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Marijuana Reform Advocates in Multiple States Turn in Signatures for 2022 Initiative Campaigns

Tulsa, OK: Cannabis reform advocates in four states - Arkansas, Nebraska, Oklahoma, and North Dakota - have recently submitted signatures to election officials to place legalization proposals on the 2022 ballot.

Last Wednesday, representatives with the group Oklahomans for Sensible Marijuana Laws announced that they had turned in over 164,000 signatures to the Secretary of State's office in an effort to place a binding, statewide marijuana legalization initiative (State Question 820) on the November ballot. That total is well above the number of signatures necessary (94,911) to qualify for the 2022 ballot.

The proposed measure seeks to permit adults to legally possess and home-cultivate personal use qualities of cannabis while also establishing a licensed, retail marketplace. Those with past marijuana convictions, or those who are currently incarcerated for certain cannabis-related crimes, would be able to petition the courts for either record expungement or re-sentencing consideration.

On Friday, the group Responsible Growth Arkansas submitted just over 190,000 signatures to the Secretary of State's office to place the Arkansas Adult Use Cannabis Amendment on the November ballot. The constitutional amendment seeks to establish a state-licensed retail cannabis market for those age 21 and older. It also seeks to expand the state's existing medical cannabis access program by increasing the total number of licensed dispensaries and by eliminating certain taxes. Advocates need just over 89,000 valid signatures to qualify the measure for the ballot.

Also on Friday, the group Nebraskans for Medical Marijuana turned in over 90,000 signatures each for a pair of medical cannabis legalization measures - just above the roughly 87,000 necessary to qualify them for the November ballot.

Finally, on Monday, representatives with the group New Approach ND announced that they had turned in 25,762 signatures to Secretary of State's office. That total is roughly 10,000 signatures above the number of signatures necessary (15,582) to qualify it for the 2022 ballot. The proposed measure permits adults to legally possess and home-cultivate personal use qualities of cannabis while also establishing a licensed retail marketplace.

Legalization measures in South Dakota and Maryland have already been confirmed for ballot placement in their respective states. In May, the group Legal Missouri 2022 turned in more than 385,000 signatures to state officials - more than double the total (171,592) necessary to place a constitutional amendment on the ballot legalizing marijuana.

Survey: Cannabis Effective at Mitigating Musculoskeletal Pain

San Juan, Puerto Rico: Patients suffering from musculoskeletal pain disorders report obtaining significant relief following their use of medical cannabis products, according to data published in the Journal of the American Academy of Orthopedic Surgeons.

A team of Puerto Rican investigators surveyed 184 patients with chronic pain conditions regarding their use of medical cannabis. (Lawmakers legalized patient access to certain cannabis preparations in 2015.)

Respondents suffering specifically from musculoskeletal conditions reported an average reduction of 4.47 points on the Numeric Rating Scale following cannabis administration. Eighty-nine percent of survey participants said that cannabis was "more effective" than opioids for pain management - a finding that is consistent with other studies.

Authors concluded: "This study showed that the use of medical cannabis among patients with musculoskeletal conditions effectively reduced pain levels based on their NRS reported scores. In addition, most patients using medical cannabis considered that this drug represents a better option than narcotics (e.g., opioids) for adequate pain management. Additional studies on medical cannabis should evaluate whether the experience and perspective presented through this study could translate into satisfactory and consistent clinical outcomes."

Survey data from 2020 estimated that one in five Canadian patients battling musculoskeletal disorders used cannabis to ease their pain. Among pain patients enrolled in medical cannabis access programs, most subjects report decreasing or even eliminating their use of opiates.

Full text of the study, "Patient experience and perspective on medical cannabis as an alternative for musculoskeletal pain management," appears in the Journal of the American Academy of Orthopedic Surgeons.

