Clinicians in a recently published case study have concluded that cannabis was the likely culprit behind a 32-year-old man’s persistent, painful erections. It’s a rare and curious example of marijuana being associated with what’s known in medical jargon as priapism—an erection lasting more than four hours that’s not related to sexual activity.
Priapism can have serious consequences, the report notes, including “damage to the penile tissue, with notable destruction obvious at twelve hours” and “over 90% of those remaining erect for 24 h losing sexual function.” The effects can be permanent.
The patient in the case study, published this month in the Journal of Cannabis Research, had been previously treated at the hospital for an erection lasting 12 hours. In a second incident described in the report, he arrived at the emergency department with an erection that had persisted for six hours. He told doctors that he had been smoking marijuana several nights a week for the past six months and during that period experienced “four or more episodes of a persistent erection lasting close to four hours.” In each case, he had smoked within a two-hour period before the erection began.
The case study’s authors, a team at Coliseum Medical Centers in Georgia, call it “the first known case of cannabis-associated priapism in a patient where all other known causes of priapism have been excluded.”
“The abstinence and subsequent use of cannabis were the only appreciable factors in this patient’s battle with recurrent unwanted erections.”
Cannabis doesn’t appear often in published case studies involving unwanted erections. When it does, it’s often in cases where the erections have other, more likely causes. The team conducted a literature review and “was only able to identify four distinct cases of cannabis use coinciding with priapism,” the report says, “none of which were convincingly able to prove cannabis was the sole cause.”
Two of the past cases involved patients with sickle-cell disease, a leading cause of priapism. Another showed concurrent use of MDMA, or ecstasy, which the report says is another proven cause. The fourth involved a patient with diabetes—another known cause—who had also used a number of other substances, including cocaine—yet another cause—and anabolic steroids.
The new patient’s case is unique. “He had no medical history other than mild hypertension, he took no medications, and used only cannabis, supported by his urinary drug screen,” the report says. “Further, his history exhibited a convincing correlation between his cannabis use and his episodes of recurrent priapism.”
“On physical exam, the patient was mildly hypertensive with an erect, swollen, and tender penis.”
The man had smoked marijuana off and on over his life, he told doctors. The periods during which he consumed cannabis seem to align with past episodes of uncomfortable erections. “He admitted a history of cannabis use at age sixteen and seventeen, during which time he had recurrent priapism lasting less than four hours and never requiring medical treatment,” the report says. “He quit cannabis use in his twenties, and during this period did not have any episodes of priapism.”
The report’s authors were left to speculate about how cannabis could have actually caused the patient’s sustained erections. Among the possibilities they identified was that cannabinoids were affecting regulatory mechanisms that would otherwise signal an erection to end. Another explanation has to do with increased blood-platelet activation, which is associated with cannabis and increased chance of heart attack for 60 minutes after consumption.
Cannabis also has direct effects of its own on the vascular system, causing blood vessels to dilate. Researchers said that effect, too, “could potentiate the unrelenting erection notable in priapism.”
As with many areas of marijuana research, the drug’s classification as a federally controlled substance has historically stymied research. “There is a paucity of studies investigating human erections and marijuana,” researchers wrote in a separate 2008 study, “and as a result there is insufficient evidence to suggest that marijuana will cause priapism in humans.” Little progress has been made since then.
A case study published in 2018 examined a patient with priapism who had consumed not marijuana but lab-created synthetic cannabinoids. Authors of the new report call that case study “supporting evidence” for the theory that cannabis caused their patient’s lasting erection, although they note that synthetic cannabinoids are “100 times more potent activators” of the body’s cannabis receptors.
“If synthetic cannabinoids can cause priapism, plant cannabis, affecting the same [cannabinoid receptors], would also be capable to potentiate this reaction,” the report says.
Of what little research does exist on cannabis and sex, most has focused on more desirable results: making sex better. According to self-reported anonymous surveys—some more scientific than others—many people, especially women, report having more frequent and satisfying sex after consuming marijuana.
A study led by Becky Lynn, an associate professor of obstetrics and gynecology at Saint Louis University in Missouri, last year found that more than two-thirds of women (68.5 percent) who said they’ve consumed marijuana before sex “stated that the overall sexual experience was more pleasurable.” Respondents also said they had an increased sex drive (60.6 percent) and more satisfying orgasms (52.8 percent).
