Legalized recreational marijuana a substitute for alcohol, but not tobacco

July 17, 2019

Science Daily/Institute for Operations Research and the Management Sciences

The recent wave of recreational cannabis legalization across the U.S. could generate $22 billion in sales per year, but not everyone is happy about it. New research to be published in an upcoming edition of the INFORMS journal Marketing Science, titled, "Asymmetric Effects of Recreational Cannabis Legalization," shows the alcohol industry could be impacted when the substance is legalized.

"It appears the alcohol industry has valid reason to be concerned about legal marijuana and may need creative strategies to avoid market decline if it passes," said Pengyuan Wang, an assistant professor in the Terry College of Business at the University of Georgia.

The study shows online searches for alcohol saw a drop of nearly 11%, but tobacco products were searched online nearly 8% more often.

The U.S. alcohol and tobacco industries are worth a combined $300 billion. They are typically avid opponents of marijuana legalization legislation, but this research suggests, "tobacco companies may need to reexamine their presumption, and that anti-cannabis legalization is not to the best of their interest," said Wang.

The research by Wang and co-author Guiyang Xiong of Syracuse University looked at anonymous data from 28 million online searches and 120 million ad impressions from a leading U.S.-based web portal from January 2014 to April 2017.

The study also found the legalization of recreational marijuana increases online searches by adults by 17%. There is actually a decrease in searches done by those age 19 years and younger after the substance is legalized.

"Contrary to widely held public concern after recreational cannabis is legalized, teenagers appear to lose interest, rather than gain interest," added Wang. "Policymakers only concerned with an uptick in teen users, may want to rethink their stance."

https://www.sciencedaily.com/releases/2019/07/190717122621.htm

Cannabis treatment counters addiction: First study of its kind

Trial shows cannabis replacement therapy can be effective

July 15, 2019

Science Daily/University of Sydney

An Australian study has demonstrated that cannabis-based medication helps tackle dependency on cannabis, one of the most widely used drugs globally.

A paper about the University of Sydney and NSW Health clinical trial provides the first strong evidence that so-called cannabinoid agonist medication -- which targets receptors in the brain -- could reduce the rate of relapse.

The paper published today in the American Medical Association's JAMA Internal Medicine.

Lead author Conjoint Professor Nick Lintzeris -- of the University of Sydney's Faculty of Medicine and Health and Director of Drug & Alcohol Services, South East Sydney Local Health District -- said the study should give hope to people with dependency on cannabis, which is a leading cause of drug treatment episodes in Australia.*

"We've never had the evidence before that medication can be effective in treating cannabis dependency -- this is the first big study to show this is a safe and effective approach," Professor Lintzeris said.

"The principles are very similar to nicotine replacement; you are providing patients with a medicine which is safer than the drug they're already using, and linking this with medical and counselling support to help people address their illicit cannabis use."

The cannabis concentrate, which comprises equal proportions of cannabidiol (CBD) and the psychoactive tetrahydrocannabinol (THC), is sprayed under the tongue and avoids the health impacts associated with smoking cannabis such as respiratory issues.

Nabiximols has been primarily used to treat pain symptoms associated with multiple sclerosis and is licensed in Australia. Alternative medical cannabis products exist but these are only available through special access schemes and unlike the trial medication, also require Therapeutic Goods Administration (TGA) approval.

This large 12-week outpatient clinical trial of 128 participants taking nabiximols medication followed an earlier study by the same research team that had previously shown nabiximols reduce withdrawal symptoms in a short-term hospital treatment program. "The latest study published today is even more important in that it shows that nabiximols can be effective in helping patients achieve longer term changes in their cannabis use," Prof Lintzeris explains.

Co-author of the paper Professor Iain McGregor, the academic director of the University's Lambert Initiative for Cannabinoid Therapeutics, noted: "Worldwide we are seeing medicinal cannabis patients transition away from the traditional smoked route of cannabis administration; this new study... complements this trend by showing that an oral spray can be an effective substitute for smoked cannabis in heavy recreational users seeking treatment for their cannabis use."

Professor Lintzeris said an important element of this National Health and Medical Research Council-supported trial was that only cannabis users were recruited who had previously unsuccessfully tried to curb their use.

"Our study is an important step in addressing the lack of effective treatments -- currently, four in five patients relapse to regular use within six months of medical or psychological interventions."

Trial and medication snapshot:

- During the clinical trial, participants had an average dose of about 18 sprays a day, with each spray of 0.1mL comprising 2.7mg of THC and 2.5mg of CBD.

- Participants treated with nabiximols used significantly less illicit cannabis than patients randomly allocated to placebo medication.

- The medicine was combined with cognitive behavioural therapy (CBT) and other therapeutic support for a holistic approach.

- Health and behavioural benefits of cannabis replacement include that patients are taken out of their usual patterns of use.

- This first large outpatient randomised controlled trial of the cannabis extract medication noted suppression of withdrawal and cravings, with improvements in physical and psychological well-being.

https://www.sciencedaily.com/releases/2019/07/190715114247.htm

Science of microdosing psychedelics remains patchy and anecdotal, say researchers

July 15, 2019

Science Daily/Imperial College London

The practice of taking small, regular doses of psychedelic drugs to enhance mood, creativity, or productivity lacks robust scientific evidence, say scientists.

The process, called microdosing, has been lauded by some, with high profile proponents in Silicon Valley. But to date, scientific evidence to support or even fully explore claims of the benefits and safety, has been lacking.

Now, an international group of researchers, led by Imperial College London and Maastricht University, has approached the issue in a wide-ranging review paper, published today in the Journal of Psychopharmacology, to tackle some of the key questions -- including what is microdosing? Is it safe? Is it legal? And are the claims of benefits from taking small amounts of psychedelics even plausible?

According to the researchers, their review aims to present evidence around several themes of microdosing psychedelics, such as LSD or psilocybin (magic mushrooms), including discussions of concerns around impacts on cardiovascular health, as well as to providing a framework for future research in the area.

"Despite so much interest in the subject, we still don't have any agreed scientific consensus on what microdosing is -- like what constitutes a 'micro' dose, how often someone would take it, and even if there may be potential health effects" said Professor David Nutt, Edmond J Safra Chair in Neuropsychopharmacology at Imperial College London and senior author of the review.

Professor Nutt and the team define microdosing as the practice of taking repeated, low doses of psychedelic substance -- at doses that do not impair a person's 'normal' functioning (a fraction of 'recreational dose') -- in order to improve well-being and enhance cognitive or emotional processes.

However, in practice, frequency may vary widely -- from a few consecutive days, to weekdays -- as may strength and potency of substances depending on what it is and where it's from.

The review explains that while most reports on microdosing to date are anecdotal and have focused on positive experiences, future research should be expanded to focus on the potential risks.

Focusing on psilocybin -- the active compound in magic mushrooms -- as one of the two most commonly used psychedelic substances (alongside LSD), and being much further along the clinical pipeline to potential approval as a treatment, the team presents the available evidence on several aspects of microdosing.

Chief among the issues raised is the lack of controlled scientific studies, the standard measure in medical science -- where the effect of a treatment is measured in those taking it against a control or placebo group (who do not take the compound). The authors also cite a lack of certainty around the doses used in previous trials, as well as where the substances came from, and their potency.

Regarding safety, they claim evidence for long-term, repeated dosing of psilocybin is lacking in humans and animals, and that there is some evidence to highlight cardiovascular risks.

Similarly, the authors describe how data on the behavioural effects of microdosing, such as increased concentration or creativity, remain patchy. Early-stage research has shown psilocybin targets specific receptors in the brain which bind to serotonin -- a chemical messenger in the brain associated with feelings of happiness, as well as learning and memory. They speculate that these changes to the activity of networks of brain cells may explain some of the reported therapeutic benefits of microdosing, such as improvement in mood, memory or productivity.

Beyond the scientific issues, the legality and regulation of substances remains a significant barrier, say the researchers. Despite the renaissance in the science of psychedelic research, the drugs in the field -- chiefly psilocybin, LSD and DMT -- remain Schedule 1 Drugs under the UN Convention and Class A under the Misuse of Drugs Act in the UK. In the UK, this currently means only researchers with a licence from the Home Office are able to obtain and test substances, and anyone obtaining substances for microdosing without a licence could face prosecution.

