Nearly 10% of cannabis users in the United States report using it for medicinal purposes.
As of August 2019, 33 states and the District of Columbia have initiated policies allowing the use of cannabis or cannabinoids for the management of specific medical conditions.
Yet, the federal government still classifies cannabis as illegal, complicating its medical use and research into its effectiveness as a treatment for the various conditions purported to benefit from cannabis pharmacotherapy. Because of this conflict and restrictions on cannabis research, evidence of the efficacy of cannabis to manage various diseases is often lacking.

This article updates a review published in the June 23, 2015, issue of JAMA2 and describes newer evidence regarding what is known and not known about the efficacy of cannabis and cannabinoids for managing various conditions.

Indications for Therapeutic Use Approved by the US Food and Drug Administration
Cannabis has numerous cannabinoids, the most notable being tetrahydrocannabinol, which accounts for its psychoactive effects. Individual cannabinoids have unique pharmacologic profiles enabling drug development to manage various conditions without having the cognitive effects typically associated with cannabis.

Only a few cannabinoids have high-quality evidence to support their use and are approved for medicinal use by the US Food and Drug Administration (FDA). The cannabinoids dronabinol and nabilone were approved by the FDA for chemotherapy-induced nausea and vomiting in 1985, with dronabinol gaining an additional indication for appetite stimulation in conditions that cause weight loss, such as AIDS, in 1992. Recently, a third cannabinoid, cannabidiol (CBD), was approved by the FDA for the management of 2 forms of pediatric epilepsy, Dravet syndrome and Lennox-Gastaut syndrome, based on the strength of positive randomized clinical trials (RCTs).

Other Medical Indications
Cannabinoids are often cited as being effective for managing chronic pain. The National Academies of Science, Engineering, and Medicine examined this issue and found that there was conclusive or substantial evidence that cannabis or cannabinoids effectively managed chronic pain, based on their expert committee’s assessment that the literature on this topic had many supportive findings from good-quality studies with no credible opposing findings.

The panel relied on a single meta-analysis of 28 studies, few of which were from the United States, that assessed a variety of diseases and compounds. Although they concluded that cannabinoids effectively managed pain, the CIs associated with these findings were large, suggesting unreliability in the meta-analysis results.
A more recent meta-analysis of 91 publications found cannabinoids to reduce pain 30% more than placebo (odds ratio, 1.46 [95% CI, 1.16 1.84]), but had a number needed to treat for chronic pain of 24 (95% CI, 15-61) and a number needed to harm of 6 (95% CI, 5-8).While a moderate level of evidence supports these recommendations, most studies of the efficacy of cannabinoids on pain are for neuropathic pain, with relatively few high-quality studies examining other types of pain. Taken together, at best, there is only inconclusive evidence that cannabinoids effectively manage chronic pain, and large numbers of patients must receive treatment with cannabinoids for a few to benefit, while not many need to receive treatment to result in harm.
There is strong evidence to support relief of symptoms of muscle spasticity resulting from multiple sclerosis from cannabinoids as reported by patients, but the association is much weaker when outcomes are measured by physicians. There is insufficient evidence to support or refute claims that cannabinoids provide relief for spinal cord injury–related muscle spasms.

Recent Clinical Trials
Two multicenter, international trials with substantial numbers of patients (n = 120 and n = 171) demonstrated the efficacy of CBD as an add-on drug to manage some seizure disorders. Over 14 weeks, 20mg/kg of CBD significantly reduced the median frequency of convulsive seizures in children and young adults with Dravet syndrome as well as the estimated median difference in monthly drop seizures between CBD and placebo in patients with Lennox-Gastaut syndrome. Although promising, these results were found in relatively uncommon disorders and the studies were limited by the use of subjective end points and incomplete blinding that is typical of cannabinoid studies because these drugs have readily identifiable side effects.
Numerous other medical conditions, including Parkinson disease, posttraumatic stress disorder, and Tourette syndrome, have a hypothetical rationale for the use of cannabis or cannabinoids as pharmacotherapy based on cannabinoid effects on spasticity, anxiety, and density of cannabinoid receptors in areas implicated in development of tics, such as the basal ganglia and cerebellum. The strength of the evidence supporting the use of cannabinoids for these diseases is weak because most studies of patients with these diseases have been small, often uncontrolled, or crossover studies.

Few pharmaceutical companies are conducting cannabinoid trials. Thus, it is not likely that additional cannabinoids will be approved by the FDA in the near future. Public interest in cannabis and cannabinoids as pharmacotherapy continues to increase, as does the number of medical conditions for which patients are utilizing cannabis and CBD, despite insufficient evidence to support this trend.

Neurologic Adverse Effects Are Better Defined Than Physical Adverse Effects
Acute cannabis use is associated with impaired learning, memory, attention, and motor coordination, areas that can affect important activities of daily living, such as driving. Acute cannabis use can also affect judgment, potentially resulting in users making risky decisions that they would not otherwise make. While there is consensus that acute cannabis use results in cognitive deficits, residual cognitive effects persisting after acute intoxication are still debated, especially for individuals who used cannabis regularly as adolescents.

Chronic cannabis use is associated with an increased risk of psychiatric illness and addiction. There is a significant association— possibly a causal relationship—between cannabis use and the development of psychotic disorders, such as schizophrenia, particularly among heavy users. Chronic cannabis use can lead to cannabis use disorder (CUD) and contributes to impairment in work, school, and relationships in up to 31% of adult users.  Regular cannabis use at levels associated with CUD (near-daily use of more than one eighth ounce of cannabis per week) is associated with worsening functional status, including lower income, greater need for socio-economic assistance, criminal behavior, unemployment, and decreased life satisfaction.

Cannabis use is associated with adverse perinatal outcomes as well; a 2019 study showed the crude rate of preterm birth was 12.0% among cannabis users and 6.1% among nonusers (risk difference, 5.88% [95% CI, 5.22%-6.54%]).

Inadequate Evidence Supporting the Use of Cannabinoids for Many Medical Conditions
The quality of the evidence supporting the use of cannabinoids is suboptimal. First, studies assessing pain and spasticity are difficult to conduct, in part because of heterogeneity of the outcome measures used in these studies. Second, most RCTs that have evaluated cannabinoid clinical outcomes were small, with fewer than 100 participants in each, and small trials may overestimate treatment effects. Third, the timeframe for most studies is too short to assess the long-term effects of these medications. Fourth, tolerance, withdrawal, and potential for drug-drug interactions may affect the usefulness of cannabis, and these phenomena are not well understood for cannabinoids.

The lack of high-quality evidence results in outsized claims of the efficacy of cannabinoids for numerous medical conditions. There is a need for well-designed, large, multisite RCTs of cannabis or cannabinoids to resolve claims of efficacy for conditions for which there are claims of efficacy not supported by high quality evidence, such as pain and spasticity.

Conclusions
Insufficient evidence exists for the use of medical cannabis for most conditions for which its use is advocated. Despite the lack of evidence, various US state governments have recommended cannabis for the management of more than 50 medical conditions. Physicians may be appropriately reticent to recommend medical cannabis for their patients because of the limited scientific evidence supporting its use or because cannabis remains illegal in federal law. Cannabis is useful for some conditions, but patients who might benefit may not get appropriate treatment because of insufficient awareness regarding the evidence supporting its use or confusion from federal law deeming cannabis illegal.

Source: Medical Use of Cannabis in 2019 | Clinical Pharmacy and Pharmacology | JAMA | JAMA Network August 2019

The title of “Cannabis in Medicine: An Evidence-Based Approach” contains an irony. In chapter after chapter in this multi-authored book written predominately by providers associated with mainstream medical facilities in Colorado, the authors point out the inadequacy of the evidence we have and the absence of the evidence we need to determine how – or even if – cannabis has medical legitimacy. The foreword’s title, “Losing Ground: The Rise of Cannabis Culture,” sets the tone. David Murray, a senior fellow at the Hudson Institute, argues convincingly that “the current experiment with cannabis, underway nationwide [is] leading us towards a future of unanticipated consequences, a future already established in the patterns of use ‘seeded’ in the population but as yet unmanifested.” In other words, the cannabis horse has not only fled the barn but has been breeding prolifically to the point that we couldn’t get rid of it and its progeny if we wanted to!

The 20 chapters following the foreword are divided into basic science (three chapters) and clinical evidence (17 chapters) sections. Over and over in the clinical evidence chapters, individual authors remind the reader of the lack of quality control in production, the dearth of strong evidence from adequately designed research trials, and the intensifying potency of cannabis with attendant dangers, particularly for youth. The organization of this section lacks consistency in that some chapters focus on specialty (e.g. pulmonary medicine), others on patient groups (e.g. the pediatric and adolescent population), others on physiological implications (e.g. clinical cardiovascular effects; neuropsychiatric effects), others on specific diseases (e.g. gastrointestinal disorders; ocular conditions), and still others on public health topics (e.g. cannabis-impaired driving). While all are relevant, a specialty or organ system focus, with a separate public health section might lend the book more coherence. It would also be worth exploring how “cannabis culture” has become in essence a parallel medical system, with many of cannabis’s most ardent proponents as dropouts from establishment medicine after its nostrums for diagnoses like chronic pain, anxiety, and depression have failed to bring them relief.

I would have liked a chapter specifically grappling with the porous boundary between federal and state jurisdictions over cannabis as medicine and marijuana as recreational substance. Lawyer David G. Evans’ admirable chapter on “The Legal Aspects of Marijuana as Medicine” moves in that direction when he writes that, “‘medical marijuana’ is not a ‘states’ rights’ issue.” To wit, for no other drug than cannabis has the federal government ceded regulatory responsibility to states that are variably (but mostly not) equipped to handle it. The truth, complex in its contradictions and inconsistencies, is that in the United States, marijuana remains a Schedule I drug without recognized medical value; the Federal Drug Administration overseeing American pharmaceuticals throws roadblocks in the way of studying it, thereby interfering with the development of a robust evidence base; the federal government has looked the other way and even colluded with the states as one after another has legalized cannabis medically, recreationally, or both; and physicians risk their federal licenses to prescribe if they do more than recommend this drug. In a nutshell, any effort to impose logic is doomed because the American scene vis-à-vis cannabis is seemingly irretrievably illogical.

The editor of this volume, Kenneth Finn, MD, a PMR and pain management specialist in Colorado Springs, Colorado, is to be commended for encouraging individual chapter authors to develop encyclopedic bibliographies. The book can thus serve as a resource for practitioners wishing to delve into a vast and growing literature that continues to offer little that is conclusive. The book can also serve as a primer on what is known about cannabis as medicine, keeping in mind a slant throughout – not necessarily unjustified, at least from an allopathic or osteopathic perspective – that cannabis is neither legitimate as medicine nor safe, even for recreational use.

Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7723137/ Sept-Oct 2020

Source: Preventing Marijuana Use Among Youth & Young Adults (getsmartaboutdrugs.gov) March 2017

Tell Your Children:
The Truth About Marijuana, Mental Illness, and Violence
by alex berenson
free press, 272 pages, $26

The smoking of marijuana, with its careful preparation of the elements and the solemn passing around of the shared joint, was the unholy communion of the counterculture in the late 1960s, when our present elite formed its opinions. Many of them allowed their children to follow their bad examples, and resent that this exposes their young to a (tiny) risk of persecution and career damage. As a result, those who still disapprove of marijuana are much disliked. The book I wrote on the subject six years ago, The War We Never Fought, received a chilly reception and remains so obscure that I don’t think Alex ­Berenson, whose book has received much friendlier coverage, even knows it exists. As a writer who naturally covets readers and sales, I find this mildly infuriating.

But let me say through clenched teeth that it is of course very good news that a fashionable young metropolitan person such as Mr. ­Berenson is at last prepared to say openly that marijuana is a dangerous drug whose use should be severely discouraged. For, as ­Berenson candidly admits, he was until recently one of the great complacent mass of bourgeois bohemians who are pretty relaxed about it. He confesses in the most important passage in the book that he once believed what most of such people believed. He encapsulates this near-universal fantasy thus:

Marijuana is safe. Way safer than alcohol. Barack Obama smoked it. Bill Clinton smoked it too, even if he didn’t inhale. Might as well say it causes presidencies. I’ve smoked it myself, I liked it fine. Maybe I got a little paranoid, but it didn’t last. Nobody ever died from smoking too much pot.

These words are a more or less perfect summary of the lazy, ignorant, self-serving beliefs of highly educated, rather stupid middle-class metropolitans all over the Western world in such places as, let’s just say for example, the editorial offices of the New York Times. Thirty years from now (when it’s too late), they will look as crass and irresponsible as those magazine advertisements from the 1950s in which pink-faced doctors wearing white coats recommended certain brands of cigarettes. But just now, we are in that foggy zone of consciousness where the truth is known to almost nobody except those with a certain kind of direct experience, and can be ignored by everyone else.

One of the experienced ones, thank heaven, is Alex ­Berenson’s wife Jacqueline. She is a psychiatrist who specializes in evaluating mentally ill criminals. One evening, the Berensons were discussing one of her cases, a patient who had committed a terrible, violent act. Casually, Jacqueline remarked, “Of course he was high, been smoking pot his whole life.” Alex doubtfully interjected, “Of course?,” and she replied, “Yeah, they all smoke.” (She didn’t mean tobacco.) And she is right. They all do. You don’t need to be a psychiatrist to know this. You just have to be able to do simple Internet searches.

Most violent crime is scantily reported, since local newspapers lack the resources they once had. The exceptions are rampage mass killings by terrorists (generally in Europe) and non-political crazies (more common in the United States). These crimes are intensively reported, to such an extent that news media find things out they were not even looking for, such as the fact that the perpetrator is almost always a long-term marijuana user. Where he isn’t (and it is almost always a he), some other legal or illegal psychotropic, such as steroids or “antidepressants,” is ­usually in evidence. But you do have to look, and most people don’t. Then you have to see a pattern, one that a lot of important, influential people specifically do not want to see.

That husband-and-wife conversation in the Berenson apartment is the whole book in a nutshell, the epiphany of a former apostle of complacency from the college-­educated classes who suddenly discovers what has been going on around him for years. What he repeats over and over again is very simple: Marijuana can make you permanently crazy. (This is a long-term cumulative effect, not the effect of immediate intoxication.) And once it has made you crazy, it can make you violent, too.

You’ll only find out if you’re susceptible by taking it. It is not soft. It is not safe. It is one of the most dangerous drugs there is, and we are on the verge of allowing it to be advertised and put on open sale. Berenson has gotten into predictable trouble for asserting that the connection is pretty much proved. Alas, this is not quite so. But the correlation is hugely powerful. The chance that it is meaningful is great. Who would be surprised if a drug with powerful psychotropic effects turned out to be the cause of mental illness in its users? Correlation is not causation, but it is one of the main tools of ­epidemiology. Causation, ­especially in matters of the brain, is extraordinarily difficult to prove, and so we may have to base our actions, or our refusals to take action, on something short of total certainty.

Tell Your Children is filled with persuasive, appalling individual case histories of wild violence, including the abuse of small children. It also lists and explains the significance of powerful, large-scale surveys of Swedish soldiers and New Zealand students, which connect the drug to mental illness and lowered school performance. Berenson provides facts and statistics about violent crime in places where marijuana is widely available, and anecdotes so repetitive that they cease to be anecdotes. The puzzle remains as to why it is necessary to say all this repeatedly when a sensible person would listen the first time.

Perhaps it is because of the large, and very well-funded, campaigns for marijuana legalization described by Berenson. People who drink fair-trade coffee and eat vegan, who loathe other greed lobbies—such as pharmaceuticals, tobacco, fast food, or sugary drinks—smile on this campaign to make money from the misery of others.

Berenson shows how mental illness has grown in our midst without being noticed in public statistics. A comparable growth in, say, measles or tuberculosis would have shown up. But deteriorating mental health does not, thanks to privacy concerns, and to the fact that mental illness is not easily classified. It is also a sad truth that rich, advanced Western societies nowadays begrudge money for the mental hospitals needed to house and protect those who have overthrown their own minds. They are reluctant to record the existence and prevalence of the very real suffering that ought to be treated in the hospitals they have sold off, demolished, or never built.

Berenson also witheringly describes the propaganda devised by those who want to legalize the drug, from the mind-expanding zealots who view drug use as liberating to the hard-headed entrepreneurs and political professionals. Argue against them at your peril. Your audience may learn something, but your opponents will not. Wilful ignorance is the most powerful barrier to communication. It seals the human mind up like a fortress. You might as well read the works of Jean-Paul Sartre to a hungry walrus as try to debate with such people. I have attempted it. They don’t hear a word you say, but they hate you for getting in their way.

Berenson gives a fairly thorough account of the “medical marijuana” campaign, an almost comically absurd attempt to portray a poison as a medicine. This campaign is so bogus that it will vanish from the earth within days of full legalization, because in truth there is very little evidence that marijuana-based medicines are of much use. Berenson quotes one refreshingly candid marijuana defender as admitting, “Six percent of all marijuana users use it for medical purposes. Medical marijuana is a way of protecting a subset of society from arrest.”

In the U.S., legalizers are poised to win the modern civil war over the legalization of marijuana which has been dividing the country for half a century. It looks now as if marijuana will soon be legalized, on general sale, advertised and marketed and taxed. This worrying process has already begun in Canada. The United States has approached the issue sideways, conceding states’ rights in a way that would have delighted the Confederates.

The United Kingdom has taken a similar route: It pretends to maintain the law and, when asked, insists it has no plans to change it. But the police and the courts have gradually ceased to enforce it, so that it is now impossible to stroll through central London without nosing the reek of marijuana. Europe has gone the same way, with minor variations. Among the free law-governed nations, only Japan and South Korea still actively and effectively enforce their drug possession laws, and benefit greatly from it. But how long can they hold out?

The legalization campaigners are working like termites to undo the 1961 U.N. Convention that is the basis of most national laws against narcotics, using all the money and dishonesty at their command. They have plenty of both. So, besides the two disastrous, irrevocably legal poisons of alcohol and tobacco, we shall before long have a third—and probably a fourth and fifth not long afterward. If marijuana is legal, how will we keep cocaine and ecstasy illegal for long? Next will come heroin and LSD.

One reason for the default in favor of legalization and non-enforcement is the false association made by so many between marijuana and liberty. The belief that a dangerous, stupefying drug is an element of human liberty has taken hold of two, perhaps three generations. They should know better. Aldous Huxley warned in his much-cited but infrequently read dystopian novel Brave New World that modern men, appalled by the disasters of war and social conflict, would embrace a world where thinking and knowledge were obsolete and pleasure and contentment were the aims of a short life begun in a test-tube and ended by euthanasia. He predicted that they would drug themselves and one another to banish the pains of real life, and—worst of all—come to love their own servitude. In one terrible scene, the authorities spray protesting low-caste workers with the pleasure drug soma, and the workers end up hugging one another and smiling vaguely before returning to their drudgery. (Soma, unlike its real-life modern equivalents, is described as harmless, something easier to achieve in fiction than in reality.) What ruler of a squalid, wasteful, unfair, and ugly society such as ours would not prefer a stupefied, flaccid population to an angry one? Yet somehow, the freedom to stupefy oneself is held up quite seriously by educated people as the equal of the freedoms of thought, speech, and assembly. This is the way the world ends, with a joint, a bong, and a simper.

Whatever was wrong with my intense little segment of the 1960s revolutionary generation (and plenty was wrong with it), we believed that when we saw injustice we should fight it, not dope ourselves into a state of mind where it no longer mattered. But my tiny strand of puritan Bolsheviks was long ago absorbed into a giggling mass of cultural revolutionaries, who scrawled “Sex, Drugs, and Rock and Roll” on their banners instead of “Liberty, Equality, and Fraternity,” or even “Workers of All Lands, Unite!”

While Berenson’s facts are devastating, his own response to the crisis is feeble. He opposes marijuana legalization—and what intelligent person does not? He babbles of education and warning our children. But he declares that “decriminalization is a reasonable compromise.” Actually, it is not. It cannot be sustained. If matters are left as they are, legalization—first de facto and then de jure—will follow, because there will be no impetus to resist it. Unless the law decisively disapproves of and discourages the actual use of the drug, it is neither morally consistent nor practically effective.

The global drug trade would be nowhere without the dollars handed over to it by millions of individuals who are the end-users. We search for Mr. Big and never catch him. But we ignore or even indulge Mr. Small, regarding him as a victim, when in truth he keeps the whole thing going. In the end, the logic leads relentlessly to the stern prosecution and deterrent punishment of individual users. It is because I recognize this grim necessity that I remain a pariah. It is because he doesn’t that Alex Berenson is still just about acceptable in the part of the Western world that believes marijuana is a torch of ­freedom. 

Peter Hitchens is a columnist for The Mail on Sunday.

Source:  https://www.firstthings.com/article/2019/05/reefer-sadness

Radula complanata, a cannabinoid moss. Henri Koskinen/Shutterstock

Most of us know that the cannabis plant produces compounds that react with the human body. That’s because we have our own system that makes similar compounds, cannabinoids, that have a wide range of actions from appetite control to immune function. Cannabis contains a cannabinoid called THC that interacts with the brain, resulting in euphoria and relaxation, as well as increased hunger and anxiety. It was long thought that there was no other natural source of cannabinoids – and along with a long list of supposed medical uses the mythical power of cannabis, and the psychoactive properties of THC, has grown.

But as it turned out, another plant contains something similar: a compound that has the structural hallmarks for it to act on the brain in a similar way to THC. The discovery of this lost twin, called cis-PET (perrottetinene), or PET, was tucked away in specialist chemistry journals in papers published in 1994 and 2002, with no subsequent research confirming its biological activity. But in a new study, published in Science Advances, a group of Swiss scientists have delved into the mechanism by which PET may be acting on the brain.

The particular liverwort in question, Radula, is endemic to New Zealand and Tasmania and is used as a herbal medicine by the Maori people. Preparations using this plant are also sold as a THC-like legal high on the internet.

But while similar to THC, does PET actually produce the same effects that THC does at a cellular and molecular level? Does it mimic the physiological effects? And is it different in ways that could give it therapeutic advantage or disadvantage? Some 24 years after its first discovery, the team of chemists and biochemists behind the new study have teased some of the answers out.

Their research was no mean feat. It required a new synthesis method to produce enough PET to do meaningful experiments. Once this was achieved, the researchers looked at two mirror versions of the two compounds, cis (the version found in the liverwort) and trans (a version they artificially created in the lab). In chemistry, the cis and trans terms tell us which side of the carbon chain the functional groups are (the bit of the molecule that does the work).

The researchers wanted to find out if these two versions of PET were able to interact with the two receptors found in humans that mediate the psychoactive effects of cannaboids – CB1, the receptor that produces the “high” effect from THC, and CB2 – in the same way as THC (how strongly they bound and how much is needed to produce an effect).

The researchers found intriguing similarities between the two versions in PET and THC. For both PET and THC, the trans versions (the abundant THC version found in cannabis and the lab-synthesised version found in liverwort) bound to the CB1 receptor better than the cis versions.

THC and PET side by side. Oliver Kayser

What’s interesting about this is that while the levels of cis-PET found in the liverwort plant are too low to produce the “high” effects produced by THC (hence why smoking PET won’t produce a high), it could explain why PET might still have a medicinal effect (similar to the effect produced by lower dose THC). However, any methods to extract and concentrate the liverwort compound could lead to the same problems as THC.

But what about CB2, the other cannabinoid receptor? This receptor plays a role in immune responses. Here the Swiss scientists found that the cisversions of both THC and PET bound this receptor better than the transversions. The implications of this are yet to be explored, but it again hints at a potential medicinal benefit worth exploring further.

The authors of the study then went on to test whether the binding of the CB1 receptors in the brains of mice had the same recognisable THC effects. Usually when THC binds with this receptor it produces four key effects: reduced body temperature, muscle rigidity, reduced movement and decreased sensitivity to pain. In this behavioural test, all four effects were also achieved in the mice using cis-PET, albeit in a much bigger amount.

But there was one notable difference. Inflammation in the brain is mediated by molecules called prostaglandins that can be derived from metabolic pathways involving our own body cannabinoids or plant-derived trans-THC. In contrast, the production of these mediators was reduced by cis-PET. It remains to be seen whether this is a good thing or a bad thing.

So while the study is just a start in understanding the mechanisms and effects of PET on the brain, there’s much we still don’t know. What we do know now, however, is that the levels of PET that are found in the natural liverwort plant are too low to produce the recognised effects of THC, so smoking it is unlikely to lead to a high. But it is also interesting that this compound could well have medicinal benefits without the high – one of the key reasons that THC has previously been dismissed as a medicine. Illegal trading and cultivation has confounded much meaningful clinical research, but this is changing and this new compound will add to the treasure trove of plant-derived cannabinoids that we still have much to understand.

Source: https://theconversation.com/liverwort-could-have-medicinal-benefits-of-cannabis-thc-without-the-high  Oct.24^th 2018

Last June, under huge and hysterical media pressure, Home Secretary Sajid Javid opened the lid on the Pandora’s box of ‘medicinal’ cannabis. He issued emergency licences to allow access for two young boys with severe forms of epilepsy and at the same time ordered a review into evidence of its therapeutic efficacy, falling for what soon transpired to be a well-orchestrated campaign. Coordinated by Volteface, the openly pro-legalising recreational cannabis think tank funded by Paul Birch, a multi-millionaire British tech tycoon, it was aided by the journalist and campaigner Ian Birrell, who has disclosed his membership of its advisory panel. Mrs Caldwell and her sick child had, the Daily Mail argued, been hijacked by a pro-cannabis lobby that stands to make billions. She herself has a vested interest as the director of a company marketing cannabis oil which she sells online.

With useful idiots like Lord Hague ready to make two and two add up to five by arguing that the current law is indefensible and therefore we must legalise cannabis altogether, the campaign had got off to a flying start.

Since then the media onslaught of the metro-elite’s demands for legal access to this drug has not stopped. Fuelled by Canada’s ill-considered decision to legalise recreational use, it reached peak volume last week. Kate Andrews of the Institute of Economic Affairs made her case for it based on a startlingly under-informed account of post-legal pot Colorado (she cannot have read the latest impact update) and arrest stats from the American Civil Liberties Union. Whatever their reliability, she should know that here you are unlikely to receive a custodial sentences before at least seven previous convictions or cautions, and that 50 per cent sent to prison for the first time have at least 15 ‘previous’. As to cannabis possession, it is a myth that is anything other than decriminalised already.

Then we had former Met Chief Lord Hogan-Howe adding his pennyworth. He has no reason not to know the devasting evidence from Colorado and Washington State, yet he thinks we need a two-year review of legalisation. Philip Collins of the Times seems equally gung-ho about Colorado’s descent into a dangerous drugs products free-for-all.

In the most sickeningly selfish article of all, the gloating Simon Jenkins raised his ‘glass of cannabis wine’ to the drug culture that no legalisation will ever sanitise.

Unmentioned was that Canada’s decision was based on no evidence at all that it would either reduce youth use or meaningfully curtail the black market, the stated goals for taking the country down this path

Nor was the fact that Canada’s ‘journey’ had started – where else? – with medicinal cannabis, the cannabis lobby’s admitted and cynical strategy to buy the drug a good name and lower the public’s defences.

This is the wheeze our Home Secretary has fallen for. He has already made good his promise of June 26 and given the all-clear for clinical specialists routinely to prescribe cannabis oil and similar products for epilepsy and multiple sclerosis. Taking effect on November 1, this decision is based on the hastily prepared recommendation of his Chief Medical Officer, Dame Sally Davies, that vaguely designated ‘cannabis based medicinal products’ should be ‘rescheduled’ (in other words, legalised for ‘prescription’).

This comes before the Advisory Council on the Misuse of Drugs (ACMD) recommendations have been followed through for a clear definition of what a cannabis-derived medicinal product is, and ‘additional frameworks’ and clinical guidance for ‘checks and balances’ for safe prescribing.

Yet these are products neither clinically tested nor of proven efficacy, which doctors will be under great pressure to prescribe and which will leak into the illegal market.

In this one misguided action, oblivious to those interests ruthlessly exploiting the medicinal cannabis pipe dream, the Home Secretary has casually trashed the UK’s world class and purposefully onerous pharmaceutical approval system.

The Home Secretary cannot have read the small print of Dame Sally’s review, or he chose not to, in his rush to get the Billy Caldwell story off the front pages. It has the hallmarks of a dodgy dossier. For the American evidence on which it relies states that there is ‘no or insufficient evidence to support or refute the conclusion that cannabis or cannabinoids are an effective treatment for epilepsy’.* Likewise the meta-analysis Dame Sally leant on provided her with no evidence for epilepsy.

The only ‘conclusive or substantial’ the American evidence finds is for the treatment of chronic pain in adults, chemotherapy-induced nausea and vomiting and for improving patient-reported multiple sclerosis spasticity symptoms. For these conditions the licensed cannabis-based drugs Sativex, Marinol and Nabilone exist.

Elsewhere the serious problems associated with the medicalisation of cannabis have been set out. The testimonial evidence it largely relies on falls short of the standards required for the approval of other drugs – which are ‘adequately powered, double blind, placebo controlled randomised clinical trials’.

Against this absence of evidence is the very real evidence of the drug’s harm which has presented itself again in rising hospital cannabis admissions. These include alarmingly high numbers of teens urgently admitted with psychosis. Had Dame Sally had taken more time, extended her search and listened to recent warnings, she would have found that this is far from the only public health risk associated with cannabis.

A long, well-written and referenced article in the BMJ by an Australian academic, Professor Albert Reece, entitled Known Cannabis Teratogenicity Needs to be Carefully Considered, published shortly after the Davies review, raises the alarming question of whether exposure to cannabis has significance for rising birth defects; and whether full-spectrum cannabis (unlike the FDA-approved drug Epidiolex) could have some of the problems of thalidomide.

Reece’s concern is that even were the clinical efficacy of cannabinoids to be demonstrated, ‘their teratogenic potential, from both mother and father’ would need to be carefully balanced with their clinical utility. A teratogen, for the uninitiated, is an agent that can disrupt the development of the embryo or foetus and halt the pregnancy or produce a congenital malformation (a birth defect).

Professor Reece reports that ‘gestational cannabis has been linked with a clear continuum of birth defects’ in a range of longitudinal studies, and increased foetal death, and reflects a worldwide increase in high cannabis-using areas.

He is not alone to be concerned. The website of NHS Wales carries a warning about cannabis which indicates that it is taking its gastroschisis (a condition in which the bowel herniates out of the abdomen during foetal development) outbreak seriously.

The question of whether cannabis is to blame for rising rates of gastroschisis has been raised elsewhere and those puzzled by it cite drug use as a risk factor, as does the NHS. 

Professor Reece’s warning needs heeding. Only once before has a known teratogen been marketed globally: thalidomide. What the Home Secretary and his Chief Medical Officer need reminding of, as Reece makes clear, is that the thalidomide disaster is ‘the proximate reason for modern pharmaceutical laws’. These are laws that Sajid Javid, Dame Sally Davies and the AMCD are prematurely prepared to overturn.

Previously supportive commentators have begun to express their reservations about the implications of ‘medicinal’ cannabis. It can’t be allowed to become a free-for-all, writes Alice Thomson in the Times.

She is right to worry, and the dangers could be worse than anything she has imagined.

This is why the Home Secretary needs to stop and take stock. He still has time to review and revoke his ill-advised and media-pressured decision. As for the vested interests behind legalising cannabis, he should know that as far as medicinal cannabis is concerned more will never be enough.

*Epidiolex, the GW Pharmaceuticals CBD-based epilepsy drug which has recently been approved for Dravet Syndrome in the US and which we can expect to be approved in Europe, does not fall into this category. One must presume that GW Pharma with twenty years of research would have included the psychoactive ingredient that Mrs Caldwell and her campaign claim is necessary, had they been able to justify it clinically.

Source: The Home Secretary has acted prematurely and dangerously on medical cannabis – The Conservative Woman October 2018

The U.S. Food and Drug Administration (FDA) has approved the first medication containing a purified substance derived from marijuana to treat rare, severe forms of epilepsy. This medicine, called Epidiolex (cannabidiol [CBD]) oral solution is approved to treat Lennox-Gastaut and Dravet syndromes in adults and children over age 2. It’s the first drug approved by the FDA for the treatment of Dravet syndrome.

The component of marijuana used in Epidiolex – cannabidiol – doesn’t induce feelings of euphoria, or “high,” typically associated with cannabis, which is caused by a chemical in marijuana called tetrahydrocannabinol (THC).

Lennox-Gastaut syndrome and Dravet syndrome – conditions that both begin in childhood – cause frequent seizures and severely impact patients’ quality of life. In three randomized, double-blind, placebo-controlled clinical trials involving 516 patients, Epidiolex, with other medications, effectively reduced seizure frequency. Common side effects include sleepiness, elevated liver enzymes, decreased appetite, diarrhea, rash, and weakness.

Sourced from: FDA

Source: FDA Approves Marijuana-Based Epilepsy Drug (healthcentral.com) June 2018

This Notice of Liability Memo and attached Affidavit of Harms give formal notification to all addressees that they are morally, if not legally liable in cases of harm caused by making toxic marijuana products legally available, or knowingly withholding accurate information about the multiple risks of hemp/marijuana products to the Canadian consumer.  This memo further gives notice that those elected or appointed as representatives of the people of Canada, by voting affirmatively for Bill C45, do so with the knowledge that they are breaching international treaties, conventions and law.  They do so also with the knowledge that Canadian law enforcement have declared that they are not ready for implementation of marijuana legalization, and as they will not be ready to protect the lives of Canadians, there may arise grounds for a Charter of Rights challenge as all Canadian citizens are afforded a the right to security of self.

Scientific researchers and health organizations raise serious questions about the safety of ingesting even small amounts of cannabinoids. Adverse effects include risk of harm to the cardio-vascular system, respiratory tract, immune system, reproductive and endocrine systems, gastrointestinal system and the liver, hyperemesis, cognition, psychomotor performance, psychiatric effects including depression, anxiety and bipolar disorder, schizophrenia and psychosis, a-motivational syndrome, and addiction.  The scientific literature also warns of teratogenicity (causing birth deformities) and epigenetic damage (affecting genetic development) and clearly establishes the need for further study. The attached affidavit cites statements made by Health Canada that are grounded in scientific evidence that documents many harms caused by smoking or ingesting marijuana.  

Putting innocent citizens in “harm’s way” has been a costly bureaucratic mistake as evidenced by the 2015 Canadian $168 million payout to victims of exposure to the drug thalidomide. Health Canada approved thalidomide in 1961 to treat morning sickness in pregnant women but it caused catastrophic birth defects and death.

It would be instructive to reflect on “big tobacco” and their multi-billion-dollar liability in cases of misinformed sick and dead tobacco cigarette smokers. Litigants won lawsuits for harm done by smoking cigarettes even when it was the user’s own choice to obtain and smoke tobacco. In Minnesota during the 1930’s and up to the 1970’s tobacco cigarettes were given to generally healthy “juvenile delinquents’ incarcerated in a facility run by the state.  One of the juveniles, now an adult, who received the state’s tobacco cigarettes, sued the state for addicting him. He won.

The marijuana industry, in making public, unsubstantiated claims of marijuana safety, is placing itself in the same position, in terms of liability, as the tobacco companies.
In 1954, the tobacco industry published a statement that came to be known during Minnesota’s tobacco trial as the “Frank Statement.” Tobacco companies then formed an industry group for the purposes of deceiving and confusing the public.

In the Frank Statement, tobacco industry spokesmen asserted that experiments linking smoking with lung cancer were “inconclusive,” and that there was no proof that cigarette smoking was one of the causes of lung cancer. They stated, “We believe the products we make are not injurious to health.” Judge Kenneth Fitzpatrick instructed the Minnesota jurors: “Jurors should assume in their deliberations that tobacco companies assumed a “special duty” by publishing the ad (Frank Statement), and that jurors will have to determine whether the industry fulfilled that duty.” The verdict ruled against the tobacco industry.

Effective June 19, 2009, marijuana smoke was added to the California Prop 65 list of chemicals known to cause cancer. The Carcinogen Identification Committee (CIC) of the Office of Environmental Health Hazard Assessment (OEHHA) “determined that marijuana smoke was clearly shown, through scientifically valid testing according to generally accepted principles, to cause cancer.”

Products liability and its application to marijuana businesses is a topic that was not discussed in the Senate committee hearings. Proposition 65, requires the State to publish a list of chemicals known to cause cancer, birth defects or other types of reproductive harm. Proposition 65 requires businesses to provide their customers with notice of these cancerous causing chemicals when present in consumer products and provides for both a public and private right of action.

The similarities between the tactics of “Big Tobacco” and the “Canadian Cannabis Trade Alliance Institute” and individual marijuana producers would seem to demand very close scrutiny. On May 23, a witness testified before the Canadian Senate claimed that marijuana is not carcinogenic. This evidence was not challenged.

The International Narcotics Control Board Report for 2017 reads: “Bill C-45, introduced by the Minister of Justice and Attorney General of Canada on 13 April 2017, would permit the non-medical use of cannabis. If the bill is enacted, adults aged 18 years or older will legally be allowed to possess up to 30 grams of dried cannabis or an equivalent amount in non-dried form. It will also become legal to grow a maximum of four cannabis plants, simultaneously for personal use, buy cannabis from licensed retailers, and produce edible cannabis products. The Board wishes to reiterate that article 4 (c) of the 1961 Convention restricts the use of controlled narcotic drugs to medical and scientific purposes and that legislative measures providing for non-medical use are in contravention of that Convention….

The situation pertaining to cannabis cultivation and trafficking in North America continues to be in flux owing to the widening scope of personal non-medical use schemes in force in certain constituent states of the United States. The decriminalization of cannabis has apparently led organized criminal groups to focus on manufacturing and trafficking other illegal drugs, such as heroin. This could explain why, for example, Canada saw a 32 per cent increase from 2015 to 2016 in criminal incidents involving heroin possession….The Canadian Research Initiative in Substance Misuse issued “Lower-risk cannabis use guidelines” in 2017. The document is a health education and prevention tool that acknowledges that cannabis use carries both immediate and long-term health risks.”

https://www.incb.org/documents/Publications/AnnualReports/AR2017/Annual_Report_chapters/Chapter_3_Americas_2017.pdf

Upon receipt of this Memo and Affidavit, the addressees can no longer say they are ignorant or unaware that promoting and/or distributing marijuana cigarettes for recreational purposes is an endangerment to citizens. Receipt of this Memo and Affidavit removes from the addressees any claim of ignorance as a defense in potential, future litigation.

Pamela McColl www.cleartheairnow.org

pam.mccoll@cleartheairnow.org

AFFIDAVIT May 27, 2018

I, Pamela McColl, wish to inform agencies and individuals of known and potential harm done/caused by the use of marijuana (especially marijuana cigarettes) and of the acknowledgement the risk of harm by Health Canada. 

Marijuana is a complex, unstable mixture of over four hundred chemicals that, when smoked, produces over two thousand chemicals.  Among those two thousand chemicals are many pollutants and cancer-causing substances.  Some cannabinoids are psychoactive, all are bioactive, and all may remain in the body’s fatty tissues for long periods of times with unknown consequences. Marijuana smoke contains carcinogenic (cancer-causing) substances such as benzo(a)pyrene, benz(a)anthracene, and benzene in higher concentrations than are present in tobacco smoke.  The mechanism by which benzo(a)pyrene causes cancer in smokers was demonstrated scientifically by Denissenko MF et al. Science 274:430-432, 1996. 

Health Canada Consumer Information on Cannabis reads as follows:  “The courts in Canada have ruled that the federal government must provide reasonable access to a legal source of marijuana for medical purposes.”

“Cannabis is not an approved therapeutic product and the provision of this information should not be interpreted as an endorsement of the use of cannabis for therapeutic purposes, or of marijuana generally, by Health Canada.”

“Serious Warnings and Precautions: Cannabis (marihuana, marijuana) contains hundreds of substances, some of which can affect the proper functioning of the brain and central nervous system.”

“The use of this product involves risks to health, some of which may not be known or fully understood. Studies supporting the safety and efficacy of cannabis for therapeutic purposes are limited and do not meet the standard required by the Food and Drug Regulations for marketed drugs in Canada.”

Health Canada – “When the product should not be used: Cannabis should not be used if you:-are under the age of 25 -are allergic to any cannabinoid or to smoke-have serious liver, kidney, heart or lung disease -have a personal or family history of serious mental disorders such as schizophrenia, psychosis, depression, or bipolar disorder-are pregnant, are planning to get pregnant, or are breast-feeding -are a man who wishes to start a family-have a history of alcohol or drug abuse or substance dependence Talk to your health care practitioner if you have any of these conditions. There may be other conditions where this product should not be used, but which are unknown due to limited scientific information.

Cannabis is not an approved therapeutic product and the provision of this information should not be interpreted as an endorsement of the use of this product, or cannabis generally, by Health Canada.”

Prepared by Health Canada Date of latest version: February 2013, accessed May 2018. https://www.canada.ca/en/health-canada/services/drugs-health-products/medical-use-marijuana/information-medical-practitioners/information-health-care-professionals-cannabis-marihuana-marijuana-cannabinoids.html

A report published by survey company RIWI Corp. (RIWI.com) can be found at: https://riwi.com/case-study/measuringcanadians-awareness-of-marijuanas-health-effects-may-2018

The report measures Canadians’ awareness of marijuana’s health effects as determined by Health Canada and published on Health Canada’s website. RIWI data indicates: 1. More than 40% of those under age 25 are unaware that marijuana impacts safe driving. Further, 21% of respondents are not aware that marijuana can negatively impact one’s ability to drive safely. Health Canada: “Using cannabis can impair your concentration, your ability to make decisions, and your reaction time and coordination. This can affect your motor skills, including your ability to drive.” 2. One in five women aged 25-34 believes marijuana is safe during pregnancy, while trying to get pregnant, or breastfeeding. • RIWI: “For women of prime childbearing age (25-34), roughly one in five believe smoking marijuana is safe during pregnancy, planning to get pregnant, and breastfeeding.” • Health Canada: “Marijuana should not be used if you are pregnant, are planning to get pregnant, or are breastfeeding. … Long-term use may negatively impact the behavioural and cognitive development of children born to mothers who used cannabis during pregnancy.” 3. One in three Canadians do not think that marijuana is addictive. • Health Canada: “Long term use may result in psychological dependence (addiction).” 4. One in three Canadians believe marijuana aids mental health. • Health Canada: “Long term use may increase the risk of triggering or aggravating psychiatric and/or mood disorders (schizophrenia, psychosis, anxiety, depression, bipolar disorder).” 5. One in two males were unaware that marijuana could harm a man’s fertility • “Marijuana should not be used if you are a man who wishes to start a family.”

ClearTheAirNow.org, a coalition of concerned Canadians commissioned the survey.

Affiant is willing to provide further sources of information about the toxicity of marijuana.

Pamela McColl

www.cleartheairnow.org

pam.mccoll@cleartheairnow.org

Source: From email sent to Drug Watch International May 2018

Veterans are twice as likely as non-veterans to die from accidental overdoses involving prescription opioids. In an effort to lower opioid intake, some veterans are turning to hemp products, like CBD oil, to treat chronic pain and PTSD. Now some veterans are saying they want more research and access, reports CBS News correspondent Nancy Cordes. 

They are not your typical lobbyists. They’re veterans whose lives were nearly ruined — first by their injuries, and then by their meds. 

“I was at a higher than likely rate of committing suicide from pain,” Navy veteran Veronica Wayne told lawmakers. She took opioids for 17 years after an airplane maintenance hatch hit her head.

“I basically became a walking zombie,” Wayne said.
 
She tried medical marijuana, but still felt impaired. That’s when she heard about hemp.

“It’ll still kill all the pain symptoms and give you the relief that you need, but you’re not going to feel high,” Wayne said.

Now she uses CBD oil. But, she notes, “You can’t get it from the VA. It’s not, it’s not legal.”

Like marijuana, hemp is derived from the cannabis plant. But hemp does not contain THC, the chemical that makes you high. Still both hemp and marijuana are classified as Schedule 1 controlled substances, restricting the VA and other federally funded entities from conducting research. The American Legion is leading the push to change that.

“Anything that makes a veteran feel better — especially something that’s non-toxic — is something we’re going to support,” said Louis Celli, national director of Veterans Affairs and rehabilitation at the American Legion.
 
Currently hemp products are marketed as unregulated supplements, which makes many doctors reluctant to recommend them.

“We’re not exactly sure how to use them, what the right dose is, how they interact,” said Wayne Jonas, the former director of the NIH office of alternative medicine.

• FDA panel backs marijuana-based drug for childhood seizures

But lawmakers on both sides are pushing to change the law.
 
“I’m actually cautiously optimistic if we get something on the floor, that it will pass,” Rep. Earl Blumenauer, D-Ore., said.

Until then, Army reservist Dale Rider said many of his buddies are wary of the product that he said helps his back pain.
 
“For them, they’re all worried that because it’s so closely related to marijuana, that it could pop up on a drug test randomly,” Rider said.

The industry has a powerful ally in Senate Majority Leader Mitch McConnell, who represents Kentucky, where hemp is seen as a potential cash crop. Last month he introduced a bill in the Senate that has bipartisan support to legalize hemp as an agricultural commodity.

Veterans push lawmakers to legalize hemp products – CBS News April 2018

Abstract

The molecular composition of the cannabinoid type 1 (CB1) receptor complex beyond the classical G-protein signaling components is not known. Using proteomics on mouse cortex in vivo, we pulled down proteins interacting with CB1 in neurons and show that the CB1 receptor assembles with multiple members of the WAVE1 complex and the RhoGTPase Rac1 and modulates their activity. Activation levels of CB1 receptor directly impacted on actin polymerization and stability via WAVE1 in growth cones of developing neurons, leading to their collapse, as well as in synaptic spines of mature neurons, leading to their retraction. In adult mice, CB1 receptor agonists attenuated activity-dependent remodeling of dendritic spines in spinal cord neurons in vivo and suppressed inflammatory pain by regulating the WAVE1 complex. This study reports novel signaling mechanisms for cannabinoidergic modulation of the nervous system and demonstrates a previously unreported role for the WAVE1 complex in therapeutic applications of cannabinoids.

Fig 1. CB1 physically interacts with members of the WAVE1 signaling complex in mouse brain and colocalizes with WAVE1 in neurons. 

(A) Expression of EGFP-tagged CB1 (CB1-EGFP) in mouse brain 4 wk after cortical injection of rAAVs. Injection site is marked with a white arrow, and medial longitudinal fissure with a yellow asterisk. Scale bar represents 0.5 mm. (B) Validation of solubilization and pulldown of CB1 by immunoprecipitation using GFP-nanotrap on membrane fractions derived from cortex of mice expressing either CB1-EGFP or GFP alone (as control). Immunoblotting (IB) experiments show that anti-GFP antibody pulls down endogenous CB1 and CB1-EGFP from CB1-EGFP-expressing mice, but not from GFP control mice. The successful pulldown shows the high molecular weight form of CB1 (black arrows), the CB1-EGFP monomer (yellow arrow) and endogenous CB1 (blue arrow head). (C) Summary of MS analysis of GFP nanotrap-immunoprecipitates from the cortex of CB1-EGFP-expressing mice or GFP-expressing control mice (n = 5). rPQ is relative peptide query score. Values for rPQ > 4 indicates specific purification in comparison over negative control. (D) Schematic representation of activation of the WAVE1 complex by GTP-bound (activated) Rac1. (E) Immunoblotting on GFP-nanotrap-immunoprecipitates showing that cytoplasmic FMR1 interacting protein 2 (CYFIP2), NCK-associated protein 1 (NCKAP1), WAVE1 and Rac1 are coimmunoprecipitated with GB1-EGFP, but not with GFP, from the mouse cortex. (F) Immunoblotting on α-CB1-immunoprecipitates showing that WAVE1 is coimmunoprecipitated with CB1 from cortical lysates derived from wild-type mice, but not in lysates from CB1-deficient mice (CB1^-/-). (G) Colocalization of WAVE1 and EGFP-tagged CB1 in growth cones (magnified in inset) of developing cortical neurons with pyramidal morphology. The actin cytoskeleton is counterstained with Phalloidin (growth cone magnified in inset). Scale bars represent 10 μm.

Fig 2. Increased localization of colocalization of WAVE1 and CB1-EGFP at the cell membrane in heterologously-transfected COS7 cells upon ACEA treatment. 

(A) Distribution of heterologously-transfected WAVE1 in cells cotransfected with either GFP (control, upper panels) or CB1-EGFP (lower panels) following treatment with vehicle (DMSO 1:30,000) or CB1 agonist (ACEA 100 nM) for 45 min. Scale bar represents 5 μm. (B) Quantitative summary of intensity of WAVE1-immunoreactivity relative to Phalloidin-stained actin at the plasma membrane in GFP- or CB1-EGFP-coexpressing COS7 cells treated with vehicle (white bars) or ACEA (red bars). (C) Quantitative summary of CB1-EGFP-WAVE1 colocalization in vehicle- or ACEA-treated cells calculated as a fraction of the total intensity of CB1-EGFP fluorescence. Values in panels B and C represent the mean ± SEM and are derived from analyses on at least 15 COS7 cells each over several independent culture experiments. *p < 0.05 one way ANOVA followed by posthoc Tukey’s test.

Fig 3. Cannabinoids directly modulate Rac1 activity and WAVE1 phosphorylation by Rac1 Activation and WAVE1 Phosphorylation via CB1. 

(A) Schematic representation of the Raichu-Rac1 FRET-biosensor employed to measure Rac1 activity. (B) Real-time images representing changes in Rac1 activity in developing mouse cortical neurons following treatment with a CB1 agonist (ACEA; 100 nM) and an inverse agonist at CB1 (AM251; 600 nM). The FRET signal intensity is represented as a pseudocoloured heat map, and insets show magnified view of growth cones. Scale bars (white) represent 20 μm, and scale bars in the inset (yellow) represent 5 μm. (C) Quantitative summary of normalized FRET ratios over the growth cone area at various time points after addition of ACEA, AM251, NGF (100 ng/ml), or vehicle normalized to the average FRET ratio value over the same area prior to addition of pharmacological agents in developing neurons derived from wild-type mice. (D) Preserved effect of NGF and loss of effects of ACEA as well as AM251 on Rac1 activity in developing cortical neurons derived from CB1^-/- mice. Values in panels C and D represent the mean ± SEM and are derived from analyses on 10–16 neurons per group over at least three independent culture experiments. (E, F) Immunoblot analyses showing changes in phosphorylation state of Serine 397 (pSer397) in WAVE1 upon treatment with ACEA (100 nM) or AM251 (600 nM) as compared to vehicle treatment in cortical neurons derived from wild-type mice without pretreatment (E), with overnight pertussis toxin (PTX) (100 ng/ml) pretreatment or from CB1^-/- mice (F). (G) Quantitative summary of cannabinoid-induced modulation of pSer397 WAVE1 levels normalized to βIII-tubulin in the above groups (n = 5–6 independent culture experiments). All graphs represent mean values ± SEM *p < 0.05, two-way ANOVA for repeated measures (C, D) or one-way (G) ANOVA followed by posthoc Tukey’s test. N.s. stands for not significant.

Fig 4. Visualization of cannabinoidergic modulation of actin dynamics in neuronal growth cones mediated by CB1 and WAVE1. 

(A) Real time images of wild-type developing cortical neurons transfected to express LifeAct-GFP, a biosensor for levels of F-actin prior to and at different time points following treatment with ACEA (100 nM), AM251 (600 nM), or vehicle. Scale bar represents 10 μm. (B, C) Analysis on the F-actin dynamics based on cannabinoid-induced changes in LifeAct-GFP intensity (B) and area (C) over time in growth cones of cultured cortical neurons derived from wild-type mice (n = 15–17 neurons per group from 5 independent culture experiments). (D, E) However, no changes in LifeAct intensity (D) nor area of the growth cones (E) were observed with cultured cortical neurons derived from CB1^-/- mice (n = at least 4 neurons per group from 2 independent culture experiments) after treatment. (F, G) Similarly, cultured cortical neurons with down-regulated WAVE1 showed no changes in LifeAct intensity (F) or area of growth cones (G) after cannabinoid treatment (n = at least 4 neurons per group). (H, I) Moreover, the abrogation of the effects after cannabinoid treatment can be contributed to the down-regulation state of WAVE1, since cultured cortical neurons nucleofected with scrambled siRNA, in turn show changes in LifeAct intensity (H) and area (I) of the growth cone following cannabinoid treatment (n = at least 4 neurons per group). (J, K) Immunoblot representation of WAVE1 down-regulation upon siRNA delivery in developing cortical neurons (J) and the corresponding quantification (K) (n = 6). All graphs represent mean values ± SEM *p < 0.05, two-way ANOVA (B-I) or one-way ANOVA (K) for random measures followed by posthoc Tukey’s test.

Fig 5. Cannabinoids regulate growth cone morphology via CB1-Gi-Rac1-WAVE1 signaling. 

(A) Characterization of changes in growth cone morphology in developing cultured cortical neurons immunostained with anti-pGAP43 to recognize normal or enlarging growth cones and Phalloidin to label actin. Insets show normal, enlarged, or collapsed morphology in developing cortical neurons; scale bar represents 10 μm in all images and insets. (B) Bidirectional modulation of the proportion of growth cones with collapsed or enlarged morphology upon treatment with ACEA (100 nM), AM251 (600 nM) or vehicle (DMSO 1:30,000) for 1 h in neurons derived from wild-type mice (n = 10 independent culture experiments), but not in neurons from CB1^-/- mice (n = 4). (C–F) Lack of modulation of cannabinoidergic modulation of growth cone morphology upon treatment in the presence of PTX (100 ng/ml), Rac1 inhibitor, CAS 1090893-12-1 (50 μM) or in neurons with siRNA-mediated downregulation of WAVE1; control siRNA-transfected neurons showed significant cannabinoidergic modulation (n = 4). All graphs represent mean values ± SEM. *p < 0.05, one-way ANOVA followed by posthoc Tukey’s test. N.s. stands for not significant.

Fig 6. CB1 receptor is expressed in axonal as well as dendritic compartments of primary neurons matured over 4 wk in vitro. 

(A) Coimmunostaining against CB1 receptor and dendritic marker MAP2 on 28 days in vitro (DIV) cortical neurons derived from wild-type mouse embryos (upper panels) shows the distribution of CB1 receptor in the axonal compartments (MAP2-negative) as well as dendritic compartments (MAP2-positive). The rabbit anti-CB1 antibody used throughout this experiment did not yield substantial staining in cortical neurons cultured from CB1-deficient mouse embryos at 28 DIV (lower panels). (B) Magnified images represent white boxed areas from main images. (C) CB1 receptor colocalizes with CamKII-GFP and the synaptic protein PSD95 in dendritic compartments, including several spine heads (white arrow heads), indicating postsynaptic localization. (D) Heterologously-expressed CB1-EGFP in mature cultured cortical neurons shows axonal and dentritic localization upon costaining with MAP2. Phalloidin is used to counterstain the entire actin cytoskeleton. Phall. stands for Phalloidin. (E) Dendritic (arrows) ad axonal (arrowhead) localization of endogenous CB1 in cortical neurons cultured from wild-type mice and matured at 28 DIV. White scale bars represent 20 μm and yellow scale bars represent 5 μm.

Fig 7. Visualization of disassembly of F-actin by cannabinoid agonists in in dendritic spines on mature cortical neurons, leading to reduction in the density of mature spines. 

(A) Representative real time images of FRAP experiments. Localized photobleaching over single, individual postsynaptic spines (red circles), led to loss of LifeAct-mCherry labeling of F-actin and progressive recovery of fluorescence with actin polymerization, which was inhibited by ACEA as compared to vehicle control. (B & C) Summary of FRAP values as a function of time expressed as one phase exponential function curves fitted to the respective data sets from neurons treated with ACEA or vehicle either from wild-type cultured cortical neurons (B) or with siRNA-mediated WAVE1 knockdown (C) (13–15 dendritic spines/group from 4 independent culture experiments). (D) Immunoblot example of WAVE1 down-regulation 3 d following siRNA delivery in mature cultured cortical neurons and the corresponding quantification (seven independent culture experiments). (E) Quantitative summary of the magnitude of F-actin recovery in the dendritic spine after photobleaching in neurons from the diverse treatment groups (five independent culture experiments). (F) Representative confocal images of mature cortical neurons transduced with rAAV-CamK-II-GFP virions and treated with ACEA (100 nM) or vehicle for 24 h. GFP-labelled dendritic spines were morphologically classified (lower panels) and quantified. Yellow bars represent 50 μm and white bars represent 5 μm. (G) Quantitative summary of average density of dendritic spines of varying morphology in cortical neurons treated with ACEA (100 nM) or vehicle (n = 20–21 dendrites analyzed from three cultures/group). All graphs represent mean values ± SEM *p < 0.05 as compared to control group and †p < 0.05 as compared to WT neurons, two-way ANOVA (E) or one-way ANOVA (D & G) followed by posthoc Tukey’s test. N.s. stands for “not significant.”

Fig 8. Intrathecal delivery of ACEA inhibits mechanical nociceptive hypersensitivity and nociceptive activity-induced structural plasticity of dendrites on spinal dorsal horn neurons in inflammatory pain conditions in vivo. 

(A) Frequency of paw withdrawal responses to mechanical force via plantar application of graded von Frey hairs recorded prior to and 24 h after hind paw intraplantar injection of CFA. Leftward shift in response curves following CFA (indicative of hypersenstivity) is diminished in mice treated intrathecally with ACEA (2 pmol) over 24 h as compared to mice intrathecally receiving vehicle (n = at least 8 per group). (B) Traced images of Golgi-stained large pyramidal-like neurons in laminae II and V of the spinal dorsal horn and dendritic spines (insets) in mice represented in (A). Scale bars represent 10 μm in all panels. (C) Quantitative summary of dendritic spine density in spinal neurons from mice represented in (A) and (B); CFA-induced enhancement in spine density does not occur in mice receiving intrathecal ACEA (n = 12–16 neurons counted from over 4 mice per group). (D, E) Mice with hind paw inflammation show reduced levels of pSer397 WAVE1, quantified over βIII-tubulin as loading control, in spinal lumbar segments L3-L5 at 24 h post-CFA, which is partially and significantly reversed by intrathecal ACEA as compared to vehicle. An example of western blot analysis and quantitative summary from seven mice per group is shown in (D) and (E), respectively. All graphs represent mean values ± SEM *p < 0.05 as compared to basal values within the group and †p < 0.05 as compared to corresponding values in the vehicle group, two-way (A) and one-way (C, E) ANOVA for repeated measures followed by posthoc Tukey’s test.

Fig 9. Role of spinally-expressed WAVE1 in nociceptive activity-induced structural plasticity, inflammatory pain, and cannabinoidergic analgesia in vivo. 

(A, B) An immunoblot example and quantitative data from western blot analysis showing down-regulation of WAVE1 in spinal cord segments L3–L5 after intrathecal in vivo application of WAVE1 siRNA as compared to control siRNA. (C) Normal basal spine density but lack of CFA-induced spine remodeling in lamina II/V lumbar spinal neurons at 24 h post-CFA in mice intrathecally injected with WAVE1 siRNA as compared to control siRNA (n = 16–17 spines counted over four mice per group). (D) Frequency of paw withdrawal responses to mechanical force via plantar application of graded von Frey hairs recorded prior to (dashed lines) and 24 h after hind paw intraplantar injection of CFA (solid lines). Leftward shift in response curves following CFA (indicative of hypersensitivity) is diminished with intrathecal siRNA-mediated WAVE1 knockdown (red symbols) as compared to mice intrathecally injected with control siRNA (black symbols). (E) Mechanical hypersensitivity at 24 h post-CFA is significantly reduced by intrathecal ACEA injection over 24 h in mice intrathecally treated with control siRNA (black squares in E, upper graph), but not in mice intrathecally treated with WAVE1 siRNA (red squares in E, lower graph). (F) Quantitative summary of dendritic spine density in laminae II or V neurons in L3–L5 segments of mice which were tested behaviorally in panels animals in (E). Intrathecal ACEA reduces spine density in control siRNA-injected CFA-inflamed mice, but not in WAVE1 siRNA-treated CFA-inflamed mice (16–18 neurons counted from over four mice per group). All graphs represent mean values ± SEM, n = 7–9 mice per group in panels D & E. *p < 0.05 as compared to basal values within the group and †p < 0.05 as compared to corresponding control, two-way (D, E) and one-way (B, C and F) ANOVA for repeated measures followed by posthoc Tukey’s test.

Source: https://pubmed.ncbi.nlm.nih.gov/26496209 October 2015

Abstract

Source: Medical Marijuana Users are More Likely to Use Prescription Drugs Medically and Nonmedically – PubMed (nih.gov) July/August 2018

Researchers identified a discrepancy between oncologists’ self-reported knowledge base and their clinical practices and beliefs regarding medical marijuana

While a wide majority of oncologists do not feel informed enough about medical marijuana’s utility to make clinical recommendations, most do in fact conduct discussions on medical marijuana in the clinic and nearly half recommend it to their patients, say researchers who surveyed a population-based sample of medical oncologists.

The study, published today in the Journal of Clinical Oncology, is the first nationally-representative survey of medical oncologists to examine attitudes, knowledge and practices regarding the agent since medical marijuana became legal on the state level in the U.S. Medical marijuana refers to the non-pharmaceutical cannabis products that healthcare providers recommend for therapeutic purposes. A significant proportion of medical marijuana products are whole-plant marijuana, which contains hundreds of active ingredients with complicated synergistic and inhibitory interactions. By contrast, cannabinoid pharmaceuticals, which are available with a prescription through a pharmacy, contain no more than a couple of active ingredients. While considerable research has gone into the development of cannabinoid pharmaceuticals, much less has been completed on medical marijuana’s utility in cancer and other diseases. The researchers speculate that the immature scientific evidence base poses challenges for oncologists.

“In this study, we identified a concerning discrepancy: although 80% of the oncologists we surveyed discussed medical marijuana with patients and nearly half recommended use of the agent clinically, less than 30% of the total sample actually consider themselves knowledgeable enough to make such recommendations,” said Ilana Braun, MD, chief of Dana-Farber Cancer Institute’s Division of Adult Psychosocial Oncology. “We can think of few other instances in which physicians would offer clinical advice about a topic on which they do not feel knowledgeable. We suspect that this is at least partly due to the uncomfortable spot in which oncologists find themselves. Medical marijuana is legal in over half the states, with cancer as a qualifying condition in the vast majority of laws, yet the scientific evidence base supporting use of medical marijuana in oncology remains thin.”

The mailed survey queried medical oncologists’ attitudes toward medical marijuana’s efficacy and safety in comparison with standard treatments; their practices regarding medical marijuana, including holding discussions with patients and recommending medical marijuana clinically; and whether they considered themselves sufficiently informed regarding medical marijuana’s utility in oncology. Responses indicated significant differences in attitudes and practices based on non-clinical factors, for instance regional location in the U.S.

“Ensuring that physicians have a sufficient knowledge on which to base their medical recommendations is essential to providing high quality care, according to Eric G. Campbell, PhD, formerly a professor of medicine at the Massachusetts General Hospital, now a professor at the University of Colorado School of Medicine. “Our study suggests that there is clearly room for improvement when it comes to medical marijuana.”

To date, no randomized clinical trials have examined whole-plant medical marijuana’s effects in cancer patients, so oncologists are limited to relying on lower quality evidence, research on pharmaceutical cannabinoids or research on medical marijuana’s use in treating diseases other than cancer.

Of note, additional findings of the current study suggest that nearly two-thirds of oncologists believe medical marijuana to be an effective adjunct to standard pain treatment, and equally or more effective than the standard therapies for symptoms like nausea or lack of appetite, common side effects of cancer treatments such as chemotherapy.

Many oncologists recommend medical marijuana clinically despite not feeling sufficiently knowledgeable to do so: Researchers identified a discrepancy between oncologists’ self-reported knowledge base and their clinical practices and beliefs regarding medical marijuana — ScienceDaily May 2018

Many marijuana dispensaries recommend marijuana products for treating pregnant women’s morning sickness, even though marijuana use in pregnancy is linked with health problems for newborns, according to a new study from Colorado researchers.

The study surveyed 400 marijuana dispensaries in Colorado, and nearly 70 percent said they would recommend marijuana products for women experiencing nausea in early pregnancy. Most dispensary employees cited their personal opinions when making the recommendation.

“As cannabis legalization becomes more common, women should be cautioned that advice from dispensary employees might not necessarily be informed by medical evidence,” the researchers, from the University of Colorado School of Medicine and the Denver Health and Hospital Authority, wrote in the June issue of the journal Obstetrics & Gynecology. [25 Odd Facts About Marijuana]

Pot during pregnancy

Marijuana use during pregnancy may be harmful for babies: Some studies have found a link between marijuana use in pregnancy and health problems in newborns, including low birth weight, according to the Centers for Disease Control and Prevention (CDC). Research also suggests that marijuana use during pregnancy could have long-term neurological effects: For example, some studies have found that children exposed to marijuana in the womb are at greater risk for attention and behavior problems, compared with babies not exposed to marijuana. The American College of Obstetricians and Gynecologists recommends that pregnant women not use marijuana.

“Babies exposed to marijuana in utero are at increased risk of admission to neonatal intensive care units. There are also concerns about possible long-term effects on the developing brain, impacting cognitive function and decreasing academic ability later in childhood,” study lead author Dr. Torri Metz, a perinatologist at Denver Health, said in a statement.

However, as more and more U.S. states legalize the drug, more pregnant women may use it, the study authors said. Already, 1 in 20 U.S. women reports using pot while pregnant, according to the CDC.

What’s more, pregnant women may not wish to discuss marijuana use with their doctors, out of fear of legal consequences, and so they may instead seek advice from marijuana retailers, the researchers said.

In the new study, the researchers called Colorado marijuana dispensaries and pretended to be eight weeks pregnant.

The researchers told the dispensary employees that they were feeling “really nauseated” and asked if the dispensaries had any products recommended for morning sickness.

Of the 400 marijuana dispensaries contacted, 277 (69 percent) recommended a marijuana product for morning sickness, and of these, 65 percent based their recommendation on personal opinion, while 30 percent did not specify a reason for their recommendation.

More than a third (36 percent) of dispensary employees contacted said that marijuana was safe in pregnancy, while about half (53 percent) said they weren’t sure about the drug’s safety during pregnancy.

The researchers also made note of some quotes from the dispensary employees, which in some cases were strikingly inaccurate. For example, one employee said that “after eight weeks [of pregnancy], everything should be good with consuming, like, alcohol and weed and stuff, but I would wait an extra week.” Another said that marijuana edibles wouldn’t be a risk to the baby, because “they would be going through your digestional [digestive] tract.”

Still, 80 percent of dispensaries did recommend that the caller discuss use of marijuana in pregnancy with their doctor. But only 32 percent of dispensaries made this recommendation without prompting from the researchers (with the question “Should I talk to my doctor about this?”)

The researchers noted that recommendations from cannabis dispensary employees may vary depending on the person who took the call and may not represent the policy of the dispensary or the views of other employees. Still, the “mystery caller” method used by the researchers reflects a “real world” situation and the advice that a woman may receive when calling the dispensary, the investigators said.

The researchers concluded that “public health initiatives should consider collaborating with dispensary owners … about standards for advice provided to pregnant women.”

Source: Most Marijuana Dispensaries Give Inaccurate Advice on Pot in Pregnancy | Live Science May 2018

SEPARATING MARIJUANA FACT FROM FICTION IN NEW YORK RESPONSE TO THE “ASSESSMENT OF THE POTENTIAL IMPACT OF REGULATED MARIJUANA IN NEW YORK STATE”

AUGUST 2018

Executive Summary
Recently, New York State (NYS) released what they claimed to be “an extensive assessment of current research and literature to evaluate the cost-risk benefit of legalizing the recreational adult use of marijuana.”
The overall conclusion of this assessment was that marijuana poses little public health risk and should be considered for legalization. But a closer look finds several flaws in the report that questions its purpose and conclusions. Unfortunately, it appears that the conclusion of the NYS report was written before the data were analyzed. The legalization of recreational marijuana is presented in the introduction as a fait accompli: “It has become less a question of whether to legalize but how to do so responsibly.” Much of the report discusses how to decrease the dangers of legal recreational marijuana. The best way to lessen the danger is to keep it from being commercialized, normalized, promoted – and legalized.
The report conflates the issues of medical marijuana and commercial sales of recreational marijuana. The potential medical benefits of medical cannabis are already available in New York. Adding indiscriminate recreational use does not increase any health benefit to New Yorkers.
Smart Approaches to Marijuana (SAM) is advised by a scientific advisory board of researchers from institutions such as Harvard and Johns Hopkins. SAM believes in the need for rational, well-informed public policy – legislation that maximizes public health benefits and minimizes harms.
This state-issued report reads more like a marijuana lobbyist’s manifesto, as we found no credible opposing evidence cited.
Based on our findings, the reference to unlisted “subject-matter experts” that the report apparently relied on, and the fact that state medical groups like the New York Society for Addiction Medicine (NYSAM) were not consulted with, we are formally requesting that the state of New York publicly disclose all sources that were consulted and those that contributed to creation of the document. We believe that National Institute of Health (NIH) scientists, NYSAM physicians, and other experts should have the chance to review these findings.
Below are the top claims from the report and rebuttals.

CLAIM: “A 2017 Marist Poll showed that 52 percent of Americans 18 years of age or older have tried marijuana at some point in their lives, and 44 percent of these individuals currently use it.”
CORRECTION:
The best usage data are not found in polls, but rather scientific studies conducted by the National Institutes of Health. According to the most recent National Survey on Drug Use and Health (NSDUH) data, 10.58% of Americans 12 or older and 10.84% of New York State residents reported being current users and 44% of Americans have tried marijuana at some point in their life (NSDUH, 2016).

CLAIM: “In 1999 the Institute of Medicine (IOM) found a base of evidence to support the benefits of marijuana for medical purposes.”
CORRECTION:
This report is supposed to be about non-medical marijuana. We should not conflate the two issues. Still, there have been several reviews since this was published almost twenty years ago. The 1999 IOM report stated: “Because of the health risks associated with smoking, smoked marijuana should generally not be recommended for long-term medical use” and called for a “heavier investment in research.”
Released at the beginning of 2017, the most recent National Academy of Sciences report said: “Despite increased cannabis use and a changing state-level policy landscape, conclusive evidence regarding the short- and long-term health effects—both harms and benefits—of cannabis use remains elusive.” The July 24, 2018 issue of the Annals of Internal Medicine stated that “Americans’ view of marijuana use is more favorable than existing evidence supports.”
Again, this NYS report recommended recreational legalization, and we should separate the issue of the possible therapeutic benefits from this study.

CLAIM: “Most women who use marijuana stop or reduce their use during pregnancy.”
CORRECTION:
Dr. Nora Volkow, NIH’s drug abuse director, published a report last year in response to an alarming trend being seen across the country of increased cannabis use during pregnancy and warned of the detrimental health risks of in utero cannabis exposure (Volkow et al., 2017).
Even more alarming is a recent study that was not included in this report where researchers found nearly 70% of 400 Colorado dispensaries surveyed in a scientific, undercover study were recommending cannabis products to mothers experiencing morning-sickness in the first trimester (Dickson et al., 2018).
A clinically-controlled study published this year found that mothers vulnerable to mental illness who smoked during pregnancy put their child at higher risk to develop significantly more psychotic symptoms earlier in life compared to mothers who didn’t smoke marijuana, but had similar vulnerabilities (Bolhuis et al., 2018).

CLAIM: “Data from multiple sources indicate that legalization in Colorado had no substantive impact on youth marijuana use.”
CORRECTION:
Despite widely publicized reports by the state of Colorado, pro-legalization lobbyists, and others with revenue-producing interests; reliable data sources say otherwise. According to NSDUH state estimates, Colorado now leads the nation in the percentage of 12- to 17-year olds who have tried marijuana for the first time (NSDUH, State Estimates, 2017). In adolescents and adults, Colorado is well above the national average.
All state-collected data related to adolescent substance use is done via the Healthy Kids Colorado Survey – a state sponsored assessment to replace all other national and state surveys administered in school. Until 2017, these data have not met the CDC’s standard qualifications for sampling methodology since 2011 – the year before recreational marijuana became legal in Colorado. The 2015 HKCS has been widely criticized for misrepresenting and promoting misleading messages surrounding adolescent drug use (Murray, 2016).

As a result of questionable reports publicized by the state of Colorado and pro-legalization activists, local investigative journalists at the Denver Post interviewed numerous law enforcement officers, educators and advocates; in addition to analyzing databases. They ultimately concluded that state-produced data appears to be unreliable (Migoya, 2017). “Records do not account for many young offenders who either are not reported to police, are not ticketed because police say there’s too little to cite or have infractions that are not tabulated because of programs designed to protect minors from blemished records.”

CLAIM: “There has been no increase in violent crime or property crime rates around medical marijuana dispensaries.”
CORRECTION:
The relationship between marijuana establishments and crime is mixed at best. A study funded by the National Institutes of Health showed that the density of marijuana dispensaries was linked to increased property crimes in nearby areas (Freisthler, et al., 2017). Colorado Public Radio reported similar findings – particularly in Denver and Pueblo – and noted the visible association with increased gang violence seen in both cities likely due to a high density of dispensaries and illegal activity, including the black market (Markus, 2017).

CLAIM: “Marijuana is an effective treatment for pain, greatly reduces the chance of dependence, and eliminates the risk of fatal overdose compared to most opioid-based medications.”

CORRECTION:
This is inaccurate and is confounding medical and recreational use. This statement was based on a survey that 17 medical marijuana patients took while being prescribed opioids. Self-report data can be useful but have no value in informing serious public health risks. Several recent and widely-circulated studies show strong contradictory evidence to this claim.
Researchers found that patients reporting marijuana use actually experienced more pain on average when admitted to the hospital following a traumatic injury than those that did not. Compared to non-users, they required more opioid medication to cope with the pain and consistently rated their pain higher during the duration of their stay (Salottolo et al., 2018).
A 4-year prospective study in the highly respected Lancet journal followed medical marijuana patients with a dual opioid prescription and found that marijuana use did not reduce opioid use or prescribing. Users reported greater pain severity and more day-to-day interference than those that did not use marijuana (Campbell et al., 2018).

CLAIM: “Regulated marijuana introduces an opportunity to reduce harm for consumers through labeling.”
CORRECTION:
Non-FDA approved commercially-produced products have received only minimal regulatory attention. Recent studies have shown rampant mislabeling of the active cannabinoid ingredients in concentrates and edibles (Peace et al., 2016).
The FDA has published warning letters on the severe mislabeling of commercial products consistently seen on the market since 2015 (FDA, 2015-17). This claim was cited from the Drug Policy Alliance website. The DPA and its affiliates have directly funded campaigns to legalize all forms of marijuana including edible products throughout the US. They also call for the legalization of all drugs. This is not a credible source.

CLAIM: “The status quo (i.e., criminalization of marijuana) has not curbed marijuana use.”

CORRECTION:
Non-public, personal use of Marijuana is not criminalized in NYS nor are possession of small amounts for personal amounts – often a reason for imprisonment. In 2016 23.5% Americans reported using legal drugs compared to 10.6% using illegal ones – signaling that the law matters in preventing drug use (NSDUH, 2016). In 2017 in New York State, marijuana made up 0.003% of non youthful-offender felony sentences to prison. There were no youthful offender felony marijuana sentences for prison. Misdemeanor marijuana arrests made up 8.5% of all state
misdemeanor arrests (NY State Division of Criminal Services, 2018). The recent rush to legalization across the country has pushed marijuana to the number one spot for recent first-time drug users aged 12 or older in 2016 compared to any other illicit drug (NSDUH, 2016).

CLAIM: “Legalizing marijuana results in a reduction in the use of synthetic cannabinoids.”
CORRECTION:
This claim is inaccurately attributed to the report Global Drug Survey which indicates that countries that decriminalize marijuana have lower rates of synthetic marijuana use. The claim cannot be found in that reference. And, even if there is an association between decreased synthetic use and decriminalized marijuana, it does not follow that legalizing marijuana will cause a reduction in synthetic use. We emailed Professor Adam R Winstock, Founder & CEO of the Global Drug Survey, to ask his opinion. He replied, ”It’s not clear cut,” indicating uncertainty. There is not much data on decreased synthetic use in countries with decriminalization (Zucker doesn’t even say “countries with legalization” which is actually the issue at hand because only Uruguay would fall into that category).

CLAIM: “The over-prosecution of marijuana has had significant negative economic, health, and safety impacts that have disproportionately affected low-income communities of color.”
CORRECTION:
Marijuana does not need to be legalized to address valid social justice concerns. Although overall drug-related offenses have decreased in states that have legalized; minorities have still disproportionately been targeted for the arrests that do still occur. Such as in 2014, two years after legalization in Colorado, the marijuana arrest rates for African‐ Americans (348 per 100,000) was almost triple that of Whites (123 per 100,000) (Co. Dept. of Public of Safety, 2016).
Colorado has seen an increase in crime in regions that attract recreational users. Although the rise in crime cannot be attributed to legalization of marijuana alone, much of the violence has been attributed to increased gang violence where dispensaries are densest (Markus, 2017). Current drug policies can be changed without legalization.

CLAIM: “The negative health consequences of marijuana have been found to be lower than alcohol, tobacco, and illicit drugs including heroin and cocaine.”

CORRECTION:
This statement is questionable because it was based on a theoretical model that estimated human consumption averages for each substance and calculated a risk ratio using lethal doses reported in animal studies. Basic research is necessary for understanding the biology underlying addiction; however, the transferability of dosing schedules between species has not been conclusively established. Much of the reason alcohol and tobacco exert more costs to society than many illegal drugs is because those two drugs are legalized and commercialized. As Dr. Nora Volkow, head of NIH’s drug abuse institute stated, “Repeated marijuana use during adolescence may result in long-lasting changes in brain function that can jeopardize educational, professional, and social achievements.
“However, the effects of a drug (legal or illegal) on individual health are determined not only by its pharmacologic properties but also by its availability and social acceptability.” “In this respect, legal drugs (alcohol and tobacco) offer a sobering perspective, accounting for the greatest burden of disease associated with drugs not because they are more dangerous than illegal drugs but because their legal status allows for more widespread exposure.”

CLAIM: “The impact of legalization in surrounding states has accelerated the need for NYS to address legalization.”
CORRECTION:
This statement reads as if two wrongs somehow make a right. NYS should not be forced into legalizing marijuana because other states are considering it (several surrounding states, it should be noted, have considered and then defeated proposals to legalize marijuana). Even if a surrounding state or two legalizes marijuana, NYS can stand out as the state promoting health, well-being, family-centered tourism – not more drug use.
This statement totally ignores newer polls such as the 2018 Emerson College poll that found that the majority of New Yorkers do not support the legalization of marijuana. A plurality support either decriminalization or the current policy.
“The poll — conducted by the same college that recently conducted a poll for pro-marijuana groups Marijuana Policy Project (MPP) and the Drug Policy Alliance (DPA) — reported that 56% of respondents did not favor legalizing the recreational sales of marijuana.”

REFERENCES
Bolhuis, K., Kushner, S. A., Yalniz, S., Hillegers, M. H., Jaddoe, V. W., Tiemeier, H., & El Marroun, H. (2018). Maternal and paternal cannabis use during pregnancy and the risk of psychotic-like experiences in the offspring. Schizophrenia research.

Campbell, G., Hall, W. D., Peacock, A., Lintzeris, N., Bruno, R., Larance, B., … & Blyth, F. (2018). Effect of cannabis use in people with chronic non-cancer pain prescribed opioids: findings from a 4-year prospective cohort study. The Lancet Public Health, 3(7), e341-e350.

Center for Behavioral Health Statistics and Quality. (2017). 2016 National Survey on Drug Use and Health: Detailed Tables. Substance Abuse and Mental Health Services Administration, Rockville, MD.

Commissioner, O. O. (n.d.). Public Health Focus – Warning Letters and Test Results for Cannabidiol-Related Products. Retrieved from https://www.fda.gov/newsevents/publichealthfocus/ucm484109.htm

Colorado Dept. Public Safety. (2016, March). Marijuana Legalization in Colorado: Early Findings. Retrieved from https://cdpsdocs.state.co.us/ors/docs/reports/2016-SB13-283-Rpt.pdf

Copyright © 2018 National Academy of Sciences. All Rights Reserved. (2017, November 08). Retrieved from http://nationalacademies.org/hmd/Activities/PublicHealth/MarijuanaHealthEffects.aspx

Dickson, B., Mansfield, C., Guiahi, M., Allshouse, A. A., Borgelt, L., Sheeder, J., … & Metz, T. D. (2018). 931: Recommendations from cannabis dispensaries on first trimester marijuana use. American Journal of Obstetrics and Gynecology, 218(1), S551.

