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Federal Agency Proposes Oral Fluid Testing for Transportation Industry

Washington, DC: The U.S. Department of Transportation has proposed changes to existing federal drug testing guidelines that would allow for the use of oral fluid testing as an alternative to urinalysis for those working in the transportation industry.

The agency proposed the rule change in the February 28, 2022 edition of the Federal Register, opining, “This will give employers a choice that will help combat employee cheating on urine drug tests and provide a more economical, less intrusive means of achieving the safety goals of the program.”

Oral fluid tests typically detect either THC or its metabolite for a period of one to two days post-exposure – a timetable that is significantly shorter than that associated with urinalysis. The latter may detect the presence of carboxy-THC for weeks or even months following abstinence.

Federal law mandates commercial drivers to routinely undergo marijuana urinalysis testing. In recent months, federal statistics have identified the suspension of over 72,000 truck drivers as a result of failed drug tests. Over half of those failed tests were for the past use of marijuana.

In 2020, the US Department of Health and Human Services proposed in the Federal Register expanding federal drug testing guidelines to include the use of hair follicle testing. To date, however, that proposed rule change has not been finalized.

NORML has long called for the use of performance testing technology, rather than drug detection technology, to determine whether someone may be impaired while on the job.

Full text of the proposed rules is available from the US Federal Register.

Study: Recent Cannabis Use Associated with Lower Resting Heart Rate

San Francisco, CA: Current cannabis use is associated with lower resting heart rate, according to data published in The American Journal of Medicine.

A team of researchers from Switzerland and the United States assessed the relationship between cannabis exposure and heart rate in a cohort of middle-aged adults. Subjects in the study were participants in the Coronary Artery Risk Development in Young Adults (CARDIA) study – which is a multi-decade assessment of cardiovascular health. Previous findings from the CARDIA sample have failed to link the use of cannabis – even long-term – with an elevated risk of either atherosclerosis, high blood pressure, ECG abnormalities, or other serious cardiovascular events at middle age.

Researchers reported that subjects who occasionally consumed cannabis (defined as five times or more per month) possessed a lower resting heart rate than did non-users, including those who were former marijuana consumers.

“Current cannabis use was associated with lower resting heart rate, but cumulative cannabis exposure was not,” they reported. “Our findings align with epidemiological research on thousands of participants from Europe and the USA that found no association between cannabis and cardiovascular disease, mortality, or surrogate outcomes.”

Authors concluded: “Current cannabis use was associated with lower resting heart rate, which supports findings from experimental studies. … Past cumulative exposure to cannabis was not associated with heart rate, indicating the effects of cannabis exposure on heart rate are transient. Our findings add to the growing body of evidence suggesting a lack of deleterious association of cannabis use at a level typical of the general population on surrogate outcomes of cardiovascular disease.”

Full text of the study, “Association between current and cumulative cannabis use and heart rate: The Coronary Artery Risk Development in Young Adults (CARDIA) Study,” appears in The American Journal of Medicine.

Review: Influence of Cannabis on Driving Performance Less Significant Than Alcohol

Alberta, Canada: The magnitude of cannabis’ influence on driving performance is far less than that of alcohol, according to a systematic review and meta-analysis published in the journal Addiction.

Canadian researchers analyzed data from 57 studies assessing the influence of cannabis and alcohol on driving behavior and crash risk.

They acknowledged that cannabis exposure was typically associated with deviation in drivers’ lateral positioning (lane weaving) and a decrease in their average speed. Cannabis use was “not associated with an increase in crashes in experimental studies.” Authors also found “no compelling evidence” that cannabis influenced hazard response time, headway variability, time out of lane, speed variability, speed exceedance, or time speeding.

They concluded, “Specifically, for the measures reported here, there are no instances where the average effect of cannabis is equal to or greater than the driving performance decrements associated with BAC concentration ranging from 0.04 to 0.06 percent.”

Consistent with other studies, authors acknowledged that the combined use of cannabis and alcohol “is generally more detrimental to driving performance relative to non-intoxication or to either drug in isolation.”

NORML has long acknowledged that acute cannabis intoxication can influence driving performance, particularly if consumed with alcohol, and has opined that anyone inhaling cannabis “should refrain from driving for a period of several hours.”

Full text of the study, “Effects of cannabis and alcohol on driving performance and driver behavior: A systematic review and meta-analysis,” appears in Addiction.

Survey: Most Internal Medicine Residents Lack Adequate Knowledge About Cannabis

New York, NY: The majority of internists in training possess little or no knowledge about the use of cannabis for medicinal purposes, according to survey data published in the journal BMJ Primary Care.

A team of investigators with the Icahn School of Medicine at Mount Sinai in New York surveyed a group of internal medicine residents regarding their knowledge about the medical use of marijuana.

Ninety-three percent of respondents said that they lacked adequate knowledge about cannabis’ overall effects, and 97 percent said that they lacked sufficient knowledge regarding which indications it could address. Eighty-three percent of participants said that they were “unsure where to find pertinent information,” and 92 percent agreed that education regarding cannabis should be included in their training.

Authors concluded: “To the best of our knowledge, this is the first study to observe a critical lack of knowledge in MM [medical marijuana] in in-training IM [internal medicine] residents. Hence, it is worth implementing a curriculum for resident physicians that includes indications, medication interactions, and side effects of MM use.”

The findings are consistent with those of surveys of other medical professionals – including nurses, pharmacists, clinicians, and other health care practitioners – all of whom report possessing insufficient training in matters specific to medical cannabis. Separate survey data published in 2020 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, “Medical marijuana knowledge and attitudes amongst internal medicine residents,” appears in BMJ Primary Care.

Study: Pain Patients’ Use of Cannabis Oils Associated with Cessation of Opioids

Milan, Italy: The long-term use of plant-derived cannabis extracts by patients with chronic pain is associated with reduced reliance on prescription opioids, according to data published in the European Review for Medical and Pharmacological Sciences.

A team of Italian researchers assessed the use of prescription opioids and other medicines in a cohort of chronic patients in the six months immediately prior to and immediately following their initiation of medical cannabis.

Authors reported that a significant percentage of subjects ceased their use of prescription opioids by the conclusion of the trial. They concluded, “Analyses by subgroups showed a statistically significant difference in the proportion of female opioid non-users before and after cannabis-based oil treatment (34.1 percent to 56.1 percent), as well as in the proportion of under-65 years old opioid non-users before and after cannabis-based oil treatment (32.5 percent to 55 percent), in the proportion of opioid non-users with non-severe comorbidity (33.3 percent to 54.2 percent), and … in the proportion of opioid non-users with a chronic pain condition (32.6 percent to 59.2 percent).”

The findings are consistent with dozens of other studies showing that pain patients typically reduce or eliminate their use of prescription opioids following the use of cannabis. Inconsistent with prior studies, authors did not identify an association between medical cannabis use and a significant reduction in patients’ use of other prescription drugs, including benzodiazepines.

Full text of the study, “Long-term cannabis-based oil therapy and pain medications prescribing patterns: An Italian observational study,” appears in European Review for Medical and Pharmacological Sciences.