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  • by Paul Armentano, NORML Deputy Director July 6, 2017

    cannabis_pillsRepresentatives of Florida for Care filed litigation today challenging a statewide ban on medical cannabis smoking. The suit was expected after lawmakers approved legislation (SB 8A) in June amending Amendment 2 — a voter initiated constitutional amendment permitting the use and distribution of medical cannabis. Seventy-one percent of voters approved the amendment in November.

    Senate Bill 8A amends the definition of medical cannabis in a manner that prohibits “marijuana in a form for smoking” and that bars the personal possession of herbal cannabis flowers, except in instances where they are contained “in a sealed, tamper-proof receptacle for vaping.” The Florida for Care suit argues that these changes inconsistent with the constitutional definition of marijuana, as passed by voters, and therefore should not be implemented.

    The lawsuit argues, “Inhalation is a medically effective and efficient way to deliver tetrahydrocannabinol (THC), and other cannabinoids, to the bloodstream. … By redefining the constitutionally defined term ‘medical use’ to exclude smoking, the Legislature substitutes its medical judgment for that of ‘a licensed Florida physician’ and is in direct conflict with the specifically articulated Constitutional process.”

    Under the revised law, patients diagnosed with cancer, epilepsy, glaucoma, HIV/AIDS, PTSD, ALS, Crohn’s disease, Parkinson’s disease, or multiple sclerosis — or who suffer from chronic pain related to any of these diseases — are eligible to receive a 70-day supply of cannabis-infused oils or edible products from a limited number of state-licensed dispensing facilities.

    NORML has long argued against regulations that limit or prohibit patients’ access to whole-plant cannabis in lieu of cannabis-derived extracts or pills. Cannabis inhalation is not associated with increased instances of lung cancer, COPD, or other tobacco-related adverse effects on pulmonary function. Inhaled cannabis is fast acting and permits patients to accurately self-regulate their dose. By contrast, non-herbal forms of cannabis possess delayed onset and their effects can often be far less predictable than those of herbal cannabis. Many patients seeking rapid relief of symptoms do not benefit from pills, tinctures, or edibles, and such restrictions unnecessarily limit patients’ choices.

    If the court invalidates SB 8A, the task of writing the rules for implementing the initiative — which must be operational by October — will fall to the Florida Department of Health.

  • by Paul Armentano, NORML Deputy Director January 25, 2016

    personal_cultivationElectronically driven vaporizers deliver cannabinoids in a relatively safe and reliable manner, according to data published in the journal PLOS ONE.

    Swiss investigators evaluated the ability of various types of vaporizer technologies to safely and effectively release THC and CBD (cannabidiol) in vapor. Researchers reported that electronically driven devices, which allow for precise temperature control, were able to provide for relatively safe and uniform dosing. By contrast, gas-powered devices performed in a more unreliable manner and “cannot be recommended for therapeutic purposes.”

    Authors concluded, “[T]he four electrically-driven and temperature-controlled vaporizers investigated in this study efficiently decarboxylate acidic cannabinoids and release reliably the corresponding neutral cannabinoids into the vapor. Therefore, they can be considered as a promising application mode for the safe and efficient administration of medicinal cannabis and cannabinoids.”

    Vaporizer technology seeks to heat marijuana to a point where cannabinoid vapors form, but below the point of combustion. In clinical trials, investigators have concluded that vaporization “does not result in exposure to combustion gases” and produces higher plasma concentrations of THC compared to smoked cannabis.

    The full text of the study, Medicinal Cannabis: “In vitro validation of vaporizers for the smoke-free inhalation of cannabis,” appears online here.

  • by Paul Armentano, NORML Deputy Director January 7, 2016

    pot_shopLong-term exposure to tobacco smoke is demonstrably harmful to health. According to the United States Center for Disease Control, tobacco smoking is the leading cause of preventable death in the United States, and chronic exposure to tobacco smoke is linked to increased incidences of cancer as well as vascular disease. Inhaling tobacco smoke is also associated with a variety of adverse pulmonary effects, such as COPD (chronic obstructive pulmonary disease).

