Cannabis Regulation Research Articles

Legalize or Prohibit It? Quebec’s Exceptionalism on Cannabis Regulation and the Framing of Evidence in Policymaking

ABSTRACT Successive governments of the Liberal and CAQ parties have worked on Quebec’s cannabis regulation. Although “progressiveness” is a key part of its political identity, and despite its population being the largest user of cannabis since it was legalized, Quebec adopted the most repressive legislation among Canadian provinces. The process of framing the issue was nevertheless heavily influenced by the use of scientific evidence. In this paper, we seek to understand how evidence from different scientific fields was mobilized in the policymaking process. In order to classify the actors’ positions and use of science, we develop a bidimensional continuum in which approaches to both health and behavior are presented. We specifically discuss three relevant issues that distinguish Quebec from other Canadian provinces: personal cultivation, public consumption, and legal age. Although multiple approaches to these issues were possible, government actors persistently put forward an individual approach to health and a moralistic approach to behavior. The adoption of the same repressive approach on each issue without scientific consensus suggests that scientific arguments were mobilized as a tool to support preexisting beliefs rather than to ground policy on evidence.

La regulación del cannabis medicinal en Uruguay y los desafíos para la conformación de circuitos innovativos

A partir de la promulgación de la Ley Nº 19.172 Uruguay comenzó un proceso nacional de regulación de cannabis. Ello involucró modificaciones institucionales trascendentes como la creación del Instituto de Regulación y Control del Cannabis (IRCCA). Así también, se sucedieron instancias de aprendizaje, adaptación y momentos de incertidumbre política y sucesivos bloqueos provenientes de diversos sectores. El artículo busca analizar cómo el esquema elegido para la regulación del mercado de cannabis genera incentivos para la instalación de circuitos innovativos (CI) y, concomitantemente, micro-procesos innovadores destinados a resolver problemas de distinto tipo. Partiendo de una aproximación metodológica cualitativa que comprendió, por un lado, la realización de entrevistas a informantes calificados y protagonistas de la implementación de la política, así como actores de la gobernanza de la política y por otro la revisión de fuentes documentales, el documento argumenta que el diseño institucional y regulatorio que se desprende del marco normativo escogido habrían generado una serie de nudos o complejidades que condicionaron la aparición de CI.

Assessing the Retail Environments of Licensed and Unlicensed Cannabis Dispensaries: Adapting the Marijuana Retail Surveillance Tool to Inform Cannabis Regulation in Los Angeles County.

After statewide legalization of recreational cannabis in California, the Los Angeles (LA) County Board of Supervisors requested a health equity impact assessment to inform its decisions on whether and how to regulate cannabis dispensaries in unincorporated areas of LA County. As part of this assessment, the LA County Department of Public Health compared the retail environments of licensed and unlicensed cannabis dispensaries in different parts of the county, using the Marijuana Retail Surveillance Tool (MRST), a validated instrument piloted in Colorado and Washington. Two waves of observational surveys were conducted, one comparing licensed and unlicensed dispensaries within and near unincorporated areas of LA County and another comparing licensed dispensaries across LA County in areas with varying levels of health advantage according to a neighborhood index measuring social determinants of health. Dispensaries were compared on measures of product types, promotional activities, security measures, regulatory compliance, and neighborhood context. Unlicensed dispensaries were more likely than licensed dispensaries to sell products in packaging designed to be attractive to children (71.8% vs 10.8%, P < .001) and in non-child-resistant packaging (98.9% vs 15.6%, P < .001) and were more likely allow on-site consumption (60.9% vs 0%, P < .001). Licensed dispensaries showed high compliance with regulations, regardless of whether they were in areas of high or low health advantage. The study points to the importance of efforts to eliminate illicit businesses as part of an overall strategy for regulating cannabis. It also demonstrates that the MRST is a flexible tool for regulatory surveillance and for continuing to study the relationships between cannabis retail environments and potential risks to public health.

