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Election Day Wrap-Up: Voters in Several States, Cities Decide in Favor of Adult-Use Legalization

Washington, DC: Voters in two states, Maryland and Missouri, decided in favor of ballot measures legalizing the adult-use of cannabis, while voters in various cities nationwide similarly approved ballot measures ending marijuana-related arrests and prosecutions.

"While this year's midterm elections may not have been a 'clean sweep' for reform advocates, our momentum continues unabated," NORML's Deputy Director Paul Armentano said. "Are we in a stronger place today than we were yesterday? Of course. Two more states, Maryland and Missouri, have wisely elected to legalize and regulate cannabis - policies that will expand the freedoms and civil liberties of over 7 million Americans. In addition, voters in cities across this country - including over 400,000 Texans - acted to end the senseless and counterproductive policy of arresting and prosecuting those who possess and use cannabis."

"Poll after poll shows record public support for the legalization of the adult-use of marijuana. This support is a testament to the fact that most Americans are now well aware of the failures of marijuana prohibition and the damages it continues to cause, and that the growing number of states which have enacted legalization are doing so in a safe and effective manner that is in accordance with voters' wishes and expectations. In the coming weeks, we anticipate that Congressional lawmakers will move ahead with longstanding promises to advance federal reform legislation while, at the state level, we anticipate numerous governments to once again take up a variety of bills protecting and expanding the rights of those adults who consume cannabis responsibly."

In Maryland, an estimated 66 percent of voters approved a referendum (Question 4) directing state lawmakers to establish rules and regulations governing the production and sale of cannabis to adults. By approving Question 4, voters also triggered the enactment of separate, complementary legislation (HB 837) defining marijuana possession limits and facilitating the automatic review and expungement of low-level cannabis convictions. Under the legislation, which was passed by lawmakers this spring, adults will be legally permitted to possess up to 1.5 ounces of cannabis and/or 12 grams of cannabis concentrates beginning in July 2023. (Between January 1, 2023 and July 1, 2023, civil penalties will apply.) Adults will also be permitted to grow up to two cannabis plants in their homes for their own personal use. Possessing amounts between 1.5 ounces and 2.5 ounces will be subject to civil fines, while the possession of greater quantities will remain subject to existing criminal penalties. Those with past records for marijuana-related crimes can also begin petitioning the courts for expungement relief beginning next year.

In Missouri, an estimated 53 percent of voters decided in favor of a ballot initiative (Amendment 3) legalizing the possession, cultivation, and licensed retail sale of cannabis for those ages 21 and older. Beginning on December 8, 2022, adults will be permitted to possess up to three ounces of cannabis and to home-cultivate up to six flowering plants, six immature plants, and six plants under 14 inches for their own personal use. It also establishes a program to automatically review and expunge criminal records for eligible non-violent marijuana-related offenses. The measure seeks to broaden participation in the licensed cannabis marketplace by including small business owners and those representing disadvantaged populations, including those with limited capital, residents of high-poverty communities, service-disabled veterans, and those who have been previously convicted of nonviolent marijuana offenses. Additionally, the initiative makes some improvements to the state's existing medical marijuana access program.

Maryland and Missouri are the 20th and 21st states to adopt adult-use legalization.

Voters in three states: Arkansas, North Dakota, and South Dakota turned back marijuana legalization measures. In two states, the proposals sought to regulate commercial cannabis sales, while South Dakota's measure more narrowly sought to end marijuana-related possession arrests.

By contrast, voters in the Texas cities of Denton, Elgin, Harker Heights, Killeen, and San Marcos all voted in support of municipal measures that largely prohibit local police officers from either arresting or citing people for Class A or Class B marijuana misdemeanors. Over 400,000 Texans reside in those cities.

In May, voters in the city of Austin overwhelmingly approved a similar local ballot measure.

Texas leads the nation in marijuana-related arrests. Under state law, the possession of two ounces or less of cannabis is defined as a criminal misdemeanor, punishable by up to 180 days in jail and a $2,000 fine. Those arrested are disproportionately African Americans.

In addition, voters in five Ohio cities - totaling some 30,000 people - similarly passed ballot measures either reducing or eliminating local marijuana possession penalties. Those towns are Corning, Kent, Laurelville, Rushville, and Shawnee. A separate measure in Helena that was approved by voters is being challenged legally. To date, voters in some two-dozen Ohio towns have enacted similar ordinances.

In Rhode Island, voters in 25 of 31 eligible towns voted in favor of measures to allow for the opportunity to have licensed marijuana retail establishments in their localities. In Michigan, voters in numerous towns decided in favor of similar local measures to allow for the retail sale of either medical or adult-use cannabis products. In Connecticut, voters in two towns - Ledyard and Waterbury - decided in favor of ballot measures to permit retail cannabis sales.

