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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

FDA Clears Researchers To Study MDMA Use By Therapists Being Trained In Psychedelic Medicine

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The Food and Drug Administration (FDA) has already authorized clinical trials into the therapeutic potential of MDMA for patients with post-traumatic stress disorders—but now it’s given the green light to a psychedelics research institute to expand its studies by administering the substance to certain therapists.

Volunteer therapists who are being trained to treat people with PTSD will be able to participate in the Phase 1 trials to gain personal experience with the treatment option. This is a complementary research project that comes as the Multidisciplinary Association for Psychedelic Studies (MAPS) is in the process of conducting Phase 3 trials involving people with the disorder.

The development comes months after Canadian regulators announced that certain therapists would be allowed to take psilocybin in order to gain a better understanding of the psychedelic when treating patients.

MAPS sought permission to proceed with the therapist-specific trials in 2019, but FDA placed them on a 20-month hold because of concerns about the merits, risks and credentials of investigators. MAPS appealed that hold, providing evidence about the study’s scientific value and ability of its staff, and FDA cleared them on Tuesday.

The organization “chose to dispute” FDA’s hold not just because of the impact it had on the planned studies, “but in an attempt to resolve an ongoing issue with the FDA regarding investigator qualifications across studies,” it said in a press release on Wednesday.

“While the term ‘dispute’ may seem adversarial, this process can actually strengthen the relationship and trust between us and our review Division and ensures the Division has support on this project from the [FDA] Office of Neuroscience,” MAPS Public Benefit Corporation (PBC) CEO Amy Emerson said. “This decision demonstrates how our strategic, data-driven strategy in challenging the FDA rulings can be successful.”

Now MAPS is able to launch the Phase 1 clinical trials into MDMA-assisted therapy for therapists.

It will be designed to “measure development of self-compassion, professional quality of life, and professional burnout among clinicians delivering the treatment to patients,” the association said.

Getting personal experience with the substance “is widely considered to be an important element in preparation and training to deliver psychedelic-assisted therapies.”

This will “support the goals of the MDMA Therapy Training Program to provide comprehensive training to future providers,” and it “builds capacity to deliver quality, accessible care to patients, pending approval of MDMA-assisted therapy as a legal prescription treatment,” MAPS PBC Director and Head of Training and Supervision Shannon Carlin said.

FDA first granted MAPS’s request for an emergency use authorization for MDMA in PTSD in 2017. The organization expects to complete its Phase 3 trails in 2022.

The scientific expansion move also comes as the psychedelics decriminalization movement continues to build in the U.S.

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Science & Health

Frequent Marijuana Consumers Are Actually More Physically Active Than Non-Users, Study Finds, Smashing Stereotypes

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In a stereotype-busting new study, researchers found that frequent marijuana consumers are actually more likely to be physically active compared to their non-using counterparts.

For decades, anti-cannabis propaganda has cast marijuana consumers as unmotivated couch potatoes. This government-funded ad is a perfect example:

But a study published in the Harm Reduction Journal on Thursday found the opposite to be true. A nationally representative analysis of accelerometer-measured sedentary behavior showed that people who frequently use marijuana—particularly those aged 40 and older—spend more time engaging in physical activity than non-users do.

“Our findings do not support the mainstream perception of cannabis users as living sedentary lifestyles,” the researchers concluded.

In general, they found that “there’s no significant differences between non-current cannabis users and light, moderate, or frequent cannabis users in minutes per day spent in [sedentary behavior].” The difference came down to the average minutes that each group spent in physical activity.

“After controlling for all covariates, frequent cannabis users engaged in significantly greater amounts of light [physical activity] and [moderate-to-vigorous physical activity] compared to non-current users,” the study states. “In the unadjusted model, moderate cannabis use predicted more minutes spent in [moderate-to-vigorous physical activity] compared to non-current use, but this association was not significant upon controlling for all covariates. Light cannabis users did not significantly differ from non-current users in time engaged in [physical activity.”

