THE EFFECTS OF RECREATIONAL MARIJUANA LEGALIZATION AND DISPENSING ON OPIOID MORTALITY

Publication cover image“This study documents how the changing legal status of marijuana has impacted mortality in the United States over the past two decades.

We use a difference‐in‐difference approach to estimate the effect of medical marijuana laws (MML) and recreational marijuana laws (RML) on fatalities from opioid overdoses, and we find that marijuana access induces sharp reductions in opioid mortality rates.

Our research corroborates prior findings on MMLs and offers the first causal estimates of RML impacts on opioid mortality to date, the latter of which is particularly important given that RMLs are far more expansive in scope and reach than MMLs.

In our preferred econometric specification, we estimate that RMLs reduce annual opioid mortality in the range of 20%–35%, with particularly pronounced effects for synthetic opioids. In further analysis, we demonstrate how RML impacts vary among demographic groups, shedding light on the distributional consequences of these laws.

Our findings are especially important and timely given the scale of the opioid crisis in the United States and simultaneously evolving attitudes and regulations on marijuana use.”

https://onlinelibrary.wiley.com/doi/full/10.1111/ecin.12819

“Marijuana legalization reduces opioid deaths. A new Economic Inquiry study finds that marijuana access leads to reductions in opioid-related deaths.” https://medicalxpress.com/news/2019-08-marijuana-legalization-opioid-deaths.html

Endocannabinoid System and Alcohol Abuse Disorders.

“Δ9-tetrahydrocannabinol (Δ9-THC), the primary active component in Cannabis sativa preparations such as hashish and marijuana, signals by binding to cell surface receptors. Two types of receptors have been cloned and characterized as cannabinoid (CB) receptors. CB1 receptors (CB1R) are ubiquitously present in the central nervous system (CNS) and are present in both inhibitory interneurons and excitatory neurons at the presynaptic terminal. CB2 receptors (CB2R) are demonstrated in microglial cells, astrocytes, and several neuron subpopulations and are present in both pre- and postsynaptic terminals.

The majority of studies on these receptors have been conducted in the past two and half decades after the identification of the molecular constituents of the endocannabinoid (eCB) system that started with the characterization of CB1R. Subsequently, the seminal discovery was made, which suggested that alcohol (ethanol) alters the eCB system, thus establishing the contribution of the eCB system in the motivation to consume ethanol. Several preclinical studies have provided evidence that CB1R significantly contributes to the motivational and reinforcing properties of ethanol and that the chronic consumption of ethanol alters eCB transmitters and CB1R expression in the brain nuclei associated with addiction pathways.

Additionally, recent seminal studies have further established the role of the eCB system in the development of ethanol-induced developmental disorders, such as fetal alcohol spectrum disorders (FASD). These results are augmented by in vitro and ex vivo studies, showing that acute and chronic treatment with ethanol produces physiologically relevant alterations in the function of the eCB system during development and in the adult stage. This chapter provides a current and comprehensive review of the literature concerning the role of the eCB system in alcohol abuse disorders (AUD).”

https://www.ncbi.nlm.nih.gov/pubmed/31332736

https://link.springer.com/chapter/10.1007%2F978-3-030-21737-2_6

“Binge Alcohol Exposure Transiently Changes the Endocannabinoid System: A Potential Target to Prevent Alcohol-Induced Neurodegeneration.”  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5742761/

Endogenous cannabinoid levels and suicidality in combat veterans.

Psychiatry Research“Combat veterans are at elevated suicide risk. The goal of this study was to test the hypothesis that combat veterans who have made a suicide attempt post-deployment can be distinguished from combat veterans who have never made a suicide attempt based on differences in psychological and biological variables. For the latter, we focused on endogenous cannabinoids, neuroendocrine markers that are associated with stress. Demographic and clinical parameters of suicide attempters and non-attempters were assessed. Blood samples were assayed for anandamide (AEA), 2-arachidonoylglycerol (2-AG), and cortisol. Suicide attempters had higher Scale for Suicidal Ideation (SSI) scores in comparison to non-attempters. Controlling for gender, 2-AG levels were higher among suicide attempters in comparison to non-attempters. Cortisol levels positively correlated with 2-AG levels and negatively correlated with SSI scores among non-attempters but not among attempters. AEA levels negatively correlated with SSI scores among attempters but not among non-attempters. Our results indicate that there are psychological and biological differences between combat veterans with or without a history of suicidal attempt. Our findings also suggest that clinically observed differences between the groups may have a neurobiological basis.”

