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Study: Cannabis Smoke Exposure Not Associated with Impaired Lung Function

South Brisbane, Australia: The long-term inhalation of cannabis smoke does not impact lung function in the same manner as inhaling tobacco, according to longitudinal data published in the journal Respiratory Medicine.

A team of Australian researchers evaluated the impact of tobacco smoking and cannabis smoking on lung function in a cohort of 30-year-old subjects. Study participants began smoking cannabis, tobacco, or both as young adults. Pulmonary performance was evaluated at age 21 and at age 30 via a spirometry assessment.

Researchers reported that cigarette-only smokers "already showed evidence of impaired lung function" at age 30. By contrast, "those who have [only] used cannabis ever since the adolescent period do not appear to have evidence of impairment of lung function." Specifically, investigators identified airflow obstructions in the lungs of cigarette-only smokers, but they observed no such obstructions in cannabis-only subjects.

Authors further acknowledged, "Co-use of tobacco and cannabis does not appear to predict lung function beyond the effects of tobacco use alone."

They concluded, "Cannabis use does not appear to be related to lung function even after years of use."

The findings are consistent with those of numerous other studies reporting that cannabis smoke exposure, even long-term, is not predictive of the sort of significant adverse pulmonary effects that are consistently associated with tobacco.

Consumers who wish to mitigate or eliminate their exposure to combustive smoke may do so via an herbal vaporizer, which heats cannabinoids to the point of vaporization but below the point of combustion. In clinical trials, herbal vaporizers have been found to be a "safe and effective" cannabinoid delivery device.

Full text of the study, "Do tobacco and cannabis use and co-use predict lung function: A longitudinal study," appears in Respiratory Medicine.

Marijuana Legalization Associated with Reductions in Codeine Prescriptions

Ithaca, NY: The adoption of statewide marijuana legalization laws is associated with reductions in the amount of codeine dispensed at retail pharmacies, according to data published in the journal Health Economics.

A team of researchers affiliated with Cornell University in New York and with George Mason University in Virginia assessed the impact of adult-use cannabis legalization laws on shipments of opioids to hospitals, pharmacies, and other endpoint distributors.

The authors reported that adult-use legalization laws were associated with a 26 percent reduction in pharmacy-based distribution of codeine; this percentage increased in magnitude to 37 percent after the law had been in effect for four years. Authors did not find other evidence of legalization laws affecting changes in other types of opioid distribution.

"This finding is particularly meaningful," one of the study's co-authors said in a press release. "Where previous studies have focused on more potent opioids, codeine is a weaker drug with a higher potential for addiction. It indicates people may be obtaining codeine from pharmacies for misuse, and that recreational cannabis laws reduce this illicit demand."

Among prescription opioids, "codeine is particularly likely to be misused and diverted," the authors wrote.

Numerous studies have documented a decrease in the use of opioids and other prescription medications, including benzodiazepines and sleep aids, among people residing in jurisdictions that provide regulated cannabis access.

Full text of the study, "Recreational cannabis and opioid distribution," appears in Health Economics.

Analysis: Fewer People Self-Report Driving Under the Influence of Drugs and Alcohol

East Lansing, MI: The percentage of US adults who self-report engaging in driving under the influence of alcohol or other controlled substances is decreasing, according to data published in the journal Addictive Behaviors.

Researchers affiliated with Michigan State University and with the University of Michigan assessed drugged driving prevalence among a nationally representative sample for the years 2016 to 2020.

They reported that fewer adults acknowledged driving under the influence of either alcohol, cannabis, or other illicit substances. In particular, they highlighted, "Subgroups with past-year cannabis use that displayed significant declines in DUIC [DUI cannabis] include males, [those] ages 18–25, Non-Hispanic Whites and Hispanics, those with a high school education or less, and those living in a state with a medical cannabis law."

Authors concluded, "US population trends of DUI from any substance declined from 2016 to 2020."

Recent studies have consistently reported that adults residing in jurisdictions where cannabis is legal are less likely to report having driven under the influence as compared to those who do not.

Full text of the study, "Driving under the influence of cannabis, alcohol, and illicit drugs among adults in the United States from 2016 to 2020," appears in Addictive Behaviors.

New Jersey: Officials Move Forward with Plans for Cannabis Consumption Lounges

Trenton, NJ: State regulators have advanced rules regulating the establishment of cannabis consumption venues.

The decision to permit social use areas will be at the discretion of municipalities, which already decide whether or not to allow adult-use retail facilities.

Proposed regulations governing the sites prohibit patrons from either purchasing food or consuming alcohol on site. Licensed cannabis retailers are not permitted to operate more than one consumption lounge. Lounges can be either indoor or outdoor.

The proposed rules are now subject to a public comment period, which runs until March 18, 2023.

In a statement issued by the New Jersey Cannabis Regulatory Commission, the agency said that it "expects the new cannabis consumption area rules to have a beneficial social impact by advancing social equity, while allowing persons 21 years of age and older another venue to safely enjoy the personal use of cannabis."

A minority of adult-use states, including Alaska, Colorado, and Nevada, currently regulate social use establishments.

New Jersey Cannabis Regulatory Commission Proposed Rules for Cannabis Consumption Areas includes a summary of the proposed rules for New Jersey consumption venues.

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Study: THC/CBD Combination Therapy Reduces Seizure Frequency in Children with Treatment-Resistant Epilepsy

London, United Kingdom: The daily administration of cannabis products is associated with reductions in seizure frequency among children with treatment-resistant epilepsy (TRE), according to observational trial data published in the journal Neuropediatrics.

British investigators assessed the safety and efficacy of cannabis-derived products in 35 patients diagnosed with pediatric epilepsy. Study subjects were participants in the UK Medical Cannabis Registry, and each of them possessed a doctor’s authorization to consume cannabis. Study participants consumed either CBD-dominant extract oils or a combination therapy containing both CBD and THC.

Researchers reported that over 90 percent of subjects treated with the combination therapy experienced a ≥50 percent reduction in seizure frequency at six months, whereas fewer than one-third of patients receiving CBD-only products did so. Investigators said that cannabis products exhibited an acceptable short-term safety profile in this patient cohort.

"The results show a promising signal toward the effectiveness of CBMPs [cannabis-based medicinal products] in children with TRE, particularly in the cohort of patients treated with delta-9-THC," the authors concluded. They added: "The short term adverse effects appear well tolerated, but the long-term effects of CBMPs on neurodevelopment are still unknown. The results from this study could be utilized in the design of future phase II randomized controlled trials, particularly for dosing regimens."

Subjects enrolled in the UK Medical Cannabis Registry who were diagnosed with a variety of other conditions, including post-traumatic stress, depression, and inflammatory bowel disease, have also demonstrated symptomatic improvements following cannabis therapy.

Survey data from Canada estimates that as many as one-third of epileptic patients consume cannabis products therapeutically.

In 2018, regulators with the United States Food and Drug Administration granted market approval for the plant-derived CBD prescription drug Epidiolex in the treatment of two rare forms of pediatric epilepsy, Lennox-Gastaut syndrome, and Dravet syndrome. The drug is categorized as a Schedule V controlled substance. In 2020, FDA regulators expanded the prescription use of Epidiolex to patients with the genetic disorder tuberous sclerosis complex (TSC).

Full text of the study, "Clinical outcomes of children treated with cannabis based medicinal products for treatment resistant epilepsy: Analysis from the UK Medical Cannabis Registry," appears in Neuropediatrics.

Case Series: Cannabis Effective at Treating Borderline Personality Disorder

London, United Kingdom: The use of cannabis products containing THC and CBD are safe and effective in mitigating symptoms in patients diagnosed with emotionally unstable personality disorder (EUPD), according to a case series reported in the journal Brain Sciences. Emotionally unstable personality disorder (a/k/a borderline personality disorder) is a common mental health disorder associated with a range of chronic and debilitating symptoms, including impaired social functioning, unstable mood, and risky, impulsive, or self-injurious behavior.

An international team of researchers assessed the use of cannabis products in a cohort of seven EUPD patients. Subjects consumed products containing both THC and CBD in varying ratios for one month.

Six of the seven participants reported "an improvement in symptoms," and "none of the participants reported any adverse side effects."

The study’s authors concluded: "To our knowledge, this case series represents the first medical evidence of the use of CBMPs [cannabis-based medicinal products] for the clinical management of patients with a diagnosis of EUPD. ... [O]ur results suggest that, when deployed in a rigorously controlled clinical environment, CBMPs can provide substantial improvement in symptoms associated with EUPD thus warranting the need for further research on this therapeutic strategy."