Study: Subjects Perceive Decreased Fatigue Following Cannabis Smoking

Albuquerque, NM: The inhalation of cannabis is associated with perceived decreases in fatigue, according to data published in the journal Medical Cannabis and Cannabinoids.

A team of researchers affiliated with the University of New Mexico assessed the effects of smoked cannabis on fatigue intensity levels in 3,922 subjects over a 3+ year period. Study participants self-administered cannabis at home and reported symptom changes in real time on a mobile software application.

"On average, 91.94 percent of people experienced decreased fatigue following consumption with an average symptom intensity reduction of 3.48 points on a zero-to-10 visual analog scale," investigators reported. They added: "While labeled plant phenotypes (‘C. indica,' ‘C. sativa,' or ‘hybrid') did not differ in symptom relief, people that used joints to combust the flower reported greater symptom relief than pipe or vaporizer users. Across cannabinoid levels, tetrahydrocannabinol, and cannabidiol levels were generally not associated with changes in symptom intensity levels."

They concluded: "Using the largest database of real-time effects of cannabis usage in the USA, we found that combusting whole, dried cannabis flower has a generally fast-acting and energetic effect for the majority of people that have symptoms of fatigue. While some user sessions resulted in increased fatigue or fatigue-related side-effect experiences, the vast majority of people reported an overall decrease in their perceived fatigue intensity levels. … Future research would benefit from investigating real-time effects of cannabis usage on behavioral and mental fatigue under altered bodily states and how different phytochemicals in the cannabis plant aggregate and/or interact in its mental and physical effects in healthy people and clinical populations."

Using similar methods, UNM researchers have previously reported that cannabis exposure is associated with real-time reductions in migraine symptoms, pain intensity, stress, depressive symptoms, and nausea, among other symptoms.

Full text of the study, "The effect of consuming cannabis flower for treatment of fatigue," appears in Medical Cannabis and Cannabinoids.

Case Report: Low Doses of THC-Rich Cannabis Extracts Show "Encouraging" Results in Patient with Alzheimer's

Foz do Iguaçu, Brazil: Cannabis microdosing is associated with cognitive and behavioral improvements in a patient with mnemonic and non-mnemonic Alzheimer's disease (AD) symptoms, according to a case report published in the Journal of Medical Case Reports.

An international team of investigators affiliated with The Federal University for Latin American Integration in Brazil and with John Hopkins University in Baltimore reported on the experimental treatment of THC-rich extracts in a 75-year-old male patient with mild-stage Alzheimer's disease. The patient had been diagnosed with AD two-years prior to his use of cannabis.

Extracts used in the trial contained an 8-to-1 ratio of THC to CBD. The patient receiving the intervention used the extracts daily for 22 months. The subject's daily dosage never exceeded 1 mg of THC per day.

Investigators reported that the patient exhibited "rapid" and "robust" symptom amelioration following his use of low doses of THC-rich extracts. Specifically, they reported, "[C]ognitive and memory enhancement lasted for more than one year following the start of treatment and remained stable while we progressively evaluate/follow up with the patient, for more than one year after the official report ended." Authors also reported improvements in the subject's quality of life and in behavioral issues, including a reduction in mood swings and aggressiveness. Follow up evaluations identified no evidence of cannabis-related toxicity or significant side effects.

They concluded: "Our results are unprecedented and very encouraging. … In summary, data presented in this case report suggest that cannabinoid microdosing is a potential therapeutic for AD, with no significant side effects, although placebo-controlled clinical trials are needed to confirm and extend these data."

Prior studies and case reports assessing the use of THC in Alzheimer's disease patients have similarly reported improvements in AD symptoms, such as reduced agitation and improved sleep, following cannabinoid dosing.

Full text of the study, "Cannabinoid extract in microdoses ameliorates mnemonic and non-mnemonic Alzheimer's disease symptoms: A case report," appears in the Journal of Medical Case Reports.

