Standardized Cannabis Medicine – The ‘Responsibility Of All In The Industry’

Creating standardized medicine is the gold standard for the cannabis industry but the nature of the plant can make this difficult, attendees to Cannabis Europa heard.

Some panelists argued that attempts by the major pharmaceutical companies to patent drugs from the cannabis plant should be challenged. Others said that for cannabis medicine to achieve globally accepted standards there would need to be an involvement from the pharmaceutical giants to fund the research.

Dr Barbara Pacchetti, of U.K. company EMMAC Life Sciences, described cannabis as an ‘unconventional medicine’. “The aim is for standardized cannabis medicine, and this would be the peak of Everest. Doctors are not comfortable with anything else, but with cannabis we have the plant’s entourage effect and this leads to a lot of questions and grey areas in relation to variability.

“For pharma companies, isolates are the gold standard, but there is variability with cannabis due the to the different cannabinoids, plant strains, the terpenes and the flavonoids and this means we have to do more work to understand this entourage; the genetics.”

Speaking on day one of the the conference in a debate on ‘Cannabis-Based Medicines’ she said it would initially be difficult to bridge the gap left by a lack of research, due to the prohibition of cannabis over the last 60 years. And she added: “We are just the beginning to learn and to connect with regulators, the health authorities and this will allow us to make the right cannabis medicines available to the public.”

standardized cannabis medication

Creating consistent medications is a challenge in the cannabis industry

Dianna Gutierrez, of Spanish firm Linneo Health, agreed there was much research to be done. She said the company was looking at selecting different cannabis molecules and products to target different diseases. She added: “We have to change way we produce, grow and manufacture a medicine and we need the money; huge investment from funds to get the quality of drug we require.”

Aras Azadian, of Canadian company Avicanna, said physicians like to have straight-forward medicines they can rely on, and this is a challenge the cannabis industry can rise to.

“They depend on one or two, high-standard products. When prescribing it’s a case of taking it in stages – crawl, walk, run – but patients may see things differently and want different strains and flowers, for example. Patients have become accustomed to having the same level of consistency in their medicines, but the variability of the cannabis plant makes this difficult to achieve.

“Cannabis medicine needs to have the highest standards; Quality assurance, and standardization of cannabis medicine is necessary, achievable, and the responsibility of the people in this room.”

In a separate panel discussion on day two of the conference Prof Mike Barnes, chairman of the U.K. Medical Cannabis Clinicians’ Society argued that attempts to patent elements of the cannabis plant – something U.K. firm GW Pharmaceuticals has successfully achieved – is bad news for patients, as it increases the price of the drugs. He went on to say these patents should be challenged, when granted. 

However, Dean Billington of Brains Bioceuticals argued that the patenting route to market for a drug – including cannabis drugs – is necessary to fund the research. 

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New Jersey Increases Medical Marijuana Supply Limits, Eligible Ailments

New Jersey expanded its medical marijuana program, including increasing the number of illnesses eligible for cannabis use, under a broad new law signed by the governor July 2, 2019.

Democratic Gov. Phil Murphy signed the Jake Honig Compassionate Use Medical Cannabis Act at a tavern in Freehold known for holding charitable fundraisers. He was with the parents and sister of the bill’s namesake.

The law is named after a 7-year-old who died in early 2018 after battling brain cancer. His parents, Mike and Janet Honig, have fought for easier access to cannabis to ease pain during illnesses.

Processing supervisor Paige Dellafave-DeRosa, sorts buds at Compassionate Care Foundation, a medical marijuana dispensary in Egg Harbor Township, New Jersey on March 22, 2019. Democratic Gov. Phil Murphy signed a bill July 2, 2019, that raises the amount of marijuana dispensaries can distribute to patients, expands the qualifying medical conditions eligible for marijuana, and permits home deliveries. (Associated Press file photo/Julio Cortez)

The measure makes a number of changes. It increases the limit that can be dispensed from 2 ounces to 3 ounces, or from 57 to 85 grams, or 18 months after the law goes into effect, with a commission that the measure establishes setting the limit afterward.

It boosts a patient’s supply from 90 days to one year and allows for home delivery to patients.