    Does smoking cannabis pose similar dangers to lung health? According to a number of recent scientific findings, marijuana smoke and tobacco smoke vary considerably in their health effects. So then why are lawmakers in various states, such a Minnesota and New York, imposing new restrictions explicitly prohibiting the inhalation of herbal preparations of cannabis?

    Marijuana Smoke vs. Tobacco Smoke

    Writing in the Harm Reduction Journal in 2005, noted cannabis researcher Robert Melamede explained that although tobacco smoke and marijuana smoke have some similar chemical properties, the two substances possess different pharmacological activities and are not equally carcinogenic. Specifically, he affirmed that marijuana smoke contains multiple cannabinoids – many of which possess anti-cancer activity – and therefore likely exerts “a protective effect against pro-carcinogens that require activation.” Melamede concluded, “Components of cannabis smoke minimize some carcinogenic pathways whereas tobacco smoke enhances some.”

    Marijuana Smoke and Cancer

    Consequently, studies have so far failed to identify an association between cannabis smoke exposure and elevated risks of smoking-related cancers, such as cancers of the lung and neck. In fact, the largest case-controlled study ever to investigate the respiratory effects of marijuana smoking reported that cannabis use was not associated with lung-related cancers, even among subjects who reported smoking more than 22,000 joints over their lifetime. Summarizing the study’s findings in The Washington Post, pulmonologist Dr. Donald Tashkin, Professor Emeritus at the David Geffen School of Medicine at UCLA, concluded: “We hypothesized that there would be a positive association between marijuana use and lung cancer, and that the association would be more positive with heavier use. What we found instead was no association at all, and even a suggestion of some protective effect.”

    A meta-analysis of additional case-control studies, published in the International Journal of Cancer in 2014, similarly reported, “Results from our pooled analyses provide little evidence for an increased risk of lung cancer among habitual or long-term cannabis smokers,” while a 2009 Brown University study determined that those who had a history of marijuana smoking possessed a significantly decreased risk of head and neck cancers as compared to those subjects who did not.

    Marijuana Smoke and Pulmonary Function

    According to a 2015 study conducted at Emory University in Atlanta, the inhalation of cannabis smoke, even over extended periods of time, is not associated with detrimental effects on pulmonary function, such as forced expiratory volume (FEV1) and forced vital capacity (FCV). Assessing marijuana smoke exposure and lung health in a large representative sample of U.S. adults, age 18 to 59, they maintained, “The pattern of marijuana’s effects seems to be distinctly different when compared to that of tobacco use.” Subjects had inhaled the equivalent of one marijuana cigarette per day for 20 years, yet did not experience FEV1 decline or deleterious change in spirometric values of small airways disease.

    Marijuana Smoke and COPD

    While tobacco smoking is recognized as a major risk factor for the development of COPD – a chronic inflammation of the airways that may ultimately result in premature death – marijuana smoke exposure (absent concurrent tobacco smoke exposure) appears to present little COPD risk. In 2013, McGill University professor and physician Mark Ware wrote in the journal Annals of the American Thoracic Society: “Cannabis smoking does not seem to increase risk of chronic obstructive pulmonary disease or airway cancers… Efforts to develop cleaner cannabinoid delivery systems can and should continue, but at least for now, (those) who smoke small amounts of cannabis for medical or recreational purposes can breathe a little bit easier.”

    Mitigating Marijuana Smoke Exposure

    The use of a water-pipe filtration system primarily cools cannabis smoke, which may reduce throat irritation and cough. However, this technology is not particularly efficient at eliminating the potentially toxic byproducts of combustion or other potential lung irritants.

