Analysis: Cigarette Smoking Poses Greater Impact to Airway Health Than Cannabis

Davis, CA: Cannabis smoking and tobacco smoking appear to have disparate impacts on lung health, according to data published in the journal Respiratory Research.

Investigators affiliated with the University of California at Davis assessed the impact of tobacco smoke and cannabis smoke on airway health by analyzing subjects’ exhaled breath condensate (EBC).

They reported that cannabis consumers possessed breath profiles similar to those of non-smokers. By contrast, tobacco smokers possessed profiles with elevated levels of certain inflammatory biomarkers.

“Cigarettes upregulate these inflammatory fatty acids, but we didn’t see that nearly as much with marijuana and marijuana products,” one of the study’s authors said. “When we look at the signatures from the marijuana smokers, they look closer to non-users and non-smokers than the tobacco smokers, and that was a surprise to us.”

Prior studies have similarly determined that cannabis consumers are exposed to fewer harmful toxicants as compared to those who smoke tobacco cigarettes.

Numerous studies have concluded that cannabis smoke and tobacco smoke are not equally carcinogenic. Moreover, the use of vaporization technology, which heats herbal cannabis to a set temperature below the point of combustion, is associated with reduced exposure to toxic gasses and has been identified as a “safe and effective” cannabis delivery device in clinical trial settings.

Full text of the study, “Impacts of vaping and marijuana use on airway health as determined by exhaled breath condensate,” appears in Respiratory Research.

Study: Patients With Treatment-Resistant Epilepsy Improve Following Medical Cannabis Therapy

London, United Kingdom: Patients with refractory epilepsy report sustained improvements in their symptoms following the use of medical cannabis preparations, according to observational data published in the journal Brain and Behavior.

British investigators assessed the use of cannabis-based medicinal products (CBMPs) in a cohort of 134 patients with treatment-resistant epilepsy. (British health care providers may prescribe cannabis-based medicinal products to patients unresponsive to conventional medications.) Patients’ outcomes were assessed at one, three, and six months.

Medical cannabis treatment was associated with improvements in patient‐reported epilepsy‐specific outcomes, alongside improvements in anxiety, sleep quality, and health-related quality of life. Over 96 percent of study subjects reported no adverse events from cannabis treatment.

“Treatment with CBMPs was associated with an improvement in both epilepsy‐specific and general HRQoL [health-related quality of life] outcomes at one, three, and six months,” the study’s authors concluded. “This study shows the promising potential of CBMPs as an adjunctive treatment option in the management of TRE [treatment-resistant epilepsy.]”

In 2018, regulators at the US Food and Drug Administration granted market approval to Epidiolex, a prescription medicine containing a standardized formulation of plant-derived cannabidiol (CBD) for the treatment of two rare forms of epilepsy: Lennox-Gastaut syndrome and Dravet syndrome.

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 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 outcomes analysis for epilepsy,” appears in Brain and Behavior.

Analysis: Alcohol Poses a “Greater Threat to Road Safety” Than Cannabis

Vancouver, Canada: Alcohol is among the most frequently detected controlled substances identified in drivers following a motor vehicle accident and it “remains the greatest threat to road safety,” according to data published in the Journal of the American Medical Association (JAMA) Network Open.

Canadian researchers reviewed bloodwork data for over 8,300 drivers involved in a motor vehicle accident. Over half of the study’s participants tested positive for the presence of a controlled substance. Drivers were most likely to test positive for either depressants, cannabis, or alcohol – with cannabis being more common among younger drivers (ages 19 to 24).

However, most drivers who tested positive for the presence of THC in blood did so at nominal levels – indicating that their exposure may have been several hours or even days beforehand. (THC may remain present in the blood of more habitual consumers for several days following past exposure.) Only about three percent of participants tested positive for THC at elevated levels (THC ≥ 5 ng/mL).

“These statistics suggest that although more drivers test positive for THC, alcohol remains the greater threat to road safety,” the study’s authors concluded.

A prior Canadian study reported that drivers treated for traffic-related injuries are over three times as likely to test positive for elevated levels of alcohol (BAC ≥ 0.08 percent) than elevated levels of THC (THC ≥ 5 ng/mL).

Driving simulator studies report that cannabis administration is typically associated with compensatory driving behavior, such as decreased mean speed and increased mean following distance, whereas alcohol administration is associated with more aggressive driving behavior. Nevertheless, cannabis exposure can influence certain psychomotor skills necessary for safe driving, such as reaction time and drivers’ ability to maintain lane positioning.