IMMORAL IN PRINCIPLE, UNWORKABLE IN PRACTICE: CANNABIS LAW REFORM, THE BEATLES AND THE WOOTTON REPORT

AbstractIn the late 1960s, the cause of cannabis law reform briefly rose to remarkable cultural prominence in several Western countries, notably the United Kingdom and the United States. Some 50 years later, as global cannabis prohibition is once again coming under intense critical scrutiny in many parts of the world, this paper revisits the events of the 1960s. Drawing on primary archival research, the paper recovers the story of the rapid emergence and development of the reform movement. The importance to reform discourse of ideas of personal freedom and civil liberties is explored and set in the context of wider shifts in liberal governance. In conclusion, it is argued that the challenge of cannabis regulation today needs to be understood in the context of contemporary regulatory capitalism.

Surveillance from the high ground: sentinel surveillance of injuries and poisonings associated with cannabis.

In October 2018, Canada legalized the nonmedical use of cannabis for adults. The aim of our study was to present a more recent temporal pattern of cannabis-related injuries and poisonings found in the electronic Canadian Hospitals Injury Reporting and Prevention Program (eCHIRPP) database and provide a descriptive summary of the injury characteristics of cannabis-related cases captured in a nine-year period. We conducted a search for cannabis-related cases in the eCHIRPP database reported between April 2011 and August 2019. The study population consisted of patients between the ages of 0 and 79 years presenting to the 19 selected emergency departments across Canada participating in the eCHIRPP program. We calculated descriptive estimates examining the intentionality, external cause, type and severity of cannabis-related cases to better understand the contextual factors of such cases. We also conducted time trend analyses using Joinpoint software establishing the directionality of cannabis-related cases over the years among both children and adults. Between 1 April 2011, and 9 August, 2019, there were 2823 cannabis-related cases reported in eCHIRPP, representing 252.3 cases/100 000 eCHIRPP cases. Of the 2823 cannabis-related cases, a majority involved cannabis use in combination with one or more substances (63.1%; 1780 cases). There were 885 (31.3%) cases that involved only cannabis, and 158 cases (5.6%) that related to cannabis edibles. The leading external cause of injury among children and adults was poisoning. A large proportion of cannabis-related cases were unintentional in nature, and time trend analyses revealed that cannabis-related cases have recently been increasing among both children and adults. Overall, 15.1% of cases involved serious injuries requiring admission to hospital. Cannabis-related cases in the eCHIRPP database are relatively rate, a finding that may point to the fact that mental and behavioural disorders resulting from cannabis exposure are not generally captured in this surveillance system and the limited number of sites found across Canada. With Canada's recent amendments to cannabis regulations, ongoing surveillance of the health impacts of cannabis will be imperative to help advance evidence to protect the health of Canadians.

Legalizing recreational cannabis use: a promising journey into the unknown.

In order to evaluate the impact of the current legalization experiences, it is cru-cial to measure their efects both on public health and on users’ criminalization and contacts with illegal activities. The Uruguay-an cannabis regulation model is a middle-ground option between prohibition and commercialization, in which the govern-ment imposes strict regulations for users: mandatory registry, maximum amount of cannabis per user (40 g per month and 480 g per year), no advertisement, no selling to tourists, no edibles allowed. These restric-tions were planned to control consumption and accomplish the public health goal of the regulation.

The effects of recreational cannabis legalization might depend upon the policy model.

The effects of recreational cannabis legalization might depend upon the policy model.

State Medical Cannabis Laws Associated With Reduction in Opioid Prescriptions by Orthopaedic Surgeons in Medicare Part D Cohort.

