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Survey: IBD Patients Frequently Report Using Medical Cannabis for Symptom Relief

San Juan, Puerto Rico: Nearly one in four patients with inflammatory bowel diseases (e.g., ulcerative colitis or Crohn’s disease) report using medical cannabis, according to survey data published in the International Journal of Environmental Research and Public Health.

A team of investigators from Puerto Rico and the United States surveyed 162 IBD patients regarding their attitudes toward cannabis.

Twenty-three percent of respondents said that they consumed cannabis products specifically to address symptoms of IBD, such as pain, decreased appetite, insomnia, and anxiety. Over 85 percent of respondents who consumed cannabis for therapeutic purposes said that it improved their symptoms.

The findings are consistent with those of other surveys showing that a significant percentage of IBD patients acknowledged using cannabis and gaining relief from it.

“The use of medical cannabis to relieve symptoms is frequent in patients with IBD, although knowledge about cannabis among patients and physicians is limited,” the study’s authors concluded. “Our study supports the need for more investigation in this area, as well as an increase in educational programs for patients and physicians.”

Observational trials have previously documented that cannabis use by IBD patients is associated with fewer ER visits. In a randomized placebo-controlled trial involving 21 patients with refractory Crohn’s disease, nearly half achieved disease remission following their use of herbal cannabis.

Full text of the study, “A survey of cannabis use among patients with inflammatory bowel disease (IBD) appears in the International Journal of Environmental Research and Public Health.

Study: Daily Use of CBD Tinctures Associated with Decreased Daytime Drowsiness, No Increased Risk of Liver Disease

Chicago, IL: Adults who consume CBD daily experience less daytime drowsiness and are not at an increased risk of suffering from either low testosterone or liver abnormalities, according to data published in the journal Medical Cannabis and Cannabinoids.

Researchers affiliated with the University of Chicago and with Tarleton University in Texas assessed the daily use of CBD in a cohort of over 1,000 adults. Most of the study’s participants reported having consumed full-spectrum CBD tinctures for at least one year.

Investigators concluded: “In this large-sample study, self-dosing [with] CBD was not associated with an increased prevalence of elevation of LT [liver tests] or low levels of TT [total testosterone] in men. Furthermore, CBD administration decreased DD [daytime drowsiness] and was associated with a lower prevalence of low testosterone levels in older men as compared to age-adjusted population norms. ... [I]n those over 45 years of age, the prevalence of type 2 diabetes was significantly lower than that of the general population.”

Several population-based studies have reported that cannabis consumers typically possess lower BMI and other favorable indices related to diabetic control. Observational studies have also shown that the past use of cannabis is significantly associated with lower odds of diabetes in adults.

Data published in 2021 similarly determined that the repeated use of oral CBD products is not associated with liver abnormalities, such as the elevated production of the enzyme alanine transaminase.

Full text of the study, “The effects of long-term self-dosing of cannabidiol on drowsiness, testosterone levels, and liver function,” appears in Medical Cannabis and Cannabinoids.

Montana: Lawmakers Table Legislation That Sought to Eliminate Adult-Use Cannabis Sales

Helena, MT: Senators on the Business, Labor, and Economic Affairs Committee voted to halt any further consideration of legislation, Senate Bill 546, to repeal much of the state’s voters-approved marijuana legalization law.

The proposed legislation sought to shut down all licensed adult-use cannabis retailers and imposed a one-plant limit upon those who home-cultivate marijuana. It also sought to dramatically increase the taxes imposed on the sale of medical cannabis products, while capping the THC potency of those products at 10 percent.

Voters approved a pair of complementary citizen-initiated ballot measures in 2020 legalizing the personal possession, commercial production, and retail sales of marijuana. Licensed retailers began legally selling marijuana products to those ages 21 and older on January 1, 2022. (Voters on two prior occasions had approved medical cannabis access initiatives.)

Twenty-one states have approved legislation regulating the adult-use cannabis market. No state has ever rolled back or repealed an adult-use legalization law.

Kentucky: Lawmakers Fail to Advance Senate-Backed THC Per Se Law

Frankfort, KY: House lawmakers failed to advance Senate-backed legislation, Senate Bill 228, that sought to impose new criminal penalties for any motorist who operates a vehicle with the presence of THC in their blood above 5ng/ml.

Senators passed the measure in March, but House members failed to move it out of committee before the session’s adjournment.

