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Federal Court Strikes Down Residency Requirement for Those Seeking State Marijuana Licensure

Augusta, ME: Federal court judges have ruled that a Maine law requiring licensed medical cannabis providers to be in-state residents is unconstitutional.

Judges for the US Court of Appeals for the First Circuit ruled 2 to 1 that the law was “facially protectionist” and thereby in violation of the Constitution’s dormant commerce clause – which seeks to discourage states from taking steps that excessively burden interstate commerce. The majority further determined that the medical cannabis industry is subject to the dormant commerce clause, even despite the federal prohibition of marijuana, because commercial activity in the marijuana market is routinely taking place absent any intervention from federal law enforcement.

They opined, “Congress’s enactment of the Rohrabacher-Farr Amendment in the wake of the CSA’s [Controlled Substances Act] passage … undermines the notion that no such interstate market exists. … [Further,] the prohibition that Maine’s Medical Marijuana Act seeks to impose on out-of-state actors entering that very market reflects the reality that the market continues to operate. That prohibition even indicates that the market is so robust that, absent the Medical Marijuana Act’s residency requirement, it would be likely to attract entrants far and wide.”

The majority concluded, “Why, then, would it be improper for us to apply the dormant Commerce Clause here? There is an interstate market, and a state is trying to protect its advantageous position with respect to it.”

The dissenting judge argued that the commerce clause’s protections ought to be applicable only to national markets involving goods or services that Congress has deemed legal.

Maine regulators had already dropped a similar residency requirement for those seeking licensure to participate in the adult-use market.

The case is Northeast Patients Group v. Maine Department of Administrative and Financial Services.

Analysis: Heavy Metals Frequently Identified in Unregulated CBD Products

Miami, FL: CBD-infused products commercially available in retail stores and online often contain heavy metals, such as lead, arsenic, and mercury, and typically contain less-than-advertised quantities of cannabidiol, according to data published in the journal The Science of the Total Environment.

Investigators affiliated with the University of Miami School of Medicine and with the Ellipse Analytics Testing Lab in Denver assessed 516 CBD products for cannabidiol content as well as for the presence of heavy metal contaminants. Of these products, 121 products were intended for oral consumption.

Consistent with prior analyses of unregulated CBD products, many contained impurities and inaccurate labeling.

Of the CBD-infused edible products analyzed, 42 percent tested positive for the presence of lead, 37 percent tested positive for mercury, 28 percent tested positive for arsenic, and eight percent tested positive for cadmium.

Over 40 percent of all of the products tested contained significant lower percentages of CBD than advertised on the products’ labeling. Among edible products only, 29 percent contained lower quantities of CBD than advertised.

“Low-level contamination of edible CBD products with heavy metals and phthalates is pervasive,” authors concluded. “There is substantial discrepancy between the product label claims for CBD potency and the amount measured in both edible and topical products, underscoring the need for tight regulations for CBD product label integrity to protect consumers.”

They added: “Given that the consumer demographic purchasing CBD products includes those afflicted with pain, insomnia, anxiety, and other health conditions, these findings could give consumers and medical practitioners hesitation about the benefits and potential harm of CBD use. If left unaddressed, these findings could lead to decline in consumer trust and public health concerns. CBD mistrust could lead to consumers and retailers abandoning this category of potentially efficacious medical therapies. … It is incumbent upon manufacturers to recognize the prevalence of misleading claims on labels, identify the sources of the discrepancies between label claims and measured CBD content, and improve label accuracy through a commitment to frequent and thorough independent testing procedures.”

Heavy metal contamination has also been identified in unregulated delta-8 THC vapor products.

More than three years following the passage of federal legislation legalizing hemp production, 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.

Full text of the study, “Heavy metal and phthalate contamination and leveling integrity in a large sample of US commercially available cannabinoid (CBD) products,” appears in The Science of the Total Environment.

