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Analysis: Cannabis Legalization Applies “Competitive Pressure” to Pharmaceuticals Market

San Louis Obispo, CA: Cannabis legalization negatively impacts stock market returns for pharmaceutical companies, according to data published in the journal PLOS One.

Researchers affiliated with California Polytechnic State University assessed whether the passage of statewide legalization laws influences pharmaceutical firms’ stock market returns.

Authors reported that legalization is correlated with lower returns. “Returns decreased in response to both medical and recreational legalization, for both generic and brand drug-makers,” they reported. “Investors anticipate a single legalization event to reduce drug-maker annual sales by $3 billion on average.”

They concluded: “Legal cannabis applies competitive pressure to both generic and brand drug markets, across both classes of drug-makers. ... We predict that if the remaining ... states without medical cannabis legalization were to legalize cannabis, spending on conventional pharmaceutical drugs would decrease by almost 11 percent. ... The size of the response we see suggests that investors expect a large substitution away from conventional pharmaceuticals. ... The market’s recognition of cannabis as an alternative to conventional medications documented here underscores the need for additional research into the medical potential of cannabis [and] ... suggests [that] cannabis might be a useful tool for increasing competition in U.S. drug markets.”

Prior studies have consistently shown that those with access to cannabis products typically reduce or eliminate their consumption of pharmaceutical drugs over time, particularly with respect to the use of opioids, benzodiazepines, anxiolytics, and sleep aids.

Specifically, data published earlier this year in the journal Health Economics identified “significant reductions in the volume of prescriptions within the drug classes that align with the medical indications for pain, depression, anxiety, sleep, psychosis, and seizures” in states that had enacted adult-use cannabis legalization. Prior ecological studies have similarly identified an association between the adoption of medical cannabis access laws and reduced Medicaid prescription drug spending.

Full text of the study, “US cannabis laws projected to cost generic and brand pharmaceutical firms billions,” appears in PLOS One.

Case Study: CBD Oil “Should Be Considered as a Treatment Option” for Autism Patients

Toronto, Canada: The administration of plant-derived CBD oil is safe and effective in the treatment of autism-related symptoms and it ought to be considered as a viable treatment option for patients with the disorder, according to the findings of a case study published in the journal Cureus.

A team of Canadian investigators assessed the long-term use of CBD oil containing 20 mg of CBD and less than one mg of THC in a non-verbal pediatric patient with autism spectrum disorder. Prior to initiating CBD treatment, the patient exhibited behavioral symptoms with outbursts of anger and physical aggression (e.g., punching, kicking, biting, head-butting, and scratching).

Following twice-daily CBD treatment, the patient “experienced a reduction in negative behaviors, including violent outbursts, self-injurious behaviors, and sleep disruptions. There was an improvement in social interactions, concentration, and emotional stability.”

Investigators concluded: “In the case study presented, the child patient has shown behavioral and cognitive improvements with no side effects reported. ... 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.”

Full text of the study, “A double-blind, randomized, controlled crossover trial of cannabis in adults with Tourette Syndrome,” appears in Cannabis and Cannabinoid Research.

Clinical Trial: Vaporized Cannabis Shows Limited Efficacy for Various Symptoms of Tourette Syndrome

Toronto, Canada: Vaporized cannabis containing ten percent THC provides symptomatic relief to patients with Tourette Syndrome (TS), according to placebo-controlled data published in the journal Cannabis and Cannabinoid Research.

Canadian researchers assessed the short-term effects of vaporized cannabis of varying potencies versus placebo in nine patients with TS.

They reported that subjects exhibited and perceived modest improvements following the administration of THC-dominant cannabis, but that they failed to demonstrate similar improvements following the use of either lower THC cannabis and/or high-CBD cannabis. Researchers acknowledged, “[G]iven the small sample size, ... it is difficult to draw definitive conclusions about the benefits of THC.”

Prior studies assessing the long-term use of oral THC have documented a reduction in tics in TS patients. The findings of a 2019 study concluded, “Medical cannabis seems to hold promise in the treatment of GTS [Gilles de la Tourette syndrome] as it demonstrated high subjective satisfaction by most patients however not without side effects and should be further investigated as a treatment option for this syndrome.”

Full text of the study, “A double-blind, randomized, controlled crossover trial of cannabis in adults with Tourette Syndrome,” appears in Cannabis and Cannabinoid Research.

Nevada: Supreme Court Rules Employers Can Fire Workers for Off-Duty Cannabis Consumption

Carson City, NV: Employees who consume cannabis off-the-job for non-medical purposes can be fired by their employers for failing a drug test, according to a ruling by the Nevada Supreme Court.

The Court rejected the plaintiff’s argument that his use of cannabis constituted “lawful activity” under the state’s employee protection law. That law makes it unlawful for employers to “[d]ischarge . . . any employee . . . because the employee engage[d] in the lawful use in this state of any product outside the premises of the employer during the employee’s nonworking hours” so long as “that use does not adversely affect the employee’s ability to perform his or her job or the safety of other employees.” In this instance, however, judges opined that the statute refers only to behaviors and/or products defined as legal under both state and federal law.

Nevada law limits employers from sanctioning workers who are enrolled in the state’s medical cannabis access program. In addition, a 2019 law makes it “unlawful for any employer in [Nevada] to fail or refuse to hire a prospective employee because the prospective employee submitted to a screening test and the results of the screening test indicate the presence of marijuana.” However, state law remains silent on the issue of whether employers can take actions against those employees who use cannabis for non-medical purpose while away from the job.

Justices concluded: “If the Legislature meant to require employers to accommodate employees using recreational marijuana outside the workplace but who thereafter test positive at work, it would have done so. It did not.”

By contrast, laws in Connecticut, New Jersey, New York, Montana, and Rhode Island explicitly prohibit employers from firing workers solely on the basis of a positive marijuana test. Last week, California lawmakers advanced similar legislation to Democratic Gov. Gavin Newsom.

The case is Ceballos v. Palace Station Hotel and Casino.

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Study: Cannabis Mitigates Pain in Patients with Refractory Gastroparesis, Is Associated with Improvements in In-Hospital Mortality

Valhalla, NY: The use of marijuana significantly reduces abdominal pain in patients with refractory gastroparesis, according to data published in The American Journal of Gastroenterology. (Gastroparesis involves the partial paralysis of the stomach; symptoms include abdominal pain, nausea and vomiting, heartburn, and weight loss.)

Researchers affiliated with New York Medical College and with Westchester Medical Center University Hospital assessed the effects of either plant cannabis or dronabinol (FDA-approved oral THC) on pain in a cohort of 24 patients with treatment-resistant gastroparesis.

While both the administration of oral THC and cannabis was associated with reductions in patients' self-reported pain, whole-plant cannabis was associated with greater improvements.

"Our study shows that cannabinoids may play an important role in the management of gastroparesis-related abdominal pain," authors concluded. "There are currently no treatments shown to be effective for gastroparetic pain in clinical trials, and cannabinoids may serve a niche for this under-treated symptom."

Separate data assessing the relationship between cannabis use and gastroparesis, published in the Journal of Clinical Gastroenterology, further reports that patients who consume cannabis possess "better hospitalization outcomes, including decreased length of stay and improved in-hospital mortality" as compared to those with no history of recent use.

Prior observational studies have similarly reported that marijuana use is associated with a decreased risk of in-hospital mortality among patients suffering from congestive heart failure, cancer, COPD, pancreatitis, HIV, burn-related injuries, traumatic brain injuries, and various other types of severe trauma.

Full text of the study, "Cannabinoids lead to significant improvement in gastroparesis-related abdominal pain," appears in The American Journal of Gastroenterology. Full text of the study, "Trends and socioeconomic health outcomes of cannabis use among patients with gastroparesis: A United States nationwide inpatient sample analysis," appears in the Journal of Clinical Gastroenterology.

Survey: Arthritis Patients Likely to Report Improvements Following CBD Therapy

Great Neck, NY: Arthritis patients frequently report symptom improvements and reductions in their use of prescription medications following the use of CBD products, according to data published in the Journal of Cannabis Research.

A team of investigators affiliated with the Zucker School of Medicine at Hofstra University in New York and with the Banner University Medical Center in Arizona surveyed a convenience sample of patients with either osteoarthritis or rheumatoid arthritis (RA). Most of the participants (70 percent) acknowledged having used CBD products for symptomatic relief.

"The overall cohort reported significant reductions in pain after CBD use, with a 44 percent reduction in numerical pain score and 2.58-point reduction [on a zero-to-ten numerical pain score]," authors reported. "Pairwise comparisons demonstrated that the osteoarthritis group had greater percentage reduction and point reduction compared to RA and other autoimmune arthritis."

