Archive for the ‘medical cannabis’ category

Minnesota: Lawmakers Approve Medical Marijuana Compromise Measure

May 19th, 2014

Minnesota House and Senate lawmakers, along with Democrat Gov. Mark Dayton, agreed late last week to legislation that seeks to provide access to limited preparations of cannabis to qualified patients.

The finalized language represents a compromise between dueling House (House File 1818) and Senate bills (Senate File 1641), both of which had passed their respective chambers. On Friday afternoon, House lawmakers approved the compromised bill by a vote of 89 to 40. Members of the Senate voted 46 to 16 for the amended measure, sending it to the Governor’s desk. 

Under the plan, state regulators intend to license two producers of cannabis and up to eight distribution centers. To be eligible to participate in the state’s program, patients need to possess a physician’s recommendation and be diagnosed with one of eight qualifying conditions (cancer/cachexia, glaucoma, HIV/AIDS, Tourette’s Syndrome, Amyotrophic Lateral Sclerosis, seizures — including those characteristic of epilepsy, severe and persistent muscle spasms — including those characteristic of multiple sclerosis, and/or Crohn’s Disease) and/or a terminal illness, and be registered with the state Department of Health.

Unlike other state medical cannabis programs, the Minnesota plan does not permit qualified patients to possess or obtain whole-plant cannabis. Instead, the forthcoming law mandates that state-licensed distribution centers provide oils, pills, and/or extracts prepared from the plant. Such products would be subject to laboratory testing for purity and potency. Patients’ health care provider must compile ongoing reports in regards to their patients’ progress.

Cannabis-based preparations are expected to be available to qualified patients by no later than July 1, 2015. Additional details on the forthcoming program are available here.

Florida Poll: Majority Of Voters Back Legalization, Super-Majority Endorse Medical Cannabis

May 5th, 2014

Nearly nine out of ten Floridians support legalizing the use of cannabis for medicinal purposes, and a majority support allowing adults to possess the plant for any purpose, according to the results of a statewide Quinnipiac University poll of registered voters.

Fifty-three percent of voters support “allowing adults in Florida to legally possess small amounts of marijuana for personal use.” Forty-two percent of respondents opposed the idea.

When Florida voters were polled in 2013, only 48 percent of respondents backed legalizing the plant.

Independents (61 percent), Democrats (59 percent), and men (58 percent) were most likely to endorse legalization, while women (48 percent) and Republicans (33 percent) were least supportive.

When asked whether patients ought to be able to access cannabis for medicinal purposes, public support rose to 88 percent. This November, Florida voters will decide on a proposed constitutional amendment that seeks to legalize and regulate the dispensing of cannabis to authorized patients. Because the measure seeks to amend the state constitution, 60 percent of voters must decide in favor of it before it may be enacted.

According to the poll, 45 percent of Florida voters — including 62 percent of those between the ages of 50 and 64 — acknowledge having tried cannabis.

The survey possesses a margin of error of +/- 2.6 percentage points.

Study: Medical Cannabis Laws Not Associated With Increased Use By Adolescents

April 22nd, 2014

The enactment of state laws legalizing the physician-recommended use of cannabis therapy is not associated with increased levels of marijuana use by young people, according to data published online in the Journal of Adolescent Health.

Researchers at Rhode Island Hospital and Brown University assessed the impact of medical cannabis laws by examining trends in reported drug use by high-schoolers in a cohort of states before and after legalization. Researchers compared these trends to geographically matched states that had not adopted medical marijuana laws.

Authors reported overall “no statistically significant differences in marijuana use before and after policy change for any state pairing,” and acknowledged that some states that had adopted medical cannabis laws experienced a decrease in adolescent’s self-reported use of the plant. “In the regression analysis, we did not find an overall increased probability of marijuana use related to the policy change,” they stated.

Investigators concluded, “This study did not find increases in adolescent marijuana use related to legalization of medical marijuana. … This suggests that concerns about ‘sending the wrong message’ may have been overblown. … Our study … may provide some reassurance to policy makers who wish to balance compassion for individuals who have been unable to find relief from conventional medical therapies with the safety and well-being of youth.”

