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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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Election Day Wrap-Up: Voters in Several States, Cities Decide in Favor of Adult-Use Legalization

Washington, DC: Voters in two states, Maryland and Missouri, decided in favor of ballot measures legalizing the adult-use of cannabis, while voters in various cities nationwide similarly approved ballot measures ending marijuana-related arrests and prosecutions.

"While this year's midterm elections may not have been a 'clean sweep' for reform advocates, our momentum continues unabated," NORML's Deputy Director Paul Armentano said. "Are we in a stronger place today than we were yesterday? Of course. Two more states, Maryland and Missouri, have wisely elected to legalize and regulate cannabis - policies that will expand the freedoms and civil liberties of over 7 million Americans. In addition, voters in cities across this country - including over 400,000 Texans - acted to end the senseless and counterproductive policy of arresting and prosecuting those who possess and use cannabis."

"Poll after poll shows record public support for the legalization of the adult-use of marijuana. This support is a testament to the fact that most Americans are now well aware of the failures of marijuana prohibition and the damages it continues to cause, and that the growing number of states which have enacted legalization are doing so in a safe and effective manner that is in accordance with voters' wishes and expectations. In the coming weeks, we anticipate that Congressional lawmakers will move ahead with longstanding promises to advance federal reform legislation while, at the state level, we anticipate numerous governments to once again take up a variety of bills protecting and expanding the rights of those adults who consume cannabis responsibly."

In Maryland, an estimated 66 percent of voters approved a referendum (Question 4) directing state lawmakers to establish rules and regulations governing the production and sale of cannabis to adults. By approving Question 4, voters also triggered the enactment of separate, complementary legislation (HB 837) defining marijuana possession limits and facilitating the automatic review and expungement of low-level cannabis convictions. Under the legislation, which was passed by lawmakers this spring, adults will be legally permitted to possess up to 1.5 ounces of cannabis and/or 12 grams of cannabis concentrates beginning in July 2023. (Between January 1, 2023 and July 1, 2023, civil penalties will apply.) Adults will also be permitted to grow up to two cannabis plants in their homes for their own personal use. Possessing amounts between 1.5 ounces and 2.5 ounces will be subject to civil fines, while the possession of greater quantities will remain subject to existing criminal penalties. Those with past records for marijuana-related crimes can also begin petitioning the courts for expungement relief beginning next year.

In Missouri, an estimated 53 percent of voters decided in favor of a ballot initiative (Amendment 3) legalizing the possession, cultivation, and licensed retail sale of cannabis for those ages 21 and older. Beginning on December 8, 2022, adults will be permitted to possess up to three ounces of cannabis and to home-cultivate up to six flowering plants, six immature plants, and six plants under 14 inches for their own personal use. It also establishes a program to automatically review and expunge criminal records for eligible non-violent marijuana-related offenses. The measure seeks to broaden participation in the licensed cannabis marketplace by including small business owners and those representing disadvantaged populations, including those with limited capital, residents of high-poverty communities, service-disabled veterans, and those who have been previously convicted of nonviolent marijuana offenses. Additionally, the initiative makes some improvements to the state's existing medical marijuana access program.

Maryland and Missouri are the 20th and 21st states to adopt adult-use legalization.

Voters in three states: Arkansas, North Dakota, and South Dakota turned back marijuana legalization measures. In two states, the proposals sought to regulate commercial cannabis sales, while South Dakota's measure more narrowly sought to end marijuana-related possession arrests.

By contrast, voters in the Texas cities of Denton, Elgin, Harker Heights, Killeen, and San Marcos all voted in support of municipal measures that largely prohibit local police officers from either arresting or citing people for Class A or Class B marijuana misdemeanors. Over 400,000 Texans reside in those cities.

In May, voters in the city of Austin overwhelmingly approved a similar local ballot measure.

Texas leads the nation in marijuana-related arrests. Under state law, 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. Those arrested are disproportionately African Americans.

In addition, voters in five Ohio cities - totaling some 30,000 people - similarly passed ballot measures either reducing or eliminating local marijuana possession penalties. Those towns are Corning, Kent, Laurelville, Rushville, and Shawnee. A separate measure in Helena that was approved by voters is being challenged legally. To date, voters in some two-dozen Ohio towns have enacted similar ordinances.

In Rhode Island, voters in 25 of 31 eligible towns voted in favor of measures to allow for the opportunity to have licensed marijuana retail establishments in their localities. In Michigan, voters in numerous towns decided in favor of similar local measures to allow for the retail sale of either medical or adult-use cannabis products. In Connecticut, voters in two towns - Ledyard and Waterbury - decided in favor of ballot measures to permit retail cannabis sales.

Analysis: Inhaled Cannabis Reduces Pain and Anxiety, Improves Health-Related Quality of Life in Patients with Treatment-Resistant Conditions

London, United Kingdom: The sustained vaporization of THC-dominant cannabis flowers improves health-related quality of life measurements in patients suffering from chronic pain and anxiety-related disorders, according to observational data published in the journal Biomedicines.

A team of British and Spanish investigators assessed cannabis' efficacy in a cohort of 451 British patients authorized to consume cannabis flowers for treatment-resistant pain and/or anxiety. Patients in the study were all enrolled with Project Twenty21, "the first U.K. multi-center registry seeking to develop a body of real-world evidence to inform on the effectiveness and safety of medical cannabis." All of the study's participants had failed to respond to at least two prescription treatment options prior to obtaining an authorization for medical cannabis. All participants vaporized cannabis flowers for a period of at least three months.

Researchers reported that cannabis inhalation was associated with sustained (6+ months) improvements in both patient populations and that side effects were "minimal." Investigators reported more significant improvements among those diagnosed with treatment-resistant anxiety.

"Our results indicate that controlled inhalation of pharmaceutical grade, THC-predominant cannabis flos [flowers] is associated with a significant improvement in patient-reported pain scores, mood, anxiety, sleep disturbances and overall HRQoL [health-related quality of life] in a treatment-resistant clinical population," authors concluded.

Numerous surveys indicate that patients most frequently self-report using cannabis to mitigate symptoms of pain and anxiety.

Full text of the study, "Controlled inhalation of THC-predominant cannabis flos (flowers for inhalation) improves health-related quality of life and symptoms of pain and anxiety in eligible UK patients," appears in Biomedicines.

Review: Data Suggests Role for CBD in Managing Opioid Withdrawal Symptoms

New York, NY: The use of CBD can mitigate various symptoms associated with opioid withdrawal and it should be considered as an adjunctive treatment for patients, according to a review of the relevant literature published in the journal Cannabis and Cannabinoid Research.

Researchers affiliated with the Icahn School of Medicine at Mount Sinai identified 41 clinical studies evaluating the use of CBD for symptoms relevant to opioid withdrawal.

They reported: "Growing evidence suggests that CBD may have the potential to reduce anxiety, pain, and insomnia with also some signals for reducing craving, nausea, vomiting, muscle spasms, and blood pressure. These clinical symptoms are commonly observed in OUD [opioid use disorder] patients undergoing withdrawal, indicating that CBD could potentially be added to the standard opioid detoxification regimen to mitigate acute withdrawal-related symptoms as well as protracted withdrawal symptoms."

They concluded: "In summary, CBD has a good safety profile, is well tolerated with opioid agonists, and reduces key withdrawal symptoms. … Easing withdrawal symptoms with CBD could improve clinical outcomes by keeping patients engaged in treatment, facilitating smoother transition to MOUD [medications for opioid use disorder] like buprenorphine or extended-release naltrexone, and helping with tapering of opioid agonist treatment or opioid analgesics."

