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Marijuana Legalization Associated with Less Use of Prescription Opioids, Review of Longitudinal Studies Concludes

Montreal, Canada: The adoption of state laws regulating the sale of cannabis to adults is strongly associated with reductions in the use of prescription opioids, according to a review of longitudinal studies published in the journal Frontiers in Psychiatry.

Canadian investigators reviewed data from 32 longitudinal studies evaluating public health outcomes in states that legalized adult-use cannabis sales compared to jurisdictions that did not.

Consistent with prior analyses, researchers identified "robust associations" between the enactment of adult-use legalization and decreases in the public's use of prescription opioids.

"Most research articles included on this topic were evaluated as having high-quality evidence," they acknowledged. "As such, the evidence is sufficient to establish a potentially beneficial association between recreational marijuana legislation and prescription opioid patterns."

Though researchers acknowledged "moderate increases" in adults' past-month use of cannabis following legalization, they identified "no increase in [use among] adolescents or young adults." They also failed to identify any uptick in incidences of problematic marijuana use among young people -- a finding consistent with prior data.

Authors reported inconsistent findings with respect to the potential impact of adult-use legalization on traffic safety or upon the public's use of alcohol. They identified no increases in the public's use of tobacco following marijuana legalization, and they failed to draw any conclusions regarding legalization's impact on either crime rates or suicides due to a lack of sufficient data.

Full text of the study, "The clouded debate: A systematic review of comparative longitudinal studies examining the impact of recreational cannabis legalization on key public health outcomes," appears in Frontiers in Psychiatry.

FDA Punts on Establishing Rules for Regulating Hemp-Derived CBD Products

Washington, DC: Regulators with the US Food and Drug Administration have announced that Congress, not the FDA, must take primary responsibility for creating a regulatory framework overseeing the commercial production and sale of hemp-derived CBD products.

The agency, which was tasked by Congress to establish regulations for hemp-derived products when federal lawmakers legalized them in 2018, said that the FDA's existing rules governing foods and dietary supplements are inadequate for addressing hemp-derived CBD products.

"[A]fter careful review, the FDA has concluded that a new regulatory pathway for [hemp-derived] CBD is needed that balances individuals' desire for access to CBD products with the regulatory oversight needed to manage risks," the agency stated in a press release. "The FDA looks forward to working with Congress to develop a cross-agency strategy for the regulation of these products to protect the public's health and safety."

For years, NORML and other groups have urged the FDA to establish regulatory guidelines governing 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 CBD products are of variable quality and potency, and that they may contain contaminants, adulterants, or elevated levels of heavy metals.

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

The FDA's press release made no mention of whether it intends to address the proliferation of novel intoxicating cannabinoid products, like THC-O and delta-8-THC, which are produced through a chemical synthesis of hemp-derived CBD. These unregulated products have grown widely in popularity in recent years, and the FDA has issued health warnings about them following consumer complaints. NORML has cautioned against the ingestion of these novel, unregulated products.

In 2018, the FDA approved the prescription use of plant-derived CBD in the drug Epidiolex. The medicine is authorized for the treatment of pediatric epilepsy, and it is classified by the DEA as a Schedule V controlled substance -- the lowest restriction classification available under federal law.

In a 2020 report to Congress, the FDA acknowledged that regulating over-the-counter hemp-derived CBD products in a manner similar to dietary supplements could potentially disincentivize further clinical research into the compound's development as a prescription drug to treat other medical conditions. The agency stated, "As FDA considers [regulating] additional non-drug products containing CBD, ... we are committed to doing all we can to encourage the development of CBD drug products and additional cannabis-derived drug products through existing, legal pathways."

They continued: "If the widespread availability of consumer CBD products were to significantly discourage clinical research, our knowledge of CBD's potential medical uses could be stunted. ... [W]e are mindful of the need to ensure that adequate incentives remain to encourage further clinical study."

CBD/CBC Combination Possesses Synergistic Anti-Cancer Effects in Cellular Model

Jerusalem, Israel: According to preclinical data published in the journal Cancers, plant-derived extracts containing both CBD and CBC (cannabichromene) are highly effective at killing head and neck cancer cells in culture.

Israeli researchers assessed the anti-cancer activity of 24 plant-derived cannabinoids in head and neck cell cultures.

They reported that the administration of CBD and CBC at a ratio of two-to-one "maximizes the cytotoxicity of HNSCC [head and neck squamous cell carcinoma] cells." Authors also identified a similar "entourage effect" when CBD was combined with THC at a two-to-one ratio, but they suggested that the former combination possessed a more beneficial safety profile.

"Our research found CBC to enhance the cytotoxic effect of CBD, establishing additional support for the phenomenon of the entourage effect in phytocannabinoids," investigators determined. "Considering the adverse psychotomimetic effects of THC, there is a clear advantage for favoring the CBD-CBC combination over CBD-THC for novel treatments for HNSCC."

They concluded, "This research suggests using whole cannabis extracts, which are decarboxylated CBD-rich, to induce cancer cell death."

Although cannabinoids possess well-established anti-cancer activity in preclinical models, scientists have largely been reluctant to try and replicate these results in controlled clinical trials.

According to a 2015 literature review, cannabis smoke exposure is not positively associated with the development of cancers of the head or neck. A 2009 study reported that the moderate long-term use of marijuana was associated with a reduced risk of head and neck cancers.

Full text of the study, "The effect of cannabis plant extracts on head and neck squamous cell carcinoma and the quest for cannabis-based personalized therapy," appears in Cancers.

Georgia: Commission Votes May Finally Open the Door for the Dispensing of State-Licensed CBD/THC Oils

Atlanta, GA: Members of a state-appointed commission advanced new rules and regulations last week overseeing the dispensing of cannabis plant-derived extracts containing low amounts of THC and high amounts of CBD.

Members will still need to finalize the rules with a series of additional votes. However, regulators are hopeful that the commission's actions may clear the way for the opening of state-licensed dispensaries by this spring.

Under the commission's plan, two companies will be licensed to open as many as five dispensaries each statewide. Dispensaries will only be permitted to provide qualified extract products to registered patients.

Georgia lawmakers in 2015 passed legislation allowing qualified patients to possess cannabis plant-derived extracts containing CBD and no more than 5 percent THC, but it failed to provide a legal source for CBD/THC products.

In 2021, lawmakers passed additional legislation that sought to permit up to 30 state-licensed retailers of high-CBD/low-THC oil products. However, following the initial selection process, several applicants sued the state -- resulting in undue delays in the law's implementation.