Cannabinoid Drugs May Slightly Increase Pain Threshold

MedicalResearch.com Interview with:
“Cannabis” by Don Goofy is licensed under CC BY 2.0Martin De Vita, MS

Doctoral Candidate
Clinical Psychology Department
Syracuse University

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: Despite widely held beliefs that cannabis is effective for pain relief, experimental trials have produced mixed results. As result, the analgesic properties of cannabinoid drugs have remained poorly understood. We aimed to clarify these findings by extracting data from every available experimental pain study and analyzing the results as a whole. We found that numerous aspects of pain were being influenced in different ways. We found that cannabinoid drugs did not significantly reduce the intensity of experimental pain, but they did produce small-sized reductions in pain unpleasantness. Cannabinoids produced significant analgesic effects on pain threshold and tolerance. There was no significant effect of cannabinoids on mechanical hyperalgesia. Continue reading

Cannabis Users Have Increased Neural Activity, Even at Rest

MedicalResearch.com Interview with:

Dr. Francesca M. Filbey PhD Professor Program Head, Cognition and Neuroscience PhD Bert Moore Chair in BrainHealth UT Dallas

Dr. Filbey

Dr. Francesca M. Filbey PhD
Professor
Program Head, Cognition and Neuroscience PhD
Bert Moore Chair in BrainHealth
UT Dallas

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The cannabis literature has generally focused on changes in brain function when engaged in a task. We were interested in examining whether these differences are present when not engaged in a task (i.e., during resting state) to understand baseline functional organization of the brain. Changes to baseline functional organization may reflect changes in brain networks underlying cognition. We also wanted to investigate whether specific brain waves, as measured by electroencephalography (EEG), are associated with measures of cannabis use, such as craving.

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More Than 2 Million High School Students Have Used Marijuana in an E-Cigarette

MedicalResearch.com Interview with:

Katrina Trivers, PhD, MSP Lead author and lead epidemiologist Office on Smoking and Health CDC

Dr. Trivers

Katrina Trivers, PhD, MSP
Lead author and lead epidemiologist
Office on Smoking and Health
CDC

MedicalResearch.com: What is the background for this study?

Response: Although we’ve seen considerable declines in the use of regular cigarettes among U.S. youth over the past several decades, the tobacco product landscape is evolving, and the use of other tobacco products have become increasingly popular. For example, as of 2014, e-cigarettes have become the most commonly used tobacco product among US youth. During 2011-2015, e-cigarette use increased 900% among U.S. high school students before declining in 2016. No change was observed in 2017, with about 2 million youth, including 12% of high school students and 3% of middle school students, reporting they had used e-cigarettes in the past 30 days.

This is a public health concern because the use of any form of tobacco product is unsafe among youth, irrespective of whether it’s smoked, smokeless, or electronic. The U.S. Surgeon General has concluded that the aerosol emitted from e-cigarettes is not harmless. It can contain harmful ingredients, including nicotine, carbonyl compounds, and volatile organic compounds known to have adverse health effects. The nicotine in these products is of particular concern given that nicotine exposure during adolescence can cause addiction and can harm the developing adolescent brain.

In recent years, many youth have also been using other psychoactive substances in e-cigarettes, including cannabinoids and other illicit drugs. This could have been fueled, in part, by shifts in the social acceptability and access to cannabis as several states have or are considering legalized cannabis sales for adults. A previous CDC study found that in 2015, almost 1 in 3 students reported using e-cigarettes with non-nicotine substances. However, it wasn’t possible to identify what exactly those substances were based on the question. Given the high concurrent use of tobacco and other substances, including cannabis, a more detailed question was added to a future survey to assess the use of cannabis in e-cigarettes among U.S. youth. This study presents the findings from that question.

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Patient-Reported Symptom Relief Following Medical Cannabis Consumption

MedicalResearch.com Interview with:

Jacob M. Vigil, PhD
Department of Psychology
University of New Mexico

MedicalResearch.com: What is the background for this study?

 

Response: For the past several years we have been using observational research designs as a means to overcome some of the logistical and legal barriers for conducting patient outcomes medical cannabis research. In partnership with the software developers of the Releaf App which currently is the largest repository of user-entered information on the consumption and effects of cannabis use in the United States, we have been able to measure how patients choose to consume cannabis and the effects of those choices in real-time.  Since its release in 2016, the commercially developed Releaf App has been the only publicly available, incentive-free patient educational software program designed for recording how individual cannabis usage sessions correspond to immediate changes in symptom intensity levels and experienced side effects.

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Breast Milk Can Contain THC From Cannabis For Almost a Week

MedicalResearch.com Interview with:

“Cannabis sativa” by Manuel is licensed under CC BY 2.0

cannabis

Christina Chambers, PhD, MPH
Principal investigator
Professor in the Department of Pediatrics
UC San Diego School of Medicine
Drector of clinical research at Rady Children’s Hospital
San Diego 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Although cannabis is one of the most common recreational drugs used by pregnant and breastfeeding women, there is little current research regarding potential exposure of the breastfed infant.  As a result, pediatricians are lacking concrete evidence to help support advice to breastfeeding mothers who use cannabis.  This is particularly important as cannabis products available today are substantially more potent than products available in years past.

