tag:theconversation.com,2011:/ca-fr/topics/cannabis-2293/articlesCannabis – La 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>
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<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>
</figcaption>
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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/2173602024-02-27T12:33:24Z2024-02-27T12:33:24ZHundreds of thousands of US infants every year pay the consequences of prenatal exposure to drugs, a growing crisis particularly in rural America<figure><img src="https://images.theconversation.com/files/567417/original/file-20231228-29-57e4ok.jpg?ixlib=rb-1.1.0&rect=50%2C10%2C6659%2C4456&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Substance use during pregnancy can lead to a broad array of harmful effects.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/adorable-newborn-baby-with-pacifier-and-toy-in-royalty-free-image/1407722363?phrase=baby">Liudmila Chernetska/iStock via Getty Images Plus</a></span></figcaption></figure><p>Nearly 1 in 12 newborns in the United States in 2020 – <a href="https://www.samhsa.gov/data/sites/default/files/reports/slides-2020-nsduh/2020NSDUHWomenSlides072522.pdf">or about 300,000 infants</a> – were exposed to alcohol, opioids, marijuana or cocaine before they were born. Exposure to these substances <a href="https://www.cdc.gov/reproductivehealth/maternalinfanthealth/substance-abuse/substance-abuse-during-pregnancy.htm">puts these newborns at a higher risk</a> for premature birth, low birth weight and a variety of physical and mental disabilities. </p>
<p>These substances can have <a href="https://doi.org/10.1038/npp.2014.147">direct and indirect consequences on fetal development</a>. By crossing the placental barrier directly, they can cause abnormal development. And by affecting the mother’s organs, they can reduce blood flow to the placenta and damage the health of the growing fetus.</p>
<p>Considerable <a href="https://doi.org/10.1111/j.1521-0391.2010.00079.x">sociodemographic and geographic disparities</a> exist in the U.S. regarding the rates of prenatal substance exposure. This includes in West Virginia, where I live, a rural Appalachian state struggling with extraordinary rates of substance use and an opioid crisis. </p>
<p><a href="https://directory.hsc.wvu.edu/Profile/47295">As an epidemiologist</a>, I study the relationship between substance use during pregnancy and infant health outcomes. I am a member of the <a href="https://www.wvdhhr.org/birthscore/">Project WATCH</a> team, which is a long-standing, state-mandated surveillance and referral system in West Virginia funded by the <a href="https://dhhr.wv.gov/Pages/default.aspx">West Virginia Department of Health</a>. The surveillance system expanded in 2020 to include substance exposure data from all births in the state. </p>
<h2>Staggering numbers</h2>
<p>Our research work showed that between 2020 and 2022, prenatal substance exposure in West Virginia was <a href="https://doi.org/10.1111/jrh.12752">nearly 50% higher, at 124 per 1,000 births</a>, than the national rate of 80 per 1,000 births. This means that nearly 1 in 8 infants born in the state had exposure to substances during pregnancy. </p>
<p>We found that the <a href="https://doi.org/10.1016/j.jpeds.2022.11.040">rate of prenatal cannabis exposure</a> in West Virginia was 80 per 1,000 births, similar to the national rate. However, the rates of opioid exposure, 44 per 1,000 births, and stimulant exposure, 21 per 1,000 births, during pregnancy were nearly 10 times higher than national rates. Additionally, 1 in 5 women in the study smoked, and 64% of the infants exposed to substances were also exposed to smoking during pregnancy. </p>
<p>There are many reasons why the numbers in West Virginia are staggering. <a href="https://doi.org/10.3390/healthcare11081182">Economic challenges</a>, including poverty, low education and limited job opportunities, contribute to chronic stress, a known risk factor for substance use. Moreover, nearly half the population lives in rural areas with a <a href="https://www.marchofdimes.org/maternity-care-deserts-report">limited number of hospitals and clinics</a>. The geographic isolation <a href="https://doi.org/10.1186/s12954-023-00795-w">limits access</a> to health care and substance use treatment services. Finally, <a href="https://doi.org/10.1016/j.mhp.2019.01.010">stigma and judgment</a> within close-knit rural communities may discourage these mothers from seeking help.</p>
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<figcaption><span class="caption">Substances that can affect a developing embryo include alcohol, tobacco, cannabis and prescribed drugs such as methadone.</span></figcaption>
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<h2>Substance exposure and infant outcomes</h2>
<p>Our earlier work demonstrated that <a href="https://doi.org/10.1038%2Fs41390-019-0731-y">alcohol consumption during pregnancy</a> was associated with preterm birth, which is when a baby is born before the 37th week of pregnancy, and low birth weight, defined as babies born weighing less than 5 pounds, 8 ounces (2,500 grams).</p>
<p>Our more recent study has shown that <a href="https://doi.org/10.1016/j.jpeds.2022.11.040">prenatal opioid exposure</a> is also associated with low birth weight, while stimulant exposure was associated with preterm birth. </p>
<p>Stimulants include cocaine, methamphetamines, ecstasy and prescription stimulants such as those used for the treatment of attention-deficit/hyperactivity disorder. Illicit or misuse of prescription stimulants have <a href="https://www.cdc.gov/pregnancy/meds/treatingfortwo/features/keyfinding-ADHD-med-increase.html">increased among pregnant women</a> over the past decade. </p>
<p>While many national and statewide efforts have focused their attention on addressing the opioid crisis, the prevalence of prenatal stimulant use remains a growing and <a href="https://doi.org/10.1097%2FGRF.0000000000000418">underrecognized epidemic in the U.S</a>.</p>
<p>After alcohol, cannabis is the <a href="https://doi.org/10.1186/s12978-020-0880-9">most common psychoactive substance</a> used during pregnancy and its rate is increasing. This trend in cannabis use may be due to the increasing legality for medicinal or recreational purposes and the social acceptability that comes with it. </p>
<p>In addition, <a href="https://theconversation.com/mounting-research-points-to-health-harms-from-cannabis-thc-and-cbd-use-during-pregnancy-adolescence-and-other-periods-of-rapid-development-198206">many people wrongly assume</a> that cannabis is relatively safe and helps manage pregnancy-related conditions such as morning sickness, nausea, vomiting, weight gain and sleep difficulty. </p>
<p>However, a <a href="https://doi.org/10.1001/jama.2023.21146">growing body of research</a>, including our own, has shown that <a href="https://www.marchofdimes.org/find-support/topics/pregnancy/marijuana-and-pregnancy">prenatal cannabis exposure</a> is associated with <a href="https://doi.org/10.1016/j.jpeds.2022.11.040">adverse pregnancy outcomes</a>, including low birth weight, preterm birth, stillbirth or hypertensive disorders of pregnancy. </p>
<p>In addition, using multiple substances during pregnancy poses a higher risk to infants than using a single substance. We found that compared to no substance exposure during pregnancy, the risk of low birth weight was twice with opioids alone, four times with concurrent exposure to opioids and stimulants, and <a href="https://doi.org/10.1016/j.jpeds.2022.11.040">almost six times with concurrent exposure</a> to opioids, stimulants and cannabis.</p>
<p>Another adverse outcome that is associated with prenatal substance exposure, primarily to opioids, is a <a href="https://www.marchofdimes.org/find-support/topics/planning-baby/neonatal-abstinence-syndrome-nas#">set of withdrawal symptoms</a> experienced by the newborn known as <a href="https://www.ncbi.nlm.nih.gov/books/NBK551498/">neonatal abstinence syndrome</a>. Symptoms include irritability, feeding difficulties, tremors and respiratory issues. The syndrome requires specialized care and attention in neonatal units and a prolonged stay in the hospital.</p>
<p>Alongside the rising prevalence of opioid use in pregnancy, a <a href="https://doi.org/10.3390%2Fchildren10061030">fivefold increase</a> in incidence of infants with this condition has been documented over the past two decades. The highest rate <a href="https://doi.org/10.1111/ppe.12728">has been observed in West Virginia</a>, at 53 per 1,000 births. Other states with high rates include Maine, Vermont, Delaware and Kentucky, which are between <a href="https://doi.org/10.1001%2Fjama.2020.24991">three and four times the national average</a> of 7.3 per 1,000 births. </p>
<h2>Substance exposure in the womb and long-term outcomes</h2>
<p>Research on long-term outcomes of infants exposed to substances in the womb is still evolving. Limited studies have shown an association between neonatal abstinence syndrome and long-term neurodevelopmental consequences that may develop as early as <a href="https://doi.org/10.1001/jamanetworkopen.2019.7025">6 months old and persist into adolescence</a>. These include delays in learning and language skills, physical growth and motor skills, as well as difficulty in regulating <a href="https://doi.org/10.1007%2Fs10802-020-00766-w">behavior and emotions</a>.</p>
<p>However, research on the long-term effects of prenatal alcohol exposure is well established. A broad range of deficits are referred to as <a href="https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/understanding-fetal-alcohol-spectrum-disorders">fetal alcohol spectrum disorders</a>. These include growth deficiency, developmental delay, craniofacial malformations, intellectual disabilities, behavior issues and emotional well-being. A recent study of first graders in the U.S. estimated that the prevalence of <a href="https://doi.org/10.1001/jama.2017.21896">fetal alcohol spectrum disorders range from 1% to 5%</a>, which means up to 1 in 20 school-age children may have this disorder. </p>
<p>With the <a href="https://doi.org/10.1016/S2215-0366(23)00235-3">changing landscape of substance use</a> in the U.S., more research is needed to understand and establish the association between the various emerging types and forms of substance exposures and their lasting effects. But the findings are difficult to discern because of the influence of other environmental factors, preexisting medical conditions and <a href="https://www.cdc.gov/publichealthgateway/sdoh/index.html#">social determinants of health</a>.</p>
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<figcaption><span class="caption">Natalie is 6 years old. She has fetal alcohol syndrome.</span></figcaption>
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<h2>Efforts to reduce harms</h2>
<p>As a maternal and child health epidemiologist, I am fortunate to be part of the <a href="https://www.wvdhhr.org/birthscore/index.html">Project WATCH</a> team that works closely with health care providers and policymakers. </p>
<p>As high-risk infants are identified through this program, its referral system notifies pediatricians of substance exposure and connects these families to early intervention services and home visitation programs. </p>
<p>These services include developmental testing, interventions appropriate to the child’s needs and case management during the first few years of life. The data also informs state-level strategies and initiatives to address the substance use crisis for this vulnerable population.</p><img src="https://counter.theconversation.com/content/217360/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Project WATCH is a grant funded by the West Virginia Department of Health. </span></em></p>Many people wrongly assume that cannabis use during pregnancy is safe. Research is increasingly documenting a host of serious health harms from prenatal exposure to cannabis and other substances.Amna Umer, Associate Professor of Pediatric Epidemiology, West Virginia UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2220242024-02-06T13:53:28Z2024-02-06T13:53:28ZDanish dog owners are medicating their pets with unlicensed cannabis products – is it safe?<figure><img src="https://images.theconversation.com/files/573280/original/file-20240204-27-f7ceiz.jpg?ixlib=rb-1.1.0&rect=0%2C21%2C7184%2C4764&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/hand-giving-dog-cbd-oil-by-2192674331">24-K Production/Shutterstock</a></span></figcaption></figure><p>Medical cannabis, often in the form of cannabidiol (CBD) oil, is one of the most recent trends in the human health and wellness world. Unsurprisingly, this trend has made its way to our pets, with a recent study suggesting that <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0296698">38% of surveyed Danish dog owners</a> routinely gave their pets some form of cannabis product.</p>
<p>Because many people actively promote the use of CBD to support their own health and wellbeing, the use of <a href="https://www.bluecross.org.uk/advice/dog/health-and-injuries/cbd-for-dogs">CBD oil for pets</a> is attracting increased attention from vets and pet owners alike.</p>
<p>Previous studies suggest that <a href="https://www.veterinarycannabis.org/uploads/1/1/6/0/116053487/dog_owner_use___perceptions.pdf">80% of dog owners</a> in the US and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6563876/">Canada</a> had bought cannabis products for their pet. While availability and regulatory differences might account for this variance, it is clear that cannabinoids are regularly being given to pets globally.</p>
<p>It is important to note that CBD doesn’t contain the psychoactive substance THC (tetrahydrocannabinol) that is responsible for some of the serious effects seen in pets after accidental ingestion of <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0261909">cannabis and derivatives</a>, so its use won’t make your pet high or give them the munchies.</p>
<p>But, is CBD safe for our pets and could it be a useful addition to our pet’s healthcare regime? </p>
<h2>Can CBD help our pets?</h2>
<p>The use of CBD oil by people to support conditions such as <a href="https://doi.org/10.7326/M21-4520">chronic pain</a>, <a href="https://headachejournal.onlinelibrary.wiley.com/doi/10.1111/head.13345">migraines</a>, <a href="https://doi.org/10.7812/TPP/18-041">anxiety</a> and <a href="https://doi.org/10.5167/uzh-197549">epilespy</a> has led many people to consider its use for their pets, who often suffer from similar conditions.</p>
<p>While anecdotal reports of the benefits of CBD use are typically positive, many studies have failed to find an <a href="https://www.ncbi.nlm.nih.gov/books/NBK425767/">effect</a>. This means that its value as a potential therapeutic aid remains poorly understood.</p>
<p>However, in line with increased interest in CBD to support human health, research is <a href="https://www.waltham.com/new-study-shows-cannabidiol-cbd-effective-reducing-stress-dogs">exploring potential</a> benefits for pets, too, with some interesting outcomes.</p>
<h2>Pet benefits</h2>
<p>CBD oil has been shown to significantly reduce the <a href="https://www.frontiersin.org/articles/10.3389/fvets.2023.1112604/full">signs of stress</a> in dogs during travel and separation – two areas of concern for many pet owners. </p>
<p>For dogs suffering from osteoarthritis, CBD oil resulted in <a href="https://www.frontiersin.org/articles/10.3389/fvets.2018.00165/full">increased activity and decreased pain scores</a>, as assessed by a vet. Indeed, <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0296698#pone.0296698.ref016">36% of respondents in the Danish study</a> indicated that they used cannabinoids for pain management in their pets. This group also reported <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0296698#pone.0296698.ref016">high perceived efficacy</a> of CBD in managing their dog’s pain.</p>
<p>For dogs with skin irritation as the result of allergy, CBD <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/vde.13077">reduced itching</a> but not skin damage or lesions. In the Danish study, <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0296698#pone.0296698.ref036">11% of respondents</a> reported using CBD to help their dog with allergies, and the perceived outcome was good.</p>
<p>While CBD is typically given as drops or oil added to food, hemp-based treats can also be used. Giving <a href="https://doi.org/10.3389/fvets.2020.569565">CBD-infused treats</a> to pets suffering from noise anxiety, however, failed to show a positive outcome.</p>
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<img alt="Hemp-based dog treats" src="https://images.theconversation.com/files/573281/original/file-20240204-17-mb9uh1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/573281/original/file-20240204-17-mb9uh1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/573281/original/file-20240204-17-mb9uh1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/573281/original/file-20240204-17-mb9uh1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/573281/original/file-20240204-17-mb9uh1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/573281/original/file-20240204-17-mb9uh1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/573281/original/file-20240204-17-mb9uh1.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">CBD-infused treats won’t help with noise anxiety.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/close-macro-treat-dogs-green-hemp-1733258240">PRO Stock Professional/Shutterstock</a></span>
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<h2>CBD challenges</h2>
<p>In many countries, treating pets with CBD is <a href="https://www.bsavalibrary.com/content/chapter/10.22233/9781910443514.chap8#html_fulltext">not authorised or approved</a>. In the UK, only a vet can prescribe a <a href="https://www.bluecross.org.uk/advice/dog/health-and-injuries/cbd-for-dogs">human CBD preparation</a> for a pet.</p>
<p>Cannabidiol is considered a complementary medicine and vets advise that it should not be used <a href="https://www.bsavalibrary.com/content/chapter/10.22233/9781910443514.chap8#html_fulltext">in place of proven treatments</a>. CBD could also <a href="https://www.ejinme.com/article/S0953-6205(18)30004-9/fulltext">interact</a> with prescribed drugs in ways that aren’t currently known.</p>
<p>Toxicity reports are rare, and healthy dogs appear to tolerate long-term, <a href="https://www.frontiersin.org/articles/10.3389/fvets.2022.977457/full">daily doses of CBD</a>. However, side-effects such as <a href="https://www.frontiersin.org/articles/10.3389/fvets.2023.1204526/full">vomiting, diarrhoea, lethargy and difficulty moving</a> have been recorded in dogs. <a href="https://www.bsavalibrary.com/content/chapter/10.22233/9781910443514.chap8#html_fulltext">Side-effects</a> in cats include excess licking and salivation, pacing, vomiting and grimacing. We still don’t have good safety and efficacy data, and effective dose rates are unclear.</p>
<p>A significant challenge in being able to identify consistent outcomes in CBD use is the variability in quality, <a href="https://www.frontiersin.org/articles/10.3389/fvets.2023.1204526/full#ref26">preparations and potency</a> of the active ingredient. CBD can also be provided in <a href="https://www.mdpi.com/2076-2615/9/10/832">edible treats</a>, oils and supplements or as <a href="https://www.ingentaconnect.com/content/cvma/cjvr/2018/00000082/00000003/art00002">topical creams</a> to be applied to the skin. These all have different uses, making outcome comparisons tricky.</p>
<p>There is also the potential for <a href="https://www.mayoclinicproceedings.org/article/S0025-6196(19)30007-2/fulltext">mislabelling and contamination of CBD products</a>, and production and distribution regulation is <a href="https://www.mayoclinicproceedings.org/article/S0025-6196(19)30007-2/fulltext">poor</a>. This can make it difficult for pet owners to make informed, safe and effective choices for their pets.</p>
<p>While the use of CBD for pets appears to be common, the potential downsides and concerns do need to be considered. How much CBD can be safely administered to our pets for effective use across a range of conditions remains largely unknown. </p>
<p>If you are thinking about using CBD for your pet, always speak to your vet in the first instance – they will be able to <a href="https://vmd.blog.gov.uk/2022/06/28/can-i-buy-cbd-oil-cannabidiol-for-my-pet/">advise you</a> on the safest and most legally appropriate way to do so.</p><img src="https://counter.theconversation.com/content/222024/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jacqueline Boyd is affiliated with The Kennel Club (UK) through membership, as Chair of the Activities Health and Welfare Subgroup and member of the Dog Health Group. Jacqueline is a full member of the Association of Pet Dog Trainers (APDT #01583) and she also writes, consults and coaches on canine matters on an independent basis, in addition to her academic affiliation at Nottingham Trent University.</span></em></p>Thirty-eight per cent of Danish dog owners surveyed said they dosed canines with cannabis products.Jacqueline Boyd, Senior Lecturer in Animal Science, Nottingham Trent UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2225682024-02-05T13:29:42Z2024-02-05T13:29:42ZAmid growing legalization, cannabis in culture and politics is the focus of this anthropology course<figure><img src="https://images.theconversation.com/files/572920/original/file-20240201-19-efs8pb.jpg?ixlib=rb-1.1.0&rect=0%2C25%2C3456%2C2214&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Laws that govern cannabis use are changing across the nation.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/marijuana-legalization-high-quality-stock-photo-royalty-free-image/1143280562?phrase=cannabis">Darren415 via Getty Images</a></span></figcaption></figure><figure class="align-right ">
<img alt="Text saying: Uncommon Courses, from The Conversation" src="https://images.theconversation.com/files/499014/original/file-20221205-17-kcwec8.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/499014/original/file-20221205-17-kcwec8.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=375&fit=crop&dpr=1 600w, https://images.theconversation.com/files/499014/original/file-20221205-17-kcwec8.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=375&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/499014/original/file-20221205-17-kcwec8.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=375&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/499014/original/file-20221205-17-kcwec8.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=471&fit=crop&dpr=1 754w, https://images.theconversation.com/files/499014/original/file-20221205-17-kcwec8.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=471&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/499014/original/file-20221205-17-kcwec8.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=471&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<p><em><a href="https://theconversation.com/topics/uncommon-courses-130908">Uncommon Courses</a> is an occasional series from The Conversation U.S. highlighting unconventional approaches to teaching.</em> </p>
<h2>Title of course:</h2>
<p>Anthropology of Cannabis</p>
<h2>What prompted the idea for the course?</h2>
<p>Whenever I taught my medical anthropology course, I noticed that students were most curious about the section of the course that deals with the uses of plants, fungi and other species for a range of medical purposes. Those purposes included healing, psychological well-being, ritual and spiritual awakening, to name a few.</p>
<p>Once Connecticut, the state where I work, legalized recreational cannabis, I decided it was timely to take the plant section from the original course and expand it to a 14-week course of its own. It was also an opportunity to introduce students to the discipline of anthropology through a topic I knew many of them found interesting. I decided to focus on cannabis instead of the entire panoply of plants and other species, since it was the one plant being legalized in the state at that time.</p>
<h2>What does the course explore?</h2>
<p>Throughout the course, we focus on the different cultural and political significance of cannabis in other geographical contexts. We look at the representation of <a href="https://www.northernstandard.com/a-brief-history-of-cannabis-in-art/">cannabis in art</a>, <a href="https://electricliterature.com/7-lesser-known-stoner-novels-with-suggested-weed-pairings/">literature and pop culture</a>, as well as what the <a href="https://www.nccih.nih.gov/health/cannabis-marijuana-and-cannabinoids-what-you-need-to-know#:%7E:text=The%20cannabis%20plant%20contains%20about,on%20a%20person's%20mental%20state">science of cannabis</a> tells us about its <a href="https://doi.org/10.31887/DCNS.2020.22.3/mcrocq">impact on health and well-being</a>.</p>
<p>We also look at the way stigma and racism impact cannabis users and producers in the United States and elsewhere.</p>
<p>We end the course with students writing letters to themselves in which they imagine how the legal and social landscape for cannabis will be in five years, in the U.S. as well as globally. I plan to send them these letters in 2028.</p>
<h2>Why is this course relevant now?</h2>
<p>While cannabis has long been a part of human existence, the legal and political landscape of cannabis production is rapidly changing. Even if they are not cannabis consumers, students will at least become more aware about the role that cannabis plays in today’s society.</p>
<p>Students may want to know how they can participate in the business side of cannabis. Or they may be interested in doing research on the uses and abuses of the plant.</p>
<p>The course also offers students a way to think about the stigma and discrimination faced by cannabis users and how different cultural systems define and treat behaviors that are deemed deviant. </p>
<h2>What’s a critical lesson from the course?</h2>
<p>My main objective is to have students develop an informed understanding of cannabis as a plant and as a cultural fact. I want them to approach the study of cannabis with an open mind and to walk away with a greater understanding of how harmful stigma can be to individuals in any society. I would hope everyone leaves informed and less inclined to stereotype others. </p>
<h2>What materials does the course feature?</h2>
<p>We read passages from <a href="https://facultyprofile.fairfield.edu/?uname=dcrawford">anthropologist David Crawford</a>’s “<a href="https://rowman.com/ISBN/9781498598187/Dealing-with-Privilege-Cannabis-Cocaine-and-the-Economic-Foundations-of-Suburban-Drug-Culture">Dealing with Privilege: Cannabis, Cocaine, and the Economic Foundations of Surburban Drug Culture</a>,” which challenges the stereotypes that many white people and politicians hold about drug dealing and also explores how drugs became raced and classed entities.</p>
<p>We also read “<a href="https://doi.org/10.1089/can.2022.0251">Understanding and Rebalancing: A Rapid Scoping Review of Cannabis Research Among Indigenous People</a>,” which gives students an opportunity to learn more about Indigenous peoples and cultures alongside learning more about the cannabis plant itself.</p>
