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Study: Medical Cannabis Treatment Reduces Daily Morphine Intake in Chronic Pain Patients

Pittsburgh, PA: The use of cannabis products is associated with a reduction in pain patients' daily consumption of opioids, according to data published in the journal Pain Physician.

A team of investigators affiliated with the Institute for Pain Medicine in Pennsylvania assessed opioid use trends in a cohort of 115 chronic pain patients who initiated medical cannabis therapy. Patients in the study suffered from intractable pain and had consumed opioids for a period of at least six-months. The majority of the study's participants were between 50 and 70 years of age.

Consistent with other studies, authors reported that patients reduced their daily morphine milligram equivalent (MME) intake after initiating cannabis therapy.

"There was a 67.1 percent average decrease in daily MME/patient from 49.9 to 16.4 MME at the first follow-up," they reported. "There was a 73.3 percent decrease in MME at the second follow-up from 49.9 to 13.3 MME."

Authors concluded: "The current study's approach has led to a significant decrement in chronic opioid use for the majority of patients with chronic pain deciding to trial medical cannabis in our clinical setting. ... Therefore, we present medical cannabis as an alternative, potentially effective, class of treatment."

Full text of the study, "Medical cannabis used as an alternative treatment for chronic pain demonstrates reduction in chronic opioid use - A prospective study," appears in Pain Physician.

Poll: Most Voters Lack Confidence that President Will Follow Through on Marijuana-Specific Campaign Pledges

Washington, DC: Most voters doubt that President Joe Biden will follow through on his campaign promises to reform federal marijuana laws, according to the results of a recently released Economist/YouGov poll.

On the campaign trail, Biden insisted, "No one should be in jail because of marijuana." He pledged, "As President, [I] will decriminalize cannabis use and automatically expunge prior convictions." Thus far, however, the White House has made almost no mention of the issue.

That fact has not gone unnoticed by voters. Fifty-six percent of those polled agreed that the President has made little or no progress on the issue, while 23 percent were unsure. Looking forward, an even greater majority said that they did not expect the President to take any substantive action on the issue in 2022.

Although the President cannot repeal the federal prohibition of marijuana by executive order, he can take steps unilaterally to follow through on several of his campaign promises – such as granting amnesty to those with federal convictions for certain marijuana-related crimes.

NORML has previously urged the White House to issue pardons for those convicted of nonviolent marijuana offenses, as have several members of Congress.

"President Biden was crystal clear on the campaign trail that his administration would prioritize criminal justice reform, and he explicitly highlighted his desire to expunge the records of those suffering from the stigma of a federal marijuana conviction," NORML's Executive Director Erik Altieri said. "Following through on this campaign promise would be an important first step in remedying the past wrongs associated with nearly a century of marijuana prohibition and healing the wounds of the many Americans who have needlessly suffered under this failed public policy. In 2022, it is readily apparent that the criminalization of cannabis, and the lifelong lost opportunities that come with a criminal marijuana conviction, causes far greater harm than the responsible use of cannabis itself."

Clinical Trial: Cannabis-Infused Eye Drops Effectively Treat Rare Form of Dystonia

Tel Aviv, Israel: The administration of cannabis-infused eye drops reduces spasms in patients diagnosed with the progressive neurological disorder benign essential blepharospasm (BEB), according to placebo-controlled data published in the journal Graefe's Archive for Clinical and Experimental Ophthalmology. BEB is a rare type of dystonia that is characterized by the abnormal blinking or spasming of the eyelids.

A team of Israeli researchers compared cannabis-infused eye drops versus placebo in patients with BEB over a period of several weeks. Cannabis treatments were associated with significant reductions in the both the frequency and duration of patients' spasms.

Authors concluded, "Medical cannabis can be an effective and safe treatment for BEB as a second line after BTX-A injections when used for three months. No significant ocular or systemic side effects was associated with the treatment."

Full text of the study, "Medical cannabis oil for benign essential blepharospasm: A prospective, randomized controlled pilot study," appears in Graefe's Archive for Clinical and Experimental Ophthalmology.

