08/27/24

To Reschedule or “Deschedule” Marijuana?

Photo by Aphiwat chuangchoem: pexels.com

The DOJ and DEA published proposed rules in the U.S. Federal Register to reschedule marijuana from Schedule I to Schedule III. The DOJ was also soliciting comments on the proposal on or before July 22, 2024. Forbes said the proposal initiates a 62-day public comment period, a necessary step in the federal rulemaking process. This action was taken after the Department of Health and Human Services (HHS) recommended the reclassification, stating that marijuana had a currently accepted medical use. But the action won’t legalize marijuana for adult use, which would require it to be completely “descheduled” by the Controlled Substances Act (CSA).

The DEA’s notice indicated that if marijuana is reclassified to Schedule III, the regulatory controls for Schedule III substances, when appropriate, would apply. These controls would include existing marijuana-specific requirements and any additional ones necessary to meet U.S. treaty obligations. The major change for the cannabis industry with the reclassification of marijuana to Schedule III, would allow marijuana businesses to take certain deductions on their federal tax returns.

The manufacture, distribution, dispensing, and possession of marijuana would still be subject to the criminal prohibitions of the CSA. Drugs containing substances defined as “marijuana” under the CSA would also remain subject to the prohibitions in the Federal Food, Drug, and Cosmetic Act.

Writing for Harvard Law, Victoria Litman pointed out that once comments are received, the DEA will review all evidence and generally respond to the comments when publishing the final rule. After publication, the DEA’s final rule will not go into effect for 30 days, during which time parties who submitted comments, and can demonstrate they have a standing, could challenge the final rule in court. SAM, Smart Approaches to Marijuana, is already soliciting funds for their “Rescheduling Legal Defense Fund.”

Litman thought there are two primary issues that will be challenged. First is the impact of rescheduling on U.S. adherence to United Nations treaty obligations. Second, was the way HHS determined that marijuana has a currently accepted medical use (CAMU). She pointed out how rescheduling would not resolve all the challenges faced by legal state marijuana businesses and wouldn’t necessarily make research easier.

Additionally, U.S. Senators Elizabeth Warren and John Fetterman have sent a letter to the DOJ and DEA urging that marijuana be descheduled altogether from the CSA. In their letter they said the case for removing marijuana from Schedule I was overwhelming. However, they thought the DEA should remove cannabis from the CSA altogether:

Although HHS recommended rescheduling, its analysis could support a decision to deschedule— particularly its emphasis on the fact that marijuana has less adverse outcomes (including less potential of an overdose) and less potential of abuse than substances that are descheduled (alcohol) or scheduled below Schedule III (such as benzodiazepines).

While there would be important policy benefits including the first federal acknowledgement of marijuana’s medical uses, “it would not automatically permit marijuana to be used as a medicine.” Marijuana as an approved medicine would still need to have FDA drug approval, DEA registration for manufacturers, “and compliance with prescription regulations in order to be legally prescribed under federal law.” Furthermore, the criminal penalties for marijuana would continue as long as marijuana remained in the CSA. They concluded the DEA had never kept a drug in Schedule I after HHS recommended removing it.

A History of the FDA and Drug Regulation in the U.S. said the original Food and Drug Act was passed in 1906. The Federal Food, Drug and Cometic Act of 1938 required new drugs demonstrate their safety before selling them. The Controlled Substances Act was part of the Comprehensive Drug Abuse Prevention Act of 1970. It combined existing federal drug laws and expanded their scope, including federal law enforcement pertaining to controlled substances. It is the primary legislation for drug control in the U.S., and has been amended several times. Warren and Fetterman said:

It is imperative that the DEA remove marijuana from Schedule I as several members of Congress and state attorneys general have urged. The DEA should do so promptly; its past record of taking years to resolve rescheduling petitions should not be repeated here. Furthermore, the DEA and HHS should be fully transparent about the evidence relied upon in the course of their review processes. The Biden Administration has a window of opportunity to deschedule marijuana that has not existed in decades and should reach the right conclusion— consistent with the clear scientific and public health rationale for removing marijuana from Schedule I, and with the imperative to relieve the burden of current federal marijuana policy on ordinary people and small businesses.

Senators Warren and Fetterman don’t seem to think the HHS recommendation to reclassify marijuana from Schedule I to Schedule III goes far enough. They want to see marijuana removed entirely from the CSA. They also think the DEA should make its decision quickly, and not take time to resolve problems raised by the rescheduling petitions, as it has in the past. This raises the question, what’s the rush?

John Fetterman has made the legalization of recreational marijuana part of his political platform from the time he was the Lieutenant Governor of Pennsylvania. He did a Statewide Cannabis Listening Tour in 2019. He also called for PA to go “full Colorado,” meaning approve recreational marijuana. See these articles and others on Fetterman’s endorsement of legalizing recreational marijuana: “From the Frying Pan Into the Fire with Recreational Marijuana In PA” and “Should Pennsylvania Go ‘Full Colorado’ with Marijuana?” Part 1 and Part 2.

Marijuana Moment observed that the director of the Office of National Drug Control Policy (ONDCP) said rescheduling was “going to be really important to remove barriers to critical research and perhaps drug development, and it could also lead to more research into the benefits of medical marijuana.” The historic nature of the proposed actions “Cannot be minimized,” he said. Yet Marijuana Moment thought he overstated what this reform would accomplish. The FDA hasn’t typically approved botanical substances like marijuana as prescription drugs. According to the Congressional Research Service, (CRS) further action from the FDA is needed before marijuana products can become available by prescription.

Without a doubt this is a political issue in a contentious presidential election year, but it’s also a business concern. Flowhub said the cannabis industry was expected to reach $40 billion in 2024, adding $115.2 billion to the economy. There are currently 440,445 full-time equivalent positions supported by legal cannabis. The anticipated financial windfall to the cannabis industry may lead them to minimize or ignore some of the potential repercussions of either rescheduling or descheduling marijuana. Given the “historic nature” with either decision, shouldn’t the DEA carefully consider the impact of the proposed actions?

STAT News said the public health use of marijuana has surpassed what we know about the cannabis plant from research. “We’re really at this point trying to play catch-up.” The complexity of the cannabis plant compared to other medications creates problems for the FDA when deciding how to regulate it.

Cannabis contains over 500 distinct compounds and over 100 different cannabinoids. THC, delta-9-tetrahydrocannabinol, is the main psychoactive cannabinoid. CBD, cannabidiol, is a non-psychoactive cannabinoid with demonstrated medically useful properties. Selective breeding of cannabis over the past two decades has increased THC levels, while reducing the CBD levels. “There are concerns that the significantly elevated THC content of modern cannabis may be exacerbating the potential health detriments, particularly in relation to cognitive and psychiatric disorders.”

STAT raised several concerns that should be considered by medical research into—and our understanding of—cannabis. First, will reclassification have much of an impact on clinical trials into marijuana’s potential as a medicine? Many top cannabis researchers are skeptical.

The FDA requires research extensive tests for a new drug in humans to submit an extensive amount of data outlining the drug’s absorption and metabolism rates and toxicology studies on lab animals. Cannabis is no different. This is to help protect participants in clinical trials from adverse effects from potentially dangerous drugs. Researchers have complained the FDA’s review of INDs (investigational new drugs) has been too strict and slow, creating a backlog of studies waiting to begin. More than 150 research applications for studies into cannabis were pending before the FDA as of March 2024, according to a recent to the head of the Drug Enforcement Administration.

Second, there are many unanswered questions about cannabis from a basic scientific perspective. For example, how do the dozens of cannabinoids influence the brain; what changes when people consume cannabis in different forms; and what does this mean for the potential for misuse? There have been multiple reports that high-potency cannabis increases the risk of psychosis, including this recent longitudinal study by Hines, Heron and Zammit. Also see (“Gambling with Cannabis and Psychosis” and “PREPARING to Legalize Cannabis”).

Third, politics could also get in the way, but it’s unlikely that rescheduling will take place before the November 2024 election. The formal regulatory process takes time, particularly when there is one with one such “historic” implications. STAT said there were over 7,000 comments on the proposed rescheduling by May 30, 2024. There are some Republican lawmakers opposed to the rescheduling, but it remains to be seen if they would sink the proposal in its entirety.

On the other hand, a coalition of Republican and Democratic senators came together on a bill in 2020 meant to lower research barriers and press federal agencies for these answers. It was signed into law in December 2022. Both pro-marijuana and anti-marijuana people have thought further medical research would prove their point. Why don’t we simply wait and find out what the research says?

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 15^th 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 29^th 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.

07/4/23

PREPARING to Legalize Cannabis

Marijuana legalization in the US has been steadily moving forward in a piecemeal, state-by-state way for several years now. According to the National Conference of State Legislators, as of April 24, 2023 38 states and the District of Columbia have legalized cannabis products for medical use, and 22 states and the District of Columbia have legalized the recreational use of marijuana. Apparently anticipating the inevitability of legalization on a national level, Congressman Dave Joyce introduced H.R. 2598, the PREPARE (Post-Prohibition Adult Use Regulated Environment) Act on April 13, 2023, “To establish a Commission on the Federal Regulation of Cannabis to study a prompt and plausible pathway to the Federal regulation of cannabis.” Hakeem Jefferies, the Minority Leader of the House of Representatives, told Forbes: “The PREPARE Act will give lawmakers a bipartisan platform to legislate not only a fair and responsible end to prohibition but also a safer future for our communities.” However, two studies published in May of 2023 suggest that ending the so-called “prohibition” of marijuana may not be a responsible or safe action for some members of our communities.

