People in states where recreational marijuana is legal were significantly less likely to experience vaping-related lung injuries than those in states where cannabis is prohibited, according to a new study published in an American Medical Association journal.
The finding seems to affirm what many reform advocates said during the peak of the e-cigarette or vaping product use-associated lung injury (EVALI) crisis last year. With thousands being hospitalized over EVALI, it became clear that contaminated vape cartridges were the source and that contamination was more common in illicit, unregulated markets where consumers can’t walk into retail stores and buy tested and labeled marijuana products.
By analyzing Centers for Disease Control and Prevention (CDC) data on EVALI cases, the prevalence of e-cigarette use and the population in each state from June 2019 to January 2020, researchers were able to confirm that.
The research letter, published by the JAMA Network Open on Monday, shows that states with recreational marijuana shops had 1.7 EVALI cases per million population compared to 8.1 cases per million in prohibition states. There was no statistically significant difference between criminalized and medical cannabis states, which experienced 8.8 cases per million population.
“The data suggest that EVALI cases were concentrated in states where consumers do not have legal access to recreational marijuana dispensaries,” the letter states. “This association was not driven by state-level differences in e-cigarette use, and EVALI case rates were not associated with state-level prevalence of e-cigarette use. One possible inference from our results is that the presence of legal markets for marijuana has helped mitigate or may be protective against EVALI.”
“Recreational marijuana states had among the lowest EVALI rates of all states.”
Cross-sectional study finds states with legal recreational marijuana had fewer cases of e-cig/vaping associated lung injury #EVALI. @aaronecarroll @ajhollingsworth @AshleyCBradford @coady_wing #VisualAbstract https://t.co/9dXGchag16 pic.twitter.com/nIoeV7v39b
— JAMA Network Open (@JAMANetworkOpen) April 7, 2020
While the researchers said the reason for the association isn’t clear yet, they surmised that it’s “possible that in recreational states, people tend to purchase marijuana products at legal dispensaries, which may be less likely to sell the contaminated products that are thought to cause EVALI.”
That has been the working theory of many industry observers, who have argued that legalization is an important safeguard to public health by ensuring compliance with quality control standards in cannabis products. It should be noted, however, that there are select reports of instances where people seemed to develop a lung injury after obtaining marijuana vaping products from licensed dispensaries in Oregon.
“It appears states that have legal access to marijuana have lower rates of EVALI cases, which is consistent with the hypothesis that people have demand for marijuana products, and in states where they don’t have access to them in this regulatory fashion, they end up purchasing them elsewhere,” study co-author Alex Hollingsworth told MedPage Today.
NORML Executive Director Erik Altieri said the findings “come as little surprise.”
“In jurisdictions where cannabis is legally regulated, consumers gravitate toward the above-ground retail marketplace where they can access lab-tested products manufactured by licensed businesses,” he said. “Just like alcohol prohibition gave rise to the illicit production of dangerous ‘bathtub gin,’ marijuana prohibition provides bad actors, not licensed businesses, the opportunity to fulfill consumers’ demand—sometimes with tragic results.”
In a historical commentary on the new study also published by the American Medical Association Journal, a separate set of researchers drew a parallel to the era of alcohol prohibition—from which an underground industry of bootleggers emerged.
“Bootleggers fortified their distillates with methanol to increase apparent potency, causing blindness and death in unwary consumers,” they said, noting that industrial ethanol, which was exempt from prohibition, was sometimes used despite the fact that government officials directed it to be adulterated with poisonous substances to deter consumption. “The resulting concoctions, known as denatured alcohol, were responsible for thousands of deaths during the 14 years that Prohibition was in effect. The history of Prohibition thus serves as a cautionary tale about unintended and unforeseen consequences of legislation regulating substances that affect public health.”
“Bootlegging was rampant and criminal syndicates proliferated, fueling a wave of organized crime.”
Commentary: EVALI rates are lower in states that have legalized recreational marijuana. Is legalizing marijuana protective against EVALI as there is less incentive to dilute THC in states where raw THC material is readily available without legal risk? https://t.co/Bd5Z8wYbjQ
— JAMA Network Open (@JAMANetworkOpen) April 7, 2020
EVALI similarly appears to be strongly associated with a specific contaminant in illicit markets, vitamin E acetate (VEA), which is used to dilute or stretch cannabis concentrates —”a scenario reminiscent of the unscrupulous bootleggers of the Prohibition era.”
