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Cannabis Legalization in Canada will Minimally Impact Emergency Departments

May 8, 2020 , , ,

Planning capacity for mental health and addiction services in the emergency department- a discrete-event simulation approach

In summary

A study published in June of 2019 has revealed the forecast for emergency department visits based on the current opioid crisis in Canada and the legalization of cannabis. Researchers observed an increase in the number of emergency department visits at hospitals in Canada, specifically for mental health addiction complaints. It was determined that the opioid crisis will continue to cause issues for emergency departments but that the legalization of cannabis will cause a minimal amount of issues due to the low-risk of addiction. While forecasting the effects of addiction-related emergencies researchers determined that there would be increased waiting times and the length of stay will deteriorate. It is recommended that Psychiatric Emergency Service Units increase their number of beds and that programs aimed at preventing alcohol and opioid addiction will be especially helpful for managing the future influx of patients. 

The opioid crisis is ravaging more than just the emergency rooms in Canada, extending all over North America. Opioids are incredibly dangerous considering their high risk of addiction, often leading to people illegally obtaining opioids or other illicit drugs like heroin. Opioids most commonly act on µ-opioid receptors which affect the reward pathway in the central nervous system, preventing pain and convincing the body that opioids are a great substance. Some doctors are all too willing to overprescribe opioids for chronic pain or during recovery periods leading many to begin their lifelong addiction. Considering the economic cost of dealing with addicts, the emotional cost to families and caretakers, and the promise of cannabis as an anti-nociceptive, the federal government should seriously consider rescheduling cannabis so that it can be more seriously considered as an adjunct or replacement therapy for pain.

The study is available for review or download here

Planning-Capacity-for-Mental-Health-and-Addiction-Services-in-the-Emergency-Department-A-Discrete-Event-Simulation-Approach-1Download

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Benjamin Caplan, MDCannabis Legalization in Canada will Minimally Impact Emergency Departments
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Adolescent Use is not Increased by Cannabis Legalization

May 2, 2020 , ,

Does liberalization of cannabis policy influence levels of use in adolescents and young adults_ A systematic review and meta-analysis

In summary

A recent meta-analysis and systematic review has shown that the liberalization of cannabis use has not increased the amount of reported cannabis use in adolescents. There appeared to be a slight increase in adult cannabis use post-recreational cannabis legalization but not a significant amount to clearly report that trend. These reports may be skewed due to the social stigma that continues to surround cannabis use and therefore prevents participants from accurately reporting their history, but further research in an area where cannabis legalization is likely to occur but hasn’t yet would provide an interesting opportunity to confirm these findings. 

Medical cannabis use has been legalized in 33 states at the time of this blog and legalized for recreational use in 11 states, highlighting the importance of looking into current demographics and legal activity. Some studies have suggested a decrease in adolescent cannabis use as illicit dealers are replaced by state-regulated dispensaries implying that legalization and regulation may actually provide a safer environment for cannabis use and allow better prevention practices for adolescents. Further research would be needed to confirm these hypotheses and previous findings but prove promising for future legalization.  

The study is available for review or download here

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Benjamin Caplan, MDAdolescent Use is not Increased by Cannabis Legalization
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Birth Defects Rose in Colorado Post-Cannabis Legalization

April 26, 2020 , , ,

Cannabis teratology explains current patterns of Coloradan congenital defects- the contribution of increased cannabinoid exposure to rising teratological trends

In summary

Researchers have recently found that the frequency of major birth defects has increased in Colorado since the legalization of cannabis. It has been hypothesized that prenatal exposure to cannabis has caused these birth defects as the reported use of pain relievers, cocaine, alcohol, and tobacco did not increase. The specific birth defects that increased in frequency were atrial septal defect, spina bifida, microcephalus, Down’s syndrome, ventricular septal defect, and patent ductus arteriosus, but further research needs to be conducted to determine any causation. 

The effect of prenatal exposure to cannabis on birth rates, birth outcomes, and the health of the mother is rather uncertain. Studies focussing on cannabis use during pregnancy are limited and what little has been reported is inconsistent. Currently, governing bodies of obstetricians advise that pregnant mothers cease any cannabis use. If someone who needs cannabis for a medical purpose that improves their quality of life becomes pregnant they need to seek out alternative methods of treatment, even if they are using cannabis because they are resistant to more common treatment methods. Research is needed so that pregnant women can safely continue their medication or so that alternatives can be found so that women do not need to suffer for the duration of their pregnancy and possible breastfeeding period. 