“The results suggest that frequent cannabis users engaged in more [physical activity] than non-current users, but spent similar amounts of time in [sedentary behavior],” the researchers said.

While the study indicated that light marijuana use is not associated with a statistically significant difference in time being physically active, those who infrequently use cannabis were more likely to self-report more moderate physical activity compared to non-users.

“In a national, population-based US sample, current cannabis use was significantly associated with accelerometer-measured [physical activity], such that frequent cannabis users engaged in greater minutes of light PA and [moderate-to-vigorous physical activity] compared to non-current users.”

The researchers also looked at the relationship between marijuana use, activity and age, finding that people over 40 who consumed cannabis moderately spent an average of 16 more minutes engaged in moderate physical activity each day than non-users.

To explain that trend, the study suggests that cannabis “is being used for exercise-induced pain recovery, since [physical activity] brings about pain and muscle soreness, and a decreased pain threshold and muscle hypersensitivity have been documented with increasing age.”

These findings “add to the cannabis and physical behavior literature by incorporating objective accelerometer measures,” the researchers concluded. “Further understanding of the association between cannabis use and health behaviors is essential to fully addressing the public health concerns associated with cannabis use.”

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Business

Legal Marijuana States See Reduced Workers’ Compensation Claims, New Study Finds

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Legalizing marijuana for adult use is associated with an increase in workforce productivity and decrease in workplace injuries, according to a new study partly funded by the federal government.

In a working paper published by the National Bureau of Economic Research, researchers looked at the impact of recreational cannabis legalization on workers’ compensation claims among older adults. They found declines in such filings “both in terms of the propensity to receive benefits and benefit amount” in states that have enacted the policy change.

Further, they identified “complementary declines in non-traumatic workplace injury rates and the incidence of work-limiting disabilities” in legal states.

These findings run counter to arguments commonly made by prohibitionists, who have claimed that legalizing marijuana would lead to lower productivity and more occupational hazards and associated costs to businesses. In fact, the study indicates that regulating cannabis sales for adults is a workplace benefit by enabling older employees (40-62 years old) to access an alternative treatment option.

“We offer evidence that the primary driver of these reductions [in workers’ compensation] is an improvement in work capacity, likely due to access to an additional form of pain management therapy,” the study, which received funding from the National Institute on Drug Abuse, states.

The implementation of adult-use legalization seems to “improve access to an additional channel for managing pain and other health conditions, suggesting potential benefits on populations at risk of workplace injuries,” it continues.

The study is based on an analysis of data on workers’ compensation benefit receipt and workers’ compensation income from
2010 to 2018 as reported in the Annual Social and Economic Supplement of the Current Population Survey.

“Our results show a decline in workers’ compensation benefit propensity of 0.18 percentage points, which corresponds to a 20 percent reduction in any workers’ compensation income, after states legalize marijuana for recreational use. Similarly, we find that annual income received from workers’ compensation declines by $21.98 (or 20.5%) post-[recreational marijuana legalization]. These results are not driven by pre-existing trends, and falsification exercises suggest that observing estimates of this magnitude is statistically rare.”

Researchers said that they’ve found evidence that cannabis use increases post-legalization among the age cohort they studied, but no such spike in misuse. Further, they found a decline in post-legalization prescriptions for medications used to treat chronic pain, indicating that some people are using marijuana as a substitute for traditional painkillers.

“We hypothesize that access to marijuana through [recreational marijuana laws] increases its medical use and, in turn, allows better management of symptoms that impede work capacity—e.g., chronic pain, insomnia, mental health problems, nausea, and so forth,” the study says. “Chronic pain management is likely to be particularly important in our context as this is the health condition most commonly reported among medical marijuana users.”

Beyond decreasing workers’ compensation claims and costs, legalization also is a boon to the economy by adding jobs in legal states.

The cannabis industry added more than 77,000 jobs over the past year—a 32 percent increase that makes the sector the fastest in job creation compared to any other American industry, according to a report released by the cannabis company Leafly last week.

Starting A Business? Study Finds Marijuana May Help—And Hinder

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