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Exactly How Cheap Will Marijuana Be In The Future?

Thu, 09/07/2017 - 09:34
Price drops are good news for consumers, not so much for producers.

As the cannabis industry continues to produce immense profits as one of the nation’s fastest growing job markets, it would stand to reason that opportunists would want in. Really, who could blame anyone who wants to work in the cannabis industry? The more, the better, right?

Well, perhaps not in the eyes of cannabis farmers. A report from the Wall Street Journal indicates that saturation within the cannabis industry has caused marijuana prices to fall within the competitive landscape. Since more states have legalized marijuana both medicinally and recreationally, weed has dropped an average from $15 a gram to $10 a gram.

From a wholesale perspective, prices have decreased as well. Following a peak in September 2015 of about $2,133 a pound, average whole sale prices across the country fell to $1,614 a pound in July, according to New Leaf Data Services LLC, which researches the U.S. cannabis market. That’s great for consumers, but not as positive for farmers.

This is why, as we’ve previously written, some cannabis farmers are turning to organic methods to differentiate themselves from the pack. Growers are using industry labels like “SunGrown Certified” and “Clean Green Certified,” as opposed to the traditional indoor practices that can soak up electricity and not conducive or beneficial to supporting the environment.

Since peaking in September 2015 at about $2,133 a pound, average U.S. wholesale cannabis prices fell to $1,614 in July, according to New Leaf. That is the sort of market decline that hit Midwestern corn and soybean growers in recent years after a string of record-breaking crops.

“The socially conscious, premium customer is going to want us because we’re sustainable,” Jeremy Moberg, an environmentally conscious grower in Washington, told WSJ. “It only takes me 30 seconds to convert somebody wearing Patagonia and driving a Prius that they should never smoke indoor weed again.

 

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Campus Cannabis: The Top 7 Stoniest Small Colleges

Wed, 09/06/2017 - 23:11
Click here for reuse options! Bob Jones University didn't make the cut.

The Princeton Review has released its annual compendium of rankings and ratings of institutions of higher learning across the land, The Best 382 Colleges 2018 Edition, and buried deep inside are student survey results that helped the Review determine which colleges and universities are the most (and least) marijuana-friendly.

In addition to a myriad of questions about academics, diversity and community, the survey asked 137,000 students "How widely is marijuana used at your school?"

Before getting to the list, a couple of caveats: First, the survey data is impressionistic—asking respondents how many other students they thought were tokers instead of asking for self-reporting, which would theoretically be more reliable. Second, the Review provides no hard numbers—just rankings—so it's impossible to know if Ithaca College is way stonier than Bard or just a bit stonier.

That said, the general outline of the pot-friendly small colleges skews heavily to the liberal arts and the Northeast, and New York state in particular, with a couple of outliers on the .legal West Coast and one on the not-so-legal Gulf Coast. Pot isn't legal in the Empire State, but it is decriminalized—and apparently pretty popular.

Here, in rank order, are the Princeton Review's stoniest small colleges:

1. Ithaca College, Ithaca, NY

Enrollment: 6,221

This is a school in a town where the mayor wants to install safe injection sites for hard drug users, and enlightened attitudes toward pot are no surprise.

2. Bard College, Avondale-on-Hudson, NY

Enrollment: 1.995

The school lives up to its reputation.

3. Eckerd College, St. Petersburg, FL

Enrollment: 1,844

Who knew?

4. Skidmore College, Saratoga Springs, NY

Enrollment: 2,680

Fun Day is more fun, and the National Comedy Festival is funnier when you're baked. This liberal arts college, a perennial high-ranker, was #1 in 2013.

5. Wesleyan University, Middletown, CT

Enrollment: 2,971

Inspiration for the '90s film PCU poking fun at campus activism, the school generates a steady stream of artists, actors, and musicians. What's inspiring them?

6. Reed College, Portland, OR

Enrollment: 1,410

Of course.

7. Pitzer College, Claremont, CA

Enrollment: 1,089

Part of the Claremont Colleges, this LA-area school is highly ranked academically, but includes intercollegiate athletics, too. Go, you fightin' Sage Hens!

 

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What We Know About Medical Marijuana’s Effect On Heart Disease

Wed, 09/06/2017 - 09:28
Research into cannabis and coronary health is its infancy, but findings so far are profound.

Almost everyone knows somebody that has been effected by heart disease—statistics show that coronary artery disease is the most fatal disease in the United States. To put this statistic into perspective, on an annual basis, one quarter of all deaths (or 600,000 yearly fatalities) in America are due to heart disorders. For the most part, individuals contract heart disorders due to unhealthy life styles and bad habits including: fatty foods, smoking, drinking, and sloth.

 

The term “heart disease” is an umbrella phrase generally used to describe symptoms related to atherosclerosis, which arises with the gradual amassing of fats on the walls of arteries and veins. Over time, with a consistently unhealthy diet and lifestyle, these fatty deposits can eventually restrict blood flow in the arteries to the point of heart attack. However, there are a few other forms of heart disease including “heart failure, arrhythmia, heart valve problems, and hypertension”. While the causes of atherosclerosis (lifestyle, etc.) can also be attributed to these other heart maladies, there are a plethora of other sources for them, including stress and genetic disorders.

As with a majority of medical applications for cannabis, legitimate scientific research into the herb’s potential as a medicine for victims of heart disease is in its infancy—but findings thus far are quite profound. For the most part, studies into the potential use of cannabis as a medicine for heart disease are related to both CBD and “abnormal cannabidiol”. For starters, studies have shown that CBD can be beneficial for heart disease victims as both a preventative and restorative medicine. Secondly, abnormal cannabidiol is potentially a “wonder drug” which can greatly help reduce the chances of heart attacks for atherosclerosis patients. Each of these fascinating compounds are worth exploring in more detail.

 

CBD has various theoretical medical applications for heart disease. To begin with, CBD “has been shown to cause blood vessels to vasodilate, improving blood flow and reducing blood pressure”. Point being, CBD can possibly be utilized as a preventative medicine for heart attacks, as it has the potential to help blood vessels restrict and move more efficiently. Doctors also feel that CBD can be used as an “anti-arrhythmic” which can reestablish normality in one’s heart beat post heart attack.

 

Abnormal cannabidiol is a synthetically derived chemical which is related, on a molecular level, to the cannabinoids found within the marijuana plant. Also, abnormal cannibidiol shares the non-psychoactive properties of CBD, meaning that it does not get users “high”. The British Journal of Pharmacology reports that the application of abnormal cannabidiol in lab rats led to “the widening of blood veins and arteries by relaxing muscles on their walls”. Point being, findings show that abnormal cannabidiol, like CBD, can help lessen the chances of heart attacks by opening up blood flow within veins and arteries that would be otherwise restricted by atherosclerosis. It goes without saying that these findings warrant far more research into the potential uses of medical marijuana in relations to heart disease.

 

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Narcos Season Three and the Lies We Tell About the Drug War

Wed, 09/06/2017 - 09:18
In popular culture the war on drugs is seen as us versus them, good versus bad, legal versus illegal. So why do our banks launder cartel drug money?

o Narcos is back for a third season, which takes us beyond the death of its hitherto protagonist Pablo Escobar into the world of his rivals, the Cali Cartel. An interesting shift is afoot if a remark from showrunner Eric Newman is anything to go by: “Unlike Escobar, who had positioned himself as an outlaw, Cali was very much a part of the system.”

Narcos season three calls the Cali Cartel “the biggest drug lords you’ve never heard of’ – with good reason. The Rodríguez Orejuela brothers Gilberto and Miguel and Jose Santacruz Londoño are not the household names they could, should – and soon will – be.

The Cali cartel split from Escobar’s Medellin syndicate years before his death, to become the trader of what some estimate as a 90% share of the global cocaine market, spearheading the supply into Europe during the “yuppie” boom of the 1980s.

But unlike Escobar, the Cali cartel didn’t wage war on the system – they became part of it.

First they dominated their region, and then national politics – even compromising a Colombian president. They didn’t want to attack the state, as Escobar did with cartel gunmen and rogue police; they wanted to be the state. Their financial affairs were so well managed that Gilberto Rodríguez founded and directed the First InterAmericas bank in Panama – he did so effectively enough to become Escobar’s banker while also trying to kill his rival. Meanwhile, the expertise of the cartel’s counter-intelligence systems baffled the CIA and the Drug Enforcement Agency.

The series seems, estimably, to want to follow not the story of one man, but the ever-expanding business he created. In doing so, Narcos season three will also illustrate a key point about the nature of cartels: the way in which they morph and mutate from generation to generation.

The famous Sinaloa cartel of Joaquín ‘El Chapo’ Guzmán, now awaiting trial in a New York jail from which he is unlikely to be tunnelled out, was a mutation of both Escobar and Cali. He was the last of the baron bosses, a “Godfather” revered as well as feared on his terrain. But he had moved beyond Escobar to find an accommodation with the state: his network of protection within the Mexican state made him the state’s best bet in trying to keep a perverse “pax mafiosa” – mafia peace – against even more vicious drug syndicates.

The latest cartel mutation is Los Zetas, from north-eastern Mexico. This is a narco-militia so brutal that – in contrast to Guzmán’s baronial status – its name is barely even mentioned within the expanding territory under its control, from the Rio Grande valley down the Gulf into Central America. They rule with raw terror, not patronage. They forge into Europe, regardless of what is licit or illicit, be it cocaine, sex-trafficking, migration or oil – all that matters is business and ultra-violence to secure it.

The Zetas are Escobar’s great grandchildren, the Cali cartel’s grandchildren, and Guzmán’s defiant sons.

Along with Narcos, the past few years have seen a flurry of films and books about narco-traffic. When I wrote a book about the drug war in Mexico in 2010, it was one among few. Now, narco-traffic is on trend and clearly lucrative.

Sadly, the narratives developed in those shows mean that audiences in the US and Europe understand it as a cops-and-robbers thriller, obscuring what narcos actually are: astute, ever-adapting businessmen in the legal and illicit economy, supplying products on which our society is more dependent than ever. The fight is seen as a just war against criminal organisations who are at war with us. Our good guys, their bad guys.

But here’s the problem: it’s not true. The idea that there is some kind of line between “us” and “them”, or the “legal” and “illegal” economies, is a fantasy and a lie. The world of narcos is not some exotic underworld horror show, because there is nothing underworld about the money.

Ask yourself: what happens to the money? If Escobar’s and Guzmán’s is a multi-billion dollar business, where is it?

Escobar and Guzmán could not drive around spending hundreds of billions out of the back of a truck. No, you have to bank it, and to do that, you have to find a bank willing to take your money. Escobar found the Bank of Credit and Commerce International, and it was busted. Guzmán found Wachovia and HSBC, which have been caught and admitted laundering his money. Yet no one goes to jail.

The New York Times articulated it rather well: “Federal and state authorities have chosen not to indict HSBC, the London-based bank, on charges of vast and prolonged money-laundering, for fear that criminal prosecution would topple the bank and, in the process, endanger the financial system.”

Without “criminal” money, the “legal” economy collapses. The man who infiltrated Escobar’s Medellin cartel to bust BCCI for the FBI, Robert Mazur, put it thus when we met: “The only thing that will make the banks properly vigilant to what is happening is the rattle of handcuffs in the boardroom” – not just in the Narcos’ palaces. “It’s simple”, said the whistleblower at Wachovia, Martin Woods: “If you don’t see the correlation between the money laundering by banks andpeople killed in Mexico, you’re missing the point.”

Series three of Narcos is unlikely to join those dots – it is, after all, a series about Colombia, not Wall Street or Canary Wharf. And even this is important: Colombia has just agreed a peace that ends the world’s longest-running war, between its government and the Marxist Farc. A war entwined with Escobar’s, and funded by Farc with narco-traffic.

And yet despite the peace process, cocaine production continues to increase exponentially in Colombia. And the power and terror of yet a further generation of neo-cartels known in Colombia as “bacrim”, bandas criminales.

The Narcos series is infinite.

 

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AlterNet Is Leading the Fight for Drug Reform: Will You Help?

Wed, 09/06/2017 - 09:03
Click here for reuse options! Every dollar counts.

As a subscriber to AlterNet's drugs newsletter, you know that independent media is a key ingredient for social change when it comes to reform. Whether the issue is legalization or ending mass incarceration, the journey starts with educating people, changing minds, inspiring people to become activists, and breaking through social taboos, racist mind-sets and powerful government agencies and business interests that stand in the way of progress. And media needs to be there every step of the way as reforms and changes begin to happen. 

AlterNet has been a media leader for almost two decades on drug reform issues. Can you make a generous contribution to support our work?