<p>And we watch “<a href="https://www.imdb.com/title/tt0028346/">Reefer Madness</a>,” a 1936 film meant to be a cautionary tale about the presumed dangers of marijuana use.</p>
<h2>What will the course prepare students to do?</h2>
<p>Students leave the class better informed about cannabis as a plant and with a better appreciation for the complexity of “drugs” in society. I believe the class also helps students to become more informed citizens, since the laws that govern the use and research on cannabis and other related plants are as much a <a href="https://doi.org/10.1177/0091450919827605">political issue as they are social</a>.</p><img src="https://counter.theconversation.com/content/222568/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Hillary Jeanne Haldane 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>Students are invited to imagine how the social, political and legal landscape for cannabis will look in the future.Hillary Jeanne Haldane, Professor of Anthropology, Quinnipiac UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2206082024-01-15T13:37:47Z2024-01-15T13:37:47ZKush: what is this dangerous new west African drug that supposedly contains human bones?<figure><img src="https://images.theconversation.com/files/568481/original/file-20240109-30-g2zjue.jpg?ixlib=rb-1.1.0&rect=31%2C31%2C2971%2C1963&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/close-african-man-smoking-joint-588753893">DeanP/Shutterstock</a></span></figcaption></figure><p>A new drug called kush is <a href="https://www.channel4.com/news/kush-a-drug-sometimes-mixed-with-human-bones-is-ravaging-sierra-leone#:%7E:text=Kush%20is%20a%20mysterious%20new,the%20drug's%20cocktail%20of%20ingredients">wreaking havoc in west Africa</a>, particularly in Sierra Leone where it is estimated to kill around a dozen people each week and <a href="https://www.telegraph.co.uk/global-health/terror-and-security/kush-synthetic-drug-addiction-epidemic-west-africa/#:%7E:text=But%20it's%20not%20just%20Sierra,the%20region%20are%20now%20addicted.">hospitalise thousands</a>. </p>
<p>The drug, taken mostly by <a href="https://www.telegraph.co.uk/global-health/terror-and-security/kush-synthetic-drug-addiction-epidemic-west-africa/#:%7E:text=But%20it's%20not%20just%20Sierra,the%20region%20are%20now%20addicted.">men aged 18 to 25</a>, causes people to fall asleep while walking, to fall over, to bang their heads against hard surfaces and to walk into moving traffic.</p>
<p>Kush should not be confused with the drug of the same name found in the US, which is a mixture of <a href="https://www.houstoniamag.com/news-and-city-life/2016/08/so-what-exactly-is-kush-city-council-is-asking-ice-house-september-2016">“an ever-changing host of chemicals”</a> sprayed on plant matter and smoked. Kush in Sierra Leone is quite different; it is a <a href="https://www.telegraph.co.uk/global-health/terror-and-security/kush-synthetic-drug-addiction-epidemic-west-africa/#:%7E:text=Kush%20first%20emerged%20in%20Sierra,under%20%C2%A3400%20a%20year">mixture</a> of cannabis, fentanyl, tramadol, formaldehyde and – according to some – ground down <a href="https://www.youtube.com/watch?v=fKc3SDBoFtA">humans bones</a>.</p>
<p>It is mixed by local criminal gangs, but the constituent drugs have international sources, facilitated no doubt by the internet and digital communications. </p>
<p>While cannabis is widely grown in Sierra Leone, the fentanyl is thought to originate in clandestine laboratories in China where the drug is manufactured illegally and shipped to west Africa. Tramadol has a similar source, namely illegal laboratories across Asia. Formaldehyde, which <a href="https://www.justice.gov/archive/ndic/pubs11/12208/index.htm#:%7E:text=Embalming%20fluid%20is%20a%20compound,resulting%20in%20a%20prolonged%20high.">can cause hallucinations</a>, is also reported in this mixture. </p>
<p>As for ground human bones, there is no definitive answer about whether or not they occur in the drug, where such bones would come from, or why they might be incorporated into the drug. Some people say that <a href="https://www.channel4.com/news/kush-a-drug-sometimes-mixed-with-human-bones-is-ravaging-sierra-leone#:%7E:text=Kush%20is%20a%20mysterious%20new,the%20drug's%20cocktail%20of%20ingredients">grave robbers</a> provide the bones, but there is no direct evidence of this. </p>
<p>But why would bones be incorporated into the drug? Some suggest that the sulphur content of the bones causes a high. Another reason might be the drug content of the bones themselves, if the deceased was a fentanyl or tramadol user. </p>
<p>However, both are unlikely. Sulphur levels in bones are not high. Smoking sulphur would result in highly toxic sulphur dioxide being produced and inhaled. Any drug content in bones is orders of magnitude less than that required to cause a physiological effect.</p>
<h2>Where is the drug found?</h2>
<p>The drug is reported in both <a href="https://www.telegraph.co.uk/global-health/terror-and-security/kush-synthetic-drug-addiction-epidemic-west-africa/#:%7E:text=Kush%20first%20emerged%20in%20Sierra,under%20%C2%A3400%20a%20year">Guinea and Liberia</a>, which share porous land borders with Sierra Leone, making drug trafficking easy. </p>
<p>Kush costs around five leones (20 UK pence) per joint, which may be used by two or three people, with up to 40 joints being consumed in a day. This represents a massive spend on drugs and illustrates the addictive nature of the mixture, in a country where the annual income per capita is <a href="https://tradingeconomics.com/sierra-leone/gdp-per-capita#:%7E:text=The%20Gross%20Domestic%20Product%20per,percent%20of%20the%20world%27s%20average.">around £500</a>.</p>
<p>The effects of the drug vary and depend on the user and the drug content. Cannabis causes a wide variety of effects, which include euphoria, relaxation and an altered state of consciousness. </p>
<p>Fentanyl, an extremely potent opioid, produces euphoria and confusion and causes sleepiness among a wide range of other side-effects. Similarly, tramadol, which is also an opioid but less potent than fentanyl (100mg tramadol has the same effect as 10mg morphine) results in users becoming sleepy and “spaced out” – disconnected from things happening around them. </p>
<figure class="align-center ">
<img alt="Blisterpacks of tramadol pills" src="https://images.theconversation.com/files/568482/original/file-20240109-27-4m2gnf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/568482/original/file-20240109-27-4m2gnf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=345&fit=crop&dpr=1 600w, https://images.theconversation.com/files/568482/original/file-20240109-27-4m2gnf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=345&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/568482/original/file-20240109-27-4m2gnf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=345&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/568482/original/file-20240109-27-4m2gnf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=434&fit=crop&dpr=1 754w, https://images.theconversation.com/files/568482/original/file-20240109-27-4m2gnf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=434&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/568482/original/file-20240109-27-4m2gnf.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">Kush can contain tramadol, an opioid.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/pain-killer-capsules-called-tramadol-hcl-789515359">Saowanee K/Shutterstock</a></span>
</figcaption>
</figure>
<p>The danger of the drug is twofold: the risk of self-injury to the drug taker and the highly addictive nature of the drug itself. A further problem is the need to finance the next dose, often achieved through prostitution or criminal activity.</p>
<h2>Joining the ranks of existing polydrugs</h2>
<p>Kush is another example of polydrug mixtures of which forensic scientists are becoming increasingly aware. Another tobacco and cannabis-based drug, <a href="https://www.sciencedirect.com/science/article/pii/S037907381830481X">nyaope</a>, otherwise known as whoonga, is found in South Africa. This time the tobacco and cannabis are mixed with heroin and antiretroviral drugs used to treat Aids, some of which are <a href="https://www.scielo.org.za/scielo.php?pid=S0038-23532021000600018&script=sci_arttext">hallucinogenic</a>. </p>
<p>A further polydrug, <a href="https://mg.co.za/article/2002-07-05-high-on-the-white-pipe/">“white pipe”</a>, a mixture of methaqualone (Mandrax), cannabis and tobacco, is smoked in southern Africa. These drugs are inexpensive and provide an escape from unemployment, the drudgery of poverty, sexual and physical abuse, and the effect, in some cases, especially in west Africa, from having been a child soldier. So what can be done about these drugs? </p>
<p>The effectiveness of legislation alone is questionable, and many of those who attend the very limited rehabilitation centres return to drug use. Perhaps what is required is an integrated forensic healthcare system where legislative control is backed up by properly resourced rehabilitation centres coupled with a public health and employment programme. What changes are made in response to this epidemic remains to be seen.</p><img src="https://counter.theconversation.com/content/220608/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Michael Cole receives funding and "in kind" support from the European Union and a number police forces and forensic science organisations around the world to carry out research. </span></em></p>A new polydrug is destroying lives in west Africa.Michael Cole, Professor of Forensic Science, Anglia Ruskin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2208512024-01-10T22:10:05Z2024-01-10T22:10:05ZTime for a Weed-Free January? How cannabis users could benefit from a ‘dry’ month<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/time-for-a-weed-free-january-how-cannabis-users-could-benefit-from-a-dry-month" width="100%" height="400"></iframe>
<p>By now, most are familiar with the idea of Dry January, a voluntary month without alcohol that follows a month when many drink more than usual.</p>
<p>The idea of <a href="https://time.com/6552262/dry-january-origins-alcohol-drinking/">Dry January</a> started in the United Kingdom in 2012, and has become popular internationally since then. The point is to use a date on the calendar that traditionally prompts resolutions to encourage drinkers to make a month-long commitment to giving their bodies a break and resetting their attitudes and habits in a healthier way for the rest of the year and possibly beyond.</p>
<p>For those who use cannabis, the idea of taking a month off is also worth considering, whether it’s January or not.</p>
<h2>1 in 4 use cannabis</h2>
<p>Canadians are among the world’s biggest consumers of cannabis, especially since <a href="https://www.justice.gc.ca/eng/cj-jp/cannabis/">it was legalized</a> in 2018. Prior to legalization, about 15 per cent of adults used cannabis once a year or more. Today, about <a href="https://www.canada.ca/en/health-canada/services/drugs-medication/cannabis/research-data/canadian-cannabis-survey-2022-summary.html">one in four</a> adult Canadians use cannabis once a year or more, with a higher concentration among young adults.</p>
<p>Frequency of use varies widely, but there is a sizable group of people who are daily or near-daily users — <a href="https://www.canada.ca/en/health-canada/services/drugs-medication/cannabis/research-data/canadian-cannabis-survey-2022-summary.html">about 25 per cent</a>. Within that group, nearly three-quarters report <a href="https://www150.statcan.gc.ca/n1/pub/82-003-x/2023006/article/00001-eng.htm">impaired control over their cannabis use</a>, a key feature of <a href="https://www.canada.ca/en/health-canada/services/drugs-medication/cannabis/health-effects/addiction.html">cannabis use disorder</a>, the medical definition of cannabis addiction.</p>
<p>Though daily use and cannabis use disorder are not identical, daily use is nonetheless a reasonable way to identify people who are more likely to experience negative consequences and might benefit from taking a break. </p>
<p>Beyond frequency, the amount of cannabis one uses and the concentration of <a href="https://www.canada.ca/en/health-canada/services/drugs-medication/cannabis/about.html">THC, the psychoactive component of cannabis,</a> are important considerations in the likelihood of experiencing harms. Many of the risks and harms from cannabis scale to the amount of THC consumed, so it’s not just a matter of consuming less frequently.</p>
<h2>The benefits of a weed-free month</h2>
<p>A Weed-Free January could do more good than cannabis users may realize. Any month will do, of course, but January is traditionally a time for resolutions and fresh starts, so it may be the most natural time to cut out weed.</p>
<p>Based on the existing evidence, regular cannabis users could expect to experience a number of positive physical and lifestyle changes from a 31-day pause.</p>
<p>Among them:</p>
<ul>
<li><p>Resetting one’s tolerance for cannabis. In response to cannabis use, the body’s <a href="https://www.health.harvard.edu/blog/the-endocannabinoid-system-essential-and-mysterious-202108112569">endocannabinoid system</a> adapts over time, causing users to develop tolerance. Indeed, for heavy users, unpleasant symptoms of withdrawal also follow these adaptations, although cannabis withdrawal is not life-threatening like alcohol withdrawal. Users could expect that taking a month off would be enough for the body to revert to its natural set-points.</p></li>
<li><p>Clearing the mental cobwebs. Cannabis use is associated with <a href="https://doi.org/10.1016/j.biopsych.2015.12.002">reduced cognitive functioning</a>, especially <a href="https://doi.org/10.1073/pnas.1206820109">heavy persistent use</a>. Even short breaks from cannabis have been found to <a href="https://doi.org/10.1001/jamapsychiatry.2018.0335">reduce cognitive consequences</a>, and a month of abstinence has been shown to return cognitive functioning to the level of <a href="https://doi.org/10.1001/archpsyc.58.10.909">non-cannabis users</a>.</p></li>
<li><p>Giving your lungs a break. It’s well established that inhaling combusted cannabis smoke is bad for the lungs <a href="https://doi.org/10.1016/j.rmed.2023.107494">in a number of ways</a>, which may be one of the reasons cannabis has been linked to <a href="https://newsroom.heart.org/news/marijuana-use-linked-with-increased-risk-of-heart-attack-heart-failure">heart attack and stroke risk</a>.</p></li>
<li><p>Developing other habits and routines that take advantage of a clearer mind, such as sports, reading and sober socializing. A rich repertoire of activities without substance use is an important lifestyle counterbalance.</p></li>
<li><p>Saving money. Cannabis is not cheap and adds up quickly if you consume daily. A Weed-Free January could save hundreds of dollars.</p></li>
<li><p>Taking stock of whether you may have a problem. Cannabis use disorder is real and can have serious consequences. A weed-free month can provide a chance to do a self-check and see how hard it is to stop. If quitting for a month is impossible (or feels like torture), it may be time to talk to a health professional. <a href="https://www.psychiatrictimes.com/view/current-treatments-for-cannabis-use-disorder">Effective treatments do exist for cannabis use disorder</a>.</p></li>
</ul>
<p>Importantly, many people have authorizations to use medical cannabis to manage a variety of conditions and this is not to suggest that those individuals should abruptly stop for a month, just as it would be foolhardy to recommend an annual abstinence from cholesterol, blood-pressure, or other medications. For medical cannabis patients who think it might be beneficial to take a break, a chat with their authorizing physician or family doctor would be in order.</p>
<p>Bottom line, though, if you use recreational cannabis regularly, especially daily, having a Weed-Free January could be both good for your health and a good way to promote other healthy resolutions. A real win-win.</p><img src="https://counter.theconversation.com/content/220851/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>James MacKillop receives research funding from the Canadian Institutes of Health Research, Health Canada, the National Institutes of Health, and other non-profit funders. He is a principal and senior scientist in Beam Diagnostics, Inc., a technology transfer startup. No Beam products or services are related to this topic. MacKillop has previously consulted to Clairvoyant Therapeutics, Inc. </span></em></p>A Weed-Free January could do more good than cannabis users may realize. Regular cannabis users could expect to experience a number of positive physical and lifestyle changes from a 31-day pause.James MacKillop, Peter Boris Chair in Addictions Research; Director, Peter Boris Centre for Addictions Research; Director, Michael G. DeGroote Centre for Medicinal Cannabis Research; Professor, Department of Psychiatry and Behavioural Neurosciences, McMaster UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2186902024-01-10T13:28:35Z2024-01-10T13:28:35ZCannabis products may harbor fungal toxins harmful to human health, but regulations are uneven or nonexistent<figure><img src="https://images.theconversation.com/files/566948/original/file-20231220-27-jnbdub.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C2175%2C1377&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The potential health benefits of cannabis are appreciable only when its products are safe to consume.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/close-up-view-of-the-cannabis-plant-on-black-royalty-free-image/1674390206">Krit of Studio OMG/Moment via Getty Images</a></span></figcaption></figure><p>Hemp and cannabis <a href="https://doi.org/10.3389/fpls.2019.01120">host many fungi</a> inside and outside the plant, most of which are harmless to most people. However, certain types of fungi such as <em>Aspergillus</em> and <em>Fusarium</em> pose <a href="https://doi.org/10.3389/fmicb.2023.1278189">potential health concerns</a>, particularly for the immunocompromised, both through direct infection and consumption of the toxins they produce.</p>
<p>There are currently <a href="https://doi.org/10.1289%2FEHP11206">no state or national testing mandates</a> for <em>Fusasrium</em> toxins in cannabis, and regulations vary greatly for <em>Aspergillus</em> toxins. To better understand the effects of these fungi and their toxins on human health and disease, <a href="https://faculty.utk.edu/Kimberly.Gwinn/about">I assembled</a> a research team of plant pathologists and toxicologists to conduct a <a href="https://doi.org/10.3389/fmicb.2023.1278189">review of the scientific literature</a> on fungal contaminants in cannabis. </p>
<p>We found that the toxins these fungi produce can make it through the manufacturing process and remain present in many cannabis products.</p>
<h2>Fungal toxins in hemp and cannabis</h2>
<p>The <a href="https://www.usda.gov/farmbill">2018 U.S. Farm Bill</a> defined hemp as any part of the plant <em>Cannabis sativa</em> with levels of <a href="https://theconversation.com/cbd-marijuana-and-hemp-what-is-the-difference-among-these-cannabis-products-and-which-are-legal-154256">THC at or below 0.3%</a>. THC is the primary component of <em>Cannabis sativa</em> that has psychoactive effects. Parts with higher levels of THC are considered marijuana. </p>
<p>Medical use of cannabis has been <a href="https://www.ncsl.org/civil-and-criminal-justice/cannabis-overview">approved in most U.S. states and many countries</a>. To provide the maximum <a href="https://theconversation.com/cannabis-derived-products-like-delta-8-thc-and-delta-10-thc-have-flooded-the-us-market-two-immunologists-explain-the-medicinal-benefits-and-potential-risks-204171">potential health benefits</a> associated with cannabis consumption, such as pain relief, plants need to be free of fungal toxins that can cause harm. However, scientists have found fungal toxin levels in <a href="https://bpb-us-e1.wpmucdn.com/blogs.cornell.edu/dist/a/7491/files/2019/08/2019-Hemp-Diseases-Field-Day-Handout8.9.19.pdf">hemp flowers</a> and <a href="https://doi.org/10.3390/toxins12020114">certain cannabis products</a> that exceed acceptable regulatory levels for other food crops.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/566938/original/file-20231220-23-l56u28.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Microscopy image of the conidial head of Aspergillus, reminiscent of a fleshy daisy" src="https://images.theconversation.com/files/566938/original/file-20231220-23-l56u28.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/566938/original/file-20231220-23-l56u28.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/566938/original/file-20231220-23-l56u28.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/566938/original/file-20231220-23-l56u28.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/566938/original/file-20231220-23-l56u28.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/566938/original/file-20231220-23-l56u28.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/566938/original/file-20231220-23-l56u28.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"></a>
<figcaption>
<span class="caption">The conidial head, or fungal spore, of <em>Aspergillus</em>.</span>
<span class="attribution"><a class="source" href="https://flic.kr/p/9fuc1N">Nadeem Zafar/Dr. Yale Rosen Atlas of Pulmonary Pathology via Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
</figcaption>
</figure>
<p><a href="https://www.cdc.gov/fungal/diseases/aspergillosis/index.html">Aspergillosis</a>, a lung infection caused by the fungus <em>Aspergillus</em>, is the most potentially harmful fungal infection associated with cannabis consumption. However, our research team determined that <em>Fusarium</em> toxins in cannabis <a href="https://doi.org/10.3389/fmicb.2023.1278189">potentially pose a greater risk</a> to human and animal health than <em>Aspergillus</em>. Researchers have isolated <a href="https://doi.org/10.3389/fagro.2021.796062">16 species of <em>Fusarium</em></a> in cannabis flowers. Many produce toxins that <a href="https://doi.org/10.3389/fmicb.2023.1278189">negatively affect humans and animals</a>, including by causing nausea, vomiting, diarrhea, cancer, reproductive disruption and kidney impairment. </p>
<p>These toxins can also <a href="https://doi.org/10.3390/ijms222212269">worsen disease</a> among those with immune disorders. A 2016 survey of 225 organ transplant professionals found that <a href="https://doi.org/10.1111/ctr.13456">43% reported cases</a> of fungal infections associated with marijuana use among their patients who may be immunocompromised. </p>
<h2>Addressing fungal toxins in cannabis</h2>
<p>The extent of fungal toxins in cannabis and hemp products is still unknown because these toxins are rarely regulated. </p>
<p>Testing for <em>Aspergillus</em> in cannabis <a href="https://doi.org/10.1289/EHP11206">varies by state</a>, and acceptable toxin levels range from zero tolerance to no action. Many states <a href="https://doi.org/10.1093%2Fjaoacint%2Fqsac114">rely on methods</a> that don’t distinguish between fungi that are or aren’t harmful and do not regulate individual pathogens.</p>
<p>Although <em>Fusarium</em> toxins are not regulated in hemp or cannabis, they are <a href="https://www.fda.gov/food/natural-toxins-food/mycotoxins">monitored in major food crops</a> such as corn and wheat because of the <a href="https://theconversation.com/pancakes-wont-turn-you-into-a-zombie-as-in-hbos-the-last-of-us-but-fungi-in-flour-have-been-making-people-sick-for-a-long-time-200428">severe symptoms</a> they can cause in people and animals.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/566940/original/file-20231220-23-watzvo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Person in protective wear examining hemp plants." src="https://images.theconversation.com/files/566940/original/file-20231220-23-watzvo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/566940/original/file-20231220-23-watzvo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/566940/original/file-20231220-23-watzvo.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/566940/original/file-20231220-23-watzvo.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/566940/original/file-20231220-23-watzvo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/566940/original/file-20231220-23-watzvo.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/566940/original/file-20231220-23-watzvo.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">Fungal toxin regulation in cannabis is inconsistent across states.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/planting-cannabis-scientist-checking-hemp-plants-royalty-free-image/1298557699">Visoot Uthairam/Moment via Getty Images</a></span>
</figcaption>
</figure>
<p>Controlling fungi in crops is essential for both plant and human health. Because hemp cultivation was until recently restricted by law, and no state or federal research funds were available, disease management strategies <a href="https://doi.org/10.3389/fmicb.2023.1278189">remain ill-defined</a>. </p>
<p>Although using resistant cultivars for plant production is a safe, economical and environmentally friendly method to control plant diseases, how cannabis develops resistance against pathogens <a href="https://doi.org/10.3390/plants12152764">remains poorly understood</a>. </p>
<p>In states where cannabis cultivation is legal, producers must rely on agricultural products approved for hemp. However, few are registered for use on hemp. Although radiation kills fungi and prevents infection in people, this technique is <a href="https://doi.org/10.3389/fmicb.2023.1278189">not universally applied</a> and there are currently no methods for <a href="https://doi.org/10.3389/fmicb.2023.1278189">removing mycotoxins from cannabis or hemp</a>.</p>
<p>Before producers, consumers and health practitioners can be assured that cannabis products are safe, filling these knowledge gaps is necessary. Additional research on cannabis pathogens and fungal toxins are also needed, as well as better and more consistent methods to regulate medicinal cannabis.</p><img src="https://counter.theconversation.com/content/218690/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Kimberly D. Gwinn 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>Hemp flowers and certain cannabis products contain fungal toxins, including Aspergillus and Fusarium, that can exceed acceptable regulatory levels.Kimberly D. Gwinn, Professor of Entomology and Plant Pathology, University of TennesseeLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2193882024-01-08T13:34:50Z2024-01-08T13:34:50ZCollege applications rose in states that legalized recreational marijuana<figure><img src="https://images.theconversation.com/files/567783/original/file-20240103-19-mty5wl.jpg?ixlib=rb-1.1.0&rect=43%2C17%2C5766%2C3324&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Effects of legalization on college application rates are short term.