The team hopes that the evidence laid out in their review will go some way to focus the attention of the research community in order to answer some of the major remaining questions in the field. They write "rigorous, placebo-controlled clinical studies need to be conducted with low doses of [psilocybin] to determine whether there is any evidence for the claims of microdosers."

Dr Kim Kuypers, from Maastricht University and first author of the review, said: "This review is timely as a lot of hope is generated by positive media reports about alleged effects of microdosing. Patients might feel attracted by those reports to try it but may actually not helped by it. We try to emphasise the lack of scientific proof that microdosing is indeed effective in combatting certain symptoms and hope that this will give impetus to new lines of research in this area."

Professor Nutt added: "Researchers working in the area of psychedelics regularly receive requests from the media asking about microdosing. We hope that this critique will provide answers to all these questions in future as well as providing a framework for research."

https://www.sciencedaily.com/releases/2019/07/190715103307.htm

Could marijuana be an effective pain alternative to prescription medications?

July 1, 2019

Science Daily/Taylor & Francis Group

A new study has shown how cannabis could be an effective treatment option for both pain relief and insomnia, for those looking to avoid prescription and over the counter pain and sleep medications -- including opioids.

The study, published in the Journal of Psychoactive Drugs, which looked at 1,000 people taking legalized marijuana in an American state found that among the 65% of people taking cannabis for pain, 80% found it was very or extremely helpful.

This led to 82% of these people being able to reduce, or stop taking over the counter pain medications, and 88% being able to stop taking opioid painkillers.

74% of the 1,000 interviewees bought it to help them sleep -- 84% of whom said the marijuana had helped them, and over 83% said that they had since reduced or stopped taking over-the-counter or prescription sleep aids.

The study suggests that cannabis could lower opioid use. However, the researchers caution that more needs to be done to understand the potential therapeutic benefits of cannabis.

"Approximately 20% of American adults suffer from chronic pain, and one in three adults do not get enough sleep," says Dr Gwen Wurm, Assistant Professor of Clinical Pediatrics at the University of Miami Miller School of Medicine.

Traditional over the counter medications and painkillers can help, however they may have serious side effects. Opioids depress the respiratory system, meaning that overdoses may be fatal.

"People develop tolerance to opioids, which means that they require higher doses to achieve the same effect," says Dr. Julia Arnsten, Professor of Medicine at Albert Einstein College of Medicine. "This means that chronic pain patients often increase their dose of opioid medications over time, which in turn increases their risk of overdose."

Although less common, sleeping pills can lead to dependence, and can also cause grogginess the next day, interfering with people's work and social lives.

As a consequence, some people are looking to marijuana to help with their symptoms.

To find out more about these users, Wurm and her colleagues used survey data from people who purchased cannabis from two retail stores in Colorado, US, where it is legal for both medical and recreational use -- meaning any adult over 21 with a valid government ID may purchase product.

"In states where adult use of cannabis is legal, our research suggests that many individuals bypass the medical cannabis route (which requires registering with the state) and are instead opting for the privacy of a legal adult use dispensary," says Wurm.

Although the survey was conducted among customers willing to participate -- meaning the results may not reflect the overall population of dispensary customers -- other national survey data, and data from medical patients at medical cannabis dispensaries, also demonstrate that people who use cannabis to treat symptoms both decrease and stop their use of prescription medications.

The study adds weight to the theory that widening access to medical cannabis could lower the use of prescription painkillers, allowing more people to manage and treat their pain without relying on opioid prescription drugs that have dangerous side effects.

This is backed up with other research that shows that states with medical cannabis laws have a 6.38% lower rate of opioid prescribing, and that Colorado's adult-use cannabis law is associated with a relative reduction in opioid overdose death rate from 1999 to 2010.

Wurm adds: "Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen cause GI bleeding or kidney damage with chronic use. Paracetemol (Acetaminophen) toxicity is the second most common cause of liver transplantation worldwide, and is responsible for 56,000 ER visits, 2600 hospitalizations, and 500 deaths per year in the U.S."

However, the researchers caution that more research is needed to understand the health benefits and side effects of cannabis.

"The challenge is that health providers are far behind in knowing which cannabis products work and which do not. Until there is more research into which cannabis products work for which symptoms, patients will do their own "trial and error," experiments, getting advice from friends, social media and dispensary employees," says Wurm.

https://www.sciencedaily.com/releases/2019/07/190701224523.htm

'Mystical' psychedelic compound found in normal brains of rats

June 27, 2019

Science Daily/Michigan Medicine - University of Michigan

A study in rats has revealed the presence of naturally occurring dimethyltryptamine, a hallucinogen.

In the past few years, thrill-seekers from Hollywood, Silicon Valley and beyond have been travelling to South America to take part in so-called Ayahuasca retreats. Their goal: to partake in a brewed concoction made from a vine plant Banisteriopsis caapi, traditionally used by indigenous people for sacred religious ceremonies. Drinkers of Ayahuasca experience short-term hallucinogenic episodes many describe as life-changing.

The active ingredient responsible for these psychedelic visions is a molecule called dimethyltryptamine (DMT). For the first time, a team led by Michigan Medicine has discovered the widespread presence of naturally-occurring DMT in the mammalian brain. The finding is the first step toward studying DMT -- and figuring out its role -- within the brains of humans.

"DMT is not just in plants, but also can be detected in mammals," says Jimo Borjigin, Ph.D., of the Department of Molecular and Integrative Physiology. Her interest in DMT came about accidentally. Before studying the psychedelic, her research focused on melatonin production in the pineal gland.

In the seventeenth century, the philosopher Rene Descartes claimed that the pineal gland, a small pinecone-shaped organ located deep in the center of the brain, was the seat of the soul. Since its discovery, the pineal gland, known by some as the third eye, has been shrouded in mystery. Scientists now know it controls the production of melatonin, playing an important role in modulating circadian rhythms, or the body's internal clock. However, an online search for notes to include in a course she was teaching opened Borjigin's eyes to a thriving community still convinced of the pineal gland's mystical power.

The core idea seems to come from a documentary featuring the work of researcher Rick Strassman, Ph.D. with the University of New Mexico School of Medicine. In the mid-1990s, he conducted an experiment in which human subjects were given DMT by IV injection and interviewed after its effects wore off. In a documentary about the experiment, Strassman claims that he believed the pineal gland makes and secretes DMT.

"I said to myself, 'wait, I've worked on the pineal gland for years and have never heard of this,'" she said. She contacted Strassman, requesting the source of his statement. When Strassman admitted that it was just a hypothesis, Borjigin suggested they work together to test it. "I thought if DMT is an endogenous monoamine, it should be very easy to detect using a fluorescence detector."

Using a process in which microdialysis tubing is inserted into a rat brain through the pineal gland, the researchers collected a sample that was analyzed for -- and confirmed -- the presence of DMT. That experiment resulted in a paper published in 2013.

However, Borjigin was not satisfied. Next, she sought to discover how and where DMT was synthesized. Her graduate student, Jon Dean, lead author of the paper, set up an experiment using a process called in situ hybridization, which uses a labeled complementary strand of DNA to localize a specific RNA sequence in a tissue section.

"With this technique, we found brain neurons with the two enzymes required to make DMT," says Borjigin. And they were not just in the pineal gland.

"They are also found in other parts of the brain, including the neocortex and hippocampus that are important for higher-order brain functions including learning and memory."

The results are published in the journal Scientific Reports.

Her team's work has also revealed that the levels of DMT increase in some rats experiencing cardiac arrest. A paper published in 2018 by researchers in the U.K. purported that DMT simulates the near death experience, wherein people report the sensation of transcending their bodies and entering another realm. Borjigin hopes to probe further to discover the function of naturally occurring levels of DMT in the brain -- and what if any role it plays in normal brain functions.

"We don't know what it's doing in the brain. All we're saying is we discovered the neurons that make this chemical in the brain, and they do so at levels similar to other monoamine neurotransmitters."

https://www.sciencedaily.com/releases/2019/06/190627113951.htm

Cannabidiol is a powerful new antibiotic

June 23, 2019

Science Daily/American Society for Microbiology

New research has found that Cannnabidiol is active against Gram-positive bacteria, including those responsible for many serious infections (such as Staphyloccocus aureus and Streptococcus pneumoniae), with potency similar to that of established antibiotics such as vancomycin or daptomycin. The research is presented at ASM Microbe, the annual meeting of the American Society for Microbiology.