Every day, we push back against the massive onslaught of corporate propaganda that dominates the airwaves. With unique, original reporting, in-depth analysis and editorials, and a curated mix of the best content from select publishers and grassroots organizations around the globe, AlterNet is recognized as one of the best on this issue. 

We are a great bang for your buck. But we simply can't do it without your supportCan you help?

In solidarity,

Phil Smith, AlterNet Drugs Editor

 

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Trump's Racist Law Enforcement Agenda

Tue, 09/05/2017 - 11:33
Click here for reuse options! He's committed to destroying the lives of black and brown people; increased law enforcement is the next weapon in his arsenal.

Earlier this month, Trump declared his plans to ramp up law enforcement to combat fatal opioid overdoses.  Less than a week later, there were violent protests in Charlottesville, VA that left a woman dead and several people seriously injured. Today, one question lingers: where were the police? Instead of the tanks, rubber bullets, tear gas and other forms of “crowd control” deployed during the conspicuously nonviolent Ferguson protests, there were police standing by as white supremacists and neo-Nazis marched the streets chanting “blood and soil” and violently attacking counter protestors in their midst. 

Despite these tragic happenings, there were no calls for increased law enforcement at these protests, nor was there championing of police “roughing them up a little.”  Instead, Trump ultimately opted to place blame on the people who showed up to demonstrate their belief that America should not be the home to hateful, white supremacist ideology and its various manifestations. His decision made it very clear that his racist rhetoric is more than just talk—it reflects the principles that inform his agenda. Against the backdrop of violence in Charlottesville and his silence on the lack of an adequate response by law enforcement, the Trump administration’s calls for more policing in response to the opioid crisis is emblematic of the racist double standard underlying the strategies used to perpetuate the war on drugs.

Historically, the institution of policing in this country has continuously operated as a tool for the enforcement of racist policies. From the actions of plantation overseers and slave patrols during slavery to the enforcement of the “black codes” that played an integral role in the creation of the prison industrial complex that plagues our society to this day, law enforcement has consistently been synonymous with the control of black people. The use of law enforcement to ensure the efficacy of racist policies was a necessity during the Jim Crow era and segregation, and even more so after segregation was ruled unconstitutional. Many states and local governments refused to cooperate with the highest court in the land, and the police were present to make sure Jim Crow laws and traditions were followed, protecting racism and bigotry instead of the lives of black Americans. Now, in the wake of the “new Jim Crow” that is the drug war, law enforcement has functioned as an instrument of reinforcement for the overarching structural racism on which the drug war was founded. 

For those of us who have witnessed the devastation that enforcement of the drug war has inflicted on communities of color, the Trump administration’s call for greater “enforcement” is clearly a dog whistle for the arrest, incarceration, and criminalization of black and brown people. The Trump administration has used the opioid crisis to justify his racist attacks on Mexican immigrants and to roll back the criminal justice reforms of the Obama era. Trump has very explicitly placed the blame for the opioid crisis on the “thugs,” gangs and cartels rather than the conditions created by the failed war on drugs. For black and brown people, who have been criminalized and demonized by this type of “tough on crime” messaging for many decades, these words signal a future tainted with more state sanctioned violence at the hands of an increased police presence in the name of “law and order.”

While Trump’s rhetoric is deplorable and his policies are proven ineffective, costly and racist, none of this is new. Trump did not invent the racism that grounds the institution of policing just as he did not invent the racist war on drugs. Like the presidents before him, rather than investing desperately needed resources into increased access to naloxone and comprehensive drug treatment, Trump intends to invest $15.6 billion in law enforcement and interdiction.  Despite bi-partisan calls for criminal justice and police reform, and a “gentler” drug war, the Trump administration is clearly committed to maintaining the status quo: the surveillance, harassment, arrest, incarceration, and criminalization of communities of color by the police in the name of the drug war. Instead of saving lives, Trump is committed to destroying the lives of black and brown people, and increased law enforcement appears to be the next weapon in his arsenal.

*Editor's note: In this monthly blog series, the Drug Policy Alliance will examine the nexus between the war on drugs and law enforcement practices that result in the mass criminalization, incarceration and dehumanization of communities of color. These pieces will reflect on the ways in which the institutions of policing and prosecution - both driven by calls for “law and order” in the wake of the war on drugs - continue to function as instruments of reinforcement for the overarching structural racism on which the drug war was founded.

This piece first appeared on the Drug Policy Alliance Blog

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Got the End-of-Summer Blues? Here’s How Marijuana Can Help

Tue, 09/05/2017 - 10:04
Cannabis can act as a "neurological laxative" for those suffering from anxiety.

The possibility that a woman could have painless labor became an idée fixe of H. L. (“Doc”) Humes, a literary wunderkind and MIT science prodigy who developed some intriguing theories about cannabis. When his wife was giving birth at their home on July 4, 1977, they tried an experiment involving marijuana, breathing exercises, and massage. Humes gave her some marijuana to inhale just before each contraction and this helped her immensely.

Marijuana is “among the most forgiving medicines we know,” said Humes, who described cannabis as a “neurological laxative” that “acts to surface anxiety which the user holds within himself.” Doc touted the weed as the best remedy for stress, “the necessary medicine for the nation’s anxiety-tension problem.” “America is so sick,” he declared, “and cannabis is the specific medicine for the disease that afflicts us.”

Chronic “anxiety-tension,” Humes explained, “is a state of general blockage that shows up most obviously at an individual’s ‘weakest link,’ so it can have a wide variety of physical and emotional symptoms, as well as being generally debilitating … Most of the common elements from which people suffer are really symptoms of anxiety-tension, including headache, backache, insomnia, fatigue, irritability, GI disturbances such as constipation and ulcers, overweight, arthritis, and so on. Anxiety-tension has also been very clearly implicated in more deadly disorders such as high blood pressure, heart disease, cancer proneness, and premature aging … Depression is frequently a symptom of anxiety-tension.”

Ganja’s biphasic qualities allowed smokers to “equilibrate” the nervous system, according to Humes. Consumed in appropriate quantities, the herb could calm the hyper or invigorate the sluggish. The medical use of cannabis depends precisely on managing its psychoactive properties,” Doc counseled. “In heavy dosage, it functions like a hypnotic. In a light dosage it functions like an illuminant.”

Humes saw early on that the widespread “recreational use of cannabis is also a form of self-medication,” even if most marijuana smokers did not acknowledge this to themselves. He lamented the fact that hundreds of thousands of young people are arrested each year for using the most efficacious and least harmful medication available to cope with the stress of living in the modern world.

Source: H. L. Humes, “Notes on Painless Detoxification from Narcotics Addiction,” unpublished manuscript. 

An excerpt from Smoke Signals: A Social History of Marijuana – Medical, Recreational and Scientific by Martin A. Lee

 

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This is What It's Like to Be An Overdose Survivor

Tue, 09/05/2017 - 09:50
Click here for reuse options! Someone will suffer an overdose today and live. Then what?

I woke up this morning alive. I finished the book my sister gave me last week, Mastering the Addicted Brain. And I wrote an emotional treatise about the three overdoses - the ones I remember. One, in the dorms, at age 17. I had taken a bunch of various forms of speed and was slurring my words. I thought I was having a heart attack. Maybe I was just really high.

The second landed me in the hospital. I showed up to a party at a friend's house drunk and high, and proceeded to get more drunk and dangerously high on any number of substances, but mostly cocaine. Those were the days I kept my stash in hollowed out Burt's Bees lip gloss pallets, or replaced loose eye shadow with it so I could have it in my purse inconspicuously. It's not lost on me that it was childhood church friends that dragged me to a car and to the hospital. It's not lost on me that Nita, my mom's best friend who came immediately to my side, didn't live long enough to see her daughter get married - and yet, here I am. (Not two days later, I got a ride to my grandparents' farm to convalesce and be with my mom, who was caring for ailing relatives. I did more cocaine - literally off the front of a Bible - in the car on the way.)

The third overdose was in Brooklyn, a few weeks before I entered long-term recovery. I'd been tripping for days at that point, and mixing hero's doses of psilocybin with cannabis and cocaine. I had a seizure, and lost control of my legs. I slammed around in the elevator on the way to my apartment. I simply told my flatmate that I'd fainted, and asked for some bread, a cold wash cloth, and water.

It occurs to me again that it was International Overdose Awareness Day last week, and somehow I woke up alive. The war stories just don't matter today.

Some wore silver to commemorate. Others visited the grave of their child, brother, or lover who died this tragic, undignified death. (Undignified on face, anyway.) Some don't know Overdose Awareness Day even exists; they don't know there's a worldwide campaign to #EndOverdose. Someone will overdose today and live. Someone will overdose today and die.

All too often, I'm reminded there are those who visit these graves daily, through the unhealed wrench in the heart, or the persistent pit in a stomach. There are parents, children, and siblings that walk the earth as zombies, numbed and hollow from the overdose death of their own. They are living mausoleums to what might have been.

And then, there's me. Unworthy, unwitting, and unclear on how I survived overdose, time and time again. It's not fair.

It's not fair.

I'm alive, and I don't know why it's me and not your sister, your girlfriend, or your daughter.

I don't always feel guilty enough, or #blessed enough, or whole enough to make it fair. All I know to do is to listen to others, offer my energy to help teach people to use drugs safely, advocate for the shift to an evidence-based, harm reduction model of drug policy in the United States, and to go to the mat over and over for those who are suffering from addiction. I don't let a day - not a minute, really - go by that I'm not grateful for being in recovery. Recovery is all I have. All I know to do is work for a better tomorrow.

This is what it's like to survive overdose.

 

Save A Life: Free Online Naloxone Training

 

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Trump's Pardon of Sherriff Arpaio, Who Leaned on Drug Laws to Deport So Many, is Malicious and Unconscionable

Tue, 09/05/2017 - 08:15
Click here for reuse options! The drug war is a war on immigrant communities.

With the unprecedented pardoning of America’s most reprehensible Sheriff, Arizona’s Joe Arpaio, the Trump administration doubles down on its blatant disregard for human and civil rights and bull horns its support of racists, racial profiling, border militarization, and white supremacy.

Summarized best by our friends at the Opportunity Agenda, “In 2011, the U.S. Justice Department sued then Maricopa County Sheriff Joe Arpaio for a “pattern of unlawful discrimination” against Latino Arizonans that included discriminatory and unjustified stops, searches, and detentions. As a result, a federal judge ordered him to stop these practices. Last month he was convicted of contempt of court for refusing to do so, opting instead to continue his harassment and intimidation of Latino Arizonans.”

Not one week after the terrorism in Charlottesville, where Nazi and Klu Klux Klan members charged the streets in riot gear and with weapons, leading to the death of one woman and dozens more critically injured, the President, under the cowardly cloak of a Friday night news dump, announced that he will use his first official pardon to give impunity to a notorious violator of equal justice and our Constitution. But the pardon is not final yet. As of Wednesday, The Washington Post reports “two surprising developments relating to the pardon of ex-sheriff Joe Arpaio: a challenge to the president’s pardon power and a court’s decision to hold a hearing rather than summarily dismiss the case.”

Nevertheless, by pardoning him, the president sends a message that civil liberties are only for some, and that he is fine with law enforcement flouting the very laws they are meant to uphold.  What’s more, on the heels of defending hateful demonstrators in Charlottesville, the president continues to use the highest office and his broad presidential pardon powers to absolve, excuse, and protect someone, who described his inhumane detention facilities as “concentration camps.” By stark contrast, the Obama administration used the presidential office to signal sentencing reform and granted clemency to 1,715 federal prisoners who were serving outrageous terms for non-violent drug offenses. In other words, reform and compassion were guiding principles in Obama’s use of presidential pardons and clemencies.  

(For a better look at Joe Arpaio’s long-time record of human rights abuses, see the Phoenix New Times' reporting highlights.)

The drug war is a war on immigrant communities. It fuels racial profiling, border militarization, violence against immigrants, intrusive government surveillance and widespread detentions and deportations. Arpaio’s police department notoriously used drug laws to stop, search, detain, and justify deportations – ripping apart families and attempting to extinguish communities.

In Maricopa County, Joe Arpaio waged his cruel, inhumane, and unconstitutional campaign against Latinx communities, because, simply, no one cared about the people suffering under the Arpaio regime. Aptly stated in this Phoenix New Times’ article on the alarming rate of alleged suicides in his jails, “The sheriff's charnel house is accepted because the victims are not members of a 4-H club. They are late on child support, use drugs, smoke cigarettes, drive without licenses, have problems with authority, sport ink with gang affiliations.”

