April 2018

Two Controversial Claims About Medical Marijuana Have Been Debunked

A pair of papers published today in the journal Addiction have poured some cold water on certain claims about medicinal marijuana.

Medical marijuana is now legal in 29 US states, leading some people to argue that this will increase recreational marijuana use. However, the first paper from Columbia University in New York says that is not the case.

Conducting a meta-analysis of 11 studies from four ongoing large national surveys dating back to 1991, the team found no evidence for increases in recreational use. They said that current evidence “does not support the hypothesis that US medical marijuana laws (MMLs) until 2014 have led to increases in adolescent marijuana use prevalence.”

They did note, however, that as states begin to legalize recreational marijuana – as has been happening in the last few years – the situation may change somewhat.

“Although we found no significant effect on adolescent marijuana use, we may find that the situation changes as commercialized markets for medical marijuana develop and expand, and as states legalize recreational marijuana use,” senior author Professor Deborah Hasin, from Columbia University, said in a statement.

“However, for now, there appears to be no basis for the argument that legalising medical marijuana increases teens’ use of the drug.”

The second paper dealt with the claim that medical marijuana could lead to a drop in the use of opioids. A study in September 2017, for example, said that medical marijuana could be used to relieve pain, and help stop opioid overdoses.

In 2015, more than 33,000 people died in the US from opioid use. Some studies, though, have shown the rate is dropping, and attributed it to the legalization of medical marijuana.

However, this paper in Addiction, from the University of Queensland in Australia, said that medical marijuana was not necessarily responsible. It said there was no evidence to suggest one caused the other.

“There is very weak evidence to support the claim that expanding access to medical cannabis will reduce opioid overdose deaths in the United States,” the researchers noted.

They added that although some studies do show a correlation between the increase of medical marijuana use and the reduction of opioid deaths, there was no evidence to suggest it was the cause. Correlation does not always equal causation.

So, good and bad news for medical marijuana. While it doesn’t seem to be causing an increase in recreational use, some of its purported benefits cannot be proven – just yet, anyway.

Read more: http://www.iflscience.com

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Opioids prescribed less in states where medical marijuana legal, studies find

Two new studies have found a correlation using data from programs used by millions of older, poor and disabled Americans

The number of opioid prescriptions for the elderly and the poor declined in states where medical marijuana is legal, two new studies have found.

In one study, researchers at the University of Georgia, Athens, used data from Medicare Part D, a government-run prescription drug program for people older than 65.

They found prescriptions filled for all opioids decreased by 2.11m daily doses a year when a state legalized medical marijuana, and by 3.7m daily doses a year when marijuana dispensaries opened. Forty-one million Americans use Medicare Part D. The study analyzed data between 2010 and 2015.

In a second study, researchers at the University of Kentucky examined opioid prescription data from Medicaid, a government-run program for the poor and disabled. More than 74 million Americans use Medicaid.

That analysis found state medical marijuana laws were associated with a 5.8% lower rate of opioid prescribing, and states with recreational marijuana laws were associated with a 6.3% lower rate of opioid prescribing. That study used data from 2011 to 2016.

Both studies were published in Journal of the American Medical Association Internal Medicine.

The findings are likely to bolster legal marijuana advocates, who have long contended legal marijuana could curb the opioid epidemic.

Americas overdose crisis has claimed more lives each year since the early 2000s, when powerful opioid painkillers such as Oxycontin were aggressively marketed. In 2016, more than 64,000 people died of an overdose.

In a JAMA opinion piece accompanying the research, Drs Kevin Hill from Harvard and Andrew Saxon from the veterans affairs health system wrote that the research supports anecdotal evidence from patients who describe a decreased need for opioids to treat chronic pain after initiation of medical cannabis pharmacotherapy.

Marijuanas effect on opioid use remains contested. Researchers at the National Institute on Drug Abuse found illicit marijuana use was associated with increased illicit opioid use. That study used data from the National Epidemiologic Survey on Alcohol and Related Conditions, which has produced analyses skeptical of the benefits of liberalizing marijuana.

Meanwhile, a 2014 JAMA Internal Medicine study would seem to support the new findings. That study found states with medical marijuana laws had higher overdose rates, but that those rates declined in years after medical marijuana laws were implemented, with an average 24.8% decline.

The Trump administration made curbing the epidemic a major public health target. Most efforts focus on criminal prosecutions of drug dealers, including emphasizing the death penalty and civil litigation.

The attorney general, Jeff Sessions, opposes efforts to liberalize marijuana access, and claimed marijuana fueled the overdose epidemic.

No new money has been allocated to the crisis since Trump took office. Further, Republican proposals for cuts to Medicaid would have disproportionately affected people in addiction treatment. Experts believe serious efforts to curb the epidemic will cost billions and will need to address bottlenecks in mental health infrastructure.

Both studies have limitations. First, the opioid crisis has touched every state in America, but there are regional variations. And marijuana laws vary significantly.

People who rely on Medicaid or Medicare Part D are generally poor, disabled and elderly, meaning the findings may not apply to the population in general. Further, it is unclear whether people avoided opioids when medical marijuana was available.

Many companies and states (via taxes) are profiting from the cannabis industry while failing to support research at the level necessary to advance the science, wrote Hill and Saxon.

This situation has to change to get definitive answers on the possible role for cannabis in the opioid crisis, as well as the other potential harms and benefits of legalizing cannabis.

Read more: http://www.theguardian.com/us

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The Dirty Secret of California’s Cannabis: It’s Dirty

This is a story about marijuana that begins in a drawer of dead birds. In the specimen collections of the California Academy of Sciences, curator Jack Dumbacher picks up a barred owl—so named for the stripes than run across its chest—and strokes its feathers. It looks like a healthy enough bird, sure, but something nefarious once lurked in its liver: anticoagulant rodenticide, which causes rats to bleed out, and inevitably accumulates in apex predators like owls. The origin of the poison? Likely an illegal cannabis grow operation in the wilds of Northern California.

