Cannabis/Marijuana

Irish teenagers whose friends use cannabis are 10 times more likely to consume the drug themselves, according to the findings of new research.

The study by researchers found that 7.3 per cent of students aged 15-16 had used cannabis within the previous 30 days with no significant difference in use of the drug between males and females.

It also highlighted how teenagers who felt it was necessary to use cannabis to fit in with their friends were almost twice as likely to use the drug compared to those who did not feel peer pressure to use cannabis.

Teenagers who believed their parents would be ambivalent towards their use of cannabis were also almost four times more likely to be current users of the drug than those students who thought their parents were strongly against cannabis use.

The findings are based on the responses by over 4,400 students in fourth and fifth year to a questionnaire issued as part of the Planet Youth survey carried out in late 2021.

The respondents were based across 40 schools in north Dublin, Cavan and Monaghan.

The study highlighted how current cannabis users among such an age group were significantly more likely to also be consuming alcohol, smoking or vaping.

It also reveals that low parental supervision was significantly associated with higher odds of current cannabis use.

The authors of the study, whose findings are published in the Irish Journal of Psychological Medicine, said its rationale was to examine individual, familial, peer, school and community factors associated with cannabis use by adolescents in Ireland in order to provide measures for prevention and early intervention.

They claimed several of the risk factors identified by the research have the potential to be modified through drug prevention strategies.

The researchers noted that earlier studies had found that long-term use of cannabis has the potential to lead to addiction with one in three regular adolescent users becoming addicted to the drug, while also having the potential to exacerbate mental health issues such as psychosis.

The study observed that cannabis-related psychiatric admissions for people aged 15-34 in the Republic rose by 140 per cent between 2011 and 2017 and have remained at the same elevated level ever since.

Despite the evidence of increased health risks associated with cannabis use, the study said adolescents continue to use cannabis for a number of various factors including boredom relief, appetite increase, sleep improvements and increased social opportunities.

Other factors can include low self-esteem and insecurity or family problems.

Asked to assess their own mental health, almost three-quarters of the teenagers (72.4 per cent) who do not use cannabis said it was good or OK compared to 54.6 per cent among cannabis users.

In contrast, 45.0 per cent of cannabis users assessed their mental health as bad or very bad compared to 27.1 per cent of those who do not use the drug.

Similarly, only 16.6 per cent of cannabis users perceived the drug to be harmful, while 67.2 per cent of non-users surveyed believed it could have a negative impact on their health.

Among cannabis users, 90.4 per cent reported that their friends also use the drug compared to 29.3 per cent of students who do not use it.

One of the report’s main authors, Teresa O’Dowd, said they believed it was the first study in an Irish setting which found no significant difference in cannabis use between males and females.

Dr O’Dowd, a specialist in public health medicine with HSE North West, said the lack of association between gender and cannabis use was a notable finding as historically male gender had been noted as a risk factor for use of the drug.

She said the finding that the odds of cannabis use were higher for those who also consume alcohol, smoke and use e-cigarettes was in keeping with other research.

“The fact that adolescents are likely to engage in polysubstance use is significant and needs to be factored into any interventions targeting cannabis prevention among adolescents in Ireland,” said Dr O’Dowd.

The study also claimed there has been a cultural shift both nationally and internationally over the past decade towards legalising cannabis.

Dr O’Dowd said it had led to an attitude among many adolescents and adults that cannabis is a relatively harmless drug.

“This shift in perception regarding cannabis-related harm may impact Irish adolescents’ decision to use cannabis, as suggested by our findings,” she added.

The authors of the study said its findings had demonstrated the importance of parental attitudes to cannabis and claimed many factors including parental supervision and perception that parents are against cannabis use were “modifiable.”

They called for the public health community and policymakers to act to ensure greater awareness of cannabis harms among both teenagers and their parents.

“A tailored public health messaging campaign addressing the known harms and complications of cannabis use in young people, is urgently required,” they added.

Source: https://www.breakingnews.ie/ireland/irish-teens-whose-friends-use-cannabis-10-times-more-likely-to-consume-the-drug-themselves-1714776.html

SAM Drug Report’s Friday Fact report – 11:31 Friday 10th Jan 2025

A study that was published last week in Addictive Behaviors found that alcohol and tobacco are more likely to be used on days when marijuana is used.

The study found that individuals consumed an average of 0.45 more alcoholic drinks on days when marijuana was used, compared to days when marijuana was not used. Similarly, the study found that individuals smoked an average of 0.63 more cigarettes on days when marijuana was used. Both of these findings were statistically significant (p=0.01).

Seeking to explain these findings, the researchers posited that “the impact of cannabis use on the endocannabinoid system may reinforce the use of alcohol and tobacco through mechanisms related to psychological reward.” They added that “bidirectionality must be considered,” given that the use of one substance may influence the effect of an additional substance––it may enhance a high, for example.

The researchers noted that “the observed within-person positive associations between cannabis use and same-day alcohol consumption and cigarettes smoked are consistent with previous research that has shown a tendency for substance use behaviors to co-occur.”

Indeed, cross-tabs from the 2023 National Survey on Drug Use and Health found that those who used marijuana in the past 30 days were three times as likely to have smoked cigarettes in the past 30 days (30.8% vs. 10.4%) and 63% more likely to have used alcohol in the past 30 days (70.7% vs. 43.4%), compared to those who did not use marijuana in the past 30 days.

Source: SAM Drug Report’s Friday Fact report – 11:31 Friday 10th Jan 2025 – The Drug Report’s

 

 

Smart Approaches to Marijuana (SAM) is an alliance of organizations and individuals dedicated to a health-first approach to marijuana policy. We are professionals working in mental health and public health. We are bipartisan. We are medical doctors, lawmakers, treatment providers, preventionists, teachers, law enforcement officers and others who seek a middle road between incarceration and legalization. Our commonsense, third-way approach to marijuana policy is based on reputable science and sound principles of public health and safety.

People smoke the stuff perfectly openly, without fear, with the threatened £90 fine seemingly a remote possibility.                                                                                                                           

by Zoe Strimpel – The Telegraph London author – 14 December 2024 4:09pm GMT

Sir Elton John Credit: Ben Gibson

Zoe Strimpel writes: I was about 23 and was still finding my feet socially in London. I’d always really been a champagne girl at heart but cannabis smoking was common in some of the circles I spent time in. It seemed so tacky and boring, the province of the sorts of bores one met while “travelling”, so I usually said no.

But one night in a run-down flat somewhere in north London, I went along with everyone else. Not long afterwards my heart began to pound like never before and a wave of horrible panic crashed over me, like I was trapped in a physiological nightmare and might die.

This was combined with a much more familiar sense of self-recrimination: why had I got myself into this? It wasn’t tempting in the first place and it could never have been worth it. And now I was paying the price – and so was the friend, now more like a sister to me, who had to tend to me in my tearful panic.

Since then, the pressure to imbibe cannabis has only grown and spread, from tatty student settings to (upper)-middle class and middle-aged environs.

Those who prefer to avoid the smoke element can still mainline the active ingredient – THC – by choosing from a wide range of edibles, which are generally like jelly babies. These make you (me) feel just as dreadful as the smoke sort, though mercifully without the stink.

All of which is why I am in full agreement with Elton John who, as Time magazine’s “icon of the year”, has lambasted the legalisation of pot in North America as “one of the greatest mistakes of all time”.

Sir Elton, himself an addict until he got sober 34 years ago, pointed out that: “It leads to other drugs. And when you’re stoned – and I’ve been stoned – you don’t think normally.”

This is a statement of blinding obviousness, and yet in our strange society it sounds reactionary, refreshing, courageous. How is it that a drug known – outside of carefully managed medical settings where it can help with pain and sleep – to trigger psychosis and turn people into paranoiacs and dullards, and, when smoked, to cause damage to the lungs and body, came to be considered safe by North American lawmakers?

To be seen as so perfectly respectable, fine and dandy that states explicitly give their blessing to recreational use of it? And this in an America that doesn’t let people drink until they are 21 or even touch containers of alcohol till that age, or in public.

In the UK, it is not legal and classed as a class B drug. But that does not mean that ‘it is not ubiquitous’.

This is depressing. I’m all for the exploration and titration of psychoactive drugs to help people in desperate need of pain relief. I am interested in, though not yet convinced by, use of mushrooms (psilocybin) and ecstasy (MDMA) in treating depression.

But the general prevalence of cannabis is a much drearier, bigger, more worrying issue, connected to a general sense of inconsistency and disconnected logic among law-makers and enforcers on one hand, and a sense that all we want to do is bury ourselves in escapist hedonism that alters our minds and our worlds so as to reduce the stress associated with, for instance, responsibility, reality and work.

Labour has indicated that it does not wish to legalise cannabis. But it seems happy, as do the police, with the fact that nobody cares about its technical illegality. People smoke the stuff perfectly openly, without fear, with the threatened £90 fine seemingly a remote possibility. Children therefore have to inhale it in parks. It is a gateway drug for hard drugs and criminality, and forms a familiar backdrop for the insouciant menace of gangs.

But according 2023 figures from the ONS, cannabis was by far the most-commonly used recreational drug in the UK, with 7.4 per cent of adults aged 16 to 59 saying they had consumed it in the last year.

The counter-currents in state attitudes to recreational drugs are just weird. Why does the state look benignly on the smoking of this illegal substance, and fail to promote information about the dangers of inhaling it via smoke (and edibles), but noisily pursue the outlawing of cigarette smoking for those born after a certain date?

Fags are toxic and cancer-causing, and nobody should have to regularly breathe second-hand smoke. But so long as the harm of smoking (the tar in tobacco) is limited to the smoker, and those who voluntarily inhale their smoke, the wider mental effects are not disturbing.

Nicotine alone doesn’t tend to ‘alter personality beyond recognition’ or induce fits of paranoia, depression, criminality or addiction to other substances.

And let’s face it: a waft of cigarette smoke is quite pleasant. Cigarettes retain a kind of aesthetic glamour; their use is not at odds with beauty, comfort, decadence and good conversation. Pot-smokers, instead, give off a polluting stink that lowers the tone of whatever environment one is in, makes conversation a thousand times more inane, and seems to celebrate the urge to do less, or nothing, smugly. Cannabis is deadening, however it is consumed.

Even among those who work hard and have children, cannabis rules, becoming a fixation without which no relaxation is possible, whipped out as soon as the working day ends or the children are asleep. Perhaps what we need is to find other ways to relax, like reading a good book. Or, of course, to stop chasing relaxation and indolence at all costs, full stop.

SOURCE: https://www.telegraph.co.uk/news/2024/12/14/elton-john-is-right-cannabis-deadening-to-soul/

COMMENT BY NATIONAL DRUG PREVENTION ALLIANCE ON THE ARTICLE BY DREXEL – 15 DECEMBER 2024:

 NDPA has significant reservations about his article. Drexel (a ‘private university’ in Philadelphia) are asserting that all drug use is stigmatised ,and that such stigmatisation as they observe should be negated. But other specialists in the field counter by giving comments on stigma/human behaviour etc, as follows:

  • There is no doubt that language which stigmatises a situation or a person is something to be avoided, and there should be an un-stigmatised opening for people to access healthful interventions, but
  • Drug use and addiction is a ‘chicken and egg’ situation, and
  • Writers like this one start half way through the situation, when a person has made a decision to stop being a ‘drug-free’ person; they are already moving down a path which can lead to consequences which were not what they wanted when deciding to use, so
  • They are already a user, and what one might call the ‘pre-addictive’ stage is ignored. Addicted users are portrayed as no less or more than victims, seduced by profiteering suppliers, which
  • Circumvents the initial chapter in the story i.e. the stage in which a person decides to use a substance which
  • In retrospect ca be seen as a bad decision, which should be the target of productive prevention. This is
  • ‘pre the event’ – the heart of the word ‘prevention’ which in its Latin-base (‘praevenire’) means ‘to come before’ – not to come ‘during’!

Take the following paragraph in this paper:

“Awareness of stigma as an impediment to treatment has grown in the last two decades. In the wake of America’s opioid epidemic — when strategic, deceitful marketing, promotion and overprescription of addictive painkillers resulted in millions of individuals unwittingly becoming addicted — the general public began to recognize addiction as a disease to be treated, rather than a moral failure to be punished — as it was often portrayed during the “War on Drugs” in the 1970s and ‘80s”.

Whilst we can harmonise with the authors of this paper in seeking to remove ‘stigma as an impediment to treatment’, we part company with them when they classify all addicts as ‘unwitting victims of deceitful marketing and promotion’. The simple fact is that they made a bad decision, for whatever reason … in some cases suckered, yes, or in other cases not looking down that road and its consequences on themselves and others around them (‘short termism’) – this was not a ‘moral  wrong’, it was what it was.

Prevention should therefore assist people to make healthful decisions – the kind of decision which countless former users make for themselves, thereby moving themselves off the ‘pre-addictive’ road onto a healthful one.

This paper does not include this wider picture, and is the less for that.

<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<NDPA>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>

DREXEL PRIVATE UNIVERSITY TEXT:

December 11, 2024

Researchers from Drexel’s College of Computing & Informatics have created large language model program that can help people avoid using language online that creates stigma around substance use disorder.

Drug addiction has been one of America’s growing public health concerns for decades. Despite the development of effective treatments and support resources, few people who are suffering from a substance use disorder seek help. Reluctance to seek help has been attributed to the stigma often attached to the condition. So, in an effort to address this problem, researchers at Drexel University are raising awareness of the stigmatizing language present in online forums and they have created an artificial intelligence tool to help educate users and offer alternative language.

Presented at the recent Conference on Empirical Methods in Natural Language Processing (EMNLP), the tool uses large language models (LLMs), such as GPT-4 and Llama to identify stigmatizing language and suggest alternative wording — the way spelling and grammar checking programs flag typos.

“Stigmatized language is so engrained that people often don’t even know they’re doing it,” said Shadi Rezapour, PhD, an assistant professor in the College of Computing & Informatics who leads Drexel’s Social NLP Lab, and the research that developed the tool. “Words that attack the person, rather than the disease of addiction, only serve to further isolate individuals who are suffering — making it difficult for them to come to grips with the affliction and seek the help they need. Addressing stigmatizing language in online communities is a key first step to educating the public and reducing its use.”

According to the Substance Abuse and Mental Health Services Administration, only 7% of people living with substance use disorder receive any form of treatment, despite tens of billions of dollars being allocated to support treatment and recovery programs. Studies show that people who felt they needed treatment did not seek it for fear of being stigmatized.

“Framing addiction as a weakness or failure is neither accurate nor helpful as our society attempts to address this public health crisis,” Rezapour said. “People who have fallen victim in America suffer both from their addiction, as well as a social stigma that has formed around it. As a result, few people seek help, despite significant resources being committed to addiction recovery in recent decades.”

Awareness of stigma as an impediment to treatment has grown in the last two decades. In the wake of America’s opioid epidemic — when strategic, deceitful marketing, promotion and overprescription of addictive painkillers resulted in millions of individuals unwittingly becoming addicted — the general public began to recognize addiction as a disease to be treated, rather than a moral failure to be punished — as it was often portrayed during the “War on Drugs” in the 1970s and ‘80s.

But according to a study by the Centers for Disease Control and Prevention, while stigmatizing language in traditional media has decreased over time, its use on social media platforms has increased. The Drexel researchers suggest that encountering such language in an online forum can be particularly harmful because people often turn to these communities to seek comfort and support.

“Despite the potential for support, the digital space can mirror and magnify the very societal stigmas it has the power to dismantle, affecting individuals’ mental health and recovery process adversely,” Rezapour said. “Our objective was to develop a framework that could help to preserve these supportive spaces.”

By harnessing the power of LLMs — the machine learning systems that power chatbots, spelling and grammar checkers, and word suggestion tools— the researchers developed a framework that could potentially help digital forum users become more aware of how their word choices might affect fellow community members suffering from substance use disorder.

To do it, they first set out to understand the forms that stigmatizing language takes on digital forums. The team used manually annotated posts to evaluate an LLM’s ability to detect and revise problematic language patterns in online discussions about substance abuse.

Once it has able to classify language to a high degree of accuracy, they employed it on more than 1.2 million posts from four popular Reddit forums. The model identified more than 3,000 posts with some form of stigmatizing language toward people with substance use disorder.

Using this dataset as a guide, the team prepared its GPT-4 LLM to become an agent of change. Incorporating non-stigmatizing language guidance from the National Institute on Drug Abuse, the researchers prompt-engineered the model to offer a non-stigmatizing alternative whenever it encountered stigmatizing language in a post. Suggestions focused on using sympathetic narratives, removing blame and highlighting structural barriers to treatment.

The programs ultimately produced more than 1,600 de-stigmatized phrases, each paired as an alternative to a type of stigmatizing language.

 

destigmatized text

 

Using a combination of human reviewers and natural language processing programs, the team evaluated the model on the overall quality of the responses, extended de-stigmatization, and fidelity to the original post.

“Fidelity to the original post is very important,” said Layla Bouzoubaa, a doctoral student in the College of Computing & Informatics who was a lead author of the research. “The last thing we want to do is remove agency from any user or censor their authentic voice. What we envision for this pipeline is that if it were integrated onto a social media platform, for example, it will merely offer an alternate way to phrase their text if their text contains stigmatizing language towards people who use drugs. The user can choose to accept this or not. Kind of like a Grammarly for bad language.”

Bouzoubaa also noted the importance of providing clear, transparent explanations of why the suggestions were offered and strong privacy protections of user data when it comes to widespread adoption of the program.

To promote transparency in the process, as well as helping to educate users, the team took the step of incorporating an explanation layer in the model so that when it identified an instance of stigmatizing language it would automatically provide a detailed explanation for its classification, based on the four elements of stigma identified in the initial analysis of Reddit posts.

“We believe this automated feedback may feel less judgmental or confrontational than direct human feedback, potentially making users more receptive to the suggested changes,” Bouzoubaa said.

This effort is the most recent addition to the group’s foundational work examining how people share personal stories online about experiences with drugs and the communities that have formed around these conversations on Reddit.

“To our knowledge, there has not been any research on addressing or countering the language people use (computationally) that can make people in a vulnerable population feel stigmatized against,” Bouzoubaa said. “I think this is the biggest advantage of LLM technology and the benefit of our work. The idea behind this work is not overly complex; however, we are using LLMs as a tool to reach lengths that we could never achieve before on a problem that is also very challenging and that is where the novelty and strength of our work lies.”

In addition to making public the programs, the dataset of posts with stigmatizing language, as well as the de-stigmatized alternatives, the researchers plan to continue their work by studying how stigma is perceived and felt in the lived experiences of people with substance use disorders.

 

 

In addition to Rezapour and Bouzoubaa, Elham Aghakhani contributed to this research.

Read the full paper here: https://aclanthology.org/2024.emnlp-main.516/

This is an RTE component

Source: https://drexel.edu/news/archive/2024/December/LLM-substance-use-disorder-stigmatizing-language

Source : https://marijuanahealthreport.colorado.gov/literature-review/evidence-statements May 2018

EXECUTIVE HIGHLIGHTS
Today’s highly potent marijuana represents a growing and significant threat to public health and safety, a threat that is amplified by a new
marijuana industry intent on profiting from heavy use.
State laws allowing marijuana sales and consumption have permitted the marijuana industry to flourish, and in turn, the marijuana industry has influenced both policies and policy-makers. While the consequences of these policies will not be known for decades, early indicators are
troubling.
This report, reviewed by prominent scientists and researchers, serves as an evidence-based guide to what we currently observe in various states. We attempted to highlight studies from all the “legal” marijuana states (i.e., states that have legalized the non-medical use of marijuana). Unfortunately, data does not exist for several “legal” states, and so this document synthesizes the latest research on marijuana impacts in states where information is available

For more information please read the full information below:

2019LessonsFinal

Source: https://learnaboutsam.org/wp-content/uploads/2019/07/2019LessonsFinal.pdf July 2019

 JooHee Yoon for Vox

Land of the free, home of the blazed.

How weed became America’s drug of choice | Vox

VOX Writer:  Marin Cogan         Dec 3, 2024

In the last few decades, marijuana’s had a major glow-up.

In 1992, less than 1 million people were using it daily or nearly every day — a low point, according to an analysis of data from the US National Survey on Drug Use and Health, which began surveying Americans in the 1970s. Ten times as many people, meanwhile, reported drinking alcohol daily or almost daily.

In the 1990s, weed was illegal nationally and in every state. But marijuana’s since had a major rebrand: Three decades later, it’s legal for recreational adult use in nearly half of the 50 states. Now, it’s even challenging alcohol for its status as America’s favorite daily intoxicant.In 2022, for the first time, more Americans were using marijuana daily, or near daily, than consuming alcohol at the same rate, according to a study by Jonathan Caulkins, a professor at Carnegie Mellon University. The number of daily or near daily marijuana users has grown from less than 1 million in 1992 to 17.7 million in 2022; in terms of per capita rate, that’s a 15-fold increase.

Marijuana is having a moment just as Americans reconsider their relationship toward alcohol. As public awareness of the toxic effects of even moderate alcohol consumption grows, many people are turning to THC products as an alternative. The THC industry touts its wares as a more natural alternative to alcohol with myriad health benefits, including decreased nausea, pain, and sleeplessness.

The rise in daily smokers (and vapers, and edible enjoyers, if you will) is also driven by the explosion of the industry. Millions of Americans live in cities and counties with retail shops offering a range of products that make the dimebags of yesteryear seem quaint by comparison: vape cartridges, edibles, oils, and waxes, offering more highly concentrated THC doses. The rise of marijuana retail has opened new doors for people who might have once shied away because they didn’t like smoking or were worried about breaking the law.

For many people, the rapid shift toward liberalization of marijuana policy, and the swiftness with which Americans have taken up consumption, has been great. But it’s also caught researchers off guard. Society has moved more quickly than they’ve been able to keep up with. That means millions of daily users are essentially conducting a real-time experiment on their own bodies. Marijuana isn’t benign for everyone, though. Some of the results of the real-time experiment are already becoming apparent, both to regular users and people working in health care.

“It is very desirable to believe that there is a drug that can make you feel good, that can relax you, and has absolutely no negative outcomes,” says Dr. Nora Volkow, director of the National Institute on Drug Abuse at the National Institutes of Health. “But in biology, there are no free lunches.”

Take the emergence of cannabinoid hyperemesis syndrome, a condition marked by intense and prolonged bouts of nausea and vomiting and brought on by regular, long-term marijuana use. While once extremely rare, some doctors are saying they now see patients with symptoms frequently. “It emerged because people were consuming marijuana regularly with high [THC] content,” Volkow says. “And similarly, there is now evidence that consumption in those patterns is associated with higher risk of stroke or cardiovascular disease.”

Maybe the most worrying studies about frequent, heavy marijuana use involve teens and young adults. (While experts say marijuana use appears to be less risky for middle-aged adults, there’s still a lot they don’t know that needs to be researched further. Some note that more research is needed on older adults in particular.) Studies show regular marijuana use among adolescents and teens can predict increased risk of the development of schizophrenia and other psychotic disorders. Others have shown an increased likelihood of depression and suicidal ideation, disrupted dopamine function, and disruptions in the anatomy of the brain.

And marijuana, contrary to popular belief, can be habit forming. It can also increase the risk of dependence on other substances. A recent analysis by Columbia University for the New York Times estimated that as many as 18 million people in the US may have some form of cannabis use disorder, or addiction.

Getting a handle on who might be harming their health is tricky. Even the findings that point to a major rise in daily users leave a lot of questions unanswered, especially around how often they’re smoking, vaping, or ingesting, and how potent the THC is.

Caulkins, the Carnegie Mellon professor who published the research showing that more Americans are using marijuana daily, says there are different categories of daily or near daily users. There are the people who use marijuana similar to the way someone might pop a melatonin before going to bed at night — a small, daily dose to help with sleep or pain. And then there are those who are more like heavy cigarette smokers, consuming marijuana multiple times a day, morning or night, before or after meals, on breaks from work, or out with friends.

His previous research has found that daily or near daily users are a small portion of overall users, but make up about three-quarters of all marijuana purchases.

But just how many of the 17.7 million daily or near daily marijuana users are truly heavy users remains a mystery, because the US National Survey on Drug Use and Health doesn’t ask about how many times a day someone is using, or what they’re taking.

“We can have people who are using near daily, but they’re taking a puff off their vape pen right before they go to sleep,” says Ziva Cooper, a researcher and director for the UCLA Center for Cannabis and Cannabinoids, “versus somebody who’s using daily or near daily and they’re using five to 10 one-gram pre-rolls every day. You can imagine that the health outcomes are going to be quite different.”

It’s not just that researchers are often unsure of how much people are taking. The consumers are also often not sure what they’re putting in their bodies. That’s partly because what’s being sold in stores is way stronger than the weed that millennials and previous generations grew up with. Over the last 25 years, government data shows, the percentage of THC in marijuana seized by the Drug Enforcement Agency (DEA) has more than tripled, from 5 percent to 16 percent. And a lot of the products for sale in dispensaries can be even more potent — with vendors selling concentrated products, some claiming 90 or close to 100 percent THC. Some teens who’ve used those products have struggled with vomiting and substance abuse.

Cooper says it’s not uncommon for her to end up on the phone with her patients as they read the label aloud to her and she searches the internet to try to find out what exactly they’re taking.

“As researchers,” Cooper says, “we are trying to catch up with what’s actually happening in the world of cannabis. And we are woefully behind.”

Though humans have been using cannabis for at least 10,000 years — it was widely used for medical purposes in the United States in the late 19th century — the demonization of marijuana under the Nixon administration in the 1970s pushed the plant into the shadows.

Nixon, according to secretly reported tapes, knew at the time that marijuana was “not particularly dangerous.” But his “war on drugs,” carried on by the administrations of Ronald Reagan, George H.W. Bush, and Bill Clinton forced consumers and their providers to stop or risk arrest.

The drug’s public image was less threatening — smoking pot was played for laughs in movies and TV shows — but the reality of its criminalization was much darker. Hundreds of thousands of people were arrested and incarcerated each year for selling and dispensing marijuana, with the harms falling disproportionately on Black people.

Public awareness of the harms caused by criminalizing marijuana grew, and so too did a movement to raise awareness about the medicinal benefits of its use, especially for chemotherapy and cancer parents, who found marijuana use helpful for combatting nausea. Meanwhile, advocates focused on reducing mass incarceration and addressing racial disparities in the judicial system pushed states to begin decriminalizing marijuana and revising the sentences for people serving time for it. After getting the states to approve marijuana for medicinal purposes, organizations began pushing for it to be legal for all adults. Today, marijuana is legal for medical use in 38 states and for recreational use for adults in roughly half of the states, plus the District of Columbia.

But marijuana is still illegal on the national level, where it is classified as a Schedule I drug — meaning the government doesn’t recognize it for medical use. That’s made getting the safety approvals and government funding necessary to study the drug difficult. Researchers say it’s made it harder to study potential risks of long-term marijuana use. But it’s made it harder to study the potential benefits, too. Earlier this year, the Biden administration proposed changing marijuana to a Schedule III, which will put it in a lower-risk category with drugs like ketamine.

In 2022, President Joe Biden signed the Medical Marijuana and Cannabidiol Research Expansion Act, hoping to reduce some of the federal barriers that have stymied research in the past. The legislation required the DEA to register and approve more researchers, and more manufacturers who can provide them with marijuana or cannabidiol (CBD). In addition to creating more opportunities and resources for researchers, the bill asked the DEA to assess whether there is enough marijuana to meet researchers’ experimental needs, and allowed doctors to discuss the benefits and harms of marijuana with their patients.

The federal government’s approach to marijuana has also meant that each state is doing its own regulation of its markets, without a concrete set of federal safety guidelines. The piecemeal nature of legalization, absence of national regulation, and lack of public awareness has contributed to the uncertainty around marijuana use and its long-term consequences.

The market is also changing rapidly. The 2018 farm bill, for example, legalized hemp, which inadvertently popularized delta-8 THC. Delta-8 THC, which is similar to delta-9 THC, is less potent in its natural form, but producers have been able to extract and synthesize the delta-8 THC in hemp, converting it into more potent concentrates. Manufacturers are now selling products the FDA says have serious health risks. But that isn’t the only thing that the government can and should be doing.

In September, the National Academies of Sciences, Engineering, and Medicine issued a report outlining what state and federal governments could do to establish better public policy around marijuana and minimize potential negative public health consequences over the next five years.

The report outlined specific actions, such as closing the loophole in the 2018 farm bill that legalized delta-8 THC and clarifying that all forms of THC are subject to regulation under the Controlled Substances Act. More broadly, the report calls for states that have legalized, public health officials, and government agencies like the CDC to come together and establish more unified guidelines for marijuana, working to develop a set of regulations around the production and sale. Marijuana, the report argues, should be regulated the same way as alcohol and tobacco.

The report also recommends that the federal government support more research into marijuana use, along with a public health campaign to educate people about individual risks for different populations, including teens and older people.

It’s a tall order, but even that doesn’t capture everything researchers want to know. Caulkins, for one, has other questions.

“Cannabis intoxication impairs short-term memory formation. When cannabis was only being used as a social drug on weekends, who cares if it reduced effective performance on intellectual tasks?” he says. “Now, roughly half of cannabis is consumed by people who use often enough that they spend perhaps 50 percent of their waking hours under the influence of the drug. A lot of those hours of cannabis intoxication are while people are on the job or in school. How does that impact your functioning, how much you’re learning in college? We underinvest in thinking about the consequences of so many billions of hours of work and school time being, in some form, under the influence.”

It’s a question that might be hard to answer empirically right now. But it matters — maybe most of all for the millions of people taking part in America’s real-time marijuana experiment. “Maybe it’s not a problem,” Caulkins says. “But possibly, it’s affecting people’s abilities to meet their life goals in some subtle ways.”

Source: https://www.vox.com/the-highlight/379637/marijuana-daily-drug-americans-alcohol

Emphatic Rejection by DrugWatch International

COMMENT BY JOHN J. COLEMAN Ph.D, PRESIDENT, DRUGWATCH INTERNATIONAL – 01 December 2024 

From: drug-watch-international@googlegroups.com

The proposal from the Secretary of HHS and the Attorney General to reschedule marijuana from Schedule I to Schedule III – responding to President Biden’s request to take a second look at marijuana scheduling – is probably DOA at this point. The hearing at DEA tomorrow is closed except to media and designated participants (apparently, though, it will be online for the public). They may go through some of the motions because that’s what they are supposed to do, but the usual time of several months to go from hearing to Final Order or Final Rule will place the resolution of this matter well into the next administration. When there’s a change of parties, as in this case, the new administration is not eager to adopt or implement the changes or proposals of the old one.

The current move to reschedule marijuana amount to a political hoax because Congress is not about to add the number of federal employees that would be needed to enforce a Schedule III status for marijuana. Every “dispensary” in all the states (est. 38 of 50, plus D,C.) would immediately or within a time set by a Final Rule must register with DEA, pay a registration fee, meet certain requirements, before being able to fill and dispense valid prescriptions for marijuana. The Controlled Substances Act imposes strict controls on imports and exports of controlled substances, as well as its packaging, labeling, distribution, and storage.

The federal government that in 1993 abdicated its responsibility for controlling marijuana (per the infamous Cole Memorandum) has neither the resources nor the desire to enforce new marijuana provisions of the CSA because it no longer enforces even a modicum of the old ones. This is nothing but a cruel joke perpetrated by insincere leaders contemptuous of those who disagree with them. The DEA administrator refused to sign the Notice of Proposed Rulemaking leaving the Attorney General to regain his authority and issue the NPRM in the form of an Attorney General’s Order. That, alone, disqualifies this rescheduling exercise, assuming, that is, that this lunacy ever reaches a judicial review.

As for tomorrow’s meeting at DEA’s administrative law court, I think it will be perfunctory and simply set the agenda for the following two or three months when there may be a hearing. I say “may” because the incoming AG and DEA administrator could very well put the kibosh on this nutty move by the Biden administration. As our late friend and colleague Otto Moulton used to say, “read what the other side is saying!” According to Cannabis.net, a pro-marijuana website, the headline of their alarming article says it all: “Trump’s Not So Cannabis Friendly Cabinet Picks – His VP, AG, Head of the CDC and FDA Nominees all Hate Legal Weed: The cannabis scorecard for Trump’s new cabinet is not shaping up well for legalization fans!”

That pretty much says it all.

John Coleman

************************

Submission by Maggie Petito to DrugWatch International –  mlp3@starpower.net
Sent: Sunday, December 1, 2024 7:21 AM
To: drug-watch-international@googlegroups.com
Subject: Chronister12-1-24

From The Washington Post: “ Chronister would enter an agency that has been roiled by the convictions of several former agents in corruption cases and scrutiny of Milgram’s hiring practices.

The incoming DEA administrator will also helm the agency as it handles a Biden Justice Department proposal to loosen restrictions on marijuana — a measure supported by Trump despite objections from other GOP leaders…

The Justice Department has proposed to reclassify marijuana from a tier reserved for substances such as heroin and LSD. The move to reclassify marijuana would not legalize the drug but would move it to Schedule III, a category that includes prescription drugs such as ketamine, anabolic steroids and testosterone. The proposal met pushback internally at the DEA, which questioned whether reclassification violated international treaty obligations regarding drug control and if a federal health agency used the wrong legal standard in making its determination, according to a Justice Department legal opinion that sided with the Department of Health and Human Services. When officials submitted the proposed rule to reclassify marijuana in April, the paperwork was signed by Attorney General Merrick Garland, not Milgram.

The marijuana proposal will be considered in DEA administrative court; a preliminary hearing is scheduled for Monday, 2nd December 2024.  The proposal, if it goes through, would not be finalized until after Trump becomes president.”

************************

Washington Post     David Ovalle and Anumita Kaur    November 30, 2024                    Hillsborough Sheriff Chad Chronister picked to lead DEA under Trump – The Washington Post

President-elect Donald Trump on Saturday tapped Hillsborough County Sheriff Chad Chronister to lead the Drug Enforcement Administration, replacing Anne Milgram.

The incoming DEA administrator will also helm the agency as it handles a Biden Justice Department proposal to loosen restrictions on marijuana — a measure supported by Trump despite objections from other GOP leaders.

The Justice Department has proposed to reclassify marijuana from a tier reserved for substances such as heroin and LSD. The move to reclassify marijuana would not legalize the drug but would move it to Schedule III, a category that includes prescription drugs such as ketamine, anabolic steroids and testosterone.

The proposal met pushback internally at the DEA, which questioned whether reclassification violated international treaty obligations regarding drug control and if a federal health agency used the wrong legal standard in making its determination, according to a Justice Department legal opinion that sided with the Department of Health and Human Services. When officials submitted the proposed rule to reclassify marijuana in April, the paperwork was signed by Attorney General Merrick Garland, not Milgram.

The marijuana proposal will be considered in DEA administrative court; a preliminary hearing is scheduled for Monday. The proposal, if it goes through, would not be finalized until after Trump becomes president.

Source: COMMENT BY JOHN J. COLEMAN Ph.D, PRESIDENT, DRUGWATCH INTERNATIONAL

The findings are still valid as to why marijuana should not be rescheduled as determined in the Denial of Petition To Initiate Proceedings To Reschedule Marijuana, by the Drug Enforcement Administration (DEA), 81 FR 53767-01(August 12, 2016)

Human Physiological and Psychological Effects of Marijuana

MARIJUANA AND MENTAL ILLNESS

Recent studies show a connection between marijuana use and mental illness. In 2017, the National Academy of Sciences (NAS) concluded after a review of over 10,000 peer-reviewed academic articles, that marijuana use is connected to mental health issues (like psychosis, social anxiety, and thoughts of suicide). [1]

A study discussed in an October 2017 Scientific American shows that people who had consumed marijuana before age 18 developed schizophrenia approximately 10 years earlier than others. The more marijuana you take – and the higher the potency – the greater the risk. [2]

A November 2017 report on a study found that marijuana use in youth is linked to bipolar symptoms in young adults. [3]

References

[1] Health Effects of Cannabis and Cannabinoids: Current State of Evidence and Recommendations for Research.
http://nationalacademies.org/hmd/~/media/Files/Report%20Files/2017/Cannabis-Health-Effects/Cannabis-chapter-highlights.pdf

[2] https://www.scientificamerican.com/article/link-between-adolescent-pot-smoking-and-psychosis-strengthens/

[3] http://www.newswise.com/articles/view/685947/?sc=dwtn November 2017

THERE IS A LINK BETWEEN MARIJUANA USE AND OPIATE USE

Marijuana use is associated with an increased risk for substance use disorders. [1] Marijuana use appears to increase rather than decrease the risk of developing nonmedical prescription opioid use and opioid use disorder. [2] In 2017, the National Academy of Sciences (NAS) landmark report written by top scientists concluded after a review of over 10,000 peer-reviewed academic articles, that marijuana use is connected to progression to and dependence on other drugs, including studies showing connections to heroin use. [3]

New research suggests that marijuana users may be more likely than nonusers to misuse prescription opioids and develop prescription opioid use disorder. The investigators analyzed data from more than 43,000 American adults. The respondents who reported past-year marijuana use had 2.2 times higher odds than nonusers of meeting diagnostic criteria for prescription opioid use disorder. They also had 2.6 times greater odds of initiating prescription opioid misuse. [4]

References

[1] JAMA Psychiatry. 2016 Apr;73(4):388-95. doi: 10.1001/jamapsychiatry.2015.3229.
Cannabis Use and Risk of Psychiatric Disorders: Prospective Evidence From a US National Longitudinal Study. Blanco C1, Hasin DS2, Wall MM2, Flórez-Salamanca L3, Hoertel N4, Wang S2, Kerridge BT2, Olfson M2. https://www.ncbi.nlm.nih.gov/pubmed/26886046

Cadoni C, Pisanu A, Solinas M, Acquas E, Di Chiara G. Behavioural sensitization after repeated exposure to Delta 9-tetrahydrocannabinol and cross-sensitization with morphine. Psychopharmacology (Berl). 2001;158(3):259-266. Available from: https://www.researchgate.net/publication/11640927_Behavioral_sensitization_after_repeated_exposure_to_D9-tetrahydrocannabinol_and_cross-sensitization_with_morphine

[2] Cannabis Use and Risk of Prescription Opioid Use Disorder in the United States, Mark Olfson, M.D., M.P.H., Melanie M. Wall, Ph.D., Shang-Min Liu, M.S., Carlos Blanco, M.D., Ph.D. Published online: September 26, 2017at: https://doi.org/10.1176/appi.ajp.2017.17040413

[3] Health Effects of Cannabis and Cannabinoids: Current State of Evidence and Recommendations for Research. See: http://nationalacademies.org/hmd/~/media/Files/Report%20Files/2017/Cannabis-Health-Effects/Cannabis-chapter-highlights.pdf

[4] https://www.drugabuse.gov/news-events/news-releases/2017/09/marijuana-use-associated-increased-risk-prescription-opioid-misuse-use-disorders

MARIJUANA USE BEFORE, DURING OR AFTER PREGNANCY CAN CAUSE SERIOUS MEDICAL CONDITIONS

Prenatal marijuana use has been linked with:

1. Developmental and neurological disorders and learning deficits in children.
3. Premature birth, miscarriage, stillbirth.
4. An increased likelihood of a person using marijuana as a young adult.
5. The American Medical Association states that marijuana use may be linked with low birth weight, premature birth, behavioral and other problems in young children.
6. Birth defects and childhood cancer.
7. Reproductive toxicity affecting spermatogenesis which is the process of the formation of male gamete including meiosis and formation of sperm cells.

References

Volkow ND, Compton WM, Wargo EM. The risks of marijuana use during pregnancy. JAMA. 2017;317(2):129-130.

https://www.drugabuse.gov/publications/research-reports/marijuana/letter-director

https://www.acog.org/Clinical-Guidance-and-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Marijuana-Use-During-Pregnancy-and-Lactation

Source: Email from Dave Evans to Drug Watch International April 2018

Attached is a submission from Professor Stuart Reece to the Food and Drug Administration in USA for forwarding to the World Health Organization relating to the re-scheduling of cannabis

FDA Federal Register Submission for WHO Review and Consideration – Colorado Teratogenicity Patterns Illustrated

Email from Stuart Reece April 2018

Policy News Roundup: November 14, 2024

by drugfree.org

The main point: Overall, a Trump administration is likely to be more focused on law enforcement and supply side responses to the overdose crisis, rather than approach the challenge from a public health perspective.

The details:

  • Treatment: We do not expect there will be efforts to remove barriers and expand access to methadone. There could be some efforts to expand buprenorphine (particularly telemedicine models).
  • Harm Reduction: Harm reduction received unprecedented federal support under the Biden administration. It is unlikely that such support will continue. Efforts to expand naloxone distribution may continue, but other harm reduction strategies (e.g., syringe service programs, overdose prevention sites) are not likely to receive support in a Trump administration.
  • Criminal Legal System: The use of Medicaid to provide medications for opioid use disorder in jails/prisons will likely face increased scrutiny. As part of a broader effort to limit Medicaid costs, a Trump administration may push to restrict federal funding for these programs. Drug courts and diversion programs will likely continue to receive support.
  • Insurance: There could be major changes to the Affordable Care Act (ACA), which includes some of the strongest insurance protections available for addiction, and Medicaid, which covers more addiction treatment than any other insurer. The enhanced ACA premium subsidies that led to record levels of insurance enrollment are not likely to be extended after they expire next year, and there may be efforts to slash funding for enrollment outreach, promote short-term health plans with skimpier coverage and allow insurers to charge sicker people higher premiums. Medicaid is likely to be targeted for funding cuts, and the Trump administration is likely to revive efforts to implement work requirements for Medicaid coverage.
  • Marijuana: It is not clear what a Trump administration will mean for marijuana. While previously strongly opposed to easing restrictions, Trump more recently came out in support of the legalization initiative in Florida (his home state) and the Biden administration’s push to reschedule marijuana.
  • Penalties: A Trump administration could push for harsher penalties for drug offenses.
  • Drug Trafficking: Combatting drug trafficking is likely to be the main focus for the administration on this issue. Rhetoric will likely focus on the U.S.-Mexico border, even though evidence has shown that most drugs are brought into the U.S. at legal ports of entry by U.S. citizens. There is likely to be continued pressure on Mexico and China for their role in fentanyl and precursor trafficking.
  • Federal Agencies: If the Trump administration takes action on plans to scale back federal agencies, it could lead to a reduced role for the Office of National Drug Control Policy, potentially in favor of the Department of Justice or Drug Enforcement Administration. Department of Health and Human Services agencies are also likely in for budget cuts and major changes in authority and focus, which could reduce the role of health agencies like the Centers for Disease Control and Prevention, the National Institutes of Health and the Food and Drug Administration in addressing the addiction crisis and the funding available to do so.

Why it’s important:

  • Federal funding for addiction has remained stable but shifts between law enforcement/interdiction and treatment, depending on the administration’s priorities. An increased focus on law enforcement/interdiction could mean less funding and focus on treatment. Funding for prevention has remained small and relatively the same.

A caveat: It is early. Trump’s campaign did not focus heavily on policy proposals or on this issue, and we do not know yet who will be appointed to top health roles in the administration.

In the states: drug policy backlash

Several states also had drug-related ballot initiatives on their ballots this election.

The main point: In recent elections, ballot measures focused on liberalizing drug policies (e.g., legalizing marijuana, decriminalizing drugs) have passed. This time, however, these types of measures failed, signaling concerns about these drug policies.

The details:

  • Marijuana: Florida, North Dakota and South Dakota all rejected measures to legalize recreational marijuana. Nebraska did approve a measure to legalize medical marijuana, but a judge could invalidate the results due to a pending lawsuit. Opponents cited concerns about crime, addiction and becoming like liberal states that have legalized marijuana. While most Americans continue to support marijuana legalization, the downsides of marijuana production and negative health impacts of high-potency marijuana and teen use have recently been in the spotlight.
  • Psychedelics: Massachusetts rejected a measure to legalize therapeutic use of certain psychedelics (psilocybin, psilocin, DMT, ibogaine, mescaline). Voters in more than a dozen Oregon cities also voted to ban sales and use of psilocybin, after the state approved licensed psilocybin treatment centers four years ago. Psychedelics have gained increased support across the political spectrum, but concerns are growing about allowing psychedelics to proliferate before there has been adequate research.
  • Penalties: California passed a measure to repeal a 2014 ballot initiative that had lessened penalties for certain drug offenses. The new measure reclassifies certain theft- and drug-related crimes as felonies, rather than misdemeanors. It also establishes court-mandated treatment for those with repeat drug offenses. Voters perceive social disruption from public drug use and want more law and order.

Another thing: Daniel Lurie won his race to be mayor of San Francisco, beating incumbent London Breed. Much of the campaign focused on debates about how to address public drug use in the city. Lurie ran on promises to expand police staffing, build more homeless shelter beds and shut down open-air drug markets.

Why it’s important: This is part of the broader recent backlash toward efforts to liberalize drug policies and emphasize treatment and harm reduction over punitive responses.

  • Increases in visible homelessness, mental illness and substance use following COVID, the rise of fentanyl and the continuing high level of overdose deaths have led many to feel that recent efforts are not working. This is exacerbated by rhetoric tying “failed” drug policies to supposed spikes in crime and drug use.

 

California report warns of high-potency marijuana health dangers

What’s new: A report by scientists convened by the California Department of Public Health suggests that state policymakers must do more to warn consumers of the health dangers of high-potency marijuana and deter its use.

The background:

  • Most of the marijuana sold in California is high potency, with a concentration of THC five to ten times greater than the marijuana of the 1970s and 1980s.
  • High-potency marijuana is more likely to be addictive and cause serious health problems, like psychosis or cannabis hyperemesis syndrome.

The takeaways: The authors say policymakers should take lessons from successful campaigns to reduce smoking and drinking. Among other ideas, they recommend:

  • Restricting marijuana advertising, packaging and marketing
  • Barring flavored products that appeal to kids
  • Limiting THC content
  • Raising taxes on high-potency products
  • Launching a public education campaign about high-potency marijuana’s health effects

What’s next: The authors say they are lobbying the California Department of Public Health, the California Department of Cannabis Control, the state legislature and other state agencies to boost regulation.

 

Source: https://drugfree.org/drug-and-alcohol-news/policy-news-roundup-november-14-2024/

MEDIA ADVISORY

WASHINGTON – Formal hearing proceedings regarding the proposed rescheduling of marijuana will begin on December 2, 2024 at 9:30 A.M. ET in the North Courtroom at DEA Headquarters located at 700 Army Navy Drive, Arlington, VA. This preliminary hearing will serve as a procedural day to address legal and logistical issues and discuss future dates for the evidentiary hearing on the merits.  No witness testimony will be offered or received at this time.

In-person attendance is limited to designated participants and credentialed members of the media who have received confirmation of their in-person attendance.

WHAT:    Commencement of formal hearing proceedings regarding the proposed rescheduling of Marijuana

WHO:    Open to designated participants and designated credentialed members of the media.

WHEN:        December 2, 2024 | 9:30 a.m. to 5 p.m.

WHERE:     DEA Headquarters | 700 Army Navy Drive, Arlington, Va. 22202 | North Courtroom

FOR MEMBERS OF THE PUBLIC: Members of the public will have access to the court sessions virtually at www.DEA.gov/live.

FOR NEWS MEDIA: News media wishing to attend in person must RSVP to DEAPress@dea.gov by 10 a.m. on November 29, 2024.  Due to limited capacity, RSVPs will be accepted on a first come, first served basis.

Designated members of the media should arrive no later than 9:00 a.m. on December 2 and follow all security screening procedures. Media credentials are required to be visible while inside DEA Headquarters. Video and audio recordings are not permitted at any time inside the courtroom.

Background:
On May 21, 2024, the Department of Justice proposed to transfer marijuana from schedule I of the Controlled Substances Act to schedule III of the CSA, consistent with the view of the Department of Health and Human Services that marijuana has a currently accepted medical use as well as HHS’s views about marijuana’s abuse potential and level of physical or psychological dependence. The CSA requires that such actions be made through formal rulemaking on the record after opportunity for a hearing. If the transfer to schedule III is finalized, the regulatory controls applicable to schedule III controlled substances would apply, as appropriate, along with existing marijuana-specific requirements and any additional controls that might be implemented, including those that might be implemented to meet U.S. treaty obligations. If marijuana is transferred into schedule III, the manufacture, distribution, dispensing, and possession of marijuana would remain subject to the applicable criminal prohibitions of the CSA. Any drugs containing a substance within the CSA’s definition of “marijuana” would also remain subject to the applicable prohibitions in the Federal Food, Drug, and Cosmetic Act. For more information, visit www.DEA.gov.

Source: https://www.dea.gov/stories/2024/2024-11/2024-11-26/dea-hold-hearing-rescheduling-marijuana

This is an exchange on Drug Watch International with questions from Roger Morgan and responses from Dr Stuart Reece (in bold italics)

Hi Stuart

In reflecting on the studies referred to by Peggy Mann from 40 or 50 years ago, combined with your recent research, I believe we need to do some more research.  I have the following questions:

  1. What is involved evaluating the chromosomes in cells of humans?  Do you take a chunk of flesh, or ???? No.  Would most universities have the capability to do this? No.

If you wanted to do this properly studies would involve the following.  I think they need to be detailed and extensive in view of the now massive populations risks which are presented.  You are actually talking about something which may be devastating – if 12% of Coloradan babies are impact PRIOR to legalization then “Houston, Houston we have a problem…  This is Apollo 13 calling.”

  1. Cell culture studies – many cells, neurons, sperm and eggs, gut cells skin cells
  2. Several species – white rabbit and hamsters model humans best.
  3. Human cell lines – many
  4. Human cells – skin cells, cheek cells, transformed white blood cells – lymphoblastoid cells – EBV infected lymphocytes taken from blood samples
  5. Human sperm
  1. A key change would be to apply next generation sequencing to these cells and tissues so:
    1. DNA
    2. RNA
    3. Proteins
    4. DNA methylation
    5. Histone changes – nuclear proteins looking for
    6. Epigenetic changes
    7. Epitranscriptomic changes
    8. Metabolome changes
    9. The interaction between the metabolome and the epigenome
    10. Profile the immune change including cytokines in detail – these are very important and far reaching and cause aging and germ cell damage – cytokines – TH17 cells etc…
    11. Compare the immune and growth factor changes seen in cannabis exposed patients with old folks and compare the way they reproduce clinical aging.
  1. Look at pregnancies prospectively.  Look at the sperm of males – sequence them do genetic and epigenetic studies.  Then study their babies and see if they carry the same abnormalities after birth…  See how the correlate with the various congenital anomalies.

2)  What are the implications if the cannabis consumers only have half of the 46 chromosomes that are normal in humans?  Not true.  Physical and mental abnormalities in offspring …. and future generations?..   Chromosomal anomalies will do this yes – and chromosomal shattering processes which cannabis can induce.  Cannabis changes cell division process causing chromosomal shattering and also epigenetic changes – changes in the signalling along the DNA on how the genes are used and expressed.

3)  Will the chromosome levels return to normal if a person quits consuming cannabis?   Short answer – not studied yet.

Long answer – yes I think there will be a degree of repair.  However I also think it is unlikely ever to return to normal. Especially after heavy use because some of the epigenetic imprinting is permanent – obviously from studies which have been done.

4)  Cannabis is known to cause mutations to sperm and ova which can affect a fetus even before pregnancy.  If they stop using, will everything return to normal?  Same as above. Serious concerns.  Depends on level of exposure.  Depends on time between cannabis and making babies…   I do not mean to imply that one or two joints as a young person and babies ten years later is bad.  Nothing suggests that.  But heavy cannabis use such as we are seeing more and more if – and Deborah Hasin from Mailman School of Public Health  in 2017 said USA has an extra 500,000 of in legal states – that is a big problem for later reproduction.

I think the evidence that young people of reproductive age should not go near cannabis for genotoxic reasons is now very strong indeed, and so too do all of my collaborators including my biostatistical friends.

Consider:

  1. 12.6% of Coloradan had major congenital anomalies in 2013 PRIOR to legalization
  2. The rate of cannabis use by people over 12 years in Colorado was 14% in 2013
  3. The rate of cannabis use by all pregnant women in California in 2015 was 8% on testing
  4. The rate of cannabis use by mothers less than 20 years in California was 24% in 2015.

So about as many babies are being born deformed AS ARE BEING EXPOSED TO CANNABIS.

So clearly a very high percentage of cannabis exposed babies are experiencing major congenital anomalies.

This should send shivers down our spine – not only that cannabis use is rolling out but that cannabis use is aimed primarily at young adults the very group who should be keeping well away from it.

We need to define these risks much better at the population level by careful studies.

Sperm would be easy to collect and study and define and then correlate with subsequent foetal outcomes.

Thanks and God bless – and spare us all,

Stuart.

Source: Email to Drug Watch International www.drugwatch.org April 2018

 – PERSPECTIVE

 CO-AUTHORS:

Albert Stuart Reece1,2 | Gary Kenneth Hulse1,2
1University of Western Australia, Crawley,
Western Australia, Australia

2School of Health Sciences, Edith Cowan
University, Joondalup, Western Australia,
Australia

Correspondence:
Albert Stuart Reece, University of Western
Australia, 35 Stirling Hwy, Crawley, WA 6009,
Australia.
Email: stuart.reece@uwa.edu.au

ABSTRACT:

Whilst mitochondrial inhibition and micronuclear fragmentation are well established
features of the cannabis literature mitochondrial stress and dysfunction has recently
been shown to be a powerful and direct driver of micronucleus formation and chromosomal
breakage by multiple mechanisms. In turn genotoxic damage can be
expected to be expressed as increased rates of cancer, congenital anomalies and
aging; pathologies which are increasingly observed in modern continent-wide studies.
Whilst cannabinoid genotoxicity has long been essentially overlooked it may in fact
be all around us through the rapid induction of aging of eggs, sperm, zygotes, foetus
and adult organisms with many lines of evidence demonstrating transgenerational
impacts. Indeed this multigenerational dimension of cannabinoid genotoxicity
reframes the discussion of cannabis legalization within the absolute imperative to
protect the genomic and epigenomic integrity of multiple generations to come.

KEYWORDS:   cannabis, chromothripsis, micronucleus


MAIN ARTICLE TEXT:

Recent papers in Science provide penetrating and far-reaching insights
into the mechanisms underlying micronuclear rupture a key genotoxic
engine identified in many highly malignant tumours.1,2 Reactive
oxygen species (ROS) generated either by damaged mitochondria or
the hypoxic tumour microenvironment were shown to damage micronuclear
envelopes, which made them more sensitive to membrane
rupture. Damage occurred by both increased susceptibility to membrane
rupture and impaired membrane repair. Micronuclear rupture is
known to be associated with downstream chromosomal shattering,
pan-genome genetic disruption by chromothripsis, widespread epigenetic
dysregulation and cellular ageing. Clinical expressions of genotoxicity
are expected to appear as cancer, birth defects and ageing.
CHMP7 (charge multivesicular body protein 7) oxidation caused
heterodimerization by disulphide crosslinking and aberrant crosslinking
with membrane bound LEMD2 (LEM-domain nuclear envelope
protein 2) inducing membrane deformation and collapse. ROS-CHMP7
directly induced chromosomal shattering. Oxidized CHMP7 bound
covalently to the membrane repair scaffolding protein ESCRT-III
(endosomal sorting complex required for transport–III). ROS triggered
homo-oligomerization of the autophagic receptor p62/sequestome
re-routing the CMPH7-ESCRT-III complex away from membrane
repair into macroautophagy via the autophagosome and microautophagy
via lysozomes.1–3 Expected downstream consequences of
micronuclear rupture including chromosomal fragmentation, chromothripsis
and cGAS-STING (cyclic adenosine-guanosine synthase–
stimulator of interferon signalling) activation were demonstrated.
Cancer-related innate inflammation is known to drive tumour progression
and distant metastasis. These principles were tested both in normal
and also numerous malignant (including head and neck squamous,
cervical, gastric, ovarian and colorectal cancers) cell lines.1,2 Similar
processes including DNA damage and epigenomic derangements have
also been identified in TH1-lymphocytes during fever indicating that
mitochondriopathic-genotoxic mechanisms may in fact be widespread
and fundamental.4


Received: 26 September 2024 Accepted: 26 September 2024
DOI: 10.1111/adb.70003
This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.


 

Addiction Biology. 2024;29:e70003. wileyonlinelibrary.com/journal/adb
https://doi.org/10.1111/adb.70003


Cannabis has been known to be linked with both micronuclear
development and mitochondrial inhibition for many decades.5,6
All cannabinoids have been implicated in genotoxicity as the moiety
identified as damaging the genetic material is the central olivetol
nucleus on the C-ring itself.7 This finding implicates Δ8-, Δ9-, Δ10-,
Δ11-tetrahydrocannabinol, cannabigerol, cannabidiol and cannabinol
amongst all other cannabinoids.
Historically, the cancer-cannabis link has been controversial. Differing
results in published studies may be attributed to various factors
including multiple exposures (including tobacco), differences in
study design and the rapid rise of cannabis potency. One often quoted
study actually specifically excluded high level cannabis exposure, which
would now appear to have been a major methodological limitation.8 It
is widely documented that there has been a sharp increase in cannabis
concentration from the 1970s to the present day. THC concentrations
of 25%–30% are commonly noted in cannabis herb and flower sold
commercially, and 100% THC concentrations are well known for cannabinoid
based products such as dabs, waxes and ‘shatter’.
In this context, the recent appearance of a series of continentwide
epidemiological, space–time and causal inferential studies in
both Europe and North America is notable for many positive signals
for various cancers including breast, pancreas, liver, AML, thyroid, testis,
lymphoma, head and neck squamous cancer, total childhood cancer
and childhood ALL.9–15 The literature on cannabis and testicular
cancer is almost uniformly positive and has a relative risk of around
2.6-fold,16 this risk factor is now widely acknowledged17–19 and the
effect is quite fast since the median age of exposure may be about
20 years and the median age of testis cancer incidence is only
31 years. Testicular cancer is the adult cancer responsible for the most
years of life lost.17,18,20,21 The inclusion of several childhood cancers
in association with cannabis exposure obviously implicates transgenerational
transmission of malignant mutagenesis.
An intriguing finding in the case report literature is that in many
cases, cancers occur decades earlier and are very aggressive at diagnosis.
22 Mechanisms such as the synergistic mitochondriopathic–
micronuclear axis presently proposed in the recent Science papers1–4
may directly explain this very worrying observation.
Whilst cancer is thought to be a rare outcome amongst cannabis
exposed individuals, ageing effects are not. A dramatic acceleration
of cellular epigenetic age by 30% at just 30 years was recently
reported23 with indications this effect likely rises with age,24 and
the demonstration that cannabis exposed patients had adverse
outcomes across a wide range of physical and mental health outcomes
including myocardial infarction and emergency room presentations.
25 Importantly, the ageing process itself has been shown to
be due to redistribution of the epigenetic machinery in such a manner
as to produce dysregulation (and widespread reduction) of gene
expression and to be inducible by limited genetic damage resulting
from just a handful of DNA breaks.26 Extremely worryingly, agerelated
morphological changes have been described in both oocytes
and sperm.27,28
Epidemiological studies of European and American cannabiscancer
links are supported by epidemiological, space–time and causal
inferential studies of links between cannabis and congenital
anomalies.29–33 Reported congenital anomalies are clustered in the
cardiovascular, neurological, limb, chromosomal, urogenital and gastrointestinal
systems. The fact that all five chromosomal anomalies
studied here are represented in this list, notwithstanding their high
rate of known foetal loss, is strong evidence for chromosomal misegregation
during germ cell meiosis, which is the genetic precursor to
micronucleus development.34,35 The fact that almost identical results
were reported in both the United States and Europe provides strong
external validation to these findings.30
This is consistent with recent press reports of dramatic increases
in babies and calves born without limbs in both France and
Germany36,37 raising the public health spectre of downstream implications
of food chain contamination. Melbourne, Australia, is a multiethnic
city, which heads the global leaderboard for babies born with
the serious limb anomalies amelia and phocomelia.37–40 This pattern
of elevated rates of major birth defects is not seen in the host nations
from which these migrant populations are derived. Cannabis farms are
increasingly common around Melbourne, just as they are in the
French province of Ain, which has similar concerns.37,41–43
Major epigenetic changes have been found in human sperm,44
which have also been identified in exposed rodent offspring.44–46
Indeed, 21 of the 31 congenital anomalies described following prenatal
thalidomide exposure have also been observed epidemiologically
following prenatal cannabis exposure and 12 of 13 cellular pathways
by which thalidomide operates have been similarly identified in the
cannabis mechanistic literature.47 Both human and rodent epigenomic
studies44–46 and epidemiological studies show that adult cannabis
exposure is linked with the incidence of autism48–53 and cerebral processing
difficulties54–57 in children prenatally exposed. Together, this
data is clear and robust evidence for the transgenerational transmission
of major genotoxic outcomes.
Notwithstanding the well-known ambiguities in the epidemiological
literature for cannabis, it is clear from the above brief overview
that there is strong and compelling evidence that cannabis genotoxic
outcomes are well substantiated and form a remarkably congruent
skein of interrelated evidence across all three domains of genotoxic
pathology including cancer, congenital anomalies and ageing.
So too compelling epidemiological, morphological and epigenetic
evidence of transgenerational transmission of cannabinoid genotoxicity
to foetus, egg, sperm and offspring carries far reaching and
transformative implications and indeed reframes the discussion surrounding
cannabis legalization from merely personal-hedonistic to the
protection of the national genomic integrity for multiple subsequent
generations.
The present time therefore represents a watershed moment.
The new profoundly insightful studies from Science point the way and
provide the trigger. Clearly, there is a great need for a new
and updated cohort of epidemiological studies on these issues at the
population level in the modern context of the widespread availability
of much more potent cannabinoid preparations.
However, our first responsibility is to act on the evidence we do
have. Given the uniform picture painted by data from myriad directions.

It can be said that the evidence for cannabinoid genotoxicity
is at once so clinically significant, robust and compelling as to constitute
a resounding clarion call to action: The only outstanding
question is ‘Will we rise to the challenge?’


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CONFLICT OF INTEREST STATEMENT:
The authors declare no conflicts of interest.

