University of Pennsylvania researchers performed Internet searches for slightly more than a month in 2016 to identify CBD products that displayed contents on their labels and were for sale online. They bought 84 products from 31 companies, blinded their labels, and had their contents tested.

A full 70 percent of the labels turned out to be incorrect. The products either contained more CBD than their labels specified, or less. Thirty percent of the labels were “accurate” within a range of 10 percent.

Of particular concern was that testing detected THC in 18 of the 84 samples, and the amounts of THC in some products were sufficient to cause intoxication or impairment, especially in children.

The publication of this article in JAMA took place just days after the FDA sent warning letters to four major CBD producers asking them to eliminate all medical claims they make for their products. All have been marketing their products with unproven medical claims. They have 15 business days from last week to remove the claims or FDA can seize their merchandise and put them out of business.

Source: Email from National Families In Action http://www.nationalfamilies.org November 2017

Psychologist Robert Margolis, PhD, has spent the past 40 years treating substance abuse disorders in adolescents. He founded and ran Solutions, an after-school alcohol and drug treatment program for young people in Atlanta, Georgia. When he retired recently, he merged Solutions with Caron Treatment Center, a nonprofit organization with treatment facilities in several states.

Dr. Margolis wrote an op-ed for the Atlanta Journal Constitution in 2002 calling for careful, reasoned debate about the legalization of marijuana. Today, he writes that that debate still hasn’t happened. He lays out what science says about the impact of marijuana use on young people and asks if we are prepared to allow next generations to be so drug damaged.
 
Read his essay here.

Source: Email from National Families In Action http://www.nationalfamilies.org November 2017

Researchers from the University of Connecticut Health Center studied data from 1,165 young adults who took part in the Collaborative Study on the Genetics of Alcoholism. People in the alchol study were assessed at age 12 and then every two years over a span of the next 13 to 22 years.

Those who became dependent on both marijuana and alcohol were found to have lower levels of educational achievement, were less likely to be employed full time, less likely to be married, and had lower social and economic potential.

“This study found that chronic marijuana use in adolescence was negatively associated with achieving important developmental milestones in young adulthood. Awareness of marijuana’s potential deleterious effects will be important moving forward given the current move in the U.S. toward marijuana legalization for recreational / medicinal use,” says study author Elizabeth Harari, MD.

She presented her study at the annual meeting of the American Public Health Association being held in Atlanta, Georgia this week.

Read abstract here.

Email from National Families In Action http://www.nationalfamilies.org November 2017

Legalizing opioids may give Americans greater freedom over their decision-making, but at what cost? One painful aspect of the public debates over the opioid-addiction crisis is how much they mirror the arguments that arise from personal addiction crises.

If you’ve ever had a loved one struggle with drugs — in my case, my late brother, Josh — the national exercise in guilt-driven blame-shifting and finger-pointing, combined with flights of sanctimony and ideological righteousness, has a familiar echo. The difference between the public arguing and the personal agonizing is that, at the national level, we can afford our abstractions.

When you have skin in the game, none of the easy answers seem all that easy. For instance, “tough love” sounds great until you contemplate the possible real-world consequences. My father summarized the dilemma well. “Tough love” — i.e., cutting off all support for my brother so he could hit rock bottom and then start over — had the best chance of success. It also had the best chance for failure — i.e., death. There’s also a lot of truth to “just say no,” but once someone has already said “yes,” it’s tantamount to preaching “keep your horses in the barn” long after they’ve left.

But if there’s one seemingly simple answer that has been fully discredited by the opioid crisis, it’s that the solution lies in wholesale drug legalization. In Libertarianism: A Primer, David Boaz argues that “if drugs were produced by reputable firms, and sold in liquor stores, fewer people would die from overdoses and tainted drugs, and fewer people would be the victims of prohibition-related robberies, muggings and drive-by-shootings.”

