Last summer an op-ed came out in response to cannabis legalization in Canada discussing the risks and benefits of the legalization. The author acknowledges the myriad of health benefits that cannabis has been shown to treat but also brings forth the gaps in our knowledge that still remain. The piece urges physicians to fully discuss the most current information with their patients when recommending cannabis and for at-home cultivators to carefully manage their plants to prevent underage consumption. The author ends the piece on a hopeful note, mentioning that the only certainty of legalization cannabis is that much more robust research will be able to be conducted and provide more information for the public.
The author emphasizes the research opportunities that have now opened up in Canada due to the legalization of cannabis, highlighting the limitations of cannabis research in the United States. As cannabis is currently ruled a schedule I drug under the Controlled Substances Act the federal government sees no medical benefit in medical cannabis, despite an abundance of research. Researchers around the world have found evidence that cannabinoids, terpenes, and flavonoids can provide novel therapies for various disorders yet research in the US is still extremely limited by the lack of federal funding. Canada’s decision to legalize cannabis opens the door for so many cannabis-based therapies to be developed, and for economic and healthcare reasons, other countries should follow along.
The study is available for review or download here
The association between the legalization of recreational marijuana and both small for gestational age births and NICU admissions in Colorado
Researchers have recently found no evidence that the legalization of recreational cannabis increases the risk for small gestational age (SGA) births but may be linked to neonatal intensive care unit (NICU) admissions immediately post-birth. The study merely looks at the prevalence of both SGA and NICU admissions immediately post-legalization of recreational cannabis in Colorado and claims no causation conclusions can be drawn from the gathered data but did note an increase of 1% of NICU admissions per month immediately following legalization. The rate of the SGA births decreased following the new laws meaning cannabis may not affect the growth of a fetus or could improve development but future research is encouraged to ensure these results and identify possible causation for an increase in NICU admissions, which could be due to a myriad of factors.
This article serves as a call for research so that patients who take cannabis and fall pregnant are fully aware of the possible risks associated with continuing cannabis use during pregnancy. Currently, most obstetricians and gynecologists advise against cannabis use due to the lack of knowledge concerning cannabis and fetal development but those who fall pregnant and rely on cannabis are often left unaware of alternative options. Considering the uncertainty of the effects of cannabis on pregnancy outcomes and the inconsistency between the few studies currently published more research is definitely needed so that pregnant women can continue to receive safe and effective treatment.
The study is available for review or download here
Randomized Clinical Trials Investigating Innovative Interventions for Smoking Cessation in the Last Decade
A recent analysis has found that cannabis-based therapies may prove useful for those attempting to quit smoking. Billions of dollars are spent every year attempting to treat smoking-related conditions yet mortality rates continue to rise, proving the current treatment methods rather ineffective. Researchers thoroughly examined previous clinical studies in a search for more effective treatments and found that the endocannabinoid system provides an ideal target as it not only reduces the desire to smoke but also minimizes the weight gain most addicts fear. Further research is needed as no specific cannabinoid or cannabis-based medicine has proven to be effective without producing negative side-effects, but the few trials that have been conducted have shown promising results.
The issue this research aimed to address is the prevalence of smoking-related illnesses, highlighting the inability of the medical community to cease all tobacco use. Despite constant warnings and lessons in school concerning the danger of tobacco use new products like e-cigarettes have been made readily available for consumers and marketed on social media to teenagers who follow celebrities like Sophie Turner, an actress rarely seen without her choice of e-cigarette in hand. The tobacco industry is driven by the economy and, despite its proven deleterious effects on users’ health, has yet to be banned on a federal level. Better restrictions need to be put into place to prevent consumers from beginning tobacco use while researchers continue to look for effective treatment methods.
The study is available for review or download here
Marketing of legalized cannabis- a concern about poisoning
A recent op-ed has come out to discuss the danger of marketing cannabis edibles as sweet treats or other types of food a child may accidentally consume. The author warns that manufacturers should boldly label their products if it contains tetrahydrocannabinol (THC) and may pose a danger to nearby children. Often-times the recommended dose of a chocolate bar is only a few pieces, but for an adventurous child who wants chocolate, the entire bar may be consumed, resulting in the consumption of a very high dose of THC. The author of the piece calls for serious marketing restrictions for cannabis products, including vaporizer pens that look like e-cigarettes, in countries or states with legal cannabis.
