”There are too many lives at stake, not to mention scientific integrity and a burgeoning field of medical discovery requiring much freer access to the marijuana plant.”
From Huffington Post
By Sunil Aggarwal, M.D., Ph.D. and Amanda Reiman, Ph.D., M.S.W.
After a 40-year battle over the placement of marijuana in Schedule I, the U.S. Court of Appeals, DC Circuit, ruled in January on the most recent petition to reschedule marijuana in the case of AMERICANS FOR SAFE ACCESS (ASA) v. DRUG ENFORCEMENT ADMINISTRATION (DEA). The court ruled that the DEA had not acted arbitrarily and capriciously when it denied ASA’s petition filed 9 years earlier to remove marijuana from Schedule I. Schedule I drugs have “no currently accepted medical use in treatment in the United States” and “a lack of accepted safety for use under medical supervision” — a classification that holds marijuana more dangerous than cocaine, morphine, or methamphetamine, all listed in Schedule II with accepted medical uses. The court ruled that the research needed to move marijuana out of Schedule I does not exist. We respectfully beg to differ.
The DEA’s argument, stated in a 2006 report from the US Department of Health and Human Services (HHS), is that there are no “adequate and well-controlled studies” proving marijuana’s efficacy. Though they noted a number of U.S.-based small-to-medium sized randomized, double-blind, placebo-controlled studies of inhaled marijuana for severe pain, spasticity, and wasting syndromes, all showing valid medical benefits, they felt these were not big enough. What DEA wants to see are akin to Phase III clinical trials — large studies, involving hundreds of subjects, comparing marijuana to placebo in a double-blind, randomized fashion for a specific indication — exactly what the Food and Drug Administration (FDA) wants when evaluating interstate drug marketing applications. Here’s the rub: those kinds of studies have been done and are published in the peer-reviewed scientific literature and yet neither the DEA, nor the HHS, nor the Court took notice. Large, multicenter, randomized, double-blind, placebo-controlled studies involving hundreds of patients in America and abroad that are in some cases a year in duration have been published in U.S. National Library of Medicine indexed journals showing that marijuana, orally administered in extract form, can treat intractable pain in cancer and improve mobility and symptom control in multiple sclerosis. What is arbitrary and capricious is federal agencies have chosen to ignore these studies because they have been done mainly in the private pharmaceutical drug development sector where marijuana-infused products are produced, tested, and sometimes strategically renamed. This hide and seek game has resulted in rigorous research having little to no bearing on public scientific understanding of the medical use of marijuana.
In the case of GW Pharma Ltd (GWP) of Wiltshire, England, it is a mouth spray directly extracted with liquid carbon dioxide from the flowers of two strains of marijuana plants grown in UK-licensed company greenhouses from a worldwide marijuana seed collection that resided in the Netherlands until the late 1990s. In the case of the non-profit Institute of Clinical Research (IKR) of Berlin, Germany, it is a capsulated alcohol extract made from marijuana flowers grown in Switzerland and extracted in Germany. Marijuana extracts have been produced for millennia for consumption, and the public has an overriding interest and right to know that these marijuana studies exist and that their results should logically have bearing on how we as a society understand, utilize, value, and ultimately classify marijuana.
”What is arbitrary and capricious is that federal agencies have chosen to ignore these studies.”
So why do the feds not include marijuana resin extract studies when weighing marijuana’s evidence base? Sometimes it is as simple as a name game. Congress’s definition of marijuana — unchanged since 1937 — has always included any compound, extract, or manufactured mixture containing a detectable amount of marijuana resin. If marijuana resin has been extracted and dissolved into a solvent or otherwise concentrated, that new substance is still called marijuana, hash, or hash oil, and this form of marijuana often carries stricter penalties, such as the life sentence penalty recently adopted by Oklahoma in 2011 for first-offense hash production. Millions have been punished under this full definition of marijuana via their possession or distribution of marijuana-infused edibles such as brownies or hash oil. Marijuana medicines made by GWP and IKR are concentrated forms of the marijuana plant with marijuana resin as a base. GWP’s lead product, imported for U.S. trials under DEA license, was named “nabiximols” (Sativex®) and not marijuana by the United States Adopted Names Council, a body composed of organized medicine and pharmacy with FDA backing. In IKR’s case, the company chose the name Cannador® for their marijuana extract seemingly without any regulatory oversight.
