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Harris Poll: Two-Thirds of US Adults Favor Legalizing Marijuana

Marijuana Poll; Chicago, IL: Two-thirds of US adults favor a repeal of federal marijuana prohibition, according to nationwide polling data compiled by Harris Research.

Sixty-six percent of respondents in a nationally representative sample endorse legalizing cannabis for adults, with support being strongest among millennials (79 percent) and members of Generation X (76 percent). By contrast, just under 50 percent of Baby Boomers (those born between 1946 and 1964) backed adult-use legalization.

The results are consistent with those of other recent national polls, including those by Gallup, Morning Consult, and Quinnipiac University, showing that a supermajority of Americans believe that marijuana ought to be legalized for adults.

When asked whether cannabis should be legal for medical purposes, 84 percent of respondents answered affirmatively – a percentage that is also consistent with prior polling.

Survey: Users of CBG-Dominant Cannabis Report Efficacy for Pain, Other Conditions

Pullman, WA: Those who consume cannabis and/or cannabis preparations high in the cannabinoid cannabigerol (CBG) say that they are effective therapeutics and that they possess few adverse side-effects, according to data published in the journal Cannabis and Cannabinoid Research.

CBG acid is the parent compound precursor to the more popularized cannabinoids THC and CBD. It is typically only found in minute quantities in harvested cannabis plants. However, in recent years, specially cultivated varieties of the plant possessing higher concentrations of CBG have been reported, particularly in the pacific northwest region of the United States.

A team of researchers affiliated with Washington State University and the University of California at Los Angeles surveyed subjects who self-identified as consumers of CBG-dominant cannabis products.

A majority of survey participants said they used CBG-dominant preparations of cannabis exclusively for medical purposes. Respondents most frequently did so to mitigate symptoms of anxiety, chronic pain, depression, and insomnia.

Most respondents described their symptoms as either “much improved” or “very much improved” following their use of CBG-dominant cannabis, and three-quarters rated it as “superior” to their conventional medications.

Authors concluded: “This is the first patient survey of CBG use to document self-reported efficacy of CBG-predominant cannabis, particularly for anxiety, chronic pain, depression, and insomnia. Most respondents claimed greater efficacy of CBG over conventional pharmacotherapy … and reported a very benign adverse event profile and negligible withdrawal. … This study demonstrates that CBG-predominant cannabis and related products are available and being used by cannabis consumers and demonstrates the urgent need for randomized controlled trials of CBG-predominant cannabis-based medicines to be studied rigorously to assess safety and efficacy as a function of dose, mode of administration, and specific therapeutic indications.”

Full text of the study, “Survey of patients employing cannabigerol-predominant cannabis preparations: Perceived medical effects, adverse events, and withdrawal symptoms,” appears in Cannabis and Cannabinoid Research.

Study: Legal Cannabis Markets Experienced Far Fewer Cases of Vaping Illness

New Haven, CT: States with legal adult-use cannabis markets were far less likely to experience incidences of the vaping-related lung illness EVALI (e-cigarette or vaping product use-associated lung injury), which was responsible for several thousand hospitalizations in 2019. The US Centers for Disease Control and Prevention eventually acknowledged that vitamin E acetate – a diluting agent sometimes present in counterfeit, unregulated vape pen products – was responsible for the outbreak.

New data published in the journal Drug and Alcohol Dependence reported that cases of EVALI were more than 40 percent lower in legal cannabis states and that they were over 60 percent lower in jurisdictions that permitted home cultivation. Home grow laws were also associated with fewer incidences of consumers engaging in the use of marijuana vape pens.

Authors concluded: “Given that EVALI cases stemmed primarily from informally-sourced vaporizable marijuana concentrates, these results are consistent with crowd-out, whereby introduction of one market (legal marijuana) displaces utilization of another (informally-sourced marijuana products). Simply put, if the public can obtain products legally from reputable sources, there is less demand for illicit market products. Thus, RM [recreational marijuana] legalization could have dampened market penetration of tainted marijuana concentrates by reducing consumption of informally-sourced marijuana products more generally.”

The findings are consistent with those of several other studies also concluding that EVALI cases were largely concentrated in states where consumers did not have legal access to cannabis products.

Full text of the study, “State marijuana policies and vaping associated lung injuries in the US,” appears in Drug and Alcohol Abuse.

Analysis: THC Levels Not Indicative of Driving Impairment

New Haven, CT: The presence of THC concentrations in either blood or saliva is an unreliable predictor of impaired driving performance, according to a literature review published in the journal Frontiers in Psychiatry.

Researchers affiliated with Yale University assessed multiple papers specific to the issue of marijuana and driving performance. Consistent with prior reviews, authors reported that the presence of THC in bodily fluids is not a consistent predictor of impairment and that state-imposed per se limits for THC are not evidence-based.

Authors reported, “While legislators may wish for data showing straightforward relationships between blood THC levels and driving impairment that parallel those of alcohol, the widely different pharmacokinetic properties of the two substances … make this goal unrealistic.”

They added: “[S]tudies suggest that efforts to establish per se limits for cannabis-impaired drivers based on blood THC values are still premature at this time. Considerably more evidence is needed before we can have an equivalent ‘BAC for THC.’ The particular pharmacokinetics of cannabis and its variable impairing effects on driving ability currently seem to argue that defining a standardized per se limit for THC will be a very difficult goal to achieve.”

Researchers concluded: “Until there is more evidence-based consensus of opinion on meaningful thresholds for per se laws, we would recommend against reliance on such legislation. This is particularly the case given the significant inconsistencies in threshold values currently determined by different states in the US, and the rather weak scientific basis for such decisions. Any such laws cannot claim to be strongly based on current scientific evidence, which suggest collectively that standard based on detectable blood THC levels are not useful.”

Their findings are consistent with those of numerous other studies and expert review panels concluding that the presence of THC is an unreliable indicator of either recent cannabis exposure or impairment of performance. A 2019 report issued by the Congressional Research Service similarly determined: “Research studies have been unable to consistently correlate levels of marijuana consumption, or THC in a person’s body, and levels of impairment. Thus, some researchers, and the National Highway Traffic Safety Administration, have observed that using a measure of THC as evidence of a driver’s impairment is not supported by scientific evidence to date.”

NORML has long opposed the imposition of THC per se thresholds for cannabinoids in traffic safety legislation, opining: “The sole presence of THC and/or its metabolites in blood, particularly at low levels, is an inconsistent and largely inappropriate indicator of psychomotor impairment in cannabis consuming subjects. … Lawmakers would be advised to consider alternative legislative approaches to address concerns over DUI cannabis behavior that do not rely solely on the presence of THC or its metabolites in blood or urine as determinants of guilt in a court of law. Otherwise, the imposition of traffic safety laws may inadvertently become a criminal mechanism for law enforcement and prosecutors to punish those who have engaged in legally protected behavior and who have not posed any actionable traffic safety threat.”

In recent months, lawmakers in two states – Indiana and Nevada – have rolled back their THC per se laws.

The study’s authors acknowledged that acute cannabis-induced intoxication can influence driving behavior, but also recognized that “the relative risk of such impaired driving is significantly lower than other legislated drug use while driving, such as that resulting from alcohol.”

Full text of the study, “Cannabis and Driving,” appears in Frontiers in Psychiatry.

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Kansas City, MO: City Council Approves Measure Eliminating Pre-Employment Marijuana Testing for Most City Workers

Members of the Kansas City, Missouri city council approved a local ordinance that will prevent pre-employment marijuana testing for most prospective government employees.

Ordinance No. 210627, which was approved with an 11 to 1 vote, says, “It shall be unlawful for the City of Kansas City to require a prospective employee to submit to testing for the presence of marijuana in the prospective employee’s system as a condition of employment.”

Kansas City Mayor Quentin Lucas, who sponsored the measure, said, “Opportunities should not be foreclosed unnecessarily. Glad to see passage of our law eliminating pre-employment screening for marijuana at Kansas City government for most positions. One step of many in becoming a fairer city.”

Certain government positions would be excluded from the protections under this law, such as law enforcement; positions requiring a commercial drivers license; those caring for children, medical patients, disabled or other vulnerable individuals; and positions “where the employee could significantly impact the health or safety of other employees or members of the public.”

Members of the council approved a municipal ordinance last year repealing all local penalties specific to activities involving the personal possession of marijuana. The Kansas City Mayor’s Office has also launched an online system to facilitate the process of pardoning those with low-level marijuana convictions.

Kansas City’s measure is similar to other municipal laws that have recently been enacted in several other cities, including Philadelphia, Atlanta, New York, and Washington, DC, limiting employers’ abilities to drug test certain employees for off-the-job marijuana exposure.

Bill to End Marijuana Prohibition to Receive Committee Vote In US House

Last night, we sent you a message about the SAFE Banking Act passing the House of Representatives as part of the NDAA.

