tag:theconversation.com,2011:/global/topics/thc-29805/articlesTHC – The Conversation2024-03-22T12:31:27Ztag:theconversation.com,2011:article/2249032024-03-22T12:31:27Z2024-03-22T12:31:27ZLab tests show THC potency inflated on retail marijuana in Colorado<figure><img src="https://images.theconversation.com/files/582213/original/file-20240315-18-4mmw21.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">An analysis of 23 cannabis samples from 10 dispensaries found a majority had at least 30% less THC than they were reported to have.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/selection-of-cannabis-and-legal-medical-royalty-free-image/1210433696">Zenkyphoto/iStock via Getty Images Plus</a></span></figcaption></figure><p>Cannabis flower sold in Colorado claims to contain much more tetrahydrocannabinol, or THC, than it actually does, according to <a href="https://doi.org/10.1371/journal.pone.0282396">my findings</a> published in the peer-reviewed journal Plos One. </p>
<p>THC is the psychoactive compound that is derived when cannabis flower – commonly referred to as “bud” – is heated through smoking or cooking.</p>
<h2>Why it matters</h2>
<p>Accurate THC reporting is a linchpin for medical patients, recreational consumers and the overall integrity of the cannabis industry. Medical and recreational flower is generally the same – the difference is in testing requirements, price, taxes and purchase limits. Misleading potency information can disrupt medical dosages, misguide recreational users and erode trust in an industry <a href="https://www.theguardian.com/business/2023/oct/08/cannabis-companies-us-financial-system-banking-safer-act">striving for legitimacy</a>. </p>
<p>Consumers often associate <a href="https://doi.org/10.1186/s42238-022-00117-0">higher THC levels in cannabis flower with superior quality</a>, potentially leading to overpayment for products that may not meet their expectations. This misconception can also create incentives for <a href="https://doi.org/10.3389/fpubh.2022.893009">cultivators, testing labs and dispensaries</a> to generate higher THC numbers – whether through cultivation techniques or through testing fraud.</p>
<p>Additionally, testing for <a href="https://www.cannabisbusinesstimes.com/news/state-testing-maine-medical-cannabis-samples-contain-contaminants/">toxins, pesticides and total yeast and mold</a> can also fall victim to falsification. Recent reports reveal instances where labs in <a href="https://www.syracuse.com/marijuana/2023/09/nys-testing-failures-expose-legal-weed-consumers-to-unsafe-cannabis-a-serious-health-threat.html">New York</a> and <a href="https://mjbizdaily.com/marijuana-lab-testing-analysis-finds-routine-thc-inflation-data-manipulation/">other states</a> have passed products that should have failed. This casts doubt on the credibility of the broader testing processes in place. </p>
<h2>How I did my work</h2>
<p>I gathered a total of 23 cannabis flower samples from 10 dispensaries across the northern Colorado Front Range, which includes Denver, Fort Collins and Garden City. The samples encompassed 12 strains, including indica, sativa and hybrid types, and varied in reported THC values. Some had ranges, such as 12.8%-19.3% on the lower end and 28.07%-31.28% on the higher end, while others had single values, such as 16.4% or 17.4%.</p>
<p>I sent the samples to a third-party testing lab that does <a href="https://chem.libretexts.org/Bookshelves/Analytical_Chemistry/Supplemental_Modules_(Analytical_Chemistry)/Instrumentation_and_Analysis/Chromatography/High_Performance_Liquid_Chromatography">high-performance liquid chromatography</a>, or HPLC. HPLC is a method to separate, identify and quantify components in mixtures based on their chemical properties. It is the most commonly used method in cannabis testing to analyze <a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/cannabinoid">cannabinoids</a> and detect contaminants. This can ensure product potency, safety and quality.</p>
<p><a href="https://doi.org/10.1371/journal.pone.0282396">Approximately 70% of the labels</a> reported THC percentages more than 15% higher than what was quantified through the lab. </p>
<p>Among the 23 flower samples analyzed, 18 displayed lower THC levels than reported – with 16 falling below 15% of the stated value, 13 falling below 30% of the reported THC and three samples falling below half of the reported THC. Notably, only one sample had slightly higher THC than reported. Four were within the reported range.</p>
<p>The observed disparity was not due to aging. When THC ages and degrades, it turns into cannabinol, or CBN. CBN was not found in measurable amounts in any of the samples, however, and further testing indicated stable THC levels over time. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/582298/original/file-20240315-20-14twiy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Cannabis buds in a miniature toy shopping cart" src="https://images.theconversation.com/files/582298/original/file-20240315-20-14twiy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/582298/original/file-20240315-20-14twiy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/582298/original/file-20240315-20-14twiy.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/582298/original/file-20240315-20-14twiy.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/582298/original/file-20240315-20-14twiy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=504&fit=crop&dpr=1 754w, https://images.theconversation.com/files/582298/original/file-20240315-20-14twiy.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=504&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/582298/original/file-20240315-20-14twiy.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=504&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Cannabis shoppers often conflate high THC with superior quality.</span>
<span class="attribution"><a class="source" href="https://www.istockphoto.com/photo/purple-cannabis-buds-gm1297291078-390472048">Yarphoto/iStock</a></span>
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<h2>What still isn’t known</h2>
<p>A fundamental query looms large: With advancements in cultivation techniques, including lighting, nutrients and selective breeding, has the potency of cannabis flower genuinely surged over the past 15 years? </p>
<p>THC levels <a href="https://doi.org/10.1016/j.bpsc.2020.12.016">averaged 9.75% back in 2009</a>, based on testing of DEA-seized cannabis flower. Today, levels reportedly <a href="https://doi.org/10.1186/s42238-024-00220-4">surpass 35%</a>, though they’re not as common as consumers have been led to believe. DEA-seized cannabis flower <a href="https://doi.org/10.1016/j.bpsc.2020.12.016">averaged 13.88% in 2019</a>, which is closer to my observed mean of 14.98% than the reported mean of my samples, which was 20.27%-24.10%.</p>
<p>We also do not know who is responsible for the misinformation regarding inflated THC potency for cannabis flower. It could be cultivators or dispensaries selecting the best flowers to test. Sampling guidelines differ by state, but all require a random sample from the entire batch. But there is little to no oversight when it comes to enforcing these guidelines. It could also be lab fraud. Facilities might manipulate the testing process or doctor numbers on the certificate of analysis to ensure repeat business from producers and distributors who set prices based on THC content, or to generate new customers.</p>
<h2>What’s next</h2>
<p>I believe a critical next step is for the cannabis industry to educate consumers on how to make more informed choices by looking beyond mere THC percentages. People generally do not shop for wine or beer based on alcohol content. Instead of focusing on THC content, a novice cannabis consumer might consider brands that are reputable or strains that have an aroma or flavor profile they enjoy. Eventually, they may move on to find a favorite breeder or grower, or a trusted dispensary that employs a knowledgeable budtender. A budtender is akin to a bartender in a dispensary setting, serving as a customer representative.</p>
<p>Cannabis consumers, industry players and the public must also continue to <a href="https://talkingjointsmemo.com/proving-the-biggest-mass-cannabis-story-of-2023/">advocate for better oversight</a> in sampling and testing to ensure <a href="https://commonwealthbeacon.org/marijuana/marijuana-content-labels-cant-be-trusted/">safety, transparency and accountability</a> and to foster trust from the cannabis community.</p><img src="https://counter.theconversation.com/content/224903/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Anna Schwabe is a board member for the Agricultural Genomics Foundation, not-for-profit group.
She also worked for Mile High Labs following post graduation, but was not involved in lab testing for this study.</span></em></p>Misleading potency labels can disrupt medical dosages, misguide recreational users and erode trust in the industry.Anna Schwabe, Associate Lecture Professor of Modern Cannabis Science, University of Colorado BoulderLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1982202023-02-22T12:54:26Z2023-02-22T12:54:26ZPeople produce endocannabinoids – similar to compounds found in marijuana – that are critical to many bodily functions<figure><img src="https://images.theconversation.com/files/510907/original/file-20230217-380-5ni8j3.jpg?ixlib=rb-1.1.0&rect=30%2C38%2C5077%2C3339&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A healthy endocannabinoid system is critical to the human body’s immune functions.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/older-hispanic-woman-lifting-weights-in-living-room-royalty-free-image/546825853?phrase=energy%20exercise&adppopup=true">Jose Luis Pelaez Inc/Digital Vision via Getty Images</a></span></figcaption></figure><p>Over the past two decades, a great deal of attention has been given to marijuana – also known as pot or weed. As of early 2023, marijuana has been <a href="https://www.usnews.com/news/best-states/articles/where-is-marijuana-legal-a-guide-to-marijuana-legalization">legalized for recreational use in 21 states</a> and Washington, D.C., and the use of <a href="https://www.mayoclinic.org/healthy-lifestyle/consumer-health/in-depth/medical-marijuana/art-20137855">marijuana for medical purposes</a> has grown significantly during the <a href="https://nap.nationalacademies.org/catalog/24625/the-health-effects-of-cannabis-and-cannabinoids-the-current-state">last 20 or so years</a>. </p>
<p>But few people know that the human body naturally produces chemicals that are very similar to delta-9-tetrahydrocannabinol, or THC, the psychoactive compound in marijuana, which comes from the <a href="https://doi.org/10.3389/fpls.2016.00019"><em>Cannabis sativa</em> plant</a>. These substances are called endocannabinoids, and they’re <a href="https://doi.org/10.3390%2Fani9090686">found across all vertebrate species</a>. </p>
<p>Evolutionarily, the appearance of endocannabinoids in vertebrate animals predates that of <em>Cannabis sativa</em> by <a href="https://doi.org/10.1300/J175v02n01_04">about 575 million years</a>. </p>
<p>It is as if the human body has its own version of a marijuana seedling inside, constantly producing small amounts of endocannabinoids.</p>
<p>The similarity of endocannabinoids to THC, and their importance in maintaining human health, have raised significant interest among scientists to further study their role in health and disease, and potentially use them as therapeutic targets to treat human diseases.</p>
<p>THC <a href="https://doi.org/10.1038/sj.bjp.0706406">was first identified</a> in 1964, and is just one of more than 100 compounds found in marijuana that are <a href="https://www.cdc.gov/marijuana/health-effects/index.html">called cannabinoids</a>.</p>
<p><a href="https://doi.org/10.1016/j.tips.2015.02.008">Endocannabinoids were not discovered</a> until 1992. Since then, research has revealed that they are critical for many important physiological functions that <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3997295/">regulate human health</a>. An imbalance in the production of endocannabinoids, or in the body’s responsiveness to them, <a href="https://doi.org/10.1111%2Ffebs.12260">can lead to major clinical disorders</a>, including obesity as well as neurodegenerative, cardiovascular and inflammatory diseases. </p>
<p>We <a href="https://scholar.google.com/citations?user=jJVj3sUAAAAJ&hl=en">are immunologists</a> who have been <a href="https://scholar.google.com/citations?user=af7TahQAAAAJ&hl=en">studying the effects of marijuana cannabinoids and vertebrate endocannabinoids</a> on inflammation and cancer for more than two decades. <a href="https://doi.org/10.1016%2Fj.phrs.2009.03.019">Research in our laboratory</a> has shown that endocannabinoids <a href="https://theconversation.com/what-is-inflammation-two-immunologists-explain-how-the-body-responds-to-everything-from-stings-to-vaccination-and-why-it-sometimes-goes-wrong-193503">regulate inflammation</a> and other immune functions. </p>
<h2>What is the endocannabinoid system?</h2>
<p>A variety of tissues in the body, including brain, muscle, fatty tissue and immune cells, <a href="https://pubmed.ncbi.nlm.nih.gov/19675519/">produce small quantities of endocannabinoids</a>. There are <a href="https://doi.org/10.1016/j.phrs.2009.03.019">two main types of endocannabinoids</a>: anandamide, or AEA, and 2-arachidonoyl glycerol, known as 2-AG. Both of them can activate the body’s cannabinoid receptors, which receive and process chemical signals in cells. </p>
<p>One of these receptors, called CB1, is <a href="https://doi.org/10.3390%2Fijms19030833">found predominantly in the brain</a>. The other, called CB2, is <a href="https://doi.org/10.4155/fmc.09.93">found mainly in immune cells</a>. It is primarily through the activation of these two receptors that endocannabinoids control many bodily functions.</p>
<p>The receptors can be compared to a “lock” and the endocannabinoids a “key” that can open the lock and gain entry into the cells. All these endocannabinoid receptors and molecules together are referred to as the endocannabinoid system. </p>
<p>The cannabis plant contains another compound called cannabidiol, or CBD, which has <a href="https://theconversation.com/cbd-is-not-a-cure-all-heres-what-science-says-about-its-real-health-benefits-186901">become popular</a> for its medicinal properties. Unlike THC, CBD doesn’t have psychoactive properties because it <a href="https://doi.org/10.1146%2Fannurev-neuro-070815-014038">does not activate CB1 receptors in the brain</a>. Nor does it <a href="https://doi.org/10.1038/sj.bjp.0707442">activate the CB2 receptors</a>, meaning that its action on immune cells is independent of CB2 receptors. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/511480/original/file-20230221-2556-95l7i5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Textbook illustration of the human endocannabinoid system, highlighting the role of CB1 and CB2 receptors." src="https://images.theconversation.com/files/511480/original/file-20230221-2556-95l7i5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/511480/original/file-20230221-2556-95l7i5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=960&fit=crop&dpr=1 600w, https://images.theconversation.com/files/511480/original/file-20230221-2556-95l7i5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=960&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/511480/original/file-20230221-2556-95l7i5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=960&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/511480/original/file-20230221-2556-95l7i5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1206&fit=crop&dpr=1 754w, https://images.theconversation.com/files/511480/original/file-20230221-2556-95l7i5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1206&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/511480/original/file-20230221-2556-95l7i5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1206&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Endocannabinoid receptors are found throughout most of the human body.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/illustration/human-endocannabinoid-system-vertical-royalty-free-illustration/1178997969">About time/iStock via Getty Images Plus</a></span>
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<h2>Role of endocannabinoids in the body</h2>
<p>The euphoric “high” feeling that people experience when using marijuana comes from THC activating the CB1 receptors in the brain. </p>
<p>But when endocannabinoids activate CB1 receptors, by comparison, they do not cause a marijuana high. One reason is that the body <a href="https://doi.org/10.1038/npp.2017.130">produces them in smaller quantities</a> than the typical amount of THC in marijuana. The other is that <a href="https://doi.org/10.1021%2Fcr0782067">certain enzymes break them down</a> rapidly after they carry out their cellular functions.</p>
<p>However, there is growing evidence that certain activities may release mood-elevating endocannabinoids. Some research suggests that the relaxed, euphoric feeling you get after exercise, called a “<a href="https://theconversation.com/the-runners-high-may-result-from-molecules-called-cannabinoids-the-bodys-own-version-of-thc-and-cbd-170796">runner’s high</a>,” results from the <a href="https://www.scientificamerican.com/article/new-brain-effects-behind-runner-s-high/">release of endocannabinoids</a> <a href="https://runningmagazine.ca/health-nutrition/new-study-confirms-endorphins-arent-the-cause-of-the-runners-high/">rather than from endorphins</a>, as previously thought.</p>
<p>The endocannabinoids <a href="https://doi.org/10.3390/ijms22179472">regulate several bodily functions</a> such as sleep, mood, appetite, learning, memory, body temperature, pain, immune functions and fertility. They control some of these functions by regulating nerve cell signaling in the brain. Normally, nerve cells communicate with one another at junctions called synapses. The endocannabinoid system in the brain regulates this communication at synapses, which explains its ability to affect a wide array of bodily functions. </p>
<h2>The elixir of endocannabinoids</h2>
<p>Research in our laboratory has shown that <a href="https://doi.org/10.1002/eji.201546181">certain cells of the immune system produce endocannabinoids</a> that can regulate inflammation and other immune functions through the activation of CB2 receptors.</p>
<p>In addition, we have shown that <a href="https://doi.org/10.1124/mol.108.047035">endocannabinoids are highly effective in lessening the debilitating effects of autoimmune diseases</a>. These are diseases in which the immune system goes haywire and <a href="https://medlineplus.gov/autoimmunediseases.html">starts destroying the body’s organs and tissues</a>. Examples include <a href="https://medlineplus.gov/multiplesclerosis.html">multiple sclerosis</a>, <a href="https://doi.org/10.1124/mol.108.047035">lupus</a>, <a href="https://www.hopkinsmedicine.org/health/conditions-and-diseases/hepatitis">hepatitis</a> and <a href="https://www.niams.nih.gov/health-topics/arthritis">arthritis</a>. </p>
<p>Recent research suggests that migraine, fibromyalgia, irritable bowel syndrome, post-traumatic stress disorder and bipolar disease are all <a href="https://doi.org/10.1089/can.2016.0009">linked to low levels of endocannabinoids</a>.</p>
<p>In a 2022 study, researchers found that a defect in a gene that helps produce endocannabinoids causes <a href="https://doi.org/10.1038/s41467-022-31168-9">early onset of Parkinson’s disease</a>. Another 2022 study linked the same gene defect to <a href="https://doi.org/10.1093/brain/awac223">other neurological disorders</a>, including developmental delay, poor muscle control and vision problems. </p>
<p>Other research has shown that people with a defective form of CB1 receptors <a href="https://doi.org/10.1371/journal.pone.0187926">experience increased pain sensitivity</a> such as migraine headaches and suffer from sleep and memory disorders and anxiety. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/510714/original/file-20230216-14-6r2f4a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/510714/original/file-20230216-14-6r2f4a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/510714/original/file-20230216-14-6r2f4a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=495&fit=crop&dpr=1 600w, https://images.theconversation.com/files/510714/original/file-20230216-14-6r2f4a.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=495&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/510714/original/file-20230216-14-6r2f4a.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=495&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/510714/original/file-20230216-14-6r2f4a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=622&fit=crop&dpr=1 754w, https://images.theconversation.com/files/510714/original/file-20230216-14-6r2f4a.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=622&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/510714/original/file-20230216-14-6r2f4a.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=622&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The endocannabinoid system – consisting of the endocannabinoids and the cannabinoid receptors – regulates nerve cell communication at the synapse, thereby playing a role in a variety of bodily functions.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/illustration/endocannabinoid-system-royalty-free-illustration/1392987232?phrase=endocannabinoid%20system&adppopup=true">Carolina Hrejsa, CMI/iStock/Getty Images Plus via Getty Images</a></span>
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<h2>The likeness between marijuana and endocannabinoids</h2>
<p>We believe that the medicinal properties of THC may be linked to the molecule’s ability to compensate for a deficiency or defect in the production or functions of the endocannabinoids. </p>
<p>For example, scientists have found that people who experience certain types of chronic pain may have <a href="https://doi.org/10.3390/molecules27144662">decreased production of endocannabinoids</a>. People who consume marijuana for medicinal purposes <a href="https://www.nationalacademies.org/news/2017/01/health-effects-of-marijuana-and-cannabis-derived-products-presented-in-new-report">report significant relief from pain</a>. Because the THC in marijuana <a href="https://dx.doi.org/10.1001/jama.2018.16202">is the cannabinoid that reduces pain</a>, it may be helping to compensate for the decreased production or functions of endocannabinoids in such patients. </p>
<p>Deciphering the role of endocannabinoids is still an emerging area of health research. Certainly much more research is needed to decipher their role in regulating different functions in the body. </p>
<p>In our view, it will also be important to continue to unravel the relationship between defects in the endocannabinoid system and the development of various diseases and clinical disorders. We think that the answers could hold great promise for the development of new therapies using the body’s own cannabinoids.</p><img src="https://counter.theconversation.com/content/198220/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Prakash Nagarkatti receives funding from the National Institutes of Health and the National Science Foundation. </span></em></p><p class="fine-print"><em><span>Mitzi Nagarkatti receives funding from National Institutes of Health. </span></em></p>A THC-like substance that occurs naturally in humans and other vertebrates helps maintain immunity, memory, nerve function and more – and research suggests a lack of it can harm health.Prakash Nagarkatti, Professor of Pathology, Microbiology and Immunology, University of South CarolinaMitzi Nagarkatti, Professor of Pathology, Microbiology and Immunology, University of South CarolinaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1869062022-11-02T12:29:49Z2022-11-02T12:29:49ZCannabis holds promise for pain management, reducing the need for opioid painkillers – a neuropharmacology expert explains how<figure><img src="https://images.theconversation.com/files/477967/original/file-20220808-82349-qkr00w.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C5760%2C3325&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The cannabis plant produces both THC – the psychoactive component in marijuana – and the compound commonly known as CBD, which does not lead to a 'high.'</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/marijuana-leaves-background-royalty-free-image/1329249971?adppopup=true">Jena Ardell/Moment via Getty Images</a></span></figcaption></figure><p>Drug overdose deaths from opioids <a href="https://www.cdc.gov/nchs/pressroom/nchs_press_releases/2021/20211117.htm">continue to rise in the U.S.</a> as a result of both the misuse of <a href="https://www.hhs.gov/opioids/about-the-epidemic/index.html">prescription opioids and the illicit drug market</a>. </p>
<p>But an interesting trend has developed: <a href="https://www.upmc.com/media/news/071221-drake-cannabisrcl">Opioid emergency room visits</a> drop by nearly 8% and <a href="https://doi.org/10.1007%2Fs11606-018-4782-2">opioid prescriptions</a> are modestly lower in <a href="https://www.usatoday.com/story/news/nation/2022/10/06/how-many-states-have-legalized-marijuana-cannabis-laws-unpacked/8200166001/">states where marijuana is legalized</a>. </p>
<p>Marijuana is produced by the cannabis plant, which is native to Asia but is now grown throughout the world. Individuals use marijuana for both its psychoactive, euphoria-inducing properties and its ability to <a href="https://doi.org/10.1002/j.1552-4604.1975.tb02348.x">relieve pain</a>. </p>
<p>Chemicals produced by the cannabis plant are commonly known as cannabinoids. The <a href="https://www.nccih.nih.gov/health/cannabis-marijuana-and-cannabinoids-what-you-need-to-know">two primary cannabinoids</a> that occur naturally in the cannabis plant are THC – the psychoactive compound in marijuana – and CBD, which does not cause the sensation of being high.</p>
<p>Many <a href="https://doi.org/10.1377/hlthaff.2018.05266">marijuana users say</a> they take it to treat pain, suggesting that readily available cannabinoids could potentially be used to offset the use of opioids such as morphine and oxycodone that are commonly used in pain treatment. A safer, natural alternative to opioid painkillers would be an important step toward <a href="https://www.cdc.gov/drugoverdose/epidemic/index.html">addressing the ongoing opioid epidemic</a>. </p>
<p>Intriguingly however, research suggests that cannabis use could also lessen the need for opioids directly by interacting with the body’s own natural <a href="https://doi.org/10.1097/j.pain.0000000000002527">opioid system</a> to produce similar pain-relief effects.</p>
<p>I am <a href="https://pharmacology.uw.edu/team-member/benjamin-land/">a neuropharmacology scientist</a> who <a href="https://scholar.google.com/citations?user=dux-xtoAAAAJ&hl=en">studies both opioids and cannabinoids</a> as they relate to pain treatment and substance abuse. My research focuses on the development of drug compounds that can provide chronic pain relief without the potential for overuse and without the tapering off of effectiveness that often accompanies traditional pain medications.</p>
<h2>How opioids work</h2>
<p>Our bodies have their own built-in opioid system that can aid in managing pain. These opioids, <a href="https://www.health.harvard.edu/mind-and-mood/endorphins-the-brains-natural-pain-reliever">such as endorphins</a>, are chemicals that are released when the body experiences stress such as strenuous exercise, as well as in response to pleasurable activities like eating a good meal. But it turns out that humans are not the only organisms that can make opioids. </p>
<p>In the 1800s, scientists discovered that <a href="https://www.history.com/topics/crime/history-of-heroin-morphine-and-opiates#">the opioid morphine</a> – isolated from opium poppy – was highly effective at relieving pain. In the last 150 years, scientists have developed additional synthetic opioids like hydrocodone and dihydrocodeine that also provide pain relief.</p>
<p>Other opioids like heroin and oxycodone are very similar to morphine, but with small differences that influence how quickly they act on the brain. Fentanyl has an even more unique chemical makeup. It is <a href="https://www.dea.gov/factsheets/fentanyl">the most powerful opioid</a> and is the culprit behind the <a href="https://theconversation.com/what-is-fentanyl-and-why-is-it-behind-the-deadly-surge-in-us-drug-overdoses-a-medical-toxicologist-explains-182629">current surge in drug overdoses and deaths</a>, <a href="https://www.uclahealth.org/news/adolescent-drug-overdose-deaths-rose-exponentially-first">including among young people</a>.</p>
<p>Opioids, whether naturally produced or synthetic, produce pain relief by binding to specific receptors in the body, which are proteins that act like a lock that can only be opened by an opioid key.</p>
<p>One such receptor, <a href="https://doi.org/10.1124%2Fpr.112.007138">known as the mu-opioid receptor</a>, is found on pain-transmitting nerve cells along the spinal cord. When activated, mu-receptors tamp down the cell’s ability to relay pain information. Thus, when these opioids are circulating in the body and they reach their receptor, stimuli that would normally cause pain are not transmitted to the brain.</p>
<p>These same receptors are also found in the brain. When opioids find their receptor, the brain releases <a href="https://www.health.harvard.edu/mind-and-mood/feel-good-hormones-how-they-affect-your-mind-mood-and-body">dopamine – the so-called “feel-good” chemical</a> – which has its own receptors. This is in part why opioids can be highly addicting. Research suggests that these receptors drive the <a href="https://doi.org/10.1016/j.biopsych.2019.05.023">brain’s reward system</a> and promote further drug-seeking. For people who are prescribed opiates, this creates the potential for abuse. </p>
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<figcaption><span class="caption">Opioid drugs, which include heroin, oxycodone and fentanyl, are highly addictive.</span></figcaption>
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<p>Opioid receptors are dynamically regulated, meaning that as they get exposed to more and more opioids, the body adapts quickly by deactivating the receptor. In other words, the body needs more and more of that opioid to get pain relief and to produce the feel-good response. This process is known as tolerance. The drive to seek more and more reward paired with an ever-increasing tolerance is what leads to the potential for overdose, which is why opioids are generally not long-term solutions for pain. </p>
<h2>The potential of THC and CBD for pain treatment</h2>
<p>Both THC and CBD have been shown in <a href="https://doi.org/10.2174/157015906778019527">numerous</a> <a href="https://pubmed.ncbi.nlm.nih.gov/20073408/">studies</a> to lessen pain, though – importantly – they differ in which receptors they bind to in order to produce these effects.</p>
<p>THC binds to cannabinoid receptors that are located throughout the central nervous system, producing a variety of responses. One of those responses is the high associated with cannabis use, and another is pain relief. Additionally, THC is believed to reduce inflammation in a manner <a href="https://theconversation.com/how-do-painkillers-actually-kill-pain-from-ibuprofen-to-fentanyl-its-about-meeting-the-pain-where-its-at-173804">similar to anti-inflammatory drugs like ibuprofen</a>. </p>
<p>In contrast, CBD appears to bind to <a href="https://doi.org/10.1111/bcpt.13710">several distinct receptors</a>, and many of these receptors can play a role in pain reduction. Importantly, this occurs without the high that occurs with THC. </p>
<p>Because they target different receptors, THC and CBD may be more effective working in concert <a href="https://doi.org/10.3390/ijms23158649">rather than alone</a>, but more studies in <a href="https://doi.org/10.2217/pmt-2020-0110">animal models and humans are needed</a>.</p>
<p>Cannabinoids may also be helpful for other conditions as well. Many studies have demonstrated that cannabinoid drugs approved for medical use are effective for pain and other symptoms like <a href="https://www.ninds.nih.gov/health-information/disorders/spasticity#">spasticity</a>, nausea and <a href="https://doi.org/10.1186/s12916-022-02459-1">appetite loss</a>.</p>
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<figcaption><span class="caption">The opioid crisis: Painkillers are killing us.</span></figcaption>
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<h2>Moving pain research forward</h2>
<p>Along with the pairing of THC and CBD, researchers are beginning to explore the use of those two cannabinoids together with existing opioids for pain management. This research is being done in <a href="https://doi.org/10.1038/s41386-022-01322-4">both animal models and humans</a>. </p>
<p>These studies are designed to understand both the benefits – pain relief – and risks – primarily addiction potential – of co-treatment with cannabinoids and opioids. The hope would be that THC or CBD may lower the amount of opioid necessary for powerful pain relief without increasing addiction risk.</p>
<p>For example, one study tested the <a href="https://doi.org/10.1038/s41386-018-0011-2">combination of smoked cannabis and oxycontin</a> for pain relief and reward. It found that co-treatment enhanced pain relief but also increased the pleasure of the drugs. This, as well as a limited number of other <a href="https://doi.org/10.1038/s41386-022-01322-4">studies</a>, suggests there may not be a net benefit.</p>
<p>However, many more studies of this type will be necessary to understand if cannabinoids and opioids can be safely used together for pain. Still, using cannabinoids as a substitution for opioids remains a promising pain treatment strategy. </p>
<p>The next decade of research will likely bring important new insights to the therapeutic potential of cannabinoids for chronic pain management. And as <a href="https://www.politico.com/news/2022/08/03/cannabis-legalization-efforts-across-the-states-00049224">marijuana legalization continues to spread</a> across the U.S., its use in medicine will undoubtedly grow exponentially.</p><img src="https://counter.theconversation.com/content/186906/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Benjamin Land receives funding from the NCCIH for cannabinoid work distinct from opioids, and has received cannabinoid related funding from the University of Washington Addiction and Drug Abuse Institute and SCAN Design Foundation.</span></em></p>Studies suggest that marijuana and CBD use might help relieve chronic pain while also reducing a patient’s need for opioids.Benjamin Land, Research Associate Professor of Pharmacology, School of Medicine, University of WashingtonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1919382022-10-13T15:36:45Z2022-10-13T15:36:45ZLegalizing cannabis led to increased cannabis poisonings in Canadian children. It could get a whole lot worse.<figure><img src="https://images.theconversation.com/files/488215/original/file-20221005-14-dt3gfq.JPG?ixlib=rb-1.1.0&rect=326%2C33%2C7176%2C4634&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Federal Health Minister Jean-Yves Duclos, Mental Health and Addictions Minister and Associate Minister of Health Carolyn Bennett and MP Nathaniel Erskine-Smith (right) listen as Morris Rosenberg, chair of the independent review board on the impact of legalization of cannabis, speaks at a news conference in Ottawa on Sept. 22. </span> <span class="attribution"><span class="source">THE CANADIAN PRESS/Adrian Wyld</span></span></figcaption></figure><iframe style="width: 100%; height: 100px; border: none; position: relative; z-index: 1;" allowtransparency="" allow="clipboard-read; clipboard-write" src="https://narrations.ad-auris.com/widget/the-conversation-canada/legalizing-cannabis-led-to-increased-cannabis-poisonings-in-canadian-children--it-could-get-a-whole-lot-worse-" width="100%" height="400"></iframe>
<p>When Canada <a href="https://laws-lois.justice.gc.ca/eng/acts/c-24.5/">legalized non-medical cannabis</a> <a href="https://www.theglobeandmail.com/cannabis/article-cannabis-legalization-day-one-live/">four years ago</a>, there was enormous uncertainty about how legalization could impact the health of Canadians. Since then, there has been increasing evidence that legalization has resulted in some negative health effects. The clearest of these is a large increase in accidental cannabis poisonings in young children. </p>
<p>We conducted two large studies that found a nine-fold increase in <a href="https://doi.org/10.1001/jamanetworkopen.2021.42521">emergency department</a> visits and a six-fold increase in <a href="https://doi.org/10.1056/NEJMc2207661">hospitalizations for cannabis poisoning</a> in children younger than 10 years (average age of 3.5 years) following cannabis legalization in Canada. These increases have been so substantial that cannabis is now a leading cause of hospitalizations for poisoning in this age group.</p>
<p>The government of Canada has just <a href="https://www.theglobeandmail.com/politics/article-federal-government-to-look-at-public-health-impact-of-cannabis/">launched a mandated federal review of the health and social impacts of cannabis legalization</a>. We argue that addressing the impacts of legalization on the health of Canadians must take precedence over the financial concerns of the cannabis industry, which are demonstrated by their <a href="https://cannabis-council.ca/advocacy">growing calls</a> to <a href="https://www.bnnbloomberg.ca/cannabis-canada-weekly-lobbying-ottawa-ahead-of-the-cannabis-act-review-stocks-suffer-decline-1.1715123">roll back or remove government regulations</a> in the <a href="https://www.canada.ca/en/health-canada/news/2022/09/government-of-canada-launches-legislative-review-of-the-cannabis-act.html">upcoming review</a>.</p>