It’s interesting that this piece highlights the need for better marketing in concern for children’s accidental consumption but does not highlight proper storage for caretakers so that children are unable to access such products. Newer evolutions of cannabis edibles make them more convenient for public use as they are discreet, and taste better than other methods of consumption, which does make them appetizing for children. The marketing restrictions in the united states vary by state considering cannabis is only legal at state levels so each state has its own set of guidelines. What is consistent, is storage recommendations for dangerous substances around children. Like any pharmaceutical, cannabis should be kept out of children’s reach and in a sealed container for safety and freshness.
The study is available for review or download here
Effects of Cannabinoid Administration for Pain- A Meta-Analysis and Meta-Regression
A recent meta-analysis has found that cannabis is an effective treatment for those dealing with chronic pain. Researchers analyzed studies that compared cannabinoid-based therapies to placebos, concluding that those therapies served as an effective replacement or adjunctive therapy for more common pain relievers, such as opioids. Some studies included in the analysis disqualified the effectiveness of cannabinoids due to the psychoactive effects of tetrahydrocannabinol (THC) but the featured piece suggests future work should aim to synthesize cannabinoids that highlight cannabis’s analgesic effects while minimizing any psychoactive effects. Future research needs to discover more about the endocannabinoid mechanism within the body before this can occur.
The authors take care to emphasize the need for alternative pain therapies for opioids that are safer and more economically responsible. Currently, pain-related costs from patients, caretakers, and healthcare facilities continue to grow beyond $600-billion annually, as more people grow dependent on opioids. Cannabis is much more cost-effective, and even if it does not entirely replace opioid therapies and is simply an adjunct therapy, it has the potential to greatly reduce the amount of opioid prescribed and lower the necessary dose. Opioids are highly addictive whereas cannabis has a much better safety profile, yet cannabis is still deemed medically irrelevant by the federal government. More research needs to be conducted to reduce the chance of addiction, the opioid crisis in general, and reduce the economic burden of pain-related costs in the United States.
The Study is available for review or download here
The heterogeneity and complexity of cannabis extracts as antitumor agents
A recent study has exposed the complexity of cannabis extracts as antitumor agents depending on the exact cannabinoid composition and cancer cell line. Researchers utilized whole cannabis extracts, meaning that the extract contains various amounts of cannabinoids, terpenes, and flavonoids produced by the cannabis plant, and found that each extract had various effects depending on cannabinoid composition. It was also found that the antitumor effects were not completely due to ∆-9-tetrahydrocannabinol (THC) as pure THC extracts did not provide the same effects as a whole plant extract. Some extracts were found to have antitumor effects on specific cancer cell lines but further research is needed to specify which ratio of cannabinoid and other chemicals provides the most benefits for each cell line.
Considering the difficulty of treating cannabis and the horrible side-effects associated with chemotherapy it seems shocking that cannabis-based medications are not more widely accepted for cancer treatments. As cannabis is still classified as a Schedule I under the Controlled Substances Act the federal government can not provide any support for cannabis research which means that current research relies almost entirely on private funding. When examing the emotional and economic toll of cancer patients it seems irresponsible to not fully examine the possible benefits of cannabis-based medications to finally determine if they can provide more benefits than easing the side-effects of chemotherapy such as cachexia, chronic pain, and nausea.
The study is available for review or download here
Binge and Cannabis Co-Use Episodes in Relation to White Matter Integrity in Emerging Adults
Researchers have recently revealed that the co-use of cannabis and alcohol can have deleterious effects on white matter in the brain. White matter integrity is frequently used as a measure of cognitive function and the negative effects of cannabis and alcohol on the white matter suggest a decrease of cognitive function in co-users. These negative effects were especially severe in co-users who frequented binge-drinking patterns. Researchers also found that those who co-used cannabis and alcohol were more likely to abuse more severe substances. These findings may prove useful when recommending cannabis for certain individuals whose cognitive function or abuse patterns are in question.