Cannabidiol, the main non-psychoactive chemical compound extracted from cannabis and hemp plants, has been approved by FDA for the treatment of a form of epilepsy, and is being investigated for a number of other medical conditions, including, anxiety, pain and inflammation. While there is limited data to suggest Cannabidiol can kill bacteria, the drug has not been thoroughly investigated for its potential as an antibiotic.

Work led by Dr Mark Blaskovich at The University of Queensland's Institute for Molecular Bioscience's Centre for Superbug Solutions, in collaboration with Botanix Pharmaceuticals Ltd, an early stage drug discovery company investigating topical uses of synthetic cannabidiol for a range of skin conditions, found that Cannabidiol was remarkably effective at killing a wide range of Gram-positive bacteria, including bacteria that have become resistant to other antibiotics, and did not lose effectiveness after extended treatment.

"Given cannabidiol's documented anti-inflammatory effects, existing safety data in humans, and potential for varied delivery routes, it is a promising new antibiotic worth further investigation," said Dr. Blaskovich. "The combination of inherent antimicrobial activity and potential to reduce damage caused by the inflammatory response to infections is particularly attractive."

Importantly, the drug retained its activity against bacteria that have become highly resistant to other common antibiotics. Under extended exposure conditions that lead to resistance against vancomycin or daptomycin, Cannabidiol did not lose effectiveness. Cannabidiol was also effective at disrupting biofilms, a physical form of bacteria growth that leads to difficult-to-treat infections.

https://www.sciencedaily.com/releases/2019/06/190623143055.htm

Gene linked to cannabis abuse

June 18, 2019

Science Daily/Aarhus University

New research from the Danish psychiatric project, iPSYCH, shows that a specific gene is associated with an increased risk of cannabis abuse. The gene is the source of a so-called nicotine receptor in the brain, and people with low amounts of this receptor have an increased risk of cannabis abuse.

Cannabis is the most commonly used illegal drug in both Denmark and internationally, and around one in ten users becomes addicted to the drug. Researchers from iPSYCH have discovered a gene that they associate with the abuse of cannabis.

"We discovered that the disorder was associated with a genetic variant. This variant affects how much of a certain nicotine receptor is formed in the brain," explains Associate Professor Ditte Demontis from Aarhus University, who is behind the study.

The genetic variant discovered by the researchers affects how much of a specific nicotine receptor is formed. People who have less of this receptor in the brain are at greater risk of becoming cannabis abusers.

Ditte Demontis and her colleagues used a nationwide Danish cohort to analyse the complete genome of more than 2,000 cannabis abusers and the genome of 50,000 control subjects. The researchers subsequently repeated these findings in an analysis of a further 5,500 cannabis abusers and more than 300,000 control subjects.

The researchers also included genetic data from studies in which researchers examined the underlying genetics for cognition such as e.g. the ability to complete an education.

Here, they found that people with a higher number of genetic variants associated with impaired cognition also have an increased risk of cannabis abuse.

"People who abuse cannabis often do worse in the education system, and our results show that this can be partly explained by genetics. That is to say that people with an abuse problem have more genetic variations in the genome which increase the risk of cannabis abuse, while at the same time negatively affecting their ability to get an education," explains Ditte Demontis.

The study is the first of its kind on this scale and represents a step towards understanding the particular biological mechanisms, which lie behind the abuse of cannabis.

"We need to undertake even more research into how the genetic differences in the genome contribute to the development of cannabis abuse, and we need to map out the precise biological mechanisms that lead to one person having a higher risk of becoming a substance abuser than another. Our hope is to be able to improve treatment and perhaps in the long-term even prevent this abuse," says Ditte Demontis.

https://www.sciencedaily.com/releases/2019/06/190618104828.htm

Marijuana use increases, shifts away from illegal market

June 18, 2019

Science Daily/University of Washington

A new article published by researchers from University of Puget Sound and University of Washington reports that, based on analysis of public wastewater samples in at least one Western Washington population center, cannabis use both increased and substantially shifted from the illicit market since retail sales began in 2014.

Led by chemist Dan Burgard, the research team analyzed wastewater samples collected from 2013-2016 from two treatment plants that service a community of two hundred thousand in Western Washington.

"We set out to perform a wastewater-based analysis that explored the impact of newly legalized retail cannabis sales on its use, and to determine if this approach could estimate the size of the legal market place," says Burgard, who chairs the chemistry department at Puget Sound.

The researchers estimate that THC-COOH (the metabolite of psychoactive THC in cannabis created within the human body) found in wastewater has increased by 9% per quarter, on average, from December 2013 to December 2016. During this time, cannabis sales increased at nearly 70% per quarter, on average, for stores operating from August 2014 to December 2016.

"Given that wastewater represents a total population measure, these findings suggest that many established users switched very quickly from the illegal to the legal market," says Burgard. "This is the strongest statement possible regarding displacement of the illegal market."

Caleb Banta-Green, interim director and principal research scientist at University of Washington's Alcohol and Drug Abuse Institute, is a co-author of the article and was a key researcher on the project.

"This project was designed to aid the understanding of how the sales of adult recreational cannabis impact its total consumption within a population," says Banta-Green. "We believe this will be a valuable tool for local, state, national and international policy makers as they assess and consider Washington's recreational cannabis law."

In the past six years nine U.S. states (Colorado, Washington, Alaska, Oregon, Nevada, California, Maine, Massachusetts, Vermont, Michigan, and the District of Columbia), as well as the countries of Uruguay and recently Canada, have legalized the adult use of recreational cannabis.

"Existing measures, particularly surveys are subject to important biases and limitations, including potential changes in self-report as social norms change as well as very limited information on the amount of THC actually consumed," Banta-Green notes. "Wastewater based estimates help address these limitations."

The researchers note that their findings suggest that legalization is, in part, achieving one of its primary objectives which was to eliminate black market sales.

Funded in part by a grant from the National Institute on Drug Abuse, the research process included testing samples from 387 days spread over three years. The team utilized a new method that enables a complementary and potentially more timely and objective assessment of illicit drug consumption compared to existing measures.

Raw wastewater samples representing a full day are collected at a treatment plant and analyzed for drugs and their metabolites at extremely low concentrations (part per billion or part per trillion levels). These data can be used to track drug consumption trends, both legal and illegal, but not individual users. In some instances, the concentration of the metabolites can be used to "back calculate" to the actual number of doses of drug used in a particular area.

https://www.sciencedaily.com/releases/2019/06/190618174349.htm

Formation of habitual use drives cannabis addiction

Individual differences in brain systems for habitual behavior distinguish heavy cannabis users who develop an addiction

June 13, 2019

Science Daily/Elsevier

A shift from brain systems controlling reward-driven use to habit-driven use differentiates heavy cannabis users who are addicted to the drug from users who aren't, according to a study in Biological Psychiatry: Cognitive Neuroscience and Neuroimaging, published by Elsevier. The findings help explain how the brain becomes dependent on cannabis, and why not all cannabis users develop an addiction, even with long-term regular use.

In the study, researchers at the University of Electronic Science and Technology of China and University of Bonn, Germany, used brain imaging to monitor neural activity when cannabis users viewed images associated with cannabis use, referred to as drug cues. Although all of the cannabis users in the study reported heavy use, only some were dependent on the drug. Both dependent and non-dependent cannabis users had exaggerated responses in a brain region that processes reward -- the ventral striatum -- compared with people who didn't use cannabis. Interestingly, the dependent users also had larger responses in a brain region that forms habits -- the dorsal striatum.

"The present findings reflect that heavy cannabis use is promoted by changes in the brain's reward system -- however, these changes alone may not fully explain addictive use. Addictive use may rather be driven by changes in brain systems that promote habitual -- automatic -- use, which also may explain the fact that addicts continue use despite a lack of experiencing rewarding effects of the drug. As such, their behavior has become under the control of the drug cues, rather than the actual reward expectation," said lead author Benjamin Becker, PhD.

Dependent users also had increased responses in other regions throughout the brain, including regions that attribute importance to things, for example, drug cues. This suggests that the development of cannabis addiction incorporates additional brain regions that may strengthen a person's desire to seek the drug.

"Cannabis is now legal for medical and recreational use in many parts of the United States and the health impacts of this development are still being understood," said Cameron Carter, MD, Editor of Biological Psychiatry: Cognitive Neuroscience and Neuroimaging. "These findings are important insights that can help us better understand why some individuals might be more likely to become addicted to cannabis," he added.

