Cannabis

The Legal Issues Concerning State Medical Cannabis Programs

Emerging public health law and policy issues concerning state medical cannabis programs

In summary

As the medical cannabis industry grows and local governments continue to legalize medical cannabis use state programs are forced to set standards without the aid of the federal government. State governments are now facing the challenge of attempting to regulate medical cannabis while maintaining the safety of patients and the general public. States now have to regulate labeling with universal warning symbols, child-resistant packaging, advertising restrictions, and pesticide use while also addressing members of the public’s concern about the safety of medical cannabis. If cannabis is ever rescheduled in the future so that the federal government can standardize the regulation of cannabis practices across the nation it will be interesting to see how local practices change in accordance. 

Despite multiple petitions and new research, the federal government has refused to reschedule cannabis. Cannabis used to be an accepted medication before a few politicians, namely Harry Anslinger began a propaganda campaign, highlighted by the film Reefer Madness (1936), turning the public opinion away from medical cannabis. This was largely thought to be a move to further ostracize minorities, further segregating races as Anslinger connected marijuana to violence to immigrants from Mexico. Cannabis never became medically dangerous in the early 1900s, merely a tool used by politicians to induce public fear and reinforce racist tendencies. In the featured article it was stated that 9 out of 10 Americans support the use of medical marijuana yet cannabis still has yet to be rescheduled and the reasons behind it are unclear but may lead back to the original push to have cannabis outlawed in the first place.

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Benjamin Caplan, MDThe Legal Issues Concerning State Medical Cannabis Programs
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Adolescent Use is not Increased by Cannabis Legalization

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.  

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Benjamin Caplan, MDAdolescent Use is not Increased by Cannabis Legalization
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A Balanced Diet and Exercise Promotes Health via the Endocannabinoid System

Diet, endocannabinoids, and health

In summary

 It has recently been revealed that the endocannabinoid system plays a crucial role in the maintenance of health while aging. Researchers found that a aerobic exercise promotes endocannabinoid levels in the blood and the increased levels are positively associated with general well-being. The collected data shows that the endocannabinoid system is especially important for controlling appetite, improving systemic metabolism, and reducing obesity and diabetes. Diet and exercise both affect the overall function of the endocannabinoid system, highlighting the importance of maintaining a healthy lifestyle in order to promote health while aging. Further research should examine how cannabis-based supplements affect health while aging. 

The endocannabinoid system affects the function of various systems and organs within the body, emphasizing its potential as a therapeutic target. Even without the use of readily available cannabis, synthetic cannabinoids are being produced that aim to address a myriad of treatment-resistant disorders. Recent research has shown that cannabinoids provide benefits for more than just inflammation and pain or other disorders centered around the central nervous system and that their possible effects extend throughout the human body. Research into cannabinoids, synthetic or otherwise, as well as terpenes and flavonoids, should be highlighted in the near future to address cancer, anorexia nervosa, and other ailments that are notoriously difficult to treat.

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Benjamin Caplan, MDA Balanced Diet and Exercise Promotes Health via the Endocannabinoid System
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The Relation Between Conduct Disorder and Cannabis

Conduct disorder-related hospitalization and substance use disorders in American teens

In summary

Cannabis use was found to highly correlate with inpatients diagnosed with conduct disorder amongst teenagers. Although some cannabis use was self-reported by patients dealing with other psychiatric disorders, it was seen most significantly in those with conduct disorder (CD), suggesting a higher risk of comorbidity between CD and substance use disorders. Although cannabis use was the most common substance reported by patients it was closely followed by tobacco and alcohol use. The demographics of patients using cannabis varied although those suffering from CD and substance use disorder were primarily male and black. Further research should be conducted to develop efficient prevention strategies. 

