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Legal Medical Marijuana Associated With Lower Opioid Use Rates, Another Study Finds

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Legal access to medical marijuana is associated with lower rates of moderate and high-risk opioid use, according to a recent study—the latest in a string of research to come to the same conclusion.

Researchers analyzed prescription data on nearly 5 million people from 2006 to 2014, and they found that patients living in states that have legalized medical cannabis were less likely to take prescription painkillers, even after adjusting for various individual and state-level factors such as whether a state had a prescription monitoring system in place.

“Medical marijuana legalization was found to be associated with a lower odds of any opioid use,” the study found.

The results were published on Friday in the Journal of General Internal Medicine.

In general, patients were less likely to take opioids if they lived in a state with medical cannabis (19.3 percent) than those in non-legal state (19.9 percent). Chronic opioid use was also lower in legal states (1.8 percent) than non-legal states (1.9 percent).

“In states where marijuana is available through medical channels, a modestly lower rate of opioid and high-risk opioid prescribing was observed.”

The study considered different subgroups as well, looking at patients who didn’t have cancer and also pain patients who didn’t have cancer. The study revealed a similar trend: lower rates of opioid use in states with medical marijuana.

For that latter group, opioid use was generally lower in legal states (33.5 percent) compared to non-legal states (34.7 percent). This group was also less likely to use opioids long-term in legal states (4.5 percent) than non-legal states (4.8 percent), which is important because chronic use is more likely to result in patients building a tolerance to opioids that leads to misuse.

High-risk opioid use—defined as taking opioids and benzodiazepines at least once on the same day, taking painkillers that contain 120 morphine milligram equivalents or being diagnosed with a substance use disorder within the same year of being prescribed opioids—was also lower in legal states (5.1 percent) than non-legal states (5.6 percent).

“This study indicates that legalizing medical marijuana is associated with lower use of opioids and opioids used chronically across states, broadly, and in subgroups of cancer patients and cancer-free groups with chronic pain,” the researchers wrote.

There are multiple recent studies supporting this conclusion. For example, a research released in November demonstrated that it’s not just a question of whether a state enacted a medical cannabis system; lower opioid overdoses occurred specifically in counties where dispensaries were allowed to operate.

Marijuana Dispensaries Reduce Local Opioid Overdose Rates, Study Finds

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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.

Kyle Jaeger is Marijuana Moment's Los Angeles-based associate editor. His work has also appeared in High Times, VICE and attn.

Science & Health

Federal Data Shows Youth Marijuana Use Isn’t Increasing Under Legalization

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Despite prohibitionists’ often-expressed fears that legalization would lead more young people to use marijuana, new federal data released on Tuesday shows no such trend.

Reports of past-month cannabis use among those 12-17 remained stable from 2017 to 2018—and they’re significantly lower than in the years prior to when the first states began legalizing for adult use.

That’s according to the 2018 National Survey on Drug Use and Health (NSDUH), an annual report produced by the Substance Abuse and Mental Health Services Administration (SAMHSA).

“The percentage of adolescents in 2018 who used marijuana in the past year was lower than the percentages in 2002 to 2004 and in 2009 to 2013, but it was similar to the percentages in 2005 to 2008 and in 2014 to 2017,” SAMHSA said.

Via SAMHSA.

Recent studies that have used NSDUH data and other sources also demonstrate that youth marijuana use is not increasing post-legalization. In fact, research published in JAMA Pediatrics in July found that states with recreational cannabis experience a decline in underage marijuana use, with the study authors stating that regulated markets appear to deter illicit use.

Indeed, on a national scale, the percentage of adolescents who reported using marijuana began declining at a greater rate in the years after states started implementing legal cannabis systems. In 2018, 12.5 percent of those 12-17 said they used cannabis in the last month, compared to 13.5 percent in 2012, according to the NSDUH results.

Colorado and Washington State became the first U.S. states to vote to legalize marijuana for recreational use in late 2012, with legal sales commencing in 2014.

Between 2002 and 2018, the highest rate of adolescent marijuana use took place in 2002, when 15.8 percent reported past-month consumption.

“The survey results suggest that marijuana use among youth has remained stable and low in recent years, even as more states legalize medical and adult use,” Sheila Vakharia, PhD, deputy director of the Drug Policy Alliance’s Department of Research and Academic Engagement, told Marijuana Moment. “Rather than encouraging increased use, it is possible that legalization has limited access and deterred youth use. We find that these results strengthen the case for legalization in the interest of public health and protecting our nation’s young people.”

