Nip It In The Bud: The Truth About the ‘Harms’ of Vaped CBD

A recent study claimed to show vaped CBD is more harmful than vaped nicotine, and while several news outlets have reported on it, they all missed numerous flaws in the methodology. As a result of numerous confounding variables, there is no way to actually show that any of the harms they found were from CBD, and not one of the many other chemicals in the oil. High Times spoke to several cannabis vaping experts in an effort to nip this story in the bud, and stop it before it can spread further. 

Seeing Through the Hazy Cloud of Vaped Variables

Rather than test a range of CBD and nicotine products, Dr. Yasmin Thanavala and her colleagues only looked at one CBD and one nicotine product, using the same Juul device to aerosolize both. The study was done on groups of ten mice, and rather than direct inhalation, the mice were in chambers filled with vapor. Things got off to a rocky start, with Table 1 showing the CBD sample used propylene glycol (PG) and vegetable glycerin (VG) and the nicotine sample used medium chain triglycerides (MCT), yet every other part of the study reported the CBD sample used MCT and the nicotine sample used PG/VG.

Source: “Not All Vaping is the Same: Differential Pulmonary Effects of Vaping Cannabidiol Versus Nicotine”

Dr. Thanavala told High Times “that is an error in Table 1,” confirming the CBD sample used MCT oil, which is banned by five legal cannabis states due to concerns over EVALI-like symptoms. Despite being “aware that ~ 5 states have banned MCT oil as a vape additive,” Dr. Thanavala and her colleagues used a CBD sample with MCT. Paradoxically, given their choice to use samples with MCT, VG, and PG, the researchers noted that “any respiratory toxic effects of vaping could potentially be exacerbated by the presence of other constituents,” like MCT, VG, PG, and terpenes.

Dr. Jeff Raber is the CEO, CVO, and a co-founder of the cannabis analytical laboratory, the Werc Shop, and is an expert on vaped cannabis and common vape additives. “VG/PG blends can be irritating to the vapor pathway,” which is one reason why they are not widely used in the cannabis industry today. Dr. Raber said “the concern with MCT is that it could stay in the lungs and lead to lipid pneumonia,” which is normally caused by “long chain fats” with over 40 carbons in their chain, cautioning “we don’t know the ‘magic number’ on what is safe to inhale.” Dr. Raber is an advocate for using alternatives that are “naturally in the plant” like terpenes or cannabinoids, and thinks terpenes are a great alternative to PG, VG, or MCT.

Dr. Peter Grinspoon is a primary care doctor, cannabis specialist at Harvard Medical School, and author of the upcoming book Seeing Through the Smoke. Dr. Grinspoon echoed some of Dr. Raber’s concerns, “I can’t see the rationale for dissolving them in different solvents, as the solvents themselves could be responsible for some of the findings.” Dale Gieringer Ph.D. is the Director of Cal NORML and a vaporizer research pioneer, who told High Times, “It’s impossible to draw meaningful conclusions about vaped CBD from this study.”

The next thing you see in Table 1 is there are a dozen terpenes in the CBD sample and seven terpenes in the nicotine sample, which all are “confounding variables,” in other words, potential sources for the supposed harm of CBD which were not controlled for by their study. When asked about their attempts to limit the myriad of confounding variables, Dr. Thanavala said, “Our goal was to test commercial pods the way a user would.” 

“That’s a fair point to test the pods consumers buy,” said Dr. Raber “but they did not clearly delineate that the CBD was the culprit.” Dr. Raber then fired off some questions for the researchers: “How pure was the CBD? Could it be the combination of that formula with that hardware? How consistent was the hardware made? How was it stored? Did they use a new battery or an old one?” Dr. Raber noted the “time and cost limitation to studies” but would have preferred to see “2-3 different CBD and tobacco samples tested to see if they all behaved the same way.” 

When pressed about the variables clouding their data, Dr. Thanavala told High Times, “Our goal was not to dissect out the effects of the individual components.” As that was their goal, one major question remains: Why did they “dissect out” the CBD and blame all the reported harms on it? If they truly wanted their study to demonstrate real-world harms of consumer-available products, they should have reported on that, rather than singling out CBD, which their study was not constructed to control for. 

Designing a Better Study

Dr. Raber had an easy solution to control for the numerous confounding variables,“they could have gotten rid of concerns by just filling the cartridges themselves.” That would allow them to test terpene and solvent free samples, limiting confounding variables significantly. As a result, Dr. Raber was “disappointed” and felt they didn’t run “the right blanks and controls.” He also brought up a meta level issue of risks vs. rewards. Any potential harms need to be weighed against the potential benefits in what Dr. Raber called a “medicinal cost benefit risk analysis.” Considering the benefits of cannabis will be one way to improve a follow up study.

