Most of us were caught off-guard by the rush of states this year that approved the limited use of CBD-only marijuana extracts because these traditionally conservative states had heretofore rejected the medical use of marijuana. So it seems worth a moment to consider how this occurred, and what it means on a grander scale.
But first, a little recent history.
Throughout this year’s state legislative season, a total of 10 states enacted laws seeking to provide limited access to medical marijuana products that contain high levels of CBD and virtually no THC for qualified, typically pediatric patients suffering from severe and disabling seizures: Alabama, Florida, Iowa, Kentucky, Mississippi, Missouri, South Carolina, Tennessee, Utah and Wisconsin.
On one level, this unexpected embrace of the medicinal qualities of marijuana by states that previously rejected the concept must be seen as a favorable development. These serendipitous adoptions reflect a degree of compassion not obvious in the previous legislative debates in those states.
But it is far from certain that these laws will actually help the young patients they are intended to help.
First, such products are primarily only available in a handful of states like California and Colorado and none of these new state laws create a viable in-state supply source for such products. Further, even if a patient from out-of-state could find these products in California or Colorado, it would be a violation of federal law (and also likely state law) to take the medicine back to their home state.
And while some of these laws attempt to establish CBD research projects at their major universities or research hospitals, recent experience demonstrates that few universities or research hospitals are willing to enter this confusing field while marijuana remains a federal crime, and those that may be willing to take the bait will face a steep and long learning curve before the first patient will have high-CBD extracts available.
This legislative rush to CBD-only extracts also suggests (1) the degree to which elected officials are influenced by popular media, (2) their willingness to pick and choose the science they like (while ignoring the science they do not), and (3) the strong puritanical impulse that remains a factor with many elected officials.
And it all relates to the “Gupta Effect”. When CNN’s Dr. Sanjay Gupta’s report highlighting how high-CBD marijuana products control debilitating seizures among children suffering from Dravet’s syndrome (the most severe form of childhood epilepsy) went public, few Americans had even heard of cannabidiol. Most people were familiar with THC (tetrahydrocannabinol), the primary psychoactive ingredient in marijuana that principally accounts for the “high” that marijuana smokers enjoy, but had zero idea that CBD even existed.
Dr. Gupta, who had previously uncritically accepted the federal government’s consistent claim that marijuana had no legitimate medical use, when confronted with actual children whose lives had been transformed following their use of high-CBD marijuana extracts, understandably felt misled by the government’s anti-marijuana propaganda, and went public with two special programs introducing the importance of high-CBD extracts in reducing or eliminating seizures in these children.
In the second program Dr. Gupta made it clear that while CBD appeared to be the primary therapeutic ingredient for this class of patients, he also made the point that some level of THC was also required, because of what he termed the “entourage effect.” Without the THC, the CBD would either be less effective, or in some instances ineffective.
It’s embarrassing that so many of our elected officials would get their scientific understanding of the medical properties of marijuana from a popular television doctor, instead of conducting their own research into the available science, before moving legislation forward. But better they be motivated by a celebrity doctor than continue to ignore the benefits of medical marijuana altogether.
Of which there are a myriad.
The marijuana plant is one of the most studied biologically active substances of modern times. A search on PubMed, the repository for all peer-reviewed scientific papers, using the term “marijuana” yields nearly 20,000 scientific papers referencing the plant and/or its constituents, nearly half of which have been published just within the past decade. In addition, more than 100 controlled trials, involving thousands of subjects, have evaluated the safety and efficacy of cannabis and/or individual cannabinoids.
Most recently, a review of FDA-approved marijuana plant trials conducted by various California universities concluded, “Based on evidence currently available the Schedule I classification (for cannabis) is not tenable; it is not accurate that cannabis has no medical value, or that information on safety is lacking.” The best summary of this research can be found in the publication Emerging Clinical Applications for Cannabis and Cannabinoids, available on the NORML website. So the basic research is available for all who care to learn.
But few elected officials appear to be aware of this considerable body of science. Rather, the common refrain is to claim they cannot support the medical use of marijuana because the only evidence is “anecdotal”. These officials prefer to remain ignorant because it reinforces their preconceived notion that medical marijuana is a hoax perpetuated by those who simply wish to get “high”.
So what this latest rush to approve CBD-only marijuana products demonstrates, more than anything else, is the degree to which our public policy can frequently be influenced by a strong strain of puritanism that remains alive among our elected officials. If it feels good, it must be bad!