The movement towards recreational marijuana legalization is promoted by a widespread sense that casual cannabis use is benign. However, a Columbia University study by Sultan et al, “Nondisordered Cannabis Use Among Adolescents,” found that teens who used marijuana recreationally were 2 to 4 times more likely to develop depression and suicidality than teens who didn’t use it at all. The lead study author, Ryan Sultan, said in a Columbia University press release, “We were surprised to see that cannabis use had such strong associations to adverse mental health and life outcomes for teens who did not meet the criteria for having a substance use condition.”

Their study found that adolescents with nondisordered cannabis use (NDCU) and cannabis use disorder (CUD) had increased odds of adverse psychosocial events. Both were significantly associated with adverse psychosocial events in a stepwise gradient manner. Sultan said their study was the first to identify that subclinical, nondisordered cannabis use has “clear adverse and impairing associations for adolescents.”

In line with past studies, cannabis use among adolescents was associated with greater odds of depression and suicidal ideation. These in turn were associated with long-term adverse educational and occupational attainment outcomes “and increased risk of harmful substance use in adulthood.” There was also evidence of worse executive control, decreased attention and deficits in episodic memory. Compared to nonusers, adolescents in NDCU and CUD groups were around 2-3 times more likely to experience cognitive deficits.

We observed a stepwise severity gradient for the odds of psychosocial associations among nonuse, NDCU, and CUD. This severity gradient was also observed in prevalence values for adverse psychosocial events across all degrees of cannabis use. Furthermore, this observation was corroborated by a stepwise cannabis use frequency trend between NDCU and CUD.

The researchers thought their findings were particularly concerning given the increasing popularity of marijuana as states continue to move toward making the drug legal. They concluded that with the growing acceptance of both medicinal and recreational cannabis use in the US, “clinicians should be vigilant to screen, evaluate, and treat cannabis use in adolescents.”

The second study was a huge Danish study of over 6 million people that discovered a strong association between cannabis use disorder and schizophrenia. The research team included Nora Volkow, the Director of the National Institute on Drug Abuse (NIDA). The study, “Association between cannabis use disorder and schizophrenia stronger in young males than in females,” analyzed health records spanning over 5 decades in order to estimate the fraction of schizophrenia cases that could be attributed to cannabis use disorder. A Scientific American review of the study said it found up to 30% of the schizophrenia diagnoses—around 3,000 in total—could have been prevented if men between the ages of 21 and 30 had not developed cannabis use disorder. The Scientific American review said:

The Danish epidemiology study does not offer hard-and-fast proof of the cannabis-schizophrenia connection, which could be accomplished only through randomized controlled trials. But this link is supported by the fact that marijuana use and potency have risen markedly—from 13 percent THC content in Denmark in 2006 to 30 percent in 2016—alongside a rising rate in schizophrenia diagnoses. “While this isn’t proving causality, it’s showing that the numbers behave exactly the way they should, under the assumption of causality,” says Carsten Hjorthøj, the study’s lead author and an associate professor at the Mental Health Services in the Capital Region of Denmark and the University of Copenhagen.

This study won’t resolve the long-running debate over the statistical cause-and-effect relationship between cannabis and schizophrenia. For example, David Nutt thought the research was intriguing, but it also raised more questions. He asked whether some of the cases may have been misdiagnosed with schizophrenia rather than an alternative diagnosis—like cannabis-induced psychosis. Along with the researchers, he pointed to the lack of data on the participants’ frequency of cannabis use or age of first use or the amount of THC in the products they used.

However, Robin Murray, a professor of psychiatric research at the Institute of Psychiatry at King’s College London and co-editor in chief of the medical journal Psychological Medicine said the Danish study examined specific factors more closely—gender and age—than previous investigations of the possible link between cannabis and schizophrenia. He thought it added to the growing body of research that has gradually discounted other factors to cannabis as a trigger for schizophrenia, making the connection more plausible, “So causal effect is almost certain.” For more on cannabis and schizophrenia, and Robin Murray’s own research into marijuana, see “Gambling with Cannabis and Psychosis” and “Cannabis and Psychosis: More Reality Than Satire.”

Psychiatric Times periodically published articles to educate its readers on cannabis and its association with schizophrenia. In “Cannabis Confusion” John Miller noted that he’s read numerous articles in the psychiatric literature that made conflicting conclusions about the effects of cannabis on cognition, its risk of psychosis, addictive potential, and its effects on suicidality, depression, anxiety, and pain relief. He thought there was only one consistent finding: Heavy cannabis use during brain development increases the risk of psychosis and cognitive impairment.

A likely explanation for the wide-ranging discrepancies is that cannabis is the product of a plant that is not a single molecule or pure substance. Many articles with the word cannabis in the title can be discarded as meaningless unless the authors took the additional step of testing all of the cannabis used by their study subjects for the quantitative and qualitative molecules present.

He noted that as more states legalize cannabis for medical or recreational use, it is likely that federal laws will eventually make cannabis use legal on a national level. “That will create an opportunity to require a comprehensive analysis and disclosure of all the components of the numerous strains of cannabis currently being sold in state dispensaries or on the streets.”

Fuller Torrey, a research psychiatrist specializing in schizophrenia, commented in “Is Cannabis Use Increasing Schizophrenia?” on an earlier Danish study that claimed the use of cannabis was a likely cause of the increasing incidence of schizophrenia over the past two decades. He noted that an increasing incidence of schizophrenia, or psychosis in general has also been reported in England, Switzerland and Canada. Torrey also gave citations and links to the various studies that supported his statement. He also thought the move towards legalizing recreational use in the US meant that “a possible relationship between cannabis use and increasing schizophrenia is potentially very important and needs to be confirmed.” He said:

It is an embarrassment to American medicine that NIMH has so little to contribute on such an important question. At a minimum, NIMH should issue a request for proposals to try and confirm the Danish study in another country which has appropriate data so that we will have a definitive answer to this question.

In “Does Cannabis Cause Psychosis?” Brian Miller reviewed several research studies of the relationship between cannabis and psychosis and concluded there was a robust association between cannabis use and the risk of psychosis, with evidence of a dose-response relationship, “which supports the plausibility of a causal association.”

Comorbid cannabis use is highly prevalent in psychosis (especially FEP [first episode of psychosis], with declining use over time), with strong evidence for an earlier age of onset of illness, as well as effects of psychopathology and cognition. In patients with psychosis, continued cannabis use is associated with antipsychotic nonadherence, illness relapse, and longer hospitalizations. These findings raise the possibility of a dose-response relationship between current cannabis use and transition to psychosis. Findings suggest that targeting cannabis use during the UHR [ultra-high risk] period may confer significant benefits on long-term outcomes. Continued cannabis use is also a potential target for intervention to improve antipsychotic adherence and other outcomes in patients with psychosis. Future research in this area is clearly warranted to elucidate mechanisms and novel treatment strategies for relevant populations.

Further research is needed to clarify the potential harms and adverse effects from using cannabis and marijuana products. While not yet proved conclusively, it does seem that there is a causative connection between schizophrenia and using marijuana for some people, but not for all people. Although this is more evident with heavy users (those who could be classified as having a cannabis use disorder), the Sultan et al study found there were even adverse mental health and life outcomes for teens that used marijuana, but did not meet the criteria for a substance use condition.

Cannabis use among adolescents increased the odds of depression and suicidal ideation among adolescents. Consistent with past research, there was also evidence of worse executive control, decreased attention and problems with episodic memory. When compared to nonusers, adolescents who used marijuana were 2 to 3 times more likely to experience cognitive deficits.

Heather Baccus spoke to America Reports on Fox News of how she believes her son’s marijuana use led to his psychotic break a few months before he committed suicide in July of 2021. Randy began using marijuana when he was 15 and had a cannabis user disorder within a year. By the time he was 21, he was experiencing delusions and paranoia. Heather said he thought it was helping him with his anxiety and depression, which she said he did not have until after he began using marijuana.

He knew that he would manage and function fairly well in life, but he was paranoid. He thought his roommates were out to get him. He thought that people at work were out to get him. He would quit a job quickly. He accused one of his employers of being in the mob. When he had a full-blown attack in March of 2021, he called us and said the mob was coming after him, that they were coming after us, and he just was out of sorts.

There is a video clip of a short interview with Nora Volkow, the director of NIDA and a coauthor of the above cited Danish study in the Fox News article. She said marijuana is not as benign as we would like it to be and is associated with psychosis. “High doses, regular use can be harmful.” She said there were likely three possibilities. Marijuana use triggers an episode in some individuals that have a latent risk for psychosis. In others, it may just accelerate the timing of the psychosis. Finally, it may also trigger a psychotic event that would not otherwise happen.

The PREPARE Act sounds like a responsible, proactive step to take before we move towards national legalization of marijuana. But I don’t believe we are thinking about the concurrent increase with adverse mental health concerns like depression, suicidal ideation and psychosis. What do we need to do to PREPARE for that?

03/14/23

Waiting Before Pennsylvania Goes “Full Colorado”

President Biden pardoned individuals convicted of marijuana possession under federal law and said marijuana’s classification as a Schedule I Controlled Substance—as is heroin—would be reviewed. The NYT reported the pardons will clear everyone convicted on federal charges of simple possession since it became illegal fifty years ago. They will not apply to individuals convicted of selling or distributing marijuana. Soon afterwards, the Pew Research Center conducted a survey in October of 2022 on whether or not marijuana should be legal for medical or recreational use. Not surprisingly, 59% of Americans thought it should be legal for medical and recreational use and 30% said it should only be legal for medical use.

