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Posted By: norml@weedconnection.com
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- Tue, 02 Jun 2020 04:20:21 PST

Study: Adult-Use Legalization Associated with Decline in Youth Treatment Admissions

Philadelphia, PA: The enactment of adult-use cannabis legalization laws is not associated with an increase in marijuana-related youth drug treatment admissions, according to data published in the journal Drug and Alcohol Dependence.

A pair of researchers from Temple University assessed annual drug treatments admissions among youth for the years 2008 to 2017.

Investigators reported: "Over all states in the analysis, the rate of adolescent treatment admissions for marijuana use declined significantly over the study period, with the mean rate falling nearly in half. The decline in admissions rate was greater in Colorado and Washington compared to non-RML (recreational marijuana law) states" following the enactment of adult-use legalization policies.

Authors speculated that a variety of factors may have influenced the decrease in admissions, including potential changes in youth use patterns and/or shifts in cultural attitudes toward marijuana consumption in general.

They concluded: "To our knowledge, this is the first study examining the effect of recreational legalization of marijuana in the US on adolescent treatment admissions for marijuana use. Our results indicate that RML in Colorado and Washington was not associated with an increase in treatment admissions. Rather, we observe a substantial decline in admissions rates across US states, with evidence suggesting a greater decline in Colorado/Washington following RML as compared to non-RML states. ... While we are encouraged that rates of new treatment admissions for marijuana use among adolescents exhibited a general decline in the states we examined, it is unclear whether this finding reflects trends in the prevalence of CUD (cannabis use disorder) or, rather, changes in treatment seeking behaviors due to changing perceptions of risk and public attitudes towards marijuana use."

Separate studies have similarly reported a decline in the prevalence of so-called 'cannabis use disorder' over the better part of the past two decades. Self-reported use of marijuana by young people has also been in decline both nationally and in legal marijuana states.

Historically, nearly half of all young people admitted to drug treatment for marijuana were referred there by the criminal justice system.

Full text of the study, "Adolescent treatment admissions for marijuana following recreational legalization in Colorado and Washington," appears in Drug and Alcohol Dependence.

Study: Orthopedic Surgeons Issue Fewer Opioid Prescriptions Following Medical Cannabis Legalization

New York, NY: The enactment of statewide medical cannabis access laws is associated with a reduction in opioid prescribing practices by orthopedic surgeons, according to observational data published in the Journal of the American Academy of Orthopedic Surgeons.

A team of researchers affiliated with Columbia University in New York evaluated the association between the implementation of state cannabis laws and opioid prescribing patterns by orthopedic surgeons between 2013 and 2017. Orthopedic surgeons specialize in the treatment of conditions involving the musculoskeletal system. They are the third highest prescribers of opioids among physicians in the United States.

Investigators reported that that the "implementation of medical THC-grade cannabis laws and patient accessibility to in-state dispensaries are each associated with significantly reduced opioid prescribing by orthopedic surgeons."

They concluded: "In this study, we observed an association between state-level legalization of medical cannabis and opioid prescribing by orthopedic surgeons in the Medicare Part D cohort. We found that overall opioid prescribing by orthopedic surgeons in this cohort was reduced in states permitting patient access to medical cannabis, compared with those who do not. ... On examination of prescription data of different opioid classes, we found that prescriptions for hydrocodone, the most commonly prescribed opioid medication, by orthopedic surgeons had a statistically significant negative association with state MCLs. Although our study does not support a direct causal relationship, these population- level findings show that legalization of medical cannabis and patient access to dispensaries may be associated with reductions in opioid prescribing by orthopedic surgeons."

The study's findings are consistent with those of a number of prior observational studies as well as numerous longitudinal studies reporting that pain patients typically reduce their use of prescription opioids after enrolling in state sanctioned medical cannabis access programs. According to the findings of a 2016 study published in the journal Health Affairs, medical cannabis access laws are associated with reduced prescriptions rates for a broad range Medicare Part D-approved medications, not just opioids.

Full text of the study, "State medical cannabis laws associated with reduction in opioid prescriptions by orthopedic surgeons in Medicare Part D cohort," appears in the Journal of the American Academy of Orthopedic Surgeons.

Clinical Trial: Cannabinoid Administration Via a Metered-Dose Inhaler Is Safe and Effective for Chronic Pain Patients

Tel Aviv, Israel: The delivery of precise doses of THC via a specialized inhaler is associated with pain mitigation in patients with neuropathy and other complex pain conditions, according to clinical trial data published in the European Journal of Pain.

