All posts tagged: Health

Lots of Doctors Recommend Weed Without Understanding It

If you go to a doctor and ask them to recommend you medical marijuana, don’t expect them to fully understand how the drug works, both for you as an individual patient and in general as a therapy. Because no one really does.

With more and more states legalizing marijuana for medical or recreational use, cannabis is shedding its stigma and entering the mainstream. That means folks who’ve shied away from the stuff are getting better access, and exploring cannabis as a non-addictive treatment for ailments like pain. But that new interest is running smack dab into a big problem plaguing medical cannabis: The research on what marijuana can actually treat, what components of the plant matter, and how different patients respond to them, is severely lacking.

Just how much doctors are struggling with it becomes clear today in the Journal of Clinical Oncology. A study reveals that half of surveyed oncologists say they recommended marijuana to patients in the last year. But half of those didn’t think they actually had sufficient knowledge to make those recommendations.

The biggest question for oncologists is what cancer symptoms cannabis can really treat. The survey found respondents split when it comes to the treatment of pain: A third of oncologists said cannabis is equally or more effective than standard pain treatments, a third said it was less effective, and a third didn’t know. “But there seemed to be clear consensus that medical marijuana is a good adjunct to standard pain treatment, so a good add-on medication,” says Ilana Braun, lead author and chief of Dana-Farber Cancer Institute's Division of Adult Psychosocial Oncology. In fact, two-thirds of respondents said it’d be a good supplemental treatment.

According to the National Academies of Sciences, Engineering, and Medicine—which last year published a massive, big-deal review of cannabis research—“there is substantial evidence that cannabis is an effective treatment for chronic pain in adults.” It’s also been shown to help control nausea and vomiting.

Now, doctors have long prescribed a synthetic THC called dronabinol, aka marinol, for the treatment of nausea and weight loss. Problem is, side effects include paranoia and “thinking abnormal.” Beyond that, you wouldn’t want to try to get high on it because it’s missing the galaxy of other active compounds in cannabis. “If it worked—it rarely does work—but if it really did work it would be abused on the streets,” says physician Allan Frankel, a pioneer in medical cannabis. “For 15 cents a pill? That's how bad marinol is.”

The reason, Frankel says, is the so-called entourage effect, the interaction of dozens of other cannabinoids in marijuana like CBD (which is an extremely effective treatment for seizures, by the way) that may produce different therapeutic effects. So by that logic, with marinol, patients aren’t getting the full effect of the cannabis plant.

And that full effect would be? Well, nobody really knows—in part because the US government makes the stuff very, very difficult to study. In the eyes of the feds, it’s still a very illegal schedule I drug, the most tightly controlled category, and the DEA decides who gets crop to research. Researchers don’t have access to a variety of strains that might produce a variety of benefits, given different levels of CBD and THC and other compounds.

Even if you could study lots of different strains, it’s not always possible to tell what a patient is going to get at the dispensary. Flowers can be mislabeled, and the THC content of oils doesn’t always match what’s on the label. “Composition standardization is a giant mess,” says Jeff Raber, CEO of the Werc Shop, a lab that tests cannabis. “So for an ultra traditional doctor, I can understand where they're like, Man, we don't really know what that is, is that OK? It's not standardized like a pharmaceutical product.”

A doctor can’t just say, Take two marijuana pills and call me in the morning. And on a physiological level, we all handle cannabis differently. “Even if I tell everybody, go inhale a tenth of a gram, their inhalation depths and absorption rates are going to be different,” says Raber.

“Unfortunately, we are going a little bit blind,” says physician Bonni Goldstein, medical director of the Canna-Centers, which provides cannabis consultations for patients. “But what I'm finding in clinical experience is I learn from every patient, and so we try to use the scientific research that we do have.”

So doctors like Goldstein try to tailor cannabis as best they can for a patient’s needs. Her patients have the luxury of attentive, personalized cannabis consultations. “Someone retired who has cancer who doesn't have to get up in the morning and get somewhere may be able to take bigger doses during the day,” says Goldstein, “versus a mom of four who has kids in and out of activities, who has breast cancer.”

But your typical oncologist isn’t going to sit down with a patient for an hour to walk through their lifestyle and needs. So patients are left to experiment with dosages on their own, or consult with their local dispensary.

Because it turns out that dispensaries have some experience dosing cannabis. “Some of the top dispensaries that have been doing this for a while know this better than anybody else,” says Rob Adelson, president and CEO of Resolve, which makes a smart inhaler for medical marijuana patients. “There's still so much about the pharmacokinetics of this plant that we just don't know yet. So asking a doctor to come in to try to solve the problem without any more data than the dispensary has is hard.”

What Adelson sees cannabis promoting is a new paradigm of medical care. “We've heard this from many doctors, that they might not know about medical cannabis, might not want to promote it, and that a patient comes in and says, ‘I'd like to try it,’” he says. “And patients bring studies with them." That inversion of responsibility has its downsides: An elderly patient might not be aware of side effects like dizziness, for example. But at the same time, it's impossible to overdose. For better or worse, if doctors don't feel they have the knowledge to appropriately prescribe a drug, patients will fill that void.

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Marijuana shops recommend products to pregnant women, against doctors’ warnings

(CNN)A majority of cannabis dispensaries in Colorado recommended their products to women posing as pregnant customers with morning sickness, clashing with doctors’ warnings about the potential harms, according to a study published Wednesday in the journal Obstetrics & Gynecology.

Of 400 randomly selected dispensaries in Colorado, about seven in 10 recommended cannabis products as a treatment for morning sickness. Nearly two-thirds of the employees who answered these calls based these recommendations on “personal opinion,” and more than a third said cannabis was safe during pregnancy. Roughly 32% of employees recommended the caller talk to a health care provider without the caller having to bring it up herself.
“I was really surprised,” said study author Dr. Torri Metz, a high-risk obstetrician at Denver Health in Colorado, where marijuana was legalized in 2012. “I did not expect dispensaries to be recommending cannabis products to pregnant women.”
    Metz said women seek information on cannabis use during pregnancy from a variety of sources beyond their doctors — including the internet, friends and family.
    “Women are hesitant to disclose any kind of drug use in pregnancy to their health care providers for fear of potential legal ramifications or involvement by social services,” she said.
    Experts worry that some of these women may seek advice from cannabis retailers, expecting that they have specialized knowledge on the drug’s safety during pregnancy.
    In the study, medical dispensaries were more likely to recommend cannabis products than retail dispensaries: About 83% and 60% did so, respectively. The authors note that the employees they spoke to may not reflect the official policy of a given dispensary.
    Dr. Katrina Mark, an OB-GYN who was not involved in the research, wrote in an email that the term “medical dispensary” is a “misnomer.”
    “They are only licensed to dispense to people who have medical marijuana cards,” said Mark, an assistant professor in the University of Maryland School of Medicine’s Department of Obstetrics, Gynecology and Reproductive Sciences. “This does not mean that they are staffed by people that have any sort of medical education.”

    Doctors’ orders

    Doctors caution that the health effects of cannabis on a fetus remain unclear but could include low birth weight and developmental problems, according to the US Centers for Disease Control and Prevention.
    In animal studies, the active ingredient THC has been shown to cross the placenta, and researchers have suggested that it could cause “irreversible, subtle dysfunctions in the offspring.”
    Still, experts say the science is still in progress, and human studies are primarily observational: “It is unethical to purposely expose women and their unborn babies to marijuana during pregnancy to study outcomes,” Mark said.
    “Marijuana in pregnancy is … not as black and white as something like alcohol,” she added.
    Though some dispensary employees did not make a recommendation in Metz’s study, some claimed that eating versus smoking cannabis products could make their products safer. Others recommended that the women not broach the subject with their doctors.
    “Google it first. Then if you feel apprehensive about it, you could ask,” one employee told a researcher who posed as a pregnant customer.
    “Maybe you have a progressive doctor that will not lie to you. All the studies done back in the day were just propaganda,” another employee said.
    “It was hard to hear that, being a health care provider,” Metz said of employees’ unproven safety claims and recommendations that women not ask their doctors about it.
    Metz and her colleagues wrote that there are no regulations in Colorado surrounding what recommendations and advice dispensaries can give to customers. Cannabis products in the state are, however, required to be labeled as follows: “There may be additional health risks associated with the consumption of this product for women who are pregnant, breastfeeding, or planning on becoming pregnant.”
    The American College of Obstetricians and Gynecologists recommends that “women who are pregnant or contemplating pregnancy should be encouraged to discontinue marijuana use” and “to discontinue use of marijuana for medicinal purposes in favor of an alternative therapy.”
    Additionally, “there are insufficient data to evaluate the effects of marijuana use on infants during lactation and breastfeeding, and in the absence of such data, marijuana use is discouraged,” according to the recommendations.
    The journal in which the new study appeared is the official publication of the organization.
    Metz said she hopes this study will “engage the cannabis industry … in really coming together in terms of what the reasonable message should be providing to pregnant women.”
    “I think that the majority of women are really trying to do the right thing for their pregnancy and for their baby,” she added. “I just think we need to get that information to their hands.”