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Study: Cannabis Use Not Predictive of Lack of Motivation

Corvallis, OR: Frequent cannabis use is not associated with motivation loss in adults, according to data published in the Journal of Clinical and Experimental Neuropsychology.

A team of researchers affiliated with Oregon State University assessed motivation and self-reported apathy in a cohort of regular (three times per week or more) cannabis users and controls (non-users).

Investigators identified no significant group differences in self-reported apathy after controlling for covariates (recent alcohol consumption and depressive symptoms).

Authors did report that cannabis consumers were more likely than non-users to "exert more [effort] for reward, suggesting enhanced motivation relative to healthy controls." Specifically, as reward magnitude increased, frequent cannabis users were more likely to select harder trials to complete than were controls.

Consistent with prior studies, they concluded: "The current findings do not support [the theory of] a-motivational syndrome in cannabis users; rather cannabis users displayed higher-effort decision-making in comparison to controls. ... Given the limited number of studies within the field, future research should continue using both self-report and task-based methodologies to assess motivation in cannabis users, while controlling for potential covariates, such as depression, substance use, and personality factors."

Full text of the study, "Effort-based decision making and self-reported apathy in frequent cannabis users and healthy controls: A replication and extension," appears in theJournal of Clinical and Experimental Neuropsychology.

Survey: Patients with Parkinson's Disease Report Symptomatic Relief from Cannabis

Bergen, Norway: Patients with Parkinson's disease (PD) often report symptomatic benefits from the use of cannabis, according to survey data published in the journal Acta Neurologica Scandinavica.

Norwegian investigators surveyed cannabis use patterns and related attitudes among PD patients. Consistent with prior surveys, they reported that a significant minority of PD patients consume cannabis for symptom relief. Respondents were most likely to report improvements in motor function, sleep, and pain as a result of their marijuana use.

Observational trial data has determined that cannabis inhalation is associated with improvements in tremor, rigidity, pain, sleep, and bradykinesia (slowness of movement) in patients with PD. Placebo-controlled trial data has also determined that acute CBD administration (300mg) is associated with a statistically significant reduction in experimentally-induced anxiety and tremor in PD patients.

Full text of the study, "Cannabis use in Parkinson's disease: A nationwide online survey," appears inActa Neurologica Scandinavica.

Clinical Trial: CBD Administration Ineffective for Restless Legs Syndrome

Manaus, Brazil: The administration of oral doses of CBD is ineffective at reducing the severity of restless legs syndrome (RLS) in patients with Parkinson's disease (PD) and REM sleep behavior disorder (RBD), according to clinical trial data published in the journal Cannabis and Cannabinoid Research.

Brazilian researchers compared the use of CBD versus a placebo over a 14-week period. Patients in the CBD arm of the trial received up to 300mgs of cannabidiol.

Patients who were administered CBD demonstrated no improvements compared to those receiving placebo.

"CBD showed no reduction in the severity of RLS manifestations in patients with PD and RBD," authors concluded.

By contrast, a series of case reports pub lished in 2020 and in 2017 reported that cannabis inhalation is associated with perceived efficacy in patients with refractory restless legs syndrome.

Full text of the study, "Cannabidiol for restless legs syndrome/Willis-Ekbom disease in Parkinson's disease patients with REM sleep behavior disorder: A post hoc exploratory analysis of a phase 2/3 clinical trial," appears in Cannabis and Cannabinoid Research.

California: Governor Signs Legislation Reducing Cannabis Tax Burden

Sacramento, CA: Democratic Gov. Gavin Newsom signed budget legislation late last week that reduces various marijuana-specific taxes.

Specifically, the legislation eliminates the cultivation tax on licensed growers and caps any further increase in the excise tax for three years, among other changes.

According to an economic analysis published this spring by The Reason Foundation, regulatory costs, high taxes, and municipal bans on cannabis retailers have significantly inhibited the growth of the licensed marijuana marketplace in California. The analysis estimated that California imposes an effective tax rate of as much as $92 per ounce. This amount is higher than the tax burden imposed on retail cannabis transactions in other states.