https://www.ncbi.nlm.nih.gov/pubmed/31375282

https://www.sciencedirect.com/science/article/abs/pii/S0165178119315173?via%3Dihub

“Role of the Endocannabinoid System in the Neurobiology of Suicide”  https://www.ncbi.nlm.nih.gov/books/NBK107200/

Stable Adult Hippocampal Neurogenesis in Cannabinoid Receptor CB2 Deficient Mice.

ijms-logo “The G-protein coupled cannabinoid receptor 2 (CB2) has been implicated in the regulation of adult neurogenesis in the hippocampus. The contribution of CB2 towards basal levels of proliferation and the number of neural progenitors in the subgranular zone (SGZ) of the dentate gyrus, however, remain unclear. We stained hippocampal brain sections of 16- to 17-week-old wildtype and CB2-deficient mice, for neural progenitor and immature neuron markers doublecortin (DCX) and calretinin (CR) and for the proliferation marker Ki67 and quantified the number of positive cells in the SGZ. The quantification revealed that CB2 deficiency neither altered overall cell proliferation nor the size of the DCX+ or DCX and CR double-positive populations in the SGZ compared to control animals. The results indicate that CB2 might not contribute to basal levels of adult neurogenesis in four-month-old healthy mice. CB2 signaling might be more relevant in conditions where adult neurogenesis is dynamically regulated, such as neuroinflammation.”

https://www.ncbi.nlm.nih.gov/pubmed/31374821

“Cannabinoids have been linked to the regulation of adult neurogenesis (AN), a process in the mammalian brain that takes place in stem cell niches in the adult brain and is responsible for the continued generation of new neurons.”

https://www.mdpi.com/1422-0067/20/15/3759/htm

Intraperitoneal cannabidiol attenuates neonatal germinal matrix hemorrhage-induced neuroinflamtion and perilesional apoptosis.

Publication Cover“As the survival of preterm infants has increased significantly, germinal matrix hemorrhage (GMH) has become an important public health issue. Nevertheless, treatment strategies for the direct neuronal injury are still scarce. The present study aims to analyze the neuroprotective properties of cannabidiol in germinal matrix hemorrhage.

Results. Reduction of reactive astrocytosis was observed both in the perilesional area 24 hours and 14 days after the hemorrhage lesion (p < 0.001) and in the Stratum oriens of the ipsilateral hippocampal CA1 14 days after the hemorrhage lesion (p < 0.05) in the treated groups. Similarly, there was a reduction in the number of Caspase 3-positive astrocytes in the perilesional area in the treated groups 24 hours after the hemorrhage lesion (p < 0.001). Finally, we found a significant increase in the weight of the rats treated with cannabidiol.

Conclusion. The treatment of GMH with cannabidiol significantly reduced the number of apoptotic cells and reactive astrocytes in the perilesional area and the ipsilateral hippocampus. In addition, this response was sustained 14 days after the hemorrhage. These results corroborate our hypothesis that cannabidiol is a potential neuroprotective agent in the treatment of germinal matrix hemorrhage.”

Cannabis Use Motivations among Adults Prescribed Opioids for Pain versus Opioid Addiction.

Pain Management Nursing“Cannabis has been linked to reduced opioid use, although reasons for cannabis use among adults prescribed opioids are unclear.

The purpose of this study was to determine whether motivations for cannabis use differ between adults prescribed opioids for persistent pain versus those receiving opioids as medication-assisted treatment for opioid use disorder.

RESULTS:

More than half the sample (n = 122) reported current, daily cannabis use and 63% reported pain as a motivation for use. Adults with persistent pain were more likely to be older, female, and have higher levels of education (p < .05). Adults with opioid use disorder were more likely to report “enhancement” (p < .01) and relief of drug withdrawal symptoms (p < .001) as motivations for cannabis use. The most common reasons for cannabis use in both populations were social and recreational use and pain relief.