Opioid prescriptions and abuse remain a significant national concern. Cannabinoids offer a potentially attractive nonopioid analgesic option for orthopaedic patients, and 32 US states have passed medical cannabis laws (MCLs), legalizing patient access to cannabinoids. We examine the association between implementation of state cannabis laws and prescribing patterns for opioids by orthopaedic surgeons in Medicare Part D patients between 2013 and 2017. Using the Medicare Part D Prescription Drug Event database, we measured annual aggregate daily doses of all opioid medications (excluding buprenorphine) prescribed by orthopaedic surgeons in each US state (and DC), in addition to total daily doses of opioid medications by generic name (hydrocodone, oxycodone, fentanyl, morphine, methadone, and "other opioids"). We used adjusted linear regression models to examine associations between state-specific cannabis regulations (state MCL, MCL type-dispensary or home cultivation, and recreational cannabis legalization) and annual total daily doses of opioid medications (all opioids and opioid types, separately). State MCLs were associated with a statistically significant reduction in aggregate opioid prescribing of 144,000 daily doses (19.7% reduction) annually (95% confidence interval [CI], -0.535 to -0.024 million; P < 0.01). States with MCLs allowing access to in-state dispensaries had a statistically significant reduction in total opioid prescriptions of 96,000 daily doses (13.1%) annually (95% CI, -0.165 to -0.026 million; P < 0.01). Specifically, MCLs were associated with a statistically significant reduction of 72,000 daily doses of hydrocodone annually (95% CI, -0.164 to -0.019 million; P < 0.01). No significant association between recreational marijuana legalization and opioid prescribing was found. Orthopaedic surgeons are among the highest prescribers of opioids, highlighting the importance of providing nonopioid analgesic alternatives in efforts to reduce opioid use in the patient cohort. This study is the first to examine the association between implementation of state cannabis laws and prescribing patterns for opioids by orthopaedic surgeons in Medicare Part D patients. Population-based ecological study.

Free and Glucuronide Urine Cannabinoids after Controlled Smoked, Vaporized and Oral Cannabis Administration in Frequent and Occasional Cannabis Users.

Total urinary 11-nor-9-carboxy-tetrahydrocannabinol (THCCOOH) concentrations are generally reported following cannabis administration. Few data are available for glucuronide and minor cannabinoid metabolite concentrations. All urine specimens from 11 frequent and 9 occasional cannabis users were analyzed for 11 cannabinoids for ~85h by liquid chromatography with tandem mass spectrometry following controlled smoked, vaporized or oral 50.6mg Δ9-tetrahydrocannabinol (THC) in a randomized, placebo-controlled, within-subject dosing design. No cannabidiol, cannabinol, cannabigerol, tetrahydrocannabivarin (THCV), THC, 11-OH-THC and Δ9-tetrahydrocannabinolic acid were detected in urine. Median THCCOOH-glucuronide maximum concentrations (Cmax) following smoked, vaporized and oral routes were 68.0, 26.7 and 360μg/L for occasional and 378, 248 and 485μg/L for frequent users, respectively. Median time to specific gravity-normalized Cmax (Tmax) was 5.1-7.9h for all routes and all users. Median Cmax for THCCOOH, THC-glucuronide and 11-nor-9-carboxy-Δ9-THCV (THCVCOOH) were <7.5% of THCCOOH-glucuronide Cmax concentrations. Only THC-glucuronide mean Tmax differed between routes and groups, and was often present only in occasional users' first urine void. Multiple THCCOOH-glucuronide and THCCOOH peaks were observed. We also evaluated these urinary data with published models for determining recency of cannabis use. These urinary cannabinoid marker concentrations from occasional and frequent cannabis users following three routes of administration provide a scientific database to assess single urine concentrations in cannabis monitoring programs. New target analytes (CBD, CBN, CBG, THCV and phase II metabolites) were not found in urine. The results are important to officials in drug treatment, workplace and criminal justice drug monitoring programs, as well as policy makers with responsibility for cannabis regulations.