Longitudinal Study: Cannabis' Impact on Lung Health Distinct from Tobacco

Dunedin, New Zealand: Smoking cannabis long-term is not associated with the same physiological consequences on lung health as is tobacco smoking, according to longitudinal data published in the American Journal of Respiratory and Critical Care Medicine.

A team of New Zealand researchers examined the long-term effects of cannabis smoking and/or tobacco smoking in a cohort of 881 middle-aged adults.

Consistent with prior studies, researchers reported that cannabis inhalation was associated with higher total lung capacity and other physiological changes that are distinct from the health consequences associated with tobacco smoking. Authors concluded, "[I]t is increasingly clear that cannabis has different effects on lung function [as compared] to tobacco and the effects of widespread cannabis use will not necessarily mirror the harms caused by tobacco smoking."

The findings are consistent with prior research concluding that cannabis smoke and tobacco smoke are not equally carcinogenic, that cannabis inhalation exposes consumers to fewer toxicants than does tobacco smoking, and that marijuana smoke exposure is typically not associated with the same health consequences as is tobacco smoking, including increased risks of COPD or lung cancer. Moreover, the use of vaporization technology, which heats herbal cannabis to a set temperature below the point of combustion, is associated with reduced exposure to toxic gasses and has been identified as a "safe and effective" cannabis delivery device in clinical trials.

Full text of the study, "Differential effects of cannabis and tobacco on lung function in mid-adult life," appears in theAmerican Journal of Respiratory and Critical Care Medicine.

New Hampshire: Supreme Courts Rules in Favor of Employment Protections for Medical Cannabis Patients

Concord, NH: Businesses are not permitted to terminate employees solely because of their off-the-job use of medical marijuana, according to a decision rendered by the state's Supreme Court.

Justices determined that those who participate in the state's medical cannabis access program qualify under the law as "individuals with a disability" and therefore employers must make "reasonable accommodations" for them. Justices ruled that providing the defendant with an exception to a company's marijuana drug testing policy was a reasonable accommodation. "We agree with the plaintiff that (the state anti-discrimination law) does not contain any language categorically excluding the use of therapeutic cannabis as an accommodation," justices ruled in an unanimous opinion.

Unlike the medical cannabis access laws of over a dozen states, New Hampshire's law does not explicitly protect qualified patients from workplace discrimination.

Henry Klementowicz, a senior staff attorney for the New Hampshire state affiliate of the American Civil Liberties Union said, "This Supreme Court ruling is a victory for the over ten thousand Granite Staters enrolled in the state's medical cannabis program who were at were at risk of experiencing employment discrimination due to their disability."

The case is Paine v. Ride-Away, Inc.

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Analysis: Liberalization of European Cannabis Policies Not Linked to Increased Marijuana Use by Young People

Stockholm, Sweden: More permissive marijuana policies are not associated with upticks in cannabis use among young people, according to data published in the journal PLoS One.

Swedish researchers assessed trends in the use of marijuana by adolescents and younger adults in 11 European countries over a 23-year period (1994-2017). During that time, several nations liberalized their marijuana laws while others made no changes.

Investigators reported that young people's use of cannabis either remained stable or increased in countries that failed to amend their marijuana laws. By contrast, teen use decreased in jurisdictions that liberalized their policies.

"This comprehensive re-analysis of all available data from EMCDDA [the European Monitoring Centre for Drugs and Drug Addiction] does not corroborate an impact of changes in cannabis legislation on cannabis use among young people in Europe," authors reported. "Overall, since the 1990's, self-reported use appeared to increase among countries without any policy changes but decrease after both decriminalization and depenalization of cannabis-related crimes."

The findings are similar to those from the United States showing decreasing rates of marijuana use by adolescents in jurisdictions that have legalized the adult-use cannabis marketplace.

The study's authors concluded, "There is no evidence as of date, considering available data and previous publications, that policy changes regarding recreational cannabis significantly affect the prevalence of recreational cannabis use among young people in Europe."