Full text of the study, "Cannabis based medicinal products in the management of emotionally unstable personality disorder: A narrative review and case series," appears in Brain Sciences.

Study: Cannabis Use History Not Associated with Increased Risk of Hypertension

Chicago, IL: Neither current nor past cannabis use is associated with an elevated risk of high blood pressure, according to data published in the Journal of Clinical Hypertension.

Investigators with Northwestern University’s Feinberg School of Medicine in Chicago assessed the relationship between cannabis use and blood pressure in a cohort of 4,565 adults.

They found no correlation between cannabis consumption and the likelihood of receiving a medical diagnosis for hypertension. They reported: "When compared with non-users, respondents who indicated sustained use of cannabis were not found to have an increased likelihood of developing hypertension. Among cannabis users, the frequency of use was not associated with increased odds of hypertension diagnosis. The age that an individual first began regularly using cannabis was also not found to have an association with the odds of hypertension diagnosis. Current users were not more likely than past users to have hypertension."

The authors concluded: "The findings of this study indicate that neither past nor current cannabis use are associated with the likelihood of having clinical hypertension. … Prospective clinical trials are needed to further determine the effects of cannabis on developing or perhaps even mitigating hypertension, particularly regarding long-term outcomes."

The findings are similar to those of a 2021 study, which also reported, "After adjustment for all confounders, neither lifetime cannabis use, 12-month cannabis use nor 12-month cannabis use frequency [at least monthly use and less than monthly use] were associated above chance with the incidence of hypertension."

Cannabinoids may influence blood pressure and other cardiovascular responses, though these effects tend to be short-term in duration and can be inconsistent. Recently, Israeli data reported that elderly subjects with hypertension respond favorably to medical cannabis treatment. Investigators involved with that study concluded, "Cannabis treatment for three months was associated with a reduction in systolic and diastolic blood pressure, as well as heart rate."

Full text of the study, "Sustained cannabis use does not predispose clinical hypertension: Findings from a national survey," appears in the Journal of Clinical Hypertension.

Analysis: Long-Term Cannabis Use Not Significantly Detrimental to Overall Health

Barcelona, Spain: Adults who regularly consume cannabis products do not report significant differences in their overall health as compared to the general public, according to data published in the journal Cannabis and Cannabinoid Research.

Spanish investigators surveyed a representative sample of regular cannabis consumers on a variety of questions specific to their daily activities and perceived overall health. Their responses were compared to previously compiled data provided by the general public.

Cannabis consumers were more likely than members of the general public to report walking at least ten minutes per day (76 percent to 70 percent), and they were more likely to positively perceive their own health (88 percent to 82 percent). Consumers were also less likely to report having issues with their cholesterol and blood pressure. Consumers were more likely than those in the general population to report experiencing problems sleeping.

One in four respondents reported reducing their need for medical interventions since using cannabis, and nearly one-third acknowledged reducing their use of prescription medications -- a finding that is consistent with prior studies.

Authors reported: "In this study, long-term users of cannabis scored in a similar way as the general population on a list of health indicators. These results were obtained using validated health indicators, especially designed and used by several governments to assess population health and compare this information between countries or specific populations. There was only one indicator associated with poorer health among cannabis users: sleep problems."

They concluded: "[T]hese findings suggest that long-term cannabis use might not play a central role in terms of public health. … We suggest inclusion of cannabis-related items in national surveys of health as they would provide valuable data to support the progress of public debates regarding its regulation."

Full text of the study, "Cannabis and public health: A study assessing regular cannabis users through health indicators," appears in Cannabis and Cannabinoid Research.

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Analysis: Adult-Use Legalization Associated with Less Alcohol Abuse, No Increase in Psychosis

Minneapolis, MN: Residents of states where cannabis is legal do not possess elevated rates of psychosis, and they are also less likely to exhibit symptoms of alcohol abuse, according to longitudinal data published in the journal Psychological Medicine.

A team of researchers affiliated with the University of Minnesota and the University of Colorado assessed the relationship between adult-use cannabis legalization and psychosocial functioning in a cohort of 240 pairs of identical twins. One twin resided in a jurisdiction where adult-use cannabis sales were legally permitted, while the other lived in a state where marijuana was criminally prohibited.

Investigators reported that legalization was associated with a slight uptick in the frequency with which subjects reported consuming cannabis - a finding consistent with prior studies. However, they also reported that those in legalization states were less likely to engage in behaviors associated with problematic alcohol use. That finding is consistent with prior data indicating the use of cannabis is associated with a decrease in the amount of alcohol consumed by individuals seeking alcohol treatment.

Authors further reported that legalization was not positively correlated with increased incidences of psychosis, substance abuse disorder, or other adverse outcomes.

They concluded: "Recreational cannabis legalization causes increases in mean cannabis frequency and residents of recreational states have fewer recent symptoms of AUD [alcohol use disorder]. Broadly speaking, our co-twin control and differential vulnerability results suggest that the impacts of recreational cannabis legalization on psychiatric and psychosocial outcomes are otherwise minimal. … Both sets of results are reassuring with respect to public health concerns around recreational cannabis legalization."

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 already have a prior diagnosis of a psychiatric disease. 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, "Recreational cannabis legalization has had limited effects on a wide range of adult psychiatric and psychosocial outcomes," appears in Psychological Medicine.

Study: Cannabis Use Associated with Improvements in Patients with Inflammatory Bowel Disease

London, United Kingdom: The daily administration of cannabis products is associated with symptom improvements in patients with inflammatory bowel disease, according to observational trial data published in the journal Expert Review of Gastroenterology & Hepatology.

British investigators assessed the safety and efficacy of cannabis products in 76 patients diagnosed with either Crohn's disease or ulcerative colitis. The study subjects were participants in the UK Medical Cannabis Registry and each of them possessed a doctor's authorization to consume cannabis. Study participants consumed either cannabis extracts, THC-dominant flowers, or both for a period of three months.

Authors reported: "Initiation of CBMPs [cannabis-based medicinal products] was associated with an improvement in HRQoL [health-related quality of life] in the short term, with statistically significant improvements in IBD-specific and general HRQoL outcomes at 1 and 3 months after initiating treatment. Participants who previously consumed cannabis had greater improvements in HRQoL and fewer adverse events compared to naïve individuals. These findings highlight the potential utility of CBMPs as an adjunctive therapeutic option in the short term, especially in patients who continue to experience debilitating symptoms despite maximal medical therapy."

Longitudinal data from Israel has similarly reported that the long-term use of whole-plant cannabis is associated with both symptom improvement and the reduced use of prescription medications in patients with treatment-resistant inflammatory bowel disease.

Subjects enrolled in the UK Medical Cannabis Registry with either post-traumatic stress or depression have also demonstrated symptomatic improvements following cannabis therapy.

Full text of the study, "The effect of medical cannabis on inflammatory bowel disease: Analysis from the UK Medical Cannabis Registry," appears in Expert Review of Gastroenterology & Hepatology.

Marijuana Legalization Laws Not Associated with Self-Reported Increases in Drugged Driving Behavior

Baltimore, MD: Cannabis consumers in states where the substance is legal for either medical or adult-use purposes are less likely to report having operated a motor vehicle while under its influence, according to data compiled in a recently published report by the group Cannabis Public Policy Consulting.

Investigators surveyed consumers from 25 states. Consistent with prior studies, authors reported that respondents residing in jurisdictions where cannabis is illegal are more likely to report driving under the influence than those in states where the substance is legally regulated.

"Those living in illicit states reported a significantly greater number of days driving under the influence of cannabis (DUIC) than those living in medical states and those living in adult use states," authors concluded. "The difference ... represents tens of millions of instances of DUIC each year across the United States."

Prior surveys of cannabis consumers have reported similar findings. A study conducted last year by investigators affiliated with the Research Triangle Institute reported: "Current cannabis users in recreational and medical-only cannabis states were significantly less likely to report driving within three hours of getting high in the past 30 days, compared to current users living in states without legal cannabis."

A 2021 study similarly determined that incidences of self-reported drugged driving behavior do not rise post-legalization. Rather, authors reported, "[M]arijuana users in states that legalized RM [recreational marijuana] self-reported driving after marijuana use less than their counterparts (who resided in states where adult-use cannabis remained illegal). They were also less likely to find such behavior [driving after ingesting cannabis] acceptable."

A 2020 study by researchers with the University of Nevada at Reno and with the Johns Hopkins Bloomberg School of Public Health also concluded that those "from states with legal recreational cannabis sales had significantly lower prevalence of driving after cannabis use and higher prevalence of protective attitudes compared to those from states without legal recreational sales."

