Friday, 28 February 2020

New Law Brings Texas One Step Closer to Legalizing Marijuana

Jamie Chung
The blossoming medicinal cannabis market gets a boost from Texas lawmakers.

Five years ago, Klick authored the first Compassionate Use Act, which said that medicinal marijuana administered via oil or inhaler could treat only those with intractable epilepsy. The new bill expands access to patients with terminal cancer, multiple sclerosis, Parkinson’s disease, ALS, autism, and other seizure disorders, allowing them to be treated with THC, the main psychoactive compound found in marijuana. The expanded diagnoses could mean an uptick for the small but growing cohort of growers, providers, and retail businesses in the THC and CBD markets.
Morris Denton is the CEO of Austin-based Compassionate Cultivation, one of just three state-licensed companies that grow cannabis, and he says the new law will have a major impact on the number of patients covered and the physicians who treat them. He estimates there are around 150,000 patients with intractable epilepsy in the state, but the new bill could expand the THC patient base to more than a million. “It will give doctors and patients more in the playbook,” Denton says. 

“They want to be able to have as many different options as they can.”

Compassionate Cultivation is a manufacturer of THC and CBD products that grows the plants, processes the chemicals, packages, and distributes the medicines and oils from their facility. It was the first dispensary in Texas to provide medical cannabis to a patient under the newly expanded conditions—an Austin woman being treated for non-Hodgkin’s lymphoma—and legislation is paving the way for their growth.

A Natural Alternative

Dallas physician Dr. Mary Caire’s understanding of medicine and the use of nonpharmaceutical medicines has changed with the times. After a double residency in physical medicine and rehabilitation and internal medicine, she grew her practice to include functional medicine, seeing the importance of diet, hormones, and other natural substances to better treat chronic conditions.

Caire practices with LifeSpan, a preventive, integrative medicine practice in Dallas, and has seen the impacts of medicinal THC on her patients. A woman with lymphoma who was receiving aggressive chemotherapy was having difficulty staying hydrated and getting proper nutrition while undergoing treatment because of the nausea caused by the chemotherapy. She was also experiencing pain and fatigue. “She got everything traditional medicine had to offer and it failed,” Caire says.
medicinal marijuana legalization map
Eleven states and the District of Columbia have adopted expansive laws.
When the new law passed, Caire began to prescribe oil with THC for the woman, and she saw many of the negative symptoms subside. THC improved the patient’s appetite and reduced the pain, and the improved nutrition allowed the chemotherapy to have a greater impact. Not only does THC help treat patients suffering from grave conditions, it can be used for pain and replace addictive opioids. The patient’s most recent scan revealed positive steps toward recovery.

While the legislation is a move in the right direction, Caire thinks more flexibility is needed to best address patients’ needs. “We are being told by the legislature with no medicinal experience how much of certain compounds we can use because they want to have some control over the amount that is prescribed,” she says. “We need the flexibility to compound it for their needs. The people who know what is best for that patient are the physician and the patient.”

Thinking Green

Texas remains behind many other states when it comes to the legalization of medicinal cannabis with THC, but it is home to a booming market for CBD oil, which extracts the cannabinoids from hemp and marijuana. Another law passed this summer adds clarity to which CBD products are legal in Texas. Hemp Business Journal reports that the CBD market will grow from an estimated $202 million in 2017 to $2.1 billion in 2020, but because there is a lack of clarity about whether CBD is a medicine, dietary supplement, or food supplement, oversight of these products leaves providers and retailers wanting standardization. 

Co-owners of retail chain CBD Kratom David Palatnik and Dafna Revah run 33 locations nationwide and six in DFW, and agree with the need for more rules. They have their own rigorous lab standards and would embrace additional oversight. “We would like to have industry standards across the board that everyone follows,” Platanik says. “Medical professionals will feel better about recommending it.”

There is still a long way to go for Texas to catch up with the rest of the country in the use, regulation, and legalization of medicinal marijuana and other products, but expanded future looks inevitable. 

For those treating patients who could benefit from added legalization, the transition can’t come soon enough. “I think we need to change the conversation and be open-minded,” Caire says. “We took an oath that we would do the best we can, do no harm, and put the patients’ interest first. This substance meets all the criteria that we strive for with our patients.”