But we care. The Drug Policy Alliance cares. We advocate for drug policies rooted in science, compassion, health, and human rights. We actively pursue policies that reduce contact between the police and immigrant communities, which helps reduce vulnerability to deportation. We increase opportunities for and accessibility of retroactive relief, like pardons, expungement and records sealing.

This country can and will move forward – if we unite and collectively resist hatred, bigotry, and systemic racism, and if we hold criminals like Joe Arpaio accountable for their crimes against humanity.

This piece first appeared on the Drug Policy Alliance blog.

 

 

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Joe Arpaio Has Been a World-Class Jerk a Lot Longer Than You Ever Knew

Sun, 09/03/2017 - 12:36
Click here for reuse options! He got his start as a narc, and took down a budding Texas music legend back in the day.

Joe Arpaio made his conservative bones as the hardline, long-time sheriff of Maricopa County, Arizona, home of Phoenix, the state's largest city. Housing inmates in sweltering tent cities in the desert heat, forcing them to wear pink underwear and feeding them slop as incarceration porn voyeurs watched with glee on internet feeds helped make Arpaio a hero of the reactionary right.

 

He cemented that status with his ill-treatment of the state's Hispanic population in the guise of enforcing federal immigration laws—even as federal courts barred him from conducting "immigration roundups" and the Justice Department found he had overseen the worst pattern of racial profiling in U.S. history. Arpaio's egregious misbehavior ended up costing Arizona taxpayers $146 million in fees, settlements and court awards.

 

Arpaio didn't care, and he positively reveled in the applause his lawless crackdowns won from the likes of Fox News and Donald Trump. Even after the federal court injunction against his racist immigration sweeps, he continued to order his office to detain "persons for investigation without reasonable suspicion a crime has been or is being committed," the court found. That behavior eventually earned him a criminal contempt citation, for which he was convicted in July and pardoned by Trump last month.

 

But Arpaio's history as a reactionary lawman goes back well before his seemingly endless tenure as "America's Sheriff." (He served for 23 years before being defeated in his 2016 election bid.) As an agent of the Federal Bureau of Narcotics (the predecessor to the DEA), Arpaio kept busy busting hippies in the 1960s, including one of Texas' biggest music legends.

 

In 1965, the Sir Douglas Quintet had a monster national and international hit with "She's About a Mover," a bouncy, infectious amalgam of Brit pop, Texas pop and Cajun two-step powered by Augie Meyers' incredibly cheesy Vox Continental organ. Although "Sir Douglas" Sahm was Texas born and bred, with deep roots in country, rhythm and blues, and other Texas music styles, legendary New Orleans producer Huey Meaux, Jr. prevailed upon Sahm to pretend to be part of the British Invasion in a bid to get a hit. It worked.  

 

T

 

The Sir Douglas Quintet appeared on its way to stardom, but got detoured in 1966, which is where Joe Arpaio comes in. At the time, Arpaio was agent in charge of the Bureau of Narcotic Drugs' San Antonio office, and when he got a tip that Sahm and band member Frank Morin were carrying marijuana on a flight to Corpus Christi, Arpaio arranged for federal narcs and local cops to meet them at the airport.

 

 

It wasn't exactly a big bust—Sahm and Morin were each nailed with "a tobacco can" full of the devil weed—but even a small-time pot bust in Texas in the 1960s was a big deal, as Lee Otis Johnson could attest. Johnson, a black student activist, was nailed in 1968 for giving a joint to a cop in Houston and sentenced to 30 years in prison. (The sentence was later overturned, but still.)

 

Not a big bust, but enough to derail the Sir Douglas Quintet, temporarily putting the kibosh on its touring plans, and ultimately inducing the band to hightail it out of Texas, shed the British affectation and relocate to the much friendlier climes of San Francisco and Northern California.

 

That led to a second round of popularity for the band, and a second hit, about a Northern California county that was becoming a popular destination for hippies fleeing the big city and that would become famous for its role in the American marijuana scene:

 

The Sir Douglas Quintet never again had a hit that big, but Sahm was well on his way to becoming a Texas music legend. Although the Quintet disbanded, Sahm and Augie Meyers continued to collaborate, and Sahm continued to release rock, blues, Tex-Mex, Cajun, country, and pop-inflected albums through the 1970s, '80s and '90s. He also joined Meyers, Tex-Mex accordion king Flaco Jimenez, and Hispanic country crooner Freddy Fender (born Baldomar Huerta) in the Texas music supergroup the Texas Tornadoes. 

 

Back in the late '80s and early '90s, I would occasionally chat with Sahm as he and Augie and sometimes Freddy Fender chilled out between Thursday night sets at the Hole in the Wall on the Drag in Austin. I loved his attitude and his music. And I really liked that "Free Baldomar Huerta" graffiti somebody painted on the side of the club, a reference to a 1960 bust involving six grams of weed that ended with Fender serving time in Louisiana.

 

Joe Arpaio did his best to bring down a budding Texas legend, but he failed. Doug Sahm died of a heart attack at a hotel in Taos in 1998, but his legacy lives on, while Joe Arpaio is reduced to being an angry loser. The two men symbolize two conflicting visions of America—one harsh, authoritarian and intolerant; the other mellow, fun- and freedom-loving and inclusive. Arpaio wanted a Texas where the law was enforced with a firm hand, especially against people with the wrong skin color or hair style; Sahm wanted a Groover's Paradise. The battle is still being waged: 

 

 .

 

 

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Debunking a Key Line of Republican Attack on Medicaid and Poor People

Fri, 09/01/2017 - 14:23
Click here for reuse options! Another right-wing trope goes down in flames.

Conservative Obamacare foes desperate for a new angle of attack on the increasingly popular health care program have come up with an intriguing new theory: The expansion of Medicaid to low-income adults under the Affordable Care Act may be driving the opioid epidemic.

For the right, tying "failed socialist" Obamacare to the drug epidemic is a two-fer. They get to decry the very notion of government programs as something good for society and they get to link "bleeding heart" efforts to help poor people with outcomes that actually hurt them.

It would be a nice little argument for cutting Medicaid, if only it were true. But there's little evidence to suggest it is true and a lot of evidence to suggest it isn't.

The notion began circulating in the conservative media echo chamber after the Health and Human Services Department did a private analysis for Sen. Ron Johnson (R-WI) that said the opioid overdose rate rose nearly twice as much in states that expanded Medicaid under the ACA than those that didn’t.

"These data appear to point to a larger problem," Johnson wrote. "Medicaid expansion may be fueling the opioid epidemic in communities across the country." Johnson pulled up just short of blaming Medicaid, saying more research is needed.

But if Johnson was looking for help from fellow Obamacare foe and Health and Human Services Secretary Tom Price, it wasn't exactly forthcoming. HHS wouldn't address questions about Johnson's analysis and instead issued a statement saying "correlation does not necessary prove causation," but that, yes, more research would be helpful.

But based on what we know so far, here are four reasons the charge that Medicaid is fueling the opioid epidemic is bogus.

1. Medicaid is actually increasing treatment for opioid addiction.

That's according to Temple University economist Catherine Maclean and Brendan Saloner of Johns Hopkins Bloomberg School of Public Health, who recently published a paper on Medicaid expansion and drug treatment: "Medicaid-reimbursed prescriptions for medications used to treat Substance Use Disorders in outpatient settings increased by 33% in expanding states relative to non-expanding states. Among patients admitted to specialty SUD treatment, we find that in expanding states Medicaid insurance and use of Medicaid to pay for treatment increased by 58% and 57% following the expansion. In an extension to the main analyses we find no evidence that the expansions affected fatal alcohol poisonings or drug-related overdoses," they wrote.

"Medicaid is doing its job," she told the Associated Pressthis week. "As more time passes, we may see a decline in overdoses in expansion states relative to non-expansion states."

2. States that expanded Medicaid did so in part because they already suffered higher overdose rates.

That same research by Maclean and Saloner also found that overdose rates were higher to begin with in states that expanded Medicaid. That suggests that pre-existing drug problems may have played a role in states deciding to expand Medicaid so they could leverage more federal money to fight addiction.

Republican labor economist Craig Garthwaite of Northwestern University's Kellogg School of Management told the AP that such a desire helped propel Ohio Republican Gov. John Kasich toward expanding Medicaid. When Kasich talks about why, he said, "it has a lot to do with mental health and substance use disorders." The claim that Medicaid is fueling opioid overdoses is "fundamentally flawed," Garthwaite added.

In other words, overdoses aren't increasing because of Medicaid; instead, Medicaid is expanding in part because of an effort to reduce overdoses.

3. Counties where insurance coverage has expanded the most have seen smaller increases in overdose deaths than those with smaller coverage gains.

A recent analysis by Vanderbilt University economist Andrew Goodman-Bacon and Harvard researcher Emma Sandoe compared trends in drug-related deaths at the county level, contrasting counties that had high levels of uninsured residents pre-ACA with those that didn't. Under the theory that Medicaid expansion is causing increased overdose deaths, we would expect to see the largest increase in deaths in those high-insured counties because that's where more people took advantage of expanded Medicaid. But that wasn't the case:

"Drug-related deaths increased at a lower rate in high-uninsurance counties than in low-uninsurance counties," the researchers found. "This does not support the notion that the ACA worsened the opioid epidemic."

In other words, the more people on expanded Medicaid, the lower the rate of increase in overdose deaths.

4. The Medicaid theory lumps all opioid overdose deaths together when many are not caused by prescription opioids.

This is bad science. If you want to measure prescription opioid deaths, you need to measure only prescription opioid deaths. But the HHS analysis for Sen. Johnson didn't do that. Instead, it lumped in deaths from non-prescription street drugs such as heroin or illicitly manufactured fentanyl. Having a Medicaid card doesn't provide access to street drugs, and it is precisely heroin and illicit fentanyl that are driving the surge in opioid deaths since 2010.

"It's worrisome because this is the type of numerical evidence that's used to propose bad policy," Garthwaite told the AP.

 

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The Claim That the Border Wall Will Stop Drug Smuggling Is Just More Trump Bullsh*t

Fri, 09/01/2017 - 14:23
Click here for reuse options! The fabulist-in-chief is at it again.

President Trump sure loves his border wall. It was a staple of his campaign rhetoric, and despite Mexico's firm insistence that there is no way Mexico is ever going to pay for it, Trump's desire for the wall is unabated. Now, he's threatening to shut down the government unless he can persuade Congress to make American taxpayers pay for it.

This week, Trump claimed that "building the wall will stop much of the drugs coming into the country." That claim is yet another example of what CNN contributor Fareed Zakaria pungently referred to as Trump's primary political product: bullshit.

Here's what Trump claimed during his joint press conference Monday with Finnish president Sauli Niinisto:

"The wall will stop much of the drugs from pouring into this country and poisoning our youth. So we need the wall. It’s imperative. …The wall is needed from the standpoint of drug — tremendous, the drug scourge, what’s coming through the areas that we’re talking about. …So we will build the wall, and we will stop a lot of things, including the drug — the drugs are pouring in at levels like nobody has ever seen. We’ll be able to stop them once the wall is up."

Here's the Reality

Trump's own DEA and outside experts agree that building a wall along the 1,700-mile-land border with Mexico will have little impact on the drug trade. Not only do drugs from Latin America enter the U.S. by sea and air as well as across the Mexican border, but the vast majority of drugs crossing the land border do so not in unfenced desert expanses, but through official ports of entry.

Mexican drug trafficking organizations "transport the bulk of their drugs over the Southwest Border through ports of entry (POEs) using passenger vehicles or tractor trailers," the DEA said in its 2015 National Drug Threat Assessment. "The drugs are typically secreted in hidden compartments when transported in passenger vehicles or comingled with legitimate goods when transported in tractor trailers."

Here's how the DEA detailed trafficking methods for various drugs:

  • Methamphetamine: "Traffickers most commonly transport methamphetamine in tractor trailers and passenger vehicles with hidden compartments. In addition, traffickers send methamphetamine through various mail services or by couriers traveling via bus or commercial airline."
  • Heroin: "Most heroin smuggled across the border is transported in privately-owned vehicles, usually through California, as well as through south Texas."
  • Cocaine: "Tractor trailers and passenger vehicles are frequently used to transport multi-kilogram quantities of cocaine. Cocaine is hidden amongst legitimate cargo or secreted inside of intricate hidden compartments built within passenger vehicles."
  • Marijuana: "Large quantities of marijuana are smuggled through subterranean tunnels."

A May 2017 DEA intelligence report obtained by Foreign Policy echoed the 2015 assessment. It, too, found that drugs coming from Mexico went across the border, but mainly concealed in vehicles using ports of entry—not those unfenced expanses. The report also noted that drugs headed for the Northeast United States, especially from Colombia—the world's leading cocaine producer, as well as source of opium and heroin second only to Mexico in the U.S. market—come more often by plane and boat.