These many state legislators were willing to show some compassion by allowing the medical use of marijuana by these poor children suffering from multiple, disabling seizures, so long as the marijuana did not make them feel “high” (i.e., feel better!). These legislators are against pleasure, and if the use medical marijuana includes the feeling of pleasure, then it cannot be approved.
Excuse me, but is that not the purpose of using medicine when one is ill – to feel better?
Admittedly, for some of these puritans, the association of the word “high” with the use of marijuana may lie at the heart of the problem for them. Marijuana has long been demonized by conservatives, law enforcement, and many in the medical community, and that has spilled-over to the marijuana “high”.
If they understood that the marijuana “high” makes the user feel better, and that seriously ill patients almost always want (and need) to feel better, perhaps they could overcome their fear of medical marijuana. But for now at least, it is clear that in their view the marijuana “high”, like marijuana itself, is something to be avoided by responsible Americans, even if that precludes the use of medical marijuana by seriously ill patients.
It is time we moved beyond the notion that pleasure is bad, and stopped treating the marijuana “high” as something to be avoided, when it makes patient feel better. For them, feeling better and feeling high is often the same.
Federal agencies are moving forward with plans to increase the US government’s production of research-grade cannabis.
Last week, the US Drug Enforcement Administration (DEA) publicly announced in the Federal Register that it is increasing its marijuana production quota from 21 kilograms to 650 kilograms (about 1,443 pounds) in order to meet increasing demand for the plant from clinical investigators.
Federal regulations permit a farm at the University of Mississippi to cultivate set quantities of cannabis for use in federally approved clinical trials. Regulators at the DEA, the US Food and Drug Administration, PHS (Public Health Service), and the US National Institute on Drug Abuse must approve any clinical protocol seeking to study the plant’s effects in human subjects.
On various occasions, marijuana reform advocates and researchers have publicly criticized NIDA for failing to approve proposed trials seeking to assess the therapeutic benefits of cannabis. However, in March, federal regulators finally signed off on a long-delayed clinical protocol from researchers at the University of Arizona College of Medicine to evaluate the use of cannabis its in war veterans suffering from post-traumatic stress. Also this spring, lawmakers in several states, including Alabama, Kentucky, and Wisconsin, passed legislation encouraging state-sponsored clinical trials to assess the therapeutic potential of cannabidiol – a nonpsychotropic organic component of cannabis – in the treatment of intractable epilepsy.
“The additional supply [of cannabis] to be manufactured in 2014 is designed to meet the current and anticipated research efforts involving marijuana,” A NIDA spokesperson told TheHill.com. “[T]his projection of increased demand is due in part to the recent increased interest in the possible therapeutic uses of marijuana.”
According to a keyword search using the terms ‘smoked marijuana’ on the clinicaltrials.gov website, eight trials are presently ongoing to evaluate the plant’s effects in humans. Two of these trials are assessing the plant’s potential therapeutic efficacy.
A new study on marijuana appeared in Journal of the American Heart Association. These are interesting data, but we have to interpret them very carefully.
Sure, we know cannabis can raise heart rate briefly, but most users develop tolerance to the effect. We’ve also seen (in a much larger sample) that it doesn’t increase mortality rates even among survivors of heart attacks.
But the new study made the news anyway. Investigators specifically searched a French database where physicians are legally bound to report any drug-related case that they view as “leading to temporary or permanent functional incapacity or disability, to inpatient hospitalization or prolongation of existing hospitalization, to congenital anomalies, or to an immediate vital risk or death.”
They then looked for cannabis users and found a shade less than 2,000 in the past 5 years. It’s impossible to know what that number means without knowing the number of people these physicians saw or how many patients used cannabis and did not end up reported to this database.
They then found a whopping 35 of these who had cardiac complications. It is impossible to know what to make of this number without knowing the number of cannabis users in France, which the authors report is 1.2 million. If you divide 35 by 1.2 million you get roughly .00003. I’m guessing that not all these cannabis users went to the doctor and not every person who used cannabis and had cardiac complications fessed up to the doctor, so let’s say that we’re off by two orders of magnitude. Let’s give the prohibitionists the benefit of the doubt and multiply by 100. That’d put the rate of problems up to .003.
If those are the chances of having cardiac complications as a French cannabis user, my first thought is that using cannabis protects people from cardiac problems. We need a comparison group of people who don’t use cannabis to know their rate of cardiac problems, but, as the authors point out, we simply don’t have those data. The closest estimates were 57 per 10,000 people, based on another study, which is .0057, or almost twice as bad as the rate among the cannabis users (after our generous overestimation). I’m not going to hold my breath for the the headline, “Cut your heart disease in half with cannabis.”
