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Study: No Rise in Youth Marijuana Use Following Legalization

Bozeman, MT: Neither the enactment of medical marijuana or adult-use legalization laws have led to an uptick in young people’s consumption of cannabis, according to data published in the Journal of the American Medical Association.

A team of researchers analyzed data compiled from the Youth Risk Behavior Survey for the years 1993 to 2017.

They reported that the adoption of medical cannabis access laws was associated with slight reductions in self-reported marijuana use by young people. The enactment of adult-use legalization laws was associated with no statistically significant changes in youth use patterns.

Authors concluded, “Consistent with estimates from prior studies, there [is] little evidence that RMLs [recreational marijuana laws] or MMLs [medical marijuana laws] encourage youth marijuana use.”

To date, dozens of federal and state-specific surveys have failed to identify any independent link between the legalization of cannabis for either adult-use or medical purposes and any rise in the percentage of teens using it. Moreover, data published in 2019 in the journal JAMA Pediatrics reported that the enactment of laws regulating the use of cannabis by adults is associated with declines in self-reported marijuana use by young people. Separate data compiled by the US Centers for Disease Control has reported that the number of adolescents admitted to drug treatment programs for marijuana-related issues has fallen precipitously in states that have legalized and regulated the adult-use market.

In a recent interview, Nora Volkow, Director of the US National Institute on Drug Abuse similarly acknowledged that statewide legalization laws have not led to an increase in the prevalence of adolescents consuming cannabis.

Full text of the study, “Association of marijuana legalization with marijuana use among US high school students, 1993-2019,” appears in JAMA Open Network.

Analysis: Medical Cannabis Provides Benefits to Migraine Patients

Miami, FL: The inhalation of medical cannabis is associated with decreases in migraine frequency and in migraine-related pain, according to a literature review published in the journal Cureus.

A team of investigators affiliated with Larkin Community Hospital in Miami reviewed 34 scientific papers assessing the use of cannabis for migraine management.

Researchers reported “encouraging data on medicinal cannabis’ therapeutic effects on alleviating migraines in all of the studies reviewed.” They added: “Beneficial long-term and short-term effects of medicinal cannabis were reported. It was effective in decreasing daily analgesic intake, dependence, and level of pain intensity. Some patients experienced a prolonged and persistent improvement in their health and well-being (both physically and mentally) after long-term use of medicinal cannabis. Overall, patients reported more positive effects rather than adverse effects with medical cannabis use.”

Authors concluded: “[T]here is a consensus for the indication of medical marijuana therapy when first and second-line treatment fails. … Further research should be performed once cannabis becomes legalized to determine a favorable delivery method, dose, and strain for migraine and chronic headache management and possible long-term effects of medical cannabis use.”

Numerous surveys of patients report that those suffering from migraines often turn to cannabis for symptomatic relief, and many patients say that it is more effective than prescription medications.

Full text of the study, “Medical cannabis, headaches, and migraines: A review of the current literature,” appears in Cureus.

Case Series: Cannabis Plant Extracts Effective in Mitigating Chronic Pain

London, United Kingdom: The use of sublingual oils containing whole-plant cannabis extracts are safe and effective in patients diagnosed with chronic pain, according to clinical outcome data published in the Journal of Clinical Pharmacology.

British researchers affiliated with London’s Imperial College assessed the use of cannabis extracts over a six-month period in 110 subjects.

Investigators reported that the administration of cannabis oils was associated with “significant improvements” in patients’ pain conditions over the study period. Adverse events associated with the extracts were described as “being mild or moderate in intensity.”

They concluded: “Treatment of chronic pain with [whole-plant cannabis] oils was associated with an improvement in pain-specific outcomes, HRQoL [health-related quality of life] and self-reported sleep quality. Relative safety was demonstrated over medium-term prescribed use. Whilst these findings must be treated with caution considering the limitations of study design, they can inform future clinical trials.”