The law lowers the threshold from debilitating illnesses to qualifying illnesses in order to make it easier for health-care practitioners to prescribe the drug. The illnesses include seizure disorder, intractable skeletal muscular spasticity, post-traumatic stress disorder (PTSD), glaucoma, cancer, as well as chronic pain and opioid use disorder. Other illnesses could be added as well.

It permits physician assistants and advanced practice nurses to authorize medical cannabis. Previously, only doctors could prescribe it.

The law also sets up three new categories of licenses, including cultivators, manufacturers, and dispensaries. Currently, only a single permit allows alternative treatment centers (ATCs) that cover all three categories.

Compassionate Care Foundation employee Heather Randazzo trims leaves at the Egg Harbor Township, New Jersey, medical marijuana dispensary. The bill Democratic Gov. Phil Murphy signed July 2, 2019, also creates new licensing categories for cannabis producers and doubles the number of alternative treatment centers (ATCs), which encompass cultivation, manufacturing, and retail, from six to 12. (Associated Press file photo/Julio Cortez)

The law calls for expanding the number of cultivators to 28. Currently, the state is in the process of increasing the number of ATCs from six to 12.

The measure also sets up a five-member commission to regulate cannabis, taking oversight of the program from the Health Department, and phases out the 6.625% sales tax over three years.

Before Murphy signed the legislation, Mike Honig told an emotional story about Jake enjoying waffle fries and a milkshake while on medical cannabis. Mike Honig said the morphine and opioids doctors had described had terrible side effects for Jake, including taking away his appetite and making him high. Medical cannabis, instead, helped his son feel like himself.

“Medical cannabis allowed Jake’s personality to shine through cancer,” Mike Honig said.

Murphy and the Democratic-led Legislature turned their attention to expanding medical marijuana after lawmakers failed in March to pass legalized adult-use cannabis.

New Jersey’s program began roughly a decade ago under Democratic Gov. Jon Corzine. 

Republican Gov. Chris Christie, an ardent marijuana opponent, implemented the program slowly over his two terms.

The program currently has more than 49,000 patients, up from about 15,000 when Christie left office in early 2018.

Thirty-four states and Washington, D.C., have medical marijuana programs.

Feature image: New Jersey Gov. Phil Murphy signed a law that expands the types of medical professional who can prescribe a now-larger amount of medical marijuana for a larger list of qualifying conditions.

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New Jersey Medical Marijuana Expansion Awaits Governor’s Approval

Nearly 50,000 patients obtain marijuana through New Jersey’s regulated medical cannabis system, a number that continues to grow steadily, straining a delivery system that cannot keep pace with demand, according to government reports.

Only six dispensaries currently serve a state with nearly 9 million people; six more are moving through the approval process. New Jersey lawmakers recently sent a bill to Democratic Gov. Phil Murphy that could speed the expansion of facilities, although not as quickly as Murphy wanted.

At a June 21, 2019, conference on the state of marijuana in Somerset, New Jersey, by the member-supported news organization NJ Spotlight, the new bill dominated the morning conference on medical cannabis.

“We do have news. Yesterday afternoon, the state Legislature approved a new medical marijuana bill,” said Lee Keough, the editor-in-chief of NJ Spotlight and moderator of the discussion. “It’s an expansion of the program. We do expect the governor to sign it, because he did negotiate it with the Legislature before they voted on it.”

Lee Keough, editor in chief of news organization NJ Spotlight, moderates a conference on marijuana in New Jersey. (Photo by Bill Barlow)

Leadership in the Democratic-majority Assembly delayed a vote to get more input from Murphy, hoping to avoid a veto. AB 20 and matching legislation in the Senate include provisions for more edible cannabis products and increasing the maximum amount that can be purchased. The Assembly bill passed 66-5, and in the Senate 31-5. 

Known as the Jake Honig Compassionate Use Medical Cannabis Act, the legislation was named for a young patient who had been diagnosed in 2012 with a rare form of cancer, Ewing sarcoma. 

Murphy had sought a more dramatic expansion of medical marijuana distribution licenses in the state, suggesting bringing the total number to more than 100. As approved, the bill would allow 28 new facilities statewide and make it easier for small operations to get started in the booming new industry.

