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Study: Cannabis Associated with Improved Sleep in Adults with Post-Traumatic Stress

Haifa, Israel: The use of cannabis prior to bedtime is associated with perceived improvements in sleep in subjects diagnosed with post-traumatic stress disorder (PTSD), according to data published in the Journal of Anxiety Disorders.

Israeli researchers assessed the impact of cannabis on sleep in a cohort of 77 PTSD patients. Study participants kept a daily journal where they recorded numerous sleep measures each morning.

Investigators acknowledged that the use of cannabis was associated with self-reported improvements in sleep onset and a reduction in the frequency of nightmares. Subjects who consumed products higher in CBD were less likely to report early awakenings.

"Our data suggest that MC [medical cannabis] may help reduce nightmares and [that] CBD in particular may be important for preventing early awakenings," they wrote. "This provides a strong basis for further hypotheses testing, potentially through clinical trials, of the sleep-inducing effects of MC and for testing CBD in particular."

Authors concluded, "Given the high comorbidity of PTSD symptoms and sleep disturbances and the potential for MC to have effects on both, a greater understanding of how patients experience the effects of MC on overall PTSD symptoms and sleep disturbances is warranted."

Prior studies have similarly reported that cannabis products may be associated with improved sleep duration and with improvements in insomnia. The enactment of adult-use marijuana legalization has also been correlated with a decrease in the sale of over-the-counter sleep aid medications.

Full text of the study, "Post-traumatic stress disorder, sleep, and medical cannabis treatment: A daily diary study," appears in the Journal of Anxiety Disorders.

Analysis: Marijuana Excise Taxes Yield Nearly $3 Billion in Revenue in Fiscal Year 2022

Washington, DC: Legal cannabis markets generated an estimated $2.8 billion in excise taxes in fiscal year 2022 (July 2021 to June 2022), according to an analysis provided by The Urban-Brookings Tax Policy Center.

Regulators in California collected the largest amount of excise tax revenue ($774 million) while regulators in Alaska collected the least ($30 million).

In the two states with the most mature adult-use cannabis markets - Colorado and Washington - cannabis excise tax revenues outpaced those collected on the sale of alcohol and tobacco. "Broadly speaking, the experience of Colorado and Washington demonstrate that a state can collect a significant amount of revenue from marijuana taxes and that collection should mostly increase over time," the report's authors wrote.

The Center's analysis did not tabulate additional revenues generated from state sales taxes and/or locally imposed taxes on cannabis products.

An analysis provided in April by the Marijuana Policy Project estimated that total tax revenues derived from the licensed retail sale of state-legal, adult-use cannabis products grew by more than 30 percent between 2020 and 2021, totaling over $3.7 billion last year.

The full text of the report is available online here.

Study: Marijuana Use Poses No Elevated Risk for Liver Transplant Patients

Birmingham, AL: Those with a history of marijuana use are no more likely than non-users to suffer from any adverse complications following liver transplantation, according to data published in The American Journal of the Medical Sciences.

A team of investigators affiliated with the University of Alabama at Birmingham compared post-liver transplant outcomes in a cohort of cannabis consumers and matched controls. Researchers assessed post-surgery data for a period of one-year.

Authors reported: "There was no statistical difference in post-LT [liver transplant] outcomes between marijuana and non-marijuana users, including incidence of cardiac, respiratory, renal, psychiatric, or neurological complications, as well as readmission rates post-surgery. There were no statistically significant associations between marijuana use with post-transplant bacterial or fungal infections, medication non-compliance, or continued substance use."

They concluded: "Our data indicates that marijuana is not associated with increased risk of postoperative noncompliance, other organ complications, infections, or death. As a single factor, marijuana may not need to be a contraindication for LT."

The researchers' findings are consistent with those of several other studies which also concluded that marijuana use is not contraindicated in patients receiving organ transplants. Nonetheless, in several states - including some states that permit medical cannabis access - those with a history of marijuana use may be ineligible to receive organ transplants.

Full text of the study, "Marijuana use and post-transplant complications and non-compliance in liver transplant patients," appears in The American Journal of the Medical Sciences.

Analysis: History of Cannabis Use Not Associated with More Severe Symptoms of Psychosis

Christchurch, NZ: Those with a history of cannabis consumption do not exhibit more severe symptoms of psychosis than do those with no history of regular use, according to longitudinal data published in the New Zealand Medical Journal.

