New WSU Study Highlights Road Blocks Faced by Cannabis Researchers

New WSU Study Highlights Road Blocks Faced by Cannabis Researchers

Even before the pandemic made Zoom ubiquitous, Washington State University researchers were using the video conferencing app to research a type of cannabis that is understudied: the kind people actually use.

For the study, published in Scientific Reports, researchers observed cannabis users over Zoom as they smoked high-potency cannabis flower or vaped concentrates they purchased themselves from cannabis dispensaries in Washington state, where recreational cannabis use is legal. They then gave the subjects a series of cognitive tests.

The researchers found no impact on the users’ performance on decision-making tests in comparison to a sober control group but did find some memory impairments  related to free recall, source memory and false memories.

While the findings are in line with previous research on low-potency cannabis, this study is one of the few to investigate cannabis that contains much more than 10% tetrahydrocannabinol (THC), the plant’s main psychoactive ingredient. This is only the second known study to examine the effect of cannabis concentrates.

“Because of federal restrictions to researchers, it was just not possible to study the acute effects of these high-potency products,” said Carrie Cuttler, WSU psychologist and lead researcher on the study. “The general population in states where cannabis is legal has very easy access to a wide array of high-potency cannabis products, including extremely high-potency cannabis concentrates which can exceed 90% THC, and we’ve been limited to studying the whole plant with under 10% THC.”

While 19 states and Washington D.C. have legalized cannabis for recreational use, the U.S. federal government still classifies it as a Schedule 1 drug, implying it has a high potential for abuse and no medicinal benefits. Until recently, researchers interested in studying cannabis were limited to using low-potency plants of around 6% THC supplied by the National Institute of Drug Abuse. In June, the U.S. Drug Enforcement Administration indicated it may allow some companies to start growing cannabis for research purposes.

For this study, which began in 2018, Cuttler and her colleagues found a way to study the effects of high-potency cannabis while still complying with federal guidelines. The study participants bought their own products and used them in their own homes. They were never in a laboratory on federal property, and the researchers never handled the cannabis themselves. Participants were not reimbursed for their purchase. Instead, they were compensated for their time with Amazon gift cards. All participants were over 21 and experienced cannabis users who reported no past negative reactions to cannabis like panic attacks. The study’s method was cleared by WSU Division of the Office of the Attorney General and the university’s research ethics board.

The 80 participants were divided into four groups: two groups used cannabis flower with more than 20% THC but one containing cannabidiol (CBD), a non-psychoactive component of cannabis, and the other without CBD. Another group vaped cannabis concentrates with more than 60% THC that included CBD. A fourth group remained sober.

For all cannabis using groups, the researchers found no effect on a range of decision-making tests including risk perception and confidence in knowledge. On a few memory tests there were also no significant differences between the cannabis-using and sober groups, including prospective memory, the ability to remember to do things at a later time, such as attend an appointment. The cannabis-using participants also did well on temporal order memory, the ability to remember the sequence of previous events.

However, the groups that smoked cannabis flower with CBD did worse on verbal free recall trials- they were unable to recall as many words or pictures that were shown to them compared to the sober group. This finding was contrary to a small number of previous studies indicating CBD might have a protective effect on memory. The groups that used cannabis without CBD and the group that used concentrates, performed worse on a measure of source memory which means being able to distinguish the way previously learned information was presented.

Finally, all three cannabis-using groups did poorly on a false memory test—when given a new word and asked if it had been presented before, they were more likely to say it had when it had not.

There was also an unexpected finding: people who vaped the high-potency concentrates with more than 60% THC performed comparably to those who smoked cannabis flower. This may have been because they tended to self-titrate—using less of the drug to achieve a similar level of intoxication and impairment as the people who smoked the less-potent cannabis flower.

Cuttler said this was cause for cautious optimism on the little-studied but widely available concentrates.

“There’s been a lot of speculation that these really high-potency cannabis concentrates might magnify detrimental consequences, but there’s been almost zero research on cannabis concentrates which are freely available for people to use,” said Cuttler. “I want to see way more research before we come to any general conclusion, but it is encouraging to see that the concentrates didn’t increase harms.”