Marijuana policy has been a priority for Murphy’s administration. The Somerset conference also included discussion of New Jersey’s move to allow adult use, which many expect to go to a referendum vote in November 2020. Advocates continue to push for action in the state Legislature.

At a later panel on legislation, Kelli Hykes, the Government Relations Director for Weedmaps, told participants that a ballot initiative would amend the state’s Constitution, which requires a much slower process to amend or change. She said she believes it is possible to move the legalization bill in 2019, if enough supporters and constituents reach out to their representatives. 

Hykes said that legalization should come through the Legislature, where policy and regulation details can be addressed with more specificity. In a referendum vote, the language is typically simple and lacking in details necessary to launch a new industry. 

Legalization should come through the Legislature, where policy and regulation details can be addressed with more specificity. In a referendum vote, the language is typically simple and lacking in details necessary to launch a new industry. 

The conference addressed medical marijuana first, however. Panelists included Jeff Brown, the assistant commissioner for the medical marijuana program under the New Jersey Department of Health. He said he had to be careful about commenting on pending legislation and gave no opinion on whether Murphy was likely to sign it.

Regarding changes to New Jersey’s medical cannabis program that are represented in the bill, Brown was more forthcoming. He said the bill could dramatically increase the number of health professionals who could recommend medical cannabis for a variety of qualifying conditions. It also aims to improve the number of dispensaries, which in New Jersey are known as Alternative Treatment Centers (ATCs).

“We still only have six dispensaries open. There are six more in the pipeline. I’m working feverishly to get those open,” Brown said, noting that the state adds about 3,000 new patients to its medical marijuana system each month. “We’re only poised to continue to grow the market and to continue to improve conditions for patients and caregivers.”

Jeff Brown, the assistant commissioner for the medical marijuana program under the New Jersey Department of Health, addresses a conference on marijuana regulations and licensing in New Jersey, where only six dispensaries serve 9 million residents. (Photo by Bill Barlow)

Currently, for the six existing ATCs, and the six more on the way, each license holder must handle each step in the production process, from growing the plant, to producing the flower or other product, to selling to the patients. As approved, the bill would change that vertically integrated system, allowing licenses to specialize in growing, production, or distribution.

The proposed change also will allow smaller operations to enter the marketplace, Brown said.

 “A lot will be left up to the commission,” he said. The bill also would shift oversight of the state’s marijuana licenses from the state Department of Health to a new state marijuana commission. 

If New Jersey legislators take action in Trenton, the capital, or voters say yes to adult-use marijuana as expected, the new five-member commission also would oversee the adult-use market.

“If there was an agency transfer in the future related to the medicinal marijuana program, I think the No. 1 priority, above and beyond all else, would be to ensure that there’s no disruption for the patients,” Brown said. “The other stuff can fall into place around that.”

As Keogh described it, state officials modeled the system after the Casino Control Commission, which was created to oversee gambling in Atlantic City.

Other expected changes include an increase in the maximum amount a patient can purchase, increasing from 2 ounces to 3 ounces, or 57 to 85 grams, and phasing out the 6% sales tax imposed on medical marijuana sales by former Republican Gov. Chris Christie, an opponent of medical marijuana. For patients with terminal illnesses, the purchase limit would be removed entirely.

The bill reduces the number of required visits to the recommending doctor to remain in the medical marijuana program. Under current law, patients must return every 90 days, and must see the recommending physician four times before getting a medical marijuana card.

“The biggest complaint about the existing program are doctors’ visits,” Brown said. “It would be ridiculous if I went to my physician and he or she said you have high blood pressure. Oh, by the way, you have to come see me three more times before I can prescribe you any medicine.”

Cost is another sore point for patients, Brown said. Currently, patients pay from $350 to $500 an ounce in New Jersey. He does not expect the prices to drop to the level of California or Oregon but said he believes progress is possible.

“In New Jersey, it’s incredibly high priced. If you think about it, it’s simple economics here. There’s only six providers. There’s not much incentive or price competition,” Brown said. “The No. 1 method [to lower prices] is increasing supply.”

Feature image: Panelists at a conference organized by news organization NJ Spotlight discuss a bill to expand access to medical marijuana that awaits signature by New Jersey Gov. Phil Murphy. (Photo by Bill Barlow)

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New Law Allows Sales of Medical and Adult-Use Marijuana in Maine

Maine Gov. Janet Mills signed a bill June 27, 2019, setting up a legal framework for the sale of recreational marijuana to adults as early as next year.