Consistent with other studies, authors reported that many patients either reduced or eliminated their use of medications following their use of CBD products. They acknowledged, "Most respondents using CBD for joint pain reported a reduction or cessation of other medications due to CBD use (60.5 percent), including a reduction in anti-inflammatories (31.1 percent), discontinuation of anti-inflammatories (17.8 percent), reduction in acetaminophen (18.2 percent), discontinuation of acetaminophen (17.8 percent), reduction in opioids (8.6 percent), and discontinuation of opioids (18.9 percent)."

Most participants taking CBD products acknowledged experiencing either mild or no adverse effects.

Authors concluded: "In terms of the perceived effects of CBD on pain, physical function, and sleep quality, many patients using CBD reported symptomatic improvements. ... These findings suggest that CBD could be an alternative to opioids for the treatment of arthritic pain. ... Clinicians and patients should be aware of the various alternative therapeutic options available to treat their symptoms of arthritis, especially in light of the increased accessibility to cannabidiol products."

The administration of a topical form of CBD has been previously shown to be effective in patients with thumb basal joint arthritis, according to placebo-controlled trial data. Arthritis patients who consume medical cannabis have similarly reported reductions in their opioid intake and improvements in their quality of life.

Full text of the study, "Cannabidiol as a treatment for arthritis and joint pain: An exploratory cross-sectional study," appears in the Journal of Cannabis Research.

Analysis: Medical Cannabis Access Not Associated with Increases in Problematic Use by Young People

New York, NY: The implementation of state laws legalizing the medical use of cannabis is not associated with increases in rates of problematic marijuana use by either adolescents or by young adults, according to data published in the Community Mental Health Journal.

A pair of researchers affiliated with the Weill Medical College at Cornell University assessed rates of so-called ‘cannabis use disorder' among those ages 15 to 24 in states with and without medical cannabis access laws.

"We found that states that have implemented MML [medical marijuana laws] for more than five years are not significantly associated with smaller or greater 2019 DALYs [disability adjusted life years] for cannabis use disorders in an adolescent and young adult population aged 15 to 19, and 20 to 24 years-old, as compared to states that have not," they concluded. "Our findings suggest that MML may have a negligible effect (if any) on cannabis use disorders in this population group."

Their findings are consistent with those of several other studies that have failed to identify any link between medical cannabis legalization and increased marijuana use among young people.

Full text of the study, "Long-term impact of medical marijuana laws on the burden of cannabis use disorders in US male and female adolescents and young adults," appears in Community Mental Health Journal.

Study: Cannabis Use Associated with Lower BMI Among Those with HIV/HCV

Marseille, France: People co-infected with HIV and hepatitis C who consume cannabis are at a lower risk of being overweight, according to data published in the journal AIDS Education and Prevention.

French investigators assessed the relationship between cannabis use and body mass index (BMI) in a cohort of 992 HIV/HCV patients. Consistent with prior research, they reported that a history of marijuana use was "inversely associated with BMI."

Prior studies involving HIV/HCV subjects have also identified a link between cannabis use and a lower risk of diabetes, fatty liver disease, and early mortality.

Other 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.

Full text of the study, "Cannabis use as a protective factor against overweight in HIV-hepatitis C virus co-infected people," appears in AIDS Education and Prevention.

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Federal Court Strikes Down Residency Requirement for Those Seeking State Marijuana Licensure

Augusta, ME: Federal court judges have ruled that a Maine law requiring licensed medical cannabis providers to be in-state residents is unconstitutional.

Judges for the US Court of Appeals for the First Circuit ruled 2 to 1 that the law was “facially protectionist” and thereby in violation of the Constitution’s dormant commerce clause – which seeks to discourage states from taking steps that excessively burden interstate commerce. The majority further determined that the medical cannabis industry is subject to the dormant commerce clause, even despite the federal prohibition of marijuana, because commercial activity in the marijuana market is routinely taking place absent any intervention from federal law enforcement.

They opined, “Congress’s enactment of the Rohrabacher-Farr Amendment in the wake of the CSA’s [Controlled Substances Act] passage … undermines the notion that no such interstate market exists. … [Further,] the prohibition that Maine’s Medical Marijuana Act seeks to impose on out-of-state actors entering that very market reflects the reality that the market continues to operate. That prohibition even indicates that the market is so robust that, absent the Medical Marijuana Act’s residency requirement, it would be likely to attract entrants far and wide.”

The majority concluded, “Why, then, would it be improper for us to apply the dormant Commerce Clause here? There is an interstate market, and a state is trying to protect its advantageous position with respect to it.”

The dissenting judge argued that the commerce clause’s protections ought to be applicable only to national markets involving goods or services that Congress has deemed legal.

Maine regulators had already dropped a similar residency requirement for those seeking licensure to participate in the adult-use market.

The case is Northeast Patients Group v. Maine Department of Administrative and Financial Services.

Analysis: Heavy Metals Frequently Identified in Unregulated CBD Products

Miami, FL: CBD-infused products commercially available in retail stores and online often contain heavy metals, such as lead, arsenic, and mercury, and typically contain less-than-advertised quantities of cannabidiol, according to data published in the journal The Science of the Total Environment.

Investigators affiliated with the University of Miami School of Medicine and with the Ellipse Analytics Testing Lab in Denver assessed 516 CBD products for cannabidiol content as well as for the presence of heavy metal contaminants. Of these products, 121 products were intended for oral consumption.

Consistent with prior analyses of unregulated CBD products, many contained impurities and inaccurate labeling.

Of the CBD-infused edible products analyzed, 42 percent tested positive for the presence of lead, 37 percent tested positive for mercury, 28 percent tested positive for arsenic, and eight percent tested positive for cadmium.

Over 40 percent of all of the products tested contained significant lower percentages of CBD than advertised on the products’ labeling. Among edible products only, 29 percent contained lower quantities of CBD than advertised.

“Low-level contamination of edible CBD products with heavy metals and phthalates is pervasive,” authors concluded. “There is substantial discrepancy between the product label claims for CBD potency and the amount measured in both edible and topical products, underscoring the need for tight regulations for CBD product label integrity to protect consumers.”

They added: “Given that the consumer demographic purchasing CBD products includes those afflicted with pain, insomnia, anxiety, and other health conditions, these findings could give consumers and medical practitioners hesitation about the benefits and potential harm of CBD use. If left unaddressed, these findings could lead to decline in consumer trust and public health concerns. CBD mistrust could lead to consumers and retailers abandoning this category of potentially efficacious medical therapies. … It is incumbent upon manufacturers to recognize the prevalence of misleading claims on labels, identify the sources of the discrepancies between label claims and measured CBD content, and improve label accuracy through a commitment to frequent and thorough independent testing procedures.”

Heavy metal contamination has also been identified in unregulated delta-8 THC vapor products.

More than three years following the passage of federal legislation legalizing hemp production, 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.

Full text of the study, “Heavy metal and phthalate contamination and leveling integrity in a large sample of US commercially available cannabinoid (CBD) products,” appears in The Science of the Total Environment.

Survey: Cannabis Reportedly More Effective Than Prescription Anti-Emetics for Hyperemesis Gravidarum

Los Angeles, CA: Survey respondents who acknowledge having consumed cannabis to address symptoms of Hyperemesis Gravidarum (HG) frequently report that it is more effective than prescription medications at reducing severe nausea and vomiting.

A team of researchers affiliated with the University of California, Los Angeles and with the Hyperemesis Education and Research Foundation in Oregon surveyed 550 respondents who suffered from HG during their pregnancy. Among respondents, 96 percent acknowledged having used prescription anti-emetics; 14 percent reported having used cannabis. Most (71 percent) of those who acknowledged having consumed cannabis said that they did so because prescription medications inadequately managed their symptoms.

Of those who consumed cannabis, 82 percent reported HG symptom relief – a finding that is consistent with prior case reports and surveys. By comparison, only 60 percent reported obtaining relief from prescription anti-emetics. Moreover, among patients who reported experiencing weight loss during pregnancy, 56 percent of those who used cannabis reported gaining some or all of it back within two weeks of treatment, compared to 25 percent of prescription drug users.

Authors concluded: “This study adds to growing literature supporting antiemetic properties of cannabis and cannabinoid compounds while also suggesting their potential to treat HG. … A minority of respondents in this survey reported using cannabis for HG; however, those who used cannabis or CBPs [cannabis-based products] reported more frequent relief from HG symptoms compared to those who used prescription antiemetics. Furthermore, those cannabis users were more likely to report weight gain within two weeks of treatment than those who used ondansetron, reportedly the most effective prescription antiemetic for survey respondents.

“Cannabis products may be perceived as a more effective alternative, but more research is required to understand its mechanism and safety… In the meantime, providers must weigh unknown risks of recommending cannabis… with the well-established risk of adverse maternal and fetal outcomes for refractory HG.”