Cannabis, marijuana’s proper name, is a commonwealth medicinal plant belonging to no government or private entity. Licensed producers of marijuana extracts in the private sector have a rare and coveted wide latitude of scientific freedom to explore and discover, in a rigorous way, many of the medicinal benefits inherent to cannabis. Does the government have the right to ignore rigorous peer-reviewed published evidence about marijuana’s medical utility accumulated in the pharmaceutical sector which enjoys privileged access to marijuana for research and development? Does private industry have the right to demand, as GWP once did, that marijuana not be rescheduled based in part on their collected data, which they recently achieved in the UK, presumably to protect company market share and pricing by avoiding competition from future marijuana producers who would be empowered by a rational reclassification of marijuana in federal law? Cannabis should not be cordoned off for the sake of private patents, monopolies, or FDA drug marketing applications.
In the U.S., federal agencies have set-up onerous roadblocks that limit researchers’ abilities to access marijuana — the very impetus for private marijuana research to get started overseas, licensed by friendlier governments. A DEA judge actually ruled that the U.S. marijuana supply monopoly was not in the public interest in 2007, but this decision has been ignored. Many major medical societies want marijuana rescheduled or are urging a scheduling review be undertaken, including the American Medical Association, the American College of Physicians, and the Massachusetts Medical Society, publishers of the New England Journal of Medicine. In fact, there has been ongoing resistance to marijuana’s placement in Schedule I ever since Congress first attempted it in 1970. When drafting the law, Congress sought input from Dr. Roger Egeberg, Assistant Secretary of Health at HHS and former personal physician to General MacArthur. He testified that “our recommendation is that marihuana be retained within schedule I at least until the completion of certain studies now underway to resolve the issue”, referring to the comprehensive “National Commission on Marihuana and Drug Abuse” study being undertaken at that time. His recommendations were echoed in a Congressional Committee report which stated “the recommendations of this Commission” would be “of aid” in determining “the appropriate location of marihuana within the schedules of the bill.” When the Commission reported in 1972 that the public threat of marijuana had been greatly exaggerated and recommended that its classification be lowered so that it was no longer on par with heroin, no one took responsibility and marijuana was left in Schedule I. Immediately afterwards, citizens filed the first of several petitions to reschedule marijuana. After 16 years, the first petition was favorably viewed by a DEA judge who concluded after an extensive, two-year evidentiary hearing, that “marijuana, in its natural form, is one of the safest therapeutically active substances known to man. By any measure of rational analysis marijuana can be safely used within a supervised routine of medical care.” He ruled that marijuana be rescheduled to Schedule II, with painkillers and anesthetics, and that to not do so would be “unreasonable, arbitrary, and capricious.” His decision was overruled by the politically appointed DEA head who said that data were inadequate.
Forty years later, the ASA v. DEA case, now on appeal, is the latest major legal challenge to marijuana’s schedule I status, and new rescheduling bills have been filed in Congress. We cannot let the federal government play fast-and-loose with science on marijuana research any longer–cannabis in all forms must be down-scheduled and de-scheduled. The public health justice imperative to stop curtailment of scientific inquiry and free medical professionals to explore alternative treatments like marijuana with patients is paramount. There are too many lives at stake, not to mention scientific integrity and a burgeoning field of medical discovery requiring much freer access to the marijuana plant.
Sunil Aggarwal, M.D., Ph.D. and Amanda Reiman, Ph.D., M.S.W.
Dr. Aggarwal is a board member of Americans for Safe Access Foundation and a resident physician at a large academic medical center in New York City. Dr. Reiman is a California policy manager for the Drug Policy Alliance and a Lecturer in the School of Social Welfare at the University of California, Berkeley.
Comment from the HuffPost article by Carol Olsen
ASA’s petitions for rehearing and for rehearing en banc were denied by the U.S. Court of Appeals yesterday, so it looks like ASA will be heading to the U.S. Supreme Court with this case. What bewilders me is that you have 18 states that have accepted the medical use of marijuana in treatment of various conditions, and yet the federal government classifies marijuana as a substance with no accepted medical use in treatment in the United States. Where are the state attorney generals to protect the will of the people who voted for this? Why aren’t they filing supporting amicus curiae briefs? Why aren’t the people in those states demanding state representation in this federal rescheduling case?
