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SCIENCE

  • by Paul Armentano, NORML Deputy Director June 5, 2018

    More than two-thirds of chronic pain patients registered to legally access medical cannabis products substitute marijuana for prescription opioids, according to data published in The Journal of Headache and Pain.

    Investigators from the United States and Canada assessed the use of medical cannabis and prescription drugs in a cohort of over 2,000 Canadian patients licensed to access marijuana products. Among those patients with a primary diagnosis of chronic pain, 73 percent reported substituting cannabis in place of opioids. Among those patients diagnosed specifically with headache/migraine, cannabis was frequently reported as a substitute for other medications – including opiates (43 percent), anti-depressants (39 percent), NSAIDS (21 percent), triptans (8 percent), and anti-convulsants (8 percent).

    “Most patients in the pain groups reported replacing prescription medications with medicinal cannabis, the most common of which were opiates/opioids across all patient groups,” authors concluded. “This is notable given the well-described ‘opioid-sparing effect’ of cannabinoids and growing abundance of literature suggesting that cannabis may help in weaning from these medications and perhaps providing a means of combating the opioid epidemic.”

    The study’s findings are consistent with those of numerous others finding that patients in medical cannabis access programs significantly reduce or eventually eliminate their use of opioid analgesics over the long-term.

    Full text of the study, “Patterns of medicinal cannabis use, strain analysis, and substitution effect among patients with migraine, headache, arthritis, and chronic pain in a medicinal cannabis cohort,” appears online here.

  • by Paul Armentano, NORML Deputy Director May 8, 2018

    Medical marijuanaPatients enrolled in New York state’s medical cannabis program reduce their use of opioids and spend less money on prescription medications, according to data published online in the journal Mental Health Clinician.

    Investigators from the GPI Clinical Research in Rochester and the University of Buffalo assessed trends in patients’ medical cannabis and prescription drug use following their enrollment into the state’s marijuana access program.

    On average, subjects’ monthly analgesic prescription costs declined by 32 percent following enrollment, primarily due to a reduction in the use of opioid pills and fentanyl patches. “After three months treatment, medical cannabis improved [subjects’] quality of life, reduced pain and opioid use, and lead to cost savings,” authors concluded.

    The study’s findings are similar to those reported among enrollees in other states medical cannabis programs, including the experiences of patients in Illinois, Michigan, Minnesota, New Mexico, and elsewhere.

    The full text of the study, “Preliminary evaluation of the efficacy, safety, and costs associated with the treatment of chronic pain with medical cannabis,” appears online here. NORML’s fact-sheet highlighting the relevant, peer-reviewed research specific to the relationship between cannabis and opioids is available online here.

  • by Paul Armentano, NORML Deputy Director April 30, 2018

    Marijuana researchThe frequent use of cannabis is not associated with changes in brain structure, according to data published online ahead of print in the journal Addiction.

    An international team of scientists from Australia, the United Kingdom, and the United States assessed the relationship between habitual cannabis exposure and grey matter volumes in seven regions of the brain – including the thalamus, hippocampus, amygdala, and the nucleus accumbens – in two large population-based twin samples.

    Researchers reported, “[N]ormal variation in cannabis use is statistically unrelated to individual differences in brain morphology as measured by subcortical volume.”

    By contrast, the repeated use of nicotine was positively associated with significantly smaller thalamus volumes in middle-aged males.

    Authors concluded: “This is the largest exploratory analysis integrating brain imaging with self-report cannabis and comorbid substance use data. After correcting for multiple testing, there was no effect of cannabis use on the volume at any subcortical region of interest in young adults or middle-aged males. … In the context of expanding medicalization and decriminalization and the concerns surrounding the consequences of increased cannabis availability, our findings suggest that normal variation in cannabis use is statistically unrelated to brain morphology as measured by subcortical volumes in non-clinical samples.”

    The findings are consistent with those of prior brain imaging studies reporting that cannabis exposure appears to have little to no significant adverse impact upon brain morphology — particularly when compared to the dramatic effects associated with the alcohol exposure.

    The study’s findings fail to replicate those of a well-publicized 2014 paper which alleged that even casual marijuana exposure may be linked to brain abnormalities, particularly in the amygdala.

    Last week, a meta-analysis of 69 separate studies reported that cannabis exposure in adolescents and young adults is not associated with any significant, residual detrimental effects on cognitive performance. The results from a pair of recently published longitudinal twin studies similarly report that cannabis use is not independently associated with any residual change in intelligence quotient or executive function.

    An abstract of the study, “Testing associations between cannabis use and subcortical volumes in two large population-based samples,” appears online here.