Cannabis use is frequently reported among patients withdrawing from opioids. According to a 2020 review paper, "[E]vidence … demonstrates the potential [of] cannabis to ease opioid withdrawal symptoms, reduce opioid consumption, ameliorate opioid cravings, prevent opioid relapse, improve OUD treatment retention, and reduce overdose deaths."

Full text of the study, "Adjunctive management of opioid withdrawal with the non-opioid medication cannabidiol," appears in Cannabis and Cannabinoid Research.

Case Report: CBD-Dominant Extracts Effectively Manage Symptoms in Autistic Patient

Toronto, Canada: The twice-daily administration of plant-derived CBD-dominant extracts is "an effective treatment for managing symptoms associated with autism," according to a case report published in the journal Cureus.

A team of Canadian investigators documented the treatment of a nine-year old patient diagnosed with nonverbal autism spectrum disorder (ASD). The patient received twice-daily dosing of a high-CBD/low-THC extract oil.

Researchers reported, "The child patient responded positively to the introduction of CBD oil treatment with reduced negative behaviors, better sleep, and improved communication." No adverse side-effects were reported.

They concluded, "With the increasing clinical studies on the use of cannabidiol in treating patients with mood disorders, anxiety, chronic pain conditions, and other behavioral problems, it should be considered as a treatment option in managing symptoms related to autism."

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 the publication 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.

Full text of the study, "Cannabidiol in the treatment of autism spectrum disorder: A case study," appears in Cureus.

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Study: Adult-Use Legalization Doesn’t Influence Children’s Attitudes Toward Cannabis

Boston, MA: The enactment of state-level laws legalizing marijuana for adults does not influence early adolescents’ attitudes toward its potential risks, according to data published in the journal Cannabis and Cannabinoid Research.

Investigators affiliated with Massachusetts General Hospital and Harvard Medical School assessed children’s perceptions of marijuana-related harms over three years in states with and without legal cannabis marketplaces.

They determined that “individual child-level characteristics, rather than state policy,” contribute primarily to young people’s attitudes toward cannabis.

“There was no significant main effect of state RCLs [recreational cannabis laws] on perceived risk of cannabis use, and no differences in change over time by state RCLs,” researchers reported.

They concluded, “This analysis indicates that state-level RCLs are not associated with differential perception of cannabis risk among children.”

The study’s conclusions are consistent with those of numerous others, finding that adult-use regulations are not associated with increased marijuana use or access among young people.

Full text of the study, “State-level recreational cannabis legalization is not differentially associated with cannabis risk perception among children: A multilevel regression analysis,” appears in Cannabis and Cannabinoid Research.

Analysis: Consumers’ Cannabis Purchasing Patterns Are Determined By Price, Ease of Access

Ontario, Canada: Consumers’ decisions regarding whether to purchase cannabis products from the legal market or the unregulated market are influenced primarily by price and convenience, according to data published in the Journal of Studies on Alcohol and Drugs.

Canadian researchers surveyed a cohort of more than 11,000 marijuana consumers in the United States and Canada. Respondents said that they were most likely to forgo accessing marijuana from the legal marketplace if they believed that they could obtain cheaper products more conveniently from unregulated sources.

“Higher prices and inconvenience of legal sources were common barriers to purchasing legal cannabis,” authors concluded. “Future research should examine how perceived barriers to legal purchasing change as legal markets mature.”

Data has previously shown that cannabis consumers are willing to pay higher prices for legal cannabis products because they believe that they are superior to those available from other sources. However, consumers acknowledge that they will not pay for products that they perceive are priced excessively high.

Separate data provided earlier this year by Leafly.com reported that jurisdictions with the most robust legal cannabis markets and the fewest local bans on retail outlets are most successful at disrupting unregulated cannabis supply chains.

“The most effective way to disrupt the unregulated marketplace is for lawmakers and regulators to swiftly provide cannabis consumers with an accessible and affordable legal marketplace,” NORML Deputy Director Paul Armentano said. NORML has consistently criticized the enactment of municipal bans on cannabis-related businesses, opining that they perpetuate the unregulated market by limiting consumers’ access to licensed products.

Full text of the study, “Reasons for purchasing cannabis from illegal sources in legal markets: Findings among cannabis consumers in Canada and U.S. States, 2019-2020,” appears in the Journal of Studies on Alcohol and Drugs.

Study: Inhaled Cannabis “Safe and Effective” for Treating Chronic Low Back Pain

Haifa, Israel: The inhalation of THC-dominant cannabis flower long-term safely mitigates symptoms of chronic lower back pain in a manner that is more effective than the use of CBD-dominant extracts, according to observational trial data published in the Israeli journal Rambam Maimonides.

Israeli researchers assessed the safety and efficacy of THC-dominant flowers and CBD-dominant sublingual extracts in a cohort of patients with low back pain. Study participants engaged in the daily use of extracts for one year, followed by the use of cannabis flower in year two.

Researchers reported, “THC-rich smoked cannabis inflorescence was more effective than CBD-rich cannabis-extracts for inducing symptom relief in LBP [lower back pain],” as assessed on a visual analogue scale and by a disability index. Additionally, patients’ use of analgesic medicines fell significantly during year two of the trial. No serious adverse events were reported.

Authors concluded: “Our findings indicate that inhaled THC-rich therapy is more effective than CBD-rich sublingual extract therapy for treating low back pain and that cannabis therapy is safe and effective for chronic low back pain.”

An estimated 111,000 Israelis are currently licensed to use medical cannabis products. More than half of those patients utilize cannabis to treat chronic pain conditions.

Several prior studies have similarly demonstrated that cannabis use is associated with reduced opioid consumption in patients with chronic back pain.

Full text of the study, “Comparing sublingual and inhaled cannabis therapies for low back pain: An observational open-label study,” appears in Rambam Maimonides Medical Journal.

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Review: Cannabis Smoke Exposure "Distinctly Different" From Tobacco

Little Rock, AR: Cannabis smoke is "distinctly different from tobacco" and its exposure is not linked to an elevated risk of either lung cancer or chronic obstructive pulmonary disease (COPD), according to a literature review published in the journal Medical Clinics of North America.

Researchers affiliated with the University of Arkansas for Medical Sciences reviewed data assessing the potential impact of cannabis smoke exposure on pulmonary health. They reported that marijuana smoking is associated with an increased risk of bronchitis, but that it is likely not responsible for lung disease, small airway injury, COPD, or lung cancer.

"[T]he data on marijuana contrast starkly with the consistent demonstration of injury from tobacco," authors concluded. "Any possible toxicity of marijuana pales in comparison."

The review's findings are consistent with those of numerous other studies determining that the long-term respiratory effects of cannabis differ from those associated with traditional smoking, and that those who exclusively smoke cannabis possess a reduced level of exposure to harmful toxicants and carcinogens than do those who smoke tobacco cigarettes. Moreover, the use of vaporization technology, which heats herbal cannabis to a set temperature below the point of combustion, is associated with even further reductions in exposure to toxic gasses and has been identified as a "safe and effective" cannabis delivery device in clinical trial settings.

Full text of the study, "Marijuana and the lung: Evolving Understandings," appears in Medical Clinics of North America.

