Shifting Perspectives toward Cannabis!
Original: June 19, 2018; Latest Update: Oct. 22, 2019;
Driven over time by the popular belief and change in public opinion, marijuana is now more accepted in many states to relieve some medical & mental ailments. Its medicinal purposes include, among others, "relieving "pain, nausea or other ailments," ease the side effects of chemotherapy, improve appetite, & help with PTSD, anxiety, or seizure. Without much "substantive national discussion" and federal interventions, millions are using "marijuana in lieu of prescription drugs," to treat a variety of conditions like glaucoma, epilepsy, chronic pain, as well as the side effects of chemotherapy (Paddock, 2018).
Political Backdrop: It all started back in 2013, when the US government stopped "enforcing its federal drug laws" in those states with legalized pot. Then in the following year, the Congress struck out all the "legislative riders" to congressional budget bills that would employ federal laws to ban marijuana use in those 33 states with legalized weed. Since then, the Justice Department "remains unwilling or unable" to challenge those state-related legalized pot policies directly. As a result, the pot industry continued to grow into today's Wild West of the cannabis market as we know it. So many state legislatures have legalized marijuana - well past the point of "blanket prohibition." (Gottlieb, 2019).
Cannabis Efficacy: Though THC is the main psychoactive compound in marijuana, Mounting evidence of the public-health consequences from regular marijuana use, especially among children and expectant mothers should give politicians pause. Studies show that regular use of THC affects memory, executive function and psychological well-being. The recent lung injuries and deaths from vaping confirm the market becoming a wild west of potent and shadowy products. THC remain illegal under federal law with no middle ground allowing federal agencies to scrutinize these compounds for their manufacturing, marketing and safety. Congress should allow for careful regulated access for uses that fall outside FDA-approved drug indications - take marijuana out of the existing paradigm for drug scheduling. Though it will continue to be legalized for recreational use, THC should be regulated - the potency of THC compounds, the forms they take, how they are manufactured, and who can make purchases(Gottlieb, 2019)..
Research Challenges: Given the dearth of scientific challenging bogus medical claims or establishing legitimate clinical uses for THC is thin. Getting legal access to marijuana for federally sanctioned drug research requires cumbersome registration and record keeping. The supply also has to come from a tightly regulated source controlled by the fed. According to scientists, the product for research is substantially substandard in potency, and other features from what is sold in states with legalized pots. The weak state bodies sanction such an assertion of authority might be hard to sustain without clear laws and firm-political support. Any federal regulation need to be backed up with oversight and vigorous enforcement to keep the black market from flourishing. Expanding access to marijuana for legitimate medical research would allow more scientists either to validate or dispel the myriad claims about marijuana therapeutic usefulness. Whatever medical claims are made should be subject to the same federal standards applied to other drugs (Gottlieb, 2019).
CBD as Derivative of Marijuana: Surged in popularity back in 2014, CBD or Cannabidiol was the byproduct of a federal law which enables the states to investigate hemp's "growth, cultivation, and marketing. It is form of cannabis with marginal levels of THC - the high potency compound (ingredient) in marijuana. Accordingly, the law initiated a surge in hemp-derived CBD which was further extended and legalized in the 2018 farm bill (Roland, 2019).
The US CBD or Cannabidiol sales have more than tripled between 2014 and 2017 to $367 million. By 2022, the market is projected to grow to $1.3 billion, according to New Frontier Data (cannabis market intelligence). Experts expect CBD products to go "mainstream," as an ingredient in the cannabis-infused coffee, tea, snacks, and other beverages and food. Over the same period, CBD-infused Edibles will account for 40% of the Cannabis market; Oils 34%; and Pills 13%. In a recent 2019 National Restaurant Association survey, over 75% of US chefs consider CBD in the top food trend (Roland, 2019).
CBD Edibles & FDA Enforcement: One underpinning that solidifies the value of cannabis for its medicinal benefit is the CBD. It comes from hemp which is a type of cannabis containing 0.3 percent or less of tetrahydrocannabinol or THC. With extreme low level of the THC potency, the CBD was touted as for its healing attributes (Roland, 2019).
In its edible food classification, the federal government didn't enforce any FDA regulations. However, the equation have changed. Though, the ideology and the science of consuming the CBD in edible formats stand, there is new twist to the federal government ruling. As an active ingredient in Epidiolex (epilepsy drug), it is illegal to infuse federally-approved "pharmaceutical drug ingredients" to food and drink products. Accordingly, restaurants, cafes, and bars might be "shut down" if featuring CBD-infused food and drinks. In states like Ohio, Maine, North Carolina, Georgia and Michigan, & New York, local inspectors are "cracking down" on establishments that serves CBD-edibles (Roland, 2019).
