Medical Cannabis No Help to Lobsters

By Pat Anson, PNN Editor

Do lobsters feel pain when they’re boiled alive?

Seafood lovers, cooks, academics, animal rights activists and even governments have debated that question for years, with the general consensus being that they do. Lobsters, crabs and other crustaceans will often writhe in pain and try to escape when dropped into a pot of scalding hot water. The practice is considered so cruel that Switzerland and New Zealand made it illegal to boil a live lobster.

Some cooks try to ease the lobsters’ pain by stunning them with a jolt of electricity or putting them on ice to dull their senses before cooking them.  In 2018, a restaurant owner in Maine even blew marijuana smoke on a lobster named Roscoe, who reportedly grew so mellow he never wielded his claws as weapons again while in captivity.

We’ll never know the long-term effect of getting a lobster stoned because Roscoe was returned to the ocean as a thank you for his service. Good for him.

Which brings us to a bizarre study recently completed by scientists at the University of California San Diego and the Scripps Research Institute, who decided to replicate the Roscoe experiment in a lab.

"The 2018 minor media storm about a restaurant owner proposing to expose lobsters to cannabis smoke really was the starting point. There were several testable claims made and I realized we could test those claims. So we did," lead author Michael Taffe, PhD, an adjunct professor at Scripps Research told IFLScience.

Taffe and his colleagues purchased ten Maine lobsters at a local supermarket, fed them a last meal of frozen krill and fish flakes, and placed them in an aerated vapor chamber.

For the next 30 to 60 minutes, the lobsters were exposed to vapor rich in tetrahydrocannabinol (THC), the psychoactive ingredient in cannabis.

Afterwards, some of the lobsters were “rapidly euthanized” with a kitchen shear and dissected, while others were immersed in hot water to see how they’d react.

bioRxiv

Detectable levels of THC were found in the muscles and organs of the euthanized lobsters, so from that standpoint the experiment was a success. But the THC apparently had little effect on the remaining live lobsters, who displayed “distinct motor responses” and other signs of pain when put in hot water.   

"The effect of vapor THC on this nociceptive (pain) behavior was very minimal. Statistically supported in one case, but of very small magnitude," said Taffe.

We’ll leave it to readers to decide whether a study like this is humane, worthwhile or even makes sense. But it is worth noting that taxpayers helped pay for it.

The lobster cannabis study was supported by grants from the U.S. Public Health Service. Researchers were careful to note that federal funding was not directly used to purchase the lobsters. That money came from La Jolla Alcohol Research, a private company that is developing vapor inhalation technologies.  According to GovTribe, La Jolla Alcohol Research has received about $3 million in federal funding in recent years, most of it coming from the National Institute on Drug Abuse.

Cannabis Poisoning Calls Rise, Particularly for Children

By Pat Anson, PNN Editor

A new analysis of calls to U.S. poison control centers suggests that more regulation is needed of cannabis products to protect consumers – and children in particular — from adverse health consequences.

Researchers found a significant increase in cannabis-related calls to poison centers from 2017 to 2019, about half of them from a healthcare facility.

Most of the 28,630 calls involved someone ingesting cannabis flower or buds, but a growing number involved manufactured cannabis products such as edibles, vaporized liquids and concentrates. About a third of the calls were considered serious.

Cannabis-Related Calls to U.S. Poison Control Centers

JAMA NETWORK OPEN

Most of the calls about manufactured cannabis products involved underage children. Twenty-seven percent involved children under the age of 10 and about a third (34.5%) involved youths between 10 and 20 years of age. Edibles were involved in about two-thirds of those calls.

“Children may be at particular risk for exposure to edible products, such as cookies or candy,” wrote lead author Julia Dilley, PhD, Oregon Health Authority, in JAMA Network Open.

“Although we did not see more serious health outcomes for manufactured product exposures compared with plant products overall, most cannabis plant exposures involved polysubstance use, whereas most cases for manufactured products were for those products alone, suggesting that exposure to manufactured products alone may be relatively more likely to generate adverse events.”

Dilley and her colleagues say cannabis products are riskier for children because they may not know they are consuming THC (tetrahydrocannabinol), the psychoactive ingredient in cannabis. Even when they are labeled, research has found that the amount of THC in cannabis products is often inaccurate.

The study did not distinguish between medical and recreational cannabis. Interestingly, the rate of calls to poison centers from states where cannabis is legal was slightly higher than those where cannabis is still illegal, suggesting that legalization does not increase the level of safety.  

“Market factors may drive the industry to continue developing novel products, which could present additional health risks. Applying regulatory controls to market-driven innovations in potency and additives is key. Novice cannabis users are often advised to ‘start low, go slow’; this guidance may be equally applicable to regulating new retail cannabis markets and products,” researchers said.

Some cannabis companies are intentionally marketing their products as candy and snacks to make them more attractive to children. The Food & Wine website reports the Wrigley Company recently filed three lawsuits against cannabis manufacturers, alleging they produced THC-spiked products that resemble Wrigley candies such as Skittles, Life Savers and Starbursts   

“We take great pride in making fun treats that parents can trust giving to their children and children can enjoy safely," a Wrigley spokesperson told Reuters. "We are deeply disturbed to see our trademarked brands being used illegally to sell THC-infused products."

One cannabis company, THC Living, recently took a “snortable” cannabis candy off the market after complaints on social media. According to Leafly, the packaging and marketing of “Cannabis Bumps” were designed to make the powdered candy look like cocaine. Each package contained a hefty dose of 600mg of THC.    

Most Older Adults Don’t Tell Doctors About Their Cannabis Use

By Pat Anson, PNN Editor

A growing number of older adults have discovered the medical benefits of cannabis – everything from pain relief to lower blood pressure. But a new study found that most older Americans aren’t telling their doctors about their cannabis use.

In an analysis of over 17,000 Americans aged 50 and older who participated in the 2018 and 2019 National Surveys on Drug Use and Health, researchers at the University of Texas at Austin found that nearly nine percent had used cannabis in the past year. Of those, less than 40% had discussed their cannabis use with a healthcare provider.

Researchers say that’s an alarming figure because the cannabis users were significantly more likely to have substance abuse and mental health problems than nonusers.  