</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/cannabis-education-royalty-free-image/1138086235?phrase=marijuana+graduation&adppopup=true">wildpixel via iStock/Getty Images Plus</a></span></figcaption></figure><p>Colleges in states where recreational marijuana became legal over the past decade saw a significant but short-term boost in applications from top-notch students. They also got more applications overall. Those were the <a href="https://doi.org/10.1111/coep.12633">key findings of a new study</a> our team published recently in the peer-reviewed journal Contemporary Economic Policy.</p>
<p>In the year that a particular state legalized recreational marijuana, the number of applications for that state’s colleges grew by about 5.5% more than colleges in states that did not legalize. This means that colleges in legal-marijuana states received a temporary boost in applications. We didn’t detect any increase beyond the initial spike. Our results control for school quality, tuition prices and labor market conditions that may affect student application decisions.</p>
<p>At a more detailed level, the gains were strongest for the largest schools, which observed a nearly 54% increase in applications compared with similarly sized schools in nonlegal states. Public colleges and universities benefited more than private ones, though applications for private schools rose in states where recreational marijuana became legal as well.</p>
<p>In addition, schools got more applications from high-achieving students. Standardized test scores for the top 25% of applicants spiked along with the quantity of applications.</p>
<h2>Why it matters</h2>
<p>As researchers continue to <a href="https://publichealth.jhu.edu/2023/risks-and-benefits-of-legalized-cannabis">assess the risks and rewards</a> of recreational marijuana, our results show that institutions of higher learning benefit when their home states allow their citizens to get high. One benefit is that schools had a larger and higher-achieving applicant pool to choose from. This in turn creates the potential to improve a school’s academic profile.</p>
<p>Our results fit into a larger body of research analyzing what affects a student’s application choices. We found that, similar to how schools <a href="https://doi.org/10.1162/REST_a_00589">see a spike in applications and SAT scores</a> when those schools <a href="https://doi.org/10.1002/j.2325-8012.2009.tb00930.x">have winning sports teams</a>, schools see spikes when they are located in states that legalize marijuana. While our data cannot prove it explicitly, this suggests that students do factor local policies into their college choice, a key result of interest for scholars and policymakers alike.</p>
<h2>How we do our work</h2>
<p>We use the Integrated Postsecondary Education Data System – a <a href="https://nces.ed.gov/ipeds/">federal database commonly referred to as IPEDS</a> – which provides information on a variety of college metrics. These metrics include the number of applications, demographic characteristics of students and detailed tuition prices, both before and after financial aid is applied. </p>
<p>Along with this data, we analyzed state legislation to see when recreational marijuana would be available to students in a particular academic year. So long as the recreational marijuana was legally available prior to the end of January – when many applications are due – we argue that marijuana could plausibly affect a prospective student’s application decision for the following fall term. </p>
<figure class="align-center ">
<img alt="Someone holds a marijuana joint near a laptop where there's a bud of marijuana." src="https://images.theconversation.com/files/567893/original/file-20240104-29-ccapi1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/567893/original/file-20240104-29-ccapi1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=391&fit=crop&dpr=1 600w, https://images.theconversation.com/files/567893/original/file-20240104-29-ccapi1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=391&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/567893/original/file-20240104-29-ccapi1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=391&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/567893/original/file-20240104-29-ccapi1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=491&fit=crop&dpr=1 754w, https://images.theconversation.com/files/567893/original/file-20240104-29-ccapi1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=491&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/567893/original/file-20240104-29-ccapi1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=491&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Students may see states that have legalized recreational marijuana as more progressive.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/unrecognized-person-holding-a-marijuana-joint-royalty-free-image/1391596415?phrase=young+people+smoking+marijuana&adppopup=true">Jose Luque Olmedo via Getty Images</a></span>
</figcaption>
</figure>
<h2>What still isn’t known</h2>
<p>Our data cannot pinpoint why freshmen who are often coming straight out of high school – and thus not of legal age (21) to buy recreational marijuana – might base their application decisions on recreational marijuana’s availability. </p>
<p>It could be the case that legal sales create a perception for prospective applicants that underage consumption is less risky. It could be simply because widespread news coverage made certain states seem more popular. Or it could be because more permissive public policies in one area, such as marijuana laws, might suggest more attractive and liberalized policies in other areas important to students, such as abortion. It’s hard to say without talking directly to students themselves. </p>
<p>We also don’t know how much of the application boosts that occur after legalization are being driven by out-of-state students. For example, did legalization in Colorado cause students from other states to apply to Colorado schools in higher numbers? Alternatively, in-state students may have elected to apply to even more Colorado schools than they would have in the absence of recreational marijuana as a way to stay in their home state.</p>
<p><a href="https://nces.ed.gov/ipeds/">The IPEDS database</a> does not require schools to distinguish between in-state and out-of-state applicants. However, the database does delineate enrollees as in-state or out-of-state. From this, we find that out-of-state enrollees increased nearly 25% for the largest schools in the year of marijuana legalization. However, applying and enrolling are two very different actions. Applying indicates interest, but enrolling is more of a commitment.</p>
<h2>What’s next</h2>
<p>A broader look at how college application rates were affected by legalization could yield important insights for colleges in states that permit people to consume cannabis without fear of incarceration. Similarly, it would be insightful to examine how legalized marijuana affected student outcomes for all schools, while accounting for the nationwide disruptions associated with COVID-19.</p>
<p><em>The <a href="https://theconversation.com/us/topics/research-brief-83231">Research Brief</a> is a short take on interesting academic work.</em></p><img src="https://counter.theconversation.com/content/219388/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Christopher D. Blake 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>New research shows colleges attract interest from higher-caliber students when the schools’ home states allow their citizens to get high.Christopher D. Blake, Assistant Professor of Economics, Emory UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2162812023-12-27T11:11:04Z2023-12-27T11:11:04ZAn African history of cannabis offers fascinating and heartbreaking insights – an expert explains<p>When I tell people that I research cannabis, I sometimes receive a furtive gesture that implies and presumes: “We’re both stoners!”, as if two members of a secret society have met. </p>
<p>Other times, I receive looks of concern. “You don’t want to be known as the guy who studies marijuana,” a professional colleague once counselled. Lastly, some respond with blank stares: “Why do academics spend time on such frivolous topics?” </p>
<p>I’ve learned that all these attitudes reflect ignorance about the plant, which few people have learned about except through popular media or their own experiences with it.</p>
<p>I <a href="https://www.dukeupress.edu/Assets/PubMaterials/978-1-4780-0394-6_601.pdf">study cannabis</a>, but I’m more broadly interested in how people and plants interact. I’ve studied plants from perspectives ranging between ecology and cultural history, including <a href="https://www.inaturalist.org/observations?taxon_id=192935">obscure plants</a> and more widely known ones, such as the <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/j.1365-2699.2007.01751.x">African baobab</a>. </p>
<p>Cannabis is in another category, being one of the world’s most famous and widespread plants. Yet it’s the one for which people most commonly question my research motivations.</p>
<p>Cannabis has a truly global history associated with a wide range of uses and meanings. The plant evolved in central Asia millions of years ago. Across Eurasia, humans began using cannabis seeds and fibre more than 12,000 years ago, and by 5,000 years ago, people in south Asia had learned to use cannabis as an edible drug. It arrived in east Africa over 1,000 years ago. </p>
<p>Cannabis has been under global prohibition for most of the last century, which has stunted understanding of the people-plant relationship. Africa, Africans and people of the African diaspora have had crucial roles in the plant’s history that are mostly forgotten. </p>
<p>I want people to learn about cannabis history for four reasons. First, understanding its historical uses can help identify potential new uses. Second, understanding why people have valued cannabis can improve how current societies manage it. Third, understanding how people have used cannabis illuminates African influences on global culture. Finally, understanding how people are profiting from cannabis exposes inequities within the global economy.</p>
<h2>Medicinal potential</h2>
<p>The African history of cannabis highlights its medicinal potential, a <a href="https://theconversation.com/cannabis-policy-changes-in-africa-are-welcome-but-small-producers-are-the-losers-179681">topic of growing interest</a>. </p>
<p>Advocates of medical cannabis often justify their interest by telling tales of the plant’s past. Yet the tales they tell – notably in medical journals – have been problematic. They are only about social <a href="https://www.tandfonline.com/doi/pdf/10.1080/1606635031000135604">elites</a> and are mostly untrue. </p>
<p>The African past is absent from this medical literature, even though historical observers reported how Africans used cannabis in contexts that justify current interest in its medicinal potential. </p>
<p>For instance, in the 1840s, <a href="https://books.google.com/books?id=oYUVAQAAIAAJ&pg=PA437&dq=great+promoter+of+exhilaration+of+spirits,+and+a+sovereign+remedy+against+all+complaints&hl=en&newbks=1&newbks_redir=0&sa=X&ved=2ahUKEwi65on7l4WCAxX0KFkFHbwjBb4Q6AF6BAgGEAI#v=onepage&q=exhilaration%20of%20spirits&f=false">a British physician reported</a> that central African people liberated from slave ships considered the plant drug </p>
<blockquote>
<p>a great promoter of exhilaration of spirits, and a sovereign remedy against all complaints. </p>
</blockquote>
<p>These were emaciated, traumatised survivors. Their experience justifies <a href="https://www.liebertpub.com/doi/abs/10.1089/can.2020.0056">exploring cannabis as a potential treatment</a> for post-traumatic stress disorder, anxiety and other conditions.</p>
<h2>Exploitative labour</h2>
<p>We need to understand why people value cannabis to identify and address <a href="https://www.sciencedirect.com/science/article/pii/S0955395902000828">social processes that may produce drug use</a>. </p>
<p>Africans have <a href="https://link.springer.com/chapter/10.1007/978-981-16-8822-5_10">valued cannabis</a> for centuries, though it’s difficult to know all the uses it had, because most weren’t documented. Despite its limits, the historical record clearly shows that people used cannabis as a stimulant and painkiller in association with hard labour. </p>
<p>Many European travellers observed their porters smoking cannabis before setting off each day. A <a href="https://books.google.com/books?id=IMwNAAAAQAAJ&pg=PA257&dq=affirm+that+it+wakes+them+up+and+warms+their+bodies,+so+that+they+are+ready+to+start+up+with+alacrity&hl=en&newbks=1&newbks_redir=0&sa=X&ved=2ahUKEwjlre3am4WCAxWVEGIAHfJZAmQQ6AF6BAgQEAI#v=onepage&q=alacrity&f=false">Portuguese in Angola stated</a> that the porters: </p>
<blockquote>
<p>affirm that it wakes them up and warms their bodies, so that they are ready to start up with alacrity.</p>
</blockquote>
<p>Because labourers valued cannabis, many overseers did too. </p>
<p>Cannabis drug use remains associated with social marginalisation in contexts from <a href="https://www.tandfonline.com/doi/full/10.1080/15332640.2017.1300972">Morocco</a> to <a href="https://www.sciencedirect.com/science/article/pii/S0955395918300124">Nigeria</a>. </p>
<p>The pan-African experience suggests using it is not a moral failing of users but is – at least in part – symptomatic of exploitation and <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/1467-9566.13244">inequity</a>. </p>
<h2>Africa’s place in global culture</h2>
<p>I also study cannabis to understand how African knowledge has shaped global culture. Cannabis travelled as an <a href="https://www.proquest.com/docview/2568024731?pq-origsite=gscholar&fromopenview=true">element of exploitative labour relationships</a> that carried people around the world, including chattel slavery, indentured service and wage slavery. There is strong evidence that <a href="https://www.dukeupress.edu/the-african-roots-of-marijuana">psychoactive cannabis crossed the Atlantic with Africans</a>. </p>
<p>Oral histories from Brazil, Jamaica, Liberia and Sierra Leone tell that enslaved central Africans carried cannabis. In 1840s Gabon, a <a href="https://books.google.com/books?id=ewUBImRf6IMC&pg=PA420&dq=%22intending+to+plant+them+in+the+country+to+which+he+should+be+sold%22&hl=en&newbks=1&newbks_redir=0&sa=X&ved=2ahUKEwjbzsOhn4WCAxW5F1kFHZw1Bv0Q6AF6BAgLEAI#v=onepage&q=%22intending%20to%20plant%20them%20in%20the%20country%20to%20which%20he%20should%20be%20sold%22&f=false">French-American traveller observed</a> a man </p>
<blockquote>
<p>carefully preserving (seeds), intending to plant them in the country to which he should be sold. </p>
</blockquote>
<p>The people who transported seeds shaped our modern language. Around the Atlantic, many terms for cannabis trace to central Africa, including the global word marijuana, derived from Kimbundu <em>mariamba</em>. </p>
<p>Further, the most common modern use of cannabis – as a smoked drug – was an African innovation. Prehistoric people in eastern Africa <a href="https://www.journals.uchicago.edu/doi/full/10.1086/719224">invented smoking pipes</a>. After the plant arrived from south Asia, eastern Africans discovered that smoking was a more efficient way to consume cannabis compared with edible forms of the drug. Notably, all water pipes – hookahs, bongs, shishas and so on – trace ultimately to African precedents. </p>
<h2>Drug policy reforms</h2>
<p>Finally, understanding the plant’s African past illuminates inequities within the global economy. </p>
<p>Drug policy reforms worldwide have opened lucrative, legal markets for cannabis. Businesses are feverishly competing for wealth, and governments are eagerly seeking new revenue sources. The rush to profit has enabled businesses from wealthy countries <a href="https://journals.openedition.org/echogeo/17599">to gain power in poorer countries</a>. </p>
<p>Most African countries that have enacted drug-policy reforms – notable exceptions being South Africa and Morocco – did so only after foreign businesses paid for cannabis farming licences. These had always been possible under existing laws, though the governments had never made them available. </p>
<p>These drug-policy reforms don’t meaningfully extend to citizens of African countries. Licensing fees are either unknown or unaffordable for most citizens of the countries that have allowed commercial farming, including Zimbabwe, Uganda, Lesotho, Malawi, Eswatini and the Democratic Republic of Congo. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/cannabis-policy-changes-in-africa-are-welcome-but-small-producers-are-the-losers-179681">Cannabis policy changes in Africa are welcome. But small producers are the losers</a>
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</p>
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<p>The countries that have allowed licensed production <a href="https://www.newsday.co.zw/southerneye/2014/03/30/binga-villagers-want-freedom-use-mbanje">still prohibit</a> traditional cannabis uses. Even as export markets grow, African citizens <a href="https://www.bbc.com/news/world-africa-46288374">face criminal consequences</a> for domestic production. </p>
<p>Cannabis-policy reforms in Africa have mostly benefited investors and consumers in wealthy countries, not Africans, a <a href="https://www.jstor.org/stable/48519445">textbook example of neocolonialism</a>. Further, profitable industries in Europe and North America <a href="https://www.tandfonline.com/doi/full/10.1080/13562576.2016.1138674">rely on seed taken from Africa</a>, where cannabis genetic diversity is high thanks to farmers’ plant-breeding skills. </p>
<p>Cannabis is the centre of industries that generate billions of dollars annually. Increasingly, this income is legal. History shows that African countries have competitive advantages for cannabis farming. Reforms should <a href="https://link.springer.com/chapter/10.1007/978-981-16-8778-5_10">enable Africans to enjoy these advantages</a>.</p>
<h2>Way forward</h2>
<p>Globally, many societies are recognising that criminalising cannabis <a href="https://www.tandfonline.com/doi/full/10.1080/09687637.2021.1972936">has produced problems and has not eliminated drug use</a>. Some African countries are <a href="https://www.liebertpub.com/doi/full/10.1089/can.2021.0110">developing cannabis-policy reforms</a> that include decriminalisation and degrees of legalisation. African (and non-African) societies must address <a href="https://www.researchgate.net/profile/Ediomo-Ubong-Nelson/publication/355507767_Between_Prohibition_and_Regulation_Narrative_Analysis_of_Cannabis_Policy_Debate_in_Africa/links/61767ccb0be8ec17a92a1ab6/Between-Prohibition-and-Regulation-Narrative-Analysis-of-Cannabis-Policy-Debate-in-Africa.pdf">complex questions in evaluating cannabis policies</a>. </p>
<p>In any case, the plant’s African past provides insight into both long-term and emerging issues in humanity’s interactions with cannabis. This is why I study African cannabis.</p><img src="https://counter.theconversation.com/content/216281/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Chris S. Duvall 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>The plant’s African past provides insight into emerging issues in humanity’s interactions with cannabis.Chris S. Duvall, Professor of Geography, University of New MexicoLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2187842023-12-12T19:53:39Z2023-12-12T19:53:39ZCanada owes its veterans new mental health tools: Access to psychedelic therapies is overdue<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/canada-owes-its-veterans-new-mental-health-tools-access-to-psychedelic-therapies-is-overdue" width="100%" height="400"></iframe>
<p>The Canadian Senate Subcommittee on Veterans Affairs recently released a striking report entitled <a href="https://sencanada.ca/en/info-page/parl-44-1/veac-psychedelic-therapies/"><em>The Time is Now: Granting Equitable Access to Psychedelic Therapies</em></a>. </p>
<p>To address high rates of suicide and post-traumatic stress disorder (PTSD) among veterans, the report calls on Veterans Affairs Canada (VAC) to immediately implement “a robust research program funded by VAC and the Department of National Defence (DND) in partnership with Health Canada, the Canadian Institutes of Health Research, and all other relevant partners.”</p>
<p>With psychedelic research, Veterans Affairs Canada has a real chance to live up to its mandate “to provide exemplary, client-centred services and benefits that respond to the needs of veterans, our other clients and their families.” </p>
<p>As a psychedelics researcher with an interest in veteran health, I couldn’t be happier, especially with the Senate focus on timeliness, equity and access. </p>
<p>Not only is <a href="https://www.researchgate.net/publication/372244882_Knowledge_Synthesis_in_the_Science_of_Psilocybin_Scoping_Reviews_of_Clinical_and_Preclinical_Research">my PhD on the therapeutic application of psilocybin</a>, but my father was a veteran of the Canadian Forces, as is my brother and two uncles and both of my grandfathers. I grew up on Canadian Forces bases.</p>
<h2>Canada’s veterans</h2>
<p>Lt. Col. (ret’d) Jack Shore, my father, graduate of the <a href="https://www.btb.termiumplus.gc.ca/tpv2alpha/alpha-eng.html?lang=eng&srchtxt=APPRENTICE%20SOLDIER">Soldier Apprentice Program</a> and a United Nations Peacekeeper in the <a href="https://peacekeeping.un.org/sites/default/files/past/onucB.htm">Congo mission</a> of the early 1960s, passed away as I was working as a guest co-editor of a special edition of the <a href="https://jmvfh.utpjournals.press/toc/jmvfh/current"><em>Journal of Military, Veteran and Family Health</em></a>. The theme of the edition is “Therapeutic use of psychedelics, entheogens, entactogens, cannabinoids and dissociative anesthetics for military members and veterans.” </p>
<p>While my Dad rarely talked about his time in the Congo, he experienced what we would now recognize as moral injury, and most likely PTSD. These conditions directly shaped our family life and upbringing. That was before Sudan, Rwanda, the Yugoslav wars and Afghanistan.</p>
<p>My childhood on bases occurred in time of relative peace, but Canada has now had a few generations of soldiers experience active combat. </p>
<p>The <a href="https://patientsmedicalhome.ca/resources/best-advice-guides/best-advice-guide-caring-for-veterans/">629,000 veterans living in Canada have rates of depression, anxiety and substance use disorder that are higher than the civilian population</a>. <a href="https://doi.org/10.1002/jts.21956">One in seven is living with PTSD</a>. Veterans are <a href="https://www.mcgill.ca/maxbellschool/files/maxbellschool/ofha_veteran_homelessness_policy_brief_-_2023.pdf">two to three times more likely</a> to experience homelessness compared to the general population. </p>
<h2>Duty of care</h2>
<p>To veterans of the Canadian Forces and to their families, we owe a duty of care, and not just to provide services and access to novel treatments. We also have a duty to care enough to do the science well and to tackle the public policy challenges (including regulatory drug reform) necessary to provide Canadian veterans with effective care.</p>
<blockquote>
<p>“It is the Government of Canada’s duty to assure veterans that it is doing everything in its power, immediately, to respect its solemn commitment to support, at any cost, those who chose to defend us with honour.” — <a href="https://sencanada.ca/en/info-page/parl-44-1/veac-psychedelic-therapies/">The Subcommittee on Veterans Affairs, Senate of Canada</a> </p>
</blockquote>
<p>The role of the VAC includes paying for the cost of health-care benefits and other services for veterans through the <a href="https://www.canada.ca/en/treasury-board-secretariat/topics/benefit-plans/plans/health-care-plan.html">Public Service Health Care Plan</a> and supplemental treatment benefits. While this single-payer provider model has advantages, it relies heavily on VAC staff and managers to assess and approve plans of care. </p>
<p>Developing a psychedelics research program for veterans should be seen as a public health priority. It will most likely require an independent panel of experts and stakeholders, including veterans, to help shape the agenda in a timely manner for the VAC. </p>
<h2>Psychedelic therapies</h2>
<p><a href="https://cimvhr.ca/">The Canadian Institute for Military and Veteran Health Research</a> (CIMVHR), founded in 2010, is well positioned as the Canadian hub for military, veteran and family health research to provide the infrastructure to foster collaboration, ensure stakeholder engagement and work on the knowledge translation so necessary to rapidly developing the capacity and expertise of Canadian researchers.</p>
<p>We can build on the work of the U.S. Department of Veterans Affairs, which is <a href="https://clinicaltrials.gov/study/NCT05876481?term=Veteran&intr=Psilocybin&rank=1">currently conducting several psilocybin trials</a>, and the long-standing work of <a href="https://maps.org/">MAPS (Multi-disciplinary Association of Psychedelic Studies)</a> in advancing MDMA-assisted therapy for PTSD towards regulatory approval. We can also listen to the experts, such as Canada Health Research Chair in Mental Health Disparities Monnica Williams, who are calling for <a href="https://doi.org/10.1007/s11469-023-01160-5">greater equity and improved inclusion of BIPOC veterans and researchers</a>. </p>
<blockquote>
<p>“When we have tried everything in our toolbox but still cannot help our patients, it is truly time for some new tools.” —<a href="https://jmvfh.utpjournals.press/toc/jmvfh/9/5">Monnica Williams</a>, Canada Health Research Chair in Mental Health Disparities </p>
</blockquote>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/the-potential-of-psychedelics-to-heal-our-racial-traumas-218233">The potential of psychedelics to heal our racial traumas</a>
</strong>
</em>
</p>
<hr>
<p>Psychedelic ketamine appears to have <a href="https://doi.org/10.1192%2Fbjo.2021.1061">positive but short-lived outcomes</a> in the treatment of mood disorders, and ketamine clinics require evaluation given recent <a href="https://www.fda.gov/drugs/human-drug-compounding/fda-warns-patients-and-health-care-providers-about-potential-risks-associated-compounded-ketamine">FDA warnings</a> about risks of commercialized mental health telemedicine and take-home doses.</p>
<p>Ultimately, the Canadian public may want to reconsider the policy framework that still severely limits access to these promising compounds for researchers, clinicians and those in need. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/albertas-new-policy-on-psychedelic-drug-treatment-for-mental-illness-will-canada-lead-the-psychedelic-renaissance-195061">Alberta’s new policy on psychedelic drug treatment for mental illness: Will Canada lead the psychedelic renaissance?</a>
