Tag: adverse effects with marijuana

10/10/23

Goodblend is Closing Its Dispensaries in PA

Medical marijuana customers in Pennsylvania received some disappointing news when Goodblend PA, a subsidiary of Parallel Cannabis, announced the company was closing its operations in the state in order to serve “patients” in other more established markets. The Northside feed and grow operation is scheduled to close by September 15th 2023 and the dispensaries, located in Erie and on Baum Boulevard in Pittsburgh will close sometime in October. A planned dispensary in Cranberry Township will never open. Trib Live reported the company said in an emailed statement, “In connection with a strategic review, we have made the decision to withdraw from the Pennsylvania market in order to serve patients in our other, more established markets.” That could be good news for PA cannabis users in the long run.

Medical marijuana was legalized in Pennsylvania is 2016 and dispensaries began to open in the state in 2018. According to the National Conference of State Legislators, as of April 24, 2023, 38 states have legalized cannabis products for medical use, and 22 states have legalized the recreational use of marijuana. But so far PA has resisted the pressure to join the 22 states who legalized recreational marijuana. I’d encourage the Commonwealth to continue to hold out while research related to the potential problems associated with marijuana use is completed and published.

In PREPARING to Legalize Cannabis, I reviewed two recent studies. One suggested cannabis use had strong associations with adverse mental health and life outcomes in teens. Another one added to the growing evidence of a causal association between cannabis use disorder (CUD) and schizophrenia that was said to be “almost certain.” Now a study published on August 29, 2023, in The Journal of the American Medical Association Network Open, by Lapham et al, found that CUD was commonly found among primary care patients in Washington State. Washington legalized recreational marijuana in 2012.

The New York Times reported that 21 percent of people in the Lapham et al study had some degree of a CUD. These findings were similar to previous research by Leung et al. They quantified the prevalence and risk of CUD as cannabis abuse (CA) or cannabis dependence (CD). Among people who used cannabis, 22% have CUD; 13% have CA (8-18%) and 13% (10-15%) have CD. The risk of developing cannabis dependence increased to 33% (22-44%) among young people who use marijuana weekly or daily.

Cannabis users need to be informed about the risks of developing CUDs and the higher risks among those who initiate early and use frequently during adolescence. Future studies are needed to examine how changes in cannabis policies may affect the risks of CUDs in the population.

The Lapham et al study in Washington State was conducted with data from Kaiser Permanente, a large health system in Washington. 5,000 patients 18 years and older were randomly selected from 108,950 eligible patients with a record of completing a cannabis screen as part of their routine primary care. They were categorized by their stated reason for using cannabis during the past 30 days: medical use only, nonmedical use only, or both. DSM-5 symptoms for CUD were used to assess severity, with 2-3 symptoms = mild, 4-5 symptoms = moderate, and 6-11 = severe.

Patients were asked about all modes of cannabis use as well as the primary mode, including inhalation (ie, smoke, vape, dab), ingestion (ie, eat, drink), application (ie, lotion, ointment), or other modes. Questions also included the frequency of past-year use and typical number of days per week and times per day of cannabis use.

Among cannabis users, 42.4% reported medical use only; 25.1% reported nonmedical use only; and 32.5% reported both recreational and medical use. The prevalence of CUD was 21.3% and interestingly did not differ depending of their reasons for use (i.e., medical use only). The most prevalent CUD symptoms for all groups were tolerance, uncontrolled escalation of use and craving. Patients with nonmedical use only or both reasons for use were more likely to report “withdrawal, use in hazardous situations, continued use despite consequences, time spent on use, interference with obligations, and activities given up.” Patients who reported any nonmedical use were at the greatest risk of moderate to severe CUD, with the lowest risk was among patients reporting medical use only. Lapham et al concluded:

In this study, CUD was common (21%) among primary care patients who use cannabis in a state with legal recreational use, with patients using for nonmedical reasons most at risk of moderate to severe CUD. As legal recreational cannabis use among adults continues to increase across the US, the results here underscore the importance of assessing patient cannabis use and CUD symptoms in medical settings.

So, as legal recreational marijuana use increases across the US, there is a corresponding call to assess people’s cannabis use and symptoms of CUD into standard medical care and practice. Research is also coalescing around a causative connection between using marijuana and schizophrenia. Teenaged use of marijuana leads to future adverse health and life outcomes. But there is a problem between the rapid pace of marijuana legalization and state and federal policy changes. These policy changes are happening faster than the scientific research can be done on the medical benefits and adverse consequences of marijuana.