  • by NORML April 18, 2018

    Cannabis exposure in adolescents and young adults is not associated with any significant long-term detrimental effects on cognitive performance, according to a systematic literature review published today in the journal JAMA Psychiatry.

    Investigators affiliated with the University of Pennsylvania, Perelman School of Medicine and with the Children’s Hospital of Pennsylvania reviewed data from 69 separate studies published between 1973 and 2017 involving 8,727 subjects (2,152 frequent or heavy users and 6,575 controls). Researchers reported no significant long-term deficits in memory, attention, or other aspects of cognitive functioning that could be independently attributed to cannabis use, regardless of subjects age of initiation. These findings are in contrast to similar studies assessing the impact of alcohol use and other controlled substances on cognition, which “have shown medium to large effect sizes.”

    Authors concluded: “Associations between cannabis use and cognitive functioning in cross-sectional studies of adolescents and young adults are small and may be of questionable clinical importance for most individuals. Furthermore, abstinence of longer than 72 hours diminishes cognitive deficits associated with cannabis use. [R]esults indicate that previous studies of cannabis youth may have overstated the magnitude and persistence of cognitive deficits associated with marijuana use.”

    Commenting on the study’s findings, NORML Deputy Director Paul Armentano said: “These conclusions are consistent with those of prior studies – in particular, recent longitudinal twin studies reporting that cannabis use is not independently associated with any residual change in intelligence quotient or executive function. These findings, combined with other recent studies reporting that cannabis exposure appears to have minimal adverse impact on brain morphology — particularly when compared to the dramatic effects of alcohol —dispute the long-standing ‘stoner-stupid’ stereotype. These findings should help to assuage fears that cannabis’ acute effects on behavior may persist long after drug ingestion, or that they may pose greater potential risks to the developing brain.”

    Presently, the medical use and dispensing of cannabis is regulated in 30 states. Eight states also regulate the retail sale of cannabis to adults. According to numerous peer-reviewed studies, neither the enactment of medicalization or adult use legalization has been linked to increased marijuana use or access by young people.

    Full text of the new study, “Association of cannabis with cognitive functioning in adolescents and young adults: A systematic review and meta-analysis,” appears in JAMA Psychiatry.

  • by Paul Armentano, NORML Deputy Director April 2, 2018

    The enactment of marijuana legalization laws is associated with a significant reduction in the number of opioids prescribed and filled, according to a pair of studies published online today in the journal JAMA Internal Medicine.

    In the first study, investigators from the University of Kentucky and Emory University assessed the association between medical and adult-use marijuana laws with opioid prescribing rates and spending among Medicaid enrollees. They reported:

    “State implementation of medical marijuana laws was associated with a 5.88 percent lower rate of opioid prescribing. Moreover, the implementation of adult-use marijuana laws, which all occurred in states with existing medical marijuana laws, was associated with a 6.38 percent lower rate of opioid prescribing. … [T]he further reductions in opioid prescribing associated with the newly implemented adult-use marijuana laws suggest that there were individuals beyond the reach of medical marijuana laws who may also benefit from using marijuana in lieu of opioids. Our finding that the lower opioid prescribing rates associated with adult-use marijuana laws were pronounced in Schedule II opioids further suggest that reaching these individuals may have greater potential to reduce the adverse consequences, such as opioid use disorder and overdose.”

    The full text of the study, “Association of Medical and Adult-Use Marijuana Laws With Opioid Prescribing for Medicaid Enrollees,” is available here.

    In the second study, University of Georgia researchers evaluated the association between the enactment of medical cannabis access laws and opioid prescribing patterns under Medicare Part D. They reported:

    “This longitudinal analysis of Medicare Part D found that prescriptions filled for all opioids decreased by 2.11 million daily doses per year from an average of 23.08 million daily doses per year when a state instituted any medical cannabis law. Prescriptions for all opioids decreased by 3.742 million daily doses per year when medical cannabis dispensaries opened. … Combined with previously published studies suggesting cannabis laws are associated with lower opioid mortality, these findings further strengthen arguments in favor of considering medical applications of cannabis as one tool in the policy arsenal that can be used to diminish the harm of prescription opioids.”

    The full text of the study, “Association Between US State Medical Cannabis Laws and Opioid Prescribing in the Medicare Part D Population,” is available here.

    Both findings are consistent with those of numerous prior studies finding that cannabis access is associated with reduced rates of opioid use and abuse, opioid-related hospitalizations, mortality, and overall prescription drug spending. A compilation of these studies is available in the NORML fact-sheet here.

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