Cannabis Use in Hospitals Is Still Prohibited, Despite State Medical Pot Programs

Every day, patients around America use cannabis to treat everything from glaucoma to chronic pain to nausea from chemotherapy treatments. Yet even in places like California, which pioneered legal medical marijuana in 1996 and passed adult-use cannabis in 2016, hospital policy has not caught up with the law and cannabis remains officially barred from hospital premises across the country. The reason why should sound familiar: federal prohibition.

Hospitals in the United States are subject to federal regulations, and could stand to lose funding and the ability to serve patients if they break the federal law, even with something like a state-legal medication.

This conflict between state and federal law on cannabis use in hospitals has very real consequences. One woman, Jessica Assaf, wrote on Healthcare in America in January 2018 about the experience of watching her partner’s father die of colon cancer at Memorial Sloan Kettering Cancer Center in New York City.

“After two years of failed chemotherapy and radiation, this prominent New York City lawyer weighed 130 pounds and could no longer talk nor move,” she wrote. “Though this patient had a medical recommendation for cannabis use in New York and vaporized THC and CBD daily to manage his pain, he could not use his medicine while he was stuck in the hospital. Instead, he was administered fentanyl.”

The medical marijuana movement, in fact, has a history of pushing for cannabis use in hospitals. The legendary activist known as Brownie Mary brought the issue into the international spotlight after she was arrested for bringing pot brownies to people dying of HIV/AIDS in San Francisco’s hospitals in the 1980s. Forty years later, it might be legal for millions to purchase medical marijuana — but using it in hospitals remains as prohibited as ever.

California Pioneering the Fight for Cannabis Use in Hospitals

The first sign of progress in allowing cannabis use in hospitals came in September 2016, just north of San Francisco. In a 2-0 vote, with three members abstaining, the board of California’s Marin Healthcare District voted in favor of  a resolution to study allowing patient cannabis use at Marin General Hospital, in the town of Greenbrae. A series of public forums were to be held to discuss the proposal.

However, in the three years since, the study has not been conducted and has effectively stalled.

The resolution was originally introduced by retired emergency room physician Dr. Larry Bedard, who had served on the California Medical Association cannabis task force that led to the association recommending legalization in 2011.

“We ought to be on the cutting edge for our patients, allowing them to openly and appropriately use medicinal cannabis,” Bedard told San Francisco’s KPIX at the time of the Marin resolution.

Speaking at the board meeting in support of the resolution was Lynnette Shaw, who opened the first licensed medical marijuana dispensary in Marin County back in 1997. She told KPIX she had been sneaking pot brownies into Marin General for 20 years, and that most doctors there were perfectly aware of the practice.  

“This is something they know about,” said Shaw. “I think it’s time for Marin General to step up, because this is a revolution for better health… For goodness sake, help the patients! Save lives!”

However, Shaw’s comments apparently didn’t get through. In the three years since the Marin Healthcare District voted to study the issue, little has come of it. Reached for comment in Marin County by Cannabis Now, Bedard says the resolution has seen no progress.

“The hospital administrators basically said ‘C’mon Larry, it’s a Schedule I drug, the Trump administration would take away our Medicare provider number and we’d have to close,” Bedard tells us.

He points out that any hospital that handles Medicare patients — predominantly people with the federal health insurance for those over 65 — must be certified by the federal Department of Health & Human Services. And while there is a small push to get Medicare to cover medical marijuana, there are few prospects for this happening under the current White House administration. 

(Lynnette Shaw PHOTO Gracie Malley for Cannabis Now)

An attempted remedy at the state level in California has also failed. Last year, Senate Bill 305, the “Compassionate Access to Medical Cannabis Act,” unanimously passed both chambers of California’s Legislature. It would have prohibited healthcare facilities from interfering with a terminally ill patient’s use of medical cannabis. It was also dubbed “Ryan’s Law,” after Ryan James Bartell, a San Diego native who had died of pancreatic cancer in April 2018. But in October, it was “begrudgingly” vetoed by Gov. Gavin Newsom.

“This bill would create significant conflicts between federal and state laws that cannot be taken lightly,” Newsom wrote in a veto statement, noting that “health facilities certified to receive payment from the from the federal Center for Medicare and Medicaid Services must comply with all federal laws.” 

But his statement also took aim at those federal laws. “It is inconceivable that the federal government continues to regard cannabis as having no medicinal value,” Newsom wrote, adding that this “ludicrous stance puts patients and those who care for them in an unconscionable position.” 

Doctors Weigh In

Clearly, the stakes in this question are high due to the illegality of cannabis at the federal level. While 11 states have legalized adult-use cannabis and 33 states have legalized medicinal marijuana, the feds still hold significant sway over hospital policy. 