Maybe. But you know what else would happen if we legalized heroin and opioids? More people would use heroin and opioids. And the more people who use such addictive drugs, the more addicts you get. Think of the opioid crisis as the fruit of partial legalization. In the 1990s, for good reasons and bad, the medical profession, policymakers, and the pharmaceutical industry made it much easier to obtain opioids in order to confront an alleged pain epidemic. Doctors prescribed more opioids, and government subsidies made them more affordable. Because they were prescribed by doctors and came in pill form, the stigma reserved for heroin didn’t exist. When you increase supply, lower costs, and reduce stigma, you increase use.

And guess what? Increased use equals more addicts. A survey by the Washington Post and the Kaiser Family Foundation found that one-third of the people who were prescribed opioids for more than two months became addicted. A Centers for Disease Control study found that a very small number of people exposed to opioids are likely to become addicted after a single use. The overdose crisis is largely driven by the fact that once addicted to legal opioids, people seek out illegal ones — heroin, for example — to fend off the agony of withdrawal once they can’t get, or afford, any more pills. Last year, 64,000 Americans died from overdoses. Some 58,000 Americans died in the Vietnam War.

Experts rightly point out that a large share of opioid addiction stems not from prescribed use but from people selling the drugs secondhand on the black market, or from teenagers stealing them from their parents. That’s important, but it doesn’t help the argument for legalization. Because the point remains: When these drugs become more widely available, more people avail themselves of them. How would stacking heroin or OxyContin next to the Jim Beam lower the availability? Liquor companies advertise — a lot. Would we let, say, Pfizer run ads for their brand of heroin? At least it might cut down on the Viagra commercials. I think it’s probably true that legalization would reduce crime, insofar as some violent illegal drug dealers would be driven out of the business.

 I’m less sure that legalization would curtail crimes committed by addicts in order to feed their habits. As a rule, addiction is not conducive to sustained gainful employment, and addicts are just as capable of stealing and prostitution to pay for legal drugs as illegal ones. The fundamental assumption behind legalization is that people are rational actors and can make their own decisions. As a general proposition, I believe that. But what people forget is that drug addiction makes people irrational. If you think more addicts are worth it in the name of freedom, fine. Just be prepared to accept that the costs of such freedom are felt very close to home.

 Source: http://www.nationalreview.com/article/453304/opioid-crisis-legalization-not-solution November 2017

The costs of using hard drugs are worse and more horrific than the costs of prohibition. There are times in life when ideas are overtaken by events, when the hard experience of reality meets and overcomes the hopefulness of ideas. Now is just such a time. As the opioid crisis takes lives on a historic scale, it’s time to kill a bad idea. Just say no to legalizing hard drugs.

To be sure, there’s not a large constituency in support of legalizing any drugs other than marijuana, but their legalization, including that of narcotics, has been a topic of lively intellectual debate ever since the war on drugs truly took off. The editors of National Review have long supported legalization, libertarians have argued vociferously for legalization for decades, and a number of influential thinkers on the left and the right have joined in agreement on this one issue.

Outside of college dorms, the argument for legalization, in general, isn’t that drugs should be legalized because they’re fun and people can be trusted to use them responsibly. Rather, it’s that the costs of the war on drugs — in lives lost, lives squandered in prison, and civil liberties curtailed — outweigh the probable harm of legalization. Here are the editors of National Review in 1996: “It is our judgment that the war on drugs has failed, that it is diverting intelligent energy away from how to deal with the problem of addiction, that it is wasting our resources, and that it is encouraging civil, judicial, and penal procedures associated with police states.”

Intelligent supporters of legalization know that drug use would increase, but would it increase so much as to overtake the cost of homicide, robbery, and incarceration? Well, after years of experimenting with opioid prescriptions so promiscuous that they functioned as a form of quasi-legalization, the answer appears to be yes. The costs of drug use are worse and more horrific than the costs of prohibition.