“How could a state’s legalization of recreational marijuana inadvertently protect its citizens against EVALI? The obvious answer is that THC-containing vaping products in states where recreational marijuana is legal are uncontaminated with VEA. If so, another question follows: why would THC products in these states be less likely to be contaminated (ie, diluted) with VEA? One salient possibility is that there is less financial incentive to dilute THC concentrates in states where raw THC material is readily available without legal risk and compensatory markup.”
“If THC concentrates are transported from states where they are legal and can be relatively cheaply mass produced (like industrial ethanol stocks during Prohibition) to other states where they are illegal and must be guarded jealously as a rare and precious commodity, there may be a strong economic inducement to dilute them, thereby increasing profits. Thus, legalization of marijuana may have protective local effects but untoward collateral effects.”
President Trump also seemed to pick up on the failure of prohibition during a meeting on the vaping crisis last year. He acknowledged that simply banning the products wouldn’t work, as people would simply move on to the illicit market, where there aren’t regulations.
What’s worse, the conflict between state and federal marijuana laws actually inhibited research into how to address EVALI cases, complicating shipments of vaping specimens, a top CDC official said.
The same official also suggested that federal cannabis regulations could mitigate the vaping problem. Former Food and Drug Administration Commissioner Scott Gottlieb made a similar argument.
This story was updated to include comment from NORML.
Feds To Send Marijuana And Hemp Samples To Labs As Part Of Large-Scale Testing Accuracy Study
A federal science agency is inviting labs to participate in a large-scale study to assess their ability to accurately analyze marijuana and hemp samples for their cannabinoid profile and possible contaminants.
The National Institute of Standards and Technology (NIST) said in a notice on Thursday that it will provide samples of cannabis that it’s already analyzed to labs and then ask them to run their own tests. Once that’s complete, NIST will reveal the actual data and compare the numbers to identify any disparities.
The point of the study isn’t to expose labs that fail to provide accurate analyses; rather, it’s intended to help forensic analysts and the cannabis industry develop best practices. NIST, which is part of the U.S. Department of Commerce, said it’s especially important given that hemp was federally legalized under the 2018 Farm Bill, while its higher THC cannabis cousin marijuana remains federally illegal.
“If you’re going to confiscate a farmer’s crop, or subject a person to prosecution, you want to be sure that measurement is accurate,” NIST research chemist Brent Wilson said in a press release.
Is it hemp or is it marijuana? Legally, there's a big difference. Now, NIST is helping labs increase the accuracy of the measurements they make to answer that question. Find out how: https://t.co/3tQZzzcleL pic.twitter.com/ntsmZuuGUb
— National Institute of Standards and Technology (@NIST) January 14, 2021
The agency has previously led research on analyzing hemp oil, but this one involving both hemp and marijuana will target flower, which is more challenging for labs. To get the samples for this new study, NIST ground down various cannabis buds and sorted them—”like a baker sifting flour”—to separate the material by particle size.
Wilson then “blended the powders into batches and carefully measured how much of each compound and contaminant was present in each batch.”
“NIST will send samples from those batches to participating labs,” the agency said. “All labs will receive legal hemp samples. Labs that are licensed to handle controlled substances can also request marijuana samples.”
Labs interested in participating in the study have until February 5 to enroll. Samples will be distributed in April.
While determining THC content is a central concern, the research will also look at CBD and other cannabinoids so that cannabis companies are able to ensure that their products meet legal standards and are properly labeled for consumers.
After a lab has analyzed the samples, it will report back to NIST with the results as well as information about the testing method it used. The results will be published, but they will be anonymized. The public will “be able to see the amount of variation across labs but not how any specific lab performed.”
“Our goal is to provide a learning opportunity for labs, not to publicize their performance,” NIST research chemist Melissa Phillips said.
Following the study’s completion, the agency will investigate which testing methods produce the most accurate results to inform the industry. Then it will re-run the test, which is expected to show “less variability in the lab measurements, as labs overall improve their methods.”
A description of the study exercise states that participating labs “may also elect to report only selected analytes (e.g., only reporting total THC, but not all cannabinoids).”
“Participants will be asked to report triplicate results for each sample provided using measurement procedures and calculations normally performed in their laboratories,” it says. “In addition, participants will also be asked to identify the type of sample preparation and analytical methods employed in their testing to facilitate conclusions about potential method bias.”
There are currently 46 labs that are listed as participants in NIST’s cannabis research program. That includes multiple private labs as well as one police department and a division of the U.S. Department of Agriculture. There are also facilities from Canada and the Netherlands enrolled.
In December, the Department of Justice announced that it was awarding NIST a grant to help to develop a method of differentiating hemp and marijuana.
The previous year, the Drug Enforcement Administration similarly announced that it was seeking a device to “provide specificity to distinguish between hemp and marijuana” since the former crop was legalized.