<h2>Provincial variation</h2>
<p>Looking at the <a href="https://www.canada.ca/en/health-canada/services/drugs-medication/cannabis/laws-regulations/provinces-territories.html">provincial variation</a> in the ways that legalization was implemented across Canada, it’s clear that increases in cannabis poisonings in young children did not need to occur. </p>
<p>At the start of legalization in October 2018, the federal government only allowed the sale of dried cannabis flower. After an intentional one-year delay, new products, including cannabis edibles like candies and chocolates, were permitted. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/488617/original/file-20221006-18-pf2fpi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Line graph showing sharp increases in cannabis poisonings in British Columbia and Ontario after legalization of cannabis edibles, in contrast to a more modest increase in Québec" src="https://images.theconversation.com/files/488617/original/file-20221006-18-pf2fpi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/488617/original/file-20221006-18-pf2fpi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=403&fit=crop&dpr=1 600w, https://images.theconversation.com/files/488617/original/file-20221006-18-pf2fpi.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=403&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/488617/original/file-20221006-18-pf2fpi.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=403&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/488617/original/file-20221006-18-pf2fpi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=507&fit=crop&dpr=1 754w, https://images.theconversation.com/files/488617/original/file-20221006-18-pf2fpi.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=507&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/488617/original/file-20221006-18-pf2fpi.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=507&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Most of the increase in cannabis poisonings in young kids happened after edible products came to market. The increase was much more modest in Québec, where the sale of these products was prohibited.</span>
<span class="attribution"><span class="source">(Daniel Myran, Yaron Finkelstein)</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>A wide variety of these edibles went on sale everywhere in Canada except in Québec, which prohibited anything in the form of chocolates, gummies and candies based on <a href="https://laws-lois.justice.gc.ca/eng/regulations/SOR-2018-144/FullText.html">concern over their high appeal to children</a>.</p>
<p>We found that most of the increase in cannabis poisonings in young kids happened after edible products came to market, and that Québec — <a href="https://www.cbc.ca/news/canada/montreal/cannabis-regulations-quebec-legal-1.5223723">which prohibited their sale</a> — was protected from this effect and saw a much more modest increase in pediatric cannabis poisonings.</p>
<p>This lack of increase in Québec strongly argues against alternative explanations, including that these hospital visits are from illegal cannabis products, caregivers becoming more comfortable disclosing that kids may have ingested cannabis or pandemic influences.</p>
<h2>Child cannabis poisonings</h2>
<p>When we care for infants and young children who have been rushed to the hospital for cannabis poisoning, we see many parents and caregivers who are shocked by the severity of the cannabis effects on their intoxicated child. Children can become very sick, be less responsive and in severe cases suffer from seizures, trouble breathing on their own, or even enter a coma. </p>
<p>With no effective antidote, children with severe cannabis poisoning require hospitalization — sometimes in intensive care units requiring a breathing machine — until the cannabis is processed and cleared from their body. The long-term effects of these unintentional poisonings are unknown.</p>
<p>These increases in child poisonings occurred despite safety efforts by the federal government, which included <a href="https://www.canada.ca/en/services/health/campaigns/cannabis/education-resources.html">parental education</a>, restricting cannabis advertising, mandating <a href="https://www.canada.ca/en/health-canada/services/cannabis-regulations-licensed-producers/packaging-labelling-guide-cannabis-products/guide.html">plain and child-resistant packaging and restricting the amount of THC</a> (the main psychoactive ingredient in cannabis) in a package to a maximum of 10 milligrams. </p>
<p>It’s important to note the <a href="https://cannabis-council.ca/files/advocacy/Not-Done-Yet-Report-Card-Rationale-10.19.21.pdf">cannabis industry is specifically asking</a> that many of these regulations — including THC limits and child-resistant packaging — be removed to make their products more competitive with the illicit market.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/488225/original/file-20221005-14-73ezx.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A display of candies, cookies and chocolate squares, each displayed with its black packaging with yellow and white warning labels." src="https://images.theconversation.com/files/488225/original/file-20221005-14-73ezx.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/488225/original/file-20221005-14-73ezx.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=373&fit=crop&dpr=1 600w, https://images.theconversation.com/files/488225/original/file-20221005-14-73ezx.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=373&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/488225/original/file-20221005-14-73ezx.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=373&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/488225/original/file-20221005-14-73ezx.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=468&fit=crop&dpr=1 754w, https://images.theconversation.com/files/488225/original/file-20221005-14-73ezx.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=468&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/488225/original/file-20221005-14-73ezx.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=468&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">A variety of cannabis edibles are displayed at the Ontario Cannabis Store in Toronto on Jan. 3, 2020.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Tijana Martin</span></span>
</figcaption>
</figure>
<p>But legalization is not shaping up to be just about replacing the illegal market. The legal market is expanding far faster than the illegal market contracts. Canadian <a href="https://www150.statcan.gc.ca/t1/tbl1/en/tv.action?pid=3610012401">households now spend an estimated 37.3 per cent more on cannabis</a> from all sources (medical, legal non-medical and illegal) than they did before legalization (1.44 billion in the third quarter of 2018 vs 1.93 billion in the second quarter of 2022). That means that we, as a country, are likely using increasing quantities of cannabis. </p>
<h2>Youth cannabis use and harms</h2>
<p>A key goal of legalization was to <a href="https://www.justice.gc.ca/eng/cj-jp/cannabis/">reduce cannabis use and related harms in youth</a>. While the data is less definitive, there is also some reason for concern that these harms have increased. </p>
<p>In Ontario, emergency department visits due to cannabis-induced <a href="https://doi.org/10.1001/jamanetworkopen.2022.31937">episodes of severe vomiting (hyperemesis)</a> and for <a href="https://doi.org/10.1111/add.15834">cannabis addiction, cannabis-induced psychosis and poisoning</a> have also increased in young adults since legalization. </p>
<p>The largest increases in emergency department visits due to cannabis occurred when the legal market began carrying new high-potency products and the <a href="https://doi.org/10.1111/dar.13351">number of cannabis retail stores rapidly expanded</a>. These increases overlapped with much of the COVID-19 pandemic so it is hard to disentangle whether they reflect changes from legalization, a response to COVID-19 related stressors or a combination.</p>
<h2>Social benefits of legalization</h2>
<p>Increases in cannabis harms in young children and youth do not negate the social benefits of cannabis policy reform. Criminalization of cannabis created major problems, including life-altering limits on employment, education and financial opportunities. These effects were well documented to be heavily <a href="https://doi.org/10.1016/j.drugpo.2020.102937">discriminatory due to over-policing among racialized communities and Indigenous youth</a>. </p>
<p>Reducing criminal justice harms is of considerable public health interest. However, we argue that it does not necessitate cannabis commercialization that includes cannabis marketing, widespread cannabis retail stores and permitting ultra-high-potency products that appeal to youth and children.</p>
<p>As the federal government reviews the impacts of legalization to date, we recommend protecting the health of Canadian children and youth by — at a minimum — maintaining existing regulations. This includes plain and child-resistant packaging and THC content limits on edibles. Without these, we will almost certainly see greater numbers and far more severe cannabis poisonings in children. </p>
<p>While we examine more evidence on the impacts of legalization on younger Canadians, we also caution against loosening current rules that limit cannabis marketing and advertising which can appeal to youth and young adults.</p>
<p>If we want to reduce cannabis poisonings in children, we should consider further national restrictions on the taste and visual appearance of edibles and the type of edibles approved, as Québec has implemented.</p><img src="https://counter.theconversation.com/content/191938/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Daniel Myran receives research funding from the Canadian Institutes of Health Research (CIHR) and the University of Ottawa Department of Family Medicine and is based at the Ottawa Hospital Research Institute. The views presented are his own and not necessarily representative of his affiliated organizations.</span></em></p><p class="fine-print"><em><span>Yaron Finkelstein has received CIHR funding for research on medical cannabis. He is a member of C4T (Canadian Childhood Cannabinoid Clinical Trials), a research group that studies medical cannabis.</span></em></p>Health repercussions — including large increases in child cannabis poisonings — must outweigh industry calls to roll back cannabis regulations in the federal review of the impact of legalization.Daniel Myran, Public Health Physician and Canadian Institutes of Health Research Fellow, L’Université d’Ottawa/University of OttawaYaron Finkelstein, Professor of Pediatrics, Pharmacology and Toxicology, University of TorontoLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1867902022-07-13T15:55:17Z2022-07-13T15:55:17ZFrance reenters medical marijuana industry after more than a half-century hiatus – a cannabis historian explains<figure><img src="https://images.theconversation.com/files/473517/original/file-20220712-27-aamlbi.jpg?ixlib=rb-1.1.0&rect=16%2C42%2C5590%2C3657&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">France led the world in medical marijuana research in the 19th century.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/young-woman-preparing-homeopathic-medicine-from-royalty-free-image/885599340?adppopup=true">CasarsaGuru/E+ via Getty Images</a></span></figcaption></figure><p>Early in 2022, the <a href="https://www.legifrance.gouv.fr/jorf/id/JORFTEXT000045185582">French legislature greenlighted</a> the cultivation of cannabis inside French territory to supply the nation’s ongoing pilot program in medical marijuana. The clinical trials were launched in March 2021 with cannabis supplied from abroad and have been overseen by the country’s food and drug office, the Agence Nationale de Sécurité du Médicament, or the National Agency for the Safety of Medicines and Health Products. </p>
<p>This two-year pilot program consists of 3,000 patients in France using medical cannabis, something that’s been prohibited since 1953. </p>
<p>While the agency has praised the pilot program for its groundbreaking efforts to produce “the first French data on the efficiency and safety” of cannabis for medical therapies to treat cancers, nerve damage and epilepsy, the trial is not the nation’s first foray into the medical cannabis industry. Far from it. </p>
<h2>‘A drug not to be neglected’</h2>
<p>I am a historian of cannabis and colonialism in modern France. <a href="https://scholar.google.com/citations?user=HAruWEAAAAAJ&hl=en&oi=sra">My research</a> has found that in the middle 19th century, Paris functioned as the epicenter of an international movement to medicalize hashish, a THC-rich intoxicant made from the pressed resin of cannabis plants. </p>
<p>Many pharmacists and physicians then working in France believed hashish was a dangerous and exotic intoxicant from the “Orient” – the Arab Muslim world – that could be <a href="https://digital.library.temple.edu/digital/collection/p245801coll10/id/490272">tamed by pharmaceutical science</a> and rendered safe and useful against the era’s most frightening diseases. </p>
<p>Starting in the late 1830s, some of those same pharmacists and physicians began preparing and selling hashish-infused edibles, lozenges and later tinctures – hashish-infused alcohol – and even “medicinal cigarettes” for asthma in pharmacies across the country. </p>
<p>Throughout the 1840s and 1850s, dozens of French pharmacists staked their careers on hashish, publishing dissertations, monographs and peer-reviewed articles on its medicinal and scientific benefits.</p>
<figure class="align-left zoomable">
<a href="https://images.theconversation.com/files/292875/original/file-20190917-19030-saruw8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/292875/original/file-20190917-19030-saruw8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/292875/original/file-20190917-19030-saruw8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=757&fit=crop&dpr=1 600w, https://images.theconversation.com/files/292875/original/file-20190917-19030-saruw8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=757&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/292875/original/file-20190917-19030-saruw8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=757&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/292875/original/file-20190917-19030-saruw8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=951&fit=crop&dpr=1 754w, https://images.theconversation.com/files/292875/original/file-20190917-19030-saruw8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=951&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/292875/original/file-20190917-19030-saruw8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=951&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Hôtel de Lauzun, the meeting place for the Club des Hachichins in Paris.</span>
<span class="attribution"><a class="source" href="https://upload.wikimedia.org/wikipedia/commons/4/4b/Hotel_de_Lauzun_2.jpg">Louis Édouard Fournier</a></span>
</figcaption>
</figure>
<p>French epidemiologist Louis-Rémy Aubert-Roche published a <a href="https://books.google.com/books?id=6p_1Hag_3_IC&dq=de+la+peste+ou+typhus&source=gbs_navlinks_s">treatise in 1840</a> in which he argued that hashish, administered as a small edible called “dawamesk” taken with coffee, successfully cured plague in seven of 11 patients he treated in the hospitals of Alexandria and Cairo during the epidemic of 1834-35. Aubert-Roche was an anti-contagionist in the era before the germ theory – the idea that microbes can lead to disease – became scientific dogma. He, like most physicians then, believed the plague to be an untransmittable disease of the central nervous system spread to humans via “miasma,” or bad air, in unhygienic and poorly ventilated areas.</p>
<p>Aubert-Roche thus believed, mistaking symptom relief and luck for a cure, that hashish intoxication excited the central nervous system and counteracted the effects of the plague. “The plague,” he wrote, “is a disease of the nerves. Hashish, a substance that acts upon the nervous system, has given me the best results. I thus believe it is a drug not to be neglected.” </p>
<h2>Reefer madness</h2>
<p>Physician Jacques-Joseph Moreau de Tours, organizer of the infamous Club des Hachichins in Paris during the 1840s, likewise <a href="https://gallica.bnf.fr/ark:/12148/bpt6k768978.r=du%20hachisch?rk=85837;2">heralded dawamesk</a> as a homeopathic wonder drug for treating mental illness. Moreau believed insanity was caused by lesions on the brain, and he also believed that hashish counteracted the effects. </p>
<p>Moreau reported in his 1845 work, “Du Hachisch et l’aliénation mentale” (“On Hashish and Mental Illness”), that between 1840 and 1843, he cured seven patients suffering from mental illness at Hôpital Bicêtre in central Paris with hashish. Moreau wasn’t totally off-base; <a href="https://doi.org/10.1007/s00406-019-00984-4">today cannabis-based medicines are prescribed</a> for depression, anxiety, post-traumatic stress disorder and bipolar disorders. </p>
<p>Despite the small sample size, <a href="https://babel.hathitrust.org/cgi/pt?id=ien.35558002006589&view=1up&seq=289">doctors from the U.S.</a>, the <a href="https://babel.hathitrust.org/cgi/pt?id=uc1.b5587100&view=1up&seq=225">U.K.</a>, <a href="https://babel.hathitrust.org/cgi/pt?id=hvd.32044097072219&view=1up&seq=518">Germany</a> and <a href="https://babel.hathitrust.org/cgi/pt?id=mdp.39015062255792&view=1up&seq=159">Italy</a> published favorable reviews of Moreau’s work with hashish during the late 1840s and across the 1850s. One praised it as a <a href="https://babel.hathitrust.org/cgi/pt?id=uc1.a0002587111&view=1up&seq=272">“discovery of much importance for the civilized world</a>.”</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/292876/original/file-20190917-19040-elshu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/292876/original/file-20190917-19040-elshu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/292876/original/file-20190917-19040-elshu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=348&fit=crop&dpr=1 600w, https://images.theconversation.com/files/292876/original/file-20190917-19040-elshu.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=348&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/292876/original/file-20190917-19040-elshu.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=348&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/292876/original/file-20190917-19040-elshu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=438&fit=crop&dpr=1 754w, https://images.theconversation.com/files/292876/original/file-20190917-19040-elshu.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=438&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/292876/original/file-20190917-19040-elshu.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=438&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Hemp harvesting on Rhine bank. Created by Lallemand and published on L'Illustration, Journal Universel, Paris, 1860.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/hemp-harvesting-on-rhine-bank-created-86840905?src=nIXX_uR7kER1zfs0wag8mg-1-0">Marzolino/Shutterstock.com</a></span>
</figcaption>
</figure>
<h2>Tincture wars</h2>
<p>Though physicians in France and abroad touted dawamesk as a miracle cure, they also complained about the inability to standardize doses due to the variation in the potency of different cannabis plants. They also wrote about the challenges posed by the common adulteration of dawamesk, which was exported from North Africa and often laced with other psychoactive plant extracts.</p>
<p>In the early 1830s, several physicians and pharmacists <a href="https://books.google.com/books?id=gMhaD7iuF8gC&printsec=frontcover&source=gbs_ge_summary_r&cad=0#v=onepage&q=william&f=false">in the British Empire</a> attempted to solve these problems by dissolving hashish in alcohol to produce a tincture. By the middle of the decade, French practitioners followed suit. They developed and marketed their own hashish tinctures for French patients. One pharmacist in Paris, Edmond de Courtive, branded his concoction “Hachischine” after the infamous <a href="https://doi.org/10.1086/SHAD30010050">Muslim assassins</a> often associated with hashish in French culture.</p>
<p>The popularity of hashish tincture grew rapidly in France during the late 1840s, peaking in 1848. That was when pharmacist Joseph-Bernard Gastinel and the aforementioned De Courtive engaged in a legal battle over the patent – then known as the “right to priority” – for a tincture manufactured though a particular distillation method. “L'Affaire Gastinel,” as the press termed it, or The Gastinel Affair, caused an <a href="https://gallica.bnf.fr/ark:/12148/bpt6k4086399/f1387.item.r=courtive">uproar in French medical circles</a> and occupied the pages of journals and newspapers in Paris for much of that fall. </p>
<p>To defend his patent, Gastinel sent two colleagues to argue his case to the Academy of Medicine in October 1848. One, a physician called <a href="https://www.biusante.parisdescartes.fr/histoire/medica/resultats/index.php?cote=90014x1848x35&p=337&do=page">Willemin, claimed</a> that not only did Gastinel devise the tincture distillation method in question but that his tincture provided a cure for cholera, also thought to be a disease of the nerves. </p>
<p>Though Willemin was unable to convince the Academy of Gastinel’s right to priority, he did convince doctors in Paris to adopt hashish tincture as a treatment against cholera. </p>
<p>Physicians in Paris didn’t have to wait long to test Willemin’s theory. A cholera epidemic erupted in the city’s outskirts just months later. But when hashish tincture failed to cure the nearly 7,000 Parisians killed by the “blue death,” doctors <a href="https://www.biusante.parisdescartes.fr/histoire/medica/resultats/index.php?p=326&cote=90068x1849&do=page">increasingly lost faith</a> in the wonder drug.</p>
<p>In the following decades, hashish tincture fell into disrepute as the medical theories of anti-contagionism that underpinned the drug’s use against the plague and cholera gave way to the germ theory and thus a new understanding of epidemic diseases and their treatment. During the same period, physicians in French Algeria increasingly pointed to hashish use as a key cause of insanity and criminality among indigenous Muslims, a diagnosis they termed “folie haschischique,” or hashish-induced psychosis. Heralded as a wonder drug only decades before, by the end of 19th century the drug was <a href="https://theconversation.com/french-cannabis-legalization-debate-ignores-race-religion-and-the-mass-incarceration-of-muslims-120558">rebranded as an “Oriental poison”</a>. </p>
<h2>Lessons for today</h2>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/292874/original/file-20190917-19076-3kfycl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/292874/original/file-20190917-19076-3kfycl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/292874/original/file-20190917-19076-3kfycl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=800&fit=crop&dpr=1 600w, https://images.theconversation.com/files/292874/original/file-20190917-19076-3kfycl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=800&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/292874/original/file-20190917-19076-3kfycl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=800&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/292874/original/file-20190917-19076-3kfycl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1005&fit=crop&dpr=1 754w, https://images.theconversation.com/files/292874/original/file-20190917-19076-3kfycl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1005&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/292874/original/file-20190917-19076-3kfycl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1005&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Hemp field near Toulouse.</span>
<span class="attribution"><a class="source" href="https://upload.wikimedia.org/wikipedia/commons/4/4e/Toulouse_-_Chemin_de_Tournefeuille_-_20140627_%281%29.jpg">Olybrius</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
</figcaption>
</figure>
<p>In my view, these earlier efforts to medicalize hashish in 19th-century France offer doctors, public health officials and policymakers of today several important insights as they work to return cannabis-based medications to the French market. </p>
<p>First, they must aim to dissociate cannabis intoxicants and medicines from colonial notions of “Oriental” otherness and Muslim violence that ironically underpinned both the rise and fall of hashish as medicine in France during the 19th century. As scholar <a href="https://www.ted.com/talks/dorothy_roberts_the_problem_with_race_based_medicine/transcript">Dorothy Roberts astutely argued</a> in her 2015 TED Talk, “race medicine is bad medicine, poor science and a false interpretation of humanity.” </p>
<p>As I see it, doctors and patients should also temper their expectations of the benefits of medicinal cannabis and not overpromise and then deliver lackluster results, as happened with hashish tincture during the cholera outbreak of 1848-49. </p>
<p>And they should be mindful that medical knowledge unfolds historically and that staking the new career of cannabis as medicine on contested theories could hitch the drug’s success to the wrong horse, as happened with hashish after the obsolescence of anti-contagionism in the 1860s.</p>
<p>But if France were to engage its colonial past, reform its prohibitionist policies and continue to open up legal room for medical and recreational cannabis, I believe perhaps it could again become a global leader in this new medical marijuana movement.</p>
<p><em>This is an updated version of a piece that <a href="https://theconversation.com/france-forgets-own-golden-age-of-medical-marijuana-122584">was published on Sept. 24, 2019</a>.</em></p><img src="https://counter.theconversation.com/content/186790/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>David A. Guba Jr. does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>In the mid-1800s, France was at the epicenter of the international movement to medicalize hashish, a potent form of cannabis. Now the country’s medical marijuana research is making a comeback.David A. Guba Jr., Assistant Professor of History, Bard Early CollegeLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1754182022-01-31T13:01:04Z2022-01-31T13:01:04ZCan delta-8 THC provide some of the benefits of pot – with less paranoia and anxiety?<figure><img src="https://images.theconversation.com/files/443022/original/file-20220127-14-1h59kho.jpg?ixlib=rb-1.1.0&rect=0%2C3%2C2119%2C1408&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Hemp plants growing on a farm in Colorado.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/rows-of-green-medicinal-hemp-plants-growing-on-farm-royalty-free-image/1190284841?adppopup=true">krblokhin/Getty Images</a></span></figcaption></figure><p>Over the past year, you may have seen something called <a href="https://www.webmd.com/mental-health/addiction/what-is-delta-8">delta-8 THC</a> or “delta 8” appear in convenience stores and pharmacies alongside CBD gummies, oils and lotions.</p>
<p>Delta-8 THC is a hemp-derived compound that’s closely related to <a href="https://www.verywellmind.com/what-is-thc-in-marijuana-4080556">delta-9 THC</a> – what’s commonly called THC and is the psychoactive component of cannabis that’s responsible for the high that users feel. </p>
<p>Like garden variety marijuana, delta-8 THC can be vaped or eaten. However, it’s rarely smoked. <a href="https://www.leafly.com/news/strains-products/i-tried-delta-8-thc-heres-what-it-feels-like">Anecdotally</a>, <a href="https://www.nytimes.com/2021/02/27/health/marijuana-hemp-delta-8-thc.html">its fans swear by its benefits</a> – that it helps with relaxation and pain relief without intense highs that can veer into <a href="https://www.vice.com/en/article/gy8pa9/weed-causes-anxiety-for-some-people">anxiety</a> or <a href="https://www.healthline.com/health/marijuana-paranoia">paranoia</a>.</p>
<p>Yet there’s been a dearth of research on this compound. As public health scholars, we decided to conduct <a href="https://doi.org/10.1089/can.2021.0124">the first survey of delta-8 THC users</a> to find out who was using it, why they were using it and what sort of effects it had.</p>
<h2>The latest cannabinoid to storm the market</h2>
<p>The 2018 Agriculture Improvement Act – also known as the farm bill – <a href="https://www.brookings.edu/blog/fixgov/2018/12/14/the-farm-bill-hemp-and-cbd-explainer/">legalized the sale of hemp-derived compounds</a>. The <a href="https://theconversation.com/cbd-sales-are-soaring-but-evidence-is-still-slim-that-the-cannabis-derivative-makes-a-difference-for-anxiety-or-pain-149612">widely available CBD</a> is a hemp-derived compound. </p>
<p>Delta-8 THC is another. It’s an isomer, or chemical analog, of THC. The difference is in the position of a double bond in the carbon ring, which makes delta-8 THC <a href="https://pubmed.ncbi.nlm.nih.gov/3018800/">have a lower affinity</a> for the CB1 receptor of the endocannabinoid system in our brains. For this reason, it may be less potent than THC and cause a less-intense high.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/443010/original/file-20220127-26-1lkg7sb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Two charts depicting the chemical structures of delta-8 THC and delta-9 THC." src="https://images.theconversation.com/files/443010/original/file-20220127-26-1lkg7sb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/443010/original/file-20220127-26-1lkg7sb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=201&fit=crop&dpr=1 600w, https://images.theconversation.com/files/443010/original/file-20220127-26-1lkg7sb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=201&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/443010/original/file-20220127-26-1lkg7sb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=201&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/443010/original/file-20220127-26-1lkg7sb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=253&fit=crop&dpr=1 754w, https://images.theconversation.com/files/443010/original/file-20220127-26-1lkg7sb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=253&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/443010/original/file-20220127-26-1lkg7sb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=253&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The chemical structures of delta-9 THC – what’s commonly called THC – and delta-8 THC are strikingly similar. The only difference is the position of a double bond in the carbon ring.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/illustration/vs-8-thc-delta-9-tetrahydrocannabinol-vs-royalty-free-illustration/1357070948?adppopup=true">About time/Getty Images</a></span>
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</figure>
<p>Natural concentrations of delta-8 THC in cannabis are too low for it to be effectively smoked in raw bud or flower. It needs to be extracted from large amounts of plant material, transformed from another cannabinoid like CBD, or synthesized chemically. The Drug Enforcement Administration <a href="https://www.deadiversion.usdoj.gov/schedules/marijuana/m_extract_7350.html">considers artificially synthesized delta-8 THC illegal</a>.</p>
<p>Nonetheless, delta-8 THC products <a href="https://www.nytimes.com/2021/02/27/health/marijuana-hemp-delta-8-thc.html">have become one of the fastest-growing sectors of the hemp industry</a>. They seem to be especially popular in areas where THC products <a href="https://en.wikipedia.org/wiki/Legality_of_cannabis_by_U.S._jurisdiction">remain illegal or medical access is very difficult</a>. </p>
<p>There is little research on this component of cannabis. One study from 1973 <a href="https://doi.org/10.1002/cpt1973143353">found that</a> the effects of delta-8 THC mimicked those of THC, but weren’t as intense. Another, <a href="https://doi.org/10.1016/0024-3205(95)00194-B">published in 1995</a>, suggested that delta-8 THC could be used as a therapeutic treatment for the adverse effects of chemotherapy.</p>
<p>These studies, however, enrolled only a dozen individuals, and few policymakers seem to even be aware of their existence. While delta-8 THC can be bought in convenience stores and hemp shops in many states, over a dozen U.S. states have <a href="https://www.nbcnews.com/health/health-news/delta-8-thc-legal-many-states-some-want-ban-it-n1272270">blocked the sale of delta-8 THC products</a> due to a lack of research on its psychoactive effects and concerns over contamination with heavy metals and other toxic substances.</p>
<h2>Clearing the smoke with science</h2>
<p>In our study, we collected data via <a href="https://doi.org/10.1186/s42238-021-00115-8">an online survey</a> that was completed by more than 500 participants across 38 states.</p>
<p>Most of our participants consumed delta-8 THC through concentrates that were either eaten as edibles and tinctures or smoked by vaping – methods of ingestion that <a href="https://doi.org/10.2105/AJPH.2017.303818">may be safer than smoking</a>. About half said they used delta-8 THC to treat a health or medical condition, and almost one-third of participants said they exclusively used delta-8 THC to treat a health condition – they didn’t use it just for fun. Common conditions treated were anxiety or panic attacks, chronic pain, depression or bipolar disorder, and stress – afflictions that <a href="https://doi.org/10.1080/02791072.2018.1563314">people also treat with delta-9 THC</a>.</p>
<p>As we expected, participants thought that delta-8 THC had effects that were somewhat less intense compared with THC. </p>
<p>What’s remarkable, though, is how the profiles of their experiences differ. </p>
<p>Compared with THC, delta-8 THC appears to provide similar levels of relaxation and pain relief. While it seems to cause slightly lower levels of euphoria, it also seems to produce fewer cognitive distortions such as an altered sense of time, short-term memory issues and difficulty concentrating. Participants were also much less likely to experience distressing mental states such as anxiety and paranoia. Many participants remarked how they could use delta-8 THC and still be productive, whereas they tended to use THC products recreationally, given its more potent, mind-altering effects.</p>
<p>Most participants reduced or stopped using pharmaceutical drugs, as well as THC products, because they were using delta-8 THC to treat their conditions. They considered delta-8 THC better than pharmaceutical drugs in terms of adverse side effects, addictiveness, withdrawal symptoms, effectiveness, safety, availability and cost.</p>
<p>[<em>Get the best of The Conversation, every weekend.</em> <a href="https://memberservices.theconversation.com/newsletters/?nl=weekly&source=inline-weeklybest">Sign up for our weekly newsletter</a>.]</p>
<p>However, participants weren’t confident that their primary care doctor could integrate medical cannabis into their course of treatment. For this reason, many hadn’t disclosed their use of delta-8 THC as a substitute for pharmaceutical drugs to their doctors.</p>
<p>These patterns demonstrate the need for more research and better education for health care providers on cannabis and its derivatives; <a href="https://doi.org/10.1186/s42238-021-00058-0">there continues to be a disconnect</a> between those who use cannabis to self-medicate and the mainstream health care system.</p>
<h2>More to be done</h2>
<p>Our findings are just the start. We hope that they’ll spur more sophisticated research, such as double-blind randomized controlled trials that explore its treatment potential for specific conditions. And we still don’t know if some of the effects reported by our participants, both beneficial and harmful, were due to contaminants or expectations – <a href="https://www.health.harvard.edu/mental-health/the-power-of-the-placebo-effect">a placebo effect</a>.</p>
<p>Yet even though delta-8 THC products may provide much of the experiential and therapeutic benefits, with lower risks and fewer adverse effects, <a href="https://www.nbcnews.com/health/health-news/delta-8-thc-legal-many-states-some-want-ban-it-n1272270">some states have outright banned delta-8 THC sales</a>. Since many of those same states permit the recreational sale of cannabis and other hemp products, this seems a bit paradoxical.</p>
<p>Criminalizing substances with high consumer demand like delta-8 THC can create a black market and produce even more concerns for consumer safety, as <a href="https://cen.acs.org/biological-chemistry/natural-products/Delta-8-THC-craze-concerns/99/i31">there’s no mechanism for the regulation and protection of consumers</a>. </p>
