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Here’s What Researchers Know So Far About How Marijuana Legalization Affects Public Health

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Opponents of medical and recreational marijuana laws often raise concerns about their effect on public health, claiming that such policies will result in a rise of cannabis use disorder and the use of other potentially harmful substances. A new review, however, found that while marijuana use does increase among adults—but not teens—after legalization, that doesn’t necessarily mean more people are engaging in risky behavior.

“Research suggests [medical cannabis laws] increase adult but not adolescent cannabis use, and provisions of the laws associated with less regulated supply may increase adult cannabis use disorders,” the paper states. “These laws may reduce some opioid-related harms, while their impacts on alcohol and tobacco use remain uncertain.”

“Research on [recreational cannabis laws] is just emerging, but findings suggest little impact on the prevalence of adolescent cannabis use, potential increases in college student use, and unknown effects on other substance use.”

To understand the relationship between marijuana laws and public health outcomes, researchers in California analyzed studies published between January 2005 and February 2019 that focused on marijuana policy and consumption, as well as alcohol, opioid and tobacco use. They found 42 articles that fit their criteria.

“Understanding how cannabis policies impact cannabis use is key to making subsequent causal claims about their effects on the use of other substances, but it is also an important question in and of itself,” the review’s authors write. “If liberalization does not impact cannabis use, but instead shifts some or all existing use (or potential use) from the illegal to legal market, then arguably such policies are welfare enhancing from a governmental perspective (e.g., increased tax revenues, reduced law enforcement expenditures) and from a consumer perspective (e.g., a safer and more consistent product).”

Here’s a brief look at some of their findings, which were published this month in the American Journal of Drug and Alcohol Abuse:

  • Most studies that examined how adolescent marijuana use changed after states approved medical marijuana found that passing such laws had little to no effect on the rate of teen consumption.
  • Researchers found that medical cannabis laws (MCLs) were associated with an increase in adult use. “Additionally,” the review’s authors write, “studies that have considered specific provisions of MCLs indicate that increases in adult use are more pronounced for states that adopted laxer policies, such as by allowing retail dispensaries or including nonspecific pain as a qualifying condition.”
  • Only five studies in the review’s sample looked at the effects of legalizing recreational marijuana on cannabis use. That’s because many of these laws have only recently been implemented. The review found their results to be mixed, showing “increased use prevalence among youth in some states (Washington and Oregon) but not in others (Colorado) and insignificant effects for adults.” The authors also caution, however, that these early studies have several limitations.
  • When they investigated whether MCLs had any effect on cannabis use disorders (CUD), the authors found mixed results among early studies. Later research, however, took a closer look at the specific provisions within them: One study found that states that allowed legal medical dispensaries saw “significantly higher rates of treatment admissions for CUD, both overall and specifically for youth.” The review cautions that “we are just beginning to understand the implications of cannabis liberalization on CUD and lifetime trajectories of cannabis use.”
  • Overall, the review’s authors write, it’s difficult to draw conclusions about the relationship between marijuana policy and alcohol use because what research has been conducted so far is minimal and include several limitations. For example, researchers have yet to figure out how to consistently survey current and changing alcohol policy in order to compare it to cannabis laws.
  • Although there’s a robust body of research looking into marijuana as a potential treatment for chronic pain in place of opioid medications, the review’s authors say it’s an issue that’s “far from settled by the current state of clinical and epidemiological research.” They point out that many of the studies that show an association between a reduction in opioid misuse and cannabis legalization policies don’t take into account new state laws addressing opioids.
  • It’s still unclear how marijuana laws affect tobacco use: One study found that medical marijuana approval was associated with a “significant decrease in the prevalence of cigarette smoking among adults as well as declines in smoking intensity among daily smokers,” while another paper found that older teens increased cigarette use but not cannabis use after medical cannabis laws were enacted.

“Despite the growing attention of researchers, the evidence related to the public health impacts of MCLs or RCLs is inconclusive regarding many of the most important considerations,” the review‘s authors conclude. Not only is more research needed, but a closer look at the nuances of each state’s laws and consideration of how long it takes markets to fully emerge are also important to understand the effects of these policies.