CBD Edibles & FDA Regulatory Confusion: The CBD-infused Epidiolex drug is creating a regulatory nightmare, threatening the 2022 projected $1.3 billion in sales. Natural ingredients like CBD are "rarely" used as active ingredients in pharmaceutical drugs. However, drugs like Vascepa with its fish-oil derivative as active ingredient might provide precedence. The fish-oil derivative was classified first as food, then used as drug. So CBD-infused producers and sellers are "banking" on such validation. The FDA acknowledges the need for regulations to accommodate CBD as a food ingredient. Though there is no "straightforward process," alternatives are explored like regulating high-concentrated CBD as pharmaceuticals while lower-concentration CBD as food and dietary supplements. Federally-approved pharmaceutical products and edible products should be regulated "appropriately in their different ways." (Roland, 2019).
Cannabis' use "cuts across a slew of social and economic backgrounds." California was the first state "to legalize medical use in 1996. Since then, another thirty-two states allow the medical use of marijuana. More often than not, users can acquire marijuana with a doctor's note. In addition to smoking the cannabis, it is extracted into oils and tinctures. Or, it is infused into foods and drinks.
According to the 2016 US Department of Health and Human Services study, more than 24 million individuals ages 12 and older reported using cannabis in the last 30 days - 90% for recreational use, 10% for medical reasons, and 36% for both. In the same context, many conservatives label this trend as "Big Marijuana." Cannabis is now widely accepted, as it is commonly inscribed for its medical benefits when sold. Its proponents were successful in framing its use from "a loser in a basement" to someone "sick grandmother," claims Kevin Sabet, former senior advisory to the Office of National Drug Control Policy.
The "Big Marijuana" is large business, with as many as 135,0000 individuals working across the country. It is an industry of $1.8 billion in federal income taxes & $300 million in state sales taxes. Wage earners are in higher tax rates than traditional workers, because of an IRS ruling pertaining to fight drug traffickers.
Medical Safety and Efficacy: Viewed as medical issue, many states would like to consider physicians as the "singular access point" for marijuana. However, many medical associations are unanimously against physicians being the prescribers of marijuana. They insist on scientific studies to validate the indication & dosage for marijuana and its compounds within the context of both individual & population health risks. After all, physicians are to "first do no harm." To date, there are no clear studies for medical studies benefits in using marijuana.
Due to a 1971 U.S. Congress Act, marijuana (cannabis), along with other known compounds like heroin, are classified as Schedule I drug. Such schedule is mainly assigned for substances with the highest potential for abuse and addiction. It is also for those compounds with unknown, scientific medical value. With such alarming underpinnings, peer-reviewed wide-scale scientific studies are prohibited. It is illegal to engage in any federal testing, unless it is rescheduled to allow for "significant controlled, & replicable scientific testing" at the federal level (Ropp, 2019).
As a result, such clinical & administrative limitations have arrested the medical community to consider marijuana for any medicinal reasons (Ropp, 2019). According to the Drug Enforcement Administration, there is "no currently accepted medical use and a high potential for abuse"(Hughes, 2018).
But, medical advocates are seeking ways "to de-stigmatize it, especially on the social impact side." They point to recent efforts by the Congress to prohibit the federal government from interfering with any state-regulated medical marijuana system." They hope the Congress will lower marijuana's classification as a schedule I drug (Hughes, 2018).
Across Borders & Ponds: Far to our north, the Canadian's government is about to legalize cannabis use. The government will vote on this "legalization measure," after years of research about its effects. The Canadian approach has been different from the US system, which is known for its criminalization and stigmatization of marijuana use. Fearing similar political polarization, the Canadian government had "much learned from the early mistakes made by some US states and other jurisdictions." It is aware of the "national challenge with cannabis" across the border. Across the pond, Britain approved the medicinal use of cannabis for patients with "exceptional need" like children with epilepsy.
Debate Perspectives: Marijuana is now accepted in many states as a relief for some medical & mental ailments. Its use "cuts across social and economic backgrounds." However, jurisdictions vary in "defining which medical conditions to treat with cannabis. In Canada and several American states, the legalization of medical use has eased (or undone) the restrictions on recreational use.
California was the sixth state "to legalize" recreational marijuana - Alaska, Colorado, Nevada, Oregon, and Washington "paved the way" (Fuller, 2019). Since then, another thirty-two states allow the medical use of marijuana. With the 2018 mid-election around the corner, voters in Michigan and North Dakota will head to the polls to vote whether to legalize marijuana for recreational use - just like Colorado and Washington State before. Unfortunately, voters, medical experts, and lawmakers alike lack any conclusive answers about its effects on public health and safety (Legal Marijuana, 2018).