Emerson College. (2018, June). June 2018 Public Opinion Survey of New York Registered Voters Attitudes on Marijuana Policy. Retrieved from https://learnaboutsam.org/wp-content/uploads/2018/06/nyspoll-1.pdf Commissioned by Smart Approaches to Marijuana

Freisthler, B., Ponicki, W. R., Gaidus, A., & Gruenewald, P. J. (2016). A micro‐temporal geospatial analysis of medical marijuana dispensaries and crime in Long Beach, California. Addiction, 111(6), 1027-1035.

Green, M. C. (2018, June). Criminal Justice Case Processing Arrest through Disposition New York State January – December 2017. Retrieved from http://www.criminaljustice.ny.gov/crimnet/ojsa/dar/DAR-4Q-2017-NewYorkState.pdf

Keyhani, S., Steigerwald, S., Ishida, J., Vali, M., Cerdá, M., Hasin, D., . . . Cohen, B. E. (2018). Risks and Benefits of Marijuana Use. Annals of Internal Medicine. doi:10.7326/m18-0810

Markus, B. (2017, July 31). A Dive Into Colorado Crime Data In 5 Charts. Retrieved from http://www.cpr.org/news/story/a-dive-into-colorado-crime-data-in-5-charts

Migoya, D. (2017, December 22). Police across Colorado questioning whether youths are using marijuana less. Retrieved from https://www.denverpost.com/2017/12/22/police-across-colorado-questioning-youth-marijuana-use/

Murray, D. W. (2016, July 2). Misrepresenting Colorado Marijuana – by David W. Murray. Retrieved from https://www.hudson.org/research/12615-misrepresenting-colorado-marijuana

National Families in Action. (n.d.). Colorado | The Marijuana Report.org. Retrieved from http://themarijuanareport.org/colorado/.

Peace, M. R., Butler, K. E., Wolf, C. E., Poklis, J. L., & Poklis, A. (2016). Evaluation of two commercially available cannabidiol formulations for use in electronic cigarettes. Frontiers in pharmacology, 7, 279.

Salottolo, K., Peck, L., Tanner II, A., Carrick, M. M., Madayag, R., McGuire, E., & Bar-Or, D. (2018). The grass is not always greener: a multi-institutional pilot study of marijuana use and acute pain management following traumatic injury. Patient Safety in Surgery, 12(1), 16.

Volkow, N. D., Compton, W. M., & Wargo, E. M. (2017). The risks of marijuana use during pregnancy. Jama, 317(2), 129-130.

Smart Approaches to Marijuana (SAM) is a nonpartisan, non-profit alliance of physicians, policy makers, prevention workers, treatment and recovery professionals, scientists, and other concerned citizens opposed to marijuana legalization who want health and scientific evidence to guide marijuana policies. SAM was co-founded by former Congressman Patrick Kennedy and former Obama Administration senior drug policy advisor, Dr. Kevin Sabet. SAM has affiliates in more than 30 states.

Source: NY-Rebuttal-Absolute-Final.pdf (learnaboutsam.org) August 2018

Cannabis Use and Health 2014
Introduction

Cannabis is a group of substances from the plant cannabis sativa. Cannabis is used in three main forms: flowering heads, cannabis resin (hashish) and cannabis oil. There are more than 60 psycho-active chemicals in cannabis, including the cannabinoids:
 delta-9 tetrahydrocannabinol (THC), which is found in the resin covering the flowering tops and upper leaves of the female plant and which alters mood and produces the feeling of a ‘high’;
and
 cannabidiol, which can offset the effects of THC.

Cannabis is usually smoked, either in a hand-rolled cigarette (a ‘joint’) containing the leaf, heads or resin of the plant, or through a water-pipe (a ‘bong’) where water is used to cool the smoke before it is inhaled. In Australia, cannabis is also commonly known as gunja, yarndi, weed and dope.

Patterns of Cannabis Use in Australia and its Public Health Impacts

In 2010, cannabis was the most commonly used illicit drug in Australia. Over one third of Australians (35.4%, approximately 6.5 million) aged 14 years and over had used cannabis at least once in their lifetime, and 1.9 million of these had used cannabis recently (i.e., in the last 12
months). Recent cannabis use among those 14 years and older has increased from 9.1% in 2007 to 10.3% in 2010, though daily users decreased from 14.9% in 2007 to 13% in 2010. In 2010, approximately 247,000 Australians 14 years and over used cannabis daily. For most cannabis users, use is relatively light. Most young people have used it once or twice. However, the younger people start using cannabis, and the greater the frequency with which they use it, the greater the risk of harm.
Based on current use patterns, alcohol abuse and tobacco pose much greater harms to individual and public health in Australia than cannabis. Cannabis-related psychosis, suicide, road-traffic crashes and dependence were estimated to account for 0.2% of the total disease burden in Australia in 2003. This compares to 7.8% of the total burden attributable to tobacco use and 2.3% attributable to alcohol use. In 2004-05, the estimated social costs of cannabis use (including health, crime, road crash and labour costs) was $3.1 billion. Ninety percent of this cost was due to dependent cannabis use. In comparison, the health, crime, road-crash and labour costs of alcohol use in 2004-05 are estimated to be more than three times as much ($9.4 billion).

The Health Effects of Cannabis Use

There is a dose-response relationship between cannabis use and its effects, with stronger effects
expected from larger doses.
 Intoxicating effects occur within seconds to minutes and can last for three hours;
 Effects last longer with larger doses;
 Effects on cognitive function and coordination can last up to 24 hours;
 Short-term memory impairment may last for several weeks; and
 A single dose in a chronic user can take up to 30 days for the metabolites to be excreted.

Short-term effects of small doses
The most common short-term effects of using cannabis are:
 a feeling of euphoria or ‘high’ – with a tendency to talk and laugh more than usual;
 impaired balance, reaction time, information processing, memory retention and retrieval, and perceptual-motor coordination;
 increased heart rate;
 decreased inhibitions such as being more likely to engage in risky behaviour, e.g. unsafe
sexual practice; and
 if smoked, increased respiratory problems including asthma.

Short-term effects of large doses
The most common short-term effects of a large dose can include:
 hallucinations and changed perceptions of time, sound, colour, distance, touch and other sensations;
 panic reactions;
 vomiting;
 loss of consciousness; and
 restlessness and confusion.

The severity of these short-term effects depend on a person’s weight, tolerance to the drug, amount taken, interactions with other drugs, circumstances in which the drug is taken, and the mode of administration.

Long-term effects
The evidence associating regular cannabis use with specific long-term health conditions and adverse effects is of variable quality. Cannabis use is highly correlated with use of alcohol, tobacco and other illicit drugs, all of which have potential adverse health effects. There is sufficient evidence, however, to indicate that cannabis is a risk factor for some chronic health effects and conditions.

Regular and prolonged cannabis use may cause:
 cannabis dependence, characterised by impaired control over its use and difficulties in ceasing use; increased tolerance (meaning more of the drug is needed to produce the same effect) and possible withdrawal symptoms, including anxiety, insomnia, appetite disturbance, and
depression;
 increased risk of myocardial infarction in those who have already had a myocardial infarction;
and
 deficits in verbal learning, memory and attention (in heavy users).

While not conclusive, there is evidence that regular cannabis use can cause chronic bronchitis and impaired immunological competence of the respiratory system. Occasional cannabis use however, is not associated with adverse effects on pulmonary function. Cannabis smoke contains many carcinogens, but there is variable evidence concerning the relationship between cannabis smoking and lung cancer.

Evidence supporting an association between cannabis use and sexual and reproductive effects is weak. However, some studies show an association between cannabis use and increased risk of testicular cancer.
Daily consumption of large quantities of cannabis may lead to the neglect of other important personal and social priorities such as relationships, parenting, careers and community responsibilities.

Pregnant women
Cannabis is the most commonly used illicit drug in women of child-bearing age. Cannabis use during pregnancy has been consistently associated with lower birth-weight babies and pre-term birth, but does not appear to increase the risk of miscarriage or birth abnormalities. Some studies suggest that children exposed to cannabis in utero may have slight impairment in higher cognitive processes such as perceptual organisation and planning. There is insufficient evidence of an association between prenatal cannabis use and postnatal behaviour.

Accidental ingestion by young children
Accidental ingestion of cannabis can cause coma in young children. Cannabis ingestion can be confirmed by positive urine screening for cannabinoids. Cannabis ingestion needs to be considered in toddlers and children with impaired consciousness.

Driving under the influence of cannabis
Cannabis slows reaction time and increases the risk of having a car crash. Other risk factors are blurred vision, poor judgement and drowsiness which can persist for several hours. The effects are increased by alcohol.

Dependence and tolerance
Cannabis dependence is usually defined as impaired control over continued use and difficulty ceasing despite the harms of continued use.19 Dependence can negatively affect personal relationships, education, employment and many other aspects of a person’s life. Data from Australia and other countries indicates that demand for professional help related to cannabis is increasing. Cannabis dependence is the most frequent type of substance-dependence in Australia after alcohol and tobacco. It has been estimated that cannabis dependence will affect around one in ten cannabis users, and around half of those who use it daily. Animal and human studies demonstrate that tolerance to many of the psychological and behavioural responses to cannabis occurs with repeated exposure to the drug. The symptoms of withdrawal from cannabis appear similar to those associated with tobacco, but less severe than withdrawal from alcohol or opiates.

There is a view that the cannabis being used today has a higher THC content and potency than in the past. This may be a perception caused by changes in the mode of use (i.e. through ‘bongs’ rather than ‘joints’, and with more consumption of the heads of the cannabis plant). However, there is some independent evidence that cannabis used today can be of a higher potency. The cannabis in recent street-level seizures in Sydney and the North Coast of NSW has been shown to have a high potency, with around 15% THC, with little or no cannabidiol.

Cannabis as a Gateway Drug
The gateway hypothesis is that cannabis use may act as a causal ‘gateway’ to the use of other illicit drugs such as cocaine and heroin. It is a controversial hypothesis with proponents arguing that because the use of so-called harder drugs is almost always preceded by cannabis use, this means that cannabis use physiologically and/or psychologically causes people to progress to harder drugs. The alternative theory is known as the ‘common cause’ theory whereby a person’s use of cannabis and their later use of other illicit drugs are both seen as effects of common causes such as personal or socio-economic factors, or exposure to illicit drug distribution networks. Evidence for the gateway hypothesis is inconclusive given the difficulties in disentangling the effect of other potential influences in drug use progression. Meta-analyses suggest that the progression in use that has been observed is likely to be due partially to the influence of independent common
causes.

Cannabis and Mental Health

Cannabis and psychosis
Cannabis use is associated with poor outcomes in existing psychosis and is a risk factor for developing psychosis. For those with existing psychosis, using cannabis can trigger further episodes of psychosis, worsen delusions, mood swings, hallucinations and feelings of paranoia, as well as contributing to poor compliance with medication regimes. The research base on cannabis and psychosis has expanded in recent years with studies showing a consistent association between early-aged onset of cannabis use, regular use and a later diagnosis of schizophrenia. Meta-analyses have noted a doubling of the risk of psychotic outcomes in regular cannabis users, and earlier onset (by 2.7 years) among cannabis users who develop psychosis.
There is increasing evidence that the association between cannabis and onset of psychosis is not due to other co-occurring factors. The most plausible view is that cannabis use is a ‘contributory cause’ of psychosis in vulnerable individuals, and that it is one of a number of potential factors that can bring on psychosis (including genetic predisposition)’

Cannabis and depression
The association between cannabis use and depression is weak and insufficient to establish a causal connection. Studies that have found an association are likely to have been affected by confounding variables such as family and personality factors, other drug use and marital status.
There is currently insufficient evidence available to conclude whether cannabis use is associated with suicide. Research is made difficult by confounding factors such as the stresses of an illicit drug-dependent life and pre-existing poor mental health.

Cannabis and anxiety
There is emerging evidence associating cannabis use with anxiety disorders. However, the current level of evidence is not yet sufficient to establish a causal relationship.

Medical Uses Of Cannabis
In addition to psychoactive compounds, cannabis has constituents with other pharmacological effects, including antispastic, analgesic, anti-emetic, and anti-inflammatory actions. These constituents may have therapeutic potential.

Cannabis extracts and synthetic formulations have been licensed for medicinal use in some countries, including Canada, the USA, Great Britain and Germany, for the treatment of severe spasticity in multiple sclerosis, nausea and vomiting due to cytotoxics, and loss of appetite and cachexia associated with AIDS. The synthetic cannabis product Nabiximols (Sativex), which is delivered as a buccal spray and so avoids the harms of cannabis smoke inhalation, is effective in the management of spasticity and pain associated with multiple sclerosis. The psycho-active effects of Nabiximols can also be managed through controlling dosage.

In Australia, the synthetic cannabinoids nabilone and dronabinol are scheduled by authorities for medicinal use. Sativex is also being trialed in Australia for cancer and cannabis withdrawal. Canada has allowed the medical use of smoked cannabis if this is authorised and monitored by a doctor.
There is a growing body of evidence that certain cannabinoids are effective in the treatment of chronic pain, particularly as an alternative or adjunct to the use of opiates, when the development of opiate tolerance and withdrawal can be avoided. Controlled trials have also shown positive effects of cannabis preparations on bladder dysfunction in multiple sclerosis, tics in Tourette syndrome, and involuntary movements associated with Parkinson’s disease. Based on existing data, the adverse events associated with the short-term medicinal use of cannabis are minor.
However, the risks associated with long-term medicinal use are less well understood, particularly the risk of dependence, and any heightened risk of cardiovascular disease. Though there is a growing body of evidence regarding the therapeutic use of cannabinoids, it is still experimental.

Synthetic Cannabis
Synthetic cannabis products have been developed, usually in herbal form for smoking. These products have been marketed in Australia as ‘legal highs’ with product names such as ‘Spice’, ‘K2’, and ‘Kronic’. The psychoactive components are usually THC analogues that bind to cannabinoid receptors in the brain. These analogues are not easily detectable by routine testing, and until recently have not been captured by legislation. These synthetic cannabis products are attractive to their users because they are perceived as safe, are not easily detectable in drug tests, and until recently have not been illegal.
The synthetic cannabis products can not be considered safe given that the synthesized psychoactive substances in them have not been rigorously tested, and little is known about their long or short-term health effects, dependence potential or adverse reactions. Psychotic
symptoms have been associated with use of some synthetic cannabinoids, as well as signs of addiction and withdrawal symptoms similar to those of cannabis. Adverse outcomes have been reported from the use of Kronic in Australia.

The Control of Cannabis Use and Supply

Australian legislation
The possession, cultivation, use, and supply of cannabis is prohibited in all Australian States and Territories. In some Australian jurisdictions there are criminal penalties for the possession, cultivation and use of cannabis, and in others there are less severe civil penalties. Legislation in Australia often distinguishes between possession of small amounts of cannabis (for personal use) possession of larger amounts (trafficable quantities), and possession of even larger “commercially trafficable” quantities. The supplying of cannabis and the possession of large quantities attract criminal penalties in all Australian jurisdictions. All Australian States and Territories have diversionary schemes for minor and early cannabis offenders which require them to undertake educative and treatment programs as an alternative to receiving a criminal penalty.

Criminalisation and health
It is often thought that criminal penalties are a deterrent to cannabis use and, therefore, an effective way to prevent the health impacts and other harms associated with cannabis use. These beliefs have little foundation. A system of criminal prohibition for cannabis use applied in Australia for many years, but the incidence of cannabis use was still significant. The introduction of less serious civil penalties and diversionary alternatives to criminal sanctions did not significantly increase the rates of uptake and use among Australians.

For those who are not deterred from use by criminal penalties, criminalisation can add to the potential health and other risks to which cannabis users are exposed. These include:

 exposure of cannabis users, including teenage and occasional users, to ‘harder drugs’. Those who acquire cannabis from large scale illicit drug distribution networks will also become exposed to more harmful drugs, including the direct marketing of those drugs to them;
 exposure of cannabis users to criminal networks and activity, including exposure to the threat of violence and the risk of taking part in criminal distribution;
 the personal and health-related costs of a criminal conviction. A criminal conviction can negatively impact on a person’s employment prospects and their accommodation and travel opportunities. Limited employment and accommodation prospects can lead to poor health,
including mental health. Individuals with a criminal record are also at a disadvantage in any subsequent criminal proceedings;
 a deterrent to individuals seeking health advice, treatment and support regarding their cannabis use;
 the inability to collect high quality, reliable data regarding patterns of use and harms.

Harm reduction
A harm-reduction approach is defined as policies and initiatives that aim to reduce the adverse health, social and economic consequences of substance use to individual drug users, their families and the community. Harm reduction considers both the potential harms to individuals using substances like cannabis and the potential harms and negative impacts of the different approaches for controlling the use and supply of these substances. When harm reduction is the primary goal, the key policy focus will be on measures to reduce individuals’ harmful levels of cannabis use, or cannabis use among individuals who are most vulnerable to adverse health impacts, or cannabis use in contexts which involve serious risks to users.

Harm-reduction measures include targeted efforts to reduce the supply of cannabis and to reduce demand for it among vulnerable groups. In certain contexts, and with certain groups, measures emphasizing abstinence may also contribute, in a preventive way, to reducing harms. Policy and legislative approaches that do not effectively address cannabis-related harms or create
significant risks and adverse impacts are not consistent with harm-reduction. Prohibition of cannabis use with criminal penalties has the potential to produce harms and risks. The effectiveness of criminal prohibition of cannabis use in reducing the health-related harms
associated with cannabis use is questionable.

Treatment Options
The number of people seeking treatment for cannabis use is increasing, but most of those who experience cannabis dependence do not seek help. Many regular cannabis users do not believe they need treatment, and there is also a low awareness of the treatment options available and how to access them.
There are fewer treatment options for cannabis dependence than for alcohol or opiate dependence, and limited research on the effectiveness of different cannabis treatment options. Treatments for problematic cannabis use include psychological interventions such as cognitive
behavioural therapy and motivational enhancement, and pharmacological interventions with medications to ease the symptoms of withdrawal or block the effects of cannabis. The research on pharmacological interventions for cannabis is in its infancy, with medications still in the experimental stages of development.

Cognitive behavioural therapy helps the cannabis user develop knowledge and skills to identify risk situations when using cannabis and to modify behaviour accordingly. Motivational enhancement techniques build the cannabis user’s desire to address their problematic use. These counseling interventions are increasingly available online as web-based programs, as well as face-to-face with a counselor. Online programs have the advantage of convenience and anonymity, for those who are concerned about possible stigma. Difficulties in maintaining motivation, and limitations in personalising the programs to individual needs, are drawbacks. According to current research, web-based treatment programs may not be as effective as in-person treatment. Some problematic cannabis users have particular treatment needs, including those with cannabis dependence and mental health issues. These individuals require integrated treatment and coordinated care. General practitioners can play an important role in developing a coordinated care plan to suit the needs of these patients.

The Australian Medical Association Position
The AMA acknowledges that cannabis use is harmful and can lead to adverse chronic health outcomes, including dependence, withdrawal symptoms, early onset psychosis and the exacerbation of pre-existing psychotic symptoms. While the absolute risk of these outcomes is low and those who use cannabis occasionally are unlikely to be affected, those who use cannabis frequently and for sustained periods, or who initiate cannabis use at an early age, or who are susceptible to psychosis, are most at risk.
The AMA also recognises that cannabis use has short-term effects on cognitive and perceptual functioning which can present risks to the safety of users and others. The AMA believes that cannabis use should be seen primarily as a health issue and not primarily as a matter for law enforcement. The most appropriate response to cannabis use should give priority to policies, programs and regulatory approaches that reduce the harms potentially associated with cannabis use, and particularly the health-related harms. The positions outlined below should be read in the light of this harm-reduction principle. The AMA believes the following are the important considerations and central elements in an appropriate harm-reduction response to cannabis use.

Prevention and Early Intervention
 As younger people and those who use cannabis frequently are most at risk of harm, prevention and early intervention initiatives to avoid, delay and reduce the frequency of cannabis use in these populations are essential.
 All children should have access to developmentally appropriate school-based life-skills programs to assist in preventing or reducing potential substance use problems.
 Evidence-based information on the potential risks of cannabis use and where to seek further assistance should be widely available, particularly to young people.
 Medical professionals can play an important role in the early identification of patients they believe to be at risk of adverse health outcomes from cannabis use.
 When a cannabis user comes into contact with law enforcement or justice administration agencies this should be used as an opportunity to direct them to education, counseling or treatment. This is particularly important with young and first time or early offenders.

Diagnosis and Treatment
 Medical professionals have the knowledge and opportunity to screen for and diagnose cannabis-related disorders, including dependence, withdrawal symptoms, and cannabis induced psychosis. Referral networks and linkages should be established within regions between primary care and specialist mental health and drug and alcohol services, to ensure integrated and coordinated treatment support for cannabis use problems.
 Medical professionals, particularly general practitioners, have the opportunity to counsel patients who are at risk of cannabis-related harms, and they should be supported to provide education and advice about those potential harms.
 Targeted treatment regimens should be developed and resourced for groups with particular needs, including those with dual diagnoses, multiple drug use, young teenage users and culturally appropriate services for Aboriginal peoples and Torres Strait Islanders. Of particular importance are suitable treatment services for cannabis users with mental health needs.
 Every effort should be made to address the personal and systemic barriers that cannabis users face in seeking treatment and support when they need it. These include barriers associated with perceptions of stigmatisation, users’ and professionals’ awareness of treatment options, and users’ beliefs that they do not have a health problem.
 Doctors should consider accidental cannabis ingestion in the differential diagnosis of children with impaired consciousness.
 Cannabis users should have access to the rehabilitative services and support they require to manage associated disorders and particularly the risk of relapse.

Medical Uses of Cannabis
The Australian Medical Association acknowledges that cannabis has constituents that have potential therapeutic uses.
 Appropriate clinical trials of potentially therapeutic cannabinoid formulations should be conducted to determine their safety and efficacy compared to existing medicines, and whether their long-term use for medical purposes has adverse effects.
 Therapeutic cannabinoids that are deemed safe and effective should be made available to patients for whom existing medications are not as effective.
 Smoking or ingesting a crude plant product is a risky way to deliver cannabinoids for medical purposes. Other appropriate ways of delivering cannabinoids for medical purposes should be developed.
 Any promotion of the medical use of cannabinoids will require extensive education of the public and the profession on the risks of the non-medical use of cannabis.

Law Enforcement, Cannabis Regulation and Health
 In assessing different legislative and policy approaches to the regulation of cannabis use and supply, primary consideration should be given to the impact of such approaches on the health and well-being of cannabis users.
 The AMA does not condone the trafficking or recreational use of cannabis. The AMA believes that there should be vigorous law enforcement and strong criminal penalties for the trafficking of cannabis. The personal recreational use of cannabis should also be
prohibited. However, criminal penalties for personal cannabis use can add to the potential health and other risks to which cannabis users are exposed. The AMA believes that it is consistent with a principle of harm reduction for the possession of cannabis for personal
use to attract civil penalties such as court orders requiring counselling and education (particularly for young and first time offenders), or attendance at ‘drug courts’ which divert users from the criminal justice system into treatment.
 When cannabis users come into contact with the police or courts, the opportunity should be taken to divert those users to preventive, educational and therapeutic options that they would not otherwise access.
 In allocating resources, priority should be given to policies, programs and initiatives that reduce the health-related risks of cannabis use. Law enforcement should be directed primarily at cannabis supply networks.
 The AMA believes that the availability and use of synthetic cannabis products (including herbal forms) poses significant health risks, given that the psychoactive chemical constituents of these products are unknown and unpredictable in their effect. There are
particular challenges in regulating these products, and Australian governments must make a concerted effort to develop consistent and effective legislation which captures current and emerging forms of synthetic cannabis.

Research
 Further research is needed into the relationship between cannabis use and psychosis and other mental health problems, including the identification of those at greatest risk of cannabis-induced psychosis.
 There should be continuing research to identify the risk factors that contribute to individuals developing problematic or early onset cannabis use, and the factors and interventions that can protect against these.
 Australian governments should fund research into best practice treatment methods, including suitable pharmacotherapies, for those who are cannabis-dependent or who wish to reduce or cease their use.
 There should be systematic ongoing monitoring of the different legislative and policy approaches on cannabis operating in overseas jurisdictions to assess their health and harm-related impacts. The evidence obtained should inform critical reviews of the
approaches that operate in Australia.

Source: 1 (ama.com.au) 2014

Medical marijuana in Florida was approved by Governor Rick Scott last month and now school districts statewide are struggling with one specific requirement of the legislation. Under the law, children with certain ailments can use cannabis while at school and the districts are obligated to make it available to students as needed.

While medical marijuana for children is legal in Florida, the schools are resistant to creating cannabis-use policy as the language used in the law is ambiguous and inconsistent. The law requires schools to store and manage cannabis like other medications but does not provide a clear definition as to who can administer it to students.

Only an authorized caregiver can give medical marijuana to a child, yet the law does not afford school employees the power to act as a caregiver. Mitch Teitelbaum, an attorney for the Manatee County School District, says making schools provide the drug to students makes no sense when the school has no legal power to do so.

“The district is compelled to adhere to all state and federal laws,” said Teitelbaum, as reported by the Bradenton Herald. “But how do we do so with such inconsistency?”

The original medical cannabis law approved by Florida voters in November did not contain the school requirement provision, but was later modified to include it. This added amendment is causing both confusion and controversy to the new marijuana law.

Most Florida school districts turn to consulting firm NEOLA for help creating school policy. Currently, the company is reviewing the law and deciding how to move forward before making any recommendations to district officials.

According to NEOLA CEO Dick Clapp, Florida’s medical marijuana law puts “schools in a real tough spot” by making them create a policy that potentially opens them up to lawsuits. Once one district comes up with solid guidelines regulating how cannabis will be given to students, other districts are likely to follow. However, Clapp says that isn’t likely to happen before the start of the 2017-18 school year.

As of now, not many children are affected by the medical marijuana law in Florida. Yet, the families that are impacted want the state’s school districts or the Florida Department of Education to make a decision.

“The number of people that will be impacted will be a small number, but they are in dire situations, so it is a tough human-relations thing,” Clapp said, per the report by the Bradenton Herald. “I don’t know what we do about that.”

It is likely the Florida school districts with the highest number of students will act first to create medical marijuana guidelines. For now, the most probable scenario will be treating medical cannabis like any other prescription medication.

The medical marijuana law in Florida allows children with severe epilepsy, cancer, and other qualifying conditions to be treated with cannabis oil, capsules, and edibles. Due to federal restrictions regarding prescribing weed for medical purposes, marijuana treatment is only available by recommendation from state-approved physicians to Florida patients.

Source: https://www.inquisitr.com/4399383/medical-marijuana-in-florida-creates-policy-smoky-challenge-for-states-school-districts/ July 2017

Question  Are US state medical marijuana laws one of the underlying factors for increases in risk for adult cannabis use and cannabis use disorders seen since the early 1990s?

Findings  In this analysis using US national survey data collected in 1991-1992, 2001-2002, and 2012-2013 from 118 497 participants, the risk for cannabis use and cannabis use disorders increased at a significantly greater rate in states that passed medical marijuana laws than in states that did not.

Meaning  Possible adverse consequences of illicit cannabis use due to more permissive state cannabis laws should receive consideration by voters, legislators, and policy and health care professionals, with appropriate health care planning as such laws change.

Importance  Over the last 25 years, illicit cannabis use and cannabis use disorders have increased among US adults, and 28 states have passed medical marijuana laws (MML). Little is known about MML and adult illicit cannabis use or cannabis use disorders considered over time.

Objective  To present national data on state MML and degree of change in the prevalence of cannabis use and disorders.

Design, Participants, and Setting  Differences in the degree of change between those living in MML states and other states were examined using 3 cross-sectional US adult surveys: the National Longitudinal Alcohol Epidemiologic Survey (NLAES; 1991-1992), the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC; 2001-2002), and the National Epidemiologic Survey on Alcohol and Related Conditions–III (NESARC-III; 2012-2013). Early-MML states passed MML between NLAES and NESARC (“earlier period”). Late-MML states passed MML between NESARC and NESARC-III (“later period”).

Main Outcomes and Measures  Past-year illicit cannabis use and DSM–IV cannabis use disorder.

Results  Overall, from 1991-1992 to 2012-2013, illicit cannabis use increased significantly more in states that passed MML than in other states (1.4–percentage point more; SE, 0.5; P = .004), as did cannabis use disorders (0.7–percentage point more; SE, 0.3; P = .03). In the earlier period, illicit cannabis use and disorders decreased similarly in non-MML states and in California (where prevalence was much higher to start with). In contrast, in remaining early-MML states, the prevalence of use and disorders increased. Remaining early-MML and non-MML states differed significantly for use (by 2.5 percentage points; SE, 0.9; P = .004) and disorder (1.1 percentage points; SE, 0.5; P = .02). In the later period, illicit use increased by the following percentage points: never-MML states, 3.5 (SE, 0.5); California, 5.3 (SE, 1.0); Colorado, 7.0 (SE, 1.6); other early-MML states, 2.6 (SE, 0.9); and late-MML states, 5.1 (SE, 0.8). Compared with never-MML states, increases in use were significantly greater in late-MML states (1.6–percentage point more; SE, 0.6; P = .01), California (1.8–percentage point more; SE, 0.9; P = .04), and Colorado (3.5–percentage point more; SE, 1.5; P = .03). Increases in cannabis use disorder, which was less prevalent, were smaller but followed similar patterns descriptively, with change greater than never-MML states in California (1.0–percentage point more; SE, 0.5; P = .06) and Colorado (1.6–percentage point more; SE, 0.8; P = .04).

Conclusions and Relevance  Medical marijuana laws appear to have contributed to increased prevalence of illicit cannabis use and cannabis use disorders. State-specific policy changes may also have played a role. While medical marijuana may help some, cannabis-related health consequences associated with changes in state marijuana laws should receive consideration by health care professionals and the public.

Source: https://jamanetwork.com/journals/jamapsychiatry/article-abstract/2619522 June 2017

Abstract

University of Alberta led guideline warns health risks may outweigh benefits, provides guidance on when (and when not to) prescribe.

A new medical guideline published today suggests Canada’s family physicians should take a sober second thought before prescribing medical cannabis to most patients.

Published in Canadian Family Physician, “Simplified Guideline for Prescribing Medical Cannabinoids in Primary Care” states there is limited evidence to support the reputed benefits of medical marijuana for many conditions, and what benefits do exist may be balanced out or even outweighed by the harms.

“While enthusiasm for medical marijuana is very strong among some people, good-quality research has not caught up,” said Mike Allan, director of evidence-based medicine at the University of Alberta and project lead for the guideline.

The guideline was created after an in-depth review of clinical trials involving medical cannabis and will be distributed to roughly 30,000 clinicians across Canada. It was overseen by a committee of 10 individuals, supported by 10 other contributors, and peer reviewed by 40 others, each a mixture of doctors, pharmacists, nurse practitioners, nurses and patients. The review examined cannabinoids for the treatment of pain, spasticity, nausea and vomiting, as well as their side-effects and harms.

Researchers found that in most cases the number of randomized studies involving medical cannabis is extremely limited or entirely absent. The size and duration of the studies that do exist are also very narrow in scope.

“In general we’re talking about one study, and often very poorly done,” said Allan. “For example, there are no studies for the treatment of depression. For anxiety, there is one study of 24 patients with social anxiety in which half received a single dose of cannabis derivative and scored their anxiety doing a simulated presentation. This is hardly adequate to determine if lifelong treatment of conditions like general anxiety disorders is reasonable.”

According to the guideline, there is acceptable research for the use of medical cannabinoids to treat a handful of very specific medical conditions. They include chronic neuropathic (nerve) pain, palliative cancer pain, spasticity associated with multiple sclerosis or spinal cord injury, and nausea and vomiting from chemotherapy. Even in those specific cases, the benefits were found to be generally minor.

For nerve pain, 30 per cent of patients given a placebo saw a moderate improvement in their pain while 39 per cent experienced the same effect while on medical cannabinoids. In patients with muscle spasticity, 25 per cent of those taking a placebo saw a moderate improvement compared to 35 per cent on medical cannabis. The use of medical cannabis was best supported in its use for chemotherapy patients experiencing nausea and vomiting. Just under half of patients using cannabinoids for their symptoms had an absence of nausea and vomiting compared to 13 per cent on placebo.

“Medical cannabinoids should normally only be considered in the small handful of conditions with adequate evidence and only after a patient has tried of number of standard therapies,” said Allan. “Given the inconsistent nature of medical marijuana dosing and possible risks of smoking, we also recommend that pharmaceutical cannabinoids be tried first before smoked medical marijuana.”

While the researchers found evidence supporting the use of medical cannabinoids to be limited, side-effects were both common and consistent. About 11 per cent of patients were not able to tolerate medical cannabinoids, versus three per cent of those taking placebo. Common effects included sedation (50 per cent versus 30 per cent), dizziness (32 per cent versus 11 per cent) and confusion (nine per cent versus two per cent).

“This guideline may be unsatisfactory for some, particularly those with polarized views regarding medical cannabinoids,” said Allan.

He added that those who oppose the use of cannabinoids for medical therapy may be disappointed that the guideline considers medical cannabinoids in specific cases. Others, who feel cannabinoids are highly effective and don’t pose any risk, may be frustrated that the guideline doesn’t advocate their use sooner or for a broader range of conditions.

“Better research is definitely needed — randomized control trials that follow a large number of patients for longer periods of time. If we had that, it could change how we approach this issue and help guide our recommendations.”

Source: https://www.sciencedaily.com/releases/2018/02/180215153923.htm February 2018

People who turn to medical marijuana are often drawn to the fact that it’s natural. This is indeed a great quality from a health standpoint, but environment-minded marijuana buyers, take note: New research shows that marijuana farming in remote locations is having a negative effect on the environment.

After studying the ecological consequences that marijuana farming had in Northern California, researchers from Ithaca College discovered that small farms were having a surprisingly big impact.

In a press release, the college’s Environmental Science Associate Professor Jake Brenner wrote that cannabis has significant environmental impacts despite its small spatial footprint. He suggests that policymakers put land-use and environmental regulations in place to help control the expansion of cannabis crops before the situation grows more widespread, given the increase in legalization and popularity of the plant. Cannabis now enjoys legalization for varying degrees of medicinal and/or recreational use across 30 states in the U.S. and several other countries.

They reached their conclusions after comparing cannabis cultivation’s environmental effects, including forest fragmentation, the loss of habitats, and deforestation. In fact, the researchers pointed out that cannabis causes bigger changes in several key metrics in terms of unit area compared to timber, although the latter’s overall landscape impact remains greater.

For example, after looking at pot farms in 62 random watersheds in Humboldt County from 2000 to 2013, the crop was shown to cause 1.5 times greater forest loss and 2.5 times more forest fragmentation than timber harvest.

California laws on marijuana cultivation inadvertently hurting the environment

Little is known about the long-term impact of marijuana farming or regulations in the industry as policymaking struggles to stay on top of the industry’s growth. Part of the problem is that California laws state marijuana cultivation must be confined to just one acre per land parcel. By preventing wide-scale industrial marijuana farms, this law is actually encouraging small farms with big environmental impacts to proliferate, breaking up the forest and hurting wildlife habitats.

This adds on to previous studies carried out by the same research team showing that the pesticides used on marijuana farms to keep rodents away can hurt mammals in the area, while irrigation is having a negative impact on local wildlife. Moreover, because their locations are typically quite remote, access roads must be created and land must be cleared for production. That report suggested that growing marijuana in places with gentler slopes, plenty of water sources, and better access to roads could help reduce the threats to the environment significantly. Marijuana can also be cultivated indoors.

Those growing the crop should avoid using chemical pesticides for obvious reasons. It’s not just bad for the environment; it’s also terrible for your health. Indeed, pesticide exposure could be behind the cancer that spurs many people to seek medical marijuana in the first place. Some illegal forest growers have been using pesticides like carbofuran, which has long been banned in the country, and it’s now making its way into the water. This causes headaches, vomiting, muscle twitches, dizziness, convulsions and even death in some cases. California is home to more than 90 percent of the illegal pot farms found in the nation.

Profits coming at expense of environment

Unfortunately, there are a lot of profits to be made here, and some of the less scrupulous growers are focusing on profits at the expense of the environment. By raising awareness about the potential impact, it is hoped that such parties will turn to more responsible growing practices in the future. As the scientists in these studies point out, however, there isn’t much research available about land-use science when it comes to cannabis agriculture.

Source: https://www.naturalnews.com/2017-11-20-marijuana-farmers-are-destroying-natural-ecosystems-as-quest-for-profits-outweighs-green-agricultural-practices.html November 2017

Abstract

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

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

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

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

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

Kenneth Finn, MD,

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

FIRST COMMERCIAL CANNABIS CROP TO HELP VICTORIAN CHILDREN

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

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

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

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

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

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

When people like the headline writer of this HealthDay news article talk about “medical marijuana,” they usually mean everything. The plant’s dried flowers which people smoke. Concentrates that can contain up to 90 percent THC, whose extraordinarily high levels are almost certainly what is sending toddlers and children who accidentally consume them and adults who consume them on purpose to emergency rooms with many needing to be hospitalized. “Edibles” – cookies, candies, and soft drinks infused with marijuana that are now in the food chain. And hundreds more, all sold as “medicines.”

 
The HealthDay author does a good job of covering a new study in Pediatrics, the journal of the American Association of Pediatrics. But notice the study’s title: “Medical Cannabinoids – not Medical Marijuana – in Children and Adolescents: A Systematic Review.”
 
What’s the difference?  
 
The marijuana plant contains about 500 different chemicals. Most have not been studied. Some 100 of those are called cannabinoids, so-called because they are unique to the cannabis plant. Most of these have not been studied either, but that is changing. Some cannabinoids show scientific promise and may become medicines. Two already are.
 
By medicines, we mean they have gone through rigorous preclinical (test tubes and animals) and clinical (humans) research. They have proven to FDA that they are both safe and effective, can be manufactured with a consistent dose, and most importantly are pure. They contain no contaminants unlike most of the products in legal states. A further FDA safeguard is that sometimes approved medicines cause dangerous side effects in the larger population after approval. FDA has a notification system that requires doctors to report any that occur so the medicine can be pulled from the market, if necessary.
 
The most studied cannabinoids are delta-9 THC and cannabidiol (CBD). The former makes people high. The latter doesn’t. The two medicines that FDA has approved are nabilone (trade name Cesamet^®) and dronabinol (trade names Marinol^® and Syndros^®). Cesamet^® and Marinol^® are pills. Syndros^® is an oral liquid. They are used to reduce chemotherapy-related nausea and AIDS wasting in patients who do not respond to standard medications.
 
Two more cannabinoids, nabiximols (trade name Sativex^®, approved in other countries but not yet in the US yet) and CBD (trade name Epidiolex^® which has completed clinical trials and is applying for FDA approval) are in the pipeline.
 
About half our medicines originated in plants. But when drug makers create a new medicine from them, they use pure chemicals to make a molecule-for-molecule carbon copy of the plant’s component. Nabilone and dronabinol are made that way. Patients know when they take these medicines that they will not contain any contaminants and FDA has approved them.
 
Not so the “medical” marijuana products being produced and sold in states that have legalized the drug for medical use. In fact, the American Epilepsy Society calls such CBD products “artisanal CBD” to differentiate them all from Epidiolex^®, which may be available as early as next year to treat children and adolescents suffering intractable seizures.
 
Not one of the marijuana products states allow to be sold as medicines has been approved by FDA.
 
This new study searched several databases for scientific articles about pharmaceutical-grade cannabinoids that are being studied to treat a variety of illnesses in children and adolescents. They found 2,743 citations that might meet their search criteria and reviewed the full texts of 103. From these, they found 21 articles about 22 studies with a total sample of 795 participants: 

• Five were randomized controlled trials, the gold standard of knowledge development.
• Five were retrospective chart reviews.
• Five were case reports.
• Four were open-label trials.
• Two were parent surveys.
• One was a case series. 

The medicines used in these studies were nabilone, dronabinol, Epidiolex^®, a formulation of delta-8 THC, and other pharmaceutical-grade preparations, not Charlotte’s Web, Haleigh’s Hope, Cannatol, or any of the hundreds of other artisanal CBD products states allow to be shipped – and Amazon sells – to all 50 states in violation of federal law.
 
The researchers found that in children and adolescents:

• “Evidence for benefit was strongest for chemotherapy-induced nausea and vomiting (four RCTs), with increasing evidence of benefit for epilepsy [1 RTC using Epidiolex^® rather than artisanal products]. At this time, there is insufficient evidence to support use for spasticity, neuropathic pain, posttraumatic stress disorder, and Tourette syndrome.
• “The methodological quality of studies varied, with the majority of studies lacking control groups, limited by small sample size, and not designed to test for the statistical significance of outcome measures. Studies were heterogeneous [varied] in the cannabinoid composition and dosage and lacked long-term follow-up to identify potential adverse effects.
• “Additional research is needed to evaluate the potential role of medical cannabinoids in children and adolescents, especially given increasing accessibility from state legalization and potential psychiatric and neurocognitive adverse effects identified from studies of recreational cannabis use.” 

Read HealthDay account of this study here.
Read American Association of Pediatrics study abstract here.
Read what Colorado Children’s Hospital tells families who want artisanal CBD for their children here.

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

Strongest evidence supports use to reduce seizures, side effects of chemotherapy

A systematic review of published studies on the use of medical cannabis in children and adolescents finds a notable lack of studies and a minimal number of the randomized, controlled trials needed to confirm the effectiveness of a treatment. In their paper published in the journal Pediatrics, Massachusetts General Hospital (MGH) investigators Shane Shucheng Wong, MD, and Timothy Wilens, MD — both of the MGH Department of Psychiatry — report that their review suggests only two pediatric uses of medical cannabis — to relieve chemotherapy-induced nausea and vomiting and to reduce seizures — are supported by existing studies.

Häuser W¹, Fitzcharles MA, Radbruch L, Petzke F.

Abstract

In a backpacking hostel during a stag weekend 10 years ago, I fell asleep on a top bunk next to an open window. Of course, that now strikes me as a stupid thing to have done, but at the time I didn’t give it a thought. I was on a weekend away, not a health-and-safety awareness course. At some point during the night, I tried getting out of the bunk, but instead of turning left and using the ladder, I turned right and hopped straight out of the window.

I fell 24ft on to concrete. From a survival point of view, I was lucky to land on my feet. The downside was that some rather important sections of my legs did not come out of it so well.

My left heel was crushed, while over on the right, my tibia and fibula – the two long bones in the lower leg – detached from their couplings and shattered. The next few weeks involved operations, plates, screws and quite unimaginable levels of agony. At one point, I felt a kind of blinding calm, as though the pain had gone all the way up the scale and rung a bell at the top.

While those pain levels have never returned, over the years there have been generous helpings of it; my legs didn’t take too kindly to being smashed up and bolted back together, and they seem to enjoy reminding me of this. After trying many different ways of managing the pain, eight months ago I started taking cannabidiol, or CBD for short – a non-psychoactive compound found in both hemp and cannabis plants.

The effect on the pain has been profound. It comes as an oil that I put under my tongue whenever pain moves from a dull niggle to the kind that is difficult to ignore.

CBD influences the release and uptake of neurotransmitters such as dopamine and serotonin, leading to many potential therapeutic uses. Crucially, it does not contain any THC, the psychoactive component of cannabis; in other words, CBD does not get you high. Since last year, it has been legal to buy in the UK, after the government’s Medicines and Healthcare Products Regulatory Agency (MHPR) approved its use as a medicine under licence.

CBD oil has since been prescribed to an 11-year-old British boy suffering from epilepsy, in what is believed to be the first instance of a cannabis-derivative being prescribed on the NHS.

Last month, a cancer patient diagnosed four years ago with an incurable brain tumour and given just six months to live, ascribed her incredible recovery to turning to cannabis oil as a last resort.

While research into the medical benefits of CBD oil is in its infancy, it is certainly encouraging. Recent reports suggest it could be a more useful anti-inflammatory than ibuprofen.

“There has been some early scientific evidence that CBD can help with inflammation,” says Dr Henry Fisher, of drug policy thinktank Volteface. “There is also a lot of anecdotal evidence that it helps people who do contact sports, because of the tendency to get inflamed joints. Taking other anti-inflammatories like ibuprofen on a long-term basis – as many sportspeople do – is not a good idea because of potential damage to your liver.”

It also has distinct advantages over opioid medicines, says Dr Fisher. “With CBD, there is no evidence of any long-term negative impact, and no likelihood of addiction. And, of course, there are no known cases of anybody overdosing on CBD.”

The comparison to prescription medicine is particularly pertinent for me. For several months after my accident, I took Oxycontin, a common opioid painkiller. It was very useful at that time because it gave me a warm fuzzy feeling, making everything seem okay. But after a while, I started waking up feeling groggy and crushed. So I decided to stop, and the withdrawal was horrendous. It was several days of indescribable misery, so bad that it made the pain from the injuries feel like a slightly over-zealous massage.

Getting off that heavy-duty medicine was key for my recovery. Because this kind of medication saps your energy, and the one thing you need to fight back to full fitness is energy. I spent months in a wheelchair, then on crutches, then finally I was able to start taking slow, painful steps on legs that had forgotten what their purpose was. I had always done a lot of sport, particularly martial arts – I got my black belt in kickboxing when I was 21 and spent some time working as an instructor. This training helped after the accident because I was in reasonably good shape – mashed bones notwithstanding – and I was used to pushing myself.

I never thought I would be able to fight again. So I just concentrated on simply being able to take care of myself. I also just got on with my life, somehow managing to acquire a lovely wife, daughter and son along the way. Then three years ago, I decided that the legs must have healed as much as they were ever going to, and I started doing martial arts again.

Rather than risk going back to kickboxing, I took up Brazilian jiu-jitsu, a grappling discipline where you subdue your opponent with chokes and joint-locks. If you watch beginners, it can look a bit like playground wrestling, but done properly it is graceful but deadly. I started off gently, but after a while I put the injuries behind me and trained as hard as ever. It was through the men I train with that I found out about CBD.

Everyone that uses it tells a similar story: they sleep better and feel less pain. While there are ongoing trials for CBD as a treatment for everything from multiple sclerosis to Parkinson’s disease, all I know is that for me it can make the difference being sitting on the sofa and being able to go training. I can now lift and carry my children without wincing.

CBD does not make the pain go away completely, but that is okay – a bit of pain is necessary, an alarm system to warn of imminent peril. But once the message has been received, it is nice to be able to turn the volume down a little bit.

Source: https://www.telegraph.co.uk/health-fitness/body/could-cannabis-extract-cbd-replace-ibuprofen-painkiller/ October 2017

Cannabis labelled ‘Sativa’ and ‘Indica’ may not come from distinct ancestries, according to a study performed by the Canadian Dalhousie University in cooperation with Bedrocan on the genetic differences between the two types and their hybrids. In this study 149 Dutch cannabis samples were analysed, correlating the genotype and chemotype to their reported ancestries. Indica- and Sativa-labelled samples were not as distinct as sub species would be assumed to be, but the genetic differences between them do correlate to their terpene profile (resin fragrance), which could explain the variation between them. Results of this new study have been presented on the International Association for Cannabis as Medicine (IACM) congress in Cologne, Germany, September 2017.

There is perhaps no debate in the world of cannabis more contentious than that of species. The genus Cannabis sativa L. is the only official species, but the terms ‘Sativa’, ‘Indica’ and ‘Hybrid’ have been widely adopted by cannabis breeders and cultivators as a way of advertising their product’s effects, aromas or purported pedigree. The degree to which these labels correspond to their actual ancestry, however, is dubious, and how this informal classification scheme relates to genotype or phenotype has been largely unexplored.

In the study an analysis of 149 cannabis samples was performed, correlating the genotype and chemotype (based on terpene and cannabinoid content of the flowers) to their reported ‘ancestry’.  The researchers then compared the reported labels to new scales they generated by reclassifying the samples based on their genetic and chemical similarity.

The Indica/Sativa classification of Dutch cannabis does not correspond to distinct genetic lineages or to cannabinoid type, but there are genetic and chemical similarities that explain the variation between the groups. Deconvolution of the Indica-Sativa ancestry showed a strong relationship between the chemical and genetic profiles, suggesting that the distinct terpene contents of the types are heritable and important to the identity of these two groups. It is likely that strains are classified by their distinct aromas, and not their lineages, which has a direct impact on the genetics of this crop.

Bedrocan, worldwide producer of standardised medicinal cannabis, is already working on the terpene profiles that are associated with the current Bedrocan products. Hugo Maassen, head of the phyto engineering department at Bedrocan: “This study shows that the Indica/Sativa differences could be largely based on terpene content, which instead of the current Indica/Sativa labelling might require for more insight in the terpene profiles related to the Bedrocan products available for patient use.”

The terpene profiles of the Bedrocan products are expected to be announced in the near future.

Source: https://bedrocan.com/no-clear-evidence/ September 2017

• US Department of Veteran Affairs found an increase in PTSD symptoms from veterans who used medical marijuana 
• Among patients who use medical marijuana, 80% use it for chronic pain and 33% for PTSD
• Use for chronic pain can lead to increased risk of motor vehicle accidents and short-term cognitive impairment, experts warn
• Medical marijuana is allowed in 30 states including DC 
• The NFL is looking into medical marijuana use for its players for pain relief

There is no conclusive evidence that marijuana helps with chronic pain and post-traumatic stress disorder, experts say.

Since legalization, 80 percent of medical marijuana patients use it for chronic pain and about 33 percent use it for PTSD.

However, experts warn that there isn’t enough research to confirm it is effective for users.

Researchers around the country are scrambling to find evidence of the harms and benefits of patients using medical marijuana as it becomes legalized in more states.

And now they have found that there is still an insufficient amount of evidence to prove if medical marijuana can help with chronic pain and PTSD.

Researchers from the US Department of Veterans Affairs analyzed data into the treatment of chronic pain and PTSD in patients.

With chronic pain, the results in one clinical trial showed only 28 percent of participants feeling a change when using nabiximols, which is a mixture THC and CBD.

Also, there was 16 percent of participants who felt a change when taking a placebo.

This suggests psychological symptoms are possible when someone thinks they are feeling pain.

Experts also warn the use of marijuana for chronic pain could lead to an increase risk of harm such as motor vehicle accidents, psychotic symptoms and short-term cognitive impairment.

Dr Thomas O’Brien, who has run his own medical marijuana office in New York City for the past year-and-a-half, told Daily Mail Online that he’s seen high success rates from his patients dealing with chronic pain.

The type of marijuana he gives to his patients is high in CBD, so he says it doesn’t have the psychotic symptoms that critics worry about.

‘My patients do not feel sleepy or experience memory loss when they take it,’ Dr O’Brien said.

The marijuana he prescribes is from an indica-dominant strain. This means there is high CBD and low THC, which he says won’t give patients the same ‘high’ feeling that is felt from recreational marijuana.

NFL says it WILL study marijuana in terms of pain relief for players

Early this month, the NFL confirmed with Daily Mail Online that it will look into using medical marijuana for its players.

The NFL has had a strict stance against their players using marijuana.

But a report came out saying 50 percent of NFL players admitted to using marijuana to relieve pain.

The league usually prescribes highly addictive opioid painkillers to help players deal with game-related injuries and pain.

This change comes after player Calvin Johnson retired due to chronic pain and injury.

He said the players were given opioids from doctors ‘like candy’.

Currently, a player caught with THC in their system will face a fine and full-season suspension.

Source: Bleacher Report

He will prescribe a dose with a higher level of THC only if his patient’s symptoms are so bad that they can’t sleep.

He works with his patients to figure out the best mixture for them and their symptoms based on a spectrum level.

‘They are in pain and suffering from their conditions,’ Dr O’Brien said. ‘This is not recreational.’

Dr O’Brien has worked with more than 600 patients and claims that close to 90 percent have seen success.

‘The key is to educate the community that it is not like you’re going out back and sneaking a puff.’

In a large observational study of veterans, the researchers found an increase in participants who experienced a heightening of their PTSD symptoms when using medical marijuana.

The study looked at evidence from 47,000 veterans dealing with PTSD from 1992 to 2011.

From this group of veterans, the researchers could not conclusively say that medical marijuana has benefits when dealing with people with PTSD.

US Secretary of Veterans Affairs David Shulkin said: ‘My opinion is, is that some of the states that have put in appropriate controls, there may be some evidence that this is beginning to be helpful. And we’re interested in looking at that and learning from that.’

But the VA does not prescribe medical marijuana to its veterans currently.

‘Until the time that federal law changes, we are not able to be able to prescribe medical marijuana for conditions that may be helpful,’ Shulkin said.

Marijuana is legal for medical and recreational use in eight states: Massachusetts, Colorado, Washington, Alaska, Oregon, Nevada, California and Maine.

It is also legal for strictly medical use in the District of Columbia and 21 states: Montana, North Dakota, Arizona, New Mexico, Arkansas, Louisiana, Florida, Illinois, Minnesota, Michigan, Ohio, New York, Pennsylvania, Maryland, Vermont, New Hampshire, New Jersey, Rhode Island, Connecticut, Delaware and Hawaii.

How is THC used and what its effects

Tetrahydrocannabinoil (THC) is a natural element found in a cannabis plant. It is the most common cannabinoid element found in the cannabis plant. THC is found in the recreational form of marijuana.

THC is psychoactive:

This means that the drug has a significant effect on the mental processes of the person taking it.

Effects on people taking it:

• Produces the ‘high’ feeling
• Relaxation
• Altered senses
• Fatigue
• Hunger

How it helps medically: 

Marijuana with THC are used to help with chemotherapy, multiple sclerosis and glaucoma.

Medical marijuana practitioners can diagnose a mixture of THC and CBD to the patient for treatment.

How is CBD used and what its effects

Cannabidiol (CBD) is a natural element found in a cannabis plant. It is lesser known than THC and does not produce the same ‘high’ that people experience when they have recreational marijuana.

CBD is an antipsychotic:

This means that the drug helps manage psychosis such as hallucinations, delusions or paranoia. Antipsychotic drugs are used for bipolar disorder and schizophrenia.

Effects on people taking it:

• Reduces anxiety and paranoia
• Boosts energy
• Helps with pain and inflammation

How it helps medically: 

Marijuana with CBD strains are used to help with chronic pain, PTSD and epilepsy

Medical marijuana practitioners can diagnose a mixture of THC and CBD to the patient for treatment.

The study notes that there is still a lack of evidence and clinical trials to conclusively say there are benefits or harms to medical marijuana.

Former Surgeon General Dr Vivek Gupta released a report in November saying: ‘Marijuana is in fact addictive.’

But he supported the idea of easing up restrictions on marijuana studies to help better understand the drug since its legalization is moving fast through the US.

Dr O’Brien said part of the issue was people not understanding the difference between the use of THC and the use of CBD.

‘It is very safe [CBD],’ he said. ‘We need to study it for other medical conditions that haven’t been approved by the states yet.’

The restrictions on marijuana studies are partly due to the Drug Enforcement Agency’s hesitation on allowing medical marijuana across the US.

Last year, the DEA said it would accept applications for new growers to be used for clinical trials and other studies.

Currently, there is only one federally regulated operation that studies marijuana use and it is at the University of Mississippi.

There have been 25 applicants so far to host a new grow operation but none have been approved yet, according to Scientific American.

This has led to many critics saying that the DEA is still trying to slow down the research into medical marijuana to prevent its use federally.

Source: http://www.dailymail.co.uk/health/article-4789388/Medical-marijuana-does-not-help-chronic-pain-PTSD.html August 2017

Anybody wondering what happens to the 8 per cent of the skunk-smoking population who develop mental illness should visit any psychiatric hospital in Britain or speak to somebody who has done so What is really needed in dealing with cannabis is a “tobacco moment”, as with cigarettes 50 years ago, when a majority of people became convinced that smoking might give them cancer and kill them. Since then the number of cigarette smokers in Britain has fallen by two-thirds.

A depressing aspect of the present debate about cannabis is that so many proponents of legalisation or decriminalisation have clearly not taken on board that the causal link between cannabis and psychosis has been scientifically proven over the past ten years, just as the connection between cancer and cigarettes was proved in the late 1940s and 1950s.

The proofs have emerged in a series of scientific studies that reach the same grim conclusion: taking cannabis significantly increases the risk of schizophrenia. One study in The Lancet Psychiatry concludes that “the risk of individuals having a psychotic disorder showed a roughly three times increase in users of skunk-like cannabis, compared with those who never used cannabis”. As 94 per cent of cannabis seized by the police today is super-strength skunk, compared to 51 per cent in 2005, almost all those who take the drug today will be vulnerable to this three-fold increase in the likelihood that they will develop psychosis.

Mental health professionals have long had no doubts about the danger. Five years ago, I asked Sir Robin Murray, professor of psychiatric research at the Institute of Psychiatry in London, about them. He said that studies showed that “if the risk of schizophrenia for the general population is about one per cent, the evidence is that, if you take ordinary cannabis, it is two per cent; if you smoke regularly you might push it up to four per cent; and if you smoke ‘skunk’ every day you push it up to eight per cent”.

Anybody wondering what happens to this 8 per cent of the skunk-smoking population should visit any mental hospital in Britain or speak to somebody who has done so. Dr Humphrey Needham-Bennett, medical director and consultant psychiatrist of Cygnet Hospital, Godden Green in Sevenoaks, explained to me that among his patients “cannabis use is so common that I assume that people use or used it. It’s quite surprising when people say ‘no, I don’t use drugs’.”

The connection between schizophrenia and cannabis was long suspected by specialists but it retained its reputation as a relatively benign drug, its image softened by the afterglow of its association with cultural and sexual liberation in the 1960s and 1970s.

This ill-deserved reputation was so widespread that even 20 years ago, the possible toxic side effects of cannabis were barely considered. Zerrin Atakan, formerly head of the National Psychosis Unit at the Maudsley Psychiatric Hospital and later a researcher at the Institute of Psychiatry,

said: “I got interested in cannabis because I was working in the 1980s in an intensive care unit where my patients would be fine after we got them well. We would give them leave and they would celebrate their new found freedom with a joint and come back psychotic a few hours later.”

She did not find it easy to pursue her professional interest in the drug. She recalls: “I was astonished to discover that cannabis, which is the most widely used illicit substance, was hardly researched in the 1990s and there was no research on how it affected the brain.” She and fellow researchers made eight different applications for research grants and had them all turned down, so they were reduced to taking the almost unheard of course of pursuing their research without the support of a grant.

Studies by Dr Atakan and other psychiatrists all showed the connection between cannabis and schizophrenia, yet this is only slowly becoming conventional wisdom. Perhaps this should not be too surprising because in 1960, long after the link between cigarettes and lung cancer had been scientifically established, only a third of US doctors were persuaded that this was the case.

A difficulty is that people are frightened of mental illness and ignorant of its causes in a way that is no longer true of physical illnesses, such as cancer or even HIV. I have always found that three quarters of those I speak to at random about mental health know nothing about psychosis and its causes, and the other quarter know all too much about it because they have a relative or friend who has been affected.

Even those who do have experience of schizophrenia do not talk about it very much because they are frightened of a loved one being stigmatised. They may also be wary of mentioning the role of cannabis because they fear that somebody they love will be dismissed as a junkie who has brought their fate upon themselves.

This fear of being stigmatised affects institutions as well as individuals. Schools and universities are often happy to have a policy about everything from sex to climate change, but steer away from informing their students about the dangers of drugs. A social scientist specialising in drugs policy explained to me that the reason for this is because “they’re frightened that, if they do, everybody will think they have a drugs problem which, of course, they all do”.

The current debate about cannabis – sparked by the confiscation of the cannabis oil needed by Billy Caldwell to treat his epilepsy and by William Hague’s call for the legalisation of the drug – is missing the main point. It is all about the merits and failings of different degrees of prohibition of cannabis when it is obvious that legal restrictions alone will not stop the 2.1 million people who take cannabis from going on doing so. But the legalisation of cannabis legitimises it and sends a message that the government views it as relatively harmless. The very fact of illegality is a powerful disincentive for many potential consumers, regardless of the chances of being punished.

The legalisation of cannabis might take its production and sale out of the hands of criminal gangs, but it would put it into the hands of commercial companies who would want to make a profit, advertise their product and increase the number of their customers. Commercialisation of cannabis has as many dangers as criminalisation.

A new legal market in cannabis might be regulated and the toxicity of super-strength skunk reduced. But the argument of those who want to legalise cannabis is that the authorities are unable to enforce regulations when the drug is illegal, so why should they be more successful in regulating it when its production and sale is no longer against the law?

The problem with these rancorous but sterile arguments for and against legalisation and decriminalisation is that they divert attention from what should and can be done: a sustained campaign to persuade people of all ages that cannabis can send them insane. To a degree people are learning this already from bitter experience. As Professor Murray told me five years ago, the average 19- to 23-year-old probably knows more about the dangers of cannabis than the average doctor “because they have a friend who has gone paranoid. People know a lot more about bad trips than they used to.”

Patrick Cockburn is the co-author of Henry’s Demons: Living With Schizophrenia, A Father and Son’s Story

A depressing aspect of the present debate about cannabis is that so many proponents of legalisation or decriminalisation have clearly not taken on board that the causal link between cannabis and psychosis has been scientifically proven over the past ten years, just as the connection between cancer and cigarettes was proved in the late 1940s and 1950s.

The proofs have emerged in a series of scientific studies that reach the same grim conclusion: taking cannabis significantly increases the risk of schizophrenia. One study in The Lancet Psychiatry concludes that “the risk of individuals having a psychotic disorder showed a roughly three times increase in users of skunk-like cannabis, compared with those who never used cannabis”. As 94 per cent of cannabis seized by the police today is super-strength skunk, compared to 51 per cent in 2005, almost all those who take the drug today will be vulnerable to this three-fold increase in the likelihood that they will develop psychosis.

Home Secretary Sajid Javid: The government will carry out a review of the scheduling of cannabis for medicinal use

Mental health professionals have long had no doubts about the danger. Five years ago, I asked Sir Robin Murray, professor of psychiatric research at the Institute of Psychiatry in London, about them. He said that studies showed that “if the risk of schizophrenia for the general population is about one per cent, the evidence is that, if you take ordinary cannabis, it is two per cent; if you smoke regularly you might push it up to four per cent; and if you smoke ‘skunk’ every day you push it up to eight per cent”.

The medical marijuana market is in a downward spiral as businesses, lured by big money, shift to recreational

At the height of the medical marijuana industry there were 420 dispensaries in Oregon. Now there are only eight.

In 2015, Erich Berkovitz opened his medical marijuana processing company, PharmEx, with the intention of getting sick people their medicine. His passion stemmed from his own illness. Berkovitz has Tourette syndrome, which triggers ticks in his shoulder that causes chronic pain. Cannabis takes that away.

Yet in the rapidly changing marijuana landscape, PharmEx is now one of three medical-only processors left in the entire state of Oregon.

On the retail end, it’s also grim. At the height of the medical marijuana industry in 2016, there were 420 dispensaries in Oregon available to medical cardholders. Today, only eight are left standing and only one of these medical dispensaries carries Berkovitz’s products.

Ironically, Oregon’s medical marijuana market has been on a downward spiral since the state legalized cannabis for recreational use in 2014. The option of making big money inspired many medical businesses to go recreational, dramatically shifting the focus away from patients to consumers. In 2015, the Oregon Liquor Control Commission (OLCC) took over the recreational industry. Between 2016 and 2018, nine bills were passed that expanded consumer access to marijuana while changing regulatory procedures on growing, processing and packaging.

In the shuffle, recreational marijuana turned into a million-dollar industry in Oregon, while the personalized patient-grower network of the medical program quietly dried up.

Now, sick people are suffering.

“For those patients that would need their medicine in an area that’s opted out of recreational sales, and they don’t have a grower or they’re not growing on their own, it does present a real access issue for those individuals,” said André Ourso, an administrator for the Center for Health Protection at the Oregon Health Authority. The woes of the Oregon Medical Marijuana Program (OMMP) were outlined in a recently published report by the Oregon Health Authority. The analysis found the program suffers from “insufficient and inaccurate reporting and tracking,” “inspections that did not keep pace with applications”, and “insufficient funding and staffing”.

Operating outside of Salem, Oregon, PharmEx primarily makes extracts – a solid or liquid form of concentrated cannabinoids. Through his OMMP-licensed supply chain, he gets his high dose medicine to people who suffer from cancer, Crohn’s, HIV and other autoimmune diseases. Many are end-of-life patients.

These days, most recreational dispensaries sell both consumer and medical products, which are tax-free for cardholders. The problem for Berkovitz is that he’s only medically licensed. This means recreational dispensaries can’t carry his exacts. Legally, they can

only sell products from companies with an OLCC license. Since issuing almost 1,900 licenses, the OLCC has paused on accepting new applications until further notice.

Limits on THC – a powerful active ingredient in cannabis products – are also an issue, according to Berkovitz. With the dawn of recreational dispensaries, the Oregon Health Authority began regulating THC content. A medical edible, typically in the form of a sweet treat, is now capped at 100mg THC, which Berkovitz says is not enough for a really sick person.

“If you need two 3000mg a day orally and you’re capped at a 100mg candy bar, that means you need 20 candy bars, which cost $20 a pop,” he said. “So you’re spending $400 a day to eat 20 candy bars.”

“The dispensaries never worked for high dose patients, even in the medical program,” continued Berkovitz. “What worked was people who grew their own and were able to legally process it themselves, or go to a processor who did it at a reasonable rate.”

But with increased processing and testing costs, and a decrease on the number of plants a medical grower can produce, patients are likely to seek cannabis products in a more shadowy place – the black market.

“All the people that we made these laws for – the ones who are desperately ill – are being screwed right now and are directed to the black market,” said Karla Kay, the chief of operations at PharmEx.

Kay, who also holds a medical marijuana card for her kidney disease, said some patients she knows have resorted to buying high dose medical marijuana products illegally from local farmers markets – in a state that was one of the first to legally establish a medical cannabis industry back in 1998.

Moreover, the networks between medical patients, growers and processors have diminished.

The OMMP maintains a record of processors and the few remaining dispensaries, but no published list of patients or grow sites – a privacy right protected under Oregon law, much to the chagrin of law enforcement.

According to the Oregon Health Authority’s report, just 58 of more than 20,000 medical growers were inspected last year.

In eastern Oregon’s Deschutes county, the sheriff’s office and the district attorney have repeatedly requested the location of each medical marijuana grower in their county. They’ve been consistently denied by the Oregon Health Authority.

Recently, the sheriff has gone as far as hiring a detective to focus solely on enforcing marijuana operations.

“There is an overproduction of marijuana in Oregon and the state doesn’t have adequate resources to enforce the laws when it comes to recreational marijuana, medical marijuana, as well as ensuring the growth of hemp is within the THC guidelines,” said the Deschutes sheriff, Shane Nelson. As of last February, the state database logged 1.1m pounds of cannabis flower, as reported by the Willamette Week in April. That’s three times what residents buy in a year, which means the excess is slipping out of the regulated market. To help curb the trend, senate bill 1544 was passed this year to funnel part of the state’s marijuana tax revenues into the Criminal Justice Commission and provide the funding needed to go after the black market, especially when it comes to illicit Oregon weed being smuggled to other states. The program’s priority is “placed on rural areas with lots of production and diversion, and little law enforcement”, said Rob Bovett, the legal counsel with the Association of Oregon Counties, who crafted the bill.

In a May 2018 memo on his marijuana enforcement priorities, Billy J Williams, a US attorney for the district of Oregon, noted that “since broader legalization took effect in 2015, large quantities of marijuana from Oregon have been seized in 30 states, most of which continue to prohibit marijuana.”

As of 1 July, however, all medical growers that produce plants for three or more patients – about 2,000 growers in Oregon – must track their marijuana from seed-to-sale using the OLCC’s Cannabis Tracking System.

Berkovitz, however, is looking to cut out the middle man (namely dispensaries) to keep PharmEx afloat. “The only way the patients are going to have large, high doses of medicine is if we revive the patient-grower networks. They need to communicate with each other. No one’s going to get rich, but everybody involved will get clean medicine from the people they trust at a more affordable rate.”

Source: https://www.theguardian.com/society/2018/jul/31/oregon-cannabis-medical-marijuana-problems-sick-people

In the following video, GW Pharmaceuticals Chief Executive Justin Gover explains what other medical uses for cannabis the drug maker is researching:

Source: https://news.sky.com/video/breakthrough-in-cannabis-medicine-for-childhood-onset-epilepsy-11412608  June 2018

SUMMARY

Background

Interest in the use of cannabis and cannabinoids to treat chronic non-cancer pain is increasing, because of their potential to reduce opioid dose requirements. We aimed to investigate cannabis use in people living with chronic non-cancer pain who had been prescribed opioids, including their reasons for use and perceived effectiveness of cannabis; associations between amount of cannabis use and pain, mental health, and opioid use; the effect of cannabis use on pain severity and interference over time; and potential opioid-sparing effects of cannabis.

Methods

The Pain and Opioids IN Treatment study is a prospective, national, observational cohort of people with chronic non-cancer pain prescribed opioids. Participants were recruited through community pharmacies across Australia, completed baseline interviews, and were followed up with phone interviews or self-complete questionnaires yearly for 4 years.

Recruitment took place from August 13, 2012, to April 8, 2014. Participants were asked about lifetime and past year chronic pain conditions, duration of chronic non-cancer pain, pain self-efficacy, whether pain was neuropathic, lifetime and past 12-month cannabis use, number of days cannabis was used in the past month, and current depression and generalised anxiety disorder. We also estimated daily oral morphine equivalent doses of opioids.

We used logistic regression to investigate cross-sectional associations with frequency of cannabis use, and lagged mixed-effects models to examine temporal associations between cannabis use and outcomes.

Findings

1514 participants completed the baseline interview and were included in the study from Aug 20, 2012, to April 14, 2014. Cannabis use was common, and by 4-year follow-up, 295 (24%) participants had used cannabis for pain. Interest in using cannabis for pain increased from 364 (33%) participants (at baseline) to 723 (60%) participants (at 4 years). At 4-year follow-up, compared with people with no cannabis use, we found that participants who used cannabis had a greater pain severity score (risk ratio 1·14, 95% CI 1·01–1·29, for less frequent cannabis use; and 1·17, 1·03–1·32, for daily or near-daily cannabis use), greater pain interference score (1·21, 1·09–1·35; and 1·14, 1·03–1·26), lower pain self-efficacy scores (0·97, 0·96–1·00; and 0·98, 0·96–1·00), and greater generalised anxiety disorder severity scores (1·07, 1·03–1·12; and 1·10, 1·06–1·15).

We found no evidence of a temporal relationship between cannabis use and pain severity or pain interference, and no evidence that cannabis use reduced prescribed opioid use or increased rates of opioid discontinuation.

Interpretation

Cannabis use was common in people with chronic non-cancer pain who had been prescribed opioids, but we found no evidence that cannabis use improved patient outcomes. People who used cannabis had greater pain and lower self-efficacy in managing pain, and there was no evidence that cannabis use reduced pain severity or interference or exerted an opioid-sparing effect. As cannabis use for medicinal purposes increases globally, it is important that large well designed clinical trials, which include people with complex comorbidities, are conducted to determine the efficacy of cannabis for chronic non-cancer pain. Funding National Health and Medical Research Council and the Australian Government.

Source:https://www.thelancet.com/pdfs/journals/lanpub/PIIS2468-2667(18)30110-5.pdf July 2018

By Alison George

Cannabis is in the headlines for its potential medical benefits after the recent confiscation of cannabis oil medication from the mother of a 12-year-old British boy with severe epilepsy. The furore that ensued is shining a light on campaigns for cannabis oils to be made legal for medical reasons, and the UK government has now announced a review into the use of medicinal cannabis. Here’s what you need to know.

What is cannabis oil?

Cannabis oil is extracted from the cannabis plant Cannabis sativa. The plants medicinal properties have been touted for more than 3,000 years. It was described in the ancient Eygyptian Ebers papyrus around 1550BC, and it was likely used as a medicine in China before that. Some varieties of the plant contain high levels of the psychoactive substance tetrahydrocannabinol (THC), which is responsible for the “high” that comes from smoking or eating cannabis leaves or resin. The plant’s other major chemical component is cannabidiol, which has no psychoactive effect. Both act on the body’s natural cannabinoid receptors which are involved in many processes such as memory, pain and appetite. The cannabis plant also contains more than 100 other different cannabinoid compounds at lower concentrations.

So can cannabis oil make you high?

It depends on the THC content. Some types of Cannabis sativa plant, known as hemp, contain very little THC. The extracts from these plants contain mainly cannabidiol, so will not get anyone stoned.

Is it legal?

That’s a complicated question. In the UK cannabidiol is legal. Cannabis plant extracts (known as hemp or CBD oils) are available in high-street stores but the THC content must be below 0.2 per cent. “THC is not psychoactive at this level,” says David Nutt, a neuropsychopharmacologist at Imperial College London. But cannabidiol is illegal in many other countries.

In the USA for example, cannabidiol is classed as a schedule 1 controlled substance, and can only be sold in states where cannabis use is legal.

However, the tide may turn in favour of cannabidiol after a recent World Health Organisation review. This concluded that cannabidiol “exhibits no effects indicative of any abuse or dependence potential” but “has been demonstrated as an effective treatment of epilepsy … and may be a useful treatment for a number of other medical conditions.”

What is the evidence that cannabis oils can help treat epilepsy?

Although there is some scientific evidence that THC has potential to control convulsions, its mind-altering effects mean that much of the focus has turned to cannabidiol – particularly for childhood epilepsies that conventional drugs fail to control.

Two recent high quality randomised and placebo controlled trials showed that cannabidiol is an effective treatment for Lennox-Gastaut syndrome and Dravet syndrome, severe forms of epilepsy. The mechanism of action is unknown, but it may be due to a combination of effects, such as inhibiting the activity of neurons and dampening inflammation in the brain.

The situation is less clear when it comes to the use of commercial cannabis oils to control seizures, where the evidence is mainly anecdotal, and the oils can contain differing concentrations of cannabidiol and THC.

The UK government announced on 19 June that it would review the use of medical cannabis.

Are there any cannabis-based epilepsy drugs on the market?

Not yet. In April the US Food and Drug Administration recommended the approval of a drug called Epidiolex for Lennox-Gastaut syndrome and Dravet syndrome. Its active ingredient is cannabidiol, and final approval is due at the end of this month.

However, it is possible the drug is not as effective as cannabis oil containing THC, says Nutt. For example, the cannabis oil used to treat Billy Caldwell, the boy at the centre of the recent cannabis oil confiscation furore, contained cannabidiol and a low dose of THC, because cannabidiol alone did not stop all his seizures.

This is one of the big unknowns. “It is important to remember that there is currently very little scientific evidence to support cannabis oil containing both THC and cannabidiol as a treatment for epilepsy,” said the charity Epilepsy Action, in a statement issued this month.

Are cannabis-based medications available for other conditions?

Yes. A synthetic version of THC called Nabilone has been used since the 1980s to treat nausea after chemotherapy and to help people put on weight. A drug called Sativex is also approved for the treatment of pain and spasms associated with multiple sclerosis. It contains an equal mix of THC and cannabidiol, but would not be suitable for the treatment of children with epilepsy such as Billy. “If you used that to treat epilepsy, the kids would be stoned off their heads,” says Nutt.

What is the aim of the UK government’s review of medical cannabis? 

The first part of the review will look at the evidence for the therapeutic value of cannabis-based products. It can recommend any promising ones for the second part of the review. This will be carried out by the government’s Advisory Council for the Misuse of Drugs, which can recommend a change to the legal medical status of cannabis and cannabinoids.

This will hopefully lead to a relaxation of the rules surrounding research into cannabis-based medicines says Tom Freeman, a clinical psychopharmacologist at King’s College London.

In the UK cannabis currently has Schedule 1 status, the most restrictive category, which is for drugs which are not used medicinally such as LSD. “This creates a Catch 22 situation,” says Freeman. “You can’t show that cannabis and cannabis-based products have medicinal value because of restrictions on medical research.”  If cannabis is moved to the Schedule 2 category, it will join substances such as morphine and diamorphine (heroin) which can be prescribed by doctors if there is a clinical need. 

Source: https://www.newscientist.com/article/2172415-cannabis-oil-what-is-it-and-does-it-really-work-as-medicine/ June 2018

In 2000, Colorado voters decriminalized marijuana for medical use; however, because marijuana use remained illegal under federal law, the number of users was low. In 2009, President Obama instructed federal officials not to enforce marijuana laws that were in conflict with state laws, and the number of registered medical marijuana users in Colorado increased to 60,000 in 2008 compared with 2,000 in the prior 8 years. In 2012, Colorado legalized recreational marijuana use. As the number of people using marijuana has increased, there has been a parallel increase in marijuana-related emergency department (ED) visits and poison center calls. We expect that as other states liberalize marijuana laws, they will also experience an increase in marijuana-related ED visits. This article reviews several common marijuana-related ED cases that we have encountered in our practice.

Total (blue line) and pediatric (red line) marijuana exposure calls received by the Rocky Mountain Poison and Drug Center from 2011 through 2015

Source: http://www.ajhp.org/content/early/2017/09/22/ajhp160715  October 2017

The Oregon Health Authority has issued two new reports on marijuana. Oregon’s Medical Marijuana Program: Statistical Snapshot, January 2016 finds that 22 physicians have recommended marijuana for medical use to 85% of the state’s registered patients.
 
Some 1,700 physicians serve between 1 and 449 patients and account for a total of 19,087 patients, while 22 physicians account for a total of 60,908 patients, an average of 2,769 patients each.
 
Oregon now has registered:

• 77,155 patients
• 35,736 caregivers
• 46,812 growers
• 32,171 grow sites

Patients are 59% male, 41% female. Conditions they registered for (they may register for more than one condition) include:

• Severe pain, 71,533 (92%)
• Spasms, 22,501 (28.9%)
• Nausea, 10,680 (13.7%)
• PTSD, 5,527 (7.1%)
• Cancer, 4,460 (5.7%)
• Seizures, 2,122 (2.7%)

Those listing cachexia, HIV/AIDS, glaucoma, and Alzheimer’s disease are less than 1.5% each.
 
Read this report here.

Source:

https://www.oregon.gov/oha/ph/DiseasesConditions/ChronicDisease/MedicalMarijuanaProgram/Documents/OMMP%20Statistic%20Snapshot%20-%2001-2016.pdf

Cannabis oil has come under scrutiny

RUNGROJ YONGRIT/EPA-EFE/REX/Shutterstock

By Alison George

Cannabis is in the headlines for its potential medical benefits after the recent confiscation of cannabis oil medication from the mother of a 12-year-old British boy with severe epilepsy. The furore that ensued is shining a light on campaigns for cannabis oils to be made legal for medical reasons, and the UK government has now announced a review into the use of medicinal cannabis. Here’s what you need to know.

What is cannabis oil?

Cannabis oil is extracted from the cannabis plant Cannabis sativa. The plants medicinal properties have been touted for more than 3,000 years. It was described in the ancient Eygyptian Ebers papyrus around 1550BC, and it was likely used as a medicine in China before that. Some varieties of the plant contain high levels of the psychoactive substance tetrahydrocannabinol (THC), which is responsible for the “high” that comes from smoking or eating cannabis leaves or resin. The plant’s other major chemical component is cannabidiol, which has no psychoactive effect. Both act on the body’s natural cannabinoid receptors which are involved in many processes such as memory, pain and appetite. The cannabis plant also contains more than 100 other different cannabinoid compounds at lower concentrations.

So can cannabis oil make you high?

It depends on the THC content. Some types of Cannabis sativa plant, known as hemp, contain very little THC. The extracts from these plants contain mainly cannabidiol, so will not get anyone stoned.

Is it legal?

That’s a complicated question. In the UK cannabidiol is legal. Cannabis plant extracts (known as hemp or CBD oils) are available in high-street stores but the THC content must be below 0.2 per cent. “THC is not psychoactive at this level,” says David Nutt, a neuropsychopharmacologist at Imperial College London. But cannabidiol is illegal in many other countries.

In the USA for example, cannabidiol is classed as a schedule 1 controlled substance, and can only be sold in states where cannabis use is legal.

However, the tide may turn in favour of cannabidiol after a recent World Health Organisation review. This concluded that cannabidiol “exhibits no effects indicative of any abuse or dependence potential” but “has been demonstrated as an effective treatment of epilepsy … and may be a useful treatment for a number of other medical conditions.”

What is the evidence that cannabis oils can help treat epilepsy?

Although there is some scientific evidence that THC has potential to control convulsions, its mind-altering effects mean that much of the focus has turned to cannabidiol – particularly for childhood epilepsies that conventional drugs fail to control.

