“We show that the introduction of medical marijuana laws (MMLs) leads to a decrease in violent crime in states that border Mexico. The reduction in crime is strongest for counties close to the border (less than 350 kilometres) and for crimes that relate to drug trafficking. In addition, we find that MMLs in inland states lead to a reduction in crime in the nearest border state. Our results are consistent with the theory that decriminalisation of the production and distribution of marijuana leads to a reduction in violent crime in markets that are traditionally controlled by Mexican drug trafficking organisations.” http://onlinelibrary.wiley.com/doi/10.1111/ecoj.12521/full “Legal marijuana cuts violence says US study, as medical-use laws see crime fall. Murder and violent crime found to have decreased most in states bordering Mexico as drug cartels lose business to regulation.” https://www.theguardian.com/world/2018/jan/14/legal-marijuana-medical-use-crime-rate-plummets-us-study
Tag Archives: medical marijuana
Practical considerations in medical cannabis administration and dosing.
“Cannabis has been employed medicinally throughout history, but its recent legal prohibition, biochemical complexity and variability, quality control issues, previous dearth of appropriately powered randomised controlled trials, and lack of pertinent education have conspired to leave clinicians in the dark as to how to advise patients pursuing such treatment.
With the advent of pharmaceutical cannabis-based medicines (Sativex/nabiximols and Epidiolex), and liberalisation of access in certain nations, this ignorance of cannabis pharmacology and therapeutics has become untenable.
In this article, the authors endeavour to present concise data on cannabis pharmacology related to tetrahydrocannabinol (THC), cannabidiol (CBD) et al., methods of administration (smoking, vaporisation, oral), and dosing recommendations. Adverse events of cannabis medicine pertain primarily to THC, whose total daily dose-equivalent should generally be limited to 30mg/day or less, preferably in conjunction with CBD, to avoid psychoactive sequelae and development of tolerance.
CBD, in contrast to THC, is less potent, and may require much higher doses for its adjunctive benefits on pain, inflammation, and attenuation of THC-associated anxiety and tachycardia. Dose initiation should commence at modest levels, and titration of any cannabis preparation should be undertaken slowly over a period of as much as two weeks.
Suggestions are offered on cannabis-drug interactions, patient monitoring, and standards of care, while special cases for cannabis therapeutics are addressed: epilepsy, cancer palliation and primary treatment, chronic pain, use in the elderly, Parkinson disease, paediatrics, with concomitant opioids, and in relation to driving and hazardous activities.”
Provider Perspectives on Use of Medical Marijuana in Children With Cancer.
“Although medical marijuana (MM) may have utility in the supportive care of children with serious illness, it remains controversial.
We investigated interdisciplinary provider perspectives on legal MM use in children with cancer.
Most pediatric oncology providers are willing to consider MM use in children with cancer and receive frequent inquiries.” https://www.ncbi.nlm.nih.gov/pubmed/29233937
http://pediatrics.aappublications.org/content/early/2017/12/08/peds.2017-0559.long
“Medical Marijuana For Children With Cancer Broadly Supported By Doctors. An overwhelming majority of health care professionals who care for children with cancer would be willing to help those children get medical marijuana” https://www.forbes.com/sites/tarahaelle/2017/12/12/medical-marijuana-for-children-with-cancer-broadly-supported-by-doctors/#3d31cf08795d
“Most doctors would allow medical marijuana for children with cancer, study finds. A considerable majority of medical physicians would help children treat cancer with medical cannabis, a new study suggests.” http://blog.sfgate.com/smellthetruth/2017/12/12/most-doctors-would-allow-medical-marijuana-for-children-with-cancer-study-finds/
“Clinicians Support Medical Marijuana Use in Children With Cancer, But Lack Knowledge” https://jamanetwork.com/journals/jama/fullarticle/2672986
Medical marijuana laws and adolescent use of marijuana and other substances: Alcohol, cigarettes, prescription drugs, and other illicit drugs
“Historical shifts have taken place in the last twenty years in marijuana policy. The impact of medical marijuana laws (MML) on use of substances other than marijuana is not well understood. We examined the relationship between state MML and use of marijuana, cigarettes, illicit drugs, nonmedical use of prescription opioids, amphetamines, and tranquilizers, as well as binge drinking.
Among 8th graders, the prevalence of marijuana, binge drinking, cigarette use, non-medical use of opioids, amphetamines and tranquilizers, and any non-marijuana illicit drug use decreased after MML enactment.
Among 10th graders, the prevalence of substance use did not change after MML enactment.
Among 12th graders, non-medical prescription opioid and cigarette use increased after MML enactment.
Conclusions
MML enactment is associated with decreases in marijuana and other drugs in early adolescence in those states.
- •Substance use decreased among 8th graders after medical marijuana use was legalized.
