuana possession and retail sales in October 2018.)

They reported, “We did not find evidence of increases in health service use or incident cases of psychotic disorders over the short-term (17 month) period following cannabis legalization.” They cautioned, however, that “a longer post-legalization observation period ... is needed to fully understand the population-level impacts of non-medical cannabis legalization.”

The finding is consistent with the conclusions of a 2022 study published in the Canadian Journal of Psychiatry. Its authors similarly determined that the “implementation of Canada’s cannabis legalization framework was not associated with evidence of significant changes in cannabis-induced psychosis or schizophrenia ED [emergency department] presentations.”

In the United States, state-level marijuana legalization laws have not been associated with a statistically significant increase in psychosis-related health outcomes. Specifically, a 2022 paper published in the Journal of the American Medical Association (JAMA) Network Open found no association between the adoption of marijuana legalization and overall rates of psychosis-related diagnoses or prescribed antipsychotics.

Although the use of cannabis and other controlled substances tends to be more common among those with psychotic illnesses, studies indicate that lifetime incidences of marijuana-induced psychosis are relatively rare among those who do not have a prior psychiatric diagnosis. According to one recently published study, fewer than one-half of one percent of cannabis consumers had ever reported experiencing psychotic symptoms requiring medical intervention – a percentage that is lower than the rate associated with alcohol.
Full text of the study, “Impact of non-medical cannabis legalization with market restrictions on health service use and incident cases of psychotic disorder in Ontario, Canada,” appears in the International Journal of Drug Policy.

Analysis: Legalization Not Associated With Spikes in Incidences of Marijuana-Related Psychosis

London, Canada: The legalization of the Canadian marijuana market is not associated with increases in rates of cannabis-related psychosis, according to data published in the International Journal of Drug Policy.

A team of Canadian researchers examined regional changes in health services use and incidences of psychotic disorders during the months immediately following legalization. (Canada legalized marijuana possession and retail sales in October 2018.)

They reported, “We did not find evidence of increases in health service use or incident cases of psychotic disorders over the short-term (17 month) period following cannabis legalization.” They cautioned, however, that “a longer post-legalization observation period … is needed to fully understand the population-level impacts of non-medical cannabis legalization.”

The finding is consistent with the conclusions of a 2022 study published in the Canadian Journal of Psychiatry. Its authors similarly determined that the “implementation of Canada’s cannabis legalization framework was not associated with evidence of significant changes in cannabis-induced psychosis or schizophrenia ED [emergency department] presentations.”

In the United States, state-level marijuana legalization laws have not been associated with a statistically significant increase in psychosis-related health outcomes. Specifically, a 2022 paper published in the Journal of the American Medical Association (JAMA) Network Open found no association between the adoption of marijuana legalization and overall rates of psychosis-related diagnoses or prescribed antipsychotics.

Although the use of cannabis and other controlled substances tends to be more common among those with psychotic illnesses, studies indicate that lifetime incidences of marijuana-induced psychosis are relatively rare among those who do not have a prior psychiatric diagnosis. According to one recently published study, fewer than one-half of one percent of cannabis consumers had ever reported experiencing psychotic symptoms requiring medical intervention – a percentage that is lower than the rate associated with alcohol.
Full text of the study, “Impact of non-medical cannabis legalization with market restrictions on health service use and incident cases of psychotic disorder in Ontario, Canada,” appears in the International Journal of Drug Policy.

Analysis: Few Serious Adverse Events Associated With Medical Cannabis Use

Montreal, Canada: Few patients authorized to consume medical cannabis products report experiencing serious side effects, according to data published in the journal Drug Safety.

McGill University researchers analyzed data from a cohort of nearly 3,000 authorized Canadian medical cannabis patients. Data regarding adverse events was collected by enrollees’ attending physicians over a period of several years.

A total of 108 patients (about four percent of the cohort) reported experiencing marijuana-related adverse events. The most frequently reported side effects were dizziness, somnolence, headache, nausea, and vomiting.

Patients with mental health disorders were no more likely than others to report side effects from cannabis treatment. The latter finding is consistent with data from a 2022 study, which found that authorized Canadian patients were at low risk for psychiatric hospitalizations resulting from their medical cannabis use.

The study’s authors concluded: “This is the first comprehensive, population-level prospective study to contribute evidence that MC [medical cannabis] is safe for a wide variety of symptoms. ... No new safety concerns were identified relative to the published literature, although notable differences in AE [adverse events] profile between modes of administration and cannabinoid content ratios should be considered by health professionals.”

Full text of the study, “A descriptive analysis of adverse event reports from the Quebec Cannabis Registry,” appears in Drug Safety.

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Recap of Top #Stories from Last Year; To be Topped in 2024?