Two recent high quality randomised and placebo controlled trials showed that cannabidiol is an effective treatment for Lennox-Gastaut syndrome and Dravet syndrome, severe forms of epilepsy. The mechanism of action is unknown, but it may be due to a combination of effects, such as inhibiting the activity of neurons and dampening inflammation in the brain.

The situation is less clear when it comes to the use of commercial cannabis oils to control seizures, where the evidence is mainly anecdotal, and the oils can contain differing concentrations of cannabidiol and THC.

The UK government announced on 19 June that it would review the use of medical cannabis.

Are there any cannabis-based epilepsy drugs on the market?

Not yet. In April the US Food and Drug Administration recommended the approval of a drug called Epidiolex for Lennox-Gastaut syndrome and Dravet syndrome. Its active ingredient is cannabidiol, and final approval is due at the end of this month.

However, it is possible the drug is not as effective as cannabis oil containing THC, says Nutt. For example, the cannabis oil used to treat Billy Caldwell, the boy at the centre of the recent cannabis oil confiscation furore, contained cannabidiol and a low dose of THC, because cannabidiol alone did not stop all his seizures.

This is one of the big unknowns. “It is important to remember that there is currently very little scientific evidence to support cannabis oil containing both THC and cannabidiol as a treatment for epilepsy,” said the charity Epilepsy Action, in a statement issued this month.

Are cannabis-based medications available for other conditions?

Yes. A synthetic version of THC called Nabilone has been used since the 1980s to treat nausea after chemotherapy and to help people put on weight. A drug called Sativex is also approved for the treatment of pain and spasms associated with multiple sclerosis. It contains an equal mix of THC and cannabidiol, but would not be suitable for the treatment of children with epilepsy such as Billy. “If you used that to treat epilepsy, the kids would be stoned off their heads,” says Nutt.

What is the aim of the UK government’s review of medical cannabis? 

The first part of the review will look at the evidence for the therapeutic value of cannabis-based products. It can recommend any promising ones for the second part of the review. This will be carried out by the government’s Advisory Council for the Misuse of Drugs, which can recommend a change to the legal medical status of cannabis and cannabinoids.

This will hopefully lead to a relaxation of the rules surrounding research into cannabis-based medicines says Tom Freeman, a clinical psychopharmacologist at King’s College London.

In the UK cannabis currently has Schedule 1 status, the most restrictive category, which is for drugs which are not used medicinally such as LSD. “This creates a Catch 22 situation,” says Freeman. “You can’t show that cannabis and cannabis-based products have medicinal value because of restrictions on medical research.”  If cannabis is moved to the Schedule 2 category, it will join substances such as morphine and diamorphine (heroin) which can be prescribed by doctors if there is a clinical need. 

Source: https://www.newscientist.com/article/2172415-cannabis-oil-what-is-it-and-does-it-really-work-as-medicine/  June 2018

TO ALL OUR READERS: THE NDPA WOULD URGE YOU TO READ THE REPORT MENTIONED IN THE ARTICLE BELOW, (Tracking the Money That’s Legalizing Marijuana and Why It Matters), WHICH GIVES A DETAILED DESCRIPTION OF HOW MARIJUANA BECAME THE NUMBER ONE DRUG OF CHOICE FOR MILLIONS OF PEOPLE WORLDWIDE, HOW IT BECAME ‘BIG BUSINESS’ IN THE USA AND WHY WE NEED TO DISSEMINATE THIS INFORMATION WIDELY.

Report by National Families in Action Rips the Veil Off the Medical Marijuana Industry
Research Traces the Money Trail and Reveals the Motivation Behind Marijuana as Medicine

Tracking the Money That’s Legalizing Marijuana and Why It Matters documents state-by-state financial data, exposing the groups and the amount of money used either to fund or oppose ballot initiatives legalizing medical or recreational marijuana in 16 U.S. states.

• NFIA report reveals three billionaires — George Soros, Peter Lewis and John Sperling — who contributed 80 percent of the money to medicalize marijuana through state ballot initiatives during a 13-year period, with the strategy to use medical marijuana as a runway to legalized recreational pot.
• Report shows how billionaires and marijuana legalizers manipulated the ballot initiative process, outspent the people who opposed marijuana and convinced voters that marijuana is medicine, even while most of the scientific and medical communities say marijuana is not medicine and should not be legal.

• Children in Colorado treated with unregulated cannabis oil have had severe dystonic reactions, other movement disorders, developmental regression, intractable vomiting and worsening seizures.

• A medical marijuana industry has emerged to join the billionaires in financing initiatives to legalize recreational pot.

ATLANTA, March 14, 2017 (GLOBE NEWSWIRE) — A new report by National Families in Action (NFIA) uncovers and documents how three billionaires, who favor legal recreational marijuana, manipulated the ballot initiative process in 16 U.S. states for more than a decade, convincing voters to legalize medical marijuana. NFIA is an Atlanta-based non-profit organization, founded in 1977, that has been helping parents prevent children from using alcohol, tobacco, and other drugs. NFIA researched and issued the paper to mark its 40th anniversary.

The NFIA study, Tracking the Money That’s Legalizing Marijuana and Why It Matters, exposes, for the first time, the money trail behind the marijuana legalization effort during a 13-year period. The report lays bare the strategy to use medical marijuana as a runway to legalized recreational pot, describing how financier George Soros, insurance magnate Peter Lewis, and for-profit education baron John Sperling (and groups they and their families fund) systematically chipped away at resistance to marijuana while denying that full legalization was their goal.

The report documents state-by-state financial data, identifying the groups and the amount of money used either to fund or oppose ballot initiatives legalizing medical or recreational marijuana in 16 states. The paper unearths how legalizers fleeced voters and outspent — sometimes by hundreds of times — the people who opposed marijuana.

Tracking the Money That’s Legalizing Marijuana and Why It Matters illustrates that legalizers lied about the health benefits of marijuana, preyed on the hopes of sick people, flouted scientific evidence and advice from the medical community and gutted consumer protections against unsafe, ineffective drugs. And, it proves that once the billionaires achieved their goal of legalizing recreational marijuana (in Colorado and Washington in 2012), they virtually stopped financing medical pot ballot initiatives and switched to financing recreational pot. In 2014 and 2016, they donated $44 million to legalize recreational pot in Alaska, Oregon, California, Arizona, Nevada, Massachusetts and Maine. Only Arizona defeated the onslaught (for recreational marijuana).

Unravelling the Legalization Strategy: Behind the Curtain

In 1992, financier George Soros contributed an estimated $15 million to several groups he advised to stop advocating for outright legalization and start working toward what he called more winnable issues such as medical marijuana. At a press conference in 1993, Richard Cowen, then-director of the National Organization for the Reform of Marijuana Laws, said, “The key to it [full legalization] is medical access. Because, once you have hundreds of thousands of people using marijuana medically, under medical supervision, the whole scam is going to be blown. The consensus here is that medical marijuana is our strongest suit. It is our point of leverage which will move us toward the legalization of marijuana for personal use.”

Between 1996 and 2009, Soros, Lewis and Sperling contributed 80 percent of the money to medicalize marijuana through state ballot initiatives. Their financial contributions, exceeding $15.7 million (of the $19.5 million total funding), enabled their groups to lie to voters in advertising campaigns, cover up marijuana’s harmful effects, and portray pot as medicine — leading people to believe that the drug is safe and should be legal for any use.
Today, polls show how successful the billionaires and their money have been. In 28 U.S. states and the District of Columbia, voters and, later, legislators have shown they believe marijuana is medicine, even though most of the scientific and medical communities say marijuana is not medicine and should not be legal. While the most recent report, issued by the National Academies of Sciences (NAS), finds that marijuana may alleviate certain kinds of pain, it also finds there is no rigorous, medically acceptable documentation that marijuana is effective in treating any other illness. At the same time, science offers irrefutable evidence that marijuana is addictive, harmful and can hinder brain development in adolescents. At the distribution level, there are no controls on the people who sell to consumers. Budtenders (marijuana bartenders) have no medical or pharmaceutical training or qualifications.

One tactic used by legalizers was taking advantage of voter empathy for sick people, along with the confusion about science and how the FDA approves drugs. A positive finding in a test tube or petri dish is merely a first step in a long, rigorous process leading to scientific consensus about the efficacy of a drug. Scientific proof comes after randomized, controlled clinical trials, and many drugs with promising early stage results never make it through the complex sets of hurdles that prove efficacy and safety. But marijuana legalizers use early promise and thin science to persuade and manipulate empathetic legislators and voters into buying the spin that marijuana is a cure-all.

People who are sick already have access to two FDA-approved drugs, dronabinol and nabilone, that are not marijuana, but contain identical copies of some of the components of marijuana. These drugs, available as pills, effectively treat chemotherapy-induced nausea and vomiting and AIDS wasting. The NAS reviewed 10,700 abstracts of marijuana studies conducted since 1999, finding that these two oral drugs are effective in adults for the conditions described above. An extract containing two marijuana chemicals that is approved in other countries, reduces spasticity caused by multiple sclerosis. But there is no evidence that marijuana treats other diseases, including epilepsy and most of the other medical conditions the states have legalized marijuana to treat. These conditions range from Amyotrophic lateral sclerosis (ALS) and Crohn’s disease to Hepatitis-C, post-traumatic stress disorder (PTSD) and even sickle cell disease.

Not So Fast — What about the Regulations?
Legalizers also have convinced Americans that unregulated cannabidiol, a marijuana component branded as cannabis oil, CBD, or Charlotte’s Web, cures intractable seizures in children with epilepsy, and polls show some 90 percent of Americans want medical marijuana legalized, particularly for these sick children. In Colorado, the American Epilepsy Society reports that children with epilepsy are receiving unregulated, highly variable artisanal preparations of cannabis oil recommended, in most cases, by doctors with no training in paediatrics, neurology or epilepsy. Young patients have had severe dystonic reactions and other movement disorders, developmental regression, intractable vomiting and worsening seizures that can be so severe that their physicians have to put the child into a coma to get the seizures to stop. Because of these dangerous side effects, not one paediatric neurologist in Colorado, where unregulated cannabidiol is legal, recommends it for these children.

Dr. Sanjay Gupta further clouded the issue when he produced Weed in 2013, a three-part documentary series for CNN on marijuana as medicine. In all three programs, Dr. Gupta promoted CBD oil, the kind the American Epilepsy Society calls artisanal. This is because not one CBD product sold in legal states has been purified to Food and Drug Administration (FDA) standards, tested, or proven safe and effective. The U.S. Congress and the FDA developed rigid processes to review drugs and prevent medical tragedies such as birth defects caused by thalidomide. These processes have facilitated the greatest advances in medicine in history.

“By end-running the FDA, three billionaires have been willing to wreck the drug approval process that has protected Americans from unsafe, ineffective drugs for more than a century,” said Sue Rusche, president and CEO of National Families in Action and author of the report. “Unsubstantiated claims for the curative powers of marijuana abound.” No one can be sure of the purity, content, side effects or potential of medical marijuana to cause cancer or any other disease. When people get sick from medical marijuana, there are no uniform mechanisms to recall products causing the harm. Some pot medicines contain no active ingredients. Others contain contaminants. “Sick people, especially children, suffer while marijuana medicine men make money at their expense,” added Ms. Rusche.

Marijuana Industry — Taking a Page from the Tobacco Industry
The paper draws a parallel between the marijuana and tobacco industries, both built with the knowledge that a certain percentage of users will become addicted and guaranteed lifetime customers. Like tobacco, legalized marijuana will produce an unprecedented array of new health, safety and financial consequences to Americans and their children.

“Americans learned the hard way about the tragic effects of tobacco and the deceptive practices of the tobacco industry. Making another addictive drug legal unleashes a commercial business that is unable to resist the opportunity to make billions of dollars on the back of human suffering, unattained life goals, disease, and death,” said Ms. Rusche. “If people genuinely understood that marijuana can cause cognitive, safety and mental health problems, is addictive, and that addiction rates may be three times higher than reported, neither voters nor legislators would legalize pot.”
The paper and the supporting data are available at www.nationalfamilies.org.
About National Families in Action

National Families in Action is a 501 (c) (3) nonprofit organization that was founded in Atlanta, Georgia in 1977. The organization helped lead a national parent movement credited with reducing drug use among U.S. adolescents and young adults by two-thirds between 1979 and 1992. For forty years, it has provided complex scientific information in understandable language to help parents and others protect children’s health. It tracks marijuana science and the marijuana legalization movement on its Marijuana Report website and its weekly e-newsletter of the same name.

Source: https://globenewswire.com/news-release/2017/03/14/936283/0/en/New-Report-by-National-Families-in-Action-Rips-the-Veil-Off-the-Medical-Marijuana-Industry.html

For decades, attorney Richard Blau focused his legal savvy on the high-stakes business of booze. Alcohol-industry law was an attorney’s dream, full of unresolved questions and deep-pocketed players clawing their way to the top.

So when Florida’s talk turned to marijuana, another storied pastime with its own dubious history, Blau’s titan of a law firm, GrayRobinson, jumped at the opportunity. Blau now leads a special practice for clients wanting to capitalize on medical cannabis — and bend the laws to their advantage.

“The playbook is to get in and lend a hand in crafting those rules, so they read the way our clients want them to read,” Blau said. “The powerful people are the ones to get in on the ground floor.”

Months before the state’s November vote to legalize medical marijuana, some of Florida’s biggest law firms are already staking their claims to the lucrative legal minefield of the budding weed industry.

Orlando-based GrayRobinson, which employs 101 attorneys in Tampa Bay and nearly 300 across the state, will devote a core of its “regulated products” group to the nuances of marijuana law.

Attorneys with Holland & Knight, a prominent firm in Tampa with more than 1,000 lawyers across the world, last week released an alert for clients on the “legal landscape (and) complex marketplace for marijuana-related businesses.”

And Akerman, the Miami-based corporate-law giant and largest law firm in the state, recently launched a “regulated substances task force” with nearly two dozen senior attorneys and public-policy professionals ready to advise, among others, cultivators, private-equity groups and dispensaries.

“The shifting interplay between state and federal laws presents new challenges and unprecedented opportunities for Akerman clients,” managing partner Richard Spees said in a statement, “and we are positioned to help them capitalize.”

Groups with ostensible legal ties have filed for Florida business licenses with names like Medical Marijuana Business Lawyers and the Cannabis Law Group, joining a wave of “ganjapreneurs” grabbing for a piece of industry profits.

But the introduction of these powerhouse firms ups the ante, helping squash the images of two-bit, Breaking Bad-style “Better Call Saul” legal operations and legitimizing what could be a landslide of million-dollar corporate disputes.

“We’re not the ‘pot lawyers.’ This is not ‘reefer madness.’ It’s 100 percent professional, 100 percent legitimate . . . and we take it 100 percent seriously,” said Troy Kishbaugh, a health care specialist serving on GrayRobinson’s regulated-products group. “We have a large health care base . . . and they want their patients to get the best care possible. And if medical marijuana happens to be part of that medical regimen, they want to make sure they’re doing it right.”

The state’s biggest firms bolstered their practices this spring after Florida lawmakers passed a “Charlotte’s Web” bill legalizing a non-high-producing cannabis strain used to treat cancer and epilepsy.

An even bigger fight comes in November, when voters could pass Amendment 2 and legalize weed for a much broader slate of medical uses. Its prospects seem increasingly upbeat: A Quinnipiac University poll last week found 88 percent of Florida voters support adult medical-cannabis use.

If the vote passes, Florida could follow California in becoming America’s second-biggest medical-weed state, with around 400,000 patients spending an average of $3,000 a year, estimates from state regulators and a national cannabis-industry trade group show.

State regulators have several months to decide on the law’s little details, leaving a huge window for “cannabusiness” interests pushing to find an unserved niche. The state Department of Health’s Office of Compassionate Use, which is drafting the rules, discussed at a public hearing Friday a range of potential enterprises, from medical-cannabis testing to home delivery.

Lawyers wise to food and alcohol regulation are shoo-ins for the firms’ legal-weed practices: Many of the rules facing Big Pot, attorneys argue, could look a lot like those governing Big Tobacco, Big Food and Big Booze.
Joining them are lawyers with a vast range of expertise:

• Health care experts to address hospital and physician groups on how to protect themselves while administering, storing and suggesting the use of a drug still illegal under federal law.
• Banking and financial gurus to advise on securing investment, handling money and saving on taxes in what has long been an all-cash business.
• Land use attorneys who can help resolve zoning and landlord disputes over where growers and distributors can operate from seed to sale.
• Even intellectual-property specialists with knowledge on how to protect and preserve cannabis companies’ strains, brands and reputations, in much the same way consultants have long advised Budweiser or Marlboro.

For precedent, attorneys here are analyzing the legal laboratories of the 23 states, plus Washington D.C., that have legalized medical cannabis, and the two states, Washington and Colorado, that have okayed weed for personal use.

They also are following in the footsteps of nationwide firms versed in guiding the emerging trade. Seattle’s Canna Law Group, launched by international law firm Harris Moure in 2011, proved “profitable almost instantly,” partner Dan Harris told the Puget Sound Business Journal last year, adding, “We were shocked at the demand.” One of the group’s attorneys, a young University of Miami graduate, was voted “Marijuana Industry Attorney of the Year” in 2013 by Dope Magazine.

For the finer details, attorneys said, firms are following their clients’ requests to lobby their way into influence. Litigation seems likely: A proposed rule limiting Florida’s medical weed to five nurseries, chosen by lottery, has already stirred up legal wrath.
Attorneys have likened their legal timing to representing alcohol outfits near the sunset of prohibition, a potentially historical chance to mold law and make nice with the grateful captains of a new industry.

But GrayRobinson’s Blau, whose practice group is taking on three new clients a week, stops short of supporting the “green rush” of small-time entrepreneurs. He compares the early days of legal Florida weed to that of the American gold rush, in which organized business interests, not excited ground troops, ended up with the most to gain.

“All those individual wannabe miners thought (they’d strike it rich) when they pushed forward to mine the Klondike … but very few emerged out of that with anything,” Blau said. “In reality, it was the established gold-mining companies who took the ground, and made it their own.”

Source: www.tampabay.com 1st August 2014

 This excellent interview  by Kevin Sabet was published in a Brazilian newspaper and has been translated.

Legalize the use of marijuana creates another “addiction industry” and also does not help to end trafficking, said Kevin Sabet, 35, an American expert who joined the team of drug control of the government of Barack Obama. For him, the politicization of “fashion theme” masks the impact of drugs on public health, whose consumption is increasing among adolescents. to use the term “medical marijuana” only confuses people. “We do not call the morphine ‘medicinal heroin'”

In an exclusive interview with UOL , Sabet showed data from a recent survey that will present the lecture “Impact of drug legalization”, organized by the SPDM – Paulista Association for the Advancement of Medicine. The event takes place on Saturday (23) in Sao Paulo.

One of the cases analyzed by Sabet is Colorado, which allows both the use of “medical marijuana” (since 2001) and recreational (starting this year). In the state, the sale of the drug is banned for children under 21 years. Even so, seven in ten adolescents in treatment for chemical dependency admitted to have used medical marijuana to another person-and, on average, it occurred 50 times.

Even in Colorado, Sabet says the number of young people between 12 and 17 who used marijuana increased from 8.15% (in 2009) to 10.47% (in 2011), well above the national average, which is 7, 55%.

For adults in the state doubled the number of drivers who, under the influence of marijuana, were involved in car accidents with death. The index rose from 5% in 2009 to 10% in 2011.

In the 19 American states that allow marijuana use for medical treatments, Sabet says three in five students in their final year of high school can drugs with “friends”. Only 25% buy drugs from dealers or strangers. The margin of error was not informed.

Art / UOL

Map of legalizing marijuana in the United States

• Medicinal and recreational use legalized

Colorado and Washington

• Legalized medicinal use

Arizona, California, Connecticut, Delaware, District of Columbia, Hawaii, Illinois, Maine, Maryland, Massachusetts, Michigan, Montana, Nevada, New Hampshire, New Jersey, New Mexico, Oregon, Rhode Island, Vermont

• Legalization analysis

Florida and Alaska

The sociologist who studies politics for 18 years for drugs and is currently a senior advisor to the Institute for Research of Crimes Justice and the UN (United Nations), says the numbers are alarming. “It’s the opening of a new industry that just wants to increase the addiction of the people.”

Even the use of marijuana for medical treatment is frowned upon by Sabet. “We do not call the morphine ‘medicinal heroin.” Using the term’ medical marijuana ‘only confuses people and comes from the belief that you have to smoke to get the benefits, “he criticizes. 

Currently, he is dedicated to Project SAM – Smart Approaches to Marijuana (Intelligent Approaches for Marijuana). The non-profit organization’s mission is to reduce the use of cannabis in the world, “without demonizing or legalize” drugs. 

Check out the full interview:

UOL – Do you agree with the legalization of marijuana for medicinal purposes and for recreation? 

Kevin Sabet – Often the debate is painted in white and black, as if you had to be either in favor of higher spending or criminals in favor of legalization. I do not agree with that. I think there are many more intelligent policies that do not fall into this polarization.  What we’re seeing in states like Colorado and Washington [where the medicinal and recreational use of marijuana is allowed] is the inauguration of a new industry that just wants to increase the addiction of people.

It is very curious that we have politicians who do not already hold more executive positions in favor of legalization. It’s the latest fashion, it makes them come back to the news and makes them more relevant. I do not know in Brazil, but in the United States, when you become a former president, you’re no longer relevant Kevin Sabet

The type of legalization that worries me is what is happening in the United States and tends to happen in the rest of the world: industrialization and promotion of other addictive industry.

In terms of effects, we also have to think, whether in relation to marijuana and other drugs like cigarettes and even alcohol in the future of our workforce. What kind of workers and students want? Of course we do not want to promote the use of cigarettes for our students, but if you go to school and smokes, her cognition is not impaired, you can still learn. You will not get lung cancer tomorrow. But if marijuana is different. It impairs the person in terms of learning, memorization, attention, motivation.

We have lived through a disaster compared to the tobacco and alcohol industry, and I do not want to raise the pot at that level.

UOL – There are several studies cited including marijuana help cancer patients, since contain tumor growth, stimulate appetite, reduce nausea and relieve pain. With so many benefits, it is possible to advocate a total ban on drugs? 

Sabet – Tue drugs using substances derived from cannabis is something promising. But we do not smoke opium to have the effects of morphine. We do not call the morphine “medical heroin”. Use the term “medical marijuana” only confuses people and comes from the belief that you have to smoke to get the benefits.

In the United States, the so-called “users” of this medical marijuana are in 98% of cases men between 30 and 40 years without terminal cancer. They are also not seropositive for HIV, do not have multiple sclerosis or amyotrophic lateral sclerosis. Basically, they have pain in the lumbar region. Logical that we should treat their pain, but there are other outputs.

The impression of people is that marijuana is good because there are patients dying of cancer who need it. But frankly, if you’re dying of cancer, with six months to live, I do not care what you’re going to use [for pain].

In addition, laws are being written very broadly and in many American states, legislation is flawed. The Colorado began selling the drug in 2008 All you need is to be 18 years and have headaches to get marijuana.

UOL – What must we do to help patients in need of “medical marijuana?” 

Sabet – We have to do special research programs that give patients access to experimental drugs. We should not sell marijuana on the corner, in a store, and say that is medicine, because this is not the way to act of medicine. I do not like this politicization of medicine, the medicine should be in the scientific field.If scientists in Brazil say tomorrow that we need to smoke pot to get the [beneficial] effects, we need to understand why this is and learn. But do not think that is the current case.

Let us study the components of the plant. I know it can be very good for a politician to say that it is in favor of medical marijuana. But honestly, we should not trust politicians talking about scientific issues [laughs]. Let’s hear scientists. And they are not telling you to smoke pot to get rid of your cancer.  

UOL – Earlier this year, Obama said that smoking marijuana is no more dangerous than drinking alcohol, but stressed that in any case, is “a bad idea.” Do you agree with him? 

Sabet – First, do not think that there is healthy this equivalence to say that one thing is better than another because they are different. Alcohol affects your liver, marijuana affects your lungs. Alcohol affects certain parts of your brain, marijuana, other.

In the case of alcohol, we have a cultural acceptance. Alcohol is not legalized because it is a success for public health. It is legal because it has been used for thousands of years in Western culture, that’s the only reason.

In the case of marijuana, it is not used for thousands of years by the majority of the western population and do not want to repeat the experience [like alcohol] again.

I know far more people who drink a glass of wine with no intention of getting drunk. I know who smoke a joint without the intention to “have a cheap”. The reason for smoking a joint is drugging. I do not drink, so would not explain properly, but I’m not justifying do one thing and not another. There is a cultural difference in relation to alcohol which makes the comparison with the fake marijuana.

UOL – Our former president, Fernando Henrique Cardoso, is one of the advocates of marijuana legalization. What do you think of politicians like him? 

Sabet – It is very curious that we have politicians who no longer occupy the executive positions in favor of legalization. It’s the latest fashion, it makes them come back to the news and makes them more relevant. I do not know in Brazil, but in the United States, when you become a former president, you’re no longer relevant [laughs]. Nobody talks about George W. Bush, even Bill Clinton.

It is a very simplistic approach. Visit the slums. Do you think that more drugs will help these communities? This offers some hope to them? Not a hopeful vision.

Marijuana causes infertility? Partially true: laboratory research showed that marijuana can lead to a drop in the amount of sperm and cause them to move about a bit differently, more slowly. “In real life, however, there is nothing showing that it causes infertility among users,” explains psychiatrist at the Hospital Clinicas in Sao Paulo Mario Ivan Braun, author of “Drugs – questions and answers” Read More Getty Images

UOL – If you were a candidate for president of Brazil and was asked in a debate whether you are for or against the legalization of the drug, which speak? 

Sabet – I advocate a health-related approach to drugs in general. This means increasing access to treatment, early intervention, training of physicians to identify the signs of addiction. Treat all problems early, without waiting for someone to give input in the hospital because it is using crack cocaine or four years ago. I want you to discover the defect in the first month of use to prevent the disease from worsening.

And I certainly would not want to start a new industry like tobacco or alcohol, selling the drug. And I also would look at the key issues. Why are people using crack? What happens in the community where they live? Are much more difficult questions, but they are much more important than say if we legalize a drug or not.

UOL – Data collected by lord over the Colorado show that the legalization of drugs had bad consequences, especially for teenagers. 

Sabet – This happens because legalization would not eliminate the black market trafficking. And this is the promise that we get rid of gangs. Gangs are very happy because they now have lower prices. In Colorado, it costs $ 300 (R $ 684) to buy 35 grams of marijuana legalized. With traffickers, the price is $ 150 (R $ 342) for the same amount of drug. You do not go to recreational marijuana store to pay twice the price? In addition, the sale is prohibited for minors. If you want marijuana, which will buy? With traffickers. All these promises that would end the trafficking and increase tax collection are not being met. The governor of Colorado for the fifth consecutive time, decreased the estimate of tax collection with this trade. Junior Lake / UOL I will not say a parent of a child suffering hundreds of seizures per day should not use something that will help her. Trafficking or grow marijuana in the backyard does not solve the problem, either. It is necessary to regulate the use of cannabidiol Kevin Sabet

UOL – So, how to stop drug trafficking?

 
Sabet – The only way would be to stop trafficking is sell the drug at cost of production. In other words, it would be like trying to get rid of trafficking in crack cocaine or selling the drug for pennies for each dose. From the standpoint of public health, you do not want that. You just want to raise taxes cigarette, you try to increase costs because the more expensive, fewer people will want it. You may be able to get rid of some of the harms and reduce some traffic, but not eliminate it. The output, once again, is to reduce the number of addicts in treatment and awareness campaigns.

UOL – For adults, shows that you doubled the number of fatal accidents involving drivers under the influence of marijuana in Colorado. 

Sabet – legalization advocates could even argue that drivers “were not under the influence of drugs”, but as they were fatal accidents, tests on the victims showed high levels of substances derived from cannabis in organisms. Of course not every accident caused by a drunk driver occurs due to intake of alcohol. Most likely, it could be because he sent an SMS at the time. But it is a big risk factor.

Many teens think that driving under the influence of marijuana is safe. But I say that it is dangerous to drive on a road where the limit is 70 km / h, so 30 km / h to 100 km / h. Even if marijuana makes you slower, it is also dangerous. It also affects your depth perception and your reaction time.

UOL – There should be stricter laws in Colorado against these drivers? 

Sabet – The issue of legalization is that you create space for a completely new political group that will do anything to make access to drugs as easy as possible. Then, during the campaigns of legalization they say: “do not worry, we will oversee and regulate.”The next minute, they shy away. In power, they hold the money, will influence the advice of the small towns, giving money to politicians to create 20 shops selling marijuana in a local community. Ie, you have these defenders who will try to minimize all the dangers of driving under the influence of drugs. Their message to the children, for example, is that smoking marijuana is safer than drinking alcohol.   

UOL – If legalization is not an option, which would then be proposed to reduce the consumption of drugs? 

Sabet – The question is: what do you think the worst? A legal market to reach 25-50% of the population, because it will increase the use of the drug or an illegal market that reaches 7%? Both are bad, but I would opt for the second scenario and work to reduce this rate.

We need better prevention and awareness, particularly for teenagers campaigns. Over the past decade, scientific research have advanced tremendously with regard to the effects of drugs on the adolescent brain, but at the same time, the perception of these young people from the harmful effects of marijuana is decreasing. This owes much to discussions of legalization.

Many people find that marijuana is not addictive, but rather addictive. And is also associated with severe mental illness. We need more campaigns, more research, more treatment. In the case of trafficking, we need to give more alternatives for youth, for the sale of the drug did not show more profitable than legitimate work. It is necessary to solve social problems.

UOL – Uruguay recently legalized the sale of the drug in the country, which should start in November, but was postponed to 2015 This precisely because the government is still studying efficient methods to identify the buyer.. On occasion, José Mujica criticized how the drug has been legalized in the USA, “anyway” and “irresponsibly that scares”. Do you agree with Mujica? 

Sabet – He is too smart to say it did not want to copy the state of Colorado and Washington, because that would be a total disaster. Would not be surprised if the sale of marijuana in Uruguay even start, or even never happen. It is not a popular measure, the government spent a few million on campaigns trying to convince people that this is something good, and yet 70% are against.

Rational argument is “let’s stop trafficking”, but again, unless you take the drug, give marijuana to children 10 years will still be traffickers. And is not that what you want. The president himself [Mujica] said he does not like marijuana, is not in favor of it, just want to control it. This is a much better approach than the American states. It is much more honest than some guys in the USA. But still do not think Uruguayans have a viable program. They are realizing that it is much more complicated than they thought it would be. So, good luck to them. I am very skeptical.

UOL – For the United States, it is worrying that a Latin American country to legalize marijuana? 

Sabet – I do not know if it would be a problem, but it is strange to the United States. The country does not want legalization, but it is happening at the state level. The American government will simply ignore the issue. To be honest, we only see them [and Uruguay Mujica] mentioned in the paper when the subject is marijuana. They [Obama and Mujica] nor talked about it when they met. So it’s not a concern for the United States.

UOL – recently had here in Brazil the case of a five year old girl with severe epilepsy that caused more than 60 seizures daily. After cannabidiol , she had significant improvement in health status. However, the parents were “smuggling” the substance, and were not satisfied with that. How is this question in the USA? 

Sabet – also have this problem in the United States. More than 400 children are receiving cannabidiol in liquid form legally by the government. However, you do not have data to show the effectiveness of the substance. If a parent is a substance that is experimental, unproven, then fine by me accordingly. I will not say to a parent of a child suffering hundreds of seizures per day not to use something that will help.

But traffic or planting marijuana in the backyard does not solve the problem. It is necessary to regulate the use of cannabidiol by pharmaceutical and health areas.

Source:  http://noticias.uol.com.br/internacional/ultimas-noticias/   23^rd August 2014

Abstract

To present a summary of current scientific evidence about the cannabinoid, cannabidiol (CBD) with regard to its relevance to epilepsy and other selected neuropsychiatric disorders. We summarize the presentations from a conference in which invited participants reviewed relevant aspects of the physiology, mechanisms of action, pharmacology, and data from studies with animal models and human subjects. Cannabis has been used to treat disease since ancient times. Δ⁹-Tetrahydrocannabinol (Δ⁹-THC) is the major psychoactive ingredient and CBD is the major non-psychoactive ingredient in cannabis. Cannabis and Δ⁹-THC are anticonvulsant in most animal models but can be proconvulsant in some healthy animals.

The psychotropic effects of Δ⁹-THC limit tolerability. CBD is anticonvulsant in many acute animal models, but there are limited data in chronic models. The antiepileptic mechanisms of CBD are not known, but may include effects on the equilibrative nucleoside transporter; the orphan G-protein-coupled receptor GPR55; the transient receptor potential of vanilloid type-1 channel; the 5-HT_1a receptor; and the α3 and α1 glycine receptors. CBD has neuroprotective and anti-inflammatory effects, and it appears to be well tolerated in humans, but small and methodologically limited studies of CBD in human epilepsy have been inconclusive.

More recent anecdotal reports of high-ratio CBD:Δ⁹-THC medical marijuana have claimed efficacy, but studies were not controlled. CBD bears investigation in epilepsy and other neuropsychiatric disorders, including anxiety, schizophrenia, addiction, and neonatal hypoxic-ischemic encephalopathy. However, we lack data from well-powered double-blind randomized, controlled studies on the efficacy of pure CBD for any disorder. Initial dose-tolerability and double-blind randomized, controlled studies focusing on target intractable epilepsy populations such as patients with Dravet and Lennox-Gastaut syndromes are being planned. Trials in other treatment-resistant epilepsies may also be warranted.

Source:   Epilepsia  Volume 55, Issue 6, pages 791–802, June 2014

As part of the U.S. Food and Drug Administration’s ongoing efforts to protect consumers from health fraud, the agency today issued warning letters to four companies illegally selling products online that claim to prevent, diagnose, treat, or cure cancer without evidence to support these outcomes. Selling these unapproved products with unsubstantiated therapeutic claims is not only a violation of the Federal Food, Drug and Cosmetic Act, but also can put patients at risk as these products have not been proven to be safe or effective. The deceptive marketing of unproven treatments may keep some patients from accessing appropriate, recognized therapies to treat serious and even fatal diseases.

The FDA has grown increasingly concerned at the proliferation of products claiming to treat or cure serious diseases like cancer. In this case, the illegally sold products allegedly contain cannabidiol (CBD), a component of the marijuana plant that is not FDA approved in any drug product for any indication. CBD is marketed in a variety of product types, such as oil drops, capsules, syrups, teas, and topical lotions and creams. The companies receiving warning letters distributed the products with unsubstantiated claims regarding preventing, reversing or curing cancer; killing/inhibiting cancer cells or tumours; or other similar anti-cancer claims. Some of the products were also marketed as an alternative or additional treatment for Alzheimer’s and other serious diseases.

“Substances that contain components of marijuana will be treated like any other products that make unproven claims to shrink cancer tumours. We don’t let companies market products that deliberately prey on sick people with baseless claims that their substance can shrink or cure cancer and we’re not going to look the other way on enforcing these principles when it comes to marijuana-containing products,” said FDA Commissioner Scott Gottlieb, M.D. “There are a growing number of effective therapies for many cancers. When people are allowed to illegally market agents that deliver no established benefit they may steer patients away from products that have proven, anti-tumour effects that could extend lives.” The FDA issued warning letters to four companies – Greenroads Health, Natural Alchemist, That’s Natural! Marketing and Consulting, and Stanley Brothers Social Enterprises LLC – citing unsubstantiated claims related to more than 25 different products spanning multiple product webpages, online stores and social media websites. The companies used these online platforms to make unfounded claims about their products’ ability to limit, treat or cure cancer and other serious diseases. Examples of claims made by these companies include:

· “Combats tumour and cancer cells;”

· “CBD makes cancer cells commit ‘suicide’ without killing other cells;”

· “CBD … [has] anti-proliferative properties that inhibit cell division and growth in certain types of cancer, not allowing the tumour to grow;” and

· “Non-psychoactive cannabinoids like CBD (cannabidiol) may be effective in treating tumours from cancer – including breast cancer.”

Unlike drugs approved by the FDA, the manufacture of these products has not been subject to FDA review as part of the drug approval process and there has been no FDA evaluation of whether they work, what the proper dosage is, how they could interact with other drugs, or whether they have dangerous side effects or other safety concerns. The FDA has requested responses from the companies stating how the violations will be corrected. Failure to correct the violations promptly may result in legal action, including product seizure and injunction.

“We have an obligation to provide caregivers and patients with the confidence that drugs making cancer treatment claims have been carefully evaluated for safety, efficacy, and quality, and are monitored by the FDA once they’re on the market,” Commissioner Gottlieb added. “We recognize that there’s interest in developing therapies from marijuana and its components, but the safest way for this to occur is through the drug approval process – not through unsubstantiated claims made on a website. We support sound, scientifically-based research using components derived from marijuana, and we’ll continue to work with product developers who are interested in bringing safe, effective, and quality products to market.”

This latest action builds on the more than 90 warning letters issued in the past 10 years, including more than a dozen this year, to companies marketing hundreds of fraudulent products making cancer claims on websites, social media and in stores. Additionally, the FDA recently took decisive action to prevent the use of a potentially dangerous and unproven treatment used in ‘stem cell’ centers targeting vulnerable cancer patients. The FDA encourages health care professionals and consumers to report adverse reactions associated with these or similar products to the agency’s MedWatch program.

The FDA, an agency within the U.S. Department of Health and Human Services, promotes and protects the public health by, among other things, assuring the safety, effectiveness, and security of human and veterinary drugs, vaccines and other biological products for human use, and medical devices. The agency also is responsible for the safety and security of our nation’s food supply, cosmetics, dietary supplements, products that give off electronic radiation, and for regulating tobacco products.

Source: https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm583295.htm

Millions of people use cannabis as a medicine. That’s not based on clinical evidence, nor do we know which of the hundreds of compounds in the plant is responsible for its supposed effects. Elizabeth Finkel reports.

LAST YEAR DEDI MEIRI, A CANNABIS RESEARCHER AT THE TECHNION, ISRAEL’S OLDEST UNIVERSITY, RECEIVED A “BEFORE AND AFTER” VIDEO OF AN AUTISTIC BOY.

The before showed the boy helmeted, hands tied behind his back, butting his head against a wall. The after showed him calmly sitting at a table, sketching. The difference: two drops of cannabis oil administered below the tongue. The video had been sent to Meiri by Abigail Dar, an Israeli champion for the use of cannabis in children with autism.

Early this year it was a different story. Over the course of a day, Meiri’s lab received a stream of phone calls from Dar: a few autistic children had gone berserk after receiving their two drops of oil.

Meiri, who is primarily a cancer researcher, received the video and the calls because he has, reluctantly, become one of Israel’s cannabis experts. “Even now I am reluctant to tell people I work on medical cannabis,” he says. “I am not pro-cannabis; I think 90% is placebo.”

But Israel is in the grip of a vast medical experiment. Cannabis has taken hold here to treat a startling range of medical conditions. Not just familiar things like anorexia and pain in cancer patients but autism, Crohn’s disease, Tourette’s syndrome, epileptic seizures, multiple sclerosis, arthritis, diabetes and more. With close to 30,000 users in a population of eight million, Meiri says “everyone knows someone who is being treated with cannabis”. While there is a semblance of orderly medicine, with doctors prescribing cannabis oil from eight registered growers, no one can say just what, exactly, is responsible for the apparent responses.

A cannabis plant is a pot-pourri of more than 500 chemicals whose abundance varies greatly across different genetic strains and according to growth conditions – they’re not cultivars so much as chemovars. The medicinal effect may depend on tetrahydrocannabinol (THC), the chemical that gives you the high, or cannabidiol (CBD), which is thought to reduce inflammation and pain, or a hundred other “cannabinoids” unique to the plant with their own medicinal profile.

Bottom line: with dozens of varieties grown under different conditions, Israeli patients are receiving quite different medicinal concoctions.

Israel’s predicament is tame by comparison to the United States. Here it is the Wild West. Federal sheriffs outlaw medical research on the plant while cannabis cowboys peddle chemovars (varying in their content of THC and CBD) for cures and profit. In the 29 US states that have legalised medical cannabis, dispensaries that resemble something out of a Harry Potter tale sell candies, cookies, oils, ointments and joints to an estimated 2.3 million Americans. As to their exact medical benefits and risks, no one knows. This is medieval medicine – akin to boiling willow bark to treat headache. It is also great business – the North American market for legal cannabis products grew 30% in 2016, with sales topping $US6.7 billion.

Israel’s medical cannabis mess is a lot easier to deal with. To help address it, Meiri’s laboratory of Cancer Biology and Cannabinoid Research is conducting a reverse clinical trial. While patients using medical cannabis fill in a monthly questionnaire, the ranks of analytical machines bursting out of Meiri’s lab create chemical fingerprints of the cannabis extracts patients are using. The idea is to try to link individual cannabis compounds to the patient response.

It is an approach that’s “two or three rungs down” from the ideal of randomised placebo-controlled clinical trials (RCTs), says Donald Abrams, an oncologist at the University of California, San Francisco, who prescribes cannabis as a palliative for patients with cancer. “But, if well done and there’s a strong effect, observational studies like these are invaluable.”

Israel is also one of the few places in the world pushing forward with gold-standard RCTs. But given that dozens of cannabis strains are already being used for a ballooning number of conditions, RCTs seem like a finger in the dyke.

Countries like Australia, where the federal government legalised medical cannabis in October 2016, are entering this brave new world with trepidation. “Because there has been no proper research, we’re now at a difficult crossroads,” says University of Melbourne pharmacologist James Angus, who chairs the federal government’s advisory council on the medical use of cannabis. “Our health workforce has no guidelines or experience in prescribing, and patients are demanding it. We’ve run out of time.”

The Promised Land may well be the world’s best bet for deliverance from the medical cannabis mess.

Anecdotes on the medical use of cannabis go back to mythical Chinese emperor Shen Neng in 2700 BCE. More piquant references can be found in ancient Roman, Greek and Indian texts. Or just google.

Thousands of years on from Shen Neng, it seems we still don’t have a great deal more than anecdotes to go on. As a report from the US National Academies of Science in January 2017 states: “Despite increased cannabis use and a changing state-level policy landscape, conclusive evidence regarding the short- and long-term health effects – both harms and benefits – of cannabis use remains elusive.”

While the medical uses of the opium poppy, a vastly more dangerous plant, are well understood, cannabis has remained stuck in a no man’s land. It had been part of the US pharmacopeia till the 1930s, as an alcohol-based tincture, until the federal government effectively outlawed its possession and sale through the Marijuana Tax Act. More draconian penalties followed. It is still demonised by federal law as a ‘Schedule 1’ drug with no medical use, lumped in the same category as heroin, LSD and ecstasy. Yet as a quick online search will show, the plant is lauded for a seemingly inexhaustible list of curative properties.

In the past two decades the disparity between evidence and anecdotes has grown extreme. Despite a majority of states (beginning with California in 1996) having legalised cannabis to treat medical conditions, federal restrictions on research remained ironclad. So researchers have great difficulty studying whether such medical uses have any basis in science. “What we have is a perfect storm,” says Daniele Piomelli, a neurobiologist at the University of California, Irvine.

Piomelli has been researching cannabis as best as he can. To comply with the mandates of the federal Drug Enforcement Agency (DEA), his precious store of 50 milligrams of THC must be kept in a locked safe, in a locked cool room, in a locked lab. “Any person on the street can go to a dispensary and for $10 obtain cannabis,” he says. “But if we bring it into the university we risk being raided by the FBI and DEA. We live in a schizophrenic state.”

Even when researchers have gained permission to do research, the cannabis can only be supplied by one authorised lab, at the University of Mississippi. The lab has been growing the same variety for decades, one that bears little resemblance to the chemovars now available through dispensaries.

In San Francisco, Abrams tried valiantly in the 1990s to set up a clinical trial to test the claims of dying AIDS patients that smoking weed outperformed their anti-nausea drugs. After more than a year trying to get permission from the National Institute on Drug Abuse, the penny finally dropped; the agency, as he often tells journalists, sees itself as the National Institute “on” Drug Abuse, not “for” Drug Abuse. So the January report of the National Academies of Science was hardly a surprise. The document, based on reviewing 10,000 publications, found “modest” evidence for the effectiveness of cannabis to treat nausea and vomiting in adults undergoing chemotherapy, for chronic pain, and to alleviate spasms in multiple sclerosis. It did not, however, deliver a verdict for a long list of illnesses including epilepsy, inflammatory bowel disease, Parkinson’s Disease, post-traumatic stress, anxiety, insomnia and cancer. “For these conditions, the report states, “there is inadequate information to assess their effects.”

But bits of information are trickling through. In May, a report in the New England Journal of Medicine offered evidence that an oily, strawberry-flavoured formulation of pure cannabidiol (made by British company GW Pharmaceuticals) could reduce the severity of seizures in children with a rare form of epilepsy known as Dravet’s syndrome. Of the 120 youngsters recruited, 60 received cannabidiol and 60 received only a strawberry-flavoured oil, the placebo. Three of the treated group achieved complete remission from their seizures while in 40% of those treated, the frequency of seizures was reduced by half. But 27% of the placebo group also saw a halving in their seizure rate and there were significant side effects amongst the treated group. “It’s not a magical drug”, explains Ingrid Scheffer, a paediatric neurologist at the University of Melbourne and co-author of the study. But she points out the sometimes exasperated parents of her patients have a different view. “The attitude is, ‘it’s obvious you fuddy duddy, just give it to us’.”

Most of the 400 pages in the hefty NAS tome report on the adverse effects of cannabis, like a raised risk of schizophrenia or road accidents or chronic cough. This, says Piomelli, reflects what researchers obtained funding for: “There is a bias towards the null hypothesis – that cannabis causes harm.” Those harms exist, he agrees. “But society is asking for answers about its benefits, and that’s not a question that researchers have been able to answer.”

Israel staked its claim in the field of cannabis research back in the 1960s. It was the beginning of the pot-smoking hippy revolution. But no one actually knew what the psychoactive ingredient of pot was.

Raphael Mechoulam, a chemist at the Hebrew University of Jerusalem, saw an opportunity. In 1964 he was the first to link pot’s mind-altering effects to THC. His research flourished in a regulated but permissive environment: his chief source of cannabis was the local police station. His group also isolated the natural equivalents of cannabis made by the brain, using pigs (with great difficulty, given the researchers were in Jerusalem). In 1992 they identified anandamide, the so-called bliss molecule, and in 1995 its more prosaically named partner, 2-arachidonoyl glycerol or 2 AG. These brain-made counterparts of THC are known as endocannabinoids.

Meanwhile the Israeli public began to clamour for medical cannabis. Just as in San Francisco, the AIDS epidemic had put medical cannabis on the radar. Mirroring the experience of Donald Abrams, immunologist Zvi Bentwich also witnessed the anti-nausea and pain-relieving effects that smoking cannabis had on his AIDS patients. While anti-retroviral drugs would mercifully bring the raging AIDS epidemic in both countries under control, the clamour for the palliative use of cannabis by cancer patients grew, aided by the internet.

Israel’s government obliged but with strict regulation. Patients, supported by a letter from a physician, could obtain a medical cannabis permit from the ministry of health. Growers needed a licence. One of the first companies to gain one, in 2007, was Tikun Olam. As patient numbers grew, it began to collect information about their responses. In 2015 Bentwich, who also heads the Centre for Emerging Tropical Diseases and AIDS at Ben Gurion University, joined Tikun Olam to lead a formal clinical trials program. “If the medical community is to accept cannabis, that depends on carrying out large reliable clinical trials,” he says. “In the US, as well as in most European countries, that is still extremely difficult.”

So far Israel is leading the pack. It is the only country, for instance, to have published the results of a randomised double blind study on the use of cannabis by Crohn’s disease patients. Timna Naftali, a gastroenterologist at Meir Medical Centre, carried out the trial after discovering several patients were self-medicating with cannabis. “They had reduced their medication and not suffered flare ups,” she says. “It was very intriguing.”

In her trial, 21 patients were assigned randomly to a group that smoked THC-rich cannabis cigarettes twice a day for eight weeks or to a group that smoked cannabis free of THC and other cannabinoids. The results, published in Clinical Gastroenterology and Hepatology, showed that in 10 of 11 patients with Crohn’s disease who smoked the THC-rich cigarettes, there were “significant clinical benefits”. One criticism was that perhaps patients merely felt better due to the euphoric effects of cannabis, so Naftali is repeating the trial, leaving it to an endoscopist to decide. This time 50 patients are receiving an oil, containing a 4:1 ratio of cannabidiol to THC. “As a doctor, I’m not happy about telling patients to smoke,” Naftali says. Another trial that tested a pure extract of cannabidiol was ineffective. “Perhaps it was the low dose,” Naftali muses. “There’s also a claim you have to have it in combination.” Perhaps it is a case of what Mechoulam has dubbed the “entourage effect” – the consequence of a mysterious biological synergy between cannabis compounds.

Another world-first trial under way in Israel is testing the effects of cannabis on youngsters with autism. Given cannabis can trigger psychotic behaviour, it is surprising to think it would be a candidate for a condition where psychotic behaviour is often part of the problem. But a third of autistic children also suffer from seizures.

When paediatric neurologist Adi Aran, at Jerusalem’s Shaare Zedek Medical Centre, prescribed cannabis for the seizures of autistic children, their parents reported dramatic results. Children who never spoke began speaking, and writing for the first time. To verify these anecdotal results, he is running a trial on 120 youngsters, aged 5 to 21 years. Some receive whole cannabis oil containing, amongst other things, a 20:1 ratio of cannabidiol to THC; others receive a purified extract containing only cannabidiol and THC; a final group receive a placebo, an identically flavoured oil. All will undergo a ‘washout’ period, where they are gradually weaned off their oil.

In principle, most doctors would like to see the results of numerous such trials before prescribing cannabis. However, parents like Abigail Dar disagree with this approach. “A parent like me with a complicated child doesn’t have the luxury of principles,” she says. Her son, Yuval, now in his early twenties, is severely autistic, and was once so prone to violent outbreaks she could not be alone with him. “Yuval tried over a dozen anti-psychotic medications since he was 12 years old to treat symptoms

like endless anxiety, restlessness, violent outbreaks or, as we call it, ‘life in the shadow of hell’. They only made him more agitated and aggressive.”

Dar managed to get a medical cannabis prescription for Yuval in 2015. Though autism did not count as one of Israel’s qualifying conditions, the health ministry finally granted permission as a ‘mercy treatment’. “It was a life-changer from the very first day,” according to Dar. “He hasn’t exhibited a single self-injurious behaviour or outburst in the last 14 months. He is calmer, more attentive and communicative. He smiles more.”

Dar has carried out her own careful experimentation for what works for her son, using chemovars that vary in their CBD-to-THC ratio. As far as she is concerned, placing Yuval in a randomised, placebo-controlled, washout trial would be immoral. “With suffering kids you don’t take it away,” she says. “I tell parents to stay away; it’s not in favour of kids.”

Instead, through a collaboration with Meiri’s lab, she is pushing to gather the data already being generated. “We have 200 kids and adults with severe autism we are guiding through strains and dosages to find out what works. We track them with questionnaires: we look at things like violent outbreaks, sleep and appetite. The idea eventually is to go global. It will give us some small amount of knowledge on how to treat autism.”

It’s not just desperate cases like Dar that make cannabis a poor fit for the box of a RCT. Abrams sees no need for more trials when it comes to treating pain or nausea in patients with cancer. Nor is he alarmed by the range of products sold in dispensaries. “I don’t consider it to be that dangerous, compared to the pharmaceutical agents we already prescribe,” he says. “I have many patients that were weaned off opiates thanks to cannabis.” He points out that in the US, 90 people die each day from overdoses of opiates, in many cases prescribed to treat chronic pain [LINK: https://www.cdc.gov/drugoverdose/epidemic/index.html].

Mieri never imagined his CV would one day include heading a laboratory for cannabis research. In early 2015, after four years at the Ontario Cancer Institute, he was all set to return to cancer research.

Then he noticed a curious publication from a Japanese research group that reported a cannabis extract blocked the ability of human breast cancer cells to spread in a culture dish. What pricked Meiri’s interest was that the extracts appeared to be scrambling the cell’s internal scaffolding – his particular area of expertise.

Meiri repeated the experiment on different types of cancer cells. He found the cannabis extract was just as potent as some chemotherapy drugs. But it was another finding that really captured his interest: the effectiveness of the extract depended on the cannabis variety and the grower.

As the son of a strawberry farmer, he understood exactly what he was seeing. “Strawberries taste different in the morning and afternoon,” he explains. He was seeing the effects of a cocktail of different chemicals.

Which of these chemicals were responsible for the anti-cancer effect? To find out, Meiri bought a machine for high-performance liquid chromatography, a technique to separate and identify parts of a mixture. Soon he was a de facto guru. A grant from a philanthropist in 2016 marked a point of no return.

‘The plural of anecdote is not data’ is an oft-quoted medical aphorism. But anecdotes can’t be ignored either. Meiri is acquiring quite a collection. On one occasion, he was contacted by the father of a seven-year-old whose seizures had returned after being free of them for nearly a year. The father, wanting to know why the oil had stopped working, sent samples to Meiri. When the scientist analysed them, he found they were just olive oil. “It was a data point,” he says, “showing that the effects of cannabis extract were real.”

Then there was the disastrous day he learned that several autistic kids taking cannabis oil had gone berserk. “Tali, we have a situation,” he recalls telling the head of the project. All the extracts the children were taking had the same 20:1 ratio of CBD to THC. But looking at the chemical profiles, it was clear the offending medication carried at least five different compounds. “It doesn’t provide the answers,” he says. “It shows where to begin searching.”

There is no simple way out of the cannabis mess. With much of the world clamouring to use cannabis as a cure for all manner of ailments, and an exploding cannabis industry that is happy to push that demand along, it is crucial to establish just how real its clinical benefits and harms are – especially for children.

The medical establishment ideally needs randomised clinical trials, such as those Israel is admirably pushing ahead with. “I would say the Israelis have taken the lead,” Abrams says.

But 30,000 users in Israel and millions in the US aren’t waiting for such results. Some, like Abigail Dar, are too desperate. Others are wedded to their own trial-and-error experiments with different chemovars.

Another complicating factor is that the diabolically complex chemistry of the cannabis plant is too overwhelming to sort out through individual RCTs. Researchers are still scratching at the surface of a potential treasure trove of medicines that appear to act synergistically. The list of conditions to try them against appears never-ending. The number of trials needed to test each combination against each condition seems mindboggling.

The database collated by Meiri and his clinical collaborators is now being prepared for publication. It should help link the pot-pourri of chemicals inside cannabis to its clinical effects. It may be second-tier science, but it appears to be one of the best strategies for navigating a path out of the haze that still envelops medical cannabis.

Conflict of interest statement. Elizabeth Finkel is a member of the scientific advisory board of AUSiMED, which raises funds to support scientific collaborations between Australia and Israel.

Source: Cosmos 76 – Spring 2017

MEDS Act promotes FDA-compliant medical research of marijuana

 (Alexandria, VA)– Smart Approaches to Marijuana (SAM) applauds U.S. Senators Brian Schatz (D-HI), Orrin Hatch (R-UT), Thom Tillis (R-NC), and Chris Coons (D-DE) for introducing the Marijuana Effective Drug Studies (MEDS) Act of 2016. Once passed, it would make it easier for researchers to perform legitimate research on the medical effectiveness and safety of marijuana’s components.

Rather than rescheduling marijuana, the MEDS Act comprehensively identifies barriers to legitimate research and offers comprehensive, responsible solutions instead of “medicine by ballot initiative.” More specifically, the bill:

• Enables more research on marijuana by creating a faster, more streamlined process for obtaining approval from the Drug Enforcement Agency (DEA) to conduct research, including the ability to amend and supplement research proposals without reapplying.  Currently, researchers who want to conduct research on marijuana must interface with several federal agencies and engage in a complex application process that can take a year or longer must start from scratch if they make any changes to their research proposal;

• Eliminates the burdensome requirement of some DEA field offices that marijuana be kept in bolted safes – a requirement not possible in many research and clinical settings – and codifies current DEA regulations that allow marijuana to be stored in securely locked, substantially constructed cabinets; and

• Requires the licensing of marijuana manufacturers for the purpose of valid scientific and clinical research and drug development and establishes manufacturing licenses for the commercial production of FDA-approved medical marijuana products.

“These steps are important because despite state laws, raw marijuana (smoked or ingested) is not medicine, and has never passed through the rigorous FDA approval process to ensure the health and safety of patients,” said Dr. Kevin Sabet, President of SAM.  “The plant’s components should be studied so those in need can access any therapeutic benefits while knowing dosage, side effects, and contraindications.  And more broadly speaking, the MEDS Act upholds the important, basic principle that all medications-including marijuana-based drugs-should go through the scientific process and accessed through legitimate doctors.”

SAM is proud to join the American Medical Association, American Academy of Pediatrics, American Cancer Society Cancer Action Network, American Society of Addiction Medicine, American Preventive Medical Association, American Pain Society, American Society of Anesthesiologists, and the American Academy of Pain Medicine in support of the MEDS Act.

Source:  https://learnaboutsam.org/sam-applauds-bi-partisan-legislation-legitimate-medical-marijuana-research/   

20^th June 2016

Abstract

IMPORTANCE:

Over the last 25 years, illicit cannabis use and cannabis use disorders have increased among US adults, and 28 states have passed medical marijuana laws (MML). Little is known about MML and adult illicit cannabis use or cannabis use disorders considered over time.

OBJECTIVE:

To present national data on state MML and degree of change in the prevalence of cannabis use and disorders.

DESIGN, PARTICIPANTS, AND SETTING:

Differences in the degree of change between those living in MML states and other states were examined using 3 cross-sectional US adult surveys: the National Longitudinal Alcohol Epidemiologic Survey (NLAES; 1991-1992), the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC; 2001-2002), and the National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III; 2012-2013). Early-MML states passed MML between NLAES and NESARC (“earlier period”). Late-MML states passed MML between NESARC and NESARC-III (“later period”).

MAIN OUTCOMES AND MEASURES:

Past-year illicit cannabis use and DSM-IV cannabis use disorder.

RESULTS:

Overall, from 1991-1992 to 2012-2013, illicit cannabis use increased significantly more in states that passed MML than in other states (1.4-percentage point more; SE, 0.5; P = .004), as did cannabis use disorders (0.7-percentage point more; SE, 0.3; P = .03).

In the earlier period, illicit cannabis use and disorders decreased similarly in non-MML states and in California (where prevalence was much higher to start with). In contrast, in remaining early-MML states, the prevalence of use and disorders increased.

Remaining early-MML and non-MML states differed significantly for use (by 2.5 percentage points; SE, 0.9; P = .004) and disorder (1.1 percentage points; SE, 0.5; P = .02). In the later period, illicit use increased by the following percentage points: never-MML states, 3.5 (SE, 0.5); California, 5.3 (SE, 1.0); Colorado, 7.0 (SE, 1.6); other early-MML states, 2.6 (SE, 0.9); and late-MML states, 5.1 (SE, 0.8). Compared with never-MML states, increases in use were significantly greater in late-MML states (1.6-percentage point more; SE, 0.6; P = .01), California (1.8-percentage point more; SE, 0.9; P = .04), and Colorado (3.5-percentage point more; SE, 1.5; P = .03).

Increases in cannabis use disorder, which was less prevalent, were smaller but followed similar patterns descriptively, with change greater than never-MML states in California (1.0-percentage point more; SE, 0.5; P = .06) and Colorado (1.6-percentage point more; SE, 0.8; P = .04).

CONCLUSIONS AND RELEVANCE:

Medical marijuana laws appear to have contributed to increased prevalence of illicit cannabis use and cannabis use disorders. State-specific policy changes may also have played a role. While medical marijuana may help some, cannabis-related health consequences associated with changes in state marijuana laws should receive consideration by health care professionals and the public.

Source: JAMA Psychiatry. 2017 Jun 1;74(6):579-588. doi: 10.1001/jamapsychiatry.2017.0724.

Objective:

The authors sought to determine whether cannabis use is associated with a change in the risk of incident nonmedical prescription opioid use and opioid use disorder at 3-year follow-up.

Method:

The authors used logistic regression models to assess prospective associations between cannabis use at wave 1 (2001–2002) and nonmedical prescription opioid use and prescription opioid use disorder at wave 2 (2004–2005) of the National Epidemiologic Survey on Alcohol and Related Conditions. Corresponding analyses were performed among adults with moderate or more severe pain and with nonmedical opioid use at wave 1. Cannabis and prescription opioid use were measured with a structured interview (the Alcohol Use Disorder and Associated Disabilities Interview Schedule–DSM-IV version). Other covariates included age, sex, race/ethnicity, anxiety or mood disorders, family history of drug, alcohol, and behavioral problems, and, in opioid use disorder analyses, nonmedical opioid use.

Results:

In logistic regression models, cannabis use at wave 1 was associated with increased incident nonmedical prescription opioid use (odds ratio=5.78, 95% CI=4.23–7.90) and opioid use disorder (odds ratio=7.76, 95% CI=4.95–12.16) at wave 2. These associations remained significant after adjustment for background characteristics (nonmedical opioid use: adjusted odds ratio=2.62, 95% CI=1.86–3.69; opioid use disorder: adjusted odds ratio=2.18, 95% CI=1.14–4.14). Among adults with pain at wave 1, cannabis use was also associated with increased incident nonmedical opioid use (adjusted odds ratio=2.99, 95% CI=1.63–5.47) at wave 2; it was also associated with increased incident prescription opioid use disorder, although the association fell short of significance (adjusted odds ratio=2.14, 95% CI=0.95–4.83). Among adults with nonmedical opioid use at wave 1, cannabis use was also associated with an increase in nonmedical opioid use (adjusted odds ratio=3.13, 95% CI=1.19–8.23).

Conclusions:

Cannabis use appears to increase rather than decrease the risk of developing nonmedical prescription opioid use and opioid use disorder.

Source: http://ajp.psychiatryonline.org/doi/abs/10.1176/appi.ajp.2017.17040413

by  Elizabeth Stuyt, MD

For the past 27 years, working as an addiction psychiatrist, I have struggled with big industries that push their products more for their financial gain rather than the best interests of the clients they serve. The most disconcerting piece occurs when physicians or other treatment providers or governmental entities appear to be influenced by big industry, touting the party line and minimizing any downsides to the product. I have experienced this with the tobacco industry, the pharmaceutical industry and now with the marijuana industry.

It is clear to me that wherever it happens, the push to legalize medical marijuana is simply a back-door effort, by industry, to legalize retail marijuana. However, the lack of any regulations on the potency of THC in marijuana or marijuana products in Colorado has allowed the cannabis industry to increase the potency of THC to astronomical proportions, resulting in a burgeoning public health crisis.

The potency of THC in currently available marijuana has quadrupled since the mid-1990s. The marijuana of the 1980s had <2% THC, 4.5% in 1997, 8.5% in 2006 and by 2015 the average potency of THC in the flower was 17%, with concentrated products averaging 62% THC.

Sadly, the cannabidiol (CBD) concentrations in currently available marijuana have remained the same or decreased. CBD is the component of marijuana that appears to block or ameliorate the effects of THC. Plants that are bred to produce high concentrations of THC cannot simultaneously produce high CBD. Higher-potency THC has been achieved by genetically engineering plants to product more THC and then preventing pollination so that the plant puts more energy into producing cannabinoids rather than seeds. This type of cannabis is referred to as sinsemilla (Spanish for without seed). (It has also been referred to as “skunk” due to its strong smell.)

In my view, this is no different than when the tobacco industry increased the potency of nicotine by genetically engineering tobacco plants to produce more nicotine and then used additives like ammonia to increase the absorption of nicotine. Industry’s efforts to increase the potency of an addictive substance seem to be done purely with the idea of addicting as many people as possible to guarantee continued customers. This certainly worked for the tobacco industry. And we have increasing evidence that high potency THC cannabis use is associated with an increased severity of cannabis dependence, especially in young people.12

Although marijuana has been used for thousands of years for various medical conditions, we have no idea if the benefit comes from the THC or CBD or one of the other multiple cannabinoids present in marijuana, or a combination. And we have no idea how much is needed or how often. Most of the research indicates that it is likely the CBD that is more helpful but we obviously need research on this. There is no evidence that increasing the potency of THC has any medical benefits. In fact, a study on the benefits of smoked cannabis on pain actually demonstrated that too high a dose of THC can cause hyperalgesia – similar to what is seen with high dose opiates – meaning that the person becomes more sensitive to pain with continued use. They found that 2% THC had no effect on pain, 4% THC had some beneficial effects on chronic pain and 8% resulted in hyperalgesia.3

The discovery of the “active component” in marijuana that makes it so desirable is a fairly recent phenomenon. THC and CBD were first discovered in 1963 in Israel.4

Because cannabis was made a DEA schedule I drug in 1970, very little research has been done on cannabis in the United States and most of the indications for medical marijuana have very little good research backing up the use. The chemical that is made by the body and fits the receptor which accommodates THC was discovered in 1992.5

The researcher named the chemical anandamide which means “supreme joy” in Sanskrit.  However, it turns out that the endocannabinoid system plays a very significant role in brain development that occurs during childhood and adolescence. It controls glutamate and GABA homeostasis and plays a role in strengthening and pruning synaptic connections in the prefrontal motor cortex. The consequences of using the high potency THC products during this period, especially without the protective benefits of CBD, are multifaceted and include disturbance of the endocannabinoid system, which can result in impaired cognitive development, lower IQ and increased risk of psychosis.

There is also evidence that marijuana use contributes to anxiety and depression. A very large prospective study out of Australia tracked 1600 girls for 7 years and found that those who used marijuana every day were 5 times more likely to suffer from depression and anxiety than non-users.6

Teenage girls who used the drug a least once a week were twice as likely to develop depression as those who did not use. In this study, cannabis use prior to age 15 also increased the risk of developing schizophrenia symptoms.

While there definitely are people who can use marijuana responsibly without any untoward effects, similar to how some people can drink alcohol responsibly and not have any problems, there are people who are very sensitive to the effects of THC, and its use can precipitate psychosis. The higher the potency of THC the more likely this may happen and we have no idea how to predict who will be affected. In one of the first double blind randomized placebo controlled trials on smoked cannabis (maximum of 8% THC) for the treatment of pain, a cannabis naïve participant had a psychotic reaction to the marijuana in the study and this then required that all future study participants have some experience with smoking marijuana.7

This kind of makes it difficult to have “blind” unbiased participants.

A 2015 study out of London analyzed 780 people ages 18-65, 410 with first episode psychosis and 370 healthy controls, and found that users of high potency (“skunk-like”) cannabis (THC > 15%) are three times as likely to have a psychotic episode as people who never use cannabis, and the risk is fivefold in people who smoke this form of the drug every day.89 There was no association of psychosis with THC levels < 5%. Most of the marijuana in the U.S. is of the high-THC variety. Many retailers in Colorado sell strains of weed that contain 25 percent THC or more.

Sadly, Colorado has now joined several other states in approving PTSD as an indication for the use of medical marijuana. Marijuana does not “treat” PTSD any more than benzodiazepines or opiates “treat” PTSD. All these addictive drugs do is mask the symptoms, allowing the person to continue life unaffected by the memory of the trauma. However, the psychological trauma is never resolved and the individual has to continue to use the substance in order to cope. This sets the individual up for the development of addiction to the substance or the use of other addictive substances. There is absolutely no good research to support the use of marijuana for PTSD, and there is observational data that this would be a bad idea unless this use was supported by a lot more (and better-designed) longitudinal research.

In an excellent longitudinal, observational study from 1992 to 2011, 2,276 Veterans admitted to specialized VA treatment programs for PTSD had their symptoms evaluated at intake and four months after discharge.10

They found that those who never used marijuana or quit using while in treatment had the lowest levels of PTSD symptoms, while those who continued to use or started using marijuana after treatment had worse symptoms of PTSD. Those who started using the drug during treatment had higher levels of violent behavior too.

Those of us working in the trenches in Colorado are seeing the downsides of what our governor has called “one of the great social experiments of the 21st century.” Emergency room physicians are seeing a significant increase in people experiencing consequences from marijuana use since it was legalized. One such physician wrote a very poignant piece about his experience returning to his home town of Pueblo, Colorado where he is now practicing.11

His experiences are totally supported by the Rocky Mountain High Intensity Drug Trafficking Report, volume 4 from September 2016 which documents significant increases in marijuana related emergency department visits (49%) and hospitalizations related to marijuana (32%) compared to rates prior to retail legalization. This report also documents significant increases in the use of marijuana by youth, with Colorado youth “past month marijuana use” for 2013/2014 being 74% higher than the national average, compared with 39% higher in 2011/2012.

In Pueblo, Colorado, where I practice, it has developed into a perfect storm. According to the Healthy Kids Colorado Survey in 2015, we have the highest incidence of youth marijuana use in the state, with 30.1% reporting using marijuana in the last 30 days. The legalization of retail marijuana seems to be reflected in the increased abuse of opiates and heroin too. In addition to the highest rates of marijuana use by youth, Pueblo has the highest rates of heroin-related deaths in the state.

This is a very disturbing correlation that needs attention. I have definitely seen in my practice that marijuana acts as a gateway drug to opiates, and to relapse to opiates after treatment if the person goes back to using marijuana. The Smart Approaches to Marijuana status report, which assesses state compliance with federal marijuana enforcement policy, following what is known as the Cole memo, documents that Colorado, four years after legalization, has failed to meet the specific DOJ requirements on controlling recreational marijuana production, distribution and use. This report documents a significant increase in drugged driving crashes, youth marijuana use, a thriving illegal black market and unabated sales of alcohol, which supports the idea that people are not using marijuana instead of alcohol but rather in addition to alcohol.

In spite of all this information, powerful people in the government of Colorado have publicly minimized the consequences. Larry Wolk, MD, the Chief Medical Officer for the Colorado Department of Public Health and Environment, has reported that he has “not seen any significant problems” with the legalization of marijuana.

Governor Hickenlooper’s response to Attorney General Sessions recent questions about compliance with the Cole Memo minimized the adolescent use of marijuana by saying that youth marijuana use in Colorado has “remained stable since legalization.” This is not true for Pueblo, but in any event, any use of marijuana by youth in Colorado should not be minimized and should be a major concern for future generations.

While there are people who believe we need to enforce federal law and go back to making marijuana illegal, I am afraid the horse is already out of the barn and cannot be put back in as we already have several states with “legal” retail marijuana and multiple more with “medical marijuana.” I cannot conceive of any way this could be reversed at this point, when the majority of society supports the legalization of marijuana.

Solutions to our marijuana problems have to be realistic to our current situation/environment. The number one solution is more education. Many people seem to lack a true understanding of the drug and all the potential negative consequences of the higher-potency THC. This is why education is so important. Adults should have the right to make their own decisions but they need informed consent, just like with any drug.

The biggest concern is with adolescent use and the developing brain. This requires a lot more education and increased efforts at prevention, early intervention and treatment. I believe society would be truly served by a federal ban on all advertising of addicting drugs including alcohol, tobacco and marijuana, as well as all pharmaceutical drugs. The decision to use a pharmaceutical medication should be between the patient and the medical professional, not influenced by big industry. We clearly have the big industries— alcohol, tobacco and marijuana—doing everything they can to influence the public and convince them to use their product.

Since we only have anecdotal evidence at this point that marijuana can aid any medical condition, I recommend eliminating “medical marijuana” and just have retail marijuana with limits on THC and regulations similar to alcohol and tobacco. This could help take away the perception, which adolescents and others have, that because is it “medical” it must be “safe.” In order to be able to say it is medical, it should go through the same standards for testing the safety and efficacy of any prescription drug.

In this vein, I believe we do need more research and that marijuana should be reclassified as a schedule II drug so this can occur. Since marijuana has been used medicinally for thousands of years, I believe that the plant deserves some true research to determine if and what parts of the plant are helpful medicinally. The reports that marijuana use resulted in less than 10% becoming addicted to it were done back in the 1990s when THC levels were <5%. Since we are seeing significant increases in people developing marijuana use disorder with the higher doses of THC, perhaps the limits on THC should be <5%. Editor’s note: for more information, see the pdf of the author’s talk on this topic.     Show 11 footnotes

Source:  https://www.madinamerica.com/2017/09/unintended-consequences-colorado-social-experiment/  11th September 2017

Key Points

Question  Are US state medical marijuana laws one of the underlying factors for increases in risk for adult cannabis use and cannabis use disorders seen since the early 1990s?

Findings  In this analysis using US national survey data collected in 1991-1992, 2001-2002, and 2012-2013 from 118 497 participants, the risk for cannabis use and cannabis use disorders increased at a significantly greater rate in states that passed medical marijuana laws than in states that did not.

Meaning  Possible adverse consequences of illicit cannabis use due to more permissive state cannabis laws should receive consideration by voters, legislators, and policy and health care professionals, with appropriate health care planning as such laws change.

Abstract

Importance  Over the last 25 years, illicit cannabis use and cannabis use disorders have increased among US adults, and 28 states have passed medical marijuana laws (MML). Little is known about MML and adult illicit cannabis use or cannabis use disorders considered over time.

Objective  To present national data on state MML and degree of change in the prevalence of cannabis use and disorders.

Design, Participants, and Setting  Differences in the degree of change between those living in MML states and other states were examined using 3 cross-sectional US adult surveys: the National Longitudinal Alcohol Epidemiologic Survey (NLAES; 1991-1992), the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC; 2001-2002), and the National Epidemiologic Survey on Alcohol and Related Conditions–III (NESARC-III; 2012-2013). Early-MML states passed MML between NLAES and NESARC (“earlier period”). Late-MML states passed MML between NESARC and NESARC-III (“later period”).

Main Outcomes and Measures  Past-year illicit cannabis use and DSM-IV cannabis use disorder.

Results  Overall, from 1991-1992 to 2012-2013, illicit cannabis use increased significantly more in states that passed MML than in other states (1.4–percentage point more; SE, 0.5; P = .004), as did cannabis use disorders (0.7–percentage point more; SE, 0.3; P = .03).

In the earlier period, illicit cannabis use and disorders decreased similarly in non-MML states and in California (where prevalence was much higher to start with). In contrast, in remaining early-MML states, the prevalence of use and disorders increased.

Remaining early-MML and non-MML states differed significantly for use (by 2.5 percentage points; SE, 0.9; P = .004) and disorder (1.1 percentage points; SE, 0.5; P = .02). In the later period, illicit use increased by the following percentage points: never-MML states, 3.5 (SE, 0.5); California, 5.3 (SE, 1.0); Colorado, 7.0 (SE, 1.6); other early-MML states, 2.6 (SE, 0.9); and late-MML states, 5.1 (SE, 0.8). Compared with never-MML states, increases in use were significantly greater in late-MML states (1.6–percentage point more; SE, 0.6; P = .01), California (1.8–percentage point more; SE, 0.9; P = .04), and Colorado (3.5–percentage point more; SE, 1.5; P = .03).

Increases in cannabis use disorder, which was less prevalent, were smaller but followed similar patterns descriptively, with change greater than never-MML states in California (1.0–percentage point more; SE, 0.5; P = .06) and Colorado (1.6–percentage point more; SE, 0.8; P = .04).

Conclusions and Relevance

Medical marijuana laws appear to have contributed to increased prevalence of illicit cannabis use and cannabis use disorders. State-specific policy changes may also have played a role. While medical marijuana may help some, cannabis-related health consequences associated with changes in state marijuana laws should receive consideration by health care professionals and the public.

Source:  JAMA Psychiatry. 2017;74(6):579-588. doi:10.1001/jamapsychiatry.2017.0724

MS Society says there is sufficient evidence of drug’s effectiveness to relax ban for patients with no other options

Ten thousand people with multiple sclerosis in the UK should be allowed to use cannabis legally in order to relieve their “relentless and exhausting” symptoms, experts in the disease have told ministers.

The MS Society claims the one in 10 sufferers of the condition whose pain and spasticity cannot be treated by medication available on the NHS should be able to take the drug without fear of prosecution.

The evidence on cannabis’s effectiveness, while not conclusive, is now strong enough that the government should relax the ban on the drug for MS patients who have no other treatment options, the society says in a report.

Doctors who treat MS patients have backed the society’s call, as have the Liberal Democrats and the Green party. Legalisation would ease “the extremely difficult situation in which many people with MS find themselves”, the charity said.

The society is calling for the first time for the 10,000 patients – one in 10 of the 100,000 people in Britain with MS – to be able to access cannabis without fear of arrest. It has changed its position after reviewing the evidence, consulting its medical advisers and seeking the views of 3,994 people who have the condition.

“We think cannabis should be legalised for medicinal use for people with MS to relieve their pain and muscle spasms when other treatments haven’t worked,” said Genevieve Edwards, the MS Society’s director of external affairs.

“The level of clinical evidence to support cannabis’s use for medicinal purposes is not conclusive. But there is sufficient evidence for our medical advisers to say that on the balance of probability, cannabis could benefit many people with MS experiencing pain and muscle spasms.” The charity is also urging NHS bosses to make Sativex, a cannabis-based drug used by some people with MS, available on prescription across the UK so that patients who can afford it no longer have to acquire it privately, at a cost of about £2,000 a year. Wales is the only home nation to provide the mouth spray through the NHS.

Patients’ inability to access Sativex on the NHS in England, Scotland and Northern Ireland “has resulted in many people with MS turning to illegal forms of cannabis as an alternative. It’s simply not right that some people are being driven to break the law to relieve their pain and spasticity. It’s also really risky when you’re not sure about the quality or dosage of what you’re buying,” Edwards said.

Norman Lamb, the Lib Dem health spokesman, said: “This is the strongest proof yet that the existing law on cannabis is a huge injustice that makes criminals of people whose only crime is to be in acute pain. This draconian law is potentially opening anything up to 10,000 MS sufferers to prosecution, and underlines why the Liberal Democrats have braved a tabloid backlash to campaign for the legalisation of cannabis. It is about time the government listened to the science.”

One in five (22%) MS patients who took part in a survey by the society said they had used cannabis to help manage their symptoms, but only 7% were still doing so. A quarter (26%) of those who had stopped taking it said they had done so out of fear of

prosecution. Another 26% of respondents had considered trying cannabis but had not done so for the same reason and also because they were concerned about the drug’s safety.

Doctors are divided over cannabis’s potential role in treating MS. Some are supportive while others are anxious about endorsing the use of a drug that can cause psychiatric problems. The Royal College of GPs said it was currently drawing up policy on the issue and could not comment. The Royal College of Physicians, which represents hospital doctors, said it had no policy on the issue.

Dr Willy Notcutt, a pain management specialist at the James Paget hospital in Norfolk, who has been treating MS patients for more than 20 years, said: “Every week I come across patients wishing to use cannabis to control their symptoms but who are unable to get proven drugs like Sativex from the NHS. Many patients seek illegal cannabis to get help. They can’t be sure of its origin but are being forced to commit a criminal act in order to obtain relief.”

Dr Waqar Rashid, a consultant neurologist at Brighton and Sussex University Hospitals NHS trust, said: “[Cannabis is] not a cure-all, and there are other treatments that should be tried first. But it makes sense for criminality not be a barrier to a treatment which could reduce the debilitating impact of symptoms and transform someone’s quality of life.”

Caroline Lucas, the Green party co-leader and its sole MP, said: “The MS Society’s new position is a big step forward, and recognises the fact that thousands of people with MS could benefit from the the use of medicinal cannabis. By rigidly sticking to criminalising cannabis the government drives MS sufferers to illegally acquire the drugs, thus putting themselves as risk of prosecution simply for searching for pain relief.” The National Institute for Health and Clinical Excellence (Nice), which advises the government, has told the NHS not to prescribe Sativex for spasticity because it is not cost-effective. The Home Office said: “This government has no plans to legalise cannabis. Cannabis is controlled as a Class B drug under the Misuse of Drugs Act 1971 and, in its raw form, currently has no recognised medicinal benefits in the UK.”

Case study: Steven Colborn, 55, from Seaham, County Durham

Imagine running a marathon while sharp pain darts up and down your legs. This is what multiple sclerosis feel like for me. When muscle spasticity kicks in my legs just twist and turn and bend back on themselves and it’s excruciatingly painful.

But three years ago I was offered a treatment that could help. During a regular appointment, a specialist nurse said they had managed to get a month’s supply of Sativex, a drug derived from cannabis, from the manufacturer.

The results were incredible. My muscle tension eased and I started to feel my legs moving better. I was able to get a good night’s sleep. I could exercise without getting as tired as quickly. For the first time in a long time I felt that I was managing my condition.

My month’s supply ran out and the drug wasn’t available free on the NHS. I was offered a muscle relaxer called Baclofen which hadn’t worked for me in the past.