A 2013 study published in the American Journal of Public Health similarly concluded that the passage of medical marijuana laws in various states has had no “statistically significant … effect on the prevalence of either lifetime or 30-day marijuana use” by adolescents residing in those states.

A 2012 study by researchers at McGill University in Montreal reported: “[P]assing MMLs (medical marijuana laws) decreased past-month use among adolescents … and had no discernible effect on the perceived riskiness of monthly use. … [These] estimates suggest that reported adolescent marijuana use may actually decrease following the passing of medical marijuana laws.”

Read the abstract of this latest study, “The Impact of State Medical Marijuana Legislation on Adolescent Marijuana Use,” online here.

Maryland: Governor Signs Marijuana Reform Measures Into Law

April 14th, 2014

Democrat Gov. Martin O’Malley today signed two separate pieces of legislation reforming the state’s marijuana laws.

Senate Bill 364 amends existing penalties for marijuana possession offenses involving ten grams or less from a criminal misdemeanor (presently punishable by arrest, up to 90 days in jail, a $500 fine, and a criminal record) to a non-arrestable, non-criminal fine-only offense ($100 fine for first-time offenders, $250 for second-time offenders). The new depenalization law takes effect on October 1, 2014.

House Bill 881 seeks to provide for the state-licensed production and dispensing of marijuana to qualified patients who possess a written certification from their physician. The new law will take effect on June 1, 2014, at which time the state shall establish a commission to draft rules and regulations overseeing the production and distribution of medical marijuana. However, the licensing program is not anticipated to be up and running until 2015.

Maryland is the 18th state to depenalize minor marijuana possession offenses to a non-arrestable offense. It is the 21st state to allow for the doctor-recommended access to medicinal cannabis.

Nevada: Governor Signs Cannabis Dispensary Measure Into Law

June 13th, 2013

Republican Gov. Brian Sandoval has signed legislation, Senate Bill 374, authorizing the creation of up to 66 not-for-profit [correction: facilities may be for profit] medical marijuana dispensaries.

Under the new law, state regulators are tasked with overseeing the creation of licensed establishments to produce, test, and dispense cannabis and cannabis-infused products to authorized patients. Nevada voters enacted a state constitutional amendment in 2000 mandating state lawmakers to allow for physicians to authorize qualified patients to consume and grow cannabis. However, that law did not provide for facilities where patients may obtain medicinal cannabis.

Approximately 3,800 Nevadans are presently authorized to grow and/or consume cannabis under state law.

Senate Bill 374 imposes limits on the home cultivation of cannabis if patients reside within 25-miles of an operating dispensary. However, patients who are cultivating specific strains of cannabis not provided by a local dispensary may continue to engage in the home cultivation of such strains. Patients who have an established history of cultivating medical cannabis prior to July 1, 2013, also may continue to do so until March 31, 2016.

The bill also amends possession limits from one-ounce to two and one-half ounces and increases plant cultivation limits from three mature plants to twelve.

Medical marijuana products dispensed by state-licensed facilities will be subject to standard state sales taxes as well as a 4 percent excise tax, of which 75 percent will be directed to education and 25 percent will be directed toward implementing and enforcing the regulations.

Arizona, Colorado, New Jersey, Maine, and New Mexico have state-licensed medical cannabis dispensaries up and running. Similar dispensary outlets are in the process of opening in Connecticut, Massachusetts, Rhode Island, Vermont, and Washington, DC.

Even More Science Suggesting That Cannabinoids May Halt Diabetes

June 10th, 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.

Oregon: Governor Signs Measure to Expand State’s Medical Cannabis Program to Include Patients With Post Traumatic Stress

June 7th, 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.

Michigan: Medical Marijuana Act Trumps Per Se Driving Law

May 22nd, 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.”

NORML To Provide Educational Content To TheAnswerPage.com

February 22nd, 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.

Study: Vaporized, Low-Potency Cannabis Mitigates Neuropathic Pain

January 3rd, 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.