ORCID:
Albert Stuart Reece https://orcid.org/0000-0002-3256-720X

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How to cite this article: Reece AS, Hulse GK. Key insights into
cannabis-cancer pathobiology and genotoxicity. Addiction
Biology. 2024;29(11):e70003. doi:10.1111/adb.70003

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Source: ORCID, Inc 10411 Motor City Drive, Suite 750, Bethesda, MD 20817, USA

By Gabrielle M. Etzel

November 6, 2024 10:45 am

Voters in the 2024 election dealt a rebuke to drug legalization efforts in four states, a major political development that will shape the future of both marijuana and psychedelic drug policy across the country:

  • Measures to legalize recreational marijuana failed in Florida, North Dakota, and South Dakota, despite record spending from the cannabis industry already operating in those jurisdictions.
  • Support for the Florida constitutional amendment, Amendment 3, to legalize recreational marijuana only received 55.9% of the vote as of 9:49 a.m. Wednesday, according to the Associated Press. A 60% supermajority threshold was necessary to amend the Florida constitution.
  • The “No” vote to the marijuana legalization efforts in both North Dakota and South Dakota received outright majorities.
  • North Dakota’s Measure 5 was voted down 52.5%-47.5% with 99% of the vote counted as of 4:08 a.m. Wednesday. The “No” vote for South Dakota’s Measure 29 received 56.3% of the vote compared to 43.7% in favor with 90.3% of the ballots counted, also as of Wednesday morning.
  • Massachusetts also heartily rejected an effort to legalize the medical and recreational use of psychedelic drugs, including psilocybin and psilocin.
  • According to the Associated Press, the ballot measure was voted down 56.9%-43.1% with 90.3% of the vote counted as of 9:28 a.m. Wednesday.

The legalization effort was dealt a decisive blow in mid-October by the Boston Globe, whose editorial board wrote that the measure “goes too far” despite the therapeutic promise of psychedelics for treating PTSD and other mental health conditions.

“Voters by wide margins rejected the legalization of drugs like marijuana and psychedelics from red Florida to blue Massachusetts,” Foundation for Drug Policy Solutions and Smart Approaches to Marijuana President Kevin Sabet said in a statement on the elections. “We expect this Administration to listen to this message loud and clear: More drugs are not good for any community.”

Nebraska medical marijuana is only victory

The two interrelated ballot initiatives for Nebraska were the only drug legalization amendments to pass on Tuesday night.

The Associated Press declared victory for the ballot measure to legalize medical marijuana, Initiative 437, 70.2%-29.3% with 99% of the votes counted as of 6:52 a.m.

The accompanying amendment, Initiative 438, which established the Nebraska Medical Cannabis Commission to regulate the medical marijuana program, passed with 67% of the vote, according to Ballotpedia. Results for Initiative 438 were not tracked by the Associated Press.

Nebraska is now one of 39 states that have legalized medical marijuana, which in the past has signaled that a recreational use policy will be introduced in the coming years.

Future of federal drug policy

Cannabis is still classified as a Schedule I drug under the Controlled Substances Act, along with heroin and ecstasy. Schedule I drugs are determined to have no accepted medical use and a high potential for abuse, and federal penalties for possession and intent to distribute can be severe.

President Joe Biden issued a directive to executive branch agencies in 2022 to begin a review of federal marijuana statutes. The Drug Enforcement Agency this spring started the process of reclassifying marijuana to a Schedule III substance, on par with ketamine and certain anabolic steroids.

Although it was not a major issue in the presidential campaigns, both Vice President Kamala Harris and President-Elect Donald Trump promised to continue with this spirit of drug reform at the federal level.

Trump, a resident of Florida, posted on Truth Social in September that he planned to vote in favor of Amendment 3 because he supported “smart regulations” for cannabis at the state level.

“As President, we will continue to focus on research to unlock the medical uses of marijuana to a Schedule 3 drug, and work with Congress to pass common sense laws, including safe banking for state authorized companies, and supporting states rights to pass marijuana laws, like in Florida, that work so well for their citizens,” Trump said in September.

Trump’s perspective on psychedelic drugs has not been as clear, but he has been a strong supporter of increasing access to clinical trials for experimental treatments for potentially fatal diseases.

Over the past two years, there has been strong bipartisan support in Congress for improving funding for the mental health benefits of psychedelic drug use for patients with severe PTSD, particularly combat veterans at risk of suicide.

Source: CLICK HERE TO READ MORE FROM THE WASHINGTON EXAMINER

From: thinkon908 via Drug Watch International
Subject: FROM DAVE EVANS WHAT TRUMP GOT WRONG PLEASE WRITE TO SENATOR VANCE ABOUT THIS

In a message dated 9/3/2024 6:52:58 AM Eastern Daylight Time:

President Trump and Senator Vance have recently come out in favor of marijuana legalization. This is a big mistake.

Here is what President Trump had to say

As everyone knows, I was, and will be again, the most respected LAW & ORDER President in U.S. History. We will take our streets back by being tough & smart on violent, & all other types, of Crime. In Florida, like so many other States that have already given their approval, personal amounts of marijuana will be legalized for adults with Amendment 3. Whether people like it or not, this will happen through the approval of the Voters, so it should be done correctly. We need the State Legislature to responsibly create laws that prohibit the use of it in public spaces, so we do not smell marijuana everywhere we go, like we do in many of the Democrat run Cities. At the same time, someone should not be a criminal in Florida, when this is legal in so many other States. We do not need to ruin lives & waste Taxpayer Dollars arresting adults with personal amounts of it on them, and no one should grieve a loved one because they died from fentanyl laced marijuana. We will make America SAFE again!

We will address these four statements made by President Trump.

1. As everyone knows, I was, and will be again, the most respected LAW & ORDER President in U.S. History.

If he supports legalization of marijuana he is not in favor of law and order. Marijuana use causes violence in general and violence against women and children. See the attached paper on marijuana and violence. Data also shows that marijuana use is the primary drug involved with child deaths by their caretakers. See the attached power point on child deaths.

2. We need the State Legislature to responsibly create laws that prohibit the use of it in public spaces, so we do not smell marijuana everywhere we go, like we do in many of the Democrat run Cities.

He got it right that marijuana smoking should be banned in public places including apartment buildings. Attached is the Cannabis Industry Victims Education Litigators paper “Marijuana Smoke Carries High Risks to the Health of Users or to the Health of Other Individuals or of the Community” that was sent to the DEA on the rescheduling issue. It covers the science on topics such as:

Relevant Facts about Marijuana Smoke – 9
Marijuana smoke has dangerous levels of particulate matter – 10
California Environmental Protection Agency Declares Marijuana Smoke a Carcinogen – 11
Marijuana Smoke is More dangerous than Tobacco Smoke – 12
Second Hand Marijuana Smoke Is Dangerous to Individuals and the Community – 13
Cannabis Smoke and Pollen Are Known Allergens – 18
Marijuana Is Addictive and Marijuana Smoke and Odor Can Trigger Relapse – 22
Marijuana Smoke May Trigger Relapse in Those Suffering from Cannabis Use Disorder – 24

3. We do not need to ruin lives & waste Taxpayer Dollars arresting adults with personal amounts of it on them.

 

President Trump got that wrong. I have been a criminal defense attorney since 1974. Attached is the AALM paper on social justice and marijuana arrests. It is a myth that there are many minorities in prison due to possession of small amount of marijuana. Most states treat this as a civil offense or a very minor offense and records can be expunged. An arrest can help get marijuana users evaluated and treated. See the attached paper on Compassionate Justice.

4. “no one should grieve a loved one because they died from fentanyl laced marijuana. We will make America SAFE again!

President Trump got that wrong

I was an EMT for 10 years and President of a rescue squad and also an EMT on a mountain fire company. Here is what first responders have to say about “fentanyl laced marijuana” in their Journal of Emergency Medical Services

Fentanyl-laced cannabis products are a malevolent myth that has appeared multiple times in law enforcement press releases and subsequent media reports. These rumors began as early as 2017 when a county coroner in Ohio erroneously stated that he had seen evidence of marijuana laced with fentanyl. It was later determined that his remarks were unsubstantiated and were based on third-hand hearsay. To-date, there are no scientifically verified reports fentanyl contamination of cannabis products. Writer and drug researcher Claire Zagorski notes that in addition to the paucity of evidence associated with the rumors, fentanyl is destroyed and rendered inert when it is burned. Meaning that even if it made its way onto cannabis flower, it would not have any effect on the individuals who inhaled it when smoking. Additionally, fentanyl is not well absorbed through the gastrointestinal tract, which is why there are no oral preparations of the medication which minimizes the risk of its impact if it were to end up in edible products. Finally, it is worth noting that it is possible that fentanyl could be vaporized (heated to its boiling point as opposed to burning). However, it requires much higher temperatures than are found in vaping devices that are used to consume tobacco and cannabis products.

There are, of course, a few different ways to consume cannabis. The method most of us probably think of is smoking. In the case of cannabis flower, smoking involves loading the material into a pipe or roll paper, lighting it on fire, and inhaling the smoke. Burning fentanyl with flame destroys it, so even if someone smoked cannabis contaminated with fentanyl, the fentanyl would not be active in the smoke. In fact, burning drugs in an incinerator is a common way to dispose of them, both for prescription medications and for illegal drugs seized by law enforcement.

David G. Evans, Esq.
www.ncagainstmarijuana.org

Source: www.drugwatch.org

Submission to the Joint Select Committee on Social Media and Australian Society

Executive Summary
Social media platforms have become a major part of young Australians’ lives. While these
platforms have many benefits, they also expose youth to content that promotes substance use,
including alcohol, tobacco, e-cigarettes, and illicit drugs. This is concerning because:
1. There are often no effective age restrictions on this content.
2. Substance-related posts are widely available and mostly show drug use in a positive
light.
3. Young people are seeing alcohol related advertisements on social media every few
minutes.
4. Exposure to this content can normalise substance use by young people and undermine
the perceived harms of substance use.

The Australian government and social media companies need to work together to protect
young people from this harmful content. This could include better age verification, stricter
content policies, and using technology to detect and remove posts promoting illegal
substances.

>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>

To access the full document:

  1. Click on the ‘Source’ link below.
  2. An image  – the front page of the full document will appear.
  3. Click on the image to open the full document.

 

Source: National Centre for Youth Substance Use Research

 

By Ian Webster  Oct 28, 2024

Ian W Webster AO is Emeritus Professor of Public Health and Community Medicine of the University of New South Wales. He has worked as a physician in public and regional hospitals in Australia and UK and in NGOs dealing with homelessness, alcohol and drug problems and mental illness.

Please review Ian Webster’s paper which clearly shows that we need to learn from our success in the past that Prevention is the best way forward.

The second New South Wales Drug Summit will be held in regional centres for two days in October and the final two days will be in Sydney on the 4th and 5th December to be co-chaired by Carmel Tebbutt and John Brogden – a balance of politics.

Do summits achieve worthwhile outcomes?

The first Drug Summit in 1985 was national. It worked. It established the enduring principle of harm minimisation. It brought police, health, and education together, canvassed all drugs – including alcohol and tobacco, and it started funding for practicable and policy-based research.

It worked because Prime Minister Hawke needed it to, for family reasons. It worked because the Health Minister, Neal Blewett, needed it to work as he had carriage of its outcomes and the national response to burgeoning HIV/AIDS epidemic.

The 1999 NSW Drug Summit was in response to the rising prevalence of heroin use and opiate deaths. It worked because there was a political will to succeed. It included measures to deal with blood borne infections of HIV, hepatitis B and C; it expanded the state’s opioid treatment programs; expanded needle-syringe programs; introduced the antidote naloxone; and three seminal firsts – the first medically supervised injecting centre, drug courts, and court referral into treatment.

It worked because the Premier Bob Carr wanted it to. Which meant that the summit’s recommendations were managed through the Cabinet Office, supported by a ministerial expert advisory group. The ‘piper called the tune’ for all the state government departments; and they were made to work together.

The Alcohol Summit of 2003 was not as effective. Politicians were too close to the alcohol problem and implementation was handed to the Department of Health which meant other departments washed their hands of involvement. Police, on the other hand, carried the day with counterattacks on alcohol violence and behaviours at liquor outlets.

Contemporary drug problems

Now other substances must be dealt with – amphetamine type stimulants, especially crystalline methamphetamine, cocaine, hallucinogens, MDMA, pharmaceutical stimulants, the potent drug fentanyl, the even more potent nitrazenes, ketamine and unsanctioned use of psychiatric/neurological drugs. Cocaine is flooding the drug markets.

Heroin and alcohol remain as major problems. The Pennington Institute estimated there were 2,356 overdose deaths in 2022, 80% of which were unintended. And alcohol, not only damages the drinker, and the bystander, but creates extensive social harms in the lives of others.

NSW Ice Inquiry

Four and half years ago Commissioner, Dan Howard, reported on his Inquiry into the Drug Ice; he had started the Inquiry six years previously. His recommendations provide a scaffold for the upcoming Summit. The earlier NSW Drug Summit (1999) was followed by a strong impetus to implement its recommendations, but the Government dropped the ball 20 years ago. The last formal drug and alcohol plan was 10 years before the Ice Inquiry.

Fundamental to drug law reform is the decriminalisation of personal use and possession of drugs. This recommendation stands above all others in Dan Howard’s Report.

The thrust of the Inquiry’s recommendations centre on harm minimisation:

  • drug problems are health problems,
  • government departments across the board have responsibilities,
  • treatment, diversion, workforce initiatives, education and prevention programs must be adequately resourced,
  • accessible and timely data are needed,
  • Aboriginal communities, and other vulnerable communities, those in contact with the criminal justice system, all disproportionally affected by alcohol and other drugs, must be high priority population groups.

The NSW Liberal Government pushed back against decriminalising low-level personal drug use, against medically supervised injecting centres, against pill testing, cessation of drug detection dogs at music festivals, and needle and syringe programmes in prisons. Later it gave in-principle support to 86 of the recommendations.

Will the Summit achieve?

The hopes of the drug and alcohol sector are for easy access to naloxone (antidote to opiates), supervised drug-taking services, accessible sites for drug-checking, early surveillance on trends, better access to now available effective treatments, for the treatment of prisoners to equal that for all citizens, and a more equitable distribution of treatment and rehabilitation services across the state, and to ‘at-risk’ population groups.

Success will depend on the practicality of the recommendations and the preparedness of government to act on them in good faith.

It is trite to say, but this depends on political will. The will was strong in the earlier national Drug Summit (1985) and NSW Drug Summit (1999). But so far, Government responses to the Ice Inquiry have been late and weak-willed which does not bode well for the delivery of needed reforms.

There is now a Labor Government, also tardy in its response. It remains to be seen whether NSW Labor has the stomach to overturn past prejudicial stances on drug use and addiction, and whether it will put sufficient funds to this under-funded and stigmatised social and health problem.

What will not be achieved

The Summit and its outcome cannot attack the real drivers of drug problems – the incessant search by humankind for mind altering substances, the mysteries of addiction, and the abysmal treatment of people in unremitting pain.

The root causes of drug problems are socially determined. Action at this level will require an unimaginable upheaval of society and government. In western countries drug overdoses (including alcohol overdoses), suicide, and alcoholic liver disease, are regarded as ‘diseases of despair’. The desperation and despair which pervades vulnerable, and not so vulnerable, population groups, is the underground of drug use problems here and in other countries. Commissioner Howard said, we [society] are given “tacit permission to turn a blind eye on the factors driving the most problematic drug use: trauma, childhood abuse, domestic violence, unemployment, homelessness, dispossession, entrenched social disadvantage, mental illness, loneliness, despair and many other marginalising circumstances that attend the human condition.”

Somehow a better balance must be struck for law enforcement between the war on traffickers and the human rights of users. It is for the rest of us to treat drug using people as our fellow citizens.

Kind Regards

Herschel Baker

 

Source: Drug Free Australia

In the early 2000s, vaping emerged as a popular alternative to smoking tobacco. E-cigarettes, marketed as nicotine delivery systems without the harmful chemicals found in traditional cigarettes, quickly gained popularity. As vaping technology evolved, so did its applications. By the mid-2010s, the marijuana industry began to adopt vaping as a method for consuming marijuana.

This shift was possibly driven by the increase in legalization across states, the perception that vaping was safer than smoking, and the convenience of discrete portable vapes. However, as the popularity of marijuana vaping grows, so does the rise in its health effects.

By 2019, reports of lung injuries associated with vaping began to surface. Studies found that the combination of vaping marijuana, smoking tobacco and smoking marijuana was linked to younger individuals experiencing lung conditions in a short period. The Centers for Disease Control and Prevention (CDC) then identified a condition known as EVALI (e-cigarette or vaping product use-associated lung injury), which was linked to THC containing vape products. A chemical used to dilute THC and create low-cost products contributed to an outbreak of EVALI. CDC reported that as of late 2019, approximately 77% of vaping-related injury cases involved THC-containing products. By February 2020, this number increased to 80%, highlighting a significant association between marijuana vaping and respiratory complications.

The increased access to marijuana through online retailers and the rise in marijuana legalization across states has contributed to the increase in marijuana use by young adults posing new challenges. A 2024 meta-analysis found that the passing of recreational marijuana laws led to an increase in past-month marijuana use of 13% among youth and 22% among young adults. In addition to this analysis, the Monitoring the Future Survey revealed that marijuana and hallucinogen use among 19–30-year-olds remained elevated compared to previous years. When including vaping of either nicotine or marijuana, both trends showed a consistent increase over the past five years and are now at record levels. Specifically, the percentage of 19–30-year-olds who vaped marijuana in the past 12 months rose from 11.5% in 2017 to 22.2% in 2023, while vaping marijuana in the past 30 days increased from 5.9% to 14.4% over the same period. This aligns with the growing perception that vaping is a healthier alternative, leading more young people to experiment with these substances, potentially leading to a higher incidence of lung-related health issues.

The increase in demand for marijuana products has also driven the development of efficient delivery methods, such as online retail, introducing new challenges for regulation. A study highlighting the significant gaps in regulatory compliance among online retailers of flavored tobacco and marijuana vape products showed that, out of 156 purchase attempts, 67.3% were successfully delivered, including to areas with flavor restrictions. Worryingly, only 1% of buyers had their ID scanned successfully by delivery personnel, as required by law, with most deliveries not conducting ID check or interacting with purchaser. These findings underscore the need for better enforcement of age verification and shipping restrictions, especially as youth and young adult use of marijuana vape products increase.

The story of vaping’s evolution from tobacco to marijuana serves as a reminder of the complexities and unforeseen consequences that can arise with new technologies and changing substance use trends. As legalization and acceptance of marijuana continue to grow, so does the need for comprehensive research, clear regulations and widespread education to ensure public safety and prevent unintended consequences.

References:
• Ali, F. (2021). Combination of vaping, cannabis and smoking exposure: shorter time to bullous lung disease and pneumothorax. Journal of Lung Health and Diseases, 5(1), 8-10. doi.org/10.29245/2689-999x/2021/1.1169
• Bando, J. (2024). Impact of marijuana use on lung health. Seminars in Respiratory and Critical Care Medicine. doi.org/10.1055/s-0044-1785679
• Centers for Disease Control and Prevention. (2020). Outbreak of lung injury associated with the use of e-cigarette, or vaping, products. Centers for Disease Control and Prevention. https://archive.cdc.gov/www_cdc_gov/tobacco/basic_information/e-cigarettes/severe-lung-disease.htm
• Dai, H. (2020). Self-reported marijuana use in electronic cigarettes among us youth, 2017 to 2018. Jama, 323(5), 473. https://doi.org/10.1001/jama.2019.19571
• Harati, R., Ellis, S.E., Satybaldiyeva N., Mejorado, T., Benitez, G., Henriksen, L., Leas, E. (2024). Online Retailer Nonadherence to Age Verification, Shipping, and Flavor Restrictions on E-Cigarettes. JAMA. doi:10.1001/jama.2024.21597
• Friedman, A. and Morean, M. (2021). State marijuana policies and vaping associated lung injuries in the us. Drug and Alcohol Dependence, 228, 109086. doi.org/10.1016/j.drugalcdep.2021.109086
• Malouff, J., Rooke, S., & Copeland, J. (2014). Experiences of marijuana-vaporizer users. Substance Abuse, 35(2), 127-128. doi.org/10.1080/08897077.2013.823902
• Navon, L., Ghinai, I., & Layden, J. (2020). Notes from the field: Characteristics of tetrahydrocannabinol–containing e-cigarette, or vaping, products used by adults — Illinois, September–October 2019. MMWR Morbidity and Mortality Weekly Report, 69(29), 973–975. doi.org/10.15585/mmwr.mm6929a5
• Pawar, A., Firmin, E., Wilens, T., Hammond, C. (2024). Systematic Review and Meta-Analysis: Medical and Recreational Cannabis Legalization and Cannabis Use Among Youth in the United States. Journal of the American Academy of Child & Adolescent Psychiatry, Volume 63, Issue 11, 1084 – 1113. DOI: 10.1016/j.jaac.2024.02.016
• Patrick, M. E., Miech, R. A., Johnston, L. D., & O’Malley, P. M. (2024). Monitoring the Future Panel Study annual report: National data on substance use among adults ages 19 to 65, 1976-2023. Monitoring the Future Monograph Series. Ann Arbor, MI: Institute for Social Research, University of Michigan. Available at: https://monitoringthefuture.org/results/annual-reports/

 

Source: Drug Free America Foundation | 333 3rd Ave N Suite 200 | St. Petersburg, FL 33701 US

Source: https://static1.squarespace.com/static/599a426ee45a7ccab72c77d2/t/5f3ad99ce4a6280272c97cb6/1597692318766/Marijuana_%2BA%2Bman%2Bmade%2Bdisaster.pdf April 2018

MEDICINAL cannabis has been the hottest of hot-button issues in medicine for some years now. It’s one the few medications where media hype and patient demand seem to have moulded – some would say muddied – the regulatory framework in a way that has troubled many clinicians.

In Australia, there are now three different pathways to legally accessing medicinal cannabis. The Category A Special Access Scheme (SAS) allows the importation of unregistered products on compassionate grounds, but requires import licences and customs clearance, while Category B SAS gives access to locally stored medicinal cannabis, but requires TGA and state review and approval. Specialists can also obtain an Authorised Prescriber status to prescribe cannabis – these will usually be either oncologists for cancer-related pain, or paediatric neurologists for the control of severe epilepsy in children.

But what is the evidence for medicinal cannabis, and is it sufficient for clinicians to feel comfortable prescribing it? These issues are explored in two articles published in the MJAone a Perspective from the Royal Australasian College of Physicians (RACP) and the other a Narrative Review on the challenges of prescribing cannabis for paediatric epilepsy, authored by researchers from the Sydney Children’s Hospital.

The RACP comes down on the side of caution. It notes that Australia, along with the rest of the world, is “navigating unchartered waters with pharmaceutical grade cannabinoids”, and that more research is needed before we can say whether or not cannabis has a place in contemporary medical practice.

In paediatric epilepsy, some of that research seems to be coming into focus. Last May, a randomised, double-blind trial of cannabidiol, a cannabis derivative that does not contain the psychoactive ingredient tetrahydrocannabinol, provided hard data for the first time that the treatment may work in children with Dravet syndrome – a severe form of childhood epilepsy with often drug-resistant seizures. This was followed by another trial, published last month in the Lancet, that showed similar efficacy of cannabidiol in Lennox–Gastaut syndrome, another form of paediatric epilepsy characterised by multiple seizure types.

Laureate Professor Ingrid Scheffer, who is Chair of Paediatric Neurology Research at The University of Melbourne and co-author of the trial of cannabadiol in Dravet syndrome, says that although her study does provide solid evidence for the drug’s efficacy, it should in no way be considered a miracle cure.

“It’s been sold as a magic bullet by the media. And you have families who are on a terrible rollercoaster, they’re vulnerable and medicinal cannabis is being cast as this drug that may save their child. And the answer is that it often does not. It may help, and in our study cannabidiol had a 43% responder rate, defined as at least a 50% reduction in the seizure frequency. But that’s exactly the same as some of the other drugs we use.”

But she says that doesn’t mean it shouldn’t be prescribed.

“Dravet syndrome is usually drug-resistant and you don’t know which drugs will work, so it could be worth trying if others have failed. But the families should be aware of its chances of success and the fact that it can have side effects.”

She says the key is more research.

“What people are accessing is very variable. They’re importing it from all over the place, they may even be getting friends to grow it in their backyard, so we do not know what they’re giving their child. What we need to do is go forward with more trials in different populations and with different formulations. If we’re going to invest in this, we need to know it works and we’re not wasting our health dollar on it.”

Professor Scheffer says that another drug currently being trialled, fenfluramine, may end up the more successful treatment. Trial results have yet to be published, but interim findings suggest that fenfluramine may have a dramatically higher responder rate of up to 70%.

Dr John Lawson, a Sydney-based paediatric neurologist and co-author of the Narrative Review on cannabis and childhood epilepsy, agrees that cannabidiol, though worth trying in some children, is no wonder drug.

“I’m not hanging my hopes on cannabidiol,” he says in an exclusive podcast for MJA Insight.

“I came in as quite a sceptic, but my attitude has changed. I now believe that it is an antiepileptic, but I’m not sure what place it has. It’s the early stages of development, and there are other compounds that haven’t been looked at.”

Dr Lawson says that he wouldn’t suggest it to a family until many other antiepileptics had already failed, and the chances of the next drug working were already low.

“I’ve come around to bringing it up in conversation because everyone knows about it, and families know I’ve prescribed it. But the biggest reason to not prescribe is cost. For a small child, it will cost over $1000 every couple of weeks to give a Therapeutics Goods Administration-approved product. Almost the only people I have prescribed it for are those who have an absolute ‘bucketload’ of money. Or I form a contract with them, and I say look, this will cost you $3000, but all the trials say you will know very quickly if it’s working or not.”

He says that in the patients who are helped by cannabidiol, the effect is still relatively modest.

“Patients are very rarely seizure-free. It may have a role in the future, once the hype has died down, but it will be a very low [on a list of preferred antiepileptics].”

 

Source:  https://www.doctorportal.com.au/mjainsight/2018/6/medicinal-cannabis-miracle-cure-or-media-hype/

This is the opening of a submission by Dr Stuart Reece to the FDA relating to the re-scheduling of cannabis:

 

“I am very concerned about the potential for increased cannabis availability in USA implied by full drug legalization; however, a comprehensive and authoritative submission of the evidence would take weeks and months to prepare. Knowing what we know now and indeed, what has been available in the scientific literature for a growing number of years concerning a myriad of harmful effects of marijuana, marijuana containing THC should not be reclassified. These effects that are now well documented in the scientific literature include, alarmingly, harm involving reproductive function and birth anomalies as a result of exposure to or use of marijuana with THC.

In addition to all of the usual concerns which you will have heard from many sources including the following I have further particular concerns:
1) Effect on developing brains
2) Effect on driving
3) Effect as a Gateway drug to other drug use including the opioid epidemic
4) Effect on developmental trajectory and failure to attain normal adult goals(stable relationship, work, education)
5) Effect on IQ and IQ regression
6) Effect to increase numerous psychiatric and psychological disorders
7) Effect on respiratory system
8) Effect on reproductive system
9) Effect in relation to immunity and immunosuppression
10) Effect of now very concentrated forms of cannabis, THC and CBD which are widely available
11) Outdated epidemiological studies which apply only to the era before cannabis became so potent and so concentrated 

These issues are all well covered by a rich recent literature including reviews from such major international authorities as Dr Nora Volkow Director of NIDA at NIH, Professor Wayne Hall and others “

 

The full text can be read here

Source: Letter from Dr Stuart Reece to FDA April 2018

Our research on the adverse effects of cannabis contributed to a major public debate and Government campaign to inform teenagers about the potential risks of cannabis.

Research led by Professors Terrie Moffitt, Avshalom Caspi, Philip McGuire, Sir Robin Murray, Louise Arseneault & Drs Paul Morrison & Marta Di Forti

Our research on the adverse effects of cannabis contributed to a major public debate and Government campaign to inform teenagers about the potential risks of cannabis.

Cannabis is the most widely used drug in the world, but its effect on mental health has only recently been uncovered.

Research led by Professors Terrie Moffitt and Avshalom Caspi demonstrated that the earlier people start using cannabis, the more likely they are to have symptoms of psychosis as a young adult. A study of 1,000 men and women in New Zealand showed that people who had been regular cannabis users at 15 were about four times more likely to have psychotic symptoms by the time they were 26 than their abstaining peers. The research also identified genetic variations that made people more vulnerable to the harmful effects of cannabis.

Further work led by Dr Marta Di Forti showed that people who smoke a potent form of cannabis (skunk) regularly are much more likely to develop psychosis than those who use traditional cannabis resin (hash) or old-fashioned grass.

Research led by Dr Paul Morrison helped explain why, by investigating the effects of the two main constituents of cannabis: THC (delta-9-tetrahydrocannabinol), the psychoactive ingredient that produces the ‘high’, and CBD (cannabidiol), which seems to moderate the effect of THC. Skunk contains much more THC than hash or old-fashioned grass and virtually no CBD. Our research illustrated that an injection of pure synthetic THC can induce transient symptoms of psychosis in people who have no experience of mental health problems.

‘Overall, our research in this area had a major impact on the perception of the risks of cannabis use on mental health,’ says Philip McGuire, Professor of Psychiatry and Cognitive Neuroscience.

In the wake of these studies and other evidence from around the world linking cannabis use with psychosis, the Home Secretary asked the UK Advisory Council on the Misuse of Drugs to review the legal classification of cannabis in 2007. Professor Murray submitted written evidence to this review and Dr Morrison, spoke at a review meeting about the effects of THC and CBD.

In 2008, the ACMD reported that the majority of its members thought cannabis should remain as a class C drug, but confirmed that the drug, particularly skunk, can damage people’s mental health, especially if young people start to use it an early age.

Despite the recommendation, the Government decided to tighten the law and in 2009 the Misuse of Drugs Act cannabis was amended and cannabis was re-classified from class C (considered the least harmful), to class B, making it illegal to possess cannabis, give to friends or sell it.

Following reclassification, the Department of Health launched a major TV, radio and online campaign to demonstrate the role cannabis can play in the development of mental health problems. The ‘Talk to Frank’ television adverts, aimed at young people, illustrated how cannabis can contribute to paranoia and damage mental health.

Although cannabis is still the most widely used illicit drug in Britain, its use has been steadily declining. The 2011/12 Crime Survey for England and Wales showed that 15.7 per cent of young people said they had used cannabis in the previous year, the lowest level since measurement began in 1996, when 26 per cent of young people said they had taken cannabis.

Additionally, our research into the effects of CBD and THC has also led to a partnership with the pharmaceutical industry to develop a new antipsychotic medication based on CBD.

Source: https://www.kcl.ac.uk/news/spotlight/uncovering-the-link-between-cannabis-and-psychosis

BY Lindsey Leake

August 27, 2024
While the modern marijuana consumer may be shedding that lazy stoner stereotype, new research shows that employees who use and abuse the drug are more likely to miss work.

The findings were published Monday in the American Journal of Preventive Medicine.

Work absences included days missed due to illness or injury in addition to skipped days when employees “just didn’t want to be there.” Respondents were a majority or plurality white (62%), male (57%), ages 35 to 49 (35%), married (52%), had at least a college degree (42%), and had an annual household income exceeding $75,000 (55%). About 16% of employees had reported using cannabis within the last month, with about 7% of whom meeting CUD criteria (mild: 4%; moderate: 2%; severe: 1%).

People who said they had never used cannabis missed an average 0.95 days of work in the past 30 days due to illness/injury and skipped 0.28 days. Cannabis users, by comparison, recorded the following absences:

  • Past-month use: 1.47 illness/injury, 0.63 skipped
  • Mild CUD: 1.74 illness/injury, 0.62 skipped
  • Moderate CUD: 1.69 illness/injury, 0.98 skipped
  • Severe CUD: 2.02 illness/injury, 1.83 skipped

The results also showed that people who used cannabis most frequently skipped the most work. For instance, those who consumed it once or twice per month skipped 0.48 days, while those who consumed it 20 to 30 days per month skipped 0.7 days. People who used cannabis three to five days per month had the highest prevalence of missed days due to illness/injury (1.68). Cannabis use longer than a month ago had no bearing on employee absence.

“These findings highlight the need for increased monitoring, screening measures, and targeted interventions related to cannabis use and use disorder among employed adults,” researchers wrote. “Moreover, these results emphasize the need for enhanced workplace prevention policies and programs aimed at addressing and managing problematic cannabis use.”

Researchers said that while their latest work supports much of the existing literature on cannabis use and workplace absenteeism, it also contrasts with other studies. One previous study, for example, showed a decline in sickness-related absences in the wake of medical marijuana legislation, while another found no link between the two.

One limitation of the new study, the authors note, is that it relied on participants’ self-reported answers. In addition, the data don’t reflect whether cannabis was used for medicinal or recreational purposes, whether it was consumed during work hours, or address other factors that may have affected a person’s cannabis use patterns.

What are the signs of cannabis use disorder?

That marijuana isn’t addictive is a myth. People with CUD are unable to stop using cannabis even when it causes health and social problems, according to the Centers for Disease Control and Prevention (CDC). Cannabis consumers have about a 10% likelihood of developing CUD, a disorder impacting nearly a third of all users, according to previous research estimates. At higher risk are people who start using cannabis as adolescents and who use the drug more frequently.

The CDC lists these behaviors as signs of CUD:

  • Continuing to use cannabis despite physical or psychological problems
  • Continuing to use cannabis despite social or relationship problems
  • Craving cannabis
  • Giving up important activities with friends and family in favor of using cannabis
  • Needing to use more cannabis to get the same high
  • Spending a lot of time using cannabis
  • Trying but failing to quit using cannabis
  • Using cannabis even though it causes problems at home, school, or work
  • Using cannabis in high-risk situations, such as while driving a car
  • Using more cannabis than intended

In addition to interfering with everyday life, CUD has been linked to unemployment, cognitive impairment, and lower education attainment. People with CUD often have additional mental health problems, including other substance abuse disorders. In this study, for example, 14% of respondents reported having alcohol use disorder within the past year.

 

Source:  https://fortune.com/well/article/marijuana-abuse-cannabis-use-disorder-workplace-absenteeism-sick-days/

With the increasing legalization of recreational marijuana across various states, employers need to proactively prepare for the changes and their implications on the workplace. As more states allow adults to legally purchase and possess marijuana, it’s essential for employers to review and update their workplace policies to ensure compliance and maintain a safe work environment.

Despite legalization, employers can still prohibit marijuana use that leads to impairment at work, akin to alcohol restrictions. Recent legal decisions, such as White v. Timken Gears & Servs., Inc. in Illinois, reinforce that a positive drug test for marijuana while working, even if used recreationally off-duty, can justify termination if it violates a reasonable and consistently applied workplace policy. This underscores the importance of clear, fair, and legally sound drug and alcohol policies to ensure workplace safety.

  • The first step is to reevaluate your drug testing protocols. Ensure they align with both state and federal regulations, particularly if your industry is governed by specific mandates, such as those from the Department of Transportation. Consider your agreements with insurance carriers, as marijuana testing might be a condition of coverage or discounts.
  • Testing for marijuana presents unique challenges due to the limitations of current testing methods. Talk with your testing laboratory to understand the differences between qualitative and quantitative tests and determine which best supports your workplace policies.
  • Evaluate whether to implement second chance agreements for employees who test positive for marijuana. Additionally, consider providing access to substance abuse programs. These measures can help manage employees who might struggle with marijuana use while offering them a chance to comply with workplace policies.
  • Update your policies in your employee handbook, workers’ compensation policies, and other relevant documents to clearly state that while marijuana may be legal, it is prohibited in the workplace. Clearly outline that possession or use of marijuana at the worksite is forbidden and that employees are not permitted to use marijuana during lunch or other breaks. Specify the consequences of violating these policies to ensure there are no ambiguities.
  • Hold meetings to communicate the company’s stance and expectations regarding marijuana use to all employees. Transparency is key; ensure employees understand the policies, the reasons behind them, and the consequences of non-compliance. Clear communication helps in setting the right expectations and reduces misunderstandings.
  • Conduct comprehensive training sessions for HR professionals, managers, and supervisors on the company’s policies regarding marijuana use. Ensure that all managerial staff understand the testing protocols and disciplinary policies. Training should also cover how to handle conversations with employees about marijuana use, ensuring consistency and sensitivity. Equip your managers with the skills to recognize signs of impairment at work. Understanding how to identify and address employees who might be under the influence of marijuana is crucial for maintaining workplace safety. Provide clear guidelines on the steps to take if impairment is suspected. Check out our trainings here!

The increasing state legalization of recreational marijuana marks a significant change for employers. By proactively updating your drug testing protocols, policies, training programs, and communication strategies, you can effectively manage the impact of this new legislation on your workplace. Staying informed and prepared will help you navigate this evolving landscape while ensuring a safe and compliant work environment.

Sources:

Federal court rules employer did not violate Illinois privacy law for firing worker testing positive for cannabis. (2024, July 30). JD Supra. https://www.jdsupra.com/legalnews/federal-court-rules-employer-did-not-4849901/

 

NATIONAL DRUG-FREE WORKPLACE ALLIANCE

As the workplace division of Drug Free America Foundation, NDWA’s mission is to be a national leader in the drug-free workplace industry by directly assisting employers and stakeholders, providing drug-free workplace program resources and assistance, and supporting a national coalition of drug-free workplace service providers.

Source:  www.ndwa.org

Past-year use of cannabis and hallucinogens stayed at historically high levels in 2023 among adults aged 19 to 30 and 35 to 50, according to the latest findings from the Monitoring the Future survey. In contrast, past-year use of cigarettes remained at historically low levels in both adult groups. Past-month and daily alcohol use continued a decade-long decline among those 19 to 30 years old, with binge drinking reaching all-time lows. However, among 35- to 50-year-olds, the prevalence of binge drinking in 2023 increased from five and 10 years ago. The Monitoring the Future study is conducted by scientists at the University of Michigan’s Institute for Social Research, Ann Arbor, and is funded by the National Institutes of Health.

 

Source: https://monitoringthefuture.org/

 

Substance use and mental health are topics that touch nearly every community, with millions across the world affected each year. In 2022 alone, approximately 168 million Americans used some type of substance such as tobacco, alcohol or illicit drugs with 48.7 million reporting suffering from a substance use disorder (SUD). Among illicit drugs, marijuana was the most used, with approximately 22% of people aged 12 or older using it in the past year. But behind these numbers are real lives impacted by a complex relationship between drug use and mental health. For instance, nearly one million adolescents were found to have co-occurring major depressive disorders (MDE) and SUDs, while 21.5 million adults struggled with both a mental illness and SUD.

 

As marijuana use becomes more normalized it is important to consider the consequences on our mental well-being. Research has shown that past-year marijuana use is a significant risk factor for suicidal thoughts and behaviors among adolescents with the risks increasing as the frequency of use rises. In addition, following legalization in the state of Washington, the prevalence of marijuana use among 8th and 10th graders increased compared to pre-legalization levels. This presents further concern given the link between high potency marijuana and psychosis—a known predictor of suicidal behavior. Additionally, studies show that adolescents who recently used marijuana had nearly twice the odds of attempting suicide compared to non-users. Similar risks are present in those using amphetamines, cigarettes, and alcohol, especially when substance use begins at an early age.

 

Further research supporting these concerns have consistently found that individuals who engage in substance use are at an increased risk for suicidal ideation attempts. For example, studies suggest that drug use can impair judgement and diminish impulse control, making users more vulnerable to suicidal thoughts and behaviors. This is further supported by findings showing that individuals with substance use disorders are six times more likely to attempt suicide compared to those who do not use substances. The combination of altered brain chemistry, mental health struggles, and poor decision-making can create a dangerous spiral, leading to devastating outcomes.

 

As substance use and suicide remain closely intertwined, with research consistently showing a strong correlation between the two, it becomes essential to raise awareness, promote early interventions, and ensure access to comprehensive treatment so we can help save lives and provide hope to those in need.

 

If you or someone you know is struggling with substance use or suicidal thoughts, please reach out for help. The National Suicide and Crisis Lifeline is available 24/7 at no cost, call 988 if you need to talk to someone. The Substance Abuse and Mental Health Service Administration (SAMHSA) offers a helpline at 1-800-662-HELP (4357).

 

Source: Drug Free America Foundation | 333 3rd Ave N Suite 200 | St. Petersburg, FL 33701 US

The following is an extract from an email by Stuart Reece to Drug Watch International (DWI)

It seems to me that the main pillars of this argument rest on the following primary evidentiary supports:

  1. AGEING (spelt “aging” in the USA)  is often defined as an accumulation of deleterious changes over time.  What is the toxicopathology of cannabis characterized by?? An accumulation of deleterious changes over time – which is obviously the same;
  2. The multi-system and panorganismal nature of the cannabis related changes is strong clinical evidence that rather than a process limited just to one organ – such as the brain – what we are actually seeing is indicative of a deeper change across all cells, which likely manifests in certain organ specific ways.  This is the list of organ damage below.
  3. A concatenation of age-defining illnesses:
  1. The arterial toxicity of cannabis is a very big deal because it is one of the major hallmarks of ageing – most people in industrialized nations die from stroke or heart attack, and arterial ageing is the major surrogate for organismal / biological ageing.  So arterial ageing – far from being a curiosity in the cannabis literature – assumes massive importance in general medical terms
  2. The association of cannabis with ten cancers is massive.  Cancer is also an age defining disease.  So one cannot say that cancer is associated with cannabis and so what – this is a very big deal indeed.  Cancer is one of the major age defining diseases
  3. Immunopathy.  By stimulating the immune system cannabis increases one of the major ageing pathways.  The pro-inflammatory actions of     cannabis are now well documented.  In ageing medicine this is described as “inflamm-aging.”  It is a major pathway to ageing and age related disease, and is known to be linked with high death rates.  Cannabis is usually described as being immunosuppressive.  But we are learning that the immune system is a very complex place.  It is like a trampoline mat.  If it goes down in one place it will go up in another.  Hence patients with immune compromising disorders like rheumatoid arthritis and systemic lupus get immune complications and autoimmune diseases – including cancer.
  4. Negative effect on stem cell division.  Obviously we need our stem cells healthy so that we can stay healthy.  Cannabis advocates cannot have their cake and eat it too.  They propose it as a cancer remedy because it stops cell division.  Well if you accept that argument then you must also accept that its effect on cell division is negative which has a catastrophic implication for general stem cell health in all tissue beds
  5. The effects on children.  If children are born with mental compromise, paediatric cancers, and foetal malformations then that is a sign of infantile induction of ageing both by definition – since cancer defines age related disease – and since this is obviously an accumulation of deleterious ages in the paediatric age group.
  6. Genotoxicity. The association of cannabis with both cancer, congenital malformations, mental retardation in offspring and congenital cancers becomes strong presumptive evidence for genotoxicity.  This is one of the best described pathways to cellular and organismal ageing.  Congenital cancers (rhabdomyosarcoma, leukaemia and neuroblastoma) are ALWAYS due to genetic defects inherited from parents or earlier generations
  7. Epigenotoxicity.  As you are aware it is now a matter of record that cannabis has now well documented epigenetic changes (Szutorisz 2018; Neuroscience Behav Rev 85: 93).  The epigenetic levels is one of the strongest hypothesized levels for ageing.  In truth it interacts strongly with the metabolome (since that supplies its substrates) and the genome (since epigenetics seems to often determine sites of DNA cutting and gene splicing both in normal cells and in cancer).  The epigenetic signature of cannabis has even been traced through sperm (Lombard).  Hence ageing has an epigenetic signature and so too does cannabis.  Whilst the two have NOT been formally compared to my knowledge, in view of the above it seems more than likely that significant overlap will be found. Indeed cannabis induced changes in some major epigenetic enzymes, particularly Sirt2 – likely the best age-documented enzyme ever – were documented by Quinn (2008; Neuropsychopharmacology 33:1113).  Inheritable epigenetic immunotoxicity was also documented by Lombard C (2011; JPET 339:607)

Source: Email from Stuart Reece to Drug Watch International drug-watch-international@googlegroups.com February 2018

By , CNN  / Sat August 10, 2024

Using marijuana daily for years may raise the overall risk of head and neck cancers three- to five-fold, according to a new study that analyzed millions of medical records.

“Our research shows that people who use cannabis, particularly those with a cannabis use disorder, are significantly more likely to develop head and neck cancers compared to those who do not use cannabis,” said senior study author Dr. Niels Kokot, a professor of clinical otolaryngology-head and neck surgery at the Keck School of Medicine at the University of Southern California in Los Angeles.

“While our study did not differentiate between methods of cannabis consumption, cannabis is most commonly consumed by smoking,” Kokot said in an email. “The association we found likely pertains mainly to smoked cannabis.”

Some 69% of people with a diagnosis of oral or throat cancer will survive five years or longer after their diagnosis, according to the National Cancer Institute. If the cancer metastasizes, however, that rate drops to 14%. About 61% of people diagnosed with cancer of the larynx will be alive five years later — a rate that drops to 16% if the cancer spreads.

The study used insurance data to look at the association of cannabis use disorder with head and neck cancers, said Dr. Joseph Califano, the Iris and Matthew Strauss Chancellor’s Endowed Chair in Head and Neck Surgery at the University of California, San Diego. He was not involved in the study.

“The researchers used a huge, huge dataset, which is really extraordinary, and there is enormous power in looking at numbers this large when we typically only see small studies,” said Califano, who is also the director of UC San Diego’s Hanna and Mark Gleiberman Head and Neck Cancer Center.

“On average, people with cannabis use disorder smoke about a joint today and do so for at least a couple years, if not longer,” said Califano, who coauthored an editorial published Thursday in JAMA Otolaryngology–Head & Neck Surgery in conjunction with the new study.

However, he added, the study does not find an association between “the occasional recreational use of marijuana and head and neck cancer.”

Just like tobacco, smoking marijuana raise the risk of head and neck cancers, experts say.

Causes of head and neck cancers

In the United States, head and neck cancers make up 4% of all cancers, with more than 71,000 new cases and more than 16,000 deaths expected in 2024, according to the National Foundation for Cancer Research.

Tobacco use, which includes smoking cigarettes, cigars, pipes and smokeless tobacco, and the use of alcohol are the two most common causes of head and neck cancers, experts say. Other risk factors include poor oral hygiene;gastroesophageal reflux disease, or GERD; a weakened immune system; and a diet low in fruits and vegetables. Occupational risk factors include exposure to asbestos and wood dust.

Epstein-Barr virus is linked to infectious mononucleosis, also called the “kissing disease,” as well as various cancers. Researchers estimate that 90% of the world’s population is infected with EBV.  A vaccine is available for HPV, which is linked to a high risk of developing cervical cancer and some non-Hodgkin lymphomas.

It’s possible to be infected with both viruses at once, and that combination is responsible for 38% of all virus-associated cancers, according to research.

How might cannabis cause cancers?

The study, published Thursday in JAMA Otolaryngology–Head & Neck Surgery, analyzed a database of 4 million electronic health records and found more than 116,000 diagnoses of cannabis use disorder among people with head and neck cancers. Those men and women, whose average age was 46, were then matched with people who also had head and neck cancers but were not diagnosed with cannabis use disorder.

The analysis showed that people with cannabis use disorder were about 2.5 times more likely to develop an oral cancer; nearly five times more likely to develop oropharyngeal cancer, which is cancer of the soft palate, tonsils and back of the throat; and over eight times more likely to develop cancer of the larynx. The findings held true for all age groups, according to the study.

Due to the way marijuana is smoked — unfiltered and breathed in deeply and held in the lungs and throat for a few seconds — the risk from cannabis smoke could be even greater, experts say.

Another key to the puzzle of how cannabis causes cancer: Research has found a link between various cannabinoids and tumor growth. There are more than 100 cannabinoids — biological compounds in the cannabis plant that bind to cannabinoid receptors in the human body, according to the National Center for Complementary and Integrative Health. All told, there are about 540 chemicals in each marijuana plant.

Tetrahydrocannabinol, or THC, is the substance that makes one euphoric, while cannabidiol, or CBD, has been shown to have medicinal uses for childhood seizures and epilepsy.

“Part of the research we have already published shows that THC or THC-like compounds can certainly accelerate tumor growth,” Califano said. “We also have some data to show that cannabinoids enhance the growth of HPV-related throat cancers.

“Especially as (marijuana) becomes more widely legalized and socially accepted, we may see a corresponding rise in head and neck cancer cases if the association is confirmed,” he said.

“This underscores the importance to inform people about the potential risks and conduct further research to understand the long-term impacts of cannabis use on cancer development.”

Source:  https://edition.cnn.com/2024/08/08/health/marijuana-head-and-neck-cancer-wellness/index.html

 

Drug gangs recruiting hundreds of compatriots arriving across Channel to work for multimillion-pound operations

by Charles Hymas      Home Affairs Editor  – Daily Telegraph  (UK) – 28 September 2024 12:00pm

Albanian migrants are recruited as workers in illegal cannabis ‘farms’ set up in rented houses or disused industrial buildings.

Hundreds of Albanians who crossed the Channel on small boats have helped their drug gangs secure a stranglehold on Britain’s cannabis market.

They have been recruited as workers in illegal cannabis “farms” set up in rented houses or disused industrial buildings to produce crops worth up to £2 million a time and which can be grown and harvested in as little as 12 weeks.

The industrial scale of the cannabis production has been revealed by an undercover investigation into a secret channel on the encrypted messaging service Telegram. It is used by more than 700 Albanians to share intelligence on their cannabis operations.

Conversations between members of the group centre on the best chemicals for plant growth, the most effective way to harvest cannabis plants, the economics of securing properties for drug production and why crossbows are better than guns to defend their crops from rival gangs.

Members of the group recount robberies where cannabis “farm” workers have had their fingers cut off and landlords have demanded five-figure shares of the profits.

The National Crime Agency (NCA) said that the ruthless professionalism that the Albanians have brought to cannabis farming has enabled them to displace the Vietnamese as the main domestic providers of the drug in Britain.

Albanian gangs who previously specialised in cocaine moved into cannabis because it was “very, very low-risk”.

It turns a good profit because of high demand – Britons consume 240 tonnes of the drug, worth £2.4 billion, a year – and does not require risky cross-border transportation because it is homegrown, according to the NCA.

The surge in Albanians crossing the Channel in 2022, when 12,685 reached the UK in small boats, has provided the ready supply of illegal workers, skilled in the hydroponic technology required to grow the plants in the darkened rooms of houses where all the windows have been sealed.

It has led to increasing focus by police on the domestic production of cannabis. Some 29 Albanians were sentenced in July alone for illegally producing the drug. That was followed by a further 24 Albanians appearing before the courts in August. That represents nearly one a day.

Some 101 illegal Albanian migrants were sentenced to more than 300 years in jail in three months at the end of last year. Three-quarters of them were convicted of offences linked to cannabis production across England and Wales in indoor farms.

Many of the illegal migrants were recruited by the gangs after a government crackdown on black economy work made it difficult for them to find jobs.

Fines for bosses who employ illegal migrants have tripled to up to £60,000 per worker to make the practice so economically damaging that it could “put them out of business”. Police are concerned that Telegram has become a go-to platform for criminals. It has 900 million users but only about 100 employees. Pavel Durov, Telegram’s Russian-born founder, was detained in France this summer over its alleged failure to fight the use of the service for crime, including the spread of child sex abuse material.

The Albanians’ channel goes under the name Kusho, which means “cousin” and is the nickname Albanians use to address each other.

It currently has 703 members who share information about how to produce the maximum amount of cannabis from seed to full-grown plant.

Posts on the channel were collected by an Albanian reporter who infiltrated the group. “Everyone, you need to know how to grow ‘roses’,” said one of the organisers of the channel.

Another member listed the six key chemicals that had proved the most effective for fast, healthy growth.

One video demonstrated the best way to trim the dead leaves from a cannabis plant, while one member, using the pseudonym Bushi06, offered cannabis seedlings for £5 and boasted that he had sold 700 so far.

In discussions on how to protect the “farms”, one Albanian explained that it was better to spend £337 on a high-powered crossbow than a gun, because being caught in possession would carry a lesser sentence.

Some appeared less worried about police discovering their illegal operations than being attacked and robbed by rival gangs.

“Most robberies in the cannabis houses are happening in Leicester. They cut off the fingers of an Albanian worker,” said one member of the group.

“Police are not the big problem,” said a London-based Albanian using the pseudonym Deni. “The main problem is robbers who are now using drones to identify the houses. They detect the heat from the plants through the roofs of the houses.”

Others complained that landlords were overcharging them for the use of their properties or demanding a cut of the profits. “London landlords are charging £4,000 a month for a house. Not worth it at all,”  said one.

Another said: “So far I have invested £31,000 in a house including 12K for sealing it up, and 12K for the lights. Do not know if I will get my money back. The agency who rented me the house are asking for £9,000 when the product is ready for harvesting.”

Last summer, police launched Operation Mille to target cannabis farms in the UK. Among those jailed was Nard Nidri, 34, who entered the UK illegally in 2022 and lived in Birmingham, then moved to Swansea, where he worked at a car wash, before being recruited for a cannabis farm.

He was one of four “gardeners” jailed for a combined total of six years in August after police arrested them at a property in Neath, south Wales. Two rooms and the attic had been adapted and insulated to grow plants with a street value of £85,000.

Sentencing them, Judge Geraint Walters said cannabis farms being run by Albanian criminal gangs had reached “epidemic levels” and had, in his judgment, “become something of an industry”.

He suggested that authorities should look at the rental housing sector, noting that while so-called cannabis “farmers” often appeared in court, landlords and others receiving money from the rent of properties being used for the growing operations rarely did so.

__

Source: https://www.telegraph.co.uk/news/2024/09/28/how-albanian-migrants-have-taken-over-uk-cannabis-market/

 

Herschel Baker of Drug Free Australia has shared research references showing links between marijuana use and violence across the globe.

 

  1. A Review of Cases of Marijuana and Violence

The main scope of this paper was to inform the general public about the relationships between marijuana and violence in the general population and in individuals with mental illnesses, as recent findings do link marijuana with cases where psychosis was present. This article is a case review and not a research study; therefore, the chief limitations regard inferences that can be made from a case study. However, the findings suggest a further need for research on marijuana and violence. The authors of this paper did not intend to take sides regarding the legalization of marijuana. The focus was public health in regards to marijuana [2,11,14,18,36]. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7084484/

  1. The Relationship Between Marijuana Use and Intimate Partner Violence in a Nationally Representative, Longitudinal Sample   These findings have a number of implications for intimate partner violence prevention. First, given that any marijuana use appears to increase the risk for intimate partner violence, violence-prevention strategies should include early and continued marijuana prevention efforts in existing intimate partner violence treatment and prevention programming. Second, knowledge regarding the link between marijuana use and intimate partner violence could be used to inform domestic violence treatment providers of issues related to intimate partner violence recidivism. If early and continual marijuana treatment is emphasized as an important component of domestic violence treatment, then repeat occurrences of intimate partner violence among marijuana users may be reduced. Third, recognizing that there is a shared overlap between intimate partner violence perpetration and victimization and that marijuana use is a strong predictor for experiencing both outcomes, programs and policies that incorporate the complex relationship between marijuana and intimate partner violence could be developed to offer a more comprehensive treatment regimen. These holistic approaches are likely to be more beneficial than the current programs that are often “client specific” (e.g., they only serve drug users, or victims, or perpetrators; Karmen, 2007). Fourth, the finding that males are at increased risk for intimate partner vioence indicates that males should be included in intimate partner violence prevention programming, which has traditionally been reserved for women. Culturally specific programming may also be relevant, as different risk fac[1]tors may be present for Blacks compared with other groups, which may increase their risk for intimate partner violence. Future research is necessary to delineate these cultural-specific risk factors. Finally, the findings from this study may shed light on the potential harms of legislation legalizing marijuana use, as increased access to marijuana may increase use and, therefore, increase the harm associated with marijuana use (e.g., domestic violence, chronic diseases, and unintentional injuries). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3782298/.

3, Association Between the Use of Cannabis and Physical Violence in Youths: A Meta-Analytical Investigation  https://ajp.psychiatryonline.org/doi/10.1176/appi.ajp.2020.19101008These results demonstrate a moderate association between cannabis use and physical violence, which remained significant regardless of study design and adjustment for confounding factors (i.e., socioeconomic factors, other substance use). Cannabis use in this population is a risk factor for violence. A large study just published by a team from Montreal University in Canada has found that people who regularly smoke cannabis are almost three times more likely to commit a violent offence as those who abstain from the drug. The paper entitled “Association Between the Use of Cannabis and Physical Violence in Youths: A Meta-Analytical Investigation” and published in the American Psychiatric Association’s (APA) American Journal of Psychiatry did a meta-analysis of 30 studies which covered 296,815 people up to the age of 30. The study found that over time, prolonged cannabis use profoundly alters the brain, making the user less able to control their temper, and that addicts may also suffer from withdrawal symptoms, making them irritable and prone to lashing out. Psychiatrist Professor Sir Robin Murray, a world-leading expert on the neurological impact of the drug, was quoted in the media saying that the link between cannabis use and violence was a ‘neglected area’. The researchers say that while ‘the [scientific] literature has shown that cannabis use may lead to violent behaviours and aggression; however, this association has been inconsistent’ – with some studies showing a relationship and others not – their meta-analysis found users were more than twice as likely (2.15 times) to have committed a violent offence as non-users. Among ‘persistent heavy users’, the risk of violence was 2.81 times higher.

  1. Think Ya Know? Is Marijuana a Risk Factor for Violence? https://saynopetodope.org.nz/family-violence-child-abuse/
  1.  Association Between the Use of Cannabis and Physical Violence in Youths: A Meta-Analytical Investigationhttps://ajp.psychiatryonline.org/doi/10.1176/appi.ajp.2020.19101008These results demonstrate a moderate association between cannabis use and physical violence, which remained significant regardless of study design and adjustment for confounding factors (i.e., socioeconomic factors, other substance use). Cannabis use in this population is a risk factor for violence.
  2. Association of Cannabis Use With Self-harm and Mortality Risk Among Youths With Mood Disordershttps://jamanetwork.com/journals/jamapediatrics/article-abstract/2775255?utm_campaign=articlePDF&utm_medium=articlePDFlink&utm_source=articlePDF&utm_content=jamapediatrics.2020.5494 Cannabis use disorder is a common comorbidity and risk marker for self-harm, all-cause mortality, and death by unintentional overdose and homicide among youths with mood disorders. These findings should be considered as states contemplate legalizing medical and recreational marijuana, both of which are associated with increased CUD.
  3. Cannabis and Cannabinoids in Mood and Anxiety Disorders: Impact on Illness Onset and Course, and Assessment of Therapeutic Potentialhttps://pubmed.ncbi.nlm.nih.gov/31577377/ Forty-seven studies were included: 32 reported on illness onset, nine on illness course, and six on cannabinoid therapeutics. Cohort studies varied significantly in design and quality. The literature suggests that cannabis use is linked to the onset and poorer clinical course in bipolar disorder and PTSD, but this finding is not as clear in depression and anxiety disorders (ADs). There have been few high-quality studies of cannabinoid pharmaceuticals in clinical settings.
  4. Association of Cannabis Use in Adolescence and Risk of Depression, Anxiety, and Suicidality in Young Adulthood A Systematic Review and Meta-analysis https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2723657?utm_campaign=articlePDF&utm_medium=articlePDFlink&utm_source=articlePDF&utm_content=jamapsychiatry.2018.4500 Although individual-level risk remains moderate to low and results from this study should be confirmed in future adequately powered prospective studies, the high prevalence of adolescents consuming cannabis generates a large number of young people who could develop depression and suicidality attributable to cannabis. This is an important public health problem and concern, which should be properly addressed by health care policy.
  5. Young-adult compared to adolescent onset of regular cannabis use: A 20-year prospective cohort study of later consequenceshttps://pubmed.ncbi.nlm.nih.gov/33497516/ Initiation of regular cannabis use after high school strongly predicted smoking and illicit drug use in the mid-30s. This group also accounted for a higher proportion of illicit drug use and smoking in the cohort. Sensitivity analyses suggested that this association was at least partially causal. Given the legalisation of cannabis use in an increasing number of jurisdictions, we should increasingly expect harms from cannabis use to lie in those commencing use in young adulthood.

10  Association between Alcohol, Cannabis and Other Illicit Substance Abuse and Risk of Developing Schizophrenia: A Nationwide Population Based Register Study https://www.cambridge.org/core/journals/psychological-medicine/article/abs/association-between-alcohol-cannabis-and-other-illicit-substance-abuse-and-risk-of-developing-schizophrenia-a-nationwide-population-based-register-study/8914A1F1A0CBFBF17982720CBE2C2451 In conclusion, the consumption of substances is an extensive problem throughout the world and a current debate on legalizing cannabis in many countries has made uncovering the risk of abusing substances an important area of investigation (21,36). We found robust associations between a wide variety of substance abuse and an increased risk of developing schizophrenia. We are not aware of any other study focusing on the effect of such a wide variety of substance abuse and the interaction between the abuses as our study.

  1. Association of High-Potency Cannabis Use With Mental Health and Substance Use in Adolescence https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2765973 In conclusion, the consumption of substances is an extensive problem throughout the world and a current debate on legalizing cannabis in many countries has made uncovering the risk of abusing substances an important area of investigation (21,36). We found robust associations between a wide variety of substance abuse and an increased risk of developing schizophrenia. We are not aware of any other study focusing on the effect of such a wide variety of substance abuse and the interaction between the abuses as our study.
  1. Cannabis use and violence in patients with severe mental illnesses: A metanalytical investigation https://pubmed.ncbi.nlm.nih.gov/30780061/

With the upcoming policy changes on cannabis internationally such as the 2018 Canadian legalization of cannabis, it is of high importance to better investigate its potential harmful effects on violence mostly in more vulnerable psychiatric populations to devise effective interventions. Cannabis use should be considered in violence risk prevention and management.

  1. Professor Dame Carol Black Inquiry Violence Stories Violent deaths/injuries caused by cannabis users

https://www.cannabisskunksense.co.uk/uploads/site-files/Professor_Dame_Carol_Black_Inquiry_Cannabis_Violent_stories.pdfMales 53 Females 5 Methods: Stabbings: 19 Shootings: 21 Killing by hand: 4 (eg. Throttling, Beating, Battering, Jaw breaking) Axe: 1 Drowning: 1 Beheading: 2 Chased/run down by vehicle: 2 Bombings: 4 Victims: Relatives: 17 Strangers: 25 Friends: 6 Obama: 1 Mass killings 11 Possible Links with terrorists 6

  1. Attacker Smoked Cannabis: suicide and psychopathic violence in the UK and Ireland“Those whose minds are steeped in cannabis are capable of quite extraordinary criminality.” https://attackersmokedcannabis.com/
  1. Easton Woodhead suffering from marijuana-smoking psychosis in the lead-up to killing of homeless man Wayne Perry

https://www.theage.com.au/national/victoria/easton-woodhead-suffering-from-marijuanasmoking-psychosis-in-the-leadup-to-killing-of-homeless-man-wayne-perry-20150302-13shuy.html

  1. At Least Eleven Pot-Related Homicides Since Legalization, DA    George Brauchler    Sayshttps://www.westword.com/news/marijuana-related-homicides-in-colorado-since-legalization-9345285
  2. Marijuana Is More Dangerous Than You Think https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6461328/

Some population-level data does exist, though. Research from Finland and Denmark, two countries that track mental illness more accurately, shows a significant increase in psychosis since 2000, following an increase in cannabis use. And last September, a large survey found a rise in serious mental illness in the U.S. too. In 2017, 7.5% of young adults met the criteria for serious mental illness, double the rate in 2008.