Numerous scientific studies have concluded that the presence of THC in blood is an unreliable predictor of either recent cannabis exposure or impairment of performance. A report by the Congressional Research Service similarly concludes: “Research studies have been unable to consistently correlate levels of marijuana consumption, or THC in a person’s body, and levels of impairment. Thus, some researchers, and the National Highway Traffic Safety Administration, have observed that using a measure of THC as evidence of a driver’s impairment is not supported by scientific evidence to date.”

NORML has long opposed the imposition of THC per se thresholds for cannabinoids in traffic safety legislation, opining: “The sole presence of THC and/or its metabolites in blood, particularly at low levels, is an inconsistent and largely inappropriate indicator of psychomotor impairment in cannabis consuming subjects. ... Lawmakers would be advised to consider alternative legislative approaches to address concerns over DUI cannabis behavior that do not rely solely on the presence of THC or its metabolites in blood or urine as determinants of guilt in a court of law. Otherwise, the imposition of traffic safety laws may inadvertently become a criminal mechanism for law enforcement and prosecutors to punish those who have engaged in legally protected behavior and who have not posed any actionable traffic safety threat.”

Six states -- Illinois, Montana, Nevada, Ohio, Pennsylvania, and Washington -- impose various per se limits for the presence of specific amounts of THC in blood while 11 states (Arizona, Delaware, Georgia, Illinois, Iowa, Michigan, Oklahoma, Rhode Island, South Dakota Utah, and Wisconsin) impose zero tolerant per se standards. In those states, it is a criminal violation of the traffic safety laws to operate a motor vehicle with any detectable levels of THC in blood. Colorado law infers driver impairment in instances where THC is detected in blood at levels of 5ng/ml or higher.

In 2021, lawmakers in Indiana and Nevada repealed their per se traffic safety limits for the presence of THC in blood.

Literature Review: CBD Beneficial for Treating Insomnia

Decorah, Iowa: The administration of plant-derived CBD is associated with improvements in patients suffering from insomnia, according to a review of human trials published in the journal Cannabis and Cannabinoid Research.

Investigators affiliated with Luther College in Iowa and with the Mayo Clinic in Rochester, Minnesota reviewed data from 34 human trials assessing the use of CBD on insomnia symptoms.

“All studies reported improvement in the insomnia symptoms of at least a portion of their participants,” authors reported.

They concluded, “The results of our systematic review suggest that CBD alone or with equal quantities of THC may be beneficial in alleviating the symptoms of insomnia.”

Randomized, placebo-controlled trial data published in December reported that the short-term use of plant-derived cannabis extracts is well-tolerated and effective in patients diagnosed with insomnia. Patients in the study were administered either extracts containing 10mg of THC and 15mg of CBD or placebo for two weeks. Those receiving cannabis extracts experienced improved sleep quality by up to 80 percent and “60 percent of participants no longer classified as clinical insomniacs at the end of the two-week intervention period.”

Full text of the study, “Use of cannabidiol in the management of insomnia: A systematic Review,” appears in Cannabis and Cannabinoid Research.

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Clinical Trial: CBD/THC Combination Controls Blood Sugar, Lowers Cholesterol in Type 2 Diabetics

Tehran, Iran: Diabetic patients administered a sublingual spray containing CBD and THC show improvements in their blood sugar and cholesterol levels, according to placebo-controlled data published in the Iranian Journal of Pharmaceutical Research.

A team of Iranian investigators evaluated the efficacy of a proprietary formulation of plant-derived CBD/THC compared to placebo in a cohort of 50 patients with type 2 diabetes. Patients utilized the spray twice daily for eight weeks. The sublingual formulation contained a ten-to-one ratio of CBD to THC.

Compared to placebo, cannabinoid therapy was associated with a “statistically significant decline in total cholesterol, triglycerides, LDL-C, FBS [fasting blood glucose levels], Hb [hemoglobin] A1C, and insulin secretion … at the end of the 8-week treatment period. ... [T]here were no statistically significant differences in reported adverse effects between the two groups.”

Researchers concluded: “In the present study, we demonstrated that sublingual administration of [a CBD/THC] spray, ... twice daily through an eight-week treatment period could effectively improve the patient’s lipid profile and glucose tolerance. ... Based on these observations, the combination of CBD/Delta9-THC regimen could be a new therapeutic regimen for controlling the lipid profile and glycemic state of DM [type 2 diabetic] patients.”

Clinical trial data has previously shown that the administration of the cannabinoid THCV (tetrahydrocannabivarin) decreases fasting glucose levels in type 2 diabetics.