<p>Cannabis laws remain a patchwork of policies and regulations. With more and more Americans having access to cannabis for medicinal and recreational purposes, we believe it behooves policymakers to advocate for further study of this promising alternative.</p><img src="https://counter.theconversation.com/content/175418/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>In the first published survey of users of the hemp-derived compound, respondents highlight some important therapeutic effects.Daniel J. Kruger, Research Assistant Professor, University of MichiganJessica S. Kruger, Clinical Assistant Professor of Community Health and Health Behavior, University at BuffaloLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1738232022-01-10T16:45:55Z2022-01-10T16:45:55ZCannabis-impaired driving: Here’s what we know about the risks of weed behind the wheel<figure><img src="https://images.theconversation.com/files/439293/original/file-20220104-27-1k5mbri.jpg?ixlib=rb-1.1.0&rect=80%2C269%2C4412%2C2573&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Cannabis use negatively affects performance on driving-related cognitive tasks.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>Cannabis is the <a href="https://www.ccsa.ca/cannabis#:%7E:text=Cannabis%20is%20the%20second%20most,of%20cannabis%20and%20cannabis%20products.">second-most widely used substance</a> in Canada, after alcohol. While there is an in-depth understanding of the <a href="https://www.who.int/roadsafety/projects/manuals/alcohol/1-Why.pdf">impact of alcohol on driving</a>, cannabis is a much more complex substance and can affect consumers differently depending on the product type, amount used and a person’s potential tolerance. </p>
<p>This has led to a number of misconceptions about the true impact of cannabis on driving. Research has shown that Canadians perceive driving under the influence of cannabis to be <a href="https://doi.org/10.1080/09687637.2019.1611738">less risky than alcohol, and that they are also less likely to intervene</a> when others engage in such behaviours. </p>
<p>Our <a href="https://www.mun.ca/pharmacy/research/cannabiseval/">Cannabis Health Policy and Research Partnership</a> (CHERP) research team spoke to <a href="https://youtu.be/kix35RzLTgU">91 youth and young adults</a> over the summer of 2021 to get their perspective. They indicated that driving under the influence of cannabis was normalized behaviour, and because it was not believed to be as risky, there was peer pressure to drive after cannabis use. </p>
<p>In fact, driving under the influence of cannabis can be a very risky behaviour, which is a grave public health concern. It is essential to provide education and promote public awareness. </p>
<h2>Driving under the influence of cannabis</h2>
<p>A recent study has shown that <a href="https://doi.org/10.1016/j.drugalcdep.2021.109008">the legalization of cannabis has not increased the rate of traffic accidents or injuries resulting from driving under the influence of cannabis</a>. Care must be taken to not misinterpret this as cannabis being safe. </p>
<p>A 2012 analysis summarizing nine earlier studies on cannabis and driving showed that <a href="https://doi.org/10.1136/bmj.e536">cannabis doubled the risk of a fatal or serious injury crash</a>. Cannabis-impaired driving was associated with <a href="https://academic.oup.com/jpubhealth/article/38/1/183/2362575?login=true">four to 12 per cent of all injuries and mortalities from motor vehicle accidents in Canada in 2012</a>. The reality is that Canadians have been engaging in risky driving behaviours even before cannabis was legal. </p>
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<em>
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Read more:
<a href="https://theconversation.com/cannabis-education-should-aim-to-normalize-not-prevent-safe-and-legal-use-153966">Cannabis education should aim to normalize — not prevent — safe and legal use</a>
</strong>
</em>
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<p>A Statistics Canada report showed that in 2019, <a href="https://www150.statcan.gc.ca/n1/pub/82-003-x/2020002/article/00002-eng.htm">13.2 per cent of cannabis consumers with a valid driver’s licence reported driving within two hours of consuming cannabis</a>. This rate was unchanged from the 2018 pre-legalization report. </p>
<p>Another study, conducted by Public Safety Canada in 2017, reported <a href="https://epe.lac-bac.gc.ca/100/200/301/pwgsc-tpsgc/por-ef/public_safety_canada/2018/019-17-e/baseline-report.pdf">even higher rates of cannabis-impaired driving, with 28 per cent of those who consumed cannabis indicating that they had operated a vehicle impaired</a>. </p>
<h2>Cannabis impairs driving differently than alcohol</h2>
<p><a href="https://www.canada.ca/en/campaign/don-t-drive-high.html">Driving needs full concentration</a>, and making the right decisions at the right time can save lives. Cannabis containing <a href="https://www.canadadrives.ca/blog/driving-tips/cannabis-impaired-driving-dui-laws-canada">tetrahydrocannabinol (THC)</a> affects motor co-ordination and reaction time, can cause hallucination and increases the risk of getting into a collision. Many studies show strong evidence that <a href="https://doi.org/10.3389/fpsyt.2021.689444">cannabis use negatively affects performance on driving-related cognitive tests on a variety of driving tasks</a>. </p>
<figure class="align-center ">
<img alt="Table showing negative effects of cannabis on several driving-related tasks." src="https://images.theconversation.com/files/438478/original/file-20211220-50538-1f9mvv2.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/438478/original/file-20211220-50538-1f9mvv2.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=411&fit=crop&dpr=1 600w, https://images.theconversation.com/files/438478/original/file-20211220-50538-1f9mvv2.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=411&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/438478/original/file-20211220-50538-1f9mvv2.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=411&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/438478/original/file-20211220-50538-1f9mvv2.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=516&fit=crop&dpr=1 754w, https://images.theconversation.com/files/438478/original/file-20211220-50538-1f9mvv2.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=516&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/438478/original/file-20211220-50538-1f9mvv2.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=516&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Cannabis use negatively affects cognitive test performance related to a number of driving-related tasks.</span>
<span class="attribution"><a class="source" href="https://doi.org/10.3389/fpsyt.2021.689444">(Data source: Pearlson, Stevens, D'Souza 2021 DOI: 10.3389/fpsyt.2021.689444)</a>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>The idea that cannabis is less risky than alcohol may stem from the fact that impairment from cannabis can differ from alcohol. The biggest difference being that with cannabis, consumers are less aware of their <a href="https://doi.org/10.3389/fpsyt.2021.689444">level of impairment</a>. </p>
<p>Alcohol consists of a single chemical that has been well studied for decades. It has a reliable test that measures blood alcohol levels and those blood alcohol levels match to <a href="https://doi.org/10.1016/j.jsr.2007.06.001">levels of impairment</a>. Cannabis on the other hand consists of several chemicals that lead to varying levels of impairment.</p>
<p>THC is the chemical we know the most about and the one that leads to the <a href="http://doi.org/10.1001/jama.2020.21218">greatest impairment</a> from cannabis. However, other less studied chemicals may also impair driving, and we are only at the beginning stages of learning about these effects. There are <a href="https://www.canada.ca/en/health-canada/news/2017/04/backgrounder_changestoimpaireddrivinglaws.html">roadside tests</a> to detect levels of THC in the blood, but the relationship between those levels and impairment is not as clear as those with alcohol. </p>
<h2>Factors that affect impairment</h2>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/439294/original/file-20220104-17-1ty1ygj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A car key in a circle with a line through it composed of dried cannabis." src="https://images.theconversation.com/files/439294/original/file-20220104-17-1ty1ygj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/439294/original/file-20220104-17-1ty1ygj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/439294/original/file-20220104-17-1ty1ygj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/439294/original/file-20220104-17-1ty1ygj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/439294/original/file-20220104-17-1ty1ygj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/439294/original/file-20220104-17-1ty1ygj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/439294/original/file-20220104-17-1ty1ygj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The safest choice is to separate cannabis consumption from driving entirely.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>It is difficult to predict the exact effect cannabis will have on a particular individual. Impairment can be based on many factors, including the dose of THC, personal experience with cannabis, individual biology and the route of consumption (for example, inhaling versus edibles).</p>
<p>There are several types of cannabis products on the Canadian market, and each product has a different amount of THC and takes a <a href="https://uwaterloo.ca/pharmacy/sites/ca.pharmacy/files/uploads/files/cannabis_infographic_2_sided.pdf">varying amount of time</a> to reach its full effects. The following outlines typical time to effect and duration of impairment.</p>
<ul>
<li><p>Inhaling (smoking or vaping): Effects start in about 10 minutes and typically last two to four hours (up to 24 hours)</p></li>
<li><p>Edibles: Effects start in about one hour and typically last four to six hours (up to 24 hours)</p></li>
</ul>
<p><a href="https://madd.ca/pages/impaired-driving/overview/cannabis-and-driving/">Experts recommend</a> waiting a minimum of four to six hours after consuming cannabis containing THC. <a href="https://www.justice.gc.ca/eng/cj-jp/sidl-rlcfa/index.html">The combination of cannabis and alcohol</a> intensifies the level of impairment beyond what a user might expect, <a href="https://doi.org/10.2105/AJPH.2017.303818">should always be avoided if driving</a>.</p>
<h2>Safety considerations when driving</h2>
<p>Cannabis-impaired driving is very risky. It is difficult to advise exactly how long someone should wait after consuming cannabis before driving. The safest choice is to separate cannabis consumption from driving entirely. </p>
<p>However, there are <a href="https://www.canada.ca/en/services/policing/police/community-safety-policing/impaired-driving/drug-impaired-driving.html">several strategies</a> to avoid this risky situation, including: </p>
<ul>
<li>Making sure you have a designated driver, </li>
<li>Calling a friend or loved one to pick you up, </li>
<li>Taking public transit, </li>
<li>Calling a cab or a ride-sharing service, or </li>
<li>Staying over.</li>
</ul>
<h2>Detection of cannabis-impaired driving</h2>
<p>Many young people believe that it is difficult for police to detect and charge drivers who consume cannabis. However, <a href="https://madd.ca/pages/impaired-driving/overview/cannabis-and-driving/">signs of intoxication</a> (bloodshot eyes, smell of cannabis, shallow breathing or rapid heart rate) can form a reasonable suspicion for police. In addition, there are <a href="https://www.ccsa.ca/sites/default/files/2019-10/CCSA-Cannabis-Use-Driving-Report-2019-en_1.pdf">three tests of the Standardized Field Sobriety Tests (SFST)</a> (horizontal gaze nystagmus (involuntary eye movements), one-leg stand and walk and turn) that are performed to evaluate impairment. </p>
<p>In Canada, the <em><a href="https://www.justice.gc.ca/eng/cj-jp/sidl-rlcfa/index.html">Criminal Code</a></em> prohibits driving while impaired. Penalties range from a minimum fine to imprisonment, depending on the severity of the offence. Impaired drivers who cause injury or death can face longer periods of incarceration, including imprisonment for life.</p>
<h2>Information for parents</h2>
<p>A Health Canada survey showed that <a href="https://www.canada.ca/en/services/policing/police/community-safety-policing/impaired-driving/drug-impaired-driving.html">very few parents (11 per cent) said they had discussed the risks of driving under the influence with their teenagers</a>. However, only four per cent of teens indicated they had discussed impaired driving with their parents. </p>
<p>It is essential to start a conversation with children and teens about the risks of driving under the influence of cannabis. Our CHERP research team’s <a href="https://www.mun.ca/pharmacy/research/cannabiseval/PartnerResources.php">public engagement events</a> and social media (<a href="https://www.twitter.com/cherpCA">Twitter</a> and <a href="https://www.facebook.com/cherpCA">Facebook</a>) can provide information and resources. Young people need to be prepared to make <a href="https://getsensible.org/en/get-toolkit/">informed decisions</a> long before they are ready to get behind the wheel.</p><img src="https://counter.theconversation.com/content/173823/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dina Gaid, post-doctoral position, is funded through a grant from Memorial University of Newfoundland, Canadian Center on Substance Use and Addiction, and Canadian Institutes of Health Research</span></em></p><p class="fine-print"><em><span>Jennifer Donnan receives funding from the Canadian Centre for Substance Use and Addiction (CCSA) and the Canadian Institutes for Health Research (CIHR). </span></em></p><p class="fine-print"><em><span>Lisa Bishop received funding from the Canadian Centre on Substance Use and Addiction (CCSA) and the Canadian Institutes of Health Research (CIHR)</span></em></p><p class="fine-print"><em><span>Maisam Najafizada receives funding from the Canadian Centre for Substance Use and Addiction (CCSA) and the Canadian Institutes for Health Research (CIHR).</span></em></p><p class="fine-print"><em><span>Maria Josey and Michael Blackwood do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Cannabis use doubles the risk of a fatal or serious-injury car crash, but some people believe it’s safer than alcohol-impaired driving. Here’s what you need to know about cannabis behind the wheel.Dina Gaid, Post-doctoral fellow, School of Pharmacy, Memorial University of NewfoundlandJennifer Donnan, Assistant Professor, School of Pharmacy, Memorial University of NewfoundlandLisa Bishop, Associate professor, School of Pharmacy, Memorial University of NewfoundlandMaisam Najafizada, Assistant Professor of Population Health Policy, Memorial University of NewfoundlandMaria Josey, PharmD Student, School of Pharmacy, Memorial University of NewfoundlandMichael Blackwood, MSc Student, School of Pharmacy, Memorial University of NewfoundlandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1707962021-12-17T13:26:16Z2021-12-17T13:26:16ZThe ‘runner’s high’ may result from molecules called cannabinoids – the body’s own version of THC and CBD<figure><img src="https://images.theconversation.com/files/436228/original/file-20211207-172173-y26qwj.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C5220%2C3453&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Exercise spurs the release of the body's natural cannabinoids, which have myriad benefits for mental health and stress relief.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/running-along-road-at-sunrise-in-iceland-royalty-free-image/578633163?adppopup=true">Luca Sage/Stone via Getty Images</a></span></figcaption></figure><p>Many people have experienced reductions in stress, pain and anxiety and sometimes even euphoria after exercise. What’s behind this so-called “runner’s high”? New research on the neuroscience of exercise may surprise you. </p>
<p>The “runner’s high” has long been attributed to <a href="https://doi.org/10.2519/jospt.1983.4.3.169">endorphins</a>. These are chemicals produced naturally in the body of humans and other animals after exercise and in response to pain or stress. </p>
<p>However, <a href="https://doi.org/10.1089/can.2021.0113">new research from my lab</a> summarizes nearly two decades of work on this topic. We found that exercise reliably increases levels of the body’s endocannabinoids – which are molecules that work to maintain balance in the brain and body – a process called “homeostasis.” This natural chemical boost may better explain some of the beneficial effects of exercise on brain and body. </p>
<p>I am a <a href="https://scholar.google.com/citations?user=S9ykvZUAAAAJ&hl=en">neuroscientist</a> at the Wayne State University School of Medicine. <a href="https://wsuthinklab.mystrikingly.com/">My lab</a> studies brain development and mental health, as well as the role of the endocannabinoid system in stress regulation and anxiety disorders in children and adolescents. </p>
<p>This research has implications for everyone who exercises with the aim of reducing stress and should serve as a motivator for those who don’t regularly exercise. </p>
<h2>Health benefits of exercise</h2>
<p><a href="https://doi.org/10.1097/HCO.0000000000000437">Several decades of research</a> has shown that exercise is beneficial for physical health. These studies find a consistent link between varying amounts of physical activity and reduced risk of <a href="http://dx.doi.org/10.1136/bjsports-2018-100393">premature death</a> and dozens of chronic health conditions, including <a href="https://doi.org/10.1007/s10654-015-0056-z">diabetes</a>, <a href="https://doi.org/10.1007/s40279-013-0065-6">hypertension</a>, <a href="https://doi.org/10.1016/j.jval.2018.06.020">cancer</a> and <a href="https://doi.org/10.3390/ijerph9020391">heart disease</a>.</p>
<figure class="align-center ">
<img alt="The marijuana plant cannabis." src="https://images.theconversation.com/files/436203/original/file-20211207-19-7n3tp8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/436203/original/file-20211207-19-7n3tp8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/436203/original/file-20211207-19-7n3tp8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/436203/original/file-20211207-19-7n3tp8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/436203/original/file-20211207-19-7n3tp8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/436203/original/file-20211207-19-7n3tp8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/436203/original/file-20211207-19-7n3tp8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">While cannabinoids are produced in cannabis, the marijuana plant, they are also made in the human body.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/background-texture-of-marijuana-plants-outdoor-royalty-free-image/1258024915?adppopup=true">Iuliia Bondar/Moment via Getty Images</a></span>
</figcaption>
</figure>
<p>More recently – over about the past <a href="https://doi.org/10.3389/fpsyt.2014.00066">two decades</a> – mounting research shows that exercise is also <a href="https://theconversation.com/swimming-gives-your-brain-a-boost-but-scientists-dont-know-yet-why-its-better-than-other-aerobic-activities-164297">highly beneficial for mental health</a>. In fact, regular exercise is associated with lower symptoms of anxiety, depression, Parkinson’s disease and other common mental health or <a href="https://doi.org/10.1159/000223730">neurological problems</a>. Consistent exercise <a href="https://doi.org/10.1159/000350946">is also linked to</a> better cognitive performance, improved mood, lower stress and higher self-esteem. </p>
<p>It is not yet clear what is behind these mental health boosts. We do know that exercise has a variety of effects on the brain, including raising <a href="https://doi.org/10.1038/tp.2017.135">metabolism</a> and <a href="https://doi.org/10.3233/JAD-201456">blood flow</a>, promoting the formation of <a href="https://doi.org/10.3389/fnins.2018.00052">new brain cells</a> – a process called neurogenesis – and increasing the release of several chemicals in the brain. </p>
<p>Some of these chemicals are called neurotrophic factors, such as <a href="https://doi.org/10.1159/000223730">brain-derived neurotrophic factor</a>. BDNF is intricately involved in brain “plasticity,” or changes in activity of brain cells, including those related to <a href="https://doi.org/10.3389/fncel.2019.00363">learning and memory</a>.</p>
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<iframe width="440" height="260" src="https://www.youtube.com/embed/lk3mrNqhn24?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">From the Dana Foundation: “How Exercise Affects The Brain”</span></figcaption>
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<p>Scientists have also shown that exercise increases blood levels of endorphins, one of the body’s natural opioids. Opioids are chemicals that work in the brain and have a variety of effects, including <a href="https://doi.org/10.3389/fpain.2021.721357">helping to relieve pain</a>. Some <a href="https://doi.org/10.1093/cercor/bhn013">early research</a> in the 1980s contributed to the long-standing popular belief that this endorphin release is related to the euphoric feeling known as the runner’s high. </p>
<p>However, <a href="http://dx.doi.org/10.1136/bjsm.2004.011718">scientists have</a> <a href="https://doi.org/10.1073/pnas.1514996112">long questioned</a> the role of endorphins in the runner’s high sensation, in part because endorphins cannot cross into the brain through the <a href="https://doi.org/10.1101/cshperspect.a020412">blood-brain barrier</a>, which protects the brain from toxins and pathogens. So endorphins are not likely to be the main driver for the beneficial effects of exercise on mood and mental state.</p>
<p>This is where our research and <a href="http://dx.doi.org/10.1136/bjsm.2004.011718">that of others</a> points to the role of our body’s natural versions of cannabinoids, called endocannabinoids.</p>
<h2>The surprising role of endocannabinoids</h2>
<p>You <a href="https://www.healthline.com/health/cbd-vs-thc">may be familiar with</a> cannabinoids such as tetrahydrocannabinol – better known as THC – the psychoactive compound in cannabis (from the <em>Cannabis sativa L.</em> plant) that causes people to feel high. Or you may have heard of <a href="https://www.fda.gov/consumers/consumer-updates/what-you-need-know-and-what-were-working-find-out-about-products-containing-cannabis-or-cannabis">cannabidiol, commonly known as CBD, an extract of cannabis</a> that is infused in some foods, medicines, oils and many other products. </p>
<p>But many people do not realize that humans also create their own versions of these chemicals, called endocannabinoids. These are tiny molecules made of lipids – or fats – that circulate in the brain and body; “endo” refers to those produced in the body rather than from a plant or in a lab.</p>
<p>Endocannabinoids work on cannabinoid receptors <a href="https://doi.org/10.1073/pnas.0703472104">throughout the brain</a> and body. They cause a variety of effects, including pain relief, reduction of anxiety and stress and enhanced learning and memory. They also affect hunger, inflammation and <a href="https://dx.doi.org/10.1038%2Fnpp.2017.130">immune functioning</a>. Endocannabinoid levels can be influenced by food, time of day, exercise, obesity, injury, inflammation and stress. </p>
<p>It’s worth noting that one should not be tempted to forgo a run or bike ride and resort to smoking or ingesting cannabis instead. Endocannabinoids lack the unwanted effects that come with getting high, such as <a href="https://doi.org/10.1007/s00213-006-0508-y">mental impairment</a>.</p>
<h2>Understanding the runner’s high</h2>
<p>Studies <a href="https://doi.org/10.1016/j.psyneuen.2021.105173">in humans</a> and in <a href="https://doi.org/10.1073/pnas.1514996112">animal models</a> are pointing to endocannabinoids – not endorphins – as the star players in the runner’s high.</p>
<p>These elegant studies demonstrate that when opioid receptors are blocked – in <a href="https://doi.org/10.1016/j.psyneuen.2021.105173">one example</a> by a drug called naltrexone – people still experienced euphoria and reduced pain and anxiety after exercise. On the flip side, the studies showed that blocking the effects of cannabinoid receptors reduced the beneficial effects of exercise on euphoria, pain and anxiety. </p>
<p>While <a href="https://doi.org/10.1016/j.mhpa.2020.100366">several studies</a> <a href="https://doi.org/10.1007/s00421-012-2495-5">have shown</a> that exercise increases the levels of endocannabinoids circulating in the blood, some have reported inconsistent findings, or that different endocannabinoids produce <a href="https://doi.org/10.3389/fnbeh.2018.00269">varying effects</a>. We also don’t know yet if all types of exercise, such as cycling, running or resistance exercise like weightlifting, produce similar results. And it is an open question whether people with and without preexisting health conditions like depression, PTSD or fibromyalgia experience the same endocannabinoid boosts.</p>
<p>To address these questions, an undergraduate student in my lab, Shreya Desai, led a <a href="https://doi.org/10.1089/can.2021.0113">systematic review and meta-analysis</a> of 33 published studies on the impact of exercise on endocannabinoid levels. We compared the effects of an “acute” exercise session – like going for a 30-minute run or cycle – with the effects of “chronic” programs, such as a 10-week running or weightlifting program. We separated them out because different levels and patterns of exertion could have very distinct effects on endocannabinoid responses.</p>
<p>We found that acute exercise consistently boosted endocannabinoid levels across studies. The effects were most consistent for a chemical messenger known as anandamide – the so-called <a href="https://doi.org/10.1126/science.1470919">“bliss” molecule</a>, which was named, in part, for its positive effects on mood.</p>
<p>Interestingly, we observed this exercise-related boost in endocannabinoids across different types of exercise, including running, swimming and weightlifting, and across individuals with and without preexisting health conditions. Although only a few studies looked at intensity and duration of exercise, it appears that moderate levels of exercise intensity – such as cycling or running – are more effective than lower-intensity exercise – like walking at slow speeds or low incline – when it comes to raising endocannabinoid levels. This suggests that it is important to keep your heart rate elevated – that is, between about 70% and 80% of age-adjusted maximum heart rate – for at least 30 minutes to reap the full benefits. </p>
<p>[<em>Over 140,000 readers rely on The Conversation’s newsletters to understand the world.</em> <a href="https://memberservices.theconversation.com/newsletters/?source=inline-140ksignup">Sign up today</a>.]</p>
<p>There are still a lot of questions about the links between endocannabinoids and beneficial effects from exercise. For example, we didn’t see consistent effects for how a chronic exercise regimen, such as a six-week cycling program, might affect resting endocannabinoid levels. Likewise, it isn’t yet clear what the minimum amount of exercise is to get a boost in endocannabinoids, and how long these compounds remain elevated after acute exercise. </p>
<p>Despite these open questions, these findings bring researchers one step closer to understanding how exercise benefits brain and body. And they offer an important motivator for making time for exercise during the rush of the holidays.</p><img src="https://counter.theconversation.com/content/170796/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dr. Marusak is funded, in part, by the National Institutes of Mental Health (K01MH119241).</span></em></p>A growing body of research points to the body’s natural cannabinoid system as the primary driver behind the runner’s high – and the mental health boost and stress relief following exercise.Hilary A. Marusak, Assistant Professor of Psychiatry and Behavioral Neurosciences, Wayne State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1699982021-11-21T13:20:58Z2021-11-21T13:20:58ZIndica and sativa labels are largely meaningless when it comes to cannabis complexities<figure><img src="https://images.theconversation.com/files/432299/original/file-20211117-23-cj20ew.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C6000%2C3376&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Cannabis is a complex plant, ideally labelling of cannabis products should accurately reflect the combinations of psychoactive ingredients present in a strain.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><iframe style="width: 100%; height: 175px; border: none; position: relative; z-index: 1;" allowtransparency="" src="https://narrations.ad-auris.com/widget/the-conversation-canada/indica-and-sativa-labels-are-largely-meaningless-when-it-comes-to-cannabis-complexities" width="100%" height="400"></iframe>
<p>Indica and sativa are commonly used to describe cannabis strains, but what’s the difference between these two labels?</p>
<p>Almost <a href="https://www150.statcan.gc.ca/n1/pub/82-003-x/2020002/article/00002-eng.htm">half of all Canadians have tried cannabis at some point in their lives</a>. If you’re one of them, you’ve probably been confronted with the choice between buying strains labelled indica or sativa.</p>
<p>Some people are adamant that <a href="https://www.thrillist.com/lifestyle/nation/indica-vs-sativa-differences-in-effects-and-appearance">indica strains are sedative with earthy aromas</a>. In contrast, sativa strains are supposedly energizing with sweet aromas. However, the extent to which indica and sativa labels actually capture meaningful information is unclear.</p>
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Read more:
<a href="https://theconversation.com/wheres-the-weed-branding-is-essential-for-cannabis-companies-87400">'Where's the weed?' Branding is essential for cannabis companies</a>
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<h2>Detailed strain analyses</h2>
<p>Our team of researchers at Dalhousie University worked with Bedrocan International, a Dutch medical cannabis company, to study hundreds of cannabis strains with indica and sativa labels. We measured the chemical compounds produced by each strain. This included not only the major psychoactive cannabinoids like THC and CBD but also the terpenes that give cannabis its distinctive aromas. We also measured the genetic profiles and were then able to examine the chemical and genetic differences between strains.</p>
<p>If labels describing cannabis strains do in fact represent two distinct groups of cannabis, then the differences should be reflected by chemical and genetic differences. Our study, published in <em>Nature Plants</em>, found that indica and sativa labels are largely meaningless. </p>
<p>It was frequently the case that <a href="https://doi.org/10.1038/s41477-021-01003-y">strains labelled indica were just as closely related to strains labelled sativa as they were to other strains labelled indica</a>.</p>
<p>An <a href="https://phytokeys.pensoft.net/article/46700/element/4/459">example that illustrates the inconsistent use of these labels</a> is that in 1999, a cannabis strain named “AK 47” won the <a href="https://www.cannabiscupwinners.com/winner-links/2-cool-cannabis-hemp-links/37-seeds-online.html">Sativa Cup</a> in the Cannabis Cup. The same strain went on to win the <a href="https://www.cannabiscupwinners.com/2015-12-03-14-51-30/high-times-cannabis-cup/cannabis-cup-2003.html">Indica Cup</a> in the same competition four years later.</p>
<p>Not only did we find that indica/sativa labelling is misleading, but so are the names given to strains. For example, we found that two strains both named “OG Kush” were more similar to other strains with different names than they were to one another. Overall, strain names are often not reliable indicators of a plant’s genetic identity and chemical profile.</p>
<h2>Broken telephone</h2>
<p>If you’ve ever played a game of telephone, you’ll know how easily words can get twisted. Usually by the end of the game, the words are completely different from when it started. The way in which indica and sativa have been used over the years is similar to a very long game of broken telephone. </p>
<p>At one point in time, indica and sativa may have been used to describe two distinct species of cannabis. Over time, the two species likely hybridized to the extent that most of the cannabis grown and consumed today is a mashup of the two ancestral lineages. However, the use of indica and sativa has persisted as vernacular labels and have today taken on new meaning to describe psychoactive effects, aromas and morphologies.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/432300/original/file-20211117-21-su2u95.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="An older woman smokes a joint and smiles" src="https://images.theconversation.com/files/432300/original/file-20211117-21-su2u95.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/432300/original/file-20211117-21-su2u95.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/432300/original/file-20211117-21-su2u95.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/432300/original/file-20211117-21-su2u95.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/432300/original/file-20211117-21-su2u95.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/432300/original/file-20211117-21-su2u95.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/432300/original/file-20211117-21-su2u95.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">People consume cannabis for a variety of reasons, including recreational and therapeutic purposes.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
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<p>In certain cases, we found weak correlations between indica and sativa labels and a small number of the aromatic terpenes. Strains labelled indica tended to have higher amounts of <a href="https://www.sciencedirect.com/topics/agricultural-and-biological-sciences/myrcene">the terpene myrcene</a>, which is thought to contribute to sedation and the <a href="https://cannabis.net/blog/history/what-does-it-mean-to-be-couchlocked">more intense “couch-lock” effect</a>.</p>
<p>On the other hand, strains labelled sativa had higher amounts of sweet and herbal terpenes, like farnesene and bergamotene. These findings echo what cannabis consumers have long said about the differences between the two labels. </p>
<p>We have a hunch that due to the absence of strict naming and pedigree tracking, producers have been assigning labels to cannabis based primarily on aroma. Considering the historically clandestine nature of cannabis breeding, it’s unsurprising that labelling would have been relegated to more subjective methods, like smell, rather than a more consistent system that reliably distinguishes strains.</p>
<h2>Improving labelling</h2>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/432301/original/file-20211117-19-lgtso3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="An employee arranges a variety of products at a cannabis store." src="https://images.theconversation.com/files/432301/original/file-20211117-19-lgtso3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/432301/original/file-20211117-19-lgtso3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=432&fit=crop&dpr=1 600w, https://images.theconversation.com/files/432301/original/file-20211117-19-lgtso3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=432&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/432301/original/file-20211117-19-lgtso3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=432&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/432301/original/file-20211117-19-lgtso3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=542&fit=crop&dpr=1 754w, https://images.theconversation.com/files/432301/original/file-20211117-19-lgtso3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=542&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/432301/original/file-20211117-19-lgtso3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=542&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">After cannabis was legalized, a flood of cannabis strains and products entered the market, from consumables to oils and foodstuffs.</span>
<span class="attribution"><span class="source">(THE CANADIAN PRESS/Nathan Denette)</span></span>
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<p>As Canada moves into its third year of legalized cannabis consumption, there is a need to revamp how cannabis is labelled, and clearly communicate its effects. The current way we label and name cannabis strains appears to fall short of the labelling standards applied to other agricultural crops.</p>
<p>For instance, imagine walking into a grocery store and buying a crunchy Honeycrisp apple, only to realize when you got home that it was in fact a less crisp McIntosh apple. Unlike apples, cannabis produces psychoactive compounds — the inconsistency of these labels could be very frustrating. From a medical standpoint, improper labelling could lead to negative or undesirable health outcomes. </p>
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Read more:
<a href="https://theconversation.com/give-cannabis-producers-more-packaging-and-labelling-flexibility-152727">Give cannabis producers more packaging and labelling flexibility</a>
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<p>Cannabis is an incredibly diverse crop that produces over <a href="https://doi.org/10.1371/journal.pone.0192247">one hundred aromatic</a> and psychoactive compounds with distinct aromas and effects. Adding to the complexity of cannabis compounds, research has also indicated the possibility of an “<a href="https://doi.org/10.1111/j.1476-5381.2011.01238.x">entourage effect</a>,” whereby terpenes interact with cannabinoids to mediate different psychoactive effects. </p>
