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medical cannabis

  • by Paul Armentano, NORML Deputy Director June 10, 2013

    Preclinical study data published online in the scientific journal Nutrition & Diabetes reports that tetrahydrocannabivarin (THCV) — a naturally occurring analogue of THC — possesses positive metabolic effects in animal models of obesity.

    British researchers assessed the effects of THCV administration on dietary-induced and genetically modified obese mice. Authors reported that although THCV administration did not significantly affect food intake or body weight gain in any of the models, it did produce several metabolically beneficial effects, including reduced glucose intolerance, improved glucose tolerance, improved liver triglyceride levels, and increased insulin sensitivity.

    Researchers concluded: “Based on these data, it can be suggested that THCV may be useful for the treatment of the metabolic syndrome and/or type 2 diabetes (adult onset diabetes), either alone or in combination with existing treatments. Given the reported benefits of another non-THC cannabinoid, CBD in type 1 diabetes, a CBD/THCV combination may be beneficial for different types of diabetes mellitus.”

    Last month, Harvard Medical School researchers published observational data in The American Journal of Medicine reporting that subjects who regularly consume cannabis possess favorable indices related to diabetic control as compared to occasional consumers or non-users of the substance. Writing in an accompanying commentary, the journal’s Editor-in-Chief stated: “These are indeed remarkable observations that are supported, as the authors note, by basic science experiments that came to similar conclusions. … I would like to call on the NIH and the DEA to collaborate in developing policies to implement solid scientific investigations that would lead to information assisting physicians in the proper use and prescription of THC in its synthetic or herbal form.”

    Observational trial data published in 2012 in the British Medical Journal previously reported that adults with a history of marijuana use had a lower prevalence of type 2 diabetes and possess a lower risk of contracting the disease than did those with no history of cannabis consumption, even after researchers adjusted for social variables such as subjects’ ethnicity and levels of physical activity.

    Previously published preclinical data also indicates that the administration of cannabidiol (CBD) halts the development of type 1 (juvenile) diabetes in mice genetically predisposed to the condition.

    Full text of the study, “The cannabinoid ?9-tetrahydrocannabivarin (THCV) ameliorates insulin sensitivity in two mouse models of obesity,” is available online here.

  • by Paul Armentano, NORML Deputy Director June 7, 2013

    Democrat Gov. John Kitzhaber on Thursday signed legislation, Senate Bill 281, into law to allow patients with post-traumatic stress to be eligible to engage in the therapeutic use of cannabis.

    The new Oregon law expands the state’s existing medical marijuana program, initially enacted by voters in 1998, to include post-traumatic stress as a state-qualified illness for which marijuana may be recommended.

    To date, only three states – Connecticut, Delaware, and New Mexico – specifically allow for the use of cannabis to treat symptoms of post-traumatic stress.

    Clinical trial data published in the May issue of the journal Molecular Psychiatry theorized that cannabinoid-based therapies would likely comprise the “next generation of evidence-based treatments for PTSD (post-traumatic stress disorder).”

    Post-traumatic stress syndrome is an anxiety disorder that is estimated to impact some eight million Americans annually. To date, there are no pharmaceutical treatments specifically designed or approved to target symptoms of PTSD.

  • by Paul Armentano, NORML Deputy Director May 22, 2013

    A Michigan traffic safety law that prohibits the operation of a motor vehicle by persons who possess any presence of THC in their blood, regardless of whether or not they are behaviorally impaired by the substance, may not be strictly applied to state-qualified medical cannabis patients. So decided the Michigan Supreme Court on Tuesday in the case People v Koon.

    In a unanimous opinion, the Court determined that legal protections extended to state-qualified patients under the Michigan Medical Marihuana Act, enacted by voters in 2008, supersede the state’s zero tolerance, internal possession law. As a result, the Court determined that state prosecutors must establish that authorized patients charged under the statute are actually impaired by their cannabis use in order to gain a DUI criminal conviction.