Comment from Poet Peter
An excellent analysis of the widespread fraud and deception on medicinal cannabis promoted by the US and UK governments. The scandalous and dishonest re-scheduling of Sativex here amounts to corruption by our most senior government ministers and civil servants and will shortly be challenged in the High Court.
See here for the full story of how the UK government has allowed GW Pharma to operate under an unlawful licence for 10 years, is promoting an unlawful monopoly and, most important of all, is maintaining a cruel and harmful policy damaging those who need cannabis as medicine.
I hate to call this a conspiracy, but how else can it be explained? I’ll say it again, it’s all about the money. We need to take control of our government once again. It’s become a huge self serving monopolistic corporation.
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The DEA is worried about losing their jobs if we reschedule marijuana. You’re right, it’s all about the money.
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What Mainah said.
Who benefits from the illegal status of this plant? Pharmaceutical companies, textile manufacturers, gangs/cartels/black markets, political parties that receive funding from any of the aforementioned, the list goes on.
Who is protected by the illegal status of this plant? NOBODY!
It’s time for the world to wake up.
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Time to let the people vote on it. Bet government would not like it. Not able to control it. We will be heard. It cures cancer. I am proof.
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great article! can i know What Mainah said.?
can you explain your request?
People die every single Day due to Cannabis Prohibition.Dying because of to many opioids, Painkillers being used. People are withhold from their ability to have decent lifequality. Medicine that may have the possibility to Cure Cancer and many other diseases have been delayed for Decades. Those whole lies about Cannabis are either 99% Stupid or have economic interests in Prohibition. 7 Billion $ reason why Medicalindustri doen’t want Canabis to replace Painkilllers. And probably 100 Billion $ reason not to make other Medicines for those more than 20 diseases where Cannabis have been proven to help. Oilcompanies. Petrol and Gazoline can be made from Cannabis. Steel, cars can be made form Cannabis. 25.000 Products can be made from Cannabis. Nixon was a Crook. We know that. But why shall we still suffer from the Crookiest thing he ever done? It is not just an US thing its a matter of life or dead for the whole world. Free Cannabis, Kill the Crook Laws. Love KeldKrist
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Clinical drug trial in France sends 6 to hospital in ‘serious accident’
Rare for volunteers to fall seriously ill when testing new [marijuana synthetic] drug
The Associated Press Posted: Jan 15, 2016 9:44 AM ET Last Updated: Jan 15, 2016 10:29 PM ET
Six people are in serious condition at CHU de Rennes hospital, in Rennes, France, after taking part in an early-stage clinical medical trial for an unnamed European laboratory.
Six people are in serious condition at CHU de Rennes hospital, in Rennes, France, after taking part in an early-stage clinical medical trial for an unnamed European laboratory. (Stephane Mahe/Reuters)
The long road to drug approval
One man is brain dead and three others are facing possible permanent brain damage after volunteering to take part in a drug test in western France, the French Health Ministry said Friday.
The prosecutor’s office has opened an investigation into what French Health Minister Marisol Touraine called “an accident of exceptional gravity” at the private Biotrial clinical lab in Rennes.
The drug trial, which was testing a new painkiller compound, involved 90 healthy volunteers who were given the experimental drug in varying doses beginning on Jan. 7, she told reporters Friday at a news conference in Rennes.
Six male volunteers between 28 and 49 years old have since been hospitalized, including one man now classified as brain dead, she said.
“A serious accident took place,” the minister said earlier in a statement.
The chief neuroscientist at the hospital in Rennes, Professor Gilles Edan, said in addition to the brain-dead volunteer, three others could have “irreversible” brain damage. A fifth man is suffering from neurological problems and a sixth volunteer is being kept in the hospital but is in a less critical condition, he said.
Edan said there’s no known treatment for the experimental drug that Biotrial was testing. The drug was based on a natural brain compound similar to the active ingredient in marijuana.
Touraine said the medication was not based on cannabis. Earlier Friday, a report from Reuters cited a person familiar with the situation as saying the drug was a cannabis-based painkiller.
The brain has a system of enzymes and molecules that respond to both plant-based cannabis compounds and ones we produce naturally.
“The aim with this synthetic approach is to mimic a cannabis-like effect, not by administering a cannabis drug, but by blocking a naturally occurring enzyme,” said Dr. Mark Ware of Montreal’s McGill University Health Centre, who researches the medical use of cannabis.