This article highlights the nonlinear pattern that the effects of cannabis, meaning that too much cannabis can actually have negative effects rather than positive benefits. A way around negative effects from overindulging on cannabis when looking to alleviate symptoms from an ailment is micro-dosing. Micro-dosing refers to the practice of consuming the minimum amount of cannabis necessary to alleviate symptoms while avoiding possible psychoactive effects or anxiety. Micro-dosing is generally a safer way to ensure proper cannabis dosing as there is very little information or research to suggest a general dose for specific ailments.
The study is available for review or download here
Although cannabis was used medically decades ago for its proven therapeutic abilities, concerns of abuse led to restrictions of its use in the 1930s and 1940s in the US. But, hemp in the form of medical cannabis, popularly known as cannabidiol or CBD, has again been a subject of research and clinical trials in the medical sciences ever since the groundbreaking research of Dr. Rafael Mechoulam.
Dr. Mechoulam discovered the Endo-Cannabinoid System in human physiognomy, which showed that human beings have CBD receptors present in the body, which creates a cascade of homeostasis (stability of health) throughout the entire central nervous system and the immune System.
Hemp has more than one hundred active chemical components, and the two most crucial ones are THC or tetrahydrocannabinol, and CBD. While THC is psychoactive and gives a high, CBD works as a nutritional supplement, which is very healthy for humans and is not psychoactive. The CBD dominant strains of marijuana have very little or nil THC, thereby being non-addictive for patients.
In this article, we will discuss how medical cannabis helps improve several diseases that are often crippling and can be potentially fatal.
Diseases and Conditions That Can Be Improved With Hemp
Right from the time medical cannabis got legalized in several states in the US and has been administered in patients clinically, it is a miracle drug in treating several acute symptoms of some major diseases plaguing millions of people. Some of them are-
1. Insomnia: Research shows that CBD helps improve sleep, mainly when induced by anxiety
2. Nausea: Nausea primarily caused as a side-effect of chemotherapy and cancer-related treatments.
3. Anxiety and depression: CBD oil has shown miraculous effects on the treatment of depression, anxiety, panic attacks. CBD has an excellent ability to act on the receptors of our brain to release the serotonin neurotransmitter, which becomes severely low in patients suffering from mental illnesses, which makes them feel “low” and enervated. (1)
4. PTSD: One of the most promising areas of research on medical marijuana is in the treatment of war veterans who have PTSD showing miraculous and drastic improvements after the administration of hemp.(2)
Whereas pharmaceutical drugs like benzodiazepines are highly addictive and can even lead to substance abuse, CBD doesn’t lead to addiction.
5. Glaucoma: It has also been reported to help treat Glaucoma, eye conditions that can lead to blindness, but the results are disputed.
6. Epilepsy: One particular type of epilepsy in kids, known as the Dravet Syndrome, is practically impossible to manage but responds to CBD miraculously. This CBD-dominant strain is also popularly known as Charlotte’s Web. (3)Epilepsy also comes with muscle spasms, stiffness, and chronic pain, all of which are significantly reduced with the use of cannabidiol.
7. Muscle Spasticity: Spasticity resulting from multiple sclerosis, or arthritis, and some neurological disorders, which also causes chronic pain, and tremors work miraculously on CBD. The most common drug, Sativex, an oral spray consisting of both CBD and THC, has been proven to be effective and safe in reducing these symptoms.
Marijuana is excellent in dulling nerve pain and multiple sclerosis. While there are several medical drugs present to treat these conditions- such as Lyrica and Neurontin, they have highly sedating effects on the patients. While patients using CBD report getting back to their daily activities feel much more relaxed.
8. Parkinson’s disease: CBD also acts as an excellent muscle relaxant and is unique in treating tremors caused by Parkinson’s disease. (4)
9. Chronic pain: CBD impacts the Endocannabinoid receptors to interact with and release neurotransmitters naturally present in the human body to reduce acute pain and inflammation.
10. Alzheimer’s disease: Inflammation, one of the biggest causes of Alzheimer’s symptoms, can be effectively reduced by CBD oil administration. Clinical trials have also shown CBD’s ability in reversing, delaying, and often preventing the negative impacts of Alzheimer’s disease.
11. ALS: ALS can be managed with CBD oil very efficiently as it delays the progression of its symptoms such as spasticity and prolongs the survival of patients, owing to its neuroprotective abilities.