Another study last year, by an Eastern Carolina University graduate student, also found that “participants perceived that cannabis use increased their sexual functioning and satisfaction,” associating cannabis consumption with “increased desire, orgasm intensity, and masturbation pleasure.”
A literature review published this past September in the journal Sexual Medicines Review evaluated decades of evidence and concluded a link between cannabis and libido seems to exist, but effects depend heavily on dose.
“Several studies have evaluated the effects of marijuana on libido, and it seems that changes in desire may be dose dependent,” the review found. “Studies support that lower doses improve desire but higher doses either lower desire or do not affect desire at all.”
Even less research has been published on marijuana and erections. Anecdotal evidence suggests that some men find that consuming cannabis is helpful in achieving and maintaining erections, but consuming too much can impede arousal. It’s not clear the degree to which those effects are physiological and to what degree they are related to psychological factors like stress and anxiety.
As for the man with the 12-hour erection, it’s not clear how he’s fared. According to the case study, he was referred to urology and internal medicine specialists for further diagnosis, “however he was lost to follow-up in this period.”
Photo by Sharon McCutcheon on Unsplash
Legal Marijuana States See Reduced Workers’ Compensation Claims, New Study Finds
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
A new study out of Washington State University suggests cannabis may inspire entrepreneurs to come up with big, bold business ideas—but could also lead them down a rabbit hole of wishful thinking.
Researchers found that entrepreneurs who were frequent marijuana consumers came up with business pitches that were more original but less feasible, according to a panel of experts who scored the ideas.
“Beyond their innate creative aptitude, entrepreneurs may attempt to enhance their creativity,” says the study, which will appear in the March 2021 issue of the Journal of Business Venturing. “Despite generating more original ideas, we found that cannabis users’ ideas were less feasible.”
Also important variables, the study found, were an entrepreneur’s passion, which may heighten creativity at the expense of feasibility, as well as their past entrepreneurial experience, which tended to increase idea feasibility but rein in creativity.
The findings “provide insight into the creative benefits and detriments associated with being a cannabis user,” the study says, “suggesting that cannabis users—especially those who are passionate about exploring new venture ideas or those with relatively little entrepreneurial experience—may benefit from non-users’ insights to develop the feasibility of their ideas.”
To test the effects of marijuana on business-idea generation, researchers had 254 entrepreneurs come up with “as many new venture ideas as possible” based on virtual reality—a prompt provided by researchers. Participants had three minutes to generate ideas, then selected the idea they believed to be their best. Two “expert raters” then evaluated the chosen pitches for originality and feasibility.
Reachers say their findings support one of the study’s core hypotheses: that there are differences between how cannabis users and non-users arrive at business ideas. “Cannabis users are more impulsive, disinhibited, and better at identifying relationships among seemingly disparate concepts,” the study proposes. “However, these differences and cannabis users’ diminished executive functioning likely detracts from idea feasibility.”
Notably, the researchers did not ask participants to consume marijuana in the study setting itself. Rather, to compare cannabis-users to non-users, researchers split participants into two groups: those who had used marijuana less than five times in their lives and never in the past month (non-users) and those who’d consumed more than five times in their life and at least twice in the past month (users).
“Unlike alcohol, where health organizations have established standards for heavy drinking,” the study notes, “scholars have yet to reach a consensus on what constitutes a cannabis user versus a non-user.”
Because the study was merely observational, it also cannot determine whether marijuana use was in fact the cause of the differences between the two groups’ ideas. It may be that some other trait or traits explain both a person’s idea generation and their decision to consume cannabis.
The study’s cannabis user group comprised 120 people, or 47.2 percent of all participants. Researchers attempted to control for certain other factors, such as gender, age, education and technological familiarity.
While the findings suggest that, overall, cannabis can both inspire originality and limit feasibility, the outcomes were influenced strongly by what researchers described as “entrepreneurial passion for inventing” as well as their “entrepreneurial experience.”
“Cannabis users’ diminished idea feasibility compared to non-users was significant in those with low entrepreneurial experience,” the study’s authors wrote, “but not in those with high entrepreneurial experience.”
Similarly, “cannabis users’ lower idea feasibility was signifiant at high entrepreneurial passion for inventing but not low entrepreneurial passion for inventing,” the study found.