Full text of the report, "Cannabis Legalization & Public Health Outcomes," is available online.

Study: Medical Cannabis Use Associated with Sustained Improvements in Pain, Anxiety, and Mood

Montreal, Canada: Canadian patients authorized to use medical cannabis products report sustained improvements in their health-related quality of life, according to longitudinal data published in the journal Cannabis and Cannabinoid Research.

A team of investigators affiliated with McGill University in Montreal assessed the safety and efficacy of medical cannabis products in a cohort of 2,991 patients. Subjects in the study consumed cannabis flower, extracts, or other related products for one year.

Consistent with other studies, researchers reported: "All patient-reported outcomes showed a statistically significant improvement at 3 months, which was maintained or further improved (for pain interference, tiredness, and well-being) over the remainder of the 12-month follow-up. Results also revealed clinically significant improvements in pain interference and tiredness, anxiety, and well-being from baseline." Few patients reported experiencing any serious adverse events as a result of their cannabis intake.

Authors concluded, "MC [medical cannabis] directed by physicians appears to be safe and effective within 3 months of initiation for a variety of medical indications."

Data published late last week in the journal JAMA Network Open reported that nearly one in four pain patients residing in states where medical cannabis access is legal self-identify as marijuana consumers.

Full text of the study, "The Quebec Cannabis Registry: Investigating the safety and effectiveness of medical cannabis," appears inCannabis and Cannabinoid Research.

Case Report: THC Tincture Effective at Reducing Dementia-Related Agitation

New Orleans, LA: The administration of plant-derived THC is associated with reductions in agitation and other behavioral issues in a patient with dementia, according to a case report published in the Journal of Palliative Medicine.

Researchers affiliated with Tulane University's School of Medicine and the University of Texas reported on the use of a THC-dominant tincture in an 85-year-old dementia patient. The subject exhibited worsening aggression over time and had been unresponsive to antipsychotic medicines.

Authors reported that the "patient's behavior rapidly improved" following THC treatment. These improvements were so significant that he was eventually discharged from in-patient treatment to home care.

The findings are consistent with those of a number of studies reporting that the use of plant-derived THC and CBD are safe and effective at alleviating dementia-related symptoms, including agitation, irritability, improved cognition, and sleep.

Full text of the study, "A case-report of treatment-resistant agitation in dementia with Lewy Bodies: Medical marijuana as an alternative to antipsychotics," appears in the Journal of Palliative Care.

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Analysis: Marijuana Seizures by Border Patrol Agents Fall to Historic Lows

Washington, DC: Federal law enforcement agents are intercepting historically low quantities of cannabis at the southern border, according to newly released data provided by the US Department of Homeland Security, US Customs and Border Protection.

Federal statistics reveal that Border Patrol and Field agents confiscated an estimated 155,000 pounds of marijuana at the US/Mexico border in 2022. That is down almost 50 percent from 2021 totals and continues the dramatic decline in seizure volume that began in 2013, when nearly 3 million pounds of cannabis were confiscated at the southern border.

Some experts have previously speculated that licensed retail access to cannabis products, which began in Colorado and Washington in 2014 and is now available in almost half of all states, has significantly undercut demand for imported Mexican cannabis. According to conclusions provided by the US Drug Enforcement Administration, "In US markets, Mexican marijuana has largely been supplanted by domestic-produced marijuana."

Separate data published last year by the Government Accounting Office and elsewhere indicates that interdiction efforts along the US border now typically involve the seizure of small quantities of marijuana and no other controlled substances.

Drug seizure statistics are available online from the US Customs and Border Protection website.

Clinical Trial: CBD Topical More Effective at Treating Skin Ulcers Than Conventional Treatments

Modena, Italy: The administration of a topical extract preparation of CBD effectively mitigates wound-related pain and promotes the healing of skin ulcers in patients with scleroderma, according to randomized trial data published in the journal Advances in Skin & Wound Care. Scleroderma (a/k/a systemic sclerosis) is a rare autoimmune disorder involving the tightening of the skin and the narrowing of blood vessels.

Italian investigators assessed the efficacy of topical CBD oil compared to conventional medications in a group of scleroderma patients with digital ulcers (skin ulcers of the fingertips). Twenty-five patients were randomly selected to use CBD for one month; the other 20 received conventional therapy.

Subjects in the CBD group experienced greater pain relief and wound healing than did those in the control group. Authors reported, "Although mean wound-related pain NRS [numeric rating scale] scores did not differ between CBD-treated patients and control patients at baseline, their mean scores differed significantly after 1 month." Specifically, patients in the treatment group experienced a decrease in pain of 29 percent over the course of the trial, whereas those in the control group only experienced a six percent decrease.

Investigators further acknowledged, "In terms of DU [digital ulcer] healing, 18 of the 25 patients in the CBD-treated group (72 percent) experienced complete healing by the end of the study. In contrast, complete healing was observed in (only) 6 of the 20 control group participants (30 percent)."

Patients receiving CBD treatment reported "no significant adverse effects" during the study.

"The present study is the first to report the effectiveness of local CBD treatment in the management of SSc-DUs [systemic sclerosis digital ulcers]," authors concluded. "Topical administration of CBD is a safe, effective, noninvasive tool that is associated with improved wound-related pain, DU healing, and QoL [quality of life] of patients with SSc."

The topical application of cannabinoids, and of CBD in particular, has demonstrated benefits in the treatment of a variety of skin-related conditions, including psoriasis, erythema, pruritis, and acne. It has also been associated with wound healing in patients with refractory leg ulcers and with the rare skin blistering disease epidermolysis bullosa.

Full text of the study, "Topical cannabidiol in the treatment of digital ulcers in patients with scleroderma: Comparative analysis and literature review," appears in Advances in Skin & Wound Care.

Study: Cannabis Use Associated with Improvements in Depressive Symptoms

London, United Kingdom: The daily consumption of cannabis products is associated with sustained improvements in depressive symptoms, according to observational trial data published in the journal Expert Review of Neurotherapeutics.

British investigators assessed the safety and efficacy of cannabis products in 129 subjects with a primary diagnosis of depression. Study subjects were participants in the UK Medical Cannabis Registry and all possessed a doctor’s authorization to consume cannabis. Study participants consumed either cannabis extracts, THC-dominant flowers, or both for a period of six-months.

Researchers reported: "The results showed that 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." While some subjects reported adverse events from cannabis products, almost all side effects were classified as either "mild or moderate."

Authors concluded, "Future studies could focus on conducting controlled observational studies or pilot trials to determine the potential of CBMPs [cannabis-based medicinal products] as a treatment for depression."

Post-traumatic stress patients enrolled in the UK Medical Cannabis Registry have similarly shown sustained symptomatic improvements following cannabis therapy.

Full text of the study, "Assessment of clinical outcomes of medicinal cannabis therapy for depression: Analysis from the UK Medical Cannabis Registry," appears in the Expert Review of Neurotherapeutics.

Analysis: Labor Markets Not Adversely Impacted by Adult-Use Legalization

San Diego, CA: The adoption of adult-use cannabis legalization laws is associated with modest improvements in labor market outcomes, according to an analysis published by the National Bureau of Economic Research.

A team of economists affiliated with San Diego State University in California and with Bentley University in Massachusetts assessed the adoption of state-level adult-use legalization laws on wages and labor market outcomes.

Investigators found "little evidence that RMLs [recreational marijuana laws] adversely affect labor market outcomes among most working-age individuals." By contrast, they reported: "For some demographic sub-groups, we find evidence of modest increases in employment or wages, particularly for individuals over age 30 (in the shorter-run), younger racial/ethnic minorities, and those working in the agriculture sector. These results are consistent with the opening of a new licit industry for marijuana and (especially for older individuals) a substitution away from harder substances such as opioids."

Prior studies have reported an association between cannabis access laws and increased levels of employment among older adults.

According to data compiled in February by Leafly and Whitney Economics, the state-licensed cannabis industry added over 100,000 new jobs in 2021 and now employs over 428,000 full-time workers.

Full text of the study, "The effects of recreational marijuana legalization on employment and earnings," is available from the National Bureau of Economic Research.

Review: Clinical Trial Data Establishes Efficacy of Cannabinoids to Treat Chronic Pain, Aid Sleep

Toronto, Canada: Cannabis compounds are effective at mitigating chronic neuropathic pain and improving sleep, according to a review of randomized controlled trial data published in the journal Regional Anesthesia & Pain Medicine.