Wired

“It's a mess out there,” says Dumbacher. “And it costs taxpayers millions of dollars to clean up the sites.”

Marijuana doesn’t just suddenly appear on the shelves of a dispensary, or the pocket of a dealer. Someone’s gotta grow it, and in Northern California, that often means rogue farmers squatting on public lands, tainting the ecosystem with pesticides and other chemicals, then harvesting their goods and leaving behind what is essentially a mini superfund site. Plenty of growers run legit, organic operations—but cannabis can be a dirty, dirty game.

Morgan Heim/BioGraphic/California Academy of Sciences
Morgan Heim/BioGraphic/California Academy of Sciences

As cannabis use goes recreational in California, producers are facing a reckoning: They’ll either have to clean up their act, or get out of the legal market. Until the federal prohibition on marijuana ends, growers here can skip the legit marketplace and ship to black markets in the many states where the drug is still illegal. That’s bad news for public health, and even worse news for the wildlife of California.

If you’re buying cannabis in the United States, there’s up to a 75 percent chance that it grew somewhere in California. In Humboldt County alone, as many as 15,000 private grows churn out marijuana. Of those 15,000 farms, 2,300 have applied for permits, and of those just 91 actually have the permits.

Researchers reckon that 15 to 20 percent of private grows here are using rodenticide, trying to avoid damage from rats chewing through irrigation lines and plants. Worse, though, are the growers who hike into rugged public lands and set up grow operations. Virtually all of them are using rodenticide. “At very high doses the rodenticides is meant to kill by basically stopping coagulation of blood,” says Dumbacher. “So what happens is if you get a bruise or a cut it you would you would literally bleed out because it won’t coagulate.”

And what’s bad for the rats can’t be good for the barred owl. How the poison might affect these predators isn’t immediately clear, but researchers think it may weaken them.

Scientists are used to seeing rodenticides in owl livers—but usually, those animals are picking off rats in urban areas. Not so for these samples. “When we actually looked at the data, it turned out that some of the owls that were exposed were from remote areas parts of the forest that don't have even roads near them,” says Dumbacher. When researchers took a look at satellite images of these areas, they were able to pick out illegal grow operations and make the connection: Rodenticides from marijuana cultivation are probably moving up the food chain.

The havoc that growers are wreaking in Northern California is worryingly similar to the environmental bedlam of the past. “We can't just take exactly the same historical approach that California did with the Gold Rush,” says Mourad Gabriel, executive director of the Integral Ecology Research Center and lead author of the study with Dumbacher. It was a massive inundation of illegal gold and mining operations that tore the landscape to pieces. “150 years down the road, we are still dealing with it.”

And Northern California’s problems have the potential to become your problem if you’re buying marijuana in a state where it’s still illegal. “We have data clearly demonstrating the plant material is contaminated, not just with one or two but a plethora of different types of pesticides that should not be used on any consumable product,” says Gabriel. “And we find it on levels that are potentially a threat to humans as well.”

Lab Rats

Across from an old cookie factory in Oakland, California sits a lab that couldn’t look more nondescript. It’s called CW Analytical, and it’s in the business of testing marijuana for a range of nasties, both natural and synthetic. Technicians in lab coats shuffle about, dissolving cannabis in solution, while in a little room up front a man behind a desk consults clients.

Morgan Heim/BioGraphic/California Academy of Sciences

Running this place is a goateed Alabama native named Robert Martin. For a decade he’s risked the ire of the feds to ensure that the medical marijuana sold in California dispensaries is clean and safe. But in the age of recreational cannabis, the state has given him a new list of enemies to test for. If you're worried about consuming grow chemicals like the owls are doing, it's scientists like Martin who have your back.

“We're trying to do it in legitimate ways, not painting our face or putting flowers in our hair,” says Martin. “We're here to show another face of the industry." Clinical. Empirical.

Labs like these—the Association of Commercial Cannabis Laboratories, which Martin heads, counts two dozen members—are where marijuana comes to pass the test or face destruction. Martin’s team is looking for two main things: microbiological contaminants and chemical residues. “Microbiological contaminants could come in the form of bacteria or fungi, depending on what kind of situation your cannabis has seen,” says Martin. (Bad drying or curing habits on the part of the growers can lead to the growth of Aspergillus mold, for instance.) “Or on the other side, the chemical residues can be pesticides, herbicides, things like that.”

The biological bit is pretty straightforward. Technicians add a cannabis sample to solution, then spread it on plates that go into incubators. “What we find is of all the flowers that come through, about 12 to 13 percent will come back with a high level of aerobic bacteria and about 13 to 14 percent will come back with a high level of fungi and yeast and mold,” says laboratory manager Emily Savage.

With chemical contaminants it gets a bit trickier. To test for these, the lab run the cannabis through a machine called a mass spectrometer, which isolates the component parts of the sample. This catches common chemicals like myclobutanil, which growers use to kill fungi.

Starting July 1 of this year, distributors and (legal) cultivators have to put their product through testing for heavy metals and bacteria like E. coli and chemicals like acephate (a general use insecticide). That’s important for average consumers but especially medical marijuana patients with compromised health. One group of researchers has even warned that smoking or vaping tainted marijuana could lead to fatal infections for some patients, as pathogens are taken deep into the lungs.

“This is why we have to end prohibition and regulate and legalize cannabis, so that we can develop the standards that everybody must meet,” says Andrew DeAngelo, director of operations of the Harborside dispensary in Oakland.