Full text of the study, “Patterns of use and self-reported effectiveness of cannabis for Hyperemesis Gravidarum,” appears in the journal of the German Society of Gynecology and Obstetrics.

Study: CBG Administration Lowers Blood Pressure in Preclinical Model

Hershey, PA: Mice injected with the cannabinoid CBG (cannabigerol) experience a significant decrease in mean blood pressure, according to preclinical data published in the journal Frontiers in Physiology.

A team of researchers with Penn State College of Medicine assessed the cardiovascular impact of CBG compared to placebo in healthy mice. Animals in the study were injected in the abdomen with either CBG or a saline solution.

Authors reported, “[A]cute CBG administration elicits a significant decrease in blood pressure in phenotypically normal male mice, without altering heart rate or locomotor activity.”

They concluded: “The present study provides new mechanistic insight into the cardiovascular effects of CBG in the context of normal blood pressure. … Overall, these findings add to the growing literature regarding the role of cannabinoids in blood pressure regulation. Additional research on CBG is needed to define the precise molecular mechanisms and sites of action, effects of more chronic administration, and potential for therapeutic use to lower blood pressure in models of hypertension.”

A 2017 clinical trial previously documented the ability of oral doses of CBD to lower blood pressure in healthy volunteers, while a 2021 observational trial identified a link between long-term cannabis use and a reduction in systolic and diastolic blood pressure in elderly subjects.

Cannabinoids have long been known to influence cardiovascular function, though data regarding their effects has been conflicting. According to the results of a 2021 literature review of 67 studies published in the American Journal of Medicine, “[M]arijuana itself does not appear to be independently associated with excessive cardiovascular risk factors,” although authors did caution that “it can be associated with other unhealthy behaviors such as alcohol use and tobacco smoking that can be detrimental” to cardiovascular health.

Data assessing neonatal outcomes among children with in utero exposure to cannabinoids is inconsistent, with some studies highlighting potential links with pre-term birth and lower birth weight and other studies finding no such associations.

Full text of the study, “Acute cannabigerol administration lowers blood pressure in mice,” appears in Frontiers in Physiology.

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Voters in Growing Number of States to Decide on Marijuana Legalization This November

Bismarck, ND: State officials this week approved a citizens’ initiative for the November ballot that seeks to legalize the adult-use possession and sale of marijuana in North Dakota.

The proposed ballot measure allows adults to possess, purchase, and home-cultivate specific quantities of cannabis. It also establishes guidelines for the licensing and regulation of commercial cultivators and retailers.

North Dakotans will join voters in several other states who will also be deciding on marijuana legalization proposals this election. Similar adult-use legalization measures have qualified for the ballot in Maryland, Missouri, and South Dakota.

In July, representatives from Oklahomans for Sensible Marijuana Laws turned in over 50,000 more signatures than required to place an adult-use legalization measure on the ballot. Those signatures are still awaiting verification from election officials.

Proponents of an Arkansas initiative to legalize the adult-use marijuana market are engaged in a legal appeal before the Supreme Court after election officials rejected their proposed ballot title. Justices have ruled that the proposal must appear on the election ballot, but they have yet to determine whether the votes will be counted.

Proponents of a Nebraska effort to authorize medical cannabis access are also awaiting verification from election officials.

In addition to these statewide efforts, voters in dozens of cities will be deciding on municipal ballot questions this fall. For instance, voters in five Texas cities – Denton, Elgin, Harker Heights, Killeen, and San Marcos – will decide on measures seeking to amend local laws curtailing police officers’ authority to “issue citations or make arrests for Class A or Class B misdemeanor possession of marijuana offenses” absent a defendant’s alleged involvement in a “felony level narcotics” case. Voters in several Ohio cities will also decide on municipal measures depenalizing activities involving marijuana possession.

In Rhode Island, voters in 31 towns will decide on measures determining whether or not to allow licensed cannabis retailers in their localities. Voters in cities in several other states, including Colorado, Michigan, and Montana, will decide on similar local ballot measures as well.

Analysis: Propagation of Cannabis Retailers Not Associated with Changes in Traffic Safety

La Jolla, CA: The establishment of licensed cannabis retailers is not independently associated with an increase in traffic crashes, according to data published in the journal Health Economics.

A researcher affiliated with the University of California, San Diego examined county-level data from Colorado to assess the relationship between retail cannabis stores and trends in traffic safety.

The investigator reported, “[T]he entry of retail cannabis stores is not associated with a statistically significant change in traffic crashes per 100,000 population in Colorado.”

He concluded: “The findings of a lack of relationship between expanding access to marijuana through retail stores and traffic crash[ees] may seem counterintuitive, especially since the use of marijuana has been linked to lower neuromotor/neurocognitive performance required to drive safely and a higher risk of being involved in a traffic crash. However, recent studies have found evidence of substitutability between marijuana and other substances that can impair driving performance, such as alcohol. In this case, the net effect of expanding access to marijuana on traffic crashes could be quite small. The findings of this study are consistent with this hypothesis.”

Several prior studies have assessed whether the enactment of adult-use legalization is associated with an increased risk in the likelihood of motor vehicle accidents. The findings of those studies have yielded inconsistent results, with some studies identifying a minor uptick in crash rates in specific states several years following legalization, and others finding no such change.

Full text of the study, “Does expanding access to cannabis affect traffic crashes? County-level evidence from recreational marijuana dispensary sales in Colorado,” appears in Health Economics.

Study: In-Utero Cannabis Exposure Not Linked with Elevated Risk of ADHD in Children

Quebec, Canada: Prenatal cannabis exposure is not associated with an increased risk of attention deficit disorders among children, according to data published in the journal BMJ Open.

Canadian investigators evaluated the relationship between in-utero marijuana exposure and attention deficit with or without hyperactivity disorder in a cohort of 2,408 children.

Researchers reported “no significant association” between either occasional or regular prenatal cannabis exposure and ADHD after adjusting for potential confounders.

“In our study, we did not find any association between in-utero occasional or regular exposure to cannabis and the risk of ADHD in children, as well as overall exposure to cannabis and the risk of ADHD in children,” authors concluded. “Further research focusing on the timing of exposure during pregnancy (e.g., first, second, third trimester), as well as using different methods for quantifying prenatal cannabis exposure (e.g., biological samples), is needed to better understand the impact of cannabis use during pregnancy and developmental outcomes in children.”

Full text of the study, “Is in-utero exposure to cannabis associated with the risk of attention deficit with or without hyperactivity disorder? A cohort study within the Quebec Pregnancy Cohort,” appears in BMJ Open.

Study: Cannabis Extract Effective in Patients with Refractory Chronic Pain

Sydney, Australia: The administration of cannabis extracts containing equal quantities of THC and CBD is associated with reduced pain intensity and improved sleep in patients with chronic refractory pain conditions, according to data published in the journal Medical Cannabis and Cannabinoids.

Australian investigators assessed the safety and efficacy of whole-plant cannabis oil in a cohort of 151 chronic pain patients. Participants in the trial used the extract daily for at least three months. All of the subjects in the trial suffered from conditions that were unresponsive to conventional analgesics, such as opioids and NSAIDs (non-steroidal anti-inflammatory drugs). Trial subjects were most likely to be diagnosed with neuropathy, musculoskeletal pain, or arthritis.

Researchers reported, “Pain impact scores were significantly reduced across the cohort. Additionally, most subjects reported improvements in sleep disturbances and fatigue.” The majority of side-effects reported by patients were categorized as mild; these most frequently included sleepiness, dizziness, and dry-mouth.

They concluded: “This analysis presents real-world data collected as part of standard of care. … The results of this study demonstrated a significantly positive effect of [a proprietary formulation of] oral medicinal cannabis oil on the impact of pain. … Amelioration of the impact of pain confirms continued prescribing of this formulation and validates our observational methodology as a tool to determine the therapeutic potency of medicinal cannabinoids.”

Survey data estimate that nearly one-third of patients suffering from chronic pain conditions acknowledge using cannabis products. 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, “Medical cannabis for the treatment of chronic refractory pain: An investigation of the adverse event profile and health-related quality of life impact of an oral formulation,” appears in Medical Cannabis and Cannabinoids.

Study: CBD Oil Mitigates Chemotherapy-Induced Neuropathy

Roskilde, Denmark: The short-term administration of CBD oil extracts is safe and effective in patients suffering from chemotherapy-induced peripheral neuropathy (CIPN), according to data published in the journal Supportive Care in Cancer.

Danish investigators assessed the twice daily administration of CBD oil (300 mg/daily) in patients receiving either oxaliplatin or paclitaxel-based chemotherapy. Subjects used CBD for a period of eight days immediately following their first cycle of chemotherapy. Patients outcomes were compared to those of similarly matched controls.