Bloomberg Locked Up Nearly Half a Million People on Marijuana Charges

Former mayor now campaigning on decriminalization

Presidential candidate Michael Bloomberg argued on the debate stage in South Carolina that people shouldn't be arrested for marijuana possession, but as the mayor of New York City, Bloomberg aggressively prosecuted the crime, arresting more people for the offense than the three previous mayors combined.
"We should not make this a criminal thing if you have a small amount," Bloomberg said at Tuesday's debate. "For dealers, yes. But for the average person, no, and we should expunge the records of those who got caught up in this before."
Bloomberg's comment marks a remarkable change-of-heart for the billionaire mogul. During his 12-year tenure as mayor, the New York Police Department arrested roughly 106 New Yorkers each day for the lowest-level marijuana possession charge, according to data from the New York State Division of Criminal Justice Services (DCJS). In comparison, the administrations of Bloomberg's three predecessors, Democrats Ed Koch and David Dinkins and Republican Rudy Giuliani, collectively arrested 226,000 people, or 25 people daily, for the same charge over a 24-year period between 1978 and 2001. During Bloomberg's tenure, approximately 471,000 people were arrested on possession charges. 
The issue of marijuana has become a litmus test for the Democratic presidential contenders, who have embraced lenient drug policies to demonstrate their commitment to criminal justice reform. This is partly because many progressives believe that the criminalization of weed possession has drastically increased incarceration rates, especially among minority communities. In fact, prison data show that legalizing weed will have little to no impact on the prison population since few inmates are incarcerated for possessing marijuana.
The former mayor has remained a skeptic on the issue even as the rest of the Democratic field—with the notable exception of former vice president Joe Biden—lurched toward full legalization of the drug. Despite his current support for decriminalization, Bloomberg bluntly said that marijuana legalization is the "stupidest thing anyone has ever done" as recently as January 2019. Bloomberg's campaign did not respond to a request for comment.
The Washington Free Beacon obtained the DCJS data from the Drug Policy Alliance and the Marijuana Arrest Research Project, research groups that support drug reform. The data include every arrest of a New Yorker over the age of 16 where the lowest criminal possession offense was the primary or only charge.
New York City had relatively lax enforcement of marijuana-related offenses until the mid-1990s, in part due to a 1977 bill that decriminalized the possession of small amounts of marijuana that were not in public view. The enforcement changed when Giuliani was elected in 1994 after pledging to be tough on crime. Under Giuliani's leadership, the NYPD cracked down on marijuana possession in public view, which was still a crime punishable with jail time, on average arresting 24,000 people each year.
While Bloomberg acknowledged on the mayoral campaign trail that he had used weed before, he doubled down on Giuliani's policies when he became mayor in 2002. During Bloomberg's time at City Hall from 2002 to 2013, the New York Police Department arrested, on average, nearly 40,000 people each year. The possession arrests for Bloomberg's tenure peaked in 2011 when the police hauled in more than 50,000 New Yorkers.
Kassandra Frederique, managing director for the Drug Policy Alliance, said that Bloomberg's policies subverted the protections of the 1977 law and turned the Big Apple into the "marijuana arrest capital of the country." The New York Times previously reported that NYPD officers frequently arrested people after ordering them to empty their pockets, an act that brought their marijuana into public view.
"Bloomberg is the reason we know decriminalization does not work and is not enough," Frederique told the Free Beacon. "New York City has had decriminalization on its books for four decades, but became known as the marijuana arrest capital of the country as the NYPD made over 400,000 marijuana arrests under Bloomberg’s draconian stop-and-frisk policy."
Bloomberg gradually softened his rhetoric as his tenure came to an end, reversing his position and supporting decriminalization for open possession of small amounts of marijuana in 2012. But the former mayor has remained suspicious of full-on legalization, arguing on the debate stage that it is "nonsensical" to legalize the drug when scientists still do not understand the possible adverse health effects of marijuana use.
The Trump administration shares Bloomberg's concerns regarding marijuana legalization. Surgeon General Jerome Adams said that legalization amounts to a "massive public-health experiment" that could endanger the public. He pointed to research that found habitual marijuana use among teens could lower their IQ. Other research that he cited showed mothers who use marijuana are more likely to experience premature births.
The former mayor's support for stop-and-frisk policing has also complicated his marijuana record. Many progressives argue that stop-and-frisk led to higher arrests for marijuana possession, especially in minority communities. Bloomberg had long defended the controversial policing practice as necessary for fighting crime until he unexpectedly apologized for the policy as he prepared to launch his presidential campaign in November.
"People say, ‘Oh my God, you are arresting kids for marijuana that are all minorities,'" Bloomberg said in 2015, addressing the pushback to stop-and-frisk. "Yes, that is true. Why? Because we put all the cops in the minority neighborhoods. Why did we do it? Because that's where all the crime is."
Sen. Kamala Harris (D., Calif.) also faced scrutiny for her record on marijuana on the campaign trail. While Harris supports legalization today, California also prosecuted 1,974 people for weed possession during Harris's six-year tenure as the state's attorney general.

Alcohol is killing more Americans than ever. Here’s how to save them

Bruce Barcott

Alcohol is killing Americans at ever-increasing rates. Switching to cannabis could save thousands of lives every year. (Daniel/AdobeStock)
‘The Haymaker’ is Leafly Senior Editor Bruce Barcott’s opinion column on cannabis politics and culture.
Opioids aren’t the only drugs killing Americans. A disturbing study published last week in JAMA Network Open revealed that alcohol-induced deaths in the US spiked alarmingly between 2000 and 2016—and are now climbing faster than ever.
Alcohol-induced deaths spiked alarmingly between 2000 and 2016—and are now climbing faster than ever.
Annual alcohol-caused deaths among American men rose 78% in that span, from 14,979 in 2000 to 25,213 in 2016. Deaths among women more than doubled, from 4,648 to 9,644.
Those aren’t deaths merely correlated with alcohol, like drunk driving fatalities. They’re deaths caused directly by the ravages of drink: alcohol-induced pancreatitis, liver disease, cardiomyopathy, and alcohol poisoning.
Some heavy drinkers recover their health through the Alcoholic Anonymous method—12 steps and complete sobriety. But the AA way isn’t for everyone. As more research, data, and personal experience come to light, we’re seeing many adults improve their health through alternative paths of harm reduction.