Another confounding variable they did not properly control for was the temperature samples were heated to. When asked if they knew how hot their samples got, Dr. Thanavala pointed to their supplemental section, which only had information on the room temperature, not device temperature. A 2021 study found that some “vape pens” heated to temperatures far above the point of combustion (450 °F, 232 °C), in worst cases as high as 633 °F/334 °C when containing liquids or 1000 °C when dry heating the coils. “Temperature is a key parameter but very hard to determine,” said Dr. Raber, because the temperature around the coil is hotter than the vapor stream. “The rate of molecular change doubles every 10 degrees celsius you go up,” said Dr. Raber, “a jump of 50 degrees can lead to a lot of changes.” The study hinted to these concerns saying, “Numerous potential degradation byproducts were detected … suggesting that both products are susceptible to high temperatures.” The CBD sample “may have been more susceptible to thermal degradation compared with nicotine product.” 

One final way to improve their methodology is to use more accurate puff topography. “At present there is no information on CBD user topography,” said Dr. Thalanavala, so their study “followed the same puffing protocols for both products.” They did note that “users of cannabis-based vaping products may use these products in a very different way than nicotine vapers.” 

Arnaud Dumas DeRauly is the CEO of the Blinc Group, and Chair of the ISO & CEN Vaping Standards Committees, and has researched cannabis user puff topography. DeRauly told High Times that this study used a puffing regime similar to Coresta Recommended Method 81, which “is totally different” than what Blinc’s research showed. In the study, “Animals were exposed … to a total of 20 puffs generated over 1 hour (1 puff every 3 min), 5 days/week.” Blinc’s research found that, while rates were different for U.S. and Canadian cannabis consumers, most needed only 20 puffs per day rather than 20 puffs per hour like the mice. Beyond puff topography, DeRauly was critical of the decision to use the Juul atomizer for both samples, and said “the Juul coil is not compatible with lipids like CBD oil.” Finally, DeRauly pointed out that one of the researchers, Maciej L Goniewicz, received funding from Pfizer and Johnson & Johnson, which the study noted was “outside of this work.”

Source: “Blinc Group and Labstat”

Mice: Nice Animals, Definitely Not Humans

As previously mentioned, this was a study done on small groups of mice, which means the results might not even be generalizable to the broader population of rodents, let alone, humans. While Dr. Thanavala said that ten mice per group is an “adequate group size,” the study’s discussion section said “larger numbers of mice could have further strengthened our study conclusions.” Dr. Raber viewed the findings as “not generalizable” and said, when it came to rodent lungs and humans, “It is a model, it is not an exact replica.” The mouse lung is not just smaller than human lungs, it “is considerably different in structure,” namely, while both mice and humans have five lobes in their right lung, “unlike the human the mouse has only a single left lung.” Research on mouse lungs also shows they lack “mast cells in the peripheral lung” and “extensive pulmonary circulation.” 

Another way this study could be improved is to actually do it on humans, which currently is very difficult due to the federal ban on cannabis research with a positive hypothesis. If a researcher sought to prove the claim that vaped CBD is more harmful than nicotine, they could be eligible for funding, but if they wanted to disprove that claim, they would not. While a lot of research is done on mice, in the words of the recently deceased Father of Cannabis Research, Raphael Mechoulam, “Mice are nice animals but they are definitely not humans.”

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Study Finds Significant Increase in Medical Cannabis Use in U.S.

With a majority of states now permitting medical cannabis treatment, a new study has found a sharp increase in its usage over the last decade.

The study, published this month in the American Journal of Preventive Medicine, found that “prevalence of US residents using cannabis for medical purposes increased significantly from 1.2% in 2013-2014 to 2.5% in 2019-2020, with an [average annual percentage] of 12.9%.”

The authors additionally noted that “many of socio-demographic and clinical subgroups showed similar significant increases in cannabis use for medical purposes.”

“In the multivariable-adjusted model, living in a state that legalized medical cannabis remained significantly associated with medical cannabis use,” the authors of the study wrote. “The study documents a continued nationwide increase in use of cannabis for diverse medical purposes between 2013 and 2020, two decades after the first state passed legalizing legislation.”

As the authors of the study noted, “Cannabis use for medical purposes is legalized across 39 states and the District of Columbia in the US.”

California became the first state to legalize the treatment back in 1996, and in the nearly three decades since, medical cannabis has been embraced in dozens more, cutting across partisan lines. 

Last year, Mississippi became the latest to legalize medical cannabis treatment when its Republican governor, Tate Reeves, signed a measure into law. 

In the last decade, more than 20 states –– and the District of Columbia –– have gone a step further and legalized recreational cannabis for adults. 

Those shifts in policy served as the backdrop of the study published this month, with the authors saying the “objective…was to evaluate temporal trends and correlates of cannabis use for medical purposes in the US.”

“Since 2013, medical cannabis use has been assessed using a dichotomous question asking whether any medical cannabis use was recommended by a doctor among those who used cannabis in the past 12 months. A modified Poisson model was used to estimate the average annual percent change (AAPC) of medical cannabis use from 2013 to 2020,” they wrote in explaining the methods used in the study. “The analyses were repeated for key socio-demographic and clinical subgroups. Data were analyzed from September to November, 2022.”

The authors said they used data “from [the] 2013-2020 National Survey on Drug Use and Health (NSDUH).”