#1: MORE STATES ENACT ADULT-USE MARIJUANA LEGALIZATION LAWS

Delaware, Minnesota, and Ohio enacted laws in 2023 legalizing adult-use marijuana possession and providing timelines for regulating retail cannabis markets. In addition, Maryland lawmakers passed legislation in May regulating adult-use marijuana sales. Those sales began on July 1st. In January, lawmakers in the US Virgin Islands also approved an adult-use legalization law, though its provisions have yet to take effect.

“For the first time since the adoption of federal marijuana prohibition, more US citizens reside in jurisdictions where cannabis is state-legal than live somewhere where it is not,” NORML Deputy Director Paul Armentano said.

#2: HHS RECOMMENDS DEA RECLASSIFY CANNABIS AS A SCHEDULE III SUBSTANCE

Bloomberg News reported in August that it had obtained a leaked letter from the Department of Health and Human Services (HHS) recommending that the US Drug Enforcement Administration reclassify cannabis from a Schedule I to a Schedule III controlled substance under federal law. The Biden Administration initiated the review last year.

The DEA, which has the final authority regarding drug scheduling under the Controlled Substances Act, has yet to publicly take any action on the matter.

NORML has criticized proposals calling for cannabis to be rescheduled from Schedule I to Schedule III, opining, “Rescheduling marijuana fails to provide states with the explicit legal authority to regulate it within their borders as they see fit, free from federal interference.” Rather, NORML calls for removing cannabis from the CSA altogether in a manner similar to alcohol.

#3: MORE AMERICANS THAN EVER SAY CANNABIS SHOULD BE LEGAL FOR ADULTS

A record 70 percent of US adults believe that “the use of marijuana should be legal,” according to nationwide polling data released in November by Gallup. That’s an increase of 19 percentage points since 2014, when Colorado and Washington became the first states to implement adult-use cannabis legalization, and the highest level of support ever reported by Gallup pollsters.

“There’s no ‘buyers’ remorse’ among the public when it comes to legalizing cannabis,” said NORML’s Political Director Morgan Fox. “As more states have adopted legalization, public support for this policy has risen dramatically. That’s because these policies are largely working as intended and because voters prefer legalization and regulation over the failed policy of marijuana prohibition.”

Other polling conducted by Gallup in 2023 determined that most US adults believe that marijuana use poses fewer risks to health than does either the use of alcohol or cigarettes, and that half of all Americans ages 18 and older have tried cannabis.

#4 MORE STATES ENACT WORKPLACE PROTECTIONS FOR CANNABIS CONSUMERS

Michigan and Washington adopted legislation in 2023 halting public employers from engaging in pre-employment marijuana testing for those applying to non-safety-sensitive positions. Several other states and municipalities have adopted similar measures. California, Connecticut, the District of Columbia, Minnesota, Montana, New Jersey, New York, and Rhode Island have enacted broader workplace protection laws limiting employers’ ability to conduct on-the-job testing for marijuana metabolites or to sanction employees for their consumption of cannabis while off the job.

“These decisions reflect today’s changing cultural and legal landscape surrounding cannabis,” NORML’s Deputy Director Paul Armentano said. “It is time for workplace policies to adapt to this new reality and to cease punishing employees for activities they engage in during their off-hours that pose no legitimate threat to either workplace safety or productivity.”

#5: FEDERAL COURTS REJECT SECOND AMENDMENT BAN FOR MARIJUANA CONSUMERS

In August, judges with the 5th U.S. Circuit Court of Appeals ruled that a 1968 federal law prohibiting the possession or sale of a firearm to an “unlawful user” of a controlled substance should not be applied so broadly that it would criminalize all gun owners with a history of marijuana use. NORML Legal Committee members filed an amicus (aka friend of the court) brief, calling on the court to find the ban unconstitutional.

The decision came months after a federal judge for the US District Court for the Western District of Oklahoma similarly ruled that the “mere status as a user of marijuana” does not justify the federal government “stripping [the defendant] of his fundamental right to possess a firearm.” A judge for the U.S. District Court for the Western District of Texas also issued a similar decision in April.

NORML lawyers have also filed a similar amicus brief in another Second Amendment case in the 11th Circuit Court of Appeals.

#6: MARIJUANA ARRESTS FALL TO 30-YEAR LOW

State and local police made at least 227,108 arrests for marijuana violations last year, according to data compiled by the FBI’s Crime Data Explorer. Not since the early 1990s has the FBI reported so few annual marijuana-related arrests.

Marijuana arrests peaked in the United States in 2007, when police made over 870,000 marijuana-related arrests. At that time, just under half (48 percent) of all drug-related arrests in the US were for marijuana-related violations.

#7: POTUS ISSUES PARDON PROCLAMATION FOR THOSE WITH MARIJUANA-RELATED CONVICTIONS

President Joe Biden issued a directive in December expanding the pool of marijuana offenders eligible for federal pardons. “I am issuing a Proclamation that will pardon additional offenses of simple possession and use of marijuana under federal and D.C. law,” the President stated. “Criminal records for marijuana use and possession have imposed needless barriers to employment, housing, and educational opportunities. Too many lives have been upended because of our failed approach to marijuana. It’s time that we right these wrongs.”