<p>Reducing cannabis to two categories does little to capture this incredible versatility and potential. We are likely better off abandoning the use of the terms sativa and indica altogether, and instead labelling cannabis with the quantities of key compounds that have medicinal effects or are known to affect consumer preferences.</p><img src="https://counter.theconversation.com/content/169998/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sophie Watts receives funding through a Vanier Scholarship from the National Sciences and Engineering Research Council of Canada. Bedrocan International funded the research referenced in this article.</span></em></p>Cannabis labelling is often misleading. Labelling cannabis products with quantities of key compounds will help consumers make informed decisions.Sophie Watts, PhD student, Plant, Food and Environmental Sciences, Dalhousie UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1681662021-09-30T15:30:35Z2021-09-30T15:30:35ZCannabis products are being sold as sleep remedies – here’s the evidence about their effectiveness<figure><img src="https://images.theconversation.com/files/423354/original/file-20210927-21-ajumn3.jpg?ixlib=rb-1.1.0&rect=5%2C5%2C3863%2C2569&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/people-bedtime-rest-concept-indian-man-1920113663">Shutterstock</a></span></figcaption></figure><p>Problems with sleep are common. In <a href="https://www.mentalhealth.org.uk/news/mental-health-millions-adults-and-teenagers-being-affected-poor-sleep">recent research</a>, 48% of UK adults said sleeping badly had a negative effect on their mental health. For teenagers, this proportion was significantly higher – 66%.</p>
<p>The large number of people experiencing sleep problems makes for an attractive market. Some companies have seized the opportunity to provide remedies, including several manufacturers of <a href="https://www.naturitas.co.uk/p/supplements/melatonin/cannabidorm-30-capsules-neo?gclid=Cj0KCQjw1ouKBhC5ARIsAHXNMI827AmU7s2MhyJtlBRB91DzZBcy2O64buEnmwElN6V7_v0_KXX3lMAaAs3OEALw_wcB">cannabis products</a>.</p>
<p>Changes to the way cannabis is regulated in many countries, including the UK, have helped the boom in cannabis products, with more people <a href="https://theconversation.com/drug-experts-on-the-new-guidance-for-medicinal-cannabis-124650">able to access</a> these types of offerings – even if the cannabis compounds that can be used in sleep products in some countries are more limited than in others. In the US, where cannabis is fully legal in many states, California-based Ganja Goddess <a href="https://www.forbes.com/sites/ajherrington/2021/03/17/can-cannabis-help-you-get-a-good-nights-sleep/?sh=30d13d17106b">reported</a> more than a sevenfold increase in revenue for its cannabis sleep products during the first year of the COVID pandemic.</p>
<p>But what is the evidence that cannabis products can help people get a better night’s sleep?</p>
<h2>Cannabis and sleep</h2>
<p>Sleep disturbance is <a href="https://www.tandfonline.com/doi/abs/10.1080/08897077.2015.1023484">a common feature</a> of withdrawal from cannabis use, indicating there may well be a relationship between cannabis use and sleep. But we still don’t have a clear understanding of the mechanisms in the brain involved in this relationship. </p>
<p>The effects of cannabis are due to a group of chemicals in the drug called cannabinoids. These include cannabidiol (CBD), cannabinol (CBN) and tetrahydrocannabinol (THC). THC is the psychoactive substance in cannabis. CBN and CBD don’t cause you to get high in the same way. </p>
<figure class="align-center ">
<img alt="Hands hold cannabis in a small jar." src="https://images.theconversation.com/files/423360/original/file-20210927-265-kqdpvt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/423360/original/file-20210927-265-kqdpvt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/423360/original/file-20210927-265-kqdpvt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/423360/original/file-20210927-265-kqdpvt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/423360/original/file-20210927-265-kqdpvt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/423360/original/file-20210927-265-kqdpvt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/423360/original/file-20210927-265-kqdpvt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Changes to the way cannabis is regulated and controlled in many countries has facilitated a boom in cannabis products.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/grinder-marijuana-fresh-buds-cannabis-many-1098835136">Shutterstock</a></span>
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<p>In the UK, CBD products are available legally, providing <a href="https://theconversation.com/cannabis-the-problem-with-defining-products-around-thc-content-146459">they don’t contain</a> more than 0.2% THC. Retailers and suppliers make all kinds of assertions about the benefits of CBD products, including how CBD can improve sleep. There is <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6164964/">some evidence</a> to support these claims, but this is mainly based on animal and human observational studies rather than randomised control trials, where comparisons can be made between CBD and a placebo.</p>
<p>Although not legal in the UK, CBN is <a href="https://www.sleepstation.org.uk/articles/sleep-aids/cbn-oil/">one of the main compounds</a> contained in commercial cannabis sleep products, with more and more CBN formulations coming onto the market. A <a href="https://www.liebertpub.com/doi/10.1089/can.2021.0006?utm_source=Adestra&utm_medium=email&utm_term=&utm_content=ReadNow1&utm_campaign=CAN+FP+September+15+2021">recent review</a> sought to find out whether CBN really does improve sleep.</p>
<p>The review included studies going back as far as the 1940s. These mainly involved administering CBN to people and comparing the self-reported quality of their sleep with participants in a control group who had not received the drug.</p>
<p>However, the author of the review, Jamie Corroon, noted several problems with the research to date, including the fact that participants tended to be male and white. This male-centric perspective is not unique to research on cannabis; it’s known to be <a href="https://theconversation.com/women-also-use-drugs-not-that-you-can-tell-from-drug-policy-87957">a problem</a> more broadly in research.</p>
<p>Corroon was also critical of the lack of structured, evidence-based questionnaires used to assess sleep in the studies. He concluded there is insufficient published evidence to support any assertions that these products improve sleep, noting: “Individuals seeking cannabis-derived sleep aids should be skeptical of manufacturers’ claims of sleep-promoting effects.”</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/does-marijuana-affect-your-sleep-81661">Does marijuana affect your sleep?</a>
</strong>
</em>
</p>
<hr>
<h2>Other factors to consider</h2>
<p>The review concentrated primarily on sleep outcomes associated with pure medical-grade CBN. This doesn’t necessarily reflect the way most people use cannabis or cannabis products. Most will either smoke a joint, or ingest a liquid or pill if they’re using a commercially supplied product. </p>
<p>The type of commercial product, the way it’s administered and the dose <a href="https://link.springer.com/chapter/10.1007/978-3-030-61663-2_11">are all known</a> to affect sleep. Notably, the dose of CBN in many commercial products is lower than what was tested in the majority of the studies in the review. </p>
<p>While most commercial cannabis sleep products contain less than 1% THC (if any), a cannabis joint will contain hundreds of compounds, including THC. And <a href="https://link.springer.com/chapter/10.1007/978-3-030-61663-2_11">combining</a> THC with CBN is thought to be a sedative. Pure CBN would therefore not have the same effect it has in real life when consumed with THC. </p>
<p>Although the review found a lack of evidence to support the sedative properties of CBN, scientists have found that medicinal cannabis containing THC and CBD <a href="https://spcare.bmj.com/content/bmjspcare/10/4/415.full.pdf">can improve sleep</a> for people with chronic pain. This benefit decreases, however, for people using these products regularly, as their tolerance to medicinal cannabis builds.</p>
<figure class="align-center ">
<img alt="A woman sits on the edge of her bed, looking at her bedside clock." src="https://images.theconversation.com/files/423366/original/file-20210927-25-nvrfxb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/423366/original/file-20210927-25-nvrfxb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/423366/original/file-20210927-25-nvrfxb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/423366/original/file-20210927-25-nvrfxb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/423366/original/file-20210927-25-nvrfxb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/423366/original/file-20210927-25-nvrfxb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/423366/original/file-20210927-25-nvrfxb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A recent review concluded there’s insufficient evidence to be confident cannabis sleep remedies work.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/people-bedtime-rest-concept-stressed-african-1926737024">Shutterstock</a></span>
</figcaption>
</figure>
<p>Further, while it’s useful to have a review that focuses on sleep and cannabis, it doesn’t capture the varied reasons many people use cannabis or products containing cannabis. Many people use cannabis <a href="https://assets.researchsquare.com/files/rs-528768/v1/fb561639-cc7b-41a3-96f8-35238eda032d.pdf?c=1631885135">to manage</a> physical problems such as <a href="https://www.sciencedirect.com/science/article/pii/S0965229919308040?casa_token=V7VsQXWYTW0AAAAA:OzLLqjPdJ86RYhJUxz7FDxQrm1amEFQbbLzPSeh47XVuojtlI56JrBrF3dS7JGoobVHZGYmahiRh">muscle and joint pain</a>, or psychological issues like anxiety or stress, rather than as a sleep aid. It’s logical that alleviating these symptoms will improve sleep.</p>
<p>One example is people experiencing vivid nightmares as a result of post-traumatic stress disorder (PTSD). Nabilone, a synthetic cannabinoid, has proved <a href="https://jmvfh.utpjournals.press/doi/full/10.3138/jmvfh-2019-0028">to be beneficial</a> in suppressing these types of nightmares, which could improve the quality of sleep for this group of people suffering from PTSD. So you can see why it’s difficult to untangle the effects of cannabis on sleep.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/we-lose-about-30-minutes-of-sleep-each-night-of-the-working-week-new-study-shows-144890">We lose about 30 minutes of sleep each night of the working week, new study shows</a>
</strong>
</em>
</p>
<hr>
<h2>We need better research</h2>
<p>As with many issues in research, there isn’t a neat answer to how effective cannabis is in improving sleep. How the drug is prepared, the way it’s taken and the person’s expectations are just some important factors that may influence the outcome. </p>
<p>And, as with all health products, there is a risk of side-effects. A <a href="https://academic.oup.com/sleep/advance-article-abstract/doi/10.1093/sleep/zsab234/6373351?redirectedFrom=fulltext">recent review</a> of medicinal cannabis products used for sleep found a substantial increase in the risk of developing dizziness, for example.</p>
<p>What is clear is when millions of people have a problem with sleep, there will be a commercial incentive to make money by offering remedies. We need more rigorous research to investigate any associations between cannabis and sleep, and whether these products work.</p><img src="https://counter.theconversation.com/content/168166/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ian Hamilton does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Although a recent review found a lack of evidence to support these products, this doesn’t mean cannabis can’t help some people with sleep. We need better research.Ian Hamilton, Associate Professor of Addiction, University of YorkLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1668462021-09-02T10:35:05Z2021-09-02T10:35:05ZE-cigarettes: misconceptions about their dangers may be preventing people from quitting smoking<figure><img src="https://images.theconversation.com/files/419043/original/file-20210902-21-bkmwle.jpg?ixlib=rb-1.1.0&rect=17%2C0%2C5734%2C3837&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Concerns about Evali may be preventing some from switching to e-cigarettes to quit smoking.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/man-holding-vaporizer-conventional-tobacco-cigarettes-1399249463">ALPA PROD/ Shutterstock</a></span></figcaption></figure><p>When electronic cigarettes (e-cigarettes) first emerged, they became a popular way for people to quit smoking. But in 2019, a mysterious lung condition emerged that primarily affected young people, particularly those who vaped. This left many questioning the safety of e-cigarettes. </p>
<hr>
<iframe id="noa-web-audio-player" style="border: none" src="https://embed-player.newsoveraudio.com/v4?key=x84olp&id=https://theconversation.com/e-cigarettes-misconceptions-about-their-dangers-may-be-preventing-people-from-quitting-smoking-166846&bgColor=F5F5F5&color=D8352A&playColor=D8352A" width="100%" height="110px"></iframe>
<p><em>You can listen to more articles from The Conversation, narrated by Noa, <a href="https://theconversation.com/uk/topics/audio-narrated-99682">here</a>.</em></p>
<hr>
<p>The condition was named e-cigarettes or vaping use-associated lung injury – or Evali for short. The average (median) age of people affected by the condition was <a href="https://www.cdc.gov/tobacco/basic_information/e-cigarettes/severe-lung-disease.html">24 years</a>. <a href="https://www.cdc.gov/tobacco/basic_information/e-cigarettes/severe-lung-disease/faq/index.html">Symptoms</a> included respiratory complaints, such as a cough, shortness of breath and chest pain, as well as stomach problems, fever, chills and weight loss.</p>
<p>We now know that Evali is not caused by regulated, commercial nicotine e-cigarettes. Rather, the condition has been <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa1916433">linked to products</a> sold as THC-containing e-liquids. Because THC (the active ingredient in cannabis) is expensive, some sellers were cutting their products with vitamin E acetate to make the e-liquid look like it contained more THC than it did. Although vitamin E acetate is an ingredient in some foods and skincare products, it’s <a href="https://www.pnas.org/content/117/12/6349">harmful when inhaled</a>.</p>
<p>Once the risk from vitamin E acetate was identified, cases of Evali <a href="https://www.cdc.gov/tobacco/basic_information/e-cigarettes/severe-lung-disease.html">declined steeply</a>. But this hasn’t changed many people’s perception of e-cigarettes, with many still concerned about their safety.</p>
<h2>Misconceptions</h2>
<p>Despite statements from <a href="https://www.nhs.uk/live-well/quit-smoking/using-e-cigarettes-to-stop-smoking/">Public Health England</a> and the US <a href="https://www.cdc.gov/tobacco/basic_information/e-cigarettes/index.htm">Centers for Disease Control and Prevention</a> which state that e-cigarettes have the potential to benefit smokers who switch to vaping, concerns about the <a href="https://link.springer.com/article/10.1007/s11166-020-09329-2">dangers of e-cigarettes</a>, in part because of Evali, are still discouraging people who smoke from switching. </p>
<p>In recent surveys, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8296202/">nearly half</a> of US and <a href="https://ash.org.uk/information-and-resources/fact-sheets/statistical/use-of-e-cigarettes-among-adults-in-great-britain-2021/">a third</a> of British respondents considered nicotine e-cigarettes to be as harmful as cigarettes, if not more harmful. Even after the link to THC-containing products was identified, <a href="https://morningconsult.com/2020/02/05/electronic-cigarettes-increasingly-blamed-by-public-for-lung-illnesses-even-as-evidence-points-elsewhere">most people surveyed</a> thought that Evali was linked to specific types of nicotine e-cigarettes and not to cannabis or THC-containing products. </p>
<figure class="align-center ">
<img alt="An assortment of different e-cigarettes/ vape pens." src="https://images.theconversation.com/files/419044/original/file-20210902-15-etsxt6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/419044/original/file-20210902-15-etsxt6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=434&fit=crop&dpr=1 600w, https://images.theconversation.com/files/419044/original/file-20210902-15-etsxt6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=434&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/419044/original/file-20210902-15-etsxt6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=434&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/419044/original/file-20210902-15-etsxt6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=546&fit=crop&dpr=1 754w, https://images.theconversation.com/files/419044/original/file-20210902-15-etsxt6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=546&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/419044/original/file-20210902-15-etsxt6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=546&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Many still believe e-cigarettes are as dangerous as cigarettes.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/vaping-device-742830484">LezinAV/ Shutterstock</a></span>
</figcaption>
</figure>
<p>There are many reasons why misconceptions about the safety of e-cigarettes persist, but undoubtedly it didn’t help that the cause of Evali was <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa1916433">confirmed</a> just as COVID began dominating news cycles. And, until now, many discussions on e-cigarettes have focused on the risks to young non-smokers. This means the <a href="https://ajph.aphapublications.org/doi/pdf/10.2105/AJPH.2021.306416">potential benefits</a> of e-cigarettes to people who smoke – and those around them – are often ignored.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/eight-ways-to-quit-smoking-in-2021-what-the-science-says-151733">Eight ways to quit smoking in 2021 – what the science says</a>
</strong>
</em>
</p>
<hr>
<p><a href="https://www.cochrane.org/CD010216/TOBACCO_can-electronic-cigarettes-help-people-stop-smoking-and-do-they-have-any-unwanted-effects-when-used">Research shows</a> nicotine e-cigarettes can help people quit smoking and may be more effective than nicotine-replacement therapy. <a href="https://www.cochrane.org/CD010216/TOBACCO_can-electronic-cigarettes-help-people-stop-smoking-and-do-they-have-any-unwanted-effects-when-used">In studies</a> testing e-cigarettes as a way to quit smoking, there was no evidence that people using e-cigarettes were more likely to experience serious health issues. Also, e-cigarettes are thought to <a href="https://www.nhs.uk/live-well/quit-smoking/using-e-cigarettes-to-stop-smoking/">pose fewer risks to bystanders</a> – while <a href="https://www.who.int/news-room/fact-sheets/detail/tobacco">secondhand smoke</a> from cigarettes kills around 1.2 million people a year. </p>
<p>It’s also worth noting that e-cigarettes typically only contain nicotine, not tobacco, which is found in cigarettes. Although nicotine is an addictive substance, <a href="https://www.nhsinform.scot/healthy-living/stopping-smoking/reasons-to-stop/tobacco">tobacco smoke</a> contains carbon monoxide, tar and toxic chemicals – including benzene, arsenic and formaldehyde. <a href="https://www.cancer.org/cancer/cancer-causes/tobacco-and-cancer/carcinogens-found-in-tobacco-products.html">These substances</a> are known to cause cancer and other heart and lung diseases. The harm from cigarettes largely comes from <a href="https://www.nhsinform.scot/healthy-living/stopping-smoking/reasons-to-stop/tobacco">burning tobacco</a> – not from the nicotine. E-cigarettes deliver nicotine without burning anything.</p>
<h2>Valid concerns</h2>
<p>E-cigarettes haven’t been around for long, so they’re very unlikely to be completely harmless, and there is still uncertainty about their longer-term effects. </p>
<p>The liquid and vapour used in e-cigarettes contain some potentially harmful chemicals also found in cigarette smoke, but at <a href="https://www.nhs.uk/live-well/quit-smoking/using-e-cigarettes-to-stop-smoking/">lower levels</a>. In addition, there are concerns about the effect of nicotine on adolescent brain development. Although, as a <a href="https://www.cochrane.org/CD010216/TOBACCO_can-electronic-cigarettes-help-people-stop-smoking-and-do-they-have-any-unwanted-effects-when-used">recent paper</a> pointed out, studies showing that nicotine causes changes in the brain have only been conducted on animals. The authors argue it is still unclear whether the same effect will be seen in humans. There are also worries that e-cigarettes could be another pathway to nicotine addiction – especially if people who would never have started smoking begin vaping.</p>
<p>In reality, because e-cigarettes are relatively new, uncertainty about their longer-term effects will undoubtedly persist for some time. </p>
<p>What we do know is that smoking <a href="https://ajph.aphapublications.org/doi/pdf/10.2105/AJPH.2021.306416">disproportionately harms</a> people from disadvantaged groups, including those from lower-income groups and people with mental health conditions. Not only is smoking linked to many harmful diseases, it’s also <a href="https://blogs.worldbank.org/health/ominous-fact-world-no-tobacco-day-2021-smoking-kills-more-people-covid-19">killed more people than COVID</a> – around <a href="https://www.cdc.gov/tobacco/data_statistics/fact_sheets/fast_facts/index.htm">720,000</a> in the US since March 2020. The evidence we have so far shows that e-cigarettes can be an effective way to help people successfully quit smoking – and are likely to have far fewer health risks than cigarettes.</p>
<p>When we communicate about the risks of e-cigarettes, we need to be clear about which e-cigarettes, who might be at risk, and who might benefit. The people who stand to benefit the most from vaping – namely people who smoke – have a right to be receiving accurate, evidence-based information, too.</p><img src="https://counter.theconversation.com/content/166846/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jamie Hartmann-Boyce receives funding from Cancer Research UK.</span></em></p>E-cigarettes are an effective way to help people quit smoking.Jamie Hartmann-Boyce, Senior Research Fellow, Departmental Lecturer and Director of Evidence-Based Healthcare DPhil Programme, Centre for Evidence-Based Medicine, University of OxfordLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1542562021-04-01T17:44:04Z2021-04-01T17:44:04ZCBD, marijuana and hemp: What is the difference among these cannabis products, and which are legal?<p>New York recently became the <a href="https://www.vox.com/2021/3/31/22350330/new-york-marijuana-legalization-bill-law-andrew-cuomo">15th U.S. state to legalize cannabis for recreational use</a>. </p>
<p>While <a href="https://www.pewresearch.org/fact-tank/2019/11/14/americans-support-marijuana-legalization/">67% of U.S. adults support marijuana legalization</a>, public knowledge about cannabis is low. A third of Americans <a href="https://onlinelibrary.wiley.com/doi/abs/10.1093/aepp/ppz001">think hemp and marijuana are the same thing</a>, according to <a href="https://www.nccih.nih.gov/health/cannabis-marijuana-and-cannabinoids-what-you-need-to-know">the National Institutes of Health</a>, and many <a href="https://www.healthline.com/health/does-cbd-get-you-high">people still search Google to find out whether cannabidiol</a> – a cannabis derivative known as CBD – will get them high, as marijuana does.</p>
<p>Hemp, marijuana and CBD are all related, but they differ in significant ways. Here’s what you need to know about their legality, effects and potential health benefits. </p>
<h2>Hemp, marijuana and cannabanoidals</h2>
<p>Both hemp and marijuana belong to the same species, <em>Cannabis sativa</em>, and the two plants look somewhat similar. However, substantial variation can exist within a species. After all, great Danes and chihuahuas are both dogs, but they have obvious differences.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/392929/original/file-20210331-13-147haqe.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Tiny chihuahua sits next to a giant great dane" src="https://images.theconversation.com/files/392929/original/file-20210331-13-147haqe.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/392929/original/file-20210331-13-147haqe.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=444&fit=crop&dpr=1 600w, https://images.theconversation.com/files/392929/original/file-20210331-13-147haqe.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=444&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/392929/original/file-20210331-13-147haqe.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=444&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/392929/original/file-20210331-13-147haqe.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=558&fit=crop&dpr=1 754w, https://images.theconversation.com/files/392929/original/file-20210331-13-147haqe.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=558&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/392929/original/file-20210331-13-147haqe.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=558&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Great Danes and chihuahuas are distant cousins, like marijuana and hemp.</span>
<span class="attribution"><a class="source" href="https://pixy.org/1445408/">Pixy</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>The defining difference between hemp and marijuana is their psychoactive component: <a href="https://medium.com/cbd-origin/hemp-vs-marijuana-the-difference-explained-a837c51aa8f7">tetrahydrocannabinol, or THC</a>. Hemp has 0.3% or less THC, meaning hemp-derived products don’t contain enough THC to create the “high” traditionally associated with marijuana. </p>
<p>CBD is a compound found in cannabis. There are <a href="https://doi.org/10.1016/j.plantsci.2019.03.022">hundreds of such compounds</a>, which are termed “cannabinoids,” because they interact with receptors involved in <a href="https://dx.doi.org/10.3390%2Fijms19030833">a variety of functions like appetite, anxiety, depression and pain sensation</a>. THC is also a cannabinoid.</p>
<p>Clinical research indicates that <a href="https://www.nytimes.com/2019/10/16/style/self-care/cbd-oil-benefits.html">CBD is effective at treating epilepsy</a>. Anecdotal evidence suggests it can help with pain and even anxiety – though scientifically <a href="https://theconversation.com/cbd-sales-are-soaring-but-evidence-is-still-slim-that-the-cannabis-derivative-makes-a-difference-for-anxiety-or-pain-149612">the jury is still out on that</a>. </p>
<p>Marijuana, containing both CBD and more THC than hemp, has <a href="https://www.pennlive.com/nation-world/2019/06/medical-marijuana-what-does-the-science-say.html">demonstrated therapeutic benefits</a> for people with <a href="https://theconversation.com/trials-a-step-forward-for-medicinal-cannabis-but-what-comes-next-40472">epilepsy</a>, <a href="https://theconversation.com/could-a-cannabis-pill-reduce-chemotherapy-induced-nausea-and-vomiting-heres-how-we-find-out-66774">nausea</a>, glaucoma and potentially even <a href="https://theconversation.com/can-marijuana-treat-ms-symptoms-its-hard-for-researchers-to-find-out-68405">multiple sclerosis</a> and <a href="https://theconversation.com/legal-weed-an-accidental-solution-to-the-opioid-crisis-81603">opioid-dependency disorder</a>.</p>
<p>However, medical research on marijuana is severely restricted by federal law. </p>
<p>The Drug Enforcement Agency <a href="https://www.deadiversion.usdoj.gov/schedules/">categorizes cannabis</a> as a Schedule 1 substance, meaning it handles cannabis as if there is no accepted medical use and a high potential for abuse. Scientists don’t know exactly <a href="https://theconversation.com/cbd-rising-star-or-popular-fad-110146">how CBD works</a>, nor how it interacts with other cannabinoids like THC to give marijuana its added therapeutic effects.</p>
<h2>Retail CBD</h2>
<p>CBD comes in food, tinctures and oils, just to name a few. Here are some commonly used terms used to describe CBD products in the store.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/392944/original/file-20210331-19-18i5psr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Wood shelf with various CBD products from the R+R Medicinals label on it" src="https://images.theconversation.com/files/392944/original/file-20210331-19-18i5psr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/392944/original/file-20210331-19-18i5psr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/392944/original/file-20210331-19-18i5psr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/392944/original/file-20210331-19-18i5psr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/392944/original/file-20210331-19-18i5psr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/392944/original/file-20210331-19-18i5psr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/392944/original/file-20210331-19-18i5psr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Full spectrum CBD products for sale, including tinctures, topical creams, edible gummies and pet products.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/various-wellness-products-containing-full-spectrum-news-photo/1266349539?adppopup=true">Smith Collection/Gado/Getty Images</a></span>
</figcaption>
</figure>
<p>While the terms “CBD tincture” and “<a href="https://theconversation.com/cbd-oil-what-you-need-to-know-99430">CBD oil</a>” are often used interchangeably, the two are actually different. Tinctures are made by soaking cannabis in alcohol, while oils are made by suspending CBD in a carrier oil, like olive or coconut oil. </p>
<p>“Pure” CBD, also called “CBD isolate,” is called that because all other cannabinoids have been removed. So have terpenes and flavonoids, which give marijuana its strong aroma and earthy flavor. </p>
<p>“Broad spectrum” CBD typically contains at least three other cannabinoids, as well as some terpenes and flavonoids – but still no THC. “Full spectrum” CBD, also called “whole flower” CBD, is similar to broad spectrum but can contain up to 0.3% THC. </p>
<p>In states where recreational marijuana is legal, the list of cannabis-derived products greatly expands to include CBD with much higher THC content than 0.3%. </p>
<p><a href="https://www.scientificamerican.com/article/as-cbd-skyrockets-in-popularity-scientists-scramble-to-understand-how-its-metabolized/">There is no standardized dosage</a> of CBD. Some retailers may have enough knowledge to make a recommendation for first-timers. There are also online resources – <a href="https://dailycbd.com/en/cbd-dosage/">like this dosage calculator</a>.</p>
<p>Consumers concerned about content and the accuracy of CBD products, which are not regulated by the Food and Drug Administration, can look for certification from independent lab testing or by scanning a QR code on product packaging. </p>
<p>Note that CBD oil is different from hemp oil – which comes from pressing cannabis seeds, and may not contain CBD – and <a href="https://www.healthline.com/health/hemp-vs-cbd-oil">hempseed oil</a>, which is a source of essential fatty acids and contains no CBD. It’s a nutritional supplement, more like fish oil than CBD oil.</p>
<h2>Legal status</h2>
<p>Another big difference among hemp, marijuana and CBD is how the law treats them. </p>
<p>Though <a href="https://drugpolicy.org/issues/marijuana-legalization-and-regulation">15 states have now legalized recreational marijuana</a>, it remains illegal federally in the United States. Technically, those in possession of marijuana in a legal weed state can still be punished under federal law, and traveling across state borders with cannabis is prohibited.</p>
<p>Hemp, on the other hand, was made <a href="https://www.usda.gov/topics/hemp">legal to grow and sell in the United States</a> in the <a href="https://www.brookings.edu/blog/fixgov/2018/12/14/the-farm-bill-hemp-and-cbd-explainer/">2018 Farm Bill</a>. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/392928/original/file-20210331-15-5a153s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Man wearing backpack looks at a row of hemp plants" src="https://images.theconversation.com/files/392928/original/file-20210331-15-5a153s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/392928/original/file-20210331-15-5a153s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=368&fit=crop&dpr=1 600w, https://images.theconversation.com/files/392928/original/file-20210331-15-5a153s.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=368&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/392928/original/file-20210331-15-5a153s.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=368&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/392928/original/file-20210331-15-5a153s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=463&fit=crop&dpr=1 754w, https://images.theconversation.com/files/392928/original/file-20210331-15-5a153s.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=463&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/392928/original/file-20210331-15-5a153s.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=463&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">A stand at the 2019 Southern Hemp Expo, in Tennessee.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/an-attendee-stops-at-the-hemp-magazine-booth-at-the-news-photo/1166764427?adppopup=true">Bill Clark/CQ-Roll Call, Inc via Getty Images</a></span>
</figcaption>
</figure>
<p>One would assume, then, that hemp-derived CBD should be <a href="https://www.marieclaire.com/politics/a27033880/where-is-cbd-legal-in-the-united-states/">federally legal in every state</a> because the THC levels don’t surpass 0.3%. But CBD occupies a legal gray area. Several states, such as Nebraska and Idaho, still essentially regulate CBD oil as a Schedule 1 substance akin to marijuana.</p>
<p><a href="https://doi.org/10.1016/j.addbeh.2020.106799">Our recent study</a> found that Americans perceive hemp and CBD to be more like over-the-counter medication and THC to be more like a prescription drug. Still, the average person in the U.S. does not view hemp, CBD, THC or even marijuana in the same light as illicit substances like meth and cocaine – even though both are classified by the DEA as having a lower potential for abuse than marijuana.</p>
<p><iframe id="hZV2Y" class="tc-infographic-datawrapper" src="https://datawrapper.dwcdn.net/hZV2Y/4/" height="400px" width="100%" style="border: none" frameborder="0"></iframe></p>
<p>The current federal prohibition of marijuana, in other words, does not align with the public’s view – though state-based legalization shows that society is moving on without the blessing of politicians on Capitol Hill. U.S. recreational marijuana retail <a href="https://americanmarijuana.org/marijuana-statistics/#Recreational_Marijuana_Retail_Sales_in_the_US">sales may reach US$8.7 billion in 2021</a>, up from <a href="https://www.forbes.com/sites/debraborchardt/2017/01/03/marijuana-sales-totaled-6-7-billion-in-2016/?sh=20cf713975e3">$6.7 billion in 2016</a>.</p>
<p>As interest in other cannabinoids, <a href="https://www.healthline.com/health/cbg-oil#cbg-vs-cbd">like cannabigerol, or CBG</a> – which some are touting as the new CBD – continues to grow, so too grows the need for further medical research into cannabis.</p>
<p>[<em>Get the best of The Conversation, every weekend.</em> <a href="https://theconversation.com/us/newsletters/weekly-highlights-61?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=weeklybest">Sign up for our weekly newsletter</a>.]</p><img src="https://counter.theconversation.com/content/154256/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Brandon McFadden receives funding from U.S. Department of Agriculture. </span></em></p><p class="fine-print"><em><span>Trey Malone receives funding from the U.S. Department if Agriculture, the Charles Koch Foundation, and the Michigan Department of Agriculture and Rural Development. </span></em></p>Hemp, CBD and marijuana are all forms of cannabis – but they are different in significant ways, from form and legality to their potential uses as treatment for various health conditions.Brandon R. McFadden, Assistant Professor of Applied Economics and Statistics, University of DelawareTrey Malone, Assistant Professor and Extension Economist, Michigan State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1464592020-12-21T10:18:29Z2020-12-21T10:18:29ZCannabis: the problem with defining products around THC content<figure><img src="https://images.theconversation.com/files/373297/original/file-20201207-21-vpqk36.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://unsplash.com/photos/hAyInG_uDtE">Sam Doucette/Unsplash</a>, <a class="license" href="http://artlibre.org/licence/lal/en">FAL</a></span></figcaption></figure><p>Cannabis policy is undergoing a global revolution. Around the world, laws are changing. In the US, there are now <a href="https://www.esquire.com/lifestyle/a21719186/all-states-that-legalized-weed-in-us/">15 states</a> in which cannabis for adult-use purposes is legal, and nearly three dozen where it is legal for medical purposes. In 2018, <a href="https://www.bbc.co.uk/news/world-us-canada-45806255">Canada</a> became the first G7 country to legalise cannabis for all purposes, following the first country to do so, <a href="https://www.bbc.co.uk/news/business-47785648">Uruguay</a>. More than <a href="https://www.fool.com/investing/stock-market/market-sectors/healthcare/marijuana-stocks/marijuana-legalization/">40 countries</a>, on every continent except Antartica, have implemented a legal framework for cannabis, primarily for medical purposes. </p>
