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Review: Clinical Trials Demonstrate Effectiveness of Cannabinoids for Managing Peripheral Neuropathy

Charlottesville, VA: Patients suffering from peripheral neuropathy respond favorably to the use of botanical cannabis and other cannabis-based products, according to the findings of a systematic review published in The Journal of Hand Surgery.

Researchers affiliated with the University of Virginia reviewed data from 14 randomized clinical trials involving over 600 patients. Ten of the trials assessed the use of either botanical cannabis or Sativex, an oromucosal spray consisting of plant-derived cannabinoids.

“Of the included studies, 79 percent showed improvement in neuropathic pain following treatment with a cannabinoid,” investigators reported. “Improvements in secondary outcomes such as sleep quality, anxiety, sensory testing, and quality of life were also noted in several studies, consistent with prior literature. Most reported side effects were mild and well-tolerated.”

The study’s authors concluded, “Overall, the data demonstrate that cannabis-based medicines are a potentially effective emerging drug class in the treatment of peripheral neuropathy via reducing neuropathic pain and related symptoms.”

Data published in 2023 in the Journal of the American Medical Association reported that nearly one in three patients with chronic pain use cannabis as an analgesic agent and many of those who do substitute it in place of opioids.

Full text of the study, “The use of cannabinoids in the treatment of peripheral neuropathy and neuropathic pain: A systematic review,” appears in The Journal of Hand Surgery.

Analysis: Black and Multiracial Newborns Disproportionately Selected for Drug Testing, but Are No More Likely To Suffer From Neglect

Ann Arbor, MI: Newborns who test positive for prenatal marijuana exposure are at no increased risk of suffering from either child abuse or neglect, according to an analysis of hospital birth records and subsequent Child Protective Services (CPS) investigations published in the journal Child Abuse & Neglect.

Investigators at the University of Michigan assessed records from over 35,000 births. They found that Black babies are disproportionately tested for drugs – a finding that is consistent with prior data – but that they are no more likely than other newborns to suffer from neglect.

Researchers wrote: “Newborns with a test positive for THC only were not more likely to experience maltreatment. … To our knowledge, this is the first study to link individual hospital birth records including newborn drug tests and results with subsequent CPS investigations and records of substantiated maltreatment.”

They concluded: “No individual person, family, or institution benefits from racially biased testing or unnecessary CPS investigations. These practices have no impact on child safety, but they represent a clear racial disparity and unnecessarily contribute to racial disproportionality in child welfare. … The evidence strongly supports a policy to end routine CPS investigations for cannabis exposure and eliminate racially biased drug testing practices.”

Separate data published last year by researchers at Harvard Medical School similarly determined that those selected to undergo marijuana-specific drug screening during the labor and delivery process are disproportionately Hispanic or African American. The authors of that study concluded, “Toxicology testing of patients for a sole indication of cannabis use, without other risk factors, may be of limited utility in elucidating other substance use and may exacerbate existing disparities in perinatal outcomes.”

Another study, published last year in The Journal of the American Medical Association, also affirmed that “racial disparities [exist] in newborn drug testing [that are] unrelated to obstetrical risk.” Full text of the study, “Prenatal cannabis exposure and the risk of subsequent maltreatment,” appears in Child Abuse & Neglect.

West Virginia: Supreme Court Rules Against Medical Cannabis Use While on Probation

Charleston, WV: Judges may prohibit people on probation from using medical marijuana despite the state’s decision to legalize and regulate the substance, according to a recent ruling by the state Supreme Court.

The Court determined that the West Virginia Cannabis Act, which lawmakers passed in 2016, “does not supersede or prevent a circuit court from requiring a probationer to refrain from using marijuana as a condition of his or her release on probation, even when the probationer has qualified as a ‘patient’ and obtained an identification card pursuant to the Cannabis Act.”

That’s because state law mandates that a “probationer may not, during the term of his or her probation, violate any criminal law of this or any other state or of the United States.” Marijuana remains classified under federal law as a Schedule I prohibited substance.

The Court further opined that judges possess the authority to impose conditions restricting probationers’ conduct if those “conditions generally focus on goals such as rehabilitation, deterring criminal behavior, and protecting the public.”