Looking into the substance use frequency and patterns of stigmatized or marginalized groups is not often done leaving many populations without specialized treatment or prevention programs. If members of the male black population are at a higher risk of developing substance use disorders then our prevention efforts should address that population first and foremost. People begin using substances for different reasons although some motivations are common among certain populations. By examining the underlying motivation for substance use frequency members of the healthcare community may be able to develop custom prevention or treatment methods by utilizing psychology or another science to drastically decrease the frequency of substance use disorders in all populations. 

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Benjamin Caplan, MDThe Relation Between Conduct Disorder and Cannabis
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The Effect of Cooling Temperature on Growth Rates

Clothing the emperor- dynamic root–shoot allocation trajectories in relation to whole-plant growth rate and in response to temperature

In Summary

An article was recently published discussing how cooling the temperature of the environment a plant is growing in effects the overall growth pattern. Researchers specifically found that root–shoot biomass allocation and whole-plant growth rate varied ontogenetically in contrasting species in response to cooling. These variations in growth rates were seen in various strains of grass and flowering plants. The authors conclude that the findings of this study highlight the importance of measuring temporal growth dynamics rather than “snapshot” comparison, like height. Further research should expand to other species of plants beyond grasses and generic flowering plants found in most garden stores. 

Mass-produced cannabis plants tend to be grown in hydroponic set-ups like the plants in this study and are known to be sensitive to changes in growth factors. As the cannabis industry continues to grow the number of growers needed is increasing, stimulating the job market, but the number of at-home cultivators is also growing. For growers at home, it is important to note that the cannabinoids produced in a strain can vary depending on growth factors such as temperature, the mineral content of the soil, etc. They can purchase seeds of their favored strain grown in Colorado and grow an entirely different plant at their home in California. Consumers should be sure to consume a small dose or perfectly replicate growing conditions to ensure safe and effective consumption. 

The study is available for review or download here

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Benjamin Caplan, MDThe Effect of Cooling Temperature on Growth Rates
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Factors that Predict Cessation of Cannabis Use

Cessation of cannabis use- A retrospective cohort study

In summary

A retrospective cohort study conducted in Germany recently found that cessation of cannabis use can be predicted by a range of factors. Among those factors was older current age, being female, nonmigrant status, less sensation seeking, using psychological treatment, more peer cannabis use during youth and a more negative first experience with cannabis. Researchers also found that if survey-responders did not increase their frequency of use over the course of three years they were more likely to cease cannabis use. All of these factors are easy to determine early on and may lead to better prevention methods for those at a high risk of abuse.
As recreational and medical use continues to grow it seems that identifying risk factors for those who may abuse the benefits of cannabis increases in importance. If certain people are at risk of misusing cannabis and causing harm to their daily lives, for example by consuming psychoactive compounds and being unable to operate functionally within their environment, then their cannabis intake should be regulated and proper prevention methods should be put in place. Medical dispensaries are good for those just starting with cannabis because they have the freedom to experiment and figure out their ideal consumption methods and cannabinoid profile but it also allows patients the freedom to consume cannabis products that may not be very beneficial for them. It will be interesting to watch the changes in standardization as the prevalence of cannabis continues to grow.

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Benjamin Caplan, MDFactors that Predict Cessation of Cannabis Use
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Birth Defects Rose in Colorado Post-Cannabis Legalization

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. 

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Benjamin Caplan, MDBirth Defects Rose in Colorado Post-Cannabis Legalization
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Cannabis Use Causes Increased Impulsivity

Cannabis and alcohol use, affect and impulsivity in psychiatric out-patients’ daily lives

In Summary

A recent study revealed the increased impulsivity seen throughout the day in psychiatric out-patients who consumed cannabis. Cannabis was also found to increase momentary hostility in psychiatric patients, namely those suffering from bipolar disorder. The study also compared the difference of activity between alcohol and cannabis, finding that although alcohol also caused an increase in impulsivity it was only momentary rather than prolonged. By observing the effects of alcohol and cannabis in patients researchers were able to determine that the two compounds are part of separate processes and operate on different time-scales. 

