States that have enacted marijuana legalization were generally less likely to see spikes in vaping-related lung injuries that occurred over the past year compared to states where cannabis remains prohibited, according to a new study.
The paper, published Tuesday in the journal Addiction, seems to bolster arguments from reform advocates that legalizing and regulating marijuana mitigates the risk to consumers of using contaminated and potentially dangerous products.
The study also concluded that apart from state policies, “neither higher adult vaping rates nor higher rates of recent cannabis use predicted increased” e-cigarette or vaping product use-associated lung injury, or EVALI.
“If e-cigarette or marijuana use per se drove this outbreak, areas with more engagement in those behaviors should show a higher EVALI prevalence,” Abigail Friedman, the study’s author and an associate professor at the Yale School of Public Health, said in a press release. “This study finds the opposite result.”
In fact, some of the earliest adopters of adult-use cannabis legalization ranked among the lowest in terms of reported lung injuries from the outbreak, with fewer than one in 100,000 cases for residents aged 12 to 64.
The average state prevalence for these lung injuries was 1.4 cases per 100,000 residents in that age group.
By contrast, none of the states with the highest rate of cases have recreational marijuana markets in place.
“A negative relationship between EVALI prevalence and rates of pre-outbreak vaping and marijuana use suggests that well-established markets may have crowded-out use of riskier, informally sourced e-liquids,” the press release on the study says. “Indeed, the five earliest states to legalize recreational marijuana—Alaska, California, Colorado, Oregon and Washington—all had less than one EVALI case per 100,000 residents aged 12 to 64. None of the highest EVALI-prevalence states—Utah, North Dakota, Minnesota, Delaware and Indiana—allowed recreational marijuana use.”
“Only one of the ten states where recreational cannabis use was legal prior to 2020 is in the top quintile (Massachusetts), with several such states in the lowest quintile (Nevada, Washington, Colorado, and Alaska).”
A ban on smokeable cannabis products in two of the states with the most cases that only allow medical marijuana could also have contributed to the lung injuries by leaving consumers with options only available in the illicit, unregulated market.
“If such policies induced people who previously smoked cannabis to switch to vaping THC e-liquids (e.g., to evade detection of illicit use), that behavior change could have increased effected states’ EVALI incidence when contaminated e-liquids entered their markets,” the study says.
Friedman, the new paper’s author, elaborated in an email to Marijuana Moment.
“Medical and recreational marijuana policies’ implications for public health are likely to depend, not simply on whether a policy is present or not, but on how the policy is structured,” she wrote. “Policymakers need to pay careful attention to marijuana policy attributes: which types of cannabis products are and are not allowed; how product safety will be assessed and ensured; licensing and enforcement mechanisms; etc.”
“These regulatory details are critical, and may affect both the licit and illicit markets for cannabinoids,” she said.
All told, the Centers for Disease Control and Prevention has identified more than 2,800 cases and 68 deaths related to contaminated vape products. The agency has identified vitamin E acetate added to illicit market cartridges as being “strongly linked” to the spate of vaping-related lung injuries.
“These findings are consistent with evidence linking the EVALI outbreak to vitamin E acetate and informally purchased or modified THC e-liquids, as opposed to use of well-established nicotine e-cigarettes,” the study states. “Specifically, if a nationally marketed and commonly used vaping product caused these illnesses, one would expect a positive relationship between vaping rates and the disease.”
“Absent this association, geographically distinct clusters of elevated EVALI prevalence are more consistent with a dangerous additive in regionally distributed e-liquids (e.g., those purchased off the street). Indeed, this mechanism might explain the negative association with states’ rates of vaping and cannabis use if a strong market for legal nicotine e-liquids or cannabis crowds out black-market products.”
A separate study published in April similarly found that 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 still banned.
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 late last year.
Image by Lindsay Fox from Pixabay.
FDA Clears Researchers To Study MDMA Use By Therapists Being Trained In Psychedelic Medicine
The Food and Drug Administration (FDA) has already authorized clinical trials into the therapeutic potential of MDMA for patients with post-traumatic stress disorders—but now it’s given the green light to a psychedelics research institute to expand its studies by administering the substance to certain therapists.
Volunteer therapists who are being trained to treat people with PTSD will be able to participate in the Phase 1 trials to gain personal experience with the treatment option. This is a complementary research project that comes as the Multidisciplinary Association for Psychedelic Studies (MAPS) is in the process of conducting Phase 3 trials involving people with the disorder.