Today, we have an even better bit of news to share with you: The MORE Act, which repeals federal marijuana criminalization, is set to be voted on by members of the powerful House Judiciary Committee NEXT WEEK.

This is an all-hands-on-deck moment. We need to push as many members of Congress to co-sponsor and publicly support the advancement of this bill. That is why we need you to send your Representative a message NOW!

For those who need a refresher, here’s what you need to know about the MORE Act:

– It removes marijuana from the federal Controlled Substances Act – thereby eliminating the existing conflict between state and federal marijuana laws and providing states with the authority to be the primary arbiters of cannabis policy within their own jurisdictions.
– It facilitates the expungement of low-level federal marijuana convictions, and incentivizing state and local governments to take similar actions;
– It creates pathways for ownership opportunities in the emerging regulated industry as well as other sectors of the economy for local and diversely-reflective entrepreneurs who have been impacted under prohibition through the Small Business Administration grant eligibility;
– It allows veterans, for the first time, to obtain medical cannabis recommendations from their VA doctors;
– It removes the threat of deportation for immigrants accused of minor marijuana infractions or who are gainfully employed in the state-legal cannabis industry;
– It provides critical reinvestment grant opportunities for communities that have suffered disproportionate rates of marijuana-related enforcement actions.
During the last Congressional session, NORML members drove in hundreds of thousands of messages in support of the MORE Act. We cannot let up. We need you to send a message to your lawmakers now.

Thanks for showing up, standing up, and speaking out.

Next Week: House Judiciary Committee to Advance Historic MORE Act

Members of the House Judiciary Committee have scheduled a hearing next week to mark up HR 3617: The Marijuana, Opportunity, Reinvestment, and Expungement (MORE) Act of 2021. The Act repeals the long-standing federal prohibition of marijuana – thereby ending the existing state/federal conflict in cannabis policies and providing state governments with greater authority to regulate marijuana-related activities, including retail sales.

“We are excited to see Chairman Nadler and House Leadership move forward once again with passing the MORE Act. Public support and sound public policy demand the repeal of federal marijuana prohibition, Congressional action on this legislation is long overdue. The days of our failed federal policy of prohibition are numbered,” said NORML Political Director Justin Strekal.

While House members deliberate over the MORE Act, members of the Upper Chamber continue to review public comments regarding The Cannabis Administration and Opportunity Act, introduced by Senators Cory Booker, Ron Wyden, and Majority Leader Chuck Schumer.

What the MORE Act Does: The legislation’s provisions remove marijuana from the federal Controlled Substances Act – thereby eliminating the existing conflict between state and federal marijuana laws and providing states with the authority to be the primary arbiters of cannabis policy within their own jurisdictions.

FURTHER: The MORE Act would also make several other important changes to federal marijuana policy, including:

– Facilitating the expungement of low-level federal marijuana convictions, and incentivizing state and local governments to take similar actions;
– Creating pathways for ownership opportunities in the emerging regulated industry as well as other sectors of the economy for local and diversely-reflective entrepreneurs who have been impacted under prohibition through the Small Business Administration grant eligibility;
– Allowing veterans, for the first time, to obtain medical cannabis recommendations from their VA doctors;
Removing the threat of deportation for immigrants accused of minor marijuana infractions or who are gainfully employed in the state-legal cannabis industry;
– Providing critical reinvestment grant opportunities for communities that have suffered disproportionate rates of marijuana-related enforcement actions.

Following action by the House Judiciary Committee, the MORE Act would require further consideration or waiver by the various jurisdictional committees before receiving a floor vote.

Key Facts Underscoring Marijuana Policy Reform Efforts:

According to the FBI UCR, over 545,000 Americans were arrested for marijuana-related crimes in 2019 alone. Over 90% of those arrested were charged with mere possession.

According to a recent report by the ACLU, Black Americans are 3.6 times more likely to be arrested for cannabis-related crimes than white Americans.
The state-legal cannabis industry employs over 321,000 full-time workers; that is over six times the number of jobs specific to the coal industry.
While the substance is not without harm, cannabis is objectively less harmful than legal and regulated alcohol and tobacco.

National Polling

Quinnipiac University, April 2021

Question: Do you think that the use of marijuana should be made legal in the United States, or not?

– Overall: 69% Yes – 25% No
– Democrat: 78% Yes – 17% No
– Republicans: 62% Yes – 32% No
– Independents: 67% Yes – 28% No
– Gallup Polling, Nov. 2020

Question: Do you think the use of marijuana should be made legal, or not?

– Overall: 68% Yes – 32% No
– Democrat: 83% Yes – 16% No
– Republicans: 48% Yes – 52% No
– Independents: 72% Yes – 27% No

Pew Research Center, April 2021

Question: Which comes closer to your view about the use of marijuana by adults?

– 60% It should be legal for medical AND recreational use
– 31% It should be legal for medical use ONLY
– 8% It should NOT be legal


– 12% of Republicans say marijuana should NOT be legal
– 5% of Democrats say marijuana should NOT be legal

History of the MORE Act:

On December 4th of 2020, Members of the House of Representatives voted to approve the MORE Act, HR 3884, by a margin of 228 to 164. However, under the leadership of then-Majority Leader Mitch McConnell (K-KY), the full Senate did not consider the legislation prior to the close of the 116th Congressional session.

HR 3884 was carried in the 116th Congress by House Judiciary Committee Chairman Jerry Nadler and in the Senate by Vice President Kamala Harris.

House Judiciary Committee Chairman Jerry Nadler, along with Cannabis Caucus co-chairs Earl Blumenauer and Barbara Lee, Judiciary Crime Subcommittee Chairwoman Sheila Jackson Lee, House Democratic Caucus Chairman Hakeem Jeffries, and Small Business Committee Chairwoman Nydia Velรกzquez reintroduced the 2021 version of the bill in May.

Kamala Harris is now Vice President of the United States and is unable to reintroduce companion legislation. In July, Senate Majority Leader Schumer, along with Finance Committee Chairman Ron Wyden and Judiciary Committee’s Senator Cory Booker introduced a discussion draft for public comment of forthcoming legislation, The Cannabis Administration and Opportunity Act, that seeks to similarly remove cannabis from the Controlled Substances Act.

House Advances SAFE Banking Act as Part of the Must-Pass NDAA

NORML Supports Swift Enactment; Stresses Need for Further Federal Reforms

Washington, DC: The NDAA funding package passed by the US House of Representatives includes the provisions of the Secure and Fair Enforcement (SAFE) Banking Act, which allows state-licensed marijuana-related businesses to engage freely in relationships with banks and other financial institutions. The language was offered as an amendment to the bill by Representatives Ed Perlmutter (D), Earl Blumenauer (D), Barbara Lee (D), Nydia Velazquez (D), David Joyce (R), and Steve Stivers (R).

This vote marks the fifth time that House members have advanced SAFE Banking legislation in recent years. House members last approved the measure in April as a stand-alone bill by a vote of 321 to 101. At that time, all Democrats and just over half of Republicans in the House voted for the bill.

“Enactment of the SAFE Banking Act would improve public safety and business efficiency in the 36 states that currently permit some form of retail marijuana sales,” said NORML Political Director Justin Strekal, “The Senate should ensure this provision remains in the final version of this funding package and approve it swiftly.”

Strekal added: “The SAFE Banking Act is only the first step toward making sure that state-legal marijuana markets operate safely and efficiently. The sad reality is that those who own or patronize these currently unbanked businesses would still be recognized as criminals in the eyes of the federal government and by federal law. This situation can only be rectified by removing marijuana from the list of controlled substances.”

Currently, thousands of state-licensed cannabis businesses are unable to partner with the banking industry due to federal restrictions. They are unable to accept credit cards, deposit revenues, access loans, or write checks to meet payroll or pay taxes. This situation is untenable. No industry can operate safely, transparently, or effectively without access to banks or other financial institutions. Congress must move to change federal policy so that this growing number of state-compliant businesses, and their consumers, may operate in a manner that is similar to other legal commercial entities.

For these reasons, NORML has long advocated that federal lawmakers vote “Yes” on The SAFE Banking Act.

The NDAA now advances to the Senate for consideration.

In an exchange on Tuesday with Politico reporter Natalie Fertig, Republican Senate co-lead of the SAFE Banking Act Senator Kevin Cramer said “(I)f it’s a vehicle that can carry it, I think it’d be fine. … Any vehicle’s good that gets it to pass it.”

Analysis: Growing Number of States Allow Reimbursement of Medical Cannabis Costs by Workers’ Compensation Insurance

Medical Marijuana
A limited but growing number of states permit eligible patients to be reimbursed for their medical cannabis-related costs through their workers’ compensation insurance (WCI) plans, according to a just-published analysis of state policies conducted by the National Institute for Occupational Safety and Health.