The complications resulting from hemp legalization is especially apparent in Texas, where marijuana possession arrests fell almost 30 percent from 2018 to 2019 following the state-level legalization of the non-intoxicating cannabis crop.
Prosecutors in the state have dismissed hundreds of low-level cannabis cases since hemp was legalized. And officials announced last year that labs wouldn’t be performing testing in misdemeanor cases, with the Department of Public Safety saying it “will not have the capacity to accept those.”
Photo courtesy of National Institute of Standards and Technology.
Best Music Playlists For Psychedelic Therapy Are Explored In New Johns Hopkins Study
Psychedelic therapy sessions often incorporate music—and typically that music is of the classical genre. But new research out of the Johns Hopkins University School of Medicine suggests there may in fact be no special value in playing a Mozart concerto or Chopin étude for tripping patients.
Gongs could work just as well, if not better, the study found.
“Western classical music has long been assumed to be the standard in psychedelic therapy,” researchers wrote in the study, published Tuesday in the American Chemical Society (ACS) journal Pharmacology and Translational Science. “The present data challenge this notion that Western classical music, or for that matter any specific genre of music, is an intrinsically superior form of music to support psychedelic therapy, at least for all people at all times.”
Analyzing a 10-person trial involving the use of psilocybin therapy to help people quit smoking tobacco, the Johns Hopkins team compared sessions featuring classical music with those involving overtone-based music, featuring instruments such as gongs, Tibetan singing bowls or the didgeridoo, among others.
“Although we found no significant differences between the two musical genres studied here,” the team wrote, “several trends suggested that the overtone-based playlist resulted in somewhat better outcomes and was preferred by a larger portion of this small sample of participants.”
Spoiler alert – they did about the same but a hint that the overtone playlist (gong etc.) did a bit better than Western classical. Apparently classical music is not such a sacred cow for psychedelic therapy. With @juststrickland and Albert Garcia-Romeu.
— Matthew W. Johnson (@Drug_Researcher) December 30, 2020
In other words, while the results don’t prove that overtone-based music yields better outcomes than classical, the findings nevertheless “call into question whether Western classical music typically played in psychedelic sessions holds unique benefit.”
As one of the study’s authors, Johns Hopkins researcher Matthew Johnson, put it in a recent tweet: “Apparently classical music is not such a sacred cow for psychedelic therapy.”
The researchers said the study “provides the first contemporary and within-subject experimental manipulation of session set and setting factors in psychedelic research” and is the “first fully randomized test of different musical genres supporting psychedelic therapy.”
Participants each had three therapy sessions, one featuring classical music, another featuring overtone music and a third session for which they could choose between the two genres. Psilocybin doses were between 20 milligrams and 30 milligrams per 70 kilograms of body weight.
Among the data researchers analyzed were participants’ evaluations of their own experiences, including “mystical experiences”—such as feelings of unity and transcendence of time and space—as well as “challenging experiences,” such as feelings of panic or losing sanity.
“Visual inspection of individual and average data indicated higher overall scores for overtone-based sessions compared to Western classical sessions,” the authors wrote. “This difference was of a medium effect size but was not statistically significant.”
As described in the paper there is about 25% overlap with the classic playlist we compared it to, link below. Most of that overlap was near onset and come down. A few tracks on the older classical playlist already fit the overtone-based genre.https://t.co/rKUsd6N005
— Matthew W. Johnson (@Drug_Researcher) December 31, 2020
Researchers also analyzed smoking abstinence outcomes based on the music genre participants selected for their third psychedelic therapy session, after sampling both genres. Participants who chose to listen to overtone music during the third session were more successful at quitting smoking—both immediately after treatment (83.3 percent) and over a period of about 30 months afterward (66 percent). By comparison, half of participants who chose Western classical music quit smoking immediately, and all of those people were still not smoking after 30 months.
Experts have long stressed the role of set and setting in a psychedelic experience, noting how both a person’s psychological state as well as their environment can affect the behavioral and clinical effects of entheogenic drugs. “Traditional laboratory contexts that contain overtly ‘sterile’ stimuli (e.g. white walls and medical equipment,” the authors note as one example, “have been suggested to increase the likelihood of negative reactions.”
While music is a standard feature of clinical psychedelic therapy, the new study says, the default by therapists to predominantly Western classical playlists is “likely due to recommendations present in early guidelines,” which specifically mentioned classical music.
But it may not be music at all, but instead a collection of sounds, that complements the psychedelic experience.