The study is available for review or download here

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Benjamin Caplan, MDBirth Defects Rose in Colorado Post-Cannabis Legalization
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Legalizing Medical and Recreational Cannabis May Decrease Adolescent Use

April 21, 2020 , , , ,

Association of marijuana laws with teen marijuana use- new estimates from the youth risk behavior surveys

In summary

 Earlier this July a letter was published providing evidence that adolescent cannabis use may actually decrease post-legalization of medical and recreational cannabis. An analysis of Youth Risk Behavioral Surveys from the past two decades revealed that legalizing medical cannabis had little to no effect on cannabis use among adolescents in 8th and 10th grade but that legalization of recreational cannabis actually led to an overall decrease of adolescent cannabis use across the states. The authors hypothesize that the rate of adolescent use may decrease as illegal drug dealers are replaced by legal, regulated dispensaries. This evidence may prove compelling for the possible rescheduling of cannabis under the federal Controlled Substances Act. 

Adolescent substance use, like that of alcohol, has been found to be detrimental to brain development. There have been varying results regarding the effects of adolescent cannabis use on brain development yet some caretakers are given special permission to administer cannabis-based products to children experiencing rare forms of epilepsy or other seizure disorders. Cannabis-based medications may be a more ethical and far less dangerous substance to administer to children so that they aren’t set up for a substance use disorder at a young age.  Research focussed on adolescent cannabis use needs to be conducted for better regulations and to better advise the parents and pediatricians of adolescents who have accidentally consumed cannabis or need a cannabis-based medical intervention.  

The study is available for review or download here

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Benjamin Caplan, MDLegalizing Medical and Recreational Cannabis May Decrease Adolescent Use
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New Opportunities Arise as Cannabis is Legalized in Canada

March 28, 2020 , ,

“Tea” Time? Cannabis Legalization in Canada

In Summary

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

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Benjamin Caplan, MDNew Opportunities Arise as Cannabis is Legalized in Canada
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THE GRASS IS GREENER

March 25, 2020

By Shuki Greer, Esq.

A friend of mine posted that during these times the marijuana industry has done more to keep people safe, inside their homes than our leaders have. Without opining on the intelligence of our leaders or their decisions, it is clear that she is at least partly right. The cannabis industry is playing a large role in people’s decisions to remain inside. Many people have reported using cannabis to get through the long days, and that it is the only thing keeping them cooped up inside. The days of “Netflix and Chill” are truly upon us. 

The numbers also confirm this notion. Dispensaries from Alaska to Colorado have reported lines around the block, similar to those seen at supermarkets and drugstores around the country. Some are seeing a spike in sales of 33%, while others are reporting a 159% jump from the same time last year. One San Francisco dispensary reported having the biggest day of business since recreational sales began there in January of 2018.  

Most noteworthy, however, has been the official treatment of dispensaries in this time when nonessential businesses are being forced to close across the country. One state after another is announcing that cannabis businesses are to remain operational. Nevada and Colorado both issued advisories to dispensaries on how to observe social distancing. New York encouraged businesses to allow patients to schedule appointments in an effort to limit overcrowding. Illinois also exempted dispensaries from the list of non-essential businesses that must cease operations. In San Francisco, the city initially didn’t list cannabis businesses as essential, and its health department asked dispensaries to shut down. However, after an outcry from the community and patients across the city, they reversed course and allowed cannabis businesses to remain open. Ultimately California announced that cannabis business was deemed “essential”, allowing them to remain open statewide. 

Because not all states have made similar moves, the Marijuana Policy Project, a cannabis legalization organization, penned a letter to all governors urging them to declare medical cannabis businesses “essential” and ensure that they remain open during this crisis. The letter is signed onto by several reputable organizations and can be found in its entirety here:

https://www.mpp.org/issues/medical-marijuana/covid-19-medical-cannabis-access-letter/)

Think about what all of this means. States are not only declaring dispensaries to be essential businesses, but they are putting out guidelines as to how to expand remote services, maintain good business practices, and safely deliver cannabis to the consumer. Just a few years ago, this would have been unimaginable. The notion of deeming a dispensary to be an “essential business” would have seemed laughable from a governmental perspective. The thought of advising them on how to remain operational in a time of crisis seems even less likely. 

In this time when everything seems chaotic, it is important that we take time to reflect on the good in our lives. It is important to remember the blessings we have and to appreciate the times we are living in. The cannabis industry remains young, but it seems to have established itself as a legitimate industry in the minds of our leaders. This is something that should not be taken for granted. I encourage all to take a moment to think about this and appreciate how far we’ve come. 

Benjamin Caplan, MDTHE GRASS IS GREENER
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Safely Marketing Cannabis Products

March 23, 2020 ,

Marketing of legalized cannabis- a concern about poisoning

In Summary

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

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Benjamin Caplan, MDSafely Marketing Cannabis Products
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