Sentencing Commission Identifies Over 6,500 Americans Eligible to Receive Pardons Under POTUS' Marijuana Directive

Washington, DC: A recent directive by the President of the United States to pardon those with low-level federal marijuana possession convictions will provide forgiveness for 6,557 citizens, according to estimates provided by the U.S. Sentencing Commission (USSC).

The USSC analysis includes federal data dating back to 1992. It found that the greatest percentage of those eligible for relief are located either in the southwest or the mid-Atlantic region of the United States.

According to the US Department of Justice, a Presidential pardon "is an expression of the President's forgiveness and ordinarily is granted in recognition of the applicant's acceptance of responsibility for the crime and established good conduct for a significant period of time after conviction or completion of sentence. It does not signify innocence. It does, however, remove civil disabilities - e.g., restrictions on the right to vote, hold state or local office, or sit on a jury - imposed because of the conviction for which pardon is sought, and should lessen the stigma arising from the conviction. It may also be helpful in obtaining licenses, bonding, or employment."

On October 6, President Joe Biden announced his intent to "pardon of all prior Federal offenses of simple possession of marijuana." The President also announced that he was encouraging Governors to take similar actions.

To date, nearly two dozen states have enacted legislation explicitly facilitating the process of having select marijuana convictions expunged, vacated, otherwise set aside, or sealed from public view. These laws have led state and local officials nationwide to expunge or seal the records of over two million people with prior cannabis convictions. In addition, the Governors of Colorado, Nevada, Illinois, and Washington have also granted an estimated 30,000 pardons to those with low-level marijuana convictions.

Since 1965, nearly 29 million Americans have been arrested for violating state or local marijuana laws, according to archived data from the FBI's Uniform Crime Report.

According to a number of recently released national polls, Americans overwhelmingly approve of the President's decision to pardon low-level marijuana offenders.

Clinical Trial: CBD Offsets THC-Induced Anxiety

Maastricht, The Netherlands: Subjects who consume cannabis containing equal amounts of THC and CBD report experiencing less anxiety than they do after consuming THC-dominant cannabis, according to trial data published in the journal Psychopharmacology.

Dutch investigators assessed perceived anxiety levels in a cohort of 26 subjects following single doses of vaporized cannabis. Subjects vaporized cannabis samples that were either high in THC (13.75 mgs), high in CBD (13.75 mgs), contained equal amounts of both CBD and THC, or that contained no cannabinoids.

Investigators reported that THC-dominant and THC/CBD equivalent samples significantly increased participants' self-rated state of anxiety compared to placebo, but subjects reported less anxiety after consuming the latter. Specifically, they reported, "Combined treatment of THC and CBD delayed the onset of ... anxiety, reduced its magnitude and shortened its duration compared to inhalation of THC alone."

The study's findings are consistent with those of prior studies documenting CBD's anxiolytic effects, and determining that subjects who consume cannabis flowers containing equal ratios of THC and CBD are less likely to report experiencing adverse effects, such as feelings of paranoia.

Authors concluded: "The present study showed that cannabis containing equivalent concentrations of THC and CBD induces less self-rated ... anxiety compared to THC-only cannabis in healthy volunteers. ... The THC/CBD combination might be more favorable in clinical settings, and it may be a reasonable public health strategy to encourage cannabis breeds containing THC/CBD mixtures where recreational use of cannabis is now legal."

Full text of the study, "Cannabis containing equivalent concentrations of delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD) induces less state anxiety than THC-dominant cannabis," appears in Psychopharmacology.

Survey: Caregivers Report That CBD Improves Symptoms of Fragile X Syndrome

New York, NY: The use of CBD products provides symptom relief to pediatric patients with Fragile X Syndrome (FXS), according to survey responses provided by their parents and caregivers. FXS is a genetic disorder that results in developmental disorders and behavioral problems (e.g., failure to make eye contact, hyperactivity, anxiety, trouble paying attention, etc.)

Investigators affiliated with the Icahn School of Medicine at Mount Sinai, New York and with the National Fragile X Foundation in McLean, Virginia surveyed the parents and caregivers of individuals with FXS who were receiving or had received CBD.

The majority of respondents reported CBD to be either very effective or somewhat effective at improving the following FSX symptoms: anxiety (80 percent), hypersensitivity (74 percent), irritability (73 percent), attention problems (60 percent), aggression (60 percent), and sleep disorders (53 percent).

"Overall, caregivers generally reported that CBD made a significant and positive difference to individuals' symptoms," authors concluded. "Most parents reported that side effects were not experienced, and any that were reported were generally mild or very mild. ... Placebo-controlled clinical trials regarding CBD as a treatment for FXS are essential to better understanding the efficacy and safety of CBD in FXS."

In a pair of pilot studies, CBD administration was associated with quality of life improvements and reductions in patients' anxiety, compulsive behavior, and irritability.

Full text of the study, "Parent and caregiver perspectives toward cannabidiol as a treatment for Fragile X Syndrome," appears in Genes.

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Study: Long-Term Use of Cannabis Extracts Safe and Effective in Dementia Patients

Geneva, Switzerland: The administration of plant-derived extracts containing a two-to-one ratio of CBD to THC is associated with behavioral improvements and few adverse side effects in dementia patients, according to data published in the journal Frontiers in Aging Neuroscience.

A team of Swiss researchers assessed the long-term safety and efficacy of the adjunctive use of cannabis extracts in a cohort of dementia patients (mean age: 81 years). Participants received an average of 12.4 mgs of THC and 24.8 mgs of CBD per day for up to 13 months.

Investigators reported "marked improvements" in patients' symptoms over the course of the trial, including reduced agitation. They reported "no problems related to the treatment and limited adverse drug reactions."

They concluded, "A long-term THC/CBD (1:2) medication can be administered safely and with overall positive clinical improvement to poly medicated older adults with severe dementia and associated problems."

The study's results are similar to those recently reported in a placebo-controlled trial which determined that the sublingual administration of CBD-dominant plant extracts reduced agitation and improved sleep in dementia patients.

Full text of the study, "Cannabinoids for behavioral symptoms in severe dementia: Safety and feasibility in a long-term pilot observational study in nineteen patients," appears in Frontiers in Aging Neuroscience.

Survey: IBD Patients Report Fewer ER Visits Following Initiation of Medical Cannabis

Bronx, NY: Patients with inflammatory bowel disease (IBD) report symptom mitigation and fewer emergency room visits following the use of cannabis products, according to data published in the Journal of Clinical Gastroenterology.

Investigators affiliated with the Albert Einstein College of Medicine in New York City surveyed a cohort of 236 IBD patients registered in the state's medical cannabis access program.

Respondents "reported fewer emergency room visits in the 12 months after versus before MC [medical cannabis] use and less impact of symptoms on daily life." Subjects in the study were most likely to consume THC-dominant products via vaporization. Minor adverse effects, specifically drowsiness, were reported among a minority (4.2 percent) of subjects.

Authors concluded: "MC users with IBD perceive symptom benefits and report decreased emergency room visits without serious adverse effects. Further studies are needed to confirm these results with objective measures of healthcare utilization and disease activity."

Observational trials have previously documented that cannabis use is associated with "decreased inpatient health care utilization" in patients with irritable bowel syndrome and with fewer disease-related hospitalizations in patients with Crohn's. In a randomized placebo-controlled trial involving 21 patients with refractory Chron's disease, nearly half achieved disease remission following their use of herbal cannabis.

Full text of the study, "Medical cannabis use patterns and adverse effects in inflammatory bowel disease," appears in the Journal of Clinical Gastroenterology.