OxyContin. Opioid prescriptions skyrocketed and addiction rates increased, and as addiction increased, so did overdoses. To be clear: Not all these new addicts were the actual patients. Simply put, families and communities were suddenly awash in narcotics, with extraordinarily potent drugs filling medicine cabinets from coast to coast. I distinctly remember the change. I remember my confusion when an emergency-room nurse asked me to measure my pain on a scale from 1 to 10 after a friend scraped my eyeball in a pickup basketball game. It all seemed so subjective. Since I’d never experienced ultimate agony, how could I measure? I said “seven” and got a bottle of Vicodin. In reality, I probably could have managed with a shot of bourbon and a few Advil. Later that same year, I asked my secretary at my law firm if she had some Tylenol to help a stress headache. Her response? “No, but I have some Percocet.”

 As Robert VerBruggen notes in his own piece rethinking drug libertarianism, it seems that most addicts don’t actually get their pain pills from a doctor. Why bother? The drugs were simply everywhere, with enough pill bottles prescribed to provide one to every American, many times over. And once addiction took hold, greater restrictions on prescriptions meant that addicts just switched to a cheaper and deadlier drug, heroin. The numbers are startling.   And now, as virtually every American knows, we face a national crisis.

In 2016 drug-overdose deaths increased 11 percent over 2015’s already-high number. A stunning 52,404 Americans lost their lives. To compare, that’s almost 15,000 more than died in car crashes and roughly 16,000 more than died to guns, including homicides and suicides. In fact, that number probably undercounts the toll from drug abuse, since doubtless some number of suicides represented addicts who’d hit rock bottom and saw no way out but through the barrel of a gun or the bottom of the pill bottle. In other words, opioids are monstrous inventions that overpower the human will on a mass scale. There are no “rational actors” among addicts, and the substances are extraordinarily addictive. Do you know an opioid addict? Then you’ve seen them slide slowly away from reality. The formula is simple — flood the market with pills, and you’ll flood the country with addicts.

A number of smart (no, brilliant) people thought that the costs of enforcement outweighed the costs of legalization. That may well be true of marijuana, but can we make that argument any longer with opioids? If people have access to pills, they tend to take pills, and an uncomfortably large proportion of them get so hooked on them that if you take them away, they move to even harder and more powerful drugs. A horrifying percentage overdose and die. That’s not to say that fighting the war on drugs means winning the war on drugs. It may mean that we do nothing more than contain the problem, preventing it from spiralling out of control even further. And, as Lopez notes in Vox, arguing against legalization isn’t the same thing as arguing against reform, including reforming the way in which the criminal-justice system deals with drug offenders.

There is much room for creativity and thoughtfulness in dealing with the crisis. I see no room for broader availability and greater ease of access. Last year I sat next to a man on a plane who lost his daughter to a combination of Xanax and Lortab. She’d taken both drugs for years, to deal with anxiety and chronic pain. As he told the story, every year she grew more tolerant. Every year she had to take more to achieve the same effect. One terrible and stressful night, she took an extra dose to force herself to sleep. She never woke up. If we legalize hard drugs, there will be more stories like that — many more. Opioids make slaves of men. There is no choice but to continue the fight.

Source:  http://www.nationalreview.com/article/447190/opioid-crisis-legalization-drugs-marijuana-narcotics-pain-killers April 2017

Abstract:

Purpose: This study aims to assess potential health care costs and adverse health effects related to cannabis use in an acute care community hospital in Colorado, comparing study findings to those medical diagnoses noted in the literature. Little information is available about specific hospital health care costs, thus this study will add to the knowledge gap and describe charges and collections from visits of these patients in one hospital’s Emergency Department (ED).

Objective: Review diagnoses of cannabis users visiting a local ED and outline the potential financial and health effects of these patients on the health care system.

Design: An Institutional Review Board (IRB) approved retrospective observational study of patients seen in the ED from 2009 to 2014 with cannabis diagnoses and positive urine drug analyses (UDA) matched with hospital billing records. Randomized patient records were reviewed to determine completeness of documentation and coding related to cannabis use.