The President issued a similar pardon proclamation last October, and in March the Justice Department opened an online portal for eligible applicants to apply for pardon certificates. Estimates provided at that time by the US Sentencing Commission suggested that nearly 7,000 Americans with low-level federal marijuana-related convictions would be eligible for relief under the directive.

It is not yet clear how many additional citizens with federal records will be eligible for relief under the President’s latest proclamation. NORML had called upon the Administration to grant blanket pardon relief to nonviolent marijuana offenders shortly after the President took office.

#8 TEEN MARIJUANA USE REMAINS BELOW PRE-PANDEMIC LEVELS

Federally funded surveys by the University of Michigan and by the Substance Abuse Mental Health Services Administration report that rates of teens’ marijuana use are below pre-pandemic levels and near historic lows. The surveys are among the latest to affirm that the adoption of statewide adult-use legalization laws is not linked to any uptick in cannabis use by young people.

“These findings ought to reassure lawmakers and the public that cannabis access for adults can be legally regulated in a manner that is safe, effective, and that does not significantly impact young people’s consumption habits,” NORML’s Deputy Director Paul Armentano said.

#9: FDA FAILS TO ESTABLISH RULES FOR HEMP-DERIVED CANNABIS PRODUCTS

Representatives of the US Food and Drug Administration announced in February that they were abandoning efforts to craft regulations governing the production and sale of hemp-derived products containing high levels of CBD and other cannabinoids. Instead, the agency called upon Congress to address the issue. The FDA had studied the issue for five years before determining that the agency’s existing rules governing foods and dietary supplements are inadequate for addressing hemp-derived products.

For years, NORML and other groups have urged the FDA to establish regulatory guidelines governing the production, testing, labeling, and marketing of hemp-derived cannabinoid products. Analyses conducted by the FDA and others have consistently reported that many of these over-the-counter products are of variable quality and potency and may contain contaminants, adulterants, or elevated levels of heavy metals.

#10: KENTUCKY BECOMES 38TH STATE TO LEGALIZE MEDICAL CANNABIS ACCESS

Democratic Gov. Andy Beshear signed legislation in March directing the state’s Cabinet for Health and Family Services to implement a comprehensive medical cannabis access program. The program is expected to be operational on January 1, 2025.

“For years, Kentuckians have been calling for medical cannabis legalization and now they will have the freedom to safely access regulated, therapeutic products right here at home,” said Matthew Bratcher, Executive Director of Kentucky NORML. “While there is still work to be done, this is a historic first step and we look forward to continuing our work representing Kentucky patients.”

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Survey: Athletes Report Using Cannabis Products To Promote Exercise Recovery

Kent, OH: Those who engage in regular exercise frequently report consuming cannabis products to assist in recovering from physical activity, according to data published in the Journal of Cannabis Research.

Researchers affiliated with Kent State University in Ohio surveyed over 100 subjects who reported using cannabis and regularly engaging in aerobic and/or resistance exercise.

Investigators summarized their findings as follows: “Twenty-two participants (20 percent) reported using CBD for recovery from aerobic exercise and 25 participants (23 percent) reported CBD use to recover from resistance exercise. Sixty-eight participants (61 percent) reported using THC after aerobic exercise for recovery. Similarly, 67 participants (60 percent) reported using THC after resistance exercise for recovery. When participants were asked, ‘Do you feel that cannabis in the form of CBD aids in your recovery?’ 93 percent stated ‘yes’ while seven percent stated, ‘I’m not sure.’ When asked, ‘Do you feel that THC aids in your recovery?’, 87 percent of participants stated, ‘yes’ while 13 percent stated, ‘I’m not sure’. No participant answered, ‘no’, for either of these questions. All of the participants felt that use of cannabis was low risk regarding health outcomes.”

The authors concluded: “The present study demonstrated that in addition to more traditional recovery methods, cannabis is used as an ergogenic recovery aid by individuals that exercise regularly. … More data are necessary to understand the role of cannabis in exercise recovery as well as perceived ergogenic benefits of cannabis by individuals who both regularly participate in exercise and habitually use cannabis.”

Another study published in the same journal earlier this year reported that the twice-daily use of topical CBD alleviates chronic pain in former elite-level (professional) athletes.

Several other studies have found that cannabis use is associated with increased exercise frequency, including among older adults. Yet another study, published in July, found that subjects reported “a more positive exercise experience” when they ran immediately after having used cannabis compared to when they did not.

Full text of the study, “Cannabis use for exercise recovery in trained individuals: A survey study,” appears in the Journal of Cannabis Research.

Study: Cannabis Oil Extracts Associated With Sustained Improvements in Patients With Chronic Health Conditions

Sydney, Australia: The use of plant-derived cannabis extracts is associated with health-related quality of life improvements in patients suffering from pain, fatigue, and other chronic conditions, according to observational trial data published in the journal PLOS One.