Population-based studies have reported that cannabis consumers typically possess lower BMI and other favorable indices related to diabetic control. Observational studies have also shown that the past use of cannabis is significantly associated with lower odds of diabetes in adults.

Full text of the study, “A phase I randomized, placebo-controlled study on efficacy and safety profile of a sublingually administered cannabidiol/delta-9-tetrahydrocannabinol (10: 1) regimen in diabetes Type 2 patients,” appears in the Iranian Journal of Pharmaceutical Research.

Fewer Federal Offenders Charged with Marijuana-Related Offenses in 2022

Washington, DC: Federal officials in 2022 charged fewer people with marijuana-related offenses than they had in previous years, according to data compiled by the US Sentencing Commission in its latest Sourcebook of Federal Sentencing Statistics.

Just over 800 people were charged with violating federal marijuana laws in 2022. Ninety-nine percent of those charged were indicted for drug trafficking. Overall, those charged for marijuana-related violations comprised just four percent of all federal drug offenders.

Those totals represent a significant decrease from a decade ago, when federal officials charged nearly 7,000 people for violating federal marijuana laws. At that time, more people were federally indicted for marijuana offenses than for any other drug-related offense. However, since 2012, the number of people federally prosecuted for marijuana-related violations has fallen steadily.

In total, 32 percent of all people federally prosecuted in 2022 were charged with drug law violations.

Full text of the 2022 Sourcebook of Federal Sentencing Statistics is available from the United States Sentencing Commission.

Survey: One in Ten Veterans Acknowledges Using Cannabis

Fort Worth, Texas: An estimated one in ten US military veterans report having consumed cannabis within the past year, according to data published in the journal Substance Use & Misuse.

A pair of researchers affiliated with the University of North Texas and the University of Illinois assessed cannabis use trends among a nationally representative cohort of over 16,000 veterans over the years 2013 to 2019.

Investigators reported that ten percent of those sampled acknowledged past-year cannabis use. Consumers were most likely to define their consumption as medical-only if they were age 65 or older.

Only a minority of the study’s respondents acknowledged having received an authorization to use cannabis from a healthcare provider. This is likely because federal law prohibits providers affiliated with the Department of Veterans Affairs from issuing recommendations, even in states where the medical use of cannabis is legal.

The study’s authors concluded: “Our findings, taken in context with current federal policy, point toward a need for enhanced care coordination among veterans who may benefit from marijuana, but are unable to access it through the VA. ... Additional research is needed to better understand veterans’ use of a marijuana in the context of federal VA restrictions, including the examination of how veterans obtain marijuana, what affect this has on their care coordination and health outcomes, and whether or not marijuana can play a role in reducing other drug use and drug-related harms among veterans.”

According to nationwide survey data compiled by the group Iraq and Afghanistan Veterans of America, 75 percent of military veterans “would be interested in using cannabis or cannabinoid products as a treatment option if it were available.”

Full text of the study, “National trends in past-year marijuana use among veterans in the United States, 2013-2019,” appears in Substance Use & Misuse.

Utah: Governor Signs Bill Establishing State-Sponsored Cannabis Research Program

Salt Lake City, UT: Republican Gov. Spencer Cox has signed legislation into law establishing a cannabis-specific medical research center within the University of Utah.

House Bill 230 appropriates $650,000 in funding for the creation of the Center for Medicinal Cannabis Research. The Center “shall facilitate and support funding for research related to the efficacy and potential health effects of various cannabis delivery methods, including vaporizing, ingesting, topical application, and combustion; shall support researchers in applying for and securing federal and private research grant funding for expanding medical cannabis research; shall review current and future cannabis research literature, clinical studies, and clinical trials; [and] shall educate medical providers, lawmakers, and the public about medical cannabis research advances.”

Several states -- including California, Colorado, Florida, and Pennsylvania -- have similarly established state-sponsored institutions to conduct clinical trials and other research specific to the safety and efficacy of cannabis. Those programs have conducted several FDA-approved clinical trials documenting cannabis’ efficacy in various patient populations.

Utah lawmakers enacted legislation permitting for the limited use and distribution of cannabis and cannabis products in 2018.

South Dakota: Governor Signs Bills into Law Amending Medical Cannabis Access Rules

Pierre, South Dakota: Republican Gov. Kristi Noem has signed several bills into law amending the state’s medical cannabis regulations.