Our group in the Department of Pediatrics at the University of California San Diego (UCSD) Center for Better Beginnings was interested in first determining how much if any of the ingredients in cannabis actually transfer into breastmilk and how long these metabolites might stay in the milk after the mom’s last use.  We invited mothers who are participating in our UCSD Human Milk Research Biorepository from across the U.S. and Canada to respond to questions about use of cannabis products over the previous 14 days and to provide a breast milk sample.

Fifty mothers participated in the study.  Samples were analyzed by investigators from the UCSD Skaggs School of Pharmacy.

Our major finding was that low, but measurable levels of THC, the main psychoactive ingredient in cannabis, were found in about 2/3 of the samples.  Although the number of hours after mother’s last use of cannabis that THC was still measurable varied widely, the longest time since mother’s last use that THC was still present was about 6 days.  Continue reading

Accelerated Aging Seen on Brain Imaging with Schizophrenia and Cannabis Use

MedicalResearch.com Interview with:

Dr. Daniel G. Amen MD Amen Clinics, Inc., Founder Costa Mesa, CA

Dr. Daniel Amen

Dr. Daniel G. Amen MD
Amen Clinics, Inc., Founder
Costa Mesa, CA

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: In the largest known brain imaging study, scientists evaluated 62,454 brain SPECT (single photon emission computed tomography) scans of more than 30,000 individuals from 9 months old to 105 years of age to investigate factors that accelerate brain aging.

SPECT was used to determine aging trajectories in the brain and which common brain disorders predict abnormally accelerated aging. It examined these functional neuroimaging scans from a large multi-site psychiatric clinic from patients who had many different psychiatric disorders, including bipolar disorder, schizophrenia and attention deficit hyperactivity disorder (ADHD).  Researchers studied 128 brain regions to predict the chronological age of the patient.

Older age predicted from the scan compared to the actual chronological age was interpreted as accelerated aging.  The study found that a number of brain disorders and behaviors predicted accelerated aging, especially schizophrenia, which showed an average of 4 years of premature aging, cannabis abuse (2.8 years of accelerated aging), bipolar disorder (1.6 years accelerated aging), ADHD (1.4 years accelerated aging) and alcohol abuse (0.6 years accelerated aging).  Interestingly, the researchers did not observe accelerated aging in depression and aging, which they hypothesize may be due to different types of brain patterns for these disorders.

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Brain Imaging Reveals How Prolonged Intermittent Cannabis Can Induce Memory Deficits

MedicalResearch.com Interview with:

Dr. Italia V. Rolle, PhD and Dr. Tim McAfee, MD Office on Smoking and Health National Center for Chronic Disease Prevention and Health Promotion CDC

Ana Maria Sebastião, PhD
Professor of Pharmacology and Neurosciences
Director Institute of Pharmacology and Neurosciences, Faculty of Medicine and
Francisco Mouro, PhD
Unit of Neurosciences, Institute of Molecular Medicine
University of Lisbon, Portugal

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: There is pressing need to comprehend how cannabinoid exposure impacts brain functioning. While cannabinoid-related research has increased exponentially in the last decade, the mechanisms through which cannabinoids affect brain functioning are still elusive. Specifically, we need to know how prolonged cannabinoid exposure affects important cognitive processes, such as memory, and also find the roots of those effects. This is particularly relevant considering that several countries have already approved cannabis-based medicines.

In this sense, our work sheds new light into the mechanisms underlaying the memory-deficits provoked by a continuous exposure to a cannabinoid drug. More precisely, using brain imaging techniques, we found that long-term exposure to a synthetic cannabinoid drug impairs the ability of key brain regions involved in learning and memory to communicate with each other. Our data points to the necessity of considering cannabinoid actions in a broader perspective, including brain circuitry and communication.  Continue reading

Study Identifies How Medical Marijuana May Ease IBD Symptoms

MedicalResearch.com Interview with:

Beth A. McCormick, Ph.D. Professor and Vice Chair | Department of Microbiology & Physiological Systems Founding Executive Director | University of Massachusetts Center for Microbiome Research Board of Editors | Gastroenterology University of Massachusetts Medical School Worcester, MA 01655

Dr. McCormick

Beth A. McCormick, Ph.D.
Professor and Vice Chair | Department of Microbiology & Physiological Systems
Founding Executive Director | University of Massachusetts Center for Microbiome Research
Board of Editors | Gastroenterology
University of Massachusetts Medical School
Worcester, MA 01655

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: There has been extensive, but to date mostly anecdotal, support for a beneficial role for cannabinoids and cannabis-derived agents to provide benefit for symptoms in individuals suffering from intestinal inflammatory disease (IBD).