Study: Oro-Buccal Cannabis Spray Provides Relief in Cancer Patients with Refractory Pain

New South Wales, Australia: Terminal cancer patients with refractory pain respond favorably to a proprietary cannabis spray containing equal ratios of plant-derived THC and CBD, according to data published in the journal PLOS One.

A team of Australian investigators assessed the safety and efficacy of a novel water-soluble oro-buccal nanoparticle spray containing 2.5 mgs of THC and 2.5 mgs of CBD in a cohort of patients with advanced cancer and intractable pain.

Researchers reported that cannabis dosing was associated with improvements in pain relief among all patients, with those patients suffering from bone metastasis experiencing the greatest levels of relief. No serious adverse events were reported, though some patients did experience drowsiness following treatment.

Patients also reported improvements in appetite and emotional well-being.

"This study demonstrated that the administration of the investigative cannabis-based medicine was generally safe and tolerated in a short-term exposure in a cohort of patients with advanced incurable cancers with controlled pain or intractable pain despite opioid treatment," authors concluded. "There was a reduction in pain overall for the study cohort of 12 percent by the end of the treatment phase. ... [This] cannabis-based medicine ... is of significant clinical interest given that this formulation was a self-titrated medicine, that showed preliminary analgesic efficacy in a subgroup of patients."

Full text of the study, "Pilot clinical and pharmacokinetic study of delat-9-tetrahydrocannabinol/cannabidiol nanoparticle oro-buccal spray in patients with advanced cancer experiencing uncontrolled pain," appears in PLOS One.

Oklahoma: Voters to Decide Marijuana Legalization Measure in March Election

Oklahoma City, OK: Voters will decide on a citizens' initiated measure legalizing the adult-use marijuana market in a special election to be held in March.

Republican Gov. Kevin Stitt issued the executive proclamation calling for the special election on Tuesday, March 7, 2023.

State Question 820, sponsored by the group Oklahomans for Sensible Marijuana Laws, permit adults to legally possess and home-cultivate personal use qualities of cannabis while also establishing a licensed, retail marketplace. Those with past marijuana convictions, or those who are currently incarcerated for certain cannabis-related crimes, would be able to petition the courts for either record expungement or re-sentencing consideration.

In July, advocates for SQ 820 turned in nearly twice the total of signatures necessary to qualify the initiative for the 2022 ballot. However, the Secretary of State's office took an excessive amount of time to ultimately verify proponents' signatures. Opponents of the measure then filed a series of questionable legal challenges litigating various facets of the campaign, including challenges to the initiative's summary language. Although justices ultimately dismissed those challenges, they did so after time had elapsed for state officials to include SQ 820 on this year's printed ballots.

"After all the delays caused by the new signature count process, we are excited to finally be going to the ballot on March 7, 2023, so that Oklahomans can experience the benefits of SQ820 without further delay," Michelle Tilley, campaign director for OSLM / Yes on 820, told the website Marijuana Moment. "Republicans, Libertarians, Democrats and independents alike are excited to stop wasting law enforcement resources and start reaping the hundreds of millions of dollars in financial benefits that come with legalizing, regulating and taxing recreational marijuana for adults in Oklahoma."

Voters in five states - Arkansas, Maryland, Missouri, North Dakota, and South Dakota - will be deciding on similar adult use legalization measures in November.

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Study: Cannabis Associated with Improved Sleep in Adults with Post-Traumatic Stress

Haifa, Israel: The use of cannabis prior to bedtime is associated with perceived improvements in sleep in subjects diagnosed with post-traumatic stress disorder (PTSD), according to data published in the Journal of Anxiety Disorders.

Israeli researchers assessed the impact of cannabis on sleep in a cohort of 77 PTSD patients. Study participants kept a daily journal where they recorded numerous sleep measures each morning.

Investigators acknowledged that the use of cannabis was associated with self-reported improvements in sleep onset and a reduction in the frequency of nightmares. Subjects who consumed products higher in CBD were less likely to report early awakenings.

"Our data suggest that MC [medical cannabis] may help reduce nightmares and [that] CBD in particular may be important for preventing early awakenings," they wrote. "This provides a strong basis for further hypotheses testing, potentially through clinical trials, of the sleep-inducing effects of MC and for testing CBD in particular."

Authors concluded, "Given the high comorbidity of PTSD symptoms and sleep disturbances and the potential for MC to have effects on both, a greater understanding of how patients experience the effects of MC on overall PTSD symptoms and sleep disturbances is warranted."

Prior studies have similarly reported that cannabis products may be associated with improved sleep duration and with improvements in insomnia. The enactment of adult-use marijuana legalization has also been correlated with a decrease in the sale of over-the-counter sleep aid medications.

Full text of the study, "Post-traumatic stress disorder, sleep, and medical cannabis treatment: A daily diary study," appears in the Journal of Anxiety Disorders.

Analysis: Marijuana Excise Taxes Yield Nearly $3 Billion in Revenue in Fiscal Year 2022

Washington, DC: Legal cannabis markets generated an estimated $2.8 billion in excise taxes in fiscal year 2022 (July 2021 to June 2022), according to an analysis provided by The Urban-Brookings Tax Policy Center.

Regulators in California collected the largest amount of excise tax revenue ($774 million) while regulators in Alaska collected the least ($30 million).

In the two states with the most mature adult-use cannabis markets - Colorado and Washington - cannabis excise tax revenues outpaced those collected on the sale of alcohol and tobacco. "Broadly speaking, the experience of Colorado and Washington demonstrate that a state can collect a significant amount of revenue from marijuana taxes and that collection should mostly increase over time," the report's authors wrote.

The Center's analysis did not tabulate additional revenues generated from state sales taxes and/or locally imposed taxes on cannabis products.

An analysis provided in April by the Marijuana Policy Project estimated that total tax revenues derived from the licensed retail sale of state-legal, adult-use cannabis products grew by more than 30 percent between 2020 and 2021, totaling over $3.7 billion last year.

The full text of the report is available online here.

Study: Marijuana Use Poses No Elevated Risk for Liver Transplant Patients

Birmingham, AL: Those with a history of marijuana use are no more likely than non-users to suffer from any adverse complications following liver transplantation, according to data published in The American Journal of the Medical Sciences.

A team of investigators affiliated with the University of Alabama at Birmingham compared post-liver transplant outcomes in a cohort of cannabis consumers and matched controls. Researchers assessed post-surgery data for a period of one-year.

Authors reported: "There was no statistical difference in post-LT [liver transplant] outcomes between marijuana and non-marijuana users, including incidence of cardiac, respiratory, renal, psychiatric, or neurological complications, as well as readmission rates post-surgery. There were no statistically significant associations between marijuana use with post-transplant bacterial or fungal infections, medication non-compliance, or continued substance use."

They concluded: "Our data indicates that marijuana is not associated with increased risk of postoperative noncompliance, other organ complications, infections, or death. As a single factor, marijuana may not need to be a contraindication for LT."

The researchers' findings are consistent with those of several other studies which also concluded that marijuana use is not contraindicated in patients receiving organ transplants. Nonetheless, in several states - including some states that permit medical cannabis access - those with a history of marijuana use may be ineligible to receive organ transplants.

Full text of the study, "Marijuana use and post-transplant complications and non-compliance in liver transplant patients," appears in The American Journal of the Medical Sciences.