California NORML Director Dale Gieringer, who authored the study's forward, recommended at that time that lawmakers impose "substantive tax cuts" in order to "reduce demand for the illicit market, while still retaining reasonable revenues" for state-licensed retailers. Following last week's bill signing, he added, "The budget bill is a helpful start, but much more needs to be done to make legal cannabis more readily accessible to consumers who now rely on the unregulated market."

District of Columbia: Mayor Signs Legislation Allowing Adults Access to Medical Cannabis Dispensaries Following 'Self-Certification' Process

Washington, DC: Mayor Muriel Bowser has signed legislation legislation removing the requirement that adults seeking to purchase cannabis products from licensed DC medical cannabis dispensaries must obtain a recommendation from a licensed physician. Members of the DC City Council had previously voted unanimously in favor of legislation, known as the Medical Marijuana Self-Certification Emergency Amendment Act of 2022.

The measure permits individuals age 21 or older to "self-certify ... that they are utilizing cannabis for medical purposes" when they register with local regulators for a medical cannabis identification card. Once registered, self-certified adults may access any of the District's seven licensed medical cannabis dispensaries.

Councilmembers Mary Cheh and Kenyan McDuffie, who sponsored the measured, said that the legislation is needed to dissuade residents from patronizing the unregulated marketplace. "Due to the lower barriers to access in the gray market, a significant number of medical marijuana patients have shifted from purchasing their medical marijuana from legal medical dispensaries to the illicit gray market, creating a significant risk to the long-term viability of the District's legal medical marijuana industry," they said. "If this trend continues, it is possible that gray market sales could wipe out the District's legal marijuana dispensaries. Given the... benefits that regulated and safe legal dispensaries provide to medical marijuana users in the District, it is vital that the industry survive until the District can stand up a regulated recreational market and transition toward full regulation of recreational marijuana products."

Under District law, adults may possess and home-cultivate limited amounts of cannabis for their own personal use. However, Congressional action has prohibited the City Council from passing municipal legislation to provide adults with retail cannabis access.

Because the self-certification bill was enacted as "emergency legislation," it is not subject to Congressional review.

In June, DC Councilmembers passed separate legislation, the Cannabis Employment Protections Amendment Act of 2022, protecting those who use cannabis from facing discrimination in the workplace. That bill currently awaits action by the mayor.

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Congress: House Appropriations Committee Approves Amendment to Protect Legal State Marijuana Programs

Washington DC: The House Committee on Appropriations voted this week to approve an amendment that would prevent the Department of Justice from interfering with legal adult-use marijuana programs as part of the Commerce, Justice, Science, and Related Agencies appropriations legislation for Fiscal Year 2023.

The bipartisan amendment, introduced by Reps. Barbara Lee (D-CA) and David Joyce (R-OH), with the non-committee support of past champions Reps. Earl Blumenauer (D-OR), Tom McClintock (R-CA), and Eleanor Holmes Norton (D-DC), would bar the DOJ from using resources to interfere with the ability of states, territories, tribal governments, or the District of Columbia to implement laws and regulations governing the legal and regulated production, sale, and use of cannabis by adults or to target people acting in compliance with those laws.

This amendment was approved by the full House of Representatives as part of the annual spending omnibus for the last two years but has yet to be included in the final legislation. Since 2014, members of Congress have passed annual spending bills that have included a provision protecting those who are in compliance with state medical cannabis programs from undue prosecution by the Department of Justice. That provision has been included in the base appropriations legislation since 2018.

"As federal lawmakers steadily work to determine the best way to finally end marijuana prohibition and undo the damage it has caused, the people involved in regulated cannabis programs in the growing number of states that are leading the way on this issue deserve to know whether the federal government will actively get in the way of their continued successes," said NORML Political Director Morgan Fox. "Including these protections in the federal budget will go a long way toward giving individuals, businesses, and state governments some peace of mind while signaling to the vast majority of Americans who support legalizing and regulating cannabis that their elected representatives are actually listening to them."