Survey: Cannabis Reportedly More Effective Than Prescription Anti-Emetics for Hyperemesis Gravidarum

Los Angeles, CA: Survey respondents who acknowledge having consumed cannabis to address symptoms of Hyperemesis Gravidarum (HG) frequently report that it is more effective than prescription medications at reducing severe nausea and vomiting.

A team of researchers affiliated with the University of California, Los Angeles and with the Hyperemesis Education and Research Foundation in Oregon surveyed 550 respondents who suffered from HG during their pregnancy. Among respondents, 96 percent acknowledged having used prescription anti-emetics; 14 percent reported having used cannabis. Most (71 percent) of those who acknowledged having consumed cannabis said that they did so because prescription medications inadequately managed their symptoms.

Of those who consumed cannabis, 82 percent reported HG symptom relief – a finding that is consistent with prior case reports and surveys. By comparison, only 60 percent reported obtaining relief from prescription anti-emetics. Moreover, among patients who reported experiencing weight loss during pregnancy, 56 percent of those who used cannabis reported gaining some or all of it back within two weeks of treatment, compared to 25 percent of prescription drug users.

Authors concluded: “This study adds to growing literature supporting antiemetic properties of cannabis and cannabinoid compounds while also suggesting their potential to treat HG. … A minority of respondents in this survey reported using cannabis for HG; however, those who used cannabis or CBPs [cannabis-based products] reported more frequent relief from HG symptoms compared to those who used prescription antiemetics. Furthermore, those cannabis users were more likely to report weight gain within two weeks of treatment than those who used ondansetron, reportedly the most effective prescription antiemetic for survey respondents.

“Cannabis products may be perceived as a more effective alternative, but more research is required to understand its mechanism and safety… In the meantime, providers must weigh unknown risks of recommending cannabis… with the well-established risk of adverse maternal and fetal outcomes for refractory HG.”

Full text of the study, “Patterns of use and self-reported effectiveness of cannabis for Hyperemesis Gravidarum,” appears in the journal of the German Society of Gynecology and Obstetrics.

Study: CBG Administration Lowers Blood Pressure in Preclinical Model

Hershey, PA: Mice injected with the cannabinoid CBG (cannabigerol) experience a significant decrease in mean blood pressure, according to preclinical data published in the journal Frontiers in Physiology.

A team of researchers with Penn State College of Medicine assessed the cardiovascular impact of CBG compared to placebo in healthy mice. Animals in the study were injected in the abdomen with either CBG or a saline solution.

Authors reported, “[A]cute CBG administration elicits a significant decrease in blood pressure in phenotypically normal male mice, without altering heart rate or locomotor activity.”

They concluded: “The present study provides new mechanistic insight into the cardiovascular effects of CBG in the context of normal blood pressure. … Overall, these findings add to the growing literature regarding the role of cannabinoids in blood pressure regulation. Additional research on CBG is needed to define the precise molecular mechanisms and sites of action, effects of more chronic administration, and potential for therapeutic use to lower blood pressure in models of hypertension.”

A 2017 clinical trial previously documented the ability of oral doses of CBD to lower blood pressure in healthy volunteers, while a 2021 observational trial identified a link between long-term cannabis use and a reduction in systolic and diastolic blood pressure in elderly subjects.

Cannabinoids have long been known to influence cardiovascular function, though data regarding their effects has been conflicting. According to the results of a 2021 literature review of 67 studies published in the American Journal of Medicine, “[M]arijuana itself does not appear to be independently associated with excessive cardiovascular risk factors,” although authors did caution that “it can be associated with other unhealthy behaviors such as alcohol use and tobacco smoking that can be detrimental” to cardiovascular health.

Data assessing neonatal outcomes among children with in utero exposure to cannabinoids is inconsistent, with some studies highlighting potential links with pre-term birth and lower birth weight and other studies finding no such associations.

Full text of the study, “Acute cannabigerol administration lowers blood pressure in mice,” appears in Frontiers in Physiology.