Analysis: History of Cannabis Use Not Associated with More Severe Symptoms of Psychosis

Christchurch, NZ: Those with a history of cannabis consumption do not exhibit more severe symptoms of psychosis than do those with no history of regular use, according to longitudinal data published in the New Zealand Medical Journal.

A team of New Zealand researchers assessed the relationship between marijuana use and the severity of psychotic symptomology in a cohort of over 1,200 subjects born in 1977. Investigators compared the symptom profile of cannabis consumers and non-consumers at age 18, 21, and at age 25.

Researchers reported that cannabis-consuming subjects were more likely than non-users to report experiencing a greater variety of psychotic symptoms overall. However, investigators acknowledged that consumers were not more likely to report experiencing severe symptoms.

Authors reported: "The present analyses sought to determine whether there was a qualitative difference in the kind of symptoms being reported by the two groups. ... Both groups tended to report common, low-level symptoms (such as "having ideas or beliefs that others do not share"), and neither group was likely to report what would be considered as more severe positive symptoms of psychosis."

They concluded: "Collectively, the results suggest that while those who were regular cannabis users reported a significantly greater number of symptoms than non-users, the symptom profile between the two groups did not differ, showing that there was no evidence of greater ‘severity' among regular cannabis users."

Although the use of cannabis and other controlled substances is 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.

Full text of the study, "Cannabis use and patterns of psychotic symptomology in a longitudinal birth cohort," appears in the New Zealand Medical Journal.

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President Biden Announces Intent to Pardon Those with Low-Level Marijuana Convictions

Washington, DC: President Joe Biden today announced his intent to "pardon of all prior Federal offenses of simple possession of marijuana."

In a statement, he said: "I have directed the Attorney General to develop an administrative process for the issuance of certificates of pardon to eligible individuals. My action will help relieve the collateral consequences arising from these convictions."

The President also announced that he was encouraging Governor's to facilitate similar actions on the state level. To date, nearly two dozen states have enacted legislation explicitly facilitating the process of having select marijuana convictions expunged, vacated, otherwise set aside, or sealed from public view. These laws have led state and local officials nationwide to expunge or seal the records of over two million people with prior cannabis convictions.

Finally, the President announced that he is "asking the Secretary of Health and Human Services and the Attorney General to initiate the administrative process to review expeditiously how marijuana is scheduled under federal law."

In response to the President's recently announced actions, NORML's Executive Director Erik Altieri has issued the following statement:

"Many of the efforts taken and proposed by the President today are long overdue. For nearly two years, NORML has called upon the Administration to fulfill the President's campaign promise to provide relief to those stigmatized with a low-level cannabis conviction. We are pleased that today President Biden is following through on this pledge and that he is also encouraging governors to take similar steps to ensure that the tens of millions of Americans with state-level convictions for past marijuana crimes can finally move forward with their lives. Since 1965, nearly 29 million Americans have been arrested for marijuana-related violations - for activities that the majority of voters no longer believe ought to be a crime.

"Moving forward, the Administration must work collaboratively with Congressional leadership to repeal America's failed marijuana criminalization laws. Nearly half of voters now agree that legalizing marijuana ought to be a priority for Congress, and such action can only be taken by descheduling cannabis and repealing it from the US Controlled Substances Act - thereby regulating it in a manner similar to alcohol. Congress should be inspired by the Administration's actions today to act quickly and send legislation to the President's desk that would help close this dark chapter of our history."

Study: Adjunctive Use of CBD-Rich Extracts "Highly Effective" in Adults with Refractory Epilepsy

Tel Aviv, Israel: Adults with treatment-resistant focal epilepsy (epilepsy characterized by seizures arising from a specific part of the brain) respond favorably to the adjunctive use of plant-derived CBD dominant cannabis extracts, according to data published in the journal Neurological Sciences.

A Colombian investigator assessed the efficacy of high CBD/low THC extracts in a cohort of epileptic patients. Of those who maintained a cannabis-treatment regimen for at least three months, 80 percent experienced a greater than 50 percent reduction in seizure frequency at 12 weeks. Only a minority of patients reported any side-effects.

"The reduction in seizures frequency is maintained over time." the study's author concluded. "The CBMF (cannabis-based magistral formulation) is a highly effective and safe therapy to treat adult patients with DRFE (drug resistant focal epilepsy)."

Israeli data published in June similarly reported that children with refractory forms of epilepsy experience significant reductions in seizure frequency following the long-term use of plant-derived CBD extracts.

In 2018, the US Food and Drug Administration granted market approval to Epidiolex, a prescription medicine containing a standardized formulation of plant-derived cannabidiol for the treatment of two rare forms of severe epilepsy: Lennox-Gastaut syndrome and Dravet syndrome. Shortly after approval, the US Drug Enforcement Administration reclassified Epidiolex to Schedule V of the US Controlled Substances Act - the lowest restriction classification available under federal law.

Full text of the study, "Cannabis based magistral formulation is highly effective as an adjuvant treatment in drug-resistant focal epilepsy in adult patients: An open-label prospective cohort study," appears in Neurological Sciences.

Survey: Most Patients Report Opioid-Sparing Effects Following Cannabis Initiation

Tallahassee, FL: The majority of patients registered with the state of Florida to access medical cannabis products report reducing their consumption of prescription opioids, according to data published in the journal Substance Use & Misuse.

Investigators affiliated with Florida State University's College of Medicine assessed health functioning before and after cannabis initiation in a cohort of over 2,100 authorized medical marijuana consumers. Consistent with dozens of prior studies, researchers reported that "the majority of participants (79 percent) reported either cessation or reduction in pain medication use following [their] initiation of medical cannabis." Nearly 12 percent of participants also reported improvements in physical mobility.

The majority of patients surveyed acknowledged consuming cannabis daily and most had little or no past history of cannabis use prior to registering in the state's medical cannabis access program.

Authors concluded: "The majority of Florida medical cannabis users surveyed described medical cannabis as helpful and important to their overall quality of life. Notably, a large percentage of patients reported improvements in the areas of physical functioning, social functioning, and bodily pain after beginning medical cannabis. We also found a substantial number of patients reduced the amount of OBPM [opioid based pain medication] used after gaining access to legalized medical cannabis, with some patients specifically describing improved functioning in daily life as a result. ... These data add to the growing body of literature suggesting that medical cannabis use may be associated with reductions in opioid (and other) prescription medication use without reducing quality of life or worsening health outcomes."

A prior analysis of Florida patients, published last year by researchers affiliated with Florida Gulf Coast University, similarly reported that 65 percent of respondents had either reduced or eliminated their use of at least one prescription or over-the-counter medication following their initiation of medical cannabis.

Full text of the survey, "Medical cannabis patients report improvements in health functioning and reductions in opiate use," appears in Substance Use & Misuse.

Study: Hemp-Derived CBD Gel Caps Effective in Older Patients with Spinal Stenosis

Philadelphia, PA: Older patients with lower back and leg pain due to chronic spinal stenosis experience statistically significant improvements following the use of hemp-derived CBD gel caps, according to data published in the journal Cureus.

Researchers affiliated with Thomas Jefferson University in Philadelphia assessed the efficacy of the twice-daily administration of hemp-derived CBD gel caps (15mgs) in a cohort of 48 patients (mean age: 75) with spinal stenosis.

Investigators reported that patients averaged a nearly two-point decrease in their pain scores (on an 11-point scale) during the trial period. Authors also reported improvements in patients' appetite, sleep quality, and overall quality of life. Trial participants did not acknowledge any adverse side effects from CBD therapy.