12. Appetite loss, and severe anorexia: Anorexia Nervosa is a critical eating and psychiatric disorder. While many anorexics are given anti-depressants and anti-anxiety medication, they come with enormous side effects rendering patients drowsy, while research shows that CBD possesses orexigenic (an appetite stimulant/hormone) which can regulate and enhances the appetite.
13. AIDS and Cancer symptoms: While many people are plagued by the agony of weight gain or obesity, gaining weight becomes extremely difficult for many people, especially those with AIDS or cancer. (5) Dronabinol, a synthetic THC commonly known as Marinol, is medically approved to be used for treatment in patients, and the effect of it has always been on the positive with the consistent improvement of appetite, lessens nausea, and vomiting in cancer and patients of AIDS.
Wasting Syndrome, a condition associated with AIDS, a slow, painful process involving loss of muscle mass and a gradual decrease in health, has also shown excellent results in reducing the symptoms.
14. Endometriosis, Fibromyalgia, Migraine, Interstitial cystitis (all these conditions cause chronic pain and inflammation), are also certain critical illnesses whose symptoms are also found to be expertly moderated by the use of hemp seed oil.
Medical marijuana is most commonly used to manage chronic pain. It is very safe as there are no chances of an overdose and is non-addictive. It can replace the NSAIDs (Non-steroidal anti-inflammatory drug(s)), which patients with kidney problems, GERD, or ulcers cannot consume. While pharmaceutical drugs work at the level of the symptoms, they do not work at the level of the system, thereby not providing a “cure,” and that causes enormous strain on the human physiognomy.
The list is not all-inclusive but rather a survey of several types of conditions that medical marijuana can be administered on, and has already proven its effectiveness.
In the larger picture, no one living in the urban society today is exempted from an inflamed immune and central nervous system, due to environmental toxins and our inflammatory diet (containing way too much sugar), reasons that lead to an inflamed immune system and symptoms of brain inflammation.
The ability of CBD to control and to provide relief to these symptoms is undeniable, and hence, more use and awareness of cannabinoids are necessary.
Author Bio: Vishal Vivek, Co-founded Hemp Foundation to increase awareness about hemp which is the most misunderstood plant on the planet. He believes that we can fight climate change, water crisis and plastic pollution with Hemp. Times Group recognized him as a legendary entrepreneur and published his biography in “I Did IT- Vol 2” at the age of 30
Oncologists Should Recommend Cannabis-Based Medicine for Palliative Care
Earlier this June a review was published that encourages oncologists to recommend cannabis products to their patients as a safe and effective method of palliative care. The opinion piece highlights how cannabis is a useful treatment for a variety of illnesses (nausea, vomiting, sleep, mood, anxiety), and encourages practitioners to prescribe cannabis for their patients so that they can appreciate the safety and effectiveness of the product.
Dr. Caplan and the #MDTake:
As Dr Abrams makes abundantly and eloquently clear, the reasons for oncologists to RETURN to recommending cannabis (as clinicians were accustomed to doing in generations past) are many. Weighing the safety profile of cannabinoid medicines and the long list of potential benefits for those battling cancers, against temporary adverse side effects (some of which, like appetite stimulation and sedation, can also be advantages for oncology patients), it is almost unethical for modern clinicians to NOT recommend that patients consider cannabis supplementation. The historical sociopolitical war on drugs was never founded in scientific rationale, nor supported by rigorous inquiry that has borne out half a million scientific reviews on the topic. It is high time that physicians return to a practice style that prioritizes patient well-being first, and emphasizes self-education about areas of medicine about which the providers may be less informed.
Year 2019 was an up and down year for the cannabis industry. As the year comes to a close, let us take some time to reflect on what transpired during this transitional period for the cannabis industry. Hopefully, a detailed look at what happened may shed some light on what is ahead in 2020.
First, public opinion on cannabis has continued to rise. For the first time, poll results suggested that more than two-thirds of Americans support legalization. Such a pervasive, bipartisan, agreement for a fundamental change in the law is rare, and is a true reflection of the state of the industry now, and where the industry is headed.