    Overstepping boundaries

    Prior research has suggested a rise in pregnant women using pot — sometimes to ease the nausea of morning sickness or heightened anxiety. The highest increase may be among women 24 and younger, according to a study of pregnant women in California in December.
    There are conventional medications for morning sickness that are considered safe for pregnancy, such as vitamin B6 and doxylamine, an antihistamine sold under brands like Unisom. For some women, eating small, frequent meals and staying hydrated can help, Mark said.

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    “My impression is that some women have a certain level of skepticism when it comes to the health care system,” she said, and that some might be “leery of taking ‘pharmaceuticals’ during pregnancy but view marijuana as a more ‘natural’ option.”
    “Legalization does not equate to safety, particularly in pregnancy,” she said. “I actually think that the fact that dispensaries are providing any recommendations for treatment of medical conditions is very much overstepping appropriate boundaries.”

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    Marissa SafontMarijuana shops recommend products to pregnant women, against doctors’ warnings
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    Veterans’ grass-roots movement shares health benefits of marijuana

    (CNN)To get away from the memories of war in Afghanistan — the violence, the unexpected danger, the rush of adrenaline and the hypervigilance that can come with post-traumatic stress disorder — Aaron Newsom started gardening.

    Since World War II, generations of veterans have found healing in horticulture. Digging in the dirt did that for Newsom, but the Marine, who served in an attack helicopter squadron, wanted more. He wanted to share this healing feeling with service members who may never even touch a spade, and he had an idea.
    In addition to the public gardening he was doing in Santa Cruz County, California, Newsom kept a secret garden in his home. “I grew medical cannabis for myself in my spare bedroom. I didn’t tell anyone for at least a year,” he said. “When I finally told my mom and dad, with my dad being so conservative, I thought they’d freak out, but they were both totally supportive, because I was growing it for the right reasons.”
      Newsom, 35, felt that the plant was a good replacement for the opioids and other drugs the Department of Veterans Affairs doctors put him on for PTSD and severe arthritis. “On those drugs, it wasn’t the quality of life that I wanted,” Newsom said. “With medical cannabis, I had such great success. I could regulate myself and my hypervigilance, and I was able to get off those other pills.”
      A friend he met through the nonprofit Farmer Veteran Coalition, fellow veteran Jason Sweatt, shared an enthusiasm for cannabis.When the two met Vietnam veterans hanging out at the VFW, it sparked an idea. Some of the veterans were disabled, and though they also felt that cannabis could helpdeal with their health issues, most had limited income.
      “Cannabis is quite expensive, so we knew we could help them out: giving them what we grew,” Newsom said. “And then they told friends who were vets, who told their friends who were vets, and it grew from there.”

        This is your brain on pain

      In 2011, after Newsom had gone back to Cabrillo Collegeto finish a degree in horticulture science, he and Sweatt made their giveaway official, creating the Santa Cruz Veterans Alliance. Today, members of the alliance grow marijuana, process it and sell it at the group’s successful dispensaries. Ten percent of everything it cultivates goes to its Veteran Compassion Program, which offers free weed to veteranswho have a doctors’ recommendation. (Doctors can only make a recommendation and aren’t allowed to prescribe cannabis or cannabis/hemp derived CBD products because they are illegal according to federal law.)
      The alliance is working on its 12th California dispensary license. It says it’s been able to help about 800 vets through the giveaway program. It also employs them in positions such as cultivation, processing and sales; 95% of the veterans it’s hired are on service-connected disability.
      Their group is part of a unique movement of vets who are trying to help themselves get through the challenges that come with going to war and living with the consequences.
      Veterans disproportionately struggle with mental problems and chronic pain, studies show, and the majority of veterans who have been surveyed say they’d like medical cannabis to be a federally legal treatment option.
      In the absence of that option, counseling works for some. Doctors prescribe a mix of opioids and psychotropics for others. But the drugs don’t always work or, in some cases, make problems worse. Veterans are 10 times more likely to abuse opioids than the general population, according to former VA secretary Robert McDonald.
      Roughly 20 veterans kill themselves each day, 2016 VA research found, and there’s emerging evidence of a link to chronic pain. Increasing doses of opioids was also tied to increased suicide risk for veterans, according to a study.
      Many vets see medical marijuana as a viable option, and the science, while limited, is starting to show promise in combating nerve pain. Researchers are also looking into its impact on PTSD and chronic pain. But some vets don’t want to wait for clinical trials. About 22% now use cannabis to treat physical or mental conditions, according to a recent American Legion survey.
      However, the VA cannot advise vets to try medical marijuana, nor can it help them get it because it’s federally prohibited.
      Vets also have to pay for it out of pocket, even in states like California where medical marijuana has been legal for more than two decades. At the federal level, it’s illegal and listed as a Schedule I drug, considered to have no medical value, meaning it’s not covered by veterans benefits or regular insurance.
      It probably won’t be covered any time soon. Attorney General Jeff Sessions has shown a dislike of the drug. The most recent head of the VA, Dr. David Shulkin, said during last year’s State of the VA speech that “there may be some evidence that (medical marijuana) is beginning to be helpful,” but he was recently fired.
      In the absence of federal action, veterans in this grass-roots movement act with urgency.
      “We all have friends or family who we have lost to suicide or opioid addiction and can’t wait for other help anymore,” said Seth Smith, a veteran and colleague of Newsom’s at the Santa Cruz Veterans Alliance. “Vets are uniquely suited for this. We are accustomed to operating in the gray areas, and cannabis is a big gray area still, although it is starting to become more mainstream. “This is Santa Cruz, surf city. We are used to riding waves out here,” he said.
      Other programs include Weed for Warriors and Hero Grown, which advocates for access and acceptance of medical marijuana. Hero Grown also does giveaways in Colorado and has a national program that ships hemp cannabidiol products to vets and first responders across the nation. Cannabidiol, or CBD, is one of the active ingredients in marijuana and is increasingly thought to have wide-ranging health benefits. Veterans Cannabis Group provides free weed for vets and employs them as security for medical marijuana providers. Other foundations are raising money for clinical trials.
      At the Santa Cruz Veterans Alliance, visible proof of how welcome the mission is comes on the first Monday of every month, when more than a hundred people typically line up at theSanta Cruz Live Oak Grange No. 503, a local gathering hall. Showing proof of service, a doctor’s recommendation, and a valid California ID, each gets a voucher for free weed from the group’s dispensaries and a lot more.
      The monthly meetings have become a fixture for veterans of the Gulf War, Iraq, Afghanistan, Vietnam and even Korea and World War II. The alliance also brings in groups to talk about other services veterans may need, such as housing, employment assistance and health care.
      Smith thinks their mission is vital. “We hope to keep (the marijuana efforts) all sustainable at least until the VA can prescribe it,” he said. “Everyone comes to find relief from everything from anxiety and depression, the PTSD, the lack of sleep and chronic pain, to get over opioid addiction. We’ve seen it all.”
      After getting vouchers, veterans stay to talk about their wars, the challenges of everyday life and cannabis itself.
      Jai Kadilak, who did tank duty in the Gulf War, has been attending meetings for the past three years. Cannabis has made him feel whole, he said, and the meeting brought back the familiar camaraderie of the war.
      “I met a woman there who said her husband never leaves the house except for this one meeting, and they drive in from hours away,” Kadilak said.
      Attendees share information unavailable at the VA. They talk about what marijuana strains work best to help sleep or to ease anxiety. There’s advice about edibles and cooking. One man turns cannabis juice into frozen cubes. Others talk about what to take if they don’t want to get high.
      Kadilak feels that cannabis is a better optionthan the “mess of pills” or “combat cocktail” of antipsychotics and opioids the VA put him on when he returned from combat. “I didn’t feel good. I didn’t feel bad. It was like I was just existing,” he said.
      Like a lot of guys he knew, Kadilak self-medicated with “quite a bit of beer on a daily basis,” which he knew was dangerous. “It really was rolling the dice with alcohol and pills, and it was a negative result,” he said. Now, as he advocates for compassionate use for other veterans, “there is no doubt about it: This is something that works, and it just can’t go away. It can’t.”
      Socrates Rosenfeld agrees. The 36-year-old, who works in the cannabis industry, as CEO of Jane Technologies, an online cannabis marketplace, has also been going to the Santa Cruz Veterans Alliance meetings for the past year and a half.
      Growing up, Rosenfeld said, he was as clean-cut as it comes. A West Point grad, an MIT student and an Apache helicopter pilot, he felt like he accomplished a lot, but when he got back from Iraq, the transition to civilian life was challenging.
      “You get used to operating at a certain level of intensity over there, with life or death decisions at every turn,” he said. “It’s hard to turn down the volume and live as a civilian sometimes.”
      Rosenfeld said he had never touched cannabis before but felt that he had to do something.
      “It’s like this thought carousel kept going around and around, and I couldn’t find any way to be present in the moment,” he said.
      Cannabis brought calm. “I wouldn’t take an opioid, as the doctors recommended. I didn’t want to feel like a zombie, but cannabis, this brought me a sense of balance, a connectedness to nature and to my loved ones and to myself.”