A team of Canadian researchers evaluated results from nine trials that compared synthetic and natural cannabinoids to placebo in patients suffering from neuropathic pain syndromes.

They reported: "Meta-analysis of data from six studies showed that cannabinoids were associated with a significant improvement in sleep quality. Meta-analysis of data from eight studies showed a significant reduction in daily pain scores in the cannabinoid group."

Authors concluded: "Cannabinoids have a role in treating chronic neuropathic pain as evidenced by significant improvements in sleep quality, pain intensity, and PGIC [Patients’ Global Impression of Change scale]. More research is needed to comprehensively evaluate the impact of cannabinoids on sleep health and analgesic efficacy."

Survey data consistently reports that patients who use cannabis products typically do so to mitigate chronic pain and improve sleep. Among patients in US states where medical cannabis access is permitted, over 60 percent are qualified to use it to treat pain.

Full text of the study, "Evaluating the impact of cannabinoids on sleep health and pain in patients with chronic neuropathic pain: A systematic review and meta-analysis of randomized controlled trials," appears in Regional Anesthesia & Pain Medicine.

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Recent Marijuana Milestones
Still Relevant....

2022 Year in Review:
Top Ten Events in Marijuana Policy

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

Voters and lawmakers in three more states - Maryland, Missouri, and Rhode Island - enacted laws in 2022 legalizing adult-use marijuana possession and regulating retail cannabis markets. Voters in Missouri voted in favor of a constitutional amendment while Maryland voters approved a legislative referendum. Rhode Island's law was enacted by the legislature. In total, 21 states - comprising nearly one-half of the US population - have now adopted laws regulating adult use marijuana production and retail sales.

"Reformers achieved numerous significant legislative victories in 2022," NORML's Executive Director Erik Altieri said. "As more lawmakers recognize that advocating for marijuana policy reforms is a political opportunity, not a political liability, we anticipate future legislative gains in 2023 and beyond."

#2: TENS OF THOUSANDS OF AMERICANS RECEIVE MARIJUANA-SPECIFIC PARDONS AND EXPUNGEMENTS

The President of the United States and several state officials issued mass pardons and expungements in 2022 to those with prior low-level cannabis convictions. In October, President Joe Biden granted pardons to over 6,500 people with federal marijuana possession convictions. In Connecticut, Colorado, Oregon and elsewhere, officials issued over 100,000 marijuana-related pardons and expungements. To date, two dozen states have enacted legislation explicitly facilitating the expungement of prior marijuana-specific convictions. As a result of these laws, NORML estimates that 2 million Americans have had their cannabis-related convictions set aside in recent years.

"Hundreds of thousands of Americans unduly carry the burden and stigma of a past conviction for behavior that most Americans, and a growing number of states, no longer consider a crime," NORML's Deputy Director Paul Armentano said. "Our sense of justice and our principles of fairness demand that public officials and the courts move swiftly to right the past wrongs of cannabis prohibition and criminalization."

#3: SENATE FAILS TO MOVE SAFE BANKING ACT

The 117th Congress adjourned without members of the US Senate holding any hearings or votes on either the Secure and Fair Enforcement (SAFE) Banking Act or other significant pieces of marijuana reform legislation. Since 2019, House members have advanced the legislation on seven separate occasions. The Senate companion bill had 42 co-sponsors, including nine Republicans.

"It is unfortunate that Congress, and members of the US Senate specifically, failed to take this opportunity to affirm the legitimacy of state-legal marijuana markets and instead acted in a way that will continue to deny this emerging legal industry access to basic financial tools and services," said NORML's Political Director Morgan Fox. "Until Congressional action is taken, state-licensed marijuana businesses, the hundreds of thousands of people they employ, and the millions of Americans that patronize them will continue to be at a higher risk of robbery due to the cash-heavy nature of this industry created by outdated federal laws. Furthermore, smaller entrepreneurs who seek to enter this industry will continue to struggle to compete against larger, more well-capitalized interests."

Prior to the 2020 election, Sen. Chuck Schumer – then Minority Leader – pledged on multiple occasions that he would prioritize bringing legislation to repeal the federal criminalization of cannabis to a floor vote.

#4: MORE LAWMAKERS ENACT WORKPLACE PROTECTIONS FOR CANNABIS CONSUMERS

State lawmakers adopted numerous laws in 2022 limiting employers' ability to either fire or refuse to hire employees solely based upon their off-the-job marijuana use. Specifically, lawmakers in California, the District of Columbia, and Rhode Island prohibited employers from discriminating against workers who test positive for carboxy-THC on a drug test, while protections for patients were enacted in several other states (e.g., Louisiana, Missouri, and Utah). In total, eight jurisdictions - California, Connecticut, the District of Columbia, Nevada, New Jersey, New York, Montana, and Rhode Island - have enacted statutes limiting employers' ability to hire/fire workers for their recreational cannabis use in certain circumstances, while more than half of medical marijuana access states have enacted similar workplace protections.

"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: HISTORIC PERCENTAGES OF AMERICANS SAY CANNABIS SHOULD BE LEGALIZED

The percentage of Americans who support adult-use cannabis legalization remains at record highs. National survey data compiled by Data for Progress reported that 74 percent of likely voters now "support ending the federal ban on marijuana." For the third consecutive year, polling data compiled by Gallup found that 68 percent of US adults say that "the use of marijuana should be legal." Separate polls released this year by Fox News, Monmouth University, YouGov, Politico, and several others similarly reported that most Americans back legalizing cannabis.

"There is no buyer's remorse on the part of the American people," NORML's Executive Director Erik Altieri said. "In the era of state-level legalization, voters' support for this issue has grown rapidly - an indication that these policy changes have been successful and are comporting with voters' desires and expectations."

#6: FBI FAILS TO PROVIDE COMPREHENSIVE MARIJUANA ARREST FIGURES FOR THE FIRST TIME

Data provided in October by the US Federal Bureau of Investigation reported that in 2021 over 400,000 drug-related seizures involved cannabis; however, for the first time in decades the agency failed to provide national estimates regarding the number of people arrested for marijuana-related violations. Data previously provided by the FBI has allowed NORML to track yearly marijuana-related arrests since 1965.

"At a time when voters and their elected officials nationwide are re-evaluating state and federal marijuana policies, it is inconceivable that government agencies are unable to produce any explicit data on the estimated costs and scope of marijuana prohibition in America," NORML's Deputy Director Paul Armentano said.

#7: POTUS SIGNS LAW FACILITATING CLINICAL CANNABIS TRIALS AND DRUG DEVELOPMENT

President Joe Biden signed legislation into law facilitating the federal approval of cannabis-specific clinical research and drug development. It is the first time in over 50 years that a President has signed a stand-alone piece of legislation loosening federal marijuana prohibitions.

Under the new law, the US Attorney General is provided with a 60-day timeline to either approve or deny applications from scientists wishing to conduct clinical trials involving the use of cannabis by human subjects. The law also mandates the US Attorney General to solicit applications from those seeking to grow cannabis for either research purposes or for potential drug development, and it provides a timeline for the AG to approve those applicants. It also calls upon federal agencies, including HHS, to provide a report on the "potential therapeutic effects of cannabidiol or marijuana on serious medical conditions."

NORML's Political Director Morgan Fox said, "While the significance of POTUS signing the first stand-alone cannabis policy reform bill should not be overlooked, in truth, we don't need more research to know definitively that prohibition is a misguided and disastrous policy." He added: "That said, this legislation is certainly a step in the right direction that shows there can be bipartisan cooperation on this issue."

With advocates facing a divided Congress in 2023, virtually any efforts to advance cannabis-specific reform legislation would require bipartisan support.

#8: ANALYSIS: STATE-LEGAL MARIJUANA INDUSTRY EMPLOYS OVER 428,000 FULL-TIME WORKERS

The state-licensed cannabis industry added over 100,000 new jobs in 2021 and now employs over 428,000 full-time workers, according to data compiled in February by Leafly.com and Whitney Economics.

According to its latest report, the cannabis industry created an average of 280 new jobs per day in 2021. That represents a 33 percent year-over-year increase, and it marks the fifth year in a row of annual jobs growth greater than 27 percent.

"At a time when the rest of the economy is struggling and people are leaving their jobs in droves, the legal cannabis industry is blooming, showing exponential employment growth, and attracting talented and driven individuals from across the workforce," NORML's Political Director Morgan Fox said.

#9: SURVEY: OVER 90% OF PAIN PATIENTS REPORT REDUCING THEIR OPIOID INTAKE FOLLOWING MEDICAL CANNABIS

The overwhelming majority of pain patients provided medical cannabis treatment report either reducing or ceasing their use of opioid medications, according to data published in August in the Journal of Addictive Diseases.