First, as already noted, hospitals must be accredited through the federal Center for Medicare & Medicaid Services and “could be found to be in violation, lose federal funding, and face penalties” if they allow even state-legal cannabis use, according to a 2017 article in the peer-reviewed journal Hospital Pharmacy.

Second, clinicians are also prohibited from prescribing or providing cannabis in a hospital because it is not approved by the U.S. Food and Drug Administration.

“Yet, hospitals in more states are asked to create cannabis policies as voters decriminalize cannabis for medical use,” the authors Laura Borgelt and Kari Franson wrote in that same article. “There is no recognized supplier of medicinal cannabis, so hospitals are often asked to allow patients to bring in their own supply for their own use.” 

But in a Kafkaesque twist, hospitals then risk running afoul of a guideline established by the Joint Commission, the national body that sets standards for medical facilities. Joint Commission Standard MM.03.01.05 states: “The hospital informs the prescriber and patient if the medication brought into the hospital by patients, their families, or licensed independent practitioners is not permitted.”

Borgelt and Franson note that some hospitals have considered that “cannabis policies that could adequately address this standard” and allow cannabis on its premises if it informs everyone involved that the cannabis is “not permitted.”

“But several questions remain,” the authors write. “For example, how is the product identified, how does the institution verify its integrity, and how is a federally illegal drug ‘permitted’?”

However, some doctors have taken a more laissez-faire approach to the issue of allowing cannabis in hospitals.

“I think there’s a legal question and an ethical question,” Dr. Benjamin Caplan, founder of the CED Clinic and a representative of the group Doctors for Cannabis Regulation, told Patient Safety Monitor Journal in 2019. “In order for doctors to best manage illnesses carefully, and to the best of our abilities, we must know as much as we can [about] what a patient is taking. But it’s very common for patients to sneak cannabis in back rooms or under the radar, which is really unfortunate for everyone. I think the hospital perspective should be embracing what patients find helpful.”

Emphasizing the ethical dimension, Caplan added: “To have cases where patients are having seizures in a hospital and they can’t get the medicine that they want (and find helpful) as an outpatient is a real cultural disconnect for the medical establishment. I think the solution is for people to not sneak around; the solution is for hospitals to open their arms to patients who find a medication helpful.”

Veterans Lack Access to Cannabis in VA Hospitals

The question of whether or not it’s allowed to use cannabis in a hospital is a particular concern for military veterans — many of whom use cannabis to treat PTSD, yet are more directly dependent on the federal government for their healthcare. The U.S. Department of Veterans Affairs has remained largely intransigent on the question of medical cannabis, despite growing pressure.

“Moving to make cannabis available through VA hospitals or other go-to sources of care is difficult,” the VA website notes. “Doctors at VA facilities aren’t just prohibited from prescribing marijuana: The drug is still listed as ‘Schedule I,’ so these health care professionals can’t even speak about it with their patients.”

Needless to say, if the VA won’t allow its doctors to prescribe cannabis, it’s certainly not allowing its patients to use cannabis on the premises of VA hospitals.

The Mayo Clinic & the Potential for Change

The most significant opening for allowing cannabis in hospitals appears to come from the Mayo Clinic, the national network of medical treatment and research facilities. The Mayo Clinic website recognizes that “medical cannabis has possible benefit for several conditions.”

It notes that three states — Arizona, Florida and Minnesota — have adopted some form of the “Right to Try Act,” allowing access to “investigational” treatments, potentially including cannabis, for people with life-threatening conditions who have exhausted approved treatment options.

In one of those states, the Mayo Clinic allows on-premises use: “Minnesota residents with a supply of medical cannabis from the Minnesota Medical Cannabis program may continue use during their Mayo Clinic visit or hospital admission.”

However, the Mayo Clinic is in a unique position as a not-for-profit organization with national renown and standing as a top research institute. While the Mayo Clinic receives a significant amount of federal funding and has a Medicare number, it appears willing to take the risk with the federal government. If other hospitals will follow remains to be seen.

TELL US, do you think patients should be allowed to use cannabis in the hospital?

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Coming clean: Your anesthesiologist needs to know about marijuana use before surgery

Given the increasing prevalence and legalization of marijuana, many patients have come to think that marijuana use is not worth mentioning to their physicians. After all, they reason, I would not necessarily tell my doctor that I had a glass of wine last night, so why should I disclose that I smoked marijuana yesterday? Unfortunately, this reasoning is flawed. Because marijuana has a variety of effects on the body and on anesthesia medicines, it is crucial that anyone undergoing a preoperative evaluation disclose their marijuana use. Don’t worry that your anesthesiologist is judging you. That’s not our job! Our job is to understand your health and body in order to provide you with the safest and most pain-free procedure. This information is part of your confidential medical record, and accurate information is crucial to helping doctors provide good care.