In October of 2022 President Biden asked the Secretary of Health and Human Services (HHS) and the Attorney General to review how marijuana is scheduled under federal law. He also pardoned all people convicted of simple marijuana possession under federal law and urged governors to take similar action. Then on August 29th 2023 Politico reported the HHS Assistant Secretary wrote a letter to the DEA recommending that marijuana be moved from Schedule I to Schedule III. The letter is the last step in the official review process initiated by the President last October. Significantly, the DEA is not required to follow HHS’s recommendation.

The HHS recommendation was the result of an almost yearlong federal review of all available marijuana research. But advocates for the legalization of recreational marijuana and some lawmakers didn’t think the recommendation went far enough. They wanted the president to completely remove cannabis from the Controlled Substances Act. A cannabis advocate told Politico, “Rescheduling cannabis from 1 to 3 does not end criminalization.” However, if approved, the rescheduling would permit cannabis businesses to take tax exemptions for business expenses like salaries and benefits, providing a huge benefit to the financially struggling industry.

The shift in federal cannabis policy would also make it easier to conduct research on the health effects of cannabis consumption and for pharmaceutical companies to bring cannabis-based drugs to market. Researchers have long chafed at restrictions that only allow them to procure cannabis from a single farm at the University of Mississippi that bears little resemblance to the high-potency products many consumers are purchasing in state-legal markets.

Both legalization advocates and anti-legalization advocates are not happy with the HHS recommendation. Pro-marijuana advocates say it does not end criminalization, but anti-legalization advocates see it as potentially detrimental to public health. They say the “addiction profiteers” have been exposed for their lies about the physical, mental and financial benefits of legalization in the wake of the cumulating evidence of the harm being done to millions of Americans. “It is regrettable that the Department of Health and Human Services move now appears to be a nod to those monied interests.”

In August, ABC News did a short, 7-minute video in their Group Chat on how the increase in marijuana use could affect federal legislation, the economy, and national health, “How the legalization of recreational cannabis use is on the rise.” It’s available on YouTube, here. One of the individuals participating in this “Chat” said there is a lot of money at stake here in the marijuana industry. “It’s estimated that the marijuana industry can pump a hundred billion dollars into the overall economy this year.”

The health concerns were mentioned with a reference to a CDC report on its effect on teen health and wellbeing. “There are a lot of unknowns about the long-term risk of any cannabis exposure to developing brains.” According to the CDC marijuana use beginning in teen years or younger can affect brain development, which may impair thinking memory, and learning.” There were mental health issues, including schizophrenia. “The association between marijuana and schizophrenia is stronger in people who start using marijuana frequently at an early age.”

The health expert went on to say he hears from both sides is that “policy changes seem to be happening faster than scientific research. Now potentially rescheduling this from a class one substance can actually help with that research, but there’s a lot more we need to know.” But until then, we know already that several states are growing more cannabis than they can sell because there aren’t enough legal retailers in the market. The impact is that “the illegal marijuana trade is actually stronger and outpacing legal sales in states where it is legal.” In California, where recreational marijuana has been legal for seven years, unlicensed marijuana sales were more than double that of licensed sales.

Returning to Parallel Cannabis closing down its Goodblend facilities in Pennsylvania, there’s more to it than just wanting to serve “patients” in other more established markets. In the Green Market Report, John Schroyer reported the Atlanta-based company Parallel Cannabis is closing its three Goodblend PA facilities and leaving the Pennsylvania medical marijuana market because financial troubles led to a lawsuit from its landlord, Innovative Industrial Properties Inc. Pennsylvania is not the only state Parallel has had problems paying its rent. Parallel also defaulted on its rent for a facility in Texas. Parallel is one of the largest privately held multistate cannabis operators in the US, with additional facilities in Florida, Massachusetts, and Nevada.

Goodblend is struggling to get its own shareholders to agree to liquidate the business, with another pending lawsuit filed by Surterra Holdings, a division of Parallel. That suit alleges that minority owner Medical Bloom, which holds a 25% stake in Goodblend, has refused to agree to a dissolution. Parallel is asking for a court order to force the liquidation in order to pay off Goodblend’s debts, given that the Pennsylvania subsidiary is insolvent, the Post-Gazette reported.

So, in Pennsylvania, let’s not be seduced by the lure of money in legalizing recreational marijuana. The federal government is poised to reschedule marijuana, which will help the cannabis industry without removing marijuana from FDA oversight as a drug. Let’s wait a few more years and see what the scientific research tells us about the benefits and adverse effects from marijuana use before we begin to craft our legalization policy at the state or federal level. And let’s slow down the marijuana lobbyists at the state level who seem to be trying to get a preponderance of states to legalize recreational marijuana before that research has a chance to be done and published. If it means some more companies like Goodblend leave the state for more profitable fields elsewhere—or go bankrupt—good riddance.