Full text of the study, "Changes in cannabis policy and prevalence of recreational cannabis use among adolescents and young adults in Europe: An interrupted time-series analysis," appears in PLoS One.

Survey: More Than One in Four North Americans Self-Report Having Used Cannabis for Medical Purposes

Waterloo, Canada: More than one in four North Americans acknowledge having used cannabis for medical purposes, according to survey data published in the journal Psychopharmacology.

An international team of researchers from Australia and Canada assessed the prevalence of self-reported medical cannabis use among a population-based cohort of more than 27,000 respondents from the United States and Canada. Participants in the study were between the ages of 16 and 65. Fifty-eight percent of subjects reported having had some prior experience with marijuana.

Just over 27 percent of all respondents reported having consumed cannabis for medical purposes. Those who did so were most likely to report having used cannabis to manage pain (53 percent), to reduce anxiety (52 percent), or to improve sleep (46 percent) - a finding that is consistent with other studies. Subjects were also likely to report using cannabis to offset symptoms of post-traumatic stress, migraine, and depression. Self-reported medical use was higher in jurisdictions where such access is permitted as compared to places where its use remains illegal.

Authors concluded: "A substantial proportion of the North American population self-reported cannabis use for medical purposes for a variety of medical reasons, including those living in jurisdictions without legal markets. ... Our findings have implications for how cannabis use is being used by the population, which may include authorized use with prescription by a health professional, and also self-defined medical use without professional guidance. ... Further research is needed to understand the safety and efficacy of these forms of medical cannabis use."

Full text of the study, "Prevalence of self-reported reasons of cannabis use for medical purposes in USA and Canada," appears in Psychopharmacology.

Cannabinoid Acids Exhibit Anti-COVID Activity in Preclinical Models

Corvallis, OR: Cannabigerolic acid (CBGA) and cannabidiolic acid (CBDA) exhibit anti-COVID activity in culture, according to data published in the Journal of Natural Products.

Researchers with the University of Oregon reported that both cannabinoids inhibited the entry of SARS-CoV-2 into human epithelial cells. Authors reported that the cannabinoid acids showed equal efficacy against multiple COVID variants.

Both compounds are abundant organically in raw hemp plants and in certain hemp extracts.

By contrast, activated compounds such as THC and CBD failed to show efficacy in the models.

Authors concluded, "Orally bioavailable and with a long history of safe human use, these cannabinoids, isolated or in hemp extracts, have the potential to prevent as well as treat infection by SARS-CoV-2."

Prior preclinical studies and reviews have similarly suggested that certain cannabis compounds could potentially modulate COVID infections. However, to date, no human studies 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. An observational study published in October reported an association between problematic cannabis use and an increased risk of COVID breakthrough infections.

Since the start of the COVID pandemic, the US Food and Drug Administration has sent numerous warning letters to companies for misrepresenting their CBD products as a COVID treatment options for patients. NORML has repeatedly cautioned consumers to beware of online misinformation surrounding the commercial marketing of either whole-plant cannabis or CBD as potential remedies for the COVID-19 virus.

Full text of the study, "Cannabinoids block cellular entry of SARS-CoV-2 and the emerging variants," appears in theJournal of natural Products.

Study: Alcohol, Not Cannabis, Associated with Violent Behaviors in Psychotic Patients

Montreal, Canada: The consumption of alcohol, but not cannabis, is associated with an increased likelihood of impulsiveness and violent behavior among subjects with schizophrenic spectrum disorders, according to data published in the Journal of Clinical Psychopharmacology.

A team of Canadian and Italian investigators assessed the relationship between the use of alcohol and cannabis on psychotic, impulsive, and violent behavior in a cohort of subjects diagnosed with either schizophrenia or other psychotic disorders. All of the subjects in the cohort possessed a history of violent behavior.

Researchers reported: "Cannabis use disorder was neither associated with impulsive behavior nor with violent behavior." By contrast, they determined that "alcohol use disorder was positively associated with increased levels of impulsivity, in particular impulsive and thoughtless behavior. ... [A]lcohol use disorder was [also] significantly associated with violence."