</strong>
</em>
</p>
<hr>
<p>Veterans have taken it upon themselves to support each other and to advocate for change. <a href="https://heroicheartsproject.org/">The Heroic Hearts Project</a> helps veterans access psychedelic therapies and has long championed the potential benefits of plant medicine ceremony.</p>
<p><a href="https://www.heroicheartsproject.ca/">Heroic Hearts Canada</a>, which aims to provide Canadian veterans with equitable access to safe, effective and affordable psychedelic therapies, has recently partnered with University of Calgary for some <a href="https://www.ucalgary.ca/research/participate/study/16168/are-you-veteran-canadian-armed-forces-have-you-investigated-working-psychedelics-legally">important observational research</a>.</p>
<h2>Faster progress to medical use</h2>
<p>The time lag from drug discovery to patient care is often decades, prompting the expression “<a href="https://doi.org/10.1186/s41231-019-0050-7">valley of death</a>” to refer to the gap between bench science and bedside care. </p>
<p>Given the real mental health needs of Canadian veterans, and the known limits on effectiveness for current standards of care, we must aim for quicker progress towards medical use, <a href="https://www.unodc.org/res/WDR-2023/WDR23_B3_CH2_psychedelics.pdf">as both the United States and Australia have done</a>. However, this progress must not be at the expense of safety and quality, and definitely not simply for commercialization. </p>
<p>Thought needs to be given to the development, evaluation and quality assurance of accessible programs for veteran-centred care, with Veterans’ voices at the table. It is time for more emphasis on psychedelics-related <a href="https://doi.org/10.1016/j.psychres.2019.04.025">implementation science</a>, the study of methods to promote the uptake (and identify barriers) of research findings into routine clinical use in order to improve effectiveness of health services.</p>
<p>There is <a href="https://healthsci.queensu.ca/source/Psychedelics%2520Research/Psychedelic%2520Medicine%2520Report%2520-%2520Final.pdf">robust and mounting evidence to support regulatory approval for MDMA and psilocybin-assisted therapies</a>. Their availability and uptake by clinicians and the public is only a matter of time. </p>
<h2>The need for more diverse research</h2>
<p>Research funds now are best allocated towards large Phase 3 trials that treat wider cross-sections of the veteran community, to begin to assess the safety and efficacy of interventions such as the naturally ocurring and culturally significant psychedelic compounds <a href="https://doi.org/10.1080/00952990.2023.2220874">ibogaine and 5-MeO-DMT</a> <a href="https://www.proquest.com/openview/2d897baa8a8203979eaf5ee7deb9037e/1?pq-origsite=gscholar&cbl=18750&diss=y">and ayahuasca</a>, and to invest in knowledge translation, program evaluation and training researchers and clinicians. </p>
<p>Apart from new biomedical research, it is time we recognized the widespread personal use of psychedelics, including among veterans, and develop safer use guidelines for psychedelics like those in place <a href="https://www.canada.ca/en/health-canada/services/substance-use/alcohol/low-risk-alcohol-drinking-guidelines.html">for alcohol</a> and <a href="https://doi.org/10.1007/BF03404169">cannabis</a>.</p>
<p>While the Senate report does not mention cannabis, it is worth noting that veterans in Canada have been <a href="https://dimensionsretreats.com/dimensions-retreats-algonquin-elevate-veterans-only/#:%7E:text=The%2520program%2520does%2520not%2520include,mind%252Dbody%2520practices%2520in%2520nature.">approved for treatment with cannabis-assisted therapy</a>. </p>
<p>This includes the use of <a href="https://doi.org/10.1177/0269881121997099">cannabis as a psychedelic</a> and mimics the <a href="https://doi.org/10.1007/s40429-021-00401-8">preparation-session-integration protocols</a> of psychedelic therapies. This intervention is also worth rapid evaluation and possible expansion. </p>
<p>Given the pressing needs of Canadian veterans and the limitations of our current tools, the need for research on psychedelic therapies, as well as for timely and equitable access, is urgent.</p><img src="https://counter.theconversation.com/content/218784/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ron Shore worked for, and consulted to Dimensions Health Centres in 2021 and 2022; he continues to own shares in the company.</span></em></p>One in seven Canadian veterans is living with PTSD. Developing a psychedelics research program for veterans should be a public health priority.Ron Shore, Research Scientist, Queen's Health Sciences and Assistant Professor, Department of Psychiatry, Queen's University, OntarioLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2155792023-10-19T13:13:35Z2023-10-19T13:13:35ZCBD: why recommended daily dose was lowered from 70mg to 10mg by food regulator<figure><img src="https://images.theconversation.com/files/554248/original/file-20231017-25-a0uhr1.jpg?ixlib=rb-1.1.0&rect=67%2C0%2C4425%2C2991&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/sublingual-cbd-hemp-oil-woman-taking-2058265334">Nuva Frames/Shutterstock</a></span></figcaption></figure><p>Since 2018 when the UK parliament passed legislation legalising CBD, the <a href="https://www.liebertpub.com/doi/full/10.1089/can.2015.0012">non-psychoactive</a> component of cannabis, sales of CBD-related products have skyrocketed. Today, you can buy CBD oil, CBD vape pens, CBD coffee, CBD muffins to go with your CBD coffee … CBD everything. And these products are often sold with various vague promises of increased wellness. </p>
<p>As CBD, in this context, isn’t a medicine, it isn’t regulated by the UK’s drugs regulator but by the Food Standards Agency (FSA). In 2020, the FSA recommended that daily consumption of CBD should not exceed 70mg. Now, the FSA and Food Standards Scotland have <a href="https://www.food.gov.uk/news-alerts/news/food-standards-agency-and-food-standards-scotland-update-consumer-advice-for-cbd">reduced this limit to 10mg</a> – roughly four drops of 5% CBD oil.</p>
<p>To be clear, 10mg is the advisable safe limit. You won’t be arrested if you consume more than 10mg a day, but the agency warns that there may be long-term health effects if you ignore the advice – namely, harm to the <a href="https://www.food.gov.uk/news-alerts/news/food-standards-agency-and-food-standards-scotland-update-consumer-advice-for-cbd">liver and thyroid</a>.</p>
<p>CBD’s effects have been tested on a range of ailments, from <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8343183/#:%7E:text=Conclusion%3A%20There%20is%20insufficient%20evidence,for%20treating%20patients%20with%20schizophrenia.">schizophrenia</a> to <a href="https://www.japha.org/article/S1544-3191(19)30514-X/fulltext">anxiety</a>, with mixed results. When benefits have been evident, it is usually at a much higher dose – about <a href="https://ascpt.onlinelibrary.wiley.com/doi/full/10.1111/cts.13425">five times the previously recommended maximum intake</a>.</p>
<p>The new 10mg recommended limit has nothing to do with the effectiveness of the drug at this dose – because there is no proven effect. The shift to a lower recommended dose comes after <a href="https://europepmc.org/article/med/36946485">several</a> <a href="https://analyticalsciencejournals.onlinelibrary.wiley.com/doi/abs/10.1002/jat.4511?casa_token=WM1oRJPXhDMAAAAA:kRo6PO64UTjb9Irp7DpHeWowjQgOtoVb1cl30PfWc1rtsW8e36516TnBmv38BMRHYAEqh0kP2eoIQO33">studies</a> have indicated that CBD <a href="https://www.sciencedirect.com/science/article/pii/S0278691523002016?casa_token=da2MxxZO46YAAAAA:xAtYFiVXH9TgRdVXv6J3SReJYCb0bcvo14T6adLGVcXUDorJP62P-6FiEnJi1cnD8gR6ZPYLSBnz">may not be as harmless</a> as previously thought. </p>
<figure class="align-center ">
<img alt="A shelf stocked with CBD products" src="https://images.theconversation.com/files/554602/original/file-20231018-29-c7e749.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/554602/original/file-20231018-29-c7e749.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/554602/original/file-20231018-29-c7e749.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/554602/original/file-20231018-29-c7e749.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/554602/original/file-20231018-29-c7e749.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/554602/original/file-20231018-29-c7e749.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/554602/original/file-20231018-29-c7e749.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">The world is saturated with CBD products.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/maui-hi-june-12-2019-abc-1422571442">Kevin McGovern/Shutterstock</a></span>
</figcaption>
</figure>
<p>To determine how harmful a substance is – or rather, what’s the highest safe amount a human can consume in a given time – scientists test it on animals and then apply a “correction level”. </p>
<p>For example, if, in a study using rats, <a href="https://www.sciencedirect.com/science/article/pii/S0278691523001886">a dose of 100mg per kilogram</a> of body weight is said to be the highest dose where no harms are observed, that would mean for a 70kg human an intake of 7g daily. </p>
<p>There are, however, <a href="https://pubmed.ncbi.nlm.nih.gov/11397514/">differences in metabolism</a> between species, with humans being potentially more susceptible to harm. </p>
<h2>Accidentally boosting the dose</h2>
<p>It is worth noting that seemingly harmless foods, such as <a href="https://www.nhs.uk/common-health-questions/medicines/does-grapefruit-affect-my-medicine/">grapefruit</a>, <a href="https://bnf.nice.org.uk/interactions/warfarin/">broccoli</a> and a <a href="https://pubmed.ncbi.nlm.nih.gov/30144900/">well-done steak</a>,can all interfere in the metabolism of certain drugs. It is already known that <a href="https://www.mdpi.com/2077-0383/8/7/989?utm_sq=g4xlu2tj61">rifampicin</a>, a widely prescribed antibiotic, can interfere with CBD metabolism. Other drugs need to be monitored closely for potential interaction.</p>
<p>There is also an increased risk of getting too high a dose when taking CBD with other medicines, such as <a href="https://springerplus.springeropen.com/articles/10.1186/2193-1801-2-236">ketoconazole</a> (a drug to control fungal infection), and even an increase in absorption when CBD is taken with fatty food. That is why it is not uncommon for drug safety experts to apply a <a href="https://academic.oup.com/toxsci/article/86/1/20/1654105">400-fold</a> correction factor to the previously calculated values. That would bring the allowed intake down from 7g a day to just 17.5mg a day. </p>
<p>Using several animal studies of CBD that indicated <a href="https://www.sciencedirect.com/science/article/pii/S0278691523001801">similar</a> <a href="https://www.sciencedirect.com/science/article/pii/S0278691523001886">values</a> and the correction factors, erring on the side of caution, the new recommended level was recently made public. That is the job of public agencies: on the best evidence possible, to indicate whether a component can do what it’s supposed to and not cause harm when doing so. </p>
<p>It is important to highlight that the FSA’s recent announcement is not a ban. You can still buy drinks infused with CBD that surpass the new daily limit in a single serving. However, any new product will need - as before - to undergo approval by the FSA, <a href="https://www.theguardian.com/business/2023/oct/14/cbd-gummies-drinks-uk-cannabidiol-safe-dose-fsa">which may be harder</a> with this new limit. Ensuring safety, especially for a substance that seems to bring very little benefit in return, is rightly the agency’s priority.</p><img src="https://counter.theconversation.com/content/215579/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Julio de Carvalho Ponce 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>The UK’s Food Standards Agency has slashed the recommended safe dose of CBD over fears of harm.Julio de Carvalho Ponce, Lecturer in Forensic Science, University of WinchesterLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2148042023-10-09T15:26:08Z2023-10-09T15:26:08ZCannabis in Canada: Debunking myths about the real impacts of legalization<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/cannabis-in-canada-debunking-myths-about-the-real-impacts-of-legalization" width="100%" height="400"></iframe>
<p>Before Canada legalized recreational cannabis in October 2018, there was <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8315217/">considerable debate about its potential effects</a>. Some predicted it would trigger <a href="https://www.thestar.com/business/real_estate/2018/08/09/cannabis-gold-rush-will-boost-retail-in-canada-riocan-says.html">an economic “goldrush,”</a> while others worried it would lead to <a href="https://doi.org/10.1503/cmaj.170555">public health “tragedies.”</a> </p>
<p><a href="https://brocku.ca/goodman/faculty-research/faculty-directory/michael-armstrong">Researchers like myself</a> have since investigated the real effects of legalization. As it turns out, certain trends were already underway before legalization and continued afterward. On the flip side, some changes did not happen as anticipated.</p>
<p>This information can help other countries that are now grappling with similar uncertainties about their own legalization plans. Politicians across the globe have been making diverse claims about the impact legalization will have on their countries. </p>
<p>In the United States, <a href="https://www.usatoday.com/story/news/politics/2021/03/12/nebraska-gov-pete-ricketts-legal-marijuana-kill-your-kids/4663466001">Nebraska Governor Pete Ricketts</a> has said cannabis is a “dangerous drug” that will kill children. German politician Markus Söder has <a href="https://www.spiegel.de/panorama/gesellschaft/cannabis-legalisierung-bayern-plant-zentrale-kontrolleinheit-a-284e3aeb-63eb-4fb2-87cc-95f142707717">voiced similar concerns</a>. </p>
<p>On the opposing end of the spectrum, Kenyan presidential candidate George Wajackoyah <a href="https://africacheck.org/fact-checks/reports/ganjanomics-fact-checking-kenyan-presidential-candidate-george-wajackoyahs">proposed the legalization and commercialization of cannabis</a> as a way to eliminate Kenya’s public debt.</p>
<p>Given these debates, Canada’s cannabis legalization experience can offer valuable insights to countries navigating the same terrain.</p>
<h2>Cannabis use</h2>
<p>Many were concerned that legalizing cannabis would trigger a huge increase in usage, resulting in <a href="https://www.cbc.ca/news/politics/wherry-marijuana-trudeau-1.4069815">“hordes of stoned teenagers”</a>. Opponents to legalization argued that <em>any</em> increase in usage <a href="https://doi.org/10.1503/cmaj.181287">would prove it had failed</a>.</p>
<p>However, the percentage of adults using cannabis had already been increasing prior to 2018. Unsurprisingly, it <a href="https://health-infobase.canada.ca/cannabis/">continued to rise after legalization</a>. <a href="https://www.canada.ca/en/health-canada/services/canadian-alcohol-drugs-survey/2019-summary.html">Government surveys</a> put the usage rate at nine per cent in 2011, 15 per cent in 2017 and 20 per cent in 2019.</p>
<p>There was a <a href="https://doi.org/10.1016/j.drugalcdep.2023.109765">boost after legalization</a> beyond the ongoing trend. But part of that might have been from people becoming <a href="https://www.canada.ca/en/health-canada/services/drugs-medication/cannabis/research-data/canadian-cannabis-survey-2021-summary.html#a2.2">more open about cannabis use</a>.</p>
<p>On the other hand, teenagers’ cannabis use <a href="https://www.doi.org/10.25318/82-003-x202100400001-eng">hardly budged after 2018</a>. This suggests teenagers who wanted cannabis were already able to buy it easily from dealers. </p>
<h2>Health issues</h2>
<p>Health impacts were also a significant concern while Canada was debating cannabis legalization. Canada’s previous prime minister, Stephen Harper, claimed cannabis was <a href="https://www.cbc.ca/news/politics/stephen-harper-pot-marijuana-1.3255727">“infinitely worse”</a> than tobacco. His successor, Justin Trudeau, instead said legalization would <a href="https://laws-lois.justice.gc.ca/eng/acts/c-24.5/page-1.html#h-76969">“protect” health</a>.</p>
<p>In reality, cannabis-related hospital visits by adults <a href="https://doi.org/10.24095/hpcdp.40.5/6.07">were already growing before</a> 2018 and <a href="https://doi.org/10.1111/add.16152">kept growing afterward</a>. Compared to early 2011, the rate in Ontario was about three times higher in 2018 and five times higher in 2021.</p>
<p>The post-2018 growth was, again, <a href="https://doi.org/10.1111/add.15834">partly legalization-related</a> and partly an on-going trend.</p>
<p>However, some health impacts have been more serious. There has been significant growth in <a href="https://theconversation.com/legalizing-cannabis-led-to-increased-cannabis-poisonings-in-canadian-children-it-could-get-a-whole-lot-worse-191938">children’s hospital visits due to accidental cannabis consumption</a>. Among children under 10 years old, there was a nine-fold increase in emergency room visits and a six-fold increase in hospitalizations.</p>
<h2>Driving safety</h2>
<p><a href="https://cacp.ca/index.html?asst_id=1332">Law enforcement was concerned that legalizing cannabis</a> would cause more impaired driving. Police complained that they lacked the equipment necessary for detecting cannabis impairment.</p>
<p>Research on <a href="https://doi.org/10.1001/jamanetworkopen.2023.31551">whether</a> <a href="https://doi.org/10.1111/add.16188">or not</a> legalization actually resulted in more cannabis-impaired driving remains inconclusive. Unfortunately, government reports often don’t specify which substances caused drivers’ impairments.</p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/cannabis-impaired-driving-heres-what-we-know-about-the-risks-of-weed-behind-the-wheel-173823">Cannabis-impaired driving: Here’s what we know about the risks of weed behind the wheel</a>
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<p>However, we do know <a href="https://www150.statcan.gc.ca/t1/tbl1/en/cv.action?pid=3510017701">overall drug-impaired driving</a> — any substance except alcohol — increased before and after 2018. Compared to 2011, drug-impaired driving arrests roughly doubled by 2017 and quadrupled by 2020.</p>
<p>There have also been ongoing increases in injuries from <a href="https://doi.org/10.1001/jamanetworkopen.2023.31551">traffic accidents involving cannabis</a>. Compared to 2011, the injury rates in Ontario were about two times higher in 2017 and three times higher in 2020.</p>
<h2>Arrest rates</h2>
<p>Legalization also brought up concerns about crime and social justice. The <a href="https://laws-lois.justice.gc.ca/eng/acts/c-24.5/page-1.html#h-76969">federal government expected legalization</a> would reduce the time police spent on cannabis enforcement. Advocates hoped to see <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8315217/">fewer arrests among marginalized groups</a>.</p>
<p>But <a href="https://doi.org/10.1016/j.drugalcdep.2023.109892">the declines in arrests that legalization triggered</a> weren’t very large. This was because arrests for <a href="https://www150.statcan.gc.ca/t1/tbl1/en/cv.action?pid=3510017701">illegal cannabis possession had already been decreasing in Canada</a> — under both Conservative and Liberal governments — long before legalization. By 2018, the arrest rate was already 71 per cent lower than its 2011 level.</p>
<p>While arrests fell again in 2019, they bottomed-out afterwards, leaving little room for further rate drops.</p>
<p>Arrests for illegal cannabis distribution offences, like growing and trafficking, fell 67 per cent between 2011 and 2018. This trend largely continued after 2018.</p>
<h2>Booming sales</h2>
<p>Businesses had high hopes that legalization would lead to <a href="https://www.thestar.com/real-estate/cannabis-gold-rush-will-boost-retail-in-canada-riocan-says/article_7d4ba63f-f3a6-5d7e-b5f2-5c11b7c6b14b.html">an economic goldrush</a>. <a href="https://thetyee.ca/News/2015/05/19/Stephen-Harper-Marijuana-Politics/">Foreign investors helped fund</a> Canadian cannabis companies. There were also debates among the governments about <a href="https://www.cbc.ca/news/politics/finance-ministers-pot-tax-1.4442540">how to distribute the new tax revenue</a>.</p>
<p>After legalization, cannabis business did boom in some ways. Although most provinces initially <a href="https://theconversation.com/scarce-retail-weed-shops-means-most-canadians-still-use-black-market-pot-113503">lacked enough stores</a>, there are now more than 3,600 across Canada. Sales have surged from $42 million in October 2018 to $446 million in July 2023. They’re now <a href="https://www150.statcan.gc.ca/n1/daily-quotidien/230224/dq230224a-eng.htm">half as large as beer sales</a>.</p>
<p>However, some regions now have <a href="https://www.theglobeandmail.com/business/commentary/article-too-many-marijuana-shops-too-much-pot-production-the-industrys/">too many cannabis stores</a> and <a href="https://www.cbc.ca/listen/live-radio/1-63-the-current/clip/16001923-the-challenges-facing-struggling-cannabis-business-owners">many businesses are struggling to stay afloat</a>. As a result, some corporations and their shareholders <a href="https://www.wsj.com/articles/legal-marijuana-canadian-cannabis-pot-stocks-11665678274">have lost billions of dollars</a>. Only the <a href="https://mjbizdaily.com/most-profitable-cannabis-businesses-in-canada-are-owned-by-government/">government-owned cannabis agencies seem to be consistently profitable</a>.</p>
<h2>Legalization lessons</h2>
<p>While legalization did cause <em>some</em> changes, it was also a government response to changes that were already underway. There are three potential lessons that can be taken away from this. </p>
<p>The first is that cannabis legalization research <a href="https://doi.org/10.1111/add.16314">needs to account for existing trends</a>. It can’t rely on simple before-versus-after comparisons. Governments can help with this by <a href="https://doi.org/10.1503/cmaj.202041">publishing more of the cannabis data</a> they collect.</p>
<p>The second lesson is that Canadian policymakers should worry less about whether legalization caused specific cannabis problems. Instead, they should focus on resolving them.</p>
<p>The third lesson is for other countries considering legalization, like <a href="https://www.cnbc.com/2023/05/11/germany-czechia-luxembourg-netherlands-push-to-legalize-cannabis.html">Germany</a>, <a href="https://www.politico.com/news/2022/11/25/germany-europe-weed-legalization-00070469">Denmark</a> and the <a href="https://theconversation.com/what-the-united-states-can-learn-from-canadas-cannabis-clarity-158500">U.S</a>. For these countries, Canada’s experience serves as a valuable case study. Policymakers should review their own trends before legalizing, because the outcomes afterward might not be as different as they expect.</p><img src="https://counter.theconversation.com/content/214804/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>There were concerns about changes that cannabis legalization might bring. But some trends that were already underway beforehand mostly carried on afterward.Michael J. Armstrong, Associate Professor, Operations Research, Brock UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2120092023-09-04T20:04:26Z2023-09-04T20:04:26ZAs many states weigh legalising cannabis, here’s what they can learn from the struggles of growers in Canberra<p>The haze of cannabis is everywhere right now. Germany has recently become the <a href="https://www.france24.com/en/live-news/20230816-german-govt-okays-controlled-use-of-cannabis">latest country</a> to move towards legalising recreational cannabis, following in the footsteps of Uruguay, Malta, Canada and parts of the United States. Even Thailand has <a href="https://www.abc.net.au/news/2022-06-10/thailand-to-give-one-million-free-cannabis-plants/101144672">begun distributing</a> one million cannabis plants to households after dropping it from the official list of prohibited substances. </p>
<p>Australia has not been left out. In the last couple months, Legalise Cannabis Party members in New South Wales, Victoria and Western Australia have <a href="https://www.abc.net.au/news/2023-06-20/legalise-cannabis-party-bill-nsw-wa-victoria/102498976">tabled bills to legalise recreational cannabis use</a>. </p>
<p>And at a federal level, the Greens <a href="https://parlwork.aph.gov.au/bills/s1353">tabled a bill</a> last month, which would provide for the registration of cannabis strains and the establishment of a national agency overseeing a new commercial cannabis industry.</p>
<p>Many policy experts both here and overseas, however, remain <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)31789-1/fulltext">very worried</a> about a for-profit industry – namely the potential for commercial interests to promote regular cannabis use.</p>
<p>Non-profit supply models offer an alternative, including allowing people to grow cannabis for their own personal consumption. But what do we know about home-growing cannabis in Australia?</p>
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<h2>Our research on cannabis growing in the ACT</h2>
<p>The Australian Capital Territory is showing the way forward. In 2020, ACT passed a law to allow people to <a href="https://www.act.gov.au/cannabis/home">possess, use and grow cannabis</a>. It is now <a href="https://www.legislation.act.gov.au/b/db_59295/">legal</a> to grow up to two cannabis plants per person (up to a maximum of four per household) for personal consumption. </p>
<p>We have been <a href="https://www.unsw.edu.au/research/sprc/our-projects/cannabis-experiences-act">studying</a> the experiences of these cannabis growers in the ACT. Our research provides important lessons for policymakers across the nation who are considering whether to allow home-growing as a legal source of cannabis supply.</p>
<p>We conducted in-depth interviews with 10 people who grow cannabis, exploring their growing techniques, what works well and what challenges they’ve faced.</p>
<p>We were struck by the diversity of the growers we met. Some were growing for medicinal purposes because it is cheaper and more accessible. Others grew for recreational consumption, while some did it for the love of gardening.</p>
<p>But our main takeaway was how <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/dar.13518">difficult</a> it is to get a home-growing cannabis policy right. In the ACT, there are odd bits of law and outdated drug-policy thinking that can make it difficult for home growers to get started, access the supplies they need and share gardening knowledge. </p>
<h2>Challenges aplenty</h2>
<p>People in Canberra are doing a lot of experimenting and finding their own ways of growing – this is a developing knowledge base that should be celebrated.
