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Patients with Chronic Back Pain Reduce Their Opioid Use Following Initiation of Medical Cannabis Therapy

Philadelphia: Patients suffering from chronic back pain reduce their use of prescription opioids and report improvements in their condition following medical cannabis treatment, according to longitudinal data published in the journal Cureus.

Investigators affiliated with Thomas Jefferson University in Philadelphia evaluated opioid consumption patterns in a cohort of 186 patients with chronic back pain during the six-months immediately prior to and immediately following their enrollment in the state's medical cannabis access program.

Consistent with prior studies, patients reduced their daily intake of opioids over the course of the trial. Over one-third of patients who were taking low daily doses of opioids at the onset of the study eliminated their opioid use by the trial's end. Subjects' opioid reductions were associated with improvements in pain scores and in patients' daily functions.

Authors concluded: "[P]atients with chronic musculoskeletal noncancer back pain who were certified for MC [medical cannabis] ... filled a significantly reduced amount of opioid prescriptions post-MC compared to pre-MC. Upon MC certification, patients with lower levels of baseline opioid use have a high chance of stopping opioid use altogether. Patients show improved pain scores and daily function scores following MC certification. ... Our study supports evidence that short-term opioid usage is diminished and potentially stopped within six months of MC certification."

Full text of the study, "Medical cannabis use reduces opioid prescriptions in patients with chronic back pain," appears in Cureus.

Study: Cannabis Consumers Are Not Less Motivated Than Non-Users

Memphis, TN: Regular consumers of cannabis are more likely to engage in effort-related decision making tasks than are non-users, according to data published in the journal Experimental and Clinical Psychopharmacology.

A team of researchers at the University of Memphis assessed motivation in a cohort of 47 college-aged students (25 frequent cannabis consumers and 22 controls). Subjects completed a series of behavioral tests (the Effort-Expenditure for Rewards Task) that provided participants with choices between tasks of differing degrees of difficulty and rewards.

Investigators reported that those subjects who most frequently consumed cannabis were also the most likely to select tasks that required the greatest amounts of effort.

"The results provide preliminary evidence suggesting that college students who use cannabis are more likely to expend effort to obtain reward, even after controlling for the magnitude of the reward and the probability of reward receipt. Thus, these results do not support the 'amotivational syndrome' hypothesis."

The team's findings are consistent with those of other recent studies refuting longstanding claims that those with a history of marijuana use lack motivation.

Full text of the study, "Effort-related decision-making and cannabis use among college students," appears in Experimental and Clinical Psychopharmacology.

Study: Cannabis Use Associated with Better Quality of Life Outcomes

Sao Paulo, Brazil: Cannabis consumers report better mental health and quality of life outcomes than do non-users, according to data published in the Journal of Psychiatric Research.

Brazilian investigators surveyed a convenience sample of 7,491 self-identified marijuana consumers and 839 non-users. Participants' responses were scored using standardized scales to assess anxiety, depression, quality of life, and subjective well-being.

Those respondents who identified as regular, but not problematic users of cannabis, scored highest on the scales, followed by more occasional consumers. Both groups scored higher on the scales than did those who abstained from marijuana. Those subjects who perceived their cannabis use to be problematic scored lowest on the scales.

"Even after controlling for possible confounders such as demographics and the use of other psychoactive drugs, occasional or habitual self-perception of cannabis use remained associated with better outcomes of quality of life and mental health," authors concluded.

They added, "[The] results obtained in this study are particularly relevant because they were obtained from a sample predominantly composed of habitual cannabis users from the general population, a group less frequently represented in other surveys. Except for self-perceived dysfunctional cannabis use, the association between cannabis use with an increased risk of adverse health outcomes was not observed in the present study. It is possible that these adverse outcomes, generally described in many other studies, may be due to publication bias or the fact that our survey data collection strategy predominantly targeted recreational cannabis users."

Full text of the study, "Mental health and quality of life in a population of recreational cannabis users in Brazil," appears in the Journal of Psychiatric Research.

Study: THC Levels in Blood Not Linked with Changes in Simulated Driving Performance

San Diego, CA: The detection of THC in blood is not correlated with changes in simulated driving performance, according to data published in the journal JAMA Psychiatry.

A team of investigators affiliated with the University of California, San Diego assessed subjects' simulated driving performance after inhaling either low-potency (six percent), moderate-potency (13 percent), or placebo cannabis.

Compared to their baseline performance, those subjects who smoked either low-potency or moderate-potency cannabis exhibited significant changes for a period of 3.5 hours. These changes were most acute for the first 90 minutes. Cannabis inhalation was not associated with any uptick in crash risk. Researchers identified no correlation between subjects' blood/THC levels and driving performance at any point during the study. Consistent with prior studies, authors reported, "The current results reinforce that per se laws based on blood THC concentrations are not supported [by evidence]."

Per se traffic laws make it a crime for a driver to operate a motor vehicle with trace levels of either THC or its metabolites in their blood or urine, regardless of whether there exists any demonstrable evidence that the driver is under the influence.

Most of the study's subjects perceived themselves to be safe to drive after 90 minutes despite continuing to exhibit lingering impairment for several hours thereafter. Authors reported that drivers in the THC groups exhibited no differences in performance compared to controls after 4.5 hours.

Researchers concluded: "In a placebo-controlled parallel study of regular cannabis users smoking cannabis with different THC content ad libitum, there was statistically significant worsening on driving simulator performance in the THC group compared with the placebo group. ... A lack of insight regarding driving impairments, particularly at 90 minutes, is of concern, given that users will likely self-evaluate when they feel safe to drive. ... The lack of relationship between blood THC concentration and driving performance raises questions about the validity of per se laws. ... Future research should address factors such as individual biologic differences, personal experience with cannabis, and cannabis administration methods in relation to driving impairment."

Prior studies have shown that THC inhalation is associated with changes in driving behavior, such as an increased likelihood of weaving and a decrease a drivers' average speed. These and other changes are typically less pronounced in subjects who are more habitual cannabis consumers, but they may be exacerbated when alcohol and marijuana are ingested in combination with one another.

By contrast, the ingestion of CBD-dominant cannabis strains has not been associated with similar changes in driving performance.

Full text of the study, "Driving performance and cannabis users' perception of safety: A randomized clinical trial," appears in JAMA Psychiatry.

Survey: Cannabis Companies Cite Lack of Banking Access as the "Top Issue" Facing the Industry

Portland, OR: Businesses' lack of access to traditional financial services and capital is perceived to be the greatest hurdle facing the cannabis industry, according to survey data compiled by Whitney Economics.

Researchers compiled opinions from 396 licensed cannabis companies on existing challenges in the US marketplace. Over 70 percent of respondents said that the "lack of access to banking or investment capital" was their top challenge. By comparison, only 42 percent of respondents cited "state regulations" as the most significant burden facing the industry, and only 39 percent cited the "influence of the illicit market."

Federal laws and regulations strongly discourage banks and other financial institutions from partnering with licensed cannabis companies because marijuana is classified as a Schedule I controlled substance. On five separate occasions, US House lawmakers have passed legislation, The SAFE Banking Act, to amend federal banking laws, but Senate leadership has refused to ever debate the issue.

According to the Whitney Economics survey, fewer than half of respondents (42 percent) are currently making a profit and only 40 percent believe that "the industry is heading in the right direction."

Full text of the Whitney Economics report, "US Cannabis Business Conditions Survey Report," is available for download.

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Study: Medical Cannabis Treatment Reduces Daily Morphine Intake in Chronic Pain Patients

Pittsburgh, PA: The use of cannabis products is associated with a reduction in pain patients' daily consumption of opioids, according to data published in the journal Pain Physician.

A team of investigators affiliated with the Institute for Pain Medicine in Pennsylvania assessed opioid use trends in a cohort of 115 chronic pain patients who initiated medical cannabis therapy. Patients in the study suffered from intractable pain and had consumed opioids for a period of at least six-months. The majority of the study's participants were between 50 and 70 years of age.

Consistent with other studies, authors reported that patients reduced their daily morphine milligram equivalent (MME) intake after initiating cannabis therapy.

"There was a 67.1 percent average decrease in daily MME/patient from 49.9 to 16.4 MME at the first follow-up," they reported. "There was a 73.3 percent decrease in MME at the second follow-up from 49.9 to 13.3 MME."

Authors concluded: "The current study's approach has led to a significant decrement in chronic opioid use for the majority of patients with chronic pain deciding to trial medical cannabis in our clinical setting. ... Therefore, we present medical cannabis as an alternative, potentially effective, class of treatment."

Full text of the study, "Medical cannabis used as an alternative treatment for chronic pain demonstrates reduction in chronic opioid use - A prospective study," appears in Pain Physician.