They concluded, "In summary, our findings indicate that lifetime cannabis use disorder is frequent among patients with psychotic disorders but is not associated with violent and impulsive behaviors."

Previous studies have identified elevated levels of cannabis use among subjects with certain psychiatric disorders, some of whom may be seeking to self-medicate with it.

Full text of the study, "Cannabis use disorder is not associated with lifetime impulsive behavior and severe violence in patients with schizophrenia spectrum disorders from a high-security hospital," appears in theJournal of Clinical Psychopharmacology.

Canada: Growing Percentage of Cannabis Consumers Transitioning to the Licit Marketplace

Waterloo, Canada: A growing number of Canadians who consume cannabis are obtaining it from the legal marketplace, according to data published in the journal Drug and Alcohol Dependence.

Investigators affiliated with the University of Waterloo, School of Public Health Sciences surveyed nearly 5,000 Canadian adults who acknowledged having purchased cannabis flowers within the past year.

Researchers reported that the percentage of consumers switching from the illicit market to the licit market increased from 2019 to 2020 and that the majority of respondents (58 percent) now acknowledge obtaining cannabis flowers from licensed retailers. The study's authors attributed these changes in behavior to increases in retail availability and falling prices for cannabis products available in the legal marketplace.

The findings are consistent with those of a 2021 study published in the journal Health Reports which found that nearly 70 percent of cannabis consumers reported obtaining cannabis from a legal source, up from 47 percent in 2019.

Canada initially legalized the retail sale of cannabis in October 2018.

Full text of the study, "Cannabis flower prices and transitions to legal sources after legalization in Canada, 2019-2020," appears in Drug and Alcohol Dependence.

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Analysis: Adult-Use Marijuana Sales Yield Over $10 Billion in New Tax Revenue

Washington, DC: State-authorized sales of retail marijuana products have yielded more than $10 billion in new tax revenue, according to an analysis compiled by the Marijuana Policy Project.

"Legalizing cannabis for adults has been a wise investment," authors of the report concluded. "Since 2014 when sales began in Colorado and Washington, legalization policies have provided states a new revenue stream to bolster budgets and fund important services and programs. As of December 2021, states reported a combined total of $10.4 billion in tax revenue from legal, adult-use cannabis sales. In addition to revenue generated for statewide budgets, cities and towns have also generated hundreds of thousands of dollars in new revenue from local adult-use cannabis taxes."

These revenues have been used to fund various state-specific projects, MPP's analysis reported. In Colorado, for instance, over $470 million in cannabis-specific tax revenue has been applied toward public schools. In Washington, some $600 million in revenue has been directed toward public health initiatives, including a fund that provides health insurance to low-income families. In California, over $100 million in revenue has been provided to community investment programs and local nonprofit groups.

In every state permitting adult-use sales, marijuana tax revenues have grown year-over-year.

Full text of the report, "Cannabis Tax Revenue in States that Regulate Cannabis for Adult Use," is available online.

 

Survey: Many Health Care Professionals Possess a "Poor" Understanding of Cannabis Use for Medical Purposes

Portland, OR: A significant percentage of health care practitioners possess only limited knowledge about the use and efficacy of medical cannabis, according to survey data published in the Journal of the American Association of Nurse Practitioners.

A team of investigators affiliated with the Oregon Health & Science University surveyed 178 health care professionals (physicians, registered nurses, and nurse practitioners) attending a Continuing Medical Education program on the clinical uses of cannabis. Nearly all of the health professionals surveyed were licensed to practice in either California, Oregon, or Washington – three jurisdictions where medical cannabis access has been legally available for more than two decades.

Researchers reported: "This study found that HCPs' [health care professionals] knowledge about the medical risks and benefits of clinical cannabis, although similar among professions, is generally poor and has specific important gaps. Health care professionals scored an average of only 63.2 percent on direct knowledge tests about clinical cannabis, with no significant differences among professions. Attendees scored highest on questions about laws and regulations (85.7 percent). Mean scores for questions related to all other topics, including risks and harms, pharmacology, pain, multiple sclerosis spasticity, and seizures, were all below 70 percent, equivalent to a C grade."