<p>In the UK, consumption of cannabis – and cultivation, production and distribution that is unlicensed for non-medical or non-industrial purposes – is still illegal, subject to a warning or a fine of <a href="https://www.gov.uk/penalties-drug-possession-dealing">£90</a>. Penalties for possession and supply production range from five to 14 years in jail, unlimited fines or both.</p>
<p>But in November 2018, the UK government <a href="https://www.gov.uk/government/news/government-announces-that-medicinal-cannabis-is-legal">legalised medical cannabis</a>, marking the opening of its legal, regulated market. This followed news that <a href="https://www.bbc.co.uk/news/uk-44519058">Billy Caldwell</a>, a young boy with severe epilepsy, was hospitalised after his cannabis medications were confiscated in June 2018. The <a href="https://www.theguardian.com/society/2018/jun/19/home-secretary-sajid-javid-announces-review-into-medicinal-cannabis-use">process of reform</a> was expedited after the UK public called the morality of the government into question. </p>
<p>Despite legalisation, patient access <a href="https://www.theguardian.com/politics/2020/jul/01/anger-at-nhs-failure-to-prescribe-cannabis-oil-medicines">remains restricted</a> – the few hundred people who have obtained medicines have primarily done so through private healthcare. In this context, the fact that the UK has historically been the world’s largest exporter of <a href="https://www.bbc.co.uk/news/health-44197038">medical cannabis</a> is something of a surprise. This paradox cuts to the heart of many of the trends across the global cannabis market.</p>
<h2>The CBD market</h2>
<p>Although medical cannabis access is restricted, there is another popular, legal cannabis market where over-the-counter cannabis-based products are available. They are predominantly made up of a cannabinoid called cannabidol, commonly referred to as CBD, which as an isolated compound is legal in the UK. </p>
<p>One way CBD is defined is by its THC (delta 9 tetrahydrocannabinol) content. THC is one of the most <a href="https://www.acpjournals.org/doi/pdf/10.7326/0003-4819-126-10-199705150-00008?casa_token=3tl4rpbE4eEAAAAA%3AsFFDS1wnhLTc7tnDALsO_6UP1xCtjnBUJ4qPRtC-fGOVsZvppNvnUwU6PF_tea7vGw_NyRvhtweErg&">widely studied</a> and well-known cannabis compounds, a principle chemical in the plant that people associate with “getting high”. THC for non-medical purposes is illegal in the UK, and CBD products must contain less than 0.2% THC and less than <a href="https://www.legislation.gov.uk/uksi/2001/3998/contents/made">1mg of THC</a> per product: i.e. very, very small levels.</p>
<p>Consumers buy <a href="https://www.health.harvard.edu/blog/cannabidiol-cbd-what-we-know-and-what-we-dont-2018082414476">CBD</a> for chronic pain, anxiety and inflammatory related issues, as well as sleep, metabolism, pleasure and mood. Name your need – from sex to sleep, relief to recovery, focus to fitness and skin health to gut health – there likely is a CBD product that claims to sort it. Currently, the UK CBD market value is around <a href="https://www.savills.co.uk/research_articles/229130/296363-0">£300 million</a>.</p>
<p>Research has found benefits of CBD use for a range of conditions, such as <a href="https://scholar.google.com/scholar_lookup?author=GW%20Biosciences&publication_year=2018&title=Epidiolex">epilepsy</a>, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6326553/">anxiety disorders</a>, and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6099309/">reducing tobacco use</a>. Acceptance is growing. Product choice is abundant, from cosmetic balms, gel capsules, liquid tinctures, food and beverages, trans-dermal patches, even toothpaste and mascara (the latter lacks evidence for use).</p>
<p>CBD products are marketed around the idea that they “can’t get you high”. This, after all, contributes to why they are on the accepted side of the law. And it’s true. You won’t experience a stereotypical high. But such jargon perpetuates the idea that “getting high” is shameful. To some patients, THC, or other psychotropic cannabinoids, are necessary compounds in their medicine. </p>
<p>Throughout <a href="https://podcasts.apple.com/gb/podcast/episode-12-women-in-cannabis-jessica-steinberg-from/id1454098889?i=1000438032634">my research</a> into the legal <a href="https://www.law.ox.ac.uk/people/jessica-steinberg">cannabis market</a>, I have observed how the commercialisation of the CBD market has created a misleading dichotomy of “bad” THC versus “good” CBD. <a href="https://www.nytimes.com/2019/10/16/style/self-care/cbd-oil-benefits.html">Media commentary</a> about CBD invariably discusses THC as a worse “option” – as if there were only two options. </p>
<figure class="align-center ">
<img alt="Packet of CBD gummy bears." src="https://images.theconversation.com/files/373295/original/file-20201207-23-10vvuxe.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/373295/original/file-20201207-23-10vvuxe.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/373295/original/file-20201207-23-10vvuxe.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/373295/original/file-20201207-23-10vvuxe.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/373295/original/file-20201207-23-10vvuxe.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/373295/original/file-20201207-23-10vvuxe.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/373295/original/file-20201207-23-10vvuxe.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">‘THC free’.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/q_vnJenyn9s">PharmaHemp/Unsplash</a>, <a class="license" href="http://artlibre.org/licence/lal/en">FAL</a></span>
</figcaption>
</figure>
<h2>THC vs. CBD</h2>
<p>Out of the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3736954/">400 plus</a> chemical compounds in the cannabis plant, CBD and THC are only the most well-known, and researched, cannabinoids. Both are psychoactive substances. But, THC is psychotropic, and CBD is <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1760722/">non-psychotropic</a>.</p>
<p>Psychoactive effects are a daily experience to most. No matter how you take your coffee, know that it includes a dose of <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4462044/">psychoactivity</a>. Morning caffeine jitters and post “coffee highs” are such symptomatic effects. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3672386/">Chocolate</a> lovers will have also experienced <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3575938/">psychoactive effects</a>, such as improved mood, stress reduction, and focus.</p>
<p>Psychotropic effects, by contrast, are what people stereotypically identify with the “high” of cannabis. There might be mood and mind-altering effects, which change behaviour, thoughts, perception and mental and motor activity. Many of the laws around cannabis, both in the UK and elsewhere, cling on to this distinction between psychoactive and psychotropic compounds as an easy way to distinguish between “benefical” and “harmful” substances.</p>
<p>But the synergy of THC and CBD, and other cannabinoids like THCV, CBN, CBG and delta-8 THC, are under <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3165946/">investigation by scientists</a> to explore how multiple compounds enhance the potential effect of the plant. This characterises a theory called “<a href="https://www.sciencedirect.com/science/article/pii/S0006295218302387?casa_token=WdJShpffTrsAAAAA:zM38MPHQJYQ3oEqm__9OvSeyEajfIUdsq1MJCQMxlKirOuBtuvzaMRth01vOQl2ehBrtJgZ6Tg">the entourage effect</a>” that suggests that the synergy of various molecules found in cannabis, when combined, maximises potential efficacy of a whole plant compound, rather than isolated extracts. </p>
<p>This has been researched in the context of <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7324885/">anxiety and mood disorders</a>, <a href="https://pubmed.ncbi.nlm.nih.gov/30152161/">migraines, pain and headaches</a>, <a href="https://www.hindawi.com/journals/bmri/2018/1691428/">cancer</a>, <a href="https://bpspubs.onlinelibrary.wiley.com/doi/pdf/10.1111/j.1476-5381.2010.00791.x">inflammation</a> and <a href="https://pubmed.ncbi.nlm.nih.gov/32149543/">Crohn’s disease</a>. Historically there have been restrictions to conduct cannabis research, so these studies provide a useful foundation for ongoing investigation.</p>
<p>Cannabis is a complex plant. Humans are complex, diverse beings. Cannabis legalisation in the UK – and many other countries – has aimed to simplify the plant, and its derived products, but the commercialisation of this has created two clumsy and unhelpful categories. Ultimately, this is detrimental to the longevity of patient access, scientific research and public knowledge about cannabis-based products and other plant medicines.</p><img src="https://counter.theconversation.com/content/146459/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jessica Steinberg is the Founder and Managing Director of international cannabis consultancy, The Global C. She works primarily with the North American and European cannabis markets, including projects related to hemp and CBD, medical cannabis and adult-use cannabis. Her research is partly funded by various bodies at the University of Oxford, including her college, St. Hildas, and her department within the Faculty of Law. She was a John Blundell Scholar awarded by the Adam Smith Institute. </span></em></p>Out of the 400 plus chemical compounds in the cannabis plant, CBD and THC are only the most well-known, and researched, cannabinoids.Jessica Steinberg, DPhil Candidate in Socio-Legal Studies, University of OxfordLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1483452020-11-03T02:18:41Z2020-11-03T02:18:41ZMedicinal cannabis users in Victoria could soon be allowed to drive with THC in their system. Is it safe?<figure><img src="https://images.theconversation.com/files/365724/original/file-20201027-22-1izape1.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C3500%2C2326&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>Around 25,000 <a href="https://freshleafanalytics.com.au/wp-content/uploads/2020/03/Freshleaf-Q1-2020-Report.pdf">Australians</a> currently use medicinal cannabis products. They may be prescribed to relieve symptoms and pain associated with certain <a href="https://www.tga.gov.au/medicinal-cannabis-role-tga">chronic medical conditions</a>, for chemotherapy-induced nausea, or during palliative care.</p>
<p>In Australia, it’s an offence for someone to drive if they’re using medicinal cannabis products containing tetrahydrocannabinol (THC, the main psychoactive component of cannabis). If they injure another person in a traffic accident, they may face criminal charges of driving while impaired.</p>
<p>If they’re picked up at a roadside test, <a href="https://www.rms.nsw.gov.au/roads/safety-rules/demerits-offences/suspension-disqualification/drug-driving-reforms-lower-range-offences/index.html">they’ll be penalised</a> in the same way as someone who tests positive to illegal drugs.</p>
<p>But <a href="https://www.theage.com.au/national/victoria/drivers-using-medicinal-cannabis-to-get-green-light-20201014-p564z0.html#comments">in Victoria</a>, this could soon change. A <a href="https://www.legislation.vic.gov.au/bills/road-safety-amendment-medicinal-cannabis-bill-2019">parliamentary bill</a> proposing to treat medicinal cannabis users like people who use other prescription drugs, rather than illegal drug users, is gaining support.</p>
<p>Generally, being on medication doesn’t mean you’re not allowed to drive. It seems fair that medicinal cannabis users should be treated in the same way as people who use legal drugs. </p>
<p>But we also need to weigh up any potential risks. Driving a car is a complex task that requires a driver to be attentive, competent and capable.</p>
<h2>The relationship between cannabis and driving impairment is complex</h2>
<p>The degree to which cannabis might impair a person’s ability to drive safely often depends on <a href="https://www.sciencedirect.com/science/article/pii/S0376871603002849?casa_token=RZ0LlhzMd1EAAAAA:fvq1__uZPK16741eQyx7-BZVCIjq8-QFPb3-V3cREBz2VFG-aSna6UbSeXCcyAxc88YsIa-Wuw">how much is consumed</a>, <a href="https://bedrocan.com/wp-content/uploads/2019_on-the-impact-of-cannabis-consumption-on-traffic-safety-a-driving_tank.pdf">how long people wait</a> to drive after using it, the <a href="https://bedrocan.com/wp-content/uploads/2019_on-the-impact-of-cannabis-consumption-on-traffic-safety-a-driving_tank.pdf">strength of the psychoactive components</a>, and the <a href="https://www.sciencedirect.com/science/article/pii/S0001457512002709?casa_token=p4M7Qyc2R6QAAAAA:XvbdssVKnz6eYsNuq80pRLkb0z9gAerSItv2RLnFookM6omRTYRSEYZqEFnx0yOovxMheIl-Xg">driver’s age and/or experience</a>.</p>
<p>Compared with drug-free drivers, drivers with <a href="https://www.sciencedirect.com/science/article/pii/S0001457519312011?casa_token=0HPq2qIJCX8AAAAA:5kin0aryt26c0AzBEVjZ5Hp8CosLMPC8T7cH6Tf9XXrgC08fwxdbjvMu0NxXPEPznxu1w3Yl-w#bib0250">high levels of THC</a> have modestly increased odds of being responsible for a traffic accident resulting in injury or death. </p>
<p>High-THC cannabis also reduces a driver’s ability <a href="https://www.sciencedirect.com/science/article/pii/S0376871615003142?casa_token=XYnsz4VrkbQAAAAA:lwCVTPZEeFt8hH38PmEeJGYFvT5fAitQh0bIYK5g0YpzKlEtmNi3Vi38el7vlg9qckBITZJnbw">to control the car</a> or respond to <a href="https://www.sciencedirect.com/science/article/pii/S0001457509000918?casa_token=Yzp0HeukmQMAAAAA:VxSlEP6RUK5_PZSzK5FXI_htsTrjmx3QjioLXPtcELX52OPspdoXgUhJl4cUwpJBtRbTaDKI8g">unexpected situations</a>. </p>
<p>It also affects a driver’s attention, and <a href="https://www.tandfonline.com/doi/pdf/10.1080/15389588.2020.1814956?casa_token=Zm9wvmoPF14AAAAA:CRI1BIlcjkGOodnYO1kFnWZswqzfjsobxwOhWDQmrnP56ahKpvwsBxiBVH2t1jy4sZ5nnPDwyU_2">the higher the THC concentration in their system</a>, the greater the impairment. </p>
<p>Conversely, some research has suggested THC has <a href="https://www.nhtsa.gov/sites/nhtsa.dot.gov/files/812117-drug_and_alcohol_crash_risk.pdf">minimal or no effect</a> on the likelihood of being involved in a crash.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/why-is-it-still-so-hard-for-patients-in-need-to-get-medicinal-cannabis-73844">Why is it still so hard for patients in need to get medicinal cannabis?</a>
</strong>
</em>
</p>
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<h2>Medicinal cannabis is different to the illegal stuff</h2>
<p>Medicinal cannabis typically contains much less of the intoxicating component (THC), and more of the components that don’t produce a “high” (cannabidiol, or CBD). Compared with THC, CBD has <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6304621/">much less effect</a> on mood, awareness, thoughts, feelings and behaviour. </p>
<p>Most often, <a href="https://freshleafanalytics.com.au/wp-content/uploads/2020/03/Freshleaf-Q1-2020-Report.pdf">Australian medical cannabis products</a> are CBD-only.</p>
<p>It’s not clear how CBD-only treatments might affect driving, although <a href="https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=378312">many studies</a> <a href="https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=377744&isReview=true">are ongoing</a>. As it stands, patients taking CBD-only medicines <a href="https://www.vicroads.vic.gov.au/safety-and-road-rules/driver-safety/drugs-and-alcohol/medicinal-cannabis-and-driving">can lawfully drive</a>, as long as they are not impaired.</p>
<figure class="align-center ">
<img alt="A cannabis plant." src="https://images.theconversation.com/files/366916/original/file-20201102-14-1al5i3s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/366916/original/file-20201102-14-1al5i3s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/366916/original/file-20201102-14-1al5i3s.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/366916/original/file-20201102-14-1al5i3s.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/366916/original/file-20201102-14-1al5i3s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/366916/original/file-20201102-14-1al5i3s.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/366916/original/file-20201102-14-1al5i3s.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Australian medicinal cannabis products are generally CBD-only.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<p>Sometimes, medicinal cannabis products are CBD/THC-balanced or THC-dominant. How medicinal cannabis might impair a person’s ability to drive safely seems to depend <a href="https://link.springer.com/article/10.1007/s00213-019-05246-8">how much THC is in it</a>. CBD does not offset this intoxicating effect.</p>
<h2>Roadside testing</h2>
<p>In Australia, THC is a <a href="https://www.legislation.gov.au/Details/F2020L01255">controlled Schedule 8 drug</a> under the Poisons Standard. Victoria has a zero-tolerance drug-driving policy for controlled drugs. This currently includes <a href="https://www.vicroads.vic.gov.au/safety-and-road-rules/driver-safety/drugs-and-alcohol/medicinal-cannabis-and-driving">medicinal cannabis products</a> that contain THC. </p>
<p>Under this system, <a href="https://www.towardszero.vic.gov.au/campaign/drug-driving">drivers are screened at the roadside</a> for cannabis (THC), (meth)amphetamine or 3,4-Methylenedioxymethamphetamine (MDMA) using a saliva test. Drivers who return a positive result will undergo verification (additional testing of a sample sent to a laboratory) to confirm how much of a drug is present.</p>
<p>The <a href="https://www.tac.vic.gov.au/road-safety/tac-campaigns/drug-driving?gclid=Cj0KCQjwuL_8BRCXARIsAGiC51AYudihG8t8y71IP8chszRrFWoGLxjsssKIDE6EoCB1g4HElJ3LNhEaAu34EALw_wcB">minimum penalty</a> for testing positive to THC is a six-month loss of licence and a fine. Drivers must also complete an education program.</p>
<p>The process is similar in other states.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/even-if-cannabis-is-legal-please-dont-toke-and-drive-97992">Even if cannabis is legal, please don't toke and drive</a>
</strong>
</em>
</p>
<hr>
<p>Roadside tests can’t differentiate between illegal recreational and medicinal cannabis products, or determine the THC concentration.</p>
<p>So patients legally prescribed medications that contain THC can be prosecuted in the same way as a driver who has consumed a higher level of THC for a non-medical reason.</p>
<figure class="align-center ">
<img alt="Two cars are damaged after an accident." src="https://images.theconversation.com/files/366922/original/file-20201102-19-l66t2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/366922/original/file-20201102-19-l66t2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/366922/original/file-20201102-19-l66t2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/366922/original/file-20201102-19-l66t2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/366922/original/file-20201102-19-l66t2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/366922/original/file-20201102-19-l66t2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/366922/original/file-20201102-19-l66t2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">High-THC cannabis reduces a driver’s ability to control the car or respond to unexpected situations.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<p>Internationally, there’s been a move away from zero-tolerance approaches to systems that use thresholds to determine whether a person driving under the influence of THC is likely to be impaired. </p>
<p><a href="https://www.justice.gc.ca/eng/cj-jp/sidl-rlcfa/qa2-qr2.html">Canada</a>, and now <a href="https://www.ncsl.org/research/transportation/drugged-driving-overview.aspx">many US states</a>, have introduced limits of between 1, but no more than 5 nanograms of THC per millilitre of blood. This roughly equates to a blood alcohol content of 0.05%. </p>
<p>Penalties for having higher levels of THC <a href="https://madd.ca/pages/impaired-driving/overview/cannabis-and-driving/">are based on a graded system</a> that factors in the level of drugs in the driver’s system, and whether the incident is a first or repeated offence. These laws apply to all drivers, including those with a medical authorisation to use cannabis.</p>
<h2>The road ahead</h2>
<p>As many as <a href="https://www.sciencedirect.com/science/article/pii/S0001457520316043?dgcid=rss_sd_all">one in three</a> Australian patients who use medicinal cannabis drive within three hours of taking their treatment. Some medications containing THC can be detected by roadside drug tests more than <a href="https://www.tga.gov.au/sites/default/files/auspar-nabiximols-130927-pi.pdf">four hours after use</a>, so patients who drive within this window may well be charged. </p>
<p>Determining whether patients who use medicinal cannabis products pose a risk to themselves or other road users is important for deciding what (if any) legislative changes would be appropriate. We need more research before we can move to a system like Canada or the US.</p>
<p>Introducing a conditional licence, subject to periodic review, may be one way of supporting people who use medicinal cannabis to drive lawfully and safely. A central registry could help law enforcement and health-care providers quickly reference what medication a driver is taking, at what dose, and for how long they’ve been using it. </p>
<p>As with other potentially impairing (but legal) medications, using <a href="https://www.legislation.gov.au/Details/F2018L00168">mandatory driving hazard warning labels</a> might be an easy way to help patients make better decisions about whether they are feeling well enough to drive when using these medications.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/1-in-10-women-with-endometriosis-report-using-cannabis-to-ease-their-pain-126516">1 in 10 women with endometriosis report using cannabis to ease their pain</a>
</strong>
</em>
</p>
<hr>
<p>With greater access to a wider range of medicinal cannabis products, it’s important we support the rights of patients who use these medications and continue to drive, as well as ensuring the safety of all road users. </p>
<p>Future decisions must include equal input from patient advocates, research groups, road safety groups and law enforcement.</p><img src="https://counter.theconversation.com/content/148345/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Amie Hayley receives funding from the National Health and Medical Council (NHMRC) Peter Doherty
Biomedical Early Career Research Fellowship (1119960) and the Jack Brockhoff and Edwin
Flack Early Career Medical Research Grant (4338-2017). She is affiliated with The International Council for Alcohol, Drugs and Traffic Safety (ICADTS) and the Institute for Breathing and Sleep (IBAS).</span></em></p>It’s important patients taking prescribed medicinal cannabis products are not unduly penalised. But it’s equally important we minimise the chance drivers put themselves or other road users at risk.Amie Hayley, NHMRC Peter Doherty Biomedical Early Career Research Fellow and Senior Research Fellow, Swinburne University of TechnologyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1420172020-07-15T13:04:25Z2020-07-15T13:04:25ZDoes cannabis really affect memory? Here’s what research currently says<figure><img src="https://images.theconversation.com/files/347657/original/file-20200715-37-uiv1zo.jpg?ixlib=rb-1.1.0&rect=35%2C8%2C5955%2C3979&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">THC and CBD, both cannabis compounds, have very different effects on the brain.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/large-number-cannabis-flowers-hands-medetsinsky-1005685864">Dmytro Tyshchenko/ Shutterstock</a></span></figcaption></figure><p>Cannabis use has long been associated with memory loss. But until now, this notion was largely anecdotal. As researchers begin to look into cannabis and the effect that it has on human health, they’re beginning to better understand the effect it has on the human brain – and whether cannabis really does impair memory.</p>
<p>Memory is divided into both short-term and long-term memory. Short-term memory is where immediate events are temporarily stored, whereas long-term memory is where information is stored indefinitely.</p>
<p>Current evidence shows that <a href="https://www.drugabuse.gov/publications/research-reports/marijuana/what-are-marijuanas-long-term-effects-brain">cannabis intoxication</a> may temporarily alter or distort short-term memory processing. This seems to be caused by compounds in cannabis that disrupt neural signalling when binding to receptors <a href="https://www.health.harvard.edu/mind-and-mood/the-effects-of-marijuana-on-your-memory">responsible for memory</a> in the brain. Interrupted short-term memory can indeed <a href="https://link.springer.com/article/10.1007/s00213-016-4383-x">impact on learning</a>, and may also cause loss of interest or <a href="https://www.drugabuse.gov/publications/research-reports/marijuana/how-does-marijuana-use-affect-school-work-social-life">problems with concentration</a>.</p>
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<iframe width="440" height="260" src="https://www.youtube.com/embed/bg3TNNvj0uU?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
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<p>However, early research also shows that cannabis could have a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6514832/">positive impact</a> on neurodegenerative diseases that affect memory, such as Alzheimer’s, Huntington Chorea, and epilepsy. In mainly animal studies, when researchers used components found in cannabis, they found it could <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6970569/">slow or even prevent</a> the advance of these diseases – essentially through the creation of neurons. </p>
<p>These apparently paradoxical effects from the same drug are best explained by two chemicals found in cannabis. Namely delta 9-tetrahydrocannabinol (THC) and cannabidiol (CBD). We all have naturally occurring cannabinoid receptors in our brains. THC is able to effectively bind to these receptors, <a href="https://www.tandfonline.com/doi/abs/10.1080/10826084.2020.1731547">creating euphoric effects</a>. However CBD can <a href="https://www.tandfonline.com/doi/abs/10.1080/10826084.2020.1731547">interfere with this binding process</a>, which dampens the feeling of euphoria.</p>
<p>Different ratios of these two chemicals are found in various types of cannabis. Consuming a cannabis product with THC but no CBD <a href="https://link.springer.com/article/10.1007/s11920-019-1044-x">increases the risk</a> of developing mental health problems, such as psychosis. However, CBD could actually be <a href="https://www.mdpi.com/2077-0383/8/7/1058">used to treat</a> psychosis.</p>
<p>Cannabis with higher levels of THC and lower, or negligible, amounts of CBD appear to have a <a href="https://www.sciencedirect.com/science/article/abs/pii/S2352464218303420">detrimental effect on short-term memory</a>, particularly in adolescents. The main problem is their ability to retain and recall information. Fortunately this is not permanent.</p>
<p>But these recent discoveries about the role of THC and CBD in cannabis show that we can no longer simply say cannabis itself causes psychosis, or is detrimental to memory. Rather, it might be the type of cannabis, and the compounds it contains, that may have specific risks or benefits.</p>
<p>And while there’s <a href="https://www.sciencedirect.com/science/article/pii/S0924977X20300614?casa_token=jJd-YCv468sAAAAA:xo4KcnhHYJEwWfWUnhEOmucgGqC733A27q5Bt8Fk6i-F4HZP-FHoqcYrFTHbZtiD5jxJLdz8zzeM">little doubt</a> that some people who use cannabis do experience impaired memory, establishing that cannabis is the cause is tricky. One reason for this is because it’s difficult to rule out the impact of other drugs that people may have used – and whether these drugs contributed to this memory impairment. For example, alcohol misuse can also cause <a href="https://www.nature.com/articles/nrneurol.2011.42">brain damage and memory loss</a>. Another obvious problem when researching this is when asking people with impaired memory to recall their past drug use and any associated problems. Their <a href="https://www.pnas.org/content/117/9/4585.short">ability to recall</a> these details could be compromised.</p>
<p>Recent research even suggests that any memory impairment associated with using cannabis <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/add.13946">can be reversed</a> when people stop using cannabis. This effect was seen mainly in those who used cannabis at least once a week.</p>
<p>Just as higher doses of alcohol can <a href="https://www.alzheimers.org.uk/about-dementia/types-dementia/alcohol-related-brain-damage#content-start">potentially cause brain damage</a>, higher doses or <a href="https://www.nature.com/articles/s41398-018-0191-x">more frequent use</a> of cannabis may also cause long-term memory problems – the ability to learn effectively and the ability to concentrate on a task for example. Some people will use <a href="https://link.springer.com/article/10.1007/s40429-017-0149-8">both alcohol and cannabis</a>, often at the same time, which may both worsen the potential impact on memory. </p>
<p><a href="https://onlinelibrary.wiley.com/doi/full/10.1002/adaw.32279?casa_token=ykInFcs7wIMAAAAA%3AP_xloPckXZZfpT9mMt76QgAefhd5iB7cBeaXNYPHdEYf6F4pWK4y1dJFfBKqp9lJd3NCpxHxjZkm_RG7cw">New research also suggests</a> that it’s cannabis, rather than alcohol, that’s responsible for damage to developing teen brains. Though alcohol can <a href="https://journals.sagepub.com/doi/abs/10.1177/0960327107070499?casa_token=QEnZyYlKZs0AAAAA:LcIP3qmomZ2DSuox91ez9FZZ_Z1g27wxOzDfBHpzxvh2YpPZnlmwj_WiQYh9S-5yrzINgoi9SmI2r5Y">destroy or severely damage</a> brain neurons and their signalling functions, this study showed cannabis actually changes the neural brain tissue responsible for memory. But this change can be reversed within a matter of weeks if a person abstains. Though surveys suggest fewer young people are using both cannabis and alcohol, those teenagers that do use cannabis use it <a href="https://www.apa.org/monitor/2015/11/marijuana-brain">twice as frequently</a>.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/347658/original/file-20200715-25-qk5si.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/347658/original/file-20200715-25-qk5si.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/347658/original/file-20200715-25-qk5si.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/347658/original/file-20200715-25-qk5si.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/347658/original/file-20200715-25-qk5si.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/347658/original/file-20200715-25-qk5si.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/347658/original/file-20200715-25-qk5si.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Frequent cannabis by teens may impact their memory and ability to concentrate.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/confused-teenager-doing-his-homework-alone-1257634138">mooremedia/ Shutterstock</a></span>
</figcaption>
</figure>
<p>Research shows that young, frequent users of cannabis have <a href="https://www.sciencedirect.com/science/article/pii/S0166432816307823?casa_token=7FHf1lhk7tYAAAAA:evoeWjbKpodZKKXHq9xnHWWcVAZ-QexBUr7qFEEIyqt_B1Kb5xVVareNAIIrYpANf7SSAO4LZ3yi">thinner temporal and frontal cortices</a>, which are both areas that help process memory functioning. Memory is a critical aid to learning and study – but cannabis doesn’t just effect memory, it can also reduce <a href="https://www.drugabuse.gov/publications/research-reports/marijuana/how-does-marijuana-use-affect-school-work-social-life">motivation to learn</a>. This dual influence reduces a young person’s engagement in education and their ability to perform.</p>
<p>However, using cannabis <a href="https://link.springer.com/article/10.1007/s40429-019-00285-9">later in life</a> (age 50 and over) appears to have only a moderate impact on cognitive functioning, including on memory. These modest declines are not fully understood, and there is a lack of high quality research in this area. That will need to change as it’s <a href="https://theconversation.com/comfortably-numb-why-some-older-people-turn-to-cannabis-for-pain-relief-91350">not just young people</a> that use cannabis. As more countries <a href="https://journals.sagepub.com/doi/full/10.1177/2333721418781668">legalise cannabis</a>, older people might also want to try it.</p>
<p>While there is likely to be no great harm to a person’s memory if they <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6587572/">experiment</a> with cannabis, current research seems to agree that the more frequent the use, the <a href="https://psycnet.apa.org/record/2019-64488-001">greater the risk</a>. Though there is still a lot that researchers don’t yet know about cannabis use on memory, current evidence suggests that any memory impairment can be reversed if a person abstains from use.</p><img src="https://counter.theconversation.com/content/142017/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Elizabeth Hughes receives funding from National Institute for Health Research.</span></em></p><p class="fine-print"><em><span>Ian Hamilton does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Current research suggest it can be both helpful and harmful to memory – here’s why.Ian Hamilton, Associate Professor, Addiction and Mental Health, University of YorkElizabeth Hughes, Professor of Mental Health, University of LeedsLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1396142020-05-30T08:09:02Z2020-05-30T08:09:02ZCannabis: high potency strains linked to greater chance of anxiety – new research<figure><img src="https://images.theconversation.com/files/338510/original/file-20200529-96695-wdmz74.jpg?ixlib=rb-1.1.0&rect=34%2C23%2C3888%2C2287&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">High potency cannabis, like "skunk", has higher levels of THC.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/cannabis-plants-background-591170201">martin_stuard/ Shutterstock</a></span></figcaption></figure><p>Cannabis is one of the <a href="https://www.who.int/substance_abuse/facts/cannabis/en/">most commonly used drugs in the world</a>, though it’s only legal in a few places. Despite its popularity, there’s still a lot that researchers don’t know about how cannabis, including how it affects our mental health. But numerous studies have now shown that people who use cannabis have a higher likelihood of <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/add.12703">experiencing mental health problems</a>. And the potency of the drug – and how often it’s used – are likely to play a role in this relationship. </p>
<p>Different types of cannabis have different levels of a component called tetrahydrocannabinol (THC). “High potency” cannabis has higher amounts of THC. High potency cannabis is widely available legally in many US states, as well as many countries where cannabis is illegal. </p>
<p>Our recent study compared people who said they <a href="https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2765973?guestAccessKey=46e9676f-ddc9-4157-89ed-ea434c65e815&utm_source=For_The_Media&utm_medium=referral&utm_campaign=ftm_links&utm_content=tfl&utm_term=052720">used high potency cannabis</a> with those using lower potency cannabis. We found that the people who used high potency cannabis were more than four times as likely to report symptoms of cannabis misuse, and almost twice as likely to report anxiety disorder. </p>
<p>For this study, we used data from the “<a href="http://www.bristol.ac.uk/alspac/">Children of the 90s</a>” study. This data has been collected since the early 1990s, and comes from more than 13,000 people in south-west England followed from birth. When these children were aged 24, the study team asked them if they’d used cannabis recently, and what kind of cannabis they had used. </p>
<p>The participants were also asked about their other drug use, symptoms of depression and anxiety, and whether they’d had “psychotic-like” experiences (such as hallucinations, which were assessed by specialists to determine if they were similar to experiences of people with psychosis). </p>
<p>In this study, six in ten people had used cannabis at least once in their life by the age of 24. Three in ten of these 24-year-olds had used cannabis in the past year. Those who said they’d used herbal cannabis or hash were classified as using lower potency cannabis. If they said they’d been using skunk or other higher potency types of cannabis, they were classified as using high potency cannabis. </p>
<p>Using this classification method, just over one in ten people who’d used cannabis at age 24 said they’d used high potency cannabis. However, this classification method isn’t perfect. Ideally we’d have preferred to use laboratory measures of the level of THC in the cannabis. As cannabis is illegal to buy and sell in the UK, we had to rely on first-person reports of what they were using. </p>
<h2>Mental health</h2>
<p>A lot of concern about cannabis is around the <a href="https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(19)30048-3/fulltext">development of psychosis</a>, but there’s often less focus the fact cannabis is potentially addictive. There’s a misconception that you can’t get addicted to cannabis, but <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3767415/">cannabis abuse and dependence</a> have very real impacts on people’s health and their lives. </p>