NORML’s Deputy Director Paul Armentano said that these policy changes are further evidence of the legitimacy and social acceptance of medical cannabis. “For millions of patients, cannabis is a legitimate therapeutic option. More and more, our laws and regulations are recognizing this fact and evolving their policies accordingly.”

Researchers affiliated with the federal agency assessed rules and regulations in 36 states permitting medical cannabis access. They identified six states – Connecticut, Minnesota, New Hampshire, New Jersey, New Mexico, and New York – that explicitly allow for employees to have their medical cannabis expenses reimbursed. In three of those states – New Hampshire, New Jersey, and New York – reimbursements were ordered as a result of state Supreme Court rulings issued earlier this year.

By contrast, authors identified six states where workers’ compensation insurance is expressly prohibited from reimbursing medical marijuana-related costs: Maine, Massachusetts, Florida, North Dakota, Ohio, and Washington.

In all other jurisdictions, the law is either silent on the issue or states that insurers are “not required” to reimburse employees who are injured on the job for the costs related to their use of medical cannabis.

Authors said that they expected the number of states permitting marijuana-related compensation to increase in the coming years “as more workers petition state courts and administrative agencies for cannabis WCI reimbursement.”

An abstract of the study, “Review of cannabis reimbursement by workers’ compensation insurance in the US and Canada,” appears in the American Journal of Industrial Medicine.

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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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Clinical Trial: Use of CBD Associated with Greater Emotional Wellness

Sao Paulo, Brazil: The daily administration of CBD is associated with lower levels of emotional exhaustion, anxiety, and depression, according to clinical trial data published in JAMA Psychiatry.

A team of investigators affiliated with the University of Sรฃo Paulo in Brazil evaluated the safety and efficacy of CBD treatment in a cohort of 120 frontline health care professionals. Half of the study’s participants received 300mgs of CBD daily for a period of four weeks. Others did not receive the substance.

Those undergoing CBD treatment exhibited fewer signs of emotional exhaustion and burnout as compared to those subjects who did not. CBD consumption was also associated with less anxiety and depression. However, five of the subjects assigned to use CBD had to eventually drop out of the trial after suffering from serious adverse events, including elevated liver enzymes.

“This randomized clinical trial found that the efficacy and safety of daily treatment with CBD, 300 mg, for 4 weeks combined with standard care was superior to standard care alone for reducing the symptoms of emotional exhaustion, anxiety, and depression among frontline health care professionals working with patients with COVID-19,” authors concluded. “Cannabidiol may act as an effective agent for the reduction of burnout symptoms among a population with important mental health needs worldwide.”

Full text of the study, “Efficacy and safety of cannabidiol plus standard care vs standard care alone for the treatment of emotional exhaustion and burnout among frontline health care workers during the COVID-19 pandemic: A Randomized clinical trial,” appears in JAMA Psychiatry.

Study: Medical Cannabis Laws Associated with Declines in Youth Cigarette Use

Irvine, CA: The enactment of medical cannabis access laws is associated with reduced rates of cigarette smoking among young people, according to data published in the journal Cannabis.

A team of researchers affiliated with the University of California at Irvine and with Pennsylvania State University assessed the relationship between medical cannabis legalization laws and cigarette initiation among adolescents.

They concluded: “Our results indicate lower odds of initiating cigarettes, in every age group (8 years old or younger, 9-10, 11-12, 13-14, 15-16, 17 years old or older) in states with MMLs [medical marijuana laws] when compared to non-MML states. … Further research should evaluate how MMLs and recreational marijuana policies are associated with e-cigarette initiation and use.”

Data published recently in the journal Nicotine & Tobacco Research reported that the passage of adult-use marijuana laws is not associated with any uptick in youth tobacco use.

Full text of the study, “State medical marijuana laws and initiation of cigarettes among adolescents in the US, 1991-2015,” appears in Cannabis.

California: Retailers Not Selling Cannabis to Underage Patrons

San Diego, CA: Marijuana retailers in California consistently check IDs prior to making cannabis sales, according to data published in the journal JAMA Pediatrics.

A pair of researchers affiliated with the University of California at San Diego and with UCLA assessed retailers’ compliance with the state’s minimum age laws.

Consistent with prior studies, investigators identified virtually no incidences of retailers selling cannabis to patrons without first validating that they were age 21 or older.

They reported, “California laws further require ID check before any purchase, and overall compliance with this rule was high at 678 [out of 700 eligible] RCDs [recreational cannabis dispensaries] (96.8 percent).”

Studies from other states where marijuana sales are legal, such as Colorado and Oregon, have similarly reported exceptionally high compliance rates among licensed facilities.

Full text of the study, “Assessment of recreational cannabis dispensaries’ compliance with underage access and marketing restrictions in California,” appears in JAMA Pediatrics.

Michigan: Most Residents Live Within 20 Minutes of a Marijuana Retailer

East Lansing, MI: A supermajority of Michigan residents live in close proximity to a licensed marijuana retail establishment, according to a geographic analysis by the Anderson Economic Group.

Their report indicates that adult-use retail stores are integrated throughout most of the state. “Over 80 percent of Michiganders now live within a 20-minute drive of an adult-use retail store,” said Brian Peterson, AEG director of public policy and economic analysis. “Our analysis shows that the retailers have established themselves across the state in order to meet consumer demand for cannabis.”

The Michigan experience differs from that of some other states, like California, where a majority of cities have prohibited the establishment of local retail stores. In New Jersey, where commercial sales are expected to begin next year, nearly half of cities and towns have opted out of permitting local marijuana businesses.

Nearly 750 commercial retailers are currently operating in Michigan. About 55 percent of retailers cater to medical cannabis patients, while the remaining 45 percent of stores are adult-use facilities.

Full text of the AEG analysis is online.

Maine: Non-Residents Eligible for Commercial Marijuana Licenses

Augusta, ME: A federal court judge has struck down regulations barring out-of-state companies from operating marijuana dispensaries.

At issue was a 2011 rule mandating that licensed medical cannabis retailers must be in-state residents. In her ruling, US District Court Judge Nancy Torres opined that Maine’s medical cannabis industry is not “wholly interstate” – as dispensaries are permitted to sell to those from other states. Therefore, she determined that it was inconsistent for the law to provide preferences to in-state residents wishing to sell medical cannabis.

Earlier this year, state officials set aside a separate regulation mandating that applicants seeking adult-use sales licenses must be in-state residents.

Going forward, out-of-state residents will be able to seek licensure to operate both medical cannabis and/or adult-use retail facilities.

The full text of the ruling, Northeast Patients Group v. Maine Department of Administrative and Financial Services, is available online.

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Study: Combined Administration of Oral THC and PEA Effective in Patients with Refractory Tourette’s Syndrome

New Haven, CT: The combined administration of oral THC (dronabinol) and the endogenous compound PEA (palmitoylethanolamide) is associated with symptomatic improvements in patients with treatment-resistant Tourette’s syndrome (TS), according to observational trial data published in the Journal of Neuropsychiatry and Clinical Neurosciences.

A team of Yale University researchers assessed the use of THX-110 (a proprietary combination of THC and PEA) over a period of 12 weeks in a cohort of patients with refractory TS.

Authors reported that participants’ tic symptoms improved within one week of treatment and continued to improve over time. Treatment with THX-110 was well-tolerated by the majority of subjects.

They concluded: “THX-110 treatment led to an average improvement in tic symptoms of roughly 20 percent, or a 7-point decrease in the YGTSS [Yale Global Tic Severity Scale] total tic score. … Our open trial of THX-110 treatment supports an emerging body of evidence suggesting that cannabinoid compounds may be effective for the treatment of Tourette’s syndrome.”

Full text of the study, “A Phase-2 pilot study of a therapeutic combination of delta-9-tetrahydrocannabinol and palmitoylethanolamide for adults with Tourette’s syndrome,” appears in the Journal of Neuropsychiatry and Clinical Neurosciences.

Analysis: Legal Cannabis Sales Projected to Reach $43 Billion By 2025

Washington, DC: Retail marijuana sales in the United States are projected to reach $43 billion per year by 2025, according to an economic analysis by New Frontier Data.

Legal marijuana sales have increased to historic levels in recent months, with sales totaling nearly $6 billion in the first quarter of this year. Retail sales are projected to increase in the coming months as additional states – such as New Jersey and New York – begin licensing cannabis retailers.

The New Frontier Data analysis estimates that by 2025, “42 percent of total annual US cannabis demand will be met by legal purchases in regulated marketplaces.”

Of the $43 billion in projected annual sales in 2025, analysts estimate that roughly 62 percent of transactions will involve adult-use purchases while the remaining 38 percent will be medical cannabis sales.