Drug traffickers "generally route larger drug shipments destined for the Northeast through the Bahamas and/or South Florida by using a variety of maritime conveyance methods, to include speedboats, fishing vessels, sailboats, yachts, and containerized sea cargo," the report found. "In some cases, Dominican Republic-based traffickers will also transport cocaine into Haiti for subsequent shipment to the United States via the Bahamas and/or South Florida corridor using maritime and air transport."

That report did not address the border wall, but its examples of how and where drugs enter the country show that in many cases, building a wall wouldn't make a scintilla of difference: "According to DEA reporting, the majority of the heroin available in New Jersey originates in Colombia and is primarily smuggled into the United States by Colombian and Dominican groups via human couriers on commercial flights to the Newark International Airport," the report found.

The report concluded with recommendations for reducing the drug trade, but none of them are about building a border wall. Instead, targeting foreign drug trafficking networks within the U.S. "would be an essential component to any broad strategy for resolving the current opioid crisis."

It's not just his own DEA that is giving the lie to Trump's bullshit. His own chief of staff, John Kelly contradicted the president's position at a congressional hearing in April.

Illegal drugs from Mexico "mostly come through the ports of entry," he said. "We know they come in in relatively small amounts, 10, 15 kilos at a time in automobiles and those kinds of conveyances."

Drug trafficking experts agreed with Kelly and the DEA—not Trump.

Brookings Institution senior fellow and long-time analyst of drug production and trafficking Vanda Felbab-Brown summed it up bluntly in an essay earlier this month: "A barrier in the form of a wall is increasingly irrelevant to the drug trade as it now practiced because most of the drugs smuggled into the US from Mexico no longer arrive on the backs of those who cross illegally."

"The wall won't stop the flow of drugs into the United States," she told Fact Check this week.

Other experts contacted by Fact Check concurred. Peter Reuter, University of Maryland criminal justice professor and founder of the Rand Drug Policy Research Center, pronounced himself skeptical that a wall would have any impact on the drug trade.

"The history is that smugglers eventually figure a workaround," he said. "There have been many promising interdiction interventions—none of them have made more than a temporary dent."

And Middle Tennessee State University political science professor Stephen D. Morris, whose research has largely focused on Mexico, came up with two reasons the border wall would not stop drugs.

"First, as you say, most drug shipments come disguised as commerce and are crossing the border by truck or in cargo containers. Human mules, to my knowledge, bring in a small fraction," he said. "Second, smugglers adapt. Whether it is tunnels, submarines, mules, drones, etc., they are good at figuring out new ways to get drugs to those in the US who will buy them."

It is a shame that Donald Trump's ascendency has so coarsened and vulgarized our national political discourse. But his lies demand a forthright response. Bullshit is bullshit. 

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Cannabis Use During Pregnancy: Is It Safe?

Fri, 09/01/2017 - 09:47
An expert discusses the controversial topic.

What do we know about marijuana's effects on unborn children?

Pamela is newly pregnant with her third child. She and her husband think this is going to be their last one because she is having a dreadful time with nausea – morning sickness that lasts all day long. She knows all the tricks. Saltines by her bedside, taking Vitamin B6 and B12, and eating frequently even though her stomach is queasy. She tried ginger. She tried acupuncture. She considered hypnosis. None of it is working, and the added stress of two little ones who still need her attention is making her pregnancy a miserable experience. She really wants this baby, but lately she’s been having guilty doubts about whether it’s worth going through all the nausea and vomiting.

Pamela consulted her physician. She was offered some prescription medications – droperidol (an antipsychotic), metoclopramide (causes drowsiness & dizziness), Benedryl (drowsiness), or Zofran. Although her doctor reassured her about side effects and effects on her baby, she really did not want to take a pharmaceutical if she could avoid it.

Pamela had used cannabis occasionally for many years. It relieved her stress at the end of the day when the kids were finally in bed and she had time to herself. It helped ease some pain she had in the past, and aided sleep when she had short bouts of insomnia. She knew it could help with nausea, appetite, and stress, but she did not know if it was safe to use it while pregnant. So she searched online for facts.

Online, Pamela found conflicting information. Some sites said it was perfectly fine to use cannabis while pregnant. Others warned of brain damage, early labors, babies with failure to thrive, and other dire consequences. There seemed to be some research on the subject, but was it well done? Was it reliable? How was she to dig down and find the real story?

I am a family physician and have attended hundreds of births during my career. I live in an area of the country (Northern California) where cannabis is used by many of my patients, and when they discovered that they could be honest with me about their use my prenatal records became more complete.

Many mothers were using it for nausea and for stress relief. Some used it because it was simply part of their lifestyle. We discussed this during their visits, and I was clear with them that I honestly did not know if cannabis caused harm because the scientific research was still incomplete.

In my experience, however, I had not seen complications from cannabis – but I had seen complications from alcohol and other drugs. We discussed the difference between ‘use’ and ‘abuse.’ If they planned to use it I, encouraged conscious use; microdosing to treat the need without overusing.

However, my personal and professional experience was not enough to rely on as a source of information for my patients. I began a search and review of the literature, reading the published peer-reviewed articles, and evaluating the study designs and the outcomes.

In this article, we are going to look at the facts. We will look at the research and outcomes, and evaluate their worth. We will look at populations that used cannabis during pregnancy and see how their children are doing now. The information shared may help you make your own decision about using cannabis during pregnancy.

It is important to remember that pregnancy recommendations regarding what to eat, what to drink, what medications to take, and any other outside influences are fraught with caution and fear. If the child does not turn out ‘right,’ who’s fault is it? Pointing a finger of blame can lead to guilt, to lawsuits, and/or a lifetime of regret. Simply being pregnant and carrying a baby for nine months creates unavoidable risks for both mother and baby. But for some, there is no end to the perceived risks or possible harms a mother may cause an unborn child.

Note: The use patterns considered here are limited to well-considered, clearly needed uses of cannabis. This includes using the herb or its constituents for medical reasons such as nausea, pain, sleep, or possibly for stress relief. I encourage any cannabis use to be done consciously, with respect for its power as medicine.

Endocannabinoids are Essential

Before we look at introducing phytocannabinoids to a pregnant mother, let’s consider the endocannabinoid system and the critical role it plays in creating new life. It turns out that our own endocannabinoids, those we create ourselves, are essential to fertilization, growth of the fetus, and survival of a newborn.1

  • Embryonal implantation into the uterus requires a temporary and localized reduction in one of the most common endocannabinoids present in the brain – anandamide.
  • The endocannabinoid system is responsible for neural development by regulating stem cell differentiation into neurons and by guiding axonal migration and synaptogenesis (making the right connections).
  • Anandamide protects the developing brain from naturally occurring trauma-induced neuronal loss.
  • Suckling initiation in the newborn, which is critical to survival, is stimulated by activation of the CB1receptors in the neonatal brain.

The essential involvement of the endocannabinoid system in pre- and post-natal development not only increases our respect for the role it plays, but may also increase concerns about introducing phytocannabinoids into the mix.

Low Birth Weight, Preterm Labor, Increased NICU Admissions?

With the use of cannabis we worry about miswiring the baby’s brain, causing an increase in pregnancy and delivery complications, admissions to the intensive care unit, and problems later in the child’s life such as psychiatric conditions, poor academic achievement, and increased addiction disorders. The possibility of harm caused by using cannabis is a fearful possibility to many pregnant women, their physicians, and midwives.

The most often quoted article in my community was work published in 2011 by Hayatbakhsh (Hai-at-bak-sheer) and his team, covering a 7-year span of observation in Australia. They interviewed almost 25,000 pregnant women, with over 2400 of these women admitting to ever using cannabis and 637 admitting to use at the time of the interview, during their pregnancy. His conclusions were:

“Use of cannabis during pregnancy strongly and significantly predicted negative birth outcomes, including low birth weight (375 g/.8 lbs lighter), preterm birth, small size for gestational age, and increased admission to the NICU (neonatal intensive care unit).”2

Because I had not seen this trend in my own community I read his research carefully. They had controlled for socioeconomic status, multi-substance use, and took into consideration the use of alcohol, cigarettes, and other illicit substances. Their results remained statistically significant.

I kept looking until I found the problem with Hayatbakhsh’s data. First, it was with the method of collection. Pregnant women were interviewed as part of a routine second trimester interview at a public, not private, maternity hospital. Midwives entered the data into a computer, and anyone admitting current use was offered directed care through the hospital’s alcohol and drug specialist service. Any admitted past use was followed by questions on current use.

Now imagine yourself sitting across a desk from a midwife who is providing your care while you are in a vulnerable, pregnant state. She asks you about drug use. Do you tell the truth? Do you admit to something that triggers a referral to a special service for drug abusers? If you answered “yes” to this, you are in the minority. A self-selected group such as this will not lead to the best data, with evidence skewed depending on how many young women were able to be truthful about their use of cannabis.

Surveys done elsewhere support my concern in the data collection process. “Seven percent of pregnant women self-report using marijuana during the prior 2–12 months,3 although studies measuring marijuana use by self-report or urine screens have identified prevalence ranging from 8% to 29% .”4

In addition, there was no long-term follow-up done on any of the mothers or babies from the positive cohort. These weaknesses in the study were enough for me to consider the data questionable. I moved on to the next concern.

Abnormal Neurodevelopment?

Miswiring the brain is a drastic, dramatic, scary thought. No one wants to think they have any avoidable part in harming a baby’s brain. This is a truly serious concern.

A study published in 2011 showed that THC disrupts the natural, highly efficient endocannabinoid signaling in the fetal brain. CB1 receptors in the brain are integral to the development of neural pathways in the developing fetus. The study found that if present, THC will bind to these receptors rather than endocannabinoids. 

Researchers dissected brains that tested positive for THC and found those brains to have less of a naturally occurring protein called SCG10, a protein that regulates neuron development. The authors hypothesized that this decrease in SCG10 could cause neurons to develop abnormally both in structure and direction.5

Based on an observation, researchers proposed one hypothesis. An alternate hypothesis could be that THC is as efficient as the endocannabinoids. A third hypothesis could be that THC is even more efficient than SCG10. We simply do not know. From this study, all we know is that THC does “promiscuously bind to members of the cannabinoid receptor family.”

There is an accepted way to measure abnormal neurodevelopment that has been used to evaluate problems like dyslexia, autistic spectrum disorder, and fetal alcohol syndrome. Global Motion Perception (GMP) is a behavioral measure of a type of brain processing that is thought to be particularly vulnerable to abnormal neurodevelopment. GMP is the ability to perceive the whole, rather than focusing only on the individual parts. Imagine watching a football half-time show and being unable to appreciate the pattern the band makes across the field, forced to see only a single tuba player. Those with impaired GMP would only be able to see that tuba player, unable to appreciate the whole picture.

A study published in 2015 measured GMP in 145 4.5-year-old children who had been exposed to different combinations of methamphetamine, alcohol, nicotine, and marijuana prior to birth along with 25 unexposed children. The results were surprising.6

As expected, GMP was impaired by prenatal exposure to alcohol. But it was improved significantly by exposure to marijuana! And the direction and size of the effect was unexpected; the children exposed to marijuana in the absence of alcohol were almost 50% better at the GMP task than children with no marijuana exposure. Global motion perception for children exposed to both marijuana and alcohol was no different from that of children who had no drug exposure. Only alcohol and marijuana exposure had independent effects on global motion perception after controlling for the effects of multiple drug exposure, verbal IQ, ethnicity, habitual visual acuity, and sex. Alcohol to the negative, marijuana to the positive.

Academic Achievement?

The information about neurodevelopment was reassuring, so I moved on to my next concern: academic achievement later in the child’s development. Goldschmidt and his team published research in 2011 that concluded, “First trimester exposure to cannabis significantly predicted poorer academic achievement scores at 14 years of age.”7Here was some long-term follow-up that could be significant.

This research was more difficult to evaluate. It looked like they had accounted for all the possible variables: prenatal alcohol use, tobacco, cigarettes, and other illicit drug exposure. Still, I had not seen this effect of cannabis in my own practice after years of delivering babies and watching those children grow up. What could be the difference?

I called a statistician. After his review, he educated me about ‘mediators.’ Mediators are the factors that must come into play to cause the seen effects. In this case, there were four mediators listed here in order of importance:

  • Depression at 10 years old
  • An abnormal IQ test at age 6 years
  • Inattention noted at age 10 years
  • Early use of cannabis before 14 years old

For academic achievement to be affected, the child had to have had prenatal marijuana exposure, PLUS at least one of these four mediators. It was not simply the use of cannabis during pregnancy, but a combination of factors that caused poorer academic achievement.