The Pew article also noted two additional states legalized the use of marijuana for recreational use, bringing the total number of states to 21 which have already done so. There are clear differences demographically by age and party affiliation. Seventy-two percent of adults aged 18-29 favored legalizing medical and recreational marijuana, while only 46% of adults 65 and over did. Seventy-three percent of those who said they were Democrats or Democratic-leaning independents favored legalizing medical and recreational marijuana use, while only 45% of Republicans and Republican-leaning independents. See the following graph taken from the Pew article.

In Pennsylvania, the Democratic support to legalize recreational marijuana received a boost at the midterms, even though it was not one of the two states to legalize it. John Fetterman, who just won the Senate race of 2022, has been vocal about his support for legalization from the beginning of his tenure as Lieutenant Governor of Pennsylvania in 2019. He said on his web page, “Weed should be legal, nationwide.” He thought we needed to “move our views on this subject out of the Stone Age.” See “Should Pennsylvania Go ‘Full Colorado’ with Marijuana? Part 1.”

Rescheduling and decriminalizing marijuana are two reform measures that do not require Pennsylvania to also go “full Colorado” with legalizing recreational marijuana. Pennsylvanians should know that Colorado has had problems after legalization and passed state bill H 1317, which applied to the state’s marijuana industry. Note the measure passed with strong bipartisan support. Purchases of high-potency marijuana were limited to one-fifth the original level. “The bill requires warning labels, real-time monitoring of sales, and stiffened medical recommendations from physicians.” It also called for research into the mental and physical health effects of marijuana.

Supporters of legalization in Colorado said creating a regulated market would drive out the “criminal element” and end the violence driving the black market, but the opposite has happened. The Black market still dominates the marijuana business, “as has happened everywhere state have legalized marijuana, from California to Illinois.” It was supposed to end corruption, but actually spread it more widely. “Not only did the promised benefits, both financial and on behalf of public safety, not come to pass, but in multiples areas of daily life the metrics have worsened.”

Colorado traffic deaths have increased 24% overall. Deaths in which drivers tested positive for marijuana increased 135%. “The percentage of all Colorado traffic deaths that were marijuana related has risen from 15 percent in 2014 to 25 percent in 2019.” More marijuana calls are coming into poison centers. Adverse marijuana-only exposures have quadrupled since legalization. Emergency-department events and marijuana-related hospitalizations increased sharply.

As the years since legalization have passed, the public health and public safety impact has grown, year over year. The effect on families, on pediatricians, on educators, on emergency departments, on the workplace, on law enforcement, and indeed on the general quality of life in a once thriving state, has been strikingly negative.

We should not be surprised to learn that there is a high cost to making an addictive and dangerous substance a commercial product. Nor should we enable this public policy mistake to take root elsewhere. Taking stock, we can now say that the so-called legalization experiment has, at least, produced one positive impact—it has issued a clear warning about the path we are on.

Then there was the publication of a study published on November 15, 2022 in the journal Radiology that found airway inflammation and emphysema were more common in people who smoked marijuana and cigarette smokers and nonsmokers, “Chest CT Findings in Marijuana Smokers.” The lead author of the study was quoted in Medical News Today as saying, “93% of the marijuana smokers had emphysema rather than 67% of the tobacco-only smokers.” The researchers also found cannabis smokers had higher rates of airway inflammation. The CT imaging showed greater mucus buildup in the airways, thickening of the bronchial wall, and sometimes irreversible enlargement of the airways, all of which can lead to more congestive symptoms and infections.

While the public impression is that cannabis is relatively safe and may be safer than cigarettes, “the newly identified link between cannabis use and irreversible lung damage could mean that cannabis is potentially more harmful than many people may realize.” A possible explanation between marijuana and irreversible lung damage could be because marijuana is usually smoked unfiltered, where tobacco cigarettes are generally filtered. When marijuana is inhaled, more particulates are deposited in the airways, likely acting as irritants. Compared to tobacco, the way marijuana is inhaled (a longer time and a higher volume when holding your breath) may lead to microtrauma with the airspaces causing emphysema.

The researchers said the small sample size of their study (56 marijuana smokers, 57 nonsmoker controls, 33 tobacco-only smokers) precluded them from drawing strong conclusions from their findings. Nevertheless, the research may have implications for patients who smoke marijuana for pain relief and other reasons. A critical care medicine specialist and pulmonologist who was not involved in the study told Medical News Today:

The findings of the research point towards confirming a trend we have observed with younger patients presenting with more breathing difficulties. Any inhalation of particulate matter, whether tobacco smoke or marijuana, causes inflammation within the airways.

President Biden’s actions with marijuana are constructive and will allow solid scientific research into the adverse effects and the medical benefits of marijuana to move forward. Hopefully, the piece-meal, state-by-state backdoor way of legalizing recreational marijuana will slow down. Pennsylvania needs to wait and see what that research will show before it goes “full Colorado.” And it seems the evidence will be a mixed bag.

12/21/21

The Risks of Legalizing Marijuana in PA

Attempts to legalize recreational marijuana in PA with Senate Bill 350, the “Adult-Use Cannabis Act,” failed. But efforts to do so have not stopped. In September of 2021, State Representatives Jake Wheatley and Dan Frankel sponsored H.B. 2050, which would legalize adult-use recreational marijuana. Not to be outdone, State Senators Dan Laughlin and Sharif Street introduced Senate Bill 473 to legalize recreational marijuana in October of 2021. Laughlin and Street believe their bi-partisan bill has the best chance of ultimately legalizing recreational marijuana in Pennsylvania, and could generate between $400 million and $1 billion of new tax revenue. But what are the risks of such legislative action?

Larry Weigand, who was running for sheriff in Delaware County, said he understood that social views on marijuana use have changed and polls report most Pennsylvanians support legalization. “But the social views of intoxication and driving under the influence have not; to the contrary, they have become more stringent.” He thought the legislature needs to be considerate of both sides of the issues, considering all who would be affected, “including the non-users of marijuana and law enforcement.”

Negative Consequences in Colorado

Consider the negative consequences of legalization in Colorado reported in The New York Times, “Reefer Madness or Pot Paradise?” Legalization coincided with a 20 percent rise in violent crime rates in Colorado, while marijuana-related arrests fell by half. Although low-level marijuana charges dropped, racial discrepancies in drug arrests persisted. African-Americans were still being arrested on marijuana charges almost twice as often. One of the state legislators who endorsed the Colorado ballot measure that legalized recreational marijuana said: “You don’t see drug-addled people roaming the streets, but we haven’t created a utopia.”

Since recreational sales began in 2014, more people in Colorado are going to emergency rooms for marijuana-related problems. Hospitals report higher rates of mental health cases associated with marijuana. An emergency room physician and researcher with the University of Colorado Hospital, Andrew Monte, analyzed hospital data that showed more people were arriving at ERs for marijuana-related reasons. He said, “There’s a disconnect between what was proposed as a completely safe drug.”

Other researchers in “Marijuana and acute health care contacts in Colorado” reported that marijuana-related ER patients were five times as likely to have a mental-health issue as those with other cases. “As more states legalize marijuana, it is important to address public education and youth prevention, and understand the impact on mental health disorders.” The most frequent primary diagnosis of ER visits with marijuana-related billing codes compared to those without marijuana-related billing codes was for mental illness.

Among primary diagnosis categories, mental illness was more prevalent in ED visits and hospitalizations with marijuana-related billing codes. Examination of the role marijuana plays in mental health driven healthcare encounters is critical given the relationship between drug use disorders and mental health disorders. While it is unclear whether this finding is reflective of changes due to a legal market, it clearly prioritizes the consequences of marijuana use within a mental health population as a priority area for further research.

Psychosis and Marijuana

While political rhetoric in favor of legalization is calling for the end of marijuana “prohibition,” scientific research is forming a consensus that THC, the psychoactive cannabinoid in marijuana, induces psychotic symptoms. A research article published in The Lancet Psychiatry, “Psychiatric symptoms caused by cannabis constituents,” included additional evidence for that consensus. The authors readily acknowledged that cannabis was one of the most widely used psychoactive substances worldwide, with 6-7% of Europeans and 15.3% of Americans using it each year. Decriminalization and legalization trends were happening globally, with Canada, Uruguay and a growing number of US state permitting the sale and recreational use of marijuana. However,

Given the projected increase in rates of cannabis use, the increasing potency of cannabis and cannabis-based products, and the burgeoning interest in the therapeutic potential of cannabinoids, it is timely to assess the psychiatric effects of cannabis constituents.

The researchers demonstrated that THC induced significant increases of symptoms as they were reported on psychiatric scales, the Brief Psychiatric Rating Scale (BPRS) and the Positive and Negative Syndrome Scale (PANSS). Positive symptoms included delusions and hallucinations; negative symptoms included blunted affect and amotivation; and general symptoms included depression and anxiety. Effect sizes were greater for positive symptoms than negative symptoms, but not for general symptoms. This finding suggested that THC induced positive symptoms like psychosis to a greater extent than negative symptoms.

