Tag: Weed Connection

Federal: Language Facilitating Medical Cannabis Access for Veterans Included in Senate, House Versions of Military Spending Bill

Washington, DC: Members of the US Senate and the House of Representatives have approved amendments allowing physicians affiliated with the Department of Veterans Affairs to recommend medical cannabis to qualified patients in jurisdictions that regulate its use.

Federal regulations currently preclude physicians associated with the Veterans Affairs Department from filling out the paperwork necessary to issue a state-authorized medical marijuana recommendation. The pending language amends these rules so that no federal funds may be used to prohibit physicians from engaging in the medical marijuana authorization process.

The new provisions are included in the House and Senate versions of a much broader legislative package, the Military Construction, Veterans Affairs, and Related Agencies Appropriations Act. However, because the two chambers have approved differing versions of the Act, members must still reconcile the language of the two bills. That process typically takes place in a conference committee.

In prior years, lawmakers have removed similar cannabis reform language from the Military Construction bill during the conference committee process.

Lawmakers are anticipated to take further action on the Act shortly after reconvening from their August recess.

Study: Medical Cannabis Associated With Health-Related Quality of Life Improvements, Reduced Opioid Use Among Patients With Substance Use Disorders

London, United Kingdom: Patients diagnosed with substance use disorders (SUD) report improved sleep quality, reduced anxiety, and decreased opioid use following the sustained use of medical cannabis products, according to observational data published in the journal European Addiction Research.

British investigators assessed the use of cannabis-based medicinal products (CBMPs) in SUD patients enrolled in the UK Medical Cannabis Registry. (British health care providers may prescribe cannabis-based medicinal products to patients unresponsive to conventional medications.) More than half (53 percent) of the participants suffered from an opioid use disorder. Patients’ outcomes were assessed at one, three, and six months.

“[T]herapy with CBMPs in patients with SUDs was associated with improvements in [patients’] anxiety, sleep quality and HRQoL [health-related quality of life] at 1, 3 and 6 months,” investigators reported. “Additionally, treatment with CBMPs was associated with a reduction in the median daily OME [oral morphine equivalent] from baseline to 6 months with no severe or life-threatening adverse events reported. These findings are in line with similar studies and broader data from the UK Medical Cannabis Registry for other conditions.”

The study’s authors concluded: “In the context of SUD, CBMPs may … play a role in the maintenance therapy of opiate-dependent individuals with co-morbid anxiety and sleep disorders or symptoms. … CBMPs may also play a role during tapering of opioid doses during maintenance therapy due to the prevalence of anxiety and sleep disruption in individuals experiencing withdrawal from medications. … Although capturing a 6-month follow-up is valuable, longitudinal data to see if PROMs [patient-reported outcome measures] would stay the same, improve further or instead decline would also prove useful in strengthening the evidence base for CBMPs in the treatment of substance use disorders.”

Survey data have previously reported that a significant percentage of patients undergoing opioid maintenance therapy acknowledge consuming cannabis to ease withdrawal symptoms and drug cravings.

Other observational studies assessing the use of cannabis products among those enrolled in the UK Medical Cannabis Registry have reported them to be effective for patients diagnosed with treatment-resistant epilepsy, cancer-related pain, anxiety, fibromyalgia, inflammatory bowel disease, hypermobility disorders, depression, migraine, multiple sclerosis, osteoarthritis, and inflammatory arthritis, among other conditions.

Full text of the study, “UK Medical Cannabis Registry: A clinical analysis of patients with substance use disorder,” appears in the European Addiction Research.

Study: Patients Engage in Compensatory Driving Behaviors Following Ingestion of THC Extracts

Queensland, Australia: Patients who consume oral doses of THC drive at slower speeds and engage in other compensatory behaviors, according to driving simulator data published in the journal Psychopharmacology.

Australian researchers assessed subjects’ simulated driving performance prior to and 90 minutes after their ad libitum consumption of prescribed THC oil extracts. (Australian physicians may prescribe cannabis products to patients unresponsive to conventional prescription treatments.) On average, study subjects consumed 11 mg of THC prior to driving.

