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Lung Injuries Tied To Contaminated Vapes Were Less Common In States With Legal Marijuana And Homegrow, Study Finds

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New federally funded research has identified another public health protection that is associated with states enacting laws to legalize marijuana.

Just before the COVID-19 pandemic, an outbreak of a different mysterious respiratory disease emerged among some users of cannabis concentrates and e-cigarettes. Eventually linked to an additive found most commonly in unregulated marijuana vape cartridges, the illness sickened nearly 3,000 people in the U.S. and killed 68, according to the Centers for Disease Control and Prevention (CDC).

A recent study of the outbreak, published late last month in the journal Drug and Alcohol Dependence, analyzed the relationship between state cannabis policies and the prevalence of the illness, known as EVALI (e-cigarette and vaping-associated lung injury). It found that in states where cannabis was legal for adults, or where medical marijuana patients could legally grow their own cannabis, EVALI was significantly less prevalent.

Specifically, states with adult-use marijuana laws in place during the 2019 outbreak had a 42 percent lower incidence of EVALI cases, according to the study, which received funding from the National Institute on Drug Abuse. And while state medical marijuana laws themselves seemed to have no significant association with prevalence of the disease, medical marijuana states that allowed home cultivation had a 60 percent lower EVALI incidence compared to those forbidding it.

“We find that recreational marijuana laws predicted lower 2019 EVALI incidences.”

“Recreational marijuana laws were associated with reduced EVALI incidence, whereas the relationship’s direction for medical marijuana laws depended on their policy attributes,” says the report, authored by Yale School of Public Health professor Abigail Friedman and Meghan Morean, a psychiatry research scientist at the Yale School of Medicine.

“States in the highest EVALI-quintile tended to either ban all marijuana use or have [medical cannabis] laws prohibiting home cultivation,” the researchers wrote. Most states with adult-use laws, meanwhile, “fell into the lower two quintiles for EVALI prevalence,” the study says.

The findings support what legalization advocates have long argued: that access to safe, legal cannabis is far preferable from a public health standpoint than sales on the illegal market, where products are unregulated and rarely tested for safety.

“Simply put,” the study says, “if the public can obtain products legally from reputable sources, there is less demand for illicit products.”

“EVALI incidence was about 40% lower in states with [recreational marijuana] legalization.”

A top CDC official suggested in 2019 that the regulations that come along with legalization can help protect consumers.

“I do think that labeling and information can help people know what they’re getting and then the systems that are there to enforce that the product is what it says it is can also help the consumer,” she said.

One exception to the trend in the new study was Massachusetts, which despite having legal adult-use marijuana, was in the highest EVALI quintile. But the researchers noted that this “may be explained by the fact that Massachusetts’s [recreational marijuana] law went into effect almost two years before its first licensed dispensary opened, a delay that could have strengthened the informal market in the interim.”

Massachusetts also banned the sale of all vape products, including both cannabis and e-cigarettes, from late September to mid-December 2019, meaning the only way for consumers to access those products was through the illicit market.

Previous research has observed that states with legal, regulated cannabis markets saw lower rates of EVALI. But authors of the new report said their analysis “is the first to show a relationship between MM [medical marijuana] policy and EVALI.”

In addition to looking at home cultivation, researchers also categorized state medical marijuana laws by whether or not they had an operating dispensary and whether they prohibited unprocessed, smokable cannabis.

Whether a dispensary was open to patients in a given state “yielded statistically significant estimates in all specifications,” the authors wrote. Forbidding smokable cannabis seemed in general to increase EVALI prevalence—at least after omitting from the analysis states that prohibited smoking cannabis but nevertheless sold smokable cannabis flower in dispensaries.

“Marijuana policies may offer a means to reduce the scale of such outbreaks if they impede the market penetration of contaminated products or affect the types of marijuana products consumers use.”

