Addiction: We’ve Been Doing it ALL WRONG

IN YOUR OPINION…

What are we, as a nation, a government… what HAVE we been doing WRONG, so that, in the space of the past 50, or 60 years, instead of minimizing substance abuse and associated problems, INSTEAD, we have spawned and cultivated global narcotrafficking terrorist cartels, which have proliferated exceedingly abundantly and are now a root cause of many crimes overall?

Isn’t 50, or 60 years long enough to get a clue as to EXACTLY WHAT we’re doing WRONG — AND CHANGE!?!

The LIES that’ve been peddled and foisted upon us are blatantly contradicted by the government’s own research findings (via the NSDUH, SAMHSA, et al):

There is NO SUCH THING as “instantly addictive” substances/drugs, for if there was,

Yes, there TRULY IS good science behind medical marijuana!

And, here’s an example.

Recently, in the course of my reading (and I read EXTENSIVELY), I happened upon a brief excerpt from a recently-published book — it was a summary of a chapter from a recently-published healthcare-science text entitled “Medicinal Usage of Cannabis and Cannabinoids,” edited by: Victor R. Preedy, Vinood B. Patel, and Colin R. Martin.

The authors are respected in their fields, all possess terminal degrees, and their biographies are impressive.

OF NOTE: One of the three, Colin R. Martin, is a Registered Nurse.

Victor R. Preedy

Professor Preedy has been elected as a Fellow to the following Royal Societies: The Royal Society of Biology, the Royal College of Pathologists, the Royal Society for the Promotion of Health, the Royal Institute of Public Health and Hygiene, the Royal Society for Public Health, the Royal Society of Chemistry, and the Royal Society of Medicine. He was founding Director of the Genomics Centre at King’s College London and held the post from 2006 to 2020. He is a leading expert on the science of health and has a long-standing interest in disease processes, biomarkers, and tissue pathology. He has lectured nationally and internationally. Professor Preedy has published over 750 articles, which includes peer-reviewed manuscripts based on original research, abstracts and symposium presentations, reviews and numerous books and volumes.

Affiliations and expertise

Professor in the Department of Clinical Biochemistry at King’s College Hospital, London, UK Emeritus Professor in Faculty of Life Sciences and Medicine at King’s College London, UK Visiting Professor at the University of Hull, UK

Vinood B. Patel

Dr. Patel is a Reader at the University of Westminster. After completing his PhD at King’s College London, he continued his research experience by undertaking his post-doctoral studies in the laboratory of Professor Cunningham in the Department of Biochemistry at the Wake Forest University School of Medicine, (Winston-Salem, NC, USA). This extensive project involved investigating mechanisms of hepatic mitochondrial ribosome dysfunction in alcoholic liver disease (ALD) using biophysical and proteomic techniques. These studies have led to new avenues in determining the pathology of ALD. His teaching areas at both post-graduate and undergraduate levels include clinical biochemistry, investigative pathology and laboratory investigation.

Affiliations and expertise

Reader, University of Westminster, London, UK

Colin R. Martin

Dr. Martin is a Professor of Mental Health at Buckinghamshire New University. He is a Registered Nurse, Chartered Health Psychologist, and a Chartered Scientist. He has published or has in press well over 250 research papers and book chapters. He is a keen book author and editor having written and/or edited several books all of which reflect his diverse academic and clinical interests that examine in-depth, the interface between mental health and physical health. These outputs include the Handbook of Behavior; Food and Nutrition (2011), Perinatal Mental Health: A Clinical Guide (2012); Nanomedicine and the Nervous System (2012), and the major reference works Comprehensive Guide to Autism (2014), Diet and Nutrition in Dementia and Cognitive Decline (2015), Comprehensive Guide to Post-Traumatic Stress Disorder (2016) and Metabolism and Pathophysiology of Bariatric Surgery: Nutrition, Procedures, Outcomes, and Adverse Effects (2017).

Affiliations and expertise

Professor of Clinical Psychobiology and Applied Psychoneuroimmunology and Clinical Director: Institute for Health and Wellbeing University of Suffolk, Ipswich, UK

Published by Elsevier (ISBN:978-0-323-90036-2), the text is divided into 6 parts with 45 chapters, and a primary intended audience being

Harvard Dishonesty Researcher Found Dishonest

Oh!
The ignominious irony!

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Harvard Professor Who Studies Dishonesty Is Accused Of Falsifying Data

Dr. Francesca Gino, PhD., Professor of Business Administration, Harvard Business School

Dr. Francesca Gino, PhD., a prominent Professor of Businss Administration at Harvard Business School known for researching dishonesty and unethical behavior, has been independently credibly accused by numerous researchers of submitting work that contained falsified data over a period of several years.

Dr. Gino, who has authored dozens of fascinating studies in the field of behavioral science — has consulted for some of the world’s most prominent and largest companies such as Goldman Sachs, and Google, and has proffered advice in respected news outlets like The New York Times, The Wall Street Journal, and NPR.

However, over the past weeks, several people, including a colleague, have claimed that Dr. Gino fraudulently falsified and

CDA Section 230 violates Equal Protection Clause & threatens National Security

There’s been a significant amount of handwringing over remarks made by so-called “free speech” advocates who assert that anyone can say anything online “because it’s ‘free’ speech,” and ostensibly protected by the First Amendment.

I demur.

Facebook, Instagram (owned by FB), and Twitter, which are the “Big Three” online Social Media (SoMe) corporate megaliths (that is, if Twitter survives Elon Musk, if not, then TikTok may take Twitter’s place), have increasingly come under fire in the past several years — justifiably so — for turning a blind eye to bad behavior, “speech” in particular (as writing and/or video, both mediums posted on the services), thereby, in essence, becoming purveyors of lies, complicit by their inactions, in aiding and abetting actions of bad actors, consequently harming our nation — a significant portion of which continues originating in nations hostile to American national interests.

Writing in the Global Security Review, June 10, 2019, in an article entitled “Facebook, Compromised: How Russia Manipulated U.S. Voters” — the second of a four-part series — Sophia Porotsky detailed how Russia, as a malign foreign actor, sought, and continues seeking, the downfall of the United States.

“Russian Information Warfare content on social media attempts to subvert Western democracies in five ways:

1.) Undermine public confidence in democratic government;
2.) Exacerbate internal political divisions;
3.) Erode trust in government;
4.) Push the Russian agenda in foreign populations, and;
5.) Create confusion and distrust by blurring fact and fiction.

Russian propaganda on social media can be divided into four themes:

1.) Political messages intended to foster distrust in government (e.g. allegations of voter fraud, corruption);
2.) Financial propaganda (i.e. create distrust in Western financial institutions);
3.) Social issues (e.g. ethnic tensions, police brutality), and;
4.) Doomsday-style conspiracy theories.

“Information warfare content is generated and disseminated through channels that fall into three attribution categories:

1.) White (overt);
2.) Grey (less-overt), and;
3.) Black (covert) channels.

They propagate a blend of authentic, manipulated, and fake stories and they feed off of and reinforce each other.”

Among the numerous sources cited was “Russia’s Approach to Cyber Warfare,” a paper written by Michael Connell and Sarah Vogler published March 2017 by the Center for Naval Analyses (CNA) — an 80-year, independent, nonprofit research and analysis organization dedicated to the safety and security of the nation that informs the decisions of Navy, Marine Corps and DOD leaders as the Department of the Navy’s federally funded research and development center — which stated that,

“Russia views cyber very differently than its western counterparts, from the way Russian theorists define cyberwarfare to how the Kremlin employs its cyber capabilities.” Part of that difference is that the Russians “conceptualize cyber operations within the broader framework of information warfare, a holistic concept that includes computer network operations, electronic warfare, psychological operations, and information operations.”

And as part of their overall operations in that realm, not only does Russia “employ cyber as a conventional force enabler,” they integrate cybercriminals, hacktivists, and other nefariously malign non-state actors into their overall operations scheme, a practice also undertaken by “China, Iran, North Korea, and other cyber adversaries.”

That information is further borne out by the writings of Professor Dr. Mark Galeotti, PhD, who in June 2022 was recently banned from travel to Russia, wrote an OpEd in the independent news journal The Moscow Times, published December 22, 2017, that, “It is hard to sustain a serious claim that NATO tanks are about to surge eastwards – though some of the Kremlin’s more fanciful propagandists do try – but the virtues of the “secret battlefield” of intelligence work is that it is precisely covert.”

Dr. Galeotti is an internationally-recognized expert in security politics, intelligence services and criminality of modern Russia, is a Senior Non-Resident Fellow of the Institute of International Relations Prague, an Associate Fellow at the Council on Geostrategy, Honorary Professor at the UCL School of Slavonic and East European Studies, Honorary Professor at University College London, and Executive Director and principal in Mayak Intelligence, a London-based consultancy specializing in, and primarily focusing upon understanding organized and transnational crime, war, politics and history in Russia. Dr. Galieotti is also a contributing member of the Network of Experts of the independent civil-society organization Global Initiative Against Transnational Organized Crime, headquartered in Geneva, Switzerland.

The root cause of such problems, wrote David J. Smith in “How Russia Harnesses Cyber Warfare,” published in Defense Dossier, American Foreign Policy Council (August 2012: Issue 4), 9,” is inherently based in, and the natural outcome of,

Researchers: “Lazy Stoner” Stereotype NOT Supported by Evidence

“Lazy stoner” NO MORE!

UK Researchers Find Cannabis Abstainers LESS Motivated Than Cannabis Consumers

—>This is NOT A JOKE!<—

Ms Martine Skumlien is a PhD student in the Department of Psychiatry, University of Cambridge, United Kingdom. Her research centers around the impact of regular cannabis use on brain and cognition, with a particular emphasis on use in adolescence, in which she utilizes behavioral data along with fMRI in her work.

Ms. Martine Skumlien, MRes, is a researcher affiliated with the Department of Psychiatry, University of Cambridge, Cambridge, UK -and- Clinical Psychopharmacology Unit, Clinical Educational and Health Psychology Department, University College London, London, UK, and was lead researcher of a team of 16 that recently published their findings in the 14 August 2022 edition of the peer-reviewed International Journal of Neuropsychopharmacology.

In the research entitled “Anhedonia, apathy, pleasure, and effort-based decision-making in adult and adolescent cannabis users and controls,” [also at: International Journal of Neuropsychopharmacology, pyac056, https://doi.org/10.1093/ijnp/pyac056] the results showed that non-cannabis users “had higher levels of anhedonia than cannabis users.” Anhedonia is the clinical term referring to the inability to feel or experience pleasure.

In their conclusion, the researchers wrote, “Our results suggest that cannabis use at a frequency of three to four days per week is not associated with

Birth of a Myth: How Ivermectin Got Mixed Up With COVID-19

Dr. Carlos Chaccour, PhD

Dr. Carlos Chaccour, PhD, Assistant Research Professor, Barcelona Institute for Global Health, and Chief Scientific Officer of the Unitaid-funded BOHEMIA consortium project in Barcelona, Spain, is a scientist and researcher whose primary area of scientific interest is with Emerging Viruses, Malaria, and Coronavirus.

For the last 10 years, his most intense professional focus has been upon “the development of mosquito-killing drugs (endectocides) as complementary vector control strategy for malaria control and elimination.” In fact, the specific area in which he “obtained his PhD in 2015, was working with slow-release ivermectin formulations for that purpose.”

Dr. Joe Brew, PhD

In May 2020, he, along with fellow researchers  Dr. Joe Brew, PhD, a Data Scientist, Epidemiologist, and Economist; and Dr. Alberto García-Basteiro, MD, Assistant Research Professor at the Barcelona Institute for Global Health, ISGlobal in Barcelona, Spain, and physician at the International Health Service of Hospital Clínic, authored “Ivermectin and COVID-19: How a Flawed Database Shaped the Pandemic Response of Several Latin-American Countries.”

Dr. Alberto Garcia-Basteiro, MD

Their critical examination was in response to efforts by healthcare professionals and officials in the nations of Peru, Bolivia, Paraguay, and Colombia who suddenly began taking an unusual interest in ivermectin, and using it on COVID-19 patients in their respective nations. Those nations’ officials were motivated, in large part by a since-retracted, and debunked manuscript initially placed on a “preprint server,” a website which publishes online, a full draft of research which has not yet been validated by the peer-review process. The respected healthcare/medical science journal Lancet, which has been continually published since 1823 with the objective to improve people’s lives, states that “a preprint is a version of a scientific manuscript posted on a public server prior to any formal peer review.”

Specifically, Dr. Chaccour and colleagues examined antiviral research published June 2020 in Science Direct entitled “The FDA-approved drug ivermectin inhibits the replication of SARS-CoV-2 in vitro,” i.e., in glass, such as test tube, beaker, or Petri dish, which was performed early in April by Australian researchers Leon Caly, Victorian Infectious Diseases Reference Laboratory, Royal Melbourne Hospital, At the Peter Doherty Institute for Infection and Immunity, Victoria, Australia, Julian D. Druce, Senior Medical Scientist in the Virus Identification Laboratory of the Victorian Infectious Diseases Reference Laboratory, et al, which “used concentrations that are not readily achieved in the human body” but raised enough interesting questions that further investigation was warranted, and because of “the drug’s excellent safety profile and lack of effective treatment for COVID-19.”

In response to their critical examination, and genuine questions about the techniques and methods, they wrote a guest editorial entitled “Ivermectin and COVID-19: Keeping Rigor in Times of Urgency” which was

Research: Moderna’s mRNA COVID-19 Vaccine MORE EFFECTIVE Than Estimated

Scientists and researchers have released their findings of the effectiveness of Modern’s mRNA COVID-19 vaccine. Initial scientific estimates were that the vaccine would have an effectiveness of 68.5%. But after the lengthy process of laboratory analysis of large groups of participants, scientists found that the vaccine is 96.1% effective after both doses have been given. And, only about one-half of one percent of the recipients had any serious side effects – a phenomenally low rate.

The long-awaited results of an immunity effectiveness study of Moderna’s mRNA COVID-19 vaccine have been released.

And, there’s GREAT NEWS!

In part, laboratory test findings of  30,415 individuals who participated in the study from July 27, 2020 to October 23, 2020, have shown that the Vaccine is

MUCH MORE EFFECTIVE THAN PREVIOUSLY ESTIMATED!

Sneak Preview

The paper entitled “Immune Correlates Analysis of the mRNA-1273 COVID-19 Vaccine Efficacy Trial” – on the preprint server (a “sneak preview” before being officially published in a scientific journal) – may be found here: https://www.medrxiv.org/content/10.1101/2021.08.09.21261290v1

Pertinent excerpts in red from the paper follow. 

Effectiveness First Estimated At 94%

Background — In the Coronavirus Efficacy (COVE) trial, estimated mRNA-1273 vaccine efficacy against coronavirus disease-19 (COVID-19) was 94%. SARS-CoV-2 antibody measurements were assessed as correlates of COVID-19 risk and as correlates of protection.

How do we identify correlates of protection?

• “Correlates of protection are generally identified by comparing the immune response of those protected by the vaccine and so called ‘breakthrough cases’, where clinical disease manifests despite prior vaccination. In the case of the COVID-19 pandemic, the numerous vaccines developed have proven very effective with low incidences of breakthrough cases making the identification of potential correlates of protection a slow process. As a result, comparisons with previously published data relating to both natural infection and vaccine studies have been drawn.”

Blood Levels Checked 3 Times

Methods — Through case-cohort sampling, participants were selected for measurement of four serum antibody markers at Day 1 (first dose), Day 29 (second dose), and Day 57: IgG binding antibodies (bAbs) to Spike, bAbs to Spike receptor-binding domain (RBD), and 50% and 80% inhibitory dilution pseudovirus neutralizing antibody titers calibrated to the WHO International Standard (cID50 and cID80). Participants with no evidence of previous SARS-CoV-2 infection were included. Cox regression assessed in vaccine recipients the association of each Day 29 or 57 serologic marker with COVID-19 through 126 or 100 days of follow-up, respectively, adjusting for risk factors.

Neutralizing Antibody Levels Highly Predictive Of Immune Protection

• Vaccine 96.1% Effective
• Vaccine EXTREMELY Safe — under ½ of 1% had serious side effects

Results — Day 57 Spike IgG, RBD IgG, cID50, and cID80 neutralization levels were each inversely correlated with risk of COVID-19: hazard ratios 0.66 (95% CI 0.50, 0.88; p=0.005); 0.57 (0.40, 0.82; p=0.002); 0.41 (0.26, 0.65; p<0.001); 0.35 (0.20, 0.60; p<0.001) per 10-fold increase in marker level, respectively, multiplicity adjusted P-values 0.003-0.010. Results were similar for Day 29 markers (multiplicity adjusted P-values <0.001-0.003). For vaccine recipients with Day 57 reciprocal cID50 neutralization titers that were undetectable (<2.42), 100, or 1000, respectively, cumulative incidence of COVID-19 through 100 days post Day 57 was 0.030 (0.010, 0.093), 0.0056 (0.0039, 0.0080), and 0.0023 (0.0013, 0.0036). For vaccine recipients at these titer levels, respectively, vaccine efficacy was 50.8% (−51.2, 83.0%), 90.7% (86.7, 93.6%), and 96.1% (94.0, 97.8%). Causal mediation analysis estimated that the proportion of vaccine efficacy mediated through Day 29 cID50 titer was 68.5% (58.5, 78.4%).

 

See also:

Antibody Levels Help Predict Immunity After A COVID Shot 

: Shots – Health News 

https://www.npr.org/sections/health-shots/2021/08/23/1029827996/new-evidence-points-to-antibodies-as-a-reliable-indicator-of-vaccine-protection

 

Terms to help understanding:

• cID – Culture Infective Dose, the amount of an infective agent which will produce infection in 50% of the cultures

• CI – Confidence Interval, statistical term indicating a range of values, and the probability at which a certain value will be found in that range

• IgG – Immunoglobulin G, also known as antibodies, a protein component of blood & body fluids, produced by immune response cells called plasma cells, is a defensive response to bacteria, viruses and exposure to other harmful antigens to prevent infection; is the most common type of antibody; IgA (15%), IgD, IgE, IgG (70-80%), and IgM are the types; each one has a different role; IgM responds first, increases, then gives way to IgG; IgA is found in tears, saliva, gastric secretions, breast milk, protects mucosal areas, including sinuses & lungs; IgD role not completely understood, not typically measured; IgE associated w allergies, allergic diseases, parasitic infections. The body has a “catalog” of IgG antibodies that can be rapidly reproduced whenever it’s exposed to the same antigen.

• mRNA-1273 – scientific “shorthand” for Moderna’s mRNA COVID-19 vaccine

• titer – a lab test measuring the concentration of any particular substance, such as antibodies, in a given volume of fluid (blood); used to determine immunity

• inverse correlation – a mathematical relationship between two things, in which when one is high, the other is low, and vice versa

• efficacy – the ability to produce desired results, as “effectiveness,” i.e., does it work?

• hazard ratio – the chance of an event occurring in the treatment, or control, group of a study

• immune correlates – a shortened form of “immune correlates of protection,” refers to immunity, asks the question “has immunity been obtained?” and is determined by a measurable immune response to a vaccine, statistically proven to protect against a particular disease

• serologic marker – refers to serum, the non-cellular component of blood, which includes antigens, antibodies, etc.; a measurement of findings associated with disease, or treatment

• SARS-CoV-2 – Sudden Acute Respiratory Syndrome COronaVirus 2, the scientific name of the pathogenic (disease causing) virus that causes COVID-19

• Cox regression – statistical term named for prominent British statistician Sir David Cox (b.1924), for a predictive model which determines the time is takes for a specific event to happen

• causal mediation analysis – mathematical test determining: 1.) Total effect of X on Y; 2.) Relationship between X and M; 3.) Relationship between M and Y, controlling for X, and; 4.) Determining if M is a full, or partial mediator. Mediation is the process through which an exposure causes disease.

Experts On Senator Ron Paul’s Debate With Dr. Anthony Fauci Over Wuhan Study

At a July 20, 2021 hearing before the Senate Health, Education, Labor, and Pensions Committee, on the nation’s COVID-19 response, Kentucky Republican Senator Rand Paul has claimed falsely and ignorantly, that the National Institutes of Health funded research through the Wuhan Institute of Virology that added “gain of function” to the virus(es) being studied.

THAT IS A FALSE STATEMENT.

Dr. Anthony Fauci, MD, Director of the National Institute of Allergy and Infectious Diseases was correct, honest, and forthright in his testimony before the Senate Committee when when he said to Senator Paul that, “Senator Paul, I have never lied before the Congress and I do not retract that statement. Senator Paul, you do not know what you’re talking about, quite frankly, and I want to say that officially. You do not know what you’re talking about.”

Below is the pertinent excerpt of the article that PROVES Dr. Fauci’s statement.

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George Mason University’s Dr. Gregory Koblentz, PhD, an expert in biodefense and dual use research, pointed out that WIV1 wasn’t an animal virus enhanced to infect humans through gain-of-function research, because it was already shown to pose a danger to humans.

“Sen. Paul is wrong when he says

Lower Your Blood Pressure Without Medicine Or Exercise

Take a deep breath — this one is gonna’ knock your socks off, because…

“Not only is it more time-efficient than traditional exercise programs, the benefits may be longer lasting.”

— Dr. Daniel H. Craighead, PhD, Post-Doctoral Fellow, Assistant Research Professor, Integrative Physiology of Aging Lab, Department of Integrative Physiology, University of Colorado Boulder, referring to research findings of a 5-minute breathing exercise upon lowering blood pressure

And, it’s easy!

How easy is “easy”?

Dr. Craighead said the exercise called “IMST can be done in five minutes in your own home while you watch TV.”

These findings are significant, because 65% of adults over age 50 have above-normal blood pressure, which puts them at greater risk of heart attack or stroke, and less than 40% meet guidelines for recommended levels of aerobic exercise.

“It’s basically strength-training for the muscles you breathe in with,” said Dr. Craighead, who added that,“it’s something you can do quickly in your home or office, without having to change your clothes, and so far

Research: Psilocybin Improves Depression

Better living through chemistry.

Because corrupt Republican President Richard Nixon’s 50-year lost cause, failed social experiment of the “War on Drugs” and Nancy Reagan’s “just say no” have never, and will never, work, nor ever benefited anyone who needed help — only those who perpetuated the war.

And, because no one — NO ONE — has ever said “when I grow up, I want to become an addict,” nor waked up one day and said, “gee… I think I want to become an addict.”

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In September 2018, Johns Hopkins researchers suggested that psilocybin should be re-categorized from a schedule I drug — one with no known medical potential — to a schedule IV drug (the lowest classification) such as with prescription sleep aids, but with somewhat tighter control, and summarized their analysis in the October print issue of Neuropharmacology, a peer-review professional journal.

Dr. Matthew W. Johnson, Ph.D., Professor of Psychiatry and Behavioral Sciences at Johns Hopkins is one of the world’s leading researchers, and most published scientists on the effects of psychedelics on humans, and has conducted original and innovative research in the behavioral economics of drug use, addiction, and risk behavior. Dr. Johnson earned his Ph.D. in experimental psychology at the University of Vermont in 2004.

Dr. Johson spoke with JHU reporters about the research, and said, “We want to initiate the conversation now as to how to classify psilocybin to facilitate its path to the clinic and minimize logistical hurdles in the future. We expect these final clearance trials to take place in the next five years or so. We should be clear that psilocybin is not without risks of harm, which are greater in recreational than medical settings, but relatively speaking, looking at other drugs both legal and illegal, it comes off as being the least harmful in different surveys and across different countries. We believe that the conditions should be tightly controlled and that when taken for a clinical reason, it should be administered in a health care setting, monitored by a person trained for that situation.”

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One Dose Of Psilocybin Improved Neural Connections Lost In Depression, Study Says

By Joseph Guzman, July 6, 2021

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The psychedelic psilocybin mushroom has shown promise in treating depression, and a number of clinical trials into the fungus’s therapeutic effects have been conducted in recent years.

But now, a Yale University study published in the peer reviewed professional journal Neuron July 5, 2021, has shed light on how the compound psilocybin —the active ingredient found in so-called “magic mushrooms” — may produce antidepressant effects.

Researchers administered a single dose of psilocybin to mice and used a laser-scanning microscope to visualize dendritic spines in the rodents’ brains in high resolution. Dendritic spines are small protrusions found on nerve cells that play a key role in transmitting information between neurons. Previous laboratory experiments demonstrated promise that psilocybin, and the anesthetic ketamine, could decrease depression.

Stress and depression degrade and reduce the number of neuronal connections.

Within 24 hours of the single psychedelic dose, researchers observed an immediate and lasting increase in

GOP Insurrectionists

The Insurrectionist wing of the Republican Party has problems.

Fox News Republicans…

…Live in their own little world.

But most objective observers already knew that – or, at least, strongly suspected it.

Now, scientific research has shown it to be true.

On practically every issue in society touching upon government has policy, or law, Fox News Republicans are far right wing extremists on everything.

And, their opinion of the 45th President is similarly high – and disturbingly so, at 98%.

The negative correlation – that of overwhelmingly negative views of high-profile Democrats – is no less than 93%.

There is in many cases a disparity between Fox News Republicans (FNRs) and Republicans (Rs). For example, FNRs gave the 45th President an 80% Strongly Approve (SA) rating, while Non-Fox News Republicans (NFNRs)  gave him 42% Strong Approval (SA). There were similar disparities between FNRs and NFNRs on matters of economic importance, with FNRs expressing 86% SA, while NFNRs were 53% SA.

Even on handling of the coronavirus pandemic, FNRs were almost double the SA difference with 59%, while NFNRs were 29%. And on dealing with protests following police killings of Black Americans, FNRs had 55% SA, while NFNRs had 28% SA.

The disparity, chasm, and gulf between FNRs an NFNRs demonstrates that the Once Grand Old Party is not merely fractured, fissured, or split, but broken asunder, and perhaps beyond repair.

The differences and the issues were almost stereotypical in their responses, whether Abortion, Appointment of SCOTUS Justices, Jobs/Unemployment, Immigration, Federal Deficit, Trade Agreements, Healthcare, coronavirus pandemic, Foreign governments’ interference in US election, Racial inequality, Increasing disparity between rich & poor, and climate change. The differences between FNRs an NFNRs was at least 3%, and as great as 20%+.

And this is telling, as well:

“Fox News Republicans are more likely than all Americans and non–Fox News Republicans to say that Confederate symbols are more symbols of Southern pride than symbols of racism. More than nine in ten Fox News Republicans believe that both Confederate flags (92%) and monuments to Confederate soldiers (94%) are symbols of Southern pride. Non–Fox News Republicans are only somewhat less likely to say the same about flags and monuments (81% and 87%, respectively). All Americans are much more divided, with 47% who say the flag is a symbol of Southern pride and 59% who say the same of Confederate monuments.”

And interestingly, they also believe that they are victims of discrimination:

“Consistent with their other views on discrimination, more than eight in ten Fox News Republicans (83%) agree with the statement that “discrimination against white Americans has become as big a problem as discrimination against Black Americans and other minorities.” Two-thirds of non-Fox News Republicans (66%) agree with the statement, compared to just 42% of all Americans.”

Fox News Republicans
• Urban/Suburban 79
• White 81
• Male 57
• Evangelical/Mainline Protestant 36/21
• No College Degree 70
• Attend religious services once or more weekly 46
• Almost evenly distributed ages 30-65+ 30-49/30; 50-64/28; 65+/32
• Household income $50,000-$100,000 43

The survey was conducted in all 50 states by

Research: Most Religious Americans Support Broad Cannabis Legalization

A Pew Research Center survey conducted April 5-11, 2021 among 5109 randomly sampled U.S. adults who were all members of Pew Research Center’s American Trends Panel – a group of over 10,000 adults randomly selected from throughout all 50 states who regularly participate in Pew’s surveys – found that most religiously affiliated Americans favor broad cannabis legalization.

Compared with other religiously affiliated groups, at 44%, White Evangelicals were

Research: 550,000+ Firearm-Related Hospitalizations 2000-2016

States in the Deep South lead the nation in average per capita firearm-related hospitalizations.

Average Firearm Injury Hospitalization Rate per 100,000, 2000–2016

1.) Louisiana – 24
2.) Tennessee – 18
3.) Alabama – 16
4.) Missouri – 16
5.) Maryland – 16
6.) Michigan – 14
7.) Illinois – 13
8.) North Carolina – 13
9.) South Carolina – 13
10.) Mississippi – 13
11.) Arizona – 13
12.) Arkansas – 12
13.) Delaware – 12
14.) Pennsylvania – 12
15.) Nevada – 12
16.) California – 12
17.) Oklahoma – 11
18.) Texas – 10
19.) Kansas – 10
20.) Indiana – 10
21.) Ohio – 10
22.) Kentucky – 9
23.) Virginia – 8

The national average is 10.

Ongoing and recently updated research by the RAND Corporation – a nonprofit, nonpartisan, research organization working in the public interest to develop solutions to public policy challenges to improve communities nationally, and worldwide by making them healthier, and more prosperous, safer, and more secure – showed that nationally:

“In 2018, 39,740 individuals in the United States were killed by firearms, making firearm violence the second leading cause of injury death in the United States (Centers for Disease Control and Prevention [CDC], undated).

“As part of the Gun Policy in America initiative, RAND researchers developed a longitudinal database of state-level estimates of inpatient hospitalizations for firearm injury between 2000 and 2016. This database was first released in 2021 and is free to the public.

RAND researcher Dr. Andrew Morral, PhD who is the Senior Behavioral Scientist, and Director of the National Collaborative on Gun Violence Research there, tweeted recently (April 28) that:

“Why are firearm hospitalizations not correlated with gun ownership in observed state hospitalization data or our estimates? Because they chiefly result from criminal assaults (vs. suicides) and these are not correlated with household gun ownership.”

Why are firearm hospitalizations not correlated with gun ownership in observed state hospitalization data or our estimates? Because they chiefly result from criminal assaults (vs suicides) and these are not correlated with household gun ownership https://t.co/pqVOh9t4bT

— Andrew Morral (@AndrewMorral) April 29, 2021

This type of research is a phenomenally difficult proposition, and highly complicated undertaking, and the entirety of the paper is spent detailing and explaining their methodology, and sources, because not every state provides information to, or participates in HCUP, the Healthcare Cost and Utilization Project.

As well, data had to be compared and cross-referenced with other similarly related databases, such as the FBI’s annual UCR – Uniform Crime Report.

And then, they get into the math – the statistical analysis – and explain the formulae used, which then has to be checked with other external mathematical models to determine, and ensure a high level of accuracy. In short, this is not “relaxing reading” by any stretch of the imagination – it is highly technical explanations of phenomenally difficult work, which only indirectly points to the significance of their findings.

HCUP is the Nation’s most comprehensive source of hospital care data, including information on in-patient stays, ambulatory surgery and services visits, and emergency department encounters. HCUP enables

Gun Ownership + Carrying + Impulsivity = Increased Firearm Violence Victimization & Death Risk

Think you need a gun “for protection”?

Think again.

The glibly superficial “good guy with a gun” notion is but a trite and specious fallacy.

Research has shown that “that individuals in possession of a gun are over four times more likely to be shot in an assault than those not in possession.”¹

Thus, while gun carrying itself is not a violent behavior, “it potentially marks heightened risk among gun carriers.”

And indeed, “research has demonstrated a strong link between (gun carrying) and gun violence victimization.”¹

“The finding has important implications for states and campuses considering open carry laws α while these policies may be intended to increase safety, they may have the unintended result of increasing gun violence victimization.”²

“On average, guns did not protect those who possessed them from being shot in an assault.³ Although successful defensive gun uses occur each year, the probability of success may be low for civilian gun users in urban areas. Such users should reconsider their possession of guns or, at least, understand that regular possession necessitates careful safety countermeasures.”

“Impulsivity was identified as

Child Abuse & Neglect Cost Alabama $3.7B in 2018

Direct economic losses attributable to child abuse and neglect cost the State of Alabama $3.7 billion in 2018, according to a study conducted by The University of Alabama College of Human Environmental Sciences and The University of Alabama Center for Business and Economic Research.

Researchers found that “the tangible cost of child maltreatment (or child abuse and neglect) to the Alabama economy in 2018 is conservatively estimated to be $3.7 billion.”

The report entitled “The Cost of Child Maltreatment to the Alabama Economy” found that figure is the direct cost which the state bears if only the child victims are considered, and does not include associated costs to families (including extended ones) and communities that are known to occur.

The research which was conducted in collaboration with the Alabama Department of Child Abuse and Neglect Prevention and The Children’s Trust Fund, found that cost of lost worker productivity of victims was the single greatest financial cost – $2,629,685,802, while costs to the state child welfare system exceed $281,886,848, and Adult Criminality costs were conservatively found to be $109,469,664.

Child maltreatment causes preventable infant mortality and low birthweight, chronic health and mental health problems, developmental and educational delays, lower work productivity, and higher involvement with the criminal justice system.

The cost to the state is

Research Study Finds COVID-19 Numbers Vastly Underestimated

This is some of the first proven and confirmed evidence that what we have been told by the experts is 100% accurate and true.

“Typhoid Mary” Mallon (1869-1938), was an impoverished, illiterate Irish emigrant to the United States who worked primarily as a cook, and who became infamous for spreading typhoid fever, which at the time was an incurable, easily-spread, often deadly disease, for which no vaccination existed.

People who DO NOT KNOW THEY ARE INFECTED ARE SPREADING THE DISEASE BECAUSE THEY DO NOT HAVE SYMPTOMS.

It is a REPEAT of the classic example first shown by “Typhoid Mary” Mallon (1869-1938), an Irish emigrant to the United States who worked as a cook (one of the highest paying jobs at the time), and was actively infected with typhoid fever, yet NEVER – NOT EVEN ONCE – showed any signs of infection.

Tragically, however, as was common in the era in which she lived, she had low education and was practically illiterate, and her refusal to heed the advice of experts, and her insistence upon working in kitchens, resulted in the deaths of many people whom she thereby infected with typhoid fever because of her deliberately wanton disregard of advice, and disobedience to the order of law. She, however, claimed that she was being persecuted for being Irish and poor.

Her case was the first, and a prime example of the dangers of ignoring sound expert medical and scientific advice. As well, her case demonstrated the differences in attitudes toward public health between now, and then, because she filed lawsuits against the governmental authorities that detained her, and forbade her from either working, or being in public, and quarantined her. At the time, there was no vaccine against typhoid.

And throughout the remainder of her life, and up to the time she died, she never – not even once – ever showed signs of typhoid fever infection. And she did not die of typhoid fever. She died of

New International Guidelines For Cannabis In Treating Chronic Pain

New Guidelines Issued on Medical Cannabis for Chronic Pain

International task force shares recommendations for dosing, administering.

by Ryan Basen, Enterprise & Investigative Writer, MedPage
September 13, 2020

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Chronic pain patients can be treated with medical cannabis following one of three protocols based on patient characteristics, according to an international task force at the virtual PAINWeek meeting.

Note the words “NO OPIATES” PROMINENTLY displayed on the label.

Citing limited clinician knowledge about medical cannabis treatment and the opioid crisis, one task force member said the recommendations are timely.

“We as a task force believe it’s extremely important to bring [medical cannabis] to patients,” Alan Bell, MD, of the University of Toronto, told MedPage Today. “Our main focus was to provide directions to clinicians.”

Medical cannabis has been suggested to treat chronic pain, the task force noted, but too many providers still do not utilize it because there has not been accepted guidelines about dosing and administration. Others prescribe medical cannabis without knowing how patients can properly dose.

“There’s a huge knowledge gap and no way clinicians can fall back on a specified dosing regimen,” Bell said.

Led by Arun Bhaskar, MD, of Imperial College Healthcare NHS Trust Pain Management Centre in London, the 20-clinician Global Task Force on Dosing and Administration of Medical Cannabis in Chronic Pain used a modified Delphi process. Among their recommendations:

• Treat the majority of patients along the “routine” scale. This means

“Just say ‘NO’” has never worked. Here’s what does.