The people we interviewed are really interested in sharing their knowledge with others, but social barriers prevent many from doing so. </p>
<p>To date, there also aren’t any resources in Australia that aggregate data or the in-depth experiences of cannabis growers, like the kind available to gardeners of other plants. People can’t pop down to Bunnings for cannabis gardening advice. Gardening Australia hasn’t produced a feature on the preferred soil and nutritional needs of cannabis plants. And while there is online information, it mostly doesn’t address Australian growing conditions.</p>
<p>As one grower told us, </p>
<blockquote>
<p>The climate is really tough in Canberra for the type of plant that cannabis is. It doesn’t do well over 30 degrees and it doesn’t do well under like 20-18 [degrees], maybe. And we’re like the extremes [here] – we’re freezing and boiling.</p>
</blockquote>
<p>The greater obstacles, however, are legal in nature. For instance, the ACT cannabis law prohibits people from using “artificial” means to grow cannabis, such as hydroponics or artificial sources of light or heat.</p>
<p>This leaves cannabis growers in the difficult position of trying to manage the wintry Canberra climate without the heat lamps and other indoor growing aids they use for their capsicum and tomato plants. There are also no such prohibitions on artificial light or heat for officially sanctioned medicinal cannabis farms.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/more-australians-back-legalising-cannabis-and-57-support-pill-testing-national-survey-shows-142720">More Australians back legalising cannabis and 57% support pill testing, national survey shows</a>
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<p>When an outdoor cannabis plant does flourish, the law also insists on a maximum yield of 150 grams of cannabis. Our interviewees are able to grow quite large (and potent) plants outdoors. So, what are they supposed to do with their excess cannabis? As one grower said,</p>
<blockquote>
<p>Are you allowed to like give it to a friend? […] I don’t know if you can bag it up and put it in the garbage bin […] like do you take it down to the green waste, do I take my bushes down there? I don’t know.</p>
</blockquote>
<p>Another obstacle: buying seeds is not permitted under the ACT law, so the Commonwealth prohibition stands. For many, this means acquiring seeds illegally from overseas markets. We spoke to plenty of people whose plants were fertilised and ended up producing seeds, leaving them in a legal quandary.</p>
<p>One grower pointed out the contradiction:</p>
<blockquote>
<p>I think it’s sort of a half-arse law to be honest […] you’re allowed to smoke it, you’re allowed to grow, but you are not really allowed to buy any of the seeds or anything to make it. </p>
</blockquote>
<p>Allowing a legally operated cannabis seed bank in the ACT makes practical sense. It would address a need we heard from cannabis growers – the importance of knowing the type of cannabis plant they are growing and its active ingredients. This includes the amount of THC (the psychoactive ingredient that produces the high), compared to CBD (the ingredient that reduces inflammation, pain, seizures and anxiety). </p>
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<p>For those growing for medicinal purposes, this information is critical for matching their crops to their particular needs.</p>
<p>Lastly, we found that growing your own cannabis at home also requires an environment that supports it. For those in rental accommodation or unstable housing, it is often not possible. Passing laws to allow for cannabis community gardens or other open growing areas would address this problem.</p>
<h2>What other states can learn</h2>
<p>With increasing moves towards cannabis legalisation, we are seeing a field of green across Australia, and the world.</p>
<p>ACT growers have a lot to offer other Australian jurisdictions about how policies can better support home cannabis gardeners. It’s important to learn from their experiences so states and territories can get their policies right.</p>
<hr>
<p><em>Correction: The caption on the photo of the man at the Fadden by-election has been amended to specify this is the president of the Legalise Cannabis Australia party, Michael Balderstone.</em></p><img src="https://counter.theconversation.com/content/212009/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Alison Ritter receives funding from the NHMRC, the ARC, state and federal governments, and non-government bodies. </span></em></p><p class="fine-print"><em><span>Kari Lancaster receives funding from the ARC, state and federal governments, industry, and non-government bodies. She is a Member of the Board of Trustees of the International Society for the Study of Drug Policy. </span></em></p><p class="fine-print"><em><span>Laura McLauchlan receives funding from the John Templeton Foundation and the Australian Research Council.</span></em></p><p class="fine-print"><em><span>Matthew Kearnes receives funding from the Australian Research Council. He is affiliated with the NSW Geographical Society.</span></em></p><p class="fine-print"><em><span>Liz Barrett 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>Cannabis growers in the capital report many obstacles, from laws banning the purchase of seeds and artificial lights to the lack of information on growing conditions.Alison Ritter, Professor & Specialist in Drug Policy, UNSW SydneyKari Lancaster, Scientia Associate Professor, Centre for Social Research in Health, UNSW SydneyLaura McLauchlan, Postdoctoral Fellow in Anthropology, Macquarie UniversityLiz Barrett, Research Officer, UNSW SydneyMatthew Kearnes, Professor, Environment & Society, School of Humanities and Languages, UNSW SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2116012023-08-30T12:18:09Z2023-08-30T12:18:09ZMany people think cannabis smoke is harmless − a physician explains how that belief can put people at risk<figure><img src="https://images.theconversation.com/files/544788/original/file-20230825-11495-v7ifhx.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C2121%2C1412&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Cannabis smoke shares many of the same toxins and carcinogens as tobacco smoke.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/joint-in-the-hand-royalty-free-image/1036594994">Tunatura/iStock via Getty Images Plus</a></span></figcaption></figure><p>Though <a href="http://dx.doi.org/10.15585/mmwr.mm6946a4">tobacco use is declining</a> among adults in the U.S., <a href="http://doi.org/10.1001/jamapsychiatry.2015.1858">cannabis use is increasing</a>. Laws and policies regulating the use of tobacco and cannabis are also <a href="https://law.siu.edu/_common/documents/law-journal/articles-2020/fall-2020/2-cork-final.pdf">moving in different directions</a>.</p>
<p>Tobacco policies are becoming more restrictive, with bans on smoking in public places and limits on sales, such as statewide bans on flavored products. In contrast, more states are legalizing cannabis for medical or recreational use, and there are efforts to allow exceptions for cannabis in smoke-free laws. </p>
<p>These changes mean an increasing number of people are likely to get exposed to cannabis smoke. But how safe is direct and secondhand cannabis smoke?</p>
<p>I am a <a href="https://profiles.ucsf.edu/beth.cohen">primary care doctor and researcher</a> in a state where cannabis is now legal for medical and recreational use. My colleagues and I were interested in how opinions about tobacco and cannabis smoke safety have been changing during this time of growing cannabis use and marketing.</p>
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<figcaption><span class="caption">An increasing number of states have legalized recreational use of marijuana.</span></figcaption>
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<p>In our survey of over 5,000 U.S. adults in 2017, 2020 and 2021, we found that people <a href="https://doi.org/10.1001/jamanetworkopen.2023.28691">increasingly felt that exposure to cannabis smoke</a> was safer than tobacco smoke. In 2017, 26% of people thought that it was safer to smoke a cannabis joint than a cigarette daily. In 2021, over 44% chose cannabis as the safer option. People were similarly more likely to rate secondhand cannabis smoke as being “completely safe” compared with tobacco smoke, even for vulnerable groups such as children and pregnant women. </p>
<p>Despite these views, emerging research raises concerns about the health effects of cannabis smoke exposure.</p>
<h2>Do opinions on cannabis match the science?</h2>
<p>Decades of research and hundreds of studies have linked tobacco smoke to <a href="https://doi.org/10.1002/ijc.23033">multiple types of cancer</a> and to <a href="https://doi.org/10.1136/bmj.j5855">cardiovascular disease</a>. However, far fewer studies have been done on the long-term effects of cannabis smoke. Since cannabis remains <a href="https://en.wikipedia.org/wiki/Legality_of_cannabis_by_U.S._jurisdiction">illegal at the federal level</a>, it is more challenging for scientists to study. </p>
<p>It has been particularly hard to study health outcomes that may take a long time and heavier exposure to develop. Recent reviews of research on cannabis and <a href="https://doi.org/10.1001/jamanetworkopen.2019.16318">cancer</a> or <a href="https://doi.org/10.7326/M17-1548">cardiovascular disease</a> found those studies inadequate because they contained relatively few people with heavy exposure, didn’t follow people for a long enough time or didn’t properly account for cigarette smoking. </p>
<p>Many advocates point to the lack of clear findings on negative health effects of cannabis smoke exposure as proof of its harmlessness. However, my colleagues and I feel that this is an example of the famous scientific quote that “absence of evidence is not evidence of absence.”</p>
<p>Scientists have identified hundreds of chemicals in both cannabis and tobacco smoke, and they share <a href="https://doi.org/10.1021/tx700275p">many of the same</a> <a href="https://doi.org/10.1038/s41598-020-63120-6">carcinogens and toxins</a>. Combustion of tobacco and cannabis, whether by smoking or vaping, also releases particles that can be <a href="https://doi.org/10.1289/EHP8689">inhaled deep into the lungs</a> and cause tissue damage. </p>
<p>Animal studies on the effects of secondhand tobacco and cannabis smoke show similar concerning effects on the cardiovascular system. These include impairments in <a href="https://doi.org/10.1161/JAHA.116.003858">blood vessel dilation</a>, <a href="https://doi.org/10.1016/j.hrthm.2022.09.021">increased blood pressure</a> and reduced heart function.</p>
<p>Though more research is needed to determine the risk of lung cancer, heart attacks and strokes posed by cannabis smoke, what is already known has <a href="https://www.epa.gov/indoor-air-quality-iaq/secondhand-marijuana-smoke-and-indoor-air-quality">raised concerns among</a> <a href="https://www.cdc.gov/marijuana/health-effects/index.html">public health agencies</a>.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/544792/original/file-20230825-19-xmkxiz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Hands of two people passing a joint between each other" src="https://images.theconversation.com/files/544792/original/file-20230825-19-xmkxiz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/544792/original/file-20230825-19-xmkxiz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/544792/original/file-20230825-19-xmkxiz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/544792/original/file-20230825-19-xmkxiz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/544792/original/file-20230825-19-xmkxiz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/544792/original/file-20230825-19-xmkxiz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/544792/original/file-20230825-19-xmkxiz.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">Public perceptions of the safety of cannabis determine how it is used and regulated.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/hands-of-man-and-woman-passing-marijuana-joint-royalty-free-image/1087610046">Jamie Grill/Tetra images via Getty Images</a></span>
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<h2>Why do opinions on cannabis matter?</h2>
<p>How people perceive the safety of cannabis has important implications for its use and public policy. Researchers know from <a href="https://doi.org/10.1016/j.drugalcdep.2018.03.012">studying cannabis</a> and <a href="https://doi.org/10.1111/j.1465-7295.2007.00079.x">other substances</a> that if people think something is less risky, they are more likely to use it. Opinions on cannabis safety will also shape medical and recreational cannabis use laws and other policies, such as whether cannabis smoke will be treated like tobacco smoke or whether exceptions will be made in smoke-free air laws.</p>
<p>Part of the complexity in decisions about cannabis use is that, unlike tobacco, clinical trials have demonstrated that cannabis can have <a href="https://doi.org/10.17226/24625">benefits in certain settings</a>. These include managing specific types of chronic pain, reducing nausea and vomiting associated with chemotherapy and increasing appetite and weight gain in those with HIV/AIDS. Notably, many of these studies were not based on smoked or vaped cannabis. </p>
<p>Unfortunately, though Googling cannabis will return thousands of hits about the health benefits of cannabis, many of these claims <a href="https://doi.org/10.1007/s11606-020-06421-w">aren’t supported by scientific research</a>.</p>
<p>I encourage people who want to learn more about the <a href="https://doi.org/10.2105%2FAJPH.2017.303818">potential benefits and risks of cannabis</a> to talk to health care providers or seek sources that present an unbiased view of the scientific evidence. The <a href="https://www.nccih.nih.gov/health/cannabis-marijuana-and-cannabinoids-what-you-need-to-know">National Center for Complementary and Integrative Health</a> has a good overview of studies on cannabis for treatment of a variety of medical conditions, as well as information about potential risks.</p><img src="https://counter.theconversation.com/content/211601/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Beth Cohen receives funding from the Tobacco Related Disease Research Program and National Institutes of Health. </span></em></p>Clinical trials have demonstrated the health benefits of cannabis for certain conditions, but many aren’t testing smoked or vaped forms. Research on cannabis smoke is raising concerns.Beth Cohen, Professor of Medicine, University of California, San FranciscoLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1946962023-06-09T12:29:31Z2023-06-09T12:29:31Z‘From Magic Mushrooms to Big Pharma’ – a college course explores nature’s medicine cabinet and different ways of healing<figure><img src="https://images.theconversation.com/files/531019/original/file-20230608-20480-dlan6s.jpg?ixlib=rb-1.1.0&rect=428%2C512%2C4455%2C2984&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">People for millennia have used what grows around them as medicine.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/dangerous-mushroom-royalty-free-image/463172611">LorenzoT81/iStock via Getty Images Plus</a></span></figcaption></figure><figure class="align-right ">
<img alt="Text saying: Uncommon Courses, from The Conversation" src="https://images.theconversation.com/files/499014/original/file-20221205-17-kcwec8.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/499014/original/file-20221205-17-kcwec8.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=375&fit=crop&dpr=1 600w, https://images.theconversation.com/files/499014/original/file-20221205-17-kcwec8.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=375&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/499014/original/file-20221205-17-kcwec8.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=375&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/499014/original/file-20221205-17-kcwec8.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=471&fit=crop&dpr=1 754w, https://images.theconversation.com/files/499014/original/file-20221205-17-kcwec8.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=471&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/499014/original/file-20221205-17-kcwec8.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=471&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<p><em><a href="https://theconversation.com/topics/uncommon-courses-130908">Uncommon Courses</a> is an occasional series from The Conversation U.S. highlighting unconventional approaches to teaching.</em> </p>
<h2>Title of course:</h2>
<p>“From Magic Mushrooms to Big Pharma”</p>
<h2>What prompted the idea for the course?</h2>
<p>I’m from the foothills of the Appalachians in southern Ohio, where my Grandma Mildred would go out into the woods, which she called her medicine cabinet, to find herbs to use as medicine. <a href="https://scholar.google.com/citations?user=DhbiqSMAAAAJ&hl=en&oi=ao">I grew up to be an anthropologist</a>, interested in how people around the world heal themselves. In the 1990s, I did my dissertation research in Ecuador and learned how Indigenous people in the Choco region used <a href="https://doi.org/10.1007/s00213-019-05446-2">ayahuasca and other medicines from the forest</a> to assist in the grieving process.</p>
<p>With the <a href="https://mjbizdaily.com/map-of-us-marijuana-legalization-by-state/">legalization of cannabis in many states</a> and <a href="https://doi.org/10.3390/jof8080870">increased research</a> on <a href="https://doi.org/10.1007/s13311-017-0542-y">how “nontraditional” drugs can assist</a> people with post-traumatic stress disorder, depression and <a href="https://doi.org/10.2174/15733998113099990003">addiction issues</a>, it seemed like an opportune time to create this course. It’s part of a new interdisciplinary minor at Western Illinois University called “<a href="http://www.wiu.edu/academics/cannabis/culture/">Cannabis & Culture</a>” that offers students a foundation for understanding the social and cultural context, history and politics of nature-based medicine use in the United States and around the globe.</p>
<h2>What does the course explore?</h2>
<p>The course looks at how different peoples and cultures use nature-based medicines to heal themselves. First we establish that there are <a href="https://doi.org/10.1038/sj.embor.7400693">many ways of knowing the world around us</a>, just as there are many ways to heal ourselves. Some of us rely on Western medicine, others pray, yet others turn to Indigenous or traditional ways of healing that are rooted in nature.</p>
<p>We talk about the ways Western medicine now seeks to validate substances that have been used for healing for centuries, like research into how <a href="https://doi.org/10.3390/molecules27123877">ginger and turmeric can alleviate inflammation</a>, or the ways cannabis can <a href="https://doi.org/10.1016/j.yebeh.2016.09.040">reduce or even eliminate some epileptic seizures</a>.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/530983/original/file-20230608-27-tlrr54.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="closeup of five dots of blood on the shoulder of a man without a shirt" src="https://images.theconversation.com/files/530983/original/file-20230608-27-tlrr54.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/530983/original/file-20230608-27-tlrr54.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/530983/original/file-20230608-27-tlrr54.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/530983/original/file-20230608-27-tlrr54.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/530983/original/file-20230608-27-tlrr54.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/530983/original/file-20230608-27-tlrr54.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/530983/original/file-20230608-27-tlrr54.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">Kambô frog medicine is a shamanic medicinal ritual that originates among Amazonian tribes who use the poisonous excretion from the <em>Phyllomedusa bicolor</em> tree frog to cure illness.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/kambo-frog-poison-medicine-for-body-detox-royalty-free-image/1065635962">GummyBone/iStock via Getty Images Plus</a></span>
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<p>We also examine how the <a href="https://doi.org/10.1111/j.1471-8847.2006.00168.x">pharmaceutical industry has</a> <a href="https://www.northatlanticbooks.com/shop/biopiracy/">exploited Indigenous peoples’ ethnobotanical knowledge</a> <a href="https://doi.org/10.1155/2021/8898842">and landscapes for monetary gain</a>.</p>
<p>Using the Amazonian giant leaf frog, or kambô (<em><a href="https://amphibiaweb.org/cgi/amphib_query?where-genus=Phyllomedusa&where-species=bicolor&account=amphibiaweb">Phyllomedusa bicolor</a></em>), as a case study, students learn that at least 15 Indigenous groups have long histories of using the frog’s secretion for its analgesic, antibiotic and wound-healing properties. <a href="https://news.mongabay.com/2022/05/amazon-frog-highlights-appropriation-of-indigenous-knowledge-for-commercial-gain/">Eleven patents related to <em>P. bicolor</em> have been granted</a> – all of them in rich countries. Indigenous people have not been compensated for their knowledge.</p>
<h2>Why is this course relevant now?</h2>
<p>The current generation of young people are <a href="https://magazine.medlineplus.gov/article/teens-are-talking-about-mental-health">open about mental health issues</a>, and many people are looking for new ways to deal with anxiety, grief, PTSD and depression. My students can discuss their health concerns and learn about alternatives to what they may be accustomed to.</p>
<p>At this politically and racially polarized moment in the U.S., the course also provides the opportunity to discuss how <a href="https://doi.org/10.1089/can.2019.0063">racism, misogyny and discrimination against people of color</a> have influenced scientific research.</p>
<h2>What’s a critical lesson from the course?</h2>
<p>Over the course of the semester, students begin to recognize that there is no one right way of healing. More importantly, there is no one right way of being human. It is my hope that students leave seeing that everything is connected, integrally linked to humanity’s relationship to nature. </p>
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<a href="https://images.theconversation.com/files/531020/original/file-20230608-17666-2vej3s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="rows of marijuana crop inside a greenhouse with two agricultural workers" src="https://images.theconversation.com/files/531020/original/file-20230608-17666-2vej3s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/531020/original/file-20230608-17666-2vej3s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/531020/original/file-20230608-17666-2vej3s.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/531020/original/file-20230608-17666-2vej3s.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/531020/original/file-20230608-17666-2vej3s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/531020/original/file-20230608-17666-2vej3s.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/531020/original/file-20230608-17666-2vej3s.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">In some parts of the U.S., cannabis is now just another agricultural crop.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/large-amounts-and-endless-rows-of-marijuana-crop-stand-news-photo/1254375856">Mark Abramson/The Washington Post via Getty Images</a></span>
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<h2>What materials does the course feature?</h2>
<ul>
<li><p>Scientific materials provided by the <a href="https://maps.org/">Multidisciplinary Association for Psychedelic Studies</a>, a nonprofit that provides some of the only scientific research on psychedelics in the U.S. and promotes awareness of these drugs</p></li>
<li><p>“<a href="https://www.penguinrandomhouse.com/books/529343/how-to-change-your-mind-by-michael-pollan/">How to Change your Mind</a>,” by Michael Pollan and the accompanying <a href="https://www.imdb.com/title/tt21062540/">Netflix series</a> </p></li>
<li><p>Work of ethnobotanist Mark Plotkin, including his Ted Talk “<a href="https://www.ted.com/talks/mark_plotkin_what_the_people_of_the_amazon_know_that_you_don_t?language=en">What the people of the Amazon know that you don’t</a>”</p></li>
</ul>
<h2>What will the course prepare students to do?</h2>
<p>Studying how different cultures approach problems that plague all humans, like being sick and healing our ill, demonstrates to students that there are many ways the world over to solve problems. This course views different approaches not as a problem to be overcome but as a resource that can yield new ways of thinking and new opportunities – a definite advantage in the professional world. I hope students also learn to become advocates for their own health and well-being.</p><img src="https://counter.theconversation.com/content/194696/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Heather McIlvaine-Newsad 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>An anthropology course explores how peoples and cultures around the world use nature-based medicines to heal.Heather McIlvaine-Newsad, Professor of Anthropology, Western Illinois UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2047792023-05-23T16:19:27Z2023-05-23T16:19:27ZCannabis can have serious health effects that Canadians may not be aware of, like nonstop vomiting and heart issues<figure><img src="https://images.theconversation.com/files/524516/original/file-20230504-27-tqv597.jpg?ixlib=rb-1.1.0&rect=166%2C8%2C2536%2C1304&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The government has an obligation to ensure that information about the health risks of cannabis use is as equally accessible to the public as cannabis products have become.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/montreal-canada-september-13-2018-official-1178920882">(Shutterstock)</a></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/cannabis-can-have-serious-health-effects-that-canadians-may-not-be-aware-of--like-nonstop-vomiting-and-heart-issues" width="100%" height="400"></iframe>
<p>Non-medical cannabis has been legal in Canada since 2018. Although a primary motivation for legalization was to <a href="https://laws-lois.justice.gc.ca/eng/acts/c-24.5/page-1.html#docCont">enhance public awareness of the health risks associated with cannabis use</a>, the Canadian government’s <a href="https://www.canada.ca/en/health-canada/services/drugs-medication/cannabis/health-effects.html">online resources</a> regarding cannabis harms may not reveal the full picture. </p>
<p>Well-known health impacts of cannabis use include <a href="https://www.canada.ca/en/health-canada/services/drugs-medication/cannabis/health-effects/effects.html">respiratory issues, decreased cognitive ability, psychosis and risk of future substance use</a>. </p>