Severe Mental Illness?

Moving to the next concern, I wondered about the possibility of increased incidence of severe mental illness in children exposed to cannabis during gestation, especially if there was a history of mental illness in the family. This went along with the theory of miswiring brains; if brains were miswired by THC, would this trigger schizophrenia? If teens used cannabis, would they be more likely to develop schizophrenia?

Harvard University and the Boston VA looked at this possibility. The question they set out to answer: “Is family risk for schizophrenia a crucial factor underlying the association between the development of schizophrenia in teens who smoke marijuana?”

They looked at 282 individuals from the New York and Boston metropolitan areas. They gathered information on 1,168 first-degree relatives and a total of 4,291 relatives. They collected information regarding cannabis use, and family history regarding schizophrenia, bipolar disorder, depression, and drug abuse. What they found was that the tendency for depression and bipolar disorder was dependent on family history of these disorders. Their conclusion: “Having an increased familial risk for schizophrenia is the underlying basis for schizophrenia in these samples — not the cannabis use.”8

Large Studies?

Still not completely reassured or satisfied with the available research, I looked for more, and found a study from Carleton University in Ottawa, Canada. Since 1978, psychologist Peter Fried and his colleagues collected longitudinal data on prenatal marijuana exposure as part of the Ottawa Prenatal Prospective Study (OPPS). These researchers administered hundreds of tests to the same group of about 145 children over a 22-year period. The group assessed physical development, psychomotor ability, emotional and psychological adjustment, cognitive functioning, intellectual capacity, and behavior.

At the end of this extensive, long-term study, they found very few differences between marijuana-exposed and nonexposed children. After controlling for known confounding variables, Fried estimated that prenatal drug exposure to alcohol, tobacco, and marijuana combined accounted for 8 percent or less of the variance in children’s scores on developmental and cognitive tests.9

Furthermore, no review of this topic would be complete without looking at the work done by Melanie Dreher, a pediatrician who published in the journal Pediatrics in 1994. She looked at children exposed to cannabis in Jamaica. It was a relatively small study – looking at 24 newborns exposed to marijuana prenatally and 20 nonexposed newborns. She found that there were no significant differences between exposed and nonexposed infants on day 3. Then, at 1 month, she found that the exposed infants showed better physiological stability. The newborns of heavy-marijuana-using mothers had better scores on autonomic stability, quality of alertness, irritability, and self-regulation, and were judged to be more rewarding for caregivers.10

This provided reassurance about my patients who used cannabis during pregnancy. Still, I had one more resource to explore.

Children of the Counterculture

In the early 1970’s, a group of young adults set out from San Francisco to establish an intentional spiritual community together with the lofty goal of ‘saving the world.’ They bought 1500 acres in Tennessee and began to build a community where they could live in harmony with each other, setting an example for the rest of the world and even reaching out to help others far beyond the boundaries of their own gates. They were young, creating not only a town but also families, delivering their babies at home in the woods of Tennessee. The lay midwives attending the births were exceptionally skilled, guided by a woman named Ina May Gaskin. They named their community The Farm.

This community used cannabis. It was part of their culture and they considered it a sacrament. Except for a brief period of two years, known as the ‘Grass Fast’, almost everyone on The Farm who had access to cannabis smoked it regularly. Women used it while they were pregnant, some during labor, and most during breastfeeding. Here was a population that had exposed their unborn babies to cannabis forty years ago, so it seemed like a good opportunity to check in and see how those babies had fared as they grew up.

In the 4th edition of the book Spiritual Midwifery, there are official statistics on over 1900 Farm births from 1970 to 1994. The incidence of ‘Small for Gestational Age’ or ‘Placental Insufficiency’ was .002% (4 births). Prematurity incidence was .01% (22 births).11 I decided to find out how those babies were doing today.

Many of the families eventually left Tennessee to pursue their lofty goals elsewhere, but they are still connected through social media and their collective history as a ‘tribe.’ I contacted the mothers who had been pregnant on The Farm and asked them to take a survey. They were interested and eager to contribute.

I must be clear — this was a survey, not a scientific study. Many of the questions asked for a comment answer, not a check-box answer — so those answers were not statistically easy to report. But after combing through all the data and comments some useful information was revealed.

The Statistics:

  • 71 responses were included in the report.
  • The average age of respondents was 66 years.
  • Those 71 women reported on a total of 178 children who were born while living at The Farm.
  • The average length of time lived at The Farm culture was 12 years.
  • The second generation birth years spanned from 1971 to 1991. This is significant in that it represents a time when cannabis generally had a lower THC content than it is today.
  • 54% of the children were male, 46% were female with a ratio of 1.20. This is slightly higher shifted towards boys compared to the USA average of ~1.07.
  • 11% of the women reporting did not use cannabis, and 89% did use cannabis.

Interestingly, some women mentioned in the comments that they didn’t like using cannabis that much, but used it because sharing a joint was a whole lot easier than trying to explain why they didn’t want to. There was a strong cultural push to use the herb.

The breakdown was right down the middle with 50% finding benefit in cannabis during deliveries. Most comments were positive, but at least one person said that smoking cannabis stalled her labor and only after the effects wore off did she get going again. Yet another indication that this herbal medicine has effects that are very individualistic.

Next, I teased out significant mental illnesses and addiction disorders. 27% of women reported a family history of diagnosed-and-reported bipolar, schizophrenia and suicides. The answers to this section of the survey were important — studies are one thing, but how the children turned out in real life is another. Granted, there were other influences: diet, lifestyle, a self-selected society, questionable memories of family histories, and early use of cannabis by the children — some as young as 7 years old. But taking what the survey gave me, I was able to report the following:

  • Significant Mental Illness: The rate for adults in the U.S. experiencing significant mental illness in a given year was 4.2%; the percentage of 2nd Generation Farm kids with a reported diagnosis of mental illness was 5.0%.
  • Addiction Disorders: In 2014, the number of Americans 12 and over classified with substance abuse disorder was 8.1%; for the 2nd Generation Farm kids it was 3.0%.

I asked questions about the ‘Grass Fast’ (the two years when the entire community abstained) but the answers did not yield any clear results. I had wondered if I could use that time as a ‘control’ since babies gestating during the fast were not exposed, but the information was too vague to provide any clarity.

Comments about the use of cannabis during pregnancy at the end of the survey varied from “I wouldn’t use it now,” to “Cannabis is the greatest, best, most wonderful ally ever and my kids are superstars because of it!” Paraphrased, of course.

The most impressive part of all this information was showing some of what the children are doing now — are they truly contributing members of society? Are they having difficulty with cognitive thinking? Are they problem citizens?

The following is a list of what these children have grown up to do. I am not ignoring this second generation that did, and do, face problems with mental health and addiction, but I did note that for the most part, those ‘kids’ are doing well. And again, I don’t want to ignore the other factors at play here: diet, personalities that led these individuals to The Farm in the first place, use of other substances, lifestyle and individual family histories.

REPORTED CAREERS, PROFESSIONAL ACCOMPLISHMENTS, AND ACADEMICACCOMPLISHMENTS FOR 2ND GENERATION AT THE FARM:

  • Nurse (several)
  • Nurse Practitioner–Women’s Health and MS
  • Occupational Therapist
  • Painting Contractor
  • Peace Corps–dual Masters in Sustainable Development and International Relations
  • Photojournalist
  • Physician (MD)
  • Professional Actor
  • Professional MMA fighter–Ranked in the top 10 for the last 11 years
  • Project Manger for large IT corporation
  • Second City Imrprov Performer
  • Senior Level Iyengar Yoga Instructor
  • Silicon Valley Tech Executive
  • Software Engineer/System Administrator
  • Software Designer
  • Teachers–Kindergarten, ESL, International, Bilingual, etc.
  • Web Developer
  • Woodworking Craftsman
  • Aquatic Biologist
  • Artist (several)
  • Attorney (several)
  • Banking VP–Financial Analyst
  • Biotech Executive
  • Carpenter
  • Civil Engineer for Army Corps of Engineers
  • Contractor
  • Electronic Navigation Device Development for DOD
  • Ergonomist
  • Homicide Investigator for the DA, speaks 7 languages and works with police and gangs
  • IT Reverse 911 mapping for France
  • Master Plumber
  • Masters Degree in Classical Language
  • Masters Degree
  • Mechanic and Angora Goat Farmer
  • Midwife
  • Motivational Speaker
  • Musician (several)

Systematic Reviews

Encouraged, I continued to search for valuable information about the safety of cannabis use while pregnant. Lynn Zimmer, a PhD Associate Professor of Sociology at Queens College in New York, and John P. Morgan, a Professor of Pharmacology at City University Medical School wrote an article for the Drug Policy Alliance in 1997.12 They did a complete review of the literature available to them at the time. Their conclusions:

  • Adverse outcomes are inconsistent from one study to another.
  • Marijuana contributes less than alcohol or tobacco.
  • The findings show no consistent relationship of fetal harm to either the timing or degree of marijuana exposure.
  • The weight of current scientific evidence suggests that marijuana does not directly harm the human fetus.

Meg Hill MBBS, a Fellow in Maternal Fetal Medicine, and Katheryn Reed MD, Professor and Head of the Department of Obstetrics and Gynecology at The University of Arizona in Tucson, Arizona did a similar review in 2013.13

Sixteen years after Dr. Zimmer’s review, this one concluded:

  • There may be some effects noted in older children.
  • If these effects do exist with light, moderate, or sporadic use, they are sufficiently subtle as to not be consistently demonstrated between studies.
  • Based on these findings, mandatory reporting of marijuana use during pregnancy and punitive measures related to the use of this drug during pregnancy or breast-feeding do not seem medically warranted.

In 2016, the British Medical Journal published a systematic review and meta-analysis of the available information. They vetted and reviewed 24 studies.14 The findings were:

  • Increased anemia in mothers.
  • Decreased birth weight, increased NICU admissions.
  • Tobacco & alcohol included in too many studies.
  • Relied on self-reported use of cannabis.
  • Studies with conflicting results so definitive conclusions not drawn.
  • Bottom line: More research needs to be done.

Most recently, in January of 2017, the National Academies of Medicine published a report on “The Health Effects of Cannabis and Cannabinoids.” A committee of sixteen respected scientists created a draft report that was then reviewed by fifteen experts prior to publication. Prenatal, perinatal, and neonatal exposure to cannabis was one section of this 468 page report. The only factor with substantial evidence of a statistical association between cannabis smoking was lower birth weight in infants. There was limited evidence for pregnancy complications and NICU admissions, and insufficient evidence for later outcomes that included SIDS, academic underachievement and later substance use.15

The lower birth weight concern that persists does not seem to be associated with any other problematic factors such as failure to thrive or inability to suckle. As a family physician and a mother, I do consider the fact that any woman who has delivered a baby will agree that if she could get a somewhat smaller baby to push out, one who was perfectly healthy and thrived, she would be grateful for it.

What I Tell My Patients

After all this reading, reviewing, and surveying, I was left with the following points I could share with my patients:

  • Cannabis can be abused. Don’t abuse it.
  • Smoke is an irritant on the airways. If you wish to inhale, vaporize flowers or use an alternate form of the medicine.
  • Federal law prohibits cannabis
  • Hospitals, physicians, and Social Services can have punitive responses to parents who test positive for THC.
  • Babies exposed to cannabis during gestation may weigh less than babies not exposed.

And if you choose to use cannabis:

  • Be clear about why you are using it and re-evaluate those reasons each time
  • Avoid smoking – vaporize herb or use non-smoked products from trusted sources
  • Use organic herb and concentrates that are clear of chemicals and pesticides
  • Be aware of the cannabinoid content and microdose medicine to efficacy
  • Keep your children safe from accidental or passive exposure
  • Avoid dabs, oils, and edibles with unknown content

What Do YOU Think?

CARL, powered by Hawaiian Ethos, is a new platform for patients and caregivers to share their perspectives and experiences with cannabis. CARL is still under development, and we would appreciate your help in testing it. Start with a survey on cannabis and pregnancy, and stay in touch with us to see how CARL evolves to share more with you.