Freedom.

What a concept, eh?

The very idea that you have a brain, and therefore, can think independently to decide FOR YOURSELF what you want, or ought, to do, continues to frustrate others who think that they know better than you do what personal decisions you should make for yourself!

It’s an adult decision.

Why, it’s nothing short of… LIBERTY!

ENOUGH! of the “Nanny State”!

Take your religion home, and GET IT OUT OF GOVERNMENT!!

Practice it PRIVATELY, with your family, friends, and other like-minded individuals. STOP forcing your PRIVATE religious ethics and morals upon others by writing public laws that mirror your private interpretation of your religion.

Thomas Jefferson wrote a letter to the Danbury Baptists that cited the establishment clause of our nation’s Constitution, which as he wrote, erected a “a wall of separation between Church & State,” or as we now say, between government, and religion.

Religious nuts have been trying to tear it down, ever since.

And they’re STILL TRYING TODAY!

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‘Drug Use For Grown-Ups’ Serves As An Argument For Personal Choice

If you grew up scared of what illicit drugs could do to you — hearing about all the horrors that could befall you from everyone from Nancy Reagan to your parents — the threat may have felt very real: If you actually took a puff off that joint that the kid who slept through math class offered you, it could lead to failed relationships, chronic unemployment, self-destruction.

The shame would outlive you.

But drugs are a more complicated matter than they’ve been made out to be, according to Dr. Carl L. Hart. In his new book Drug Use for Grown-Ups, the Columbia University professor of psychology and psychiatry zealously argues that drug use should be a matter of personal choice — and that, in more cases than not, personal choice can lead to positive outcomes. His positions may seem quite extreme to some but they also, by and large, make a lot of sense — and are backed up by ample research.

A major reason drugs have such a negative public image, Hart asserts, is racism. He notes that after the Civil War, some Chinese railroad construction workers smoked opium and, sometimes, established “opium dens” to do so. Over time, more and more white Americans visited these dens to smoke opium too. That in turn led to broader, bigoted social fear among whites, like, for example, the sentiments captured in H.H. Kane’s 1882 report:

“The practice spread widely…Many women and young girls, as also young men of respectable family, were being induced to visit the dens, where they were ruined morally and otherwise.”

Then there was the post-Civil War use of cocaine among some Black day laborers, something Hart writes was at first encouraged by white employers because of the productivity it could promote. Soon enough, however, articles appeared widely that tried to make a connection between African American cocaine use and criminality. One particularly egregious article in The New York Times in 1914, cited by Hart, even reported that some police in the South “who appreciate the vitality of the cocaine-crazed” were switching to higher-caliber weaponry capable of “greater shocking power for the express purpose of combating ‘the fiend’.”

But horrifying history aside, one of the book’s most eye-opening aspects is its challenge of the long-running association between drugs and addiction. First the basics: Addiction, according to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM – 5), must be a source of distress for a drug user. It must also interfere with a person’s job, parenting or personal relationships. Other indications of addiction may be

A COVID-19 vaccine was ready January 13, 2020 – long before the pandemic began.

Margaret Keenan, a 90-year old Irish-English grandmother, was the world’s first to receive a coronavirus vaccination.

While the world is crowing about Margaret Keenan, a 90-year old Irish-British grandmother of four, being the first in the world to receive a coronavirus vaccine yesterday, on Tuesday, December 8, 2020, around 0630 local time (GMT) – she received the version collaboratively developed by the American company Pfizer and German company BioNTech – the American biotechnology company Moderna, in Massachusetts, had long had a vaccine developed.

Moderna had already designed a COVID-19 vaccine – mRNA-1273 – by January 13.

It was only recently, on  November 16, that they reported a 94.5% efficacy rate.

Moderna developed their vaccine only two days after the genetic sequence had been publicized internationally by Chinese researcher Professor Dr. Yong-Zhen Zhangm Ph.D. His humanitarian act of scientific generosity resulted in him being temporarily forced out of his lab.

Professor Dr. Zhang believes science holds the key to predicting viral outbreaks with similar accuracy as with which we now anticipate typhoons and tornadoes. He said, “If we don’t learn lessons from this disease, humankind will suffer another.”

Moderna’s vaccine design only took one weekend to develop at their Massachusetts facilities.

In fact, Moderna had completed development of their COVID-19 vaccine mRNA-1273 before the Chinese government had acknowledged the disease was transmitted by human-to-human means, and more than a week before the first confirmed coronavirus case in the United States – January 21.

And by the time the first American coronavirus death was reported a month later, on February 29, Moderna’s mRNA-1273 coronavirus vaccine had already been manufactured and shipped to the National Institutes of Health to begin its Phase I clinical trial.

All of that was long before the President had made any announcement about his “Operation Warp Speed,” the public-private partnership to develop a coronavirus vaccine, and yet even 2 months before Bloomberg News reported on April 29 that such a plan was in the works.

Regarding the announcement of the first known coronavirus-related death, it should be noted that, following autopsy results in mid-to-late April, the Santa Clara County California Medical Examiner’s office reported on April 21 that the first known COVID-19 related death occurred in United States on February 6. The first death was previously thought to have occurred in Kirkland, Washington on February 29. The New York Times reported that, “The virus has an incubation period of 14 days and people who die of it are often sick for at least three weeks, so the individual who died on February 6 could have been infected — and transmitting the infection to others — in early January, experts said.”

In essence, what that means, is that for the entire time the COVID-19 coronavirus pandemic has infected well over 15 million – and counting – in the United States, we had the tools we needed to prevent it, as well as the death of over 250,000 Americans… and counting.

So, that begs the question: If Moderna had a vaccine ready in January, why has it taken until now – December, very nearly a year later – to have a vaccine readily available?

Moderna, a publicly-traded company (stock symbol: MRNA) with operations and headquarters in Massachusetts, is a biotechnology firm focused exclusively upon development of vaccines using mRNA – messenger RNA. Their vaccine is the first in the history of vaccine development to use mRNA.

Drs. Emmanuelle Charpentier-L & Jennifer A Doudna-R, are 2020 Nobel laureates, and creators of the CRISPR/Cas9 gene editing tool

Vaccines made using mRNA are fundamentally different from any other vaccine ever made. The history of vaccination began on May 14, 1796, when a country doctor from Gloucestershire, England, Dr. Edward Jenner, MD, first took some fluid from a cowpox blister and scratched it into the skin of James Phipps, an 8-year-old boy.

Dr. Jenner developed his vaccine while he was still a medical student, after noticing that milkmaids who had contracted a disease called cowpox, which caused blistering on a cow’s udders, did not catch smallpox. However, unlike smallpox, which caused severe skin eruptions and dangerous fevers in humans which often led to death, cowpox led to few ill symptoms in those women.

Science has come a very long way since then. While traditionally, vaccines were first made using active, live, then attenuated, then inactivated, or dead cells from the organism or virus. Throughout the history, the process of making vaccines used chickens’ eggs for the protein they contained, and were literally injected into the shell of an egg. Some are still made that way.

Most recently, two women have forever changed health, medicine, and many other life sciences, which gives hope to millions, and holds untold promises. Dr. Emmanuelle Charpentier, Ph.D., Director of Infection Biology at the Max Planck Institute, and Professor Dr. Jennifer A. Doudna, MD, Ph.D., Professor of Chemistry, Biochemistry & Molecular Biology, Li Ka Shing Chancellor’s Professor in Biomedical and Health at the University of California Berkeley, in October 2020 won the Nobel prize in chemistry for the development of the revolutionary CRISPR/Cas9 gene editing tool which has been described as enabling “rewriting the code of life.”

Drs. Emmanuelle Charpentier-L & Jennifer Doudna-R, are the 2020 Nobel laureates in chemistry, and creators of the CRISPR/Cas9 gene editing tool.

Cas9 is a type of modified protein and acts like a pair of scissors that can cut parts of DNA strands. CRISPR stands for Clustered Regularly Interspaced Short Palindromic Repeats, in essence, a repeating mirrored DNA sequence in genomes that repeats. The technology has worked in most every organism that it has been used on, including plants, animals, microbes and humans.

By using the gene editing platform CRISPR, which could be thought of as cut-and-paste, the idea is to remove parts of a genome using RNA as a means of guiding to a particular place within a genome, genes can then be modified to eliminate mutated, or harmful parts.

The ability to use such sophisticated gene splicing technology holds enormous promise.

As it relates to the coronavirus, the gene splicing technology uses a very small portion of messenger RNA (mRNA) from the coronavirus genome, and produces a gene that codes for the spike protein – the characteristic protruding part seen on images.

The coronavirus has 4 proteins, the spike is 1, and is the part that enables the virus to invade cells. By using only that part of the virus, it causes the body to produce antibodies that neutralize that spike protein. RNA vaccines cause the body to make only that spike protein. Then, encased in a fat molecule mRNA then enters cells, and sends a coded message to the body to make the protein, which in turn causes an immune response.

RNA vaccines have many advantages, which, unlike other vaccines produced other ways, they stimulate the production of killer T-cells which stop the coronavirus from replicating. And because mRNA vaccines are produced in test tubes or tanks, rather than being cultivated in cells (such as in eggs), they should be relatively quick and easy to produce.

The use of mRNA to treat disease, even genetic-based disease, such as cystic fibrosis, is brand new, but holds exciting possibilities. Moderna is perhaps one of the most promising mRNA therapeutics research firms in the world. And under the leadership and direction of Chief Science Officer Dr. Melissa Moore, Ph.D., Moderna has developed, and publicized, the scientific blueprint for a unique form of cancer therapy using mRNA which when used used, ensures its mRNA is made only inside cancer cells. Ryan Cross reported in Chemical and Engineering News on September 3, 2018 in “Can mRNA disrupt the drug industry? Messenger RNA technology promises to turn our bodies into medicine-making factories. But first Moderna—and a long list of old and new competitors—needs to overcome some major scientific challenges.” and wrote in part that, “Moderna scientist Ruchi Jain designed an mRNA that causes cancer cells to self-destruct but is recognized by, and destroyed in, healthy cells.”

Dr. Moore has a distinguished scientific pedigree, and

Dating Eddie Van Halen

Eddie Van Halen performing at New Haven Coliseum, color-corrected image

Rock guitar god and musical innovator Eddie Van Halen (1955–2020) died recently from throat cancer which had spread to his brain, and other organs. For nearly 20 years, from the late 1970’s through the mid-1990’s, through the ascendancy to peak of the band’s popularity, he had made his mark upon the world by and through his musicianship, and a well-known penchant for “tinkering” with his equipment, much like another renown late rock god and inventor – Les Paul – whom is considered the father of multi-track recording, and of the electric guitar.

As well, the Van Halen band’s customary practices brought about significant changes to the live-performance industry in performance contracts, with the addition of “riders” to their contracts – criteria stipulating certain conditions and specifications which must be met. The band was renown for their stipulation of seemingly picayune, senseless and inane requests, such as a bowlful of M&M’s candies which had to be placed in each of their dressing rooms. While deeper within the contract a separate stipulation would require the removal of all the brown-colored M&M’s.

Bizarre as it may seem, however, David Lee Roth, former lead singer and frontman who for 10 years helped catapult the band to success with now-iconic hits and his characteristic ultra high-energy performances, then rejoining for its last 10, said there was rhyme and reason to the seeming madness. It was a test to see if the contract had been thoroughly read and honored, which was critically important because of legitimate safety concerns the band had for their own, and others’ safety and well-being, as well as for preventing costly damage to equipment.

Early in the band’s history, several members of their road crew had very nearly been fatally electrocuted because of

The Economy WILL Crash. It’s only a matter of “WHEN?”

Economics has long been called the “dismal science.”¹

Perhaps it’s because they either a.) Tell the truth, or b.) Warn about bad things to come. Either way, it’s hardly a French tickler, and more like a Marquis de Sade.

But, some folks don’t enjoy hearing the truth, or as the actor Jack Nicholson’s character Guantanamo Base Commander Colonel Nathan Jessup raged upon the witness stand in the 1992 motion picture “A Few Good Men,” that “You can’t handle the truth!”

Of course, we’re familiar with how that movie turned out.

Free economies are based upon consumer spending. Period. Full stop.

If consumers don’t have money, they don’t spend. That’s easy enough to understand.

And, if anything, the coronoavirus pandemic has shown up how poorly prepared this president’s administration has been, and continues to be.

Again, those aren’t “nice words” to hear or read, but they are the unvarnished truth.

To say that “the economy is improving” is a mischaracterization of enormous proportion, so much so, and to the extent that, it’s either whistling past the graveyard, or Whistler’s Mother – both of whom are dead.

The economy was “doing well” according to some estimates. Those estimates included the DJIA, the stock indices of various firms and select industries, and some hedge funds. The “essential” worker bees were just hanging on by a thread in their retail, meat processing, and low-paid food service industry jobs. And once they got sick, they were fired, and… BAMMO! The shit hit the high-speed fan.

Suddenly, there were no more “worker bees” and the economic house of cards began to collapse with each puff of wind from COVID-19 patients’ coughs.

Fortunately, Congress (as in the House of Representatives) had the wisdom and foresight to actually bail out THE PEOPLE this time, and to give a much smaller hand-out to industry. The familiar cry “Where’s MY bailout!?!” was the primary sticking point with the previous administration in the process of recovery from “the Great Recession” when Big Business and industry got practically everything their hearts desired, but the people got nothing. Literally, nothing. Bupkis. Zero. Zilch. Nada. Not even a peck on the cheek after they were screwed.

This time, The People who lost their jobs due to COVID-19 were given an extra $600 per week of Unemployment Compensation, which was set to expire July 31. Ever seeking cheap labor to fill their stores, factories and farms, the Republicans decried the matter, but agreed to go along with the plan, hoping that the administration would  have a more cohesively unified plan to stop the assault of COVID-19 upon America’s lives, young and old, alike.

But as it became increasingly clear that nothing of the sort was going to happen, and that an extension of such benefits would likely become necessary because either businesses went belly-up, or couldn’t guarantee their employees’ safety on the job (as protection against COVID-19), the employees, many of whom were already at risk of serious injury from such infection, declined to return to work, and continued to draw their extra $600/week Unemployment Compensation.

But hey! A bright spot!

Facebook, Apple, Google, Amazon, and other industry monoliths were doing A-okay, and were even increasing profits! So yah… it was all sweetness and pleasantries once again for the Billionaire Class.

But The People.

Those pesky people.

Those essential sacrificial lambs of industry… what to do with them? Those who could – and still had jobs – worked from their residences. Those who, for whatever reason

French Scientists Discover COVID-19 In December 2019 BEFORE The China Outbreak

This information, which was reported just yesterday (Monday, 4 May 2020), is turning the entire understanding of this disease on its ear.

Previously thought to have originated in China, COVID-19 is now thought to have been spreading globally long before the outbreak in Wuhan, China ever occurred.

An interesting observation:
This individual –and– “Patient Zero” in Wuhan were BOTH fishmongers.

A germane question:
Could this virus be related to, or capable of being transmitted in aquatic wildlife?

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Who: 42 year old man born in Algeria, lived in France for many years, worked as fishmonger

What: retrospective investigation for SARS-COV2 (novel coronavirus, aka COVID-19) in respiratory samples collected

Where: intensive care units (ICUs) of hospital north of Paris, France

When: December 27, 2019

Why: Presented to emergency ward with hemoptysis (coughing up blood/bloody sputum), cough, headache and fever, evolving for 4 days

How: RT-PCR test (reverse transcription-polymerase chain reaction) the most sensitive technique for mRNA (genetic) detection and quantitation currently available

Additional Facts: Last trip was in Algeria during August 2019. One of his children presented with ILI (influenza-like illness) prior to the onset of his symptoms. His medical history included asthma, type II diabetes mellitus. Had not visited China.

See also: COVID-19 in France since December, hospital test suggests
Researchers testing old samples found COVID-19 in a man treated a month before France confirmed its first cases.
(https://www.aljazeera.com/news/2020/05/covid-19-france-december-hospital-test-suggests-200504154024084.html)

See also: French hospital discovers Covid-19 case from December
Man found to have had virus a month before government confirmed first cases
(https://www.theguardian.com/world/2020/may/04/french-hospital-discovers-covid-19-case-december-retested)

See also: After retesting samples, French hospital discovers COVID-19 case from December
(https://www.reuters.com/article/us-health-coronavirus-france/after-retesting-samples-french-hospital-discovers-covid-19-case-from-december-idUSKBN22G20L)

See also: French hospital discovers country’s first known Covid-19 case, from December
A French hospital which has retested old samples from pneumonia patients discovered that it treated a man who had Covid-19 as early as Dec. 27, nearly a month before the French government confirmed its first cases.
(https://www.france24.com/en/20200505-france-s-first-known-covid-19-case-was-in-december)

See also: After Retesting Samples, French Hospital Discovers COVID-19 Case From December
(https://www.nytimes.com/reuters/2020/05/04/world/europe/04reuters-health-coronavirus-france.html)

See also: Genetic Study Shows COVID-19 Was in France Weeks Before The First Case Was Reported
(https://www.sciencealert.com/genetic-investigation-reveals-covid-19-was-circulating-in-europe-before-cases-were-reported)

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International Journal of Antimicrobial Agents

Available online 3 May 2020, 106006

In Press, Journal Pre-proof
https://doi.org/10.1016/j.ijantimicag.2020.106006
https://www.sciencedirect.com/science/article/pii/S0924857920301643#fig0002

Highlights

• Covid-19 was already spreading in France in late December 2019, a month before the official first cases in the country.

• Early community spreading changes our knowledge of covid-19 epidemic.

• This new case changes our understanding of the epidemic and modeling studies should adjust to this new data.

Abstract

The COVID-19 epidemic is believed to have started in late January 2020 in France. We report here a case of a patient hospitalized in December 2019 in our intensive care, of our hospital in the north of Paris, for hemoptysis with no etiological diagnosis and for which RT-PCR was performed retrospectively on the stored respiratory sample which confirmed the diagnosis of COVID-19 infection. Based on this result, it appears that the COVID-19 epidemic started much earlier.

SARS-COV-2 was already spreading in France in late December 2019

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Introduction

After its onset in December 2019 in China, the new coronavirus (SARS-COV-2) spreads widely in several countries, causing COVID-19 illness.¹ World Health Organization (WHO) declared COVID-19 a pandemic on March 11, 2020.³ France reported the first cases of SARS-COV-2 related infection on January 24, 2020.⁵ Both cases had a history of travel to Wuhan.⁶ To the best of our knowledge, these 2 cases are believed to be the first confirmed cases in France. COVID-19 most commonly present with influenza-like illness (ILI).⁷ While China was facing COVID-19 outbreak, European countries were struggling with seasonal influenza.⁸ Clinical symptomatology between COVID-19 and ILIis similar,we therefore decided retrospectively to look for SARS-COV2 in respiratory samples collected in the intensive care units (ICUs) of our hospital near Paris.

Methods – Retrospective analysis

Selected records

We reviewed medical record of ICUs patients admitted for ILI between December 2, 2019 and January 16, 2020, with a negative RT-PCR performed at admission. Every respiratory sample collected in our hospital are

Scientific, Peer-Reviewed Study: Conservative-Only News Consumers Ill Informed, Believe COVID-19 Conspiracy Theories

No surprise there.

There’s a reason why Fox News is monikered Faux Noize.

The Republican party is NO LONGER the “Grand” Old Party.

It’s NOT the “party of Lincoln,” and hasn’t been for quite some time.

Since circa 1964, it’s been the party of the Ku Klux Klan, the John Birch Society, libertarians, and other radical elements. And, it was seriously ushered in during the Reagan administration when in his first inaugural address, the B-movie actor and longtime GE mouthpiece said in part that, “In this present crisis, government is not the solution to our problem; government is the problem.”

It’s easy to understand that if “government is the problem,” the solution to that problem is elimination of it. And that is anarchy. And yet, in his carefully crafted address, that was precisely what he was intimating – the abolition of government. For in his next sentence, he said, “From time to time we’ve been tempted to believe that society has become too complex to be managed by self-rule…”

It’s not difficult to see that his slashing of the Top Personal Income Tax bracket for the wealthiest Americans from 70% to 50%, and then to 28%, in conjunction with reductions in Capital Gains tax rates, and the “Paris Hilton Tax Cuts,” also monikered as the “Death Tax,” which is properly known as the Estate Tax, which only wealthy Americans have ever paid, was purposely designed to eliminate government, rather than to refine its operations, increase efficiency, or reduce fraud, waste, and abuse at any level.

When he said, “It is time to check and reverse the growth of government, which shows signs of having grown beyond the consent of the governed,” it could not have been made any more clear that his was a “starve the monster” approach to an alleged, though imaginary, and non-existing problem, that government was too big and the “monster” was the government.” And that was despite what he said in that same address that “Now, so there will be no misunderstanding, it’s not my intention to do away with government,”
because it couldn’t have been made more clear what his ultimate objectives were.

He again clearly identified government as being an evil monster when he said, “It is no coincidence that our present troubles parallel and are proportionate to the intervention and intrusion in our lives that result from unnecessary and excessive growth of government.” Hardly anyone could have done a better job of setting up a Straw Man Argument, for afterward, he beat that government straw man to a pulp.

Again, it is beyond the scope of the pale to imagine that a more populous nation would need fewer laws, or fewer people to efficiently and effectively conduct operations to provide for the demands and needs of more people. For that would be an inversely proportional relationship, that somehow a larger (more populous) nation, with more inventions, more businesses, more works of art, science, and other forms of creativity, would need fewer laws to govern their behavior and operations, and at some point in time, would eventually disappear.

The contradictions in his speech were blatant, and his intentions were fully uncloaked. Bluntly stating that “It is my intention to curb the size and influence of the Federal establishment,” he set about using his skills as an actor reassuring the people in a grandfatherly way that he had their best interests at heart, despite what he said otherwise.

The notion of “self-rule” is one which is emphasized by the ultra-radical group headquartered in Auburn, Alabama known as the Mises Institute, which promotes a heterodox economic world view, which includes anti-government sentiment, and the belief in the idea of anarchy – a world without government – and a “free market only” solution to everything as a one-size-fits-all solution to all problems.

Again, while Reagan was a B-movie actor, he was an actor nevertheless, and in his years on the stump for General Electric nationwide, he honed his public persuasion speeches to a fine edge, and was able to parlay that into a run for the White House which he won twice being monikered as the “Great Communicator.” But the language he used, while delivered quite well, was “dog whistle” language for anti-governmental radicals, all whom he welcomed into the GOP’s “Big Tent.”

The ground had earlier been ploughed at the 1964 Republican National Convention at Cow Palace in Daly City, CA (immediately adjacent and SOUTH of San Francisco) when then-NY Governor Nelson Rockefeller was granted 5 minutes to address the delegates to request adoption of language in the official party platform which would “repudiate here and now any doctrinaire, militant minority, whether Communist, Ku Klux Klan or Bircher which would subvert this party to purposes alien to the very basic tenets which gave this party birth.”

He was booed for over 16 minutes.

The language was simple, and read as follows:

Questions & Answers About Cannabis

NOTE: The more frequently, regularly updated version of this entry is found on the front page of this blog, which is linked here:
https://warmsouthernbreeze.wordpress.com/questions-answers-about-cannabis/

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Updated Tuesday, 26 October 2021

Effort is made to update this page regularly.

While the intended audience for these Q’s & A’s is meant primarily for medical, and healthcare science professionals, they may still be of some interest, or use, by others –– particularly for those who do not know that there is legitimate science behind the use, and recommendation of cannabis in various therapies.

From Franz Eugen Köhler’s Medizinal-Pflantzen. Published and copyrighted by Gera-Untermhaus, FE Köhler in 1887 (1883–1914). Hemp plant. A–flowering male and B–seed-bearing female plant, actual size; 1-male flower, enlarged detail; 2&3-pollen sac of same from various angles; 4-pollen grain of same; 5-female flower with cover petal; 6-female flower, cover petal removed; 7-female fruit cluster, longitudinal section; 8-fruit with cover petal; 9-same without cover petal; 10-same; 11-same in cross-section; 12-same in longitudinal section; 13-seed without hull.

So in that sense, enjoy!

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QUESTION: How should a clinician monitor the outcome of cannabinoid-based therapy?

ANSWER: As suggested by the Australian Centre for Cannabinoid Clinical and Research Excellence, monitoring should initially involve reviewing the patient weekly in person, and via phone if required in the interim between clinical reviews.
“There are three areas of outcomes that should be considered:
1.) Symptom control
“A pre-defined measure of success should be negotiated with the patient prior to commencement of therapy. This can be measured by using a validated tool, for example by the Palliative Care Symptom Assessment Scale.”
2.) Drug adverse events
“Careful monitoring of patients for adverse events and the need for a change in dosage is important. Adverse events may become apparent after commencement or after change in dose… Adverse events may be related to other concurrent medications. Doses of these medicines should be adjusted as appropriate.”
3.) Pathology monitoring
“Drug concentrations of drugs where there is a potential or actual drug-drug interaction may be important. Cannabidiol may cause hepatocellular injury. Patient’s liver function biochemistry should be monitored prior to initiation and periodically as clinically indicated.“

reference: Prescribing Cannabis Medicines for Chronic Non-cancer Pain v2 September 2019 c10. – by the Australian Centre for Cannabinoid Clinical and research Excellence https://www.ces.edu.co/wp-content/uploads/2020/09/acre-prescribing-guidance-chronic-non-cancer-pain.pdf

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QUESTION: Some patients use cannabinoid-based medicines to treat nausea and vomiting. Is one of the side effects of cannabinoid-based medicines nausea/ vomiting?

ANSWER: Yes. The adverse event profile of cannabinoid-based formulations is dependent upon the ratio of CBD:THC, the presence of other cannabinoids and terpenes, and the dose consumed. The known common adverse effects of cannabinoid-based medicines include sedation/somnolence, dizziness, anxiety, cognitive dysfunction, nausea, vomiting, diarrhea, vertigo, increased or decreased appetite and dry mouth.

reference: “Brenneisen R, Egli A, ElSohly MA, Henn V, Spiess Y. The effect of orally and rectally administered delta9-tetrahydrocannabinol on spasticity: a pilot study with 2 patients. Int. J. Clin. Pharmacol. Ther. 1996 Oct;34(10)446-52. https://pubmed.ncbi.nlm.nih.gov/8897084/

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QUESTION: Even if an individual employs the same mode of administration over time, the effects of cannabinoids may change for that individual. Provide some reasons why this may be so.

ANSWER: The effects of cannabinoids may change over time due to multiple factors, including:
• Tolerance to the cannabinoids may develop
• A change in the patient’s health status/ medical condition may change over time and lead to physiological changes in the endocannabinoid system (For example, inflammation impacts the ECS. Also, impaired G.I./liver function affects the absorption and metabolism of cannabinoids.)
• The patient may start or stop taking a medication that interacts with cannabinoids or affects the metabolism of the cannabinoid-based product.
• Physiologic changes in the endocannabinoid system take place as patients age.

reference: Grotenhermen F. Clinical pharmacokinetics of cannabinoids. J Cannabis Ther, 2003; 3(1): 3-51. https://www.tandfonline.com/doi/abs/10.1300/J175v03n01_02 Huestis MA. Human cannabinoid pharmacokinetics. Chem Biodivers. 2007;4(8):1770-804. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2689518/

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QUESTION: The effects of cannabinoids are dependent upon the route of administration, the health of the consumer and other factors. There is also interindividual variation. Provide some reasons why the effects of cannabinoids vary among individuals.

ANSWER: There are many reasons why the effects of cannabinoids vary among individuals. SOME of the reasons are: diet, age, health of the patient, and co-administered medications may impact metabolism and efficacy of cannabinoid-based products. Also, some patients have a genetic profile such that they are predisposed to experience side effects (for ex., exacerbation of a psychotic disorder/schizophrenia) after exposure to THC. In addition, patients that have been consuming cannabinoid-based products long-term react differently than patients who have never consumed cannabinoid-based products.

reference: Grotenhermen F. Clinical pharmacokinetics of cannabinoids. J Cannabis Ther, 2003; 3(1): 3-51. https://www.tandfonline.com/doi/abs/10.1300/J175v03n01_02 Huestis MA. Human cannabinoid pharmacokinetics. Chem Biodivers. 2007;4(8):1770-804. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2689518/

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QUESTION: How should the cannabinoid-based therapy be withdrawn?

ANSWER: According to the Health Canada document entitled “Information for Health Care Professionals – Cannabis (marihuana, marijuana) and the Cannabinoids,” “If intolerable adverse effects appear without significant benefit, dosing should be tapered and stopped. Tapering guidelines have not been published, but the existence of a withdrawal syndrome suggests that tapering should be done slowly (i.e. over several days or weeks).” Note: When discontinuing cannabidiol therapies used for the treatment of seizure disorders, the dose should be decreased gradually. As with all antiepileptic drugs, abrupt discontinuation should be avoided when possible, to minimize the potential risk of increased seizure frequency and status epilepticus.

reference: Grotenhermen F. Clinical pharmacokinetics of cannabinoids. J Cannabis Ther, 2003; 3(1): 3-51. https://www.tandfonline.com/doi/abs/10.1300/J175v03n01_02. Huestis MA. Human cannabinoid pharmacokinetics. Chem Biodivers. 2007;4(8):1770-804. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2689518/

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QUESTION: What is the half life of CBD? How does it compare to the half life of THC?

ANSWER: The half life of CBD is 18-32 hours, which is similar to the half life of THC of 20-30 hours. Both CBD and THC are distributed to fatty tissues and highly perfused organs such as brain, heart, lung, and liver.

reference: Medical Marijuana, Recreational Cannabis, and Cardiovascular Health: A Scientific Statement From the American Heart Association. Robert L. Page II , Larry A. Allen , Robert A. Kloner , Colin R. Carriker, Catherine Martel , Alanna A. Morris , Mariann R. Piano , Jamal S. Rana , Jorge F. Saucedo , … See all authors. Originally published 5 Aug 2020. https://www.ahajournals.org/doi/full/10.1161/CIR.0000000000000883

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QUESTION: What are some of the more common reasons dermatologists recommend cannabinoid-based medicines?

ANSWER: According to the results of a survey of 145 dermatologists, 91 % of dermatologists were in support of medical cannabis use and 13.8 % have recommended it for a dermatologic condition. Atopic dermatitis (45 %) and psoriasis (40 %) were the most common. The most common form of administration was topical (75 %). The main reasons for not recommending medical cannabis were limited knowledge (56 %) and lack of experience (48 %).

reference: Perceptions and recommendation behaviors of dermatologists for medical cannabis: A pilot survey. Samuel Yeroushalmi, Kamaria Nelson, AndrewSparks, AdamFriedman. https://pubmed.ncbi.nlm.nih.gov/33220620/

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QUESTION: Has the use of a transdermal gel for regional and systemic delivery of CBD been evaluated for the treatment of epilepsy?

ANSWER: Yes. A transdermal gel for regional and systemic delivery of CBD (Zynerba Pharmaceuticals) is in clinical development for treatment of epilepsy, developmental and epileptic encephalopathy, fragile-X syndrome, and osteoarthritis. NOTE: As of September 2021, the company’s website indicates that the product is not yet approved by government regulatory bodies, including the United States Food and Drug Administration (FDA) and other agencies, and must be tested to see if it is an effective and safe treatment.

reference: A Review of the Safety and Effectiveness of Select Ingredients in Compounded Topical Pain Creams.” National Academies of Sciences, Engineering, and Medicine. 2020. Compounded Topical Pain Creams: Review of Select Ingredients for Safety, Effectiveness, and Use. Washington, DC: The National Academies Press. https://www.nap.edu/catalog/25689/compounded-topical-pain-creams-review-of-select-ingredients-for-safety

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QUESTION: Have human studies evaluated the effects of cannabinoid consumption on cortisol levels?

ANSWER: Yes – Human studies have demonstrated that the consumption of cannabinoids modulate cortisol release. Acutely, the consumption of cannabis (or THC) by naive or infrequent cannabis users may increase the secretion of cortisol. In chronic cannabis users, the stimulatory effect of THC on cortisol levels is blunted. This blunted response suggests that a tolerance develops. Some studies have reported that chronic cannabis users exhibit elevated basal cortisol levels, but that stress- induced activation of the axis is blunted in chronic adult and adolescent cannabis users.

reference: Meah, F., Lundholm, M., Emanuele, N. et al. The effects of cannabis and cannabinoids on the endocrine system. Rev Endocr Metab Disord (2021). Aug 30, 2021. https://doi.org/10.1007/s11154-021-09682-w

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QUESTION: Do endocannabinoids impact insulin release?

ANSWER: Yes. Endocannabinoids act in an autocrine and paracrine fashion to mediate the activity of the pancreas and mediate insulin secretion. – It has been shown that endocannabinoids influence basal as well as glucose-induced insulin release. Also, endocannabinoids have been shown to have an effect on β cell proliferation and survival. (Pancreatic β cells are the cells that synthesize and secrete insulin.)

reference: Meah, F., Lundholm, M., Emanuele, N. et al. The effects of cannabis and cannabinoids on the endocrine system. Rev Endocr Metab Disord (2021). Aug 30, 2021. https://doi.org/10.1007/s11154-021-09682-w

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QUESTION: Can children with developmental and epileptic encephalopathies tolerate adjunctive cannabidiol (CBD) transdermal gel, and is CBD gel associated with reduced seizure frequency?

ANSWER: Yes, CBD is well tolerated, and is associated with a reduction in seizure activity – frequency and intensity – in children, including improvements in alertness, energy, improved sleep, and in cognition or concentration. According to a JAMA Open Network article published in September 2021, in a “nonrandomized controlled trial, CBD transdermal gel was well tolerated over 6.5 months of treatment, with 60% of patients experiencing a treatment-related adverse event, 96% of which were mild or moderate. A 43.5% reduction in seizure frequency was observed in focal impaired awareness seizures and tonic-clonic seizures.” Also, the researchers stated that “Parents and caregivers noted improvements in social or interpersonal engagement and irritability (33 of 43 [77%] participants); alertness, energy, and sleep (23 of 43 [53%]); and cognition or concentration (20 of 43 [47%]).”

reference: Scheffer IE, Hulihan J, Messenheimer J, et al. Safety and Tolerability of Transdermal Cannabidiol Gel in Children With Developmental and Epileptic Encephalopathies: A Nonrandomized Controlled Trial. JAMA Netw Open. 2021;4(9):e2123930. doi:10.1001/jamanetworkopen.2021.23930 https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2783716

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QUESTION: What influences chronic pain patients’ use of medical cannabinoids?

ANSWER: The British Medical Journal recently published results of a systematic review that explored values and preferences towards medical cannabis (MC) among people living with chronic pain. The results were as follows: “High to moderate certainty evidence showed that patient’s use of MC for chronic pain was influenced by both positive (eg, support from friends and family) and negative social factors (eg, stigma surrounding cannabis use). Most patients using MC favoured products with balanced ratios of THC and CBD, or high levels of CBD, but not high THC preparations. Many valued the effectiveness of MC for symptom management even when experiencing adverse events related to concentration, memory or fatigue. Reducing use of prescription medication was a motivating factor for use of MC, and concerns regarding addiction, losing control or acting strangely were disincentives. Out-of-pocket costs were a barrier, whereas legalisation of MC improved access and incentivised use.”

reference: Zeng L, Lytvyn L, Wang X, et al Values and preferences towards medical cannabis among people living with chronic pain: a mixed-methods systematic review BMJ Open 2021;11:e050831. doi: 10.1136/bmjopen-2021-050831. https://bmjopen.bmj.com/content/11/9/e050831#ref-10

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QUESTION: Do cannabinoids affect the male reproduction system?

