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Legal Marijuana States Have Lower Opioid Use, New Studies Show

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Letting people legally access marijuana appears to reduce reliance on addictive opioids, two new studies published by the American Medical Association find.

“Medical cannabis laws are associated with significant reductions in opioid prescribing in the Medicare Part D population,” concludes one paper from researchers at the University of Georgia, Athens. “This finding was particularly strong in states that permit dispensaries, and for reductions in hydrocodone and morphine prescriptions.”

The second study, from scientists at the University of Kentucky and Emory University, noted that “marijuana is one of the potential nonopioid alternatives that can relieve pain at a relatively lower risk of addiction and virtually no risk of overdose.” It found that laws allowing medical cannabis or recreational marijuana “have the potential to lower opioid prescribing for Medicaid enrollees, a high-risk population for chronic pain, opioid use disorder, and opioid overdose.”

“Marijuana liberalization may serve as a component of a comprehensive package to tackle the opioid epidemic,” the researchers conclude.

The two papers, released Monday by JAMA Internal Medicine, a publication of the AMA, looked at use of opioids such as fentanyl by people enrolled in Medicare and Medicaid, with both examinations finding that states with legal marijuana access saw lower reliance on the pharmaceutical drugs.

And the easier the access to legal marijuana, the lower the rate of opioid prescribing.

“States with active dispensaries saw 3.742 million fewer daily doses filled; states with home cultivation only [laws] saw 1.792 million fewer filled daily doses,” one of the studies, which focused on medical cannabis laws, found.

The other new paper shows that while medical marijuana is associated with reduced opioid prescriptions, recreational laws have an even greater effect.

“State implementation of medical marijuana laws was associated with a 5.88% lower rate of opioid prescribing,” the authors wrote. “Moreover, the implementation of adult-use marijuana laws, which all occurred in states with existing medical marijuana laws, was associated with a 6.38% lower rate of opioid prescribing.”

U.S. Sen. Kirsten Gillibrand (D-NY) recently suggested that pharmaceutical companies oppose marijuana legalization for selfish reasons.

“To them it’s competition for chronic pain, and that’s outrageous because we don’t have the crisis in people who take marijuana for chronic pain having overdose issues,” she said. “It’s not the same thing. It’s not as highly addictive as opioids are.”

The results of the new studies add to a growing body of research indicating that legal marijuana access is associated with reduced opioid issues.

In 2014, for example, a previous JAMA study showed that states with medical cannabis laws have roughly 25 percent lower opioid overdose rates.

A separate analysis published in February concluded that “legally protected and operating medical marijuana dispensaries reduce opioid-related harms,” suggesting that “some individuals may be substituting towards marijuana, reducing the quantity of opioids they consume or forgoing initiation of opiates altogether.”

And previous work by Ashley and David Bradford of the University of Georgia, who authored one of the new studies released on Monday, showed broad reductions in Medicare and Medicaid pain prescriptions when state medical cannabis laws went into effect. Their new paper builds on that by zeroing in on opioid painkillers and showing that the type of state marijuana law has an effect on the reduction in prescriptions.

“The type of [medical cannabis law] matters,” David Bradford said in an email. “Dispensaries have the biggest effect.”

The other paper, by the Kentucky and Emory researchers, tabulated reductions in opioid prescriptions associated with changes in laws, finding that medical cannabis policies lead to 39.41 fewer opioid prescriptions per 1,000 enrollees annually and that the effect for recreational legalization was even larger.

“Furthermore, the implementation of adult-use marijuana laws was associated with a 9.78% lower Medicaid spending on prescription opioids, equivalent to an annual saving of $1,815 Medicaid spending per 1,000 enrollees,” the study found. “The implementation of medical and adult-use marijuana laws was also associated with a lower rate of Medicaid-covered prescriptions for nonopioid pain medications of 8.36% and 8.69%, respectively.”

The research teams behind both new studies said that medical cannabis shows promise as a partial solution to opioid issues.

“Combined with previously published studies suggesting cannabis laws are associated with lower opioid mortality, these findings further strengthen arguments in favor of considering medical applications of cannabis as one tool in the policy arsenal that can be used to diminish the harm of prescription opioids,” the Bradfords’ Georgia team wrote. “Furthermore, a growing consensus suggests that cannabis can be used to effectively manage pain in some patients. If initial licit prescriptions for opioids can be reduced, then there is a plausible theoretical pathway to anticipate that opioid misuse and abuse could also fall.”