Speaking with Healio Psychiatry in “THC linked to psychiatric symptoms with large effect sizes,” Oliver Howes, one of the co-authors, said: “These findings highlight a potential risk of taking THC-containing cannabis products, and, importantly, show that THC can lead to short-term psychotic symptoms even in people with no history of mental illness or other risk factors.” While there has been previous evidence for the association of positive psychiatric symptoms and marijuana, Howes said he was surprised that THC induced other psychiatric symptoms like social withdrawal.

In conclusion, these findings demonstrate that the acute administration of THC induces positive, negative, and general psychiatric symptoms with large effect sizes. By contrast, CBD does not induce psychiatric symptoms, and there is inconclusive evidence that it moderates the induction of psychiatric symptoms by THC. These effects are larger with intravenous administration than with inhaled administration, and tobacco smokers have less severe positive symptoms. These findings highlight the acute risks of cannabis use, which are highly relevant as medical, societal, and political interest in cannabinoids continues to grow.

In a related editorial published in the same issue of The Lancet Psychiatry, “THC: harmful even in low doses?”, Carsten Hjorthøj, and Christine Merrild Posselt said there was a growing scientific consensus that marijuana does have a causal role in the development of psychosis. And they thought the association seems to be bidirectional. “In some people, cannabis leads to incident psychosis, whereas in other people, psychosis leads to incident cannabis use.” However, they noted this consensus was not reflected in mainstream public discourses, “which have a major effect on the political agenda to decriminalize cannabis.”

Referring to “Psychiatric symptoms caused by cannabis constituents,” Hjorthøj and Posselt said finding large effect sizes for general psychiatric symptoms, even with low doses of THC, was “extremely important and worrying.”

Moreover, the authors failed to find any clear evidence that concurrent administration of cannabidiol (CBD) reduced these symptoms. Indeed, such an ameliorating effect was observed in only one of four included studies. This finding is notable because CBD in particular is being touted as a potential wonder drug with antipsychotic, anxiolytic, and other properties. . . As Hindley and colleagues have clearly demonstrated, there are at least transient psychiatric symptoms associated with even relatively low doses of THC. Of course, this result should not be extrapolated as meaning that single doses of THC will eventually lead to schizophrenia or other severe disorders. However, it might be prudent to extrapolate and paraphrase the words of Moore and colleagues from their 2007 meta-analysis to apply to both recreational and medicinal use of THC-containing cannabis: “there is sufficient evidence to warn people that using THC could increase their risk of developing psychiatric symptoms or even a psychotic illness”.

So, pointing to the potential for increased tax revenue, the opportunity for new jobs in the marijuana industry, and all the other supposed benefits of ending the so-called ‘prohibition’ of recreational marijuana is not enough. Pennsylvania also needs to consider the risks to its citizens if it legalizes recreational marijuana. And one of them is people who use cannabis increase their risk of experiencing psychosis and other psychiatric symptoms.

There are several other articles on the risk of psychosis with marijuana on this website, and the concerns for Pennsylvania if recreational marijuana is legalized in the Commonwealth. Here are a few: “Cannabis and Psychosis: More Reality Than Satire,” “Telling the Truth About Marijuana and Psychosis,” “The Business of Legalizing Marijuana in PA,” and “Should Pennsylvania Go ‘Full Colorado’ with Marijuana?” Part 1 and Part 2.

04/20/21

The Business of Legalizing Marijuana in PA

Brass big marijuana coin with cannabis leaf near business inscription.

In the midst of our national political news, there was an announcement by John Fetterman, the Lieutenant Governor of Pennsylvania, that he is formally exploring a run for the U.S. Senate in 2022. According to Marijuana Moment, legalizing weed is a central part of his political platform. Fetterman said: “We’re going to get there. There’s never going to be a time when that’s not true. It’s inevitable. They know it, I know it, everyone knows it.” He even placed a marijuana flag on the balcony of his office in the Pennsylvania Capitol building as lawmakers were sworn in ahead of the 2021 legislative session.

If he decides to run, this will be his second try for the U.S. Senate. In 2016 Fetterman lost in the Democratic primary, but earned 20 percent of the vote in a four-way race. Two years later, he ran for Pennsylvania Lieutenant Governor and won. Weeks after taking office, he began a listening tour through all 67 counties of the state “to engage with Pennsylvanians about legalizing marijuana.” He said: “We want full legalization. I mean, that’s really the net goal.”

Given Fetterman’s commitment to full legalization, which means legalizing marijuana for recreational use, Pennsylvanians should know more about the potential consequences of this proposed marijuana legalization. If HB 2050 is passed, adults 21 and over could possess any amount of cannabis. Public consumption is prohibited. Adults 21 and older could cultivate 50 square feet of mature, flowering cannabis plants within a private residence. And adults could gift up to one ounce from cannabis grown in their private residences.

Going “full Colorado,” as Fetterman has called it has had negative consequences in Colorado, with the crime rate increasing 11 times faster than the rest of the nation since legalization, according to the Colorado Department of Public Safety. SAM, Smart Approaches to Marijuana, reported the number of drivers intoxicated with marijuana and involved in fatal accidents increased 88% from 2013 to 2015. The proportion of Colorado youth who reported marijuana use in the past 30 days was higher than the national average. Fuller discussion of these facts and more can be found in, “Should Pennsylvania Go ‘Full Colorado’ With Marijuana?” Part 1 and Part 2. Also see, “From The Frying Pan Into the Fire With Recreational Marijuana in PA.”

There are also concerns with the potential consequences with high-potency marijuana. Today’s cannabis is much more powerful than it was in the past. The U.S. Surgeon General published an advisory on Marijuana Use and the Developing Brain. Citing a study published in Biological Psychiatry, “Changes in Cannabis Potency over the Last Two Decades,” he said the THC concentration in commonly cultivated marijuana plants increased three-fold from 1995 through 2014, 4% to 12%. Researchers of a different study of legal cannabis sold in Washington State dispensaries found that the median THC levels varied from 17.7% to 23.2%.

Concentrated THC products, known as “dabs,” “wax,” “budder,” are becoming more widely available to recreational users and were found in yet another study, “To Dab or Not to Dab,” to range from 23.7% to 75.9% THC. The authors also cited published case reports that showed significant psychosis, neurotoxicity and cardiotoxicity with dabs. They described three males in their teens or twenties who used some form of dab. Two of the subjects had paranoia-like symptoms and one subject had seizure-like activity. Analysis of the dab sample used by one of the subjects was 20.5% THC without any detectable level of cannabidiol (CBD). The Surgeon General said the risks of physical dependence and other negative consequences increase with exposure to high concentrations of THC. “Higher doses of THC are more likely to produce anxiety, agitation, paranoia, and psychosis.”

A systematic review and meta-analysis published in the Lancet found that acute administration of THC induced increased positive (psychotic), negative (i.e., poor rapport) and general (depression) psychiatric symptoms. “These findings demonstrate that the acute administration of THC induces positive, negative, and general psychiatric symptoms with large effect sizes.” However, CBD did not induce psychiatric symptoms and there was inconclusive evidence that it moderated the initiation of psychiatric symptoms by THC.

These findings highlight the acute risks of cannabis use, which are highly relevant as medical, societal, and political interest in cannabinoids continues to grow.

In addition to mental health concerns with the legalization of marijuana, there are physical health concerns. Marijuana smoke contains some of the same toxic combustion products in tobacco smoke, which raises the possibility that exposure to some smoke-related toxicants could have adverse effects on the health of heavy cannabis users.

In another Lancet study, the plasma and urine levels of exclusive marijuana smokers, exclusive tobacco smokers, dual users of both substances and non-smokers were compared. Participants were classified as marijuana or tobacco smokers based upon self-report and detection of nicotine or THC metabolites in their plasma or urine. Marijuana smoking was independently associated with smoke-related toxicants including acrylamide and acrylonitrile metabolites, which are known to be toxic at high levels. But levels were lower when compared with those associated with tobacco smoking. Researchers also found elevated levels of an acrolein metabolite that may identify adults at risk of cardiovascular disease. The senior author of the study told Science Tech Daily:

Marijuana use is on the rise in the United States with a growing number of states legalizing it for medical and nonmedical purposes — including five additional states in the 2020 election. The increase has renewed concerns about the potential health effects of marijuana smoke, which is known to contain some of the same toxic combustion products found in tobacco smoke.

While there is less of a risk of cardiovascular disease when smoking marijuana than tobacco, there is a clear risk of experiencing psychiatric symptoms of psychosis and depression. This occurs as a result of the psychoactive substance in the cannabis plant, THC. However, another of the 66 chemicals (cannabinoids) in cannabis, cannabidiol (CBD), does not induce psychiatric symptoms. This distinction is crucial when considering whether or not to broaden the existing use of medical marijuana in Pennsylvania to include recreational use.

The FDA has approved only one CBD product Epidiolex, a prescription drug to treat two rare, severe forms of epilepsy. It is also illegal to market CBD by adding it to a food or drink; or currently to label it as a dietary supplement. According to Marijuana Moment, the FDA is in the process of developing regulations for hemp-derived cannabidiol products and is actively exploring ways to permit lawful sales of CBD as a dietary supplement. In 2019 the World Health Organization (WHO) said hemp-derived CBD did not contain more than .2 percent THC and was not under international control.