Riding along with public opinion, Congress saw more movement towards full legalization than in any single year prior. The list of cannabis-related bills that were introduced in Congress this year tops 15, covering topics from banking to immigration. Most noteworthy among those bills are the MORE Act, a comprehensive legalization bill that passed its committee in the House, and the SAFE Banking Act, which passed the full House by a landmark 321-102 bipartisan vote. At the same time that these provide an optimistic outlook for the federal regime, no actual progress has been made in Congress, largely because the Republican-led Senate remains staunchly opposed to reform (google “Mitch marijuana machete” for an idea of Mitch McConnell’s recent activities relating to drug policy reform).
The executive branch has not been without movement either. President Trump does not have the traditional hard-lined anti-cannabis stance that some Republican leaders espouse. He campaigned on a platform of not interfering with states’ ability to manage their own medical and adult-use programs. He has publicly stated his support for the States’ Act, a bill that would essentially codify the same, leaving enforcement up to the states. Under Trump, the FinCEN continued its policy of allowing banks to do business with the cannabis industry, assuming that the Suspicious Activity Report (“SAR”) requirements were being followed. There are also no known examples of DEA or other federal law enforcement actions taken against operators lawfully operating under state law.
At the same time, the executive branch has made moves against the legalization movement. In 2018, then-AG Sessions rescinded the Cole Memorandum, signaling that the feds were looking into increasing enforcement against cannabis businesses (Thankfully Sessions is no longer a part of the administration, as his views are notoriously more anti-legalization than Trump’s). Just last week, as Trump signed the yearly spending bill into law, he attached a vague statement reserving the right to enforce federal law even in the face of full state-law compliance. Overall the federal government has progressed, albeit slowly, in the right direction.
Many states had significant progress towards legalization in 2019. Illinois became the 11th state to fully legalize adult-use, while Hawaii, New Mexico, and North Dakota decriminalized. We now stand with 33 states having passed a robust medical program, a full two-thirds of the union. Bills were proposed in more than two dozen states, some to expand existing frameworks, and others to create new ones. Just this week Alabama’s legislature’s commission recommended legalizing for medical purposes, a stark shift from the traditional views thought to be widely-held in the deep south. Overall the trend is clearly moving towards more states joining the legalization team, some quicker than others.
Though 2018 set a high bar for the hemp/CBD industry in terms of significant reform, Year 2019 arguably topped the significant progress of the 2018 Farm bill. In October, the USDA published its interim final rule, providing much-needed guidance to the hemp community. It created a federal framework for hemp farmers, creating registration, licensing, and testing requirements. It also allowed states to create their own systems, and many of the largest states for hemp farming are doing just that. FinCEN, the same treasury bureau that regulates banking for marijuana businesses, announced in December that banks may do business with the hemp industry without having to adhere to the SAR reporting requirements like those doing business with marijuana.
At the same time, the hemp/CBD industry skyrocketed in 2019. We saw an explosion of CBD products, and the industry is now estimated to be worth $4 billion. Tinctures, edibles, lotions, balms, you name it, someone has put CBD in it and made money this year. There remains so much uncertainty about the legalities of the market, and many have taken advantage of this “Wild West” atmosphere to quickly seize market shares, without guaranteed continuity once enforcement occurs. Year 2019 was not without foreshadowing of enforcement, however. In November, the FDA sent out warning labels to several companies that were selling CBD products. The letters go into detail regarding the various items being sold and analyzed how each company was violating various laws. Although the FDA hasn’t actually seized anyone’s assets or froze any bank accounts, they are clearly watching and thinking about doing it.
A really interesting piece of news swept the nation this year. At the beginning of November, the NYPD posted a picture of two officers posing with “106 pounds of marijuana that was destined for our city streets”, bragging about its success. Only one problem… it was all legal hemp, with certifying papers and all. The NYPD quickly dropped all the charges, and recently returned the hemp to the owner. This incident also highlights a significant issue with the hemp industry, in that it comes from and has all the outward appearance of marijuana, leading to confusion and enforcement problems. Until law enforcement agencies are properly trained, this type of incident is likely to repeat itself.