A study conducted by the US National Highway Traffic Safety Administration reported that drivers who test positive for any amount of THC possess, on average, a far lower risk of being involved in a traffic collision than do drivers who test positive for alcohol at or near legal limits.

By contrast, drivers who test positive for the presence of both THC and alcohol in their system tend to possess significantly higher odds of being involved in a motor vehicle accident than do those who test positive for either substance alone.

Full text of the study, “Prevalence of impairing substance use in injured drivers,” appears in JAMA Network Open.

Texas: Appellate Court Strikes Down Voter-Approved Marijuana Ordinances

Austin, TX: A Texas appellate court issued a pair of rulings last week halting the implementation of voter-approved marijuana initiatives in the cities of Austin (population: 980,000) and San Marcos (population: 72,000).

Voters in both cities had overwhelmingly approved municipal ordinances in 2022 prohibiting local police officers from issuing citations or making arrests for minor marijuana possession offenses. Last year, Republican Attorney General Ken Paxton filed suit against Austin, San Marcos, and several other cities for adopting the measures. The Attorney General filed an additional suit against the city of Dallas in December, opining, “Cities cannot pick and choose which state laws they follow.”

Reversing a lower court judge’s ruling, judges on the Fifteenth Court of Appeals sided with the Attorney General and held that state law preempts San Marcos from enforcing its ordinance. Specifically, judges ruled: “Section 370.003 of the Local Government Code … prohibits local governments from putting up any barrier to the full enforcement of drug-related laws. Texas law gives local governments and law enforcement officers a panoply of tools — such as the authority to issue citations and arrests — to enforce drug laws. Section 370.003 prohibits the City of San Marcos from making a policy that takes any of those tools off the table.”

Judges issued a similar ruling days later, striking down Austin’s marijuana ordinance, finding, “Consistent with City of San Marcos, we conclude that the ordinance in this case is also preempted by state law.” That ruling also reversed a lower court judge’s decision.

Police in both cities are anticipated to revert to issuing marijuana-related citations and arrests while the cases continue to be litigated.

Similar ordinances are in effect in the cities of Elgin, Dallas, Denton, and Killeen. Earlier this year, city council members in Bastrop (population: 11,700) and Lockhart (population: 15,300) declined to implement voter-approved depenalization ordinances out of fear of litigation.

State law defines marijuana possession of two ounces or less as a criminal misdemeanor, punishable by up to 180 days in jail, a $2,000 fine, and a criminal record. According to data compiled by Texas NORML, police made an estimated 219,000 marijuana-related arrests between 2017 and 2021. Ninety-seven percent of those arrested were charged with possession only. Fifty-six percent of those arrested were under 25 years of age.

In addition to the Attorney General’s legal efforts, Texas lawmakers are also moving forward with legislation to prohibit localities from placing any future marijuana-related measures on the ballot. Specifically, Senate lawmakers recently approved SB 1870, which forbids voters from deciding upon any local ordinances that seek to decriminalize marijuana. The measure also prohibits cities and towns from adopting policies that do not “fully enforce” the state’s criminal marijuana laws.

Study: Post-Traumatic Stress Patients Experience Sustained Improvements Following Use of Medical Cannabis Products

London, United Kingdom: Patients diagnosed with post-traumatic stress experience significant long-term benefits following their use of medical cannabis preparations, according to data published in the journal Expert Review of Neurotherapeutics.

British researchers assessed changes in patients’ health-related quality of life (HRQoL) following the use of cannabis-based medicinal products (CBMPs). (British health care providers may prescribe cannabis-based medicinal products to patients unresponsive to conventional medications.) Two hundred and sixty-nine patients with post-traumatic stress enrolled in the United Kingdom’s Medical Cannabis Registry were enrolled in the trial. Participants’ symptoms were assessed at 1, 3, 6, 12, and 18 months.

Consistent with other observational studies, “significant improvements in post-traumatic stress symptoms, anxiety, sleep quality, and HRQoL were observed at all follow-up points.” Symptomatic improvements were sustained for the entire study period (18 months).

Other observational studies assessing the use of cannabis products among patients enrolled in the UK Medical Cannabis Registry have reported them to be effective for those diagnosed with 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: An updated clinical outcomes analysis of patients with post-traumatic stress disorder,” appears in Expert Review of Neurotherapeutics.