What’s harm reduction?

It’s a set of ideas and interventions that reduce the harms of problematic substance use. It often involves stepping down from a more harmful drug to a less harmful one—and not necessarily an embrace of complete abstinence. In its mildest form it may involve moving from coffee to tea. At the other extreme: moving from heroin to methadone.
Opponents often mock this as simply swapping one addiction for another. It’s not. And as cannabis legalization continues to expand, it’s playing a growing role in harm reduction strategies—especially when it comes to alcohol.

A mystery tipster

I was reminded of that fact a couple weeks ago at a cannabis conference in San Francisco. During a presentation at the International Cannabis Business Conference (ICBC) gathering, I mentioned the surprising popularity of Leafly’s guide to going ‘Cali sober.’ That’s when people don’t drink alcohol but do enjoy cannabis.
A white-haired gentleman approached me after I left the stage. “You shouldn’t be surprised that so many people are interested,” he said. “It’s not a new concept. In fact, Tod Mikuriya did some of the earliest work on that here in California in the 1970s.”
I didn’t realize until the next day that the tipster was the legendary Fred Gardner, editor of the cannabis website O’Shaughnessy’s. Part underground zine, part medical journal, and part historical archive, O’Shaughnessy’s has served as the OG voice of the medical marijuana movement since its first issue in 2003.

Yes, ‘Cali sober’ started in California

About the trend of Cali sober, Gardner spoke the truth. Back in 1970 Dr. Tod Mikuriya, a Northern California physician, published an article titled Cannabis Substitution: An Adjunctive Therapeutic Tool in the Treatment of Alcoholism. A 49-year-old patient of his, whom he called Mrs. A., came to him with a long history of alcohol abuse. She happened to mention her use of marijuana as well, and the fact that she decreased her booze intake when she smoked.
So Mikuriya gave her advice that in 1970 was truly radical: “I instructed her to substitute cannabis daily—any time she felt the urge to partake in alcohol,” he wrote.
Guess what: It worked. Five months later, Mrs. A’s health was on the upswing. “Her appearance, complexion, posture and energy level have gradually improved,” Mikuriya noted. “She is afforded a new awareness and control over her life, instead of being continually sick and intoxicated and acting out in a maladaptive fashion.”
“I can in no way claim a total cure,” Mikuriya cautioned. But “for selected alcoholics the substitution of smoked cannabis for alcohol may be of marked rehabilitative value.”
That was 1970. Years later Mikuriya would become one of the most courageous—and persecuted—leaders of California’s medical marijuana movement. But he never forgot the curious case of Mrs. A.

Abstinence isn’t the only way

In 2003, he published a follow-up paper, Cannabis as a Substitute for Alcohol. In a harm reduction regimen adopted by 92 alcoholic patients, Mikuriya found that all 92 reported some benefit. “Even if [cannabis] use is daily,” he wrote, replacing alcohol with cannabis “reduces harm because of its relatively benign side-effect profile.” Cannabis doesn’t damage the liver, spleen, esophagus, or digestive tract, as alcohol does. “Sleep and appetite are restored, ability to focus and concentrate is enhanced, energy and activity levels are improved, pain and muscle spasms are relieved.”
Abstinence-only advocates can be zealous and confrontational. A recent tweet by Leo Beletsky, a leading drug policy expert and a professor of both law and public health, pointed out that alcohol harm reduction exists and works. An abstinence advocate responded by mocking the idea as “cuckoo” and heralding full sobriety as “the only way!” In recovery culture this is not an atypical response.
The vast majority of the institutional medical world agrees with him. Most public health agencies still view any cannabis use as problematic cannabis use. Sobriety is counseled as the one true path.
Here and there, though, new thinking around harm reduction is taking hold.

Official recognition slow in coming

Public health officials now recognize that medication assisted treatment (MAT) offers great hope to people struggling with opioid use disorder. Methadone maintenance programs, born in the late 1970s, have long reduced heroin-related deaths. Now the next generation of opioid MAT, extended-release naltrexone, is allowing patients to use a single monthly injection to block the body’s opioid receptors, reduce cravings, and prevent relapse.
Some opioid treatment programs are also using cannabis as an exit drug, with research-proven success. The controlled use of marijuana eases a patient’s withdrawal from opioids while providing relief from the conditions that led to opioid use in the first place, like chronic pain. Researchers have found that opioid prescription rates are 6% lower in medical and rec-legal states. Leafly began covering this phenomenon in 2017. In just three years the concept has moved from an idea mocked as “stupid” to an increasingly accepted recovery strategy.