Several randomized, placebo-controlled trials have previously demonstrated the safety and efficacy in herbal cannabis in the treatment of chronic pain, particularly neuropathy. A 2017 review of over 10,000 peer-reviewed scientific papers by the National Academies of Sciences, Engineering, and Medicine acknowledged, “In adults with chronic pain, patients who [are] treated with cannabis or cannabinoids are more likely to experience a clinically significant reduction in pain symptoms. … There is conclusive or substantial evidence that cannabis is effective for the treatment of chronic pain in adults.”

Full text of the study, “Clinical outcome data of first cohort of chronic pain patients treated with cannabis-based sublingual oils in the United Kingdom โ€“ Analysis from the UK Medical Cannabis Registry,” appears in Journal of Clinical Pharmacology.

Survey: Most Physicians “Insufficiently Prepared” to Discuss Cannabis-Related Health Issues

Ann Arbor, MI: Physicians report possessing limited knowledge about cannabis, particularly with respect to advising patients on medical marijuana treatment plans, according to data published in the journal Cannabis and Cannabinoid Research.

A pair of researchers with the University of Michigan at Ann Arbor anonymously surveyed 244 practicing physicians. All of the participants practiced in a state where both the use of cannabis for medical and for recreational purposes was legal.

Consistent with prior surveys of health care professionals, the majority of respondents said that they possessed little or no formal knowledge about either cannabis or individual cannabinoids, and 64 percent said that they were “somewhat uncomfortable or very uncomfortable in integrating cannabis into their patients’ treatment regimens.”

Authors concluded: “We show that physicians from a university-affiliated health system in a state with legal recreational and medical cannabis have generally low levels of factual knowledge about medical cannabis. … Our results highlight the mismatch between physician knowledge and medical cannabis policy. Despite numerous long-standing medical cannabis laws (11 years in the state of the current study), physician training and education has insufficiently prepared physicians on cannabis-related knowledge. This is especially true for dosing, as most respondents were unsure about effective doses (in mg) of THC or CBD. … This lack of knowledge has contributed to general discomfort with integrating cannabis into medical practice. This discomfort likely pushes patients to turn to other sources to obtain cannabis-related knowledge, including the popular press, personal research, or from dispensary staff who receive little or no medical training. As such, more comprehensive training is necessary for physicians to bridge the gap between cannabis policy and clinical care.”

Full text of the study, “Assessing health care providers’ knowledge of medical cannabis,” appears in Cannabis and Cannabinoid Research.

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Review: Cannabinoids Are an “Adequate Potential Treatment Option” for Fibromyalgia Patients

Fairfield, CA: Human trials indicate that the use of either whole-plant cannabis or cannabinoids can improve various symptoms in patients with fibromyalgia (FM) and that they possess an adequate safety profile for use in treatment, according to the findings of a literature review published in the journal Cureus.

Investigators affiliated with the California Institute of Behavioral Neurosciences and Psychology reviewed 22 scientific papers specific to the use of either cannabis or synthetic cannabinoids in FM patients.

Authors concluded: “[T]he data suggest that the use of cannabinoids and cannabis carries limited side effects in the treatment of FM, and they can also improve some common and debilitating symptoms associated with FM, thus making them an adequate potential treatment option, when other treatment lines have been exhausted.”

Cannabis use is frequently reported by patients with fibromyalgia, and the results of several human trials indicate that cannabinoids provide therapeutic relief to patients with fibromyalgia. Most recently, observational trial data published in February reported that the long-term use of various types of cannabis preparations was associated with significant improvements in pain and other symptoms in patients with refractory fibromyalgia.

Full text of the study, “A systematic review of fibromyalgia and recent advancements in treatment: Is medicinal cannabis a new hope?” appears in Cureus.

Top Federal Drug Official Acknowledges that Adult-Use Marijuana Legalization Hasn’t Led to Jumps in Adolescent Use

Washington, DC: The enactment of statewide laws regulating the adult-use cannabis market has not led to an increase in the percentage of young people experimenting with the plant, according to comments made recently by Nora Volkow, Director of the US National Institute on Drug Abuse.