A team of Israeli researchers conducted a randomized placebo-controlled clinical trial to assess the safety and efficacy of a novel, metered-dose cannabis inhaler in 27 patients with chronic pain. Participants inhaled a precise dose containing either THC (at doses of either 0.5mg or 1mg) or placebo.

Investigators reported: "Both doses, but not the placebo, demonstrated a significant reduction in pain intensity compared with baseline and remained stable for 150-minutes. The 1mg dose showed a significant pain decrease compared to the placebo. Adverse events were mostly mild and resolved spontaneously. There was no evidence of consistent impairments in cognitive performance."

Authors concluded: "This feasibility trial demonstrated that a metered-dose cannabis inhaler delivered precise and low THC doses [that] produced a dose-dependent and safe analgesic effect in patients with neuropathic pain/complex-regional pain syndrome (CRPS). Thus, it enables individualization of medical cannabis regimens that can be evaluated pharmacokinetically and pharmacodynamically by accepted pharmaceutical models."

Prior clinical trials, such as those here and here, have similarly reported that a metered-dose inhaler can deliver precise therapeutic doses of cannabis to pain patients absent any significant adverse effects.

Chronic pain is the most commonly reported qualifying condition among medical cannabis patients enrolled in state-specific access programs. A 2017 literature review by the National Academy of Sciences, Engineering, and Medicine concluded, "There is conclusive or substantial evidence that cannabis or cannabinoids are effective for the treatment of chronic pain in adults."

Full text of the study, "Pharmacokinetics, efficacy, and safety of a novel selective-dose cannabis inhaler in patients with chronic pain: A randomized, double-blinded, placebo-controlled trial," appears in the European Journal of Pain. Additional information regarding cannabinoids and pain appears online.

Analysis: Adult-Use Legalization Associated with Tourism Spike

Rome, GA: The enactment of adult-use cannabis legalization laws in Colorado and Washington is associated with increased tourism in both states, according to data published in the Journal of Regional Analysis & Policy.

A team of researchers affiliated with Berry College in Georgia compared rates of hotel occupancy in Colorado and Washington post-legalization as compared to trends in other non-legal states.

Authors reported a "large increase in hotel rooms rented in Colorado" immediately following legalization. Washington state also experienced an uptick, but it was not as significant. Both states experienced their highest jumps in tourism following the advent of retail cannabis sales.

"[L]egalization in Colorado is associated with an increase of nearly 51,000 hotel rooms rented per month [and] once commercial sale is permitted, there is an increase of almost 120,000 room rentals per month," authors determined. In Washington, increases were approximately half that total.

Authors concluded: "Marijuana legalization led to a larger increase in tourism in Colorado than Washington. One possible explanation is that Colorado is an easier travel destination than Washington. ... Another possible explanation is that Colorado may have achieved a first mover advantage over Washington since it legalized commercial sale six months earlier than Washington. A third possible explanation is that Washington is adjacent to British Columbia which has a strong reputation for growing marijuana and a laid-back attitude toward marijuana consumption (though use remains illegal). While marijuana legalization increased tourism, especially in Colorado, the benefit may wane as additional states including California, Michigan, and Illinois, legalize the possession and sale of marijuana."

Survey data commissioned by the Colorado Tourism Office has previously reported that nearly half of all tourists who visit the state are motivated do so because of Colorado's liberal marijuana policies.

Full text of the study, "(Pot)heads un bed: The effect of marijuana on hotel occupancy in Colorado and Washington," appears in Journal of Regional Analysis & Policy.

Study: Legalization Associated with Increased Cannabis Use During Pregnancy, No Significant Differences in Neonatal Outcomes

Los Angeles, CA: The enactment of adult-use legalization in California is associated with greater incidences of marijuana use by pregnant women, but no significant changes in neonatal outcomes, according to data published in The Journal of Maternal-Fetal & Neonatal Medicine.

A team of investigators affiliated with the University of California, Los Angeles assessed rates of marijuana positives among a cohort of pregnant women before and one-year following the enactment of adult-use marijuana legalization.

Researchers reported that the rate of initial marijuana use during pregnancy increased in the first twelve months after legalization. Compared to non-users, those testing positive for cannabis were more likely to be younger, suffer from depression, and to consume other controlled substances. Most subjects who tested positive for cannabis ceased their use over the course of their pregnancy, and "the majority of users had negative UDT (urine drug test) at the time of delivery."