“Just as reasonable conditions restricting a probationer’s association with certain persons does not conflict with the Constitution’s guarantee of free association, prohibiting [the defendant’] use of medical cannabis through a probation condition imposed pursuant to West Virginia Code § 62-12-9 does not conflict with [state’s medical marijuana law] and the ‘notwithstanding’ clause in the latter provision does not apply,” it concluded.

The Court’s ruling contrasts decisions rendered in some other states, including Pennsylvania and Michigan, which have rejected arguments that those on probation can be restricted from accessing medical cannabis. Last year, Maine lawmakers enacted legislation limiting the ability of courts to order those on probation, parole, or pre-trial release to refrain from the use of cannabis.

New Mexico: Officials in State’s Largest County Vote to End Cannabis Testing for Most Public Employees

Albuquerque, NM: Bernalillo County (population: 672,000) commissioners voted unanimously to revise the county’s Drug and Alcohol-Free Workplace Policy to remove cannabis “when used legally off-duty for medical or recreational purposes” from its definition of illegal drugs. As a result, most public employees will no longer be subject to either pre-employment or random workplace testing for cannabis.

Bernalillo County, which includes Albuquerque, is the most populous in the state.

The commissioners’ actions are similar to those of lawmakers in numerous other municipalities and counties nationwide, including Atlanta, Cleveland, the District of Columbia, Philadelphia, and St. Louis, which also limit marijuana screening for most public employees.

California, Connecticut, Minnesota, Montana, New Jersey, New York, and Rhode Island have adopted similar protections statewide.

Lawmakers legalized the adult-use marijuana market in New Mexico in 2021. However, the law does not provide workplace protections for those who consume cannabis while away from the job.

Additional information is available from the NORML Fact Sheet, ‘Marijuana Legalization and Impact on the Workplace.’

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Clinical Trial: Cannabis Oil Mitigates Knee Pain From Osteoarthritis

Sukhothai, Thailand: The sublingual administration of oil extracts containing plant-derived cannabinoids significantly reduces knee pain in subjects suffering from treatment-resistant osteoarthritis, according to clinical data published in the Journal of Southeast Asian Orthopaedics.

A team of Thai investigators conducted a randomized, double-blind, placebo-controlled clinical trial involving 32 patients diagnosed with severe osteoarthritic knee pain. All the participants in the study were awaiting total knee arthroplasty. Participants consumed either oral extracts containing THC (4.59 mg/drop) and CBD (24.25 mg/drop) or a placebo (coconut oil) for 30 days in addition to traditional prescription medications.

Patients’ pain scores “demonstrated a statistically significant improvement” following cannabis treatment, researchers reported.

The study’s authors concluded: “Cannabis oil significantly reduced pain intensity and improved the QOL [quality of life] in patients with knee OA, as reflected by improvements in the NRS [Numeric Rating Scale]and KOOS [Knee Injury and Osteoarthritis Outcome] scores. ... Future research with optimized dosages, larger sample sizes, and longer follow-up periods is needed to evaluate its true clinical relevance.”

Full text of the study, “Effectiveness of cannabis oil as an adjuvant therapy in patients with severe knee osteoarthritis: A randomized, double-blind study,” appears in the Journal of Southeast Asian Orthopaedics. Additional information on cannabis and arthritis is available from NORML’s publication, Clinical Applications for Cannabis & Cannabinoids.

Study: Changes in Marijuana’s Legal Status Do Not Soften Public’s Stance Toward Driving Under the Influence

Columbus, OH: Adults express similar degrees of intolerance toward driving under the influence of marijuana, regardless of whether they live in a jurisdiction where cannabis is legal or illegal, according to survey data published in the Biometrical Journal.

Researchers affiliated with Ohio State University assessed the public’s attitudes and their willingness to drive after consuming marijuana in states where medical cannabis is legal and where it remains prohibited.

They concluded: “The hypothesis that more liberal marijuana policies will lead to dangerous driving conditions was not corroborated by our analysis. In all three analyses, there was practically no evidence to reject the null hypothesis and to conclude that medical marijuana legalization leads to more tolerant behaviors and attitudes toward DAMU [driving after marijuana use]. In fact, … we found practically no evidence for this hypothesis.”