<p>Recently, <a href="https://www.canada.ca/en/health-canada/services/publications/drugs-health-products/cannabis-addictive.html#s5">cannabis dependence</a> has been identified as a risk for users of all ages. Approximately <a href="https://doi.org/10.1016/j.drugalcdep.2010.11.004">one in 10 adults</a> and <a href="https://doi.org/10.1016/S0140-6736(09)61037-0">one in six adolescents</a> who experiment with cannabis will become dependent. The risk increases to <a href="https://doi.org/10.1056/NEJMra1402309">one in two for daily users</a>.</p>
<p>Chronic use refers to <a href="https://www.ccsa.ca/clearing-smoke-cannabis-highlights">weekly or more frequent cannabis use over a period of months or years</a>. Chronic cannabis users are at risk of more severe and less frequently discussed health consequences. Examples include <a href="https://doi.org/10.1503/cmaj.140154">cannabinoid hyperemesis syndrome (CHS)</a> and <a href="https://doi.org/10.1161/CIRCULATIONAHA.111.052662">Takotsubo cardiomyopathy (TTC)</a>. </p>
<p>These conditions are rarely mentioned in the media. They are also absent from Canada’s online consumer resources on cannabis, despite their potential to be debilitating and, <a href="https://doi.org/10.1111/1556-4029.13819">in some cases, fatal</a>. More research is required to gauge the incidence rates of these conditions. </p>
<h2>Cannabinoid hyperemesis syndrome</h2>
<p>Cannabinoid hyperemesis syndrome, <a href="https://doi.org/10.1136/gut.2003.036350">first defined in 2004</a>, refers to cyclical vomiting experienced by chronic cannabis users (“emesis” means vomiting). People who have CHS can exhibit <a href="https://www.doi.org/10.1007/s13181-016-0595-z">reoccurring episodes of nausea, vomiting, abdominal pain and dehydration</a>, sometimes requiring hospitalization.</p>
<p>CHS is typically divided into three stages. In the first, prodromal phase, an individual starts to negatively react to cannabis, but vomiting has not begun. Symptoms include <a href="https://doi.org/10.1016/j.jen.2020.11.006">nausea, abdominal pain, heavy indigestion and lack of appetite</a>. This initial phase can last for months to years, during which most affected people maintain normal eating habits.</p>
<p>Next is the hyperemetic phase, characterized by cyclic vomiting or “hyperemetic episodes.” Patients report intense and overwhelming vomiting during this phase. <a href="https://doi.org/10.2147/IJGM.S49701">Some find that hot showers or baths temporarily ease their nausea</a>. </p>
<p>The hyperemetic phase continues until the individual stops using cannabis. Once cannabis use has ceased, the recovery phase starts.</p>
<p>Currently, the <a href="https://doi.org/10.1080/15563650.2023.2183790">most informative online resources regarding CHS are hosted on Reddit</a>, in threads such as <a href="https://www.reddit.com/r/CHSinfo/comments/wxwf41/cannabinoid_hyperemesis_syndrome_chs_a_complete/">r/CHSinfo</a>. While cases of CHS are not well-documented, evidence suggests that the <a href="https://doi.org/10.1001/jamanetworkopen.2022.31937">commercialization of the cannabis market led to an increase in CHS-related emergency department visits</a>. Increased public awareness of CHS could help address these trends. </p>
<h2>Takotsubo cardiomyopathy</h2>
<p>Takotsubo cardiomyopathy, <a href="https://doi.org/10.1097/01.JAA.0000654368.35241.FC">also known as “broken heart syndrome,”</a> is an acute reversible heart failure condition characterized by the weakening of the heart’s left ventricle, <a href="http://dx.doi.org/10.1016/j.ijcard.2016.02.012">often caused by severe emotional or physical stress</a>. “Takotsubo” refers to the <a href="https://doi.org/10.1067/mhj.2002.120403">apical ballooning shape in TTC, which resembles Japanese octopus traps</a>. </p>
<p>Although originally believed to be a benign condition, <a href="https://doi.org/10.1016/j.jacc.2018.07.072">there is a substantial risk of mortality with TTC</a>.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/523914/original/file-20230502-28-dy4z1w.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/523914/original/file-20230502-28-dy4z1w.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/523914/original/file-20230502-28-dy4z1w.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/523914/original/file-20230502-28-dy4z1w.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/523914/original/file-20230502-28-dy4z1w.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/523914/original/file-20230502-28-dy4z1w.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/523914/original/file-20230502-28-dy4z1w.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Illustration of the mechanism linking cannabis use, stress, and Takotsubo cardiomyopathy proposed by Ma, Del Buono, and Moeller in 2019. Brain and heart icons courtesy of Freepik.</span>
</figcaption>
</figure>
<p>TTC is most common in post-menopausal women, however, studies have <a href="https://doi.org/10.1007/s11886-019-1210-0">suggested a link between chronic cannabis use and TTC in younger individuals</a>. <a href="https://doi.org/10.7759/cureus.18575">Incidents of TTC in cannabis users are associated with serious illness</a> including stroke and cardiac arrest, even though these patients usually have more favourable cardiac risk factor profiles compared to older, non-cannabis using patients.</p>
<p>While the interplay between chronic cannabis use and TTC remains unclear, <a href="https://doi.org/10.1007/s11886-019-1210-0">researchers have hypothesized cannabis use and stress have similar hyperactivation effects on the amygdala</a>, a structure located in the brain’s temporal lobe. <a href="https://doi.org/10.1007/s10286-021-00844-z">Excessive activation of the amygdala and the sympathetic nervous system is believed to be a dominant contributor to TTC</a>.</p>
<h2>The cost of chronic cannabis use</h2>
<p>Although I research cannabis, I was unaware of TTC and CHS until I heard Liv Wilder’s story in <a href="https://open.spotify.com/episode/2Wzxibub1lBF8Qi5IIKLcU">episode 135 of the <em>This Is Actually Happening</em> podcast</a>. I reached out to Wilder, who lives in the United States, to ask about his experience with cannabis and these conditions, which he also <a href="https://www.instagram.com/all.in.amputee/">discusses on Instagram</a>.</p>
<p>When Wilder was introduced to cannabis at age 20, he found a new sense of peace after struggling with anxiety and alienation since childhood. He began using cannabis daily. </p>
<p>After several months, he began experiencing intense nausea and vomiting that would last for hours. Some episodes required emergency room visits, where he received intravenous anti-nausea medication, but no clear diagnosis.</p>
<p>When Wilder switched from dried flower to concentrates, <a href="https://www.canada.ca/en/health-canada/services/drugs-medication/cannabis/personal-use/accessories-inhalation.html#a4">colloquially known as “dabs</a>,” the higher dose of cannabinoids increased the frequency of his nausea and vomiting. Over the next two years of cannabis use, his nausea and vomiting became increasingly tortuous.</p>
<p>After a minor, unrelated surgical procedure performed under general anesthesia, Wilder breathed vomit into his lungs during recovery, turned blue and was rushed to emergency. </p>
<p>The apex of his heart had ballooned due to the stress of the anesthesia, years of chronic cannabis use and persistent vomiting. He was put on dialysis and life support, which led to a blockage in his right femoral artery, resulting in his foot becoming necrotic. His leg was amputated while he remained in a coma. </p>
<p>He woke up some time after his surgery as an above-the-knee amputee. Three years of chronic cannabis use had cost him his right leg.</p>
<p>Wilder was diagnosed with TTC, CHS, acute kidney injury and neuropathy in his left foot. He struggled with cannabis and alcohol abuse for 18 months following his amputation, but has abstained from both since July 2019. He is now very active in the gym, and loves rock climbing and camping. </p>
<h2>Improving cannabis education</h2>
<p>At present, occurrence rates of CHS and TTC in Canada remain unclear. According to the <a href="https://www.canada.ca/en/health-canada/services/drugs-medication/cannabis/research-data/canadian-cannabis-survey-2022-summary.html">2022 Canadian Cannabis Survey</a>, one in five Canadian cannabis users reported daily use in the past year. <a href="https://doi.org/10.1503/cmaj.1096027">CHS has been estimated to affect one of every 200 daily cannabis users</a>. Associations between TTC and chronic cannabis use are not as well understood.</p>
<p>Providing consumers with a regulated source of cannabis that is not synthetic, contaminated with pesticides, or laced with other drugs is necessary. As a scientist who studies cannabis emissions, I am an avid supporter of legalization. Nonetheless, commercialization of the market without sufficient cannabis education contradicts the <a href="https://www.ccsa.ca/policy-and-regulations-cannabis">goal of the Cannabis Act</a>: to protect the public health and safety of Canadians.</p>
<p>Now that <a href="https://www.theglobeandmail.com/business/article-health-canada-cannabis-act-review/">Canada’s federal review of the impacts of legalization</a> is underway, it is essential to highlight chronic cannabis use and associated health risks. The government has an obligation to ensure that information about the health risks of cannabis use is as equally accessible to the public as cannabis products have become.</p><img src="https://counter.theconversation.com/content/204779/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Kristen Yeh’s financial support for research on cannabis emissions comes from the Natural Sciences and Engineering Research Council, Ontario Graduate Scholarship program, the Alfred P. Sloan Foundation, and the University of Toronto Department of Chemistry.</span></em></p>Potential long-term, serious consequences of cannabis use include severe cyclical vomiting and a form of cardiomyopathy sometimes called ‘broken heart syndrome.’Kristen Yeh, PhD Candidate, Environmental Chemistry, University of TorontoLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2017162023-05-07T08:28:51Z2023-05-07T08:28:51ZMental health: almost half of Johannesburg students in new study screened positive for probable depression<figure><img src="https://images.theconversation.com/files/522267/original/file-20230421-15-slnlgo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Wesley Lazarus/Shutterstock </span></span></figcaption></figure><p>Depression is a mental health disorder characterised by a persistently low mood or loss of interest in activities. It causes significant impairment in daily life. Possible causes include a combination of biological, psychological and social sources of distress. </p>
<p>It’s a major mental illness that largely goes undiagnosed. Survey <a href="https://doi.org/10.1192/bjp.187.6.495">estimates</a> put the lifetime risk of depression at 10%. This makes depression one of the <a href="https://www.who.int/news-room/fact-sheets/detail/depression#:%7E:text=Approximately%20280%20million%20people%20in%20the%20world%20have%20depression%20(1)">most common mental illnesses</a>. In 2019, the World Health Organization estimated that <a href="https://www.who.int/news-room/fact-sheets/detail/depression#:%7E:text=Approximately%20280%20million%20people%20in%20the%20world%20have%20depression%20(1)">280 million</a> people in the world – about 3.8% of the population – had depression. </p>
<p>Projections for South Africa are alarming, with research suggesting that <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4038770/">one in three people</a> will experience depression, anxiety or a substance use disorder in their lifetime. </p>
<p>University students are particularly at <a href="https://pubmed.ncbi.nlm.nih.gov/30211576/">high risk</a> of depression. One South African study estimated that <a href="https://www.tandfonline.com/doi/full/10.1080/07448481.2016.1178120">24.2%</a> of university students have mild depression, and <a href="https://www.tandfonline.com/doi/full/10.1080/07448481.2016.1178120">12.4%</a> have moderate to severe depression. Globally, an average of about <a href="https://psycnet.apa.org/manuscript/2018-44951-001.pdf#page=17">21%</a> of university students have major depressive disorder.</p>
<p>This is concerning because students with depression face very specific challenges. These include: </p>
<ul>
<li><p>worse <a href="https://pubmed.ncbi.nlm.nih.gov/7793438/">academic outcomes</a></p></li>
<li><p>low productivity</p></li>
<li><p>more likely to struggle with <a href="https://pubmed.ncbi.nlm.nih.gov/15060400/">alcohol abuse</a> in their adulthood </p></li>
<li><p>and high <a href="https://pubmed.ncbi.nlm.nih.gov/21823951/">rates of suicide</a>. </p></li>
</ul>
<p>It is clear that this population group needs targeted interventions. Up-to-date research on the prevalence and drivers of depression among students is crucial to inform potential interventions in this group.</p>
<p>The studies that have been done in South Africa do not cover the student population across the country. There’s a lack of data on the prevalence and drivers of depression among students in Johannesburg. Johannesburg is South Africa’s main commercial city and has the country’s highest population of students. To address this gap, we recently conducted an <a href="https://www.frontiersin.org/articles/10.3389/fpsyt.2023.1018197/full">online survey</a> among undergraduate students at the University of the Witwatersrand in South Africa.</p>
<p>Almost half of the study participants screened positive for probable depression. Probable depression was associated with socio-demographic factors such as economic status, and modifiable behavioural factors such as substance use. These two factors are commonly identified correlates of depression in this group. The prevalence of probable depression among undergraduate students in this study was high relative to the general population. Our findings are an important step towards helping universities tailor mental health programmes to students’ needs.</p>
<h2>Our study</h2>
<p>We used the <a href="https://aidsetc.org/sites/default/files/resources_files/PHQ-2_English.pdf">Patient Health Questionnaire (PHQ-2)</a> to assess the prevalence of probable depression. We also identified factors associated with probable depression. These factors included age, marital status and substance use (alcohol, cannabis, tobacco and other substances). </p>
<p>We had a response rate was 8.4% (1,046/12,404). Though low, such response rates are common in online surveys. While our survey should be interpreted with caution, the key findings are similar to other <a href="https://pubmed.ncbi.nlm.nih.gov/32664032/">studies elsewhere</a>.</p>
<p>Forty-eight per cent (439/910) screened positive for probable depression.</p>
<p>Certain socio-demographic factors were associated with lower odds of screening positive for probable depression. Students who identified as white were 36% less likely than black students to screen positive for depression. Those who could afford the most important things – but few luxury goods – were 50% less likely to screen positive for depression than those who had enough money for food and clothes, but were short of many other things.</p>
<p>Students with enough money for luxury goods and extra things were 56% less likely than those who had enough money for food and clothes, but were short of many other things, to screen positive for depression. These findings are similar to a recent <a href="https://sajp.co.za/index.php/SAJP/article/view/1795">study</a> among undergraduate physiotherapy clinical students. </p>
<p>Students who reported substance use had higher odds of screening positive for probable depression. But the probabilities varied based on the substance used. </p>
<p>Those reporting using cannabis were 29% more likely than students who didn’t use cannabis to screen positive for probable depression. It’s important to note that the global <a href="https://www.cambridge.org/core/journals/psychological-medicine/article/association-between-cannabis-use-and-depression-a-systematic-review-and-metaanalysis-of-longitudinal-studies/B144B7AE5A3D973289DBDD99ADE21E58">findings</a> on the <a href="https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2723657">association</a> between cannabis use and depression <a href="https://pubmed.ncbi.nlm.nih.gov/17662880/">vary</a>. But our finding is an important consideration given the legal use of cannabis in South Africa.</p>
<p>Reported alcohol use was common in our study. But it was not associated with screening positive for probable depression. This is contrary to <a href="https://onlinelibrary.wiley.com/doi/10.1111/add.14935">findings</a> from other <a href="https://pubmed.ncbi.nlm.nih.gov/31733662/">studies</a>. Our study did not find an association between tobacco use and screening positive for probable depression. But other <a href="https://bmcpublichealth.biomedcentral.com/articles/10.1186/1471-2458-9-356">researchers</a> have reported a strong association between smoking and depression in adolescents and adults. While we did not find significant associations between alcohol and tobacco use and screening positive for depression, we believe these are important correlates. Alcohol and tobacco are often used as coping mechanisms for individuals with depression. </p>
<h2>Recommendations</h2>
<p>The odds of screening positive for depression were associated with specific sociodemographic and selected behavioural factors. </p>
<p>Mental health professionals working with undergraduate students at the University of Witwatersrand should strengthen mental health (including depression) and risk factors (substance use) screening and referral for treatment services. </p>
<p>In addition, these findings call for strengthening the awareness and use of existing counselling services among undergraduate students at the campus and other services out of the university campus, such as the South African Depression and Anxiety Group’s <a href="https://www.sadag.org/index.php?option=com_content&view=article&id=11&Itemid=114">help line</a>.</p><img src="https://counter.theconversation.com/content/201716/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Joel Msafiri Francis receives funding from the South Africa National Research Foundation (NRF) and the University of the Witwatersrand. </span></em></p>University students are particularly at high risk of depression. One global study suggests 21% of students have major depressive disorder.Joel Msafiri Francis, Senior Researcher, University of the WitwatersrandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2041712023-04-28T12:46:00Z2023-04-28T12:46:00ZCannabis-derived products like delta-8 THC and delta-10 THC have flooded the US market – two immunologists explain the medicinal benefits and potential risks<figure><img src="https://images.theconversation.com/files/522403/original/file-20230421-881-3y816m.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C5980%2C3926&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Thousands of cannabis-derived products are now on the market.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/cannabis-oils-and-bud-in-a-small-bowl-surrounded-by-royalty-free-image/1277453803?phrase=Cannabis%20products&adppopup=true">skodonnell/E+ via Getty Images</a></span></figcaption></figure><p>These days you see signs for delta-8 THC, delta-10 THC and CBD, or cannabidiol, everywhere – at gas stations, convenience stores, vape shops and online. Many people are rightly wondering which of these compounds are legal, whether it is safe to consume them and which of their supposed medicinal benefits hold up to scientific scrutiny.</p>
<p>The rapid proliferation of cannabis products makes clear the need for the public to better understand what these compounds are derived from and what their true benefits and potential risks may be. </p>
<p>We are immunologists who have been studying the effects of <a href="https://scholar.google.com/citations?user=jJVj3sUAAAAJ&hl=en">marijuana cannabinoids</a> <a href="https://scholar.google.com/citations?user=af7TahQAAAAJ&hl=en">on inflammation and cancer</a> for more than two decades.</p>
<p>We see great promise in these products in medical applications. But we also have concerns about the fact that there are still many unknowns about their safety and their psychoactive properties. </p>
<h2>Parsing the differences between marijuana and hemp</h2>
<p><em>Cannabis sativa</em>, the <a href="https://doi.org/10.1016/B978-0-12-386454-3.00745-4">most common type of cannabis plant</a>, has <a href="https://doi.org/10.1007/978-3-030-57369-0_1">more than 100 compounds called cannabinoids</a>. </p>
<p>The most well-studied cannabinoids extracted from the cannabis plant include delta-9-tetrahydrocannabinol, or delta-9 THC, which is psychoactive. A psychoactive compound is one that affects how the brain functions, thereby altering mood, awareness, thoughts, feelings or behavior. Delta-9 THC is the main <a href="https://doi.org/10.1007/s00213-002-1231-y">cannabinoid responsible for the high</a> associated with marijuana. CBD, in contrast, is non-psychoactive. </p>
<p>Marijuana and hemp are <a href="https://theconversation.com/cbd-marijuana-and-hemp-what-is-the-difference-among-these-cannabis-products-and-which-are-legal-154256">two different varieties of the cannabis plant</a>. In the U.S., <a href="https://www.fda.gov/news-events/public-health-focus/fda-regulation-cannabis-and-cannabis-derived-products-including-cannabidiol-cbd">federal regulations stipulate that</a> cannabis plants containing greater than 0.3% delta-9 THC should be classified as marijuana, while plants containing less should be classified as hemp. The marijuana grown today has high levels – from 10% to 30% – of delta-9 THC, while hemp plants contain 5% to 15% CBD. </p>
<p>In 2018, the Food and Drug Administration approved the use of CBD extracted from the cannabis plant <a href="https://www.fda.gov/news-events/press-announcements/fda-approves-first-drug-comprised-active-ingredient-derived-marijuana-treat-rare-severe-forms">to treat epilepsy</a>. In addition to being a source of CBD, hemp plants can be used commercially to <a href="https://doi.org/10.1007/s11356-021-16264-5">develop a variety of other products</a> such as textiles, paper, medicine, food, animal feed, biofuel, biodegradable plastic and construction material. </p>
<p>Recognizing the potential broad applications of hemp, when Congress passed the Agriculture Improvement Act, <a href="https://www.pbs.org/newshour/politics/hemp-high-speed-internet-and-other-highlights-from-the-new-farm-bill">called the Farm Bill</a>, in 2018, it removed hemp from the category of controlled substances. This made it legal to grow hemp. </p>
<p>When <a href="https://theconversation.com/cbd-is-not-a-cure-all-heres-what-science-says-about-its-real-health-benefits-186901">hemp-derived CBD saturated the market</a> after passage of the Farm Bill, CBD manufacturers began harnessing their technical prowess <a href="https://cen.acs.org/biological-chemistry/natural-products/Delta-8-THC-craze-concerns/99/i31">to derive other forms of cannabinoids from CBD</a>. This led to the emergence of delta-8 and delta-10 THC.</p>
<p>The chemical difference between delta-8, delta-9 and delta-10 THC is the position of a double bond on the chain of carbon atoms they structurally share. Delta-8 has this double bond on the eighth carbon atom of the chain, delta-9 on the ninth carbon atom, and delta-10 on the 10th carbon atom. These minor differences cause them to exert different levels of psychoactive effects.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/523068/original/file-20230426-20-f816k5.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Illustration of the chemical formula and structural composition of CBD versus delta9 THC." src="https://images.theconversation.com/files/523068/original/file-20230426-20-f816k5.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/523068/original/file-20230426-20-f816k5.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=372&fit=crop&dpr=1 600w, https://images.theconversation.com/files/523068/original/file-20230426-20-f816k5.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=372&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/523068/original/file-20230426-20-f816k5.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=372&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/523068/original/file-20230426-20-f816k5.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=468&fit=crop&dpr=1 754w, https://images.theconversation.com/files/523068/original/file-20230426-20-f816k5.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=468&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/523068/original/file-20230426-20-f816k5.png?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">Delta-9 THC is believed to be the primary cannabinoid that gives marijuana its psychoactive effects. Both CBD and marijuana have been shown in studies to be beneficial for various medicinal uses.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/illustration/vs-9-thc-cannabidiol-vs-delta-9-royalty-free-illustration/1305259512">About time/iStock via Getty Images Plus</a></span>
</figcaption>
</figure>
<h2>The properties of delta-9 THC</h2>
<p>Delta-9 THC was <a href="https://doi.org/10.1038/sj.bjp.0706406">one of the first forms of cannabinoid</a> to be isolated from the cannabis plant in 1964. The highly psychoactive property of delta-9 THC is based on its <a href="https://doi.org/10.1093/brain/awg143">ability to activate certain cannabinoid receptors</a>, called CB1, in the brain. The receptor, CB1, is like a lock that can be opened only by a specific key – in this case, delta-9 THC – allowing the latter to affect certain cell functions. </p>
<p>Delta-9 THC mimics the cannabinoids, called <a href="https://theconversation.com/people-produce-endocannabinoids-similar-to-compounds-found-in-marijuana-that-are-critical-to-many-bodily-functions-198220">endocannabinoids</a>, that our bodies naturally produce. Because delta-9 THC emulates the actions of endocannabinoids, it also affects the same brain functions they regulate, such as appetite, learning, memory, anxiety, depression, pain, sleep, mood, body temperature and immune responses. </p>
<p>The FDA approved delta-9 THC in 1985 to treat <a href="https://www.ncbi.nlm.nih.gov/books/NBK563174/">chemotherapy-induced nausea and vomiting in cancer patients</a> <a href="https://doi.org/10.1007/s10461-019-02430-x">and, in 1992, to stimulate appetite in HIV/AIDS patients</a>.</p>
<p>The National Academy of Sciences has reported that cannabis is <a href="https://doi.org/10.17226/24625">effective in alleviating chronic pain in adults</a> and for improving muscle stiffness in patients with <a href="https://www.nationalmssociety.org/What-is-MS">multiple sclerosis</a>, an autoimmune disease. That report also suggested that cannabis may help sleep outcomes and fibromyalgia, a medical condition in which patients complain of fatigue and pain throughout the body.