They added, "Despite more than 95 percent of respondents practicing in states (Oregon, Washington, or California) where clinical cannabis had been legal for more than 20 years and recreational cannabis had been legal for at least two years, their knowledge about clinical cannabis was poor. This supports that wide and prolonged availability of cannabis is not sufficient to accomplish provider knowledge and that more education is needed."

Authors concluded, "The findings of this study support that, despite a growing evidence base, and even after many years of legalization, HCPs including APRNs [advance practice registered nurses] have substantial gaps in their knowledge of the potential risks and benefits associated with the use of cannabis for medical purposes."

The study's conclusions are consistent with those of prior surveys of health care professionals in which most doctors and nurses acknowledge that they are insufficiently trained in issues related to the use of cannabis. Separate survey data published in 2020 also reported that fewer than one-in-five patients believe that their primary care providers are sufficiently knowledgeable about cannabis-specific health-related issues.

Full text of the study, "Cannabis for medical purposes: A cross-sectional analysis of health care professionals' knowledge," appears in the Journal of the American Association of Nurse Practitioners.

 

Analysis: Frequent Cannabis Use Associated with Lower Incidences of Diabetes Among Women

College Station, TX: Women who frequently consume cannabis are less likely to be diagnosed with diabetes mellitus, according to data published in the journal Cannabis and Cannabinoid Research.

Researchers at Texas A&M University assessed the relationship between cannabis use and diabetes in a nationally representative sample of over 15,000 adults.

They reported that women who were frequent cannabis consumers were less than half as likely to be diagnosed with diabetes as compared to female non-users. No differences were observed among women who only consumed cannabis occasionally.

Researchers did not identify a similar inverse relationship among males. They concluded, "Further studies are needed to explore the sex-based heterogeneity-and individual and contextual factors responsible-in the association between cannabis use and diabetes mellitus."

Several previous studies have identified a correlation between frequent cannabis use and lower odds of adult-onset diabetes, while clinical trial data has shown that the administration of THCV is associated with improved glycemic control in type 2 diabetics.

Full text of the study, "Sex differences in the association between cannabis use and diabetes mellitus among US adults: The National Health and Nutritional Examination Survey, 2013-2018," appears in Cannabis and Cannabinoid Research.

 

Study: Labeling of Commercially Available CBD Products Often Inaccurate

Madison, WI: Commercially available CBD-infused products typically contain percentages of cannabidiol that differ significantly from the information provided on their labels, according to data published in the journal Epilepsy & Behavior.

A team of investigators affiliated with the University of Wisconsin, School of Pharmacy performed laboratory analyses on a variety of commercially available CBD products, including infused oils, beverages, and edibles.

Consistent with numerous other analyses of unregulated, commercially available CBD-branded products, investigators reported that the percentage of CBD available in many of the products tested "varies largely from their label claims." CBD-infused beverage products were most likely to contain CBD percentages that differed from their labels.

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. Speaking in October at the National Industrial Hemp Business Summit in Washington, DC, FDA representative Gail Sipes said that the agency cannot move forward with regulations without more data on the safety of CBD products. At that time, she reiterated the agency's position that companies that market CBD-infused products as either food products or as dietary supplements are violating the Food, Drugs, and Cosmetics Act.

In a report provided by the FDA to Congress in 2020, the agency said that regulating over-the-counter CBD products presents a unique challenge because the substance is already available as a FDA-approved medicine (Epidiolex).

NORML and other groups have consistently urged the FDA to provide regulatory guidelines overseeing the production, testing, labeling, and marketing of hemp-derived CBD products.

Full text of the study, "Analysis of cannabidiol (CBD) and THC in nonprescription consumer products: Implications for patients and practitioners," appears inEpilepsy & Behavior.