Setting: An acute care hospital in one city in Colorado. The city has nearly 100 medical marijuana dispensaries, but has not legalized recreational cannabis use. The city decided to not allow recreational stores in city limits as they were allowed to make that determination as a result of Amendment 64, which allowed municipalities to determine if they wanted recreational marijuana in their town. As of this publication, more than 70% of Colorado’s municipalities have opted out of recreation marijuana sales.

Participants: Subjects seen through the ED who had both a diagnosis code listing cannabis and a positive UDA for cannabis. Exclusions were subjects with UDA for cannabis but also tested positive for other substances, subjects who had cannabis diagnosis but no UDA result or those who had no UDA but did have a cannabis diagnosis.

Conclusion: Subjects seen in the ED had similar diagnoses as those reviewed in the literature, confirming the serious side effects of marijuana use. During the study period, the study hospital incurred a true loss of twenty million dollars in uncollected charges after allowing for contractual obligations. While adverse health effects have been described in the literature, there is little data on the financial impact of marijuana use on the health care system. This study demonstrated an increasing number of patients who are seen in the ED also have used cannabis. These patients are not always able to pay their bills, resulting in a financial loss to the hospital. The authors encourage the collection of hospital financial data for analysis in the states where medicinal (MMJ) and/or recreational marijuana is legal

https://www.researchgate.net/publication/314140400_The_Hidden_Costs_of_Marijuana_Use_in_Colorado_One_Emergency_Department’s_Experience

Kenneth Finn, MD,

The problem of increased marijuana use has origin in its purported use for pain, but the medical literature is completely void of evidence for the treatment.

Pain is the most common diagnosis associated with marijuana being recommended for medical use. With more states moving towards accepting marijuana use for medical purposes, there is a call from the
medical and scientific community for more research and evidence that it actually works for common pain conditions.

Out of the top 20 medical diagnoses presenting to the primary care physician nationally, there are only three that are associated with a painful condition:
spinal disorders (i.e., lower back pain), arthropathies and related disorders (i.e., knee arthritis), and abdominal pain.

There were no other pain diagnoses in the top 20 diagnoses that present to the primary care physician for treatment, including cancer pain or neuropathic pain. What does the medical literature tell us about the
use of marijuana for pain? In 2011, The British Journal of Pharmacology released a paper looking at the use for cannabinoids for the treatment of chronic non-cancer pain.

They narrowed a broad literature review to only 18 trials with a total of 925 participants. Most of the trials studied neuropathic pain (72%), including HIV neuropathy and multiple sclerosis related neuropathy (three trials), with single studies looking at arthritis and chronic spinal pain.

There were four studies that looked at smoked cannabis and neuropathic pain only. Six studies evaluated synthetic cannabinoids (Dronabinol, Nabilione) for pain (offlabel use).
From these trials, the average number of patients was 49 with average duration of 22 days, some of which were one week long. Despite their conclusion that cannabinoids may help for chronic non-cancer pain, they noted study limitations of small sample size, modest effects, and the need for larger trials of longer duration to determine safety and efficacy.

In 2015, the Journal of the American Medical Association (JAMA) released an article on cannabinoids for medical use.4 Chronic pain was assessed in 28 studies, involving 63 reports and 2,454 participants. Thirteen studies evaluated nabiximols (not available in the United States), four smoked THC, six synthetic THC, three oromucosal spray, one oral THC, and one vaporized cannabis. The majority of studies looked at some form of neuropathic pain or cancer pain. Two studies were at low risk of bias, nine at unclear risk, and 17 at high risk. Studies generally suggested improvements in pain measures associated with cannabinoids but did not reach statistical significance in most individual studies.

