New Guideline Cautions Against Use of Medical Cannabis for Chronic Pain

By Pat Anson

One of the nation’s largest medical organizations has released a cautious new guideline that recommends against the use of medical cannabis for most patients with chronic noncancer pain. The American College of Physicians (ACP) represents over 160,000 internal medicine doctors and medical students in the United States.

The ACP’s “Best Practice Advice,” recently published in the Annals of Internal Medicine, is based on a review of medical cannabis in over three dozen randomized controlled trials and observational studies.

It urges physicians to warn patients that the harms of cannabis and cannabinoid use outweigh their potential benefits. Medical cannabis may produce small improvements in pain, function and disability, but potential harms include addiction and cognitive issues, as well as cardiovascular, gastrointestinal and pulmonary problems.

“This Best Practice Advice is important for practicing physicians when counseling our patients on the potential use of cannabis and cannabinoids to treat their chronic noncancer pain,” said Isaac Opole, MD, President of the ACP.

“As the use of cannabis for medicinal purposes grows it’s critical to open that dialogue and review the emerging evidence related to benefits and harms. We need to raise awareness and get the word out to ensure that patients have the information they need to make informed decisions.” 

The use of cannabis has steadily grown in recent years, with polls showing that nearly one in four U.S. adults have used medical or recreational cannabis at least once in the past year. Although chronic pain is the most common reason patients use medical cannabis, most have never discussed it with their physicians. Many get their information about cannabis from dispensary workers, who typically do not have any medical training.

The ACP recommends against the use of cannabis for chronic pain by young adults and adolescents, patients with substance use disorders, patients with a serious mental illness, patients who are pregnant or breastfeeding, and frail patients at risk of falling. Inhaled cannabis is not recommended for any patients.

There is some evidence that patients with painful neuropathy may benefit from using cannabis products that contain equal amounts of CBD and THC. 

“Evidence shows that in patients primarily with chronic noncancer neuropathic pain, a cannabis formulation with comparable THC–CBD ratio probably results in small improvements in pain severity (about 0.5 to 1.0 points on a zero to 10 pain scale) and function or disability (about 0.4-point improvement on the pain scale),” the ACP said.

“However, the evidence is insufficient to show benefit for other types of chronic noncancer pain. High THC–CBD ratio synthetic or purified products may result in small improvements in pain severity (about 0.5- to 1.0-point on the pain scale) but no change in overall function or disability.”

Currently, 24 states in the District of Columbia have legalized cannabis for adult recreational and medical use. It is legal for medical use only in an another 14 states. 

Research into the pain-relieving benefits of cannabis has been slow in the U.S., largely due to marijuana’s status as a Schedule 1 controlled substance, the same category as LSD and heroin. The DEA dragged its feet on implementing a request from the Biden Administration to reclassify marijuana as a Schedule 3 controlled substance that could be used for medical purposes. Rescheduling marijuana does not appear to be a priority for the Trump Administration.

There are only three cannabis-based medicines approved for use by the FDA: dronabinol and nabilone, which are used to treat nausea and loss of appetite, and a concentrated form of CBD used to control seizures from childhood epilepsy.

A German biotech company is in preliminary talks with the FDA about approving an experimental cannabis extract for chronic low back pain. A recent study in Australia found patients with chronic pain and other health conditions showed significant improvement in their quality of life, fatigue and sleep after taking cannabis oil over a one-year period. There were also small improvements in pain, anxiety and depression.

Cannabis Oil Has Long-Term Benefits for Chronic Health Conditions

By Pat Anson

Patients suffering from chronic pain and other chronic health conditions showed significant improvement in their quality of life, fatigue and sleep after taking cannabis oil over a one-year period, according to a new Australian study published in the journal PLOS One. Anxiety, depression and pain also improved during the course of the study, one of the first to demonstrate the long-term benefits of medical cannabis.

Researchers at the University of Sydney followed over 2,350 patients from across Australia who ingested cannabis oils containing both THC and CBD. Nearly two-thirds of the participants suffered from chronic musculoskeletal or neuropathic pain. Others lived with insomnia, depression, fatigue and anxiety. Participants did not get adequate relief from conventional treatments.   

Researchers found that the initial improvements in health over three months were maintained over 12 months. Because there was no control or placebo group, the improvements can’t be directly attributed to cannabis oil. But researchers noted that most of the participants stopped or reduced their use of opioid pain medication by the end of the study.

“This is promising news for patients who are not responding to conventional medicines for these conditions," said lead author Margaret-Ann Tait, a Research Manager and PhD Student at Sydney Nursing School, University of Sydney. 

The ratio of THC and CBD in the cannabis oil varied. Patients with conditions like fatigue or insomnia did better with oils that contained more THC; while those with chronic pain did better with higher ratios of CBD.

“We observed differences in the degree of improvement in fatigue, insomnia, anxiety, and depression depending on the ratio of CBD and THC in average daily MC (medical cannabis) doses. For these outcomes, average daily doses of THC-dominant MC was associated with greater odds of improvement than CBD:THC-balanced MC,” researchers said.

“Our findings suggest that people with chronic pain conditions experience better outcomes over time on lower doses of CBD when combined with smaller amounts of THC at a ratio of 10:1.”

Because this was an observational study, with different ratios of THC and CBD, researchers said they could not draw definitive conclusions about which ratios work best for each condition. The oils are made by Little Green Pharma , which funded the Quality of Life Evaluation Study (QUEST).

A 2023 survey of Australian patients with chronic illness found significant improvements in their physical and mental health after they started using medical cannabis. Most of the cannabis products in that study were oils containing CBD and/or THC.   

Nearly All Hemp Products Could Get You High

uy Crystal Lindell

The promise of legalized hemp products was always that you couldn’t high on them, and they would be more regulated and thus safer for consumers. But a new white paper reveals that most hemp products contain intoxicants like THC, synthetic cannabinoids, kratom or even hallucinogenic mushrooms.

Hemp products have only been sold legally in the United States since 2021, the result of hemp being legalized as part of the 2018 Farm Bill. The thinking at the time was that hemp contained such minuscule amounts of THC that farmers could grow hemp again as a cash crop to make things like rope, fuel and horse feed. 

But it didn’t take long for the cannabis industry to figure out how to tweak the chemical composition of hemp to make delta-8 tetrahydrocannabinol (THC) and other potent synthetic cannabinoids, which you can get high on.

The white paper, called The Great Hemp Hoax, examined the composition and potency of hemp products sold in two southern California counties, focusing on chemically synthesized cannabinoids. The results reveal the hemp market has evolved far beyond what lawmakers and regulators intended. 

In an analysis of 104 hemp-based products from 68 brands, researchers found that 95 percent contain synthetic cannabinoids, which are illegal in California. These compounds are often far more potent than naturally occurring THC.  

More than half of the tested products exceeded the federal 0.3 percent THC limit, technically classifying them as cannabis rather than hemp under federal law. In fact, researchers found that many of these products vastly exceeded THC potency limits imposed on regulated cannabis products. 

Some hemp gummies contained up to 325 milligrams of synthetic THC per serving — which is way over the 10mg cap in California’s legal market.

You could also get high on hemp-derived vape products, which had an average THC equivalency level 268% above the state’s threshold for adult-use cannabis.

Some hemp products — such as Cheech & Chong’s “Kosmic Chews” — even contain psychoactive additives like kratom, while others include hallucinogenic mushrooms.