Our studies have provided one possible rationale for these previous findings: that there is a constitutively active efflux system at the luminal surface of cells that line the intestine that pumps out one class of lipids of the family known as endocannabinoids. In doing so, the intestine floods this surface with these endocannabinoids in a manner that counteracts the actions of a particular potent stimulators of intestinal inflammation that appears to be over-active in certain forms of IBD. This is most significant because a number of cannabinoids and cannabis-derived agents can mimic the actions of this class of endocannabinoids. Moreover, while cannabinoids and endocannabinoids have been shown to provide anti-inflammatory actions, these studies have identified one mechanism used by the body to localize and focus this protective function at a critical site where pro-inflammatory and anti-inflammatory events intersect, providing new insights into how to treat that imbalance in these process that occurs in certain forms of IBD.

Therefore, there is the immediate opportunity to use this research to identify new therapeutic strategies to treat individuals suffering from IBD that could include either agents extracted from marijuana plants or novel molecules selected based upon superior properties made obvious by this newly defined mechanism.

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Pancreatic Cancer: Cannabidiol + Chemotherapy Improved Survival (in mice)

MedicalResearch.com Interview with:

Prof Marco Falasca Head Metabolic Signalling Group  School of Pharmacy & Biomedical Sciences | Faculty of Health Sciences Curtin University Western University

Prof. Falasca

Prof Marco Falasca
Head Metabolic Signalling Group
School of Pharmacy & Biomedical Sciences
Faculty of Health Sciences
Curtin University
Western University

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: Each year around 9,800 people in the UK are diagnosed with pancreatic cancer. The disease is particularly aggressive and has one of the lowest survival rates of all cancers.

Indeed, the life expectancy for pancreatic cancer patients has barely changed in the last 40 years because there are very few, and mostly only palliative care, treatments available. Given the five-year survival rate for people with pancreatic cancer is less than seven per cent, the discovery of new treatments and therapeutic strategies is urgently needed.

In this study, we decided to concentrate on a protein, named GPR55, found in high levels in pancreatic cancer. Our results show that GPR55 promotes pancreatic cancer progression. Consequently, we decided to use its inhibitor cannabidiol, a naturally occurring constituent of medicinal cannabis, as a pharmacological strategy to block GPR55 activity.

Strikingly, mice with pancreatic cancer that were treated with cannabidiol alongside chemotherapy, survived almost three times longer than those treated with chemotherapy alone, our study reports.  Continue reading

COPD: Vaporized Cannabis Did Not Reduce Breathlessness or Improve Exercise Capacity

MedicalResearch.com Interview with:

“Cannabis sativa” by Manuel is licensed under CC BY 2.0

cannabis

Sara Abdallah, PhD Student, first author and
Dennis Jensen, PhD Associate Professor,
Department of Kinesiology and Physical Education
Associate Dean – Infrastructure, Faculty of Education
Director, McGill Research Center for Physical Activity and Health
Canada Research Chair in Clinical Exercise & Respiratory Physiology
Associate Member, Translational Research in Respiratory Diseases Program
Research Institute of the McGill University Health Center

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: Many patients with chronic obstructive pulmonary disease (COPD) suffer from severe breathlessness at rest and on minimal exertion despite receiving optimal drug therapy for their underlying disease (e.g., bronchodilators). In these patients, breathlessness significantly diminishes exercise capacity and quality of life. Thus, research focused on identifying adjunct therapies for management of breathlessness in patients with advanced COPD is clinically relevant.

A series of studies conducted in the 1970’s found that smoked cannabis caused bronchodilation (i.e., improved airway function) in healthy individuals and in patients with asthma. More recently, it has been demonstrated that delta-9 (∆9)-tetrahydrocannabinol (THC, the major cannabinoid constituent of cannabis) inhibits cholinergic contractions in isolated human bronchi and that a positive association exists between measure of lung function (e.g., forced expiratory volume in 1-sec) and cannabis use in patients with COPD. These studies lead us to hypothesize that inhalation of vaporized cannabis may alleviate exertional breathlessness and improve exercise tolerance in patients with advanced COPD by improving airway function at rest and during exercise. Continue reading

Study finds Cannabis Use Not Associated With Increased Suicide Risk in Patients with Psychiatric Disorders

MedicalResearch.com Interview with:

“Cannabis sativa” by Manuel is licensed under CC BY 2.0

Leen Naji, BHSc, MD
Family Medicine Resident
McMaster University

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Cannabis use has consistently been linked to suicide attempt in the general population, but little data exists linking the association between cannabis use and suicide attempt amongst patients with psychiatric disorders. This is important data as we know that patients with psychiatric disorders are both more likely to use cannabis and to attempt suicide. Therefore, our goal was to study the association between cannabis use and suicide attempt amongst patients with psychiatric disorders. Additionally, since we know that women are more likely to suffer from mental health disorders, are more likely to attempt suicide and are more likely to incur the deleterious consequences of drug use at lower doses, we sought to compare the association between cannabis use and suicide attempt in men and women amongst our study population.

We conducted our analysis on a large sample of over 900 adults with psychiatric disorders (465 men, 444 women), of whom 112 men and 158 women had attempted suicide. The average age of our study sample was 40 years.