ANSWER: Yes. Cannabinoid receptors are located in multiple parts of the male reproductive system, including the hypothalamus, pituitary, Leydig cells, and sperm. The binding of cannabinoids to cannabinoid 1 receptors may lead to a reduction in plasma testosterone, LH and FSH.

reference: Meah, F., Lundholm, M., Emanuele, N. et al. The effects of cannabis and cannabinoids on the endocrine system. Rev Endocr Metab Disord (2021). Aug 30, 2021 https://doi.org/10.1007/s11154-021-09682-w

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QUESTION: How does anandamide’s activation of CB1 receptors on sperm cells impact sperm cells?

ANSWER: Activation of CB1 receptors on sperm by anandamide – a fatty acid neurotransmiter endocannabinoid, or THC, leads to reduction of sperm survival and motility, and inhibition of fertilization capacity by hindering the capacitation-induced acrosome reaction needed to penetrate the zona pellucida.

reference: Meah, F., Lundholm, M., Emanuele, N. et al. The effects of cannabis and cannabinoids on the endocrine system. Rev Endocr Metab Disord (2021). Aug 30, 2021 https://doi.org/10.1007/s11154-021-09682-w

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QUESTION: Marijuana use has been associated with an impairment of spermatogenesis and testicular function. How long will those effects last?

ANSWER: It has been reported that recovery of spermatogenesis and testicular cell function status post exposure to marijuana is approximately about 45 days.

reference: Meah, F., Lundholm, M., Emanuele, N. et al. The effects of cannabis and cannabinoids on the endocrine system. Rev Endocr Metab Disord (2021). Aug 30, 2021 https://doi.org/10.1007/s11154-021-09682-w

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QUESTION: How do endocannabinoids differ from many other neurotransmitters?

ANSWER: Endocannabinoids are very lipophilic and therefore cannot be stored in vesicles like many other neurotransmitters. The precursors of endocannabinoids are present in lipid membranes and, upon activation of some G-protein coupled receptors, these precursors are released into the extracellular space. Endocannabinoids are synthesized on demand in post-synaptic structures and travel retrograde through the synaptic cleft to cannabinoid type 1 receptors located presynaptically. Activation of cannabinoid type 1 receptors leads to inhibition of neurotransmitter release.

reference: Meah, F., Lundholm, M., Emanuele, N. et al. The effects of cannabis and cannabinoids on the endocrine system. Rev Endocr Metab Disord (2021). Aug 30, 2021 https://doi.org/10.1007/s11154-021-09682-w

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QUESTION: Polycystic ovarian syndrome (PCOS) is a syndrome associated with hyperandrogenism, menstrual irregularities, and polycystic ovaries. Is there any evidence that the endocannabinoid system is involved in the development of PCOS?

ANSWER: Yes. In a human study that evaluated the possibility of a link between the endocannabinoid system and PCOS, the researchers found that the endometrium of PCOS patients exhibited reduced levels of fatty acid amide hydrolase, (the catabolic enzyme for anandamide), compared to women without PCOS. This finding correlated with increased levels of anandamide in patients with PCOS. Also the activation of the ECS and overexpression of CB1 receptors may be associated with insulin resistance in women in PCOS.

reference: Meah, F., Lundholm, M., Emanuele, N. et al. The effects of cannabis and cannabinoids on the endocrine system. Rev Endocr Metab Disord (2021). Aug 30, 2021. https://doi.org/10.1007/s11154-021-09682-w

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QUESTION: Does marijuana impact platelet function?

ANSWER: Yes. Some cannabinoids have antiplatelet and antithrombogenic effects. However, in some instances marijuana use has been reported to have the opposite effect and promote platelet aggregation.

reference: Meah, F., Lundholm, M., Emanuele, N. et al. The effects of cannabis and cannabinoids on the endocrine system. Rev Endocr Metab Disord (2021). Aug 30, 2021. https://doi.org/10.1007/s11154-021-09682-w

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QUESTION: Are endocannabinoids hydrophilic or lipophilic?

ANSWER: Endocannabinoids are lipophilic neurotransmitters. They mediate agonist as well as antagonist effects via cannabinoid receptors found in the brain and peripheral nervous system.

reference: Meah, F., Lundholm, M., Emanuele, N. et al. The effects of cannabis and cannabinoids on the endocrine system. Rev Endocr Metab Disord (2021). Aug 30, 2021 https://doi.org/10.1007/s11154-021-09682-w

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QUESTION: When the endocannabinoid system was originally discovered in the 1990’s, it was described as a neural communication system. Does the endocannabinoid system have functions other than neural communication?

ANSWER: Yes. The endocannabinoid system can be found in almost every cell/ tissue and this system plays an important role in the normal functioning of many organ systems.

reference: Meah, F., Lundholm, M., Emanuele, N. et al. The effects of cannabis and cannabinoids on the endocrine system. Rev Endocr Metab Disord (2021). Aug 30, 2021 https://doi.org/10.1007/s11154-021-09682-w

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QUESTION: How do exogenous cannabinoids (phytocannabinoids or synthetic cannabinoids) affect physiologic systems like the endocrine system?

ANSWER: Exogenous cannabinoids bind to endogenous cannabinoid receptors in various organs, and may also modulate cannabinoid receptor expression. As a result, exogenous cannabinoids may alter endocannabinoid target effects and organ function.

reference: Meah, F., Lundholm, M., Emanuele, N. et al. The effects of cannabis and cannabinoids on the endocrine system. Rev Endocr Metab Disord (2021). Aug 30, 2021 https://doi.org/10.1007/s11154-021-09682-w

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QUESTION: True or false? Cannabinoid type 1 receptors are G-protein coupled receptors found in multiple organ systems, including the nervous system, skeletal system, lungs, cardiovascular system, musculoskeletal system, gi tract, and the lymph system, as well as in many endocrine organs, including the hypothalamus, pituitary, thyroid, adrenals, uterus, ovaries, testes, and placenta.

ANSWER: The statement is true, but the density and level of expression of cannabinoid receptors varies in the different organ systems.

reference: Meah, F., Lundholm, M., Emanuele, N. et al. The effects of cannabis and cannabinoids on the endocrine system. Rev Endocr Metab Disord (2021). Aug 30, 2021 https://doi.org/10.1007/s11154-021-09682-w

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QUESTION: On what cell surfaces are cannabinoid type 2 receptors typically found?

ANSWER: Cannabinoid type 2 receptors, like type 1 receptors, are G-protein coupled receptors; the type 2 receptors are primarily on the surface of the immune system cells, tonsils, the gi tract, bone, and peripheral nerve endings. Expression is highly inducible and is most often expressed when there is active inflammation or injury.

reference: Meah, F., Lundholm, M., Emanuele, N. et al. The effects of cannabis and cannabinoids on the endocrine system. Rev Endocr Metab Disord (2021). Aug 30, 2021 https://doi.org/10.1007/s11154-021-09682-w

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QUESTION: In some legal states, edibles, such as candies, baked goods, beverages and condiments (butter and oils) containing THC may be sold. Is 2.5mg of THC in an edible a low dose or high dose of THC to be consumed orally?

ANSWER: The dosing of THC always needs to be adjusted on an individual basis. For reference, 2.5 mg is the lowest dose of dronabinol, a synthetic THC that is FDA-approved.

reference: Meehan-Atrash, J., Luo, W., & Strongin, R. M. (2017). Toxicant Formation in Dabbing: The Terpene Story. ACS Omega, 2(9), 6112–6117. https://doi.org/10.1021/acsomega.7b01130

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QUESTION: Does short term treatment with THC rich cannabis induce clinical remission and improve quality of life in patients with mild to moderately active ulcerative colitis?

ANSWER: Yes, according to a recent study. However, these beneficial clinical effects were NOT associated with significant anti-inflammatory improvement in the Mayo endoscopic score or laboratory markers for inflammation. These results were derived from a double-blind, randomized, placebo-controlled trial, – 32 patients received either cigarettes containing 0.5 g of dried cannabis flowers with 80mg THC or placebo cigarettes for 8 weeks. Parameters of disease including Lichtiger disease activity index, C reactive protein (CRP), calprotectin, Mayo endoscopic score and quality of life (QOL) were assessed before, during and after treatment.

reference: Cannabis is associated with clinical but not endoscopic remission in ulcerative colitis: A randomized controlled trial Timna Naftali , Lihi Bar-Lev Schleider, Fabiana Scklerovsky Benjaminov, Fred Meir Konikoff, Shelly Tartakover Matalon, Yehuda Ringel Published: February 11, 2021 https://doi.org/10.1371/journal.pone.0246871

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QUESTION: What are the effects of cannabis-based therapies on oxaliplatin-induced peripheral neuropathy among oncology patients?

ANSWER: The results of a retrospective study indicated that the rate of neuropathy was reduced among patients treated with cannabis-based therapies and oxaliplatin. This reduction was more significant in patients who received cannabis-based products prior to treatment with oxaliplatin, suggesting a protective effect. (A large prospective trial examining the effects of cannabis-based products on oxaliplatin-induced neuropathy is planned.)

reference: Waissengrin B, Mirelman D, Pelles S, et al. Effect of cannabis on oxaliplatin-induced peripheral neuropathy among oncology patients: a retrospective analysis. Theranpeutic Advances in Medical Oncology. January 2021. doi: 10.1177/1758835921990203. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7876573/

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QUESTION: The Veterans Health Administration (VHA) abides by the classification of cannabis as a Schedule I substance. Does the VHA prohibit their clinicians from speaking with their patients about cannabis?

ANSWER: No, the VHA recently recommended that clinicians discuss cannabis with their patients. However, according to a study published in February 2021, VHA clinicians identified several factors that inhibit conversations about cannabis use with their patients including the unfamiliarity with pharmacology, formulations, and dosing of cannabis; and uncertainty regarding VHA policy.

reference: Vivian A Christensen, Shannon M Nugent, Chelsea K Ayers, Benjamin J Morasco, Devan Kansagara; A qualitative study of VHA clinicians’ knowledge and perspectives on cannabis for medical purposes; Family Practice, 2021; cmaa151, https://doi.org/10.1093/fampra/cmaa151

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QUESTION: True or false? CBD interacts with transient receptor potential cation channel subfamily V member 1 (TRPV1) receptors.

ANSWER: True. It has been found in rat models of acute inflammation that the vanilloid TRPV1 receptor mediates the antihyperalgesic effect of cannabidiol.

reference: Maguire R.F, Wilkinson D.J., England T.J., O’Sullivan S.E.; The Pharmacological Effects of Plant-Derived versus Synthetic Cannabidiol in Human Cell Lines. Medical Cannabis and Cannabinoids. July 29 2021. https://www.karger.com/Article/Pdf/517120

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QUESTION: True or false? CBD interacts with serotonin 1 A receptors (5HT1A) and impacts cellular activity of some cell lines.

ANSWER: True. In in vitro models, COX-2 and PPAR-γ confer cannabidiol-induced apoptosis of human lung cancer cells.

reference: Ramer R, Heinemann K, Merkord J, Rohde H, Salamon A, Linnebacher M, et al.; COX-2 and PPAR-γ confer cannabidiol-induced apoptosis of human lung cancer cells. Mol Cancer Ther. 2013 Jan 1;12(1):69–82. https://mct.aacrjournals.org/content/12/1/69

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QUESTION: Did the “Stay at Home” orders during COVID lead to a significant decrease in sales of cannabinoid-based products in Alaska, Colorado, Oregon and Washington?

ANSWER: No. Actually, cannabis sales increased in all four states coinciding with state stay-at-home orders, and sales reached a three-year peak in all four states between May and July 2020.

reference: Schauer GL et al. Cannabis sales increases during COVID-19: Findings from Alaska, Colorado, Oregon, and Washington, International J of Drug Pol Vol 98, 2021. https://www.sciencedirect.com/science/article/abs/pii/S0955395921002899

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QUESTION: Are cannabinoid receptors present on skin cells?

ANSWER: Yes. Cannabinoid receptors are present on many types of skin cells, including keratinocytes and fibroblasts. The results of preliminary studies evaluating the effects of cannabis extracts on skin cells indicate that hemp extracts may reduce oxidative stress, inhibit skin aging processes and positively affect the viability of skin cells. Analyses also showed that hydrogels based on cannabis extracts have a positive effect on skin hydration.

reference: Zagórska-Dziok,M.; Bujak, T.; Ziemlewska, A.; Nizioł-Łukaszewska, Z. Positive Effect of Cannabis sativa L. Herb Extracts on Skin Cells and Assessment of Cannabinoid-Based Hydrogels Properties. Molecules 2021, 26, 802. https://www.mdpi.com/1420-3049/26/4/802

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QUESTION: The labels of some probiotic supplements indicate that probiotics support a healthy immune system, strengthen digestive balance, help maintain a balance of healthy intestinal bacteria, help breakdown undigested carbohydrates and sugars, and facilitate the absorption of nutrients. Do cannabis-based edibles exhibit pre-biotic/probiotic properties?

ANSWER: In addition to cannabinoids, flavonoids, terpenoids, and polysaccharides may be present in cannabis-based edibles, and these cannabis constituents may exhibit prebiotic/probiotic properties and improve the composition of the gut microbiome.

reference: Cannabis and Cannabis Edibles: A Review; Han Peng and Fereidoon Shahidi* J. Agric. Food Chem. 2021, XXXX, XXX, XXX-XXX. © 2021 American Chemical Society Publication Date: February 8, 2021 https://doi.org/10.1021/acs.jafc.0c07472

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QUESTION: What is the most common mode of administration of CBD?

ANSWER: According to an online survey conducted in 2017-2018, the most common method of CBD administration was sublingual, followed by vaping, oral ingestion of capsules and liquids, smoking, edibles, and topical administration.

reference: Corroon J, Phillips JA. A cross-sectional study of cannabidiol users. Cannabis Cannabinoid Res 2018; 3(1):152–61. https://pubmed.ncbi.nlm.nih.gov/30014038/

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QUESTION: Does THC have a dose-dependent effect on sleep?

ANSWER: Yes – Human experimental data suggests “THC has a dose-dependent effect on sleep—low doses appear to decrease sleep onset latency and increase slow-wave sleep and total sleep time, while high doses appear to cause sleep disturbances.” Also, “limited evidence from clinical studies also suggest that certain cannabinoids (cannabis, nabilone, dronabinol, nabiximols) may improve sleep in patients with disturbances in sleep associated with certain chronic disease states.”

reference: https://www.canada.ca/content/dam/hc-sc/documents/services/drugs-medication/cannabis/information-medical-practitioners/information-health-care-professionals-cannabis-cannabinoids-eng.pdf

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QUESTION: Is there ANY evidence that CBD attenuates the THC-induced psychosis?

ANSWER: Yes – “Emerging evidence from pre-clinical, clinical and epidemiological studies suggests CBD may attenuate THC-induced psychosis.”

reference: https://www.canada.ca/content/dam/hc-sc/documents/services/drugs-medication/cannabis/information-medical-practitioners/information-health-care-professionals-cannabis-cannabinoids-eng.pdf

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QUESTION: Efficacy and safety of add-on cannabidiol (CBD) to treat seizures associated with Lennox Gastaut Syndrome (LGS) was demonstrated in two randomized controlled trials (RCTs). Have the long-term effects of CBD use to treat the drug resistant seizures of LGS been evaluated?

ANSWER: Yes. 366 patients enrolled in a long-term open-label extension trial. The results are as follows: “Adverse events (AEs) occurred in 96% of patients, serious AEs in 42%, and AE-related discontinuations in 12%. Common AEs were convulsion (39%), diarrhea (38%), pyrexia (34%), and somnolence (29%). Fifty-five (15%) patients experienced liver transaminase elevations more than three times the upper limit of normal; 40 (73%) were taking concomitant valproic acid. Median percent reductions from baseline ranged 48%–71% for drop seizures and 48%–68% for total seizures through 156 weeks. Across all 12-week visit windows, 87% or more of patients/caregivers reported improvement in the patient’s overall condition on the Subject/Caregiver Global Impression of Change scale.”

reference: Patel, AD, Mazurkiewicz-Bełdzińska, M, Chin, RF, Gil-Nagel, A, Gunning, B, Halford, JJ, et al. Long-term safety and efficacy of add-on cannabidiol in patients with Lennox–Gastaut syndrome: Results of a long-term open-label extension trial. Epilepsia. 2021; 00: 1– 12. https://onlinelibrary.wiley.com/doi/abs/10.1111/epi.17000

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QUESTION: CBD interacts with warfarin. Does this drug:drug interaction lead to an increased risk of bleeding or a decrease in warfarin’s anticoagulation effect?

ANSWER: The inhibition of CYP2C19 by CBD can increase levels of warfarin, and multiple reports have indicated that the interaction between warfarin and CBD results in an increased risk of bleeding.

reference: 1.) Treese NM, Flowers M. Pharmacist’s guide to CBD oil. US Pharm. 2020; 45(3):20-23. https://www.uspharmacist.com/article/pharmacists-guide-to-cbd-oil 2.) Welty TE, Chapman KE, Faught RE, Kotloski RJ. American Epilepsy Society (AES): Written Comments to Norman E. “Ned” Sharpless, MD, Acting Commissioner of Food and Drugs, U.S. Food and Drug Administration (FDA), Department of Health and Human Services (HHS): on Docket ID# FDA-2019-N-1482, Scientific Data and Information about Products Containing Cannabis or Cannabis-Derived Compounds; Public Hearing; Request for Comments: Submitted on: July 16, 2019. Epilepsy Currents 2019; 19(6):361-368. doi:10.1177/1535759719878716. https://journals.sagepub.com/doi/10.1177/1535759719878716

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QUESTION: Have CBD’s effects in monkeys been evaluated?

ANSWER: Yes, according to a World Health Organization Cannabidiol (CBD) report in November 2017, in studies involving the use of CBD in monkeys, no effect on a wide range of physiological and biochemical parameters or significant effects on animal behavior were noted unless extremely high doses of CBD (e.g., in excess of 150 mg/kg iv as an acute dose or in excess of 30 mg/kg orally daily for 90 days) were administered.

reference: World Health Organization (WHO) – Expert Committee on Drug Dependence Thirty-ninth Meeting Cannabidiol (CBD) Pre-Review Report Agenda Item 5.2 Geneva, 6-10 November 2017 See: https://www.who.int/medicines/access/controlled-substances/5.2_CBD.pdf

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QUESTION: PRE-CLINICAL studies show that certain cannabinoids (THC, CBD, THCV, CBDV) and cannabinoid acids (THCA and CBDA) suppress acute nausea and vomiting. Do PRE-CLINICAL studies also show that those same cannabinoids and cannabinoid acids suppress anticipatory nausea?

ANSWER: Yes. In addition, there is limited evidence from CLINICAL studies that suggests that the use of certain cannabinoids and cannabis may provide relief from chemotherapy-induced nausea and vomiting (CINV).

reference: https://www.canada.ca/content/dam/hc-sc/documents/services/drugs-medication/cannabis/information-medical-practitioners/information-health-care-professionals-cannabis-cannabinoids-eng.pdf

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QUESTION: Evidence from observational studies and clinical studies suggests that marijuana (limited evidence) and prescription cannabinoids (e.g. dronabinol, nabilone, or nabiximols) may be useful in alleviating one or several co-occurring symptoms often experienced by patients in the palliative care setting. What are some of these palliative care setting symptoms?

ANSWER: These symptoms may include, but are not limited to, intractable nausea and vomiting associated with chemotherapy or radiotherapy, anorexia/cachexia, severe intractable pain, severe depressed mood and anxiety, and insomnia. Also, a limited number of observational studies suggest that the use of cannabinoids in the palliative care setting may be associated with a decrease in the number of some medications used by palliative care patients.

reference: https://www.canada.ca/content/dam/hc-sc/documents/services/drugs-medication/cannabis/information-medical-practitioners/information-health-care-professionals-cannabis-cannabinoids-eng.pdf

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QUESTION: Available evidence from human clinical studies suggests that marijuana (limited evidence) and prescription cannabinoid-based medicines (dronabinol) may increase appetite and caloric intake, and promote weight gain in patients with HIV/AIDS. Has the use of cannabinoid-based medicines in cancer or anorexia nervosa been evaluated, too?

ANSWER: Yes. The evidence for dronabinol is mixed and effects modest for patients with cancer and weak for patients with anorexia nervosa.

reference: https://www.canada.ca/content/dam/hc-sc/documents/services/drugs-medication/cannabis/information-medical-practitioners/information-health-care-professionals-cannabis-cannabinoids-eng.pdf

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QUESTION: Evidence from PRE-CLINICAL studies suggests THC, CBD and nabiximols improve multiple sclerosis (MS) associated symptoms of tremor, spasticity and inflammation. Has the utility of cannabinoids for MS symptoms been evaluated in CLINICAL STUDIES?

ANSWER: Yes. -the available evidence from CLINICAL studies suggest marijuana (limited evidence) and certain cannabinoids (dronabinol, nabiximols (Sativex), THC/CBD) are associated with some measure of improvement in some MS symptoms and spinal cord injury (SCI), including spasticity, spasms, pain, sleep and symptoms of bladder dysfunction.

reference: https://www.canada.ca/content/dam/hc-sc/documents/services/drugs-medication/cannabis/information-medical-practitioners/information-health-care-professionals-cannabis-cannabinoids-eng.pdf

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QUESTION: An oral CBD product (Epidiolex®) has been approved by the FDA for the treatment of certain drug-resistant seizures, including Dravet syndrome and Lennox-Gastaut syndrome. Does THC also have anti-seizure properites?

ANSWER: The available evidence from pre-clinical studies suggests that some CB1 receptor agonists (including THC) may have either pro- or anti-epileptic properties.

reference: https://www.canada.ca/content/dam/hc-sc/documents/services/drugs-medication/cannabis/information-medical-practitioners/information-health-care-professionals-cannabis-cannabinoids-eng.pdf

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QUESTION: What is the half life of CBD?

ANSWER: The half life of CBD is dependent upon the mode of administration. When administered intravenously, the half life of CBD is 18-30 hours, when administered via inhalation, the half life is 27-35 hours, and when administered orally, the half life is 2-5 days.

reference: SOUZA, A.A.F. de; SILVA, A.F.M. da .; ABREU, L.R. de; SILVA, T.F. da; GRECO, G.; SANTOS, S. da S.; GONZAGA, R.V.; Medicinal uses of Cannabis sp. Research, Society and Development, [S.l.], v.10, n.7, p.e58010716930, 2021. DOI: 10.3344

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QUESTION: N-arachidonoyl ethanolamine (AEA) aka anandamide, and 2- arachidonoyl glycerol (2-AG) are the two most well-studied endocannabinoids. Are there other endocannabinoids?

ANSWER: Other than Anandamide and 2-AG, there are other endocannabinoids: “virodhamine… acts as a full and selective CB1 agonist; N-arachidonyl- dopamine (NADA) is a CB1 agonist and potent activator of TrpV1; and palmitoylethanolamide (PEA) is involved with anti- inflammatory, analgesic and neuroprotective processes.”

reference: SOUZA, A. A. F. de; SILVA , A. F. M. da .; ABREU , L. R. de .; SILVA, T. F. da .; GRECO, G. .; SANTOS, S. da S. .; GONZAGA, R. V. Medicinal uses of Cannabis sp. . Research, Society and Development, [S. l.], v. 10, n. 7, p. e58010716930, 2021. DOI: 10.33448/rsd-v10i7.16930. Disponível em: https://rsdjournal.org/index.php/rsd/article/view/16930. Acesso em: 2 jul. 2021. https://rsdjournal.org/index.php/rsd/article/view/16930

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QUESTION: What are THCA-A and CBDA?

ANSWER: THCA-A (tetrahydrocannabinolic acid-A) and CBDA (cannabidiolic acid ) are the acid forms (the carboxylated forms) of THC and CBD, and these acid forms are found in the cannabis plant. Decarboxylation of THCA-A and CBDA takes place when the plant products are heated, and results in the bioactive compounds THC and CBD, respectively.

reference: SOUZA, A. A. F. de; SILVA , A. F. M. da .; ABREU , L. R. de .; SILVA, T. F. da .; GRECO, G. .; SANTOS, S. da S. .; GONZAGA, R. V. Medicinal uses of Cannabis sp. . Research, Society and Development, [S. l.], v. 10, n. 7, p. e58010716930, 2021. DOI: 10.33448/rsd-v10i7.16930. Disponível em: https://rsdjournal.org/index.php/rsd/article/view/16930. Acesso em: 2 jul. 2021. https://rsdjournal.org/index.php/rsd/article/view/16930

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QUESTION: Are cannabinoids lipophilic or hydrophylic?

ANSWER: Cannabinoids are actually highly lipophilic. In fact, oral and topical cannabinoid products are often administered with a carrier to facilitate their absorption. The high lipophilicity of cannabinoid-based products is associated with a THC and CBD oral absorption range of only 10 to 20%.

reference: SOUZA, A. A. F. de; SILVA , A. F. M. da .; ABREU , L. R. de .; SILVA, T. F. da .; GRECO, G. .; SANTOS, S. da S. .; GONZAGA, R. V. Medicinal uses of Cannabis sp. . Research, Society and Development, [S. l.], v. 10, n. 7, p. e58010716930, 2021. DOI: 10.33448/rsd-v10i7.16930. Disponível em: https://rsdjournal.org/index.php/rsd/article/view/16930. Acesso em: 2 jul. 2021. https://rsdjournal.org/index.php/rsd/article/view/16930

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QUESTION: N-arachidonoyl ethanolamine (AEA) aka anandamide, and 2- arachidonoyl glycerol (2-AG) are the two most well-studied endocannabinoids. Are there other endocannabinoids?

ANSWER: Other than Anandamide and 2-AG, there are other endocannabinoids: “virodhamine… acts as a full and selective CB1 agonist; N-arachidonyl- dopamine (NADA) is a CB1 agonist and potent activator of TrpV1; and palmitoylethanolamide (PEA) is involved with anti- inflammatory, analgesic and neuroprotective processes.”

reference: SOUZA, A. A. F. de; SILVA , A. F. M. da .; ABREU , L. R. de .; SILVA, T. F. da .; GRECO, G. .; SANTOS, S. da S. .; GONZAGA, R. V. Medicinal uses of Cannabis sp. . Research, Society and Development, [S. l.], v. 10, n. 7, p. e58010716930, 2021. DOI: 10.33448/rsd-v10i7.16930. Disponível em: https://rsdjournal.org/index.php/rsd/article/view/16930. Acesso em: 2 jul. 2021. https://rsdjournal.org/index.php/rsd/article/view/16930

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QUESTION: Cannabinoids may impact gastro-intestinal motility and gastro-intestinal secretory activity. Have these effects been noted in IBD patients who consume marijuana to treat their conditions?

ANSWER: Yes. In fact, according to population studies, diarrhea was one of the most common symptoms that improved with cannabis use.

reference: Storr M, Devlin S, Kaplan GG, Panaccione R, Andrews CN. Cannabis use provides symptom relief in patients with inflammatory bowel disease but is associated with worse disease prognosis in patients with Crohn’s disease. Inflamm Bowel Dis. 2014;20(3):472–80. https://doi.org/10.1097/01.MIB.0000440982.79036.d6.

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QUESTION: Are blunts and joints the same thing?

ANSWER: No. Blunts and joints are not the same. Blunts consist of marijuana wrapped in tobacco leaves, whereas joints consist of marijuana wrapped in cigarette paper.

reference: Cooper ZD, Haney M. Comparison of subjective, pharmacokinetic, and physiological effects of marijuana smoked as joints and blunts. Drug and Alcohol Dependence. Vol 103 Iss 3, 1 August 2009, Pages 107-113. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2776770/ https://rdcu.be/cnacn

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QUESTION: How does THC impact the gastro-intestinal system of a patient with IBD?

ANSWER: Cannabis might be a mediator within the gastrointestinal system, affecting inflammation, motility and the secretory response. Also, some cannabinoids increase appetite. A thorough 2021 review article summarized the current research evaluating the relationship between cannabinoid-based medicines and the treatment of IBD. A summary of their highlights include the following: “Patients with IBD often experience pain, nausea, and decreased appetite. As described here, in multiple studies, patients with IBD reported a significant improvement in symptoms and quality of life metrics with the use of cannabis. While initially promising, additional double-blind, placebo-controlled studies have found that even though CBD may improve perceived symptoms, it does not reduce inflammation or address underlying disease activity. These studies failed to demonstrate that when given cannabis, patients with IBD had an improvement in inflammatory markers [including CRP and calprotectin] or mucosal healing on endoscopy compared to patients with IBD in placebo conditions.”

reference: Buckley, M.C., Kumar, A. & Swaminath, A. Inflammatory Bowel Disease and Cannabis: A Practical Approach for Clinicians. Adv Ther (2021). https://doi.org/10.1007/s12325-021-01805-8. https://rdcu.be/cnacn

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QUESTION: Cannabis-based products may be some of the world’s oldest medicines. Documents dating back thousands of years BC describe the use of cannabis-based medicines in many Eastern cultures. What is the Chinese character for cannabis? Is that character used to represent other things?

ANSWER: The Chinese character for cannabis is 大麻 and the Chinese character for anesthesia is 麻木. The character 麻 means to “have pins and needles”

reference: Schlag, A.K., O’Sullivan, S.E, Zafar, R.R, Nutt, D.J, Current controversies in medical cannabis: recent developments in human clinical applications and potential therapeutics, Neuropharmacology; https://doi.org/10.1016/j.neuropharm.2021.108586 . And Google translation.

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QUESTION: Has the terpenoid caryophyllene, which is found in the cannabis plant, been found to significantly reduce craving to cigarettes?

ANSWER: Yes, according to one study with significant findings (P <0.01). Forty-eight cigarette smokers participated in a 3-h session conducted after deprivation from smoking overnight. The subjects were randomly assigned to one of three conditions: one group of smokers puffed on a device that delivered a vapor from essential oil of black pepper (black pepper contains caryophyllene); a second group puffed on the device with a mint/menthol cartridge, and a third group used a device containing an empty cartridge. Subjects puffed and inhaled ad libitum from the device throughout the session during which no smoking was allowed. Reported craving for cigarettes was significantly reduced in the pepper-containing device group relative to each of the two control conditions. Also, it was noted that negative affect and some somatic symptoms of anxiety were alleviated in the pepper-containing device group relative to the unflavored placebo. The authors suggested that one possible mechanism is via CB2 receptor agonism, with caryophyllene being a CB2R agonist.

reference: Rose JE, Behm FM. Inhalation of vapor from black pepper extract reduces smoking withdrawal symptoms. Drug Alcohol Depend. 1994 Feb;34(3):225-9. doi: 10.1016/0376-8716(94)90160-0. PMID: 8033760.

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QUESTION: The most common conditions for which cannabinoid-based medicines are used include chronic pain, anxiety, and depression. Of these 3 conditions, which , if any, is there a high strength of evidence for the efficacy of cannabinoid-based medicines.

ANSWER: Of the three conditions (chronic pain, anxiety and depression) there is only a high strength of evidence for chronic pain.

reference: Schlag, A.K., O’Sullivan, S.E, Zafar, R.R, Nutt, D.J, Current controversies in medical cannabis: recent developments in human clinical applications and potential therapeutics, Neuropharmacology; https://doi.org/10.1016/j.neuropharm.2021.108586.

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QUESTION: How does the endocannabinoid system impart analgesic effects?

ANSWER: The endocannabinoid system inhibits release of presynaptic neurotransmitters, modifies postsynaptic neuronal excitability, activates descending inhibitory pathways, and reduces neuroinflammation.

reference: Chung M, Kim H, Abdi S. Update on cannabis and cannabinoids for cancer pain. Current Opinion in Anesthesiology. 2020, 33:825 – 831. https://pubmed.ncbi.nlm.nih.gov/33110020/ DOI:10.1097/ACO.0000000000000934

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QUESTION: There is a high strength of evidence for the efficacy of cannabinoid-based medicines for the treatment of intractable epilepsy, multiple sclerosis and cancer-related nausea. Which of these 3 conditions has the greatest relative number of patients using cannabinoid -based medicines to treat the condition?

ANSWER: Among epilepsy, multiple sclerosis and cancer-related nausea, the least number of patients use cannabinoid-based medicines for intractable epilepsy and the greatest number of people use cannabinoid-based medicines for cancer-related nausea.

reference: Schlag, A.K., O’Sullivan, S.E, Zafar, R.R, Nutt, D.J, Current controversies in medical cannabis: recent developments in human clinical applications and potential therapeutics, Neuropharmacology; https://doi.org/10.1016/j.neuropharm.2021.108586.

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QUESTION: CB1 receptors are abundant in the CNS, including areas involved in pain transmission. CB2 receptors are mostly located on peripheral tissues and immune cells. Are CB2 receptors involved with pain transmission?

ANSWER: Yes. When activated, CB2 receptors may modulate peripheral afferent pain fiber activity and immune-mediated neuro-inflammatory processes. For example, CB2 activation may lead to the inhibition of prostaglandin synthesis and/or mast cell degranulation; both of these cellular activities can precipitate and maintain chronic pain states.

reference: Current Psychiatry. 2021 May;20(5):21-23, 28-33 | doi:10.12788/cp.0121, and MD Raphael J. Leo Raymond M. St. Marie. “Cannabinoid-Based Medications for Pain.” MDedge Psychiatry, 3 May 2021, https://www.mdedge.com/psychiatry/article/239193/pain/cannabinoid-based-medications-pain.

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QUESTION: Haloperidol is an antipsychotic medication and used to treat schizoaffective disorders and schizophrenia. Is the metabolism of haloperidol impacted by THC?

ANSWER: Yes, THC inhibits CYP3A4, the enzyme that metabolizes haloperidol, and therefore the co-administration of THC and haloperidol may result in an increased availability of haloperidol.

reference: Current Psychiatry. 2021 May;20(5):21-23, 28-33 | doi:10.12788/cp.0121, and MD Raphael J. Leo Raymond M. St. Marie. “Cannabinoid-Based Medications for Pain.” MDedge Psychiatry, 3 May 2021, https://www.mdedge.com/psychiatry/article/239193/pain/cannabinoid-based-medications-pain.

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QUESTION: What has been the most common mode of administration of cannabinoid-based medicines (CBMs) in RCTs examining the efficacy of CBMs to treat pain?

ANSWER: Most RCTs evaluated inhaled herbal CBMs and oromucosal spray (nabiximols (Sativex) – an oral spray with 50:50 mix of THC:CBD); there is a paucity of data derived from studies evaluating the effectiveness of other CBM formulations.

reference: Current Psychiatry. 2021 May;20(5):21-23, 28-33 | doi:10.12788/cp.0121, and MD Raphael J. Leo Raymond M. St. Marie. “Cannabinoid-Based Medications for Pain.” MDedge Psychiatry, 3 May 2021, https://www.mdedge.com/psychiatry/article/239193/pain/cannabinoid-based-medications-pain.

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QUESTION: Do oral mucosal spray cannabinoid-based medicines (CBMs) have the same bioavailability as ingested CBMs?

ANSWER: No. The administration of CBMs via oromucosal sprays (sublingual) avoids first-pass metabolism (although some of the product is swallowed) and therefore sublingual administration has a higher bioavailability than ingested formulations.

reference: Current Psychiatry. 2021 May;20(5):21-23, 28-33 | doi:10.12788/cp.0121, and MD Raphael J. Leo Raymond M. St. Marie. “Cannabinoid-Based Medications for Pain.” MDedge Psychiatry, 3 May 2021, https://www.mdedge.com/psychiatry/article/239193/pain/cannabinoid-based-medications-pain.

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QUESTION: Is the bioavailability of THC greater with inhaled cannabinoid-based medicines (CBMs) or ingested CBMs?

ANSWER: The bioavailability of inhaled CBMs is nearly 30% while the bioavailability of ingested CBMs is approximately 4%-20%. (It should be noted that the bioavailability is higher with vaporized cannabis as compared with combusted (smoked) cannabis products.

reference: Current Psychiatry. 2021 May;20(5):21-23, 28-33 | doi:10.12788/cp.0121, and MD Raphael J. Leo Raymond M. St. Marie. “Cannabinoid-Based Medications for Pain.” MDedge Psychiatry, 3 May 2021, https://www.mdedge.com/psychiatry/article/239193/pain/cannabinoid-based-medications-pain.