I have been forced to pay for this drug myself. I can’t work any more so I rely on disability benefits. I have to save up a lot of money to be able to afford it – it costs £412 a month. Over the past four years I’ve only managed to buy about seven months’ worth.

I take Sativex but other people get similar relief from cannabis in its pure form. I don’t like taking this myself because of the narcotic effect, which you don’t get with Sativex. But for those it helps, it should be made legal.

I have had this illness for 36 years and every day I wake up and think ‘maybe there has been a breakthrough’. I know there will never be a cure, but I am just looking for a way to make things easier. Now I have been presented with something that offers me hope and the NHS say they cannot afford it. My question is: can you afford people like me getting worse?

Source:  https://www.theguardian.com/society/2017/jul/27/legalise-cannabis-as-treatment-of-last-resort-for-multiple-sclerosis-says-charity

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Comments by  NDPA:

UK  is 1st world nation with 1st world medicine approval system, even then we get things wrong e.g Thalidomide.

Cannabis based medicine is no problem if it goes through that system.

Sadly, ill people have been and are being exploited by the drug legalisation lobby, in furtherance of their nirvana of recreational cannabis for all.

Cannabis is a very harmful psychoactive drug, it induces dependency in around 1 in 9 or 10 users. It has numerous bad effects.

Smoking is obviously not a sensible delivery system for medication, yet a lot of those complaining want to smoke cannabis.

Cannabis based drugs like Sativex are in the pharmacopeia thanks to the wise licensing of the research on them by successive UK governments.

The mechanisms by which those cannabis based drugs are made available to  specific MS sufferers are a matter for the relevant authorities who deal with all pharmaceutical drugs. They must show efficacy and they must satisfy NICE.

There are no grounds at all for making cannabis any sort of special case, in fact the recreational user base and the legalisation lobby distort the arguments and would be better remaining silent.

Today, Dr. Kevin Sabet, president of Smart Approaches to Marijuana (SAM), a national group promoting evidence-based marijuana laws, issued the following statement regarding medical marijuana legislation introduced by Senators Booker (D-NJ) and Gillibrand (D-NY) and Rep. Steve Cohen (D-TN):

“No one wants to deprive chronically ill patients of medication that could be helpful for them, but that’s not what the legislation being introduced today is about. We wouldn’t allow Pfizer to bypass the FDA – why would we let the marijuana industry? This bill would completely undermine the FDA approval process, and encourage the use of marijuana and marijuana products that have not been proven either safe or effective. The FDA approval process should set the standard for smart, safe, and sound healthcare in our country, so we can be sure that patients are receiving the best treatments that do more help than harm,” said SAM President and former senior White House drug policy advisor Kevin Sabet.

“Raw marijuana is not medicine, so marijuana in crude form should not be legal, but the medicinal components properly researched, purified, and dosed should be made available through compassionate research programs, as outlined in SAM’s six-point plan entitled “Researching Marijuana’s Medical Potential Responsibly.” We understand the FDA process can seem cumbersome to those suffering from intractable diseases, but early access programs to drugs in development are already available.

“Also, while FDA approval is the long-term goal, seizure patients shouldn’t have to go to the unregulated market to get products full of contaminants. Responsible legislation that fast-tracks these medications for those truly in need should be supported, rather than diverting patients to an unregulated CBD market proven to be hawking contaminated or mislabeled products as medicine, as this bill would endorse. In 2015 and 2016 the FDA sent multiple warning letters to numerous CBD manufacturers, outlining these concerns. We support the development of FDA-approved CBD medications, like Epidolex, which is in the final stages of approval.”

News media requesting a one-one-one interview with a representative from SAM can contact anisha@learnaboutsam.org.

 About SAM

Smart Approaches to Marijuana (SAM) is a nonpartisan, non-profit alliance of physicians, policy makers, prevention workers, treatment and recovery professionals, scientists, and other concerned citizens opposed to marijuana legalization who want health and scientific evidence to guide marijuana policies. SAM has affiliates in more than 30 states. For more information about marijuana use and its effects, visit http://www.learnaboutsam.org.

Illicit cannabis use and cannabis use disorders increased at a greater rate in states that passed medical marijuana laws than in other states, according to new research at Columbia University’s Mailman School of Public Health and Columbia University Medical Center. The findings will be published online in JAMA Psychiatry.

Laws and attitudes regarding cannabis have changed over the last 20 years. In 1991, no Americans lived in states with medical marijuana laws, while in 2012, more than one-third lived in states with medical marijuana laws, and fewer view cannabis use as entailing any risks.

The new study is among the first to analyze the differences in cannabis use and cannabis use disorders before and after states passed medical marijuana laws, as well as differentiate between earlier and more recent periods and additionally examine selected states separately.

The researchers used data from three national surveys collected from 118,497 adults: the 1991-1992 National Longitudinal Alcohol Epidemiologic Survey, the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions and the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions-III.

Overall, between 1991-1992 and 2012-2013, illicit cannabis use increased significantly more in states that passed medical marijuana laws than in other states, as did cannabis use disorders. In particular, between 2001-2002 and 2012-2013, increases in use ranged from 3.5 percentage points in states with no medical marijuana laws to 7.0 percentage points in Colorado. Rates of increase in the prevalence of cannabis use disorder followed similar patterns.

“Medical marijuana laws may benefit some with medical problems. However, changing state laws — medical or recreational — may also have adverse public health consequences, including cannabis use disorders,” said author Deborah Hasin, PhD, associate professor of Epidemiology at the Mailman School of Public Health and in the Department of Psychiatry at Columbia University Medical Center. “A prudent interpretation of our results is that professionals and the public should be educated on risks of cannabis use and benefits of treatment, and prevention/intervention services for cannabis disorders should be provided.”

While illicit use of marijuana decreased and marijuana use disorder changed little between 1991-1992 and 2001-2002, both use and disorder rates increased between 2001-2002 and 2012-2013. In 1991-1992, predicted prevalence of use and disorder were higher in California than other states with early-medical marijuana laws (use: 7.6 percent vs. 4.5 percent; disorder: 2 percent vs. 1.15 percent). However, the predicted prevalence of past year use in California did not differ significantly from states that passed laws more recently. In contrast, the prevalence of use and disorder increased in the other 5 states with early medical marijuana laws.

“Future studies are needed to investigate mechanisms by which increased cannabis use is associated with medical marijuana laws, including increased perceived safety, availability, and generally permissive attitudes,” Dr. Hasin also noted.

Journal Reference:

   Melanie M. Wall, PhD et al. US Adult Illicit Cannabis Use, Cannabis Use Disorder, and Medical Marijuana Laws: 1991-1992 to 2012-2013. JAMA Psychiatry, April 2017 DOI: 10.1001/jamapsychiatry.2017.0724

Source:     ScienceDaily, 26 April 2017. <www.sciencedaily.com/releases/2017/04/170426111917.htm:

Prescribing medicinal cannabis for patients with chronic non-cancer pain is not going to revolutionise their treatment and should not be supported until there is substantial proof of its effectiveness, according to a leading pain specialist.

Professor Milton Cohen is presenting Medicinal cannabis for chronic non-cancer pain: promise or pothole? at the Australian and New Zealand College of Anaesthetists (ANZCA) annual scientific meeting in Brisbane on Saturday May 13. “There is no reason to be enthusiastic about cannabinoids in the treatment of non-cancer related chronic pain,’’ Professor Cohen said.

‘‘On the basis of what we know about cannabis as a treatment it’s not going to revolutionise the field of chronic pain management.’’

Professor Cohen is a specialist pain medicine physician in Sydney and Director of Professional Affairs for ANZCA’s Faculty of Pain Medicine. The Faculty does not support the use of cannabinoids in chronic non-cancer pain ‘’until such time as a clear therapeutic role for them is identified in the scientific literature.’’

Professor Cohen said he was concerned that ‘’anecdote and clamour’’ and ‘’community enthusiasm’’ had preceded science on the issue of prescribing medicinal cannabis for patients who suffered chronic non-cancer pain. As a result, a culture of ‘’false hope’’ based on the elusive idea of a ‘’magic pill’’ was driving community misinformation about medicinal cannabis as a treatment for such patients.

The Federal government last year legalised a pathway for access of patients to Australian-grown and manufactured medicinal cannabis, subject to state and territory government regulations. In New Zealand, the use of cannabis-based products for medicinal purposes is available only on prescription authorised by the Ministry of Health.

‘’It’s a classic example of the cart being put before the horse with a political imperative to facilitate access to an unproven medicine,’’ Professor Cohen said. International studies that have assessed the effectiveness of medicinal cannabis for non-cancer chronic pain have revealed very ‘’modest’’ effects, he said.

‘’The international data on which one could make an informed decision about the effect of medicinal cannabis on chronic non-cancer pain is in fact very poor. The conclusions have been oversold,’’ he said.

Professor Cohen said the management of chronic non-cancer pain is complex as it required consideration of a range of factors including the medical, physical, psychological and social.

‘’We know that chronic pain is a much more complex phenomenon which requires a holistic approach to management that is tailored to the individual’s circumstances. To rely only on medicines is just not going to work.

‘’If doctors are to prescribe substances—that is if they are to be available on doctors’ prescriptions—they should be proven substances,’’ Professor Cohen explained.

Professor Cohen cited an ongoing study of 1500 people who had been prescribed opioids for chronic non-cancer pain, undertaken by the National Drug and Alcohol Research Centre at the University of New South Wales. Almost half of those surveyed said they had used cannabis for recreational purposes, one in six admitted to using cannabis in search of pain relief and one quarter said they would use cannabis in search of pain relief if they could.

‘’We know that cannabis is freely available but we also know that drugs are not the mainstay of managing chronic pain,’’ Professor Cohen said.

Professor Cohen said that, given the legislative changes introduced by the Federal government and some states and territories, the introduction of individualised trials of medicinal cannabis for patients with chronic non-cancer pain to monitor and evaluate its effectiveness and adverse effects might be considered. This would require the development of a patient register, similar to an approach introduced in Israel, to ensure that the trial was properly monitored and managed.

‘’Given the reality of the situation – these substances are going to be produced in Australia and will be marketed — so there now is an opportunity for individual, personalised clinical studies to ascertain if there is a benefit from this treatment,’’ Professor Cohen said.

About FPM 

The Faculty of Pain Medicine is a world-leading professional organisation for pain specialists that sets standards in pain medicine and is responsible for education and training in the discipline in Australia and New Zealand. Pain medicine is multidisciplinary, recognising that the management of severe pain requires the skills or more than one area of medicine. Chronic pain affects about one in five people in Australia and New Zealand. Specialists also manage acute pain (post-operative, post-trauma, acute episodes of pain in medical conditions) and cancer pain.

Source:  http://www.scoop.co.nz/stories/GE1705/S00087/false-hope-driving-claims-medicinal-cannabis-is-magic-pill.htm   13th May 2917

A new study released today by JAMA Psychiatry found that rates of marijuana use and marijuana addiction increased significantly more in states that passed medical marijuana laws as compared to states that have not. Examining data from 1992 to 2013, researchers concluded that medical marijuana laws likely contributed to an increased prevalence of marijuana and marijuana-addicted users.

“Politicians and pro-pot special interests are quick to tout the benefits of medical marijuana legalization, but it’s time to see through the haze —     medical marijuana has gone completely unregulated,” said SAM President Kevin Sabet. “More people in these states are suffering from an addiction to marijuana that harms their lives and relationships, while simultaneously more have begun using marijuana. No one wants to see patients denied something that might help them, but this study underscores the fact that “medical” and “recreational” legalization are blurred lines. Smoked marijuana is not medicine, and has not been proven safe and effective as other FDA-approved medications have.”

The study’s researchers wrote that increases in marijuana use in states with medical marijuana laws “may have resulted from increasing availability, potency, perceived safety, [or] generally permissive attitudes.” They conclude that “changing state laws (medical or recreational) may also have adverse public health consequences.”  Evidence demonstrates that marijuana —     which has skyrocketed in average potency over the past decades —     is addictive and harmful to the human brain, especially when used by adolescents. Moreover, in states that have already legalized the drug, there has been an increase in drugged driving crashes and youth marijuana use. States that have legalized marijuana have also failed to shore up state budget shortfalls with marijuana taxes, continue to see a thriving black market, and are experiencing a continued rise in alcohol sales.

Source:  http://www.learnaboutsam.org.  Alexandria, VA, April 26, 2017

About SAM

Smart Approaches to Marijuana (SAM) is a nonpartisan, non-profit alliance of physicians, policy makers, prevention workers, treatment and recovery professionals,  scientists, and other concerned citizens opposed to marijuana legalization who want health and scientific evidence to guide marijuana policies. SAM has affiliates in more than 30 states. For more information about marijuana use and its effects, visit http://www.learnaboutsam.org.

We are often judged by the company we keep, even unfairly. For decades, that has been the fate of cannabidiol, a chemical compound that has the bad luck to occur naturally in marijuana, the world’s most controversial plant. Because cannabidiol is subject to the same tight legal restrictions on personal and scientific use as is marijuana, its potential medical benefits have been underappreciated — at least up until now.

A growing body of research suggests that cannabidiol (CBD) can reduce seizures in individuals with epileptic disorders, reducing the damage caused by these diseases as well as improving quality of life. Importantly, the drug company GW Pharmaceuticals has developed a process to extract CBD in pure form, thereby removing the psychoactive and potentially addictive effect of consuming marijuana. This CBD extract-based medication has yielded positive results in clinical trials with children suffering from forms of epilepsy such as Dravet Syndrome and Lennox-Gastaut Syndrome.

Now, the CBD extract is currently being considered for approval as a medication by the Food and Drug Administration, which would pave the path for doctors to prescribe it.

To legally approve a medicine, the FDA must have specific information on what it contains and in what specific doses. The FDA could thus never approve the whole marijuana plant as a medicine because there are many different combinations of chemicals in different concentrations from strain to strain, plant to plant, and even from one part of the same plant to another. However, a pure CBD extract that could be dosed in a standardized manner would be a different matter, and there is no barrier to the FDA going forward.

Assuming the FDA approves CBD extract as a medicine, the Drug Enforcement Administration would then have to agree to remove CBD from Schedule I of the Controlled Substances Act, which is where it now sits by virtue of being part of an illegal drug with no officially recognized medical use (marijuana). Would the DEA really consent to scheduling as a legitimate medicine an extract of a plant they have spent decades battling? Based on a recent announcement in the Federal Register, the answer appears to be yes. The DEA is creating a separate classification for scheduling cannabis extracts, and specifically mentioned CBD as a potential example. The resulting legal framework would seem to allow CBD-derived medications to move to a less restrictive schedule while leaving marijuana on Schedule I.

Even if that were to happen, however, hurdles would remain for getting the medication into the hands of those who need it.  States would have to agree to mirror the federal schedule change in state-level drug scheduling, which could be contentious in some states and bureaucratically slow in others. One California legislator is trying to avoid those problems. Jim Wood, chair of the California Assembly’s Health Committee, has introduced legislation that would reschedule CBD medications in California the moment that the federal government does likewise.

If passed, Wood’s legislation will eliminate delays between any future approval of CBD medications and the medication’s availability to California patients. Otherwise, Wood notes “a new bill would have to go through the entire legislative process and then get signed by the Governor.” Wood doesn’t want the normal legislative grind to slow down the rate at which “doctors can prescribe and pharmacists can dispense FDA-approved epilepsy treatments derived from CBD.” The more than 5 million Americans who suffer from epilepsy would almost certainly agree.

Source:  https://www.washingtonpost.com/news/wonk/wp/2017/04/04/a-promising-childhood-epilepsy-treatments-biggest-hurdle-marijuana-laws/

Story highlights

* A kidney patient was removed from an organ transplant waiting list due to his use of medical marijuana

* The growing use of medical marijuana is changing organ transplantation, similar to how HIV once did, experts say

(CNN)A rise in the use of medical marijuana has spurred a debate about organ transplantation, and it’s changing some laws across the nation.

Garry Godfrey found out in 2010 that he was removed from an organ transplant waiting list in Maine due to a health risk associated with his use of medical marijuana, CNN affiliate WGME reported. Now Godfrey is speaking out in support of a bill in Maine that would prohibit hospitals from determining a patient’s suitability for transplantation solely on the basis of medical marijuana use (PDF).

That bill is in committee, and similar legislation has been passed in other states, including California, Washington, Illinois, Arizona, Delaware and New Hampshire (PDF).

US organ transplants increased nearly 20% in five years  Godfrey, 32, uses marijuana to relieve pain and other symptoms he suffers due to Alport syndrome, a genetic condition that can cause renal failure — and he needs a new kidney, WGME reported.

“I’ve tried so many pharmaceuticals and none of them worked, but the medical cannabis does,” Godfrey told WGME. “It helps me function. It helps me take care of my kids.”

But if a transplant candidate already has a compromised immune system and is taking prescribed or recreational marijuana, that can increase their risk of a deadly fungal infection known as Aspergillosis during the transplantation process, according to a press statement released this week by the Maine Transplant Program. Once off marijuana, patients can be put back on the waiting list.

Meanwhile, researchers are desperately trying to better understand the potential health risk that may be associated with marijuana use and organ transplantation.

‘When we turn someone down, it’s a personal failure’ 

“The thing that comes up with marijuana is the risk of pulmonary infections, (specifically) fungal infections with Aspergillosis,” said Dr. David Klassen, chief medical officer at the United Network for Organ Sharing.

Such infections “can be an absolutely devastating complication but, you know, how often does that really happen? How likely is it? Those questions are less well understood,” Klassen said. “It’s a question of how much risk does that really impose versus the benefit that the patient potentially gets from getting the transplant.”

The Maine Transplant Program has a policy in place around marijuana because two people who had transplants died as a result of the fungal infection, Maine Medical Center spokesman Clay Holtzman said. Both patients had smoked marijuana, which suggests it might have been the cause of the infections. It’s not clear what the risks are around edible medical marijuana, he said.

How a 22-year-old’s overdose death saved lives

The issue is an emerging puzzle that is also shaping conversations within the transplant community, said Dr. James Whiting, surgical director of the Maine Transplant Program at Maine Medical Hospital.

“These conversations around medical marijuana will continue, and I think that we will try to find ways, whether they be using edibles or other things, to allow people to be listed and transplanted,” Whiting said.

“The transplant community is always going to be focused on using as many organs as possible,” he said. “Our goal is to transplant as many Mainers successfully as we can. That’s how our program’s evaluated. That’s how I’m evaluated. That’s why we’re here. So when we turn someone down, it’s a personal failure in many ways.”

More than 118,000 people in the United States are waiting for a life-saving organ transplant, according to UNOS.

The behind-the-scenes politics of organ donation

The policies of most transplant programs, which determine who gets on a waiting list, are evaluated through UNOS and the Centers for Medicare and Medicaid Services, among other agencies.

“The decisions for a center to accept anything — (for example) some people say I’m not going to transplant anybody over the age 50 or 60 — they’re allowed to do that,” said Dr. John Fung, chief of transplantation surgery and director of the Transplantation Institute at the University of Chicago Medicine.

Other than protecting against racial or gender discrimination “no rule says you have to transplant any given population,” Fung said. “But each center basically evolves their own criteria,” he said.

In 1986, UNOS was awarded the initial contract by the US Department of Health and Human Services to develop the requirements for the nation’s Organ Procurement and Transplantation Network. The Department’s Health Resources and Services Administration is responsible for oversight of the transplant system.

“The people who review our transplant programs, Medicare and UNOS, review us on a periodic basis to make sure we have those criterion and that they’re not discriminatory and that we are adhering to them,” Whiting said about the individual policies of transplant programs.

“That being said, there is a lot of local variability allowed in those inclusion and exclusion criteria,” he said. “So across the country, someone who gets turned down in one program may actually be able to go to another program.”

Some variability was seen among how heart and lung transplant providers listed medical marijuana patients in a paper that published last year in the journal Circulation: Heart Failure.

For the paper, 360 heart and lung transplant providers from 26 countries around the world completed online surveys about their individual practice patterns and attitudes. About 64% indicated that they supported listing transplant recipients who legally use medical marijuana and about 27% supported listing patients who legally use recreational marijuana.

‘People feel like they’re in a Catch-22’

“The decision on whether to list the patient or not is really up to the transplant program. We don’t have any real policy that says a patient like this must be accepted or must be denied,” said UNOS’s Klassen.

Yet, “there are some things that are quite common to all transplant programs,” he said. “A patient that has active malignancy cancer, (for example), typically those patients are not for transplant.”

Organ transplant program may favor wealthy over most needy, reports finds

Current or recent cancer diagnoses are among the few widely accepted medical conditions that might rule out organ transplantation, according to UNOS. Morbid obesity, for instance, is also among those common conditions.

Certain long-term medications, including prescribed marijuana, can also impact organ transplantation eligibility, such as, “people who might be on an anticoagulant because they needed a heart stent,” said Maine Medical Hospital’s Whiting.

In some cases, “the only reason they knew they needed a heart stent was because they went through the testing for transplant and now they can’t get the transplant because they’re on an anticoagulant,” he said. “A lot of these people feel like they’re in a Catch-22.”

Parallels of HIV then, medical marijuana now

Human immunodeficiency virus, or HIV, used to be widely seen as a condition to disqualify a patient for organ transplantation, Whiting said. But then, opinions changed.

“One of the absolute contra indications to receiving an organ was HIV positivity. One of the absolute contra indications to giving an organ was HIV. And, of course, we know now that’s not true at all,” Whiting said.

“Certainly I think most people now, if not everybody, realize that HIV patients can do quite well after transplant, but,” he said, “that change happened over 10 to 15 years.”

When research studies started revealing that the anti-viral therapy for HIV could prolong survival, that shifted conversations about organ transplantation, said the University of Chicago Medicine’s Fung.

“Around 1997 I had to argue to all of my colleagues that, ‘Hey we shouldn’t just say that transplants with HIV are out entirely. Look at all this new literature and technology that’s coming out. Let’s think about it,'” Fung said. “So, I would like to think that we were, as a community of transplanters, reasonable and willing to accept new findings and data as we evolve our criteria.”

Fung sees many parallels between past conversations about HIV and organ transplantation and current conversations about medical marijuana and organ transplantation, he said.

“The biggest question, in this day and age of increasing acceptance of medical marijuana and its benefits, is: Should it be considered illegal or as a factor in deciding whether or not somebody’s a candidate for transplant or not?” Fung said about medical marijuana.

He mentioned that he knew a young man who was a medical marijuana patient in Ohio. That patient was turned down for organ transplantation “and he died,” Fung said.

“My views have gone more towards allowance of a patient with medical marijuana, documented for a good medical reason, to be allowed to take it without getting penalized for it,” Fung said. “I would still say that that is the minority view.”

In the future, UNOS’s Klassen said that he thinks more transplant programs will continue to evaluate and evolve their policies to address the changing climate around medical marijuana.

“There is an increasing acceptance of medical marijuana as an acceptable and relatively commonly prescribed medication,” Klassen said. “I think programs are incorporating that into their assessment of patients.”

Source: .cnn.com/2017/03/31/health/medical-marijuana-organ-transplants-explainer/index.html    

Outdoor cannabis cultivation in northern California has damaged forestlands and their inhabitants. Will legalization of recreational marijuana make things worse or better?

A visit to a marijuana farm in Willow Creek, the heart of northern California’s so-called Emerald Triangle feels like strolling through an orchard. At 16 feet high and eight feet around, its 99 plants are too overloaded with cannabis buds to stand on their own. Instead each plant has an aluminium cage for support.

Welcome to America’s “pot basket.” The U.S. Drug Enforcement Administration estimates 60 percent of cannabis consumed nationwide is grown in California. According to the Department of Justice, the bulk of that comes from the three upstate counties of the Emerald Triangle: Mendocino, Humboldt and Trinity. Conditions here are said to be perfect for outdoor marijuana cultivation. But that has proved to be a very mixed blessing for the region, bringing with it a litany of environmental disturbances to local waterways and wildlife. Creek diversions threaten fish habitat and spur toxic algal blooms. Road building and clear-cuts erode soil and cloud streams. Deep within, illegal “guerilla grows” pepper forestlands with banned rodent poisons that are intended to eradicate crop pests but are also fatal to other mammals.

On November 8 voters in four states—Massachusetts, Maine, California and Nevada—legalized recreational marijuana. These states join Colorado, Washington, Oregon and Alaska, along with the District of Columbia, where one can already legally buy the drug for recreational use. Will this expanded market mean more environmental damage? Or will legalization pave the way for sounder regulation?

In 1996 California legalized marijuana for medical use, providing the first legal space for pot cultivation since the federal government’s blanket ban on the crop some 60 years before. As grow operations in the state flourished, California Department of Fish and Wildlife biologist Scott Bauer analyzed satellite imagery to examine the impact of cultivation on water levels in four Emerald Triangle watersheds. His study, published in PLoS ONE in 2015, found that in three of the four watersheds, “water demand for marijuana cultivation exceeds stream flow during the low-flow [summer] periods.”

The real problem is not marijuana’s overall water consumption, which still falls far short of California staples like walnuts or almonds, explains environmental scientist Van Butsic of the University of California, Berkeley. Rather it is an issue of where and when pot is

grown. Analyzing aerial imagery of 4,428 grow sites in 60 Humboldt county watersheds, Butsic found that one in 20 grow sites sat within 100 meters of fish habitat and one in five were located on steep land with a slope of 17 degrees or more. “The problem is that cannabis is being grown in the headwaters, and much of the watering is happening in the summer,” Butsic says.

If that arrangement goes on unchecked, U.C. Berkeley ecologist Mary Powers warns, summer plantations could transform local rivers from cool and “salmon-sustaining” to systems full of toxic cyanobacteria. Over eons of evolution native salmon species have adapted to “deluge or drought” conditions, she says. But the double whammy of climate change and water extraction could prove to be a game-changer.

Powers spelled out the unprecedented stresses in a 2015 conference paper focused on the Eel River that flows through Mendocino and southern Humboldt. She and her team found riverbed-scouring floods in winter, followed by dry, low-flow conditions in summer, led to warm, stagnant, barely connected pools of water. That is bad news for salmon, but ideal for early summer algal blooms. The algae then rot, creating an oxygen-deficient paradise for toxic cyanobacteria, which have been implicated in the poisoning deaths of 11 dogs along the Eel River since 2002.

Dogs are not the only terrestrial creatures endangered by the grow operations. Between 2008 and 2013 Mourad Gabriel, then a doctoral candidate at the University of California, Davis, Veterinary Genetics Lab, carried out a study of the American fisher, a small carnivorous mammal that is a candidate for the endangered species list. He wanted to suss out the threats to fisher populations in northern California. So he radio-tagged fishers from Trinity County’s Hoopa Valley Reservation and public lands near Yosemite National Park to track their movements. Between 2006 and 2011, 58 of the fishers Gabriel and his team tracked turned up dead. Gabriel studied the necropsies and found that 46 of the animals had been exposed to anticoagulant rodenticides—rat poisons that block liver enzymes, which enable blood clotting. Without the enzyme the exposed mammals bled to death from flesh wounds.

The finding puzzled Gabriel at first, because rat poison is more common in agricultural and urban settings than in remote forests. But then he started visiting the remnants of guerilla grows that had been busted under the guidance of lawmen such as Omar Brown, head of the Narcotics Division at the Trinity County Sheriff’s Office. “We have found [anticoagulant rodenticides] carbofuron on grows in the national forest,” Brown reports. “These are neurotoxin-laced pesticides that have been banned in the U.S. since 2011. And even for allowed pesticides, we’ve found instances where trespass grows are using them in illegally large quantities.” The poisons hit female fishers particularly hard, because the early, pest-prone phase of marijuana cultivation coincides with the fishers’ nesting season, when pregnant females are actively foraging.

Gabriel, now director of the Integral Ecology Research Center based in Humboldt County, says other states may be dealing with rodenticides, water diversions and other problems from guerilla grows, too. “The climate in Colorado, Oregon and Washington is conducive for marijuana cultivation,” he observes. But “there just isn’t the scientific data to prove whether other states have these problems because there has not been research funding put towards answering these questions.”

In California headwater ecosystems could get a reprieve if a greatly expanded legalized pot industry moves to the Central Valley, where production could take place indoors and costs would be less. In pot-growing pioneer states like Colorado or Washington much of the production has moved indoors, where temperatures can be more closely managed. But other factors may hinder that move. “Bud and pest problems are always worse indoors, which biases farmers toward a chemically intensive regime,” says Marie

Peterson of Downriver Consulting, a Weaverville, Calif.–based firm that helps growers fill out the paperwork for state and county permits as well as assesses water management plans for their plantations. And besides, the Central Valley already suffers from prolonged drought.

Of the eight states that legalized the cultivation of recreational marijuana, only Oregon and California allow outdoor grows. But regulating open-air pot plantations in these states remains challenging, even though legal operations for medical marijuana have been around since 1998 and 1996, respectively. In 2015 California passed the Medical Marijuana Regulation and Safety Act, which calls on the state’s departments of Food and Agriculture, Pesticide Regulation, and Fish and Wildlife, along with the state’s Water Board—to oversee environmental impacts of the industry. The board came up with a list of requirements for a marijuana plantation water permit, which in turn became a necessary condition for a license to grow medical pot in any of the three Emerald Triangle counties. Counties have until January 2018 to decide whether to create similar stipulations for recreational marijuana growing permits.

Butsic is optimistic about a more regulated future for the marijuana industry in California. “I think five years from now things will be more sustainable. Permitting shows growers that the state is interested in water use and their crop.”

Source:  https://www.scientificamerican.com/article/burgeoning-marijuana-market-prompts-concerns-about-crop-rsquo-s-environmental-impact/  2nd Feb. 2017

GW intends to advance oncology research and development efforts

GW Pharmaceuticals plc (Nasdaq:GWPH) (“GW,” “the Company” or “the Group”), a biopharmaceutical company focused on discovering, developing and commercializing novel therapeutics from its proprietary cannabinoid product platform, today announced positive top-line results from an exploratory Phase 2 placebo-controlled clinical study of a proprietary combination of tetrahydrocannabinol (THC) and cannabidiol (CBD) in 21 patients with recurrent glioblastoma multiforme, or GBM. GBM is a particularly aggressive brain tumour, with a poor prognosis. GW has received Orphan Drug Designation from the U.S. Food and Drug Administration (FDA) and the European Medicines Agency (EMA) for THC:CBD in the treatment of glioma.

The study showed that patients with documented recurrent GBM treated with THC:CBD had an 83 percent one year survival rate compared with 53 percent for patients in the placebo cohort (p=0.042). Median survival for the THC:CBD group was greater than 550 days compared with 369 days in the placebo group. THC:CBD was generally well tolerated with treatment emergent adverse events leading to discontinuation in two patients in each group. The most common adverse events (three patients or more and greater than placebo) were vomiting (75%), dizziness (67%), nausea (58%), headache (33%), and constipation (33%). The results of some biomarker analyses are still awaited.

“The findings from this well-designed controlled study suggest that the addition of a combination of THC and CBD to patients on dose-intensive temozolomide produced relevant improvements in survival compared with placebo and this is a good signal of potential efficacy,” said Professor Susan Short, PhD, Professor of Clinical Oncology and Neuro-Oncology at Leeds Institute of Cancer and Pathology at St James’s University Hospital and principal investigator of the study. “Moreover, the cannabinoid medicine was generally well tolerated. These promising results are of particular interest as the pharmacology of the THC:CBD product appears to be distinct from existing oncology medications and may offer a unique and possibly synergistic option for future glioma treatment.”

We believe that the signals of efficacy demonstrated in this study further reinforce the potential role of cannabinoids in the field of oncology and provide GW with the prospect of a new and distinct cannabinoid product candidate in the treatment of glioma.

These data are a catalyst for the acceleration of GW’s oncology research interests and over the coming months, we expect to consult with external experts and regulatory agencies on a pivotal clinical development program for THC:CBD in GBM and to expand our research interests in other forms of cancer.

The study, designed to evaluate a number of safety and efficacy endpoints, comprised an initial phase where the safety of THC:CBD in combination with dose-intense temozolomide (an oral alkylating agent that is a standard first-line treatment for GBM) was assessed in 2 cohorts of 3 patients each.  Following a satisfactory independent safety evaluation, the study then entered a randomized placebo-controlled phase where 12 patients were randomized to THC:CBD as add-on therapy compared with 9 patients randomized to placebo (plus standard of care).

Beginning in 2007 and prior to initiating this study, GW conducted substantial pre-clinical oncologic research on several cannabinoids in various forms of cancer including brain,

lung, breast, pancreatic, melanoma, ovarian, gastric, renal, prostate and bladder. These studies have resulted in approximately 15 publications and show the multi-modal effects of cannabinoids on a number of the key pathways associated with tumour growth and progression. Cannabinoids have been shown to promote autophagy (the process of regulated self-degradation by cells) via several distinct mechanisms, including acting on the AKT/mTOR pathway, an important intracellular signalling pathway that is overactive in many cancers.

In glioma, THC and CBD appear to act via distinct signalling pathways. The combination of THC and CBD showed good efficacy in various animal models of glioma, particularly when used in combination with temozolomide. Initial in vitro studies showed that the combined administration of THC and CBD led to a synergistic reduction in the viability of U87MG glioma cells when compared to the administration of each cannabinoid individually. The co-administration of temozolomide with THC and CBD had further synergistic effects, causing a significant reduction in cell viability. These pre-clinical studies justified the initiation of the Phase 2 clinical study.

GW’s portfolio of intellectual property related to the use of cannabinoids in oncology includes a number of issued patents and pending applications in both the U.S. and Europe. This portfolio is designed to protect the use of various cannabinoids individually or in combination, in the treatment of a variety of oncology-specific disorders and product formulations.

About GBM

Gliomas are tumours that arise from glial cells mainly in the brain but can also be found within the spinal cord. Within the category of Glioma there are multiple different tumor types. GBM is the most common Glioma and is one of the most common primary brain tumors, accounting for 15.6% of all primary brain tumors (Ostrom et al. 2013). They are also the most aggressive with only 28.4% of patients surviving one year and only 3.4% surviving to year five (Brodbelt et al. 2015). Studies of patients with high-grade gliomas showed that headache was the most common initial presenting symptom. These headaches can be persistent lasting more than six months and are often associated with other symptoms, including seizures, visual disturbances, cognitive impairment and nausea and vomiting depending on the location and growth rate of the tumor.

About GW Pharmaceuticals plc

Founded in 1998, GW is a biopharmaceutical company focused on discovering, developing and commercializing novel therapeutics from its proprietary cannabinoid product platform in a broad range of disease areas. GW is advancing an orphan drug program in the field of childhood epilepsy with a focus on Epidiolex® (cannabidiol), which is in Phase 3 clinical development for the treatment of Dravet syndrome, Lennox-Gastaut syndrome, Tuberous Sclerosis Complex and Infantile Spasms. GW commercialized the world’s first plant-derived cannabinoid prescription drug, Sativex® (nabiximols), which is approved for the treatment of spasticity due to multiple sclerosis in 31 countries outside the United States. The Company has a deep pipeline of additional cannabinoid product candidates which includes compounds in Phase 1 and 2 trials for glioma, schizophrenia and epilepsy. For further information, please visit www.gwpharm.com.

Original press release: http://ir.gwpharm.com/releasedetail.cfm?ReleaseID=1010672

Source:  https://www.newcannabisventures.com/gw-pharma  17th Feb. 2017

Since the state legalized marijuana for recreational use, the Colorado Department of Public Health and Environment has issued a report on marijuana and health every two years. Colorado legalized recreational pot in 2012 to go into effect in 2014. This is the second health report. The report contains a huge amount of data. An executive summary appears on pages 1-6. The most startling data about the consequences of legalization are the number of marijuana-related hospitalizations that have occurred from 2000, the year Colorado legalized marijuana for medical use to September 2015, 21 months after recreational legalization began. A graph showing rates of these hospitalizations by age is pictured below. They are rates per 100,000 and have nearly doubled among adolescents and quintupled among young adults. A graph of the data broken down by race on page 291 of the report are equally stunning. Read report here.

Source:  http://themarijuanareport.org/  Feb.2017

Germany’s lower house of parliament has passed a law legalising the use of cannabis for medicinal purposes.

People with serious illnesses, such as multiple sclerosis and chronic pain, or a lack of appetite or nausea, could be offered marijuana under the law.  Patients will only have the right to be treated with cannabis “in very limited exceptional cases” and they will not be allowed to grow their own cannabis, according to the bill.

The health minister, Hermann Gröhe, said: “Those who are severely ill need to get the best possible treatment and that includes health insurance funds paying for cannabis as a medicine for those who are chronically ill if they can’t be effectively treated any other way.”

A health ministry spokeswoman said cannabis would only be used as a last resort. She said a scientific study would simultaneously be carried out to assess the effects of cannabis use in such cases.  Until now, patients have only been able to access cannabis for medicinal purposes by special authorisation, making the process complicated. Now they will be able to get a prescription from their doctor and a refund for the upfront cost from their health insurance, she said.

The spokeswoman said the law was likely to take effect in March after a procedural reading by the upper house of parliament.  Until state-supervised cannabis plantations are set up in Germany cannabis will be imported.

Other European countries that allow cannabis to be used for medical purposes include Italy and the Czech Republic.

Source:  https://www.theguardian.com/society/2017/jan/19/german-mps-vote-to-legalise-cannabis-for-medicinal-purposes

A medical marijuana patient in Lower Sackville, N.S., said he’s worried after the marijuana he consumed for nearly a year was recalled by Health Canada because it was grown with two pesticides that, if heated, can emit hydrogen cyanide.

John Percy, 67, smokes, vapes and bakes his cannabis to control pain in his hip caused by osteoarthritis. The former Green Party leader had been ordering his medical marijuana from OrganiGram in Moncton, N.B., the only licensed producer in Atlantic Canada.

He said his pain was an “eight out of 10.”

“I was shocked,” said Percy, when he first learned of the voluntary recall in late December. The letter said the marijuana he consumed “tested positive for bifenazate and/or myclobutanil, both unapproved pesticides and not registered for use on marijuana.”

“I assumed like most patients that the product would be organic,” he said.

According to Health Canada hydrogen cyanide interferes with how oxygen is used in the body and may cause headaches, dizziness, nausea, and vomiting. Larger concentrations may cause gasping, irregular heartbeats, seizures, fainting, and even death.

‘I got angry’

He said he was willing to take a wait-and-see approach. But less than two weeks later, there was another, higher-level recall notice from OrganiGram saying all products manufactured since February had been recalled.

“That’s when I got angry and I started to consider what the effects on me have been,” said Percy, who also sits on the board of Maritimers Unite for Medical Marijuana.

He said he plans to talk to his doctor about whether the recalled medical marijuana he’d been consuming, about three grams a day, has adversely affected his health.

‘Patient safety at risk’

Percy said he’s upset that Health Canada did not issue a mandatory recall. Health Canada said no cases of adverse reactions have been reported.

“Putting patient safety at risk is unacceptable, and for a government department that is supposed to take care of people’s safety, I think they’ve fallen down on the job,” said Percy.

He said he’s written to the health minister and to members of Parliament. He believes Health Canada should test marijuana for more than 13 compounds to ensure it’s safe for consumption.

Percy said he and other licensed medical marijuana patients have discussed starting a class-action lawsuit.

Without a licensed producer, he’s going to an illegal dispensary — and paying 30 per cent more for his medication. There’s no compassionate pricing at the illegal spot, so his monthly marijuana budget has shot up to about $850 from $600. “It hurts, it hurts,” he said.

He said getting a prescription filled for another one of the 30-plus licensed producers in Canada would take months, but didn’t want to wait in pain.

Source:  https://ca.news.yahoo.com/medical-marijuana-user-shocked-recall-120500202.html

November 28, 2016

This shows a sample case of a visual 3-D rendering of a baseline SPECT scan of a long standing marijuana user compared to a control subject. The marijuana user has multiple perfusion defects with lower perfusion shown as scalloping and gaps …more

As the U.S. races to legalize marijuana for medicinal and recreational use, a new, large scale brain imaging study gives reason for caution. Published in the Journal of Alzheimer’s Disease, researchers using single photon emission computed tomography (SPECT), a sophisticated imaging study that evaluates blood flow and activity patterns, demonstrated abnormally low blood flow in virtually every area of the brain studies in nearly 1,000 marijuana compared to healthy controls, including areas known to be affected by Alzheimer’s pathology such as the hippocampus.

Hippocampus, the brain’s key memory and learning center, has the lowest blood flow in marijuana users suggesting higher vulnerability to Alzheimer’s. As the U.S. races to legalize marijuana for medicinal and recreational use, a new, large scale brain imaging study gives reason for caution. Published in the Journal of Alzheimer’s Disease, researchers using single photon emission computed tomography (SPECT), a sophisticated imaging study that evaluates blood flow and activity patterns, demonstrated abnormally low blood flow in virtually every area of the brain studies in nearly 1,000 marijuana compared to healthy controls, including areas known to be affected by Alzheimer’s pathology such as the hippocampus.

All data were obtained for analysis from a large multisite database, involving 26,268 patients who came for evaluation of complex, treatment resistant issues to one of nine outpatient neuropsychiatric clinics across the United States (Newport Beach, Costa Mesa, Fairfield, and Brisbane, CA, Tacoma and Bellevue, WA, Reston, VA, Atlanta, GA and New York, NY) between 1995-2015. Of these, 982 current or former marijuana users had brain SPECT at rest and during a mental concentration task compared to almost 100 healthy controls. Predictive analytics with discriminant analysis was done to determine if brain SPECT regions can distinguish marijuana user brains from controls brain. Low blood flow in the hippocampus in marijuana users reliably distinguished marijuana users

from controls. The right hippocampus during a concentration task was the single most predictive region in distinguishing marijuana users from their normal counterparts. Marijuana use is thought to interfere with memory formation by inhibiting activity in this part of the brain.

According to one of the co-authors on the study Elisabeth Jorandby, M.D., “As a physician who routinely sees marijuana users, what struck me was not only the global reduction in blood flow in the marijuana users brains , but that the hippocampus was the most affected region due to its role in memory and Alzheimer’s disease. Our research has proven that marijuana users have lower cerebral blood flow than non-users. Second, the most predictive region separating these two groups is low blood flow in the hippocampus on concentration brain SPECT imaging. This work suggests that marijuana use has damaging influences in the brain – particularly regions important in memory and learning and known to be affected by Alzheimer’s.”

Dr. George Perry, editor in chief of the Journal of Alzheimer’s Disease said, “Open use of marijuana, through legalization, will reveal the wide range of marijuana’s benefits and threats to human health. This study indicates troubling effects on the hippocampus that may be the harbingers of brain damage.”

According to Daniel Amen, M.D., Founder of Amen Clinics, “Our research demonstrates that marijuana can have significant negative effects on brain function. The media has given the general impression that marijuana is a safe recreational drug, this research directly challenges that notion. In another new study just released, researchers showed that marijuana use tripled the risk of psychosis. Caution is clearly in order.”

More information: Daniel G. Amen et al. Discriminative Properties of Hippocampal Hypo perfusion in Marijuana Users Compared to Healthy Controls: Implications for Marijuana Administration in Alzheimer’s Dementia, Journal of Alzheimer’s Disease (2016). DOI: 10.3233/JAD-160833

Source:http://medicalxpress.com/news/2016-11-marijuana-users-bloodbrain.html#nRlv

Currently, 29 states and Washington, DC, have passed laws to legalize medical marijuana. Although evidence for the effectiveness of marijuana or its extracts for most medical indications is limited and in many cases completely lacking, there are a handful of exceptions. For example, there is increasing evidence for the efficacy of marijuana in treating some forms of pain and spasticity, and 2 cannabinoid medications (dronabinol and nabilone) are approved by the US Food and Drug Administration for alleviating nausea induced by cancer chemotherapy.

A systematic review and meta-analysis by Whiting et al1 found evidence, although of low quality, for the effectiveness of cannabinoid drugs in the latter indication. The anti -nausea effects of tetrahydrocannabinol (THC), the main psychoactive ingredient in marijuana, are mediated by the interactions of THC with type cannabinoid (CB1) receptors in the dorsal vagal complex. Cannabidiol, another cannabinoid in marijuana, exerts antiemetic properties through other mechanisms. Nausea is a medically approved indication for marijuana in all states where medical use of this drug has been legalized. However, some sources on the internet are touting marijuana as a solution for the nausea that commonly accompanies pregnancy, including the severe condition hyperemesis gravidarum.

Although research on the prevalence of marijuana use by pregnant women is limited, some data suggest that this population is turning to marijuana for its antiemetic properties, particularly during the first trimester of pregnancy, which is the period of greatest risk for the deleterious effects of drug exposure to the foetus. Marijuana is the most widely used illicit drug during pregnancy, and its use is increasing. Using data from the National Survey of Drug Use and Health, Brown et al report in this issue of JAMA that 3.85%of pregnant women between the ages of 18 and 44 years reported past-month marijuana use in 2014, compared with 2.37%in 2002. In addition, an analysis of pregnancy data from Hawaii reported that women with severe nausea during pregnancy, compared with other pregnant women, were significantly more likely to use marijuana (3.7%vs 2.3%, respectively).

Although the evidence for the effects of marijuana on human prenatal development is limited at this point, research does suggest that there is cause for concern. A recent review and a meta-analysis found that infants of women who used marijuana during pregnancy were more likely to be anaemic, have lower birth weight, and require placement in neonatal intensive care than infants of mothers who did not use marijuana. Studies have also shown links between prenatal marijuana exposure and impaired higher-order executive functions such as impulse control, visual memory, and attention during the school years.

The potential for marijuana to interfere with neurodevelopment has substantial theoretical justification. The endocannabinoid system is present from the beginning of central nervous system development, around day 16 of human gestation, and is increasingly thought to play a significant role in the proper formation of neural circuitry early in brain development, including the genesis and migration of neurons, the outgrowth of their axons and dendrites, and axonal pathfinding. Substances that interfere with this system could affect foetal brain growth and structural and functional neurodevelopment.

An ongoing prospective study, for example, found an association between prenatal cannabis exposure and foetal growth restriction during pregnancy and increased frontal cortical thickness among school-aged children. Some synthetic cannabinoids, such as those found in “K2/Spice” products, interact with cannabinoid receptors even more strongly than THC and have been shown to be teratogenic in animals.

A recent study in mice found brain abnormalities, eye deformations, and facial disfigurement (cleft palate) in mouse foetuses exposed at day 8 of gestation to a potent full cannabinoid agonist, CP-55,940. The percentage of mouse foetuses with birth defects increased in a linear fashion with dose. (The eighth day of mouse gestation is roughly equivalent to the third or fourth week of embryonic development in humans, which is before many mothers know they are pregnant.) It is unknown whether these kinds of effects translate to humans; thus far, use of synthetic cannabinoids has not been linked to human birth defects, although use of these substances is still relatively new.

THC is only a partial agonist at the CB1 receptor, but the marijuana being used both medicinally and recreationally today has much higher THC content than in previous generations (12% in 2014 vs 4% in 1995), when many of the existing studies of the teratogenicity of marijuana were performed. Marijuana is also being used in new ways that have the potential to expose the user to much higher THC concentrations—such as the practice of using concentrated extracts (eg, hash oil). More research is needed to clarify the neurodevelopmental effects of prenatal exposure to marijuana, especially high-potency formulations, and synthetic cannabinoids.

One challenge is separating these effects from those of alcohol, tobacco, and other drugs, because many users of marijuana or K2/Spice also use other substances. In women who use drugs during pregnancy, there are often other confounding variables related to nutrition, prenatal care, and failure to disclose substance use because of concerns about adverse legal consequences.    Even with the current level of uncertainty about the influence of marijuana on human neurodevelopment, physicians and other health care providers in a position to recommend medical marijuana must be mindful of the possible risks and err on the side of caution by not recommending this drug for patients who are pregnant. Although no states specifically list pregnancy-related conditions among the allowed recommendations for medical marijuana, neither do any states currently prohibit or include warnings about the possible harms of marijuana to the foetus when the drug is used during pregnancy. (Only 1 state, Connecticut, currently includes an exception to the medical marijuana exemption in cases in which medical marijuana use could harm another individual, although potential harm to a foetus is not specifically listed.)

In 2015, the American College of Obstetricians and Gynecologists issued a committee opinion discouraging physicians from suggesting use of marijuana during preconception, pregnancy, and lactation. Pregnant women and those considering becoming pregnant should be advised to avoid using marijuana or other cannabinoids either recreationally or to treat their nausea.

Source:  http://jamanetwork.com/ on 12/21/2016

Hippocampus, the brain’s key memory and learning center, has the lowest blood flow in marijuana users suggesting higher vulnerability to Alzheimer’s. As the U.S. races to legalize marijuana for medicinal and recreational use, a new, large scale brain imaging study gives reason for caution. Published in the Journal of Alzheimer’s Disease, researchers using single photon emission computed tomography (SPECT), a sophisticated imaging study that evaluates blood flow and activity patterns, demonstrated abnormally low blood flow in virtually every area of the brain studies in nearly 1,000 marijuana compared to healthy controls, including areas known to be affected by Alzheimer’s pathology such as the hippocampus.

All data were obtained for analysis from a large multisite database, involving 26,268 patients who came for evaluation of complex, treatment resistant issues to one of nine outpatient neuropsychiatric clinics across the United States (Newport Beach, Costa Mesa, Fairfield, and Brisbane, CA, Tacoma and Bellevue, WA, Reston, VA, Atlanta, GA and New York, NY) between 1995-2015. Of these, 982 current or former marijuana users had brain SPECT at rest and during a mental concentration task compared to almost 100 healthy controls.

Predictive analytics with discriminant analysis was done to determine if brain SPECT regions can distinguish marijuana user brains from controls brain. Low blood flow in the hippocampus in marijuana users reliably distinguished marijuana users from controls.

The right hippocampus during a concentration task was the single most predictive region in distinguishing marijuana users from their normal counterparts. Marijuana use is thought to interfere with memory formation by inhibiting activity in this part of the brain.

According to one of the co-authors on the study Elisabeth Jorandby, M.D., “As a physician who routinely sees marijuana users,  what struck me was not only the global reduction in blood flow in the marijuana users brains, but that the hippocampus was the most affected region due to its role in memory and Alzheimer’s disease.

Our research has proven that marijuana users have lower cerebral blood flow than non-users. Second, the most predictive region separating these two groups is low blood flow in the hippocampus on concentration brain SPECT imaging.

This work suggests that marijuana use has damaging influences in the brain – particularly regions important in memory and learning and known to be affected by Alzheimer’s.”

Dr. George Perry, Editor in Chief of the Journal of Alzheimer’s Disease said, “Open use of marijuana, through legalization, will reveal the wide range of marijuana’s benefits and threats to human health.  This study indicates troubling effects on the hippocampus that may be the harbingers of brain damage.”

According to Daniel Amen, M.D., Founder of Amen Clinics, “Our research demonstrates that marijuana can have significant negative effects on brain function. The media has given the general impression that marijuana is a safe recreational drug, this research directly challenges that notion.  In another new study just released, researchers showed that marijuana use tripled the risk of psychosis. Caution is clearly in order.”

Source: Press http://content.iospress.com/articles/journal-of-alzheimers-disease/jad160833 – DOI: 10.3233/JAD-160833

By Dr. Carlton E. Turner

As the former Drug Czar under President Ronald Reagan, with an extensive background in marijuana research, I thought I should share some of my thoughts about ‘medical’ marijuana.

From 1970 to 1981, I held various positions at the Research Institute of Pharmaceutical Sciences, School of Pharmacy at the University of Mississippi. During this time, I published over 100 original papers, chapters in books, patents, and two large Marijuana Bibliographies covering marijuana research starting in the 1880s. I also served as the Director of the federal government’s Marijuana Project.

That research project was funded by the National Institute of Mental Health and the National Institute on Drug Abuse. The project grew Cannabis sativa L. plants from seeds obtained from over 100 sites worldwide. We processed the plant material into marijuana and supplied this standardized research marijuana to researchers throughout the world. All of the marijuana shipped was analyzed by a procedure developed at the University and recognized as the world standard by the United Nations Narcotic Laboratory.

Now that you know a bit of my background let me give you the facts about marijuana:

Marijuana is a very crudely prepared drug comprised of the dried leaves, small stems, and flowers of the Cannabis plant. Marijuana contains unique chemicals called cannabinoids. Cannabinoids have biological activity and have been the subject of thousands of research studies since the 1970s. Some cannabinoids can be medicinal and have been regulated by the FDA, and prescribed by licensed physicians since 1985.

The synthetic form of the major psychoactive ingredient in marijuana, Delta-9-THC (Delta-9-tetrahydrocannabinol), known as Marinol®, is prescribed daily by physicians for nausea, vomiting, as an appetite stimulant for AIDS patients, and to ease the pain in multiple sclerosis patients. Another drug, which has been approved by the FDA is the Nabilone, a synthetic cannabinoid, which is prescribed for vomiting in patients undergoing cancer treatment.

Pro-drug groups, marijuana users, the media, politicians, and those wanting to profit from marijuana sales distort the truth about FDA-approved cannabinoid drugs and all cannabinoid research findings. They claim that society should not use marijuana derivative drugs approved by the FDA. That only “natural” marijuana should be used as medicine. To further cloud the facts, medical reporters claim marijuana works for many ailments, but in reality, they are referring to cannabinoid drugs.  The marijuana legalization advocates want to confuse the public to accept that ‘natural’ marijuana as a panacea for any human condition, and falsely claim it is safe to use as an unregulated “medicine.” But this so-called “medical marijuana” is a fraud and a con job.

The fact is that marijuana is a dirty drug with so many different side effects that it will never pass the required safety and efficacy testing for medicine. Marijuana can contain over 700 individual chemicals, and when smoked the number of chemicals expand to the thousands. The smoke contains 50 percent to 70 percent more cancer-causing compounds than tobacco. To argue that the “natural” plant form of marijuana should be used over FDA approved marijuana derivatives is like telling a mother whose child is suffering from a bacterial infection that she should offer her child moldy bread instead of penicillin. Think about the life expectancy when people took herbs for medical conditions compared to the life expectancy with modern medicines. Marijuana is not, and will never be medicine. * Carlton E. Turner, Ph.D., served as Deputy Assistant to President Ronald Reagan for Drug Abuse Policy and as Director of the White House Drug Abuse Policy Office. Turner is considered one of the nation’s leading experts on the pharmacology of marijuana.

Source:  : brent@brentbeleskey.com  American Center for Democracy  19th November 2016

ABOUT ACD American Center for Democracy is a New York-based not-for-profit organization, which monitors and exposes the enemies of freedom and their modus operandi, and explores pragmatic ways to counteract them.

Ben Cort, an addiction treatment specialist from Colorado, speaks in opposition to Proposition 64 during a panel about the legalization of marijuana at the Anaheim Convention Center.

An addiction expert from Colorado, where marijuana is legal, Cort is drowning in a sea of concern over Proposition 64, California’s ballot initiative that would allow recreational weed.

Once an addict himself, Cort can’t believe the Golden State appears on the verge of legalizing something that terrifies him. Though he’s no fan of pot, it’s not so much the plant that scares Cort. What worries him is that science allows THC – the active ingredient in marijuana that gets you high – to become nuclear-charged.

A little THC wax or oil, he cautions, can go a very long way, especially when it’s ingested.

“We’re the canary in the coal mine,” says Cort, a manager with the University of Colorado Hospital’s rehab program. “We’re treating more addicts for cannabis than we are for opiates.”

Cort says he’s seen THC levels in so-called gummy bears 20 times higher than levels that are legal in Oregon, another state where recreational marijuana is law but where THC percentages are controlled.

Prop. 64, Cort says, will legalize dangerously high THC. That’s not Snoop Dogg cool. That’s emergency room serious.

The federal National Institute on Drug Abuse reports, “These extracts can deliver extremely large amounts of THC to users, and their use has sent some people to the emergency room.” Such high THC levels, institute officials warn, also can turn what many consider a relatively benign drug into something addictive.

UNICORN PROMISES

While writing about marijuana, I’ve interviewed doctors, lawyers, pot growers, medical marijuana dispensary owners, officials with the National Organization for the Reform of Marijuana Laws and patients in pain.

Until I attended a two-hour informational panel discussion Tuesday sponsored by the Anaheim Police Department, I figured I knew all about pot. Speakers included Cort; Police Chief John Jackson of the Greenwood Village, Colo., Police Department; Chief Justin Nordhorn of the Washington State Liquor and Cannabis Board; Attorney Robert Bovett of Oregon Counties Legal Counsel; Lauren Michaels, legislative affairs manager

for the California Police Chiefs’ Association; and Nate Bradley, executive director of the California Cannabis Industry Association.

When a speaker asked who had read Prop. 64, only one hand went up and it wasn’t mine. So to prepare for this column I also read – OK, I skimmed some chunks – all 62 pages. A lot of Prop. 64 is wonky and details who can do what and where. But some reads more like dreams of fairies and unicorns than reality.

“Incapacitate the black market,” the proposal promises “and move marijuana purchases into a legal structure with strict safeguards against children accessing it.”

Untrue, said Jackson, who stressed that illegal sales continue in Colorado.

“Revenues will,” Prop. 64 predicts, “provide funds to invest in public health programs that educate youth to prevent and treat serious substance abuse.”

Wrong, Jackson said. More teens in Colorado are being sent to emergency rooms because of THC-laced edibles.

Revenues will pay to “train local law enforcement to enforce the new law with a focus on DUI enforcement.”

Incorrect again. Jackson said his department is busier than ever dealing with more drivers high on weed and handling more THC-related traffic fatalities.

Other parts of Prop. 64 are just dumb and dumberer.   Like allowing radio and television advertising.

“Make no mistake,” Jackson said of Prop. 64. “This whole thing is about money.

“A drug dealer in a suit is still a drug dealer.”

‘NECESSARY REFORM’

Once marijuana became legal in Washington in 2012, Nordhorn said, children and teens considered it less harmful, and that had ripple effects.

With the advent of vaping, for example, young people inhale THC without anyone knowing if they are taking in an innocent type of e-juice or marijuana.

“Legal marijuana,” Nordhorn said, “is not a silver bullet to get rid of marijuana problems.”

Bovett echoed other panelists, saying that Oregon also has seen an increase in impaired driving, although he added that has been going up since the state approved medical marijuana.

The Oregon Poison Center also reports increases in marijuana-related calls.

Even Bradley, the lone pro-Prop. 64 voice on the panel, admitted he’s concerned about edibles.

Instead of THC levels, Bradley focused on dollars. He said the initiative will take $100 million out of the hands of criminals and the measure will generate $300 million for law enforcement to focus on such things as protecting children.

Bradley has plenty of backers. Among the most visible are Gavin Newsom, lieutenant governor, and Rep. Dana Rohrabacher, R-Costa Mesa. Our local representative has said, “Current marijuana laws have undermined many of the things conservatives hold dear – individual freedom, limited government and the right to privacy.”

Rohrabacher went on to say, “This measure is a necessary reform which will end the failed system of marijuana prohibition in our state, provide California law enforcement the resources it needs to redouble its focus on serious crimes while providing a policy blueprint for other states to follow.”

‘SEED TO SALE’

The most sobering speaker was Michaels of the chiefs’ association. She simply defended California’s newly revamped medical marijuana policies.

Called “seed to sale,” three new laws inked last year shoot down the need for Prop. 64, Michaels said. She stated California now has an enhanced working system to distribute medicinal marijuana legally.

California, Michaels said, already allows local control, protects current producers and includes checkpoints at distribution.

In contrast, she said, Prop. 64 is vertically integrated, favors big business and independent distribution, appoints the state as sole actor for operating licenses and ensures regulatory confusion. Research, learn, vote. Contact the writer: dwhiting@scng.com

Source:   http://www.ocregister.com/articles/marijuana-731244-thc-prop.html   5th October 2016

The marijuana industry would rather you didn’t know this nasty truth about weed use before and during pregnancy.

Nine states are carrying measures to legalize marijuana on the Nov. 8 ballot — California, Nevada, Maine, Arizona, Massachusetts, Florida, Arkansas, Montana, and North Dakota. Pot peddlers claim the industry will boost jobs and grow the economy.

But the marijuana industry isn’t interested in the occasional or casual adult user. Like any drug industry, this group is interested in addicts — people who start using early and make it a lifetime habit. Maybe that’s why they don’t care about how their drugs are affecting babies — and why they occasionally take measures to market their products to pregnant women.

Between 7 and 10 percent of newborns at the [Pueblo] hospital are testing positive for THC, the mind-altering ingredient in cannabis.

The data is only now starting to roll in. Recently, 237 physicians from Pueblo, Colorado, banded together to detail some of the health risks associated with marijuana legalization. In particular, Dr. Steven Simerville, a paediatrician at St. Mary-Corwin Hospital, has found that between 7 and 10 percent of newborns at the hospital are testing positive for THC, the mind-altering ingredient in cannabis.

Researchers have found that THC levels in babies lead to decreased spatial reasoning, I.Q., learning, and memory, as well as an increased risk for suicide and later drug use.

Marijuana use in pregnancy takes a toll, said Pamela McColl of British Columbia. She has eyewitness proof. Her sister, who was married to a longtime marijuana user, had a newborn baby who suffered a cerebral haemorrhage at three weeks old. Her sister’s two other children also experienced complications, including reproductive abnormalities and heart defects.

A 2015 study from the University of Copenhagen confirmed that male use of marijuana damages sperm and can lead to birth defects. “So nobody is going to tell me that this isn’t related to marijuana,” she told LifeZette. McColl has been working for years as national director of Smart Approaches to Marijuana in British Columbia in order to spread awareness of the health risks of marijuana. Related: The Heavy Price of Persistent Pot Smoking

Women have been a target market for marijuana use for a while. Whoopi Goldberg and Maya Elisabeth have been instrumental in pushing marijuana as a solution for menstrual cramps — and many government officials are listening. States such as New Jersey are moving to add menstrual cramps to the list of medically approved maladies that could be addressed with marijuana usage. Dispensaries and midwives have been peddling marijuana as a cure-all for morning sickness.

Warning labels on prescription medications, cigarette boxes, and other hazardous products help women understand the risks of casual usage during pregnancy. Pot products carry no such warning.

But using marijuana during pregnancy can lead to a myriad of health problems, including cerebral haemorrhage, spina bifida, Down syndrome — even babies who are born with only half a brain. Research from the University of Adelaide in South Australia shows that marijuana use even before conception can damage the foetus.

“The risk to the foetus is not only cognitive development damage, which shows up in the early preschool years, but also in DNA studies,” McColl explained. “So we’re seeing preliminary research now that shows that use of marijuana by men or women is detrimental to chromosomal health. You can see generational damage here. This is really quite terrifying. People who use marijuana — it may not just be their own children but their grandchildren. This is a 100-year problem we may now be facing.”

By not requiring warning labels on cannabis products, the government is leaving itself open to lawsuits. Warning labels on prescription medications, cigarette boxes, and other hazardous products help women understand the risks of casual usage during pregnancy. Marijuana products carry no such warning.

By not condemning the marijuana movement, the U.S. government violates the United Nations Drug Control Conventions and betrays its allies. “When I was at the U.N. in April, they reamed out the Americans, saying, ‘You cannot do this. We all agreed,’” McColl said. Sweden, Zimbabwe, Nigeria, and numerous other countries are worried that the U.S. drug industry would leak across to their borders and pose public health problems for their rising generations.

Nobody knows what will happen to the babies who are born THC-positive. Previous studies in the 1970s on THC-positive infants had levels around 2.5 percent; many of these infants today are measuring around 15 percent. “We don’t know what it means now,” Dr. Simerville said in a press conference about the marijuana crisis. He explained the brain doesn’t finish developing until the late twenties — and early exposure to cannabis will have devastating neurological effects on the developing brain.

There may not be enough research to document exactly what neurological trauma will occur for some of these babies. But McColl confirmed that the 20,000-plus scientific studies have shown clearly that cannabis is “unsafe for human consumption” and could cost taxpayers billions of dollars down the road in health care costs.

Source:  http://www.lifezette.com/healthzette/littlest-most-vulnerable-going-to-pot/  6th Nov.2016A

In  2014, an estimated 22.2 million Americans aged 12 years or older had used marijuana in the past month.1

Under federal law, marijuana is considered an illegal Schedule I drug. However, over the last 2 decades, more than half of the states have allowed limited access to marijuana or its components, Δ9-tetrahydrocannabinol (THC) and cannabidiol, for medical reasons.2 More recently, 4 states and the District of Columbia have legalized marijuana for recreational purposes.

Currently, evidence for the therapeutic benefits of marijuana are limited to treatment and improvements to certain health conditions (eg, chronic pain, spasticity, nausea).3 Recreational use of marijuana is established by patterns of individual behaviors and lifestyle choices. In either case, use of marijuana or any of its components, especially in younger populations, is associated with an increased risk of certain adverse health effects, such as problems with memory, attention, and learning, that can lead to poor school performance and reduced educational and career attainment, early-onset psychotic symptoms in those at elevated risk, addiction in some users, and altered brain development.4- 7

In September 2016, the Substance Abuse and Mental Health Services Administration and the Centers for Disease and Control and Prevention (CDC) released an issue of the CDC’s Morbidity and Mortality Weekly Report—Surveillance Summary describing historical trends in marijuana use and related indicators among the non-institutionalized civilian population aged 12 years or older using 2002-2014 data from the National Survey on Drug Use and Health (NSDUH).8

During the last 13 years, marijuana access (ie, perceived availability) and use (ie, past-month marijuana use) have steadily increased in the United States, particularly among people aged 26 years or older, increasing from 54.9% in 2002 to 59.2% in 2014 and from 4.0% in 2002 to 6.6% in 2014, respectively. The factors associated with the national behavior patterns of marijuana use cannot be attributed solely to the heterogeneous body of state laws and policies that vary considerably with respect to year of enactment, implementation lag time, and access stipulations.

However, as state laws and policies continue to evolve, these data will be useful as a baseline to monitor changes in patterns of use and associated variables. Monitoring behavioral patterns is important given the possible increased risk of adverse health consequences due to potency changes—higher concentrations of THC (the psychoactive compound)—of the cannabis plant in the United States in the last 2 decades.9

Estimates from NSDUH data suggest that in 2014, 2.5 million persons aged 12 years or older had used marijuana for the first time within the past 12 months; this projected estimate suggests that there is an average of about 7000 new users each day (approximately 1000 more new users each day in 2014 compared with in 2002). In 2014, mean age at first use of marijuana was 19 years among persons aged 12 years or older and was 15 years among persons aged 12 to 17 years.8

During 2002-2014, the estimated prevalence of marijuana use in the past month, in the past year, and daily or almost daily increased among persons aged 18 years or older but

not among those aged 12 to 17 years, while the perceived risk from smoking marijuana decreased across all age groups. Conversely, the estimated prevalence of past-year marijuana dependence decreased from 1.8% in 2002 to 1.6% in 2014 among all persons aged 12 years or older and from 16.7% in 2002 to 11.9% in 2014 among past-year marijuana users.

Overall, the perceived availability to obtain marijuana among persons aged 12 years or older increased, and acquiring marijuana by buying the drug and growing it increased vs obtaining marijuana for free and sharing the drug. The percentage of persons aged 12 years or older perceiving that the maximum legal penalty for the possession of 1 oz or less of marijuana in their state of residence is a fine and no penalty increased vs perceptions that penalties included probation, community service, possible prison sentence, and mandatory prison sentence.8

These findings on perceived availability to obtain marijuana and fewer punitive legal penalties (eg, no penalty) for the possession of marijuana for personal use may play a role in the observed increased prevalence in use among adults in the United States. However, surveillance data do not reveal causal relationships; therefore, more granular research is needed.

As states adopt policies that increase legal access to marijuana, new indicators will be needed to understand trends in marijuana use and the risk of health effects. Questions regarding mode of use (eg, smoked, vaped, dabbed, eaten, drunk), frequency of use, potency of marijuana consumed, and reasons for use (ie, medical use, recreational use, or both) could be added to existing surveillance systems or launched in new systems.

Traditionally, understanding factors underlying the trends in marijuana use have been assessed by looking at 1 or 2 indicators (eg, perception of harm risk or dependence or abuse). A multivariable approach that includes environmental (eg, law enforcement, laws/policies) and cultural (eg, religion, individual choice) factors might be required to understand the relationship between the perceptions and attitudes toward marijuana and use behavior.

The health effects associated with marijuana use are still widely debated. Nonetheless, marijuana use during early stages of life, when the brain is developing, poses potential public health concerns, including reduced educational attainment, addiction in some users, poor education outcomes, altered brain structure and function, and cognitive impairment.4- 7

Given these potential health and social consequences of marijuana use, additional data sources at the federal and state levels may be required to assess the public health effects of marijuana use. These sources may include data from sectors such as health care (eg, emergency department data), criminal justice (eg, law enforcement data), education (eg, school attendance and performance data), and transportation (eg, motor vehicle injury data).

Assessing the prevalence and public health effects of marijuana use in the United States remains important given the evolving policies for marijuana for medical or recreational use at the state level. Therefore, it is vital to continue to monitor key traditional marijuana indicators but also to enhance public health surveillance to include monitoring of indicators that assess emerging issues so that public health actions could prevent adverse health consequences.

Given that legislation, types of products, use patterns, and evidence for potential harms and benefits of marijuana and its compounds are all evolving, clinicians need to understand the magnitude of marijuana use and associated behaviors so they can provide informed answers to patient questions, screen, counsel, treat, and refer patients to community treatment or counseling centers if abuse or adverse effects are identified.

Source: JAMA. 2016;316(17):1765-1766. doi:10.1001/jama.2016.13696

Abstract

BACKGROUND:

There is concern that medical marijuana laws (MMLs) could negatively affect adolescents. To better understand these policies, we assess how adolescent exposure to MMLs is related to educational attainment.

METHODS:

Data from the 2000 Census and 2001-2014 American Community Surveys were restricted to individuals who were of high school age (14-18) between 1990 and 2012 (n=5,483,715). MML exposure was coded as: (i) a dichotomous “any MML” indicator, and (ii) number of years of high school age exposure. We used logistic regression to model whether MMLs affected: (a) completing high school by age 19; (b) beginning college, irrespective of completion; and (c) obtaining any degree after beginning college. A similar dataset based on the Youth Risk Behavior Survey (YRBS) was also constructed for confirmatory analyses assessing marijuana use.

RESULTS:

MMLs were associated with a 0.40 percentage point increase in the probability of not earning a high school diploma or GED after completing the 12th grade (from 3.99% to 4.39%). High school MML exposure was also associated with a 1.84 and 0.85 percentage point increase in the probability of college non-enrollment and degree non-completion, respectively (from 31.12% to 32.96% and 45.30% to 46.15%, respectively). Years of MML exposure exhibited a consistent dose response relationship for all outcomes. MMLs were also associated with 0.85 percentage point increase in daily marijuana use among 12th graders (up from 1.26%).

CONCLUSIONS:

Medical marijuana law exposure between age 14 to 18 likely has a delayed effect on use and education that persists over time.

Source:  https://www.ncbi.nlm.nih.gov/pubmed/27742490 Drug Alcohol Depend. 2016 Nov 1;168:320-327. doi: 10.1016/j.drugalcdep.2016.09.002. Epub 2016 Oct 11.

Chelsea Clinton recently suggested that marijuana might be deadly when taken with other drugs. But is this really true?

Although marijuana can interact with other drugs, there do not appear to be any reports of deaths that directly resulted from taking marijuana in combination with other drugs.

While speaking in Ohio on Sept. 24, Clinton was asked whether her mother, Hillary Clinton, supports changing the way marijuana is categorized by the Drug Enforcement Administration so that it would be easier for researchers to conduct studies on the drug. Chelsea Clinton replied that her mother does support research on marijuana. Then, she added, “But we also have anecdotal evidence now from Colorado, where some of the people who were taking marijuana for those purposes, the coroner believes, after they died, there was drug interactions with other things they were taking.”

A spokesperson for Clinton later said Clinton “misspoke about marijuana’s interaction with other drugs contributing to specific deaths,” according to The Huffington Post.

By itself, marijuana is not known to have direct lethal effects. According to the U.S. Drug Enforcement Administration, no overdose deaths from marijuana have been reported in the United States.

In addition, the evidence that marijuana may interact with other drugs is limited, according to a 2007 review paper in the American Journal of Health-System Pharmacy.

Still, marijuana does appear to interact with a number of drugs, the review said. If marijuana is taken with alcohol, benzodiazepines (drugs that treat anxiety) or muscle relaxants, the combination can result in “central nervous system depression,” the review said, which means that people can experience decreased breathing and heart rate, and loss of consciousness. [How 8 Common Medications Interact with Alcohol]

There also have been reports of people experiencing a rapid heart rate and delirium after using marijuana while taking older forms of antidepressants (known as tricyclic antidepressants), the review said.

Marijuana may also interact with drugs that are broken down by enzymes in the liver known as cytochrome P450 enzymes, according to the Mayo Clinic. That’s because a compound in marijuana called cannabidiol can inhibit these enzymes. Therefore, marijuana may prevent other drugs from being broken down properly, and as a result,

levels of these other drugs may be increased in the blood, which “may cause increased effects or potentially serious adverse reactions,” the Mayo Clinic says.

One example is the drug sildenafil, commonly known by the brand name Viagra, which is broken down by cytochrome P450 enzymes. In 2002, researchers in the United Kingdom reported that a 41-year-old man had a heart attack after taking marijuana and Viagra together. This report could not prove that the marijuana-Viagra combination was definitely the cause of the man’s heart attack. However, the researchers said that doctors “should be aware” of the effects of inhibiting cytochrome P450 enzymes when prescribing Viagra.

Still, Live Science could not find any scientific or news reports of people who have died as a result of marijuana interacting with another drug.

But that doesn’t mean marijuana is harmless — the drug can impair coordination and slow down reaction time, and it has been linked with fatal car crashes, according to the National Institute on Drug Abuse (NIDA). A 2011 study found that people who reported driving within 3 hours of using marijuana, or drivers who tested positive for the drug, were more than twice as likely to be involved in a car crash compared with other drivers.

The Mayo Clinic says marijuana can increase the drowsiness caused by some drugs, including diazepam (Valium), codeine, antidepressants and alcohol, and so people need to be cautious if they drive or operate machinery after using these drugs with marijuana.

People who take high doses of marijuana may experience anxiety attacks or hallucinations, according to the NIDA. In some rare cases, intoxication with marijuana has been linked with suicide. In 2014, researchers from Germany reported that two men died from heart problems that were brought on by smoking cannabis. But marijuana may have a benefit in terms of reducing deaths from opioid painkillers. A 2014 study found that rates of overdose death from opioids were lower in states where medical marijuana is legal. Another study, published earlier this month, found that rates of opioid use decreased among younger adults in states that had legalized medical marijuana. It’s possible that people are substituting medical marijuana for opioids to treat chronic pain, the researchers said.

Source:http://www.livescience.com/56356-marijuana-drug-interactions.html

3rd Oct.2016

Cannabis is bad for you, cannabis is good for you – confused?

That’s not surprising. Complicated and controversial, cannabis is revealed by recent science to have a dual personality, with a dark side and a more positive one. Radio 4’s PM programme is this week running a whole series on cannabis, and the debate surrounding it.

Key to understanding this strange plant are two of the ingredients that make it up, known by their initials as THC and CBD.

I asked Prof Val Curran of University College London to describe how they work and she came up with a memorable answer:  “In a way, THC and CBD are a bit like yin and yang. The THC makes you stoned, but it can also make you anxious. It can also make you feel a bit psychotic, and it will seriously impair your memory.  10% of people who use it will become addicted to the drug.  The other side of the yin/yang is CBD, which has almost the opposite effects. CBD calms you down, it has anti-psychotic properties and it also offsets the effects on memory, so that on CBD-containing cannabis you’re less likely to forget what’s going on.”

So the first step to understanding cannabis is to realise how it can vary, how different types contain very different quantities of these polar opposites, with dramatically different outcomes.

Changing risks

The weed so familiar to many of my generation was characterised by a relatively balanced amount of THC and CBD.

Today, the vast majority of cannabis on sale on the streets is unrecognisably stronger.

Known as skunk, it contains a far higher proportion of THC – as much as 15% – which produces a much more powerful high, making it more appealing for users.

But, at the same time, because it hardly contains any of the CBD that might lessen its effects, the risks are correspondingly greater.

Prof Curran is among those worried about its potency.

“What concerns me is that on this high-THC skunk, people will experience more memory problems, which could affect how well they do at school. And in terms of addiction, 10% of people who use it will become addicted to the drug.”

According to a study by two researchers at UCL, Dr Tom Freeman and Dr Adam Winstock, the strongest cannabis increases the risk of addiction, along with memory loss and paranoia.

If you smoke high-potency skunk at all, then you are three times more likely to be psychoticProf Robin Murray, King’s College London

And in a trial to explore ways of helping addicts, they are giving drug users medication based on cannabis itself. The hope is that administering doses of CBD, the more benign ingredient of cannabis, might make it easier for habitual users to wean themselves off the lure of the more potent element, THC.

Dr Freeman told the BBC: “We think that CBD can reverse long-term changes which happen when you smoke cannabis repeatedly, and in people who smoke a lot of cannabis it’ll help them quit.  It blocks the effects of THC and it reduces anxiety and paranoia. If this trial is successful, then we will have found the first effective drug treatment for cannabis dependence.”

Meanwhile, new evidence has surfaced that will stir the long-running debate over whether – or to what extent – cannabis can trigger psychosis.  New research published this week in the Lancet Psychiatry suggests a connection, a finding which is most relevant to people already vulnerable to mental illness.  The study, conducted in south London, involved some 800 people – about half of them users, the rest not.

One of the authors, Prof Sir Robin Murray of King’s College London, says it’s clear that regular use of highly potent skunk has a real impact.

“We found that smoking cannabis, particularly of the high-potency forms, was associated with an increased risk.  If you smoke high-potency skunk at all, then you are three times more likely to be psychotic. If you smoke high-potency cannabis every day, you are five times more likely to be psychotic.”

Cautious optimism

And at this point we come back to that yin and yang of cannabis. While this new research finds that the strongest cannabis, laden with THC, can be linked to psychosis, it turns out that the gentler twin, CBD, might possibly be useful in treating it.

Prof Murray, though cautious, highlights recent studies.

“If you give THC to normal volunteers, you can make them psychotic, but if you pre-treat them with CBD, you can prevent that happening.  So this made us think – would it be possible to actually treat psychosis with CBD? So there’s one encouraging study, which suggests that CBD is useful in the treatment of psychosis, but it’s still very early days yet.”

So running in parallel with concerns about cannabis is another world of optimism about its uses.

In Colorado, there is much excitement about a medication called Charlotte’s Web, derived from cannabis and named after a girl who took it as a treatment for her epilepsy.

It may open up a completely new avenue of treatment options for patients with epilepsyDr Richard Chin, University of Edinburgh

Such is the potential of what’s seen as a wonder drug that the Mattison family sold up their business in Tennessee and moved to Colorado purely so that their daughter Millie, who’s two years old and epileptic, could receive Charlotte’s Web.

Her seizures, soon after birth, were so severe that she had been given very little chance of surviving. But her mother Nicole told me that the drug proved immediately beneficial, transforming Millie’s life almost at a stroke.  “It’s miraculous. The first time we gave her oil, within 15 minutes her eyes were open, and I almost felt like I was in a movie. It was crazy, you wouldn’t believe it unless you saw it.”

Here in the UK, the only legal medicine derived from cannabis is for sufferers of multiple sclerosis (MS), a product called Sativex made by GW Pharma.  But now the company,

the only one with a licence to grow cannabis in the UK, has developed another formulation which is being tested to treat epileptic conditions like Millie’s.

Early days

The trial, with 80 patients, is now in its second stage and is being run by the University of Edinburgh.

The scientist in charge of the process, Dr Richard Chin, says that so far the results look promising, not just to control seizures but – remarkably – to prevent them as well.

“One of the interesting things about cannabidiol (CBD) is that it shows not just anti-seizure effects, but it also curiously seems to have an effect on cognitive and behavioural problems, which are very highly represented in people with epilepsy.

“So it doesn’t seem, on preliminary data, as if it’s just an anti-seizure medication. It may actually be an anti-epilepsy medication in its wider sense, and what I would hope is that it may open up a completely new avenue of treatment options for patients with epilepsy.”

For thousands of years cannabis was used medically. But only now is research revealing why that’s possible and how it can be put to best use.

These are relatively early days but, on the horizon, researchers see potential for the CBD in cannabis to help with everything from easing the pain of cancer to tackling autism.

At the same time, science is also unpicking the full implications of the potent stuff being dealt on our streets.

Source:  18th Feb 2018

Introduction.