Similar to the results of prior studies, subjects engaged in compensatory driving behaviors – such as driving at slower speeds and increasing the distance between their vehicle and the vehicles in front of them – following THC dosing. Few other changes in participants’ baseline performance were identified, leading investigators to presume that patients likely become tolerant to THC’s potential effects on cognitive and psychomotor performance.

“Our results align with a growing body of evidence demonstrating that chronic THC use can mitigate the acute effects of the substance on driving performance and driving-related cognitive functions,” researchers reported.

The study’s authors concluded: “Taken together, our findings suggest that … medicinal cannabis users may … be more inclined to compensate for cannabis impairment through alterations in speed and following distance. … Future research is needed to further investigate the effects of THC on these driving-related skills and behaviors using a wider range of doses and administration methods, with populations of varying tolerance levels.”

The study’s findings are consistent with those of several others, determining that daily cannabis consumers, and patients especially, exhibit tolerance to many of cannabis’ psychomotor-influencing effects. According to the findings of a literature review published in the Journal of the German Medical Association, “Patients who take cannabinoids at a constant dosage over an extensive period of time often develop tolerance to the impairment of psychomotor performance, so that they can drive vehicles safely.”

Full text of the study, “The effects of orally ingested delta-9-tetrahydrocannabinol on drivers’ hazard perception and risk-taking behaviors: A within-subjects study of medicinal cannabis users,” appears in Psychopharmacology.

Analysis: Cannabis Use Not Associated with Elevated Risk of Kidney Disease

Baltimore, MD: Adults with a history of cannabis use do not possess an elevated risk of kidney disease at midlife, according to longitudinal data published in the journal Cannabis and Cannabinoid Research.

A team of investigators affiliated with Johns Hopkins University School of Medicine in Baltimore and Tulane University in New Orleans assessed the relationship between cannabis use and kidney function. Study participants included current cannabis consumers and non-users. Participants were assessed at baseline and again nearly a decade later.

“Compared with those with no history of cannabis use, participants with current regular cannabis use were not at higher risk of incident CKD [chronic kidney disease] (OR: 0.79), rapid kidney function decline (OR: 0.80) or incident albuminuria [the presence of albumin in urine, a symptom of kidney disease (OR: 0.84) after adjustment for [confounders],” researcher reported.

The study’s authors concluded, “[T]here was no independent association between cannabis use and adverse kidney outcomes over time.”

Full text of the study, “Evaluating the association of cannabis use and longitudinal kidney outcome,” appears in Cannabis and Cannabinoid Research.

Analysis: Marijuana Legalization in California Associated With Lower Alcohol Consumption

San Francisco, CA: The passage of adult-use marijuana legalization in California is associated with sustained decreases in alcohol consumption, according to data published in the journal Addiction.

Researchers affiliated with the University of California, San Francisco and the healthcare provider Kaiser Permanente assessed trends in self-reported alcohol consumption among northern Californians prior to and following voters’ decision to legalize marijuana. (California legalized marijuana in 2016.) Study participants were Kaiser Permanente patients who underwent annual screenings for alcohol use during visits with their primary care doctors. Investigators reviewed data from over 3.5 million adults over four years.

Researchers identified sustained declines in participants’ weekly drinking patterns, as well as in how often they engaged in heavy episodic drinking, following legalization. Declines were most pronounced among those ages 35 to 49.

“Specifically, this group showed a significant immediate reduction in frequent HED [heavy episodic drinking], along with gradual declines over time in HED and rates of exceeding both daily and weekly limits,” investigators determined. “This may suggest that cannabis policy changes contributed to a meaningful shift away from higher risk drinking behaviors, potentially reflecting greater substitution effects as compared to younger groups.”

Declines were less pronounced among those ages 21 to 34 and among those 65+.

The study’s authors concluded, “Cannabis policy changes in California, USA, appear to be linked to age-specific changes in alcohol use, with moderate reductions, particularly among middle-aged adults.”

The findings are consistent with those from Canada determining that alcohol sales declined in that country following the adoption of adult-use marijuana legalization.

Survey data published last year in The Harm Reduction Journal found that 60 percent of cannabis consumers acknowledge using it to reduce their alcohol intake.

Full text of the study, “Are cannabis policy changes associated with alcohol use patterns? Evidence from age-group differences based on primary care screening data,” appears in Addiction.