A team of Israeli investigators affiliated with Tel Aviv University assessed the relationship between cannabis and opioids in a cohort of patients with non-cancer specific chronic pain. All of the patients enrolled in the study were prescribed medical cannabis therapy in accordance with Israel's medical cannabis access laws. Among those patients who reported using opioids at baseline, 93 percent either "decreased or stopped [using] opioids following cannabis initiation" – a finding that is consistent with dozens of other studies involving numerous other patient populations.

"The data is clear and consistent," NORML's Deputy Director Paul Armentano said. "Cannabis is effective in treating a variety of forms of chronic pain and, for some patients, it provides a viable alternative to potentially deadly opioids."

#10: MISSISSIPPI BECOMES 37TH STATE TO LEGALIZE MEDICAL CANNABIS ACCESS

State lawmakers passed comprehensive legislation in February regulating the production and dispensing of medical cannabis products. The legislation was enacted 15 months after state voters initially passed a similar medical marijuana legalization initiative. However, the courts later struck down the state's citizens' initiative process – thus nullifying the 2020 election result.

"Marijuana access has been long overdue for Mississippi's patients," NORML's State Policies Manager Jax James said. "The overwhelming majority of voters decided in favor of this policy change two years ago, and while lawmakers cannot make up for lost time, they have an obligation to roll out this program as swiftly as possible so that patients can finally access the medicine they need."

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Clinical Trial: Cannabis Oil Effective at Improving Sleep in Adults with Insomnia

Melbourne, Australia: The short-term use of plant-derived cannabis extracts is well-tolerated and effective in patients diagnosed with insomnia, according to placebo-controlled trial data published in the Journal of Sleep Research.

Australian researchers assessed the use of a proprietary cannabis oil product (Entoura-10:15) versus placebo in 29 subjects with chronic insomnia. Extracts contained 10mg of THC and 15mg of CBD. Participants consumed either extracts or placebo for a period of two weeks.

Investigators reported that those receiving cannabis extracts experienced improved sleep quality by up to 80 percent, and that "60 percent of participants no longer classified as clinical insomniacs at the end of the two-week intervention period."

They concluded: "Our short-term trial suggests Entoura 10:15 medicinal cannabis oil, containing THC:CBD 10:15 and lesser amounts of other CBs and naturally occurring terpenes, to be well tolerated and effective in significantly improving sleep quality and duration, midnight melatonin levels, quality of life, and mood within 2-weeks in adults with insomnia. … Long-term studies are needed to assess whether chronic medicinal cannabis intake can restore natural circadian rhythm without the need for ongoing cannabis intake."

The results are similar to those of a prior placebo-controlled clinical trial, published in 2021, that also reported that plant-derived cannabis extracts are "well tolerated and improve insomnia symptoms and sleep quality in individuals with chronic insomnia symptoms." Observational trials similarly report benefits in patients' sleep quality following the inhalation of cannabis flowers prior to bedtime.

Full text of the study, "Medicinal cannabis improves sleep in adults with insomnia: A randomized double-blind placebo-controlled crossover trial," appears in the Journal of Sleep Research.

Review: Cannabis Safe and Effective in Migraine Treatment

Fairfield, CA: The inhalation of cannabis flowers is effective and well-tolerated among patents with migraine, according to a systematic review of the literature published in the journal Cureus.

A team of researchers affiliated with the California Institute of Behavioral Neurosciences and Psychology reviewed nine recent studies involving over 5,600 subjects.

They reported: "All the studies showed encouraging findings on the therapeutic effects of medicinal marijuana in migraine treatment. Additionally, medical marijuana is well-tolerated with fewer side effects and is safe to use in migraine patients."

Authors concluded: "The studies demonstrated that medical marijuana has a significant clinical response by reducing the length and frequency of migraines. No severe adverse effects were noted. Due to its effectiveness and convenience, medical marijuana therapy may be helpful for patients suffering from migraines."

Survey data published earlier this year reported that an estimated one-third of patients suffering from headache disorders acknowledge using cannabis products for symptom management.

Full text of the study, "Efficacy and safety of medical marijuana in migraine headache: A systematic review," appears in Cureus.

Study: Oral Cannabis Products Show Long-Term Safety and Efficacy in Patients

Western Australia, Australia: Patients authorized to consume plant-derived oral cannabis products show sustained improvements in their symptoms, according to longitudinal data published in the journal PLOS One.

Researchers assessed the long-terms safety and efficacy of oral cannabis products in a cohort of nearly 4,000 Australian patients authorized to use them. Study participants were naïve to cannabis prior to their enrollment in the trial. The majority of the study's subjects (64 percent) suffered from chronic pain conditions. All of the study's participants consumed oral cannabis products for a period of two years.

Investigators reported: "This is the largest and longest real-world analysis of the efficacy and safety of GMP [good manufacturing practices]-like oral medicinal cannabis (MC) in a continuous enrolment cohort registry. 3,961 heterogenous, cannabis naïve patients with a wide range of ages, clinical and complex conditions, and concomitant medications, prescribed oral MC, demonstrated a rapid and significant improvement across all measured patient and clinical reported validated outcomes. … Oral MC was well tolerated. … This safety is particularly salient in contrast to the safety and tolerability of prescribed long-term opioids."

They concluded, "This large Australian longitudinal cohort registry of cannabis naïve, complex chronic disease patients treated with oral MC for over 24 consecutive months, demonstrates safety of oral generic medicinal cannabis, and demonstrated oral MC improves patient and clinician reported impact of pain, sleep and well-being."

An estimated 100,000 Australians have been prescribed cannabis products following the enactment of legal changes in 2016 providing patients with regulatory access to medical marijuana products.

Full text of the study, "A large Australian longitudinal cohort registry demonstrates sustained safety and efficacy of oral medicinal cannabis for at least two years," appears in PLOS One.

Study: No Adverse Events in Stroke Survivors Taking Cannabis Spray

Genova, Italy: The daily consumption of a proprietary oromucosal spray containing equal ratios of plant-derived THC and CBD (nabiximols aka Sativex) is not associated with cardiovascular complications in stroke survivors, according to clinical data published in the journal Frontiers in Cardiovascular Medicine.

A team of Italian researchers assessed the safety of nabiximols in a cohort of 34 spasticity patients that had previously suffered from strokes.

Investigators reported: "No cardiovascular treatment-emergent adverse drug effects emerged during nabiximols treatment, namely no significant fluctuation of blood pressure and heart rate, nor ischemic or hemorrhagic events occurred. During nabiximols treatment, self-assessed blood pressure and heart rate did not change compared to the baseline condition. No patients showed significant acceleration or decrease in heart rate or change in rhythm and none required an additional ECG or cardiological evaluation during the study."

They concluded, "These data support the cardiovascular safety of nabiximols."

Analyses of nationally representative samples of recreational marijuana consumers have reported inconsistent results regarding the relationship between cannabis and adverse cardiovascular events. A 2021 study of 57,000 US adults concluded, "After controlling for several confounding variables, we found that there was a decrease in the prevalence of cardiovascular events with marijuana use (Odds Ratio: 0.74)." By contrast, a 2020 review of nearly 134,000 US adults reported, "Frequent marijuana smoking is associated with significantly higher odds of stroke and myocardial infarction or coronary artery disease, with a possible role in premature cardiovascular disease."

More recently, the results of a literature review of 67 studies published in The American Journal of Medicine concluded, "[M]arijuana itself does not appear to be independently associated with excessive cardiovascular risk factors." Authors did caution, however, that "it can be associated with other unhealthy behaviors such as alcohol use and tobacco smoking that can be detrimental" to cardiovascular health.

Similarly, a separate review published last year of 46 randomized clinical trials involving 2,800 patients concluded that consumption of either purified or synthetic cannabinoids, including THC, is not associated with any increased risk of serious cardiovascular events.

Full text of the study, "Nabiximols effect on blood pressure and heart rate in post-stroke patients of a randomized controlled study," appears in the journal Frontiers in Cardiovascular Medicine.

New Mexico: Regulators Approve Changes Expanding Medical Cannabis Access

Santa Fe, NM: State regulators have expended the pool of patients eligible to access medical cannabis products to include those with anxiety disorders. Members of the New Mexico Medical Cannabis Advisory Board approved the policy expansion, which takes effect on January 1, 2023.

A pair of physicians petitioned regulators to expand the scope of the program, opining that alternatives to conventional medications are needed to address the needs of those with treatment-resistant anxiety disorders.