Sources:

  1. E Fride, Multiple Roles for the Endocannabinoid System During the Earliest Stages of Life: Pre- and Postnatal Development, ‎J Neuroendocrinol. 2008 May;20 Suppl 1:75-81. doi: 10.1111/j.1365-2826.2008.01670.x
  2. R. Hayatbakhsh, etal, Birth outcomes associated with cannabis use before and during pregnancy, Mohammad Pediatr Res 71: 215-219, December 21, 2011; doi:10.1038/pr.2011.2
  3. Ko JY, Farr SL, Tong VT, Creanga AA, Callaghan WM. Prevalence and Patterns of Marijuana Use among Pregnant and Non-Pregnant Women of Reproductive Age. Am J Obstet Gynecol. 2015
  4. Chang J, Holland C, Tarr J, Rodriguez K, Kraemer K, Rubio D, Arnold R. Direct observation of screening for and disclosure of illicit drug use in pregnancy visits. American Journal of Health Promotion. 2015 In Press
  5. E. Keimpema, Molecular model of cannabis sensitivity in developing neuronal circuits, Trends Pharmacol Sci. 2011 Sep;32(9):551-61. doi: 10.1016/j.tips.2011.05.004..
  6. Arijit Chakraborty, etal. Prenatal exposure to recreational drugs affects global motion perception in preschool children. Scientific Reports, 2015; 5: 16921 DOI: 10.1038/srep16921
  7. Goldschmidt L, et al, School achievement in 14-year-old youths prenatally exposed to marijuana, Neurotoxicol Teratol,(2011), doi:10.1016/j.ntt.2011.08.009
  8. AC Proal, et al, A controlled family study of cannabis users with and without psychosis, Schizophrenia Research, Volume 152, Issue 1, January 2014, Pages 283–288 doi:10.1016/j.schres.2013.11.014
  9. Fried, P.A., Prenatal exposure to tobacco and marijuana: effects during pregnancy, infancy, and early childhood. Clinical Obstetrics and Gynecology 36:319-337, 1993.
  10. Melanie C. Dreher, etal, Prenatal Marijuana Exposure and Neonatal Outcomes in Jamaica: An Ethnographic Study, Pediatrics, Feb 1994, 93 (2) 254-260
  11. Spiritual Midwifery Third Edition, Ina May Gaskin, The Book Publishing Company, Summertown, TN
  12. Use of Marijuana during Pregnancy, Article excerpted from Marijuana Myths, Marijuana Facts: A Review of the Scientific Evidence by Lynn Zimmer, PhD, and John P. Morgan, MD (New York: Drug Policy Alliance, 1997)
  13. Meg Hill, MBBS, and Kathryn Reed, MD, Pregnancy, Breast-feeding, and Marijuana: A Review Article, CME Review Article, Volume 68, Number 10, Obstetrical and Gynecological Survey, Copyright 2013
  14. Gunn JKL, Rosales CB, Center KE, et al., Prenatal exposure to cannabis and maternal and child health outcomes: a systematic review and meta-analysis. BMJ Open 2016;6:e009986. doi:10.1136/bmjopen-2015-009986
  15. Health Effects of Cannabis and Cannabinoids - The Current State of Evidence and Recommendations for Research, published by the National Academies of Sciences, 2017
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Obama's Former Drug Czar Calls for Ban on High-Grade Opioids at Center of Epidemic

Fri, 09/01/2017 - 09:36
Michael Botticelli is supporting a "citizen petition" to the FDA which calls for the removal of the powerful painkillers from pharmacy shelves

Barack Obama’s former drug czar, Michael Botticelli, has backed a ban on the high-strength opioid painkillers at the heart of the US overdose epidemic now claiming about 50,000 lives a year.

Botticelli supported a petition to the Food and Drug Administration (FDA) by families of opioid victims, doctors and health organisations seeking the removal of the powerful painkillers from pharmacy shelves.

Activists see the “citizen petition”, which legally requires a response – Congress passed legislation in 2007 that requires the FDA to rule on citizen petitions within 180 days – as a test. It will show whether the FDA is finally turning away from policies that critics contend have contributed to the epidemic by putting the financial interests of pharmaceutical companies ahead of public health.

Among the signatories was Dr Andrew Kolodny, co-founder of Physicians for Responsible Opioid Prescribing, who said that high-dose opioids not only significantly increased the likelihood of addiction but endangered lives when taken accidentally.

He said that 11 million Americans had misused an opioid pill in 2015, and many of them were borrowing pills to deal with aches and pains without knowing how strong they were.

“Borrowing that one pill can lead to a fatal overdose,” he said. “These are not medicines. These are lethal weapons that should be removed from the market.”

The petition says that a person taking high-strength opioids is twice as likely to develop an addiction as a person taking the low-strength version. Botticelli supported the call for their removal from the market but said that it should be matched by an effort to reduce the number of opioid prescriptions. Although the numbers have been falling since the epidemic drew political attention, doctors still wrote 240m prescriptions for opioids last year – roughly equivalent to one for every American adult.

“We clearly know that high dosage increases the probability of addiction. Where we have products that are dangerous, it’s important to call for their removal. It is equally as important as doctor prescribing behaviours,” said Botticelli.

The petition is part of a day of events in Washington and across the US led by an activist group, Fed Up!, to raise awareness of the opioid epidemic and to demand policy changes. Bereaved families rallied at the White House to demand the Trump administration take action to curb the distribution of opioids and fund treatment for those addicted. Victoria Allendorf, who lost both sons on the same day to an opioid overdose, spoke of the helplessness of watching a child struggle with addiction and then slowly dying.

Among the drugs the activists want withdrawn are higher strength versions of OxyContin. Its launch 20 years ago with a marketing campaign claiming that it was neither addictive nor dangerous kickstarted the opioid epidemic, which swept out of Appalachia and across the country. Both claims were false and the manufacturer, Purdue Pharma, has paid out hundreds of millions of dollars to settle legal actions. Three of its executives were also convicted of crimes over the false claims.

Judy Rummler, the chair of Fed Up!, signed the petition on behalf of her organisation. Rummler’s son, Steve, died of an opioid overdose in 2011. Fed Up! has been a strong critic of the FDA, saying that it is compromised by financial relationships with the pharmaceutical industry and has bowed to political pressure from a powerful lobby to approve dangerous drugs.

But Rummler said there were signs the FDA’s policy is shifting. In June, the FDA called for the removal of a high-strength opioid, Opana, from pharmacy shelves as a public health hazard just a decade after it was approved for sale in controversial circumstances. Opana was rejected in 2003 as unsafe but approved three years later after the rules of the process were rewritten amid accusations that pharmaceutical companies had undue influence over the process.

The manufacturer withdrew the drug after the FDA call. The new FDA commissioner, Scott Gottlieb, implicitly acknowledged criticisms of his agency when he endorsed a report by the National Academies of Sciences, Engineering, and Medicine in July that recommended that approval take into account “the public health effects of the inappropriate use of these drugs”.

“We’ve already begun to put this policy to work. Last month, the agency requested the removal of an opioid product from the market based on concern that the product’s risks associated with its deliberate misuse outweigh its intended benefits when it was used as directed and lead to dangerous unintended consequences,” he said.

On Tuesday, Gottlieb phoned Emily Walden, who has been among the strongest critics of the FDA for its approval of Opana after her son died of an overdose of the drug. Walden declined to discuss the details of the conversation but said she was impressed.

“He has given me hope for sure,” she said. “I feel like for the first time in a long time we have an FDA commissioner who is willing to correct some of the mistakes. It seems like he understands this issue.”

Botticelli said he thought the FDA was finally changing course. “It does seem there’s been a significant shift around FDA’s framework on opioids,” he said.

Kolodny called for the federal government to commit $60bn over the next 10 years to provide treatment to people addicted to opioids to bring down the rising death toll. Botticelli was not confident it would happen. He criticised Donald Trump for his failure to follow through on a call by his own opioid commission to declare a national emergency. He said that the president could not say he takes the crisis seriously while at the same time proposing deep cuts to the healthcare funding that provides treatment for people who are addicted.

 

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Pundits Focused on Trump's Craziness Are Ignoring His Threat to Mentally Ill People and Addicts

Thu, 08/31/2017 - 14:41
Click here for reuse options! The Trump administration is waging war on opioid abusers, the seriously mentally ill and chronic pain patients.

Even as pundits and political observers, including former intelligence director James Clapper and some House Democrats, are increasingly questioning President Trump's mental stability, they're not paying nearly as much attention to the threat he poses to people already proven to be grappling with mental illness, addiction and chronic pain. In early August, our mercurial president declared that the opioid crisis that plays the dominant role in roughly 60,000 overdose deaths a year is a "national emergency," yet no meaningful response has yet been set in motion.

He seemed to be following the initial recommendations of his ex-crony Gov. Chris Christie's opioid panel that called for everything from more inpatient treatment for addicts to better training of physicians. But that commission was  justly derided as "farcical" by critics because it ignored all the different ways that the Trump administration is scheming to undermine both Obamacare and Medicaid treatment programs for mentally ill people and substance abusers, at least half of whom are hobbled by mental illness.   

Amid all this new attention to the opioid emergency, there's a growing awareness that there's not enough real-time access to the sparsenumber of drug treatment clinicians and to the effective medications for opioid addiction 90 percent of providers don't offer. But there is far less notice being given to the generally poor quality of care given to substance abusers who manage to find addiction treatment.

“The opioid crisis is an emergency, and I’m saying officially right now it is an emergency. It’s a national emergency. We’re going to spend a lot of time, a lot of effort and a lot of money on the opioid crisis,” Trump said while on a "working vacation" at his New Jersey golf club.

In theory, that could free up more money for treatment and give states greater flexibility in using Medicaid funds to help addicts. But that seems unlikely, especially with millions of people with addiction and mental illness conditions enrolled in the 32 states and the District of Columbia that expanded state Medicaid programs under the Obamacare program. That is the same program still under attack by Trump and his HHS secretary Tom Price, even after repeal failed in Congress.

In an administration that wasn't so dysfunctional, Trump's declaration of added emergency funding and expanded powersshouldbe expected to promote the expanded use of "medication-assisted" treatment. This includes take-home Suboxone, with the primary ingredient buprenorphine, that now faces rigid prescription limits on doctors who must jump through regulatory hoops to prescribe it to more than 30 patients. Equally valuable, but potentially riskier if misused, is the more widely prescribed but stigmatized methadone, which can't be provided outside of specialized clinics. All told, such medications can cut fatal overdose rates by up to 75 percent, but federal and state governments are still slow-walking making them easily available for all who need them. In the meantime, over 140 people a day die from opioid overdoses.

 As science writer Maia Szalavitz, the author of The Unbroken Brain, has pointed out, "If the Trump administration wants to dramatically cut the death rate from opioid overdose, it should use its emergency powers to strip away the bureaucracy associated with obtaining methadone or buprenorphine."

Yet such minimally necessary reforms are unlikely to be implemented by HHS or pushed through Congress by a crippled administration in political free-fall, and one that's all too eager to pander to Trump's right-wing base.

The administration's hard-line views have already been made clear. HHS Secretary Tom Price has derided proven medication-assisted approaches as "substituting one opioid for another," although his PR staff sought to clean up his comments by claiming they didn't really reflect his or HHS's policy views. And regardless of how many vague platitudes Trump might declaim about the opioid crisis, his real attitudes were best reflected when he, Price and other officials pandered to his base in a briefing by emphasizing tougher law enforcement and stronger security on the Mexican border to stop illegal drugs.

At his August briefing, Trump essentially ignored the role of expanding treatment options. Instead, he echoed the earlier law-and-order demands by Attorney General Jeff Sessions to drastically increase sentencing for drug offenders, even though 75 percent of them return to prison within five years after being released, largely because they can't access effective drug treatment in or out of prison.  Trump is eager to ramp up these failed policies: "Strong law enforcement is absolutely vital to having a drug-free society," he declared. 

The administration has a wide array of other enforcement and regulatory schemes -- joined with insurance subsidy cut-offs -- that it's advancing which could devastate the lives of emotionally disturbed people, substance abusers and chronic pain patients who have been using opioids in legitimate ways, but are now facing heedless cutbacks. Many people in all three groups are either being set adrift or could soon  find themselves without minimally acceptable care, leading to an increase in suicides, overdoses, emergency room visits and life-threatening incarceration. As a Huffington Post investigation found in 2016, the year after the suicide by hanging of Sandra Bland in July 2015, over 800 inmates died in local jails—roughly a third due to suicides in the first three days of incarceration.

First, Do Harm: The Federal Government's Approach to Opioids, Addiction and Chronic Pain

The risk of suicide is already mounting steadily for all those chronic pain patients recently cut off from opioids in a drastic  way that focuses narrowly on arbitrary opioid dosage limits rather than on patient well-being, according to a recent open letter of concern penned by 80 academic experts. For instance, a few months after the CDC in 2016 rolled out influential new guidelines that spurred a crackdown on opioid prescribing for chronic pain patients, 47-year-old Donald Alan Beyer of Bovill, Idaho, a disabled logger with a degenerative disc disease who had injured himself on the job, walked out the back door of his home and shot himself in the head.