Poll: Most Voters Lack Confidence that President Will Follow Through on Marijuana-Specific Campaign Pledges

Washington, DC: Most voters doubt that President Joe Biden will follow through on his campaign promises to reform federal marijuana laws, according to the results of a recently released Economist/YouGov poll.

On the campaign trail, Biden insisted, "No one should be in jail because of marijuana." He pledged, "As President, [I] will decriminalize cannabis use and automatically expunge prior convictions." Thus far, however, the White House has made almost no mention of the issue.

That fact has not gone unnoticed by voters. Fifty-six percent of those polled agreed that the President has made little or no progress on the issue, while 23 percent were unsure. Looking forward, an even greater majority said that they did not expect the President to take any substantive action on the issue in 2022.

Although the President cannot repeal the federal prohibition of marijuana by executive order, he can take steps unilaterally to follow through on several of his campaign promises – such as granting amnesty to those with federal convictions for certain marijuana-related crimes.

NORML has previously urged the White House to issue pardons for those convicted of nonviolent marijuana offenses, as have several members of Congress.

"President Biden was crystal clear on the campaign trail that his administration would prioritize criminal justice reform, and he explicitly highlighted his desire to expunge the records of those suffering from the stigma of a federal marijuana conviction," NORML's Executive Director Erik Altieri said. "Following through on this campaign promise would be an important first step in remedying the past wrongs associated with nearly a century of marijuana prohibition and healing the wounds of the many Americans who have needlessly suffered under this failed public policy. In 2022, it is readily apparent that the criminalization of cannabis, and the lifelong lost opportunities that come with a criminal marijuana conviction, causes far greater harm than the responsible use of cannabis itself."

Clinical Trial: Cannabis-Infused Eye Drops Effectively Treat Rare Form of Dystonia

Tel Aviv, Israel: The administration of cannabis-infused eye drops reduces spasms in patients diagnosed with the progressive neurological disorder benign essential blepharospasm (BEB), according to placebo-controlled data published in the journal Graefe's Archive for Clinical and Experimental Ophthalmology. BEB is a rare type of dystonia that is characterized by the abnormal blinking or spasming of the eyelids.

A team of Israeli researchers compared cannabis-infused eye drops versus placebo in patients with BEB over a period of several weeks. Cannabis treatments were associated with significant reductions in the both the frequency and duration of patients' spasms.

Authors concluded, "Medical cannabis can be an effective and safe treatment for BEB as a second line after BTX-A injections when used for three months. No significant ocular or systemic side effects was associated with the treatment."

Full text of the study, "Medical cannabis oil for benign essential blepharospasm: A prospective, randomized controlled pilot study," appears in Graefe's Archive for Clinical and Experimental Ophthalmology.

Longitudinal Study: Cannabis' Impact on Lung Health Distinct from Tobacco

Dunedin, New Zealand: Smoking cannabis long-term is not associated with the same physiological consequences on lung health as is tobacco smoking, according to longitudinal data published in the American Journal of Respiratory and Critical Care Medicine.

A team of New Zealand researchers examined the long-term effects of cannabis smoking and/or tobacco smoking in a cohort of 881 middle-aged adults.

Consistent with prior studies, researchers reported that cannabis inhalation was associated with higher total lung capacity and other physiological changes that are distinct from the health consequences associated with tobacco smoking. Authors concluded, "[I]t is increasingly clear that cannabis has different effects on lung function [as compared] to tobacco and the effects of widespread cannabis use will not necessarily mirror the harms caused by tobacco smoking."

The findings are consistent with prior research concluding that cannabis smoke and tobacco smoke are not equally carcinogenic, that cannabis inhalation exposes consumers to fewer toxicants than does tobacco smoking, and that marijuana smoke exposure is typically not associated with the same health consequences as is tobacco smoking, including increased risks of COPD or lung cancer. Moreover, the use of vaporization technology, which heats herbal cannabis to a set temperature below the point of combustion, is associated with reduced exposure to toxic gasses and has been identified as a "safe and effective" cannabis delivery device in clinical trials.

Full text of the study, "Differential effects of cannabis and tobacco on lung function in mid-adult life," appears in theAmerican Journal of Respiratory and Critical Care Medicine.

New Hampshire: Supreme Courts Rules in Favor of Employment Protections for Medical Cannabis Patients

Concord, NH: Businesses are not permitted to terminate employees solely because of their off-the-job use of medical marijuana, according to a decision rendered by the state's Supreme Court.

Justices determined that those who participate in the state's medical cannabis access program qualify under the law as "individuals with a disability" and therefore employers must make "reasonable accommodations" for them. Justices ruled that providing the defendant with an exception to a company's marijuana drug testing policy was a reasonable accommodation. "We agree with the plaintiff that (the state anti-discrimination law) does not contain any language categorically excluding the use of therapeutic cannabis as an accommodation," justices ruled in an unanimous opinion.

Unlike the medical cannabis access laws of over a dozen states, New Hampshire's law does not explicitly protect qualified patients from workplace discrimination.

Henry Klementowicz, a senior staff attorney for the New Hampshire state affiliate of the American Civil Liberties Union said, "This Supreme Court ruling is a victory for the over ten thousand Granite Staters enrolled in the state's medical cannabis program who were at were at risk of experiencing employment discrimination due to their disability."

The case is Paine v. Ride-Away, Inc.

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Analysis: Liberalization of European Cannabis Policies Not Linked to Increased Marijuana Use by Young People

Stockholm, Sweden: More permissive marijuana policies are not associated with upticks in cannabis use among young people, according to data published in the journal PLoS One.

Swedish researchers assessed trends in the use of marijuana by adolescents and younger adults in 11 European countries over a 23-year period (1994-2017). During that time, several nations liberalized their marijuana laws while others made no changes.

Investigators reported that young people's use of cannabis either remained stable or increased in countries that failed to amend their marijuana laws. By contrast, teen use decreased in jurisdictions that liberalized their policies.

"This comprehensive re-analysis of all available data from EMCDDA [the European Monitoring Centre for Drugs and Drug Addiction] does not corroborate an impact of changes in cannabis legislation on cannabis use among young people in Europe," authors reported. "Overall, since the 1990's, self-reported use appeared to increase among countries without any policy changes but decrease after both decriminalization and depenalization of cannabis-related crimes."

The findings are similar to those from the United States showing decreasing rates of marijuana use by adolescents in jurisdictions that have legalized the adult-use cannabis marketplace.

The study's authors concluded, "There is no evidence as of date, considering available data and previous publications, that policy changes regarding recreational cannabis significantly affect the prevalence of recreational cannabis use among young people in Europe."

Full text of the study, "Changes in cannabis policy and prevalence of recreational cannabis use among adolescents and young adults in Europe: An interrupted time-series analysis," appears in PLoS One.

Survey: More Than One in Four North Americans Self-Report Having Used Cannabis for Medical Purposes

Waterloo, Canada: More than one in four North Americans acknowledge having used cannabis for medical purposes, according to survey data published in the journal Psychopharmacology.

An international team of researchers from Australia and Canada assessed the prevalence of self-reported medical cannabis use among a population-based cohort of more than 27,000 respondents from the United States and Canada. Participants in the study were between the ages of 16 and 65. Fifty-eight percent of subjects reported having had some prior experience with marijuana.

Just over 27 percent of all respondents reported having consumed cannabis for medical purposes. Those who did so were most likely to report having used cannabis to manage pain (53 percent), to reduce anxiety (52 percent), or to improve sleep (46 percent) - a finding that is consistent with other studies. Subjects were also likely to report using cannabis to offset symptoms of post-traumatic stress, migraine, and depression. Self-reported medical use was higher in jurisdictions where such access is permitted as compared to places where its use remains illegal.

Authors concluded: "A substantial proportion of the North American population self-reported cannabis use for medical purposes for a variety of medical reasons, including those living in jurisdictions without legal markets. ... Our findings have implications for how cannabis use is being used by the population, which may include authorized use with prescription by a health professional, and also self-defined medical use without professional guidance. ... Further research is needed to understand the safety and efficacy of these forms of medical cannabis use."

Full text of the study, "Prevalence of self-reported reasons of cannabis use for medical purposes in USA and Canada," appears in Psychopharmacology.

Cannabinoid Acids Exhibit Anti-COVID Activity in Preclinical Models

Corvallis, OR: Cannabigerolic acid (CBGA) and cannabidiolic acid (CBDA) exhibit anti-COVID activity in culture, according to data published in the Journal of Natural Products.

Researchers with the University of Oregon reported that both cannabinoids inhibited the entry of SARS-CoV-2 into human epithelial cells. Authors reported that the cannabinoid acids showed equal efficacy against multiple COVID variants.

Both compounds are abundant organically in raw hemp plants and in certain hemp extracts.

By contrast, activated compounds such as THC and CBD failed to show efficacy in the models.

Authors concluded, "Orally bioavailable and with a long history of safe human use, these cannabinoids, isolated or in hemp extracts, have the potential to prevent as well as treat infection by SARS-CoV-2."

