Studies

The existence of hallucinations, delusions, and organic brain dysfunction in heavy cannabis users seems to be associated with cannabinoid levels in hair. The continuation of persistent symptoms 3 months after the discontinuation of cannabis abuse, was a remarkable finding. SCIENTIFIC SIGNIFICANCE: We provide evidence that chronic and heavy cannabis abuse results in long-lasting brain dysfunction in all users and in long-lasting schizophrenia-like psychotic symptoms in more than half of all users. These findings suggest a reevaluation of the current classification of cannabis as a "soft narcotic" which erroneously, therefore, is typically considered harmless. (Am J Addict 2017;XX:1-8).

Detailed Information
. Patients freely share their “medicine” with family and friends, and parents are self-diagnosing, and subsequently dosing their children with high-concentration marijuana products for conditions that may simply not exist (attention-deficit/hyperactivity disorder, anxiety, etc.); or allow their medical cards to expire and continue to grow their own.
The use of marijuana for medical conditions, including pain, needs robust studies, and subsequent products need more regulation and consistency for public consumption. Colorado is an example of the societal effect across a wide spectrum of arenas that comes with rampant cannabis use, particularly in youth use and impaired driving fatalities. The problems Colorado is seeing completely transcend “responsible use” or “marijuana as medicine.” 

CONCLUSIONS:
Medical marijuana law exposure between age 14 to 18 likely has a delayed effect on use and education that persists over time.

A common theme among every article in this issue is the overlap be- tween NMUPD, excessive drinking, and marijuana and other forms of substance use. In every investigation, nonmedical users were observed to have a history of using alcohol, marijuana, tobacco, and other psycho- active substances. Kalyanam, Katsuki, Lanckriet, and Mackey (2017)
Kalyanam, J., Katsuki, T., Lanckriet, G., & Mackey, T. K. (2017). Exploring trends of non- medical use of prescription drugs and polydrug abuse in the Twittersphere using un- supervised machine learning. Addictive Behaviors, 65, 289–295. http://dx.doi.org/10. 1016/j.addbeh.2016.08.019.

“In this observational study,” it found that “initiating marijuana use after treatment was associated with worse PTSD symptoms, more violent behavior, and alcohol use. Marijuana may actually worsen PTSD symptoms or nullify the benefits of specialized, intensive treatment. Cessation or prevention of use may be an important goal of treatment.”

What makes this new study more compelling than previous studies is that the researchers followed the same individuals for over 50 years from a young age to adulthood.  This is precisely what one needs to solve the chicken or egg riddle with respect to cannabis and violence:  just look and see which one happens first.
One fifth of those who were pot smokers (22%) reported violent behavior that began after beginning to use cannabis, whereas only 0.3% reported violence before using weed.  Continued use of cannabis over the life-time of the study was the strongest predictor of violent convictions, even when the other factors that contribute to violent behavior were considered in the statistical analysis.
 In conclusion, the results show that continued cannabis use is associated with a 7-fold greater odds for subsequent commission of violent crimes.  This level of risk is similar to the increased risk of lung cancer from smoking cigarettes over a similar duration (40 years).  The authors suggest that impairments in neurological circuits controlling behavior may underlie impulsive, violent behavior, as a result of cannabis altering the normal neural functioning in the ventrolateral prefrontal cortex. 

A new study suggests marijuana smokers may be significantly more likely to develop an addiction to other drugs and alcohol than people who don’t use marijuana.
The study, published in JAMA Psychiatry, included almost 35,000 adults who were interviewed three years apart. At the time of the first interview, almost 1,300 used marijuana. After three years, two-thirds of people who used marijuana had some form of substance use disorder, compared with less than 20 percent of people who did not use marijuana in the previous year.

These results from an uncontrolled study support the animal studies and prior reports showing that CBD may be a promising treatment for TRE and it is generally well-tolerated in doses up to 25mg/kg/day. Epidiolex is now being investigated in randomized controlled studies in DS and LGS.