CONCLUSIONS:

Both studied populations have unmet health needs motivating them to use cannabis and commonly use cannabis for pain. Persistent pain participants were less likely to use cannabis for euphoric effects or withdrawal purposes. Nurses should assess for cannabis use, provide education on known risks and benefits, and offer options for holistic symptom management.”

https://www.ncbi.nlm.nih.gov/pubmed/31375419

https://www.painmanagementnursing.org/article/S1524-9042(19)30096-7/fulltext

Olivia Newton John says medicinal cannabis is key to her cancer recovery

“Olivia Newton-John says medicinal marijuana is a key part of her treatment for stage four cancer. In an exclusive interview with 60 Minutes reporter Liz Hayes, Newton-John says that not only has cannabis assisted with her pain management, sleep and anxiety – but it’s having affects on her physical health too. “I’m incredibly pro cannabis,” she told Liz Hayes. “If I don’t take the cannabis, I can feel the pain so I know it’s working.”

 “Newton-John is maintaining her health with a combination of conventional and alternative medicines and remedies. But her husband of ten years, John Easterling, says he’s confident medicinal cannabis is contributing significantly to maintaining her health.
Easterling, who spent years cultivating herbs from the Amazon, has long held a strong belief in the medicinal power of plants. In a greenhouse at the Santa Barbara ranch the couple share in California, he grows various strains of cannabis that he uses to help treat his wife. “Cannabis can be used for so many things,” he told Hayes. “I don’t use the word cure…. but I’m confident. We had MRIs showing a lesser number of tumours, and the majority of the other ones are shrinking.”
 “Now a cannabis convert, Newton-John is joining the fight for medicinal cannabis to be legalised. She and Easterling want Australians to have greater access to the plant, like they do in their home state of California – where both medicinal and recreational cannabis is legal.  She’s also hoping to break down the stigma surrounding cannabis use.
“It’s not a drug, it’s a herb and a plant,” she told Hayes. “I think when people use the word drug, it’s a misconception as to what it is and it gets people thinking, ‘oh it’s just another drug’, but it’s not.” Doctors at the Olivia Newton-John Research Institute will conduct a clinical trial to determine the effectiveness of medicinal cannabis later this year.”
 
 “EXCLUSIVE: Olivia Newton-John and Chloe Lattanzi emotional interview | 60 Minutes Australia” https://www.youtube.com/watch?v=rJtPgpedcFo&feature=share

“Olivia Newton-John: ‘Medicinal cannabis enhanced my quality of life’.  For this special 60 Minutes report, Olivia Newton-John tells Liz Hayes that despite her latest diagnosis she was “getting strong again” and that her quality of life had been greatly enhanced by medicinal cannabis, grown for her by her husband John. Olivia and John are strong believers in the power of plants particularly cannabis. “I really believe the cannabis has made a huge difference,” says Olivia. “I’m confident,” John concurs. Olivia, John and Chloe are now cannabis converts, and now want medicinal cannabis legalised as an alternative treatment in Australia.” https://www.9news.com.au/national/olivia-newton-john-60-minutes-medical-cannabis-advocate-after-cancer-treatment-news/da315271-7387-47e0-a14e-c7fbb9a4b18b

“I have to credit again my wonderful husband because he gives me Cannabis oil that he makes for me, grows the plants here. We’re so lucky in California that we can grow our own, and so he’s made me these incredible tinctures that help with my pain and with sleep, and everything.” https://www.today.com/video/watch-olivia-newton-john-s-full-interview-with-natalie-morales-1455610947796