Former FDA Head Hints Feds Should Regulate Marijuana To Protect Public Health

Photo courtesy of Sam Doucette on Unsplash.

Marijuana Moment is made possible with support from readers. If you rely on our cannabis advocacy journalism to stay informed, please consider a monthly Patreon pledge.

Kimberly Lawson is a former altweekly newspaper editor turned freelance writer based in Georgia. Her writing has been featured in the New York Times, O magazine, Broadly, Rewire.News, The Week and more.

Politics

Military Invests $27M To Develop New Class Of Psychedelics-Inspired Drugs

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The successful use of controlled substances such as ketamine and psilocybin mushrooms to treat mental health issues like depression and anxiety has ushered in a new era of interest in psychedelic drugs. But for researchers and clinicians eager to expand such therapies, an obvious question remains: Does treatment with psychedelics necessarily require a psychedelic experience?

An international research team hopes to answer that question by researching and developing a new class of drugs that offers the same fast-acting mental health benefits as traditional psychedelics without the disorienting, sometimes uncomfortable effects of a full-blown trip. Funded by $26.9 million from the U.S. Department of Defense’s Defense Advanced Research Projects Agency (DARPA), a new project announced this month “aims to create new medications to effectively and rapidly treat depression, anxiety, and substance abuse without major side effects,” according to a University of North Carolina (UNC) School of Medicine press release.

“Although drugs like ketamine and potentially psilocybin have rapid antidepressant actions, their hallucinogenic, addictive, and disorienting side effects make their clinical use limited,” said Bryan L. Roth, a professor of pharmacology at UNC School of Medicine and the research project’s leader. “Our team has developed innovative methods and technologies to overcome these limitations with the goal of creating better medications to treat these neuropsychiatric conditions.”

Research into the possible therapeutic effects of currently illicit drugs such as ketamine, psilocybin, MDMA and others has expanded tremendously during the past decade. Nonprofit groups such as the Multidisciplinary Association for Psychedelic Studies have led the way, with university researchers and drugmakers entering the mix more recently.

In September of last year, Johns Hopkins University announced the launch of the nation’s first-ever psychedelic research center, a $17-million project to study the use of psychedelics to treat conditions such as opioid use disorder, Alzheimer’s disease, depression, anxiety and post-traumatic stress disorder (PTSD).

Government interest in psychedelic drugs has also grown. Also in September, DARPA, a federal agency that exists to support the development of emerging technologies for use by the U.S. military, announced its Focused Pharma program, meant to develop drugs “that work quickly and deliver lasting remedies for conditions such as chronic depression and post-traumatic stress.”

While that DARPA announcement didn’t mention specific substances or even use the word “psychedelics,” it referred to “certain Schedule 1 controlled drugs that engage serotonin receptors” and that have “significant side effects, including hallucination.”

The press release for the new DARPA-funded project, lead by Roth at UNC, mentions ketamine and psilocybin specifically. The team will use both biological modeling and sophisticated computational approaches in an effort to design fast-acting drugs inspired by psychedelics but free from what researchers call “disabling side effects.”

“Depression, anxiety, and substance abuse affect large segments of the population,” Roth said. “Rapidly acting drugs with antidepressant, anti-anxiety, and anti-addictive potential devoid of disabling side effects do not exist, not even as experimental compounds for use in animals. Creating such compounds would change the way we treat millions of people around the world suffering from these serious and life-threatening conditions.”

At DARPA, Dr. Tristan McClure-Begley, Focused Pharma’s program manager, said last fall that the agency’s interest in developing such drugs is due to the country’s large number of veterans with PTSD and other mental health conditions.

“It is research we need to undertake given the scale of the mental health crisis our veterans face,” he said in September, “and if it works, the payoff is a completely new, safe, and effective therapeutic option that transforms complex and previously intractable mental conditions into something more acutely treatable.”

Along with Roth at UNC Chapel Hill, the newly announced research project includes members Georgios Skiniotis and Ron Dror of Stanford University, Jian Jin of Icahn School of Medicine at Mt. Sinai, Brian Shoichet and Nevan Krogan of University of California at San Francisco and William Wetsel of Duke University.