Year 2019 also took its toll on many cannabis companies. Large companies like Eaze and MedMen had to lay off many employees, as the actual returns were less than what their projections anticipated. Many stocks took big hits in 2019, for the same reasons. The projections for the industry have been huge, and are likely accurate, but are also likely skewed because of the nature of the industry. There is still a large “traditional” market in existence, which continues to dwarf the legal one. While some have come out of the shadows, progress remains slow because of the monumental taxes, regulations, and difficulties associated with being a fully-legal operating cannabis company.
WHAT ABOUT 2020?
The year 2020 is upon us. The cannabis industry is not going anywhere. It will continue to grow and mature as the year goes on. We aren’t going to see any reversal of the general trend towards legalization. At the federal level, I don’t believe that 2020 will see a single cannabis bill passed and enacted into law, and certainly nothing like full legalization. The country is not ready for it yet, as many of the industry leaders remain staunchly opposed for two reasons. First, there remains distrust and skepticism that is leftover from the reefer madness days. Many politicians still feel that marijuana is a gateway drug to other substances, and until they are convinced otherwise will stay opposed. Second, and more sinister perhaps, legalization denotes trouble for industries like alcohol, tobacco, and pharmaceuticals, all of whom stand to lose significant market shares once cannabis replaces these vices as people’s substance of choice. Lobbyists for these industries continue to work tirelessly to oppose legalization, and members of Congress are still forced to follow. Until these issues change, we must wait for full legalization.
At the state level, change will happen, and rapidly. Already several states seem poised to have recreational programs on the ballot, in states where it is almost certain to pass. These include New Jersey, New York, North Dakota, Minnesota, Vermont, and Pennsylvania, all of whom will pass legalization by years end. More states will join the medical bandwagon, leaving perhaps one or two states with absolutely no cannabis legalization framework.
Public opinion will continue to positively increase and have more of an impact on the industry. If in 2019 we finally hit 66%, I predict that Year 2020 will have us hit 75%. As the younger generation grows up, and as the older one retires and fades away, the numbers will continue to rise. At the same time, science continues to develop, as new studies are coming out nearly every week showing another beneficial use of the cannabis plant. At the same time, organizations like CED Foundation and The IJCA continue to run awareness campaigns and spread the word, adding to the number of people who are exposed to ideas and understanding of the plant’s many uses. More studies and more awareness, reaching even more people, means more backing for legalization.
Hemp is poised for a huge gain in 2020. With the federal regulations in place, the industry now has definitive guidance on the government’s position. While CBD as medicine remains a tricky subject, certainly hemp’s use as a tobacco alternative, a plastic alternative, textiles, fabric, and other industry uses will skyrocket. I also believe that 2020 will see the FDA, DEA and USDA will work out some of the kinks with using CBD as an active ingredient, providing helpful guidance to an industry running around like a headless chicken. Once that occurs, again, the industry will expand rapidly, as more certainty from the government will allow more companies to enter the market.
Lastly, I think 2019 brought some valuable lessons to the industry. The way the projections did not turn into reality, and the hits that many businesses had to take, give us some really important lessons. Caution is urged when investing in an industry plagued by burdensome regulations and strong financial incentives not to join the legal market. The “traditional” market remains the elephant in the room. The likelihood of real enforcement crackdown is low, because of limited resources, sheer numbers, and the probability that any enforcement would result in really bad press. Because investors have now been warned, the industry’s growth will slow. We will continue to see startups join the market, but perhaps on a smaller scale.
I hope that this discrepancy between projections and sales will also be a lesson for our legislatures. They need to come up with solutions that create subsidies for those coming out of the shadows so that states can see the actual revenues they hoped for. They may have to accept several billion in illegal sales as water under the bridge. They may have to lower tax rates to incentivize people to legitimize their operations. They may have to lessen the licensing requirements, making it easier and cheaper for those interested in joining to actually do so. The specific decisions are theirs to make, but they need to get creative about solving this problem.
Overall 2019 was a successful year for the industry. Even the downsizing and financial hits taken will prove to be valuable in the long run. Just like getting out of bed too fast can result in injury, an industry that expands too rapidly can result in harmful consequences.
Benjamin Caplan, MDWHAT 2019 HAS TAUGHT US ABOUT WHAT 2020 WILL LOOK LIKE: PROCEED WITH CAUTION