"This open-label, prospective, observational study found that treatment with hemp-derived CBD gel caps was associated with significant improvements in pain scores and several quality-of-life measures," they concluded. "CBD gel caps were not associated with any adverse effects. Using CBD to help alleviate pain in spinal stenosis is supported by the evidence in this study."

Previous studies have reported reduced analgesia and prescription opioid use in patients using either CBD-rich gel caps or topical creams.

Full text of the study, "The use of cannabidiol in patients with low back pain caused by lumbar spinal stenosis: An observational study," appears in Cureus.

Analysis: Daily Use of Hemp Extracts Results in Positive Drug Tests for Cannabis

Baltimore, MD: Those who consume hemp-derived extracts on a regular basis risk testing positive for cannabis on a urinalysis drug screen, according to data published in the journal Therapeutic Drug Monitoring.

A team of researchers from the United States and Canada evaluated whether the ingestion of retail oral hemp-derived CBD products (containing ≤0.3 percent THC) would trigger a positive drug screen for the presence of carboxy-THC. (Carboxy-THC is the inert metabolite that is identified in conventional marijuana drug tests.)

Authors reported, "Findings showed that the daily use of oral hemp-derived CBD extracts consistently resulted in positive urine IA [immunoassay] screening results for THC-COOH at the 20 ng/mL detection criterion."

They concluded, "Therefore, efforts should be made to increase public awareness regarding the risk of positive [urine] drug test results following oral hemp-derived CBD product use."

Federal legislation enacted in 2018 legalized the licensed production of cannabis hemp plants containing no more than 0.3 percent THC. The law also broadened the definition of ‘hemp' to include "any part of the plant, including ... extracts [or] cannabinoids" that do not possess greater than 0.3 percent THC on a dry weight basis.

However, more than three years following the law's passage, the US Food and Drug Administration (FDA) has yet to promulgate rules regulating the marketing and sale of commercial products containing hemp-derived CBD or other cannabinoids. Survey data compiled by the National Consumers League previously determined that more than eight in ten US voters desire greater federal regulatory oversight over the labeling and marketing of commercially available CBD products.

Several federal agencies, including the US Department of Transportation and various branches of the US military, have previously cautioned against the use of legal hemp products and have warned that their consumption is not a legitimate excuse for a drug test failure.

Full text of the study, "Likelihood of positive urine screens of THC-COOH after daily use of full-spectrum hemp extracts varies as a function of screening criterion used," appears in Therapeutic Drug Monitoring.

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Study: Post-Operative Cannabis Use Associated with Opioid-Sparing Effects

Denver, CO: Patients who self-report consuming cannabis following hip or knee surgery are less likely than non-users to engage in the long-term use of prescription opioids, according to data in the journal Arthroplasty Today.

A team of investigators affiliated with the University of Denver and with John Hopkins University in Baltimore assessed opioid use trends in a cohort of patients who had recently undergone either total hip or total knee arthroplasty.

Researchers reported that those patients who reported perioperative cannabis use were less likely to engage in the use of prescription opioids long-term than were matched controls. The findings are consistent with dozens of prior studies documenting reduced levels of opioid consumption in pain patients who initiate cannabis use.

Authors concluded: "This study helps to shed light on what role if any cannabis should play as a part of an opioid-sparing multimodal pain protocol after TJA [total joint arthroplasty]. Self-reported perioperative cannabis use appeared to significantly reduce the number of patients that persistently used opioids greater than 90 days after TJA from 9.5 percent to 1.4 percent. ... As cannabis becomes more widely available and patient interest in its use for pain management continues to increase, further research with higher quality, prospective studies are required to clarify its role in perioperative pain management, including the examination of different preparations (delta-9-tetrahydrocannabinol vs cannabidiol), dosages, routes of administration (edible, inhalation, topical), and frequency of use."

Full text of the study, "Self-reported cannabis use associated with a lower rate of persistent opioid use after total joint arthroplasty," appears in Arthroplasty Today.

Study: Cannabis Preparations Associated with Quality of Life Improvements in Adults with Autism

London, United Kingdom: The use of cannabis flowers and extracts is associated with symptom improvements in adults diagnosed with autism spectrum disorder (ASD), according to data published in the journal Therapeutic Advances in Psychopharmacology.

British investigators affiliated with Imperial College in London assessed the safety and efficacy of cannabis products in a cohort of autistic adults (mean age: 32) enrolled in the UK Medical Cannabis Registry. Subjects in the study either inhaled cannabis flowers or consumed sublingual extracts for a period of up to six months. Subjects primarily consumed cannabis preparations that were elevated in THC content and lower in CBD.

Consistent with prior studies, investigators reported that patients experienced symptomatic improvements following cannabis therapy. They also reduced their use of prescription medications. Specifically, there was "a 33.3 percent and 25.0 percent reduction in the concomitant prescribing of benzodiazepines and neuroleptics, respectively, within this cohort." Authors further acknowledged that cannabis preparations were "well tolerated" by over 80 percent of the participants.

"In this first published experience of clinical outcomes in adult patients with ASD treated with CBMPs [cannabis-based medicinal products], there were associated improvements in general health-related quality of life, in addition to sleep- and anxiety-specific outcomes," they concluded. "Moreover, there was a reduction in the administration of concomitant medications, some of which are associated with serious adverse events with long-term use. ... These results ... provide scientific justification for further evaluation within the context of randomized controlled trials while also providing guidance for clinical practice in the interim."

Numerous trials have previously identified clinical improvements in autistic children who consume plant-derived CBD extracts. Survey data published in 2021 by the publication Autism Parenting Magazine reported that 22 percent of US caregivers or parents have provided CBD to an autistic child.

Full text of the study, "Clinical outcome analysis of patients with autism spectrum disorder: Analysis from the UK Medical Cannabis Registry," appears in Therapeutic Advances in Psychopharmacology.

Clinical Trial: Plant-Derived CBD Extracts Reduce Agitation in Dementia Patients

Tel Aviv, Israel: The administration of plant-derived extracts containing high levels of CBD and low levels of THC reduces agitation in patients suffering from behavioral disturbances related to dementia, according to clinical trial data published in the journal Frontiers in Medicine.

Israeli researchers assessed the safety and efficacy of CBD-dominant extracts (30 to 1 ratio of CBD to THC) compared to placebo in a cohort of seniors (mean age: 79 years) with dementia. Subjects in the trial received sublingual drops of either cannabis extracts or a placebo (olive oil) three times daily for a period of 16 weeks.

"Patients in the investigational group experienced a significantly greater reduction in sleep disturbances, and in agitation and aggression sub-score using two different measurement tools. The improvements were accompanied with non-serious side-effects," authors reported. "We recommend conducting a large scale randomized controlled trial on behavioral disturbances related to dementia and to compare clinical sub-types of dementia."

The findings are consistent with those of other studies – such as those here, here, and here – reporting that the use of either cannabis flowers or extracts mitigates agitation in dementia patients.

Full text of the study, "Effects of rich cannabidiol oil on behavioral disturbances in patients with dementia: A placebo controlled randomized clinical trial," appears in Frontiers in Medicine.

Analysis: Medical Cannabis Products Safe and Effective for Older Adults

Ontario, Canada: Medical cannabis products are safe and effective for older adults with chronic pain conditions, according to data published in The Journal of Cannabis Research.

Researchers assessed the safety and efficacy of cannabis products in a cohort of medically authorized Canadian patients age 65 or older. Subjects in the study used cannabis for at least three months.