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Voters in Growing Number of States to Decide on Marijuana Legalization This November

Bismarck, ND: State officials this week approved a citizens’ initiative for the November ballot that seeks to legalize the adult-use possession and sale of marijuana in North Dakota.

The proposed ballot measure allows adults to possess, purchase, and home-cultivate specific quantities of cannabis. It also establishes guidelines for the licensing and regulation of commercial cultivators and retailers.

North Dakotans will join voters in several other states who will also be deciding on marijuana legalization proposals this election. Similar adult-use legalization measures have qualified for the ballot in Maryland, Missouri, and South Dakota.

In July, representatives from Oklahomans for Sensible Marijuana Laws turned in over 50,000 more signatures than required to place an adult-use legalization measure on the ballot. Those signatures are still awaiting verification from election officials.

Proponents of an Arkansas initiative to legalize the adult-use marijuana market are engaged in a legal appeal before the Supreme Court after election officials rejected their proposed ballot title. Justices have ruled that the proposal must appear on the election ballot, but they have yet to determine whether the votes will be counted.

Proponents of a Nebraska effort to authorize medical cannabis access are also awaiting verification from election officials.

In addition to these statewide efforts, voters in dozens of cities will be deciding on municipal ballot questions this fall. For instance, voters in five Texas cities – Denton, Elgin, Harker Heights, Killeen, and San Marcos – will decide on measures seeking to amend local laws curtailing police officers’ authority to “issue citations or make arrests for Class A or Class B misdemeanor possession of marijuana offenses” absent a defendant’s alleged involvement in a “felony level narcotics” case. Voters in several Ohio cities will also decide on municipal measures depenalizing activities involving marijuana possession.

In Rhode Island, voters in 31 towns will decide on measures determining whether or not to allow licensed cannabis retailers in their localities. Voters in cities in several other states, including Colorado, Michigan, and Montana, will decide on similar local ballot measures as well.

Analysis: Propagation of Cannabis Retailers Not Associated with Changes in Traffic Safety

La Jolla, CA: The establishment of licensed cannabis retailers is not independently associated with an increase in traffic crashes, according to data published in the journal Health Economics.

A researcher affiliated with the University of California, San Diego examined county-level data from Colorado to assess the relationship between retail cannabis stores and trends in traffic safety.

The investigator reported, “[T]he entry of retail cannabis stores is not associated with a statistically significant change in traffic crashes per 100,000 population in Colorado.”

He concluded: “The findings of a lack of relationship between expanding access to marijuana through retail stores and traffic crash[ees] may seem counterintuitive, especially since the use of marijuana has been linked to lower neuromotor/neurocognitive performance required to drive safely and a higher risk of being involved in a traffic crash. However, recent studies have found evidence of substitutability between marijuana and other substances that can impair driving performance, such as alcohol. In this case, the net effect of expanding access to marijuana on traffic crashes could be quite small. The findings of this study are consistent with this hypothesis.”

Several prior studies have assessed whether the enactment of adult-use legalization is associated with an increased risk in the likelihood of motor vehicle accidents. The findings of those studies have yielded inconsistent results, with some studies identifying a minor uptick in crash rates in specific states several years following legalization, and others finding no such change.

Full text of the study, “Does expanding access to cannabis affect traffic crashes? County-level evidence from recreational marijuana dispensary sales in Colorado,” appears in Health Economics.

Study: In-Utero Cannabis Exposure Not Linked with Elevated Risk of ADHD in Children

Quebec, Canada: Prenatal cannabis exposure is not associated with an increased risk of attention deficit disorders among children, according to data published in the journal BMJ Open.

Canadian investigators evaluated the relationship between in-utero marijuana exposure and attention deficit with or without hyperactivity disorder in a cohort of 2,408 children.

Researchers reported “no significant association” between either occasional or regular prenatal cannabis exposure and ADHD after adjusting for potential confounders.

