In recent weeks, lawmakers in several states have moved forward with legislative proposals to permit specific strains and/or extracts of cannabis possessing high quantities of the cannabinoid cannabidiol (CBD), but otherwise maintaining criminal prohibitions on the whole plant.
But is this new direction in the best interest of patients? As I wrote in a recent column for Alternet.org (republished with permission by Cannabis Now under the title “Patients Ought To Be Skeptical Of Proposed CBD-Only Legislation — Here’s Why”), I believe the answer is ‘no.’
Ultimately, patients should not be unnecessarily forced to decide between either accessing the whole plant or its isolated components. They should have safe, legal access to both, and politicians, even well-intentioned ones, should not restrict patients’ right to choose the most suitable option.
Below are excerpts from my commentary. You can read the entire text here.
Patients Ought To Be Skeptical Of Proposed CBD-Only Legislation — Here’s Why
via Cannabis Now
[excerpt] If the plant ain’t broke, why fix it?
For longtime marijuana law reformers, the ongoing political conversation surrounding CBD is instructive. It makes it clear that many politicians’ public opposition to the idea of patients using marijuana therapeutically isn’t because of supposed unanswered questions surrounding the plant’s safety or efficacy. Rather, it is because lawmakers oppose the idea of some people getting high from a naturally growing herb. (The fact that patients can get equally high or even higher from FDA-approved synthetic THC has, for whatever reason, never been an expressed concern of either lawmakers or prohibitionists.) After all, the very same politicians who argue that marijuana isn’t medicine because it hasn’t been approved by the FDA or who allege that the substance hasn’t yet been subjected to sufficient scientific scrutiny utter no such public objections to the idea of legalizing patient access to CBD – a schedule I compound that hasn’t been reviewed, much less approved by the FDA, and that has been clinically studied far less than cannabis.
Perhaps most ironically is that were it not for the advent of legalized whole plant marijuana, a policy change publicly opposed by many present day CBD-only political advocates, lawmakers (and anti-pot groups like SAM) today wouldn’t be aware of CBD, much less advocating for it. The reality is that it was the stakeholders in medical marijuana states, and those who provide for them, who have done the most to explore and promote cannabidiol as a legitimate therapeutic agent. And they were able to do so because they, unlike most federally licensed medical researchers, had access to the whole plant.
We’ve been down this road before. Not long ago, lawmakers and anti-marijuana zealots were dismissing patients’ desire to access the marijuana plant because they alleged that the THC-pill Marinol could adequately meet patients’ needs. Patients and their advocates were skeptical of lawmakers’ claims then, and properly so. Now many of these same politicians are once again dismissing patients’ calls for whole plant medicine by claiming that products and strains containing CBD alone only will suffice. Patients and their advocates ought to be equally skeptical once again.
CNN Chief Medical Correspondent Dr. Sanjay Gupta is “doubling down” in his advocacy for patients to have legal access to cannabis as a therapeutic agent.
In a commentary featured on the CNN website today, Gupta writes: “I am more convinced than ever that it is irresponsible to not provide the best care we can, care that often may involve marijuana. I am not backing down on medical marijuana; I am doubling down.”
Last August, Gupta authored a commentary apologizing for his past opposition to medical cannabis, stating, “We have been terribly and systematically misled for nearly 70 years in the United States (in regards to cannabis), and I apologize for my own role in that.”
In today’s editorial, Gupta acknowledges, “Marijuana is classified as a Schedule I substance, defined as (one of) the most dangerous drugs with no currently accepted medical use. Neither of those statements has ever been factual.”
He criticizes President Obama for acknowledging that cannabis poses less harm than alcohol while failing “to remove marijuana from the list of the most tightly controlled substances in the country.” Dr. Gupta also questions how the US government can possess a patent on the therapeutic application of cannabinoids yet still deny that the compounds possess medical utility.
Ultimately, cannabis prohibition is a “Draconian system where politics override science,” Gupta concludes.
Gupta’s forthcoming documentary on the plant, entitled “Weed 2: Cannabis Madness: Dr. Sanjay Gupta Reports,” at 10 p.m. ET on Tuesday, March 11.
(Dr. Mitch Earleywine was elected as the Chairman of the NORML Board of Directors in February 2014)
A recent headline reads: “Can Marijuana Kill You? German Scientists Say Yes.” The article focuses on a study of two (count ‘em, two!) young men who died while they had detectable levels of THC in their blood. I take a lot of pleasure in this kind of melodrama. If prohibitionists are stooping this low, we must really be frightening them. (It’s not completely pharmacologically ridiculous. Marijuana does increase heart rate. In fact, it can jack up heart rate almost as much as an espresso or energy drink. Maybe if you already had a weak heart and a coffee and a bong hit, well, something might happen.)