Her office said that the state’s Office of Marijuana Policy plans to accept applications for licenses by the end of 2019. The Democratic governor said her administration has worked quickly to implement the voter-approved law since she took office earlier in 2019.

The state’s voters chose to legalize both the use and sale of recreational marijuana among adults in November 2016, but months of delays and political squabbles have slowed the implementation of a commercial industry. 

State officials say retail adult-use marijuana could arrive in stores as soon as early 2020. 

Medical marijuana was already legal in Maine, and under the 2016 law, adults over 21 can possess up to 2.5 ounces (70.9 grams) of marijuana without penalty.

The new law becomes effective in September 2019. At that point, the Office of Marijuana Policy has 60 days to finalize regulations. Then, the state must start accepting applications within 30 days.

In the meantime, Mills’ administration is working on a public health and safety education campaign, and figuring out how the state will track, trace and license marijuana.

“We have drafted these rules with a view toward keeping the public’s health and safety at the forefront,” said Office of Marijuana Policy Director Erik Gundersen.

The new framework makes several changes to state law ahead of sales.

Municipalities could opt in or out of allowing marijuana sales. Only a handful of cities and towns have laid the groundwork for retail sales.

Currently, state law defines poisonous or harmful substances as “adulterated.” The new law says Maine would not consider edibles produced with recreational marijuana adulterated.

Under the new law, Maine residents who have lived in the state for at least four years would have to claim at least 51% ownership of a cannabis company to qualify for a license. The state would also authorize the department to impose an administrative hold on a licensee.

Marijuana is legal for adult use in 10 states and the District of Columbia, though some, like Maine, have yet to set up commercial sales. 

— Marina Villeneuve

Feature image: Democratic Maine Gov. Janet Mills signed a bill June 27, 2019 setting up a legal framework for the sale of adult-use marijuana that could arrive in stores as early as 2020. (AP Photo/Robert F. Bukaty, File)

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Cannabis is medicine — don’t make it taste good

Most of the clinical fiascos I’ve seen and heard about associated with cannabis consumption have involved the use of cannabis edibles, going back to the days when two bohemian college roommates visited Amsterdam, took two “space cakes,” waited 30 minutes, took two more, and spent the next 20 hours clinging to each other and hiding in the closet. I asked, “How was Amsterdam?” In unison, they replied, “We don’t know.”

I was surprised recently to be accused of “reefer madness” when I suggested, on Twitter, that cannabis shouldn’t be formulated into gummy bears or other succulent treats that a young child or a pet could gleefully over-consume. According to my logic, if cannabis is, or can be used as, a medicine, one should make it look and taste like a medicine. If we wouldn’t put ibuprofen into a candy, why would we put a psychoactive substance like THC into a chocolate bar? To me this is a no-brainer, but some people appear to take any limitation on their inherent right to consume medicine (or get stoned) by eating a gummy bear quite seriously.

Edibles have fueled the debate about cannabis safety

The topic of cannabis edibles is a flashpoint in the debate over how cannabis should be legalized and regulated, with arguments of personal freedom and responsibility clashing with concerns for public health. As with many things cannabis-related, the issue is highly politicized, and usually, when a new study comes out about some cannabis-related benefit or harm, such as levels of teenage usage, crime rates, medical uses, or driving statistics, there isn’t consensus on either the validity of the data or the implications of the data. It can be difficult to get a clear picture of the true benefits and dangers of cannabis.

Availability of edibles and emergency room visits

A recent study in the Annals of Internal Medicine discussed ED visits that were “deemed at least partially attributable to cannabis,” meaning that other conditions and factors could have been contributing to the admission. The study authors suggest that visits for cannabis edibles in the ED have been steadily rising in Colorado as a consequence of legalization of cannabis. Another explanation for the perceived increase in cannabis-related ED visits is that with legalization, patients are finally able to state the true reason they are in the ED without fear of getting in trouble with law enforcement or social services for using an illegal drug.