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      The Santa Cruz Veterans Alliance meetings have also brought him a connection to other vets who sometimes struggle with the stigma that comes with using marijuana.
      “I think that is why SCVAhas done such a great job. Being in the group, they are essentially saying, ‘you don’t have to be ashamed or worried about using this. You can find a way to treat whatever you are experiencing in a peaceful, natural and healing way,’ ” Rosenfeld said. “For the veterans’ community that goes through so much, this is really beautiful, and I hope other people learn about it. It’s not just about smoking a joint on 4/20. It’s about accessing a way to heal.”

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      Come aboard the cannabus: More seniors taking trips to get weed

      (CNN)An 86-year-old man in a bright yellow sweatshirt and matching baseball cap grips his walker tightly. He stands near the door of a large bus, the charter name American stretching over his shoulder. He greets neighbors and trades jokes with an official-looking woman, clipboard at the ready, checking people in as they board.

      Watch Chief Medical Correspondent Dr. Sanjay Gupta’s CNN Special Report “Weed 4: Pot vs. Pills” on Sunday, April 29, at 8 p.m. ET.
      They spot an older woman in black running toward them, her purse bouncing behind her. “Chin,” the woman gives her last name when she stops, a little out of breath. “I worried you’d leave without me, and I definitely didn’t want to miss this.”
      She joins about 50 seniors from Laguna Woods Village, an active-lifestyle community in Orange County, California, for people 55 and older, who are alreadyaboard the bus and ready for a new adventure. Many say they saw an ad for the free senior shuttle in their local paper.
        They aren’t catching a ride to bingo, nor are they headed to walk at the mall. Instead, this special charter comes to the community once a month to spare these seniors a half-hour drive to Santa Ana. Their destination: Bud and Bloom, a store that organizes the shuttle and bills itself as a senior-friendly medical marijuana dispensary. Some nicknamed the charter “the cannabus.”
        This is the first trip for the energetic man in yellow, John Lustig, and his spouse, Anne, who knits next to him on the bus. He fell and hurt his back and uses the walker for balance. “I’ve been having unpleasant back pain, and the medications weren’t doing it, so I thought, at 86, I would give cannabis a try,” Lustig says.
        The retired librarian’s doctor gave him a shot for the pain, but it hasn’t worked well, and his wife said the opioid he’s on doesn’t always work, either.
        A lot of other riders expressed reluctance about opioids, worried that they’ll feel unmotivated. The group takes the “active” description of their senior community seriously: There are horse trails, pools and tennis.
        Lustig hopes cannabis will help. Asked what neighbors will think, he jokes, “I don’t give a damn.
        “If I can help them lift something because my back is OK again, I think they would even help pay for the trip.”
        On board, the festive atmosphere is punctuated by the buzz of neighbors getting to know each other. One woman looks over a long handwritten shopping list. She’s gathered neighbors’ requests, and the list is four pages long. Others hand iPhones across the aisle, showing off photos of grandkids and great-grandkids. Many laugh and share stories, learning that they have at least one thing in common: If they’ve tried the drug before, it was a grandson who introduced them to it.
        “My grandson gave me a block of this chocolate,” says a woman with an old Hollywood style coif and a sensible knit vest, a glasses chain around her neck. She asks that her name not be used, saying her children would be mortified. “I couldn’t see straight for hours. It made me feel so weird, but I hear that there is some you can get that won’t get you high. I’m interested in that. I’ve got arthritis.”
        Arthritis, pain, insomnia, lack of appetite: All problems familiar to seniors and problems medical marijuana may address. As a result, seniorsare one of the fastest-growing demographics to show interest in weed, a study showed.
        Kandice Hawes, who was checking people in with the clipboard, is a longtime legalization advocate hired by Bud and Bloom. She said that since she’s been coordinating the senior shuttle, she’s seen a shift in attitudes, especially after marijuana became legal in all forms in California in January. Seniors, she finds, are particularly curious. “We usually have a happy bunch who want to learn something new and to try out new things,” she said.
        Scientific studies are still limited due to the Schedule I classificationof the drug, which means it’s illegal on the federal level and is considered to be of no medical value. However, the evidence is starting to show otherwise. The seniors on board the “cannabus” — many new to the drug, many like the Lustigs — want to find out whether it will work for them.
        Weed has already fixed a huge health issue for Christy Diller, who is going to be 80 in a few months. She’s been using it for a couple of years.
        “I’ve got rheumatoid arthritis really bad. That’s why I’m taking the marijuana,” Diller said. She eats a marijuana brownie every night, about two hours before she goes to bed. Before marijuana, she’d getabout only two hours of sleep a night. “I was like a walking zombie, and that was almost every day.” Now, with her brownies, she gets a full night’s rest.
        Today, she’s on the bus to buy mint lozenges. She bought some a few months ago, on another shuttle ride, and found that they helped when the brownies weren’t enough. Some friends have given her a hard time about using marijuana, but she doesn’t care what they think.
        “I think it is great. I think older people that have a lot of pain should use the marijuana, you know. When nothing else helps, then use it,” Diller said. “For me, nothing else helped me anymore, so I used the marijuana. It got a little better. It didn’t get much better, but it got better. So I can at least getsome steps already, and I can walk. I could not even walk before.”
        The bus passes through an industrial area and pulls up alongside a set of nondescript concrete buildings. The only thing distinguishing the Bud and Bloom dispensary is a bright green cross in the window and a large man in black, with the air of a bouncer, standing at the door for security.
        Inside, the seniors must show an ID and fill out city-required paperwork. At a desk that resembles the check-in area at a doctor’s office, they have to state whether they are there for medical or recreational purposes. “If you have a doctor’s recommendation, you get a 10% discount here,” the clerk tells Diller. “And if you are over 55, you also get a seniors discount.”
        Part of the group goes to the back of the building, where there is an information fair. Vendors sell weed wares and services. The Lustigs seem intrigued by a mixture that goes in your morning coffee, and they get a massage from a woman who rubs cannabis oil onto their backs.
        Christina Espiritu, founder of the 420 Foodie Club, speaks with a group of seniors as they eat sandwiches in metal folding chairs. “How many of you have ever cooked with marijuana?” Espiritu asks. A few hands shoot up.
        “Do you remember what you made?” she asks.
        “Brownies, of course,” shouts a woman, laughing, at the front.
        “Did you like them?” Espiritu asks.
        “No, they tasted like dirt,” the woman responds.
        “Well, we can teach you about how you can make marijuana into butter. I promise that tastes a lot better,” the instructor tells the class.
        Other seniors ask about creams on display. “These do different things for different times of day,” says a man with a million-dollar smile who looks like he should work at a high-end cosmetics counter. “The bliss from this is very uplifting, meant for a mood enhancement. It is quite energetic at times, but it is meant to elevate your mood and make you feel good. The other is great for sleep. Even Time magazine wrote about it. There’s satisfaction guaranteed.”
        In the store, a group looks around what could pass for a posh hotel spa rather than a hippie-era head shop. On displays of modern furniture and glass cabinets are cannabis products in every imaginable variety: weed popcorn, potato chips, mints, gummies, lip gloss and the more traditional glass bongs and rolled joints. “These are a little fancier than what we used in the ’60s,” one man tells his wife as they look over bongs.
        Clerks and an on-site pharmacist are ready to answer any questions.
        “I do have the oil,” a clerk tells the Lustigs. “It would work really well for your back pain. But that’s only if you have someone who can assist you.”
        John Lustig pats the hand of his wife of 64 years with a mischievous grin, and she nods that she will help. “How do you know how much to apply?” he asks the clerk.
        “It’s very personal. You will have to test the waters,” the clerk replies. “The thing about our topicals is, it’s not intoxicating.”
        “Do you have your exit bag?” a nearby clerk asks as Diller checks out. An exit bag is a secure envelope required by state law for all dispensary purchases.
        “Oh, you have to bring that every time?” she asks.
        “You have to bring them back every time. It is just the law. It’s a dollar.”
        “Oh, dear. A dollar is a dollar for we seniors,” Diller says.
        One of the drawbacks of marijuana as medicine: It can be expensive. Diller’s tiny box of mints costs $24.49. The clerk blames taxes, and since marijuana is illegal at the federal level, it’s not something Medicaid or insurance covers, even with a doctor;s recommendation.
        Though disappointed about the expense, Diller still thinks the benefits are worth it. “For me, it’s a miracle,” she says. “Although the cream can smell pretty bad. I went to my daughter one time. She said, ‘You smell horrible. What do you have on?’ I said ‘marijuana.’ My daughter laughed and said ‘whatever works.’ ”