THE GREAT HEMP HOAX

“Much of what’s being sold as ‘hemp’ today isn’t hemp at all — it’s a cocktail of synthetic intoxicants and illicit THC masquerading as a natural, legal product. It's essentially the ultra-processed junk food of cannabis, but far more dangerous," said Tiffany Devitt, Director of Regulatory Affairs at Groundwork Holdings, which helped establish the cannabis industry in California and is trying to protect it from hemp competitors. 

"These companies aren't just skirting regulations – they're putting consumers at serious risk with designer drugs that look a whole lot more like ‘Spice’ than natural hemp."

Devitt and other authors of the white paper believe the contamination is not accidental. They said that filtering out or reducing the amount of delta-8 or delta-9 THC in hemp products is inefficient and cost-prohibitive, incentivizing companies to not do it.

“Because of these inefficiencies, most so-called ‘hemp-derived’ THC products are, in reality, synthetic cannabis — reminiscent of illegal products like ‘Spice’ that flooded California a decade ago,” they wrote. 

The lack of oversight also results in tax evasion. Over 90% of the hemp products analyzed were sold without collecting California’s sales tax, and none of the vendors paid the state’s cannabis excise tax. 

“The failure to ensure tax accountability allows unregulated ‘hemp’ products to undercut the legal cannabis market while depriving the state of revenue meant for public health, environmental mitigation, and enforcement,” the authors concluded. 

The white paper calls for all hemp products containing THC to be regulated as cannabis within California, to protect consumers and workers.

“These illicit operations aren’t just dangerous — they’re undercutting California’s regulated cannabis businesses and workers,” said Kristin Heidelbach, Legislative Director of the United Food and Commercial Workers Union, which helped pay for the white paper.

“While licensed cannabis businesses provide good union jobs and comply with strict labor standards, many synthetic ‘hemp’ producers manufacture out-of-state or import from overseas, dodging California’s labor laws and tax obligations.”

This isn’t just a California issue. A recent study found that nationwide sales of hemp products reached $2.8 billion in 2023. They are legally sold to minors in many U.S. states, even in those where cannabis is illegal. In 2023, about 11% of 12th graders said they had used hemp products containing Delta-8 THC.  

Experimental Cannabis Extract Has ‘Potential to Replace Opiates’

By Pat Anson

A German biotech company says it is seeking regulatory approval in Europe and the United States for an experimental cannabis extract that could be an alternative to opioid pain medication.

Vertanical recently completed two Phase 3 studies of its new drug – called VER-01 – on over 1,000 patients with chronic low back pain who didn’t get sufficient relief from non-opioid analgesics.

One study compared VER-01 to a placebo, while the second trial compared the drug’s safety and tolerability to patients treated with opioids. The company told The Times it was awaiting publication of the studies’ findings in The Lancet before making them public.

“VER-01 reduces pain without creating dependency or having an abuse potential,” said Clemens Fischer, MD, Vertanical’s CEO. “It has the full potential to replace opiates as it’s more effective. It’s a real alternative for chronic patients — the first one.

“Pain patients around the world are trapped in a vicious cycle of pain, insomnia, limited mobility, and depression. VER-01 has the potential to successfully break this cycle.”

VER-01 is a “full-spectrum” extract derived from cannabis sativa leaves and flowers. Although it contains THC, the main psychoactive substance in cannabis, Fischer says patients enrolled in the studies didn’t become high or intoxicated. About 25 percent did “feel a bit dizzy” for two weeks after they started taking it.

Participants also didn’t get “the munchies” or gain weight, a well-known side effect of cannabis.

“We were looking very carefully, because that’s what we hear from cannabis smokers — that the appetite increases as well their weight. But we haven’t seen any increase in weight,” Fischer told The Times.

Vertanical is seeking regulatory approval of VER-01 in Europe and with the UK’s Medicines and Healthcare Products Regulatory Agency. If granted, VER-01 would be the first cannabis-based medicine approved for chronic pain. It would be sold under the brand name Exilby and be taken orally in drops.

The timeline for approval in Europe may be as soon as this summer, but it’s likely to take longer in the U.S.

“We are seeking regulatory approval in the US and are in talks with the FDA. For approval in the US, a further phase 3 study with US patients in the indication of chronic low back pain will start in Q2 2025,” Merit Renner, Senior Manager of Business Development at Vertanical, told PNN in an email. “This, together with the phase 3 study successfully conducted in Europe, will form the basis for approval in the US.”

Vertanical also plans further studies of VER-01 on patients with osteoarthritis and peripheral neuropathy.

Research into the pain-relieving properties of cannabis has been slow in the U.S., in large part because of marijuana’s status as a Schedule 1 Controlled Substance, the same classification as LSD and heroin. The DEA recently allowed more marijuana to be used for research purposes, but has dragged its feet about reclassifying marijuana as a Schedule 3 substance that could be used for medical purposes. Until marijuana is rescheduled, VER-01 is unlikely to get FDA approval.

Some recent studies have shown that certain cannabinoids found in marijuana -- cannabidiol (CBD), cannabigerol (CBG), and cannabinol (CBN) – block pain signals in the peripheral nervous system, not the brain, and don’t have a psychoactive effect that could lead to abuse.

“These findings open new avenues for the development of cannabinoid-based therapies,” said Mohammad-Reza Ghovanloo, PhD, lead author of a study published in PNAS and a research scientist at Yale School of Medicine. “Our results show that CBG in particular has the strongest potential to provide effective pain relief without the risks associated with traditional treatments.”

The cannabinoids in the Yale study interact with a protein in cell membranes called Nav1.8, which blocks peripheral nerves from transmitting pain signals. Inhibiting Nav1.8 is the same method used by Journavx (suzetrigine), a non-opioid analgesic recently approved by the FDA for relieving moderate to severe acute pain in adults.

CBD Is a Scam. Will New Cannabinoid Products Be Any Different?

By Crystal Lindell

CBD didn’t do anything for me. I tried different brands, different formats, and different price points because I really wanted it to work. 

I like to describe my experience like this: Wine and grape juice are both made from grapes – but that doesn’t mean a glass of Welch's has the same effect as a glass of wine.

From the beginning, CBD always sounded a little too good to be true. Touted as the “cannabis that doesn’t get you high, but treats chronic pain,” it was supposed to be the new holy grail of pain medicine. After all, doctors are looking for something to give patients that doesn’t give them any pleasurable mental effects, but does actually treat their pain. 

Unfortunately, CBD was too good to be true because the marketing and hype are fake. 

For a while, CBD seemed to be sold in every gas station, supermarket and convenience store. Filling shelves with everything from candies to liquid elixirs. 

But I’ve noticed over the last couple years that a lot of those CBD display cases have either shrunk or disappeared completely. 

It’s not just in my head. A 2023 article from SupplySide Supplement Journal was among the first to report on the downward trend in the sector. 

Headlined: "Major CBD brands report steep annual sales declines,” it focused on the fact that two major brands, CV Sciences and Charlotte’s Web, reported depressed earnings and “significant downsizing initiatives.”  

Almost a year later, The New York Times published a similar article, with the headline “Companies Were Big on CBD. Not Anymore.” 

The article blamed the sales decline on a “lack of federal regulation and a mishmash of state laws [that] made selling products featuring the cannabis-derived ingredient not worth the trouble.” 

I think that’s just generous industry framing. Sales declined because CBD products were not good and inordinately expensive. CBD did not do much of anything for most people, and the price points were astronomical. 

A 2024 study at Bath University in the U.K. makes the point directly. The subhead on a press release reads: "There is no evidence that CBD products reduce chronic pain, and taking them is a waste of money and potentially harmful to health, new research finds." 