For more information, see the NORML fact sheet ‘Marijuana Regulation: Impact on Health, Safety, Economy.’

Israel: Politicians Narrowly Reject Measure Depenalizing Cannabis Possession

Jerusalem, Israel: Members of the Israeli Parliament have narrowly defeated legislation that sought to depenalize activities involving the possession and cultivation of cannabis by adults.

The proposal sought to eliminate criminal and civil penalties involving the possession of up to 50 grams of cannabis and/or the home-cultivation of personal use quantities of the plant. The legislation failed in the Israeli Knesset (Parliament) by a vote of 55 to 52.

Lawmakers decriminalized low-level marijuana possession offenses in 2017 – subjecting first-time and second-time offenders to a fine-only penalties. The production and prescribed use of medical cannabis is permitted nationwide.

Additional information on Israeli cannabis laws is available on Lexology.

Survey: Many Patients with Spine-Related Pain Turning to CBD

New York, NY: An estimated one-in-four patients with spine-related pain report using CBD to combat their symptoms, according to survey data published in the International Journal of Spine Surgery.

Researchers anonymously surveyed patients at a spinal surgery clinical in New York over a four-week period.

Twenty-five percent of respondents acknowledged either using or having used CBD for symptom control. Nearly half (46 percent) of users reported that it mitigated their pain. Thirty-three percent said that the use of CBD improved sleep and 20 percent said that it reduced their anxiety. By contrast, nearly 25 percent of users reported no therapeutic benefits from CBD.

Authors concluded: “This is the first study, to our knowledge, to examine the consumption patterns and perceived effects of CBD in patients with spinal pathology. This investigation demonstrates that CBD is a prevalent alternative therapy used by many patients with spine-related symptoms. As the popularity of the supplement is only expected to increase over time, spine surgeons must educate themselves on the evidence behind the use of CBD, understand its legal status, and be aware of the potential for mislabeling of ingredients.”

Full text of the study, “Prevalence of cannabidiol use in patients with spine complaints: Results of an anonymous survey,” appears in the International Journal of Spine Surgery.

New Hampshire: Governor Signs Law Expanding Patients’ Medical Cannabis Access

Concord, NH: Republican Gov. Chris Sununu has signed legislation into law expanding the pool of patients eligible for medical cannabis access.

House Bill 605 permits physicians to recommend cannabis therapy to patients with opioid use disorder. Some studies have shown that the use of cannabis is associated with greater rates of treatment retention in patients with OUD and that cannabinoids may mitigate opioid-related cravings.

Separate provisions in the law permit non-resident patients who possess a valid registration from another state to legally possess and purchase limited quantities of medical cannabis from dispensaries in New Hampshire.

The new law takes effect in early October. Additional information is available from the NORML fact sheet, ‘Relationship Between Marijuana and Opioids.’

Alaska: Regulatory Change Permits for Greater THC Levels in Edible Products

Juneau, AK: Regulatory changes set to take effect on September 1, 2021 will allow adult-use cannabis retailers and manufacturers to provide edible products containing elevated quantities of THC.

The new rules raise the amount of THC permissible in a single serving of an adult-use edible product from 5mg of THC to 10mg. Multi-serving products will be permitted to contain up to 100mgs of THC – twice the amount previously permitted under the law. The regulatory changes were codified on August 2.

The rule change comes at a time when lawmakers in a handful of states have recently debated imposing new rules lowering the amount of THC permissible in certain products. Specifically, recently passed legislation in Colorado reduced the quantity of THC concentrates that younger patients may purchase in a single day, and called on public health officials to consider making further recommendations regarding the availability of higher-potency THC products.

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Study: Medical Cannabis Treatment Associated with Sustained Relief, Decreased Use of Analgesics in Chronic Pain Patients

Haifa, Israel: Patients diagnosed with chronic pain experience sustained relief from the use of medical cannabis, and many of them reduce or eliminate their use of analgesic drugs over time, according to longitudinal data published in the European Journal of Pain.

A team of Israeli investigators evaluated the safety and efficacy of medical cannabis treatment over a one-year period in patients with chronic pain. Most subjects in the study consumed cannabis via smoking.

Following treatment, subjects’ average pain intensity declined from baseline by 20 percent. Nearly half of the subjects who had been using analgesic medications at the start of trial were no longer using them by the study’s end.

Authors reported: “Forty-three percent of the patients who had been using analgesic medications prior to MC [medical cannabis] treatment initiation were no longer using them. This was true for all classes of analgesic drugs including over the counter analgesics, non-steroidal anti-inflammatory drugs, anticonvulsants and antidepressants. As for opioid use, 24 percent and 20 percent of the participants who had been using weak or strong opioids, respectively, at baseline stopped using them by the time they reached the 12-month follow-up.’

They concluded, “This prospective study provides further evidence for the effects of medical cannabis on chronic pain and related symptoms, demonstrating an overall mild-to-modest long-term improvement of the tested measures and identifying possible predictors for treatment success.’

Full text of the study, “Medical cannabis treatment for chronic pain: Outcomes and prediction of response,’ appears in the European Journal of Pain.

Clinical Trial: Sublingual Administration of CBD Is Effective in Patients with Diabetic Neuropathy

West Bloomfield, MI: The administration of a proprietary, water-soluble CBD tablet mitigates neuropathic foot pain compared to placebo, according to randomized clinical trial data published in the Journal of Diabetes & Metabolism.

Researchers affiliated with Pure Green Pharmaceuticals assessed the efficacy of sublingual CBD tablets (20mg) versus placebo in a cohort of subjects with painful diabetic peripheral neuropathy (pDPN) pain in their feet. Subjects were administered either the active drug or a placebo three times per day for 28 days.

Those taking the active drug reported significant reductions in pain compared to placebo and no adverse side-effects. Subjects taking CBD also reported improvements in their sleep quality and reduced levels of anxiety.

Authors concluded: “This 28-day trial revealed statistically and clinically significant improvement in pain and a clinically significant improvement in sleep quality and in anxiety reduction for those in the CBD treatment group. Additionally, subjects taking CBD affirmed these results by having a statistically significant greater response to treatment as compared with subjects taking placebo. The benefit of this study demonstrates that the sublingual 20 mg CBD tablet should be considered as a safe and effective treatment for pDPN.’

Numerous placebo-controlled clinical trials similarly document the ability of whole-plant cannabis to mitigate neuropathic pain in a wide range of patient populations, including in subjects with HIV and diabetes.

Full text of the study, “Cannabidiol for the treatment of painful diabetic peripheral neuropathy of the feet: A placebo-controlled, double-blind, randomized trial,’ appears in the Journal of Diabetes & Metabolism.

Marijuana Legalization Laws Don’t Undermine Tobacco Smoking Prevention Efforts

Columbus, OH: State-level changes to the legal status of cannabis have not limited the effectiveness of anti-tobacco smoking efforts targeting young adults, according to data published in the journal Nicotine & Tobacco Research.

A team of investigators with Ohio State University and with Purdue University in Indiana assessed the impact of medical cannabis access laws and adult-use legalization laws on cigarette smoking patterns among young adults.

They reported, “Cannabis policy liberalization is not associated with individual-level patterns of cigarette use.’

Authors concluded: “[T]he liberalization of cannabis laws does not disrupt gains made through the implementation of tobacco control policies. Also, we see no evidence that liberalized cannabis policies are directly associated with increased smoking behaviors among young adults. Within a context of rapidly changing cannabis policies throughout the U.S. and several countries, these results provide positive news that newly implemented cannabis laws may not adversely affect tobacco control efforts that have reduced cigarette use among young people.’

The findings differ from those of an unpublished working paper by a pair of students at the University of Texas, Dallas which contends that cigarette sales have slightly increased in some adult-use legalization states.

Full text of the study, “Further consideration of the impact of tobacco control policies on young adult smoking in light of the liberalization of cannabis policies,’ appears in Nicotine & Tobacco Research.

Survey: Over 90 Percent of Chronic Pain Patients Report Mitigating Their Use of Opioids

Tel Aviv, Israel: The overwhelming majority of pain patients provided medical cannabis treatment report either reducing or ceasing their use of opioid medications, according to data published in the Journal of Addictive Diseases.

A team of Israeli investigators affiliated with Tel Aviv University assessed the relationship between cannabis and opioids in a cohort of patients with non-cancer specific chronic pain. All of the patients enrolled in the study were prescribed medical cannabis therapy in accordance with Israel’s medical cannabis access laws.

Among those patients who reported using opioids at baseline, 93 percent either “decreased or stopped [using] opioids following cannabis initiation’ – a finding that is consistent with dozens of other studies.

Full text of the study, “Risk and benefit of cannabis prescription for chronic non-cancer pain,’ appears in the Journal of Addictive Disorders.

