Eight states and the District of Columbia have legalized cannabis use for recreational purposes, and 28 states plus the District of Columbia have legalized cannabis for medical purposes. Recent studies suggest that 45-80% of individuals who seek cannabis for medical purposes do so for pain management, and an estimated 6%-39% of patients prescribed opioid medication for pain are also utilizing cannabis. Over one-third of patients seeking cannabis for medical purposes list post-traumatic stress disorder (PTSD) as the primary reason for the request. Approximately 15% of Veterans who are treated in Department of Veterans Affairs (VA) outpatient PTSD clinics report recent (past 6 months) cannabis use.

Given the social, political, and legal changes surrounding cannabis use, physicians in both VA and non-VA settings will increasingly need to engage in evidence-informed discussions about the potential benefits and harms of cannabis use with their patients. Despite the rapidly moving legislative landscape, there is little comprehensive and critically appraised information available about what is known and not known about cannabis use for the treatment of chronic pain or PTSD.

The objectives of this systematic review are to: 1) assess the physical and mental health outcome effects of cannabis in patients with chronic pain; 2) assess the physical and mental health outcome effects of cannabis in patients with PTSD; 3) assess the impact of short- and long-term cannabis use on the risk of adverse effects such as pulmonary diseases, cardiovascular diseases, cancer, cannabis use disorder (CUD), and psychosis in the general adult population; and 4) provide a broad overview of more recently recognized “emerging harms” of cannabis use.

Summary of Findings

Overall, there is limited evidence examining the effects of cannabis on chronic pain. There are relatively few methodologically sound trials, and most trials had small sample sizes. There is low-strength evidence that cannabis-based treatments with precisely defined THC:CBD content (most in a 1:1 to 2:1 ratio) have the potential to improve pain, spasticity, and sleep in select populations with MS. However, the results are inconsistent across studies, the long-term benefits and harms are unclear given the brief follow-up duration of most studies, and there is insufficient evidence of the effects on quality of life or functional status.

Moreover, the applicability to current practice may be low in part because the formulations studied may not be reflective of what most patients are using, and because the consistency and accuracy of labeled content in dispensaries are uncertain. There is insufficient evidence to determine the effects of cannabis in populations other than MS.

Two recent systematic reviews examined the efficacy of cannabis and cannabinoids for the treatment of chronic pain,14,15 and reported mixed findings for the management of various chronic pain symptoms related to conditions such as MS, fibromyalgia, peripheral and central neuropathy, human immunodeficiency virus (HIV), rheumatoid arthritis, and cancer.

Specifically, across a subset of 8 trials (N=1370) that evaluated non-synthetic cannabinoids (THC or nabiximols), cannabis treatments were associated with a non-significant trend toward benefit (proportion showing greater than 30% reduction in pain: 37% versus 31%; odds ratio [OR] 1.41; 95% confidence interval [CI], 0.99 to 2.00]) compared to placebo and no difference in quality of life among groups.14 While the authors concluded that there is low- to moderatestrength
evidence supporting efficacy of cannabis in chronic pain (limited mainly to MS or neuropathic pain), a separate group reviewed and re-analyzed a similar set of published articles, and determined that there is insufficient to low-strength evidence examining the use of medical cannabis to treat chronic non-cancer pain.15 Our own interpretation of the evidence is consistent with the latter review because the vast majority of the trials cited in support of a moderatestrength evidence rating were methodologically flawed. Both reviews found insufficient evidence examining the use of medical cannabis for pain related to other conditions such as
cancer, rheumatoid arthritis, and musculoskeletal pain.

While the prior reviews included the pharmaceutical, synthetic prescription medications dronabinol and nabilone, studies of these drugs did not contribute substantially to the body of evidence for chronic pain. There was only one small study with high risk of bias examining the effects of nabilone in chronic pain.
We also searched the primary literature and found an additional 8 studies25-32 that met our inclusion criteria and were not included in the prior reviews. Those additional studies included patients with pain related to MS (4 studies) and mixed pain-related conditions (4 studies), but we found no additional studies of neuropathy.