When legal marijuana is available, some patients appear to be more likely to choose it instead of prescription pain pills that can lead to addiction or overdose.

“Most opioid use disorder and overdose cases occurred in patients with legitimate prescriptions from health care professionals for pain management. Marijuana liberalization, therefore, may have benefited these patients by providing them with legal protection and access to marijuana as an alternative relief from their pain conditions,” the Kentucky and Emory team wrote. “The widespread public support will bring medical marijuana laws to more and more states for years to come, which may help decrease the use of prescription opioids in pain management and the adverse consequences, such as opioid use disorder and overdose.”

Those researchers also noted that “marijuana may help ease opioid withdrawal symptoms.”

“Thus, marijuana liberalization potentially reduced prescription opioid use on 2 fronts, serving as a substitute for opioid pain medications, and as a complement to opioid use disorder treatment,” the wrote. “The potential of adult-use marijuana laws to reduce the use and consequences of addictive opioids deserves consideration, especially in states that have been hit hard by the opioid epidemic.

This piece was first published by Forbes.

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.

Tom Angell is the editor of Marijuana Moment. A 20-year veteran in the cannabis law reform movement, he covers the policy and politics of marijuana. Separately, he founded the nonprofit Marijuana Majority. Previously he reported for Marijuana.com and MassRoots, and handled media relations and campaigns for Law Enforcement Against Prohibition and Students for Sensible Drug Policy. (Organization citations are for identification only and do not constitute an endorsement or partnership.)

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Medical Marijuana Patients With ADHD Use Fewer Prescription Drugs, Study Finds

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When people with attention-deficit hyperactivity disorder (ADHD) consume more medical marijuana they tend to use fewer prescription drugs, including powerful, habit-forming psychostimulants, according to a new study.

Patients who used medical cannabis components—cannabinoids themselves as well as terpenes— also “reported a higher occurrence of stopping all ADHD medications,” the researchers, whose findings were published late last month in the Rambam Maimonides Medical Journal, wrote.

“In this study, we demonstrated that patients treated with [medical cannabis] stopped their ADHD medications, especially in the high MC dose and in the low ADHD symptoms frequency subgroups.”

Specifically, the study found that the cannabinoid CBN, or cannabinol, which is found in the plant in only trace amounts, seemed to trigger the best results—though they conceded that “more studies are needed in order to fully understand” if cannabis and its constituents can be a workable ADHD treatment.

“These results, although not causal, might shed light on the potential beneficial effects of [medical cannabis] on ADHD symptom severity and motivate future prospective studies in order to validate our results,” the researchers concluded, “and perhaps even consider making ADHD an approved indication” for medical cannabis where it is legal.

The team collected data from 53 Israeli medical cannabis patients in an existing database who had previously agreed to participate in surveys and who also had an ADHD diagnosis. Thirty-seven of the 53 patients suffered from some from of mental health condition.

Participants were asked to self-report monthly doses, how they consumed cannabis, the manufacturer or grower and the cultivar name (or strain) between October 2019 and January 2020.

“These findings reveal that the higher-dose consumption of [medical cannabis] components (phyto-cannabinoids and terpenes) is associated with ADHD medication reduction.”

This is a departure from previous research into ADHD and cannabis, the researchers noted. Prior studies had “considered cannabis as a single product in ADHD research, disregarding its inherent complexities and variability between cultivars and combinations of cultivars,” they wrote.

Most patients had previously obtained medical cannabis licenses (the terminology used in Israel) for chronic pain or cancer treatment rather than neurological disorders that co-exist with ADHD.

Forty-seven patients in the study, which was funded by the Evelyn Gruss Lipper Charitable Foundation, reported either smoking or vaporizing their cannabis.

The cannabis consumers were divided into two subgroups: high dose and low dose. Cultivar combinations were complicated: There were 27 different combinations of varieties but, in addition to CBN, the cannabinoids most associated with reduced or eliminated ADHD medication use including THC, THCV and CBD.

Exactly how various combinations of cannabinoids and terpenes “modulate the circuitry involved in both ADHD and comorbid psychiatric conditions” is still unclear, the researchers said. But the study also suggests that finding the proper dose and the proper cultivar—and cultivar combination—may require significant experimentation on the part of the patient.

And patients in Israel enjoy more reliable access to more regulated cultivars than patients anywhere else in the world—suggesting that most American patients, with a basic understanding of THC and CBD and not a lot else, still have a ways to go.