Qualifying conditions for medical cannabis vary from state to state, but it has been known as a particularly effective treatment for patients suffering from chronic pain, for which it can serve as a safer alternative to highly addictive prescription opioids.

A new study this month out of Great Britain found a connection between medical cannabis and improvements in health-related quality of life for patients suffering from chronic illness.

The authors of that study said that their research “suggests that [cannabis-based medicinal products] are associated with an improvement in health-related quality of life in UK patients with chronic diseases,” and that it “was tolerated well by most participants, but adverse events were more common in female and cannabis-naïve patients.”

“This observational study suggests that initiating treatment with [cannabis-based medicinal products] is associated with an improvement in general [health-related quality of life], as well as sleep- and anxiety-specific symptoms up to 12 months in patients with chronic illness … Most patients tolerated the treatment well, however, the risk of [adverse events] should be considered before initiating [cannabis-based medicinal products],” the researchers wrote in their conclusions.

They added, “In particular, female and cannabis-naïve patients are at increased likelihood of experiencing adverse events. These findings may help to inform current clinical practice, but most importantly, highlights the need for further clinical trials to determine causality and generate guidelines to optimize therapy with [cannabis-based medicinal products].”

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Study: Cannabis Linked With Higher Quality of Life in Chronic Illness Patients

A new study out of Great Britain suggests that medical cannabis may lead to improvements in health-related quality of life among patients suffering from chronic illness.

The study, published in the Expert Review of Clinical Pharmacology, analyzed 2,833 patients who are enrolled in the United Kingdom Medical Cannabis Registry. (The researchers said they excluded 443 patients from an original pool of 3,546 because they failed to complete their “patient reported outcome measures,” or “PROMs.”)

They wrote that the “study suggests that [cannabis-based medicinal products] are associated with an improvement in health-related quality of life in UK patients with chronic diseases,” and that treatment “was tolerated well by most participants, but adverse events were more common in female and cannabis-naïve patients.”

“This observational study suggests that initiating treatment with [cannabis-based medicinal products] is associated with an improvement in general [health-related quality of life], as well as sleep- and anxiety-specific symptoms up to 12 months in patients with chronic illness … Most patients tolerated the treatment well, however, the risk of [adverse events] should be considered before initiating [cannabis-based medicinal products],” the researchers wrote in their conclusions.

“In particular, female and cannabis-naïve patients are at increased likelihood of experiencing adverse events. These findings may help to inform current clinical practice, but most importantly, highlights the need for further clinical trials to determine causality and generate guidelines to optimize therapy with [cannabis-based medicinal products],” they added.

Medical cannabis was legalized in the United Kingdom in 2018, but it can only be prescribed when other licensed medications have failed to produce an adequate response. 

That limitation was the impetus for the researchers to conduct the study.

“Since 2018, cannabis-based medicinal products (CBMPs) can be prescribed in the United Kingdom by specialist doctors for chronic illnesses where there has been insufficient response to licensed medications,” they wrote in the introduction of the study, which was published online earlier this month. 

“However, the National Institute for Health and Care Excellence currently only recommends CBMPs for intractable chemotherapy-induced nausea and vomiting, spasticity in adults with multiple sclerosis, and severe treatment-resistant epilepsy in Lennox-Gastaut and Dravet syndromes,” they continued. “The reason for these narrow recommendations is that current evidence is limited and of low quality.” 

Specifically, the researchers said there is “a paucity of randomized controlled trials, due to the challenges of investigating CBMPs in this setting.”

The findings mesh with another study published in January that found a growing number of patients across the United States turning to cannabis to treat their chronic pain.

That study, from researchers at the University of Michigan, found that “31.0% … of adults with chronic pain reported having ever used cannabis to manage their pain; 25.9% … reported using cannabis to manage their chronic pain in the past 12 months, and 23.2% … reported using cannabis in the past 30 days,” and that “more than half of adults who used cannabis to manage their chronic pain reported that use of cannabis led them to decrease use of prescription opioid, prescription nonopioid, and over-the-counter pain medications, and less than 1% reported that use of cannabis increased their use of these medications.”

“Most persons who used cannabis as a treatment for chronic pain reported substituting cannabis in place of other pain medications including prescription opioids. The high degree of substitution of cannabis with both opioid and nonopioid treatment emphasizes the importance of research to clarify the effectiveness and potential adverse consequences of cannabis for chronic pain,” the researchers wrote. “Our results suggest that state cannabis laws have enabled access to cannabis as an analgesic treatment despite knowledge gaps in use as a medical treatment for pain. Limitations include the possibility of sampling and self-reporting biases, although NORC AmeriSpeak uses best-practice probability-based recruitment, and changes in pain treatment from other factors (eg, forced opioid tapering).” 

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Black, Hispanic Patients More Likely To Be Tested for Perinatal Cannabis Use

According to data published in the journal Hospital Pediatrics, patients selected to undergo drug screening during the labor and delivery process for cannabis are disproportionately Hispanic or African American and were also more likely to be on subsidized health insurance plans.