In short, this study tells us a lot about what kinds of cardiac complications appeared in people who were reported to the French government for cannabis-related problems, but tells us little about the link between cannabis use and cardiovascular disease.
The enactment of state laws legalizing the physician-recommended use of cannabis therapy is not associated with increased levels of marijuana use by young people, according to data published online in the Journal of Adolescent Health.
Researchers at Rhode Island Hospital and Brown University assessed the impact of medical cannabis laws by examining trends in reported drug use by high-schoolers in a cohort of states before and after legalization. Researchers compared these trends to geographically matched states that had not adopted medical marijuana laws.
Authors reported overall “no statistically significant differences in marijuana use before and after policy change for any state pairing,” and acknowledged that some states that had adopted medical cannabis laws experienced a decrease in adolescent’s self-reported use of the plant. “In the regression analysis, we did not find an overall increased probability of marijuana use related to the policy change,” they stated.
Investigators concluded, “This study did not find increases in adolescent marijuana use related to legalization of medical marijuana. … This suggests that concerns about ‘sending the wrong message’ may have been overblown. … Our study … may provide some reassurance to policy makers who wish to balance compassion for individuals who have been unable to find relief from conventional medical therapies with the safety and well-being of youth.”
A 2013 study published in the American Journal of Public Health similarly concluded that the passage of medical marijuana laws in various states has had no “statistically significant … effect on the prevalence of either lifetime or 30-day marijuana use” by adolescents residing in those states.
A 2012 study by researchers at McGill University in Montreal reported: “[P]assing MMLs (medical marijuana laws) decreased past-month use among adolescents … and had no discernible effect on the perceived riskiness of monthly use. … [These] estimates suggest that reported adolescent marijuana use may actually decrease following the passing of medical marijuana laws.”
Read the abstract of this latest study, “The Impact of State Medical Marijuana Legislation on Adolescent Marijuana Use,” online here.
Minnesota: African Americans Six Times More Likely Than Whites To Be Arrested For Marijuana PossessionApril 21, 2014
African Americans are arrested for marijuana possession offenses in Minnesota at a rate that is more than six-times higher than that of Caucasians, according to an analysis of 2011 FBI arrest data released today by the nonpartisan think-tank Minnesota 2020 and commissioned in part by Minnesota NORML.
Although African Americans comprise less than six percent of the state’s population, they represented over 27 percent of those persons arrested for violating marijuana possession laws in 2011. By comparison, whites comprise some 87 percent of the state’s population and constituted 69 percent of those arrested for violating marijuana possession laws. “Thus, the black arrest rate for marijuana possession was 687 and the white arrest rate was 107, making blacks 6.4 times more likely to be arrested for marijuana possession than whites,” the study found.
In 2010, blacks in Minnesota were arrested for cannabis possession at 7.8 times the rate of whites. Both African Americans and Caucasians consume cannabis at approximately similar rates.
The racial disparity in Minnesota in marijuana possession arrests is significantly higher than the national average. According to a 2013 analysis of marijuana possession arrests by race in 945 counties nationwide, blacks are approximately four times as likely as whites to be arrested for marijuana possession.
“[This] kind of over-representation cannot be accounted for without racial bias,” Minnesota 2020 Executive Director Steve Fletcher said today at a press conference. “It means black Minnesotans are bearing a disproportionate share of the personal and collateral costs of our war on drugs.”
A variety of factors contribute to the disparity in arrest rates, the study found. These include “over-policing in communities of color, cultural differences in where or how marijuana is used and purchased, and [the prevalence] of grants and seizure policies that incentivize volume over quality in drug arrests,” the think-tank acknowledged in a press release.
The report estimated that the collateral costs of a low-level marijuana arrest may total as much as $76,000 over the course of a decade, including attorney fees, fines, costs associated with attending mandatory drug treatment, lost income and job prospects, and barriers to public assistance and federal aid.
“In light of these human and financial costs, Minnesota lawmakers and law enforcement officials have a responsibility to consider whether marijuana possession laws in their current conception are actually contributing to public safety, or if they are instead producing undue hardship for individuals and growing inequities within society,” the study concludes.
Full text of the study, entitled “Collateral Costs: Racial Disparities and Injustice in Minnesota’s Marijuana Laws,” is available online here.