Consistent with other studies assessing the use of cannabis by seniors, investigators reported that marijuana treatments were safe, well-tolerated, and associated with meaningful reductions in pain. "No serious AEs (adverse events) were reported, and non-serious AEs were experienced in less than 12 percent of the cohort," they acknowledged.

Most patients in the study reported no prior experience with cannabis. Most initially purchased cannabis products either high in CBD or containing equal ratios of CBD and THC. Participants typically preferred cannabis oils over other formulations.

Authors concluded, "Our findings inform the underexplored area of medical cannabis use in this population and suggest that medical cannabis is associated with therapeutic effects on pain in older adults with an acceptable safety profile."

Full text of the study, "Medical cannabis authorization patterns, safety, and associated effects in older adults," appears in The Journal of Cannabis Research.

Review: Available Data Supports the Use of CBD for Treatment of Social Anxiety

New Haven, CT: Data indicates that CBD is "effective" for improving social anxiety and suggests that it may have "key benefits over existing pharmacotherapies" for social anxiety disorder (SAD), according to a systemic review of human studies published in the journal Psychiatry Research Communications.

A pair of researchers affiliated with Yale University reviewed data from seven studies involving 278 total participants.

Authors reported: "Overall, the literature reviewed supports the anxiolytic effect of CBD administration, both among healthy volunteers undergoing experimental social anxiety paradigms, as well as individuals with SAD. ... Additionally, CBD may have key advantages over existing treatments, including a rapid course of action, reduced abuse liability and potential for drug interactions with alcohol and opioids, as well as reduced sedative and cognitive side effects."

They concluded: "Existing data suggest that acute administration of CBD significantly attenuates social anxiety, without significant sedation or cognitive impairment. However, additional research is needed to determine optimal dosing among individuals with SAD, assess the time-course of CBD's acute effects, examine the efficacy and side effect profile of chronic CBD administration, assess sex differences in the use of CBD for social anxiety, as well as investigate CBD's mechanisms of action."

Open-label trial data published in June in The Journal of Clinical Psychiatry reported that the adjunctive use of CBD safely and effectively reduces severe anxiety in young people with treatment-resistant anxiety disorders.

Social anxiety disorder is characterized by clinical fear of one or more specific social situations. Some seven percent of US adults are estimated to have suffered from SAD within the past year.

Full text of the study, "Systemic literature review of human studies assessing the efficacy of cannabidiol for social anxiety," appears in Psychiatry Research Communications.

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Study: Artisanal CBD-Rich Extracts Show Long-Term Efficacy in Children with Epilepsy

Tel Aviv, Israel: Children with refractory epilepsy respond favorably to long-term treatment with plant-derived CBD extracts, according to data published in Pediatric Neurology.

Israeli researchers assessed the safety and efficacy of artisanal CBD-rich extracts in a cohort of adolescents with treatment-resistant forms of epilepsy. Among patients administered extracts for a period of at least one year, 51 percent experienced a significant decline in seizure frequency. Patients reported only nominal side-effects associated with CBD treatment.

Authors concluded, "Artisanal cannabidiol-enriched cannabis may be an effective and safe long-term treatment for refractory epilepsy."

In 2018, the US Food and Drug Administration granted market approval to Epidiolex, a prescription medicine containing a standardized formulation of plant-derived cannabidiol for the treatment of two rare forms of severe epilepsy: Lennox-Gastaut syndrome and Dravet syndrome. Shortly after approval, the US Drug Enforcement Administration reclassified Epidiolex to Schedule V of the US Controlled Substances Act - the lowest restriction classification available under federal law.

Full text of the study, "The long-term effectiveness and safety of cannabidiol-enriched oil in children with drug-resistant epilepsy," appears in Pediatric Neurology.

Analysis: Incidences of Acute Cannabis-Induced Psychosis Are Uncommon

Lausanne, Switzerland: Cannabis consumption rarely triggers episodes of acute psychosis in those without a pre-existing psychiatric disorder, according to data published in the journal Translational Psychiatry.

An international team of researchers from Australia, Switzerland, and the United Kingdom assessed lifetime occurrences of "cannabis-associated psychotic symptoms" (CAPS) requiring hospitalization in a cohort of 233,000 European marijuana consumers.

Authors reported that less than one-half of one percent of subjects reported ever having had such an experience. Those at higher risk for such incidences included younger aged subjects, as well as those with a prior diagnosis of bipolar, anxiety, or depressive disorder, or psychosis.

"Our findings are in line with the idea of a common (genetic) vulnerability representing risk that is shared across psychiatric disorders," authors determined. They concluded, "Rates of CAPS as observed here are comparable to rates of other drug-induced psychosis, such as alcohol-associated psychosis (around 0.4 – 0.7 percent)."

The study's findings are consistent with those of a separate paper, published in July in the journal Substance Use & Misuse, which reported that medical cannabis patients are at "low" risk for psychiatric hospitalizations resulting from their marijuana use. In that trial, investigators assessed marijuana-related hospitalizations among a cohort of over 23,000 subjects over a median period of 240 days. During that time, only 26 patients were hospitalized explicitly because of "mental or behavioral disorders due to the use of cannabis."

The findings push back against high-profile claims from some cannabis reform opponents that marijuana exposure is a frequent trigger for psychosis and other mental health disorders.

Full text of the study, "Rates and correlates of cannabis-associated psychotic symptoms in over 230,000 people who use cannabis," appears in Translational Psychiatry.

Canada: Nearly One-in-Ten Cannabis Consumers Engage in Home Cultivation

Waterloo, Canada: Approximately ten percent of Canadian cannabis consumers report engaging in home cultivation, according to data published in the journal Addictive Behavior Reports.

Canadian researchers surveyed home cultivation patterns prior to and following the enactment of adult-use legalization in 2018. Under the law, adults in most regions of the country are permitted to grow up to four cannabis plants for their own personal use. (The provinces of Quebec and Manitoba prohibit home cultivation.)

Researchers reported that the percentage of consumers who grew their own cannabis increased from six percent prior to the passage of legalization to nine percent in 2020. Those residing in more rural areas were more likely to home cultivate. Most of those who engaged in home cultivation did not exceed legally imposed plant limits.

"Almost one-in-ten Canadian cannabis consumers reported home cultivation of cannabis in 2020, with modest increases following legalization of non-medical cannabis," authors concluded. "The uptake of home cultivation is associated with province and cultivation policies; specifically, Manitoba and Quebec, the only provinces to prohibit non-medical home cultivation, reported among the lowest rates. Although the current study reported an increase in home cultivation among past 12-month consumers after legalization, it will be important to see whether rates continue to increase, even as access to legal cannabis and the price of legal cannabis decreases."

Data from the United States has estimated that fewer than two percent of cannabis consumers acknowledge engaging in home cultivation, although the actual percentage of home growers has likely increased in recent years as more jurisdictions have adopted marijuana legalization policies.

NORML has long advocated that consumers in legal jurisdictions ought to have the option to home cultivate personal use quantities of cannabis, opining: "The inclusion of legislative provisions protecting the non-commercial home cultivation of cannabis serves as leverage to assure the product available at retail outlets is high quality, safe and affordable. Additionally, permitting home cultivation provides adult consumers with an immediate source of cannabis - providing an alternative to the illicit market. Such a source is necessary because it typically takes state regulators several months, or even years, following the law's enactment to establish licensed retail operators."