Case Report: Cannabis Associated with Improvements in a Patient with Refractory Stuttering

Warsaw, Poland: The use of herbal cannabis is associated with marked improvements in a patient with treatment-resistant stuttering, according to a case report published in the journal Cannabis and Cannabinoid Research.

A team of investigators affiliated with the Medical University of Warsaw (Poland) and with Hannover Medical School (Germany) presented the case of a 20-year-old male patient with refractory stuttering. Following the daily administration of vaporized plant cannabis, the patient exhibited sustained improvements in speech fluency and also reported benefits to his overall quality of life. The patient did not report any adverse side effects from cannabis over the one-year observational period.

Authors reported: “[T]his is the first case report of a patient suffering from impairing and treatment-resistant stuttering, who markedly improved after treatment with medicinal cannabis. Based on patient’s self-report and reports of family and friends, as well as several established assessments, use of cannabis resulted not only in an improvement of stuttering but also remission of (social) anxiety, and reduced depression and stress, as well as improved sleep, attention, concentration, self-confidence, social life, and overall quality of life without any side effect. Importantly, treatment effects did not decrease over time.’

They concluded, “Medicinal cannabis could be effective in treatment of refractory stuttering, but these preliminary data have to be confirmed in controlled studies.’

While this is the first case report specific to the efficacy of cannabis in the case of a patient with a stuttering disorder, several prior studies have documented the ability of THC to improve symptoms in patients with Tourette Syndrome.

Full text of the study, “Cannabis improves stuttering: Case report and interview with the patient,’ appears in Cannabis and Cannabinoid Research.

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Proximity to Marijuana Retailers Doesn’t Influence Young People’s Intention to Use Cannabis

Santa Monica, CA: Young adults who live near state-licensed marijuana retailers are no more likely to express an intention to use either cannabis or tobacco than those who do not, according to data published in The Journal of Cannabis Research.

Researchers with the RAND Corporation and with the University of Southern California assessed the relationship between the density of marijuana retailers and subjects’ intentions to use either cannabis or tobacco in a cohort of young adults (ages 18 to 23) living in Los Angeles county.

Authors reported, “Living near more outlets of any type was not significantly associated with intentions to use in the full sample, adjusting for individual- and neighborhood-level characteristics.”

They concluded: “This is the first study to simultaneously examine the density of both MCDs [medical cannabis dispensaries] and RCRs [recreational cannabis retailers] around young adults’ homes and associations with future intentions to use cannabis, including the co-use of cannabis with tobacco/nicotine. Our results suggest that young adults who lived in an area with a greater density of any type of outlet were not significantly more likely to report stronger intentions to use cannabis, e-cigarettes, or cannabis mixed with tobacco/nicotine in the future.”

Their findings are consistent with those of prior studies similarly concluding that the prevalence of cannabis retailers is not positively associated with increases in either marijuana use or access among younger people.

Full text of the study, “Density of medical and recreational cannabis outlets: racial/ethnic differences in the association with young adult intentions to use cannabis, e-cigarettes, and cannabis mixed with tobacco/nicotine,” appears in The Journal of Cannabis Research.

Canada: No Uptick in Trauma Patients Testing Positive for Cannabis Post-Legalization

London, Canada: The enactment of adult-use marijuana legalization is not associated with any immediate uptick in the percentage of trauma patients testing positive for past cannabis exposure, according to data published in the Canadian Journal of Surgery.

A team of researchers with Western University in London, Ontario evaluated adults admitted into a leading Canadian trauma center in the three months immediately prior to and immediately following legalization. Subjects were screened for the presence of cannabis metabolites upon admission. Most patients were admitted to the trauma unit following motor vehicle collisions.

Investigators reported: “We found that the rate of positive cannabinoid screen results among patients with trauma referred directly to our trauma service was similar in the 3 months before and [in] the 3 months after the legalization of recreational cannabis in Canada. … In the subgroup of patients whose mechanism of trauma was a motor vehicle collision, there was no difference in the rate of positive toxicology screen results or positive cannabinoid screen results between the two periods.”

They concluded, “These preliminary single-center data showing no increased rates of cannabis use in patients with trauma after legalization are reassuring.”

The data is consistent with prior studies showing no significant changes in traffic safety in the months immediately following the enactment of adult-use legalization. However, separate assessments evaluating longer-term trends in traffic safety following legalization have yielded mixed results.

Full text of the study, “Drug use in Canadian patients with trauma after cannabis legalization,” appears in the Canadian Journal of Surgery.

Daily Cannabis Use Associated with Reduced Neuroinflammation in HIV Patients

San Diego, CA: HIV+ patients who consume cannabis on a daily basis possess lower levels of neuroinflammation as compared to non-users, according to data published in the Journal of the International Neuropsychological Society.

Investigators with the University of California, San Diego evaluated the relationship between cannabis use and CNS (central nervous system) inflammation in a cohort of patients with and without HIV.

Researchers reported that HIV+ subjects who consumed cannabis daily possessed lower levels of chronic inflammation than did HIV+ subjects who abstained from marijuana. Further, users’ results were similar to those of HIV- subjects with no history of cannabis use.

Daily consumers also achieved better on measurements of cognitive performance than did those HIV+ patients with no history of regular use โ€“ a finding that is consistent with prior analyses of HIV+ patients.

Authors concluded, “Taken together, findings are consistent with the notion that cannabinoids may modulate inflammatory processes in PWH [patients with HIV], specifically in the CNS, and suggest a link between lower CNS inflammation and better neurocognitive function. … Future studies in PWH are needed to investigate potential distinct effects of specific cannabinoids, and adult medicinal use, on brain structure and function.”

Full text of the study, “Daily cannabis use is associated with lower CNS inflammation in people with HIV,” appears in the Journal of the International Neuropsychological Society.

Study: Cannabis Use Not Linked to Motivation Loss

Miami, FL: Marijuana use by teens is not independently associated with an increased risk of so-called โ€˜Amotivational syndrome,” according to longitudinal data published in the Journal of the International Neuropsychological Society.

A team of researchers affiliated with Florida International University assessed the association between cannabis use and motivation in a cohort of 401 adolescents (ages 14 to 17) over two years.

Authors reported that adolescents’ cannabis use was not associated with any significant changes in motivation, apathy, or engagement after investigators controlled for subjects’ use of alcohol and tobacco, among other potential confounders (such as age, sex, and depression).

They reported, “[D]espite significant increases in levels of cannabis use in our sample, change in cannabis use did not predict changes in motivation, which suggests that cannabis use may not lead to reductions in motivation over time.”

The study’s authors concluded: “Our findings do not support a relationship between cannabis use and reductions in motivation over time in a sample of adolescents at risk for escalation in cannabis use. … The current study contributes to the extant literature by examining these associations longitudinally in a large sample of adolescent cannabis users while controlling for important and often overlooked confounds, including sex and depression. … Future studies should continue to examine these associations longitudinally to determine whether heavier levels of cannabis use lead to reductions in motivation, and whether these reductions may be responsible for poorer educational and later life outcomes.”

Full text of the study, “Evidence lacking for cannabis users slacking: A longitudinal analysis of escalating cannabis use and motivation among adolescents,” appears in the Journal of the International Neuropsychological Society.

Analysis: Tax Increases on Cigarettes Don’t Influence Youth Marijuana Use

Bozeman, MT: Tax measures enacted to increase the costs of cigarettes do not inadvertently influence more young people to switch to marijuana, according to data published in the National Tax Journal.

A trio of economists assessed whether increased taxes on cigarettes influenced young adults to gravitate toward marijuana instead.

They reported, “The spillover effect of cigarette taxes on youth marijuana use has been the subject of intense public debate. Opponents of cigarette taxes warn that tax hikes will cause youths to substitute toward marijuana. … We find little evidence to suggest that teen marijuana use is sensitive to changes in the state cigarette tax.”

Authors also analyzed the effect of medical and recreational marijuana legalization laws upon youth cigarette and cannabis use. Consistent with prior studies, they reported, “We find that both state MMLs [medical marijuana laws] and RMLs [recreational marijuana laws] are associated with decreases in teen marijuana consumption, consistent with the hypothesis that selling to minors becomes a relatively risky proposition for licensed marijuana dispensaries.”

Full text of the study, “Cigarette taxes and teen marijuana use,” is available from the National Tax Journal.

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Analysis: Adult-Use Legalization Laws Not Linked to Increases in Violent Crime, Problematic Substance Abuse

Cambridge, MA: The enactment of state-level, adult-use marijuana legalization laws is not associated with increases in either drug treatment admissions, violent crime, or overdose deaths, according to a comprehensive analysis published by the National Bureau of Economic Research.