Do Highly Potent Marijuana Concentrates Get Users More High? Not Exactly, Study Finds

Photo courtesy of Wikimedia/Workman

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Do Highly Potent Marijuana Concentrates Get Users More High? Not Exactly, Study Finds

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High-potency marijuana concentrates on today’s legal markets can contain upwards of 90 percent THC, so one might reasonably expect them to pack a greater psychoactive punch than typical flower, which tops out around 30 percent.

But that may not be the case, according to a new study out of the University of Colorado at Boulder.

Researchers found that while THC blood levels spiked after users consumed concentrates, impairment levels didn’t significantly differ from participants who used flower.

“Surprisingly, we found that potency did not track with intoxication levels,” said lead author Cinnamon Bidwell, an assistant professor in CU’s Institute of Cognitive Science. “While we saw striking differences in blood levels between the two groups, they were similarly impaired.”

The study, published Wednesday in JAMA Psychiatry, involved 121 Colorado adults who were regular marijuana consumers. Participants were randomly assigned to consume either relatively low-THC marijuana flower, which ranged from 16-24 percent THC, or higher-potency concentrates, which ranged from 70-90 percent. At various points, researchers tested participants’ blood plasma THC levels, surveyed their mood and subjected them to an array of neurobehavioral tasks meant to test attention, memory, inhibitory control and balance.

Researchers used a mobile pharmacology lab they dubbed the “cannavan” to study participants’ cannabis while complying with federal law, the University of Colorado said.

“Most neurobehavioral measures were not altered by short-term cannabis consumption,” the study found. “However, delayed verbal memory and balance function were impaired after use. Differing outcomes for the type of product (flower vs concentrate) or potency within products were not observed.” Impairment faded after about an hour.

“Despite differences in THC exposure, flower and concentrate users showed similar neurobehavioral patterns after acute cannabis use.”

A University of Colorado at Boulder press release calls the paper “the first to assess the acute impact of cannabis among real-world users of legal market products” and says the findings “could inform everything from roadside sobriety tests to decisions about personal recreational or medicinal use.”

Lawmakers and police departments who assume higher THC blood levels correlate with greater impairment, for example, may need to re-educate themselves on how to measure impaired driving. Consumers hoping that high-THC products will mean more mind-blowing highs, on the other hand, may ultimately be putting that extra THC—and the money spent on it—to waste.

“It raises a lot of questions about how quickly the body builds up tolerance to cannabis and whether people might be able to achieve desired results at lower doses,” Bidwell said.

cannavan image

Via the University of Colorado at Boulder.

As more states have opened legal marijuana markets, high-potency concentrates have become more widely available. Critics of marijuana legalization, as well as some health experts, have worried that those products could unleash health hazards on both individual users and broader society. While the University of Colorado paper doesn’t answer questions about potential long-term side effects of THC exposure, its findings indicate short-term impacts of concentrates don’t necessarily warrant additional concern.

“People in the high concentration group were much less compromised than we thought they were going to be,” said co-author Kent Hutchison, a professor of psychology and neuroscience at CU Boulder who also studies alcohol addiction. “If we gave people that high a concentration of alcohol it would have been a different story.”

One reason that higher THC blood levels didn’t translate to higher highs could be that the body’s finite number of cannabinoid receptors, which THC molecules bind to, become saturated regardless of whether higher- or lower-THC products are used. Any excess THC in consumers’ blood plasma, in that case, would be metabolized and not contribute to further impairment.

“Cannabinoid receptors may become saturated with THC at higher levels,” the study says, “beyond which there is a diminishing effect of THC.”

That’s not to forget the “striking differences in blood levels” the study observed between the two groups of participants. Researchers cautioned that while short-term effects of higher-potency cannabis consumption don’t seem to differ much from more traditional methods, we still don’t know much about how elevated cannabinoid levels affect health over time.

“Does long-term, concentrated exposure mess with your cannabinoid receptors in a way that could have long-term repercussions?” asked Hutchison. “Does it make it harder to quit when you want to? We just don’t know yet.”