Survey data indicates that those who consume cannabis for purposes of self-medication are most likely to do so to mitigate symptoms of pain, anxiety, and to improve sleep.

According to data compiled by the state's Department of Health, over 130,000 New Mexicans are registered to access medical cannabis products.

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Study: Cannabis Products Associated with Quality of Life Improvements in Patients with Post-Traumatic Stress

London, United Kingdom: Patients with post-traumatic stress experience symptom improvements following the use of cannabis products, according to data published in the journal Expert Review of Neurotherapeutics.

British investigators assessed the safety and efficacy of cannabis products in 162 PTSD patients with a physician's authorization. Study subjects were participants in the UK Medical Cannabis Registry. Study participants consumed either cannabis extracts or THC-dominant flowers for a period of six-months.

Authors reported that patients showed "statistically significant improvements" in a variety of domains, including sleep, anxiety, and stress. Self-reported adverse events were typically mild in severity.

"This observational study suggests an association between CBMP [cannabis-based medicinal products] treatment and improvement in PTSD-specific, HRQoL [health-related quality of life], sleep, and anxiety outcomes at up to 6-month follow-up," they concluded. "CBMPs were well-tolerated and adverse events manageable. … [T]his study can serve to inform future randomized placebo-controlled trials with the aim of confirming these promising effects, whilst informing current clinical practice."

Observational studies assessing the role of cannabinoids in mitigating symptoms of PTSD have generally yielded mixed results. 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, "Assessment of clinical outcomes in patients with post-traumatic stress disorder: Analysis from the UK Medical Cannabis Registry," appears in the journal Expert Review of Neurotherapeutics.

Analysis: Medical Cannabis Access Associated with Reduced Alcohol Sales

Ontario, Canada: The adoption of medical cannabis access in Canada was associated with reductions in alcohol sales, according to data published in the journal Health Policy.

A Canadian researcher evaluated the relationship between medical cannabis legalization and retail sales of alcohol in various regions of the country over an eight-year period.

The author determined: "This study found a significant negative association between legal medical cannabis sales and liquor store alcohol sales: each cannabis sales dollar was associated with an average alcohol sales reduction of between $0.74 and $0.84. The negative association was robust with respect to several alternative modeling choices."

He concluded, "From a public health perspective, the results likewise imply that reductions in alcohol-related health impacts might partly offset the increased cannabis-related health impacts that legalization might bring."

A 2017 analysis of US beverage sales identified a similar decline in alcohol sales following the adoption of statewide medical cannabis legalization laws, as did a 2021 assessment of Youth Risk Behavioral Survey data. By contrast, a more recent study evaluating the impact of adult-use legalization laws in the United States reported an association with increased alcohol use those age 21 and older.

Full text of the study, "Relationship between sales of legal cannabis and alcohol in Canada," appears in Health Policy.

Study: Consumption of Commercially Available CBD Products Associated with Perceived Improvements in Pain, Anxiety, Sleep, and Well-Being

Los Angeles, CA: Subjects who consume commercially available CBD products report improvements in their overall well-being as compared to those taking a placebo, according to data published in the journal Integrative Medicine Reports.

A team of investigators affiliated with the University of California, Los Angeles and with the Scripps Institute assessed the health and safety of 13 commercially available CBD products in a cohort of over 2,800 participants. Subjects were randomly assigned to consume either CBD or a placebo for a period of 4 weeks.

Researchers reported: "Well-being, anxiety, sleep disturbance, and pain significantly improved among those assigned to take a CBD product relative to waitlist controls. Among those assigned to a CBD product, the percentage of individuals with a given condition who experienced an improvement which could be considered clinically meaningful or important was 46.6 percent for anxiety; 47.9 percent for sleep disturbance, and 35.2 percent for pain. … [A]ll products in the study exhibited a favorable safety profile; no severe side effects were reported."

They concluded: "Our results suggest that the commercially available CBD products included in this study are safe and may serve as potentially effective complementary therapies for management of anxiety, sleep disturbance, and pain. These effects appear independent of the prior CBD use and product spectrum."

Prior analyses of commercially available CBD products have raised concerns about their purity and potency. Survey data compiled by the National Consumers League in 2020 determined that more than eight in ten US voters desire greater federal regulatory oversight over the labeling and marketing of commercially available CBD products.

Full text of the study, "The safety and effectiveness of commercially available cannabidiol products for health and well-being: A randomized, multi-arm, open-label waitlist-controlled trial," appears in Integrative Medicine Reports.

Review: Evidence Lacking for Supposed Cannabis 'Hangover' Effect

New South Wales, Australia: The majority of available data fails to support claims that cannabis may potentially impact either cognitive function or subjects' performance of safety sensitive tasks 24 hours after consumption, according to a review of the scientific literature published in the journal Cannabis and Cannabinoid Research.

A team of Australian researchers reviewed data from 20 studies involving 458 subjects. Selected studies assessed subjects' performance 12 to 24 hours following THC dosing.

Investigators failed to identify any evidence of so-called THC-specific "next-day effects" in 16 of the 20 studies reviewed.

They concluded: "A small number of lower-quality studies have observed negative (i.e., impairing) 'next day' effects of THC on cognitive function and safety-sensitive tasks. However, higher-quality studies, and a large majority of performance tests, have not. Overall, it appears that there is limited scientific evidence to support the assertion that cannabis use impairs 'next day' performance."

Authors further opined that the imposition of workplace drug testing policies that detect the long-term presence of cannabis metabolites and impose sanctions upon those who test positive for them are arguably not justified by the available data.

Full text of the study, "The 'next day' effects of cannabis use: A systematic review," appears in Cannabis and Cannabinoid Research.

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POTUS Signs Law Amending Federal Rules Governing Cannabis Research and Drug Development

Washington, DC: President Joe Biden has signed legislation into law, The Medical Marijuana and Cannabidiol Research Expansion Act, facilitating the federal approval of cannabis-specific clinical research and drug development. It is the first time in over 50 years that a President has signed a stand-alone piece of legislation loosening federal marijuana prohibitions.

Under the new law, the US Attorney General is provided with a 60-day timeline to either approve or deny applications from scientists wishing to conduct clinical trials involving the use of cannabis by human subjects. (Protocols must first be reviewed and approved by both the Secretary of the US Department of Health and Human Services and by the National Institutes of Health prior to the AG's authorization. Those agencies do not have an explicit timeline with which to complete their reviews.)

The law also mandates the US Attorney General to solicit applications from those seeking to grow cannabis for either research purposes or for purposes of potential drug development, and it provides a timeline for the AG to approve those applicants. It also calls upon federal agencies, including HHS, to provide a report on the "potential therapeutic effects of cannabidiol or marijuana on serious medical conditions."

Under current regulations, the US Drug Enforcement Administration is primarily tasked with reviewing and licensing marijuana cultivators, as well as granting Schedule I licenses to scientists wishing to study cannabis in clinical settings. In 2016, the agency announced that it would expand the pool of federally licensed growers beyond just the University of Mississippi (which was initially granted a federal cannabis cultivation license in 1968). In May 2021, the agency announced that it had reached agreements with a handful of third-party applicants to allow them to grow cannabis for use in federally approved clinical trials, but progress towards these official partnerships has been slow to materialize.

For decades, scientists wishing to work with marijuana have complained that it often takes years before their research protocols are approved by federal agencies, and that the quality of cannabis provided by the University of Mississippi's cultivation program is of inferior quality and is not representative of the products available in state-legal markets.

In response to those complaints, House members earlier this year passed legislation, HR 5657: The Medical Marijuana Research Act, permitting authorized scientists for the first time to access cannabis flowers and other products manufactured in accordance with state-approved marijuana programs. However, those explicit provisions were not included in The Medical Marijuana and Cannabidiol Research Expansion Act.

NORML's Deputy Director Paul Armentano criticized this omission. "While the Expansion Act is a step in the right direction, the limited variety of cannabis cultivars accessible to federally licensed researchers does not represent the type or quality of cannabis products currently available in legal, statewide markets," he said. "The fact that nearly one-half of US adults have legal access to these multitude of cannabis products, but our nation's top scientists do not, is the height of absurdity and highlights the need for continued legislative action if we want to more easily study the state-legal products that millions of Americans are actually using."

NORML's Political Director Morgan Fox said, "While the significance of POTUS signing the first stand-alone cannabis policy reform bill should not be overlooked, in truth, we don't need more research to know definitively that prohibition is a misguided and disastrous policy." He added: "That said, this legislation is certainly a step in the right direction that shows there can be bipartisan cooperation on this issue. We commend Senate Majority Leader Schumer for prioritizing cannabis policy, and we remain hopeful for the passage of even more substantial legislation before the end of the current session."