Differentiating the unique brain circuits behind dependent cannabis use could also be useful for understanding how to combat the problem of cannabis addiction. "The identification of the dorsal striatum and habitual behavior as a driver of addiction may allow the development of more specific treatment approaches to increase treatment success," said first author Xinqi Zhou.

https://www.sciencedaily.com/releases/2019/06/190613095213.htm

Origins of cannabis smoking

Evidence from ancient burials at high elevations

June 12, 2019

Science Daily/Max Planck Institute for the Science of Human History

A chemical residue study of incense burners from ancient burials at high elevations in western China has revealed psychoactive cannabinoids. The finding provides some of the earliest evidence for the use of cannabis for its psychoactive compounds.

Cannabis has been cultivated as an oil-seed and fibre crop for millennia in East Asia. Little is known, however, about the early use and eventual cultivation of the plant for its psychoactive and medicinal properties. Despite being one of the most widely used psychoactive drugs in the world today, there is little archaeological or historical evidence for the use of marijuana in the ancient world. The current study, published in the journal Science Advances, identified psychoactive compounds preserved in 2,500-year-old funerary incense burners from the Jirzankal Cemetery in the eastern Pamirs. Researchers from the Max Planck Institute for the Science of Human History, the Chinese Academy of Sciences, and the Chinese Academy of Social Sciences have shown that people were selecting plants with higher levels of THC, and burning them as part of mortuary rituals. This is the earliest clear evidence to date of cannabis being used for its psychoactive properties.

Cannabis is one of the most infamous plants on the planet today, especially in light of rapidly changing legislation surrounding its legalisation in Europe and America. Despite the popularity of the plant for its psychoactive properties, very little is known about the earliest use or cultivation of cannabis for its mind-altering effects. Cannabis plants were cultivated in East Asia for their oily seeds and fibre from at least 4000 BC. However, the early cultivated varieties of cannabis, as well as most wild populations, have low levels of THC and other cannabinoid compounds with psychoactive properties. Therefore, it has been a long-standing mystery as to when and where specific varieties of the plant with higher levels of these compounds were first recognized and used by humans. Many historians place the origins of cannabis smoking on the ancient Central Asian steppes, but these arguments rely solely on a passage from a single ancient text from the late first millennium BC, written by the Greek historian Herodotus. Archaeologists have thus long sought to identify concrete evidence for cannabis smoking in Eurasia, but to date, there are few reliable, well-identified and properly dated examples of early cannabis use.

The researchers in the current study uncovered the early cannabis use when they sought to identify the function of ancient wooden burners discovered by archaeologists from the Chinese Academy of Social Sciences, who were excavating in the high mountainous regions of western China. The burners were recovered from 2500-year-old tombs in the Pamir mountain range. The international research team used a method called gas chromatography-mass spectrometry to isolate and identify compounds preserved in the burners. To their surprise, the chemical signature of the isolated compounds was an exact match to the chemical signature of cannabis. Moreover, the signature indicated a higher level of THC than is normally found in wild cannabis plants.

The data produced by the research effort, which brought together archaeologists and laboratory scientists from Jena, Germany and Beijing, China, provides clear evidence that ancient people in the Pamir Mountains were burning specific varieties of cannabis that had higher THC levels. The findings corroborate other early evidence for cannabis from burials further north, in the Xinjiang region of China and in the Altai Mountains of Russia. As Nicole Boivin, Director at the Max Planck Institute for the Science of Human History notes, "The findings support the idea that cannabis plants were first used for their psychoactive compounds in the mountainous regions of eastern Central Asia, thereafter spreading to other regions of the world."

Cannabis likely spread across exchange routes along the early Silk Road

The THC-containing residues were extracted from burners from a cemetery known as Jirzankal in the remote Pamir Mountains. Some of the skeletons recovered from the site, situated in modern-day western China, have features that resemble those of contemporaneous peoples further west in Central Asia. Objects found in the burials also appear to link this population to peoples further west in the mountain foothills of Inner Asia. Additionally, stable isotope studies on the human bones from the cemetery show that not all of the people buried there grew up locally.

These data fit with the notion that the high-elevation mountain passes of Central and Eastern Asia played a key role in early trans-Eurasian exchange. Indeed, the Pamir region, today so remote, may once have sat astride a key ancient trade route of the early Silk Road. The Silk Road was at certain times in the past the single most important vector for cultural spread in the ancient world. Robert Spengler, the lead archaeobotanist for the study, also at the Max Planck Institute for the Science of Human History, explains, "The exchange routes of the early Silk Road functioned more like the spokes of a wagon wheel than a long-distance road, placing Central Asia at the heart of the ancient world. Our study implies that knowledge of cannabis smoking and specific high-chemical-producing varieties of the cannabis plant were among the cultural traditions that spread along these exchange routes."

People sought and later cultivated more psychoactive varieties of cannabis for use in burial rituals

Compared to cultivated varieties, wild cannabis plants contain lower levels of THC, one of the psychoactive compounds in cannabis. It is still unclear whether the people buried at Jirzankal actively cultivated cannabis or simply sought out higher THC-producing plants. One theory is that cannabis plants will produce greater quantities of active compounds in response to increased UV radiation and other stressors related to growing at higher elevations. So people roaming the high mountainous regions may have discovered more potent wild plants there, and initiated a new kind of use of the plant.

While modern cannabis is used primarily as a recreational drug or for medical applications, cannabis may have been used rather differently in the past. The evidence from Jirzankal suggests that people were burning cannabis at rituals commemorating the dead. They buried their kin in tombs over which they created circular mounds, stone rings and striped patterns using black and white stones.

Whether cannabis also had other uses in society is unclear, though it seems likely that the plant's ability to treat a variety of illnesses and symptoms was recognized early on. Yimin Yang, researcher at the University of the Chinese Academy of Sciences in Beijing observes, "This study of ancient cannabis use helps us understand early human cultural practices, and speaks to the intuitive human awareness of natural phytochemicals in plants." Dr. Yang has studied ancient organic residues in East Asia for over ten years. He notes that "biomarker analyses open a unique window onto details of ancient plant exploitation and cultural communication that other archaeological methods cannot offer."

Professor Boivin points out that "given the modern political climate surrounding the use of cannabis, archaeological studies like this can help us to understand the origins of contemporary cultural practice and belief structures -- which, in turn, can inform policy." As Dr. Spengler observes, "Modern perspectives on cannabis vary tremendously cross-culturally, but it is clear that the plant has a long history of human use, medicinally, ritually, and recreationally, over countless millennia."

https://www.sciencedaily.com/releases/2019/06/190612165603.htm

Curbing your enthusiasm for overeating

Mouse study focuses on cannabis-like molecules that augment feeding behavior

June 11, 2019

Science Daily/University of California - Riverside

Signals between our gut and brain control how and when we eat food. But how the molecular mechanisms involved in this signaling are affected when we eat a high-energy diet and how they contribute to obesity are not well understood.

Using a mouse model, a research team led by a biomedical scientist at the University of California, Riverside, has found that overactive endocannabinoid signaling in the gut drives overeating in diet-induced obesity by blocking gut-brain satiation signaling.

Endocannabinoids are cannabis-like molecules made naturally by the body to regulate several processes: immune, behavioral, and neuronal. As with cannabis, endocannabinoids can enhance feeding behavior.

The researchers detected high activity of endocannabinoids at cannabinoid CB1 receptors in the gut of mice that were fed a high-fat and sugar -- or Western -- diet for 60 days. This overactivity, they found, prevented the food-induced secretion of the satiation peptide cholecystokinin, a short chain of amino acids whose function is to inhibit eating. This resulted in the mice overeating. Cannabinoid CB1 receptors and cholecystokinin are present in all mammals, including humans.

Study results appear in the journal Frontiers in Physiology, an open-access journal.

"If drugs could be developed to target these cannabinoid receptors so that the release of satiation peptides is not inhibited during excessive eating, we would be a step closer to addressing the prevalence of obesity that affects millions of people in the country and around the world," said Nicholas V. DiPatrizio, an assistant professor of biomedical sciences in the UCR School of Medicine who led the research team.

DiPatrizio explained that previous research by his group on a rat model showed that oral exposure to dietary fats stimulates production of the body's endocannabinoids in the gut, which is critical for the further intake of high-fat foods. Other researchers, he said, have found that levels of endocannabinoids in humans increased in blood just prior to and after eating a palatable high-energy food, and are elevated in obese humans.