“My initial reading of this means it shouldn’t interfere with work on the plant cannabis or plant cannibinoids. It does raise important questions about the role of that specific enzyme, and why blocking it has this devastating result, if this is what was responsible. The scientific community will be watching this story very closely.”
Touraine urged calm, saying that no drug currently on the market was implicated in the failed trial. She said the drug was produced by the Portuguese pharmaceutical company Bial.
On a statement on its website, Bial called the drug an experimental molecule in the field of pain. The company said the new drug had already been administered to 108 people without any moderate or serious adverse reactions.
All the other 83 volunteers are being contacted, Touraine said.
It’s rare for volunteers to fall seriously ill when testing new drugs. Researchers generally start with the lowest possible dose for humans after extensive drug tests in animals. The French ministry statement said those who had fallen ill had taken an oral medication in the first phase of testing, which was studying safe usage, tolerance and other measures on healthy volunteers.
There was ‘an accident of exceptional gravity’ at the private Biotrial clinical lab in Rennes, France, the health minister says. (Damien Meyer/AFP/Getty )
Biotrial, with headquarters in Rennes and offices in London and Newark, New Jersey, says it has over 25 years of experience in clinical trials and uses “state-of-the-art facilities.” In France, adults volunteering for Biotrial tests can earn between 100 euros and 4,500 euros ($110 US to $4,922 US).
There have been very few instances worldwide of trials going wrong, said pharmacy and medicine professor Jack Uetrecht of the University of Toronto.
“I would say it’s probably safer to be part of a phase 1 trial than to take a prescribed drug,” Uetrecht said, because they start with a low dose and monitor so carefully.
Uetrecht recalls only two disasters in thousands of phase 1 clinical trials.
Decades ago, a hepatitis B drug caused liver failure, a delayed response that wasn’t picked up in pre-clinical studies on typical animal models.
The other was in 2006 in Britain.
Six previously healthy men were treated for organ failure only hours after being given an experimental drug targeting the immune system. That prompted a review of procedures and resulted in the U.K. regulatory agency imposing new testing standards.
Regulations for clinical trials are largely the same in Europe and Canada, Uetrecht said.
With files from CBC’s Vik Adhopia, Amina Zafar and Reuters
Your blog is superb. Good work!
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Tell me these politicians, know more than a doctors. Oh they dont want a cut in there 60 million a year for treatments that just help kill you. Simple I make iso hash oil , gave to cancel patient for 3 weeks everyday orally at bedtime. White cell count dropped, they felt better. Doctor ask questions at this point, than told her to continue treatment with the iso/HO.
Scoot Miller , can I contact you pls for some info?
Cannabis reverses aging processes in the brain, study suggests
Posted: 08 May 2017 08:24 AM PDT
Memory performance decreases with increasing age. Cannabis can reverse these ageing processes in the brain. This was shown in mice by scientists at the University of Bonn with their colleagues at The Hebrew University of Jerusalem (Israel). Old animals were able to regress to the state of two-month-old mice with a prolonged low-dose treatment with a cannabis active ingredient. This opens up new options, for instance, when it comes to treating dementia.
Hi Wings ~ thank you!
A Conservative Mom Breaks the Pot Taboo
A Commentary by Michelle Malkin
in Political Commentary
Let’s talk about marijuana.
Specifically, let’s talk about how and why I came to be one of the countless parents across America (and around the world) who have let their chronically ill children try it.
A groundbreaking new study published last week in the New England Journal of Medicine reported on the health benefits of cannabidiol for children with epilepsy. The randomized, double-blind, controlled study found that among children with Dravet syndrome taking cannabidiol, the decrease in the frequency of convulsive seizures was 23 percentage points greater than the decrease in seizures among children taking a placebo.
Cannabidiol is one of hundreds of chemical components found in cannabis plants. Unlike THC, the most famous of marijuana’s compounds, CBD is nonhallucinogenic and nonaddictive. It doesn’t make you high. CBD can be extracted from hemp and sold as an oil. That’s what the pioneering Stanley Brothers of Boulder, Colorado, did several years ago when they conceived and manufactured “Charlotte’s Web” — named after Charlotte Figi, a Colorado Springs girl with Dravet syndrome whose seizures dramatically decreased after using CBD.
Until now, evidence of marijuana’s benefits for pediatric epilepsy patients has been largely anecdotal. The new CBD study, led by researchers at the NYU Langone’s Comprehensive Epilepsy Center, is a hugely significant development because it uses the scientific gold standard of a randomized controlled trial. Other limited clinical trials involving CBD have explored the drug’s therapeutic benefits for pediatric patients with conditions ranging from anxiety to movement disorders to inflammatory diseases, multiple sclerosis and cancer.