The Report

 Benefits and Harms of Cannabis in Chronic Pain or Post-traumatic Stress Disorder: A Systematic Review, November 2016 [125 Pages, 1.3MB]

https://documents.theblackvault.com/documents/health/cannabis-nov16.pdf

The post Benefits and Harms of Cannabis in Chronic Pain or Post-traumatic Stress Disorder: A Systematic Review, November 2016 first appeared on The Black Vault.

Drug traffickers and out-of-state opportunists are exploiting Colorado’s medical marijuana laws. Recent revisions to state law have done little to prevent the
involvement of criminals and individuals who use the law for financial gain.

Currently, convicted criminals and known drug traffickers participate in Colorado’s medical marijuana industry. Moreover, an influx of traffickers and entrepreneurs from other states is seeking to cash in on Colorado’s medical marijuana industry. Investigative and intelligence information reveal a significant volume of Colorado-produced marijuana being diverted to out-of-state marijuana markets where it commands a higher price. This activity is facilitated both by  those directly involved in medical marijuana businesses, as well as illicit brokers who seek “excess” or diverted marijuana to sell to marijuana traffickers.

Background

When Amendment 20, which established the state constitutional right for medicinal marijuana in Colorado, was passed by citizen petition in November 2000, the law dealt with the use and distribution of medical marijuana in a very general fashion. By 2010, Coloradans had witnessed a proliferation in the number of medical marijuana patients, caregivers, commercial dispensaries, sophisticated grow operations, and various associated business ventures such as marijuana brokers and consultants. Vague legislation and loose enforcement combined with an aggressive, profitable industry presents ample opportunity for diversion and exploitation. Colorado’s legislative attempts to address the evolving industry are described in DEA-DEN-DIB-012-12. This document identifies avenues being used by drug traffickers and “ganjapreneurs” exploiting the permissive medical marijuana industry for profit.

Download the Document

 DEA Intelligence Brief: Green Acres is the Place to Be – Drug Traffickers and “Ganjapreneurs” Are Exploiting Colorado’s Medical Marijuana Industry, April 24, 2012 [11 Pages, 2.5MB]

https://documents.theblackvault.com/documents/dea/16-00673-F.pdf

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In late October 2013, a 31-year-old British national woman reportedly died as a result of cannabis toxicity.

Although a recent review confirmed the coroner’s findings. the exact cause of death remains unclear and several outside organizations dispute claims that the woman’s death was caused by cannabis toxicity.

Significance

Death from cannabis toxicity is highly unusual and this is only the second documented case of this kind to occur in the United Kingdom (UK). In 2004, a 36-year-old man from Wales also is believed to have died as a result of cannabis toxicity. While the woman’s official cause of death is disputed by several marijuana advocacy groups and other medical experts, the coroner found no evidence of any serious medical condition or natural cause of death and, therefore, concluded that cannabis toxicity was the most likely cause.

Although very few deaths have been attributed to cannabis toxicity, marijuana has a wide range of toxic health effects and is potentially fatal, even when
used in small doses.

For example, studies have shown that marijuana increases the heart rate and blood pressure shortly after use, which can result in cardiac arrest, stroke, and other acute pulmonary or cardiovascular reactions, especially in individuals with pre-existing conditions.

Although increasing cannabis consumption and the introduction of more potent varieties of the drug could result in other health issues, fatal overdoses will likely remain rare.

A greater concern is that users will combine marijuana with other substances and/or drive a vehicle while under the influence of the drug.

DEA Bulletin BUL-089-14 – Cannabis Toxicity Death, March 2014

DEA Bulletin BUL-089-14 – Cannabis Toxicity Death, March 2014 [4 Pages, 1.1MB]

https://documents.theblackvault.com/documents/dea/BUL-089-14.pdf

The post DEA Bulletin BUL-089-14 – Cannabis Toxicity Death, March 2014 first appeared on The Black Vault.