“CBD presents consumers with a big problem,” said Professor Chris Eccleston, who led the research at the Centre for Pain Research at Bath. “It’s touted as a cure for all pain but there’s a complete lack of quality evidence that it has any positive effects. It’s almost as if chronic pain patients don’t matter, and that we’re happy for people to trade on hope and despair.”

Eccleston is definitely right there. The views of chronic pain patients are often dismissed. That’s why many doctors are happy to push placebos and snake oils on us, as long as it means they can avoid prescribing any opioids. 

The decline in CBD’s popularity hasn’t stopped the medical industry from trying to find other ways to use cannabinoids to treat pain without causing the mental high. 

Last week, researchers at Stanford University and Washington University School of Medicine in St. Louis announced that they designed a new compound to potentially treat chronic pain by targeting type 1 cannabinoid (CB1) receptors in the peripheral nervous system.

In a paper published in Nature, the researchers said the compound “could effectively treat multiple types of pain in mouse models without causing the psychoactive side effects typically associated with the CB1 receptor or causing the mice to build up a tolerance to it.”

So it’s still being studied in mice, which means it’s a long way off from being offered to humans, if it ever is. 

While this is a synthetic version of a cannabinoid – as opposed to the natural version – I’m skeptical of anything that claims to treat physical pain without psychoactive side effects.  

It’s also frustrating to see researchers still trying to push for this at all. 

In a news release about the study, co-author Alexander Powers,  who conducted the work while earning his PhD in chemistry at Stanford, said: “This molecule shows that we can get a separation between the side effects and the analgesic effects – we can target the CB1 receptor and get the good effects without the bad.”

The most telling part of that quote is at the very end: “without the bad.”

The implication is that psychoactive effects are inherently bad. I disagree. When you’re in extreme pain, it impacts you emotionally and mentally. So it only makes sense that medications that treat pain also improve your mood. That’s a good side effect. 

Maybe research like that coming out of Stanford will lead to new breakthroughs. Maybe they will finally discover the holy grail of pain medication that they desperately seek. But I remain skeptical of any research from people who frame positive effects of pain medication as “bad.” 

You Can Get High on Hemp, Even Where Cannabis Is Illegal

By Katharine Neill Harris

In Texas, where I live, marijuana has long been illegal. Yet on a busy street in my Houston neighborhood, at least five stores within a half-mile of each other sell cannabis products that promise a strong high.

Texas isn’t alone. Due to a mix of recent legal changes and an uncertain policy landscape, residents in roughly half of American states have easy access to impairing hemp products that bear a strong resemblance to marijuana and are far less regulated.

As hemp sales soar – reaching nearly US$3 billion in 2023 – a number of states are tightening their restrictions, while experts are analyzing the public health implications. That’s why I analyzed hemp policies in all 50 states with some of my colleagues at Rice University’s Baker Institute, where I’m a drug policy fellow.

Same Plant, Different Policies

Marijuana and hemp are both varieties of cannabis sativa, a plant with many uses that produces thousands of compounds. Among them is the popular intoxicant delta-9 tetrahydrocannabinol, or delta-9 THC.

Hemp is widely valued as an industrial crop, and for most of American history, farmers freely cultivated it. But by the mid-20th century, lawmakers had grown increasingly opposed to marijuana and were concerned by hemp’s similarity to its impairment-causing cousin.

In an effort to permit hemp cultivation while prohibiting production of a psychoactive plant, the Agricultural Marketing Act of 1946 defined hemp as all parts of the cannabis plant with less than 0.3 percent concentration of delta-9 THC by dry weight. Cannabis that exceeded this threshold was considered marijuana.

The 1970 Controlled Substances Act ushered in the modern era of prohibition of marijuana and other drugs. Hemp remained technically legal, but because of its similarity to marijuana, it was listed as a Schedule I drug, alongside heroin and other substances deemed to have a high potential for abuse and no medical value.

Because of hemp’s Schedule I status, the Drug Enforcement Administration tightly regulated its production. But hemp farmers have long argued that these regulations were excessive – and in 2018, Congress agreed. That year, lawmakers passed a farm bill that removed hemp from the Controlled Substances Act and legalized the manufacture and sale of hemp and its derivatives.

Crucially, the 2018 bill still defines hemp as all parts of the plant and its derivatives that have less than 0.3 percent delta-9 THC. But it left a loophole: While delta-9 is the most well-known form of THC, it’s not the only one.

Other forms of THC, known as THC isomers, have similar effects. These isomers, like delta-8 and delta-10 THC, can be derived from the hemp plant, and like delta-9 THC, they can cause impairment. The 2018 Farm Bill legalized all of them.

In 2023, sales of hemp-derived cannabinoids reached US$2.8 billion. Market growth has been accompanied by a rise in adverse health events. Chemists have expressed alarm at how some hemp products are made, and analyses of commercially available products have found them to contain heavy metals, residual solvents and pesticides.

Given the lax regulatory environment, many public officials now question the lack of guardrails on this burgeoning hemp industry. As a result, officials and governments across the country are now enacting or considering policy changes.

Some States Have Age, Advertising and Potency Limits

In 2023, 11.4% of 12th graders said they had used hemp-derived delta-8 THC in the past year. Easy access to any substance can encourage use, and THC can have negative impacts on the adolescent brain.

While federal law prohibits the sale of tobacco and alcohol to individuals under 21, there is no similar national requirement for hemp. But at least 27 states that permit the sale of hemp-derived products now have minimum age requirements, and several others have pending legislation.

Lessons from the tobacco market also demonstrate that advertising restrictions can reduce the use of legal but potentially harmful products. Most efforts to curtail hemp advertising focus on youth. Sixteen states restrict the use of packaging and marketing materials that may appeal to minors. Meanwhile, federal regulations also limit youth-targeted marketing.

There are fewer restrictions on advertising to adults. The Food and Drug Administration does prohibit using unverified health claims to sell hemp products, but this standard gives the industry plenty of leeway. Hemp ads often tout their purported physical benefits, like reducing pain or improving sleep, or portray them as mood-boosters that can make one feel euphoric and aroused, with few downsides.

The use of products high in THC has been linked to greater risk of cannabis dependence and adverse mental health outcomes. Concerns about product potency have led all states with recreational marijuana markets to limit the amount of delta-9 THC in edible products. This threshold is typically around 10 milligrams, a dose that’s strong enough to affect most people.

Hemp is a different story. To satisfy federal requirements, hemp just has to have less than 0.3% delta-9 THC by weight. This limit sounds low, but the weight-based metric does not account for heavier products, like food and drinks.

For example, a 50-gram candy bar – roughly the size of a Snickers bar – with 150 milligrams of hemp-derived delta-9 THC is legal in the 34 states that don’t have milligram caps on hemp products. This is a dose 15 times higher than what any recreational marijuana market allows. Meanwhile, states that only restrict hemp’s delta-9 content also leave the door open to products with high amounts of other forms of THC.

At least 13 states have responded to potency concerns by adding milligram caps on the total THC permitted in a single serving of a hemp product. Some of these limits are so low – 1 milligram or less in Connecticut, New York, Montana and Rhode Island – that one serving is unlikely to cause impairment.

Enforcement Is a Wild Card

Only regulations that are enforced are effective, and states differ in the level of energy they devote to industry oversight.

In Virginia, the Office of Hemp Enforcement has issued over $12 million in fines to noncompliant hemp retailers since its creation in 2023. On the other end of the spectrum, Massachusetts considers hemp-derived THC products illegal, but it has not provided local jurisdictions with funding for enforcement, resulting in continued availability of prohibited products.