Texas Considers Extending Scope of Medical Cannabis Laws

Texas Considers Extending Scope of Medical Cannabis Laws

The Texas House gave approval on Thursday to a bill that would expand the state’s medical cannabis program to include those with chronic pain, all cancer patients, and Texans suffering from PTSD.

House Bill 1535, by Rep. Stephanie Klick, R-Fort Worth, who authored the bill establishing Texas’ initial medical cannabis program in 2015, would also authorize the Department of State Health Services to add additional qualifying conditions through administrative rulemaking, instead of the Legislature needing to pass a law to expand eligibility.

Currently, patients eligible include those with terminal cancer, intractable epilepsy, seizure disorders, multiple sclerosis, spasticity, amyotrophic lateral sclerosis, autism or an incurable neurodegenerative disease. Next, the Senate will consider the bill, before it can be sent to the governor to be signed into law.

When hemp was legalized in 2019, the medical cannabis program was rendered mostly moot — with legally permissible cannabis treatments only being marginally more potent than over-the-counter CBD oils or tinctures.

The bill would also raise the THC, or Tetrahydrocannabinol, cap from 0.5% to 5% and make it possible for those in Texas’ medical cannabis program to have access to much higher doses than currently available. THC is the psychoactive compound which produces a high. The National Organization for Reforming Marijuana Laws doesn’t recognize the state’s current program as a true medical marijuana program, instead labeling it a “medical CBD” program  because of its emphasis on cannabidiol, derived from hemp and containing only traces of the psychoactive compounds found in cannabis, over THC for medicinal use.

Texas’ program is called the Compassionate Use Program and has fewer enrolled patients and businesses than most other states with medical cannabis programs. At least some form of medical cannabis is legal in 47 states nationwide, but Texas’ restrictions put it in the bottom 11 in terms of accessibility, according to the National Conference of State Legislatures.

There were only about 3,500 Texans registered with the state to use medical cannabis, though advocates estimate that there are over 2 million people eligible based on current law.

Heather Fazio, director of Texans for Responsible Marijuana Policy, says the increased THC limit is “a step in the right direction,” but it still would limit doctors from being able to decide the proper dosages for their patients.

“There’s an incredibly restrictive cap on THC,” she said. “Low levels of THC will work for some people but it doesn’t work for others. And so what we think is that doctors need to be the ones making these decisions, not lawmakers.”

Fazio said the bill would help bring more Texas patients to the program and help reduce the use of addictive opioids. However, she says the bill still “leaves patients behind who desperately need access to this medicine.”

While Klick’s bill strictly affects the legal use of medical cannabis in the state, lawmakers are also taking up bills that tackle how recreational marijuana use is penalized.

The House passed House Bill 2593 on Wednesday, which would reduce penalties for possession of some marijuana concentrate. The penalty for possession of up to two ounces of those products would be lowered to a class B misdemeanor.

And on Thursday, the Texas House preliminarily approved House Bill 441, which would lower the criminal penalty for possessing small amounts of marijuana and provide a path for many Texans charged with such a crime to expunge it from their criminal records. 

Fazio said the bill would especially help keep young people from suffering criminal consequences.

“Not that we want to condone young people smoking weed, but the punishment for possessing it shouldn’t be harsher than the actual use of the plant,” Fazio said. “The penalties have caused far more harm than smoking marijuana ever could.”

While the House has been receptive to bills related to reducing penalties for marijuana use, the Senate has been less welcoming. In 2019, the House approved a bill that would have reduced penalties for marjiana possession, but Lt. Gov. Dan Patrick declared it dead in the Senate — not allowing it to be brought to a vote.

But in recent years, Texans have increasingly demonstrated a desire to see marijuana use legalized in the state. According to the February 2021 University of Texas/Texas Tribune polls, 60% of respondents supported legalization for at least small amounts of marijuana for both medical and recreational use — compared to 49% in 2014.

“There’s a significant shift happening now, and it’s so wonderful to see,” Fazio said. “To see the shift in the way that this issue is perceived, the seriousness that is given at the legislature and now increased support — it’s very rewarding. It’s such an exciting time to be an advocate.”

Texas Considers Extending Scope of Medical Cannabis Laws

Study Finds Cannabis Satisfaction High Despite Little Change in Pain Scores

Chronic pain patients expressed high satisfaction with medical cannabis despite clinically insignificant changes in pain scores, a prospective study showed.