Prior preclinical studies and reviews have similarly suggested that certain cannabis compounds could potentially modulate COVID infections. However, to date, no human studies 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. An observational study published in October reported an association between problematic cannabis use and an increased risk of COVID breakthrough infections.

Since the start of the COVID pandemic, the US Food and Drug Administration has sent numerous warning letters to companies for misrepresenting their CBD products as a COVID treatment options for patients. NORML has repeatedly cautioned consumers to beware of online misinformation surrounding the commercial marketing of either whole-plant cannabis or CBD as potential remedies for the COVID-19 virus.

Full text of the study, "Cannabinoids block cellular entry of SARS-CoV-2 and the emerging variants," appears in theJournal of natural Products.

Study: Alcohol, Not Cannabis, Associated with Violent Behaviors in Psychotic Patients

Montreal, Canada: The consumption of alcohol, but not cannabis, is associated with an increased likelihood of impulsiveness and violent behavior among subjects with schizophrenic spectrum disorders, according to data published in the Journal of Clinical Psychopharmacology.

A team of Canadian and Italian investigators assessed the relationship between the use of alcohol and cannabis on psychotic, impulsive, and violent behavior in a cohort of subjects diagnosed with either schizophrenia or other psychotic disorders. All of the subjects in the cohort possessed a history of violent behavior.

Researchers reported: "Cannabis use disorder was neither associated with impulsive behavior nor with violent behavior." By contrast, they determined that "alcohol use disorder was positively associated with increased levels of impulsivity, in particular impulsive and thoughtless behavior. ... [A]lcohol use disorder was [also] significantly associated with violence."

They concluded, "In summary, our findings indicate that lifetime cannabis use disorder is frequent among patients with psychotic disorders but is not associated with violent and impulsive behaviors."

Previous studies have identified elevated levels of cannabis use among subjects with certain psychiatric disorders, some of whom may be seeking to self-medicate with it.

Full text of the study, "Cannabis use disorder is not associated with lifetime impulsive behavior and severe violence in patients with schizophrenia spectrum disorders from a high-security hospital," appears in theJournal of Clinical Psychopharmacology.

Canada: Growing Percentage of Cannabis Consumers Transitioning to the Licit Marketplace

Waterloo, Canada: A growing number of Canadians who consume cannabis are obtaining it from the legal marketplace, according to data published in the journal Drug and Alcohol Dependence.

Investigators affiliated with the University of Waterloo, School of Public Health Sciences surveyed nearly 5,000 Canadian adults who acknowledged having purchased cannabis flowers within the past year.

Researchers reported that the percentage of consumers switching from the illicit market to the licit market increased from 2019 to 2020 and that the majority of respondents (58 percent) now acknowledge obtaining cannabis flowers from licensed retailers. The study's authors attributed these changes in behavior to increases in retail availability and falling prices for cannabis products available in the legal marketplace.

The findings are consistent with those of a 2021 study published in the journal Health Reports which found that nearly 70 percent of cannabis consumers reported obtaining cannabis from a legal source, up from 47 percent in 2019.

Canada initially legalized the retail sale of cannabis in October 2018.

Full text of the study, "Cannabis flower prices and transitions to legal sources after legalization in Canada, 2019-2020," appears in Drug and Alcohol Dependence.

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Analysis: Adult-Use Marijuana Sales Yield Over $10 Billion in New Tax Revenue

Washington, DC: State-authorized sales of retail marijuana products have yielded more than $10 billion in new tax revenue, according to an analysis compiled by the Marijuana Policy Project.

"Legalizing cannabis for adults has been a wise investment," authors of the report concluded. "Since 2014 when sales began in Colorado and Washington, legalization policies have provided states a new revenue stream to bolster budgets and fund important services and programs. As of December 2021, states reported a combined total of $10.4 billion in tax revenue from legal, adult-use cannabis sales. In addition to revenue generated for statewide budgets, cities and towns have also generated hundreds of thousands of dollars in new revenue from local adult-use cannabis taxes."

These revenues have been used to fund various state-specific projects, MPP's analysis reported. In Colorado, for instance, over $470 million in cannabis-specific tax revenue has been applied toward public schools. In Washington, some $600 million in revenue has been directed toward public health initiatives, including a fund that provides health insurance to low-income families. In California, over $100 million in revenue has been provided to community investment programs and local nonprofit groups.

In every state permitting adult-use sales, marijuana tax revenues have grown year-over-year.

Full text of the report, "Cannabis Tax Revenue in States that Regulate Cannabis for Adult Use," is available online.

 

Survey: Many Health Care Professionals Possess a "Poor" Understanding of Cannabis Use for Medical Purposes

Portland, OR: A significant percentage of health care practitioners possess only limited knowledge about the use and efficacy of medical cannabis, according to survey data published in the Journal of the American Association of Nurse Practitioners.

A team of investigators affiliated with the Oregon Health & Science University surveyed 178 health care professionals (physicians, registered nurses, and nurse practitioners) attending a Continuing Medical Education program on the clinical uses of cannabis. Nearly all of the health professionals surveyed were licensed to practice in either California, Oregon, or Washington – three jurisdictions where medical cannabis access has been legally available for more than two decades.

Researchers reported: "This study found that HCPs' [health care professionals] knowledge about the medical risks and benefits of clinical cannabis, although similar among professions, is generally poor and has specific important gaps. Health care professionals scored an average of only 63.2 percent on direct knowledge tests about clinical cannabis, with no significant differences among professions. Attendees scored highest on questions about laws and regulations (85.7 percent). Mean scores for questions related to all other topics, including risks and harms, pharmacology, pain, multiple sclerosis spasticity, and seizures, were all below 70 percent, equivalent to a C grade."

They added, "Despite more than 95 percent of respondents practicing in states (Oregon, Washington, or California) where clinical cannabis had been legal for more than 20 years and recreational cannabis had been legal for at least two years, their knowledge about clinical cannabis was poor. This supports that wide and prolonged availability of cannabis is not sufficient to accomplish provider knowledge and that more education is needed."

Authors concluded, "The findings of this study support that, despite a growing evidence base, and even after many years of legalization, HCPs including APRNs [advance practice registered nurses] have substantial gaps in their knowledge of the potential risks and benefits associated with the use of cannabis for medical purposes."

The study's conclusions are consistent with those of prior surveys of health care professionals in which most doctors and nurses acknowledge that they are insufficiently trained in issues related to the use of cannabis. Separate survey data published in 2020 also reported that fewer than one-in-five patients believe that their primary care providers are sufficiently knowledgeable about cannabis-specific health-related issues.

Full text of the study, "Cannabis for medical purposes: A cross-sectional analysis of health care professionals' knowledge," appears in the Journal of the American Association of Nurse Practitioners.

 

Analysis: Frequent Cannabis Use Associated with Lower Incidences of Diabetes Among Women

College Station, TX: Women who frequently consume cannabis are less likely to be diagnosed with diabetes mellitus, according to data published in the journal Cannabis and Cannabinoid Research.

Researchers at Texas A&M University assessed the relationship between cannabis use and diabetes in a nationally representative sample of over 15,000 adults.

They reported that women who were frequent cannabis consumers were less than half as likely to be diagnosed with diabetes as compared to female non-users. No differences were observed among women who only consumed cannabis occasionally.

Researchers did not identify a similar inverse relationship among males. They concluded, "Further studies are needed to explore the sex-based heterogeneity-and individual and contextual factors responsible-in the association between cannabis use and diabetes mellitus."

Several previous studies have identified a correlation between frequent cannabis use and lower odds of adult-onset diabetes, while clinical trial data has shown that the administration of THCV is associated with improved glycemic control in type 2 diabetics.

Full text of the study, "Sex differences in the association between cannabis use and diabetes mellitus among US adults: The National Health and Nutritional Examination Survey, 2013-2018," appears in Cannabis and Cannabinoid Research.

 

Study: Labeling of Commercially Available CBD Products Often Inaccurate

Madison, WI: Commercially available CBD-infused products typically contain percentages of cannabidiol that differ significantly from the information provided on their labels, according to data published in the journal Epilepsy & Behavior.

A team of investigators affiliated with the University of Wisconsin, School of Pharmacy performed laboratory analyses on a variety of commercially available CBD products, including infused oils, beverages, and edibles.

Consistent with numerous other analyses of unregulated, commercially available CBD-branded products, investigators reported that the percentage of CBD available in many of the products tested "varies largely from their label claims." CBD-infused beverage products were most likely to contain CBD percentages that differed from their labels.

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. Speaking in October at the National Industrial Hemp Business Summit in Washington, DC, FDA representative Gail Sipes said that the agency cannot move forward with regulations without more data on the safety of CBD products. At that time, she reiterated the agency's position that companies that market CBD-infused products as either food products or as dietary supplements are violating the Food, Drugs, and Cosmetics Act.