Some states with legal hemp markets have added additional sales taxes to help fund enforcement. In Nebraska, Missouri and Connecticut, attorneys general have sued hemp retailers for selling illegal items, marketing to minors and engaging in deceptive trade practices.

As the hemp industry expands, so will concerns about how to protect public health. The demand for THC, and the market to supply it, continues to grow. If lawmakers want to develop industrywide safety standards or deal with the challenges of online marketplaces that sell hemp products to minors, it will take action from Washington. In the meantime, many states and policymakers are exploring an expansive middle ground between unfettered access and blanket bans.

Katharine Neill Harris, PhD, is a Fellow in Drug Policy at Rice University’s Baker Institute for Public Policy. Her current research focuses on cannabis policy and the response to the overdose crisis.

This article originally appeared in The Conversation and is republished with permission.

6 Things to Try If Your Doctor Won’t Prescribe Opioid Pain Medication

By Crystal Lindell

Many doctors are extremely resistant to prescribing opioid pain medication for any reason these days. Whether it’s for post-operative pain, chronic pain or even pain from terminal cancer, patients are finding that doctors shrug their shoulders and tell them to go home and take ibuprofen.

Unfortunately, over-the-counter pain medication is just not effective in many cases, and that can leave patients in desperate situations. 

As someone who’s been navigating my own chronic illness for more than a decade, as well as helping my loved ones with their health issues, I do have some very realistic advice I can offer.

If you ever find yourself in extreme pain, but your doctor won’t give you pain medication, here are 6 things you can try. 

1. Doctors Expect You To Negotiate

Many doctors now have an unwritten policy where they will only give you opioid medication if you ask a certain number of times, especially when it comes to acute trauma like a broken bone or post-op pain. 

Doctors believe that this helps them to make sure that you really need it. 

So just because your doctor tells you no one time, two times or even three times, that doesn’t mean you should just accept the response. If your pain is severe enough that OTC medication is not working, then ask again. And again. Ideally, they eventually relent and will send in at least a small opioid prescription for you. 

This also helps future patients. Many doctors assume that if patients don’t ask repeatedly for pain medication after a surgery then that means that the surgery doesn’t result in severe pain for anyone. By showing them that you need it, you make it more likely for doctors to believe the next patient.  

2. Tell Your Doctor You’re Unable To Work Due to Pain

Unfortunately, under our current financial structures, much of our worth as humans is still tied to our ability to be productive at our jobs. So telling your doctor that you’re in too much pain to work may inspire them to finally send in an opioid prescription for you. 

They do not want you missing work, which could mean you losing health insurance and being unable to pay them. 

3. Threaten To Go to the ER

Another option when your doctor refuses to give you opioid medication is to tell them that you’re going to go to the emergency room then. This will often spur them to send in a prescription.to your pharmacy.

When it comes to something like post-surgical care, many doctors feel like it makes them look bad when their patients have to go to the ER for after-care. 

I have also seen this work for chronic pain as well, especially if you’re in their office when you bring it up. One time, for example, after explaining that I was going to go to the ER because my pain had spiked, my doctor gave me stronger pain medication in his office.

As an aside: Just make sure that if you get something very strong, like a hydromorphone shot, that you also get medication for nausea, like Zofran. While most ERs do this as a matter of policy, sometimes a doctor will skip it if it’s administered in their office. 

This is something I learned the hard way after an in-office hydromorphone shot left me vomiting for more than 24 hours because I wasn’t used to the strength of the medication. The whole thing could have been prevented with some Zofran.

4. Go to the Emergency Room

If telling your doctor that you want to go to the ER doesn’t motivate them to send in an opioid prescription, then the next step is to actually go to the emergency room. 

In my experience, ER doctors will, at the very least, usually give you a dose of pain medication to take on site. That can help you get the pain down to a level where you can at least think clearly and then figure out next steps and/or get some needed sleep. 

Depending on the situation, sometimes you can also convince ER doctors to give you a small prescription for at-home use too, especially if it’s for something like post-op pain or a severe injury.  

5. Consider a Pain Management Doctor 

If you have chronic pain, many times your best option is getting a referral to a doctor who specializes in pain management. 

This is not ideal because pain management doctors tend to be quite different from primary care doctors. That’s because many pain specialists believe they are being watched by the Drug Enforcement Administration. The DEA has no medical expertise, but has targeted hundreds of doctors for what it calls “unlawful” opioid prescribing.  

Because of that, many pain management doctors act more like probation officers than medical professionals, requiring invasive and expensive monitoring like drug tests and pill counts on a regular basis. This means the patient experience tends to be more like being on probation than getting healthcare. The only thing missing is an ankle monitor.

That said, pain specialists are usually willing to prescribe a low-dose opioid if it doesn’t exceed medical guidelines, which could get them in trouble. For many patients, even a low dose can literally be life saving. 

If you can’t get pain treatment anywhere else, then it can be worth it to put up with the draconian atmosphere. 

6. Try Kratom or Cannabis

The two most effective pain treatments you can get without a prescription are kratom and cannabis, although your mileage may vary and their legal status varies a lot by jurisdiction. 

While I am not sure how effective kratom or cannabis is at treating short-term intense pain, like a broken bone, I have personally found kratom to be the only substance I can get without a prescription that helps my chronic intercostal neuralgia pain. I would describe kratom as having an extremely mild opioid effect. 

Personally, I use it by taking a spoonful of kratom powder with a swig of Gatorade, as I find that to be the most effective delivery method. However, there are many options, ranging from capsules to kratom candy and even kratom seltzer. 

I also know many others who have found relief by using cannabis, which is thankfully legal in many places now. THC gummies seem to be especially helpful to anyone who’s new to cannabis use and doesn’t want to smoke. Cannabis dispensaries are also usually staffed with knowledgeable, friendly employees who are happy to guide you to the best option. 

I always say pain will make you crazy much faster than you expect. Within just three days of severe pain, I have seen people openly saying they were ready to die. 

It’s a true shame that in 2025, when effective and cheap pain medication exists, so many people are still left to suffer simply because of opioid-phobia and an overzealous DEA. 

However, that doesn’t mean you should be forced to suffer through pain just because you may not know how to navigate the healthcare system. You do have options. 

And if you’re in a situation where you’re denied pain care that you need, I hope you’ll use it to inspire more compassion in yourself. Pain treatment is a human right, and the more people who support it, the more likely we are to get it. 

RFK Jr. Wants to Create Drug Rehab ‘Wellness Farms’

By Pat Anson

Confirmation hearings for Robert F. Kennedy Jr., President Trump’s nominee to be Secretary of Health and Human Services, are expected to begin next week, with senators likely to ask about his controversial views on vaccines, fluoride, abortion and other hot-button health issues.  

Less well known is Kennedy’s ambitious plan for drug rehabilitation “wellness farms” for people addicted to illicit drugs or prescription medications such as opioids, antidepressants, stimulants and anti-anxiety medications. Kennedy outlined his plans to treat addiction and “re-parent” people with substance use problems during a “Latino Town Hall” last July, when he was running for president and had yet to endorse Trump.

“I’m going to make it so people can go, if you’re convicted of a drug offense, or if you have a drug problem, you can go to one of these places for free,” said Kennedy, adding that he would pay for the wellness farms with a tax on cannabis sales, if and when marijuana is removed as a prohibited Schedule One controlled substance.    