Full text of the study, "Home cultivation across Canadian provinces after cannabis legalization," appears in Addictive Behavior Reports.

New York: State Regulators Finalize Home Cultivation Rules for Qualified Patients

New York, NY: Qualified patients and their designated caregivers can begin home cultivating marijuana next month, following the adoption of rules by state regulators.

Under the new rules, patients and caregivers registered with the state may grow specified quantities of marijuana on their own private property. Individual patients are limited to no more than three mature plants and three immature plants. Caregivers with multiple patients are limited to growing no more than six mature plants and six immature plants at any one time.

The new rules will take effect on October 5, 2022. State regulators initially announced their intent to authorize limited home grows nearly one year ago.

Nearly 125,000 New Yorkers are currently registered in the state's medical marijuana access program.

State lawmakers in 2021 approved separate legislation, The Marijuana Regulation and Taxation Act (MRTA), legalizing and regulating marijuana possession and sales for adults. Regulators just recently began accepting applications from those seeking licensure to establish retail cannabis facilities.

Additional information is available from the New York State Office of Cannabis Management.

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Study: Autism Patients Show Clinical Improvements Following Use of CBD-Rich Cannabis

Tel Aviv, Israel: The administration of CBD-rich cannabis is associated with clinical improvements in adolescents with autism spectrum disorder (ASD), according to data published in the journal Translational Psychiatry.

Israeli researchers evaluated the efficacy of cannabis treatment in a cohort of 82 young people (ages 5 to 25) with ASD. Subjects in the trial consumed whole-plant cannabis extracts (oils with a CBD:THC ratio of 20 to 1) adjunctively over a period of six months. Investigators used a variety of standardized clinical assessments to evaluate patients’ symptoms prior to and immediately following treatment.

They reported, “Our results revealed significant improvements in [the] overall … scores of the ASD participants who completed the 6-month treatment protocol with CBD-rich cannabis. Overall changes were mostly driven by improvements in social communication skills.

“[T]hese findings suggest that treatment with CBD-rich medicinal cannabis can lead to significant improvements in social communication skills of some ASD individuals, particularly those with more severe initial symptoms,” authors concluded. “These positive findings motivate further double-blind placebo-controlled studies for determining the efficacy of treatment with specific cannabis strains and/or synthetic cannabinoids.​”

The researchers’ findings are consistent with those of numerous other studies demonstrating that the use of either CBD-dominant cannabis or oral extracts is associated with symptom mitigation in adolescents with ASD.

Full text of the study, “Children and adolescents with ASD treated with CBD-rich cannabis exhibit significant improvements, particularly in social symptoms: An open label study,” appears in Translational Psychiatry.

Analysis: Adoption of Adult-Use Legalization Associated with Decrease in State-Level Obesity Rates

Fargo, ND: States that license adult-use marijuana sales may experience a decrease in state-level obesity rates, according to data published in the journal Health Economics.

Researchers affiliated with North Dakota State University compared obesity rates in Washington state following legalization to those of a synthetic control state.

They reported, “Our primary experiment revealed recreational marijuana legalization, which allowed for recreational marijuana dispensaries to open, resulted in decreases in obesity rates for Washington State” as compared to their synthetic control.

Authors concluded, “As more states gravitate to decriminalization, expanded medicinal use, and legalized recreational use of marijuana, our findings provide important insights into contemporary drug policy.”

Case control studies have consistently reported that those with a history of marijuana use are less likely than abstainers to be obese or to suffer from type 2 diabetes. Studies have also previously linked cannabis use to greater rates of physical activity.

Full text of the study, “Assessing the impact of recreational marijuana legalization on obesity,” appears in Health Economics.

Canada: Most Health Care Providers Unfamiliar with Topics Related to Medical Cannabis

Montreal, Canada: Despite the federal government having legalized patients’ access to marijuana two decades ago, most Canadian health care providers acknowledge that they possess little knowledge about medical cannabis and almost none report having received any training about it while in medical school.

Survey data published in the journal BMC Complementary Medicine and Therapies reported that 56 percent of respondents felt either “uncomfortable or ambivalent regarding their knowledge of medical cannabis,” and that only six percent of medical professionals received any formal training about it while attending medical school. (By contrast, 60 percent of respondents said that they had attended either a workshop or a conference on the topic.) Fewer than one-in-three (27 percent) acknowledged being familiar with the regulations surrounding patients’ access to medical cannabis products.

The results are consistent with numerous other surveys from the United States and abroad finding that health professionals seldom receive any formal training about cannabis and that most lack sufficient understanding of the subject.

Authors concluded: “The majority of HCPs [health care practitioners] received little, if any, formal training in cannabinoid-based medicine in medical school or residency, … and nearly one-third were unfamiliar with the requirements for obtaining CMP [cannabis for medical purposes] in Canada. Respondents endorsed discomfort with their knowledge of MC [medical cannabis.] …. These findings suggest that medical training programs must reassess their curricula to enable HCPs to gain the knowledge and comfort required to meet the evolving needs of patients.”

Full text of the study, “Healthcare practitioner perceptions on barriers impacting cannabis prescribing practices,” appears in BMC Complementary Medicine and Therapies.

Analysis: Blacks Disproportionately Drug Tested for Marijuana During Labor

St. Louis, MO: Patients ordered to undergo marijuana-specific drug screening during the labor and delivery process are disproportionately Black and are also likely to be on subsidized health insurance plans, according to data published in the journal Obstetrics & Gynecology.

Researchers affiliated with Washington University in St. Louis assessed drug screening practices in a labor and delivery unit of an urban hospital over a one-year period (January 1, 2020 – December 31, 2020).

Investigators reported that hospital personnel ordered marijuana-related drug tests for 753 patients during this period. (Doctors performed just under 4,000 total deliveries.) Of those tested, over 70 percent were Black. Those tested for marijuana were also more likely to be younger and on public insurance.

Most of those who underwent drug screening tested negative for the presence of cannabis or other controlled substances. Of those who did test positive for cannabis, 90 percent were mandatorily reported to child abuse services.

There were no statistically significant differences in preterm birth rates, Apgar scores, or infant birth weight for patients who underwent urine drug screening for marijuana versus those who did not.

Authors concluded: “Isolated marijuana use was a poor predictor of other substance exposure in our cohort, but a urine drug screening test result positive for marijuana exposed a historically underserved population that is already subject to pervasive systemic racism in the medical field to further stigmatization without changing outcomes. The utility of using isolated marijuana use as a criterion for urine drug screening appears limited in benefit but rife with inequitable potential to harm and should be carefully reconsidered in labor and delivery units for necessity.”

The study’s findings are consistent with those of others reporting that patients of color and their newborns are disproportionately drug screened for cannabis exposure during labor and delivery.

Data assessing the relationship between in utero cannabis exposure and various neonatal outcomes, such as birth weight, is inconsistent. However, longitudinal data indicates that cannabis exposure is rarely independently linked with adverse neurodevelopmental consequences, finding, “Although there is a theoretical potential for cannabis to interfere with neurodevelopment, human data drawn from four prospective cohorts have not identified any long-term or long lasting meaningful differences between children exposed in utero to cannabis and those not.” Nonetheless, in some states, such as in Oklahoma and Alabama, mothers are arrested and criminally prosecuted for the use of cannabis during their pregnancy.

Full text of the study, “Urine drug screening for isolated marijuana use in labor and delivery units,” appears inObstetrics & Gynecology.

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