Analysis: Inhaled Cannabis Reduces Pain and Anxiety, Improves Health-Related Quality of Life in Patients with Treatment-Resistant Conditions

London, United Kingdom: The sustained vaporization of THC-dominant cannabis flowers improves health-related quality of life measurements in patients suffering from chronic pain and anxiety-related disorders, according to observational data published in the journal Biomedicines.

A team of British and Spanish investigators assessed cannabis' efficacy in a cohort of 451 British patients authorized to consume cannabis flowers for treatment-resistant pain and/or anxiety. Patients in the study were all enrolled with Project Twenty21, "the first U.K. multi-center registry seeking to develop a body of real-world evidence to inform on the effectiveness and safety of medical cannabis." All of the study's participants had failed to respond to at least two prescription treatment options prior to obtaining an authorization for medical cannabis. All participants vaporized cannabis flowers for a period of at least three months.

Researchers reported that cannabis inhalation was associated with sustained (6+ months) improvements in both patient populations and that side effects were "minimal." Investigators reported more significant improvements among those diagnosed with treatment-resistant anxiety.

"Our results indicate that controlled inhalation of pharmaceutical grade, THC-predominant cannabis flos [flowers] is associated with a significant improvement in patient-reported pain scores, mood, anxiety, sleep disturbances and overall HRQoL [health-related quality of life] in a treatment-resistant clinical population," authors concluded.

Numerous surveys indicate that patients most frequently self-report using cannabis to mitigate symptoms of pain and anxiety.

Full text of the study, "Controlled inhalation of THC-predominant cannabis flos (flowers for inhalation) improves health-related quality of life and symptoms of pain and anxiety in eligible UK patients," appears in Biomedicines.

Review: Data Suggests Role for CBD in Managing Opioid Withdrawal Symptoms

New York, NY: The use of CBD can mitigate various symptoms associated with opioid withdrawal and it should be considered as an adjunctive treatment for patients, according to a review of the relevant literature published in the journal Cannabis and Cannabinoid Research.

Researchers affiliated with the Icahn School of Medicine at Mount Sinai identified 41 clinical studies evaluating the use of CBD for symptoms relevant to opioid withdrawal.

They reported: "Growing evidence suggests that CBD may have the potential to reduce anxiety, pain, and insomnia with also some signals for reducing craving, nausea, vomiting, muscle spasms, and blood pressure. These clinical symptoms are commonly observed in OUD [opioid use disorder] patients undergoing withdrawal, indicating that CBD could potentially be added to the standard opioid detoxification regimen to mitigate acute withdrawal-related symptoms as well as protracted withdrawal symptoms."

They concluded: "In summary, CBD has a good safety profile, is well tolerated with opioid agonists, and reduces key withdrawal symptoms. … Easing withdrawal symptoms with CBD could improve clinical outcomes by keeping patients engaged in treatment, facilitating smoother transition to MOUD [medications for opioid use disorder] like buprenorphine or extended-release naltrexone, and helping with tapering of opioid agonist treatment or opioid analgesics."

Cannabis use is frequently reported among patients withdrawing from opioids. According to a 2020 review paper, "[E]vidence … demonstrates the potential [of] cannabis to ease opioid withdrawal symptoms, reduce opioid consumption, ameliorate opioid cravings, prevent opioid relapse, improve OUD treatment retention, and reduce overdose deaths."

Full text of the study, "Adjunctive management of opioid withdrawal with the non-opioid medication cannabidiol," appears in Cannabis and Cannabinoid Research.

Case Report: CBD-Dominant Extracts Effectively Manage Symptoms in Autistic Patient

Toronto, Canada: The twice-daily administration of plant-derived CBD-dominant extracts is "an effective treatment for managing symptoms associated with autism," according to a case report published in the journal Cureus.

A team of Canadian investigators documented the treatment of a nine-year old patient diagnosed with nonverbal autism spectrum disorder (ASD). The patient received twice-daily dosing of a high-CBD/low-THC extract oil.

Researchers reported, "The child patient responded positively to the introduction of CBD oil treatment with reduced negative behaviors, better sleep, and improved communication." No adverse side-effects were reported.

They concluded, "With the increasing clinical studies on the use of cannabidiol in treating patients with mood disorders, anxiety, chronic pain conditions, and other behavioral problems, it should be considered as a treatment option in managing symptoms related to autism."

The findings are consistent with several other studies similarly reporting improvements in pediatric patients' ASD symptoms following the use of cannabinoid products, particularly CBD-rich extracts. Survey data published in 2021 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, "Cannabidiol in the treatment of autism spectrum disorder: A case study," appears in Cureus.