Investigators also assessed birth outcomes between those who ever tested positive for cannabis and those who tested negative. Authors reported no significant differences in either birth weight or rates of pre-term delivery among the two groups after controlling for potential confounders. Babies born to mothers with past cannabis exposure were also no more likely to have low Apgar scores or require intensive medical care. "Overall, neonatal outcomes were similar between both groups," authors concluded.

Full text of the study, "The impact of state legalization on rates of marijuana use in pregnancy in a universal drug screening population," appears in The Journal of Maternal-Fetal & Neonatal Medicine.

Case Report: Cannabis Oil Effective in Patient with Treatment-Resistant Oscillopsia

Toronto, Canada: The daily administration of CBD oil is associated with the alleviation of oscillopsia (ocular instability) in a 26-year-old patient with superior oblique myokymia (SOM), according to a case report published in the Journal of Neuro-Ophthalmology. Oscillopsia is a vision problem in which objects appear to jump, jiggle, or vibrate when they're actually still.

A team of University of Toronto ophthalmologists and neurologists reported on the experience of a SOM patient with treatment-resistant oscillopsia. After conventional treatments had failed to mitigate the patients' symptoms, he began taking CBD-dominant cannabis oil three times daily for a period of three months. Following three months of CBD therapy, the patient, "was essentially symptom free and able to return to work."

Researchers reported that the patient continued to remain symptom free at follow up (seven months later), during which time he only sparingly continued his use CBD oil.

Authors concluded, "We postulate that oral CBD oil played a significant role in our patient's symptom resolution, given ... the close temporal relationship between symptom relief and CBD oil administration."

Full text of the study, "Successful treatment of superior oblique myokymia with cannabis oil," appears in the Journal of Neuro-Ophthalmology.

Oklahoma: Governor Vetoes Measure Expanding Medical Cannabis Access, Reducing Possession Penalties

Oklahoma City, OK: Republic Gov. Kevin Stitt has vetoed legislation, House Bill 3288, which sought to expand patients' access to medical cannabis and make other amendments to the state's marijuana laws.

In his veto message, the Governor wrote: "The language in the bill makes substantial policy changes to the medical marijuana program that were not fully scrutinized through normal legislative procedures before the bill was received by my office in the middle of the night Saturday. While there is much room for improvement in the way our state's program operates, this bill does not address those items in a way I can support."

The bill sought to allow operators to engage in the home delivery of medical cannabis products to authorized patients who live within a ten-mile radius of a state-licensed facility. Other provisions in the bill sought to enhance privacy protections for patients and caregivers registered in the program and strengthen parental rights for qualified patients.

Separate language in the measure amended criminal penalties for persons who possess marijuana (up to 42.45 grams) without a state-issued medical card from a maximum penalty of $1,000 and up to one year in jail to a $400 fine and no jail time.

Members of both chambers overwhelmingly voted in favor of the measure. However, Senate leadership refused to hold a vote in an effort to override the Governor's veto prior to adjourning the 2020 legislative session sin die (with no intended date to resume). Local activists remain hopeful that lawmakers may revisit the measure, perhaps in a special session later this summer.

Louisiana: Senate Passes Amended Bill Permitting Doctors to Recommend Medical Cannabis for "Any Condition"

Baton Rouge: Senators on Wednesday passed legislation to significantly expand the pool of patients eligible to qualify for medical cannabis access.

Members voted 28 to 6 in favor of an amended version of House Bill 819, which expands the discretion of physicians so that they can recommend cannabis therapy for "any condition" that he or she "considers debilitating to an individual patient and is qualified through his [or her] medical education and training to treat." Under the current law, doctors may only recommend medical cannabis products to those patients with a limited number of select conditions, such as HIV and cancer.

A handful of states, such as California, Maine, and Virginia, have enacted similar measures providing physicians with the ability to recommend medical cannabis preparations to any patient who they believe may benefit from them.

Members of the House previously passed the measure by a vote of 77 to 15. As amended by the Senate, state-licensed dispensaries will be mandated to "comply with the reporting requirements of the [state's] prescription monitoring program."

House Bill 819 is scheduled for a concurrence vote on Friday.

Other bills before the Senate include HB 792, which establishes regulations permitting the home delivery of medical cannabis products to registered patients, and HB 418, which provides immunity from prosecution to "any facility that is licensed by the Louisiana Department of Health that has patients in its care using medical marijuana."

The state's legislative session concludes at 6pm on Monday, June 1, 2020.

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