Largest Ever Meta-Analysis: There Exists a “Strong Consensus Supporting the Therapeutic Use of Cannabis”

New York, NY: Cannabis has a “well-established role in managing symptoms related to cancer” and there is a “substantial scientific basis” for re-evaluating its classification as a Schedule I controlled substance, according to the findings of a meta-analysis of over 10,000 scientific papers published in the journal Frontiers in Oncology.

Investigators affiliated with the Chopra Foundation in New York and the Whole Health Oncology Institute in Hawaii reviewed data from 10,641 peer-reviewed studies assessing the efficacy and safety of cannabis for managing cancer-related symptoms. The analysis is the largest ever conducted on the subject of cannabis and cancer management.

They reported, “Across all categories examined – health metrics, cancer treatments, and cancer dynamics – there is a consistent consensus that supports the potential of medical cannabis.”

The study’s authors concluded: “In medical practice, the strong support for cannabis as a palliative adjunct to cancer treatments offers healthcare providers a data-driven foundation to consider cannabis as part of a comprehensive cancer care strategy. The demonstrated efficacy in managing symptoms like pain, nausea, and appetite loss can significantly enhance patients’ quality of life, making cannabis a valuable tool in both palliative care and potentially in curative settings. The growing consensus around cannabis’ therapeutic benefits also highlights the need for medical professionals to stay informed about the latest research, as cannabis continues to evolve from a controversial substance to a scientifically validated treatment option.”

In an accompanying press release, the study’s lead author added: “This is one of the clearest, most dramatic validations of medical cannabis in cancer care that the scientific community has ever seen. We expected controversy. What we found was overwhelming scientific consensus.”

Full text of the study, “Meta-analysis of medical cannabis outcomes and associations with cancer,” appears in Frontiers in Oncology.

Analysis: Changes in Cannabis’ Legal Status Not Associated With Reduced Traffic Safety

Cambridge, MD: Changes in the legal status of cannabis in US states and Canada are not associated with significant changes to traffic safety, according to an analysis published in the peer-reviewed journal Variance.

A researcher affiliated with the University of Maryland Center for Environmental Science assessed the impact of adult-use marijuana legalization on car accident fatality rates, insurance claim frequency, and average costs per insurance claim.

The study’s author did not identify any “statistically significant impacts of legalization” on any of the assessed outcomes during the study period. Rather, the author concluded that other factors, such as inclement weather and seasonal spikes in travel, are far more likely to influence trends in traffic safety.

The findings are consistent with those of a 2023 analysis, which assessed trends in fatal motor vehicle accidents in four legalization states—California, Maine, Massachusetts, and Nevada—compared to five control states: Idaho, Indiana, Kansas, Nebraska, and Wyoming. Researchers found that traffic deaths fell by an average of 12 percent in legal states in the three years immediately following legalization. By contrast, deaths increased nearly two percent over this same time in the five control states. Nationwide, traffic fatalities decreased 10.6 percent during the study period.

Other studies have yielded inconsistent results, with some identifying a minor increase in crash rates in specific states after legalization, while others found no such change.

Full text of the study, “A data-based assessment of the impact of marijuana legalization on vehicle accident risk,” appears in Variance.

Survey: Smoking Remains Most Popular Method for Consuming Cannabis

Atlanta, GA: Nearly eight-in-ten consumers say that smoking is their preferred method of cannabis ingestion, according to data provided by the Centers for Disease Control and Prevention.

Researchers reviewed marijuana use data provided by more than 138,000 respondents.

Fifteen percent of those surveyed reported having consumed cannabis within the past month, while eight percent reported daily use. Seventy-nine percent of consumers acknowledged smoking cannabis, while 41 percent acknowledged consuming edible formulations. Fewer than 15 percent of those surveyed acknowledged dabbing cannabis concentrates. The findings are consistent with others reporting that most consumers smoke cannabis.

Among those who reported dabbing, most respondents were young adults. Among older adults, fewer than 5 percent of respondents reported engaging in this practice.

In recent years, lawmakers in various states have introduced legislation to recriminalize higher-THC concentrated products. Most of these efforts have been unsuccessful.

Full text of the CDC white paper is available from the Centers for Disease Control and Prevention.

Arkansas: Governor Vetoes Bill Seeking To Expand Patients’ Ease of Access to Medical Cannabis Products

Little Rock, AR: Republican Gov. Sarah Sanders vetoed legislation that sought to provide greater ease of access for patients authorized to use medical cannabis.