In fact, a combination of delta-9 THC and CBD has been used to treat muscle stiffness and spasms in multiple sclerosis. This medicine, called Sativex, <a href="https://doi.org/10.1186/s12883-021-02246-0">is approved in many countries</a> but not yet in the U.S.</p>
<p>Delta-9 THC can also activate another type of cannabinoid receptor, called CB2, which is expressed mainly on immune cells. Studies from our laboratory have shown that <a href="https://doi.org/10.4155/fmc.09.93">delta-9 THC can suppress inflammation</a> through the activation of CB2. This makes it highly effective <a href="https://doi.org/10.1016/j.bbi.2019.07.028">in the treatment of autoimmune diseases</a> like multiple sclerosis and colitis as well as <a href="https://doi.org/10.1111/bph.15226">inflammation of the lungs caused by bacterial toxins</a>.</p>
<p>However, delta-9 THC has not been approved by the FDA for ailments such as pain, sleep, sleep disorders, fibromyalgia and autoimmune diseases. This has led people to self-medicate against such ailments for which there are currently no effective pharmacological treatments. </p>
<p><iframe id="GQtTY" class="tc-infographic-datawrapper" src="https://datawrapper.dwcdn.net/GQtTY/2/" height="400px" width="100%" style="border: none" frameborder="0"></iframe></p>
<h2>Delta-8 THC, a chemical cousin of delta-9</h2>
<p>Delta-8 THC is found in <a href="https://doi.org/10.2147/DHPS.S391857">very small quantities in the cannabis plant</a>. The delta-8 THC that is widely marketed in the U.S. is a derivative of hemp CBD.</p>
<p>Delta-8 THC binds to CB1 receptors <a href="https://doi.org/10.1111/bph.15865">less strongly than delta-9 THC</a>, which is what makes it <a href="https://theconversation.com/can-delta-8-thc-provide-some-of-the-benefits-of-pot-with-less-paranoia-and-anxiety-175418">less psychoactive than delta-9 THC</a>. People who seek delta-8 THC for medicinal benefits <a href="https://www.discovermagazine.com/health/delta-8-thc-promises-to-get-you-high-without-the-paranoia-or-anxiety">seem to prefer it over delta-9 THC</a> because delta-8 THC does not cause them to get very high. </p>
<p>However, delta-8 THC binds to CB2 receptors with a similar strength as delta-9 THC. And because activation of CB2 plays a critical role <a href="https://doi.org/10.3390/ijms22147302">in suppressing inflammation</a>, delta-8 THC could potentially be preferable over delta-9 THC for treating inflammation, since it is less psychoactive.</p>
<p>There are no published clinical studies thus far on whether delta-8 THC can be used to treat the clinical disorders such as chemotherapy-induced nausea or appetite stimulation in HIV/AIDS that are responsive to delta-9 THC. However, animal studies from our laboratory have shown that delta-8 THC is also <a href="https://doi.org/10.4049/jimmunol.208.Supp.60.10">effective in the treatment of multiple sclerosis</a>.</p>
<p>The sale of delta-8 THC, especially in states where marijuana is illegal, <a href="https://www.npr.org/2022/01/04/1070338052/a-loophole-in-federal-marijuana-law-has-led-to-the-creation-of-new-thc-product">has become highly controversial</a>. Federal agencies consider all compounds isolated from marijuana or synthetic forms, similar to THC, <a href="https://doi.org/10.3389/fpls.2019.00697">Schedule I controlled substances</a>, which means they currently have no accepted medical use and have considerable potential for abuse.</p>
<p>However, hemp manufacturers <a href="https://www.publichealthlawcenter.org/sites/default/files/resources/Delta-8-THC-FAQ.pdf">argue that delta-8 THC should be legal</a> because it is derived from CBD <a href="https://us.eversheds-sutherland.com/NewsCommentary/Legal-Alerts/257006/DEA-confirms-Delta-8-THCO-Delta-9-THCO-are-schedule-I-controlled-substances-but-confusion-remains">isolated from legally cultivated hemp plants</a>. </p>
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<figcaption><span class="caption">In this California-based recreational and medical cannabis store, cannabis gummies are “easily” the most popular product.</span></figcaption>
</figure>
<h2>The emergence of delta-10 THC</h2>
<p>Delta-10 THC, another chemical cousin to delta-9 and delta-8, has recently entered the market. </p>
<p>Scientists do not yet know much about this new cannabinoid. Delta-10 THC is <a href="https://www.natlawreview.com/article/real-or-not-real-difference-between-legal-delta-8delta-10-thc-and-illegal-delta">also derived from hemp CBD</a>. People have anecdotally reported <a href="https://inchemistry.acs.org/atomic-news/delta-8--thc-craze-concerns-chemists.html">feeling euphoric and more focused</a> after consuming delta-10 THC. Also, anecdotally, people who consume delta-10 THC say that it <a href="https://www.pghcitypaper.com/pittsburgh/delta-10-vs-delta-8-whats-the-difference-22709804">causes less of a high than delta-8 THC</a>. </p>
<p>And virtually nothing is known about the medicinal properties of delta-10 THC. Yet it is being marketed in similar ways as the other more well-studied cannabinoids, <a href="https://ourculturemag.com/2022/08/10/lesser-known-benefits-of-delta-10-thc/">with claims of an array of health benefits</a>. </p>
<h2>The future of cannabinoid derivatives</h2>
<p>Research and clinical trials using marijuana or delta-9 THC to treat many medical conditions have been hampered <a href="https://www.ncbi.nlm.nih.gov/books/NBK425757/">by their classification as Schedule 1 substances</a>. In addition, the psychoactive properties of marijuana and delta-9 THC create side effects on brain functions; the high associated with them causes some people to feel sick, or they simply hate the sensation. This limits their usefulness in treating clinical disorders. </p>
<p>In contrast, we feel that delta-8 THC and delta-10 THC, as well as other potential cannabinoids that could be isolated from the cannabis plant or synthesized in the future, hold great promise. With their strong activity against the CB2 receptors and their lower psychoactive properties, we believe they offer new therapeutic opportunities to treat a variety of medical conditions.</p><img src="https://counter.theconversation.com/content/204171/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 the National Institutes of Health. </span></em></p>Researchers are working to determine how and which cannabis products can help those suffering from chronic pain or serious illness. But science is having a hard time keeping up with the booming market.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/2006022023-03-24T09:34:30Z2023-03-24T09:34:30ZCannabis industry plans for South Africa have stalled: how to get them moving again<figure><img src="https://images.theconversation.com/files/513601/original/file-20230306-16-3n7h97.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Melina Mara/The Washington Post via Getty Images)</span></span></figcaption></figure><p>South African president Cyril Ramaphosa recently reiterated plans to accelerate the commercialisation of hemp as well as cannabis plants. His speech setting out government’s priorities <a href="https://www.gov.za/SONA2023">for 2023</a> was a reminder of a <a href="https://www.gov.za/SONA2022">pledge in 2022</a> – also in his state of the nation address – that the government would mobilise investment in the hemp and cannabis sectors. </p>
<p>In his speech, the president indicated that government is in the process of addressing the conditions for the growth of the cannabis sector, particularly for rural farmers. The Department of Agriculture, Land Reform and Rural Development and the Department of Health are working closely to address the existing conditions for growing hemp and cannabis to enable outdoor cultivation and harvesting by rural farmers. </p>
<p>Currently farmers who have licences, grow their hemp and cannabis indoors under controlled conditions. The commercialisation will allow them to farm outdoors on a larger scale. </p>
<p>This is very exciting. The industry has the potential to create jobs, alleviate poverty and help reduce the extreme inequality in South Africa. One estimate is that the sector has the potential to <a href="https://african.business/2022/03/energy-resources/aiming-high-africas-cannabis-future/">create more than 130,000</a> new jobs. </p>
<p>The opportunity to commercialise the hemp and cannabis industry is that it is a new, fast-growing, multi-billion dollar sector with local and international markets. The potential legal pharmaceutical market for hemp and cannabis in South Africa alone <a href="https://african.business/2022/03/energy-resources/aiming-high-africas-cannabis-future/">has been estimated</a> at over R100 billion a year. </p>
<p>But there are challenges. </p>
<p>First, that the government fails to implement changes needed to ensure the sector grows in a way that benefits township and rural entrepreneurs farmers. Adding a paragraph dedicated to the cannabis and hemp sector to the annual state of the nation address each year is one thing. But seeing action being taken and plans implemented is another.</p>
<p>The second is that, from mid-2022, small scale farmers farming cannabis promised to be issued with licences to farm legally. However, some farmers in the rural areas of the Eastern Cape are still waiting. </p>
<p>But there is a way forward. Based on my experience as a member of the <a href="https://www.cannabisorgup.com/about#:%7E:text=COUP%2C%20the%20Cannabis%20Organisation%20at,Africa%20economically%2C%20socially%20and%20legally.">Cannabis Organisation University of Pretoria</a> and a member of one of the working groups set up to give inputs for a government masterplan first drawn up in 2021, I make four recommendations to fast-track the process. </p>
<p>These include reviewing and revising the existing master plan, getting defunct working groups up and running again, ensuring the plan is in place before investments begin and setting up a monitoring and evaluation capability.</p>
<h2>A stalled process</h2>
<p>The president mentioned that, in accelerating commercialisation of the sector, urgent work is being finalised by government to create an enabling regulatory framework for hemp and cannabis plants. This includes their use for complementary medicines, food, cosmetics as well as some industrial products.</p>
<p>The president said that the government was urgently finalising the work to create this enabling environment.</p>
<p>But some crucial questions need answering: what happened to the cannabis master plan working groups and workstreams set up in 2021/2022?. These working groups and workstreams consisted of representatives from government, the private sector, academic institutions and the cannabis research community. The groups got off to a good start and were in a process or reviewing and revising a plan to commercialise hemp and cannabis. One of the key objectives was to ensure that township entrepreneurs and rural farmers would benefit from any changes.</p>
<p>But working groups collapsed and disappeared without trace. </p>
<p>The president’s comments therefore invite the question: what happened to the master plan working groups, and the workstreams? When the president speaks about acceleration to commercialise the cannabis sector, which includes the participation of rural farmers, how far along is the planning?</p>
<h2>The way forward</h2>
<p>Firstly, the presidency must reinstate the cannabis master plan working groups and workstreams. They must be allowed to finalise the review and revision of the current master plan. </p>
<p>The revised master plan should enable the inclusion of township entrepreneurs and rural farmers. They are currently excluded from the mainstream commercialisation of hemp and cannabis due to a cumbersome licensing process.</p>
<p>Secondly, investments in the hemp and cannabis sector should only be implemented once the master plan has been reviewed and revised. This will provide guidance on how the proposed funds can be properly channelled.</p>
<p>The wheel should not be reinvented. Neither should time and effort be wasted.</p>
<p>Thirdly, a monitoring and evaluation committee needs to be set up to look after the hemp and cannabis project implementation. It should be set up in the same way as the working groups were formed with representatives from all interested players. This will ensure that all players in the sector are included. And that funds are appropriately spent.</p><img src="https://counter.theconversation.com/content/200602/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Motshedisi Mathibe is affiliated with University of Pretoria's Cannabis Organisation (COUP). She's also a faculty at GIBS Business School.</span></em></p>The industry has the potential to create jobs, alleviate poverty and help reduce the extreme inequality in South AfricaMotshedisi Mathibe, Senior Lecturer Gordon Institute of Business Science, University of PretoriaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1982062023-03-22T12:39:42Z2023-03-22T12:39:42ZMounting research points to health harms from cannabis, THC and CBD use during pregnancy, adolescence and other periods of rapid development<figure><img src="https://images.theconversation.com/files/516806/original/file-20230321-22-j5u7ba.jpg?ixlib=rb-1.1.0&rect=122%2C45%2C4970%2C3305&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Marijuana use by the mother can affect a baby's brain development.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/pregnant-couple-having-sonogram-royalty-free-image/186366123?phrase=pregnant%20woman&adppopup=true">John Fedele/Tetraimages via Getty Images</a></span></figcaption></figure><p>Cannabis is a <a href="https://www.who.int/teams/mental-health-and-substance-use/alcohol-drugs-and-addictive-behaviours/drugs-psychoactive/cannabis">widely used psychoactive drug worldwide</a>, and its popularity is growing: The U.S. market for recreational cannabis sales could surpass <a href="https://www.forbes.com/sites/irisdorbian/2022/03/24/us-cannabis-sales-could-top-72-billion-by-2030-says-top-researcher/?sh=7e3ee34d148c">US$72 billion by 2023</a>. </p>
<p>As of early 2023, 21 U.S. states and the District of Columbia <a href="https://disa.com/maps/marijuana-legality-by-state">have legalized cannabis for recreational use</a> for people age 21 and up, while 39 states plus the District of Columbia have legalized it for medical use.</p>
<p>The growing wave of legalization and the <a href="https://doi.org/10.1016/j.biopsych.2016.01.004">dramatic increase in cannabis potency</a> over the past two decades have raised concerns among scientists and public health experts about the potential health effects of cannabis use during pregnancy and other vulnerable periods of development, such as the teen years. </p>
<p>I am a <a href="https://psychiatry.med.wayne.edu/profile/eq0200">developmental neuroscientist</a> specializing in studying what’s known as the <a href="https://doi.org/10.1038/npp.2017.130">endocannabinoid system</a>. This is an evolutionarily ancient system found in humans and other vertebrates that produces natural cannabinoids such as THC and CBD.</p>
<p>Cannabis and its constituents <a href="https://theconversation.com/people-produce-endocannabinoids-similar-to-compounds-found-in-marijuana-that-are-critical-to-many-bodily-functions-198220">interact with</a> the body’s endocannabinoid system to product their effects. THC and CBD are the most commonly known cannabis extracts and can be synthesized in a lab. <a href="https://www.wsuthinklab.com">My lab</a> also studies the risks versus potential therapeutic value of cannabis and cannabinoids.</p>
<p>People often assume there’s no risk when using cannabis or cannabinoids during vulnerable periods of life, but they’re basing that on little to no data. Our research and that of others suggests that cannabis use during pregnancy and adolescence can present myriad health risks the public should be aware of.</p>
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<figcaption><span class="caption">Data shows that many people who use cannabis continue to do so during pregnancy. But there are health risks.</span></figcaption>
</figure>
<h2>Cannabis use during pregnancy</h2>
<p>More and more pregnant people are using cannabis today <a href="https://doi.org/10.1001/jama.2019.7982">compared with a decade ago</a>, with some studies showing that nearly 1 in 4 pregnant adolescents report that they use cannabis. </p>
<p>Many cannabis-using people may have not known they were pregnant and stopped using when they found out. Others report using cannabis for its touted ability to ease pregnancy-related symptoms, <a href="https://doi.org/10.1503/cmaj.211236">like nausea and anxiety</a>. However, studies do not yet confirm those health claims. What’s more, the potential harms are often downplayed by pro-cannabis marketing and <a href="https://www.doi.org/10.1097/AOG.0000000000002619">messaging by dispensaries</a>, advocacy groups and even <a href="https://doi.org/10.1186/s12912-022-00887-1">midwives</a> or doulas. </p>
<p>In addition, physicians and other health care providers often are not knowledgeable enough or don’t feel well equipped to discuss the <a href="https://doi.org/10.1016/j.drugalcdep.2017.08.010">potential risks and benefits of cannabis</a> with their patients, including during pregnancy. </p>
<p>While research shows that most people who are pregnant <a href="https://doi.org/10.1016/j.ajog.2015.03.021">perceive little to no risk</a> in using cannabis during pregnancy, the data show there is clear cause for concern. Indeed, a growing number of studies link prenatal cannabis exposure to greater risk of <a href="https://doi.org/10.1111/add.16072">preterm birth</a>, <a href="https://doi.org/10.1001/jamanetworkopen.2021.45653">lower birth weight</a> and <a href="https://doi.org/10.1001/jamapsychiatry.2020.2902">psychiatric and behavioral problems in children</a>. These include, for example, difficulties with attention, thought, social problems, anxiety and depression. </p>
<h2>Cannabis and the developing brain</h2>
<p>When cannabis is inhaled, consumed orally or taken in through other routes, it can easily <a href="https://doi.org/10.1002/jnr.24992">cross through the placenta and deposit in the fetal brain</a>, disrupting brain development. </p>
<p>A recent study from my lab, led by medical student Mohammed Faraj, found that cannabis use during pregnancy can shape the developing brain in ways that are <a href="https://doi.org/10.1002/jnr.25136">detectable even a decade later</a>. </p>
<p>We used data from the National Institutes of Health <a href="https://abcdstudy.org/">Adolescent Brain Cognitive Development Study</a>, which is the largest long-term study of brain development and child and adolescent health in the U.S. It has followed more than 10,000 children and their families from age 9-10 over a 10-year period.</p>
<p>Through that analysis, we linked prenatal cannabis exposure to alterations in functional brain networks in 9- and 10-year-old children. In particular, prenatal cannabis exposure appeared to disrupt the communication between brain networks involved in attentional control, which may explain why children who were exposed to cannabis in utero may develop difficulties with <a href="https://doi.org/10.1001/jamapsychiatry.2020.2902">attention or other behavioral issues or mental disorders</a> as they develop. </p>
<p>While alcohol abuse has <a href="https://monitoringthefuture.org/wp-content/uploads/2022/12/mtf2022.pdf">steadily declined among adolescents</a> since 2000 in the U.S., cannabis use shows the opposite pattern: It increased by <a href="https://doi.org/10.1080/15563650.2022.2120818">245% during that same period</a>. </p>
<p>Data reported in 2022 from the Monitoring the Future survey of over 50,000 students in the U.S. found that nearly one-third of 12th grade students reported <a href="https://nida.nih.gov/news-events/news-releases/2022/12/most-reported-substance-use-among-adolescents-held-steady-in-2022">using cannabis in the past year</a>, including cannabis vaping. Yet <a href="https://monitoringthefuture.org/wp-content/uploads/2022/08/mtf-overview2021.pdf">only about 1 in 4</a> 12th grade students perceive great harm in using cannabis regularly. This suggests that many teens use cannabis, but very few consider it to have potential negative effects.</p>
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<figcaption><span class="caption">High-potency, concentrated forms of cannabis extracts have far higher levels of THC than the pot of earlier decades.</span></figcaption>
</figure>
<h2>Cannabis use during adolescence</h2>
<p>Research shows that the adolescent brain is <a href="https://doi.org/10.1111/j.1467-7687.2006.00579.x">primed to engage in high-risk behaviors</a> such as experimenting with cannabis and other substances. Unfortunately, <a href="https://doi.org/10.1038/13158">owing to ongoing brain development</a>, the adolescent brain is also particularly susceptible to the effects of cannabis and other substances. Indeed, many neuroscientists now agree that the brain continues to develop well into the second and even <a href="https://doi.org/10.1038/13154">third decade of life</a>. </p>
<p>In line with this vulnerability, research shows that, relative to those who did not use cannabis during adolescence, those who started using it during adolescence are at increased risk of <a href="https://doi.org/10.1001/jamapsychiatry.2018.4500">developing depression, suicidal ideation</a>, <a href="https://doi.org/10.1080/08897077.2021.1876200">psychosis</a> and <a href="https://doi.org/10.1016/j.euroneuro.2020.03.012">reductions in IQ</a> during adolescence and adulthood. Neuroimaging studies also show <a href="https://doi.org/10.1016/j.neubiorev.2018.03.008">residual effects of adolescent cannabis use</a> on brain functioning, even later during adulthood. </p>
<h2>Reading beyond the label</h2>
<p>Despite common misconceptions that cannabis is “all natural” and safe to use during pregnancy or adolescence, the data suggests there are real risks. In fact, in 2019, the U.S. surgeon general <a href="https://www.hhs.gov/surgeongeneral/reports-and-publications/addiction-and-substance-misuse/advisory-on-marijuana-use-and-developing-brain/index.html">issued an advisory</a> against the use of cannabis during pregnancy and adolescence, stating that “no amount … is known to be safe.” </p>
<p>Cannabis may be harmful to the developing brain because it <a href="https://doi.org/10.1016/j.ntt.2016.08.003">disrupts the developing endocannabinoid system</a>, which plays a critical role in shaping brain development from conception and into adulthood. This includes neural circuits involved in <a href="https://doi.org/10.1038/npp.2017.143">learning, memory, decision-making and emotion regulation</a>. </p>
<p>While much of this research has focused on cannabis use, there is also other research that comes to <a href="https://doi.org/10.1073/pnas.0537849100">similar conclusions for THC</a> and <a href="https://doi.org/10.3390/toxins14100720">CBD in other forms</a>. In fact, although CBD is widely available as an unregulated supplement, we researchers know almost nothing about its effects on the developing brain. Of note, these harms apply not only to smoking, but also to ingesting, vaping or other ways of consuming cannabis or its extracts.</p>
<p>In my view, it’s important that consumers know these risks and recognize that not everything claimed in a label is backed by science. So before you pick up that edible or vape pen for stress, anxiety, or sleep or pain control, it’s important to talk to a health care provider about potential risks – especially if you are or could be pregnant or are a teen or young adult.</p><img src="https://counter.theconversation.com/content/198206/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Hilary A. Marusak receives funding from the National Institutes of Health and the State of Michigan. </span></em></p>Studies show that smoking marijuana during pregnancy can lead to premature birth, lower birth weight and psychological problems in the newborn.Hilary A. Marusak, Assistant Professor of Psychiatry and Behavioral Neurosciences, Wayne State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1980112023-02-05T08:02:19Z2023-02-05T08:02:19ZWeed in South Africa: apartheid waged a war on drugs that still has unequal effects today<figure><img src="https://images.theconversation.com/files/505591/original/file-20230120-26-2j6065.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">South Africa's governing ANC has continued the anti-cannabis repression inherited from apartheid.
</span> <span class="attribution"><span class="source">shutterstock</span></span></figcaption></figure><p>Cannabis is being commercialised into a multibillion-dollar global industry and South Africa wants a piece of the pie. In his <a href="https://www.gov.za/speeches/president-cyril-ramaphosa-2022-state-nation-address-10-feb-2022-0000">2022 state of the nation address</a>, President Cyril Ramaphosa spoke of developing a hemp and cannabis sector to boost the post-COVID economy.</p>
<p>Poor rural communities in South Africa have <a href="https://www.bbc.com/news/world-africa-62524501">long cultivated cannabis</a> in illegal conditions of risk. They now face losing out to corporate interests and the wealthy.</p>
<p>How did the stakes become so high – and so unequal?</p>
<p>My <a href="https://www.journals.uchicago.edu/doi/10.1086/721253">recent historical study</a> helps answer this question. It reveals how an apartheid-era drug law incited a “war on drugs” that was in effect a “war on cannabis”.</p>
<p>In 1971 a law was passed that subjected the cannabis plant and its products to the strictest possible controls. This set in motion a structurally racist policy that continued well into the post-apartheid era. </p>
<h2>Apartheid’s 1971 anti-drug law</h2>
<p>In 1971, South Africa’s apartheid government passed the <a href="https://www.lac.org.na/laws/annoSTAT/Abuse%20of%20Dependence-Producing%20Substances%20and%20Rehabilitation%20Centres%20Act%2041%20of%201971.pdf">Abuse of Dependence-Producing Substances and Rehabilitation Centres Act</a>. Lawmakers boasted it was the</p>
<blockquote>
<p>toughest anti-drug law in the Western World. </p>
</blockquote>
<p>The law’s main target was white “hippy” youth. </p>
<p>The law followed recommendations by a state-sponsored inquiry, the <a href="https://libguides.lib.uct.ac.za/c.php?g=182363&p=1581392">Grobler Commission</a>. The commission focused only on white South Africans’ misuse of synthetic and pharmaceutical drugs such as LSD, Mandrax (methaqualone) and heroin. </p>
<p>Though the commission did not in fact turn up evidence of an extensive drug abuse problem, it nevertheless recommended tough suppression.</p>
<p>To the ruling <a href="https://www.sahistory.org.za/article/national-party-np">National Party</a>, the use of drugs by white people appeared to threaten Afrikaner religious culture and the future of a white South Africa. They hyped the drug problem as</p>
<blockquote>
<p>a form of terrorism that is more dangerous than the armed terrorism we are familiar with on our country’s borders. </p>
</blockquote>
<p>This language of crisis enabled the apartheid lawmakers to borrow from the country’s draconian anti-terrorism laws, such as the <a href="https://omalley.nelsonmandela.org/index.php/site/q/03lv01538/04lv01828/05lv01829/06lv01927.htm">1967 Terrorism Act</a>, used to put down anti-apartheid activism.</p>
<p>Like the anti-terrorism legislation, the 1971 anti-drug act provided for harsh minimum prison sentences and detention without trial for purposes of interrogation. It also removed the court’s discretion in sentencing for drug offences.</p>
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Read more:
<a href="https://theconversation.com/cannabis-policy-changes-in-africa-are-welcome-but-small-producers-are-the-losers-179681">Cannabis policy changes in Africa are welcome. But small producers are the losers</a>
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<p>When it was debated in parliament, the principle of “toughness” appealed across party lines – except for the lone voice of the Progressive Party MP <a href="https://www.sahistory.org.za/people/helen-suzman">Helen Suzman</a>. Suzman observed that although the Grobler Commission excluded research on substance use by the majority black South Africans, the law would nonetheless apply to them. </p>
<p>Similarly, she argued, the commission had not investigated cannabis – a substance considered by many to be less socially harmful than legal alcohol or tobacco. Yet it was to be scheduled in the new law as a “prohibited dangerous drug”, along with heroin and cocaine. </p>
<h2>Lone voice of reason</h2>
<p>For <a href="https://www.dukeupress.edu/the-african-roots-of-marijuana">centuries in Africa</a>, including parts of South Africa, the cannabis plant had important indigenous cultural value and was cultivated for a variety of social and pharmacological uses. </p>
<p>Cannabis was first <a href="https://www.tandfonline.com/doi/abs/10.1080/02582473.2022.2128274">criminalised in the country in 1922</a>. But drug <a href="https://theconversation.com/what-history-teaches-us-about-shaping-south-africas-new-cannabis-laws-150889">policing remained relatively weak</a> for three decades. In the gap, and with growing urban markets, commercial cannabis livelihoods emerged to combat <a href="https://www.jstor.org/stable/24566750#metadata_info_tab_contents">growing rural poverty</a>. </p>
<p>In such conditions – as Suzman pointed out – punitive drug control, created to combat white pill-popping, was clearly going to fall on black South Africans for cannabis offences. </p>
<p><a href="https://www.journals.uchicago.edu/doi/10.1086/721253">Suzman fought hard</a>. She pointed out that a <a href="https://en.wikipedia.org/wiki/Shafer_Commission">“Marijuana Commission”</a> was under way in the US, documenting how the supposed dangers of cannabis were greatly exaggerated. She argued for a less criminalising status for cannabis in South Africa.</p>
<p>Her views were defeated and apartheid’s extraordinary drug legislation was easily passed. Cannabis was classified among those substances marked for strictest suppression.</p>
<h2>The law’s impacts</h2>
<p>This decision proved to be a watershed. The <a href="https://www.journals.uchicago.edu/doi/10.1086/721253">effects of the 1971 anti-drug law</a> were immediately evident, falling disproportionately on black South Africans. Cannabis accounted for well over 95% of drug-related arrests and convictions across all “race” groups. </p>
<p>In a 1972 assessment by the Natal Provincial Supreme Court – in the case <a href="https://www.journals.uchicago.edu/doi/10.1086/721253">State v Shangase and Others</a> - judges showed how prison terms of two to ten years were being imposed even for the petty possession of single cannabis “<em>zol</em>” (joint).</p>
<p>The “rehabilitation centres” part of the 1971 law applied only to white offenders since – <a href="https://www.journals.uchicago.edu/doi/10.1086/721253">as Suzman had pointed out</a> – the segregationist state did not provide drug treatment programmes for black people. But, even for convicted white users, sentences involving treatment applied in less than 1% of cases.</p>
<p>Paradoxically, but unsurprisingly, illegal cannabis cultivation increased within the segregated spaces of apartheid.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/a-new-approach-to-criminalisation-could-end-cape-towns-drug-wars-121769">A new approach to criminalisation could end Cape Town's drug wars</a>
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</em>
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<p>An illegal crop in high demand was profitable to grow, and even more so to trade. Helicopters spraying herbicides and multiple checkpoints raised the stakes of drug politics for all parties.</p>
<p>The laws’s embedded racism meant that as tough drug suppression continued after apartheid ended, its racist effects also continued.</p>
<h2>A reckoning with history is needed</h2>