After testing, a lab like CW has to report their results to the state, whose guidelines may dictate that the crop be destroyed. If everything checks out, the marijuana is cleared for sale in a dispensary. “That gives the public confidence that these supply chains are clean for them and healthy for them,” says DeAngelo.

That safety comes at a price, though. To fund the oversight of recreational marijuana, California is imposing combined taxes of perhaps 50 percent. “They're too high,” says DeAngelo. He’s worried that the fees will push users back into the black market, where plants don’t have to hew to the same strict safety standards. “This shop should be a lot fuller than it is right now.”

And the black market gets us right back to the mess we started off in. Illegal cultivation is bad for consumers and bad for the environment. The only real solution? The end of prohibition. At the very least, the owls would appreciate it.

Read more: http://www.wired.com/

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John Boehner Now Lobbying For Medical Marijuana

Make no mistake: John Boehner’s career after serving as speaker of the House has really gone to pot.

Really.

The former Ohio congressman has signed on to the advisory board of Acreage Holdings, a cannabis company that cultivates, processes and dispenses marijuana in 11 U.S. states.

The decision to support weed comes nine years after the Republican claimed to be “unalterably opposed” to legalization, according to Bloomberg.

“Over the last 10 or 15 years, the American people’s attitudes have changed dramatically,” he said the website. “I find myself in that same position.”

Boehner said his position on pot evolved after he saw the positive effects the plant had on a friend dealing with serious back pain.

He said marijuana has great potential for helping veterans with PTSD and reversing the opioid epidemic. He also believes de-scheduling marijuana from the Drug Enforcement Agency’s controlled substances list, saying the move would help ease problems with the criminal justice system.

“When you look at the number of people in our state and federal penitentiaries, who are there for possession of small amounts of cannabis, you begin to really scratch your head,” Boehner said. “We have literally filled up our jails with people who are nonviolent and frankly do not belong there.”

Former Massachusetts Governor William Weld (R), who has supported medical marijuana since the early 1990s, has also just joined the Acreage advisory board.

Like Boehner, he believes pot is the key to reversing the opioid epidemic.

“Cannabis could be perceived as an exit drug, not a gateway drug,” he told Bloomberg.

However, both politicians insist they’ve never tried marijuana in any of its forms.

Although President Donald Trump and Attorney General Jeff Sessions are no fans of marijuana, Boehner’s decision ― as unexpected as it may seem on the surface ― is actually mainstream.

A Gallup poll from October shows that 64 percent of Americans favor making marijuana legal. The same poll found that 51 percent of Republicans favored legalization, an increase of nine percentage points from the 2016 survey.

Acreage Founder and CEO Kevin Murphy believes having the two former politicians on the board will advance U.S. cannabis policy.

“The addition of [former] Speaker Boehner and [former] Governor Weld to our Board will lead to even greater access for patients by changing the conversation overnight,” Murphy said in a release. “These men have shaped the political course of our country for decades and now they will help shape the course of this nascent but ascendant industry.”

Some people in the cannabis industry believe Boehner’s budding involvement is a good thing.

Eddie Miller, Chief Strategy Officer for GreenRush.com, a business that is like GrubHub or Amazon for weed, thinks Boehner will lend new credibility to the whole cannabis industry. 

“It will help [us] by bringing a new wave of support from conservative politicians that have never considered cannabis to be a legitimate industry,” he told HuffPost.

Erik Knutson, CEO of Keef Brands, which manufactures cannabis-infused cola and sparkling water, said Boehner’s pro-pot stance harkens the end of an era.

“With the majority of Republicans favoring legalization and states rights, it is no surprise that mainstream right-leaning politicians are beginning to gravitate towards Cannabis,” he told HuffPost by email. “Luckily for all of us, the Reagan era drug warrior platform is dying.”

However, attorney Perry N. Salzhauer, who specializes in cannabis industry law, worries Boehner’s involvement is a sign that big business could drive out the little guy.

When a powerful political figure with ties to the tobacco industry makes a public move like this, it certainly raises fears among the smaller operators that their days may be numbered,” he told HuffPost. “Despite this, we believe that there will always be room for a craft cannabis industry similar to what we’ve been seeing in the beer and spirits industry.”

Read more: http://www.huffingtonpost.com/

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The 6 Most Insane Things Happening Right Now (11/14/17)

Look, we get it. There’s way too much important news to keep track of, but if you look away, you might miss something. So we’re here to save your sanity by combing through the current headlines and quickly summing up the most ridiculous and/or important stories. Please note that we’re not responsible for any insanity caused by the stories themselves.

6

Source: CNN

5

4

Source: Fox 31 Denver

3

Read more: http://www.cracked.com/

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Top Senate Democrat Endorses Decriminalizing Marijuana at the Federal Level

The push to decriminalize marijuana has picked up another high-profile backer — Senate Democratic leader Chuck Schumer — just a week after President Donald Trump endorsed letting states decide how to regulate the drug.

"I’ll be introducing legislation to decriminalize marijuana at the federal level from one end of the country to the other," Schumer, of New York, told Vice News in an interview airing Thursday evening. "I’ve seen too many people’s lives ruined because they had small amounts of marijuana and served time in jail much too long."

Schumer’s backing of decriminalization adds to what has become a bipartisan effort in the Senate, led by Republican Senator Cory Gardner of Colorado, which was the first state to legalize recreational marijuana. Marijuana currently is legal for medicinal use in 29 states and for recreational use in eight.

Trump’s promise to let states handle the issue caused pot-related stocks to spike. It also eased the threat that the Department of Justice under Attorney General Jeff Sessions — a staunch foe of legalization — would step up enforcement of federal prohibitions on sales and use of marijuana in states like Colorado.