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        A few weeks after their shopping trip, Anne Lustig said they aren’t completely sold on marijuana. Before she uses it, she wants to do more research. “Honestly, I haven’t given it a chance yet,” she said, though she rubbed some of the liquid on her husband’s back. “I do think that may have helped, at least a little bit.
        “We will have to see. As my husband always says, ‘getting old is not for sissies.’ ”

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        Marissa SafontCome aboard the cannabus: More seniors taking trips to get weed
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        Gupta to Jeff Sessions: Medical marijuana could save many addicted to opioids

        (CNN)Dear Honorable Jeff Sessions,

        Watch Chief Medical Correspondent Dr. Sanjay Gupta’s CNN Special Report “Weed 4: Pot vs. Pills” on Sunday, April 29, at 8 p.m. ET.
        I feel obligated to share the results of my five-year-long investigation into the medical benefits of the cannabis plant. Before I started this worldwide, in-depth investigation, I was not particularly impressed by the results of medical marijuana research, but a few years later, as I started to dedicate time with patients and scientists in various countries, I came to a different conclusion.
        Not only can cannabis work for a variety of conditions such as epilepsy, multiple sclerosis and pain, sometimes, it is the only thing that works. I changed my mind, and I am certain you can, as well. It is time for safe and regulated medical marijuana to be made available nationally. I realize this is an unconventional way to reach you, but your office declined numerous requests for an interview, and as a journalist, a doctor and a citizen, I felt it imperative to make sure you had access to our findings.
          Mr. Sessions, there is an added urgency, as we are in the middle of a deadly opioid epidemic that has been described as the worst self-inflicted epidemic in the history of our country.
          The drug overdose scourge claimed about 68,000 US lives in 2017, just over 45,000 of them from opioids alone. Every day, 115 Americans die from opioid overdoses. It has fueled a decline in an entire country’s life expectancy and will be remembered as a sad and tragic chapter in our collective history.
          These are desperate times, and while some may consider making medical marijuana widely available to be a desperate measure, the evidence has become increasingly clear of the important role cannabis can have.
          We have seen real-world clues of medical marijuana’s benefits. Researchers from the Rand Corp., supported by the National Institute on Drug Abuse, conducted “the most detailed examination of medical marijuana and opioid deaths to date” and found something few initially expected. The analysis showed an approximately 20% decline in opioid overdose deaths between 1999 and 2010 in states with legalized medical marijuana and functioning dispensaries.
          It’s not the first time this association between medical marijuana and opioid overdose has been found. Though it is too early to draw a cause-effect relationship, these data suggest that medicinal marijuana could save up to 10,000 lives every year.

          The science of weed

          Cannabis and its compounds show potential to save lives in three important ways.
          Cannabis can help treat pain, reducing the initial need for opioids. Cannabis is also effective at easing opioid withdrawal symptoms, much like it does for cancer patients, ill from chemotherapy side effects. Finally, and perhaps most important, the compounds found in cannabis can heal the diseased addict’s brain, helping them break the cycle of addiction.
          Mr. Sessions, there is no other known substance that can accomplish all this. If we had to start from scratch and design a medicine to help lead us out of the opioid epidemic, it would likely look very much like cannabis.

          A better, and safer, way to treat pain

          The consensus is clear: Cannabis can effectively treat pain. The National Academies of Sciences, Engineering, and Medicine arrived at this conclusion last year after what it described as the “most comprehensive studies of recent research” on the health effects of cannabis.
          Furthermore, opioids target the breathing centers in the brain, putting their users at real risk of dying from overdose. In stark contrast, with cannabis, there is virtually no risk of overdose or sudden death. Even more remarkable, cannabis treats pain in a way opioids cannot. Though both drugs target receptors that interfere with pain signals to the brain, cannabis does something more: It targets another receptor that decreases inflammation — and does it fast.
          I have seen this firsthand. All over the country, I have met patients who have weaned themselves off opioids using cannabis. Ten years ago, attorney Marc Schechter developed a sudden painful condition known as transverse myelitis, an inflammation of the spinal cord. After visiting doctors in several states, he was prescribed opioids and, according to our calculations, consumed approximately 40,000 pills over the next decade. Despite that, his pain scores remained an eight out of 10. He also suffered significant side effects from the pain medication, including nausea, lethargy and depression.
          Desperate and out of options, Schechter saw Dr. Mark Wallace, head of University of California, San Diego Health’s Center for Pain Medicine, where he was recommended cannabis. Minutes after he took it for the first time, Schechter’s pain was reduced to a score of two out of 10, with hardly any side effects. One dose of cannabis had provided relief that 40,000 pills over 10 years could not.

          Using marijuana to get off opioids

          For Schechter, as with so many others, the seemingly insurmountable barrier to ending his opioid use was the terrible withdrawal symptoms he suffered each time he tried. When a patient stops opioids, their pain is often magnified, accompanied by rapid heart rate, persistent nausea and vomiting, excessive sweating, anorexia and terrible anxiety.
          Here again, cannabis is proven to offer relief. As many know, there is longstanding evidence that cannabis helps chemotherapy-induced symptoms in cancer patients, and those symptoms are very similar to opioid withdrawal. In fact, for some patients, cannabis is the only agent that subdues nausea while increasing appetite.

          Why we can’t ‘just say no’ to opioids

          Finally, when someone is addicted to opioids, they are often described as having a brain disease. Yasmin Hurd, director of the Addiction Institute at Mount Sinai in New York City, showed me what this looks like in autopsy specimens of those who had overdosed on opioids. Within the prefrontal cortex of the brain, she found damage to the glutamatergic system, which makes it difficult for neural signals to be transmitted. This is an area of the brain responsible for judgment, decision-making, learning and memory.
          Hurd told me that when an individual’s brain is “fundamentally changed” and diseased in this manner, they lose the ability to regulate opioid consumption, unable to quit despite their best efforts — unable to “just say no.”
          It is no surprise, then, that abstinence-only programs have pitiful results when it comes to opioid addiction. Even the current gold standard of medication-assisted treatment, which is far more effective, still relies on less-addictive opioids such as methadone and buprenorphine. That continued opioid use, Hurd worries, can cause ongoing disruption to the glutamatergic system, never allowing the brain to fully heal. It may help explain the tragic tales of those who succeed in stopping opioids for a short time, only to relapse again and again.