<p>The 1971 anti-drug law was replaced in 1992 with a <a href="https://www.gov.za/documents/drugs-and-drug-trafficking-act">Drugs and Drug Trafficking Act</a>. The new law maintained harsh sentences and cannabis remained illegal. The African National Congress, which came into power in 1994, reproduced the heavy-handed tactics it had inherited from the apartheid National Party: militarised suppression, spraying and incarcerations.</p>
<p>In <a href="https://theconversation.com/south-african-court-frees-cannabis-from-colonial-and-apartheid-past-103644">2017 and 2018</a>, the government’s cannabis policy was successfully challenged in the courts, on grounds of cultural and religious freedom. This also opened a window for liberalising cannabis as a commercial venture for certain products. Yet <a href="https://theconversation.com/cannabis-policy-changes-in-africa-are-welcome-but-small-producers-are-the-losers-179681">the actual policy remains unclear and contested</a>.</p>
<p>Apartheid’s 1971 law, and the parallel growth of an illegal economy, shaped South Africa’s unequal cannabis landscape. Now, in an opening cannabis economy, rural cultivators remain in a vulnerable position against more powerful interests. </p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/marijuana-use-in-south-africa-what-next-after-landmark-court-ruling-103607">Marijuana use in South Africa: what next after landmark court ruling?</a>
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<p><a href="https://www.journals.uchicago.edu/doi/full/10.1086/721752">Decolonising drug-related knowledge and policies</a> in South Africa requires a deeper reckoning with history, including from apartheid into the present.</p>
<p>*Quotations from the <em>Debates of the House of Assembly</em>, Hansard (Cape Town: Government of the Republic of South Africa, 5 May 1971.</p><img src="https://counter.theconversation.com/content/198011/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Thembisa Waetjen receives funding from the National Research Foundation.</span></em></p>A 1971 law, and the parallel growth of an illegal economy, shaped South Africa’s unique cannabis landscape.Thembisa Waetjen, Associate Professor of History, University of JohannesburgLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1962622022-12-12T14:42:53Z2022-12-12T14:42:53ZBrittney Griner’s case was difficult for US negotiators for one key reason: She was guilty<figure><img src="https://images.theconversation.com/files/500248/original/file-20221212-91737-3bblu5.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C2621%2C1577&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Brittney Griner on the plane after being released.</span> <span class="attribution"><a class="source" href="https://newsroom.ap.org/detail/EEUUGRINER/756381fe7d504e49abb86844c71a4c0f/photo?Query=griner&mediaType=photo&sortBy=arrivaldatetime:desc&dateRange=Anytime&totalCount=2694&currentItemNo=0">Russian Security Service via AP</a></span></figcaption></figure><p>The <a href="https://www.cnn.com/2022/12/10/us/brittney-griner-release-us-arrival-saturday/index.html">release from Russian prison of WNBA star Britney Griner</a> has been greeted with general delight in the United States.</p>
<p>Announcing the deal that saw her freed on Dec. 8, 2022, President Joe Biden <a href="https://www.whitehouse.gov/briefing-room/speeches-remarks/2022/12/08/remarks-by-president-biden-on-the-release-of-brittney-griner/">lauded the “painstaking and intense negotiations</a>” that made it happen. Others may have <a href="https://www.businessinsider.com/pentagon-fears-russias-viktor-bout-could-restart-old-arms-business-2022-12">legitimate concerns</a> over the equivalence of the exchange, which saw <a href="https://www.cbsnews.com/news/viktor-bout-russia-arms-dealer-merchant-of-death-brittney-griner/">convicted arms merchant Viktor Bout</a> returned to Russia.</p>
<p>As a <a href="https://dickinsonlaw.psu.edu/william-e-butler">longtime scholar of Russian law</a>, I believe the episode prompts a reflection on the application of Russian law in Griner’s case, and more broadly consideration about such exchanges in general.</p>
<p>The problem American negotiators face <a href="https://www.usatoday.com/story/news/nation/2022/12/10/brittney-griner-exchanged-viktor-bout-history-prisoner-swaps/10865122002/">in such situations</a> is that it matters whether the U.S. citizen is guilty of committing the crime alleged under foreign law or whether there has been a miscarriage of justice, incompetent investigation or prosecution, or false accusation.</p>
<p>And from this perspective, the Griner case was difficult.</p>
<h2>A question of ‘direct intent’</h2>
<p>Griner has yet to give a full account of her story, but the available facts suggest that she legally acquired in the U.S., probably in Arizona or California where she is based, vaping cartridges containing hashish oil <a href="https://www.nytimes.com/2022/07/15/world/brittney-griner-trial-russia.html">upon a physician’s recommendation</a>, but not prescription. She then, probably illegally under federal law, carried them across state lines to New York, where vaping cartridges are sold but cannot be carried to states where they are not legal.</p>
<p>From there, the question becomes a classic law school examination issue: Did Griner violate <a href="https://www.aljazeera.com/news/2022/7/26/russias-drug-laws-tool-to-silence-critics">zero-tolerance Russian legislation</a> on narcotics when she boarded a Russian aircraft in New York – unless, of course, she flew Delta as the only U.S. carrier that goes direct?</p>
<p>Or was the law broken when that aircraft entered Russian airspace, or touched down in Moscow? Or perhaps it was when passengers disembarked at Sheremetevo airport, when Griner passed through passport control; or when the basketball star chose the green customs channel at the airport instead of declaring what she had in the red channel and was found out by a <a href="https://www.wsj.com/livecoverage/russia-ukraine-latest-news-2022-03-04/card/wnba-star-brittney-griner-arrested-by-russian-customs-officials-on-drug-charges-aAZ31g6YmoOZrWGSeGA5">sniffer dog policing the green channel</a>. These were all possibilities, but the green channel was incontrovertible.</p>
<p>Accusations of possession and smuggling of narcotics <a href="https://books.google.com/books/about/Russian_Law_and_Legal_Institutions.html?id=aWy-ugEACAAJ">under Russian criminal law</a> require proof of “direct intent” – that the individual knew or should have known what act they were performing. In this case, passing through the green channel with nothing to declare while carrying a controlled substance would constitute direct intent.</p>
<p>That, as <a href="https://defendernetwork.com/news/national/brittney-griner-pleads-guilty-to-drug-charges-in-russia/">Griner said</a>, she did not “intend to commit a crime” when she packed the vaping cartridges in her hand luggage was immaterial. The question was whether she entered the green customs channel with intent.</p>
<figure class="align-center ">
<img alt="A woman in glasses looks pensive behind bars." src="https://images.theconversation.com/files/500293/original/file-20221212-90872-krmmcp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/500293/original/file-20221212-90872-krmmcp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=396&fit=crop&dpr=1 600w, https://images.theconversation.com/files/500293/original/file-20221212-90872-krmmcp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=396&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/500293/original/file-20221212-90872-krmmcp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=396&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/500293/original/file-20221212-90872-krmmcp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=497&fit=crop&dpr=1 754w, https://images.theconversation.com/files/500293/original/file-20221212-90872-krmmcp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=497&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/500293/original/file-20221212-90872-krmmcp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=497&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">Brittney Griner, prior to release.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/womens-national-basketball-association-basketball-player-news-photo/1242302271?phrase=griner%20prison&adppopup=true">Evgenia Novozhenina/AFP via Getty Images)</a></span>
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<p>The choice she made was to not declare the cartridges. Had she done so, the cartridges likely would have been confiscated, but no offense committed.</p>
<p>Under Russian law and also that of the U.S., direct intent was present. What she did was, from her government’s standpoint, at best careless and thoughtless. Moreover, it exposed the United States, in the end, to a unwelcome scenario of exchanges at a most difficult time in the international community.</p>
<p>The personal costs to Griner were not insignificant. It likely cost her <a href="https://www.nytimes.com/article/brittney-griner-russia.html#:%7E:text=Griner%20was%20detained%20on%20Feb,off%2Dseason.">a lucrative contract</a>, a criminal conviction, and some nine or so months in custody.</p>
<h2>Under Russian law, quantity matters</h2>
<p>Russian law – just as many jurisdictions, including many American states – does not recognize medical uses of marijuana. Griner has been traveling to Russia for eight years and will have been expected to know this.</p>
<p>Under Russian law, the <a href="https://www.washingtonpost.com/world/2022/08/04/brittney-griner-russia-court/#:%7E:text=She%20also%20was%20fined%201,was%20a%20%E2%80%9Csignificant%20amount.%E2%80%9D">amount in her hand luggage qualified as</a> a “significant amount” – the lowest threshold of criminal liability.</p>
<p>Another individual whose situation is receiving more media attention in light of the Griner case is <a href="https://www.npr.org/2022/12/11/1142141118/marc-fogels-family-hopes-they-are-closer-to-seeing-him-after-brittney-griner-rel">Marc Fogel</a>, an American still serving a criminal sentence in Russia of 14 years for smuggling narcotics. His case fell into the next category – a “large-scale amount” of marijuana, and a more severe sentence. He beyond doubt was aware of the risks in bringing it in for personal medical purposes.</p>
<p>There is no question that the sentences imposed on Griner and Fogel were severe. Other alternatives were potentially available, including <a href="https://books.google.com/books/about/Russian_Law_and_Legal_Institutions.html?id=aWy-ugEACAAJ">administrative responsibility</a> – a legal code embodying a category of offenses we do not have in Common Law jurisdictions. There are sanctions for violations, but they are not treated as criminal.</p>
<p>Without imputing political motives to the apprehension of Griner – which may or may not be justified – the <a href="https://doi.org/10.1163/ej.9789004155336.i-226.5">Russian Procuracy</a> will have had reason to assume that both Griner and Fogel acted with direct intent both in the narrow legal sense and in the larger human sense. Both are familiar with Russia, not casual tourists. They brought in a prohibited substance, had prior experience with and knowledge of Russian legal practice in this domain, and nonetheless either carelessly or knowingly brought in a prohibited drug.</p>
<h2>The problem of ‘Americanizing’ Russian law</h2>
<p>Another lesson to be learned from the Griner case is that American media frequently experiences difficulty in explaining foreign systems of criminal law. Part of the problem is the “Americanizing” or “Anglicizing” of Russian criminal law and procedure. In the Griner case, most media reported that she was liable to punishment of up to 10 years, but omitted to say that the Criminal Code imposed a minimum of five years. This understated the gravity of the offense in Russian law. The nine-year sentence handed to Griner was on the heavy end, but not unheard of or unreasonable and is consistent with the Fogel sentence.</p>
<p>That wasn’t the only misstep in foreign media reporting. The accusation of smuggling was widely and correctly reported, but said nothing about the charge of possession. References were made to a “<a href="https://www.npr.org/2022/07/14/1111492772/brittney-griner-trial-resumes-guilty-plea">guilty plea” by Griner</a>, but Russian criminal procedure does not have pleas. The prosecution had to prove its case irrespective of what the accused may say. </p>
<p>There are good historical reasons from the Soviet past as to why acknowledgments of guilt – or “confessions” – do not affect the burden of proof on the prosecution. In this case, however, the burden of proof was easy to satisfy, and Griner’s counsel will have given sound advice in suggesting that she acknowledge guilt after the prosecution had presented its case.</p>
<p>We have yet to hear a more complete version of Griner’s side since her return to the U.S. One must hope that the American negotiators achieved not only the exchange, but an outcome which gives her no record of conviction in Russia and enables her, at an appropriate time, to resume her million-dollar Russian contract if she wishes to do so and circumstances permit.</p><img src="https://counter.theconversation.com/content/196262/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>William E. Butler 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>When it comes to prisoner swaps it matters if an individual is guilty of committing the crime or whether there has been a miscarriage of justice. And this is where the Griner case gets tricky.William E. Butler, Distinguished Professor of Law, Penn StateLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1953942022-11-28T17:18:14Z2022-11-28T17:18:14ZCannabis is no better than a placebo for treating pain – new research<figure><img src="https://images.theconversation.com/files/497650/original/file-20221128-17-vrmqf1.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C4920%2C3292&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Many people use cannabis to manage pain.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/indoors-marijuana-growing-planting-cannabis-holding-501493168">photolona/ Shutterstock</a></span></figcaption></figure><p>Cannabis is one of the most <a href="https://pubmed.ncbi.nlm.nih.gov/31657733/">widely used drugs</a> in the world. While there are only a few countries where cannabis is legal for recreational use, many more countries have legalised the use of cannabis for <a href="https://pubmed.ncbi.nlm.nih.gov/28549263/">medical reasons</a>. </p>
<p><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7231516/">Reducing pain</a> is one of the most common reasons people report using medical cannabis. According to a US national survey, <a href="https://pubmed.ncbi.nlm.nih.gov/28549263/">17% of respondents</a> who had reported using cannabis in the past year had been prescribed medical cannabis. When it comes to self-medication, the numbers are even higher – with estimates that <a href="https://pubmed.ncbi.nlm.nih.gov/28549263/">between 17-30%</a> of adults in North America, Europe and Australia reporting they use it to manage pain. </p>
<p>Although cannabis (and cannabis-derived products, such as CBD) may be widely used for reducing pain, how effective it really is in doing this is still unclear. This is what our recent systematic review and meta-analysis sought to uncover. Our study, published in the Journal of the American Medical Association, suggests cannabis is <a href="https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2799017?utm_source=For_The_Media&utm_medium=referral&utm_campaign=ftm_links&utm_term=112822">no better at relieving pain</a> than a placebo.</p>
<p>To conduct our study, we looked at the results of randomised controlled trials in which cannabis was compared with a placebo for the treatment of clinical pain. We specifically included studies that compared the change in pain intensity before and after treatment. In total, we looked at 20 studies involving almost 1,500 people altogether. </p>
<p>The studies we included looked at a variety of different pain conditions (such as neuropathic pain, which is caused by damage to the nerves, and multiple sclerosis) and types of cannabis products – including THC, CBD and synthetic cannabis (such as nabilone). These treatments were administered in a variety of ways, including via pill, spray, oil and smoked. </p>
<p>The majority of the study’s participants were female (62%) and aged between 33 and 62. Most of the studies were conducted in the US, UK or Canada – though we also included studies from Brazil, Belgium, Germany, France, the Netherlands, Israel, the Czech Republic and Spain.</p>
<figure class="align-center ">
<img alt="An assortment of cannabis products, including pills and oils." src="https://images.theconversation.com/files/497651/original/file-20221128-533-1uod5w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/497651/original/file-20221128-533-1uod5w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/497651/original/file-20221128-533-1uod5w.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/497651/original/file-20221128-533-1uod5w.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/497651/original/file-20221128-533-1uod5w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/497651/original/file-20221128-533-1uod5w.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/497651/original/file-20221128-533-1uod5w.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">Our review included studies which looked at a variety of different cannabis products.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/green-leaves-medicinal-cannabis-extract-oil-1928703866">Bukhta Yurii/ Shutterstock</a></span>
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</figure>
<p>Our meta-analysis showed that pain was rated as being significantly less intense after treatment with a placebo, with a moderate to large effect depending on each person. Our team also observed no significant difference between cannabis and a placebo for reducing pain.</p>
<p>This corroborates the <a href="https://pubmed.ncbi.nlm.nih.gov/32804836/">results of a 2021 meta-analysis</a>. In fact, this 2021 meta-analysis also found that higher-quality studies with better blinding procedures (where both participants and researchers are unaware of who is receiving the active substance) actually had higher placebo responses. This suggests that some placebo-controlled cannabis trials fail to ensure correct blinding, which may have led to an overestimation of the effectiveness of medical cannabis. </p>
<p>Our study also revealed many participants can distinguish between a placebo and active cannabis, despite having the same odour, taste and appearance. If they are aware that they are receiving or not receiving cannabinoids, they are more likely to provide a biased assessment of the effectiveness of the intervention. So to ensure researchers are observing the actual effect of cannabis, participants can’t know what they receive.</p>
<h2>Media coverage</h2>
<p>Our study also examined the way the studies were covered by the media and academic journals to see whether it related to the therapeutic effect participants reported. We did this because research has shown media coverage and information on the internet can <a href="https://www.nejm.org/doi/10.1056/NEJMra1907805">affect the expectations</a> that a person has of a treatment.</p>
<p>Media presence was measured through Altmetric, which is a method of evaluating mentions of a study in the media, blogs and on social media. Academic impact was measured in terms of citations by other researchers. We found a total of 136 news items in the media and blogs. </p>
<p>We categorised coverage as positive, negative or neutral depending on how the results were presenting concerning the effectiveness of cannabis for treating pain. The overwhelming majority of news items reported that cannabis had a positive effect for treating pain. This means that media coverage towards cannabis tends to be positive, regardless of what a study’s outcomes actually were.</p>
<p>There are numerous examples of the relationship between <a href="https://www.bmj.com/content/370/bmj.m1668">treatment expectations and placebo responses</a>. If a person thinks they will experience relief from their pain by using a certain product or treatment, this can change the way they <a href="https://pubmed.ncbi.nlm.nih.gov/30122170/">end up perceiving</a> incoming pain signals – making them think their pain is less severe. Recent evidence suggests that the placebo effect may work even if we’re presented with evidence that <a href="https://www.nature.com/articles/s41562-018-0455-8">contradicts our initial expectations</a>. </p>
<p>We cannot say with 100% certainty that media coverage is responsible for the high placebo response observed in our review. But given placebos were shown to be just as good as cannabis for managing pain, our results show just how important it is to think about the placebo effect and how it can be influenced by external factors – such as media coverage. For treatments, such as cannabinoids, that receive a lot of media attention, we need to be extra rigorous in our clinical trials.</p><img src="https://counter.theconversation.com/content/195394/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Filip Gedin 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>Our study also examined the way media coverage may affect a patient’s expectations of cannabis in treating pain.Filip Gedin, Postdoctoral Researcher, Pain research, Karolinska InstitutetLicensed 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>
</figure>
<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/1929142022-11-01T18:51:54Z2022-11-01T18:51:54ZUber Eats’ cannabis delivery partnership with Leafly is mostly smoke and mirrors<figure><img src="https://images.theconversation.com/files/492821/original/file-20221101-22-pf88r1.jpg?ixlib=rb-1.1.0&rect=574%2C1047%2C4105%2C2397&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A new partnership between Uber and Leafly allows users to order cannabis for delivery using the popular Uber Eats app.</span> <span class="attribution"><span class="source">(Shutterstock)</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/uber-eats--cannabis-delivery-partnership-with-leafly-is-mostly-smoke-and-mirrors" width="100%" height="400"></iframe>
<p>Before 2018, cannabis was illegal in Canada. Now, as of mid-October, <a href="https://www.uber.com/en-CA/newsroom/leafly-cannabis-delivery/">Uber Eats can deliver it in Toronto</a> as the result of a partnership with Leafly, an online marketplace for licensed cannabis retailers. This is the <a href="https://apnews.com/article/canada-business-ontario-toronto-5913ace985c9d5fdec70e17bc3022f21">first time Uber will deliver cannabis anywhere in the world</a>.</p>
<p>This deal is <a href="https://www.leafly.ca/news/strains-products/uber-eats-leafly-toronto-delivery-weed">being touted by Uber and Leafly as a great leap forward for the industry</a>. The companies claim the arrangement will provide several benefits, including more business for the retailers, increased choice and flexibility for consumers while reducing the illicit market, and cutting down on impaired driving. However, these arguments hold little water.</p>
<h2>How it will work</h2>
<p>Consumers are able to use the Uber Eats platform to order cannabis products from any of three Toronto-based retailers — Hidden Leaf Cannabis, Minerva Cannabis and Shivaa’s Rose — provided they are within the retailer’s delivery footprint. </p>
<p>The ordering experience is similar to ordering food delivery on the app: customers navigate to the “recreational cannabis” category, then to their chosen retailer’s menu where they select their desired products, then state whether they will pick up the order or prefer delivery. Uber then transmits the order to the applicable store. Once filled, the order is delivered to the customer by the retailer’s own delivery staff, as prescribed by law. </p>
<p>Ontario’s provincial <a href="https://www.agco.ca/bulletin/2022/information-bulletin-supporting-cannabis-retailers-curbside-pick-and-delivery-become">cannabis regulations were only recently modified to permit delivery</a>, although they do not permit third-party delivery. The retailer’s drivers must be employees of the retailer, be <a href="https://purchase.cannsell.ca/product?catalog=CannSell-Standard-Certification">CannSell certified</a> and are required to verify identity and age at the time of delivery.</p>
<figure class="align-center ">
<img alt="Hands holding a smartphone with the Uber Eats app loading screen visible on it" src="https://images.theconversation.com/files/492651/original/file-20221031-12-zz85qx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/492651/original/file-20221031-12-zz85qx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/492651/original/file-20221031-12-zz85qx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/492651/original/file-20221031-12-zz85qx.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/492651/original/file-20221031-12-zz85qx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/492651/original/file-20221031-12-zz85qx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/492651/original/file-20221031-12-zz85qx.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">Consumers can use the Uber Eats platform to order cannabis products from any of three Toronto-based retailers.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
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</figure>
<h2>Little to gain for consumers and retailers</h2>
<p>From the consumer’s perspective, the deal will merely provide another online location to order cannabis for delivery, on top of the <a href="https://www.ontario.ca/page/buying-recreational-cannabis">Ontario Cannabis Store and other private retailers</a>.</p>
<p>All three of the initial stores currently offer online ordering for either in-store pickup or free same-day delivery to a designated area within the Greater Toronto Area (with a minimum purchase amount). </p>
<p>Consumers can also order these same products from the Ontario Cannabis Store run by the Ontario government where they can opt for <a href="https://ocs.ca/blogs/about-my-order/shipping-updates">same-day delivery within Toronto for a fee of eight dollars</a>. Any gain on the part of consumers is minimal.</p>
<p>There’s also little in this for retailers. They will likely see a marginal increase in orders, but at what price to them? Neither the retailers nor Uber have been willing to disclose the commercial terms of this deal so we’re left to guess. Cannabis, as of this moment, doesn’t enjoy the kind of margins that can sustain the fees that Uber is charging.</p>
<p>It’s not hard to imagine that most cannabis retailers will also want to join Uber Eats down the road, when the industry has consolidated more. When this happens, it will mean overwhelming choices for consumers, <a href="https://www.scienceofpeople.com/choice-paralysis/">something that has been proven to reduce sales in other categories</a>.</p>
<h2>The profitability question</h2>
<p>Since the majority of cannabis retailers are private, we don’t have visibility into their profitability. We can, however, gain some insight into it using the Québec-owned <a href="https://www.sqdc.ca/fr-CA/">la Société québécoise du cannabis</a> as a case study. It represents the upper boundary of profitability, since they have the <a href="https://cannabisretailer.ca/2021/sales-per-store-how-do-you-stack-up/">highest sales per store in Canada on average</a>, and a relatively modest 90 store footprint compared to the <a href="https://www.agco.ca/status-current-cannabis-retail-store-applications">1,680 currently authorized in Ontario</a>. </p>
<p>La Société québécoise du cannabis is, by any measure, a healthy cannabis retailer. In their <a href="https://www.sqdc.ca/en-CA/about-the-sqdc/medias/2022/09/12/The-SQDC-reports-net-income-of-205-million-for-its-first-quarter-ended-June-18-2022">most recent quarterly report</a>, they reported a net income of $20.5 million on sales of $139 million, which translates to a net profit margin of just under 15 per cent.</p>
<figure class="align-center ">
<img alt="SQDC logo on the outside of a store" src="https://images.theconversation.com/files/492652/original/file-20221031-7758-24bv97.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/492652/original/file-20221031-7758-24bv97.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/492652/original/file-20221031-7758-24bv97.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/492652/original/file-20221031-7758-24bv97.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/492652/original/file-20221031-7758-24bv97.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/492652/original/file-20221031-7758-24bv97.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/492652/original/file-20221031-7758-24bv97.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">La Société québécoise du cannabis store in Montreal.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>Uber <a href="https://news.yahoo.com/much-restaurants-really-order-grubhub-171851427.html">charges food retailers 15 per cent of their total revenue</a> to those that provide their own delivery service and use the platform solely to take orders (30 per cent if Uber’s drivers are used). Assuming Uber takes a similar bite out of cannabis retailers’ profits, there isn’t margin enough for this to make sense to retailers. The math just doesn’t work.</p>
<p>The value offered by Leafly in this arrangement is unspecified, but given their <a href="https://investor.leafly.com/news/news-details/2022/Leafly-Holdings-Inc.-Reports-Second-Quarter-2022-Financial-Results/default.aspx">recent losses in both end user and retail accounts</a>, it may be in the deal to merely juice their stock price.</p>
<h2>Uber and Leafly come out on top</h2>
<p>Arguments claiming that this partnership will help <a href="https://www.cannabisbusinesstimes.com/article/leafly-uber-eats-delivery-partnership/">reduce cannabis-impared driving and the size of the illicit market</a> are simply not defensible. While <a href="https://madd.ca/pages/wp-content/uploads/2018/05/Alcohol-and-or-Drugs-Among-Crash-Victims-Dying-Within-12-Months2c-by-Jurisdiction-Canada2c-2014_April-202c-2018.pdf">driving while high is a serious and increasingly prevalent issue</a>, the existence of another cannabis delivery service will not affect the current statistics.</p>
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Read more:
<a href="https://theconversation.com/cannabis-impaired-driving-heres-what-we-know-about-the-risks-of-weed-behind-the-wheel-173823">Cannabis-impaired driving: Here’s what we know about the risks of weed behind the wheel</a>
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<p>There are already plenty of delivery options for people who would rather stay on the right side of the law and avoid driving to the nearest store. Similarly, consumers who are interested in purchasing legal weed, not black market weed, already have the means to do so.</p>
<p>There is no reason why an Uber Eats-specific delivery service will have any more of an impact than current delivery services do. It also remains to be seen if people will want to use Uber to buy their weed in the first place, considering the options already available.</p>
<p>It’s clear that retailers and consumers will not be the winners in this new partnership — that honour goes to the middlemen, Uber and Leafly. At the moment, that seems to be the state of the Canadian cannabis industry — business is booming for provincial wholesalers, while private retailers and cannabis producers are left in the lurch.</p><img src="https://counter.theconversation.com/content/192914/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Brad Poulos 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>A third platform for ordering cannabis in Ontario provides little to no benefit to consumers or retailers.Brad Poulos, Lecturer and Ambassador for Cannabis Education, Entrepreneurship and Strategy Department, Toronto Metropolitan UniversityLicensed as Creative Commons – attribution, no derivatives.