Gardner separately said in an interview Wednesday he is 80 percent finished with legislation he is writing to ensure states don’t run afoul of the federal prohibition on marijuana and to allow marijuana businesses access to the financial system.

It’s not clear, however, when or if such a bill might move. In the meantime Schumer’s backing could help Democrats, given that polls have increasingly shown a strong majority backing legalization.

Previous efforts to expand an existing appropriations rider protecting state-licensed medical-marijuana operations failed.

Read more: http://www.bloomberg.com/

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Marijuana legalization could help offset opioid epidemic, studies find

(CNN)Experts have proposed using medical marijuana to help Americans struggling with opioid addiction. Now, two studies suggest that there is merit to that strategy.

The studies, published Monday in the journal JAMA Internal Medicine, compared opioid prescription patterns in states that have enacted medical cannabis laws with those that have not. One of the studies looked at opioid prescriptions covered by Medicare Part D between 2010 and 2015, while the other looked at opioid prescriptions covered by Medicaid between 2011 and 2016.
The researchers found that states that allow the use of cannabis for medical purposes had 2.21 million fewer daily doses of opioids prescribed per year under Medicare Part D, compared with those states without medical cannabis laws. Opioid prescriptions under Medicaid also dropped by 5.88% in states with medical cannabis laws compared with states without such laws, according to the studies.
    “This study adds one more brick in the wall in the argument that cannabis clearly has medical applications,” said David Bradford, professor of public administration and policy at the University of Georgia and a lead author of the Medicare study.
    “And for pain patients in particular, our work adds to the argument that cannabis can be effective.”
    Medicare Part D, the optional prescription drug benefit plan for those enrolled in Medicare, covers more than 42 million Americans, including those 65 or older. Medicaid provides health coverage to more than 73 million low-income individuals in the US, according to the program’s website.
    “Medicare and Medicaid publishes this data, and we’re free to use it, and anyone who’s interested can download the data,” Bradford said. “But that means that we don’t know what’s going on with the privately insured and the uninsured population, and for that, I’m afraid the data sets are proprietary and expensive.”

    ‘This crisis is very real’

    The new research comes as the United States remains entangled in the worst opioid epidemic the world has ever seen. Opioid overdose has risen dramatically over the past 15 years and has been implicated in over 500,000 deaths since 2000 — more than the number of Americans killed in World War II.
    “As somebody who treats patients with opioid use disorders, this crisis is very real. These patients die every day, and it’s quite shocking in many ways,” said Dr. Kevin Hill, an addiction psychiatrist at Beth Israel Deaconess Medical Center and an assistant professor of psychiatry at Harvard Medical School, who was not involved in the new studies.
    “We have had overuse of certain prescription opioids over the years, and it’s certainly contributed to the opioid crisis that we’re feeling,” he added. “I don’t think that’s the only reason, but certainly, it was too easy at many points to get prescriptions for opioids.”
    Today, more than 90 Americans a day die from opioid overdose, resulting in more than 42,000 deaths per year, according to the US Centers for Disease Control and Prevention. Opioid overdose recently overtook vehicular accidents and shooting deaths as the most common cause of accidental death in the United States, the CDC says.
    Like opioids, marijuana has been shown to be effective in treating chronic pain as well as other conditions such as seizures, multiple sclerosis and certain mental disorders, according to the National Institute on Drug Abuse. Research suggests that the cannabinoid and opioid receptor systems rely on common signaling pathways in the brain, including the dopamine reward system that is central to drug tolerance, dependence and addiction.
    “All drugs of abuse operate using some shared pathways. For example, cannabinoid receptors and opioid receptors coincidentally happen to be located very close by in many places in the brain,” Hill said. “So it stands to reason that a medication that affects one system might affect the other.”
    But unlike opioids, marijuana has little addiction potential, and virtually no deaths from marijuana overdose have been reported in the United States, according to Bradford.
    “No one has ever died of cannabis, so it has many safety advantages over opiates,” Bradford said. “And to the extent that we’re trying to manage the opiate crisis, cannabis is a potential tool.”

    Comparing states with and without medical marijuana laws

    In order to evaluate whether medical marijuana could function as an effective and safe alternative to opioids, the two teams of researchers looked at whether opioid prescriptions were lower in states that had active medical cannabis laws and whether those states that enacted these laws during the study period saw reductions in opioid prescriptions.
    Both teams, in fact, did find that opioid prescriptions were significantly lower in states that had enacted medical cannabis laws. The team that looked at Medicaid patients also found that the four states that switched from medical use only to recreational use — Alaska, Colorado, Oregon and Washington — saw further reductions in opioid prescriptions, according to Hefei Wen, assistant professor of health management and policy at the University of Kentucky and a lead author on the Medicaid study.
    “We saw a 9% or 10% reduction (in opioid prescriptions) in Colorado and Oregon,” Wen said. “And in Alaska and Washington, the magnitude was a little bit smaller but still significant.”
    The first state in the United States to legalize marijuana for medicinal use was California, in 1996. Since then, 29 states and the District of Columbia have approved some form of legalized cannabis. All of these states include chronic pain — either directly or indirectly — in the list of approved medical conditions for marijuana use, according to Bradford.
    The details of the medical cannabis laws were found to have a significant impact on opioid prescription patterns, the researchers found. States that permitted recreational use, for example, saw an additional 6.38% reduction in opioid prescriptions under Medicaid compared with those states that permitted marijuana only for medical use, according to Wen.
    The method of procurement also had a significant impact on opioid prescription patterns. States that permitted medical dispensaries — regulated shops that people can visit to purchase cannabis products — had 3.742 million fewer opioid prescriptions filled per year under Medicare Part D, while those that allowed only home cultivation had 1.792 million fewer opioid prescriptions per year.
    “We found that there was about a 14.5% reduction in any opiate use when dispensaries were turned on — and that was statistically significant — and about a 7% reduction in any opiate use when home cultivation only was turned on,” Bradford said. “So dispensaries are much more powerful in terms of shifting people away from the use of opiates.”
    The impact of these laws also differed based on the class of opioid prescribed. Specifically, states with medical cannabis laws saw 20.7% fewer morphine prescriptions and 17.4% fewer hydrocodone prescriptions compared with states that did not have these laws, according to Bradford.
    Fentanyl prescriptions under Medicare Part D also dropped by 8.5% in states that had enacted medical cannabis laws, though the difference was not statistically significant, Bradford said. Fentanyl is a synthetic opioid, like heroin, that can be prescribed legally by physicians. It is 50 to 100 times more potent than morphine, and even a small amount can be fatal, according to the National Institute on Drug Abuse.
    “I know that many people, including the attorney general, Jeff Sessions, are skeptical of cannabis,” Bradford said. “But, you know, the attorney general needs to be terrified of fentanyl.”