            Your brain on marijuana

          This is precisely why Hurd started to look to other substances to help and settled on nonpsychoactive cannabidiol or CBD, one of the primary components in cannabis. Hurd and her team discovered that CBD actually helped “restructure and normalize” the brain at the “cellular level, at the molecular level.” It was CBD that healed the glutamatergic system and improved the workings of the brain’s frontal lobes.
          This new science sheds lights on stories like the one I heard from Doug Campbell of Yarmouth, Maine. He told me he had been in and out of drug rehab 32 times over 25 years, with no success. But soon after starting cannabis, he no longer has “craving, desire and has not thought about (opioids) at all, period.”
          For the past 40 years, we have been told that cannabis turns the brain into a fried egg, and now there is scientific evidence that it can do just the opposite, as it did for Campbell. It can heal the brain when nothing else does.
          I know it sounds too good to be true. I initially thought so, as well. Make no mistake, though: Marc Schechter and Doug Campbell are emblematic of thousands of patients who have successfully traded their pills for a plant.
          These patients often live in the shadows, afraid to come forward to share their stories. They fear stigma. They fear prosecution. They fear that someone will take away what they believe is a lifesaving medication.

          Where do we go from here?

          Mr. Sessions, Dr. Mark Wallace has invited you to spend a day seeing these patients in his San Diego clinic and witness their outcomes for yourself. Dr. Dustin Sulak could do the same for you in Portland, Maine, as could Dr. Sue Sisley in Phoenix. Staci Gruber in Boston could show you the brain scans of those who tried cannabis for the first time and were then able to quit opioids. Dr. Julie Holland in New York City could walk you through the latest research. All over the country, you will find the scientists who write the books and papers, advance the science and grow our collective knowledge. These are the women and men to whom you should listen. They are the ones, free of rhetoric and conjecture, full of facts and truth, who are our best chance at halting the deadly opioid epidemic.

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          Making medicinal marijuana available should come with certain obligations and mandates, just as with any other medicine. It should be regulated to ensure its safety, free of contamination and consistent in dosing. It should be kept out of the hands of children, pregnant women and those who are at risk for worse side effects. Any responsible person wants to make sure this is a medicine that helps people, not harms.
          Recently, your fellow conservative John Boehner changed his mind after being “unalterably opposed” to marijuana in the past. If you do the same, Mr. Attorney General, thousands of lives could be improved and saved. There is no time to lose.

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          Marissa SafontGupta to Jeff Sessions: Medical marijuana could save many addicted to opioids
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          Getting off opioids with medical marijuana: Patients turn to pot over pills

          (CNN)In 2016, opioids killed more Americans than breast cancer. The drug overdose epidemic has become one of the most concerning public health issues of recent time, and in an effort to stem the tide, moreg and more patients and doctors are turning to pot over pills.

          Watch Chief Medical Correspondent Dr. Sanjay Gupta’s CNN Special Report “Weed 4: Pot vs. Pills” on Sunday, April 29, at 8 p.m. ET.
          For much of the past two decades, 51-year-old Angie Slinkertook a cocktail of narcotics, antidepressants and anti-anxiety medications to manage the pain stemming from a car accident in 1998. She had between 50 and 60 surgeries, but her pain persisted, and doctors kept giving her more pills.
          “It was just a vicious cycle,” she told CNN Chief Medical Correspondent Dr. Sanjay Gupta. “You started taking something for pain, and before you knew it, you were into another surgery. Which brought on anxiety.” To treat the anxiety, doctors prescribed more pills. And when she felt depressed, they added even more medications.
            All the drugs left in her a fog. She spent most of her days in bed. When Slinker woke up, she was in pain and looking for immediate relief.
            By 2012, she was taking up to 25 pills a day. She weighed close to 350 pounds, and she didn’t want to move, because the medications sapped whatever will or desire she had. “I can’t do this anymore. It is killing me from the inside out,” she told her doctors.
            And so she stopped cold turkey.
            The withdrawal symptoms were severe. Slinker said she was moody and irritable from the pounding headaches and constant nausea. Without any medications, her hands began to spasm and freeze.
            Her then 22 year-old sonsuggested cannabis. The relief was quick. “I realized immediately that there are medicinal properties within cannabis,” she said.
            It didn’t completely eliminate her pain, but pot allowed her to live again, she says. She was able to play with her granddaughter and participate in life. “I’m never going to be pain-free, ever. But cannabis has given me a reason to live,” Slinker said.
            But it is also illegal in her home state of Indiana. “I could have bought cannabis off the street. But that was not me. I wanted to do it the right way. I wanted to do it legally,” she said. So in July 2012, Slinker moved to Maine.

            Treating patients with weed

            Medical marijuana has been legal in Maine since 1999. The state has one of the top ten highest rates of opioid overdose in the country. In 2016, the rate of overdoses from opioid drugs in Maine was nearly double the national rate. The number of heroin related deaths has jumped more than fourfold since 2012.

              This is your brain on pain

            For a state deeply embedded in the opioid crisis, Dustin Sulak believes that medical marijuana could be part of a solution. “There’s no pill, there’s no spray, no drop, no puff [that] can completely solve this problem,” Sulak told Gupta. “But cannabis, when it’s used in the right way, can take a big bite out of it.”
            Sulak is a doctor of osteopathic medicine. He says he has treated hundreds of people with marijuana to wean them off opioid painkillers. He runs two outpatient clinics in Maine and started looking to marijuana as a potential solution when he noticed that a number of his patients were able to sustain their opioid dosages for years, never asking for more.
            Production of natural opioids is triggered when the body experiences pain. But opioid medications can act as a signal to the body to stop producing endorphins; it instead becomes more and more reliant on the drugs. When the person takes more opioids, that increases the risk for overdose.
            Sulak was curious as to why some of his patients didn’t need to increase their opioid doses, so he asked them what was different. “The answer was that they were using opioids in combination with cannabis. And they felt that it made the opioids stronger.”
            Sulak’s review of the medical literature resulted in the same conclusion. He points out that when opioids are used in combination with cannabis in animals, marijuana can boost an opioid’s effectiveness without requiring higher dosages.
            Slinker is now a patient of Sulak’s integrative health practice. Instead of taking 25 pills a day, she supplements smoking a gram of marijuana every three or four weeks with marijuana tinctures, oils and vapor. She also uses a drug called naltrexone to help with her autoimmune-related issues.
            She credits her life now to cannabis and wants others to know about it. “I want people to know that they have options. Do not be afraid to tell your doctor that you do not want these chemicals in your body,” she said.

            ‘I don’t think I would be alive today if I didn’t have it’

            Doug Campbell, another patient of Sulak’s, agrees that cannabis is a real alternative. “I don’t think I would be alive today if I didn’t have it,” he said.
            Like Slinker, Campbell said he started off using narcotics to manage pain. He was 18 years-old when he fell off a roof and fractured three vertebrae in his lower back. But it wasn’t until he started getting involved in a more party lifestyle that opioids became more than just therapy.
            After 32 times in and out of rehabilitation, he finally found a way to stop using opioids. “I have no cravings. I have no desire. I do not have any thought about it at all,” he told Gupta.
            Dr. Mark Wallace, a pain management specialist and head of the University of California, San Diego Health’s Center for Pain Medicine, is seeing similar results in his patients. Wallace began investigating cannabis in 1999, when he received a grant from the state of California. He looked at the literature and realized that pot had a long history of therapeutic use for many disorders including leprosy, epilepsy and pain.
            Within a decade, there were enough studies to convince him that marijuana was a real alternative to use in his practice. He estimates that hundreds of his patients, like Marc Schechter, have been weaned off pills through pot.

            40,000 pills over 10 years

            In the past 10 years, Schechter estimates, he took almost 40,000 opioid pills, all prescribed to him by his doctors. Percocet, fentanyl and OxyContin — they all worked, but when the dosage wore off, he needed more.
            Schechter had a rare condition that flared up while he was playing golf in 2007. At the 17th hole, pain began radiating from his back. By the time he got back to his room, he couldn’t move his left leg at all.
            Schechter was diagnosed with idiopathic transverse myelitis, an inflammation of the spine. He was eventually able to walk again, but the pain persisted.
            Without the drugs, it felt like his leg was burning with pins and needles, as if it had fallen asleep. “It’s like that 24/7. Not a second of relief,” he said. He needed the drugs just to live.
            “Were you addicted to them?” Gupta asked.
            “Physically, yeah,” Schechter said.
            The drugs never interfered with his work as an attorney, but Schechter kept needing more and more of them. He started to question their effectiveness. Schechter told his neurologist, “I really am starting to doubt whether this is even having any effect because I’m in so much neuropathic pain.”
            His neurologist had heard of Wallace’s work and referred Schechter to the clinic. The first night Schechter used marijuana, he took a puff or two from a vaporizer. “Within a minute, I had immediate pain relief. … [The pain level] was so tolerable that I was, like, in heaven.”