My own interest in pediatric use of medicinal marijuana is more than academic.
When my daughter, Veronica, fell ill in late spring of 2015 — unable to breathe normally, bedridden with chronic pain and fatigue — she saw dozens of specialists. Among those doctors was a leading neurologist at one of Denver’s most well-regarded hospitals who treated intractable cases. The various drugs prescribed to my daughter weren’t working and had awful side effects.
One of them, a potent anti-epileptic drug called Trileptal, was supposed to treat the severe motor tic that left her gasping for air nonstop for months. But Trileptal ended up causing extreme loss of appetite, more fatigue and temporary dystonia, while doing nothing to alleviate the tics. The constant jerking of her body caused one of my daughter’s hypermobile shoulders to dislocate multiple times a day — increasing her pain and anxiety.
To our surprise, the mainstream neurologist suggested Veronica try CBD. This doctor had other young patients who used CBD oil with positive results, but she could not directly prescribe it because of her hospital affiliation. So we did our own independent research, talked to a Colorado Springs family whose son had great success using CBD to treat his Crohn’s disease symptoms, consulted with other medical professionals and friends — and entered a whole new world.
Two physicians signed off on our daughter’s application for a medical marijuana card. She became one of more than 360 children under 18 to join Colorado’s medical marijuana registry in 2015.
And we became pediatric pot parents.
For Veronica, CBD provided more relief than all the other mainstream pharmaceutical interventions she had endured, and without the scary side effects. But ultimately, it was a temporary remedy for her complicated basket of neurological and physiological conditions. We were glad for the chance to try CBD at the recommendation of medical professionals, and glad that so many other families are having success with it.
Our experience showed us the importance of increasing therapeutic choices in the marketplace for all families — and trusting doctors and patients to figure out what works best.
It flies in the face of current science to classify CBD oil as a Schedule I drug, as the feds did at the end of 2016. Nor does it make sense to draw the line at CBD if some patients and doctors believe that the benefits of using THC therapeutically outweigh the potential harm.
As a lifelong social conservative, my views on marijuana policy may surprise some of you.
I used to be a table-pounding crusader for the government’s war on drugs. When I worked in Seattle in the 1990s, I initially opposed efforts to legalize medical marijuana. I also opposed efforts to loosen restrictions on conducting studies on the potential therapeutic effects of using marijuana.
But the war on drugs has been a ghastly quagmire — an expensive and selective form of government paternalism that has done far more harm than good. What has this trillion-dollar war wrought?
Overcrowded jails teeming with nonviolent drug offenders. An expanded police state enriched by civil asset forfeiture. And marginalization of medical researchers pursuing legitimate research on marijuana’s possible therapeutic benefits for patients with a wide variety of illnesses.
The Trump administration has sent mixed signals on a medical marijuana crackdown.
So let me be clear as a liberty-loving, conservative mom: Keep your hands off. Let the scientists lead. Limited government is the best medicine.
Michelle Malkin is host of “Michelle Malkin Investigates” on CRTV.com. Her email address is firstname.lastname@example.org. To find out more about Michelle Malkin and read features by other Creators Syndicate writers and cartoonists, visit the Creators Syndicate webpage at http://www.creators.com.
COPYRIGHT 2017 CREATORS.COM
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Cannabis Use Disorder less in liberal use states than in conservative, restrictive states
Cannabis use disorder: The policy climate matters
January 23, 2019
Columbia University’s Mailman School of Public Health
Adolescents and young adults living in states with more liberal policies reported higher average rates of past-year cannabis use than those in states with more conservative policies. However, the rates of cannabis use disorder — abuse or dependence on the drug — were significantly lower in states with more liberal policies compared to states with more conservative policies. The study is one of the first to assess the relationship between policy liberalism and health outcomes, and specifically cannabis use-related outcomes.
Adolescents and young adults living in states with more liberal policies reported higher average rates of past-year cannabis use than those in states with more conservative policies, according to a new study conducted at Columbia University Mailman School of Public Health. However, the rates of cannabis use disorder — abuse or dependence on the drug — were significantly lower in states with more liberal policies compared to states with more conservative policies, for ages 12 to 17, and marginally lower for ages 26 and older. These results remained significant even when controlling for the presence of medical cannabis laws. This study is one of the first to assess the relationship between policy liberalism and health outcomes, and specifically cannabis use-related outcomes. The findings are published in the International Journal of Drug Policy.