    According to the syllabus of the Opinion:

    “The MMMA [Michigan Medical Marihuana Act] does not define what it means to be ‘under the influence,’ but the phrase clearly contemplates something more than having any amount of marijuana in one’s system and requires some effect on the person. Thus, the MMMA’s protections extend to a registered patient who internally possesses marijuana while operating a vehicle unless the patient is under the influence of marijuana. The immunity from prosecution provided under the MMMA to a registered patient who drives with indications of marijuana in his or her system but is not otherwise under the influence of marijuana inescapably conflicts with MCL 257.625(8) [the state's zero tolerance per se DUI law], which prohibits a person from driving with any amount of marijuana in her or system.”

    The state’s zero tolerance per se drug law remains applicable to non-patients. Under such laws, motorists are guilty per se (in fact) of a criminal traffic safety violation if they engage in the act of driving while detectable levels of certain controlled substances or, in some cases, their inert metabolites (byproducts) are present in the defendants’ blood or urine. Proof of actual impairment is not a requirement for a conviction under the law.

    To date, ten states — Arizona, Delaware, Georgia, Illinois, Indiana, Iowa, Michigan, Rhode Island, Utah, and Wisconsin — have enacted legislation imposing zero tolerance per se thresholds for the presence of cannabinoids and/or their metabolites. (State-authorized medical cannabis patients in Arizona and Rhode Island are exempt from prosecution under these per se statutes unless the state can provide additional evidence of psychomotor impairment.)

    Five additional states impose non-zero-tolerant per se thresholds for cannabinoids in blood: Montana (5ng/ml — law takes effect on October 1, 2013), Pennsylvania (1ng/ml), Ohio (2ng/ml), Nevada (2ng/ml) and Washington (5ng/ml). Most recently, Colorado lawmakers approved legislation stating that the presence of THC/blood levels above 5ng/ml “gives rise to permissible inference that the defendant was under the influence.” State-qualified patients in Colorado, Montana, and Nevada are not provided legal exemptions from these statutes, although legislation is presently pending in Nevada to do so.

    NORML believes that it is inadvisable to infer behavioral impairment based on the presence of blood/cannabinoid levels alone — a position that we outline here, here, and in public testimony here.

    Such caution is similarly expressed by the United States National Highway Transportation and Safety Administration, which acknowledges: “It is difficult to establish a relationship between a person’s THC blood or plasma concentration and performance impairing effects. … It is inadvisable to try and predict effects based on blood THC concentrations alone.”

    A 2013 review of per se drugged driving laws and their impact on road safety found “no evidence that per se drugged driving laws reduce traffic fatalities.”

  • by Paul Armentano, NORML Deputy Director February 22, 2013

    The National Organization for the Reform of Marijuana Laws is pleased to announce that it is now providing educational content to the editors of The Answer Page, Inc. The Answer Page, Inc. is an online medical educational resource founded in 1998 that provides daily education to healthcare professionals in 120 countries. TheAnswerPage (online at TheAnswerPage.com) uses the Socratic question-and-answer teaching method. The content for the website is primarily written by academic clinicians respected in their fields. All content is peer-reviewed and referenced from current texts and recent literature.

    TheAnswerPage now features educational content in the area of medical marijuana. The editorial team of TheAnswerPage states: “Medical marijuana may be controversial, but it is now an important area of study in healthcare. Doctors and healthcare professionals must understand the medical, legal, social and political issues to best respond to their patients’ questions and attend to their needs.”

    The medical marijuana ‘lecture series’ begins with an introductory primer to the cannabis plant. The following week focuses on five distinct cannabinoids and their therapeutic potential.

    “NORML recognizes that physicians and health care professionals desire balanced information regarding the safety and efficacy of cannabis as a potential therapy,” NORML’s Deputy Director Paul Armentano said. “NORML is pleased to provide its expertise to TheAnswerPage to assist health care professionals better understand and navigate this important public health issue.”

    Subscribers to TheAnswerPage receive continuing medical education (CME) credit by reading the content and completing an industry-unique Interactive Crossword Puzzle. The clues are structured to reinforce the educational material, and links are provided to the related content. Subscribers have personal educational accounts that organize their earned CME credit and allow clinicians to download, email or print CME certificates for credentialing and licensing.