“Only a minority of older cannabis users discussed their drug use with a healthcare professional, although medical users were more likely than nonmedical users to have done so,” said lead author Namkee Choi, PhD, Professor of Gerontology at the University of Texas at Austin.

“Given little difference in cannabis and other substance use/use disorders between nonmedical and medical users, older cannabis users, regardless of use reasons, should consult healthcare professionals about their use, and healthcare professionals should screen for cannabis and other substance use as part of routine care.”

Compared to recreational users, medical users consumed cannabis more frequently, with nearly 40% using it everyday or a few times each week. Surprisingly, less than 20% of medical users bought their cannabis from a dispensary; most obtained it from friends, family or strangers. About 95% of medical users said obtaining cannabis was fairly easy or very easy.

“The finding that a significant proportion of medical and nonmedical users obtained cannabis via private/informal sources indicates that they are likely to use cannabis and cannabis products with unknown tetrahydrocannabinol (THC) potency,” said Choi. “Given the increase in THC potency, healthcare professionals should educate older cannabis users, especially high-frequency users, on potential safety issues and adverse health effects of cannabis and cannabis products obtained from unregulated sources.”

The study findings were published in The American Journal of Drug and Alcohol Abuse.

A 2018 survey by the American Association of Retired Persons (AARP) found that most older Americans think marijuana is effective for pain relief, anxiety and nausea. Seventy percent of those surveyed say they would consider asking their healthcare provider about medical marijuana if they had a serious condition that they thought might respond to it.

A recent study published in the journal Cannabis and Cannabinoid Research found that older adults are more likely to purchase sublingual formulations of cannabis, such as edibles and tinctures, as well as products low in THC and high in CBD.

Urine Tests Show Medical Cannabis Often Mislabeled

By Pat Anson, PNN Editor

Pick up almost any canned or packaged food in a grocery store and you’ll see a lengthy list of its ingredients, right down to the amount of sodium, fat, vitamins and calories in each serving.

That kind of attention to detail – and truth in advertising -- continues to elude the cannabis industry, according to a new study that found the amount of THC and CBD listed on many medical cannabis products to be wildly inaccurate.

Researchers at Massachusetts General Hospital didn’t test the products themselves, but instead analyzed urine samples from nearly 100 patients who frequently used medical cannabis to treat their pain, anxiety, depression or insomnia. Vaping was the most common form of administration, but patients also smoked or ingested cannabis products purchased at Boston-area dispensaries.   

Laboratory testing showed no CBD metabolites in about a third of the urine samples from patients who said they used cannabis products that were mostly CBD or had equal parts THC and CBD. THC was detected in nearly 80% of those samples, including ones from patients who thought they were only ingesting CBD.

The distinction is important because THC (tetrahydrocannabinol) is the psychoactive ingredient in cannabis that can make users high, while CBD (cannabidiol) is the chemical compound believed to have health benefits.

"People are buying products they think are THC-free but in fact contain a significant amount of THC," says lead author Jodi Gilman, PhD, an investigator in the Center for Addiction Medicine in Massachusetts General’s Department of Psychiatry. "One patient reported that she took a product she thought only contained CBD, and then when driving home that day she felt intoxicated, disoriented and very scared."

About 20% of patients who used a vaporizer had no detectable levels of either THC or CBD in their urine. Researchers think that’s because some vaping devices may not heat cannabis products sufficiently for patients to inhale the active ingredients. THC was more likely to be found in patients who smoked cannabis or ingested it orally.

"A lot of questions about the content of the products and their effects remain," says Gilman. "Patients need more information about what's in these products and what effects they can expect."

The study findings, published in JAMA Network Open, are the latest to show that the actual ingredients in cannabis products vary considerably from their labels. Although 36 states and Washington DC have legalized medical cannabis, there is little consistency in labeling, regulating or testing medical cannabis, as there is for food, supplements and pharmaceutical drugs.

A 2015 study of cannabis edibles sold in California and Washington found that only 17% were labeled accurately. Over half had significantly less CBD than labeled and some had negligible amounts of THC.   

A recent study conducted by the Food and Drug Administration of 147 hemp and cannabis products found that less than half contained CBD within 20% of their label declarations.   

Study Shows Cannabis Oil Improves Fibromyalgia Symptoms

By Pat Anson, PNN Editor

A small placebo-controlled trial shows that daily doses of cannabis oil rich in THC (tetrahydrocannabinol) significantly improves pain, fatigue and quality of life in people with fibromyalgia.

The study findings, recently published in the journal Pain Medicine, involved 17 women with fibromyalgia living in Florianopolis, Brazil. Participants were given drops of cannabis oil or a placebo for eight weeks, starting with an initial dose of one drop a day orally and then titrating to an average of 3-4 drops a day.

The cannabis oil used in the study contained 1.22 mg of THC and 0.02 mg of CBD (cannabidiol) per drop. THC is the psychoactive ingredient in marijuana.

The women self-reported their symptoms on a questionnaire every 10 days. Few changes were noted in the placebo group, but the women receiving cannabis oil reported significant improvement on a wide range of symptoms, including pain, depression, anxiety and fatigue. They were also more likely to “feel good” and not miss work compared to the placebo group.

“To our knowledge, this is the first randomized controlled trial to demonstrate the benefit of cannabis oil -- a THC-rich whole plant extract -- on symptoms and on quality of life of people with fibromyalgia,” researchers said. “During the intervention, the impact of the intervention on quality of life in the cannabis group participants was evident, resulting in reports of well-being and more energy for activities of daily living. Pain attacks were also reduced, albeit subjectively, in frequency and intensity.”

The researchers concluded that cannabinoids can be a low-cost and well-tolerated therapy for fibromyalgia patients, and recommended that it be included as an herbal medicine option in Brazil’s public health system.

“The demonstration of safety and efficacy in this gold-standard model is significant. Millions of Americans suffer with FM (fibromyalgia) – a condition that tends to be poorly controlled by standard medicines. These clinical findings indicate that for many of these patients, plant-derived cannabis preparations may be a safe and effective alternative,” said Paul Armentano, Deputy Director of NORML, a pro-marijuana advocacy group.

A major weakness of the Brazilian study is its small size. Participants also continued to self-medicate with analgesics and anti-inflammatory medications during the study, which could have affected the findings.

