Connecticut Gov. Dannel Malloy yesterday signed legislation, HB 5450, to protect nurses who administer medical marijuana to qualified patients in hospital settings from any criminal, civil, or disciplinary action. Other provisions in the bill expand the pool of patients eligible for cannabis therapy to include those under the age of 18, and seek to establish a state-sponsored research program.
In Maine, Gov. Paul LePage recently signed LD 726 into law, which similarly protects hospital administrators and staff from criminal or civil liability if they permit qualified patients access to non-inhaled preparations of medical marijuana in hospitals. Under the law, patients would not necessarily be provided or administered medical marijuana by hospital staff, but could be provided cannabis products by third parties.
Separate provisions in LD 726 establish licensing protocols for marijuana testing facilities and the labeling of medical cannabis products.
Connecticut and Maine are the first states to explicitly provide immunity to hospitals that permit patients to medicate with cannabis.
A summary of 2016 state legislation is online from NORML’s Take Action Center here.
Members of the Senate initially approved the measure in 2015. House leadership delayed acting on the bill for several months until finally passing an amended version of SB 3 in March.
Senate and House members voted this week in favor of a concurrent version of the proposal. The measure now goes before Gov. Tom Wolf, who supports patients’ access to medical cannabis and has pledged to sign the bill into law.
Senate Bill 3 permits regulators to license up to 25 marijuana cultivators and processors, and up to 150 dispensary locations to provide cannabis products to qualified patients who possess a recommendation from select physicians. Qualifying conditions eligible to receive cannabis therapy include intractable pain, multiple sclerosis, HIV/AIDS, cancer, seizure disorders, and autism, among others. The measure permits for the dispensing of herbal cannabis via vaporization, as well as the use of marijuana-infused extracts or oils, but it does not permit smoking. (To date, only two other states — Minnesota and New York — impose similar restrictions regarding patients’ use of herbal cannabis.)
Once signed into law, Pennsylvania will become the 24th state to permit the use of physician-recommended cannabis.
Long-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.
NORML is pleased to present the latest expanded/updated edition of the publication Emerging Clinical Applications for Cannabis & Cannabinoids — a comprehensive review of the latest peer-reviewed science specific to the safety and therapeutic efficacy of whole-plant cannabis and/or its components.
The 2015 updated edition includes two additional disease profiles (Parkinson’s disease and PTS) and includes summaries of an additional 50+ relevant clinical and/or preclinical trials specific to cannabinoids’ therapeutic utility. Several existing sections, such as Chronic Pain, Diabetes, and Epilepsy, have been significantly expanded since the last edition (January 2013). Also updated is the Introduction to the Endocannabinoid System (authored by Dustin Sulak, DO) and Why I Recommend Medical Cannabis (authored by Estelle Goldstein, MD).
With summaries and citations of well over 250 recent peer-reviewed studies, this updated publication is one of the most thorough and up-to-date source-books available specific to documenting the established therapeutic qualities of cannabis. The updated publication is available online here.
Individual sections of this publication may be accessed at the links below:
Introduction to the Endocannabinoid System
Why I Recommend Medical Cannabis
Amyotrophic Lateral Sclerosis
Human Immunodeficiency Virus
Methicillin-resistant Staphyloccus aureus (MRSA)
Inhaling cannabis is associated with the remission of refractory idiopathic angioedema, according to a clinical report published in the journal Case Reports in Immunology. Angioedema is a condition characterized by rapid swelling under the skin in regions around the face and throat, which may result in airway obstruction or suffocation.
Investigators from the Soroka University Medical Center in Israel reported on the progress of a 27-year-old male patient with life-threatening, recurrent angioedema of unknown origin. Doctors placed the patient on a regiment of 20 grams of inhaled cannabis monthly after he failed to respond favorably to prescribed steroids and antihistamines.
Authors reported: “The use of inhaled cannabis resulted in a complete response, and he has been free of symptoms for 2 years. An attempt to withhold the inhaled cannabis led to a recurrent attack within a week, and resuming cannabis maintained the remission, suggesting a cause and effect relationship.”
They concluded: “This is the first report in which a cannabis product for the treatment of refractory idiopathic angioedema was associated with an excellent clinical response. … More research into the exact mechanism of action of cannabis products in cases of idiopathic angioedema and on the modulation of the immune response in general is indicated.”
The Israeli government has authorized the limited production and distribution of marijuana as a medical treatment since 2011, and preparations of the plant are expected to be available in pharmacies imminently.
Full text of the report, “Life threatening idiopathic recurrent angioedema responding to cannabis,” appears online here.