“In our study, we did not find any association between in-utero occasional or regular exposure to cannabis and the risk of ADHD in children, as well as overall exposure to cannabis and the risk of ADHD in children,” authors concluded. “Further research focusing on the timing of exposure during pregnancy (e.g., first, second, third trimester), as well as using different methods for quantifying prenatal cannabis exposure (e.g., biological samples), is needed to better understand the impact of cannabis use during pregnancy and developmental outcomes in children.”

Full text of the study, “Is in-utero exposure to cannabis associated with the risk of attention deficit with or without hyperactivity disorder? A cohort study within the Quebec Pregnancy Cohort,” appears in BMJ Open.

Study: Cannabis Extract Effective in Patients with Refractory Chronic Pain

Sydney, Australia: The administration of cannabis extracts containing equal quantities of THC and CBD is associated with reduced pain intensity and improved sleep in patients with chronic refractory pain conditions, according to data published in the journal Medical Cannabis and Cannabinoids.

Australian investigators assessed the safety and efficacy of whole-plant cannabis oil in a cohort of 151 chronic pain patients. Participants in the trial used the extract daily for at least three months. All of the subjects in the trial suffered from conditions that were unresponsive to conventional analgesics, such as opioids and NSAIDs (non-steroidal anti-inflammatory drugs). Trial subjects were most likely to be diagnosed with neuropathy, musculoskeletal pain, or arthritis.

Researchers reported, “Pain impact scores were significantly reduced across the cohort. Additionally, most subjects reported improvements in sleep disturbances and fatigue.” The majority of side-effects reported by patients were categorized as mild; these most frequently included sleepiness, dizziness, and dry-mouth.

They concluded: “This analysis presents real-world data collected as part of standard of care. … The results of this study demonstrated a significantly positive effect of [a proprietary formulation of] oral medicinal cannabis oil on the impact of pain. … Amelioration of the impact of pain confirms continued prescribing of this formulation and validates our observational methodology as a tool to determine the therapeutic potency of medicinal cannabinoids.”

Survey data estimate that nearly one-third of patients suffering from chronic pain conditions acknowledge using cannabis products. Among patients in US states where medical cannabis access is permitted, over 60 percent are qualified to use it to treat pain.

Full text of the study, “Medical cannabis for the treatment of chronic refractory pain: An investigation of the adverse event profile and health-related quality of life impact of an oral formulation,” appears in Medical Cannabis and Cannabinoids.

Study: CBD Oil Mitigates Chemotherapy-Induced Neuropathy

Roskilde, Denmark: The short-term administration of CBD oil extracts is safe and effective in patients suffering from chemotherapy-induced peripheral neuropathy (CIPN), according to data published in the journal Supportive Care in Cancer.

Danish investigators assessed the twice daily administration of CBD oil (300 mg/daily) in patients receiving either oxaliplatin or paclitaxel-based chemotherapy. Subjects used CBD for a period of eight days immediately following their first cycle of chemotherapy. Patients outcomes were compared to those of similarly matched controls.

Researchers reported that the use of CBD was associated with pronounced improvements in patients’ pain-related outcomes, including cold sensitivity and throat discomfort.

“CBD attenuated early symptoms of CIPN with no major safety concerns,” they concluded. “Long-term follow-up is ongoing. Results should be confirmed in a larger, randomized study.”

Separate studies have identified an association between patients’ long-term use of cannabis products and statistical improvements in cancer-related symptoms as well as significant reductions in their use of prescription painkillers.

Full text of the study, “Oral cannabidiol for prevention of acute and transient chemotherapy-induced peripheral neuropathy,” appears in Supportive Care in Cancer.

Analysis: History of Cannabis Use Inversely Associated with Urological Cancers

London, United Kingdom: Women with a past history of cannabis use are at lower risk of suffering from certain types of urological cancers, according to population-based data published in the journal Cancer Medicine.

An international team of researchers from China, France, and the United Kingdom assessed the relationship between cannabis use and cancer risk in a cohort of more than 151,000 subjects.