A larger 2019 study in Israel also found that cannabis reduces pain and improves quality of life for fibromyalgia patients. The cannabis used in that study was ingested by tincture, oil or vaporizer.

Study Finds Cannabis Effective for Treating Depression

By Pat Anson, PNN Editor

Consuming dried cannabis flowers significantly reduces symptoms of depression and works much faster than pharmaceutical antidepressants, according to a new study of over 1,800 cannabis consumers.

The study findings, published in the Yale Journal of Biology and Medicine, is the latest research derived from the Releaf App, a free mobile software program that collects self-reported, real-time information from people on their use of cannabis and its effect on chronic pain, depression and over two dozen other medical conditions.

This particular study excluded the use of cannabis edibles, lotions and oils, and focused solely on cannabis buds that were smoked or inhaled through a vaporizer.

Over 95% of participants in the study reported a decline in depression within hours of ingesting cannabis, with an average reduction in symptom intensity of nearly 4 points, based on a numerical zero to 10 depression scale.

Relief from depression did not vary by the strain of cannabis consumed, but flowers with high levels of tetrahydrocannabinol (THC) were the strongest predictors of symptom relief. THC is the main psychoactive ingredient in cannabis. Levels of cannabidiol (CBD) were generally unrelated to changes in depression.

“Almost all patients in our sample experienced symptom relief from using Cannabis to treat depression and with minimal evidence of serious side effects in the short run,” researchers reported.

“One of the most clinically relevant findings from this study was the widely experienced relief from depression within 2 hours or less. Because traditional antidepressants have times-to-effect in weeks, short-term Cannabis use might be a solution to these delays in treatment or could be used to treat acute episodes associated with suicidal behavior and other forms of violence.”

Prescription drugs used to treat depression include sedatives such as benzodiazepines and antidepressants such as selective serotonin-reuptake inhibitors and tricyclics, as well as anticonvulsant medicines. Most normally take several weeks or months to cause significant relief and have potential side effects such as sedation and suicidal thoughts. Benzodiazepines have become particularly difficult for many pain patients to obtain if they are also prescribed opioid medication.

Medical marijuana is legal in 33 U.S. states and Washington, DC, but depression is not generally recognized as an approved condition under state-regulated medical marijuana programs.

“With no end to the depression epidemic in site, and given the limitations and potential severe negative side effects of conventional antidepressant medications, there is a real need for people to be able to treat mood disturbances with natural, safe, and effective medications, and cannabis checks off all three boxes,” co-author Jacob Vigil, PhD, a University of New Mexico psychology professor, told Forbes.

An earlier study by Vigil using data from the Releaf App found that cannabis flowers rich in THC reduced pain levels an average of three points on a 0 to 10 pain score. Those who ingested cannabidiol (CBD) did not experience similar pain relief.

Another study derived from ReLeaf App data found that cannabis can provide relief from a wide range of symptoms associated with chronic pain, including insomnia, seizures, anxiety and fatigue.

A significant weakness of these studies is that they rely on cannabis users to subjectively self-report their symptoms outside of a clinical setting. There is also no control group or way to measure the quality or quantity of the cannabis they are ingesting.   

Study Finds Microdosing THC Reduces Pain Levels

By Pat Anson, PNN Editor

Very low doses of inhaled THC – the psychoactive ingredient in cannabis – can significantly reduce pain levels in chronic pain patients, according to a small study conducted in Israel.

The concept of “microdosing” cannabis isn’t new, but this was the first clinical study to demonstrate its effectiveness in temporarily relieving pain. The study was sponsored by Syqe Medical, an Israeli medical technology company that makes an inhaler designed to deliver microdoses of cannabis and other drugs.

The study involved 27 patients living with neuropathy, radiculopathy, phantom limb pain or Complex Regional Pain Syndrome (CRPS), who self-reported pain levels of at least 6 on a zero to 10 pain scale. Participants were randomly assigned to three groups that inhaled either a placebo or two different microdoses of THC.  

The most effective dose to relieve pain was just 500 micrograms of THC, inhaled 3-4 times per day. Participants reported a 2 to 3 point reduction in their pain levels for 150 minutes.  

A typical cannabis patient might consume 150,000 micrograms of THC per day – about 75 times more than the highest dose used in the study. Researchers say their findings, published in the European Journal of Pain, suggest that pain patients can benefit from dramatically lower doses.

"We can conclude from the study results that low doses of cannabis may provide desirable effects while avoiding cognitive debilitations, significantly contributing to daily functioning, quality of life, and safety of the patient,” said lead researcher Elon Eisenberg, PhD, Director of the Multidisciplinary Pain Relief Unit at Rambam Health Care Campus in northern Israel.

“The doses given in this study, being so low, mandate very high precision in the treatment modality. This precision is unique to the Syqe drug delivery technology, enabling cannabis dosing at pharmaceutical standards."

There were side effects from inhaling microdoses of THC. About 20% of patients reported feeling “high” or experienced dizziness, sleepiness, nausea, cough or dry mouth. But researchers said there was “no evidence of consistent impairment” in any of the participants.

The risk of impairment from THC is one reason researchers and cannabis companies have largely focused on the medical benefits of cannabidiol (CBD), a compound also found in marijuana. CBD is not psychoactive, while THC can make people impaired – at least in high doses.

"This study is the first to show that human sensitivity to THC is significantly greater than previously assumed, indicating that if we can treat patients with much higher precision, lower quantities of drug will be needed, resulting in fewer side effects and an overall more effective treatment,” said Perry Davidson, CEO of Syqe Medical.

“The Syqe drug delivery technology is also applicable to opioids and other compounds that, while potentially effective, are notoriously associated with dangerous side effects. The introduction of a tool to prescribe medications at such low doses with such high resolution may allow us to achieve treatment outcomes that previously were not possible."

In addition to cannabis, the company is also exploring the use of its inhaler to deliver other drugs for treating pain, sleep, anxiety and cancer. The Syqe inhaler is sold in Israel by Teva Pharmaceuticals. Approval is also being sought to begin sales in Europe, Canada and Australia. Syqe is planning to submit a medical device application to the Food and Drug Administration in the United States.

Most Medical Cannabis Has Too Much THC

By Pat Anson, PNN Editor

More than 90% of the medical cannabis products advertised in the U.S. contain more tetrahydrocannabinol (THC) than is recommended for chronic pain relief, according to a large new study published in the journal PLOS ONE.