We found that cannabis use is not associated with an increased risk of suicide in patients with psychiatric disorders, though this association may vary when looking at specific subpopulations and/or amount of cannabis use. For instance, we found that heavier cannabis use is associated with an increased risk of suicide attempt amongst men with psychiatric disorders. Specifically, there was a 3% increased risk of suicide attempt for every day of cannabis use per month in men with psychiatric disorders. We also found that amongst those with psychiatric conditions, women, unemployed individuals and those with a mood disorder were at increased risk of suicide attempt.   Continue reading

Age of First Pot Smoking Does Matter

MedicalResearch.com Interview with:
Natalie Castellanos Ryan, PhD

École de Psychoéducation
Université de Montréal
Outremont Canada 

MedicalResearch.com: What is the background for this study?

Response: Our study followed a group of boys living in low socioeconomic neighbourhoods in Montreal (N=1030) from early childhood to 28 years of age to investigate:

1) whether the age at which one starts to use cannabis across adolescence is associated with the risk of developing drug abuse by early adulthood, when one controls for  arrange of known risk factors for cannabis use and problems assessed across development (risk factors in childhood, adolescence and early adulthood); and

2) the developmental pathways from early risk factors to drug abuse problems.

To examine these associations, the study collected  self-reported cannabis use information from these boys annually from ages 13 to 17 years and drug abuse symptoms at 28 years, as well as teacher, parent and child reported information on a number of environmental (family and friend) and child characteristics (e.g., impulsivity, delinquency, school performance) across childhood and adolescence. Alcohol and other drug use was also assessed across adolescence and early adulthood.

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Less Restrictive Marijuana Laws Linked To Reduced Opioid Prescriptions

MedicalResearch.com Interview with:

Dr. Italia V. Rolle, PhD and Dr. Tim McAfee, MD Office on Smoking and Health National Center for Chronic Disease Prevention and Health Promotion CDC

Marijuana plant

Hefei Wen, PhD
Assistant Professor, Department of Health Management & Policy
University of Kentucky College of Public Health 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Marijuana is one of the potential, non-opioid alternatives that can relieve pain at a relatively lower risk of addiction and virtually no risk of overdose. Medical and adult-use marijuana laws, has made marijuana available to more Americans. Yet no study to date has focused on the effect of medical and adult-use marijuana laws on opioid prescribing in particular.

Our study provides some of the first empirical evidence that the implementation of medical and adult-use marijuana laws between 2011 and 2016 was associated with lower opioid prescribing rates and spending among Medicaid enrollees.   Continue reading

States with Medical Cannabis Dispensaries Had Bigger Drop in Opioid Prescriptions

MedicalResearch.com Interview with

“Cannabis sativa” by Manuel is licensed under CC BY 2.0

David Bradford, Ph.D.
Busbee Chair in Public Policy
Department of Public Administration and Policy
University of Georgia
Athens, GA 30602

MedicalResearch.com: What is the background for this study?

Response: To give you some background, in 2016, part of our research team (Bradford and Bradford) published the first study to directly examine the impact that medical cannabis laws (MCLs) may be having on prescription use. We used yearly physician-level Medicare Part D data, looked at nearly all prescription drugs used to treat 9 broad categories of illness/diagnoses, and found substantial reductions in prescriptions. We published a follow-up study in 2017, this time using data from Medicaid Fee-for-Service.

Again, we found significant substitution away from prescription medications. In both of these studies, pain was included in the list of conditions for which cannabis may be used in patients, and in both studies, pain prescriptions fell. One of the unanswered questions from both of those studies, though, was what *type* of pain medications were being reduced.  From a public health standpoint, when we’re worried about opioid overdose, it matters whether the substitution away from pain medications is coming from substitutions away from things like NSAIDs or whether there is substitution away from opioids.

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Teen Marijuana Use Did Not Increase After Passage of Medical Marijuana Laws

MedicalResearch.com Interview with:
“medical marijuana : strains and varieties” by torbakhopper is licensed under CC BY 2.0Professor Deborah Hasin PhD
Department of Epidemiology in Psychiatry
Mailman School of Public Health
Columbia University

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: We began to think about this study after we published an earlier report (Hasin et al., The Lancet Psychiatry 2015) showing that after state medical marijuana laws (MML) were passed, U.S. teen marijuana use did not increase compared to the period before the laws were passed and to overall national trends. However, people continued to question whether MML led to teen increases in marijuana use. Therefore, in the present study, we combined findings from 11 large-scale national studies of teens to provide a more definite answer.

The findings were clear that teen marijuana use did not increase after passage of medical marijuana laws.  Continue reading

More Car Crashes on 4/20 Marijuana Celebration Day

MedicalResearch.com Interview with:
Dr. John A Staples, MD, FRCPC, MPH Scientist, Centre for Health Evaluation and Outcome Sciences Clinical Assistant Professor University of British ColumbiaDr. John A Staples
MD, FRCPC, MPH
Scientist, Centre for Health Evaluation and Outcome Sciences
Clinical Assistant Professor
University of British Columbia

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Around 64 million Americans live in states that have legalized recreational marijuana. Many policymakers are trying to figure out what that means for traffic safety.