Speaking on a podcast hosted by Ethan Nadelmann, the former Director of the Drug Policy Alliance, Volkow admitted that she had initially expressed concerns that legalization would lead to an increase in the prevalence of adolescents consuming cannabis. Thus far, however, she said, “Overall, it hasn’t.”

To date, dozens of federal and state-specific surveys have failed to identify any independent link between the legalization of cannabis for either adult-use or medical purposes and any rise in the percentage of teens using it. Moreover, data published in 2019 in the journal JAMA Pediatrics reported that the enactment of laws regulating the use of cannabis by adults is associated with declines in self-reported marijuana use by young people. Separate data compiled by the US Centers for Disease Control has reported that the number of adolescents admitted to drug treatment programs for marijuana-related issues has fallen precipitously in states that have legalized and regulated the adult-use market.

During the interview, Volkow also acknowledged that legalization has been associated with “better outcomes” in various states, and that federal laws and regulations on the cannabis plant have “hindered” scientists’ ability to research it – particularly with respect to the plant’s therapeutic efficacy.

An audio archive of the Nadelmann/Volkow interview is available online.

Commentary: Herbal Cannabis Vaporization Safer Alternative to Smoking

Toronto, Canada: Vaporizing herbal cannabis reduces consumers’ exposure to combustion-related toxins and provides a safer alternative to marijuana smoking, according to a commentary published in the Canadian Journal of Public Health.

A team of researchers with the University of Toronto’s School of Public Health opined, “Cannabis vaporizer use can reduce the emission of carbon monoxide, chronic respiratory symptoms, and exposure to several toxins while producing similar subjective effects and blood THC concentration compared with smoking cannabis, holding potential for harm reduction among habitual cannabis smokers.”

Vaporizing devices heat cannabis to the point where cannabinoid vapors form, but below the point of combustion. The results of human clinical trials assessing this technology have concluded that vaporizing herbal cannabis is a “safe and effective” cannabinoid delivery mode that does not result in exposure to combustion gases. Researchers have also reported that vaporization results in higher plasma concentrations of THC compared to those associated with smoking cannabis.

Full text of the commentary, “Are vaporizers a lower risk alternative to smoking cannabis?” appears in the Canadian Journal of Public Health.

Case Report: Cannabis Tincture Associated with Tic Reduction in Tourette Syndrome Patient

Erfurt, Germany: The administration of the proprietary cannabis tincture Nabiximols (a/k/a Sativex) is associated with a “dramatic decrease” in tic-related symptoms in a patient with Tourette Syndrome (TS), according to a case report published in the journal Tremor and Other Hyperkinetic Movements.

A pair of German researchers documented the treatment of a 25-year-old male TS patient with Nabiximols. The patient had previously reported consuming whole-plant cannabis to manage his TS symptoms. Symptoms had returned after he ceased using the plant.

Following at least twice-daily treatment with Nabiximols, the patient experienced a “marked tic reduction … without experiencing relevant side effects.” The acute effects of the drug lasted about four hours.

Authors concluded: “Based on our case, and in line with previous reports, we propose that buccal Nabiximols might be an effective addition to โ€˜acute’ or โ€˜as required’ tic treatment under specialist guidance, especially for predictable situations in the short term when severely disabling or stigmatizing tics are anticipated.”

Sativex is a whole-plant cannabis tincture containing nearly equal ratios of THC and CBD. It is available via prescription in numerous nations, but not in the United States, and it is primarily utilized for the treatment of multiple sclerosis.

Several small studies and case-reports have documented the efficacy of either inhaled cannabis or oral THC in mitigating symptoms in TS patients. In a recent survey of TS patients with experience using either herbal cannabis or oral cannabinoids, those who expressed a preference between the two products said that inhaled cannabis provided superior therapeutic benefits.

Full text of the study, “Tic reduction in adult onset Gilles De La Tourette syndrome using as required Nabiximols spray,” appears in Tremor and Other Hyperkinetic Movements.

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