Australian investigators assessed the efficacy of cannabinoid extracts in a cohort of 2,300+ patients authorized to use medical cannabis. (Under Australian law, physicians may authorize cannabis products to patients unresponsive to conventional prescription treatments.) Study participants consumed extracts containing varying percentages of THC and CBD for three months.

Consistent with the results of other large-scale observational studies, researchers reported clinically meaningful improvements following cannabis treatment.

“This study found [that] overall HRQL [health-related quality of life] improved over 3-months in patients accessing prescribed MC [medicinal cannabis] in Australia,” authors reported. “Results showed both statistically significant and clinically meaningful improvements in overall HRQL and fatigue for people with chronic health conditions. Similar improvements were found in pain scores for participants with chronic pain; depression scores for patients with depression; and anxiety scores in patients with anxiety.”

They concluded: “Our findings suggest that prescribing MC in clinical practice may alleviate symptoms of pain, fatigue, anxiety, and depression in patients with chronic health conditions and improve overall HRQL. ... The findings from this study contribute to the ongoing evidence for decision making both in clinical practice and at policy level.”

Full text of the study, “Health-related quality of life in patients accessing medicinal cannabis in Australia: The QUEST initiative results of a 3-month follow-up observational study,” appears in PLOS One.

Pilot Study: Vaporized Cannabis Associated With Reduced Symptoms in Patients With Post-Traumatic Stress

Vancouver, Canada: The short-term use of herbal cannabis consisting of a balanced ratio of THC and CBD is associated with symptom reductions in patients with post-traumatic stress, according to data published in the journal Trials.

Canadian researchers assessed subjects’ use of vaporized cannabis over a three-week period.

Investigators reported, “Comparison of CAPS [Clinician Administered PTSD Scale] scores pre and post treatment identified a trend toward reduction in PTSD symptoms. ... However, under-recruitment resulted in low power and prohibited placebo comparison, making these results more suggestive than persuasive.”

They concluded, “Positive trending results and high patient need mandate future studies of cannabis for the treatment of PTSD.”

Two recent observational studies, one from Australia and the other from the United Kingdom, reported that patients diagnosed with post-traumatic stress respond favorably to medical cannabis treatment. By contrast, a 2021 clinical trial reported that the inhalation of marijuana flowers provided limited benefits compared to placebo in treating symptoms of PTSD.

Full text of the study, “A small clinical trial of vaporized cannabis for PTSD: Suggestive results and directions for future study,” appears in Trials.

Survey: Many Canadian Nurses Don’t Receive Any Training on the Use of Medical Cannabis

Winnipeg, Canada: Fewer than four in ten Canadian nursing students say that they receive information about the use of medical cannabis during their training, according to survey data published in the journal Nurse Education Today.

Over three hundred nursing students participated in the survey. Only 38 percent acknowledged “receiving any education on cannabis in their nursing program.” Over 90 percent of respondents acknowledged that they would feel uncomfortable discussing cannabis with their patients without further educational training.

“Education on both medical and non-medical cannabis is needed to support future nurses addressing cannabis use in their clinical practice,” the study’s authors concluded. “Nursing institutions must implement and evaluate curricula to ensure nursing students are adequately prepared to address cannabis use in their clinical practice and their own fitness to practice.”

Cannabis has been legally available in Canada via a doctor’s authorization since 2001. The Canadian government legalized marijuana products for adults in 2018.

The study’s findings are consistent with those of prior surveys of health professionals in Canada and the United States which report that most doctors and nurses believe that they receive insufficient training with regard to cannabis.

Full text of the study, “Baccalaureate nursing students’ knowledge, attitudes, educational needs, and use of medical and non-medical cannabis at five institutions in Manitoba, Canada: A cross-sectional analysis,” appears in Nurse Education Today.

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Study: Cannabis Products Associated With Improvements in Patients With Attention-Deficit/Hyperactivity Disorder

London, United Kingdom: Patients with attention-deficit/hyperactivity disorder (ADHD) exhibit sustained improvements in their symptoms following the use of cannabis products, according to data published in the journal Neuropsychopharmacology Reports.

British investigators assessed the safety and efficacy of plant-derived cannabis products (either oils, flower, or a combination of both) in a cohort of 68 patients enrolled in the UK Medical Cannabis Registry. Participants possessed a doctor’s authorization to access cannabis products. (Since 2018, specialists have been permitted to prescribe cannabis-based medicinal products to patients unresponsive to conventional medications.) Authors assessed the efficacy of cannabis at one, three, six, and twelve months.

Researchers reported improvements in patients’ anxiety, sleep quality, and overall health-related quality of life following cannabis treatment. Over one-third of patients ceased taking at least one ADHD prescription drug medication over the course of the study.