Marijuana can affect the type and amount of anesthesia

The way(s) you use marijuana (smoking, edibles, etc.), how often you use, and how much all can affect how your body responds to anesthesia. Since marijuana and anesthesia both affect the central nervous system, people who use marijuana regularly may need different amounts of anesthesia medicines. In order to know which medicines and how much to use, your doctor needs to know ahead of time how much and how often you use marijuana.

Regular users of marijuana generally need larger doses of anesthesia medicines in order to achieve the same degree of sedation. If you don’t tell your anesthesiologist how much marijuana you smoke, he or she may underestimate how much anesthesia will be needed for you to “go to sleep” and stay asleep during your procedure. For example, compared to nonusers, regular marijuana users (daily to weekly) need over three times as much more propofol to achieve adequate sedation for endoscopies. That is a huge increase in dose that your doctor would want to be prepared to administer.

The higher anesthesia dose required for regular marijuana users can lead to an increased risk of complications, such as decreased blood pressure and delayed awakening from anesthesia.

Marijuana use before surgery can increase the risk of complications

Other side effects of regular marijuana use can lead to serious complications of anesthesia. Inhaled marijuana can affect your lungs and increase phlegm, coughing, wheezing, and the risk of respiratory infections. These lung issues can lead to breathing problems during your anesthetic, such as increased airway sensitivity when the breathing tube is put into or taken out of the airway. This may feel like an asthma attack, with a sensation of difficulty breathing and decreased oxygen getting into the lungs. Regular users of marijuana can also have increased postoperative pain, which leads to higher opioid use during and after surgery. This puts regular marijuana users at risk for opioid use disorder after surgery.

Don’t use marijuana the day of surgery — especially edibles

No matter how worried you are about your procedure, don’t use marijuana to relax — you may end up with your surgery rescheduled or with serious complications. Regardless of how often you usually use marijuana, anesthesiologists agree that you should skip it completely on the day of surgery. You should not smoke or inhale marijuana the day of your surgery, and certainly you should avoid any edible marijuana the day of surgery, since the American Society of Anesthesiologists’ guidelines for preoperative fasting do not allow any solid food for six to eight hours prior to anesthesia, in order to decrease the risk of food getting inhaled into your lungs. This can lead to aspiration pneumonia, a very serious complication that may cause death in some patients.

The physical effects of marijuana can increase the risk of complications, especially if consumed within an hour or two of anesthesia. Marijuana can raise your heart rate and lower your blood pressure. These changes are even more serious in patients with heart disease. In selected patient populations, this combination of decreased blood pressure and increased heart rate can cause ischemia (lack of blood supply) to the heart muscle, commonly known as a heart attack.

There are still many unknowns about marijuana

Your anesthesiologist needs accurate information about your marijuana use in order to plan safe anesthesia, and we know that no one should use marijuana on the day of surgery. Because of marijuana’s classification as a drug of abuse, we cannot do medical research on marijuana without legislation to allow that research, and this includes research about how marijuana affects surgical procedures and aspects of anesthesia. The American Society of Anesthesiologists (ASA) has urged the federal government to allow medical studies and has endorsed bills to expand research in marijuana.

Your anesthesiologist just wants to keep you safe

The ASA has a list of eight things that you should tell your physician and anesthesiologist before surgery, and the use of marijuana is one of them. Please don’t be afraid to disclose your use of marijuana to your physician, as it will not affect what we think of you. You will help us manage and adjust your anesthetic, prevent complications, and keep you as safe and healthy as possible.

The post Coming clean: Your anesthesiologist needs to know about marijuana use before surgery appeared first on Harvard Health Blog.

Can Smoking CBD Flowers Help Fight The Flu?

Flu season is in full swing and people are looking for relief wherever they can find it. CBD (cannabidiol) is often promoted as a way to diminish the symptoms of flu and common cold, but does it actually work?

You always know when it hits; sore throat, stuffy nose, coughing and sneezing eventually give way to fever, body aches, and extreme fatigue. It’s the flu (influenza), and it’ll knock you down like you’ve been hit by a bus. For most adults with a healthy immune system, symptoms will disappear after about a week (although it feels never ending).

Aside from loading yourself up with a cocktail of over-the-counter cold medications, pain relievers, and cough drops, is there anything else you can do to manage the symptoms? Unsurprisingly, many people swear by cannabis-based products, CBD flowers are particularly popular. And let’s be honest, wouldn’t it be nice to be able to light up a joint and feel better?

There
are no published studies researching this specific use for CBD, but that doesn’t
necessarily mean it doesn’t work. Let’s investigate further.  

