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THE GRASS IS GREENER

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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Possible Associations Between Recreational Cannabis and Birth Outcomes

The association between the legalization of recreational marijuana and both small for gestational age births and NICU admissions in Colorado

In Summary

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

View more studies like this in the CED Foundation Archive 

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Benjamin Caplan, MDPossible Associations Between Recreational Cannabis and Birth Outcomes
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Utilizing Cannabis to Quit Smoking

Randomized Clinical Trials Investigating Innovative Interventions for Smoking Cessation in the Last Decade

In Summary

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

View more studies like this in the CED Foundation Archive 

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Benjamin Caplan, MDUtilizing Cannabis to Quit Smoking
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Safely Marketing Cannabis Products

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

View more studies like this in the CED Foundation Archive 

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Benjamin Caplan, MDSafely Marketing Cannabis Products
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Further Evidence For Cannabis as an Effective Pain Reliever

Effects of Cannabinoid Administration for Pain- A Meta-Analysis and Meta-Regression

In Summary

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

 View more studies like this in the CED Foundation Archive

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Benjamin Caplan, MDFurther Evidence For Cannabis as an Effective Pain Reliever
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Acute THC Consumption Can Be Determined From Breath Concentration

Correlation of Breath and Blood Δ9 -Tetrahydrocannabinol Concentrations and Release Kinetics Following Controlled Administration of Smoked Cannabis

In Summary

A recent study has found a method to determine acute ∆-9-tetrahydrocannabinol (THC) intoxication by analyzing THC concentration in exhaled breath. The more common method of analyzing blood concentration of THC or urinalysis is unable to determine whether THC consumption is acute or chronic as concentrations in blood and urine matrices can remain high long after consumption. By standardizing a method to analyze acute intoxication researchers will be able to determine a legal limit of intoxication for driving or other activities, police officers will be able to better regulate driving under the influence, and hospitals will be able to better treat those who come in with intoxication symptoms. 

This research highlights the importance of standardizing cannabis-induced intoxication levels. People often drive under the influence of alcohol and are frequently the cause of accidents, but have been legally determined to drive as long as their blood-alcohol level is under 0.08. As cannabis is still under-researched and not recognized as a medically beneficial substance by the federal government the standardization of cannabis-intoxication levels has not been formed. As medical marijuana continues to be legalized at state levels local government should take care to implement methods to judge acute intoxication to better protect citizens and allow patients who need to consume cannabis to live their lives as normally as possible. 


The study is available for review or download here

View more studies like this in the CED Foundation Archive 

To explore related information, click the keywords below:

Benjamin Caplan, MDAcute THC Consumption Can Be Determined From Breath Concentration
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The Characterization of Synthetic Cannabinoids Psychoses

Clinical characteristics of synthetic cannabinoidinduced psychotic disorders- a single-center analysis of hospitalized patients

In Summary

A recent clinical study in Russia has documented four clinical variants of cannabis-induced psychoses, as well as the signs to recognize them. The researchers limited their study to males, so it is uncertain if these psychotic disorders can also be seen in women. Patients admitted to the emergency room who claimed to have ingested synthetic cannabinoids or tested positive for synthetic cannabinoids during urinalysis and were then asked to give consent. After all of the participants were confirmed to be suffering from psychoses the researchers separated patients into four distinct groups defined by their characteristics and highlighted predominant symptoms so that others may efficiently identify the specific psychoses when a new patient is identified. The data provides a basis for future diagnostic techniques and management. 

The featured report emphasizes the importance of micro-dosing. The dose of cannabis is not reported in the article but is likely to include patients who overindulged in tetrahydrocannabinol (THC) which can have alarming effects. Microdosing prevents excess consumption by suggesting that patients start low and go slow when self-dosing their cannabis. It is also a good idea to keep a product that features cannabidiol (CBD) which mitigates the psychotic effects of THC. Patients should take care to minimize the amount of cannabis they consume so that any pain or other symptoms are treated but psychoactive effects are minimal.


The study is available for review or download here

View more studies like this in the CED Foundation Archive 

To explore related information, click the keywords below:

Benjamin Caplan, MDThe Characterization of Synthetic Cannabinoids Psychoses
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Cannabis for Rheumatic Pain is Under-researched

Cannabis for rheumatic pain- hope or hype?