Researchers reported that the use of CBD was associated with pronounced improvements in patients’ pain-related outcomes, including cold sensitivity and throat discomfort.

“CBD attenuated early symptoms of CIPN with no major safety concerns,” they concluded. “Long-term follow-up is ongoing. Results should be confirmed in a larger, randomized study.”

Separate studies have identified an association between patients’ long-term use of cannabis products and statistical improvements in cancer-related symptoms as well as significant reductions in their use of prescription painkillers.

Full text of the study, “Oral cannabidiol for prevention of acute and transient chemotherapy-induced peripheral neuropathy,” appears in Supportive Care in Cancer.

Analysis: History of Cannabis Use Inversely Associated with Urological Cancers

London, United Kingdom: Women with a past history of cannabis use are at lower risk of suffering from certain types of urological cancers, according to population-based data published in the journal Cancer Medicine.

An international team of researchers from China, France, and the United Kingdom assessed the relationship between cannabis use and cancer risk in a cohort of more than 151,000 subjects.

Investigators reported, “Previous use of cannabis was a significant protective factor” in women against renal cell carcinoma (RCC) and bladder cancer (BCa). They further reported that “previous cannabis use was a significant protective factor for PCa (prostate cancer) in men with a history of tobacco smoking.” A history of cannabis use had a null effect on rates of testicular cancer.

Authors concluded: “In the current study, we investigated the association between the use of cannabis and the risk of urological cancers. We observed that: (1) previous use of cannabis was a significant inverse association with both RCC and PCa; (2) cannabis use was associated with the lower risk of BCa in the point estimates; (3) the protective effect of cannabis on RCC and BCa was significant for females but not for males; (4) cannabis use had a causal effect on lower incidence of RCC.”

Prior studies have similarly identified an inverse association between a past history of cannabis use and the development of certain types of cancers, including bladder cancer, liver cancer, and head and neck cancers.

Full text of the study, “Association between cannabis use with urological cancers: A population-based cohort study and mendelian randomization study in the UK biobank,” appears in Cancer Medicine.

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Clinical Trial: CBD Safe and Effective for Young People with Treatment-Resistant Anxiety Disorders

Melbourne, Australia: The adjunctive use of CBD safely and effectively reduces severe anxiety in young people, according to clinical data published in The Journal of Clinical Psychiatry.

Australian researchers assessed the daily administration of CBD in a cohort of 31 young people (ages 12 to 25) with refractory anxiety. Participants self-titrated their daily doses of CBD (between 400 mgs and 800 mgs) over a 12-week period.

CBD dosing was associated with a "statistically significant reduction in anxiety severity," as measured on the Overall Anxiety Severity and Impairment Scale (OASIS). CBD dosing also "demonstrated an acceptable safety profile, with no serious adverse events reported and no clinically significant deviations to blood cell counts."

Investigators reported, "Approximately 40 percent of all participants experienced a 50 percent reduction in OASIS score, and two-thirds experienced a 33 percent reduction." They added, "By the end of treatment, the number of participants rated as markedly or severely ill had decreased from 17 (56.7 percent) to 5 (16.7 percent)."

Authors acknowledged that CBD’s greatest efficacy was observed during the final four weeks of treatment, indicating that a longer treatment regimen may potentially lead "to even greater improvements."

They concluded: "Given that the patients included in our trial were some of the most severe and treatment resistant and had significant functional impairment and multiple failed treatment attempts, the reduction in anxiety severity observed here suggests that CBD has clinically meaningful anxiolytic effects. ... The findings of this trial suggest that further investigation of CBD for anxiety in conjunction with usual care is warranted."

Other human trials evaluating the use of CBD for anxiety have yielded inconsistent results. A 2019 placebo-controlled trial reported that daily CBD intake reduces symptoms of social anxiety disorder in teens, whereas a 2022 study determined oral doses of CBD to be ineffective at reducing symptoms of moderate-to-severe testing anxiety in college students. A 2018 Brazilian study reported that the consumption of 300mg of CBD significantly reduced anxiety due to public speaking, but that higher (600mg) and lower (150mg) had no effect.

Full text of the study, "Cannabidiol for treatment-resistant anxiety disorders in young people: An open-label trial," appears in The Journal of Clinical Psychiatry.

Study: Medical Cannabis Use Not Associated with Elevated Risk of Hospitalizations Due to Mental Health Disorders

Quebec, Canada: Authorized medical cannabis patients are at low risk for psychiatric hospitalizations resulting from their marijuana use, according to data published in the journal Substance Use & Misuse.

Canadian researchers assessed marijuana-related hospitalizations among a cohort of over 23,000 authorized medical cannabis patients. (Canada has legalized the use of cannabis products for both medical purposes and for adult use.) Specifically, investigators tracked incidences of hospitalizations attributable to either "cannabis poisoning" or because of "mental or behavioral disorders due to the use of cannabis." Patients in the study were tracked for a median of 240 days.

During the course of the trial, investigators reported that a total of 14 patients were hospitalized for issues related to cannabis toxicity and 26 were admitted for either mental or behavioral disorders. The findings push back against high-profile claims from some cannabis reform opponents that frequent marijuana exposure is a trigger for psychosis and other mental health disorders.

"The results suggest that the incidence of cannabis poisoning or cannabis-related mental or behavioral disorders was low among patients who were authorized to use cannabis for medical care," authors concluded. "Our observation of small rates of ED visits and hospitalization for cannabis poisoning and CUDs [cannabis use disorders] among this large cohort of medical cannabis users helps address concerns regarding increasing use of medical cannabis."

Full text of the study, "Incidence and predictors of cannabis-related poisonings and mental and behavioral disorders among patients with a medical cannabis authorization: A cohort study," appears in Substance Use & Misuse.

Analysis: Cannabis Use Not Associated with Increased COVID Severity

Los Angeles, CA: Current cannabis use is associated with deceased disease severity in patients hospitalized for COVID 19, according to data published in the Journal of Cannabis Research.

Researchers affiliated with the David Geffen School of Medicine at the University of California, Los Angeles conducted a retrospective analysis of 1,831 COVID patients admitted to two medical centers in California. They reported, "Active cannabis users hospitalized with COVID 19 had better clinical outcomes compared with non-users, including decreased need for ICU admission or mechanical ventilation." However, investigators reported no association between cannabis use and better overall survival rates.

Authors reported that the association between cannabis use and decreased symptom severity remained consistent even after researchers adjusted for potential confounders, such as age and comorbid conditions.

"To our knowledge, this study is one of the first evaluations of the effect of cannabis use on outcomes in patients hospitalized with COVID-19," they concluded. "While previous data have determined the detrimental relationship of tobacco smoking with COVID-19, this study suggests that cannabis may actually lead to reduced disease severity and better outcomes despite a five-fold greater concomitant use of tobacco amongst cannabis users compared to non-users in our study population."

Preclinical studies and reviews have suggested that the administration of certain cannabis compounds could potentially modulate COVID infections. However, to date, no controlled clinical trials have substantiated the theory that cannabinoids can assist in either preventing COVID infections or in mitigating symptoms of the virus. Clinical trial data published in November failed to demonstrate that the adjunctive use of CBD aided COVID patients in their recovery from the virus. A separate observational study published last year reported that COVID 19 patients with elevated rates of overall substance use were more likely to experience more adverse outcomes, including hospitalization and death.

Full text of the study, "Cannabis consumption is associated with lower COVID-19 severity among hospitalized patients: A retrospective cohort analysis," appears in the Journal of Cannabis Research.

Texas: Voters in Five Cities to Decide on Marijuana Depenalization Initiatives

Austin, Texas: Voters in five Texas cities will decide this November on local ballot measures to end low-level marijuana possession arrests.

Activists with the group Ground Game Texas successfully gathered signatures from voters in the cities of Denton (population: 140,000), Elgin (population: 10,000), Harker Heights (32,000), Killeen (149,000), and San Marcos (64,000) to place marijuana-related questions before local lawmakers. In each instance, councilmembers moved to defer the issue to the November ballot.

The measures seek to amend local laws so that police officers can no longer "issue citations or make arrests for Class A or Class B misdemeanor possession of marijuana offenses" absent defendants' alleged involvement in a "felony level narcotics" case. If voters approve the proposals, police will still be permitted to confiscate cannabis from those who possess it in small quantities.

In May, voters in Austin overwhelmingly approved a similar municipal measure depenalizing marijuana possession and prohibiting police from executing 'no knock' warrants.

Texas law does not allow for statewide, citizen-initiated measures.

Statewide polling finds that 67 percent of Texans, including majorities of Democrats, Independents, and Republicans, support legalizing the sale and use of marijuana.

Under state law, minor marijuana possession is classified as a criminal misdemeanor, punishable by up to 180 days incarceration and a $2,000 fine. Texas police made an estimated 219,000 marijuana-related arrests between 2017 and 2021. Ninety-seven percent of those arrested were charged with possession only.