“The lack of superiority of the Western classical playlist is even more interesting considering that some of the overtone-based playlist tracts consisted of sounds without traditionally identifiable melody and/or rhythm and therefore might not be classified as songs or music by some,” the study says. “This suggests that the sounds capable of supporting psychedelic therapy sessions may go beyond the bounds of traditionally defined musical genres.”
The researchers concluded that the study lends support to the idea that “developing a process for generating patient-specific musical selections rather than providing standardized music may improve therapeutic outcomes.”
“For example, future work could evaluate how patient-selected music impacts therapeutic effects or identify individual factors predictive of response to varying musical genres or musical features other than genre to individualize session selections,” the wrote. “More broadly, these findings emphasize the need for the parametric study of psychedelic session components to either provide improved standardized conditions, or to individualize conditions to improve the therapeutic effects of psychedelic therapy across diverse and varied populations.”
Johns Hopkins University, where the study analysis was done, is widely regarded as a leading institution on psychedelic research. In 2000, it became the first U.S. institution to gain federal approval to reinstitute research into psychedelic drugs using subjects who didn’t already have a history of using the drug, and last year it launched the country’s first-ever psychedelic research center.
Photo courtesy of Wikimedia/Workman
Youth Marijuana Use Remains Stable Amid Surge Of State-Level Legalization, Feds Report
Youth marijuana use continues to be stable, even as more states move to legalize the plant, according to the latest edition of an annual survey funded by the federal government.
The Monitoring the Future (MTF) report, released on Tuesday, found that cannabis consumption among adolescents “did not significantly change in any of the three grades for lifetime use, past 12-month use, past 30-day use, and daily use from 2019-2020.” That’s based on self-reports from 8th, 10th and 12th grade students.
What’s more, daily marijuana vaping actually decreased by more than half during that time period for 10th and 12th graders. It’s down to 1.1 percent and 1.5 percent, respectively.
NEWS: Rates of past-year #nicotine and #marijuana vaping among high schoolers remained steady from 2019 to early 2020, although they are still high. See the latest #MonitoringTheFuture survey results on teen drug use:https://t.co/giFEFnZaeB#MTF2020 pic.twitter.com/9epVIQbnzu
— nidanews (@NIDAnews) December 15, 2020
For all three grades, lifetime cannabis use, past 30-day consumption and daily use either remained the same or slightly decreased from 2019 to 2020, the survey shows. The only exception is daily use among 12th grade students, which ticked up by half a percentage point.
Perceptions of the harmfulness of marijuana also generally remained stable.
These results run counter to the narrative that prohibitionists have consistently put forward, arguing that the state-level legalization movement will lead to significant increases in youth cannabis use because it would normalize the behavior.
Advocates have countered that establishing regulated marijuana programs would restrict access to underage people, while at the same time mitigating the influence of the illicit markets where policies like ID checks are not required.
The 2018 MTF survey, which is conducted by the University of Michigan and funded by the National Institute on Drug Abuse, also revealed that fewer adolescents are using marijuana now compared to 2012, when the first states moved to legalize cannabis.
These results are consistent with other federal data from the Centers for Disease Control and Prevention (CDC). The agency’s biennial Youth Risk Behavior Survey found that marijuana consumption among high school students declined during the peak years of state-legal recreational cannabis legalization.
There was “no change” in the rate of current cannabis use among high school students from 2009-2019, the survey found. When analyzed using a quadratic change model, however, lifetime marijuana consumption decreased during that period.
The prohibitionist argument that cannabis legalization would embolden young people to use cannabis has been repeatedly debunked in research. And the claim becomes all the more shaky each year as more states legalize legislatively or through the ballot.
Colorado and Washington were the first two states to legalize marijuana, in 2012. Since then, additional states have come on board with every election cycle. Most recently, Arizona, Mississippi Montana, New Jersey and South Dakota voters elected to enact the reform via the ballot last month.
Another study released by Colorado officials in August showed that youth cannabis consumption in the state “has not significantly changed since legalization” in 2012, though methods of consumption are diversifying.
An official with the White House Office of National Drug Control Policy’s National Marijuana Initiative went even further in July, admitting that, for reasons that are unclear, youth consumption of cannabis “is going down” in Colorado and other legalized states and that it’s “a good thing” even if “we don’t understand why.”
Past studies looking at teen use rates after legalization have found declines in consumption or a similar lack of evidence indicating there’s been an increase.
Last year, for example, a study took data from Washington State and determined that declining youth marijuana consumption could be explained by replacing the illicit market with regulations or the “loss of novelty appeal among youths.” Another study from last year showed declining youth cannabis consumption in legalized states but didn’t suggest possible explanations.
Photo courtesy of Martin Alonso.