Though Colorado and Washington State both have legalized marijuana use since 2014, any valuable lessons from both states about the drug's effects are either limited or mixed. Contrary to earlier predictions, Colorado high school students' use of marijuana is the same since 2013. According to 2017 state studies, Colorado's high school students who used the drug in the past 30 days was 19.4 percent - close to the 19.8 percent nationally. For older adults age 18 to 25, their utilization rate has increased (Legal Marijuana, 2018)
Food Labeling Standards with THC Mold: The State of Nevada will usher in the 2019 with new labeling requirements for all cannabis-based food products. This move is in line with Nevada's continued efforts for stringent regulations regarding edible marijuana products. Edible packages are already set to include warning label. However, these new labeling standards are "an extra safeguard against underage consumption." According to Kristin Ehasz of Even Cannabis Company., the new marijuana regulations will require the THC warning symbol printed onto all edible marijuana-infused products (Walker, Patrick, 2018).
Warning Labels: An early 2017 review from the National Academies of Sciences, Engineering and Medicine found "significant health risks associated with using cannabis & cannabinoils." Cannabidiol is the official name of CBD, a nonintoxicating hemp extract, acting as a pain reliever, anti-anxiety, & anti-inflammatory (Caraway, 2019). Yet none of those supporters of legalized medical or recreational marijuana sought "adequate warning labels" to avoid danger of such risks. To add credence to the marijuana industry, its medical & retail providers should clearly display such risks on all products/services & marketing and public service announcements. This is akin to the earlier days of cigarettes for which "the health risks were known but not disclosed" - masking the trends in disease and lives lost of more than 480,000 deaths a year. This is in addition to subsequent spending of millions of dollars to re-educating misled consumers.
Pressures to use CBD-infused products are mounting from the marketplace, employers, and peers, with clients requesting CBD-infused products. Whether to use CBD-infused products for medicinal reasons is fraught with both "confusion and tension," as confronting forces are colliding with efficacy. There are not much data about the safety or effectiveness of CBD-infused products. Debates about CBD-efficacy or effectiveness abound, with a number of elements are at play (Walton, 2019):
- Changing and conflicting legislation on cannabis;
- State of research on CBD-infused product;
- Consumer demand, markets, and profits;
- Potential professional, ethical, or jurisdictional constraints on CBD use;
- Profits for CBD vendors and "CBD" up charging;"
- CDD-infused efficacy compared to other treatments;
- Lack of oversight of product potency, purity, and safety;
Understandably, it is a charged topic. Rushed with information, the acceptance of CBD-infused products is hard to navigate. According to a study at U. Penn, nearly 70% of products tested were mislabeled. Since not all products are equally tested for purity, potency, labeling, safety, and effectiveness issues, concerns about CBD-based products are further exacerbated, especially about unknown CBD-drug interactions. For now, however, it is accepted as a solution for pain and anxiety management/(Walton, 2019).
The following is unedited excerpt of DJ Jaffe article...
In the report "The Health Effects of Cannabis and Cannabinoids,'' the findings show that marijuana is especially damaging for individuals who are "either prone or have" a mental illness. Also, the report found "either substantial or moderate evidence of association between the use of cannabis and development of schizophrenia or other psychoses; increased symptoms of mania and hypo mania in individuals diagnosed with bipolar disorders; increased risk for the development of depressive disorders; and increased incidences of suicidal idealization, attempts and completions."
In early 2017, after exhaustive review, the National Academies of Sciences, Engineering, and Medicine found that there are significant health risks associated with using cannabis and cannabinoids. Yet none of the 33 states that have legalized medical marijuana, or the 10 states that have legalized recreational use, gives adequate warnings of those risks.
The academies, founded by Congress, comprise the country’s leading researchers. They have become the nation’s most reputable arbiters of the science that should guide policy. The findings of the report, "The Health Effects of Cannabis and Cannabinoids," were particularly disturbing for people prone to mental illness and those who have a mental illness.
The report found either substantial or moderate evidence of an association between cannabis use and the development of schizophrenia or other psychoses; increased symptoms of mania and hypo mania in individuals diagnosed with bipolar disorders; increased risk for the development of depressive disorders; and increased incidence of suicidal idealization, attempts and completions. Schizophrenia and bipolar disorders are two of the most devastating neurological disorders and the ones that are often associated with homelessness and incarceration. If there is an association with using legalized marijuana, shouldn’t the public be warned?