Study: Medical Cannabis Legalization Associated with Lower Rates of Opioid Use Among Cancer Patients

New York, NY: The adoption of statewide medical cannabis access laws is associated with lower rates of opioid use and with a reduction in the number of pain-related hospitalizations among newly diagnosed patients with cancer, according to data published in the journal JAMA Oncology.

Investigators affiliated with Cornell University's Weill Medical College assessed the relationship between medical cannabis legalization and opioid-related and pain-related outcomes for adults receiving cancer treatment.

Authors determined that medical marijuana legalization was "associated with a five percent to 20 percent relative reduction in the rate of opioid dispensing to adults younger than 65 years receiving cancer treatment after a new cancer diagnosis. Medical marijuana legalization with dispensary allowances was associated with a larger reduction in opioid dispensing compared with legalization without dispensary allowances." Legalization was also associated with reductions in patients' total number of pain-related hospital events.

Researchers concluded: "This cross-sectional study found that medical marijuana legalization between 2012 and 2017 was associated with reductions in the rate of opioid dispensing and pain-related hospital events in some privately insured patients aged 18 to 64 years receiving anticancer treatment. The findings suggest that medical marijuana could be serving as a substitute for opioids to some extent."

The findings are consistent with numerous other studies showing reduced rates of opioid consumption and dispensing in jurisdictions where cannabis is legally accessible.

Full text of the study, "Medical marijuana legalization and opioid- and pain-related outcomes among patients newly diagnosed with cancer receiving anticancer treatment," appears in JAMA Oncology.

Study: Plant-Derived CBD Extracts Significantly Improve Symptoms in Autistic Children

Melbourne, Australia: Children with autism spectrum disorder (ASD) show significant improvements in their symptoms following the use of plant-derived CBD dominant extracts, according to phase 1 trial results reported by Australian media.

Patients in the trial consumed extracts containing CBD and other non-THC phyto-cannabinoids twice daily for a period of at least two months. Researchers affiliated with the study said that patients experienced significant changes in communication and socialization skills, among other symptom improvements. Side-effects were minimal.

The findings are consistent with several other studies similarly reporting improvements in pediatric patients' ASD symptoms following the use of cannabinoid products, particularly CBD-rich extracts. Survey data published in 2021 by Autism Parenting Magazine reported that 22 percent of US caregivers or parents have provided CBD to an autistic child. Survey data from the United Kingdom recently reported that autistic adults were nearly four times as likely as controls to report having used CBD within the past year.

Review: Medical Cannabis Retail Access Associated with Lower Rates of Drug Overdose Mortality

San Antonio, TX: Medical cannabis retail access is inversely associated with drug overdose mortality rates, according to the findings of a literature review published in the journal Drug and Alcohol Dependence.

Investigators affiliated with the University of Texas and Arizona State University reviewed data from over 50 studies highlighting county-level predictors of overdose mortality.

"[M]easures related to cannabis dispensaries, substance use treatment, social capital, and proportions of family households, were generally consistently associated with lower drug overdose mortality outcomes across multiple studies," authors concluded. "Findings support the need for additional research to elucidate the pathways by which the county context shapes residents' risk of fatal overdose, in order to translate data into contextual interventions to reverse the rising rates of overdose deaths across the US."

Numerous studies have documented lower rates of opioid use over time among populations who either have legal access to retail cannabis products or who possess recommendations for medical cannabis.

Full text of the study, "County-level predictors of US drug overdose mortality: A systematic review," appears in Drug and Alcohol Dependence.

Clinical Trial: CBD Gel Is Safe and Effective in Fragile X Syndrome Patients

Chicago, IL: The administration of a proprietary transdermal CBD gel (aka ZYN002) is safe and effective in patients with Fragile X syndrome (FXS), according to phase 3 clinical trial data published in the Journal of Neurodevelopmental Disorders. FXS is a genetic disorder resulting in developmental delays, learning disabilities, and behavioral problems, such as aggression and attention deficits.

Over 200 pediatric patients (mean age 9.7 years) participated in the 12-week trial. Subjects received either CBD or placebo in addition to their prescribed medications. The study is the largest double-blind, randomized, placebo-controlled clinical trial ever conducted involving FXS patients.

Consistent with prior studies, investigators reported that CBD treatment was effective, safe, and well-tolerated. No serious adverse events were reported.

"In this trial, ZYN002 was well tolerated in patients with FXS and demonstrated evidence of efficacy with a favorable benefit risk relationship," they concluded. "A confirmatory phase 3, randomized, controlled trial is being conducted in children and adolescent patients with FXS."

Full text of the study, "A randomized, controlled trial of ZYN002 cannabidiol transdermal gel in children and adolescents with Fragile X Syndrome," appears in the Journal of Neurodevelopmental Disorders.

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Study: Cannabis Use Associated with Health Improvements in Patients with Treatment-Resistant Fibromyalgia

Holon, Israel: Cannabis treatment is associated with quality of life improvements in patients with treatment-resistant fibromyalgia (FM), according to the results of a prospective cohort study published in the journal Pain Practice.

Israeli researchers evaluated cannabis' efficacy in a cohort of 30 patients diagnosed with fibromyalgia. All of the study's participants had previously failed to respond to conventional pharmaceutical treatments. Investigators assessed patients' quality of life, general health, and physical health following 30 days of cannabis treatment.

They determined: "Cannabis treatment ... showed a marked improvement in general quality-of-life by 1.97 points out of a 5-point score and enhanced general health by 1.83 scores. Cannabis treatment also improved the physical health domain score by 1.5 points. Further examination of the physical health subdomains showed a reduction of 1.67 points in pain and discomfort, pain and fatigue (1.57), and an improvement of 2.13 points in activities of daily living."

The authors further acknowledged that cannabis use was also associated with improvements in patients' self-esteem, mood, memory, and concentration.

"This study suggests that cannabis treatment shows short-term improvement in quality of life through its influence on pain, sleep, and physical and psychological domains," they concluded. "Further studies are still indicated to understand this potential and its long-term beneficial impact."

Survey data reports that fibromyalgia patients frequently consume cannabis for therapeutic purposes, and several recent observational trials have affirmed its safety and efficacy in this population. A recent review of the relevant literature, published in 2021, concluded, "[T]he use of cannabinoids and cannabis carries limited side effects in the treatment of FM, and they can also improve some common and debilitating symptoms associated with FM, thus making them an adequate potential treatment option, when other treatment lines have been exhausted."

Full text of the study, "The role of cannabis in treatment-resistant fibromyalgia women," appears in Pain Practice.

Pew Poll: Americans Overwhelmingly Support Legalizing Marijuana

Washington, DC: Eighty-nine percent of Americans say that marijuana ought to be legal for either medical or adult use, according to nationwide polling compiled by the Pew Research Center.

Fifty-nine percent of respondents said that cannabis should be legal for adults, while an additional 30 percent said that it should be legal explicitly for therapeutic purposes. Both findings are consistent with prior Pew polls.

Adult-use legalization was most popular among Democrats (73 percent), those ages 18 to 29 (72 percent), and African Americans (68 percent). Older respondents and Republicans were least likely to express support. By contrast, broad majorities of Republicans and older Americans favor the legalization of medical marijuana.

Survey: Headache Patients Frequently Report Benefits from Cannabis

Alberta, Canada: Patients suffering from headache disorders frequently experience relief from the use of cannabis, according to survey data published in the Canadian Journal of Neurology.

Researchers surveyed 200 patients associated with a tertiary headache clinic in Calgary regarding their use of cannabis products. (Cannabis is legal in Canada for both medical and adult use.)

Over one-third of respondents (34 percent) acknowledged currently engaging in the use of cannabis. Of these, 60 percent perceived cannabis to be effective at reducing the severity of their headaches, while 29 percent said it mitigated headache frequency. Subjects most frequently reported consuming liquid cannabis preparations or inhaling cannabis flowers.

"The findings of this survey document patient's perceived benefit of cannabinoids in the management of headache," authors reported. "The results of this exploratory survey will aid neurologists and headache specialists in understanding the current trends in use of cannabis products in more severely affected headache patients and inform treatment parameters when designing controlled studies of cannabis in this setting."

Numerous other surveys similarly report that those suffering from migraines often turn to cannabis for symptomatic relief, and many patients say that it is more effective than prescription medications. A recent literature review of 12 previously published studies involving 1,980 participants concluded that cannabis preparations likely provide for the prophylactic and abortive treatment of migraines.