THC is the psychoactive ingredient in marijuana that makes people “high.” Previous studies have shown that medical cannabis containing about 5% THC is effective for treating neuropathic pain. But researchers at Wake Forest University found that many cannabis products sold at dispensaries contain nearly four times as much THC, similar to the amount found in recreational cannabis.

"We know that high-potency products should not have a place in the medical realm because of the high risk of developing cannabis-use disorders, which are related to exposure to high THC-content products," said lead author Alfonso Edgar Romero-Sandoval, MD, associate professor of anesthesiology at Wake Forest School of Medicine.

Romero-Sandoval and his colleagues found that over 8,500 medical cannabis products advertised online contain an average THC concentration of 19.2% -- similar to the average 21.5% THC in recreational cannabis. At least one medical cannabis product contained 35% THC.

Ironically, lower concentrations of cannabinoids (CBD) – the compound in marijuana most often associated with pain relief – were found in high THC cannabis.

“These stated concentrations seem unsuitable for medicinal purposes, particularly for patients with chronic neuropathic pain. Therefore, this information could induce the misconception that high potency cannabis is safe to treat pain,” researchers reported.

“This data is consistent with reports in which THC and CBD in products from legal dispensaries or in nationwide products from the illegal market were actually measured, which indicates that patients consuming these products may be at risk of acute intoxication or long-term side effects.”

Medical cannabis is legal in 33 U.S. states and in Washington, DC. The cannabis products analyzed in the Wake Forest study were advertised by 653 legal dispensaries in California, Colorado, Maine, Massachusetts, New Hampshire, New Mexico, Rhode Island, Vermont and Washington.

Most had THC content well above 15 percent, with Maine reporting the least (70%) and Colorado having the most (91%).

PLOS ONE

Researchers say between 60% and 80% of people who use medical marijuana use it for pain relief. High concentrations of THC put them at greater risk of intoxication, dependency and tolerance — which means higher and higher concentrations might be needed to get the same level of pain relief.

"It can become a vicious cycle," Romero-Sandoval said. "Better regulation of the potency of medical marijuana products is critical. The FDA regulates the level of over-the-counter pain medications such as ibuprofen that have dose-specific side effects, so why don't we have policies and regulations for cannabis, something that is far more dangerous?"

A recent study published in the journal Cannabis and Cannabinoid Research found that cannabis products often come with misleading labels and marketing claims.

“Widespread mislabeling of hemp and cannabis products has been documented by both independent researchers and the FDA and other organizations. Underlabeling and overlabeling of both CBD and THC content have been reported,” the authors found.

“The actual contents of available products can vary considerably from what are disclosed on the label; sometimes no CBD is present at all. Inadequate label information also poses risks of unintended, unwitting, or overconsumption of THC, the primary intoxicating compound in cannabis, as well as potentially harmful contaminants.”

Veteran With Chronic Pain Hospitalized After Vaping THC

By Marlene Harris-Taylor, Ideastream

As vaping has grown more popular in recent years, the trend has been fueled by the habit’s pleasurable allure: Compared with smoking cigarettes or pot, vaping is discreet and less smelly. Vaping fluids come in hundreds of flavors. There’s no tar or other byproducts of burning. And vape pens are high-tech, customizable and sleek.

But none of that mattered to Paul Lubell when he decided to try vaping. He wasn’t thinking about pleasure; he was trying to avoid pain. The retired Navy veteran turned to vaping marijuana, hoping it would help him cope with his chronic, debilitating musculoskeletal pain.

Unfortunately, it wasn’t long before he became part of the national statistics tracking an outbreak of a vaping-related lung illness that has killed more than 50 Americans and sickened 2,400. Lubell ended up in the hospital, seriously ill from vaping an oily liquid containing extracts of THC, the psychoactive ingredient in marijuana.

Lubell, who lives in the Cleveland suburb of Beachwood, is older than most of those who have contracted what is now being called “e-cigarette or vaping associated lung injury,” or EVALI.

Three-quarters of patients with the condition have been under age 35; Lubell is 59.

But like patients in the majority of those cases, he used THC. And the latest information from the Centers for Disease Control and Prevention suggests that it’s some added ingredient in THC vapes — likely vitamin E acetate — that is causing the lung disease. The CDC is warning people to stop vaping altogether, given the risk of lung illness, which puts people who vape to manage pain in a tough position.

‘My Pain Would Be Gone’

Lubell suffers from pain in his back, neck and knees. He is not sure when his problems started, but he wonders if they are related to his days on a Navy helicopter rescue team.

“It was fun. I was indestructible and good at what I did. Everybody wanted me,” he recalled, while looking at photos of his much younger self posing on top of one of the helicopters.

Lubell sometimes jumped out of the helicopter and smacked into the water during training and rescue missions. That could have been the genesis of some of his back pain, he said. Lubell has had two back surgeries, and he also suffers from serious neck pain. Every day is a struggle, he said.

Looking for relief, he has tried many medications, including opioids such as hydrocodone, but that drug is no longer an option. Lubell is a patient at Louis Stokes Cleveland VA Medical Center, and in the wake of the national opioid addiction epidemic, the VA has revised its pain-treatment protocols.

“The VA is not a friend of opioids at all,” Lubell said. “Unless you’re coming out of the hospital for surgery or something like that, they do not give vets opioids.”

“It leaves someone who is in chronic pain in a very tough situation, having to decide how to deal with it,” he added.

Lubell started using an electronic cigarette device paired with prefilled THC cartridges. Medical marijuana is legal in Ohio, as it is in 32 other states, plus the District of Columbia.

“When I say it took away pain — it was almost instantaneous,” he said. “Within the span of 10 minutes, my pain would be gone. … It made me capable of doing my daily activities.”

Lubell described his old vaping cartridges as tiny sticks that screwed on top of the vaping pen. When he inhaled at one end of the pen, it pulled the THC extract and other liquids in the cartridge over a heating element. Vaping was different from when he had smoked marijuana, Lubell said.

“It doesn’t have a stench to it. You could do it out on the streets. It doesn’t have that — what’s the word I’m looking for? — stigma,” he said.