A belief that the U.S. government holds a patent for medical marijuana is a yet another example of scientific imprecision that obfuscates the national debate on the uses of marijuana as medicine. Advocates for marijuana as medicine, including the journalist Dr. Sanjay Gupta, refer to U.S Patent No. 6,630,507 as evidence of government hypocrisy on marijuana. “the United States already holds a patent on medical marijuana for that very purpose… How can the government deny the benefits of medical marijuana even as it holds a patent for those very same benefits?” The patent in question, “Cannabinoids as Antioxidants and Neuroprotectants” is assigned to the U.S. government (HHS) on behalf of three inventors serving at that time at the National Institutes of Health: Aidan J. Hampson, Julius Axelrod (a Nobel laureate) and Maurizio Grimaldi. The issued patent was published Oct 7 2003, with a priority date of 1998.

A primer on patent claims. Claims are the heart of a patent. Patents protect inventions listed in the patent claims. If a substance is not listed in the claims, the patent does not protect the substance. Claims define the limits of precisely what the patent covers and protects. The patent holder has the right to exclude others from making, using or selling those things which are described by the claims. The claims define, in technical terms, the extent, the scope, of the protection conferred by a patent.

The US government does not hold a patent for marijuana as a medicine. This U.S. patent makes a number of claims but marijuana and THC are not among them. It clearly distinguishes unprocessed botanical marijuana from individual cannabinoids. It specifically rejects marijuana or THC as claims. Instead the patent claims uniquely designed novel cannabinoids not found in nature, or cannabidiol made by the marijuana plant, or endocannabinoids made by the brain. It specifically rejects marijuana and the most abundant plant cannabinoid THC because of their psychoactivity and psychotoxicity. The claims in this patent focus on non-psychoactive cannabinoids synthesized in laboratories or by the brain that act at different targets (receptors) than marijuana or THC. The claims are for specific neuroprotective and antioxidant actions, which are distinct from the majority of reasons currently stated for using marijuana.

Even though the marijuana plant contains some chemicals that may be useful for treating illnesses or symptoms or as leads for chemical modification, the plant itself is psychoactive and the effects of its 750 chemicals, including some 104 different cannabinoids remain largely unknown. The inventors of this U.S. government patent did not patent medicinal uses of whole plant marijuana, nor its most prominent cannabinoid, THC, because they explicitly chose to avoid their undesirable, unacceptable psychoactive effects based on actions at cannabinoid receptors. Instead, the patent claims focus on specific cannabinoids, the majority of which are designed by medicinal chemists and are not found in the marijuana plant. The inventors discovered that certain cannabinoids have neuroprotective and antioxidant properties and antagonize specific glutamate receptor subtypes (neurotoxicity), without activating cannabinoid receptors (psychoactivity), as does the (2) marijuana plant or THC therein. The claim that the U.S. government has a patent on marijuana as a medicine is untenable.

Patent Claims in U.S. Patent No. #6,630,507. Patents protect inventions listed in the patent claims. If a substance is not listed in the claims, the patent does not cover the substance. This patent focuses on individual cannabinoids, mostly synthetic cannabinoids designed and created in laboratories. The claims do not mention marijuana nor are most of the claims based on cannabinoids found in the marijuana plant. Marijuana cannot be used interchangeably with the term cannabinoid (see The Folly of Extrapolation). A few claims include endocannabinoids made by the brain and CBD of the marijuana plant. Even these cannabinoids are not addictive, psychoactive, or intoxicating, in contrast to marijuana and the cannabinoid THC of the marijuana plant which are psychotoxic.

The following outline more specifically the reasons why it is erroneous to conclude that the United States government has patented “medical marijuana” (#6,630,507).

1. Marijuana is not a claim of this invention. The inventions/claims in this patent do not include marijuana (medical or otherwise), and do not mention marijuana in the abstract, which summarizes key concepts of what is claimed and why. The invention refers to single cannabinoids designed by medicinal chemists, including synthetic analogs of cannabidiol (CBD). With the exception of CBD, the cannabinoids claimed are synthetic or derivatives from the brain and not produced by, or have been discovered in the marijuana plant.

2. The claims of this invention are unique, single cannabinoids, not a mixture of 104 cannabinoids or 650 other chemicals found in the marijuana plant. The chemical claims in this patent are single, unique cannabinoids, each of which is to be assessed alone in biological tests – in marked contrast to marijuana, a complex mixture of over 750 chemicals that include 104 known cannabinoids, terpenoids, small molecules like ammonia and hydrogen cyanide and heavy metals. The chemical composition of marijuana is quite similar to that of tobacco, except that it instead of nicotine, it contains cannabinoids (1). If this had been a marijuana patent, it would, by necessity, claim a complex mixture of at least 750 chemicals.

1 Moir et al, A Comparison of Mainstream and Sidestream Marijuana and Tobacco Cigarette Smoke Produced under Two Machine Smoking Conditions. Chem. Res. Toxicol., 2008, 21 (2), pp 494–502

3. A primary objective of the patent is to develop individual cannabinoids that are free of psychoactive or psychotoxic effects and that are substantially non-toxic even at very high doses. The inventors specifically focus on developing single cannabinoids without actions at cannabinoid receptors. This precludes marijuana or THC. Marijuana would not qualify as a claim, and is not claimed because it is psychoactive, psychotoxic at high doses, is a complex mixture that acts primarily at cannabinoid receptors. THC, the most prominent cannabinoid in the marijuana plant is also excluded and not claimed, for the same reasons that

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marijuana is avoided. It is psychoactive and psychotoxic and acts at cannabinoid receptors. The patent defines the term “psychoactivity” to mean “cannabinoid receptor mediated psychoactivity.” “Such effects include euphoria, lightheadedness, reduced motor coordination, and memory impairment.” Unprocessed marijuana and THC mediate psychoactivity via cannabinoid receptors.

4. The majority of the newly designed compounds in the claims not produced by the marijuana plant and may have effects distinctly different from, or may be medicinally advantageous compared with cannabinoids made by whole plant marijuana. The patent covers and assesses unique, synthesized cannabinoids, the majority not found in the marijuana plant. It focuses on newly designed dibenzopyran cannabinoids and newly designed analogs of CBD, as previous studies have indicated that cannabidiol is not psychotoxic or psychoactive or acts at cannabinoid receptors.

5. The patent states that the “cannabinoid may be a cannabinoid other than THC” (the main cannabinoid in marijuana), and excludes “other potent cannabinoid receptor agonists”. This exclusion eliminates any potent cannabinoid receptor agonist that has a cannabinoid receptor potency of 50 nM or less (or even as weak as 190 nM or 250 nM or less). The cannabinoid receptor (CB1) is the mediator of psychoactive effects of marijuana and THC.2 THC potency is higher (25 nM) than the stated cut-off potency and is excluded for this reason. Marijuana is not mentioned and if it were, it would be excluded because it contains psychoactive THC (25 nM) and other cannabinoids with high cannabinoid receptor potency. The patent states: “THC (tetrahydrocannabinol) is another of the cannabinoids that has been shown to be neuroprotective in cell cultures, but this protection was believed to be mediated by interaction at the cannabinoid receptor, and so would be accompanied by undesired psychotropic side effects.” There are no claims of isolating cannabinoids from marijuana or assessing marijuana or THC.

2 Huestis MA, Gorelick DA, Heishman SJ, Preston KL, Nelson RA, Moolchan ET, Frank RA. Blockade of effects of smoked marijuana by the CB1-selective cannabinoid receptor antagonist SR141716. Arch Gen Psychiatry. 2001 Apr; 58(4): 322-8.

6. The neuroprotective and antioxidant actions of listed cannabinoids in the claims are based on actions independent of cannabinoid receptors. De facto, marijuana and THC are excluded. The results presented in the patent “therefore surprisingly demonstrate that cannabinoids can have useful therapeutic effects that are not mediated by cannabinoid receptors, and therefore are not necessarily accompanied by psychoactive side effects. The inventors further state, “the therapeutic potential of nonpsychoactive cannabinoids is particularly promising, because of the absence of psychotoxicity, and the ability to administer higher doses than with psychotropic cannabinoids, such as THC.”

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7. Most of the cannabinoids claimed in this patent are not made by, or found in the marijuana plant. 14 claims describe a number of newly designed cannabinoids that can be synthesized in a medicinal laboratory. CBD is claimed, but many of the CBD analogs claimed are novel and not found in the marijuana plant. Separate, unique individual cannabinoids designed and created de novo represent the majority of the patent claims.

The Folly of Extrapolation. The inventors appreciated the pursuit of individual cannabinoids regardless of their origins (plant, synthetic, brain) and not whole plant marijuana. They rejected cannabinoids acting at cannabinoid receptors, the major target of marijuana and THC, to avoid psychoactive and psychotoxic effects. Thus extrapolating the claims of this patent to include whole plant marijuana or even THC is folly. The patent also avoids extrapolating from whole plant marijuana to individual isolated cannabinoids for the same reasons. The patent also recognizes that individual cannabinoids may engender markedly different effects via different brain targets, and eschews extrapolating from one unique cannabinoid to another. For this reason, it outlines biological testing templates designed to assess the therapeutic potential of individual cannabinoids. Currently, about 104 different cannabinoids have been identified in the marijuana plant, which in smoked or ingested form, may be delivered as an ensemble to the brain or body. These include THC that acts at cannabinoid receptors (precluding its development), its active metabolite, and others that may or may not produce similar or opposing pharmacological effects.

Some reasons to avoid extrapolation from whole plant marijuana to cannabinoids: 

a. To avoid confusing terminology of marijuana and cannabinoids;

b. The composition, bioavailability, pharmacokinetics and pharmacodynamics of botanical marijuana differs from extracts or purified individual cannabinoids;

c. The bioavailability of active cannabinoids in marijuana, delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD), cannot be predicted because differences in smoking or vapor inhalationor ingestible products vary between users and types of delivery systems. In contrast, a fixed oral dose of a cannabinoid can be quantified in plasma or whole blood samples, yielding relatively predictable results;

d. To avoid extrapolating to marijuana, conclusions drawn from efficacy of purified cannabinoid or newly designed cannabinoids of known doses, and delivered by common routes used for medications. Marijuana is used predominantly by smoking, inhalation from water pipes or vaporizing, a rapid form of brain delivery considered a route of administration with higher addiction potential;

e. To avoid extrapolation and appropriation of safety data generated from isolated or newly synthesized and medically approved cannabinoids (with known doses) to whole plant marijuana, for which there are no guidelines for doses.

f. To avoid extrapolating from marijuana and THC to novel cannabinoids that may have different medicinal properties and sites of action.

Examples of why modern medicinal chemistry, biology and drug development focus on isolated or synthesized compounds for drug discovery and not on whole plants. Examples of why extrapolating evidence from one unique cannabinoid to another cannabinoid if folly. 5

THC and CBD (cannabidiol) research has shown that these cannabinoids in the marijuana plant have opposite effects in the brain.

a. THC is intoxicating, psychoactive and addictive, can induce psychosis, anxiety, memory impairment and in some cases seizures.

b. THC principal targets are cannabinoid receptors, which the patent clearly states is not a desired biological target.

c. CBD is neither psychoactive nor addictive, does not impair memory, and may alleviate psychosis, anxiety and seizure activity, even antagonizing these THC-induced adverse effects.

d. CBD has very weak activity at cannabinoid receptors (affinity greater than 1,000 nM) and apparently acts on different brain receptors than THC.

e. From the perspective of medicinal properties, it is illogical to deliver two chemicals to the brain which produce opposite effects.

f. In peripheral organs, there are examples of CB2 receptors having beneficial functions in specific organs whereas CB1 receptors may be associated with disease processes. Yet THC targets both receptors with similar potency.

Conclusion. Dr. Gupta and others who allege that the U.S. government is hypocritical because it holds a marijuana patent while simultaneously classifying marijuana in the most restrictive Schedule I category, use the term marijuana inaccurately and indiscriminately to refer to the patented cannabinoids, the vast majority of which don’t exist in the marijuana plant. They disregard the primary focus of this patent, individual and novel cannabinoids created in chemical laboratories. The patent claims are restricted to individual cannabinoids and their structures, regardless of origin: chemically synthesized in a laboratory, made by brain, or CBD made by the marijuana plant. The patent recognizes the complexity, unpredictability and undesirability of marijuana or THC, as both activate undesirable targets (cannabinoid receptors) and display undesirable psychoactive and psychotoxic effects. As marijuana contains over a hundred cannabinoids that may act synergistically, antagonistically, the patent recognizes the value of pursuing individual cannabinoids with their knowable biological targets, beneficial or adverse effects.

The claim that the U.S. government has patented medical marijuana is analogous to claiming that a patent on medicinal amphetamine or digoxin or quinine sulphate or oxycodone, or lidocaine is the same as a patent on Ma Huang, or foxglove, or cinchona bark, or opium poppies, or coca bushes. By this reductio ad absurdum, garden centers marketing foxglove or poppy plants for decorative purposes, Whole Foods marketing cinchona bark as a source for creating tonic water, chemical companies that sell digitonin (an isolate from the digitalis plant) to dissolve lipids in water, would violate patents that protect medicinal preparations of chemically modified drugs whose lead structures are of plant origins. The extrapolation of this patent to a marijuana patent is as irrational as claiming that coca bushes and lidocaine (a cocaine derivative) are one and the same.

Source:  Bertha Madras in a letter to Drugwatch International Feb. 2016

Among the 137 people who completed the study, the number of seizures fell by an average of 54 percent, according to a team led by Dr. Orrin Devinsky, of New York University Langone Comprehensive Epilepsy Center in New York City.

Keep in mind that Epidiolex is VERY different than the so-called low THC strains of marijuana (also known as Charlotte’s Web) that are being grown and sold in several states. Unlike Epidiolex, the strains of marijuana are not cloned and the end products vary widely. Most importantly, these strains contain varying levels of THC whereas Epidiolex is virtually pure CBD.

Liquid Medical Marijuana Shows Promise for Epilepsy

A liquid form of medical marijuana may help people with severe epilepsy that does not respond to other treatments, according to a new report.

The study included 213 child and adult patients with 12 different types of severe epilepsy. Some of them had Dravet syndrome and Lennox-Gastaut syndrome, which are types of epilepsy that can cause intellectual disability and lifelong seizures.

The patients took a liquid form of medical marijuana, called cannabidiol, daily for 12 weeks.

Among the 137 people who completed the study, the number of seizures fell by an average of 54 percent, according to a team led by Dr. Orrin Devinsky, of New York University Langone Comprehensive Epilepsy Center in New York City.

Among the 23 patients with Dravet syndrome who completed the study, the number of convulsive seizures fell by 53 percent, the investigators found. The 11 patients with Lennox-Gastaut syndrome who finished the study also had a 55 percent decline in the number of attacks called “atonic” seizures, which cause a sudden loss of muscle tone.

The drug wasn’t always easy to take, however, and 12 patients stopped taking it due to side effects, the researchers said. The types of side effects seen in more than 10 percent of the patients included drowsiness (21 percent), diarrhea (17 percent), tiredness (17 percent) and decreased appetite (16 percent).

The study was supported by drug maker GW Pharmaceuticals. The findings are scheduled to be presented next week at the annual meeting of the American Academy of Neurology (AAN) in Washington, D.C. Experts note that findings presented at medical meetings are typically considered preliminary until published in a peer-reviewed journal

Devinsky agreed that larger, placebo-controlled studies are needed to assess the effectiveness of the drug.

“So far there have been few formal studies on this marijuana extract,” he said in an AAN news release. “These results are of great interest, especially for the children and their parents who have been searching for an answer for these debilitating seizures.”

One expert unconnected to the study called the findings “very exciting.”

“Prior to this study, there were mainly anecdotal reports and very few formal studies evaluating cannabidiol, a component of cannabis, in treating seizures,” explained Dr. Scott Stevens, director of Advanced Clinical Experience in Neurology at North-Shore-LIJ Health System in Manhasset, N.Y.

Stevens believes that “these results stand as a stepping stone toward further studies evaluating the use of marijuana in the treatment of epilepsy.”

Source:http://www.webmd.com/epilepsy/news 13/04/2015 (HealthDay News

An analysis has found moderate-quality evidence supporting the use of cannabinoids for certain types of pain, but not for other conditions such as nausea and sleep disorders. This review of nearly 80 randomized controlled trials has been published in JAMA.

Penny F. Whiting, PhD, of the University of Bristol, Bristol, United Kingdom, and colleagues collected data from 79 randomized controlled clinical trials with 6,462 patients on the use of cannabinoids for nausea and vomiting due to chemotherapy, appetite stimulation in HIV/AIDS, chronic pain, spasticity due to multiple sclerosis or paraplegia, depression, anxiety disorder,sleep disorder, psychosis, glaucoma, or Tourette syndrome. Study quality was determined using the Cochrane risk of bias tool.

Improvements in symptoms with use of cannabinoids were not statistically significant in most studies. Only two trials evaluated cannabis and there was no evidence of differential effects between cannabis and other cannabinoids. There was moderate-quality evidence suggesting that cannabinoids could be beneficial for the treatment of chronic neuropathic or cancer pain, along with spasticity due to multiple sclerosis but low-quality evidence for nausea and vomiting due to chemotherapy, weight gain in HIV, sleep disorders, and Tourette’s syndrome. For cannabinoids in the treatment of anxiety, there was very low-quality evidence; in addition, there was low-quality evidence for no effect on psychosis and very low-level evidence for no effect on depression. No clear evidence for benefits or risks with specific types of cannabinoids or modes of administration was noted. An increased risk of short-term adverse events including dizziness, dry mouth, nausea, fatigue, somnolence, euphoria, vomiting, disorientation, drowsiness, confusion, loss of balance, and hallucination was also found.

In an accompanying editorial, Deepak Cyril D’Souza, MBBS, MD, and Mohini Ranganathan, MD, of the Yale University School of Medicine noted that large double-blind randomized clinical trials are needed to test the short- and long-term safety and efficacy of medical marijuana for various medical conditions. They also added that “since medical marijuana is not a life-saving intervention, it may be prudent to wait before widely adopting its use until high-quality evidence is available to guide the development of a rational approval process.” Currently 23 states and the District of Columbia have introduced laws permitting the use of medical marijuana. For more information visit JAMANetwork.c

Source:  http://www.empr.com/   3rd June 2016

Increasing numbers of Belgian teenagers are seeking help for cannabis use, De Standaard reported on Monday.

According to a report by the Flemish Association of Addiction Treatment Centres Care (VVBV), in 2013 495 boys and 78 girls aged between 15 and 19 sought assistance over continued use of the drug.

In addition, 36 children under the age of 15 also asked for help.

The report also found that more and more women are seeking help for heroin and cocaine use.

Counselling services are now been targeted at the young.

“Young men with a cannabis addiction used to be all in their twenties before they took the step to recovery.

In recent years, more and more 15- to 19-year olds are added, and they became a separate group in health care,” said VVBV Chairman Dirk Vandevelde.

“Based on these figures, it is difficult to estimate whether it is youth who are experimenting or already have an advanced addiction, and how long they remain in counselling,” he said.

Last week, a law allowing for the sale of medical marijuana was published in Belgium.

The law will come into effect at the beginning of July.

Amongst the drug’s medical properties is the alleviation of pain for sufferers of conditions such as multiple sclerosis.

Source:

http://news.xinhuanet.com/english/2015-06/15/c_134328368.htm  15^th June 2015

Summary

The 2012/13 New Zealand Health Survey (NZHS) provides valuable information about cannabis use by adults aged 15 years and over. It builds upon and adds value to the findings of the 2007/08 New Zealand Alcohol and Drug Use Survey report on cannabis.

This report presents information on cannabis use in New Zealand, including patterns of use, drug-driving, harms from use (productivity and learning, and mental health), legal problems, and cutting down and seeking help. Information on the medicinal use of cannabis is also presented.

Patterns of cannabis use

Eleven percent of adults aged 15 years and over reported using cannabis in the last 12 months (defined here as cannabis users). Cannabis was used by 15% of men and 8.0% of women. Māori adults and adults living in the most deprived areas were more likely to report using cannabis in the last 12 months. Thirty-four percent of cannabis users reported using cannabis at least weekly in the last 12 months. Male cannabis users were more likely to report using cannabis at least weekly in the last 12 months.

Cannabis and driving

Thirty-six percent of cannabis users who drove in the past year reported driving under the influence of cannabis in the last 12 months. Men were more likely to have done so.

Cannabis-related learning and productivity harms

Six percent of cannabis users reported harmful effects on work, studies or employment opportunities, 4.9% reported difficulty learning, and 1.7% reported absence from work or school in the last 12 months due to cannabis use.

Cannabis and mental health harms

Eight percent of cannabis users reported a time in the last 12 months that cannabis use had a harmful effect on their mental health. Younger cannabis users (aged 25–34 years) were most affected, with reported harm to mental health decreasing markedly by age 55+ years.

Cannabis and legal problems

Two percent (2.1%) of cannabis users reported experiencing legal problems because of their use in the last 12 months.

Cutting down and help to reduce cannabis use

Most cannabis users (87%) did not report any concerns from others about their use. Seven percent of cannabis users reported that others had expressed concern about their drug use or had suggested cutting down drug use within the last 12 months. Of cannabis users, 1.2% had received help to reduce their level of drug use in the last 12 months. Few cannabis users who wanted help did not get it (3.6%).

Cannabis use for medicinal purposes

Forty-two percent of cannabis users reported medicinal use (ie, to treat pain or another medical condition) in the last 12 months. Rates were similar for men and women. Older cannabis users (aged 55+ years) reported higher rates of medicinal use.

An  infographic (PDF, 174 KB)  provides a short overview of these findings.

The methodology report for the 2012/13 New Zealand Health Survey is also available on this website.

If you have any queries please email hdi@moh.govt.nz

Downloads

• Cannabis Use 2012/13: New Zealand Health Survey (docx, 405 KB)
• Cannabis Use 2012/13: New Zealand Health Survey (pdf, 705 KB)
• Infographic (pdf, 174 KB)

Source:  Ministry of Health. 2015. Cannabis Use 2012/13: New Zealand Health Survey. Wellington: Ministry of Health. Published online:  28 May 2015

http://www.health.govt.nz/publication/cannabis-use-2012-13-new-zealand-health-survey

Bertha Madras is a professor of psychobiology at McLean Hospital and Harvard Medical School, with a research focus on how drugs affect the brain. She is former deputy director for demand reduction in the White House Office of National Drug Control Policy. Data from 2015 indicate that 30 percent of current cannabis users harbor a use disorder — more Americans are dependent on cannabis than on any other illicit drug. Yet marijuana advocates have relentlessly pressured the federal government to shift marijuana from Schedule I — the most restrictive category of drug — to another schedule or to de-schedule it completely. Their rationale? “States have already approved medical marijuana”; “rescheduling will open the floodgates for research”; and “many people claim that marijuana alone alleviates their symptoms.”

Yet unlike drugs approved by the Food and Drug Administration, “dispensary marijuana” has no quality control, no standardized composition or dosage for specific medical conditions. It has no prescribing information or no high-quality studies of effectiveness or long-term safety. While the FDA is not averse to approving cannabinoids as medicines and has approved two cannabinoid medications, the decision to keep marijuana in Schedule I was reaffirmed in a 2015 federal court ruling. That ruling was correct. [https://www.washingtonpost.com/news/in-theory/wp/2016/04/29/scientists-want-to-study-marijuana-big-pot-just-wants-to-sell-it/]

To reside in Schedules II-V and be approved for diagnosing, mitigating, treating or curing a specific medical condition, a substance or botanical must proceed through a rigorous FDA scientific process proving safety and efficacy. Not one form of “dispensary marijuana” with a wide range of THC levels — butane hash oil, smokables, vapors, edibles, liquids — has gone through this rigorous process for a single medical condition (let alone 20 to 40 conditions).

To approve a medicine, the FDA requires five criteria to be fulfilled:

1. The drug’s chemistry must be known and reproducible.Evidence of a standardized product, consistency, ultra-high purity, fixed dose and a measured shelf life are required by the FDA. The chemistry of “dispensary marijuana” is not standardized. Smoked, vaporized or ingested marijuana may deliver inconsistent amounts of active chemicals. Levels of the main psychoactive constituent, THC, can vary from 1 to 80 percent. Cannabidiol (known as CBD) produces effects opposite to THC, yet THC-to-CBD ratios are unregulated.

2. There must be adequate safety studies. “Dispensary marijuana” cannot be studied or used safely under medical supervision if the substance is not standardized. And while clinical research on long-term side effects has not been reported, drawing from recreational users we know that marijuana impairs or degrades brain function, and intoxicating levels interfere with learning, memory, cognition and driving. Long-term use is associated with addiction to marijuana or other drugs, loss of motivation, reduced IQ, psychosis, anxiety, excessive vomiting, sleep problems and reduced lifespan. Without a standardized product and long-term studies, the safety of indefinite use of marijuana remains unknown.

3. There must be adequate and well-controlled studies proving efficacy. Twelve meta-analyses of clinical trials scrutinizing smoked marijuana and cannabinoids conclude that there is no or insufficient evidence for the use of smoked marijuana for specific medical conditions. There are no studies of raw marijuana that include high-quality, unbiased, blinded, randomized, placebo-controlled or long-duration trials.

4. The drug must be accepted by well-qualified experts. Medical associations generally call for more cannabinoid research but do not endorse smoked marijuana as a medicine. The American Medical Association: “Cannabis is a dangerous drug and as such is a public health concern”; the American Academy of Child and Adolescent Psychiatry: “Medicalization” of smoked marijuana has distorted the perception of the known risks and purposed benefits of this drug;” the American Psychiatric Association: “No current scientific evidence that marijuana is in any way beneficial for treatment of any psychiatric disorder … the approval process should go through the FDA.”

5. Scientific evidence must be widely available. The evidence for approval of medical conditions in state ballot and legislative initiatives did not conform to rigorous, objective clinical trials nor was it widely available for scrutiny.

Marijuana fails to meet any of these five criteria for accepted medical use in the United States. At present, it belongs in Schedule I.

Is Schedule I drug a roadblock to marijuana research? Not really. The major roadblock to five proposed studies at the California Center for Medicinal Cannabis Research was not the Schedule I label, but the scarcity of patients willing to enrol in five major clinical trials. The process for marijuana research could be streamlined by Drug Enforcement Administration oversight and expansion of marijuana production, and a special sub-category of Schedule I could further reduce paperwork. But moving marijuana to Schedule II “to promote research” is conceivably unethical, as marijuana would then be designated a safe and effective medicine in the absence of high-quality evidence.

Should we dismiss heartfelt appeals from people suffering various diseases, knowing that a host of chronic, debilitating ailments are inadequately managed? Human stories should not be ignored, and rigorous, creative solutions can be formulated in response. However, the “marijuana mess” and its “new realities” were created not by the federal government but by political processes designed to circumvent the FDA, the only federal agency that safeguards our nation’s medicines. If the more than $100 million spent on ballot and legislative initiatives instead had been used for quality clinical trials, our nation would know much more about the therapeutic potential of cannabinoids. Instead, “dispensary marijuana” is evolving into a human experiment without informed consent.

We revere the brain more than other body part because it is the repository of our humanity. When a brain disease strikes, it can fundamentally transform an individual. We schedule and restrict psychoactive drugs because they can negatively affect the human brain and behavior. Of brain diseases, substance use disorders are among the most lamentable forms of human anguish. They are also among the most preventable.

Source:  www.washingtonpost.com/news/in-theory/wp/2016/04/29/5

There is, naturally, a hope amongst parents whose child is desperately ill with seizures that a new treatment will help.  Many parents in the USA have been convinced that medical marijuana may be the answer – and some have even moved home in order to be able to legally purchase this substance.  Sadly however, it has been shown that whilst this substance may be able to help some patients it can also have disastrous effects on others.  There is much research going on with a purified and uniform preparation of cannabidiol (CBD) called Epidiolex to see if this can indeed become a genuine treatment for epileptic seizures.  Until then, parents should be advised not to use the products available in ‘medical marijuana dispensaries’ – which are not regulated for purity or uniformity and could be dangerous for their children. (see letter below).

This situation has come about because of the shameful way so called medical marijuana has been used as a wedge to introduce the recreational use of the substance – dating from the statement made in the seventies  by Keith Stroup in a post debate encounter at Emory University in the USA when he said “we’ll be using the issue as a red herring to give marijuana a good name’.

This is the current position of the American Epilepsy Society, as written in a letter from Dr. Brooks-Kayal to a Pennsylvania legislator:

March 22, 2015

Dear Representative,

As Pennsylvania considers enacting new cannabis legislation (HB 193), I write to offer the perspective of the American Epilepsy Society (AES), the leading U.S. organization of clinical and research professionals specializing in the treatment and care of people with epilepsy.

Epilepsy is the most common and potentially devastating neurological disease that affects people across the lifespan. In America, one in 26 people will be diagnosed with epilepsy at some time in the course of their life – more will experience an isolated seizure. Epilepsy is associated with significant morbidity and mortality and is associated with many co-morbidities including depression, cognitive dysfunction, and autism. Today between 2.2 and 3 million Americans, including almost 400,000 children, live with epilepsy, with one third living with treatment-resistant seizures that do not respond to current medications.

The American Epilepsy Society position on medical marijuana as a treatment option for people with epilepsy is informed by the current research and supported by the position statements from the American Academy of Neurology, the American Academy of Pediatrics and the American Medical Association. Additionally, a 2014 survey of practitioners published in the journal Epilepsy Currents found that the majority of epilepsy practitioners agreed with and supported the AES position.

Specifically, AES has called for more research, for the rescheduling of marijuana by the DEA to ease access for clinical studies, and has supported the compassionate use program of GW Pharmaceuticals, where a is being administered under the guidance and close monitoring of an appropriate medical professional. AES has also been highly supportive of the double-blind clinical trial now underway by GW Pharmaceuticals and of the forthcoming clinical trial by INSYS Therapeutics.

These clinical trials utilize a vastly different substance than the artisanal cannabis products that are being considered for use in Pennsylvania, and that have been used in Colorado. As you likely know, medical marijuana and its derivatives are legal in Colorado, but you may not realize that the content of these products is not regulated for purity or uniformity. A study by a team from Children’s Hospital Colorado that was presented during the AES Annual Meeting in December 2014 and has recently been accepted for publication in the journal Epilepsy & Behavior, found that artisanal “high CBD” oils resulted in no significant reduction in seizures in the majority of patients and in those for whom the parents reported improvements, these improvements were not associated with improvement in electroencephalograms (EEGs), the gold standard monitoring test for people with epilepsy.

Additionally, in 20% of cases reviewed seizures worsened with use of cannabis and in some patients there were significant adverse events. These are not the stories that you have likely heard in your public hearings, but they are the reality of practitioners at Children’s Hospital Colorado who have cared for the largest number of cases of children with epilepsy treated with cannabis in the U.S.

The families and children coming to Colorado are receiving unregulated, highly variable artisanal preparations of cannabis oil prescribed, in most cases, by physicians with no training in pediatrics, neurology or epilepsy. As a result, the epilepsy specialists in Colorado have been at the bedside of children having severe dystonic reactions and other movement disorders, developmental regression, intractable vomiting and worsening seizures that can be so severe they have to put the child into a coma to get the seizures to stop. Because these products are unregulated, it is impossible to know if these dangerous adverse reactions are due to the CBD or because of contaminants found in these artisanal preparations. The Colorado team has also seen families who have gone into significant debt, paying hundreds of dollars a month for oils that do not appear to work for the vast majority. For all these reasons not a single pediatric neurologist in Colorado recommends the use of artisanal cannabis preparations. Possibly of most concern is that some families are now opting out of proven treatments, such as surgery or the ketogenic diet, or newer antiseizure medications because they have put all their hope in CBD oils.

AES is sympathetic to the desperation parents of children with severe, treatment-resistant epilepsy feel, and understand the need for compassionate or promising new therapies in in appropriate and controlled circumstances. We are however opposed to the use of artisanal preparations of unregulated compounds of cannabis that contain unverified content and are produced by people with no experience in pharmaceutical production. That is what is currently happening in Colorado and may soon be happening in multiple states across the county as they legalize the use of medical marijuana products.

The products currently provided in Colorado do not meet the FDA definition of expanded or compassionate use. The FDA requires compassionate use therapies to meet the same criteria as an investigational new drug which require standard purity, content and content uniformity testing of the product. None of these criteria are met in the products being given to people with epilepsy in Colorado and we are seeing the distressing results noted above. And yet, these and other similar products are being considered for use in Pennsylvania.

It is also worth noting that in late February 2015, the FDA issued several warning letters to firms that claim that their products contain CBD. The FDA has tested those products and, in some of them, did not detect any CBD as claimed on the label. Because there is no standard for these products, the market is increasingly flooded with a wide variation of products and states which approve access to these preparations will bear the burden of monitoring for quality and controlling for the continuity of supply.

In sum, there simply is no clinical, controlled research to support the adoption of new CBD legislation for epilepsy such as your state is considering. The anecdotal results of a few families in Colorado, shared in the media, should not be the basis for law making. The rush by states to pass CBD legislation has created an unusual situation where people with epilepsy and their families are demanding access to a highly variable homegrown substance that may or may not be beneficial and the medical and scientific community lacks the necessary efficacy and safety data to make good treatment decisions regarding cannabis for people with epilepsy, especially in children.

The new legislation in most states places epilepsy practitioners in an untenable situation where they are expected, or in some states directed by law, to respond to requests for these highly variable artisanal products with no protocols, no research and no clinical guidelines regarding dosing or side-effects, and no assurance that the cannabis products that are to be recommended are pure, safe or uniform, making it nearly impossible to know if we are truly “Doing No Harm.”

We need to accelerate the clinical research and wait to act until we have results to support decisions. If there are components of cannabis with specific therapeutic values we need to know this and we need to develop pharmacy grade compounds that utilize these components to help the nearly one million people living with drug resistant epilepsy. And if the harmful aspects of cannabis outweigh the therapeutic benefits, we need to find out now, before more medically fragile children have been exposed to cannabis products that are not effective and may risk damage to vital organs, brain development, or worse.

We urge you and your fellow committee members to delay adoption of new cannabis legislation and to continue to support and encourage new research. If we can be of additional help please contact our Executive Director, Eileen Murray, at emurray@aesnet.org.

Thank you for your consideration of our position.

Sincerely,

Amy Brooks-Kayal, MD,  President, American Epilepsy Society.  Chief and Ponzio Family Chair, Children’s Hospital Colorado,  Professor of Pediatrics and Neurology, University of Colorado School of Medicine

Cannabis and cannabinoid drugs are widely used to treat disease or alleviate symptoms, but their efficacy for specific indications is not clear.

OBJECTIVE    To conduct a systematic review of the benefits and adverse events(AEs) of cannabinoids.

DATA SOURCES    Twenty-eight databases from inception to April2015.

STUDY SELECTION    Randomized clinical trials of cannabinoids for the following indications: nausea and vomiting due to chemotherapy, appetite stimulation inHIV/AIDS, chronic pain, spasticity due to multiple sclerosis or paraplegia, depression, anxiety  disorder, sleep disorder, psychosis, glaucoma, or Tourette syndrome.

DATA EXTRACTION AND SYNTHESIS    Study quality was assessed using the Cochrane risk of bias tool. All review stages were conducted independently by 2 reviewers. Where possible, data were pooled using random-effects meta-analysis.

MAIN OUTCOMES AND MEASURES     Patient-relevant/disease-specific outcomes, activities of daily living, quality of life, global impression of change, and AEs.

RESULTS    A total of 79 trials (6462participants) were included; 4 were judged at low risk of bias. Most trials  showed improvement in symptoms associated with cannabinoids but these associations did not reach statistical significance in all trials. Compared with placebo, cannabinoids were associated with a greater average number of patients showing a complete nausea and vomiting response (47%vs20%; odds ratio[OR], 3.82[95%CI,1.55-9.42]; 3 trials),reduction in pain (37%vs31%;OR,1.41[95%CI,0.99-2.00]; 8 trials), a greater average reduction in numerical rating scale pain assessment (ona0-10-point scale; weighted mean difference[WMD],−0.46[95%CI,−0.80to−0.11]; 6 trials), and average reduction in the Ashworth spasticity scale (WMD,−0.36[95%CI,−0.69to−0.05];7trials). There was an  increased risk of short-term AEs with cannabinoids, including serious AEs. Common AEs  included dizziness, dry mouth, nausea, fatigue, somnolence, euphoria, vomiting, disorientation, drowsiness, confusion, loss of balance, and hallucination.

CONCLUSIONS AND RELEVANCE There was moderate-quality evidence to support the use of cannabinoids for the treatment of chronic pain and spasticity.  There was low-quality evidence suggesting that cannabinoids were associated with improvements in nausea and  vomiting due to chemotherapy, weight gain in HIV infection, sleep disorders, and Tourette syndrome. Cannabinoids were associated with an increase d risk of short –term AEs.

Source: JAMA. 2015;313(24):2456-2473.doi:10.1001/jama.2015.6358

CHICAGO (AP) — Medical marijuana has not been proven to work for many illnesses that state  laws have approved it for, according to the first comprehensive analysis of research on its potential benefits.

The strongest evidence is for chronic pain and for muscle stiffness in multiple sclerosis, according to the review, which evaluated 79 studies involving more than 6,000 patients. Evidence was weak for many other conditions, including anxiety, sleep disorders, and Tourette’s syndrome and the authors recommend more research.

The analysis is among several medical marijuana articles published Tuesday in the Journal of the American Medical Association. They include a small study suggesting that many brand labels for edible marijuana products list inaccurate amounts of active ingredients. More than half of brands tested had much lower amounts than labeled, meaning users might get no effect.

Highlights from the journal:

THE ANALYSIS

The researchers pooled results from studies that tested marijuana against placebos, usual care or no treatment. That’s the most rigorous kind of research but many studies found no conclusive evidence of any benefit. Side effects were common and included dizziness, dry mouth and sleepiness. A less extensive research review in the journal found similar results.

It’s possible medical marijuana could have widespread benefits, but strong evidence from high-quality studies is lacking, authors of both articles say.

“It’s not a wonder drug but it certainly has some potential,” said Dr. Robert Wolff, a co-author and researcher with Kleijnen Systematic Reviews Ltd., a research company in York, England.

EDIBLE PRODUCTS

Researchers evaluated 47 brands of medical marijuana products, including candy, baked goods and drinks, bought at dispensaries in Los Angeles, San Francisco and Seattle. Independent laboratory testing for THC, marijuana’s leading active ingredient, found accurate amounts listed on labels for just 13 of 75 products. Almost 1 in 4 had higher amounts than labeled, which could cause ill effects. Most had lower-than-listed amounts. There were similar findings for another active ingredient. Products were not identified by name. Johns Hopkins University researcher Ryan Vandrey, the lead author, said he was surprised so many labels were inaccurate. The researchers note, however, that the results may not be the same in other locations. MARIJUANA LAWS Twenty-three states and Washington, D.C. have laws permitting medical marijuana use. Approved conditions vary but include Alzheimer’s disease, epilepsy, glaucoma, kidney disease, lupus and Parkinson’s disease. An editorial in the journal says approval in many states has been based on poor quality studies, patients’ testimonials or other  non-scientific evidence. Marijuana is illegal under federal law and some scientists say research has been stymied by government hurdles including a declaration that marijuana is a controlled substance with no accepted medical use. But in a notice published Tuesday in the Federal Register, the Department of Health and Human Services made it a little easier for privately funded medical marijuana research to get approved. The department said that a federal Public Health Service review of research proposals is no longer necessary because it duplicates a required review by the Food and Drug Administration. THE FUTURE Colorado, one of a few states where recreational marijuana use is legal, has pledged more than $8 million in state funds for several studies on the drug’s potential medical benefits, including whether it can reduce veterans’ symptoms of post-traumatic stress disorder. That study may begin recruiting participants later this year, said Vandrey, one of that study’s leaders. Vandrey said there’s a feeling of optimism in the research community that “we’ll start to get a good science base” for the potential medical uses of marijuana. THE RECOMMENDATIONS The editorial by two Yale University psychiatrists suggests enthusiasm for medical marijuana has outpaced rigorous research and says widespread use should wait for better evidence. Federal and state governments should support and encourage such research, the editorial says. “Perhaps it is time to place the horse back in front of the cart,” Drs. Deepak Cyril D’Souza and Mohini Ranganathan wrote in the editorial. They note that repeated recreational marijuana use can be addictive and say unanswered questions include what are the long-term health effects of medical marijuana use and whether its use is justified in children whose developing brains may be more vulnerable to its effects.

Source:  JAMA: http://jama.ama-assn.org   National Institute on Drug Abuse: http://tinyurl.com/axxzhrj   Jun 23, 2015

… By: Jodi M. Gilman and Bertha K. Madras

People will tell you that “medical marijuana” is beneficial for a variety of disorders, from anxiety and depression to glaucoma, pain, and nausea. It would certainly be terrific if smoking marijuana could have such widespread therapeutic effects! After all, it would mean that one drug can treat a multitude of different ailments, and is now actually medicine! The fact that medical marijuana is now legal and available in 23 states lends credibility to this idea. Unfortunately, there’s one critical problem with “medical marijuana”; the science to support its effectiveness and safety, the dual standard for an approved medicine, does not yet exist, if it ever will.

To be clear, “medical marijuana” refers mainly to smoked marijuana available in dispensaries, not to the FDA-approved oral medications that contain constituents of marijuana such as the psychoactive THC (tetrahydrocannabinol) or the non-psychoactive CBD (cannabidiol).  There is a THC/CBD based medication that shows benefits for spasticity in multiple sclerosis, and a THC medicine (Marinol) approved for treatment of appetite loss in people with AIDS. The FDA-approved THC-based Marinol is stocked at pharmacies, is in capsule form, and is legal in all 50 states! There is no need to vote on whether Marinol is legal because it has been thoroughly tested by the FDA. Smoked marijuana, on the other hand, has not been tested, and the FDA has not approved its use for any medical condition.

Voting on ballots or having state legislators decide what is and what is not “medicine” is not the same as scientifically testing whether a product meets standards for medicinal use. Real medicines have to go through a rigorous FDA (Food and Drug Administration) process of testing in human subjects for safety, efficacy, long term effects and side effects for a single medical condition, in addition to meeting many other standards, including measuring shelf life, manufacturing practices, labelling practices, and even inspections of the cleanliness of the facilities in which the drug is manufactured.

There are very sound reasons why this process was developed. Before FDA-approval was required for medications in 1938, companies could claim whatever they wanted about their products, and there was no recourse when people were harmed by these false claims. There are examples throughout history of people experiencing harm, going blind, and even dying from products and medicines that were not properly tested and regulated.

Later on, an important layer of regulation was added, after it became clear that certain psychoactive drugs, medical or not, could be misused, produce intoxication, lead to addiction, or cause other harms if misused. Under the Controlled Substances Act of 1970, specific criteria had to be met in order

for a drug to have accepted medical use in the United States. Failure to meet just one of these five criteria disqualifies a drug for medicinal use. These criteria are not unreasonable, and each makes sense from a medical, safety, and personal perspective. Unfortunately, marijuana fails each and every one of these criteria:

1. The chemistry of medical marijuana is not known and not reproducible.

There are lots of variables that influence the composition of marijuana; soil, water, temperature, fertilizer, different breeds of seed, age of harvested plant, and any possible toxic chemicals will affect the plant. Furthermore, the marijuana plant itself contains over 400 chemicals; most are the same chemicals present in tobacco cigarettes, and some toxic ones are present in even higher amounts.  Simply put, marijuana is not a pure compound; there is no way to make sure that ingredients are measured reliably and are consistent from one batch to another. There are no standards for how much smoked or vaporized marijuana gets into the bloodstream or into the brain. THC content and amounts vary, the time course of peak effects varies, and delivery efficiency varies.  In other words, there is absolutely no standardization of the chemical nature of medicinal marijuana. This lack of standardization wouldn’t be acceptable with any other medicine.

2. There is a lack of evidence of safety for the use of marijuana under medical supervision.  Studies have shown that long-term use of marijuana can affect memory, attention, decision-making, IQ, even brain structure and connectivity. Most, if not all, of these effects have been shown to be worse in adolescents. Clinical trials have not reported whether marijuana can be used safely long term for chronic conditions, whether it interferes with daily functioning, whether its use extends to family members or children, or what proportion of daily marijuana users become addicted to the drug, if they use it to relieve symptoms.  Trials have also not shown what range of doses is safe. Possible risks of intoxication (e.g. changed perceptions, impaired thinking, memory, judgment, driving, psychosis, risks for accidents, injuries, and falls), psychological effects (e.g. anxiety, panic, increased appetite), cardiovascular effects (e.g. increased heart rate, blood pressure), and pulmonary effects (e.g. may worsen symptoms of asthma) have not been adequately studied. Long-term effects of marijuana use (e.g. addiction, withdrawal symptoms, impaired learning and memory) have not been adequately quantified. There is virtually no research on long-term effects of marijuana used for chronic medical conditions.

3. There is a lack of evidence of efficacy of medical marijuana.

This may be the biggest problem of all! Simply, we do not know whether or not it actually works. While some people believe that marijuana makes them feel better, belief is not the same as objective proof, and the scientific evidence is largely absent. While marijuana has been approved under state laws for dozens of chronic diseases and conditions (in fact, some state laws have added the words “any other medical condition that may benefit from marijuana” to its list of conditions for which marijuana can be recommended), the evidence for efficacy for most of these targeted uses does not exist. Clinical trials of smoked marijuana (i.e., medical marijuana as it is purported to be used to confer therapeutic benefits) suffer from issues such as small sample sizes, the use of subjects who are experienced marijuana users, lack of control groups, inconsistent dosing, modest/not clinically meaningful effects, and difficulty with blinding (i.e., people can soon figure out that they are either are or are not smoking real marijuana, which “unblinds” the study). There is

evidence also that some psychiatric disorders, such as psychosis, anxiety and depression, may actually get worse when patients use marijuana. There is insufficient evidence that the benefits outweigh the risks of marijuana.

4. Qualified experts do not accept the drug.

The American Medical Association, the largest national organization representing physicians in the United States, is opposed to legalization of marijuana for medicinal purposes, calling for further study.  So is the American Society of Addiction Medicine, American Cancer Society, and a whole host of other key medical associations.  An Institute of Medicine report, from an esteemed body of physicians and scientists agreed that there is no future in smoked marijuana as a medicine, but there may be some isolated cannabinoids from the plant that have therapeutic potential.

5. Scientific evidence is not widely available.

Data from clinical trials is not available for smoked marijuana. Again, clinical trials are small and limited, and physicians, scientists, and statisticians do not have access to raw data from these trials.

Because smoked marijuana fails in all five of these categories, it should not be considered medicine. While scientists may someday discover that individual constituents of the marijuana plant at specified doses may be useful in relieving symptoms or treating certain medical conditions, proof of this medicinal effect remains elusive. This is not to deny that marijuana may actually confer therapeutic benefit; only that we don’t know currently whether smoking marijuana has clinically significant medical benefits, whether these benefits outweigh any potential risks, and whether it is possible to isolate the potential therapeutic chemicals in marijuana from the intoxicating chemicals. If you have a medical problem, chances are, there are far more effective treatments than smoked marijuana; prescribed treatments have undergone meticulous testing procedures to minimize risk. Though some may be disappointed, today’s smoked marijuana should not be confused with real medicine. Smoking and inhaling a large array of chemicals in order to deliver a drug is a backward step in medicine and a risky step for a patient.

Source:  http://www.recoveryanswers.org/   1st April 2015

DENVER, CO – MARCH, 4: Lights hang above cannabis plants in a “flower room” inside a medical cannabis cultivation facility in Denver, Colorado, U.S., on Monday, March 4, 2013. (Photo by Matthew Staver/For The Washington Post)

Across the country, there’s a growing trend toward the legalization of marijuana. Four states— Oregon, Washington, Colorado, Alaska —have voted to allow people to possess limited amounts of marijuana for personal use and also to let producers apply for licenses to produce and sell it. D.C. also just voted to allow personal possession. All of this is on top of the 23 states that allow it for medical reasons.

In some states, where businesses are also now legally cultivating and producing marijuana, a mainstream industry is emerging. Marijuana sales totalled $700 million in Colorado last year, for instance. But there’s a surprising catch. It turns out that indoor marijuana growth in particular — a cultivation method often favoured in the industry for many reasons — uses a surprising amount of energy.

Indeed, the level of power use appears to be so significant that one scholar is now suggesting that as the industry grows, states and localities should take advantage of marijuana licensing procedures to also regulate the industry’s energy use and greenhouse gas emissions.

“Given that this is a new ‘industry’ that is going to be pretty highly regulated, I felt like the state and local policymakers have a unique opportunity to incorporate energy usage and climate assessments into their state marijuana licensing fees,” says Gina Warren, a professor at the Texas A&M University School of Law whose paper, titled “Regulating Pot to Save the Polar Bear: Energy and Climate Impacts of the Marijuana Industry,”will soon appear in the Columbia Journal of Environmental Law.

The published statistics on energy use from indoor marijuana production will blow your mind (whether or not you use the stuff). In a 2012 study of the “carbon footprint of indoor cannabis production” published in the journal Energy Policy, researcher Evan Mills noted that “on occasion, previously unrecognized spheres of energy use come to light,” and marijuana is a textbook example.

The study estimated that indoor cannabis (both illegal and legal) uses $6 billion worth of electricity every year, amounting to 1 percent ofoverall U.S. electricity. And in some production-intensive states like California, it was much higher — 3 percent, Mills found.

“One average kilogram of final product is associated with 4,600 kg of carbon dioxide emissions to the atmosphere, or that of 3 million average U.S. cars when aggregated across all national production,” wrote Mills.

The reason is simply the technology required. “Specific energy uses include high-intensity lighting, dehumidification to remove water vapour and avoid mould formation, space heating or cooling during non-illuminated periods and drying, pre-heating of irrigation water, generation of carbon dioxide by burning fossil fuel, and ventilation and air-conditioning to remove waste heat,” writes Mills.

Outdoor production also has environmental consequences —it has been charged with deforestation and high levels of water and pesticide use.But as pot becomes more legal and mainstream, notes Warren, outdoor producers will have to abide by pre-existing environmental laws, just like everyone else.

In effect, that makes indoor production the chief climate change and energy concern. According to Warren’s article, while underground indoor marijuana production already consumed plenty of energy, legalization will increase energy use even farther. “As theindustry grows, so will its negative externalities,” she writes.

Which is why she’s proposing that states that legalize marijuana use should also require the growing industry to power itself cleanly. And it’s not without precedent: Starting in October of this year, Boulder County in Colorado will require many marijuana facilities to “directly offset 100% of electricity, propane, and natural [gas] consumption” through renewables or other means.

Warren says she’s not “picking on the marijuana industry” with her proposals — it’s just that, well, we don’t often have new industries appear that use a lot of energy and are likely to be highly regulated as they become legal.

“I think it could actually be a marketing tool for the industry,” says Warren, “because if you have people who are purchasing the product who are the type of individual who cares about the environment, then they would gravitate towards the green marijuana production.”

Source:http://www.washingtonpost.com/

CLEARING THE HAZE

….The ugly truth is that Colorado was suckered. It was promised regulation and has been met by an industry that fights tooth and nail any restrictions that limit its profitability.”  Ben Cort, Director of Professional Relations for the Center for Additction Recovery and rehabilitation at the University Of Colorado Hospital

Source:   http://gazette.com/clearingthehaze

REGULATION STILL INEFFECTIVE

But how it would work was described only in general terms and sound bites before voters headed to the polls to make a decision Gov. John Hickenlooper later would call “reckless” and “a bad idea” and new Colorado Attorney General Cynthia Coffman declared “not worth it” to dozens of state attorneys general last month.

Source:http://www.washingtonexaminer.com/regulation-still-ineffective/article/2562323?custom_click=rss

NO APPROVED MEDICINE IN MARIJUANA

Dr. Stuart Gitlow, a physician serving as president of the American Society of Addiction Medicine, does not mince words: “There is no such thing at this point as medical marijuana,” he said. It’s a point he has made routinely for the past decade, as advocates for marijuana legalization have claimed the drug treats an array of serious illnesses, or the symptoms of illnesses, including cancer, depression, epilepsy, glaucoma and HIV, the virus that causes AIDS.

Source:http://www.washingtonexaminer.com/no-approved-medicine-in-marijuana/article/2562336

LEGALIZATION DIDN’T UNCLOG PRISONS

Of all the misunderstandings about marijuana’s impact on the country, perhaps none is greater than the belief that America’s courts, prisons and jails are clogged with people whose only offense was marijuana use. This is the perception, but statistics show few inmates are behind bars strictly for marijuana-related offenses, and legalization of the drug will do little to affect America’s growing incarceration numbers.

Source:http://www.washingtonexaminer.com/legalization-didnt-unclog-prisons/article/2562326

DRUG USE A PROBLEM FOR EMPLOYERS

“This is a very troublesome issue for our industry, but I do not see us bending or lowering our hiring standards,” Johnson said. “Our workplaces are too dangerous and too dynamic to tolerate drug use. And marijuana? In many ways, this is worse than alcohol. I’m still in shock at how we (Colorado) voted. Everyone was asleep at the wheel.”

Source:http://www.washingtonexaminer.com/drug-use-a-problem-for-employers/article/2562334

MEDICAL MARIJUANA INDUSTRY STILL GROWING

And amid all the hoopla around legalized recreational pot, its older cousin, the medical marijuana (MMJ) industry — with 505 stores throughout Colorado — quietly continued to grow, adding patients by the thousands who seemingly had no problem finding physicians willing to diagnose what critics say are often phantom medical conditions. Statewide, the number of people on the Medical Marijuana Registry grew 4 percent in 2014 — the first year of legal recreational sales — from 111,030 to 115,467 by year’s end.

Source:http://www.washingtonexaminer.com/medical-marijuana-industry-still-growing-in-colorado/article/2562335

 Colorado released a sweeping report Monday about marijuana and health — everything from pot’s effect on drivers, asthma, cancer rates and birth defects.

The 188-page report doesn’t include new research on marijuana. Instead, it’s a review of what its authors call limited existing studies.

The report looks at studies showing that risk of a motor vehicle crash doubles among drivers with recent marijuana use, and that heavy use of marijuana is associated with impaired memory.

Other highlights from the report:

— In adults, heavy use of marijuana is associated with impaired memory, persisting a week or more after quitting.

— Maternal use of marijuana during pregnancy is associated with negative effects on exposed offspring, including decreased academic ability, cognitive function and attention.

— Regular marijuana use by adolescents and young adults is strongly associated with developing psychotic symptoms and disorders such as schizophrenia in adulthood.

The Colorado Department of Public Health and Environment review was ordered by state lawmakers. A panel of doctors met for several months to compile the survey, which was delivered to lawmakers last week.

The report also lays out areas where there is limited evidence, or where research is lacking.

For example, the report found insufficient evidence to say how long after smoking pot a person is impaired. Other areas of scanty research:

— Doctors noted there is little available research on the health effects of edible or concentrated marijuana.

— Marijuana smoke contains “many of the same cancer-causing chemicals as tobacco smoke.” But doctors noted there is “limited” or “mixed” evidence to suggest pot-smoking is associated with greater risk of lung cancer or other respiratory health effects.

The doctors suggested additional education about the health effects of marijuana and asked for increased public-health surveys about how people use pot.

Researchers noted that because marijuana use was illegal nationwide until 1996 — when California voters approved the first medical uses for pot — research is extremely limited. Marijuana research has historically looked for adverse effects, not possible health benefits.

“This legal fact introduces both funding bias and publication bias into the body of literature related to marijuana use,” authors noted.

Colorado last year funded eight studies to examine possible health benefits of marijuana, including treatment for seizures, Parkinson’s disease and post-traumatic stress disorder. Those studies, totalling about $8 million, may not have results for several years.

Source: CBS  Feb.02 2015   http://denver.cbslocal.com/2015/02/02/colorado-publishes-review-of-marijuana-health-research/

Jehle CC Jr1, Nazir N, Bhavsar D.

Abstract

The use of cannabis is currently increasing according to U.S. Department of Health and Human Services (HHS). Surprisingly, cannabis use among burn patients is poorly reported in literature. In this study, rates of cannabis use in burn patients are compared with general population.

Data from the National Burn Repository (NBR) were used to investigate incidence, demographics, and outcomes in relation to use of cannabis as evidenced by urine drug screen (UDS). Thousands of patients from the NBR from 2002 to 2011 were included in this retrospective study.

Inclusion criteria were patients older than 12 years of age who received a drug screen. Data points analyzed were patients’ age, sex, UDS status, mechanism of burn injury, total body surface area, length of stay, ICU days, and insurance characteristics. Incidence of cannabis use in burn patients from the NBR was compared against national general population rates (gathered by Health and Human Services) using chi-square tests. Additionally, the burn patient population was analyzed using bivariate analysis and t-tests to find differences in the characteristics of these patients as well as differences in outcomes. Seventeen thousand eighty out of over 112,000 patients from NBR had information available for UDS.

The incidence of cannabis use is increasing among the general population, but the rate is increasing more quickly among patients in the burn patient population (P = .0022). In 2002, 6.0% of patients in burn units had cannabis+ UDS, which was comparable with national incidence of 6.2%. By 2011, 27.0% of burn patients tested cannabis+ while national incidence of cannabis use was 7.0%. Patients who test cannabis+ are generally men (80.1%, P < .0001) and are younger on average (35 years old vs 42, P < .0001). The most common mechanisms of injury among patients who test cannabis+ or cannabis- are similar. Flame injury makes up >60% of injuries, followed by scalds that are >15%. In comparing cannabis+/- patients, cannabis+ patients are more likely to be uninsured (25.2% vs 17.26%, P < .0001). Finally, patients who test cannabis+ have larger burns (TBSA% of 12.94 vs 10.98, P < .0001), have a longer length of stay (13.31 days vs 12.6, P = .16), spend more days in the ICU (7.84 vs 6.39, P = .0006), and have more operations (2.78 vs 2.05, P < .0001).

The rate patients testing positive for cannabis in burn units is growing quickly. These patients are younger and are less likely to be insured. These patients also have larger burns, spend more time in ICUs, and have a greater number of operations. The increasing use of cannabis, as expected from legalization of cannabis in multiple states, among burn patient population may lead to increased burden on already tenuous health care resources.

Source: J Burn Care Res. 2015 Jan-Feb;36(1):e12-7. doi: 10.1097/BCR.0000000000000192.

A close look at the under-25 age group shows cognitive decline, poor attention and memory and decreased IQ among those who regularly smoke pot — defined as at least once a week.

Teenagers and young adults who frequently use marijuana may be hurting their brainpower, according to studies about pot and adolescence presented today at the American Psychological Association’s annual convention. A close look at the under-25 age group shows cognitive decline, poor attention and memory and decreased IQ among those who regularly smoke pot, defined as at least once a week, says Krista Lisdahl, director of the brain-imaging and neuropsychology lab at the University of Wisconsin-Milwaukee.

“It needs to be emphasized that regular cannabis use, defined here as once a week, is not safe and may result in addiction and neurocognitive damage, especially in youth,” says a study she co-wrote in the June issue of the journal Current Addiction Reports.

Lisdahl says recent moves toward legalization and decriminalization of marijuana as well as increases in youth use have focused new attention on studies such as hers and others seeking to know more about the impact on youth and their developing brains.  “The adolescent period is a sensitive period of neurodevelopment,” she says.

Overall, marijuana use begins in the later teens, around age 16 or 17, peaks in the early 20s and drops off between ages 23 and 25, says Lisdahl.  “Is it a coincidence that use significantly goes down at 25 when the brain is at its full maturation? I don’t think so,” she says.

Lisdahl says recent studies show increases in marijuana use among high school seniors and young adults. And brain-imaging studies of these regular marijuana users have shown significant changes in brain structure, especially among teens. Brain imaging shows abnormalities in the brain’s gray matter — which is associated with intelligence — have been found in 16- to 19-year-olds whose pot smoking increased in the previous year, she says.

A study co-written by Bettina Friese, a research scientist at the Pacific Institute for Research and Evaluation in California, analyzed data from 17,482 teenagers in Montana and found that pot smoking was higher in counties where larger numbers of people voted to legalize medical marijuana in 2004.

“People don’t perceive it as a very harmful substance, and these community norms translate to teens,” she says. “From the teen study, they do reference legalization:   ‘If it was that bad a drug, they wouldn’t be trying to legalize it.’ “

But psychologist Alan Budney, of Dartmouth College, (who works in treatment) says marijuana now is likely a more dangerous product and may mean greater chances for addiction since some legalized forms have higher levels of tetrahydrocannabinol, or THC, the major psychoactive chemical.

“Unfortunately, much of what we know from earlier research is based on smoking marijuana with much lower doses of THC than are commonly used today,” he says. “All we know so far is that more people are showing up in the ERs with adverse effects. We’ve only seen a little bit of it with marijuana, but now we’re seeing more of it.”

Budney worries that teen pot use is “much, more troublesome” because teens are more vulnerable to the negative consequences of overuse.  “It is just as hard to treat cannabis addiction as it is to treat alcohol addiction,” he says.

Source: www.usatoday.com 9th August 2014

If I had a world of my own, everything would be nonsense. Nothing would be what it is, because everything would be what it isn’t.”

-Alice In Wonderland

Why is it that all of the conversation nowadays on the subject of medical marijuana leaves me feeling like we have all fallen down the proverbial rabbit hole? Voices in the discussion, who would normally have been considered sensible and sane, are now being made to seem provincial, prudish, callous and even crazy. All the while, those who once were considered “a little crazy” in their views are being held up as open-minded, wise, sensible and compassionate. How have we, in so short a time, come to a point where the whole debate seems to be turned upside-down?

It seems to me this curious turn has come about by blowing a lot of smoke at the State Legislature and among Nevada voters. Unfortunately after tumbling down that rabbit hole, we have come to this strange place where nothing can be seen as what it is, and everything seems to be nonsense.

Here are just a few of the strange myths and misperceptions which have actually gotten traction on the subject of medical marijuana.

It’s Just a Harmless Little Vice

The advocates of medical marijuana often are the same folks who downplay the effects of cannabis products; both on public health and on society as a whole. They would say, “Lighten up, man! It’s not a big deal. It’s just a modest vice, no different from alcohol or tobacco.” They would argue that marijuana’s mild consequences affect only the person who takes it. Overall societal consequences are minimal.

Of course, the more savvy advocates among them would quickly change the subject and say that this really isn’t about the free recreational use of marijuana. All that is irrelevant. Rather, it is about the rights of a small group of seriously ill people to derive some comfort or benefit from using marijuana as a medicine. No doubt, they would produce studies showing that marijuana has helped people through terminal illnesses or severe pain. They will cite other studies that show children prone to seizures deriving benefits from marijuana products. Some studies might even claim that the substance has curative powers against cancer or other terminal diseases.

Of course, it’s hard to argue with this. Medical studies are a dime a dozen nowadays; and it seems you can find a study to prove any point you want to make. Still, I, for one, won’t reject the idea that the marijuana plant may have important and valid medicinal uses. I believe that every plant is here on earth for an intended good purpose. So there may indeed be severe cases where marijuana is helpful in managing pain or bringing comfort to a suffering patient. I doubt anyone would deny such a person the one treatment that might help, just because it happens to be marijuana.

On the other hand, I also know human nature all too well. Common sense dictates that there are always a lot of people out there trying to game the system. And I’d predict that a majority of medical marijuana cardholders will not be those extreme cases we are talking about. Rather they will be people willing to say whatever is necessary to have access to the substance. Let’s face it, the use of medical marijuana will become much more widespread than just those few extreme and justifiable cases. It will undoubtedly have a way of spilling over its bounds onto people who have no medical need for it whatsoever.

And that kind of marijuana use is just what bothers most of the medical marijuana naysayers. That’s because it comes at a huge cost to society.Marijuana has been shown to dull the senses, slow down productivity, degrade intelligence and disable employees in the workforce. It has also been shown to cause an increase in certain types of crimes in the neighborhoods and communities where it is present; including violent crimes. Marijuana does NOT only affect the one who takes it. It affects homes, families and schools. It affects children, spouses, neighbors and other innocent bystanders.

So don’t let the proponents of medical marijuana downplay the real effects of this substance on the community.Make no mistake. This is not just a harmless little vice we are talking about. Marijuana use is a bad thing for communities, for the nation and for society as a whole.

 The Myth Of Regulation

Of course, there is the argument that the full regulation of marijuana would be far better than the black market model of distribution we have now. This concept may have merit. But numerous problems with the state law, and careful observation of other states where marijuana has been legalized, seem to indicate that marijuana can’t really be regulated in a meaningful way at this point by the states.

The fact that federal law prohibits the use of marijuana; medical or not; makes regulation by the states problematic to say the least. In the case of medical use, it requires the establishment of an alternative state distribution system outside of the standard FDA-regulated pharmacy distribution.

Coming up with a problem-free system for that is a tall order. Recently passed Nevada state law has tried to tackle it; but there are still a multitude of unintended loopholes and catch-22s that have come up.

Meanwhile, it comes as no surprise that medical marijuana has become an emerging big business opportunity in Nevada.And wherever there is a lot of money involved, there will also be those who will exploit the loopholes and catch-22s. That leads to plenty of unintended consequences.

Moapa Valley is on track to become a victim to at least one of these unintended consequences. One provision in the law allows registered marijuana cardholders to grow their own medical supply if there is not a registered dispensary within 25 miles of their home. Of course, the local town advisory boards have wisely stood firm in saying ‘No!’ to marijuana dispensaries in these communities. Even if their answer had been ‘yes,’ it is doubtful whether a dispensary operator would choose to locate here due to such low demand and minimal profit potential.

So what does that mean? Well, without a licensed dispensary around, anyone with a doctor’s note can obtain a medical marijuana card allowing them to legally grow far more marijuana here in their local basement than they would ever use for medical purposes. And “Dr. Reefer” (of Las Vegas billboard fame) is reportedly giving those cards out to anyone who claims to have a headache.

So what happens when some of these urban cardholders find out (as they inevitably will) that there is a quiet little town nearby where they could legally cultivate an ongoing crop of marijuana with minimal regulation? What’s more, by selling the excess of said crop on the black market, they could easily add $1,000 a month or more to their household income! Well, as Mesquite Mayor Al Litman said last week in a city council meeting, we are “bound to see some budding entrepreneurs moving into the community.” And they probably won’t be the type to join the Chamber of Commerce or flip pancakes at Rotary Club Breakfasts.

As the state law is now, this will change things for Moapa Valley, beginning early next year. The home-growers will move in and set up shop. And eventually all of those adverse effects of marijuana at-large in the community will begin to be felt here in these little towns.

The state law, as currently written, leaves no good option for towns like Moapa Valley and Moapa in combatting this catch-22. It is not a matter of choice whether we want marijuana in our community or not. We will have it.

Fortunately, there have been some recent efforts begun by local leaders to appeal to our State Legislators asking for changes to be enacted in the law at next year’s session. A few small revisions in the wording of the law could provide better options for small outlying communities in this matter. We applaud these efforts by town board members and other leaders; and we hope they will be successful.

 The Elephant In The Room

Finally, we must address the concept that everyone sees, but no one wants to admit is there. Whether it’s advocates confess it or not, medical marijuana is just a brief sleight of hand to divert public attention away from the real goal which is the enactment of full recreational use.

With that being so obviously the case; and the whole medical marijuana discussion being a flim-flam sham leading up to it; the whole thing feels even more like we are falling down Alice’s rabbit hole into a strange world of nonsense.

Honestly! How is a sensible person supposed to engage in an intelligent conversation about the medical benefits of marijuana; and talk about how we will all be better off if it is regulated by government agencies; when we all know that we aren’t just talking about medical use at all. It’s obvious that once a medical use distribution system is established, well regulated or not, it will be just one more little nibble of the mushroom before the conversation will have suddenly expanded into full recreational use right before our eyes. And that would be truly nothing short of madness.

At that point, the once sensible voices in the debate will exclaim, like Alice did in Lewis Carroll’s classic story book, “But we don’t want to go among mad people!”To which marijuana proponents will respond as did the famous Hatter, “Oh, you can’t help that, my dear. We’re all mad here!”

Source: http://mvprogress.com/ 16 July 2014

http://mvprogress.com/2014/07/16/from-the-editors-desk-down-the-rabbit-hole/

Cannabis has long been used for medicinal as well as recreational purposes.  Few topics spark as much debate on this blog and on our Facebook page than cannabis.

So we thought we’d take a look at the common questions raised about the evidence and research into cannabis, cannabinoids (the active chemicals found in the plant and elsewhere) and cancer, and address some of the wider issues that crop up in this debate.

This post is long, but can be summarised by saying that at the moment there isn’t enough reliable evidence to prove that cannabinoids – whether natural or synthetic – can effectively treat cancer in patients, although research is ongoing around the world.

What are cannabinoids and how do they work? “Cannabinoids” is a blanket term covering a family of complex chemicals (both natural and man-made) that lock on to cannabinoid receptors – protein molecules on the surface of cells.

Humans have been using cannabis plants for medicinal and recreational purposes for thousands of years, but cannabinoids themselves were first purified from cannabis plants in the 1940s. The structure of the main active ingredient of cannabis plants – delta-9 tetrahydrocannabinol (THC) – was discovered in the 60s. It wasn’t until the late 1980s that researchers found the first cannabinoid receptor, followed shortly by the discovery that we create cannabinoid-like chemicals within our own bodies, known as endocannabinoids.

The CB1 and CB2 receptors.

We have two different types of cannabinoid receptor, CB1 and CB2, which are found in different locations and do different things. CB1 is mostly found on cells in the nervous system, including certain areas of the brain and the ends of nerves throughout the body, while CB2 receptors are mostly found in cells from the immune system. Because of their location in the brain, it’s thought that CB1 receptors are responsible for the infamous ‘high’ (known as psychoactive effects) resulting from using cannabis.

Over the past couple of decades scientists have found that endocannabinoids and cannabinoid receptors are involved in a vast array of functions in our bodies, including helping to control brain and nerve activity (including memory and pain), energy metabolism, heart function, the immune system and even reproduction. Because of this molecular multitasking, they’re implicated in a huge range of illnesses, from cancer to neurodegenerative diseases.

Can cannabinoids treat cancer?

There is no doubt that cannabinoids – both natural and synthetic – are interesting biological molecules. Hundreds of scientists around the world are investigating their potential in cancer and other diseases – as well as the harms they can cause – brought together under the blanket organisation The International Cannabinoid Research Society.

Researchers first looked at the anticancer properties of cannabinoids back in the 1970s, and many hundreds of scientific papers looking at cannabinoids and cancer have been published since then. This Wellcome Witness seminar is also fascinating reading for aficionados of the history of medical cannabis, including the scientific, political and legal twists. [Updated KA 26/03/14]

But claims that this body of preclinical research is solid “proof” that cannabis or cannabinoids can cure cancer is highly misleading to patients and their families, and builds a false picture of the state of progress in this area.    Let’s take a closer look at the evidence.

Lab research

Virtually all the scientific research investigating whether cannabinoids can treat cancer has been done using cancer cells grown in the lab or animal models. It’s important to be cautious when extrapolating these results up to real live patients, who tend to be a lot more complex than a Petri dish or a mouse.

Virtually all the research into cannabinoids and cancer so far has been done in the lab.

Through many detailed experiments, handily summarised in this recent article in the journal Nature Reviews Cancer, scientists have discovered that various cannabinoids (both natural and synthetic) have a wide range of effects in the lab, including:

* Triggering cell death, through a mechanism called apoptosis

* Stopping cells from dividing

* Preventing new blood vessels from growing into tumours

* Reducing the chances of cancer cells spreading through the body, by stopping cells from moving or invading neighbouring tissue

* Speeding up the cell’s internal ‘waste disposal machine’ – a process known as autophagy – which can lead to cell death

All these effects are thought to be caused by cannabinoids locking onto the CB1 and CB2 cannabinoid receptors. It also looks like cannabinoids can exert effects on cancer cells that don’t involve cannabinoid receptors, although it isn’t yet clear exactly what’s going on there.

So far, the best results in the lab or animal models have come from using a combination of highly purified THC and cannabidiol (CBD), a cannabinoid found in cannabis plants that counteracts the psychoactive effects of THC. But researchers have also found positive results using synthetic cannabinoids, such as a molecule called JWH-133.

It’s not all good news though, as there’s also evidence that cannabinoids may also have undesirable effects on cancer.

For example, some researchers have found that although high doses of THC can kill cancer cells, they also harm crucial blood vessel cells, although this may help their anti-cancer effect by preventing blood vessels growing into a tumour. And under some circumstances, cannabinoids can actually encourage cancer cells to grow, or have different effects depending on the dosage and levels of cannabinoid receptors present on the cancer cells. [Edited for clarity and to add reference – KA 27/07/12] Others have discovered that activating CB2 receptors may actually interfere with the ability of the immune system to recognise and destroy tumour cells, although some scientists have found that certain synthetic cannabinoids may enhance immune defences against cancer. Furthermore, cancer cells can develop resistance to cannabinoids and start growing again, although this can be got round by blocking a certain molecular pathway in the cells known as ALK.  combining cannabinoids with other chemotherapy drugs may be a much more effective approach

And yet more research suggests that combining cannabinoids with other chemotherapy drugs may be a much more effective approach. This idea is supported by lab experiments combining cannabinoids with other drugs including gemcitabine and temozolomide.

Clinical research But that’s the lab – what about clinical research involving people with cancer? Results have been published from only one clinical trial testing whether cannabinoids can treat cancer in patients, led by Dr Manuel Guzman and his team in Spain. Nine people with advanced, terminal glioblastoma multiforme – an aggressive brain tumour – were given highly purified THC through a tube directly into their brain.

Eight people’s cancers showed some kind of response to the treatment, and one didn’t respond at all. All the patients died within a year, as might be expected for people with cancer this advanced.

The results from this study show that THC given in this way is safe and doesn’t seem to cause significant side effects. But because this was an early stage trial, without a control group, it’s impossible to say whether THC helped to extend their lives. And while it’s certainly not a cure,  the trial results suggest that cannabinoids are worth pursuing in clinical trials. There is also a published case report of a 14-year old girl from Canada who was treated with cannabis extracts (also referred to as “hemp oil”), but there is limited information that can be obtained from a single case treated with a varied mixture of cannabinoids. More published examples with detailed data are needed in order to draw a fuller picture of what’s going on. [Updated 26/03/14, KA]

A handful of other clinical trials of cannabinoids are currently being set up. We are helping to support the only two UK trials of cannabinoids for treating cancer, through our Experimental Cancer Medicine Centre (ECMC) Network funded by Cancer Research UK and the devolved Departments of Health. One early-stage trial is testing a synthetic cannabinoid called dexanabinol in patients with advanced cancer, and the other is an early-stage trial testing a cannabis extract called Sativex for treating people with glioblastoma multiforme brain tumours. [Edited to add more information about the trials – KA 22/08/12, KA 24/03/14]

Unanswered questions

There are still a lot of unanswered questions around the potential for using cannabinoids to treat cancer.

The biggest issue is that there isn’t enough evidence to show that they can treat cancer in people, although research is still ongoing around the world.

And it’s not clear which type of cannabinoid – either natural or synthetic – might be most effective, what kind of doses might be needed, or which types of cancer might respond best to them. So far there have been intriguing results from lab experiments with prostate, breast, lung cancer, skin, bone and pancreatic cancers, glioma brain tumours and lymphoma. But the take-home message is that different cannabinoids seem to have different effects on various cancer types, so they are far from being a ‘universal’ treatment.

Most research has been focused on THC, which occurs naturally in cannabis plants, but researchers have found that different cannabinoids seem to work better or worse different types of cancer cells. Lab experiments have shown promising results with THC on brain tumour and prostate cancer cells, while CBD seems to work well on breast cancer cells.

Then there’s the problem of the psychoactive effects of THC, particularly at high doses, although this can be counteracted by giving it together with CBD. Because of this problem, synthetic cannabinoids that don’t have these effects might be more useful in the long term.

There are also big questions around the best way to actually get the drugs into tumours. Because of their chemical makeup, cannabinoids don’t dissolve easily in water and don’t travel very far in our tissues. This makes it hard to get them deep into a tumour, or even just deliver them into the bloodstream in consistently high enough doses to have an effect.

The clinical trial led by Dr Guzman in Spain involved directly injecting cannabinoids into patients’ brains through a small tube. This isn’t an ideal method as it’s very invasive and carries a risk of infection, so researchers are investigating other delivery methods such as tablets, oil injections, mouth sprays or even microspheres.

We also don’t know whether cannabinoids will help to boost or counteract the effects of chemotherapy, nor which combinations of drugs might be good to try. And there are currently no biological markers to help doctors identify who might benefit from cannabinoids and who might not – remember that one patient on the brain tumour trial failed to respond to THC at all.

None of these issues are deal-breakers, but these questions need answering if there’s any hope of using cannabinoids to effectively and safely treat cancer patients.

there are hundreds of exciting potential cancer drugs being developed and tested in university, charity and industry labs all over the world – cannabinoids are merely a small part of a much larger picture

It’s worth remembering that there are hundreds of exciting potential cancer drugs being developed and tested in university, charity and industry labs all over the world – cannabinoids are merely a small part of a much larger picture.

Most of these compounds will never make it into the clinic to treat patients for a huge range of reasons including toxicity, lack of effectiveness, unacceptable side effects, or difficulty of delivering the drug to tumours.

Without doing rigorous scientific research, we will never sift the ‘hits’ from the ‘misses’. If cannabinoids are ever to get into clinical use, they need to overcome these hurdles and prove they have benefits over existing cancer treatments.

Can cannabis prevent or cause cancer?

So that’s a brief look at cannabinoids to treat cancer. But can they stop the disease from developing? Or could they play a role in causing cancer?

There’s controversy around the health risks of cannabis.

In experiments with mice, animals given very high doses of purified THC seemed to have a lower risk of developing cancer, and there has been some research suggesting that endocannabinoids (cannabinoids produced by the body) can suppress tumour growth. But there’s no solid scientific evidence at the moment to show that cannabinoids or cannabis can cut the risk of cancer in people.

When it comes to finding out whether cannabis can cause cancer, the evidence is a lot murkier. This is mainly because most people who use cannabis smoke it mixed with tobacco, a substance that definitely does cause cancer. This complex issue recently hit the headlines when the British Lung Foundation released a study suggesting that the cancer risks of cannabis had been underestimated, although this has been questioned by some experts including Professor David Nutt.

What about controlling cancer symptoms such as pain or sickness?

Although there’s a lack of data showing that cannabinoids can effectively treat cancer, there is good evidence that these molecules may be beneficial in other ways. As far back as the 1980s, cannabinoid-based drugs – including dronabinol (synthetic THC) and nabilone – were used to help reduce nausea and vomiting caused by chemotherapy. But there are now safer and more effective alternatives and cannabinoids tend to only be used where other approaches fail.

In some parts of the world – including the Netherlands – medical use of marijuana has been legalised for palliative use (relieving pain and symptoms), including cancer pain. For example, Dutch patients can obtain standardised, medicinal-grade cannabis from their doctor, and medicinal cannabis is available in many states in the US.

But one of the problems of using herbal cannabis is about dosage – smoking it or taking it in the form of tea often provides a variable dose, which may make it difficult for patients to monitor their intake. So researchers are turning to alternative dosing methods, such as mouth sprays, which deliver a reliable and regulated dose.

Large-scale clinical trials are currently running in the UK testing whether a mouth spray called Sativex (nabiximols) – a highly purified pharmaceutical-grade extract of cannabis containing THC and CDB – can help to control severe cancer pain that doesn’t respond to other drugs.

There may also be potential for the use of cannabinoids in combating the loss of appetite and wasting experienced by some people with cancer, although a clinical trial comparing appetite in groups of cancer patients given cannabis extract, THC and a placebo didn’t find a difference between the treatments.

Is Cancer Research UK investigating cannabinoids?

We want to see safe, reliable and effective treatments become available for patients as quickly as possible. We receive no government funding for our research, and it is all paid for by the generosity of the public.  This is obviously not a bottomless purse, and we do not have financial reserves to draw on.

Because of this limitation, we can only fund the very best research proposals that come to us that will bring benefits to people with cancer.  We’ve previously written in detail about how we fund research projects. Cancer Research UK has funded research into cannabinoids, notably the work of Professor Chris Paraskeva in Bristol investigating the properties of cannabinoids as part of his research into the prevention and treatment of bowel cancer. He has published a number of papers detailing lab experiments looking at endocannabinoids as well as THC, and written an interesting review looking at the potential of cannabinoids for treating bowel cancer.

Our funding committees have previously received other applications from researchers who want to investigate cannabinoids that have failed to reach our high standards for funding. If we receive future proposals that do meet these stringent requirements, then there is no reason why they would not be funded – assuming we have the money available to do so.