Very little research has been conducted that addresses drug interactions with cannabis. As the prevalence of cannabis use continues to rise as state governments continue to legalize medical and recreational cannabis it is imperative to understand how cannabis affects everyday medications. For those who need blood thinners, muscle relaxants, etc., drug interactions can be dangerous, even fatal, emphasizing the importance of understanding how cannabis interacts with other medications at the cellular level. Pharmacists and physicians need more knowledge to be able to thoroughly inform patients consuming marijuana of the potential risks. Future research should be conducted, as well as chemical modeling studies, to ensure the safety of cannabis users. 

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Benjamin Caplan, MDCannabis Use Causes Increased Impulsivity
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The Canadian Association of Gastroenterology Requires Guidance when Recommending Medical Cannabis

Canadian Association of Gastroenterology position statement- use of cannabis in gastroenterological and hepatic disorders

In summary

The Canadian Association of Gastroenterology has stated that guidance is required on the issues of relevance for gastroenterologists who discuss cannabis benefits and harms with patients. In their statement, they reviewed the current evidence for cannabis use among common gastroenterological and hepatic disorders providing a brief statement and commentary.  Inflammatory bowel disease is not thought to benefit from cannabis use. Alcohol liver disease, nonalcoholic fatty liver disease, and GI symptom control are thought to benefit from cannabis due to the anti-inflammatory and anti-nociceptive effects. Further evidence is needed before the association can fully sign off on the medical use of cannabis for their patients but they acknowledge the potential of cannabis-based medications. 

Despite the fact that cannabis is now legal for medical and recreational use cannabis is not an approved therapeutic substance by Canada’s governing medical body. The legalization for recreational use across the country was recent (2018) and it should be interesting as a country where legalization is varied to watch the research and other policies that come out in the near future. Perhaps the findings of the Canadian government will provide American politicians the evidence they need to support or reject the medical benefits of cannabis.

The study is available for review or download here

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Benjamin Caplan, MDThe Canadian Association of Gastroenterology Requires Guidance when Recommending Medical Cannabis
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Addictive Disorders are Associated with Neuroticism, Low Agreeableness, and Low Conscientiousness

Big Five personality traits and alcohol, nicotine, cannabis, and gambling disorder comorbidity

In summary

In a recent study published by the American Psychological Association researchers determined that addictive disorders, like cannabis use disorder, are associated with neuroticism, low agreeableness, and low conscientiousness. Neuroticism, agreeableness, and conscientiousness are some of the Big Five personality traits, which was the taxonomy chosen by the researchers to examine possible personality underpinnings of addictive behavior and comorbidity. As all three of the traits were equally associated with substance use disorders they may explain the co-occurrence of addictive behaviors but these traits also may more broadly associate the propensity to develop any psychiatric disorder. Further research is needed to fully elucidate the relationship between neuroticism, agreeableness, and conscientiousness for substance use disorders as the research may lead to the development of better prevention programs. 

The idea of cannabis use disorder is interesting as the endocannabinoid system does not act upon the reward system, making the threat of addiction almost nil. Cannabis is often pedestilized by advocates for its safety profile, especially when compared to other pain medications like opioids, yet there are still some concerns for dependency. The endocannabinoid system is ever changing, especially as we learn more about it. Very little research has been done that assesses cannabis dependency although it is known that, like with most substances, frequent users gain a tolerance to cannabis.  Tolerance to cannabis can be reset with abstinence, supposedly for a 48 hour period, but again more research is needed. Tolerance, addiction, and dependence all need to be properly defined and standardized across the medical community, not just the advocates, because addiction and dependence can be frightening words that should not be thrown about.

The study is available for review or download here: https://drive.google.com/file/d/1xQqAEU3sr5niKtarRR_nUutUwDE6E4um/view?usp=sharing

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Benjamin Caplan, MDAddictive Disorders are Associated with Neuroticism, Low Agreeableness, and Low Conscientiousness
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