Though it may seem counterintuitive that smoking cannabis could in some cases be less dangerous than vaping, the study’s findings reflect that EVALI was caused by a chemical contaminant, vitamin E acetate, primarily used as a cutting agent in unregulated cannabis vape cartridges.

From that perspective, it makes sense that the findings generally showed that “policy attributes linked to lower EVALI incidences were also associated with reduced likelihoods of vaping as one’s primary mode of use.” During an outbreak of contaminated vape cartridges, avoiding vape cartridges turned out to be effective.

Authors acknowledged some limitations to their findings. One was data-gathering, as researchers relied on state-reported EVALI case data, which may be inconsistent from state to state. The illness itself is known variously as EVALI, VAPI (vaping-associated pulmonary injury) and VALI (vaping-associated lung injury).

Trying to distinguish between types of cannabis use also proved to be a challenge. Both cannabis concentrate and flower can be consumed in a vape, but only concentrates were implicated in the EVALI outbreak. (Dissecting the data can get confusing. As part of their statistical analysis, researchers at one point employed what they called “a vaping-or-dabbing indicator,” explaining that “Dabbing via a ‘dab pen’ is functionally equivalent to vaping marijuana concentrates, though dabbing with a ‘dab nail’ may involve combustion.”)

Authors also wrote that the were unable to assess policy differences within the 10 states that had implemented adult-use marijuana laws prior to 2020: None prohibited smokable marijuana, for example, and only Washington State forbids home cultivation for personal use.

Another limitation is that the findings are merely observational. “Although these findings are not causal, they provide direction to states that have passed or are considering MM legalization,” the report says. “Specifically, to the extent that such policies affect licit and illicit marijuana use, policymaking not only must ensure the safety of legal products but also should consider potential impacts on illicit market offerings.”

“To the extent that policymakers seek to leverage marijuana policies as a means to reduce the risk of future outbreaks,” it concludes, “close attention to these laws’ details, particularly those expected to affect mode of use, will be critical.”

Philadelphia Will Vote On Marijuana Referendum Calling For Statewide Legalization Next Month

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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.

Ben Adlin is a Seattle-based writer and editor. He has covered cannabis as a journalist since 2011, most recently as a senior news editor for Leafly.

Science & Health

Dogs Are Being Exposed To Marijuana Through Human Poop And Pet Owners Should Beware, Study Finds

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A word of caution to dog owners: apparently some canines are getting intoxicated off marijuana by eating the feces of people who’ve consumed cannabis, according to a new study.

Dogs are natural scavengers, and so the instinct to eat poop—while gross—is just a fact of life. But a team of Australian researchers found that, in some cases, that instinct can become dangerous, warranting the attention of puppy parents.

The study, published in the Australian Veterinary Journal, looked at 15 cases of confirmed THC toxicosis in dogs who were suspected of, or observed to have, ingested human feces in Melbourne from 2011-2020.

The dogs presented symptoms of incoordination, dilated pupils, urinary incontinence and stupor. Urine tests from eight of the dogs showed THC metabolites in their system.

However, study author Clara Lauinger told Marijuana Moment that this shouldn’t necessarily be taken to mean that any level of THC is toxic in dogs.

“The animals in my study had ingested an unknown quantity of feces that contained an unknown concentration of THC and so one would assume this concentration would be at a level that clearly caused toxicity,” she wrote in an email. “However this does not mean that all THC ingestions can lead to toxicity.”

In fact, there are other studies where animals were administered a controlled dosage of THC and “not a single one of them displayed any adverse effects that we might see with toxicity,” she said.

“There are so so many anecdotal reports of the huge benefits that THC administration has on animals, albeit reports are from owners perception rather than peer reviewed research, but this does not mean the industry should disparage THC as a therapeutic agent,” Lauinger said.

Most of the dogs in her new study apparently ate the poop at local parks, while others ingested it at the beach, camp sites and walking trails.

“All dogs survived to discharge. Ingestion of human feces containing THC may lead to marijuana toxicosis in dogs,” the study states. “Veterinary staff and owners should be attentive in regard to using appropriate hygiene measures when managing these dogs.”