The risks are not limited to mental impairments alone. The reviewers found substantial evidence of an association between cannabis smoking and worse respiratory symptoms, more frequent chronic bronchitis episodes, increased risk of motor vehicle crashes, and lower birth weight of the offspring of those who use cannabis and cannabinoids. For pediatric populations, there is moderate evidence of an association between cannabis use and increased risk of overdose injuries, including respiratory distress.
In the rush to legalize and decriminalize marijuana, these risks are largely being ignored. Washington and Colorado were the first states to legalize recreational marijuana. While both warn pregnant mothers not to use it, the only other significant warning on the packaging is that there “may be health risks,” a watered-down mealy mouthed warning that fails to give consumers the concrete information they need to avoid danger.
While the National Academies found "association," association is not the same as causality. Perhaps the increased risk of schizophrenia developing is because those who are prone to schizophrenia also are prone to use these products.
Government Cannabis Research: A number of states are taking the fore to medical or recreational marijuana utility. In SC, a number of SC legislators are exploring ways to open more research on medical uses for marijuana - another step forward to losing state's attitudes toward the drug. SC is one of the latest states to allow the legalization of marijuana for treatment of critically ill patients
Marijuana-related measures have made strides in SC in recent years - pushing for effort to pass a law allowing patients with severe epilepsy to legally possess cannabidiol, or CBD, a non-psychoactive oil derived from marijuana. Such measures implores the federal lawmakers to "take immediate and additional steps to promote and actively pursue scientific research and testing into the potential use of cannabis to treat other medical conditions and illness by removing the federal statutory and regulatory barriers that prevent these scientific endeavors. Many lawmakers of both parties support the prospect of medical uses of cannabis, with the right testing, procedures, and caution - not embraced in other states of medical marijuana.
There are legitimate medical uses for cannabis derivatives or compounds. and toward expanding safe uses for treatments including marijuana with the government needs to make more cannabis available for research and about the effectiveness of cannabis for veterans suffering from post-traumatic stress disorder that are resistant to other treatments - safety and efficacy of cannabis (Kinnard, 2019).
The use of marijuana for medical purposes is gaining public support. In SC, several polls have shown the majority of the 5 million individuals favor legalization of marijuana for medical use. According to a Benchmark Research poll last month, about 72 percent of 400 SC polled supported legalization, including 84 % of Democrats, 78% of independents and 63% of Republicans
While some on the liberal side are pushing for legalization, others on the conservative side are warning about 'basically the decriminalization of marijuana. Attorney General Alan Wilson, along with the State Law Enforcement Division Chief Mark Keel oppose the Compassionate Care Act. They are also joined by the S.C. Medical Association, SC Sheriff's Association and other coalition who are lobbying against bills in both the House and Senate to legalize it. The alliance of law enforcement and doctors could be potent.
The medical association which represents 6,000 of the state's 18,000 physicians argues that physicians should be the threshold for medical marijuana as it is a medicine recognized by the US Food and Drug Administration. Dr. March Seabrook, president of the medical association noted that "The Compassionate Care Act is not about medicine ... as "marijuana is a plant and a drug ... Marijuana is not a medication. But, he favors lowering marijuana from Schedule I to a Schedule 2 drug. But he called for "more comprehensive research" to conduct. Law enforcement officials fear it would open a venue of problems such as drugged driving, as well as a step toward legalization of marijuana for recreational use. Keel, the Sled chief, remarked "there are 5 million people in SC ... to not be victims of the unintended consequences of this bill.
SC is poised to become the 34th state to legalize marijuana for medical use after the CCA pass both the House and Senate. After five years of fighting for patients to have access to medical marijuana, there might be a bill conservative and restrictive enough for legislators to not vote for it - especially when an overwhelming majority of their constituents support this bill, according to Jamel Ralph of Conway, chairwoman of Compassionate South Carolina . If passed, "the most conservative in the country,' its program would be administered by the SC DHEC with SLED oversight - it will also bans the sale, use, or distribution of marijuana in its leaf form. - it wouldn't be legal to smoke it. The bill would allow possession of derivatives such as oil up to the equivalent of 2 ounces of pot - would be sold in free-standing outlets in all 4 counties (Wilkinson, 2019).
DJ Jaffe, author of “Insane Consequences: How the Mental Health Industry Fails the Mentally Ill,” is executive director of Mental Illness Policy Org. Follow him on Twitter: @MentalIllPolicy
As a side note, Thailand has recently approved the use of medical cannabis. Upon effect next year, the legislation would allow the use of cannabis under medical supervision. This was a surprisingly move, given the "region hard-line approach to drugs and strict penalties for drug-related crimes." Recreational use will remain illegal (Olarn & Goldschmidt, 2018). It is up to five years in prison for possession of 10 kilograms or less.