In a report provided by the FDA to Congress in 2020, the agency said that regulating over-the-counter CBD products presents a unique challenge because the substance is already available as a FDA-approved medicine (Epidiolex).

NORML and other groups have consistently urged the FDA to provide regulatory guidelines overseeing the production, testing, labeling, and marketing of hemp-derived CBD products.

Full text of the study, "Analysis of cannabidiol (CBD) and THC in nonprescription consumer products: Implications for patients and practitioners," appears inEpilepsy & Behavior.

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Analysis: Public Interest in Delta-8 Products Rising in States Where Cannabis Remains Criminalized

San Diego, CA: The popularity of unregulated products containing delta-8 THC is far greater in states where cannabis is illegal than it is in jurisdictions where it has been legalized, according to an analysis published in The International Journal of Drug Policy.

Researchers at the University of California, San Diego analyzed Internet users' interest in delta-8 THC products in all 50 states. They found that online searches for delta-8 THC products grew significantly in the years 2019 and 2020 and that public interest "was particularly high in US states that restricted delta-9 THC use."

Although delta-8 THC occurs organically in the cannabis plant, it is only produced in nominal quantities. By contrast, the elevated quantities of delta-8 THC found in grey market products are the result of a chemical synthesis during which manufacturers convert hemp-derived CBD to delta-8 THC. Manufacturers engaged in synthesizing delta-8 THC are not regulated and often use potentially dangerous household products to facilitate this process. Lab analyses of unregulated delta-8 products have consistently found them to contain lower levels of the compound than advertised on the products' labels. Some products have also been found to possess heavy metal contaminants and unlabeled cutting agents.

In October, NORML issued a report on delta-8 THC and other novel, synthetically derived cannabinoids that cautioned consumers to avoid these unregulated products because they are untested and may contain impurities.

According to survey results published in The Journal of Cannabis Research, consumers of delta-8 THC products typically use them for relaxation and pain management. Consumers often report the effects of these products to be less potent than those of whole-plant cannabis and of a shorter duration.

Full text of the study, "Public interest in delta-8 THC increased in US states that restricted delta-9 THC use," appears in The International Journal of Drug Policy. Full text of the study - "Delta-8-THC: Delta-9-THC's nicer younger sibling?" - appears in The Journal of Cannabis Research.

Review: Minor Cannabinoids Acknowledged to Possess Therapeutic Properties

Columbia, South Carolina: Numerous minor cannabinoids found in the cannabis plant possess therapeutic properties that may hold clinical significance, according to a review paper published in the journal Frontiers of Pharmacology.

A team of US investigators affiliated with the University of South Carolina and Doane University in Nebraska summarized data on the potential therapeutic applications of a number of secondary cannabinoids, including CBN (cannabinol), CBC (cannabichromine), cannabigerol (CBG), and tetrahydrocannabivarin (THCV). Most of the research available on these compounds has thus far been limited to preclinical studies.

Specifically, authors highlighted the analgesic and anti-inflammatory properties of various ancillary cannabinoids, including CBG, CBC, THCV, and CBN.

They acknowledged that CBN also "shows promise as an antibacterial agent and [as] an appetite stimulant," but cautioned that it has shown inconsistent results as a sleep aid.

Several of these minor cannabinoids, such as CBG and CBC, also possess anti-cancer properties, while THCV "regulates blood glucose levels, suggesting it might be useful in weight reduction and treating diabetes." THCV has also demonstrated anti-epileptic and neuroprotective properties.

Another cannabinoid highlighted by the authors, cannabidivarin (CBDV) possesses anti-seizure activity and may possess therapeutic utility in the treatment of autism, muscular dystrophy, and as an anti-emetic agent.

A number of these minor cannabinoids have "also shown promise in the treatment of skin disorders," investigators reported.

Authors also highlighted the promise of various cannabinoid acids (e.g., CBDA, CBGA, and THCA). Specifically, they acknowledged that CBGA "may play a role in controlling diabetes mellitus and preventing the cardiovascular complications that can accompany Type 2 diabetes," whereas THCA has been shown to mitigate liver fibrosis in animals.

"Minor cannabinoids and their chemical homologs offer the potential medicinal benefits of D9-THC without adverse effects," authors concluded. "Future studies will need to evaluate the risk versus benefit of these and other minor cannabinoids when compared to D9-THC and traditional analgesic drugs."

Full text of the study, "Minor cannabinoids: Biosynthesis, molecular pharmacology and potential therapeutic uses," appears inFrontiers of Pharmacology.

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Analysis: Changes in Marijuana Laws Not Associated with Increased Traffic Fatalities

Lakeland, FL: Neither the enactment of medical cannabis access laws or adult-use legalization laws are associated with any significant upticks in motor vehicle traffic fatalities, according to data published in the journal The Review of Regional Studies.

A team of researchers affiliated with Florida Polytechnic University examined the relationship between traffic fatalities and statewide policies legalizing marijuana access over a 35-year period (1985 to 2019).

Researchers identified no significant changes in trends in fatal motor vehicle crashes following the enactment of adult-use marijuana laws, and they reported a decrease in fatal traffic accidents following the passage of statewide medical cannabis access laws.

Authors wrote: "We find lower state traffic fatalities following the implementation of MMLs [medical marijuana laws], consistent with earlier work. This is true whether we employ a simple MML indicator or a continuous indicator of the permissiveness of state medical marijuana laws. ... Controlling for prior MMLs, we find no evidence of a statistically significant association between RMLs [recreational marijuana laws] and traffic fatalities. Further, we find no evidence of an association between traffic fatalities and cross-border recreational legalization."

They concluded, "Liberalization [of marijuana policies] may eventually be shown to lead to more fatalities, at least under some sets of circumstances, as more and different states legalize recreational use and more data accrues. However, as of 2019, we find liberalization has been associated with lower traffic fatalities, not higher."

Previous analyses have consistently reported no changes in traffic safety following the enactment of medical cannabis liberalization laws. Data trends have been less consistent following the imposition of statewide adult-use legalization laws, with some jurisdictions showing minor changes over time and others showing no changes.

Full text of the study, "State marijuana laws and traffic fatalities," appears in The Review of Regional Studies.

Study: Use of CBD-Dominant Cannabis Associated with Reduced Prescription Drug Use Among Some Older Adults

Toronto, Canada: Between 20 percent and one-third of older adults who consume CBD-dominant cannabis products for medical purposes reduce their use of prescription opioids and benzodiazepines, according to data published in the journal Drugs & Aging.

A team of Canadian researchers assessed marijuana consumption patterns in a cohort of nearly 10,000 patients ages 65 and older over a six-year period. All of the study's subjects possessed a valid prescription from a Canadian doctor to access medical cannabis products at a licensed retail dispensary. Medical marijuana products have been legal in Canada by prescription for several decades.

Subjects consumed either herbal cannabis flowers or oil extracts - with the majority of participants consuming extracts. Most subjects consumed products containing high percentages of CBD.

Consistent with prior studies, a portion of patients reported reducing their use of prescription medications following their initiation of cannabis products. Specifically, researchers reported that 36 percent of respondents decreased their use of opioids, while 20 percent reduced their use of benzodiazepines.

Also similar to other studies, subjects frequently reported that the use of medical cannabis products was associated with reduced pain, better sleep, and improvements in mood.

In recent years, self-reported marijuana use by seniors has increased dramatically in both the United States and Canada. Several surveys report that seniors' use of cannabis products is associated with improvements in their overall quality of life.

Full text of the study, "Medical use among older adults in Canada: Self-reported data on types and amount used, and perceived effects," appears in Drugs & Aging.

Pennsylvania: Supreme Court Rules Marijuana Odor Is Insufficient Grounds for a Warrantless Search

Harrisburg, PA: Police officers may not engage in the warrantless search of a vehicle based solely upon the smell of marijuana, according to a determination by the state's Supreme Court.

The majority ruled that law enforcement cannot infer criminal activity from the odor of marijuana because medical cannabis can legally be possessed by authorized patients under state law.

"We conclude that the MMA [Medical Marijuana Act] makes abundantly clear that marijuana no longer is per se illegal in this Commonwealth," the majority opined. "Accordingly, the enactment of the MMA eliminated this main pillar supporting the 'plain smell' doctrine as applied to the possession or use of marijuana. Indeed, so long as a patient complies with the dictates of the MMA, that person can legally possess and consume various forms of medical marijuana, including the plant itself. Accordingly, the smell of marijuana alone cannot create probable cause to justify a search under the state and federal constitutions."

The court concluded, "We hold that the odor of marijuana alone does not amount to probable cause to conduct a warrantless search of a vehicle but, rather, may be considered as a factor in examining the totality of the circumstances."