What’s more, the report found that cases of cannabis use disorder declined again for the 12-17 group in 2018, marking the seventh year in a row that fewer young people seem to be misusing the substance.

Via SAMHSA.

Interestingly, these trends are developing even as people’s perceptions of the risks of casual marijuana consumption are dropping. That seems to contradict an argument from reform opponents who claimed that legalizing cannabis would normalize it in such a way that underage individuals would feel more emboldened to experiment with marijuana.

Via SAMHSA.

Overall, marijuana consumption increased across age groups by about one percentage point over the past year, the survey found, with the bulk of that rise being attributable to those over 26. Past-month cannabis use for that demographic increased from 12.2 percent in 2017 to 13.3 percent in 2018.

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This story was updated to include comment from the Drug Policy Alliance.

Photo courtesy of Philip Steffan.

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Politics

Federal Health Agency Releases List Of Marijuana Research Priorities

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In one of the latest signs that the federal government is recognizing the reality of the marijuana legalization movement’s continued success, a top health agency released an extensive list of cannabis-related research objectives it hopes to fund.

The notice, published on Wednesday, notes the rapid evolution of marijuana policies in the U.S. and globally, which is “far outpacing the knowledge needed to determine and minimize the public health impacts of these changes.”

“A growing number of states have loosened restrictions on cannabis, including those on sales and use, by passing medical marijuana laws or by making cannabis legal for adult recreational use, and in some cases, states have done both,” the National Institute on Drug Abuse (NIDA) wrote.

It also referenced a 2018 report from a cannabis policy working group that was tasked with identifying “cannabis policy research areas with the greatest urgency and potential for impact.”

Evidently, there are quite a few areas that fit that description, as NIDA listed 13 research objectives of “programmatic interest.” And while the agency has previously called for studies into several areas that are featured on the notice, there are others that signal NIDA is evolving in its understanding of research needs as more states opt to legalize.

For example, NIDA is not simply focusing on providing grants to explore the health risks of cannabis use, it’s also interested in learning about “reasons for initiation and continued use of marijuana for therapeutic purposes” as well as investigating “how cannabis industry practices, including research on marketing, taxes, and prices, impact use and health outcomes.”

The agency also wants to fund studies that look at the differences in legal marijuana regulatory schemes in various jurisdictions to “understand which combinations or components minimize harm to public health.”

Other research goals NIDA described include exploring the impact of cannabis use during pregnancy and developing roadside testing instruments to identify THC impaired drivers as well as standards to measure marijuana dosing.

Here’s the full list of research objectives: 

—Develop standards for measuring cannabis (including hemp and hemp product) dose, intoxication, and impairment.

—Enhance existing epidemiology research to study trends for cannabis use and CUD; including new products, patterns of use, and reasons for use in different populations.

—Characterize the composition/potency of cannabis, methods of administration, cannabis extracts/concentrates, and cannabis of varying constituents (e.g. cannabinoid or terpene content), as well as how those factors impact physical and mental health.

—Determine the physical and mental health antecedents of use, as well as outcomes of use.

—Explore the impact of polysubstance use on health outcomes, including interactions (substitution/complementation) with alcohol, tobacco, and prescription and nonprescription opioids.

—Examine reasons for initiation and continued use of marijuana for therapeutic purposes.

—Investigate the effects of different patterns of cannabis use on brain development, educational attainment, and transition to work and adult roles.

—Identify the effects of maternal cannabis consumption during pregnancy and breastfeeding.

—Develop effective roadside tests for cannabis impairment that can be practically deployed by law enforcement.

—Determine the prevalence of cannabis-involved vehicular crashes and other types of injury or property damage.

—Investigate how cannabis industry practices, including research on marketing, taxes, and prices, impact use and health outcomes (e.g. how different price points impact consumption patterns across different levels of use).

—Determine the impact of federal, state, and local marijuana policies and their implementation on use and health outcomes.

—Explore the heterogeneity of regulatory schemes (e.g. models for retail distribution of cannabis) to understand which combinations or components minimize harm to public health.

A number of federal health agencies have issued several notices for marijuana-related research opportunities in recent months. One that received particular attention came from NIDA in May, when it said applications were open for what is essentially a professional research-grade marijuana joint roller and analyst position.