A 2012 paper in the Journal of Interpersonal Violence, examining a federal survey of more than 9,000 adolescents, found that marijuana use was associated with a doubling of domestic violence in the U.S. A 2017 paper in the journal Social Psychiatry and Psychiatric Epidemiology, examining drivers of violence among 6,000 British and Chinese men, found that drug use was linked to a fivefold increase in violence, and the drug used was nearly always cannabis.

Source: https://www.dbrecoveryresources.com/2024/08/marijuana-and-violence-2/

Tuesday, July 30, 2024

Today, the U.S. Department of Health and Human Services’ (HHS) Substance Abuse and Mental Health Services Administration (SAMHSA) released the results of the 2023 National Survey on Drug Use and Health (NSDUH), which shows how people living in United States reported their experience with mental health conditions, substance use and pursuit of treatment. The 2023 NSDUH report includes selected estimates by race, ethnicity and age group. The report is accompanied by two infographics offering visually packaged highlight data as well as visual data by race and ethnicity.

“Each year, data from the annual NSDUH provides an opportunity to identify and address unmet healthcare needs across America. We’re pleased to see that more people received mental health treatment in 2023 than the previous year,” said Miriam E. Delphin-Rittmon, Ph.D., HHS Assistant Secretary for Mental Health and Substance Use and the leader of SAMHSA. “Also, to build upon increasing accessibility to data, this year’s release features two infographic reports: one focusing on race and ethnicity and one highlighting selected overall data.”

The 2023 NSDUH Report includes the following selected key findings.

Mental Health:

  • Among adults aged 18 or older in 2023, 22.8% (or 58.7 million people) had any mental illness (AMI) in the past year.
  • 4.5 million youth (ages 12 to 17) had a major depressive episode in the past year, of which nearly 1 in 5 also had a substance use disorder.
  • Among adults aged 18 or older in 2023, 5.0% (or 12.8 million people) had serious thoughts of suicide, 1.4% (or 3.7 million people) made a suicide plan, and 0.6% (or 1.5 million people) attempted suicide in the past year.
  • Multiracial adults aged 18 or older were more likely than adults in most other racial or ethnic groups to have AMI, serious mental illness (SMI), and serious thoughts of suicide.
  • Estimates of suicidal thoughts and behaviors among adults in 2023 were comparable to 2022 and 2021.

Substance Use:

  • In 2023, 3.1% of people (8.9 million) misused opioids in the past year, which is similar to 2022 and 2021 (3.2% and 8.9 million, 3.4% and 9.4 million respectively).
  • Among the 134.7 million people aged 12 or older who currently used alcohol in 2023, 61.4 million people (or 45.6%) had engaged in binge drinking in the past month.
  • Marijuana was the most commonly used illicit drug, with 21.8% of people aged 12 or older (or 61.8 million people) using it in the past year.
  • American Indian or Alaska Native and Multiracial people were more likely than most other racial or ethnic groups to have used substances or to have had an SUD in the past year.
  • In 2023, 9.4% of people aged 12 or older vaped nicotine in the past month, up from 8.3% in 2022.
    • In the past year, more people initiated vaping (5.9 million people) compared to any other substance.
    • Nicotine vaping estimates from 2021 are not comparable with estimates from 2022 and 2023.

Services and Recovery:

  • 31.9% of adolescents aged 12 to 17 (or 8.3 million people) received mental health treatment in the past year, an increase of more than 500,000 from 2022.
  • 23.0% of adults aged 18 or older (or 59.2 million people) received mental health treatment in the past year, an increase of 3.4 million from 2022.
  • Among people aged 12 or older in 2023 who were classified as needing substance use treatment in the past year, about 1 in 4 (23.6% or 12.8 million people) received substance use treatment in the past year. People were classified as needing substance use treatment in the past year if they had a substance use disorder (SUD) or received substance use treatment in the past year.
  • 30.5 million adults aged 18 or older (or 12.0%) perceived that they ever had a substance use problem. Among these adults, 73.1% (or 22.2 million people) considered themselves to be in recovery or to have recovered.
  • 64.4 million adults aged 18 or older (or 25.3%) perceived that they ever had a mental health issue. Among these adults, 66.6% (or 42.7 million people) considered themselves to be in recovery or to have recovered.
  • There were no racial ethnic differences among adults aged 18 or older in 2023 who perceived that they ever had a substance use problem or problem with their mental health who considered themselves to be in recovery or to have recovered from their drug or alcohol use problem or mental health issue.

About the National Survey on Drug Use and Health

Conducted by the federal government since 1971, the NSDUH is a primary source of statistical information on self-reported substance use and mental health of the U.S. civilian, noninstitutionalized population 12 or older. For the 2023 NSDUH national tables and some reports, statistical testing was conducted between estimates from different years (e.g., past month alcohol use in 2023 vs. the estimate in 2022). Where testing involved 3 years of comparable data for 2021 to 2023, pairwise testing was conducted between estimates in these years (i.e., 2021 vs. 2022, 2021 vs. 2023, and 2022 vs. 2023). Statistical tests for overall trends from the baseline year to the current year will not be conducted until four comparable NSDUH data points are available. The NSDUH measures include:

  • Use of illegal drugs, prescription drugs, alcohol, and tobacco,
  • Substance use disorder and substance use treatment,
  • Major depressive episodes, suicidal thoughts and behaviors, and other symptoms of mental illness, mental health care, and
  • Recovery from substance use and mental health disorders.

Addressing the nation’s mental health crisis and drug overdose epidemic is a top priority of the Biden-Harris Administration and are core pillars of the Administration’s Unity Agenda. The President’s Unity Agenda is operationalized through the HHS Overdose Prevention Strategy, the HHS Roadmap for Behavioral Health Integration, and the National Strategy for Suicide Prevention.

If you or someone you know is struggling or in crisis, help is available. Call or text 988 or chat at 988lifeline.org. To learn how to get support for mental health, drug or alcohol issues, visit FindSupport.gov. If ready to locate a treatment facility or provider, go directly to FindTreatment.gov or call 800-662-HELP (4357).

 


The Substance Abuse and Mental Health Services Administration (SAMHSA) is the agency within the U.S. Department of Health and Human Services (HHS) that leads public health efforts to advance the behavioral health of the nation. SAMHSA’s mission is to lead public health and service delivery efforts that promote mental health, prevent substance misuse, and provide treatments and supports to foster recovery while ensuring equitable access and better outcomes.

Last Updated:
Source: https://www.samhsa.gov/newsroom/press-announcements/20240730/samhsa-releases-annual-national-survey-drug-use-and-health

Background: Most violent crimes (52 %) are committed by adults aged 18-34, who account for 23 % of the US population and have the highest prevalence of cannabis use and cannabis use disorder (CUD). We examined whether and how associations of cannabis use, use frequency, and CUD with violent behavior (i.e., attacking someone with the intent to harm seriously) vary by sex in U.S. young adults.

Methods: Data were from 113,454 participants aged 18-34 in the 2015-2019 US National Surveys on Drug Use and Health, providing nationally representative data on cannabis use, CUD (using DSM-IV criteria), and violent behavior. Descriptive analyses and bivariate and multivariable logistic regression analyses were conducted.

Results: Among U.S. adults aged 18-34, 28.9 % (95 % CI = 28.5-29.2 %) reported past-year cannabis use (with/without CUD), including 20.5 % (95 % CI = 20.2-20.8 %) with non-daily cannabis without CUD, 4.7 % (95 % CI = 4.5-4.8 %) with daily cannabis use without CUD, 2.1 % (95 % CI = 1.9-2.2 %) with non-daily cannabis use and CUD, and 1.7 % (95 % CI = 1.5-1.8 %) with daily cannabis use and CUD. Past-year adjusted prevalence of violent behavior was higher among males with daily cannabis use but without CUD (2.9 %, 95 % CI = 2.4-2.7 %; adjusted prevalence ratio (PR) = 1.7, 95 % CI = 1.3-2.2) and males with daily cannabis use and CUD (3.1 %, 95 % CI = 2.3-4.0 %; adjusted PR = 1.8, 95 % CI = 1.3-2.4) than males without past-year cannabis use (1.7 %, 95 % CI = 1.6-1.9 %). Adjusted prevalence of violent behavior was higher among females with cannabis use regardless of daily cannabis use/CUD status (adjusted prevalence = 1.6-2.4 %, 95 % CIs = 0.9-3.2 %; adjusted PRs = 1.6-2.4, 95 % CI = 1.3-3.2) than females without past-year cannabis use (1.0 %, 95 % CI = 0.9-1.1 %).

Conclusions: Research is needed to ascertain the directionality of the associations between cannabis use and violent behavior and underlying sex-specific mechanism(s). Our results point to complex sex-specific relationships between cannabis use frequency, CUD, and violent behavior and highlight the importance of early screening for and treatment of CUD and of preventive interventions addressing cannabis misuse.

Keywords: Attacking someone with the intent to seriously hurt them; Cannabis use; Cannabis use disorder; Violent behavior.

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Source: https://pubmed.ncbi.nlm.nih.gov/38677161/

One of the most pressing issues for businesses in states where marijuana use is legal is determining employee impairment before taking any adverse action. Unlike alcohol, where a simple breathalyzer test can gauge impairment, marijuana’s effects vary significantly based on consumption method, strain, and user tolerance.

Studies have shown that THC—the psychoactive compound in cannabis—and its metabolites can linger in the body long after the “high” has worn off. Recognizing this, many states have enacted laws requiring employers to prove impairment, not just the presence of THC. Traditional drug tests like urinalysis, oral fluid tests, hair tests, and even emerging breath THC tests only indicate prior use, not current impairment.

This means that zero-tolerance policies based solely on the detection of THC metabolites are no longer viable in many states. Instead, employers must place more focus on assessing fitness for duty through reasonable suspicion training for supervisors and consider adopting impairment detection technology.

Given that measuring THC levels cannot be the sole indicator of impairment, new tools have emerged to detect impairment from drug and alcohol use. Advanced impairment detection technologies offer more accurate insights into an employee’s current state of impairment. These devices measure psychological and/or physical indicators, allowing employers to make informed decisions about workplace safety. Leading solutions are portable, scientifically defensible, and provide results within minutes.

However, these technologies alone are not enough. Supervisors play a crucial role in identifying and documenting impairment. Proper training in recognizing the signs of impairment and documenting these observations is essential. Supervisors must be equipped to take appropriate action based on their assessments, ensuring that safety and performance standards are upheld. We here at NDWA can help provide trainings for your supervisors – find out more here.

Employees must understand that they are not exempt from workplace safety regulations regardless of their state’s marijuana laws. Being under the influence at work can endanger themselves and their colleagues, and impact work quality and efficiency. It is the responsibility of employees to ensure their marijuana use doesn’t impair their fitness for duty. They must arrive at work sober and ready to perform.

Advanced impairment detection technology is promising, but isn’t a singular solution. By training supervisors to document regular behavior and performance, businesses can maintain safe and productive work environments.

 

Source:  NATIONAL DRUG-FREE WORKPLACE ALLIANCE

BY JULIA MARNIN –  AUGUST 02, 2024

 

A New Jersey man caused the diversion of a flight due to his dangerous behavior and was arrested when the plane landed, feds say. Jan Rosolino via Unsplash An American Airlines passenger forced a Dallas-bound flight to land in a different city because of his “violent” and dangerous behavior, including repeated attempts to open the plane’s doors and his assault on a flight attendant, federal prosecutors said. The flight crew and passengers had to restrain Eric Nicholas Gapco’s hands and feet with flexible restraints until the flight from Seattle landed in Salt Lake City on July 18, according to the U.S. Attorney’s Office for the District of Utah. Gapco, 26, of Delanco, New Jersey, was arrested when the flight landed, according to prosecutors. Gapco continued “to engage in violent and erratic behavior” at the Salt Lake City International Airport, where he smashed the glass door of a holding cell, court documents say. He denied consuming illegal drugs or prescription medication, but later told his arresting officers he ate “approximately ten marijuana edibles,” according to a motion for his detention. Gapco said he didn’t know how much THC, a psychoactive component of the cannabis plant, was in each edible, the motion says. Gapco was indicted July 31 on charges of interference with a flight crew and attempted damage to an aircraft, the U.S. Attorney’s office said in a news release. His federal public defender didn’t immediately respond to McClatchy News’ request for comment on Aug. 1. On the July 18 flight, prosecutors said Gapco wouldn’t stay in his seat, tried to take a flight attendant’s seat, “propositioned a flight attendant for sex,” was loud, yelling, vaping and disrupting others. He also locked himself in a plane bathroom, went on to try to open the flight’s doors and is accused of trying to hand another passenger a bag of pills, according to prosecutors. Gapco “assaulted and intimated a flight attendant and aircraft crew members,” prosecutors said. “The safety and security of our customers and team members is our top priority,” American Airlines told McClatchy News in a statement on Aug. 1. “We thank our team members for their professionalism and our customers for their understanding.” American Airlines didn’t immediately respond to McClatchy News’ request for comment on Aug. 1. After Gapco broke a glass door at the Salt Lake City airport following his arrest, Gapco was taken to a hospital to be medically evaluated, according to prosecutors. “He continued to be belligerent” and “combative with medical staff and the police,” prosecutors wrote in the motion for his detention. “At one point, he spat on an officer.” Galco’s temporary detention was granted on July 23, court records show. He is due to appear for his initial appearance in court the afternoon of Aug. 1, prosecutors said.

Source: https://www.sacbee.com/news/nation-world/national/article290654789.html

 

As marijuana policies change across the nation, the conversation around its impact often centers on human health. However, it is critical to consider the impact on animals as a new study published in the Journal of the American Veterinarian Medical Association sheds light on the concern of marijuana toxicity in dogs.

Currently, the gold standard confirmatory testing for THC toxicity in dogs is costly, not easily accessible, and takes time to receive results. Thus, veterinarians often use the human urine multidrug test (HUMT) for point-of-care testing, which is unfortunately, unreliable in dogs. To rule out serious and severe conditions, HUMT is done in conjunction with additional tests such as bloodwork and advanced imaging.

To understand the history, physical, neurological, and clinical-pathological findings associated with marijuana toxicity in dogs, this study analyzed the medical records of 223 dogs diagnosed with THC toxicity between January 2017 and July 2021 from a university teaching hospital.

Key findings include:

  • Demographics: The median age of the exposed dogs was 1 year, and the breeds varied, with mixed breeds being the most common.
  • Owner Denial: Most dog owners denied the possibility of marijuana ingestion. Common stories reported were that their dog began “acting abnormal after going outside or to a public space” and when asked about marijuana being in the home, 55.6% claimed “absolutely no marijuana is in the house”.
  • Clinical Signs: Most dogs developed clinical signs of toxicity within four hours of ingestion. Common clinical signs included ataxia (88.3%), hyperesthesia (75.3%), lethargy (62.8%), urinary incontinence (45.7%), and vomiting (26%). The majority (70.4%) experienced both ataxia (abnormal movement/lack of coordination) and hyperesthesia (increased sensitivity).
  • Vitals and Bloodwork: While most dogs had normal vitals like heart rate, respiratory rate, and body temperature, common abnormalities included systemic hypertension (60.7%), tachycardia (37%), and hyperthermia (22.6%). Common electrolyte abnormalities included mild hyperkalemia (51.3%) and mild hypercalcemia (79.1%), with the researchers noting that this study was the first to report such abnormalities in dogs.
  • Prognosis: Fortunately, all dogs survived; however, 22% were hospitalized.

The denial of dog owners in disclosing the possibility of marijuana exposure can lead to delays in diagnosis and treatment, resulting in needless testing, increased costs, and undue stress. Educating pet owners on the risks and signs of marijuana exposure and ensuring veterinarians are equipped with the tools and resources to diagnosis marijuana toxicity, are critically needed. These findings underscore the need for policies to prioritize the health and safety of pets, especially considering that many of these cases occurred within the same year as legalization in the area where the university hospital is located, as the researchers point out.

Source: Save Our Society From Drugs | 333 3rd Ave N Suite 200 | St. Petersburg, FL 33701 US

 

A recent poll, conducted by Gallup, found that there has been a shift in public opinion regarding marijuana.

This is SAM’s  The Drug Report’s Friday Fact report

 

The first asked the question, “What effect do you think the use of marijuana has on most people who use it – very positive, somewhat positive, somewhat negative or very negative?” Gallup focused on several demographic subgroups and found that all of them were less likely in 2024 than in 2022 to say that marijuana had a positive effect on users. Here’s a breakdown for each subgroup:

This poll revealed a 12% drop among Independents, a 7% drop among young adults,  and a 13% drop among nonreligious people. Likewise, as the percentage of Americans that say marijuana has a positive effect on most people who use it has declined, there has been an increase in the percentage that say it has a negative effect on them. This increased from 45% in 2022 to 51% in 2024, with the remainder answering that they had “no opinion.” A majority of Americans now recognize that marijuana has harmful effects on users, which include cannabis use disorder, depression, anxiety, and impairment, among others.

 

A second question asked, “What effect do you think the use of marijuana has on society – very positive, somewhat positive, somewhat negative or very negative?” It found that the percentage of Americans that thought it was “very negative” or “somewhat negative” increased from 50% in 2022 to 54% in 2024, as the percentage that thought it had a “very positive” or “somewhat positive” effect declined from 49% to 41%.

 

More and more Americans are waking up to the harmful effects of marijuana. Now a majority of Americans believe that marijuana is harmful for both users and society. Public opinion is clearly shifting as more families have seen first-hand the results of marijuana use.

Source: Smart Approaches to Marijuana (SAM) – Friday Fact – Fri 30/08/2024

With the increasing legalization of recreational marijuana across various states, employers need to proactively prepare for the changes and their implications on the workplace. As more states allow adults to legally purchase and possess marijuana, it’s essential for employers to review and update their workplace policies to ensure compliance and maintain a safe work environment.

Despite legalization, employers can still prohibit marijuana use that leads to impairment at work, akin to alcohol restrictions. Recent legal decisions, such as White v. Timken Gears & Servs., Inc. in Illinois, reinforce that a positive drug test for marijuana while working, even if used recreationally off-duty, can justify termination if it violates a reasonable and consistently applied workplace policy. This underscores the importance of clear, fair, and legally sound drug and alcohol policies to ensure workplace safety.

  • The first step is to re-evaluate your drug testing protocols. Ensure they align with both state and federal regulations, particularly if your industry is governed by specific mandates, such as those from the Department of Transportation. Consider your agreements with insurance carriers, as marijuana testing might be a condition of coverage or discounts.
  • Testing for marijuana presents unique challenges due to the limitations of current testing methods. Talk with your testing laboratory to understand the differences between qualitative and quantitative tests and determine which best supports your workplace policies.
  • Evaluate whether to implement second chance agreements for employees who test positive for marijuana. Additionally, consider providing access to substance abuse programs. These measures can help manage employees who might struggle with marijuana use while offering them a chance to comply with workplace policies.
  • Update your policies in your employee handbook, workers’ compensation policies, and other relevant documents to clearly state that while marijuana may be legal, it is prohibited in the workplace. Clearly outline that possession or use of marijuana at the worksite is forbidden and that employees are not permitted to use marijuana during lunch or other breaks. Specify the consequences of violating these policies to ensure there are no ambiguities.
  • Hold meetings to communicate the company’s stance and expectations regarding marijuana use to all employees. Transparency is key; ensure employees understand the policies, the reasons behind them, and the consequences of non-compliance. Clear communication helps in setting the right expectations and reduces misunderstandings.
  • Conduct comprehensive training sessions for HR professionals, managers, and supervisors on the company’s policies regarding marijuana use. Ensure that all managerial staff understand the testing protocols and disciplinary policies. Training should also cover how to handle conversations with employees about marijuana use, ensuring consistency and sensitivity. Equip your managers with the skills to recognize signs of impairment at work. Understanding how to identify and address employees who might be under the influence of marijuana is crucial for maintaining workplace safety. Provide clear guidelines on the steps to take if impairment is suspected. Check out our trainings here!

The increasing state legalization of recreational marijuana marks a significant change for employers. By proactively updating your drug testing protocols, policies, training programs, and communication strategies, you can effectively manage the impact of this new legislation on your workplace. Staying informed and prepared will help you navigate this evolving landscape while ensuring a safe and compliant work environment.

Source: 

  • Drug Free Foundation AMERICA, Inc.
  • National Drug-Free Workplace Alliance

Vaping among younger adults and binge drinking among mid-life adults also maintained historically high levels, NIH-supported study shows

August 29, 2024

 

Past-year use of cannabis and hallucinogens stayed at historically high levels in 2023 among adults aged 19 to 30 and 35 to 50, according to the latest findings from the Monitoring the Future survey. In contrast, past-year use of cigarettes remained at historically low levels in both adult groups. Past-month and daily alcohol use continued a decade-long decline among those 19 to 30 years old, with binge drinking reaching all-time lows. However, among 35- to 50-year-olds, the prevalence of binge drinking in 2023 increased from five and 10 years ago. The Monitoring the Future study is conducted by scientists at the University of Michigan’s Institute for Social Research, Ann Arbor, and is funded by the National Institutes of Health.

Reports of vaping nicotine or vaping cannabis in the past year among adults 19 to 30 rose over five years, and both trends remained at record highs in 2023. Among adults 35 to 50, the prevalences of nicotine vaping and of cannabis vaping stayed steady from the year before, with long-term (five and 10 year) trends not yet observable in this age group as this question was added to the survey for this age group in 2019.

For the first time in 2023, 19- to 30-year-old female respondents reported a higher prevalence of past-year cannabis use than male respondents in the same age group, reflecting a reversal of the gap between sexes. Conversely, male respondents 35 to 50 years old maintained a higher prevalence of past-year cannabis use than female respondents of the same age group, consistent with what’s been observed for the past decade.

“We have seen that people at different stages of adulthood are trending toward use of drugs like cannabis and psychedelics and away from tobacco cigarettes,” said Nora D. Volkow, M.D., director of NIH’s National Institute on Drug Abuse (NIDA). “These findings underscore the urgent need for rigorous research on the potential risks and benefits of cannabis and hallucinogens – especially as new products continue to emerge.”

Since 1975, the Monitoring the Future study has annually surveyed substance use behaviors and attitudes among a nationally representative sample of teens. A longitudinal panel study component of Monitoring the Future conducts follow-up surveys on a subset of these participants (now totaling approximately 20,000 people per year), collecting data from individuals every other year from ages 19 to 30 and every five years after the participants turn 30 to track their drug use through adulthood. Participants self-report their drug use behaviors across various time periods, including lifetime, past year (12 months), past month (30 days), and other use frequencies depending on the substance type. Data for the 2023 panel study were collected via online and paper surveys from April 2023 through October 2023.

Full data summaries and data tables showing the trends below, including breakdowns by substance, are available in the report. Key findings include:

Cannabis use in the past year and past month remained at historically high levels for both adult age groups in 2023. Among adults 19 to 30 years old, approximately 42% reported cannabis use in the past year, 29% in the past month, and 10% daily use (use on 20 or more occasions in the past 30 days). Among adults 35 to 50, reports of use reached 29%, 19%, and 8%, respectively. While these 2023 estimates are not statistically different from those of 2022, they do reflect five- and 10-year increases for both age groups.

Cannabis vaping in the past year and past month was reported by 22% and 14% of adults 19 to 30, respectively, and by 9% and 6% of adults 35 to 50 in 2023. For the younger group, these numbers represent all-time study highs and an increase from five years ago.

Nicotine vaping among adults 19 to 30 maintained historic highs in 2023. Reports of past-year and past-month vaping of nicotine reached 25% and 19%, respectively. These percentages represent an increase from five years ago, but not from one year ago. For adults 35 to 50, the prevalence of vaping nicotine remained steady from the year before (2022), with 7% and 5% reporting past-year and past-month use.

Hallucinogen use in the past year continued a five-year steep incline for both adult groups, reaching 9% for adults 19 to 30 and 4% for adults 35 to 50 in 2023. Types of hallucinogens reported by participants included LSD, mescaline, peyote, shrooms or psilocybin, and PCP.

Alcohol remains the most used substance reported among adults in the study. Past-year alcohol use among adults 19 to 30 has showed a slight upward trend over the past five years, with 84% reporting use in 2023. However, past month drinking (65%), daily drinking (4%), and binge drinking (27%) all remained at study lows in 2023 among adults 19 to 30. These numbers have decreased from 10 years ago. Past-month drinking and binge drinking (having five or more drinks in a row in the past two week period) decreased significantly from the year before for this age group (down from 68% for past month and 31% for binge drinking reported in 2022).

Around 84% of adults 35 to 50 reported past-year alcohol use in 2023, which has not significantly changed from the year before or the past five or 10 years. Past-month alcohol use and binge drinking have slightly increased over the past 10 years for this age group; in 2023, past-month alcohol use was at 69% and binge drinking was at 27%. Daily drinking has decreased in this group over the past five years and was at its lowest level ever recorded in 2023 (8%).

Additional data: In 2023, past-month cigarette smoking, past-year nonmedical use of prescription drugs, and past-year use of opioid medications (surveyed as “narcotics other than heroin”) maintained five- and 10-year declines for both adult groups. Among adults 19 to 30 years old, past-year use of stimulants (surveyed as “amphetamines”) has decreased for the past decade, whereas for adults 35 to 50, past-year stimulant use has been modestly increasing over 10 years. Additional data include drug use reported by college/non-college young adults and among various demographic subgroups, including sex and gender and race and ethnicity.

The 2023 survey year was the first time a cohort from the Monitoring the Future study reached 65 years of age; therefore, trends for the 55- to 65-year-old age group are not yet available.

“The data from 2023 did not show us many significant changes from the year before, but the power of surveys such as Monitoring the Future is to see the ebb and flow of various substance use trends over the longer term,” said Megan Patrick, Ph.D., of the University of Michigan and principal investigator of the Monitoring the Future panel study. “As more and more of our original cohorts – first recruited as teens – now enter later adulthood, we will be able to examine the patterns and effects of drug use throughout the life course. In the coming years, this study will provide crucial data on substance use trends and health consequences among older populations, when people may be entering retirement and other new chapters of their lives.”

View more information on data collection methods for the Monitoring the Future panel study and how the survey adjusts for the effects of potential exclusions in the report. Results from the related 2023 Monitoring the Future study of substance use behaviors and related attitudes among teens in the United States were released in December 2023, and 2024 results are upcoming in December 2024.

 

Source:  https://nida.nih.gov/news-events/news-releases

NIH:       National Institute on Drug Abuse

Premium Reports August 27, 2024 Updated:August 28, 2024

Officials are finding houses riddled with residual nerve agent pesticides from China that aren’t in any U.S. chemical library …

LOS ANGELES—On a recent summer morning, a caravan of unmarked state police vehicles and white hazmat trucks crept past strip malls and wide intersections, making its way toward a pair of modest homes in a remote suburb north of Los Angeles.

A command came from the officers in the front of the black-and-white: “Seat belts off—in case we start taking fire.”

But there was no shootout. Just a tense half hour as a phalanx of two dozen state police—agents from the Department of Cannabis Control (DCC)—kept snipers trained on the house, waiting for the second of two suspects to emerge.

When she finally did, petite and barefoot in a black dress, the effect was mercifully anticlimactic.

Police officers arrest people while raiding an illegal cannabis site in Lancaster, Calif., on Aug. 14, 2024.

John Fredricks/The Epoch Times

Illegal cannabis cultivation operations, or “grows,” are a multi-billion-dollar-a-year industry in California, dominated by a mix of transnational criminal organizations that authorities believe are symbiotic, if adversarial.

When agents serve a warrant, they often find human trafficking victims, automatic weapons, booby traps and, increasingly, banned toxic pesticides smuggled from China.

This particular raid, in Lancaster, netted around 1,020 plants—a modest haul compared with the herculean grows that have become common across California’s booming black market.

But such mild suburban tableaus belie a sleeping, sinister threat.

“What we have right now is organized criminal enterprises literally destroying the city building by building as they modify them for illegal cultivation,” Mike Katz, a Lancaster code enforcement officer who heads the city’s cannabis unit, told The Epoch Times.

“They’re endangering the families who will occupy those buildings in the future, they are lowering the value of neighboring properties and dragging the whole community down,” he said.

‘Super Toxic’

Buildings contaminated by illegal grows are dangerous because the harsh pesticides growers use permeate every surface—ceilings, walls, floors, vents and drywall.

Toxic black mold blooms in the 75 percent humidity needed to grow marijuana. The massive amounts of water and electricity required to sustain an operation can result in structural damage to vents and sunken floors, overloaded transformers and corroded wiring just itching for a fire.

Katz, whom the city’s chief of police refers to as the department’s “Swiss Army knife,” has been a firefighter, reserve police officer, and now, an unarmed code enforcement official. He approaches the job with a certain zeal, devouring scientific studies and how-to books on cultivation, and generally making it his mission to stop grow houses from slipping through the cracks.

Owners can often get away with making cosmetic fixes—“candy coating,” as one inspector puts it—if local governments don’t intervene before they start concealing the damage.

Working and middle-class families migrate to bedroom communities like Lancaster, where you can still find a single-family home with a backyard for around $500,000—about half the median price in Los Angeles, according to Redfin. You may find one for even less if a grower has been busted and is offloading at a discount.

The injustice of it rankles Katz. He imagines families struggling to buy a home, and their toddlers probing surfaces tainted with insecticides—potent carcinogens, endocrine disruptors, nerve agents and others no one even knows how to identify.

“They are super toxic, but very effective,” he said. “One we just learned of last week has a 14-year half-life. We did a search warrant back in January and didn’t get test results until this week. I’m having to tell all the detectives and everyone involved that we were exposed to these chemicals.”

Low-cost housing also attracts sophisticated criminal enterprises looking for ways to launder money and turn a profit. Often, illegal growers can do that after just one harvest. Typically, an operation can turn four to six harvests a year.

Wholesale value for the plants seized in the modest raid we accompanied—they were days away from a second harvest—is more than $540,000.

 

To avoid detection and stay a step ahead of authorities, growers are continually adapting.

“There are probably a lot more growing indoors that we don’t know about,” Jennifer Morris, a code enforcement officer with Riverside County and former head of its cannabis unit, told The Epoch Times. “But they’re pretty good at keeping themselves looking very nondescript.”

From the outside, the houses look normal, and it typically takes a fire, robbery, or neighbors reporting electrical theft to tip off law or code enforcement, Morris said. Growers also build walls to conceal grow rooms, and sometimes install a resident worker or a dog to give the appearance of normality.

Because the entire industry is clandestine, no one can accurately estimate the extent of the problem. Many communities might not even be aware it’s happening.

“I’ve talked to cities where they say, ‘We don’t have a problem,’” said David Welch, an attorney who contracts as a special counsel with cities in Los Angeles County that want “a more aggressive” approach to narcotics enforcement. “Then law enforcement will hit a grow in that city.”

Where there is one, there are likely more. But perpetrators are opportunistic, itinerant.

“We have seen the same owners of properties in different counties that have had illegal cultivation on them,” Morris said.

Wilson Linares, who leads the Department of Cannabis Control’s Los Angeles County law enforcement unit, said it’s hard to pinpoint which players are tied to which territories. “They’re just everywhere. It doesn’t really stay in that area, they just go wherever they can master operations.”

Growers, he said, “do a good job of layering their operation. I don’t think they even know they’re working for the same organization sometimes.”

That makes it difficult to go after the few bigger fish, to which, some insiders say, all these operations are ultimately “funneling up.”

Those caught at the grows are inevitably low-level employees, if not forced labor, and are typically interviewed and released. Illegal cultivation—anything more than six plants per person, whether it’s 10 or 10,000—is a misdemeanor in California.

“Sometimes our investigations do a good job at digging to make sure we’re eradicating the problem,” Linares said. “But sometimes they cut losses and move on and go somewhere else. We have to follow and chase them. It takes a lot of effort and time to conduct these investigations.”

Like meth houses of decades past, there are residential grows too damaged to flip.

But it’s the moderate ones, the ones that are at risk of selling at a discount to families, that keep Katz up at night.

 

While they can’t prevent the sale, or in many cases, habitation, building inspectors and code enforcement officers use “red tagging” and other methods to compel compliance—like creating liens to cloud the title, or disconnecting utilities. And in some cases, those costs and headaches transfer to new owners.

California law gives local government broad authority to abate “public nuisances”—which include dangerous and contaminated buildings, Katz said. But enforcing compliance can often depend on a municipality’s ability to pay for things like civil lawsuits.

If public safety officials don’t discover a grow before property owners start hiding the damage, it’s often too late.

“There is no roadmap,” Katz said. “These sociopaths are buying and selling these houses.”

‘I Didn’t Know Anything’

There were signs. Two dozen large bags of what Virginia Aceres thought was ordinary grass fertilizer and canisters of chemicals bearing designs of spiders and worms that the previous owner left behind. He offered to pay her $500 to get rid of them.

In two months, a $10,000 electricity bill.

Aceres said she moved from Los Angeles to the Antelope Valley because she didn’t want her kids hanging out with people who use drugs. She nabbed a five-bedroom house for $535,000, $15,000 below asking. “It’s super big—we thought, oh wow, this is perfect.”

But she found out after moving in that it had been used by the previous owners to grow weed.

“Every afternoon the upstairs smells of marijuana and it gives me a raging headache,” she told The Epoch Times. When a city inspector came by and pointed out a meter wired to steal electricity and stains on the bathroom ceilings from burned chemicals, she said, “Now I understand.”

The five bedrooms were originally three, she discovered; the previous owner had added two and it was up to her to register the additions with the city.

When property owners obtain permits to modify buildings but don’t follow up to call for a final inspection of the work, this can tip off code enforcement and form part of the basis for a warrant. So too can electrical fires or electricity theft.

But Aceres said she bought her house without any compliance obligations that would arise from a pre-sale code enforcement; inspectors came after she moved in and pointed out the damage.

The circuit breakers at Aceres’ house are constantly blowing, especially if electronics are running at the same time, and electricians tell her she has to completely redo the wiring.

“My daughter relies on a machine to help her breathe,” Aceres said, referring to a nebulizer that delivers oxygen and liquid steroids. “We had to buy a generator. She’s 9; she can’t ride a bike, can’t walk more than 20 minutes, can’t run. At night she has panic attacks, she comes to my door in pain, she can’t breathe, so I connect the machine and give her medicine.”

A neighbor warned her the previous owner had installed multiple, massive air conditioners and there were fires. People cruise by the house. Someone showed up looking to collect on a debt. The IRS, the police and city inspectors have all visited.

“For all this, I’d like to move—because they’re going to confuse us and they’re going to think that we sell drugs or have something to do with all that. But we haven’t been able to sell the house because of all these problems,” she said. “If a buyer asks questions we’re obligated to tell them the truth.”

 

Banned Pesticides

Labor and sex trafficking, animal abuse, gun violence and rampant environmental crimes have long been associated with illegal marijuana cultivation.

The prevalence of indoor grows and collateral impacts on residential buildings are not new or limited to California. In 2017 Denver police estimated one in 10 homes was being used to cultivate, leaving the city with a dangerous mold problem.

But the influx of banned toxic insecticides in California’s illicit operations is relatively novel, according to those on the front lines.

“About a year ago we started seeing these banned pesticides—they’ve made their way into most of the cultivation sites,” said Jeremiah LaRue, sheriff of Siskiyou County.

LaRue oversees a mountainous swath of Northwest California bordering Oregon, notorious for flourishing outdoor grows. Last year, the DCC confiscated more marijuana in Siskiyou than any other county aside from Alameda.

While operations have moved from federal lands to private property in recent years, LaRue said these days it’s a mix of outdoor grows, “hoop houses” and some converted residential homes.

Linares said he noticed an uptick in pesticides as some producers transitioned from outdoor to indoor.

“They’re easier to operate in that they can control the environment a lot better. So that’s why at least in the Los Angeles County area you see quite a few indoor grows,” he said, pointing to the Antelope Valley as a primary SoCal hotspot, along with the San Fernando Valley and Frazier Park in Kern County.

It may seem counterintuitive that indoor operations are increasingly relying on contraband pesticides, but the lack of natural predators inside means spider mites, aphids, mildew and black rot or fungus can easily take hold, explained Josh Wurzer, CEO and cofounder of SC Labs, a cannabis testing and research lab based in Santa Cruz, with outlets in Colorado, Arizona, Oregon, and Michigan.

“Once you get a single fungus spore or any tiny spider mite into a grow and it starts to proliferate, they take root and it takes off. There are no birds to eat them or natural controls to keep pests in check like there are outdoors.”

Morris, with Riverside County Code Enforcement, said she has observed a lot of indoor grows using fumigated miticides.

‘They tend to have a problem with spider mites, and I think some of the problem is someone tending several house grows, they get mites on them and take them to the next location.”

In the regulated market, growers have adopted organic solutions—such as neem oil, predatory insects, and sterile environments, Wurzer said. But on the black market, where there is no testing and no regulation, the point is to make money as fast as possible.

“If no one is checking, if consumers won’t know the difference, people will do what is easiest,” said Wurzer. “And the easiest solution is to spray all kinds of pesticides so there are no problems with pests and you get the highest yield and make as much money as possible.”

The California Department of Pesticide Regulation publishes a pocket guide for law and code enforcement officers, listing more than two dozen insecticides, fungicides, miticides, rodenticides, and plant growth regulators to look out for in mitigation operations. Several are banned in the United States.

Increasingly, officers say, they are finding chemicals they aren’t familiar with or can’t identify.

‘No One Is Going to Find It’

At recent raids, Katz’s team found endrine, a highly toxic pesticide with neurological, developmental, and reproductive effects that was discontinued in the United States in 1986 and has been shown to persist in soil for 14 years or more. They also found endosulfan sulfate, a similarly toxic pesticide known to be an endocrine disruptor, that was phased out in the United States by 2010 and globally banned under the 2011 Stockholm Convention.

“All kinds of chemicals are being found. The ones from China, they’re not even in any chemical library,” said Katz, noting they’re having to send samples to an “extremely expensive” lab in Sacramento.

“The EPA got involved. We’ve found all kinds of nerve agent pesticides, and they’re not listed in any of these libraries for the machines that read this stuff.”

When it comes to testing for pesticides on the regulated market, Wurzer said a proper lab can find any chemical eventually—if they’re looking for it and they know it exists.

“But we’re not as good at finding things we’re not looking for. If someone develops a new pesticide, until people realize it’s being used, no one is going to be looking for it, so no one is going to find it.”

That problem extends to products consumers buy in state-regulated dispensaries. While Wurzer says less than 3 percent of regulated cannabis samples his lab tests contain pesticides, growers are getting “really creative,” using compounds they know won’t show up in panels in order to circumvent regulation. “A lot of these line up with what we find in illegal grows—pesticides with Chinese origin,” he said.

After a recent investigation found “alarming” levels of toxic pesticides in regulated products, Wurzer said he’s begun offering an expanded testing panel that includes some of these known black market pesticides. But there are plenty of disreputable labs, he said, that will produce results their clients want to see.

On illegal grow sites, some pesticides look like wood chips, burned in halved soda cans as a fumigant; others come in bottles that are mixed and repurposed, leaving public safety teams to guess.

“They started bringing them into indoor grows, and it’s really hard for us to identify all the banned pesticides because they start taking labels off, they start mixing the canned products with other items, and it’s really hard to pinpoint exactly which items are from where, or if we’re finding the same items somewhere else,” Linares said.

The fact that these compounds are inhaled—either by unsuspecting consumers who think they’re smoking regulated cannabis, or by unsuspecting residents who move into a former grow house—exacerbates the harm.

As Wurzer explains, when the plant is inhaled rather than eaten, it goes directly into the lungs, bypassing many of the body’s natural defense mechanisms, like the digestive system and the liver, which filter toxins.

“Any pesticide deemed harmful on a food crop in the U.S. would be extra harmful when it’s inhaled,” Wurzer said.

“I can only imagine anyone who moves into these houses where they’ve been spraying indoors for years and years—certainly there would be off-gassing of these pesticides and the people living there would be breathing them in.”

Nor do they disappear when you stop using them. Wurzer recalled when growers using pesticides to cultivate medical marijuana at indoor facilities tried to transition after legalization but kept failing tests even though they’d phased out the chemicals.

“This was a huge issue. … Because these pesticides permeate every surface and are leeching out of the walls and ceilings,” he said. “The drywall absorbed them, the paint had absorbed them. The grow lights and the heat—now they were continuing to off-gas. The contaminated plants would fail pesticide tests a year later.”

At high enough levels, those agents can be just as toxic to humans as they are to bugs, he said, recalling the history of companies like Monsanto and Bayer, which repurposed compounds originally developed as chemical warfare during WWII for the agricultural market.

Similar to the challenge of regulating performance enhancing drugs in sports, he said, pesticide producers can create new compounds that will evade existing test panels.

‘It’s Just Pot’

California is home to one of the largest legal cannabis markets in the world. But since legalization the state’s black market has only grown, dwarfing and infecting its regulated sales.

“The bargain that was given to voters was—we’ll give out licenses, collect taxes to fund government services and smash the illegal market and the criminal organizations would go away,” Katz said. “That’s not happening. And these collateral issues are something they hadn’t even thought about.”

Recent raids have netted tens of thousands of plants and millions of dollars of product from subterranean operations the size of football fields. The state, touting ramped up enforcement, has seized more than $120 million worth of illegal cannabis so far this year.

In early August, the DCC reported the state’s Unified Cannabis Enforcement Task Force had served 309 warrants since its inception in 2022, and the agency reported serving 386 search warrants since it was formed in 2021, in operations that overlap with the task force’s. A representative for DCC said its enforcement division has served 250 warrants related to indoor grows since forming in 2021.

But some say soft laws, a patchwork approach, and regulatory blind spots—as well as a lack of interest from federal authorities and local prosecutors—are allowing the black market to wreak havoc.

Tom Lackey, a California assembly member whose district includes the Antelope Valley, thinks the dangers are underestimated, in part because of a prevailing misconception that “it’s just pot.”

 

He points to the fact that black market marijuana comprises some 80 percent of total sales in California, , and licensed growers pressured by high taxes and the cost of compliance are taking shortcuts to survive. Various industry analyses over the past several years have estimated between one half and two thirds of California sales are from illegal sources. According to a 2023 report by New Frontier Data, an estimated $77 billion—or 72 percent of all U.S. sales in 2022—were from illicit sources.

“We’ve overdone it. It’s well-intentioned but we’ve done very little to go after these illicit players. The majority of our focus is directed toward those trying to comply, which is ironic,” Lackey said.

When the state does go after illicit players, it’s costly and time-consuming, and labor-intensive intelligence gathering and warrants can lead to dead ends.

During the recent Lancaster raid, the city’s new assistant chief of police, Chris Roberts, gestured at the two dozen highly trained agents in tactical gear and said, “There’s a lot that goes into this. This isn’t cheap.”

Since voters passed Proposition 64 in 2016, illegal cultivation is a misdemeanor. Violating the six-plant-per-person limit carries the same penalty, regardless of how many plants you have. And while the law is written to include jail time for certain cultivation, possession, and other crimes, most communities have neither the appetite nor the space to incarcerate people for marijuana offenses.

“The court system would not, in my opinion, be locking someone up for six months,” Sheriff LaRue said, referring to the penalty for cultivating more than six plants.

“The jails are so impacted in most communities, there is just no space for people committing misdemeanors. To be housed in jail for any substantive time, it needs to be serious or violent. And marijuana possession, even if it’s thousands of plants, is still a minor crime. It would never happen because it’s not viewed as serious enough,” he said.

Some municipalities appear to be more aggressive, as in the Kern County sheriff’s recent raid of a massive underground grow that seized 17,650 plants and resulted in the arrest of three Chinese nationals. And in some cases a state agency like Fish and Wildlife will serve a warrant that leads to felony environmental crimes.

But that’s less likely to happen in the residential raids that tend to result in misdemeanor referrals to the district attorney, those familiar with the issue say.

“If they’re not going to charge you for dealing drugs, why would they charge you for environmental crimes? Typically drugs are a higher priority,” Welch says.

He estimates L.A. County’s illegal marijuana trade is “90 percent unenforced—and that might actually be somewhat forgiving.”

Previously, he told The Epoch Times that also applies even when there are narcotics or guns involved at the locations. “I’ve seen enough of these cases to know they’re not being filed,” he said.

An inquiry to the L.A. County District Attorney’s Office requesting total referrals for cannabis-related crimes, filings, and rejections was not returned.

Linares said it’s far more common for offenders to get fined, or informal probation. “I have not seen any jail sentences for the misdemeanors.”

Lackey suggested the relaxed penalties are in part because of a misconception–a “‘70s marijuana attitude”–about what the illicit industry really is.

“Everybody thinks people in this business look like Zig-Zag,” he said. “No—these are white collar, brilliant people making billions and billions of dollars. Our system is not taking them seriously.”

The environmental destruction and impacts of pesticides are super toxic—everyone knows this, Lackey said. “Some of these illicit grows, law enforcement finds deceased animals all over the place. The residential impact, molds, cancer, fertility issues—all sorts of human threats. But they turn a blind eye because it’s weed.”

While fentanyl deserves to be “front and center,” he said, “we can walk and chew gum at the same time.”

Chinese Dominance

At scale, the two problems are inextricably linked.

The uneasy mix of crime syndicates running illicit marijuana in California, according to law enforcement officials, includes Chinese and Hmong groups, Mexican cartels and Latin American street gangs, and Chaldean and Armenian organizations.

 

San Bernardino County Sheriff’s deputies review documents inside a home during a raid of an illegal cannabis farm in Newberry Springs, Calif., on March 29, 2024. Robyn Beck/AFP via Getty Images

While the DCC’s Linares says these groups are not all working together, they maintain a kind of territorial detente.

But according to the Drug Enforcement Administration (DEA), Mexican cartels and Chinese groups continue to dominate the state’s black market. And in recent years, federal investigations have unearthed how Chinese crime networks have risen to global prominence, in part by laundering cartel drug money.

Ray Donovan, the DEA’s former chief of operations, has described how networks supplying fentanyl precursor chemicals to Mexican cartels were also laundering fentanyl money and reinvesting it in illicit marijuana. Testifying before the House’s Select Committee on the CCP in April, he outlined how these groups operate with at least tacit support from the Chinese communist regime.

At a Senate drug caucus hearing later that month, William Kimbell, current chief of operations for the DEA, said his agency has found Chinese organizations have “taken over” marijuana cultivation in 23 states, some of which are “legitimate” but still staffed by people controlled by Chinese money laundering organizations.

A 2024 DEA report noted the recent uptick in the number of illicit grows linked to Chinese and other Asian organized crime groups, with “Asian investors” emerging as a new funding source of illegal marijuana production in the U.S.

“Asian drug trafficking organizations have been involved in illegal marijuana cultivation for decades, operating industrial-scale indoor marijuana grows in residential homes, primarily in the western United States,” the report states.

The federal government has kept its eye on California’s Central Valley, which stretches from the Sacramento Valley to the Tulare Basin; in 2017 more than 58 percent of 3.4 million marijuana plants the DEA eradicated in the United States were located in this region.

In 2018, an operation involving hundreds of federal and local agents raided 75 houses in the Sacramento area used for cultivation by Chinese drug traffickers, and filed civil forfeiture against more than 100 houses, making it one of the largest residential forfeitures in U.S. history.

In its announcement, the U.S. Justice Department said patterns had begun to emerge during years-long investigations of indoor grows in residential neighborhoods—including financing and distribution methods.

In 2019, a grand jury indicted six Chinese nationals on money laundering counts alleging they used funds from China to buy grow houses in Sacramento and Placer counties.

‘It’s All Connected’

“The fentanyl, the money laundering, the marijuana grows—it’s all connected,” Leland Lazarus, associate director of national security at Florida International University’s Jack D. Gordon Institute for Public Policy, told The Epoch Times in an email.

These syndicates, Lazarus said, typically employ illegal Chinese migrants, who are often subjected to forced labor or criminality, terrible working conditions, and even sexual violence.

Sheriff LaRue pointed to an instantly recognizable structure—as if growers had been given a manual—at Chinese-led grows, which dominate Siskiyou County.

“They’re almost cookie-cutter, they all look the same. Even the houses are the same. It’s almost a prescribed thing: This is what you’re going to use, this is what you’re going to have,” the sheriff said. “You can almost go on a site and say, ‘This is Chinese.’”

Lazarus notes U.S. law enforcement agencies have been tracking “the vast Chinese money laundering networks” across 22 states for years, but the problem remains “a lack of significant resources, language skills and cultural knowledge to truly dismantle these networks.”

LaRue conducted a recent raid in which his team encountered 28 people onsite—all of them elderly women. “We couldn’t talk to any of them. One that spoke English, she was not about to let anyone open their mouth. That bothers me,” he said. “What is really going on there?”

The women were released from custody while LaRue’s office continues its investigation.

Some of Lazarus’s recent research has focused on the vast reach of these organizations, far beyond California grow houses, or even the East Coast, where federal authorities say they are anchored.

“Like other transnational criminal organizations, Chinese illegal gangs operate around the globe. You’re seeing some of the same illicit activities in Southeast Asia, Europe, and even Latin America,” Lazarus said.

“And it’s hard to imagine that China—which is the largest surveillance state in the world—isn’t aware of these activities. That’s why we need a truly international effort to deal with the scourge of global Chinese organized crime.”

Path Forward

In a 2013 memorandum, then Deputy Attorney General James M. Cole outlined priorities for federal prosecutors in pursuing marijuana-related crimes, in large part deferring to state authority and taking a hands-off approach in jurisdictions that had legalized the drug.

Such guidance, Cole reasoned, relied on an expectation that those jurisdictions “will implement strong and effective regulatory and enforcement systems that will address the threat those state laws could pose to public safety, public health, and other law enforcement interests.”

To many working to contain the collateral fallout of California’s illegal marijuana trade, that has not happened.

“The feds are hands-off on anything involving cannabis,” said Katz, while also pointing to a lack of appetite among local prosecutors. “My guess would be they’re a little gun-shy about jury nullification. … A jury will be like, ‘Who cares? It’s just cannabis.’”

Lackey, the assembly member, is hopeful a DEA proposal to reclassify marijuana from a Schedule I drug to a Schedule III drug will loosen restrictions that, for example, prevent the legal market from using banks.

Meanwhile, he said, California needs to take the lead in stronger prosecution efforts and be able to mete out consequences.

“The reason we’re struggling in California is we’ve relaxed consequences, and of course that’s going to increase evasion and it’s going to create victims,” Lackey said. “It really has been a hurtful experience for me to have a front row seat to watch this mistake being made.”

For Katz and Morris, the key to navigating the no-man’s land between the state and the feds, between lax prosecution and the absence of a standardized mandate, remains collaboration.

Morris pointed to Riverside’s creation of a roundtable bringing together 43 jurisdictions each quarter to discuss what agents are seeing on the ground.

“We found there were a lot of the same players, especially in our sister counties like San Bernardino. … There’s a lot of money in this, so they change tactics,” she said. Learning how growers in Kern County were burying shipping containers to house grows, for example, helped Riverside stay ahead of the game, she said.

Katz says his department immerses itself in the issue, cross-training with other disciplines, attending Environmental Protection Agency trainings and medical conferences. In the absence of leadership, or a standard approach, they cobble it together.

“A lot of cities are not investing that kind of effort into combatting this problem, so they don’t even know what they don’t know,” he said.

Ultimately, he says, the battle has nothing to do with the morality of cannabis—“that’s not the war we’re waging”—and everything to do with preventing a multi-billion-dollar criminal industry from sickening and killing residents.

“They don’t care if the pesticides they apply in the house poisons a family. They don’t care about the people who consume their contaminated cannabis. Money is all that matters to them.

“Only a sociopath would allow other human beings into buildings that might kill them. That’s what we’re combatting.”

Source:

NIH:       National Institute on Drug Abuse – Premium Reports August 27, 2024

Parents Opposed to Pot Report on 312 Child Deaths Linked to Marijuana
News reports of child deaths since November 2012 show adult marijuana use harms minors. Violent neglect
includes marijuana DUI (35), guns (17). The last column includes infants (28) in the care of pot using moms

Please find the details below:

021424-Child-dangers-fact-sheet-FINAL

Source: https://poppot.org/wp-content/uploads/2024/02/021424-Child-dangers-fact-sheet-FINAL.pdf February 2024

  • A 48-year-old woman in California developed meningitis after between three and six medical marijuana blunts contaminated by a fungus daily
  • Meningitis causes potentially fatal brain and spinal cord inflammation 
  • This is the first known case of meningitis coming from cannabis 
  • The soil in Bakersfield, where the woman lived is known to be contaminated with another fungus that causes the flu-like ‘valley fever’ 
  • The dispensary and area soil are being investigated, though similar infections are unlikely for healthy people who smoke smaller quantities    

A 48-year-old woman in California contracted a potentially deadly meningitis infection in 2016 from smoking her favourite medical marijuana strain three to six times a day, according to a British Medical Journal case study report published last month. 

The infection came from a fungus, called cryptococcus, that most people contract from inhaling contaminated dust or eating food that mouse faeces have touched. 

Meningitis is the most common illness to develop from exposure to cryptococcus, and causes potentially fatal inflammation in the brain and spinal cord. 

Dr Bryan Shapiro, who treated the woman, says that cannabis smokers in California should be sure to know where their marijuana came from, especially if their immune systems are compromised in any way, as meningitis could be lethal for them. 

The unnamed woman’s sister brought her to the Cedars-Sinai Medical Center (CSMC) in Los Angeles, California. She had ‘strange symptoms,’ Dr Shapiro said, including being dizzy, tired, struggling to recall even her own name, and behaving aggressively. 

In fact, her behaviour had become so erratic that she was fired from her job as an administrative assistant before being admitted to the hospital. 

At CSMC, the emergency room team could not figure out what was ailing the otherwise healthy patient. When she assaulted a nurse, the team called in the psychiatric department.  

‘We thought it might be catatonia [abnormal movement triggered by mental issues], and it took us some time to rule out a psychiatric illness,’ Dr Shapiro said. 

Still unable to diagnose her, they took a sample of her brain fluid, which tested positive for Cryptococcus neoformans, ‘a rare fungal infection usually only seen in people with late stage HIV or transplant patients,’ Dr Shapiro explained. 

But the woman was otherwise in reasonably good health. The only things that stood out in her medical history were high blood pressure and a significant marijuana habit. 

‘She said she had smoked between three and six marijuana blunts about daily since her teenage years,’ Shapiro said, ‘I’ve never known a patient who smokes that heavily and wondered if there could be a link between her heavy cannabis use for a lifetime.’ 

They treated the woman for meningitis, but if they hadn’t done so ‘prudently…there is a strong possibility she would have died, she was very, very severe at the time we saw her,’ he says. 

As she was recovering, Dr Shapiro and his team investigated her favourite medical marijuana dispensary in Bakersfield where she always purchased one of the shop’s cheaper strains, which was grown locally outdoors.

DNA sequencing of nine samples revealed small amounts of the rare fungus. 

‘That lent credibility to the idea that the cryptococcus in the cannabis may have caused the woman’s systemic malfunction, and smoking might actually predispose someone to invasive fungal infection,’ Dr Shapiro said. 

Fungus spores are actually grow on cannabis quite commonly. 

A study conducted last year identified evidence of mould, pesticides and other contaminants on much of the weed grown in the state.  

More than 90 percent of the marijuana plants tested were contaminated with pesticides, and crops from 20 farms were positive for mold. 

The soil in Bakersfield and the surrounding Central Valley area is known to be a breeding ground for another fungus called Coccidioides immitis, which is to blame for a slew of cases of an infection, dubbed ‘valley fever.’ 

Valley fever is a potentially sever lung infection and its symptoms can mirror those of the flu that has killed nearly 100 people in California since the start of the year. 

The prevalence of the valley fever fungus – which causes infection when it is inhaled – in the area ‘raised suspicions’ for Dr Shapiro and his team that the soil could harbour cryptococcus as well. 

The spores of these fungi are very heat resistant, so they survive even as the weed they are attached to is smoked. 

Even so, it is rare for someone with an otherwise healthy immune system to get such an infection, and Dr Shapiro points to other research that has suggested that THC – the psychoactive component of weed – may itself suppress the immune system. 

‘So, the more you smoke, the greater the exposure [to the fungus and] the more likely it is that your body is unable to fight off the infection,’ he says. 

Dr Shapiro was unable to disclose the name of the particular dispensary that the contaminated marijuana came from, but said that it is under investigation.

This case was the first of its kind that Dr Shapiro or his team had seen, so it’s too early to make formal recommendations, he says, but advises: ‘Make sure you know where your marijuana is coming from. 

‘I recommend buying indoor-grown strains and, for people who are immuno-compromised like those with HIV or other infections, I would recommend avoiding inhaled marijuana products,’ he says. Edible products, on the other hand are probably safer for consumption.     

Source: https://www.dailymail.co.uk/health/article-5327367/California-woman-caught-meningitis-CANNABIS.html January 2018

How much should we worry?

American parents have been warning teenagers about the dangers of marijuana for about 100 years. Teenagers have been ignoring them for just as long. As I write this, a couple of kids are smoking weed in the woods just yards from my office window and about a block and a half from the local high school. They started in around 9 A.M., just in time for class.

Exaggerating the perils of cannabis—the risks of brain damage, addiction, psychosis—has not helped. Any whiff of Reefer Madness hyperbole is perfectly calibrated to trigger an adolescent’s instinctive skepticism for whatever an adult suggests. And the unvarnished facts are scary enough.

We know that being high impairs attention, memory and learning. Some of today’s stronger varieties can make you physically ill and delusional. But whether marijuana can cause lasting damage to the brain is less clear.

A slew of studies in adults have found that nonusers beat chronic weed smokers on tests of attention, memory, motor skills and verbal abilities, but some of this might be the result of lingering traces of cannabis in the body of users or withdrawal effects from abstaining while taking part in a study. In one hopeful finding, a 2012 meta-analysis found that in 13 studies in which participants had laid off weed for 25 days or more, their performance on cognitive tests did not differ significantly from that of nonusers.

But scientists are less sanguine about teenage tokers. During adolescence the brain matures in several ways believed to make it more efficient and to strengthen executive functions such as emotional self-control. Various lines of research suggest that cannabis use could disrupt such processes.

For one thing, recent studies show that cannabinoids manufactured by our own nerve cells play a crucial role in wiring the brain, both prenatally and during adolescence. Throughout life they regulate appetite, sleep, emotion, memory and movement—which makes sense when you consider the effects of marijuana. There are “huge changes” in the concentration of these endocannabinoids during the teenage years, according to neurologist Yasmin Hurd of the Icahn School of Medicine at Mount Sinai, which is why she and others who study this system worry about the impact of casually dosing it with weed.

Brain-imaging studies reinforce this concern. A number of smallish studies have seen differences in the brains of habitual weed smokers, including altered connectivity between the hemispheres, inefficient cognitive processing in adolescent users, and a smaller amygdala and hippocampus—structures involved in emotional regulation and memory, respectively.

More evidence comes from research in animals. Rats given THC, the chemical that puts the high in marijuana, show persistent cognitive difficulties if exposed around the time of puberty—but not if they are exposed as adults.

But the case for permanent damage is not airtight. Studies in rats tend to use much higher doses of THC than even a committed pothead would absorb, and rodent adolescence is just a couple of weeks long—nothing like ours. With brain-imaging studies, the samples are small, and the causality is uncertain. It is particularly hard to untangle factors such as childhood poverty, abuse and neglect, which also make their mark on brain anatomy and which correlate with more substance abuse, notes Nora Volkow, director of the National Institute on Drug Abuse and lead author of a superb 2016 review of cannabis research in JAMA Psychiatry.

To really sort this out, we need to look at kids from childhood to early adulthood. The Adolescent Brain Cognitive Development study, now under way at the National Institutes of Health, should fill the gap. The 10-year project will follow 10,000 children from age nine or 10, soaking up information from brain scans, genetic and psychological tests, academic records and surveys. Among other things, it should help pin down the complex role marijuana seems to play in triggering schizophrenia in some people.

But even if it turns out that weed does not pose a direct danger for most teens, it’s hardly benign. If, like those kids outside my window, you frequently show up high in class, you will likely miss the intellectual and social stimulation to which the adolescent brain is perfectly tuned. This is the period, Volkow notes, “for maximizing our capacity to navigate complex situations,” literally building brainpower. On average, adolescents who partake heavily wind up achieving less in life and are unhappier. And those are things a teenager might care about.

Source: https://www.scientificamerican.com/article/what-pot-really-does-to-the-teen-brain/ December 2017

Cannabis or more commonly known as marijuana, is one of the most frequently used drugs in the United States. In 2022, marijuana became more popular than alcohol as the preferred daily drug of use among Americans. In the same year, it was found that 30 out of every 100 high school age students reported using the drug within the past 12 months, and 3 of every 50 reported using it daily.

Marijuana is often perceived as harmless, which has influenced its increased use by a factor of 15 within the past three decades, but this substance can have severe physical and mental health effects.

This blog will share the heart-wrenching stories of Brant Clark and Shane Robinson, as told by their families, along with a recent article by Alton Northup editor-in-chief of KentWired. Their lives were tragically cut short by marijuana induced psychosis.

Brant Clark

Ann Clark shares the heartbreaking story of her 17-year-old son, Brant, who experienced cannabis-induced psychosis leading to his tragic suicide. She recounts his rapid descent into hopelessness and the devastating impact on their family to raise awareness about the dangers of marijuana use on mental health.

Ann Clark shares the heartbreaking story of her 17-year-old son, Brant, who experienced cannabis-induced psychosis leading to his tragic suicide. She recounts his rapid descent into hopelessness and the devastating impact on their family to raise awareness about the dangers of marijuana use on mental health.

Brant Clark (pictured) was a happy and bright 17-year-old who reported using marijuana socially. However, during his last high school winter break, after smoking marijuana at a party with friends, he experienced a psychotic break believed to have been triggered by smoking a large amount of potent marijuana.

After the party Brent expressed to his mother his feelings of “emptiness and hopelessness”, and deep regret, lamenting his decision to smoke marijuana. Within two days of the onset of symptoms, Brant was admitted to the ER and psychiatric care unit. Tragically, three weeks later, he ended his own life, leaving behind a note revealing his intense mental anguish and regret.

Brant’s doctor diagnosed him with Cannabis-Induced Psychosis, a condition where marijuana use leads to severe mental disturbances. Brant’s case highlights how this condition can manifest suddenly and with tragic consequences. Ann, Brant’s mother, recalls the happiness her son brought to her life, and the pain that lingers after his loss.