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Analysis: Public Interest in Delta-8 Products Rising in States Where Cannabis Remains Criminalized

San Diego, CA: The popularity of unregulated products containing delta-8 THC is far greater in states where cannabis is illegal than it is in jurisdictions where it has been legalized, according to an analysis published in The International Journal of Drug Policy.

Researchers at the University of California, San Diego analyzed Internet users' interest in delta-8 THC products in all 50 states. They found that online searches for delta-8 THC products grew significantly in the years 2019 and 2020 and that public interest "was particularly high in US states that restricted delta-9 THC use."

Although delta-8 THC occurs organically in the cannabis plant, it is only produced in nominal quantities. By contrast, the elevated quantities of delta-8 THC found in grey market products are the result of a chemical synthesis during which manufacturers convert hemp-derived CBD to delta-8 THC. Manufacturers engaged in synthesizing delta-8 THC are not regulated and often use potentially dangerous household products to facilitate this process. Lab analyses of unregulated delta-8 products have consistently found them to contain lower levels of the compound than advertised on the products' labels. Some products have also been found to possess heavy metal contaminants and unlabeled cutting agents.

In October, NORML issued a report on delta-8 THC and other novel, synthetically derived cannabinoids that cautioned consumers to avoid these unregulated products because they are untested and may contain impurities.

According to survey results published in The Journal of Cannabis Research, consumers of delta-8 THC products typically use them for relaxation and pain management. Consumers often report the effects of these products to be less potent than those of whole-plant cannabis and of a shorter duration.

Full text of the study, "Public interest in delta-8 THC increased in US states that restricted delta-9 THC use," appears in The International Journal of Drug Policy. Full text of the study - "Delta-8-THC: Delta-9-THC's nicer younger sibling?" - appears in The Journal of Cannabis Research.

Review: Minor Cannabinoids Acknowledged to Possess Therapeutic Properties

Columbia, South Carolina: Numerous minor cannabinoids found in the cannabis plant possess therapeutic properties that may hold clinical significance, according to a review paper published in the journal Frontiers of Pharmacology.

A team of US investigators affiliated with the University of South Carolina and Doane University in Nebraska summarized data on the potential therapeutic applications of a number of secondary cannabinoids, including CBN (cannabinol), CBC (cannabichromine), cannabigerol (CBG), and tetrahydrocannabivarin (THCV). Most of the research available on these compounds has thus far been limited to preclinical studies.

Specifically, authors highlighted the analgesic and anti-inflammatory properties of various ancillary cannabinoids, including CBG, CBC, THCV, and CBN.

They acknowledged that CBN also "shows promise as an antibacterial agent and [as] an appetite stimulant," but cautioned that it has shown inconsistent results as a sleep aid.

Several of these minor cannabinoids, such as CBG and CBC, also possess anti-cancer properties, while THCV "regulates blood glucose levels, suggesting it might be useful in weight reduction and treating diabetes." THCV has also demonstrated anti-epileptic and neuroprotective properties.

Another cannabinoid highlighted by the authors, cannabidivarin (CBDV) possesses anti-seizure activity and may possess therapeutic utility in the treatment of autism, muscular dystrophy, and as an anti-emetic agent.

A number of these minor cannabinoids have "also shown promise in the treatment of skin disorders," investigators reported.

Authors also highlighted the promise of various cannabinoid acids (e.g., CBDA, CBGA, and THCA). Specifically, they acknowledged that CBGA "may play a role in controlling diabetes mellitus and preventing the cardiovascular complications that can accompany Type 2 diabetes," whereas THCA has been shown to mitigate liver fibrosis in animals.

"Minor cannabinoids and their chemical homologs offer the potential medicinal benefits of D9-THC without adverse effects," authors concluded. "Future studies will need to evaluate the risk versus benefit of these and other minor cannabinoids when compared to D9-THC and traditional analgesic drugs."

Full text of the study, "Minor cannabinoids: Biosynthesis, molecular pharmacology and potential therapeutic uses," appears inFrontiers of Pharmacology.

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