The team of researchers from the American Academy of Pediatrics looked to describe the characteristics of people undergoing toxicology testing at delivery solely for the indication of cannabis use along with evaluating the rate of unexpected positive testing results among the cohort to identify additional social risk factors and clinical outcomes.

The Disproportionate Impact of Perinatal Drug Testing

The retrospective cohort study included dyads with a maternal history of cannabis use who were given peripartum toxicology testing between 2016 and 2020 at five Massachusetts birthing hospitals.

Researchers reviewed a total of 60,608 live births, of which 1,924 dyads underwent toxicology testing. Of that group, 614 (31.9%) were tested for the sole indication of cannabis use. The data revealed that significantly greater patients in the cannabis cohort were less than 25 years old, non-Hispanic Black, Hispanic or Latino and publicly insured.

Specifically, Hispanic patients were twice as likely to be mandated to undergo testing (30.5% vs. 15.5% of the birthing population) and Black patients were four times as likely (32.4% vs. 8.1%). Patients under 25 were more than five times as likely to be mandated for testing (32.4% vs. 6.1%), and those on public healthcare plans were more than twice as likely to be tested for past cannabis exposure (39.9% vs. 15.6%).

Regarding positive results, eight of the 614 dyads (1.3%) had an unexpected positive toxicology test result, including two (0.3%) who unexpectedly tested positive for opioids. Seven dyads (1.1%) also had false positive test results for unexpected substances.

Doctors also rarely took any follow up actions or made changes to the clinical management of patients after they tested positive for cannabis, as just a single test result changed clinical management: monitoring and no medication for neonatal opioid withdrawal syndrome. 

“Toxicology testing of patients for a sole indication of cannabis use, without other risk factors, may be of limited utility in elucidating other substance use and may exacerbate existing disparities in perinatal outcomes,” the study’s authors concluded.

Echoes of Previous Research

The findings are consistent with previous studies. Namely, one study released just last month published in Academic Pediatrics similarly found that younger individuals and people of color were more likely to be tested for cannabis use or maternal medical complications compared to white, non-Hispanic individuals. This study found the disproportionality ratios were greater than 1.0 for individuals under 25 years old (3.8), Hispanic individuals (1.6), non-Hispanic Black individuals (1.8) individuals of other races (1.8) and those with public insurance (Medicaid 2.6; Medicare 10.6). 

While this is one of the most recent studies investigating the topic, a number of studies from years past have found similar figures. One study published in the Journal of Women’s Health reported that Black women and their newborns were 1.5 times more likely to be tested for illicit drugs than non-Black women. 

Another published in the New England Journal of Medicine showed that, even though Black and White women had similar rates of illicit drug consumption during pregnancy, Black women were “reported [to health authorities] at approximately 10 times the rate of white women.”

Drug Use, Drug Testing and Childbirth: A Complex Issue

False positive test results of THC are generally uncommon in adults, they can be fairly prevalent among newborns. For example, a 2012 study found that commonly used soap and wash products used for newborn and infant care, like Johnson’s Head-to-Toe Baby Wash and CVS Baby Wash, often cross-react with the immunoassay test and can cause false positive results for carboxy THC. 

“[The] addition of Head-to-Toe Baby Wash to drug-free urine produced a dose dependent measurable response in the THC immunoassay,” the investigators concluded. “Addition of other commercially available baby soaps gave similar results, and subsequent testing identified specific chemical surfactants that reacted with the THC immunoassay. … Given these consequences, it is important for laboratories and providers to be aware of this potential source for false positive screening results and to consider confirmation before initiating interventions.”

Even though the Hospital Pediatrics study had few follow up actions after positive testing, that’s not always the case. Another study from 2018 notes the importance of considering a number of technical, medical, ethical, legal and social issues when screening pregnant people for drug use. 

Specifically, it cites that birthing people “can and have been arrested for positive drug screens with even preliminary results used to remove children from custody, before rigorous confirmatory testing is completed. Balancing the scientific, medical, public health, legal, and ethical aspects of screening tests for drugs in pregnancy is critical for helping to address this crisis at all levels.”

The study concludes that the medical field largely lacks a good understanding of the pharmacokinetics of drugs in pregnancy. While there is a clear need for testing, authors note that there is a lack of pharmacological knowledge, compounded by a “general misunderstanding of addiction and substance use/misuse within the medical profession” that is further complicated when working with pregnant people and their children. 

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Study: Those with History of Cannabis Use Had Shorter Hospital Stays After Joint Surgery

Patients undergoing certain major operations may be in line for a shorter length of recovery – if they have a history of cannabis use. 

That is according to a new study published last month in the journal Arthroplasty. The research centered on patients who have undergone total joint arthroplasty (TJA), or an operation where the individual has their hip or knee replaced.

According to the authors of the study, patients with a history of  “cannabis use disorder,” or “CUD,” “had significantly shorter length of stay (LOS) and higher rates of home discharge following primary TJA compared to the control group.”