The study’s authors concluded: “This case series is the first of its kind in assessing the clinical outcome of patients from the UKMCR with a primary diagnosis of ADHD prescribed CBMPs [cannabis-based medicinal products] for up to 12 months. This study reports that treatment with CBMPs was associated with improvements in general HRQoL [health-related quality of life] after 1, 3, and 6, months, in addition to anxiety and sleep quality after 1, 3, 6, and 12 months. These results suggest that CBMPs may play a role in alleviating symptoms and co-morbid anxiety and sleep disruption associated with ADHD.”

Prior studies assessing the use of cannabis products in patients enrolled in the UK registry have reported them to be effective for those suffering from chronic pain, post-traumatic stress, depression, generalized anxiety, migraine, inflammatory bowel disease, and other afflictions.

Full text of the study, “An analysis of clinical outcomes of medicinal cannabis therapy for attention-deficit/hyperactivity disorder,” appears in Neuropsychopharmacology Reports.

Congressional Representatives Introduce Legislation Protecting State Marijuana Laws From Federal Interference

Washington, DC: A bipartisan coalition of House lawmakers have introduced legislation, the Strengthening the Tenth Amendment Through Entrusting States (STATES) Act, protecting state-level marijuana legalization laws and allowing for the interstate commerce of cannabis products between legal states.

“The current federal approach to cannabis policy infringes on the rights of states to implement their own laws, stifling critical medical research, hurting legitimate businesses, and diverting vital law enforcement resources needed elsewhere,” said Rep. David Joyce (R-OH), co-chair of the Congressional Cannabis Caucus and the lead sponsor of the bill. “The STATES Act does what every federal bill should do – help all 50 states succeed. This bill respects the will of the states that have legalized cannabis in some form and allows them to implement their own policies without fear of repercussion from the federal government.”

Congressman Joyce is joined by Reps. Earl Blumenauer (D-OR), Troy Carter (D-LA), Rep. Lori Chavez-Remer (R-OR), and Brian Mast (R-FL). A more limited version of the STATES Act was initially introduced in Congress in 2018.

The STATES Act is one of several House bills, including the States Reform Act and the Marijuana Opportunity, Reinvestment and Expungement (MORE) Act, that seek to remove marijuana from the scheduling system established by the Controlled Substances Act. However, it is unlikely that newly elected House Speaker Mike Johnson (R-LA) will prioritize any of these measures. Representative Johnson has repeatedly voted against proposed legislative changes in federal marijuana policy, and he has criticized Democratic leadership for advancing cannabis reform measures, particularly The MORE Act.

Missouri: 100,000 Marijuana Convictions Expunged Following Legalization

Columbia, MO: State officials over the past year have expunged the records of more than 100,000 marijuana-related cases, according to data highlighted by Missouri NORML.

Provisions included in the state’s voter-approved adult-use legalization law, which took effect on December 8, 2022, provided a one-year timeline for the expungement of marijuana-related convictions. Since then, over 100,000 cases have been expunged, says Dan Viets – a NORML Board Member and a co-author of the law.

“This automatic expungement of marijuana cases is one of the most significant parts of Article XIV,” he said. “In addition to stopping approximately 20,000 marijuana arrests each year, the law now requires state government to undo much of the damage which was inflicted on hundreds of thousands of Missourians during the past 100 years.”

Viets predicted that additional cases would be expunged in the future. “The courts are going to need more time to finish the job, and in fact, it might be years before all the cases from the past century are expunged,” Viets acknowledged. “We’ve had more than 100 years of marijuana prohibition in Missouri. Many of the older cases have never been put on a database. So, it’s going to take a lot of physical work to locate those paper records in boxes and attics and go through them.”

Twenty-four states and the District of Columbia have enacted laws providing explicit pathways to either expunge (or otherwise set aside) the records of those with low-level marijuana convictions. According to publicly available data compiled by NORML, state and local officials have issued over 100,000 pardons and more than 1.7 million marijuana-related expungements since 2018.

Review the full text of the NORML Report, Marijuana Pardons and Expungements: By the Numbers.

Georgia: DEA Sends Warning Letters to Independent Pharmacies Seeking To Dispense State-Licensed Cannabis Products

Washington, DC: A recent letter from the US Drug Enforcement Administration is warning pharmacies that they may not legally engage in the dispensing of non-FDA-approved marijuana products.

The letter, dated November 27th, comes just weeks after several Georgia pharmacies applied with the state’s Board of Pharmacy to dispense state-approved plant-derived low-THC products.

Low-THC/high CBD products have been legal to possess under state law since 2015. However, regulators failed to approve licensed providers or dispensaries until earlier this year. Last month, a handful of independent pharmacies reportedly began dispensing cannabis products to qualified patients. About 14,000 Georgians are registered to access cannabis products for a variety of ailments, including autism, cancer, Crohn’s disease, seizure disorders, and Tourette syndrome.

The DEA letter states: “A DEA-registered pharmacy may only dispense controlled substances in Schedules II-V of the Controlled Substances Act. Neither marijuana nor THC can lawfully be possessed, handled, or dispensed by any DEA-registered pharmacy.”