 Shane Robinson

In 2009, Lori Robinson’s son faced a similar fate. Shane, a vibrant 23-year-old, turned to marijuana for pain relief after a knee injury. Despite his parents’ concerns, Shane believed that the drug was a safe alternative to pain medication. However, Shane’s behavior changed drastically. He began to experience hallucinations and delusions. After being hospitalized several times and a prolonged struggle with mental health, Shane took his own life at the age of 25.

Lori, Shane’s mother, shared that the psychologists who treated her son questioned marijuana’s role in Shane’s mental illness, but neither Shane nor Brant had any prior history of mental illness, and their symptoms rapidly emerged after using marijuana.

Cannabis-Induced Psychosis would finally be added as a recognized mental health diagnosis in the year of 2013.

 

Medical and Scientific Insights

Although research still has a long way to go and should continue to examine how mental health disorders are affected by marijuana use independently, it should also focus on understanding the physiological mechanisms, as well as the effects of increased potency and contaminants in marijuana. The progress that has been made is enough to encourage the continuation of this field of research. Recent studies have shown strong associations between cannabis use disorder (CUD) and psychotic episodes. One study showed that 5 out of every 6 teenagers who sought help for a psychotic episode had used marijuana and that they were 11 times more likely to experience psychotic episodes compared to non-users of the drug. Another study showed a 30% increase in schizophrenia cases among men aged 21-30 were associated with CUD.

Dr. David Streem from the Cleveland Clinic shared with the editor of KentWired that he has observed a dramatic increase in psychosis cases over the past decade, which aligns with the increase in marijuana potency from less than 10% in the 90s to 30% or more today.

Advocating for Prevention

Ann Clark and Lori Robinson have become advocates, raising awareness about the dangers of cannabis-induced psychosis. Despite facing skepticism and opposition, they courageously continue to share their son’s stories to educate others about the potential risks of marijuana use.

As marijuana becomes widely legalized, Ann believes that “it only gives our young people a lower perception of harm, and a false sense of security and safety”. However, increased levels of THC and the building body of evidence linking marijuana to mental health conditions, call for greater public health education and regulations.

The tragic stories of Brant and Shane underscore the urgent need for awareness about cannabis-induced psychosis as the use of marijuana becomes more prevalent among younger populations.

Source: https://kentwired.com/120770/news/cannabis-induced-psychosis-cost-their-sons-their-lives-more-could-be-next/

By FOX TV Digital Team

Published  July 8, 2024 7:26am EDT

 

Demand for high-potency marijuana causing concerns

Cary Quashen, Owner of Action Family Counseling, joins LiveNOW’s Austin Westfall to dive deep into concerns over the rising demand for high-potency marijuana.

As marijuana use becomes more prevalent, a severe illness linked to frequent cannabis use is also on the rise. 

Cannabinoid (or Cannabis) hyperemesis syndrome, also known as CHS, is an often debilitating condition that affects a small but growing number of chronic marijuana users. 

People with CHS experience severe nausea and vomiting, in some cases 20-24 times a day. It can last days or even weeks and is hard to control – often the only thing that brings relief is a hot shower or bath. 

RELATED: Frequent marijuana use linked to increase in heart attack and stroke risk

Signs of cannabis hyperemesis syndrome

In National Library of Medicine literature, doctors outlined the following criteria for diagnosing CHS: 

  • Long-term cannabis use (often daily)
  • Cyclic nausea and vomiting
  • Relief when stopping marijuana
  • Hot showers/baths relieve symptoms
  • Abdominal pain

RELATED: Teen use of delta-8, an unregulated marijuana alternative, is rising

Ironically, marijuana is often used to treat two key symptoms of CHS: Recent data compiled by the U.S. Food and Drug Administration concluded there is “credible scientific support” for the use of marijuana to treat pain, anorexia, nausea and vomiting

Doctors are seeing a rise in serious illness linked to heavy marijuana use (Photo by Lauren DeCicca/Getty Images)

Three cycles of cannabis hyperemesis syndrome

There are three phases of CHS, according to Connecticut state’s Adult Cannabis Use website

  • Prodromal – Nausea and vomiting following long-term cannabis use. This often leads to a person using more cannabis to reduce nausea.
  • Hyperemetic – Triggered by increased cannabis use, nausea, abdominal pains and vomiting increase
  • Recovery – Once a person stops using cannabis, symptoms may take several weeks to decrease and disappear until they begin using again, which starts the cycle over.

What causes cannabis hyperemesis syndrome?

Researchers are still early in their exploration of what causes CHS. Dr. Sushrut Jangi, a gastroenterologist at Tufts Medical Center, told The Boston Globe it has something to do with the “somewhat mysterious” endocannabinoid system, which regulates critical bodily functions like sleep, mood, pain control, immune response, appetite and more. 

READ MORE: Michigan dog attacks, nearly kills owner after being fed THC gummy

A lot of receptors in the brain and the gut bind to THC, the substance in cannabis that makes people feel high. Those receptors evolve after long-term cannabis use, Jangi told The Globe. 

Jangi said although it’s hard to calculate, he estimates somewhere between 5% and 20% of chronic marijuana users will experience CHS. 

According to the National Library of Medicine, after Colorado legalized recreational marijuana, ER visits for cyclic vomiting nearly doubled.

 

Source: https://www.livenowfox.com/tag/cannabis

By Kevin A. Sabet

PUBLISHED: June 30, 2024 at 6:00 a.m.

This month, Gov. Wes Moore pardoned more than 175,000 prior marijuana convictions, impacting more than 100,000 individuals. This comes 18 months after the Old Line State voted to legalize recreational marijuana, which went on sale exactly one year ago on July 1. While the pordons were a good move, the move was a too-little-too-late acknowledgement that marijuana legalization isn’t about social justice, and pot profiteers aren’t necessary to end the criminalization of small possession of marijuana.

Moore’s decision to pardon these prior marijuana convictions should be commended. The charges related to low-level possession and paraphernalia. He followed in the steps of President Joe Biden, who in 2022 pardoned federal convictions for the low-level possession of marijuana.

Moore called it “the most sweeping state level pardon in any state in American history.” Yet nobody will be released from prison, just as nobody was released from federal prison because of Biden’s pardons. The pardons in Maryland will also not expunge the criminal records of those with prior convictions.

These recent steps highlight the false dichotomy between the criminalization of marijuana and the legalization of today’s highly potent THC drugs. While nobody should be in jail for the use of marijuana, the alternative policy need not legalize dangerous psychoactive drugs and usher in a for-profit marijuana industry, as was done in Maryland. Removing criminal penalties could address concerns related to the criminal justice system, while not giving the marijuana industry free rein to do as it pleases.

Indeed, when polls ask voters about the specific policy they prefer for marijuana, they do not come out in support of a full-scale commercial industry. A national poll in 2022 from Emerson College found that only 38% of Americans prefer full legalization, with the remaining 62% majority favoring decriminalization of marijuana, or continued prohibition — among other options. Americans remain wary of legalization.

This trend is also playing out in Maryland, with some voters having second thoughts about legalization. According to a Washington Post/University of Maryland poll, only 31% of voters have a positive view of legalization. Notably, Black Marylanders were more likely to say it’s been bad than good, at 32% vs 28%, respectively. Opposition comes across party lines, with 63% of Democrats and 76% of Republicans saying legalization has not been good for the state.

The same poll also asked people whether they support allowing a dispensary to open in their community. Statewide, half of Marylanders opposed this proposition. In Prince George’s County specifically 59% of poll respondents opposed it. Voters recognize the difference between the harms of criminalization and the harms of the addiction-for-profit industry. Marylanders don’t want people in prison for marijuana, but they also don’t want pot shops in their neighborhood.

Moore’s pardons come amid calls for a shift in national marijuana policy. The Biden Administration is actively working to reclassify marijuana as a Schedule III substance, a move that would be a boon for the industry. Politicians should know better by now. They should know to distrust the industry and prioritize public health and public safety — they’ve gone through the same routine with the tobacco industry.

Despite promises that commercial pot sales would improve racial equity, we have seen that Black Americans continue to be disproportionately harmed, now by a predatory industry and its mind-altering products. Black Americans were 4x more like to have marijuana-related emergency department visits than white Americans. Additionally, in 2022, Black minors between the ages of 12 and 17 were 25% more likely to have used marijuana in the past month, compared to white minors and they were 31% more likely to have a cannabis use disorder.  Pot shops are disproportionately concentrated in low-income communities and communities of color, helping to explain the concentration of these harms.

The marijuana industry uses arguments about racial equity as a guise to advance its financial interests. It’s a myth not supported by an honest assessment of the industry and its practices.

Moore’s actions are proof positive it is possible to advance racial equity without legalizing marijuana, a drug associated with numerous mental health harms, including anxiety, depression and schizophrenia. A good first step to protect Marylanders would be curbing public use, educating young people about the risks, requiring product labels with science-based warnings, and enacting strong regulations on the industry. The governor should turn his pulpit to these real concerns before more Marylanders get hurt.

Dr. Kevin Sabet (info@learnaboutsam.org) is the president of Smart Approaches to Marijuana (SAM), the nation’s leading nonpartisan voice for health and safety-based marijuana policy, and a three-time White House drug policy advisor.

 

US President Joe Biden’s plan to downgrade marijuana, whether politically motivated or empathic, is a regressive step in the global fight against drugs, say Tan Chong Huat and Narayanan Ganapathy from Singapore’s National Council Against Drug Abuse.

23 Jun 2024 06:00AM(Updated: 23 Jun 2024 07:40AM)

Under the move, marijuana – which has been classified since 1970 as a Schedule I drug alongside heroin, LSD and ecstasy – will be downgraded to a Schedule III drug, putting it in the same category as drugs like testosterone or painkillers containing codeine. Schedule III drugs are deemed to have a “moderate to low potential” of dependence.

“No one should be in jail merely for using or possessing marijuana,” US President Joe Biden said in a video on May 17. “Far too many lives have been upended because of failed approach to marijuana and I’m committed to righting those wrongs.”

Earlier this week, Maryland pardoned more than 175,000 marijuana convictions, becoming the latest state to do so after similar mass pardons by Massachusetts and Oregon, among others.

Research reported in The American Journal of Drug and Alcohol Abuse highlights that prolonged cannabis abuse can disrupt brain function, particularly during critical developmental stages.

Similarly, the Singapore Medical Journal featured local research that attests to these findings, showing that early initiation of cannabis use leads to greater long-term negative impacts.

The reclassification of marijuana at the federal level could legitimise the cannabis industry and accelerate the normalisation of recreational cannabis use at the state level, despite concerns about the risks.

RISING CONCERNS ABOUT DRUG USE AMONG SINGAPOREAN YOUTHS

In Singapore, recent data highlights growing concerns about drug use among youths.

The 2022 Health and Lifestyle survey by the Institute of Mental Health (IMH) revealed that the mean age of drug initiation in Singapore is 15.9 years.

Drug-related arrests are also on the rise, increasing by 10 per cent to 3,122 cases last year. Notably, there was a 17 per cent increase in cannabis abusers arrested. Amongst new cannabis abusers arrested, close to two in three were below the age of 30.

These statistics reflect a troubling trend that underscore the need for more robust and concerted drug prevention measures. Despite Singapore’s comprehensive demand and supply reduction efforts, endorsed by strong public opinion, misconceptions about cannabis are prevalent among youths.

In the 2023 National Drug Perception Survey by the National Council Against Drug Abuse (NCADA), 90.4 per cent of youths agreed that “drug-taking should remain illegal in Singapore”, but only 79.3 per cent supported the continued criminalisation of cannabis.

Qualitative interviews revealed that some youths believe cannabis use can be personally regulated, while young adults in their early 30s often view cannabis as a “soft” drug suitable for recreational use without addiction risks.

But research invalidates the perception that cannabis is less harmful than other drugs. In a study published in the Singapore Medical Journal last year, researchers found that almost half of the 450 participants surveyed progressed to using other illicit drugs after trying cannabis, with 42 per cent progressing to heroin.

The distorted knowledge among youths is unfortunately compounded by social media and pop culture. The task of combating misinformation about drugs is made more difficult by the vast digital landscape, where young people encounter a wide array of information, some of which can potentially fuel drug-abusing behaviours.

THE INTERGENERATIONAL IMPACT OF DRUG ABUSE

The repercussions of drug abuse extend far beyond individual abusers, deeply affecting their families and the community.

A 2020 study by Singapore’s Ministry of Social and Family Development stated that children of parents who committed drug offenses are 5.18 times more likely than other children to have contact with the criminal justice system in the future.

Additionally, youth offenders from households with a history of substance abuse are 2.2 times more likely to join gangs.

Research shows that children of drug-abusing parents experience a range of social-psychological deficits including weakened social bonds to conventional institutions and role models.

The Biden administration’s decision to relax its stance towards marijuana has been lauded by advocates for addressing what they say is an uneven drug enforcement policy that has fuelled mass incarceration and disproportionately affected certain communities. However, this commendation appears contradictory, as it fails to recognise the potential adverse effects such a move could have on socio-economically deprived and disadvantaged communities already afflicted by the drug scourge.

Empirical evidence from countries that have adopted harm reduction approaches, such as Portugal, the Netherlands, Switzerland, Canada, and Australia, reveals mixed outcomes.

For instance, the Netherlands, known for its regulated sale of cannabis through so-called “coffeeshops”, continues to face issues of drug tourism and associated social ills where children as young as 14 years old are recruited as “cocaine collectors”. In January 2024, the Mayor of Amsterdam warned in an opinion piece published in the Guardian that the Netherlands risks becoming a “narco-state”.

In Sweden, the number of fatal shootings has more than doubled since 2013, reaching 391 in 2022, primarily due to gang-related drug and arms conflicts. A lawyer representing teenage shooting victims told the BBC in December that “children are using their own bags not to carry books, but to carry the drug markets of Sweden on their shoulders.

Similarly, Canada and Australia, despite their comprehensive harm reduction strategies, persistently encounter drug-related crime and health issues. In 2023, British Columbia decriminalised drugs to reduce overdose rates, but only to see it surge by 5 per cent, the BBC reported. BC authorities are now considering re-criminalising the use of hard drugs in public places.

Closer to home, Thailand is planning to relist cannabis as a narcotic, just two years after it became the first in Southeast Asia to decriminalise its recreational use.

These cases illustrate the complexities and potential negative consequences of relaxed drug policies, particularly for vulnerable populations.

It is precisely for this reason that Singapore maintains its unwavering commitment to shield vulnerable communities from the devastating effects of drug abuse and prevent the intergenerational cycle of crime, arrest, incarceration, and re-incarceration.

Singapore’s approach, guided by science and sensible considerations, prioritises harm prevention over harm reduction and serves as a robust framework for tackling this pervasive issue.

Tan Chong Huat is Chairman of National Council Against Drug Abuse (NCADA) and Associate Professor Narayanan Ganapathy is an NCADA member.

Vienna, 26 June 2024

The emergence of new synthetic opioids and a record supply and demand of other drugs has compounded the impacts of the world drug problem, leading to a rise in drug use disorders and environmental harms, according to the World Drug Report 2024 launched by the UN Office on Drugs and Crime (UNODC) today.

“Drug production, trafficking, and use continue to exacerbate instability and inequality, while causing untold harm to people’s health, safety and well-being,” said Ghada Waly, Executive Director of UNODC. “We need to provide evidence-based treatment and support to all people affected by drug use, while targeting the illicit drug market and investing much more in prevention.”

The number of people who use drugs has risen to 292 million in 2022, a 20 per cent increase over 10 years. Cannabis remains the most widely used drug worldwide (228 million users), followed by opioids (60 million users), amphetamines (30 million users), cocaine (23 million users), and ecstasy (20 million users).

Nitazenes – a group of synthetic opioids which can be even more potent than fentanyl – have recently emerged in several high-income countries, resulting in an increase in overdose deaths.

Though an estimated 64 million people worldwide suffer from drug use disorders, only one in 11 is in treatment. Women receive less access to treatment than men, with only one in 18 women with drug use disorders in treatment versus one in seven men.

In 2022, an estimated 7 million people were in formal contact with the police (arrests, cautions, warnings) for drug offences, with about two-thirds of this total due to drug use or possession for use. In addition, 2.7 million people were prosecuted for drug offences and over 1.6 million were convicted globally in 2022, though there are significant differences across regions regarding the criminal justice response to drug offences.

The Report includes special chapters on the impact of the opium ban in Afghanistan; synthetic drugs and gender; the impacts of cannabis legalization and the psychedelic “renaissance”; the right to health in relation to drug use; and how drug trafficking in the Golden Triangle is linked with other illicit activities and their impacts.

Drug trafficking is empowering organized crime groups

Drug traffickers in the Golden Triangle are diversifying into other illegal economies, notably wildlife trafficking, financial fraud, and illegal resource extraction. Displaced, poor, and migrant communities are suffering the consequences of this instability, sometimes forced to turn to opium farming or illegal resource extraction to survive, falling into debt entrapment with crime groups, or using drugs themselves.

These illicit activities are also contributing to environmental degradation through deforestation, the dumping of toxic waste, and chemical contamination.

Consequences of cocaine surge

A new record high of 2,757 tons of cocaine was produced in 2022, a 20 per cent increase over 2021. Global cultivation of coca bush, meanwhile, rose 12 per cent between 2021 and 2022 to 355,000 hectares. The prolonged surge in cocaine supply and demand has coincided with a rise in violence in states along the supply chain, notably in Ecuador and Caribbean countries, and an increase in health harms in countries of destination, including in Western and Central Europe.

Impact of cannabis legalization

As of January 2024, Canada, Uruguay, and 27 jurisdictions in the United States had legalized the production and sale of cannabis for non-medical use, while a variety of legislative approaches have emerged elsewhere in the world.

In these jurisdictions in the Americas, the process appears to have accelerated harmful use of the drug and led to a diversification in cannabis products, many with high-THC content. Hospitalizations related to cannabis use disorders and the proportion of people with psychiatric disorders and attempted suicide associated with regular cannabis use have increased in Canada and the United States, especially among young adults.

Psychedelic “renaissance” encourages broad access to psychedelics

Though interest in the therapeutic use of psychedelic substances has continued to grow in the treatment of some mental health disorders, clinical research has not yet resulted in any scientific standard guidelines for medical use.

However, within the broader “psychedelic renaissance”, popular movements are contributing to burgeoning commercial interest and to the creation of an enabling environment that encourages broad access to the unsupervised, “quasi-therapeutic” and non-medical use of psychedelics. Such movements have the potential to outpace the scientific therapeutic evidence and the development of guidelines for medical use of psychedelics, potentially compromising public health goals and increasing the health risks associated with the unsupervised use of psychedelics.

Implications of opium ban in Afghanistan

Following the drastic decrease of Afghanistan’s opium production in 2023 (by 95 per cent from 2022) and an increase in production in Myanmar (by 36 per cent), global opium production fell by 74 per cent in 2023. The dramatic contraction of the Afghan opiate market made Afghan farmers poorer and a few traffickers richer. Long-term implications, including on heroin purity, a switch to other opioids by heroin users, and/or a rise in demand for opiate treatment services may soon be felt in countries of transit and destination of Afghan opiates.

Right to health for people who use drugs

The report outlines how the right to health is an internationally recognized human right that belongs to all human beings, regardless of a person’s drug use status or whether a person is imprisoned, detained or incarcerated. It applies equally to people who use drugs, their children and families, and other people in their communities.

Source: https://www.unodc.org/unodc/en/press/releases/2024/June/unodc-world-drug-report-2024_-harms-of-world-drug-problem-continue-to-mount-amid-expansions-in-drug-use-and-markets.html

 Law and Crime Prevention

The UN agency tackling crime and drug abuse (UNODC) released its annual World Drug Report on Wednesday warning that there are now nearly 300 million users globally, alongside an increase in trafficking.

The International Day against Drug Abuse and Illicit Trafficking, or World Drug Day, is commemorated every year on June 26 and aims to increase action in achieving a drug-free world.

This year’s campaign recognises that “effective drug policies must be rooted in science, research, full respect for human rights, compassion, and a deep understanding of the social, economic, and health implications of drug use”.

Ghada Waly, Executive Director of UNODC, said that providing evidence-based treatment and support to all those affected by drug use is needed, “while targeting the illicit drug market and investing much more in prevention”.

New threat from nitazenes

Drug production, trafficking, and use continue to exacerbate instability and inequality, while causing untold harm to people’s health, safety and well-being.
— Ghada Waly

In the decade to 2022, the number of people using illicit drugs increased to 292 million, the UNODC report says.

It noted that most users worldwide consume cannabis – 228 million people – while 60 million people worldwide consume opioids, 30 million people use amphetamines, 23 million use cocaine and 20 million take ecstasy.

Further, UNODC found that there was an increase in overdose deaths following the emergence of nitazenes – a group of synthetic opioids potentially more dangerous than fentanyl – in several high-income countries.

Trafficking in the Triangle

The drug report noted that traffickers in the Golden Triangle, a region in Southeast Asia, have found ways to integrate themselves into other illegal markets, such as wildlife trafficking, financial fraud, and illegal resource extraction.

“Displaced, poor and migrant communities” bear the brunt of this criminal activity and on occasion are forced to engage in opium farming or illegal resource extraction for their survival; this can lead to civilians becoming drug users or fall into debt at the mercy of crime groups.

Environmental fallout

These illegal crimes contribute to environmental degradation via deforestation, toxic waste dumping and chemical contamination.

“Drug production, trafficking, and use continue to exacerbate instability and inequality, while causing untold harm to people’s health, safety and well-being,” UNODC’s Ms. Waly said.

The potency of cannabis has increased by as much as four times in parts of the world over the last 24 years.

Cocaine surge and cannabis legalisation

In 2022, cocaine production hit a record high with 2,757 tons produced – a 20 per cent increase from 2021.

The increase in supply and demand of the product was accompanied by a surge of violence in nations along the supply chain, especially in Ecuador and Caribbean countries. There was also a spike in health problems within some destination countries in Western and Central Europe.

Similarly, harmful usage of cannabis surged as the product was legalized across Canada, Uruguay, and 27 jurisdictions in the United States, much of which was laced with high-THC (delta9-tetrahydrocannabinol) content – which is believed to be the main ingredient behind the psychoactive effect of the drug.

This led to an increase in the rate of attempted suicides among regular cannabis users in Canada and the US.

The hope for World Drug Day

The UNODC report highlights that the “right to health is an internationally recognized human right that belongs to all human beings, regardless of a person’s drug use status or whether a person is imprisoned, detained or incarcerated”.

UNODC’s calls for governments, organizations and communities to collaborate on establishing evidence-based plans that will fight against drug trafficking and organized crime.

The agency also hopes communities will assist in “fostering resilience against drug use and promoting community-led solutions”.

 

(Slip Opinion)

The approach that the Drug Enforcement Administration currently uses to determine whether a drug has a “currently accepted medical use in treatment in the United States” under the Controlled Substances Act is impermissibly narrow. An alternative, two-part inquiry proposed by the Department of Health and Human Services is sufficient to establish that a drug has a “currently accepted medical use” even if the drug would not satisfy DEA’s current approach.

Under 21 U.S.C. § 811(b), a recommendation by HHS that a drug has or lacks a “currently acceptable medical use” does not bind DEA. In contrast, the scientific and medical determinations that underlie HHS’s “currently acceptable medical use” recommendation are binding on DEA, but only until the initiation of formal rulemaking proceedings to schedule a drug. Once DEA initiates a formal rulemaking, HHS’s determinations no longer bind DEA, but DEA must continue to accord HHS’s scientific and medical determinations significant deference, and the CSA does not allow DEA to undertake a de novo assessment of HHS’s findings at any point in the process.

Neither the Single Convention on Narcotic Drugs nor the CSA requires marijuana to be placed into Schedule I or II of the CSA. Both the Single Convention and the CSA allow DEA to satisfy the United States’ international obligations by supplementing scheduling decisions with regulatory action, at least in circumstances where there is a modest gap between the Convention’s requirements and the specific restrictions that follow from a drug’s placement on a particular schedule. As a result, DEA may satisfy the United States’ Single Convention obligations by placing marijuana in Schedule III while imposing additional restrictions pursuant to the CSA’s regulatory authorities.

April 11, 2024

NDPA EXPLANATORY: GUIDANCE TO ASSISTANT ATTORNEY GENERAL’S FULL COMMENT:

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DOJ.OLC.Rescheduling opinion

Source: MEMORANDUM OPINION FOR THE ATTORNEY GENERAL – by  CHRISTOPHER C. FONZONE –  Assistant Attorney General, Office of Legal Counsel

SUMMARY: The Department of Justice (“DOJ”) proposes to transfer marijuana from schedule
I of the Controlled Substances Act (“CSA”) to schedule III of the CSA, consistent with the view
of the Department of Health and Human Services (“HHS”) that marijuana has a currently
accepted medical use as well as HHS’s views about marijuana’s abuse potential and level of
physical or psychological dependence. The CSA requires that such actions be made through
formal rulemaking on the record after opportunity for a hearing. If the transfer to schedule III is
finalized, the regulatory controls applicable to schedule III controlled substances would apply, as
appropriate, along with existing marijuana-specific requirements and any additional controls that
might be implemented, including those that might be implemented to meet U.S. treaty
obligations. If marijuana is transferred into schedule III, the manufacture, distribution,
dispensing, and possession of marijuana would remain subject to the applicable criminal
prohibitions of the CSA. Any drugs containing a substance within the CSA’s definition of
“marijuana” would also remain subject to the applicable prohibitions in the Federal Food, Drug,
and Cosmetic Act (“FDCA”). DOJ is soliciting comments on this proposal.

NDPA EXPLANATORY: GUIDANCE TO THE ATTORNEY GENERAL’S COMMENT:

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Scheduling NPRM 508

Source:

21 CFR Part 1308 – Docket No. DEA-1362; A.G. Order No. 5931-2024 – DEA USA.
‘Schedules of Controlled Substances: Rescheduling of Marijuana’

OPENING STATEMENT BY THE AUTHOR – JOHN COLEMAN

To Whom It May Concern:

As a former DEA assistant administrator for operations and current president of Drug
Watch International, Inc. a 501c3 non-profit global organization of unpaid volunteers
dedicated to reducing drug abuse in the world through education, prevention, and
treatment, I wish to submit the following public comment in opposition to the rescheduling
of marijuana from Schedule I to Schedule III, as described in a Notice of Proposed
Rulemaking (NPRM), issued by U.S. Attorney General Merrick B. Garland on May 16,
2024, and published in the Federal Register on May 21, 2014.

Synopsis of Our Grounds in Opposition:

The Summary of the Attorney General’s NPRM provides the following rationale for proposing
rescheduling marijuana from Schedule I to Schedule III of the Controlled Substances Act (CSA):
The Department of Justice (‘‘DOJ’’) proposes to transfer marijuana from schedule
I of the Controlled Substances Act (‘‘CSA’’) to schedule III of the CSA, consistent
with the view of the Department of Health and Human Services (‘‘HHS’’) that
marijuana has a currently accepted medical use as well as HHS’s views about
marijuana’s abuse potential and level of physical or psychological dependence.

Speaking on behalf of the members of Drug Watch International, Inc., we disagree with the
rationale offered by the Attorney General in support of rescheduling marijuana. While our specific
objections will be addressed in greater detail below, it suffices here to state that procedures for
drug scheduling, rescheduling, and removing drugs and other substances from scheduling are
actions defined by federal statute, specifically, Title II of the Comprehensive Drug Abuse
Prevention and Control Act of 1970 (Public Law 91-513), also known as the Controlled Substances
Act (CSA), U.S. Code, Section 801, et seq.

In sum, the justification cited by the Attorney General in the NPRM for rescheduling marijuana 

does not comport with the statutory requirements of the CSA, specifically at 21 U.S.C. § 811 & § 812, 

for rescheduling controlled substances.

The view of HHS, as mentioned in the NPRM, that marijuana has a currently accepted medical
use (CAMU) is inaccurate and is based solely on redefining court-tested, statutorily-based, and
longstanding approved methods for determining CAMU. These methods are derived from the
Food, Drug, and Cosmetic Act (FDCA) and the CSA, not from or based on popular appeal, and
they are intended to evaluate the safety and efficacy of medicinal drugs submitted to the Food and
Drug Administration (FDA) for approval. The proposed action of the Attorney General, as
described in the NPRM, would set aside statutes and regulations intended to protect public health
and public safety to accommodate political constituents and the profiteers of a cannabis industry
that already has seriously harmed many Americans – especially, as we will show, children and
young adults. The modest medicinal benefits that some purport marijuana to have pale by
comparison with the significant risks posed by this powerful intoxicant.

Throughout the NPRM, DEA’s consistent response to the HHS analyses is to suggest a need to
consider additional information. We interpret the DEA’s carefully nuanced wording to mean that
the agency has misgivings as to the appropriateness of rescheduling marijuana. This, added to the
NPRM’s seeking of comments on the practical consequences of rescheduling marijuana, reflects,
we believe, the rank and file’s uncertainty with this radical proposal.

Of additional note is that the Attorney General – not the DEA Administrator, the Attorney General’s
lawful delegate for drug scheduling actions – signed the NPRM as “A.G. Order No. 5931-2024.”3
The Department’s Office of Legal Counsel (OLC) released a slip opinion that was published by
the Department at the same time as this order.

This opinion begins with the following sentence:

“The approach that the Drug Enforcement Administration currently uses to determine whether a
drug has a ‘currently accepted medical use in treatment in the United States’ under the Controlled
Substances Act is impermissibly narrow.” [emphasis added]

The OLC opinion is essential in this discussion because everything else – mainly, the scheduling
recommendation of the HHS Assistant Secretary and the Attorney General’s decision to accept it
– depends on redefining the heretofore accepted and agreed-upon meaning of the expression,
“currently accepted medical use” (CAMU) to mean something other than what Congress intended.
CAMU, we will show, is a specific criterion in the CSA that separates a Schedule I controlled
substance from a controlled substance in any of the other four schedules. We will show that the
convenient redefinition of CAMU by HHS, OLC, and the Attorney General is not only arbitrary
and capricious, but also contrary to pertinent provisions of the CSA and FDCA.

In this public comment, we will show that the proposal to reschedule marijuana is without merit,
conflicts with specific provisions of the CSA and the FDCA, and sacrifices the safety and efficacy
of the nation’s medicinal drug supply to satisfy a political agenda of the President to benefit the
commercial cannabis industry. The misgivings expressed by the DEA, along with the overt
political contrivances of OLC to support the President’s wishes, lead us to conclude that bringing
this proposal to a Final Rule would not be done by carefully considering statutory requirements –
as the law requires – but, instead, by furthering a political goal in a way that is arbitrary, capricious,
an abuse of statutory intent as well as an abuse of agency discretion. For these reasons and more,
we believe that this proceeding should be halted and a Final Rule should not be issued to reschedule
marijuana.

NDPA EXPLANATORY: GUIDANCE TO JOHN COLEMAN’S FULL COMMENT:

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Public Comment.06.10.24

Source: John Coleman, formerly with the DEA (USA) – authored these comments.

By Priyanjana Pramanik, MSc.Jun 11 2024

Reviewed by Lily Ramsey, LLM

In a recent study published in JAMA Network Open, researchers explored whether cannabis use is linked to mortality from all causes, cancer and cardiovascular disease (CVD).

Their findings indicate that heavy cannabis use is associated with a significantly higher risk of CVD mortality among females. However, they observed no association between cancer and all-cause mortality among the entire sample of males and females.

Background

Cannabis is the most commonly used illegal drug worldwide, and its increasing legalization underscores the need to understand its health impacts.

Previous research has suggested potential cardiovascular risks associated with cannabis use, but these studies often focused on specific populations, limiting the generalizability of their findings.

Furthermore, there has been a lack of research examining the differential effects of cannabis on males and females. Although cannabis use for medical purposes is expanding, its safety and efficacy for various conditions remain unclear.

Some studies have suggested a link between heavy cannabis use and increased all-cause and cardiovascular mortality. Still, others have found no such associations, often constrained by methodological limitations like small sample sizes, short follow-up periods, or limited age ranges of participants.

Only one prior study explored the relationship between cannabis use and cancer mortality, finding no significant link.

About the study

This study addressed existing gaps by examining sex-stratified links of lifetime cannabis use to CVD, cancer, and all-cause mortality in a large general population sample.

The cohort study utilized data from the UK Biobank, a large-scale biomedical database comprising 502,478 individuals aged 40 to 69, recruited from 2006 to 2010 from 22 cities across the UK.

Participants provided detailed health information through questionnaires, interviews, physical assessments, and biological samples, and their data was linked to mortality records up to December 19, 2020.

Pittcon Highlights: Cannabis & Psychedelic eBook Check out the highlights from Pittcon in the Cannabis & Psychedelic industriesDownload the latest edition

Cannabis use was self-reported and categorized into never, low, moderate, and heavy use based on lifetime frequency.

The study assessed the association between cannabis use and mortality using Cox proportional hazards regression models, adjusting for clinical and demographic variables.

Analyses were stratified by sex to address potential differences between males and females. Mortality outcomes were defined using codes from the International Statistical Classification of Diseases and Related Health Problems, 10th Revision, and various covariates such as age, education, income, smoking history, alcohol use, hypertension, diabetes, dyslipidemia, body mass index (BMI), prior CVDs, and antidepressant use were included in the models.

The study employed Kaplan-Meier survival analyses, considering two-sided P values less than 0.05 as significant.

Findings

The study analyzed 121,895 UK Biobank participants, aged 55.15 years on average for females and 56.46 years for males.

Among the participants, 3.88% of males and 1.94% of females were heavy cannabis users. Over a median follow-up of 11.8 years, there were 2,375 deaths, including 440 due to cancer and 1,411 due to CVD.

Heavy cannabis use in males was associated with an increased risk of all-cause mortality, with a hazard ratio (HR) of 1.28, but not significantly with CVD or cancer mortality after adjusting for all factors.

In females, heavy use of cannabis was associated with a higher risk of mortality from CVD (HR 2.67) and a non-significant increase in all-cause and cancer mortality after full adjustment.

Notably, among female tobacco users, heavy cannabis use significantly increased risks for all-cause mortality (HR 2.25), CVD mortality (HR 2.56), and cancer mortality (HR 3.52).

In contrast, male tobacco users saw an increased risk only for cancer mortality (HR 2.44). Excluding participants with comorbidities showed no significant associations between heavy use of cannabis and mortality.

The findings suggest a sex-specific impact of heavy cannabis use on mortality, particularly in females.

Conclusions

This study diverges from previous research that largely examined all-cause mortality among younger populations, showing a heightened risk associated with cannabis use.

Few studies addressed the link between cannabis use and CVD mortality, with mixed findings. Some studies indicated a significant association, while others did not.

The study’s strengths include a large sample size and standardized data collection protocols from the UK Biobank. However, the cross-sectional design limits causal inference, and the low response rate might introduce participant bias.

The study’s focus on middle-aged UK participants limits generalizability to other demographics.

Self-reported data on cannabis use and lack of recent usage patterns, dosage information, and follow-up on cannabis use during the study period are significant limitations.

Future research should involve longitudinal studies to explore the possible causal impact of cannabis use on mortality, with a focus on precise measurements of cannabis use, including frequency, dosage, and methods of consumption.

These studies should also aim to understand the sex-specific impacts and the links between of cannabis use and cancer mortality, given the ambiguous current evidence.

 

Source: https://www.news-medical.net/news/20240611/Heavy-cannabis-use-increases-the-risk-of-cardiovascular-disease-for-women-study-finds.aspx

by Eric W. Dolan

June 16, 2024

A new study published in the journal Psychological Medicine has found that teens who use cannabis are at an elevenfold higher risk of developing a psychotic disorder compared to those who do not use the drug. This finding underscores the potential mental health risks associated with cannabis use among adolescents, suggesting the association may be stronger than previously thought.

Cannabis, commonly known as marijuana, is a plant that has been used for both medicinal and recreational purposes for thousands of years. It contains numerous chemical compounds called cannabinoids, with tetrahydrocannabinol (THC) being the most well-known for its psychoactive effects.

THC is the substance primarily responsible for the “high” that users experience, as it interacts with the brain’s endocannabinoid system, influencing mood, perception, and various cognitive functions. Another major cannabinoid is cannabidiol (CBD), which is non-psychoactive and often touted for its potential therapeutic benefits.

The potency of cannabis, particularly in terms of its THC content, has significantly increased over the past few decades. In the 1980s, the average THC content in cannabis was around 1%. However, due to selective breeding and advanced cultivation techniques, modern strains can contain THC levels upwards of 20%, and some extracts can even exceed 90% THC.

This dramatic increase in potency has raised concerns among health professionals about the potential for more severe and widespread adverse health effects, especially among young users whose brains are still developing.

“My interest in this topic was initially driven by the legalization of recreational cannabis in Canada, which happened largely in the absence of solid evidence on the risks of cannabis use,” said study author André McDonald, a CIHR Postdoctoral Fellow at the Peter Boris Centre for Addictions Research and the Michael G. DeGroote Centre for Medicinal Cannabis Research at McMaster University.

“One of the big questions related to cannabis is its link with psychotic disorders, particularly during youth. Most studies on this topic have used data from the 20th century when cannabis was significantly less potent than today in terms of THC, so we were also curious whether using more recent data would show a stronger link.”

To conduct their study, the researchers linked population-based survey data from over 11,000 youths in Ontario, Canada, with health service use records. These records included hospitalizations, emergency department visits, and outpatient visits. The survey data came from the Canadian Community Health Survey (CCHS) cycles from 2009 to 2012, while the health service data was obtained from ICES.

The sample included non-institutionalized Ontario residents aged 12 to 24 years. To ensure the accuracy of their findings, the researchers excluded respondents who had used health services for psychotic disorders in the six years before their survey interview. This exclusion was intended to reduce the risk of reverse causation, where individuals might have started using cannabis to self-medicate for already existing psychotic symptoms.

Respondents were asked whether they had ever used cannabis and, if so, whether they had used it in the past 12 months. The primary outcome measured was the time to the first outpatient visit, emergency department visit, or hospitalization related to a psychotic disorder. The researchers also adjusted for various sociodemographic and substance use confounders to isolate the effect of cannabis use on the development of psychotic disorders.

Teens who reported using cannabis in the past year were found to be over eleven times more likely to be diagnosed with a psychotic disorder compared to non-users. Interestingly, this elevated risk was not observed in young adults aged 20 to 24, indicating that adolescence is a particularly vulnerable period for the mental health impacts of cannabis.

The data also showed that among the teens diagnosed with a psychotic disorder, the vast majority had a history of cannabis use. Specifically, about 5 in 6 teens who were hospitalized or visited an emergency department for a psychotic disorder had previously reported using cannabis. This finding supports the neurodevelopmental theory that the adolescent brain is especially susceptible to the effects of cannabis, which may disrupt normal brain development and increase the risk of severe mental health issues.

“People should be aware of the risks associated with using cannabis at an early age. This study estimates that teens using cannabis are at 11 times higher risk of developing a psychotic disorder compared to teens not using cannabis,” McDonald told PsyPost.

“It’s important to acknowledge that the vast majority of people who use cannabis will not develop a psychotic disorder, but this study suggests that most teens who develop a psychotic disorder have a history of cannabis use. This is important information to convey to teens but also parents of teens, who may not be aware that cannabis products today are different and may be more harmful than the ones that were around when they were teens. ”

While the study provides compelling evidence of a strong link between adolescent cannabis use and psychotic disorders, it still has some limitations. The potential for reverse causation remains, as early symptoms of psychosis could lead some teens to use cannabis as a form of self-medication before seeking formal medical help. Additionally, the study could not account for genetic predispositions, family history of mental health issues, or trauma — all factors that could influence both cannabis use and the risk of psychotic disorders.

Nonetheless, the findings heighten concerns about early cannabis use.

“As commercialized cannabis products have become more widely available, and have a higher THC content, the development of prevention strategies targeting teens is more important than ever,” said senior author Susan Bondy, an affiliate scientist at ICES and associate professor at the University of Toronto’s Dalla Lana School of Public Health.

McDonald added: :Canadian youth are among the heaviest users of cannabis in the world. If we follow the precautionary principle, the bottom line is that more needs to be done to prevent early cannabis use.”

 

Source: https://www.psypost.org/exclusive/drugs/marijuana-research/

Lieberman is The Constance and Stephen Lieber Professor of Psychiatry at Columbia University Vagelos College of Physicians and Surgeons, and President of the ARETE INSTITUTE for Health, Well-Being and Human Potential. He is also the author of SHRINKS: The Untold Story of Psychiatry (Little Brown, 2015) and MALADY OF THE MIND: Schizophrenia and the Path to Prevention (Scribner-Simon and Schuster, 2023)

In a dramatic example of government yielding to public opinion the Senate has introduced legislation to legalize cannabis on the federal level. Though passage before the November election is unlikely, this long overdue legislative action seeks to update a statute stemming [pun intended] from marijuana’s demonized image as depicted in the 1936 documentary film “Reefer Madness” and better reflect public opinion and liberal social trends. Currently, under the Federal Controlled Substances Act (CSA) of 1970, cannabis is considered to have “no accepted medical use” and a high potential for abuse and physical or psychological dependence. This Federal statute contrasts with the claims of therapeutic benefits of cannabis’ biochemical constituents such as cannabidiol and THC (tetra-hydro-cannabinol) when the sole FDA indication for their use is a rare childhood (Lennox-Gasteau) seizure disorder.

While the scientific information to officially endorse cannabis products as having therapeutic benefits is lacking, a recent Pew Research Center Survey found that 88 percent of Americans felt that marijuana should be legal for medical or recreational use. This wave of popular opinion has led to marijuana’s approval in 38 states for medical use, in 24 states for recreational use and decriminalization in an additional seven states.

Americans now have access to a recreational intoxicant that is arguably no more dangerous than alcohol or tobacco without fear of the disproportionately severe punishments previously meted out to those apprehended for possession and use. But at the same time, there are numerous inconsistencies and cross-purposes integral to the legalization and commercialization of cannabis products. The most obvious of these is the fact that Federal law considers the use, sale, and possession of cannabis illegal.

The consequence of the latter was not just that the exaggerated therapeutic claims were not born out by scientific research, but that it served as a “Trojan Horse” to galvanize public opinion and advance cannabis advocates ultimate goal of unfettered access. This came to fruition when the state legislatures of Colorado and Washington voted to legalize the commercial production and sale of cannabis products in 2012. This triggered a stunning demonstration of states’ rights in which a majority of states followed suit by liberalizing their cannabis laws despite Federal prohibitions.

In a glaring recent example of governmental missteps, on March 17, Gov. Kathy Hochul declared New York State’s commercialized cannabis licensing and distribution system “a disaster” and announced “a top-to-bottom review of the NYS Cannabis Control Board and its system for regulating legalized cannabis products.” The main purpose of the review was to process applications faster and enable more cannabis vendors to open. Just weeks before  Hochul’s executive order which was intended to give New Yorkers greater access to cannabis, the American Heart Association had issued a warning on the higher risks of cardiovascular events associated with heavy cannabis use. This was based on a National Institutes of Health (NIH)-funded study of nearly 435,000 American adults reported last November which found that “Daily use of cannabis –– was associated with a 25% increased likelihood of heart attack and a 42% increased likelihood of stroke when compared to non-use of the drug.”

Such health hazards are not some abstract possibility or unconfirmed scientific speculation, but a growing current reality. As a practicing psychiatrist I have witnessed these effects first-hand as a burgeoning number of cannabis-induced medical and mental disturbances—particularly in young people—show up in our hospital emergency rooms and are referred to me for consultation.  And while the rising numbers of adverse effects occurring in the wake of legislative reform are disturbing, they are not surprising. Rather, they were anticipated.

At the start of the movement to liberalize access to cannabis in 2014, Roger Dupont, the founding director of the National Institute of Drug Abuse, and I published an article in the medical journal Science that predicted such adverse effects.“The debates over legalization, decriminalization, and medical uses of marijuana in the United States are missing an essential piece of information: scientific evidence about the effects of marijuana on the adolescent brain,” we wrote. “Much is known about the effects of recreational drugs on the mature adult brain, but there has been no serious investigation of the risks of marijuana use in younger users.”

This was revealed in an NBC News report on states enacting legislation to legalize cannabis in April 2022: “We were not aware when we were voting [in 2012] that we were voting on anything but the plant,” said Dr. Beatriz Carlini, a research scientist at the University of Washington’s Addictions, Drug & Alcohol Institute. She has led the effort in Washington state to research high-potency pot and is now exploring policy options to limit access. Her team concluded in 2020 that “high-potency cannabis can have lifelong mental health consequences.”

So while possible therapeutic value has been the lever, tax revenue for states and profits for new industries—resulting from broad access—has clearly become the goal with unsuspecting users as the potential victims. This is the template now driving rapid legalization of a host of previously prohibited recreational drugs including MDMA (ecstasy) and psychedelics.

Source: https://time.com/6973962/health-hazards-of-legalizing-marijuana/

Young people who smoked marijuana in the 1960s were seen as part of the counterculture. Now the cannabis culture is mainstream. A 2022 survey sponsored by the National Institutes of Health found that 28.8% of Americans age 19 to 30 had used marijuana in the preceding 30 days—more than three times as many as smoked cigarettes. Among those 35 to 50, 17.3% had used weed in the previous month, versus 12.2% for cigarettes.

While marijuana use remains a federal crime, 24 states have legalized it and another 14 permit it for medical purposes. Last week media outlets reported that the Biden administration is moving to reclassify marijuana as a less dangerous Schedule III drug—on par with anabolic steroids and Tylenol with codeine—which would provide tax benefits and a financial boon to the pot industry.

Bertha Madras thinks this would be a colossal mistake. Ms. Madras, 81, is a psychobiology professor at Harvard Medical School and one of the foremost experts on marijuana. “It’s a political decision, not a scientific one,” she says. “And it’s a tragic one.” In 2024, that is a countercultural view.

Ms. Madras has spent 60 years studying drugs, starting with LSD when she was a graduate student at Allan Memorial Institute of Psychiatry, an affiliate of Montreal’s McGill University, in the 1960s. “I was interested in psychoactive drugs because I thought they could not only give us some insight into how the brain works, but also on how the brain undergoes dysfunction and disease states,” she says.

In 2015 the World Health Organization asked her to do a detailed review of cannabis and its medical uses. The 41-page report documented scant evidence of marijuana’s medicinal benefits and reams of research on its harms, from cognitive impairment and psychosis to car accidents.

She continued to study marijuana, including at the addiction neurobiology lab she directs at Mass General Brigham McLean Hospital. In a phone interview this week, she walked me through the scientific literature on marijuana, which runs counter to much of what Americans hear in the media.

For starters, she says, the “addiction potential of marijuana is as high or higher than some other drug,” especially for young people. About 30% of those who use cannabis have some degree of a use disorder. By comparison, only 13.5% of drinkers are estimated to be dependent on alcohol. Sure, alcohol can also cause harm if consumed in excess. But Ms. Madras sees several other distinctions.

One or two drinks will cause only mild inebriation, while “most people who use marijuana are using it to become intoxicated and to get high.” Academic outcomes and college completion rates for young people are much worse for those who use marijuana than for those who drink, though there’s a caveat: “It’s still a chicken and egg whether or not these kids are more susceptible to the effects of marijuana or they’re using marijuana for self-medication or what have you.”

Marijuana and alcohol both interfere with driving, but with the former there are no medical “cutoff points” to determine whether it’s safe to get behind the wheel. As a result, prohibitions against driving under the influence are less likely to be enforced for people who are high. States where marijuana is legal have seen increases in car accidents.

One of the biggest differences between the two substances is how the body metabolizes them. A drink will clear your system within a couple of hours. “You may wake up after binge drinking in the morning with a headache, but the alcohol is gone.” By contrast, “marijuana just sits there and sits there and promotes brain adaptation.”

That’s worse than it sounds. “We always think of the brain as gray matter,” Ms. Madras says. “But the brain uses fat to insulate its electrical activity, so it has a massive amount of fat called white matter, which is fatty. And that’s where marijuana gets soaked up. . . . My lab showed unequivocally that blood levels and brain levels don’t correspond at all—that brain levels are much higher than blood levels. They’re two to three times higher, and they persist once blood levels go way down.” Even if people quit using pot, “it can persist in their brain for a while.”

Thus marijuana does more lasting damage to the brain than alcohol, especially at the high potencies being consumed today. Levels of THC—the main psychoactive ingredient in pot—are four or more times as high as they were 30 years ago. That heightens the risks, which range from anxiety and depression to impaired memory and cannabis hyperemesis syndrome—cycles of severe vomiting caused by long-term use.

There’s mounting evidence that cannabis can cause schizophrenia. A large-scale study last year that examined health histories of some 6.9 million Danes between 1972 and 2021 estimated that up to 30% of young men’s schizophrenia diagnoses could have been prevented had they not become dependent on pot. Marijuana is worse in this regard than many drugs usually perceived as more dangerous. “Users of other potent recreational drugs develop chronic psychosis at much lower rates,” Ms. Madras says. When healthy volunteers in research experiments are given THC—as has been done in 15 studies—they develop transient symptoms of psychosis. “And if you treat them with an antipsychotic drug such as haloperidol, those symptoms will go away.”

Marijuana has also been associated with violent behavior, including in a study published this week in the International Journal of Drug Policy. Data from observational studies are inadequate to demonstrate causal relationships, but Ms. Madras says that the link between marijuana and schizophrenia fits all six criteria that scientists use to determine causality, including the strength of the association and its consistency.

Ms. Madras says at the beginning of the interview that she was operating on three hours of sleep after crashing on scientific projects. Yet she is impressively lucid and energized. She peppers her explanations with citations of studies and is generous in crediting other researchers’ work.

Another cause for concern, she notes, is that more pregnant women are using pot, which has been linked to increased preterm deliveries, admissions of newborns into neonatal intensive care units, lower birth weights and smaller head circumferences. THC crosses the placenta and mimics molecules that our bodies naturally produce that regulate brain development.

“What happens when you examine kids who have been exposed during that critical period?” Ms. Madras asks. During adolescence, she answers, they show an increased incidence of aggressive behavior, cognitive dysfunction, and symptoms of ADHD and obsessive-compulsive disorders. They have reduced white and gray matter.

A drug that carries so many serious side effects would be required by the Food and Drug Administration to carry a black-box warning, the highest-level alert for drugs with severe safety risks. Marijuana doesn’t—but only because the FDA hasn’t cleared it.

The agency has selectively approved cannabis compounds for the treatment of seizures associated with Lennox-Gastaut or Dravet syndrome, nausea associated with chemotherapy for cancer, and anorexia associated with weight loss in AIDS patients. But these approved products are prescribed at significantly less potent doses than the pot being sold in dispensaries that are legal under state law.

What about medicinal benefits? Ms. Madras says she has reviewed “every single case of therapeutic indication for marijuana—and there are over 100 now that people have claimed—and I frankly found that the only one that came close to having some evidence from randomized controlled trials was the neuropathic pain studies.” That’s “a very specific type of pain, which involves damage to nerve endings like in diabetes or where there’s poor blood supply,” she explains.

For other types of pain, and for all other conditions, there is no strong evidence from high-quality randomized trials to support its use. When researchers did a “challenge test on normal people where they induce pain and tried to see whether or not marijuana reduces the pain, it was ineffective.”

Ms. Madras sees parallels between the marketing of pot now and of opioids a few decades ago. “The benefits have been exaggerated, the risks have been minimized, and skeptics in the scientific community have been ignored,” she says. “The playbook is always to say it’s safe and effective and nonaddictive in people.”

Advocates of legalization assert that cannabis can’t be properly studied unless the federal government removes it from Schedule I. Bunk, Ms. Madras says: “I have been able to study THC in my research program.” It requires more paperwork, but “I did all the paperwork. . . . It’s not too difficult.”

Instead of bankrolling ballot initiatives to legalize pot, she says, George Soros and other wealthy donors who “catalyzed this whole movement” should be funding rigorous research: “If these folks, these billionaires, had just taken that money and put it into clinical trials, I would have been at peace.”

It’s a travesty, Ms. Madras adds, that the “FDA has decided that they’re going to listen to that movement rather than to what the science says.” While the reclassification wouldn’t make recreational marijuana legal under federal law, dispensaries and growers would be able to deduct their business expenses on their taxes. The rescheduling would also send a cultural signal that marijuana use is normal.

Ms. Madras worries that “it sets a precedent for the future.” She points to the movement in states to legalize psychedelic substances, for whose medicinal benefits there also isn’t strong scientific evidence. Meantime, she says it makes no sense that politicians continuously urge more spending on addiction treatment and harm reduction while weakening laws that prevent people from becoming addicted in the first place.

Her rejoinder to critics who say the war on drugs was a failure? “This is not a war on drugs. It’s a defense of the human brain at every possible age from in utero to old age.”

Source:  https://www.wsj.com/articles/what-you-arent-reading-about-marijuana-permanent-brain-damage-biden-schedule-iii-9660395e

Forbes Staff : Ty Roush is a breaking news reporter based in New York City.

May 22, 2024,10:18am EDT

Teens who use cannabis have a significantly higher risk of developing a psychotic disorder compared to those who don’t, according to a study published in the journal Psychological Medicine Wednesday, the latest research linking the drug to mental health disorders among young adults.

Other research has linked the drug to mental health disorders in young adults.

KEY FACTS

Teens aged 12 to 19 who used cannabis had an 11 times higher risk of developing a psychotic disorder compared to teens not using cannabis, according to an analysis of health data for 11,000 teens and young adults aged 12 to 24.

The study did not find an association between cannabis use and psychotic disorders in people aged 20 to 33.

The data—pulled from the annual Canadian Community Health Survey from 2009 to 2012—looked into hospitalizations, emergency room visits and outpatient visits, and researchers followed up with the participants for additional visits to the doctor, the emergency room or other hospitalizations in the nine years after the survey.

Among the teens who visited the emergency room or were hospitalized for psychotic disorders, about 5 in 6 reported using cannabis previously, researchers said.

Teens who use cannabis might be at a higher risk of developing psychotic disorders because the drug disrupts the endocannabinoid system, which helps regulate bodily functions like sleep or mood, resulting in symptoms like hallucinations, according to the study.

Though there is a strong yet age-dependent association between cannabis use and psychotic disorders, researchers noted it’s hard to say whether there is a direct link, as it’s possible the teens were self-medicating with cannabis to treat symptoms of psychotic disorders before they were clinically diagnosed.

Get Forbes Breaking News Text Alerts: We’re launching text message alerts so you’ll always know the biggest stories shaping the day’s headlines. Text “Alerts” to (201) 335-0739 or sign up here.

BIG NUMBER

29%. That’s the percentage of high school seniors in the U.S. who reported using cannabis over the previous year, according to the annual Monitoring the Future Survey in 2023, which reports drug and alcohol use among adolescent students.

KEY BACKGROUND

Other studies in recent years have linked psychotic disorders in young adults to cannabis. In a study published last year, researchers found young men who used cannabis have an increased risk of developing schizophrenia compared to young women. A year earlier, researchers found there was “considerable evidence” linking cannabis use and depression among adolescents. The study also suggested the link was caused by a disruption of the endocannabinoid system. In 2018, researchers called for additional drug prevention programs targeting cannabis use in teens, after data indicated cannabis use could result in increased anxiety.

TANGENT

Last week, the Justice Department moved to reclassify marijuana—listed as a Schedule I drug like heroin, LSD and ecstasy—as a Schedule III drug under the federal Controlled Substances Act. The designation, if approved, recognizes marijuana as having potential medical benefits, which could allow for future studies on the drug’s potential benefits. The proposal still requires approval from the Drug Enforcement Administration.

 

Source:  https://www.forbes.com/sites/tylerroush/2024/05/22/teens-using-cannabis-are-at-higher-risk-of-psychosis-study-suggests/

April 24, 2024

The Australian community deserve a clear picture of all persons whose Mental Health has come to the attention of the police, hospitals and the community.

When cannabis genotoxicity effects are added to cannabis neurotoxicity effects the argument against the widespread use of cannabis for everything becomes very robust indeed.

The drug prevention taskforce outlines below our real concerns regarding the Stabbing rampage at Sydney.  It does appear that here in Australia our State and Federal Medical Department has been testing toxic factors using blood and not using the much better hair test.

Most of the cannabis (80-90%) is excreted within 5 days as hydroxylated and carboxylated metabolites. See attached (Chemistry and Toxicology of cannabis).

Because 90% of THC is gone in 80 minutes from blood. Please demand hair testing of the subject for marijuana use (blood test may not be positive due to rapid clearance).  This is very indicative of cannabis induced psychosis most of the cannabis (80-90%) is excreted within 5 days as hydroxylated and carboxylated metabolites . There are eighteen acidic metabolites as per Goulle JP, Saussereau E, Lacroix C. [Delta-9-tetrahydrocannabinol pharmacokinetics]. Ann Pharm Fr 2008; 66: 232-244. Studies attached.

Drug Free Australia is seeking to bring urgent attention to Australian whether Federal or State, regarding extremely important research relating to Mental Health and cannabis use.  It appears that Australian public policies have moved from concern for the health and wellbeing of society – by improving and promoting good health – to pushing unnecessary drug use for profiteers while charging the tab to society-at-large.  DFA believes that it is time for governments worldwide to promote research and media publicity which avoids the cherry-picked faux studies used by those wanting to legalise cannabis.  Rather, the focus should be on its serious harms to mental and physical health particularly related to early use.

TOP 15 RISKS OF MARIJUANA ON HEALTH   https://iasic1.org. The Drug Free Australian paper (MENTAL HEALTH AND CANNABIS USE) see attached.  (A Panel Study of the Effect of Cannabis Use on Mental Health, Depression and Suicide in the 50 States)see attached.

 EXCLUSIVE: Regular cannabis use in people’s mid-20s can cause permanent damage to the brain development and legalizing the drug has WRONGLY presented it as harmless, drug safety expert Dr Nora Volkow, director of the National Institute on Drug Abuse, warned cannabis use among young adults was a ‘concern’. She called for ‘urgent’ research into the potential health risks of the drug. Several papers have suggested regular use could be damaging mental development and affecting users’ social life

But these often also include people regularly using alcohol and tobacco, making it difficult to deduce whether cannabis is behind the changes. About 48million Americans use cannabis annually, a number that is rising. https://www.dailymail.co.uk/health/article-11138001/Taking-cannabis-mid-20s-damages-cognitive-development-NIH-expert-warns.html

  1. Prohibition has worked globally for more than 100 years since the UN Drug Conventions began. These have kept illicit drug use down to 5% use worldwide, whereas legalised tobacco and alcohol have much higher rates.
  2. Legalising and decriminalizing substances inevitably gives a green light for use (as we have seen with increased use of cannabis in parts of the United States where it has been made legal.
  3. Global illicit drug industries are responsible for an enormous amount of environmental destruction

(Illegal Marijuana growers poison forests-these people fight back) https://www.nationalgeographic.com/environment/article/illegal-marijuana-growing-threatens-california-national-forests (Green But Not Green: How Pot Farms Trash the Environment) http://www.slate.com/articles/news_and_politics/uc_breakthroughs_2014/2014/04/green_but_not_green_how_pot_farms_trash_the_environment.html

 

RECOMMENDATIONS THAT CAN HELP PREVENT THE AUSTRALIAN “LOST GENERATION DYING”

 All Australian Governments and community leaders need to take this evidence regarding Mental Health very seriously.  The issue of cannabis-caused violence needs to be addressed. For example, the Australian Government must consider organising several Mental Health teams working 24/7 to evaluate the mental health and wellbeing of those involved in animal cruelty, road rage, spousal abuse and child fatalities. These teams should have the authority to place these individuals into detox and rehabilitation centres for three to twelve months according to their progress. They will also need to be constantly reminded that they are very important to the Australian community’s future.  Here in Queensland, we have one centre available. .and a third that could be built. They could be equipped at minimum cost and run with existing staff for this mental health program.

The Australian National Drug Strategy 2017-2026 identifies cannabis as a priority substance for action, noting 20% of Australian drug and alcohol treatment services are provided to people identifying cannabis as their principal drug of concern. DFA believes that the number is higher for those under 25 years of age.

We greatly appreciate your time in responding to these extremely important matters in terms of community health, welfare and safety and would value your response early Should you require further information and/or a face-to-face meeting we would be very pleased to accommodate.

Kind Regards

Herschel Baker, International Liaison Director,

>>>>>>>>>>>>>>>>>>>>>>>

Please click on the links below to read the reports:

  • When you click on the link an image of the report cover will appear
  • Then please click on the report cover image to open the report.
  1. DFA Mental Health Cannabis Use 18-08-22
  2. DFAF-Study-FINAL-A-panel-study-of-the-effect-of-cannabis-use-on-mental-health-depression-and-suicide-in-the-50-states-3
  3. Hair testing test for THC OH 2018 Drug Testing and Analysis Franz
  4. Paddock hair toxicology results
  5. Postmortum diagnosis and toxicology validation of illicit substance use hair sampling Addict Biol 2008 Huestis
Research shows how a major shift in the drug supply could be leading to an increasing amount of overdose deaths. Fentanyl continues to devastate American lives. Now, new research shows how a major shift in the drug supply could be leading to an increasing amount of overdose deaths. (Scripps News)
Posted at 5:47 PM, Jul 05, 2024

A new study by NYU Langone, funded by the National Institutes of Health and the National Institute on Drug Abuse, shows how fentanyl has taken over America’s illegal drug supply. It has happened fast.

Law enforcement seizure data shows that illicit fentanyl seizures grew more than 1700% in the 6 year span from 2017 to 2023.

Fentanyl pills specifically made up nearly half of fentanyl seizures in 2023, at 49%. Compare that to 10% in 2017.

As much as 85% of these seizures are happening in the western part of the United States.

A lead researcher on the study, Dr. Joseph Palamar, said that though the numbers are staggering, they’re not surprising given recent trends.

“A couple of years ago, most fentanyl was in powder form. The way it began was fentanyl started creeping up into the heroin supply …then pills started coming around — particularly in the West, and pills introduced fentanyl in a whole different manner to people,” he said.

Related stories:

Palamar says fentanyl in pill-form changes the game, so to speak, in terms of who is now able to obtain it.
Pills are easier to take or to smoke, so there’s no need to figure out how to use a needle. Also, because many fentanyl pills are meant to look like legitimate pills, it’s easier for people who don’t necessarily know they’re taking fentanyl to find it, ingest it and overdose.

“My fear in particular is that there are young people who are trying to get their hands on pills like Adderall or Oxy or Xanax and if they buy them illegally, they don’t know that they could have fentanyl in them — just a few milligrams is enough to kill a teenager,” Palamar said.

Rob Sullivan oversees multiple drug detox programs in northwestern Washington state, and has been in the industry for 20 years.

He says he and his colleagues have noticed that it takes longer for someone to detox from fentanyl — prompting requests to insurance companies to extend detox stays. He also says people have a harder time completing detox, and many times people detox without even realizing they’ve taken fentanyl.