A team of New Zealand researchers assessed the relationship between marijuana use and the severity of psychotic symptomology in a cohort of over 1,200 subjects born in 1977. Investigators compared the symptom profile of cannabis consumers and non-consumers at age 18, 21, and at age 25.

Researchers reported that cannabis-consuming subjects were more likely than non-users to report experiencing a greater variety of psychotic symptoms overall. However, investigators acknowledged that consumers were not more likely to report experiencing severe symptoms.

Authors reported: "The present analyses sought to determine whether there was a qualitative difference in the kind of symptoms being reported by the two groups. ... Both groups tended to report common, low-level symptoms (such as "having ideas or beliefs that others do not share"), and neither group was likely to report what would be considered as more severe positive symptoms of psychosis."

They concluded: "Collectively, the results suggest that while those who were regular cannabis users reported a significantly greater number of symptoms than non-users, the symptom profile between the two groups did not differ, showing that there was no evidence of greater ‘severity' among regular cannabis users."

Although the use of cannabis and other controlled substances is more common among those with psychotic illnesses, studies indicate that lifetime incidences of marijuana-induced psychosis are relatively rare among those who do not already have a prior diagnosis of a psychiatric disease.

Full text of the study, "Cannabis use and patterns of psychotic symptomology in a longitudinal birth cohort," appears in the New Zealand Medical Journal.

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President Biden Announces Intent to Pardon Those with Low-Level Marijuana Convictions

Washington, DC: President Joe Biden today announced his intent to "pardon of all prior Federal offenses of simple possession of marijuana."

In a statement, he said: "I have directed the Attorney General to develop an administrative process for the issuance of certificates of pardon to eligible individuals. My action will help relieve the collateral consequences arising from these convictions."

The President also announced that he was encouraging Governor's to facilitate similar actions on the state level. To date, nearly two dozen states have enacted legislation explicitly facilitating the process of having select marijuana convictions expunged, vacated, otherwise set aside, or sealed from public view. These laws have led state and local officials nationwide to expunge or seal the records of over two million people with prior cannabis convictions.

Finally, the President announced that he is "asking the Secretary of Health and Human Services and the Attorney General to initiate the administrative process to review expeditiously how marijuana is scheduled under federal law."

In response to the President's recently announced actions, NORML's Executive Director Erik Altieri has issued the following statement:

"Many of the efforts taken and proposed by the President today are long overdue. For nearly two years, NORML has called upon the Administration to fulfill the President's campaign promise to provide relief to those stigmatized with a low-level cannabis conviction. We are pleased that today President Biden is following through on this pledge and that he is also encouraging governors to take similar steps to ensure that the tens of millions of Americans with state-level convictions for past marijuana crimes can finally move forward with their lives. Since 1965, nearly 29 million Americans have been arrested for marijuana-related violations - for activities that the majority of voters no longer believe ought to be a crime.

"Moving forward, the Administration must work collaboratively with Congressional leadership to repeal America's failed marijuana criminalization laws. Nearly half of voters now agree that legalizing marijuana ought to be a priority for Congress, and such action can only be taken by descheduling cannabis and repealing it from the US Controlled Substances Act - thereby regulating it in a manner similar to alcohol. Congress should be inspired by the Administration's actions today to act quickly and send legislation to the President's desk that would help close this dark chapter of our history."

Study: Adjunctive Use of CBD-Rich Extracts "Highly Effective" in Adults with Refractory Epilepsy

Tel Aviv, Israel: Adults with treatment-resistant focal epilepsy (epilepsy characterized by seizures arising from a specific part of the brain) respond favorably to the adjunctive use of plant-derived CBD dominant cannabis extracts, according to data published in the journal Neurological Sciences.

A Colombian investigator assessed the efficacy of high CBD/low THC extracts in a cohort of epileptic patients. Of those who maintained a cannabis-treatment regimen for at least three months, 80 percent experienced a greater than 50 percent reduction in seizure frequency at 12 weeks. Only a minority of patients reported any side-effects.

"The reduction in seizures frequency is maintained over time." the study's author concluded. "The CBMF (cannabis-based magistral formulation) is a highly effective and safe therapy to treat adult patients with DRFE (drug resistant focal epilepsy)."

Israeli data published in June similarly reported that children with refractory forms of epilepsy experience significant reductions in seizure frequency following the long-term use of plant-derived CBD extracts.