"Research in humans has shown that eating associated with a palatable diet led to an increase in endocannabinoids -- but whether or not endocannabinoids control the release of satiation peptides is yet to be determined," said Donovan A. Argueta, a doctoral student in DiPatrizio's lab and the first author of the research paper.

Previous attempts at targeting the cannabinoid CB1 receptors with drugs such as Rimonabant -- a CB1 receptor blocker -- failed due to psychiatric side effects. However, the DiPatrizio lab's current study suggests it is possible to target only the cannabinoid receptors in the gut for therapeutic benefits in obesity, greatly reducing the negative side effects.

The research team plans to work on getting a deeper understanding of how CB1 receptor activity is linked to cholecystokinin.

"We would also like to get a better understanding of how specific components of the Western diet -- fat and sucrose -- lead to the dysregulation of the endocannabinoid system and gut-brain signaling," DiPatrizio said. "We also plan to study how endocannabinoids control the release of other molecules in the intestine that influence metabolism."

https://www.sciencedaily.com/releases/2019/06/190611081915.htm

Medical marijuana does not reduce opioid deaths

June 10, 2019

Science Daily/Stanford Medicine

Legalizing medical marijuana does not reduce the rate of fatal opioid overdoses, according to researchers at the Stanford University School of Medicine.

The finding contradicts a 2014 study that legal-pot advocates, public officials and even physicians have touted as a reason to legalize marijuana. That study found lower rates of fatal opioid overdoses in the states that had legalized marijuana for medical purposes than in states where marijuana remained illegal.

The Stanford study, which revisited the issue after many more states had legalized medical marijuana, found no evidence of a connection between opioid deaths and the availability of medical cannabis, said Keith Humphreys, PhD, professor of psychiatry and behavioral sciences.

"If you think opening a bunch of dispensaries is going to reduce opioid deaths, you'll be disappointed," Humphreys said. "We don't think cannabis is killing people, but we don't think it's saving people."

A paper describing the new study will be published online June 10 in Proceedings of the National Academy of Sciences. Humphreys is the senior author. The lead author is postdoctoral scholar Chelsea Shover, PhD.

Medical pot now legal in 47 states

In 1996, California became the first state to legalize medical marijuana. By 2010, 13 states, most of them in the West, had legalized medical marijuana. Today, 47 states permit some version of medical pot.

For the new study, the Stanford researchers used the same method employed in the 2014 study to evaluate the connection between legalized medical marijuana and fatal opioid overdoses. They confirmed the findings from the 2014 study, but when they looked at opioid deaths up to 2017 -- by which point most states had legalized some form of medical marijuana, if not recreational marijuana -- they found that the opposite was true: States with legal medical marijuana had a higher rate of deaths due to opioid overdose.

After the 2014 study was released, medical marijuana proponents and some public officials interpreted the results to mean that, given access to legalized pot, people would turn to it rather than opioids for pain relief or recreation. Yet when the Stanford researchers compared states that have more restrictive medical marijuana laws with those that allow recreational marijuana, they found no correlation between opioid overdose mortality and the level of restriction.

"Accounting for different types of laws didn't change the bottom line," Shover said.

Also, given that only 2.5% of the U.S. population uses medical marijuana, it's unlikely that use could affect mortality statistics, the researchers said.

'Something else about those states'

Humphreys said the results of the 2014 study may have reflected policies and conditions in states that legalized medical marijuana early. Those states tended to be wealthier and more politically liberal, with greater access to addiction treatment and to naloxone, which reverses the effects of opioids and can prevent overdose fatalities. The states that legalized pot early also incarcerate fewer people for drug use, Humphreys added. When people are released from prison, where they lack access to drugs and lose tolerance to them, they may try to use the same levels as they did before they were incarcerated, leading to overdose.

The finding of lower death rates "wasn't about the cannabis," Humphreys said. "It was something else about those states."

Humphreys and Shover said they believe that medical marijuana provides benefits and that research into its effectiveness should continue.

"There are valid reasons to pursue medical cannabis policies, but this doesn't seem to be one of them," Shover said. "I urge researchers and policymakers to focus on other ways to reduce mortality due to opioid overdoses."

https://www.sciencedaily.com/releases/2019/06/190610151933.htm

Cannabis use among older adults rising rapidly

Colorado study is first state-wide investigation of cannabis use among older Americans and the outcomes they experience

May 30, 2019

Science Daily/University of Colorado Anschutz Medical Campus

Cannabis use among older adults is growing faster than any other age group but many report barriers to getting medical marijuana, a lack of communication with their doctors and a lingering stigma attached to the drug, according to researchers.

The study, the first to look at how older Americans use cannabis and the outcomes they experience, was published this month in the journal Drugs & Aging.

"Older Americans are using cannabis for a lot of different reasons," said study co-author Hillary Lum, MD, PhD, assistant professor of medicine at the University of Colorado School of Medicine. "Some use it to manage pain while others use it for depression or anxiety."

The 2016 National Survey of Drug Use and Health showed a ten-fold increase in cannabis use among adults over age 65.

The researchers set out to understand how older people perceived cannabis, how they used it and the positive and negative outcomes associated with it.

They conducted 17 focus groups in in senior centers, health clinics and cannabis dispensaries in 13 Colorado counties that included more than 136 people over the age of 60. Some were cannabis users, others were not.

"We identified five major themes," Lum said.

These included: A lack of research and education about cannabis; A lack of provider communication about cannabis; A lack of access to medical cannabis; A lack of outcome information about cannabis use; A reluctance to discuss cannabis use.

Researchers found a general reluctance among some to ask their doctors for a red card to obtain medical marijuana. Instead, they chose to pay more for recreational cannabis.

Lum said this could be driven by feeling self-conscious about asking a doctor for cannabis. That, she said, points to a failure of communication between health care providers and their patients.

"I think [doctors can] be a lot more open to learning about it and discussing it with their patients," said one focus group respondent. "Because at this point I have told my primary care I was using it on my shoulder. And that was the end of the conversation. He didn't want to know why, he didn't want to know about effects, didn't want to know about side effects, didn't want to know anything."

Some said their doctors were unable or unwilling to provide a certificate, the document needed to obtain medical marijuana. They also said physicians need to educate themselves on the latest cannabis research.

Some older users reported positive outcomes when using cannabis for pain as opposed to taking highly addictive prescription opioids. They often differentiated between using cannabis for medical reasons and using it recreationally.

"Although study participants discussed recreational cannabis more negatively than medical cannabis, they felt it was more comparable to drinking alcohol, often asserting a preference for recreational cannabis over the negative effects of alcohol," the study said.

The researchers also found that despite the legalization of cannabis in Colorado and other states, some older people still felt a stigma attached to it.

"Some participants, for example, referred to the movie `Reefer Madness' (1936) and other anti-marijuana propaganda adverts that negatively framed cannabis as immoral and illegal," the researchers said.

The study adds to the growing literature on the diversity of marijuana use patterns in older adults, said co-author Sara Honn Qualls, PhD, ABPP, professor of psychology and director of the Gerontology Center at the University of Colorado Colorado Springs.

"Older adults who use marijuana are ingesting it in a variety of ways for multiple purposes," she said. "This and other papers from the same project show growing acceptance of marijuana use for medical purposes by older adults, and a clear desire to have their primary health providers involved in educating them about options and risks.

Lum agreed.

She said Colorado, the first state to legalize recreational marijuana, provides a unique laboratory to gauge public attitudes toward cannabis.

"From a physician's standpoint this study shows the need to talk to patients in a non-judgmental way about cannabis," she said. "Doctors should also educate themselves about the risks and benefits of cannabis and be able to communicate that effectively to patients."

https://www.sciencedaily.com/releases/2019/05/190530122019.htm

'Ecstasy' shows promise for post-traumatic stress treatment

Psychotherapy and medication proves helpful for chronic sufferers

May 30, 2019

Science Daily/University of British Columbia Okanagan campus

An international study has shown that MDMA, also known as ecstasy, may be a valuable tool for treating post-traumatic stress disorder (PTSD). The study demonstrated substantial improvements in individuals who had not responded to prior treatments. This is also, he adds, the most comprehensive evaluation of the safety and effectiveness of MDMA-assisted psychotherapy for PTSD.

An international study involving researchers from UBC Okanagan has shown that MDMA, also known as ecstasy, may be a valuable tool for treating post-traumatic stress disorder (PTSD).