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QUESTION: The most well studied endocannabinoids are N-arachidonoyl- ethanolamine (AEA; anandamide) and 2-arachidonoylglycerol (2-AG). Are these two neurotransmitters stored in the presynaptic neurons?

ANSWER: No. Unlike most neurotransmitters, neither AEA or 2-AG is stored within vesicles in presynaptic neuron axons. They are actually produced on demand; they are synthesized from arachidonic acid of the membranes of post-synaptic neurons, and then they are released directly into the synapse and bind to receptors on the pre-synaptic neuron. In other words, they act in a retrograde fashion.

reference: Current Psychiatry. 2021 May;20(5):21-23, 28-33 | doi:10.12788/cp.0121, and MD Raphael J. Leo Raymond M. St. Marie. “Cannabinoid-Based Medications for Pain.” MDedge Psychiatry, 3 May 2021, https://www.mdedge.com/psychiatry/article/239193/pain/cannabinoid-based-medications-pain.

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QUESTION: Some NFL players strongly believe that it’s safer for them to use marijuana to treat pain than to take prescription medication. What has the NFL done in response to this claim?

ANSWER: For years, the NFL suspended a player if the player tested positive for marijuana multiple times. That changed due to an agreement approved in 2020. Now, the pain management committee of the NFL and the NFL Players Association will provide $1 million in funding for research into pain management and cannabinoids. Specifically, the research is evaluating marijuana as a potential alternative to opioids. Also, the NFL is investigating how using cannabis-based products and CBD to treat pain affects performance in elite athletes.

reference: https://www.nfl.com/news/nfl-nflpa-will-provide-funding-for-research-into-pain-treatment-including-medica

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QUESTION: The results of recent clinical trials indicate that Cannabidiol (CBD) reduces seizures among patients with refractory epilepsies of various etiologies. Most of these clinical studies report efficacy over short time periods (<1 year). Is CBD effective long term?

ANSWER: Yes. A May 2021 study demonstrated that CBD does not lose its efficacy in controlling seizures over a treatment period of up to 60 months. In addition, other results on the efficacy and tolerability of CBD in the treatment of refractory epilepsies, suggest that CBD is an effective, safe, and well-tolerated anti-epileptic drug for long-term use.

reference: The long-term efficacy of cannabidiol in the treatment of refractory epilepsy. Sandip Patel, Reid Grinspoon, Bradley Fleming, Lauren A. Skirvin, Christina Wade. 29 May 2021 https://doi.org/10.1111/epi.16936

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QUESTION: Some patients in the US may wish to travel with CBD to Canada, or vice versa. CBD is legally sold in the US and in Canada. So, is it legal to transport CBD across the US/Canadian border?

ANSWER: The transporting of cannabis (in any form, including oils containing THC or cannabidiol) into or out of Canada without special authorization from Health Canada is a serious criminal offense.

reference: Cannabis in Canada – What you need to know; https://www.canada.ca/content/dam/hc-sc/documents/services/drugs-medication/cannabis/resources/cannabis-act-what-you-need-to-know.pdf

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QUESTION: For what health conditions is the therapeutic applicability of CBD being evaluated?

ANSWER: The range of conditions for which CBD has been (or is being) assessed is quite diverse. Currently, clinical trials are evaluating CBD’s analgesic, neuroprotective, antiepileptic, anxiolytic, antipsychotic, anti-inflammatory, antitumor and anti-hypoxia/ischemia properties. According to a March 2021 search of the National Library of Medicine’s database, clinicaltrials.gov, there were more than 300 registered clinical trials that involve the use of CBD as a therapeutic intervention.

reference: Clinicaltrials.gov

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QUESTION: Does pretreatment with CBD prevent the transient psychotic symptoms induced by THC?

ANSWER: According to a study in humans, pretreatment with CBD does diminish THC’s psychotic effects. This particular study involved 6 healthy volunteers who were given THC intravenously on two separate occasions – once with a placebo pretreatment and once with a CBD pretreatment.

reference: Atakan Z. Cannabis, a complex plant: Different compounds and different effects on individuals. Ther Adv Psychopharmacol 2012 Dec; 2(6):241-254. doi:10.1177/2045125312457586. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3736954/

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QUESTION: Has any national drug administration approved a CBD-containing product for therapeutic use in conditions other than epilepsy?

ANSWER: Yes. The oromucosal spray Sativex (nabiximols) is a cannabis extract that contains the principal cannabinoids delta-9-tetrahydrocannibinol (THC) and cannabidiol (CBD) in a 50:50 ratio, as well as specific minor cannabinoids and other non-cannabinoid components. Regulatory approval has been obtained in numerous countries outside the United States for the treatment of multiple sclerosis symptoms (nerve pain, spasticity, overactive bladder, and other symptoms).

reference: GW Pharmaceuticals website. Sativex. https://www.gwpharm.com/healthcare-professionals/sativex

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QUESTION: Some patients consume CBD hoping that it will cure their cancer. Do the findings of clinical research studies indicate that CBD cures cancer?

ANSWER: No. There is no substantial clinical evidence to support that cannabinoids (natural or synthetic), including CBD, can effectively and safely treat cancer in humans.

reference: NO CLINICAL RESEARCH CITATION

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QUESTION: Epidiolex is an FDA-approved oral CBD solution indicated for the treatment of seizures associated with Lennox-Gastaut syndrome (LGS), Dravet syndrome (DS), or tuberous sclerosis complex (TSC) in one year of age and older. Can it be prescribed for indications other than these three seizure disorders (i.e. off label)?

ANSWER: Yes, Epidiolex may be prescribed off-label, but insurance coverage may be subject to pre-authorization.

reference: GW Pharmaceuticals press release: “GW Pharmaceuticals plc and Its U.S. Subsidiary Greenwich Biosciences, Inc. Announce That EPIDIOLEX® (cannabidiol) Oral Solution Has Been Descheduled And Is No Longer A Controlled Substance” April 6, 2020. https://ir.gwpharm.com/news-releases/news-release-details/gw-pharmaceuticals-plc-and-its-us-subsidiary-greenwich-1 Accessed April 30, 2020. GW Pharmaceuticals website. Sativex. https://www.gwpharm.com/healthcare-professionals/sativex accessed Mar 31, 2021.

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QUESTION: St. John’s wort is an over the counter medication used as a remedy for mild depression. Does St. John’s wort interact with CBD?

ANSWER: Yes. St. Johns wort inhibits some of the liver enzymes that metabolize CBD. As a result, there is an increase in bioavailability of CBD, and a possible increase of adverse effects associated with CBD consumption.

reference: Brown JD, Winterstein AG. Potential Adverse Drug Events and Drug-Drug Interactions with Medical and Consumer Cannabidiol (CBD) Use. J Clin Med. 2019;8(7):989. Published 2019 Jul 8. doi:10.3390/jcm8070989. https://pubmed.ncbi.nlm.nih.gov/31288397/

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QUESTION: A seizure disorder is a qualifying condition in many medical marijuana state programs. Does CBD interact with commonly prescribed anti-epileptic medications?

ANSWER: Yes. According to a presentation at the 2014 annual meeting of the American Epilepsy Society, an increasing dose of CBD was associated with significant increases in serum levels of topiramate, rufinamide, and N-desmethylclobazam. Also, there is a significant association between increasing CBD doses and increased zonisamide and eslicarbazepine serum levels.

reference: Friedman D, Cilio MR, Tilton N, et al. The effect of Epidiolex (cannabidiol) on serum levels of concomitant anti-epileptic drugs in children and young adults with treatment-resistant epilepsy in an expanded access program. Presented at the annual meeting of the American Epilepsy Society, Seattle, December 5–9, 2014; abstract.

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QUESTION: Is CBD addictive?

ANSWER: According to the drug package insert of an FDA-approved CBD product, CBD is not addictive.

reference: GW Pharmaceuticals website. Sativex. https://www.gwpharm.com/healthcare-professionals/sativex accessed Mar 31, 2021.

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QUESTION: Proton pump inhibitors (PPIs) are commonly used to relieve the symptoms of gastro-esophageal reflux disease (GERD). Do PPIs interact with CBD?

ANSWER: Yes. PPIs inhibit some of the liver enzymes that metabolize CBD. As a result, there is an increase in bioavailability of CBD, and a possible increase of adverse effects associated with CBD consumption.

reference: Brown JD, Winterstein AG. Potential Adverse Drug Events and Drug-Drug Interactions with Medical and Consumer Cannabidiol (CBD) Use. J Clin Med. 2019;8(7):989. Published 2019 Jul 8. doi:10.3390/jcm8070989. https://pubmed.ncbi.nlm.nih.gov/31288397/

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QUESTION: Other than pill form, in what forms is CBD sold?

ANSWER: There are multiple CBD product types, including CBD oils (for oral/sublingual administration or vaporization), gummy candies, joint balms, creams, lotions, and capsules. CBD is also being sold in food products, beverages and healthcare goods, including hair products and skincare products. CBD has even been marketed as an ingredient in sleeping masks and dog treats.

reference: “Ads Pitching CBD as a Cure-all Are Everywhere. Oversight Hasn’t Kept Up.” The New York Times, Aug 13, 2019 – https://www.nytimes.com/2019/08/13/business/media/cbd-marijuana-fda.html – accessed Aug 2019.

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QUESTION: Does CBD alter the metabolism of methadone?

ANSWER: Yes. Cannabidiol inhibits CYP3A4 and CYP2C19, both of which are involved in the metabolism of methadone. As a result, the co-administration of CBD and methadone may lead to increased sedation.

reference: Madden K, Tanco K, Bruera E. Clinically Significant Drug-Drug Interaction Between Methadone and Cannabidiol. Pediatrics May 2020; e20193256; DOI: https://doi.org/10.1542/peds.2019-3256.
https://pediatrics.aappublications.org/content/145/6/e20193256

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QUESTION: The FDA has approved a CBD product (Epidiolex) for the treatment of 3 rare forms of epilepsy. What is the mechanism of action of CBD in this anti-epileptic medication? How does CBD exert its anti-convulsant effects?

ANSWER: According to the prescribing information of this FDA-approved product, “The precise mechanisms by which Epidiolex exerts its anticonvulsant effect in humans are unknown. Cannabidiol does not appear to exert its anticonvulsant effects through interaction with cannabinoid receptors.”

reference: Highlights for prescribing information for Epidiolex https://www.accessdata.fda.gov/drugsatfda_docs/label/2018/210365lbl.pdf

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QUESTION: Fluoxetine (sold under the name Prozac) is a commonly prescribed antidepressant of the SSRI – Selective Serotonin Reuptake Inhibitor – class. Does Fluoxetine impact the metabolism of CBD?

ANSWER: Yes. Fluoxetine inhibits some of the liver enzymes that metabolize CBD. As a result, there is an increase in bioavailability of CBD, and a possible increase of adverse effects associated with CBD consumption.

reference: Brown JD, Winterstein AG. Potential Adverse Drug Events and Drug-Drug Interactions with Medical and Consumer Cannabidiol (CBD) Use. J Clin Med. 2019;8(7):989. Published 2019 Jul 8. doi:10.3390/jcm8070989. https://pubmed.ncbi.nlm.nih.gov/31288397/

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QUESTION: Some patients apply CBD topically. Does CBD easily penetrate the skin?

ANSWER: Due to CBD’s large size and hydrophobic properties, CBD does not penetrate the skin efficiently, however, permeation-enhancing gels have been developed. Currently, CBD-containing gels are being evaluated for the treatment of several pediatric disorders, and a heterogeneous group of rare and ultra-rare epilepsies known as developmental and epileptic encephalopathies.

reference: https://zynerba.com/in-development/zygel/

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QUESTION: Have CBD’s effects on human embryonic development been fully evaluated?

ANSWER: No, but according to a World Health Organization Cannabidiol (CBD) report in November 2017, in studies involving the use of CBD in monkeys, no effect on a wide range of physiological and biochemical parameters or significant effects on animal behavior were noted unless extremely high doses of CBD (e.g., in excess of 150 mg/kg iv as an acute dose or in excess of 30 mg/kg orally daily for 90 days) were administered.

reference: World Health Organization (WHO) – Expert Committee on Drug Dependence Thirty-ninth Meeting Cannabidiol (CBD) Pre-Review Report Agenda Item 5.2 Geneva, 6-10 November 2017

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QUESTION: CBD interacts with warfarin. Does this drug:drug interaction lead to an increased risk of bleeding or a decrease in warfarin’s anticoagulation effect?

ANSWER: The inhibition of CYP2C19 by CBD can increase levels of warfarin, and multiple reports have indicated that the interaction between warfarin and CBD results in an increased risk of bleeding.

reference: Treese NM, Flowers M. Pharmacist’s guide to CBD oil. US Pharm. 2020; 45(3):20-23. https://www.uspharmacist.com/article/pharmacists-guide-to-cbd-oil

Welty TE, Chapman KE, Faught RE, Kotloski RJ. American Epilepsy Society (AES): Written Comments to Norman E. “Ned” Sharpless, MD, Acting Commissioner of Food and Drugs, U.S. Food and Drug Administration (FDA), Department of Health and Human Services (HHS): on Docket ID# FDA-2019-N-1482, Scientific Data and Information about Products Containing Cannabis or Cannabis-Derived Compounds; Public Hearing; Request for Comments: Submitted on: July 16, 2019. Epilepsy Currents 2019; 19(6):361-368. doi:10.1177/1535759719878716

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QUESTION: What is the most common mode of CBD administration?

ANSWER: According to a 2017–2018 online survey evaluating modes of CBD administration, the most common method of CBD administration was sublingual, followed by vaping, oral ingestion of capsules and liquids, smoking, edibles, and topical administration

reference: Corroon J, Phillips JA. A cross-sectional study of cannabidiol users. Cannabis Cannabinoid Res. 2018;3(1):152–61. https://pubmed.ncbi.nlm.nih.gov/30014038/

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QUESTION: A common adverse effect of chronic recreational marijuana use is cannabinoid hyperemesis syndrome. In fact, cannabinoid hyperemesis syndrome is a near daily diagnosis in many Canadian emergency departments. Anecdotal evidence supports the use of haloperidol to treat cannabinoid hyperemesis syndrome. Is haloperidol more effective than odansetron for the treatment of the nausea and vomiting associated with cannabinoid hyperemesis syndrome?

ANSWER: According to the results of a randomized controlled trial involving 33 patients with cannabinoid hyperemesis syndrome, haloperidol (0.05 mg/kg or 0.1 mg/kg) was superior to odansetron 8mg for average reduction from baseline in abdominal pain and nausea at 2 hours, and was associated with the need for fewer rescue antiemetics and shorter time to ED departure. In this study, there were 2 haloperidol and 6 ondansetron return ED visits for ongoing nausea/vomiting, as well as 2 return visits for acute dystonia, both in the higher dose haloperidol group.

reference: Ruberto, A., Sivilotti, M., Forrester, S., Hall, A., Crawford, F., & Day, A. (2020). LO69: Haloperidol versus ondansetron for hyperemesis due to cannabis (HaVOC): A randomized, controlled clinical trial. CJEM, 22(S1), S32-S33. doi:10.1017/cem.2020.124. https://www.researchgate.net/publication/341353323_LO69_Haloperidol_versus_ondansetron_for_hyperemesis_due_to_cannabis_HaVOC_a_randomized_controlled_clinical_trial

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QUESTION: Cannabinoid receptors have been located in the central nervous system and the peripheral nervous system, as well as on immune cells. Have cannabinoid receptors been isolated in reproductive tissues/cells?

ANSWER: In addition to cannabinoid receptors being identified in the hypothalamus and the pituitary gland, cannabinoid receptors have also been identified on ovary, endometrial tissue, testes, and spermatozoa. In fact, research suggests that marijuana may alter the release of FSH and LH, ovulation, sperm motility, fertilization, as well as placentation.

reference: Caitlin Dunne, MD, FRCSC. THE EFFECTS OF CANNABIS ON FEMALE AND MALE REPRODUCTION. BCMJ, vol. 61 , No. 7 , September 2019 , Pages 282-285. https://bcmj.org/articles/effects-cannabis-female-and-male-reproduction

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QUESTION: What is the most common route of administration for the synthetic cannabinoids K2 or Spice?

ANSWER: K2 and Spice are used for recreational purposes, and smoking is the most common route of administration. Spraying or mixing the synthetic cannabinoids on dried plant material allows one to smoke it (using a pipe, a water pipe, or rolling the drug-laced plant material in cigarette papers). Also, liquid synthetic cannabinoids have been designed to be vaporized via e-cigarettes.

reference: Drugs of Abuse – A DEA Resource Guide /2020 Edition. https://www.dea.gov/sites/default/files/2020-04/Drugs%20of%20Abuse%202020-Web%20Version-508%20compliant-4-24-20_0.pdf

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QUESTION: What are K2 and Spice?

ANSWER: K2 and Spice are synthetic cannabinoid “designer drugs” that are intended to mimic the effects of THC. These synthetic cannabinoids are sold as “herbal incense” at convenience stores/gas stations, smoke shops and via the internet. They are produced in powder form, and then often dissolved in solvents, so they can be applied to dry plant material to make the “herbal incense” products.

rreference: Drugs of Abuse – A DEA Resource Guide /2020 Edition. https://www.dea.gov/sites/default/files/2020-04/Drugs%20of%20Abuse%202020-Web%20Version-508%20compliant-4-24-20_0.pdf

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QUESTION: Respiratory depression is associated with the overdose of opioids or benzodiazepines. Is respiratory depression associated with an overdose of cannabinoids? Why or why not?

ANSWER: Respiratory depression is not associated with cannabinoid use because CB1 receptors are not located in the midbrain, the part of the brain responsible for respiratory drive.

reference: Levinsohn EA, Hill KP. Clinical uses of cannabis and cannabinoids in the United States. J Neurol Sci. 2020 Apr 15;411:116717. doi: 10.1016/j.jns.2020.116717. Epub 2020 Jan 30. PMID: 32044684. https://pubmed.ncbi.nlm.nih.gov/32044684/

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QUESTION: As of January 2020, how many Americans were using marijuana-based products for medicinal purposes?

ANSWER: It has been estimated that more than 2 million Americans use marijuana for medical reasons. Some of the many ailments being treated with marijuana include: chronic pain, PTSD, depression, sleep disorders, multiple sclerosis (MS), cancer-related ailments, and GI disorders. Some indications are supported by good scientific evidence, but some are not.

reference: Levinsohn EA, Hill KP. Clinical uses of cannabis and cannabinoids in the United States. J Neurol Sci. 2020 Apr 15;411:116717. doi: 10.1016/j.jns.2020.116717. Epub 2020 Jan 30. PMID: 32044684. https://pubmed.ncbi.nlm.nih.gov/32044684/

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QUESTION: Cannabinoids are metabolized by many of the same cytochrome P450 enzymes as warfarin. In fact, THC, CBD and CBN can inhibit the hydroxylation of warfarin, and thus lead to an increase in INR. Do cannabinoids also affect the metabolism of heparin? Is the metabolism of direct oral anticoagulants (DOACs), including rivaroxaban, edoxaban, and apixaban, impacted by cannabinoids?

ANSWER: While cannabinoids do not alter the metabolism of heparin, cannabinoids may impact the metabolism of DOACs. DOAC levels may increase, leading to an increased risk of bleeding.

reference: Jessica Greger, PharmD, Vernice Bates, MD, Laszlo Mechtler, MD, and Fran Gengo, PharmD. A Review of Cannabis and Interactions With Anticoagulant and Antiplatelet Agents. The Journal of Clinical Pharmacology 2019, 0(0) 1–7. https://accp1.onlinelibrary.wiley.com/doi/abs/10.1002/jcph.1557?af=R

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QUESTION: Does CBD interact with receptors other than CB1 or CB2?

ANSWER: Yes. CBD has cannabinoid receptor-independent properties. For example, CBD is an agonist at the TRPV1 receptor and has agonist properties at the 5-HT1A/2A/3A serotonergic receptors. CBD is also a capsaicin analog. CBD has antagonist activity on alpha-1 adrenergic and μ-opioid receptors, too. In addition, CBD has been found to inhibit synaptosomal uptake of noradrenaline, dopamine, serotonin, and gamma-amino butyric acid. CBD also inhibits anandamide uptake.

reference: Levinsohn EA, Hill KP. Clinical uses of cannabis and cannabinoids in the United States. J Neurol Sci. 2020 Apr 15;411:116717. doi: 10.1016/j.jns.2020.116717. Epub 2020 Jan 30. PMID: 32044684. https://pubmed.ncbi.nlm.nih.gov/32044684/

reference: Brown JD, Winterstein AG. Potential Adverse Drug Events and Drug-Drug Interactions with Medical and Consumer Cannabidiol (CBD) Use. J Clin Med. 2019 Jul 8;8(7):989. doi: 10.3390/jcm8070989. PMID: 31288397; PMCID: PMC6678684. https://pubmed.ncbi.nlm.nih.gov/31288397/

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QUESTION: Cannabinoid receptors are located throughout various parts of the CNS, including the basal ganglia, hippocampus, cerebellum and cerebral cortex, and in the peripheral nervous system. Do these receptors have effects on neurotransmitters such as serotonin?

ANSWER: Yes. CB receptor activity not only impacts serotonin, but it also affects acetylcholine, dopamine, glutamate, and GABA, as well as NMDA and opioid receptor systems.

reference: Levinsohn EA, Hill KP. Clinical uses of cannabis and cannabinoids in the United States. J Neurol Sci. 2020 Apr 15;411:116717. doi: 10.1016/j.jns.2020.116717. Epub 2020 Jan 30. PMID: 32044684. https://pubmed.ncbi.nlm.nih.gov/32044684/

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QUESTION: Epidemiological studies indicate that as many as 15% of inflammatory bowel disease (IBD) patients may use cannabinoids to ameliorate some of their symptoms, including improvement in diarrhea, abdominal pain and appetite. Do the studies show that cannabinoids are effective in Crohn’s disease?

ANSWER: Although the findings of studies examining the efficacy of cannabinoids in Crohn’s disease indicate that cannabinoids do not improve inflammatory markers or endoscopic score, the results indicate that THC reduces the Crohn’s disease activity index by >100 points (on a scale of 0–450).

reference: Naftali T, Dor M. Cannabis for the Treatment of Inflammatory Bowel Disease: A True Medicine or a False Promise?. Rambam Maimonides Med J 2020;11 (1):e0008. Review. doi:10.5041/RMMJ.10390. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7000156/

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QUESTION: Some cancer patients use medical marijuana to treat various cancer-associated ailments. What are some of the ailments ameliorated by medical marijuana?

ANSWER: According to one study involving 96 cancer patients receiving supportive cancer care, the data support the safety and effectiveness of medical marijuana as a complementary option for improving pain control, appetite and quality of life for cancer patients. The top three adverse events of this study included drowsiness, low energy and nausea. (Note: other studies indicate that chemotherapy-induced nausea and vomiting is ameliorated by medical marijuana.)

reference: Safety and effectiveness of medical cannabis as a complementary option for supportive cancer care: Results from the Cannabis Pilot Project. Antonio Vigano, Saro Aprikian, Popi Kasvis, Virginie Bacis, Amna Al Harrasi, Nathalie M Aubin, MariaLuisa Vigano, and Manuel Borod. Journal of Clinical Oncology 2020 38:15_suppl, 12106-12106.
https://ascopubs.org/doi/abs/10.1200/JCO.2020.38.15_suppl.12106

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QUESTION: What is Sativex®?

ANSWER: Sativex® is a buccal (oral) spray containing Δ-9-THC and CBD (2.7 mg Δ-9-THC and 2.5 mg CBD per spray) and it is indicated for spasticity and neuropathic pain in multiple sclerosis, and as adjunctive analgesia for moderate to severe cancer pain. While Sativex® is approved in several European countries, Canada, and other countries, it has not been approved for medical use in the U.S.

reference: Brown JD, Winterstein AG. Potential Adverse Drug Events and Drug-Drug Interactions with Medical and Consumer Cannabidiol (CBD) Use. J Clin Med. 2019;8(7):989. Published 2019 Jul 8. doi:10.3390/jcm8070989.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6678684/

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QUESTION: According to the results of a survey of breast cancer patients’ use of cannabinoid products, 42% of survey participants had used medical cannabinoid products to relieve symptoms. What symptoms were treated with cannabinoid products?

ANSWER: Members of the Breastcancer.org and Healthline communities were asked to participate in a survey during the period of 12/16/2019 – 1/19/2020. According to the results of the survey, cannabinoids were used to relieve insomnia (70%), pain (59%), anxiety (57%), stress (51%), and nausea/vomiting (46%).

reference: A survey of breast cancer patients’ use of cannabis before, during, and after treatment. Marisa C. Weiss, Julianne Hibbs, Terri W. McHugh, Meghan Buckley, Sharon Larson, Nancye Green, Virginia G. Kaklamani, Rowan T. Chlebowski, and Diana Martinez. Journal of Clinical Oncology 2020 38:15_suppl, e19210-e19210. https://ascopubs.org/doi/10.1200/JCO.2020.38.15_suppl.e19210

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QUESTION: Are cannabinoids an effective analgesic agent in the acute pain setting? Are cannabinoids an effective analgesic agent in the chronic pain setting?

ANSWER: According to the results of multiple randomized controlled trials examining the efficacy of cannabinoids to treat acute pain, THC, nabilone and other cannabinoid-based products were not associated with a reduction in pain, but were associated with adverse side effects, including sedation. In contrast to the lack of efficacy in the acute pain setting, cannabinoids are effective analgesic agents in the chronic pain setting. According to 2 systematic reviews involving a total of 29 randomized controlled trials (RCTs), 22 of the 29 RCTs demonstrated that cannabinoids do have a modest analgesic effect in the management of chronic pain.

reference: Vulfsons S, Minerbi A, Sahar T. Cannabis and Pain Treatment-A Review of the Clinical Utility and a Practical Approach in Light of Uncertainty. Rambam Maimonides Med J. 2020;11(1):e0002. Published 2020 Jan 30. doi:10.5041/RMMJ.10385. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7000155/

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QUESTION: What are the common modes of administration of medical marijuana used by cancer patients?

ANSWER: According to a survey completed by 183 cancer patients of an oncology clinic at Sutter Medical Center in Sacramento, California, over 50% reported use of oils and tinctures and 44% used edibles. A smaller percentage consumed cannabis-based products via vaping (26%) or smoking (30%). Topical use was preferred by fewer patients (17%). Over 58% of patients stated they used more than one method.

reference: Patterns of use of medical cannabis in a community oncology clinic. Deepti Behl, Stacy D. D’Andre, and Carol Parise, Journal of Clinical Oncology 2020. 38:15_suppl, e24111-e24111. https://ascopubs.org/doi/abs/10.1200/JCO.2020.38.15_suppl.e24111

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QUESTION: What CBD products, if any, have been evaluated and approved by the FDA?

ANSWER: CBD is marketed in various forms, including oils, capsules, food products, cosmetics/topical lotions and creams, and CBD products are marketed for pets, too. These products are sold in grocery stores, specialty stores, and convenience stores across the US and on the internet. However, only one prescription CBD product has been approved by the FDA. It is called Epidiolex. It is approved to treat rare, severe pediatric epilepsy disorders.

reference: FDA Advances Work Related to Cannabidiol Products with Focus on Protecting Public Health, Providing Market Clarity – March 5 2020. https://www.fda.gov/news-events/press-announcements/fda-advances-work-related-cannabidiol-products-focus-protecting-public-health-providing-market

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QUESTION: On the current (last revised May 2020) US Department of Justice Firearms Transaction Record form, is there a question related to the unlawful use of, or addiction to marijuana, depressants, stimulants, narcotics and other controlled substances?

ANSWER: Yes. There is a question related to drug use. In fact, there is a warning note that reads as follows: “Warning: The use or possession of marijuana remains unlawful under Federal law regardless of whether it has been legalized or decriminalized for medicinal or recreational purposes in the state where you reside.”

reference: U.S. Department of Justice Bureau of Alcohol, Tobacco, Firearms and Explosives OMB No. 1140-0020, Firearms Transaction Record. https://www.atf.gov/firearms/docs/4473-part-1-firearms-transaction-record-over-counter-atf-form-53009/download

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QUESTION: Does consuming a high fat/high calorie meal at the same time as you take liquid CBD orally impact the amount of CBD absorbed into the bloodstream?

ANSWER: Yes. According to studies performed by a pharmaceutical company that manufactures the FDA-approved CBD product called Epidiolex, a high fat/high calorie meal can increase CBD absorption by up to 5 fold.

reference: Epidiolex insert. https://www.accessdata.fda.gov/drugsatfda_docs/label/2018/210365lbl.pdf

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QUESTION: It has been estimated that a significant proportion of cancer patients (18.3-40.0%) in the United States use marijuana or cannabinoid-based products. Does the evidence indicate that cannabinoid-based products are effective in treating cancer-related pain? chemotherapy-induced nausea and vomiting? Cancer-related cachexia (wasting)?

ANSWER: According to a study published in the Journal of Clinical Oncology, there is substantial evidence for the effectiveness of marijuana and cannabinoids in treating cancer-related pain; specifically, an oral THC/CBD spray. Also, there is conclusive evidence that marijuana and cannabinoids effectively relieve chemotherapy-induced nausea and vomiting; (specifically, oral THC). However, there is inconclusive evidence about the effectiveness of cannabinoid-based products in treating cancer-related cachexia (wasting).

reference: A systematic review of evidence for cannabis and cannabinoids as adjuvant therapy in palliative and supportive oncology care.
Sebastian Jugl, Shailina Keshwani, Lauren Adkins, Coy D. Heldermon, Almut Winterstein, and Amie Goodin. Journal of Clinical Oncology 2020. 38:15_suppl, 12091-12091 https://ascopubs.org/doi/abs/10.1200/JCO.2020.38.15_suppl.12091

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QUESTION: Do cannabinoids affect the function of the gastrointestinal system?

ANSWER: It appears that cannabinoids affect many functions of the digestive system, including the regulation of the production of digestive enzymes, gastrointestinal motility, and visceral inflammation as well as visceral sensation.

reference: Izzo AA, Sharkey KA. Cannabinoids and the gut: New developments and emerging concepts. Pharmacol Ther 2010 04;126(1879-016; 0163-7258; 1):21-38. https://pubmed.ncbi.nlm.nih.gov/20117132/

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QUESTION: Marijuana use is not associated with a decrease in respiratory drive. Why not?

ANSWER: In the lower brainstem areas that control respiratory function/respiratory drive, cannabinoid receptor expression is low, and this accounts for the lack of decreased respiratory drive and the absence of a risk of fatal respiratory arrest with the use of medical marijuana and pharmaceutical grade cannabinoid drugs.

reference: Herkenham M, Lynn AB, Little MD, et al. Cannabinoid receptor localization in brain. Proc Natl Acad Sci USA. 1990; 87:1932–1936.38. https://pubmed.ncbi.nlm.nih.gov/2308954/

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QUESTION: What is the pharmacokinetic profile of marijuana when it is administered orally?

ANSWER: The psychoactive and physiological effects of orally consumed marijuana typically appear approximately 90 minutes after ingestion, reach their maximum after 2-3 hours and last for about 4-12 hours. However, there is a heterogeneous response to oral marijuana consumption and some individuals may not appreciate the peak effect until 6 hours after consumption.

reference: Grotenhermen F. Clinical pharmacokinetics of cannabinoids. J Cannabis Ther, 2003; 3(1): 3-51. https://www.tandfonline.com/doi/abs/10.1300/J175v03n01_02

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QUESTION: Does marijuana affect appetite and metabolism?

ANSWER: Marijuana has been reported to stimulate appetite. There is a high concentration of CB1 receptors in the areas of the brain that control food intake and satiety, and these findings suggest that there is an association between marijuana consumption and appetite regulation. Additionally, studies suggest that the endocannabinoid system modulates taste sensation as well as the metabolism of lipids and glucose.

references: Di Marzo V, Matias I. Endocannabinoid control of food intake and energy balance. Nat.Neurosci. 2005; 8: 585-589. https://pubmed.ncbi.nlm.nih.gov/15856067/
• Farrimond JA, Mercier MS, Whalley BJ, Williams CM. Cannabis sativa and the endogenous cannabinoid system: therapeutic potential for appetite regulation. Phytother.Res. 2011; 25: 170-188. https://pubmed.ncbi.nlm.nih.gov/21213357/
• Matias I, Bisogno T, Di Marzo V. Endogenous cannabinoids in the brain and peripheral tissues: regulation of their levels and control of food intake. Int.J.Obes.(Lond). 2006; 30 Suppl 1: S7-S12. https://pubmed.ncbi.nlm.nih.gov/16570107/

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QUESTION: Does the dosing of cannabinoid-based drugs need to be adjusted for patients with hepatic disease?

ANSWER: Cannabinoids are metabolized by the liver and excreted through the GI tract and kidney. When considering cannabinoid therapy for patients with severe liver impairment, the dosage may need to be adjusted. For example, according to the prescribing information for an FDA-approved cannabidiol product, “dose adjustment is recommended in patients with moderate (Child-Pugh B) hepatic impairment or severe (Child-Pugh C) hepatic impairment. It may be necessary to have slower dose titration in patients with moderate or severe hepatic impairment than in patients without hepatic impairment. [This drug] does not require dose adjustment in patients with mild (Child-Pugh A) hepatic impairment.”

Epidiolex prescribing information highlights:
https://www.accessdata.fda.gov/drugsatfda_docs/label/2018/210365lbl.pdf

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QUESTION: Does the endocannabinoid system modulate pain without the being triggered by THC or other phytocannabinoids?

ANSWER: Yes. Neural and non-neural cells of injured tissues produce endocannabinoids, including anandamide and 2-AG, and when these endocannabinoids activate the CB receptors, pain signals are modulated. Note: CB1 receptors are abundant in nociceptive and non-nociceptive sensory neurons of the dorsal root ganglion (DRG), the spinal cord, the brain, mast cells, macrophage defense cells, the trigeminal ganglion (TG), and epidermal keratinocytes. Few CB2 receptors are expressed in these regions, but the density of CB2 receptors increases when peripheral nerve damage occurs.

reference: Breijyeh Z,Jubeh B, Bufo SA, Karaman R, Scrano L. Cannabis: A Toxin-Producing Plant with Potential Therapeutic Uses. Toxins (Basel). 2021 Feb 5;13(2):117. doi.10.3390/toxins13020117. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7915118/

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QUESTION: Other than via pills, capsules and liquid preparations, are there any other vehicles by which medical marijuana can be consumed orally?

ANSWER: In addition to pills, capsules and liquid preparations, medical marijuana can be consumed orally by ingesting marijuana-infused edibles, such as baked goods, candies, gummies, chocolates, lozenges, and beverages. It must be noted that the amounts of the various cannabinoids in edibles may not be consistent throughout a single baked product (a cookie, for example) or across a batch of baked products. As a result, it is difficult to estimate the amount of marijuana contained in each portion of edible product.

reference: Barrus DG, Capogrossi KL, Cates SC, et al. Tasty THC: Promises and Challenges of Cannabis Edibles. Methods Rep RTI press. 2016; 2016:10.3768/rtipress.2016.op.0035.1611. http://europepmc.org/article/MED/28127591

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QUESTION: Do some cannabinoids reduce spasticity?

ANSWER: Studies have suggested that some cannabinoids effectively reduce the spasticity associated with multiple sclerosis, and, in fact, the federal drug agencies of several countries (but not the US) have approved a cannabinoid-based formula (50:50 THC:CBD) called Sativex (nabiximols) for the treatment of severe spasticity in multiple sclerosis. The cannabinoids act on the presynaptic CB1 receptors, and the receptor activation reduces massive glutamate release and regulates glutamatergic excitability during spasticity. The American Academy of Neurology proposes that the use of oral cannabinoid extracts or an oromucosal cannabinoid spray (1:1 THC:CBD) by MS patients may reduce symptoms of spasticity.

reference: Yadav V. Bever C. Jr et al. Summary of evidence –based guideline: complimentary and alternative medicine in multiple sclerosis: Report of the guideline development subcommittee of the American Academy of neurology. Neurology 2014. 82(12): 1083-1092. https://pubmed.ncbi.nlm.nih.gov/24663230/

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QUESTION: Is marijuana a sedative or stimulant?