Consumers in legal states already embracing it

‘Cali sober’ is the next step in mainstream harm reduction. There are data sets hinting that some consumers are already going Cali, perhaps without even realizing it. A 2017 University of Connecticut study found a 12% decline in alcohol sales in states that legalized medical marijuana between 2006 and 2015. A 2018 report by Cowen & Company found that legal adult-use states saw a 13% lower rate of binge drinking than states that prohibit all cannabis.
‘Cali sober’ is the next step in mainstream harm reduction. Some consumers are already going Cali without knowing it.
Going Cali sober isn’t a panacea. In the words of the late Dr. Mikuriya, the method may be “of marked rehabilitative value” for some people, but not everybody. And that’s okay. In medicine as in life we too often demand one approved drug for all patients, one approved path to health and happiness. Human bodies don’t work like that, and neither do human lives.
There’s one thing I know absolutely doesn’t work: Belittling and punishing a person for taking a first step. A few months ago I heard a harm reduction worker explain their work at a street outreach clinic in Washington, DC. “The most important thing is to meet people where they are,” they said, “and help them reduce harm from there. In whatever form that takes.”
That stuck with me, because it reminded me of the insight I’ve gained over the years about how people change their minds about cannabis legalization. Meet people where they are. Don’t mock them. Encourage them to ask around, do some research, keep an open mind. Three of the most powerful phrases I’ve learned are these: “I hear you”;“Seven years ago I thought the same thing”;“Then I started looking into it, and…”
Small steps lead to great change. In 2020, moving from alcohol to cannabis could literally save thousands of lives. Spread the word.

Why Was Weed Ever Illegal? The History of Marijuana Laws

Marijuana LawsIn 2020, in a progressive state like California, it is almost inconceivable that marijuana was ever illegal. The drug seems harmless; it provides a relaxing, satisfying high while easing pain, stress and other ills, and it is definitively not addictive or physically dangerous. How could a drug that is even safer than alcohol and nicotine be against the law for so long?
The story of how marijuana became illegal isn’t long or complicated — but it is interesting and extremely important for weed enthusiasts to know, especially as more and more states (and even the federal government) make plans to legalize it.

The Beginnings of Weed in the U.S.

In truth, cannabis was integral to the success of the first colonies in North America. In the 17th and 18th centuries, cannabis was used to make hemp, a lightweight and strong material used to make clothing, rope and other critical textiles. The early colonies, especially in swampy Virginia, struggled to find crops that would flourish in the New World, and because hemp was so valuable, some colonies mandated that all landowners devote some property to producing cannabis. In fact, founding fathers George Washington, Thomas Jefferson and Benjamin Franklin were cannabis growers.
Cannabis — and by extension marijuana — remained legal for 135 years of American history, but after the turn of the 20th century, public perception of the drug started to change. 
In the 1910s, immigrants from Mexico and other Latin American countries began flooding into the U.S., bringing with them recreational marijuana use. Unfortunately, bigotry and fear fueled a nationwide reaction to both the Spanish-speaking newcomers and their psychoactive drug.
In the 1920s and ‘30s, as Mexican-Americans competed with white Americans for scarce employment, a rash of research emerged linking marijuana use with deviant behavior, like violence and crime. Reprehensibly, these studies found that “racially inferior” communities were particularly susceptible to these negative reactions to the drug. As a result, more than half of the states outlawed marijuana by 1931, and by 1937, the federal government enacted the Marihuana Tax Act, which criminalized weed and imposed heavy taxes for its use in medical and industrial fields.
Despite increasing evidence that marijuana was not nearly as dangerous as believed, the public continued to rally against the drug thanks to intensive propaganda campaigns, including the film “Reefer Madness.” Through the ‘40s and ‘50s, sentences for marijuana-related offenses increased; a first-time marijuana possession charge could land a person in prison for 10 years with fines up to $20,000. Though some decriminalization attempts were made in the 1970s, Presidents Reagan and Bush Sr. led two severe Wars on Drugs which raised federal penalties for possession and sale of marijuana.
It wasn’t until 1996, when California passed medical marijuana legislation, that public perceptions of the drug started to change — and the weed revolution began.

Why Weed Was Illegal for So Long

In the scope of American history, marijuana has been illegal for much less time than it was permitted. Even so, why did weed remain illegal despite its relative harmlessness, which was discovered in the 1940s? There are several reasons why most people long despised the drug, and why people continue to loathe it today. They include:
  • Racist associations. At first, recreational marijuana use was tied to Mexican American culture; then, it became linked to African American communities, who participated in its illegal growth and sale. Though white Americans have long enjoyed recreational weed, the association of the drug with minority groups sparked long-lasting fear and outrage.
  • Unconvincing advocacy. For decades, there weren’t many people legitimately trying to reverse marijuana legislation — and the people who were trying weren’t doing a good job. Even today, marijuana advocates market weed as a cure-all, a wonder drug that increases productivity, creativity and spirituality while removing all pain and erasing all disease. Most people simply don’t buy this pitch.
  • Insufficient research. Marijuana was outlawed before much legitimate research could be done on the drug, so researchers have long struggled to obtain samples for legal, safe and accurate testing. While there are some rigorous studies on cannabinoids, there simply isn’t enough evidence that marijuana isn’t dangerous to convince those who grew up on unfounded propaganda.
These reasons aren’t meant to convince you that marijuana should be illegal. To the contrary — I wholeheartedly believe that marijuana can be beneficial to communities and individuals. These reasons should help many weed advocates and enthusiasts better understand why many people aren’t immediately interested in legalization. Before marijuana becomes legal at the federal level, marijuana advocates need to be serious about funding convincing research into safety and uses; meanwhile, marijuana detractors need to understand the racist legacy of marijuana laws and draft new legislation to protect at-risk communities — as Illinois has done.