His son Garrett told the local paper, "He was in so much pain he could barely get out of bed to go to the bathroom. I guess he felt suicide was his only chance for relief."

Beyer was left stranded when his doctor retired the previous year, and other doctors, apparently frightened of potential prosecution by the DEA or regulatory sanctions, declined to take on a new patient with chronic pain. (These strict responses to federal advisories began in the Obama administration, but they've been accelerated by the hard-liners now in charge of Trump's federal health agencies.)

A 2016 article on Beyer's suicide, and the far-reaching prescribing cutbacks published by the Pain News Network continues to draw comments from readers that amount to suicide notes in advance. A patient with a severe chronic cranial nerve pain condition, Renee Urbanek, wrote just two weeks ago, "My pain clinic just told me I will be weaned off all opioids. I will also have to end my life when that happens. I only had one yr to go to c my only daughter married. I'll never hold a grandchild."  Three months ago, "Craig" wrote, "We're not going to get no help...By Sunday evening @6p.m. central I will be a statistic."

Lauri Nickel of Phoenix, Arizona, 60, might have ended up as one of those statistics, after her degenerative disc disease she had managed with non-opioid medications, steroid injections and six spinal and neck surgeries since the 1990s was then drastically worsened by a badly administered steroid epidural over a decade ago. That botched procedure, in turn, eventually triggered the development of arachnoiditis, a severe inflammation in the membranes surrounding the nerves of the spinal cord that was misdiagnosed for years, leading to unbearable, burning pain. She managed to find some relief for about two years after she got an implanted spinal cord stimulator -- and was also allowed to take high dosages of opioids, including a timed-release fentanyl patch that's quite different from the counterfeit pills laced with fentanyl that are killing thousands each year. She even felt well enough to take part in the Susan B. Komen annual charity 5k walks.  But the stimulator stopped working, her pain increased and she needed additional surgeries, but she is now still too wracked with pain to do much of anything, stuck at home aided by modest doses of oxycodone that risks being removed at any point under the new crackdown. She also turned outside the traditional medical system for unproven, costly ketamine infusion treatment, and medical marijuana permitted in Arizona to help deal with her pain.

She's not sure what her future holds, as she remains largely confined to bed in agony and uses Facebook to champion the cause of chronic pain patients. "We are shamed in pharmacies and treated like drug-seekers in the ER," she says. "We are collateral damage."

"If tapering is forced on people, significant harm is observed," says Stefan Kertesz, a family practitioner and addiction researcher at the University of Alabama in Birmingham. "Some patients become emotionally volatile or they experience a disruption in their health care. They're at higher risk of suicides and illicit outcomes," which can mean using counterfeit street drugs laced with fentanyl or heroin.  

Kertesz has emerged as a vocal critic of the current harsh restrictions, observing, "Every week my inbox tells me about another suicide of someone forced off opioids against their will or I hear about overdoses." On his Facebook page, he reposted a disturbing video from August 4, 2017 featuring a Montana physician, Mark Ibsen, with his distraught patient, as the physician declared, "This patient is suicidal due to sudden severe cuts in her medications."

Yet few government officials are doing anything about it, not even bothering to measure the real-world impact of the new guidelines or even study the actual benefits and harm of using opioids for chronic pain patients over the long term.

Surprisingly, Kertesz's in-depth research on Alabama county death reports, and new CDC findings indicate that prescription drugs now account for only about 15 percent of opioid overdose deaths, whether or not the victims obtained them legally. Even CDC officials admit that prescription drugs aren't the main culprits now in opiate deaths  As Debra Houry, the director of the agency's injury prevention and control center, told a House committee in March, "More recently, the large increase in overdose deaths has been due mainly to increases in heroin and synthetic opioid (other than methadone) overdose deaths, not prescription opioids.

The available data indicate these increases are largely due to illicitly manufactured fentanyl. So it's even more striking that while there has been nearly a 20 percent downturn in legal opioid prescribing since 2010, overdose deaths, mostly due to street opioids, are now increasing at the rate of 19 percent a year. And contrary to another common myth, 75 percent of new heroin users started on illegally obtained prescription pills while young, not from drugs prescribed them as older chronic pain patients.   

So while it is obvious that the nation has been swamped by massive opioid overprescribing since the late 1990s until recently, our largely inept efforts to help addicts, chronicled in Anne Fletcher's book Inside Rehab (supplemented by new findings in my own Mental Health, Inc.) has created a perfect storm of relapses, deaths and common treatment failures. Now a Category 5 hurricane unleashing even greater tragedy is headed our way under the Trump administration.

The administration and Republican leaders have a vested interest in the failure of government health programs: they have done whatever they could to hasten Obamacare's demise and limit the scope of Medicaid, threatening coverage for at least four million people with mental and substance abuse disorders who were previously uninsured. Tom Price has already signaled through rule-making and a letter to the nation’s governors a willingness to grant state officials a relatively free hand to eviscerate government and private-sector health insurance programs. Administrators of both the state Obamacare exchanges and Medicaid programs have been offered far greater flexibility to limit required health benefits and eligibility for those programs.

The federal waivers Price wants to deploy are like catnip to budget-conscious officials eager to drastically cut spending. States such as Arizona, Indiana, Kentucky and Wisconsin, among others, are seeking or have already won permission to lock out Medicaid recipients if they don't pay premiums; require so-called “able-bodied” recipients to work to be eligible for benefits; limit Medicaid eligibility to five years; and test them for illegal drugs without acknowledging the deterrent effect on addicts needing treatment. As a result, new risks face all of the 14 million recipients already added through the Medicaid expansion and millions more who could be denied coverage.

The dystopian future awaiting the most seriously mentally ill people and addicts needing treatment under a Trump administration can, perhaps, be glimpsed by looking at what happened when Tennessee, facing a fiscal crisis, used HHS waivers to cut over 350,000 people from the Medicaid rolls starting in 2005 and drastically curtailed benefits for others. These included limiting virtually all recipients to a total of five medications. With 35,000 of the most seriously and chronically mentally ill recipients losing all coverage, homelessness, emergency room visits and jailings rose sharply in Tennessee.

The Trump administration not only can learn from the past but is looking for ways to use waivers to undermine the "essential health benefits" required by the Affordable Care Act and the basic health care services that Medicaid is supposed to offer. Price and his new director of the Centers for Medicare and Medicaid Services (CMS), Seema Verma, have the authority to grant draconian administrators broad freedom to clamp down on the program through "Section 115" waivers.

Verma, an Indiana health care consultant who is a protégé of Vice President Mike Pence, has already had plenty of practice in Indiana adapting the waiver’s authority to boot people off the Medicaid rolls and limit their benefits under the guise of promoting “personal responsibility” —by requiring sliding-scale monthly premiums. In practice, as WFYI public radio reported, the state and private insurers too often made repeated bureaucratic mistakes that left even steadfast payers without coverage.

The far skimpier coverage that could be potentially offered nationally is a likely deathblow especially for the most troubled mentally ill people and addicts who turn to Medicaid for help. It's disturbing that despite  at least 60,000 overdose deaths annually nearly three million—often mentally ill— substance abusers, including 2220,000 with opioid disorders, who got coverage for the first time under Obamacare and Medicaid could face new barriers to care; others will be frightened away from enrolling in Medicaid by those states that adopt drug-testing requirements applicants fear could lead to their arrest.

If these addicted individuals on a pathway to death or jail manage to retain their coverage under Trump and somehow get treatment, they are unlikely to get even minimally competent care. With about half of all addicts having mental illness and half of all those with serious, disabling mental illnesses suffering from substance abuse, effective dual-diagnosis programs that treat both illnesses together can reduce mental health symptoms and substance abuse disorders by up to 70 percent.

Unfortunately, the federal Substance Abuse and Mental Health Services Administration and state programs have abandoned useful, evidence-based assessment tools to measure whether clinics actually deliver effective dual-diagnosis treatment. As many as 90 percent of drug and mental health clinics now fail to do so, but SAMHSA pulled the plug on the evaluation program in 2012 just when opiate use started rising dramatically.

Stanford University Medical School professor Mark McGovern’s assessment tools have been essential in evaluating quality. Going by the names Dual Diagnosis Capability in Addiction Treatment (DDCAT) and Dual Diagnosis Capability in Mental Health Treatment (DD-CMHT), they’re used, respectively, for drug treatment and mental health centers. They measure everything from leadership to evidence-based treatments, and then are used to spur improvements. Except for a relative handful of states, such as Washington, spending their own funds on it, McGovern’s smart method to promote quality dual-diagnosis care isn't widely used anymore.

“We had an opportunity to offer good care and save lives,” he says. “The human toll is immeasurable.”

All told, Trump's pending attacks on people with mental illness, chronic pain and addictions are likely to kill far more people than the over 7,000 drug offenders gunned down by the death squads deployed by the Philippine strongman he admires. Indeed, Trump praised Rodrigo Duterte for doing an "unbelievable job on the drug problem," according to a leaked transcript. 

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Labor Day Weekend Is Top Holiday for Marijuana Sales

Thu, 08/31/2017 - 10:13
As summer vacations end, cannabis retailers cash in on busy three-day rush.

Labor Day weekend marks the unofficial end of summer as Americans (and Canadians) celebrate the labor movement with picnics, barbecues and one last pool party … and marijuana.

According to market research from  BDS Analytics, the three-day North American holiday is the busiest multi-sales period of the year for cannabis retailers. April 20 — the unofficial 420 holiday — remains the the largest retail day for the industry, but this weekend tops all others. Even Christmas takes a back seat to Labor Day weekend when it comes to marijuana sales.

In Colorado, BDS Analytics research shows that cannabis sales between Friday and Sunday of the 2016 holiday weekend brought in $29.94 million in sales of products. The following weekend, by comparison, saw $24.64 million. During last year’s July 4 weekend, dispensaries sold $26.98 million worth of product.

Washington state also saw an uptick in Labor Day weekend sales last year with $8.05 million in sales.

In Washington, September beats all of the months of the year, except for one — December. Washington dispensaries sold $70.68 million worth of cannabis in September; December brought in $72.93 million.

 

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Decriminalization is Not Enough, Says Cannabis Lawyer

Thu, 08/31/2017 - 10:04
Attorney Mitchell Kulick talks about how the legalization of marijuana will continue to pan out in the U.S.

The legalization of marijuana has become so mainstream that a segment called “Marijuana Moms” appeared on the “Today Show” earlier this month, featuring moms who regularly smoke weed and claim it makes them better parents. But make no mistake, scores of people, particularly poor and of color, have criminal records or still sit in prison because of marijuana.

Mitchell Kulick, founding partner at the New York City law firm Feuerstein Kulick LLP, which advises investors and early stage cannabis companies, talked to Salon’s Amanda Marcotte about the the status of legal marijuana across the country and whether decriminalization works.

Here are some highlights from their conversation. Watch the video below for more on the legalization of marijuana.

On the state of legal marijuana in the U.S.:

The overall state of legalized marijuana in the United States is fragmented. So you have at this point in time, about 30 states that have a medical program, sort of a robust medical program. I think it’s probably closer to almost 50 states that have some form, but a real medical program is about 30 states and then there are eight states that have a recreational. I think you just mentioned Maine, Massachusetts, Nevada, those are the most recent to have passed a recreational program.

Decriminalization—people confuse the two, between legalization and decriminalization. In New York City, marijuana is decriminalized, meaning that if you were caught with possessing a certain small amount, you’re going to get a ticket like a traffic ticket, which is different than legalized, which is your ability to go purchase it at a store or dispensary.

On whether decriminalization is effective:

Definitely, it’s not an effective way, but this seems to be the only way, as far as the United States at this point in time. Certainly, if you look to Canada, our neighbor to the north, what they’ve done is, they’ve legalized it across the entire country for medical, at this point in time, moving towards recreational. That solves a lot of problems when you’re legal across your entire country, in terms of banking, access to capital markets, etc, which are very difficult aspects participating in the industry here in the United States being so fragmented.

It was a Western movement, but now it’s going to be, it’s everywhere. Once Massachusetts voted there, which will start July 1, 2018, it puts a lot of pressure on the neighboring states to do the same thing because otherwise all their citizens are going to move across the border and pay their taxes to Massachusetts and not to Connecticut, and Rhode Island, and Vermont. I think it’s going to spread, the East Coast is going to be huge.