On April 20th, some Americans participate in an annual “4/20” counterculture holiday that celebrates and promotes the use of cannabis. Some 4/20 events such as those in Denver and San Francisco involve thousands of participants. Much like celebrations at midnight on New Year’s eve, public 4/20 events sometimes mark 4:20 p.m. by a countdown followed by synchronized mass consumption of cannabis. We thought this was a perfect natural experiment to evaluate the influence that cannabis intoxication has on the risk of motor vehicle crash.

To examine this question, we analyzed 25 years of data on all fatal traffic crashes in the United States. We compared the number of drivers in crashes between 4:20 p.m. and midnight on April 20th to the number of drivers in crashes during the same time interval on control days one week earlier and one week later.

We found that the risk of crash involvement was 12% higher on April 20th than on control days. In the subgroups of drivers younger than 21 years of age, the risk of crash involvement was 38% higher on April 20th than on control days.

Assuming fewer than 12% of Americans celebrate 4/20, our results suggest that substance use at April 20th celebrations more than doubles the risk of fatal crash.

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Marijuana Dispensaries Have Ability To Reduce Opioid Overdoses and Substance Abuse

MedicalResearch.com Interview with:

MedicalResearch.com Interview with: David Powell  PhD Economist; Core Faculty, Pardee RAND Graduate School RAND, Santa Monica     MedicalResearch.com:  What is the background for this study?  What are the main findings?   Response: There has been some research suggesting that the adoption of state medical marijuana laws leads to reductions in prescriptions for opioid analgesics among certain populations and opioid-related overdoses overall.  However, medical marijuana laws are very different across states and they have changed over time as well.  We wanted to understand what components of a medical marijuana law could potentially lead to reductions in overdoses and substance abuse.  We focused specifically on the role of dispensaries, given their importance in providing access to medical marijuana, and tested for different effects in states with and without legally-protected and operational dispensaries.  We found that dispensaries are critical to reduce opioid-related overdoses and substance abuse.  We also found evidence that more recently-adopting states have experienced smaller reductions in overdoses and opioid substance abuse, potentially because the more recent adopters tend to enforce more stringent guidelines for dispensaries than the early adopters.   MedicalResearch.com: What should readers take away from your report?  Response: We find that the introduction of medical marijuana dispensaries has the potential to reduce opioid-related harms quite significantly.  More broadly, it also suggests that, when we think about the opioid crisis, improving access to pain management alternatives may be a useful mechanism for reducing dependence on opioids.        MedicalResearch.com: What recommendations do you have for future research as a result of this work?  Response: During most of the time period that we studied, prescription opioids were driving the opioid crisis, but it has recently transitioned to the point where heroin and illicit synthetic opioids are playing more prominent roles.  We are hesitant to suggest that medical marijuana access will have the same scope in a climate in which synthetic opioids and heroin are the primary substances of abuse.  Future work could do more to explore the potential of different types of medical marijuana laws to reduce overdoses related to these substances.        Citations: Do medical marijuana laws reduce addictions and deaths related to pain killers? ☆ •David Powella, , ,  •	Rosalie Liccardo Paculaa, b,  Mireille Jacobsonb  RAND, Santa Monica, United States  NBER Cambridge, MA, United StatesUniversity of California, Irvine, United States Received 14 November 2015, Revised 15 August 2017, Accepted 30 December 2017, Available online 3 February 2018  Journal of Health Economics Volume 58, March 2018, Pages 29–42  https://doi.org/10.1016/j.jhealeco.2017.12.007     The information on MedicalResearch.com is provided for educational purposes only, and is in no way intended to diagnose, cure, or treat any medical or other condition. Always seek the advice of your physician or other qualified health and ask your doctor any questions you may have regarding a medical condition. In addition to all other limitations and disclaimers in this agreement, service provider and its third party providers disclaim any liability or loss in connection with the content provided on this website.

Dr. Powell

David Powell  PhD
Economist; Core Faculty, Pardee RAND Graduate School
RAND, Santa Monica 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: There has been some research suggesting that the adoption of state medical marijuana laws leads to reductions in prescriptions for opioid analgesics among certain populations and opioid-related overdoses overall.  However, medical marijuana laws are very different across states and they have changed over time as well.  We wanted to understand what components of a medical marijuana law could potentially lead to reductions in overdoses and substance abuse.  We focused specifically on the role of dispensaries, given their importance in providing access to medical marijuana, and tested for different effects in states with and without legally-protected and operational dispensaries.