Published recently in Psychopharmacology, the study demonstrated substantial improvements in individuals who had not responded to prior treatments, explains UBCO Associate Professor of psychology Zach Walsh. This is also, he adds, the most comprehensive evaluation of the safety and effectiveness of MDMA-assisted psychotherapy for PTSD.

"PTSD symptoms decreased after one session of MDMA together with psychotherapy," says Walsh, study co-author. He adds that 54 per cent of participants no longer met PTSD criteria after two sessions and that there was also improvement in their symptoms of depression.

The response of participants to MDMA-assisted psychotherapy was compared to those who received small doses or non-drug psychotherapy.

"These findings are promising and indicate the needed for larger studies," says Walsh. "Too many people with PTSD struggle to find effective treatment, and use of MDMA in a supportive environment with trained mental health professionals could be an important addition to our treatment options."

Ecstasy, also known as Molly, is the nickname for MDMA -- a synthetic drug made from a combination of methylenedioxy-methamphetamine. It is a controlled, illegal drug in Canada classified as a stimulant with hallucinogenic properties.

Walsh, as well as researchers from the United States, Switzerland and Israel, examined the results from six clinical trials, involving 103 people. Trial participants included men and women with chronic, treatment-resistant PTSD from a wide variety of causes.

Based on these results, the US Food and Drug Administration granted breakthrough therapy designation to MDMA-assisted psychotherapy for PTSD, acknowledging that it "may demonstrate substantial improvement over existing therapies" and agreeing to expedite its development and review.

The first of two more in-depth clinical trials of MDMA-assisted psychotherapy for PTSD began enrolling participants in November 2018, and aims to have 100-150 volunteers across 15 sites in the US, Canada and Israel. The second trial will take place after an interim analysis of the data from the first trial, and will enrol an additional 100-150 participants. European trials are planned to start in the near future.

Nearly four per cent of all people worldwide will suffer from PTSD during their lifetime. PTSD can be a debilitating disorder, with symptoms including intrusive thoughts and memories, negative effects on thinking and mood, depression, hyperarousal and reactivity, and avoidance. People with PTSD can experience much lower quality of life and relationships, related mental health conditions and suicidal tendencies.

https://www.sciencedaily.com/releases/2019/05/190530101215.htm

Genetic analysis of cannabis is here

May 29, 2019

Science Daily/Washington State University

Research from Washington State University could provide government regulators with powerful new tools for addressing a bevy of commercial claims and other concerns as non-medical marijuana, hemp and CBD products become more commonplace. The new analysis of the genetic and chemical characteristics of cannabis is believed to be the first thorough examination of its kind.

The current method is inadequate, says Mark Lange, a professor in WSU's Institute for Biological Chemistry. Regulators focus on levels of the psychoactive compound THC and just a handful of the more than 90 other cannabinoids. The industry makes various claims about different strains, from sedating indicas to invigorating sativas, Acapulco Gold to Zkittlez, but they defy objective analysis.

"There is a reason why all these strains have different names -- because a lot of them are very different," said Lange. "But some strains with different names are actually very similar. The bottom line is there is a lot of confusion."

Until now.

Lange and his colleagues analyzed genetic sequences from nine commercial cannabis strains and found distinct gene networks orchestrating each strain's production of cannabinoid resins and terpenes, volatile compounds behind the plant's powerful aroma.

Their research was published today in the journal Plant Physiology.

 Armed with this new tool, people can start to sort out a variety of issues that are already emerging as recreational cannabis is legal in 11 states, including the entire West Coast, and hemp is legal across the country.

Lange's analytical method, for example, can be used to clearly delineate between psychoactive cannabis and hemp, which by law has to have less than 0.3 percent THC. It might help identify the skunky smell that elicits complaints from the neighbors of pot farms, opening a way to breed and grow something easier on the nose. It can test the health claims of cannabidiol, known by the shorthand CBD, or the alleged synergy, known as the "entourage effect," between cannabis compounds.

It can truth squad your bud tender.

 "One of the things that needs to happen in the emerging market is that you know what you're selling," said Lange. "You can't just call it something and then that's good. We need to be very clear that this is the cannabinoid profile that is associated with, say, Harlequin -it has a specific cannabinoid profile, a specific terpenoid profile, and that's what it is. If it has a different name, then it should have a different profile. Currently you can do whatever you want."

Lange is an expert on trichomes, the resin-producing glands of plants like mint. But in this case, he could not touch the plant if he was to comply with federal and university policy on cannabis research. All the material was handled by EVIO Labs, a private cannabis testing company licensed by the Oregon Liquor Control Commission. Anthony Smith, an EVIO biochemist and co-author, drew RNA from each strain by abrading trichomes with glass beads and filtering the material. A third party sequenced the RNA. In the end, Lange and his team touched only a high-resolution data set that clearly marks both the genes of each strain and their end products.

https://www.sciencedaily.com/releases/2019/05/190529145039.htm

Cannabidiol significantly reduces seizures in patients with severe form of epilepsy

Study looked at two doses of cannabis-derived medication's effectiveness in Lennox-Gastaut syndrome

May 16, 2018

Science Daily/NYU Langone Health / NYU School of Medicine

Cannabidiol (CBD), a compound derived from the cannabis plant that does not produce a "high" and has been an increasing focus of medical research, was shown in a new large-scale, randomized, controlled trial to significantly reduce the number of dangerous seizures in patients with a severe form of epilepsy called Lennox-Gastaut syndrome.

In the new study comparing two doses of CBD to a placebo, the researchers reported a 41.9 percent reduction in "drop seizures" -- a type of seizure that results in severe loss of muscle control and balance -- in patients taking a 20 mg/kg/d CBD regimen, a 37.2 percent reduction in those on a 10 mg/kg/d CBD regimen, and a 17.2 percent reduction in a group given a placebo.

The phase III trial was led by principal investigator and study first co-author Orrin Devinsky, MD, a professor of neurology, neurosurgery, and psychiatry at NYU School of Medicine and director of NYU Langone's Comprehensive Epilepsy Center, and was published online May 17 in The New England Journal of Medicine.

"This new study adds rigorous evidence of cannabidiol's effectiveness in reducing seizure burden in a severe form of epilepsy and, importantly, is the first study of its kind to offer more information on proper dosing," says Dr. Devinsky. "These are real medications with real side effects, and as providers we need to know all we can about a potential treatment in order to provide safe and effective care to our patients."

The study included an investigational liquid, oral formulation of CBD called Epidiolex. The product is manufactured by GW Pharmaceuticals, which operates in the U.S. as Greenwich Biosciences; GW Pharmaceuticals funded the clinical trial.

Safety of Two CBD Doses Studied

Lennox-Gastaut syndrome is a rare and severe form of epilepsy characterized by frequent drop seizures and severe cognitive impairment. Six medications are approved to treat seizures in patients with the syndrome, but disabling seizures occur in most patients despite these treatments.

Researchers enrolled 225 patients (age 2 to 55) with Lennox-Gastaut syndrome across 30 international sites in a randomized, double-blind, placebo-controlled trial to assess the efficacy and safety of two doses of CBD: Seventy-six patients received 20 mg/kg/d CBD, 73 received 10 mg/kg/d CBD, and 76 were given a placebo. All medications were divided into two doses per day for 14 weeks. The number of seizures were monitored beginning four weeks prior to the study for baseline assessment, then tracked throughout the 14-week study period and afterwards for a four-week safety check.

Side effects occurred in 94 per of patients in the 20 mg CBD group, 84 percent in the 10 mg CBD group, and 72 percent of those taking placebo. Side effects were generally reported as mild or moderate in severity and those that occurred in more than 10 percent of patients included: sleepiness, decreased appetite, diarrhea, upper respiratory infection, fever, vomiting, nasopharyngitis, and status epilepticus. Fourteen patients taking CBD experienced dose-related, elevated liver enzymes that were reversible. Seven participants from the CBD group withdrew from the trial due to side effects compared to one participant in the placebo group.

"This landmark study provides data and evidence that Epidiolex can be an effective and safe treatment for seizures seen in patients with Lennox Gastaut Syndrome, a very difficult to control epilepsy syndrome," adds study co-first author, Anup Patel, MD, chief of Neurology at Nationwide Children's Hospital.