The controversy—and uncertainty—around how cannabis affects driver safety has long been a sticking point for legalization. And given the ongoing difficulty in associating THC levels with impairment, it’s unlikely to be resolved anytime soon.

As legalization spreads, however, more and more studies are examining marijuana-related impairment. A study published last year found that drivers who tested at the legal limit in many states (2-5 nanograms THC per milliliter of blood) were statistically no more likely to cause a crash than people who had not consumed cannabis, concluding that “the impact of cannabis on road safety is relatively small at present time.”

Earlier this month, Democratic leadership in a House committee introduced a bill that would require states with legal cannabis programs to consider creating programs “to educate drivers on the risks associated with marijuana-impaired driving and to reduce injuries and deaths resulting from individuals driving motor vehicles while impaired by marijuana.”

A congressional report from a year earlier, however, suggested that much of the alarmism about cannabis-impaired driving was unfounded.

“Although laboratory studies have shown that marijuana consumption can affect a person’s response times and motor performance,” the Congressional Research Service wrote, “studies of the impact of marijuana consumption on a driver’s risk of being involved in a crash have produced conflicting results, with some studies finding little or no increased risk of a crash from marijuana usage.”

NORML Pushes Top Federal Health Official To Admit Criminalization Is More Harmful Than Marijuana

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Proof Of Marijuana Use Discovered At Ancient Biblical Site In Israel

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An ancient biblical tribe in Israel likely used marijuana to produce hallucinogenic effects as part of cultic rituals, according to a new study that identified cannabis resin on an alter in a shrine built around 750 BCE.

Two alters that appeared near the entrance of the “Holy of Holies” in the Judahite shrine were excavated about 50 years ago and now an analysis of the materials on top of the alters turned up evidence of marijuana combustion at the site.

The study, published Thursday in the journal Tel Aviv, states that “cannabis inflorescences were burnt there, conceivably as part of a ritual that took place in the shrine.”

Via Tel Aviv.

“It seems feasible to suggest that the use of cannabis on the Arad altar had a deliberate psychoactive role,” the study concluded.

“Cannabis odors are not appealing,” the researchers opined, “and do not justify bringing the inflorescences from afar. The frequent use of hallucinogenic materials for cultic purposes in the Ancient Near East and beyond is well known and goes back as early as prehistoric periods.”

However, this is the first time physical evidence has been identified that indicates the tribe of Judah participated in marijuana-infused ceremonies. Evidence of frankincense being burned was also found at the site.

The team behind the study, from the Israel Museum and the Volcani Center, relied on two common methods of identifying cannabinoids: liquid chromatography and gas chromatography. They found components of marijuana known widely today such as THC, CBD, CBN and various terpenoids.

Researchers said it’s unclear where the ancient tribe obtained cannabis, but they suspect that it “may have been imported from distant origins and were transported as dried resin (commonly known as hashish).”

To burn the marijuana and let out the smoke, it was apparently mixed with animal feces “to enable its mild heating,” the study states.

“It seems likely that cannabis was used at Arad as a deliberate psychoactive, to stimulate ecstasy as part of cultic ceremonies,” it continues. “If so, this is the first such evidence in the cult of Judah.”

“The discovery of cannabis on the smaller altar was a surprise. Arad provides the earliest evidence for the use of cannabis in the Ancient Near East. Hallucinogenic substances are known from various neighboring cultures, but this is the first known evidence of hallucinogenic substance found in the Kingdom of Judah.”

Eran Arie, a curator at the Israel Museum where the excavated shine is housed, told CNN that they “never thought about Judah taking part in these cultic practices.”

Via Tel Aviv.

“The fact that we found cannabis in an official cult place of Judah says something new about the cult of Judah,” he said.

A separate study released last year documented how people from a diverse range of cultures have been using marijuana for thousands of years—in different forms and for different purposes. For example, cannabis was considered a “holy plant” in Tibet and was used in Tantric Buddhism to “facilitate meditations.” It was also used in Arabic medicine to treat ear infections, skin diseases, flatulence, intestinal worms, neurological pain, fever and vomiting.

States With Medical Marijuana Laws Saw 20% Drop In Some Opioid Prescriptions

Photo courtesy of Brian Shamblen.

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