“We see right now, we’re about 66% complete. And 44% don’t complete. Whereas we used to be higher when it was just regular opioids, because people knew what to expect, meaning clients, and also professionals knew what to expect,” Sullivan said.

“Whereas with fentanyl — so different, and so powerful — that it’s really, it’s a different ballgame than what it was,” he said.

Palamar hopes that these findings spark a stronger emphasis on drug use prevention

“We need people to be educated about fentanyl and the associated risks, particularly the people who have not used fentanyl. I worry about people starting fentanyl, and I also worry about people being unintentionally exposed to fentanyl — especially young people.”

Source: https://www.ktvq.com/us-news/new-study-shows-the-rising-prevalence-of-fentanyl-pills

Mary Brett – in memoriam

Mary Brett, Former biology teacher (30 years at Dr Challoner’s Grammar School for boys, Amersham, Buckinghamshire. UK), Trustee of CanSS (Cannabis Skunk Sense), Member of PandA (Centre for Policy Studies) and former Vice President of Eurad. With regret, it is noted that Mary has recently died, in 2024, after a long illness – her expert contribution to the field of drug prevention and education is to be celebrated, and remembered for the quality of her work throughout.

The paper reproduced here below  is but one example of Mary’s expert contributions to the field.

Executive Summary

Prevention is the policy of this Government but harm-reduction organisations are being consulted for information and evidence—the Advisory Council on Misuse of Drugs (ACMD), Drugscope and the John Moores University Liverpool.

Information on cannabis from these sources is out-of-date, misleading, inaccurate, has huge omissions and is sometimes wrong. It does not stand comparison with current scientific evidence.

Children do not want to take drugs. They want reliable information to be able to refuse them.

Tips on safer usage and “informed choice” have no place in the classroom.

Prevention works.

  1. Current information about drugs being given to this government comes mainly, if not entirely, from harm-reduction organisations. I find this astonishing. The policy of this Coalition Government is prevention.
  2. I had long suspected, and had it confirmed by BBC’s Mark Easton’s blog 20 January 2011, that “Existing members of the council (ACMD) are avowed “harm-reductionists”. Drugscope, a drugs information charity paid for entirely by the taxpayer, has always had a harm reduction policy. We find statements like, “prevention strategies are not able to prevent experimental use” and “harm minimisation reflects the reality that many young people use both legal and illegal substances”. And the John Moores University in Liverpool has been at the forefront of the harm reduction movement since the eighties. Pat O’Hare, President of the International Harm Reduction Association (IHRA), said: “As founder of the first IHRA conference, which took place in Liverpool in 1990, it gives me a great sense of pride to see it coming “home” after being held all over the world in the intervening 20 years”.
  3. FRANK is the official government website providing information to the public, especially children 11–15. I have learned that the information for the recently re-launched FRANK website came from The John Moores University. A member of the FRANK team, Dr Mark Prunty was involved in a commissioned report, “Summary of Health Harms of Drugs” published in August 2011.
  4. Harm reduction has its place in the treatment of addiction, eg reducing the dose till abstinence is attained. But no place in the classroom where well over 90% of children have no intention of ever taking drugs. Harm reduction can and does sometimes act as a green light.
  5. This government says it wants to stop young people from ever starting to use drugs, but that’s not the aim of harm reductionists. They assume children will take drugs anyway, so give them “tips” on taking them more safely, and offer them “informed choice”. And for some reason I have never understood, they always downplay the harmful effects of cannabis—information is vague, inadequate, misleading, out-of-date and sometimes completely wrong.
  6. Brains are not fully developed till the 20s, the risk-taking part developing before the inhibitory area. Children from seven upwards are simply incapable of making the right decision. They need to be protected, not abandoned to make critical life choices. Only 30–40% will ever try drugs—a world away from regular use. What other illegal activities do we invite them to choose—pilfering, graffiti-spraying? Harm reduction advocates are so wrong. Children don’t actually want to take drugs. They want sound, reliable and full information to help them refuse drugs from peer group users who are pressuring them. I know—they’ve told me. Harm reduction policies are tantamount to condoning drug use.
  7. Prevention works. The prevention campaign in USA 1979–1991 saw illicit drug users drop from 23 to 14 million. Cannabis and cocaine use halved. Over 70% abstained from cannabis use because of concern over physical and/or psychological harm (P.R.I.D.E. survey USA 1983). In Sweden, 2010 “last month use” of cannabis was 0.5% (ages15 to 64), European average—3.7%.
  8. Overall, drug use may have fallen in the last 10 years but the last BCS reported that there had been a 1% increase in the “last year” use of cannabis among 16 to 24 year olds in the UK. This amounts to around 55,000 people—no room for complacency.
  9. At a meeting of the FRANK team, Dr Mark Prunty, asked me to send my large scientific report on cannabis (“Cannabis—A general view of its harmful effects”, written for The Social Justice Policy Group, in 2006, fully endorsed by eminent scientists, and regularly updated), and all new research papers that I received. He also had the two books I have written (“Drug Prevention Education” and “Drugs—it’s just not worth it”1). I wasted my time. Why is there no scientific researcher on the FRANK team or at least temporarily co-opted?
  10. One of the John Moore’s staff members, Dr Russell Newcombe helped to pioneer the harm-reduction movement in Merseyside from the mid-1980s and was Senior Researcher for Lifeline Publications & Research (Manchester, 2005–10). Lifeline literature on drugs, used in some schools, is hugely harm reduction based. Several leaflets and DVDs on “How to inject” are freely advertised on the Internet and can be easily accessed, as are needles, by children. Children are scared of injecting—now they needn’t worry!
  11. The last paragraph in Lifeline’s Big Blue Book of Cannabis says, “If we look at our crystal ball at the world of tomorrow what can we expect to see? More medical uses for cannabis; stronger types of weed appearing on the streets; more laws; more fiendish ways of catching users and the same old hysterical reactions to people smoking a plant”—That says it all!
  12. My analysis of the cannabis information in the “Summary of Health Harms of Drugs” pages 31–33 follows:
  13. “No cases of fatal overdose have been reported”. Isn’t it the same with tobacco? “No confirmed cases of human death”. “Stoned” drivers kill themselves/others. Cancers recorded, especially head and neck at young age (Donald 1993, Zang 1999). Serotonin, “happiness” neurotransmitter depleted (Gobbi 2009) causing depression—can lead to suicides (Fugelstad (Sweden) 1995). Violence from psychosis or during withdrawal, murders documented in the press and coroners’ reports. Teenagers have had strokes and died after bingeing (Geller 2004).
  14. Strength: No figures are given for Tetrahydrocannabinol (THC) content. Skunk now averages 16.2% but can range up to 46% THC, old herbal 1–2%, Hash 5.9% (Home Office Report 2008). No warning that skunk occupies 80% of the UK market, hash 20%. FRANK says that skunk is 2–4 times stronger than old herbal cannabis—wrong! They mislead the public by comparing it with hash. The enlightened Dutch, who know about drugs, have now banned any skunk with a THC content over 15%, equating it with cocaine and heroin. The vast bulk of our young users are smoking what amounts to a class “A” drug!
  15. 50% of THC will remain in cells for a week, 10% for a month. The John Moores report makes no mention of its persistence. Numerous studies show the adverse effects of this on academic results (Grade D student four times more likely to use cannabis than one with A grades, USA 2002) and personality. Users become inflexible, can’t plan their days, can’t find words or solve problems, development stalls, they remain childish. At the same time they feel lonely, miserable and misunderstood (Lundqvist 1995).
  16. Psychosis: Not reported is that anyone (with/without family history) taking cannabis can develop psychosis if they take enough THC (Morrison, Robin Murray team 2009). D’Souza (2007) had also shown this. Cannabis increases dopamine (pleasure neurotransmitter) in the brain. Excess dopamine is found in brains of schizophrenics. The first paper linking psychosis and cannabis was published in 1845! The report says: “Health effects of increases in the potency of cannabis products are not clear”. Skunk users have been found to be seven times more likely to develop psychosis than hash users ( Di Forte, Murray’s team 2009).
  17. No mention of absence of Cannabidiol (CBD) (anti-psychotic) in skunk, so psychotic THC is not counteracted! Old herbal cannabis had equal amounts CBD and THC. (McGuire 2008 and 2009, Morgan (2010), Demirakca (2011) etc. Dependence risks and psychotic symptoms are blamed on bingeing—regular use is enough! It is suggested that psychotic or schizophrenic patients may be self-medicating negative symptoms—disproved in several papers (Degenhardt 2007, Van Os 2005).
  18. They say that likelihood of progressing to other drugs is more to do with personality, lifestyle and accessibility than a gateway effect. Swedish research (Hurd 2006, Ellgren 2007) on animals finds THC primes the brain for use of others, and Fergusson (2006 and 2008) in a 25 year NZ study from birth found cannabis to be the single most significant factor for progressing.
  19. It is claimed that there is “no conclusive evidence that cannabis causes lung cancer” We don’t have conclusive proof for cigarettes and lung cancer! “Evidence for the effects on the immune system is limited”—over 60 references in my report! No warning that people should not drive within 24 hours of consumption (Leirer 1991).
  20. Children born to cannabis-using mothers may have “mild developmental problems”. Fried has followed child development since 1987. He has found cognitive impairment, behaviour and attention problems, babies twice as likely to use the drug at adolescence. Goldschmidt (2002) found delinquent behaviour, Bluhm (2006) warned of an increased risk of neuroblastoma, a childhood cancer.
  21. Now several recent papers demonstrate structural brain damage eg Welch (September 2011) loss of volume in thalamus, Solowij 2011 smaller cerebellum white matter volume, Ashtari (2011) loss in hippocampus volume, (Yucel 2008, Rais 2008).
  22. I have cited only a few references, there are well over 600 in my report.
  23. At least one piece of information in FRANK’s magic mushroom (Psilocybe—Liberty Caps) section is not in the Moore’s report, so where did it come from? The extremely poisonous familiar red/white spotted fungus, the Fly Agaric, is included. This is serious—it should not be there. Its inclusion is even more alarming as the amount used (1–5g) and the fact that it should not be eaten raw are given—blatant harm reduction advice! A child could die!
  24. New posters from FRANK:

www.homeoffice.gov.uk/publications/alcohol-drugs/drugs/frank/coke-poster

www.homeoffice.gov.uk/publications/alcohol-drugs/drugs/frank/meow-poster

www.homeoffice.gov.uk/publications/alcohol-drugs/drugs/frank/skunk-poster

My pupils would have used words like: pathetic, patronising, trite, useless and positively encouraging drug use—and so would I.

  1. I repeat—children don’t want to take drugs. They want a sound education and good grades, free from hassle and the pressure to take drugs.
  2. Drugscope’s cannabis information updated 2011 is even less reliable than FRANK’s. They continue to deny that cannabis can cause physical addiction, say “There are suggestions that the drug can in rare cases trigger psychosis, a factor that led to the government in 2009 to reclassify cannabis” (Drugscope disagreed with the reclassification), state that the strength of skunk is 12–14% THC when in 2008 it averaged 16.2%, and completely ignore all the Swedish and New Zealand evidence for the “Gateway Theory”. Professor Murray’s 2009 papers are not mentioned, and in a reply to me, the writer of Drugscope’s literature, seemed to think it was the THC that caused cancers, not the smoke.
  3. In 2006, Professor David Nutt said that LSD and Ecstasy probably shouldn’t be class A. In May 2008 I attended an open meeting of the ACMD at which a presentation (by Pentag) on ecstasy was given—a meta-analysis commissioned by the ACMD. I was concerned about their conclusions so contacted the foremost ecstasy researcher in Britain, Professor Andrew Parrott of Swansea University.
  4. Incredibly Professor Parrott knew nothing about the proposed down-grading of ecstasy by the ACMD until I alerted him. He was leaving for Australia to Chair an International Conference on Ecstasy and sent me his numerous publications. I passed them to the ACMD. When he returned, having missed the evidence—gathering meeting in September, I alerted him to the open meeting in November. He had to send three e-mails before they answered and allowed his presentation to go ahead. He was given a mere 20 minutes.

In an open letter to the ACMD on November 13 he wrote:

  1. 29. I cannot believe that I have spent the past 14 years undertaking numerous scientific studies into Ecstasy/MDMA in humans, then for the ACMD to propose downgrading MDMA without a full and very detailed consideration of the extensive scientific evidence on its damaging effects. My research has been published in numerous top quality journals, and can be accessed via my Swansea University web-page.
  2. Professor Nutt, who was Chairing the ACMD meeting on November 25 2008 for the first time was severely criticized by Professor Parrott. He said that Nutt made numerous factual errors, eg that there were zero dangers from injection of MDMA. Parrott said it was probably safer to inject heroin. Nutt said that ecstasy was not addictive, involved no interpersonal violence, was not responsible for road deaths, did not cause liver cirrhosis or damage the heart. Scientific work demonstrates that users show compulsive and escalating use, midweek aggression, that driving under its influence is extremely dangerous, that it is hepatotoxic—liver transplants have been needed in young people under 30, and profound cardiovascular effects. Professor Nutt did not defend himself in our presence. Nor to my knowledge has he since!
  3. Answers from Anne Milton, Minister for Public Health given to Parliamentary Questions from Charles Walker MP, October 2011 include:
  4. The Medical Research Council (MRC), funded by The Department of Business, Innovation and Skills, is supporting Professor Glyn Lewis in his research on adolescence and psychosis and Professor Val Curran’s research into the vulnerability of people to the harmful effects of cannabis.
  5. Professor Lewis, widely quoted on the Web by Peter Reynolds (CLEAR—Cannabis Law Reform) said that, “there is no certainty of a causal relationship between cannabis use and psychosis”, and announced that the risk of psychosis from cannabis use is at worst 0.013% and perhaps as little as 0.0030%. Professor Curran is a member of Professor Nutt’s Independent Scientific Committee on Drugs (ISCD).
  6. I find it incredible that there is essential sound accurate up-to-date scientific information about the effects of cannabis available in scientific journals and publicised in the press and the public is not being made aware of it by FRANK, the official Government website. Why has FRANK not been taken to task?
  7. While the harm reduction lobby are being consulted, persisting with their own agendas, and the preventionists supporting the Government’s New Strategy not listened to, nothing will change.
  8. Prevention is better than cure. Prevention is what every parent wants for their children. Prevention is common sense and it works.
  9. Meanwhile, while we wait for common sense to prevail, some children will become psychotic, addicted, move on to other drugs, drop out of education or even die. And the parents I work with will be left picking up the pieces.

January 2012

Source: Home Affairs  or visit http://www.parliament.uk/business/committees/committees-a-z/commons-select/home-affairs-committee/publications/

UNIVERSITY OF BATH, UK – Last updated on Tuesday 26 March 2024

There is no evidence that CBD products reduce chronic pain, and taking them is a waste of money and potentially harmful to health, new research finds.

CBD oil may be popular for treating pain but taking it appears to be a waste of money

There is no evidence that CBD products reduce chronic pain, and taking them is a waste of money and potentially harmful to health, according to new research led by the University of Bath.CBD (short for cannabidiol) is one of many chemicals found naturally in the cannabis plant. It’s a popular alternative treatment for pain and is readily available in shops and online in the form of oils, tinctures, vapes, topical creams, edibles (such as gummy bears) and soft drinks.However, consumers would do well to steer clear of these products, according to the new study.“CBD presents consumers with a big problem,” said Professor Chris Eccleston, who led the research from the Centre for Pain Research at Bath. “It’s touted as a cure for all pain but there’s a complete lack of quality evidence that it has any positive effects.”

He added: “It’s almost as if chronic pain patients don’t matter, and that we’re happy for people to trade on hope and despair.”

For their study, published this week in The Journal of Pain, the team – which included researchers from the Universities of Bath, Oxford and Alberta in Canada – examined research relevant to using CBD to treat pain and published in scientific journals up to late 2023.

They found:

  • CBD products sold direct to consumers contain varying amounts of CBD, from none to much more than advertised.
  • CBD products sold direct to consumers may contain chemicals other than CBD, some of which may be harmful and some illegal in some jurisdictions. Such chemicals include THC (tetrahydrocannabinol), the main psychoactive component of the cannabis plant.
  • Of the 16 randomised controlled trials that have explored the link between pain and pharmaceutical-grade CBD, 15 have shown no positive results, with CBD being no better than placebo at relieving pain.
  • A meta-analysis (which combines data from multiple studies and plays a fundamental role in evidence-based healthcare) links CBD to increased rates of serious adverse events, including liver toxicity.

Medical vs non-medical CBD

In the UK, medical cannabis is the only CBD product that is subject to regulatory approval. It’s occasionally prescribed for people with severe forms of epilepsy, adults with chemotherapy-related nausea and people with multiple sclerosis.

Non-medical CBD is freely available in the UK (as well as in the US and many European countries) so long as it contains negligible quantities of THC or none at all. However, CBD products sold on the retail market are not covered by trade standards, meaning there is no requirement for them to be consistent in content or quality.

Most CBD products bought online – including popular CBD oils – are known to contain very small amounts of CBD. Moreover, any given product may be illegal to possess or supply, as there’s a good chance it will contain forbidden quantities of THC.

Chronic pain

An estimated 20% of the adult population lives with chronic pain, and sufferers are often desperate for help to alleviate their symptoms. It’s no surprise then that many people reach for CBD products, despite their high price tag and the lack of evidence of their effectiveness or safety.

Dr Andrew Moore, study co-author and former senior pain researcher in the Nuffield Division of Anaesthetics at the University of Oxford, said: “For too many people with chronic pain, there’s no medicine that manages their pain. Chronic pain can be awful, so people are very motivated to find pain relief by any means. This makes them vulnerable to the wild promises made about CBD.”

He added that healthcare regulators appear reluctant to act against the spurious claims made by some manufacturers of CBD products, possibly because they don’t want to interfere in a booming market (the global CBD product market was estimated at US$3 billion in 2021 or £2.4 billion and is anticipated to reach US$60 billion by 2030 or £48 billion) especially when the product on sale is widely regarded as harmless.

“What this means is that there are no consumer protections,” said Dr Moore. “And without a countervailing body to keep the CBD sellers in check, it’s unlikely that the false promises being made about the analgesic effects of CBD will slow down in the years ahead.”

The study’s authors are calling for chronic pain to be taken more seriously, with consumer protection becoming a priority.

“Untreated chronic pain is known to seriously damage quality of life, and many people live with pain every day and for the rest of their lives,” said Professor Eccleston. “Pain deserves investment in serious science to find serious solutions.”

 

Source: https://www.bath.ac.uk/announcements/cbd-products-dont-ease-pain-and-are-potentially-harmful-new-study-finds/

Teens who use cannabis have a significantly higher risk of developing a psychotic disorder compared to those who don’t, according to a study published in the journal Psychological Medicine Wednesday, the latest research linking the drug to mental health disorders among young adults.  Other research has linked the drug to mental health disorders in young adults.

KEY FACTS

Teens aged 12 to 19 who used cannabis had an 11 times higher risk of developing a psychotic disorder compared to teens not using cannabis, according to an analysis of health data for 11,000 teens and young adults aged 12 to 24.

The study did not find an association between cannabis use and psychotic disorders in people aged 20 to 33.
The data—pulled from the annual Canadian Community Health Survey from 2009 to 2012—looked into hospitalizations, emergency room visits and outpatient visits, and researchers followed up with the participants for additional visits to the doctor, the emergency room or other hospitalizations in the nine years after the survey.

Among the teens who visited the emergency room or were hospitalized for psychotic disorders, about 5 in 6 reported using cannabis previously, researchers said.

Teens who use cannabis might be at a higher risk of developing psychotic disorders because the drug disrupts the endocannabinoid system, which helps regulate bodily functions like sleep or mood, resulting in symptoms like hallucinations, according to the study.

Though there is a strong yet age-dependent association between cannabis use and psychotic disorders, researchers noted it’s hard to say whether there is a direct link, as it’s possible the teens were self-medicating with cannabis to treat symptoms of psychotic disorders before they were clinically diagnosed.

BIG NUMBER

29%. That’s the percentage of high school seniors in the U.S. who reported using cannabis over the previous year, according to the annual Monitoring the Future Survey in 2023, which reports drug and alcohol use among adolescent students.

KEY BACKGROUND

Other studies in recent years have linked psychotic disorders in young adults to cannabis. In a study published last year, researchers found young men who used cannabis have an increased risk of developing schizophrenia compared to young women. A year earlier, researchers found there was “considerable evidence” linking cannabis use and depression among adolescents. The study also suggested the link was caused by a disruption of the endocannabinoid system. In 2018, researchers called for additional drug prevention programs targeting cannabis use in teens, after data indicated cannabis use could result in increased anxiety.

TANGENT

Last week, the Justice Department moved to reclassify marijuana—listed as a Schedule I drug like heroin, LSD and ecstasy—as a Schedule III drug under the federal Controlled Substances Act. The designation, if approved, recognizes marijuana as having potential medical benefits, which could allow for future studies on the drug’s potential benefits. The proposal still requires approval from the Drug Enforcement Administration.

Source: https://www.forbes.com/sites/tylerroush/2024/05/22/teens-using-cannabis-are-at-higher-risk-of-psychosis-study-suggests/

In Canada, cannabis poisonings rose sharply among people 65 and older after the country legalized the drug, a new study found.

By Matt Richtel

May 20, 2024

The News

As more places legalize marijuana, policymakers and health officials have worried about the health risks that the drug may pose to adolescents. But a new study suggests that an additional demographic is at risk: seniors.

The study, published Monday in JAMA Internal Medicine, found that after Canada legalized marijuana, the number of emergency room visits for cannabis poisoning rose sharply among people ages 65 and older. Poisonings doubled after Canada legalized sale of the cannabis flower, and then tripled just 15 months later, when Canada legalized the sale of edibles.

“It’s often a baked good, a chocolate or a gummy,” said Dr. Nathan Stall, a geriatrician at Mount Sinai Hospital and researcher at Women’s College Hospital in Toronto, and lead author on the study. Dr. Stall noted that researchers and emergency room doctors were finding that seniors used drugs intentionally but also sometimes by accident, when edibles were mistaken for regular food or snacks.

Symptoms of cannabis poisoning can include dizziness, confusion, nausea, loss of coordination and balance, drowsiness and hallucinations.

The findings were consistent with other research published in the United States, Dr. Stall said, and showed that more attention needed to be paid to drug use by seniors, and to the health effects.

“It’s somewhat in the shadows, and there is some ageism and bias in thinking that older adults aren’t using drugs,” Dr. Stall said.

Image

Edible marijuana samples at a cannabis testing laboratory in Santa Ana, Calif.Credit…Chris Carlson/Associated Press

The Study

The study looked at 2,322 emergency room visits for cannabis poisoning among people 65 and older in Ontario. The visits spanned 2015 through 2022, allowing researchers to see what happened before and after October 2018, when Canada legalized the sale of dried cannabis, and January 2020, when the sale of edibles was legalized.

In 2015, there were 55 emergency room visits caused by cannabis poisoning. That figure rose steadily to 462 by 2021, and then fell off slightly to 404 in 2022.

Dr. Stall said he was motivated to undertake the study after being called into the emergency room to consult on an octogenarian who was experiencing severe confusion. The patient was barely conscious and showed strokelike symptoms. Multiple tests revealed no clear cause, until Dr. Stall ordered a toxicology test and found cannabis in the patient’s urine.

When Dr. Stall disclosed the finding, he said, a family member of the patient who was present at the bedside “went beet red and realized that the older adult had got into their edible cannabis product and mistaken it for food.”

Dr. Stall said that the patient was hospitalized and given supportive care, and that there was not a specific treatment or antidote for such poisonings.

Why the Increase?

The study did not look at why seniors overdosed, but Dr. Stall said that he and other doctors were seeing poisonings caused by accidental ingestion as well as intentional use of edibles for recreation or medicinal reasons.

There are several reasons seniors might be prone to overdose, Dr. Stall said. Many cannabis strains are far more potent than in past decades, and seniors who used the drug earlier in life may underestimate the concentrations of THC they are inhaling or ingesting. Particularly with edibles, Dr. Stall said, the high can take about three hours to unfold, which might prompt users to ingest too much in the buildup.

Older adults also metabolize cannabis differently from younger people, Dr. Stall said, and their bodies eliminate the drug more slowly. Seniors also are more likely than younger people to take other medications, including psychoactive drugs for sleep, that can have problematic interactions with cannabis. And, Dr. Stall said, some seniors might already be prone to confusion or falling, which the use of cannabis could worsen.

“The question is What do we do about it?” Dr. Stall said.

What Can Be Done

Dr. Stall noted the importance of ensuring edibles were kept in locked locations and in clearly identified packaging, to prevent unintentional exposure.

Also, he said, policymakers should encourage senior-specific dosing information for cannabis, along with public-education campaigns about the kinds of conditions and circumstances that put older adults at risk when using the drug. He added that seniors who are experimenting with cannabis for the first time might want to draw from a mantra used in geriatric medicine: “Start low and go slow.”

“That would mean starting lower and going slower than a younger population who is trying cannabis for a first time,” Dr. Stall said.

Matt Richtel is a health and science reporter for The Times, based in Boulder, Colo. More about Matt Richtel

 

Source:  https://www.nytimes.com/2024/05/20/science/cannabis-seniors-poisoning.html?smid=nytcore-ios-share&referringSource=articleShare#site-content

Filed under: Canada,Cannabis/Marijuana :

Source: Email from Ed Moses to Drug Watch International drug-watch-international@googlegroups.com August 2017

Research published earlier this week in the monthly peer-reviewed scientific journal “Addiction,” showed that more than 17.7 million Americans used marijuana daily or near-daily in 2022 as compared to 14.7 million who reported drinking alcohol at the same rate.

Far more people consume alcohol than cannabis, research showed, but “high-frequency” drinking is less common. In 2022, the “median drinker” reported drinking on 4 to 5 days in the past month, compared to 15 to 16 days in the past month for the median cannabis user.

Regular cannabis use still pales in comparison to daily use of cigarettes, researchers noted. More than 24.1 million people smoked cigarettes daily or near-daily compared to the 17.7 million Americans who used cannabis regularly.

The research also showed that older Americans are using more regularly than younger.

“In 2022, people 35 and older accounted for (slightly) more days of use than did those under the age of 35,” the study notes.

Researchers used data compiled over more than 40 years from the National Household Survey on Drug Abuse, which showed cannabis use began to rise at a corresponding rate to changes in cannabis policies.

As of 2024, 24 states and the District of Columbia have legalized recreational marijuana use, according to the Pew Research Center. Another 14 states allow for medical use only.

Last week, the U.S. Department of Justice proposed new regulations that would designate cannabis a Schedule III drug, rather than its current designation of a Schedule I drug. Cocaine, methamphetamine and fentanyl are among the drugs that have received the Schedule II designation.

Schedule I drugs are those with the highest potential to create dependency issues and are considered to have “no currently accepted medical use.” The DOJ decision cites the use of marijuana in the medical field as one of the reasons it warrants reclassification.

The recently published research concluded that long-term trends in cannabis use have paralleled cannabis policy changes, with declines during periods of “greater restriction and growth during periods of policy liberalization.”

But researchers stressed that changes in laws regarding cannabis can’t be definitely attributed to the rise in use.

“Both could have been manifestations of changes in underlying culture and attitudes. However, whichever way causal arrows point, cannabis use now appears to be on a fundamentally different scale than it was before legalization,” researchers wrote.

To read the full study and read more about the findings and methodology used, click here.

Copyright 2024 Nexstar Media, Inc. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.

Source:https://www.yahoo.com/news/daily-cannabis-surpasses-daily-alcohol-211954850.html?

Australia won’t see any cannabis cafes selling brownies anytime soon, despite agreement that the use of marijuana should be prioritised as a health issue.

Eleanor Campbell  

https://www.dailytelegraph.com.au

 

A push to legalise the recreational use of cannabis on a national scale has been knocked back after experts expressed concerns it would lead to more use of the drug among young people.

A Senate committee rejected a bill introduced by Greens senator David Shoebridge on Friday, which calls to allow for cannabis possession for personal use in Australia, as well as the establishment of a national agency to regulate the growing of plants.

After receiving over 200 submissions the committee noted evidence from peak medical bodies including the Australian Medical Association (AMA) that warned wider access could exacerbate health risks, particularly for adolescents.

“Ultimately, the committee is concerned that the legalisation of cannabis for adult recreational use would create as many, if not more, problems than the bill is attempting to resolve,” the report said.

“While endeavouring to do so, the bill does not address several significant concerns, for example, ensuring that children and young people cannot access cannabis (particularly home-grow), managing risky cannabis use, and effective oversight of THC content.”

Multiple countries, including half of all US states have legalised recreational marijuana use. Picture: Ethan Miller/Getty Images/AFP

The committee report noted that the majority of submissions agreed that cannabis use “should be treated first and foremost as a health issue instead of a criminal issue.”

Cannabis remains the most commonly used illicit drug in Australia, according to the latest National Drug Strategy Household Survey, with more than 2.5 million people having used it recently.

In 2019, about 11.7 per cent of people aged 14 years reported having had used the drug at least once it in the past 12 months. The figure was higher for Aboriginal and Torres Strait Islander young people, at 16 per cent.

Under the Greens model, adults in Australia could legally grow six cannabis plants but it would remain a crime to sell the drug to anyone under the age of 18.

The bill also proposes the creation of licensed Amsterdam-style ‘cannabis cafes’ that sell marijuana products, such as edibles.

In his dissenting report, Senator Shoebridge argued the creation of a national cannabis market would generate thousands of jobs and remove “billions” from the black market.

“This inquiry shows clearly how evidence-based and human-centred reforms like this, we will need to break the stranglehold of politics as usual,” he said.

He said despite the committee’s findings the Greens plan to introduce the bill into parliament this year.

Senator Shoebridge claims up to 80,000 Australians could be flushed out of the criminal justice system if his Bill passed. Picture: NewsWire / Martin Ollman.

“The majority report in this inquiry reasonably fairly covers the evidence we had in the inquiry, although it does not detail the hundreds of individual submissions to the inquiry that, almost unanimously, asked us to vote this into law and to finally legalise cannabis,” he added.

Medical cannabis was legalised in Australia in 2016 and last year around 700,000 people reported having used cannabis for medical purposes.

Penalties for illicit use of marijuana, which remains illegal in all states and territories, vary based on jurisdiction.

In NSW, a first-time offender caught with a small amount of cannabis could be issued with a formal caution.

Offenders caught with up to 50 grams of cannabis in Queensland must be first offered a drug diversion program as an alternative to criminal prosecution.

In Western Australia, maximum fines can range from $2,000 to $20,000 and up to two years in prison.

 

Source: NCA NewsWire  June 3, 2024 – 5:10PM

 

The communication below was issued by John Coleman, Chairman of DrugWatch International, to summarise the position with CBD and its legal status, as reported on in May 2020.

The format, as an email, has been retained in this version.

 

From: drug-watch-international@googlegroups.com <drug-watch-international@googlegroups.com> On Behalf Of John J. Coleman, PhD
Sent: 21 May 2020 17:30
To: drug-watch-international@googlegroups.com
Subject: Is CBD a controlled substance? DEA: Yes- FDA: No

 

In April 2020, the FDA approved a labelling for Epidiolex that specifically stated (at sect. 9.1) “EPIDIOLEX is not a controlled substance.” (see attachment). The DEA’s list of controlled substances as of May 2020 shows “APPROVED CANNABIDIOL DRUGS, AS DEFINED IN 21 CFR 1308.15(f)” as Schedule V controlled substance. The Code of Federal Regulations section referred to defines this as: “(f) Approved cannabidiol drugs. (1) A drug product in finished dosage formulation that has been approved by the U.S. Food and Drug Administration that contains cannabidiol (2-[1R-3-methyl- 6R-(1-methylethenyl)-2-cyclohexen-1-yl]-5-pentyl-1,3- benzenediol) derived from cannabis and no more than 0.1 percent (w/w) residual tetrahydrocannabinols.” (See attachment)

 

It should be noted that the scheduling of Epidiolex and CBD was not done in the usual manner by both FDA and DEA performing medical and scientific evaluations and assessments of abuse potential but, instead, the placement of CBD in the Epidiolex formulation is Schedule V was done upon an Order by the Attorney General pursuant to notification by the Secretary of State that the drug is required to be controlled (i.e., scheduled) by virtue of its scheduling status in the 1961 Single Convention on Narcotic Drugs. The U.S. ratified this treaty and, as a result, the Constitution requires that treaty obligations be enforceable as domestic law. The Attorney General could undo the scheduling by simply rescinding his Order or issuing a replacement Order setting forth the removal of CBD and the approved formulation of Epidiolex from Schedule V.

 

I’ve checked the Federal Register and there is nothing indicating that the Attorney General has removed CBD or Epidiolex from Schedule V as of May 20, 2020. I will make additional inquiries to see what’s going on here. The FDA’s label (prescribing information) is a legal certification of an approved drug’s uses and indications – as is the Attorney General’s Order (delegated to DEA) of 9/28/2018, described in 83 FR 48953. (See attachment)

 

John Coleman

Source:  www.drugwatch.org

<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<DEA>>>>>>>>>>>>>>>>>>>>>>>>>>>>>

Links to view the articles related to the above presentation:

First click on the link, then click on the image that appears:

This is The Drug Report’s Friday Fact report – The rate of violent behavior in daily marijuana users aged 18-34 was nearly twice the violent behavior rate of non-users

The study “Associations of cannabis use, use frequency, and cannabis use disorder with violent behavior among young adults in the United States” was recently published by Nora D. Volkow and the team at NIDA. The study found that the rate of violent behavior in daily marijuana users aged 18-34 was nearly twice the violent behavior rate of non-users.

The study consisted of 113,434 participants, aged 18 to 34, and relied on data from the 2015-2019 National Surveys on Drug Use and Health (NSDUH).

The datasets provided information on the rates of daily marijuana use, whether the participants had Cannabis Use Disorder, and violent behavior. The study found:

The violence behavior rates for both males and females who were daily marijuana users and had Cannabis Use Disorder were close to doubling that of males and females who were non-marijuana users.

Source: Email from Smart Approaches to Marijuana (SAM) reply@learnaboutsam.org May 2024

Bertha Madras, a leading expert on weed, outlines the science linking it to psychiatric disorders, permanent brain damage, and other serious harms.

Young people who smoked marijuana in the 1960s were seen as part of the counterculture. Now the cannabis culture is mainstream. A 2022 survey sponsored by the National Institutes of Health found that 28.8% of Americans age 19 to 30 had used marijuana in the preceding 30 days—more than three times as many as smoked cigarettes. Among those 35 to 50, 17.3% had used weed in the previous month, versus 12.2% for cigarettes.

While marijuana use remains a federal crime, 24 states have legalized it and another 14 permit it for medical purposes. Last week media outlets reported that the Biden administration is moving to reclassify marijuana as a less dangerous Schedule III drug—on par with anabolic steroids and Tylenol with codeine— which would provide tax benefits and a financial boon to the pot industry.

Bertha Madras thinks this would be a colossal mistake. Ms. Madras, 81, is a psychobiology professor at Harvard Medical School and one of the foremost experts on marijuana. “It’s a political decision, not a scientific one,” she says. “And it’s a tragic one.” In 2024, that is a countercultural view.

Ms. Madras has spent 60 years studying drugs, starting with LSD when she was a graduate student at Allan Memorial Institute of Psychiatry, an affiliate of Montreal’s McGill University, in the 1960s. “I was interested in psychoactive drugs because I thought they could not only give us some insight into how the brain works, but also on how the brain undergoes dysfunction and disease states,” she says.

In 2015 the World Health Organization asked her to do a detailed review of cannabis and its medical uses. The 41-page report documented scant evidence of marijuana’s medicinal benefits and reams of research on its harms, from  cognitive impairment and psychosis to car accidents.

She continued to study marijuana, including at the addiction neurobiology lab she directs at Mass General Brigham McLean Hospital. In a phone interview this week, she walked me through the scientific literature on marijuana, which runs counter to much of what Americans hear in the media.

For starters, she says, the “addiction potential of marijuana is as high or higher than some other drug,” especially for young people. About 30% of those who use cannabis have some degree of a use disorder. By comparison, only 13.5% of drinkers are estimated to be dependent on alcohol. Sure, alcohol can also cause harm if consumed in excess. But Ms. Madras sees several other distinctions.

One or two drinks will cause only mild inebriation, while “most people who use marijuana are using it to become intoxicated and to get high.” Academic outcomes and college completion rates for young people are much worse for those who use marijuana than for those who drink, though there’s a caveat: “It’s still a chicken and egg whether or not these kids are more susceptible to the effects of marijuana or they’re using marijuana for self medication or what have you.”

Marijuana and alcohol both interfere with driving, but with the former there are no medical “cutoff points” to determine whether it’s safe to get behind the wheel. As a result, prohibitions against driving under the influence are less likely to be enforced for people who are high. States where marijuana is legal have seen increases in car accidents.

One of the biggest differences between the two substances is how the body metabolizes them. A drink will clear your system within a couple of hours. “You may wake up after binge drinking in the morning with a headache, but the alcohol is gone.” By contrast, “marijuana just sits there and sits there and promotes brain adaptation.”

That’s worse than it sounds. “We always think of the brain as gray matter,” Ms. Madras says. “But the brain uses fat to insulate its electrical activity, so it has a massive amount of fat called white matter, which is fatty. And that’s where marijuana gets soaked up. . . . My lab showed unequivocally that blood levels and brain levels don’t correspond at all—that brain levels are much higher than blood levels. They’re two to three times higher, and they persist once blood levels go way down.” Even if people quit using pot, “it can persist in their brain for a while.”

Thus marijuana does more lasting damage to the brain than alcohol, especially at the high potencies being consumed today. Levels of THC—the main psychoactive ingredient in pot—are four or more times as high as they were 30 years ago. That heightens the risks, which range from anxiety and depression to impaired memory and cannabis hyperemesis syndrome—cycles of severe vomiting caused by long-term use.

There’s mounting evidence that cannabis can cause schizophrenia. A large-scale study last year that examined health histories of some 6.9 million Danes between 1972 and 2021 estimated that up to 30% of young men’s schizophrenia diagnoses could have been prevented had they not become dependent on pot. Marijuana is  worse in this regard than many drugs usually perceived as more dangerous.

“Users of other potent recreational drugs develop chronic psychosis at much lower rates,” Ms. Madras says. When healthy volunteers in research experiments are given THC—as has been done in 15 studies—they develop transient symptoms of psychosis. “And if you treat them with an antipsychotic drug such as haloperidol, those symptoms will go away.”

Marijuana has also been associated with violent behavior, including in a study published this week in the International Journal of Drug Policy. Data from observational studies are inadequate to demonstrate causal relationships, but Ms. Madras says that the link between marijuana and schizophrenia fits all six criteria that scientists use to determine causality, including the strength of the association and its consistency.

Ms. Madras says at the beginning of the interview that she was operating on three hours of sleep after crashing on scientific projects. Yet she is impressively lucid and energized. She peppers her explanations with citations of studies and is generous in crediting other researchers’ work.

Another cause for concern, she notes, is that more pregnant women are using pot, which has been linked to increased preterm deliveries, admissions of newborns into neonatal intensive care units, lower birth weights and smaller head circumferences. THC crosses the placenta and mimics molecules that our bodies naturally produce that regulate brain development.

“What happens when you examine kids who have been exposed during that critical period?” Ms. Madras asks. During adolescence, she answers, they show an increased incidence of aggressive behavior, cognitive dysfunction, and symptoms of ADHD and obsessive-compulsive disorders. They have reduced white and gray matter.

A drug that carries so many serious side effects would be required by the Food and Drug Administration to carry a black-box warning, the highest-level alert for drugs with severe safety risks. Marijuana doesn’t—but only because the FDA hasn’t cleared it.

The agency has selectively approved cannabis compounds for the treatment of seizures associated with Lennox-Gastaut or Dravet syndrome, nausea associated with chemotherapy for cancer, and anorexia associated with weight loss in AIDS patients. But these approved products are prescribed at significantly less potent doses than the pot being sold in dispensaries that are legal under state law.

What about medicinal benefits? Ms. Madras says she has reviewed “every single case of therapeutic indication for marijuana—and there are over 100 now that people have claimed—and I frankly found that the only one that came close to having some evidence from randomized controlled trials was the neuropathic pain studies.” That’s “a very specific type of pain, which involves damage to nerve endings like in diabetes or where there’s poor blood supply,” she explains.

For other types of pain, and for all other conditions, there is no strong evidence from high-quality randomized trials to support its use. When researchers did a “challenge test on normal people where they induce pain and tried to see whether or not marijuana reduces the pain, it was ineffective.”

Ms. Madras sees parallels between the marketing of pot now and of opioids a few decades ago. “The benefits have been exaggerated, the risks have been minimized, and skeptics in the scientific community have been ignored,” she says. “The playbook is always to say it’s safe and effective and nonaddictive in people.”

Advocates of legalization assert that cannabis can’t be properly studied unless the federal government removes it from Schedule I. Bunk, Ms. Madras says: “I have been able to study THC in my research program.” It requires more paperwork, but “I did all the paperwork. . . . It’s not too difficult.”

Instead of bankrolling ballot initiatives to legalize pot, she says, George Soros and other wealthy donors who “catalyzed this whole movement” should be funding rigorous research: “If these folks, these billionaires, had just taken that money and put it into clinical trials, I would have been at peace.”

It’s a travesty, Ms. Madras adds, that the “FDA has decided that they’re going to listen to that movement rather than to what the science says.” While the reclassification wouldn’t make recreational marijuana legal under federal law, dispensaries and growers would be able to deduct their business expenses on their taxes. The rescheduling would also send a cultural signal that marijuana use is normal.

Ms. Madras worries that “it sets a precedent for the future.” She points to the movement in states to legalize psychedelic substances, for whose medicinal benefits there also isn’t strong scientific evidence. Meantime, she says it makes no sense that politicians continuously urge more spending on addiction treatment and harm reduction while weakening laws that prevent people from becoming addicted in the first place.
Her rejoinder to critics who say the war on drugs was a failure? “This is not a war on drugs. It’s a defense of the human brain at every possible age from in utero to old age.”

Ms. Finley is a member of the Journal’s editorial board.

Source: https://www.wsj.com/articles/what-you-arent-reading-about-marijuana-permanent-brain-damage-biden-schedule-iii-9660395e May 2024

Understanding motives for cannabis use is important for addiction prevention and intervention

(SACRAMENTO)A study in Psychology of Addictive Behaviors by researchers at UC Davis Health and the University of Washington surveyed teens over a six-month period to better understand their motives for using cannabis.

The researchers found that teens who have more “demand” for cannabis (meaning they are willing to consume more when it is free and spend more overall to obtain it) are likely to use it for enjoyment.

Using cannabis for enjoyment (“to enjoy the effects of it”) was linked to using more of it and experiencing more negative consequences.

Teens who have more demand for cannabis were also likely to use it to cope (“to forget your problems”). Using cannabis to cope was linked to experiencing more negative consequences, as identified by the Marijuana Consequences Checklist. Examples of negative effects include having trouble remembering things, difficulty concentrating and acting foolish or goofy.

Cannabis — also called marijuana, pot or weed — is the most used federally illegal drug in the United States. As of November 2023, 24 states and the District of Columbia have legalized cannabis for medicinal and recreational use. At the federal level, marijuana remains a Schedule One substance under the Controlled Substances Act.

“Understanding why adolescents use marijuana is important for prevention and intervention,” said Nicole Schultz, first author of the study and an assistant professor in the UC Davis Department of Psychiatry and Behavioral Sciences. “We know that earlier onset of cannabis use is associated with the likelihood of developing a cannabis use disorder. It is important we understand what variables contribute to their use so that we can develop effective strategies to intervene early,” Schultz said.

We know that earlier onset of cannabis use is associated with the likelihood of developing a cannabis use disorder. It is important we understand what variables contribute to their use so that we can develop effective strategies to intervene early.”Nicole Schultz, assistant professor, Department of Psychiatry and Behavioral Sciences

Cannabis a public health concern

Cannabis is the most used psychoactive substance among adolescents. In 2022, 30.7% of twelfth graders reported using cannabis in the past year, and 6.3% reported using cannabis daily in the past 30 days.

The increased use is a public health concern, as cannabis can have significant impacts on teen health. A study earlier this year from Columbia University found teens who use cannabis recreationally are two to four times as likely to develop psychiatric disorders, such as depression and suicidality, than teens who do not use cannabis. Teens are also at risk for addiction or cannabis use disorder, where they try but cannot quit using cannabis.

When talking about prevention and intervention with addictive substances, it is essential to know why people use the substances, according to Schultz.

“The reasons often change over time. At the beginning, someone might use a substance for recreational reasons but have different motives later when the substance has become a problem for them,” she said.

For the study, the researchers used mediation analysis to focus on two motives: enjoyment and coping. They examined how these two motives explained the relationship between cannabis demand — a measure of how important or “reinforcing” cannabis is to the user — and cannabis-related outcomes, which included negative consequences and use.

Study participants were between the ages of 15 and 18. Participants completed an initial survey and follow-up surveys at three months and six months. High school students comprised 60.7% of the participants, and four-year college students comprised 24.7%. All lived in the greater metropolitan area of Seattle, where the legalized age for recreational cannabis use is 21 and older.

Of these participants, 87.6% identified as white, 19.1% as Asian or Asian American, 16.9% identified as Hispanic or Latinx, 4.5% as Black or African American, 3.4% as American Indian or Alaska Native and 3.4% identified with another race. Participants could choose more than one selection for race.

The researchers found that greater cannabis demand was significantly associated with using cannabis for enjoyment. Using for enjoyment was also significantly associated with cannabis use for the young study participants.

“This finding makes sense because using for enjoyment is typically related to the initiation of use versus problematic use. And given the age of the participants in this study, they may have short histories of use,” Schultz said.

Being willing to consume more cannabis at no cost, spend more money on cannabis overall, and continue spending at higher costs was positively associated with using cannabis for coping reasons.

Participants who used cannabis for coping and enjoyment both reported experiencing negative consequences from cannabis use. These included feeling increased anxiety, making decisions that were later regretted and getting in trouble with school or an employer.

The researchers noted several limitations of the study, including a lack of diversity, with nearly 88% of the survey participants identifying as white. Another limitation was that the participants’ cannabis usage was self-reported. The study results may also be specific to regions like Seattle, where cannabis has been legalized for adults.

“The current study suggests that encouraging substance-free activities that are fun for adolescents and help adolescents cope with negative feelings may help them use less cannabis and experience fewer negative consequences from use,” said Jason J. Ramirez senior author of the study. Ramirez is an assistant professor in the Department of Psychiatry and Behavioral Sciences at the University of Washington and a faculty member of the Center for the Study of Health and Risk Behaviors.

Additional authors include Tessa Frohe from the University of Washington and Christopher J. Correia from Auburn University.

The Substance Abuse and Mental Health Services Administration has a website and a national hotline, at 1-800-662-4357, for individuals and families facing substance use disorders. Information about cannabis use disorder is available on the Centers for Disease Control webpage.

This research was supported by the National Institute on Drug Abuse (R21DA045092) and the National Institute on Alcohol Abuse and Alcoholism (F32AA028667, T32AA007455, K01AA030053)

Source: https://health.ucdavis.edu/news/headlines/teens-use-cannabis-for-coping-enjoyment/2023/12

Ten years after cannabis was first legalized for casual use in adults, scientists are struggling to provide evidence-based recommendations about the risks to young people.

Krista Lisdahl has been studying cannabis use among adolescents for two decades, and what she sees makes her worried for her teenage son.

“I see the data coming in, I know that he is going to come across it,” she says.

As a clinical neuropsychologist at the University of Wisconsin–Milwaukee, she sees plenty of young people who have come into contact with the drug to varying degrees, from trying it once at a party to using potent preparations of it daily. The encounters have become more frequent as efforts to legalize cannabis for recreational use intensify around the world. In some of her studies, around one-third of adolescents who regularly use cannabis show signs of a cannabis use disorder — that is, they can’t stop using the drug despite negative impacts on their lives. But she wants more conclusive evidence when it comes to talking about the drug and its risks to young people, including her son.

Deciding what to say is difficult, however. Anti-drug messaging campaigns have dwindled, and young people are forced to consider sometimes-conflicting messages on risks in a culture that increasingly paints cannabis and other formerly illicit drugs as harmless or potentially therapeutic. “Teenagers are pretty smart, and they see that adults use cannabis,” Lisdahl says. That makes blanket warnings and prohibitions practically useless.

It’s now a decade since the drug was officially legalized for recreational use by adults aged 18 and older in Uruguay, and aged 21 and older in the states of Colorado and Washington. Many other states and countries have followed, and researchers are desperately trying to get a handle on how usage patterns are changing as a result; how the drug impacts brain development; and how cannabis use correlates with mental-health conditions such as depression, anxiety and schizophrenia.

The data so far don’t tell clear stories: young people don’t seem to be using in greater numbers than before legalization, but there seem to be trends towards more problematic use. Frequent use also coincides with higher rates of mental-health issues and the risk of addiction, but there could be other explanations for these trends. Experimental studies in humans and animals could help, but they are stymied by the fact that cannabis is still illegal in many places. And it is difficult to study the same products and potencies that people can now readily access.

As a result, some researchers worry that society is stumbling, unaware, into a big public-health problem. “I am concerned that this will hit us like tobacco hit us,” says Nora Volkow, director of the National Institute on Drug Abuse in Bethesda, Maryland. Even if the risks of cannabis use are small, “it’s like playing roulette,” she says.

In the hope of getting a better handle on the situation, her agency funded the Adolescent Brain Cognitive Development (ABCD) study. Started in 2015, ABCD recruited more than 10,000 children aged 9 and 10, with the goal of taking annual images of their brains to monitor how different factors affect their development. Participants are now between 16 and 18, and some are starting to come into contact with the drug, says Lisdahl, who co-leads the project. “So we should be able to really measure the impact of starting cannabis,” she says.

Changing patterns of use

Medicinal cannabis has been legal in some parts of the United States since 1996, but Colorado and Washington led the way on legalizing its recreational use when the issue was put to public votes in 2012. Uruguay was the first country to legalize the sale of the drug for recreational use the following year. There were fears that legalization would result in a flood of adolescent users, but so far, this doesn’t seem to be the case, says Angela Bryan, a neuroscientist at the University of Colorado, Boulder. “Paradoxically, the legalization of cannabis has decreased use among adolescents”, at least in her state, she says.

A series of biennial surveys by the Colorado Department of Public Health and Environment found that cannabis use among students aged 14–18 declined from a stable rate of about 21% during 2005–19 to 13% in 2021 (see go.nature.com/47yojx9). Nationwide usage patterns seem to show a similar dip, which one study associated with the COVID-19 pandemic1.

But legalization is bound to have varying effects in different areas, says James MacKillop, a clinical psychologist at McMaster University in Hamilton, Canada. There was no initial spike in cannabis use among adolescents when it was legalized in Canada for adults aged 18 and older 5 years ago. But there was a rise in use when illegal cannabis stores that are not licensed by the government began to open, he says.

Now, “There are more cannabis storefronts than there are Tim Hortons,” says MacKillop, referring to a famously ubiquitous Canadian coffee shop. Some negative consequences might also be emerging. A recent study in Ontario found that residents who were within walking distance of a cannabis dispensary were more likely to attend a hospital for treatment of psychosis2 — which is increasingly being linked to high-potency cannabis products.

A hemisphere away, Uruguay saw an initial spike in usage among those age 18 to 21 as legalization rolled out in 2014. But usage quickly went back to pre-legalization levels, according to survey results3. The survey also found no increase in adolescents developing addiction or having more problematic use of cannabis. This could be because of a slew of factors, says Ariadne Rivera-Aguirre, a social epidemiologist at New York University, who led the survey. These include the fact that Uruguay has set limits on the potency of products sold legally, banned advertisements on packaging and only permits the sale of cannabis flower products — no edibles or concentrates.

Rivera-Aguirre measured not just how many adolescents were using cannabis, but also how many were using it at problematic levels, which she says many past surveys haven’t taken into account. The spike in use might have been the result of increased discussion and media attention surrounding legalization, Rivera-Aguirre says. Many others are also interested in understanding when casual use becomes problematic. “That’s where I think the research needs to focus, rather than worrying about the typical 17-year-old who has a joint at a party,” says Bryan.

Whereas use hasn’t exploded in people under 21, there are concerns about the types of product being sold. Increasingly, what is available at dispensaries — at least outside Uruguay — has much higher concentrations of delta-9-tetrahydrocannabinol (THC), the main active ingredient in cannabis. “The cannabis of today is not the cannabis of yesteryear,” says Ryan Sultan, a clinical psychiatrist at Columbia University in New York City. The THC concentration in products obtained by the US Drug Enforcement Administration has increased by more than threefold since 1996 (see go.nature.com/3r7fmbm), and many dispensaries sell vaping fluids and products for ‘dabbing’, a method of consuming concentrated THC that can deliver large amounts of the drug into a person’s lungs.

Health impacts

High-potency preparations carry much higher risks of inducing psychosis, and some researchers fear that this could have long-term effects. “The thing that the psychiatric community is scared to their bones about is the link between cannabis and schizophrenia,” says Sultan.

A study of more than 40,000 people with schizophrenia in Denmark, where cannabis has been legal since 2018, found that around 15% of cases could be tied to cannabis use disorder, with that figure being even higher in young men4.

But it is unclear whether the association in Denmark is causal or not, says Carsten Hjorthøj, an epidemiologist at the University of Copenhagen who led the work. It could be that those with schizophrenia are seeking out cannabis to self-medicate. There are similar issues in clarifying the connections between cannabis and depression and anxiety, but the associations are there.

In a study of almost 70,000 adolescents in the United States, Sultan found that around 1 in 40 were addicted to cannabis. Another 1 in 10 used cannabis but were not addicted. Even in this group, young people were twice as likely to experience bouts of depression along with other negative outcomes, such as skipping school, having lower grades than non-users and being arrested5.

Some researchers are working on establishing possible mechanisms by which cannabis can affect mental health, and others are finding connections through surveys and health records. Many are hoping that more conclusive results will come from long-term studies such as ABCD.

Studies that just look at connections at a single point in time are limited. “You have to wonder, what is the reason that you find that adolescent cannabis users show higher levels of depression?” asks Madeline Meier, a clinical psychologist at Arizona State University in Tempe. “Is that because the cannabis caused depression in these adolescents, or is it because adolescents with depression selectively seek out cannabis? Or is there some third variable?”

What’s going on in the brain?

Cannabis works by mimicking natural cannabinoid neurotransmitters in the body, which can activate a handful of receptors in the brain. “It’s mimicking that system, but it’s cheating the system,” Lisdahl says, because high-potency THC products are stimulating receptors much more than everyday activities would.

In adolescents, one of the main concerns is THC’s ability to bind easily to one receptor, called CB1. These receptors are found all over the brain, but they are particularly common in areas associated with reward and executive functioning — which includes memory and decision-making. CB1 is more abundant in adolescent brains than in adult ones.

Researchers are trying to see how the prolonged use of cannabis, especially products with high concentrations of THC, can affect mental health or cognitive function. Meier and her colleagues analysed the effect of cannabis use into adulthood for a group of around 1,000 people born between 1972 and 1973. They found that those who used cannabis consistently scored lower, on average, on IQ tests than did those who used cannabis less frequently or not at all. And this effect was most pronounced in people who started using cannabis in adolescence6.

Meier says her work points to infrequent cannabis use in adolescence not leading to significant cognitive decline. But, she says, “it’s enough to urge caution against using.” The bigger issue, to her, is that people who start using during adolescence are at a higher risk of long-term use.

One criticism of her team’s study, Meier says, is that it didn’t account for other factors that affect cognitive function, such as genetics and socio-economic status7.

These criticisms were all considered when designing the ABCD study, Volkow says. By recruiting 10,000 children from various backgrounds, the study is likely to include a sufficiently large and diverse group of frequent cannabis users. Over the course of the study, researchers will be imaging participants’ brains, tracking academic test scores and measuring cognitive function, all while interviewing them about their contact with drugs. Many think that it will be able to paint as accurate a picture of the effects of cannabis as one study can.

And its timing should also help researchers to understand the long-term effect of high-potency THC products, because many of the participants are likely to end up trying these. Efforts to study such products in the United States have been hampered by the fact that cannabis is still illegal at the federal level. Publicly funded research institutions can access only one strain of cannabis, and it is notoriously weaker than the products sold in dispensaries or on the street.

“Certain kinds of research are not being done because it takes so many complicated steps,” says R. Lorraine Collins, a psychologist at the University at Buffalo in New York. “It adds extra costs and extra staffing.” And as for research-grade cannabis, study participants “don’t like it at all”, says psychiatrist Jesse Hinckley, who specializes in adolescent addiction at the University of Colorado Anschutz Medical Campus in Aurora.

Some researchers have created workarounds to study cannabis on the streets. Bryan and others in Colorado have fashioned several vans into mobile laboratories, which they call canna-vans, to allow them to test the blood of cannabis users before and after they take the drug. The researchers have begun to expand their work to adolescents.

Volkow is working to make research on cannabis relevant to the current landscape — one rife with vaping, dabbing, edibles and other products. And Lisdahl is gearing up for the next stage of the ABCD study. Most of her cohort is now aged between 16 and 18 — the point at which she and others are expecting that some will begin using cannabis. When Lisdahl talks to the young people in her study and their parents, she worries that there’s little concrete guidance on cannabis safety — so she has to give advice on a case-by-case basis.

“I would just like to have information for the teens and for the adults to make better decisions for themselves,” Lisdahl says.

She also hopes to nail down how much cannabis is too much, and what contributes to the risk of developing a cannabis use disorder. This might differ from person to person, and could involve genetics and even the structure of the brain. All of this could help her in conversations with her own son. “He has lofty academic goals and I’ve seen that cannabis disrupts things like speed of thinking, complex attention and short-term memory, and it affects grades negatively.” For now, she hopes that pointing this out will make a difference, or at the very least, keep him informed of the risks.

Source: https://doi.org/10.1038/d41586-023-03860-3

Filed under: Cannabis/Marijuana,USA,Youth :

Appointing Jeff Sessions as US Attorney General infused new life into those of us who know that marijuana is destroying our nation from within. But were we premature in believing that Donald Trump would put an end to what Barack Obama and George Soros inflicted on this nation in the last eight years? After eight months, we still don’t have federal drug policy flowing from the President.

The pattern of past presidents is familiar. Bill Clinton moved the Office of National Drug Control Policy (ONDCP) to a backwater, and reduced its size by about 75 per cent. In 1996, with help from Hillary Clinton and investor George Soros, Clinton allowed California to violate federal laws and become the first victim of the ‘medical marijuana’ hoax. Soros, Peter Lewis and John Sperling, all out-of-state billionaires, financed that campaign with close to $7million (£5.3million).

Obama downgraded the position of Drug Czar from cabinet level to reporting to the Vice President. He then allowed, or directed, Attorney General Eric Holder to ignore the inherent responsibility of the Executive Branch to enforce federal law. Drug strategy in ONDCP was changed to focus on ‘harm reduction’, the subversive ploy of Soros to focus on treatment and rehabilitation, at the expense of primary prevention. The President espoused the claim that ‘marijuana is no worse than alcohol’, leaving most people with a flawed impression. Federal agencies such as the Substance Abuse and Mental Health Services Administration (SAMHSA) spent their fortunes on anything other than marijuana. Congress passed the Rohrabacher/Farr Bill which withheld federal dollars from the Drug Enforcement Administration (DEA) so they couldn’t even enforce the law. The result? Twenty-nine states now have some form of legalised pot. Marijuana users had increased from about 15million to 22.3million Americans at the last count.

Now comes President Trump. During the campaign he indicated he felt legalising marijuana should be a state’s right. He is wrong, but could be forgiven if he took the time to learn why. He was building a hotel empire while many of us have been fighting the drug problem for 40 years. The truth about marijuana has been so misrepresented and suppressed for the last 20 years that he, like most people, doesn’t know what to believe. He has the best scientific information in the world available to him, but the question is: who is giving him advice? Anyone? Or drug legalisers such as Rohrabacher, Peter Theil, Trump confidant Roger Stone? Or even George Soros?

The truth is, marijuana was a dangerous drug 50 years ago, when the potency was only 0.5 per cent to 2 per cent. Today’s highly potent pot, with an advertised range of 25 per cent (+/-) of the active ingredient THC, and up to 98 per cent as wax or oils used in edibles, dabbing and vaping, has the potential to destroy the country by ruining our collective health and intellectual capacity.

Experts such as Dr Stuart Reece from Australia or Dr Bertha Madras of Harvard will attest that marijuana use by either parent can cause congenital abnormalities in a foetus. What’s worse, these abnormalities can affect the next four generations.

Psychotic breaks, mental illness and addiction caused by marijuana have led to a substantial increase in crime, homelessness, erosion of the quality of our inner cities, academic failure, traffic fatalities and public health costs. The combined economic impact in the US is well over $1trillion per annum.

Only the federal government has the resources to combat billionaire-backed legalisation campaigns and the illicit drug trade; the enforcement of federal laws is the only thing that will save California and the nation. Hopefully the President will step up and get us back on track without further delay.

Roger Morgan

RogerMorgan is the Chairman of the Take Back America Campaign http://www.tbac.us

Source: https://www.conservativewoman.co.uk/roger-morgan-trump-must-clamp-marijuana-america-doomed/ October 2017

Abstract

We tested whether cannabinoids (CBs) potentiate alcohol-induced birth defects in mice and zebrafish, and explored the underlying pathogenic mechanisms on Sonic Hedgehog (Shh) signaling. The CBs, Δ9-THC, cannabidiol, HU-210, and CP 55,940 caused alcohol-like effects on craniofacial and brain development, phenocopying Shh mutations. Combined exposure to even low doses of alcohol with THC, HU-210, or CP 55,940 caused a greater incidence of birth defects, particularly of the eyes, than did either treatment alone. Consistent with the hypothesis that these defects are caused by deficient Shh, we found that CBs reduced Shh signaling by inhibiting Smoothened (Smo), while Shh mRNA or a CB1 receptor antagonist attenuated CB-induced birth defects. Proximity ligation experiments identified novel CB1-Smo heteromers, suggesting allosteric CB1-Smo interactions. In addition to raising concerns about the safety of cannabinoid and alcohol exposure during early embryonic development, this study establishes a novel link between two distinct signaling pathways and has widespread implications for development, as well as diseases such as addiction and cancer.

Source: https://www.nature.com/articles/s41598-019-52336-w November 2019

Cannabis is harmful to the lungs, but in a different way to tobacco, causing significant respiratory symptoms such as bronchitis with evidence to suggest it can result in destructive lung disease – sometimes referred to as ‘bong lung’ – in heavy cannabis users.

These are the key findings from a review of research on the effects of smoking cannabis on the lungs undertaken by respiratory specialists, Professor Bob Hancox, from the University of Otago’s Department of Preventive and Social Medicine and Dr Kathryn Gracie, from Waikato Hospital’s Respiratory Department.