We found that dispensaries are critical to reduce opioid-related overdoses and substance abuse.  We also found evidence that more recently-adopting states have experienced smaller reductions in overdoses and opioid substance abuse, potentially because the more recent adopters tend to enforce more stringent guidelines for dispensaries than the early adopters.   Continue reading

Insufficient Evidence To Determine Cardiovascular Risks of Marijuana

Dr. Italia V. Rolle, PhD and Dr. Tim McAfee, MD Office on Smoking and Health National Center for Chronic Disease Prevention and Health Promotion CDC

Marijuana plant (Cannabis sativa)

MedicalResearch.com Interview with:
Divya Ravi, MD, MPH

The Wright Center for Graduate Medical Education
Scranton, PA

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: There is evidence to suggest that Marijuana can bring about changes at the tissue level and has the ability to potentiate vascular disease, in ways similar to tobacco.  With change in legalization and increase usage trends, we conducted this review to examine the known effects of marijuana on cardiovascular outcomes and risk factors, given that cardiovascular disease remains the greatest cause of morbidity and mortality worldwide.

Our review found insufficient evidence to draw meaningful conclusions that marijuana use is associated with cardiovascular risk factors and outcomes. The few studies that suggested a possible benefit from marijuana use, were cross-sectional, and were contradicted by more robust longitudinal studies that reported potential harmful effects.

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Fewer Cigarettes But More Vaping Among Today’s Adolescents

MedicalResearch.com Interview with:
“Checking your phone and vaping as you do” by Alper Çuğun is licensed under CC BY 2.0
Richard Allen Miech, PhD
Research Professor, Survey Research Center
Institute for Social Research
University of Michigan 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Monitoring the Future conducts annual, nationally-representative surveys of ~45,000 adolescents every year to assess trends in substance use.  We track which drugs are gaining traction among adolescents and which are falling out of favor.  The survey draws separate, nationally-representative samples of 8th, 10th, and 12th grade students from about 400 total schools every year.  Once a recruited school agrees to participate, a field interviewer travels to the school to administer the paper-and-pencil survey, typically in classrooms.  The project is funded by the National Institute of Drug Abuse and is carried out by the University of Michigan.  More details on the project’s survey design and survey procedures can be found in chapter 3 here: http://monitoringthefutu re.org/pubs/monographs/mtf- vol1_2016.pdf

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Local Politics Determine How Cannabis Is Distributed and Marketed By Dispensaries

MedicalResearch.com Interview with:

MedicalResearch.com Interview with: Greta Hsu PhD Graduate School of Business Stanford University, Graduate School of Business   MedicalResearch.com: What is the background for this study? What are the main findings?  Response:  My co-authors, Ozgecan Kocak at Emory University and Balazs Kovacs at Yale University, and I became interested in the cannabis industry in early 2014, when Colorado and Washington states were in the early stages of licensing recreational cannabis operations.  As organizational researchers, we were interested in how the emergence of the new legalized recreational-use dispensary stores would impact existing medical cannabis dispensaries that had already been in existence for years in both states.  For decades, activists and many dispensaries had framed cannabis as medicine that relieves pain for patients suffering from a wide variety of illnesses.  As recreational-use legalization took hold, would medical dispensaries emphasize their identities as medical providers or downplay their medical orientation to compete directly for potential customers?  We found that some clusters of dispensaries were more conservative in their marketing, continuing and even accentuating an organizational identity focused on therapy and patients.  This was reflected in statements like: “We aim to educate our patients about cannabis treatments and other alternative health approaches to supplement their medicine.”  Counties where the majority of voters voted against legalizing recreational marijuana tended to encourage this increasing focus on therapy.  Dispensaries that embraced the new recreational market took more risk by advertising to a broader, emerging consumer class, which has been bolstered by a growing tourism industry.  These dispensaries de-emphasized their medical orientation and focused more on themes such as product variety and prices.  Dispensaries with this more recreational-oriented marketing tended to be in counties that voted in favor of legalizing recreational use.  Overall, our research suggests local communities hold a great deal of power in affecting how dispensaries present themselves both to consumers and the broader population.  MedicalResearch.com: What should clinicians and patients take away from your report? Response:  In states that have legalized cannabis for adult recreational-use and sales, the law often gives local municipalities flexibility in deciding how easily dispensaries can operate within their boundaries. Many counties have chosen to ban cannabis-related businesses. Others are carefully regulating sales and businesses through zoning and taxes.  Our research suggests that dispensaries are responsive to the level of concern raised by local community members about recreational-use cannabis.  How dispensaries choose to market and present themselves will be shaped by their need to project a positive organizational identity and be accepted as legitimate members of the local community.   MedicalResearch.com: What recommendations do you have for future research as a result of this study?  Response: Many national polls indicate strong support for legalizing the use of cannabis for medical and, to a somewhat lesser degree, recreational uses.  The progression of state-level legalization has been fast and is likely to continue in the coming years.  The overall landscape in the United States is incredibly complex.  Different states has enacted different types of state-level regulations, and different localities within each of these states also differ widely in the types of regulations enacted.  Future research studying dynamics in different states is needed to better understand how this fast-growing industry will continue to evolve.   MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.  Citation: Co-opt or co-exist? A study of medical cannabis dispensaries’ identity-based responses to recreational-use legalization in Colorado and Washington Greta Hsu* University of California, Davis Özgecan Koçak Emory University Balázs Kovács Yale University https://gsm.ucdavis.edu/sites/main/files/file-attachments/cannabis_os_final.pdf  Note:  Content is Not intended as medical advice.  Please consult your health care provider regarding your specific medical condition and questions.