House Bill 1889 “authorized deliveries [of medical cannabis products] by dispensaries via delivery vehicles and via a drive-through window located at the dispensary.” Only patients who had previously submitted online orders that same day would have been permitted to use the drive-through option.

In her veto message, Gov. Sanders said that passage of the bill would have “expanded access to usable marijuana, therefore I am vetoing this legislation.”

The bill’s lead sponsor, Rep. Aaron Pilkington, called the Governor’s message confusing. “This [legislation] doesn’t increase the number of cardholders, and it doesn’t increase the amount [of cannabis] a cardholder can get,” he said.

House Bill 1889 had previously passed the House by a vote of 51 to 31. Senators voted 19 to 15 in favor of the legislation. Nonetheless, Rep. Pilkington doubted he had ample legislative support to override the Governor’s veto.

Arkansas voters approved medical cannabis access in 2016. An estimated 110,000 Arkansans are registered with the state to use medical cannabis products.

Analysis: Cannabis Use Associated With Less Stress, Better Sleep Quality Among Military Veterans With PTSD

Santa Monica, CA: Cannabis use by veterans with post-traumatic stress is linked to reduced stress and better same-night sleep quality, according to data published in the journal Drug and Alcohol Dependence.

A team of investigators affiliated with the RAND Institute and the University of Southern California assessed cannabis and alcohol consumption on stress and sleep quality in a cohort of 74 recently discharged military veterans with elevated post-traumatic stress disorder symptoms. Study participants provided baseline data and completed daily follow-up assessments for three months.

On days when subjects acknowledged using cannabis, they reported “lowers levels of stress that day … and better sleep quality that night.” By contrast, subjects who consumed greater levels of alcoholic drinks during the day reported “poorer sleep quality that same evening.”

Researchers concluded: “While alcohol use appears to perpetuate a reinforcing cycle of stress and poor sleep, cannabis use may offer short-term stress relief and perceived sleep benefits. … Future research should aim to elucidate the chronic effects of cannabis use on sleep and stress to guide evidence-based recommendations for veterans seeking to manage these issues.”

The study’s conclusions are consistent with those of others, finding that cannabis products reduce levels of anxiety and provide other improvements in patients with post-traumatic stress.

Thirty-nine percent of military veterans say that they “know a veteran” who is using cannabis medicinally, and 75 percent say that they “would be interested in using cannabis or cannabinoid products as a treatment option if it were available.”

Full text of the study, “Daily associations between sleep quality, stress, and cannabis or alcohol use among veterans,” appears in Drug and Alcohol Dependence.

Clinical Trial: Orally Administered Delta-8 THC Possesses Similar But Milder Effects Than Delta-9 THC

Baltimore, MD: Orally ingested delta-8 THC produces dose-dependent psychoactive effects that are similar but milder than those associated with equivalent quantities of delta-9 THC, according to clinical trial data published in the journal Drug and Alcohol Dependence.

Researchers affiliated with Johns Hopkins University assessed the effects of delta-8 THC and delta-9 THC in a cohort of 19 healthy adults. Study participants consumed brownies infused with standardized dosages of either synthetic delta-8 THC or synthetic delta-9 THC. The trial is the first study in over five decades to assess the effects of delta-8 THC in human subjects.

Investigators reported: “Overall, ingestion of delta-8 THC produced dose-dependent increases in subjective, cognitive performance, and physiological outcomes that were qualitatively similar to delta-9 THC. Consistent with prior findings, delta-8 THC exhibited lower potency compared to delta-9 THC at equivalent doses, though this reduced potency was overcome by increasing the delta-8 THC dose. Together, these findings demonstrate that delta-8 THC products have the potential to produce psychoactive and physiological effects that are comparable to delta-9 THC.”

The study’s authors concluded, “With the widespread availability of retail delta-8 THC to consumers as a byproduct of the 2018 Farm Bill, the findings from the present study underscore the importance of establishing regulatory frameworks that address safety, labeling, and consumer education related to delta-8 THC products.”

Although delta-8 THC occurs organically in the cannabis plant, it is only produced in nominal quantities. By contrast, elevated quantities of delta-8 THC in commercially available products are typically the result of a chemical synthesis during which manufacturers convert hemp-derived CBD to delta-8 THC.