The authors said that there are a number of reasons that a dog might eat poop—or, put scientifically, engage in coprophagy. But they floated one possibility for the marijuana-specific feces-eating trend: “It is possible that the presence of marijuana in feces increases its attractiveness for ingestion by altering its scent, texture and/or taste.”

Also, while this study is limited to data on about two dozen dogs in one city of Australia, the authors also said that the habit “might be more common than what owners report,” pointing to Google search results from people reporting a dog ate feces and exhibited signs of lethargy.

The idea of dogs getting high off THC-containing human waste might seem like a stretch on its own, but the study also explains that canines have more cannabinoid receptors than humans, “making dogs more sensitive to the effects of THC.”

“In conclusion, this case series suggests that ingestion of feces produced by a human marijuana user may lead to signs of marijuana toxicosis,” the researchers said. “Clinical signs of toxicosis were similar to those previously reported for dogs with conrmed marijuana toxicosis though gastrointestinal signs were not the most common feature despite coprophagy.”

“Veterinary staff and owners should be mindful of this exposure source to ensure appropriate hygiene measures are taken when managing these dogs,” the study says.

Lauinger said that there “needs to be an industrywide understanding of the fact that there are so many different strains of cannabis and each of these strains has different cannabinoid profiles that have possible potential for beneficial therapeutic effects.”

“These strains could be researched with a focus on what ones are suitable for animals and at what dose rather than blanketing all strains as being toxic,” she said. “I hope the public can be patient and also get behind us researching the dosing more.”

While there are clear concerns about dogs ingesting excess levels of THC, studies have found promising results when it comes to the therapeutic potential of other cannabinoids like CBD for pets.

For example, dogs with epilepsy experience considerably fewer seizures when treated with CBD oil, a study published in the journal Pet Behaviour Science in 2019 found.

The prior year, a separate study determined that CBD can alleviate the symptoms of osteoarthritis in dogs.

The Food and Drug Administration (FDA), for its part, has repeatedly warned pet owners about using CBD to treat firework-related anxiety in pets around the July 4 holiday.

“You should be aware that FDA has NOT evaluated these products and can’t say whether they are safe or effective, how they are manufactured, or whether they contain CBD,” the agency said this year.

Germany Will Legalize Marijuana And Promote Drug Harm Reduction, Governing Party Coalition Officially Announces

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Psychedelics Use Associated With 55 Percent Decrease In Daily Opioid Consumption, Study Finds

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The use of psychedelics like LSD, psilocybin, mescaline and DMT is associated with a significant decrease in illicit opioid consumption, according to a new study.

Researchers looked at data from “three harmonized prospective cohorts of community-recruited” people with substance misuse disorders. A total of 3,813 individuals were involved, including 1,093 who reported illicit opioid consumption and 229 who said they’d used psychedelics in the past six months.

“Recent psychedelic use was associated with 55% reduced odds of daily opioid use,” the Vancouver-based study, published last week in the Journal of International Drug Policy, found.

While there have been numerous studies connecting legal marijuana access to reduced opioid use and fewer overdose deaths, this is “the first longitudinal study to link psychedelic use with lower daily opioid use,” the paper says.

“Over study follow-up after adjusting for a range of potential confounders, psychedelic use remained independently associated with a significantly reduced odds of subsequent daily opioid use,” the study states. “While confirmation in other settings is required, these findings align with growing evidence that psychedelic use may be associated with detectable reductions in subsequent substance use including illicit opioid use.”

While there’s not a clear explanation for the trend—and the researchers urged additional studies—psychedelics like psilocybin and MDMA have been touted as potentially powerful tools in mental health treatment, effectively treating conditions like severe depression, post-traumatic stress disorder and addiction.