Dr. Hsu

Greta Hsu PhD
Graduate School of Business
Stanford University, Graduate School of Business

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: My co-authors, Ozgecan Kocak at Emory University and Balazs Kovacs at Yale University, and I became interested in the cannabis industry in early 2014, when Colorado and Washington states were in the early stages of licensing recreational cannabis operations.  As organizational researchers, we were interested in how the emergence of the new legalized recreational-use dispensary stores would impact existing medical cannabis dispensaries that had already been in existence for years in both states.

For decades, activists and many dispensaries had framed cannabis as medicine that relieves pain for patients suffering from a wide variety of illnesses.  As recreational-use legalization took hold, would medical dispensaries emphasize their identities as medical providers or downplay their medical orientation to compete directly for potential customers?

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What Impact Have State-Level Laws Had on Marijuana Use?

MedicalResearch.com Interview with:

MedicalResearch.com Interview with: Christine Mauro PhD Assistant Professor Biostatistics Columbia University Medical Center   MedicalResearch.com: What is the background for this study? What are the main findings?  Response:  As of November 2016, 28 states have legalized medical marijuana. Several previous studies have found an increase in use for adults after legalization, but not for adolescents.  We wanted to examine whether these age-specific findings varied by gender.  Consistent with past findings, we found past-month marijuana use did not increase after enactment of medical marijuana laws in men or women ages 12-25. Among people 26+, past-month marijuana use increased for men from 7.0% before to 8.7% after enactment (+1.7%, p<0.001) and for women from 3.1% before to 4.3% after enactment (+1.1%, p=0.013). Daily marijuana use also increased after enactment in this age group for both genders (men: 16.3% to 19.1%, +2.8 %, p=0.014; women: 9.2% to 12.7%, +3.4%, p=0.003). There were no statistically significant increases in past-year Marijuana Use Disorder prevalence for any age or gender group after medical marijuana law enactment.    MedicalResearch.com: What should clinicians and patients take away from your report? Response:  The readers should take away several things.  First, despite men being more likely to use marijuana than women are in all age groups, there were relatively few gender differences in terms of the impact of medical marijuana on marijuana use. Second, we found no evidence of an effect of medical marijuana law enactment in any marijuana use outcome for both men and women aged 12-17.  Lastly, we did see an increase in both past-month use and daily use among past-year users in both men and women aged 26+ after enactment, but no changes in past year marijuana used disorder.    MedicalResearch.com: What recommendations do you have for future research as a result of this study?  Response: Because most states in our sample more recently passed medical marijuana laws, it is possible that not enough time has elapsed to observe meaningful and significant changes in Marijuana Use Disorder. Given the impact Marijuana Use Disorder may have on individuals, families, and society, the prevalence of Marijuana Use Disorder should continue to be monitored regularly.   Second, there is considerable variation across provisions included in different states’ medical marijuana laws; some aspects, such as allowances on home cultivation or dispensaries, might have a role in changes in several health outcome indicators.  In addition, eight states have now legalized recreational marijuana, which may also have an impact on marijuana use outcomes over time. Future analyses should account for this variability in marijuana related policies.   MedicalResearch.com: Is there anything else you would like to add? Response: As marijuana use becomes more prevalent, monitoring state-wide trends in marijuana use by age and gender is important for public health planning. In particular, efforts to prevent and limit injury that may be associated with specific activities, such as driving, may be needed as daily marijuana use increases among adults. Downstream effects, either positive or negative, of a growing proportion of the adult population reporting daily marijuana use in states with medical marijuana laws warrants further attention. Disclosure: This work was supported by the National Institutes of Health, National Institute on Drug Abuse (grant R01 DA037866 to S. S. Martins).   MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.  Citation: Christine M. Mauro, Paul Newswanger, Julian Santaella-Tenorio, Pia M. Mauro, Hannah Carliner, Silvia S. Martins. Impact of Medical Marijuana Laws on State-Level Marijuana Use by Age and Gender, 2004–2013. Prevention Science, 2017; DOI: 10.1007/s11121-017-0848-3   Note:  Content is Not intended as medical advice.  Please consult your health care provider regarding your specific medical condition and questions.

Dr. Mauro

Christine Mauro PhD
Assistant Professor Biostatistics
Columbia University Medical Center 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: As of November 2016, 28 states have legalized medical marijuana. Several previous studies have found an increase in use for adults after legalization, but not for adolescents.

We wanted to examine whether these age-specific findings varied by gender.  Consistent with past findings, we found past-month marijuana use did not increase after enactment of medical marijuana laws in men or women ages 12-25. Among people 26+, past-month marijuana use increased for men from 7.0% before to 8.7% after enactment (+1.7%, p<0.001) and for women from 3.1% before to 4.3% after enactment (+1.1%, p=0.013). Daily marijuana use also increased after enactment in this age group for both genders (men: 16.3% to 19.1%, +2.8 %, p=0.014; women: 9.2% to 12.7%, +3.4%, p=0.003).