A study led by Dr. Devinsky published in last May's New England Journal of Medicine showed a 39 percent drop in seizure frequency in patients with a different rare form of epilepsy, Dravet syndrome. Those findings represented the first large-scale, randomized clinical trial for the compound. Open label CBD studies led by Dr. Devinsky also have shown positive results for treatment-resistant epilepsies.

In April, a U.S. Food and Drug Administration advisory panel unanimously voted to recommend approval of a new drug application for Epidiolex cannabidiol oral solution, following a meeting where researchers, including Dr. Devinsky, presented their findings. The FDA will decide whether to approve the medication in late June.

"While the news gives hope for a new treatment option to the epilepsy community, more research remains imperative to better determine the effects of CBD and other similar cannabis-derived compounds on other forms of the disease and in more dosing regimens," says Dr. Devinsky.

https://www.sciencedaily.com/releases/2018/05/180516172255.htm

Legal marijuana reduces chronic pain, but increases injuries and car accidents

Overall hospital stays remain steady after colorado legalized cannabis

May 15, 2019

Science Daily/University of California - San Francisco

The legalization of recreational marijuana is associated with an increase in its abuse, injury due to overdoses, and car accidents, but does not significantly change health care use overall, according to a study by researchers at UC San Francisco.

In a review of more than 28 million hospital records from the two years before and after cannabis was legalized in Colorado, UCSF researchers found that Colorado hospital admissions for cannabis abuse increased after legalization, in comparison to other states. But taking the totality of all hospital admissions and time spent in hospitals into account, there was not an appreciable increase after recreational cannabis was legalized.

The study, appearing online May 15, 2019, in BMJ Open, also found fewer diagnoses of chronic pain after legalization, consistent with a 2017 National Academy of Sciences report that concluded substantial evidence exists that cannabis can reduce chronic pain.

"We need to think carefully about the potential health effects of substantially enhancing the accessibility of cannabis, as has been done now in the majority of states," said senior author Gregory Marcus, MD, MAS, a UCSF Health cardiologist and associate chief of cardiology for research in the UCSF Division of Cardiology.

"This unique transition to legalization provides an extraordinary opportunity to investigate hospitalizations among millions of individuals in the presence of enhanced access," Marcus continued. "Our findings demonstrate several potential harmful effects that are relevant for physicians and policymakers, as well as for individuals considering cannabis use."

According to the 2014 National Survey on Drug Use and Health, more than 117 million Americans, or 44.2 percent of all Americans, have used cannabis in their lifetime, and more than 22 million Americans report having used it within the past 30 days. While its use is a federal crime as a controlled substance, 28 states and the District of Columbia now allow it for treating medical conditions. Nine of those states have legalized it for recreational use.

To understand the potential shifts in health care use resulting from widespread policy changes, Marcus and his colleagues reviewed the records of more than 28 million individuals in Colorado, New York and Oklahoma from the 2010-2014 Healthcare Cost and Utilization Project, which included 16 million hospitalizations. They compared the rates of health care utilization and diagnoses in Colorado two years before and two years after recreational marijuana was legalized in December 2012 to New York, as a geographically distant and urban state, and to Oklahoma, as a geographically close and mainly rural state.

The researchers found that after legalization, Colorado experienced a 10 percent increase in motor vehicle accidents, as well as a 5 percent increase in alcohol abuse and overdoses that resulted in injury or death. At the same time, the state saw a 5 percent decrease in hospital admissions for chronic pain, Marcus said.

"There has been a dearth of rigorous research regarding the actual health effects of cannabis consumption, particularly on the level of public health," said Marcus, holder of the Endowed Professorship of Atrial Fibrillation Research in the UCSF School of Medicine. "These data demonstrate the need to caution strongly against driving while under the influence of any mind-altering substance, such as cannabis, and may suggest that efforts to combat addiction and abuse of other recreational drugs become even more important once cannabis has been legalized."

The study findings may be beneficial in guiding future decisions regarding cannabis policy, the researchers said.

"While it's convenient and often most compelling to simplistically conclude a particular public policy is 'good' or 'bad,' an honest assessment of actual effects is much more complex," Marcus said. "Those effects are very likely variable, depending on each individual's idiosyncratic needs, propensities and circumstances. Using the revenues from recreational cannabis to support this sort of research likely would be a wise investment, both financially and for overall public health."

The researchers could not explain why overall health care utilization remained essentially neutral, but said the harmful effects simply may have been diluted among the much larger number of total hospitalizations. They said it also may be that some beneficial effects, either at the individual or societal level, such as violent crime, counterbalanced the negatives.

https://www.sciencedaily.com/releases/2019/05/190515110341.htm

Health and Wellness in Addiction Recovery

Story contribution by Hailey Parks

Living a healthy lifestyle is something that can easily fall to the wayside in today’s fast-paced, technology-driven society. Health and wellness can easily become something that is taken for granted. For people in recovery from addiction or alcoholism, health and wellness can be a tool used to treat mental health and help maintain sobriety. 

Addiction and Malnutrition

Those who suffer from addiction are likely to be malnourished, lacking the essential vitamins and nutrients to fuel their bodies for various reasons. 

• Opiate withdrawal can cause diarrhea, nausea, and vomiting which can lead to a lack of nutrients and an electrolyte imbalance. However, eating balanced meals during detox, including foods high in fiber, whole grain carbohydrates, and lean protein, can actually help make the detox process go smoother. 

• Alcohol abuse is one of the top causes of nutrient deficiency in the U.S. as people who abuse alcohol tend to lack B vitamins. In addition, many people who abuse alcohol can cause damage to their liver and pancreas, leading to metabolism problems. 

• Stimulants typically reduce user’s appetites causing weight loss, poor nutrition, dehydration, and electrolyte imbalances. 

Although abusing drugs or alcohol can lead to nutrient deficiencies, eating a balanced diet and getting sober can help reverse many of these issues. 

Nutrition in Recovery 

Eating a nutritious diet in early recovery can benefit both physical and mental health. For those choosing to detox, a great way to jump-start the detox process is to eat raw foods like fruits, vegetables, and nuts. Another essential aspect of making the detox process more bearable is by staying properly hydrated. 

After detox is over, it is important to keep in mind that drug or alcohol abuse can take a toll on the heart, liver, and brain. To help keep these essential organs healthy, one should consume foods like:

• Leafy greens

• Berries

• Nuts

• Avocados

• Almonds

• Dark chocolate

• Edamame

• Whole grains

• Green tea

• Beans

• Broccoli

• Lean protein

Eating this type of diet in early recovery can be especially difficult because it is common for people in recovery to crave sugary foods. When drugs and alcohol are removed, levels of dopamine drop. Eating sugar, on the other hand, can cause a surge in dopamine levels similar to that of the effects of drugs and alcohol. However, sugar can become an addiction in itself and lead to weight gain. In addition, eating excess sugar can cause fluctuating blood sugar levels. When blood sugar fluctuates up and down, a person can become anxious or depressed, causing their mental health to become unstable. When it comes to sobriety, mental health is just as important as physical health.

Exercise for Mental Clarity

Along with nutrition, exercise can be beneficial in promoting mental health in sobriety. Exercise can help boost mental health in several ways. 

• As little as 1 hour of physical activity a week is related to less anxiety and fewer drug cravings.

• Those who make exercise a regular part of their routine are less likely to suffer from depression, panic disorders, and anxiety.

• Serotonin increases during exercise which helps regulate sleep, appetite, and mood. 

• GABA and Glutamate are responsible for processing emotions and thought patterns. These chemicals are released during exercise which can prevent depression, anxiety, PTSD, and other mood disorders. 

• Exercise lowers stress and is a great outlet for mitigating negative emotions.

Keeping one’s mental health as a top priority during sobriety can help prevent relapse. After all, those who suffer from co-occurring mental illness and addiction typically have a difficult time maintaining sobriety due to the unique obstacles they face. By enjoying an active lifestyle, people in recovery can prevent their mental health symptoms from getting worse.

Mindfulness for Relaxation and Decision Making

It’s easy to let human instincts run the show when feeling anxious, but this can be a recipe for disaster in sobriety. Instead, it is important to learn how to relax in sobriety and to be mindful about making the right decisions. Mindfulness is a useful technique for relaxation and decision making that can be easily incorporated into daily routines 

Mindfulness has been proven to help alleviate stress by improving emotion regulation. When individuals have an appropriate way of regulating and processing emotions, they will be able to think clearly about decisions that need to be made. Practicing mindfulness can be as easy as laying down in a comfortable position, closing the eyes, and focusing on breathing. Another way to practice mindfulness is through looking up free mindful meditation videos on the internet. This practice will raise a person’s awareness of their body, energy, feelings, and surroundings. 