<p>Those using high potency cannabis were more than four times as likely to report issues such as using cannabis on their own, their family expressing concern over their cannabis use, failing in an attempt to cut back on use, and getting into fights or problems at school or work as a result of use. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/338511/original/file-20200529-96713-1ibe2dg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/338511/original/file-20200529-96713-1ibe2dg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/338511/original/file-20200529-96713-1ibe2dg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/338511/original/file-20200529-96713-1ibe2dg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/338511/original/file-20200529-96713-1ibe2dg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/338511/original/file-20200529-96713-1ibe2dg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/338511/original/file-20200529-96713-1ibe2dg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">High potency users were also more likely to have problems from use.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/marijuana-joint-hand-drugs-concept-650375488">Tunatura/ Shutterstock</a></span>
</figcaption>
</figure>
<p>Typically, age of starting to use cannabis or frequency of use are linked with problematic use. But our research found that using high potency cannabis was linked with greater likelihood of experiencing problems, regardless of these factors. However, from this study we’re still unable to tell if problems with cannabis began before or after the use of high potency forms of the drug.</p>
<p>Because the Children of the 90s study has tracked participants from birth, we could be more certain any relationship we found came from participants developing mental health problems after using high potency cannabis, and not the other way around. We also know that those who use cannabis more often at <a href="https://pubmed.ncbi.nlm.nih.gov/12446533/">higher likelihood of experiencing problems</a>.</p>
<p>Not only was likelihood of experience anxiety disorder twice as high, but also we found high potency cannabis users were almost twice as likely to have psychotic experiences. However, this was not the case once we took into account how often they were using the drug. This suggests the relationship between psychotic experiences and high potency cannabis may depend on how often the drug is used. </p>
<p>Though we can learn much from this study, we still need better data that can show whether changes in cannabis potency relates to changes in a peron’s mental health. Future studies may also assess the content of the cannabis objectively, rather than relying on a people self-reporting. But these results do suggest that, for those who choose to use cannabis, using lower potency forms of the drug and not using it too often could reduce some of the harms that we see associated with use.</p><img src="https://counter.theconversation.com/content/139614/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Lindsey Hines receives funding from The Wellcome Trust, and has previously received funding from the UK Medical Research Council and the Australian Government Department of Education, Skills and Employment Endeavour Fellowship Scheme. </span></em></p>People who used strains with higher levels of THC were two times more likely to have anxiety – and four times more likely to report problems from their use.Lindsey Hines, Senior research associate, frequent adolescent cannabis use epidemiology, University of BristolLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1324922020-04-15T12:11:09Z2020-04-15T12:11:09ZNo, CBD is not a miracle molecule that can cure coronavirus, just as it won’t cure many other maladies its proponents claim<figure><img src="https://images.theconversation.com/files/319476/original/file-20200310-118897-8o1vv0.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C7216%2C5357&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Health fads have come and gone over the decades. Is CBD another one? </span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/cannabidoil-royalty-free-image/1187414585?adppopup=true">Getty Images / Lauri Patterson</a></span></figcaption></figure><p>The claims for CBD’s alleged healing powers have been so exaggerated that it’s no surprise that a CBD maker was warned in 2020 by the New York attorney general for <a href="https://nypost.com/2020/04/02/company-falsely-claims-cbd-oil-can-fight-coronavirus-new-york-ag-says/">claiming that the molecule can fight COVID-19</a>. There are no credible animal or human studies showing CBD has any effect on SARS-CoV-2 or the course of COVID-19 infection.</p>
<p><a href="https://pharmacy.uconn.edu/person/c-michael-white/">As professor and chair</a> of the Department of Pharmacy Practice at the University of Connecticut, I’ve investigated many claims of vitamin cures for various illnesses over the decades, including CBD. </p>
<p><a href="http://www.biologydiscussion.com/herbal-drugs/antioxidant-history-measurement-and-antioxidant-capacity/25176">Antioxidant vitamin cocktails</a> were once believed the new stars of the nutrition world. The cocktails, with vitamin E, beta-carotene and vitamin C, supposedly reduced the risk of heart disease, stroke and cancer. That story – derived from single-cell and small-animal studies – was captivating. Imagine taking a vitamin pill to halt free radical damage or keep your arteries from hardening.</p>
<p>Next up was <a href="https://www.ncbi.nlm.nih.gov/books/NBK11870">soy</a> and <a href="https://www.nytimes.com/2011/01/11/science/11aging.html">resveratrol</a>, so-called superfoods that could lower rates of heart disease and cancer; then <a href="https://www.atherosclerosis-journal.com/article/S0021-9150(14)01636-0/fulltext">coenzyme Q10</a>, touted to prevent statin-induced muscle damage. All fell from grace when definitive studies were conducted. </p>
<p>But the CBD hype is in a class by itself, as the misinformation for this cannabis-derived molecule exploded after <a href="https://www.fda.gov/news-events/press-announcements/fda-approves-first-drug-comprised-active-ingredient-derived-marijuana-treat-rare-severe-forms">one drug containing cannabidiol – or CBD</a> – received Food and Drug Administration approval in 2018 – for treatment of seizures associated with two rare forms of epilepsy. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/319479/original/file-20200310-118951-q2ttm1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/319479/original/file-20200310-118951-q2ttm1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=357&fit=crop&dpr=1 600w, https://images.theconversation.com/files/319479/original/file-20200310-118951-q2ttm1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=357&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/319479/original/file-20200310-118951-q2ttm1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=357&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/319479/original/file-20200310-118951-q2ttm1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=449&fit=crop&dpr=1 754w, https://images.theconversation.com/files/319479/original/file-20200310-118951-q2ttm1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=449&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/319479/original/file-20200310-118951-q2ttm1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=449&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Beware advertising hype on health products.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/dont-take-too-much-royalty-free-image/1199838445?adppopup=true">Getty Images/PeopleImages</a></span>
</figcaption>
</figure>
<h2>How strong is the CBD data?</h2>
<p>On behalf of the Journal of Clinical Pharmacology, in 2020 <a href="https://doi.org/10.1002/jcph.1387">conducted a review</a> that evaluated the evidence supporting the use of CBD.</p>
<p>There is strong evidence that CBD may do some good for some people. CBD can prevent seizures in people with two rare diseases, <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa1714631">Lennox-Gestaut</a> and <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa1611618">Dravet syndrome</a>. CBD consistently shows benefits when used before an anxiety-provoking event, <a href="https://www.ncbi.nlm.nih.gov/pubmed/2130784">like public speaking</a> (although not as effective as clonazepam, an FDA-indicated drug for performance anxiety). </p>
<p>Limited studies show promising initial findings for other conditions, although more research is needed. CBD might help with <a href="https://ce.pharmacy.uconn.edu/wp-content/uploads/sites/2102/2019/11/CBD-MAY2019-FINAL.pdf">inflammation</a> of the joints or skin, sleep disturbances, chronic anxiety, psychosis and behavioral issues associated with <a href="https://jneurodevdisorders.biomedcentral.com/articles/10.1186/s11689-019-9277-x">Fragile X syndrome</a>. But natural alternatives already exist that offer much more evidence for some of these benefits: <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3656905/">Melatonin</a> helps with sleep, <a href="https://doi.org/10.1002/jcph.126">kava</a> for chronic anxiety and the <a href="https://doi.org/10.1016/j.phrs.2019.104280">curcumin extract of turmeric</a> for general inflammation or <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6463416/#!po=75.9259">fatty liver disease</a>. </p>
<p>CBD has been shown ineffective for treating symptoms of Parkinson’s and Crohn’s disease. Data on treating pain and muscle spasms is poor. As for preventing cancer, rosacea or the dozens of other things it’s supposed to fix, that’s pure speculation. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/319481/original/file-20200310-61070-19eojar.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/319481/original/file-20200310-61070-19eojar.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/319481/original/file-20200310-61070-19eojar.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/319481/original/file-20200310-61070-19eojar.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/319481/original/file-20200310-61070-19eojar.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/319481/original/file-20200310-61070-19eojar.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/319481/original/file-20200310-61070-19eojar.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A marijuana plant.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/marijuana-background-marijuana-leaf-marijuana-plant-royalty-free-image/1163257898?adppopup=true">Getty Images / Jena Ardell</a></span>
</figcaption>
</figure>
<h2>The risks of CBD</h2>
<p>CBD is a drug. The FDA allows it to be sold as a cosmetic and prescription product, and you can also buy it without a prescription. But just because it’s in lots of things (seltzer, cupcakes and beer, to name a few) does not mean it’s risk-free. <a href="https://www.accessdata.fda.gov/drugsatfda_docs/label/2018/210365lbl.pdf">In the largest evaluation</a>, high doses of CDB induced mild liver damage in 17% of the people taking it. Severe or irreversible damage would have occurred had researchers not stopped the subjects from taking more. If you’re taking CBD at home, without medical supervision, you would not know about the liver damage until it was acute. </p>
<p>There are drug interactions too. Add CBD to other drugs you’re taking and it might produce unexpected side effects, or cause those drugs to be less efficient. I wouldn’t take CBD without checking with my doctor or pharmacist to assure me there were no risky drug interactions.</p>
<p>Because CBD is a seizure medication, the FDA is concerned it could <a href="https://www.accessdata.fda.gov/drugsatfda_docs/label/2018/210365lbl.pd">promote suicidal thoughts,</a> as some <a href="https://www.webmd.com/epilepsy/news/20080131/suicide-risk-from-11-epilepsy-drug">other seizure medications</a> do. Although no data supports that concern, CBD hasn’t been studied long-term. The most common side effects of CBD include sleepiness and diarrhea, which happens in one-third of users, and vomiting and fever, which happens in 15%. </p>
<p>You take <a href="https://doi.org/10.1177/1060028019900504">additional risks</a> if the CBD product is not certified by an outside laboratory. Without that, bacterial, fungal or heavy metal contamination of the CBD becomes more likely – so does mixing of the CBD with synthetic drugs. Many independent evaluations already show many products do not contain the amount of CBD they claim; some provide much less. </p>
<p>Conversely, a few of the products contain more than the legal limit for THC. This places you at risk of arrest for marijuana possession. There are also other unhappy scenarios: You might have used a subpotent product and took 500 mg to get the desired benefits. Then after switching to a better-quality product, you take the same 500 mg and accidentally overdose. </p>
<p>CBD is neither a miracle or snake oil. So far, the evidence – or lack of it, for most ailments – suggests the risks may outweigh the benefits.</p>
<p>Eating a balanced diet, exercising regularly, getting enough sleep, maintaining a healthy body weight and managing stress are the basis of good health. Nowhere in there is a recommendation to adopt every health fad that comes along. But people are <a href="https://www.heart.org/en/healthy-living/healthy-lifestyle/mental-health-and-wellbeing/be-science-savvy-to-avoid-falling-for-health-trends-and-fad-diets">psychologically attracted</a> to health fads because they are novel, they sound plausible (at least on the surface) and they’re easy to use. What’s more, there’s the bandwagon effect: Nobody wants to be left out.</p>
<p>But it’s a mistake to believe that studies of <a href="https://doi.org/10.1002/jcph.1569">cells in a lab</a> are directly applicable to humans. It’s a mistake to believe <a href="https://www.bigcommerce.com/blog/customer-testimonials/#social-medi">testimonials from customers</a> in television commercials. For that matter, it’s a mistake to believe much of the content in these advertisements. Some make <a href="https://www.ftc.gov/news-events/media-resources/truth-advertising/health-claims">false claims</a>, some are selective in the information they provide and some suppress negative information about the product.</p>
<p>[<em>You need to understand the coronavirus pandemic, and we can help.</em> <a href="https://theconversation.com/us/newsletters?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=upper-coronavirus-help">Read The Conversation’s newsletter</a>.]</p><img src="https://counter.theconversation.com/content/132492/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>C. Michael White does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>CBD may not be a panacea for your aches and pains – and it certainly isn’t for COVID-19.C. Michael White, Distinguished Professor and Head of the Department of Pharmacy Practice, University of ConnecticutLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1257302019-11-12T02:57:01Z2019-11-12T02:57:01ZVaping-related lung disease now has a name – and a likely cause. 5 things you need to know about EVALI<figure><img src="https://images.theconversation.com/files/300589/original/file-20191107-10973-voh39n.jpg?ixlib=rb-1.1.0&rect=5%2C0%2C3948%2C2632&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Health authorities in the United States are investigating what exactly has caused the recent outbreak of vaping-related illness.</span> <span class="attribution"><span class="source">From shutterstock.com</span></span></figcaption></figure><p>More than <a href="https://www.cdc.gov/tobacco/basic_information/e-cigarettes/severe-lung-disease.html">2,000 people</a> in the United States have developed serious lung damage in a poisoning outbreak associated with the use of vaping devices this year. At least 39 people have died from the condition. </p>
<p>Most of those affected are young men. Their symptoms, which developed over a few days to several weeks, included cough, shortness of breath, chest pain, nausea, vomiting, abdominal pain, diarrhoea, fever, chills, and weight loss. </p>
<p>The United States Centers for Disease Control and Prevention (CDC) has recently named this combination of symptoms – “e-cigarette or vaping product use associated lung injury”, or EVALI.</p>
<p>Importantly, <a href="https://www.nytimes.com/2019/11/08/health/vaping-illness-cdc.html?smtyp=cur&smid=tw-nytimes">it has now implicated vitamin E acetate</a>, an ingredient added to illicit cannabis vaping liquids, as the most likely cause of EVALI.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1192867329278926848"}"></div></p>
<h2>1. What EVALI is and how it’s diagnosed</h2>
<p>EVALI cases are characterised by pneumonitis (lung inflammation). Some cases have involved the accumulation of oil in the lungs, while others have involved an accumulation of white blood cells – a marker of the immune system responding to a threat.</p>
<p>To be classified as EVALI, cases have to satisfy the following <a href="https://www.cdc.gov/tobacco/basic_information/e-cigarettes/severe-lung-disease/health-departments/index.html">criteria</a>:</p>
<ul>
<li>having vaped or “dabbed” (inhaled a concentrated cannabis product) in the 90 days before symptoms started</li>
<li>a chest image showing the presence of a substance denser than air in the lungs (pulmonary infiltrates) or pathology confirming acute lung injury</li>
<li>absence of lung infection or any alternative plausible medical diagnosis that explains the symptoms.</li>
</ul>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/its-safest-to-avoid-e-cigarettes-altogether-unless-vaping-is-helping-you-quit-smoking-123274">It's safest to avoid e-cigarettes altogether – unless vaping is helping you quit smoking</a>
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<h2>2. Why this new diagnosis was needed</h2>
<p>When investigating the causes of an outbreak like this, it’s important to have a clear definition that determines who is and who is not likely to be part of the outbreak. </p>
<p>For example, some people who vape may develop similar symptoms from other lung conditions unrelated to vaping (for example, they may have influenza, or chronic obstructive pulmonary disease due to a history of cigarette smoking). </p>
<p>If these people were included as outbreak cases it would be more difficult to identify the cause of EVALI.</p>
<h2>3. The cause of EVALI</h2>
<p>Cases have followed a typical acute outbreak pattern, with most occurring over a number of months. The <a href="https://www.cdc.gov/tobacco/basic_information/e-cigarettes/severe-lung-disease.html">peak</a> was in September this year when 463 cases were admitted to hospitals. </p>
<p>This pattern indicates EVALI is a form of acute poisoning, rather than a condition that has developed from chronic vaping over many years. It’s most likely there’s something new in vaping products used by these patients that’s caused the spike in lung injuries.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-a-person-vapes-not-just-what-a-person-vapes-could-also-play-a-big-role-in-vaping-harm-122527">How a person vapes, not just what a person vapes, could also play a big role in vaping harm</a>
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<p><a href="https://www.washingtonpost.com/health/2019/10/25/cdc-most-people-who-died-vaping-linked-disease-used-products-containing-thc/">Most people with EVALI</a> have either admitted using, or later been found to have vaped products containing tetrahydrocannabinol (THC), the major psychoactive ingredient in cannabis. They have typically purchased these products from <a href="https://www.cdc.gov/mmwr/volumes/68/wr/mm6845e1.htm">illicit sources</a>. </p>
<p>Laboratory analyses of THC vaping product samples supplied by EVALI cases have found many of these contain vitamin E acetate (oil). Vitamin E acetate is sometimes <a href="https://www.leafly.com/news/health/toxic-vaping-vapi-evali-lung-injury-rise-and-fall-of-vitamin-e-oil-honey-cut">added to illicit THC vaping products</a> to dilute and then thicken the liquid to hide the dilution, in the same way other illicit drugs are “cut” with other substances to reduce their purity.</p>
<p>The CDC tested fluid samples collected from the lungs of 29 EVALI cases and found <a href="https://www.cdc.gov/mmwr/volumes/68/wr/mm6845e2.htm">all samples contained vitamin E acetate</a>. </p>
<p>One theory is the oil may be the direct cause of the lung injury, because some of these patients have been diagnosed with lipoid pneumonia (lung inflammation associated with oil inhalation). However, it increasingly looks like a <a href="https://www.nejm.org/doi/full/10.1056/NEJMc1913069">chemical</a> formed from the vitamin E acetate may be causing the toxicity. Research is continuing to test this hypothesis. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/301158/original/file-20191111-178520-ahczjc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/301158/original/file-20191111-178520-ahczjc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=345&fit=crop&dpr=1 600w, https://images.theconversation.com/files/301158/original/file-20191111-178520-ahczjc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=345&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/301158/original/file-20191111-178520-ahczjc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=345&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/301158/original/file-20191111-178520-ahczjc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=434&fit=crop&dpr=1 754w, https://images.theconversation.com/files/301158/original/file-20191111-178520-ahczjc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=434&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/301158/original/file-20191111-178520-ahczjc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=434&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Vitamin E oil is safe to use on the skin, but not to inhale via vaping.</span>
<span class="attribution"><span class="source">From shutterstock.com</span></span>
</figcaption>
</figure>
<p>It appears increasingly unlikely standard commercially produced nicotine vaping products are a cause of EVALI. </p>
<p>Of 849 EVALI patients who provided information about the <a href="https://www.cdc.gov/tobacco/basic_information/e-cigarettes/severe-lung-disease.html">products they used</a>, only 10% reported exclusive use of nicotine-containing products, while 78% reported using THC-containing products. Some EVALI patients who initially denied using THC vaping products <a href="https://www.cdc.gov/mmwr/volumes/68/wr/mm6839e2.htm">were later found to have used them</a>.</p>
<p>EVALI has not been evident in other countries with widespread use of nicotine vaping products but little use of THC vaping products, <a href="https://publichealthmatters.blog.gov.uk/2019/10/29/vaping-and-lung-disease-in-the-us-phes-advice/">such as the UK</a>.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/vaping-likely-has-dangers-that-could-take-years-for-scientists-to-even-know-about-123051">Vaping likely has dangers that could take years for scientists to even know about</a>
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</p>
<hr>
<h2>4. How EVALI can be treated</h2>
<p>Many patients with EVALI have developed a severe illness that requires hospitalisation. In the most serious cases, <a href="https://www.cdc.gov/tobacco/basic_information/e-cigarettes/severe-lung-disease/healthcare-providers/pdfs/evaluating-caring-evali-patients.pdf">treatment</a> has involved intubation and mechanical ventilation because the patient cannot breathe on their own. </p>
<p>Most patients have been treated with corticosteroids to reduce the inflammation on the lungs. Antiviral and antibiotic medicines may also be given on a case-by-case basis. </p>
<p>EVALI patients are strongly advised to avoid vaping and cigarette smoking, so treatment may be needed to address dependence on nicotine and/or cannabis, such as behavioural support and non-inhaled nicotine replacement therapies like nicotine gum and patches.</p>
<h2>5. How you can avoid EVALI</h2>
<p>The US authorities recommend consumers <a href="https://www.fda.gov/consumers/consumer-updates/vaping-illness-update-fda-warns-public-stop-using-tetrahydrocannabinol-thc-containing-vaping">do not use any cannabis or THC vaping products</a>, especially those purchased illegally. </p>
<p>Only one EVALI case has been reported outside the US, <a href="https://www.cbc.ca/news/canada/montreal/vaping-related-illness-quebec-1.5299487">in Canada</a>, but it’s difficult to rule out the possibility illicit THC vaping products sold in other countries may also be contaminated with the causative agent.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/vaping-as-an-imaging-scientist-i-fear-the-deadly-impact-on-peoples-lungs-123435">Vaping: As an imaging scientist I fear the deadly impact on people’s lungs</a>
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</em>
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<img src="https://counter.theconversation.com/content/125730/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Coral Gartner receives funding from the National Health and Medical Research Council (NHMRC), the Australian Research Council (ARC), Queensland Health, and previously the Health Promotion Foundation of Victoria (VicHealth), the New South Wales Ministry of Health, and the HIV Foundation Queensland.</span></em></p><p class="fine-print"><em><span>Wayne Hall has received funding from VicHealth and NHMRC for research on tobacco harm reduction and e-cigarettes. </span></em></p>Defining what this disease is and who has it has helped those investigating the outbreak understand what caused it.Coral Gartner, Associate Professor, School of Public Health, The University of QueenslandWayne Hall, Professor and Director, Centre for Youth Substance Abuse Research, The University of QueenslandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1253702019-11-05T16:40:45Z2019-11-05T16:40:45ZCannabis shows potential for treating PTSD: New study<figure><img src="https://images.theconversation.com/files/298384/original/file-20191023-119409-ujvfo1.jpg?ixlib=rb-1.1.0&rect=16%2C133%2C2674%2C1888&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Research shows that cannabis use by people living with post-traumatic stress disorder may reduce their likelihood of depression and suicide.</span> <span class="attribution"><span class="source">THE CANADIAN PRESS/Ryan Remiorz</span></span></figcaption></figure><p>Post-traumatic stress disorder (PTSD), a psychiatric condition linked to surviving or witnessing a traumatic life event, will <a href="https://doi.org/10.1192/bjp.bp.115.176628">affect around one in 10 Canadians</a> at some point in their lives. PTSD can cause <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3181836/">agitation, flashbacks, impaired concentration and memory, insomnia and nightmares</a> and these symptoms can increase the risk of substance abuse and dependence, depression and suicide.</p>
<p>Many patients <a href="https://doi.org/10.4088/JCP.15m09932">struggle to find adequate symptom relief</a> from <a href="https://www.nejm.org/doi/full/10.1056/NEJMra1612499">conventional treatments for PTSD</a> including anti-depressant or anti-psychotic medications and psychological treatments such as trauma-focused cognitive behavioural therapy. </p>
<p>Unsurprisingly, many turn to alternative ways of coping — such as medical cannabis use. This is especially evident in the dramatic rise in number of <a href="https://www.veterans.gc.ca/eng/about-vac/research/research-directorate/publications/reports/cmp2018">Canadian military veterans receiving government reimbursement for medical cannabis</a>, with <a href="http://publications.gc.ca/collections/collection_2019/sen/yc33-0/YC33-0-421-26-eng.pdf">PTSD as a common reason</a> for use.</p>
<p>The results of clinical trials testing <a href="https://clinicaltrials.gov/ct2/show/results/NCT02517424?view=results">cannabis as a PTSD treatment are pending</a>. Previous research has linked cannabis use with <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5029083/">poorer mental health in PTSD patients</a>, but it’s unclear whether cannabis exacerbates PTSD symptoms, or if patients with worse symptoms are simply self-medicating more. Much of the existing evidence for cannabis as a PTSD treatment comes from <a href="https://doi.org/10.3109/00952990.2013.821477">patient reports of success</a>.</p>
<p>As epidemiologists and substance use researchers, we have been exploring the relationship between cannabis and PTSD using readily available <a href="http://www23.statcan.gc.ca/imdb/p2SV.pl?Function=getSurvey&SDDS=5015">Statistics Canada mental health data</a>. </p>
<p>In <a href="https://journals.sagepub.com/doi/full/10.1177/0269881119882806">a recent study, published in the <em>Journal of Psychopharmacology</em></a>, we found that PTSD increased the risk of major depressive episodes among Canadians who didn’t use cannabis by roughly seven times, and suicidal ideation by roughly five times. But, among Canadians who did use cannabis, PTSD was not statistically associated with either outcome.</p>
<h2>How cannabis works in the body</h2>
<p>Substance use, <a href="http://dx.doi.org/10.1037/adb0000110">including cannabis use</a>, is common among trauma survivors. It’s easy to write off the drug as just a tool to briefly escape negative feelings, at the risk of worsening longer-term symptoms. However, the relationship between cannabis and PTSD is more complex than it appears on the surface.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/298380/original/file-20191023-119414-fvaup7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/298380/original/file-20191023-119414-fvaup7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/298380/original/file-20191023-119414-fvaup7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/298380/original/file-20191023-119414-fvaup7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/298380/original/file-20191023-119414-fvaup7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/298380/original/file-20191023-119414-fvaup7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/298380/original/file-20191023-119414-fvaup7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A marine veteran shows support for cannabis for PTSD sufferers, outside the state capitol in Des Moines, Iowa, in 2015.</span>
<span class="attribution"><span class="source">(Michael Zamora/The Des Moines Register via AP)</span></span>
</figcaption>
</figure>
<p>Our bodies naturally produce molecules called <a href="https://doi.org/10.1016/j.biopsych.2015.07.028">endogenous cannabinoids that fit into special cannabinoid receptors</a> throughout the brain and body. This endocannabinoid system is involved in <a href="https://doi.org/10.1016/j.amjmed.2006.11.013">stabilizing bodily processes</a>, including regulating many functions of the brain that tend to be affected after traumatic experiences, such as <a href="https://doi.org/10.1002/dta.1377">fear, memory and sleep</a>.</p>
<p><a href="https://www.cpha.ca/sites/default/files/uploads/resources/cannabis/cannabasics-2018-fact-sheets-e.pdf">Certain components of the cannabis plant</a>, including the well-known molecules tetrahydrocannabinol (THC, the component of cannabis that produces the high) and cannabidiol (CBD, the component of cannabis that won’t get you high, but has potential for treating <a href="https://doi.org/10.1016/S1474-4422(15)00379-8">epilepsy</a>, <a href="https://doi.org/10.1016/j.bmc.2015.01.059">inflammation</a>, <a href="https://doi.org/10.1111/j.1476-5381.2010.01176.x">nausea</a> and <a href="https://doi.org/10.1007/s13311-015-0387-1">anxiety</a>) are also cannabinoids because of their structural similarity to endogenous cannabinoids. </p>
<p>Even though THC and CBD aren’t naturally produced in our bodies, <a href="https://doi.org/10.1016/j.mayocp.2019.01.003">they can interact with the endocannabinoid system to influence a number of biological processes.</a></p>
<p>Research is still uncovering if and how cannabis works within the body to affect the course of PTSD. Brain imaging research suggests that patients with PTSD have an <a href="https://doi.org/10.1038/mp.2013.61">abundance of cannabinoid receptors</a> but produce few <a href="https://doi.org/10.1016/j.psyneuen.2013.08.004">endogenous cannabinoids</a> to lock into them, meaning that supplementing the body with plant-based cannabinoids like THC might help some brain processes function as normal.</p>
<h2>Reduced depression and suicide</h2>
<p>Roughly one in four individuals with PTSD in the Statistics Canada survey data that we analyzed used cannabis, compared to about one in nine in the general population. </p>
<p>In our study, we used statistical models to quantify the relationship between having PTSD and recently experiencing a major depressive episode or suicidal ideation. We hypothesized that if cannabis helped mitigate symptoms of PTSD, we’d see a much weaker association between PTSD and these indicators of mental distress in the cannabis-using population.</p>
<p>Indeed, exploring the associations in this way while controlling for other factors (such as sex, age, income, other substance use, other mental health problems) supported our hypothesis. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/298386/original/file-20191023-119414-1uvqjxv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/298386/original/file-20191023-119414-1uvqjxv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/298386/original/file-20191023-119414-1uvqjxv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/298386/original/file-20191023-119414-1uvqjxv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/298386/original/file-20191023-119414-1uvqjxv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/298386/original/file-20191023-119414-1uvqjxv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/298386/original/file-20191023-119414-1uvqjxv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A customer sniffs a display sample of marijuana at Evergreen Cannabis, in Vancouver, B.C.</span>
<span class="attribution"><span class="source">(AP Photo/Elaine Thompson)</span></span>
</figcaption>
</figure>
<p>In a follow-up analysis of the 420 individuals in the sample who had PTSD, we categorised cannabis use into “no use,” “low-risk use” and “high-risk use” (meaning that they screened positive for cannabis abuse or dependence). </p>
<p>We found that low-risk cannabis users were actually less likely than non-users to develop a major depressive episode or to be suicidal, though there was a trend towards increased risk of both outcomes for the high-risk users.</p>
<h2>A promising new signal</h2>
<p>People with PTSD are more likely to experience depression and suicidal ideation. However, our findings suggested that these indicators of mental health were improved when they were engaging in lower-risk cannabis use.</p>
<p>Our study has a number of limitations that prevent us from being able to understand whether cannabis is what’s causing the reduced association between PTSD, depression and suicide. </p>
<p>For example, our data captures information covering participants’ experiences from the previous year, meaning we can’t actually decipher what came first: the cannabis use, the PTSD or the major psychological episodes. </p>
<p>We didn’t have detailed information about how participants used cannabis: for example, the type and dose of cannabis they used, how often they used it or how they consumed it. These details will be crucial to future research in this area.</p>
<p>Our study’s strength comes from its ability to describe patterns of PTSD symptoms and cannabis use in a large sample that’s considered to be representative of the Canadian population. Although our findings suggest that cannabis could be of possible therapeutic use in the treatment of PTSD, cannabis use is not without risks, including the development of <a href="https://www.canada.ca/en/health-canada/services/drugs-medication/cannabis/health-effects/addiction.html">cannabis use disorder</a>. </p>
<p>We’ve uncovered a promising new signal on the potential of cannabis-based therapies, but we look forward to much work ahead in understanding how they might fit into PTSD and mental health treatment more broadly.</p>
<p>[ <em>Deep knowledge, daily.</em> <a href="https://theconversation.com/ca/newsletters?utm_source=TCCA&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=deepknowledge">Sign up for The Conversation’s newsletter</a>. ]</p><img src="https://counter.theconversation.com/content/125370/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Stephanie Lake receives doctoral funding from the Canadian Institutes of Health Research and the Pierre Elliott Trudeau Foundation. She is affiliated with Canadian Students for Sensible Drug Policy. </span></em></p><p class="fine-print"><em><span>M-J Milloy is supported by a Canadian Institutes of Health Research New Investigator Award, a Michael Smith Foundation for Health Research Scholar Award, and the National Institutes of Drug Abuse. His institution has received an unstructured gift to support his research from NG Biomed, Ltd, an applicant to the Canadian federal government for a license to produce medical cannabis. He is the Canopy Growth Professor of cannabis science at the University of British Columbia, a position created by an unstructured gift to the university from Canopy Growth, a licensed producer of cannabis, and the Government of British Columbia's Ministry of Mental Health and Addictions. </span></em></p>Cannabis use is common among trauma survivors, and may improve some of the symptoms of those with PTSD.Stephanie Lake, PhD student in Population and Public Health, University of British ColumbiaM-J Milloy, Research Scientist, BC Centre on Substance Use and Assistant Professor in the Division of AIDS, Department of Medicine, University of British ColumbiaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1225842019-09-24T11:29:47Z2019-09-24T11:29:47ZFrance forgets own golden age of medical marijuana<figure><img src="https://images.theconversation.com/files/292877/original/file-20190917-19055-h0obt0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">France is exploring the uses of marijuana as medicine.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/decriminalization-marijuana-france-cannabis-legalization-procedure-1243710901?src=XTukciN67PIRbm7gHUu7-g-1-22">Lifestyle discover/SHutterstock.com</a></span></figcaption></figure><p>This past summer the French food and drug office, the Agence Nationale de Sécurité du Médicament, greenlighted limited medical cannabis trials inside France, something that’s been <a href="https://www.legifrance.gouv.fr/affichTexte.do?cidTexte=JORFTEXT000000845281&categorieLien=id">illegal since 1953</a>. </p>