As the authors pointed out, the shifting laws and attitudes in the United States toward cannabis use has forced a reckoning for the medical community in how they manage treatment for their patients. The growing “legalization and decriminalization of cannabis across the United States has been associated with a considerable rise in self-reported cannabis use amongst surgical patients, including those undergoing total joint arthroplasty,” they wrote. Although “cannabis is primarily used for recreational purposes,” they said, “cannabinoid metabolites have shown analgesic and anti-inflammatory properties and have thus been proposed as an alternative to opioids in the management of acute and chronic pain.” 

And while “cannabis use may conceivably be beneficial in the postoperative setting, cannabis use disorder (CUD), defined in part as a problematic pattern of cannabis use leading to clinically significant impairment or distress, has been correlated with increased postoperative pain and opioid use following orthopedic surgical procedures.” 

“Progressive legalization of cannabis use makes it increasingly important for clinicians to understand the characteristics of this evolving patient population. As this growing population continues to evolve, understanding their comorbidities, behavioral characteristics, and postoperative clinical and economic outcomes allow orthopedic surgeons and the multidisciplinary healthcare teams to better tailor their care and management of these patients,” the authors wrote. 

Taken together, the authors said that means that subsequent research “should aim to more closely and comparatively assess the demographic profile of patients with both recreational use and substance use disorder, along with potential barriers in their access to medical care.” 

“This understanding should be associated with the expansion and improvement of public health initiatives and the development of frameworks to better deliver substance use screenings and interventions to this patient population. Such initiatives, combined with the development of standardized perioperative protocols, have the potential to optimize postsurgical and overall health outcomes in this at-risk patient population,” the authors wrote. 

The authors did, however, offer up some caveats, noting that the “study is limited for several reasons.”

For example, they pointed out that patients with cannabis use disorder “would be incentivized to leave the hospital as soon as possible and return home to continue use of cannabis and potentially other substances.”

“Because such use may be associated with problematic behavioral changes and abandonment of social, occupational, or recreational activities, these patients may be at risk for worse postoperative and overall health outcomes in the postoperative, post-discharge period. In contrast, the preoperative and in-hospital period, during which a multidisciplinary team has full access to care for these patients, can thus serve as an opportune time for comprehensive social and medical intervention. As such, orthopedic surgeons and the multidisciplinary medical and social service team should remain aware of the risks these patients face, and perioperative interventions should be considered to optimize both long-term outcomes and general health improvement in these patients,” they wrote.

As NORML noted, other “studies have reported contrary findings, including a paper recently published in The Lancet which determined that patients diagnosed [with] cannabis use disorder more often required advanced post-procedural health care than did those with no recent history of use.”

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Analysis: Legal Cannabis Associated with Less Alcohol-Related Pedestrian Fatalities

Younger generations are also beginning to veer away from alcohol in favor of cannabis and psilocybin, and new research shows that state-level cannabis legalization laws may be even more influential regarding alcohol use and its associated risks.

According to a new study published in the journal International Association of Traffic and Safety Sciences Research, the adoption of legal cannabis laws on a state level is associated with reductions in the number of alcohol-related fatalities involving pedestrians.

The study was conducted by two Florida Polytechnic University researchers, who examined the relationship between cannabis legalization and frequency of pedestrian-involved fatal crashes between 1985 and 2019. The study used data from all 50 states and Washington, D.C. from the Fatality Analysis Reporting System, maintained by the National Highway Traffic Safety Administration.

Cannabis Legalization and Pedestrian Fatalities: An Ongoing Question

The authors point to the potential benefits of cannabis law liberalization beyond its therapeutic potential. They reference the growing literature showing an association between medical cannabis laws and decreased traffic fatalities, citing the evidence that the decline was due to substituting cannabis for alcohol. 

Moreover, they reference the mixed evidence as to whether alcohol and cannabis are substitutes or complements in consumption, with some states seeing an increase in alcohol use after legalizing cannabis and others the opposite.

The analysis of overall pedestrian fatalities, those involving alcohol and legal cannabis laws revealed a number of findings. Similar to previous research, the study found that medical cannabis laws were followed by a statistically significant reduction in overall fatalities and in daytime fatalities involving alcohol; nighttime fatalities involving alcohol also saw a decline, though it was not statistically significant.

Following recreational cannabis laws, the study similarly found a statistically significant decline in alcohol-related daytime fatalities and a decline in nighttime alcohol-related fatalities that was not statistically significant. There were no apparent changes in daytime or nighttime non-alcohol-related fatalities related to either medical or recreational cannabis laws.

Affirming the Alcohol Substitution Hypothesis

Researchers referenced the expectation that recreational cannabis laws might have larger impacts than medical cannabis laws, though they suggest that a state’s permissiveness toward cannabis use is generally well-captured by the presence of medical cannabis laws, resulting in fewer differences between states with medical cannabis laws only and both medical and recreational cannabis laws.

The study notes that this can be a complex topic, given the lack of available data on recreational cannabis laws. It’s further compounded by different histories, policies and norms state-by-state, even if they all share a common thread of legal adult-use cannabis. They admit that recreational cannabis laws could even be shown to lead to more pedestrian fatalities “under some sets of circumstances.”