For "our nation's 20 million veterans," many are denouncing "the refusal of the V.A. to offer cannabis as an alternative" to opioids. According to a 2017 American Legion survey, about 20 percent of them have self-reportedly used cannabis to self-treat PTSD, chronic pain and other ailments." (Williamson, 2019).
Hemp and marijuana are related, albeit not identical. More and more, individuals are attesting to CBD, for its medicinal and healing value. Mike Sims has lost 30 pounds over the last two-month regimen of cannabidiol, better known as CBD. The pain in his knees, feet, and ankles from playing sports and being overweight has subsided significantly. His cholesterol dropped 400 points, reversing a diagnosis of prediabetes. The owner of Charlotte CBD at Five Points believes in consumer awareness through education and expertise. From a medical perspective, Mike teamed up with a network of doctors for consumer's awareness and medical contraindication. He will add a licensed physician who can prescribe/offer medical cannabis cards. From quality control, his products are put through rigorous testing - all are tested for purity by a lab at Wingate University. From education perspective, he will hold classes about the medicinal value of cannabis. Though CBD is not yet regulated, such derivative medication is being used to help certain types of childhood epilepsy, insomnia, anxiety, and chronic pain. With individuals looking for better pain relief in an era of opioid epidemic, they are more looking for CBD as a natural pain relief. They are finding out better options to pursue (Sponsored, 2019)
To be Continued...
References:
Carraway, Kate. (2019, Jan. 10). Millennials By the 6-Pack. NY Times, p. D1, D2 - Sparkling water spiked with CBD is the latest entry into the wellness market.
Fuller, Thomas. (2019, Jan. 3). Californians Voted for Legal Cannabis, but Good Luck Getting Them to Buy It. NY Times, p. A.16
Gottlieb, Scott. (2019, Oct. 11). Pot Legalization Makes Vaping Deadly. [Opinion]. WSJ, p. A19
Jaffe, DJ. (2019, Jan. 9). Marijuana needs warning labels like tobacco for associated mental, physical health risks. USA Today, https://www.usatoday.com/story/opinion/2019/01/08/marijuana-warning-labels-legalization-warn-health-risks-tobacco-mental-column/2496077002/
Hawkins, Steve. (2018, Nov 1). Opposing View: States lead the way with marijuana legalization. [Opinion]. USA Today, p. 5A
Hughes, Trevor. (2018, June 7). Canada is expected to legalize marijuana. USA Today, Pg. 3A
Kinnard, Meg. AP . (2019, Jan. 11). SC panel advances bill on medical pot research. The State, p. 3A
Legal Marijuana: Our View: On Election Day, will two more states go to pot? [Opinion]. USA Today, p. 5A
Ropp, John C. III. (2019, Jan. 13). SC should avoid another drug crisis by not rushing to approve medical marijuana. The State, p. 1C
Olarn, Kocha & Goldschmidt, Debra. (2018, Dec. 25). Health: Thailand approves medical marijuana. CNN,
Paddock, Richard C. (2018, Dec. 27). Thailand to Permit Use of Medical Marijuana. NY Times, p. A5 - Legislation Awaits Approval by the King.
Roland, Denise. (2019, March 29). Business News: Food Containing Cannabis Extract Runs Into a Snag. WSJ, p. B6
Sponsored. (2019, Oct 16-22). From Charlotte to Columbia: New Store Brings Power of CBD to Five Points. free times, p. 23
Walker, Patrick. (2018, Dec. 26). Local News: New regulation says edible marijuana products have to be marked with special symbol. LasVegasNow.com, https://www.lasvegasnow.com/news/local-news/new-law-says-edible-marijuana-products-have-to-be-marked-with-special-symbol/1676047125
Walton, Tracy. (2019, Oct). Contributor: How To Explain Why You Don't Use CBD. Massage Today, www.massagetoday.com, Issue 224, Vol. 19, No. 8, p. 8, 9
Wilkinson, Jeff. (2019, Jan. 24). Attorney general, SLED chief oppose medical marijuana. The State, p. 1A, 2A
Williamson, Elizabeth. (2019, June 4). Once an Enemy, Now a Promoter of Legalized Pot. NY Times, p. A1, A15
Supplement Readings:
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Don't legalize recreational marijuana in my state. Marijuana is still a harmful mind-altering drug.