A growing number of states, including Delaware, Maryland, and Virginia, similarly limit police from conducting either warrantless searches or arrests based solely upon the odor of cannabis.

The case is Commonwealth of Pennsylvania v. Barr.

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Government-Funded Survey Shows Unprecedented Decline in Marijuana Use by Young People

Ann Arbor, MI: Data provided by the University of Michigan's annual Monitoring the Future survey shows an unprecedented year-over-year decline in young people's self-reported use of marijuana and other controlled substances.

Authors reported, "The percentage of students who reported using marijuana (in all forms, including smoking and vaping) within the past year decreased significantly for eighth, 10th, and 12th grade students."

Specifically, the data identified a 38 percent year-over-year reduction in self-reported marijuana use among eighth graders, a 38 percent decline among 10th graders, and a 13 percent decrease among 12th graders.

"We have never seen such dramatic decreases in drug use among teens in just a one-year period," said Nora Volkow, Director of the US National Institute on Drug Abuse, which funded the study. "These data are unprecedented and highlight one unexpected potential consequence of the COVID-19 pandemic, which caused seismic shifts in the day-to-day lives of adolescents."

In September, Dr. Volkow publicly acknowledged that the enactment of statewide laws regulating the adult-use cannabis market has not led to an increase in the percentage of young people experimenting with the substance.

The MTF findings come just months after the US National Institutes of Health released similar conclusions. That study also reported dramatic year-over-year decreases in cannabis use by those ages 12 to 17.

NORML's Deputy Director Paul Armentano said, "These latest findings add to the growing body of scientific literature showing that marijuana regulation policies can be implemented in a manner that provides access for adults while simultaneously limiting youth access and misuse."

The Monitoring the Future findings are consistent with numerous other studies - such as those here, here, here, and here - concluding that statewide marijuana legalization policies are not associated with any significant rise in either the use of marijuana by young people or in their ability to access it.

Study: CBD-Dominant Extracts Associated with Behavioral Improvements in Children with Autism

Istanbul, Turkey: The long-term use of cannabis extracts containing high percentages of CBD and low percentages of THC is associated with reduced symptoms in adolescent patients with autism spectrum disorder (ASD), according to data published the Journal of Cannabis Research.

Turkish investigators reported on the use of CBD-dominant extracts in a cohort of 33 adolescent subjects diagnosed with mild-to-severe autism. Authors reported: "[M]ain improvements of the treatment were as follows: a decrease in behavioral problems was reported in 10 patients (32.2 percent), an increase in expressive language was reported in 7 patients (22.5 percent), improved cognition was reported in 4 patients (12.9 percent), an increase in social interaction was reported in 3 patients (9.6 percent), and a decrease in stereotypes was reported in 1 patient (3.2 percent). The parents reported improvement in cognition in patients who adhered to CBD-enriched cannabis treatment for over two years."

Six patients reported no significant improvements in behavior.

Compared to conventional treatments, cannabis extracts were not associated with any significant side effects.

Authors concluded, "Using lower doses of CBD and trace THC seems to be promising in managing behavioral problems associated with autism."

The study's findings are consistent with those of several other small trials similarly finding improvements in patients' ASD symptoms following the use of cannabinoid products. Survey data published in October 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, "CBD-enriched cannabis for autism spectrum disorder: An experience of a single center in Turkey and reviews of the literature," appears in the Journal of Cannabis Research.

Survey: Over 70 Percent of US Physicians Believe Cannabis Has Medical Value

Orlando, FL: A supermajority of practicing US physicians believe that cannabis possesses medical value, according to survey data published in the journal Cureus.

A pair of researchers anonymously surveyed 539 US physicians attending the 2018 American College of Emergency Physicians' Annual Conference. The conference is the largest gathering of emergency medicine physicians in the country.

Seventy-one percent of survey respondents "believed that cannabis has medical value."

The survey's finding is consistent with that of another recent poll, compiled by the US Centers for Disease Control, which reported that 69 percent of US clinicians believe that cannabis possesses medical utility. The CDC survey also acknowledged that over 25 percent of physicians have recommended medical cannabis treatment to their patients.

Commenting on the findings, NORML's Deputy Director Paul Armentano said: "Overwhelming majorities of patients and their providers acknowledge that cannabis is medicine. Politicians should not be standing in their way by opposing efforts to permit medical professionals from recommending cannabis to their patients in instances where they believe it is therapeutically appropriate."

Full text of the study, "Emergency room physicians would prefer using cannabis over opioids for first-line treatment of a medical condition if provided with medical evidence: A national survey," appears in Cureus.

Case Series: Whole-Plant Cannabis Extracts Effective in Pediatric Patients with Intractable Epilepsy

London, United Kingdom: The use of whole-plant cannabis extracts of varying potencies is effective in reducing seizure frequency in pediatric patients with intractable epilepsy, according to a case series published in the journal BMJ Paediatrics Open.

A team of British researchers assessed seizure frequency data on 10 children, including two participants who had failed to respond to treatment with Epidiolex. Epidiolex, which contains plant-derived CBD, is approved in both the United Kingdom and in America as a prescription treatment for rare forms of childhood epilepsy.

Study participants were treated with a variety of whole-plant medical cannabis oils, including those dominant in THC and in CBD. Individual dosing regimens were determined by the children's clinicians.

Researchers reported: "Seizure frequency across all ten participants reduced by 86 percent with no significant adverse events. Participants reduced use of antiepileptic drugs from an average of seven to one following treatment with medical cannabis."

They concluded: "This study shows the effectiveness of whole-plant medical cannabis in a group of patients suffering with severe intractable childhood-onset epilepsies. The reduction in monthly seizure frequency in our group demonstrates the feasibility for this medication in such patients. ... Moreover, our data suggest that whole-plant medical cannabis products are superior to isolated CBD products in the patients examined. ... We believe that our data on whole-plant medical cannabis in childhood-onset severe treatment-resistant epilepsy, provides evidence to support its introduction into the NHS [National Health Service] within current NICE [National Institute for Clinical and Healthcare Excellence] prescribing guidelines."

Full text of the study, "Medical cannabis for severe treatment-resistant epilepsy in children: A case series of 10 patients," appears in BMJ Paediatrics Open.

NORML Files Amicus Brief in Case Asking SCOTUS to Rule on Whether Medical Cannabis Costs Can Be Reimbursed by Employers

New York, NY: Lawyers are petitioning the Supreme Court to rule on the issue of whether employees can be reimbursed for their medical marijuana-related costs through their workers' compensation insurance plans following divergent rulings from various state supreme courts.

A friend-of-the-court (amicus) brief filed on behalf of Empire State NORML and two other groups - the New York City Cannabis Industry Association and the Hudson Valley Cannabis Industry - is urging justices to take the case and to use it as an opportunity to settle broader conflicts between state and federal marijuana laws. The brief reads, "Upholding the supremacy of the designation of cannabis under the CSA [Controlled Substances Act] is futile when the coordinate branches of government have affirmatively promoted and protected state medical cannabis programs. ... [T]he doctrine of estoppel is needed to end the nullification crisis and to protect those who relied on the guidance of federal officials and agencies and engaged in the cannabis industry despite federal illegality."

David C. Holland, Esq, the Executive and Legal Director of Empire State NORML and author of the brief said: "The United States Supreme Court needs to step in and hear this case to resolve not only the split amongst state supreme courts regarding medical cannabis reimbursement laws, but also whether the Schedule I classification of cannabis under the federal Controlled Substances Act is still enforceable in light of the 25 years of flourishing medical programs in [the majority of] states. Refusing to hear the case not only prolongs that uncertainty, but also provides no definitive answer to the issue of preemption of state medical marijuana laws as a result of that continued Schedule I status."

In the case in question, Musta v. Mendota Heights Dental Center and Hartford Insurance Group, the Minnesota Supreme Court held that employees are ineligible for reimbursement because cannabis remains classified as a Schedule I controlled substance under federal law. That determination is inconsistent with a separate ruling issued this year by the New Jersey Supreme Court which held that the use of cannabis is eligible for reimbursement under the states' workers' compensation laws because both state and federal marijuana laws can "coexist."

Currently, five states — Connecticut, New Hampshire, New Jersey, New Mexico, and New York - explicitly allow for employees to have their medical cannabis expenses reimbursed. By contrast, seven states expressly prohibit workers' compensation insurance from reimbursing medical marijuana-related costs: Maine, Massachusetts, Minnesota, Florida, North Dakota, Ohio, and Washington.

In all other jurisdictions, the law is either silent on the issue or states that insurers are "not required" to reimburse employees who are injured on the job for the costs related to their use of medical cannabis.

Study: Inhaled CBD Limits Tumor Growth in Animal Model

Augusta, GA: The inhalation of CBD provides anti-cancer activity in animals with glioblastoma, a highly aggressive form of brain cancer.