            ‘We need objective data’

            Patients and doctors across the country have told similar stories. But Dr. Nora Volkow, director of the National Institute on Drug Abuse, said anecdotes are not enough.
            “We cannot be guided by wishful thinking. We need objective data,” she told Gupta.

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            And a growing number of doctors and researchers like Wallace and Sulak are ready to provide those data. They say federal regulations are standing in the way of getting people the help they need.
            According to the Drug Enforcement Administration, marijuana is a Schedule I drug, meaning it has no medical use and a high potential for abuse.
            “We have enough evidence now that it should be rescheduled,” Wallace said.
            Sulak wonders, “When will the medical community catch up with what their patient populations are doing?”

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            Marissa SafontGetting off opioids with medical marijuana: Patients turn to pot over pills
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            NFL player makes medical marijuana history: ‘I have a life to live’

            (CNN)NFL running back Mike James calls it his medicine for pain management, but league officials call it a banned substance. Now, James’ athletic career is hanging in limbo because he chose pot over pills.

            In 2013, James was prescribed opioid painkillers after injuring his left ankle in a Monday night football game. Within weeks, he developed a dangerous dependency on the drugs.
            To get off of the opioids, he turned to medical marijuana for his pain.
              Suddenly, “my pain subsided,” James told CNN Chief Medical Correspondent Dr. Sanjay Gupta in an exclusive interview in the documentary “Weed 4: Pot vs. Pills,” which aired Sunday night.
              “I never had something where I could be coherent and still have pain relief,” he said.
              He turned to the sport that both he and his mother loved to help overcome his grief. “For him to be all right and mentally deal with this, he was going to lean on football,” said his wife, Aubrey James.
              Three years later, James was drafted by the Tampa Bay Buccaneers. As a Bleacher Report headline put it, James proved that he had the talent to enjoy a “promising future” with the Buccaneers, but then he injured his ankle, and his life changed.
              Doctors prescribed a cocktail of opiates to deal with the pain, a common prescription among professional athletes for sports-related injuries.
              A study published in the journal Drug and Alcohol Dependence in 2011 found that more than half — 52% — of former NFL players reported using opioids during their career, and 71% of those players reported misusing opioids.
              The prevalence of current opioid use among those players was 7%, according to that study: about three times the rate of use among the general population. The study included 644 retired players who answered questions in a telephone survey about their opioid use.
              James never worried about developing an opioid addiction, “because I was getting them from a doctor,” he said, but Aubrey worried.
              Within weeks of his injury, James joined the about 2.5 million Americans who struggle with opioid use disorder.
              In an effort to help him stop using pills, his wife suggested that James use pot to treat his pain.
              James, a 27-year-old father of two, knew that he needed to stop using opioids whenever he thought about “the notion that I would do what my father did to me, to my boys,” he said. His sons are 4 and 1.
              He remained skeptical, however, about using marijuana to make that change.
              “I thought, ‘Weed? No, that’s a street drug.’ I didn’t even want to hear what it had to offer,” he said, but after more convincing, he finally tried marijuana in February 2014, and it helped him get off the opioids.
              “I felt like I was beginning a new life,” he said.
              Yet since cannabis is banned in the NFL and James was unsure how he could get more, he said, he didn’t use it again until last year.

                Goodell addresses NFL ban on marijuana use

              Then, in August, James took a drug test as part of the NFL’s routine testing program. In October, he learned that the test was positive for marijuana, leading to his filing of the therapeutic use exemption for cannabis.
              “This is the first active player who’s been willing to put their professional career on the line, to openly admit that they not only have been using this cannabis but need it to function at the highest level,” said Dr. Sue Sisley, an Arizona-based physician who is a board member of the nonprofit Doctors for Cannabis Regulation and has been helping James with his exemption application.
              “Mike’s case is such a perfect example of why cannabis needs to be made available, because he’s really not a candidate for opioids,” she said. “So this is a safe alternative for him.”

              ‘I’m not ashamed of it. … I have a life to live’

              Twenty-nine states, the District of Columbia, Guam and Puerto Rico have approved some form of legalized cannabis. The first state in the US to legalize marijuana for medicinal use was California, in 1996.
              As it turns out, 69% of Americans say they approve of a professional athlete using marijuana for pain, and 67% saythat using a doctor’s prescription for an opioid is a greater health risk than using a doctor’s prescription for marijuana, according to a Yahoo News/Marist Poll released last year.
              The stance of the NFL remains somewhat unclear, and the league did not respond to a request for comment.
              In 2016, the NFL Players Association formed a committee to investigate all pain management options for players, including cannabis.
              “Our job is to find the best medical science to support your therapeutic use exemption,” DeMaurice Smith, executive director of the NFL Players Association, told Gupta.
              As for James’ case, “what I would say to him and every NFL player: Our job is to figure out, how do we build the best medical support for the best treatment for you?” Smith said.

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              James never would have guessed that he would make history due to a therapeutic use exemption, but if, 30 years from now, his biography states “medicinal marijuana advocate,” he would be fine with that.
              “I’m not ashamed of it,” James said. “I’m not embarrassed about it. It is something that I will continue to use, because I have a life to live.”

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              Marissa SafontNFL player makes medical marijuana history: ‘I have a life to live’
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              Marijuana’s effects on young brains diminish 72 hours after use, research says

              (CNN)Marijuana is notorious for slowing certain cognitive functions such as learning, memory and attention span (maybe that’s why they call it “dope”?). But new research in young people suggests that these cognitive effects, while significant, may not persist for very long, even among chronic users.

              The meta-analysis, published Wednesday in the journal JAMA Psychiatry, combines data from 69 previous studies that look at the effects of heavy cannabis use on cognitive functioning in adolescents and young adults. It found that those young people who identified as heavy marijuana users scored significantly lower than non-users in a variety of cognitive domains such as learning, abstraction, speed of processing, delayed memory, inhibition and attention.
              “There have been a couple of meta-analyses done in adult samples, but this is the first one to be done specifically in adolescent and young adult samples,” said Cobb Scott, assistant professor of psychiatry at the Perelman School of Medicine at the University of Pennsylvania and a lead author of the study.
                “We looked at everything from learning and memory to different aspects of executive functioning such as abstraction ability,” Scott said. “And we basically showed that the largest effects — which was around a third of a standard deviation — was in the learning of new information and some aspects of executive functioning, memory and speed of processing.”
                But when the researchers separated the studies based on length of abstinence from marijuana use, the difference in cognitive functioning between marijuana users and non-users was no longer apparent after 72 hours of marijuana abstinence. That could be an indication “that some of the effects found in previous studies may be due to the residual effects of cannabis or potentially from withdrawal effects in heavy cannabis users,” Scott said.
                The study comes as America continues to debate the merits of marijuana legalization. Recreational marijuana use is legal in nine states. Twenty-nine states and the District of Columbia have legalized some form of medical marijuana use, with at least three additional states potentially deciding on the issue in the upcoming November election, according to Melissa Moore, New York deputy state director for the nonprofit Drug Policy Alliance.
                Studies on the long-term cognitive effects of marijuana use among adolescents and young adults have shown inconsistent results. A 2008 study reported that frequent or early-onset cannabis use among adolescents was associated with poorer cognitive performance in tasks requiring executive functioning, attention and episodic memory.
                A 2014 study also warned against the use of marijuana during adolescence, when certain parts of the brain responsible for executive functioning — such as the prefrontal cortex — are still developing.
                “There have been very important studies showing evidence for irreversible damage (from marijuana use), and so there needs to be more research in this area,” said Kevin Sabet, assistant adjunct professor at the Yale School of Medicine and president of the nonprofit Smart Approaches to Marijuana, who was not involved in the new study.
                “I hope they’re right. We want there to be little effect after 72 hours. But given the other studies that have had very large sample sizes that have been published over the past five years in prominent journals, I think we need to look into that more,” added Sabet, whose group is focused on the harms of marijuana legalization.
                But a number of recent studies have also shown that the association between marijuana use and reduced cognitive functioning disappears after controlling for factors such as psychiatric illness and substance use disorders, according to Scott.
                In an attempt to make sense of these discordant results, the new research combined data from 69 previous studies, resulting in a comparison of 2,152 frequent marijuana users with 6,575 non-users. Participants ranged in age from 10 to 50, with an average age of 21.
                The researchers found that, overall, the cognitive functioning of frequent marijuana users was reduced by one-third of a standard deviation compared with non-frequent marijuana users — a relatively small effect size, according to Scott.
                “It surprised, I think, all of us doing this analysis that the effects were not bigger than we found,” Scott said. “But I would say that the clinical significance of a quarter of a standard deviation is somewhat questionable.”
                But according to Sabet, even a relatively small effect size could be important, especially in a large meta-analysis such as this one.
                “The small effect size may be meaningful in a large population, and again, all (cognitive) measures are worse for those using marijuana,” Sabet said.
                “The study is pretty bad news for marijuana users,” he added. “Overall, I think this is consistent with the literature that marijuana use shows worse cognitive outcomes among users versus non-users.”
                In an effort to identify other potential factors that could have affected the relationship between marijuana use and cognition,the researchers also separated the studies based on the length of marijuana abstinence, age of first cannabis use, sociodemographic characteristics and clinical characteristics such as depression.
                Of these, only the length of marijuana abstinence was found to significantly affect the association between chronic marijuana use and reduced cognitive functioning. Specifically, cognitive functioning appeared to return to normal after about 72 hours of marijuana abstinence — a threshold identified in previous studies, according to Scott.
                “The reason we chose the 72-hour mark is that in looking at the data on cannabis withdrawal effects in heavy cannabis users, 72 hours seems to be past the peak of most withdrawal effects that occur,” he said.
                However, the 69 studies included in the review did not have a uniform definition for “chronic” or “frequent” marijuana use, one of the study’s main limitations, according to Sabet.
                “When you put all of these studies together that have different definitions of marijuana users and are from different times, it’s not surprising that you’d get a smaller effect size,” Sabet said.
                The studies also relied on a variety of tests to determine cognitive functioning, including the Trail Making Test, the Digital Span Memory Test and the California Verbal Learning test, according to Scott.
                “The other thing that’s important to highlight is that we’re only looking at cognitive functioning. We’re not looking at risks for other adverse outcomes with cannabis use, like risk for psychosis, risks for cannabis use problems or other medical issues like lung functioning outcomes,” Scott said.