“I’m going to move it off Schedule One and I’m going to start collecting taxes on it. That’s going to bring in $8.5 billion dollars in revenue. I’m going to dedicate that revenue to creating wellness farms, drug rehabilitation farms, in rural areas all over this country.”

Kennedy released a documentary called “Recovering America” last year, in which he tours the country looking for innovative drug treatment programs. The issue is close to his heart because Kennedy was addicted to heroin as a young man. He’s been in recovery for 40 years and regularly attends 12-step meetings.

“We have a whole generation of kids who are dispossessed, they’re alienated, they’re marginalized, their suicide rates are exploding. The second largest killer for young people is drug addiction,” Kennedy said.

“I’m going to create these wellness farms where they can go to get off of illegal drugs, off of opiates, but also legal drugs, psychiatric drugs, if they want to, to get off of SSRIs, to get off of benzos, to get off of Adderall, and to spend time, as much time as they need — three or four years if they need it — to learn to get re-parented, to reconnect with communities, to understand how to talk to people.”

Participants at the wellness farms would also receive job training and grow their own organic food. Kennedy has long blamed pesticides and processed food for America’s “chronic disease epidemic.”

If confirmed as HHS secretary, Kennedy would oversee a vast bureaucracy and supervise agencies such as the Food and Drug Administration, Centers for Medicare and Medicaid Services, National Institutes of Health, and the Centers for Disease Control and Prevention.

It’s not clear what his views are about the CDC’s opioid guideline, which led to many patients in pain losing access to opioids. But Kennedy has been outspoken about the influence drug makers and lobbyists have on public health policy, saying Trump gave him instructions to end the “corruption and the conflicts” at federal health agencies.

“FDA’s war on public health is about to end,” Kennedy wrote in an October 25 tweet. “If you work for the FDA and are part of this corrupt system, I have two messages for you: 1. Preserve your records, and 2. Pack your bags.”

Trump also said he would let Kennedy “go wild” on healthcare, but according to Politico, his transition team is intent on surrounding RFK Jr. at HHS with conservative aides who have more experience in government and remain loyal to Trump.

The Washington Post reported that the Office of Government Ethics is still looking into Kennedy's financial disclosure statements, which were recently amended. That may delay his confirmation hearings until late January.

Anxiety Medications Decline in States Where Marijuana Is Legal

By Ashley Bradford

In states where both medical and recreational marijuana are legal, fewer patients are filling prescriptions for medications used to treat anxiety. That is the key finding of my recent study, published in the journal JAMA Network Open.

I am an applied policy researcher who studies the economics of risky behaviors and substance use within the United States. My collaborators and I wanted to understand how medical and recreational marijuana laws and marijuana dispensary openings have affected the rate at which patients fill prescriptions for anti-anxiety medications among people who have private medical insurance.

These include:

• Benzodiazepines, which work by increasing the level of gamma-aminobutyric acid, or GABA, a neurotransmitter that elicits a calming effect by reducing activity in the nervous system. This category includes the depressants Valium, Xanax and Ativan, among others.

• Antipsychotics, a class of drug that addresses psychosis symptoms in a variety of ways.

• Antidepressants, which relieve symptoms of depression by affecting neurotransmitters such as serotonin, norepinephrine and dopamine. The most well-known example of these is selective serotonin re-uptake inhibitors, or SSRIs.

We also included barbiturates, which are sedatives, and sleep medications – sometimes called “Z-drugs” – both of which are used to treat insomnia. In contrast to the other three categories, we did not estimate any policy impacts for either of these types of drugs.

We find consistent evidence that increased marijuana access is associated with reductions in benzodiazepine prescription fills. “Fills” refer to the number of prescriptions being picked up by patients, rather than the number of prescriptions doctors write. This is based on calculating the rate of individual patients who filled a prescription in a state, the average days of supply per prescription fill, and average prescription fills per patient.

Notably, we found that not all state policies led to similar changes in prescription fill patterns.

Why It Matters

In 2021, nearly 23% of the adult U.S. population reported having a diagnosable mental health disorder. Yet only 65.4% of those individuals reported receiving treatment within the past year. This lack of treatment can exacerbate current mental health disorders, leading to increased risk for additional chronic conditions.

Marijuana access introduces an alternative treatment to traditional prescription medication that may provide easier access for some patients. Many state medical laws allow patients with mental health disorders such as post-traumatic stress disorder, or PTSD, to use medical cannabis, while recreational laws expand access to all adults.

Our findings have important implications for insurance systems, prescribers, policymakers and patients. Benzodiazepine use, like opioid use, can be dangerous for patients, especially when the two classes of drugs are used together. Given the high level of opioid poisonings that also involve benzodiazepines – in 2020, they made up 14% of total opioid overdose deaths – our findings offer insights into potential substitution with marijuana for medications where misuse is plausible.

What Still Isn’t Known

Our research does not clarify whether the changes in dispensing patterns led to measurable changes in patient outcomes.

There is some evidence that marijuana acts as an effective anxiety treatment. If this is the case, moving away from benzodiazepine use – which is associated with significant negative side effects – toward marijuana use may improve patient outcomes.

This finding is critical given that about 5% of the U.S. population is prescribed benzodiazepines. Substituting marijuana has the potential to result in fewer negative side effects nationwide, but it’s not yet clear if marijuana will be equally effective at treating anxiety.

Our study also found evidence of a slight – albeit somewhat less significant – increase in antipsychotic and antidepressant dispensing. But it’s not clear yet whether marijuana access, particularly recreational access, increases rates of psychotic disorders and depression.

While we found that, overall, marijuana access led to increased antidepressant and antipsychotic fills, some individual states saw decreases.

There is a lot of variation in the details of state marijuana laws, and it’s possible that some of those details are leading to these meaningful differences in outcomes. I believe this difference in outcomes from state to state is an important finding for policymakers who may want to tailor their laws toward specific goals.

Ashley Bradford, PhD, is an Assistant Professor of Public Policy at the Georgia Institute of Technology. Her research focuses on how public policies shape health outcomes within the United States.

This article originally appeared in The Conversation and is republished with permission.

What Rescheduling Will Mean for Marijuana

By Dr. Chris Meyers

The Drug Enforcement Administration announced in early 2024 that it would act on President Joe Biden’s call to reclassify marijuana, moving it from the tightly controlled Schedule I category that it has been in since 1970 to the less restrictive Schedule III status of the Controlled Substances Act. That triggered a long process of hearings and reviews that will not be completed until after the presidential election in November.

The news drew strong reactions from critics: 25 Republican lawmakers sent a letter to Attorney General Merrick Garland protesting any changes to federal marijuana laws. They argued that the decision “was not properly researched … and is merely responding to the popularity of marijuana and not the actual science.”

As a philosopher and drug policy expert, I focus on assessing arguments and evidence rather than politics or rhetoric. So, what are the arguments for and against rescheduling cannabis?

Scheduling Under Controlled Substances Act

The Controlled Substances Act places each prohibited drug into one of five schedules based on known medical use, addictive potential and safety. Schedule I drugs – which, along with marijuana, also includes heroin, LSD, psilocybin, ecstasy (MDMA) and quaaludes – is the most restrictive category.

Schedule I substances cannot be legally used for any purpose, including medical use or research, though an exception for research can be made with special permission from the DEA. The criteria for inclusion in the Schedule I category is that the substance has a high potential for abuse, is extremely addictive and has “no currently accepted medical use.”

Schedule II, which is slightly less restrictive than Schedule I, includes drugs that are addictive and potentially unsafe but also have some accepted medical use. These include strong opioids such as fentanyl, as well as cocaine, PCP and methamphetamine. Though they are still tightly regulated, Schedule II drugs can be used medically with a prescription or administered by a licensed physician.