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Study: Medical Cannabis May Present a "Useful Treatment Strategy" for Fibromyalgia Patients

Montreal, Canada: Cannabis products are associated with symptom relief among fibromyalgia (FM) patients, according to data published in the journal Arthritis Care & Research.

Canadian researchers assessed the efficacy of medical cannabis products (flower or extracts) over a one-year period in a cohort of patients with FM. Investigators assessed patients' levels of pain intensity, sleep quality, and depression/anxiety every three months. All of the subjects enrolled in the study were qualified to use medical cannabis products by their general practitioner.

Consistent with other studies, researchers reported an association between the consumption of medical cannabis and improvements in subjects' sleep, depression/anxiety, and pain - with the greatest reduction in pain intensity (a mean decrease of 1.7 points on a zero to 10 scale) occurring within the first six-months of treatment.

Authors reported: "Our current findings are consistent with observations of pain relief, improved sleep, and alleviation of symptoms of anxiety and depression in other studies among patients with chronic pain using medical cannabis. Although preliminary, our findings suggest that improvements in negative affect and sleep might represent potential mechanisms of action underlying pain reductions among FM patients who are using medical cannabis."

They concluded, "Medical cannabis may present a useful treatment strategy for patients with FM in light of an effect on the triad of symptoms of pain, negative affect, and sleep disturbances."

Survey data reports that fibromyalgia patients frequently consume cannabis for therapeutic purposes. A recent review of the relevant literature 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, "Predictors of pain reduction among fibromyalgia patients using medical cannabis: A long-term prospective cohort trial," appears in Arthritis Care & Research.

Congress: Bipartisan Bill Introduced to Designate Funding for Clinical Trials on the Efficacy of State-Licensed Medical Cannabis Products

Washington, DC: Representatives Scott Peters (D-CA) and David Joyce (R-OH) have introduced legislation, the Developing and Nationalizing Key Cannabis Research Act of 2022, to provide designated funding for clinical research into the therapeutic benefits of cannabis.

The legislation authorizes the Director of the National Institutes of Health to designate "institutions of higher education as Centers for Excellence in Cannabis Research for the purpose of interdisciplinary research related to cannabis and other biomedical, behavioral, and social issues related to cannabis." This research will explicitly include clinical investigations assessing "the safety and efficacy of cannabis in providing therapeutic benefits for certain priority diseases or conditions" as well as studies evaluating "the relative risk of cannabis as compared to alcohol and tobacco," among other purposes.

To carry out this work, the measure appropriates $50,000,000 for each of fiscal years 2024 to 2028 to ten designated research centers. It also allows scientists affiliated with these designated centers to obtain state-legal cannabis products and to administer those products to subjects in clinical trials.

Under current federal law and regulations, researchers are prohibited from clinically evaluating any state-licensed products. Rather, scientists wishing to study cannabis in clinical settings must utilize cannabis provided by federally-licensed entities - of which there has been only one (the University of Mississippi) for more than 50+ years. (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. However, the US National Institute on Drug Abuse has yet to officially partner with any of these entities and there is no explicit timeline as to when they will do so.) Scientists have long complained that the quality of cannabis provided by the University of Mississippi's cultivation program is of inferior quality and that it is not representative of the products available in state-legal markets.

Last month, members of the US House of Representatives voted in favor of legislation, "The Medical Marijuana and Cannabidiol Research Expansion Act," to facilitate cannabis-specific scientific research and potential drug development. That language is anticipated to be fast-tracked to the President's desk. However, it does not authorize scientists to access cannabis flowers and other products manufactured in accordance with state-approved marijuana programs.

"This proposed legislation is long overdue," NORML's Deputy Director Paul Armentano said. "It seeks to address knowledge gaps by providing dedicated funding so that scientists can better understand the safety and efficacy of real-world products - products that are currently being consumed by patients and by others daily in the majority of states in America."

Despite federal hurdles, scientific interest and studies involving cannabis have increased significantly over the past two decades. Since 2010, scientists in the US and around the world have published an estimated 30,000 peer-reviewed papers referencing the cannabis plant or its constituents, with the annual number of total papers increasing every year. By comparison, researchers published fewer than 3,000 total papers about marijuana in the years between 1990 and 1999 and fewer than 2,000 total studies during the 1980s.

Study: Medical Cannabis Associated with Pain Mitigation, Reduced Reliance on Opioids in Patients with Advanced Cancer

Syracuse, NY: Patients with advanced cancer respond favorably to medical cannabis, according to data published in the journal Cureus.

Investigators affiliated with Upstate University Hospital in Syracuse, New York evaluated cancer patients' use of cannabis for palliative purposes. All of the participants in the trial were enrolled in the state's medical cannabis registry.

Consistent with prior data, the majority of subjects (85 percent) reported symptom improvements following their use of cannabis - with nearly half reporting reductions in their pain. Also consistent with prior studies, a significant percentage (45 percent) of subjects reported decreasing their use of opioid pain medications. Very few participants (less than four percent) experienced adverse effects from their use of medical cannabis products.

"Medical marijuana appears to have an important role in the palliation of symptoms in advanced cancers with few adverse effects," authors concluded. "Prospective studies examining this treatment modality should be prioritized."

Full text of the study, "Experience with medical marijuana for cancer patients in the palliative setting," appears in Cureus.

Survey: Middle-Aged Women Frequently Report Cannabis Use to Mitigate Menopause Symptoms

Belmont, MA: Many middle-aged women acknowledge consuming cannabis products to alleviate menopause-related symptoms, according to survey data published in the journal Menopause.

A team of researchers affiliated with McLean Hospital and with Harvard Medical School in Boston surveyed 258 women (median age: 51 years old) regarding their use of cannabis.

The majority of respondents (79 percent) said that cannabis effectively treats menopause-related symptoms. Women were most likely to report using cannabis to alleviate sleep disturbances and to regulate mood. Respondents were most likely to report consuming cannabis via smoking.

"The current study indicates that many individuals are currently using commercially available MC [medical cannabis] products as an adjunct treatment for menopause-related symptoms. ... The most commonly reported indications for MC use were menopause-related disturbance of sleep and mood/anxiety, indicating these symptoms may be salient targets for future clinical trials of cannabinoid-based therapies," authors concluded. "Future research should continue to examine MC use for menopause-related symptoms, including assessing how unique cannabinoid profiles, modes of use, and other MC use characteristics impact safety and efficacy."

Previous surveys, such as those here and here, have estimated that one-third of women consume cannabis for purposes of managing menopause-related symptoms.

Full text of the study, "A survey of medical cannabis use during peri-menopause and post-menopause," appears in Menopause.

Massachusetts: Lawmakers Advance Legislation Creating 'Social Equity Trust Fund,' Facilitating Licensing of On-Site Consumption Lounges

Boston, MA: House and Senate lawmakers have advanced legislation (S. 3096) which seeks to promote greater diversity among those participating in the state's licensed cannabis industry and that lays the groundwork for the establishment of on-site cannabis consumption facilities.

Specifically, the measure creates a "Cannabis Social Equity Trust Fund to encourage the full participation ... of entrepreneurs from communities that have been disproportionately harmed by marijuana prohibition and enforcement." Money in the fund "shall be used to make grants and loans, including no-interest loans and forgivable loans, to social equity program participants and economic empowerment priority applicants."

In addition, the bill provides guidance for the eventual licensing of on-site adult-use consumption facilities. It also calls on state officials to conduct a study and to make recommendations "to ensure that students have access to [the] medical use of marijuana" while they attend school.

To date, only a handful of states - including Alaska and Nevada - have allowances for social consumption facilities. By contrast, many states now provide allowances for qualified students to access cannabis products while on school grounds.

The bill now awaits action from Republican Gov. Charlie Baker, who reportedly favors the bill and is expected to sign it into law.

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Feds Report Significant Year-Over-Year Decline in Marijuana Seizures at the US Border

Washington, DC: Federal officials report a significant drop in the quantity of marijuana they are seizing at the US international border, according to data compiled by the US Department of Homeland Security.

According to reporting provided by borderreport.com, "Department of Homeland Security agencies in FY2021 seized 160 tons of marijuana, an average of 874 pounds a day. With three months left in the current fiscal year, agents have seized 56 tons, an average of 408 pounds a day."

The year-over-year decline in marijuana-related seizures at the border is in stark contrast to more generalized data showing a 25 percent increase in overall drug-related seizures. However, it is consistent with longstanding trends previously reported by the US Drug Enforcement Administration that determined, "In US markets, Mexican marijuana has largely been supplanted by domestic-produced marijuana."