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5 Policy Solutions Proven to Prevent Fatal Overdoses

Thu, 08/31/2017 - 09:37
Click here for reuse options! We need policies that value life, liberty and humanity, not criminalization and punishment

Today marks International Overdose Awareness Day, a day to commemorate those whose lives were cut short by drug overdoses. As we remember these loved ones – sons, daughters, sisters, mothers, fathers and friends – let us pledge to shift our approach to drug use from policies that champion enforcement, criminalization and punishment to policies that value life, liberty and humanity

Below are 5 policy solutions that are proven to prevent fatal overdoses.  

  1. Increase 911 Good Samaritan Laws & Naloxone Access

The chance of surviving an overdose, like that of surviving a heart attack, depends greatly on how fast one receives medical assistance. By providing limited immunity from prosecution for drug users who seek emergency medical assistance in an overdose situation, 911 Good Samaritan Laws give drug users less reason to hesitate in calling for the help that is necessary for preventing overdoses from turning fatal.

As well, increasing drug users’ access to naloxone will prevent fatal overdose. A number of states have already made it legal to buy naloxone over the counter, but that is not enough.  Drug users are, oftentimes, the first people at the scene of an overdose. Consequently, they are often in the best position to administer naloxone and reverse an overdose before it becomes fatal.  We need naloxone in the hands of every drug user, and that means providing access to free naloxone at syringe exchanges, drug treatment centers, and even jails and prisons.

  1. Drug checking at syringe exchanges and/or pharmacies

Given the increasing numbers of instances involving the adulteration of heroin and other drugs with fentanyl, there is an even greater reason to increase access to drug checking services. When drug users are able to check their drugs, they are able to make more responsible consumption decisions as well as inform others of the risks of the tested substance.

  1. Safe Consumption Services

With over 100 safe consumption service (SCS) sites worldwide, the evidence supporting their efficacy in preventing HIV & Hep C transmissions and fatal overdose is too great to ignore. SCS are places that drug users can take their pre-obtained drugs to use in a monitored setting where service providers do everything from provide sterile consumption equipment to connect users with treatment services to reverse drug overdoses.  We need to increase and support efforts to establish SCS across the country, such as in Seattle and San Francisco, where organizers are moving forward with plans to open SCS sites. As well, California’s groundbreaking legislation, AB 186 (Eggman), which is currently up for vote in the CA Senate, would make CA the first state to authorize SCS through state legislation.  Efforts such as these need to be championed as we find alternative ways to combat overdose.

  1. Heroin-Assisted Treatment (HAT)

HAT programs provide substantial benefits to long-term heroin users who have not been responsive to other treatment.  Studies have shown that those enrolled in HAT demonstrate a reduction in drug use and an improvement in overall physical and mental health. As well, by being administered unadulterated heroin, we minimize the risk of fatal overdoses that happen as a result of unknown drug combinations and potencies.

  1. All-drug decriminalization

All drug decriminalization is the elimination of criminal penalties for drug use and possession, as well as the elimination of criminal penalties for the possession of equipment used for the purpose of introducing drugs into the human body, such as syringes. Decriminalizing drugs would improve the cost-effectiveness of limited public health resources, create a climate in which people who are using drugs problematically have an incentive to seek treatment, and remove barriers to the implementation of practices and policies that reduce the potential harms of drug use, such as drug checking and sterile syringe access.

This piece first appeared on the Drug Policy Alliance Blog.

 

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On Overdose Awareness Day, We Must Remember and Speak Up

Thu, 08/31/2017 - 09:30
Click here for reuse options! Only approaches rooted in humanity, justice, and respect will save thousands of lives

Today is International Overdose Awareness Day, August 31st, a day where the whole world comes together to make the public aware that opioid overdose is preventable, that we don’t have to bury our family, friends or loved ones due to this epidemic. Overdose is the leading cause of accidental death in the state of New York. While the epidemic does not discriminate, my hometown borough of the Bronx has the highest number of overdoses in New York City, and overdoses among Black New Yorkers are increasing the most rapidly, jumping 89% from last year. I am sick and tired of seeing my community torn apart by deaths that are preventable!

Through education, advocacy, and training, people who use drugs can learn to prevent overdoses, respond to overdoses that they witness, and be provided with options for stabilizing and/or abstaining from drugs.  Naloxone, also known as Narcan, is the medication that can save the lives of those experiencing an opioid overdose.  Naloxone is easy to use, safe, and has been shown to save thousands of lives.  When I was a Peer Educator, I worked in the streets of the South Bronx distributing Naloxone and educating people who use drugs on overdose prevention.  I encourage everyone who uses drugs, everyone who knows someone who uses drugs, every service provider, and everyone with a prescription for painkillers to use today as an opportunity to get trained on using Naloxone.

Naloxone is just one of the many overdose prevention interventions that are part the theory of treatment called “harm reduction.”  The most effective intervention for preventing opioid overdose death is Medication Assisted Treatment (MAT) such as Buprenorphine or Methadone.  This intervention substitutes illicit and unregulated drugs with a safer alternative.  When people are on the appropriate medication, they will no longer feel withdrawal symptoms and will not need to turn to the black market for illegal drugs.  Overdoses occur when people relapse or when the drugs are stronger than expected.  MAT can begin to bring the number of overdoses down.

On this day, we must remember and mourn those we have lost to overdose, but we must not forget about those who have passed on who were fighting to create a better world where overdoses would be a thing of the past. Today is a day to talk about other alternatives such as Safer Consumption Spaces (where people could use pre-obtained drugs in a safe and private environment), the decriminalization of drugs, anti-stigma campaigns and more.

The war on drugs has been going on for over 40 years and it has done nothing but oppressed low-income people of color. It has demoralized, disenfranchised, and stigmatized our communities systematically to keep them oppressed and unable to rise to their full potential. The system has done its job well by keeping this community uneducated and dependent on a system that does not respect or accept them as fellow citizens.

Today, while we remember those we’ve lost and raise awareness on how to prevent senseless deaths, it is our duty to also speak up and out for the injustices that the war on drugs has caused, and how approaches rooted in humanity, justice, and respect will save thousands of lives.

Hiawatha Collins also contributed. 

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8 Things Everyone Gets Wrong About Marijuana's Key Medical Ingredient

Wed, 08/30/2017 - 10:11
CBD is amazing—and misunderstood. Here's what you need to know.

It doesn’t get you high, but it’s causing quite a buzz among medical scientists and patients. The past year has seen a surge of interest in marijuana’s CBD, a non-intoxicating cannabis compound with significant therapeutic properties. Numerous commercial start-ups and internet retailers have jumped on the CBD bandwagon, touting CBD derived from industrial hemp as the next big thing, a miracle oil that can shrink tumors, quell seizures, and ease chronic pain — without making people feel “stoned.” But along with a growing awareness of cannabidiol as a potential health aid there has been a proliferation of misconceptions about CBD.

 1. “CBD Is Medical. THC Is Recreational.”

Project CBD receives many inquiries from around the world and oftentimes people say they are seeking “CBD, the medical part” of the plant, “not THC, the recreational part” that gets you high. Actually, THC, “The High Causer,” has awesome therapeutic properties. Scientists at the Scripps Research Center in San Diego reported that THC inhibits an enzyme implicated in the formation of beta-amyloid plaque, the hallmark of Alzheimer’s-related dementia.

The federal government recognizes single-molecule THC (Marinol) as an anti-nausea compound and appetite booster, deeming it a Schedule III drug, a category reserved for medicinal substances with little abuse potential. But whole plant marijuana, the only natural source of THC, continues to be classified as a dangerous Schedule I drug with no medical value.

2. “THC Is The Bad Cannabinoid. CBD Is The Good Cannabinoid.”

The drug warrior’s strategic retreat: Give ground on CBD while continuing to demonize THC. Diehard marijuana prohibitionists are exploiting the good news about CBD to further stigmatize high-THCcannabis, casting tetrahydrocannabinol as the bad cannabinoid, whereas CBD is framed as the good cannabinoid. Why? Because CBD doesn’t make you high like THC does.

Project CBD categorically rejects this moralistic, reefer madness dichotomy in favor of whole plant cannabis therapeutics. (Read the foundational science paper: A Tale of Two Cannabinoids.)

 3. “CBD Is Most Effective Without THC.”

THC and CBD are the power couple of cannabis compounds — they work best together. Scientific studies have established that CBD and THC interact synergistically to enhance each other’s therapeutic effects. British researchers have shown that CBD potentiates THC’s anti-inflammatory properties in an animal model of colitis.

Scientists at the California Pacific Medical Center in San Francisco determined that a combination of CBD and THC has a more potent anti-tumoral effect than either compound alone when tested on brain cancer and breast cancer cell lines. And extensive clinical research has demonstrated that CBDcombined with THC is more beneficial for neuropathic pain than either compound as a single molecule.

4. “Single-Molecule Pharmaceuticals Are Superior To ‘Crude’ Whole-Plant Medicinals.”

According to the federal government, specific components of the marijuana plant (THC, CBD) have medical value, but the plant itself does not have medical value. Uncle Sam’s single-molecule blinders reflect a cultural and political bias that privileges Big Pharma products. Single-molecule medicine is the predominant corporate way, the FDA-approved way, but it’s not the only way, and it’s not necessarily the optimal way to benefit from cannabis therapeutics.

Cannabis contains several hundred compounds, including various flavonoids, aromatic terpenes, and many minor cannabinoids in addition to THC and CBD. Each of these compounds has specific healing attributes, but when combined they create what scientists refer to as a holistic “entourage effect,” so that the therapeutic impact of the whole plant is greater than the sum of its single-molecule parts. The Food and Drug Administration, however, isn’t in the business of approving plants as medicine. (See the scientific evidence.)

5. “Psychoactivity Is Inherently An Adverse Side Effect.”

According to politically correct drug war catechism, the marijuana high is an unwanted side effect. Big Pharma is keen on synthesizing medically active marijuana-like molecules that don’t make people high — although it’s not obvious why mild euphoric feelings are intrinsically negative for a sick person or a healthy person, for that matter.

In ancient Greece, the word euphoria meant “having health,” a state of well-being. The euphoric qualities of cannabis, far from being an unwholesome side effect, are deeply implicated in the therapeutic value of the plant.

“We should be thinking of cannabis as a medicine first,” said Dr. Tod Mikuriya, “that happens to have some psychoactive properties, as many medicines do, rather than as an intoxicant that happens to have a few therapeutic properties on the side.”

6. “CBD Is Legal In All 50 States.”

Purveyors of imported, CBD-infused hemp oil claim it’s legal to market their wares anywhere in the United States as long as the oil contains less than 0.3 percent THC. Actually, it’s not so simple.

Federal law prohibits U.S. farmers from growing hemp as a commercial crop, but the sale of imported, low-THC, industrial hemp products is permitted in the United States as long as these products are derived from the seed or stalk of the plant, not from the leaves and flowers. Here’s the catch: Cannabidiol can’t be pressed or extracted from hempseed. CBD can be extracted from the flower, leaves, and, only to a very minor extent, from the stalk of the hemp plant. Hemp oil start-ups lack credibility when they say their CBD comes from hempseed and stalk.

7. “CBD-Only’ Laws Adequately Serve The Patient Population.”

Some U.S. state legislatures have passed “CBD only” (or, more accurately, “low THC”) laws, and other states are poised to follow suit. Some states restrict the sources of CBD-rich products and specify the diseases for which CBD can be accessed; others do not. Ostensibly these laws allow the use of CBD-infused oil derived from hemp or cannabis that measures less than 0.3 percent THC.

But a CBD-rich remedy with little THC doesn’t work for everyone. Parents of epileptic children have found that adding some THC (or THCA, the raw unheated version of THC) helps with seizure control in many instances. For some epileptics, THC-dominant strains are more effective than CBD-rich products.

The vast majority of patients are not well served by CBD-only laws. They need access to a broad spectrum of whole plant cannabis remedies, not just the low THC medicine. One size doesn’t fit all with respect to cannabis therapeutics, and neither does one compound or one product or one strain. (Read more: Prohibition’s Last Gasp: “CBD Only.”)

8. “CBD Is CBD—It Doesn’t Matter Where It Comes From.”

Yes it does matter. The flower-tops and leaves of some industrial hemp strains may be a viable source of CBD (legal issues notwithstanding), but hemp is by no means an optimal source of cannabidiol. Industrial hemp typically contains far less cannabidiol than CBD-rich cannabis. Huge amounts of industrial hemp are required to extract a small amount of CBD, thereby raising the risk of toxic contaminants because hemp is a “bio-accumulator” that draws heavy metals from the soil.

Single-molecule CBD synthesized in a lab or extracted and refined from industrial hemp lacks critical medicinal terpenes and secondary cannabinoids found in cannabis strains. These compounds interact with CBD and THC to enhance their therapeutic benefits.

 

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