“The majority of existing work has explored the relationship between medical cannabis laws and cannabis outcomes, whereas our results identified important relationships between the state-level policy context as a whole, and cannabis use outcomes,” said Morgan Philbin, PhD, assistant professor of Sociomedical Sciences, and first author. “While this research does not suggest that being in a liberal state causes people to use cannabis, or have lower rates of cannabis use disorder, it does highlight how states may differ beyond substance use policies, and how these differences also merit attention.”
Using nationally-representative state-level data, the researchers examined the associations between policy liberalism and cannabis use and cannabis use disorder among past year users. Data were obtained for ages 12-17, 18-25, and 26 and older from the 2004-2006 and 2010-2012 National Survey on Drug Use and Health.
Past year cannabis use was consistently higher in liberal compared to conservative states, and remained significantly higher for ages 12-17 and 18-25 after adjusting for medical cannabis law status. As of December 2018, a total of 33 states had approved medical cannabis laws and eight states plus Washington, D.C. had legalized cannabis use.
Prevalence of cannabis use has increased overall since 2007 which has raised concerns about potential negative consequences associated with problematic use, specifically cannabis use disorder. “These latest findings could directly inform policymakers and public health practitioners about the degree to which other broader contextual factors also influence cannabis use patterns in the U.S.,” noted Philbin.
States were categorized as liberal, moderate, or conservative based on the 2005 and 2011 State Rank on Policy Liberalism Index, which is based on policy indicators for which liberals and conservatives commonly differ. The Index ranked each state from 1 (most liberal) to 50 (most conservative) based on its policies regulating gun control, abortion access, Temporary Assistance to Needy families, collective bargaining, and tax structure.
Average state-level prevalence of past-year cannabis use by age was lowest for ages 26 and older and highest for ages 18 to 25 throughout the study period. Average prevalence increased for ages 18-25 in liberal states, from 33 percent to 37 percent, and rose marginally in conservative states, from 25 percent to 26 percent. The same pattern of use was observed for ages 26 and over in liberal (8 percent to 10 percent) and conservative (6 percent to 7 percent) states. For ages 12-17, however, past year use did not significantly change from 2004-2006 to 2010-2012 in liberal or conservative states.
In contrast, cannabis use disorder among past-year cannabis users decreased from 2004-2006 to 2010-2012 among those aged 18-25 in conservative states (22 percent to 18 percent) and liberal states (20 percent to 17 percent). Among individuals ages 26 and over, cannabis use disorder among past-year users decreased in liberal states (11 percent to 8 percent). For 12-17 year olds, cannabis use disorder decreased in conservative states (28 percent to 25 percent), though still remained marginally higher than in liberal states (24 percent).
“Our study highlights the need for researchers and public health professionals to distinguish between cannabis use and cannabis use disorder when interacting with patients at the individual level and when developing primary prevention strategies and interventions at the population level,” said Silvia Martins, MD, PhD, associate professor of Epidemiology and senior author. “This line of research not only helps identify how state-level policies as a whole impact cannabis use outcomes, but ultimately supports the development of more health-promoting policies.”
The work was funded by the National Institutes of Health/National Institute on Drug Abuse (DA037866, DA039804A, DA031099).
Co-authors are Pia Mauro, Julian Santaella-Tenorio, Christine Mauro, and Elizabeth Kinnard, Columbia Mailman School; and Magdalena Cerdá, New York University.
Materials provided by Columbia University’s Mailman School of Public Health. Note: Content may be edited for style and length.
Morgan M. Philbin, Pia M. Mauro, Julian Santaella-Tenorio, Christine M. Mauro, Elizabeth N. Kinnard, Magdalena Cerdá, Silvia S. Martins. Associations between state-level policy liberalism, cannabis use, and cannabis use disorder from 2004 to 2012: Looking beyond medical cannabis law status. International Journal of Drug Policy, 2019; DOI: 10.1016/j.drugpo.2018.10.010
Columbia University’s Mailman School of Public Health. “Cannabis use disorder: The policy climate matters.” ScienceDaily. ScienceDaily, 23 January 2019. <www.sciencedaily.com/releases/2019/01/190123091158.htm>.