Separate data provided earlier this year by the US Government Accounting Office reported that "most drug seizure events [at the US border] involved only US citizens (91 percent), of which 75 percent involved the seizure of marijuana and no other drugs." Of those seizures, 69 percent involved only personal use quantities of cannabis.

Additional information on drug-related border seizures is available from the US Customs and Border Protection agency.

Study: Legalization of Retail Cannabis Sales Not Linked to Any Increase in Youth Use

East Lansing, MI: The adoption of statewide laws regulating the sale of marijuana products to adults is not associated with any increase in cannabis initiation among people under the age of 21, according to data published in the journal PLoS One.

Researchers affiliated with Michigan State University assessed marijuana use trends in a nationally representative cohort of subjects in order to evaluate whether or not legalization was associated with any changes in the percentage of people initiating cannabis use for the first time.

Investigators identified an increase in the number of new adult cannabis consumers following legalization, but they reported no changes among those under 21 years of age.

They reported: "These results show consistent evidence of an increase in the occurrence of newly incident cannabis use for adults aged 21 years and older after the removal of prohibitions against cannabis retail sales. For those aged 12-20-years-old, the study estimates support the hypothesis that RCLs [recreational cannabis laws] did not affect the occurrence of newly incident cannabis use for underage persons."

The findings are consistent with those of prior studies reporting that adult-use legalization is not associated with either increased use or access among young people.

"Cannabis policy liberalization continues to be a contentious issue in the national political landscape. ... Policymakers and the voters who elect these policy-makers cannot make the best judgments in the absence of evidence, unless their decisions are to be based on potentially erroneous prejudices or beliefs," authors concluded. "The evidence from this study is not perfect, but the estimates provide an evidence base that can be judged in relation to an important question - namely, should we worry about underage cannabis use when adults are allowed to buy cannabis products in retail shops? And might the occurrence of adult-onset newly incident cannabis use increase if this policy change is made? The answer to the first question at this point seems to be that there has been no policy influence on cannabis incidence in the underage adolescent population after adults have been allowed to buy cannabis in retail shops. The answer to the second question at this point indicates a tangible uptick in the occurrence of newly incident cannabis use among adults who otherwise might never have tried cannabis. We are hopeful that voters, policymakers, and public health officials can use this evidence as they forecast what might change if cannabis policies are liberalized to permit adult purchases from retail cannabis shops in their jurisdictions."

Full text of the study, "Estimating the effects of legalizing recreational cannabis on newly incident cannabis use," appears in PLoS One.

Analysis: Labels Often Inaccurate for Hemp-Derived CBD Topical Products

Baltimore, MD: A significant percentage of hemp-derived CBD topical products contain percentages of CBD and THC that differ significantly from what is listed on their packaging, according to data published in the journal JAMA Network Open.

A team of researchers affiliated with John Hopkins University School of Medicine and the Substance Abuse Mental Health Services Administration assessed the purity of 105 commercially available hemp-derived CBD topical products.

Of the 89 products that provided information regarding the percentage of CBD available in them, only 24 percent provided accurate data. Thirty-five percent of topical products also tested positive for trace quantities of THC - including 11 percent of products that were explicitly labeled as "THC free." (Over half of the products tested made no mention of THC on the product label.)

The findings are consistent with dozens of prior studies similarly reporting that commercially available CBD products seldom provide accurate information on their packaging.

Authors concluded, "This case series found that topical cannabinoid products purchased online and at popular retail stores were often inaccurately labeled for CBD content and many contained the psychoactive cannabis constituent THC. Moreover, some products made therapeutic claims for indications not approved by the FDA. These findings highlight the need for proper regulatory oversight of cannabis and hemp products to ensure these products meet established standards for quality assurance and so that consumers are not misled by unproven therapeutic or cosmetic claims."

More than three years following the passage of federal legislation legalizing hemp production, 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.

Full text of the study, "Cannabinoid content and label accuracy of hemp-derived topical products available online and at national retail stores," appears in JAMA Network Open.

CBD Extract Shows Anti-Bacterial Activity Against Salmonella in Preclinical Model

Montgomery, AL: Whole-plant CBD extracts exhibit anti-bacterial activity against various species of salmonella, according to preclinical data published in the journal Molecules. Salmonella species are among the most common and prevalent foodborne pathogens worldwide.

A team of scientists affiliated with Alabama State University assessed the efficacy of CBD as an anti-bacterial agent against salmonella newington and salmonella typhimurium.

Researchers determined that CBD extracts inhibited salmonella bacteria cell growth in culture in a manner similar to that of the conventional antibiotic ampicillin.

They reported: "Salmonella infections are typically treated with broad-spectrum antibiotics such as ampicillin; however, the development of resistance to these treatments has become more prevalent, thus increasing the need for alternative treatments. ... These experiments confirmed that CBD has antibacterial activity against our target bacteria. Additionally, our comparative studies showed that CBD has antibacterial activity similar to ampicillin. ... These results posed the question of CBD-antibiotic co-therapy as a potential novel application."

They concluded: "Discovery and development of novel antibacterial agents such as CBD are a major step towards the future of therapeutics in a world where antibiotics are no longer efficacious and cost effective. .... This study further progresses our current knowledge on the effectiveness of CBD as an antibacterial agent and demonstrates the effectiveness of CBD against Gram-negative bacteria, S. typhimurium and S. newington. ... While this study illuminates the potential of CBD as a therapeutic and fills a void in the current literature, future work is necessary for further development of this bioactive compound as a therapeutic agent."

Initial acknowledgements in the scientific literature of cannabinoids' antibacterial properties date back over six decades. More recently, preclinical studies have demonstrated that cannabinoids can inhibit the spread of methicillin-resistant Staphylococcus aureus (a/k/a MRSA), malaria, and certain forms of dental bacteria.

Full text of the study, "Cannabis sativa CBD extract shows promising antibacterial activity against salmonella typhimurium and salmonella newington," appears in Molecules.

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Analysis: Patients with a History of Cannabis Use Less Likely to Have Medical Complications Following Spinal Fusion Surgery

New York, NY: Patients with a history of cannabis use are less likely than non-users to experience adverse medical outcomes following thoracolumbar (lower back) spinal fusion (TLF) surgery, according to data published in The Iowa Orthopedic Journal.

A team of orthopedic specialists affiliated with the State University of New York (SUNY) Downstate Health Sciences University in Brooklyn assessed the relationship between cannabis use and surgical outcomes in a cohort of 704 patients undergoing TLF surgery for adult spinal deformity (ASD). Half of the subjects in the sample identified as cannabis consumers and half did not.

Compared to non-users, cannabis consumers experienced significantly lower rates of medical complications during the 90-day period immediately after surgery. Those with a history of cannabis use were no more likely than non-users to seek post-operative readmissions.

"Compared to patients with ASD who underwent TLF without baseline cannabis use, patients with isolated baseline cannabis use were found to have no increase in odds of incurring 90-day surgical complications or readmissions or revisions two years postoperatively, though reduced odds of experiencing 90-day medical complications were observed," authors concluded. "Future prospective, randomized-controlled studies could help further characterize the impact of isolated cannabis use on the postoperative course of surgical patients undergoing complex procedures such as thoracolumbar fusion for adult spinal deformity."

Prior observational studies have similarly reported that marijuana use is associated with a decreased risk of in-hospital mortality among patients suffering from congestive heart failure, cancer, COPD, pancreatitis, HIV, burn-related injuries, traumatic brain injuries, and various other types of severe trauma.

Full text of the study, "The impact of isolated baseline cannabis use on outcomes following thoracolumbar spinal fusion: A propensity score-matched analysis," appears in The Iowa Orthopedic Journal.

Poll: Plurality of Americans Favor Federal Marijuana Legalization Mandate

New York, NY: By a margin of more than 2 to 1, Americans favor a federal mandate legalizing the adult use of marijuana nationwide, according to polling data compiled by The Economist and YouGov.com.

Forty-five percent of respondents say that the federal government should legalize the adult use of marijuana nationally. That's higher than the percentage of Americans who favor a national mandate permitting abortion (41 percent) or physician-assisted suicide (32 percent).

Twenty-one percent of respondents said that the decision whether or not to legalize marijuana should be left primarily up to the individual states. Several pieces of marijuana reform legislation currently pending in Congress, such as The MORE Act and The States Reform Act, seek to deschedule marijuana from the US Controlled Substances Act – thereby providing state governments the ability to either legalize or criminalize marijuana absent federal interference.

Only 20 percent of those surveyed agree that cannabis should be "banned nationally."

Commenting on the polling data, NORML's Deputy Director Paul Armentano said: "While a plurality of Americans favors the idea of the federal government mandating the states to adopt marijuana legalization, such an outcome remains entirely unlikely in our federalist system. Rather, issues pertaining to marijuana legalization have historically been decided, and continue to be decided, on a state-by-state basis and the best — and most practical way the federal government can respond — is to take steps to undo the past harms of federal prohibition while leaving states free to adopt their own policy alternatives."