A team of investigators affiliated with Augusta University in Georgia and with the Georgia Cancer Center assessed the effects of inhaled CBD on GBM (glioblastoma) tumor growth in mice.

Authors reported that CBD administration limited tumor growth and also altered several other factors necessary for tumor progression.

They concluded, "Overall, our novel findings support the possible therapeutic role of inhaled CBD as an effective, relatively safe, and easy to administer treatment adjunct for GBM with significant impacts on the cellular and molecular signaling of TME [tumor microenvironment] warranting further research."

Although several previous preclinical trials have similarly associated anti-tumor growth activity with cannabinoids, this is the first study to assess inhalation as an effective mode of administration in an animal model of cancer.

Limited human data has identified an association between the administration of plant-derived cannabinoid extracts and improvements in quality of life and survival rates in glioma patients.

Full text of the study, "Inhalant cannabidiol inhibits glioblastoma progression through regulation of tumor microenvironment," appears in the journal Cannabis and Cannabinoid Research.

Study: CBD Not Associated with Liver Abnormalities in Healthy Volunteers

Los Angeles, CA: The repeated use of oral CBD products is not associated with liver abnormalities, including the elevated production of certain liver enzymes, according to observational data published in the journal Cannabis and Cannabinoid Research.

A team of researchers affiliated with the University of Buffalo and the University of California at Los Angeles assessed the effect of oral CBD products on liver function in a cohort of nearly 1,500 healthy volunteers. Subjects consumed the products for a minimum of 30 days.

Lab testing failed to identify any association between the use of CBD products and liver abnormalities. Specifically, authors identified "no relationship between continuing to take CBD, daily dose of CBD and ALT [alanine transaminase - an enzyme found mostly in the liver] levels or change in ALT elevation severity." Elevated amounts of ALT in the blood can indicate liver disease.

Prior studies assessing the influence of CBD on the liver have yielded inconsistent results. While some studies have theorized that CBD products may adversely impact the liver's ability to effectively metabolize certain prescription medications, others have reported few if any changes on liver function. Other studies have identified an inverse association between cannabis use and certain liver diseases, including cirrhosis and fibrosis.

Full text of the study, "Observed impact of long-term consumption of oral cannabidiol on liver function in healthy adults," appears in the journal "Cannabis and Cannabinoid Research."

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Analysis: Jurisdictions Permitting Adult-Use Retail Facilities Experience Employment Growth

Albuquerque, NM: Local jurisdictions that permit licensed marijuana operations experience job growth at higher rates than do localities that prohibit them, according to data published in the IZA Journal of Labor Economics.

A team of economists affiliated with the University of New Mexico and with California Polytech State University compared county-level economic data in Colorado between the years 2011 and 2018. They reported that unemployment fell in counties where dispensaries opened relative to counties in which they did not.

Authors reported, "[W]e find consistent evidence of a decrease in unemployment and increases in the number of employees in manufacturing."

They concluded: "Overall, the findings in this paper provide evidence that recreational cannabis dispensaries improved county-level labor market conditions in Colorado. ... Our results suggest that policymakers considering recreational access to cannabis should consider employment effects as a potential outcome from recreational cannabis legalization."

Separate studies have previously reported that marijuana retailers are positively associated with rising property values and reductions in certain types of localized criminal activities, such as larceny.

NORML's Deputy Director Paul Armentano said that the data should guide local city councilmembers when deciding whether to regulate marijuana-related retail activities in their jurisdictions. "Locally-elected officials must choose which sort of cannabis marketplace they want operating in their neighborhoods - an above ground, transparent, legally regulated marketplace or an underground illicit market. These data should reassure local politicians that licensing the marijuana marketplace provides economic benefits without compromising public health or safety."

Full text of the study, "The effects of recreational cannabis access on labor markets: Evidence from Colorado," appears in the IZA Journal of Labor Economics.

Study: Chronic Pain Patients Significantly Decrease Opioid Use Following Initiation of Medical Cannabis

Washington, DC: Chronic pain patients dramatically reduce their use of prescription opioids following their enrollment into a statewide medical cannabis access program, according to data published in the journal Cureus.

A team of investigators assessed opioid use trends in a cohort of 63 pain patients following their registration into Delaware's medical cannabis program. All 63 patients were using prescription opioids at the time of their enrollment.

Consistent with dozens of other studies, subjects significantly decreased their overall use of opioids over time.

Authors reported: "For non-outlier individuals with positive baseline opioid use before receiving medical marijuana certification (n=63), the average percent change in opioid use was found to be -31.3 percent. Examining subgroups based upon pain location, individuals with low back pain (n=58) displayed a 29.4 percent decrease in MME [morphine milligram equivalent] units, while individuals with neck pain (n=27) were observed to have a 41.5 percent decrease in opioid use. Similarly, individuals with knee pain (n=14) reduced their opioid use by 32.6 percent. ... Since the underlying pathology and their source of pain in the individuals was unlikely to significantly change during the period examined, medical marijuana use could have played a large role in allowing the individuals to decrease their opioid use."

They concluded: "The results of this study indicate that medical marijuana certification is associated with a decrease in prescription opiate use for chronic pain treatment and supports greater use of this adjunct treatment modality. Given the significance of opioid addiction in American society, any treatment or additional resource to reduce opioid overuse can aid in the multifactorial management of chronic pain. Although marijuana use causes a variety of side effects, the findings here suggest that the use of medical cannabis as an adjunct treatment for chronic pain may be beneficial to public health."

Full text of the study, "Medical cannabis certification is associated with decreases opiate use in patients with chronic pain: A retrospective cohort study in Delaware," appears in Cureus.

Analysis: Unregulated Delta-8 Vape Products Frequently Mislabeled, May Contain Heavy Metals

Rochester, NY: Delta-8 vapor products frequently contain heavy metals and are typically far less potent than advertised on the products' labeling, according to data published in the journal Chemical Research in Toxicology.

A pair of researchers affiliated with the University of Rochester, Department of Environmental Medicine assessed the purity of 27 e-cigarette products containing synthetically derived delta-8 THC.

Researchers determined that none of the products provided accurate labeling regarding delta-8 THC content - a finding that is consistent with prior research. They wrote, "Delta-8 THC levels can vary as much as 40 percent from the label value, suggestive of poor testing capabilities and falsified results."

Additionally, 11 of the products contained high levels of "unlabeled cutting agents," and all of the products tested positive for the presence of heavy metals - including magnesium, chromium, nickel, and mercury. Investigators suggested, "These metals are likely leachates from vaporizer components or production materials, and their inhalation could cause deleterious effects on the respiratory tract that stem from the generation of reactive oxygen species." Prior analyses of commercially available vapor cartridges have similarly identified the presence of metal contaminants following the use of the cartridges' heating mechanisms.

"Further chemical, pharmacological, and toxicological testing of these and similar products is necessary," authors concluded.

Although delta-8 THC appears organically in cannabis, it is only produced in minute amounts. By contrast, the elevated quantities of delta-8 THC in grey market products is the result of a chemical synthesis during which manufacturers convert CBD to delta-8 THC. Manufacturers engaged in synthetizing delta-8 THC are not regulated and often use potentially dangerous household products to facilitate this process.

In October, NORML issued a report on delta-8 THC and other novel, synthetically derived cannabinoids that cautioned consumers to avoid these unregulated products because they are untested and may contain impurities.

Full text of the study, "Novel delta-8 tetrahydrocannabinol vaporizers contain unlabeled adulterants, unintended byproducts of chemical synthesis, and heavy metals," appears in Chemical Research in Toxicology.

Oral THC Treatment Associated with Prolonged Survival Times in Palliative Outpatient Care Patients

Kleinmachnow, Germany: The administration of oral THC (e.g., dronabinol) is associated with prolonged survival times in patients with advanced illnesses who are at the end-stages of their lives, according to preliminary data posted online by a team of German researchers.

Investigators assessed the use of cannabis-based medicines in relation to survival times in a cohort of patients in Specialized Palliative Outpatient Care (SAPV). SAPV offers team-based home care for patients with advanced and progressive diseases whose life expectancies are limited to days, weeks or months.

Researchers reported, "The therapy with CBM [cannabis-based medicines] was associated with prolonged median survival ... from 44 to 65 days." Prolonged survival was most pronounced among female patients and those over 75 years of age.

Authors concluded, "From the available data, we can conclude that ... CBM therapy should be included as first line therapy for the patient groups considered due to the significant prolongation of survival time."

They added: "Due to the pressing relevance of our observations for palliative care patients, we are making the preliminary data from our ongoing retrospective study available in this pre-publication. Based on the current trend in the evaluation, we consider that patients could promptly benefit from a low and slowly increasing dose."

A summary of the data, "Cannabis-based medicines prolong survival time in patients under Specialized Palliative Outpatient Care," is available online.