But I want to point out that we should actually expect literally thousands of reports like this. We should hear about lots of people who have heart attacks on the same day that they commune with the plant. It’s not because cannabis causes heart attacks. It’s simple chance.
I hate for my first blog as Chair of The Executive Board to be this nerdy, but I’ve been teaching statistics for more than 20 years. If that doesn’t make me a nerd, I’m not sure what would. But given how many people use cannabis daily and how many heart attacks occur in the United States, it’s actually a miracle that we haven’t heard about this kind of thing before. We also should expect to hear it a lot more often.
According to the National Survey on Drug Use and Health, roughly 7,600,000 Americans (over age 12) used marijuana daily or near daily in 2012. In addition, the Center for Disease Control suggests that about 715,000 of us have heart attacks in a year. (Let’s assume those under age 12 are probably not grabbing their chests with a myocardial infarction too often.) In addition, let’s guess that the United States has about 280 million people over age 12. It’s hard to know the exact number, but that’s probably in the ballpark.
With this in mind, we can predict how many people should have a heart attack the same day that they used cannabis simply by chance. That is, even if these two things had nothing to do with each other, we should expect some folks to have a heart attack the same day that they used cannabis just by accident.
Okay. It’s going to get nerdy here, but this is comparable to asking simpler questions. If I had a dime and a nickel, I might want to know what the chances are that I’d flip heads on both. I flip heads 1 out of 2 times on average for the dime, for a probability of .5. Then I flip heads on the nickel 1 out of 2 times on average, also for a probability of .5. So the chances of flipping heads on both is .5 * .5 for .25. So we’d expect to get heads on both coins about 1Ž4 of the time. If I flipped both coins 100 times, I’d get around 25 pairs of heads. Note that there’s nothing causal here. The nickel doesn’t know what the dime did. It doesn’t want to be like the dime. It’s not that the dime caused the nickel to flip heads.
So it’s the same deal for the cannabis-related heart attacks. If 7.6 million people use cannabis daily out of 280 million relevant Americans, that’s a probability of .0271. And if 715 thousand of 280 million have heart attacks, that’s a probability of .0026. Multiply these the same way we did with the probabilities for flipping heads (.0271 * .0026 = .00007). Now .00007 is a dinky number. If there were only 100 people in the country, we wouldn’t expect any of them (well, .007) to have a heart attack and smoke cannabis on the same day. But we’re talking about 280 million people here. So we’d expect .00007 * 280,000,000, = 19,600. That’s over 19,000 heart attacks.
So the question isn’t, “How did these two guys die of a heart attack with THC in their blood?” It should be, “Where are the other 19,598 guys who should have had heart attacks with THC in their blood?” In fact, the absence of this many cannabis-related myocardial infarctions inspired my wife to ask, “Does cannabis protect the heart?”
If we repeal prohibition, we’ll get to find out.
Go AS, Mozaffarian D, Roger VL, Benjamin EJ, Berry JD, Borden WB, Bravata DM, Dai S, Ford ES, Fox CS, Franco S, Fullerton HJ, Gillespie C, Hailpern SM, Heit JA, Howard VJ, Huffman MD, Kissela BM, Kittner SJ, Lackland DT, Lichtman JH, Lisabeth LD, Magid D, Marcus GM, Marelli A, Matchar DB, McGuire DK, Mohler ER, Moy CS, Mussolino ME, Nichol G, Paynter NP, Schreiner PJ, Sorlie PD, Stein J, Turan TN, Virani SS, Wong ND, Woo D, Turner MB; American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics—2013 update: a report from the American Heart Association. Circulation. 2013 Jan 1;127(1):e6-e245.
Substance Abuse and Mental Health Services Administration, Results from the 2012 National Survey on Drug Use and Health: Summary of National Findings, NSDUH Series H-46, HHS Publication No. (SMA) 13-4795. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2013.
The imposition of student drug testing programs is not effective in limiting students’ consumption of controlled substances, according to survey data published in the January edition of the Journal of Studies on Alcohol and Drugs.
Investigators from Israel and the United States assessed whether students’ awareness of drug testing programs in their school was associated with a reduction in the frequency of their use of alcohol, cigarettes, or cannabis.
Authors reported, “Consistent with previous research, results of the current study show that perceived SDT (student drug testing) is not associated with a reduction in initiation or escalation of substance use in the general student population.”
They concluded, “The current research reinforces previous conclusions that SDT is a relatively ineffective drug-prevention policy.”
An estimated 20 percent of US high schools impose drug testing upon members of the student body.
Previous assessments of student drug testing programs, including random testing programs, report that the imposition of such programs are not associated with reduced levels of student drug use and, in some instances, are “associated with increased use of illicit drugs other than marijuana.”
Full text of the study, “Student Drug Testing and Positive School Climates: Testing the Relation Between Two School Characteristics and Drug Use Behavior in a Longitudinal Study,” is available online here.