11/29/16

Marijuana & Adverse Health Effects

© David Castillo Dominici | 123rf.com
© David Castillo Dominici | 123rf.com

In the 2016 election there was another political milestone met besides the presidential election of Donald Trump—four more states voted to legalize recreational marijuana. California, Maine, Massachusetts, and Nevada joined Alaska, Colorado, Oregon, Washington and the District of Columbia. However, the public use of marijuana—recreational or medical—is still not permitted anywhere. Arkansas, Florida and North Dakota approved medical marijuana initiatives and Montana loosened restrictions on an existing medical marijuana law. The executive director of the Drug Policy Alliance was quoted in The Washington Post as saying: “The end of marijuana prohibition nationally, and even internationally, is fast approaching.”

Given the election of Donald Trump and the international position on marijuana, this may be more optimism than reality. Within the U.S. there has been clear momentum towards legalization of some kind, as there are now eight states and the District of Columbia where recreational marijuana is legal; and 28 states and the District of Columbia where medical marijuana is permitted. However, because of the ongoing federal classification of marijuana as a Schedule I drug, reliable research into the benefits and adverse health effects from marijuana use is hard to come by. The public needs to be more aware of the scientific research into the potential adverse effects and medical benefits from marijuana as the U.S. continues to move toward a complicated, patchwork quilt of varied state laws and regulations regarding marijuana.

A good place to start is with an article written by the current director of the National Institute on Drug Abuse (NIDA), Dr. Nora Volkow and three others, “Adverse Health Effects of Marijuana Use.” Volkow et al. reviewed the current state of the scientific findings on the adverse health effects related to the recreational use of marijuana. Their review focused on the areas where the evidence was the strongest. In a table summarizing their confidence in the evidence for adverse effects of marijuana on health and wellbeing, they gave the following assessment of marijuana use, particularly with heavy or long-term use that starts in adolescence.

Effect

Overall Level of Confidence

Addiction to marijuana or other substances

High

Diminished lifetime achievement

High

Motor vehicle accidents

High

Symptoms of chronic bronchitis

High

Abnormal brain development

Medium

Progressive use of other drugs

Medium

Schizophrenia

Medium

Depression or anxiety

Medium

Lung cancer

Low

Long-term marijuana use can lead to addiction; there’s no real doubt. About 9% of those who experiment with marijuana will develop dependence, according to the criteria for dependence in the DSM-IV. This increases to one in six (16.7%) among those who started using marijuana as teens. Daily smokers have a 25% to 50% risk of developing an addiction to marijuana. There is also a cannabis withdrawal syndrome, with symptoms such as: irritability, sleep difficulties, dysphoria (a state of being unhappy or unwell), cravings, and anxiety.

Since the brain remains in a state of active development until around the age of 21, individuals under 21 who use marijuana are more vulnerable to adverse long-term effects from marijuana use. Adults who smoked marijuana regularly during adolescence have impaired neural connectivity (fewer fibers) in certain brain regions.

The impairments in brain connectivity associated with exposure to marijuana in adolescence are consistent with … findings indicating that the cannabinoid system plays a prominent role in synapse formation during brain development.

While regular use of marijuana is associated with anxiety and depression, causality has not been established. Marijuana is also regularly linked to psychosis, especially among people with a predisposition. Heavy marijuana use, greater drug potency, and exposure at a young age can all negatively effect the experience of psychosis or schizophrenia, accelerating the time of a first psychotic episode by 2 to 6 years.

Because marijuana use impairs critical cognitive functions during acute intoxication and for days after use, many students may be functioning below their natural capabilities for long periods of time. “The evidence suggests that such use results in measurable and long-lasting cognitive impairments, particularly among those who started to use marijuana in early adolescence.” A failure to learn at school, even for short or sporadic periods of time because of acute intoxication, will interfere with the capacity to achieve educational goals. This seems to explain the association between marijuana use and poor grades.

Heavy marijuana use has been linked to lower income, greater need for socioeconomic assistance, unemployment’s, criminal behavior, and lower satisfaction with life.

There is also a relationship between THC levels in blood and performance in controlled driving-simulation studies. These studies have been a good predictor of real-world driving ability. “Recent marijuana smoking and blood THC levels of 2 to 5 mg per milliliter are associated with substantial driving impairment.” The overall risk of involvement in an accident increases by a factor of 2 when someone drives soon after using marijuana. Not surprisingly, combining marijuana and alcohol seems to result in greater risks than the use of either drug alone.

The authors noted that most of the long-term effects of marijuana use in the article have been seen among heavy or long-term users. Yet the presence of multiple confounding factors, including the frequent use of marijuana with other drugs, detracts from their ability to establish causality.