Hospitalized With Cough And Fever

Lubell purchased the THC cartridges from a friend at what he described as a below-market price. A few months later, in July, Lubell started running a very high fever and went to the Cleveland VA Medical Center.

“He had this cough that was persistent. He just looked very, very sick,” recalled Dr. Amy Hise, who was on the team of physicians that treated Lubell.

“He was put on very strong broad-spectrum antibiotics, and yet he continued to have fevers. He continued to feel unwell. He had very flu-like symptoms,” Hise said.

After a few days, Lubell seemed to improve and was released, according to Hise. But then, he grew ill again.

Hise said she was surprised when he came back to the emergency department in late August.

By then, however, she had seen a new alert from the CDC about the vaping illness. Lubell had also seen reports in the media about health problems related to vaping.

“He was forthright that he had been vaping, and indeed what had happened is when he was in the hospital before, he’d stopped vaping,” Hise said. “He stopped for a period of time until he started to feel better. And then he started it up again, and that’s when his lung disease came back.”

The doctors at the VA switched tactics, taking Lubell off antibiotics and starting him on steroids, based on information provided by the CDC. Lubell was soon released and on the road to recovery.

No More Vaping

Even though vaping eased his pain, those two bouts of respiratory sickness were too much. Lubell said he won’t vape again, and his doctor endorsed that decision.

“I think there’s just too much that’s not known about what’s in these products to safely use them,” Hise said.

But Lubell is not alone in having turned to marijuana for pain management. Dr. Melinda Lawrence, a pain management specialist at University Hospitals, said many patients have told her they are trying marijuana to see if it will help.

“That is probably something that I get from patients every day,” Lawrence said. “And it’s not just people who are young, in their 20s. [There are] people in their 80s who are telling me they are looking to try anything to help with their pain.”

Even though some patients say marijuana helps their pain, there is not enough research to prove it’s broadly and reliably effective, Lawrence said.

“Personally, I don’t recommend it for my patients. But maybe after we have more studies, it can be something in the future” she said.

Lubell, who has an Ohio medical marijuana card, is still planning to use marijuana — but he won’t vape it. He turned over his equipment and leftover THC cartridges to health officials for analysis.

This story is part of a partnership that includes ideastream, NPR and Kaiser Health News, a national health policy news service.

Hold the CBD and Pass the Gravy

By Pat Anson, PNN Editor

You can now buy cannabis-infused juice, beer, popcorn, gummies, breakfast cereal, and just about every food and drink imaginable with CBD or even THC.  

But you know things are getting out of hand when a company starts selling cannabis-infused turkey gravy – just in time for Thanksgiving.

KIVA Confections – a California company that makes a line of cannabis chocolates and edibles -- has introduced a “groundbreaking” turkey gravy infused with 10mg of THC, the psychoactive compound in marijuana. Thanksgiving dinner will never be quite the same.

“Awkward family dinner conversation? In just under 15 minutes you’ll start feeling the effects, so you can sit back, relax, and let the holiday cheer wash over you,” said Kiva in a tongue-in-cheek blog post

The company plans to introduce a cannabis-infused hot cocoa mix by Christmas.  

KIVA CONFECTIONS

FDA Warns CBD Companies

Federal health officials are finally blowing the whistle on cannabis marketing. The Food and Drug Administration has issued warning letters to 15 companies for illegally selling and marketing cannabis infused products.

Ironically, the FDA’s focus is not on THC, but on cannabidiol (CBD), the seemingly harmless and over-hyped compound in cannabis associated with many health claims. The FDA has revised a Consumer Update to more clearly state that CBD is not recognized as safe for use in human or animal food.

“We remain concerned that some people wrongly think that the myriad of CBD products on the market, many of which are illegal, have been evaluated by the FDA and determined to be safe, or that trying CBD ‘can’t hurt.’ Aside from one prescription drug approved to treat two pediatric epilepsy disorders, these products have not been approved by the FDA,” Amy Abernethy, MD, FDA Principal Deputy Commissioner, said in a statement.

“We recognize the significant public interest in CBD and we must work together with stakeholders and industry to fill in the knowledge gaps about the science, safety and quality of many of these products.”

What most concerns the FDA is that CBD is being marketed as a treatment for chronic pain, arthritis, depression, addiction, anxiety and other medical conditions with no clinical evidence that it actually works.

Red Pill Medical of Phoenix, one of the companies that received a warning letter, claims CBD can cure cancer.

“We’ve seen CBD kill prostate cancer cells, kill colon cancer cells…there’s just thousands of anecdotal stories on the internet where people have cured themselves when they were told they had weeks or months to live using CBD,” Red Pill claims in a promotional video.

Another company, Whole Leaf Organics of Los Angeles, was warned about selling CBD products for pets.

“Beneficial and safe for both people and animals, CBD has been known to reduce inflammation, assist with chronic fatigue, alleviate joint and muscle pain, and help in regards to the management of stress and anxiety,” Whole Leaf claims on its website.

One company was warned about marketing CBD products for infants and children, while another was warned about selling CBD for food-producing animals such as chickens and cows.

This isn’t the first time the FDA has warned cannabis companies to be more discerning in their marketing. Similar warning letters were sent in March to three companies for making unsubstantiated health claims about their CBD oils, extracts and edibles.

One of the companies, NutraPure, now has a disclaimer on its website stating that its products “have not been evaluated” by the FDA and “are not intended to diagnose, prevent, treat, or cure any disease.” As PNN reported, however, that didn’t stop a NutraPure representative from recommending the company’s hemp oil to this reporter as a treatment for fibromyalgia.

The FDA says it will “explore potential pathways” for CBD products to be marketed legally and would be providing an update in coming weeks.

In the meantime, pass the gravy.

What Are Health Risks of Vaping CBD?

By Roger Chriss, PNN Columnist

An outbreak of lung illnesses linked to vaping is raising important questions about the safety of vaping cannabis products. The cause is still unclear, but the CDC reports about 76% percent of the patients who became ill vaped products containing THC – the psychoactive ingredient in cannabis. Only about 17% reported vaping a cannabidiol (CBD) product.

At present, very little is known about CBD vaping safety. The World Health Organization’s 2017 report on cannabidiol looked at oral, sublingual and intranasal routes of administration. When the WHO wrote that “CBD is generally well tolerated with a good safety profile,” it was not considering vaping at all.