“This indicates a more complex story than simply stratifying treatment based on THC and CBD alone,” the researchers wrote.

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Hemp Is For Horses? New Study Examines CBD’s Calming And Painkilling Effects In Animals

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Imagine you’re a race horse. Do you get nervous before the starting bell?

Scientists are curious to learn if CBD might help.

The hype around cannabidiol has hit the equestrian world hard since the 2018 Farm Bill federally legalized industrial hemp and its derivatives, including CBD. While federal officials have yet to finalize rules formally allowing the non-intoxicating cannabinoid in animal feed—or in food products for humans for that matter—CBD supplements have become hot products among horse owners looking to ease pain, reduce pain in muscles and joints and calm signs of stress in their animals.

Now researchers want to know if they actually work. A Texas-based team is currently collecting data on how CBD affects equine physiology. In particular, their new study is examining whether the cannabis compound can help reduce stress, inflammation and obsessive compulsive behaviors in horses.

“I had been interested in the CBD movement for a while, and primarily it is because we’re in a highly horse-populated area,” said Kimberly Guay, a professor at Tarleton State University in Stephenville who specializes in how stress affects animals. “A lot of the horse people I knew were already using CBD, illegally you would say, because it wasn’t legal in Texas at the time.”

Guay’s team is experimenting by giving horses various doses of CBD, generally in the form of oils and edible pellets, and then assessing how they respond. Researchers monitor the animals’ heart rates, inflammation and levels of cortisol, a hormone animals produce under stress. They also observe the horses’ behavior, looking for how CBD affects behavioral indications of pain, stiffness or anxiety.

Guay herself said she has no vested interest in the outcome of the study and doesn’t currently give CBD to her own horse, but she’s eager to see whether the data support what she’s heard from other owners. “The anecdotal evidence is incredibly strong,” Guay told Marijuana Moment in an interview. “And if there is a chance to mediate stress, then I’m all for it.”

The team is aiming to publish the results of the study next year, but Guay said some initial findings could be available as soon as this fall.

“I still can’t say one way or the other, but I know there’s no adverse effects, apparently,” she said, explaining that researchers have given some animals “a significant dose, and there was no obvious adverse reactions from it.”

Across the country, the U.S. Equestrian Federation, which sets the rules for most of the country’s competitive horse events, noted last year that “cannabinoids have gained increased attention and have become nearly mainstream.”

But the rulemaking body said that a horse testing positive for CBD violates competition rules because the cannabinoid is “likely to [affect] the performance of a horse due to its reported anxiolytic effects,” referring to the compound’s apparent role in reducing anxiety.

The U.S. Food and Drug Administration is responsible for regulating the country’s animal feed, and so far CBD has been forbidden. Guay said that if the horse study shows positive results, CBD could also be looked at as a supplement for livestock used for food production.

“If there’s some version of the byproduct of the plant in hemp that could be utilized or incorporated into feed or whatever that could help minimize stress for livestock animals, that would be a huge benefit,” she said.

Currently stress in livestock is managed either with behavioral controls, such as limiting the amount of time animals spend in confined spaces, or through the use of sedative drugs. But sedatives, Guay said, can affect an animal’s balance and its ability to regulate body temperature.

Anecdotally, horse owners who experimented with giving CBD to their animals continued using it “because they believed so strongly in the effects CBD was giving them without the need for sedation,” Guay said.

“That intrigued me,” she added. “We can get the empirical evidence, it’s just going to take time and some effort.”

Most horse owners she’s talked to are on board with the study, Guay said, and are eager to hear the results. But stigma around CBD, even when produced from industrial hemp, remains evident in her home state of Texas, which legalized hemp and CBD production in mid-2019. Federal regulators approved the state’s hemp plan last month.

Guay told Marijuana Moment that she’d been interested in studying the effects of CBD on horses prior to Texas legalizing, but the university system was wary. “I had been chasing this project for a year before it was legal in Texas, and the A&M system would not give me clearance,” she said. “I knew the wave was coming.”

Even today, there are still lingering fears. “People holler at [research assistants] on the phone and voice their opinion,” Guay said, “and some people hang up on them because of that stereotype, that stigma that comes with CBD so far.”