In a 2017 report to the WHO, the Expert Committee on Drug Dependence said in humans, “CBD exhibit no effects indicative of any abuse or dependence potential.” It is generally well tolerated and has a good safety profile. Reported adverse effects were thought to be a result of interactions between CBD and patients’ existing medications. “CBD has been demonstrated as an effective treatment of epilepsy in several clinical trials. . . There is also preliminary evidence that CBD may be a useful treatment for a number of other medical conditions.”

The evidence that CBD may be a useful treatment for a number of other medical conditions is not as scientifically sound as the research for treating epilepsy. For most indications, there is only pre-clinical evidence. Consistent with its properties, the range of conditions for which CBD has been assessed is diverse. Why can’t there be changes in how CBD from cannabis is scheduled and regulated to facilitate further research into these preliminary findings? The following table in the WHO report represents a review of the various therapeutic applications for CBD found in “Cannabidiol: State of the art and new challenges for therapeutic applications.”

The WHO commented that since CBD was not considered a drug of abuse (as was THC) and at the same time was legal and not regulated, a market for CBD-based products for medical purposes (such as CBD oil, tinctures and vapors) has rapidly expanded. It flourishes “in a no man’s land with potential health dangers for patients and all end-users.” The WHO cautioned that the lack of regulation with these products cannot guarantee the patient “the quality of the product itself, the effective dosage of CBD that is fundamental for its therapeutic effectiveness, the purity and the absence of chemical or microbiological contaminations, thus raising critical public safety concerns.”

Regulatory changes with regard to CBD are needed in the U.S. At the end of December 2020, the FDA announced it had issued five more warning letters to companies selling CBD products in ways that violated the Federal Food, Drug and Cosmetic Act (FD&C Act). “All five warning letters address the illegal marketing of unapproved CBD products claiming to treat medical conditions. In addition, they address violations relating to the addition of CBD to food, and the impermissible marketing of CBD products as dietary supplements.” Under the FD&C Act, any product intended to diagnose, cure, treat or prevent a disease and any product intended to affect the structure or function of the body of humans or animals, is considered to be a drug.

In “FDA is Committed to Sound, Science-based Policy on CBD,” the FDA said the Agriculture and Improvement Act of 2018, the Farm Bill, removed cannabis and cannabis derivatives that are very low in THC from the definition of marijuana in the Controlled Substances Act while specifically preserving the FDA’s responsibility over such products. If a product is being marketed as a drug, meaning it is intended to have a therapeutic effect as in treating a disease, then it is regulated as a drug. Over the past several years the FDA has issued several warning letters to companies for marketing unapproved new drugs claiming to contain CBD, including for uses such as treating cancer or Alzheimer’s disease. “These products were not approved by the FDA for the diagnosis, cure, mitigation, treatment, or prevention of any disease.”

Legislative action is needed, but not to legalize recreational marijuana. An official distinction between THC and CBD should be made that permits research into the therapeutic potential of CBD, while keeping THC as a controlled substance at a less restrictive Schedule. Marijuana was listed as a Schedule I Controlled Substance in 1970. This has hampered the scientific investigation of the therapeutic benefits of CBD as well as the potential harms (or lack thereof) from THC to be done.

There is enough evidence of the therapeutic potential of CBD to research the above-noted therapeutic benefits and we desperately need legislation that permits this. There is also evidence that high levels of THC can be a catalyst to the emergence of psychotic symptoms in some users—and we need to protect those users from this danger. The science is clear enough to stop the push towards legalizing recreational marijuana in Pennsylvania while we permit the scientists to do their research into the potential benefits of CBD and the adverse effects of THC. Activists and those in favor of legalizing recreational marijuana like Lieutenant Governor Fetterman are really seeking to legalize THC, a psychoactive chemical in cannabis with serious adverse effects and significant profit potential for some. We need to clearly see this.

10/6/20

Should Pennsylvania Go ‘Full Colorado’ with Marijuana? Part 2

In Part 1, we began to examine some of the potential impact to Pennsylvania if the state were to go “full Colorado,” unreservedly legalizing recreational marijuana as the state of Colorado has done. We started out with the September 3, 2020 call by Governor Tom Wolf for the legalization of marijuana use for adults in Pennsylvania. Lieutenant Governor John Fetterman, who stood beside him, also voiced his unreserved support of legalization. But as we looked at the hope for legalization in Pennsylvania, we saw the reality of what had already happened in other states that legalized recreational marijuana was dramatically different.

On the Facebook page for the “Pennsylvania Family Council” dated September 25, 2019, is a shot video that presents a quick series of sound bites and facts about going full-on Colorado: “Lt. Gov. Fetterman wants ‘full Colorado’ with marijuana.” He thinks the legalization of recreational marijuana is “the right thing for Pennsylvania.” You can also view the video on YouTube. We’ll look at most, if not all of the information that this short video throws at you. If there was something I failed to cover, it can be found within the links presented in either Part 1 or here in Part 2 of this article.

According to a 2018 state report, “Impacts of Marijuana Legalization in Colorado,” seizures of Colorado-sourced marijuana were most likely to occurs in states bordering or near Colorado: Kansas, Nebraska, and Wyoming. At least 3 made it to Pennsylvania. Seizure used to be almost exclusively marijuana flower, accounting for over 90% of the reported seizures in 2012. By 2017, 58% of seizures were for flower, 26% were for concentrates/hash and 16% were for edibles. See the following table from the report.

Overall crime rates for property remained stable from 2012 to 2017, but violent crime increased 20%. An increase in the number of aggravated assaults was primarily responsible for the increase in the violent crime rate while larceny was responsible for the increase in property crime rates. SAM (Smart Approaches to Marijuana) reported the crime rate in Colorado has increased 11 times faster than the rest of the nation since legalization. “Marijuana arrests of young African-American and Hispanic youth have increased since legalization (Colorado Department of Public Safety [CDPS], 2016).” See the table below.

SAM reported that in Colorado, the number of drivers intoxicated with marijuana and involved in fatal traffic accidents increased 88% from 2013 to 2015. “Driving under the influence of drugs (DUIDs) have also risen in Colorado, with 76% of statewide DUIDs involving marijuana” (Colorado State Patrol [CSP], 2017). Washington State had a doubling of drugged driving fatalities. In Oregon, 50% of all drivers assessed by drug recognition experts (DRE) in 2015 tested positive for THC. See “Driving Under the Influence of Cannabis” for more information on DUIDs.

The proportion of Colorado youth who reported marijuana use in the past 30 days was significantly higher than the national average. This held true from 2008/2009 through 2015/2016. Colorado was in the top 20% of states for youth marijuana use. See the following figure. Smart Approaches to Marijuana (SAM) reported that since legalization, Washington, Oregon Alaska and Washington, DC have had past-month use of marijuana above the national average among youth aged 12-17. See the chart below.

“Reefer Madness or Pot Paradise?” also noted how politics was infiltrated by marijuana legalization. With a new, marijuana-friendly governor in office, Colorado legislators passed six marijuana laws in 2019 that included approving marijuana-delivery services; out-of-state investment and publicly traded cannabis companies; the creation of pot lounges—“marijuana hospitality establishments”—where marijuana could be consumed without violating the state’ indoor clean-air laws. As the industry expands, some of marijuana’s earliest supporters and entrepreneurs have raised concerns about being left out as pot companies in the US and Canada chase billion-dollar projected incomes and hire powerful politicians like John Boehner, the former Speaker of the House.

Luke Niforatos, the Executive Vice President for Smart Approaches to Marijuana (SAM), said despite claims of states not allowing child-friendly pot products, marijuana shops sell products like “Pot Tarts,” “Kush Pop,” and pot-laced gummy bears. Edible and drinkable products are becoming the direction the marijuana industry is going. “How many people think this is for 21 and up?”

The industry has prospered in selling marijuana-infused “edibles” that come in the form of cookies, candy, ice cream, sodas, and other sweet treats that are particularly appealing to children. These edibles comprise approximately 20 to 50% of the market in legalized states (where data is available), thereby increasing their availability to children and youth who are normally unaware of consumption serving sizes and consequences (Colorado Department of Revenue, 2015; O’Connor, Danelo, Fukano, Johnson, Law, & Shortt, 2016).

So, where does this leave the supposed success of other states implementing marijuana legalization and what Pennsylvania can look forward to?

The concern expressed for the danger to children in PA from candy-like edibles was legitimate. But it does not seem in states where recreational marijuana is legal that the marijuana industry has any interest in attempting to limit or restrict the sale of edibles that could appeal to children. 53.5% of high school students in Colorado feel it would be easy to get marijuana if they wanted, not more difficult, as Sharif Street said would happen after legalization (see Part 1). Financial assistance for restorative justice programs and historically disadvantaged businesses is roughly 1.5% of the projected tax income from marijuana sales; .065% of the total state budget. It seems to be more of a political carrot to gain public approval than real restorative social justice.

As the marijuana industry expands, the economic benefit to legalization seems to be primarily to the cannabis corporations, not the small, locally owned and operated businesses which are concerned about being left out. “Reefer Madness or Pot Paradise” in The New York Times said marijuana is starting to look like the next Silicon Valley. Vehicular accidents and driving under the influence of drugs (DUIDs) increased dramatically in various states that legalized marijuana. Legalization has led to increased black-market activity, not less; especially in rural areas that border states where marijuana is still illegal. Drug trafficking organizations and Mexican cartels have begun growing marijuana illegally in the US.