In Summary

Despite the large number of patients utilizing cannabis for rheumatic pain there is a lack of clinical evidence for such use. A recent review has come out discussing the inconsistent results found amongst previous clinical trials that examine the effects of cannabis on patients with rheumatoid arthritis, fibromyalgia, and spinal pain. Previous studies have found a myriad of results, all uncertain when compared to each other or statistically analyzed despite the many online articles boasting about the benefits of cannabis for rheumatoid arthritis. Physicians of those suffering from chronic pain are advised to caution their patients and make them fully aware of the lack of clinical evidence, but also to push for clinical studies so that evidence can be provided as many continue to suffer. 

It is important to note the “known side effects” of cannabis are different depending on the person and consumption method. The author of the featured piece highlights the dangerous side effects including psychosis and short-term dizziness or sleepiness. Various cannabinoids have different effects and act on different receptors, meaning that blanketing the entire plant with a warning label is often misleading. Patients should discuss cannabis use with their physicians and should be careful to mind which cannabinoids they aim to use and the method of consumption as that can greatly affect the potency and perceived effects. Consume cannabis responsibly and continue reading blogs like this one or other well-researched articles to remain fully aware of current findings.  

The study is available for review or download here

View more studies like this in the CED Foundation Archive 

To explore related information, click the keywords below:

Benjamin Caplan, MDCannabis for Rheumatic Pain is Under-researched
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Beta-Caryophyllene Oxide Lessens the Sedative Effects of Alcohol

The sesquiterpene beta-caryophyllene oxide attenuates ethanol drinking and place conditioning in mice

In Summary

It has recently been revealed that the terpene beta-caryophyllene and its derivative, beta-caryophyllene oxide, are able to lessen the sedative effects of alcohol while not affecting its pharmacokinetics. Researchers determined that a high dose of ß-caryophyllene oxide was 10 times more effective at reducing the sedative effects than its precursor by conducting a loss of righting reflex (LORR) assay on mice who had been administered a consistent amount of ethanol. Interestingly the caryophyllene compounds were found to act on cannabinoid receptor 2 (CB2), not directly interact with the ethanol, and therefore not affect the pharmacokinetics of ethanol. This study provides a basis for further analysis of the mechanism for alcohol modulation by the endocannabinoid system. 

The need for research concerning drug interactions with cannabinoids, both endogenous, naturally occurring, or synthesized, is emphasized by this research. Opioid and cannabinoid interactions have been looked into but the results are inconsistent across the board, and very little is known about how cannabinoids interact with other common medications such as ibuprofen, birth control, blood thinners, and alcohol. This research is vital moving forward as state legislature continues to recognize the benefit of medical marijuana and chemists and pharmacists need to recognize how little is known about the mechanism behind the endocannabinoid systems far-reaching effects. 

The study is available for review or download here

View more studies like this in the CED Foundation Archive 

To explore related information, click the keywords below:

Benjamin Caplan, MDBeta-Caryophyllene Oxide Lessens the Sedative Effects of Alcohol
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A Flavonoid Improves Neurocognitive Function and Mood in Seniors

A highly bioavailable curcumin extract improves neurocognitive function and mood in healthy older people- A 12-week randomized, double-blind, placebo-controlled trial

In Summary

A recent study has revealed the neurocognitive benefits of curcumin, a flavonoid isolated from turmeric. Curcumin extract was given to a cohort of healthy, aged individuals over a 12-week period. At the end of that period improved working memory, as well as reduced fatigue and stress reactivity,  were all recorded effects. A preceding study recorded similar effects from curcumin extract that were seen at 4 weeks, suggesting that the supplement works quickly and maintains effectiveness. The extract, also known as LongvidaTM, improves overall hippocampal function and may prevent cognitive decline in aging individuals. 

The desire to prevent neurocognitive decline is evergrowing as individuals continue to be plagued by diagnoses of dementia, Alzheimer’s, and numerous other neurocognitive diseases associated with aging. Compounds found in cannabis plants, various cannabinoids, flavonoids similar to curcumin, and terpenes, have been found to have neuroprotective effects. If preventative measures can be found to delay or completely eradicate neurodegenerative diseases it would lessen the economic burden posed by such patients, ease the lives of caretakers, and allow patients for freedom and a better quality of life. Further research should continue to focus on this line of work. 

The study is available for review or download here

View more studies like this in the CED Foundation Archive 

To explore related information, click the keywords below:

Benjamin Caplan, MDA Flavonoid Improves Neurocognitive Function and Mood in Seniors
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