Personally, I believe the premise that ED visits are up for cannabis, in part because of the availability of edibles, and because of the many anecdotal stories I have heard through lifelong involvement with this issue. For example, an acquaintance, who is trying to be open-minded about a family member who uses medical cannabis, consumed that family member’s THC-infused medicinal chocolate bar which he found, unmarked, in the fridge, and ended up in the emergency department with a panic attack. This should never happen. By leaving a medicated but unmarked edible lying around, you put someone else’s well-being at risk. What if that person tried to drive? Then even someone else could have been harmed. The same goes for cannabis-infused barbecue sauce, pizza, honey, etc. I would suggest that these items are intrinsically too dangerous, in terms of accidental or incidental risk to others, to market and sell.

On social media, some people defend this type of risk, or the risk of exposure of a small child or a pet to some cannabis-infused treat, by saying, most commonly, “People should be responsible,” “A few irresponsible people shouldn’t ruin it for the rest of us,” or “Parents should just not leave it out around their kids.” Not to be cynical, but after practicing as a primary care doctor for 25 years, I can say with confidence: not all adults act like responsible adults. Also, even responsible adults can make mistakes. Any unmarked “spiked” consumable risks the well-being of anyone who is not aware of that fact.

Edibles are not for novice cannabis users

The main benefit of cannabis edibles is that they are long-acting — up to 12 hours — which can be helpful for chronic pain or chemotherapy patients. But the long-acting nature of edibles can also explain some of their menace: if you have consumed too high a dosage, you are stuck with it for a long time, and, if this is causing a panic attack, it can be extremely uncomfortable. It also can be difficult to gauge one’s dose correctly, as edibles can take from 30 to 200 minutes to kick in, and people often make the mistake of re-dosing too early, leading to an over-dosage and a miserable experience.

Edibles don’t always have the same effect every time

Edibles take effect more rapidly on an empty stomach, and their absorption depends on the amount of fat in your last meal. They aren’t always labeled accurately in dispensaries and, when cooked at home, the cannabis isn’t always evenly spread throughout the brownie batter. The effects of edibles are chemically different from that of smoked cannabis, because orally consumed cannabis passes more directly through the liver (versus the lungs) and the THC, which causes the high, is chemically converted to a different cannabinoid, called 11-hydroxy-THC, which has a different, and potentially stronger, psychoactive effect.

What if you’ve unknowingly consumed too much?

In clinic, with medical cannabis patients, I try to steer clear of problems with edibles altogether by advising all but the most experienced cannabis users to flat-out avoid them, and by reminding all patients to “start low and go slow.” If a medical or recreational cannabis user finds oneself in the unenviable situation of having consumed too large a dosage of a cannabis-containing edible, the best practice is to sit in a calm, quiet place, practice some mindfulness, hold the hand of a friend, drink plenty of water, try some CBD if you have it (which may antagonize the effect of the cannabis). Many people believe that consuming CBD helps negate the effects of THC, but this has not been definitively proven. Remind yourself that this will wear off, and you will be fine. This method almost always works. However, if you start to develop a full-blown panic attack, difficulty breathing, chest pain, or start having any unusual psychiatric symptoms, you must at that point consider having a friend take you to the emergency department.

If it can be used as a medicine, make it look like a pill

I believe there are a few sensible regulations that would reduce the problems caused by cannabis edibles: make them look and taste like medicine, in pill form, in pill bottles, with specific labeling that specifies exact dosages and with childproof packaging. This could go a long way toward helping us protect our pets and our kids, as well as those who find a benefit from cannabis and those around them. Sensible regulation of edibles may move us toward finding a larger patch of common ground on which to construct future cannabis policies.

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Is Coca-Cola really putting pot in its beverages?

A flurry of recent news reports would make you think so — here are a few examples:

Coke plans to brew weed drink
Coca-Cola In Talks To Make Marijuana-Infused Drink
Coca-Cola eyes cannabis market

The truth turns out to be a bit less dramatic. Here’s how the company’s statement put it:

“We have no interest in marijuana or cannabis. Along with many others in the beverage industry, we are closely watching the growth of non-psychoactive CBD as an ingredient in functional wellness beverages around the world…. No decisions have been made at this time.”