ANSWER: Marijuana is a CNS depressant and may cause drowsiness or somnolence. Its CNS depressant effects are additive with other CNS depressants, including opioids. There is moderate evidence that marijuana or cannabinoids are effective for improving short-term sleep outcomes in individuals with sleep disturbance associated with obstructive sleep apnea syndrome, fibromyalgia, chronic pain, and multiple sclerosis.

reference: Kumar RN, Chambers WA, Pertwee RG. Pharmacological actions and therapeutic uses of cannabis and cannabinoids. Anaesthesia. 2001; 56: 1059-1068. https://pubmed.ncbi.nlm.nih.gov/11703238/

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QUESTION: What is the pharmacokinetic profile of marijuana when it is smoked?

ANSWER: When herbal marijuana is smoked via a cigarette or a pipe, THC, CBD and other phytocannabinoids, as well as terpenoids, are vaporized by the heat of combustion and inhaled. Inhaled constituents quickly pass from alveoli into the bloodstream and readily cross the blood-brain barrier. CNS effects appear within seconds to a few minutes of inhalation, reach a maximum after 15-30 minutes, and taper off within 2-3 hours. It must be noted that the amounts of cannabinoids consumed are, in part, dependent upon the patient’s inhalation techniques, including the quality and efficiency of inhalation, duration of inhalation, and spacing of inhalations.

references: Huestis MA. Human cannabinoid pharmacokinetics. Chem Biodivers. 2007;4(8):1770-804. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2689518/.
• Grotenhermen F. Clinical pharmacokinetics of cannabinoids. J Cannabis Ther, 2003; 3(1): 3-51. https://www.tandfonline.com/doi/abs/10.1300/J175v03n01_02

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QUESTION: What is the pharmacokinetic profile of marijuana when it is smoked?

ANSWER: When herbal marijuana is smoked via a cigarette or a pipe, THC, CBD and other phytocannabinoids, as well as terpenoids, are vaporized by the heat of combustion and inhaled. Inhaled constituents quickly pass from alveoli into the bloodstream and readily cross the blood-brain barrier. CNS effects appear within seconds to a few minutes of inhalation, reach a maximum after 15-30 minutes, and taper off within 2-3 hours. It must be noted that the amounts of cannabinoids consumed are, in part, dependent upon the patient’s inhalation techniques, including the quality and efficiency of inhalation, duration of inhalation, and spacing of inhalations.

references: Huestis MA. Human cannabinoid pharmacokinetics. Chem Biodivers. 2007;4(8):1770-804. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2689518/.
• Grotenhermen F. Clinical pharmacokinetics of cannabinoids. J Cannabis Ther, 2003; 3(1): 3-51. https://www.tandfonline.com/doi/abs/10.1300/J175v03n01_02

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QUESTION: What are endocannabinoids?

ANSWER: Endocannabinoids (also called endogenous cannabinoids) are endogenous agonists of the receptors to which delta-9- tetrahydrocannabinol (THC) also binds. Two of the most well studied endocannabinoids are derivatives of arachidonic acid: N-arachidonoylethanolamine (also called anandamide or AEA) and 2-arachidonoylglycerol (2-AG).

reference: Atakan, Z. “Cannabis, a complex plant: different compounds and different effects on individuals.” Therapeutic advances in psychopharmacology 2012; 2(6): 241-54. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3736954/

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QUESTION: What are terpenes?

ANSWER: Terpenes are aromatic hydrocarbons and just like the phytocannabinoids, terpenes are manufactured in the glands of the cannabis flower. Terpenes may influence the uptake and effects of phytocannabinoids. The terpenes found in cannabis include limonene, pinene, myrcene, delta-3-carene, eucalyptol and humulene.

reference: Russo EB. Taming THC:potential cannabis synergy and phytocannabinoid-terpenoid entourage effects. Br J of Pharmacolo. 2011;163(7):1344-1364. doi:10.1111/j.1476-5381.2011.01238. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3165946/

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QUESTION: THC and CBD have significantly different receptor binding capacities, and thus different pharmacological effects. Are the differences in binding capacity due to different chemical compositions?

ANSWER: THC and CBD actually have the same chemical formula, C21H30O2. They are structural isomers. The key structural difference between the two molecules is that there is an oxygen-containing closed ring in THC that is open in CBD. This one structural difference leads to significantly different receptor binding capacities and thus different pharmacological effects of the two substances.

reference: de Meijer EP, Bagatta M, Carboni A, et al. The inheritance of chemical phenotype in Cannabis sativa L. Genetics. 2003;163(1):335-346. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1462421/

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QUESTION: True or False? CB1 receptors are only found on nerve cells.

ANSWER: False. In addition to the brain, nociceptive and non-nociceptive sensory neurons of the dorsal root ganglion (DRG), and the spinal cord, CB1 receptors are abundant in mast cells, macrophage defense cells, epidermal keratinocytes, adipose, liver, pancreas and skeletal muscle cells.

reference: Breijyeh Z, Jubeh B, Bufo SA, Karaman R, Scrano L. Cannabis: A Toxin-Producing Plant with Potential Therapeutic Uses. Toxins (Basel). 2021 Feb 5;13(2):117. doi.10.3390/toxins13020117 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7915118/

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QUESTION: What is the most common qualifying condition reported by medical marijuana patients?

ANSWER: Currently and historically, the most common qualifying condition reported by medical marijuana patients is chronic pain. In fact, according to Boehnke et al’s analysis of 2016 data, chronic pain was the qualifying condition reported by medical marijuana patients nearly 65 percent of the time.

reference: Boehnke et al. Qualifying Conditions of medical cannabis license holders in the United States. Health Affairs Vol 38, No2: Hospitals, Health IT and more. https://doi.org/10.1377/hlthaff.2018.05266. https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2018.05266

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QUESTION: Epidiolex is an FDA-approved seizure medication derived from plant material (it is not a synthetic CBD product). Is it possible that a patient taking Epidiolex will test positive for THC?

ANSWER: Epidiolex is cannabidiol (CBD) derived from marijuana, not hemp, and therefore there may be traces of cannabinoids other than CBD. Patients using Epidiolex may test positive for marijuana/THC on drug screening.

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QUESTION: Is it a good idea to store THC products in glass jars?

ANSWER: THC has the ability to bind to glass and plastic. Therefore, THC products are often stored in basic or organic solvents in amber silicate glassware to avoid loss.

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QUESTION: Do CBD products that contain less than 0.3 percent THC violate the Controlled Substances Act?

ANSWER: Industrial hemp (which contains less than 0.3 percent THC) is no longer considered to be a controlled substance, but CBD products that contain less than 0.3 percent THC are not legal. The CBD products no longer violate the Controlled Substances Act, but they do violate the Food, Drug, and Cosmetic (FD&C) Act, according to the FDA. Any CBD food or purported dietary supplement products in interstate commerce is in violation of the FD&C Act, according to the principal deputy FDA commissioner.

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QUESTION: What is industrial hemp?

ANSWER: Industrial hemp and marijuana are cultivated from the same species, but industrial hemp has concentrations of THC less than 0.3 percent. Industrial hemp, a high-fiber plant, is used to make various products, including textiles as well as biodegradable plastics. The 2018 Farm Bill, signed into law by President Donald Trump, removed industrial hemp, from the definition of marijuana in the Controlled Substances Act.

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QUESTION: Of all state-approved health conditions, what are the 7 most frequent health conditions for which patients seek to obtain a medical marijuana card?

ANSWER: Chronic noncancer pain, multiple sclerosis and other motor neuron disorders, epilepsy, cancer-related symptoms, mental health disorders (primarily anxiety disorders such as PTSD), glaucoma, and symptoms related to irritable bowel diseases top the list of reasons to apply for a medical marijuana card.

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QUESTION: CBD is legally sold in US supermarkets, pharmacies and convenience stores. CBD is also legally sold in Canada. So, is it legal to transport CBD across the US/Canadian border?

ANSWER: According to Canada’s national laws, “the transporting of cannabis (in any form, including oils containing THC or cannabidiol) into or out of Canada without special authorization from Health Canada is a serious criminal offense. “

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QUESTION: Does the dosing of CBD need to be adjusted in patients with liver disease?

ANSWER: According to the prescribing information packet of Epidiolex (an FDA-approved CBD product),, dose adjustment is recommended in patients with moderate (Child-Pugh B) or severe (Child-Pugh C) hepatic impairment. Dose adjustment in patients with mild (Child-Pugh A) hepatic impairment is not needed.

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QUESTION: Are physicians required to notify the DEA when prescribing Epidiolex (a CBD product derived from the cannabis plant)?

ANSWER: Prior to April 2020, Epidiolex was classified as a schedule V drug under the Controlled Substances Act. On April 6, 2020, the manufacturers of Epidiolex “received notification from the United States Drug Enforcement Administration (DEA) confirming that Epidiolex ® (cannabidiol) is no longer subject to the Controlled Substances Act (CSA).” Since Epidiolex is no longer a controlled substance, physicians are not required to notify the DEA when prescribing the medication. The descheduling of Epidiolex also enables physicians to prescribe this medicine free of the requirements of state prescription drug monitoring programs.

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QUESTION: Is the use of marijuana for medicinal reasons an acceptable explanation for a positive drug test result in ANY Federal agency drug testing program?

ANSWER: As of March 2021, the answer to this question is still ‘NO.’ ALL Federal drug testing programs – regardless whether the programs under the regulatory and legal auspices of the Department of Health and Human Services, the Department of Defense, the Department of Transportation, or the Nuclear Regulatory Commission, or any other Federal agency – have taken the identical stance: Use of Schedule I drugs by individuals in Federally regulated workplaces is unacceptable, and any individual who tests positive for a Schedule I drug will have a positive drug test on his or her record.

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QUESTION: If a patient uses a CBD product, will a THC drug screen be positive?

ANSWER: The answer to this question depends on 2 things: 1.) Is the patient consuming pure CBD or full spectrum CBD. (Full spectrum CBD contains multiple cannabinoids, including THC.) and 2.) The sensitivity of the drug screening test.

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QUESTION: How should cannabis products be stored?

ANSWER: Products should be stored in opaque containers, in a cool dry location, and in a place that is not accessible to children or pets, or individuals who should not be handling the cannabis-based products.

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QUESTION: What are some of the microbial and fungal contaminants that can be present in cannabis products?

ANSWER: Aspergillus and Salmonella and Aflatoxin may be present in cannabis products. It is important to review the certificate of analysis to determine if the cannabis product contains any of these contaminants.

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QUESTION: What should be listed on a Certificate of Analysis (CoA)?

ANSWER: First, a Certificate of Analysis (CoA) should be from an independent and properly certified testing laboratory, and not from the retailer. CoA should show the amount and concentration of major cannabinoids and terpenes present in the tested sample, as well as testing data regarding the lack of (or presence of) microbial organisms, fungal contaminants, the levels of heavy metals, and amount of pesticide and residual solvents.

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QUESTION: Does raw cannabis flower contain CBD or CBDA?

ANSWER: The raw flower contains CBDA (the acid form of cannabidiol). When the raw cannabis material is heated via vaporization, smoking or baking, the CBDA is converted to CBD.

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QUESTION: CBD products are marketed as full spectrum, broad spectrum and CBD isolate products. What are the differences between these products?

ANSWER: While full CBD spectrum products contain a full array of cannabinoids, (including THC) and terpenes, broad spectrum products are manufactured in a way that the product does not contain THC. CBD isolate products are often sold as 99%+ pure CBD and they do not contain other cannabinoids or any terpenes, unless specified on the label.

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QUESTION: How many people in the US die each day from overdoses involving PRESCRIPTION opioids?

ANSWER: According to recent data published by the Center for Disease Control (CDC), approximately 41 people/day are dying from an overdose involving prescription opioids. This CDC website – https://www.cdc.gov/rxawareness/index.html – provides resources for individuals struggling with opioid drug abuse.

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QUESTION: What is Rick Simpson oil (aka RSO)?

ANSWER: Solvent-based concentrates are made by extraction of the plant matter with chemical solvents. In this method, cannabis is soaked in the solvent and then the cannabis is removed by straining. Then, the solvent is boiled off, and a sticky cannabis resin remains. These extracts are often a very dark color (green to black) and contain residuals from the solvents used. These products are sometimes referred to as Rick Simpson Oil (RSO), named after the individual that made this type of extraction popular.

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QUESTION: Some people consume cannabinoids via “dabbing.” Describe this method of consumption.

ANSWER: Basically, with dabbing, a cannabis concentrate is applied to a hot platform and the cannabinoids are volatilized. The vapor then passes through a water-pipe device and is inhaled by the consumer. The hot platform (commonly called “the nail”) is usually constructed from quartz, ceramic or titanium. This nail is heated, often with a blow torch, and after the nail is hot, a small amount of cannabis concentrate is applied. Vaporization of the cannabinoids is immediate. Inhalation by the consumer during application of the cannabis concentrate draws the vapors from around the nail into the water pipe.

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QUESTION: Other than butane, what are some of the chemical solvents used to create cannabis concentrates? Other than using solvents to create cannabis concentrates, what other methods to produce cannabis concentrates can be used?

ANSWER: Hexane, isopentane, isopropyl alcohol, acetone, and propane are used to make cannabis concentrates. In addition to using solvents, concentrates can also be manufactured via a dry method, a water-based method or a CO2 based method.

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QUESTION: Do all medical marijuana legal states allow the sale of products manufactured through butane extraction and supercritical CO2 extraction?

ANSWER: Supercritical CO2 extraction does not leave residual hydrocarbons, while butane extraction does. As a result, some states will allow the sale of supercritical CO2 extraction products, but not allow the sale of butane extracts.

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QUESTION: In addition to butane extraction, supercritical CO2 extraction is another process used to manufacture cannabis extracts. What is the major difference in the end products of the two processes?

ANSWER: Supercritical CO2 extraction does not leave any trace of hydrocarbon solvents in the end product, while butane extraction does. The viscosity of the supercritical CO2 products is less than the viscosity of the butane extraction products. As a result of a lower viscosity, supercritical CO2 extraction process products can be used in vaporizer pens on its own without cutting agents. While products derived from a butane extraction are used in dabbing, products derived from supercritical CO2 extraction are not.

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QUESTION: Some patients may use shatter, budder, crumble, pull-and-snap, and/or wax. Are all of these products exactly the same?

ANSWER: All of these products are cannabis extracts, but it is the specific manufacturing/ processing of the hash oil cannabis products that will determine the consistency of the product. Depending upon the consistency and other physical characteristics, the product will be called shatter, budder, crumble, pull-and-snap or wax.

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QUESTION: Does short term treatment with THC rich cannabis induce clinical remission and improve quality of life in patients with mild to moderately active ulcerative colitis?

ANSWER: Yes, according to a recent study. However, these beneficial clinical effects were not associated with significant anti-inflammatory improvement in the Mayo endoscopic score or laboratory markers for inflammation. These results were derived from a double-blind, randomized, placebo-controlled trial, – 32 patients received either cigarettes containing 0.5 g of dried cannabis flowers with 80mg THC or placebo cigarettes for 8 weeks. Parameters of disease including Lichtiger disease activity index, C reactive protein (CRP), calprotectin, Mayo endoscopic score and quality of life (QOL) were assessed before, during and after treatment.

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QUESTION: In some legal states, edibles, such as candies, baked goods, beverages and condiments (butter and oils) containing THC may be sold. Is 2.5mg of THC in an edible a low dose or high dose of THC to be consumed orally?

ANSWER: The dosing of THC always needs to be adjusted on an individual basis. For reference, 2.5 mg is the lowest dose of dronabinol, a synthetic THC that is FDA-approved.

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QUESTION: When speaking with their clinicians, patients may use the terms “dabs”, “wax”, or “butane honey oil” – what do these terms mean?

ANSWER: Dabs, wax and butane honey oil are all highly concentrated cannabis extracts of THC. These THC products are often smoked or vaporized. Because these THC products are quite highly concentrated, the consumption of only a very small amount may produce a significant effect.

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QUESTION: What is “hashish”?

ANSWER: Hashish is a crude product made up of compacted sticky resin glands of the cannabis plant. The popularity of hashish has been diminished by the availability of cannabis concentrates.

reference: Special Report | February 2018
Contemporary Routes of Cannabis Consumption: A Primer for Clinicians
Jeramy Peters, DO; Joseph Chien, DO
The Journal of the American Osteopathic Association, February 2018, Vol. 118, 67-70. doi: https://doi.org/10.7556/jaoa.2018.020

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QUESTION: Are smoking marijuana and vaporizing marijuana equally efficient? (In other words, are the cannabinoids absorbed to the same extent with smoking vs. vaporizing? )

ANSWER: When ingesting marijuana via a vaporizer, the user absorbs up to 33% of the total cannabinoids present in herbal mixture. When smoking, an individual typically absorbs about 25% of the cannabinoids present in herbal mixture.

reference: Special Report | February 2018
Contemporary Routes of Cannabis Consumption: A Primer for Clinicians
Jeramy Peters, DO; Joseph Chien, DO
The Journal of the American Osteopathic Association, February 2018, Vol. 118, 67-70. doi: https://doi.org/10.7556/jaoa.2018.020

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QUESTION: The amounts of marijuana in a joint, blunt, spliff or bowl are not standardized. How does a clinician estimate the amount of marijuana being used by the patient?

ANSWER: When trying to assess the quantity of marijuana consumed by a patient, multiple questions should be addressed, including: how often and how much the patient typically purchases, how many bowls (or joints, or blunts or spliffs) the patient smokes each time he consumes marijuana, and how many times he uses marijuana before he needs to purchase again. It must be noted that the total amount of cannabinoids present in marijuana is not equal to the amount that is ingested. (when smoking, an individual typically absorbs about 25% of the cannabinoids present in herbal marijuana mixture.) Also, the concentration of the cannabis-based product must be considered, as well.

reference: Special Report | February 2018
Contemporary Routes of Cannabis Consumption: A Primer for Clinicians
Jeramy Peters, DO; Joseph Chien, DO
The Journal of the American Osteopathic Association, February 2018, Vol. 118, 67-70. doi: https://doi.org/10.7556/jaoa.2018.020

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QUESTION: Are smoking marijuana and vaporizing marijuana equally efficient? (In other words, are the cannabinoids absorbed to the same extent with smoking vs. vaporizing? )

ANSWER: When ingesting marijuana via a vaporizer, the user absorbs up to 33% of the total cannabinoids present in herbal mixture. When smoking, an individual typically absorbs about 25% of the cannabinoids present in herbal mixture.

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QUESTION: A patient may be speaking to you about his marijuana consumption, and he may use the terms joints, blunts and spliffs, and bowl. What do these terms mean?

ANSWER: A joint is a cigarette of marijuana, a blunt is a marijuana cigar, and a spliff can refer to marijuana mixed with tobacco, though some people use this term when referring to a cone-shaped joint with a filter. A bowl refers to the chamber of a pipe.

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QUESTION: In patients 60 years old or older, does long term (3 months) marijuana use impact blood pressure?

ANSWER: According to a recent study that was published in the European Journal of Internal Medicine, amongst adults 60 years or older with hypertension, marijuana treatment for 3 months was associated with a reduction in 24-hours systolic and diastolic blood pressure. At 3 months follow-up, the mean 24-hours systolic and diastolic blood pressures were reduced by 5.0 mmHg and 4.5 mmHg, respectively (p<0.001 for both). The nadir for the blood pressure and heart rate was achieved at 3 hours post-administration. The proportion of normal dippers changed from 27.3% before treatment to 45.5% afterward. No significant changes were seen in the different metabolic parameters assessed by blood tests, anthropometric measurements, or ECG exam.

reference: Cannabis is associated with blood pressure reduction in older adults – A 24-hours ambulatory blood pressure monitoring study Ran Abuhasira, Yosef S. Haviv, Merav Leiba, Adi Leiba, Larisa Ryvo, Victor Novack Published:January 20, 2021 DOI: European J of Int. Medicine https://doi.org/10.1016/j.ejim.2021.01.005

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QUESTION: What are the effects of cannabis-based therapies on oxaliplatin-induced peripheral neuropathy among oncology patients?

ANSWER: The results of a retrospective study indicated that the rate of neuropathy was reduced among patients treated with cannabis-based therapies and oxaliplatin. This reduction was more significant in patients who received cannabis-based products prior to treatment with oxaliplatin, suggesting a protective effect. (A large prospective trial examining the effects of cannabis-based products on oxaliplatin-induced neuropathy is planned.)

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QUESTION: In older adults, is there a significant positive association between THC dose and incidence rate ratio for dizziness or lightheadedness and thinking or perception disorder when the THC is combined with CBD?

ANSWER: A systematic review and metaregression analysis published In JAMA (February 2021) evaluated the THC neuropsychiatric symptoms among adults 50 years and older. The authors examined 30 RCTs [Randomized Controlled Trials] using THC-only cannabis-based medicines (CBM) (total THC exposure, 1252.83 person-years) and 24 RCTs using CBMs with different combinations of cannabidiol (CBD) and THC (total THC and CBD exposure, 388.56 person-years). They did find a significant positive association between THC dose and incidence rate ratio for dizziness or lightheadedness (estimate, 0.05; 95% CI, 0.02-0.08; P = .001) and thinking or perception disorder (estimate, 0.07; 95% CI, 0.03-0.11; P < .001) for the THC-ONLY studies, but there were no associations with any other neuropsychiatric adverse effects for the THC and CBD combination studies.

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QUESTION: Can prison inmates use medical cannabis?

ANSWER: In New Mexico, the prison inmates can use cannabis. In 2021, a New Mexico landmark case concluded that inmates CAN use medical cannabis. As stated by the victorious lawyer, ‟the law is clear: You must, under existing law, provide incarcerated persons with the ability to access medical cannabis free from penalty. That’s the law.” Importantly, the ruling specifies that this applies to those on probation, house arrest or in prison.

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QUESTION: In 2020, the 20 member ‘Global Task Force on Dosing and Administration of Medical Cannabis in Chronic Pain’ developed recommendations for the dosing of cannabinoids for patients suffering with severe pain. What were those recommendations?

ANSWER: According to the recommendations of the ‘Global Task Force on Dosing and Administration of Medical Cannabis in Chronic Pain,’ patients suffering from severe pain and those patients who have a history of significant prior cannabis consumption can use a 50:50 CBD-THC product and start with a dose of 2.5-5 mg of each compound 1 or 2 times/day.

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QUESTION: In 2020, recommendations for the dosing of THC in the elderly population were developed by the 20 member ‘Global Task Force on Dosing and Administration of Medical Cannabis in Chronic Pain.’ What were their recommendations for the dosing of THC in the elderly population?

ANSWER: According to the recommendations of the ‘Global Task Force on Dosing and Administration of Medical Cannabis in Chronic Pain,’ elderly patients, patients with severe co-morbidity or patients who take multiple medications should be managed through a conservative route; start with THC doses at 1 mg/day and the dose should be titrated up slowly.

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QUESTION: What are some of the more common reasons dermatologists recommend cannabinoid-based medicines?

ANSWER: According to the results of a survey of 145 dermatologists, 91 % of dermatologists were in support of medical cannabis use and 13.8 % have recommended it for a dermatologic condition. Atopic dermatitis (45 %) and psoriasis (40 %) were the most common. The most common form of administration was topical (75 %). The main reasons for not recommending medical cannabis were limited knowledge (56 %) and lack of experience (48 %).

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QUESTION: In 2020, the 20 member ‘Global Task Force on Dosing and Administration of Medical Cannabis in Chronic Pain’ developed recommendations for the dosing of cannabinoids. For what pain conditions are medical cannabinoids a viable option?

ANSWER: According to the global task force, cannabinoids may be effective for neuropathic, inflammatory, nociplastic* and mixed pain conditions. *Nociplastic pain is defined as: “Pain that arises from altered nociception despite no clear evidence of actual or threatened tissue damage causing the activation of peripheral nociceptors or evidence for disease or lesion of the somatosensory system causing the pain.”

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QUESTION: Have any PRECLINICAL studies shown that cannabinoids have anti-neoplastic (anti-cancer) effects?

ANSWER: Yes – PRECLINICAL studies have shown that cannabinoids exhibit anti -tumor properties in different ADULT cancers, including breast, melanoma, pancreatic, lymphoma, glioblastoma, lung, hepatocellular, colorectal, prostate, and other cancers. This data has been obtained from EXPERIMENTAL models of cancer, including genetically engineered mouse models.

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QUESTION: The use of cannabinoid-based products for medicinal purposes is legal in Canada at the federal level. Is the medicinal use of cannabinoid-based products legal at the federal level in Mexico, too?

ANSWER: Yes, as of January 13, 2021, the use of cannabinoid-based products for medicinal purposes is legal in Mexico. Mexican President López Obrador published regulations for the production, research and use of medicinal marijuana. The federal government’s official gazette published the new regulations that authorize the government to oversee the production of marijuana for research and medicinal purposes. Pharmacies will be allowed to supply cannabis-based medicines to authorized patients. In addition, the regulatory framework permits the importation of seeds, cannabis derivatives to be used in medicinal products, and processed marijuana-based medications to Mexico.

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QUESTION: Does the National Basketball Association (NBA) test their players for cannabis use?

ANSWER: Prior to the 2020-2021 season, the NBA had randomly conducted cannabis testing on players, but the NBA and National Basketball Players Association announced they will stop testing players for cannabis use during the 2020–2021 season in response to the stress and quarantining brought on by the COVID-19 global pandemic, and also based on COVID safety to limit unnecessary contacts,. Although cannabis testing is paused for now, random testing for performance-enhancing drugs will continue.

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QUESTION: As of 2018, what percentage of the population uses marijuana?

ANSWER: The 2018 World Health Organization (WHO) data suggest that approximately 2.5% of the global population (147 million) use marijuana.

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QUESTION: Researchers have evaluated the anti-neoplastic (anti-cancer) effects of cannabinoids. What have the results indicated?

ANSWER: Over the past two decades, PRECLINICAL data indicate that THC, CBD, as well as some synthetic cannabinoids induce apoptosis of cancer cells and inhibit tumor proliferation, metastasis, and angiogenesis. Note: The results of preclinical trials are NOT equivalent to clinical trials.

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QUESTION: What are the two most well-studied endocannabinoids?

ANSWER: The best-characterized endocannabinoids are 2-arachidonoylglycerol (also called 2-AG) and N- arachidonoylethanolamide (also called AEA or anandamide). These endocannabinoids are lipid-based molecules that are synthesized from arachidonic acid from the cellular membrane. These two endocannabinoids are signaling molecules that bind to and stimulate cannabinoid receptors CB1R and CB2R.

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QUESTION: Which US states had the greatest sales of cannabis products in 2020?

ANSWER: Florida, a medical marijuana only state, had more than $1.2 billion in sales, and was the nation’s fourth largest cannabis market. Only California, Colorado and Washington (all medical and recreational use states) out sold Florida.

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QUESTION: CB1 receptors are expressed by neurons in the brain, especially in the cerebral cortex, basal ganglia, cerebellum, and hippocampus. Are CB1 receptors expressed in other parts of the nervous system? Are CB1 receptors present on cells outside of the nervous system?

ANSWER: In addition to being expressed by neurons in the brain, CB1 receptors are also expressed in parts of the peripheral and autonomic nervous system. CB1 receptors are also expressed on several other tissues, including heart, lung, reproductive organs, thymus and spleen.

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QUESTION: Does the consumption of THC and CBD via vaporization impair driving ability?

ANSWER: A recent study published in JAMA examined the magnitude and duration of driving impairment following vaporization of cannabis containing various concentrations of THC and CBD. The results of the study indicated that the impairment of driving after consuming vaporized THC-dominant and 50:50 THC/CBD cannabis compared with placebo was significantly greater at 40-100 minutes but not at 240-300 minutes after vaporization. There were no significant differences between CBD-dominant cannabis and placebo found, but the doses tested may not represent common usage.

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QUESTION: To which receptor do cannabinoids bind that impact pain sensation?

ANSWER: In addition to acting on cannabinoid receptors (CB1 and CB2), cannabinoids may modulate pain by interacting with the G protein-coupled receptor 55 (GPR55) and GPR18 and other G protein-coupled receptors such as serotonin and opioids receptors. Cannabinoids also interact with TRPV-1 receptors. CBD and THC (along with the endocannabinoid, Anadamide) activate glycine receptors, and as a result, lead to analgesia in inflammatory and neuropathic pain.

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QUESTION: Does the anti-fungal agent ketoconazole interact with cannabinoids?

ANSWER: Yes. Ketoconazole Inhibits the metabolism of THC and CBD and can significantly increase concentrations of THC and CBD. In contrast, drugs such as rifampicin, carbamazepine and St John’s Wort induce cytochrome enzyme activity and lower THC and CBD concentrations.

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QUESTION: If a patient is allergic to tomatoes or tobacco, is the patient a good candidate for medical marijuana therapy?

ANSWER: Patients who have previously experienced an allergic reaction to tobacco or tomato are at increased risk for developing an allergy to the products from the cannabis plant.

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QUESTION: Is a “full spectrum” product the same as a “whole plant” product?

ANSWER: No. “Whole plant” products contain fats, waxes and fibrous materials not found in “full spectrum” products.

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QUESTION: What does “full spectrum” marijuana mean? What does “broad spectrum” mean?

ANSWER: Full spectrum means that the product contains all of the original compounds found in the flower of the cannabis plant (cannabinoids, terpenes and flavonoids). In contrast, broad spectrum products are processed in such a manner as to ensure that the final product does NOT contain THC.

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QUESTION: Describe the exact mechanism of action of Epidiolex.

ANSWER: According to the Epidiolex FDA Approved Package Insert, (Greenwich Biosciences, Inc.), the precise mechanism(s) by which Epidiolex exerts its anticonvulsant effects in humans are unknown. It does not appear to be through cannabidiol receptors.

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QUESTION: Have the results of studies examining the impact of maternal marijuana use identified a unique phenotypic congenital anomaly?

ANSWER: Studies evaluating maternal use of marijuana have not found a unique phenotypic signature of prenatal exposure of marijuana. There does appear to be an increased risk of congenital anomalies, particularly gastroschisis, though.

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QUESTION: In 2018, Epidiolex was approved for the treatment of seizures associated with two rare and severe forms of epilepsy, Lennox-Gastaut syndrome (LGS) and Dravet syndrome (DS). Has the FDA approved Epidiolex for any other conditions since 2018?

ANSWER: Yes. On July 31, 2020, the U.S. Food and Drug Administration approved Epidiolex (cannabidiol or CBD) oral solution for the treatment of seizures associated with tuberous sclerosis complex (TSC) in patients one year of age and older.

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QUESTION: Does the use of cannabinoid-based products impact female sexual function, including desire, arousal, lubrication, orgasm, satisfaction, and pain?

ANSWER: According to a study published in the journal Sexual Medicine, an increased frequency of marijuana use is associated with improved sexual function among females. (i.e. – sexual desire increased, arousal increased, orgasm domain increased, and sexual satisfaction increased.) Interestingly, it was noted that chemovar type and method of consumption did not impact outcomes, though.

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QUESTION: Does consuming a high fat/high calorie meal at the same time as you take liquid CBD orally impact the amount of CBD absorbed into the bloodstream?

ANSWER: Yes. According to studies performed by a pharmaceutical company that manufactures an FDA- approved CBD product, a high fat/high calorie meal can increase CBD absorption by up to 5 fold.

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QUESTION: Did the United Nations Commission for Narcotic Drugs vote in December 2020 to accept the World Health Organization’s (WHO) recommendation to remove cannabis and cannabis resin for medicinal purposes from Schedule IV of the 1961 Single Convention on Narcotic Drugs?

ANSWER: Yes, and it was a close one (27 to 25), with the United States and many European nations in favor. The US published a statement about its rationale for the vote – “The vote of the United States to remove cannabis and cannabis resin from Schedule IV of the Single Convention while retaining them in Schedule I is consistent with the science demonstrating that while a safe and effective cannabis-derived therapeutic has been developed, cannabis itself continues to pose significant risks to public health and should continue to be controlled under the international drug control conventions. Further, this action has the potential to stimulate global research into the therapeutic potential and public health effects of cannabis, and to attract additional investigators to the field, including those who may have been deterred by the Schedule IV status of cannabis.”

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QUESTION: The House of Representatives approved the MORE Act. Is marijuana legal now?

ANSWER: The House of Representatives approved the bill called the MORE Act on December 4, 2020, but marijuana is not legal at the federal level. The bill must go to the Senate, and then the White House for the President to sign. Until the President signs it, it’s not a law – it’s just a bill.

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QUESTION: What is the MORE act?

ANSWER: The Marijuana Opportunity, Reinvestment, and Expungement (MORE) Act (HR 3884 / S. 2227) is bipartisan legislation that removes marijuana from the Controlled Substances Act, thus decriminalizing the substance at the federal level and enabling states to set their own policies.

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QUESTION: Do cannabinoids affect cardiac function?

ANSWER: Low doses of cannabinoids have been associated with tachycardia, hypertension and increased contractility (an increased sympathetic response). In contrast, high doses of cannabinoids enhance parasympathetic tone leading to dose-dependent bradycardia and hypotension.

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QUESTION: What percentage of US medical marijuana legal states list cancer as a qualifying condition?

ANSWER: Cancer is listed as a qualifying condition in 100% of the US medical marijuana states, but the patterns of cannabinoid use among patients with breast cancer (one of the most common cancers in the US) is unknown. NOTE: Cannabinoids have been shown to ameliorate some of the symptoms associated with cancer and the side effects associated with some cancer treatments, however, cannabinoids have not been shown to be an effective anti-cancer agent.

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QUESTION: Epidemiological studies indicate that as many as 15% of inflammatory bowel disease (IBD) patients may use cannabinoids to ameliorate some of their symptoms, including improvement in diarrhea, abdominal pain and appetite. Do the studies show that cannabinoids are effective?

ANSWER: There are few studies evaluating cannabinoid use in IBD, and those studies are small. In Crohn’s disease, it has been demonstrated that THC reduces the Crohn’s disease activity index by >100 points (on a scale of 0–450). Also, two small studies involving ulcerative colitis patients showed a marginal benefit. However, no improvement in inflammatory markers or in endoscopic score in either disease was detected.

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QUESTION: The findings of multiple randomized controlled trials (RCTs) indicate that cannabinoids effectively treat chronic pain. Do cannabinoids effectively treat the chronic pain associated with fibromyalgia?

ANSWER: No. According to a Cochrane systematic review published in 2016 on the use of cannabinoids to treat fibromyalgia, there is no convincing, unbiased, high-quality evidence suggesting that a cannabinoid-based medicine (nabilone) is of value in treating people with fibromyalgia. Furthermore, the tolerability of nabilone was low in people with fibromyalgia. Also, the results of a 2019 study where 4 varieties of pharmaceutical grade marijuana were administered by single shot vapor to fibromyalgia patients indicated that none of the 4 marijuana varieties had an effect greater than placebo. (Note: The data from the 2019 study could not be used to extrapolate the long-term effects of cannabinoids on fibromyalgia-associated pain.)

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QUESTION: Some cancer patients use medical marijuana to treat various cancer-associated ailments. What are some of the ailments ameliorated by medical marijuana?

ANSWER: According to one study involving 96 cancer patients receiving supportive cancer care, the data support the safety and effectiveness of medical marijuana as a complementary option for improving pain control, appetite and quality of life for cancer patients. The top three adverse events of this study included drowsiness, low energy and nausea, and were reported in 28% of patients, with 9% having to stop using the medical marijuana. (Note: other studies indicate that chemotherapy-induced nausea and vomiting is ameliorated by medical marijuana.)