Kannabis Yasal, Ya Sonra…

Yakın tarihe baktığımızda kannabis gibi psikoaktif etkili maddelerin kullanımı ile ilgili düzenlemelerin belirli dönemlerde sadece bir asayiş sorunu olarak değerlendirilerek, yasal tedbirlerle kontrol edilmek istendiği görülmüştür. Ancak, madde kullanımı ve bağımlılığı sorununun, zamanla sadece bir asayiş sorunu olmadığının farkına varılmasıyla, tedavi ve önleme faaliyetlerine de önem verilmeye başlanmıştır. Son yıllarda ise, tıbbi tedaviyi düzenleyen, yasal çerçeve konusunda çalışan ve olayın psikososyal boyutu ile ilgili kişilerin yasal düzenlemeler ve yeni gelişmeler konusunda hassasiyet ile birlikte çalıştığı görülmektedir. Madde kullanımının artık “halk sağlığı ve toplum güvenliği sorunu” olarak beraber değerlendirilmesi ile birlikte, son dönemlerde özellikle kannabise ilişkin düzenlemeler hızla değiştirilmekte, konu birçok ülkede hala tartışılmaktadır. Bu uygulamaların birey ve toplum bazında halk sağlığı ve toplum güvenliği açısından uzun vadede ortaya çıkacak sonuçlarının öngörülmesinin zor olacağı düşünülmektedir. Bu makale, konuya ilişkin yapılan çalışmaların derlenerek özellikle eğlence amaçlı (rekreasyonel) kannabis kullanımına izin verilmesi durumunda doğabilecek bireysel ve toplumsal sonuçları özetlemek amacıyla yazılmıştır.

International differences in patterns of cannabis use among adult cigarette smokers: Findings from the 2018 ITC Four Country Smoking and Vaping Survey

BackgroundAlthough evidence shows that co-use of cigarettes and cannabis is common, there is little research examining if co-use patterns vary depending on the regulatory environment for cannabis. This study examined patterns of co-use and perceptions of relative harm among cigarette smokers in four countries with different histories, and at different stages of cannabis legalization. MethodsData are from the 2018 International Tobacco Control 4CV Survey and included 10035 adult cigarette smokers from Canada, United States (US), Australia, and England. At the time of the survey, Canada and the US had relatively more permissive cannabis regulations compared to Australia and England. ResultsAmong this sample of 10035 cigarette smokers, Canada had the highest rate of cannabis co-use in the last 12 months (36.3%), followed by the US (29.1%), England (21.6%), and Australia (21.4%). Among past 12 month co-users (n = 3134), the US (40.2%) and Canada (35.2%) had the highest rates of daily cannabis use, followed by smokers in England (26.3%) and Australia (21.7%); Australian co-users had the highest rate of infrequent (<monthly) cannabis use. The highest proportion of co-users who smoked daily and used cannabis daily was in the US (34.8%), followed by Canada (30.6%), England (25.8%), and Australia (22.7%). More co-users in the US (78.3%) and Canada (73.6%) perceived smoked cannabis to be less harmful than cigarettes than in Australia (65.5%) and England (60.8%). The majority of co-users who used cannabis in the last 30 days had smoked it (92.3%), with those in England more likely to smoke cannabis (95.7%) compared to Canada (88.6%); there were no other differences between countries (US: 92.0%, Australia: 93.0%). Co-users in England (90.4%) and Australia (86.0%) were more likely to mix tobacco with cannabis than co-users in Canada (38.5%) and the US (22.3%). ConclusionPatterns of tobacco and cannabis co-use differed between countries. Smokers in Canada and the US had higher rates of co-use, daily cannabis use, dual-daily use of both cannabis and cigarettes, and were more likely to perceive smoked cannabis as less harmful than cigarettes compared to England and Australia. Further attention as to how varying cannabis regulations may impact co-use patterns is warranted.