In 2018, the US Food and Drug Administration granted market approval to Epidiolex, a prescription medicine containing a standardized formulation of plant-derived cannabidiol for the treatment of two rare forms of severe epilepsy: Lennox-Gastaut syndrome and Dravet syndrome. Shortly after approval, the US Drug Enforcement Administration reclassified Epidiolex to Schedule V of the US Controlled Substances Act - the lowest restriction classification available under federal law.

Full text of the study, "Cannabis based magistral formulation is highly effective as an adjuvant treatment in drug-resistant focal epilepsy in adult patients: An open-label prospective cohort study," appears in Neurological Sciences.

Survey: Most Patients Report Opioid-Sparing Effects Following Cannabis Initiation

Tallahassee, FL: The majority of patients registered with the state of Florida to access medical cannabis products report reducing their consumption of prescription opioids, according to data published in the journal Substance Use & Misuse.

Investigators affiliated with Florida State University's College of Medicine assessed health functioning before and after cannabis initiation in a cohort of over 2,100 authorized medical marijuana consumers. Consistent with dozens of prior studies, researchers reported that "the majority of participants (79 percent) reported either cessation or reduction in pain medication use following [their] initiation of medical cannabis." Nearly 12 percent of participants also reported improvements in physical mobility.

The majority of patients surveyed acknowledged consuming cannabis daily and most had little or no past history of cannabis use prior to registering in the state's medical cannabis access program.

Authors concluded: "The majority of Florida medical cannabis users surveyed described medical cannabis as helpful and important to their overall quality of life. Notably, a large percentage of patients reported improvements in the areas of physical functioning, social functioning, and bodily pain after beginning medical cannabis. We also found a substantial number of patients reduced the amount of OBPM [opioid based pain medication] used after gaining access to legalized medical cannabis, with some patients specifically describing improved functioning in daily life as a result. ... These data add to the growing body of literature suggesting that medical cannabis use may be associated with reductions in opioid (and other) prescription medication use without reducing quality of life or worsening health outcomes."

A prior analysis of Florida patients, published last year by researchers affiliated with Florida Gulf Coast University, similarly reported that 65 percent of respondents had either reduced or eliminated their use of at least one prescription or over-the-counter medication following their initiation of medical cannabis.

Full text of the survey, "Medical cannabis patients report improvements in health functioning and reductions in opiate use," appears in Substance Use & Misuse.

Study: Hemp-Derived CBD Gel Caps Effective in Older Patients with Spinal Stenosis

Philadelphia, PA: Older patients with lower back and leg pain due to chronic spinal stenosis experience statistically significant improvements following the use of hemp-derived CBD gel caps, according to data published in the journal Cureus.

Researchers affiliated with Thomas Jefferson University in Philadelphia assessed the efficacy of the twice-daily administration of hemp-derived CBD gel caps (15mgs) in a cohort of 48 patients (mean age: 75) with spinal stenosis.

Investigators reported that patients averaged a nearly two-point decrease in their pain scores (on an 11-point scale) during the trial period. Authors also reported improvements in patients' appetite, sleep quality, and overall quality of life. Trial participants did not acknowledge any adverse side effects from CBD therapy.

"This open-label, prospective, observational study found that treatment with hemp-derived CBD gel caps was associated with significant improvements in pain scores and several quality-of-life measures," they concluded. "CBD gel caps were not associated with any adverse effects. Using CBD to help alleviate pain in spinal stenosis is supported by the evidence in this study."

Previous studies have reported reduced analgesia and prescription opioid use in patients using either CBD-rich gel caps or topical creams.

Full text of the study, "The use of cannabidiol in patients with low back pain caused by lumbar spinal stenosis: An observational study," appears in Cureus.

Analysis: Daily Use of Hemp Extracts Results in Positive Drug Tests for Cannabis

Baltimore, MD: Those who consume hemp-derived extracts on a regular basis risk testing positive for cannabis on a urinalysis drug screen, according to data published in the journal Therapeutic Drug Monitoring.

A team of researchers from the United States and Canada evaluated whether the ingestion of retail oral hemp-derived CBD products (containing ≤0.3 percent THC) would trigger a positive drug screen for the presence of carboxy-THC. (Carboxy-THC is the inert metabolite that is identified in conventional marijuana drug tests.)

