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Analysis: Adult-Use Legalization Doesn't Negatively Impact Crime Rates

Colorado Springs, CO: The adoption of state-level marijuana legalization laws does not lead to any significant uptick in overall criminal activity, according to data published in the Journal of Drug Issues.

A pair of researchers affiliated with the University of Colorado at Colorado Springs and with Boise State University in Idaho compared crime data in Colorado and Washington to a synthetic control over a ten-year period (2010-2019). They reported that legalization was "generally not associated with changes in index crime rates."

Authors concluded: "These findings substantiate prior research. Increased crime rates should not be a primary concern as more states move to adopt recreational marijuana use legislation."

Prior evaluations have reported an association between adult-use legalization and improvements in police clearance rates, concluding that legalization "positively influences police performance."

Full text of the study, "Crime in a time of cannabis: Estimating the effects of legalizing marijuana on crime rates in Colorado and Washington using a synthetic control method," appears in The Journal of Drug Issues.

Clinical Trial: CBD Dosing Reduces Anxiety, Improves Cognitive Performance

Boston, MA: Patients with moderate-to-severe anxiety experience symptom improvements and better cognitive performance following the daily administration of full spectrum CBD extracts, according to open-label trial data published in the journal Communications Medicine.

A team of investigators affiliated with Harvard Medical School assessed the safety and efficacy of CBD extracts in a cohort of anxiety patients over a four-week period. Trial participants consumed oral extracts three times daily. Extracts contained approximately 10mgs of CBD and less than one percent THC. Subjects in the trial had either no prior experience with cannabis products or had been abstinent from cannabis for at least one year.

Researchers reported significant improvements in patients' symptoms over the course of the trial. "Treatment response analyses revealed rapid onset of clinically significant reductions in anxiety with most patients achieving and maintaining treatment response after one week and all patients achieving and maintaining treatment response by week three," they determined. "Secondary outcome assessments demonstrated improvements on measures of mood, sleep disturbance, quality of life and executive functioning following treatment. ... Specifically, patients exhibited significantly faster performance with fewer errors on several tasks of executive function relative to baseline, while assessments of visual and verbal memory remained stable. These findings are consistent with data from observational investigations reporting long-term treatment with medical cannabis is associated with improved clinical state and executive functioning."

Authors reported that CBD doses were "well-tolerated with no serious adverse events and few side effects."

Although prior studies have similarly identified anxiolytic activities associated with CBD, patients in this study achieved a treatment response at comparably lower doses (30 mgs per day versus 300 mgs per day). Researchers theorized that the use of full-spectrum products is likely more efficacious than the administration of a single extracted CBD isolate. A 2019 study assessing the use of plant-derived CBD-dominant capsules similarly showed improvements in anxiety and sleep following the daily administration of low-dose (25mgs) products.

Investigators concluded: "Initial results from the open-label stage of this clinical trial demonstrated significant improvement of primary outcome assessments of anxiety, providing preliminary evidence that a full- spectrum, high-CBD product may be efficacious for treating anxiety with few side effects. ... A definitive assessment of the impact of this novel treatment on clinical symptoms and cognition will be ascertained in the ongoing double-blind, placebo-controlled stage."

Full text of the study, "Clinical and cognitive improvement following full-spectrum, high cannabidiol treatment for anxiety: open-label data from a two-stage, phase 2 clinical trial," appears in Communications Medicine.

Analysis: Young People No More Likely to Try Cannabis in States That License Retail Sales

Seattle, WA: Adolescents who reside in states where retail sales of cannabis are legal for adults are no more likely to consume cannabis than are young people in states where it isn't, according to data published in the American Journal of Preventive Medicine.

A team of investigators affiliated with the University of Washington and with Colorado State University evaluated longitudinal data from three US states. In two of the states (Oregon and Washington), legal sales were permitted, while in the other state they were not.

Researchers reported: "Change in legalization status across adolescence was not significantly related to within-person change in the probability or frequency of self-reported past-year cannabis use. At the between-person level, youth who spent more of their adolescence under legalization were no more or less likely to have used cannabis at age 15 years than adolescents who spent little or no time under legalization."

They concluded, "[Our] findings are not consistent with changes in the prevalence or frequency of adolescent cannabis use after legalization. ... Taken together with previous studies, these findings add weight to the conclusion that adolescent cannabis use is holding steady in the wake of legalization."

The study's conclusions are consistent with those of numerous others, finding that adult-use regulations are not associated with either increased marijuana use or access among young people, or with any changes in young people's perceptions toward the substance.

Full text of the study, "Effects of cannabis legalization on adolescent cannabis use across 3 states," appears in the American Journal of Preventive Medicine.

Study: Cannabis Use Associated with Greater Rates of Physical Activity in HIV+ Patients

Providence, RI: Cannabis use is associated with greater levels of physical activity in HIV+ positive patients, according to data published in the journal AIDS Care.

A team of researchers from Brown University in Rhode Island and Boston University's School of Public Health assessed the relationship between self-reported substance use and exercise engagement in a cohort of HIV+ patients.

Investigators reported that those who reported consuming cannabis were significantly more likely to be physically active than those patients who did not.

They reported, "The estimated mean rate of vigorous METs [Metabolic Equivalent of Task Units] was ... 6.25 times higher for people who used cannabis than non-users."

Researchers theorized that cannabis' ability to mitigate symptoms associated with HIV, such as pain, may facilitate greater engagement in physical activity.

The findings are consistent with several prior studies reporting a positive association between cannabis use and exercise, particularly among seniors.

Full text of the study, "The relationship between substance use and physical activity among people living with HIV, chronic pain, and symptoms of depression: A cross-sectional analysis," appears in AIDS Care.

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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.

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