    ‘A call to action’

    This is not the first time researchers have found a link between marijuana legalization and decreased opioid use. A 2014 study showed that states with medical cannabis laws had 24.8% fewer opioid overdose deaths between 1999 and 2010. A study in 2017 also found that the legalization of recreational marijuana in Colorado in 2012 reversed the state’s upward trend in opioid-related deaths.
    “There is a growing body of scientific literature suggesting that legal access to marijuana can reduce the use of opioids as well as opioid-related overdose deaths,” said Melissa Moore, New York deputy state director for the Drug Policy Alliance. “In states with medical marijuana laws, we have already seen decreased admissions for opioid-related treatment and dramatically reduced rates of opioid overdoses.”
    Some skeptics, though, argue that marijuana legalization could actually worsen the opioid epidemic. Another 2017 study, for example, showed a positive association between illicit cannabis use and opioid use disorders in the United States. But there may be an important difference between illicit cannabis use and legalized cannabis use, according to Hill.
    “As we have all of these states implementing these policies, it’s imperative that we do more research,” Hill said. “We need to study the effects of these policies, and we really haven’t done it to the degree that we should.”
    The two recent studies looked only at patients enrolled in Medicaid and Medicare Part D, meaning the results may not be generalizable to the entire US population.

    See the latest news and share your comments with CNN Health on Facebook and Twitter.

    But both Hill and Moore agree that as more states debate the merits of legalizing marijuana in the coming months and years, more research will be needed to create consistency between cannabis science and cannabis policy.
    “There is a great deal of movement in the Northeast, with New Hampshire and New Jersey being well-positioned to legalize adult use,” Moore said. “I believe there are also ballot measures to legalize marijuana in Arizona, Florida, Missouri, Nebraska and South Dakota as well that voters will decide on in Fall 2018.”
    Hill called the new research “a call to action” and added, “we should be studying these policies. But unfortunately, the policies have far outpaced the science at this point.”

    Read more: http://edition.cnn.com/

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    Why No Gadget Can Prove How Stoned You Are

    If you’ve spent time with marijuana—any time at all, really—you know that the high can be rather unpredictable. It depends on the strain, its level of THC and hundreds of other compounds, and the interaction between all these elements. Oh, and how much you ate that day. And how you took the cannabis. And the position of the North Star at the moment of ingestion.

    OK, maybe not that last one. But as medical and recreational marijuana use spreads across the United States, how on Earth can law enforcement tell if someone they’ve pulled over is too high to be driving, given all these factors? Marijuana is such a confounding drug that scientists and law enforcement are struggling to create an objective standard for marijuana intoxication. (Also, I’ll say this early and only once: For the love of Pete, do not under any circumstances drive stoned.)

    Sure, the cops can take you back to the station and draw a blood sample and determine exactly how much THC is in your system. “It's not a problem of accurately measuring it,” says Marilyn Huestis, coauthor of a new review paper in Trends in Molecular Medicine about cannabis intoxication. “We can accurately measure cannabinoids in blood and urine and sweat and oral fluid. It's interpretation that is the more difficult problem.”

    You see, different people handle marijuana differently. It depends on your genetics, for one. And how often you consume cannabis, because if you take it enough, you can develop a tolerance to it. A dose of cannabis that may knock amateurs on their butts could have zero effect on seasoned users—patients who use marijuana consistently to treat pain, for instance.

    The issue is that THC—what’s thought to be the primary psychoactive compound in marijuana—interacts with the human body in a fundamentally different way than alcohol. “Alcohol is a water-loving, hydrophilic compound,” says Huestis, who sits on the advisory board for Cannabix, a company developing a THC breathalyzer.1 “Whereas THC is a very fat-loving compound. It's a hydrophobic compound. It goes and stays in the tissues.” The molecule can linger for up to a month, while alcohol clears out right quick.

    But while THC may hang around in tissues, it starts diminishing in the blood quickly—really quickly. “It's 74 percent in the first 30 minutes, and 90 percent by 1.4 hours,” says Huestis. “And the reason that's important is because in the US, the average time to get blood drawn [after arrest] is between 1.4 and 4 hours.” By the time you get to the station to get your blood taken, there may not be much THC left to find. (THC tends to linger longer in the brain because it’s fatty in there. That’s why the effects of marijuana can last longer than THC is detectable in breath or blood.)