Despite these difficulties, the authors concluded there was moderate-quality evidence to suggest that cannabinoids may be beneficial for the treatment of chronic neuropathic or cancer pain (smoked THC and nabiximols). Note these are less common pain conditions presentimg to the physician for treatment nationally. The authors noted an increased risk of short-term adverse effects with cannabinoid use, including some serious adverse effects. Common adverse effects included asthenia, balance problems, confusion, dizziness, disorientation, diarrhea, euphoria, drowsiness, dry mouth, fatigue, hallucination, nausea, somnolence, and vomiting.

In 2017, the National Academies of Science, Engineering, and Medicine released a paper on the health effects of cannabis and cannabinoids. It may be important to note that none of the authors had a background in Anesthesia or Pain Medicine. The authors felt the referenced JAMA article was the most comprehensive and that the medical condition most often associated with chronic pain in that article was neuropathy, and a majority of studies evaluated treatment with nabiximols, which are not available in the United States. The committee found that only a handful of studies evaluated the use of cannabis and that many of the cannabis products sold in state regulated markets bear little resemblance to the products available for research at the federal level in the United States. They also note that very little is known regarding efficacy, dose, routes of administration, or side effects of commonly used and commercially available products in the U.S. Despite this, they concluded that “cannabis is an effective treatment for chronic pain in adults.” The above noted papers demonstrate the limited data available to the public and medical community, and represent the only information available regarding treatment of pain with marijuana. Despite that, the public has embraced that marijuana can treat all pain conditions, and state governments have followed suit, without scientific evidence, and have allowed an industry to prosper on the thin ice of what is currently and scientifically available.

It is important to understand that pain covers a broad spectrum of disorders and pain of different origins does not necessarily respond the same to different medications. Additionally, dispensary cannabis is considered a generic substance without defined or accepted dosing guidelines, and will vary in purity as well as potency. It may also contain hundreds of other compounds, some of which may have physiologic activity. Cannabinoids are purified components of the plant which have been isolated in a laboratory and have more scientific foundation, but are currently not available for study or use in pain conditions in the U.S.

Since de facto legalization in Colorado in 2009, there has been a significant increase in public health and safety concerns, which include utilization of the health care system, an increase in adolescent substance use treatment for cannabis, and an increase in marijuana-related driving fatalities. The addiction rates are reportedly 9% in the adult and roughly 18% in the adolescent, which was based on the potency of marijuana from nearly 20 years ago. The potency has significantly increased in the past five years alone, so we are now in uncharted waters and unable to predict the long term effects or addiction rates of currently available, highly potent products, with variable delivery systems.

As the number of medical marijuana patients increased in Colorado, there appeared to be a parallel increase in the number of adolescents needing substance use treatment, most often for cannabis. Colorado is now contending with a huge opioid and heroin epidemic, and despite the widespread availability of Narcan, does not appear to have leveled off or curbed the number of opioid or heroin deaths in the state which continue to rise.

Although the concept of using marijuana to decrease opioid use is attractive, there is little data to suggest that may be the case. According to the Centers for Disease Control, the number of drug overdose deaths in Colorado has continued to increase, ahead of the national average. The above problems are now falling into the laps of other groups including law enforcement and mental health providers who are pushing back and straining their respective resources.

In summary, the problem of increased marijuana use has origin in its purported use for pain, but the medical literature is completely void of evidence for the treatment of common pain conditions with cannabinoids or cannabis. Current medical literature suggests benefit in less common pain conditions, with products not commercially available in the U.S., or with synthetic THC, not with dispensary cannabis. The variability of available products changes regularly and their use in medicine, particularly pain, is unproven. The end game is in the court of law enforcement, mental health providers, the medical community, and our educational systems, at unknown societal costs, which are only now becoming apparent.