"Congress must honor the will of the voters and prevent wasteful Department of Justice prosecution of those complying with their respective state's or tribe's cannabis regulations," said Congressman Blumenauer. "I have spearheaded the work to develop this language, which protects the state and tribal-legal programs that have been enacted laws to end prohibitionary policies and allow the development of both adult-use and medical marijuana programs. I appreciate the partnership and leadership of my colleagues, Representatives McClintock, Lee, Joyce, and Norton to move this important language forward today."

Official DOJ internal guidance to de-prioritize prosecutions of people acting in compliance with state cannabis laws was in place from 2013 until 2018 when former Attorney General Jeff Sessions rescinded the Cole Memo. As recently as April, Attorney General Merrick Garland has reiterated his position that it is a waste of DOJ resources to interfere with state cannabis programs. Unfortunately, such guidance has not been officially renewed under the current Administration and does not carry the force of law, and federal prosecutors have a great deal of discretion in terms of the cases they pursue.

There are currently 19 states as well as the District of Columbia and several territories where cannabis is legal for adults, and 37 states have effective medical cannabis laws. National and state polling shows significant majority support for making cannabis legal.

Survey: Consumers Most Likely to Self-Medicate with Cannabis to Alleviate Anxiety, Pain, and Depression

Quebec City, Canada: Canadians who consume cannabis for purposes of self-medication most frequently report doing so to address pain, anxiety, sleep disturbances, and depression, according to data published in the Journal of Cannabis Research.

Canadian researchers surveyed 489 subjects who purchased cannabis products at adult-use retailers, but who acknowledged doing so to self-medicate. Consistent with prior data, respondents were most likely to report consuming cannabis products to mitigate anxiety (70 percent), improve sleep (56 percent), alleviate pain (53 percent), and address feelings of depression (37 percent). Subjects were also likely to acknowledge using cannabis to alleviate muscle spasticity, migraine, nausea, and symptoms of post-traumatic stress.

Survey respondents typically reported using cannabis flower and selecting products dominant in THC. However, those respondents that exclusively defined their cannabis use as medical-only expressed a preference for CBD-dominant products.

In contrast with other surveys, most respondents acknowledged reporting their cannabis use to their health care professionals.

The results of another recent survey, published in the journal Complimentary Therapies in Clinical Practice, similarly determined that patients certified to use medical cannabis in the US most commonly do so to treat symptoms of pain, anxiety, post-traumatic stress, and depression. The results of yet another recent survey, conducted by Harris Polling, also found that consumers most often report consuming cannabis to reduce stress, improve sleep, and mitigate anxiety.

Separate survey data compiled in April reported that 21 percent of US Medicare recipients acknowledge consuming cannabis for therapeutic purposes, typically to address symptoms associated with chronic pain, anxiety, and depression.

Full text of the study, "A description of self-medication with cannabis among adults with legal access to cannabis in Quebec, Canada," appears in the Journal of Cannabis Research.

Analysis: Flower Continues to Dominate US, Canadian Marijuana Markets

Santa Monica, CA: Cannabis consumers in the United States and Canada predominantly consume marijuana flower instead other product formulations, according to data published in the International Journal of Drug Policy.

Investigators affiliated with the RAND Drug Policy Research Center in California and the University of Waterloo in Ontario, Canada assessed cannabis consumption patterns in the US and in Canada in a cohort of more than 40,000 subjects.

Consistent with prior surveys, they reported, "Dried flower was the most commonly used product" among consumers – regardless of whether those consumers patronized either the licit or illicit marketplace. However, investigators acknowledged that the popularity of other formulations of cannabis, particularly vape oils and edibles, had increased in recent years – especially in markets where cannabis products are legally available from licensed retailers.