A few clarifications are in order here:

“CBD” is short for cannabidiol; it’s found in marijuana but also in hemp, and there are claims that it can provide a number of health benefits (see below).

“Non-psychoactive” means that it does not cause a person to feel intoxicated or “high.” As such, CBD is not considered to be addictive or prone to abuse; that’s why it is legal in all 50 states (though with some restrictions).

“Functional wellness beverages” are those that provide some health benefit above and beyond nutrition or hydration. Gatorade is one example, as it is ‘fortified’ with electrolytes lost during intense exercise. There are many others, such as Pom Wonderful, which describes its products as “the Antioxidant Superpower” and “the perfect fuel to get you to CrazyHealthy;” or Red Bull, which “Vitalizes Body and Mind.” It’s worth emphasizing that in the US, functional beverages do not have to prove that their health claims are true; as with conventional foods, they only have to have ingredients that are “generally recognized as safe.”

There was no mention in this statement of actually putting CBD or other marijuana-related substance in Coca-Cola.

Why would the Coca-Cola Company put CBD in its beverages?

Soda sales are down, while functional wellness beverage consumption and the respectability of CBD are on the rise; industry experts see this as a financial opportunity.

And what is CBD good for? The list of supposed health benefits of CBD is long and includes the treatment of:

  • anxiety and depression
  • insomnia
  • chronic pain
  • symptoms related to cancer and its treatment, such as nausea
  • symptoms related to neurologic disease, such as multiple sclerosis and Parkinson’s disease.

Most of these claims are considered unproven, based on preliminary evidence such as animal research, or human studies involving a very small number of people. The only approved use of CBD is for certain childhood seizure disorders (called Lennox-Gastaut syndrome and Dravet syndrome); the FDA approved the first-ever medication containing CBD for these conditions in June of 2018, and then in September the FDA reclassified CBD from Schedule I (“drugs with no currently accepted medical use and a high potential for abuse,” such as heroin) to Schedule V (drugs with a low potential for abuse)

Side effects of CBD are generally minor and include diarrhea, fatigue, and anxiety. It can also interact with medications you take, so it’s important for your doctor to know if you’re taking it.

Is pot going mainstream?

The news about the Coca-Cola Company follows recent announcements by Coors and Constellation Brands (makers of Corona beer) about developing marijuana-containing products. And a few CBD-containing beverages are already on the market.

So, it seems like this is only the beginning. In fact, the time could soon come when CBD (and, perhaps, marijuana) make it into widely available foods and beverages, including those sold in supermarkets. With the legalization of marijuana spreading like a weed (sorry, couldn’t resist!), it may be just a matter of time before it’s viewed a bit like alcohol. And that means it could soon be in the food supply. I just hope that by the time that happens, we have a better understanding of its risks and benefits.

As for CBD, you can expect claims of health benefits to multiply as it morphs from a component of an illicit drug to a financial opportunity in the growing “wellness” food and beverage industry. But I’ll still be looking for more studies confirming its safety and health benefits before I’ll buy anything containing CBD.

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Why pregnant and nursing mothers shouldn’t smoke marijuana

As more states legalize marijuana, the number of pregnant women who smoke marijuana is rising — and this could be really bad for babies.

In 2002, 2.3% of pregnant women used marijuana. In 2014, that number was up to 3.84%, a rise of two-thirds. To make matters worse, the amount of tetrahydrocannabinol (THC) in marijuana has quadrupled. THC is the active ingredient in marijuana, the chemical that gives the “high.”

We don’t know all the effects of THC on infants, but we know enough that the American Academy of Pediatrics (AAP) has issued a statement warning parents.

THC can pass easily through the placenta and into the bloodstream of a developing baby. Studies suggest that when it does, it can affect the brain. Because babies are still developing, anything that affects that development can lead to permanent changes. THC can affect something called executive function. These are skills such as concentration, attention, impulse control, and problem solving; they are crucial skills for learning and life success. Studies also suggest that children who have prenatal exposure to marijuana may have a higher risk of substance use disorder or mental illness.

THC also passes into breast milk. That means that it’s still not okay to smoke marijuana after birth, because the brains of infants are actively developing — actually they are actively developing for the first three or so years of life. The effects of secondhand marijuana smoke on kids appear to last even longer, with possibly permanent effects on executive function continuing even through the teenage years.