Source: http://www.omagdigital.com/publication/?i=450168#{%22issue_id%22:450168,%22page%22:8} September/October 2017

U.S. marijuana growers’ and processors’ greatest fear has just been realized. One of the largest international producers and marketers of beer, wine, and spirits, Constellation Brands, has bought a 9.9 percent stake in a Canadian marijuana grower, Canopy Growth Corporation. The two companies plan to develop a line of marijuana-infused drinks to sell in Canada, expected to legalize the drug for recreational use in 2018

US marijuana growers and processors have long feared that mega corporations like those that make up the alcohol and tobacco industries would swoop in and put them out of business if pot is legalized nationwide. They just didn’t think it would happen in Canada first.
 
Business analysts say this is a smart move on the part of Constellation Brands, given now-Prime Minister Justin Trudeau’s campaign promise to legalize the drug if elected.
 
Whether parents, public health officials, scientists, and doctors agree is another matter. Marijuana beverages being marketed by an alcoholic beverages company with Constellation Brand’s clout is hardly likely to reduce auto traffic injuries and deaths.
 
Read story here and here.

Source: Email from National Families in Action http://nationalfamilies.org November 2017

MOUNT SHASTA, Siskiyou County (KPIX 5) — It’s happening in the shadow of Mount Shasta — hundreds of marijuana gardens pockmarking the landscape in neighborhoods that have little in the way of housing.

For law enforcement officials in Siskiyou County, it’s a state of emergency.

“This is a monumental effort but, then again, we’ve got a monumental problem,” says Sheriff Jon E. Lopey.

What’s unfolding in this county is a race between growers and the law to see who can get to the countless grow gardens first.

“We’re in harvest season. We’re really putting a lot of resources into it and a lot of personnel, trying to take out as much as we can before it gets harvested and goes off back east or wherever it’s going,” said Siskiyou County Sheriff’s Deputy Mike Gilley.

You can see the enormous extent of the grow gardens from space. Fire up Google Earth and you can count grow after grow dotting the high desert landscape like an outbreak of measles.

“I have a one-mile-square photograph and you can pick out 80 gardens in that one square mile,” said Sgt. Gilley.

All of this is happening in a county that is decidedly not part of the “Emerald Triangle.” In fact, elected officials and voters have passed laws aimed at keeping marijuana out of Siskiyou County.

“Our county does not allow outdoor cultivation of cannabis,” asserts Sheriff Lopey.

Siskiyou County has some of the cheapest — as well as most scenic — land you can find in California. You can purchase nearly three acres for about $16,000. That brings in people who see an opportunity. The sheriff thinks those people represent a nationwide problem.

“I think … that this is an organized-crime effort. (They) basically take over large geographic areas to grow illegal marijuana. That’s basically what it amounts to,” Lopey said.

Source: https://sanfrancisco.cbslocal.com/2017/10/27/marijuana-illegal-grow-mount-shasta-siskiyou-county/(contains video report)  October 2017

MEDICINAL cannabis is no better than conventional drugs for treating children with severe epilepsy, according to a top Victorian doctor.

After months of treatment, none of the 29 Victorian children accessing $1 million worth of medicinal cannabis product, imported from Canada, has been seizure free.

FIRST COMMERCIAL CANNABIS CROP TO HELP VICTORIAN CHILDREN

UNIVERSITY OF MELBOURNE GETS $500K FROM TURNBULL GOVERNMENT FOR RESEARCH INTO MEDICINAL CANNABIS PLANTS

Paediatric neurologist Professor Ingrid Scheffer told the Sunday Herald Sun medicinal cannabis had been effective in some of the cases by reducing fits among some of the group.

However, the results had been similar to outcomes achieved on other pharmaceutical drugs and it was not the miracle solution families were hoping for

Families hear the news kids who need cannabis to help with chronic illness will gain access. Picture: Jason Edwards

“Initially we all had a sense of hope but that didn’t last but that is the nature of these diseases,” Prof Scheffer said.

For more http://www.heraldsun.com.au/news/victoria/medicinal-cannabis-not-miracle-epilepsy-drug-says-professor-treating-victorian-children/news-story/9107a6249aec2e59a7c0a49f6c8b0b71 October 2017