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THC vs CBD

To quickly clarify, in this article
we’ll be discussing the effects of smoking CBD flowers when sick with flu. CBD-dominant
hemp flowers differ from THC-dominant cannabis flowers in a number of ways. First
of all, they’re non-psychoactive. This makes it much more likely that people
will use CBD flowers in a medicinal way, since these can be smoked throughout
the day without causing the user to be mentally impaired.

That’s not to say that THC (tetrahydrocannabinol) doesn’t offer any medical benefits of its own, but each cannabinoid is unique. Typical medical uses for THC include depression, pain, nausea and problems with appetite, insomnia, and it’s also believed to have neuroprotective qualities. CBD on the other hand, is most commonly used to treat anxiety, inflammation, epilepsy, and addiction to other substances.

 Both THC and CBD, as well as other cannabinoids
including CBG, are believed to have antiviral and antibacterial properties, and
this is the main reason people are using it to fight the cold and flu.

The (limited) Research on CBD and the Flu

As expected, you’d be hard pressed
to find a general practitioner who would suggest smoking CBD flowers to treat
the flu. There are some naturopathic doctors who agree that there is a possibility
it could work, although the evidence just isn’t there at the moment.

Dr. Shawn Meirovici, a naturopathic doctor from Toronto had this to say on the subject: “The cannabinoids THC and CBD have been shown to have pain-relieving, sleep-inducing, and anti-inflammatory properties,” he says. “So, on your sick day when you’re wrapped in a blanket cannabis may help reduce body aches, ease inflammation of the airways, and increase relaxation to help you sleep.”

He also suggested that cannabis may
also have “antipyretic or fever-reducing properties, due to its ability to
suppress the immune system.” He also pointed out that CBD has some anti-viral
properties that could be helpful for fighting influenza.

There is one thing to take note of
though, and that the fact that some preliminary research suggests CBD, and THC,
might actually hinder the immune system’s ability to fight certain infections. This
means that, even though CBD is providing some symptom relief, it might actually
prolong the time it takes for a virus to run its course.

And yes, I know this directly
contradicts other studies regarding CBD and immunity, but this is exactly why
more large-scale research is so desperately needed. “The research has been
primarily in vitro or in rats; there hasn’t been any studies on humans to
date,” added Dr. Meirovici.

I want to use CBD for my flu, what should I do?

Bottom line, don’t smoke.

If you’ve done your due diligence and
believe that CBD is the best treatment option for you, it’s advisable that you
stay away from smoking or vaping it while you’re sick with the flu. Although it
might feel nice for a short period, the smoke and heat can further irritate
mucus membranes, making a cough or sore throat that much worse.

The best way to use CBD in this
scenario would be in the form of a beverage. Something soothing like CBD-infused
tea, CBD-infused honey (always go for raw, unfiltered honey if that’s an option),
or just a simple CBD tincture that you can add to your drink of choice.

What ever you chose to do, the most important
thing is get your rest, since your immune system is working in overdrive to get
your body back to normal.

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The Cannabis Now Guide to Pairing Herbs with Your Herb

Stop for a second and think about your last smoke session. Imagine the smell after grinding up the bud, the flavor after that first full exhale and the pleasant effects that follow: a boost of energy, a wave of relaxation or a sense of peace. The unsung hero of your perfect post-high moment? Terpenes. These aromatic compounds, also found in other plants, herbs, flowers and even fruits, are key players in the taste and scent of your cannabis and the distinct buzz that follows.

Because terpenes also interact with cannabinoids to create all of the components that make up your favorite strain, adding herbs to your cannabis can enhance the consumption experience.

Depending on which herbs you use, you can boost flavor profiles, increase energy and focus, ease pain or reduce stress. There are lots of different ways to pair herbal blends with cannabis and knowing what to consider before making your own combination is crucial for coming up with the perfect mix.

Monica Fine, a California-based master herbalist, has some simple tips when it comes to matching herbs with cannabis strains. She says it’s best to use what you like in small amounts, change herbs regularly and try to use what is actually in season around you. Fine explains that any herb used in excess can be dangerous — even ones you think are the safest.

She also suggests staying away from herbs like datura, morning glory and nightshades, which are poisonous.

Unfortunately, she cautions that both burning and vaping dried herbs don’t allow you to enjoy the highest terpene content possible, because of the process of combustion and oxidation burns off terpenes. So, Fine says, tinctures are the better option when it comes to cannabis and herbal blends. Still, there are some benefits if you are interested in consuming cannabis and herbs by vaping or smoking, especially since Fine notes that smoking hits the central nervous system much faster than other delivery methods, which makes it useful for immediate relief.