There were no statistically significant increases in past-year Marijuana Use Disorder prevalence for any age or gender group after medical marijuana law enactment.

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Labels of Majority of Online Cannabidiol Extracts Contain Inaccuracies

MedicalResearch.com Interview with:

Dr. Italia V. Rolle, PhD and Dr. Tim McAfee, MD Office on Smoking and Health National Center for Chronic Disease Prevention and Health Promotion CDC

Marijuana plant (Cannabis sativa)

Marcel Bonn-Miller, PhD
Adjunct assistant professor
Department of Psychiatry
Leader of the Substance Abuse and Anxiety Program
U.S. Veterans Affairs Department 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: A 2015 study found that edible cannabis products (e.g., brownies, cookies, drinks) are often mislabeled.  The FDA has also sent warning letters to a handful of companies selling cannabidiol extracts because of inaccurate labeling of content. This led us to conduct a systematic evaluation of the label accuracy of all cannabidiol extracts sold online.  We tested 84 products from 31 different companies.

The primary take-home of this study is that nearly 70 percent of all cannabidiol extracts sold online had over 10% more or less cannabidiol than advertised; 26% of products were over-labeled (less cannabidiol than indicated) and 42% of products were under-labeled (more cannabidiol than indicated).

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Medical Tetrahydrocannabinol May Be Beneficial For Seizures and Chemotherapy Side Effects

MedicalResearch.com Interview with:

Dr. Wong

Dr. Wong

Shane Shucheng Wong, MD
Massachusetts General Hospital
Boston, Massachusetts 

MedicalResearch.com: What is the background for this study?

Response: Medical cannabis is now legal in 29 states and the District of Columbia, and in those areas with active programs, children and adolescents can legally access medical cannabis with certification from their doctor and consent from a parent. This means that doctors and families need to understand what we know and what we don’t yet know about medical cannabis in order to make the best decision for the health of the individual child. Two synthetic cannabinoids – compounds that act on specific receptors in the brain – have been approved for medical use in the U.S., both of which mimic a form of THC (tetrahydrocannabinol), the compound responsible for the “high” of recreational cannabis use. Dronabinol (Marinol) is approved to treat chemotherapy-induced nausea and vomiting in both children and adults, while the pediatric use of nabilone (Cesamet) carries a caution. A third cannabinoid, cannabidiol, is currently in phase 3 trials for treatment of seizures.

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Marijuana Use Linked To Cognitive Impairment In HIV Patients

MedicalResearch.com Interview with:

Richard Saitz, MD, MPH, FACP, DFASAM Department of Community Health Sciences Boston University School of Public Health Clinical Addiction Research and Education (CARE) Unit Section of General Internal Medicine, Department of Medicin Boston University School of Medicine and Boston Medical Center Boston , Massachusetts

Dr. Saitz

Richard Saitz, MD, MPH, FACP, DFASAM
Department of Community Health Sciences
Boston University School of Public Health
Clinical Addiction Research and Education (CARE) Unit
Section of General Internal Medicine, Department of Medicin
Boston University School of Medicine and Boston Medical Center
Boston , Massachusetts

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Many people living with HIV infection use alcohol and other drugs including marijuana. People with HIV infection are also susceptible to cognitive dysfunction from many causes from HIV infection itself to aging.

The main findings were that among people with HIV and substance use disorder, lifetime marijuana and alcohol use were not associated with cognitive dysfunction, likely due to competing risks.  But current marijuana use was associated with cognitive dysfunction.

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Edible Marijuana Preferred By Consumers Due To Lack of Smoke and Convenience

MedicalResearch.com Interview with:

Sheryl Cates RTI International

Sheryl Cates

Sheryl Cates
RTI International
Durham, NC

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The goal of this research was to provide a better understanding of consumer perceptions of edible marijuana products, including why users prefer edibles relative to other forms of marijuana such as smoking and vaping and concerns regarding the consumption of edibles. This is important as more states legalize the use of recreational marijuana products. With the increasing popularity of edibles, concerns exist that do not exist with other methods of using marijuana, such as smoking or vaping. These concerns include delayed activation time; accidental ingestion, particularly by children and older adults; and dose titration.

The study team conducted eight focus groups (four groups in Denver, Colorado, and four groups in Seattle, Washington) with users of edibles. Most participants preferred edibles to smoking marijuana because there is no smell from smoke and no secondhand smoke. Other reasons participants like edibles included convenience, discreetness, longer-lasting highs, less intense highs, and edibles’ ability to aid in relaxation, reduce anxiety, and alleviate pain more so than smoking marijuana. Concerns and dislikes about edibles included delayed effects, unexpected highs, the unpredictability of the high, and inconsistency of distribution of marijuana in the product. No participants in either location mentioned harmful health effects from consuming edibles as a concern.  Although focus group findings are not generalizable, the findings are useful for helping inform policy makers and regulators as they establish regulations regarding the manufacture, labeling, and sale of edibles.

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