Of a subset of chronic pain patients who used both medical cannabis and opiate drugs, 76% successfully tapered their opioid dose over 3 months, reported Alyson Engle, MD, of UPMC Pain Medicine and the University of Pittsburgh, and colleagues, at the American Academy of Pain Medicine  annual meeting.

“The chronic pain patients we see daily suffer from a complex myriad of symptoms that goes beyond just pain, including disruption in normal sleep patterns, exacerbation of anxiety or depression, and increased stress response,” Engle told MedPage Today.

In this study, “we were able to track the percent change in symptom improvement before and after certification for medical cannabis,” she added. “The data show that patient satisfaction is high among medical cannabis users and likely is due more to the improved sleep and overall mood improvement than from improved pain scores.”

The National Academies of Sciences, Engineering, and Medicine found conclusive or substantial evidence supporting cannabis for chronic pain in its 2017 report, but data are lacking about the health effects of cannabis and the best treatment regimen. “We believe this research is important since many states, including Pennsylvania, have legalized medical cannabis for certain qualifying conditions,” Engle said.

To conduct their study, the researchers collected data from patients who signed medical marijuana contracts for chronic pain treatment with a certified physician, using the CHOIR platform to assess patient responses. They evaluated satisfaction with medical cannabis, global impression of change, and changes in pain, mood, and sleep, and reviewed patient records.

The study ran from May 2018 through July 2019. The researchers recruited 193 patients and 82 patients were included in the final analysis. Baseline data was collected at the initial visit and follow-up data at the next visit, typically 3 months later.

Of 193 patients, 90 (46%) were on opioids at baseline, and 76% of these patients tapered their opioid dose successfully. Their average decrease was 11.67 morphine milligram equivalents (MME) over the 3-month period, reflecting a 26.86% reduction in opiate dose.

Patients’ overall impression of change was high with medical cannabis, but their scores for mood, sleep, and pain were substantially lower. Over 3 months, sleep scores improved most and pain interference scores improved least; improvement in depression and anxiety scores fell between.

Patients who stayed on the same dose of opioids while using medical cannabis had higher pain satisfaction rates. Patients who were not on opioids initially or who tapered opioids had lower pain satisfaction scores, but scored their overall satisfaction with cannabis as high.

It’s possible that better sleep with medical cannabis is a key driver of increased patient satisfaction and successful opioid tapering, the researchers wrote. Unknown confounders also may have influenced results.

This finding supports a role for medical cannabis in an appropriate subset of patients, Engle noted. “We do believe cannabis and cannabis-derived medication merit further research, given the lack of randomized studies describing the medical benefit, safety, and optimal dosing,” she said.

Primary Source

American Academy of Pain Medicine

Source Reference: Engle A, et al “Cannabis Satisfaction Rates in Chronic Pain Patients” AAPM 2020; Abstract LB005.

By Judy George, Senior Staff Writer, MedPage Today

House Hearing: More Research Needed on Health Effects of Cannabis

House Hearing: More Research Needed on Health Effects of Cannabis

WASHINGTON — Healthcare providers don’t know enough about cannabis to talk with patients about the potential risks and benefits, witnesses said at a mid-January House Energy and Commerce Health Subcommittee hearing .

“We need to have much more education with respect to how the use of marijuana products can negatively impact or help someone,” said Nora Volkow, MD, director of the National Institute on Drug Abuse (NIDA). “The problem is we do not have sufficient evidence that could help us mount those programs in a way that’s actually required. At this point, I don’t feel the evidence is sufficient to say, ‘We’re going to recommend that this product should be used by this patient.'” For example, elderly patients who take marijuana-containing products may be on a lot of other medications, and little is known about potential interactions between marijuana and prescription drugs. “So I do believe in the importance of expanding our knowledge so we can develop educational training programs that are based on knowledge, not on anecdote.”

Making it Easier to Research Cannabis

Rep. John Sarbanes (D-Md.) noted that a 2015 survey of healthcare providers concluded that the providers “perceive a knowledge gap related to cannabis dosing, treatment plans, and different areas related to cannabis products, so providers themselves realize the need for research and expertise to be developed in this area.”