Personally, Fine favors herbs like damiana, life everlasting flower and any of the artemisia family added to joints and spliffs. She is working to launch a brand that will feature sublingual extracts that utilize the powerful combination of herbs and cannabis, using formulas designed to preserve the integrity of the plants.

When it comes to picking your own herbs to pair, she refers to her mentor Jeanne Rose, a world-renowned author, herbalist and aromatherapist who suggests using herbs like rosemary and sage to dry mucus and excess secretions from the lungs and recommends trying marjoram, chamomile and gentian to help kick a tobacco habit. And of course, there are also other herbs and flowers, from peppermint and mullein to rose and jasmine blossom, that you can choose from to complement your strain of choice.

How to Combine Herbal Terpenes With Cannabis

Linalool is an anti-inflammatory, antiepileptic and analgesic terpene found in herbs like lavender and is good for pain management and reducing anxiety and stress. Pairs well with the strains Romulan, Sour Kush and Purple Urkle.

Pinene is a bronchodilator, expectorant and antimicrobial terpene found in herbs like rosemary and sage and helps with boosting focus, increasing alertness and improving airflow to the lungs. Pairs well with strains like Purple Kush, AK-47, Dutch Treat and Bay Dream.

Myrcene is an antibiotic, antimutagenic and a muscle-relaxing terpene found in herbs like eucalyptus and hops and is known for its calming properties. Pairs well with strains like Mango Kush, Granddaddy Purple, Trainwreck and Grape Ape.

Geraniol is a natural antioxidant terpene that’s antiviral, anti-inflammatory and antispasmodic. It’s found in roses and is good for adding floral flavor profile. It also has antibacterial and antifungal properties that can help reduce infections. Pairs well with strains like Afghan, Headband, Amnesia Haze and Great White Shark.

TELL US, do you go for certain taste profiles when it comes to choosing cannabis?

Originally published in Issue 39 of Cannabis Now. LEARN MORE

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New Cannabinoid Said to be 30x Stronger Than THC

Last week, researchers from the University of Salento in Italy discovered two new cannabinoids. The compounds have been deemed tetrahydrocannabiphorol (THCP) and cannabidiphorol (CBDP). What’s interesting about THCP is that it is apparently 30 times stronger than THC. However, nobody is yet to understand what this really means in the grand scheme of cannabis science. The only thing the ganja geeks can say for sure is that this new compound appears to be more prevalent than THC when given to mice. They also believe the presence of THCP could be what provides cannabis strains with varying effects. In other words, we have two new cannabinoids — one that may even be the real rockstar — and we still know very little about their roles or what they are capable of.

Until now, all the scientific sector has really known is that there are hundreds of cannabinoids getting down to business in the cannabis plant. It just so happens, though, that when it comes to how this plant works when providing a buzz, healing, curing or whatever it is a person needs it to do, THC and CBD have been given all the credit. Still, we have known for a long time that the presence of unsung cannabinoids, like cannabinol (CBN) and cannabigerol (CBG), are responsible for helping to produce unique effects. There is also a little something called the entourage effect, whereby all of these compounds work together in harmony to create a certain kind of magic. Yet, we have continued the course in making THC and CBD the focal point of the spiel. Scientists now believe that at least one of the new cannabinoids, THCP, could also prove to have substantial benefits.

“A number of clinical trials and a growing body of literature provide real evidence of the pharmacological potential of cannabis and cannabinoids on a wide range of disorders from sleep to anxiety, multiple sclerosis, autism and neuropathic pain,” researchers said. “In particular, being the most potent psychotropic cannabinoid, THC is the main focus of such studies.”

“THCP is endowed of an even higher binding affinity for CB1 receptor and a greater cannabimimetic activity than THC itself.”

Although the wheels might be turning in the brains of cannabis industry executives curious about whether the discovery of CBDP might provide them with a new revenue stream, scientists argue that it might not be worth it. At least not yet. It seems the compound is wonky (it doesn’t bind well to CB1 or CB2 receptors). Therefore it is not something they are interested in learning more about right away. “In our opinion, this compound should be included in the list of the main phytocannabinoids to be determined for a correct evaluation of the pharmacological effect of the cannabis extracts administered to patients,” researchers explained.

In the end, the discovery of two new cannabinoids means there is still a wealth of opportunity to learn about what makes cannabis tick. But the longer the federal government keeps trying to separate these compounds into good and bad — CBD is medicine, THC is the devil — the longer it’s going to be before anyone of us has a real understanding about what happens when we consume this plant.

TELL US, do you think you could handle a cannabinoid with 30 times of the potency of THC?

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Ireland Approves Two Canadian Firms To Supply Medical Cannabis

Two Canadian companies have been approved as the first suppliers to the recently launched medical cannabis program in Ireland.