Survey: IBD Patients Report Symptomatic Benefits, Decreased Reliance on Opioids Following Cannabis Use

Cleveland, OH: Patients with inflammatory bowel disease (IBD), including Crohn’s disease and ulcerative colitis, frequently report using cannabis products to manage their symptoms, according to survey data published in the journal Academia Medicine.

Investigators affiliated with the Case Western Reserve School of Medicine surveyed 93 IBD patients regarding their use of either cannabis or CBD products.

Among those participants who acknowledged consuming cannabis, most said that it mitigated their IBD-related pain, stress, and anxiety. Many patients also reported using CBD oil products; however, they did not perceive them to be as effective as cannabis.

Thirty-four percent of patients reported decreasing their opioid consumption when using either cannabis or CBD products – a finding that is consistent with prior data. Fifteen percent of patients reported that their use of cannabis products induced disease remission.

“The findings indicate that a significant proportion of IBD patients use cannabis, notice symptom relief, and prefer its therapeutic use,” the study’s authors concluded. “As interest in alternative treatments gains momentum, these results can influence future clinical trials, guide healthcare professionals in patient counseling, and be included in altering treatment modalities.”

Observational trials have previously documented that cannabis use by IBD patients is associated with fewer ER visits. In a randomized placebo-controlled trial involving 21 patients with refractory Crohn’s disease, nearly half achieved disease remission following their use of herbal cannabis. A separate placebo-controlled trial reported that herbal cannabis is associated with clinical improvements and increased quality of life in patients with mild to moderate ulcerative colitis.

Full text of the study, “Inflammatory bowel disease patients believe cannabis and cannabidiol oil relieve symptoms,” appears in Academia Medicine.

Delaware: Medical Cannabis Dispensaries To Begin Adult-Use Sales

Dover, DE: Consumers ages 21 and older can begin purchasing cannabis products from licensed retailers on Friday, August 1st – some 28 months after lawmakers approved legislation legalizing the adult-use market.

Consumers will initially be able to purchase cannabis at approximately a dozen retail locations — all of which are existing medical cannabis dispensaries that have received ‘conversion licenses’ to sell to patients and adults.

Regulators have pledged to approve additional licenses to new applicants in the coming months.

“Delaware has taken a major step forward by launching a legal adult-use cannabis market that prioritizes equity, safety, and accountability,” Democratic Governor Matt Meyer said. “This new industry will generate critical revenue to strengthen our schools, infrastructure, and public health systems, while creating real opportunities for entrepreneurs. This revenue also gives us a powerful tool to invest in the communities most impacted by the war on drugs, addressing past wrongs and ensuring that the benefits of this new market reach every corner of our state.

A Delaware State Auditor’s report estimates that adult-use sales will generate $43 million in annual tax revenue.

Survey: Patients Undergoing Opioid Maintenance Therapy Frequently Use Cannabis To Mitigate Cravings, Withdrawal Symptoms

Munich, Germany: A significant percentage of patients undergoing opioid maintenance therapy (OMT) acknowledge consuming cannabis to ease withdrawal symptoms and drug cravings, according to survey data published in the journal Brain Sciences.

German researchers affiliated with the University of Munich surveyed 128 opioid use disorder (OUD) patients receiving OMT. Forty-one percent of respondents reported using cannabis. Of those, 59 percent said that they did so “to suppress cravings for other [controlled] substances.” Thirty-nine percent said they used cannabis “to suppress opioid withdrawal symptoms.”

The findings are consistent with prior studies involving opioid-dependent subjects.

“These findings highlight a complex interaction between opioid treatment and cannabis use,” the study’s authors concluded. “Further longitudinal and placebo-controlled trials are needed to investigate the clinical and pharmacological interactions between cannabis and OMT, including effects on craving, withdrawal, and overall treatment outcomes.”

Full text of the study, “Cannabis use in opioid maintenance therapy: Prevalence, clinical correlates, and reasons for use,” appears in Brain Sciences.

Analysis: Medical Cannabis Associated With Reduced Healthcare Utilization in Chronic Pain Patients

Miami, FL: The sustained use of state-authorized medical cannabis products is associated with improved quality of life and reduced healthcare utilization among chronic pain patients, according to data published in the journal Pharmacy.