The Food and Drug Administration still considers CBD in food and drugs sold commercially to be illegal, unless the product falls under the Food, Drug and Cosmetic Act. Vaping CBD does not, and so there has been no testing or regulatory action.

There have been no good human studies on CBD vaping. Research generally looks at CBD in edibles and liquids, or smoked using traditional means.

It is not known what happens to CBD under vaping temperatures, if there are thermal degradants, or important chemical reactions between CBD and other ingredients in vaping liquids or other drugs.

A recent lung tissue study found concerning results about inhaling CBD while using steroids. CBD helps reduce inflammation, but “acts as an antagonist with steroids, overriding the anti-inflammatory potential of steroids when used in combination.”

Last year Vice reported on public health warnings in North Carolina after 90 people became sick with headaches, nausea, hallucinations and other health problems after vaping CBD products. Adulterants appear to have been the problem, and Vice noted that vape oils are poorly regulated and sometimes contain chemicals that “when heated in a vape and inhaled, can cause serious lung irritation.”

A recent study on the quality of CBD liquids used in e-cigarettes is also concerning, finding that “the quality control of manufacturers and the relative safety of these products is uncertain.”

An AP investigation last month found that in lab tests on 30 CBD vape products, ten samples contained synthetic marijuana such as K2 or spice, while others had no CBD at all.

Some states with legalized cannabis do require testing of CBD vapes. But it’s not clear what to test for, and even the lab methods for testing have yet to be validated. It is also not known which cutting agents, adulterants and contaminants should be cause for concern. Lung tissue is fragile, vulnerable in ways the GI tract is not, and not well studied. So testing regimes may ultimately require information we currently lack.

Oversight of cannabis testing is limited. California’s Sequoia Analytical Labs was found to be falsifying lab results last year. Plus, many CBD vapes come from the gray or black markets, or are home-brewed, making attempts at quality control irrelevant. As a result, CBD vaping safety is an open question, assuming it is even possible to make a safe CBD vape.

Fortunately, new research may help. Researchers are testing vaporized cannabis extracts on rats. This will allow for studying the effects of THC and CBD in animal models in a way that closely mimics human behavior.

Such information is urgently needed. Animal studies on vaping are raising concerns about lung cancer risk, but such research may not be representative of how humans vape, limiting their value.

There is ongoing debate on what CBD is good for. And now we also have to consider how CBD should be administered. It may be possible to create a low-risk CBD vape product. But at present we don’t really know how to do it.

Roger Chriss lives with Ehlers Danlos syndrome and is a proud member of the Ehlers-Danlos Society.

Roger is a technical consultant in Washington state, where he specializes in mathematics and research.

The information in this column is for informational purposes only and represents the author’s opinions alone. It does not inherently express or reflect the views, opinions and/or positions of Pain News Network.

Has Vaping Hysteria Gone Too Far?

By Anna Maria Barry-Jester and Jenny Gold, Kaiser Health News

On Sept. 16, Tulare County in California announced the nation’s seventh death from vaping-related illness. Its advisory warned about “the dangerous effects of using electronic cigarettes, or e-cigarettes.”

As federal and state health officials struggle to identify what exactly is causing the deadly outbreak, vaping advocates are stepping into the void and crafting an alternative narrative that is being echoed broadly in online communities.

The people getting sick, according to their version of events, all vaped THC — the psychoactive ingredient in cannabis — using products bought on an illicit black market. They also contend federal officials have seized on the crisis to crack down on a nicotine vaping culture they don’t appreciate or understand, a culture proponents insist has helped them and millions of others quit smoking.

As of Oct. 1, the federal Centers for Disease Control and Prevention had identified more than 1,000 cases of vaping-related lung illness in 48 states. Eighteen people have died, including two in California. Of the 578 patients who have reported using specific products, most said they had vaped THC, but a significant portion — 17% — said they had used only nicotine.

CDC officials maintain they can’t identify one product or chemical culprit, and while they recently began emphasizing the risks of vaping THC, they continue to warn against any vape use at all.

Meanwhile, cities and states have responded with a divergent mix of warnings and bans. Michigan, New York and Rhode Island have moved to ban most flavored nicotine vaping products. The California Department of Public Health recently warned against all vaping devices, and the governor of Massachusetts issued a four-month ban on all vaping products.

The actions have sparked a backlash among hundreds of thousands of people who say they’ve been vaping for years without a problem. Compounding their distrust: the political calls to ban flavored nicotine products even though the vast majority of illnesses identified appear to involve people who were vaping THC.

They see a government out to quash nicotine vaping because its popularity with teens has caused a public outcry, ignoring the adults who find it a pleasing alternative to cigarettes. When it comes to vaping, they have stopped looking to the CDC for advice.

Debbye Saladine-Thompson is a registered nurse in Michigan who was a smoker for 32 years before she switched to vaping. She now manages the Michigan Facebook page for Consumer Advocates for Smoke-Free Alternatives Association (CASAA), a nonprofit that advocates for access to e-cigarettes and receives industry funding.

“I do not trust the CDC. Not anymore” Saladine-Thompson said. “I cannot trust an agency that says the product that I and so many people have been using for 10 years and hasn’t caused one death is now causing hundreds of illnesses. No, I do not believe that.”

Online vaping forums are roiling with accusatory messages suspicious of the government response. In Facebook groups, including one called ‘BLACK MARKET THC CARTRIDGES CAUSED THIS QUIT LYING ABOUT VAPOR PRODUCTS,’ vapers have expressed outrage over the bans on nicotine products while cigarettes remain readily available. They’re organizing phone calls to legislators and rallies at state capitols.

“We’re living and dying by these decisions,” said Kristin Noll-Marsh, the member coordinator for CASAA who moderates the group’s national Facebook group. “This vaping panic of 2019 is gonna go down in the history books as being like flat Earth, bloodletting and burning witches.”

CDC Messaging Criticized

Throughout the outbreak, the CDC has said that people who vape to quit smoking should not return to cigarettes. But the emphasis on all vaping devices drowns out that warning, said Dr. Michael Siegel, a professor at Boston University and proponent of e-cigarettes as a smoking cessation tool.