The Irish Government signed off on the launch of its five-year pilot in June, and now Aurora and MGC Pharmaceuticals have been selected to provide its first cannabis medicine.

Under the scheme consultants can prescribe to patients with spasticity, associated with multiple sclerosis, chemotherapy-related intractable nausea and treatment-resistant epilepsy. The two products are Aurora High CBD Oil Drops and CannEpil, both are CBD based drugs with the latter being used to treat epilepsy.

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Weeks To Wait

However, much like its U.K. neighbor there will be a time-lag of weeks between prescription and receipt of the drug. The Irish Journal reports that under the scheme the two companies have to apply for a licence to bring the product into Ireland for distribution. 

CannEpil is a product that ‘has been years in the making’, and was released into the market in 2017, says Roby Zomer, Executive Director and CEO at MGC. Dr Shane Morris, Chief Product Officer at Aurora said: “We are very proud to be one of the first approved suppliers of medical cannabis…and will continue to work closely with all parties and state agencies to facilitate further availability.”

The Medical Cannabis Access Programme was signed into law in June this year, by the Minister for Health in Ireland, Simon Harris. 

80,000 New Jobs

Mr Harris said at the time that the program would allow ‘compassionate access to cannabis for medical reasons’ in cases where conventional treatment has failed. The Irish Government says it wants to encourage the development of a home-grown cannabis cultivation and hemp industry saying it the potential to create over 80,000 jobs.

Meanwhile, a third Canadian company Province Brands of Canada, has appointed Irish drinks distributor Barry & Fitzwilliam, as its distribution partner to bring its  non-alcoholic CBD beer to the Irish consumer.

Barry & Fitzwilliam is Ireland’s largest independent drinks distributor, and the new venture is expected to begin offering CBD-infused, barley-based, non-alcoholic beverages across Ireland in February 2020.

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German Medical Cannabis – A Model For Europe, As Prices Fall

The success of the robust German medical cannabis program is an example for the rest of Europe, claims a newly-formed lobby group.

As patients in other European jurisdictions struggle to access cannabis medicine, Germany is leading the way with over 142,000 prescriptions written in 2018. It is also leading the way in cutting prices with a new wholesale prices of 2.3 euros per gram set to substantially reduce the current cost of medical cannabis, reports the Mjbizdaily website.

Sita Schubert, secretary general of The European Medicinal Cannabis Association (EUMCA) says the positive example of Germany can change perceptions when discussing an EU regulatory framework for medical cannabis, reports the Euractiv website.

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Black Market Dangers

Its members include larger firms such as Tilray, Panaxia and Materia Ventures, smaller companies like Cannaflos, and a large German pharmaceutical association.

It wants to ensure all drugs comply with The European Medicines Agency guidelines and European GMP standards. In the absence of an EU-wide framework, more patients could be forced on to a dangerous black market, warns the EUMCA.

Prices Plummet

The Czech Republic, Italy, Malta, and the Netherlands have all adopted medical cannabis programmes and the one in the United Kingdom has been far from successful with just a handful of patients securing prescriptions through the NHS.

Meanwhile the German federal government has announced it will buy at least 650 kilograms of medical cannabis flower from domestic producers for approximately 1.5 million euros ($1.66 million) per quarter, which sets the average wholesale price at 2.3 euros per gram.

With a mandated  pharmacy markup of 100% this will substantially reduce the current retail prices of medical cannabis in Germany which is about 20 euros per gram. Meanwhile, CBD use in Germany continues to grow, although a new report from New Frontier Data shows that German public are slightly less aware of, and exposed to, CBD than the European average.

It says that Germans are reportedly confident about CBD’s medical applications, although few have used products other than oils and tinctures, and many are uncertain about dosing.

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New Research Highlights Europe’s Glaring CBD Differences

The French are the most skeptical of CBD whilst their Swiss neighbors are the most engaged, new European research has revealed.

The findings from New Frontier Data found French respondents are least likely to agree that CBD had valid medical uses – at 46% – nine points less than the rest of Europe. They are also the most likely to believe that CBD should only be available with a doctor’s recommendation, at 49%, compared to 36% on the rest of the continent.

Meanwhile, in Switzerland and Austria more than half – 53% – are positive about CBD, compared to 42% of Europeans overall.

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Pain Relief and Relaxation

The October 2019 European CBD Survey polled 3,100 respondents from the continent about their attitudes and CBD use. It found that most consumer are using CBD to treat, pain, at 40%, for relaxation at 34%, and to reduce stress and anxiety levels at 31% and 26% respectively.

In relation to CBD usage the French were once again at the bottom with 7% compared to 16% of all Europeans. There is also a marked difference in familiarity with cannabidiol – or CBD – in France at 36% compared to 78% in the United Kingdom and Ireland. 