“These findings align with growing evidence demonstrating that psychedelic use may be associated with detectable reductions in subsequent opioid use, and warrant further research on psychedelics for opioid and other substance use disorders,” the study’s lead author, Elena Argento of the University of British Columbia, told Marijuana Moment.

“This study found naturalistic psychedelic use to be independently associated with a significantly reduced odds of subsequent daily illicit opioid use among a community-based sample of [people who use drugs],” the study concluded. “More research with controlled trials and longer-term follow-up is required to elucidate the therapeutic potential of psychedelics to augment existing interventions for substance use disorders, including among more diverse populations. Additional qualitative studies would also provide opportunities to improve understanding of the possible psycho-social mechanisms underpinning psychedelic experiences.”

Another recent study found that when people use cannabis together with psychedelics, it was “associated with higher scores of mystical-type experience, ego-dissolution and visual alterations.”

With respect to marijuana alone, a study published earlier this year found that cannabis use is associated with significant reductions in dependence on opioids and other prescription drugs, as well as an increase in quality of life

Another study released last year determined that states with active medical marijuana laws saw certain opioid prescription rates drop nearly 20 percent compared to prohibition states.

Using Marijuana With Psychedelics Intensifies The Mystical Experience, Study Finds

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Marijuana Legalization In Canada Did Not Result In Increased Traffic Injuries, Study Finds

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Canada’s move to legalize marijuana did not result in increased traffic injuries, a new study has found.

In a paper published in the journal Drug and Alcohol Dependence, researchers said they sought to investigate claims that establishing the cannabis legalization law, which took effect in October 2018, would make roads less safe, as prohibitionists frequently argue.

But after analyzing Ontario and Alberta emergency department data from April 2015 to December 2019, however, they couldn’t find any evidence to support that hypothesis.

“Implementation of the Cannabis Act was not associated with evidence of significant post-legalization changes in traffic-injury [emergency department] visits in Ontario or Alberta among all drivers or youth drivers, in particular,” the study states.

“Legalization not associated with changes in traffic injuries in all drivers or youth drivers.”

That’s despite the fact that “worldwide momentum toward legalization of recreational cannabis use has raised a common concern that such policies might increase cannabis-impaired driving and consequent traffic-related harms, especially among youth.”

The study’s lead author, Russ Callaghan, said in a press release that his team’s results “show no evidence that legalization was associated with significant changes in emergency department traffic-injury presentations.”

The researcher admitted that the outcome of the study is “somewhat surprising,” adding that he “predicted that legalization would increase cannabis use and cannabis-impaired driving in the population, and that this pattern would lead to increases in traffic-injury presentations to emergency departments.”

“It is possible that our results may be due to the deterrent effects of stricter federal legislation, such as Bill C-46, coming into force shortly after cannabis legalization,” he said, referring to a separate impaired driving bill. “These new traffic-safety laws imposed more severe penalties for impaired driving due to cannabis, alcohol, and combined cannabis and alcohol use.”

While Callaghan said he wasn’t expecting the results that his team ended up with, there is a body of existing research that’s also challenged the idea that legalization leads to increased traffic risks.

A U.S. congressional research body said in a 2019 report that concerns expressed by lawmakers that cannabis legalization will make the roads more dangerous might not be totally founded. In fact, the experts tasked by the House and Senate with looking into the issue found that evidence about cannabis’s ability to impair driving is currently inconclusive.

Other researchers have found on several occasions that traffic fatalities do not increase after a state legalizes marijuana.

A study published in the Journal of the American Medical Association late last year found that small doses of CBD appear to have no significant impact on driving, whereas comparable doses of THC were associated with short-term impairment “modest in magnitude and similar to that seen in drivers with a 0.05%” blood alcohol concentration.

In any case, House-approved report language related to funding for the Departments of Transportation, and Housing and Urban Development addresses drug-impaired driving from substances such as marijuana and urges the National Highway Traffic Safety Administration to take steps to address the issue.

DEA Boosts Psilocybin, MDMA And DMT Production Levels Again In Final Quotas For 2021

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