Schedule III is much less restrictive and is intended for substances with legitimate medical use and only moderate risk of abuse or dependency. This category includes low-dose morphine, anabolic steroids and ketamine.

Schedule IV – which includes the sedative Valium, the weak opioid tramadol and sleep medicines such as Ambien – is even less restrictive.

The least restrictive category is Schedule V, which includes cough syrups with codeine and calcium channel blockers such as gabapentin and pregabalin. All scheduled drugs require a doctor’s prescription and can be distributed only by licensed pharmacies.

Schedule III Would Only Legalize Some Medical Use

The push to reschedule is largely to make federal laws consistent with state medical marijuana programs that – as of October 2024 – are legal in 38 states plus the District of Columbia.

Moving marijuana to Schedule III would not change its legal status in states where it is banned. It would make marijuana legal at the federal level but only for medical use. Recreational use would still be federally prohibited, even though it is currently legal in 24 states plus Washington.

Rescheduling, however, might not make medical marijuana any easier for patients to access and could even make it much harder for some. Currently, getting a medical marijuana card is quite easy in most states. In Washington D.C., where I live, patients can self-certify.

If marijuana is reclassified as Schedule III, medical marijuana programs will have to start requiring a doctor’s prescription, just like with all other scheduled substances. And it could be distributed only by licensed pharmacies, which would put medical dispensaries that are now selling it without a license from the Food and Drug Administration out of business.

Rescheduling, however, would give medical marijuana legitimacy as a bona fide medicine. And the intent of the move is to increase access, even if it is unclear how rescheduling would achieve that.

So, assuming that rescheduling would have the intended effect of expanding access to medical marijuana, should it be rescheduled?

Medical Uses of Marijuana

Though there are three criteria for Schedule I in the Controlled Substances Act, the DEA in fact relies on only the medical use criterion. This was the basis of the DEA’s proposal to reschedule marijuana. The fact that almost 75% of Americans live in a state with a medical marijuana program suggests that marijuana has an accepted medical use.

More importantly, Schedule III of the Controlled Substances Act already includes dronabinol, which is delta-9 THC, the active ingredient in marijuana. Although dronabinol is synthesized in the lab rather than extracted from the cannabis plant, it is the exact same molecule. The FDA approved THC in the form of dronabinol in 1985 for treating anorexia caused by HIV/AIDS as well as nausea and vomiting due to chemotherapy. Placing marijuana in the same schedule as its primary active ingredient makes a lot of sense.

Another argument in favor of rescheduling is that it would open up new opportunities for medical research into marijuana’s effects, research that is currently hampered by its Schedule I status. This work is critical because the system of cannabinoid receptors through which marijuana causes its therapeutic and psychoactive effects is crucial for almost every aspect of human functioning.

Research has shown that cannabis is effective not only in treating nausea and AIDS but also chronic pain and some symptoms of multiple sclerosis.

There is also good evidence that marijuana can help treat other conditions, including Lou Gehrig’s disease (amyotrophic lateral sclerosis, or ALS), glaucoma, irritable bowel syndrome, insomnia, migraine, post-traumatic stress disorder and Tourette syndrome. Keeping marijuana in the Schedule I category severely hampers research that might establish more effective treatments for these conditions.

Balancing Risks and Benefits

Those opposed to rescheduling cite possible health risks associated with marijuana consumption. Heavy use is linked to an increased risk of developing schizophrenia. However, the increased risk of schizophrenia from cannabis use is comparable to that caused by watching excessive television, eating junk food or smoking cigarettes.

Long-term marijuana use can also lead to sleep problems and diminished visuospatial memory. It can also cause gastrointestinal trouble, such as cannabis hyperemesis syndrome, which is characterized by nausea, vomiting and abdominal pain. The symptoms, while extremely unpleasant, are temporary and occur only after consuming marijuana. The condition disappears in people who stop using.

Marijuana use can also be addictive. According to the Centers for Disease Control and Prevention, about three out of every 10 regular marijuana users meet the diagnostic criteria for cannabis use disorder.

All of the concerns above are legitimate, though it is worth noting that virtually no effective medicine is free from undesirable side effects. And although marijuana can be habit-forming, it is not as addictive as alcohol, tobacco, oxycodone, cocaine, methamphetamine or benzodiazepines. None of those other drugs are categorized as Schedule I, and alcohol and tobacco are not scheduled at all.

Unlike most other prescription medications, marijuana use is associated with many benefits. For example, in states where marijuana has been legalized, worker’s compensation payments have fallen by an average of 21% among people over 40. Researchers think that this is because marijuana helps workers better manage chronic pain. The use of marijuana for pain management also helps to reduce dependency on opioids. One study found that U.S. counties with one or two marijuana dispensaries had an average of 17% fewer opioid-related fatalities compared with counties with no dispensaries.

Research also shows that marijuana use can help to prevent Alzheimer’s by blocking the enzymes that produce amyloid plaques. It also shows promise for reducing a person’s risk of developing Type 2 diabetes by helping the body regulate insulin and glucose levels.

All of these benefits add up to marijuana users having an overall lower rate of premature death than nonusers.

Chris Meyers, PhD, is an Adjunct Professor of Philosophy at George Washington University. His main area of research is in moral psychology, moral theory, and applied ethics/public policy. Meyers is the author of “Drug Legalization,” a textbook that looks at the pros and cons of prohibiting recreational drugs.

This article originally appeared in The Conversation and is republished with permission.

Pain Patients More Likely Than Doctors to Favor Greater Access to Cannabis

By Pat Anson

Americans living with chronic pain are significantly more likely to support greater access to cannabis than the physicians who treat them, according to a new survey that found broad support for cannabis education in medical schools.

Rutgers Health surveyed over 1,600 adults with chronic pain and 1,000 physicians in states with medical cannabis programs. The survey results, recently published in JAMA Network Open, show that 71% of  pain patients support federal legalization of medical cannabis, compared to 59% of physicians.

Patients are also more likely to support nationwide legalization of recreational cannabis (55%), compared to about a third of physicians (38%).

"Cannabis is unique in terms of the complicated policy landscape," said lead author Elizabeth Stone, PhD, an Instructor at Rutgers Robert Wood Johnson Medical School. "Depending on what state you're in, it could be that medical cannabis is legal, it could be that medical and recreational use are legal, it could be that neither is legal, but some things are decriminalized.”

Currently, 38 states and Washington, DC have legalized medical cannabis and 23 of those states (plus DC) have legalized its recreational use. Cannabis remains illegal under federal law as a Schedule I controlled substance, but the DEA is considering a proposal from the Biden Administration to reclassify cannabis as Schedule III substance, which would allow for limited use of cannabis-based medication.

Personal experience plays a significant role in shaping attitudes about cannabis. The Rutgers survey found that people who used cannabis for chronic pain had the highest levels of support for expanding access, while physicians who don’t recommended cannabis for pain management had the lowest levels of support.

Although they have different attitudes about legalization, about 70% of patients and physicians favor requiring medical schools to train future doctors on cannabis treatment of chronic pain. There is also broad support for training that would allow physicians and nurse practitioners to recommend cannabis to their patients.  

"I think it points to the need for future guidance around cannabis use and efficacy," Stone said. "Is it something they should be recommending? If so, are there different considerations for types of products or modes of use or concentration?"

Nearly two thirds of patients (64%) and about half of physicians (51%), favor requiring insurance companies to cover cannabis treatment of chronic pain.