A team of economists reviewed nationally representative data across all 50 states and the District of Columbia to “comprehensively explore the broader impacts of RMLs [recreational marijuana laws], providing some of the first evidence on how marijuana legalization is affecting illicit drug use, heavy alcohol use, arrests for drug and non-drug offenses, and objectively-measured adverse drug-related events including drug-related overdose deaths and admissions into substance abuse treatment services.”

They determined: “We find little compelling evidence to suggest that RMLs result in increases in illicit drug use, arrests for part I [violent] offenses, drug-involved overdoses, or drug-related treatment admissions for addiction. … Our findings provide key evidence evaluating the ongoing, occasionally contentious, political debate on legalizing marijuana use, and inform whether recreational marijuana use is a โ€˜gateway’ to addiction to harder drugs and criminal behavior.”

The study’s findings are consistent with those others – such as those here and here – which have similarly reported that changes in the state-legal status of cannabis are not associated with any significant adverse effects on overall health and safety.

Full text of the study – “Is recreational marijuana a gateway to harder drug use and crime?” – is available from the National Bureau of Economic Research.

Cannabis Use Not Independently Linked to Increased Risk of Ischemic Stroke in Young Adults

Baltimore, MD: Those with a history of cannabis use do not possess an increased risk of early-onset ischemic stroke, according to the findings of a population-based case-control study published in the journal Stroke.

Researchers with the University of Maryland School of Medicine assessed the relationship between cannabis and stroke risk in a cohort of 1,564 subjects between the ages of 15 to 49. Investigators said that their study was “the largest case-control study to date” evaluating the association between marijuana and ischemic stroke risk.

They reported, “After adjusting for other risk factors, including the amount of current tobacco smoking, marijuana use was not associated with ischemic stroke, regardless of the timing of use in relationship to the stroke, including ever use, use within 30 days, and use within 24 hours.”

Authors concluded, “These analyses do not demonstrate an association between marijuana use and an increased risk of early-onset ischemic stroke.”

Results of a 2020 study published in the journal Neurology: Clinical Practice similarly reported that recent exposure to cannabis was not associated with an increased risk of hospitalization due to acute ischemic stroke.

Other studies have yielded inconsistent results with respect to the degree with which a history of cannabis use may play a role in the risk of ischemic stroke. NORML has cautioned that those patients with a history of cardiovascular disorders may be at an elevated risk of suffering from adverse events due to the use of cannabis.

Full text of the study, “Marijuana use and the risk of early ischemic stroke: The stroke prevention in young adults study,” appears in Stroke.

Medical Cannabis Patients Show Sustained Improvements in Cognitive Performance

Belmont, MA: The use of cannabis products, particularly CBD-dominant products, is associated with sustained improvements in cognitive performance, according to longitudinal data published in the Journal of the International Neuropsychological Society.

A team of Harvard investigators assessed executive function in a cohort of medical cannabis patients prior to their use of marijuana and then again at three months, six months, and at twelve months. Patients enrolled in the study possessed little-to-no prior experience with cannabis.

Researchers reported that subjects showed improved cognitive performance within three months of treatment and that these improvements were sustained throughout the 12-month trial period. Improvements in executive function were correlated with clinical improvements in patients’ mood, anxiety, and sleep. The use of CBD-dominant products was most closely associated with participants’ changes in mood and anxiety.

Authors concluded: “In a 12-month longitudinal, observational study, patients using MC [medical cannabis] for various medical conditions exhibited improved executive function and stable verbal learning and memory within the context of improvements on measures of mood, anxiety, and sleep relative to baseline. [I]mprovement of clinical state over time was significantly associated with increased CBD exposure. … Future investigations examining the impact of individual cannabinoids and age of onset of use are warranted to clarify the implications of MC use. Ultimately, for MC patients, it is imperative to understand the relationship between these variables in order to maximize the therapeutic potential of cannabis while minimizing potential risk and harms.”

A 2020 study published in the journal AIDS Care also reported that HIV patients with a history of cannabis use exhibited better neurocognitive performance than similarly matched patients with no history of consumption.

Full text of the study, “An observational, longitudinal study of cognition in medical cannabis patients over the course of 12-months of treatment: Preliminary results,” appears in the Journal of the International Neuropsychological Society.

Enactment of Adult-Use Marijuana Legalization Associated with Immediate, But Temporary Reductions in Opioid-Related Emergency Room Visits

Boston, MA: The enactment of adult-use marijuana legalization laws is associated with immediate reductions in opioid-related emergency department (ED) visitation rates among men, according to data published in the journal Health Economics.

A team of investigators from the Harvard Pilgrim Health Care Institute and the University of Pittsburgh assessed the relationship between marijuana legalization and opioid-related ED visitation rates in 29 states over a six-year period (2011-2017). Four of those states enacted adult-use access during the study period, and researchers compared trends in these legal states with trends in the remaining 25 states.

Authors reported that ED visit rates fell nearly eight percent among males (ages 24 to 44) during the first six-months following the enactment of legalization laws. However, these reductions dissipated in the months that followed and were no longer significant within one year.

“Our results indicate that RCLs [recreational marijuana laws] may only affect a temporary reduction in opioid-related ED visits,” they concluded. “While cannabis liberalization may offer some help in curbing the opioid crisis, our results suggest that it is not a panacea.”

The study’s lead investigators added: “We can’t definitively conclude from the data why these laws are associated with a temporary downturn in opioid-related emergency department visits but, based on our findings and previous literature, we suspect that people who use opioids for pain relief are substituting with cannabis, at least temporarily. … [T]his is good news for state policymakers. States can fight the opioid epidemic by expanding access to opioid use disorder treatment and by decreasing opioid use with recreational cannabis laws. These policies aren’t mutually exclusive; rather, they’re both a step in the right direction.”

Full text of the study, “Recreational cannabis laws and opioid-related emergency department visit rates,” appears in Health Economics.

Study: Experienced Cannabis Consumers Self-Titrate Higher Potency Products

Pullman, WA: Subjects consuming high-potency cannabis concentrates perform similarly on measurements of cognitive performance as do those inhaling lower-potency cannabis flowers, according to data published in the journal Scientific Reports.

A team of investigators affiliated with Washington State University assessed the impact of high-potency concentrates (above 60 percent THC) and lower potency flower (around 20 percent THC) on cognitive performance in a group of experienced marijuana consumers. Users’ performance was measured against that of 20 sober participants.

Researchers reported that cannabis consumers scored similar to controls on a number of measurements, including on tasks involving decision-making and prospective memory.

Cannabis users did not perform as well as controls on tests involving verbal recall and false memories. However, subjects consuming high-potency THC products performed no worse on those tests than did those subjects who ingested less potent products. Researchers attributed this latter result to the fact that those participants who consumed concentrates ingested significantly lesser quantities – thereby achieving similar levels of intoxication as did those who consumed lower potency flower.

Authors concluded: “[P]articipants randomly assigned to use a cannabis concentrate self-titrated after significantly fewer puffs yet reported comparable levels of intoxication and demonstrated equivalent levels of impairment as those who inhaled the flower products. [While] there has been concern and speculation that extremely high-potency cannabis concentrates will magnify harms, … [these] results failed to support our hypothesis that concentrates would exacerbate cognitive impairments.”

The authors’ conclusions are consistent with those of prior experimental studies showing that subjects exposed to higher-potency cannabis tend to self-titrate their intake accordingly.

The study’s findings come at a time when some state lawmakers are calling for the imposition of arbitrary caps on the percentage of THC available in certain retail cannabis products. Those opining in favor of these restrictions have claimed that there are greater adverse effects associated with the use of higher potency products. NORML has pushed back against the imposition of THC caps – arguing that proponents’ concerns are not evidence-based and that banning the sale of more potent products will only serve to expand the growth of the illicit marijuana market.

Full text of the study, “Acute effects of high-potency cannabis flower and cannabis concentrates on everyday life memory and decision making,” appears in Scientific Reports.

Animal Data: CBD Administration Mitigates Symptoms of Nicotine Withdrawal

San Diego, CA: The administration of cannabidiol reduces nicotine withdrawal symptoms in animals, according to preclinical data published in the journal Psychopharmacology.

Researchers with the University of California, San Diego assessed the use of CBD or placebo in nicotine-dependent rats during periods of acute and protracted abstinence.

Investigators reported that CBD dosing “prevented” rats from exhibiting various signs of nicotine withdrawal. These findings “suggest that using CBD as a strategy to alleviate withdrawal symptoms upon nicotine cessation may be beneficial,” they concluded.

Separate animal models have demonstrated the ability of CBD to reduce cravings for alcohol and cocaine, while human studies have reported associations between CBD intake and reduced desires for alcohol, cocaine, heroin, tobacco, and cannabis.

Full text of the study, “Cannabidiol reduces withdrawal symptoms in nicotine-dependent rats,” appears in Psychopharmacology.