<p>Many have <a href="https://www.santemagazine.fr/actualites/actualites-traitement/cannabis-a-visee-therapeutique-lansm-dit-oui-a-une-experimentation-425774">applauded</a> the move as an important first step toward rational, public health-oriented cannabis regulation in France. The Agence Nationale de Sécurité du Médicament similarly <a href="https://www.ansm.sante.fr/S-informer/Points-d-information-Points-d-information/Cannabis-a-visee-therapeutique-en-France-l-ANSM-souscrit-au-cadre-de-la-phase-experimentale-de-mise-a-disposition-propose-par-le-Comite-d-experts-Point-d-information">praised</a> the trial for its groundbreaking efforts to produce “the first French data on the efficiency and safety” of cannabis for medical therapies. </p>
<p>This is all well and good. However, when it comes to cannabis, a peculiar historical amnesia seems to be gripping French medicine. These trials are not the nation’s first efforts to produce scientific data on medicinal cannabis products. Far from it. </p>
<h2>‘A drug not to be neglected’</h2>
<p>During <a href="https://djguba.com">my research</a> into the history of intoxicants in modern France, I found that in the middle 19th century Paris functioned as the epicenter of an international movement to medicalize hashish, an intoxicant made from the pressed resin of cannabis plants.</p>
<p>Many pharmacists and physicians then working in France believed hashish was a dangerous and exotic intoxicant from the “Orient” – the Arabo-Muslim world – that could be <a href="https://digital.library.temple.edu/digital/collection/p245801coll10/id/490272">tamed by pharmaceutical science</a> and rendered safe and useful against the era’s most frightening diseases. </p>
<p>Starting in the late 1830s they prepared and sold hashish-infused edibles, lozenges and later tinctures – hashish-infused alchohol – and even “medicinal cigarettes” for asthma in pharmacies across the country. </p>
<p>Throughout the 1840s and 1850s dozens of French pharmacists staked their careers on hashish, publishing dissertations, monographs and peer-review articles on its medicinal and scientific benefits.</p>
<figure class="align-left zoomable">
<a href="https://images.theconversation.com/files/292875/original/file-20190917-19030-saruw8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/292875/original/file-20190917-19030-saruw8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/292875/original/file-20190917-19030-saruw8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=757&fit=crop&dpr=1 600w, https://images.theconversation.com/files/292875/original/file-20190917-19030-saruw8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=757&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/292875/original/file-20190917-19030-saruw8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=757&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/292875/original/file-20190917-19030-saruw8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=951&fit=crop&dpr=1 754w, https://images.theconversation.com/files/292875/original/file-20190917-19030-saruw8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=951&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/292875/original/file-20190917-19030-saruw8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=951&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Hôtel de Lauzun, the meeting place for the Club des Hachichins in Paris.</span>
<span class="attribution"><a class="source" href="https://upload.wikimedia.org/wikipedia/commons/4/4b/Hotel_de_Lauzun_2.jpg">Louis Édouard Fournier</a></span>
</figcaption>
</figure>
<p>French epidemiologist Louis-Rémy Aubert-Roche published a <a href="https://books.google.com/books?id=6p_1Hag_3_IC&dq=de+la+peste+ou+typhus&source=gbs_navlinks_s">treatise in 1840</a> in which he argued hashish, administered as a small edible called “dawamesk” taken with coffee, successfully cured plague in seven of 11 patients he treated in the hospitals of Alexandria and Cairo during the epidemic of 1834-35. An anti-contagionist in a pre-germ theory era, Aubert-Roche, as most physicians then, believed the plague an untransmittable disease of the central nervous system spread to humans via “miasma,” or bad air, in unhygienic and poorly ventilated areas. </p>
<p>Aubert-Roche thus believed, mistaking symptom relief and luck for a cure, that hashish intoxication excited the central nervous system and counteracted the effects of the plague. “The plague,” he wrote, “is a disease of the nerves. Hashish, a substance that acts upon the nervous system, has given me the best results. I thus believe it is a drug not to be neglected.” </p>
<h2>Reefer madness</h2>
<p>Physician Jacques-Joseph Moreau de Tours, organizer of the infamous Club des Hachichins in Paris during the 1840s, likewise <a href="https://gallica.bnf.fr/ark:/12148/bpt6k768978.r=du%20hachisch?rk=85837;2">heralded dawamesk</a> as a homeopathic wonder drug for treating mental illness. Moreau believed insanity was caused by lesions on the brain. And also believed that hashish counteracted the effects. </p>
<p>Moreau reported in his 1845 work, “Du Hachisch et l’aliénation mentale,” that between 1840 and 1843 he cured seven patients suffering mental illness at Hôpital Bicêtre in central Paris with hashish. Moreau wasn’t totally off-base; <a href="https://www.ncbi.nlm.nih.gov/pubmed/30706168">today cannabis-based medicines are prescribed</a> for depression, anxiety, PTSD and bipolar disorders. </p>
<p>Despite the small sample size, <a href="https://babel.hathitrust.org/cgi/pt?id=ien.35558002006589&view=1up&seq=289">doctors from the U.S.</a>, the <a href="https://babel.hathitrust.org/cgi/pt?id=uc1.b5587100&view=1up&seq=225">U.K.</a>, <a href="https://babel.hathitrust.org/cgi/pt?id=hvd.32044097072219&view=1up&seq=518">Germany</a> and <a href="https://babel.hathitrust.org/cgi/pt?id=mdp.39015062255792&view=1up&seq=159">Italy</a> published favorable reviews of Moreau’s work with hashish during the late 1840s and across the 1850s. One praised it as a <a href="https://babel.hathitrust.org/cgi/pt?id=uc1.a0002587111&view=1up&seq=272">“discovery of much importance for the civilized world</a>.”</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/292876/original/file-20190917-19040-elshu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/292876/original/file-20190917-19040-elshu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/292876/original/file-20190917-19040-elshu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=348&fit=crop&dpr=1 600w, https://images.theconversation.com/files/292876/original/file-20190917-19040-elshu.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=348&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/292876/original/file-20190917-19040-elshu.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=348&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/292876/original/file-20190917-19040-elshu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=438&fit=crop&dpr=1 754w, https://images.theconversation.com/files/292876/original/file-20190917-19040-elshu.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=438&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/292876/original/file-20190917-19040-elshu.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=438&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Hemp harvesting on Rhine bank. Created by Lallemand and published on L'Illustration, Journal Universel, Paris, 1860.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/hemp-harvesting-on-rhine-bank-created-86840905?src=nIXX_uR7kER1zfs0wag8mg-1-0">Marzolino/Shutterstock.com</a></span>
</figcaption>
</figure>
<h2>Tincture wars</h2>
<p>Though physicians in France and abroad touted dawamesk as a miracle cure, they also complained about the inability to standardize doses due to the variation in the potency of different cannabis plants. They also wrote about the challenges posed by the common adulteration of dawamesk, which was exported from North Africa and often laced with other psychoactive plant extracts.</p>
<p>In the early 1830s several physicians and pharmacists <a href="https://books.google.com/books?id=gMhaD7iuF8gC&printsec=frontcover&source=gbs_ge_summary_r&cad=0#v=onepage&q=william&f=false">in the British Empire</a> attempted to solve these problems by dissolving hashish in alcohol to produce a tincture. By the middle of the decade, French practitioners followed suit. They developed and marketed their own hashish tinctures for French patients. One pharmacist in Paris, Edmond de Courtive, branded his concoction “Hachischine” after the infamous <a href="https://doi.org/10.1086/SHAD30010050">Muslim assassins</a> often associated with hashish in French culture.</p>
<p>The popularity of hashish tincture grew rapidly in France during the late 1840s, peaking in 1848. That was when pharmacist Joseph-Bernard Gastinel and the aforementioned De Courtive engaged in a legal battle over the patent – then known as the “right to priority” – for tincture manufactured though a particular distillation method. “L'Affaire Gastinel,” as the press termed it, caused an <a href="https://gallica.bnf.fr/ark:/12148/bpt6k4086399/f1387.item.r=courtive">uproar in French medical circles</a> and occupied the pages of journals and newspapers in Paris for much of that fall. </p>
<p>To defend his patent, Gastinel sent two colleagues to argue his case to the Academy of Medicine in October 1848. One, a physician called <a href="https://www.biusante.parisdescartes.fr/histoire/medica/resultats/index.php?cote=90014x1848x35&p=337&do=page">Willemin, claimed</a> that not only did Gastinel devise the tincture distillation method in question but that his tincture provided a cure for cholera, also thought to be a disease of the nerves. </p>
<p>Though Willemin was unable to convince the Academy of Gastinel’s right to priority, he did convince doctors in Paris to adopt hashish tincture as a treatment against cholera. </p>
<p>Physicians in Paris didn’t have to wait long to test Willemin’s theory. A cholera epidemic erupted in the city’s outskirts just months later. But when hashish tincture failed to cure the nearly 7,000 Parisians killed by the “blue death,” doctors <a href="https://www.biusante.parisdescartes.fr/histoire/medica/resultats/index.php?p=326&cote=90068x1849&do=page">increasingly lost faith</a> in the wonder drug.</p>
<p>In the following decades hashish tincture fell into disrepute as the medical theories of anti-contagionism that underpinned the drug’s use against the plague and cholera gave way to the germ theory and thus a new understanding of epidemic diseases and their treatment. During the same period, physicians in French Algeria increasingly pointed to hashish use as a key cause of insanity and criminality among indigenous Muslims, a diagnosis they termed “folie haschischique,” or hashish-induced psychosis. Heralded as a wonder drug only decades before, by the end of 19th century the drug was <a href="https://theconversation.com/french-cannabis-legalization-debate-ignores-race-religion-and-the-mass-incarceration-of-muslims-120558">rebranded as an “Oriental poison.”</a> </p>
<h2>Lessons for today</h2>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/292874/original/file-20190917-19076-3kfycl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/292874/original/file-20190917-19076-3kfycl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/292874/original/file-20190917-19076-3kfycl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=800&fit=crop&dpr=1 600w, https://images.theconversation.com/files/292874/original/file-20190917-19076-3kfycl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=800&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/292874/original/file-20190917-19076-3kfycl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=800&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/292874/original/file-20190917-19076-3kfycl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1005&fit=crop&dpr=1 754w, https://images.theconversation.com/files/292874/original/file-20190917-19076-3kfycl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1005&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/292874/original/file-20190917-19076-3kfycl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1005&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Hemp field near Toulouse.</span>
<span class="attribution"><a class="source" href="https://upload.wikimedia.org/wikipedia/commons/4/4e/Toulouse_-_Chemin_de_Tournefeuille_-_20140627_%281%29.jpg">Olybrius</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
</figcaption>
</figure>
<p>These earlier efforts to medicalize hashish in 19th-century France offer doctors, public health officials and policymakers today several important insights as they work to return cannabis-based medications to the French market. </p>
<p>First, they must work to dissociate cannabis intoxicants and medicines from colonial notions of “Oriental” otherness and Muslim violence that ironically underpinned both the rise and fall of hashish as medicine in France during the 19th century. As scholar <a href="https://www.ted.com/talks/dorothy_roberts_the_problem_with_race_based_medicine/transcript">Dorothy Roberts astutely argued</a> in her 2015 TED talk, “race medicine is bad medicine, poor science and a false interpretation of humanity.” </p>
<p>Doctors and patients also must be measured in their expectations of the benefits of medicalized cannabis and not overpromise and then deliver lackluster results, as happened with hachichine during the cholera outbreak of 1848-49. </p>
<p>And they must remain mindful that medical knowledge unfolds historically and that staking the new career of cannabis as medicine on contested theories could hitch the drug’s success to the wrong horse, as happened with hashish after the obsolescence of anti-contagionism in the 1860s.</p>
<p>But if France were to engage its colonial past, reform its prohibitionist policies and continue to open up legal room for medical cannabis trials, perhaps it could again become a global leader in this new medical marijuana movement.</p>
<p>[ <em>Deep knowledge, daily.</em> <a href="https://theconversation.com/us/newsletters?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=deepknowledge">Sign up for The Conversation’s newsletter</a>. ]</p><img src="https://counter.theconversation.com/content/122584/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>David A. Guba Jr. does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>After a long prohibition, France is permitting medical cannabis trials. This isn’t the first time that France is testing medicinal marijuana – in the 19th century it led the world in this research.David A. Guba Jr., History Faculty, Bard Early CollegeLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1223802019-09-23T21:56:55Z2019-09-23T21:56:55ZA campaign promise kept: Canada’s modestly successful cannabis legalization<figure><img src="https://images.theconversation.com/files/293605/original/file-20190923-54759-g2fjs3.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C6122%2C3849&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Different kinds of cannabis on display are seen at SpritLeaf's store in Kingston, Ont., in March 2019.</span> <span class="attribution"><span class="source">THE CANADIAN PRESS/Lars Hagberg</span></span></figcaption></figure><p>The anniversary of Canada’s recreational cannabis legalization arrives Oct. 17, just days before the federal election. Legalization was a <a href="https://www.cbc.ca/news/politics/trudeau-pot-marijuana-legalization-timeline-1.3252088">Liberal campaign promise</a> from the last election, so it’s timely to review how it’s worked out.</p>
<p>Consumers evidently like legalization. Statistics Canada just reported that July’s recreational sales hit <a href="https://www150.statcan.gc.ca/t1/tbl1/en/cv.action?pid=2010000801">$104 million</a>.</p>
<p>Politicians apparently like it too. It’s an <a href="https://www.cbc.ca/news/politics/justin-trudeau-2019-election-andrew-scheer-1.5252988">election promise the Liberals kept</a> and that <a href="https://montrealgazette.com/cannabis-news/three-of-the-federal-party-leaders-say-theyve-used-cannabis-what-plans-do-all-frontrunners-have-for-pot/wcm/42eb1128-4479-484d-9526-71890a2d86fd">no other party plans to repeal</a>.</p>
<p>But how well has it <a href="https://nationalpost.com/pmn/news-pmn/canada-news-pmn/trudeau-expects-cannabis-supply-shortages-to-be-fixed-within-a-year">reduced black market cannabis, as promised</a>?</p>
<h2>Increasing legal sales</h2>
<p>A government-funded study in 2018 estimated Canada’s total cannabis consumption at roughly <a href="https://www.cbc.ca/news/business/legal-cannabis-shortage-looms-1.4845816">926,000 kilograms annually</a>, or some 77,000 kilograms monthly.</p>
<p>Health Canada says that in June 2018, when only medical usage was legal, licensed producers sold <a href="https://www.canada.ca/en/health-canada/services/drugs-medication/cannabis/licensed-producers/market-data.html">2,151 kilograms of dry cannabis and 4,652 litres of cannabis oil</a>. That represents around nine per cent of national demand.</p>
<p>In June 2019, by comparison, legal medical and recreational sales totalled <a href="https://www.canada.ca/en/health-canada/services/drugs-medication/cannabis/licensed-producers/market-data/supply-demand.html">9,976 kilograms of dry and 9,614 litres of oil</a>. That’s about 26 per cent of the market.</p>
<p>So legal sales have roughly tripled. But illegal sales remain the majority.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/293450/original/file-20190921-135097-1c1bi12.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/293450/original/file-20190921-135097-1c1bi12.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=344&fit=crop&dpr=1 600w, https://images.theconversation.com/files/293450/original/file-20190921-135097-1c1bi12.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=344&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/293450/original/file-20190921-135097-1c1bi12.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=344&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/293450/original/file-20190921-135097-1c1bi12.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=432&fit=crop&dpr=1 754w, https://images.theconversation.com/files/293450/original/file-20190921-135097-1c1bi12.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=432&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/293450/original/file-20190921-135097-1c1bi12.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=432&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Legal medical and recreational cannabis monthly sales volumes, combining dry (kilograms) and oil (litres) products. Prepared by author from Health Canada data.</span>
<span class="attribution"><span class="source">Michael Armstrong</span></span>
</figcaption>
</figure>
<p>By contrast, StatCan seems more optimistic. Its surveys ask users whether they buy at least some cannabis legally. It estimated that number at 47 per cent, or 2.5 million Canadians, for the first quarter of 2019. That’s up sharply from <a href="https://www150.statcan.gc.ca/n1/daily-quotidien/190502/dq190502a-eng.htm">23 per cent, or 954,000 people</a>, in 2018’s first quarter.</p>
<p>Unfortunately, those estimates aren’t really plausible. The only people who could legally buy cannabis in March 2018 were Health Canada’s <a href="https://www.canada.ca/en/health-canada/services/drugs-medication/cannabis/licensed-producers/market-data.html">296,702 registered patients</a>. And just 132,975 did so. That implies StatCan’s estimates are three to seven times too high.</p>
<p>So while survey participants <em>reported</em> purchasing legally, they mostly didn’t.</p>
<h2>Growing pains</h2>
<p>One reason legal sales haven’t done better is a lack of retailers in some regions. <a href="https://www.cbc.ca/news/canada/british-columbia/legal-cannabis-sales-province-bc-pot-sales-online-1.5260430">British Columbia</a> and <a href="https://www.theglobeandmail.com/robcannabispro/article-why-better-transparency-at-the-ocs-will-help-beat-the-illegal-market/">Ontario</a> were especially slow to open stores.</p>
<p>Product shortages have posed bigger problems. While there’s <a href="https://www.thegrowthop.com/cannabis/just-not-selling-canopys-results-take-hit-as-some-retailers-struggle-to-move-oil-and-gel-products/wcm/74474041-2837-49b3-a5fa-10dc067ffeea">ample oil</a>, producers until recently hadn’t <a href="https://www.theglobeandmail.com/business/commentary/article-cannabis-sales-and-supply-are-booming-but-complications-remain/">processed enough dry products</a>. And legal foods, drinks, vapes and lotions aren’t yet available.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/canadas-legalization-of-weed-edibles-is-another-global-social-experiment-116919">Canada's legalization of weed edibles is another global social experiment</a>
</strong>
</em>
</p>
<hr>
<p>Those shortages are predictable side effects of the government’s legalization strategy. It chose a regulated pharmaceutical approach, rather than the more hands-off approach many U.S. states have used.</p>
<p>That hands-off approach has several drawbacks, however. Ex-black-market producers don’t always prioritize consumer safety. Some reportedly <a href="https://www.leafly.ca/news/industry/lab-shopping-thc-inflation-marijuana-2019-leafly-review">fudge their product lab tests</a>.</p>
<p>Furthermore, minimal government oversight is worrisome to social conservatives. <a href="https://www.latimes.com/politics/la-pol-ca-california-sued-pot-deliveries-20190405-story.html">Almost 80 per cent of California cities</a> banned state-licensed cannabis shops.</p>
<p>But the pharmaceutical approach has its own drawbacks. Rigorous standards prevent existing grow-ops from going legit. Instead, they remain illegal and <a href="https://www150.statcan.gc.ca/n1/daily-quotidien/190710/t001c-eng.htm">undercut legal producers’ prices</a>.</p>
<p>Meanwhile, legal producers need time to build facilities and gain experience. That almost guarantees initial product shortages.</p>
<p>It’s understandable the feds chose the regulation-heavy approach. But <a href="https://theconversation.com/feds-are-blowing-smoke-about-pot-supplies-114507">as I</a> <a href="https://www.theglobeandmail.com/business/commentary/article-liberal-claims-about-cannabis-legalization-dont-add-up/">and others</a> <a href="https://nationalpost.com/opinion/the-liberals-are-blowing-smoke-with-claim-they-wiped-out-half-of-illegal-cannabis-market">have complained</a>, they shouldn’t be denying its limitations.</p>
<h2>Head-spinning spin</h2>
<p>Already in January, Border Security Minister Bill Blair was implausibly bragging that cannabis supplies were “<a href="https://twitter.com/BillBlair/status/1085649196558872577">adequate</a>” and “<a href="https://twitter.com/BillBlair/status/1090643226254561285">exceed existing demand</a>.” </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1090643226254561285"}"></div></p>
<p>That was despite government data showing <a href="https://www.canada.ca/en/health-canada/services/drugs-medication/cannabis/research-data/market/dried.html">legal production</a> met less than a fifth of <a href="https://www.theglobeandmail.com/robcannabispro/article-canada-is-a-tale-of-two-cannabis-shortages/">Canada’s dry cannabis needs</a> that month. </p>
<p>A <a href="https://www.cbc.ca/news/canada/newfoundland-labrador/clarenville-pot-shop-closing-1.4997670">Newfoundland store even closed</a> due to the shortages.</p>
<p>In March, Health Canada spokespeople similarly said “<a href="https://www.cbc.ca/news/canada/manitoba/cannabis-supply-black-market-1.5074428">there is not — as some have suggested — a national shortage</a>.” That was when shortages were keeping Québec’s shops closed <a href="https://www.cbc.ca/news/canada/montreal/sqdc-cannabis-seven-days-a-week-supply-shortage-1.5138599">three days a week</a> and <a href="https://edmonton.ctvnews.ca/cannabis-shortage-continues-five-months-after-legalization-1.4355221">preventing hundreds of Alberta store openings</a>.</p>
<p>Those premature claims only added to the frustrations felt by retailers and consumers.</p>
<p>However, some other criticisms of the government seem frivolous. </p>
<h2>Other complaints</h2>
<p>For example, some critics say the government legalized too slowly. <a href="https://nationalpost.com/opinion/the-liberals-are-blowing-smoke-with-claim-they-wiped-out-half-of-illegal-cannabis-market">Edibles should have been allowed sooner</a> to <a href="https://theconversation.com/legal-cannabis-vs-black-market-can-it-compete-104915">better compete with black markets</a>, they say.</p>
<p>Unfortunately, that wasn’t realistic. Given limited regulatory resources, it made sense to legalize simpler dry and oil products first. That allowed another year to figure out the rest.</p>
<p>Besides, producers have struggled to supply just two product categories. More categories would have meant more severe shortages.</p>
<p>Conversely, other observers argue <a href="https://www.theglobeandmail.com/business/commentary/article-liberal-claims-about-cannabis-legalization-dont-add-up/">legalization went too quickly</a>. They think governments should have resolved problems like product shortfalls and <a href="https://www.thegrowthop.com/back-to-school/the-truth-is-everything-we-thought-we-knew-about-cannabis-is-blather">impaired driving</a> before beginning sales.</p>
<p>Again, that’s unrealistic. First, legalization has been discussed since 1972’s <a href="https://www.huffingtonpost.ca/2018/10/11/canada-cannabis-timeline_a_23558319/">Le Dain Report</a>; 46 years isn’t rushing.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/293603/original/file-20190923-54759-brlu5q.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/293603/original/file-20190923-54759-brlu5q.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/293603/original/file-20190923-54759-brlu5q.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/293603/original/file-20190923-54759-brlu5q.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/293603/original/file-20190923-54759-brlu5q.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/293603/original/file-20190923-54759-brlu5q.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/293603/original/file-20190923-54759-brlu5q.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A sales clerk helps customers at a retail cannabis store in Manitoba in April 2019.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS</span></span>
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</figure>
<p>Second, the government only has four years between elections. Had it moved more slowly, legalization wouldn’t have happened.</p>
<p>Finally, many problems require research to resolve. Since legalization, Health Canada has issued <a href="https://twitter.com/GovCanHealth/status/1170083044772012033">145 research licences</a> and <a href="https://www.sciencemag.org/news/2019/08/system-swamped-canada-cant-keep-requests-study-cannabis">hundreds more are pending</a>. Studies have already examined <a href="https://papers.ssrn.com/sol3/Delivery.cfm/SSRN_ID3340680_code891250.pdf?abstractid=3310456&mirid=1">grow-op lights</a>, <a href="https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3319762">black market financing</a> and <a href="http://cmajopen.ca/content/7/3/E454.full?sid=3ec14942-9196-468c-8d1b-057d26bd4f5a">alternative retailing strategies</a>.</p>
<h2>Canadian compromises</h2>
<p>Canada has come a long way since 2001, <a href="https://www.huffingtonpost.ca/2018/10/11/canada-cannabis-timeline_a_23558319/">when the government began the process of legalizing medical cannabis</a>. In a sense, we’re <a href="https://www.cnn.com/2016/02/24/health/medical-marijuana-legal-australia-irpt/index.html">15 years ahead of Australia</a> and <a href="https://www.independent.co.uk/life-style/health-and-families/health-news/medicinal-cannabis-legalised-access-marijuana-nhs-a8903051.html">17 ahead of Britain</a>.</p>
<p>Here, recreational users now grumble about <a href="https://theconversation.com/cannabis-quality-involves-careful-science-and-carefree-highs-118679">product quality</a> and <a href="https://www.thegrowthop.com/cannabis-business/quebec-petition-calls-for-provincial-cannabis-retailer-to-ban-single-use-pot-packaging">wasteful packaging</a>. But in the U.K., epileptic children still <a href="https://www.theguardian.com/society/2019/sep/20/mother-sells-house-buy-daughter-medical-cannabis">struggle to access medical cannabis oil</a>.</p>
<p>Yes, legalization has been a muddled mess of compromises and glitches. It still needs years of work. But at least it happened. And it’s taken a bite out of black markets. So it should be considered a typical Canadian success story.</p>
<p>[ <em><a href="https://theconversation.com/ca/newsletters?utm_source=TCCA&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=expertise">Expertise in your inbox. Sign up for The Conversation’s newsletter and get a digest of academic takes on today’s news, every day.</a></em> ]</p><img src="https://counter.theconversation.com/content/122380/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Michael J. Armstrong does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Illegal cannabis products still dominate the market. But a fanciful election promise has become mainstream reality.Michael J. Armstrong, Associate professor of operations research, Goodman School of Business, Brock UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1232742019-09-20T02:05:58Z2019-09-20T02:05:58ZIt’s safest to avoid e-cigarettes altogether – unless vaping is helping you quit smoking<figure><img src="https://images.theconversation.com/files/293137/original/file-20190919-53524-an3xyu.jpg?ixlib=rb-1.1.0&rect=6%2C0%2C4187%2C2791&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The recent vaping-related deaths in the US have brought the issue into the spotlight around the world.</span> <span class="attribution"><span class="source">From shutterstock.com</span></span></figcaption></figure><p>Health authorities in the <a href="https://www.fda.gov/news-events/public-health-focus/lung-illnesses-associated-use-vaping-products">United States</a> are investigating <a href="https://www.cdc.gov/tobacco/basic_information/e-cigarettes/severe-lung-disease.html#latest-outbreak-information">530 cases</a> of lung illness, including seven deaths, reportedly connected to vaping. Some of these <a href="http://dx.doi.org/10.15585/mmwr.mm6836e1">patients</a> have been diagnosed with lung inflammation caused by inhaling oil.</p>
<p>The US Food and Drug Administration (<a href="https://www.fda.gov/news-events/public-health-focus/lung-illnesses-associated-use-vaping-products">FDA</a>) has advised many samples tested have contained tetrahydrocannabidol (THC), the psychoactive ingredient in cannabis, as well as significant amounts of vitamin E.</p>
<p>No cases of vaping-related lung disease have been reported in Australia to date. But we know a small proportion of people in Australia do vape (<a href="https://www.ncbi.nlm.nih.gov/pubmed/30784874">about 1.2% of the population</a>), and may therefore be worried about developing this serious lung disease.</p>
<p>Of people who vape, it’s those relying on the practice to avoid smoking cigarettes who may find the current headlines most confronting.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/vaping-likely-has-dangers-that-could-take-years-for-scientists-to-even-know-about-123051">Vaping likely has dangers that could take years for scientists to even know about</a>
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</p>
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<h2>Vaping as an alternative to smoking cigarettes</h2>
<p>Many experts regard the delivery of nicotine through vaping to be <a href="https://www.rcplondon.ac.uk/projects/outputs/nicotine-without-smoke-tobacco-harm-reduction-0">less risky</a> than smoking traditional cigarettes, because it avoids most of the harmful combustion products inhaled through cigarette smoke.</p>
<p>Whether vaping works to help people quit smoking continues to be debated, although some <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa1808779">clinical trials</a> show it is more effective than other quit aids such as nicotine patches. We know some people who <a href="https://www.ncbi.nlm.nih.gov/pubmed/30740790">vape in Australia</a> are doing so because they used the practice to quit smoking cigarettes. </p>
<p>While vaping products containing nicotine are banned in Australia, some people source them illegally or obtain a prescription to bring them in from overseas. For others, the behavioural features of vaping nicotine-free products may be enough to prevent them going back to smoking cigarettes.</p>
<p>The widespread reports of an outbreak of a sudden-onset and serious lung disease associated with vaping may leave this group wondering if they would be better off ditching vaping and returning to smoking. </p>
<p>The simple answer is, no, they wouldn’t. Research shows vaping poses <a href="https://www.gov.uk/government/publications/e-cigarettes-an-evidence-update">less of a danger</a> to our health than smoking traditional cigarettes. But that doesn’t mean it’s without risk.</p>
<h2>The chemicals in vapour</h2>
<p>Most commercially produced vaping liquids contain water soluble liquid (propylene glycol, glycerol), nicotine (though not in Australia), and flavourings. The liquid is heated by the vaping device to produce a mist that’s inhaled into the lungs.</p>
<p>Other substances can also be used in vaping devices. Vaping cannabis extracts and concentrates such as THC oil (known as “dabbing”) has increased in recent years, particularly in the US, where <a href="https://www.esquire.com/lifestyle/a21719186/all-states-that-legalized-weed-in-us/">11 states</a> have legalised recreational cannabis use and over 30 have legalised medical cannabis. It’s likely these sorts of products are in circulation among people who use cannabis illicitly in Australia, too.</p>
<p>Cannabis vaping liquids are often oil-based, unlike most nicotine vaping liquids. Many come from the black market and may be <a href="https://www.karger.com/Article/FullText/489287">contaminated</a> with pesticides, fungi and heavy metals. There may also be serious risks posed by added ingredients, such as vitamin E oil, a focus of the current US investigation. This additive is used to dilute and then thicken the liquid to hide the dilution. </p>
<p>The risks from inhaling these vaporised cannabis liquids are not fully known, but likely differ from vaping water soluble liquids.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/vaping-as-an-imaging-scientist-i-fear-the-deadly-impact-on-peoples-lungs-123435">Vaping: As an imaging scientist I fear the deadly impact on people’s lungs</a>
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<p>No single chemical has been identified as the cause of all cases in the US outbreak. This may be impossible because for some cases there is no vaping liquid leftover to test, some cases used multiple products, and some people don’t want to admit to using illicit substances.</p>
<p>But based on evidence of a strong association between the cases of illness and vaping illicit cannabis liquids, the <a href="https://www.fda.gov/consumers/consumer-updates/vaping-illnesses-consumers-can-help-protect-themselves-avoiding-tetrahydrocannabinol-thc-containing">FDA recommends consumers</a> “avoid buying vaping products on the street, and to refrain from using THC oil or modifying/adding any substances to products purchased in stores”. </p>
<p>There have been calls in Australia to <a href="https://www.dailymail.co.uk/news/article-7459017/Kevin-Rudd-calls-vaping-BAN-Australia-health-fears-Trump-set-halt-sales.html">ban all vaping products</a> in response to the US outbreak. But because most of the outbreak cases have admitted to vaping illegal THC oil liquids, this would be unlikely to prevent similar cases from occurring here. </p>
<p>No recall of commercial nicotine vaping products has been issued in the US, suggesting the regulator does not currently suspect those products are responsible for the outbreak.</p>