Support for Cannabis Policies

JAMA NETWORK OPEN

Previous surveys have also found distinct differences in patient and physician attitudes about cannabis. A recent survey of primary care doctors found that nearly one in five (18%) would not accept a new patient using medical cannabis. And 40% said they would not accept a patient using non-medical or recreational cannabis.

Many doctors are worried what their colleagues will think or what law enforcement will do if they prescribed or recommended cannabis. A 2019 survey of oncologists and pain management specialists found that nearly two-thirds (65%) were concerned about the legal repercussions of recommending medical cannabis to their patients. And 60% were worried about professional stigma.

Many patients who live with chronic pain are turning to cannabis as an alternative to opioids. A recent PNN survey found that over 30% of pain patients said they had used cannabis for pain relief. Many did so because they couldn’t get an opioid prescription or had problems getting one filled.

Should CDC Be Involved in Cannabis Regulation?

By Pat Anson

If you think the Centers for Disease Control and Prevention bungled its handling of COVID-19 tests and misled the public about the risks of opioid pain medication – then you’re probably not going like a new recommendation from a federal advisory panel.     

The National Academies of Sciences, Engineering, and Medicine (NASEM) wants the CDC to play a much larger role in setting federal policy on cannabis, such as expanding its surveillance of cannabis use and establishing “best practices” for states to follow in cannabis regulation.

In other words, a CDC cannabis guideline that would be used as a model for state laws and regulations, much like the agency’s opioid prescribing guideline was. Only this guideline would go much further.

“The best practices should encompass marketing restrictions, age restrictions, physical retail and retail operating restrictions, taxation, price restrictions, product design, and measures to limit youth access,” NASEM said in a 312-page report released this week. “Once the Centers for Disease Control and Prevention’s best practices have been developed, they should be incorporated into the model legislation.”

Cannabis is currently illegal under federal law, but 38 states and the District of Columbia allow its medical and/or recreational use. At the urging of the Biden Administration, the DEA is considering a proposal to reclassify cannabis as a Schedule III controlled substance, which would allow for some medical use of cannabis under federal law. A final decision is not likely until sometime next year.    

But with a major change in federal policy on the horizon and a hodgepodge of state regulations already in place, NASEM wants federal agencies and Congress to get more involved in setting policy for legalized cannabis.

“There is an urgent need for a coordinated public health approach to cannabis policy in the U.S.,” said Steven Teutsch, a senior fellow at the University of Southern California and chair of the committee that wrote the NASEM report. “Our report shows that cannabis policy often focuses on regulating sales and revenue first, and protecting public health second. Now is the time for the federal government to create guidance for states that have legalized cannabis in the interest of protecting the public’s health.”

The first recommendation from NASEM is for Congress to overhaul the regulation of hemp, which was legalized under the 2018 Farm Bill.  That opened the door for cannabis companies to tweak the chemical composition of hemp-derived Delta-8 THC to make it more potent. Intoxicating edibles containing Delta-8 THC are now widely sold as candy, cookies, gummies and beverages – even in states where medical and recreational cannabis are illegal.

NASEM wants Congress to close that loophole by changing the definition of hemp so that Delta-8 THC is regulated the same way as other cannabis products.

Public Health Campaigns

The report also calls for the CDC to develop “targeted public health campaigns” to warn about the risks of cannabis use by children, pregnant women and older adults.  

The latter is one of the fastest growing segments of the population using cannabis, according to a recent survey that found 12% of Americans over 50 had consumed a THC-containing product in the past year. Only 3% were using cannabis in 2006. Ironically, many older adults use cannabis to manage chronic pain because they are no longer able to obtain opioids after the widespread misapplication of the CDC’s opioid guideline.

The NASEM report also warns about the lobbying influence of the cannabis industry, which it blames for the weakening of cannabis regulations in Colorado and Washington, as well as conflicts of interest and “financial entanglements” that some state regulators have with the industry.

“The influence of the burgeoning legal cannabis industry on policy development raises concern about potential bias. Lobbying efforts by the industry have demonstrably impacted regulation,” the report states.

That’s pretty rich when you consider the many biases and conflicts the CDC had when it secretly developed the opioid guideline, and how CDC insiders hijacked a public hearing to silence anyone who might oppose it. Some CDC consultants were later paid millions of dollars testifying as expert witnesses in opioid litigation.

Conservative critics of the CDC are unlikely to support any effort to get the agency involved in cannabis regulation.  The Heritage Foundation’s Project 2025 calls for the CDC’s budget to be slashed and its ability to set healthy policies severely restricted.

“COVID-19 exposed the Centers for Disease Control and Prevention as perhaps the most incompetent and arrogant agency in the federal government,” wrote Roger Severino, former director of the Office for Civil Rights at the Department of Health and Human Services during the Trump administration.

“Never again should public health bureaucrats be allowed to hide information, ignore information, or mislead the public concerning the efficacy or dangers associated with any recommended health interventions.”

A CDC spokesperson told the Associated Press the agency would study NASEM’s recommendations, but more money would be needed to implement them.

Cannabis Advocates Push Back on California Plan to Ban Hemp THC

By Crystal Lindell

The cannabis industry is pushing back on plans by California Gov. Gavin Newsom to impose emergency regulations that would effectively ban all food and beverage products containing Delta-8 tetrahydrocannabinol (THC) derived from hemp.

The proposed regulations would require that any products intended for human consumption have no detectable levels of Delta-8 THC or other intoxicating hemp cannabinoids; establish a minimum age to purchase hemp products at 21; and limit the number of servings of hemp products to five per package.

When hemp was legalized by Congress in 2018, the thinking was that hemp had such minimal amounts of THC that no one could possibly use it to get high. But cannabis companies soon found ways to tweak the chemical composition of hemp-derived THC and other cannabinoids (CBD) to make them more potent. Edibles containing delta-8 THC are now widely sold as candy, cookies, gummies and beverages – even in states where medical and recreational cannabis are still illegal.

“We will not sit on our hands as drug peddlers target our children with dangerous and unregulated hemp products containing THC at our retail stores,” Newsom said in a statement. “We’re taking action to close loopholes and increase enforcement to prevent children from accessing these dangerous hemp and cannabis products.”

But the advocacy group Cal NORML says Newsom’s regulations go too far and would make it impossible to sell any products containing hemp-derived CBD. It wants the rules modified to allow for non-intoxicating levels of THC. . 

“In practice, it’s impossible to eliminate detectable but non-intoxicating traces of THC from natural hemp extracts,” the group said. “THC is readily detectable at levels of 1 billionth of a gram, far below the threshold of human sensitivity.”

Cal NORML says the practical result of Newsom’s proposal would be to ban a host of hemp products that some people use to treat health conditions. It wants California to adopt Colorado’s definition of non-intoxicating hemp. That state allows hemp extracts with a CBD:THC ratio of at least 15:1 and no more than 1.75 milligrams of THC per dose. 

“There’s no danger that minors will try to get high on hemp products with less than 2 mg of THC, especially when other, much more potent marijuana products are readily available at bargain prices on the illegal market,” the group said.

“[Cal NORML] does not take issue with the regulations’ intent to block the sale of hemp products with intoxicating levels of THC in liquor stores, gas stations, smoke shops and convenience outlets, often with inadequate labeling and in a manner accessible to minors.”

As currently drafted, Cal NORML says the proposed regulations would violate the mandate of California’s medical marijuana law to provide “safe and affordable” access to cannabis for all patients in medical need.