    So law enforcement can measure THC, sure enough, but not always immediately. And they’re fully aware that marijuana intoxication is an entirely different beast than drunk driving. “How a drug affects someone might depend on the person, how they used the drug, the type of drug (e.g., for cannabis, you can have varying levels of THC between different products), and how often they use the drug,” California Highway Patrol spokesperson Mike Martis writes in an email to WIRED.

    Accordingly, in California, where recreational marijuana just became legal, the CHP relies on other observable measurements of intoxication. If an officer does field sobriety tests like the classic walk-and-turn maneuver, and suspects someone may be under the influence of drugs, they can request a specialist called a drug recognition evaluator. The DRE administers additional field sobriety tests—analyzing the suspect’s eyes and blood pressure to try to figure out what drug may be in play.

    The CHP says it’s also evaluating the use of oral fluid screening gadgets to assist in these drug investigations. (Which devices exactly, the CHP declines to say.) “However, we want to ensure any technology we use is reliable and accurate before using it out in the field and as evidence in a criminal proceeding,” says Martis.

    Another option would be to test a suspect’s breath with a breathalyzer for THC, which startups like Hound Labs are chasing. While THC sticks around in tissues, it’s no longer present in your breath after about two or three hours. So if a breathalyzer picks up THC, that would suggest the stuff isn’t lingering from a joint smoked last night, but one smoked before the driver got in a car.

    This could be an objective measurement of the presence of THC, but not much more. “We are not measuring impairment, and I want to be really clear about that,” says Mike Lynn, CEO of Hound Labs. “Our breathalyzer is going to provide objective data that potentially confirms what the officer already thinks.” That is, if the driver was doing 25 in a 40 zone and they blow positive for THC, evidence points to them being stoned.

    But you might argue that even using THC to confirm inebriation goes too far. The root of the problem isn’t really about measuring THC, it’s about understanding the galaxy of active compounds in cannabis and their effects on the human body. “If you want to gauge intoxication, pull the driver out and have him drive a simulator on an iPad,” says Kevin McKernan, chief scientific officer at Medicinal Genomics, which does genetic testing of cannabis. “That'll tell ya. The chemistry is too fraught with problems in terms of people's individual genetics and their tolerance levels.”

    Scientists are just beginning to understand the dozens of other compounds in cannabis. CBD, for instance, may dampen the psychoactive effects of THC. So what happens if you get dragged into court after testing positive for THC, but the marijuana you consumed was also a high-CBD strain?

    “It significantly compounds your argument in court with that one,” says Jeff Raber, CEO of the Werc Shop, a cannabis lab. “I saw this much THC, you're intoxicated. Really, well I also had twice as much CBD, doesn't that cancel it out? I don't know, when did you take that CBD? Did you take it afterwards, did you take it before?

    “If you go through all this effort and spend all the time and money and drag people through court and spend taxpayer dollars, we shouldn't be in there with tons of question marks,” Raber says.

    But maybe one day marijuana roadside testing won’t really matter. “I really think we're probably going to see automated cars before we're going to see this problem solved in a scientific sense,” says Raber. Don’t hold your breath, then, for a magical device that tells you you’re stoned.

    1 UPDATE: 1/29/18, 2:15 pm ET: This story has been updated to disclose Huestis' affiliation with Cannabix.

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    My Son Pioneered an Epilepsy Drug Derived From Marijuana. An FDA Panel Just Approved It

    Yesterday morning a tall, lanky 16-year-old boy in a red polo shirt stood at a podium in front of a roomful of doctors, scientists, and regulators and told them about how a drug they were considering for approval had changed his life. “I had seizures for 10 years,” he said. “My parents tell me there were times I had seizures 100 times a day.” Now, he said, he has been seizure free for nearly two and a half years.

    “I can understand what goes on at school,” he said. “And I can have adventures that never would have been possible before.” He told them about how seizure freedom enabled him to study to be a Bar Mitzvah in 2016. He told them about a school trip he’d just taken without his parents to South Africa—12,000 miles from home. And he said that he hoped to become a neurologist one day so that he could help other people with epilepsy. The audience, despite being told not to applaud speakers until the end, clapped anyway.

    About an hour later, after about a dozen parents of epileptic children spoke of their struggles with the disease, the Food and Drug Administration panel of scientists and doctors voted 13-0 to recommend approval. The FDA is expected to render a final decision on the drug, Epidiolex, by June. One of the panelists John Mendelson, an addiction treatment executive and a UCSF professor said, “This is clearly a breakthrough drug for an awful disease.”

    The whole event, which I watched on a live stream from my home office in Berkeley, was one of the thrills of my life. Sam is my son. He and my wife Evelyn both testified because Sam was the first person in the US to take Epidiolex back in December 2012. After trying more than two dozen medications, a crazy sounding diet, and corticosteroids that made Sam look like a cancer patient, Epidiolex—which didn’t even have a name when Sam tried it—was truly our last option to help him.

    The author’s son, Sam Vogelstein, testified Thursday in Washington DC before the FDA’s advisory committee.

    Evelyn Nussenbaum

    I should mention that Epidiolex is derived from cannabis. Its active ingredient is cannabidiol, aka CBD, which is a chemical in the plant that doesn’t make you high.

    The manufacturer, GW Pharmaceuticals, knew little about epilepsy back then. But Sam’s response was so extraordinary, their executives decided they needed to learn more about the disease, and quickly embarked on clinical trials. Sam actually tried the medicine in London under a doctor’s supervision. Such a trial in the UK was straightforward, whereas conducting it in the US would have been impossible because of our cannabis laws. Since then nearly 1,800 patients have tried it at US hospitals, with about 40 to 50 percent seeing greater than 50 percent reductions in seizures. That sounds small until you consider that admission to the trials required patients to have exhausted all other medicinal options. Officially, Epidiolex will be approved only to treat two of the most severe types of epilepsy, Dravet and Lennox Gastaut syndromes. But doctors will likely have the flexibility to prescribe it for other epilepsies too. Many epilepsy drugs are prescribed this way, known as off label. (Many patients, including Sam, are on more than one drug.)