By contrast, the letter acknowledges that products derived from hemp plants containing 0.3 percent THC or less may be sold on store shelves because they are no longer regulated under the Controlled Substances Act.

Local news outlets have reported that some pharmacies have abandoned plans to dispense low-THC products after receiving the letter.

Regulators pushed to allow independent pharmacies to stock plant-derived cannabis products because there are so few licensed dispensaries currently operating in the state.

Ohio: Lawmakers Adjourn for 2023 Without Advancing Legislation Modifying State’s Newly Approved Adult-Use Legalization Law

Columbus, OH: Lawmakers held their final hearings of 2023 without taking any further legislative action on bills to modify the state’s voter-approved adult-use legalization law.

Fifty-seven percent of voters favored the ballot measure (Issue 2) in November. The law took effect on December 7th. However, because the measure was put before voters as a statutory question rather than a constitutional amendment, state lawmakers can amend or repeal its provisions.

Earlier this month, Senate President Matt Huffman introduced legislation that sought to repeal much of the law. That plan was met with resounding resistance from voters, pundits, and members of House leadership. (A NORML Action Alert urging lawmakers to respect the majority of Ohio voters’ will was sent to lawmakers over 7,500 times in 72 hours.) Senators eventually approved substitute language that largely preserves adults’ ability to possess and home-cultivate cannabis, but also prohibits Ohioans’ ability to gift marijuana to one another, amend tax rates, and impose a low THC cap on marijuana concentrates, among other changes. House members have yet to take up the Senate’s proposal and are considering their own legislation to modify certain aspects of the new law.

Lawmakers in both chambers are anticipated to revisit the issue when they reconvene in January.

Any modifying legislation passed by lawmakers will not take effect until 90 days after it is signed into law.

Cleveland: City Officials Ending Pre-Employment Testing for Cannabis

Cleveland, OH: City officials have removed pre-employment drug screening requirements for many public employees.

Officials announced the municipal policy change on Thursday, the same day provisions of a voter-approved marijuana legalization measure (Issue 2) took effect.

Under the new rules, public employees will only undergo pre-employment drug tests if they apply for certain safety-sensitive positions, such as fire-fighters, police officers, and emergency responders.

“Pre-employment screening can often create obstacles in filling open positions by preventing otherwise qualified candidates from even applying,” city officials stated in a press release. “These policy updates are more cost-effective and will ultimately help us widen the applicant pool for several city positions.”

Several other municipalities – including Atlanta, Baltimore, Philadelphia, and St. Louis – have enacted similar ordinances. Michigan, Nevada, and Washington have passed legislation halting pre-employment marijuana testing statewide. Several other states -- including California, Connecticut, Minnesota, Montana, New Jersey, New York, and Rhode Island -- have enacted broader workplace protections limiting employers’ ability to test for or sanction employees for their cannabis use while off the job.

Ohio’s new marijuana law permits adults to consume cannabis in private, but it does not amend workplace drug testing policies.

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Study: No Increase in Cannabis Use Among Older Teens Following Adult-Use Legalization

Philadelphia, PA: Those between the ages of 18 and 20 show no uptick in their use of cannabis following the adoption of statewide adult-use legalization, according to data published in the Journal of Psychoactive Drugs.

Researchers affiliated with Drexel University in Philadelphia assessed cannabis use trends in Los Angeles, California in two separate cohorts of subjects between the ages of 18 and 20. The first cohort was assessed during the years immediately prior to the adoption of adult-use legalization in California. The second cohort was assessed in 2019-2020. (California voters legalized marijuana in November 2016; retail sales began the following January.) Participants in both cohorts reported being current cannabis consumers prior to their enrollment in the study.

Investigators failed to identify any significant differences in cannabis use frequency between the two groups. However, those in the latter cohort were less likely to report consuming either alcohol or cigarettes.

The study’s authors concluded: “Despite purported greater access to cannabis during the post-AUL [adult-use legalization] period in Los Angeles, California, no significant differences in cannabis use frequency among 18–20-year-old cannabis users were observed. ... Also, the post-AUL cohort reported fewer days of alcohol and cigarette use, suggesting the possibility of a protective effect offered by cannabis. .... Future studies should monitor whether stable rates of cannabis use and declines in alcohol and cigarette use will be sustained as some participants reach legal age to access these substances for adult use, and how these trends continue or alter as participants enter later emerging adulthood.”

The study’s findings are consistent with those of several others similarly finding no significant uptick in cannabis use by young people following adult-use legalization.

Full text of the study, “Pre-post cannabis legalization for adult use: Trend study of two cohorts of young cannabis users in Los Angeles,” appears in the Journal of Psychoactive Drugs.

Study: Nighttime Cannabis Use Associated With Improved Sleep Quality

Haifa, Israel: Cannabis use prior to bedtime is associated with improved sleep quality, according to data published in the journal Drug and Alcohol Review.