Study: CBD Administration Associated with Reduced Cannabis/Tobacco Intake

Paris, France: Vaporizing a liquid formulation of CBD is associated with reduced cannabis/tobacco intake, according to data published in the journal Frontiers in Psychiatry.

A team of French investigators assessed the impact of vaporized CBD on daily cannabis consumption patterns in a cohort of 20 daily consumers. Nearly all of the subjects in the study smoked cannabis mixed with tobacco in joints. Prior studies have previously demonstrated that CBD administration mitigates smoker's desire for tobacco cigarettes.

Of the nine patients who completed the 12-week trial, six of them reduced their daily consumption of cannabis/tobacco joints by 50 percent.

Authors concluded: "This research provides evidence in favor of the use of CBD in CUD [patients with cannabis use disorder] … and illustrates the interest of proposing an addictological intervention targeting at the same time tobacco and cannabis dependence in users who are co-consumers. … A double-blind, randomized, multi-center, placebo-controlled clinical trial is still needed to assess the efficacy of inhaled CBD in CUD."

CBD consumption has previously been associated with reductions in alcohol intake as well as reductions in cue-induced cravings and anxiety in subjects with a history of heroin use.

Full text of the study, "Efficacy of inhaled cannabidiol in cannabis use disorder: the pilot study Cannavap," appears inFrontiers in Psychiatry.

Survey: Cannabis Is a "Common Treatment" for Those Living with Chronic Pain

Quebec, Canada: Nearly one-third of patients living with chronic pain conditions acknowledge using cannabis for pain management, according to data published in the Canadian Journal of Pain.

Canadian investigators assessed cannabis use trends in a cohort of 1,935 chronic pain patients residing in Quebec. (Cannabis products are legal for both medical purposes and for adult use in Canada.)

Just over 30 percent of patients in the sample said that they used cannabis explicitly for purposes of pain management.

Authors identified greater cannabis prevalence among younger patients, but they reported no significant differences between men and women with respect to how likely they were to consume the substance.

"Cannabis is thus a common treatment reported in people living with CP [chronic pain]," they concluded. "Our study re-emphasizes the importance of rapidly generating evidence on the safety and effectiveness of cannabis, in addition to age-tailored education and awareness efforts among people living with CP."

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, "Prevalence of cannabis use for pain management in Quebec: A post-legalization estimate among generations living with chronic pain," appears in the Canadian Journal of Pain.

Colorado: Executive Order Prevents Denial of Professional Licensure to Those with Past Cannabis Convictions

Denver, CO: Those with prior in-state or out-of-state marijuana-related convictions will no longer be denied professional licensure in Colorado, under an executive order signed by Democratic Gov. Jared Polis.

The new order (Executive Order 34: Protecting Colorado's Workforce and Expanding Licensing Opportunities) states: "No one who lawfully consumes, possesses, cultivates or processes marijuana pursuant to Colorado law should be subject to professional sanctions or denied a professional license in Colorado. This includes individuals who consume, possess, cultivate or process marijuana in another state in a manner that would be legal in Colorado.

It directs the state Department of Regulatory Affairs, which oversees professional licensing for close to 1 million Coloradans in at least 50 different sectors, to "promulgate and issue rules as necessary to ensure that no person shall be subject to disciplinary action against a professional license or disqualified from professional licensure for any civil or criminal judgment, discipline or other sanction threatened or imposed under the laws of another state regarding consumption, possession, cultivation or processing of marijuana so long as the actions are lawful and consistent with professional conduct and standards of care within the state of Colorado."

The Governor said that the order was necessary in order to stimulate job growth in the state. "There is a workforce shortage in Colorado," he wrote. "Employers are having difficulty recruiting and retaining qualified employees, many of whom need professional licenses. The exclusion of people from the workforce because of marijuana-related activities that are lawful in Colorado, but illegal in other states, hinders our economy and our state."

Full text of the executive order is online.

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Marijuana Reform Advocates in Multiple States Turn in Signatures for 2022 Initiative Campaigns

Tulsa, OK: Cannabis reform advocates in four states - Arkansas, Nebraska, Oklahoma, and North Dakota - have recently submitted signatures to election officials to place legalization proposals on the 2022 ballot.

Last Wednesday, representatives with the group Oklahomans for Sensible Marijuana Laws announced that they had turned in over 164,000 signatures to the Secretary of State's office in an effort to place a binding, statewide marijuana legalization initiative (State Question 820) on the November ballot. That total is well above the number of signatures necessary (94,911) to qualify for the 2022 ballot.

The proposed measure seeks to 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.

On Friday, the group Responsible Growth Arkansas submitted just over 190,000 signatures to the Secretary of State's office to place the Arkansas Adult Use Cannabis Amendment on the November ballot. The constitutional amendment seeks to establish a state-licensed retail cannabis market for those age 21 and older. It also seeks to expand the state's existing medical cannabis access program by increasing the total number of licensed dispensaries and by eliminating certain taxes. Advocates need just over 89,000 valid signatures to qualify the measure for the ballot.

Also on Friday, the group Nebraskans for Medical Marijuana turned in over 90,000 signatures each for a pair of medical cannabis legalization measures - just above the roughly 87,000 necessary to qualify them for the November ballot.

Finally, on Monday, representatives with the group New Approach ND announced that they had turned in 25,762 signatures to Secretary of State's office. That total is roughly 10,000 signatures above the number of signatures necessary (15,582) to qualify it for the 2022 ballot. The proposed measure permits adults to legally possess and home-cultivate personal use qualities of cannabis while also establishing a licensed retail marketplace.

Legalization measures in South Dakota and Maryland have already been confirmed for ballot placement in their respective states. In May, the group Legal Missouri 2022 turned in more than 385,000 signatures to state officials - more than double the total (171,592) necessary to place a constitutional amendment on the ballot legalizing marijuana.

Survey: Cannabis Effective at Mitigating Musculoskeletal Pain

San Juan, Puerto Rico: Patients suffering from musculoskeletal pain disorders report obtaining significant relief following their use of medical cannabis products, according to data published in the Journal of the American Academy of Orthopedic Surgeons.

A team of Puerto Rican investigators surveyed 184 patients with chronic pain conditions regarding their use of medical cannabis. (Lawmakers legalized patient access to certain cannabis preparations in 2015.)

Respondents suffering specifically from musculoskeletal conditions reported an average reduction of 4.47 points on the Numeric Rating Scale following cannabis administration. Eighty-nine percent of survey participants said that cannabis was "more effective" than opioids for pain management - a finding that is consistent with other studies.

Authors concluded: "This study showed that the use of medical cannabis among patients with musculoskeletal conditions effectively reduced pain levels based on their NRS reported scores. In addition, most patients using medical cannabis considered that this drug represents a better option than narcotics (e.g., opioids) for adequate pain management. Additional studies on medical cannabis should evaluate whether the experience and perspective presented through this study could translate into satisfactory and consistent clinical outcomes."

Survey data from 2020 estimated that one in five Canadian patients battling musculoskeletal disorders used cannabis to ease their pain. Among pain patients enrolled in medical cannabis access programs, most subjects report decreasing or even eliminating their use of opiates.

Full text of the study, "Patient experience and perspective on medical cannabis as an alternative for musculoskeletal pain management," appears in the Journal of the American Academy of Orthopedic Surgeons.

Study: Subjects Perceive Decreased Fatigue Following Cannabis Smoking

Albuquerque, NM: The inhalation of cannabis is associated with perceived decreases in fatigue, according to data published in the journal Medical Cannabis and Cannabinoids.

A team of researchers affiliated with the University of New Mexico assessed the effects of smoked cannabis on fatigue intensity levels in 3,922 subjects over a 3+ year period. Study participants self-administered cannabis at home and reported symptom changes in real time on a mobile software application.

"On average, 91.94 percent of people experienced decreased fatigue following consumption with an average symptom intensity reduction of 3.48 points on a zero-to-10 visual analog scale," investigators reported. They added: "While labeled plant phenotypes (‘C. indica,' ‘C. sativa,' or ‘hybrid') did not differ in symptom relief, people that used joints to combust the flower reported greater symptom relief than pipe or vaporizer users. Across cannabinoid levels, tetrahydrocannabinol, and cannabidiol levels were generally not associated with changes in symptom intensity levels."

They concluded: "Using the largest database of real-time effects of cannabis usage in the USA, we found that combusting whole, dried cannabis flower has a generally fast-acting and energetic effect for the majority of people that have symptoms of fatigue. While some user sessions resulted in increased fatigue or fatigue-related side-effect experiences, the vast majority of people reported an overall decrease in their perceived fatigue intensity levels. … Future research would benefit from investigating real-time effects of cannabis usage on behavioral and mental fatigue under altered bodily states and how different phytochemicals in the cannabis plant aggregate and/or interact in its mental and physical effects in healthy people and clinical populations."