However, this French skepticism towards CBD, and all things cannabis, is currently under attack from two sides. Earlier this year the Government approved the country’s first medical cannabis trial, and the French Parliament looks set to ease restrictions on the CBD wellness market.

In a recent interview with CBD Testers Aurélien Bernard and Benjamin-Alexandre Jeanroy, supporters of the French Medical Cannabis and Wellness Hemp Union, elaborated on the shifting attitudes in France.

CBD: Under The Radar

Mr Bernard said: “Previously CBD was under the radar but we are confident of seeing the creation of acceptable regulations that will allow for the processing and extracting of CBD in France.

“Over the last year there has been a growing interest in cannabis, where previously it has been under the radar, with little recognition. This needs to change that and we are fairly confident that will happen by mid 2020.”

The report’s authors conclude: “France is among the least CBD-friendly markets in the continent; it has the lowest rates of CBD use and purchasing, with the least public awareness and exposure to CBD. 

“In general, the French are not only uninterested in CBD, but are the least accepting of its medical applications and availability to consumers. France reported the most negative attitudes toward CBD among any region in Europe.”

Analysts at the Brightfield Group estimate the European CBD market will boom over the next four years. The market was estimated at $318 million in 2018 and is expected to grow over 400 percent through 2023.

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Can CBG Be The Answer To Treating Glaucoma?

Glaucoma was one of the very first
conditions to be treated with medical cannabis, but over time it’s been
determined that certain cannabinoids can make the condition worse.

Back in 1971, Hepler and Frank reported a 25–30% drop in intraocular eye pressure in a small number of subjects who had recently smoke cannabis. To this day, glaucoma is still a commonly cited reason for prescribing medical cannabis.

When it comes to glaucoma, the cannabinoid most commonly associated with healthcare – CBD – is actually detrimental to this condition. Historically, THC has been successful treatment option, but new studies indicate that another cannabinoid might be even more effective – CBG or cannabigerol.

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What is Glaucoma?

Glaucoma is a condition categorized by
increased pressure in the eye, called intraocular eye pressure, caused by fluid
buildup in the front part of the eye. Over time, the pressure builds up and
damages the optic nerve, which is what sends images from your eyes to your
brain. This can eventually lead to blindness.

Glaucoma is the second-leading cause
of blindness in the United States. There are certain criteria that make certain
people predisposed to glaucoma. It’s more likely to effect African Americans
and Hispanics, and it’s there is an elevated risk for people who have a family
history of this condition. Other risk factors include: thinner corneas, chronic
eye inflammation and certain medications.

Glaucoma effects more than 3 million
Americans, 2.7 million of whom are over the age of 40. Although it primarily effects
adults, there is an infant (congenital) form that exists. There are two main
types of glaucoma: Primary open-angle glaucoma, which happens gradually over a
long period of time; and Angle-closure glaucoma, which is acute onset and
considered a true ocular emergency.

What is CBG?

Since cannabigerol is usually only
present in cannabis in very small amounts – normally less than 1 percent – it’s
considered a minor cannabinoid. CBG is important for another reason though, and
that is its ability to synthesize other major cannabinoids. Because of this, CBGA
(cannabigerolic acid) has been appropriately nicknamed “The Mother of
Cannabinoids”.

CBGA is a direct line to three main cannabinoids:
tetrahydrocannabinolic acid (THCA), cannabidiolic acid (CBDA), and
cannabichromenic acid (CBCA). Once exposed to heat or light during a process referred
to as decarboxylation, THCA, CBDA, and CBCA will shed their carboxyl acid group
and become THC, CBD, and CBC, respectively

If we’re following the pattern above, CBGA should break down to CBG, but this doesn’t happen very often. Usually, certain enzymes break down CBGA and it is immediately converted to THCA, CBDA, or CBCA. This is why more THC means less CBG, because of the unique way these compounds interact and are synthesized.

However, in certain strains, CBGA naturally converts to CBG. These strains are low in THC and easily able to pass compliance standards. To get more flowers with these high levels of CBG, breeders are practicing plant cross-breeding and other forms of genetic manipulation.

The Research: CBG for Glaucoma

CBG may also help with treating
glaucoma, because of the way it reduces intraocular pressure. Our eyes contain
many endocannabinoid receptors which can be activated by cannabinoids like CBG.
When activated, the result can be a shift in intraocular pressure. While cannabinoids
in general have been suggested as helpful for this, some studies show that CBG
may be particularly helpful with decreasing pressure and expediting the
draining of fluids.