<p>The <a href="https://www.cochrane.org/CD010216/TOBACCO_can-electronic-cigarettes-help-people-stop-smoking-and-are-they-safe-use-purpose">short-term risks</a> associated with vaping commercial nicotine liquids appears to be very low. The long term risks are less certain but there is <a href="https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/534708/E-cigarettes_joint_consensus_statement_2016.pdf">widespread agreement</a> vaping nicotine liquids is less risky than smoking cigarettes.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/293166/original/file-20190919-53549-5nykxe.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/293166/original/file-20190919-53549-5nykxe.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/293166/original/file-20190919-53549-5nykxe.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/293166/original/file-20190919-53549-5nykxe.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/293166/original/file-20190919-53549-5nykxe.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/293166/original/file-20190919-53549-5nykxe.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/293166/original/file-20190919-53549-5nykxe.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Some people turn to vaping as a way to quit smoking.</span>
<span class="attribution"><span class="source">From shutterstock.com</span></span>
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<h2>This isn’t the first time vaping has raised health concerns</h2>
<p>In 2009, the FDA <a href="https://wayback.archive-it.org/7993/20170111124329/http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm173401.htm">tested 18 e-cigarette cartridges</a> and found diethylene glycol, an ingredient in anti-freeze, at 1% in one cartridge. However, <a href="https://www.ncbi.nlm.nih.gov/pubmed/28511098">subsequent studies</a> have either not detected this contaminant, or found it at the trace levels allowed in medicines.</p>
<p>There were also fears vapers could develop <a href="https://rarediseases.info.nih.gov/diseases/9551/bronchiolitis-obliterans">bronchiolitis obliterans</a>, a serious and irreversible lung disease, because research found <a href="https://www.osha.gov/SLTC/flavoringlung/diacetyl.html">diacetyl</a>, a flavouring added to give a buttery taste, in some vaping liquids. </p>
<p>This disease was nicknamed “popcorn lung” after microwave popcorn factory workers, who were exposed to airborne diacetyl, developed the condition. The urban myth that vaping causes popcorn lung persists, despite <a href="https://www.cancerresearchuk.org/about-cancer/causes-of-cancer/cancer-controversies/does-vaping-cause-popcorn-lung">no cases</a> being reported from vaping. </p>
<p>Cigarette smokers are actually exposed to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4892705/">more diacetyl from tobacco</a> than are vapers from vaping diacetyl-containing liquid. Nevertheless, the UK banned diacetyl as an ingredient in vaping liquids in 2016 as a precaution.</p>
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<strong>
Read more:
<a href="https://theconversation.com/how-a-person-vapes-not-just-what-a-person-vapes-could-also-play-a-big-role-in-vaping-harm-122527">How a person vapes, not just what a person vapes, could also play a big role in vaping harm</a>
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<p>Other potentially harmful chemicals have been found in the vapour from commercially produced nicotine vaping products. These include <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5253272/#R321">metals, acrolein and formaldehyde</a>. But again, these chemicals are found in much higher levels in <a href="https://www.mdpi.com/1660-4601/8/2/613">cigarette smoke</a>, along with more than 5,000 other chemicals, including many carcinogens.</p>
<p>One <a href="https://tobaccocontrol.bmj.com/content/27/1/10">study</a> that compared the harmful chemicals in nicotine vapour and cigarette smoke estimated the lifetime cancer risk from smoking was 250 times that from vaping.</p>
<h2>So, what’s the take home message?</h2>
<p>Vaping should not be seen as a harmless practice. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5816191/">Cell and animal studies</a> indicate vaping may adversely affect lung tissue, although it’s uncertain how these effects translate into disease risk in humans. Across the board, we still have a lot to learn about the health effects of vaping long term.</p>
<p>People who do not smoke tobacco should not begin vaping. However, for someone who smokes tobacco, the choice is more complicated because of the very high risks from smoking. Ideally, the safest option is not to smoke or vape, but the priority for smokers should be to stop smoking. </p>
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Read more:
<a href="https://theconversation.com/dont-ban-e-cigarettes-sell-them-under-tight-regulation-42608">Don't ban e-cigarettes, sell them under tight regulation</a>
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<p>Professional support from Quitline and medicinal nicotine products or prescription medicines can help. But those who have tried and failed to quit, and have switched instead to vaping, should not return to smoking on the basis of these cases in the United States.</p>
<p>To reduce risks to their health, people who vape should avoid any liquids that contain oils, and especially avoid cannabis/THC liquids. Only purchase vaping products from reputable manufacturers, such as those that comply with <a href="https://www.gov.uk/guidance/e-cigarettes-regulations-for-consumer-products">European regulatory standards</a>. Working towards stopping vaping is also recommended, if this can be done without relapsing to smoking.</p><img src="https://counter.theconversation.com/content/123274/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Coral Gartner receives funding from the National Health and Medical Research Council (NHMRC), the Australian Research Council (ARC), the Health Promotion Foundation of Victoria (VicHealth), Queensland Health, the New South Wales Ministry of Health and previously the HIV Foundation Queensland</span></em></p>We’ve still got a lot to learn about the long term health effects of vaping. But based on what we know so far, vaping liquids containing oils, and especially cannabis/THC liquids, should be avoided.Coral Gartner, Associate Professor, School of Public Health, The University of QueenslandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1207502019-07-30T01:45:16Z2019-07-30T01:45:16ZPotential cost to patient safety as NZ debates access to medicinal cannabis<figure><img src="https://images.theconversation.com/files/285966/original/file-20190729-43114-ku8ahq.jpg?ixlib=rb-1.1.0&rect=50%2C117%2C5557%2C3589&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The New Zealand government is introducing a scheme for regulating medicinal cannabis.</span> <span class="attribution"><span class="source">from www.shutterstock.com</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span></figcaption></figure><p>Cannabis-based products will be allowed to bypass usual processes required for medicines in New Zealand and go directly onto the market without any proof of safety or effectiveness. This unprecedented proposal is contained in the government’s <a href="https://www.health.govt.nz/system/files/documents/publications/medicinal-cannabis-scheme-consultation-document.pdf">consultation document</a> on giving greater access to medicinal cannabis. </p>
<p>The government is introducing a <a href="https://www.newshub.co.nz/home/politics/2019/07/exclusive-further-details-of-government-s-medicinal-cannabis-scheme-revealed.html">scheme for regulating medicinal cannabis</a>. The consultation covers proposed licensing, cultivation, manufacturing and product standards, and a prescription and enforcement regime.</p>
<p>The key driver for this seems to be that people currently access cannabis through the illegal recreational market. But even if there is no doubt that a regulated market would provide a safer environment for access, we argue that there could be a potential cost to patient safety. </p>
<h2>From trial to market</h2>
<p>The usual market pathway for a drug in New Zealand is the development and manufacture to good manufacturing practice (<a href="https://www.medsafe.govt.nz/regulatory/Guideline/NZGMPCodePart1Intro.asp">GMP</a>) standards. This ensures each batch has the same amount of active ingredient and is free from contaminants. </p>
<p>Companies then run clinical trials, first on small groups of healthy subjects to establish the compound is safe and to understand how it behaves in the body. This information is essential to ascertain dosage. </p>
<p>Finally, the medicine moves into “efficacy” trials. This is the first time it is given to patients. These trials confirm safety and, importantly, establish effectiveness. The data are then presented to the medical regulatory body <a href="https://www.medsafe.govt.nz/">Medsafe</a>, which decides if the drug can be prescribed.</p>
<p>Current medicinal cannabis regulations suggest bypassing all these processes and moving straight from manufacture to prescription. Whether or not manufacture needs to be to GMP standards is one of the consultation questions. </p>
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Read more:
<a href="https://theconversation.com/legal-highs-arguments-for-and-against-legalising-cannabis-in-australia-95069">Legal highs: arguments for and against legalising cannabis in Australia</a>
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<h2>What are cannabinoids</h2>
<p>Cannabis, like all plants, contains a wide array of different chemicals. Of these, <a href="https://www.ncbi.nlm.nih.gov/pubmed/28120229">phytocannabinoids</a> generate most interest. The most highly expressed cannabinoids in dried plant material are Δ9-tetrahydrocannabinol (<a href="https://www.ncbi.nlm.nih.gov/pubmed/30689342">THC</a>) and cannabidiol (<a href="https://www.ncbi.nlm.nih.gov/pubmed/30730563">CBD</a>), but at least 100 other cannabinoids are present, many in vanishingly small quantities. </p>
<p>THC is the main psychoactive component of the plant, known to generate a “<a href="https://www.ncbi.nlm.nih.gov/pubmed/30689342">high</a>” or sense of euphoria. Its <a href="https://www.drugabuse.gov/publications/research-reports/marijuana/how-does-marijuana-produce-its-effects">mechanism of action within the human body is well understood</a>. It mimics the body’s natural cannabinoids (endocannabinoids) to bind to and <a href="https://www.ncbi.nlm.nih.gov/pubmed/28120231">activate specific proteins in the brain</a>. The endocannabinoid system is involved in lots of different physiological processes, including memory formation, appetite, pain regulation and inflammation. THC can therefore alter these functions.</p>
<p>There is nothing unusual about a plant compound interacting with human proteins. A large number of drugs are originally from plants. This includes morphine, which comes from opiate poppies and mimics the body’s own opiates, the endorphins. </p>
<p>In contrast to THC, CBD does not produce a high and is often described as not-psychoactive. But this is a mistake as it clearly <a href="https://www.ncbi.nlm.nih.gov/pubmed/28412918">alters activity within the brain</a>. It is better described as a non-intoxicating cannabinoid. The mechanism by which CBD produces responses in the body are not well understood. </p>
<p>A <a href="https://www.ncbi.nlm.nih.gov/pubmed/26264914">recent review of scientific literature</a> described more than 65 discrete molecular targets that might interact with CBD, but concluded that it probably isn’t acting within the endocannabinoid system at all. </p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/cannabis-and-psychosis-what-is-the-link-and-who-is-at-risk-95368">Cannabis and psychosis: what is the link and who is at risk?</a>
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<h2>Cannabinoids as medicines</h2>
<p>There is a commonly held idea that cannabis doesn’t lend itself to being treated as a typical medicine because it is the combination of different chemicals that produces the desired effects. But there is <a href="https://www.ncbi.nlm.nih.gov/pubmed/31084880">little scientific evidence</a> to support this. </p>
<p>Many plants have medically useful compounds and these, without fail, have been isolated, either by extraction from the plant or chemical synthesis. They form the basis of medicines such as morphine, codeine, aspirin and pseudoephidrine to name but a few. This same approach has been used for cannabis. Marinol (dronabinol) is synthetic THC, Nabilone is a synthetic THC derivative, Sativex is a plant extract blending two plant varieties, one high THC, one high CBD.</p>
<p>Sativex is <a href="https://medsafe.govt.nz/profs/RIss/Sativex.asp">approved by Medsafe</a> in New Zealand to treat muscle spasms related to multiple sclerosis and through the medicinal cannabis access scheme for other diseases. Although not yet approved for distribution in New Zealand, the pharmaceutical grade CBD product, Epidiolex recently became <a href="https://www.fda.gov/news-events/press-announcements/fda-approves-first-drug-comprised-active-ingredient-derived-marijuana-treat-rare-severe-forms">the first FDA-approved plant derived cannabinoid medication</a>. </p>
<p>All of these products have been through clinical trials to establish their safety and efficacy. They come with clear recommendations on dosage, likely adverse effects and indications on their likely effectiveness in given conditions. This means the doctor and the patient can genuinely make an informed decision about risks versus potential benefits. </p>
<p>This information also highlights potential drug-drug interactions. For example, clinical trials on Epidiolex for paediatric epilepsy highlighted that, at effective doses, CBD changes how other anti-epileptic medications are processed in the body, sometimes increasing them to toxic levels. </p>
<h2>Equity issues</h2>
<p>If we already have data for these existing medicines, why don’t we just manufacture a similar product but market it more cheaply? This is a model New Zealand has already adopted for <a href="https://www.pharmac.govt.nz/assets/factsheet-generic-meds.pdf">generic medicines</a>, essentially copies of original medicines for which the <a href="https://www.pharmac.govt.nz/about/">drug-funding agency PHARMAC</a> can negotiate cheaper pricing. </p>
<p>But even these medicines require early clinical testing. The manufacturer must test their medicine in people and prove that it is processed by the body in the same way as the established medicine before it can be prescribed. Even following these rigorous tests, differences can remain which make the copy of the drug less acceptable to a patient, such as was seen recently when <a href="https://www.nzherald.co.nz/nz/news/article.cfm?c_id=1&objectid=12002918">PHARMAC swapped the antidepressant EFFexor-XR for Enlafax-XR</a>. </p>
<p>The consultation document also raises the question of equity, both in terms of equity to access cannabis products and equity to enter the market as a manufacturer. There is an expectation that requiring cannabis derived medicines to meet Medsafe standards would <a href="https://www.newsroom.co.nz/2019/07/11/676984/cautious-optimism-over-proposed-medicinal-cannabis-scheme">push costs to prohibitive levels</a>. But data from the <a href="https://www.cfpc.ca/uploadedFiles/CPD/Cannabinoid_Guidelines_One-Pager.pdf">Canadian College of Family Physicians</a> suggest pricing in Canada is very similar between dried plant materials and pharmaceutical grade products. </p>
<p>Regardless, do any of these considerations outweigh patients’ right to safe, and proven effective medicine? Or doctors’ right to make a fully informed decision before writing a prescription?</p>
<p>New Zealand’s <a href="https://www.nzdoctor.co.nz/article/undoctored/budget-2019-health-32-billion-under-funded-200910">limited health care budget</a> already strains to keep up with demand. The lack of public funding for <a href="https://www.noted.co.nz/health/health/cancer-cost-the-great-disparity-between-treatment-for-rich-and-poor/">expensive but proven cancer medications</a> is just one example. How can we justify spending any of this budget on access to and regulatory control of products that don’t meet our standards, when we can’t afford to fund medicines that do? These are questions that should be answered before we add untested cannabis-based products into our health care system.</p><img src="https://counter.theconversation.com/content/120750/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Michelle Glass is affiliated with the Medicinal Cannabis Advisory Group.
John Ashton is patient ambassador for Lung Foundation New Zealand</span></em></p><p class="fine-print"><em><span>John Ashton is affiliated with Lung Foundation NZ and is Chair of the EACD </span></em></p>There is no doubt a regulated market for access to medicinal cannabis is safer, but if cannabis-based products were allowed to bypass efficacy trials, there’s a potential cost to patient safety.Michelle Glass, Professor of Pharmacology, University of OtagoJohn Ashton, Associate Professor, University of OtagoLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1186762019-07-09T22:10:19Z2019-07-09T22:10:19ZCannabis: Misinformation about CBD can be life-threatening<figure><img src="https://images.theconversation.com/files/282373/original/file-20190702-126350-1k6r178.jpg?ixlib=rb-1.1.0&rect=38%2C183%2C2975%2C2269&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">We need many more funded research studies to fully understand exactly how CBD might play a role in the treatment of opioid use disorder.</span> <span class="attribution"><span class="source">(AP Photo/Susan Montoya Bryan, File)</span></span></figcaption></figure><p>Hyperbole can be rampant in health news, particularly with respect to cannabis. One recent headline declared: <a href="https://www.cnn.com/2019/05/21/health/heroin-opioid-addiction-cbd-study/index.html">“CBD is effective in treating heroin addiction.”</a> Another proclaimed: <a href="https://www.rollingstone.com/culture/culture-news/cbd-heroin-addiction-study-838448/">“New study finds CBD could curb heroin addiction</a>.” </p>
<p>These stories were referring to a <a href="https://doi.org/10.1176/appi.ajp.2019.18101191">recent study in the <em>American Journal of Psychiatry</em></a> that found a short-term course of cannabidiol (CBD) reduced cue-induced cravings and anxiety in drug-abstinent individuals who were recovering from opioid use disorder, specifically heroin addiction.</p>
<p>This study is undoubtedly exciting and a welcome contribution to the scientific literature demonstrating the potentially <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6135562/">helpful role of cannabinoids in the treatment of opioid use disorder</a>.</p>
<p>That said, there is a mismatch between these headlines and the accurate interpretation of the findings from the study. And this mismatch is not trivial.</p>
<h2>Medicinal uses of cannabidiol</h2>
<p>CBD is one of many phytocannabinoid compounds found in the plant <em>cannabis sativa</em>. It is quickly gaining traction as a legitimate medicine in the medical community. For example, it has been associated with <a href="https://doi.org/10.2147/DHPS.S158592">benefits in treating some neurological disorders</a> and has recently been <a href="https://www.accessdata.fda.gov/drugsatfda_docs/label/2018/210365lbl.pdf">FDA-approved for the treatment of seizures</a> in people with <a href="https://rarediseases.org/rare-diseases/lennox-gastaut-syndrome/">Lennox-Gastaut syndrome</a>, a severe form of epilepsy. </p>
<p>CBD has also been linked with <a href="https://www.ncbi.nlm.nih.gov/pubmed/29789034">success in treating some psychiatric symptoms — such as anxiety</a> <a href="https://journals.lww.com/cja/Abstract/2018/09000/Narrative_Review_of_Cannabidiol_as_an.6.aspx">and psychosis</a> — and its use has been shown to <a href="https://doi.org/10.3389/fphar.2016.00361">reduce the size of certain cancerous tumors</a> in animal models.</p>
<p>Further, unlike its sister cannabinoid, delta-9-tetrahydrocannabinol (THC), CBD is largely non-intoxicating and therefore is thought to be non-addictive. It also appears <a href="https://doi.org/10.1089/can.2016.0034">to be relatively safe to use</a>. It’s no wonder CBD has garnered so much excitement and positive attention. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/282371/original/file-20190702-126400-fdc644.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/282371/original/file-20190702-126400-fdc644.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/282371/original/file-20190702-126400-fdc644.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/282371/original/file-20190702-126400-fdc644.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/282371/original/file-20190702-126400-fdc644.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/282371/original/file-20190702-126400-fdc644.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/282371/original/file-20190702-126400-fdc644.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Cannabidiol (CBD), a compound derived from hemp and marijuana that doesn’t cause a high, is now added to an array of products, from drinks to skin creams.</span>
<span class="attribution"><span class="source">(Jennifer Lett/South Florida Sun-Sentinel via AP, File)</span></span>
</figcaption>
</figure>
<p>That said, scientific enterprise is a slow-moving and cautiously critical machine, and we still have much to learn about the medicinal uses of CBD. In fact, there remains a substantial gap between the <a href="https://www.nbcnews.com/think/opinion/cbd-oil-products-promise-miracle-cures-does-science-support-hype-ncna984216">hype surrounding CBD</a> and the actual evidence guiding its medicinal use.</p>
<h2>Participants already abstinent</h2>
<p>In the study published in the <em>American Journal of Psychiatry</em>, the researchers recruited 42 people recovering from opioid use disorder (specifically heroin) and randomly allocated them to either a treatment group (to receive 400 or 800 milligrams of CBD once a day) or a control group (to receive a placebo once a day).</p>
<p>An important aspect of the study is that participants were already abstinent, not actively using heroin, and not experiencing heroin withdrawal. In other words, the participants were in recovery and CBD was not used to treat their withdrawal or maintain tolerance. It was instead used to help treat cravings for heroin and anxiety that were experimentally induced (for example, by showing participants videos and objects related to heroin use) that could lead to relapse.</p>
<p>The researchers concluded: </p>
<blockquote>
<p>“CBD’s potential to reduce cue-induced craving and anxiety provides a strong basis for further investigation of this phytocannabinoid as a treatment option for opioid use disorder.”</p>
</blockquote>
<p>It is worth reiterating and highlighting that the study compared CBD to a placebo group, and did not compare to <a href="https://www.camh.ca/-/media/files/oat-info-for-clients.pdf">other opioid agonist treatments</a>, such as therapy with methadone (Methadose) or buprenorphine (Suboxone). </p>
<p>Additionally, and importantly, the participants were abstinent and not in active withdrawal.</p>
<p><a href="https://www.medicinenet.com/script/main/art.asp?articlekey=7835">Opioid agonist treatments</a> are particularly helpful for the mitigation of opioid cravings and withdrawal. Another therapeutic effect of opioid agonist treatments is that they help people in recovery <a href="https://www.ncbi.nlm.nih.gov/pubmed/30896911">maintain some level of tolerance</a> to opioids, which is helpful for preventing overdose in the event of relapse. </p>
<p>One particular opioid agonist medication, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5855417/">buprenorphine</a>, even blocks stronger opioids like heroin from working as effectively. CBD, on the other hand, does not provide these important protective effects. </p>
<p>Further, to suggest that CBD is an effective treatment for opioid use disorder is misleading and harmful, as this misinformation could be used to justify <a href="https://jamanetwork.com/journals/jama/fullarticle/2723649">not initiating, or discontinuing, opioid agonist medications</a>.</p>
<h2>Language matters</h2>
<p>The findings from the opioid study are certainly important. Investigations into novel therapies that can help people manage cravings to use drugs such as opioids is a major advancement. If future studies can replicate these findings, especially among people who are experiencing difficulties with management of cravings, then this would lend stronger support to the idea that CBD could be used as an adjunctive treatment to opioid agonist therapies among people who are experiencing opioid use disorder.</p>
<p>Crucially, this means that we need many more studies and funded research to fully understand exactly how CBD might play a role in the treatment of opioid use disorder.</p>
<p>Despite what some headlines might have implied, this study does not indicate that CBD should replace first-line, evidence-based opioid agonist therapies such as methadone and buprenorphine.</p>
<p>Nor does it suggest that “<a href="https://www.cnn.com/2019/05/21/health/heroin-opioid-addiction-cbd-study/index.html">CBD is effective in treating heroin addiction</a>.” </p>
<p>These conceptual distinctions are not trivial because they may yield devastating consequences. When it comes to <a href="https://cjb-rcb.ca/index.php/cjb-rcb/article/view/141/75">articulating the implications of scientific results</a> that involve medical treatments, language matters. And so do headlines.</p><img src="https://counter.theconversation.com/content/118676/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>There is no evidence yet that cannabidiol (CBD) is effective in treating heroin addiction, despite news headlines claiming this.Dr. Tyler Marshall, PhD Student, Graduate Research Assistant, University of AlbertaJonathan N. Stea, Clinical Psychologist and Adjunct Assistant Professor, University of CalgaryLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1134212019-03-21T10:44:46Z2019-03-21T10:44:46ZYour pet on pot, or even CBD: Not a good thing, a vet toxicologist explains<figure><img src="https://images.theconversation.com/files/264696/original/file-20190319-60982-ycg239.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Dogs don't need pot or CBD or other marijuana derivatives. </span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/cute-dog-closeup-1242606808">Harshad Rathod/Shutterstock.com</a></span></figcaption></figure><p>My family and I were on vacation in Florida recently and took advantage of a free afternoon to do some gift shopping for local memorabilia – not your ordinary T-shirts and key chains. Our adventure took us to St. Armand’s Key, part of Sarasota, and the many unique shops there. </p>
<p>While meandering between shops around the outdoor circle, my daughter, 14, was often quick to ask the locals, “Can I pet your dog?” She was missing her dog, Belle, who was being boarded back home and thought it would be a good idea to get her something too. </p>
<p>In our efforts to find Belle a gift, we stumbled upon the most unlikely of shops – a store that proudly advertised <a href="https://theconversation.com/cbd-rising-star-or-popular-fad-110146">CBD (cannabidiol)</a> for you and your pets. CBD is a chemical derived from the cannabis plant, but it does not contain THC, the chemical in pot that makes people high. Nonetheless, CBD appears to be the molecule of the moment after the <a href="https://www.fda.gov/newsevents/newsroom/pressannouncements/ucm611046.htm">Food and Drug Administration approved</a> a drug in June 2018 that contains a CBD derivative to treat some forms of epilepsy. </p>
<p>Now, in all honesty, I was quite hesitant to make my way in, but there were quite a few dogs and their owners entering and exiting with various products – not all appearing to be CBD-related. So, I looked at my wife and said, “Why not?” </p>
<p>As a <a href="https://scholar.google.com/citations?user=cY5ee78AAAAJ&hl=en">board-certified toxicologist</a> at a major veterinary diagnostic laboratory, I have had experience working with a broad spectrum of poisoning incidents in all types of animals, including our companions. Recently, our lab has seen an increase in the number of positive tests for marijuana in dogs, many of whom may have accidentally ingested edible forms of marijuana. The American Society for the Prevention of Cruelty to Animals has reported a <a href="https://www.aspcapro.org/resource/shelter-health-poison-control/marijuana-toxicosis-animals">more than 700 percent increase in calls</a> related to marijuana to its poison center in 2019.</p>
<p>As a dad and as a toxicologist, I welcomed the idea of answering my daughter’s questions about CBD and other chemicals in marijuana that are making their way to our pets. But, of course, I had to start with providing her with some context. </p>
<h2>‘Why would people give it to their pets?’</h2>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/264698/original/file-20190319-60964-64fgdr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/264698/original/file-20190319-60964-64fgdr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/264698/original/file-20190319-60964-64fgdr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/264698/original/file-20190319-60964-64fgdr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/264698/original/file-20190319-60964-64fgdr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=504&fit=crop&dpr=1 754w, https://images.theconversation.com/files/264698/original/file-20190319-60964-64fgdr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=504&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/264698/original/file-20190319-60964-64fgdr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=504&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Bottles of CBD labeled as ‘pet tincture.’</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/indianapolis-circa-march-2019-sunmed-cbd-1341153149">Jonathan Weiss/Shutterstock.com</a></span>
</figcaption>
</figure>
<p>Several items caught my daughter’s attention and, of course, she chuckled with amusement. In that moment, though, she began to ask some great questions: “What is CBD and hemp, and why would people give it to their pets?” </p>
<p>I first reminded her of the most recent election. In 2018, we saw the number of states that legalized marijuana for medical and recreational use <a href="https://theconversation.com/marijuana-is-a-lot-more-than-just-thc-a-pharmacologist-looks-at-the-untapped-healing-compounds-112935">expand to 33</a>, including our home state, Michigan. Because of this legalization, there was also a marked expansion in the quantity and types of marijuana-related products available to people and pets, including hemp and CBD oils and pet treats. </p>
<p>So, what is the difference and significance of these products? Marijuana – also known as <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4740396/"><em>Cannabis sativa</em></a> – is comprised of somewhere between 66 and 113 different cannabinoid compounds. Of these, recreational use of marijuana is sought after for the psychotropic “high” produced by <a href="https://theconversation.com/cbd-rising-star-or-popular-fad-110146">delta-9-tetrahydrocannabinol</a>, or THC. Humans either smoke marijuana or convert it into butters or oils for baked products – most notable of these are the often joked about “brownies” – or other edibles such as candy, or they may use the oil itself.</p>
<p>These edible formulations are more problematic for our household companion animals as these are more likely to contain higher concentrations of THC. And, they often include other ingredients that may independently cause harm to your pet such as <a href="https://www.petmd.com/dog/chocolate-toxicity">chocolate</a>, sugar and xylitol, a sugar substitute. </p>
<p>We have received cases at the veterinary diagnostic laboratory in which animals have been either inadvertently or intentionally exposed to marijuana products. </p>
<p>THC is known to be toxic to dogs. According to the <a href="https://todaysveterinarybusiness.com/free-download-merck-veterinary-manual/">Merck Veterinary Manual</a>, common signs of <a href="https://www.aspcapro.org/resource/shelter-health-poison-control/marijuana-toxicosis-animals">marijuana toxicosis</a> that owners may notice include inactivity; incoordination; dilated pupils; increased sensitivity to motion, sound or touch; hypersalivation; and urinary incontinence. A veterinary exam can reveal depression of the central nervous system and an abnormally slow heart rate. Less common signs include restlessness, aggression, slow breathing, low blood pressure, an abnormally fast heart rate, and rapid, involuntary eye movements. In rare cases, animals can have seizures or become comatose.</p>
<p><a href="https://www.britannica.com/plant/hemp">Hemp</a> differs from marijuana in that it has a significantly lower THC content with predominantly more CBD. In a sense, this lessens the chances that an individual or pet will experience the negative side effects of THC, as CBD doesn’t exert the same psychoactive potential. However, there are no regulations on the chemical makeup of hemp products and therefore no way of really knowing, apart from relying on manufacturers’ labels for batch-to-batch variability in THC content. Additionally, very little is known regarding the long-term health effects of chronic exposure to these products, or about their use in conjunction with other medications. </p>
<p>Last, many CBD oils have claims of even higher purity than hemp. Similarly, though, these products are not regulated and therefore may still exhibit variability in chemical makeup. Additionally, many of the claims about cannabinoids’ effectiveness are anecdotal and have not yet been scientifically proven. This means that doctors of humans and animals remain somewhat skeptical about the potential benefits to their patients. </p>
<h2>Why you shouldn’t give pot to your pets</h2>
<p>So, why do people give these products to their pets? </p>
<p>For marijuana itself, my answer to my daughter was blunt. It is simply ignorance, or an abusive behavior that spawns from negligence. There are no good reasons to give your pet a “high” regardless of whether the product is legal for human medical or recreational purposes. </p>
<p>Pets are not people. Many prescription and over the counter drugs as well as foods that are safe for humans are not safe for pets. For example, alcohol is also toxic to pets and while some owners may think it’s funny to let their pets drink their beer or liquor, it can in fact be quite dangerous for the animal. </p>
<p>As for hemp and CBD oils – as a toxicologist, I am skeptical at best. </p>
<p>It is difficult to watch our pets suffer through anxiety or pain from ailments such as cancer. However, although these products have been touted for their therapeutic potential, none of them have gone through the rigor of an FDA approval. <a href="https://www.tandfonline.com/doi/abs/10.1080/24734306.2018.1434470">Anecdotal findings and limited case studies</a> in humans do not constitute the wealth of information that is needed to establish these products as “safe” for our pets.</p>
<p>For people, there is an inclination to deem products that originate from plants as being “natural,” and thus rather arbitrarily “safe.” This, too, can be harmful. Simply put, “natural” does not always equal “safe.” </p>
<p>There is something to be said about the doctor-patient relationship in treating the whole patient – this goes for pets and their veterinarians as well. When we choose to use supplements, this needs to be disclosed to a licensed professional so as to allow for conversations about risks and continued health monitoring. It is not wise to bypass our trained professionals for the ill-trained Dr. Google. </p>
<p>As I continue to see more of these products show up in veterinary diagnostic samples, our interpretations will continually be guided by future scientific studies and case-based outcomes. Hopefully, a fuller understanding of these products and their associated benefits and risks will be had. </p>
<p>As for Belle – we purchased her a brightly colored new collar. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/264984/original/file-20190320-93024-1b1oge7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/264984/original/file-20190320-93024-1b1oge7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=460&fit=crop&dpr=1 600w, https://images.theconversation.com/files/264984/original/file-20190320-93024-1b1oge7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=460&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/264984/original/file-20190320-93024-1b1oge7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=460&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/264984/original/file-20190320-93024-1b1oge7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=579&fit=crop&dpr=1 754w, https://images.theconversation.com/files/264984/original/file-20190320-93024-1b1oge7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=579&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/264984/original/file-20190320-93024-1b1oge7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=579&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The author’s dog, Belle, with her new collar from St. Armand’s Key.</span>
<span class="attribution"><span class="source">Dr. John Buchweitz</span>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
</figcaption>
</figure><img src="https://counter.theconversation.com/content/113421/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>John P. Buchweitz does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>As marijuana and its derivatives are sold legally in more states, pets are getting into pot, accidentally. And some owners are intentionally giving them CBD. A vet explains the dangers.John P. Buchweitz, Toxicology and Nutrition Section Chief, Michigan State UniversityLicensed as Creative Commons – attribution, no derivatives.