European Island Nation of Malta Moves to Depenalize Marijuana Possession

Valletta, Malta: Lawmakers in the island nation of Malta (population 525,000) have approved legislation permitting the personal possession of marijuana by adults without penalty.

Members of Parliament voted in favor of the legislation Tuesday and it is expected to be signed into law imminently. Under the measure, those ages 18 and older may legally possess up to seven grams of cannabis and/or home-cultivate up to four plants for personal use. (Up to 50 grams of homegrown flower may be legally stored at home.) Possessing higher amounts will trigger civil fines.

The measure does not formally regulate the commercial cannabis marketplace, but it does permit not-for-profit cooperatives to provide personal use quantities of cannabis flowers and seeds to their members.

The nation's President is anticipated to sign the legislation into law as soon as this weekend.

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Congress: Bipartisan Legislation Introduced to Facilitate Expungements for Those with State-Level Cannabis Convictions

Washington, DC: Representatives Dave Joyce (R-OH) and Alexandria Ocasio-Cortez (D-NY) have introduced legislation to incentivize state and local governments to expunge the criminal records of those who have previously been convicted of marijuana offenses.

Their bill, entitled The Harnessing Opportunities by Pursuing Expungement (HOPE) Act, seeks to appropriate $20 million to the US Attorney General for the purposes of financially assisting states and local governments with the process of reviewing and expunging cannabis convictions.

"This bipartisan effort represents the growing consensus to reform marijuana policies in a manner that addresses the harms inflicted by prohibition," said NORML Political Director Justin Strekal. "It provides cash assistance for states and localities that are wisely choosing to remove these stigmatizing records. There is no justification for continuing to prevent tens of millions of Americans from fully participating in their community and workforce simply because they bear the burden of a past marijuana conviction."

Legislatures in over a dozen states have enacted laws explicitly facilitating the expungement of low-level cannabis convictions. State officials have vacated an estimated 2.2 million marijuana-related convictions under these laws over the past two years.

"Having been both a public defender and a prosecutor, I have seen first-hand how cannabis law violations can foreclose a lifetime of opportunities ranging from employment to education to housing," said Rep. Dave Joyce. "By helping states establish and improve expungement programs for minor cannabis offenses, the HOPE Act will pave the way for expanded economic opportunities to thrive alongside effective investments to redress the consequences of the War on Drugs."

Representative Alexandria Ocasio-Cortez added, "As we continue to advocate for the decriminalization and legalization of marijuana, this bipartisan bill will provide localities the resources they need to expunge drug charges that continue to hold back Americans, disproportionately people of color, from employment, housing and other opportunities."

To contact your lawmakers in support of The HOPE Act, please visit NORML"s Take Action Center.

Analysis: Cannabis Use Not Associated with Increased Risk of Adverse Perioperative Outcomes

Ottawa, Canada: Surgery patients with a history of moderate cannabis use are no more likely to experience adverse perioperative outcomes than are those with no history of use, according to data presented at the 2021 Meeting of the American Society of Regional Anesthesia and Pain Medicine.

Canadian researchers assessed surgical outcomes among a cohort of cannabis users and non-users at a single institution over a 14-month period. After controlling for potential confounders – such as age, sex, and surgery type – investigators identified no statistically significant differences among the two patient groups.

"Our results do not demonstrate a convincing association between self-reported cannabis use and either major surgical outcomes or [post-operative] pain management," one of the study's researchers told Anesthesiology News.

In some US jurisdictions, patients with a history of medical cannabis use have been denied access by hospitals to certain surgical procedures, like organ transplants, despite any evidence indicating that they are at higher risk for experiencing adverse outcomes.

Separate analyses have previously identified a correlation between patients with a history of cannabis use and lower in-hospital mortality among those with COPD, congestive heart failure, cancer, pancreatitis, HIV, burn-related injuries, traumatic brain injuries, and other types of severe trauma.

A poster of the study, "Effect of preoperative cannabis use on perioperative outcomes: A retrospective cohort study," is available online.

National Poll: Marijuana Legalization Supported by Majorities of All Age Groups

Washington, DC: Majorities of those ages 18 and older say that "the recreational use of marijuana should be made legal in the United States," according to nationwide polling data compiled by YouGov America.

Overall, 57 percent of respondents backed legalization, while 27 percent opposed it. Support was strongest among Democrats (70 percent), those respondents between the ages of 25 and 44 years old (62 percent), and Independents (61 percent).

Only 40 percent of Republican respondents who participated in the survey endorsed legalization. Forty-four percent opposed it.

The polling data is consistent with prior surveys showing majority support for legalizing cannabis among US adults, though recent polls by Gallup and others have identified greater levels of public support.

Study: Inhalation of CBD-Dominant Cannabis Does Not Negatively Influence Fitness to Drive

Bern, Switzerland: The inhalation of CBD-dominant cannabis flowers does not influence subjects' reaction time, concentration, balance, time perception, or other skills associated with driving ability, according to data published in the journal Forensic Sciences Research.

A team of Swiss researchers assessed the influence of either CBD-dominant cannabis (16.6 percent CBD and 0.9 percent THC) or placebo on a variety of neurocognitive and psychomotor skills. Researchers observed "no symptoms of impairment" and "no significant impact on driving ability" in study subjects who inhaled CBD-dominant cigarettes.

Despite showing no impairment of performance, several subjects did nonetheless test positive for trace levels of THC in their blood 45 minutes after smoking. Authors cautioned that subjects' elevated THC levels would place them in violation of certain traffic safety per se laws that criminalize the operation of a motor vehicle with detectable quantities of THC or THC metabolites in the driver's bloodstream.

Numerous studies have confirmed that the presence of THC in blood is not predictive of psychomotor impairment. As a result, NORML opposes the imposition of THC per se thresholds for cannabinoids in traffic safety legislation, opining: "The sole presence of THC and/or its metabolites in blood, particularly at low levels, is an inconsistent and largely inappropriate indicator of psychomotor impairment in cannabis consuming subjects. … Lawmakers would be advised to consider alternative legislative approaches to address concerns over DUI cannabis behavior that do not rely solely on the presence of THC or its metabolites in blood or urine as determinants of guilt in a court of law. Otherwise, the imposition of traffic safety laws may inadvertently become a criminal mechanism for law enforcement and prosecutors to punish those who have engaged in legally protected behavior and who have not posed any actionable traffic safety threat."

Full text of the study, "Impact of smoking cannabidiol (CBD)-rich marijuana on driving ability," appears in Forensic Sciences Research.

Survey: IBD Patients Frequently Report Using Medical Cannabis

San Juan, Puerto Rico: More than a quarter of patients diagnosed with Inflammatory Bowel Disease report having used cannabis therapeutically, according to survey data published in the Puerto Rico Health Sciences Journal.

A team of investigators affiliated with the University of Puerto Rico School of Medicine surveyed IBD patients about their use of medical marijuana. Medical cannabis products are legal in Puerto Rico for patients with certain inflammatory bowel diseases, such as Crohn's.

Twenty-seven percent of survey respondents affirmed having consumed cannabis for medical purposes. The majority of those who did so (68 percent) said that cannabis improved their symptoms. Most (78 percent) did not discuss their cannabis use with their primary care physician.

The findings are consistent with those of other surveys showing that a significant percentage of IBD patients acknowledged using cannabis and gaining relief from it.

Full text of the study, "Knowledge, perception, and use of cannabis therapy in patients with Inflammatory Bowel Disease," appears in the Puerto Rico Health Sciences Journal.

Analysis: Plant-Derived Cannabinoids Provide Relief from Neuropathic Pain

Los Angeles, CA: The use of either herbal cannabis or medicines containing plant-derived cannabinoids is associated with significant reductions in patients' neuropathic pain, according to a review of placebo-controlled clinical trial data published in the Journal of Dental Anesthesia and Pain Medicine.

Researchers with the University of Southern California reviewed data from 17 placebo-controlled clinical trials involving 861 neuropathic pain patients. Patients in the trials consumed a variety of cannabis-related products, including whole-plant cannabis, plant-derived cannabis medicines (e.g., Sativex), oral CBD, and/or synthetic cannabinoids (e.g., dronabinol).

Authors reported that patients receiving either whole-plant cannabis containing THC or plant-derived medicines containing both THC and CBD received significant improvements in pain intensity, while subjects administered other cannabinoids (e.g., CBD and CBDV) and/or synthetic cannabinoids (e.g., dronabinol and CT-3) did not. Most commonly reported side-effects among patients in the trials were anxiety, sedation, and dizziness.

Investigators concluded, "THC/CBD and THC interventions provide statistically significant improvements in pain intensity in NP patients and [are] more likely to provide a 30 percent reduction of NP [neuropathic pain] when smoked or vaped at different concentrations (3.56 percent to 9.4 percent THC) or using a spray (THC 2.5-2.7 mg and CBD 2.5 mg per 100mL) compared to placebo. … Additional long-term studies with more uniform study parameters are needed to achieve more clinically relevant recommendations."