The hearing was held to discuss six bills on cannabis, several of which were aimed at making it easier for researchers to obtain cannabis for research purposes. Currently, the only cannabis legally available for research comes from a single farm housed at the University of Mississippi, and researchers who want to use it must get permission from three agencies: the FDA, the Drug Enforcement Administration (DEA), and the NIH. “We need to figure out a way to take advantage of different producers of cannabis plants to evaluate the diversity of products out there, as opposed to limiting us to the Mississippi farm,” said Volkow.

Rep. Kurt Schrader (D-Ore.) agreed. “The sad part is we’re not testing the right stuff,” he said. “I fail to understand why we have one bloody facility that is the sole nexus for research and analysis of CBD [cannabidiol] products. It seems to me we ought to be testing products on the marketplace.” Subcommittee chairman Anna Eshoo (D-Calif.) agreed. “I don’t understand why the three agencies before us can’t get this done,” she said, referring to NIDA, the FDA, and the DEA, which all had officials testifying at the hearing.

The Cannabis Research “Catch-22”

Several subcommittee members expressed frustration over what they called the “Catch 22” problem that cannabis researchers face. “They can’t conduct cannabis research until they can show cannabis has a medical use, but they can’t demonstrate cannabis has a medical use until they conduct research. It doesn’t make sense,” said Eshoo.

“You’ve got to help us figure out how we’re going to get out of this Catch 22,” Rep. Debbie Dingell (D-Mich.) said to the witnesses at the hearing. “This lack of knowledge poses a public health risk.”

One issue with conducting research on marijuana is its classification as a Schedule 1 drug; these are substances deemed to have no medical value and have a high potential for abuse, and their availability is highly restricted. Several bills the subcommittee is considering, including the Legitimate Use of Medicinal Marijuana Act, the Marijuana Freedom and Opportunity Act, and the Marijuana Opportunity Reinvestment and Expungement (MORE) Act, would either downgrade marijuana from a Schedule 1 drug to a Schedule 2 drug, which has fewer restrictions, or remove it from the drug schedule altogether.

Rep. Michael Burgess, MD (R-Texas), the subcommittee’s ranking member, said the latter “is going too far,” adding that “using our congressional authority to override this may be a dangerous move, especially given the lack of research.”

So far, only one marijuana-related drug has been approved by the FDA: Epidiolex, which contains cannabidiol, was approved in June 2018 for treating a rare seizure disorder in patients ages 2 and over.

Diverse Testimony from Both Sides of the Aisle

Both the witnesses and the subcommittee members seemed divided on marijuana’s potential harms and benefits for patients. Volkow mentioned research showing that cannabis exposure during pregnancy was associated with low birthweight and preterm delivery, and added that it was also linked with episodes of psychosis. She also said that there was some evidence that cannabis may be useful in treating spasticity, multiple sclerosis, and pain, “but otherwise there is little benefit for other indications for which patients are using it.”

Rep. Morgan Griffith (R-Va.) said that his support of medical marijuana began some years ago when he learned that people were smuggling marijuana into a Virginia hospital to help a terminally ill father who wanted to be feeling well enough to spend time with his 2-year-old son. Years later, when he told that story at a high school town hall, one student raised his hand and said, “They did that for my daddy too.”

“These communities were 20 years apart, 30 years apart, yet doctors were turning a blind eye to allow marijuana to be brought into the hospital because they recognized that for those patients who are dying, that was the only way they would get relief and get the nutrients they needed to spend a little more time with their children,” Griffith said.

Rep. Greg Gianforte (R-Mont.) said he was opposed to efforts to “make any Schedule 1 drug legal without adequate research.” Instead, “we should focus on combating addiction,” he said.

by Joyce Frieden, News Editor, MedPage Today

Originally published in MedPage Today

Bipartisan House Cannabis Decriminalization Bill Passes Initial Committee Vote

Bipartisan House Cannabis Decriminalization Bill Passes Initial Committee Vote

Cannabis and politics are at an intriguing crossroads as we creep ever closer to the next election year. Politicians must decide how to position themselves on the hot-button issue of cannabis legalization. Many potential legalization bills have been proposed in the House of Representatives but very few have ever made it out of committee. National legalization bills have a history of facing intense scrutiny in the houses of Congress. There are a number of reasons for this but the vast differences in political opinions of members of Congress makes compromise on any bill, let alone one about a hot button issue like cannabis legalization, very difficult.