Authors reported, "Findings showed that the daily use of oral hemp-derived CBD extracts consistently resulted in positive urine IA [immunoassay] screening results for THC-COOH at the 20 ng/mL detection criterion."

They concluded, "Therefore, efforts should be made to increase public awareness regarding the risk of positive [urine] drug test results following oral hemp-derived CBD product use."

Federal legislation enacted in 2018 legalized the licensed production of cannabis hemp plants containing no more than 0.3 percent THC. The law also broadened the definition of ‘hemp' to include "any part of the plant, including ... extracts [or] cannabinoids" that do not possess greater than 0.3 percent THC on a dry weight basis.

However, more than three years following the law's passage, the US Food and Drug Administration (FDA) has yet to promulgate rules regulating the marketing and sale of commercial products containing hemp-derived CBD or other cannabinoids. Survey data compiled by the National Consumers League previously determined that more than eight in ten US voters desire greater federal regulatory oversight over the labeling and marketing of commercially available CBD products.

Several federal agencies, including the US Department of Transportation and various branches of the US military, have previously cautioned against the use of legal hemp products and have warned that their consumption is not a legitimate excuse for a drug test failure.

Full text of the study, "Likelihood of positive urine screens of THC-COOH after daily use of full-spectrum hemp extracts varies as a function of screening criterion used," appears in Therapeutic Drug Monitoring.

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Study: Post-Operative Cannabis Use Associated with Opioid-Sparing Effects

Denver, CO: Patients who self-report consuming cannabis following hip or knee surgery are less likely than non-users to engage in the long-term use of prescription opioids, according to data in the journal Arthroplasty Today.

A team of investigators affiliated with the University of Denver and with John Hopkins University in Baltimore assessed opioid use trends in a cohort of patients who had recently undergone either total hip or total knee arthroplasty.

Researchers reported that those patients who reported perioperative cannabis use were less likely to engage in the use of prescription opioids long-term than were matched controls. The findings are consistent with dozens of prior studies documenting reduced levels of opioid consumption in pain patients who initiate cannabis use.

Authors concluded: "This study helps to shed light on what role if any cannabis should play as a part of an opioid-sparing multimodal pain protocol after TJA [total joint arthroplasty]. Self-reported perioperative cannabis use appeared to significantly reduce the number of patients that persistently used opioids greater than 90 days after TJA from 9.5 percent to 1.4 percent. ... As cannabis becomes more widely available and patient interest in its use for pain management continues to increase, further research with higher quality, prospective studies are required to clarify its role in perioperative pain management, including the examination of different preparations (delta-9-tetrahydrocannabinol vs cannabidiol), dosages, routes of administration (edible, inhalation, topical), and frequency of use."

Full text of the study, "Self-reported cannabis use associated with a lower rate of persistent opioid use after total joint arthroplasty," appears in Arthroplasty Today.

Study: Cannabis Preparations Associated with Quality of Life Improvements in Adults with Autism

London, United Kingdom: The use of cannabis flowers and extracts is associated with symptom improvements in adults diagnosed with autism spectrum disorder (ASD), according to data published in the journal Therapeutic Advances in Psychopharmacology.

British investigators affiliated with Imperial College in London assessed the safety and efficacy of cannabis products in a cohort of autistic adults (mean age: 32) enrolled in the UK Medical Cannabis Registry. Subjects in the study either inhaled cannabis flowers or consumed sublingual extracts for a period of up to six months. Subjects primarily consumed cannabis preparations that were elevated in THC content and lower in CBD.

Consistent with prior studies, investigators reported that patients experienced symptomatic improvements following cannabis therapy. They also reduced their use of prescription medications. Specifically, there was "a 33.3 percent and 25.0 percent reduction in the concomitant prescribing of benzodiazepines and neuroleptics, respectively, within this cohort." Authors further acknowledged that cannabis preparations were "well tolerated" by over 80 percent of the participants.

"In this first published experience of clinical outcomes in adult patients with ASD treated with CBMPs [cannabis-based medicinal products], there were associated improvements in general health-related quality of life, in addition to sleep- and anxiety-specific outcomes," they concluded. "Moreover, there was a reduction in the administration of concomitant medications, some of which are associated with serious adverse events with long-term use. ... These results ... provide scientific justification for further evaluation within the context of randomized controlled trials while also providing guidance for clinical practice in the interim."

Numerous trials have previously identified clinical improvements in autistic children who consume plant-derived CBD 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.