Conclusions

Because California (and a handful of other states) have legalized recreational use and possession of weed, I can find a recreational dispensary near me in my California neighborhood. However, there are still many states where even medicinal use of marijuana is outlawed, and federally, weed remains a Schedule I drug, amongst the likes of heroin, MDMA, Quaaludes and bath salts.
Legalizing marijuana is a good step, but it might not do much to change how people feel about the drug or those communities associated with it. States and the federal government should reeducate communities with accurate information about marijuana’s benefits, those medical and economical. Additionally, governments should strive to ensure that communities unfairly punished for marijuana possession (Latin and African groups, specifically) are protected in some way. If we look into the history, we can learn how to move into the future with power and positivity for all.

Wednesday, 26 February 2020

Why won’t your doctor prescribe you cannabis?

Emma Stone

doctors prescribing marijuana
(New Africa/AdobeStock)
Almost 60% of US healthcare providers feel negatively about medical cannabis, while less than 12% view it positively. These results, the product of a survey reported in the forthcoming March 2020 issue of Preventative Medicine, provide a startling insight into the relationship between medical cannabis and those who can prescribe it. 
The survey, which investigated the opinions of 1,439 licensed clinicians anonymously from 2011 through to 2017, hints at some of the hurdles cannabis needs to clear for doctors to warm to it. The survey’s authors found that provider advice tended to discourage cannabis use, while the most positive clinician views toward cannabis were for palliative use. 
Notably, the findings also reported that the proportion of positive sentiment toward cannabis did increase over time. With the survey wrapping up in 2017, one could hope that contemporary clinicians are better-versed in the therapeutic applications of cannabis. 
For those familiar with the current lay of the medical landscape, however, that’s not the case. Leafly turned to Joe Dolce to help unpack this clinician reticence toward cannabis. Dolce is author of Brave New Weed and co-founder of MedicalCannabisMentor.com, an online learning platform that provides evidence-based, research-grounded courses for healthcare providers, dispensary personnel, and in the not-too-distant future, patients. He works alongside Dr. Junella Chin, an expert cannabinoid-prescribing physician who has treated more than 10,000 patients. 
For Dolce, the obstacles hindering physicians from getting behind cannabis are clear and need to be urgently addressed. While healthcare providers may be digging their heels in, patients are leveling up with their knowledge of cannabis.
“The problem for patients is that they are often ahead of their providers when it comes to cannabinoid meds, and they often have no one they can turn to for trusted advice on dosing and how to use them for optimal efficacy,” said Dolce. 

The origin of the problem: omission in education

One glaring omission that disadvantages doctors can be traced back to med school. “The endocannabinoid system (ECS) is not taught in most medical schools, so healthcare providers have no knowledge of what it does, nor that it is the master regulator of all the other receptor systems,” said Dolce. “Because neither the ECS nor cannabinoid medicine are taught in med school, healthcare providers are largely uneducated about it and quite naturally don’t trust it.”
The ECS isn’t new knowledge, though. Scientists have known about the existence of the endocannabinoid system for more than 25 years. More recently, researchers hypothesized that this internal signaling system started evolving over 600 million years ago, dating back to prehistoric forms of life no more complex than sponges. 
Today, studies have demonstrated that cannabinoid receptors are present in skin, immune cells, bones, fatty tissue, pancreas, the liver, the heart, blood vessels, and the gastro-intestinal tract. We also know that the endocannabinoid system participates in multiple processes such as pain, memory, mood, appetite, sleep, stress, immune function, metabolism, and reproductive function. 
You could justifiably argue—and some experts have—that the endocannabinoid system is one of the most critical physiologic systems implicated in the establishment and maintenance of human health, operating as a bridge between the body and mind.
But among the least educated are those who need to be the most informed. Many healthcare providers are still unfamiliar with the ECS—at last count, in 2013, only 13% of med schools taught the ECS in any capacity. A recent Leafly report suggests that very little has changed.

Cannabis is botanical medicine, not pharmaceutical medicine

According to Dolce, there are additional barriers that impact clinician sentiment toward cannabis. “Physicians are used to single-action targeted pharmaceutical meds. Cannabis is a botanical medicine composed of over 165 active compounds that work synergistically,” he said. “Botanical meds require more patient education and often, hand-holding. The way most clinics work doesn’t allow enough time for this.” 
Dolce also points out that it can be challenging for healthcare providers to allow time to familiarize themselves with something new. “Being a doctor is a stressful and high-pressured job,” said Dolce. “They work a lot, and there is always more to learn and read. Convincing a doctor to spend more time learning about a medicine that is still federally illegal is not the easiest task.”
Prescribing medical cannabis also requires patience and time. Dolce, and many cannabis medicine experts, emphasize that it can take some patients weeks, or even months, to reach their optimal cannabis dose. Learning to dose medicine incrementally to find the sweet spot can be empowering for a patient but can absorb more time in consultation. 
“All this being said, teaching patients to self-administer meds is not unfamiliar to clinicians. They do it with diabetic patients using insulin or patients in pain who must self-titrate Gabapentin (Neurontin). And don’t forget those SSRIs,” he said. 
Finally, the risk of liability represents a further deterrent. “No insurance company will cover healthcare providers for prescribing cannabinoid meds, so there are structural and systemic reasons docs stay away from it,” said Dolce. 

How to move forward?