We support the only two UK clinical trials of cannabinoids for treating cancer through our national network of Experimental Cancer Medicine Centres, funded by Cancer Research UK and the devolved Departments of Health. One is an early-stage trial testing a synthetic cannabinoid called dexanabinol for people with advanced cancer, the other is an early-stage trial testing a drug called Sativex (an extract from cannabis plants) for people with glioblastoma multiforme brain tumours. [Added 22/08/12 – KA, Updated KA 25/03/14]

“It’s natural so it must be better, right?” There’s no doubt that the natural world is a treasure trove of biologically useful compounds. But whole plants or other organisms are a complex mix of hundreds of chemicals (not all of which may be beneficial) and contains low or variable levels of active ingredients. This makes it difficult to give accurate doses and runs the risk of toxic side effects. For example, foxgloves (Digitalis) are a useful source of chemicals called cardiac glycosides, first purified in 1785 – a date widely considered to be the beginning of modern drug-based medicine. These drugs are now used to treat many thousands of people around the world with heart failure and other cardiac problems. But the entire plant itself is highly toxic, and eating just a small amount can kill. As another example, although the antibiotic penicillin was first discovered in a fungus, it doesn’t mean that someone should munch some mould when suffering an infection. In fact, the bug-beating powers of ‘natural’ penicillin are confined to a relatively small range of bacteria, and chemists have subsequently developed a wider range of life-saving antibiotics based on the drug’s structure. Aspirin is another old drug, first discovered in the form of salicylic acid in white willow bark. But this naturally-occurring chemical causes severe stomach irritation, which led to the German company Bayer developing an alternative version – acetylsalicylic acid – which was kinder to the tummy. Aspirin is now arguably one of the most successful drugs of all time, and is still being investigated for its potential in preventing or even treating cancer.

Numerous potent cancer drugs have also been developed in this way – purifying a natural compound then improving it and testing it to create a beneficial drug – including taxol (originally from yew leaves); vincristine and vinblastine (from rosy periwinkles); camptothecin (from the Chinese Xi Shu tree); colchicine (from crocuses); and etoposide (from the May Apple). And we recently wrote about a clinical trial being run by our scientists to test whether curcumin, a purified chemical from the curry spice turmeric, could help treat people with advanced bowel cancer.

But it bears repeating that the fact that these purified drugs in controlled, high doses can treat cancer doesn’t mean that the original plant (or a simple extract) will have the same effect.  So although cannabis contains certain cannabinoids, it doesn’t automatically follow that cannabis itself can treat cancer.

As we said above, there is no good evidence that natural cannabinoids, at the doses present in simple cannabis preparations, can treat cancer in patients. It’s also completely unknown whether there may be any other chemicals in ‘street’ cannabis extracts that could be harmful to patients or even encourage tumour growth.

“Have you seen this video? This guy says cannabis cures cancer!”

There is a strong and persistent presence on the internet arguing that cannabis can cure cancer. For example, there are numerous videos and unverified anecdotes claiming that people have been completely cured of cancer with cannabis, hemp/cannabis oil or other cannabis derivatives.

YouTube videos are not scientific evidence.

Despite what the supporters of these sources may claim, videos and stories are not scientific evidence for the effectiveness of any cancer treatment. Extraordinary claims require extraordinary evidence – YouTube videos are emphatically not scientific evidence, and we are not convinced by them.

Based on the arguments presented on these kinds of websites, it’s impossible to tell whether these patients have been ‘cured’ by cannabis or not. We know nothing about their medical diagnosis, stage of disease or outlook. We don’t know what other cancer treatments they had. We don’t know about the chemical composition of the treatment they got. And we only hear about the success stories – what about the people who have tried cannabis and not been cured? People who make these bold claims for cannabis only pick their best cases, without presenting the full picture.

This highlights the importance of publishing data from scientifically rigorous lab research and clinical trials. Firstly because conducting proper clinical studies enables researchers to prove that a prospective cancer treatment is safe and effective. And secondly because publishing this data allows doctors around the world to judge for themselves and use it for the benefit of their patients.

This is the standard to which all cancer treatments are held, and it’s one that cannabinoids should be held to too. Internet anecdotes and videos prove nothing and benefit no-one – we need reliable, scientific research, which (as discussed above) is exactly what is going on.

“It’s all a big conspiracy – you don’t want people to be cured!” As we’ve previously said, accusations that we are somehow part of a global conspiracy to suppress cancer cures are as absurd as they are offensive. Not only to the thousands of our scientists, doctors and nurses who are working as hard as they can to find more effective treatments for the complex set of challenging diseases we call cancer, but also the hundreds of thousands of people in the UK and beyond who support this life-saving work through generous donations of money, energy and time.

Our aim is to beat cancer through research

Our aim is to beat cancer, and we believe that the best way to do this through rigorous scientific research aimed at understanding cancer on a biological level and working out how to prevent, detect and treat it more effectively. This approach has helped to change the face of cancer prevention, diagnosis, treatment, leading to a doubling in survival rates over the past 40 years.

As a research-based organisation, we want to see reliable scientific evidence to support claims made about any cancer treatment, be it conventional or alternative.  The claims made for many alternative cancer therapies still require solid evidence to support them, and it often turns out that these ‘miracle cures’ simply don’t work when they’re put to the test.

This doesn’t mean there’s a conspiracy to suppress the “True Cure for Cancer” – it means that doctors and researchers want to see solid evidence that the claims made by people peddling these treatments are true.

This is vital because lives are at stake. Some people may think that a cancer patient has nothing to lose by trying an alternative treatment, but there are big risks.

“What’s the harm? There’s nothing to lose.”

If someone chooses to reject conventional cancer treatment in favour of unproven alternatives, including cannabis, they may miss out on treatment that could save or significantly lengthen their life. They may also miss out on effective symptom relief to control their pain and suffering, or the chance to spend precious time with their loved ones.

Furthermore, many of these unproven therapies come at a high price, and are not covered by the NHS or medical insurance. And, in the worst cases, an alternative therapy may even hasten death.

Although centuries of human experimentation tells us that naturally-occurring cannabinoids are broadly safe, they are not without risks. They can increase the heart rate, which may cause problems for patients with pre-existing or undiagnosed heart conditions. They can also interact with other drugs in the body, including antidepressants and antihistamines. And they may also affect how the body processes certain chemotherapy drugs, which could cause serious side effects. There is also a reported case where a Dutch lung cancer patient took cannabis extract that had been bought from a street source. Within a matter of hours she was in hospital in a coma. This highlights the risks of taking ‘street’ cannabis extracts of unknown concentration and quality in an uncontrolled way, and accentuates the need for careful research into how best to use cannabinoids for treating patients.

when conventional treatment fails, there is little chance that turning to an unproven alternative touted on the internet will provide a cure It is a sad fact that although huge progress has been made over recent years, many thousands of people in the UK lose their lives to cancer every year – a situation that we urgently want to change through research. But when conventional treatment fails, there is little chance that turning to an unproven alternative touted on the internet will provide a cure. In this situation, we recommend that cancer patients talk to their doctor about clinical trials that they may be able to join, giving them access to new drugs and providing valuable data that will help other sufferers in future.

“Big Pharma can’t patent it so they’re not interested.”

Some people argue that the potential of cannabinoids is being ignored by pharmaceutical companies, because they can’t patent the chemicals occurring in cannabis plants. But pharma companies are not stupid, and they are quick to jump on promising avenues for effective therapies.

As we’ve shown, there are hundreds of researchers around the world investigating cannabinoids, in both private and public institutions. And there are many ways that these compounds can be patented – for example, by developing more effective synthetic compounds or better ways to deliver them.

On the flip side, other people argue that patients should be treated with ‘street’ or homegrown cannabis preparations, and that the research being done by companies and other organisations is solely to make money and prevent patients accessing “The Cure”. This is also a false and

misleading argument, analogous to suggesting that patients in pain should buy heroin or grow opium poppies rather than being prescribed morphine by a doctor.

The best way to ensure that the benefits of cannabinoids – whether natural or synthetic – are brought to patients is through proper research using quality-controlled, safe, legal, pharmaceutical grade preparations containing known dosages of the drugs.

To do this requires time, effort and money, which may come from companies or independent organisations such as charities or governments. And, ultimately, this investment needs to be paid back by sales of a safe, effective new drug.

We are well aware of the issues around drug pricing and availability – for example, the recent situations with abiraterone and vemurafenib – and we are pushing for companies to make new treatments available at a fair price. We would also hope that if any cannabinoids are shown to be safe and effective enough to make it to the clinic, they would be available at a fair price for all patients that might benefit from them.

“Why don’t you campaign for cannabis to be legalised?” As things currently stand, cannabis is classified as a class B drug in the UK, meaning that it is illegal to possess or supply it.

It is not for Cancer Research UK to comment on the legal status of cannabis, its use or abuse as a recreational drug, or its medical use in any other diseases. But we are supportive of properly conducted scientific research that could benefit cancer patients.

In summary

At the moment, there simply isn’t enough evidence to prove that cannabinoids – whether natural or synthetic – works to treat cancer in patients, although research is ongoing. And there’s certainly no evidence that ‘street’ cannabis can treat cancer.

As a research-based organisation, we continue to watch the progress of scientists around the world for advances that may benefit people with cancer.

As a research-based organisation, we continue to watch the progress of scientists around the world for advances that may benefit people with cancer. And although cannabinoid research is an interesting avenue, it’s certainly not the only one.

Kat

Note: We’ve already entered into two lengthy, time-consuming and ultimately circular debates about cannabis, cannabinoids and cancer which you can read here and here.

Because of this, we are taking the unusual step of keeping public comments closed on this post, as we feel that we have fully laid out our position. If you have a considered comment you would like us to publish on this post you can contact the blog team at scienceblog.cancer.org.uk

Finally, we are grateful to Dr Manuel Guzman (Complutense University, Madrid), Professor Vincenzo di Marzo (Institute of Biomolecular Chemistry, Naples, and GW Pharmaceuticals) and Dr Wai Liu (St George’s Hospital, London) for helpful discussions as we were writing this post.

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References and further reading: * CancerHelp UK – Does smoking cannabis cause cancer? * CancerHelp UK – Is cannabis a treatment for brain tumours? * CancerHelp UK – Two trials of Sativex for cancer-related pain * National Cancer Institute (US) – Information about cannabis and cannabinoids for cancer patients * National Cancer Institute (US) – Information about cannabis and cannabinoids for health professionals

* Velasco, G., Sánchez, C. & Guzmán, M. (2012). Towards the use of cannabinoids as antitumour agents, Nature Reviews Cancer, 12 (6) 444. DOI: 10.1038/nrc3247

* Sarfaraz, S. et al (2008). Cannabinoids for Cancer Treatment: Progress and Promise, Cancer Research, 68 (2) 342. DOI: 10.1158/0008-5472.CAN-07-2785

* Guindon, J. & Hohmann, A.G. (2011). The endocannabinoid system and cancer: therapeutic implication, British Journal of Pharmacology, 163 (7) 1463. DOI: 10.1111/j.1476-5381.2011.01327.x

* Engels, F.K. et al (2007). Medicinal cannabis in oncology, European Journal of Cancer, 43 (18) 2644. DOI: 10.1016/j.ejca.2007.09.010

* Cannabinoids in the treatment of chemotherapy-induced nausea and vomiting – Todaro (2012) Journal of the National Comprehensive Cancer Network

* Bowles, D.W. et al (2012). The intersection between cannabis and cancer in the United States, Critical Reviews in Oncology/Hematology, 83 (1) 10. DOI: 10.1016/j.critrevonc.2011.09.008

* Hall, W., Christie, M. & Currow, D. (2005). Cannabinoids and cancer: causation, remediation, and palliation, The Lancet Oncology, 6 (1) 42. DOI: 10.1016/S1470-2045(04)01711-5.

Here in California, marijuana is now treated as a minimal vice, with legalization inevitable and decriminalization for possession amounting to a tap on the hand. Medical marijuana cards are so easy to obtain, they’re the butts of endless popular jokes.

On the famed Venice Beach boardwalk, booths tout on-the-spot “evaluations” and customers walk out the door with newly minted photo ID cards in under an hour. High schools across the country celebrate April 20th as “420 Day”, a fact I know because my daughter’s high school, San Rafael High, is nationally famous (or infamous, depending on your perspective) as the birthplace of the term 420. (Coined, supposedly, because 4:20 pm was the time at which kids would meet after school to light up.)

So, as we move towards viewing pot with the same tolerance with which we view alcohol (in other words, it’s bad for your health if you become addicted, but casual use is harmless), let’s look at the evidence. Is it really relatively harmless for young men — and women — to get high?

Pot Smoking May Double Risk of Testicular Cancer

Today’s headline was pretty bold: Smoking pot leads to double the risk of developing testicular cancer. Testicular cancer is on the rise, and experts have been trying for a while to figure out why. Now, after comparing groups of young men who smoked and those who didn’t, there’s a possible answer. Those who smoked pot recreationally were twice as likely to develop testicular germ cell tumors, or nonseminomas, the most common kind in men under 35, says a study in Cancer. Nonseminomas are faster growing and harder to treat – a deadly combination – say researchers at the University of Southern California.

This study, though small, is actually the third study to link nonseminomas to pot use; the first two were also published in Cancer. The first word of the connection came out in 2009 from research out of the Fred Hutchinson Cancer Center in Seattle. The pot use researchers studied was described as “once a week or more”, and it’s important to note that many smokers toke up every day. No studies have contradicted the link, experts point out. It’s important to note that the risk of testicular cancer is relatively low, slightly more than 1 percent, so even when the risk is doubled, it’s still extremely small.

Pot Smoking May Lower IQ

Last week’s headline was at least as alarming as this week’s. Researchers followed a group of youngsters from age 13 to age 38, and found that the IQs of regular pot smokers fell up to 8 points during the 25-year period, compared with the IQs of those who didn’t smoke pot, which stayed the same. The study, published in the Proceedings of the National Academy of Sciences, also found an increase in memory and attention problems among those deemed marijuana-dependent.

Pot Smoking May Trigger Schizophrenia

There should have been headlines, “Marijuana May Make You Psychotic” at least a couple times over the past few years, but somehow the studies documenting this issue haven’t gotten as much attention as you might expect. Maybe it’s because this link is much harder to prove, which it is. That’s because the association could work backward: Those who smoke pot could be self-medicating for symptoms of schizophrenia that hasn’t become full-blown yet.

However, there have been several studies, and they’ve controlled for a backwards causation pretty well. In a  German study  that followed a group of teenagers for ten years, those who smoked pot at least 5 times were more than twice as likely to develop schizophrenia. The biggest and probably best known study followed 45,000 young men in Sweden starting when they enlisted in the military. As I reported in a previous article, synthetic marijuana, also known as “Spice”, has also been linked to psychosis as well as to paranoia and violence.

Fifteen years later, those who smoked pot at least once were more than twice as likely to develop schizophrenia. A third study followed young men whose family genetic history predisposed them to develop schizophrenia. In these kids, who are considered to have a one in ten chance of developing schizophrenia, pot use doubled that risk to one in five.

Pot Smoking Lowers Fertility and Causes Genetic Damage

The health risks of marijuana for women are much less well known, as of yet. But what is known is that pot smoking decreases fertility for both men and women, and appears to have the potential for genetic damage to future children. Though a complex mechanism, cannabinoids — the chemicals in cannabis — affect the production of sperm and the ability of the sperm and egg to join together. The research on pot and testicular cancer has implicated the endocannabinoid system, which is the cellular network that reacts to cannabis, the active ingredient in pot. The endocannabinoid system also plays a central role in sperm production.

There’s also been considerable research on the issue of marijuana use causing genetic mutations that are then passed on to children. Of course most folks under 20 aren’t looking ahead to the health of their future offspring — or to the possibility of not being able to have said offspring — so this health issue is less influential with teens and young adults. But it’s something everyone should be paying more attention to.

Source: www.forbes.com   10.09.2012

SMOKED MARIJUANA IS NOT MEDICINE

In 1970, Congress enacted laws against marijuana based in part on its conclusion that marijuana has no scientifically proven medical value. Likewise, the Food and Drug Administration (FDA), which is responsible for approving drugs as safe and effective medicine, has thus far declined to approve smoked marijuana for any condition or disease. Indeed, the FDA has noted that “there is currently sound evidence that smoked marijuana is harmful,” and “that no sound scientific studies support medical use of marijuana for treatment in the United States, and no animal or human data support the safety or efficacy of marijuana for general medical use.”1

Voices in the medical community likewise do not accept smoked marijuana as medicine:

· The American Medical Association (AMA) in November 2013, amended their position on cannabis, stating that “(1) cannabis is a dangerous drug and as such is a public health concern; (2) sale of cannabis should not be legalized; (3) public health based strategies, rather than incarceration should be utilized in the handling of individuals possessing cannabis for personal use; and (4) that additional research should be encouraged.”2

· The American Society of Addiction Medicine’s (ASAM) public policy statement on “Medical Marijuana,” clearly rejects smoking as a means of drug delivery. ASAM further recommends that “all cannabis, cannabis-based products and cannabis delivery devices should be subject to the same standards applicable to all other prescription medication and medical devices, and should not be distributed or otherwise provided to patients …” without FDA approval. ASAM also “discourages state interference in the federal medication approval process.”3 ASAM continues to support these policies, and has also stated that they do not “support proposals to legalize marijuana anywhere in the United States.”4

· The American Cancer Society (ACS) “is supportive of more research into the benefits of cannabinoids. Better and more effective treatments are needed to overcome the side effects of cancer and its treatment. However, the ACS does not advocate the use of inhaled marijuana or the legalization of marijuana.”5

· The American Glaucoma Society (AGS) has stated that “although marijuana can lower the intraocular pressure, the side effects and short duration of action, coupled with the lack of evidence that its use alters the course of glaucoma, preclude recommending this drug in any form for the treatment of glaucoma at the present time.”6

· The Glaucoma Research Foundation (GRF) states that “the high dose of marijuana necessary to produce a clinically relevant effect on intraocular pressure in people with glaucoma in the short term requires constant inhalation, as much as every three hours. The number of significant side effects generated by long-term use of marijuana or long-term inhalation of marijuana smoke make marijuana a poor choice in the treatment of glaucoma. To date, no studies have shown that marijuana – or any of its approximately 400 chemical components – can safely and effectively lower intraocular pressure better than the variety of drugs currently on the market.”7 2

· The American Academy of Pediatrics (AAP) believes that “[a]ny change in the legal status of marijuana, even if limited to adults, could affect the prevalence of use among adolescents.” While it supports scientific research on the possible medical use of cannabinoids as opposed to smoked marijuana, it opposes the legalization of marijuana.8

· The American Academy of Child and Adolescent Psychiatry (AACAP) “is concerned about the negative impact of medical marijuana on youth. Adolescents are especially vulnerable to the many adverse development, cognitive, medical, psychiatric, and addictive effects of marijuana.” Of greater concern to the AACAP is that “adolescent marijuana users are more likely than adult users to develop marijuana dependence, and their heavy use is associated with increased incidence and worsened course of psychotic, mood, and anxiety disorders.” “The “medicalization” of smoked marijuana has distorted the perception of the known risks and purposed benefits of this drug.” Based upon these concerns, the “AACAP opposes medical marijuana dispensing to adolescents.”9

· The National Multiple Sclerosis Society (NMSS) has stated that “based on studies to date – and the fact that long-term use of marijuana may be associated with significant, serious side effects – it is the opinion of the National Multiple Sclerosis Society’s Medical Advisory Board that there are currently insufficient data to recommend marijuana or its derivatives as a treatment for MS symptoms. Research is continuing to determine if there is a possible role for marijuana or its derivatives in the treatment of MS. In the meantime, other well tested, FDAapproved drugs are available to reduce spasticity.”10

· The National Association of School Nurses (NASN) consensus it that marijuana is properly categorized as a Schedule I substance under the Controlled Substances Act and concurs with DEA that “the clear weight of the currently available evidence supports this classification, including evidence that smoked marijuana has a high potential for abuse, has no accepted medicinal value in treatment in the United States, and evidence that there is a general lack of accepted safety for its use even under medical supervision.”11 NASN also supports of the position of the AAP that “any change in the legal status of marijuana, even if limited to adults, could affect the prevalence of use among adolescents.”12

· The American Psychiatric Association (APA) states that there is no current scientific evidence that marijuana is in any way beneficial for treatment of any psychiatric disorder. Current evidence supports, at minimum, a strong association of cannabis use with the onset of psychiatric disorders. Adolescents are particularly vulnerable to harm due to the effects of cannabis on neurological development. The APA does support further research of cannabisderived substances as medicine, facilitated by the federal government, and if scientific evidence supports the use for treatment of specific conditions, the approval process should go through the FDA and in no way be authorized by ballot initiatives.13  3

DANGERS OF MARIJUANA

MARIJUANA IS DANGEROUS TO THE USER AND OTHERS

Without a clear understanding of the mental and physical effects of marijuana, its use on our youth, our families, and our society, we will never understand the ramifications it will have on the lives of our younger generation, the impact on their future, and its costs to our society. Legalization of marijuana, no matter how it begins, will come at the expense of our children and public safety. It will create dependency and treatment issues, and open the door to use of other drugs, impaired health, delinquent behavior, and drugged drivers. This is not the marijuana of the 1970s; today’s marijuana is far more powerful. On May 14, 2009, analysis from the National Institute on Drug Abuse (NIDA)-funded University of Mississippi’s Potency Monitoring Project revealed that marijuana potency levels in the U.S. are the highest ever reported since the scientific analysis of the drug began.14   This trend continues.

· According to the latest data, the average amount of THC in seized samples has reached 12.98 percent. This compares to an average of just under four percent reported in 1983 and represents more than a tripling of the potency of the drug since that time.15

· “We are increasingly concerned that regular or daily use of marijuana is robbing many young people of their potential to achieve and excel in school or other aspects of life,” said NIDA Director Nora D. Volkow, MD. “THC, a key ingredient in marijuana, alters the ability of the hippocampus, a brain area related to learning and memory, to communicate effectively with other brain regions. In addition, we know from recent research that marijuana use that begins during adolescence can lower IQ and impair other measures of mental function in adulthood.”16

· “We should also point out that marijuana use that begins in adolescence increases the risk they will become addicted to the drug,” said Volkow. “The risk of addiction goes from about 1 in 11 overall to 1 in 6 for those who start using in their teens, and even higher among daily smokers.”17 The most recent statistics on the use of marijuana in the United States shows that marijuana use continues to rise.

· In 2012, an estimated 23.9 million American’s aged 12 and older were current (past month) illicit drug users. This represents 9.2 percent of the population 12 and older. Marijuana was the most commonly used illicit drug with 18.9 million past month users.18

· The use of illicit drug use among young adults aged 18 to 25 increased from 19.7 percent in 2008 to 21.3 percent in 2012, driven largely by an increase in marijuana use (from 16.6 percent in 2008 to 18.7 percent in 2012). 19

· In 2012, an estimated 2.9 million persons aged 12 and older used an illicit drug for the first time within the past 12 months. That equals about 7,900 initiates per day. The largest number of new initiates used marijuana (2.4 million).20  4

· Among 12 and 13 year olds, 1.2 percent used marijuana; for 14 and 15 year olds, it was 6.1 percent; and for 16 and 17 year olds, it climbed to 14 percent.21

· An estimated 17 percent of past year marijuana users aged 12 and older used marijuana on 300 or more days within the past 12 months. This means that almost 5.4 million persons used marijuana on a daily or almost daily basis over a 12 month period.22

· An estimated 40.3 percent (7.6 million) of current marijuana users aged 12 and older used marijuana on 20 or more days in the past month.23

· Among persons 12 or older, of the estimated 1.4 million first-time past year marijuana users initiated use prior to age 18.24

· On an average day 646,707 adolescents aged 12-17 years of age smoked marijuana, and 4,000 adolescents used marijuana for the first time.25

· According to the 2013 Monitoring the Future Survey, one in every 15 high school seniors (6.5 percent) is a daily or near-daily marijuana user.26

· Nearly 23 percent of high school seniors say they smoked marijuana in the month prior to the survey, and just over 36 percent say they smoked within the previous year. More than 12 percent of eight graders said they used marijuana during the past year.27

· The 2011 Partnership Attitude Tracking Study found that nine percent of teens (nearly 1.5 million) smoked marijuana heavily (at least 20 times) in the past month. Overall, past-month teen use was up 80 percent from 2008.28

§ Nearly half of teens (47 percent) have ever used marijuana – a 21 percent increase from2008.29

§ Two out of every five teens (39 percent) have tried marijuana during the past year, an increase from 31 percent in 2008.30

§ Past-month use increased 42 percent, from 19 percent in 2008 to 27 percent in 2011 (an increase of 4 million teens).31

§ Past-year use is up 26 percent from 31 percent in 2008 to 39 percent in 2011 (an increase of 6 million teens).32

§ Lifetime use is up 21 percent, from 39 percent in 2008 to 47 percent in 2011 (an increase of 8 million teens).33  Increasingly, the international community is joining the United States in recognizing the fallacy of arguments claiming marijuana use is a harmless activity with no consequences to others.

· Antonio Maria Costa, then Executive Director of the United Nations Office on Drugs and Crime, noted in an article published in The Independent on Sunday “The debate over the drug is no longer about liberty; it’s about health.” He continued, “Evidence of the damage to mental 5 health caused by cannabis use–from loss of concentration to paranoia, aggressiveness and outright psychosis–is mounting and cannot be ignored. Emergency-room admissions involving cannabis is rising, as is demand for rehabilitation treatment. …It is time to explode the myth of cannabis as a ‘soft’ drug.”34

· The President of the International Narcotics Control Board (INCB), Raymond Yans, voiced grave concern about the recent referenda in the United States that would allow the recreational use of cannabis by adults. “Legalization of cannabis within these states would send wrong and confusing signals to youth and society in general, giving the false impression that drug abuse might be considered normal and even, most disturbingly, safe. Such a development could result in the expansion of drug abuse, especially among young people, and we must remember that all young people have a right to be protected from drug abuse and drug dependency.”35 “The concern with marijuana is not born out of any culture war mentality, but out of what science tells us about the drug’s effects.”36

MENTAL HEALTH ISSUES RELATED TO MARIJUANA

There is mounting evidence that use of marijuana, particularly by adolescents, can lead to serious mental health problems.

· According to Nora Volkow, the Director of the National Institute of Drug Abuse, “Regular marijuana use in adolescence is known to be a part of a cluster of behaviors that can produce enduring detrimental effects and alter the trajectory of a young person’s life – thwarting his or her potential. Beyond potentially lower IQ, teen marijuana use is linked to school dropout, other drug use, mental health problems, etc. Given the current number of regular marijuana users (1 in 15 high school seniors) and the possibility of this increasing with marijuana legalization, we cannot afford to divert our focus from the central point: regular marijuana use stands to jeopardize a young person’s chances of success – in school and in life.”37

· A major study published in the Proceedings of the National Academy of Sciences in August 2012 provides finding that long-term marijuana use started in teen years does have a negative effect on intellectual function. The more dependent the person becomes

on marijuana, the more significant the impairment. The impairment was significant in five different cognitive areas, especially executive function and processing speed. Participants who used cannabis heavily in their teens and continued through adulthood showed a significant drop in their intelligence quotient (IQ) – an average of eight points. Those who started using marijuana regularly after age 18 showed minor declines. Those who never used marijuana showed no decline. Even after stopping cannabis use, neuropsychological deficits were never recovered among those who started smoking during their teen years.38

· “Nearly one in ten first-year college students at a mid-Atlantic university have a cannabis use disorder (CUD) according to a NIDA-funded study of drug use conducted by investigators from the Center for Substance Abuse Research at the University of Maryland.” “Students who had used cannabis five or more times in the past year – regardless of whether or not they met the criteria for CUD – reported problems related to their cannabis use, such as concentration problems (40.1 percent), regularly putting themselves in physical danger (24.3 percent), and driving after using marijuana (18.6 percent).”39   6

· According to a report by the Office of National Drug Control Policy on teens, depression and marijuana use: 40

§ Depressed teens are twice as likely as non-depressed teens to use marijuana and other illicit drugs.

§ Depressed teens are more than twice as likely as their peers to abuse or become

dependent on marijuana.

§ Marijuana use can worsen depression and lead to more serious mental illness such as

schizophrenia, anxiety, and even suicide.

§ Teens who smoke marijuana at least once a month are three times more likely to have suicidal thoughts than non-users.

§ The percentage of depressed teens is equal to the percentage of depressed adults, but depressed teens are more likely than depressed adults to use marijuana than other drugs.

· Researchers from the University of Oulu in Finland interviewed over 6,000 youth ages 15 and 16 and found that “teenage cannabis users are more likely to suffer psychotic symptoms and have a greater risk of developing schizophrenia in later life.”41

· John Walters, then the Director of the Office of National Drug Control Policy, Charles G. Curie, then the Administrator of the Substance Abuse and Mental Health Services

Administration, and experts and scientists from leading mental health organizations joined together in May 2005 to warn parents about the mental health dangers marijuana poses to teens. According to several recent studies, marijuana use has been linked with depression and suicidal thoughts, in addition to schizophrenia. These studies report that weekly marijuana use among teens doubles the risk of developing depression and triples the incidence of suicidal thoughts.42

· Dr. Andrew Campbell, a member of the New South Wales (Australia) Mental Health Review Tribunal, published a study in 2005 which revealed that four out of five individuals with schizophrenia were regular cannabis users when they were teenagers. Between 75-80 percent of the patients involved in the study used cannabis habitually between the ages of 12 and 21.43 In addition, a laboratory-controlled study by Yale scientists, published in 2004, found that THC “transiently induced a range of schizophrenia-like effects in healthy people.”44

· In a presentation on “Neuroimaging Marijuana Use and Effects on Cognitive Function”

Professor Krista Lisdahl Medina suggests that chronic heavy marijuana use during adolescence is associated with poorer performance on thinking tasks, including slower psychomotor speed and poorer complex attention, verbal memory and planning ability. “While recent findings suggest partial recovery of verbal memory functioning within the first three weeks of adolescent abstinence from marijuana, complex attention skills continue to be affected. Not only are their thinking abilities worse, their brain activation to cognitive task is abnormal.”45  7 Many of these effects of using marijuana affect all ages, not just youth.

· Memory, speed of thinking, and other cognitive abilities get worse over time with marijuana use, according to a study published in the March 14, 2006 issue of Neurology, the scientific journal of the American Academy of Neurology. The study found that frequent marijuana users performed worse than non-users on tests of cognitive abilities, including divided attention and verbal fluency. Those who had used marijuana for 10 years or more had more problems with their thinking abilities than those who had used marijuana for 5-to-10 years. All of the marijuana users were heavy users, which was defined as smoking four or more joints per week.46

· Australian researchers report that long-term, heavy cannabis use may be associated with structural abnormalities in areas of the brain which govern memory, emotion, and aggression. Brain scans showed that the hippocampus was 12 percent smaller and the amygdale 7 percent smaller in men who smoked at least 5 cigarettes daily for almost 10 years. Dr. Mura Yucel, the lead researcher stated that “this new evidence plays an important role in further understanding the effects of marijuana and its impact on brain functions. The study is the first to show that long-term cannabis use can adversely affect all users, not just those in the high-risk categories such as the young, or those susceptible to mental illness, as previously thought.”47

· A two-year study by the National Cannabis Prevention and Information Centre, at the

University of New South Wales in Sydney, Australia found that cannabis users can be as

aggressive as crystal methamphetamine users, with almost one in four men and one in three women being violent toward hospital staff or injuring themselves after acting aggressively. Almost 12 percent were considered a suicide risk. The head of the Emergency Department at St. Vincent’s Hospital, Gordian Fulde, said “that most people still believed marijuana was a soft drug, but the old image of feeling sleepy and having the munchies after you’ve smoked is entirely inappropriate for modern-day marijuana. With hydroponic cannabis, the levels of THC can be tenfold what they are in normal cannabis so we are seeing some very, very serious fallout.”48

· Carleton University researchers published a study in 2005 showing that current marijuana users who smoke at least five “joints” per week did significantly worse than non-users when tested on neurocognition tests such as processing speed, memory, and overall IQ.49

· U.S. scientists have discovered that the active ingredient in marijuana interferes with

synchronized activity between neurons in the hippocampus of rats. The authors of this

November 2006 study suggest that action of tetrahydrocannabinol, or THC, might explain why marijuana impairs memory.50

· According to an Australian study, there is now conclusive evidence that smoking cannabis hastens the appearance of psychotic illnesses by up to three years. Dr. Mathew Large from the University of New South Wales reports that “…in addition to early cannabis smoking bringing on schizophrenia it brings it on early by an average of 2.7 years early – earlier than you would have otherwise developed it had you not been a cannabis smoker. The risks for older people is about a doubling of the risk.” “For young people who smoke cannabis regularly, instead of having around a one percent chance of developing schizophrenia during their life they will end up with something like a five percent chance of developing schizophrenia.” Philip Mitchell, 8 head of Psychiatry at the University stated that while “this research can’t distinguish about whether cannabis causes schizophrenia or brings it out in vulnerable people…it makes it very clear that cannabis is playing a significant role in psychosis.”51

· Doctors at Yale University documented marijuana’s damaging effect on the brain after nearly half of 150 healthy volunteers experienced psychotic symptoms, including hallucinations and paranoid delusions, when given THC, the drug’s primary active ingredient. The findings were released during a May 2007 international health conference in London. 52

· According to Margaret Trudeau, “Marijuana can trigger psychosis.” “Quitting cannabis has been an important part of my recovery from mental illness,” Margaret Trudeau, ex-wife of former Canadian prime Minister Pierre Trudeau, reported at a press conference at the Canadian Mental Health Conference in Vancouver on February 15, 2007. “Every time I was hospitalized it was preceded by heavy marijuana use.”53

· A pair of articles in the Canadian Journal of Psychiatry reflects that cannabis use can trigger schizophrenia in people already vulnerable to the mental illness and assert that this fact should shape marijuana policy.54

· Robin Murray, a professor of psychiatry at London’s Institute of Psychiatry and consultant at the Maudsley Hospital in London, wrote an editorial which appeared in The Independence on Sunday, on March 18, 2007, in which he states that the British Government’s “mistake was rather to give the impression that cannabis was harmless and that there was no link to psychosis.” Based on the fact that “…in the late 1980s and 1990s psychiatrists like me began to see growing numbers of young people with schizophrenia who were taking large amounts of cannabis.” Murray claims that “…at least 10 percent of all people with schizophrenia in the UK would not have developed the illness if they had not smoked cannabis.” By his estimates, 25,000 individuals have ruined their lives because they smoked cannabis. He also points out that the “skunk” variety of cannabis, which is very popular among young people in Great Britain, contains “15 to 20 percent THC, and new resin preparations have up to 30 percent.”55

· Dr. John MacLeod, a prominent British psychiatrist states: “If you assume such a link (to schizophrenia with cannabis) then the number of cases of schizophrenia will increase

significantly in line with increased use of the drug.” He predicts that cannabis use may account for a quarter of all new cases of schizophrenia in three years’ time.56

· A study by scientists at the Queensland Brain Institute in Australia on long-term marijuana use and the increased risk of psychosis confirms earlier findings. “Compared with those who had never used cannabis, young adults who had six or more years since first use of cannabis were twice as likely to develop a non-affective psychosis (such as schizophrenia), “ McGrath wrote in a study published in the Archives of General Psychiatry Journal. “They were also four times as likely to have high scores in clinical tests of delusion.”57

· A study published in the March 2008 Journal of the American Academy of Child and

Adolescent Psychiatry cited the harm of smoking marijuana during pregnancy. The study

found a significant relationship between marijuana exposure and child intelligence.

Researchers concluded that “prenatal marijuana exposure has a significant effect on school-age intellectual development.”58 9

· A study by doctors from the National Institute of Drug Abuse found that people who smoked marijuana had changes in the blood flow in their brains even after a month of not smoking. The marijuana users had PI (pulsatility index) values somewhat higher

than people with chronic high blood pressure and diabetes, which suggests that marijuana use leads to abnormalities in the small blood vessels in the brain. These findings could explain in part the problems with thinking and remembering found in other studies of marijuana users.59

PHYSICAL HEALTH ISSUES RELATED TO MARIJUANA

Marijuana use also affects the physical health of users, both short and long term.

· In 2011, according to the Drug Abuse Warning Network (DAWN), there were 1,252,000 emergency department (ED) visits involving an illicit drug. Marijuana was involved in 455,668 of these visits, second only to cocaine.60

· ED visits for marijuana increased 19 percent between 2009 and 2011.61

· Among ED visits made by patients aged 20 or younger resulting in drug misuse or abuse, marijuana was the most commonly involved illicit drug (143.9 visits per 100,000).62

· In 2012, an estimated 22.2 million persons aged 12 or older were classified with substance dependence and abuse in the past year (8.5 percent of the population 12 or older). Marijuana was the illicit drug with the largest number of persons (4.3 million) with past year dependence or abuse.63

· On an average day in 2010 there were 266 drug related ED visits for youth 12 to17 years of age that involved marijuana.64

· Under the Safe Drinking Water and Toxic Enforcement Act of 1986, the Governor of

California is required to revise and republish at least once a year the list of chemicals known to the state to cause cancer or reproductive toxicity. On September 11, 2009, the California Environmental Protection Agency, Office of Environmental Health Hazard Assessment, published the latest list. The list included a chemical added in June, marijuana smoke, and lists cancer as the type of toxicity.65

· A study by researchers at the Erasmus University Medical Center in Rotterdam, Netherlands found women who smoked pot during pregnancy may impair their baby’s growth and development in the womb. The babies born to marijuana users tended to weigh less and have smaller heads than other infants, both of which are linked to increased risk of problems with thinking, memory, and behavioral problems in childhood.66

· A long-term study of over 900 New Zealanders by the University of Otago, New Zealand School of Dentistry has found that “heavy marijuana use has been found to contribute to gum disease, apart from the known effects that tobacco smoke was already known to have.”67  10

· A study from Monash University and the Alfred Hospital in Australia has found that “bullous lung disease occurs in marijuana smokers 20 years earlier than tobacco smokers. Often caused by exposure to toxic chemicals or long-term exposure to tobacco smoke, bullae is a condition where air trapped in the lungs causes obstruction to breathing and eventual destruction of the lungs.” Dr. Matthew Naughton explains that  the peak inspiration and held for as long as possible before slow exhalation. This predisposes to greater damage to the lungs and makes marijuana smokers more prone to bullous disease as compared to cigarette smokers.”68

· In December 2007 researchers in Canada reported that “marijuana smoke contains significantly higher levels of toxic compounds — including ammonia and hydrogen cyanide — than tobacco smoke and may therefore pose similar health risks.” “Ammonia

levels were 20 times higher in the marijuana smoke than in the tobacco smoke, while hydrogen cyanide, nitric oxide and certain aromatic amines occurred at levels 3-5 times higher in the marijuana smoke.”69

· Marijuana worsens breathing problems in current smokers with chronic obstructive pulmonary disease (COPD), according to a study released by the American Thoracic Society in May 2007. Among people age 40 and older, smoking cigarettes and marijuana together boosted the odds of developing COPD to 3.5 times the risk of someone who smoked neither.70

· Scientists at Sweden’s Karolinska Institute, a medical university, have advanced their

understanding of how smoking marijuana during pregnancy may damage the fetal brain.

Findings from their study, released in May 2007, explain how endogenous cannabinoids exert adverse effects on nerve cells, potentially imposing life-long cognitive and motor deficits in afflicted new born babies.71

· A study from New Zealand reports that cannabis smoking may cause five percent of lung cancer cases in that country. Dr. Sarah Aldington of the Medical Research Institute in Wellington presented her study results at the Thoracic Society conference in Auckland on March 26, 2007.72

· Researchers at the Fred Hutchinson Cancer Research Center in Seattle found that frequent or long-term marijuana use may significantly increase a man’s risk of developing the most aggressive type of testicular cancer, nonseminoma. Nonseminoma is a fast-growing testicular malignancy that tends to strike early, between the ages of 20 and 35, and accounts for about 40 percent of all testicular cancer cases. Dr. Stephen Schwartz stated that researchers are still studying the long-term health consequences of marijuana smoking, especially heavy marijuana smoking and “in the absence of more certain information, a decision to smoke marijuana recreationally means that one is taking a chance on one’s future health.”73

· According to researchers at the Yale School of Medicine, long-term exposure to marijuana smoke is linked to many of the same kinds of health problems as those experienced by long term cigarette smokers. “…[C]linicians should advise their patients of the potential negative impact of marijuana smoking on overall lung health.”74

· While smoking cigarettes is known to be a major risk factor for the bladder cancer most common among people age 60 and older, researchers are now finding a correlation between smoking marijuana and bladder cancer. In a study of younger patients with transitional cell 11 bladder cancer, Dr. Martha Terriss found that 88.5 percent had a history of smoking marijuana.

Marijuana smoke has many of the same carcinogen-containing tars as cigarettes and may get even more into the body because marijuana cigarettes are unfiltered and users tend to hold the smoke in their lungs for prolonged periods. Dr. Terriss notes that more research is needed, but does recommend that when doctors find blood in a young patient’s urine sample, they may want to include questions about marijuana use in their follow-up.75

· Smoking marijuana can cause changes in lung tissue that may promote cancer growth, according to a review of decades of research on marijuana smoking and lung cancer. However, it is not possible to directly link pot use to lung cancer based on existing evidence. Nevertheless, researchers indicate that the precancerous changes seen in studies included in their analysis, as well as the fact that marijuana smokers generally inhale more deeply and hold smoke in their lungs longer than cigarette smokers, and that marijuana is smoked without a filter, do suggest that smoking pot

could indeed boost lung cancer risk. It is known, they add, that marijuana smoking deposits more tar in the lungs than cigarette smoking does.76

· Smoking three cannabis joints will cause one to inhale the same amount of toxic chemicals as a whole pack of cigarettes according to researchers from the French National Consumers’ Institute. Cannabis smoke contains seven times more tar and carbon monoxide than cigarette smoke. Someone smoking a joint of cannabis resin rolled with tobacco will inhale twice the amount of benzene and three times as much toluene as if they were smoking a regular cigarette.77

· According to research, the use of marijuana by women trying to conceive or those recently becoming pregnant is not recommended, as it endangers the passage of the embryo from the ovary to the uterus and can result in a failed pregnancy. Researchers from Vanderbilt University say a study with mice has shown that marijuana exposure may compromise the pregnancy outcome because an active ingredient in marijuana, tetrahydrocannabinol (THC), interferes with a fertilized egg’s ability to implant in the lining of the uterus.78

· Infants exposed to marijuana in the womb show subtle behavioral changes in their first days of life, according to researchers in Brazil. The newborns were more irritable than non-exposed infants, less responsive, and more difficult to calm. They also cried more, startled more easily, and were jitterier. Such changes have the potential to interfere with the mother-child bonding process. “It is necessary to counter the misconception that marijuana is a ‘benign drug’ and to educate women regarding the risks and possible consequences related to its use during pregnancy,” Dr. Marina Carvahlo de Moraes Barros and her colleagues concluded.79

· Marijuana smoking has been implicated as a causative factor in tumors of the head and neck and of the lung. The marijuana smokers in whom these tumors occur are usually much younger than the tobacco smokers who are the usual victims of these malignancies. Although a recent study published by the Medical College of Georgia and Stanford University suggests a causal relationship between marijuana exposure and bladder cancer, larger scale epidemiologic and basic science studies are needed to confirm the role of marijuana smoking as an etiologic agent in the development of transitional cell carcinoma.80

· According to a 2005 study of marijuana’s long-term pulmonary effects by Dr. Donald Tashkin at the University of California, Los Angeles, marijuana smoking deposits significantly more tar 12 and known carcinogens within the tar, such a polycyclic aromatic hydrocarbons, into the airways. In addition to precancerous changes, marijuana smoking is associated with impaired function of the immune system components in the lungs.81

· Smoked marijuana has also been associated with an increased risk of the same respiratory symptoms as tobacco, including coughing, phlegm production, chronic bronchitis, shortness of breath and wheezing. Because cannabis plants are contaminated with a range of fungal spores, smoking marijuana may also increase the risk of respiratory exposure by infectious organisms (i.e., molds and fungi).82

· Marijuana takes the risks of tobacco and raises them. Marijuana smoke contains more than 400 chemicals and increases the risk of serious health consequences, including lung damage.83

· An April 2007 article published by the Harm Reduction Journal, and funded by the prolegalization Marijuana Policy Project, argues that the use of a vaporizer has the potential to reduce the danger of cannabis as far as respiratory symptoms are concerned. While these claims remain scientifically unproven, serious negative

consequences still remain. For example, driving skills are still impaired, heavy adolescent use may create deviant brain structure, and 9-12 percent of cannabis users develop symptoms of dependence. A vaporizer offers no protection against these  consequences.84

· According to two studies, marijuana use narrows arteries in the brain, “similar to patients with high blood pressure and dementia,” and may explain why memory tests are difficult for marijuana users. In addition, “chronic consumers of cannabis lose molecules called CB1 receptors in the brain’s arteries,” leading to blood flow problems in the brain which can cause memory loss, attention deficits, and impaired learning ability.85

· A small study (50 patients) was conducted by the University of California San Francisco, from 2003 to 2005, leading researchers to find that smoked marijuana eased HIV-related foot pain. This pain, known as peripheral neuropathy, was relieved for 52 percent of the patients in the controlled experiment. Dr. Donald Abrams, director of the study said that while subjects’ pain was reduced he and his colleagues “found that adverse events, such as sedation, dizziness and confusion were significantly higher among the cannabis smokers.”86

· In response to this study, critics of smoked marijuana were quick to point out that while THC does have some medicinal benefits, smoked marijuana is a poor delivery mechanism. Citing evidence that marijuana smoke is harmful, Dr. David Murray, then chief scientist at the Office of National Drug Control Policy, noted that “People who smoke marijuana are subject to bacterial infections in the lungs…Is this really what a physician who is treating someone with a compromised immune system wants to prescribe?”87

§ Dr. Murray also said that the findings are “not particularly persuasive” because of the small number of subjects and the possibility that subjects knew they were smoking marijuana and had an increased expectation of efficacy. He expressed the government’s support for pain relief for HIV-affected individuals and said that while “We’re very much supportive of any effort to ameliorate the suffering of AIDS patients,the delivery mechanism for THC should be pills, and not smoked marijuana, which can cause lung damage and deliver varying dosages of THC.”88  13

§ Researchers involved with the University of California, San Francisco, project admitted that there may be a problem with efforts to gauge the effects of marijuana vs. the effects of a placebo. Some users were immediately able to acknowledge that their sample was indeed cannabis because of the effects of that substance. One participant, Diana Dodson said, “I knew immediately [that I received cannabis] because I could feel the effects.”89

· Pro-marijuana advocates were encouraged by a medical study published in Cancer

Epidemiology, Biomarkers & Prevention. The study, published in October 2006, was based on interviews with people in Los Angeles (611 who developed lung cancer, 601 who developed cancer of the head or neck regions, and 1,040 people without cancer who were matched [to other subjects] on age, gender, and neighborhoods). The study found that people who smoke marijuana do not appear to be at increased risk of developing lung cancer.90 While this study’s findings differed from previous studies and researchers’ expectations, “[o]ther experts are warning that the study should not be viewed as a green light to smoke pot, as smoking marijuana has been associated with problems such as cognitive impairment and chronic bronchitis.”91 The National Institute on Drug Abuse (NIDA) continues to maintain that smoking marijuana is detrimental to pulmonary functions.

§ In its October, 2006, issue of NIDA Notes, mention is made of the most recent Tashkin study. “Biopsies of bronchial tissue provide evidence that regular marijuana smoking injures airway epithelial cells, leading to dysregulation of bronchial epithelial cell growth and eventually to possible malignant changes.” Moreover, he adds, because marijuana smokers typically hold their breath four times as long as tobacco smokers after inhaling, marijuana smoking deposits significantly more tar and known carcinogens within the tar, such as polycyclic aromatic hydrocarbons, in the airways. In addition to precancerous changes, Dr. Tashkin found that marijuana smoking is associated with a range of damaging pulmonary effects, including inhibition of the tumor-killing and bactericidal activity of alveolar macrophages, the primary immune cells within the lung.”

§ NIDA also comments on the Tashkin study in the Director’s Notes from February 2007. While acknowledging that the study concluded “that the association of these cancers with marijuana, even long-term or heavy use, is not strong and may be below practically detectable limits…these results may have been affected by selection bias or error in measuring lifetime exposure and confounder histories.”92

§ In October 2006, one of the study’s authors, Dr. Hal Morgenstern, Chair of Epidemiology at the University of Michigan School of Public Health, said although the risk of cancer did not prove to be large in the recent study, “I wouldn’t go so far as to say there is no increased cancer risk from smoking marijuana.”93

· The British Lung Foundation‘s 2012 survey of 1,000 adults found that a third wrongly believed that cannabis did not harm one’s health. The survey also revealed that 88 percent thought tobacco cigarettes were more harmful than cannabis ones, although the risk of lung cancer is actually 20 times higher from a cannabis cigarette than a tobacco cigarette. Part of the reason for this is that people smoking cannabis take deeper puffs and hold them for longer than tobacco smokers. This means that a person smoking a cannabis cigarette inhales four times as 14 much tar and five times as much carbon monoxide as someone smoking a tobacco cigarette. The Foundation warned that smoking one cannabis cigarette increase the chances of developing lung cancer by as much as an entire packet of 20 cigarettes. “It is alarming that, while new research continues to reveal the multiple health consequences of smoking cannabis, there is still a dangerous lack of public awareness of quite how harmful this drug can be,” said Dame Helena Shovelton, Chief Executive of the British Lung Foundation. “We therefore need a serious public health campaign – of the kind that helped raise awareness of the dangers of eating fatty food or smoking tobacco – to finally dispel the myth that smoking cannabis is somehow a safe pastime.”94

· A large international study by researchers from the University of Adelaide found that women who use marijuana during pregnancy double the risk of giving birth prematurely. Preterm or premature births, which is at least three weeks prior to the due date, can result in serious and life-threating health problems for the baby, and increased health problems in later life, such as heart disease and diabetes.95

MARIJUANA AS A PRECURSOR TO ABUSE OF OTHER DRUGS

· Teens who experiment with marijuana may be making themselves more vulnerable to heroin addiction later in life, if the findings from experiments with rats are any indication. “Cannabis has very long-term, enduring effects on the brain,” according to Dr. Yamin Hurd of the Mount Sinai School of Medicine in New York, the study’s lead author.96

· Marijuana is a frequent precursor to the use of more dangerous drugs and signals a significantly enhanced likelihood of drug problems in adult life. The Journal of the American  Medical Association reported, based on a study of 300 sets of twins, “that marijuana-using twins were four times more likely than their siblings to use cocaine and crack cocaine, and five times more likely to use hallucinogens such as LSD.”97

· Long-term studies on patterns of drug usage among young people show that very few of them use other drugs without first starting with marijuana. For example, one study found that among adults (age 26 and older) who had used cocaine, 62 percent had initiated marijuana use before age 15. By contrast, less than one percent of adults who never tried marijuana went on to use cocaine.98

· Columbia University’s National Center on Addiction and Substance Abuse (CASA) reports that teens who used marijuana at least once in the last month are 13 times likelier than other teens to use another drug like cocaine, heroin, or methamphetamine and almost 26 times likelier than those teens who have never used marijuana to use another drug.99

· Marijuana use in early adolescence is particularly ominous. Adults who were early marijuana users were found to be five times more likely to become dependent on any drug, eight times more likely to use cocaine in the future, and fifteen times more likely to use heroin later in life.100

· Healthcare workers, legal counsel, police and judges indicate that marijuana is a typical precursor to methamphetamine. For instance, Nancy Kneeland, a substance abuse counselor in Idaho, pointed out that “in almost all cases meth users began with alcohol and pot.”101  15

· An estimated 2.9 million persons aged 12 or older – an average of approximately 7,900 per day  used a drug other than alcohol for the first time in the past year according to the 2012 National Survey on Drug Use and Health. Almost two-thirds (65.6 percent) of these new users reported that marijuana was the first drug they tried.102

· Nearly one in ten high school students (9 percent) report using marijuana 20 times or more in the past month according to the findings of the 2011 Partnership Attitude Tracking Survey.103

· Teens past month heavy marijuana users are significantly more likely than teens that have not used marijuana in the past to: use cocaine/crack (30 times more likely); use Ecstasy (20 times more likely); abuse prescription pain relievers (15 times more likely): and abuse over the counter medications (14 times more likely). This clearly denotes that teens that use marijuana regularly are using other substances at a much higher rate than teens who do not smoke marijuana, or smoke less often.104

DEPENDENCY AND TREATMENT

· “The basic rule with any drug is if the drug becomes more available in the society, there will be more use of the drug,” said Thomas Crowley, a University of Colorado psychiatry professor and director of the university’s Division of Substance Dependence. “And as use expands, there will be more people who have problems with the drug.”105

· A study of substance abuse treatment admissions in the United States between 1998 and 2008 found that although admission rates for alcohol treatment were declining, admission rates per 100,000 population for illicit drug use were increasing. One consistent pattern in every region was the increase in the admission rate for marijuana use which rose 30 percent nationally.106

· California, a national leader in ‘medical’ marijuana use, saw admission for treatment for marijuana dependence more than double over the past decade. Admissions grew from 52 admissions per 100,000 population in 1998 to 113 per 100,000 in 2008, an increase of 117 percent.107

· “Research shows that use of [marijuana] can lead to dependence. Some heavy users of marijuana develop withdrawal symptoms when they have not used the drug for a period of time. Marijuana use, in fact, is often associated with behavior that meets the criteria for substance dependence established by the American Psychiatric Association.”108

· Marijuana was the illicit drug with the highest rate of past year dependence or abuse in 2012; of the 7.3 million persons age 12 or older classified with illicit drug dependence or abuse, 4.3 million had marijuana dependence or abuse (representing 1.7 percent of the total population aged 12 or older and 58.9 percent of all those classified with illicit drug dependence or abuse).109  16

· Among all ages, marijuana was the second most common illicit drug responsible for treatment admissions in 2011 after opioids, accounting for 18 percent of all admissions—outdistancing cocaine, the next most prevalent cause.110

· The proportion of admissions for marijuana as the primary substance of abuse for persons aged 12 or older increased from 15 percent in 2001 to 18 percent in 2011.111

· Forty percent of primary marijuana admissions were under age 20 (versus 11 percent of all admissions).112

· Twenty-five percent of primary admissions had first used marijuana by age 12 and another 32 percent by age 14.113

DANGERS TO NON USERS

DELINQUENT BEHAVIORS

Marijuana use is strongly associated with juvenile crime:

· In a 2008 paper entitled Non-Medical Marijuana III: Rite of Passage or Russian Roulette, CASA reported that in 2006 youth who had been arrested and booked for breaking the law were four times likelier than those who were never arrested to have used marijuana in the past year.114

· According to CASA in their report on Criminal Neglect: Substance Abuse, Juvenile Justice and the Children Left Behind, youth who use marijuana are likelier than those who do not to be arrested and arrested repeatedly. The earlier an individual begins to use marijuana, the likelier he or she is to be arrested.

· Marijuana is known to contribute to delinquent and aggressive behavior. A June 2007 report released by the White House Office of National Drug Control Policy (ONDCP) reveals that teenagers who use drugs are more likely to engage in violent and delinquent behavior. Moreover, early use of marijuana, the most commonly used drug among teens, is a warning sign for later criminal behavior. Specifically, research shows that the instances of physically attacking people, stealing property, and destroying property increase in direct proportion to the frequency with which teens smoke marijuana.115

In a report titled The Relationship between Alcohol, Drug Use, and Violence among Students, the Community Anti-Drug Coalitions of America (CADCA) reported that according to the 2006 Pride Surveys, during the 2005-2006 school year:

· Of those students who report carrying a gun to school during the 2005-2006 year, 63.9 percent report also using marijuana.

· Of those students who reported hurting others with a weapon at school, 68.4 percent had used marijuana. 17

· Of those students who reported being hurt by a weapon at school, 60.3 percent reported using marijuana.

· Of those students who reported threatening someone with a gun, knife, or club or threatening to hit, slap, or kick someone, 27 percent reported using marijuana.

· Of those students who reported any trouble with the police, 39 percent also reported using marijuana.116

· According to ONDCP, the incidence of youth physically attacking others, stealing, and destroying property increased in proportion to the number of days marijuana was smoked in the past year.117

· ONDCP reports that marijuana users were twice as likely as non-users to report they disobeyed school rules.118

· Youths aged 12 to 17 who had engaged in fighting or other delinquent behaviors were more likely than other youths to have used illicit drugs in the past month. In 2011 past month illicit drug use was reported by 18.5 percent of youths who had gotten into a serious fight at school or work compared with 8 percent of those who had not engaged in fighting at school or work, and by 45.1 percent of those who had stolen or tried to steal something worth over $50 in the past year compared with 8.7 percent who had not attempted or engaged in such theft.119

DRUGGED DRIVERS

Drugged driving, also referred to as impaired driving, is driving under the influence of alcohol, over-the-counter-medications, prescription drugs, or illegal drugs.

· The principal concern regarding drugged driving is that driving under the influence of any drug that acts on the brain could impair one’s motor skills, reaction time, and judgment. Drugged driving is a public health concern because it puts not only the driver at risk, but also passengers and others who share the road.120

· In Montana, where there has been an enormous increase in “medical” marijuana cardholders, Narcotics Chief Mark Long told a legislative committee in April 2010 that “DUI arrests involving marijuana have skyrocketed, as have traffic fatalities where marijuana was found in the system of one of the drivers.”121

· In 2011 there were 9.4 million persons aged 12 and older who reported driving under the influence of illicit drugs during the past year. The rate was highest among young adults aged 18 to 25.122

· Drugs that may affect driving were detected in one of every seven weekend nighttime drivers in California during the summer of 2012. In the first California statewide roadside survey of alcohol and drug use by drivers, 14 percent of drivers tested positive for drugs and 7.4 percent of drivers tested positive for alcohol, and just as many as tested positive for marijuana as alcohol. 123 18

· Since 2000, Liberty Mutual Insurance and Students Against Destructive Decisions (SADD) have been conducting a study of teens driving under the influence. Their most recent report, released in February 2012, found that nearly one in five teens have gotten behind the wheel after smoking marijuana.

§ They also found that driving under the influence of marijuana (19 percent) is a greater threat than driving under the influence of alcohol (13 percent). What greatly concerned the researchers is that many teens don’t even consider marijuana use a distraction to their driving. 124

§ “Marijuana affects memory, judgment, and perception and can lead to poor decisions when a teen under the influence of this or other drugs gets behind the wheel of a car,” said Stephen Wallace, Senior Advisor for Policy, Research and Education at SADD. “What keeps me up at night is that this data reflects the dangerous trend toward acceptance of marijuana and other substances compared to our study of teens conducted just two years ago.”125

§ The study also found that most teen drivers would not drive while under the influence if asked by their passengers not to. However, even more alarming is that teen passengers are less concerned about riding in a car with a driver who has smoked marijuana than one who has used alcohol.126

· A study in the British Medical Journal on the consequences of cannabis impaired driving found that drivers who consume cannabis within three hours of driving are nearly twice as likely to cause a vehicle collision as those who are not under the influence of drugs or alcohol.127

· A study in the Epidemiologic Reviews by researchers from Columbia University found that drivers who get behind the wheel after smoking pot run more than twice the risk of getting into an accident. This risk is even greater if the driver had also been drinking alcohol. “As more states consider medical use of marijuana, there could be health implications,” said senior author Gouhua Li. 128

· Researchers at the Pacific Institute for Research and Evaluation in Maryland studied a government data base on traffic fatalities and examined the data from 44,000 drivers involved in single-vehicle crashes who died between 1999 and 2009. They found that 24.9 percent of the drivers tested positive for drugs and 37 percent had blood-alcohol levels in excess of .08, the legal limit. The study is one of the first to show the prevalence of drug use among fatally injured drivers. Among the drivers who tested positive for drugs, 22 percent were positive for marijuana, 22 percent for stimulants, and 9 percent for narcotics.129

· In a study of seriously injured drivers admitted to a Maryland Level-1 shock-trauma center, 65.7 percent were found to have positive toxicology results for alcohol and/or drugs. Almost 51 percent of the total tested positive for illegal drugs. A total of 26.9 percent of the drivers tested positive for marijuana.130 19

· The percentage of fatally injured drivers testing positive for drugs increased over the last five years according to data from the National Highway Traffic Safety Administration (NHTSA). In 2009, 33 percent of the 12,055 drivers fatally injured in motor vehicle crashes with known test results tested positive for at least one drug compared to 28 percent in 2005. In 2009, marijuana was the most prevalent drug found in this population – approximately 28 percent of fatally injured drivers who tested positive tested positive for marijuana.131

· Recognizing that drugged driving is a serious health and safety issue, the National Organization for the Reform of Marijuana Laws (NORML) has called for a science-based educational campaign targeting drugged driving behavior. In January of 2008, Deputy Director Paul Armentano released a report titled, Cannabis and Driving, noting that motorists should be discouraged from driving if they have recently smoked cannabis and should never operate a motor vehicle after having consumed both marijuana and alcohol. The report also calls for the development of roadside, cannabis-sensitive technology to better assist law enforcement in identifying drivers who may be under the influence of pot.132

· In a 2007 National Roadside Survey of alcohol and drug use by drivers, a random sample of weekend night time drivers across the United States found that 16.3 percent of the drivers tested positive for drugs, compared to 2.2 percent of drivers with blood alcohol concentrations at or above the legal limit. Drugs were present more than 7 times as frequently as alcohol.133

· According to a National Institute of Drug Abuse (NIDA) funded study, a large number of American adolescents are putting themselves and others at great risk by driving under the influence of illicit drugs or alcohol. In 2006, 30 percent of high school seniors reported driving after drinking heavily or using drugs, or riding in a car whose driver had been drinking heavily or using drugs, as least once in the prior two weeks. Dr. Patrick O’Malley, lead author of the study, observed that “Driving under the influence is not an alcohol-only problem. In 2006, 13 percent of seniors said they drove after using marijuana while ten percent drove after having five or more drinks.” “Vehicle accidents are the leading cause of death among those aged 15 to 20,” added Dr. Nora Volkow, Director of NIDA. “Combining the lack of driving experience among teens with the use of marijuana and/or other substances that impair cognitive and motor abilities can be a deadly combination.” 134

· A June 2007 toxicology study conducted at the University of Maryland’s Shock-Trauma Unit in Baltimore found that over 26 percent of injured drivers tested positive for marijuana. In an earlier study, the U.S. National Survey on Drug Use and Health estimated that 10.6 million Americans had driven a motor vehicle under the influence of drugs during the previous year. 135

· A study of over 3000 fatally-injured drivers in Australia showed that when marijuana was present in the blood of the driver they were much more likely to be at fault for the accident. And the higher the THC concentration, the more likely they were to be culpable.136

· The National Highway Traffic Safety Administration (NHTSA) has found that marijuana significantly impairs one’s ability to safely operate a motor vehicle. According to its report, “epidemiology data from road traffic arrests and fatalities indicate that after alcohol, marijuana is the most frequently detected psychoactive substance among driving populations.” Problems reported include: decreased car handling performance, inability to maintain headway, 20 impaired time and distance estimation, increased reaction times, sleepiness, lack of motor coordination, and impaired sustained vigilance.137

OTHER CONSEQUENCES OF MARIJUANA USE

· In Massachusetts in 2009 the possession of one ounce of marijuana went from a criminal charge to a civil fine. Police and District Attorneys want residents to know that smoking marijuana is not a victimless crime. Middlesex District Attorney Gerard T. Leone Jr. says that he fears that “decriminalization has created a booming ‘cottage industry’ for dope dealers to target youths no longer fearing the stigma of arrest or how getting high could affect their already dicey driving. What we’re seeing now is an unfortunate and predictable outcome. It’s a cash and carry business. With more small-time dealers operating turf encroachment is inevitable. This tends to make drug dealers angry.” Wellesley Deputy Police Chief William Brooks III, speaking on behalf of the Massachusetts Chiefs of Police Association said “the whole thing is a mess. The perception out there among a lot of people is it’s ok to do it now, so there’s an uptick in the number of people wanting to do it…Most of the drug-related violence you see now – the shootings, murders – is about weed.” Several 2010 high-profile killings have been linked by law enforcement to the increased market:

§ The May fatal shooting of a 21-year-old inside a Harvard University dorm, allegedly in a bid to rob him of his pot and cash.

§ The June murder of a 17-year-old in Callahan State Park, where he was lured by two men seeking revenge in a fight over marijuana.

§ The September massacre of four people in Mattapan, including a 21-year-old woman and her 2-year-old son, over an alleged pot-dealing turf dispute.

§ The September fatal shooting of a 29-year-old man, by four men, one a high school senior, in connection with robbery and murder of a drug dealer.138

· Children often bear the consequences of actions engaged in by parents or guardians involved with marijuana:

§ In Bradenton, Florida a Highway Patrol officer tried to stop a man speeding on  I-75. The driver did not stop until he ran up on the median and crashed into a construction barrel. In the car the troopers found three small children, forty pounds of marijuana and several thousand dollars in cash.139

§ A Hamilton, Montana man put his three toddlers in the back seat of his one ton Chevy pickup and then partied with a friend as he drove along the highway. At 50 miles an hour he swerved into another car killing the owner. While partying with his friend in the vehicle he had smoked two bowls of pot.140

§ An Ohio mother is accused of teaching her two-year-old daughter smoke pot and recording the incident on her cell phone.141  21

§ A Virginia mother and her roommate were charged with reckless child endangerment after her two-year-old daughter ingested an unknown amount of marijuana in a motel room.142

§ A California couple was arrested after a video surfaced of them allowing their 23- month-old son to use a marijuana pipe. The video showed the child smoking the pipe. The pipe was tested and found to have marijuana residue in it. Both parents said they had medical marijuana cards, but could not explain why they would give it to their child and then videotape the incident.143

§ Cincinnati, Ohio police arrested a woman for allegedly giving her three children, ages seven, four, and one, marijuana. The seven-year-old told the school counselor that she had been forced to smoke marijuana. All three children tested positive for marijuana..144

§ In Stockton, California a two-year-old girl was in critical condition after ingesting marijuana resin. Although four adults were home at the time, none were supervising the child when she found a jar lid containing resin.145

§ Two toddlers in Louisiana were hospitalized after ingesting marijuana and amphetamines. A search warrant of the home found several unsecured bottles of prescription medication and a hand-rolled cigar containing marijuana.146

· In Santa Clara, California, in one week in December, four dispensaries and one marijuana grower were hit by vandals, burglars, or armed robbers. At one location four suspects robbed the victim by throwing him to the floor, holding a piece of metal to his throat, and demanding marijuana and money. At one dispensary, the owner, who is paralyzed and in a wheelchair, was closing up the shop when armed robbers knocked him over and barged in. The robbers tied him up and took marijuana and cash.147

· The Los Angeles Police Department investigated a series of robberies and shootings at marijuana dispensaries. Over a one week period in June 2010 a Northridge dispensary robbery left one employee in critical condition after being shot in the face; the shooting was the second at that business that year and the third dispensary to be targeted in three days. Two people were fatally shot in a pot shop robberies in Echo Park and Hollywood, and a third person was wounded.148

· On March 4, 2010, a California man was killed after opening fire on two Pentagon Police Officers. In a story on MSNBC, the Friday before the incident, John Patrick Bedell’s parents had warned local authorities that his behavior had become erratic and that he was unstable and had a gun. Bedell was diagnosed as bipolar and had been in and out of treatment programs for years. His psychiatrist, J. Michael Nelson, said “Bedell tried to self-medicate with marijuana, inadvertently making his symptoms more pronounced.”149   Bedell had been given a recommendation for medical use of marijuana in 2006 for chronic insomnia. According to long-time friend Reb Monaco “he was not a person who should have been issued a medical clearance to use marijuana, but he was.”150  22

· A marijuana dealer kidnapped and murdered a 15 year-old boy after he got angry at the teen’s half-brother for owing him a $2,500 drug debt.151

· Grant Everson and three friends armed with box cutters and a shot-gun slipped into Everson’s parents’ Chaska, Minnesota home demanding money to open a coffee house in the marijuana friendly City of Amsterdam, Netherlands. Although Grant lost his nerve, his friends proceeded to shoot and kill his mother. All four were arrested. Their alibi was that they had been sleeping in the same Burnsville apartment after a night of smoking marijuana and playing video games.152 The National Transportation Safety Board investigation of a small plane crash near Walnut Ridge, Arkansas, killing a passenger and the pilot, was a result of pilot error. Pilot Jason Heard failed to fly high enough and maintain enough airspeed to avoid a stall. The report notes that Pilot Jason Heard had enough marijuana in his system to have contributed to the accident.153

MARIJUANA AND INCARCERATION

Federal marijuana investigations and prosecutions usually involve hundreds of pounds of marijuana. Few defendants are incarcerated in federal prison for simple possession of marijuana.

· In 2008, according to the United States Sentencing Commission (USSC), 25,337 people were sentenced in federal court for drug crimes under six offense categories. Marijuana accounted for 6,337 (25 percent). Looking even further, of the 6,337 people sentenced, only 99 people or 1.6 percent, were sentenced for “simple possession” of marijuana.154

· According to a Bureau of Justice Statistics survey of state and federal prisoners published in October 2006, approximately 12.7 percent of state prisoners and 12.4 percent of federal prisoners were serving time for a marijuana-related offense. This is a decrease from 1997 when these figures were 12.9 percent and 18.9 percent respectively.155

· Between October 1, 2005 and September 30, 2006, there were 6,423 federal offenders sentenced for marijuana-related charges in the U.S. Courts. Approximately 95.9 percent of the cases involved trafficking.156

· In Fiscal Year 2006, there were 25,814 offenders sentenced in federal court on drug charges. Of those, only 1.6 percent (406 people) were sentenced for simple possession.157

· According to the White House Office of National Drug Control Policy, “Many inmates ultimately sentenced for marijuana and possession were initially charged with more serious crimes but were able to negotiate reduced charges or lighter sentences through plea agreements with prosecutors. Therefore the …figure for simple possession defendants may give an inflated impression of the true numbers, since it also includes these inmates who pled down from more serious charges.” 158

· While illicit drugs are implicated in three-quarters of incarcerations (75.9 percent), few inmates are incarcerated for marijuana possession as their controlling or only offense. 23 Inmates incarcerated in federal and state prisons and local jails for marijuana possession as the controlling offenses accounted for 1.1 percent of all inmates and 4.4 percent of those only offense accounted for .9 percent of all inmates and 2.9 percent those incarcerated for drug law violations.159

· Findings from the 2008 Arrestee Drug Abuse Monitoring System (ADAM II), which surveys drug use among booked male arrestees in ten major metropolitan areas across the country, shows the majority of arrestees in each city test positive for illicit drug use, with as many as 87 percent of arrestees testing positive for an illegal drug. Marijuana is the most commonly detected drug at the time of the arrest. In seven of the ten sites arrestees who are using marijuana are using it on the average of every other day for the past 30 days.160

OTHER CONSIDERATIONS

MARIJUANA USE AMONG YOUTH IS RISING AS PERCEPTION OF RISK DECREASES

· Historical drug trends from the national Monitoring the Future Survey show that when anti drug attitudes soften there is a corresponding increase in drug use in the coming years. An adolescent’s perception of risks associated with substance use is an important determinant of whether he or she engages in substance abuse. Youths who perceive high risk of harm are less likely to use drugs than youths who perceive low risk of harm.

· The 2013 Monitoring the Future Survey, five-year trends are showing significant increase in past-year and past-month (current) marijuana use across all three grades as well as increase in lifetime and daily marijuana use among 10th graders. From 2008 to 2013, past month use increased from 5.8 percent to 7 percent among 8th graders, 13.8 percent to 18 percent among 10th graders and 19.4 percent to 22.7 percent among 12th graders.161

· Nearly 23 percent of seniors say they smoked marijuana in the past month, and just over 36 percent smoked it in the past year.162 This means that one in every 15 high school seniors is a daily or near daily user of marijuana.163

· For 10th graders, 4 percent say they use marijuana daily, with 18 percent using in the past month, and 29.8 percent using in the past year. More than 12 percent of 8th graders (13 and 14 year olds) say they used marijuana in the past year.164

· This increase in use by teens reiterates the link between use and the perception of risk. Lloyd Johnston, principal investigator of the Monitoring the Future Survey, once again raises this concern as a result of the findings of the survey. “Most noteworthy is the fact that the proportion of adolescents seeing marijuana use as risk declined again sharply in all three grades. Perceived risk- namely the risk to the user that teenagers associate with a drug- has been a lead indicator of use, both for marijuana and other drugs, and it has continued its sharp decline in 2013 among teens. This could foretell further increases in use in the future.”165  24

· From 2005 to 2013, the percent of teens seeing great risk from being a regular marijuana user has fallen among 8th graders from 74 percent to 61 percent; among 10th graders, from 66 percent to 47 percent; and among 12th graders, from 58 percent to 40 percent.166

· This means that among high school seniors, sixty percent do not view regular marijuana use as harmful.167

· Survey results from the past two years also revealed that 34 percent of marijuana-using 12thgraders living in states with medical marijuana laws say that one of the ways the obtain the drug is through someone else’s medical marijuana “prescription.” In addition, more than 6 percent say they get it with their own “prescription.” Thus states with medical marijuana laws do seem to provide another avenue of accessibility to the drug. This link between state laws and marijuana’s accessibility to teens will continue to be explored.168

· According to the Partnership Attitude Tracking Survey, 2011 Parents and Teens, nine percent of teens (1.5 million) smoked marijuana heavily (at least 20 times in the past month). Between 2008 and 2011, past month use is up 42 percent, past year use is up 26 percent and lifetime use is up 21 percent among teens.169

· Teens report seeing more of their peers smoking marijuana; only 26 percent say that in their school most teens don’t smoke marijuana. Also, 71 percent of teens say they have friends that smoke marijuana regularly, up from 64 percent in 2008.170

· A continuing erosion of anti-marijuana attitudes was also noted; only about half of teens (51 percent) say the see great risk in using marijuana, down from 61 percent in 2005.171

· Media also plays a role in changing the perception of marijuana use. Nearly half (45 percent) of teens say that the music they listen to makes marijuana seem cool and almost half (47 percent) agree that movies and television shows make drugs seem like the thing to do.172

A final note: DEA’s responsibility as it pertains to marijuana is clearly delineated in federal law. But our responsibility to the public goes further – to educate about the fallacy of smoked marijuana as medicine with fact and scientific evidence. DEA supports research into the use of marijuana as a medicine, to be approved through the FDA process, the same as with all other medicines in the U.S.

We also want the public to understand the ramifications of the use of this drug and the consequences it will have on our youth and our society as a whole.

For more information about marijuana and other drugs of abuse, please visit our websites:

www.DEA.gov; our teen website, written for teens and educators: www.justthinktwice.com; and our parent website, written for parents, caregivers, and educators: www.GetSmartAboutDrugs.com.  25

Endnotes

1 “Inter-Agency Advisory Regarding Claims That Smoked Marijuana Is a Medicine.” U.S. Food and Drug

Administration, April 20, 2006.

<http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/2006/ucm/108643.htm>.

2 “AMA Policy Statement on Cannabis, H-95.998.” American Medical Association House of Delegates (1-13), Council

on Science and Public Health Report 2. November 19, 2013. P. 6

3 ASAM Public Policy on “Medical Marijuana.” (April 23, 2010) http://www.wfad.se/latest-news/1-articles/213-asampublic-

policy-statement-on-qmedical-marijuanaq.

4 “American Society of Addiction Medicine Reiterates ASAM Marijuana Policy Positions.” October 27, 2011,

http://www.asam.org/1MARIJUANA%205-062.pdf. “White Paper on State-Level Proposals to Legalize Marijuana.”

Adopted by the ASAM Board of Directors July 25, 2012. www.asam.org/policies/state–level-proposals-to-legalizemarijuana.

5 “Medical Use of Marijuana: ACS Position.” American Cancer Society. April 14, 2010.

Documents.cancer.org/acs/groups/cid/documents/webcontent/001976-pdf.pdf.

6 “American Glaucoma Society Position Statement: Marijuana and the Treatment of Glaucoma.” Jampel, Henry MD.

MHS, Journal of Glaucoma: February 2010- Volume 19-Issue 2 –pp.75-76 doi:10.1097/IJG.obo13e3181d12e39. also

www.glaucomaweb.org .

7 “Medical Marijuana.” Glaucoma Research Foundation, April 24, 2012, www.glaucoma.org/treatment/medicalmarijuana.

php.

8 Committee on Substance Abuse and Committee on Adolescence. “Legalization of Marijuana: Potential Impact on

Youth.” Pediatrics Vol. 113, No. 6 (June 6, 2004): 1825-1826. See also, Joffe, Alain, MD, MPH, and Yancy,

Samuel, MD. “Legalization of Marijuana: Potential Impact on Youth.” Pediatrics Vol. 113, No. 6 (June 6, 2004):

e632-e638h.

9 “AACAP Medical Marijuana Policy Statement.” Approved by Council, June 11, 2012,

http://www.aacap.org/cs/root/policy_statements/aacap_medical_marijuana_policy_statement.

10 “Complementary and Alternative Medicine, Marijuana” National Multiple Sclerosis Society,

www.nationalmssociety.org/about-multiple-sclerosis/what-we-know-about-ms/treatments/complementary–

alternative-medicine/index.aspx. January 30, 2013.

11 “Legalization of Marijuana, Consensus Statement.” National Association of School Nurses. March 2013. p. 1

12 Ibid. p.2

13 “Position Statement on Marijuana as Medicine.” American Psychiatric Association. November 10, 2013. P.1

14 “New Report Finds Highest Levels of THC in U.S. Marijuana to Date.” Office of National Drug Control Policy Press

Release. May 14, 2009.

15 “Potency Monitoring Program Quarterly Report Number 123, Reporting Period September 16, 2013 – December 15,

2013.” Mahmoud ElSohly, Director, NIDA Marijuana Project. p.7.

16 “Regular marijuana use by teens continues to be a concern.” National Institute of Drug Abuse, Press Release,

December 19, 2012. P.2

17 Ibid.

18 “Results from the 2012 National Survey on Drug Use and Health: Summary of National Findings.” U.S. Department

of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Behavioral Health

Statistics and Quality. September 2013. p.1

19 Ibid. p.2

20 Ibid. p.4

21 Ibid. p.19

22 Ibid. p.28

23 Ibid. p.28

24 Ibid. p.56

25 “Substance use by adolescents on an average day is alarming.” SAMHSA News Release, September 29, 2013.

www.samhsa.gov/newsroom/advisories/1308285320.

26 “American teens are more cautious about synthetic drugs.” University of Michigan Press Release, December 18, 2013.

P. 3 www.umich.edu/news.

27 “Sixty percent of 12th graders do not view regular marijuana use as harmful.” National Institutes of Health, National

Institute of Drug Abuse, Press Release, December 18, 2013. p. 1.

28 “The Partnership Attitude Tracking Study: 2011 Parents and Teens Full Report.” METLIFE Foundation and the

Partnership at drufree.org. May 2, 2012.

29 Ibid.

26

30 Ibid.

31 Ibid.

32 Ibid.

33 Ibid.

34 “The Debate Over the Drug is No Longer about Liberty. It’s about Health.” Antonio Maria Costa. March 27, 2007.

Independent on Sunday, United Kingdom.

35 “INCB President voices concern about the outcome of recent referenda about non-medical use of cannabis in the

United States in a number of states.” United Nations Information Service. Press Release. November 15, 2012.

36 “Why Marijuana Legalization Would Compromise Public Health and Safety.” ONDCP Director Gil Kerlikowske,

Speech Delivered at the California Police Chiefs Association Conference. March 4, 2010.

37 “Marijuana’s Lasting Effects on the Brain.” Messages from the Director, Nora Volkow, Director, National Institute of

Drug Abuse. January 2013. www.drugabuse.gov/about-nida-/directors+page/messages-director/2013/01/marijuanaslasting-

effects-brain.

38 “Marijuana Can Lower IQ in Teens.” Sarah Glynn. Medical News Today. September 19, 2012.

http://www.medicalnewstoday.com/articles/250404.php; “Teen Cannabis Use Linked to Lower IQ.” Christian Nordqvist.

Medical News Today. August 28, 2012. http://www.medicalnewstoday.com/articles/249508.php.

39 “Nearly One in Ten First-Year College Students at One University Have a Cannabis Use Disorder; At-Risk Users

Report Potentially Serious Cannabis-Related Problems.” CESAR FAX, Vol. 17, Issue 3, January 21, 2008.

www.cesar.umd.edu.