Investigators reported, “Previous use of cannabis was a significant protective factor” in women against renal cell carcinoma (RCC) and bladder cancer (BCa). They further reported that “previous cannabis use was a significant protective factor for PCa (prostate cancer) in men with a history of tobacco smoking.” A history of cannabis use had a null effect on rates of testicular cancer.

Authors concluded: “In the current study, we investigated the association between the use of cannabis and the risk of urological cancers. We observed that: (1) previous use of cannabis was a significant inverse association with both RCC and PCa; (2) cannabis use was associated with the lower risk of BCa in the point estimates; (3) the protective effect of cannabis on RCC and BCa was significant for females but not for males; (4) cannabis use had a causal effect on lower incidence of RCC.”

Prior studies have similarly identified an inverse association between a past history of cannabis use and the development of certain types of cancers, including bladder cancer, liver cancer, and head and neck cancers.

Full text of the study, “Association between cannabis use with urological cancers: A population-based cohort study and mendelian randomization study in the UK biobank,” appears in Cancer Medicine.

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Clinical Trial: CBD Safe and Effective for Young People with Treatment-Resistant Anxiety Disorders

Melbourne, Australia: The adjunctive use of CBD safely and effectively reduces severe anxiety in young people, according to clinical data published in The Journal of Clinical Psychiatry.

Australian researchers assessed the daily administration of CBD in a cohort of 31 young people (ages 12 to 25) with refractory anxiety. Participants self-titrated their daily doses of CBD (between 400 mgs and 800 mgs) over a 12-week period.

CBD dosing was associated with a "statistically significant reduction in anxiety severity," as measured on the Overall Anxiety Severity and Impairment Scale (OASIS). CBD dosing also "demonstrated an acceptable safety profile, with no serious adverse events reported and no clinically significant deviations to blood cell counts."

Investigators reported, "Approximately 40 percent of all participants experienced a 50 percent reduction in OASIS score, and two-thirds experienced a 33 percent reduction." They added, "By the end of treatment, the number of participants rated as markedly or severely ill had decreased from 17 (56.7 percent) to 5 (16.7 percent)."

Authors acknowledged that CBD’s greatest efficacy was observed during the final four weeks of treatment, indicating that a longer treatment regimen may potentially lead "to even greater improvements."

They concluded: "Given that the patients included in our trial were some of the most severe and treatment resistant and had significant functional impairment and multiple failed treatment attempts, the reduction in anxiety severity observed here suggests that CBD has clinically meaningful anxiolytic effects. ... The findings of this trial suggest that further investigation of CBD for anxiety in conjunction with usual care is warranted."

Other human trials evaluating the use of CBD for anxiety have yielded inconsistent results. A 2019 placebo-controlled trial reported that daily CBD intake reduces symptoms of social anxiety disorder in teens, whereas a 2022 study determined oral doses of CBD to be ineffective at reducing symptoms of moderate-to-severe testing anxiety in college students. A 2018 Brazilian study reported that the consumption of 300mg of CBD significantly reduced anxiety due to public speaking, but that higher (600mg) and lower (150mg) had no effect.

Full text of the study, "Cannabidiol for treatment-resistant anxiety disorders in young people: An open-label trial," appears in The Journal of Clinical Psychiatry.

Study: Medical Cannabis Use Not Associated with Elevated Risk of Hospitalizations Due to Mental Health Disorders

Quebec, Canada: Authorized medical cannabis patients are at low risk for psychiatric hospitalizations resulting from their marijuana use, according to data published in the journal Substance Use & Misuse.

Canadian researchers assessed marijuana-related hospitalizations among a cohort of over 23,000 authorized medical cannabis patients. (Canada has legalized the use of cannabis products for both medical purposes and for adult use.) Specifically, investigators tracked incidences of hospitalizations attributable to either "cannabis poisoning" or because of "mental or behavioral disorders due to the use of cannabis." Patients in the study were tracked for a median of 240 days.

During the course of the trial, investigators reported that a total of 14 patients were hospitalized for issues related to cannabis toxicity and 26 were admitted for either mental or behavioral disorders. The findings push back against high-profile claims from some cannabis reform opponents that frequent marijuana exposure is a trigger for psychosis and other mental health disorders.