“In an outbreak investigation like this one, you have to be as specific as possible if you want people to listen. If you say ‘Just don’t vape,’ that’s not telling anyone anything they don’t already know.”

Many also are critical of the messaging used by the CDC, states and some media outlets, saying they are out of touch with vaping culture and its terminology. Public officials often use one word — e-cigarettes — to describe what to people who vape is a wide range of products with different names.

People who see headlines about illnesses linked to “e-cigarettes” may not know it applies to them, said Jim McDonald, a journalist with Vaping360, a consumer news site. “Cannabis vapers don’t use the term e-cigarettes. They never, never use that term.”

Even among e-cigarettes, a term many equate with nicotine delivery devices, people differentiate between cartridge-based devices like Juul and the handheld “mods,” which tend to be larger and produce more vapor. E-liquids can come prepackaged in ready-to-use form or can be mixed in stores or at home. Whether cannabis is legal and regulated also varies among states.

The problem with the alternative narrative, say doctors who are treating patients, is that it’s not clear whether only illicit THC is to blame. Dr. Dixie Harris, a critical care pulmonologist with Intermountain Healthcare in Utah, has been reporting five to seven cases a week for the past six weeks. While many patients have reported using illicit THC, she also has had patients who have fallen ill after using products purchased at licensed medical dispensaries in states where cannabis is regulated.

A new study looking at lung tissue samples from 17 patients found the damage resembled chemical burns and included two samples from people who fell ill before the outbreak. The findings cast doubt on a popular theory that vitamin E oil, which has been used as a thickening agent in THC oil, is the culprit.

The investigation is challenging on many fronts. Vaping — both legal and illicit, nicotine and cannabis — has exploded in the past few years with little regulation. There are hundreds of products, do-it-yourself kits and home brews. The potential culprits are many: popular flavorings in nicotine vapes never tested for inhalation. Oils used to dilute THC. Contaminants. Pesticides. Possible toxic residue from the containers themselves.

The CDC is grappling with a dearth of information. The process of alerting the many agencies and entities involved — doctors, hospitals, law enforcement, public health departments — has been slow.

Among 86 cases in Illinois and Wisconsin, where the outbreak first was identified and investigators are further along in their work, people reported using 234 different products involving both nicotine and cannabis, according to a report published last month. Those products, in turn, involved a variety of brands, numerous supply chains and packaging without listed ingredients.

Dr. Anne Schuchat, principal deputy director of the CDC, said the agency wasn’t narrowing the investigation only to cannabis, stressing it needed to “have an open mind” to understand the possible risks.

“Personally, with all the data that I’ve been seeing,” Schuchat said Friday, “I don’t know what ‘safe’ is right now.”

Kaiser Health News, a nonprofit health newsroom whose stories appear in news outlets nationwide, is an editorially independent part of the Kaiser Family Foundation.

The Risks of Vaping THC

By Roger Chriss, PNN Columnist

An outbreak of vaping-associated pulmonary illness is getting national attention. Over 800 people have been sickened and 12 have died.

The CDC reported last week that vaping products containing tetrahydrocannabinol (THC) -- the psychoactive compound in marijuana – were involved in 77 percent of the illnesses. Several states responded with bans on vaping products and health alerts on vaping THC.

What do we know about the risks of vaping?

Vaping THC is so new that there is very little research. An animal study on vaping THC was published earlier this year. Performed on male and female rats, the study found that “repeated THC vapor inhalation in adolescent rats results in lasting consequences observable in adulthood."

Specifically, both sexes became tolerant to THC and male rats ate more. Interestingly, THC use did not change oxycodone self-administration in either sex, but increased fentanyl self-administration in female rats. There is no mention of lung effects.

While vaping with e-cigarettes is relatively new, inhaling THC via cannabis smoking is old. And there is an extensive literature on multiple harms.

A recent study of nearly 9,000 people found that regular cannabis use was significantly associated with greater risk of respiratory diseases such as asthma, chronic obstructive pulmonary disease (COPD) and pneumonia. The study used blood work to confirm use and had a control group, making its results more reliable than a simple population survey.

According to the National Institute on Drug Use, cannabis smoke contains multiple carcinogens and inhalation causes lung inflammation, increased airway resistance and hyperinflated lungs, a symptom of COPD

Josh Bloom at the American Council of Science and Health writes that the solubility and boiling point of THC and CBD in cannabis vaping products may play a role in the lung illnesses.

But complicating matters is the presence of other subtsances in vaping liquids and in the devices themselves. A newly published study in Scientific Reports on aerosols in tank-style e-cigarettes found levels of chromium, lead and nickel, all known carcinogens, in excess of OSHA permissible exposure limits.

Most cases of vaping-associated pulmonary illness involve illicit products. But one fatal case in Oregon involved someone who bought vaping products at two state-licensed cannabis dispensaries.

Some vaping illnesses involve people who report no use of THC products at all, though investigators are finding that these self-reports are not necessarily accurate. According to STAT News, eight patients in Wisconsin initially said they didn’t use THC products, but were later found to have used the drug.

In other words, we may not know what people were really vaping. Given that vaping THC is federally illegal and only marginally regulated in states where cannabis is legal, investigating the role of THC in the vaping outbreak is challenging.

But the emerging risks have led states like Washington to ban all flavored vaping products. And the FDA has asked the DEA to pursue criminal charges against anyone who sells illicit vaping products.

For patients who use cannabis products for pain relief, there are better alternatives than vaping. The Arthritis Foundation recently released new guidelines that recommend CBD oils and tinctures that can be taken orally.

It is not clear what this means for the cannabis industry. But Joe Tierney, known as the "Gentleman Toker,” told the Washingtonian that he would be shutting down his cannabis website.

“I don’t feel good about the industry any longer,” Tierney said. “I don’t think it’s safe to consume cannabis anywhere after all of my travels.”

Sorting out the risks of THC vaping will take time. At present there is only circumstantial evidence and intriguing ideas. It is possible that THC is one of several different causes or is just guilty by association. Beyond that, we have the unknowns of vaping itself, which may be too novel for anyone to fully understand the risks.

Roger Chriss lives with Ehlers Danlos syndrome and is a proud member of the Ehlers-Danlos Society. Roger is a technical consultant in Washington state, where he specializes in mathematics and research.