However, on Wednesday, November 20th, a new bill that would decriminalize cannabis nationally, allow states to make their own laws on full-scale legalization, and create the potential for expunging criminal records related to cannabis arrests passed in the House Judiciary Committee.

Chances of the Bill Passing

Though it is tough to envision a cannabis bill actually seeing the light of day, there is hope for this most recent iteration. The bill already has 50 co-sponsors, bipartisan support from notable pro-cannabis legalization Republicans like Matt Gaetz of Florida, and passed the House Judiciary Committee with a vote of 24-10. It is always encouraging when Republicans and Democrats can agree on legislation, especially when it comes to a potential cannabis legalization bill. Recently, the House of Representatives passed the SAFE Banking Act with bipartisan support. The bill allows for cannabis businesses to bank safely and discreetly. Its passage shows the willingness of Congressional Republicans and Democrats to work together to pass a cannabis bill.

The House cannabis bill is undoubtedly an exciting moment for those in the legalization movement. As promising as the bill seems, it is unlikely that it will be passed without major changes. It may pass the Democrat-controlled House of Representatives, but will face an intense battle in the Republican-controlled Senate. As unlikely as the bill’s passage is, those investing in the cannabis industry seem to believe the bill has a chance to become a part of American law soon.

Impact On The Cannabis Industry

As news of the forwarding of the house cannabis bill was announced, cannabis company stocks soared. The three biggest cannabis stocks, Canopy Growth, Tilray Inc., and Aurora Cannabis all saw prices rise between 8% and 15% on Wednesday, according to Reuters . Investor excitement is palpable, but some experts warn about the long term future for the House cannabis bill. Alan Brochstein, managing partner at New Cannabis Ventures, cautioned that the bill is, “such an early step in a long process that there are no near-term implications for cannabis stocks.”

The merits of the House cannabis bill will likely debated for the next few months. Changes will be made and votes will be cast before anything is set in stone. Whether or not this iteration of a legalization bill becomes law is unknown, but the fact that some politicians continue to fight for cannabis legalization is tremendously promising.

Minnesota Grants Medical Cannabis Access for Chronic Pain

Minnesota Grants Medical Cannabis Access for Chronic Pain

The state of Minnesota is making headlines this December, not for its freezing temperatures or a new record snowfall, but for increasing medical cannabis access. Clinical cannabis got its start in the state when former governor Mark Dayton signed the first Minnesota medical cannabis bill into law in 2014. Many criticized the bill for being far too restrictive as it listed only 9 qualifying conditions and stipulates a lengthy patient registration process. However, as of December 3rd, 2019, the state added macular degeneration and the much more generally outlined chronic pain to the list of qualifying conditions. Minnesota can now expect to see more registered medical cannabis patients thanks to the expanded list of qualifying conditions.

Making Medical Marijuana More Accessible

Though many American states have taken steps to legalize clinical cannabis, a number of potential patients still do not have access. In most cases, state regulations prevent people with certain conditions from using medical cannabis. If the state regulatory body does not list a medical condition as qualifying, then people suffering from that condition may not use cannabis for medicinal reasons, even if a medical professional recommends it as a potential treatment. The stringent nature of qualifying condition lists make Minnesota’s addition of chronic pain as a qualifying condition a massive win for medical cannabis advocates.

Chronic pain is a very generally defined medical condition. Any number of ailments can cause it and is usually up to the patient to define. For these reasons, acquiring a recommendation for medical cannabis can be far easier than it is for other conditions. There is little doubt that Minnesota’s clinical cannabis patient registry will expand greatly in the coming months thanks to the addition of chronic pain and macular degeneration. According to the Boston Globe, “As of October, nearly 18,000 patients were certified for the state’s medical marijuana program.” That number is bound to increase as more conditions make the list.

The Future of Medical Cannabis in Minnesota

Many consider Minnesota as having one of the more severely restrictive medical cannabis programs. Though Minnesota’s list of qualifying conditions is still small, it is encouraging that the state continues to implement updates. Lawmakers must work with patients and advocates to continue to pursue the creation of a fair and easily accessible medical cannabis program. If the state continues to update its list of qualifying conditions, it can at least begin to change the narrative.