Marijuana-related emergency room visits have increased drastically since legalization. According to the Colorado Department of Public Health and Environment, the rate of marijuana-related ER visits increased 35% between 2011 and 2015. SAM reported these ER visits included a growing number of Butane Hash Oil (BHO) burn victims. “BHO is a marijuana concentrate that yields a THC potency of 70–99% and is highly lucrative. Production involves forcing raw marijuana and butane into a reaction chamber, which creates a highly combustible liquid that easily explodes when introduced to an ignition source.” See: “A Little Dab Will Do Ya” for more on BHO.

There is a clear negative effect on teens and youth in states that have legal recreational marijuana, even though it has always been legalized for adults and not teens. SAM reported the average rate of regular teen marijuana use is 30% higher in Alaska, Colorado, Oregon, and Washington than the US rate as a whole. Almost one-third of all 18 to 25-year-olds in legalized states said they’ve used marijuana in the past month, up from around one-fifth 10 years ago. See the research of Stacey Gruber detailed in “From the Frying Pan Into the Fire with Recreational Marijuana in PA,” “Double Whammy of Teens Vaping Marijuana,” and “Listening to Marijuana Research” for further concerns with teens using marijuana.

The research into whether or not marijuana is a gateway drug is mixed, but it does seem to have been a “stepping stone” of sorts with individuals who go on to use other drugs. See “Marijuana as a ‘Gateway’ Drug” and “Rebirth of the Gateway Hypothesis,” for more on the gateway hypothesis.

Cannabis may be safer now, but its strength is increasing under legalization. SAM reported the average national THC potency of flower is 11.04%, but in Colorado it is 17.10% and it is 21.24% in Washington State. In the 1960s and 1970s, cannabis contained less than 4% THC. And there is emerging evidence of a strong link between high-potency marijuana and psychosis. “The odds of psychotic disorder among daily cannabis users were 3.2 times higher than for never users, whereas the odds among users of high potency cannabis were 1.6 times higher than for never users.” See “Gambling with Cannabis and Psychosis” and “Cannabis and Psychosis: More Reality Than Satire” and “Psychosis and Adolescent Marijuana Use” for more information on the link between marijuana and psychosis.

One final piece of information came in mid-September of 2020. The Pittsburgh Business Times reported that two of the largest Pittsburgh-area medical marijuana startups, Solevo and PurePenn, have been acquired by a Florida company, Trulieve Cannabis Corp., based in Tallahassee, Florida. Solevo ranks second on the The Pittsburgh Business Times’ list of the region’s largest medical marijuana dispensaries and growers/processors; PurePenn is fourth. In addition to Florida, Trulieve has operations in California, Massachusetts and Connecticut.

Do Pennsylvanians really want to go “full Colorado?”

09/29/20

Should Pennsylvania Go ‘Full Colorado’ with Marijuana? Part 1

On September 3, 2020, Governor Wolf renewed his call for the legalization of recreational marijuana use for adults in Pennsylvania, which he originally announced his support of in September of 2019. Pointing to a presumed economic windfall such a legislative act would bring to the Commonwealth, he said: “Now more than ever, specially right in the middle of a pandemic, we have a desperate need for the economic boost that the legalization of cannabis could provide.” Lieutenant Governor John Fetterman also highlighted the economic impact to come from legalization. He said he could pitch marijuana legalization as a jobs bill. “Legalizing marijuana would create tens of thousands of jobs that require no subsidy.” This is a complete about-face from Wolf’s position two years ago, when he said, “I don’t think Pennsylvania’s actually ready for recreational marijuana.”

His rejection of legalization from August of 2018 was followed by a statement on Twitter in December of 2018 that signaled an evolving position, where Governor Wolf said more and more states were implementing marijuana legalization and we should keep learning from their efforts. “I think it is time for Pennsylvania to take a serious and honest look at recreational marijuana.” In an article I wrote in January of 2020, “From the Frying Pan Into the Fire with Recreational Marijuana in PA,” I said I hoped PA would learn from the long-term consequences of marijuana legalization in other states. We should not allow the political pressure to legalize marijuana to outpace learning from the consequences to other states and the science from research into marijuana.

Is the pressure to legalize recreational marijuana use in Pennsylvania a consequence of “more and more states successfully implementing marijuana legalization,” as Governor Wolf said in December of 2018? Let’s look at some of the claims that have been made about legalization, especially in Colorado, to see what this supposed successful implementation could mean for Pennsylvania.

In his most recent call for legalization, Governor Wolf said the revenue from legalization would benefit restorative justice programs and historically disadvantaged businesses. Another factor in the proposed legislation is reform to the criminal justice system and the uneven enforcement of marijuana laws against Blacks and Latinos. Fetterman said: “If you go over the span of decades we are talking nearly a quarter of a million Pennsylvanians that now have some affiliation with the criminal justice system for nothing more than consuming a plant that’s actually legal in 12 jurisdictions across this country.” State Senator Sharif Street of Philadelphia, one of the co-sponsors of the “Adult-Use Cannabis Act,” added that marijuana would economically benefit farmers, who could rotate it with corn. He added that regulation would also make it more difficult for dealers to sell to minors.

In addition to these claims made during the September 3^rd announcement, there were the results from a May 2019 statewide “listening tour” by John Fetterman to hear people’s opinions as to whether or not they were in favor of or opposed to legalizing adult-use recreational marijuana. The most commonly stated reasons cited in support of legalization included in the Listening Tour Report were: a perceived economic benefit with increase funding for education and infrastructure, the expungement of past non-violent cannabis convictions and the belief that cannabis is safer than alcohol and opioids. Common reasons stated by those opposing legalization included concerns marijuana is a gateway drug, increased vehicular accidents and problems measuring a DUI level, and potential negative effects on youth.

The Listening Tour Report also found there was a 65-70% approval of adult-use cannabis legalization. Residents were overwhelming supportive of decriminalization and expungement of non-violent and small cannabis-related offenses. There was near-unanimous support for removing marijuana from its classification as a Schedule 1 drug. Many residents said that if legalized, marijuana should be grown on Pennsylvania farms and should create jobs in Pennsylvania. People were also concerned about an increase of people driving under the influence of marijuana. Most people were opposed to candy-like edibles because of their potential appeal to children.

A Franklin & Marshall College Poll in Mach of 2019 found that 59% of Pennsylvania voters supported legalization, a dramatic change since May of 2006 when only 22% supported legalization. There was a dramatic upshift of approval between 2015 (40%) and 2017 (56%), with Pennsylvania’s approval of medical marijuana occurring in 2016. Many polls reporting on whether or not marijuana should be made legal did as the Franklin & Marshall poll did, by asking an either-or, yes or no question: “do you think the use of marijuana should be made legal, or not?” But when polls distinguished between the recreational use and medical use of marijuana, support, support for legalization dropped. See the following compilation of survey results on PollingReport.com. Look at a 2014 question by the Pew Research Center that begins with: “Which comes closer …”

It seems a legitimate question of the reported percentages of Pennsylvanians supporting adult-use cannabis legalization is to ask to what extent was it influenced by the previous approval of medical marijuana? I previously raised the question of a possible strategy in the long-term goal of gaining national approval for recreational marijuana legalization was to pursue it one state at a time; initially concentrating on the supposed medical benefits from marijuana (See “Marijuana Peek-A-Boo” and “Eating the Elephant of Marijuana Legalization in PA”). These touted medical benefits are difficult to replicate or refute since marijuana is currently a Schedule I drug, which makes reliable research into its effects—good or bad—difficult to do.

Governor Wolf said recently the revenue from legalization would benefit restorative justice programs and historically disadvantaged businesses. However, the original “Adult-Use Cannabis Act” said $9 million would annually be distributed from the fund annually to the Department to carry out its duties, which include grants and loans to “low-income permittees.” These departmental duties include up to $2 million annually “to provide financial assistance to growers, processors, dispensers, and microgrowers who were harmed by effects of cannabis prohibition.” Interest-free loans could be granted to individuals with a prior cannabis-related criminal conviction, whose annual income was below $80,000, and who had successfully completed an educational program and passed an exam; again, up to $2 million annually.

95% of the remaining annual tax income (projected to be $581 million) was supposed to go to school districts. The projected income was calculated from the 17.5% tax rate that would be imposed on cannabis sold by licensed dispensaries. Yes, there would be some benefit to historically disadvantaged businesses and restorative justice programs, but that is out of merely 1.5% of the projected tax income. The governor’s rhetoric seems to be a bone tossed in reaction to the economic crisis of the COVID pandemic and the social justice issues that have been sweeping the country the past several months rather than a serious proposal. That is, if the roughly $539.6 million would really go towards schools. $581 million sounds like a significant figure, but it is actually 0.65% of the total operating budget for Pennsylvania for fiscal year 2020-2021.

The same 2019 Franklin & Marshall poll mentioned above also found that legalizing marijuana for recreational use was a top priority for only 5% of Pennsylvanians surveyed, while increasing state funds for public education (23%) and improving the state’s infrastructure (18%) were viewed as more important top priorities. Proposing to spend the anticipated income from legalization on schools sounds like a strategic political move to increase the chances of getting the Adult-Use Cannabis Act through the state legislature.

The same can be said about the inclusion of social justice reform actions in Senate Bill 350. Decriminalization and expungement can be accomplished independent of legislation that legalizes recreational marijuana. While changing the scheduling is popular in PA, there is nothing really that can be done, as that would take federal action. And as long as cannabis is a Schedule I controlled substance, selling, distributing, possessing and/or using marijuana or marijuana-derived products is a federal crime. JDSupra ended their article on the Adult-Use Cannabis Act with a disclaimer that said while federal policy may recommend enforcement discretion, “it is important to understand that compliance with state law does not equal compliance with federal law, and that federal marijuana policy may change at any time.”