Cannabis is the second-most commonly smoked substance after tobacco and the most widely-used illicit drug world-wide. Although cannabis remains illegal in most countries, many countries – like New Zealand – are considering decriminalising or legalising its use.

Professor Hancox explains that much of the debate about legalising cannabis appears to revolve around the social and mental health effects. Both he and Dr Gracie believe policies around the liberalisation of cannabis should consider the wider health effects of smoking cannabis.

“The potential for adverse effects on respiratory health from smoking cannabis has had much less attention than the social and mental health effects,” Professor Hancox says.

“We believe policies around the liberalisation of cannabis should consider the potential impacts on the lungs.

“Whether liberalising availability will lead to further increases in cannabis use remains to be seen, but it is likely that patterns of cannabis use will change, with resulting health consequences.”

Because cannabis has been an illegal and unregulated substance and the fact most cannabis users also smoke tobacco, making the effects difficult to separate, Dr Gracie explains that it has been difficult to carry out research on cannabis and its direct impact on the lungs.

“Perhaps, most importantly, the individuals who are extremely heavy users of cannabis may not be well represented in the existing epidemiological research. Most case reports of cannabis-related destructive lung disease document very heavy cannabis consumption.

“Despite these limitations there is sufficient evidence that cannabis causes respiratory symptoms and has the potential to damage both the airways and the lungs.”

“Cannabis may also increase the risk of lung cancer, but there is not enough evidence to be sure of this yet,” Dr Gracie says.

Professor Hancox says there is still a lot to learn about cannabis, but there is sufficient evidence to show that smoking cannabis is not harmless to the lungs.

A combination of smoking both cannabis and tobacco is likely to result in poorer health outcomes.

“Many people smoke both cannabis and tobacco and are likely to get the worst of both substances.”

Source: https://www.otago.ac.nz/news/news/smoking-cannabis-causes-bronchitis-and-changes-to-lung-function May 2020

Abstract and Figures

In 2017 Iceland received word-wide attention for having dramatically reversed the course of teenage substance use. From 1998 to 2018, the percentage of 15-16-year-old Icelandic youth who were drunk in the past 30 days declined from 42% to 5%; daily cigarette smoking dropped from 23% to 3%; and having used cannabis one or more times fell from 17% to 5%. The core elements of the model are: 1) long-term commitment by local communities; 2) emphasis on environmental rather than individual change; 3) perception of adolescents as social attributes. This presentation describes how the Iceland prevention model is built upon collaboration between policy makers, researchers, parent organizations, and youth practitioners. These groups have created a system whereby youth receive the necessary guidance and support to live fun and productive lives without reliance on psychoactive substances. The Model is being replicated in 35 municipalities within 17 countries around the globe. The Icelandic Model: Evidence Based Primary Prevention – 20 Years of Successful Primary Prevention Work was featured for the past two years at the Special Session of the United Nations General Assembly on the World Drug Problem.

Source: https://www.researchgate.net/publication/330347576_Perspective_Iceland_Succeeds_at_Preventing_Teenage_Substance_Use February 2019

US DRUG CZAR EXPLAINS CAUSES AND RSDT TOOL TO PREVENT TEEN DRUG USE AND OVERDOSE DEATH INTERVIEW WITH U.S. DRUG CZAR JOHN WALTERS

Introduction:  In response to recent news of a huge increase in drug overdose deaths and arrests for drug trafficking among Fairfax County youths, Fox News TV5 reporter Sherri Ly interviewed U.S. Drug Czar John Walters for his expert views on the cause and potential cure for these horrific family tragedies.  Following is a transcript of that half-hour interview with minor editing for clarity and emphasis added.  The full original interview is available through the 11/26/08 Fox5 News broadcast video available at link:

WALTERS:  Well, as this case shows, while we’ve had overall drug use go down, we still have too many young people losing their lives to drugs, either through overdoses, or addiction getting their lives off track.  So there’s a danger.  We’ve made progress, and we have tools in place that can help us make more progress, but we have to use them

Q 1:  You meet with some of these parents whose children have overdosed.  What do they tell you, and what do you tell them?

WALTERS:  It’s the hardest part of my job; meeting with parents who’ve lost a child.  Obviously they would give anything to go back, and have a chance to pull that child back from the dangerous path they were on.  There are no words that can ease their grief.  That’s something you just pray that God can give them comfort.  But the most striking thing they say to me though is they want other parents to know, to actAnd I think this is a common thing that these terrible lessons should teach us.

Many times, unfortunately, parents see signs: a change in friends, sometimes they find drugs; sometimes they see their child must be intoxicated in some way or the other.  Because it’s so frightening, because sometimes they’re ashamed – they hope it’s a phase, they hope it goes away – they try to take some half measures.  Sometimes they confront their child, and their child tells them – as believably as they ever can – that it’s the first time.  I think what we need help with is to tell people; one, it’s never the first time.  The probability is low that parents would actually recognize these signs – even when it gets visible enough to them – because children that get involved in drugs do everything they can to hide it.  It’s never the first time.  It’s never the second time.  Parents need to act, and they need to act quickly.  And the sorrow of these grieving parents is, if anything, most frequently focused on telling other parents, “Don’t wait: do anything to get your child back from the drugs.”

Secondly, I think it’s important to remember that one of the forces that are at play here is that it’s their friends.  It’s not some dark, off-putting stranger – it’s boyfriends, girlfriends.  I think that was probably a factor in this case.  And it’s also the power and addictive properties of the drug.  So your love is now being tested, and the things you’ve given your child to live by are being pulled away from them on the basis of young love and some of the most addictive substances on earth.  That’s why you have to act more strongly.  You can’t count on the old forces to bring them back to safety and health.

Q 2:  When we talk about heroin – which is what we saw in this Fairfax County drug ring, alleged drug ring – what are the risks, as far as heroin’s concerned?  I understand it can be more lethal, because a lot of people don’t know what they’re dealing with?

WALTERS:  Well it’s also more lethal because one, the drug obviously can produce cardiac and respiratory arrest.  It’s a toxic substance that is very dangerous.  It’s also the case that narcotics, like heroin – even painkillers like OxyContin, hydrocodone, which have also been a problem – are something that the human body gets used to.  So what you can frequently get on the street is a purity that is really blended for people who are addicted and have been long time addicted.  So a person who is a new user or a naïve user can more easily be overdosed, because the quantities are made for people whose bodies have adjusted to higher purities, and are seeking that effect that only the higher purity will give them in this circumstance.  So it’s particularly dangerous for new users.  But we also have to remember, it almost never starts with heroin.  Heroin is the culmination here.  I think some of the – and I’ve only seen press stories on this — some of these young people may have gotten involved as early as middle school.

We have tools so that we don’t have to lose another young woman like this– or young men.  We now have the ability to use Random Student Drug Testing (RSDT) because the Supreme Court has, in the last five years, made a decision that says it can’t be used to punish.  It’s used confidentially with parents.  We have thousands of schools now doing it since the president announced the federal government’s willingness to fund these programs in 2004.  And many schools are doing it on their own.  Random testing can do for our children what it’s done in the military, what it’s done in the transportation safety industry– significantly reduce drug use.

First, it is a powerful reason not to start.  “I get tested, I don’t have to start.”  We have to remember, it’s for prevention and not a “gotcha!”  But it’s a powerful reason for kids to say, even when a boyfriend or girlfriend says come and do this with me, “I can’t do it, I get tested.  I still like you, I still want to be your friend; I still want you to like me, but I just can’t do this,” which is very, very powerful and important.  And second, if drug use is detected the child can be referred to treatment if needed.

Q 3:  Is the peer pressure just that much that without having an excuse, that kids are using drugs and getting hooked?

WALTERS:  Well one of the other unpleasant parts of my job is I visit a lot of young people in treatment; teenagers, sometimes as young as 14, 15, but also 16, 17, 18.  It is not uncommon for me to hear from them, “I came from a good family.  My parents and my school made clear what the dangers were of drugs.  I was stupid.  I was with my boyfriend (or girlfriend) and somebody said hey, let’s go do this.  And I started, and before I knew it, I was more susceptible.

We have to also understand the science, which has told us that adolescents continue to have brain development up through age 20-25.  And their brains are more susceptible to changes that we can now image from these drugs.  So it’s not like they’re mini-adults.  They’re not mini-adults.  They’re the particularly fragile and susceptible age group, because they don’t have either the experience or the mental development of adults.  That’s why they get into trouble, that’s why it happens so fast to them, that’s why it’s so hard for them to see the ramifications.

So what does RSDT do?  It finds kids early–­ if prevention fails.  And it allows us to intervene, and it doesn’t make the parent alone in the process.  Sometimes parents don’t confront kids because kids blackmail them and say “I’m going to do it anyway, I’m going to run away from home.”  The testing brings the community together and says we’re not going to lose another child.  We’re going to do the testing in high school – if necessary, in middle school.  We’re going to wrap our community arms around that family, and get those children help.  We’re going to keep them in school, not wait for them to drop out.  And we’re certainly not going to allow this to progress until they die.

Q 4:  And in a sense, if you catch somebody early, since you’re saying the way teenagers seem to get into drug use is a friend introduces it to a friend, and then next thing you know, you have a whole circle of friends doing it.  Are you essentially drying that up at the beginning, before it gets out of hand?

WALTERS:  That is the very critical point.  It’s not only helping every child that gets tested be safer, it means that the number of young people in the peer group, in the school, in the community that can transfer this dangerous behavior to their friends shrinks.  This is communicated like a disease, except it’s not a germ or a bacillus.  It’s one child who’s doing this giving it behaviorally to their friends, and using their friendship as the poison carrier here.  It’s like they’re the apple and the poison is inside the apple.  And they trade on their friendship to get them to use.  They trade on the fact that people want acceptance, especially at the age of adolescence.  So what you do is you break that down, and you make those relationships less prone to have the poison of drugs or even underage drinking linked to them.  And of course we also lose a lot of kids because of impaired driving.

Q 5:  And how does the drug testing program work, then, in schools– the schools that do have it.  Is it completely confidential?  Are you going to call the police the minute you find a student who’s tested positive for heroin or marijuana or any other illicit drug?

WALTERS:  That’s what is great about having a Supreme Court decision.  It is settled – random testing programs cannot be used to punish, to call law enforcement; they have to be confidential.  So we have a uniform law across the land.  And what the schools that are doing RSDT are seeing is that it’s an enormous benefit to schools for a relatively small cost.  Depending on where you are in the country, the screening test is $10-40.  It’s less than what you’re going to pay for music downloads in one month for most teenage kids in most parents’ lives.  And it protects them from some of the worst things that can happen to them during adolescence.  Not only dying behind the wheel, but overdose death and addiction.

 Schools that have done RSDT have faced some controversy; so you have to sit down and talk to people; parents, the media, young people.  You have to engage the community resources.  You’re going to find some kids and families that do have treatment needs.  But with RSDT you bring the needed treatment to the kids.

I tell, a lot of times, community leaders – mayors and superintendents, school board members – that if you want to send less kids into the criminal justice system and the juvenile justice system, drug test — whether you’re in a suburban area or in an urban area.

What does the testing do?  It takes away what we know is an accelerant to self-destructive behavior: crime, fighting in school, bringing a weapon, joining a gang.  We have all kinds of irrefutable evidence now – multiple studies showing drugs and drinking at a young age accelerate those things, make them worse, make them more violent, as well as increasing their risks of overdose deaths and driving under the influence.  So drug testing makes all those things get better.  And it’s a small investment to make everything else we do work better.

Again, drug testing is not a substitute for drug education or good parenting or paying attention to healthy options for your kid.  It just makes all those things work better.

Q 6:  And I know you’ve heard this argument before, but isn’t that big brother?  Aren’t there parents out there who say to you, “I’m the parent: why are you going to test my child for drugs in school; that’s my job?” 

WALTERS:  I think that is the critical misunderstanding that we are slowly beginning to change by the science that tells us substance abuse is a disease.  It’s a disease that gets started by using the drug, and then it becomes a thing that rewires our brain and makes us dependent.  So instead of thinking of this as something that is a moral failing, we have to understand that this is a disease that we can use the kind of tools for public health – screening and interventions – to help reduce it.

Look, let me give you the counter example.  It’s really not big brother.  It’s more like tuberculosis.  Schools in our area require children to be tested for tuberculosis before they come to school.  Why do they do that?  Because we know one, they will get sicker if they have tuberculosis and it’s not treated.  And we can treat them, and we want to treat them.  And two, they will spread that disease to other children because of the nature of the contact they will have with them and spreading the infectious agent.  The same thing happens with substance abuse.  Young people get sicker if they continue to use.  And they spread this to their peers.  They’re not secretive among their peers about it; they encourage them to use them with them.  Again, it’s not spread by a bacillus, but it’s spread by behavior.

If we take seriously the fact that this is a disease and stop thinking of it as something big brother does because it’s a moral decision that somebody else is making, we can save more lives.  And I think the science is slowly telling us that we need to be able to treat this in our families, for adults and young people.  We have public health tools that we’ve used for other diseases that are very powerful here, like screening – and that’s really what the random testing is.  We’re trying to get more screening in the health care system.  So when you get a check up, when you bring your child to a pediatrician, we screen for substance abuse and underage drinking.  Because we know we can treat this, and we know that we can make the whole problem smaller when we do. 

Q 7:  You have said there were about 4,000 schools across the country now that are doing this random drug testing.  What can we see in the numbers since the Supreme Court ruling in 2002, as far as drug use in those schools, and drug use in the general population?

WALTERS:  Well, what a number of those schools have had is of course a look at the harm from student drug and alcohol use.  Some of them have put screening into place, random testing, because they’ve had a terrible accident; an overdose death; death behind the wheel.  What’s great is when school districts do this, or individual schools do this, without having to have a tragedy that triggers it.  But if you have a tragedy, I like to tell people, you don’t have to have another one.  The horrible thing about a tragic event is that most people realize those are not the only kids that are at risk.

There are more kids at risk, obviously, in our communities in the Washington, DC area where this young woman died.  We know there’s obviously more children who are at risk of using in middle school and high school.  The fact is those children don’t have to die.  We cannot bring this young lady back.  Everybody knows that.  But we can make sure others don’t follow her.  And the way we can do that is to find, through screening, who’s really using.  And then let’s get them to stop – let’s work with their families, and let’s make sure we don’t start another generation of death.  So what you see in these areas is an opportunity to really change the dynamic for the better.

Q 8:  Now, although nationally drug use among our youth is going down – what does it say to you – when I look at the numbers specific to Virginia, the most recent that I could find tells me that 3% of 12th graders, over their lifetime, have used a drug like heroin?  What does it say to you?  To me, that sounds like a lot.

WALTERS:  Yeah, and it’s absolutely true.  I think the problem here is that when you tell people we are taking efforts that are making progress nationwide, they jump to the conclusion that that means that we don’t have a problem anymore.  We need to continue to make this disease smaller.  It afflicts our young people.  It obviously also afflicts adults, but this is a problem that starts during adolescence — and pre-adolescence in some cases — in the United States.  We can make this smaller.  We not only have the tools of better prevention but also better awareness and more recognition of addiction as a disease.  We need to make that still broader.  We need to use random testing.  If we want to continue to make this smaller, and make it smaller in a permanent way, random testing is the most powerful tool we can use in schools.

We want screening in the health care system.  We have more of that going on through both insurance company reimbursement and public reimbursement through Medicare and Medicaid for those who come into the public pay system.  That needs to grow.  It needs to grow into Virginia, it’s already being looked at in DC; it needs to grow into Maryland and the other states that don’t have it.  We are pushing that, and it’s relatively new, but it’s consistent with what we’re seeing – the science and the power of screening across the board.

We need to continue to look at this problem in terms of also continuing to push on supply.  We’re working to reduce the poisons coming into our communities, which is not the opposite of demand; that we have to choose one or the other.  They work together.  Keeping kids away from drugs and keeping drugs away from kids work together.  And where we see that working more effectively, we’ll save more lives.  So again, we’ve seen that a balanced approached works, real efforts work, but we need to follow through.  And the fact that you still have too many kids at risk is an urgent need.  Today, you have kids that could be, again, victims that you have to unfortunately tell about on tonight’s news, that we can save.  It’s not a matter we don’t know how to do this.  It’s a matter of we need to take what we know and make it reality as rapidly as possible.

Q 9:  Where are these drugs coming from?  Where’s the heroin that these kids allegedly got coming from?

WALTERS:  We do testing about the drugs to figure out sources for drugs like heroin.  Principally, the heroin in the United States today has come from two sources.  Less of it’s coming out of Colombia.  Colombia used to be a source of supply on the East Coast, but the Colombian government, as a part of our engagement with them on drugs, has radically reduced the cultivation of poppy and the output of heroin.  There still is some, but it’s dramatically down from what it was even about five years ago.  Most of the rest of the heroin in the United States comes from Mexico.  And the Mexican government, of course, is engaged in a historic effort to attack the cartels.  You see this in the violence the cartels have had as a reaction.  So we have promising signs.  There are dangerous and difficult tasks ahead, but we can follow through on that as well.

Most of the heroin in the world comes from Afghanistan; 90% of it.  And we are working there, of course, as a part of our effort against the Taliban and the forces of terror and Al Qaeda, to shrink that.  The good news is that last year we had a 20% decline in cultivation and a 30% decline in output there.  Most of that does not come here, fortunately.  But it has been funding the terrorists.  It’s been drained out of most of the north and the east of the country.  It’s focused on the area where we have the greatest violence today, in the southwest.  We’re working now – you see Secretary Gates talking to the NATO allies about bringing the counter-insurgency effort together with the counter-narcotics effort to attack both of these cancers in Afghanistan.  We have a chance to change heroin availability in the world in a durable way by being successful in Afghanistan.  We’ve started that path in a positive way.  Again, it’s a matter of following through as rapidly as possible.

Q 10:  Greg Lannes, the father of the girl in Fairfax County who died, told me that one of his main efforts, as you imagined, was to let people know that those drugs, they’re coming from where it is produced, outside our country; that they’re getting all the way down to the street level and into our neighborhoods– something that people don’t realize.  So when you hear that they busted a ring of essentially teenagers who have been dealing, using and buying heroin, what does that say to you as the man in charge of combating drugs in our country?

WALTERS:  Well again, we have tools that can make this smaller.  But we have to use those tools.  And we have multiple participants here.  Yes we need to educate.  And we need to make sure that parents know they need to talk to their children, even when their children look healthy and have come from a great home.  Drugs – we’ve learned, I think, over the last 25 years or more, drugs affect everybody; rich or poor, middle class, lower class or upper class.  Every family’s been touched by this, in my experience, by alcohol or drugs.  They know that reality– we don’t need to teach them that.

What we need to teach them is the tools that we have that they can help accelerate use of.  Again, I think – there is no question in my mind that had this young woman been in a school, middle school or high school that had random testing – since that’s where this apparently started, based on the information I’ve seen in the press – she would not be dead today.  So again, we can’t go back and bring her to life.  But we can put into place the kind of screening that makes the good will and obvious love that she got from her parents, the obvious good intentions that I can’t help but believe were a part of what happened in the school, the opportunities that the community has to have a lot of resources that she didn’t get when she needed them.  And now she’s dead.  Again, we can stop this: we just have to make sure we implement that knowledge in the reality of more of our kids as fast as possible.

Q 11:  Should anyone be surprised by this case?  And that such a hardcore drug like heroin is being used by young people?

WALTERS:  We should never stop being surprised when a young person dies.  They shouldn’t die.  They shouldn’t die at that young age, and we should always demand of ourselves, even while we know that’s sometimes going to happen today, that every death is a death too many.  I think that it is very important not to say we’re going to accept a certain level.  Never accept this.  Never!  That’s my attitude, and I know that’s the president’s  attitude as well here.  Never accept that heroin’s going to get into the lives of our teenagers.  Never accept that our children are going to be able to use and not be protected.  It’s our job to protect themThey have a role, also, obviously in helping to protect themselves.  But we need to give them the tools that will help protect them.

When I talk to children and young adults in high school or college, they know what’s going on among their peers.  And in some ways, when you get them alone and they feel they can talk candidly, they tell us they don’t understand why we, as adults who say this is serious, don’t act.  They know that we see children who are intoxicated; they know that we must see signs of this, because as kid’s lives get more out of control, they show signs of it.  They want to know why we don’t act.

We can use the tools of screening, and we can use the occasion of a horrible event like this to bring the community together and say it’s time for us to use the shock and the sorrow for something positive in the future.  I haven’t met a parent of a child who’s been lost who doesn’t say I just want to use this now for something positive.  And that’s understandable, and I think we ought to honor that wish.

Q 12:  Well, I guess I’m not asking should we accept that this is in our schools, but is it naïve for people not to understand or realize that these hardcore drugs are in our schools, and in our communities, and in our neighborhoods. 

WALTERS:  Yeah.  Where it is naïve, I think, is to not recognize the extent and access that young people have to drugs and alcohol.  I think we sometimes think that because they come from a home where this isn’t a part of their lives now, that it’s not ever going to be part of their lives.  Look, your viewers should go on the computer.  Type marijuana into the Google search engine and see how many sites encourage them to use marijuana, how to get marijuana, how to grow marijuana, the great fun of marijuana.  Go on YouTube and type in marijuana, and see how many videos come up using marijuana, joking around about marijuana.  And then when you start showing one, of course the system is designed to show you similar things.  Type in heroin.  See what kind of sites come up, and see what kind of videos come up on these sites.  Young people spend more time on these sites than they do, frequently, watching television.  Remember, there is somebody telling your children things about drugs.  And if it’s not you, the chances are they’re telling them things that are false and dangerous.  So there is a kind of naiveté about what the young peoples’ world, as it presents itself to them, tells them about these substances.  It minimizes the danger, it suggests that it’s something that you can do to be more independent, not be a kid anymore. 

We, from my generation — because I’m a baby boomer — unfortunately have had an association of growing up in America with the rebellion that’s been associated with drug use.  That’s been very dangerous, and we’ve lost a lot of lives.  We have to remember that it’s alive and well, and has become part of the technological sources of information that young people have.  I also see young people in treatment centers who got in a chat room and somebody offered them drugs or offered them to come and buy them alcohol and flattered them, and got them involved in incredibly self-destructive behavior.  The computer brings every predator and every dangerous influence into your own child’s home – into their bedroom in some cases, if that’s where that computer exists.  You wouldn’t let your kids go out and play in the park with drug dealers.  If you have a computer and it’s not supervised, those drug dealers are in that computer.  Remember that.  And they’re only a couple of keystrokes away from your child.

Q 13:  And you talk about the YouTube and the computers and all those things.  What about just the overall societal image?  Because we have this whole image with heroin, of heroin chic.  How much does that contribute to the drug use, and how difficult does it make your job, when a drug is being made out to be cool in society by famous people?

WALTERS:  There are still some elements of that.  It was more prominent a number of years ago.  I would say you see less of that now glamorized in the entertainment industry, or among people who are celebrities in and out of entertainment.  You see more cases of real harm.  But it’s still out there.  The one place that I think is replacing that, just to get people ahead of the game here, is prescription pharmaceuticals.  Those have been marketed to kids on the internet as a safe high.  They falsely suggest that you can overcome the danger of an overdose because you can predict precisely the dosage of OxyContin, hydrocodone, Vicodin.  And there are sites that suggest what combination of drugs to use.  We’ve seen prescription drug use as the one counter example of a category of drug use going up among teens.  We’re trying to work on that as well, but that’s something that’s in your own home, because many people get these substances for legitimate medical care.  Young people are going to the medicine cabinet of family or friends, taking a few pills out and using those.  And those are as powerful as heroin, they’re synthetic opioids, and they have been a source of overdose deaths. 

So let’s not forget – while this Fairfax example reminds us of the issues of heroin chic and of the heroin that’s in our communities, the new large problem today is a similar dangerous substance in pill form in our own medicine cabinets.  Barrier to access is zero.  They don’t have to find a drug dealer; they just go find the medicine cabinet.  They don’t have to pay a dime for it because they just take it and they share that with their friends.  We need to remember, that’s another dimension here.  Keep these substances out of reach – under our control when we have them in our home.  Throw them away when we’re done with them.  Make sure we talk to kids about pills.  Because people, again, are telling them that’s the place to go to avoid overdose death, is to take a pill.

Q 14:  When you see a lot of these celebrities checking in and out of rehab, does it sort of glamorize it for kids?  And teach them hey, you can use, you can check into rehab, you can come back, you can – you know.  Is there a mixed message there?

WALTERS:  There is.  Some young people interpret it the way you describe; of it’s something you do and you can get away with it by going into rehab.  We do a lot of research on young people’s attitudes for purposes of helping shape prevention programs in the media, as well as in schools and for parents.  We do a lot with providing material to parents.  I would say that compared to where we’ve been in the last 15 or 20 years, there’s less glamorization today.

I think we should also remember the positive, because we reinforce that.  A lot of young people – obviously not all or we wouldn’t have this death – believe that taking drugs makes you a loser.  They’ve seen that a lot of those celebrities are showing their careers going down the toilet because they can’t get away from the pills and the drugs and the alcohol.  And I think they see that even among some of their peers.  That’s a good thing.  We should reinforce that as parents: teaching our kids that drug and alcohol use may be falsely presented to you as something you do that would make you popular, make you seem like you should have more status in society generally.  But actually, look at a lot of these people; they’ve had enormous opportunities, enormous gifts, and they can’t stop themselves from throwing them away.  And they may not stop themselves from throwing away their lives. 

I think you could use these events as a teachable moment.  It can go two ways.  Help your child understand what the truth is here.  And I tell young people – and I think parents have to start this more directly – this is the way this is going to come to you:  Somebody you really, really want to like you; somebody you really, really like; someone you may even love — or think you love — they’re going to say come and do this with me.  If you can’t find any other reason to not do this with them, say, “Before we do this, let’s go to a treatment center.  Let’s go talk to people who stood where we stood and said it’s not going to happen to me.”  If everybody, when they got the chance to start, thought of an addict or somebody who was dead, they wouldn’t start.  The fact is that does not enter their mind. 

Many people in treatment centers understand that part of the task of recovery is helping other people avoid this.  So they’re willing to talk about it.  In fact, that’s part of their path of staying clean and sober, which not many kids are going to be able to do on their own.  But it makes them think that what presents itself as something overwhelmingly attractive has behind it a horrible dimension, for their friends as well as for themselves.  And more and more, I think kids understand this.

We can use the science of this as a disease, and the experience of many families.  Remember, uncle Joe didn’t used to be like this.  Especially Thanksgiving, when we have families getting together and all of a sudden mom’s going to get loaded and become ugly in the corner.  We also have to remember we have an obligation to reach out to those people, and to get them help.  We can treat them.  Nobody gets sober, in my experience, by themselves.  They have to take responsibility.  But you have to overcome the pushback, and addiction and alcoholism have, as a part of the disease, denial.  When you tell somebody they have a problem, they get angry with you.  They don’t say hey thanks, I want your help.  They don’t hit bottom and become nice.  That’s a myth.  They need to be grabbed and encouraged and pushed.  Almost everybody in treatment is coerced – by a family member, by an employer, sometimes by the criminal justice system.

So remember that, when you find your child using and they want to lie to you up down and sideways saying, “It’s the first time I’ve ever done it.”  No, no, no, no, no, that’s the drugs talking.  That shows you, if anything, you have a bigger problem than you realized and you need to reach out, get some professional help.  But don’t wait!

Source:    National Institute of Citizen Anti-drug Policy (NICAP)

DeForest Rathbone, Chairman, Great Falls, Virginia, 703-759-2215, DZR@prodigy.net

 

A groundbreaking study presented at the European Psychiatric Association Congress 2024, unveiled disturbing findings relating to the impacts of marijuana use by pregnant mothers. This research linked such usage to various neurodevelopmental disorders, including attention deficit hyperactivity disorder (ADHD), autism spectrum disorder (ASD) and intellectual disability (ID) in kids. Unlike previous studies reliant on self-reported data, this study dived into health registries examining confirmed diagnoses of prenatal marijuana addiction (otherwise known as cannabis use disorder or CUD) and the specified neurodevelopmental disorders using diagnostic tools based on the ISD-10-AM to capture a more reliable assessment of the risks associated with marijuana use during pregnancy.

 

Conducted by researchers at Curtin University in Australia, they scrutinized over 222,000 mother-child pairs in New South Wales, Australia and found that children born to mothers with diagnosed marijuana addiction during pregnancy exhibit a:

 

·    98 percent increased risk of ADHD,

·    94 percent increased risk of autism, and

·    46 percent increased risk of intellectual disability compared to children whose mothers did not have a CUD during pregnancy.

 

Researchers noted a stronger risk for these neurodevelopmental conditions when mothers also smoked during pregnancy. They also found a combined impact between prenatal CUD and other pregnancy complications such as low birth weight and premature birth, amplifying the risk of neurodevelopmental disorders in kids.

 

Dr. Julian Beezhold, the Secretary General of the European Psychiatric Association, emphasized the study’s uniqueness, offering a more comprehensive understanding of the potential risks associated with prenatal marijuana use. He also stressed the need for public health education campaigns and clinical interventions.

Recognizing the growing prevalence of marijuana use among pregnant women and the heightened potency of THC, which escalates the risks associated with its use during pregnancy, Drug Free America Foundation has launched an educational project dedicated to marijuana and pregnancy. For comprehensive resources, we invite you to explore our dedicated webpage for this project: https://www.marijuanaknowthetruth.org/marijuana-and-pregnancy/. This website provides access to downloadable resources, fact-based research, videos from subject matter experts, shareable social media content, and more available in multiple languages.

Source:  Drug Free America Foundation 

Cannabis and cannabinoids are implicated in multiple genotoxic, epigenotoxic and chromosomal-toxic mechanisms and interact with several morphogenic pathways, likely underpinning previous reports of links between cannabis and congenital anomalies and heritable tumours. However the effects of cannabinoid genotoxicity have not been assessed on whole populations and formal consideration of effects as a broadly acting genotoxin remain unexplored. Our study addressed these knowledge gaps in USA datasets. Cancer data from CDC, drug exposure data from National Survey of Drug Use and Health 2003–2017 and congenital anomaly data from National Birth Defects Prevention Network were used. We show that cannabis, THC cannabigerol and cannabichromene exposure fulfill causal criteria towards first Principal Components of both: (A) Down syndrome, Trisomies 18 and 13, Turner syndrome, Deletion 22q11.2, and (B) thyroid, liver, breast and pancreatic cancers and acute myeloid leukaemia, have mostly medium to large effect sizes, are robust to adjustment for ethnicity, other drugs and income in inverse probability-weighted models, show prominent non-linear effects, have 55/56 e-Values > 1.25, and are exacerbated by cannabis liberalization (P = 9.67 × 10 –43 ,2.66 × 10 –15 ). The results confirm experimental studies showing that cannabinoids are an important cause of community-wide genotoxicity impacting both birth defect and cancer epidemiology at the chromosomal hundred-megabase level.

Source: https://www.nature.com/articles/s41598-021-93411-5.epdf July 2021

Nearly half of all U.S. citizens now live in a state where they can purchase cannabis from a recreational market, and all but 13 states have legalized medical use.  These state-level policies have all been developed and adopted under a federal prohibition, which may be changing soon as lawmakers in both the House and the Senate are developing federal proposals to legalize cannabis.

A new USC Schaeffer Center white paper shows how state-level cannabis regulations have weak public health parameters compared to other countries, leaving consumers vulnerable. Federal legalization is an opportunity to implement regulations that better protect consumers and promote reasonable use. Regulations policymakers should consider include placing caps on the amount of the main intoxicant (THC) allowed in products sold in the marketplace and placing purchase limits on popular high-potency cannabis products, like edibles and vape cartridges, as has been done in other legalized jurisdictions abroad.  

“Allowing the industry to self-regulate in the U.S. has generated products that are more potent and diverse than in other countries and has led to a variety of youth-oriented products, including cannabis-infused ice cream, gummies and pot tarts,” says Rosalie Liccardo Pacula, a senior fellow at the USC Schaeffer Center and Elizabeth Garrett Chair in Health Policy, Economics & Law at the USC Price School of Public Policy. “Current state regulations and public advisories are inadequate for protecting vulnerable populations who are more susceptible to addiction and other harm.”

High-potency cannabis products have been linked to short-term memory and coordination issues, impaired cognitive functions, cannabis hyperemesis syndrome, psychosis, and increased risks of anxiety, depression and dependence when used for prolonged periods. Acute health effects associated with high-potency products include unexpected poisonings and acute psychosis.

Policies should discourage excessive cannabis use

Product innovation within the legal cannabis industry has outpaced state regulations and our knowledge of health impacts of nonmedical, adult-use cannabis, write Pacula and her colleagues.  Cannabis concentrates and extracts can reach concentrated THC levels of 90% in certain cases – many, many times more potent than dried flower that ranges between 15-21%. These products are also increasingly popular – sales for concentrates like vape pens rose 145% during the first two years of legalization in Washington state.

But state approaches to regulation have insufficiently considered quantity and potency limits. Just two states, Vermont and Connecticut, have set potency limits on both flower and concentrates. Most states base sales limits on product weight and product type, an approach that allows individuals to purchase excessive amounts of high-potency products in a single transaction.

An individual in most states can purchase 500 10-milligram servings of concentrates in a single transaction. Six states allow purchases that exceed 1,000 servings. By comparison, a full keg of beer, which usually requires registration, provides 165 servings of alcohol.

“Voters in many of these states supported legalization because they were told we would regulate cannabis like alcohol, but in reality, when it comes to product innovation, contents and standard serving sizes, the cannabis market has largely been left on its own,” says Seema Pessar, a senior health policy project associate at the USC Schaeffer Center. “And that is what is concerning for public health.”

“We are seeing evidence of real health consequences from this approach, especially among young adults,” explains Pacula. For example, studies show a rise cannabis-related emergency department visits for acute psychiatric symptoms and cyclical vomiting in states that legalize recreational cannabis.

Key policies to support responsible cannabis use

To better regulate legal cannabis markets and products, researchers find four policy areas in which state laws and federal proposals can do more to encourage responsible use.

  • Placing limits on the amount of THC in legal products soldSetting clear and moderate caps on flower, concentrates and extracts.
  • Instituting potency-based sales limitsRestricting the amount of cannabis that a retailer can sell to an individual in a single transaction or over a period of time, based on the THC amount in the product.
  • Designing a tax structure based on the potency of productsTaxing cannabis in a manner similar to alcohol, based on intoxicating potential rather than by container weight or retail price.
  • Implementing seed-to-sale data-tracking systems: Allowing regulatory agencies to view every gram of legal cannabis that is cultivated and watch it as it migrates throughout supply chain, including the comprehensive monitoring of ingredients added to products that are eventually purchased in stores.

While generating tax revenue and reversing damages from prohibition are important, so is prioritizing public health — and prolonged use of high-potency cannabis products has health consequences, the researchers write.

“It is difficult to implement restrictive health regulations in markets that are already operating, generating jobs and revenue,” Pacula says. “Now is when the federal government has the best chance of ensuring a market that fully considers public health.”

Source: Cannabis Regulations Inadequate Given Rising Health Risks of High-Potency Products – USC Schaeffer July 2022

Abstract

Background

Previous research suggests an increase in schizophrenia population attributable risk fraction (PARF) for cannabis use disorder (CUD). However, sex and age variations in CUD and schizophrenia suggest the importance of examining differences in PARFs in sex and age subgroups.

Methods

We conducted a nationwide Danish register-based cohort study including all individuals aged 16–49 at some point during 1972–2021. CUD and schizophrenia status was obtained from the registers. Hazard ratios (HR), incidence risk ratios (IRR), and PARFs were estimated. Joinpoint analyses were applied to sex-specific PARFs.

Results

We examined 6 907 859 individuals with 45 327 cases of incident schizophrenia during follow-up across 129 521 260 person-years. The overall adjusted HR (aHR) for CUD on schizophrenia was slightly higher among males (aHR = 2.42, 95% CI 2.33–2.52) than females (aHR = 2.02, 95% CI 1.89–2.17); however, among 16–20-year-olds, the adjusted IRR (aIRR) for males was more than twice that for females (males: aIRR = 3.84, 95% CI 3.43–4.29; females: aIRR = 1.81, 95% CI 1.53–2.15). During 1972–2021, the annual average percentage change in PARFs for CUD in schizophrenia incidence was 4.8 among males (95% CI 4.3–5.3; p < 0.0001) and 3.2 among females (95% CI 2.5–3.8; p < 0.0001). In 2021, among males, PARF was 15%; among females, it was around 4%.

Conclusions

Young males might be particularly susceptible to the effects of cannabis on schizophrenia. At a population level, assuming causality, one-fifth of cases of schizophrenia among young males might be prevented by averting CUD. Results highlight the importance of early detection and treatment of CUD and policy decisions regarding cannabis use and access, particularly for 16–25-year-olds.

Source: Association between cannabis use disorder and schizophrenia stronger in young males than in females | Psychological Medicine | Cambridge Core May 2023

Drug Free America Foundation is launching its new digital advertisement campaign targeting viewers in Illinois. The digital animated ad is the second in a series titled “Marijuana…Know the Truth” and discusses the real dangers of marijuana use.  

As you know, Illinois is a state that is considering legalizing recreational marijuana this year. We hope this ad campaign will help address the misconceptions about the real dangers of marijuana use

This digital advertising campaign will utilize banner ads to drive viewers to our website where they can view the 2-minute ad. We are excited to say that through a generous donation, this campaign will provide over 10 million digital impressions in Illinois. We are hopeful that through additional donations, we are able to expand this campaign to other states and continue to spread the word on the dangers of marijuana.

Email from Drug Free America Foundation https://www.dfaf.org/ March 2019

 

Aaron Hernandez was supposed to be the epitome of the American Dream—overcoming childhood setbacks to earn a spot in the NFL on the New England Patriots. Millions of kids across America wish they could be so lucky. But the 2020 documentary on Netflix, “Killer Inside: The Mind of Aaron Hernandez,” takes a deep dive into his life to investigate how his dream unraveled into a nightmare. Convicted of murdering his friend Odin Lloyd and accused of killing two other men (but found not guilty), Hernandez took his own life in a prison suicide in 2017. He was only 27.
The compelling docuseries explores many of the factors that could have contributed to the tragic end of such a promising life—childhood abuse, unstable parenting, hidden bisexuality. And then there was his brain. The docuseries delivers a fascinating look at his troubled brain, but it misses one key factor that may have contributed to Hernandez’ brain dysfunction.

The Brain of Aaron Hernandez
After Hernandez’s death, his brain was delivered to Boston University, where researchers made razor-thin slices for examination. Their findings? His brain was “riddled” with Stage 3 chronic traumatic encephalopathy (CTE). This neurodegenerative disease, which has 4 stages, has been found in athletes like football players, boxers, and soccer players who endure repeated concussions and other blows to the head. It has been associated with memory loss, cognitive dysfunction, and suicidal thoughts and behavior.
A Boston University publication reported that Ann McKee, director of BU’s Chronic Traumatic Encephalopathy Center, said that his brain was the worst case of CTE ever seen in someone so young. “Especially in the frontal lobes, which are very important for decision-making, judgment, and cognition, we could see damage to the inner chambers of the brain,” she said. The frontal lobes are also involved in impulse control, empathy, and learning from past experiences.
The documentary focuses heavily on CTE and the significant role it likely played in Hernandez’ downfall, and for good reason. The filmmakers also hone in on another aspect of his life that may have contributed to his troubles—cannabis use. It is reported that the football player began smoking marijuana regularly in high school and continued to smoke throughout his pro career. The docuseries calls him a “chainsmoker” with a serious habit, but it neglects to connect the dots between marijuana use and brain dysfunction.

Marijuana and the Brain
A growing body of evidence shows that marijuana use impairs brain activity. In the largest known brain imaging study, which appeared in the Journal of Alzheimer’s Disease, scientists from Amen Clinics, Google, Johns Hopkins University, UCLA, and the UC San Francisco evaluated 62,454 brain SPECT scans of more than 30,000 individuals (ages 9 months to 105 years) to investigate factors that accelerate brain aging. SPECT (single-photon emission computed tomography) is a brain imaging technology that measures brain activity and blood flow. The study found that a number of brain disorders and behaviors predicted accelerated aging. Of all the disorders and behaviors analyzed, cannabis abuse ranked as the second-highest brain ager, topped only by schizophrenia.
The study, which included brain scans from 1,000 cannabis users, 25,168 non-cannabis users, and 100 healthy controls, showed reduced cerebral blood flow among the cannabis users compared to non-users and healthy controls. A significant decrease in blood flow was noted specifically in the right hippocampus, an area of the brain that helps with memory formation. This part of the brain is severely affected in those that suffer from Alzheimer’s disease.


Healthy SPECT Scan

Marijuana Affected SPECT Scan

Other research has concluded that marijuana harms the teenage brain in numerous ways. For example, a 2019 review found that it increases the risk of depression and suicidal thoughts and behaviors. And marijuana use at a young age has also been associated with increased impulsivity.
Although pot promoters would argue that most people who smoke marijuana don’t become murderers and don’t die by suicide, it’s important to understand that in vulnerable people it may have negative impacts on brain function that contribute to unhealthy behaviors. Sadly, considering that Hernandez’s brain was so damaged by CTE, marijuana use was likely only making bad brain function worse.

You Can Change Your Brain
Unfortunately, this information is too late to help Hernandez, but it isn’t too late for other football players who have endured years of helmet-to-helmet tackles. A study at Amen Clinics on 30 retired professional football players who had suffered head trauma showed that after following a brain healthy program for 6 months, 80% showed significant improvement in blood flow to the frontal lobes, as well as improvements in overall cognitive functioning, processing speed, attention, reasoning, and memory. Hall of Fame quarterback Terry Bradshaw spoke openly about his own brain rehabilitation after suffering multiple concussions. 
Likewise, it isn’t too late for people who grew up in traumatic households. See how a man named Kevin overcame his traumatic upbringing to enhance his brain health using a variety of innovative therapies. And it isn’t too late for people who have been bad to their brain with drug use. Find out how Arnie broke free from the chains of addiction. It’s never too late to start enhancing brain function.
The world’s largest database of brain scans related to behavior—over 160,000 and growing —shows that when you adopt a brain health program, you can change your brain and change your life for the better.
At Amen Clinics, we take a unique brain-body approach that gets to the root cause of your symptoms. Our comprehensive evaluations include brain SPECT imaging, as well as laboratory testing and assessing other important factors that could be contributing to symptoms. By getting to the root cause of your symptoms, we can create a more effective, personalized treatment plan for you.
If you want to join the tens of thousands of people who have already enhanced their brain health, overcome their symptoms, and improved their quality of life at Amen Clinics, speak to a specialist today at 888-288-9834. If all our specialists are busy helping others, you can also schedule a time to talk.

Source: What the Aaron Hernandez Documentary Missed About His Brain | Amen Clinics Amen Clinics February 2020

Abstract

Background:

Cardiovascular anomalies are the largest group of congenital anomalies and the major cause of death in young children, with various data linking rising atrial septal defect incidence (ASDI) with prenatal cannabis exposure.

Objectives / Hypotheses:

Is cannabis associated with ASDI in USA? Is this relationship causal?

Methods:

Geospatio/temporal cohort study, 1991–2016. Census populations of adults, babies, congenital anomalies, income and ethnicity.

Drug exposure data on cigarettes, alcohol abuse, past month cannabis use, analgesia abuse and cocaine taken from National Survey of Drug Use and Health (78.9% response rate). Cannabinoid concentrations from Drug Enforcement Agency. Inverse probability weighted (ipw) regressions.

Analysis conducted in R.

Results:

 ASDI rose nationally three-fold from 27.4 to 82.8 / 10,000 births 1991–2014 during a period when tobacco and alcohol abuse were falling but cannabis was rising. States including Nevada, Kentucky, Mississippi and Tennessee had steeply rising epidemics (Time: Status β-estimate = 10.72 (95%C.I. 8.39–13.05), P < 2.0 × 10 − 16). ASDI was positively related to exposure to cannabis and most cannabinoids.

Drug exposure data was near-complete from 2006 thus restricting spatial modelling from 2006 to 2014, N = 282. In geospatial regression models cannabis: alcohol abuse term was significant (β-estimate = 19.44 (9.11, 29.77), P = 2.2 × 10 − 4 ); no ethnic or income factors survived model reduction.

Cannabis legalization was associated with a higher ASDI (Time: Status β-estimate = 0.03 (0.01, 0.05), P = 1.1 × 10 -3). Weighted panel regression interactive terms including cannabis significant (from β-estimate = 1418, (1080.6, 1755.4), P = 7.3 × 10 -15). Robust generalized linear models utilizing inverse probability weighting interactive terms including cannabis appear (from β-estimate = 78.88, (64.38, 93.38), P = 1.1 × 10 -8).

Marginal structural models with machine-aided Super Learning association of ASDI with high v. low cannabis exposure R.R. = 1.32 (1.28, 1.36). Model e-values mostly > 1.5.

Conclusions:

ASDI is associated with cannabis use, frequency, intensity and legalization in a spatiotemporally significant manner, robust to socioeconomic demographic adjustment and fulfilled causal criteria, consistent with multiple biological mechanisms and similar reports from Hawaii, Colorado, Canada and Australia. Not only are these results of concern in themselves, but they further imply that our list of the congenital teratology of cannabis is as yet incomplete, and highlight in particular cardiovascular toxicology of prenatal cannabinoid and drug exposure.

Albert Stuart Reece and Gary Kenneth Hulse

Source:  BMC Pediatrics volume 20, Article number: 539 (2020) https://bmcpediatr.biomedcentral.com/articles/10.1186/s12887-020-02431-z November 2020

One way to deter harmful recreational drug use by teenagers is to treat them like adults. Rather than simply tell them to “Just Say No” to alcohol, tobacco or illicit drugs, it may be more helpful to explain how these substances create unique risks for them risks that arise due to the changing state of the adolescent brain.

 

It’s an approach recommended by Dr. Robert DuPont, the first director of the National Institute of Drug Abuse, the second White House “drug czar” and the current head of the Institute for Behavior and Health.

 

Scientists have long recognized that people who use alcohol, tobacco, marijuana and other drugs while adolescents are far more likely to use more dangerous drugs in their 30s and 40s. Back in 1984, researchers writing in the American Journal of Public Health reported that “the use of marijuana is a good predictor of the use of more serious drugs only if it begins early” and that early drinking is a similar “predictor of marijuana use.”

 

It should come as no surprise, then, that Americans in their 30s and 40s who used recreational drugs as teenagers are the group most severely affected by opioid overdoses today.

 

Unfortunately, neither the media nor popular culture adequately informs young people about the neurological damage alcohol, nicotine, and marijuana can inflict on the brain. On the contrary, despite strong evidence that early recreational drug use increases the likelihood of future drug addiction, the media and today’s culture often describe marijuana use as an “organic,” “natural” approach to anxiety and stress management. Indeed, Northern Michigan University launched the nation’s first medicinal plant chemistry major, offering students the chance to focus on marijuana-related studies. What message does that send to the still-developing minds of college students?

 

One group is taking a non-traditional approach to convincing students otherwise.

 

One Choice is a drug prevention campaign developed for teenagers by the Institute for Behavior and Health. It relies on cutting-edge neuroscience to encourage young Americans to make decisions that promote their brain health.

 

Pioneered by Dr. DuPont, One Choice specifically advocates that adolescents make “no use of any alcohol, nicotine, marijuana or other drugs” for health reasons. The theory is that adolescents who make the decision not to use alcohol, nicotine, or marijuana at all that make “One Choice” to avoid artificial, chemical brain stimulation are far less likely to wind up addicted to drugs such as opioids later on.

 

The One Choice approach is evidence-based. In 2017, scientists at Mclean Hospital and Harvard Medical School published their findings on the impact of early substance use on cognitive development. They explained that the brains of teenagers are still developing and can be negatively impacted by substance use. Adolescent brains are still forming the communication routes that regulate motivation, stress and habit-formation well into adulthood. As such, it is easier for substances to hijack and alter those routes in developing brains than in adult brains.

 

Hindering the vital attributes of habit formation, stress management and motivational behavior can drastically affect a young person’s academic performance. Collectively, and in the long run, that can impair the competitiveness of a national economy. Thus, it is crucial that young Americans learn to prioritize brain health.

 

The timing for the innovative One Choice approach is propitious. Today’s young Americans are more interested in biology, psychology and health sciences than ever before. According to the National Center for Education Statistics, the field of “health professions and related programs” is the second most popular major among college students, with psychology and biological or biomedical sciences following as the fourth and fifth most popular, respectively. By explaining developmental neuroscience to teenagers, One Choice engages young people on a topic of interest to them and presents the reality of a pressing public health issue, instead of throwing moral platitudes and statistics at them.

 

Pro-marijuana legalization organizations, such as the Drug Policy Alliance, agree: “The safest path for teens is to avoid drugs, doing alcohol, cigarettes, and prescription drugs outside of a doctor’s recommendations.” And certainly honesty, along with scientific accuracy, is critical if we are to persuade adolescents not to use drugs.

 

Brain health is critical to the pursuit of happiness. And leveraging scientifically accurate presentations and testimonies to convince young Americans to prioritize their own brain health early on can prevent future substance abuse.

Source: Using Neuroscience to Prevent Drug Addiction Among Teenagers | The Heritage Foundation January 2019

Just one or two joints seem to change the structure of the brain, say researchers from universities around the world, led by senior author and University of Vermont professor of psychiatry Hugh Garavan, PhD, and first author and former UVM postdoctoral fellow Catherine Orr, PhD.
 
The study is part of a long-term European effort called IMAGEN, which has collected brain images from 2,000 children in Ireland, France, and Germany, starting when they were age 14 and continuing through age 23.
 
Researchers compared the brain images of 46 children age 14 who reported having used marijuana once or twice with those of children that age who had not used the drug. The images of the marijuana triers showed greater brain volume in areas with cannabinoid receptors. The biggest differences were in the amygdala, involved in fear and other emotions, and the hippocampus, the site of memory development and spatial abilities.
 
“You’re changing your brain with just one or two joints. Most people would likely assume that one or two joints would have no impact on the brain,” says Dr. Garavan.
 
It is unclear what the extra gray matter in these brain areas means. Normally at age 14, the brain is refining its synaptic connections to make it thinner, not thicker. Dr. Garavan says one possibility is that initial marijuana use in this age group may be disrupting that “pruning” process.
 
The new findings open a new area of focus for future research.
 
Read study abstract here.

Source:  The Marijuana Report  16.01.2019

Abstract

Little attention has been paid to the potential impact of paternal marijuana use on offspring brain development. We administered Δ9-tetrahydrocannabinol (THC, 0, 2, or 4 mg/kg/day) to male rats for 28 days. Two days after the last THC treatment, the males were mated to drug-naïve females. We then assessed the impact on development of acetylcholine (ACh) systems in the offspring, encompassing the period from the onset of adolescence (postnatal day 30) through middle age (postnatal day 150), and including brain regions encompassing the majority of ACh terminals and cell bodies. Δ9-Tetrahydrocannabinol produced a dose-dependent deficit in hemicholinium-3 binding, an index of presynaptic ACh activity, superimposed on regionally selective increases in choline acetyltransferase activity, a biomarker for numbers of ACh terminals. The combined effects produced a persistent decrement in the hemicholinium-3/choline acetyltransferase ratio, an index of impulse activity per nerve terminal. At the low THC dose, the decreased presynaptic activity was partially compensated by upregulation of nicotinic ACh receptors, whereas at the high dose, receptors were subnormal, an effect that would exacerbate the presynaptic defect. Superimposed on these effects, either dose of THC also accelerated the age-related decline in nicotinic ACh receptors. Our studies provide evidence for adverse effects of paternal THC administration on neurodevelopment in the offspring and further demonstrate that adverse impacts of drug exposure on brain development are not limited to effects mediated by the embryonic or fetal chemical environment, but rather that vulnerability is engendered by exposures occurring prior to conception, involving the father as well as the mother.

The increasing use of marijuana by women of childbearing age raises a concern for potential adverse outcomes in the offspring (Ryan et al., 2018). There have been numerous studies of the consequences of maternal cannabis use in humans or Δ9-tetrahydrocannabinol (THC) administration during pregnancy in animals (Abel, 1980Fried, 2002Huizink, 2014Trezza et al., 2008), but little or no attention has been paid to the role of paternal exposure for adverse consequences to the developing fetus or child. Animal studies where both males and females were exposed to THC in adolescence identified persistent changes in gene methylation in association with neurobehavioral anomalies in the offspring (Szutorisz and Hurd, 2018) ; however, these did not distinguish whether there was a specific paternal contribution, which would presumably involve epigenetic changes in sperm. Indeed, recent work found that cannabis exposure in humans, or THC exposure in rats, produces persistent changes in sperm DNA methylation, including the genes that were affected by combined paternal and maternal exposure, as well as genes associated with risk of autism spectrum disorder (Murphy et al., 2018Schrott et al., 2020). The effects in rats were associated with long-lasting attentional impairment in the offspring (Levin et al., 2019).

In the present study, we provide one of the first demonstrations that paternal THC administration, prior to mating, results in abnormalities of offspring brain development, specifically targeting acetylcholine (ACh) systems, which provide essential inputs for learning, memory, reward, and mood. We exposed male rats for 28 days to THC at doses commensurate with moderate cannabis use in humans, mated them to drug-naïve females, and then assessed biomarkers of ACh synaptic function in the offspring. We conducted our evaluations longitudinally from adolescence through adulthood, so as to capture early and late stages of brain development and function, and made our assessments in brain regions comprising all the major ACh projections and their corresponding cell bodies. We evaluated the concentration of presynaptic high-affinity choline transporters (hemicholinium-3 [HC3] binding), the activity of choline acetyltransferase (ChAT), and the concentration of α4β2 nicotinic ACh receptors (nAChRs). High-affinity choline transporters and ChAT are both constitutive components of ACh nerve terminals but they differ in their regulatory mechanisms and hence in their functional significance. Choline acetyltransferase is the enzyme that synthesizes ACh, but is not regulated by nerve impulse activity, so that its presence provides an index of the density of ACh innervation (Slotkin, 2008). In contrast, HC3 binding to the choline transporter is directly responsive to neuronal activity (Klemm and Kuhar, 1979), so that comparative effects on HC3 binding and ChAT enable the characterization of both the concentration of ACh terminals and presynaptic impulse activity. We then calculated the HC3/ChAT ratio as an index of presynaptic activity relative to the number of cholinergic nerve terminals (Slotkin, 2008). Finally, the α4β2 nAChR is the most abundant subtype in the mammalian brain and regulates the ability of ACh systems to release other neurotransmitters involved in reward, cognition, and mood (Dani and De Biasi, 2001). These indices have been used successfully to characterize the impact of diverse neurotoxicants and diseases on ACh systems: neuroactive pesticides (Slotkin et al., 20132019b), nicotine or tobacco smoke (Slotkin et al., 2015), polycyclic aromatic hydrocarbons (Slotkin et al., 2019a), and glucocorticoids (Slotkin et al., 2013); and terminal stages of Alzheimer’s disease (Slotkin et al., 1994).

Source: https://doi.org/10.1093/toxsci/kfaa004 February 2020

  • Neither the cause of autism nor the effects of cannabis on a developing fetus are entirely clear 
  • Researchers at the Ottawa Hospital and University of Ottawa studied 2,200 Canadian women who reported using marijuana while pregnant 
  • The rate of autism among their children was four per 1,000 person-years, compared to 2.42 among children whose mothers did not use marijuana  

Pregnant women who smoke cannabis almost double the risk of their baby being born autistic, warns a new study.

In the largest ever study of its kind, researchers found that children whose mothers reported using cannabis during pregnancy were at greater risk of autism.

The incidence of autism was four per 1,000 person-years among children exposed to cannabis in pregnancy, compared to 2.42 among unexposed children.

‘There is evidence that more people are using cannabis during pregnancy,’ said senior study author Professor Mark Walker, of the University of Ottawa in Canada.

‘This is concerning, because we know so little about how cannabis affects pregnant women and their babies.

‘Parents-to-be should inform themselves of the possible risks, and we hope studies like ours can help.’

A Canadian study found that rates of autism were twice as high among the children of women who used marijuana during pregnancy, compared to rates among children of mothers  who did not use the drug (file)

The researchers reviewed data from every birth in Ontario between 2007 and 2012, before recreational cannabis was legalised in Canada.

Of the half a million women in the study, about 3,000 (0.6 per cent) reported using cannabis during pregnancy.

Importantly, these women reported using only cannabis.

The team had previously found that cannabis use in pregnancy was linked to an increased risk of premature birth.

In that study, they found that women who used cannabis during pregnancy often used other substances including tobacco, alcohol and opioids.

The findings, published in the medical journal Nature Medicine. showed that babies born to this group still had an increased risk of autism compared to those who didn’t use cannabis.

The researchers do not know exactly how much cannabis the women were using, how often, at what time during their pregnancy, or how it was consumed.

But as cannabis becomes more socially acceptable, doctors are concerned that some parents-to-be might think it can be used to treat morning sickness.

Dr Daniel Corsi, an epidemiologist at The Ottawa Hospital, said: ‘In the past, we haven’t had good data on the effect of cannabis on pregnancies.’

He added: ‘This is one of the largest studies on this topic to date.

‘We hope our findings will help women and their health-care providers make informed decisions.’

Autism is fairly common, but still poorly understood.

In the US, about one in every 59 children born will fall somewhere on the autism spectrum.

About one in every 66 children in Canada are autistic and, globally, the rate is approximately one in every 160 children.

Research suggests that there is likely some genetic basis for autism,  which is about four-times more common among boys than girls.

But scientists believe exposures in the womb likely play a role as well.

The effects of cannabis are similarly poorly understood to the origins of autism.

Although doctors caution against it, cannabis use has not been linked to miscarriages in humans (though animal studies have suggested an increased risk) and evidence on the link between weed and low birth-weight is mixed.

Marijuana use during pregnancy has been linked, however, to up to 2.3 times greater risks of stillbirth.

The Ottawa Hospital study did not investigate how exactly marijuana use in pregnancy might lead to autism in a child, but scientists believe that the drug’s interaction with the so-called endocannabinoid system within the nervous system could play a role in the development of the behavioral condition.

Source: Autism is twice as common in children whose mothers used cannabis in pregnancy | Daily Mail Online

Cannabis use during pregnancy is associated with a host of negative outcomes.

Sondem/AdobeStock

The recent paper by Stanciu discussing cannabis use in pregnancy1 makes several useful and highly salient points. With a more complete understanding of the published literature further important patterns in the data emerge. They aid our understanding of the pathobiology of in utero cannabis exposure and thereby powerfully inform the community on the most appropriate manner in which to regulate cannabis and cannabinoids from an improved evidence base.

It is well known that cannabis use has been liberalized across the United States as a result of well-financed and orchestrated campaigns.2 Stanciu is correct that most epidemiological studies point towards harmful associations, that cannabis use in pregnancy is becoming more common, that it is widely recommended in pregnancy by cannabis dispensaries, and that increased rates of low birth weight, premature and stillbirths, and increased neonatal intensive care admission are well recognized associations. It is correct that all 4 longitudinal studies of children born after prenatal cannabis exposure (PCE) show increased adverse neurodevelopmental outcomes including impaired executive function, visuomotor processing deficits, heightened startle responses, impulse control, heightened susceptibility to addiction in later life, emotional behaviors, and motor defects.3-5 Well-documented impacts on the glutamatergic, GABAergic and dopaminergic signaling in the brain are of concern as they represents major neurotransmitters in the central nervous system [CNS]. Well-established links between cannabis use and schizophrenia, bipolar disorder, anxiety, depression, and suicidal ideation are also correctly described. It is true that ACOG have made both historical and recent recommendations against its use in pregnancy, and these recommendations are relevant to practice in all medical specialties.

Conceptual and epidemiological extensions

While it is correct to observe that there is no described phenotype following PCE, it is also important to note that many of these neurodevelopmental deficits have been noted to overlap the ADHD and autism spectrum disorders. This is likely epidemiologically highly significant for the US, where autistic spectrum disorders have been shown to be growing exponentially.6 Cannabis use across the US was shown to be independently associated with autism rates across both time and space, to be dose-related6, and, based on conservative projections, has been predicted to be at least 60% higher in cannabis-legal states than in states where cannabis was illegal by 2030.7

A large Hawaiian study found an increased incidence of microcephaly (R.R. = 12.80, 95%C.I. 4.13-36.17)8 and the CDC have twice reported elevated rates of anencephalus (adjusted O.R. 1.7, C.I. 0.9-3.4) and (posterior O.R. 1.9 (C.I. 1.1, 3.2).9,10 This sets up a clear spectrum of severity from mild neurodevelopmental impairment, to microcephaly, to anencephalus and then fetal death. In the context of dose-response relationships and strong geotemporospatial associations issues of causality necessarily arise.

Stanciu’s observation that preclinical studies in experimental animals are important to understand the likely effects of PCE in individuals, not least due to the problem of the frequent exposure to multiple substances clinically, is also correct. This issue was studied in detail long ago in the 1960s and 1970s, and succinctly summarized by Graham’s telling observation: “oedema, phocomelia, omphalocoele, spina bifida, exencephaly, multiple malformations including myelocoele. This is a formidable list.”11

However, a reasonable question might be: “Why don’t we see such a broad teratological spectrum clinically?”

Stanciu’s remark that there are “no overt birth defects” is an oft-repeated myth and is in error, as well as obviously being at odds with several preclinical studies, especially in the most predictive species for human teratology (ie, hamsters and white rabbits).12,13

A recent paper from the Centers for Disease Control (CDC) noted that 4 defects, anencephalus, gastroschisis, diaphragmatic hernia and esophageal atresia were more common following PCE.9 The American Academy of Pediatrics (AAP) and the American Heart Association (AHA) issued a joint position statement that both ventricular septal defect (VSD) and Ebsteins anomaly were also elevated by PCE.14

The review of 17 years of birth defects from Hawaii found 21 defects to be elevated after PCE and featured prominently cardiovascular defects (atrial septal defect (ASD), VSD, hypoplastic left heart syndrome, tetralogy of Fallot (ToF) and pulmonary valve atresia or stenosis), chromosomal defects such as Downs syndrome, body wall defects such as gastroschisis, limb defects including syndactyly and upper limb reduction defects, facial, bowel and genitourinary system defects with calculated rate ratios ranging from 5.26 (C.I. 1.08-15.46) to 39.98 (C.I. 9.03-122.29).8

In September and October 2018 Colorado released 2 datasets of congenital anomalies across the period of its cannabis legalization program from 2000 to 2013 and 2000 to 2014 and reported 87,772 and 64,463 major defects respectively (which are obviously contradictory).15 Based on 4830 and 4026 major anomalies in the year 2000 this represents a case excess of 20,152 (29.80%) or 11,753 anomalies (22.30%) respectively. During this period the use of tobacco and alcohol was declining and other drug use was not rising. Only cannabis use rose. Importantly, models quartic in time indicated a non-linear response of total birth defects to rising cannabinoid exposure. Estimated exposure to several cannabinoids including cannabinol, THC, and tetrahydrocannabivarin was shown to be positively associated with major defect rates and to be robust to adjustment for other drug use. CNS defects (microcephalus, neural tube defects), cardiovascular defects (ASD, VSD, patent ductus arteriosus (PDA)), total chromosomal anomalies including Downs syndrome, musculoskeletal, respiratory and genitourinary anomalies all rose dramatically.