As with alcohol, it’s impossible to say for sure what a safe amount is during pregnancy. The safest thing is not to use it at all, and to not take any form of it while breastfeeding or to smoke it around children. Some women use it to manage the nausea of pregnancy, but there are many other ways of managing nausea.

When you are pregnant and parenting, it’s no longer just about you. The choices you make could have a lifelong effect on your child — so make good choices.

Follow me on Twitter @drClaire

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Cannabidiol (CBD) — what we know and what we don’t

Cannabidiol (CBD) has been recently covered in the media, and you may have even seen it as an add-in booster to your post-workout smoothie or morning coffee. What exactly is CBD? Why is it suddenly so popular?

How is cannabidiol different from marijuana?

CBD stands for cannabidiol. It is the second most prevalent of the active ingredients of cannabis (marijuana). While CBD is an essential component of medical marijuana, it is derived directly from the hemp plant, which is a cousin of the marijuana plant. While CBD is a component of marijuana (one of hundreds), by itself it does not cause a “high.” According to a report from the World Health Organization, “In humans, CBD exhibits no effects indicative of any abuse or dependence potential…. To date, there is no evidence of public health related problems associated with the use of pure CBD.”

Is cannabidiol legal?

CBD is readily obtainable in most parts of the United States, though its exact legal status is in flux. All 50 states have laws legalizing CBD with varying degrees of restriction, and while the federal government still considers CBD in the same class as marijuana, it doesn’t habitually enforce against it. In December 2015, the FDA eased the regulatory requirements to allow researchers to conduct CBD trials. Currently, many people obtain CBD online without a medical cannabis license. The government’s position on CBD is confusing, and depends in part on whether the CBD comes from hemp or marijuana. The legality of CBD is expected to change, as there is currently bipartisan consensus in Congress to make the hemp crop legal which would, for all intents and purposes, make CBD difficult to prohibit.

The evidence for cannabidiol health benefits

CBD has been touted for a wide variety of health issues, but the strongest scientific evidence is for its effectiveness in treating some of the cruelest childhood epilepsy syndromes, such as Dravet syndrome and Lennox-Gastaut syndrome (LGS), which typically don’t respond to antiseizure medications. In numerous studies, CBD was able to reduce the number of seizures, and in some cases it was able to stop them altogether. Videos of the effects of CBD on these children and their seizures are readily available on the Internet for viewing, and they are quite striking. Recently the FDA approved the first ever cannabis-derived medicine for these conditions, Epidiolex, which contains CBD.

CBD is commonly used to address anxiety, and for patients who suffer through the misery of insomnia, studies suggest that CBD may help with both falling asleep and staying asleep.

CBD may offer an option for treating different types of chronic pain. A study from the European Journal of Pain showed, using an animal model, CBD applied on the skin could help lower pain and inflammation due to arthritis. Another study demonstrated the mechanism by which CBD inhibits inflammatory and neuropathic pain, two of the most difficult types of chronic pain to treat. More study in humans is needed in this area to substantiate the claims of CBD proponents about pain control.

Is cannabidiol safe?

Side effects of CBD include nausea, fatigue and irritability. CBD can increase the level in your blood of the blood thinner coumadin, and it can raise levels of certain other medications in your blood by the exact same mechanism that grapefruit juice does. A significant safety concern with CBD is that it is primarily marketed and sold as a supplement, not a medication. Currently, the FDA does not regulate the safety and purity of dietary supplements. So you cannot know for sure that the product you buy has active ingredients at the dose listed on the label. In addition, the product may contain other (unknown) elements. We also don’t know the most effective therapeutic dose of CBD for any particular medical condition.

The bottom line on cannabidiol

Some CBD manufacturers have come under government scrutiny for wild, indefensible claims, such that CBD is a cure-all for cancer, which it is not. We need more research but CBD may be prove to be an option for managing anxiety, insomnia, and chronic pain. Without sufficient high-quality evidence in human studies we can’t pinpoint effective doses, and because CBD is currently is mostly available as an unregulated supplement, it’s difficult to know exactly what you are getting. If you decide to try CBD, talk with your doctor — if for no other reason than to make sure it won’t affect other medications you are taking.

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