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QUESTION: Side effects of short-term cannabinoid-based therapy may differ from person to person, and the same person may experience different side effects at different times. What factors influence the probability and the severity of adverse events?

ANSWER: Many factors influence the likelihood and the severity of adverse events, including the type of cannabinoid preparation; the mode of administration; the dose administered; the patient’s expectations, the patient’s prior experience with cannabinoid-based therapies, and the age of the patient. Drug–drug interactions may also lead to adverse events.

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QUESTION: Side effects of short-term cannabinoid-based therapy may differ from person to person, and the same person may experience different side effects at different times. What factors influence the probability and the severity of adverse events?

ANSWER: Many factors influence the likelihood and the severity of adverse events, including the type of cannabinoid preparation; the mode of administration; the dose administered; the patient’s expectations, the patient’s prior experience with cannabinoid-based therapies, and the age of the patient. Drug–drug interactions may also lead to adverse events.

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QUESTION: What is Sativex®?

ANSWER: Sativex® is a buccal (oral) spray containing Δ-9-THC and CBD (2.7 mg Δ-9-THC and 2.5 mg CBD per spray) and it is indicated for spasticity and neuropathic pain in multiple sclerosis, and as adjunctive analgesia for moderate to severe cancer pain. While Sativex® is approved in several European countries, Canada, and other countries, it has not been approved for medical use in the U.S.

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QUESTION: Other than feeling “high” what are some of the reported psychological CNS-related side effects associated with cannabinoid use?

ANSWER: Psychological side effects associated with cannabinoid use include: restless/anxiety/nervousness, depressed mood, dysphoria, confusion, dissociation, hallucinations, hyperactivity, weird dreams, paranoia and psychosis.

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QUESTION: Are cannabinoids an effective analgesic agent in the acute pain setting?

ANSWER: No. According to the results of multiple randomized controlled trials examining the efficacy of cannabinoids to treat acute pain, THC, nabilone and other cannabinoid-based products were not associated with a reduction in pain, but were associated with adverse side effects, including sedation.

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QUESTION: What are the common modes of administration of medical marijuana used by cancer patients?

ANSWER: According to a survey completed by 183 cancer patients of an oncology clinic at Sutter Medical Center in Sacramento, California, over 50% reported use of oils and tinctures and 44% used edibles. A smaller percentage consumed cannabis-based products via vaping (26%) or smoking (30%). Topical use was preferred by fewer patients (17%). Over 58% of patients stated they used more than one method.

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QUESTION: What CBD products, if any, have been evaluated and approved by the FDA?

ANSWER: CBD is marketed in various forms, including oils, capsules, food products, cosmetics/topical lotions and creams, and CBD products are marketed for pets, too. These products are sold in grocery stores, specialty stores, and convenience stores across the US and on the internet. However, only one prescription CBD product has been approved by the FDA. It is called Epidiolex. It is approved to treat rare, severe pediatric epilepsy disorders.

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QUESTION: On the current (last revised May 2020) US Department of Justice Firearms Transaction Record form, is there a question related to the unlawful use of, or addiction to marijuana, depressants, stimulants, narcotics and other controlled substances?

ANSWER: Yes. There is a question related to drug use. In fact, there is a warning note that reads as follows: “Warning: The use or possession of marijuana remains unlawful under Federal law regardless of whether it has been legalized or decriminalized for medicinal or recreational purposes in the state where you reside.”

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QUESTION: Does consuming a high fat/high calorie meal at the same time as you take liquid CBD orally impact the amount of CBD absorbed into the bloodstream?

ANSWER: Yes. According to studies performed by a pharmaceutical company that manufactures the FDA-approved CBD product called Epidiolex, a high fat/high calorie meal can increase CBD absorption by up to 5 fold.

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QUESTION: What psychiatric condition is most often listed as a qualifying condition for medical marijuana?

ANSWER: The psychiatric diagnosis most often listed as a qualifying condition by the medical marijuana legal US states is PTSD, but other psychiatric diagnoses include Tourette syndrome, Alzheimer’s disease, and autism.

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QUESTION: Is marijuana use linked to higher hospital mortality in COPD patients?

ANSWER: Actually, no. According to a nationwide population-based study, patients diagnosed with COPD who reported using marijuana had less risk of in-hospital mortality and pneumonia than non-users. The results from this study, which was performed by Yale physicians, indicated that marijuana use was associated with a 37.6% reduction in the odds of dying in the hospital (OR 0.624, 95% CI 0.407-0.958, P=0.0309) among COPD patients. This same study also found that COPD patients who admitted to using marijuana had an 11.8% lower risk of pneumonia (OR 0.882, 95% CI 0.806-0.964, P=0.0059). Note: these findings may be a correlation rather than a causation, according to some clinicians not associated with the study. Also, the authors performed a retrospective analysis of COPD-associated hospitalizations over the years 2005-2014. (Pre-COVID)

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QUESTION: Is there a governmental office to which patients can report any adverse effects from CBD products?

ANSWER: Yes, even though CBD (with the exception of Epidiolex) is not approved by the FDA, patients can report any adverse effects from CBD products to the FDA’s MedWatch program.

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QUESTION: To date, has the FDA approved cannabis for the treatment of any psychiatric condition?

ANSWER: No. However, the FDA has approved 1 cannabis-derived medication (CBD) called Epidiolex and 2 cannabis-related medications (dronabinol and nabilone) for specific indications. Dronabinol is a synthetic THC product that is used as an antiemetic agent. It is approved for treating or preventing nausea and vomiting caused by chemotherapeutic agents, and as an appetite stimulant for individuals with AIDS. Nabilone is a synthetic that is structurally similar to THC. It is approved for treating chemotherapy induced nausea and vomiting.

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QUESTION: What percentage of Americans support marijuana legalization?

ANSWER: In a 2019 Pew Research Center survey, 67% of Americans supported marijuana legalization. Since that 2019 survey, more US states have legalized recreational marijuana.

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QUESTION: Does ketamine interact with cannabinoids?

ANSWER: Yes. Ketamine is a CYP3A4 substrate, and thus may inhibit the metabolism of cannabinoids, including THC. This, in turn, can increase blood levels of cannabinoids and possibly lead to fatal dysrhythmias, heart attack, or stroke, according to the American Heart Association. Also, ketamine levels may increase which can lead to negative effects, including agitated delirium, respiratory depression (ketamine is primarily an NMDA antagonist, but it may also bind to mu and the sigma receptors.)

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QUESTION: What is the most common reason for cannabinoid use among cancer survivors?

ANSWER: The most common reason for cannabinoid use among cancer survivors was pain. Other common reasons why cancer survivors used cannabinoids include sleeping problems and anxiety.

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QUESTION: What are the most common reasons older adults use cannabis-based products?

ANSWER: According to an anonymous survey of 568 adults age 65 or older, the majority (78%) used cannabinoids for medical purposes only, with the most common targeted conditions/symptoms being pain/arthritis (73%), sleep disturbance (29%), anxiety (24%), and depression (17%). Of note, only 41% reported that their healthcare provider knew that they use cannabinoids for medicinal purposes.

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QUESTION: Are symptoms of OCD significantly reduced after smoking or vaporizing marijuana?

ANSWER: Data from an app that tracks the changes of medical marijuana patients’ symptoms as a function of different doses and strains of cannabis across time was analyzed. The results indicate that inhaled cannabinoids appear to have short-term beneficial effects on symptoms of OCD. However, tolerance to the effects on intrusions may develop over time.

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QUESTION: Which US states have legalized adult-use marijuana possession and have also legalized adult-use marijuana sales?

ANSWER: As of October 10, 2020, the following 11 US states had legalized adult use marijuana possession and adult use marijuana sales: Alaska, California, Colorado, Illinois, Maine, Massachusetts, Michigan, Nevada, Oregon, Vermont, and Washington. Washington DC and Guam have also legalized adult use marijuana sales. In November 2020, Arizona, Montana, New Jersey and South Dakota legalized recreational marijuana, too.

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QUESTION: Are there any US states that do NOT deny solid organ transplants for patients that use marijuana for medicinal purposes?

ANSWER: Legislation has passed in at least 7 US states (California, Washington, Illinois, Arizona, Delaware, New Hampshire, and Maine) that explicitly forbids denial of transplantation listing on the basis of an individual’s use of medical marijuana. *Of note, transplant recipients take immunosuppressive drugs, and inhaled smoked or vaporized marijuana can expose the consumer to life-threatening pulmonary infections (Aspergillosis, for example). Typically, most US state solid organ transplant programs have recommended that individuals with active drug or alcohol abuse not undergo transplantation.

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QUESTION: Does THC stimulate the sympathetic or parasympathetic system?

ANSWER: Tetrahydrocannabinol stimulates the sympathetic nervous system while inhibiting the parasympathetic nervous system. After THC consumption, there may be increases heart rate, myocardial oxygen demand, supine blood pressure, and platelet activation. (Of note, THC is associated with endothelial dysfunction and oxidative stress.)

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QUESTION: What is the half life of CBD? How does it compare to the half life of THC?

ANSWER: The half life of CBD is 18-32 hours, which is similar to the half life of THC of 20-30 hours. Both CBD and THC are distributed to fatty tissues and highly perfused organs such as brain, heart, lung, and liver.

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QUESTION: At what point during gestation are endocannabinoid receptors expressed in the fetus?

ANSWER: Endocannabinoid receptors are first expressed in the fetus at 5 to 6 weeks’ gestation.

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QUESTION: Did past-month cannabis use among pregnant US women increase or decrease during the 15 year span of 2002 to 2017?

ANSWER: Past-month cannabis use among pregnant US women more than doubled from 2002 (3.4%) to 2017 (7.0%).

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QUESTION: Is prenatal exposure to cannabis associated with child outcomes?

ANSWER: The results of a cross-sectional analysis published in a September 2020 JAMA Psychiatry journal, indicate that prenatal exposure does impact child outcome. This particular cross-sectional analysis involved 11,489 children (655 exposed to cannabis prenatally) and the findings indicate that prenatal cannabis exposure after maternal knowledge of pregnancy was associated with greater psychopathology (i.e., internalizing, externalizing, attention, thought, and social problems, as well as psychotic-like experiences) during middle childhood, even after accounting for potentially confounding variables.

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QUESTION: Does marijuana use during pregnancy affect the birth weight of the baby?

ANSWER: Yes. According to a 2018 study by Campbell et al., marijuana use during pregnancy triples the likelihood of having a low birth weight baby, even after adjusting for factors such as socioeconomic status, medical history, and other substance use such as tobacco smoking

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QUESTION: What percentage of 12th graders in the US have used marijuana at least once in their life?

ANSWER: According to the National Institute on Drug Abuse’s Monitoring the future, nearly one half of all 12th-graders in the United States have used marijuana in their lifetime, with more than one third during the past year, and almost one quarter in the past month.

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QUESTION: What percentage of individuals who misuse prescription opioids seek treatment?

ANSWER: Only 8% of individuals who misuse prescription opioids seek treatment. Of note, approximately 80% of heroin users first misused prescription opioids.

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QUESTION: How does CBD impact the cardiovascular system?

ANSWER: CBD reduces heart rate and blood pressure, and improves vasodilation in models of endothelial dysfunction. Also, CBD reduces inflammation and vascular hyperpermeability in diabetic models.

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QUESTION: Compared to previous years, has the number of opioid deaths since the COVID pandemic increased or decreased?

ANSWER: Since the beginning of the COVID-19 pandemic, a dramatic increase in the number of opioid overdose deaths has been reported. According to a recent report put out by the American Medical Association, opioid overdose deaths have increased in more than 35 states since the pandemic began. This surge is believed to be multifactorial, and due to isolation, economic issues, disruptions to the drug trade and other factors.

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QUESTION: How many adolescents in the US misused opioids in 2018?

ANSWER: In 2018, 699,000 adolescents between the ages of 12 and 17 misused opioids, with the vast majority misusing prescription opioids. Of these 699,000 adolescents, 108,000 had opioid use disorder.

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QUESTION: Does substance use disorder increase the risk for COVID-19?

ANSWER: Yes, according to an analysis of electronic health records (EHR). As reported by Nora D. Volkow, MD, director of the National Institute on Drug Abuse, and colleagues, the evaluation of over 73 million electronic health records, the risk of COVID-19 was far greater among patients diagnosed with a substance use disorder in the past year compared with the general population after adjusting for age, gender, race, and insurance type.

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QUESTION: Does the oral administration of CBD alter plasma concentrations of diazepam?

ANSWER: CBD can alter the toxicity or efficacy of other drugs through inhibition of certain enzymes. For example, increases in the plasma concentration of diazepam have been reported when the diazepam is coadministered with Epidiolex (a CBD product).

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QUESTION: Has the use of a transdermal gel for regional and systemic delivery of CBD been evaluated for the treatment of epilepsy?

ANSWER: Yes. A transdermal gel for regional and systemic delivery of CBD (Zynerba Pharmaceuticals) is in clinical development for treatment of epilepsy, developmental and epileptic encephalopathy, fragile-X syndrome, and osteoarthritis. NOTE: As of September 2020, the company’s website indicates that the product is not yet approved by government regulatory bodies, including the United States Food and Drug Administration (FDA) and other agencies, and must be tested to see if it is an effective and safe treatment.

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QUESTION: Is cannabidiol in compounded topical pain creams safe to use?

ANSWER: According to the National Academies of Science, Engineering and Medicine’s 2020 publication A Review of the Safety and Effectiveness of Select Ingredients in Compounded Topical Pain Creams, “there is insufficient evidence on the safety of topical application of cannabidiol. However, if systemic absorption to therapeutic levels is achieved through topical application, there is potential for side effects similar to other routes of administration (e.g., oral).”

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QUESTION: Does cannabidiol in compounded topical pain creams penetrate the skin of animals?

ANSWER: According to the National Academies of Science, Engineering and Medicine’s 2020 publication, A Review of the Safety and Effectiveness of Select Ingredients in Compounded Topical Pain Creams, “there is limited preclinical evidence to suggest that cannabidiol penetrates animal skin. Modifications to the ingredient or excipient may increase aqueous solubility and increase absorption.”

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QUESTION: In PRECLINICAL studies, it has been shown that cannabinoids induce apoptosis of cancer cells. Do cannabinoids induce apoptosis of normal non-malignant cells?

ANSWER: According to the results of PRECLINICAL studies, including in vitro studies and and studies in mice, cannabinoids induce apoptosis of cancer cells without causing negative effect on the viability of normal non-malignant cells. In some mouse models, it has been noted that cannabinoids act synergistically with standard anti-cancer drugs or radiation therapy to reduce tumor growth. These studies have not detected overt signs of toxicity in the treated animals. NOTE: The observations noted in culture or animal models do NOT always readily translate into clinical benefit.

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QUESTION: Most of the currently available scientific evidence for anti-neoplastic activity of cannabinoids is derived from PRECLINICAL models, including in vitro studies and studies involving mouse models. What have the results of these PRECLINICAL studies indicated?

ANSWER: These PRECLINICAL studies have reported that THC and some other cannabinoids can activate the CB1 and CB2 receptors on the surface of cancer cells and impact the intracellular signaling pathways of the cancer cells. Some effects include (1) apoptosis of the cancer cells (2) the blockade of cancer cell proliferation (3) inhibition of tumor angiogenesis and (4) inhibition of metastasis. NOTE: the results of PRECLINICAL studies do NOT always correlate with CLINICAL outcome/benefit.

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QUESTION: Clinical trials evaluating the use of human monoclonal antibodies against interleukin 1 and interleukin 6 to treat cytokine storm syndrome in COVID-19 patients are underway or in the planning stage. Are there any possible significant pharmacodynamic interactions between monoclonal antibodies and CBD?

ANSWER: Yes. The combination of monoclonal antibody agents, including eculizumab and sarilumab, or other immuno/myelosuppressive agents with CBD may potentiate the risk of infection.

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QUESTION: Nelfinavir is an HIV-1 protease inhibitor. Patients who have HIV may be taking this drug and may also be using cannabinoids to treat some of the symptoms associated with the HIV infection. Does Nelfinavir interact with CBD? (Of note, Nelfinavir may also inhibit SARS-Cov-2 replication.)

ANSWER: The combination of Nelfinavir and CBD may lead to an increase risk of diarrhea and/or headache.

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QUESTION: Dexamethasone, a commonly used corticosteroid to treat various inflammatory conditions, has been recommended for use in COVID-19 patients with severe respiratory symptoms (according to data from Randomized Evaluation of COVID-19 Therapy (RECOVERY) trial). Does THC interact with dexamethasone? Does CBD interact with dexamethasone?

ANSWER: Both THC and CBD have possible pharmacodynamic interactions with dexamethasone. While the combination of THC and dexamethasone may lead to an increase in euphoria, the combination of CBD and dexamethasone may lead to a potentiation of immunosuppression and an increase in risk of infection, and could increase the risk of headache.

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QUESTION: Darunavir with cobicistat has been used to treat HIV and it has also been trialed for the treatment of COVID-19 infection. Are there any possible pharmacodynamic interactions between CBD and Darunavir/ Cobicistat?

ANSWER: Yes, this drug combination may increase headache and/or diarrhea.

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QUESTION: What is the most common qualifying condition reported by medical marijuana patients?

ANSWER: Currently and historically the most common qualifying condition reported by medical marijuana patients is chronic pain. In fact, according to an analysis by Boehnke et al, chronic pain was the qualifying condition reported by medical marijuana patients nearly 65 percent of the time (according to 2016 data).

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QUESTION: Hydrochloroquine has been trailed as a therapy for COVID-19 infections. Does this drug interact with CBD? If so, what are the potential consequences?

ANSWER: The combination of CBD and hydrochloroquine may lead to an increase of headache and/or diarrhea risk.

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QUESTION: Baricitnib, a drug approved for the treatment of rheumatoid arthritis, may reduce COVID-19 viral entry and mitigate inflammation. (A clinical trial evaluating this drug has begun in Italy .) Does CBD interact with Baricitnib?

ANSWER: Yes. A possible pharmacodynamic interaction between Baricitnib and CBD may develop, and there may be an increased effect on tumor necrosis factor. There may also be an increased risk of serious infection, malignancy or thrombosis.

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QUESTION: There may be pharmacokinetic and pharmacodynamic drug–drug interactions between cannabinoids and medications used to treat COVID infections. Azithromycin may have anti-viral activity and has been co-administered with hydroxychloroquine in a RCT of COVID treatment. Does Azithromycin interact with CBD?

ANSWER: Yes, a possible pharmacodynamic interaction may occur and lead to an increase risk for diarrhea.

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QUESTION: Did the number of naloxone prescriptions increase, decrease or stay the same during the time span of 2010 to 2018?
ANSWER: According to research conducted by the Urban Institute, prescriptions for naloxone increased by more than 70-fold from 2010 to 2018. (3,300 to 236,000 prescriptions). The most significant increase in naloxone prescriptions occurred after 2016.

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QUESTION: What have been the most frequently filled prescriptions at US pharmacies in 2020? Are most of them prescriptions for pain relief?

ANSWER: According to research conducted by GoodRx, an online platform that provides users with coupons for discounts on prescription drugs, the 10 most frequently filled prescriptions are: Atorvastatin, Lisinopril, Albuterol, Levothyroxine, Amlodipine, Gabapentin (for the treatment of nerve pain or seizures in adults), Omeprazole, Glucophage, Losartan, and Hydrocodone/acetaminophen (for the treatment of moderate to severe pain.)

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QUESTION: Greater social acceptance of marijuana may result in some prospective parents to reason that it could be used to treat morning sickness. Does marijuana use have any implications for fetal neurodevelopment?

ANSWER: A study evaluating the association between maternal marijuana use during pregnancy and child neurodevelopmental outcomes posed the following question: “Was there an association between cannabis exposure in pregnancy and child neurodevelopmental outcomes in a Canadian cohort?” The results of this retrospective study in Canada found that children exposed to marijuana in utero had a moderately elevated risk of developing autism spectrum disorder. Autism incidence was 4.0 per 1,000 person-years among children exposed to cannabis in pregnancy versus 2.42 among unexposed children (adjusted hazard ratio [HR] 1.51, 95% CI 1.17-1.96)

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QUESTION: In 2020, the 20 member ‘Global Task Force on Dosing and Administration of Medical Cannabis in Chronic Pain’ developed recommendations for the dosing of cannabinoids. These recommendations were presented at a virtual meeting. One of their recommendations addressed the use of medicinal cannabinoids in patients with severe pain. What were the recommendations for the dosing of cannabinoids for patients suffering with severe pain?

ANSWER: According to the recommendations of the ‘Global Task Force on Dosing and Administration of Medical Cannabis in Chronic Pain,’ patients suffering from severe pain and those patients who have a history of significant prior cannabis consumption can use a 50:50 CBD-THC product and start with a dose of 2.5-5 mg of each compound 1 or 2 times/day.

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QUESTION: In 2020, the 20 member ‘Global Task Force on Dosing and Administration of Medical Cannabis in Chronic Pain’ developed recommendations for the dosing of cannabinoids. These recommendations were presented at a virtual meeting. One of their recommendations addressed the use of medicinal cannabinoids in elderly patients. What were the recommendations for the dosing of THC in the elderly population?

ANSWER: According to the recommendations of the ‘Global Task Force on Dosing and Administration of Medical Cannabis in Chronic Pain,’ elderly patients, patients with severe co-morbidity or patients who take multiple medications should be managed through a conservative route; start with THC doses at 1 mg/day and the dose should be titrated up slowly.

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QUESTION: In 2020, the 20 member ‘Global Task Force on Dosing and Administration of Medical Cannabis in Chronic Pain’ developed recommendations for the dosing of cannabinoids. These recommendations were presented at a virtual PAINWeek meeting. One of their recommendations included “Treat the majority of patients along the “routine” scale.” What does this mean?

ANSWER: Treating the majority of patients along the “routine” scale means to start with a dose of 5 mg of cannabidiol (CBD) twice daily, and tetrahydrocannabinol (THC) should only be added if the patient does not respond to at least 40 mg of CBD daily. If THC is added, the starting dose should be 2.5-mg daily. THC doses should be capped at 40 mg daily.

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QUESTION: In 2017, the National Academies of Sciences, Engineering and Medicine (NASEM) published The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research. According to this report, are cannabinoids an effective treatment for chronic pain?

ANSWER: According to this report, “There is conclusive or substantial evidence that cannabis or cannabinoids are effective for the treatment of chronic pain in adults (cannabis).”

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QUESTION: Do cannabinoids decrease or increase g.i. motility?

ANSWER: The pharmacological actions of cannabinoids include decreased gastrointestinal motility, secretion, and emptying.

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QUESTION: Does dronabinol increase appetite in HIV/AIDS patients?

ANSWER: There is limited to moderate evidence to suggest that dronabinol, a synthetic pharmaceutical preparation of delta-9-tetrahydrocannabinol, may be effective in stimulating appetite and weight gain among patients suffering from HIV wasting syndrome. In 1992, the US Food and Drug Administration approved dronabinol for the treatment of AIDS-related anorexia.

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QUESTION: What is the most prevalent side effect of opioids in cancer patients?

ANSWER: Constipation is reported as the most prevalent and most disabling side effect of opioids in both cancer and non-cancer pain patients, with a prevalence as high as 90%.

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QUESTION: What are conduction-based vaporizers?

ANSWER: Conduction-based vaporizers heat herbal cannabis on a surface that is warmed, such as a metal plate, which then allows compounds to passively volatilize. Meanwhile, the consumer generates a steady inhalation, similar to the technique used by asthma patients with metered-dose inhalers or nebulizers to achieve pulmonary administration.

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QUESTION: What physiological systems are affected by the endocannabinoid system?

ANSWER: In addition to regulating neuronal excitability and inflammation in pain circuits, the endocannabinoid system has been shown to play a regulatory role in movement, appetite, hypothalamic-pituitary-adrenal axis modulation, immunomodulation, mood, blood pressure, bone density, tumor surveillance, neuroprotection and reproduction. The endocannabinoid system has also been shown to affect sensory perception, cardiac output, cerebral blood flow and intraocular pressure.

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QUESTION: What does cannabinergic mean?

ANSWER: Any drug that modifies or interacts with the endocannabinoid system is ‘cannabinergic’.

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QUESTION: What is the pharmacological profile of buccally administered cannabinoids?

ANSWER: With buccal administration, a mix of cannabinoids can be sprayed on to the oral mucosa and the medicine is absorbed through the mucous membranes. Peak plasma concentrations usually occur within 2-4 hrs after administration. When compared to inhalation of cannabinoids, buccal administration of cannabinoids is associated with lower blood levels of cannabinoids because absorption is slower, redistribution into fatty acids occurs rapidly and some of the cannabinoids undergo first pass metabolism.

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QUESTION: Nabiximols (a cannabinoid medicine containing THC and CBD) is approved in many European countries for the treatment of neuropathic pain, spasticity and bladder dysfunction in patients suffering from multiple sclerosis. What are the potential drug interactions between nabiximols and analgesic medications?

ANSWER: The nabiximols product monograph cautions prescribers against combining nabiximols with amitriptyline or fentanyl because these drugs are metabolized by the same enzymes as nabiximols. Potential drug interactions with other opioids (oxycodone, tramadol and methadone) also exist.

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QUESTION: What is the purpose of urine drug testing?

ANSWER: Urine drug tests typically screen for the patient’s prescribed opioids and the commonly abused drugs: cocaine, amphetamines, alcohol, barbiturates, opiates and benzodiazepines. Although a urine drug test can confirm if the patient is taking the prescribed opioid, it cannot determine if the patient is taking the prescribed dose.

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QUESTION: What are the drugs that are inhibitors to cytochrome P450 and therefore decrease the metabolism of cannabinoids?

ANSWER: THC is oxidized by the cytochrome P450 (CYP) mixed-function oxidases 2C9, 2C19 and 3A4 1. Therefore, substances that inhibit these CYP isoenzymes (e.g. fluoxetine, cimetidine, clarithromycin, ketoconazole, verapamil, indinavir, among others) can potentially increase the bioavailability of THC, and thus increase the chance of experiencing THC-related side effects.

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QUESTION: Why do NSAIDS relieve pain?

ANSWER: NSAIDs reduce the production of prostaglandin E2 (PGE2) and prostacyclin (PGI2), which mediate pain and inflammation.

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QUESTION: Describe the process of vaporization of cannabis.

ANSWER: Vaporization is a smokeless delivery system in which warm air or heat of 180°C to 200°C, rather than a flame, is used to convert cannabinoids and other compounds into a fine mist that can be inhaled. Due to their volatility, cannabinoids will vaporize at temperatures of 180°C to 200°C, but will not combust and therefore few combustion by-products such as soot or polycyclic aromatic hydrocarbons are produced. As temperatures increase, the amount of cannabinoids released increases, and the amount of combustion by-products increases, too.

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QUESTION: The pharmacological properties of cannabigerol have been investigated. What have the studies shown?

ANSWER: Cannabigerol (CBG) is the phytocannabinoid precursor molecule, and demonstrates weak partial agonism at CB1 and CB2. In in vitro studies, CBG displays analgesic and anti-erythemic effects. CBG also displays anti-hypertensive activity.

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QUESTION: The pharmacological properties of tetrahydrocannabivarin have been investigated. What have the studies shown?

ANSWER: Tetrahydrocannabivarin (THCV) is a CB1 antagonist at low doses, but displays weak agonistic effects at high doses. In obese mice models, THCV reduced appetite, produced weight loss and decreased body fat and leptin concentration.

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QUESTION: What is the pharmacologic profile of cannabis when it is vaporized?

ANSWER: The pharmacologic profile of cannabis when it is vaporized is similar to the profile when it is smoked. Psychoactive effects appear within 90 seconds, reach a maximum after 15-30 minutes, and taper off within 2-3 hours.

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QUESTION: What is the pharmacologic profile of cannabis when it is smoked?

ANSWER: When herbal cannabis is smoked, the active ingredients in cannabis are vaporized by the heat of combustion and inhaled. Inhaled constituents quickly pass from alveoli into the bloodstream and readily cross the blood-brain barrier. Psychoactive effects appear within 90 seconds, reach a maximum after 15-30 minutes, and taper off within 2-3 hours. This short onset of action makes dose titration possible, by spacing inhalations at 90-second intervals.

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QUESTION: The pharmacological properties of cannabichromene have been investigated. What have the studies shown?

ANSWER: Cannabichromene (CBC) is a potent anadamide uptake inhibitor and thus may modulate the endocannabinoid system similarly to CBD. In mice studies, it has been shown that CBC has anti-inflammatory properties and analgesic activity. CBC has other pharmacological properties, as well.

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QUESTION: The pharmacological properties of cannabinol have been investigated. What have the studies shown?

ANSWER: Cannabinol (CBN) is the oxidative by-product of THC and appears after long storage. It is a weaker partial agonist at CB1 and CB2 as compared to THC. In in vitro studies, it has been found that cannabinol is anticonvulsant and anti-inflammatory, and stimulates bone formation.

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QUESTION: It is the mixture of phytocannabinoids, terpenes and other active components present in a cannabis product that ultimately determines the therapeutic effects and side effects. Does CBD affect THC absorption and tolerance?

ANSWER: CBD has long been thought to influence the effects of THC. This thinking was extended to consider that CBD potentiates some of the beneficial effects of THC, as it reduces the psychoactive effects of THC and thus could improve tolerability. CBD may counteract some of the functional consequences of CB1 receptor activation in the brain. This effect has been used to explain why high CBD:THC cannabis use is less associated with the development of psychotic symptoms compared to low CBD:THC cannabis. Also, CBD is thought to interact with the cytochrome p450 enzymes that metabolize THC and thus may alter the metabolism and influence the effects of the THC consumed. It has been proposed that THC and CBD act synergistically in therapeutic use.

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QUESTION: Does methadone alter cardiac conduction?

ANSWER: Yes. Methadone is known to prolong QTc intervals in up to 16% of patients. Studies have shown a linear dose response curve, with higher doses leading to a higher propensity for QTc prolongation. This has led to an FDA “black box” warning for methadone and the recommendation for routine ECG monitoring.

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QUESTION: How have medical advances altered opioid use in cancer patients?

ANSWER: Cancer is no longer considered a “terminal disease.” Because of significant advances in surgical, radiation, and chemotherapeutic treatments, more than 50% of cancer patients are living greater than 2 years after the diagnosis of cancer. This allows for more cancer patients to develop chronic pain. All of these factors have led to more cancer patients taking opioids long-term.

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QUESTION: What are terpenes (or terpenoids)?

ANSWER: Terpenes are aromatic components produced in the glandular part of the cannabis plant’s flower bud. Terpenes are manufactured by many plants (not just the cannabis plant) and can be found in many food products, including coffee beans, ginger and cinnamon. Often, it is the terpenes that are responsible for a plant’s odor.

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QUESTION: Does smoking marijuana impact the metabolism of theophylline?

ANSWER: It may. Reports have indicated that smoking marijuana may increase the clearance of theophylline. Note: this effect appears to be a direct result of the hydrocarbons found in marijuana smoke rather than the cannabis-based products, as there is a lack of evidence for enzyme induction when cannabis-based drugs are consumed via oral ingestion.

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QUESTION: Do the hydrocarbons in marijuana smoke impact drug metabolism?

ANSWER: Possibly. Similar to cigarette smoke, the hydrocarbons in marijuana smoke appear to induce the activity of some cytochromes, including CYP1A2.

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QUESTION: What criteria should be used when selecting a CBD hemp product?

ANSWER: According to a 2019 Mayo Clinic publication, the following 4 questions should be asked, and the answers to each of the questions should be “yes” :
1. Does the hemp product meet the quality standards of the Current Good Manufacturing Practices Certification from the FDA, or the European Union, Australian or Canadian organic certification, or the National Science Foundation International Certification?
2. Does the manufacturer have an independent review adverse event reporting system?
3. Is the product certified organic or ecofarmed?
4. Have the company’s products been lab tested to confirm THC levels to be < 0.3% and to confirm that no pesticides or heavy metals are present?

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QUESTION: Is full spectrum CBD the same as whole plant CBD?

ANSWER: No. Whole plant CBD contains fats, waxes and fibrous materials not found in full spectrum CBD.

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QUESTION: Is the plasma concentration of Epidiolex (CBD) affected by co-administration of high fat/high calorie food?

ANSWER: Yes. It has been that if CBD is co-administered with a high fat/high calorie meal, the plasma concentration of CBD may increase by as much as 5-fold.

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QUESTION: Describe the exact mechanism of action of Epidiolex.

ANSWER: According to the Epidiolex FDA Approved Package Insert, (Greenwich Biosciences, Inc.), the precise mechanism(s) by which Epidiolex exerts its anticonvulsant effects in humans are unknown. It does not appear to be through cannabidiol receptors.

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QUESTION: Epidiolex has been approved for the treatment of seizures associated with two rare and severe forms of epilepsy, Lennox-Gastaut syndrome (LGS) and Dravet syndrome (DS). Has the FDA approved Epidiolex for any other conditions?

ANSWER: Yes. On July 31, 2020, the U.S. Food and Drug Administration approved Epidiolex (cannabidiol or CBD) oral solution for the treatment of seizures associated with tuberous sclerosis complex (TSC) in patients one year of age and older.

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QUESTION: The International Association for the Study of Pain (IASP) has updated the definition of pain. What is their new definition of pain?

ANSWER: After 40+ years, the IASP has revised their definition of pain to reflect advances in our understanding of pain. The revised definition emphasizes that tissue damage is not required. The updated definition of pain is: “An unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage.” The revised definition also includes 6 notes:
1.) Pain is always a personal experience that is influenced to varying degrees by biological, psychological, and social factors
2.) Pain and nociception are different phenomena, and pain cannot be inferred solely from activity in sensory neurons
3.) Through life experiences, people learn the concept of pain
4.) A person’s report of an experience as pain should be respected
5.) Although pain usually serves an adaptive role, it may have adverse effects on function and social and psychological well-being
6.) Verbal description is only one of several behaviors to express pain, and an inability to communicate does not negate the possibility that a human or a nonhuman animal experiences pain

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QUESTION: What is oliceridine (Olinvyk)? Is it a new FDA-approved opioid?

ANSWER: According to an August 7, 2020 FDA news release, “the FDA approved Olinvyk (oliceridine), an opioid agonist for the management of moderate to severe acute pain in adults, where the pain is severe enough to require an intravenous opioid and for whom alternative treatments are inadequate. Olinvyk is indicated for short-term intravenous use in hospitals or other controlled clinical settings, such as during inpatient and outpatient procedures. It is not indicated for at-home use.” https://www.fda.gov/news-events/press-announcements/fda-approves-new-opioid-intravenous-use-hospitals-other-controlled-clinical-settings

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QUESTION: What is the safety profile of Olinvyk?

ANSWER: According to an August 7, 2020 FDA news release, “The safety profile of Olinvyk is similar to other opioids. As with other opioids, the most common side effects of Olinvyk are nausea, vomiting, dizziness, headache and constipation. Olinvyk should not be given to patients with significant respiratory depression; acute or severe bronchial asthma in an unmonitored setting or in the absence of resuscitative equipment; known or suspected gastrointestinal obstruction; or known hypersensitivity to the drug. Prolonged use of opioid analgesics during pregnancy can result in neonatal opioid withdrawal syndrome.” “Olinvyk carries a boxed warning about addiction, abuse and misuse; life-threatening respiratory depression; neonatal opioid withdrawal syndrome; and risks from concomitant use with benzodiazepines or other central nervous system depressants. Unlike other opioids for intravenous administration, Olinvyk has a maximum recommended daily dose limit of 27 milligrams.” https://www.fda.gov/news-events/press-announcements/fda-approves-new-opioid-intravenous-use-hospitals-other-controlled-clinical-settings

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QUESTION: Changes in fetal growth have been described in some epidemiological studies examining the impact of maternal use of marijuana. Do the long‐term patterns of physical growth appear to be affected?