    The pending approval of Epidiolex isn’t just a big deal for me and my family. It’s a big deal for 3 million people in the US who have epilepsy, and, if approved elsewhere, 73 million people worldwide. Epilepsy affects about one percent of the world’s population, more than Parkinson’s and Multiple Sclerosis combined. And yet for all humanities’ scientific prowess, only about two-thirds of people who take epilepsy medicines become seizure free. The imminent approval of a medication that might shrink the number of unresponsive patients is a major, even historic, development.

    It’s also a big deal for cannabis research and by extension the cannabis legalization discussion. Epidiolex will be the first FDA approved drug derived from a cannabis plant. It can’t get anyone high because the manufacturer extracts all the THC during production.

    To manufacture CBD, GW maintains tens of thousands of cannabis plants in hothouses all over the UK. It extracts the CBD from the plants in a lab, ending up with a 100 milliliter bottle of strawberry flavored sesame oil that it ships to the US.

    A common refrain from cannabis opponents has long been that there is no scientific evidence that anything associated with cannabis can be medicine. And that’s been true because regulators and police worldwide make studying illegal substances like cannabis nearly impossible.

    But to get this far in the FDA approval process, GW had to marshal the same scientific evidence of safety and efficacy that every other drug manufacturer must present. It created a medicine that was consistent from dose to dose, bottle to bottle, and batch to batch. It conducted all the required placebo controlled trials, administered by doctors in hospital settings. And those doctors published peer reviewed research in top medical journals like the New England Journal of Medicine. “It’s an honor to be participating in a (cannabis) decision based on science instead of politics," said panelist Mark Green, professor of neurology and anesthesiology at the Icahn School of Medicine in New York, after the vote.

    Indeed, it doesn’t require too much imagination to see how Epidiolex’s pending approval forces a public reckoning on how we think about cannabis nationally. Attorney General Jeff Sessions has made no secret of his virulent opposition to the legalization of cannabis in any form. He has said that “good people do not smoke marijuana.” Yet, assuming Epidiolex gets formal FDA approval, he will have to weigh in through his supervision of the Drug Enforcement Administration.

    At the moment, CBD is a Schedule 1 drug like cannabis. Its medical use—except in the specially approved trials that proved its effectiveness—is not allowed. The DEA must reschedule it before it can be sold. Technically, the DEA could refuse. But it would have to explain how it—a police agency—was in a better position to make that call than the FDA, an agency of scientists and doctors. An explanation would also be needed for neurologists, and the parents of millions of very sick children. The DEA can’t delay its decision either. By law it must rule within 90 days.

    All that maneuvering would be moot, of course, if Congress decides to pass a law legalizing cannabis entirely, as Senate Minority Leader Chuck Schumer proposed last night. He is not the first senator to propose such a law, but he is by far the most influential to do it. “If smoking marijuana doesn’t hurt anybody else, why shouldn’t we allow people to do it and not make it criminal" he told Vice News.

    By now you are probably wondering what a family from California like us was thinking when it traveled to the UK to have their kid try a drug derived from a cannabis plant. Remarkably, that’s where you had to go to get pharmaceutical grade CBD back then. We tried to procure it from artisanal producers here for six months. Everything we tried turned out to be ineffective and sometimes fraudulent. Getting the CBD out of cannabis plant is complicated, expensive, and time consuming.

    The artisanal CBD market is more robust today. There are some good, reliable preparations that are helping epilepsy patients who could not get into the GW trials. Hopefully they will force GW to keep Epidiolex affordable. But many parents have told me that in a perfect world they'd just go to the pharmacy to treat their kids' seizures. They have complicated lives, but simple needs. They want the same experience they get when they fill a penicillin prescription: a cure.

    All of this made yesterday one of the best days in Sam's young life. Other parents thanked him for speaking for all the kids who were too sick to speak for themselves, and he felt like he was part of something bigger than himself. “And when I suggested that we made a good team as speakers," Evelyn said, “he said with a big grin, ‘You set ’em up. And I knock ’em down.’ ”

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    These Doctors Want Your Doctor To Know More About Weed

    Dr. Janice Knox was several years into retirement in Oregon when she was asked to fill in at a “card mill” ― a facility where patients can be diagnosed with conditions that qualify them for a medical card to buy cannabis.

    This was a few years ago, and public sentiment about medical marijuana wasn’t quite what it is today. “I had the mindset that most people had at the time ― ‘marijuana is a terrible drug, it’s just a drug,’” Knox told HuffPost.

    When she arrived at the clinic, the makeup of the waiting room was “not who I was expecting,” she said.

    “There were businesspeople, doctors, lawyers, moms, dads, grandmothers, grandfathers. I just couldn’t believe who I saw,” Knox said. “They were coming because conventional medicine had failed them. They wanted a better quality of life.”

    “People were coming in with their last dime to get a card,” she added. “I was stunned.”

    Equally surprising to Knox was how she, a practicing anesthesiologist for 35 years, had been taught so little about the mechanisms and effects of cannabis ― a substance that people said eased their suffering, even from symptoms related to chronic diseases.

    “I knew nothing about this medicine. I felt so embarrassed as a physician that that’s where I was. So I really made it a point to learn everything that I could about it,” Knox said. Since then, she’s tried to “change the narrative” about who uses cannabis and why.

    The Canna MDs
    Dr. Janice Knox grew the American Cannabinoid Clinics from her existing wellness clinic.