"The results suggest that the incidence of cannabis poisoning or cannabis-related mental or behavioral disorders was low among patients who were authorized to use cannabis for medical care," authors concluded. "Our observation of small rates of ED visits and hospitalization for cannabis poisoning and CUDs [cannabis use disorders] among this large cohort of medical cannabis users helps address concerns regarding increasing use of medical cannabis."

Full text of the study, "Incidence and predictors of cannabis-related poisonings and mental and behavioral disorders among patients with a medical cannabis authorization: A cohort study," appears in Substance Use & Misuse.

Analysis: Cannabis Use Not Associated with Increased COVID Severity

Los Angeles, CA: Current cannabis use is associated with deceased disease severity in patients hospitalized for COVID 19, according to data published in the Journal of Cannabis Research.

Researchers affiliated with the David Geffen School of Medicine at the University of California, Los Angeles conducted a retrospective analysis of 1,831 COVID patients admitted to two medical centers in California. They reported, "Active cannabis users hospitalized with COVID 19 had better clinical outcomes compared with non-users, including decreased need for ICU admission or mechanical ventilation." However, investigators reported no association between cannabis use and better overall survival rates.

Authors reported that the association between cannabis use and decreased symptom severity remained consistent even after researchers adjusted for potential confounders, such as age and comorbid conditions.

"To our knowledge, this study is one of the first evaluations of the effect of cannabis use on outcomes in patients hospitalized with COVID-19," they concluded. "While previous data have determined the detrimental relationship of tobacco smoking with COVID-19, this study suggests that cannabis may actually lead to reduced disease severity and better outcomes despite a five-fold greater concomitant use of tobacco amongst cannabis users compared to non-users in our study population."

Preclinical studies and reviews have suggested that the administration of certain cannabis compounds could potentially modulate COVID infections. However, to date, no controlled clinical trials have substantiated the theory that cannabinoids can assist in either preventing COVID infections or in mitigating symptoms of the virus. Clinical trial data published in November failed to demonstrate that the adjunctive use of CBD aided COVID patients in their recovery from the virus. A separate observational study published last year reported that COVID 19 patients with elevated rates of overall substance use were more likely to experience more adverse outcomes, including hospitalization and death.

Full text of the study, "Cannabis consumption is associated with lower COVID-19 severity among hospitalized patients: A retrospective cohort analysis," appears in the Journal of Cannabis Research.

Texas: Voters in Five Cities to Decide on Marijuana Depenalization Initiatives

Austin, Texas: Voters in five Texas cities will decide this November on local ballot measures to end low-level marijuana possession arrests.

Activists with the group Ground Game Texas successfully gathered signatures from voters in the cities of Denton (population: 140,000), Elgin (population: 10,000), Harker Heights (32,000), Killeen (149,000), and San Marcos (64,000) to place marijuana-related questions before local lawmakers. In each instance, councilmembers moved to defer the issue to the November ballot.

The measures seek to amend local laws so that police officers can no longer "issue citations or make arrests for Class A or Class B misdemeanor possession of marijuana offenses" absent defendants' alleged involvement in a "felony level narcotics" case. If voters approve the proposals, police will still be permitted to confiscate cannabis from those who possess it in small quantities.

In May, voters in Austin overwhelmingly approved a similar municipal measure depenalizing marijuana possession and prohibiting police from executing 'no knock' warrants.

Texas law does not allow for statewide, citizen-initiated measures.

Statewide polling finds that 67 percent of Texans, including majorities of Democrats, Independents, and Republicans, support legalizing the sale and use of marijuana.

Under state law, minor marijuana possession is classified as a criminal misdemeanor, punishable by up to 180 days incarceration and a $2,000 fine. Texas police made an estimated 219,000 marijuana-related arrests between 2017 and 2021. Ninety-seven percent of those arrested were charged with possession only.

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