- •Substance use did not change among 10th graders following legalization.
- •Prescription drug and cigarette use increased among 12th graders after legalization.”
http://www.drugandalcoholdependence.com/article/S0376-8716(17)30569-0/abstract
From “Azalla” to Anandamide: Distilling the Therapeutic Potential of Cannabinoids
“Cannabis has held a unique place in the hearts and minds of people since time immemorial: some have exalted its properties and considered it to be sacred; others have reviled it, considering it a root cause of social evil.
The Assyrians, who lived about 3000 years ago, documented the effects of cannabis on clay tablets. They referred to the plant according to its various uses: as “azalla,” when used as a medical agent; as hemp; and as “gan-zi-gun-nu”—“the drug that takes away the mind” These seemingly contradictory properties—a substance that can be both a therapeutic agent and a corrupting psychoactive drug—have continued to puzzle us over the ensuing centuries.
As early as the 11th century, excessive cannabis use was suggested to be a cause of “moral degeneracy.” On the other hand, the ostensible therapeutic value of cannabis was documented extensively in the early 19th century by Sir William B. O’Shaughnessy, an Irish physician working in Calcutta, India.
Given the critical role of the endocannabinoid system in modulating anxiety, it is clear that compounds that can modulate this system offer great promise as therapeutic agents for psychiatric disorders. It is therefore not surprising that the concept of medical marijuana is compelling to laypersons, clinicians, and researchers alike.
While there is not yet a robust body of literature supporting any specific psychiatric indication (despite the regulatory approval in some states of medical marijuana for specific psychiatric disorders), active lines of investigation of therapeutic targets within the endocannabinoid system offer hope for better treatment options.
The evidence at present suggests that the question of whether cannabinoids are good or bad is not dichotomous—it is likely both good and bad depending on the context of use, including dose, duration of exposure, and an individual’s genetic vulnerabilities. Therefore, the challenge that remains is to distill the good therapeutic effects of cannabinoids and thus weed out “gan-zi-gun-nu” from “azalla.””
http://www.biologicalpsychiatryjournal.com/article/S0006-3223(17)32207-2/fulltext
Therapeutic Value of Medical Marijuana in New Jersey Patients: A Community Partnership Research Endeavor.
“The Public Health Program at Stockton University partnered with the Compassionate Care Foundation to ascertain the impact of medical marijuana on patients in New Jersey.
Results provide insight into the diagnoses for which patients used medical marijuana.
Results indicate increased mood, general overall condition, and energy as the highest consequences; level of pain in the middle range; and most frequent usage as 3 to 4 times a day. Repeated measures done after visit 2 showed eight statistically significant differences for patients after using medical marijuana: an increase in general quality of life, mobility, and mood, with a decrease in inflammation, intraocular pressure, spasms, seizures, and pain.
Results after visit 3 indicated seven significant differences compared to visit 1: decreased seizures, intraocular pressure, spasms, nausea, and pain, along with increased energy and mobility. No differences were found by patient diagnosis or age, but sex-related differences occurred in inflammation, mood, and energy.
Results support positive therapeutic benefits of medical marijuana, and despite methodological limitations, our study contributes to the growing body of literature.”
https://www.ncbi.nlm.nih.gov/pubmed/29202158
Targeting Cannabinoid Signaling in the Immune System: “High”-ly Exciting Questions, Possibilities, and Challenges.
“It is well known that certain active ingredients of the plants of Cannabis genus, i.e., the “phytocannabinoids” [pCBs; e.g., (-)-trans-Δ9-tetrahydrocannabinol (THC), (-)-cannabidiol, etc.] can influence a wide array of biological processes, and the human body is able to produce endogenous analogs of these substances [“endocannabinoids” (eCB), e.g., arachidonoylethanolamine (anandamide, AEA), 2-arachidonoylglycerol (2-AG), etc.].
These ligands, together with multiple receptors (e.g., CB1 and CB2 cannabinoid receptors, etc.), and a complex enzyme and transporter apparatus involved in the synthesis and degradation of the ligands constitute the endocannabinoid system (ECS), a recently emerging regulator of several physiological processes.
The ECS is widely expressed in the human body, including several members of the innate and adaptive immune system, where eCBs, as well as several pCBs were shown to deeply influence immune functions thereby regulating inflammation, autoimmunity, antitumor, as well as antipathogen immune responses, etc.
Based on this knowledge, many in vitro and in vivo studies aimed at exploiting the putative therapeutic potential of cannabinoid signaling in inflammation-accompanied diseases (e.g., multiple sclerosis) or in organ transplantation, and to dissect the complex immunological effects of medical and “recreational” marijuana consumption.