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Senate Leader Unveils Long-Awaited Marijuana Descheduling Plan

Washington, DC: United States Senate Leader Chuck Schumer (D-NY), along with Senators Cory Booker (D-NJ) and Ron Wyden (D-OR) unveiled draft legislation repealing the federal prohibition of marijuana at a press conference on Wednesday.

The draft legislation, titled the Cannabis Administration and Opportunity Act, makes numerous changes to federal marijuana laws while providing deference to states' cannabis policies.

Upon introducing the legislation, Sen. Schumer said: "This is monumental because at long last we are taking steps in the Senate to right the wrongs of the failed war on drugs. ... I will use my clout as Majority Leader to make this [legislation] a priority in the Senate. ... It makes eminent sense to legalize marijuana."

NORML Executive Director Erik Altieri said: "The days of federal prohibition are numbered. These actions by Senate Majority Leader Schumer and Senators Booker and Wyden reflect the fact that the supermajority of Americans is demanding that Congress take action to end the cruel and senseless policy of federal prohibition. It is time for legislators to comport federal law with the laws of the growing number of states that have legalized the plant, and it is time for lawmakers to facilitate a federal structure that allows for cannabis commerce so that responsible consumers can obtain high-quality, low-cost cannabis grown right here in America without fear of arrest and incarceration."

NORML Political Director Justin Strekal added: "Our main priority is to ensure that Americans who choose to responsibly consume cannabis are no longer discriminated against under the law. "With one in eight Americans choosing to consume on a semi-regular basis, including nearly one in four veterans, we must end the practice of arresting over 500,000 Americans every year and denying countless others employment, housing, and other civic rights if we are truly to be the โ€˜Land of the Free'. The federal government can take great strides toward rectifying this situation by advancing the Cannabis Administration and Opportunity Act through the legislative process."

Specifically, the Cannabis Administration and Opportunity Act directs the US Attorney General to remove marijuana from the federal Controlled Substances Act -- thereby allowing states to either maintain or establish their own cannabis regulatory policies free from undue federal interference. Under this scheme, state governments - if they choose to do so - can continue to impose criminal penalties for marijuana possession offenses. However, states would not be permitted to prohibit the interstate commerce of legal cannabis products transported through their borders.

The proposal also mandates for the expungement of the records of anyone convicted of a federal, non-violent marijuana offense. The expungements must take place within one year of the law's enactment.

The Act also forbids federal officials from taking discriminatory actions against those who legally use cannabis. It prohibits "individuals from being denied any federal public benefit ... on the basis of [the] use or possession of cannabis." It also, for the first time, permits physicians associated with the US Department of Veterans Affairs to make recommendations to their patients to access medical cannabis.

The proposal transfers primary agency jurisdiction over cannabis regulation from the US Drug Enforcement Administration to the Food and Drug Administration and to the Alcohol and Tobacco Tax and Trade Bureau in manner similar to the ways in which these agencies already oversee alcohol and tobacco products. A federal excise tax of 10 percent would be imposed within the first year of the law's enactment. Medical cannabis access programs, which are operational in the majority of US states, would not be disrupted under this federal plan.

Pending language in the US House of Representatives, the Marijuana Opportunity, Reinvestment, and Expungement (MORE) Act of 2021, similarly removes (deschedules) cannabis from the CSA and facilitates the expungement of past federal marijuana-related crimes. House lawmakers passed a previous version of the MORE Act in December by a vote of 228 to 164, marking the first time that a chamber of Congress ever advanced legislation to end the federal prohibition of cannabis. Senate lawmakers, however, failed to take up the bill.

Senators are seeking feedback on the draft legislation through September 1. Public comments may be provided to Cannabis_Reform@finance.senate.gov. In an interview with the publication Politico in April, Sen. Schumer pledged that he would hold a floor vote on the bill "sooner or later" this term. The Senate has never held a floor vote on legislation pertaining to descheduling cannabis.

Study: Youth Cannabis Exposure Not Associated with Residual Cognitive Deficits

Berlin, Germany: Adolescents with moderate exposure to cannabis show no decline in neurocognitive skills compared to controls, according to longitudinal data published in the journal Cognitive Development.

An international team of investigators from Canada, France, Germany, Ireland, and the United States examined the relationship between adolescent marijuana use at age 14 and cognitive performance at age 19. Researchers reported that those subjects with light-to-moderate cannabis use after age 15 demonstrated little difference in neurocognitive performance compared to non-users.

Authors determined: "Our data suggests that decision-making is not impaired when cannabis is used in moderation, and onset of use occurs after the age of 15. ... [A]fter controlling for confounders, we found no evidence of effects of cannabis on the remaining neurocognitive variables such as attention, working memory, short-term memory and risk-taking."

They concluded, "In summary, we find no evidence to support the presumption that cannabis consumption leads to a decline in neurocognitive ability."

Full text of the study, "Residual effects of cannabis use on neuropsychological functioning," appears in Cognitive Decline. Additional information is available from NORML's fact sheet, "Marijuana Exposure and Cognitive Performance."

Study: Adolescent Cannabis Use Not Independently Predictive of Depression, Suicidal Ideation

Quebec, Canada: Cannabis use by adolescents is not independently predictive of either depression or suicidal ideation, according to longitudinal data published in the Journal of Affective Disorders.

A team of Canadian investigators examined the relationship between cannabis use at age 15 and the likelihood of depressive symptoms and suicidal ideation at age 20 in a cohort of over 1,600 adolescents.

Researchers reported that cannabis use was not independently associated with a greater risk of suicidal thoughts at young adulthood after investigators controlled for subjects' use of alcohol, tobacco, and other substances. In addition, researchers reported that adolescents who suffered from depression were more likely to use cannabis later in life, not vice-versa.

Authors concluded: "This population-based study is the first, to our knowledge, to examine the temporal relation between cannabis use, depression and suicidal ideation simultaneously over five years during adolescence. Depression (but not suicidal ideation) predicted weekly cannabis use throughout adolescence. Weekly cannabis use predicted suicidal ideation (but not depression), but this association was no longer significant after taking into account other substance use including alcohol, tobacco and other drugs consumption. ... These findings highlight the importance of targeting depressive symptoms during this sensitive developmental period in an attempt to offset the potential increased use of cannabis over time."

In June, NIH researchers published data in the Journal of the American Medical Association highlighting an association between frequent cannabis use and elevated levels of suicidal ideation in young adults. However, authors of the study neither controlled for the use of other drugs, nor did they assess whether the relationship was bidirectional.

Full text of the study, "Cannabis use, depression and suicidal ideation in adolescence: Direction of associations in a population-based cohort," appears in the Journal of Affective Disorders.

Trends in Alcohol Purchases Mixed Following States' Enactment of Marijuana Legalization

Minneapolis, MN: Trends in alcohol sales are inconsistent following the enactment of statewide marijuana legalization laws, according to data published in the Journal of Cannabis Research.

A pair of researchers affiliated with the University of Minnesota assessed trends in households' alcohol purchases in marijuana legalization states (Colorado, Oregon, and Washington) compared to control states.

In two states - Colorado and Oregon - alcohol purchased decreased compared to control states. In Washington, sales of spirits increased compared to control states.

"Results suggest that alcohol and cannabis are not clearly substitutes nor complements to one-another," authors concluded. They added: "Alcohol may substitute or complement cannabis depending on subgroup characteristics, including any history of substance abuse or age. ... As cannabis becomes legalized and more widely available across the USA, there is a greater need to understand any unintentional consequences these policy changes may have for alcohol-related harms and public health problems more broadly."

Numerous studies have sought to resolve whether cannabis and alcohol are more likely to act as substitutes or as complements. A 2020 review of the relevant literature identified 30 studies finding that cannabis acted as a substitute for alcohol and 17 studies finding that the two substances act as complements. Authors of the study concluded, "We identified stronger support for substitution than complementarity, though evidence indicates different effects in different populations and to some extent across different study designs."

Most recently, data published in January in the journal Addiction reported that heavy drinkers significantly reduced their alcohol intake on days when they used cannabis.

Full text of the study, "Recreational cannabis legalization and alcohol purchasing: A difference-in-difference analysis," appears in the Journal of Cannabis Research.

Clinical Trial: Cannabis Extracts Effective for Refractory Chemotherapy-Induced Nausea

Sydney, Australia: The adjunctive use of cannabis extracts significantly reduces symptoms in patients with treatment-resistant chemotherapy-induced nausea, according to clinical trial data published in the journal Annals of Oncology.

Australian researchers compared cannabis extracts (oral capsules containing 2.5mg of THC and 2.5mg of CBD) versus placebo in a cohort of 72 patients with chemotherapy-induced nausea and vomiting (CINV).

Researchers reported that the adjunctive use of cannabis extracts was associated with reductions in patients' nausea and vomiting, and also with improvements in subjects' overall quality of life. Although the majority of patients did report side-effects, these effects were largely limited to non-serious events such as sedation and dizziness.