Practicing mindfulness is also attributed to:

• Increased attention and focus

• Lowered anxiety

• Relaxation

• Higher brain function

• Decreased heart rate and blood pressure

• A shift in perception and mental clarity

Health & Wellness in Maintaining Long Term Sobriety

By eating a nutritious diet, getting adequate exercise, and participating in mindful relaxation exercises, individuals help keep their mind and body healthy in sobriety. After all, people don’t get sober to feel unhealthy and depressed - people get sober to change their lifestyles for the better. Taking care of mental and physical health is a key aspect of living healthy and maintaining long term sobriety 

Hailey is a recovering alcoholic and addict who enjoys writing about addiction. After years of neglecting her physical and mental health in sobriety, she began to make dramatic changes in her lifestyle to be happier and healthier. Her passions include helping others, taking hikes with her dog, and spending time by the beach. 

Hailey Parks hailey.parks01 @ g mail .com

Health professionals wary of medicinal cannabis misuse and adverse effects

May 7, 2019

Science Daily/Queensland University of Technology

A Queensland University of Technology (QUT) analysis of studies gauging attitudes to medicinal cannabis has found that while health professionals are broadly supportive, they feel they lack clinical and legislative knowledge, and their greatest concerns are the psychiatric harm that may be caused to patients and misuse by recreational drug users.

The findings have been reported in PLOS One.

Key points:

·     26 published studies conducted in Australia, the United States, Canada, Ireland and internationally were analysed

·     These studies assessed the beliefs, knowledge and concerns about medicinal cannabis held by medical practitioners, nurses, pharmacists and allied health professionals

·     Generally, health professionals supported clinical use of medicinal cannabis, however they said they lacked knowledge across all aspects, from pharmacology and dosing to legislation around access, distribution and supply

·     Their greatest concerns about the drug were patient harm, adverse drug interactions and whether cannabis would be obtained 'medicinally' as a legal guise for recreational use

QUT pharmacy PhD researcher Kyle Gardiner led the analysis of the studies with principal supervisor Professor Lisa Nissen, Head of QUT's Faculty of Health School of Clinical Sciences.

Mr Gardiner said with cannabis moving rapidly from a criminalised product to where it may be prescribed medicinally it was important to understand the views of the health sector.

"In almost all international jurisdictions the involvement of at least one health professional is required for patients to acquire medicinal cannabis," he said.

"So, clinicians are in the crosshairs and we need to understand their behaviours and engagement.

"It is important to know their attitudes and concerns about the delivery and use of medicinal cannabis, what knowledge they have, and where they are getting their information. However, these are a few pieces of a much larger picture.

"The picture we need to build is a more robust understanding of health professional behaviour. This is an important step in recognising and better informing strategies that change the way healthcare is delivered so that patients are not disadvantaged.

"This study is one part of putting together that picture relating to medicinal cannabis."

In Australia, several forms of imported medicinal cannabis are available, to be prescribed under certain conditions and used in clinical trials.

Mr Gardiner said in the various studies examined, practitioners raised concerns around people growing cannabis for medicinal use, potential contamination, drug misuse, interactions with other drugs, and driving under the influence.

They were also concerned about psychiatric adverse effects, and in three of the studies medical practitioners believed "negative mental health outcomes were positively correlated with the use of medicinal cannabis."

However, Mr Gardiner said it wasn't clear whether the views of all health professionals were based on peer-reviewed clinical evidence or something else.

"Consistently across medicine, pharmacy and nursing, health professionals all said their knowledge of medicinal cannabis was poor," he said.

"Many highlighted a need for further education and easy-to access information. Where they felt evidence-based resources were not accessible, their knowledge was generated from online learning, news and media, and patient experiences."

Mr Gardiner said it wasn't surprising that in the more recently published studies, health professionals' views were more supportive of medicinal cannabis than those reported in older studies.

"Support did vary between jurisdictions, but there was no obvious pattern relative to the laws and leniency or strictness around cannabis in those jurisdictions.

"There was also greater support from professionals who were in specialty medical fields rather than in general or community practice."

Mr Gardiner said while broadly health professionals in the various studies expressed support for medicinal cannabis, this doesn't necessarily mean a willingness to deliver it.

"There is a fundamental difference between being supportive of medicinal cannabis and being directly responsible for its delivery. More research is needed in this area."

https://www.sciencedaily.com/releases/2019/05/190507110441.htm

The new 'runner's high'? Some often mix weed, workouts

82% of cannabis users say they partake before, after exercise

May 1, 2019

Science Daily/University of Colorado at Boulder

Eight out of 10 marijuana users in states where cannabis is legal say they partake in the drug shortly before or after exercise, and most report that it motivates them to work out, helps them enjoy exercise more and improves their recovery, according to surprising new University of Colorado Boulder research.

The paper, published Tuesday in the journal Frontiers in Public Health, is among the first to explore the complicated intersection between cannabis use and physical activity.

While many assume the former impedes the later, the data suggest otherwise.

"There is a stereotype that cannabis use leads people to be lazy and couch-locked and not physically active, but these data suggest that this is not the case," said senior author Angela Bryan, a professor in the Department of Psychology and Neuroscience and the Institute for Cognitive Science.

She stresses that she is in no way recommending using cannabis as an adjunct to exercise.

"The evidence is not there yet," she said. "But I am also not convinced it is harmful."

Marijuana is now legal for recreational use in 10 states and medicinal use in dozens more. Yet, little is known about how rising acceptance could impact public health measures like physical activity and obesity.

Some have speculated that increased use could worsen the obesity epidemic by fueling a sedentary lifestyle. On the other hand, the authors note, the World Anti-Doping Agency prohibits cannabis use in sporting competitions due to its potential to improve performance.

Anecdotally, ultrarunners sometimes use marijuana to battle nausea and boredom on long runs. And epidemiological studies show cannabis-users tend to be leaner, less prone to diabetes and have healthier blood sugar levels.

"There are a lot of interesting data points and hypotheses out there but not a lot of them have been tested," says Bryan.

In a first step toward filling the research gap, she and her colleagues surveyed 600 adult marijuana users in California, Colorado, Nevada, Oregon and Washington, asking -- among other questions -- if they ever used cannabis within one hour before or four hours after exercise.

Eighty-two percent said 'yes.'

"We were stunned it was that high," says Bryan.

A follow-up question of 345 "co-users" (people who use cannabis with exercise) found they were more likely to use it after than before. But 67% said they did both.

Among those who co-used, 70% said it increased enjoyment of exercise, 78% said it boosted recovery, and 52% said it heightened motivation.

"Given that these are all recognized barriers to exercise, it is possible that cannabis might actually serve as a benefit to exercise engagement," the authors write.

Only 38% said it boosted performance, and in fact some small previous studies have suggested it may harm it.

Notably, those who co-used also got about 43 minutes more exercise per week than those who didn't.

How might cannabis, physiologically, impact physical activity?

"There is evidence to suggest that certain cannabinoids dampen pain perception, and we also know that the receptors cannabis binds to in the brain are very similar to the receptors that are activated naturally during the runners high," said co-author Arielle Gillman, a former PhD student in Bryan's lab who recently published a review paper on the subject. "Theoretically, you could imagine that if it could dampen pain and induce an artificial 'runner's high,' it could keep people motivated."

Cannabis is also anti-inflammatory, which could aid recovery.

The study did not look at which kind of cannabis (edibles, smoked flower, etc.) people use alongside exercise.

The authors note that the survey has limitations, in that it looked only at people who use cannabis regularly and focused on states which have already legalized it.

But more research is already in the works at CU Boulder, comparing the activity levels of older adults who use cannabis with those who do not.

Preliminary results of that separate study show that after embarking on a 16-week exercise program, the cannabis users exercised more than the non-users.

"As we get older, exercise starts to hurt, and that is one reason older adults don't exercise as much," Bryan said. "If cannabis could ease pain and inflammation, helping older adults to be more active that could be another benefit."

Graduate students Sophie York Williams (first author), Charleen Gust and Raeghan Mueller, Assistant Professor Cinnamon Bidwell and Professor Kent Hutchison contributed to this study.

https://www.sciencedaily.com/releases/2019/05/190501114629.htm