Among the broader veterinary community, that stigma is slowly fading. A survey last year found that most veterinarians consider themselves fairly knowledgeable about recommending cannabinoid therapy for dogs, for example. The problem? Respondents said their state veterinary associations didn’t provide specific guidance on the subject, even in states where cannabis was legal. They also felt research was lacking.

More research is coming, even if it’s not quite keeping up with industry hype. In his annual budget proposal released last week, President Donald Trump directed $500,000 to the FDA’s Animal Drugs and Feeds program in order to “strengthen its capacity to evaluate scientific data related to the safe use of cannabis and cannabis derivatives in animal products.”

Asked if she’d tried CBD herself since Texas legalized the products, Guay at Tarleton State said she had. “Of course I’m going to try it,” she replied. “We’re making our animals ingest it, so I wanted to see what their experience is. They can’t talk.”

She hasn’t noticed many effects so far from cannabis oils, she said, other than “some versions taste terrible.” But after recently using a topical cream, she felt the product may actually have helped. “I have tennis elbow, and I rubbed it on my elbow, and I feel like it significantly helps my elbow. It reduced the pain in my elbow,” she said.

Despite a positive result, Guay knows her evidence is only anecdotal. She knows better than to put stock in what could be a placebo affect.

“I’d have to quantify it,” she said. “I always need numbers.”

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Lasers Can Tell Hemp And Marijuana Apart With ‘100 Percent Accuracy,’ Scientists Reveal

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Hemp can look and smell like marijuana, presenting a series of challenges to law enforcement and farmers alike. But according to new research, lasers can be used to tell the difference between the two cannabis crops in a fast, affordable and highly precise way.

In a study published last month in the journal RSC Advances, a team of researchers at Texas A&M University were able to “determine whether plant material is hemp or [marijuana] with 100% accuracy” by using a hand-held laser device called a Raman spectrometer (RS).

To test whether the tool could effectively distinguish the two plants, fresh samples of hemp and marijuana strains were frozen, which, according to the authors, “does not result in any noticeable changes in plant appearance or texture.”

The researchers observed that lasers could reliably map a “change of intensities” in vibrational bands, which indicated “structural differences between hemp and [marijuana] plants.”

The results found that hemp has more cellulose, compared to marijuana plants.

“Because of the portable nature of our analysis, this spectroscopic approach will be highly advantageous for police and border control officers.”

The Raman spectrometer was also shown to potentially identify different strains by accurately measuring the potency of individual plants, which “can be used for confirmatory, non-invasive and non-destructive detection and identification of cannabis,” the authors wrote.

The researchers noted that their device detects delta-9-tetrahydrocannabinolic acid (THCA) which is itself non-psychoactive but turns into the intoxicating compound THC when it undergoes decarboxylation (usually by being heated). “[W]e can speculate that RS allows to predict the amount of THC in the analyzed sample without necessary oxidation of THCA to THC,” they wrote.

Additional laboratory testing is underway “to determine accuracy and range” of THCA prediction with the device.

Hemp is defined under federal law as having no more than 0.3 percent total THC, with a negligence threshold of 0.5 percent. And while there’s strong bipartisan interest in ensuring that hemp farmers have the resources they need following the crop’s federal legalization, proving that the plant isn’t marijuana currently requires costly and lengthy laboratory analysis.

“These results demonstrate that RS can be a great tool for hemp cultivation and breeding allowing for accurate detection of THCA levels in intact growing plants.”

With the right tools, officials could quickly determine whether a plant in question is hemp or marijuana, which remains prohibited federally and in several states.

In December, a Texas man was arrested when his vehicle was found hauling more than a ton of cannabis through Amarillo. The plants were seized, and the driver spent almost a month in jail before lab results showed he was transporting hemp.

Other similar discrepancies and mistakes are likely to keep occurring in states and municipalities across the country as new hemp laws come online.

Marijuana prosecutions in Texas were cut in half after hemp laws changed, for example, an unintentional side effect of expanding access to the non-intoxicating cannabis crop. Because police officers in many cases can’t determine whether a cannabis sample is legal hemp or illegal marijuana, prosecutors in the state and others across the country have stopped pursuing many cases until testing methods are more readily available.

The promising new laser technology could mean fewer headaches on the part of state and federal regulators—and a lower risk of getting tied up with law enforcement for law-abiding hemp traders.

“These findings suggest that a hand-held Raman spectrometer can be an ideal tool for police officers and hemp breeders to enable highly accurate diagnostics of THCA content in plants,” the researchers concluded.

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