“As of 2019, we find liberalization has been associated with lower pedestrian fatalities, not higher. Further, the pattern is consistent with the alcohol substitution hypothesis,” the researchers conclude. “Specifically, the induced decline in alcohol related fatalities following liberalization is large enough to more than compensate for any additional fatalities due to marijuana consumption.”

Other Reasons For U.S. Increase in Pedestrian Fatalities

The authors also point out that, while state-level cannabis laws were associated with lower pedestrian fatalities, pedestrian fatality rates in the U.S. as a whole began to rise in 2009. They similarly pointed out that the data did, in fact, coincide with cannabis liberalization in the U.S., though a 2018 study similarly examining the increase of pedestrian fatalities over a 10-year period didn’t explicitly blame cannabis or high drivers.

In fact, the report highlighted that the use of cell phones could be a possible cause for the country-wide increase, referencing a 236% increase in active smartphone use from 2010 to 2016. In tandem, the number of cell phone-related emergency department visits increased during this period.

The report also noted that a number of other factors can impact the number of pedestrian collisions and deaths. Specifically, lower fuel prices, good weather and better economic conditions can all translate into more miles driven and walked.

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Patients Turn to Cannabis for Tinnitus Relief, Study Finds

Patients with tinnitus commonly seek symptom relief via cannabis use, according to new research.

The study, published last month in the Journal of Otolaryngology – Head & Neck Surgery, is being called the first “to assess perspectives and usage patterns of cannabis in patients experiencing tinnitus.”

The findings, based on interviews with 45 individuals suffering from tinnitus, showed “that 42% (19/45) of patients had never used cannabis, 36% (16/45) previously used cannabis at some point in the past, and 22% (10/45) reported current cannabis use at the time of questionnaire completion.”

“Of the 10 patients currently using cannabis, 80% (8/10) reported that it helps with tinnitus-related symptoms. Patients reported that it helped with dizziness/unsteadiness/disequilibrium (3/8, 38%), auditory symptoms (3/8, 38%), emotional difficulties (anxiety, depression, feeling upset, fear) (6/8, 75%), pain (headache, neck pain/aches) (7/8, 88%), sleep disturbances (7/8, 88%), and functional difficulties (concentration, fatigue, work disturbances) (4/8, 50%),” the study said.

“Overall, 96% (43/45) of patients responded that they would consider cannabis as a treatment for their tinnitus. Patients also considered cannabis as a viable treatment for their tinnitus-related symptoms,” it continued.

Here is more on the findings:

“Patients considered cannabis use for auditory symptoms (91%), and symptoms related to their tinnitus, such as emotional complaints (60%), sleep disturbances (64%), and functional disturbances (56%). 36% of patients had previously used cannabis and 22% of patients reported cannabis use at the time of the study. 80% of patients that were actively using cannabis reported that it helped with tinnitus-related symptoms, such as dizziness, anxiety, bodily pain, and sleep disturbances. Most patients would prefer to use edibles (62%), tablet (58%) and cream (47%) formulations of cannabis. Patients were concerned about the cost (29%), potential physical health implications (53%) and psychosocial side effects (60%) of cannabis. Over half of patients learned about cannabis from a friend or family member and only 22% of patients learned about cannabis from a physician or nurse.”

The authors of the study believe that the findings could serve as the groundwork for more research, and perhaps even clinical trials that assess the effectiveness of cannabis for tinnitus treatment.

“The results of this study demonstrate an active interest amongst patients with tinnitus to consider cannabis as a potential adjunctive treatment for symptom management. Moreover, cannabis use is both common and can be beneficial in this patient population. An understanding of patient attitudes towards cannabis use is a prerequisite to exploring its potential use in clinical practice,” they wrote in their conclusion.

“Cannabis use is common amongst patients with tinnitus and most participants would consider cannabis as a treatment option to manage their symptoms. Almost all patients were interested in learning more about cannabis if proven to help with symptoms of tinnitus, but physicians must be aware that most patients receive their information on cannabis from non-medical sources. This data may lay the groundwork for future research and clinical trials on cannabis use for tinnitus alleviation. Otolaryngologists can develop an understanding of patient attitudes and usage patterns to guide patient counseling on the use of cannabis for symptoms associated with tinnitus,” they added.

Those who suffer from this are often vexed by the lack of an effective treatment.

The authors noted that “antiepileptic drugs, such as lamotrigine and gabapentin, have been studied as pharmacological treatment for tinnitus, given their inhibitory effect in the central nervous system,” but “there is insufficient evidence to support the use of antiepileptic drugs for tinnitus and it has not shown to be beneficial compared to placebo.”

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Study: Personal Psychedelic Use Common Among Therapists

Therapists who administer psychedelic treatments to patients apparently like to use psychedelics themselves.

That is the chief takeaway of a new study published in the journal Psychedelic Medicine, revealing that “Personal experience with psychedelics was notably common in this sample of psychedelic therapists.”