Full text of the study, "Clinical outcome analysis of patients with autism spectrum disorder: Analysis from the UK Medical Cannabis Registry," appears in Therapeutic Advances in Psychopharmacology.

Clinical Trial: Plant-Derived CBD Extracts Reduce Agitation in Dementia Patients

Tel Aviv, Israel: The administration of plant-derived extracts containing high levels of CBD and low levels of THC reduces agitation in patients suffering from behavioral disturbances related to dementia, according to clinical trial data published in the journal Frontiers in Medicine.

Israeli researchers assessed the safety and efficacy of CBD-dominant extracts (30 to 1 ratio of CBD to THC) compared to placebo in a cohort of seniors (mean age: 79 years) with dementia. Subjects in the trial received sublingual drops of either cannabis extracts or a placebo (olive oil) three times daily for a period of 16 weeks.

"Patients in the investigational group experienced a significantly greater reduction in sleep disturbances, and in agitation and aggression sub-score using two different measurement tools. The improvements were accompanied with non-serious side-effects," authors reported. "We recommend conducting a large scale randomized controlled trial on behavioral disturbances related to dementia and to compare clinical sub-types of dementia."

The findings are consistent with those of other studies – such as those here, here, and here – reporting that the use of either cannabis flowers or extracts mitigates agitation in dementia patients.

Full text of the study, "Effects of rich cannabidiol oil on behavioral disturbances in patients with dementia: A placebo controlled randomized clinical trial," appears in Frontiers in Medicine.

Analysis: Medical Cannabis Products Safe and Effective for Older Adults

Ontario, Canada: Medical cannabis products are safe and effective for older adults with chronic pain conditions, according to data published in The Journal of Cannabis Research.

Researchers assessed the safety and efficacy of cannabis products in a cohort of medically authorized Canadian patients age 65 or older. Subjects in the study used cannabis for at least three months.

Consistent with other studies assessing the use of cannabis by seniors, investigators reported that marijuana treatments were safe, well-tolerated, and associated with meaningful reductions in pain. "No serious AEs (adverse events) were reported, and non-serious AEs were experienced in less than 12 percent of the cohort," they acknowledged.

Most patients in the study reported no prior experience with cannabis. Most initially purchased cannabis products either high in CBD or containing equal ratios of CBD and THC. Participants typically preferred cannabis oils over other formulations.

Authors concluded, "Our findings inform the underexplored area of medical cannabis use in this population and suggest that medical cannabis is associated with therapeutic effects on pain in older adults with an acceptable safety profile."

Full text of the study, "Medical cannabis authorization patterns, safety, and associated effects in older adults," appears in The Journal of Cannabis Research.

Review: Available Data Supports the Use of CBD for Treatment of Social Anxiety

New Haven, CT: Data indicates that CBD is "effective" for improving social anxiety and suggests that it may have "key benefits over existing pharmacotherapies" for social anxiety disorder (SAD), according to a systemic review of human studies published in the journal Psychiatry Research Communications.

A pair of researchers affiliated with Yale University reviewed data from seven studies involving 278 total participants.

Authors reported: "Overall, the literature reviewed supports the anxiolytic effect of CBD administration, both among healthy volunteers undergoing experimental social anxiety paradigms, as well as individuals with SAD. ... Additionally, CBD may have key advantages over existing treatments, including a rapid course of action, reduced abuse liability and potential for drug interactions with alcohol and opioids, as well as reduced sedative and cognitive side effects."

They concluded: "Existing data suggest that acute administration of CBD significantly attenuates social anxiety, without significant sedation or cognitive impairment. However, additional research is needed to determine optimal dosing among individuals with SAD, assess the time-course of CBD's acute effects, examine the efficacy and side effect profile of chronic CBD administration, assess sex differences in the use of CBD for social anxiety, as well as investigate CBD's mechanisms of action."

Open-label trial data published in June in The Journal of Clinical Psychiatry reported that the adjunctive use of CBD safely and effectively reduces severe anxiety in young people with treatment-resistant anxiety disorders.

Social anxiety disorder is characterized by clinical fear of one or more specific social situations. Some seven percent of US adults are estimated to have suffered from SAD within the past year.

Full text of the study, "Systemic literature review of human studies assessing the efficacy of cannabidiol for social anxiety," appears in Psychiatry Research Communications.

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