Using similar methods, UNM researchers have previously reported that cannabis exposure is associated with real-time reductions in migraine symptoms, pain intensity, stress, depressive symptoms, and nausea, among other symptoms.

Full text of the study, "The effect of consuming cannabis flower for treatment of fatigue," appears in Medical Cannabis and Cannabinoids.

Case Report: Low Doses of THC-Rich Cannabis Extracts Show "Encouraging" Results in Patient with Alzheimer's

Foz do Iguaçu, Brazil: Cannabis microdosing is associated with cognitive and behavioral improvements in a patient with mnemonic and non-mnemonic Alzheimer's disease (AD) symptoms, according to a case report published in the Journal of Medical Case Reports.

An international team of investigators affiliated with The Federal University for Latin American Integration in Brazil and with John Hopkins University in Baltimore reported on the experimental treatment of THC-rich extracts in a 75-year-old male patient with mild-stage Alzheimer's disease. The patient had been diagnosed with AD two-years prior to his use of cannabis.

Extracts used in the trial contained an 8-to-1 ratio of THC to CBD. The patient receiving the intervention used the extracts daily for 22 months. The subject's daily dosage never exceeded 1 mg of THC per day.

Investigators reported that the patient exhibited "rapid" and "robust" symptom amelioration following his use of low doses of THC-rich extracts. Specifically, they reported, "[C]ognitive and memory enhancement lasted for more than one year following the start of treatment and remained stable while we progressively evaluate/follow up with the patient, for more than one year after the official report ended." Authors also reported improvements in the subject's quality of life and in behavioral issues, including a reduction in mood swings and aggressiveness. Follow up evaluations identified no evidence of cannabis-related toxicity or significant side effects.

They concluded: "Our results are unprecedented and very encouraging. … In summary, data presented in this case report suggest that cannabinoid microdosing is a potential therapeutic for AD, with no significant side effects, although placebo-controlled clinical trials are needed to confirm and extend these data."

Prior studies and case reports assessing the use of THC in Alzheimer's disease patients have similarly reported improvements in AD symptoms, such as reduced agitation and improved sleep, following cannabinoid dosing.

Full text of the study, "Cannabinoid extract in microdoses ameliorates mnemonic and non-mnemonic Alzheimer's disease symptoms: A case report," appears in the Journal of Medical Case Reports.

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Study: Cannabis Use Not Predictive of Lack of Motivation

Corvallis, OR: Frequent cannabis use is not associated with motivation loss in adults, according to data published in the Journal of Clinical and Experimental Neuropsychology.

A team of researchers affiliated with Oregon State University assessed motivation and self-reported apathy in a cohort of regular (three times per week or more) cannabis users and controls (non-users).

Investigators identified no significant group differences in self-reported apathy after controlling for covariates (recent alcohol consumption and depressive symptoms).

Authors did report that cannabis consumers were more likely than non-users to "exert more [effort] for reward, suggesting enhanced motivation relative to healthy controls." Specifically, as reward magnitude increased, frequent cannabis users were more likely to select harder trials to complete than were controls.

Consistent with prior studies, they concluded: "The current findings do not support [the theory of] a-motivational syndrome in cannabis users; rather cannabis users displayed higher-effort decision-making in comparison to controls. ... Given the limited number of studies within the field, future research should continue using both self-report and task-based methodologies to assess motivation in cannabis users, while controlling for potential covariates, such as depression, substance use, and personality factors."

Full text of the study, "Effort-based decision making and self-reported apathy in frequent cannabis users and healthy controls: A replication and extension," appears in theJournal of Clinical and Experimental Neuropsychology.

Survey: Patients with Parkinson's Disease Report Symptomatic Relief from Cannabis

Bergen, Norway: Patients with Parkinson's disease (PD) often report symptomatic benefits from the use of cannabis, according to survey data published in the journal Acta Neurologica Scandinavica.

Norwegian investigators surveyed cannabis use patterns and related attitudes among PD patients. Consistent with prior surveys, they reported that a significant minority of PD patients consume cannabis for symptom relief. Respondents were most likely to report improvements in motor function, sleep, and pain as a result of their marijuana use.

Observational trial data has determined that cannabis inhalation is associated with improvements in tremor, rigidity, pain, sleep, and bradykinesia (slowness of movement) in patients with PD. Placebo-controlled trial data has also determined that acute CBD administration (300mg) is associated with a statistically significant reduction in experimentally-induced anxiety and tremor in PD patients.

Full text of the study, "Cannabis use in Parkinson's disease: A nationwide online survey," appears inActa Neurologica Scandinavica.

Clinical Trial: CBD Administration Ineffective for Restless Legs Syndrome

Manaus, Brazil: The administration of oral doses of CBD is ineffective at reducing the severity of restless legs syndrome (RLS) in patients with Parkinson's disease (PD) and REM sleep behavior disorder (RBD), according to clinical trial data published in the journal Cannabis and Cannabinoid Research.

Brazilian researchers compared the use of CBD versus a placebo over a 14-week period. Patients in the CBD arm of the trial received up to 300mgs of cannabidiol.

Patients who were administered CBD demonstrated no improvements compared to those receiving placebo.

"CBD showed no reduction in the severity of RLS manifestations in patients with PD and RBD," authors concluded.

By contrast, a series of case reports pub lished in 2020 and in 2017 reported that cannabis inhalation is associated with perceived efficacy in patients with refractory restless legs syndrome.

Full text of the study, "Cannabidiol for restless legs syndrome/Willis-Ekbom disease in Parkinson's disease patients with REM sleep behavior disorder: A post hoc exploratory analysis of a phase 2/3 clinical trial," appears in Cannabis and Cannabinoid Research.

California: Governor Signs Legislation Reducing Cannabis Tax Burden

Sacramento, CA: Democratic Gov. Gavin Newsom signed budget legislation late last week that reduces various marijuana-specific taxes.

Specifically, the legislation eliminates the cultivation tax on licensed growers and caps any further increase in the excise tax for three years, among other changes.

According to an economic analysis published this spring by The Reason Foundation, regulatory costs, high taxes, and municipal bans on cannabis retailers have significantly inhibited the growth of the licensed marijuana marketplace in California. The analysis estimated that California imposes an effective tax rate of as much as $92 per ounce. This amount is higher than the tax burden imposed on retail cannabis transactions in other states.

California NORML Director Dale Gieringer, who authored the study's forward, recommended at that time that lawmakers impose "substantive tax cuts" in order to "reduce demand for the illicit market, while still retaining reasonable revenues" for state-licensed retailers. Following last week's bill signing, he added, "The budget bill is a helpful start, but much more needs to be done to make legal cannabis more readily accessible to consumers who now rely on the unregulated market."

District of Columbia: Mayor Signs Legislation Allowing Adults Access to Medical Cannabis Dispensaries Following 'Self-Certification' Process

Washington, DC: Mayor Muriel Bowser has signed legislation legislation removing the requirement that adults seeking to purchase cannabis products from licensed DC medical cannabis dispensaries must obtain a recommendation from a licensed physician. Members of the DC City Council had previously voted unanimously in favor of legislation, known as the Medical Marijuana Self-Certification Emergency Amendment Act of 2022.

The measure permits individuals age 21 or older to "self-certify ... that they are utilizing cannabis for medical purposes" when they register with local regulators for a medical cannabis identification card. Once registered, self-certified adults may access any of the District's seven licensed medical cannabis dispensaries.

Councilmembers Mary Cheh and Kenyan McDuffie, who sponsored the measured, said that the legislation is needed to dissuade residents from patronizing the unregulated marketplace. "Due to the lower barriers to access in the gray market, a significant number of medical marijuana patients have shifted from purchasing their medical marijuana from legal medical dispensaries to the illicit gray market, creating a significant risk to the long-term viability of the District's legal medical marijuana industry," they said. "If this trend continues, it is possible that gray market sales could wipe out the District's legal marijuana dispensaries. Given the... benefits that regulated and safe legal dispensaries provide to medical marijuana users in the District, it is vital that the industry survive until the District can stand up a regulated recreational market and transition toward full regulation of recreational marijuana products."

Under District law, adults may possess and home-cultivate limited amounts of cannabis for their own personal use. However, Congressional action has prohibited the City Council from passing municipal legislation to provide adults with retail cannabis access.

Because the self-certification bill was enacted as "emergency legislation," it is not subject to Congressional review.

In June, DC Councilmembers passed separate legislation, the Cannabis Employment Protections Amendment Act of 2022, protecting those who use cannabis from facing discrimination in the workplace. That bill currently awaits action by the mayor.

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