The findings, the authors of the study noted, are “the first to delineate the personal use of psychedelics among professionals and can inform a pressing debate for the field.”

That psychedelic therapists use psychedelics might seem like a “dog bites man” caliber headline, but as the authors noted, an “emerging controversy in psychedelic therapy regards the appropriateness or necessity of psychedelic therapists having personal experience using psychedelics themselves.”

“Although there are a number of potential advantages and disadvantages to personal use among psychedelic therapists, no studies to date have measured their use or other aspects of their training,” they wrote. 

For the study, the researchers said that they “broadly review[ed] the literature on experiential learning in psychotherapy and psychiatry as well as the history of personal use of psychedelics by professionals,” and then reported “on the results of a survey that was sent to all 145 therapists associated with Usona Institute’s Phase II clinical trial of psilocybin for major depressive disorder.”

They said that 32 of those individuals participated in the survey, representing a 22% response rate. 

In their conclusion, the authors said that “study was limited by a low response rate and a lack of diversity among participants,” as “the majority of psychedelic therapists identified as white, female, and having doctoral degrees.” 

The authors also noted that six individuals “did not fully complete the survey and were removed from all analyses,” and that “all six of these participants stopped the survey when prompted to answer questions regarding their personal substance use.”

“Future research is needed to address these limitations as well as to identify whether personal experience with psychedelics contributes to therapists’ competency or introduces bias to the field,” they wrote. 

“One interpretation of the low response rate is that only a small proportion of the practitioners working as psychedelic facilitators felt comfortable answering questions—anonymously and confidentially—about their personal experiences with psychedelic substances, but other explanations such as the lack of compensation for participating in the study may also be relevant,” the authors added.

Still, the findings are significant, particularly as psychedelic therapy continues to become more prevalent. 

“This sample of psychedelic therapists had considerable experience using classic psychedelic drugs and related hallucinogens themselves, with 28 of 32 (88%) endorsing use of a classic psychedelic and all but 1 participant trying at least one hallucinogen-related substance. This figure differs from the general population lifetime rate of psychedelic use, which tends to be around 10–15%; although several recent studies have indicated that usage seems to be increasing. Only one of four individuals without previous classic psychedelic experience had previous psychedelic training, making these individuals unique and relatively psychedelic-naive candidates to provide the treatment. Given their paucity of experience in the field, these individuals may represent interesting case studies in understanding the role of experiential learning with psychedelics,” the authors wrote.

They continued: “In terms of intentions, personal development and spiritual growth were the most common reasons reported for substance use, particularly with the classic psychedelics. However, most participants also reported intentions related to having fun and curiosity … Although the role of intentions has often been noted as being critical to the acute experience and subsequent outcomes among psychedelic users … there has been limited research prospectively testing the relationship between intentions and drug effects. Nonetheless, our results add to a growing body of literature suggesting a distinct set of intentions among psychedelic users.”

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CBD Could Inhibit Nicotine Metabolism, According to New Study

A recent study conducted by Washington State University (WSU) examined how CBD could potentially help curb cigarette smoking. It was originally published in the journal Chemical Research in Toxicology on Jan. 10, but the university shared a press release about its findings on Feb. 16.

The study, called “Inhibition of Nicotine Metabolism by Cannabidiol (CBD) and 7-Hydroxycannabidiol (7-OH-CBD),” used human liver tissue and cell samples, and found that CBD “inhibited a key enzyme for nicotine metabolism.” Slowing metabolism of nicotine’s key enzyme could help smokers wait before they need to inhale more, according to an WSU press release.

“The whole mission is to decrease harm from smoking, which is not from the nicotine per se, but all the carcinogens and other chemicals that are in tobacco smoke,” said Philip Lazarus, Senior Author and WSU Professor of Pharmaceutical Sciences. “If we can minimize that harm, it would be a great thing for human health.”

The study found that CBD slowed many nicotine enzymes, including the enzyme CYP2A6 which metabolizes more than 70% of nicotine in smokers. The researchers found that CBD inhibited the activity of CYP2A6 by 50%. “In other words, it appears that you don’t need much CBD to see the effect,” Lazarus said.

Lazarus and his team are currently working on a clinical study to learn more about how CBD can affect nicotine in smokers by measuring a participant’s nicotine levels in their blood between a six-to-eight-hour period. Eventually, the team hopes to expand their research efforts to examine CBD and nicotine addiction on a larger scale as well. The most recent study was conducted with the help of a grant from the National Institute of Health.

In August 2021, researchers at Mydecine Innovations Group signed a five-year research agreement with Johns Hopkins University to analyze how psychedelic formulations could help smokers overcome smoking addiction.

However, many cigarette smokers are just moving to cannabis consumption instead. The annual Gallup Consumption Survey published in August last year found that only 11% of Americans identified as cigarette smokers, and 16% identified as cannabis consumers. The percentage of cigarette smokers is at it’s lowest percentage yet since Gallup began asking the questions in the 1940s. In 1947, when asked if participants have smoked cigarettes in the past week, 41% said yes. In 1949 the percentage rose to 44%, and reached a height of 45% in 1954.