Clearly, providers need to familiarize themselves with the unique therapeutic profile of cannabis and stay current with research to support patients who wish to try it. According to Dolce, the release of cannabis from the shackles of a Schedule 1 status at the federal level—which restricts cannabis research—is critical to achieving this. But other initiatives could also shift the sentiment of hesitant healthcare providers.
“We need to encourage more high-profile physicians to publicly talk about how cannabis is as effective as over-the-counter meds for pain, insomnia, and stress/anxiety, not to mention relief from nausea associated with chemotherapy,” said Dolce. “I also feel that nurses, nurse practitioners, and health coaches would be well-served to learn about cannabinoid meds so they could then act as necessary support to docs who are already suffering under time and administrative pressures.”


Overall, however, Dolce maintains a somewhat optimistic outlook. “There is a certain amount of hubris that some doctors have about using botanical or so-called alternative medicines,” he said. “But a small percentage of doctors we encounter are increasingly open and willing to learn about cannabinoid therapies, especially because their patients are telling them that they work. Once they become open to it, they’re often sold.”

Monday, 24 February 2020

After Baby And Beyond: How CBD And Marijuana Can Help New Moms

By: Kate-Madonna Hindes

Known to have a positive effect on the reduction of inflammation, CBD oils and tinctures can offer moms benefits they may not know of. 

As more and more companies are catering to new moms or new-again moms, physicians are often answering questions about CBD and marijuana. Dr. Marina Yuabova FNP, DNP Associate Professor in Health and Science Department at CUNY, believes CBD lotion and creams are useful during the postpartum period.

“CBD’s effects are comprehensive and can help your body self regulate, which can potentially boost the mood and increase energy levels,” she explained. “Many people have found success in overcoming exhaustion, sleeplessness, and fear using these kinds of products.” Known to have a positive effect on the reduction of inflammation, CBD oils and tinctures can offer moms benefits they may not know of.

Often marketed as self-care, CBD and marijuana products have been studied in their benefits including, easing inflammation, helping with anxiety, as well as offering reprieve for pain.

In fact a University of Washington publication recently focused on marijuana as an alternative to opioids given for pain. Their research cited several studies, finding that cannabis could be a substitute for opiates, decreasing overdose risk, citing:

“The evidence so far suggests that — among people who are open to using cannabis — substitution of cannabis for opiates, while not risk-free, can be beneficial in preventing opioid dose escalation and in controlling chronic pain. Considering the high overdose risk of opioid-based medications these findings are reason for optimism underscore the urgency to conduct research on medicinal cannabis soon.

Other studies cite the opposite, claiming that cannabis as an alternative to opioid overdoses while promising, has a long way to go. With conflicting news and reports, patients often don’t know how to bring up CBD or marijuana to their doctors. Kellie Stecher, an OBGYN out of Edina, Minn. recently sat down and discussed considerations to keep in mind with marijuana, CBD and new mothers. 

As new moms begin to explore their bodies and new lifestyle how does marijuana or CBD fit in?

It’s important to realize that Marijuana and CBD are very different medicines, with very different
results and side effects for individuals. There are few studies that look at CBD oil and marijuana in the postpartum period. 

Some studies show a decrease in anxiety with less marijuana use. This may be critical because in the postpartum time period anxiety and depression are major concerns. Some studies suggest that marijuana can have a beneficial effect on depression. However, we don’t know what doses or frequency could achieve this and would be different in every person. You can also develop apathy and lack of motivation from marijuana which can make postpartum depression worse. This is a very complex relationship.
Moms Are Smoking More Marijuana
Photo by Dawid Sobolewski via Unsplash
Is there an opportunity for new moms to use the projects to help with the added stresses and lack of sleep when parenting a new, tiny human? 

CBD oil seems more helpful to decrease anxiety. CBD effects the central nervous system. 

There have been multiple studies looking at effects on seasonal affective disorder, PTSD, generalized anxiety. There have been favorable findings for these disorders.  There hasn’t been research completed into postpartum anxiety specifically. One could argue since its more hormonally driven it would be less effective, we need more studies to sort this out.

Are there certain ways new moms can use CBD or marijuana products on their body?

There are many products on the market. The biggest thing to keep in mind is patients need to know what they’re getting. One way to be safe is to ensure labels are read carefully.

There are many CBD topical applications; there are lotions, creams, oils, all that you can apply directly to your skin. There are gummies, tablets, and vapes you can use as well.  Anything you ingest orally needs caution about medication interactions. There is also a higher likelihood of side effects. Topical use hasn’t been linked to many side effects other than skin irritation and rash.
What Prince William And Kate Will Name Their Baby
Photo by Omar Lopez via Unsplash

Are there any postpartum considerations when approaching CBD and marijuana?

If you’re breastfeeding, we would advise you to avoid the products entirely. You pass THC in breastmilk at 10-30% the concentration that is in your own body. The studies we have are underpowered, and often don’t control for confounders, such as obesity, smoking and more.

Some studies suggest that infants who receive breastmilk from mothers who use marijuana have gross motor delays.

CBD on the other hand is readily available; it is derived from the hemp plant and doesn’t cause a high. CBD also has not been linked to dependency or abuse. However, this is a substance that isn’t regulated. There is a big concern about CBD being contaminated with pesticides and other impurities.
The other concern is the lack of research. We don’t know how it will interact with other medication.