40 “Teen Marijuana Use Worsens Depression: An Analysis of Recent Data Shows “Self Medication” Could Actually

Make Things Worse.” Office of National Drug Control Policy May 2008.

http://www.whitehousedrugpolicy.gov/news/press08/marij_mental_health.pdf.

41 “Cannabis increases risk of psychosis in teens.” Telegraph News, June 2, 2008.

http://www.telegraph.co.uk/news/uknews/2063199/Cannabis-increases-risk-of-psychosis-in-teens.html.

42 “Drug Abuse; Drug Czar, Others Warn Parents that Teen Marijuana Use Can Lead to Depression.” Life Science

Weekly. May 31, 2005.

43 Kearney, Simon. “Cannabis is Worst Drug for Psychosis.” The Australian. November 21, 2005.

44 Curtis, John. “Study Suggests Marijuana Induces Temporary Schizophrenia-Like Effects.” Yale Medicine.

Fall/Winter 2004.

45 “Marijuana Use Takes Toll on Adolescent Brain Function, Research Finds.” Science Daily, October 15, 2008.

http://www.scienedaily.com/releases/2008/10/081014111156.htm.

46 “Memory, Speed of Thinking and Other Cognitive Abilities Get Worse Over Time With Marijuana Use” March 15,

2006. http://www.news-medical.net

47 “Marijuana May Shrink Parts of the Brain.” Steven Reinberg. U.S. News and World Report – Online. June 2, 2008.

http://health.usnews.com/articles/healthday/2008/06/02/marijuana_may_shrink_parts_of_the_brain.html. “Long-term

Cannabis Users May Have Structural Brain Abnormalities.” Science Daily. June 3, 2008.

http://www.sciencedaily.com/releases/2008/06/080602160845.htm.

48 Kate Benson, “Dope smokers not so mellow.” The Sydney Morning Herald, July 30, 2009.

http://www.smh.com/au/news/health/dope-smokers-not-so-mellow-20090407-9yOi.html.

49 “Neurotoxicology; Neurocognitive Effects of Chronic Marijuana Use Characterized.” Health & Medicine Week. 16

May 2005.

50 “Study: Marijuana may Affect Neuron Firing.” November 29, 2006. UPI.

51 “Marijuana Links with Psychosis.” AM with Tony Eastley. February 8, 2011.

http://www.abc.nte.au/am/content/2011/s3132596.htm.

52 “A Functional MRI Study of the Effects of Cannabis on the Brain.” Prof. Phillip McGuire, UK, May 1, 2007. 2nd

International Cannabis and Mental Health Conference, London, UK.

53 “Quitting Pot Important Part of Trudeau’s Recovery.” Denise Ryan, Vancouver Sun, February 12, 2007.

54 Laucius, Joanne. “Journal Articles Link Marijuana to Schizophrenia” August 28, 2006 www.Canada.com

55 “Teenage Schizophrenia is the Issue, Not Legality.” Robin Murray. Independent on Sunday. March 18, 2007.

www.independent.co.uk.

56 “UN Warns of Cannabis Dangers as it Backs ‘IoS’ Drugs ‘Apology’.” Jonathan Owen. Independent on Sunday.

March 25, 2007. www.independent.co.uk. and “Cannabis-related Schizophrenia Set to Rise, Say Researchers.”

Science Daily. March 26, 2007. www.sciencedaily.com/releases/2007/03/070324132832.htm.

57 “Long-term pot use can double risk of psychosis.” March 1, 2010. http://www.msnbc.com/id/35642202/ns/healthaddictions/?

ns=health-addictions. Also McGrath J, et al “Association between cannabis use and psychosis-related

outcomes using sibling pair analysis in a cohort of young adults” Arch Gen Psych 2010; DOI:

10.1001/archgenspychiatry.2010.6.

27

58 “Prenatal Marijuana Exposure and Intelligence Test Performance at Age 6.” Abstract, Journal of the American

Academy of Child & Adolescent Psychiatry. 47(3):254-263, March 2008. Goldschmidt, Lidush Ph.D. et al.

59 “Marijuana Use Affects Blood Flow in Brain Even After Abstinence.” Science Daily, February 12, 2005.

www.sciencedaily.com/releases/2005/02/050211084701.htm; Neurology, February 8, 2005, 64.488-493.

60 “Highlights of the 2011 Drug Abuse Warning Network (DAWN) Findings on Drug-Related Emergency Department

Visits.” The DAWN Report, Department of Health and Human Services, Substance Abuse and Mental Health

Services Administration, Center for Behavioral Health Statistics and Quality February 22, 2013.p.3

61 Ibid. p.4.

62 “Highlights of the 2010 Drug Abuse Warning Network (DAWN) Findings on Drug-Related Emergency Department

Visits.” The DAWN Report, Department of Health and Human Services, Substance Abuse and Mental Health

Services Administration, Center for Behavioral Health Statistics and Quality July 2, 2012. P.4.

63 “Results from the 2012 National Survey on Drug Use and Health: Summary of Findings.” U.S. Department of Health

and Human Services, Substance Abuse and Mental Health Services Administration, Center for Behavioral Health and

Quality Statistics, September 2013. p. 77

64 “A Day in the Life of American Adolescents: Substance Use Facts Update.” The CBHSQ Report, Center for

Behavioral Health Statistics and Quality, August 29, 2013. http://www.samhsa.gov/data .

65 State of California, Environmental Protection Agency, Office of Environmental Health Hazard Assessment, Safe

Drinking Water and Toxic Enforcement Act of 1986, “Chemicals Known to the State to Cause Cancer or

Reproductive Toxicity, September 11, 2009. http://www.oehha.ca.gov/prop65_list/files/P65single091001.pdf.

66 “Pot smoking during pregnancy may stunt fetal growth.” January 22, 2010.

http://www.reuters.com/article/id=Ustre60L55L20100122.

67 “Heavy Marijuana Use Linked to Gum Disease, Study Shows.” Science Daily, February 6, 2008.

http://www.sciencedaily.com/releases/2008/02/080205161239.htm. “Cannabis Smoking and Periodontal Disease

Among Young Adults.” The Journal of the American Medical Association, Vol. 299, No. 5, February 6, 2008.

http://www.jama.ama-assn.org/cgi/content/full/299/5/25.

68 “Marijuana Smokers Face Rapid Lung Destruction – As Much As 20 Years Ahead of Tobacco Smokers.” Science

Daily, January 27, 2008. http://www.sciencedaily.com/releases/2008/01/080123104017.htm. “Bullous Lung Disease

Due to Marijuana.” Respirology (2008) 13, 122-127.

69 Marijuana Smoke Contains Higher Levels of Certain Toxins Than Tobacco Smoke.” Science Daily, December 18,

2007. http://sciencedaily.com/releases/2007/12/071217110328.htm. “A Comparison of Mainstream and Sidestream

Marijuana and Tobacco Smoke Produced Under Two Machine Smoking Conditions.” American Chemical Society,

Chemical Research in Toxicology, December 17, 2008.

70 “Marijuana Worsens COPD Symptoms in Current Cigarette Smokers.” American Thoracic Society. Science Daily,

May 23, 2007.

71 “How Smoking Marijuana Damages the Fetal Brain.” Karolinska Institute. Science Daily, May 29, 2007.

72 “Cannabis Linked to Lung Cancer Risk.” Martin Johnston. New Zealand Herald, March 27, 2007.

73 “Marijuana Use Linked to Increased Risk of Testicular Cancer.” Science Daily, February 9, 2009.

http://www.scienedaily.com/releases/2009/02/090209075631.htm. “Marijuana Use Linked to Testicular Cancer.

Kelly Fitzgerald. Medical News Today. September 10, 2012.

http://www.medicalnewstoday.com/articles/250050.php.

74 Tertrault, Jeannette M. MD, et. al., “Effects of Marijuana Smoking on Pulmonary Function Respiratory

Complications: A Systematic Review” Arch. Intern. Med. 2007:167:221-228; Science Daily, “Long-term Marijuana

Smoking Leads to Respiratory Complaints,” www.sciencedaily.com/releases/2007/02/070212184119.htm.

75 “Marijuana Use Linked to Early Bladder Cancer.” http://www.medicalnewstoday.com/articlces/36695.php. January

26, 2006.

76 “Marijuana Tied to Precancerous Lung Changes” Reuters. July 13, 2006. http://today.reuters.com/misc See also:

“The Association Between Marijuana Smoking and Lung Cancer” Archives of Internal Medicine.

http://archinte.ama.assn.org/cgi/content/full/166/12/1359?maxtoshow July 10, 2006.

77 “Cannabis More Toxic than Cigarettes: Study,” French National Consumers’ Institute, 60 Million Consumers

(magazine) April 2006, www.theage.com.au.

78 “Conception and Pregnancy Put at risk by Marijuana Use” News-Medical.Net August 2, 2006 See also: “Fatty Acid

Amide Hydrolase Deficiency Limits Earl Pregnancy Events” Research Article. Journal of Clinical Investigation.

Published March 22, 2006, revised May 23, 2006 http://www.jci.org/cgi/content/full/116/8/2122

79 In utero Marijuana Exposure Alters Infant Behavior. Reuters, January 17, 2007.

80 Metro, Michael J., MD. “Association Between Marijuana Use and the Incidence of Transitional Cell Carcinoma

Suggested” http://www.news.medical.net June 28, 2006.

28

81 Tashkent, D.P., “Smoked Marijuana is a Cause of Lung Injury.” Monaldi Archives for Chest Disease 63(2):93-100,

2005.

82 “Marijuana Associated with Same Respiratory Symptoms as Tobacco,” YALE News Release. January 13, 2005.

<http://www.yale.edu/opa/newsr/05-01-13-01.all.htm> (14 January 2005). See also, “Marijuana Causes Same

Respiratory Symptoms as Tobacco,” January 13, 2005, 14WFIE.com.

83 “What Americans Need to Know about Marijuana,” page 9, ONDCP.

84 “Decreased Respiratory Symptoms in Cannabis Users Who Vaporize,” Harm Reduction Journal 4:11, April 16,

2007.

85 “Marijuana Affects Brain Long-Term, Study Finds.” Reuters. February 8, 2005. See also: “Marijuana Affects

Blood Vessels.” BBC News. 8 February 2005; “Marijuana Affects Blood Flow to Brain.” The Chicago Sun-Times.

February 8, 2005; Querna, Elizabeth. “Pot Head.” US News & World Report. February 8, 2005.

86 Smith, Michael. Medpage Today. February 12, 2007.

http://www.medpagetoday.com/Neurology.GeneralNeurology/tb/5048.

87 “HIV Patients: Marijuana Eases Foot Pain.” Associated Press. February 13, 2007.

88 Weiss, Rick. “Research Supports Medicinal Marijuana.” Washington Post. February 13, 2007.

89 Dahlbert, Carrie Peyton. “Marijuana Can Ease HIV-related Nerve Pain.” McClatchy Newspapers. Feb. 13, 2007.

90 Hashibe M, Morgenstem H, Cui Y, et al. Marijuana use and the risk of lung and upper aerodigestive tract cancers:

results of a population-based case-control study. Cancer Epidemiol Biomarkers Prev 2006; 15:1829-1834.

91 “Heavy marijuana use not linked to lung cancer,” News-Medical.Net, Wednesday, May 24, 2006.

92 http://www.nida.nih.gov/DirReports/DirRep207/DirectorReport8.html.

93 http://www.umich.edu/news/index.html?Releases/2006/Oct06/r101006a.

94 “Health risks of cannabis ‘underestimated,’ experts warn.” BBC News. June 5, 2012.

http://www/bbc.co.uk/news/health-18283689. “The impact of cannabis on your lungs.” British Lung Foundation 2012.

www.wkcia.org/research/blf_cannabis_lungs.pdf.

95 “Risk of Premature Birth Doubled By Marijuana Use.” University of Adelaide. Medical News Today. July 19, 2012.

http://www.medicalnewstoday.com/releases/247945.php.

96 Harding, Anne. “Pot May Indeed Lead to Heroin Use, Rat Study Shows” Reuters. July 12, 2006. See also: “Why

Teenagers Should Steer Clear of Cannabis” Vine, Gaia. www.NewScientist.com

97 “What Americans Need to Know about Marijuana.” Office of National Drug Control Policy. October 2003.

98 Gfroerer, Joseph C., et al. “Initiation of Marijuana Use: Trends, Patterns and Implications.” Department of Health

and Human Services, Substance Abuse and Mental Health Services Administration, Office of Applied Studies. July

2002. Page 71.

99 “Non-Medical Marijuana II: Rite of Passage or Russian Roulette?” CASA Reports. April 2004. Chapter V, Page 15.

100 “What Americans Need to Know about Marijuana,” page 9, ONDCP.

101 Furber, Matt. “Threat of Meth—‘the Devil’s Drug’—increases.” Idaho Mountain Express and Guide. December

28, 2005.

102 “Results from the 2012 National Survey on Drug Use and Health: Summary of National Findings.” U.S. Department

of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Behavioral Health

Statistics and Quality. September 2013. p.52

103 “Nearly One in Ten U.S High School Students Report Heavy Marijuana Use in the Past Month: One Third or More of

Heavy Users Also Used Cocaine, Ecstasy, or Other Drugs.” CESARFAX, Vol 21. Issue 21. May 29, 2012.

104 The Partnership Attitude Tracking Study: 2011 Parents and Teens Full Report.” MetLife and the Partnership At

Drugfree.org. May 2, 2012. P7.

105 “Medical pot laws result in increased teen drug use. “White Mountain Independent. January 13, 2011.

http://www.wmicentral.com/news/atests_news/medical-pot-laws-result-in-increased-teen-drug-use/article_a6622a0c-

1f42-11e0-a38e-001cc4c002e0.html.

106 “New Study shows dramatic shifts in substance abuse treatment admissions among states between 1998 and 2008.”

Department of Health and Human Services, Substance Abuse and Mental Health Administration, Office of Applied

Studies. Press Release. December 22, 2010. http://www.samhsa.gov.

107 California No. 1 in marijuana admissions.” Cheryl Wetzstein. The Washington Times. December 30, 2010.

http://www.washingtontimes.com/news/2010/dec/30/

108 “Marijuana Myths & Facts: The Truth Behind 10 Popular Misperceptions.” Office of National Drug Control Policy.

<http://www.whitehousedrugpolicy.gov/publications/marijuana_myths_facts/index.html> (January 12, 2006).

109 Ibid. p. 77

110 Treatment Episode Data Sets (TEDS) 2001-2011: National Admissions to Substance Abuse Treatment Services.”

Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for

Behavioral Health Statistics and Quality. July 2012. p.1

29

111 Ibid. P.2

112 Ibid. p19.

113 Ibid. 19.

114 “Non-Medical Marijuana III: Rite of Passage or Russian Roulette?” A CASA White Paper, June 2008.

http://www.casacolumbia.org.

115 “Early Marijuana Use a Warning Sign For Later Gang Involvement,” ONDCP press release, June 19, 2007.

116 “The Relationship Between Alcohol, Drug Use and Violence Among Students.” Community Anti-Drug Coalitions of

American (CADCA). www.cadca.org. Pride Surveys, (2006) Questionnaire report for grades 6-12: 2006 National

Summary. Page 184. http://www.pridesurveys.com/customercetner/us05ns.pdf.

117 Office of National Drug Control Policy. (2006) “Marijuana Myths and Facts: The Truth Behind 10 Popular

Misperceptions. “Page 10. http://www.whitehousedrugpolicy.gov/publications/marijuana_mythis_facts.

118 Ibid.

119 “Results from the 2011 National Survey on Drug Use and Health: Summary of National Findings.” U.S. Department

of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Behavioral Health

Statistics and Quality. September 2012.

120 NIDA Info Facts: Drugged Driving, September 10, 2009, page 1. http://drugabuse.gov/Infofacts/driving.html.

121 Volz, Matt. “Drug overdose: Medical marijuana facing a backlash.” http://www.msnbc.msn.com/id/37282436.

122 Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Office of

Applied Studies. Results from the 2011 National Survey on Drug Use and Health: Summary of National Findings.

September 2012. P.2.

123 “California Roadside Survey Finds Twice as Many Weekend Nighttime Drivers Test Positive for Other Drugs as for

Alcohol: Marijuana as Likely as Alcohol.” CESARFAX, Col. 21, Issue 48, December 3, 2012.

www.cesar.umd.edu/cesar/vol21/21-48.pdf.

124 “Hazy Logic: Liberty Mutual Insurance/SADD Study Finds Driving Under the Influence of Marijuana a Greater

Threat to Teen Drivers than Alcohol.” Liberty Mutual Press Release. February 22, 2012.

http://www.sadd.org/press/presspdfs/marijuana%20Teen%20Release.pdf.

125 Ibid.

126 Ibid.

127 “Cannabis Use Doubles Chances of Vehicle Crash, Review Finds.” Sciencedaily. February 9, 2012.

http://www.sciencedaily.com/releases/2012/02/120210111254.htm.

128 Marijuana and Crash Risk Linked. Caitlin Bronson. ThirdAge. October 13, 2011.

http://www.thirdage.com/news/marijuna-and-crash-risk-linked_10-13-2011.

129 “Drug use involved in 25% of fatal crashes, study finds.” Jonathan Shorman. USA Today. July 23, 2011.

http://www.yourlife.usatoday.com/yhealth/story/2011/06/Drug-use-involved-in-25-of-fatal-chrashes-studyfinds/

48740704/1. “Drugs and Alcohol Involvement in Four Types of Fatal Crashes.” Eduardo Romano and Robert Voas.

Journal of Studies on Alcohol and Drugs. July 2011.

130 DuPont, Robert. “National Survey Confirms that Drugged Driving is Significantly More Widespread than Drunk

Driving.” Commentary, Institute for Behavior and Health, July 17, 2009. page 1. http://www..ibhinc.org.

131 “One-third of Fatally Injured Drivers with Known Test Results Tested Positive for at Least one Drug in 2009.

CESARFAX. Vol. 19, Issue 49. December 20, 2010. www.cesar.umd.edu.

132 “Cannabis and Driving: A Scientific and Rational Review.” Armentano, Paul. NORML/NORML Foundation. January

10, 2008. http://normal.org/index.cfm?Group_ID=7475 for article and http://normal.org/index.cfm?Group_ID=7459

for the full report.

133 DuPont, Robert. “National Survey Confirms that Drugged Driving is Significantly More Widespread than Drunk

Driving.” Commentary, Institute for Behavior and Health, July 17, 2009. page 1. http://www.ibhinc.org.

134 “Drug-Impaired Driving by Youth Remains Serious Problem.” NIDA News Release, October 29, 2007.

http://www.drugabuse.gov/newsroom/07/NR10-29.html.

135 “The Drugged Driving Epidemic,” The Washington Post, June 17, 2007.

136 Drummer, OH, Gerostamoulos J, Batziris H, Chu M, Caplehorn J, Robertson MD, Swann P. “The Involvement of

drugs in drivers of motor vehicles killed in Australian road traffic crashes..” Accid Anal Prev 36(2):229-48, 2004.

137 Couper, Fiona, J, and Logan, Barry Drugs and Human Performance Fact Sheets National Highway Traffic Safety

Administration., page 11. April 2004.

138 “New pot law blamed as violence escalates.” Laurel J. Sweet and O’Ryan Johnson. Boston Herald. November 15,

2010. http://www.bostonherald.com/news/politics/view.bg?articleid=1296392.

139 “FHP: Man led trooper on chase with kids-and pot – in car.” Bay News 9. February 3, 2011.

http://www.baynews9.com/article/news/2011/february/204034/FHP:-Man-led-trooper-on-chase-with-kids-in-car-

?cid=rss.

30

140 “Driving under influence of marijuana a growing problem.” Gwen Florio. Missoulian.com January 16, 2011.

http://missoulian.com/news/local/article_1d9f6f8a-2137-11e0-a0be-001cc4c002e0.html.

141 “Jessica Gamble, Ohio Mom, Charged for Teaching 2-Year-Old Daughter to Smoke Marijuana.” Caroline Black.

CBS WKRC. September 16, 2010. http://www.cbsnews.com/8301-504083_162-20016662-504083.html.

142 “Va. Pair Charged After Toddler Eats Marijuana.” Whz.com. October 8, 2010.

http://wjz.com/wireapnewsva/Manassas.pair.charged.2.1953794.html.

143 “Video shows parents giving pot pipe to toddler.” Beatriz Valenzuela. Daily Press. January 17, 2011.

http://www.vvdailypress.com/articles/parents-25426-pipe.pot.html.

144 “Police: Mom gave pot to her 3 kids.” Lance Berry. October 28, 2010.

http://www.wcpo.com/dpp/news/region/_east_cincinnati/madisonville/police%3A-mom-gave-pot-to-3-kids.

145 “Toddler in Critical Condition After Ingesting Marijuana.” February 2, 2011.

http://losangeles.cbslocal.com/2011/02/02/toddler-in-critical-condition-after-ingesting-marijuana.

146 “Mother charged after toddler hospitalized for eating marijuana, pills.” Michelle Hunter. The Times-Picayune.

October 13, 2008. http://www.nola.com/news/index.ssf/2008/10children_3_and_4_hospitalized. html.

147 “Police: Criminal targeting San Jose’s medicinal marijuana clubs.” Sean Webby. The Mercury News. December 16,

2010. http://www.mercurynews.com/fdcp?1293042861859.

148 “LAPD investigates third shooting at a medical marijuana dispensary.” Andrew Blackstein, Los Angeles Times, July

1, 2010. http://www.latimes.com/news/local/la-me-pot-shooting-201000701,0,4009176.story.

149 “Pentagon shooter had a history of mental illness.” March 5, 2010.

http://www.msnbc.com/id/35716821/ns/us_news_crime_and_courts/

150 Parents warned police of Pentagon shooter’s bizarre mental state.” Washington Post. March 5, 2010.

http://www.washingtonpost.com/wp-dyn/cotnent/article/2010/03/05/AR2010030500957_2.html?hpid=dynamiclead.

151 “Calif. Drug dealer guilty of murdering 15-year-old.” San Diego Union Tribune, July 9, 2008. www.sandiego.com.

152 “4 charged in Chaska Slaying.” David Hanners. Pioneer Press. January 13, 2006. http://www.twincities.com.

153 “NTSB: Pilot Had Marijuana In His System.” KTHV Little Rock. February 6, 2006. www.todaysthv.com.

154 U.S. Sentencing Commission, “2008 Sourcebook of Federal Sentencing Statistics, see:

http://www.ussc.gov/ANNRPT/2008/SBTOC08.htm, Table 33.

155 Bureau of Justice Statistics, “Drug Use and Dependence”, State and Federal Prisoners, 2004, October 2006.

156 United States Sentencing Commission, “2006 Sourcebook of Federal Sentencing Statistics,” June 2007.

157 Ibid.

158 Office of National Drug Control Policy. “Who’s Really in Prison for Marijuana?” May 2005 Page 22.

159 “Behind Bars II: Substance Abuse and America’s Prison Population.” The National Center on Addiction and

Substance Abuse, Columbia University. February 2010. P. 2.

160 “New study Reveals Scope of Drug and Crime Connection: As Many as 87 Percent of People Arrested for Any Crime

Test Positive for Drug Use.” Office of National Drug Control Policy Press Release, May 28, 2009 and Fact Sheet

2008 ADAM II Report, www.whitehousedrugpolicy.gov.

161 “Monitoring the Future Survey, Overview of Findings.” National Institute of Drug Abuse, December 2013. P.2.

www.drugabuse.gov/mointoring-the-future-survey-overview-findings-2013.

162 “Sixty percent of 12 graders do not view regular marijuana use as harmful.” NIDA Press Release, National Institutes

of Health, National Institute on Drug Abuse, December 18, 2013. P. 1

As the Florida Legislature and citizens debate the issues of medical marijuana, our hearts are with the families struggling to find answers for their children who live with severe forms of epilepsy like Dravet Syndrome.

Yet, as physicians and researchers specializing in the treatment of this challenging spectrum of disorders we must ensure that our professional and lay community does not make treatment decisions that are not based in sound research and science.

While there are a number of anecdotal reports of positive outcomes from a particular strain of marijuana used for treating patients with epilepsy, robust scientific evidence for the use of marijuana for treatment of epilepsy is lacking. The lack of information does not mean that marijuana is ineffective for epilepsy. It merely means that we do not know if marijuana is a safe and efficacious treatment for epilepsy.

In addition, little is known about the long term effects of using marijuana in infants and children on memory, learning and behavior. This is of particular concern because of both clinical data in adolescents and adults and laboratory data in animals demonstrating potential negative effects of marijuana and its derivatives on their critical neurological functions.

Such safety concerns coupled with a lack of evidence of efficacy in controlled studies result in a risk/benefit ratio that does not yet support use of marijuana for treatment of seizures.

The form of marijuana in the spotlight is known as Charlotte’s Web from a plant that is thought to contain relatively little tetrahydrocannabinol, or THC, the primary component that produces a high. Instead, the strain has high amounts of another compound — cannabidiol, or CBD. This is not smoked but used in an oil form.

Several members of the American Epilepsy Society are now conducting clinical trials of CBD including one developed by a British drug company. There are several steps in a clinical trial and we need to wait to draw conclusions until there has been a trial with a control group or a placebo-controlled trial.

The preliminary steps underway now will not have a placebo group and will be used for dose finding, tolerability and to establish an understanding of how human bodies absorb and process the drug. If these initial safety studies are encouraging then further controlled studies will be needed to determine if CBD is effective in the treatment of seizures and in which patient populations (ie., what ages and types of epilepsy). These studies are critical, as the pathway to finding new drugs and treatments is full of treatments once thought to be the “miracle cure” that were rejected after the rigors of a clinical trial.

These studies are especially important in a condition like epilepsy that has a very variable course, and sometimes significant improvement can actually be a result of unpredictable ebb and flow of the disease.

Treatments cannot advance without clinical trials. Clinical trials are necessary to test the safety and effectiveness of new therapies and to develop better ways of using known treatments. The American Epilepsy Society is supportive of well-designed clinical research to determine the safety and efficacy of marijuana in the treatment of epilepsy. We urge the entire community of

medical professionals, patients, families and regulators to focus their efforts on getting accurate information and allowing proper research to be done.

Healthcare professionals, patients, and caregivers are reminded that use of marijuana for epilepsy may not be advisable due to lack of information on safety and efficacy, and that despite 20 states legalizing the use of medical marijuana, it has not been reviewed and approved by the Food and Drug Administration for use in the treatment of any form of seizures or epilepsy.

Under federal law, every new therapy and device must go through carefully monitored studies in human volunteers before it can be marketed for regular use in patients. The studies with CBD and many other clinical studies need people with epilepsy to volunteer. To this end, those with epilepsy are in a special position to help themselves and others through participation in medical research that can lead to effective treatments.

The recent discussions surrounding medical marijuana highlight the fact that the epilepsy community desperately needs new therapies and approaches for patients with resistant or refractory seizures. We need to know more about the basic mechanisms and causes of epilepsy so that we can better match therapies to patients, and someday soon find targets for cures.

But none of these giant steps forward will be possible without robust, careful research that safeguards the health of study participants while uncovering important new findings

The actions of the people of Florida will be watched closely by the entire nation. We hope the needs of people living with epilepsy and their families will be a strong voice in this debate. However we also urge that the eagerness to find treatments will not overshadow the need to conduct rigorous research and testing. Together as an epilepsy community we must take this step to find the answers for people living with these severe forms of epilepsy.

Dr. Elson So,  president of the American Epilepsy Society.

Source: http://www.miamiherald.com/2014/01/22/3886526/  22.01.14

But there may be some benefit to those at the lower end of the disability scale

The first large non-commercial clinical study to investigate whether the main active constituent of cannabis (tetrahydrocannabinol or THC) is effective in slowing the course of progressive multiple sclerosis (MS), shows that there is no evidence to suggest this; although benefits were noted for those at the lower end of the disability scale.

The study is published in The Lancet Neurology.

The CUPID (Cannabinoid Use in Progressive Inflammatory brain Disease) study was carried out by researchers from Plymouth University Peninsula Schools of Medicine and Dentistry.

The study was funded by the Medical Research Council (MRC), the Multiple Sclerosis Society and the Multiple Sclerosis Trust, and managed by the National Institute for Health Research (NIHR) on behalf of the MRC-NIHR partnership.

CUPID enrolled nearly 500 people with MS from 27 centers around the UK, and has taken eight years to complete.

People with progressive MS were randomized to receive either THC capsules or identical placebo capsules for three years, and were carefully followed to see how their MS changed over this period.

The two main outcomes of the trial were a disability scale administered by neurologists (the Expanded Disability Status Scale), and a patient report scale of the impact of MS on people with the condition (the Multiple Sclerosis Impact Scale 29).

Overall the study found no evidence to support an effect of THC on MS progression in either of the main outcomes.

However, there was some evidence to suggest a beneficial effect in participants who were at the lower end of the disability scale at the time of enrollment but, as the benefit was only found in a small group of people rather than the whole population, further studies will be needed to assess the robustness of this finding.

One of the other findings of the trial was that MS in the study population as a whole progressed slowly, more slowly than expected. This makes it more challenging to find a treatment effect when the aim of the treatment is to slow progression.

As well as evaluating the potential neuroprotective effects and safety of THC over the long-term, one of the aims of the CUPID study was to improve the way that clinical trial research is done, by exploring newer methods of measuring MS and using the latest statistical methods to make the most of every piece of information collected.

This analysis continued for several months and has provided important information about conducting further large scale clinical trials in MS.

Professor John Zajicek, Professor of Clinical Neuroscience at Plymouth University Peninsula Schools of Medicine and Dentistry, said: “To put this study into context: current treatments for MS are limited, either being targeted at the immune system in the early stages of the disease or aimed at easing specific symptoms such as muscle spasms, fatigue or bladder problems.

At present there is no treatment available to slow MS when it becomes progressive.

Progression of MS is thought to be due to death of nerve cells, and researchers around the world are desperately searching for treatments that may be ‘neuroprotective’. Laboratory experiments have suggested that certain cannabis derivatives may be neuroprotective.”

He added: “Overall our research has not supported laboratory based findings and shown that, although there is a suggestion of benefit to those at the lower end of the disability scale when they joined CUPID, there is little evidence to suggest that THC has a long term impact on the slowing of progressive MS.”

Source:  www.redorbit.com/news/health/1112904623/  July 23rd 2013

“Marijuana is perfectly safe” is one of the marijuana legalization movement’s most widely accepted (and most important) truisms.

Comical estimations of what would constitute a “lethal dose” — such as orally consuming more marijuana than the stomach can physically hold — lead to the also-accepted truism that it’s impossible to overdose on marijuana.

That may not be true.

With high-dosage edibles, it’s easy to become “uncomfortably high,” and with a recent trend called “dabbing,” it’s also easy to become so high that the user passes out. And passing out leads to the only recorded method of marijuana-related death.

“Dabbing” is a simple concept: a small amount of super-high concentrate — hash oil, wax, or another compound where so much of the marijuana plant’s plant material is removed that what’s left is between 50-to-80 percent active ingredients, a sort of grain alcohol to a bud’s wine — is put on a heated surface. A puff of smoke is emitted, and then the user inhales the entire puff of super-concentrated smoke.

The effects are immediate — and they’re intense. Folks who have used cannabis daily for 30 years report, “I am high again!” Other people not so used to the magic plant usually need to sit down for a minute or two before they can talk again. In other words, “dabbing” is a way to ingest a lot of medicine very quickly — and a way to get really f-d up.

It also may be dangerous, as California NORML’s Dale Gieringer writes in a recent letter to O’Shaughnessy’s, the marijuana medical journal published by veteran journalist Fred Gardner.

“In the past couple of years, there have been repeated occasions in which 911 teams have had to be called in due to cannabis overdoses,” Gieringer writes, going on to describe people passing out from high-concentrates at High Times Cannabis Cups in LA. The most authenticated record of someone dying from marijuana use, by the way? A man who became so incredibly high on hashish he passed out — and then died after hitting his head on a hard floor.

“Things like this never happened until the popularization of hash oil in recent years,” he adds. “The dangers are dire enough to merit a special warning.”

Most cannabis clubs in San Francisco don’t allow on-site consumption anymore — a by-product of newly opened dispensaries wishing to make a concession, any concession, in order to appease wary neighbors and win a permit, and also the federal Justice Department’s oddly selective crackdown, which shuttered popular smoking lounges at the Vapor Room and at HopeNet. But some that do also offer “dab bars” — where patients can have a couple mind-numbing, sense-paralyzing hits as a “thank you.”

This practice, while defensible for anyone who thinks marijuana prohibition should end, is hardly medical except for the sickest patients or those with the highest of tolerances. It also carries one more hidden danger — butane poisoning.

There are more concentrated forms of cannabis available on the market today than ever before — hashes, oils, waxes, a concoction called “budder,” glass, you name it. It’s surmised that a glut on the market led to this — there was too many flowers and too much bud than could be sold, and like many other commodities, a repacking or repurposing was necessary in order to find market value — and it’s also led to more of a dangerous chemical extraction process.

In order to separate the psychoactive components from the plant material, some kind of extraction process is required. A common process is ‘butane extraction.’  “When cannabis plant material is drenched in butane, its oils dissolve and can be captured in a container,” Dr. Jeffrey Hergenrather explains. “Instantaneously, the butane evaporates leaving only the oil behind.”

Sounds ok, but not only is this process illegal, it can also leave behind neurotoxins in your cannabis. If it smells like lighter fluid, don’t smoke it, Hergenrather writes — but it may not smell that bad, and still contain neurotoxins.

So dab away — but realize when you smoke yourself stupid, you may be literally doing so.

Source: http://blogs.sfweekly.com/thesnitch/ 2013/03/medical_marijuana_overdose_dabbing.php

Peter Bensinger is former administrator, of the U.S. Drug Enforcement Administration and former director of the Illinois Department of Corrections. Andrea Barthwell is former deputy director of the Office of National Drug Control Policy.

The marijuana bill the Illinois legislature is considering does away with the Food and Drug Administration process, and the legislature assumes the role of the FDA.

The FDA has concluded that marijuana has a high potential for abuse, has no accepted medical use and lacks an acceptable level of safety even under medical supervision. The FDA has approved Marinol, which is not smoked, but is marijuana in pill form.

Over a century ago, people bought all sorts of stuff from salesmen selling heroin, cocaine, marijuana — out of the back of a wagon. Often called Snake Oil Salesmen, they sold products touted as painkillers.

We had almost 3 million heroin addicts in the early 1900s. The Harrison Narcotics Act passed in 1914, then the Food, Drug and Cosmetic Act, the FDA was established and Charles Walgreen opened a drugstore.

Today people know where they can get medicine approved by the FDA as safe and effective — at drugstores — and manufacturers list the ingredients, directions, side effects and warnings. This bill would make medical marijuana available to 18 year olds, but it won’t be with a prescription or at a drugstore.

Marijuana as medicine means more use and more abuse. Each cardholder can get 2.5 ounces of marijuana every 14 days (2.5 ounces makes 183 joints). Medical marijuana cardholders will either sell their marijuana or give it to others. This is not debatable; this will happen. Based upon Michigan’s experience, Illinois could expect more than 270,000 medical marijuana cardholders.

Research documents that regular users of marijuana have twice the motor vehicle crashes as non-users. In Colorado, since medical marijuana was introduced, the number of drivers causing fatal motor vehicle crashes testing positive for marijuana has more than tripled.

Substance Abuse Treatment centers for children report marijuana as the leading cause for admission. Marijuana is second only to alcohol at adult substance abuse treatment centers.

Illinois employers responsible for a safe work environment prohibit employees from coming to work under the influence of alcohol or illegal drugs. Employers would now have new problems dealing with employees and applicants using marijuana. Can employers maintain a safe work environment when people with marijuana in their system come to work under the influence or stoned, threatening the safety of the workplace and co-workers?

Since when is smoking good for your health? Marijuana is fat soluble and stays in the fatty tissues and the brain 75 times longer than a drink of alcohol.

If smoked marijuana is good for cancer, glaucoma and multiple sclerosis patients, why do national associations representing these patients oppose marijuana as medicine? The legislation sponsors argue that marijuana can provide relief from those suffering untreatable pain, but as the U.S. Court of Appeals ruled on January 22 “no adequate and well controlled studies exist on marijuana’s medical efficacy.”

This is about whether Illinois citizens want the legislature to decide on how to approve and dispense medicine instead of the FDA. The medical marijuana lobby has put together myths and money that will not make for a safe or healthier Illinois. The proposal endangers our youth, our highways and our workplaces and increases costs for employers and taxpayers. It is bad medicine.

Source: Springfield, Illinois, State Journal-Register April 12, 2013

Reacting to a federal appellate court decision upholding the U.S. Drug Enforcement Administration’s denial of reclassification of marijuana, The Times states in its Jan. 25 editorial that whether marijuana should be reclassified under federal law to permit its prescription as a medicine should be based on science and an evaluation of the facts, rather than on myths. I fully agree.

And yet the editorial is based on the myth that the DEA has made it “nearly impossible” for researchers to obtain marijuana for such scientific studies. To the contrary, not a single scientifically valid study by a qualified researcher has ever been denied by the DEA or, for that matter, by the National Institute of Drug Abuse. And there is ample government-grown marijuana, specifically for research, available at the marijuana farm run by the University of Mississippi. More surprising, as your editorial points out, is that there is still no scientifically valid study that proves that marijuana is effective, much less safe, as a medicine.

As the DEA administrator 20 years ago, I denied the reclassification of marijuana from a Schedule I controlled drug because there were no valid scientific studies showing that smoking marijuana was an effective medicine. In my decision, published in the Federal Register, I interpreted federal law and set forth a five-part test that included whether there were valid scientific studies demonstrating that marijuana was safe and effective for treating any medical condition. I noted that at that time there were none of the kind of controlled, double-blind studies that the Food and Drug Administration would require before approving a new drug application, and I clearly spelled out that this would be necessary before marijuana would be reclassified to a lower schedule that would permit its use as a physician-prescribed medicine.

Essentially, I invited those who advocate marijuana use as a medicine to conduct research and then present it to the DEA. I laid out a road map for what they needed to do. If scientifically valid studies demonstrated that marijuana was “effective” and “safe,” as the FDA defines those terms, the agency would reclassify marijuana into one of the other schedules. It is amazing that 20 years later there is still no such scientific study establishing that marijuana is effective as a medicine. And yet in the interim, the well-funded marijuana lobby, including the National Assn. for the Reform of Marijuana Laws and others, have spent tens of millions of dollars on convincing voters to pass medical marijuana initiatives based on anecdotes but not science.

The reason the FDA and the DEA have scientific standards is because snake-oil salesmen are able to sell just about anything to sick people without any scientific proof that it has a truly helpful therapeutic effect. If proponents of medical marijuana had invested even a small fragment of their money in scientifically valid studies, we would know one way or the other whether it works.

One can only conclude the marijuana proponents did not go this route because doing so would have shown that cannabis is not an effective and safe medicine. Alternatively, we are left to conclude that their agenda was not about marijuana to help sick people, but rather was getting voters to pass medical marijuana initiatives as a wedge to legalize the drug for “recreational” use.

Source: http://www.latimes.com/news/opinion/opinion-la/la-ol-dea-marijuana-blowbac-20130201,0,5287678.story?track=rss By Robert Bonner – February 1, 2013

http://www.bio-medicine.org/medicine-news http://www.bio-medicine.org/medicine-news THURSDAY, Aug. 2 (HealthDay news) — Among teens receiving treatment for substance abuse, many have used medical marijuana that was recommended for someone else, also known as “diverted” medical marijuana, a new study has found.

The study authors, from the University of Colorado Anschutz Medical Campus in Aurora, Colo., suggest that policy changes are needed to curb the improper use of medical marijuana by young people.

In conducting the study, lead author Stacy Salomonsen-Sautel and colleagues questioned 164 teens aged 14 to 18 at two adolescent substance abuse treatment programs in Denver about their use of medical marijuana. The investigators found that nearly 74 percent of the teens used marijuana that was recommended for someone else an average of 50 times.

Compared with teens who did not use medical marijuana, those who did began using the drug regularly at a younger age and were also more dependent on marijuana and showed more symptoms of conduct disorder, according to the report published in the July issue of the Journal of the American Academy of Child and Adolescent Psychiatry.

The researchers pointed out, however, that most of the teens believed the drug comes with little or no risk.

Because recent state and federal policy changes have opened doors for more legalized medical marijuana use in Colorado, the researchers suggested that teens using medical marijuana most likely got it from an adult with a valid registry identification card for the drug.

The study authors concluded that improved safeguards are needed to prevent medical marijuana from falling into the hands of people who should not have it, particularly teenagers.

“Many high-risk adolescent patients in substance abuse treatment have used diverted medical marijuana on multiple occasions, which implies that substantial diversion is occurring from registered users,” Salomonsen-Sautel said in a journal news release. “Our results support the need for policy changes that protect against diversion of medical marijuana to adolescents.”

Source: http://www.bio-medicine.org/medicine-news 2.08.2012

Community groups from around the state of California celebrated the fact that neither marijuana legalization nor an expansion of the current “medical” marijuana system will be on the statewide ballot this November. The Secretary of State’s office has confirmed that none of the six pro-legalization measures gathered enough signatures to qualify for the ballot. Legalization failed in 2010 and last July the Los Angeles City Council voted to ban “medical” marijuana storefronts.

“We may be seeing the beginning of the end for marijuana advocates in our state,” noted John Redman, Executive Director of Californians for Drug-Free Youth (CADFY), the state’s oldest anti-drug coalition. “After sixteen years of experimenting with de facto legalization, the majority of Californians who don’t smoke marijuana have realized that more marijuana availability isn’t good for our kids or our state.”

Initiatives 1516, 1518, 1524, 1544, 1571, and 1579 varied in their specific provisions. Initiatives 1516, 1518, 1524 and 1544 would have essentially legalized marijuana, whereas initiatives 1571 and 1579 would have expanded medical marijuana and legalized industrial hemp. Prevention and youth advocates feared these initiatives would have further pushed up drug use rates in the state.

“We have seen a direct correlation between increase marijuana availability through dispensaries and increased youth marijuana use,” remarked Aaron Byzak, President of the Vista, California based North Coastal Prevention Coalition (NCPC).

Two peer-reviewed studies published in prominent scientific journals in late 2011 reveal that states with mature medical marijuana programs, like California, have youth marijuana rates significantly higher than states without such programs. This has translated to a significant increase in marijuana use over the last five years.

“For a time it appeared that we were losing ground as we fought for the future of our kids,” Byzak continued. “But it appears that the people of California have seen through the smoke screen and chosen a healthy future.”

“Preventionists in California can finally breathe a huge sigh of relief,” Redman commented. “And focus on preventing marijuana use before it ever starts.”

Source: Press Release Californians for Drug Free Youth August 30th 2012

The Los Angeles City Council voted Tuesday to ban medical marijuana dispensaries in the city, the culmination of years of controversy over the sale of pot here. Meanwhile, in Oakland, a federal crackdown closed the nation’s largest dispensary amid protests and demonstrations. But authorities rarely seem to address the real issue about marijuana in California: Is it good medicine?

Some proponents of medical marijuana argue that pot is “natural” and therefore better, or at least no worse, than legally prescribed drugs, which may be addictive and may carry dangerous side effects. But natural is not the standard for whether a drug is safe and effective.

Marijuana advocates also say that physicians who warn against marijuana merely want to push prescriptions. But just because some doctors practice bad medicine with legal drugs doesn’t make marijuana good medicine. In most cases, it isn’t.

Anyone who wants to get a medical marijuana card knows there are unscrupulous doctors who will give you a recommendation with few questions asked. Without doubt, medical marijuana hands a get-out-of-jail-free card to people who just want to get high. Those who get a card and indulge in the infrequent use of marijuana will probably experience few problems. But the situation is different with chronic marijuana use.

Marijuana acts on cannabinoid receptors in the brain. These receptors, which are the most prevalent in the nervous system, influence just about every bodily function, including memory, attention, disposition, arousal, motivation, perception, appetite and sleep.

Many chronic marijuana users insist that marijuana is not addictive the way alcohol and other drugs are. However, neuroscience, animal studies, clinical reports of withdrawal in humans and epidemiology all show that marijuana is potentially addictive.

As to its benefits, controlled clinical studies show they exist, but they are limited. Marijuana can effectively treat neuropathic pain, and it has been shown to improve appetite and reduce nausea in cancer and AIDS patients.

But other generally accepted ideas about marijuana’s effectiveness don’t hold up.

The Glaucoma Research Foundation disputes the idea that medical marijuana is good medicine for the disease. “The high dose of marijuana necessary to produce a clinically relevant effect,” the foundation’s website explains, makes it a poor choice for the treatment of glaucoma, especially given its “significant side effects” and the availability of safer effective drugs.

In addition, those who use marijuana to treat mental health symptoms might be surprised to learn that studies show it not only may not help such symptoms, it may cause them.

Increased funding for research may lead to a better understanding of the impact cannabis has on our bodies, but for now the claims that the drug is effective in the treatment of multiple disorders as distinct as lupus and anxiety seem far-fetched at best. It seems more likely that for some people, getting high just makes them feel better, the way a drink or two might. You would be shocked, however, if in response to a diagnosis of lupus, your doctor suggested you “take two drinks and call me in the morning.”

And pot’s general ineffectiveness is only part of picture. It is not a neutral substance. Chronic marijuana use is associated with a number of well-documented health problems, including a variety of cancers in adults as well as in children who were exposed to the drug in utero.

As to its mental health effects, marijuana is linked to long-term psychiatric problems such as depression, anxiety and psychosis. “Marijuana often is regarded as a ‘soft drug’ with few harmful effects,” says Dr. Joseph M. Pierre, co-chief of the Schizophrenia Treatment Unit at the Department of Veterans Affairs’ West Los Angeles Healthcare Center. “However, this benign view is now being revised, along with mounting research demonstrating a clear association between cannabis and psychosis.”

If the lack of health benefits and manifest risks aren’t enough to raise doubts about medical marijuana, consider basic questions of quality and dose. Although medical marijuana sometimes comes from “cleaner” sources than say a drug cartel, independent labs have found mold, synthetic insecticides and other toxins in pot. Molds such as Aspergillus can be highly dangerous to immune-compromised patients. And there is no way to accurately judge what a proper dose of dispensary marijuana would be.

Habitual marijuana use is helpful for very few medical conditions. It can cause insidious changes in personality and attitude that are clear to everyone but the users themselves. There are nearly 400,000 emergency room visits per year due to marijuana use. Before we advocate for medical marijuana, and before another person doses himself with it, we have to ask: Is medical marijuana making us sick?

Dr. David Sack is a psychiatrist and addiction specialist. He is chief executive of Promises Treatment Centers and Elements Behavioral Health in Southern California.

Source: Dr.David Sack. CEO Promises Treatment Centers. Southern California USA

July 26th 2012

Background & Aims:
Complications of HCV infection are primarily related to the development of advanced fibrosis and whether cannabis use is a risk factor for more severe fibrosis is controversial.

Methods: Baseline data from a prospective cohort study of 204 persons with chronic HCV infection were used for analysis.

The outcome was fibrosis score on biopsy, and the primary predictor evaluated was daily cannabis use.
Results: The median age of the cohort was 46.8 years, 69.1% were male, 49.0% were white, and the presumed route of infection was injection drug use in 70.1%.

The median lifetime duration and average daily use of alcohol were 29.1 years and 1.94 drink equivalents per day, respectively. Cannabis use frequency (within prior 12 months) was daily in 13.7%, occasional in 45.1%, and never in 41.2%. Fibrosis stage, assessed by the Ishak method, was F0, F1–2, and F3–6 in 27.5%, 55.4%, and 17.2% of subjects, respectively.

Daily compared with non-daily cannabis use was significantly associated with moderate to severe fibrosis (F3– 6 vs F1–2) in univariate (odds ratio [OR], 3.21; 95% confidence interval [CI], 1.20 – 8.56, P _ .020) and multivariate analyses (OR, 6.78; 95% CI, 1.89 –24.31, P _ .003). Other independent predictors of F3–6 were >11 portal tracts (compared with <5, OR, 6.92; 95% CI, 1.34 –35.7, P _
.021) and lifetime duration of moderate to heavy alcohol use (OR per decade, 1.72; 95% CI, 1.02–2.90, P _ .044).
Conclusions:
Daily cannabis use is strongly associated with moderate to severe fibrosis, and HCV-infected individuals should be counseled to reduce or abstain from cannabis

Source: CLINICAL GASTROENTEROLOGY AND HEPATOLOGY 2008;6:69–75*Departments of Medicine, ‡Epidemiology and Biostatistics, and §Pathology, University of California at San Francisco , San Francisco , California

While negative influences abound, positive messages reinforcing a drug-free lifestyle seem scarcer all the time. More responsibility than ever falls on the parents of our teens to educate them of the pitfalls of marijuana — a gateway drug. New data suggests a connection between perceived risk and frequency of use, along with an increase in escalation to more dangerous drugs after experimenting with marijuana.

According to The Partnership Attitude Tracking Study (PATS), 2011, past-month marijuana use among teens was 27 percent — up a staggering 42 percent from 2008, and marking an upward trend in teen marijuana use the past three years. These disturbing statistics hint at a more relaxed opinion of the drug among teens, which leads to heavier use.

While the PATS data reflect that about half of teens seemingly disapprove of their peers using marijuana, the data also found among teens a decrease in perceived risk involved with smoking the dangerous drug. The still small voice of anti-drug messages is waning in the face of negative pressures from pot enthusiasts, causing more and more teens to use marijuana early and often.

We can assume from the findings in the study that if more teens are using marijuana more regularly, then more teens will experiment and transition to more dangerous drugs and substances. Regular and heavy teen marijuana users are significantly more likely to use substances like cocaine (30 times more likely), Ecstasy (20 times more likely), and abuse prescription pain relievers (15 times more likely), according to PATS data. Now, teens are not only at risk of becoming addicted to marijuana, they are more likely to develop an addiction to hard-core drugs as a result.

At the root of the alarming potential trends is the decrease in perceived risk. We are losing the war for our teens’ attention, and the cost will be dear if perceptions are not changed.

Still believe the myth that marijuana’s not a gateway drug? Not only are heavy pot users more likely to experiment with heavier drugs, they are also in as much risk of developing cancer as a heavy cigarette smoker. Marijuana smoke contains some of the same carcinogens found in cigarettes and often in higher concentrations. Studies have shown that someone who smokes five joints a week may be taking in as many cancer-causing chemicals as someone who smokes a full pack of cigarettes every day.

Many people know the typical short-term effects of marijuana use — dry-mouth, anxiety or paranoia, decreased motor skills — but more disturbing are the long-term effects, which quickly can escalate into lifelong issues for abusers. The most common effect is “amotivational syndrome,” in which abusers suffer from a chronic lack of interest in their future and cease to care about things that used to be important to them. Also, as their tolerance for the narcotic agents in marijuana increase, the abuser needs larger and larger amounts of the drug to achieve the same high. This also contributes to the gateway process — once the user stops experiencing the high, he or she escalates use to other drugs to make up the difference.

Source: www.reporternews.com  3^rd June 2012

As a leader of a nationally prominent anti-drug coalition in San Diego County, I was thoroughly disappointed with the California Medical Association’s recent report endorsing marijuana legalization as a way to speed research into medical marijuana. Unfortunately, the CMA conflated those two very different issues by recklessly supporting the risky proposition of legalization.

First, it is important to discuss the disastrous impact marijuana legalization would have on our state. Marijuana is illegal because it is dangerous – not dangerous because it’s illegal. Recent studies link the drug with cognitive impairment (think memory loss and other brain dysfunction), motor skills impairment (think drugged driving accidents), and mental illness (like psychosis and schizophrenia). Indeed, marijuana negatively impacts the development of the adolescent brain, which is still maturing until about age 25.

We also know, according to a recent RAND report, that the price of marijuana would fall dramatically if it were legalized. Our experience with alcohol and tobacco tells us that lower price means greater use and addiction rates. And while about 1 in 10 adults who ever start marijuana will become dependent on it, according to the National Institutes of Health, that number jumps to between 1 in 4 and 1 in 2 when the drug is initiated in adolescence. Calling for legalization for adults only and thinking it will prevent drug use among kids is naive and dangerous – just ask any kid who has easy access to alcohol and tobacco today, despite age limits.

Finally, marijuana tax revenues would pale in comparison to the social costs of the increased use of the drug. Again, our two legal drugs, alcohol and tobacco, can be used as a reference point – they bring in about one-tenth of the social costs they produce.

That one opposes legalization does not mean that one has to be all for the status quo. Indeed, we need to invest more into prevention programs to stop marijuana use before it starts, intervene on early use, and treat marijuana addiction.

Nor does opposition to legalization signal acrimony toward increased medical research into the individual components of marijuana. This is where CMA makes its mistake. The organization reasoned that legalization is the only way to achieve this kind of research. And it is wrong.

Research into the active ingredients of marijuana – and there are hundreds of them – is an important area of science that should be explored. Indeed, today we have two such drugs derived from marijuana and the FDA is currently exploring others, like Sativex. Sativex is a tongue spray that is comprised of the active ingredient in marijuana – THC – and another ingredient called CBD. The THC in marijuana is what gets someone “high,” and the CBD counteracts that so that the drug is not dangerous or dependence-inducing. Late-stage trials of the drug show promise for spasticity related to multiple sclerosis and pain related to cancer. It has been approved in other countries for these purposes, too.

The bottom line is that one of CMA’s core arguments is a myth – that the government’s prohibition of marijuana prevents proper investigation into the drug’s therapeutic properties. The National Institute on Drug Abuse grows marijuana, in several different strains and varieties, for this exact purpose. According to the Drug Enforcement Administration, which issues licenses to deal with marijuana for research purposes, over 200 researchers have access to the drug.

So it is unfortunate that the California Medical Association – representing only a small number of their doctors who pushed a legalization position from the start – is now mixing politics with science. Advocating for legalization as the only route to research not only displays an ignorance of the drug-approval process, but it also represents a platform that will have untold consequences from a profession that should, first and foremost, “do no harm.”

Source:  www.signonsandiego.com  6^th Nov 2011

Marijuana causes disruptions in concentration and memory similar to those that occur in people with schizophrenia, according to a new study.

U.K. researchers measured the electrical activity from hundreds of neurons in the brains of rats given a drug that mimics the effects of cannabis, the psychoactive ingredient of marijuana.

The effects of the drug on individual brain regions were subtle but the drug completely disrupted the coordinated brain waves across the hippocampus and prefrontal cortex. Both of these brain structures are essential for memory and decision-making and play a key role in schizophrenia.

Due to the “decoupling” of the hippocampus and prefrontal cortex, the rats were unable to make accurate decisions while attempting to find their way through a maze, the University of Bristol researchers said.

“Marijuana abuse is common among sufferers of schizophrenia and recent studies have shown that the psychoactive ingredient of marijuana can induce some symptoms of schizophrenia in healthy volunteers. These findings are therefore important for our understanding of psychiatric diseases, which may arise as a consequence of ‘disorchestrated brains’ and could be treated by re-tuning brain activity,” lead author Matt Jones said in a university news release.

The study appears Oct. 25 in the Journal of Neuroscience.
“These results are an important step forward in our understanding of how rhythmic activity in the brain underlies thought processes in health and disease,” study first author Michal Kucewicz said

Source: www.everydayhealth.com Oct. 25, 2011

As marijuana use among teenagers increases and its perceived danger among this age group decreases, clinicians need to know the latest science about the harmful effects of the drug on the adolescent brain, according to a researcher at the University of Colorado, Denver.

Paula Riggs, PhD, Professor of Psychiatry, notes the most recent Monitoring the Future Survey shows a significant increase in marijuana use, including daily marijuana use among U. S. high school students and a decrease in perceived risk of use. “There are a number of indicators, including the increasing number of states that have passed ‘medical marijuana’ legislation, and that society as a whole tends to view marijuana as a relatively benign, recreational drug. However, scientific research does not support this.”

A growing body of research shows that adolescent marijuana use can be detrimental to the brain development and may produce long-lasting neurocognitive deficits and increased risk of mental health problems including psychosis, said Dr. Riggs, who spoke about this topic at the recent California Society of Addiction Medicine meeting.

Marijuana is the most commonly used illicit drug in the United States. Although some have questioned whether marijuana is an addictive drug, scientific research shows that one in 10 people overall, and one in six adolescents, who use marijuana develop dependence or addiction, Dr. Riggs says. Research shows that marijuana can cause structural damage, neuronal loss and impair brain function on a number of levels, from basic motor coordination to more complex tasks, such as the ability to plan, organize, solve problems, remember, make decisions and control behavior and emotions.

Dr. Riggs also cited recent studies indicating that adolescents may be more vulnerable to addiction, in part due to rapid brain development. “Emerging research suggests that individuals who start using marijuana during their teenage years may have longer-lasting cognitive impairments in executive functioning than those who start later,” she says. “Animal studies also suggest that exposure to marijuana during adolescence compared to adulthood may increase the vulnerability or risk of developing addiction to other substances of abuse such as cocaine and methamphetamine.”

She adds, “It is important for pediatricians, psychiatrists and other mental health clinicians to be aware of current research because they are on the front line to identify teens when they first start to experiment. They need to be able to effectively screen adolescents for marijuana use, and be armed with the scientific facts to educate teens and families about associated risks.”

Source   www.partnershipatdrugfree.org  Nov. 2011

Feinstein says the marijuana users performed significantly worse than the non-users on tests measuring attention, speed of thinking, visual perception, and cognition related to planning and organizing.  Scores on one test measuring speed of processing information were about a third lower among marijuana users compared to non-users.  Thirty-two percent of non-users and 64% of users met the definition of globally cognitively impaired, meaning that they had measurable impairments in two or more aspects of intellectual functioning.

Neurologist Lily Jung Hensen, MD, of Seattle’s Swedish Neurosciences Institute, tells WebMD that the findings make a strong argument that the cognitive risks associated with marijuana use outweigh potential benefits for MS patients.

Source: http://www.cbs47.tv/webmd/ms/story/Medical-Marijuana-May-Impair-Thinking-of-MS/FmQ00ndFKkKhQ199RrPTDQ.cspx  Oct.2011

(St. Petersburg, FL) The National Survey on Drug Use and Health conducted by the Substance Abuse and Mental Health Services Administration (SAMHSA) and released this week shows a significant rise in marijuana use. In 2007, 4.4 million Americans 12 and older used marijuana; as of 2010 that number has risen to 17.4 million. The National Office of Drug Control Policy’s Director, Gil Kerlikowske, said the increases are prominent in states in which “medical” marijuana is legal. The survey also shows that 21.5 percent of young adults aged 18 to 25 used illicit drugs in 2010, an increase from 19.6 percent in 2008.

“Other than the lone voice of Director Kerlikowske and large marijuana dispensary raids by the DEA, the Obama Administration has basically turned a blind eye to the medi-pot issue, a matter that fuels the rise in marijuana use and continues to be the biggest scam ever to be perpetrated on the American public. While a crude toxic weed is peddled to sick and dying people as a medicine, our government has done far too little to protect the public. It is absolutely no surprise to me that marijuana use has sharply increased,” said Calvina Fay, executive director of Drug Free America Foundation, Inc. and Save Our Society From Drugs.

“Surveys have shown for years that when the perception of the harms of drugs decreases, use rises. The ruse that marijuana is a medicine has created a false sense that this addictive, dangerous drug is not harmful, but in fact helpful. Clearly, this belief has contributed to the increase of marijuana use among young people. In order to protect the public, it is time for our government to take its head out of the sand and aggressively push back against marijuana legalization for any purposes! Perhaps it’s time to withhold federal funds from states that fail to uphold our nation’s drug laws,” Fay concluded.

Source: Press Release Drug Free America Foundation 9th Sept.2011

The percentage of fatally injured drivers testing positive for drugs increased over the last five years, according to data from the National Highway Traffic Safety Administration (NHTSA). Each year between 56% and 65% of drivers fatally injured in motor vehicle crashes were tested for the presence of drugs in their systems.

In 2009, 33% of the 12,055 of drivers fatally injured in motor vehicle crashes with known test results tested positive* for at least one drug, compared to 28% in 2005 (see figure below). The drugs tested for included both illegal substances as well as over-the counter and prescription medications, (which may or may not have been misused). In 2009, marijuana was the most prevalent drug found in this population—approximately 28% of fatally injured drivers who tested positive were positive for marijuana. The authors caution that “drug involvement rates among those with unavailable drug test results may be similar to those for whom results are available, or there may be a systematic bias that could influence the unavailable rates in a positive or negative direction.”

*Nicotine, aspirin, alcohol, and drugs administered after the crash are excluded. Testing positive for drugs only means that the drugs were found in the driver’s system and does not imply impairment or indicate that drug use was the cause of the crash or the fatality.

SOURCE: Adapted by CESAR from National Highway Traffic Safety Administration (NHTSA),
drug Involvement of Fatally Injured Drivers,” Traffic Safety Facts, November 2010.
Available online at http://www-nrd.nhtsa.dot.gov/Pubs/811415.pdf

Vol. 13, Issue 26
Distribution: 6,606
U n i v e r s i t y o f M a r y l a n d , C o l l e g e P a r k

A Weekly FAX from the Center for Substance Abuse Research
Nine behaviors and attitudes differentiate students who used marijuana before age 15 from those who had not, according to an analysis of data from the 2002 Maryland Adolescent Survey (MAS). Overall, one-fifth of Maryland12th grade students reported using marijuana before age 15.

A scale of 9 warning signs of early marijuana use among 12th graders was developed from an analysis of the MAS data (see below). The scale also detected early use among 8th and 10th graders. The more warning signs a student had, the more likely he or she was to have used marijuana early (see Figure 1). For example, approximately three-fourths of 12th graders with 6 or more warning signs were early marijuana users, compared to 3% of 12th graders with no warning signs.
Students with more warning signs also reported using a greater number of other illegal drugs* and experiencing a greater number of serious problems resulting from drug and alcohol use (see Figure 2). The report, “Warning Signs for Early Marijuana Users Among Maryland’s Public School Students,” discusses the implications of these findings for intervening with youth and implementing prevention programs. Complimentary copies of the report can be ordered by contacting CESAR at cesar@cesar.umd.edu or 301-405-9770.

The 9 Warning Signs for Early Marijuana Use:

Alcohol & Drug Problems Other Illegal Drugs Used
Figure 1: Percentage of Maryland
12th Grade Students Reporting
Marijuana Use Before Age 15

*Other illegal drugs were inhalants, nitrates, crack, cocaine, LSD, PCP, other hallucinogens, methamphetamines, designer drugs, heroin, amphetamines,
barbiturates, narcotics, and Ritalin®.

Figure 2: Mean Number of Other Illegal Drugs* Used
in Lifetime and Alcohol and Drug Problems**
by Maryland 12th Graders

**Alcohol and drug problems were school absences, health problems, family problems, being high/drunk at school, poor school performance, inability to stop
using drugs/alcohol, and driving while under the influence of alcohol/drugs.
301-405-9770 (voice) 301-403-8342 (fax) CESAR@cesar.umd.edu www.cesar.umd.edu

CESAR FAX is supported by BYRN 2003-1006, awarded by the U.S. Department of Justice through the Governor’s Office of Crime Control and Prevention.

SOURCE: Maryland Drug Early Warning System (DEWS), CESAR, “Warning Signs for Early Marijuana Users Among Maryland’s Public School Students,” DEWS Investigates, June 2004. For more information, contact Dr. Eric Wish at ewish@cesar.umd.edu.

Source: CesarFax June 28, 2004

[Correspondence]
Tashkin, Donald P.; Roth, Michael D.; Dubinett, Steven M.
UCLA School of Medicine; Los Angeles, CA 90095-1690

———————————————-

To the Editor: You point to largely experiential evidence of the medicinal
benefits of marijuana and the apparent absence of serious short-term toxicity.
However, a note of caution is warranted. Although it is true that smoking
marijuana carries no immediate risk of death, there may be serious adverse
effects in the very patients for whom medicinal marijuana is most commonly
considered (i.e., those whose immune defenses are already compromised by AIDS or
cancer plus chemotherapy). For example, in patients with AIDS, marijuana use has
been associated with the development of both fungal and bacterial pneumonias.
[1,2] Moreover, among HIV-positive persons, marijuana use has been shown to be a
risk factor for rapid progression from HIV infection to AIDS and the acquisition
of opportunistic infections or Kaposi’s sarcoma, or both. [3]

Cellular studies and studies in animals lend support to these potential health
consequences of marijuana. For example, delta-9-tetrahydrocannabinol has been
shown to have immunosuppressive effects on macrophages, natural killer cells,
and T cells, as well as on the response of mice to opportunistic infection. [4]
In our own studies, [5] (and unpublished data) we recovered alveolar macrophages
from the lungs of habitual marijuana smokers and found a significant reduction
in their ability to kill fungi, bacteria, and tumor cells, as well as a
deficiency in their ability to produce protective inflammatory cytokines, such
as tumor necrosis factor (alpha).

Donald P. Tashkin, M.D.

Michael D. Roth, M.D.

Steven M. Dubinett, M.D.

UCLA School of Medicine; Los Angeles, CA 90095-1690

REFERENCES

1. Denning DW, Follansbee SE, Scolaro M, Norris S, Edelstein H, Stevens DA.
Pulmonary aspergillosis in the acquired immunodeficiency syndrome. N Engl J Med
1991;324:654-62. Bibliographic Links

2. Caiaffa WT, Vlahov D, Graham NM, et al. Drug smoking, Pneumocystis carinii
pneumonia, and immunosuppression increase risk of bacterial pneumonia in human
immunodeficiency virus-seropositive injection drug users. Am J Respir Crit Care
Med 1994;150:1493-8. Bibliographic Links

3. Tindall B, Cooper DA, Donovan B, et al. The Sydney AIDS Project: development
of acquired immunodeficiency syndrome in a group of HIV seropositive homosexual
men. Aust N Z J Med 1988;18:8-15. Bibliographic Links

4. Newton CA, Klein TW, Friedman H. Secondary immunity to Legionella pneumophilia
and Th1 activity are suppressed by delta-9-tetrahydrocannabinol. Inject Infect
Immun 1994;62:4015-20.

5. Sherman MP, Campbell LA, Gong H Jr, Roth MD, Tashkin DP. Antimicrobial and
respiratory burst characteristics of pulmonary alveolar macrophages recovered
from smokers of marijuana alone, smokers of tobacco alone, smokers of marijuana
and tobacco, and nonsmokers. Am Rev Respir Dis 1991;144:1351-6. Bibliographic
Links Accession Number: 00006024-199704170-00025

New research shows that a synthetic analogue of the active component [THC] of marijuana may reduce the inflammation and prevent the mental decline associated with Alzheimer’s disease.

“This research is not only a major step in our understanding [of] how the brain reacts to Alzheimer’s disease, but may also help open a route to novel anti-Alzheimer’s drugs,” says Raphael Mechoulam, professor emeritus of medicinal chemistry at Hebrew University in Jerusalem and discoverer of marijuana’s active component.

To show the preventive effects of cannabinoids on Alzheimer’s disease, researchers at the Cajal Institute and Complutense University in Madrid, led by Maria de Ceballos, conducted studies using human brain tissue, as well as experiments with rats.

Source:The Journal of Neuroscience February 23, 2005

The active ingredient in marijuana may stall decline from Alzheimer’s disease, research suggests. Scientists showed a synthetic version of the compound may reduce inflammation associated with Alzheimer’s and thus help to prevent mental decline. They hope the cannabinoid may be used to developed new drug therapies. The research, by Madrid’s Complutense University and the Cajal Institute, is published in the Journal of Neuroscience.

Source:http://www.biopsychology.com/index. Feb 2005

A cannabis-based drug could help people with Alzheimer’s disease by giving them the “munchies”, researchers say.

Patients with the condition often experience weight loss because they stop recognising when they are hungry. The study does not suggest they should be given cannabis to smoke – instead, they tested a synthetic version of a cannabis extract. It was found the cannabinoid led to weight and reduced agitation, another symptom of the disease. The researchers from the Meridian Institute for Aging in New Jersey looked at a drug called dronabinol which is an artificial version of delta-9 THC, the active ingredient in cannabis.

Dronabinol may reduce agitation and improve appetite in patients with Alzheimer’s disease

Dr Joshua Shua-Haim, Meridian Institute for Aging

Source: BBC report 21 Aug.2003

A new compound similar to the active component of marijuana (cannabis) might provide effective pain relief without the mental and physical side effects of cannabis, according to a study in the July issue of Anesthesia & Analgesia, official journal of the International Anesthesia Research Society (IARS).

The synthetic cannabinoid (cannabis-related) compound, called MDA19, seems to avoid side effects by acting mainly on one specific subtype of the cannabinoid receptor. “MDA19 has the potential for alleviating neuropathic pain without producing adverse effects in the central nervous system,” according to the study by Dr Mohamed Naguib of The University of Texas M.D. Anderson Cancer Center.

MDA19 Works on a Single Cannabinoid Receptor
The researchers performed a series of experiments to analyze the pharmacology and effects of the synthetic cannabinoid MDA19. There are two subtypes of the cannabinoid chemical receptor: CB1, found mainly in the brain; and CB2, found mainly in the peripheral immune system.

Dr. Naguib’s group has been doing research to see if the cannabinoid receptors—particularly CB2—can be a useful target for new drugs to treat neuropathic pain. Neuropathic pain is a difficult-to-treat type of pain caused by nerve damage, common in patients with trauma, diabetes, and other conditions.

MDA19 was designed to have a much stronger effect on the CB2 receptor than on the CB1 receptor. In humans, MDA19 showed four times greater activity on the CB2 receptor than on the CB1 receptor. In rats, the difference was even greater. The experiments also showed that MDA19 had “protean” effects, so-called after the shape-shifting Greek sea god Proteus—under different conditions, it could either block or activate the cannabinoid receptors.

In rats, treatment with MDA19 effectively reduced specific types of neuropathic pain, with greater effects at higher doses. At the same time, it did not seem to cause any of the behavioral effects associated with marijuana.

Potential to Develop Effective Pain Drugs that Avoid Side Effects
The “functional selectivity” of MDA19—the fact that it acts mainly on the CB2 receptor and has a range of effects under differing conditions—could have important implications for drug development. “[W]ith functionally selective drugs, it would be possible to separate the desired from the undesired effects of a single molecule through a single receptor,” Dr. Naguib and colleagues write.
This means that MDA19 could be a promising step toward developing medications that have the pain-reducing effect of cannabinoids while avoiding the mental and physical side effects of marijuana itself. However, more research will be needed before MDA19 or other agents that act on the CB2 receptor are ready for testing in humans.

“These elegant studies by Professor Naguib demonstrate remarkable analgesic properties for this synthetic cannabinoid,” comments Dr. Steven L. Shafer of Columbia University, Editor-in-Chief of Anesthesia &Analgesia. “The studies suggest a novel mechanism for this protean agonist. Although preliminary, these studies suggest that synthetic cannabinoids may be significant step forward for patients suffering from neuropathic pain.”

SOURCE : www.news-medical.net 2nd July 2010

Marijuana used for medical purposes has the same long term effect on the user as marijuana used for recreation. Marijuana use can cause impairment of short-term memory, attention, motor skills, reaction time, and the organization and integration of complex information.

Marijuana use alters perceptions and creates time distortion and can cause drowsiness and lethargy. Heavy marijuana use can cause apathy, decreased motivation, and impair cognitive performance and can cause mental health problems.

Employees who use marijuana off-duty are still effected by it. Impaired cognition that can cause lapses in judgement can remain for a long period. Memory defects can last as long as six weeks. See: Abbie Crites-Leoni, Medicinal Use of Marijuana: Is the Debate a Smoke Screen for Movement Toward Legalization? 19 J. Legal Med. 273, 280 (1998) (citing Schwartz, et al., Short- Term Memory Impairment in Cannabis-Dependent Adolescents, 143 Am. J. Dis. Child. 1214 (1989)

Employers may be liable for the actions of employee who use marijuana especially those employees in safety sensitive positions. The more chronic the use of “medical” marijuana the higher the risk.

VIOLATIONS OF FEDERAL LAW

Will employers have to accommodate marijuana use that violates federal law? Marijuana, remains illegal under federal law because of its “high potential for abuse,” its lack of any “currently accepted medical use in treatment in the United States,” and its “lack of accepted safety for use … under medical supervision.”Gonzales v. Raich, 545 U.S. 1 (2005); United States v. Oakland Cannabis Buyers’ Cooperative, 532 U.S. 483 (2001)

IF THIS BILL PASSES “MEDICAL” MARIJUANA WILL RESULT IN MORE MARIJUANA USE AMONG EMPLOYEES

As consumers we all pay for lost productivity and job-related accidents in the final costs of the produced goods and higher insurance premiums due to workplace accidents. Drug using employees are not as safe. They are 3.6 times more likely to be involved in a work-related accident than their non-using employee, and 5 times more likely to file workers’ compensation claims. As many as 50% of all workers’ compensation claims may involve substance abuse.[FN1]

The U.S. Postal Service did a study that showed that substance abusers have 55% more accidents, experience 85% more on-the-job injuries, and have a 78% higher rate of absenteeism when compared to non-substance abusing employees.[FN2] A report by the National Safety Council claimed that 80% of those injured in serious drug-related work accidents are not the drug using employees, but innocent employees and others.[FN3]

Drug using employees commit workplace crimes. There is a very significant statistical correlation between drug use and criminal conduct.[FN4]

Substance abuse also causes:
Domestic and financial difficulties for employees;
Poor judgment in employment decision making;
Potential embarrassment to the employer as a result of off-duty conduct, which may be publicized, including criminal charges, diversion of supervisory and managerial time;
Damage to company property; and
Time devoted to discipline and grievance matters.[FN5]

While the studies vary somewhat, it is clear that there is substantial substance abuse in the workplace and it has a powerful negative impact on our economy and productivity. The increased use of “medical” marijuana will magnify all these problems.

References

[FN1] Current, The Truth About Drug Testing: Answers to the Questions Everyone Is Asking, p. 3 (1st Ed., Fort Lauderdale, FL, 1998).

[FN2] “Pre-employment Drug Testing: Association with EAP, Disciplinary, and Medical Claims Information” U.S. Postal Service, Personnel Research and Development Branch, Office of Selection and Evaluation, July 1992.

[FN3] Wisotsky, The Ideology of Drug Testing [Ideology of Drug Testing], 11 Nova L Rev 763, 768 (1987).

[FN4] See Stewart, Proof Positive of Drug Link to Crime, Wall St J, May 28, 1987, at 26, col 3.

[FN5]Alcohol & Drugs in the Workplace: Costs, Control and Controversies, A BNA Special Report [Costs, Control and Controversies], 7 (Bureau of National Affairs, Washington, D.C. 1986)

Source: David Evans sent to DFAF May 2010

California data on drivers involved in passenger vehicle fatal crashes using Marijuana were analyzed to determine the impact on traffic safety and to provide information on the possible impact of an initiative, the Tax and Regulate Cannabis Initiative or “TC2010” which is on the California ballot in November 2010 to reform and partially legalize Marijuana.

A total of 1240 persons were killed in the last five years in fatal motor vehicle crashes involving Marijuana. 230 were killed in 2008. Use has increase steadily in the last ten years and is now at 5.5% in fatal passenger vehicle crashes. The use in single vehicle fatal crashes where most drivers are tested shows an involvement rate of 8.3%.

The largest increases occurred in the 5 years following the establishment of the Medical Marijuana Program in January 2004. For the five years following legalization there were 1240 fatalities in fatal crashes, compared to the 631 fatalities for the five years prior, for an increase of almost 100%.

In 2008 there were 8 counties where more than 16% of the drivers in fatal crashes tested positive for Marijuana. Five of the 8 counties had rates over 20% Based on this experience, a use rate of 16% to 20% is very likely. A rate increase to only 16%, would result in 670
fatalities, and at 20% we would have about 840 fatalities annually. The 20% level would be more than triple the present level of 230 fatalities in 2008. At these levels, Marijuana would rival alcohol at 17.9%, as the top cause of traffic fatalities.

If “TC2010” passes, tax income on Marijuana is estimated at $1.4 billion annually compared to an estimated $4 billion or more economic loss from Marijuana related fatal crashes.
Over 80% of the Marijuana drivers are male, with a median age of 25. In addition, about half (48%) of the drivers using Marijuana also were legally intoxicated. About 75% of the drivers that used Marijuana did not use any other drug. About 1.2 fatalities were reported for each Marijuana involved driver.

Authors: Alfred Crancer and Alan Crancer

Source: -Received June 2010 from Drug Free America Foundation

Cannabinoids may suppress tumor invasion in highly invasive cancers, according to a study published online December 25 in the Journal of the National Cancer Institute.
Cannabinoids, the active components in marijuana, are used to reduce the side effects of cancer treatment, such as pain, weight loss, and vomiting, but there is increasing evidence that they may also inhibit tumor cell growth. However, the cellular mechanisms behind this are unknown.
Robert Ramer, Ph.D., and Burkhard Hinz, Ph.D., of the University of Rostock in Germany investigated whether and by what mechanism cannabinoids inhibit tumor cell invasion.
Cannabinoids did suppress tumor cell invasion and stimulated the expression of TIMP-1, an inhibitor of a group of enzymes that are involved in tumor cell invasion.
“To our knowledge, this is the first report of TIMP-1-dependent anti-invasive effects of cannabinoids. This signaling pathway may play an important role in the antimetastatic action of cannabinoids, whose potential therapeutic benefit in the treatment of highly invasive cancers should be addressed in clinical trials,” the authors write.

Source: Journal of the National Cancer Institute (2007, December 27). Cannabinoids May Inhibit Cancer Cell Invasion. ScienceDaily. Retrieved July 18, 2008, from http://www.sciencedaily.com¬ /releases/2007/12/071226004546.htm

Marijuana and its main psychoactive component, THC, exert a plethora of behavioral and autonomic effects on humans and animals.
Some of these effects are the cause of the widespread illicit use of marijuana, while others might be involved in the potential therapeutic use of this drug for the treatment of several neuronal disorders. The great majority of these effects of THC are mediated by cannabinoid receptor type 1 (CB1), which is abundantly expressed in the central nervous system. The exact anatomical and neuronal substrates of each action, however, were previously unknown. Using an advanced genetic approach, Krisztina Monory and colleagues at the Johannes Gutenberg University Mainz discovered that specific neuronal subpopulations mediate the distinct effects of THC. Their work is published online this week in the open-access journal PLoS Biology.
In their study, the researchers generated mutant mice lacking CB1 expression in defined neuronal subpopulations but not in others. These mice were treated with THC, and typical effects of the drug on motor behavior, pain, and thermal sensation were scored. Their discovery of the neural substrates underlying specific effects of THC could lead to a refined interpretation of the pharmacological actions of cannabinoids. Moreover, these data might provide the rationale for the development of drugs capable of selectively activating CB1 in specific neuronal subpopulations, thereby better exploiting cannabinoids’ potential therapeutic properties. http://www.plos.org/

Source: News-Medical.net Oct. 2007

People with multiple sclerosis (MS) who smoke marijuana are more likely to have emotional and memory problems, according to new research.

“This is the first study to show that smoking marijuana can have a harmful effect on the cognitive skills of people with MS,” said study author Anthony Feinstein, MPhil, PhD, of the University of Toronto. “This is important information because a significant minority of people with MS smoke marijuana as a treatment for the disease, even though there are no scientific studies demonstrating that it is an effective treatment for emotional difficulties.”
Feinstein noted that MS itself can cause cognitive problems. “In addition, cognitive problems can greatly affect the quality of life for both patients and their caregivers,” he said.
For the study, researchers interviewed 140 Canadian people with MS. Of those, 10 people had smoked marijuana within the last month and were defined as current marijuana users. The marijuana users were then each matched by age, sex, the length of time they had MS, and other factors to four people with MS who did not smoke marijuana.
The researchers then evaluated the participants for emotional problems such as depression, anxiety and other psychiatric disorders. They also tested the participants’ thinking skills, speed at processing information, and memory.
The study found marijuana smokers performed 50 percent slower on tests of information processing speed compared to MS patients who did not smoke marijuana. There was also a significant association between smoking marijuana and emotional problems such as depression and anxiety.
People with MS have higher rates of depression and suicide compared to the general population. “Since marijuana can induce psychosis and anxiety in healthy people, we felt it was especially important to look at its effects on people with MS,” Feinstein said.

Source: the online edition of Neurology, February 13, 2008

This research study is very encouraging – showing another area of illness where cannabinoids ( extracts of cannabis) may be able to be used medicinally Reputable scientists and researchers, and companies like G W Pharmaceuticals, are excited by the possible use of extracts of cannabis as treatments for some illnesses.
Please note however, this is not a recommendation for smoking raw cannabis – any substance taken into the body via smoking is harmful and can lead to severe health problems.Use of cannabinoids (marijuana) could assist in the treatment of post-traumatic stress disorder patients. This is exposed in a new study carried out at the Learning and Memory Lab in the University of Haifa’s Department of Psychology.