Another advocacy group – One Hemp – is threatening a lawsuit against Newsom for exceeding his authority to enact emergency regulations without the approval of the state legislature.

“Newsom’s overreach is shameful,” said Jared Stanley, founding member of One Hemp.  “Other states have successfully banned Delta 8 products while also protecting natural hemp products through a simple solution that would safeguard ALL California’s children, not just some.”

“These rules signify that the Governor intends to turn his back on my daughter and millions in the disabled community,” says Stephanie Bohn, whose 10-year old daughter recently marked one year without seizures after she started taking natural hemp CBD.

“Governor Newsom, please acknowledge children like my daughter – the ones with intractable seizures and debilitating insomnia that conventional pharmaceuticals don't help. The only thing that offered rescue was full-spectrum CBD. This is more than a policy issue, this is a life-or-death issue.”  

One Hemp says parents of disabled children in California are “panic buying CBD products” before the proposed regulations take effect. 

The hemp rules await final approval from the California Office of Administrative Law. If they are approved, sellers of hemp products will be required to immediately impose purchase restrictions and remove items with detectable THC levels.

DEA Delays Decision on Reclassifying Marijuana Until After the Election

By Crystal Lindell

The Drug Enforcement Administration has likely eliminated any possibility of marijuana being rescheduled until after a new president is sworn into office next year. The agency will hold a public hearing on the matter on December 2nd —  nearly a month after the presidential election —  according to a notice published yesterday in the Federal Register. 

The hearing will help determine if marijuana should be re-classified under Schedule III of the Controlled Substances Act (CSA) from its current status as an illegal Schedule I substance. 

Moving marijuana to schedule III would place it in a category of drugs that are considered to have an accepted medical use. Rescheduling would also indicate that cannabis has less potential for abuse than Schedule I and II substances, with only moderate to low risk of physical or psychological dependence. 

But the DEA has also made it clear that rescheduling does not equal legalization, noting that “the manufacture, distribution, dispensing, and possession of marijuana would remain subject to the applicable criminal prohibitions of the CSA.” 

To make a cannabis-based medicine legal under Schedule III, the Food and Drug Administration would first have to approve it for a specific medical condition, which would likely require a lengthy clinical trial process that could take years to complete.

The National Organization for the Reform of Marijuana Laws (NORML), an advocacy organization that has long fought for cannabis to be legalized, says it’s not surprised that the DEA wants to have public hearings. 

“Hearings are an integral part of the rescheduling process. To think that the DEA, which historically has opposed any changes to cannabis’ prohibitive status, would sign off on the most significant proposed change in federal marijuana policy in over fifty years absent such hearings was always wishful thinking,” said NORML Deputy Director Paul Armentano.

“That said, the scientific evidence in favor of removing cannabis from Schedule I remains overwhelming. Cannabis clearly has legitimate therapeutic value and it possesses a superior safety profile compared to other Schedule I or Schedule II controlled substances.”

The Biden Administration initiated the regulatory process to review the scheduling of cannabis in late 2022, a review that has dragged on for nearly two years. The Department of Health and Human Services (HHS) recommended marijuana be moved to Schedule III in August 2023.

But the Justice Department and DEA Administrator Anne Milgram – who has the final say on rescheduling – have yet to approve the HHS recommendation.  The DEA published the proposed change in cannabis’ classification in May in the Federal Register. That notice drew over 43,000 responses during a 60-day public comment period, with numerous requests for a public hearing.

Seeing the process take so long is frustrating. With 38 states and the District of Columbia allowing medical cannabis, it’s clear that marijuana has a legitimate medical use – a fact confirmed by the HHS recommendation to reschedule. So why are the DOJ and DEA dragging their feet?  

Holding the public hearing after the presidential election also risks that it won’t be done at all, depending on who wins and what their policy preference is on the matter. 

Although Democratic nominee Kamala Harris is likely to continue President Joe Biden’s push to have marijuana reclassified, we can’t be sure what she would do. Republican nominee Donald Trump has also indicated in recent days that he favors “decriminalizing” marijuana, but we also don’t know with certainty what he would do. 

With so many states having already legalized the medical and recreational use of marijuana, it’s become increasingly clear that there are no compelling health-related reasons to continue classifying cannabis as a Schedule I controlled substance. And the longer the DEA delays changing marijuana’s status, the more it should make all of us question how much health concern there really is behind the Controlled Substances Act.

Patients and Providers Say Cannabis Helps Reduce Opioid Use

By Crystal Lindell

More than half the pain patients certified in New York state’s medical cannabis program say they’re using cannabis as an alternative to opioid medication. 

That’s great news for patients who see real benefits from cannabis, but we have to be careful to avoid further demonizing opioids when data like this is released. Using something as an alternative doesn’t show that it’s necessarily more effective or more helpful. Often, it just means that something is more accessible. 

The data comes from the New York State Office of Cannabis Management’s 2023 Patient and Provider Survey Report, which was recently released. This was a large survey that collected responses from 10,781 patients and 265 providers enrolled in the state’s medical cannabis program. 

“Findings from both the patient and provider surveys demonstrate that medical cannabis is effective for pain management and has the potential to reduce the use of opioids,” the report found.

About 57% of the patients were pain sufferers, making pain the top condition for using cannabis, followed by post-traumatic stress disorder (24%), neuropathy (19%), spasticity (11%), rheumatoid arthritis (11%), inflammatory bowel disease (10%) and cancer (8%).

The survey found that 66% of patients think medical cannabis helped reduce their use of opioids for pain management.

The providers were largely in agreement, with 83% saying “medical cannabis should be used to reduce the use of opioids for pain management” and 75% saying cannabis poses less risk than opioids. 

However, this is where I start to raise my eyebrow a bit. 

It makes me nervous that so many providers see cannabis as being safer than opioids. The fact that 25% of them don’t is also a telling statistic. It means the data on this is unclear.

All substances have side effects. Both patients and providers understand this. In a just world, patients should be able to make the choice about which substances or medications they use, after factoring in their own preferences for what side effects are acceptable as a tradeoff for pain relief. 

Even if it was proven that cannabis is significantly safer than opioids for managing pain, that doesn’t mean it’s just as effective as opioids. Personally, I don’t find cannabis to be very effective at all for treating my pain. I also really dislike how sleepy it makes me. For my life and my needs, opioids remain a much better option. 

I’m lucky enough to have a recurring prescription for opioid medication. But for patients who can’t get an opioid prescription, they don’t truly get a choice or “alternative.” Cannabis may be their only legal option. 

The New York State report also shows me that it’s long past time to make cannabis legal at the federal level. It’s clear now that classifying cannabis as an illegal controlled substance never had any foundation in health concerns. Clearly, cannabis can help treat a large number of medical conditions. And many people get health benefits from using it. 

A lot of drugs that are classified as harmful controlled substances can still be obtained by prescription. And some that are not “controlled” are potentially more dangerous than cannabis. That doesn’t make any sense, but that’s how the system is set up under the Controlled Substance Act. 

The way that cannabis has been slowly legalized across the country should make us take a long look at all of our drug laws. There are many illegal substances, such as psychedelics, that could potentially help people manage health conditions – but only if they had access to them in the same way most Americans can now access medical or recreational cannabis. 

If nothing else though, cannabis’ slow legalization has given me some hope. I can remember even 25 years ago, being in college, listening to guys in dorm rooms ramble on about how cannabis would be legalized someday. I confess I didn’t believe them. At the time, it felt impossible. 

Turns out, I was wrong. Now I just hope we don’t stop at cannabis.