The development comes months after Canadian regulators announced that certain therapists would be allowed to take psilocybin in order to gain a better understanding of the psychedelic when treating patients.
MAPS sought permission to proceed with the therapist-specific trials in 2019, but FDA placed them on a 20-month hold because of concerns about the merits, risks and credentials of investigators. MAPS appealed that hold, providing evidence about the study’s scientific value and ability of its staff, and FDA cleared them on Tuesday.
— MAPS (@MAPS) May 13, 2021
The organization “chose to dispute” FDA’s hold not just because of the impact it had on the planned studies, “but in an attempt to resolve an ongoing issue with the FDA regarding investigator qualifications across studies,” it said in a press release on Wednesday.
“While the term ‘dispute’ may seem adversarial, this process can actually strengthen the relationship and trust between us and our review Division and ensures the Division has support on this project from the [FDA] Office of Neuroscience,” MAPS Public Benefit Corporation (PBC) CEO Amy Emerson said. “This decision demonstrates how our strategic, data-driven strategy in challenging the FDA rulings can be successful.”
Now MAPS is able to launch the Phase 1 clinical trials into MDMA-assisted therapy for therapists.
It will be designed to “measure development of self-compassion, professional quality of life, and professional burnout among clinicians delivering the treatment to patients,” the association said.
Getting personal experience with the substance “is widely considered to be an important element in preparation and training to deliver psychedelic-assisted therapies.”
This will “support the goals of the MDMA Therapy Training Program to provide comprehensive training to future providers,” and it “builds capacity to deliver quality, accessible care to patients, pending approval of MDMA-assisted therapy as a legal prescription treatment,” MAPS PBC Director and Head of Training and Supervision Shannon Carlin said.
FDA first granted MAPS’s request for an emergency use authorization for MDMA in PTSD in 2017. The organization expects to complete its Phase 3 trails in 2022.
The scientific expansion move also comes as the psychedelics decriminalization movement continues to build in the U.S.
Frequent Marijuana Consumers Are Actually More Physically Active Than Non-Users, Study Finds, Smashing Stereotypes
In a stereotype-busting new study, researchers found that frequent marijuana consumers are actually more likely to be physically active compared to their non-using counterparts.
For decades, anti-cannabis propaganda has cast marijuana consumers as unmotivated couch potatoes. This government-funded ad is a perfect example:
But a study published in the Harm Reduction Journal on Thursday found the opposite to be true. A nationally representative analysis of accelerometer-measured sedentary behavior showed that people who frequently use marijuana—particularly those aged 40 and older—spend more time engaging in physical activity than non-users do.
“Our findings do not support the mainstream perception of cannabis users as living sedentary lifestyles,” the researchers concluded.
In general, they found that “there’s no significant differences between non-current cannabis users and light, moderate, or frequent cannabis users in minutes per day spent in [sedentary behavior].” The difference came down to the average minutes that each group spent in physical activity.
“After controlling for all covariates, frequent cannabis users engaged in significantly greater amounts of light [physical activity] and [moderate-to-vigorous physical activity] compared to non-current users,” the study states. “In the unadjusted model, moderate cannabis use predicted more minutes spent in [moderate-to-vigorous physical activity] compared to non-current use, but this association was not significant upon controlling for all covariates. Light cannabis users did not significantly differ from non-current users in time engaged in [physical activity.”
“The results suggest that frequent cannabis users engaged in more [physical activity] than non-current users, but spent similar amounts of time in [sedentary behavior],” the researchers said.
While the study indicated that light marijuana use is not associated with a statistically significant difference in time being physically active, those who infrequently use cannabis were more likely to self-report more moderate physical activity compared to non-users.
“In a national, population-based US sample, current cannabis use was significantly associated with accelerometer-measured [physical activity], such that frequent cannabis users engaged in greater minutes of light PA and [moderate-to-vigorous physical activity] compared to non-current users.”
The researchers also looked at the relationship between marijuana use, activity and age, finding that people over 40 who consumed cannabis moderately spent an average of 16 more minutes engaged in moderate physical activity each day than non-users.
To explain that trend, the study suggests that cannabis “is being used for exercise-induced pain recovery, since [physical activity] brings about pain and muscle soreness, and a decreased pain threshold and muscle hypersensitivity have been documented with increasing age.”
These findings “add to the cannabis and physical behavior literature by incorporating objective accelerometer measures,” the researchers concluded. “Further understanding of the association between cannabis use and health behaviors is essential to fully addressing the public health concerns associated with cannabis use.”
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.