Authors concluded: "The current study provides one of the most comprehensive assessments of cannabis consumption at the population level in Canada and the US to date. The findings highlight the rapidly evolving nature of the cannabis product market, including notable shifts in the types of cannabis products used by consumers. ... Although dried flower continues to dominate the market, it has begun declining with a notable shift towards increasing popularity of processed cannabis products."

Full text of the study, "Trends in the use of cannabis products in Canada and the USA, 2018 – 2020: Findings from the International Cannabis Policy Study," appears in the International Journal of Drug Policy.

Study: Cannabis Use by College Students Seldom Tied to Negative Consequences Absent Concurrent Use of Other Substances

Gainesville, FL: College students who consume cannabis, but not other controlled substances, do not appear to be at significant risk of suffering from either substance use disorder or low academic achievement, according to data published in the Journal of American College Health.

A team of investigators affiliated with the University of Florida at Gainesville assessed the relationship between college students' self-reported use of marijuana and other substances and academic outcomes.

They reported that those students who consumed cannabis – but who did not also consume either alcohol, cigarettes, or other substances – were less likely to report problems associated with substance abuse, skipping class, or poor grades than were those who were polysubstance users.

Authors determined: "The cannabis-only users reported experiencing the least amount of cannabis-related consequences and CUD [cannabis use disorder] symptoms but used cannabis on more days in the past month than any other group except the all-substance user group (CACS-cannabis, alcohol, cigarettes and other substance users). ... These findings may indicate that although cannabis-only users use more frequently than other groups, this group may be at lower risk for negative consequences associated with use compared to all-substance users. This is in line with previous findings showing that polysubstance use is related to more negative consequences compared to single use."

They concluded: "Overall, the current findings suggest that (1) alcohol use is prevalent among cannabis-using college students and (2) concurrent polysubstance use of four or more substances is associated with increased risk of cannabis-and academic-related problems including CUD symptom severity, skipping classes, and lower GPA. When addressing cannabis use among college students, clinicians should assess and target multiple substances in addition to cannabis. Risks associated with sole cannabis use were low compared to concurrent substance use. Hence, efforts aimed at preventing the initiation of additional substance use may be warranted."

Full text of the study, "Independent and concurrent cannabis use with alcohol, cigarettes, and other substances among college students: Rates and consequences," appears in the Journal of American College Health.

Analysis: Labels of Hemp-Derived CBD Products Often Provide Inaccurate Information

Lexington, KY: Commercially available CBD products are often labeled in ways that misrepresent the true percentage of cannabinoids available in them, according to data published in the Journal of Cannabis Research.

Researchers affiliated with the University of Kentucky College of Medicine lab-tested 80 commercially available hemp-derived CBD products. Products were acquired either online on at brick and mortar retail stores.

Consistent with dozens of other analyses, authors reported that a significant percentage of the products tested (46 percent) contained CBD concentrations that were significantly different than the concentration listed on the label.

Authors reported: "These data suggest that additional regulation is required to ensure label accuracy as nearly half of the products in this study were not properly labelled (i.e., not within a +/- 10 percent margin of error). Consumers and practitioners should remain cautious of unregulated and often-mislabeled CBD products due to the risks of taking too much CBD (e.g., drug-drug interactions, liver enzyme elevations, increased side effects) and the consequences of taking too little (e.g., no clinical benefits due to underdosing)."

They concluded: "The findings reported here emphasize the continued need for clear and consistent regulation from federal and state agencies to ensure label accuracy of CBD products and subsequent enforcement. These results also indicate the need for continued development of good manufacturing practices and testing standards. As consumers are taking CBD products for an ever-increasing range of conditions, independent of medical guidance, the accuracy of content labeling is important for the safety of the consumer."

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, "Label accuracy of unregulated cannabidiol (CBD) products: Measured concentration vs. label claim," appears in the Journal of Cannabis Research.

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