Thus, the objective of the current article is (i) to summarize the most recent findings of the field; (ii) to highlight the putative therapeutic potential of targeting cannabinoid signaling; (iii) to identify open questions and key challenges; and (iv) to suggest promising future directions for cannabinoid-based drug development.” https://www.ncbi.nlm.nih.gov/pubmed/29176975
“Although, many open questions await to be answered, pharmacological modulation of the (endo)cannabinoid signaling, and restoration of the homeostatic eCB tone of the tissues augur to be very promising future directions in the management of several pathological inflammation-accompanied diseases.” https://www.frontiersin.org/articles/10.3389/fimmu.2017.01487/full
Associations between medical cannabis and prescription opioid use in chronic pain patients: A preliminary cohort study.
“Current levels and dangers of opioid use in the U.S. warrant the investigation of harm-reducing treatment alternatives.
PURPOSE:
A preliminary, historical, cohort study was used to examine the association between enrollment in the New Mexico Medical Cannabis Program (MCP) and opioid prescription use.
RESULTS:
By the end of the 21 month observation period, MCP enrollment was associated with 17.27 higher age- and gender-adjusted odds of ceasing opioid prescriptions (CI 1.89 to 157.36, p = 0.012), 5.12 higher odds of reducing daily prescription opioid dosages (CI 1.56 to 16.88, p = 0.007), and a 47 percentage point reduction in daily opioid dosages relative to a mean change of positive 10.4 percentage points in the comparison group (CI -90.68 to -3.59, p = 0.034). The monthly trend in opioid prescriptions over time was negative among MCP patients (-0.64mg IV morphine, CI -1.10 to -0.18, p = 0.008), but not statistically different from zero in the comparison group (0.18mg IV morphine, CI -0.02 to 0.39, p = 0.081). Survey responses indicated improvements in pain reduction, quality of life, social life, activity levels, and concentration, and few side effects from using cannabis one year after enrollment in the MCP (ps<0.001).
CONCLUSIONS:
The clinically and statistically significant evidence of an association between MCP enrollment and opioid prescription cessation and reductions and improved quality of life warrants further investigations on cannabis as a potential alternative to prescription opioids for treating chronic pain.” https://www.ncbi.nlm.nih.gov/pubmed/29145417
“In summary, if cannabis can serve as an alternative to prescription opioids for at least some patients, legislators and the medical community may want to consider medical cannabis programs as a potential tool for combating the current opioid epidemic.” http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0187795
“Study finds medical cannabis is effective at reducing opioid addiction” http://news.unm.edu/news/study-finds-medical-cannabis-is-effective-at-reducing-opioid-addiction
Study finds medical cannabis is effective at reducing opioid addiction
“A new study conducted by researchers at The University of New Mexico, involving medical cannabis and prescription opioid use among chronic pain patients, found a distinct connection between having the legal ability to use cannabis and significant reductions in opioid use.
The study titled, “Associations between Medical Cannabis and Prescription Opioid Use in Chronic Pain Patients: A Preliminary Cohort Study,” and published in the open access journal PLOS ONE, was conducted by Drs. Jacob Miguel Vigil, associate professor, Department of Psychology and Sarah See Stith, assistant professor, Department of Economics.
The results from this preliminary study showed a strong correlation between enrollment in the New Mexico Medical Cannabis Program (MCP) and cessation or reduction of opioid use, and that whole, natural Cannabis sativa and extracts made from the plant may serve as an alternative to opioid-based medications for treating chronic pain.
“If cannabis can serve as an alternative to prescription opioids for at least some patients, legislators and the medical community may want to consider medical cannabis programs as a potential tool for combating the current opioid epidemic,””
http://news.unm.edu/news/study-finds-medical-cannabis-is-effective-at-reducing-opioid-addiction
“Associations between medical cannabis and prescription opioid use in chronic pain patients: A preliminary cohort study.” http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0187795
Medical cannabis for the treatment of chronic pain and other disorders: misconceptions and facts.
“Recently, many countries have enacted new cannabis policies, including decriminalization of cannabis possession, medical cannabis legalization, and legalization of recreational cannabis. In this context, patients and their physicians have had an increasing number of conversations about the risks and benefits of cannabis. While cannabis and cannabinoids continue to be evaluated as pharmacotherapy for medical conditions, currently, the best evidence exists for the following medical conditions: chronic pain, neuropathic pain, and spasticity resulting from multiple sclerosis. We also reviewed the current state of evidence for cannabis and cannabinoids for a number of other medical conditions while addressing the potential acute and chronic effects of cannabis use, which are issues that physicians must consider before making an official recommendation on the use of medical cannabis to a patient. As patient requests for medical cannabis increase, physicians must become knowledgeable on the science of medical cannabis and open to a discussion about why the patient feels that medical cannabis may be helpful to them.”