The study, carried out by research student Eti Ganon-Elazar under the supervision of Dr. Irit Akirav, was published in the Journal of Neuroscience.

In most cases, the result of experiencing a traumatic event — a car accident or terror attack — is the appearance of medical and psychological symptoms that affect various functions, but which pass. However, some 10%-30% of people who experience a traumatic event develop post-traumatic stress disorder, a condition in which the patient continues to suffer stress symptoms for months and even years after the traumatic event. Symptoms include reawakened trauma, avoidance of anything that could recall the trauma, and psychological and physiological disturbances. One of the problems in the course of treating trauma patients is that a person is frequently exposed to additional stress, which hinders the patient’s overcoming the trauma.

The present study, carried out by Dr. Akirav and research student Eti Ganon-Elazar, aimed to examine the efficiency of cannabinoids as a medical treatment for coping with post-traumatic stress. The researchers used a synthetic form of marijuana, which has similar properties to the natural plant, and they chose to use a rat model, which presents similar physiological responses to stress to that of humans.

The first stage of the research examined how long it took for the rats to overcome a traumatic experience, without any intervention. A cell colored white on one side and black on the other was prepared. The rats were placed in the white area, and as soon as they moved over to the black area, which they prefer, they received a light electric shock. Each day they were brought to the cell and placed back in the white area. Immediately following exposure to the traumatic experience, the rats would not move to the black area voluntarily, but a few days later after not receiving further electric shocks in the black area, they learned that it is safe again and moved there without hesitation.

Next, the researchers introduced an element of stress. A second group of rats were placed on a small, elevated platform after receiving the electric shock, which added stress to the traumatic experience. These rats abstained from returning to the black area in the cell for much longer, which shows that the exposure to additional stress does indeed hinder the process of overcoming trauma.

The third stage of the research examined yet another group of rats. These were exposed to the traumatic and additional stress events, but just before being elevated on the platform received an injection of synthetic marijuana in the amygdala area of the brain — a specific area known to be connected to emotive memory. These rats agreed to enter the black area after the same amount of time as the first group — showing that the synthetic marijuana cancelled out the symptoms of stress. Refining the results of this study, the researchers then administered marijuana injections at different points in time on additional groups of rats, and found that regardless of when exactly the injection was administered, it prevented the surfacing of stress symptoms.

Dr. Akirav and Ganon-Elazar also examined hormonal changes in the course of the experiment and found that synthetic marijuana prevents increased release of the stress hormone that the body produces in response to stress. According to Dr. Akirav, the results of this study show that cannabinoids can play an important role in stress-related disorders. “The results of our research should encourage psychiatric investigation into the use of cannabinoids in post-traumatic stress patients,” she concludes.

Source: University of Haifa (2009, November 4). Use Of Cannabinoids Could Help Post-traumatic Stress Disorder Patients. ScienceDaily. Retrieved November 12, 2009, from http://www.sciencedaily.com¬ /releases/2009/11/091104091726.htm

Scientists have been studying cannabinoids, substances that are chemically related to the ingredients found in marijuana, for more than two decades, hoping to learn more about how the drug produces its effects–both therapeutic and harmful. Marijuana has been reported effective in the treatment of multiple sclerosis, glaucoma, nausea caused by chemotherapy and wasting caused by AIDS. However, like all drugs, it also causes numerous unwanted side effects, including hypothermia, sedation, memory impairment, motor impairment and anxiety. Research on cannabinoids could someday yield new, more effective drugs or drug combinations.At Temple University’s School of Pharmacy and Center for Substance Abuse Research (CSAR), one of only a few centers in the nation focused on the basic science of substance abuse, several researchers are investigating how cannabinoids produce pharmacological effects in rats.
One such study, “L-NAME, a nitric oxide synthase inhibitor, and WIN 55212-2, a cannabinoid agonist, interact to evoke synergistic hypothermia,” published in the February issue of the Journal of Pharmacology and Experimental Therapeutics, reveals how cannabinoids produce one of the drug’s most robust actions, hypothermia, or decreased body temperature.
According to lead author Scott Rawls, Ph.D., assistant professor of pharmacodynamics at Temple’s School of Pharmacy, “To operate at maximum efficiency, the body needs to maintain a stable, normal temperature. When the body’s temperature is altered, as in hypothermia, normal body functions, such as blood pressure and circulation, are impaired.”
Marijuana operates via two receptors in the body. One receptor, called CB1, is located in the brain and produces the drug’s psychoactive effects, including euphoria and dizziness. The other receptor, CB2, is found throughout the body and impacts the immune system. Substances in marijuana bind to one of these receptors and set off a chemical process that leads to an effect, such as hypothermia. Scientists have focused on this chemical process at the molecular level to pinpoint the exact molecules involved.
Knowing that the molecule nitric oxide (NO) plays an important role in the regulation of body temperature, the Temple researchers set out to determine what role it might play in cannabinoid-induced hypothermia. By combining a cannabinoid with a substance that blocked NO synthesis, they found that cannabinoid-induced hypothermia increased more than two-fold.
“This demonstrates the possibility that NO plays a part in regulating the impact of cannabinoids on body temperature and other cannabinoid-mediated actions,” said Rawls. “These findings could be helpful in determining the mechanisms that underlie some of the pharmacological actions of marijuana,” he added.
Rawls’ research team is currently investigating the impact of cannabinoids on other physiological systems, such as analgesia and movement, and the brain neurotransmitters that mediate those systems.

Source: ScienceDaily. Retrieved July 18, 2008, from http://www.sciencedaily.com¬ /releases/2004/03/040309071927.htm

A Cognitive and Psychiatric Study

Originally, those asserting that crude marijuana should be approved for medical use claimed that it should be available for the terminally ill or those suffering from intractable pain. The scope of projected uses rapidly expanded to include “debilitating” conditions, which might be anything that the user perceived was a handicap or impairment. 

Marijuana contains numerous unique compounds known as cannabinoids.  Several of these have been synthesized and developed into useful drugs for specific medical use but these drugs are devoid of the more than 2000 impurities found in smoked cannabis, and the potency and dose of these manufactured drugs can be carefully adjusted to the patient.

In a recent study by Drs. Ghaffar and Feinstein, in the journal Neurology, 2008:71:164-169,(Multiple sclerosis and cannabis: a cognitive and psychiatric study),  found that patients with multiple sclerosis (MS) who were regular smoking of street cannabis had more extensive cognitive abnormalities compared to patients with MS who don’t use cannabis.  The study did not note this disparity in the controlled pharmaceutical use of cannabis-based medicinal extracts (CBMEs).  The authors, in response to an inquiry in the January 6, 2009 issue of Neurology, stated that “Based on the existing literature, it seems unlikely that the cognitive problems identified in our cannabis smokers are a function of a withdrawal syndrome, but we cannot be certain this given the limitations in our data.”   This statement acknowledges that there is a “withdrawal syndrome” for cannabis and that “cognitive problems” are associated with withdrawal from cannabis. 
Source:  Journal Neurology, 2008:71:164-169

Researchers at Brigham and Women’s Hospital found that patients taking cannabinoid medicines for pain may be getting “high,” but these effects were unrelated to relief from their pain symptoms. Results of their study, one of the first to examine the addictive potential of this class of pain medicine, were presented today at the American Academy of Pain Medicine’s 25th Annual Meeting.
In the study, Ajay Wasan, MD MSc and colleagues found that when used for non-cancer pain management, the cannabinoid class of medicines (such as dronabinol), got patients “high,” but the majority of subjects experienced significant pain relief independent of these psychoactive effects. Results indicate that these medicines have the likelihood of an addiction similar to smoking marijuana, leading researchers to conclude the abuse potential of this class should be studied further.
Using the Addiction Research Center Inventory (ARCI), the gold-standard for determining the abuse liability of substances, Dr. Wasan and colleagues at McLean Hospital looked at two different patient populations to compare the effects of medicinal, synthetic cannabinoid and marijuana. The first population was suffering from pain, and took each of the following at separate visits where they were observed for eight hours: placebo, 10mg, or 20 mg of dronabinol. The second population was not suffering from pain, but they were monitored every 30 minutes after smoking a high and low strength marijuana cigarette. Participants in both populations were given the ARCI every hour. After two hours, patients in the first population (synthetic cannabinoid medicine) were found to have the same psychoactive effects that patients from the second population (smoked marijuana) did after 30 minutes.
“Based on our study we believe the addictive qualities of this class of medicines need more investigation. In our study, patients taking the medicine, like the patients smoking the marijuana, were, essentially, stoned. However, they didn’t report less pain, indicating the pain relief properties were independent of the psychoactive effects,” said Dr. Wasan, lead author of the study, and director of clinical pain research at Brigham and Women’s Hospital. “We discovered that both the synthetic cannabinoid medicines we studied and marijuana have similar psychoactive properties and suggestive of an addiction potential.”
Source:  http://www.painmed.org/

Dale Deutsch, Ph.D., Professor of Biochemistry and Cell Biology at Stony Brook University and colleagues discovered a new molecular mechanism for the processing of endocannabinoids, brain compounds similar to THC, the active ingredient in marijuana, and essential in physiological processes such as pain, appetite, and memory.
Reported online this week in the Proceedings of the National Academy of Sciences (PNAS) , the finding could pave the way for new medicines for pain, addiction, appetite control and other disorders.
Dr. Deutsch and colleagues in the Departments of Biochemistry and Cell Biology (Martin Kaczocha) and Neurobiology and Behavior (Sherrye Glaser, Ph.D.) are the first to successfully identify two known fatty acid binding proteins (FABPs) that carry the endocannabinoid anandamide (AEA), a neurotransmitter, from the cell membrane to interior of the cell where it is destroyed. This identification enabled the research team to inhibit FABPs in various laboratory experiments and thereby reduce AEA breakdown inside cells. In their study, “Identification of intracellular carriers for the endocannabinoid anandamide,” the researchers report that they decreased the breakdown of AEA in some instances by approximately 50 percent.
“Inhibiting FABPs could potentially raise the levels of AEA in the brain’s synapses,” says Dr. Deutsch. “Naturally occurring AEA levels have been shown to curb pain without the negative side effects, such as motor coordination problems, from molecules like THC. Therefore, it makes sense to target AEA for therapeutic purposes.”
He emphasizes that their groundbreaking discovery of the role of FABPs in transporting this class of neurotransmitters may prove to be a crucial step in developing novel drug targets for endocannabinoids by way of inhibiting FABPs. In support of the research, The State University of New York (SUNY) Stony Brook Office of Technology Licensing and Industry Relations (OTLIR) has filed U.S. Patent applications comprising the discovery.
The OTLIR manages all intellectual property matters for the SUNY Research Foundation. In actively marketing this unlicensed technology created by Dr. Deutsch, the Stony Brook OTLIR welcomes commercial entities interested in partnering with the University. The licensing agent for the project is Adam DeRosa of the OTLIR.

The breakdown of AEA requires two factors. First, there needs to be a mechanism for transporting AEA to the location where it is inactivated because AEA is a fatty compound and thus unable to move inside the watery cellular environment. Second, the cell must express an enzyme called FAAH, which controls the breakdown and inactivation of AEA. In the laboratory, the researchers coaxed a nonneuronal cell type (COS-7) to express FAAH. These FAAH-expressing COS-7 cells were able to break down AED efficiently, indicating that the intracellular AEA transport mechanism was already present and operation in these cells. The researchers identified these carriers as two separate FABPs.
Dr. Deutsch believes that because a transporter for the AEA class of neurotrasmitters had never been discovered until the Stony Brook findings, continued research may explain many unanswered questions about AEA. Future research may uncover more knowledge about AEA transport, as well as the entire role these neurotransmitters play in pain, inflammation, appetite control, addiction, and perhaps other physiological processes related to many human disorders.
The research was funded by the National Institute on Drug Abuse, part of the National Institutes of Health.
Source: http://www.stonybrook.edu/   25th March 2009

Marijuana’s active ingredient may form the basis for new antiviral drugs that fight cancer-causing herpes viruses.

Professor Peter Medveczky, MD, of the University of South Florida’s medical microbiology and immunology department, and H. Lee Moffitt Cancer Center &Research Institute in Tampa, and colleagues worked on the study.

Their report appears in the Sept. 15 issue of the journal BMC Medicine.

Key IngredientThe researchers focused on marijuana’s active ingredient, delta-9-tetrahydrocannibol (THC).

In tissue culture tests, THC blocked the reactivation of various types of herpes viruses. Infection with herpes virus is recurrent and lifelong. The virus lies dormant in nerve tissue in infected people after symptoms have gone away. Later the virus can reactivate itself leading to an increasing number of viruses and causing another symptomatic infection.

In the study, researchers tested THC against various herpes viruses including Kaposi’s sarcoma-associated herpes virus (KSHV) and Epstein-Barr virus.

Kaposi’s sarcoma, prevalent among people with AIDS and a common form of cancer in Africa, stems from KSHV.

Cancers of cells from the immune system such as Burkitt’s lymphoma and Hodgkin’s disease are associated with Epstein-Barr virus, a member of the herpes virus family.

In the presence of THC, cells infected with the viruses couldn’t reactivate.

THC may interfere with a gene called ORF50, which is found in these herpes viruses, say the researchers. This gene helps turn on the virus’s machinery that is involved with reactivating the virus; it also helps start viral replication.

Not a Fix for HerpesThe researchers also tested THC on herpes simplex-1, which causes cold sores. It didn’t work.

THC appears to specifically work against herpes viruses that cause these tumors — gamma herpes viruses.

New Drugs Ahead?The findings may lead to the development of new drugs that thwart cancer-causing herpes viruses from reactivating, say the researchers.

Any new antiviral drugs based on THC would not have marijuana’s psychoactive effects.

The next step is testing THC’s benefits on lab animals.

No Pot PrescriptionAccording to a news release, Medveczky says that since THC can suppress the immune system, smoking marijuana might do more harm than good to patients infected with these viruses who often have weakened immune systems.

“Our findings do not recommend that people take pot to prevent or treat cancers associated with gamma herpes viruses,” says Medveczky in the news release.

Marijuana-like drug eludes scientists; As Ricky Williams fights social anxiety disorder with marijuana, scientists are working to take advantage of the plant’s anti-anxiety properties while avoiding the drug’s side effects.

MEDICINE

Ricky Williams’ claim that marijuana helps stave off social anxiety may have scientific merit, but developing a drug that could produce similar results will take years, medical experts said Thursday.

In lab animals, higher levels of cannabinoids — the compounds found in marijuana, and which occur naturally in the brain — sometimes decrease anxiety.

Scientists are trying to develop a drug that would replicate this effect in humans. But even under the rosiest circumstances, it will take nearly a decade to bring the drug to market.

In the meantime, scientists recommend against smoking marijuana to relax.

”One of the reasons humans use marijuana is because it reduces anxiety,” said Cecilia Hillard, a professor of pharmacology at the Medical College of Wisconsin, ”On the other hand, the reason most often cited for stopping using marijuana is that it causes anxiety.”

Daniele Piomelli, the scientist who is developing the cannabinoid-based drug, is more blunt.

”Cannabis is not a very good medicine,” he said.

PROMISING TESTS

A compound Piomelli developed at the University of California at Irvine slows the breakdown of the canabinoids that occur naturally in the brain.

Tests in mice and rats suggest this may reduce anxiety without causing the memory loss, appetite increase and decrease in cognitive function associated with smoking marijuana. Human trials of the compound are slated to begin within two years, Piomelli said.

But drugs that work in mice often fail in people, and several experts said they were not aware of any studies that used marijuana to treat anxiety in humans.

Scientists following federal recommendations have studied marijuana to treat multiple sclerosis, advanced HIV and cancer-related pain. The government has approved a marijuana-like drug to treat chemotherapy-induced nausea.

It’s more difficult for psychiatrists to study marijuana.

”It’s kind of hard to do that research, because of the illegal nature of the drug,” said Dianne Chambless, a University of Pennsylvania psychologist who studies social-anxiety disorder. Chambless said therapy for social-anxiety disorder often helps patients relax by understanding that the whole world is not judging their every move – which might not be the case for a star running back like Williams. ”For most people with social anxiety everybody really isn’t watching you or judging you, but for people in his position, people really are,” she said. ”It’s a very tough position to be in.”

Studies Find High Medical Marijuana Use

Two new Canadian studies conclude that more patients are using marijuana for multiple sclerosis and epilepsy than researchers had thought, Health Day News reported June 8.

One study of 136 epilepsy patients from the University of Alberta Epilepsy Clinic found that nearly half had used marijuana in their lifetime; one in five had used it in the past year; 15 percent had used it in the past month; 13 percent used marijuana more than 48 days a year; and 8 percent used it more than half the days of the year.

“Studies suggest one-third of the general population uses alternative healthcare on a yearly basis,’ said study author Dr. Donald Gross. “Not surprisingly, patients tend to look to alternative therapies in situations where conventional medicine has been unsuccessful, in particular for chronic medical situations. The finding of increased marijuana use in epilepsy patients with longer duration of disease and frequent seizures is consistent with the findings regarding other forms of non-conventional therapies.”

The second study of 205 multiple-sclerosis patients in Halifax, Nova Scotia, found that 20 percent of patients who were medical-marijuana users used the drug more than once a week. Eight patients said they used marijuana more than once a day.

“We have learned several things from these patients,’ said study author Mark Ware of McGill University in Montreal. “Firstly, that pain and spasms are not the only reasons for use, and the effects of marijuana on mood, sleep, and stress are important areas of therapeutic need and should be addressed in clinical trials. Secondly, there is a wide variance in doses used, ranging from single puffs to more than a gram at a time. Clinical trials will also need to include early dose-finding phases and allow for subject variability in dose adjustments.’

He added, “Thirdly, marijuana appears to be well-tolerated, though some subjects experienced intolerable side effects and deterioration of symptoms.’

The studies appear in the June 8 issue of the journal Neurology.
Source:

(One study of 136 patients and the second of 205 can hardly be extrapolated to “one-third of the population”.)

A new study suggests that a form of marijuana that occurs naturally in our lungs may hold the key to fighting all kinds of coughs. An international research team reports the marijuana-related chemical in our lungs controls how our airways expand and contract. They say the findings could lead to new treatments for a variety of respiratory problems, without the addictive qualities of marijuana or codeine, a traditional cough treatment. Scientific studies from the l970 s had shown that delta-9-tetrahydrocannabinol the active ingredient in marijuana improved chronic asthma symptoms for some patients but worsened symptoms in others. Why this happened remained a puzzle. Researchers found that rats and guinea pigs have a chemical called anandamide, which is similar to marijuana’s active ingredient, that causes the dual effect. Anandamide locks onto the surface of lung muscle cells and controls how the lungs respond to various chemical agents that trigger dry coughing. Piomelli found anandamide’s influence depends on how much the lungs already are contracted. For example, if the lungs were already tense, anandamide relaxed them. Yet if the airways were relaxed, the chemical triggered lung constriction.

While seeming paradoxical, Piomelli says anandamide’s true function may be as a regulatory mechanism. “What we want with our muscles is not for them to be completely relaxed or completely contracted. We want them to be always at a certain level of contraction, ready to go further up or further down,” Piomelli says. Anandamide may control that balance. To test that theory, the researchers severed the vagus nerve, which keeps lung muscles contracted to a certain tone, relaxing the lung. When anandamide was given to these animals, the lungs contracted again, while it had no effect on animals with an intact vagus nerve. “It looks like it’s some sort of compensatory factor,” says Piomelli. Piomelli says the findings could lead to new treatments for chronic cough, asthma, hay fever, certain cancers and chronic obstructive pulmonary disease. in animals with a cough produced by capsaicin, the active ingredient in red pepper, giving anandamide orally stopped the cough. It seems that (the researchers] are able to block bronchospasm or the irritation that occurs from capsaicin with anandamide.” Piomelli says anandamide shows promise as an alternative to current cough treatments. “Codeine, the mother of all cough suppressants, acts on the cough centre in the brain,” says Piomelli. “Because it’s a central effect, codeine, which is basically a derivative of morphine ,.. produces sedation, respiratory depression you can even die of codeine intoxication.” However, since anandamide acts on nerves in the trachea and lungs and is quickly eliminated from the body, an inhaler could potentially control the cough without any side effects. Piomelli says don’t smoke marijuana for asthma, because it could trigger lung constriction and make the problem worse.

Patients with the condition often experience weight loss because they stop recognising when they are hungry. The study does not suggest they should be given cannabis to smoke – instead, they tested a synthetic version of a cannabis extract. It was found the cannabinoid led to weight gain and reduced agitation, another symptom of the disease. The researchers from the Meridian Institute for Aging in New Jersey looked at a drug called Dronabinol which is an artificial version of delta-9 THC the active ingredient in cannabis.Dronabinol may reduce agitation and improve appetite in patients with Aizheimer’s disease

The drug has already been approved in the US for the treatment of anorexia in patients with HIV/Aids and nausea associated with chemotherapy. In the UK, a THC cannabinoid is also being tested in a trial to see if cannabis-based drugs can ease post-operative pain. In the latest US trial, 48 patients with an average age of 77 who had experienced problems with agitation and had been diagnosed with anorexia were studied. All lived in a dementia unit or a care home. Researchers assessed their cognitive skills and looked at how they coped with daily life. They were then given daily doses of five milligrams of Dronabinol per day, which was gradually increased to 10 mg a day. They were also given anti-psychotic drugs, which reduce delusions and have a calming effect, and at least four other medications to control behaviour. After a month, it was found all the patients had gained weight. Two thirds experienced a significant improvement in agitation.
No adverse events such as falls, seizures or depressions were reported.

Dr Joshua Shua-Haim, medical director at the Meridian Institute for Aging, who led the study, said.. “Our research suggests dronabinol may reduce agitation and improve appetite in patients with Alzheimer’s disease, when traditional therapies are not successful.


Source:Presented at Annual Conference of the International
Psychogeriatric Association in Chicago,2003

The three year CAMS (cannabis in multiple sclerosis) trial, involving more than 600 patients in the United Kingdom, has yielded no definitive verdict on whether the drug can ease the symptoms of multiple sclerosis. The study, funded by the Medical Research Council, was published in last week’s issue of the Lancet ( 2003;362: 1517-26)
Fifteen weeks’ treatment with oral capsules containing either whole cannabis extract or tetrahydrocannabinol (THC), the drug’s principal active ingredient, did not produce a significant improvement in spasticity as measured by the widely used Ashworth scale. But in face to face interviews, patients assigned to the treatment arm of the double blinded trial were more likely than those receiving placebo to report a subjective improvement in symptoms. The participants reported significant improvements in pain, sleep quality, spasms, and spasticity, though not in irritability, depression, tiredness, tremor, or energy. The researchers found that patients taking the cannabis derivative showed an improvement in the time taken to walk 10 metres.

The proportion of patients reporting improvements in spasticity was 61% in the arm receiving cannabis extract (n=121, 95% confidence interval 55% to 68%),
60% in the arm receiving THC (n=108, 53% to 67%),
and 46% (n=91, 39% to 53%) in the placebo arm.

The lead researchers, John Zajicek, consultant neurologist at Plymouth Hospitals NHS Trust, and Professor Alan Thompson, consultant neurologist at the National Hospital for Neurology and Neurosurgery, London, cautioned that about three quarters of the patients given cannabis had guessed they were taking active medication, and half of those receiving placebo had guessed that they were not receiving cannabis.

Dr Zajicek said: “The primary aim of the trial was to measure, as objectively as possible, the actual physical changes in limb spasticity in MS patients, and we found no evidence of this. “Although we based the study around spasticity, we also wanted to capture any treatment effects among the other important symptoms described by people with MS. When patients were asked to describe how they felt that their symptoms,including spasticity, had been affected, the picture was very different. They felt some of the impact of their painful and distressing symptoms had been eased. “We did see a high placebo effect in this trial and it may be indicative of how much patients gain by taking part in clinical trials, irrespective of the treatment they are given. Patients experienced very few side effects from the treatments, and, given that how a patient feels is an important part of improving health, cannabis based treatments may be of benefit to some patients.”

Mike Barnes, professor of neurological rehabilitation at the University of Newcastle, said: “The results of this study are mixed, but the positive aspects undoubtedly outweigh the negatives. It is my hope that in the near future, people with MS will have access to cannabis derived medicines on the NHS.”


Source:Issue of the Lancet 15th Nov 2003.

A major clinical trial in Britain finds that marijuana-based pills may have more of a psychological than physiological effect on patients with multiple sclerosis (MS).
According to the three-year study, which involved 630 MS patients, marijuana had no effect on muscle stiffness or spasticity, but most patients reported that it reduced their symptoms and improved their mobility.

“The primary aim of the trial was to measure, as objectively as possible, the actual physical changes in limb spasticity in MS patients, and we found no evidence of this,” said Dr John Zajicek of the University of Plymouth, who led the study.

However, Zajicek said that additional research is needed because the study’s subjective results “provide some evidence that cannabinoids could be clinically useful in treatment of symptoms of MS.” He added, “The results of this study present an interesting and complex picture of the value of cannabis-derived medicines for treating MS.”
The study’s findings are published in the Nov. 8, 2003 issue of The Lancet.


Source:The Times of London reported Nov7 2003

A new study shows, for the first time, that the release of the body’s own marijuana-like compounds is crucial to stress-induced analgesia – the body’s way of initially shielding pain after a serious injury.

The work, led by scientists at the University of Georgia and the University of California, Irvine, may yield a target for new drug therapies that will completely bypass the current arguments over the use of medical marijuana. In theory, the new research makes it possible to design a pill that will have the same pain relieving effects as smoked marijuana, but through an indirect mechanism that could also reduce unwanted psychoactive side effects and not have the same political baggage.

“There is no prescription or over the counter drug that allows us to manipulate the level of the brain’s marijuana-like compounds,” said Andrea Hohmann, a neuroscientist in the department of psychology at the University of Georgia and co-author of the paper. “This is the first time anyone has shown that one of the body’s naturally occurring cannabinoids, a compound known as 2-AG, has anything to do with pain regulation under natural conditions.”

The study was published today in the journal Nature.

Hohmann’s co-author, Daniele Piomelli at the University of California-Irvine, is the discoverer of a compound that blocks the breakdown of this marijuana-like compound called 2-AG, and it is that blocking compound, patented by UC-Irvine, that could become the new drug of choice for those suffering from pain or stress conditions. Importantly, it would not require people to smoke marijuana to obtain relief or wrestle with the legal issues surrounding the drug.

Others from UGA involved in the study include faculty members Philip Holmes and Jonathon Crystal and students Richard Suplita, Nathan Bolton and Mark Neely.

Authors from UC-Irvine include Darren Fegley and Regina Mangieri, in addition to Piomelli. Other co-authors are Jocelyn Krey and Michael Walker from Brown University; Andrea Duranti, Giorgio Tarzia and Andrea Tontini from the University of Urbino Carlo Bo in Italy; and Marco Mor from the University of Parma, also in Italy. All were crucial in designing and synthesizing the enzyme inhibitor.

Scientists have long known that injured athletes or even gunshot victims have a period of time in which the body’s pain reaction is delayed. This effect is called “stress-induced analgesia.” By the mid-1990s, researchers had targeted the sites of action of the brain’s naturally occurring marijuana-like compounds as having a crucial role in blocking pain, but no one understood the conditions in which these compounds were released to block pain.

Researchers along the way found out there are two kinds of stress-induced analgesia mechanisms, opioid and nonopioid (or “opioid independent”).

Hohmann and colleagues discovered that the opioid-independent form was produced by release of the brain’s own marijuana-like compounds.

“We showed that cannabinoid receptors were involved in this remarkable phenomenon,” said Hohmann, “because blocking the receptors where marijuana acts virtually erased this opioid-independent form of stress analgesia.”

If this is true, was there a compound that could also prolong the action of these compounds, making them work better? The answer lay in Piomelli’s pioneering work on inhibitors that break down the brain’s own marijuana-like compounds.

“If we design chemicals that tweak the levels of these transmitter substances in the brain,” said Piomelli, “we might be able to boost their normal effects.”

When rats used in Hohmann’s study were given the compound developed by Piomelli and his collaborators at the University of Urbino Carlo Bo and the University of Parma, it increased stress-induced analgesia dramatically, proving the connection between pain suppression and the release of these marijuana-like compounds.

The enzyme that inhibits the formation of the naturally occurring marijuana-like compound 2-AG is called monoacylglycerol lipase, and it is this enzyme that could be a target for therapeutic drug intervention to help those in pain.

A new drug increasing the body’s own marijuana-like compounds could work similar to something like Prozac, which blocks the body’s reuptake of the compound serotonin, causing it to be active longer, Hohmann said.

Apparently, several parts of the brain are involved in the effect, most notably a structure in the midbrain known as the periaqueductal gray. In this region, stress causes the release of the naturally occurring marijuana-like compounds in the brain.

A drug derived from the new research would likely be more effective and specific than smoked marijuana, said Hohmann.

Cannabinoids have been suggested to have therapeutic value as analgesics and in various conditions, including migraine headaches, nausea and vomiting, wasting syndrome and appetite stimulation in HIV-infected patients, muscle spasticity due to multiple sclerosis or spinal cord injury, movement disorders such as Parkinson’s disease, epilepsy, and glaucoma. When new therapeutic indications are suggested, two major factors should be taken into account: what are the adverse effects of the treatment and how does its effectiveness compare with that of existing alternatives?
In this week’s issue two high quality systematic reviews shed light on the therapeutic potential of cannabinoids in the management of pain and the nausea and vomiting induced by chemotherapy. Campbell et al sought and examined all randomised controlled trials that. compared the efficacy and safety of cannabinoids with those of conventional analgesics.   The nine trials included 222 patients, of whom 128 had cancer (five studies), two chronic non malignant pain (two studies, one patient per trial), and the rest postoperative pain. Cannabinoids were no more effective than codeine in controlling acute and chronic pain and they had undesirable effects in depressing the central nervous system. These studies are mostly from 1970s. Since then we have learnt to use non-steroidal anti-inflammatory analgesics alone and in combination with opioids in both cancer related and postoperative pain. There is thus no need for cannabinoids for these indications.
In chronic non cancer pain, however, we do need more effective analgesics than those currently available. Cannabinoids have anti-inflammatory effects, but it is difficult to believe that they would beat the anti-inflammatory drugs available today. Neuropathic pains, particularly those with spastic components are one area where cannabinoids may have potential. Future research may provide us with better cannabinoid compounds with potential new therapeutic applications. However, the current information is that the adverse effects of cannabinoids outweigh their effectiveness. About a year ago in the BMJ Strang et al asked for a more informed debate about the therapeutic use of cannabinoids, and this week’s two systematic reviews contribute to this debate. On current evidence cannabinoids can be recommended only for use in controlled clinical trials in carefully selected conditions for which there is no effective treatment. The launch of the first large multicentre trial on cannabis in the control of pain and tremors in multiple sclerosis is the first step on this way.

This study  examined the anti-emetic (anti-nausea) properties of the cannabinoid, Cannabidiol (CBD) which, as opposed to THC, has no psychoactive properties. The authors state that the results of this study are the first to demonstrate that the non-psychoactive component of marijuana [cannabis], cannabidiol [CBD], and its synthetic analog, cannabidiol dimethylheptyl [CBD-DMH], interfere with nausea and with condition nausea in rats.

In findings that contradict earlier research, a team of scientists reports that marijuana does not improve the often painful symptoms of multiple sclerosis (MS). Their small study found that a synthetic form of tetrahydrocannabinol (THC), the active ingredient in marijuana, and a plant extract were no better at relieving severe spasticity or muscle contraction compared with an inactive placebo.  Patients’ muscle tone improved while taking marijuana but their self-reported ratings on a scale measuring their overall disability declined.
And while marijuana was found to be safe, some patients experienced mild side effects such as headache and dizziness, particularly after taking the plant extract, according to the report in the May 14th issue of Neurology.
MS is a neurodegenerative disorder in which the slow destruction of myelin – the thin, protective coating that insulates nerve fibres in the brain and spine – can lead to numbness, muscle weakness and stiffness, impaired vision and coordination problems.
A previous study in mice indicated that marijuana might help to relieve these painful spasms.  However, the amount of the drug used in mice would not be tolerated in humans, the researchers explain.  While their study included just 16 patients, it is the largest randomized, controlled clinical trial to investigate the use of marijuana to treat MS.
“Compared to placebo, neither THC nor plant-extract treatment reduced spasticity,” Dr. Joep Killestein from the VU Medical Centre in Amsterdam, the Netherlands, told Reuters Health.  “Even though the sample size is too small to be conclusive, our study was the largest and longest completed study addressing cannabinoid therapy in MS so far.”
The authors suggest that the dose used in the study may have been too low to show any beneficial effects, or giving the drug in capsule form may have slowed its absorption.
“THC is absorbed reasonably well from the gut, but the process is slow,” Killestein and colleagues explain.
In the study, patients took an inactive pill (placebo), a marijuana plant extract or synthetic THC for 4 weeks. The researchers measured muscle tone and overall disability, and patients responded to questions assessing their quality of life.

Cannabinoid  has no impact on spasticity associated with MS

In a report published in the scientific journal Movement Disorders, Vol. 17, No. 1.2002, Fox and associates.A Randomised, Double-Blind, Placebo-Controlled crossover study designed to see whether Nabilone would be effective in the treatment of muscle spasm (dystonia) associated with multiple sclerosis found no significant reduction in dystonia following treatment with nabilone”
Though the researchers seemed to have expected more favorable results, these results are consistent with a controlled, double-blind study done in 1995 on balance and coordination of MS patients, using smoked Marijuana Although the participants claimed to have relief from symptoms, high tech monitoring equipment showed that smoking marijuana actually made it worse.

Study shows MS patients further impaired by smoking Low-THC marijuana

‘Greenburg et al, in their paper in Clinical Pharmacology and Therapeutics Vol. 55:324-328,1994, performed a double-blind randomized, placebo-controlled study of inhaled marijuana smoke on balance and coordination responses in ten adult patients with spastic multiple sclerosis, and normal volunteers who were matched for age, sex, and weight. A sophisticated computer-controlled video system was used to identiFY responses. The study showed that marijuana smoking enhanced the abnormalities already present in MS patients and that smoking just one marijuana cigarette containing 1.5% delta-9 THC increased the objective errors in these responses. The authors concluded that marijuana smoking impairs coordination and balance in patients with spastic MS.

Nation’s Youth Turning Away from Marijuana, as Perceptions of Risk Rise; Most Adults with Substance Abuse Problems Are Employed

Secretary Tommy G. Thompson announced today that there is a five percent decline in the number of American youth between the ages of 12 and 17 who have ever used marijuana. Current use of marijuana plummeted nearly 30 percent among 12 and 13 year olds. The findings were included in the 2003 National Survey on Drug Use and Health released today at the annual Recovery Month press conference.

The findings, released by HHS’ Substance Abuse and Mental Health Services Administration (SAMHSA), show that while overall, the change in the category “current use of any illicit drug” was not statistically significant, the use of some drugs decreased sharply. For youth, 12-17, past year use of Ecstasy and LSD dropped precipitously, by 41 percent for Ecstasy and 54 percent for LSD. Overall, 19.5 million Americans ages 12 and older, 8 percent of this population, currently use illicit drugs. The data indicate that of the 16.7 million adult users (18 and older) of illicit drugs in 2003, about 74 percent were employed either full time or part time.

SAMHSA Administrator Charles Curie said: “Employers who think alcohol and drug abuse will never be a problem in their workplace need to consider that more than three quarters of adults who have serious drug and or alcohol problems are employed. Encouraging employees to find help when they need it can result in fewer accidents and fewer workers absent on Monday morning. It may even save an employee’s life, family, or job. Creating a drug-free workplace program or enhancing an existing program can lead to a healthier, more productive work force and be an important part of solving one of our nation’s most persistent problems.”
The survey found that of the 19.4 million adults (age 18 and over) characterized with abuse of or dependence on alcohol or drugs (19.4 million) in 2003, 14.9 million (77 percent) were employed either full or part time. This amounts to over ten percent of full-time workers as well as over ten percent of part-time workers.

Marijuana continues to be the most commonly used illicit drug, with 14.6 million current users (6.2 percent of the population). The study shows that there were an estimated 2.6 million new marijuana users in 2002. About two thirds of these new users were under age 18, and about half were female.

An important positive change detected by the survey was an increase in the perception of risk in using marijuana once a month or more frequently. Both youth and young adults reported a significant increase in their awareness of the risks of smoking marijuana. Particularly striking was the 20 percent decline between 2002 and 2003 in the number of youth that were “heavy users” of marijuana (those smoking either daily or 20 or more days per month). Perceived availability of the drug also declined significantly among youth.

The results of this year’s survey demonstrate that anti-drug messages inside and outside of school, participation in religious and other activities, parental disapproval of substance use and positive attitudes about school are linked to lower rates of youth marijuana use. For example, those exposed to anti-drug messages outside of school had rates of current marijuana use that were 25 percent lower than those not reporting such exposure (7.5 percent vs. 10.0 percent). Youth who believe that their parents would “strongly disapprove” of marijuana had use rates fully 80 percent lower than those who reported that their parents would not “strongly disapprove” (5.4 percent vs. 28.7 percent).

The numbers of binge and heavy drinkers did not change between 2002 and 2003. About 54 million Americans ages 12 and older participated in binge drinking at least once in the 30 days prior to being surveyed. These people had five or more drinks on one or more occasion in the past month. There were 16.1 million heavy drinkers, who had five or more drinks on five or more occasions in the past month. The highest prevalence of binge and heavy drinking in 2003 was among young adults ages 18-25, with both binge and heavy drinking at their peak at age 21.

There were 10.9 million drinkers under legal age (ages 12-20) in the month prior to the survey interview in 2003. This is 29 percent of this age group. Of these, nearly 7.2 million (19.2 percent) were binge drinkers and 2.3 million (6.1 percent) were heavy drinkers.

Drunk driving declined from the 2002 survey, but drugged driving remained similar to that reported in the 2002 survey. An estimated 13.6 percent of persons aged 12 or older drove under the influence of alcohol at least once in the 12 months prior to their interviews (32.3 million people) in 2003, a decrease from 14.2 percent (33.5 million) in 2002. An estimated 10.9 million persons reported driving under the influence of an illicit drug during the past year. This is 4.6 percent of the population ages 12 and older.

Against the backdrop of generally good news, the non-medical lifetime use of prescription pain relievers showed a five percent increase for the population 12 and older, with young adults (18-25) experiencing a 15 percent increase in lifetime, as well as current use. Over all, current use of prescription pain relievers non-medically remained stable from 2002-2003. There was a statistically significant increase in lifetime non-medical use of Vicodin, Lortab, or Lorcet from 13.1 million to 15.7 million. Percocet, Percodan, or Tylox misuse in a lifetime increased from 13.1 million to 15.7 million people. Hydrocodone lifetime non-medical use increased from 4.5 million people to 5.7 million; OxyContin lifetime misuse increased from 1.9 million people to 2.8 million; non-medical methadone use increased from 0.9 million to 1.2 million; and non-medical use of Tramadol increased from 52,000 to 186,000 from 2002 to 2003.

Estimates for persons who currently used psychotherapeutic drugs taken non-medically are similar in 2003 to estimates for 2002. There were 6.3 million persons currently using prescription medications non-medically in 2003, about 2.7 percent of the population ages 12 or older. Of these, an estimated 4.7 million used prescription pain relievers; 1.8 million used tranquilizers; 1.2 million used stimulants, including methamphetamine; and 0.3 million used sedatives.

There were an estimated 2.3 million persons who currently used cocaine in 2003, 604,000 of whom used crack. One million persons used hallucinogens, including LSD, PCP, Ecstasy and other substances, and 119,000 people were estimated to currently use heroin. These projections are all similar to estimates for these drugs in 2002. But, past month inhalant use among youth ages 16 or 17 increased from 0.6 percent in 2002 to 1.0 percent in 2003. Methamphetamine use did not change significantly between 2002 and 2003, with 600,000 past month users each year.

The survey reported 21.6 million Americans in 2003 classified with dependence on drugs, alcohol, or both (9.1 percent of the population ages 12 and older). Over 20 million persons needed but did not receive treatment for an alcohol or drug problem in 2002 and 2003, but the number receiving specialized substance abuse treatment declined from 2.3 million in 2002 to 1.9 million in 2003. Of the 20 million people in need of treatment in 2003 who did not receive it, about 1 million recognized that need. Only 273,000 tried to obtain treatment and were unable to access it. The other 764,000 made no effort to get treatment.

The report found a major correlation between serious mental illness and substance dependence and abuse. In 2003, an estimated 4.2 million adults suffered from serious mental illness and substance dependence or abuse in the past year. Adults who used illicit drugs were more than twice as likely to have serious mental illness, compared to adults who did not use an illicit drug. In 2003, 18.1 percent of adult past-year users of illicit drugs had serious mental illness that year, while the rate was 7.8 percent among adults who had not used an illicit drug. Among adults with substance dependence or abuse, 21.6 percent had serious mental illness, compared to 8.0 percent among those who did not have dependence or abuse.

Among adults with serious mental illness in 2003, 21.3 percent (4.2 million people) were dependent on or abused alcohol or illicit drugs. The rate among adults without serious mental illness was only 7.9 percent.

Tobacco use rates in the past month remained essentially the same from 2002 to 2003, with 70.8 million people reporting current use of a tobacco product. Of these, 60.4 million smoked cigarettes in the past month, 12.8 million smoked cigars, 7.7 million used smokeless tobacco and 1.6 million smoked tobacco in pipes. There were significant declines in past year and lifetime cigarette use among youths ages 12 to 17 between 2002 and 2003, and a decline in the rate of cigarette smoking among young females.

The 2003 survey is based on interviews with 67,784 respondents ages 12 and older who were interviewed in their homes. This includes persons residing in dormitories or homeless shelters. Not included in the survey are persons on active military duty, in prisons, or other institutionalized populations or people who are homeless but not in shelters. Lifetime use is defined as ever used a substance in one’s lifetime. Past year use is having used the substance at least once in the past 12 months. Current use is use in the past 30 days.

Marijuana indicators continued upward trends that began in the early 1990s. In 2002, however, marijuana ED mentions stabilized, after rising from almost 600 to 1,200 from 1999 to 2001. When found as the sole drug in a hospital ED situation, patients typically present with symptoms of a panic or anxiety attack.

As in past years, marijuana precipitated more admissions into addiction treatment programs than any other illicit drug in the Twin Cities in 2003. Overall, one out of five (22.8 percent) people entering addiction treatment programs reported marijuana as the primary substance problem, compared with only 8 percent in 1991. Most (77.3 percent) were males, and 68.3 percent were white. For many, it was the first treatment experience (44.2 percent), which can reflect a relatively short abuse history. The average age of first marijuana use was 13.7 years.

Marijuana was overwhelmingly the primary drug among adolescents and young adults in treatment. Among treatment admissions under age 18, a whopping 73.2 percent reported marijuana as the primary substance problem, and among youth age 18 – 25, 34.8 percent. In contrast, among patients age 26 to 34, 14.6 percent reported marijuana as the primary substance problem, and among patients 35 and older, only 4.5 percent.

In 2003 in Minneapolis, 48.3 percent of adult male arrestees tested positive for marijuana. Nationwide, it ranged from a high of 54.9 percent in Oklahoma City, to a low of 30.9 percent in Honolulu and 31.9 percent in Salt Lake City.  The median across all cities was 44.1 percent.

Marijuana, readily available according to multiple sources, sold for $5 per joint, and could be purchased by any metropolitan area middle school student. Standard, commercial grade marijuana sold for $50 per quarter ounce, $150–$175 per ounce, and $600–$900 per pound. Higher potency “BC Bud” from British Columbia was increasingly available and sold for $100 per quarter ounce and up to $600 per ounce.

Marijuana joints that are dipped in formaldehyde, which is often mixed with phencyclidine (PCP), are known as “wets,” “wet sticks,” “water,” or “wet daddies.” Marijuana joints containing crack cocaine are known as “primos.”

A short article on two Canadian surveys (self-reporting by users) showing that many epilepsy and multiple sclerosis patients self-medicate with marijuana. The author states that social and legal obstacles have hampered clinical advances in the study of cannabis sativa for medical treatment of a variety of neurological symptoms.

“Cannabis use may be occurring in these settings but there is little scientific evidence of its effectiveness for neurological symptoms. No controlled data lend support to its use for epilepsy. Small studies in multiple sclerosis have shown variable results against spasticity and no effect for tremor. A large [660 subjects] randomized trial comparing oral THC, oral cannabis extract, and placebo showed no effect on spasticity (measured by the Ashworth scale), despite participants reporting fewer spasms and less pain.

“Some of the many variables facing clinical investigators include different drug formulations (cannabis extracts, synthetic cannabinoids), uncertain dose, and multiple methods of delivery (some patients insist cannabis is effective only when smoked). Difficulties in trial design include a strong placebo effect and maintenance of double-blind status. A recurrent theme in multiple sclerosis trials is no effect on an objective primary outcome despite subjective improvement. Valid, reliable, and responsible objective measures are needed.

The Canadian survey data, Wingerchuk states, “suggest that people with recreational drug experiences are more likely to use cannabis for neurological symptom relief, and are at greater risk of becoming active or dependent users than the general population.”

Although Wingerchuk indicates that “hazards of regular cannabis use, such as persistent mood disorders and cognitive dysfunction, should be considered,” no mention is made of the many social, economic and criminal hazards associated with marijuana use.

The question of whether a clinically significant marijuana (cannabis) withdrawal syndrome exists remains controversial. In spite of the mounting clinical and preclinical evidence suggesting that such a syndrome exists (Beardsley et al., 1986; Budney et al., 2001; Holson et al., 1989; Huestis et al., 2001), the DSM-IV does not include marijuana withdrawal as a diagnostic category. The clinical syndrome has been characterized by restlessness, anorexia, irritability and insomnia that begin less than 24 hours after discontinuation of marijuana, peak in intensity on days 2 to 4, and last for seven to 10 days (Budney et al., 1999; Haney et al., 1999; Mendelson et al., 1984).

The question of whether this syndrome is clinically significant is important, not only because marijuana is the most commonly used illicit drug in the United States (Johnston et al., 2001), but also because marijuana has been shown to produce dependence at rates comparable to other drugs of abuse (Kandel et al., 1997; Kessler et al., 1994) and because relapse rates among individuals seeking treatment for marijuana dependence are similar to those with other drugs of abuse (Budney et al., 1998; Stephens et al., 1993). Furthermore, many violent crimes are committed by individuals undergoing withdrawal from drugs of abuse, including marijuana (Kouri et al., 1997; Peters and Kearns, 1992). If a clinically significant marijuana withdrawal syndrome does exist, the omission of this syndrome from the DSM-IV might contribute to the perception that behavioral or pharmacological treatment regimens for marijuana dependence are not necessary.

We conducted two studies in our laboratory to determine whether abstinence from marijuana after long-term use results in withdrawal symptoms, to identify those symptoms and to quantify their severity (Kouri and Pope, 2000; Kouri et al., 1999). The first study focused specifically on whether abrupt discontinuation of marijuana following chronic use results in changes in aggressive behavior (Kouri et al., 1999).

To measure aggressive behavior, we used the Point Subtraction Aggression Paradigm (PSAP). This computer test has been used to detect changes in aggressive responses following acute administration of a number of drugs, and its external validity has been demonstrated in a number of studies of male and female parolees with histories of violent behavior (Cherek and Lane, 1999; Cherek et al., 1996).

Subjects in our study were long-term heavy users of marijuana who reported a history of at least 5,000 separate episodes of marijuana use in their lifetime (the equivalent to smoking once per day for 13.7 years), were smoking at least once daily at the time of recruitment and met DSM-IV criteria for marijuana dependence without meeting criteria for a current Axis I disorder. Subjects were excluded if they reported that they had used another class of drugs more than 100 times in their lifetimes or had consumed more than five alcoholic drinks per day continuously for one month or more in their lifetimes. The controls were composed of two groups: 1) individuals who had not smoked marijuana more than 50 times in their lives and had not smoked more than once per month in the last year and 2) individuals who had formerly smoked marijuana on a daily basis but who had not smoked more than once per week during the last three months. The rationale for using infrequent or former smokers rather than marijuana-naive subjects as controls was to minimize possible confounding variables that might differentiate individuals who had never tried marijuana from those who had. We based this decision on data from our laboratory demonstrating that heavy marijuana users do not differ from occasional users in a wide range of demographic and psychiatric measures (Kouri et al., 1995).

During the study, subjects were required to abstain from smoking marijuana and using any other drugs for 28 consecutive days. To verify abstinence, subjects had to come to the laboratory every day to provide supervised urine samples that we analyzed quantitatively for tetrahydrocannabinol (THC) metabolites. We measured aggressive responses with the PSAP on study days 0 (before abstinence), 1 (after 24 hours of abstinence), 3, 7 and 28.

Subjects were told they would be playing a computer game against an anonymous same-sex subject from the study. In fact, however, this second subject was actually a computer. During the course of each 20-minute computer session, subjects had the option of pressing one of two buttons on the PSAP response panel (labelled “A” or “B”). Pressing button A resulted in the accumulation of points that were exchanged for money at the end of the study. Pressing this button was defined as a non-aggressive response. By pressing button B, subjects could subtract points from the fictitious opponent. Points taken from the opponent, however, were not added to the subject’s counter, and pressing button B was defined as an aggressive response. Aggressive responding was provoked by random subtractions of the subject’s points, which were attributed to the fictitious opponent.

On study day 0 (before marijuana abstinence) and study day 1 (24 hours of marijuana abstinence), the current marijuana users did not differ from past heavy users or light users in the number of aggressive or non-aggressive responses they made. However, current marijuana users were significantly more aggressive on days 3 and 7 of marijuana abstinence compared to their pre-withdrawal levels of aggression and compared to the controls. By day 28, the number of aggressive responses from the current marijuana users was not different from their pre-withdrawal baseline levels or the controls (Figure). These data demonstrate that abstinence from marijuana after chronic use is associated with increases in aggressive responding following provocation. Specifically, during the first week of abstinence, current marijuana users displayed levels of aggression that were significantly higher than before abstinence and higher than the levels displayed by matched controls. Interestingly, the increases in aggressive responding followed a specific time course and then returned to pre-withdrawal levels after 28 days of abstinence. The transient nature of these changes is consistent with other reports of marijuana withdrawal.

The second study was designed to further characterize symptoms of marijuana withdrawal and to quantify their magnitude (Kouri and Pope, 2000). We used the same study entry criteria as in the first study and subjects were required to come to the laboratory every day to provide urine samples and to fill out a daily diary.

The items assessed in the daily diaries were: mood, appetite, sleep, anxiety, irritability, physical tension or agitation, physical symptoms, ability to concentrate, desire to use marijuana, and desire to resume using marijuana at the end of the study. The questions were presented on a 10-point Likert scale with the qualifiers “extremely low” at the zero end of the scale and “extremely high” at the 10-point end of the scale. We obtained pre-withdrawal baseline levels for all of the diary items via a personal interview with each subject before the beginning of the withdrawal period.

Thirty current marijuana users and 30 controls (16 former heavy users and 14 light users) participated in the study. Before the beginning of the abstinence period, the current marijuana users were not different from the former users or the light users on any of the items assessed in the diaries except for the ability to concentrate item. The current users reported a lower ability to concentrate than the controls. Interestingly, the former heavy users were not different from the light users on any of the diary scores during the course of the study. In contrast, the current users reported increases in irritability, anxiety, physical tension and physical symptoms, and decreases in mood and appetite starting on day 1 and peaking between days 7 and 10 of marijuana abstinence.

It is important to note that although, as a group, the current marijuana users experienced an increase in withdrawal symptoms compared to the controls, only 60% of the subjects in the current users group reported a change in symptoms of at least three points in magnitude. The fact that 40% of subjects who had used marijuana regularly for an average of 22 years did not report experiencing severe withdrawal symptoms during abstinence might suggest that physical dependence on marijuana is not as strong as that observed with other drugs of abuse. This may be due, at least in part, to the long half-life of THC. However, many subjects reported that when trying to remain abstinent in the past, the presence of withdrawal symptoms had played an important role in their relapse. Thus, alleviation of abstinence symptoms may contribute to the maintenance of daily marijuana use in chronic users.

Another significant finding is that after 28 days of marijuana abstinence, all of the symptoms returned to pre-withdrawal levels except for irritability and physical tension. It is possible that these two symptoms remained slightly elevated because they represented a premorbid characteristic of the current users and were not a result of marijuana withdrawal. If this is the case, the fact that the former users did not have elevated scores on these two items may reflect a characteristic that potentially differentiates individuals with a history of heavy marijuana use who have successfully stopped from individuals who continue to smoke regularly.

Taken together, the data from these two studies provide further evidence of the existence of a marijuana withdrawal syndrome. An important aspect of both of our studies is that we used two control groups: 1) former heavy marijuana users and 2) individuals who had rarely smoked marijuana during their lives.

It is noteworthy that these control groups were indistinguishable from one another in diary scores or number of aggressive responses on the PSAP, whereas both were significantly distinguishable from the current marijuana users. This observation argues that the elevated diary scores and aggressive responses of the current marijuana users were attributable to marijuana withdrawal, rather than a mere history of marijuana use or some other aspect of subject selection or study design. Future studies should focus not on whether a marijuana withdrawal syndrome exists but rather on determining the clinical significance of this syndrome and the role withdrawal symptoms play in perpetuating marijuana use.

Acknowledgement
These studies were supported by NIDA grants DA10346, DA03994, DA00343. Dr. Kouri is assistant profesor of psychiatry at Harvard Medical School in Boston, Mass.
References
Beardsley PM, Balster RL, Harris LS (1986), Dependence on tetrahydrocannabinol in rhesus monkeys. J Pharmacol Exp Ther

Today, the Florida Department of Law Enforcement (FDLE) released the Florida Medical Examiners Commission’s Report on Drugs Identified in Deceased Persons. The report contains information compiled from autopsies performed by medical examiners across the state in 2003. During that period there were approximately 170,000 deaths. According to the report, 6,767 individuals examined had drugs in the system.

Medical Examiners collected information on the following drugs: Ethyl Alcohol, Amphetamines, Methamphetamines, MDMA (Ecstasy), MDA, MDEA, Alprazolam, Diazepam, Flunitrazepam (Rohypnol), other Benzodiazepines, Cannabinoids, Carisoprodol/Meprobamate, Cocaine, GHB, Inhalants, Ketamine, Fentanyl, Heroin, Hydrocodone, Hydromorphone, Meperidine, Methadone, Morphine, Oxycodone, Propoxyphene, Tramadol, and Phencyclidine (PCP).

The report reveals a decrease in the incidences of Heroin in 2003 when compared with 2002. This decrease includes cases in which the drug levels found during the exams were both lethal and non-lethal. In addition, the report indicates the three most frequently occurring drugs found in decedents were Ethyl Alcohol (3,467), all Benzodiazepines (1,794), and Cocaine (1,614). The drugs that caused the most deaths were Cocaine, all Benzodiazepines, Methadone, Oxycodone, Ethyl Alcohol, Heroin, Alprazolam, and Morphine.

The three drugs that were the most lethal, meaning more than 50 percent of the deaths were caused by the drug when the drug was found, were Heroin (88 percent), Fentanyl (63 percent), and Methadone (60 percent). The report also reveals that excluding newly tracked prescription drugs, prescription drugs of Benzodiazepines, Hydrocodone, Methadone, and Oxycodone continued to be found more often than illicit drugs in both lethal (60 percent) and non-lethal (55 percent) levels during 2003.

“This report shows that with few exceptions, both illicit and prescription drugs persist in being a continuing and increasing danger to the citizens of the State of Florida,” said FDLE Commissioner Guy Tunnell. “While heroin deaths have decreased over the past year, most of the other illicit and prescription drug deaths remain at an alarming level for the year, although decreases are noted during the second half of the year.”

“The results from this report are evidence of the immense danger associated with drug abuse and more specifically prescription drug abuse,” said Jim McDonough, Director of the Florida Office of Drug Control. “Far too many Floridians are dying from prescription drugs. To address this problem Florida will continue to strengthen its efforts in the areas of prevention, treatment, and law enforcement in order to reduce the unacceptable amount of deaths that result from the abuse of prescription drugs.”

The present study investigated whether maternal cigarette smoking and marijuana use during pregnancy were associated with an increased risk of initiation and daily/regular use of such substances among one hundred fifty-two 16- to 21-year-old adolescent offspring. The participants were from a low risk, predominately middle-class sample participating in an ongoing, longitudinal study. Findings indicated that offspring whose mothers reported smoking cigarettes during their pregnancy were more than twice as likely to have initiated cigarette smoking during adolescence than offspring of mothers who reported no smoking while pregnant. Offspring of mothers who reported using marijuana during pregnancy were at increased risk for both subsequent initiation of cigarette smoking (OR=2.58) and marijuana use (OR=2.76), as well as daily cigarette smoking (OR=2.36), as compared to offspring of whose mothers did not report using marijuana while pregnant. There was also evidence indicating that dose-response relationships existed between prenatal exposure to marijuana and offspring’s use of cigarettes and marijuana. These associations were found to be more pronounced for males than females, and remained after consideration of potential confounds. Such results suggest that maternal cigarette smoking and marijuana use during pregnancy are risk factors for later smoking and marijuana use among adolescent offspring, and add to the weight of evidence that can be used in support of programs aimed at drug use prevention and cessation among women during pregnancy.
Porath AJ, Fried PA. Department of Psychology, Carleton University, Ottawa, Ontario, Canada K1S 5B6. aporath@ccs.carleton.ca

Source: PMID: 15734278 [PubMed – indexed for MEDLINE

Club drug hinders long-term recollection, while marijuana limits short-term memory By Steven Reinberg.

Adding to an already hefty body of evidence a new study finds ecstasy users suffer from long-term memory problems while marijuana smokers struggle with short-term memory lapses. The study found those who regularly took the popular club drug ecstasy were 23% more likely to report problems with remembering things than people who are drug-free. And marijuana smokers reported up to 20% more memory problems than non-users.

“There is a lot of evidence that ecstasy users are likely to use other drugs, including cannabis. Users of both substances may therefore be vulnerable to a myriad of memory afflictions, which may represent a time bomb of cognitive problems for later life,” says lead researcher Jacqui Rodgers Rodgers is with the School of Neurology, Neurobiology and Psychiatry at the University of Newcastle in England. The findings appear in the January issue of the Journal of Psychopharmacology.

Collecting data through a Web site, Rodgers and colleagues used a standard questionnaire to assess drug use among the 763 individuals who responded. They also looked closely at a subgroup of 81 ‘typical’ ecstasy users who had taken the drug at least 10 times.

The people were asked about their short-term and long-term memory. They were also asked to rank the probability of scenarios such as finding a television story difficult to follow or forgetting to pass a message on to someone.

The group of ‘typical’ ecstasy users reported their long-term memory to be 14% worse than the 483 people who had never taken ecstasy, and 23% worse than the 242 non-drug users.

“We found that people who regularly take ecstasy report experiencing long-term memory difficulties, and are 23% more likely to report problems with remembering things than nonusers,” she says.

“We also found that people who use cannabis regularly report up to 20% more memory problems than non-users, in terms of short-term memory performance,” Rodgers adds.

Rodgers team also noted the number of mistakes the people made when titling out the questionnaire.

Users of ecstasy – also known as MDMA –made 21% more mistakes on the questionnaire compared with non-ecstasy users and 29% more mistakes than people who did not take drugs at all.

These differences were the same for men and women.

“Our findings may help drug services in the U.K. and elsewhere explain the potential consequences of use, so that people can make an informed decision as to whether to take ecstasy or not,” Rodgers says.

“Users may think that ecstasy is fun and that it feels fairly harmless at the time. However, our results show slight but measurable impairments to memory as a result of use, which is worrying,” she notes. “It’s equally concerning that we don’t realy know what the long-term effects of ecstasy use will be, as it is still a poorly understood drug,” Rodgers adds. “The findings also suggest that ecstasy users who take cannabis are suffering from a double whammy, where both their long-term and short-term memory is being impaired.

“Rodgers team is planning to launch a Web site within the next two months that will include memory tests that may determine whether self-reported memory impairment is actually detectable by objective measurement.

Dr Stephen Koesters, a clinical assistant professor at the College of Medicine and Public Health at Ohio State University, says, “The study has a number of limitations, but does seem to support other studies that have been released in the past.”

“While the specific effects of MDMA are difficult to pinpoint in light of multiple drug use by many patients, self- reporting of the amount and the frequency of drug use, there is certainly a trend in the available literature that suggests memory impairment is a real side effect of MDMA use” he adds.

Whether these effects are cumulative is difficult to determine, Koesters adds.

“Current evidence does suggest that MDMA can be dangerous, both with acute ingestion and to longer-term memory impairment,” Koesters says. “With the current rate that MDMA is being abused, it is not safe to wait 30 or 40 years to see if we have a true epidemic,” he adds.

Source: Journal of Psychopharmacology. Jan 2004 Reported on www.healthday.com

Published: Monday, 20-Feb-2006

A fifth of young adults whose blood vessels ruptured inside their brain abused drugs and more than 40% had malformed blood vessels, according to a study reported Feb. 17 at the American Stroke Association’s International Stroke Conference 2006 in Kissimmee, FL.

The study included 307 patients with intracerebral hemorrhage (ICH) — a stroke caused by a blood vessel bursting inside the brain. Of the 75 patients 49-years-old or younger, 20% had drugs in their system.

“The dominant drug of abuse was cocaine, long recognized as a risk factor for ICH,” said Michael Hoffmann, MD, lead author of the study and director of the stroke program at the University of South Florida-Tampa General Hospital. “Marijuana was another frequently abused drug and is beginning to emerge as a risk factor for stroke. Amphetamines also were commonly abused.”

How these drugs make brain blood vessels prone to rupture is not clear, but is being studied, Dr. Hoffmann said.

The study analyzed the causes and outcomes of ICH patients. 24% of ICH patients in a registry at Tampa General Hospital were ages 18 to 49. Half were women, about two thirds were Caucasian, 15% were black and 12% were Hispanic.

ICH is often linked with high blood pressure in people over age 50, and in this study, 57% of those age 50 and older had it. Only 33% of ICH patients ages 18 to 49 had high blood pressure.

Of the younger patients in the study, 41% had malformed blood vessels, known as arteriovenous malformations, aneurysms or other vascular disorders. Cerebral arteriovenous malformation occurs when blood vessels in the brain develop in an abnormal tangle in which the arteries connect directly to the veins without the normal capillaries between them. A cerebral aneurysm is the bulging of the wall of an artery in the brain. Both these conditions weaken blood vessels and increase the risk of a hemorrhagic (bleeding) stroke.

The good news is that patients under age 50 who experience this vessel rupture inside the brain have better outcomes than older patients.

“Surprisingly, our study showed a low mortality rate compared to population studies,” said Dr. Hoffmann, professor of neurology at USF.

The 30-day mortality was 14.6% for the younger group, significantly lower than for older patients, whose mortality rate was 21%, he said. Previously, national population studies have found a high 30-day mortality rate for stroke patients with ICH. Some epidemiological data have suggested a 45% to 50% mortality rate, Dr. Hoffmann said.

ICH has traditionally been associated with older age groups and higher mortality rates.

Dr. Hoffmann attributes the low mortality rate in younger ICH patients to intensive neurocritical care management at Tampa General. The protocol includes decreasing intracranial pressure and using drains to prevent hydrocephalus, mechanical ventilation, sepsis control, blood pressure control and cooling.

The younger patients came into the emergency room, then were rapidly transferred to a neurocritical care unit within six hours. Typically, patients are hospitalized in the neurocritical care unit for one to eight weeks. Patients were evaluated by MRI, CT and angiography.

“This new way of thinking about how to manage patients with ICH is an important approach, and patients are reaping benefits,” Dr. Hoffmann said.

Most of the younger patients were able to live independently three to six months after their ICH, with only mild to moderate cognitive impairment that tends to improve over time, he said.

Dr. Hoffmann said the degree and nature of disability at six months is now the focus of the extension of this study.

“Intensive neurocritical care is the key to successful outcome,” Dr. Hoffmann said. “Good medical care can salvage a high quality of life after a stroke.”

The study was funded by USF Health and the Tampa General Hospital Stroke Registry. Co-author is Ali Malek, MD, USF assistant professor of neurology.
Source: http://www.hsc.usf.edu ; News-medical.net

In a recent double-blind, placebo-controlled study, using both smoked marijuana and THC infusions, Mathew et al studied the effect of tetrahydrocannabinol (THC) on blood pressure, pulse rate and blood flow to the brain to determine the extent of the phenomenon of dizziness or faiting associated with blood pressure drop when standing up after smoking a joint. A blood pressure drop that results in fainting ‘has considerable clinical relevance. In healthy individuals, it can cause injuries including lacerations and fractures. In individuals with pre-existing cerebrovascular disorders it can lead to stroke and sudden death’. Further it complicates a variety of diseases including multiple sclerosis, diabetes mellitus, Shy Drager syndrome, nephrosis, chronic fatigue syndrome, Parkinsonism, organic dementia and cervical myelopathy’. In ‘elderly ambulatory men’ it was found to be a significant and independent predictor of mortality. 28% of those studied reported severe symptoms, both with smoked marijuana and the THC infusions. The study found that the most marked autonomic change caused by marijuana was increased pulse rate. ‘ The results of the study clearly show loss of cerebral autoregulation and postural syncope (fainting when standing up) after ingestion of marijuana/THC. However the mechanism responsible for these phenomena is unclear.

Note: the 29 subjects were all experienced marijuana smokers. The study was reviewed and approved by the Institution Review Board (IRB) at Duke University Medical Center.
Source: A transcranial Doppler study of the hemodynamics. R J. Mathew et al Pharmacology:
Biochemistry and Behavior 75 (2003) 309-318

Mon Mar 24, 5:33 PM

NEW YORK (Reuters Health) – A new study in rats suggests that prenatal exposure to marijuana may affect offsprings’ behavior and memory, Italian researchers announced Monday.

The findings reaffirm advice for pregnant women and lactating women to avoid marijuana use, according to one of the study’s authors.

“We cannot say that findings in rats can be directly translated to humans,” said Dr. Vincenzo Guomo of the University “La Sapienza’ Roma in Rome via e-mail. “But we know that animal studies can generate predictive information on various aspects of human brain function and could represent an essential step in the development of interventions to manage human diseases.”

“In this regard, our findings suggest that both pregnant and lactating women should avoid the use of marijuana,” Cuomo said.

The findings are pub]ished in the advance online edition of the journal Proceeding of the National Academy of Sciences (news – web sites).

Although marijuana is one of the most widely used illegal drugs, studies of its effects on pregnant women and their offspring have had conflicting results, said Cuomo.

This may be explained by possible impurities in the drug and by the use of tobacco along with marijuana, according to Cuomo. Rigorous studies on the effects of marijuana in pregnancy are reratively rare, Cuomo said.

However, some researchers have for many years been following relatively large numbers of children whose mothers smoked marijuana during pregnancy, according to the Italian researcher. In general, their findings suggest that exposure to marijuana during pregnancy is related to later adverse effects on mental and motor development, Cuomo said.

In the current study, Cuomo’s team injected pregnant rats with a synthetic compound that is similar to a chemical found in marijuana. The daily dose in rats corresponded to the low-to-moderate dose people get when they smoke marijuana.

Among the rats born to exposed mothers, the researchers identified memory and behavioral problems. The offspring of exposed mothers were hyperactive, though this difference in behavior was not long lasting. However, rats whose mothers bad been exposed to the marijuana-like compound did have memory problems, according to the report.

The results of the study, Cuomo said, are in line with clinical data showing that the use of marijuana by women during pregnancy has negative consequences on the mental function and behavior of their children.

SOURCE: Proceedings of the National Academy of Sciences 2003/lO1073/pnas.05378491 30.

JULIE A. CHACKO, JARED G. HEINER, WENDY SIU, MARIE MACY, AND MARTHA K. TERRIS

ABSTRACT

Objectives: Marijuana smoking has been implicated as a causative factor in traditionally tobacco-related tumours of the head and neck and of the lung. When associated with marijuana use, such tumours occur in a much younger patient population than do similar tumours in tobacco smokers. Owing to the large number of young men with a history of marijuana presenting with transitional cell carcinoma to VA facilities, this study was designed to compare the marijuana use among young (aged less than 60 years) transitional cell carcinoma patients with that among age-matched controls.

Methods: Fifty-two men aged less than 60 years presenting consecutively with transitional cell carcinoma and 104 age-matched controls (defined by having no history of transitional cell carcinoma, hematuria, or irritative voiding symptoms, as well as unremarkable results on urinalysis and urine cytology) completed questionnaires about exposure to various potential carcinogens, including radiation, Agent Orange, smoked or processed meats, dyes, tobacco, and marijuana.

Results: Of the 52 transitional cell carcinoma patients, 46(88.5%) reported a history of habitual marijuana usage, and 72 (69.2%) of the age-matched controls gave a history of habitual marijuana use. This difference was statistically significant (P = 0) In those with transitional cell carcinoma, marijuana use significantly correlated with tumour stage, grade, and number of recurrences.

Conclusions: Marijuana smoking might increase the risk of transitional cell carcinoma.
Source: UROLOGY 61:100—104, 2006. © 2006 Elsevier Inc.

A little light relief in amongst all the serious data – there are occasionally sections – which although still serious – can bring a smile to one’s face. One such is this extract from the book ‘Marijuana – Deceptive Weed’ by Professor Gabriel Nahas.

Experiments carried out in Germany by Luff (1972) indicate that driving under the effects of Cannabis intoxication induced by active material is hazardous. Twelve young volunteers Ingested 3.2 gr. of a potent preparation, and were tested under actual driving conditions. They passed through 35 stop signs, ignored three red lights, made 233 parking mistakes, ran through l9 pedestrian crossings, demolished a simulated wall of plastic blocks and ran over a large stuffed lion. The dose of delta-9-THC these volunteers absorbed was certainly elevated (60 – 100 mg) but the results are nevertheless sobering.

Source: ‘Marijuana – Deceptive Weed’ by Professor Gabriel Nahas, O.B.E., Ph.D. Published Raven press NY 1975.

The aim of this conference was to review the pharmacological and molecular basis of the therapeutic properties of marijuana and THC, and to evaluate their clinical applications. Fifty scientists and physicians from the United States, Israel, France, Germany and Sweden gathered for two days to present papers in their areas of expertise.

The prolonged storage of THC in the body, whatever its route of absorption, was again discussed in reference to the persistent properties of this drug, even after its acute effects have dissipated. The marijuana cigarette manufactured and distributed by the National Institute on Drug Abuse for clinical research contains toxic substances in greater amounts than those contained in a tobacco cigarette of the same weight. NIDA has not been able to develop a standard marijuana cigarette with uniform concentrations of THC devoid of tars and other noxious agents. THC, taken orally, has been approved by the FDA for the treatment of vomiting and as an appetite stimulant under the name of “Marinol.’ This drug may be prescribed by physicians; however, it is not as effective as other presently available medications.

The addiction/tolerance mechanisms of THC and marijuana are similar to those induced by opiates, cocaine, nicotine and alcohol. The evidence of persistent, abnormal biochemical alterations (produced by THC in the brain and recorded with PET scans) were presented by scientists from Brockhaven National Laboratory. These were related to the persistent alterations by marijuana of the brain molecular mechanism, which control DNA expression and correlated with changes in memory, attention, awareness, and goal-oriented behavior. THC interacts with ‘receptors’ in brain cells, which are part of a regulatory “anandamide cannabinoid” system that regulates the function of brain cells and their neuro-transmission (signal transduction). Through this mechanism, THC interacts with the receptors to brain neurotransmitters (norepinephrine, dopamine, GABA, acetylcholine), altering the release of these substances. By the same mechanism, THC modifies the effects of many drugs commonly used like psycho-stimulants and psycho-depressant, opiates, alcohol and stimulants: some are enhanced and some are decreased. THC acts as a major ‘deregulator’ of all brain regulation of basic bodily functions. However, unlike ‘anandamide’ and its physiological ligands, THC sticks to the receptor molecule for hours, even days, and disturbs its signalling function in a persistent fashion. This fundamental impairment of the intracellular signalling mechanism can be observed in all cells of vital body organs: brain, heart, lung, kidney, immunity cells, and the reproductive system, carrying the risk of impairing future generations before they are born.

THC receptors identical to those of the brain cells have been identified in cells of the immunity system, of sex organs and of germ cells (gametes). They are present on the head of sperm cells and in the cells of the testes that generate the sperm. These molecular studies confirm those performed in 1976-1978, by researchers at Columbia University who reported that marijuana smokers had decreased sperm count and abnormal forms of sperm. This alteration of sperm was due to the effect of THC on spermiogenesis, the process of sperm formation in the testes. Marijuana is ‘gametotoxic’, toxic to germ cells, and is fetotoxic, impairing foetal development and is in animal species.

Marijuana in the treatment of pain was discussed in a special international panel. The difficulty of separating the subjective perception of pain from its objective measurement was discussed, and it appears to be insuperable to solve; marijuana smoking can actually lower the threshold of pain perception. THC is not an effective all-purpose analgesic when compared to aspirin, Tylenol or opiates. An evaluation of THC and of marijuana smoke in the following conditions was discussed: emesis and vomiting in cancer chemo-therapy (where orally administered THC or marijuana smoking were less effective than alternate medications); glaucoma (where THC and smoked marijuana were not deemed acceptable); use of marijuana and THC have proven unsuitable as sedative or for pain management in anesthesiology; in neurological disorders, epilepsy and multiple sclerosis. In management of the AIDS wasting syndrome, the reported therapeutic results of THC and of marijuana smoke were inconclusive.

The effects of marijuana in psychiatry were evaluated in the following conditions: schizophrenia, alcoholism and acute psychiatric syndromes. Marijuana smoking may trigger some of these ailments or worsen their course.

Dr. Paul C. ]anssen, who has designed some of the most widely used medications in psychiatry, anaesthesia and dermatology, gave a special lecture entitled: How to Search for the Ideal Drugs of the Future.’ He emphasized the importance of obtaining a perfect fit between a drug and a specifically localized receptor in order to obtain the ideal therapeutic effect. Cannabinoids do not seem to possess this property of ideal therapeutic drugs.

International conference held at New York University School of Medicine March 20-21, 1998. (A brief precis from 700 pages!)

Documents the harm to young people from marijuana use. The Denver-area teenagers studied were in delinquency/substance abtise treatment and most were dependent on marijuana, although most reported behavior problems predated, and were not initially caused by, drug use. Most of the dependent youth had let marijuana control their lives, interfering with school, home, and work situations and with driving. Three-quarters of the dependent young people spent much time in getting, using or recovering from the effects of marijuana. Two-thirds had given up important activities to use or acquire marijuana. Most of these dependent children experienced withdrawal symptoms when they tried to quit marijuana. Among other findings of this study:

Marijuana is a strong reinforcer of itself, propelling further use.
Among the dependent youth, even moderate marijuana use commonly led to dependence. For those who had used marijuana at least 6 times, 83% developed dependence.
Progression in marijuana use was significantly more rapid than for alcohol.
An anti-drug prevention organization recently compiled an extensive bibliography of studies showing marijuana’s harm. This is available from DNE/Strategic Intelligence upon request.
Aside from the harm caused by marijuana directly, its role as a “gateway drug” has been well established. Marijuana use is of particular concern because, for some, it is a forerunner of use of other drugs with their attendant problems. Documentation of the association of marijuana with abuse of more serious drugs was reported in the June 1997 Bulletin. One study showed that the earlier a person starts using marijuana, the more likely it is that they will at least experiment with other drugs. This is shown in the graph below and suggests that the longer marijuana use can be prevented, the better the chance for a drug-free life.
Risk of using other drugs varies directly with how young a person is when they start using marijuana

Source:Recent research conducted at the University of Colorado and published in Drug and Alcohol Dependence
How Marijuana Use Relates to Other Drug Use
(Based on Federal Drug Use Figures)

This study examines the extent to which alcohol and drug use is related to violent and nonviolent criminal activity among adolescent males. Based on data collected from 312 youthful offenders at a public juvenile facility, the findings reveal that in comparison to marijuana and heroin, alcohol use is more strongly and consistently associated with both violent and nonviolent offenses. When other factors are introduced into the analysis, the results show that while an adolescent’s criminal history and racial identity are relatively more important in predicting criminal activity overall, the effect of substance use (especially alcohol and marijuana) continues to be present.

Source: Dawkins, M. Adolescence 32(126):395-405, 1997
Availability: Marvin P Dawkins, Department of Sociology Coral Gables FL 33124

The aim of this conference was to review the pharmacological and molecular basis of the therapeutic properties of marijuana and THC, and to evaluate their clinical applications. Fifty scientists and physicians from the United States, Israel, France, Germany and Sweden gathered for two days to present papers in their areas of expertise.
The prolonged storage of THC in the body, whatever its route of absorption, was again discussed in reference to the persistent properties of this drug, even after its acute effects have dissipated. The marijuana cigarette manufactured and distributed by the National Institute on Drug Abuse for clinical research contains toxic substances in greater amounts than those contained in a tobacco cigarette of the same weight. NIDA has not been able to develop a standard marijuana cigarette with uniform concentrations of THC devoid of tars and other noxious agents. THC, taken orally, has been approved by the FDA for the treatment of vomiting and as an appetite stimulant under the name of “Marinol.’ This drug may be prescribed by physicians; however, it is not as effective as other presently available medications
The addiction/tolerance mechanisms of THC and marijuana are similar to those induced by opiates, cocaine, nicotine and alcohol. The evidence of persistent, abnormal biochemical alterations (produced by THC in the brain and recorded with PET scans) were presented by scientists from Brockhaven National Laboratory. These were related to the persistent alterations by marijuana of the brain molecular mechanism, which control DNA expression and correlated with changes in memory, attention, awareness, and goal-oriented behavior. THC interacts with ‘receptors’ in brain cells, which are part of a regulatory “anandamide cannabinoid” system that regulates the function of brain cells and their neuro-transmission (signal transduction). Through this mechanism, THC interacts with the receptors to brain neurotransmitters (norepinephrine, dopamine, GABA, acetylcholine), altering the release of these substances. By the same mechanism, THC modifies the effects of many drugs commonly used like psycho-stimulants and psycho-depressant, opiates, alcohol and stimulants: some are enhanced and some are decreased. THC acts as a major ‘deregulator’ of all brain regulation of basic bodily functions. However, unlike ‘anandamide’ and its physiological ligands, THC sticks to the receptor molecule for hours, even days, and disturbs its signalling function in a persistent fashion. This fundamental impairment of the intracellular signalling mechanism can be observed in all cells of vital body organs: brain, heart, lung, kidney, immunity cells, and the reproductive system, carrying the risk of impairing future generations before they are born.
THC receptors identical to those of the brain cells have been identified in cells of the immunity system, of sex organs and of germ cells (gametes). They are present on the head of sperm cells and in the cells of the testes that generate the sperm. These molecular studies confirm those performed in 1976-1978, by researchers at Columbia University who reported that marijuana smokers had decreased sperm count and abnormal forms of sperm. This alteration of sperm was due to the effect of THC on spermiogenesis, the process of sperm formation in the testes. Marijuana is ‘gametotoxic’, toxic to germ cells, and is fetotoxic, impairing foetal development and is in animal species.
Marijuana in the treatment of pain was discussed in a special international panel,. The difficulty of separating the subjective perception of pain from its objective measurement was discussed, and it appears to be insuperable to solve; marijuana smoking can actually lower the threshold of pain perception. THC is not an effective all-purpose analgesic when compared to aspirin, Tylenol or opiates. An evaluation of THC and of marijuana smoke in the following conditions was discussed: emesis and vomiting in cancer chemo-therapy (where orally administered THC or marijuana smoking were less effective than alternate medications); glaucoma (where THC and smoked marijuana were not deemed acceptable); use of marijuana and THC have proven unsuitable as sedative or for pain management in anesthesiology; in neurological disorders, epilepsy and multiple sclerosis. In management of the AIDS wasting syndrome, the reported therapeutic results of THC and of marijuana smoke were inconclusive.
The effects of marijuana in psychiatry were evaluated in the following conditions: schizophrenia, alcoholism and acute psychiatric syndromes. Marijuana smoking may trigger some of these ailments or worsen their course.
Dr. Paul C. ]anssen, who has designed some of the most widely used medications in psychiatry, anaesthesia and dermatology, gave a special lecture entitled: How to Search for the Ideal Drugs of the Future.’ He emphasized the importance of obtaining a perfect fit between a drug and a specifically localized receptor in order to obtain the ideal therapeutic effect. Cannabinoids do not seem to possess this property of ideal therapeutic drugs.