A study https://www.ncbi.nlm.nih.gov/pubmed/1965836 conducted by the Department of Ophthalmology at
West Virginia University Health Sciences Center North in Morgantown, determined
that “After chronic administration of CBG unilaterally to the cornea via Alzet
osmotic minipumps and connecting extraocular cannulas, a considerable fall in
ocular tension amounting to 4 to 7 mm Hg occurred. Both CBG and THC produced a
two-to three-fold increase in aqueous outflow facility. These results suggest
that cannabigerol and related cannabinoids may have therapeutic potential for
the treatment of glaucoma.”

Final Thoughts

CBG is cannabinoid that hasn’t gotten much attention but seems to have very much therapeutic value, and this is especially true when it comes to treating glaucoma, which can be a completely debilitating condition. Endocannabinoid receptors are prevalent in eye structures, and interestingly, CBG is thought to be particularly effective in treating glaucoma because it reduces intraocular pressure. It is a powerful vasodilator and has neuroprotective effects to boot.

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Using CBG To Treat Clinical Depression

Cannabis has long been used to alleviate symptoms of depression, anxiety, and other mental health conditions, but which cannabinoid is most effective has always been up for debate.

Today we will focus on Cannabigerol, or CBG, and the different reasons why it’s an excellent option for treating depression. According to the World Health Organization, depression is the most common mental illness, affecting over 264 million people worldwide. Depression is a leading cause of disability as well as a major contributor to the overall poor health.

Finding a healthy, effective, and sustainable treatment option is of utmost importance. Prescription antidepressants can have numerous unpleasant side effects including but not limited to nausea, sexual dysfunction, weight gain, insomnia, blurred vision, dizziness, and in some cases, even suicidal thoughts.

This is exactly why researchers are looking at individual cannabinoids as a possible solution to this growing problem.

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What is CBG?

Cannabigerol is considered a minor cannabinoid because its presence
in cannabis is usually in very low levels – typically less than 1 percent. It
does have an important role as a  precursor to other cannabinoids, and thus, CBGA
has been rightfully dubbed the “Mother of Cannabinoids”. Its ability to
synthesize major cannabinoids has pushed into the limelight for researchers,
investors, and consumers alike.

Specifically, CBGA (cannabigerolic acid) is a direct line to
three main cannabinoids: tetrahydrocannabinolic
acid (THCA), cannabidiolic acid (CBDA), and cannabichromenic acid (CBCA). Once
exposed to heat or light in process known as decarboxylation, THCA, CBDA, and
CBCA will shed their carboxyl acid group and become THC, CBD, and CBC,
respectively.

When it comes to CBGA though, certain
enzymes break it down and it is immediately converted to THCA, CBDA , or CBCA.
This is why more THC means less CBG, because of the unique way these compounds
interact and are synthesized.

In certain strains, CBGA naturally converts
to CBG. These strains are low in THC and easily able to pass compliance
standards. To get more flowers with these high levels of CBG, breeders are
practicing plant cross-breeding and other forms of genetic manipulation.

The Research: CBG for Depression

Although minimal research exists, there
are numerous possible therapeutic uses for CBG which have been previously noted.
For example, it can be used to treat glaucoma, inflammatory bowel disease,
colorectal cancers, and Huntington’s disease.

Another area of interest is the role of CBD in mental health and the treatment of clinical depression. Researchers have discovered that CBG can inhibit uptake of GABA and serotonin in the brain, which can lead to increased levels of these neurotransmitters in the brain. Decreased levels both GABA and serotonin have been linked to depression, making CBG a promising option when it comes to treating this disorder.

What’s also interesting is that when
in comes to GABA, CBG is said to inhibit uptake more effectively than other
cannabinoids, namely CBD and THC. This is noteworthy because, just like CBD,
Cannabigerol is also non-psychoactive and has no intoxicating effects whatsoever.
It can be a mild, alternative mood enhancer.

And finally, it’s also believed
that CBG can boost production of Anandamide, an endocannabinoid
known as ‘The Bliss Molecule’. Anandamide naturally increases dopamine levels and
is responsible for regulating various functions such as sleep, mood, and
appetite.

2015 study, which examined both humans and rats, found that high levels of anandamide contributed to mood enhancement and fear reduction. When the enzymes that break down anandamide were inhibited, that led to a decrease in fear and anxiety when threats were perceived. This is another way that CBG can be used for depression.

Final Thoughts

Although much more research is needed, it does seem that CBG
has potential as a natural and holistic method for treating depression, a condition
that effects so many people across the globe.

As the number of sufferers continues to rise, health organization
in major nations will have to dedicate a lot more time and resources to
combating this condition. And instead of using potentially dangerous drugs like
SSRIs, the answer may be found in something natural and much safer: CBG-rich
cannabis plants.

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