“Smoking cigarettes is clearly on the decline and is most likely to become even more of a rarity in the years ahead,” said Gallup Author Frank Newport about the newest results. “This reflects both public awareness of its negative effects and continuing government efforts at all levels to curtail its use. Smoking remains legal in general but is prohibited in many public places, offices, modes of transportation and in private places across the U.S. Each pack of cigarettes carries draconian warning messages about their harmful effects.”

An Australia-based study found similar results with residents preferring cannabis to smoking tobacco. The Australian Institute of Health and Welfare analyzed data from 2019 in its newest analysis, and found that 20% of respondents support regular cannabis use, and only 15% support tobacco use.

Legislators in some states such as California are introducing bills to ban tobacco completely. Assembly Bill 935, which was recently introduced by Assemblymembers Damon Connolly and Evan Low, would ban tobacco products for anyone born after Jan. 1, 2007. “Preventing the next generation of Californians from becoming addicted to smoking should be a priority for anyone who cares about public health and the well-being of our children,” Connolly said.

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Growing Number of Canadian Weed Consumers Source Products Legally

According to a study published in the Harm Reduction Journal, a growing number of Canadian consumers have transitioned to the legal cannabis market over the country’s first three years of cannabis legalization, with legal sourcing highest for drinks and oils and lowest for solid concentrates and hash.

One goal of the Canadian Cannabis Act was transitioning customers to the legal market, essential to ensure other aims of protecting public health as regulations initiated product standards, labeling, and age-verification checks. 

Investigators from the University of Waterloo School of Public Health surveyed more than 15,000 Canadian cannabis consumers about where they obtain their products, evaluating data from years 2019 to 2021. The data covers the majority of Canada’s first three years of cannabis legalization, as licensing for retail sales first began in October 2018.

According to a 2021 study published in the International Journal of Drug Policy, legal recreational products’ share of Canada’s overall cannabis consumption started at 7.8% in October 2018 and grew to 23.7% by September 2019, with a hefty variance depending on the province. During that first year, only dried flower and some cannabis oils were available for legal purchase, and other products like edibles, topicals, and extracts were made available at retail locations starting in December 2019.

“After the expansion of legal sales to include non-flower products, it is important to examine whether consumers are using the legal market to source all their edibles, topicals, and extracts, as well as dried flower,” the authors state.

Data from the International Cannabis Policy Study were collected via self-completed web-based surveys in September-October 2019, 2020, and 2021 from respondents aged 15 to 65. Respondents were asked, “Overall, about what percentage (%) of the [products] that you used in the past 12 months came from LEGAL/AUTHORIZED sources?” They were able to enter a numerical value between 0 and 100, with responses categorized into “All” (100%), “Some” (1-99%) and “None” (0%).

All products saw a year-over-year increase for respondents reporting “all” their products were sourced legally, with solid concentrates, hash, and dried flower ranking the lowest and oral oil capsules, oral oil drops, and drinks as most likely to be sourced legally. As of 2021, 54.3% of dried flower purchases were from legal retail locations.

Variables Contributing to Canadian Market Sourcing

The study also looked at consumers’ frequency of use, finding that frequent consumers had higher odds of sourcing “some” of their products from the legal market versus occasional consumers. This was counter to the researchers’ hypothesis, believing that frequent consumers would be less likely to source legally due to “poorer perceptions of legal cannabis.”

The authors cite the variance in legal sourcing depending on product, with about half of solid concentrate consumers purchasing “all” products legally to 82% of cannabis drink consumers. The high rates of legal sourcing for drinks may be because they are newer products that are less accessible in illegal markets.

They add that products typically perceived as “medical products,” like oral oils and capsules, similarly saw more consumers purchasing “all” products legally. They also point to consumers of “medical” products potentially holding a higher priority for legal products where quality is regulated, tested, and standardized to guarantee a better, more consistent dose.

Examining provincial differences, the authors cite that all provinces were more likely to source “all” their edibles legally than those in Québec, citing that it is the only province that restricts edible products that may appeal to youth, removing some of the most popular edible formats like candy and chocolate. 

Conversely, dried flower consumers in Québec were more likely to purchase “all” their dried flower legally over British Columbia and Ontario, citing Québec as boasting some of the lowest dried flower prices since legalization, potentially making it more desirable than purchasing illegal dried flower compared to other provinces. 

The Need for Further Monitoring

“Legal sourcing of cannabis was greater in 2021 than 2020 for all ten cannabis products [surveyed]. In 2021, the percentage of consumers sourcing all their products legally in the past 12 months ranged from 49 percent of solid concentrate consumers in 2021 to 82 percent of cannabis drink consumers,” investigators reported. 

Investigators pointed to the need for future studies to continue to examine cannabis product sourcing in Canada over time, along with exploring other ways to displace the illegal market for all cannabis products “without also promoting the use of high-potency cannabis products.” 

They also called for further research to examine how product consumption varies across provinces and whether these habits occur in response to price and availability from legal sources.

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