NORML and others have urged the FDA to establish regulatory guidelines governing the production, testing, labeling, and marketing of hemp-derived cannabinoid products. In 2021, NORML issued a report on delta-8 THC and other novel, synthetically derived cannabinoids, cautioning consumers that these products are unregulated and may contain impurities.

Full text of the study, “A within-subject cross-over trial comparing the acute effects of oral delta-8 tetrahydrocannabinol and delta-9 tetrahydrocannabinol in healthy adults,” appears in Drug and Alcohol Dependence.

Study: CBD Reduces Chronic Pelvic Pain, Related Symptoms

Ann Arbor, MI: Women suffering from chronic pelvic pain frequently report that CBD mitigates their symptoms.

Researchers affiliated with the University of Michigan surveyed 477 women diagnosed with pelvic pain who also reported current marijuana use.

Eighty-one percent of participants reported reduced pain following their use of CBD products. Many respondents reported improved sleep, reduced anxiety, less depression, less fatigue, and better overall health. A large proportion of those using CBD reported substituting it instead of prescription medications – a finding consistent with prior research.

Prior surveys estimate that some 20 percent of subjects with chronic pelvic pain consume either cannabis or CBD therapeutically, with many reporting that cannabinoids reduce their reliance on prescription opioids.

Full text of the study, “Cannabidiol use and perceptions of effectiveness in women with chronic pelvic pain,” appears in the Journal of Obstetrics and Gynecology Canada.

Florida: Appeals Court Throws Out Cannabis Conviction Because Canines Can’t Distinguish Between Hemp and Marijuana

Tampa, FL: Judges on Florida’s 2nd District Court of Appeals have reversed a marijuana trafficking conviction because the prosecution failed to take adequate steps to distinguish whether the defendant possessed marijuana or hemp.

The defendant had been convicted of marijuana trafficking after he was intercepted at Tampa International Airport with a duffle bag containing 50 vacuum-sealed bags of a “leafy green” substance. A canine had alerted to the duffle bag. Law enforcement later provided one of the 50 bags for a chemical analysis. It tested positive for cannabis.

The defendant appealed his conviction, arguing that he believed the packages contained hemp products, which are legal federally and in Florida. The court agreed, opining that there was no way to determine whether the defendant was carrying hemp or marijuana absent analytical testing of every bag.

It determined: “Legal hemp and illegal cannabis are indistinguishable by appearance, texture, and odor. … Because there is an identifiable danger of misidentification between legal hemp and illegal cannabis, where the contents of multiple packages are to be considered in proving the quantity of illegal cannabis, the state can no longer rely solely on appearance and odor to extend an inference of illegal cannabis to the remaining untested packets and must chemically test each packet of green, leafy substance to meet the threshold weight required for trafficking. To hold otherwise and allow the state to rely on the identification of similar packages of a green, leafy substance by appearance and odor alone would undermine a defendant’s presumption of innocence and erroneously negate the state’s burden to prove the identity and weight of the alleged substance.”

The case is Campbell v. Florida.

Montana: Lawmakers Approve Bills Imposing New Restrictions on Cannabis Edibles, Zero-Tolerant Per Se Limits for Drivers Under 21

Helena, MT: House and Senate lawmakers have sent bills to the Governor mandating new restrictions on edible cannabis products and imposing new penalties for motorists with trace levels of THC in their blood.

House Bill 636 stipulates that a single serving of an edible cannabis product may not exceed 5 milligrams of THC. Under current law, single servings are capped at 10 mgs.

Senate Bill 508 imposes new criminal penalties for motorists under the age of 21 who operate a vehicle with any detectable amounts of THC in their system, regardless of whether they are under the influence. (The measure does not impose penalties for those who test positive solely for inactive cannabis metabolites.) State law already prohibits anyone from operating a motor vehicle with THC levels above 5ng/ml.

Because THC may be present in blood even after several days of abstinence, NORML opposes the imposition of per se THC thresholds for motorists and alternatively calls for the expanded use of mobile performance technology like DRUID to determine whether someone is under the influence.

A bill (Senate Bill 27) extending the moratorium on new marijuana business licenses was also approved by lawmakers. All three bills await action from Republican Gov. Greg Gianforte.

Separate legislation seeking to impose a mandatory registry for cannabis consumers and significantly restricting the potency of adult-use cannabis products failed to make it out of committee.

Montana voters legalized the adult-use marijuana market in 2020.