More Positive Results With Cannabidiol in Epilepsy (You will need to google this title in order to get the article to avoid creating an account)
They found a reduction of the total number of seizures by a median of 38% at 3 months and 31% at 6 months.
These patients started on a cannabidiol (CBD) dose of 2 mg/kg per day, which was increased to a maximum tolerated dose or to 25 mg/kg per day.
Of the 25 patients enrolled in the study, two discontinued treatment before 6 months. One boy stopped medication after a few months because of intolerable diarrhea, and another patient discontinued the drug because of persistent nausea/vomiting. One patient didn't report 6-month data at the time of the analysis.
More than three quarters (77%) of the 22 remaining patients experienced fewer seizures after 6 months.
However, he stressed that the study was uncontrolled, symptoms were self-reported by families, and there has been a lot of news coverage of medical marijuana for the treatment of epilepsy. "Many parents had been avidly desirous of their child going on this cannabidiol because of what they had read in the lay press, so they were primed to believe this cannabidiol might be beneficial." On the other hand, he said, it's important to keep in mind that these children have "horrible epilepsy" and most have been on more than 10 medications for seizure without success. "Any improvement to that degree in this population that is sustained is a pretty dramatic response."

"We found support for the synergistic effect on an individual level; people who tend to use more marijuana also tend to use more opioids," said Scott Novak, PhD, senior research scientist at RTI International, a leading research institute in Research Triangle Park, North Carolina.
What's worrisome is that the positive association between cannabis and opioid use is growing stronger. The study found that over time, people were using these drugs more often; there were more opioids days and more cannabis days.

Twenty-eight studies were undertaken to evaluate the effectiveness of cannabinoids for chronic pain. Of these, only 2 were found to be at low risk of bias. 

Overall, these studies seem to indicate that cannabinoids have a significant role to play in the management of chronic pain. However, there are important issues that limit the validity of this conclusion. First and most important is how the improvement in pain was evaluated. In many of the studies, only instruments to measure the level of pain, most notably the Visual Analogue Scale, were used. This is fine when one is measuring acute pain. But when it comes to chronic pain—which is what the studies were looking at—the most important measures of the impact of any treatment are improvement in functioning and other objective measures, such as reduction in use of analgesic medications. 

Current marijuana use was positively related to frequency of child physical abuse and negatively related to physical neglect.Density of medical marijuana dispensaries and delivery services was positively related to frequency of physical abuse. As marijuana use becomes more prevalent, those who work with families, including child welfare workers must screen for how marijuana use may affect a parent's ability to provide for care for their children, particularly related to physical abuse.

PLEASE note:  23 states in the US have legalized marijuana- using the entire plant as medicine not isolating specific cannabinoids as done in research labs.
However, Dr. McCormick was quick to warn of the dangers of individuals self-medicating, but stated he hopes the research would lead to a "safe synthetic equivalent being available in the future."

The principal psychoactive constituent of cannabis is Δ9-tetrahydrocannabinol (THC). THC administered intravenously is characterized by the appearance of psychopharmocological effects within 5 minutes, which continue for at least 90 minutes, providing an excellent experimental window.[12] In within-subjects tests with nonclinical volunteers, D'Souza, in particular, has shown that intravenous administration of THC causes schizophrenia-like symptoms, perceptual disturbances, anxiety, and impaired working memory (eg, Morrison et al[13] and D'Souza et al[14,15]). Similar but more pronounced results were found in patients with schizophrenia.[15]

"But what we've found out is that as alcohol-impaired driving is going down, drug-impaired driving is going up." 

• THC moves more rapidly than alcohol out of the bloodstream and into the body, making it harder to detect accurately with a blood test.

The researchers pooled results from studies that tested marijuana against placebos, usual care or no treatment. That's the most rigorous kind of research but many studies found no conclusive evidence of any benefit. Side effects were common and included dizziness, dry mouth and sleepiness. A less extensive research review in the journal found similar results.

Marijuana use for medical conditions is an issue of growing concern. Some Veterans use marijuana to relieve symptoms of PTSD and several states specifically approve the use of medical marijuana for PTSD. However, controlled studies have not been conducted to evaluate the safety or effectiveness of medical marijuana for PTSD. Thus, there is no evidence at this time that marijuana is an effective treatment for PTSD. In fact, research suggests that marijuana can be harmful to individuals with PTSD.

The study involved 50 participants diagnosed with dementia and behavioral symptoms. They were divided into two groups: one was given 1.5 milligrams of medical marijuana pills, while the other received placebo. They took the pills three times a day for three weeks. The researchers also assessed their behavioral symptoms by giving them a dementia questionnaire called Neuropsychiatric Inventory prior to the study and after the three-week study period for comparison.
The test scores showed no significant difference between those who took the medical marijuana pills and the placebo group. However, the study confirmed that the pills are safe to take with minor side effects.

Participants in a study who had used the drug daily for around three years in their teens had an abnormally shaped hippocampus by the time they were in their early 20s.
They also performed around 18 per cent worse in long-term memory tests than individuals who had never touched the drug.