ANSWER: No, long-term physical growth does not appear to be affected. In contrast, long‐term impacts on psychological health have been noted and include increased rates of depressive symptoms and anxiety as well as delinquency.

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QUESTION: Does the use of cannabinoid-based products impact female sexual function?

ANSWER: According to a study published in the journal Sexual Medicine, an increased frequency of marijuana use is associated with improved sexual function among females. Interestingly, it was noted that chemovar type and method of consumption did not impact outcomes, though.

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QUESTION: CBD and medical marijuana are legal in Florida and California. Do the major amusement parks in these states and other legal marijuana states allow medical marijuana patients to carry CBD and medical marijuana into the amusement parks?

ANSWER: With a few exceptions, the answer is no. Medical marijuana and CBD products are not allowed in Disney parks and resorts (including hotels, shopping and restaurants). Six Flags, Universal, and Cedar Fair also prohibit all forms of legal cannabinoid products, including CBD. In contrast, Sea World properties (which include all Busch Gardens and Sea World parks) allow visitors to carry CBD—but no forms of medical marijuana with significant amounts of THC.

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QUESTION: According to an estimate by the United Nations, what percentage of the world’s population used cannabis products in 2016?

ANSWER: The UN estimated that in 2016, 3.9% of the world’s population used cannabis products. (3.9% of the world population is equivalent to ~ 192.2million people)—The UN’s data suggest that there was an increase of 16% compared with estimates of the previous decade.

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QUESTION: Does the Food and Drug Administration (FDA) currently certify the levels of THC contained within CBD products?

ANSWER: Actually, no. The FDA does not regulate the CBD products sold in convenience stores, grocery stores and on line. Although they are labeled as containing no THC, some may actually contain a small amount of THC. (Note: The FDA does monitor the CBD product called Epidiolex.)

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QUESTION: Has the FDA approved any drugs that contain a purified drug substance derived from cannabis?
ANSWER: Yes. Epidiolex oral solution contains purified cannabidiol that has been extracted from the cannabis plant, and this drug has been approved by the FDA. The FDA has also approved medications, such as marinol, that contain synthetic THC.

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QUESTION: Do cannabinoids induce clinical remission or affect inflammation in inflammatory bowel disease patients?

ANSWER: According to a systematic review with meta-analysis of the efficacy of cannabis and cannabinoids for inflammatory bowel disease, cannabis/cannabinoids do not induce clinical remission or affect inflammation in IBD patients. (No effect on inflammatory biomarkers was observed.) However, in this systematic review it was found that cannabis/cannabinoids significantly improved patient-reported symptoms and quality of life. (Clinical symptoms (abdominal pain, general well-being, nausea, diarrhea, and poor appetite) all improved with cannabis/cannabinoids on Likert-scales.) This systematic review involved 15 nonrandomized studies and 5 randomized controlled trials.

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QUESTION: In July of 2020, the FDA announced that labeling for opioid analgesics and medicine to treat opioid use disorder (OUD) must be updated. What do the updates entail?

ANSWER: The updates include that naloxone availability be routinely discussed as part of prescribing opioid analgesics and OUD medicines. The labelling changes also recommend that health care professionals consider prescribing naloxone when they prescribe medicines to treat OUD. Additionally, the labeling changes recommend “that health care professionals consider prescribing naloxone to patients being prescribed opioid pain medicines who are at increased risk of opioid overdose… A naloxone prescription should also be considered for patients prescribed opioids who have household members, including children, or other close contacts at risk for accidental ingestion or opioid overdose.”

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QUESTION: Do cannabinoid-based medicines impact the deposition of Amyloid β peptide in Alzheimer’s disease?

ANSWER: According to the results of a systematic review, the findings of 9 animal studies indicated that cannabis-based medicines might modulate Amyloid β modifications and inhibit the progression of Alzheimer’s disease. (The maximum and minimum cannabinoid dosages, mostly CBD and THC in animal studies, were 0.75 and 50 mg/kg, respectively. The cannabinoids (CBD and THC) were injected for 10 to 21 days.)

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QUESTION: What is the most common mode of CBD administration?

ANSWER: According to a 2017–2018 online survey evaluating modes of CBD administration, the most common method of CBD administration was sublingual, followed by vaping, oral ingestion of capsules and liquids, smoking, edibles, and topical administration.

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QUESTION: In what dosage forms are pharmaceutical fentanyl products supplied?

ANSWER: Pharmaceutical fentanyl products are currently available in the following dosage forms: oral transmucosal lozenges (AKA fentanyl “lollipops”), buccal tablets and sublingual tablets, sublingual sprays, nasal sprays, transdermal patches, and injectable formulations.

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QUESTION: Chronic pelvic pain affects up to 15% of women in the United States. Cannabinoid receptors are expressed on reproductive tissues (including the uterus) and non-reproductive pelvic tissues. Do patients with chronic pelvic pain use cannabinoid-based products to ameliorate their symptoms?

ANSWER: The conclusions of a survey of 122 chronic pelvic pain female patients indicated that up to 23% report using cannabinoid-based products as an adjunct to their prescribed therapies. The patients use a variety of formulations and doses of cannabinoid-based products, and most report daily or weekly use. Most users report improvement in symptoms, but did acknowledge that side effects are common.

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QUESTION: Describe the chemical makeup of endocannabinoids.

ANSWER: Endocannabinoids are ester, ether, and amide derivatives of long chain polyunsaturated fatty acids. Arachidonic acid is an example of a polyunsaturated fatty acid in endocannabinoids.

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QUESTION: How is the endocannabinoid system linked to the opioid system?

ANSWER: Opioid receptors and CB receptors are located within the same neurons within the CNS. In addition, cannabinoids activate kappa and delta receptors to initiate a release of endogenous opioids.

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QUESTION: Does the co-administration of THC and alcohol impact serum THC levels?

ANSWER: Yes. According to a study by Hartman in 2015, alcohol may increase serum THC levels.

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QUESTION: Some producers of cannabinoid products will provide a certificate of analysis (CoA) from an independent and certified testing laboratory. What information is typically displayed on a CoA?

ANSWER: CoAs typically indicate the amount and concentration of major cannabinoids and terpenes present, and data regarding the presence of microbial/ fungal contaminants, levels of heavy metals, and presence and concentration of pesticide and solvent residues.

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QUESTION: Drug screens are sometimes done in the pre-operative. Is it clinically useful to do a drug screen for the presence of cannabinoids or cannabinoid metabolites?

ANSWER: Drug screens for the presence of cannabinoids and metabolites of cannabinoids will not inform the healthcare provider of the recency of marijuana use, as cannabinoids can remain in the body for several weeks.

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QUESTION: Does CBD isolate contain any other cannabinoids or terpenes?

ANSWER: CBD isolate is CBD in its molecular form, and is typically sold as 99+% pure. Unless indicated on the label, products made with CBD isolate do not contain any other cannabinoids or terpenes.

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QUESTION: What does “broad spectrum” mean?
ANSWER: Broad spectrum and full spectrum are not synonymous. Broad-spectrum products are processed in such a manner as to ensure that the final product does NOT contain THC.

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QUESTION: What does “full spectrum” marijuana product mean?

ANSWER: Full spectrum means that the product contains all of the original compounds found in the flower of the cannabis plant (cannabinoids, terpenes and flavonoids).

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QUESTION: Have the results of studies conducted between 2003-2017 indicated that cannabinoids are effective at treating chronic non-cancer pain?

ANSWER: Yes. Lynch and Ware published 2 systematic reviews (SR). One SR evaluated trials from 2003 to 2010 and the other SR evaluated trials from 2010 to 2014. Of the 29 RCTs evaluated in the 2 SRs, 22 of them demonstrated that cannabinoids have a modest analgesic effect and are safe in the management of chronic pain. The modes of administration explored in these 29 SRs included: smoking, oromucosal and oral. All 6 smoked cannabis trials showed a positive analgesic response.

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QUESTION: Epidemiological studies indicate that as many as 15% of inflammatory bowel disease (IBD) patients may use cannabinoids to ameliorate some of their symptoms, including improvement in diarrhea, abdominal pain and appetite. Do the studies show that cannabinoids are effective?

ANSWER: There are few studies evaluating cannabinoid use in IBD, and those studies are small. In Crohn’s disease, it has been demonstrated that THC reduces the Crohn’s disease activity index by >100 points (on a scale of 0–450). Also, two small studies involving ulcerative colitis patients showed a marginal benefit. However, no improvement in inflammatory markers or in endoscopic score in either disease was detected.

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QUESTION: The findings of multiple RCTs indicate that cannabinoids effectively treat chronic pain. Do cannabinoids effectively treat the chronic pain associated with fibromyalgia?

ANSWER: No. According to a Cochrane systematic review published in 2016 on the use of cannabinoids to treat fibromyalgia, there is no convincing, unbiased, high-quality evidence suggesting that a cannabinoid-based medicine (nabilone) is of value in treating people with fibromyalgia. Furthermore, the tolerability of nabilone was low in people with fibromyalgia. Also, the results of a 2019 study where 4 varieties of pharmaceutical grade marijuana were administered by single shot vapor to fibromyalgia patients indicated that none of the 4 marijuana varieties had an effect greater than placebo. (Note: The data from the 2019 study could not be used to extrapolate the long-term effects of cannabinoids on fibromyalgia-associated pain.)

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QUESTION: Some cancer patients use medical marijuana to treat various cancer-associated ailments. What are some of the ailments ameliorated by medical marijuana?

ANSWER: According to one study involving 96 cancer patients receiving supportive cancer care, the data support the safety and effectiveness of medical marijuana as a complementary option for improving pain control, appetite and quality of life for cancer patients. The top three adverse events of this study included drowsiness, low energy and nausea, and were reported in 28% of patients, with 9% having to stop using the medical marijuana. (Note: other studies indicate that chemotherapy-induced N/V and anxiety are ameliorated by medical marijuana.)

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QUESTION: Side effects of short-term cannabinoid-based therapy may differ from person to person, and the same person may experience different side effects at different times. What factors influence the probability and the severity of adverse events?

ANSWER: Many factors influence the likelihood and the severity of adverse events, including the type of cannabinoid preparation; the mode of administration; the patient’s expectations, the patient’s prior experience with cannabinoid-based therapies, and the age of the patient. Drug–drug interactions may also lead to adverse events.

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QUESTION: According to the results of a survey of breast cancer patients’ use of cannabinoid products before, during, and after treatment, 42% of survey participants had used medical cannabinoid products to relieve symptoms. What symptoms were treated with the cannabinoid products?

ANSWER: Members of the Breastcancer.org and Healthline communities were asked to participate in a survey during the period of 12/16/2019 – 1/19/2020. Among the 832 respondents who completed screening, 725 met the eligibility criteria, and 612 (84%) completed the survey. According to the results, the symptoms for which cannabinoids were used included insomnia (70%), pain (59%), anxiety (57%), stress (51%), and nausea/vomiting (46%). The results also indicated that cannabinoids were used prior to treatment in 24%, during treatment in 79%, and after treatment in 54%. Of subjects reporting cannabis use during treatment: 86% used it during chemotherapy, 71% during HER2 therapy, 65% during hormonal therapy, 49% during breast radiation, and 47% during radiation for metastatic sites. Post-surgical use was reported in 51% after mastectomy alone, 40% after lumpectomy, and 38% after mastectomy/reconstruction.

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QUESTION: Other than feeling “high” what are some of the reported psychological CNS-related side effects associated with cannabinoid use?

ANSWER: Psychological side effects associated with cannabinoid use include: restless/anxiety/nervousness, depressed mood, dysphoria, confusion, dissociation, hallucinations, hyperactivity, weird dreams, paranoia and psychosis.

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QUESTION: Are cannabinoids an effective analgesic agent in the chronic pain setting?

ANSWER: In contrast to the lack of efficacy in the acute pain setting, cannabinoids are effective analgesic agents in the chronic pain setting. According to 2 systematic reviews involving a total of 29 RCTs, 22 of the 29 RCTs demonstrated that cannabinoids have a modest analgesic effect in the management of chronic pain. The following modes of administration were examined in the RCTs: smoked cannabis (6 trials), oromucosal and oral cannabis extract (11 trials), nabilone (8 trials), dronabinol (2 trials), THC-11 acid analogue (2 trials), and fatty acid amide hydrolase inhibitor (1 trial).

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ANSWER: Are cannabinoids an effective analgesic agent in the acute pain setting?

ANSWER: No. According to the results of multiple RCT examining the efficacy of cannabinoids to treat acute pain, THC, nabilone and other cannabinoid-based products were not associated with a reduction in pain, but were associated with adverse side effects, including sedation.

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QUESTION: What are the common modes of administration of medical marijuana used by cancer patients?

ANSWER: According to a survey completed by 183 cancer patients of an oncology clinic at Sutter Medical Center in Sacramento, California, over 50% reported use of oils and tinctures and 44% used edibles. A smaller percentage consumed cannabis-based products via vaping (26%) or smoking (30%). Topical use was preferred by fewer patients (17%). Over 58% of patients stated they used more than one method.

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QUESTION: It has been estimated that a significant proportion of cancer patients (18.3-40.0%) in the United States use cannabis or cannabinoid-based products. Does the evidence indicate that cannabinoid-based products are effective in treating cancer-related pain? chemotherapy-induced n/v? cancer-related cachexia?

ANSWER: According to a study published in the Journal of Clinical Oncology, there is substantial evidence for the effectiveness of cannabis and cannabinoids in treating cancer-related pain; specifically, oromucosal THC/CBD spray. Also, there is conclusive evidence that cannabis and cannabinoids effectively relieve chemotherapy-induced nausea and vomiting; (specifically, oral THC). However, there is inconclusive evidence about the effectiveness of cannabinoid-based products in treating cancer-related cachexia.

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QUESTION: Does the administration of marijuana affect insulin levels in humans?

ANSWER: In a DBRCT involving 20 participants, it was found that marijuana consumed via oral, smoked, or vaporized routes affected blood concentrations of some metabolic hormones, including insulin. In fact, the results of this study indicate that acute marijuana use blunted the insulin spike associated with the consumption of a brownie.

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QUESTION: Are there any special considerations for patients who consume cannabinoid-based products and are undergoing plastic surgery?

ANSWER: Yes. On occasion, plastic surgeons administer atropine and/or epinephrine during a procedure. Both of these medications can increase heart rate, and cannabinoids may potentiate the increase in heart rate.

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QUESTION: Cannabinoid receptors have been located in the central nervous system and the peripheral nervous system, as well as on immune cells. Have cannabinoid receptors been isolated in reproductive tissues/cells?

ANSWER: In addition to cannabinoid receptors being identified in the hypothalamus and the pituitary gland, cannabinoid receptors have also been identified on ovary, endometrial tissue, testes, and spermatozoa. In fact, research suggests that marijuana may alter the release of FSH and LH, ovulation, sperm motility, fertilization, as well as placentation.

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QUESTION: What are K2 and Spice?

ANSWER: K2 and Spice are synthetic cannabinoid “designer drugs” that are intended to mimic the effects of THC. These synthetic cannabinoids are sold as “herbal incense” at convenience stores/gas stations, smoke shops and via the internet. They are produced in powder form, and then often dissolved in solvents, so they can be applied to dry plant material to make the “herbal incense” products.

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QUESTION: Heroin is processed from morphine, an extract from the poppy plant. Heroin is often depicted as a white powder. Is heroin sold in forms other than white powder?

ANSWER: In addition to white powder, heroin is sold as a brownish powder, or as a black sticky/tar-like substance (AKA black tar heroin). Heroin is either sold in pure form or is “cut” with other drugs (quinine, for example) or with other white powdery substances, including sugar, starch or powdered milk.

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QUESTION: Respiratory depression is associated with the overdose of opioids or benzodiazepines. Is respiratory depression associated with an overdose of cannabinoids? Why or why not?

ANSWER: Respiratory depression is not associated with cannabinoid use because CB1 receptors are not located in the midbrain, the part of the brain responsible for respiratory drive.

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QUESTION: As of January 2020, how many Americans were using marijuana-based products for medicinal purposes?
ANSWER: It has been estimated that more than 2 million Americans use marijuana for medical reasons. Some of the many ailments being treated with marijuana include: chronic pain, PTSD, depression, sleep disorders, multiple sclerosis (MS), cancer-related ailments, and GI disorders. Some indications are supported by good scientific evidence, but many are not.

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QUESTION: Rohypnol® is the trade name for the benzodiazepine called unitrazepam. Has this drug ever been approved by the Food and Drug Administration for medical use in the United States?

ANSWER: No, but outside the US, Rohypnol® is prescribed to treat insomnia. Rohypnol® has been referred to as a date rape drug or roofies. Before 1997, Rohypnol® was manufactured as a white tablet, and when mixed in liquids, it was colorless, tasteless, and odorless. In 1997, the manufacturer responded to concerns about the drug’s role in sexual assaults, and reformulated the drug. Now, Rohypnol® is produced as an olive green tablet with a speckled blue core that when dissolved in light-colored drinks will change the color of the liquid to blue. Of note, generic versions of the drug may not contain the blue dye.

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QUESTION: What is the Chemical Diversion and Trafficking Act (CDTA) of 1988?

ANSWER: The CDTA is an Act that regulated 12 (drug manufacturing) precursor chemicals, eight essential chemicals, tableting machines, and encapsulating machines. The Act imposed recordkeeping and import/export reporting requirements on transactions involving these regulated products. One of the goals of this Act was to reduce the supply of methamphetamine. As of 2020, the DEA regulates more than 40 chemicals that are often used in the production of illicit drugs.

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QUESTION: Cannabinoids are metabolized by many of the same cytochrome P450 enzymes as warfarin, including CYP3A4, CYP2C9, and CYP2C19. THC, CBD and CBN can inhibit the CYP2C9-mediated hydroxylation of warfarin, and thus lead to an increase in INR. Do cannabinoids also affect the metabolism of heparin? Is the metabolism of direct oral anticoagulants (DOACs), including rivaroxaban, edoxaban, and apixaban, impacted by cannabinoids?

ANSWER: While cannabinoids do not alter the metabolism of heparin, cannabinoids may impact the metabolism of DOACs. DOACs are substrates of P-gp and are absorbed by the gut through the P-gp efflux transporter. Cannabinoids may bind to P-gp membrane transporters and alter DOAC metabolism. DOAC levels may increase, leading to an increased risk of bleeding.

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QUESTION: CBD is a CB1 antagonist and a negative allosteric modulator at CB2. Does CBD interact with receptors other than CB1 or CB2?

ANSWER: Yes. CBD has cannabinoid receptor-independent properties. For example, CBD is an agonist at the TRPV1 receptor and has agonist properties at the 5-HT1A/2A/3A serotonergic receptors. CBD is also a capsaicin analog. CBD has antagonist activity on alpha-1 adrenergic and μ-opioid receptors, too. In addition, CBD has been found to inhibit synaptosomal uptake of noradrenaline, dopamine, serotonin, and gamma-amino butyric acid. CBD also inhibits anandamide uptake.

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QUESTION: Cannabinoid receptors are located throughout various parts of the CNS, including the basal ganglia, hippocampus, cerebellum and cerebral cortex, and in the peripheral nervous system. Do these receptors have effects on neurotransmitters such as serotonin?

ANSWER: Yes. CB receptor activity not only impacts serotonin, but it also affects acetylcholine, dopamine, glutamate, and GABA, as well as NMDA and opioid receptor systems.

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QUESTION: The Controlled Substances Act (CSA) regulates five classes of drugs. What are they?

ANSWER: The Controlled Substances Act (CSA) regulates five classes of drugs, including narcotics, depressants, stimulants, hallucinogens and anabolic steroids. All controlled substances have abuse potential or they are immediate precursors to substances that have abuse potential. Note: Alcohol and tobacco are specifically exempt from
control by the CSA.

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QUESTION: Methamphetamine is a Schedule II highly addictive stimulant. What is methamphetamine’s mechanism of action that leads to the “rush” and “high”?

ANSWER: It is believed that the “rush” and the “high” associated with amphetamine use result from the release of very high levels of dopamine into areas of the brain that regulate feelings of pleasure.

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QUESTION: Methadone, morphine and heroin are all narcotics. Do they all have a similar chemical structure?
ANSWER: No. Morphine and heroin (which is derived from morphine) have a similar structure. Methadone, which is a synthetic narcotic, does not have a similar structure to morphine.

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QUESTION: Methamphetamine is a controlled substance and is classified as a Schedule II drug. Schedule II drugs have a high potential for abuse and have an accepted medical use. What medical use(s) does methamphetamine have?

ANSWER: As of April 2020, there is only one legal “meth” product, and it is sold under the name Desoxyn®. It has very limited use in the treatment of obesity and ADHD.

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QUESTION: Is the analgesic potency of hydromorphone more or less than the potency of morphine?

ANSWER: Hydromorphone is (2 to 8 times) more potent than morphine but not as potent as fentanyl.

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QUESTION: Chronic pelvic pain affects up to 15% of women in the United States. Cannabinoid receptors are expressed on reproductive tissues (including the uterus) and non-reproductive pelvic tissues. Do patients with chronic pelvic pain use cannabinoid-based products to ameliorate their symptoms?

ANSWER: The conclusions of a survey of 122 chronic pelvic pain female patients indicated that up to 23% report using cannabinoid-based products as an adjunct to their prescribed therapies. The patients use a variety of formulations and doses of cannabinoid-based products, and most report daily or weekly use. Most users report improvement in symptoms, but did acknowledge that side effects are common.

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QUESTION: In what dosage forms are pharmaceutical fentanyl products supplied?

ANSWER: Fentanyl pharmaceutical products are currently available in the following dosage forms: oral transmucosal lozenges (AKA fentanyl “lollipops”), buccal tablets and sublingual tablets, sublingual sprays, nasal sprays, transdermal patches, and injectable formulations.

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QUESTION: Fentanyl, morphine and heroin are all analgesics. Which one of the three is the most potent analgesic?

ANSWER: Fentanyl is the most potent analgesic of the three. It is about 100 times more potent than morphine and 50 times more potent than heroin, as an analgesic agent.

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QUESTION: What are common street names for marijuana?

ANSWER: Often, marijuana concentrates look similar to honey with either a brown or gold color, and many of the street names refer to the golden brown color. The terms wax, ear wax, honey oil, budder, butane hash oil, butane honey oil (BHO), shatter, dabs (dabbing), black glass, and errl have all been used to refer to marijuana concentrates.

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QUESTION: What is hashish?

ANSWER: Hashish (AKA hash) is a THC-rich resin from the cannabis plant. This resin is collected and processed into various forms, including balls, cakes or cookies. Pieces of hashish can be broken off, and placed in pipes or cigarettes for smoking. Some individuals mix hashish with tobacco. Hashish products are considered to be Schedule I substances.

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QUESTION: What is the most common route of administration for the synthetic cannabinoids K2 or Spice?

ANSWER: K2 and Spice are used for recreational purposes, and smoking is the most common route of administration. Spraying or mixing the synthetic cannabinoids on dried plant material allows one to smoke it (using a pipe, a water pipe, or rolling the drug-laced plant material in cigarette papers). Also, liquid synthetic cannabinoids have been designed to be vaporized via e-cigarettes.

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QUESTION: Does marijuana use alter the sexual intercourse experience?

ANSWER: An online survey posed questions regarding various aspects of sexual experience and how those aspects were impacted by marijuana use. The results indicated that marijuana helped individuals relax, heightened their sensitivity to touch, and increased intensity of feelings, thus enhancing their sexual experience, while others found that marijuana interfered by making them sleepy and less focused or had no effect on their sexual experience.

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QUESTION: CB1 receptors are located on neurons in the CNS and PNS. Are CB1 receptors also located on cardiomyocytes?

ANSWER: Yes. CB1 receptors are located in cardiomyocytes, vascular endothelial cells as well as smooth muscle cells. Activation of these CB1 receptors may lead to oxidative stress, inflammation, fibrosis, vasodilation, and negative inotropy.

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QUESTION: Some cannabinoid-based medicines are used to treat chemotherapy-induced n/v. Have cannabinoid-based medicines been shown to be effective in the treatment of post-op n/v?

ANSWER: The results of studies indicate that neither nabilone or intravenous THC is effective for post-op n/v. Even premedication with nabilone was ineffective at treating post-op n/v.

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QUESTION: Does ketamine interact with the endocannabinoid system?

ANSWER: Yes. Ketamine induces the release of endocannabinoids.

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QUESTION: Do CB1 and CB2 agonists facilitate endogenous opioid signaling?

ANSWER: Yes. In fact, CB1 and CB2 agonists increase the concentrations of endogenous opioids.

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QUESTION: Is the endocannabinoid system linked to the opioid system?

ANSWER: Yes. Opioid receptors and CB receptors are located within the same neurons within the CNS. In addition, cannabinoids activate kappa and delta receptors to initiate a release of endogenous opioids.

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QUESTION: How do cannabinoids modulate pain sensation? In other words, describe the mechanism of action of cannabinoids.

ANSWER: Endocannabinoids are synthesized in the postsynaptic neuron in response to stimuli such as pain, stress and inflammation. Endocannabinoids travel in a retrograde fashion and activate the presynaptic CB receptors. Antinociceptive effects occur when either endocannabinoids or phytocannabinoids activate presynaptic inhibitory CB1 receptors. Stimulation of CB1 receptors (G protein coupled receptors (Gi,Go)) leads to a reduction of cAMP production via the inhibition of adenylyl cyclase. This results in an action on voltage gated calcium and potassium channels – there is a depression of neuronal excitability and a reduction of neurotransmitter release.

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QUESTION: A study by Jamal et al. published in the European Journal of Anaesthesiology reported that marijuana users required a higher dose of morphine s/p abdominal surgery. They estimated that there was a 23% increased opioid dose requirement. Have the results of studies examining the opioid requirements s/p orthopedic surgery also shown that marijuana users require more opioids than patients who do not use marijuana?

ANSWER: In a retrospective study including 3793 patients, patient-reported postoperative outcomes of 155 marijuana users were compared with those of 155 non-users. The results indicate that pre-operative marijuana users had higher pain scores at rest and on movement but did not consume more post-operative opioid analgesics. The cannabinoid users also reported a greater incidence of post-operative sleep impairment.

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QUESTION: CBD is a negative allosteric modulator. What does that mean?

ANSWER: A negative allosteric modulator changes the shape of the receptor and, as a result, reduces the binding ability of components that typically bind to the receptor. In the case of cannabinoids, CBD alters the shape of CB1 receptors, and THC along with endogenous cannabinoids do not bind to the CB1 receptor to the same degree as they do when CBD is not present.

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QUESTION: Some producers of cannabinoid products will provide a Certificate Of Analysis (CoA) from an independent certified testing laboratory. What information is typically displayed on a CoA?

ANSWER: CoAs typically indicate the amount and concentration of major cannabinoids and terpenes present, and data regarding the presence of microbial/ fungal contaminants, levels of heavy metals, and presence and concentration of pesticide and solvent residues.

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QUESTION: What medications alleviate the symptoms of marijuana withdrawal?

ANSWER: There are no general guidelines to treat the symptoms of marijuana withdrawal, but it has been reported that benzodiazepines and synthetic THC products used for the treatment of chemotherapy induced N/V may help alleviate some of the symptoms.

–––

QUESTION: What does “broad spectrum” mean?

ANSWER: Broad-spectrum products are processed in such a manner as to ensure that the final product does NOT contain THC.

–––

QUESTION: What does “full spectrum” marijuana product mean?

ANSWER: Full spectrum means that the product contains all of the original compounds found in the flower of the cannabis plant (cannabinoids, terpenes and flavonoids).

–––

QUESTION: Over 2 million Americans with cardiovascular disease use marijuana. Warfarin interacts with marijuana. Do statins interact with cannabinoids?

ANSWER: Yes. Statins and cannabinoids are metabolized by the same liver enzymes. The co-administration of cannabinoids and statins can lead to a decrease in statin metabolism. As a result, the potency of the statins may increase, and lead to hypotension.

–––

QUESTION: Although Illinois and Nevada have both legalized the use of medical and recreational marijuana, it is illegal to take marijuana on a flight from Chicago to Las Vegas. The reason – airspace is regulated by the federal government and marijuana is illegal under federal law. Do any US airports have “marijuana amnesty boxes” for the disposal of marijuana?

ANSWER: Yes. In addition to 2 airports in Chicago, Mc Carran International Airport in Las Vegas and the Colorado Springs Airport have installed amnesty boxes for passengers who need to surrender their marijuana before boarding a flight.

–––

QUESTION: What are the precursors for the most commonly naturally occurring phytocannabinoids?

ANSWER: The precursors for THC, CBD and CBC are olivetolic acid and geranyl pyrophosphate. These precursors undergo a condensation reaction which results in the formation of cannabigerolic acid (CBGA). A cyclase enzyme converts CBGA into either tetrahydrocannabinolic acid (THCA) or cannabidiolic acid (CBDA) or cannabichromenic acid (CBCA). Then, heat decarboxylates these cannabinoids into THC, CBD or CBC, respectively.

–––

QUESTION: True or false? Cannabinoids impact NMDA, opioid AND gamma amino butyric acid (GABA) receptors.

ANSWER: True. Not only do cannabinoids act at NMDA, opioid AND gamma amino butyric acid (GABA) receptors, but they also have activity at receptors such as adenosine, serotonergic, adrenergic, nicotinic acetylcholine, glycine, and PPAR receptors, and ion channels such as TRPV.

–––

QUESTION: Are pupillary responses to light affected by marijuana?

ANSWER: Yes – marijuana may impair pupillary responses.

–––

QUESTION: Is the legalization of medical marijuana associated with an increase in sexual activity?

ANSWER: Yes, according to researchers from the University of Connecticut and Georgia State University, the legalization of medical marijuana is associated with an increase in sexual activity. Of note, the study also determined that there’s a decrease in the use of contraceptives and an increase in the number of births following the enactment of medical marijuana policies. This study was published in the Journal of Health Economics.

–––

QUESTION: What is the definition of drug diversion?

ANSWER: In the National Academies of Sciences, Engineering & Medicine’s Framing Opioid Prescribing Guidelines for Acute Pain: Developing the Evidence (2020), drug diversion is defined as the transfer of regulated prescription drugs from the legal market to illegal markets. The sharing of drugs with other individuals for medical or nonmedical purposes is NOT considered to be drug diversion. (The sharing of drugs is drug misuse.)

–––

QUESTION: Is it legal to carry marijuana on a Greyhound bus?

ANSWER: No. Greyhound Lines bans alcohol and drugs (including marijuana) “anywhere on the bus (including in your checked baggage).”

–––

QUESTION: Animal research studies on CBD’s potential therapeutic effects often employ rodents. Is CBD administered to rodents the same way CBD is administered to humans?

ANSWER: No. CBD is commonly administered to rodents either via intraperitoneal injection or via the oral route. In contrast, CBD has been studied in humans using oral administration or inhalation, but not via intraperitoneal. The pharmacokinetics of these various routes of administration differ and therefore the blood concentrations of CBD may differ.

–––

QUESTION: Has the use of CBD been evaluated for the treatment of heroin addiction?

ANSWER: Yes. Dr. Yasmin Hurd, director of the Addiction Institute of Mount Sinai in NYC led a double-blind study of 42 recovering heroin addicts and found that CBD reduced both cravings and cue-based anxiety, both of which can cycle people back into using heroin.

–––

QUESTION: Does CBD modulate 5-HT1A receptor activity?

ANSWER: Yes, and this modulation may directly improve hyperarousal/insomnia symptoms in PTSD patients.

–––

QUESTION: Is the US VA Office of research and Development conducting any clinical trials that evaluate the use of CBD for the treatment of PTSD?

ANSWER: Yes. A RCT evaluating the efficacy of using CBD as an adjunctive to prolonged exposure therapy (PE therapy)) was started in March 2019 and will conclude on September 30,2023. The trial will compare PE + CBD to PE + placebo in a sample of 136 military Veterans with PTSD at the VA San Diego Medical Center.

–––

QUESTION: Is it legal to transport marijuana on Amtrak’s railway?

ANSWER: Amtrak has a strict policy: “The use or transportation of marijuana in any form for any purpose is prohibited, even in states or countries where recreational use is legal or permitted medically.”

–––

QUESTION: Do any medical marijuana legal states accept out-of-state medical marijuana authorizations?

ANSWER: Yes. About twenty states accept out-of-state medical marijuana authorizations, BUT reciprocity laws vary from state to state. In some states, visitors are required to sign up for the medical marijuana program 30 days in advance and pay a $50 nonrefundable fee. The state’s purchasing limit may differ for permanent vs. temporary residents. In Oregon, for example, residents can possess up to 24 ounces, while visitors are allowed only one ounce.

–––

QUESTION: Does the CBD molecule contain an aromatic ring?

ANSWER: Yes, it does. The CBD molecule contains a cyclohexene ring and an aromatic ring (a phenolic ring). Of interest, the rings are located in planes that are almost perpendicular to each other.

–––

QUESTION: Describe the chemical makeup of endocannabinoids.

ANSWER: Endocannabinoids are ester, ether, and amide derivatives of long chain polyunsaturated fatty acids. Arachidonic acid is an example of a polyunsaturated fatty acid in endocannabinoids.

–––

QUESTION: Does chronic use of THC and/or CBD by individuals with multiple sclerosis impact cerebral glucose metabolism?

ANSWER: The results of “The Effects of Chronic Δ-9-Tetrahydrocannabinol (THC) and Cannabidiol (CBD) use on Cerebral Glucose Metabolism in Multiple Sclerosis: A Pilot Study” published in 2019 in ‘Applied Physiology, Nutrition and Metabolism‘ indicate that “Compared to non-users, THC-users had hypermetabolism of three regions (p < 0.039, d >1.17) in left temporal areas, while CBD-users had hypometabolism of five regions (p < 0.032, d > 1.31) in left temporal areas.”

–––

QUESTION: True or False? According to the results of a survey conducted by the FDA, about 90% of US adults understand that FDA-approved prescription drugs may cause harm.

ANSWER: False. The results of the survey indicate that 42.9% of consumers were not able to accurately report that FDA‐approved prescription drugs may cause harm.

–––

QUESTION: The FDA approves the language used on package inserts of prescription drugs. Does the FDA also approve the language of “direct-to -consumer” ads?

ANSWER: Actually, no. The language, including the risk or benefit statements, used in “direct to consumer” ads is not FDA-approved.

–––

QUESTION: Based on data from the 2016 to 2017 National Survey on Drug Use and Health and the U.S. Department of Health and Human Services, do more people in the US smoke marijuana or tobacco cigarettes”

ANSWER: According to the 2016 to 2017 National Survey on Drug Use and Health, more than 39 million people smoke marijuana, and according to data from the U.S. Department of Health and Human Services, 34.3 million people smoke tobacco cigarettes. Recent trends show that the number of marijuana smokers is rising while the number of cigarette smokers is declining.

—

QUESTION: CB1 receptors are located on neurons in the CNS and PNS. Are CB1 receptors also located on cardiomyocytes?

ANSWER: Yes. CB1 receptors are located in cardiomyocytes, vascular endothelial cells as well as smooth muscle cells. Activation of these CB1 receptors may lead to oxidative stress, inflammation, fibrosis, vasodilation, and negative inotropy.

—

QUESTION: Smoking and vaporizing marijuana may induce an increase in heart rate. Is smoking marijuana associated with other cardiac electrical effects?

ANSWER: Yes. THC may increase catecholamine levels and therefore may theoretically increase the likelihood of arrhythmias. Various cardiac electrical effects have been described in observational studies. Atrial fibrillation was one of the more commonly reported arrhythmias. Other marijuana-associated arrhythmias reported include atrial flutter, atrioventricular block/asystole, sick sinus syndrome, ventricular tachycardia, and Brugada pattern.

—

QUESTION: Some cannabinoid-based medicines are used to treat chemotherapy-induced n/v. Have cannabinoid-based medicines been shown to be effective in the treatment of post-op n/v?