 Olivia Newton-John: “The choices of your treatment is a very personal thing. I can’t tell anyone else what they should do. I’d like to tell you all something that I did that people should know about. I’ve mixed traditional medicine and herbal medicine and homoeopathic medicine and a lot of mind-body spiritual focus. Staying positive and believing I can get well is really important. I’m very fortunate that I have a husband who’s a plant medicine man who helps me with herbs and medicinal cannabis, it’s been a huge part of my journey. I weaned myself off morphine with cannabis and I just want people to know that that is possible and it’s not going to kill you. If we can start teaching people that cannabis can help keep the pain away and not kill you, that’s an important message to get out there. I want to see an end to cancer in my lifetime. I’ve had three bouts with cancer. I am living with it well, and I think I’m going to see an end of it. And that’s my dream, that it will be gone.” https://www.image.ie/life/olivia-newton-john-shares-her-advice-for-women-with-cancer-154470
 “”I want to see an end to cancer in my lifetime. And if it could be through cannabis, or helping people with cannabis, the patients, particularly who are in pain, that’s my goal. I want everyone to have access to this amazing plant”” https://www.facebook.com/watch/?v=269501097009373
 ““I truly believe medicinal cannabis will play a huge part in defeating cancer.”“I absolutely believe all patients should have the right to try. It is a matter of common-sense and it is a compassionate thing to do for people,” she said,” https://starinvesting.com.au/medicinal-cannabis-to-play-huge-role-in-beating-cancer-olivia-newton-john/
Olivia Newton-John reveals she’s using marijuana grown by her husband to fight cancer – and says reports she was on death’s door hurt her deeply. Australian singing sensation Olivia Newton-John says she has been using marijuana grown by her husband to help her through her cancer battle. ‘I really believe the cannabis has made a huge difference,'”
“‘It Has Helped Incredibly’. It’s an amazing plant, a maligned plant, but it’s helping so many people.”” https://www.inquisitr.com/5330159/home-grown-cannabis-is-helping-olivia-newton-john-amid-cancer-battle-it-has-helped-incredibly/
“Olivia Newton-John says she uses cannabis to treat her stage 4 breast cancer… and her husband grows it at home” https://www.dailymail.co.uk/tvshowbiz/article-6782847/Olivia-Newton-John-uses-cannabis-treat-stage-4-breast-cancer.html
““I’m Living With Cancer and It’s Going Away!” Olivia Newton John Declares That Her Body is “Winning” Against Stage 4 Cancer” https://www.survivornet.com/articles/im-living-with-cancer-and-its-going-away-olivia-newton-john-declares-that-her-body-is-winning-against-stage-4-cancer/
“Mainstream media has reported that the cannabis tincture she takes helps with pain, but Amazon John Easterling eagerly expounds on its many healing properties, including the potential to cause cancer cell death. “Cannabis initiates a number of healing responses that can result in apoptosis, cancer cell death—while healing and strengthening the body,” he detailed. His focus is on the plant as chemovar, a more scientific approach to looking at the many compounds, via terpene and cannabinoid extraction from the whole plant to treat the cancer and the entire body, building the immune system so it can aid in fighting the disease.“ https://culturemagazine.com/olivia-newton-john-and-john-easterling/
“Medicinal cannabis is a big part of my recovery. I’m living proof that it works. It’s a healing herb.” https://www.facebook.com/watch/?v=1580591005362546

Pharmacological and Therapeutic Properties of Cannabidiol for Epilepsy.

 “Cannabidiol (CBD) is a major active component of the Cannabis plant, which, unlike tetrahydrocannabinol (THC), is devoid of euphoria-inducing properties.

During the last 10 years, there has been increasing interest in the use of CBD-enriched products for the treatment of epilepsy.

In 2018, an oil-based highly purified liquid formulation of CBD (Epidiolex) derived from Cannabis sativa was approved by the US Food and Drug Administration for the treatment of seizures associated with Dravet syndrome (DS) and Lennox-Gastaut syndrome (LGS).

The mechanisms underlying the antiseizure effects of CBD are unclear but may involve, among others, antagonism of G protein-coupled receptor 55 (GPR55), desensitization of transient receptor potential of vanilloid type 1 (TRPV1) channels, and inhibition of adenosine reuptake. CBD has complex and variable pharmacokinetics, with a prominent first-pass effect and a low oral bioavailability that increases fourfold when CBD is taken with a high-fat/high-calorie meal.

In four randomized, double-blind, parallel-group, adjunctive-therapy trials, CBD given at doses of 10 and 20 mg/kg/day administered in two divided administrations was found to be superior to placebo in reducing the frequency of drop seizures in patients with LGS and convulsive seizures in patients with DS.