They also noted there is a need to improve our knowledge on the potential medical benefits of the marijuana plant. A report by the Institute of Medicine sees the benefits for stimulating appetite and in combating chemotherapy-induced nausea and vomiting, severe pain and decreasing intraocular pressure in the treatment of glaucoma. “Nevertheless, the report stresses the importance of focusing research efforts on the therapeutic potential of synthetic or pharmaceutically pure cannabinoids.” With all of its problems, the existing structure for the approval of new medicines through the FDA is better than the current lack of any safety and regulatory apparatus with medical marijuana. The ongoing failure to confirm or refute the plethora of health and medicinal claims with marijuana use is progressively taking us back to the days of patent medicine claims in state-by-state approval. In conclusion they summarized the results of their review of the literature on adverse effect from marijuana use as follows:

Marijuana, like other drugs of abuse, can result in addiction. During intoxication, marijuana can interfere with cognitive functions (e.g. memory and perception of time) and motor function (e.g. coordination), and these effects can have detrimental consequences (e.g. motor-vehicle accidents). Repeated marijuana use during adolescence may result in long-lasting changes in brain function that can jeopardize educational, professional, and social achievements. . . . . As policy shifts toward legalization of marijuana, it is reasonable and probably prudent to hypothesize that its use will increase and that, by extension, so will the number of persons for whom there will be negative health consequences.

A German review study by Hoch et al., “Risk Associated with the Non-Medical Use of Cannabis,” also sought to summarize the current state of knowledge regarding the physical and mental adverse effects of intensive recreational cannabis use. They came to conclusions similar to the Volkow et al. study. Hoch et al. noted the potential for addiction and withdrawal, mild negative effects on learning capacity, neurocognitive impairments with adolescents, an increased risk of psychosis, and others. “Further research is required to clarify the causal nature of the links between cannabis consumption patterns and adverse events.”

Empirical data have now clearly shown that starting early in life and regularly using high amounts of cannabis for a long period of time increases the risk of various mental and physical disorders and endangers age-appropriate development. Because many studies have failed to control properly for confounding variables, it still cannot be stated beyond doubt that there is a causal connection between cannabis consumption patterns and cognitive damage or the development of comorbid psychic or somatic disorders. The worldwide increase in the THC content of cannabis may increase the health risks, particularly for adolescent users. Further research is required to determine why some people are more affected than others by the unfavorable consequences.

On the other hand, another long-term study of chronic marijuana use among young adult men by Bechtold et al., was published  in the journal, Psychology of Addictive Behavior. The study used data from The Pittsburgh Youth Study, a longitudinal study that followed seventh grade students until they were 36. The study found that chronic marijuana users were no more likely than other groups to experience several physical or mental health problems, including early onset psychosis and heart problems. Some limitations in applying the findings of this study would include the fact that participants were only followed until the age of 36, perhaps too early for many of the health problems to become evident. Another difference was that the heaviest use category for marijuana was “more than 3 times per week,” while Volkow et al. seems to have been looking at daily or almost daily use.

In a postscript addition to the above studies, a 2016 study by Columbia researchers found evidence of a compromised dopamine system in heavy marijuana users. Dopamine levels were lower in the striatum, an area in the brain involved in working memory, impulsive behavior and attention. Previous studies have found addiction to other drugs of abuse, like cocaine and heroin, have similar effects on dopamine release. This was the first such evidence for marijuana.

A press release by the Columbia University Medical Center quoted the lead author as stating that in light of the increasing use and acceptance of marijuana, especially by young people, it is important to look more closely at the potentially addictive effects of cannabis on key regions of the brain. The study was small, with 11 adults who were severely dependent upon marijuana and 12 matched healthy controls. The average age of onset among the marijuana users was 16, with dependence occurring by 20. In the month before the study, all users in the study had smoked daily.

“Compared with controls, the cannabis users had significantly lower dopamine release in the striatum, including subregions involved in associative and sensorimotor learning.” The investigators also explored the relationship between dopamine release in the striatum and cognitive performance on learning and working memory tasks. The bottom line was that long-term, heavy marijuana use could impair the dopaminergic system, which in turn could have a series of negative effects on learning and behavior.

I talked with someone who had been to California a few weeks after the 2016 election when recreational marijuana use was legalized. She reported how employees of her hotel were gathering outside on their break to smoke pot, similar to what cigarette smokers do. If legal recreational use becomes more widespread in the U.S., the adverse physical and mental adverse effects from heavy, regular use will also become more evident. Then marijuana use will take a place beside alcohol use and tobacco use as a public health problem.