For example, if someone is trying CBD oil and are taking an antidepressant or anti-anxiety medication, could it render these medications more or less effective?  We don’t know. The hardest part is there are so many unknown variables here that we often can’t make direct medical recommendations.  This is why the FDA says not to use these products if you are breastfeeding.

The problem really is no one wants to sign up to be studied. We need more information to determine the exact effects on infants. Most evidence of harm is associated with prenatal exposure and not exposure during lactation.

New moms may be nervous about discussing CBD or marijuana with their team. What should they know before asking about CBD and marijuana?

You should never be going to a physician you don’t feel comfortable having honest conversations with. They should be able to talk through the good, the bad, and ugly of anything you want to do in life. Just be as open and honest with them as you can, and they will help you make the best decisions for you and your health.

Elizabeth Warren Has A New Plan For Legalizing Marijuana

By Kyle Jaeger
Sen. Elizabeth Warren (D-MA) unveiled a plan for federal marijuana reform on Sunday, calling for legalization as well as a series of policies aimed at righting the wrongs of the drug war and promoting involvement in the legal industry by communities harmed by prohibition.

In the “Just and Equitable Cannabis Industry” plan, which Warren’s campaign shared with Marijuana Moment ahead of a town hall event in Colorado, the 2020 Democratic presidential candidate slams the “racist ‘War on Drugs’ policy” perpetuated during the Nixon administration and the mass incarceration that has followed.

She also introduces noteworthy ideas, such as using her executive authority to begin the federal legalization process within 100 days of taking office, respecting the sovereignty of other nations to legalize marijuana, protecting immigrants who participate in the legal industry, empowering veterans to access medical cannabis and ensuring that corporations aren’t able to monopolize the market.

Further, the Warren plan promotes unionization in the marijuana industry, protecting Indian tribes’ authority to enact their own reform programs and lifting a current ban so that Washington, D.C. can use its local monies to implement legal marijuana sales

“Even as the federal government has held fast to its outdated marijuana policy, states have led the charge in adopting thoughtful, evidenced-based marijuana policy,” the six-page document says.

“And what have we learned in the eight years since the first states legalized marijuana? Legalization works.”

The senator details the progress of the legalization movement and the economic potential of the industry, and she argues that access to cannabis has been shown to play a role in mitigating the opioid epidemic. All that said, she notes that marijuana arrests have continued to increase nationally—and they continue to be carried out on racially disproportionate basis—and so comprehensive reform at the federal level is a goal she is pledging to pursue starting day one if elected president.
“It’s not justice when we lock up kids caught with an ounce of pot, while hedge fund managers make millions off of the legal sale of marijuana. My administration will put an end to that broken system.”
“Legalizing marijuana is about more than just allowing recreational use, or the potential medicinal benefit, or the money that can be made from this new market,” the Warren plan says. “It’s about undoing a century of racist policy that disproportionately targeted Black and Latinx communities.

It’s about rebuilding the communities that have suffered the most harm. And it’s about ensuring that everyone has access to the opportunities that the new cannabis market provides.”

The plan for marijuana reform.

Warren’s proposal is two-pronged. The first objective is to “address the disproportionate enforcement of our drug laws.” Here’s how she plans to accomplish that:

1. Urge Congress to pass comprehensive marijuana legalization bill such as the Marijuana Opportunity Reinvestment and Expungement (MORE) Act, which cleared the House Judiciary Committee last year. “We need full legalization, as quickly as possible,” the plan states.

2. Should Congress not follow suit, Warren says she will use her executive powers to begin the process of descheduling marijuana within her first 100 days in office. The senator is promising to appoint heads of the Justice Department, Drug Enforcement Administration, Food and Drug Administration and Office of National Drug Control Policy who support legalization and says she will “direct those agencies to begin the process of delisting marijuana via the federal rule-making process.” Additionally, Warren is pledging to reinstate Obama-era guidance directing federal prosecutors to generally respect local cannabis laws.

3. Expunge prior cannabis convictions. Again the candidate cites the MORE Act as an ideal vehicle for that policy change, stating that it would also “prohibit the denial of federal benefits, such as housing, because of the use or possession of, or even a past conviction for, marijuana.”

4. Ensure that immigrants are not penalized over marijuana convictions or participation in a state-legal cannabis market. That’s “because any equitable and just cannabis economy must also include immigrant communities,” she says, slamming a Trump administration move declaring that those who use cannabis do not have the “good moral character” needed for citizenship.

5. Encourage the U.S. Department of Veterans Affairs (VA) to research the therapeutic potential of cannabis for service members and allow VA doctors to recommend medical marijuana to veterans. She is also pledging to end a current policy that blocks veterans from getting home loans “for no reason other than being employed in their state’s legal marijuana industry“—an issue she recently filed Senate legislation on.

6. Deschedule cannabis to promote “serious research into the potential benefits and drawbacks of medical marijuana [that’s been] largely blocked by outdated federal laws and policies”and allocate funds for such studies.

7. Lift the appropriations ban that prohibits Washington, D.C. from using its local tax dollars to implement a regulated cannabis market. While there’s been widespread interest in removing the congressional rider at issue, eliminating the policy hasn’t received much attention on the presidential stage until now. Warren says she will “encourage the District to develop a legal market that includes impacted communities and fulfills the racial justice goals of the original referendum” that voters approved in 2014.