“Entrepreneurial passion for inventing appears to play a role in channeling cannabis users toward idea originality but away from idea feasibility,” it says. “Conversely, entrepreneurial experience appears to attenuate the positive relationship of being a cannabis user with idea originality and its negative relationship with idea feasibility.”
As the study itself acknowledges, many successful business leaders and visionaries have credited the inspirational powers of cannabis. Apple luminary Steve Jobs, for example, “noted that his use of cannabis helped him feel ‘relaxed and creative.’” (Biographer Walter Isaacson also quoted Jobs as saying another drug, LSD, was “one of the most important things in my life. … It reinforced my sense of what was important—creating great things instead of making money.”)
On the other hand, researchers argue that cannabis use can be a double-edged sword. “Regular cannabis use is associated with numerous detrimental effects, such as the potential for dependence and addiction, risk of motor vehicle accidents, mental and respiratory health problems, as well as memory and other cognitive impairments.”
Benjamin Warnick, assistant professor at Washington State University’s Carson School of Business and lead author of the study, said in a press release that the research is “the first study we know of that looks at how any kind of drug use influences new business ideation,” adding that “there is still much to explore.”
“Clearly there are pros and cons to using cannabis that deserve to be investigated further,” Warnick said. “As the wave of cannabis legalization continues across the country, we need to shed light on the actual effects of cannabis not only in entrepreneurship but in other areas of business as well.”
Photo courtesy of the Drug Policy Alliance, Sonya Yruel
Areas With More Marijuana Dispensaries Have Fewer Opioid Deaths, New Study Finds
Increasing access to marijuana dispensaries is associated with a significant reduction in opioid-related deaths, according to a new study.
“Higher medical and recreational storefront dispensary counts are associated with reduced opioid related death rates, particularly deaths associated with synthetic opioids such as fentanyl,” the paper, published on Wednesday in the British Medical Association journal’s BMJ, concluded.
It’s a finding that “holds for both medical and recreational dispensaries,” the study says.
Researchers looked at opioid mortality and cannabis dispensary prevalence in 23 U.S.states from 2014 to 2018 and found that, overall, counties where the number of legal marijuana shops increased from one to two experienced a 17 percent reduction in opioid-related fatalities.
Increasing the dispensary count from two to three was linked to an additional 8.5 percent decrease in opioid deaths.
Further, the study found that this trend “appeared particularly strong for deaths associated with synthetic opioids other than methadone, with an estimated 21 percent reduction in mortality rates associated with an increase from one to two dispensaries.”
“If consumers use cannabis and opioids for pain management, increasing the supply of legal cannabis might have implications for fentanyl demand and opioid related mortality rates overall.”
“While the associations documented cannot be assumed to be causal, they suggest a potential association between increased prevalence of medical and recreational cannabis dispensaries and reduced opioid related mortality rates,” the researchers wrote. “This study highlights the importance of considering the complex supply side of related drug markets and how this shapes opioid use and misuse.”
This is far from the first piece of research to draw a connection between legal cannabis access and reduced harms from opioids. Multiple studies have found that marijuana effectively treats conditions like chronic pain for which opioids are regularly prescribed, and surveys show that many patients have substituted addictive painkillers with cannabis.
“Cannabis is generally thought to be a less addictive substance than opioids,” the new study says. “Cannabis can potentially be used medically for pain management and has considerable public support.”
“Given the alarming rise in the fentanyl based market in the US, and the increase in deaths involving fentanyl and its analogs in recent years, the question of how legal cannabis availability relates to opioid related deaths is particularly pressing.”
“Our findings suggest that increasing availability of legal cannabis (modeled through the presence of medical and recreational dispensary operations) is associated with a decrease in deaths associated with the T40.4 class of opioids, which include the highly potent synthetic opioid fentanyl,” it continues. “This finding is especially important because fentanyl related deaths have become the most common opioid related cause of death.”
Earlier this month, a separate study determined that medical cannabis use is associated with significant reductions in dependence on opioids and other prescription drugs, as well as an increase in quality of life.
These studies could also provide valuable context to a federal health agency in the U.S. that is conducting a review of studies to learn if marijuana and kratom could potentially treat chronic pain with fewer side effects than opioids.
Photo courtesy of WeedPornDaily.