Preliminary results from a recently completed controlled trial indicate that efficacy also extends to the treatment of seizures associated with the tuberous sclerosis complex.

The most common adverse events that differentiated CBD from placebo in controlled trials included somnolence/sedation, decreased appetite, increases in transaminases, and diarrhea, behavioral changes, skin rashes, fatigue, and sleep disturbances.

About one-half of the patients included in the DS and LGS trials were receiving concomitant therapy with clobazam, and in these patients a CBD-induced increase in serum levels of the active metabolite norclobazam may have contributed to improved seizure outcomes and to precipitation of some adverse effects, particularly somnolence.”

https://www.ncbi.nlm.nih.gov/pubmed/31372958

https://link.springer.com/article/10.1007%2Fs40265-019-01171-4

A phase 1/2, open-label assessment of the safety, tolerability, and efficacy of transdermal cannabidiol (ZYN002) for the treatment of pediatric fragile X syndrome.

 

Image result for journal of neurodevelopmental disorders“Fragile X syndrome (FXS) is characterized by a range of developmental, neuropsychiatric, and behavioral symptoms that cause significant impairment in those with the disorder.

Cannabidiol (CBD) holds promise as a potential treatment for FXS symptoms due to its safety profile and positive effects on a number of emotional and behavioral symptoms associated with FXS.

The aim of the current study was to evaluate the safety, tolerability, and initial efficacy of ZYN002, a transdermal CBD gel, in a pediatric population with FXS.

RESULTS:

The majority of treatment-emergent AEs (reported by 85% of participants) were mild in severity (70%), and no serious adverse events were reported. There was a statistically significant reduction in ADAMS total score from screening to week 12 and significant reductions on nearly all other secondary endpoints, including all ADAMS subscales (except depressed mood), all ABC-CFXS subscale scores (e.g., social avoidance, irritability), PARS-R total severity score, and PedsQL total score.

CONCLUSIONS:

ZYN002 was well tolerated and produced clinically meaningful reductions in anxiety and behavioral symptoms in children and adolescents with FXS. These findings support further study of ZYN002 in a randomized, well-controlled trial for the treatment of behavioral symptoms of FXS.”

https://www.ncbi.nlm.nih.gov/pubmed/31370779

https://jneurodevdisorders.biomedcentral.com/articles/10.1186/s11689-019-9277-x

β-Caryophyllene Mitigates Collagen Antibody Induced Arthritis (CAIA) in Mice Through a Cross-Talk between CB2 and PPAR-γ Receptors.

biomolecules-logo “β-caryophyllene (BCP) is a cannabinoid receptor 2 (CB2) agonist that tempers inflammation.

An interaction between the CB2 receptor and peroxisome proliferator-activated receptor gamma (PPAR-γ) has been suggested and PPAR-γ activation exerts anti-arthritic effects.

The aim of this study was to characterize the therapeutic activity of BCP and to investigate PPAR-γ involvement in a collagen antibody induced arthritis (CAIA) experimental model.

BCP significantly hampered the severity of the disease, reduced relevant pro-inflammatory cytokines, and increased the anti-inflammatory cytokine IL-13. BCP also decreased joint expression of matrix metalloproteinases 3 and 9. Arthritic joints showed increased COX2 and NF-ĸB mRNA expression and reduced expression of the PPARγ coactivator-1 alpha, PGC-1α, and PPAR-γ. These conditions were reverted following BCP treatment.

Finally, BCP reduced NF-ĸB activation and increased PGC-1α and PPAR-γ expression in human articular chondrocytes stimulated with LPS. These effects were reverted by AM630, a CB2 receptor antagonist.

These results suggest that BCP ameliorates arthritis through a cross-talk between CB2 and PPAR-γ.”

https://www.ncbi.nlm.nih.gov/pubmed/31370242

https://www.mdpi.com/2218-273X/9/8/326

“β-caryophyllene (BCP) is a common constitute of the essential oils of numerous spice, food plants and major component in Cannabis.”   http://www.ncbi.nlm.nih.gov/pubmed/23138934

“Beta-caryophyllene is a dietary cannabinoid.”   https://www.ncbi.nlm.nih.gov/pubmed/18574142