While NIDA said that research isn’t keeping up with the rapid reform movement, its director also acknowledged in April that the federal drug scheduling system—which regards cannabis as a tightly restricted Schedule I drug—has inhibited such research by making it difficult for scientists to access marijuana.

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Science & Health

Study Reviews How Marijuana Compounds Inhibit Tumor Growth And Kill Cancer Cells

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A recent scientific review concludes that marijuana’s legal status should be revisited given existing research that shows cannabis’s components can inhibit tumor growth and help with cancer management.

Researchers at Amity University in India detailed the scientific literature surrounding the effects of cannabinoids on different cancer types and also looked at marijuana’s anti-nausea, appetite stimulation and pain relieving qualities.

Besides treating symptoms of chemotherapy side effects, cannabis also shows potential in slowing the growth of cancer cells and even kill cancer cells in certain cases, the researchers wrote.

“THC and CBD exhibit effective analgesic, anxiolytic, and appetite-stimulating effect on patients suffering from cancer.”

But that’s not all. “Apart from exerting palliative effects, THC also shows promising role in the treatment of cancer growth, neurodegenerative diseases (multiple sclerosis and Alzheimer’s disease), and alcohol addiction and hence should be exploited for potential benefits,” an abstract of the study, published in the Journal of Cancer Research and Therapeutics, states.

The majority of the studies that were reviewed were based on in vitro experiments, meaning they did not involve human subjects but rather isolated cancer cells from humans, while some of the research used mice.

Cannabinoids appear to “exert potent [anti-growth] activity and activate various apoptotic mechanisms eventually leading to cell death” of cancer cells associated with glioma, an aggressive form of brain cancer.

At least once clinical trial showed that patients with recurrent glioblastoma multiforme who were treated with a “proprietary combination of THC and CBD” in addition to a traditional pharmaceutical had a higher one-year survival rate (83 percent) compared to a placebo group (53 percent).

Another study found blood cancer cells that were treated with two synthetic endocannabinoids activated receptors that “mediated apoptosis,” or the death of the cells.

In certain cell lines of prostate cancer, similar findings were observed. There was “[s]ignificant cell growth inhibition followed by apoptosis” in one particular cancer cell type in a “study which was designed to evaluate the in vitro effects of endocannabinioids such as 2-arachidonoyl glycerol, anadamine, and its synthetic analog methazolamide.”

Less research has been conducted on the effects of cannabis on lung, breast, oral and liver cancers, but the study authors documented instances where mice with certain lung cancer types treated with THC experienced a “notable reduction of the subcutaneous tumor growth and lung metastasis” of those cells, “prompting its significance as a novel therapeutic molecule in lung cancer treatment.”

But while THC is a common study focus, other cannabinoids show particular potential in treating different cancer types, they found. For example, a synthetic CBD compound (940-CBD) was the most effective “in terms of antiproliferative effects and invasiveness” of a particular breast cancer cell line.

When treated with THC, an oral cancer cell line that’s “highly resistant to anticancer drugs,” showed increased “cellular respiration inhibition,” whereas another conventional treatment option “showed no such effect.”

While researchers have investigated a wide range of cancer treatments, “the utilization of THC and their derivatives is still unexplored pharmacologically owing to their ‘habit-forming’ nature,” the researchers concluded. “Specific targeting of cannabinoid receptors can be used to manage severe side effects during chemotherapy, palliative care and overall cancer management.”

“Furthermore, research evidences on cannabinoids have suggested tumor inhibiting and suppressing properties which warrant reconsidering legality of the substance,” they said. “Studies on [cannabinoid] receptors, in case of cancers, have demonstrated the psychoactive constituents of cannabinoids to be potent against tumor growth.”

Because the activation of CB1 and CBD2 cannabinoid receptors “tends to limit human cancer cell growth,” there may be a “role of the endocannabinoid system as a novel target for treatment of cancers” and “[f]urther explorations are required to exploit cannabinoids for an effective cancer management.”

The findings reflect another recent study that also explored the therapeutic potential of cannabis extracts in the treatment of different cancers. Like this new review, it demonstrated that while variation in cannabinoids that are used to treat distinct cancer cell lines is an important consideration, the growing data on marijuana’s ability to inhibit cell growth and kill cancer cells indicates that it should be a major area of research going forward.

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