A New York Times article in June of 2019, “Reefer Madness or Pot Paradise?” looked at what has happened in Colorado since they became the first-in-the-nation to experiment with legalizing recreational marijuana. Let’s look first at the social justice issue John Fetterman was concerned about. While low-level marijuana charges have fallen dramatically, the racial divide in drug arrests has continued. State data shows that African-Americans in Colorado are still being arrested on marijuana charges at twice the rate of white people. Jonathan Singer, one of two state legislators who endorsed the Colorado ballot measure that legalized their adult use recreational marijuana measure, said: “You don’t see drug-addled people roaming the streets, but we haven’t created a utopia.” Once known for its wide range of outdoor activities, now Colorado is known as the state that has “great weed.”

Colorado’s first-in-the-nation experiment has reshaped health, politics, rural culture and criminal justice in surprising ways that often defy both the worst warnings of critics and blue-sky rhetoric of the marijuana industry, giving a glimpse of what the future may hold as more and more states adopt and debate full legalization.

Law enforcement officials say legalization caused the black-market cultivation of marijuana to expand and made the problem worse. While licensed growers harvest marijuana from fields and greenhouses, police and sheriff’s officers raid houses converted to illegal cultivations they say export marijuana to other states. People cover the windows of grow houses to have the glowing grow lights and rewire the electric and water lines to avoid the meters. In May of 2019 police and federal drug-enforcement agents raided 240 homes around Denver and Northern Colorado that were illegally growing marijuana. The US attorney in Denver said Colorado has become “The epicenter of black-market marijuana in the United States.”

Small rural, towns near Utah, Nebraska or New Mexico are opening marijuana shops and raising concern from officials about out-of-state trafficking. Smart Approaches to Marijuana (SAM) reported there has been a 50% increase in illegal grow operations across rural areas of the state. “In 2016 alone, Colorado law enforcement confiscated 7,116 pounds of marijuana, carried out 252 felony arrests, and made 346 highway interdictions of marijuana headed to 36 different U.S. states.”

Legalization has made it easier for the black market to thrive in rural areas due to the difficulties involved in distinguishing between legal and criminal marijuana farms. About $6.5 million worth of illegal marijuana was confiscated by federal agencies in the White River National Forest in Aspen, Colorado, and 9,200 illegal marijuana plants were found growing on islands in the middle of the Colorado River (Associated Press, September 29, 2017; Roy, 2017). The ability to hide black market activity in legalized states has encouraged drug trafficking organizations (DTOs) and Mexican cartels to begin growing marijuana illegally within the United States and there is now a strong presence of cartel activity in Alaska (ADPS, 2016).

Since recreational sales began in 2014, more people visited emergency rooms for marijuana-related problems and hospitals report higher rates of mental health cases tied to marijuana. Yet thousands of others make daily stops at dispensaries without any problems. Calls to poison centers rose 210% in Colorado after legalization. The annual rate of marijuana-related ER visits increased 35% between 2011 and 2015.

In Part 2, we will continue with our examination of whether Pennsylvanians can hope to successfully implement recreational marijuana legalization. There is a 2018 report by Colorado, “Impacts of Marijuana Legalization in Colorado” that has some interesting data on seizures of Colorado-sourced marijuana (some Colorado-sourced marijuana was seized in Pennsylvania). Violent crime increased, as did marijuana arrests of young African-American and Hispanic youth. Oh, and Colorado was in the top 20% of states for youth marijuana use.

03/30/18

Psychosis and Adolescent Marijuana Use

In November of 2017 Canada’s House of Commons passed legislation to legalize recreational marijuana in Canada. The bill is now in the Canadian Senate, which is a “wild card,” according to University of Toronto political scientist, Nelson Wiseman. “It’s a wild card because you’ve got all these independents and you don’t know what they’re going to say, how engaged they are with the issue. Some might fight it tooth and nail, some might try delay tactics as individual members,” he said. The slow pace of debate in the Senate has led to impatience among supporters of Bill C-45. Perhaps the delay will allow some consideration of how the Canadian government will address findings by researchers at the University of Montreal that links marijuana use and psychotic-like experiences (PLE) in Canadian adolescents.

In an article published in The Journal of Child Psychology and Psychiatry in July of 2017, Bourque et al. sought to investigate whether there was a longitudinal relationship between cannabis use and PLE. The researchers found that a steeper growth in cannabis use between the ages of 13 and 16 was associated with a higher likelihood of recurrent PLEs. The study’s lead author, Josiane Bourque, was quoted by Science Daily as saying: “Our findings confirm that becoming a more regular marijuana user during adolescence is, indeed, associated with a risk of psychotic symptoms. This is a major public-health concern for Canada.” Going from an occasional user to a weekly or daily user increased an adolescent’s risk of having PLEs by 159%. The link between marijuana use and PLEs was best explained by emerging symptoms of depression.

There were also only mild effects of marijuana use on measures of cognitive development, specifically with response inhibition performance. “Our results show that apart from a marginal effect of response inhibition, there was no association between change in cognitive functioning and PLE trajectory membership.” These findings were inconsistent with the emerging literature on adolescents and PLE. The researchers speculated the difference in their findings may be because their study used longitudinal, multi-level modeling to examine the relationship between cannabis use and PLE among adolescents. However, “these results are in accordance with recent findings from our team demonstrating that cannabis use has a neurotoxic effect that is specific to response inhibition, as opposed to a general impact on cognitive functioning.”

The clinical implications of these results nevertheless highlight the need for reducing cannabis use in high risk adolescents, as well as the importance of addressing depressive symptoms in programs aimed at preventing increasing PLE in high risk youth.

The Canadian study isn’t the only recent research linking psychosis and marijuana use in adolescents. Carney et al. at the University of Manchester did a meta-analysis in “Cannabis use and symptom severity in individuals at ultra high risk for psychosis.” They sought to investigate whether ultra high risk (UHR) individuals have higher rates of current and lifetime cannabis use than healthy controls (HCs); whether UHR individuals have higher rates of cannabis use disorders (CUD) than HCs; and do UHR cannabis users have higher positive and negative symptoms than non-cannabis using UHR subjects.

UHR individuals had high rates of cannabis use. They found that 52.8% of UHR individuals reported using cannabis in their lifetime. “Our analyses found significantly higher rates of lifetime cannabis use in the UHR samples than in the HC groups.” Approximately one in four UHR individuals were currently using cannabis. They also found high rates of comorbid CUDs in UHR individuals. “Even prior to the onset of psychosis, UHR individuals are likely to engage in risky cannabis use.”

High rates of cannabis use in this group are perhaps unsurprising given that use of substances is common in young people who present for mental health care and people with early psychosis. As there is evidence to suggest frequent use of high‐potency cannabis increases the risk for later transition, it is important that early intervention services encourage substance use reduction upon first presentation. A previous review and meta‐analysis found that UHR individuals are significantly more likely to smoke, abuse alcohol and have lower levels of physical activity than their peers. Here, we add to this evidence to suggest that this group is also more likely to have used cannabis or have a CUD, posing an additional risk factor to both physical and mental health.

Carney et al. found there was a statistically significant relationship between UHR cannabis use and severe positive symptoms of psychosis such as unusual thought content and suspiciousness. This was consistent with previous research with first episode psychosis individuals, where cannabis use was associated with increased positive symptoms of psychosis (i.e., hallucinations, suspiciousness and delusions) and poorer psychosocial functioning and long-term outcome. They were not able to analyze individual negative symptoms because of a lack of available data. They speculated that positive symptoms of psychosis may occur as a direct result of substance use. “Indeed, cannabis can induce symptoms of psychosis in healthy populations, and may therefore influence symptom severity in the UHR group.”

Irrespective of causation, high rates of cannabis use in the UHR group carries important clinical implications. Although many UHR individuals will not develop full‐threshold psychosis, they may go on to have anxiety, mood or substance use disorders, and continue to function poorly regardless of transition or symptomatic remission. Therefore, it is important to address any comorbid disorders at an early stage. Future research should assess the efficacy of interventions used to reduce cannabis use in UHR individuals upon first presentation to mental health services. For example, motivational interviewing and cognitive behaviour therapy have been found to be effective in reducing cannabis use among early psychosis groups, although a randomised control trial in the UHR group is yet to be conducted. Longitudinal studies are also required to highlight any relationship between continued cannabis use and factors such as long‐term outcome, functioning and symptoms over time.

High THC levels in cannabis are associated with psychosis. Writing for Scientific American, R. Douglas Fields reported on research presented at the World Psychiatric Conference that teenage cannabis use hastens the onset of schizophrenia in vulnerable individuals. Hannelore Ehrenreich presented results of a study of 1,200 people with schizophrenia. “The results … show people who had consumed cannabis before age 18 developed schizophrenia approximately 10 years earlier than others. The higher the frequency of use, the data indicated, the earlier the age of schizophrenia onset.” Ehrenreich said: “Cannabis use during puberty is a major risk factor for schizophrenia,”

Robin Murray, a professor of psychiatry at King’s College London, was one of the first scientists to research the link between cannabis and schizophrenia. Speaking at the conference, he cited 10 studies that found a significant risk of young marijuana users developing psychosis. “The more [cannabis] you take—and the higher the potency—the greater the risk.” His research with users in London has shown that high potency cannabis (about 16% THC) was involved in 24% of all cases having a first episode of psychosis.