    TheAnswerPage.com has over 50 interactive crossword puzzles posted, for earning CME credit. New content and crosswords are posted daily.

    TheAnswerPage‘s medical cannabis content is available at the ‘syllabus;’ select the pull down menu option: “Medical Marijuana — Medical, Legal, Social, and political Issues.” Free registration to the site is required.

  • by Paul Armentano, NORML Deputy Director January 3, 2013

    The administration of vaporized, low THC cannabis is associated with reduced pain in subjects with neuropathy, according to clinical trial data published online by The Journal of Pain.

    Investigators at the University of California, Davis Medical Center conducted a double-blind, placebo-controlled, crossover study evaluating the analgesic efficacy of vaporized cannabis in 39 subjects, the majority of whom were experiencing neuropathic pain despite traditional treatment. Subjects inhaled cannabis of either moderate THC (3.53 percent), low dose THC (1.29 percent), or zero THC (placebo). Subjects continued to take all other concurrent medications as per their normal routine during the 3- to 4-week study period. Spontaneous pain relief, the primary outcome variable, was assessed by asking participants to indicate the intensity of their current pain on a 100-mm visual analog scale (VAS) between 0 (no pain) and 100 (worst possible pain).

    Researchers reported: “Both the low and medium doses proved to be salutary analgesics for the heterogeneous collection of neuropathic pain conditions studied. Both active study medications provided statistically significant 30% reductions in pain intensity when compared to placebo.”

    They concluded: “Both the 1.29% and 3.53% vaporized THC study medications produced equal antinociception at every time point. … [T]he use of low doses could potentially be prescribed by physicians interested in helping patients use cannabis effectively while minimizing cognitive and psychological side effects. Viewed with this in mind, the present study adds to a growing body of literature supporting the use of cannabis for the treatment of neuropathic pain. It provides additional evidence of the efficacy of vaporized cannabis as well as establishes low-dose cannabis (1.29%) as having a favorable risk-benefit ratio.”

    Previous clinical trials have indicated that inhaled cannabis can safety and effectively relieve various types of pain, particularly neuropathy — a hard-to-treat nerve condition often associated with cancer, HIV, spinal cord injury, diabetes, multiple sclerosis, and other conditions. These include the following double-blind, placebo-controlled (FDA gold-standard) studies:

    Ware et al. 2010. Smoked cannabis for chronic neuropathic pain: a randomized controlled trial. CMAJ 182: 694-701.

    Wilsey et al. 2008. A randomized, placebo-controlled, crossover trial of cannabis cigarettes in neuropathic pain. Journal of Pain 9: 506-521.

    Ellis et al. 2008. Smoked medicinal cannabis for neuropathic pain in HIV: a randomized, crossover clinical trial. Neuropsychopharmacology 34: 672-80.

    Abrams et al. 2007. Cannabis in painful HIV-associated sensory neuropathy: a randomized placebo-controlled trial. Neurology 68: 515-521.

    Wallace et al. 2007. Dose-dependent Effects of Smoked Cannabis on Capsaicin-induced Pain and Hyperalgesia in Healthy Volunteers Anesthesiology 107: 785-796.

    Separate clinical trial data also reports that inhaled “cannabis augments the analgesic effect of opioids” and therefore “may allow for opioid treatment at lower doses with fewer side effects.”

    Since 1999, US sales of opiate drugs have tripled in number and in 2010, a record-setting 254 million prescriptions for opioids were filled in the United States — enough to medicate every American adult around the clock for a month. (In particular, the manufacturing of the drug Oxycodone has increased from 8.3 tons in 1997 to 105 tons in 2011, an increase of 1,200 percent.) Overdose deaths from the use of prescription painkillers are also now at record levels, totaling some 15,000 annually — more than triple the total a decade ago.

    Full text of the study, “Low-dose vaporized cannabis significantly improves neuropathic pain,” appears in The Journal of Pain.

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