    In 2014, Knox founded the American Cannabinoid Clinics from her existing wellness clinic in Portland, Oregon, where marijuana has been legal for medical purposes since 1998 and legal for recreational use since 2015. Other than Knox, there are very few U.S. medical professionals who specialize in cannabis therapeutics. Fortunately, three of them are members of her family. 

    Knox’s husband, David, is a former emergency room doctor. Their two daughters, Rachel and Jessica, are physicians who received both medical and business degrees from Tufts University.

    At his wife’s urging, David Knox also visited the “card clinics” where his wife had been providing care. Like Janice, he was struck by the diversity of patients and conditions for which the plant seemed to offer relief.

    “It was an eye-opener. The potential is just incredible,” he said, adding that he’s seen patients successfully reduce or eliminate their use of opiates for chronic pain after beginning cannabis therapeutics. (Federally funded research has also found this result, which could have meaningful implications amid America’s ongoing opioid crisis.)

    People were coming in with their last dime to get a card. I was stunned. Dr. Janice Knox

    At their clinic, the Knoxes practice what they call “integrative cannabinoid medicine.” They counsel new and experienced cannabis patients alike on the best treatment options for their conditions, the best way to deliver the medicine (e.g. vaping, topical, ingesting), and how to mitigate undesired effects. These are all aspects of cannabis medicine that a general practitioner might not know as much, or indeed anything, about.

    “We’re looking at the whole patient, and how to use cannabis optimally, so the patient can get the best benefit from the minimal dosage without side effects or complications,” David said.

    Rachel Knox, 35, wasn’t particularly surprised by her parents’ new career path. She and her mother share an interest in natural medicine. For Rachel, this interest only grew stronger in a medical school and residency environment where emergency treatments for the most urgent symptoms of chronic illness were rarely followed up with meaningful conversations with patients about maintenance and prevention.

    “We weren’t being taught how to prevent or reverse chronic illness in our medical education,” she said. “We had this longing for more. My curiosity for natural medicine grew out of that frustration in conventional medicine.”

    “My sister and I really felt like if we were going to pursue medicine, we should do something different with it,” she went on. “When my mom and my dad said they had started writing cannabis authorization for patients, that fit right into the natural options I wanted to investigate for patient care.”

    The Canna MDs
    Dr. Rachel Knox’s involvement in cannabis therapeutics grew out of her interest in natural medicine.

    Cannabis provides therapeutic effects mainly through its impact on the endocannabinoid system, which regulates various processes throughout the body such as organ function and immune response. Last year, the National Academies of Sciences, Engineering, and Medicine produced a sweeping report on the health effects of cannabis and cannabinoids, concluding that restrictions on possession and consumption have made it difficult to develop research-based consensus on its medical utility.

    The barriers to conducting meaningful research on the effects of a federally prohibited substance are considerable. Trials involving cannabis have to be approved by three government agencies and an independent review board, the Knoxes said. After that, there’s the matter of procuring the cannabis itself.

    “Right now you can’t ship cannabis across state lines, so you have to rely on a secure source within that state to do that,” Rachel said.

    The American Medical Association has long referred to cannabis as a “public health concern” ― but it recently issued a policy update calling for a review of the plant’s Schedule I designation, which categorizes marijuana as a drug with no medical benefits and restricts its availability for research. Heroin and bath salts are also Schedule I substances

    SAEED KHAN via Getty Images
    The U.S. still officially considers cannabis a Schedule I substance with no medicinal value.

    Given the limits on research and accessibility, many doctors are reluctant to discuss cannabis-related treatment options with patients. Many of the Knoxes’ patients come to the clinic because they’re not sure whether their general practitioners condone medical cannabis, or even know very much about it.

    The Knoxes have seen more than 3,000 patients at the American Cannabinoid Clinics. Very few, they said, have any interest in getting high. In fact, many would prefer to avoid it.

    “Patients will tell me eight or nine times, ‘I don’t want to get high,’” David said. 

    Many patients, especially seniors, come in asking for CBD, or cannabidiol, a non-psychoactive component of cannabis, Rachel added.

    “What surprises the patients most who say that is when we come back and tell them, ‘This condition that you have actually will respond better with some THC on board, let us talk to you about how to use THC to avoid those adverse effects,’” she said. “I had a patient today who was surprised to hear that she could use THC without getting high.”

    Patients are also “shocked” to learn they don’t have to smoke the cannabis to feel better, Janice said.

    “People have this image of a smoker smoking the joint, and when you tell them, ‘No, you don’t have to do it that way, you can use it incrementally and won’t get a THC high’ ― I think that’s really shocking to them,” she said, adding that placing medicine under the tongue, rubbing it into the navel, and delivering THC through a rectal suppository are all effective and in some cases superior alternatives to smoking cannabis. 

    Patients will tell me eight or nine times, “I don’t want to get high.” Dr. David Knox

    Though based in Oregon, the Knoxes see patients from neighboring states such as California and Washington. Rachel Knox is vice chair of the Oregon Cannabis Commission, which oversees the state’s medical marijuana program, and serves as the medical chair for the Minority Cannabis Business Association. Janice Knox sits on the board of Doctors For Cannabis Regulation, which promotes safe practices and improved quality of medical cannabis products.

    Through their clinics and ancillary work in the industry, the Knoxes hope to help more medical practitioners integrate cannabis therapeutics into their practices and promote more specialization in cannabinoid medicine. They plan to launch their own training program for medical professionals later this year.

    “We need to be helping trained clinicians in the practical implementation of cannabis therapeutics in the same way we do it at the clinic,” Rachel said. “Patients should feel comfortable that the doctor they’re talking about cannabis with is knowledgeable about this medicine.”  

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