Israeli investigators assessed the relationship between cannabis and self-reported sleep quality in a cohort of 347 subjects who reported suffering from anxiety. Subjects reported their quality of sleep each morning for 30 days.

Researchers reported: “Cannabis use [was] ... linked to higher perceived sleep quality versus non-use. ... These findings add to the emerging evidence of cannabis’s sleep-enhancing properties.”

The survey’s findings are consistent with those of others concluding that consumers frequently use cannabis to mitigate sleep disorders, including insomnia, and that moderate doses of cannabis improve sleep quality. Data published in the journal Complementary Therapies in Medicine previously reported that the enactment of adult-use marijuana legalization laws is associated with a significant reduction in the sales of over-the-counter sleep aids among the general public.

Full text of the study, “Daily diary study of associations between alcohol, cannabis, co-use and sleep quality in individuals with intentions to use cannabis to cope with anxiety,” appears in Drug and Alcohol Review.

Florida: Majority of Voters Approve of Proposed Adult-Use Legalization Ballot Measure

Tallahassee, FL: Sixty-seven percent of Florida voters support a proposed constitutional amendment to legalize the adult-use possession and retail sale of marijuana, according to statewide polling data compiled by the University of North Florida.

Pollsters reported that 78 percent of Democrats, 69 percent of non-affiliated voters, and 55 percent of Republicans back the plan. Support is strongest among younger voters (86 percent). Most seniors (51 percent) also endorse the plan.

Advocates for the proposed amendment, Smart & Safe Florida, have already collected a sufficient number of signatures to place it on the 2024 ballot. However, the state’s Attorney General, Republican Ashley Moody, has asked the Supreme Court to disqualify the measure. The Court heard oral arguments in the case last month.

Florida’s Attorney General successfully brought suit in 2021 to keep a similar initiative off the 2022 ballot.

The proposed initiative, which has been primarily funded by the marijuana retail company Trulieve, allows adults to possess up to three ounces of cannabis. It permits existing state-licensed medical cannabis dispensaries to serve the adult-use market, and it would authorize -- but not require -- lawmakers to license additional marijuana businesses.

Additional information is available from Smart & Safe Florida.

New Hampshire: Task Force Fails To Find Consensus on 2024 Legislative Legalization Plan

Concord, NH: Members of a state-appointed commission tasked with studying the feasibility of regulating adult-use cannabis sales in state-owned stores failed to issue policy recommendations in its final report to lawmakers.

Lawmakers in August enacted legislation establishing the task force after Republican Gov. Chris Sununu voiced support for potentially legalizing adult-use cannabis sales through state-owned stores. (State law mandates that retail sales of wine and spirits take place exclusively in state-owned ABC outlets.) The Governor had previously been an outspoken critic of legalization.

Those on the 19-member commission failed to achieve consensus on a model distribution system for cannabis sales and also failed to agree upon a number of related issues, such as proposed THC potency caps, public use penalties, and whether or not to allow adults to engage in personal home cultivation.

Currently, the possession of limited amounts of marijuana (up to ¾ of one ounce) is a civil violation in New Hampshire. It is the only state in New England that has not legalized marijuana possession and sales.

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Study: Patients Fail to Exhibit Changes in Neurocognitive Performance Following Cannabis Use

Melbourne, Australia: The use of medical cannabis is not associated with significant changes in patients’ cognitive performance or driving abilities, according to data published in the journal CNS Drugs.

Australian researchers assessed neurocognitive performance in a cohort of 40 patients authorized to use medical cannabis products. (Under Australian law, physicians may authorize cannabis products to patients unresponsive to conventional prescription treatments.) Participants’ performance was assessed at baseline and again three hours later. Patients either vaporized herbal cannabis or consumed oral extracts. Study participants had regularly used medical cannabis products for at least ten months prior to enrolling in the trial.

Patients exhibited no changes in simulated psychomotor performance, executive function, memory, or reaction time following their self-administration of a “standard dose of their prescribed medical cannabis.” Results were consistent regardless of the type of cannabis product consumed.

Investigators reported: “We found no evidence for impaired cognitive function when comparing baseline with post-treatment scores on a comprehensive neuropsychological test battery, nor did we observe any change in performance on the DRUID [psychomotor] test battery over time. … These findings are consistent with two systematic reviews published in the last year that suggest that medical cannabis, when used regularly and consistently for a chronic health condition, may have little if any impact on cognitive function.”

The study’s authors concluded, “Medical cannabis may have minimal acute impact on cognitive function when prescribed and used as directed.”

Other studies have similarly determined that habitual cannabis consumers become tolerant to cannabis-induced changes in either cognitive or psychomotor performance. According to a 2018 meta-analysis of 36 studies involving over 1,000 participants: “Available evidence suggests that the effects of acute marijuana or Δ9-THC administration are less prominent in individuals with a regular pattern of cannabis use compared to non-regular users. Cognitive function appears to be the domain most likely to demonstrate tolerance upon repeated exposure, with some evidence of full tolerance indicating a complete absence of acute effect.”