Full text of the study, "Cannabinoid use in a tertiary headache clinic: A cross-sectional survey," appears in the Canadian Journal of Neurology.

Study: Cannabis Use Associated with Improved Quality of Life in Patients with Tourette Syndrome

Tel Aviv, Israel: Tourette syndrome (TS) patients' who consume cannabis products report significant improvements in their quality of life and reduce their intake of prescription medicines, according to data published in the journal Cannabis and Cannabinoid Research.

Israeli researchers assessed patients' symptoms immediately prior to and following six months of cannabis treatment. Study participants generally inhaled THC-dominant cannabis flowers, though some patients also consumed extract formulations.

Researchers reported, "A statistically significant improvement in quality of life, employment status, and [a] reduction in the number of medications was found, with a statistically significant number of patients reporting improvements in OCD and anxiety symptoms after six months of treatment." The authors also identified improvements in motor and vocal tic severity, but they acknowledged that these changes were not statistically significant.

Few patients reported experiencing adverse effects from cannabis treatment. Most commonly reported side effects were dry mouth, dizziness, and fatigue.

"Our findings suggest that medical cannabis may be an effective and safe option to improve comorbidities and quality of life in TS patients," authors concluded. "Medical cannabis effectiveness should be further evaluated in large-scale randomized clinical trials."

TS patients frequently report gaining symptomatic relief from cannabis, and several human trials have identified positive results in cohorts using either oral THC or inhaled cannabis.

Full text of the study, "Use of medical cannabis in patients with Gilles de la Tourette's Syndrome in a real-world setting, appears in Cannabis and Cannabinoid Research.

Texas: Harker Heights Council Members Repeal Voters-Initiated Marijuana Depenalization Ordinance

Harker Heights, TX: Members of the Harker Heights (population: 34,000) City Council voted 4 to 1 to repeal a voter-initiated ordinance that sought to prohibit local law enforcement from making low-level marijuana-related arrests.

Sixty-four percent of city residents voted on election day in favor of Proposition A, which ordered local police to cease issuing citations or making arrests for misdemeanor marijuana violations. Harker Heights was one of five cities where voters approved depenalizing marijuana offenses. In May, voters in the city of Austin also approved a similar local ballot measure.

Local officials argued that the ordinance placed inappropriate burdens on police officers and conflicted with state law. Texas law defines the possession of two ounces or less of cannabis is defined as a criminal misdemeanor, punishable by up to 180 days in jail and a $2,000 fine.

Ground Game Texas, the group that coordinated the initiative campaigns, is seeking to put the Council's decision before voters via a referendum. Doing so would allow voters the opportunity to either confirm or reject the Council's vote.

Council members in Killeen, Texas (population: 156,000) - where 70 percent of voters approved a similar ballot proposal - decided in favor of temporarily pausing the implementation of their marijuana ordinance.

Additional information is available from Ground Game Texas.

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Analysis: Adult-Use Legalization Doesn't Negatively Impact Crime Rates

Colorado Springs, CO: The adoption of state-level marijuana legalization laws does not lead to any significant uptick in overall criminal activity, according to data published in the Journal of Drug Issues.

A pair of researchers affiliated with the University of Colorado at Colorado Springs and with Boise State University in Idaho compared crime data in Colorado and Washington to a synthetic control over a ten-year period (2010-2019). They reported that legalization was "generally not associated with changes in index crime rates."

Authors concluded: "These findings substantiate prior research. Increased crime rates should not be a primary concern as more states move to adopt recreational marijuana use legislation."

Prior evaluations have reported an association between adult-use legalization and improvements in police clearance rates, concluding that legalization "positively influences police performance."

Full text of the study, "Crime in a time of cannabis: Estimating the effects of legalizing marijuana on crime rates in Colorado and Washington using a synthetic control method," appears in The Journal of Drug Issues.

Clinical Trial: CBD Dosing Reduces Anxiety, Improves Cognitive Performance

Boston, MA: Patients with moderate-to-severe anxiety experience symptom improvements and better cognitive performance following the daily administration of full spectrum CBD extracts, according to open-label trial data published in the journal Communications Medicine.

A team of investigators affiliated with Harvard Medical School assessed the safety and efficacy of CBD extracts in a cohort of anxiety patients over a four-week period. Trial participants consumed oral extracts three times daily. Extracts contained approximately 10mgs of CBD and less than one percent THC. Subjects in the trial had either no prior experience with cannabis products or had been abstinent from cannabis for at least one year.

Researchers reported significant improvements in patients' symptoms over the course of the trial. "Treatment response analyses revealed rapid onset of clinically significant reductions in anxiety with most patients achieving and maintaining treatment response after one week and all patients achieving and maintaining treatment response by week three," they determined. "Secondary outcome assessments demonstrated improvements on measures of mood, sleep disturbance, quality of life and executive functioning following treatment. ... Specifically, patients exhibited significantly faster performance with fewer errors on several tasks of executive function relative to baseline, while assessments of visual and verbal memory remained stable. These findings are consistent with data from observational investigations reporting long-term treatment with medical cannabis is associated with improved clinical state and executive functioning."

Authors reported that CBD doses were "well-tolerated with no serious adverse events and few side effects."

Although prior studies have similarly identified anxiolytic activities associated with CBD, patients in this study achieved a treatment response at comparably lower doses (30 mgs per day versus 300 mgs per day). Researchers theorized that the use of full-spectrum products is likely more efficacious than the administration of a single extracted CBD isolate. A 2019 study assessing the use of plant-derived CBD-dominant capsules similarly showed improvements in anxiety and sleep following the daily administration of low-dose (25mgs) products.

Investigators concluded: "Initial results from the open-label stage of this clinical trial demonstrated significant improvement of primary outcome assessments of anxiety, providing preliminary evidence that a full- spectrum, high-CBD product may be efficacious for treating anxiety with few side effects. ... A definitive assessment of the impact of this novel treatment on clinical symptoms and cognition will be ascertained in the ongoing double-blind, placebo-controlled stage."

Full text of the study, "Clinical and cognitive improvement following full-spectrum, high cannabidiol treatment for anxiety: open-label data from a two-stage, phase 2 clinical trial," appears in Communications Medicine.

Analysis: Young People No More Likely to Try Cannabis in States That License Retail Sales

Seattle, WA: Adolescents who reside in states where retail sales of cannabis are legal for adults are no more likely to consume cannabis than are young people in states where it isn't, according to data published in the American Journal of Preventive Medicine.

A team of investigators affiliated with the University of Washington and with Colorado State University evaluated longitudinal data from three US states. In two of the states (Oregon and Washington), legal sales were permitted, while in the other state they were not.

Researchers reported: "Change in legalization status across adolescence was not significantly related to within-person change in the probability or frequency of self-reported past-year cannabis use. At the between-person level, youth who spent more of their adolescence under legalization were no more or less likely to have used cannabis at age 15 years than adolescents who spent little or no time under legalization."

They concluded, "[Our] findings are not consistent with changes in the prevalence or frequency of adolescent cannabis use after legalization. ... Taken together with previous studies, these findings add weight to the conclusion that adolescent cannabis use is holding steady in the wake of legalization."

The study's conclusions are consistent with those of numerous others, finding that adult-use regulations are not associated with either increased marijuana use or access among young people, or with any changes in young people's perceptions toward the substance.

Full text of the study, "Effects of cannabis legalization on adolescent cannabis use across 3 states," appears in the American Journal of Preventive Medicine.

Study: Cannabis Use Associated with Greater Rates of Physical Activity in HIV+ Patients

Providence, RI: Cannabis use is associated with greater levels of physical activity in HIV+ positive patients, according to data published in the journal AIDS Care.

A team of researchers from Brown University in Rhode Island and Boston University's School of Public Health assessed the relationship between self-reported substance use and exercise engagement in a cohort of HIV+ patients.

Investigators reported that those who reported consuming cannabis were significantly more likely to be physically active than those patients who did not.

They reported, "The estimated mean rate of vigorous METs [Metabolic Equivalent of Task Units] was ... 6.25 times higher for people who used cannabis than non-users."

Researchers theorized that cannabis' ability to mitigate symptoms associated with HIV, such as pain, may facilitate greater engagement in physical activity.

The findings are consistent with several prior studies reporting a positive association between cannabis use and exercise, particularly among seniors.

Full text of the study, "The relationship between substance use and physical activity among people living with HIV, chronic pain, and symptoms of depression: A cross-sectional analysis," appears in AIDS Care.

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