#1 Public Support For Legalizing Marijuana Hits Historic Highs
An unprecedented 58 percent of Americans believe that marijuana ought to be “made legal” for adult consumption, according to survey data reported in October by Gallup. The percentage is the highest level of support ever recorded by Gallup, which has been inquiring on the issue since 1969, and marks a ten percent increase in voter approval since 2012. Regional polls conducted this year in several states, including California, Louisiana, and Texas, also reported majority support for legalization.
#2 Nation Of Uruguay Passes Legislation Regulating Cannabis Use
Lawmakers in the South American nation of Uruguay enacted legislation authorizing the licensed production and retail sale of cannabis to all citizens age 18 and older. Residents will be able to legally purchase up to 40 grams of cannabis per month from state-licensed stores at a price of $1 per gram. Uruguay is the first country in modern history to officially legalize and regulate the licensed production and retail sale of cannabis.
#3 Feds Pledge Not To Interfere In State-Licensed Retail Sales Of Cannabis
Deputy Attorney General James Cole issued a three-page memorandum in August affirming that the US Justice Department will allow Colorado and Washington to move forward with statewide efforts to license and regulate the adult marijuana market. Cole later reaffirmed the agency’s position in testimony before the US Senate, stating, “We will not … seek to preempt state ballot initiatives.”
#4 States Finalize Regulations Governing Adult Cannabis Sales
Regulators in Colorado and Washington this fall began accepting applications from businesses seeking to engage in the licensed cultivation, production, and retail sale of cannabis and cannabis-infused products. In Washington, several thousand applicants have applied to pot business licenses. In Colorado, regulators have begun approving licenses and several commercial establishments are expected to be open for business on January 1, 2014.
#5 Record Number Of Statewide Marijuana Reform Measures Enacted Into Law
Lawmakers in a dozen states approved some 20 pieces of marijuana law reform legislation in 2013. Specifically, lawmakers in Colorado and Vermont enacted legislation licensing commercial hemp production; Illinois and New Hampshire legalized the use and distribution of marijuana for medical purposes; Oregon and Nevada approved regulations allowing for the establishment of medical cannabis distribution facilities; and Oregon and Vermont significantly reduced marijuana possession penalties.
#6 Cannabis Dispensaries Open In Washington, DC
Medical cannabis facilities opened for business in Washington, DC in 2013. The establishments are licensed and regulated by the District of Columbia, which finally unveiled its long-awaited medical marijuana program earlier this year. State-authorized dispensaries also opened for the first time this year in New Jersey, Rhode Island, and Vermont. Lawmakers in four states, Illinois, Oregon, Nevada and New Hampshire, enacted legislation in 2013 allowing for the establishment of medicinal cannabis facilities.
#7 Study: Blacks Arrested For Pot Offenses At Rates Four Times That Of Whites
African Americans are far more likely to be arrested for marijuana possession offenses than are whites, according to an American Civil Liberties Union (ACLU) report released in June that analyzed arrest data from 945 counties nationwide. The report found that blacks were approximately four times as likely as whites to be arrested for marijuana possession in 2010, even though both ethnicities consumed the substance at similar rates. Authors reported that the racial disparity in arrest rates had grown significantly over the past decade and that in some states African Americans were nearly eight times as likely as whites to be arrested for cannabis possession.
#8 FDA Approves Clinical Trials Of CBD In Cases Of Pediatric Epilepsy
The US Food and Drug Administration this fall granted approval for the importation of cannabidiol (CBD) extracts as an experimental treatment for a rare, intractable form of pediatric epilepsy known as Dravet syndrome. Preliminary clinical trials assessing the safety and tolerability of the compound in children are scheduled to begin in early 2014. Cannabidiol is a non-psychoactive cannabinoid that has been documented to possess a variety of therapeutic qualities, including anti-inflammatory, anti-diabetic, anti-epileptic, anti-cancer, and bone-stimulating properties.
#9 Study: No Association Between Cannabis Smoking And Lung Cancer
Subjects who regularly inhale cannabis smoke possess no greater risk of lung cancer than do those who consume it occasionally or not at all, according to data presented in May at the annual meeting of the American Academy for Cancer Research. UCLA investigators analyzed data from six case-control studies, conducted between 1999 and 2012, involving over 5,000 subjects (2,159 cases and 2,985 controls). They reported, “Our pooled results showed no significant association between the intensity, duration, or cumulative consumption of cannabis smoke and the risk of lung cancer overall or in never smokers.”
#10 Members Of Congress Introduce Legislation To End Federal Pot Prohibition
Members of Congress in February introduced historic legislation, HR 499: The Ending Federal Marijuana Prohibition Act, to remove cannabis from the control of the Drug Enforcement Administration and authorize the US Department of Treasury to license state-authorized retail marijuana producers and distributors. Although Congress refused to vote on the measure in 2013, it was the most-viewed legislation on the Congress.gov website.