A literature review published in the journal of the German Medical Association concluded, “Patients who take cannabinoids at a constant dosage over an extensive period of time often develop tolerance to the impairment of psychomotor performance, so that they can drive vehicles safely.”

Full text of the study, “A semi-naturalistic, open-label trial examining the effect of prescribed medical cannabis on neurocognitive performance,” appears in CNS Drugs.

Survey: Consumers Prefer Cannabis Over Conventional Sleep Aids

Pullman, WA: Many consumers report using cannabis as a substitute for conventional sleep aids, including melatonin and benzodiazepines, according to survey data published in the journal Exploration in Medicine.

Researchers affiliated with Washington State University surveyed over 1,200 individuals who reported using cannabis for sleep.

More than 80 percent of respondents said that they had eliminated their use of over the counter and prescription sleep aids after switching to cannabis. Respondents were more likely to use herbal cannabis rather than edible products prior to bedtime. About half of those surveyed reported using products that contained CBD and/or the terpene myrcene. Myrcene is reported to possess sedative effects.

The survey’s findings are consistent with those of others concluding that patients frequently consume cannabis to mitigate sleep disorders, including insomnia. Data published in the journal Complementary Therapies in Medicine reports that the enactment of adult-use marijuana legalization laws is associated with a significant reduction in the sales of over the counter sleep aids among the general public.

Full text of the study, “A large-scale survey of cannabis use for sleep: Preferred products and perceived effects in comparison to over the counter and prescription sleep aids,” appears in Exploration in Medicine.

Survey: Most Cancer Patients Say Cannabis “Improves Their Ability To Cope With Their Illness”

Tel Aviv, Israel: The majority of cancer patients suffering from refractory pain say that the use of medical cannabis helps them cope with their illness, according to survey data published in the journal BMJ Supportive & Palliative Care.

Israeli researchers surveyed 138 cancer patients authorized to use cannabis products. (Medical cannabis is legal by prescription in Israel.) Thirty-eight percent of respondents said that cannabis significantly helped them to cope with their illness while 32 percent said that it “partially” helped them.

Authors concluded: “A large majority of patients using cannabis report that the therapy significantly improves their ability to cope with their illness, with almost 40 percent stating it has done so to a large extent. In this cohort of patients with intractable cancer pain that has proved minimally responsive to numerous conventional treatments, including of course powerful opioids, adjuvants and radiotherapy, this seems to be a striking response. … This ... seems to suggest that this therapy should be considered in addition to current therapies for cancer-related pain and could be offered to patients even earlier in the course of their illness and treatments than is acceptable now.”

Other studies have documented sustained improvements in pain intensity, cognition, and sleep quality among cancer patients who consume cannabis products. Cancer patients also report decreasing their use of opioids following cannabis therapy.

Full text of the study, “Medical cannabis for refractory cancer-related pain in a specialized clinical service: A cross-sectional study,” appears in BMJ Supportive & Palliative Care.

Maine: Testing Analysis Identifies Contaminants in Many Medical Cannabis Products

Augusta, ME: A significant percentage of medical cannabis products contain potentially harmful contaminants, according to an analysis performed by the state’s Office of Cannabis Policy.

State investigators collected and analyzed samples from 120 registered caregivers and dispensaries. Products analyzed included herbal cannabis and oil extracts.

Maine law does not mandate third-party lab testing for medical cannabis products. By contrast, products produced for the adult-use market are required to undergo testing prior to being sold by retailers.

Of the products tested, 42 percent contained contaminants, including yeast and mold, pesticides, and heavy metals. The presence of molds and other contaminants may pose increased risks to patients, particularly those who may be more susceptible to infection.

NORML has long opined in favor of third-party purity testing for cannabis products. It has also called for greater regulatory oversight for state-licensed testing laboratories.

Testing analyses of other unregulated cannabis products, such as those containing hemp-derived CBD and/or delta-8-THC, have similarly reported elevated percentages of heavy metals and other contaminants.

Full text of Maine’s Office of Cannabis policy report is available from the Maine Office of Cannabis Policy.

Georgia: Regulators Award Licenses to Four Additional Producers of Low-THC Cannabis Products

Atlanta, GA: State regulators have awarded cannabis production licenses to four additional companies. The licenses allow the companies to grow cannabis and manufacture low-THC/high-CBD oil products.

Low-THC/high CBD products became legal to possess in 2015. However, regulators failed to approve any licensed providers or dispensaries until earlier this year. There are now a total of six licensed producers in the state.

In November, independent pharmacies began selling cannabis oil products statewide. Medical cannabis products are also available in state-licensed dispensaries, though fewer than ten facilities are currently licensed by state officials.

About 14,000 Georgians are registered to access cannabis products for a variety of ailments, including autism, cancer, Crohn’s disease, seizure disorders, and Tourette syndrome.

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