Defects described as being cannabis-related (by the Hawaiian, CDC, AAP and AHA investigators) rose more quickly than cannabis-unrelated defects (P<0.003). As fetal cardiac tissue and the central great vessels have high numbers of cannabinoid receptors from early in fetal life it is easy to understand why this pattern might emerge. Since ASD, VSD and PDA are the most common cardiovascular congenital anomalies it is understandable that total cardiovascular anomalies increased in Colorado.

recent review of total congenital anomalies in Canada showed that they were 3 times more common in the northern territories which consume more cannabis, and that these effects were robust to adjustment for other drug exposure and for socioeconomic variables.16 Total cardiovascular defects, Downs syndrome and gastroschisis were noted prominently in this series. Neural tube defects including anencephalus and spinal bifida and meningomyelocoele were falling across Canada from 1991 to 2007, although it was not clear whether the decline was due to dietary folate supplementation or increased antenatal early termination of pregnancy for anomalies (ETOPFA).17 Notwithstanding this it was recently shown that within each of 3 periods (the pre-folate period, the transitional period and the post-folate period) neural tube defects across Canada were becoming more common.17

An Australian dataset found greatly elevated relative rates of cardiovascular (PDA, ASD, VSD, ToF, transposition of great vessels), body wall (gastroschisis, exomphalos, diaphragmatic hernia), chromosomal (Downs syndrome, Turners syndrome, Edwards Syndrome (trisomy 18)), genitourinary, hydrocephalus, neural tube defects, and bowel defects with borderline results for anencephalus (ETOPFA data unavailable) in a high cannabis use area in Northern New South Wales compared to Queensland state-wide data.18

Transposition of the great vessels was previously linked with paternal cannabis exposure.19

The presence of Downs syndrome on the list of cannabis-associated anomalies in Hawaii, Colorado, Canada and Australia is important as it necessarily implies megabase-scale genetic damage.8,15,16,18 Since cannabis interferes with tubulin metabolism and thus the separation of the chromosomes which occurs in mitotic anaphase it is easy to see how PCE-induced chromosomal mis-segregation errors might occur.20 Studies of PCE in rodents show that cannabis induces major alterations of gene expression widely with 8% alteration in DNA sperm methylation patterns, changes which are transmissible to subsequent F1 generations.21

Stanciu’s comment about a so-called “cannabis phenotype” is provocative. It is true that a “fetal cannabis syndrome” (FCS) has not been described in the way that a “fetal alcohol syndrome” (FAS) has. Fetal alcohol syndrome of course is a very diverse and pleomorphic group of clinical presentations and a wide spectrum of presentations is described. Importantly the fetal alcohol has been described as being mediated by the cannabinoid type 1 receptor (CB1R’s) and is mediated epigenetically.22-26 The suggestion that alcohol can work epigenetically via CB1Rs but cannabinoids cannot defies the bounds of credulity. Moreover, as noted above, there is as yet no objective marker of gestational cannabinoid exposure. Once such a biomarker has been derived (say epigenetically and / or glycomically27) then an objective measure will exist to allow genotype-epigenotype-phenotype correlative studies to be performed so that we can usefully investigate if a fetal cannabis syndrome phenotype spectrum might exist. However, if researchers do not believe it might exist then it is clear that one will not be described. It is our view that once an objective biomarker is established it will only be a matter of time before a diverse and highly variable FCS is also defined and enters the clinical diagnostic compendium.

Recent US data and analysis

CDC publish 5-year averaged birth defect data for many states as part of the National Birth Defects Prevention Network (NBDPN) annual reports which can be combined with Substance Abuse and Mental Health Services Administration (SAMHSA) state and substate data to examine nationwide drug-related trends. ETOPFA rates are taken from historical time series.

Figure 1A charts Downs syndrome rates corrected for estimated ETOPFA rates against cannabis exposure. Both rates are elevated (shown as pink and purple) in Colorado, Oregon, Washington, Alaska, Maine and Massachusetts.

Downs Syndrome By Cannibas Use

Figure 1B shows the relationship of Downs syndrome to cigarette use for this year which is very different.

Downs Syndrome By Cigarette Use

The Figure also shows the Downs syndrome rates by cannabis use quintile for both the raw Downs syndrome rates (Figure 1C) and the ETOPFA-corrected data (Figure 1D). One notes not only a rising trend with cannabis use, but also an abrupt jump from the fourth to the fifth quintile.

Downs Syndrome Rate by Quintiles of Cannabis Use

This jump is seen when many defects are analyzed in this manner. A list of defects would include, but would not be limited to: atrial septal defect, atrioventricular septal defect, cleft lip and / or palate (all forms combined), trisomy 21 (Downs syndrome), Turners syndrome and ventricular septal defect.

Downs Syndrome by Quintiles of Cannabis Use (ETOPFA-CORRECTED)

Figure 2 lists the prevalence ratio of 62 congenital anomalies tracked by the National Birth Defect Prevention Network (NBDPN) in quintile 5 versus lower quintiles and notes that 44 of them are significantly elevated in the highest quintile of cannabis using states.

Prevalence Ratios

Literature-wide limitations

It should be noted in passing that most of these studies suffer from several major common limitations. Many of the defects described are disorders for which ETOPFA is commonly practiced and frequently recommended to pregnant patients. ETOPFA data was generally not available to investigators. It is beyond question that were such data included the findings would be of greater magnitude and of even greater concern. Secondly many studies rely on self-report which is subject to recall-bias and may be misled. Patients who use cannabis early in pregnancy but stop after they are informed of their pregnant status might answer “no” to questions of PCE, but in fact their fetus is exposed prenatally due to the prolonged terminal half-life of excretion of cannabinoids from body fat stores. Hence a reliable biomarker is required to properly define the denominator in these studies, but it is not thought to exist at present. It could however easily be derived from epigenomic and/or glycomic studies.27

Thirdly there are major analytical limitations of the described series. Advanced analytical methods that allow data analysis simultaneously across both space and time exist and are called geospatial or spatiotemporal techniques. The CDC has demonstrated ability to track congenital anomalies by county. Application of geospatial techniques to county data is therefore possible and would be well assisted by the provision of cannabis-exposure data from the SAMHSA 395 substate areas. Methods which allow the investigation of apparently causal relationships, including inverse probability weighting and the calculation of E-values to quantify unmeasured confounding have similarly not been deployed in this field.

These deficits in the literature represent major gaps in our knowledge which may readily be addressed by the application of available techniques to currently extant data and thus vastly augment the evidence base for well-informed policy formulation. Our group is presently addressing this major knowledge gap with a series of papers on these and related subjects utilizing geospatiotemporal regression, the formal techniques of causal inference, and multiple imputation of chained equations to complete CDC data for various congential anomalies and heritable childhood cancers where such data is missing or withheld for specific ethnic minorities.

Extensive presently unpublished analyses from our group extend the United States analyses presented in preliminary and embryonic form in Figure 1 and Figure 2 using geotemporospatial and causal inference techniques with strongly confirmatory results for both state-based spatiotemporal association and in several cases causal links.

Concluding thoughts

In broad overview the patterns which emerge from these major population-based studies of cannabis-related human teratology indicate several findings that are remarkable for their consistency across series originating from Hawaii, Colorado, Canada, and Australia and for their exact and precise concordance with very worrying data in experimental animals. Prominent amongst affected organ systems includes the CNS, CVS and chromosomal disorders. Body wall and limb defects also likely follow the endovascular cannabinoid receptor distribution pattern, and this is consistent with current understandings related to the pathogenesis of gastroschisis and limb embryogenesis which are both thought to be primarily vasculocentric. Similarly, in the genitourinary and gastrointestinal systems, peripheral cannabinoid receptors are widely distributed and appear from as early as 12 weeks of fetal life. Dose-response effects are seen in many of the above analyses which is one of the major criteria of Hill’s causal algorithm. The sequence of severity of CNS defects (neurodevelopmental impairments/autism-microcephaly-anencephaly-foetal death) also implies a gradation of phenotypic effects of PCE.

The PCE literature has widespread limitations including its reliance on self-report data, the general non-availability of ETOPFA data, the lack of reliable biomarkers to define exposure, and the pointed absence of state-of-the-art analytical techniques including high-resolution geotemporospatial analysis and the formal techniques of causal inference assessment.

Given these limitations the concordance with preclinical and mechanistic data and the positive and highly consistent associations that have been demonstrated in several jurisdictions are particularly concerning. They carry far-reaching genotoxic and intergenerational implications and argue powerfully against cannabis legalization.

Dr Reece is practice principal at Southcity Family Medical Centre and Professor of Medicine at University of Western Australia and Edith Cowan UniversityDr Hulse is Professor of Addiction Medicine within the Division of Psychiatry at The University of Western Australia and the Faculty of Health Sciences at the Edith Cowan UniversityNeither author has any conflicts of interest to declare.

Source:  https://www.psychiatrictimes.com/view/cannabis-pregnancy-rejoinder-exposition-cautionary-tales   October 2020

There is evidence in both patients with psychotic disorders and the general population that cannabis use is associated with adverse effects of psychopathology and cognition.

RESEARCH UPDATE

Substance use comorbidity in schizophrenia has been described as “the rule rather than the exception.”1 The large Epidemiological Catchment Area study estimated that 47% of patients with schizophrenia also had a lifetime comorbid diagnosis of a substance use disorder.2 Substance use comorbidity is also often deleterious to the course of schizophrenia, including potential contributions to medication non-adherence and illness relapse.1 Cannabis (marijuana) is one of the most commonly used substances by patients with schizophrenia.

There is recent, renewed interest in the endocannabinoid system, which represents a novel potential treatment target in schizophrenia.3 Modulation of this system by the main psychoactive component in marijuana, Δ9-tetrahydro-cannabinol (THC), can induce acute psychosis and cognitive impairment. However, the non-psychotropic plant-derived agent cannabidiol (CBD) may decrease psychotic symptoms and improve cognitive function in schizophrenia.4-6

Presently, CBD oil is sold at numerous shops throughout the US, with purported benefits that include alleviation of symptoms such as depression, anxiety, insomnia, and pain. However, the purity and safety of CBD is not regulated by the US Food and Drug Administration. CBD may be “contaminated” with some amount of THC and/or other unknown ingredients. In the past decade, there have been a number of systematic reviews regarding associations between cannabis use and psychosis. Therefore, a review of systematic evidence for associations between cannabis use, risk of psychosis, and the clinical course of schizophrenia is of particular relevance to the practicing clinician.

Adverse effects of cannabis on psychosis and cognition

There is evidence from a quantitative review of 15 studies in healthy participants that a single administration of THC (intravenous, oral, or nasal) versus placebo induced positive, negative, and other psychopathology with large effect sizes (ESs).7 Furthermore, evidence from 69 studies, comprising 2152 adolescents and young adults who used cannabis and 6575 controls with minimal cannabis exposure, showed that frequent or heavy use was associated with significantly reduced cognitive functioning with a small-to-medium ES = -0.25, although these effects were diminished with abstinence for more than 72 hours.8

Cannabis use and risk of psychosis

Moore and colleagues9 performed a systematic review of 35 studies of cannabis use and risk of psychotic mental health outcomes. They found that individuals who had used cannabis had a significant, 1.4-fold increased risk of any psychotic outcomes, independent of potential confounding and transient intoxication effects. Findings also provided evidence for a dose-response effect, with even greater, 2.1-fold risk in individuals who used cannabis most frequently.

More recently, Marconi and colleagues10 performed a meta-analysis of 10 studies, including 66,810 individuals, that investigated the association between the degree of cannabis consumption and risk of psychosis. In all individual studies, higher levels of cannabis use were associated with increased risk of psychosis. They also found evidence for a dose-response relationship, with a 2-fold increase in risk for the average cannabis user, and a 4-fold increase in risk for the heaviest users, compared with non-users. Although these findings do not definitively establish a causal association between marijuana use and psychotic disorders, it nevertheless remains a replicated risk factor for psychosis with a clear dose-dependent relationship.

Cannabis use in patients with psychotic disorders

Koskinen and colleagues11 performed a quantitative review of the rates of cannabis use disorders (CUDs) in clinical samples of patients with schizophrenia. They identified 35 studies for inclusion in the meta-analysis. The median current rate of CUD was 16.0% (Interquartile Range [IQR] 8.6-28.6%), and the median lifetime rate of CUD was 27.1% (IQR=12.2-38.5). The rate of current/lifetime CUDs was markedly higher in first-episode (28.6%/44.4%) versus chronic schizophrenia (22.0%/12.2%), as well as in younger patient samples and samples with a high proportion of males. They concluded that approximately 1 in 4 patients with schizophrenia has a diagnosis of a comorbid CUD.

Hunt and colleagues12 more recently performed a systematic review of the prevalence of comorbid substance use in patients with schizophrenia spectrum disorders. They identified 69 studies, and the pooled estimate for current or lifetime CUD was 26.2%. Consistent with the review by Koskinen and colleagues,11 the prevalence was significantly higher in individuals with first-episode psychosis (35.6%) versus chronic schizophrenia (20.8%), but did not differ by study setting or patient clinical status.

The substantial prevalence of cannabis use also appears to extend to the psychosis prodrome. There is evidence from 30 studies, including 4205 individuals at ultra high risk (UHR) for psychosis, that there are high rates of current (26.7%) and lifetime (52.8%) cannabis use, and CUDs (12.8%).13 Compared with non-users, UHR cannabis users also had higher rates of suspiciousness and unusual thought content.

Furthermore, research suggests that people with substance-induced psychoses will later transition to a diagnosis of schizophrenia. Murrie and colleagues14 synthesized the results of longitudinal observations studies of transition from substance-induced psychosis to schizophrenia. Six studies with estimates of transition to schizophrenia among 3040 people with cannabis-induced psychosis were included. The risk of transition to schizophrenia in these individuals was 34% (95% CI 25-46%), which was the highest risk among all substances. They concluded that substance-induced psychoses are common reasons for seeking care, and these serious conditions are associated with substantial risk of transition to schizophrenia. Treatment of cannabis-induced psychoses should be considered in the same framework as that for other brief psychotic disorders (i.e., engagement, assessment, and care); this also may help decrease rates of transition to schizophrenia.

Impact of cannabis on psychotic disorders

Large and colleagues15 conducted a systematic review of the association between cannabis use and the age of onset of psychosis. They included 41 samples, finding that the age of onset of psychosis for those who used cannabis was 2.7 years younger than for non-users, corresponding to a small-to-medium effect size of 0.41. These findings are broadly consistent with a potential causal role for cannabis in the development of psychosis in some patients.

Bogaty and colleagues16 performed a meta-analysis of 14 studies of neurocognition in lifetime cannabis users and never-users in young patients with psychotic disorders (aged 15 to 45 years). They found that lifetime cannabis users performed significantly worse than never-users on several cognitive domains, including premorbid and current IQ, verbal learning and working memory, and motor inhibition. Effect sizes were small to medium for most domains (0.17-0.40), except for verbal working memory, which showed a large effect size (0.76). Interestingly, patients who use cannabis performed better on tests of conceptual set-shifting. Increasing age exacerbated the between-group differences.

Schoeler and colleagues17 conducted a systematic review and meta-analysis of the effect of continued versus discontinued cannabis use after the onset of psychosis. They identified 24 studies, including 16,565 patients with pre-existing psychosis and at least a 6 month duration of follow-up. They found that continued cannabis use was associated with a significant: increase in risk of relapse of psychosis compared with non-users (ES=0.36) and discontinued users (ES=0.28); longer hospital admissions than non-users (ES=0.36); and more severe positive, but not negative, symptoms. Krause and colleagues18 performed a meta-analysis of the efficacy, acceptability, and tolerability of antipsychotics in patients with schizophrenia and comorbid substance use. They included 8 randomized controlled trials in patients with cannabis use comorbidity. Clozapine was superior to other antipsychotics for reduction of substance use and negative symptoms in those who used cannabis. Risperidone was superior to olanzapine for reducing of drug cravings and weight gain.

Conclusions

Premorbid cannabis use is associated with a dose-dependent increased risk of developing a psychotic disorder. There is evidence in both patients with psychotic disorders and the general population that cannabis use is associated with adverse effects of psychopathology and cognition. Cannabis use and CUDs are highly prevalent throughout the clinical course of illness.

Cannabis use is associated with an earlier age of onset of psychosis and more severe impairments in neurocognition. Continued cannabis use after the onset of psychosis is associated with increased risk of illness relapse, longer hospitalizations, and more severe positive psychopathology. There is also evidence for superior efficacy of clozapine for reduction of substance use and negative symptoms in patients with schizophrenia and comorbid cannabis use. Targeted interventions for improved prevention, detection, and treatment are warranted to improve outcomes in this population.

Dr Miller is Professor, Department of Psychiatry and Health Behavior, Augusta University, Augusta, GA. He is the Schizophrenia Section Chief for Psychiatric Times.

The author reports that he receives research support from Augusta University, the National Institute of Mental Health, the Brain and Behavior Research Foundation, and the Stanley Medical Research Institute.

Source: https://www.psychiatrictimes.com/view/novel-insights-cannabis-psychosis July 2020

Research suggests that smoking marijuana carries many of the same cardiovascular health hazards as smoking tobacco.

Credit…Gracia Lam

Do you have the heart to safely smoke pot? Maybe not, a growing body of medical reports suggests.

Currently, increased smoking of marijuana in public, even in cities like New York where recreational use remains illegal (though no longer prosecuted), has reinforced a popular belief that this practice is safe, even health-promoting.

“Many people think that they have a free pass to smoke marijuana,” Dr. Salomeh Keyhani, professor of medicine at the University of California, San Francisco, told me. “I even heard a suggestion on public radio that tobacco companies should switch to marijuana because then they’d be selling life instead of selling death.”

But if you already are a regular user of recreational marijuana or about to become one, it would be wise to consider medical evidence that contradicts this view, especially for people with underlying cardiovascular diseases.

Compared with tobacco, marijuana smoking causes a fivefold greater impairment of the blood’s oxygen-carrying capacity, Dr. Keyhani and colleagues reported.

In a review of medical evidence, published in January in the Journal of the American College of Cardiology, researchers described a broad range of risks to the heart and blood vessels associated with the use of marijuana.

The authors, led by Dr. Muthiah Vaduganathan, cardiologist at Brigham and Women’s Hospital in Boston, point out that “marijuana is becoming increasingly potent, and smoking marijuana carries many of the same cardiovascular health hazards as smoking tobacco.”

Edible forms of marijuana have also been implicated as a possible cause of a heart attack, especially when high doses of the active ingredient THC are consumed.

With regard to smoking marijuana, Dr. Vaduganathan explained in an interview, “The combustion products a tobacco smoker inhales have a very similar toxin profile to marijuana, so the potential lung and heart effects can be comparable. When dealing with patients, we really have to shift our approach to the use of marijuana.”

His team reported, “Although marijuana is smoked with fewer puffs, larger puff volumes and longer breath holds may yield greater delivery of inhaled elements.” In other words, when compared to tobacco smoking, exposure to chemicals damaging to the heart and lungs may be even greater from smoking marijuana.

Dr. Vaduganathan said he was especially concerned about the increasing number of heart attacks among marijuana users younger than 50. In a registry of cases created by his colleagues, in young patients suffering a first heart attack, “marijuana smoking was identified as one factor that was more common among them.” The registry revealed that, even when tobacco use was taken into account, marijuana use was associated with twice the hazard of death among those under age 50 who suffered their first heart attack.

Other medical reports have suggested possible reasons. A research team headed by Dr. Carl J. Lavie of the John Ochsner Heart and Vascular Institute in New Orleans, writing in the journal Missouri Medicine, cited case reports of inflammation and clots in the arteries and spasms of the coronary arteries in young adults who smoke marijuana.

Another damaging effect that has been linked to marijuana is disruption of the heart’s electrical system, causing abnormal heart rhythms like atrial fibrillation that can result in a stroke. In one survey of marijuana smokers, the risk of stroke was increased more than threefold.

These various findings suggest that a person need not have underlying coronary artery disease to experience cardiovascular dysfunction resulting from the use of marijuana. There are receptors for cannabinoids, the active ingredients in marijuana, on heart muscle cells and blood platelets that are involved in precipitating heart attacks.

Cannabinoids can also interfere with the beneficial effects of various cardiovascular medications, including statins, warfarin, antiarrhythmia drugs, beta-blockers and calcium-channel blockers, the Boston team noted.

The researchers found that in an analysis of 36 studies among people who suffered heart attacks, the top three triggers were use of cocaine, eating a heavy meal and smoking marijuana. And 28 of 33 systematically analyzed studies linked marijuana use to an increased risk of what are called acute coronary syndromes — a reduction of blood flow to the heart that can cause crushing chest pain, shortness of breath or a heart attack.

“In settings of an increased demand on the heart, marijuana use may be the straw on the back, the extra load that triggers a heart attack,” Dr. Vaduganathan said. He suggested that the recent decline in cardiovascular health and life expectancy among Americans may be related in part to the increased use of marijuana by young adults.

“We should be screening and testing for marijuana use, especially in young patients with symptoms of cardiovascular disease,” Dr. Vaduganathan urged.

He expressed special concern about two recent practices: the vaping of marijuana and the use of more potent forms of the drug, including synthetic marijuana products.

“Vaping delivers the chemicals in marijuana smoke more effectively, resulting in increased doses to the heart and potentially adverse effects that are more pronounced,” the cardiologist said. “Marijuana stimulates a sympathetic nervous system response — an increase in blood pressure, heart rate and demands on the heart that can be especially hazardous in people with preexisting heart disease or who are at risk of developing it.”

Dr. Vaduganathan’s team estimated that more than two million American adults who say they have used marijuana also have established cardiovascular disease, according to data from the National Health and Nutrition Examination Surveys in 2015 and 2016.

According to Dr. Keyhani, who works at the San Francisco VA Medical Center, the combination of marijuana smoking and pre-existing heart disease is especially concerning because inhaling particulate matter of any kind can harm the heart and blood vessels.

“Marijuana is a leafy green, and combustion of any plant is probably toxic to human health if the resulting products are inhaled,” she explained. “Unfortunately, the research base is inadequate because marijuana hasn’t been studied in randomized clinical trials.”

A major problem in attempts to clarify the risks of marijuana is its classification by the U.S. Drug Enforcement Administration as a Schedule I drug, making it illegal to study it rigorously in controlled clinical trials.

Scientists must then resort to the next best research method: prospective cohort studies in which large groups of people with known habits and risk factors are followed for long periods to assess their health status. “The challenge is to recruit a cohort of daily cannabis users,” Dr. Keyhani said. “It’s absolutely important to look at the health effects of cannabis now that the prevalence of daily use is increasing. The absence of evidence is not evidence of absence.”

While there are currently no official guidelines, Dr. Vaduganathan’s team urged that anyone known to be at increased risk of cardiovascular disease should be advised to minimize the use of marijuana or, better yet, quit altogether.

Source:  https://www.nytimes.com/2020/10/26/well/live/marijuana-heart-health-cardiovascular-risks.html October 2020

Abstract

Accidental paediatric cannabis poisonings are an incidental effect of cannabis use. The average THC content of cannabis resin and the number of consumers are rising sharply in the USA and in most European countries. The objective is to study the evolution of prevalence and severity of paediatric exposures to cannabis in France.

Method

This is a retrospective observational study of cases detected by French poison centers between January 1st 2010 and December 31st 2017 of cannabis exposure by ingestion in children aged ten or younger. The clinical severity was assessed using the Poisoning Severity Score (PSS). The criteria used for assessing the overall severity were as follows: PSS ≥ 2, admission to paediatric intensive care, coma and respiratory depression (univariate and multivariate logistic regression).

Results

A total of 965 cases of poisoning were covered. The annual average number of cases was 93 between 2010 and 2014 and 167 between 2015 and 2017. The median age was 15 months (range, 6 months–10 years) and the sex ratio was 1:1. The form of cannabis ingested was mainly resin (75%). During the period covered by the study, 26.1% of children (n = 252) presented with a PSS ≥ 2, 4.5% (n = 43) coma, 4.6% (n = 44) with respiratory depression and 11.7% (n = 113) were admitted into paediatric intensive care (out of 819 hospitalizations). No fatal cases were reported. In comparison to the 2010–2014 period, the length of hospital stays was significantly higher (p < 0.0001) and the comas were significantly deeper (lower score on the Glasgow coma scale, p < 0.005) in 2015–2017. Following adjustments made for the sex, age and weight of the children, the data show that the severity of the poisonings was significantly greater in 2015–2017 in terms of PSS score, the number of comas and monitoring in intensive care (p < 0.001).

Conclusion

The data indicates a significant increase in the number of cases of paediatric exposure to cannabis and a rise in the seriousness of poisonings between 2010 and 2017.

Source:  https://www.tandfonline.com/doi/abs/10.1080/15563650.2020.1806295 June 2020

A new study recently published in Nature Medicine found a stunning association between prenatal THC exposure and development of autism. Using provincial birth registries, Canadian researchers analyzed all live births that occurred in Ontario between April 2007 and March 2012 for a total of 497,821 births.

Investigators found that infants who were prenatally exposed to THC were 57% more likely to develop autism spectrum disorder (ASD) and 35% more likely to develop intellectual disabilities and learning disorders. Previous studies of this type have been difficult to interpret due to polysubstance use among expectant mothers making it difficult to tease out the effects of THC exposure alone. In this study, researchers were able to directly compare unexposed infants to those whose mothers only used marijuana during their pregnancy. Thus, any effects observed in this study can be reliably attributed to prenatal THC exposure since no other substances were used. Results persisted even adjusting for other potential risk factors for ASD such as maternal age, education, psychiatric disorders, socioeconomic status, parity, and race.

The results of this study confirm that of previous research on the harms of prenatal THC exposure. Nevertheless, marijuana is routinely recommended to pregnant women by pot docs as well as dispensary employees with no medical training at all. Given the explosion in marijuana use among pregnant women in states like FL, lawmakers must take immediate action to fund education campaigns and ban marijuana recommendations for pregnant women. How many more lives need to be ruined so that Big Pot and their political allies can line their pockets?

Source:  https://www.dfaf.org/study-finds-link-between-prenatal-thc-exposure-and-autism/ 19.08.20

ABSTRACT

Parental cannabis use has been associated with adverse neurodevelopmental outcomes in offspring, but how such phenotypes are transmitted is largely unknown. Using reduced representation bisulphite sequencing (RRBS), we recently demonstrated that cannabis use is associated with widespread DNA methylation changes in human and rat sperm. Discs-Large Associated Protein 2 (DLGAP2), involved in synapse organization, neuronal signaling, and strongly implicated in autism, exhibited significant hypomethylation (p < 0.05) at 17 CpG sites in human sperm. We successfully validated the differential methylation present in DLGAP2 for nine CpG sites located in intron seven (p < 0.05) using quantitative bisulphite pyrosequencing. Intron 7 DNA methylation and DLGAP2 expression in human conceptal brain tissue were inversely correlated (p < 0.01). Adult male rats exposed to delta-9-tetrahydrocannabinol (THC) showed differential DNA methylation at Dlgap2 in sperm (p < 0.03), as did the nucleus accumbens of rats whose fathers were exposed to THC prior to conception (p < 0.05). Altogether, these results warrant further investigation into the effects of preconception cannabis use in males and the potential effects on subsequent generations.

KEYWORDS: Cannabis, sperm, DNA methylation, autism, heritability

Introduction

Cannabis sativa is the most commonly used illicit psychoactive drug in the United States (U.S.) and Europe [1]. In the U.S., 11 states and Washington D.C. have legalized the recreational use of cannabis and 33 states have legalized the use of medicinal cannabis [2,3]. Since 1995, cannabis potency (defined as the concentration of the psychoactive cannabis component delta-9-tetrahydrocannabinol, or THC, in the sample [4]) has consistently risen from ~4% to as high as 32% in some states [2,5,6]. Changes in cannabis potency have been accompanied by changes in attitudes about cannabis and patterns of cannabis use. Between 2002 and 2014, the percentage of adults in the U.S. who perceived cannabis use as risky declined from 50% to 33% [6]. During this same period, the percentage of U.S. adults who believed cannabis to have no risk rose from 6% to 15% [6]. According to a 2015 Survey on Drug Use and Health, 52.5% of men in the U.S. of reproductive age (≥18) have reported cannabis use at some point in their lives, making cannabis exposure especially relevant for potential future fathers [711].

Given the increased prevalence of cannabis use in the U.S., studies are beginning to focus on the effects of use on the health and development of offspring. Prenatal cannabis exposure via maternal use during pregnancy is associated with decreased infant birth weight, an increased likelihood to require the neonatal intensive care unit, and the potential for an impaired fetal immune system compared to those infants who are not exposed during gestation [1,12]. In rodent studies, rat pups born to parents who were both exposed to THC during adolescence had increased heroin-seeking behaviour later in life, a phenotype that was accompanied by epigenetic changes in the nucleus accumbens [1315]. These studies and others have begun to highlight the potential for intergenerational consequences of cannabis exposure [16]. Identifying the mechanism that underlies these changes is critical as cannabis use continues to increase across the U.S.

The environment impacts the integrity and maintenance of the epigenome such that it is now viewed as a molecular archive of past exposures [17]. While the majority of environmental epigenetic studies are focused on the impact of the inutero environment on the epigenome and health of the child, it has become apparent that the exposure history of the father must also be considered – specifically the impact of his exposures on the sperm epigenome. Studies have shown that exposure to phthalates, pesticides, nutritional deficiencies, and obesity can all induce potentially heritable changes in the sperm epigenome [1824]. It is likely that other common and emerging exposures, including cannabis, may also contribute to disruption of sperm DNA methylation in a similar fashion, and that such changes could be transmitted to the subsequent generation.

Using reduced representation bisulphite sequencing (RRBS) our group recently demonstrated that cannabis use in humans, and THC exposure in rats, is associated with decreased sperm concentrations and widespread changes in sperm DNA methylation [25]. Of the regions identified in humans, Discs-Large Associated Protein 2 (DLGAP2) exhibited significant hypomethylation in the sperm of cannabis-exposed men compared to controls (p < 0.05). DLGAP2, a membrane-associated protein located in the post-synaptic density of neurons, plays a key role in synapse organization and neuronal signaling [26]. Dysregulation of DLGAP2 is associated with various neurological and psychiatric disorders, such as autism spectrum disorder (ASD) and schizophrenia [2629]. In our prior screen, we identified 17 differentially methylated CpG sites within DLGAP2 in the sperm of cannabis-exposed men compared to controls. DLGAP2 was just one of 46 genes with greater than 10 CpG sites showing significantly altered DNA methylation in the sperm of cannabis users compared to controls, out of the 2,077 genes we identified as having altered DNA methylation. The first objective of this study was to validate our preliminary RRBS findings for DLGAP2 using quantitative bisulphite pyrosequencing. Our second objective was to determine the functional association between DNA methylation and gene expression of DLGAP2 to better understand how cannabis use might affect this relationship. To determine the possible intergenerational effects of paternal cannabis use, our third objective was to determine if Dlgap2 was differentially methylated in the sperm of rats exposed to THC versus controls, and if so, whether or not these changes were intergenerationally heritable.

Results

DLGAP2 is hypomethylated in sperm from cannabis users versus controls by Reduced Representation Bisulphite Sequencing (RRBS)

Our prior study [25] revealed 17 differentially methylated sites by RRBS in the sperm of cannabis users compared to controls for the DLGAP2 gene. Table S1 lists all 17 of these sites and their genomic coordinates. Figure 1a graphically demonstrates the significant hypomethylation of nine of these sites that are clustered together in the seventh intron of this gene. DLGAP2 is schematically shown in Figure 1b, including the exon-intron structure, position of CpG islands, transcription start site and the region of interest in intron 7 within the context of the gene body, with an inset showing the nucleotide sequence analysed in this study.

Validation of DLGAP2 RRBS methylation data

To confirm the methylation differences that were initially detected using RRBS, we designed a bisulphite pyrosequencing assay for the DLGAP2 intron 7 region (see Figure 1b) which captures 10 CpG sites, nine of which were identified as significantly differentially methylated using RRBS. We first validated pyrosequencing assay performance using defined mixtures of fully methylated and unmethylated human genomic DNAs. The measured levels of methylation by pyrosequencing showed good agreement between the amount of input methylation levels and the amount of methylation detected (r2 = 0.99 and p = 0.0003) (Figure 1c). These results confirmed the linearity of the assay in the ability to detect increasing amounts of DNA methylation at this region across the full range of possible methylation values, and indicate that the assay is suitable for use with biological specimens.

The DLGAP2 intron 7 region is not an imprinting control region (ICR)

DLGAP2 is paternally expressed in the testis, biallelically expressed in the brain, and has low expression elsewhere in the body [30]. Since DLGAP2 is known to be genomically imprinted in testis [30], and since the imprint control region for this gene has not yet been defined, we sought to determine if the region of interest in intron 7 is part of the DLGAP2 imprint control region (ICR). The methylation at ICRs is established during epigenome reprogramming in the primordial germ cells in embryonic development. Male and female gametes exhibit divergent methylation at ICRs, and this methylation profile is maintained through subsequent post-fertilization epigenetic reprogramming and in somatic cells throughout the life course. Therefore, we expected that if the DLGAP2 intron 7 region is an ICR, the diploid testis tissues from human conceptuses would exhibit approximately 50% methylation due to the complete methylation of one allele at this region and the complete lack of methylation at the other allele. Human conceptal testes tissues (n = 3) showed an average of 72.5% methylation at the DLGAP2 intron 7 region (Figure 1d). This finding, of higher than anticipated and variable levels of methylation, is inconsistent with ICR status.

Bisulphite pyrosequencing validates the RRBS methylation data in human sperm

We next performed quantitative bisulphite pyrosequencing on the same sperm DNA samples from cannabis users and controls as those used to generate the RRBS data to confirm the loss of methylation present at the intron 7 region of DLGAP2. All nine CpG sites that were hypomethylated in the cannabis users by RRBS were also found to be hypomethylated by bisulphite pyrosequencing, as well as an additional CpG site that was captured in the assay design (p < 0.05 for all 10 sites) (Figure 2). Following Bonferroni correction of the p value to adjust for multiple comparisons (p < 0.005), CpG sites 1,2,3,5,7,8,9, and 10 remained significant. From this pyrosequencing assay we observed methylation differences of 7–15% between the sperm of the cannabis users (n = 8) compared to controls (n = 7). Correlation of the RRBS and pyrosequencing data for each individual CpG site showed significant agreement at all sites analysed (p < 0.02 for all sites; Figure S1). All CpG sites showed a significant loss of methylation in accordance with the direction of change observed by RRBS for these same CpG sites.

Methylation of DLGAP2 intron 7 is inversely correlated with DLGAP2 expression

Given that we observed significant loss of intron 7 DLGAP2 DNA methylation in sperm of cannabis users relative to non-users, we next examined the relationship between DNA methylation and gene expression in the brain, where this gene’s function is critical. We used 28 conceptal brain tissues to examine the relationship between DNA methylation and mRNA expression. Expression levels were normalized to the lowest expressing sample, and the relationship between DNA methylation and mRNA expression was calculated with a Pearson correlation. We found that as methylation increased in this region, mRNA expression decreased significantly (p < 0.05) (Figure 3a). Knowing that there are sex differences in autism spectrum disorder (ASD), and that dysregulation of DLGAP2 is associated with ASD [26], we sought to determine if there were any sex differences in the methylation-expression relationship in these tissues. To investigate this, we ran the correlation for males (n = 15) and females (n = 13) independently. The inverse relationship between methylation and expression was evident for both males and females, but this relationship was significant only in females (p = 0.006) (Figure 3b, c).

Intergenerational inheritance of altered Dlgap2 DNA methylation

We next sought to investigate Dlgap2 using data obtained from our prior study [25] to determine if there was any differential methylation of Dlgap2 in THC versus control rats that was not initially identified using the imposed thresholds of that study. We were particularly interested in the potential for intergenerational transmission and to determine if route of THC exposure affected DNA methylation at this gene. The pilot study rats [25] were given THC via oral gavage (to mimic oral ingestion of drug) while subsequent studies dosed rats via intraperitoneal injection (to mimic inhalation of drug). From the rats administered THC via oral gavage versus controls, we identified a region of Dlgap2 that showed differential methylation by the RRBS analysis that contains eight CpG sites. This region is in the first intron of Dlgap2, in a CpG island that spans the first exon of this gene as well (schematic of the gene structure and sequence of this region shown in Figure 4a). We validated the rat Dlgap2 pyrosequencing assay using commercially available rat DNA of defined methylation status. The results showed good agreement between the input methylation and the amount of methylation detected by pyrosequencing (r2 = 0.92, p = 0.01) (Figure 4b).

We were able to demonstrate intergenerational inheritance of an altered DNA methylation pattern in Dlgap2. Comparing the average methylation for exposed and unexposed sperm for each CpG site revealed that sites 2,3,4 and 6 of the eight CpG sites analysed were significantly hypomethylated in the sperm of rats exposed via injection to 4mg/kg THC compared to controls (p = 0.03 to p = 0.005) (Figure 4c). CpG site 6 remained significant after Bonferroni correction (p < 0.006). The same region of Dlgap2 was then analysed in the hippocampus and nucleus accumbens of rats whose fathers were exposed to control or 4mg/kg THC. While CpG site 7 was significantly hypomethylated (p < 0.05) in the hippocampus of the offspring (Figure 5a), this site was not identified as differentially methylated in the sperm of THC exposed rats, and therefore we could not conclude that this change was transmitted as the result of changes present in the exposed sperm. In the nucleus accumbens, however, significant hypomethylation (p = 0.02) at CpG site 2 was detected in the offspring (Figure 5b), one of the same sites identified in the sperm of THC exposed rats. We also found that there was an inverse relationship between DNA methylation and expression of Dlgap2 in the nucleus accumbens, though not statistically significant likely due to the small sample size available in this study (n = 6 exposed, n = 8 unexposed; Figure S2).

Discussion

In this study, we examined the effects of regular male cannabis use on human sperm DNA methylation, at DLGAP2. Our RRBS study initially identified 17 CpG sites in DLGAP2 that were differentially methylated in the sperm of cannabis users compared to controls. Of the sites that were initially identified, nine of them all reside together in the seventh intron of this gene, though not in a defined CpG island. To first confirm the RRBS data, we performed quantitative bisulphite pyrosequencing for the nine clustered CpG sites. We were able to capture an additional CpG site with careful assay design for a total of ten CpG sites analysed via bisulphite pyrosequencing. We successfully validated the RRBS findings, confirming that there was significant hypomethylation among these ten sites with cannabis use. We confirmed a significant inverse correlation between methylation and expression at this region in human conceptal brain tissues.

To begin to determine whether or not the effects of cannabis on sperm are heritable, we analysed sperm from THC exposed and control male rats, as well as the hippocampus and nucleus accumbens from offspring of THC exposed and control males for changes in DNA methylation at Dlgap2. Rats exposed to THC were given a dose (4mg/kg THC for 28 days) that is pharmacodynamically equivalent to daily cannabis use to resemble frequent use in humans. We identified significant hypomethylation at Dlgap2 in the sperm of exposed rats as compared to controls. This hypomethylated state was also detected in the nucleus accumbens of rats born to THC exposed fathers compared to controls, supporting the potential for intergenerational inheritance of an altered sperm DNA methylation pattern. While the changes in the degree of methylation are small in the rats (0.5–0.7%), we previously reported that fractional changes in methylation can significantly influence the degree to which the gene’s expression is altered [31].

DLGAP2 is a member of the DLGAP family of scaffolding proteins located in the post-synaptic density (PSD) of neurons. The PSD is a protein-dense web that lies under the postsynaptic membrane of neurons and facilitates excitatory glutamatergic signaling in the central nervous system [26,32]. DLGAP2 functions to transmit neuronal signals across synaptic junctions and helps control downstream signaling events [26,32]. Due to its important role in PSD signaling, even small changes in the expression of DLGAP2 can have severe consequences [26,32]. Of particular relevance, DLGAP2 has been linked to schizophrenia and importantly, has been identified as an autism candidate gene [27,28,33,34]. Differential methylation of DLGAP2 is reported in the brain of individuals with autism, and has been linked to post-traumatic stress disorder in rats [27,35]. Knockout of Dlgap2 in mice results in abnormal social behaviour, increased aggressive behaviour, and learning deficits [36].

Studies are increasingly showing associations between cannabis use and various neuropsychiatric and behavioural disorders including anxiety, depression, cognitive deficits, autism, psychosis, and addiction [2,6,7,9,14,3739]. Research looking into the effects of THC exposure found that rat pups born to parents who were exposed to THC during adolescence showed increased effort to self-administer heroin compared to those born to unexposed parents [13]. This increase in addictive behaviour was driven by THC-induced changes in DNA methylation, occurring in the striatum, including the nucleus accumbens [14,15]. One of the genes whose methylation was altered by parental THC exposure was Dlgap2 [15]. Recently, a group from Australia analysed datasets from two independent cohorts to examine the relationship between cannabis legalization in the U.S. and ASD incidence. They determined there was a strikingly significant positive association between cannabis legalization and increased ASD incidence. Further, the study authors predicted that there will be a 60% increase in excess ASD cases in states with legal cannabis by 2030, and deemed ASD the most common form of cannabis-associated clinical teratology [40].

It is estimated that the ratio of boys with ASD to girls with ASD is 4:1 which led us to stratify our analysis looking at the relationship between DNA methylation and gene expression by sex [41,42]. The results of our methylation-expression analyses demonstrated a significant association in females but not males. While we don’t know the ASD status of these samples, there are several reasons why this may be the case. First, there are certain genes that confer a stronger ASD phenotype in girls compared to boys [41,42]. Thus, while we see the trend in both sexes, it is possible that dysregulation of this gene may manifest phenotypically more in girls. Alternatively, it may be that the regulatory relationship between methylation and expression is retained in females while altered methylation further exacerbates an already fragile relationship in males. Overall, this data confirms that the region of DNA methylation within DLGAP2 that was differentially methylated in the sperm of cannabis users compared to controls is functionally important in the brain.

DLGAP2 is an imprinted gene that exhibits paternal expression in the testis, biallelic expression in the brain, and low expression elsewhere in the body [30]. Because the methylation established at imprinted genes resists post-fertilization epigenetic reprogramming [4345], this supports the possibility that changes in methylation at DLGAP2 in sperm could be transmitted to the next generation. However, given that the region in intron 7 is not an ICR, it is unlikely that this would be a potential mechanism for intergenerational inheritance of an altered methylation pattern at this region. However, it has recently been discovered that a subset of genes termed ‘escapees’ are able to escape primordial germ cell (PGC) and post-fertilization reprogramming events [46,47], providing a mechanism for epigenetic changes incurred by sperm to be passed on to the subsequent generation.

Processes in the PSD are sensitive to endocannabinoids [26,4851], which suggests that these processes are potentially sensitive to exogenous cannabinoids, such as THC and cannabis. This is especially important as cannabis legalization and use are increasing dramatically across the U.S. It is estimated that 22% of American adults currently use cannabis, of which 63% are regular users (≥1–2 times per month) [710]. Among regular users 55% are males and over half of all men over 18 have reported cannabis use in their lifetime [710]. Importantly, this age range includes individuals of reproductive age. Since almost half of all pregnancies in the U.S. are unplanned, there is concern that many pregnancies may occur during a time when one, or both, parents are using or are exposed to cannabis [52].

Our results provide novel findings about the effects of paternal cannabis use on the methylation status of an ASD candidate gene, a disorder whose rates continue to climb, but whose precise aetiologies remain unknown. Studies are beginning to show that there is a potential for paternal intergenerational inheritance. In particular, epigenetic changes in umbilical cord blood of babies born to obese fathers were also found in the sperm of obese men. This study is the first to demonstrate that there are changes present in the sperm epigenome of cannabis users at a gene involved in ASD.

The results of this study have several limitations. The sample size was small, which might limit generalization of the study findings. However, even though our sample size was small, we were able to identify common pathways that were differentially methylated in both human and rat sperm, highlighting the potential specificity of these effects [25]. We did not account for a wide variety of potential confounders such as various lifestyle habits, sleep, diet/nutrition, exercise, etc, given that their influence on the sperm DNA methylome is largely unknown. Larger studies are required to confirm these findings. In the conceptal tissues we were only able to analyse whole brain, rather than the areas where DLGAP2 is most highly expressed such as the hippocampus and the striatum, which could have diluted the strength of the results.

Strengths of the study included that we used a highly quantitative method to confirm the methylation status that was measured by RRBS. This study was the first demonstration of the association between cannabis use and substantial hypomethylation of DLGAP2 in human sperm. Additionally, we are able to confirm a functional relationship between methylation and expression in a relevant target tissue, and have shown that the relationship between methylation and expression is weakened in males, which could bear relevance to the sexual dimorphism in the prevalence of autism. This is the first demonstration of potential heritability of altered methylation resulting from preconceptional paternal THC exposure. Given the increasing legalization and use of cannabis in the U.S., our results underscore a need for larger studies to determine the potential for heritability of DLGAP2 methylation changes in the human F1 generation and beyond. It will also be important to examine how cannabis-associated methylation changes relate to neurobehavioral phenotypes

Source:   Epigenetics. 2020; 15(1-2): 161–173.

Published online 2019 Aug 26. doi: 10.1080/15592294.2019.1656158

To Whom it may concern

On behalf of Drug Free Australia and our coalition of drug prevention researchers, we wish to commend to you, research that could well be a game-changer in informing and preventing a large proportion of Australia’s substance use issues.

The research is in various stages of development and a synopsis of current and emerging research, being done by Dr Stuart Reece and Professor Gary Hulse should be of genuine interest for all Australian Health Professionals. However, it appears that, to date, too many of the world’s researchers have placed this important research in the ‘too hard’ basket, similar to the way the NHS in the United Kingdom did with research into Pandemics.

At present the COVID-19 pandemic and how it is being addressed, should be a ‘wakeup call’ to Australian health authorities that prevention is the single most important goal. A ‘Harm Minimisation’ only approach, fails to achieve best-practice primary prevention outcomes. The passive discounting of the primary pillar of the National Drug Strategy – Demand Reduction over the last 30 years (and particularly the last 10) has seen a very large increase in illegal drug use in this nation.

The only exception to this has been seen in the correct and full use of both demand and supply reduction on the drug Tobacco. There has been little or no use of harm reduction mechanisms and a relentless and unified approach to abstinent/cessation modelling and it has worked spectacularly well, seeing Australia with, arguably, the lowest daily tobacco use in the world.

The research, that we now summarise, should not be placed in Australia’s ‘too hard’ basket. Rather, it warrants recognition by all Australian Health authorities for the world break-through that it is. Such evidence-based data offers timely insights that should promote and resource primary prevention and demand reduction.

Synopsis of the research:
1. Canadian Cannabis Consumption and Patterns of Congenital Anomalies: An Ecological Geospatial Analysis Albert Stuart Reece, MBBS(Hons), FRCS(Ed), FRCS(Glas), FRACGP, MD(UNSW), and Gary Kenneth Hulse, BBSc(Hons), MBSc, PhD
https://journals.lww.com/journaladdictionmedicine/Abstract/publishahead/Canadian_Cannabis_Consumption_and_Patterns_of.99248.aspx

Status
Mapping showed cannabis use was more common in the northern Territories of Canada in the Second National Survey of Cannabis Use 2018. Total congenital anomalies, all cardiovascular defects, orofacial clefts, Downs syndrome and gastroschisis were all found to be more common in these same regions and rose as a function of cannabis exposure.

When Canada was dichotomized into high and low cannabis use zones by Provinces v Territories the Territories had a higher rate of total congenital anomalies 450.026 v 390.413 (O.R.=1.16 95%C.I. 1.08-1.25, P=0.000058; attributable fraction in exposed 13.25%, 95%C.I. 7.04–19.04%). In geospatial analysis in a spreml spatial error model cannabis was significant both alone as a main effect (P<2.0×10-16) and in all its first and second order interactions with both tobacco and opioids from P<2.0×10-16.

Conclusion:

These results show that the northern Territories of Canada share a higher rate of cannabis use together with elevated rates of total congenital anomalies, all cardiovascular defects, Down’s syndrome and gastroschisis. This is the second report of a significant association between cannabis use and both total defects and all cardiovascular anomalies and the fourth published report of a link with Downs syndrome and thereby direct major genotoxicity.

The correlative relationships described in this paper are confounded by many features of social disadvantage in Canada’s northern territories. However, in the context of a similar broad spectrum of defects described both in animals and in epidemiological reports from Hawaii, Colorado, USA and Australia they are cause for particular concern and indicate further research.

139 References – click on this link to access.
https://journals.lww.com/journaladdictionmedicine/Abstract/publishahead/Canadian_Cannabis_Consumption_and_Patterns_of.99248.aspx

2. Cannabis Consumption Patterns Parallel the East-West Gradient in Canadian Neural Tube Defect Incidence – An Ecological Study
https://www.researchgate.net/publication/337911618_Cannabis_Consumption_Patterns_Explain_the_East-West_Gradient_in_Canadian_Neural_Tube_Defect_Incidence_An_Ecological_Study

Status:
Whilst a known link between prenatal cannabis exposure (PCE) and anencephaly exists, the relationship of PCE with neural tube defects (NTD’s) generally has not been defined. Published data from Canada Health and Statistics Canada was used to assess this relationship. Both cannabis use and NTDs were shown to follow an east-west and north-south gradient. Last year cannabis consumption was significantly associated (P<0.0001; Cannabis use: time interaction P<0.0001). These results were confirmed when estimates of termination for anomaly were used. Canada Health population data allowed the calculation of an NTD O.R.=1.27 (95%C.I. 1.19-1.37; P<10-11) for high risk provinces v. the remainder with an attributable fraction in exposed populations of 16.52% (95%C.I. 12.22-20.62). Data show a robust positive statistical association between cannabis consumption as both a qualitative and quantitative variable and NTDs on a background of declining NTD incidence. In the context of multiple mechanistic pathways these strong statistical findings implicate causal mechanisms.

82 References – click on this link to access.
https://www.researchgate.net/publication/337911618_Cannabis_Consumption_Patterns_Explain_the_East-West_Gradient_in_Canadian_Neural_Tube_Defect_Incidence_An_Ecological_Study

3. Cannabis exposure as an interactive cardiovascular risk factor and accelerant of organismal ageing: a longitudinal study. Response to Lane
https://bmjopen.bmj.com/content/6/11/e011891.responses

Status:
We wish to thank Dr Lane for his interest in our study. We are pleased to see statistical input to the issues of cannabis medicine as we feel that sophisticated statistical methodologies have much to offer this field.

Most of the concerns raised are addressed in our very detailed report. As described our research question was whether, in our sizeable body of evidence (N=13,657 RAPWA studies), we could find evidence for the now well-described cannabis vasculopathy and what such implications might be. As this was the first study of its type to apply formal quantitative measures of vascular stiffness to these questions it was not clear at study outset if there would be any effect, much less an estimate of effect size. In the absence of this information power calculations would be mere guesswork. Nor indeed are they mandatory in an exploratory study of this type. Similarly the primary focus of our work was on whether cannabis exposure was an absolute cardiovascular risk factor in its own right, and how it compared to established risk factors. Hence Table 2 contains our main results. The role of Table 1 is to illustrate the bivariate (uncorrected) comparisons which can be made, show the various groups involved, and compare the matching of the groups. It is not intended to be a springboard for effect-size-power calculations which are of merely esoteric interest.
Calculations detailing the observed effect size are clearly described in our text being 11.84% and 8.35% age advance in males and females respectively.

Mixed-effects models are the canonical way to investigate longitudinal data given a usual random error structure 1. We agree with Lane that unusual error structures can affect significance conclusions. Diagnostic tests run on our models confirm that the residuals had the usual spheroidal error structure so that the application of mixed-effects models in the classical way is quite satisfactory. Another way to investigate this issue is that of incremental model building comparing models with and without cannabis exposure terms. If one considers regression equations from our data with cannabis use treated either as a categorical (RA/CA ~ Days_Post-Cannabis * BMI + * Cannabis_Category) or a continuous (RA/(CA*BMI) ~ Cigs*SP + * Cannabis_Use +Chol+DP+HDL+HR+CRH) variable one notes firstly that terms including cannabis use remain significant in final models (after model reduction) and secondly that models which include cannabis exposure are significantly better than ones without (Categorical: AIC = 1088.56 v. 1090.22, Log.Ratio = 19.62, P = 0.0204; Continuous: AIC = 412.33 v. 419.73, Log.Ratio = 9.37, P = 0.0022). Unfortunately formatting rules for BMJ Rapid Responses do not allow us to include a detailed table of regression results in each model in the present reply. We also note that AIC’s are little used in our report, and simply indicate the direction of the ANOVA results comparing models linear, quadratic and cubic in chronological age. They also appear routinely in the display of mixed-effects model results. Their use in such contexts is methodologically unremarkable. Control groups are also spelled out in fine detail in Table 1, in all our Figures and in the text.

We are aware that various algorithms for vascular age have been reported in the literature. The list proposed by Lane is correct but non-exhaustive. Such algorithms are generally derived from known cardiovascular risk factors. As clearly stated in our report the algorithm for vascular age we employed is derived from the proprietary software used. As such its details have not been publicized and indeed are commercially protected information.

We have however been assured by AtCor on many occasions that it includes measures of chronological age, sex, arterial stiffness and height (which is important as it dictates distance and thus speed parameters for the reflected and augmented central arterial pressure waves) and is very well validated and tested. AtCor recently advised that their algorithm is based on a very large series of studies done with arterial stiffness published in 2005 2. As such it has distinct advantages over algorithms which do not include indices of arterial stiffness. The AtCor website includes a very interesting, informative and educative animated loop which clearly illustrates the complex relationship between chronological and vascular age as a function of arterial stiffness and vascular tone 3

We are keen to see advanced statistical methods applied to such questions. We are becoming interested in geospatial and spacetime analyses and its application to the important questions of cannabis epidemiology 4. We find the very breadth of the organ systems impacted by cannabis to be quite remarkable with effects on the brain, cardiovasculature, liver, lungs, testes, ovaries, gastrointestinal, endocrine, reproductive and immune systems being well described and constituting most of the body’s major systems 5 6. Testicular and several pediatric cancers have also been described as being cannabis-associated 5. Such a multisystem generality of toxicity suggests to us that some basic cellular functions may be deleteriously affected – as implied by its well described mitochondriopathy 7, its heavy epigenetic footprint 8, accelerated aging as described in our present report 9 or some multi-way interaction between these and other processes. Given that the cannabis industry is presently entering a major commercialization growth phase, and given the multigenerational implications of mitochondriopathy-epigenotoxicity (by direct: substrate supply including ATP, NAD+ and acetate; and indirect: RNA transfer and malate-aspartate and glycerol-3-phosphate shuttle; pathways 10) further study and elucidation of these points is becoming an increasingly imperative international research priority.

Apropos of the recent Covid-19 pandemic emergency it is also worth noting that since cannabis is immunosuppressive, is known to be damaging to lungs and airways and often carries chemical, microbial and fungal contaminants cannabis use and cannabis vaping is also likely to have a deleterious effect on the coronavirus epidemic. Such data implies an untoward convergence of two public health epidemics. Appropriate controls on cannabis use imply improved public health management of SARS-CoV-2.

10 References – click on this link to access. https://bmjopen.bmj.com/content/6/11/e011891.responses

4. Cannabis Teratology Explains Current Patterns of Coloradan Congenital Defects: The Contribution of Increased Cannabinoid Exposure to Rising Teratological Trends.
https://www.researchgate.net/publication/334368364_Cannabis_Teratology_Explains_Current_Patterns_of_Coloradan_Congenital_Defects_The_Contribution_of_Increased_Cannabinoid_Exposure_to_Rising_Teratological_Trends/link/5d2d4d39a6fdcc2462e3097c/download

Status
Rising Δ9-tetrahydrocannabinol concentrations in modern cannabis invites investigation of the teratological implications of prenatal cannabis exposure.

Data from Colorado Responds to Children with Special Needs (CRCSN), National Survey of Drug Use and Health, and Drug Enforcement Agency was analyzed. Seven, 40, and 2 defects were rising, flat, and falling, respectively, and 10/12 summary indices rose. Atrial septal defect, spina bifida, microcephalus, Down’s syndrome, ventricular septal defect, and patent ductus arteriosus rose, and along with central nervous system, cardiovascular, genitourinary, respiratory, chromosomal, and musculoskeletal defects rose 5 to 37 times faster than the birth rate (3.3%) to generate an excess of 11 753 (22%) major anomalies. Cannabis was the only drug whose use grew from 2000 to 2014 while pain relievers, cocaine, alcohol, and tobacco did not. The correlation of cannabis use with major defects in 2014 (2019 dataset) was R = .77, P = .0011. Multiple cannabinoids were linked with summary measures of congenital anomalies and were robust to multivariate adjustment.

66 References – click on this link to access
https://www.researchgate.net/publication/334368364_Cannabis_Teratology_Explains_Current_Patterns_of_Coloradan_Congenital_Defects_The_Contribution_of_Increased_Cannabinoid_Exposure_to_Rising_Teratological_Trends/link/5d2d4d39a6fdcc2462e3097c/download

5. Impacts of cannabinoid epigenetics on human development: reflections on Murphy et. al. ‘cannabinoid exposure and altered DNA methylation in rat and human sperm’ epigenetics 2018; 13: 1208-1221.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6773386/pdf/kepi-14-11-1633868.pdf
Status

ABSTRACT Recent data from the Kollins lab (‘Cannabinoid exposure and altered DNA methylation in rat and human sperm’ Epigenetics 2018; 13: 1208–1221) indicated epigenetic effects of cannabis use on sperm in man parallel those in rats and showed substantial shifts in both hypo- and hyper-DNA methylation with the latter predominating. This provides one likely mechanism for the transgenerational transmission of epigenomic instability with sperm as the vector. It therefore contributes important pathophysiological insights into the probable mechanisms underlying the epidemiology of prenatal cannabis exposure potentially explaining diverse features of cannabis-related teratology including effects on the neuraxis, cardiovasculature, immune stimulation, secondary genomic instability and carcinogenesis related to both adult and pediatric cancers. The potentially inheritable and therefore multigenerational nature of these defects needs to be carefully considered in the light of recent teratological and neurobehavioural trends in diverse jurisdictions such as the USA nationally, Hawaii, Colorado, Canada, France and Australia, particularly relating to mental retardation, age-related morbidity and oncogenesis including inheritable cancerogenesis.

Increasing demonstrations that the epigenome can respond directly and in real time and retain memories of environmental exposures of many kinds implies that the genome-epigenome is much more sensitive to environmental toxicants than has been generally realized. Issues of long-term multigenerational inheritance amplify these concerns. Further research particularly on the epigenomic toxicology of many cannabinoids is also required. 

206 References – click on this link to access

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6773386/pdf/kepi-14-11-1633868.pdf

6. Canadian Cannabis Consumption and Patterns of Congenital Anomalies: An Ecological Geospatial Analysis.
https://www.ncbi.nlm.nih.gov/pubmed/32187114

Status:
These results show that the northern Territories of Canada share a higher rate of cannabis use together with elevated rates of total congenital anomalies, all cardiovascular defects, Down’s syndrome and gastroschisis. This is the second report of a significant association between cannabis use and both total defects and all cardiovascular anomalies and the fourth published report of a link with Downs syndrome and thereby direct major genotoxicity. The correlative relationships described in this paper are confounded by many features of social disadvantage in Canada’s northern territories. However, in the context of a similar broad spectrum of defects described both in animals and in epidemiological reports from Hawaii, Colorado, USA and Australia they are cause for particular concern and indicate
further.

139 references – click on this link to access https://www.ncbi.nlm.nih.gov/pubmed/32187114

7. The Potential Association Between Prenatal Cannabis use and Congenital Anomalies
https://journals.lww.com/journaladdictionmedicine/Citation/9000/The_Potential_Association_Between_Prenatal.99243.aspx

Status:
Rates of prenatal cannabis use are likely to rise with legalization, increasing social tolerability, and promotion in social media. Cannabis consumption does not appear to be a benign activity, and there may be significant risk factors to the developing fetus when used in pregnancy. Even as epidemiological data continue to emerge, The American College of Obstetricians and Gynecologists and The Society of Obstetricians and Gynecologists of Canada recommend that women avoid the use of cannabis during pregnancy.14 Whether we will definitively establish the risk of prenatal cannabis use on congenital anomalies using epidemiological approaches remains unclear; however, combing data from ecological and patient-level approaches will be crucial. Patient engagement and increasing awareness of the health implications of cannabis are critical first steps to highlight the potential risks of cannabis use in pregnancy.

14. References – click on this link to access
https://journals.lww.com/journaladdictionmedicine/Citation/9000/The_Potential_Association_Between_Prenatal.99243.aspx

8. America Addresses Two Epidemics – Cannabis and Coronavirus and their Interactions: An Ecological Geospatial Study
Status: Embargoed until publication.

Question: Since cannabis is immunosuppressive and is frequently variously contaminated, is its use associated epidemiologically with coronavirus infection rates?

Findings: Geospatial analytical techniques were used to combine coronavirus incidence, drug and cannabinoid use, population, ethnicity, international flight and income data. Cannabis use and daily cannabis use were associated with coronavirus incidence on both bivariate regression and after multivariable spatial regression with high levels of statistical significance. Cannabis use quintiles and cannabis legal status were also highly significant.

Meaning: Significant geospatial statistical associations were shown between cannabis use and coronavirus infection rates consistent with mechanistic reports and environmental exposure concerns.

Extracts from Abstract:

Results. Significant associations of daily cannabis use quintile with CVIR were identified with the highest quintile having a prevalence ratio 5.11 (95%C.I. 4.90-5.33), an attributable fraction in the exposed (AFE) 80.45% (79.61-81.25%) and an attributable fraction in the population of 77.80% (76.88-78.68%) with Chi-squared-for-trend (14,782, df=4) significant at P<10-500. Similarly when cannabis legalization was considered decriminalization was associated with an elevated CVIR prevalence ratio 4.51 (95%C.I. 4.45-4.58), AFE 77.84% (77.50-78.17%) and Chi-squared-for-trend (56,679, df=2) significant at P<10-500. Monthly and daily use were linked with CVIR in bivariate geospatial regression models (P=0.0027, P=0.0059). In multivariable additive models number of flight origins and population density were significant. In interactive geospatial models adjusted for international travel, ethnicity, income, population, population density and drug use, terms including last month cannabis were significant from P=7.3×10-15, daily cannabis use from P=7.3×10-11 and last month cannabis was independently associated (P=0.0365).