Full text of the study, "Efficacy of cannabis-based medications compared to placebo for the treatment of chronic neuropathic pain: A systematic review with meta-analysis," appears in the Journal of Dental Anesthesia and Pain Medicine.

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Analysis: Marijuana Legalization Associated with Improved Clearance Rates for Violent Crimes

Salt Lake City, UT: The legalization of marijuana is associated with improvements in police clearance rates for multiple types of violent crimes, according to data published online ahead of print in The International Journal of Drug Policy.

A pair of researchers affiliated with the University of Utah and the University of China assessed trends in crime clearance rates in Oregon versus control states in the years prior to and immediately following the enactment of adult-use legalization.

Investigators identified "significant increases in the clearance rate for overall violent crimes and for aggravated assault in Oregon counties relative to those in non-legalized states following legalization." They concluded, "The finding largely aligns with the argument made by the proponents of marijuana legalization that legalization would improve police effectiveness in addressing serious crimes, and as a result would increase clearance rates and generate a crime deterrence effect."

Their findings are consistent with those of a prior study documenting improved crime clearance rates in Colorado and Washington following legalization, particularly for violent crimes and property crimes.

Commenting on the study's findings, NORML's Deputy Director Paul Armentano said: "These conclusions reaffirm the notion that states can sensibly regulate the adult use and sale of cannabis in a manner that doesn't adversely impact public safety. Moreover, in some cases, legalization may contribute to an environment that positively affects police officers' performance in solving serious crimes."

Full text of the study, "Effect of recreational marijuana legalization on clearance rates for violent crimes: Evidence from Oregon," appears in The International Journal of Drug Policy.

Clinical Trial: CBD Cigarettes Associated with Reductions in Antipsychotic Medications in Patients with Schizophrenia

Basel, Switzerland: The adjunctive use of CBD is associated with a reduction in patients' use of antipsychotic medicines, according to placebo-controlled trial data published in the journal Frontiers in Psychiatry.

An international team of researchers from Canada, Switzerland, and Germany assessed the use of CBD cigarettes versus placebo in a cohort of acutely psychotic patients with schizophrenia or other psychotic disorders. Patients received either CBD or a placebo daily for 28 days in addition to their standard treatments.

Investigators reported that both CBD and placebo were associated with similar reductions in psychotic symptoms and depression, but that those participants who consumed CBD cigarettes used fewer antipsychotic medication during treatment. Conversely, those in the placebo group increased their use of prescription medications.

They concluded: "The main group effects in the discontinuous multilevel model were higher subjective well-being and less overall antipsychotic medication use throughout the acute therapy for the CBD-group. These results may suggest an antipsychotic medication sparing effect of CBD-cigarettes as adjunctive therapy in acutely psychotic patients. ... However, future studies with more rigorous study designs and larger samples are needed."

CBD administration is established to have anxiolytic and antipsychotic effects in human subjects, and its use is associated with changes in brain activity that may lower some people's risk of a psychotic episode. Previously published clinical trial data indicates that the daily administration of high doses of CBD (1,000mg) reduces psychotic symptoms in patients with schizophrenia in a manner that is superior to the prescription antipsychotic agent amisulpride.

Full text of the study, "Cannabidiol cigarettes as adjunctive treatment for psychotic disorders – A randomized, open-label pilot study," appears in Frontiers in Psychiatry.

South Dakota: State's Supreme Court Strikes Down Adult-Use Marijuana Vote

Pierre, SD: Justices on the South Dakota Supreme Court ruled 4 to 1 last week to strike down a voter-approved initiative (Constitutional Amendment A) legalizing the adult-use possession and sale of cannabis.

"Legalization opponents cannot succeed in the court of public opinion or at the ballot box," NORML's Deputy Director Paul Armentano said. "Thus, they are now petitioning the courts to overturn the will of the people. Whether or not one supports marijuana legalization, Americans should be deeply concerned by this trend and by the outcome of this case."

Fifty-four percent of South Dakota voters decided on Election Day in favor of the ballot measure. However, shortly following the vote, Republican Gov. Kristi Noem facilitated litigation seeking to strike down the law as unconstitutional. In February, Judge Christina Klinger of the state's Sixth Judicial Circuit Court ruled in favor of the challenge - opining that the amendment violated state requirements that ballot measures not encompass more than one topic. Last week, the majority of the Supreme Court affirmed her ruling, opining that the amendment "violated the single subject requirement in the South Dakota Constitution."

The decision marks the second time this year that a state Supreme Court has nullified the result of a statewide vote legalizing the use of cannabis. In May, justices of the Mississippi Supreme Court ruled 6 to 3 to nullify Initiative 65, which sought to regulate medical cannabis access in the state. Seventy-three percent of Mississippi voters had approved the measure on Election Day.

Over the past year, political opponents of marijuana law reform have been more frequently turning to the courts in efforts to either repeal cannabis-related votes or to stop them from taking place. In Nebraska, members of the state Supreme Court struck down a 2020 ballot initiative months after it had been approved by the Secretary of State's office. Polling in the state showed that 77 percent of Nebraskans backed the proposal. More recently, Florida's Republican attorney general successfully brought suit to preemptively deny a proposed 2022 legalization initiative from appearing on the ballot.

South Dakota voters last November also decided in favor of a separate ballot measure (Measure 26) regulating medical marijuana access by qualified patients. State lawmakers have not challenged that law from taking effect.

Proponents behind Amendment A have already taken steps to place a new legalization measure before voters in 2022. Some state lawmakers are also recommending that the legislature implement legalization legislation next year.

A summary of the decision is available online from the Supreme Court of South Dakota.

Study: Cannabis Use History Inversely Associated with Common Stomach Infection

Pittsburgh, PA: The use of cannabis is associated with a decreased risk of Helicobacter Pylori infection (HPI) – a bacterial stomach infection that can be associated with abdominal pain, weight loss, and ulcers. HPI is relatively common in adults worldwide, though many people with it do not experience severe symptoms.

A team of investigators from the United States and Canada assessed the relationship between cannabis use and an HPI diagnosis in a nationally representative cohort of 4,556 subjects.

They reported that subjects with no prior use of cannabis were nearly twice as likely to have HPI as compared to subjects with a history of marijuana use, even after authors adjusted for demographic confounders and comorbidities.

They concluded: "Recreational cannabis use is associated with diminished risk of HPI. These observations suggest the need for additional research assessing the effects of medical cannabis formulations on HPI."

Separate studies have shown that cannabis can provide relief to patients with a variety of gastrointestinal disorders, including IBS, Crohn's disease, while preclinical data indicates that cannabinoids can inhibit the development of gastric ulcers.

Full text of the study, "Relationship between recreational cannabis use and Helicobacter pylori infection," appears in Cannabis and Cannabinoid Research.

Study: Maternal Cannabis Use Not Linked to Higher Risk of Autism in Children

Aurora, CO: Mothers with a history of consuming cannabis in the months prior to or during pregnancy do not possess a greater likelihood of having children with autism spectrum disorder (ASD), according to data published in the Journal of Autism and Developmental Disorders.

A team of researchers with the University of Colorado, School of Public Health assessed whether mothers with a self-reported history of maternal cannabis use are more likely to give birth to children with either ASD or development disorders. They reported that mothers with a history of marijuana use were no more likely than non-users to have children with either autism or developmental delays by age five.

Other studies have shown inconsistent results with respect to in utero cannabis exposure and certain neonatal outcomes, including birth weight and certain behavioral outcomes.

Full text of the study, "Per-pregnancy cannabis use and autism spectrum disorder in the offspring: Findings from the study to explore early development," appears in the Journal of Autism and Developmental Disorders.

FDA: No Regulations on OTC CBD Products Forthcoming

Washington, DC: Nearly 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.

Speaking last month at the National Industrial Hemp Business Summit in Washington, DC, FDA representative Gail Sipes said that the agency cannot move forward with regulations without more data on the safety of CBD products. She reiterated the agency's position that companies which market CBD-infused products as either food products or as dietary supplements are violating the Food, Drugs, and Cosmetics Act.

NORML and other groups have urged the FDA to provide regulatory guidelines overseeing the production, testing, labeling, and marketing of hemp-derived CBD products. Analyses conducted by the FDA and others have consistently reported that many over-the-counter (OTC) CBD products are of variable quality and potency, and that they may contain contaminants or elevated levels of heavy metals.

Survey data compiled last year by the National Consumers League reported that more than eight in ten US voters desire greater federal regulatory oversight over the labeling and marketing of commercially available CBD products.

In a report provided by the FDA to Congress in 2020, the agency said that regulating OTC CBD products presents unique challenges because the substance is already available as a FDA-approved medicine (Epidiolex).

Additional information is available from the NORML fact sheet, "FAQs About Cannabidiol (CBD)."

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