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                But the results still suggest that the negative cognitive effects of marijuana use, while significant in the short-term, probably diminish with time. They also shed light on the need for more research in this area, particularly as cannabis policy in the United States continues to change at a rapid pace.
                “As attitudes change about cannabis use and cannabis use becomes a little bit more accepted in terms of policy and government regulation and medical cannabis use increases, I think we need to have a real understanding of the potential risks and benefits of cannabis use,” Scott said.

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                Marissa SafontMarijuana’s effects on young brains diminish 72 hours after use, research says
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                Marijuana legalization could help offset opioid epidemic, studies find

                (CNN)Experts have proposed using medical marijuana to help Americans struggling with opioid addiction. Now, two studies suggest that there is merit to that strategy.

                The studies, published Monday in the journal JAMA Internal Medicine, compared opioid prescription patterns in states that have enacted medical cannabis laws with those that have not. One of the studies looked at opioid prescriptions covered by Medicare Part D between 2010 and 2015, while the other looked at opioid prescriptions covered by Medicaid between 2011 and 2016.
                The researchers found that states that allow the use of cannabis for medical purposes had 2.21 million fewer daily doses of opioids prescribed per year under Medicare Part D, compared with those states without medical cannabis laws. Opioid prescriptions under Medicaid also dropped by 5.88% in states with medical cannabis laws compared with states without such laws, according to the studies.
                  “This study adds one more brick in the wall in the argument that cannabis clearly has medical applications,” said David Bradford, professor of public administration and policy at the University of Georgia and a lead author of the Medicare study.
                  “And for pain patients in particular, our work adds to the argument that cannabis can be effective.”
                  Medicare Part D, the optional prescription drug benefit plan for those enrolled in Medicare, covers more than 42 million Americans, including those 65 or older. Medicaid provides health coverage to more than 73 million low-income individuals in the US, according to the program’s website.
                  “Medicare and Medicaid publishes this data, and we’re free to use it, and anyone who’s interested can download the data,” Bradford said. “But that means that we don’t know what’s going on with the privately insured and the uninsured population, and for that, I’m afraid the data sets are proprietary and expensive.”

                  ‘This crisis is very real’

                  The new research comes as the United States remains entangled in the worst opioid epidemic the world has ever seen. Opioid overdose has risen dramatically over the past 15 years and has been implicated in over 500,000 deaths since 2000 — more than the number of Americans killed in World War II.
                  “As somebody who treats patients with opioid use disorders, this crisis is very real. These patients die every day, and it’s quite shocking in many ways,” said Dr. Kevin Hill, an addiction psychiatrist at Beth Israel Deaconess Medical Center and an assistant professor of psychiatry at Harvard Medical School, who was not involved in the new studies.
                  “We have had overuse of certain prescription opioids over the years, and it’s certainly contributed to the opioid crisis that we’re feeling,” he added. “I don’t think that’s the only reason, but certainly, it was too easy at many points to get prescriptions for opioids.”
                  Today, more than 90 Americans a day die from opioid overdose, resulting in more than 42,000 deaths per year, according to the US Centers for Disease Control and Prevention. Opioid overdose recently overtook vehicular accidents and shooting deaths as the most common cause of accidental death in the United States, the CDC says.
                  Like opioids, marijuana has been shown to be effective in treating chronic pain as well as other conditions such as seizures, multiple sclerosis and certain mental disorders, according to the National Institute on Drug Abuse. Research suggests that the cannabinoid and opioid receptor systems rely on common signaling pathways in the brain, including the dopamine reward system that is central to drug tolerance, dependence and addiction.
                  “All drugs of abuse operate using some shared pathways. For example, cannabinoid receptors and opioid receptors coincidentally happen to be located very close by in many places in the brain,” Hill said. “So it stands to reason that a medication that affects one system might affect the other.”
                  But unlike opioids, marijuana has little addiction potential, and virtually no deaths from marijuana overdose have been reported in the United States, according to Bradford.
                  “No one has ever died of cannabis, so it has many safety advantages over opiates,” Bradford said. “And to the extent that we’re trying to manage the opiate crisis, cannabis is a potential tool.”

                  Comparing states with and without medical marijuana laws

                  In order to evaluate whether medical marijuana could function as an effective and safe alternative to opioids, the two teams of researchers looked at whether opioid prescriptions were lower in states that had active medical cannabis laws and whether those states that enacted these laws during the study period saw reductions in opioid prescriptions.
                  Both teams, in fact, did find that opioid prescriptions were significantly lower in states that had enacted medical cannabis laws. The team that looked at Medicaid patients also found that the four states that switched from medical use only to recreational use — Alaska, Colorado, Oregon and Washington — saw further reductions in opioid prescriptions, according to Hefei Wen, assistant professor of health management and policy at the University of Kentucky and a lead author on the Medicaid study.
                  “We saw a 9% or 10% reduction (in opioid prescriptions) in Colorado and Oregon,” Wen said. “And in Alaska and Washington, the magnitude was a little bit smaller but still significant.”
                  The first state in the United States to legalize marijuana for medicinal use was California, in 1996. Since then, 29 states and the District of Columbia have approved some form of legalized cannabis. All of these states include chronic pain — either directly or indirectly — in the list of approved medical conditions for marijuana use, according to Bradford.
                  The details of the medical cannabis laws were found to have a significant impact on opioid prescription patterns, the researchers found. States that permitted recreational use, for example, saw an additional 6.38% reduction in opioid prescriptions under Medicaid compared with those states that permitted marijuana only for medical use, according to Wen.
                  The method of procurement also had a significant impact on opioid prescription patterns. States that permitted medical dispensaries — regulated shops that people can visit to purchase cannabis products — had 3.742 million fewer opioid prescriptions filled per year under Medicare Part D, while those that allowed only home cultivation had 1.792 million fewer opioid prescriptions per year.
                  “We found that there was about a 14.5% reduction in any opiate use when dispensaries were turned on — and that was statistically significant — and about a 7% reduction in any opiate use when home cultivation only was turned on,” Bradford said. “So dispensaries are much more powerful in terms of shifting people away from the use of opiates.”
                  The impact of these laws also differed based on the class of opioid prescribed. Specifically, states with medical cannabis laws saw 20.7% fewer morphine prescriptions and 17.4% fewer hydrocodone prescriptions compared with states that did not have these laws, according to Bradford.
                  Fentanyl prescriptions under Medicare Part D also dropped by 8.5% in states that had enacted medical cannabis laws, though the difference was not statistically significant, Bradford said. Fentanyl is a synthetic opioid, like heroin, that can be prescribed legally by physicians. It is 50 to 100 times more potent than morphine, and even a small amount can be fatal, according to the National Institute on Drug Abuse.
                  “I know that many people, including the attorney general, Jeff Sessions, are skeptical of cannabis,” Bradford said. “But, you know, the attorney general needs to be terrified of fentanyl.”