A study by a team from Children's Hospital Colorado that was presented during the AES Annual Meeting in December 2014 and has recently been accepted for publication in the journal Epilepsy & Behavior, found that artisanal "high CBD" oils resulted in no significant reduction in seizures in the majority of patients and in those for whom the parents reported improvements, these improvements were not associated with improvement in electroencephalograms (EEGs), the gold standard monitoring test for people with epilepsy.

Additionally, in 20% of cases reviewed seizures worsened with use of cannabis and in some patients there were significant adverse events. These are not the stories that you have likely 

heard in your public hearings, but they are the reality of practitioners at Children's Hospital Colorado who have cared for the largest number of cases of children with epilepsy treated with cannabis in the U.S.

New research out of Britain’s Warwick University has found a “significant link” between marijuana use and mania, which can range from hyperactivity and difficulty sleeping to aggression, becoming delusional and hearing voices



 

Medical cannabinoids are here to stay, but intellectual honesty is imperative if we are moving toward exploiting their potential benefits. Owing to rising THC concentrations of products, "medical" marijuana is rarely good medicine. This review has identified the dangers associated with whole­plant marijuana, whether used for recreational or for supposedly medical purposes.

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The reviewers consider areas in which little research has been conducted. This includes possible health consequences of secondhand marijuana smoke; the long-term impact of prenatal marijuana exposure; the therapeutic potential of the individual chemicals found in the marijuana plant; and effects of marijuana legalization policies on public health.

The damaging effects remain even if the person stops smoking the drug
·         Teenagers are at particular risk because their brains are still developing
·         Smoking cannabis affects critical thinking and memory
·         Researchers warn that stronger varieties today are causing more damage 

For the first time, researchers at Northwestern University have analyzed the relationship between casual use of marijuana and brain changes – and found that young adults who used cannabis just once or twice a week showed significant abnormalities in two important brain structures.

Marijuana for Epilepsy: Weighing the Evidence, Epilepsy Notes, Andrew N. Wilner, MD, March 25, 2014

In 2011 (more than 2.5 years ago) in "Marijuana: A Viable Epilepsy Therapy?" I reviewed the possibility of marijuana (Cannabis sativa) for the treatment of epilepsy. That article concluded, "More research is needed before patients should consider marijuana for seizure relief, particularly because this represents criminal activity under US federal law and may be accompanied by adverse medical (and legal) events."

What Hasn't Changed Since 2011?

What hasn't changed is the desperation of people with uncontrolled seizures and their families. Heather Jackson, the mother of Zaki, one of the children who responded to Charlotte's web, stated in a Huffington Post video interview, "If you wanted to take my money, I would give it to you. I wanted to save my boy."^[13] Such vulnerable families need to be protected from scams, false promises, and dangerous drugs.

Conclusions

Despite the recent journalistic hype, my 2011 conclusions about "medical marijuana" have not changed. Marijuana is still a schedule I drug. It is not FDA-approved for the treatment of epilepsy or any other neurologic condition. Its medical (and recreational) use is still illegal under federal law. There are no controlled trials demonstrating that marijuana is "safe" or "effective" for the treatment of epilepsy. On the other hand, there is evidence that marijuana may be harmful, particularly in the developing brain after regular use. Synthetic cannabinoids appear even more toxic.

However, for many people with epilepsy, seizures cannot be controlled with FDA-approved medications. Other treatment options, such as the vagus nerve stimulator, responsive neurostimulation, or the ketogenic diet, may not work or may not be appropriate choices. For patients who have exhausted conventional therapies, medical marijuana, for which there is anecdotal evidence of seizure control, could be considered as an unproven, "compassionate use" alternative. Any such use of marijuana should be carefully monitored by a physician. A better alternative for children with intractable epilepsy would be enrollment in the new Epidiolex clinical trial.

Recent attention has been focused on the long-term impact of cannabis exposure, for which experimental animal studies have validated causal relationships between neurobiological and behavioral alterations during the individual's lifetime.

Institute for Behavioral and Health- 
The threat to public safety on the roadways posed by marijuana-impaired driving has been pushed to the top of nation’s agenda by the legalization of marijuana in Colorado and Washington as well as by the legalization of “medical” marijuana in 18 states and the District of Columbia. Marijuana has significant impairing psychological and physiological effects on driving. 

Conclusions/Significance: Sustained cannabis abstinence moderately improved critical tracking and divided attention performance in chronic, daily cannabis smokers, but impairment was still observable compared to controls after 3 weeks of 

abstinence. Between group differences, however, need to be interpreted with caution as chronic smokers and controls were not matched for education, social economic status, life style and race.