A team of researchers affiliated with the medical cannabis telehealth company Leafwell and George Mason University in Virginia assessed healthcare utilization trends in chronic pain patients with and without prior medical cannabis experience. An estimated one in three pain patients residing in medical cannabis access states report using marijuana as an analgesic agent.

Investigators determined that patients who had used medical cannabis products during the prior year reported fewer urgent care visits, fewer emergency department visits, and fewer “unhealthy days per month” than did those with no prior cannabis use history.

“The findings of this study suggest … that medical cannabis is likely an effective treatment option for patients with chronic pain,” the study’s authors concluded. “Moreover, we found that, in addition to an increase in QoL [patients’ quality of life], medical cannabis exposure is associated with lower risk of urgent care and ED visits, when comparing patients who used medical cannabis for at least one year to cannabis-naïve patients. This underscores the potential for not only QoL gains associated with medical cannabis use, but also positive downstream effects on the healthcare system resulting from treatment.”

A prior analysis by Leafwell researchers concluded that state-level access to medical cannabis is associated with significant reductions in healthcare premiums.

Full text of the study, “Medical cannabis use and healthcare utilization among patients with chronic pain: A causal inference analysis using TMLE,” appears in Pharmacy.

Study: Cannabis Consumption Not Associated With Elevated Risk of Adverse Cardiovascular Events in Older Adults

San Francisco, CA: Older adults who consume cannabis are no more likely to suffer from adverse cardiovascular events, such as heart attack and stroke, as compared to non-users, according to longitudinal data published in the journal Circulation.

Researchers affiliated with the University of California, San Francisco assessed cannabis use and cardiovascular health in a cohort of 4,285 older veterans (mean age: 67.5) with a history of coronary artery disease. Approximately 25 percent of study participants (1,015 veterans) reported current cannabis use, while the remaining 3,122 participants did not. Subjects were followed for an average of 3.3 years.

Contrary to investigators’ expectations, current cannabis use was not independently associated with elevated rates of heart attack, stroke, cardiovascular death, or all-cause mortality once researchers adjusted for covariates.

“To our knowledge, the current study is the only study to examine the association of cannabis use with longitudinal cardiovascular disease outcomes among persons with established CAD [coronary artery disease],” the study’s authors concluded. “In this older cohort of veterans with CAD, smoking cannabis was not associated with the composite outcome of AMI [acute myocardial infarction], stroke, and cardiovascular death, a finding that was consistent across multiple measures of cannabis exposure.”

Although individual studies assessing cannabis use and cardiovascular health have yielded inconsistent results, a literature review of 67 papers published in The American Journal of Medicine concluded, “[M]arijuana itself does not appear to be independently associated with excessive cardiovascular risk factors.” Most recently, an analysis of over 720,000 adults published in the American Journal of Preventive Medicine (AJPM) Focus concluded that current cannabis consumers do not possess a greater risk of heart attack as compared to non-users.

Full text of the study, “Association of smoking cannabis with cardiovascular events among veterans with coronary artery disease,” appears in Circulation.

Pilot Study: Cannabis Extracts Show Promise in Adolescents With Tourette Syndrome

Sydney, Australia: The administration of plant-derived cannabis extracts containing standardized percentages of THC and CBD is associated with symptomatic improvements in adolescent patients with Tourette syndrome (TS), according to data published in the journal BJPsych Open.

Australian investigators assessed the efficacy of standardized cannabis extracts in ten teenagers (mean age: 14) with refractory TS. Study participants consumed cannabis oil once daily in the evening.

“There was positive signal of efficacy with a statistically significant improvement in parent and self-reported tics and quality of life, as well as behavioral/emotional issues,” researchers reported. “Commonly reported adverse events were tiredness and drowsiness, followed by dry mouth.”

The study’s authors concluded: “Although there is emerging evidence supporting the use of cannabis-based interventions in the management of Tourette syndrome in adults, this study uniquely contributes to the evidence on the benefits and safety of medicinal cannabis in adolescents with Tourette syndrome. … A larger scale, randomized controlled trial is needed to validate these findings.”

Separate data involving adults with TS reports that the sustained use of cannabis reduces tic frequency by as much as 75 percent, while also improving patients’ mood, anxiety, and sleep.

Full text of the study, “Medicinal cannabis for tics in adolescents with Tourette syndrome,” appears in BJPsych Open.