ANSWER: The results of studies indicate that neither nabilone or intravenous THC is effective for post-op n/v. Even premedication with nabilone was ineffective at treating post-op n/v.

—

QUESTION: Do cannabinoid-based medicines have a higher NNT (number needed to treat) than opioids for pain relief? Than pregabalin? Than tricyclic antidepressant (TCA) agents?

ANSWER: According to recent systematic reviews and meta-analyses (from 2016-2018), cannabinoid -based medicines have a higher NNT than opioids, pregabalin and TCAs. It was also noted that there was a higher risk of adverse events associated with cannabinoid-based medicines compared to opioids, pregabalin and TCAs.

—

QUESTION: The 2017 National Academies of Sciences, Engineering and Medicine’s (NASEM)review on the health effects of cannabinoid-based medicines concluded that there was conclusive or substantial evidence for the use cannabis or cannabinoids for the treatment of pain in adults. Do other national regulatory bodies have similar conclusions to the NASEM’s conclusion?

ANSWER: Actually, no. The Health Products Regulatory Authority of Ireland does not support the use of cannabinoid-based medicines for the treatment of chronic pain. Also, the European Pain Federation’s recent position paper recommended cannabinoid-based medicines be considered for chronic neuropathic pain only as a third line agent. Furthermore, the European Pain Federation found that the results of the studies examining chronic non-cancer pain indicated that there was insufficient evidence for the use of cannabinoid-based medicines for the treatment of non-neuropathic chronic non-cancer pain.

—

QUESTION: Does ketamine interact with the endocannabinoid system?

ANSWER: Yes. Ketamine induces the release of endocannabinoids.

—

QUESTION: Do CB1 and CB2 agonists facilitate endogenous opioid signaling?

ANSWER: Yes. In fact, CB1 and CB2 agonists increase the concentrations of endogenous opioids.

—

QUESTION: Do opioid antagonists impact the effects of cannabinoids?

ANSWER: Yes. For example, it has been shown that the administration of opioid antagonists block some of the effects of THC.

—

QUESTION: Is the endocannabinoid system linked to the opioid system?

ANSWER: Yes. Opioid receptors and CB receptors are located within the same neurons within the CNS. In addition, cannabinoids activate kappa and delta receptors to initiate a release of endogenous opioids.

—

QUESTION: True or false? Cannabinoids impact NMDA, opioid AND gamma amino butyric acid (GABA) receptors.

ANSWER: True. Not only do cannabinoids act at NMDA, opioid AND gamma amino butyric acid (GABA) receptors, but they also have activity at receptors such as adenosine, serotonergic, adrenergic, nicotinic acetylcholine, glycine, and PPAR receptors, and ion channels such as TPRV.

—

QUESTION: How do cannabinoids modulate pain sensation? In other words, describe the mode of action of cannabinoids.

ANSWER: The endocannabinoid system, consisting of the cannabinoid₁ receptor (CB₁R) and cannabinoid₂ receptor (CB₂R), endogenous cannabinoid ligands (endocannabinoids), and metabolizing enzymes, is present throughout the pain pathways. Endocannabinoids, phytocannabinoids, and synthetic cannabinoid receptor agonists have antinociceptive effects in animal models of acute, inflammatory, and neuropathic pain. CB₁R and CB₂R located at peripheral, spinal, or supraspinal sites are important targets mediating these antinociceptive effects. The mechanisms underlying the analgesic effects of cannabinoids likely include inhibition of presynaptic neurotransmitter and neuropeptide release, modulation of postsynaptic neuronal excitability, activation of the descending inhibitory pain pathway, and reductions in neuroinflammatory signaling. The large body of preclinical evidence in support of cannabinoids as potential analgesic agents is supported by clinical studies demonstrating their efficacy across a variety of pain disorders.

—

QUESTION: EXPERIMENTAL pain studies indicate that cannabinoids may be an effective therapy for acute and chronic pain. Have the results of CLINICAL studies also shown that cannabinoids are effective at alleviating acute and chronic pain?

ANSWER: In contrast to experimental studies, the results of clinical trials with cannabinoids provide only moderate-quality evidence for the relief of chronic pain. Also, the analgesic effects of cannabinoids have not been found to be superior to placebo in acute pain. In addition, pre-operative and peri-operative marijuana use may increase post-operative perceived pain.

—

QUESTION: A study published in the European Journal of Anaesthesiology, by Jamal et al. reported that marijuana users required a higher dose of morphine s/p abdominal surgery. They estimated that there was a 23% increased opioid dose requirement. Have the results of studies examining the opioid requirements s/p orthopedic surgery also shown that marijuana users require more opioids than patients who do not use marijuana?

ANSWER: In a retrospective study including 3793 patients, patient-reported postoperative outcomes of 155 marijuana users were compared with those of 155 non-users. The results indicate that pre-operative marijuana users had higher pain scores at rest and on movement but did NOT consume more post-operative opioid analgesics. The cannabinoid users also reported a greater incidence of post-operative sleep impairment.

Once upon a time in Atlanta…

For breakfast, I ate a Russet potato which was steamed in the pressure cooker for about 10 minutes. It was kept out of the water by placing it in a basket placed atop a trivet inside the stove-top cooker.

Most often, in any pressure cooker, the food being cooked rests in the water. However, I wanted to find out what the food would be like if it did not.

The potato had been thoroughly cleansed and rinsed in the usual manner some weeks earlier, which for me, includes a capful of common, unscented, household bleach in addition to Dawn® brand liquid dishwashing soap.

My general rule is, all fresh fruit and vegetables get that treatment because:

1.) You don’t know how many people handled it at the store having not washing their hands after toileting, and;

2.) You don’t know about the conditions in which it was grown, if e.coli or other really bad cooties might have been present, or if it “picked up” something in transit.

While recalls of vegetables tainted with e.coli or other pathological bacteria are neither rare, nor common, per se, they are ONLY on the outside of the food, never within. So, every vegetable – including green leafy ones – tubers, and fruits of all kinds – are all

Scandalous!!

Reproduction of an original photograph of Prince George of Greece and Denmark (1869-1957) and Princess Marie Bonaparte (1882-1962). Prince George is sitting to the right wearing military uniform. Princess Marie is standing beside him to the left with her right hand resting on her hip. She is wearing a pale coloured dress and strings of pearls. There is a wooden wall behind them. The photograph is signed and dated. Prince George of Greece and Denmark was the second son of George I, King of the Hellenes. Princess Marie Bonaparte was a descendant of Emperor Napoleon I, an heiress and a psychoanalyst. They married in 1907.

Identify the TRUE statements about Marie Bonaparte (1882-1962), great grand-niece of Emperor Napoleon:

1.) Was anorgasmic.

2.) Was a psychoanalyst.

3.) Helped advance

Federal Reserve Study: Trump Tariffs Hurt Economy & Employees

It’s official!

In their research work “Disentangling the Effects of the 2018-2019 Tariffs on a Globally Connected U.S. Manufacturing Sector,” Aaron Flaaen, a Senior Economist, and Justin Pierce, a Principal Economist at the Board of Governors of the Federal Reserve System, make their findings that Trump’s Tax Increase – aka “tariffs” – have actually harmed the Economy, and Employment.

“Since the beginning of 2018,
the United States has undertaken unprecedented tariff increases,
with one goal of these actions being
to boost the manufacturing sector.
In this paper, we estimate the effect of the tariffs
—including retaliatory tariffs by U.S.trading partners—
on manufacturing employment, output, and producer prices.”

“Higher tariffs are also associated with relative increases in producer prices via rising input costs.”
– Abstract; p.1

“We find that tariff increases enacted in 2018 are associated with relative reductions in manufacturing employment and relative increases in producer prices.”
– Section 1; p.3

“Since the end of 2018, however, manufacturing output has declined noticeably and manufacturing employment growth has stalled.”
– Section 2.1; p.5

Is the Banana Boat Sunk?

You’re fixing to lose the bananas in your breakfast cereal.

And banana pudding will become only a sweet memory.

Grocery stores may no longer be selling bananas.

Why?

The global crop is dying, and will soon be dead.

Global as in worldwide.

Dead as in extinct.

Extinct as the Dodo bird.

Which, by the way, is thought to have become extinct c.1690 – a very long time ago. So naturally, there are no photographs of the Dodo bird, since the development of photography (yes, it’s a bad pun) was begun c.1826 with the image entitled “View from the Window at Le Gras,” which was made by Nicéphore Niépce, a French inventor in Saint-Loup-de-Varennes, France.

A harmful soil fungus, for which there is no known remedy, has begun to affect banana crops worldwide. Found in Taiwan in the 1990’s, the fungus, which resides naturally in the soil, is a variant of

Close To Home: An Alabama Native was First to Hike the Entire US/Mexico Border

“Border Walk,” by Mark J. Hainds, an Andalusia, Alabama native, documents his journey as the first individual to have trekked along the 1954 miles of the US/Mexico border.

While the Washington Post is getting clicks on their news feature story headlined “Is the border actually lawless? This father and son are hiking all 1,954 miles to find out.,” it was actually Mark J. Hainds, an Andalusia, Alabama resident, who was the first person to have ever hiked the length of the US/Mexico border.

In November 2014, the Research Associate and Research Coordinator with Auburn University and the Longleaf Alliance, resigned his 20-year-plus positions, and took temporary leave of his family, to hike the 1,954 miles of the US/Mexico border.

PBS documented his journey in a full-length feature film named “La Frontera,” which can be viewed for free at the link below:

https://southdocs.org/project/lafrontera/

His book “Border Walk” which describes his journey, was published in March 2018, and in April he authored an article which was published on Daily Kos website (“I Walked the Entire US-Mexico Border”) about his journey which also referenced his book.

He leads that story by writing, “On November 24^th, 2017, I became the first person in history to have walked the length of the US-Mexico border.”

His feat was reported by:

• The Houston Chronicle in October 2016 (“A walk along the border: Man traverses Texas-Mexico line for documentary“)

• Vice in October 2016 (“We Talked to the Man Walking the Length of the US-Mexico Border“)

• The Associated Press April 2017 (“Day 14: Fellow border travelers meet, in the middle of nowhere“)

• The San Diego Tribune July 2017 (“For 700 miles, hiker kept the border in view, and on his mind“)

16-Year Study: Medical Marijuana Laws Decrease Underage Use

Results of a large-scale, 16-year anonymized research project found that states with Medical Marijuana Laws (MMLs) and decriminalization statutes, underage cannabis consumption declines, especially among minority youth.

One concern some have regarding legalization of cannabis – whether for Medical (MMJ), or Adult Recreational Use (ARU) – is whether or not it will adversely affect youth. Specifically, a question often asked is, “will legalizing cannabis increase underage consumption?”

Lead Researcher Dr Rebekah Levine Coley said that, “Some people have argued that decriminalizing or legalizing medical marijuana could increase cannabis use amongst young people, either by making it easier for them to access, or by making it seem less harmful.”

“However, we saw the opposite effect,” said Dr Coley, and noted that results of the 16-year-long study show that in states where MMJ is legal, rates of underage consumption of cannabis have declined.

Those findings occurred even after accounting for other variables, including policies on

Teen Grey Matter and Cannabis Use

In a recently published article entitled “Grey Matter Volume Differences Associated with Extremely Low Levels of Cannabis Use in Adolescence,” in the Journal of Neuroscience, 14 January 2019 edition, pp3375-17, researchers wrote in part that “We identified extensive regions in the bilateral medial temporal lobes as well as the bilateral posterior cingulate, lingual gyri, and cerebellum that showed greater GMV in the cannabis users.”

News items related to that newly published research are focusing upon that singular line as if it’s something negative. Since when did INCREASED grey matter become something dangerous, or cause for concern? Colloquially, the term “grey matter” is used to describe the brain, and by extension, brain power. So let’s examine this matter (no pun intended) in more detail.

But before proceeding further, it bears mentioning that adolescents should NOT be consuming cannabis, neither alcohol, nor tobacco. And try as much as we want, we will not ever stop underage consumption of any adults-only substance. The BEST we can do is to educate them, and others, of potential risks involved in its use – especially and particularly underage use – and deny them opportunities to consume alcohol, tobacco, and cannabis. THAT is a strategy which has PROVEN to work, because the trite “Just say ‘no'” has never worked, nor will it ever.

Dr David Robert Grimes is a physicist, cancer researcher and science writer, who was the joint recipient of the 2014 Nature / Sense About Science Maddox Prize and wrote in a brief anti-marijuana article dated 15th May 2017 entitled “The rise of the cannabis cult: don’t believe the hype about medical marijuana” that

Trump: Who Voted For, And Supports Him?

Formerly titled, “With Trump WYSIWYG: Who Voted For, And Supports Him?”

African leopard, Panthera pardus pardus, near Lake Panic, Kruger National Park, South Africa, 31 December 2013
Attribution 2.0 Generic (CC BY 2.0), Derek Keats, https://www.flickr.com/photos/93242958@N00/19448654130M

One either loves, or loathes, Donald Trump.

One does not simply “tolerate” him.

He is a divisive political figure.

He is starkly contrasted to former POTUS George W. Bush, who in a May 6, 1999 interview with David Horowitz of Salon magazine, famously said, “I’m a uniter, not a divider.”

Trump is a divider, not a uniter.

For Trump, e pluribus unum means nothing, even though we are the United States of America.

And for those who voted for him thinking he’d change, that he was merely spouting hollow campaign rhetoric, they might as well have asked a leopard to change it’s spots.

With Trump, WYSIWYG.

Specifically, I mean to refer to him in his executive Presidential capacity.

And yet, strangely enough, he has coalesced support from diverse, divergent sub-groups within, and without the GOP. The importance of that feat cannot, and should not be underestimated, glossed over, or minimized, because understanding it is key to political success, especially for

Oops… there goes the “Good Guy With A Gun” theory. #2A

In a direct blow to the firearm radicals (aka “gun nuts”) crowd’s assertions, the Bureau of Justice Statistics (BJS) has shown that, contrary to what the tax-free National Rifle Association has publicly claimed, “of over 14,000 incidents in which the victim was present, 127 (0.9%) involved a SDGU.” (Self Defense Gun Use)

In other words,

“a good guy with a gun”

does NOT

lower nor reduce criminal activity.

What is the National Crime Victimization Survey (NCVS)?

The BJS writes this about the NCVS:
“The Bureau of Justice Statistics’ (BJS) National Crime Victimization Survey (NCVS) is the nation’s primary source of information on criminal victimization. Each year, data are obtained from a nationally representative sample of about 135,000 households, composed of nearly 225,000 persons, on the

Research: #Cannabis Smoke Much Less Harmful Than #Tobacco Smoke

Researchers publishing their findings of a 25-year international research project involving over 5000 people in the 22 November 2017 in the Journal “Addiction” have concluded that periodic marijuana smoking is not associated the cardiovascular disease.

However, they note that regular marijuana smoking does

11 Year Study Finds Opioid Deaths Down In Medical #Marijuana States

In an article entitled “Medical Cannabis Laws and Opioid Analgesic Overdose Mortality in the United States, 1999-2010” published August 25, 2014 in the Journal of the American Medical Association, researcher and primary author, Dr. Marcus A. Bachhuber, MD, with the Center for Health Equity Research and Promotion, Philadelphia Veterans Affairs Medical Center, 423 Guardian Dr, 1303-A Blockley Hall, Philadelphia, PA 19104 (marcus.bachhuber@gmail.com), and others concluded that, “The present study provides evidence that medical cannabis laws are associated with

Why I Advocate 100% Marijuana Legalization

Let there be NO MISTAKE: Based upon a preponderance of scientific evidence, logic, reason, and numerous substantiating rationales, I openly advocate for, and am a proponent of the 100% full and total legalization of marijuana (aka cannabis) for adult recreational, and medical use.

And as a triple-degree, BSN-prepared Registered Nurse, Nationally Certified EMT, State Certified Volunteer Firefighter, and First Responder, I am a long-time Licensed Healthcare Professional, and presently possess, and have possessed unblemished active licenses to practice in numerous states, and internationally.

While I have “worn other hats” in Nursing, the bulk of my professional healthcare career has been in Critical Care. Working in Critical Care is the type of stressful job in which one keeps the Grim Reaper at bay by the hour. And I have been fortunate to have worked at some of the nation’s, and world’s premiere, and leading healthcare research institutions. It is research that drives much of such care, to ensure the best possible outcomes for the individuals for whom we care. Thus, keeping abreast of current research findings on many topics within, and without Critical Care, healthcare, and public policy related to healthcare in general, is a special interest and forté of mine.

As well, I am also a United States

National Academies #Marijuana Findings @theNASEM

Many have heard or read about United States Attorney General Jeff Sessions’ ignorant remark about marijuana, and many of us have heard or read numerous claims about cannabis, ranging from “it cures cancer” to “it makes you hungry,” and almost everything between. But if you want to make an effective argument for or against anything, you need facts. And the following information from the National Academies of Sciences, Engineering, and Medicine is THE MOST authoritative, up-to-date volume on the subject of cannabis. You would be wise to cite this research when you lobby your local, state or national legislator to legalize (or not) marijuana. (I am a legalization proponent & advocate for the 100% legalization, regulation, and taxation of adult recreational & prescriptive medical use of marijuana.)

Now, with the 2017 release of “The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research” by the Committee on the Health Effects of Marijuana: An Evidence Review and Research Agenda, Board on Population Health and Public Health Practice Health and Medicine Division, A Report of the National Academies of Science, we have one of THE MOST to-date conclusive pieces of EVIDENCE for/against cannabis consumption, either medically, and/or recreationally. It is AUTHORITATIVE, and unbiased. Bear in mind, this is findings of SCIENTIFIC MEDICAL RESEARCH.

An independent examination of the report was carried out in accordance with institutional procedures and all review comments were carefully considered. A committee of experts was convened to conduct a comprehensive review of the literature regarding the health effects of using cannabis and/or its constituents that had appeared since the publication of the 1999 IOM (Institute of Medicine) report.

From their review, the committee arrived at nearly 100 different research conclusions related to cannabis or cannabinoid use and health.

Committee members formulated four recommendations to address research gaps, improve research quality, improve surveillance capacity, and address research barriers.

Categories, including subtopics, are as follows:

Therapeutic effects
• Chronic pain; cancer, chemotherapy-induced nausea/vomiting; anorexia and weight loss; irritable bowel syndrome; epilepsy; spasticity related to multiple sclerosis or spinal cord injury; Tourette syndrome; amyotrophic lateral sclerosis; Huntington’s disease; Parkinson’s disease; dystonia; dementia; glaucoma; traumatic brain injury; addiction; anxiety; depression; sleep disorders; post-traumatic stress disorder; schizophrenia and other psychoses

Cancer
• Lung cancer; head and neck cancer; testicular cancer; esophageal cancer; other cancer

Cardiometabolic risk
• Acute myocardial infarction; stroke; metabolic dysregulation, metabolic syndrome, prediabetes, and diabetes mellitus

Respiratory disease
• Pulmonary function; chronic obstructive pulmonary disorder; respiratory symptoms (including chronic bronchitis); asthma

Immunity
• Immune function; infectious disease

Injury and death
• All-cause mortality; occupational injury; motor vehicle crash; overdose injury and death

Prenatal, perinatal, and postnatal exposure to cannabis
• Pregnancy complications for the mother; fetal growth and development; neonatal conditions; later outcomes for the infant

Psychosocial
• Cognition (learning, memory, attention, intelligence); academic achievement and educational outcomes; employment and income; social relation- ships and other social roles

Mental health
• Schizophrenia and other psychoses; bipolar disorders, depression; suicide; anxiety; post-traumatic stress disorder

Problem cannabis use
• Cannabis use disorder

Cannabis use and abuse of other substances
• Abuse of other substances

Weight Of Evidence Categories for Conclusions are ranked High-to-Low-and-None as Substantial, Moderate, Limited Evidence, and No or Insufficient Evidence to Support the Association for therapeutic effects, and other health effects.

Here are: 
Conclusions—Therapeutic Effects of Cannabis and Cannabinoids

There is conclusive or substantial evidence that cannabis or cannabinoids are effective:
• For

God Is Mysterious, Naturally

Today is the memorial of Albert Magnus, known as Albert the Great, Bishop, Doctor of the Church.

Albert was known for his vast knowledge in all areas of learning. He was Saint Thomas Aquinas’ tutor, a man skilled in all the sciences of his age. Albert did not fear science; for him there was no contradiction between what he learned about the natural world through scientific observation and what he believed as a person of faith. People of mature faith have nothing to

Want More #Sex? Smoke More #Cannabis!

NPR recently reported about research that seems to point to one benefit of daily use of cannabis.

Increased sexual activity.

I continue to maintain that:
a.) People NEED & OUGHT to have MORE SEX, and;
b.) Cannabis NEEDS & OUGHT to be legalized, taxed & regulated.

Because:
a.) No one ever had an orgasm while “mad” or “angry,” and;
b.) I’ve neither read nor heard of anyone being “mad” or “angry” while high.

Fact is, research is continuing to show that increasingly, people are ANGRY at/because of many things, some of which are outside the locus of their immediate control, and that correspondingly, people are having sexual encounters less often – including married couples (for the benefit of those who believe that sexual activity belongs only among married couples). STOP ANGER! Get high! Have sex!

There’s SIGNIFICANTLY MORE argument to be made AGAINST ETOH (ethanol alcohol, aka “beverage” alcohol) than against cannabis.

Researchers Find Frequency of Sex Rises With Marijuana Use

“Surveys of 50,000 people found that those who smoked marijuana had sex more often than those who

Keep Your Horse And Your Heart Healthy: A How To Guide

In the late-1970s, a pioneering medication was discovered in Japan which was made from a single microorganism.

Isolated at the Kitasato Intitute, Tokyo, Japan, it came from a single Japanese soil sample, and has had an immeasurably beneficial impact in improving the lives and welfare of billions of people worldwide. And, despite continued research since, it has only been found in Japan.

While it was originally introduced as a veterinary medication and found to kill a phenomenally wide range of internal and external parasites in livestock and companion animals, it was quickly discovered to be ideal in combating two of the world’s most devastating and disfiguring diseases which have plagued the world’s poor throughout tropical regions for centuries. It’s now being used free-of-charge as the exclusive tool in campaigns to eliminate both diseases globally, and has also been used to successfully overcome several other human diseases, with new uses for it continually being found.

Few medications can seriously lay claim to the title of ‘Wonder Drug’, and penicillin and aspirin are two that have perhaps had the greatest beneficial effect on the health and well-being of Humankind. But this medication can also be considered alongside those worthy contenders, based on its versatility, safety and the beneficial impact that it has had, and continues to have, worldwide — especially on hundreds of millions of the world’s poorest people.

The medication treats

Your Child May Not Truly Be Allergic To Penicillin

Reported penicillin allergies in children usually inconsistent with true allergy

Jul 3, 2017

Clinical Essentials from Pediatrics

Takeaway
• Parent-reported penicillin allergy symptoms in children presenting to the emergency department (ED) are likely inconsistent with true, immunoglobulin E-mediated allergy when evaluated by the 3-tier penicillin allergy questionnaire.

• Data demonstrate that the true incidence of penicillin allergy is 0.004%-0.015%.

Why this matters
• Because of time constraints and invasiveness associated with standard allergy testing, an allergy pediatric questionnaire may optimize first-line penicillin use in children presenting with the ED with parent-reported penicillin allergies.

• Data suggest that the majority of reported pediatric penicillin allergy symptoms (eg, maculopapular rash, hives, vomiting, diarrhea) are actually low risk for true allergy.

Study design
• This study evaluated 597 children between the ages of

Research: For Older Adults To Get Smarter, They Should Have More Sex

Research Shows Sex Is Good For Your Brain, Cognitive Function & Mental Health

So, Are You Fucking Smarter Every Fucking Day?

Maybe. 

Could you be fucking stupid? If you are, then stop. Fuck someone smarter.

But, there’s a catch.

Fucking stupid may be good for your AND your partner’s brain. So fucking stupid might not be so fucking stupid.

Perhaps that may explain why some people in America are so fucking stupid. They’re not fucking. Hence, they’re fucking stupid.

Writing in Forbes, David DiSalvo cited a study of adults aged 50-83 which found that

Are you over 65 & taking statin meds? Know anyone who is? It may not be worth it.

If you’re a prescriber, consider this research. If you’re a patient, or know someone who is, consider this for your, or their well-being.

—//—

Statins Have No Primary CVD Prevention Benefit To Older Patients

Takeaway
Statins offer no benefit for the primary prevention of cardiovascular disease (CVD) in adult patients aged ≥65 y.

Why this matters
“[S]tatins may be producing untoward effects in the function or health of older adults that could offset any possible cardiovascular benefit,” say the study authors.

Study design
Researchers conducted post hoc secondary data analyses of patient data from a randomized, open-label clinical trial (N=2867; age, ≥65 y; 49.4% women; all without evidence of atherosclerotic cardiovascular disease); patients were assigned to either a treatment group receiving pravastatin sodium 40 mg/d or a usual care (UC) group.
Funding: National Heart, Lung, and Blood Institute; AstraZeneca; Bristol-Myers Squibb; Pfizer; National Center for Advancing Translational Sciences; The Stroke Foundation.

Key results
Hazard ratios for all-cause mortality in the treatment group vs the UC group were

How can you know if you’re in an Emotionally Abusive Relationship?

Just because there’s no physical violence, does that mean a relationship isn’t abusive?

No.

The adage, “can’t see the forest for the trees” is particularly true in emotionally abusive relationships, and it’s not uncommon for men and women in them to be unable to identify the relationship as being abusive.

Why is that?

It goes back to 1973 and an unsuccessful bank robbery in Stockholm, Sweden in which two perpetrators – both repeat offender prisoners – took four hostages, three women and one man. Over the six days they were held, the hostages began to identify and sympathize with their captors.

Hostages in the Norrmalmstorg Kreditbanken bank vault, Stockholm, Sweden. The 1973 robbery gave rise to the term “Stockholm Syndrome” which characterized a scenario in which captives sympathized with their captors.

As the standoff was ending, police called for the hostages to come out first, but the four captives – who protected their abductors to the very end – refused. One female hostage, 23-year old Kristin Enmark, called out, “No, Jan and Clark go first—you’ll gun them down if we do! We want to leave with the robber!”

When police seized the gunmen, two female hostages cried sympathetically, “Don’t hurt them – they didn’t harm us!”

When interviewed by investigators and others following the crisis’ conclusion, the hostages reported fearing Law Enforcement Officers’ rescue effort attempts, and felt their captors were protecting them from harm. The bonds formed during that stand-off had become so strong that there were reports of one female hostage who had been engaged to be married to one of the kidnappers – which was later discovered to be false, though it is true that one hostage developed a Legal Defense Fund to help pay the perpetrators’ criminal defense costs.

Researcher Ian K.Mackenzie wrote
in “Journal For Police Crisis Negotiations”
that Stockholm Syndrome consisted of:
“strong emotional ties that develop between two persons
where one person intermittently harasses, beats, threatens, abuses, or intimidates the other.”

Psychological researchers utilizing the FBI’s Hostage Barricade Database System (HOBAS) – the only entity that compiles national statistics on crisis incidents (hostage, barricade, and/or suicide) which are used in research and decision making – found that

Rethinking Addiction

Perhaps you’ve studied the 12-Step program, or perhaps you’ve practiced it. I have done both. Practicing it was not as a matter of addiction, or any such thing for myself, but instead, was a part of my personal spiritual growth and development.

Over the years, I’ve heard commentary, or news features which interviewed people with divergent perspectives on 12-Step programs, most notably which were skeptical of them, and were thoughtfully seeking answers themselves for the “whys and wherefores” of substance abuse, whether it’s long-term or temporary, and whether it is a genetic fault, or if it is a personality or character flaw in response to external or internal stressors. In other words, it’s the classic “Heredity vs Environment” argument.

As I have come to view it, there is validity for both sides, but I think the stronger case is made for a combination of environment and character flaw, instead of genetic defect.

—/—

“In his recent book, The Sober Truth: Debunking the Bad Science Behind 12-Step Programs and the Rehab Industry, Lance Dodes, a retired psychiatry professor from Harvard Medical School, looked at Alcoholics Anonymous’s retention rates along with studies on sobriety and rates of active involvement (attending meetings regularly and working the program) among AA members. Based on these data, he put AA’s actual success rate somewhere between 5 and 8 percent. That is just a rough estimate, but it’s the most precise one I’ve been able to find.”

https://www.theatlantic.com/magazine/archive/2015/04/the-irrationality-of-alcoholics-anonymous/386255/

The Irrationality of Alcoholics Anonymous
By Gabrielle Glaser, April 2015 Issue
Its faith-based 12-step program dominates treatment in the United States. But researchers have debunked central tenets of AA doctrine and found

In Response to John Goodwin’s FaceBook Post

A man named John Goodwin made a public post on FaceBook, which also included a link to an OpEd published in the Washington Post on November 9, 2016, which was written by Charles Camosy (PhD, University of Notre Dame), and entitled “Trump won because college-educated Americans are out of touch.” Dr. Camosy is an Associate Professor of Theological and Social Ethics at Fordham University, and the author of a book entitled “Beyond the Abortion Wars: A Way Forward for A New Generation.”

Mr. Goodwin’s FaceBook profile is sufficiently ambiguous of himself, though in his public post which is time & date-stamped 9:45AM, November 10, 2016, and ostensibly geolocated from Washington, D.C., he wrote of himself that, “I haven’t posted about the election mostly because 1) I do this for a living and most of you don’t,” which would lead one to suppose that at some level, he works in or with public policy, or more likely, with politicians.

I do not.

However, suffice it to say, that for many, many, many years, I have remained immensely interested in public policy, though I do not now, nor have I ever made my living from it, or influencing, or attempting to influence others in elected office.

In other words, I have taken the high road.

Mr. Goodwin’s public post to FaceBook is linked herein, as is the article upon which he expounded.

https://www.facebook.com/goody37/posts/10154328123133884

In order to fully understand the matter of discussion herein, I encourage the reader to fully read this item following herein, as well as Mr. Goodwin’s post, and the OpEd upon which he opined

I have responded to Mr. Goodwin’s post as follows:
His words appear italicized, and in “quotation marks.”
My commentary follows immediately after.

“…not everyone lives in big cities.”
• That is correct. The United States Census Bureau says that 80.7% of American reside in urban areas. In fact, they report that “the population density in cities is more than 46 times higher than the territory outside of cities.” So that leaves a whopping 19.3% in rural areas.

“I didn’t grow up with money.”
• Money had been invented by the time I was born. But seriously, someone votes for Donald Trump as if the wealthy are advocates for the impoverished or even the average American? C’mon. Mr. Born-With-A-Silver-Spoon-In-His-Mouth? Really?

“…not everyone went to elite colleges.”
• According to the United States Census Bureau, “in 2015, almost 9 out of 10 adults (88 percent) had at least a high school diploma or GED, while nearly 1 in 3 adults (33 percent) held a bachelor’s or higher degree.” I’m in the 33%. So I’m an elite. Thanks!

“You think they (people who eat at

How TRUE is “largely poor, uneducated, and easy to command”? You’d be surprised… or, maybe not.

Remember how ANGRY some folks got when Michael Weisskopf (b.1946) of the Washington Post wrote on February 1, 1993 (link to original article with the WaPo’s editorial addendum) that the simple-minded evangelical groupies of Jerry Falwell (who himself died in 2007), Pat Robertson (b.1930), et al, that:
“The gospel lobby evolved with the explosion of satellite and cable television, hitting its national political peak in the presidential election of Ronald Reagan in 1980.

“Unlike other powerful interests, it does not lavish campaign funds on candidates for Congress nor does it entertain them. The strength of fundamentalist leaders lies in their flocks. Corporations pay public relations firms millions of dollars to contrive the kind of grass-roots response that Falwell or Pat Robertson can galvanize in a televised sermon. Their followers are largely poor, uneducated and easy to command.

“”The thing that makes them powerful is they’re mobilizable,” said Seymour Martin Lipset (d.2006), professor of public policy at George Mason University. “You can activate them to vote, and that’s particularly important in congressional primaries where the turnout is usually low.”

“Some studies put the number of evangelical Americans as high as 40 million, with the vast majority considered politically conservative.”

[ed. note: The excerpt, which has frequently been distilled to “largely poor, uneducated and easy to command,” is provided here in full proper context with leading and following sentences, not merely excerpted, in order to thoroughly show proper context.]

It’s true.

Folks don’t get mad because of falsehoods.

They get mad because of truth.

It’s true.

According to the United States Census Bureau (USCB), in 2015 (22 years AFTER that was written), 32.5% of the American public aged 25, or older, have a Bachelor’s Degree (Table 1.), which is CLEARLY a minority. Thus, we see automatically the “largely” part of “uneducated.”

The USCB has also performed research on income, which is similarly delineated and categorized by education. For the year 2011 (18 years AFTER the remarks were made), and those aged 25+ with at least a Bachelor’s Degree, the average income was

Late Term #Abortion #Politics On #DebateNight

A few thoughts on a Presidential Debate topic by Moderator Chris Wallace of Fox News, with candidates Hillary Clinton (D) and Donald Trump (R) from the third, and final debate held last night at the University of Nevada, Las Vegas, Wednesday, 19 October 2016:

1.) Tweet from Dr. Jen Gunter, MD: “There is no such thing as a ninth month abortion – I’m a doctor who trained in late term abortions”
https://twitter.com/DrJenGunter/status/788912646330257408

2.) A portion of her blog entry (linked herein) on the topic from the Debate states: “Trump’s statement, as incorrect as it may be, supports the fallacy of the due-date abortion. It is a common anti-choice narrative that

UNC Chapel Hill Research: Medicaid Expansion Helps Rural Hospitals

As of the date of this posting – Monday, 19 September 2016 – there are 19 states which have NOT Expanded Medicaid, and Alabama is one of those 19.

In alphabetical order, they are:

Current Condition of Medicaid Expansion
Has YOUR state expanded Medicaid?
Orange=NO

1.) Alabama
2.) Florida
3.) Georgia
4.) Idaho
5.) Kansas
6.) Maine
7.) Mississippi
8.) Missouri
9.) Nebraska
10.) North Carolina
11.) Oklahoma
12.) South Carolina
13.) South Dakota
14.) Tennessee
15.) Texas
16.) Utah
17.) Virginia
18.) Wisconsin
19.) Wyoming

 

 

 

 

 

Lack Of Medicaid Expansion Hurts Rural Hospitals More Than Urban Facilities

By Shefali Luthra September 7, 2016

It isn’t news that in rural parts of the country, people have a harder time accessing good health care. But new evidence suggests opposition to a key part of the 2010 health overhaul could be adding to the gap.

The finding comes from a study published Wednesday in the journal Health Affairs, which analyzes how the states’ decisions on implementing the federal health law’s expansion of Medicaid, a federal-state insurance program for low-income people, may be influencing rural hospitals’ financial stability. Nineteen states opted not to join the expansion.

Rural hospitals have long argued they were hurt by the lack of Medicaid expansion, which leaves many of their patients without insurance coverage and strains the hospitals’ ability to better serve the public. The study suggests they have a point.

Specifically, the researchers, from the University of North Carolina Chapel Hill, found that

Your Tax Dollars At Work: Taxpayers Subsidize CEO Pay, Here’s How #BonusLoophole

Executive Excess 2016: The Wall Street CEO Bonus Loophole

This 23rd annual report reveals how taxpayers are subsidizing financial crisis windfalls.

By Sarah Anderson and Sam Pizzigati, August 31, 2016

This report is the first to calculate how much taxpayers have been subsidizing executive bonuses at the nation’s largest banks.

The study focuses on a 1993 Clinton administration reform that was intended to rein in runaway CEO pay by capping the tax deductibility of executive compensation at $1 million. But the new rule included a huge loophole for stock options and other “performance” pay. As a result, the more corporations hand out in executive bonuses, the lower their tax bill. This perverse incentive for excessive compensation has been a major factor in the explosion of CEO pay.

The financial bailout program closed this loophole for recipients, but only until