8. Warren says she will “streamline and remove unnecessary administrative barriers that impede economic growth on Tribal lands, respect tribal jurisdiction over tribal businesses, and promote forward-looking efforts to ensure full access to new and emerging economic opportunities, including in the cannabis industry.“

9. Respect the sovereignty of other nations that opt to legalize marijuana. The senator promises she will “support the legalization of marijuana in any nation that wishes to do so and fully support our neighbors exercising their sovereignty when it comes to their internal drug policy.” 

She further says that U.S. officials need to “recognize the role our War on Drugs has had in destabilizing Latin America – a root cause of migration to the United States.”

Warren’s second broad objective as described in the plan is to “prioritize opportunities in the cannabis industry for communities of color and others who were harmed by the failed policies of the past.” That will involve:

1. Working to support unions, including those representing cannabis workers, to enhance collective bargaining rights. “As president, I will safeguard the organizing rights of working people and make it easier for unions to secure contracts and assert their rights in the cannabis industry,” Warren says. Sen. Bernie Sanders (I-VT), another 2020 candidate, also raised this issue last month, imploring employees at a major marijuana business in Illinois to vote in favor of unionization.

2. Freeing up banks and financial institutions to service cannabis businesses. Additionally, Warren says she will direct her administration “to investigate discrimination in cannabis-related capital lending that prevents many aspiring entrepreneurs of color from securing needed loans.”

3. Promoting participation in the legal industry by minorities and women—something that Warren says the MORE Act would accomplish. She also says she would “mitigate the high permitting and licensing fees that prevent many aspiring entrepreneurs of color from starting a cannabis business.”

4. Preventing large corporations from overtaking the marijuana industry and working to “protect consumers by closely regulating the safety and marketing of marijuana products.” 

Like Sanders, Warren points specifically at tobacco companies as examples of businesses that shouldn’t be able to enter the market. “We’ll make sure Big Tobacco can’t muscle in on the fledgling marijuana industry,” she says, adding that her administration will “use anti-trust laws and federal oversight to prevent consolidation in the cannabis industry that drives up prices, restricts new businesses from entering the markets, and lowers quality.”

5. Allowing individuals with prior drug convictions to participate in the marijuana and hemp industries. “I will remove collateral sanctions associated with federal convictions for activity that is no longer criminalized and encourage states to do the same,” the senator says.

“For four decades, we’ve subscribed to a ‘War on Drugs’ theory of crime, which has criminalized addiction, ripped apart families—and failed to curb drug use,” the plan states.

“Legalizing marijuana and erasing past convictions won’t fully end the War on Drugs or address its painful legacy, but it’s a needed step in the right direction.”

“As we move to harness the economic potential of a legalized cannabis industry, we must ensure that the communities that were harmed by the War on Drugs—disproportionately communities of color—are fully included in the opportunity and prosperity that legalization will create. I support investing federal and state revenue from the cannabis industry into communities that have been disproportionately impacted by enforcement of our existing marijuana laws.

“Legalizing marijuana gives us an opportunity to repair some of the damage caused by our current criminal justice system, to invest in the communities that have suffered the most harm, and to ensure that everyone can participate in the growing cannabis industry. We have an opportunity now to get this right, and I’ll fight to make that happen.”

Warren also calls out former House Speaker John Boehner (R-OH) in her proposal, stating that the country “cannot allow affluent and predominantly white hedge-funders and capital investors to hoard the profits from the same behavior that led to the incarceration of generations of Black and Latino youth.”

“Boehner, who declared that he was ‘unalterably opposed’ to legalization while in Congress, now profits handsomely as a lobbyist for legalization even as others continue to live with the consequences of a prohibition he defended,” she points out, referencing the former speaker’s role as a board member at the cannabis firm Acreage Holdings.

While Warren’s plan repeatedly cites the need to broadly address the harms of the broader drug war, her proposals are exclusively focused on cannabis policy changes. While she and Sanders have been strong champions of marijuana reform, drug policy advocates have emphasized the need to expand reform to other illicit substances, as former South Bend, Indiana Mayor Pete Buttigieg and Rep. Tulsi Gabbard (D-HI) have by proposing decriminalization and legalization of all illegal drugs, respectively.

In terms of her marijuana reform agenda, however, experts who spoke to Marijuana Moment recently have indicated that Warren’s 100-day plan would probably be legally and practically more realistic that Sanders’s most recent proposal to use an executive order to legalize marijuana in all 50 states on day one of his presidency.

While Sanders initially proposed something similar to Warren—appointing key officials within his administration who would pursue legalization during his first 100 days in office—he shifted gears last month and pledged to deschedule cannabis on his first day in the White House.

Last year, Warren laid out a criminal justice reform plan that called for marijuana reform, as well as the legalization of safe injection sites where individuals could use illicit substances under medical supervision—a move also backed by Sanders.

Warren and Sanders might have differing approaches to marijuana legalization, but what’s clear is they stand in stark contrast to former New York City Mayor Mike Bloomberg and former Vice President Joe Biden, both of whom are the only contenders in the Democratic race who remain opposed to ending cannabis prohibition.