Conclusions and Relevance. Data indicate CVIR demonstrates significant trends across cannabis use intensity quintiles and with relaxed cannabis legislation. Recent cannabis use is independently predictive of CVIR in both bivariate and multivariable adjusted models and intensity of use is significant in several interactions. Cannabis thus joins tobacco as a SARS2-CoV-2 risk factor.

Summary and Conclusions

The above research clearly shows the links with substance use and Mental illness, Autism, Congenital anomalies and Paediatric cancer including testicular cancer with marijuana use and abuse. Drug Free Australia respectfully and urgently requests a Position Statement and proposed actions from your Department regarding this research and how it can be further promoted and supported within Australia. We look forward to your timely response.

You can find a list of list of Ngo’s and Medical Professional who written support for Drug Free Australia’s Response to the commercialization of Cannabis/Marijuana/CBD in Australia

https://drugfree.org.au/images/pdf-files/homepagepdf/DRReeceSupport2020_updated6May2020.pdf.

Yours sincerely
Major Brian Watters AO B.A.
President
Drug Free Australia
PO Box 379
Seaford, SA 516

 

Highlights

  • Population-based longitudinal cohort study over 30 years spanning age 19/20 to 49/50
  • Cannabis use in adolescence predicted the occurrence of depression and suicidality in adulthood
  • Association between adolescent cannabis use and adult depression/suicidality hold when adjusted for various covariates, including time-varying pattern of substance abuse in adulthood
  • Younger age at first cannabis use and more frequent use in adolescence related to an particularly increased risk of adult depression

Abstract

  • Objective

    To examine the association between cannabis use in adolescence and the occurrence of depression, suicidality and anxiety disorders during adulthood.

  • Methods

    A stratified population-based cohort of young adults (n = 591) from Zurich, Switzerland, was retrospectively assessed at age 19/20 for cannabis use in adolescence. The occurrence of depression, suicidality and anxiety disorders was repeatedly assessed via semi-structured clinical interviews at the ages of 20/21, 22/23, 27/28, 29/30, 34/35, 40/41, and 49/50. Associations were controlled for various covariates, including socio-economic deprivation in adolescence as well as repeated time-varying measures of substance abuse during adulthood.

  • Results

    About a quarter (24%) reported cannabis use during adolescence; 11% started at age 15/16 or younger and 13% between the ages of 16/17 and 19/20. In the adjusted multivariable model, cannabis use during adolescence was associated with adult depression (aOR = 1.70, 95%-CI = 1.24–2.32) and suicidality (aOR = 1.65, 95%-CI = 1.11–2.47), but not anxiety disorders (aOR = 1.10, 95%-CI = 0.82–1.48). First use at age 15/16 and younger (as against first use between age 16/17 and 19/20 and no use) and frequent use in adolescence (as against less frequent use and no use) were associated with a higher risk of depression in adult life.

  • Conclusions

    In this longitudinal cohort study over 30-years, cannabis use during adolescence was associated with depression and suicidality in adult life. Young age at first use and high frequency of use in adolescence may particularly increase the risk of depression in adulthood. All associations were independent of cannabis abuse and other substance abuse during adulthood.

Introduction

An extensive body of evidence suggests that cannabis use in adolescence increases the risk of adult psychotic disorders (Arseneault et al., 2002, Moore et al., 2007, Rossler et al., 2012); based on Mendelian randomization studies it appears that this association may at least partly be causal (Gage et al., 2017, Vaucher et al., 2018). However, it is less clear whether adolescent cannabis use also predicts depression and other affective disorders (Moore et al., 2007). For instance, a recent 35-year longitudinal cohort study of male conscripts found a weak association between cannabis use and an increased risk for depression, but this association disappeared after adjustment for covariates (Manrique-Garcia et al., 2012).

Another prospective population-based study over 3 years including both male and female adults likewise found that cannabis use at baseline weakly increased the risk of depression and anxiety, but once again these associations disappeared after controlling for covariates (comprising alcohol and drug use, education level, and family climate) (Danielsson et al., 2016). In contrast, a longitudinal cohort study of 14-15 year-old students followed over seven years reported a remarkably strong association between early cannabis use and later depression and anxiety that persisted after adjustment for baseline covariates (Patton et al., 2002). Finally, a recent meta-analysis of longitudinal studies found that adolescent cannabis use predicts the development of depression (OR = 1.4), suicidal ideation (OR = 1.5) and suicide attempts (OR = 3.5), but not anxiety (OR = 1.2), in young adulthood (Gobbi et al., 2019).

The aim of the present work was to re-address the association between adolescent cannabis use and later mood and anxiety disorders. We extended previous research by focusing separately on mood disorders, anxiety disorders and suicidality. Moreover, we did not only control for baseline covariates, such as family climate and socio-economic background, but also for concomitant abuse of both alcohol and illicit drugs (including both cannabis and other substances) across the participants’ adult lives. Finally, with a total observation period of 30 years, the present longitudinal study is much longer than most research conducted thus far.

Section snippets

Participants and sampling procedure

The Zurich Study comprised a cohort of 4547 subjects (m = 2201; f = 2346) representative of the canton of Zurich in Switzerland, who were screened in 1978 with the Symptom Checklist 90-Revised (SCL-90-R) (Derogatis, 1977) when males were 19 and females 20 years old. Male and female participants were sampled with different approaches. In Switzerland, every man of Swiss nationality must undertake a military screening test at the age of 19. With the consent of the military authorities, but…

Results

Comprehensive dropout analyses of this cohort have been presented elsewhere (Eich et al., 2003, Hengartner et al., 2016). In short, dropouts appeared to be either extremely low or extremely high scorers on the SCL GSI, but except for a weak gender bias (men were more likely to drop out) there were no baseline characteristics that predicted early study termination. The frequencies of adolescent cannabis use and baseline socio-demographic characteristics are shown in Table 1. In total 143 of 586…

Discussion

In this 30-year longitudinal cohort-study we examined the associations between cannabis use in adolescence (i.e. before the age of 19/20 years) and the development of depressive disorders, severe suicidality and anxiety disorder during adulthood (i.e. between the ages of 20/21 and 49/50). Our results show that cannabis use in adolescence, independently of substance abuse in adulthood, is significantly related to the occurrence of depressive disorders and severe suicidality, but not to anxiety…

Funding

The Zurich Cohort Study was supported by the Swiss National Science Foundation (Grant number 32-50881.97). The donator/sponsor had no further role in the experimental design, the collection, analysis, and interpretation of data, the writing of this report, or the decision to submit this paper for publication…

Author contributions

MPH drafted the manuscript and conducted all statistical analyses; JA and WR contributed to design and conduct of the study, interpretation of the data and critical revision of the manuscript; VAG contributed to interpretation of the data and critical revision. All authors approved the final version of this manuscript…

Source: https://www.sciencedirect.com/science/article/abs/pii/S0165032719320919 May 2020

Source: 20-Reasons-to-Vote-NO-in-2020-SAM-VERSION-Cannabis.pdf (saynopetodope.org.nz) May 2020

In what is sure to be a controversial finding among cannabis users and proponents, a review of existing research published this week in The Lancet Psychiatry suggests that a single dose of THC may induce a variety of psychiatric symptoms associated with schizophrenia and other psychiatric disorders.

According to a news release issued by The Lancet on March 17:

A single dose of the main psychoactive component in cannabis, tetrahydrocannabinol (THC), can induce a range of psychiatric symptoms, according to results of a systematic review and meta-analysis of 15 studies including 331 people with no history of psychotic or other major psychiatric disorders, published in The Lancet Psychiatry journal.

The study was funded by the Medical Research Council and was conducted by researchers from Kings College London, South London and the Maudsley NHS Foundation Trust, Imperial College London, Leiden University Medical Hospital, Yale University School of Medicine, Connecticut Mental Health Center, and VA Connecticut Healthcare System.

The study also notes that these psychiatric symptoms are not associated with cannabidiol (CBD), one of the other major active compounds in cannabis. The authors reviewed four studies examining CBD’s effects on the development of the same psychiatric symptoms, and no significant differences were found between the effects of CBD and the effects of a placebo. “In studies that focused on whether CBD counters THC-induced symptoms, one study identified reduced symptoms, using a modest sample, but three larger studies failed to replicate this finding.”

The aforementioned news release quotes King’s College professor Oliver Howes as saying, “As the THC-to-CBD ratio of street cannabis continues to increase, it is important to clarify whether these compounds can cause psychotic symptoms. Our finding that THC can temporarily induce psychiatric symptoms in healthy volunteers highlights the risks associated with the use of THC-containing cannabis products. This potential risk should be considered in discussions between patients and medical practitioners thinking about using cannabis products with THC. This work will also inform regulators, public health initiatives, and policy makers considering the medical use of THC-containing cannabis products or their legalisation for recreational use.” 

There’s an important distinction to note here. Although the researchers found that a dose of THC—which they say is roughly equivalent to a single joint—can induce symptoms that mimic those of certain psychiatric disorders, THC does not in fact cause said disorders in users. 

This will come as little surprise to cannabis users, who are well aware from decades of anecdotal evidence that smoking a joint can make some people a little paranoid, but it has certainly never made anyone schizophrenic.

To put things in perspective, consider that in a commentary he wrote for the Straight last August, author and activist Dana Larsen noted that “every analysis of relative drug harms lists cannabis as one of the safest psychoactive substances there is.”

You can read the paper, which is title “Psychiatric symptoms caused by cannabis constituents: a systematic review and meta-analysis”, at the Lancet Psychiatry website.

Source:  https://www.straight.com/cannabis/1374471/review-studies-suggests-thc-cannabis-could-induce-psychotic-symptoms-healthy-people  19th March 2020

Abstract

Objectives: Many reports exist of the cardiovascular toxicity of smoked cannabis but none of arterial stiffness measures or vascular age (VA). In view of its diverse toxicology, the possibility that cannabis-exposed patients may be ageing more quickly requires investigation.

Design: Cross-sectional and longitudinal, observational. Prospective.

Setting: Single primary care addiction clinic in Brisbane, Australia.

Participants: 11 cannabis-only smokers, 504 tobacco-only smokers, 114 tobacco and cannabis smokers and 534 non-smokers.

Exclusions: known cardiovascular disease or therapy or acute exposure to alcohol, amphetamine, heroin or methadone.

Intervention: Radial arterial pulse wave tonometry (AtCor, SphygmoCor, Sydney) performed opportunistically and sequentially on patients between 2006 and 2011.

Main outcome measure: Algorithmically calculated VA.

Secondary outcomes: other central haemodynamic variables.

Results: Differences between group chronological ages (CA, 30.47±0.48 to 40.36±2.44, mean±SEM) were controlled with linear regression. Between-group sex differences were controlled by single-sex analysis. Mean cannabis exposure among patients was 37.67±7.16 g-years. In regression models controlling for CA, Body Mass Index (BMI), time and inhalant group, the effect of cannabis use on VA was significant in males (p=0.0156) and females (p=0.0084). The effect size in males was 11.84%. A dose-response relationship was demonstrated with lifetime exposure (p<0.002) additional to that of tobacco and opioids. In both sexes, the effect of cannabis was robust to adjustment and was unrelated to its acute effects. Significant power interactions between cannabis exposure and the square and cube of CA were demonstrated (from p<0.002).

Conclusions: Cannabis is an interactive cardiovascular risk factor (additional to tobacco and opioids), shows a prominent dose-response effect and is robust to adjustment. Cannabis use is associated with an acceleration of the cardiovascular age, which is a powerful surrogate for the organismal-biological age. This likely underlies and bi-directionally interacts with its diverse toxicological profile and is of considerable public health and regulatory importance.

Keywords: Accelerated aging; Biological age; Biomarkers of aging; Cannabis and aging.

Source: Cannabis exposure as an interactive cardiovascular risk factor and accelerant of organismal ageing: a longitudinal study – PubMed (nih.gov) November 2016

A meta-analysis of all studies worldwide showing association between marijuana use and schizophrenia:

Moore TH, Zammit S, Lingford-Hughes A, et al. Cannabis use and risk of psychotic or affective mental health outcomes: a systematic review. Lancet. 2007;370:319–328.
http://dirwww.colorado.edu/alcohol/downloads/Cannabis_and_behavior.pdf

“There was an increased risk of any psychotic outcome in individuals who had ever used cannabis…with greater risk in people who used cannabis most frequently. There is now sufficient evidence to warn young people that using cannabis could increase their risk of
developing a psychotic illness later in life.”

The most recent study conducted in the United States (Columbia University, New York), showing a high risk (odds ratio, “OR”) for schizophrenia spectrum disorders, particularly in those who become cannabis-dependent:

Davis GP, Compton MT, Wang S, Levin FR, Blanco C. Association between cannabis use, psychosis, and schizotypal personality disorder: findings from the National Epidemiologic Survey on Alcohol and Related Conditions. Schizophr Res. 2013 Dec;151(1-3):197-202.
“There was a similar dose-response relationship between the extent of cannabis use and schizotypal personality disorder (OR=2.02 for lifetime cannabis use, 95% CI 1.69-2.42; OR=2.83 for lifetime cannabis abuse, 95% CI 2.33-2.43; OR=7.32 for lifetime cannabis dependence, 95% CI 5.51-9.72). Likelihood of individual schizotypal features increased significantly with increased extent of cannabis use in a dose-dependent manner.”

Studies that corrected for general genetic background effects and many non-cannabis environmental variables by comparing siblings. The risk ratios are somewhat lower than general population studies, because genetic predisposition is more or less controlled for:

McGrath J, Welham J, Scott J, Varghese D, Degenhardt L, Hayatbakhsh MR, Alati R, Williams GM, Bor W, Najman JM. Association between cannabis use and psychosis-related outcomes using sibling pair analysis in a cohort of young adults. Arch Gen Psychiatry. 2010; 67(5):440-7.
“Longer duration since first cannabis use was associated with multiple psychosis-related outcomes in young adults… the longer the duration since first cannabis use, the higher the risk of psychosis-related outcomes…
Compared with those who had never used cannabis, young adults who had 6 or more years since first use of cannabis (i.e., who commenced use when around 15 years or younger) were twice as likely to develop a nonaffective psychosis…
This study provides further support for the hypothesis that early cannabis use is a risk-modifying factor for psychosis-related outcomes in young adults.”

Giordano GN, Ohlsson H, Sundquist K, Sundquist J, Kendler KS. The association between cannabis abuse and subsequent schizophrenia: a Swedish national co-relative control study.
Psychol Med. 2014 Jul 3:1-8. [Epub ahead of print]
http://journals.cambridge.org/download.php?file=%2FPSM%2FS0033291714001524a.pdf&code=79f795824a92c8eead870197ef071dd8

“Allowing 7 years from initial CA registration to later diagnosis, the risk for schizophrenia in discordant full sibling pairs remained almost twofold….The results of this study therefore lend support to the etiologic hypothesis, that CA is one direct cause of later schizophrenia.”

Those diagnosed with schizophrenia who also use recreational drugs are much more likely to be violent, including those who use cannabis:

Fazel S, Långström N, Hjern A, Grann M, Lichtenstein P. Schizophrenia, substance abuse, and violent crime. JAMA. 2009 May 20;301(19):2016-23.
“The risk was mostly confined to patients with substance abuse comorbidity (of whom 27.6% committed an offense), yielding an increased risk of violent crime among such patients (adjusted OR, 4.4; 95% CI,3.9-5.0), whereas the risk increase was small in schizophrenia patients without substance abuse comorbidity (8.5% of whom had at least 1 violent offense; adjusted OR,1.2; 95% CI, 1.1-1.4; P<0.001 for interaction).”

Fazel S, Gulati G, Linsell L, Geddes JR, Grann M. Schizophrenia and violence: systematic review and meta-analysis. PLoS Med. 2009 Aug;6(8):e1000120. doi: 10.1371/journal.pmed.1000120. Epub 2009 Aug 11.
“The effect of comorbid substance abuse was marked with….. an OR of 8.9” (as compared to the general population)

Arseneault L, Moffitt TE, Caspi A, Taylor PJ, Silva PA. Mental disorders and violence in a total birth cohort: results from the Dunedin Study. Arch Gen Psychiatry. 2000;57(10):979-86.
“for having more than two of these disorders at once…..the OR (odds ratio for violence) was, …..for marijuana dependence plus schizophrenia spectrum disorder, 18.4”

Harris AW, Large MM, Redoblado-Hodge A, Nielssen O, Anderson J, Brennan J. Clinical and cognitive associations with aggression in the first episode of psychosis. Aust N Z J Psychiatry. 2010 Jan;44(1):85-93.
‘The use of cannabis with a frequency of more than fourfold in the previous month was the only factor that was found to be associated with serious aggression’

Self-report of psychotic symptoms by otherwise healthy users (12% to 15%):

Thomas H. A community survey of adverse effects of cannabis use. Drug Alcohol Depend. 1996 Nov;42(3):201-7.
“This survey estimates the frequency of various adverse effects of the use of the drug cannabis. A sample of 1000 New Zealanders aged 18-35 years were asked to complete a self-administered questionnaire on cannabis use and associated problems. The questionnaire was derived from criteria for the identification of cannabis abuse which are analagous to criteria commonly used to diagnose alcoholism. Of those who responded 38% admitted to having used cannabis. The most common physical or mental health problems, experienced by 22% of users were acute anxiety or panic attacks following cannabis use. Fifteen percent reported psychotic symptoms following use.”

Smith MJ, Thirthalli J, Abdallah AB, Murray RM, Cottler LB. Prevalence of psychotic symptoms in substance users: a comparison across substances. Compr Psychiatry. 2009 May-Jun;50(3):245-50. doi: 10.1016/j.comppsych.2008.07.009. Epub 2008 Sep 23.
“Among all users of substances without a diagnosis of abuse or dependence, cannabis users reported the highest prevalence of psychotic symptoms (12.4%).”

Barkus EJ, Stirling J, Hopkins RS, Lewis S.. Cannabis-induced psychosis-like experiences are associated with high schizotypy Psychopathology 2006;39(4):175-8.
“In the sample who reported ever using cannabis (72%) the means for the subscales from the CEQ were as follows: ……Psychotic-Like Experiences (12.98%).”

Rates of psychotic symptoms in those with cannabis dependence as compared to non-dependent users and nonusers:

Fergusson DM, Horwood LJ, Swain-Campbell NR. Cannabis dependence and psychotic symptoms in young people. Psychol Med. 2003 Jan;33(1):15-21.
“Young people meeting DSM-IV criteria for cannabis dependence had elevated rates of psychotic symptoms at ages 18 (rate ratio = 3.7; 95% CI 2.8-5.0; P < 0.0001) and 21 (rate ratio = 2.3; 95% CI 1.7-3.2; P < 0.0001).”

Smith MJ, Thirthalli J, Abdallah AB, Murray RM, Cottler LB. Prevalence of psychotic symptoms in substance users: a comparison across substances. Compr Psychiatry. 2009 May-Jun;50(3):245-50. doi: 10.1016/j.comppsych.2008.07.009. Epub 2008 Sep 23.
“more than half of the respondents who were dependent on cocaine (80%), cannabis (63.5%), amphetamines (56.1%), and opiates (53.1%) reported psychotic symptoms. Among all users of substances without a diagnosis of abuse or dependence, cannabis users reported the highest prevalence of psychotic symptoms (12.4%)……. There was also a marked increase in the risk for psychotic symptoms when dependence became moderate or severe for cannabis (OR=25.1, OR=26.8; respectively).”

Studies on the psychotomimetic properties of THC administered to healthy individuals in the clinic:

D’Souza DC, Perry E, MacDougall L, Ammerman Y, Cooper T, Wu YT, Braley G, Gueorguieva R, Krystal JH. The psychotomimetic effects of intravenous delta-9-tetrahydrocannabinol in healthy individuals: implications for psychosis. Neuropsychopharmacology. 2004 Aug;29(8):1558-72.
“∆-9-THC (1) produced schizophrenia-like positive and negative symptoms; (2) altered perception;(3) increased anxiety; (4) produced euphoria; (5) disrupted immediate and delayed word recall, sparing recognition recall; (6) impaired performance on tests of distractibility, verbal fluency, and working memory (7) did not impair orientation; (8) increased plasma cortisol. These data indicate that D-9-THC produces a broad range of transient symptoms, behaviors, and cognitive deficits in healthy individuals that resemble some aspects of endogenous psychoses.”

Morrison PD, Nottage J, Stone JM, Bhattacharyya S, Tunstall N, Brenneisen R, Holt D, Wilson D, Sumich A, McGuire P, Murray RM, Kapur S, Ffytche DH. Disruption of frontal θ coherence by ∆9-tetrahydrocannabinol is associated with positive psychotic symptoms. Neuropsychopharmacology. 2011;;36(4):827-36.
“Compared with placebo, THC evoked positive and negative psychotic symptoms, as measured by the positive and negative syndrome scale (p<0.001)…… The results reveal that the pro-psychotic effects of THC might be related to impaired network dynamics with impaired communication between the right and left frontal lobes.”

Bhattacharyya S, Crippa JA, Allen P, Martin-Santos R, Borgwardt S, Fusar-Poli P, Rubia K, Kambeitz J, O’Carroll C, Seal ML, Giampietro V, Brammer M, Zuardi AW, Atakan Z, McGuire PK. Induction of psychosis by ∆9-tetrahydrocannabinol reflects modulation of prefrontal and striatal function during attentional salience processing. Arch Gen Psychiatry. 2012 Jan;69(1):27-36. doi: 10.1001/archgenpsychiatry.2011.161.
“Pairwise comparisons revealed that 9-THC significantly increased the severity of psychotic symptoms compared with placebo (P<.001) and CBD (P<.001).”,

Freeman D, Dunn G, Murray RM, Evans N, Lister R, Antley A, Slater M, Godlewska B, Cornish R, Williams J, Di Simplicio M, Igoumenou A, Brenneisen R, Tunbridge EM, Harrison PJ, Harmer CJ, Cowen P, Morrison PD. How Cannabis Causes Paranoia: Using the Intravenous Administration of ∆9-Tetrahydrocannabinol (THC) to Identify Key Cognitive Mechanisms Leading to Paranoia. Schizophr Bull. 2014 Jul 15. pii: sbu098. [Epub ahead of print]
“THC significantly increased paranoia, negative affect (anxiety, worry, depression, negative thoughts about the self), and a range of anomalous experiences, and reduced working memory capacity.”

For data on dose-response (a very large study by Zammit et al., and another by van Os et al.) and the greater risk for psychosis posed by high strength marijuana (DiForti et al.):

Zammit S, Allebeck P, Andreasson S, Lundberg I, Lewis G, 2002, Self reported cannabis use as a risk factor for schizophrenia in Swedish conscripts of 1969: historical cohort study. BMJ. 2002 Nov 23;325(7374):1199. http://www.bmj.com/content/325/7374/1199.full.pdf
“We found a dose dependent relation between frequency of cannabis use and risk of schizophrenia, with an adjusted odds ratio for linear trend across the categories of frequency of cannabis use used in this study of 1.2 (1.1 to 1.4, P < 0.001). The adjusted odds ratio for subjects with a history of heaviest use of cannabis ( > 50 occasions) was 3.1 (1.7 to 5.5)………………Cannabis use is associated with an increased risk of
developing schizophrenia, consistent with a causal relation. This association is not explained by use of other psychoactive drugs or personality traits relating to social integration.”

van Os J, Bak M, Hanssen M, Bijl RV, de Graaf R, Verdoux H. Cannabis use and psychosis: a longitudinal population-based study. Am J Epidemiol. 2002 Aug 15;156(4):319-27.
“…..further evidence supporting the hypothesis of a causal relation is demonstrated by the existence of a dose-response relation.. between cumulative exposure to cannabis use and the psychosis outcome……. About 80 percent of the psychosis outcome associated with exposure to both cannabis and an established vulnerability to psychosis was attributable to the synergistic action of these two factors. This finding indicates that, of the subjects exposed to both a vulnerability to psychosis and cannabis use, approximately 80 percent had the psychosis outcome because of the combined action of the two risk factors and only about 20 percent because of the action of either factor alone.”

DiForti M, Morgan C, Dazzan P, Pariante C, Mondelli V, Marques TR, Handley R, Luzi S, Russo M, Paparelli A, Butt A, Stilo SA, Wiffen B, Powell J, Murray RM. High-potency cannabis and the risk of psychosis. Br J Psychiatry. 2009,195(6):488-91.
“78% (n = 125) of the cases group preferentially used sinsemilla (skunk) compared with only 31% (n = 41) of the control group (unadjusted OR= 8.1, 95% CI 4.6–13.5). This association was only slightly attenuated after controlling for potential confounders (adjusted OR= 6.8, 95% CI 2.6–25.4)………. Our most striking finding is that patients with a first episode of psychosis preferentially used high-potency cannabis preparations of the sinsemilla (skunk) variety…… our results suggest that the potency and frequency of cannabis use may interact in further increasing the risk of psychosis.”

DiForti M, Marconi A, Carra E, Fraietta S, Trotta A, Bonomo M, Bianconi F, Gardner-Sood P, O’Connor J, Russo M, Stilo SA, Marques TR, Mondelli V, Dazzan P, Pariante C, David AS, Gaughran F, Atakan Z, Iyegbe C, Powell J, Morgan C, Lynskey M, Murray RM. Proportion of
patients in south London with first-episode psychosis attributable to use of high potency cannabis: a case-control study. Lancet Psychiatry, online February 18, 2015, http://dx.doi.org/10.1016/S2215-0366(14)00117-5.
“In the present larger sample analysis, we replicated our previous report and showed that the highest probability to suffer a psychotic disorder is in those who are daily users of high potency cannabis. Indeed, skunk use appears to contribute to 24% of cases of first episode psychosis in south London. Our findings show the importance of raising awareness among young people of the risks associated with the use of high-potency cannabis. The need for such public education is emphasised by the worldwide trend of liberalisation of the legal constraints on cannabis and the fact that high potency varieties are becoming much more widely available.”

For data on percent of those with marijuana-induced psychosis who go on to receive a diagnosis of a schizophrenia spectrum disorder:

Arendt M, Mortensen PB, Rosenberg R, Pedersen CB, Waltoft BL. Familial predisposition for psychiatric disorder: comparison of subjects treated for cannabis-induced psychosis and schizophrenia. Arch Gen Psychiatry. 2008;65(11):1269-74. http://archpsyc.ama-assn.org/cgi/reprint/65/11/1269
“Approximately half of the subjects who received treatment of a cannabis induced psychosis developed a schizophrenia spectrum disorder within 9 years after treatment…… The risk of schizophrenia after a cannabis-induced psychosis is independent of familial predisposition……. cannabis-induced psychosis may not be a valid diagnosis but an early marker of schizophrenia……. Psychotic symptoms after cannabis
use should be taken extremely seriously.”

Niemi-Pynttäri JA, Sund R, Putkonen H, Vorma H, Wahlbeck K, Pirkola SP. Substance-induced psychoses converting into schizophrenia: a register-based study of 18,478 Finnish inpatient cases. J Clin Psychiatry. 2013 74(1):e94-9.
“Eight-year cumulative risk to receive a schizophrenia spectrum diagnosis was 46% for persons with a diagnosis of cannabis-induced psychosis ….. chances for amphetamine-, hallucinogen-, opioid-, sedative- and alcohol-induced (schizophrenia spectrum diagnoses) were 30%, 24%, 21%, and 5% respectively.”

For cause and effect (which comes first: psychosis or marijuana use):
Arseneault L, Cannon M, Poulton R, Murray R, Caspi A, Moffitt TE, 2002, Cannabis use in
adolescence and risk for adult psychosis: longitudinal prospective study.BMJ. 2002 Nov 23;325(7374):1212-3.
“Firstly, cannabis use is associated with an increased risk of experiencing schizophrenia symptoms, even after psychotic symptoms preceding the onset of cannabis use are controlled for, indicating that cannabis use is not secondary to a pre-existing psychosis. Secondly, early cannabis use (by age 15) confers greater risk for schizophrenia outcomes than later cannabis use (by age 18). Thirdly, risk was specific to cannabis use, as opposed to use of other drugs….”

Henquet C, Krabbendam L, Spauwen J, et al. Prospective cohort study of cannabis use, predisposition for psychosis, and psychotic symptoms in young people. BMJ. 2005;330:11–15. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC539839/pdf/bmj33000011.pdf
“Exposure to cannabis during adolescence and young adulthood increases the risk of psychotic symptoms later in life. Cannabis use at baseline increased the cumulative incidence of psychotic symptoms at follow up four years later…but has a much stronger effect in those with evidence of predisposition for psychosis……….Predisposition for psychosis at baseline did not significantly predict cannabis use four years later..”

and also:

Kuepper R, van Os J, Lieb R, Wittchen HU, Höfler M, Henquet C. Continued cannabis use and risk of incidence and persistence of psychotic symptoms: 10 year follow-up cohort study.BMJ. 2011 Mar 1;342: d738 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3047001/pdf/bmj.d738.pdf
“In individuals who had no reported lifetime psychotic symptoms and no reported lifetime cannabis use at baseline, incident cannabis use over the period from baseline to T2 increased the risk of later incident psychotic symptoms over the period from T2 to T3 (adjusted odds ratio 1.9, 95% confidence interval 1.1 to 3.1; P=0.021)…………There was no evidence for self medication effects, as psychotic experiences at T2 did not predict incident cannabis use between T2 and T3 (0.8, 0.6 to 1.2; P=0.3).”

For data on those who quit using when psychotic symptoms develop (further evidence against self-medication):

Fergusson DM, Horwood LJ, Ridder EM. Tests of causal linkages between cannabis use and psychotic symptoms. Addiction. 2005;100(3):354-66.

For degree of risk relative to other drugs:

Niemi-Pynttäri JA, Sund R, Putkonen H, Vorma H, Wahlbeck K, Pirkola SP. Substance-induced psychoses converting into schizophrenia: a register-based study of 18,478 Finnish inpatient cases. J Clin Psychiatry. 2013 74(1):e94-9.
“Eight-year cumulative risk to receive a schizophrenia spectrum diagnosis was 46% for persons with a diagnosis of cannabis-induced psychosis ….. chances for amphetamine-, hallucinogen-, opioid-, sedative- and alcohol-induced (schizophrenia spectrum diagnoses) were 30%, 24%, 21%, and 5% respectively.”

Smith MJ, Thirthalli J, Abdallah AB, Murray RM, Cottler LB. Prevalence of psychotic symptoms in substance users: a comparison across substances. Compr Psychiatry. 2009 May-Jun;50(3):245-50. doi: 10.1016/j.comppsych.2008.07.009. Epub 2008 Sep 23.
“more than half of the respondents who were dependent on cocaine (80%), cannabis (63.5%), amphetamines (56.1%), and opiates (53.1%) reported psychotic symptoms. Among all users of substances without a diagnosis of abuse or dependence, cannabis users reported the highest prevalence of psychotic symptoms (12.4%)……. There was also a marked increase in the risk for psychotic symptoms when dependence became moderate or severe for cannabis (OR=25.1, OR=26.8; respectively).”

Another angle on the potential confound of self-medication: genetic predisposition for schizophrenia does not predict cannabis use:

Veling W, Mackenbach JP, van Os J, Hoek HW. Cannabis use and genetic predisposition for schizophrenia: a case-control study. Psychol Med. 2008 Sep;38(9):1251-6. Epub 2008 May 19.
“BACKGROUND: Cannabis use may be a risk factor for schizophrenia. RESULTS: Cannabis use predicted schizophrenia [adjusted odds ratio (OR) cases compared to general hospital controls 7.8, 95% confidence interval (CI) 2.7-22.6; adjusted OR cases compared to siblings 15.9 (95% CI 1.5-167.1)], but genetic predisposition for schizophrenia did not predict cannabis use [adjusted OR intermediate predisposition
compared to lowest predisposition 1.2 (95% CI 0.4-3.8)].”

For data on potential benefits of cessation:

González-Pinto A, Alberich S, Barbeito S, Gutierrez M, Vega P, Ibáñez B, Haidar MK, Vieta E, Arango C. Cannabis and first-episode psychosis: different long-term outcomes depending on continued or discontinued use. Schizophr Bull. 2011 May;37(3):631-9. Epub 2009 Nov 13. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3080669/pdf/sbp126.pdf
“OBJECTIVE: To examine the influence of cannabis use on long-term outcome in patients with a first psychotic episode, comparing patients who have never used cannabis with (a) those who used cannabis before the first episode but stopped using it during follow-up and (b) those who used cannabis both before the first episode and during follow-up….. CONCLUSION: Cannabis has a deleterious effect, but stopping use after the first psychotic episode contributes to a clear improvement in outcome. The positive effects of stopping cannabis use can be seen more clearly in the long term.”

Kuepper R, van Os J, Lieb R, Wittchen HU, Höfler M, Henquet C. Continued cannabis use and risk of incidence and persistence of psychotic symptoms: 10 year follow-up cohort study.BMJ. 2011 Mar 1;342: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3047001/pdf/bmj.d738.pdf
“The finding that longer exposure to cannabis was associated with greater risk for persistence of psychotic experiences is in line with an earlier study showing that continued cannabis use over time increases the risk for psychosis in a dose-response fashion. This is also in agreement with the hypothesis that a process of sensitisation might underlie emergence and persistence of psychotic experiences as an indicator of liability to psychotic disorder.”

For data on marijuana use resulting in an earlier age of onset of schizophrenia (suggestive of causality), see Dragt et al. and a meta-analysis (see Large et al.,); also: a very extensive (676 schizophrena patients) and therefore more statistically powered analysis (see DeHert paper); two papers showing that the age-of-onset effect may be specific to those without a family history (see Scherr et al. and Leeson et al., papers); two studies that evaluate the age of onset specific to gender (Veen et al. and Compton et al. ) which is important because comparing across genders can be confounded by the greater tendency of males to engage in risky behavior (the conclusions are not the same in terms of gender; the gender distribution was slightly better in the Veen et al. study) and finally, two papers of relevance to specificity of age of onset effect to cannabis, a meta-analysis of published studies on age of onset that shows another drug of abuse (tobacco) is not associated with
a decreased age of onset (Myles et al.) and a study showing that ecstasy, LSD, stimulants, or sedatives did not have an effect to lower age of onset whereas cannabis use did (Barnes et al.) :

Large M, Sharma S, Compton MT, Slade T, Nielssen O. Cannabis Use and Earlier Onset of Psychosis: A Systematic Meta-analysis. Arch Gen Psychiatry. 2011 68(6):555-61. http://www.ncbi.nlm.nih.gov/pubmed/21300939
“The results of meta-analysis provide evidence for a relationship between cannabis use and earlier onset of psychotic illness, and they support the hypothesis that cannabis use plays a causal role in the development of psychosis in some patients. The results suggest the need for renewed warnings about the potentially harmful effects of cannabis.”

Dragt S, Nieman DH, Schultze-Lutter F, van der Meer F, Becker H, de Haan L, Dingemans PM, Birchwood M, Patterson P, Salokangas RK, Heinimaa M, Heinz A, Juckel G, Graf von Reventlow H, French P, Stevens H, Ruhrmann S, Klosterkötter J, Linszen DH; on behalf of the EPOS group.Cannabis use and age at onset of symptoms in subjects at clinical high risk for psychosis. Acta Psychiatr Scand. 2011 Aug 29. doi: 10.1111/j.1600-0447.2011.01763.x. [Epub ahead of print]
“Cannabis use and age at onset of symptoms in subjects at clinical high risk for psychosis. Objective: Numerous studies have found a robust association between cannabis use and the onset of psychosis. Nevertheless, the relationship between cannabis use and the onset of early (or, in retrospect, prodromal) symptoms of psychosis remains unclear. The study focused on investigating the relationship between cannabis
use and early and high-risk symptoms in subjects at clinical high risk for psychosis. Results: Younger age at onset of cannabis use or a cannabis use disorder was significantly related to younger age at onset of six symptoms (0.33 < r(s) < 0.83, 0.004 < P < 0.001). Onset of cannabis use preceded symptoms in most participants. Conclusion: Our results provide support that cannabis use plays an important role in the development of psychosis in vulnerable individuals.”

De Hert M, Wampers M, Jendricko T, Franic T, Vidovic D, De Vriendt N, Sweers K, Peuskens J, van Winkel R.Effects of cannabis use on age at onset in schizophrenia and bipolar disorder. Schizophr Res. 2011 Mar;126(1-3):270-6.

“BACKGROUND: Cannabis use may decrease age at onset in both schizophrenia and bipolar disorder, given the evidence for substantial phenotypic and genetic overlap between both disorders….RESULTS:… Both cannabis use and a schizophrenia diagnosis predicted earlier age at onset. There was a significant interaction between cannabis use and diagnosis, cannabis having a greater effect in bipolar patients….DISCUSSION:…. Our results suggest that cannabis use is associated with a reduction in age at onset in both schizophrenic and bipolar patients. This reduction seems more pronounced in the bipolar group than in the schizophrenia group: the use of cannabis reduced age at onset by on average 8.9 years in the bipolar group, as compared to an average predicted reduction of 1.5 years in the schizophrenia group.”

Scherr M, Hamann M, Schwerthöffer D, Froböse T, Vukovich R, Pit schel-Walz G, Bäuml J.. Environmental risk factors and their impact on the age of onset of schizophrenia: Comparing familial to non-familial schizophrenia. Nord J Psychiatry. 2011 Aug 31. [Epub ahead of print]
“Background and aims: Several risk factors for schizophrenia have yet been identified. The aim of our study was to investigate how certain childhood and adolescent risk factors predict the age of onset of psychosis in patients with and without a familial component (i.e. a relative with schizophrenia or schizoaffective disorder). Results: Birth complications and cannabis abuse are predictors for an earlier onset of schizophrenia in patients with non-familial schizophrenia. No environmental risk factors for an earlier age of onset in familial schizophrenia have been identified.”

Leeson VC, Harrison I, Ron MA, Barnes TR, Joyce EM. The Effect of Cannabis Use and Cognitive Reserve on Age at Onset and Psychosis Outcomes in First-Episode Schizophrenia. Schizophr Bull. 2011 Mar 9. [Epub ahead of print] http://schizophreniabulletin.oxfordjournals.org/content/early/2011/03/09/schbul.sbq153.full.pdf+html
“Objective: Cannabis use is associated with a younger age at onset of psychosis, an indicator of poor prognosis, but better cognitive function, a positive prognostic indicator. We aimed to clarify the role of age at onset and cognition on outcomes in cannabis users with first-episode schizophrenia as well as the effect of cannabis dose and cessation of use……Conclusions: Cannabis use brings forward the onset of psychosis in people who otherwise have good prognostic features indicating that an early age at onset can be due to a toxic action of cannabis rather than an intrinsically more severe illness. Many patients abstain over time, but in those who persist, psychosis is more difficult to treat.”

Veen ND, Selten JP, van der Tweel I, Feller WG, Hoek HW, Kahn RS. Cannabis use and age at onset of schizophrenia. Am J Psychiatry. 2004 Mar;161(3):501-6. http://ajp.psychiatryonline.org/cgi/reprint/161/3/501
“The results indicate a strong association between use of cannabis and earlier age at first psychotic episode in male schizophrenia patients.”

Compton MT, Kelley ME, Ramsay CE, Pringle M, Goulding SM, Esterberg ML, Stewart T, Walker EF. Association of pre-onset cannabis, alcohol, and tobacco use with age at onset of prodrome and age at onset of psychosis in first-episode patients. Am J Psychiatry. 2009 Nov;166(11):1251-7. Epub 2009 Oct 1. http://ajp.psychiatryonlie.org/cgi/reprint/166/11/1251
“Whereas classifying participants according to maximum frequency of use prior to onset (none, ever, weekly, or daily) revealed no significant effects of cannabis or tobacco use on risk of (editor’s note: “timing of”) onset, analysis of change in frequency of use prior to
onset indicated that progression to daily cannabis and tobacco use was associated with an increased risk of onset of psychotic symptoms. Similar or even stronger effects were observed when onset of illness or prodromal symptoms was the outcome. A gender-by-daily-cannabis use interaction was observed; progression to daily use resulted in a much larger increased relative risk of onset of psychosis in females than in males.”

Myles N, Newall H, Compton MT, Curtis J, Nielssen O, Large M. The age at onset of psychosis and tobacco use: a systematic meta-analysis. Soc Psychiatry Psychiatr Epidemiol. 2011 Sep 8. [Epub ahead of print]
“Unlike cannabis use, tobacco use is not associated with an earlier onset of psychosis.”

Barnes TR, Mutsatsa SH, Hutton SB, Watt HC, Joyce EM. Comorbid substance use and age at onset of schizophrenia. Br J Psychiatry. 2006 Mar;188:237-42. http://bjp.rcpsych.org/content/188/3/237.full.pdf+html
“Alcohol misuse and any substance use (other than cannabis use) were not significant in relation to age at onset….. those patients in the sample who reported that they had used cannabis had an earlier age at onset of psychosis than other patients who did not report cannabis use but who shared the same profile with regard to the other variables (e.g. comparing men who reported alcohol misuse and use of both cannabis and other drugs with men who had the same characteristics apart from the fact that they had not used cannabis).”

Data from other cultures

Sarkar J, Murthy P, Singh SP. Psychiatric morbidity of cannabis abuse. Indian J Psychiatry. 2003 Jul;45(3):182-8. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2952166/pdf/IJPsy-45-182.pdf
“The paper evaluates the hypothesis that cannabis abuse is associated with a broad range of psychiatric disorders in India, an area with relatively high prevalence of cannabis use. Retrospective case-note review of all cases with cannabis related diagnosis over a 11 -year period, for subjects presenting to a tertiary psychiatric hospital in southern India was carried out. Information pertaining to sociodemographic, personal, social, substance-use related, psychiatric and treatment histories, was gathered. Standardized diagnoses were made according to Diagnostic Criteria for Research of the World Health Organization, on the basis of information available.Cannabis abuse is associated with
widespread psychiatric morbidity that spans the major categories of mental disorders under the ICD-10 system, although proportion of patients with psychotic disorders far outweighed those with non-psychotic disorders. Whilst paranoid psychoses were more prevalent, a significant number of patients with affective psychoses, particularly mania, was also noted.”

Rodrigo C, Welgama S, Gunawardana A, Maithripala C, Jayananda G, Rajapakse S. A retrospective analysis of cannabis use in a cohort of mentally ill patients in Sri Lanka and its implications on policy development. Subst Abuse Treat Prev Policy. 2010 Jul 8;5:16. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2910013/pdf/1747-597X-5-16.pdf
”BACKGROUND: Several epidemiological studies have shown that cannabis; the most widely used illegal drug in the world, is associated with schizophrenia spectrum disorders (SSD)……. CONCLUSIONS: Self reported LTC (editor’s note: life time cannabis) use was strongly associated with being diagnosed with SSD (editor’s note: schizophrenia spectrum disorders”.

Population study showing change in incidence rate in young when drug laws are eased

Ajdacic-Gross V, Lauber C, Warnke I, Haker H, Murray RM, Rössler W. Changing incidence of psychotic disorders among the young in Zurich. Schizophr Res. 2007 Sep;95(1-3):9-18. Epub 2007 Jul 16.
“There is controversy over whether the incidence rates of schizophrenia and psychotic disorders have changed in recent decades. To detect deviations from trends in incidence, we analysed admission data of patients with an ICD-8/9/10 diagnosis of psychotic disorders in the Canton Zurich / Switzerland, for the period 1977-2005. The data was derived from the central psychiatric register of the Canton Zurich. Ex-post forecasting with ARIMA (Autoregressive Integrated Moving Average) models was used to assess departures from existing trends. In addition, age-period-cohort analysis was applied to determine hidden birth cohort effects. First admission rates of patients with psychotic
disorders were constant in men and showed a downward trend in women. However, the rates in the youngest age groups showed a strong increase in the second half of the 1990’s. The trend reversal among the youngest age groups coincides with the increased
use of cannabis among young Swiss in the 1990’s.”

Estimates of how many men aged 20-40 would have to avoid regular marijuana use for one year in order to prevent one case of schizophrenia in that same year (but for number relevant to a 20 year avoidance of schizophrenia by avoiding regular marijuana use during
20 years, divide by 20):

Hickman M, Vickerman P, Macleod J, Lewis G, Zammit S, Kirkbride J, Jones P. If cannabis caused schizophrenia–how many cannabis users may need to be prevented in order to prevent one case of schizophrenia? England and Wales calculations. Addiction. 2009;104(11):1856-61.

“In men the annual mean NNP (number needed to prevent) for heavy cannabis and schizophrenia ranged from 2800 [90% confidence interval (CI) 2018–4530] in those aged 20–24 years to 4700 (90% CI 3114–8416) in those aged 35–39”.

Key studies interpreted to diminish the connection between marijuana and schizophrenia:

Proal AC, Fleming J, Galvez-Buccollini JA, Delisi LE. A controlled family study of cannabis users with and without psychosis. Schizophr Res. 2014 Jan;152(1):283-8.
“The results of the current study, both when analyzed using morbid risk and family frequency calculations, suggest that having an increased familial risk for schizophrenia is the underlying basis for schizophrenia in these samples and not the cannabis use. While cannabismay have an effect on theage of onset of schizophrenia it is unlikely to be the cause of illness.”

Rebuttal: Miller CL. Caution urged in interpreting a negative study of cannabis use and schizophrenia. Schizophr Res. 2014 Apr;154(1-3):119-20.
“The morbid risk reported for the relatives of the non-cannabis-using patients (Sample 3) was actually 1.4-fold higher than the cannabis using patients (Sample 4), but the study did not have enough power to statistically confirm or refute a less than 2-fold difference. An increase in sample size would be required to do so, and if the observed difference were to be confirmed, it would explain not only why the Sample 4 data fits poorly with a multigene/small environmental impact model but also would give weight to the premise that cannabis use significantly contributes to the development of this disease.”

Power RA, Verweij KJ, Zuhair M, Montgomery GW, Henders AK, Heath AC, Madden PA, Medland SE, Wray NR, Martin NG. Genetic predisposition to schizophrenia associated with increased use of cannabis. Mol Psychiatry. 2014 Jun 24. doi: 10.1038/mp.2014.51. [Epub ahead of print] http://emilkirkegaard.dk/en/wp-content/uploads/Genetic%20predisposition%20to%20schizophrenia%20associated%20with%20increased%20use%20of%20cannabis.pdf
“Our results show that to some extent the association between cannabis and schizophrenia is due to a shared genetic aetiology across common variants. They suggest that individuals with an increased genetic predisposition to schizophrenia are
both more likely to use cannabis and to use it in greater quantities.”

Rebuttal: Had this paper been titled “The causal genes for schizophrenia have been discovered” it would never have been published. In the absence of a consistent finding of genes of major effect size for schizophrenia, this study of inconsistently associated genes of low effect size is meaningless.

Buchy L, Perkins D, Woods SW, Liu L, Addington J. Impact of substance use on conversion to psychosis in youth at clinical high risk of psychosis. Schizophrenia Res 156 (2-3): 277–280.
“Results revealed that low use of alcohol, but neither cannabis use nor tobacco use at baseline, contributed to the prediction of psychosis in the CHR sample”.
Rebuttal: The study was small in size and the age range of their subjects at study onset was large (12 to 31) which included both subjects that had not reached the peak age of risk for schizophrenia even by the end of the study as well as subjects who were well past the peak age of onset of schizophrenia. The fact that the study screened out psychotic individuals was problematic for the latter group, in that those who were most vulnerable to the psychosis inducing effects of cannabis would already have converted to psychosis by that age.

Overview of Key Public Health Issues Regarding the Mental Health Effects of Marijuana

For the monetary cost of schizophrenia to the U.S. annually ($63 billion in 2002 dollars):

Wu EQ, Birnbaum HG, Shi L, Ball DE, Kessler RC, Moulis M, Aggarwal J. The economic burden of schizophrenia in the United States in 2002. J Clin Psychiatry. 2005 Sep;66(9):1122-9.

For the trends in adolescent drug, alcohol and cigarette use, showing an upward tick in marijuana use as medical marijuana has become more prevalent, and that the mind-altering drug legal for adults (alcohol) is still more commonly used by teens than is marijuana:

Johnston, L. D., O’Malley, P. M., Bachman, J. G., & Schulenberg, J. E. (2012). Monitoring the Future national results on adolescent drug use: Overview of key findings, 2011. Ann Arbor, MI: Institute for Social Research, The University of Michigan.

For a summary of Sweden’s drug law experience:
Hallam C., 2010, Briefing paper 20, The Beckley Foundation: What Can We Learn from Sweden’s Drug Policy Experience? www.beckleyfoundation.org/pdf/BriefingPaper_20.pdf
“in the case of Sweden, the clear association between a restrictive drug policy and low levels of drug use is striking. In his foreword to the article on Sweden’s Successful Drug Policy, Antonio Maria Costa is frank enough to confess that, “It is my firm belief that the generally positive situation of Sweden is a result of the policy that has been applied to address the problem”.

For data showing the relationship between drug enforcement policies in Europe and drug use, such that Sweden has a zero tolerance policy on drugs and has one of the lowest rates of “last month use” in Europe (1%), 4-fold lower than the Netherlands and 7-fold lower than Spain and Italy, two countries that have liberalized their enforcement policies so that marijuana possession carries no substantive penalty.

European Monitoring Centre for Drugs and Addiction, 2012 Annual report
http://www.emcdda.europa.eu/attachements.cfm/att_190854_EN_TDAC12001ENC_.pdf

Source: Microsoft Word – 2015- Summary of literature on marijuana and psychosis.doc (momsstrong.org) January 2016

(-)-Trans-Δ9-tetrahydrocannabinol (Δ9-THC) is the main compound responsible for the intoxicant activity of Cannabis sativa L. The length of the side alkyl chain influences the biological activity of this cannabinoid. In particular, synthetic analogues of Δ9-THC with a longer side chain have shown cannabimimetic properties far higher than Δ9-THC itself. In the attempt to define the phytocannabinoids profile that characterizes a medicinal cannabis variety, a new phytocannabinoid with the same structure of Δ9-THC but with a seven-term alkyl side chain was identified.

The natural compound was isolated and fully characterized and its stereochemical configuration was assigned by match with the same compound obtained by a stereoselective synthesis. This new phytocannabinoid has been called (-)-trans-Δ9-tetrahydrocannabiphorol (Δ9-THCP). Along with Δ9-THCP, the corresponding cannabidiol (CBD) homolog with seven-term side alkyl chain (CBDP) was also isolated and unambiguously identified by match with its synthetic counterpart. The binding activity of Δ9-THCP against human CB1 receptor in vitro (Ki=1.2nM) resulted similar to that of CP55940 (Ki=0.9nM), a potent full CB1 agonist. In the cannabinoid tetrad pharmacological test, Δ9-THCP induced hypomotility, analgesia, catalepsy and decreased rectal temperature indicating a THC-like cannabimimetic activity.
The presence of this new phytocannabinoid could account for the pharmacological properties of some cannabis varieties difficult to explain by the presence of the sole Δ9-THC.

Cannabis sativa has always been a controversial plant as it can be considered as a lifesaver for several pathologies including glaucoma and epilepsy, an invaluable source of nutrients, an environmentally friendly raw material for manufacturing and textiles, but it is also the most widely spread illicit drug in the world, especially among young adults
.
Its peculiarity is its ability to produce a class of organic molecules called phytocannabinoids, which derive from an enzymatic reaction between a resorcinol and an isoprenoid group. The modularity of these two parts is the key for the extreme variability of the resulting product that has led to almost 150 different known phytocannabinoids. The precursors for the most commonly naturally occurring phytocannabinoids are olivetolic acid and geranyl pyrophosphate, which take part to a condensation reaction leading to the formation of cannabigerolic acid (CBGA). CBGA can be then converted into either tetrahydrocannabinolic acid (THCA) or cannabidiolic acid (CBDA) or cannabichromenic acid (CBCA) by the action of a specific cyclase enzyme. All phytocannabinoids are biosynthesized in the carboxylated form, which can be converted into the corresponding decarboxylated (or neutral) form by heat.

The best known neutral cannabinoids are undoubtedly Δ9-tetrahydrocannabinol (Δ9-THC) and cannabidiol (CBD), the former being responsible for the intoxicant properties of the cannabis plant, and the latter being active as antioxidant, anti-inflammatory, anti-convulsant, but also as antagonist of THC negative effects.
All these cannabinoids are characterized by the presence of an alkyl side chain on the resorcinol moiety made of five carbon atoms. However, other phytocannabinoids with a different number of carbon atoms on the side chain are known and they have been called varinoids (with three carbon atoms), such as cannabidivarin (CBDV) and Δ9-tetrahydrocannabivarin (Δ9 -THCV), and orcinoids (with one carbon atom), such as cannabidiorcol (CBD-C1) and tetrahydrocannabiorcol (THC-C1)7. Both series are biosynthesized in the plant as the specific ketide synthases have been identified.
Our research group has recently reported the presence of a butyl phytocannabinoid series with a four-term alkyl chain, in particular cannabidibutol (CBDB) and Δ9-tetrahydrocannabutol (Δ9-THCB), in CBD samples derived from hemp and in a medicinal cannabis variety. Since no evidence has been provided for the presence of plant enzymes responsible for the biosynthesis of these butyl phytocannabinoids, it has been suggested that they might derive from microbial ω-oxidation and decarboxylation of their corresponding five-term homolog.
The length of the alkyl side chain has indeed proved to be the key parameter, the pharmacophore, for the biological activity exerted by Δ9-THC on the human cannabinoid receptor CB1 as evidenced by structure-activity relationship (SAR) studies collected by Bow and Rimondi. In particular, a minimum of three carbons is necessary to bind the receptor, then the highest activity has been registered with an eight-carbon side chain to finally decrease with a higher number of carbon atoms. Δ8-THC homologs with more than five carbon atoms on the side chain have been synthetically produced and tested in order to have molecules several times more potent than Δ9-THC.
To the best of our knowledge, a phytocannabinoid with a linear alkyl side chain containing more than five carbon atoms has never been reported as naturally occurring. However, our research group disclosed for the first time the presence of seven-term homologs of CBD and Δ9-THC in a medicinal cannabis variety, the Italian FM2, provided by the Military Chemical Pharmaceutical Institute in Florence.

The two new phytocannabinoids were isolated and fully characterized and their absolute configuration was confirmed by a stereoselective synthesis. According to the International Non-proprietary Name (INN), we suggested for these CBD and THC analogues the name “cannabidiphorol” (CBDP) and “tetrahydrocannabiphorol” (THCP), respectively. The suffix “-phorol” comes from “sphaerophorol”, common name for 5-heptyl-benzen-1,3-diol, which constitutes the resorcinol moiety of these two new phytocannabinoids.
A number of clinical trials and a growing body of literature provide real evidence of the pharmacological potential of cannabis and cannabinoids on a wide range of disorders from sleep to anxiety, multiple sclerosis, autism and neuropathic pain20–23. In particular, being the most potent psychotropic cannabinoid, Δ9-THC is the main focus of such studies.

In light of the above and of the results of the SAR studies, we expected that THCP is endowed of an even higher binding affinity for CB1 receptor and a greater cannabimimetic activity than THC itself. In order to investigate these pharmacological aspects of THCP, its binding affinity for CB1 receptor was tested by a radioligand in vitro assay and its cannabimimetic activity was assessed by the tetrad behavioral tests
in mice.
Results
Identifcation of cannabidiphorol (CBDP) and Δ9-tetrahydrocannabiphorol (Δ9-THCP) by liquid chromatography coupled to high-resolution mass spectrometry (LC-HRMS).

The FM2 ethanolic extract was analyzed by an analytical method recently developed for the cannabinoid profiling of this medicinal cannabis variety. As the native extract contains mainly the carboxylated forms of phytocannabinoids as a consequence of a cold extraction25, part of the plant material was heated to achieve decarboxylation where the predominant forms are neutral phytocannabinoids.

The advanced analytical platform of ultra-high performance liquid chromatography coupled to high resolution Orbitrap mass spectrometry was employed to analyze the FM2 extracts and study the fragmentation spectra of the analytes under investigation. The precursor ions of the neutral derivatives cannabidiphorol (CBDP) and Δ9-tetrahydrocannabiphorol (Δ9-THCP), 341.2486 for the [M-H]− and 343.2632 for the [M+H]+, showed an elution time of 19.4 min for CBDP and 21.3 min for Δ9-THCP (Fig. 1a).
Their identification was confirmed by the injection of a mixture (5 ng/mL) of the two chemically synthesized CBDP and Δ9-THCP (Fig. 1b) as it will be described later. As for their carboxylated counterpart, the precursor ions of the neutral forms CBDP and Δ9-THCP break in the same way in ESI+mode, but they show a different fragmentation pattern in ESI− mode. Whilst Δ9-THCP shows only the precursor ion [M-H]− (Fig. 1d), CBDP molecule generates the fragments at m/z 273.1858 corresponding to a retro Diels-Alder reaction, and 207.1381
corresponding to the resorcinol moiety after the break of the bond with the terpenoid group (Fig. 1c). It is noteworthy that for both molecules, CBDP and Δ9-THCP, each fragment in both ionization modes differ exactly by an ethylene unit (CH2)2 from the corresponding five-termed homologs CBD and THC.

Moreover, the longer elution time corroborates the hypothesis of the seven-termed phytocannabinoids considering the higher lipophilicity of the latter.

Source: https://www.nature.com/articles/s41598-019-56785-1 December 2019

Alex Azar
Secretary of Health and Human Services
US Department of Health and Human Services
200 Independence Avenue SW
Washington D.C, 20201
November 5, 2019

Dear Secretary Azar:
This letter is to bring to your attention a study underway at the University of Washington referred to as the “Moms and Marijuana Study” and granted under the title: “Olfactory Activation and Brain Development in Infants with Prenatal Cannabis Exposure.” The Office of Human Research Protections issued a decision against opening a case on this research, and we are asking you, as the Secretary of Health and Human Services, to overturn that decision based on the scientific concerns we outline in this letter.

Women who are in their first trimester of a pregnancy, who are frequent users of marijuana for morning sickness, are being recruited. The study seeks to assess the damage marijuana prenatal exposure may have on the babies by means of various testing, including an MRI scan of the infants at six months of age. The recruited women will receive $300.00 + for their participation. The study is solely funded by NIDA. This study calls into question serious issues over human rights and raises ethical questions, including mandatory reporting pertaining to substance abuse in pregnancy. This open letter seeks to gather support from you in seeing that this study is re-evaluated at the federal level. The study’s website is at the following link: https://depts.washington.edu/klab/infoMM.html

We are of the view that the Kleinhans study does not meet the requirements set forth by the Office of Human Research Protections (https://www.hhs.gov/ohrp/regulations-and-policy/regulations/45-cfr46/ ): “Subpart B presumption that pregnant women may be included in research, provided certain conditions are met. According to Subpart B, the permissibility of research with pregnant women hinges on a judgment of the potential benefits and risks of the research. Approval of proposed research carrying no “prospect of direct benefit” to the woman or fetus requires that the risk to the fetus be judged “not greater than minimal”. Fetal risk that exceeds that standard is permissible only when the proposed research offers a prospect of direct benefit to the pregnant woman, the fetus, or both.

Notably, if the proposed research does not fit within either of those two parameters, Subpart B offers an additional mechanism at the national level for approval by the Secretary of Health and Human Services.”

The federal definition of minimum risk reads: “That the magnitude and probability of harm or discomfort anticipated in the research are not greater in and of themselves than those ordinarily encountered in daily life or during the performance of routine physical or psychological examinations or tests.” Although the primary harm at issue is exposure to marijuana, the use of MRI or fMRI has not yet been proven safe for otherwise healthy infants, where an unknown risk would come with no benefit, as there is no diagnosis being sought. The UW study consent form reads on page 3:“There are no known side effects associated with MRI or fMRI when earphones are used to protect your hearing.” …. “There may be risks associated with the use of magnetic resonance which are not known at this time.” It is precisely questions about the potential for MRI risks that should be investigated in an animal model first. In principle, any study that recruits subjects and then tracks the consequences of drug transfer to a developing fetus should be carried out in animal models first, and not in humans until the animal results point towards safety. The evidence of decades of research on marijuana in pregnancy does not point to safety but rather to risk and harm.

Two basic principles in bioethics are relied upon to determine the merit of research that involves human subjects: Is the study necessary and can the research be done without the use of human subjects? There now exists a significant body of scientific evidence that warrants and justifies warning women not to use marijuana products at pre-conception, while pregnant, or breast-feeding. The University of Washington study is not necessary to conclude that marijuana use is associated with risk to the child (and also the mother). The National Academies, a lead authority, concluded in a scientific literature review in 2017: There is substantial evidence of a statistical association between maternal cannabis smoking and lower birth weight of the offspring. Studies have already shown that prenatal use is associated with a 50 percent increased likelihood of low birth weight. The Surgeon General’s advisory of August 29, 2019 is also relied upon here. What is the “necessity” that this study addresses? The conclusion has already been made by the findings of science – pregnant women should refrain from marijuana use in order to protect the life and health of their child.

Yet, in spite of existing scientific literature of concern, a highly misleading recruitment statement appears on the University of Washington study’s website introductory page: “We do not expect to find anything of medical concern during the infant MRI scans…If you’re interested in helping us learn more about whether cannabis is safe to use for morning sickness, click the Sign Up button and let us know!” Their lack of concern about the potential for adverse medical outcomes directly contradicts the findings of Grewen et al. (2015) which similarly evaluated postnatal outcomes using MRI scans on infants that had been exposed to marijuana in utero. As compared to controls, the exposed infants showed hypoconnectivity between brain regions: ” Marijuana-specific differences were observed in insula and three striatal connections: anterior insula–cerebellum, right caudate–cerebellum, right caudate–right fusiform gyrus/inferior occipital, left caudate–cerebellum. +MJ neonates had hypo-connectivity in all clusters compared with −MJ and CTR groups.” While an imperfect study because the cases included a proportion of women in the case group who used not only marijuana but also alcohol, tobacco, opiates and SSRIs, one of the two control groups was matched to the cases for use of those drugs, while the other was completely drug free. Notably, work in an animal model by Tortoriello et al. (2014) presents a plausible mechanism for the observed effect of marijuana seen between cases and controls. The combined evidence points towards harm, and confirmation could easily be sought in an animal model that parallels the intent of the University of Washington study.

Furthermore, the ethics are clearly different between the Kleinhans et al. and Grewen et al. studies, because unlike the protocol for the former, the study of Grewen et al. did not recruit women while the fetus was developing but recruited shortly before or after the time of birth. Being unaware of ma