The researchers’ findings are consistent with those of several prior studies. For instance, a 2022 study conducted by investigators at the Research Triangle Institute reported: “Current cannabis users in recreational and medical-only cannabis states were significantly less likely to report driving within three hours of getting high in the past 30 days, compared to current users living in states without legal cannabis.”

A 2021 study similarly determined that self-reported drugged driving behavior does not rise post-legalization. Rather, authors reported, “[M]arijuana users in states that legalized RM [recreational marijuana] self-reported driving after marijuana use less than their counterparts (who resided in states where adult-use cannabis remains illegal). They were also less likely to find such behavior [driving after ingesting cannabis] acceptable.”

A 2020 study by researchers affiliated with the Johns Hopkins Bloomberg School of Public Health also concluded that adults “from states with legal recreational cannabis sales had significantly lower prevalence of driving after cannabis use and higher prevalence of protective attitudes compared to those from states without legal recreational sales.”

Full text of the study, “A matched design for causal inference with survey data: Evaluation of medical marijuana legalization in Kentucky and Tennessee,” appears in Biometrical Journal.

Analysis: Pain Patients Enrolled in Utah’s Medical Cannabis Program Significantly Reduce Their Use of Opioids

Salt Lake City, UT: Chronic pain patients enrolled in Utah’s medical cannabis access program significantly reduce their opioid intake, according to an analysis provided to the state’s Medical Cannabis Advisory Board.

Researchers assessed prescription opioid use trends in 157 patients enrolled in the program. They reported: “In this population, 157 patients (84.4 percent) showed a decrease in Morphine Milligram Equivalents (MME) per month after starting cannabis use. Specifically, there was a 53.1 percent reduction. The mean MME/month in the period before cannabis use was 3832 MMD/Month, and after starting cannabis we observed a mean of 1798 MME/Month.”

Analysts also acknowledged that opioid-related overdose deaths fell significantly following the adoption of the cannabis access program. “This shift suggests that the introduction of cannabis as a therapeutic alternative may have contributed to a reduction in opioid use among patients seeking pain relief,” they wrote.

Numerous other studies have similarly documented reduced opioid use in pain patients following their use of medical cannabis.

The study’s authors concluded, “The results from this study align with previous literature indicating that medical cannabis can serve as an effective adjunctive therapy for chronic pain, leading to a significant reduction in opioid use.”

Full text of the analysis, “Impact of Cannabis on Opioid Prescriptions in Chronic Pain: Insights from Recent Research in Utah,” is available online.

Illinois: Supreme Court Rules “Odor of Raw Cannabis” Is Probable Cause for a Motor Vehicle Search

Chicago, IL: Justices on the state Supreme Court have determined that police can search a motor vehicle without a warrant based solely on the “odor of raw cannabis” emanating from the car.

The majority’s decision hinged on statutory language in the state’s Vehicle Code prohibiting the possession of cannabis in a motor vehicle unless it is in a “sealed, odor-proof, child-resistant cannabis container.” Lawmakers amended the Code when it established regulations legalizing the adult-use marijuana market in 2019. Violators of the law may face civil or criminal penalties.

“Although cannabis may no longer be contraband in all circumstances, ‘users must possess and use cannabis in accordance with’ our laws,” the majority opined. “When the odor of raw cannabis comes from a vehicle driven on an Illinois highway, it is almost certain that the cannabis is being possessed in violation of the Vehicle Code’s odor-proof container requirement.”

They concluded: “In sum, we hold that the odor of raw cannabis coming from a vehicle being operated on an Illinois highway, alone, is sufficient to provide police officers, who are trained and experienced in distinguishing between burnt and raw cannabis, with probable cause to perform a warrantless search of a vehicle.”

The decision contrasts with a ruling issued by the court months earlier finding that police may not conduct a warrantless search of a vehicle based solely on the odor of burnt marijuana. The conflicting opinions “defy logic,” justices wrote in their dissent.

Though police officers frequently testify that they can identify the presence of raw marijuana in a car solely based on its odor, empirical studies have challenged these claims.

The case is Illinois v. Molina.

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