Senate Bill 1 expands the pool of patients eligible to receive medical cannabis authorizations to include those diagnosed with AIDS/HIV, ALS (aka Lou Gehrig’s disease), multiple sclerosis, cancer (or who are undergoing chemotherapy), Crohn’s disease, epilepsy, and/or post-traumatic stress. However, the legislation repeals provisions that previously provided patients and others the ability to petition health department officials to add additional qualifying conditions. Going forward, lawmakers will have the sole discretion to add new qualifying conditions.

Another bill, House Bill 1053, prohibits health practitioners from providing patients with an authorization to access medical cannabis if they are either pregnant or breastfeeding. No other state explicitly imposes similar restrictions. NORML opposed HB 1053 on the grounds that it unduly interferes with doctor/patient relations.

Governor Noem signed a third bill into law, House Bill 1154, which prohibits recommending physicians from offering discounts or other financial incentives in exchange for their services.

The Governor also vetoed legislation, House Bill 1209, which sought to increase the amount allowable THC levels in state-legal hemp products.

South Dakotans approved a citizens’ initiative legalizing cannabis for medical purposes in 2020. At that time, Gov. Noem campaigned against the initiative effort.

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Analysis: Drivers in Traffic Collisions More Likely to Test Positive for High Levels of Alcohol Than THC

Drivers treated for traffic-related injuries are more likely to test positive for high levels of alcohol (BAC ≥ 0.08 percent) than they are likely to test positive for elevated levels of THC (THC in blood ≥ 5 ng/mL), according to data published in the journal Addiction.

Canadian investigators quantified and reviewed alcohol and THC concentrations in a cohort of nearly 7,000 injured drivers.

They reported, “In this sample, there were over three times as many drivers with BAC ≥ 0.08% (12.6 percent) than with THC ≥ 5 ng/mL (3.5 percent), suggesting that alcohol remains a greater threat to road safety.”

Authors also acknowledged that drivers who tested positive for high levels of alcohol were more likely to be involved in single vehicle accidents as well as in motor vehicle accidents resulting in serious injuries.

Because THC can remain present in blood for extended periods of time, the study’s authors emphasized that at least some subjects who tested positive for cannabis may not necessarily have had recent exposure to it. They further emphasized that subjects testing positive for the presence of THC at levels below 5 ng/ml are typically not under the influence and likely do not possess a significantly increased risk of being involved in a motor vehicle accident.

Driving simulator studies generally report that cannabis administration is associated with compensatory driving behavior, such as decreased mean speed and increased mean following distance, whereas alcohol administration is associated with more aggressive driving behavior. Nevertheless, cannabis exposure can influence certain psychomotor skills necessary for safe driving, such as reaction time and drivers’ ability to maintain lane positioning.

A study conducted by the US National Highway Traffic Safety Administration reported that drivers who test positive for any amount of THC possess, on average, a far lower risk of being involved in a traffic collision than do drivers who test positive for alcohol at or near legal limits.

By contrast, drivers who test positive for the presence of both THC and alcohol in their system tend to possess significantly higher odds of being involved in a motor vehicle accident than do those who test positive for either substance alone.

Full text of the study, “A comparison of cannabis and alcohol use in drivers presenting to hospital after a vehicular collision,” appears in Addiction.

Study: Short-Term Use of Prescription Medication Containing THC and CBD Not Associated with Cardiovascular Complications in High-Risk Patients

Genova, Italy: Patients with a history of stroke are not at an increased risk of cardiovascular complications following the use of nabiximols (a/k/a Sativex – an oromucosal spray containing a balanced ratio of plant-derived THC and CBD), according to clinical trial data published in the journal Frontiers in Cardiovascular Medicine. Nabiximols is available by prescription in various countries, but not in the United States, for patients suffering from symptoms of multiple sclerosis.

Italian researchers compared the cardiovascular impact of nabiximols versus placebo in a cohort of 34 stroke survivors. Subjects in the study suffered from symptoms of spasticity. Patients in the study took either nabiximols or placebo in addition to their standard medications for a period of one-month.

Investigators reported: “No … adverse drug effects emerged during nabiximols treatment, namely no significant fluctuation of blood pressure and heart rate, nor ischemic or hemorrhagic events occurred. During nabiximols treatment, self-assessed blood pressure and heart rate did not change compared to the baseline condition. No patients showed significant acceleration or decrease in heart rate or change in rhythm and none required an additional ECG or cardiological evaluation during the study.”

Authors concluded: “The present study is the first to evaluate the effects of a cannabinoid drug (nabiximols) in patients with post-stroke spasticity. … This ancillary study adds evidence that, in patients who already underwent a cerebrovascular accident, nabiximols does not determine significant blood pressure and heart rate variation or cardiovascular complications. These data support the cardiovascular safety of nabiximols, encouraging more extensive studies involving cannabinoids characterized by slow absorption rates.”