Another speaker at the conference, Beat Lutz, a neurochemist, described how marijuana might produce adverse effects in a young person’s brain. THC disrupts the normal flow of signals among brain cells—“a process normally regulated by chemicals called endocannabinoids.” These occur naturally in the body and activate the CB₁or cannabinoid type 1 receptor. The CB₁receptor acts like a circuit breaker in the brain, keeping its signaling activity or “excitation” within a normal range.

Too little endocannabinoid signaling results in excessive excitation of the nervous system, and this can promote anxiety disorders, impulsivity and epilepsy. Too much activity has the opposite effect and can promote depression, for example. Upsetting the information flows regulated by the endocannabinoid system has also been linked to psychosis.

THC acts differently than the naturally occurring endocannabinoids. It doesn’t break down rapidly in the body the way endocannabinoids do. This sustained activation causes serious wide-ranging problems in the brain. Low doses of THC might reduce anxiety, but high doses can heighten it. Chronic overstimulation of CB₁receptors by THC shuts down the body’s natural endocannabinoid signaling system by eliminating the CB₁receptors from neurons. Lutz also believes:

THC’s disruption of endocannabinoid signaling in the early teen brain can hinder key neurodevelopmental processes that involve the CB₁ receptors, thereby impairing brain communication permanently.

Researchers at the conference commented on the need for the public to become aware of these new findings. Peter Falkai, a psychiatrist at the Munich Center for Neurosciences at Ludwig Maximilian University, said: “Looking into the data, clearly yes, the data show increasing risk of psychosis.”

09/8/17

Pot Market Getting a “Black” Eye

On April 3, 2017 the governors of four states with legalized recreational marijuana—Alaska, Colorado, Oregon and Washington—sent a letter to Attorney General Jeff Sessions. They asked that the Trump administration “engage” with them before making any changes to the existing federal regulatory and enforcement systems. Their particular concern was potential revision to the “Cole Memo,” an Obama-era policy that attempted to strike a balance between federal interests and state sovereignty in the growing legalization of marijuana. The governors said the Cole Memo provided guidance to the foundation of state regulatory systems and was “vital to maintaining control over marijuana in our states.” They warned that overhauling it could produce unintended consequences such as diverting “existing marijuana product into the black market and increase dangerous activity in both our states and our neighboring states.”

On July 24, 2017, Attorney General Sessions replied individually to the governors who signed the April 3^rd letter. You can review copies of the letters sent to Governor Brown of Oregon and Governor Inslee of Washington. Each letter pointed to documents from the respective states that raised serious questions about the efficacy of marijuana “regulatory structures” in that state. He then directed their attention to the concluding paragraph of the memo that said it “does not alter in any way the Department’s authority to enforce federal law, including federal laws relating to marijuana, regardless of stat law.”

Among the specific concerns for Oregon Sessions highlighted was that only 30% of the marijuana market in Oregon was compliant with state marijuana laws. There was a “pervasive illicit cannabis cultivation in the state,” which was trafficked out-of-state. Law enforcement was said to be unable to keep pace with out-of-state diversion. “The reality of legalization is that it has provided an effective means to launder cannabis products and proceeds.” Individuals were said to be exploiting legal mechanisms to obscure their products’ origin and their true profits.

Among the concerns he highlighted for Washington was the lack of regulation and oversight of the medical marijuana market has “unintentionally” led to a growth of the black market. “Since legalization in 2012, Washington State marijuana has been found to have been destined for 43 different states.” The recreational marijuana market is incompletely regulated. One of the leading regulatory violations has been the failure to use and/or maintain the traceability of marijuana products.

Writing for The Washington Post, Christopher Ingraham said the Sessions’ letter indicated he remained deeply skeptical of efforts to legalize recreational marijuana. But for now, Justice Department actions will be dictated by the Cole Memo. Federal non-interference seems to hinge on whether there is evidence of a public health or safety threat. John Hudak, a drug policy expert with the Brookings Institution, said the Sessions letter is an important indicator that Sessions is serious about enforcing marijuana law under the Cole Memo. He also expressed concerns with the accuracy of the data Sessions cited. He said reports compiled by law enforcement authorities were “notorious for cherry-picking data and failing to put data into context.” He suggested the Attorney General was drawing conclusions on incomplete data or data taken out of context.

Reporting for the Associated Press, Andrew Selsky said Governor Brown responded to Attorney General Sessions, noting the document he cited to her on Oregon marijuana problems was invalid and had incorrect data and conclusions. She went on to say new laws, including the tracking of all marijuana grown for legal sale, will help cut down on diversion into the black market. She added that she had recently signed legislation making it easier to prosecute the unlawful import and export of marijuana products. A Washington state official similarly said Sessions made claims about the situation in the state of Washington that were “outdated, incorrect, or based on incomplete information.”

Pause for a moment here. There isn’t denial that diversion occurs, just that the data the reports were based on was incorrect, outdated, incomplete. The thinking seems to be that more legalization will lessen the black market problem. Oregon Congressman Earl Blumenauer said: “”The more that we go down the path of legalization, regulation and taxation, diversion becomes less and less of a problem.” But is this just wishful thinking, rhetoric expressed to encourage the ongoing march towards nationwide legalization?

In a different article, Selsky noted the movement in several states, including Oregon, Colorado and California to implement tracking systems for marijuana and marijuana products. “The tracking system is the most important tool a state has,” according to Michael Crabtree. But as the systems rely on user honesty, they aren’t fool-proof. ““We have seen numerous examples of people ‘forgetting’ to tag plants.”

In California, recreational pot sales become legal in January of 2018. The Emerald Triangle area of northern California is the largest cannabis-producing region in the U.S. It is estimated to produce 60% of America’s marijuana. Although growers have been cultivating marijuana in the area since the 1960s during San Francisco’s Summer of Love, the industry really took off when Proposition 215 legalized medical marijuana in 1996.

Senator Mike McGuire, who represents the Emerald Triangle region, thought California’s tracking program would help limit the cannabis black market. But implementing a fully operational legal market in California could take years. “In the first 24 months, we’re going to have a good idea who is in the regulated market and who is in the black market.”

Anthony Taylor is a licensed marijuana processor and lobbyist. But as far back as the 1970s, he was growing cannabis illegally in an area east of Portland. He said it is easier to grow marijuana illegally these days because authorities don’t have the resources to uncover every operation. Growers who risk selling outside the state can earn thousands of dollars per pound, according to Taylor.

The Los Angeles Times reported that Hezekiah Allen, the executive director of the California Grower’s Association, warned that California growers are in for a “painful downsizing curve” when new laws go into effect in January of 2018. “We are producing too much.” He estimated the state cannabis growers produce eight times the amount of marijuana the citizen’s of the state can consume. He expects that some growers will stay in the black market and continue to illegally send marijuana to other states. Some growers may stop growing cannabis, but he expects others simply just won’t apply for state permits.

Lori Ajax, chief of California’s Bureau of Medical Cannabis Regulation said: “For right now, our goal is to get folks into the regulated market, as many as possible.” But, “There are some people who will never come into the regulated market.”

A Denver Grand Jury indicted 62 people and 12 businesses for operating the largest illegal marijuana uncovered in Colorado since Colorado legalized recreational marijuana in 2012. The drug bust, known as Operation Toker Poker, executed almost 150 search warrants at 33 homes and 18 warehouses and storage units in Denver. Seizures included 2,600 illegally cultivated marijuana plants and 4,000 pounds of marijuana. The ring operated from 2012 to 2016 and brought in an estimated $200,000 a month. The operation produced more than 100 pounds of cannabis monthly and shipped it to Kansas, Texas, Nebraska, Ohio, Oklahoma and other states.

Read original articles on Operation Toker Poker here at: The Denver Post, U.S. News, and the Daily Mail.

The DEA and State Patrols for Kansas and Nebraska participated in the investigation. Barbara Roach, special agent in charge of the DEA’s Denver field office, said since 2014 there has been an influx of organized criminal groups coming to Colorado in order to produce marijuana to sell in other states. “The marijuana black market has increased exponentially since state legalization.” Colorado Attorney General Cynthia Coffman said: “The black market for marijuana has not gone away since recreational marijuana was legalized in our state, and in fact continues to flourish.”

Andrew Freedman, a cannabis regulation consultant, said he is hopeful that state legislation passed in 2017 will make it more difficult for criminal to grow quantities of marijuana for the so-called “gray market,” while using a legal interest in the business as a cover. “

I do think the experiment is under the microscope, . . . Anything negative that happens will be a national story. This was a weakness in our system, and I’m hopeful the legislation shores up that weakness, but it is something the story will be judged on.

So it seems the expectation that ongoing legalization of recreational marijuana will make diversion less of a problem is wishful thinking. It may even be rhetoric to calm the fears of individuals who are unsure about where they stand on the issue. What does seem clear from the information above is that legalizing recreational marijuana in Colorado hasn’t made diversion go away; and officials seem to think it has been “flourishing.” At least one California official expects state regulation will not be followed by all the instate cannabis growers when the new laws go into effect. Even cannabis supporters acknowledge there will be a time lag of perhaps years before the regulatory machinery can get a handle on illegal cannabis growers.

Faith Seeking Understanding

Charles Sigler, D.Phil.

Tag: legalizing marijuana