They concluded: "The oral THC:CBD cannabis extract was active and tolerable in preventing CINV, when combined with guideline-consistent antiemetic prophylaxis for a study population with refractory CINV. ... Further research is necessary to determine the significance and durability of improvements observed in specific AQOL-8D [quality of life] dimensions."

Cannabis extracts containing equal ratios of THC and CBD are already available in many countries by prescription under the brand name Sativex. The substance is not legally available in the United States. By contrast, oral synthetic THC, marketed under the brand name Marinol, is FDA-approved in the US for the treatment of nausea and vomiting associated with cancer chemotherapy.

Full text of the study, "Oral THC;CBD cannabis extract for refractory chemotherapy-induced nausea and vomiting: A randomized, placebo-controlled, phase II crossover trial," appears in Annals of Oncology.

Survey: Medical Cannabis Frequently Used as a Substitute for Prescription Medicines

Aarhus, Denmark: Europeans who consume cannabis for medical purposes frequently report using it to replace prescription medications, according to survey data published in The Harm Reduction Journal.

A team of Dutch researchers surveyed over 2,800 medical cannabis consumers. Over half of respondents (56 percent) reported using cannabis "for the purpose of replacing a prescribed drug."

Those who reported engaging in drug substitution were most likely to do so for pain medications, specifically opioids, as well as for anti-depressants, and arthritis medications.

Forty-six percent of respondents said that their use of medical cannabis led them to "substantially decrease" their use of prescription medications, while 38 percent reported ceasing their use of at least one prescription medicine. Sixty-six percent of respondents perceived cannabis to be "much more effective" than prescription drugs and 86 percent said that it possessed a more favorable side-effect profile.

Numerous studies of North American patients have reported similar findings.

Authors concluded: "Findings from our sample show that most substitution users find CaM [cannabis as medicine] more effective in managing their condition(s) compared to prescription drugs, and that an overwhelming majority found CaM to have a better side effect profile compared to the prescription drugs that they had been prescribed for their condition(s). ... Findings from our study add to the growing body of research indicating that from a user perspective, CaM has a substantial substitution effect for a variety of prescription drugs, most notably opioids."

Full text of the study, "Exploring the use of cannabis as a substitute for prescription drugs in a convenience sample," appears in the Harm Reduction Journal.

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Feds: Marijuana Trafficking Convictions Have Fallen Dramatically Following Statewide Legalization

Washington, DC: The federal government is prosecuting and convicting fewer people for violating marijuana trafficking laws, according to data provided by the United States Sentencing Commission (USSC).

According to a new fact sheet issued by the Commission, just over 1,000 people were sentenced federally in 2020 for violating marijuana trafficking laws. That’s down 67 percent since 2016, and over 80 percent since 2012 โ€“ when Colorado and Washington became the first two states to legalize and regulate the adult-use marijuana market.

“These trends illustrate the fact that state-legal domestic cannabis production has supplanted the foreign market and that marijuana law enforcement is becoming less of a federal priority in an age where the majority of Americans believe that cannabis ought to be legal,” NORML’s Deputy Director Paul Armentano said. “It is vital that Congress take action to amend federal law in a manner that comports with this reality.”

Overall, fewer than seven percent of all federal drug trafficking cases in 2020 involved marijuana, the USSC reported. Eighty-eight percent of marijuana trafficking prosecutions resulted in a prison sentence.

Additional information is available on the USSC.gov website.

Study: Marijuana Legalization Not Associated with Changes in Marijuana Use Among High-Risk Youth

Toronto, Canada: The enactment of adult-use marijuana legalization in Canada is not associated with changes in either cannabis use or perceived access among high-risk youth, according to data published in the Journal of Substance Abuse Treatment.

A pair of researchers affiliated with the University of Toronto assessed cannabis use patterns immediately prior to and following legalization in a cohort of young people who had been enrolled in a substance abuse treatment program. All of the 269 participants in the study had a history of marijuana use.

Investigators determined: “[A]s a whole, cannabis use patterns did not change with legalization across a range of cannabis use and polysubstance use behaviors, nor did the perception of ease of access or safety of the source of cannabis.” Authors also reported “no change in mental health symptomatology or substance use dependence” following legalization.

They concluded, “Cannabis use does not appear to have changed substantially in the short-term following legalization among youth seeking services for substance use disorders, whether or not the youth have reached the age of majority.”

Full text of the study, “Legalization of cannabis use in Canada: Impacts on the cannabis use profiles of youth seeking services for substance use,” appears in the Journal of Substance Abuse Treatment.

Clinical Trial: Single Dose of CBDV Modulates Atypical Brain Circuitry in Patients with Autism Spectrum Disorder

London, United Kingdom: The administration of the phytocannabinoid CBDV (cannabidivarin) modulates brain chemistry in autistic patients in a manner that is typically associated with better patient outcomes, according to clinical data published in the journal Molecular Autism.

An international team of investigators from Germany, Spain, the Netherlands, and the United Kingdom assessed the administration of CBDV versus placebo in a cohort of male patients with autism spectrum disorder (ASD). Researchers reported that CBDV dosing led to brain changes in the striatum that are typically associated with the mitigation of ASD symptoms.

Authors concluded: “A single dose of CBDV was sufficient to shift atypical striatal FC [functional connectivity] in the mature autistic brain towards the profile found at baseline in neurotypicals. … Future studies are required to determine whether modulation of striatal FC is associated with a change in ASD symptoms.”

Several observational trials have documented behavioral improvements in ASD patients administered whole-plant cannabis extracts. Most recently, a 2021 review of the relevant literature summarized: “Cannabis products [have been demonstrated to] reduce the number and/or intensity of different symptoms, including hyperactivity, attacks of self-mutilation and anger, sleep problems, anxiety, restlessness, psychomotor agitation, irritability, aggressiveness perseverance, and depression. Moreover, they [are associated with an] improvement in cognition, sensory sensitivity, attention, social interaction, and language.”

Authors of the review concluded, “Cannabis and cannabinoids may have promising effects in the treatment of symptoms related to ASD and can be used as a therapeutic alternative in the relief of those symptoms.”

Full text of the study, “Modulation of striatal functioning connectivity differences in adults with and without autism spectrum disorder in a single-dose randomized trial of cannabidivarin,” appears in Molecular Autism.

Study: Legal Marijuana Farms Are Not a Drain on Water Resources

Berkeley, CA: Licensed outdoor marijuana farms in northern California do not put undue strain on limited water resources, according to data published in the Journal of Environmental Management.

A team of researchers affiliated with the University of California, Berkeley and with the State of California, North Coast Regional Water Quality Control Board assessed irrigation patterns among licensed cannabis farms.

Authors stated that cannabis farming isn’t “particularly thirsty relative to other crops.” They estimated that “legal outdoor [cannabis] production uses about the same amount of water as a crop like tomatoes” and about 33 times less water than almonds.

The study’s findings run counter to previous claims that cannabis farming placed undue strain on the state’s limited water supply.

Because the University study only assessed water use among legally licensed farms, the authors cautioned that their findings may not be applicable to illicit growing practices. A prior study, published by New Frontier Data in partnership with the Resource Innovation Institute and the University of California, Berkeley similarly concluded that cannabis is among the most “water-economical” of California’s top revenue crops.

Full text of the study, “Water storage and irrigation practices for cannabis drive seasonal patterns of water extraction and use in northern California,” appears in the Journal of Environmental Management.

Clinical Trial: Oral CBD Dosing Doesn’t Consistently Mitigate Experimental Pain in Healthy Volunteers

New York, NY: The administration of oral CBD is not consistently associated with analgesia in healthy volunteers exposed to experimentally-induced pain, according to clinical data published in the British Journal of Clinical Pharmacology.

Researchers affiliated with Columbia University assessed the administration of various doses of purified CBD (200, 400, or 800mg) versus placebo in subjects exposed to experimental pain conditions.

Investigators reported that CBD “failed to consistently affect pain threshold and tolerance … relative to placebo.” In some cases, CBD dosing was associated with increases in subjects’ perceptions of pain.

Authors concluded: “CBD did not elicit consistent dose-dependent analgesia and in fact increased pain on some measures. Future studies exploring CBD-induced pain relief should consider using a more extensive pain assessment paradigm in different participant populations.”

Other studies have documented the anti-inflammatory effects of CBD, which may be useful in the treatment of chronic pain in certain pain populations. Moreover, the inhalation of whole-plant cannabis is well-established as an analgesic agent in various populations, particularly those suffering from neuropathy.

Full text of the study, “The dose-dependent analgesic effects, abuse liability, safety and tolerability of oral cannabidiol in healthy humans,” appears in the British Journal of Clinical Pharmacology.

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