                  ‘A call to action’

                  This is not the first time researchers have found a link between marijuana legalization and decreased opioid use. A 2014 study showed that states with medical cannabis laws had 24.8% fewer opioid overdose deaths between 1999 and 2010. A study in 2017 also found that the legalization of recreational marijuana in Colorado in 2012 reversed the state’s upward trend in opioid-related deaths.
                  “There is a growing body of scientific literature suggesting that legal access to marijuana can reduce the use of opioids as well as opioid-related overdose deaths,” said Melissa Moore, New York deputy state director for the Drug Policy Alliance. “In states with medical marijuana laws, we have already seen decreased admissions for opioid-related treatment and dramatically reduced rates of opioid overdoses.”
                  Some skeptics, though, argue that marijuana legalization could actually worsen the opioid epidemic. Another 2017 study, for example, showed a positive association between illicit cannabis use and opioid use disorders in the United States. But there may be an important difference between illicit cannabis use and legalized cannabis use, according to Hill.
                  “As we have all of these states implementing these policies, it’s imperative that we do more research,” Hill said. “We need to study the effects of these policies, and we really haven’t done it to the degree that we should.”
                  The two recent studies looked only at patients enrolled in Medicaid and Medicare Part D, meaning the results may not be generalizable to the entire US population.

                  See the latest news and share your comments with CNN Health on Facebook and Twitter.

                  But both Hill and Moore agree that as more states debate the merits of legalizing marijuana in the coming months and years, more research will be needed to create consistency between cannabis science and cannabis policy.
                  “There is a great deal of movement in the Northeast, with New Hampshire and New Jersey being well-positioned to legalize adult use,” Moore said. “I believe there are also ballot measures to legalize marijuana in Arizona, Florida, Missouri, Nebraska and South Dakota as well that voters will decide on in Fall 2018.”
                  Hill called the new research “a call to action” and added, “we should be studying these policies. But unfortunately, the policies have far outpaced the science at this point.”

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                  Marissa SafontMarijuana legalization could help offset opioid epidemic, studies find
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                  Why No Gadget Can Prove How Stoned You Are

                  If you’ve spent time with marijuana—any time at all, really—you know that the high can be rather unpredictable. It depends on the strain, its level of THC and hundreds of other compounds, and the interaction between all these elements. Oh, and how much you ate that day. And how you took the cannabis. And the position of the North Star at the moment of ingestion.

                  OK, maybe not that last one. But as medical and recreational marijuana use spreads across the United States, how on Earth can law enforcement tell if someone they’ve pulled over is too high to be driving, given all these factors? Marijuana is such a confounding drug that scientists and law enforcement are struggling to create an objective standard for marijuana intoxication. (Also, I’ll say this early and only once: For the love of Pete, do not under any circumstances drive stoned.)

                  Sure, the cops can take you back to the station and draw a blood sample and determine exactly how much THC is in your system. “It's not a problem of accurately measuring it,” says Marilyn Huestis, coauthor of a new review paper in Trends in Molecular Medicine about cannabis intoxication. “We can accurately measure cannabinoids in blood and urine and sweat and oral fluid. It's interpretation that is the more difficult problem.”

                  You see, different people handle marijuana differently. It depends on your genetics, for one. And how often you consume cannabis, because if you take it enough, you can develop a tolerance to it. A dose of cannabis that may knock amateurs on their butts could have zero effect on seasoned users—patients who use marijuana consistently to treat pain, for instance.

                  The issue is that THC—what’s thought to be the primary psychoactive compound in marijuana—interacts with the human body in a fundamentally different way than alcohol. “Alcohol is a water-loving, hydrophilic compound,” says Huestis, who sits on the advisory board for Cannabix, a company developing a THC breathalyzer.1 “Whereas THC is a very fat-loving compound. It's a hydrophobic compound. It goes and stays in the tissues.” The molecule can linger for up to a month, while alcohol clears out right quick.

                  But while THC may hang around in tissues, it starts diminishing in the blood quickly—really quickly. “It's 74 percent in the first 30 minutes, and 90 percent by 1.4 hours,” says Huestis. “And the reason that's important is because in the US, the average time to get blood drawn [after arrest] is between 1.4 and 4 hours.” By the time you get to the station to get your blood taken, there may not be much THC left to find. (THC tends to linger longer in the brain because it’s fatty in there. That’s why the effects of marijuana can last longer than THC is detectable in breath or blood.)

                  So law enforcement can measure THC, sure enough, but not always immediately. And they’re fully aware that marijuana intoxication is an entirely different beast than drunk driving. “How a drug affects someone might depend on the person, how they used the drug, the type of drug (e.g., for cannabis, you can have varying levels of THC between different products), and how often they use the drug,” California Highway Patrol spokesperson Mike Martis writes in an email to WIRED.

                  Accordingly, in California, where recreational marijuana just became legal, the CHP relies on other observable measurements of intoxication. If an officer does field sobriety tests like the classic walk-and-turn maneuver, and suspects someone may be under the influence of drugs, they can request a specialist called a drug recognition evaluator. The DRE administers additional field sobriety tests—analyzing the suspect’s eyes and blood pressure to try to figure out what drug may be in play.

                  The CHP says it’s also evaluating the use of oral fluid screening gadgets to assist in these drug investigations. (Which devices exactly, the CHP declines to say.) “However, we want to ensure any technology we use is reliable and accurate before using it out in the field and as evidence in a criminal proceeding,” says Martis.

                  Another option would be to test a suspect’s breath with a breathalyzer for THC, which startups like Hound Labs are chasing. While THC sticks around in tissues, it’s no longer present in your breath after about two or three hours. So if a breathalyzer picks up THC, that would suggest the stuff isn’t lingering from a joint smoked last night, but one smoked before the driver got in a car.

                  This could be an objective measurement of the presence of THC, but not much more. “We are not measuring impairment, and I want to be really clear about that,” says Mike Lynn, CEO of Hound Labs. “Our breathalyzer is going to provide objective data that potentially confirms what the officer already thinks.” That is, if the driver was doing 25 in a 40 zone and they blow positive for THC, evidence points to them being stoned.

                  But you might argue that even using THC to confirm inebriation goes too far. The root of the problem isn’t really about measuring THC, it’s about understanding the galaxy of active compounds in cannabis and their effects on the human body. “If you want to gauge intoxication, pull the driver out and have him drive a simulator on an iPad,” says Kevin McKernan, chief scientific officer at Medicinal Genomics, which does genetic testing of cannabis. “That'll tell ya. The chemistry is too fraught with problems in terms of people's individual genetics and their tolerance levels.”

                  Scientists are just beginning to understand the dozens of other compounds in cannabis. CBD, for instance, may dampen the psychoactive effects of THC. So what happens if you get dragged into court after testing positive for THC, but the marijuana you consumed was also a high-CBD strain?

                  “It significantly compounds your argument in court with that one,” says Jeff Raber, CEO of the Werc Shop, a cannabis lab. “I saw this much THC, you're intoxicated. Really, well I also had twice as much CBD, doesn't that cancel it out? I don't know, when did you take that CBD? Did you take it afterwards, did you take it before?

                  “If you go through all this effort and spend all the time and money and drag people through court and spend taxpayer dollars, we shouldn't be in there with tons of question marks,” Raber says.

                  But maybe one day marijuana roadside testing won’t really matter. “I really think we're probably going to see automated cars before we're going to see this problem solved in a scientific sense,” says Raber. Don’t hold your breath, then, for a magical device that tells you you’re stoned.

                  1 UPDATE: 1/29/18, 2:15 pm ET: This story has been updated to disclose Huestis' affiliation with Cannabix.

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                  Marissa SafontWhy No Gadget Can Prove How Stoned You Are
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