The information in this column is for informational purposes only and represents the author’s opinions alone. It does not inherently express or reflect the views, opinions and/or positions of Pain News Network.

Study: THC More Effective Than CBD in Treating Pain

By Pat Anson, PNN Editor

The psychoactive ingredient in marijuana -- tetrahydrocannabinol (THC) – is more effective than cannabidiol (CBD) in treating chronic pain and other medical conditions, according to a new study that challenges the widespread belief that THC is harmful and has limited value in medical cannabis products.

Researchers at the University of New Mexico used the Releaf App, a mobile software program, to analyze self-reported data from over 3,300 people who logged their responses in nearly 20,000 user sessions to a variety of cannabis products, including natural dried flower, edibles, tinctures and ointments.

Dried flower was the most commonly used product and was generally associated with greater pain relief than other cannabis products, regardless of the amount of THC.

"Despite the conventional wisdom, both in the popular press and much of the scientific community that only CBD has medical benefits while THC merely makes one high, our results suggest that THC may be more important than CBD in generating therapeutic benefits,” said Jacob Miguel Vigil, PhD, a professor in UNM’s Department of Psychology.

“In our study, CBD appears to have little effect at all, while THC generates measurable improvements in symptom relief. These findings justify the immediate de-scheduling of all types of cannabis, in addition to hemp, so that cannabis with THC can be more widely accessible for pharmaceutical use by the general public.”

Hemp is a strain of marijuana that was legalized by Congress in the 2018 Farm Bill. It has very low levels of THC, but is being grown commercially as a source for CBD.

UNM researchers found that indica strains of cannabis were more effective than sativa strains in treating pain and insomnia. Both strains have substantially higher levels of THC than hemp, but are illegal Schedule I controlled substances under federal law.

“Only THC potency levels showed independent associations with symptom relief and experiences of both positive and negative side effects, with higher levels (of THC) resulting in larger effects,” Vigil said.

Researchers say the relative weakness of CBD in treating symptoms may be due to inaccurate labeling of CBD content in cannabis products, which is a widespread industry problem. It’s also possible that THC simply heightens the experience or awareness of symptom relief.

Vigil published his findings in the journal Scientific Reports. Three of his co-authors developed the Releaf App, which has collected information from cannabis users since 2016. The app is an important data source for researchers, who are currently limited in conducting clinical studies of cannabis because of federal regulations.

Two previous studies by Vigil using data from the Releaf App found that cannabis provides significant relief from a wide range of symptoms associated with chronic pain, including insomnia, seizures, depression, anxiety and fatigue.

CBD Is Now Regulated and That May Be a Good Thing

By Roger Chriss, PNN Columnist

The legal status of cannabidiol (CBD) is changing. Once classified exclusively as a Schedule I drug under the Controlled Substances Act, CBD is now legal under federal law. And this means regulation.

The 2018 Farm Bill removed hemp from Schedule I. Hemp is a strain of marijuana with very low levels of THC, but high amounts of CBD.  This has opened the door to a legal market for CBD products, including food and supplements. But there’s a catch. The FDA has strict regulations about CBD being used in dietary supplements or promoted as medical treatments.

“It’s unlawful under the FD&C Act (Federal Food, Drug, and Cosmetic Act) to introduce food containing added CBD or THC into interstate commerce, or to market CBD or THC products as, or in, dietary supplements, regardless of whether the substances are hemp-derived,” FDA commissioner Scott Gottlieb, MD, said in a December 2018 statement.

“Among other things, the FDA requires a cannabis product (hemp-derived or otherwise) that is marketed with a claim of therapeutic benefit, or with any other disease claim, to be approved by the FDA for its intended use before it may be introduced into interstate commerce. This is the same standard to which we hold any product marketed as a drug for human or animal use.”

 The FDA has a FAQ page about cannabis that answers some basic questions:

"Can products that contain THC or cannabidiol (CBD) be sold as dietary supplements? A. No."

"Is it legal, in interstate commerce, to sell a food to which THC or CBD has been added? A. No."

The FDA has reason to be concerned. Product quality for CBD products is iffy at best. An investigation by the NBC affiliate in Miami (see “Patients Are Being Duped”) found that 20 of 35 CBD products tested had less than half the amount of CBD advertised on the label. Some samples had no CBD at all.

Other recent analyses have found THC, pesticides, synthetic cannabinoids and toxic solvents in CBD products.

Moreover, a lack of regulatory oversight has led to an abundance of false, misleading or unsubstantiated claims. A recent review of CBD in the Journal of Clinical Pharmacology found that “CBD has been touted for many ailments for which it has not been studied, and in those diseases with evaluable human data, it generally has weak or very weak evidence.”

There is a lot of research on CBD going back years. The FDA’s approval of the CBD-based drug Epidiolex for rare childhood seizure disorders and a 2018 review that found potential for treating multiple sclerosis symptoms are important indicators of CBD’s medical value. At the same time, researchers have found no benefit in treating spinal cord injury, Crohn’s disease and osteoarthritis.

Yet CBD is now being widely promoted as a wellness product, and added to everything from coffee and pastries to bath oils and mascara. So it is not surprising that the FDA is concerned that people may be duped or put at risk.

The FDA is not alone in this. The New York City Department of Health has banned CBD products from being sold in bars and restaurants. Maine, New York, and Ohio are also banning CBD edibles.

For medically complicated people with chronic illness, regulation could be beneficial. At present these patients face significant risks with CBD products. Tainted CBD may cause unexpected allergic reactions or drug interactions. And contaminated CBD could trigger a positive result on a urine drug test, a common part of pain management amid the opioid crisis. Regulatory oversight could help reduce these risks. 

The legal and regulatory landscape surrounding CBD is shifting quickly. The FDA and state government agencies are watching closely and starting to intervene. This may flush out bad actors in the CBD marketplace and improve product quality and reliability. A stable marketplace with reliable products may be a net gain for the people who stand to benefit the most from CBD.

Roger Chriss lives with Ehlers Danlos syndrome and is a proud member of the Ehlers-Danlos Society. Roger is a technical consultant in Washington state, where he specializes in mathematics and research.

The information in this column should not be considered as professional medical advice, diagnosis or treatment. It is for informational purposes only and represents the author’s opinions alone. It does not inherently express or reflect the views, opinions and/or positions of Pain News Network.