    By contrast, vaporization heats herbal cannabis to a point where cannabinoid vapors form, but below the point of combustion – thereby reducing the intake of combustive smoke or other pollutants, such as carbon monoxide and tar. Observational studies show that vaporization allows consumers to experience the rapid onset of effect while avoiding many of the associated respiratory hazards associated with smoking – such as coughing, wheezing, or chronic bronchitis. Clinical trials also report that vaporization results in the delivery of higher plasma concentrations of THC (and likely other cannabinoids) compared to smoked cannabis. As a result, the authors affiliated with the University of California Center for Medicinal Cannabis Research and elsewhere now acknowledge that vaporizers provide a “safe and effective” way to for consumers to inhale herbal cannabis.

    The Bottom Line

    Based on this scientific record, it makes little sense for lawmakers to impose legislative bans on herbal cannabis products, such as those that presently exist for patients in Minnesota and New York and which are now being proposed in several other states (e.g., Georgia and Pennsylvania). Oral cannabis preparations, such as capsules and edibles, possess delayed onset compared to inhaled herbal cannabis, making these options less suitable for patients desiring rapid symptomatic relief. Further, oral administration of cannabis-infused products is associated with significantly greater bioavailability than is inhalation – resulting in more pronounced variation in drug effect from dose to dose (even in cases where the dose is standardized). These restrictions unnecessarily limit patients’ choices and deny them the ability to obtain rapid relief from whole-plant cannabis in a manner that has long proven to be relatively safe and effective.

  • by Paul Armentano, NORML Deputy Director January 14, 2015

    Study: Long Term Cannabis Exposure Not Associated With Significant Effects On Lung FunctionThe inhalation of one marijuana cigarette per day over a 20-year period is not associated with adverse changes in lung health, according to data published online ahead of print in the journal Annals of the American Thoracic Society.

    Investigators at Emory University in Atlanta assessed marijuana smoke exposure and lung health in a large representative sample of US adults age 18 to 59. Researchers reported that cannabis exposure was not associated with FEV1 (forced expiratory volume) decline or deleterious change in spirometric values of small airways disease.

    Authors further reported that marijuana smoke exposure may even be associated with some protective lung effects among long-term smokers of tobacco. Investigators acknowledged, “[T]he pattern of marijuana’s effects seems to be distinctly different when compared to that of tobacco use.”

    Researchers also acknowledged that habitual cannabis consumers were more likely to self-report increased symptoms of bronchitis, a finding that is consistent with previous literature. Separate studies indicate that subjects who vaporize cannabis report fewer adverse respiratory symptoms than do those who inhale combustive marijuana smoke.

    Authors concluded, “[I]n a large representative sample of US adults, ongoing use of marijuana is associated with increased respiratory symptoms of bronchitis without a significant functional abnormality in spirometry, and cumulative marijuana use under 20 joint-years is not associated with significant effects on lung function.”

    This study is the largest cross-sectional analysis to date examining the relationship between marijuana use and spirometric parameters of lung health.

    A separate study published in 2012 in The Journal of the American Medical Association (JAMA) similarly reported that cumulative marijuana smoke exposure over a period of up to 7 joint-years (the equivalent of up to one marijuana cigarette per day for seven years) was not associated with adverse effects on pulmonary function.

    A 2013 review also published in the Annals of the American Thoracic Society acknowledged that marijuana smoke exposure was not positively associated with the development of lung cancer, chronic obstructive pulmonary disease (COPD), emphysema, or bullous lung disease. It concluded: “[H]abitual use of marijuana alone does not appear to lead to significant abnormalities in lung function. Findings from a limited number of well-designed epidemiological studies do not suggest an increased risk of either lung or upper airway cancer from light or moderate use. … Overall, the risks of pulmonary complications of regular use of marijuana appear to be relatively small and far lower than those of tobacco smoking.”

    You may view an abstract of the study, “Effects of marijuana exposure on expiratory airflow: A study of adults who participated in the US National Health and Nutrition Examination Study,” here.