Numerous studies demonstrate the ability of cannabinoids to influence blood pressure and other cardiovascular responses. However, data is inconsistent with respect to whether the frequent use of cannabis may increase one’s risk of stroke, heart attack, or other adverse cardiovascular events. While some studies report an increased risk of stroke and other cardiovascular diseases among marijuana consumers, others report either no risk or provide evidence of possible cardioprotection. A 2021 literature review of 67 studies published in The American Journal of Medicine concluded, “[M]arijuana itself does not appear to be independently associated with excessive cardiovascular risk factors.” Authors did caution, however, that “it can be associated with other unhealthy behaviors such as alcohol use and tobacco smoking that can be detrimental” to cardiovascular health.

Full text of the study, “Nabiximols effect on blood pressure and heart rate in post-stroke patients: A randomized controlled study,” appears in Frontiers in Cardiovascular Medicine.

Mississippi: Bill Amending Medical Cannabis Access Regulations Advanced to Governor

Jackson, MS: Lawmakers have approved legislation, House Bill 1158, amending provisions of the state’s medical cannabis access law.

Proposed changes to the law will make it easier for qualified patients to register for the program and for physicians to participate in it. Language in the bill also expedites the timeline during which officials must approve patients’ registry applications. Other proposed changes require designated caregivers to undergo criminal background checks.

The measure now goes to Republican Gov. Tate Reeves for final approval.

State-licensed dispensaries began selling medical cannabis to qualified patients in January, nearly one year after legislators passed comprehensive legislation regulating its production and dispensing.

Voters in 2020 had initially decided in favor of a citizens’ initiative legalizing medical cannabis use. However, the state Supreme Court later struck down the state’s initiative process, thereby nullifying the election result.

Tourette Syndrome Patients Report Quality of Life Improvements Following Cannabis Therapy

Tel Aviv, Israel: Tourette Syndrome (TS) patients report improvements in their quality of life and reductions in their use of prescription medications following cannabis therapy, according to data published in the journal Cannabis and Cannabinoid Research.

Israeli investigators surveyed patients prior to and six-months following cannabis treatment. Subjects in the study consumed products containing roughly twice as much THC as CBD.

Participants reported statistically significant improvements in their quality of life and employment status following cannabis treatment. Most subjects also reported reduced symptoms of anxiety and obsessive-compulsive tendencies. Patients reduced their use of prescription medicines.

By contrast, subjects did not report statistically significant improvements in their frequency of either vocal or motor tics during the study period.

Authors concluded: “Subjective reports from TS patients suggest that medical cannabis may improve their quality of life and comorbidities. More studies are needed to evaluate the efficacy and safety of medical cannabis.”

A limited number of clinical trials have shown both oral THC and inhaled cannabis to be associated with symptom improvements in TS patients, including decreased tic severity and reductions in obsessive-compulsive behaviors. The results of a randomized, placebo-controlled trial published last month in the journal Psychiatry Research reported that patients with more severe TS symptoms experienced symptomatic improvements following the consumption of a balanced formulation of oral THC and CBD.

Full text of the study, “Using medical cannabis in patients with Gilles de la Tourette’s Syndrome in a real-world setting” appears in Cannabis and Cannabinoid Research.

CBD Administration Mitigates Opioid Cravings in Animals

Portland, OR: The administration of plant-derived CBD significantly reduces opioid cravings in animals, according to preclinical data published in the journal Addiction Neuroscience.

Investigators affiliated with Washington State University in Spokane and with the Legacy Research Institute in Portland assessed the efficacy and safety profile of vaporized CBD in a cohort of female rats.

They reported that rats provided with CBD were less likely to self-administer morphine.

“[T]he ability of WPE [whole-plant cannabis extract] to reduce opioid reward and drug seeking behavior appears quite robust and of great clinical utility,” authors concluded. “Additional systematic research is required to fully evaluate the potential for CBD to serve as an adjunct treatment for opioid use disorder.”

A limited number of clinical trials have previously demonstrated the ability of CBD to mitigate subjects’ cravings for various substances, including heroin, tobacco, and cannabis. Other studies indicate that CBD may also play a role in mitigating symptoms of opioid withdrawal. 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, “High-CBD cannabis vapor attenuates opioid reward and partially modulates nociception in female rats,” appears in Addiction Neuroscience.

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