Periodic Graphics: Cannabidiol, medicine from hemp

Chemical educator and Compound Interest blogger Andy Brunning explains the CBD craze, how the compound works, and how it’s regulated To download a PDF of this article, visit cenm.ag/cbdgraphic. Read more C&EN coverage of CBD and hemp Erickson, Britt E. “Hemp Growing Pains.” Chemical & Engineering News, Feb. 24, 2020. References used to create this graphic: Erickson, Britt E. “US Hemp Boom Creates Chaos.”Chemical & Engineering News, May 31, 2019. FDA. “Drug Trials Snapshots: Epidiolex.” Updated July 17, 2018. FDA. “FDA Regulation of Cannabis and Cannabis-Derived Products, Including Cannabidiol (CBD).” Updated Feb. 13, 2020. Halford, Bethany. “CBD: Medicine from Marijuana.”Chemical & Engineering News, July 22, 2018. A collaboration between C&EN and Andy Brunning, author of the popular graphics blog Compound Interest To see more of Brunning’s work, go to compoundchem.com. To see all of C&EN’s Periodic Graphics, visit cenm.ag/periodicgraphics.

Health considerations of the legalization of cannabis edibles.

KEY POINTS On Oct. 17, 2019, Canada’s amended cannabis regulations entered into force, authorizing the legal production and sale of cannabis edibles in the next phase of the country’s legalization journey. Edible products are anticipated to become publicly available after the required 60-day

Cannabis Policy Innovations and the Challenges for EU Coordination in Drug Policy

In the past decades, Europe has been the site of multiple drug policy innovations and cannabis policy experimentation. Most of the policy reforms in this area are taking place at the national and subnational levels. They have not resulted from agreements or harmonization initiatives at the EU level, but rather from bottom-up adoption of cannabis policies and practices that deviate from punitive approaches. Cannabis regulation has been only marginally debated by European institutions and is not discussed in depth in any EU document. On the one hand, the diversity of European drug policies is a positive development: it serves as a policy laboratory and reflects adaptations to local contexts in light of drug market-related challenges. On the other hand, a greater EU consensus would be helpful for policy coordination and international engagement.

A Brief History of Cannabis and the Drug Conventions

“Drugs” have been regulated at the international level since 1912, while cannabis has been specifically regulated since 1925. Contemporary local, national, and international cannabis regulations are now diverging, with some jurisdictions legalising its recreational production, sale and consumption. This essay explores the legal and historical complexity and contingencies around the development of international cannabis regulations and prohibitions. It highlights that the global drug control system was not solely focused on prohibition and instead was a complex mix of regulations underpinned by frequently ill-defined and unclear prohibitions. It argues that the international drug control system should not serve as a bar to national-level reforms and that the two can continue to coexist. The essay favors a flexible, functional and pragmatic interpretation and implementation of the system as the most likely and indeed preferred outcome of international cannabis policy reforms.

Qualitative terpene profiling of Cannabis varieties cultivated for medical purposes

Abstract With the upcoming medical Cannabis regulation, quality control methods on raw material will be required. Besides testing for contaminants and potency, there are also pharmaceutical and forensic interests in the determination of the terpene profile in different strains of Cannabis as complementary identification methods. A simple non-destructive HS-SPME GC-MS method was used to identify the terpene content in twelve Cannabis samples, four of them were of the hemp type (Harle-tsu), seven from various marihuana types and one of the intermediate type. They all were previously analyzed by HPLC to determine the potency (THC and CBD content). Spectral library matching was used to identify the terpenes compounds. Thirty terpenes compounds were detected, nine of them were present in all Cannabis samples and used to find their terpene profile: α-pinene, β-pinene, β-myrcene, D-limonene, terpinolene, linalool, caryophyllene, α-bergamotene and humulene. Three of them, caryophyllene, α-pinene and β-myrcene were found as larger components in most of samples. A principal components analyses (PCA) was performed. The four hemp type samples showed two different profiles, two samples showed caryophyllene as main component and the others two with β-myrcene as such. The marihuana type samples showed wider profiles with no clear patterns at all, which is not surprising because of the low number of samples. The simple methodology shows viable to set the terpenes profile for analyses of raw Cannabis material. Suitability for differentiation between different sorts of types needs more studies, with increasing numbers of samples.

Out-of-state cannabis purchases in the United States

BackgroundCannabis legalization at the US state level may have implications for cross-border purchases and diversion of legal products. The current study examined the association between out-of-state purchases and 1) cannabis regulations; and 2) the length of time a state has had recreational retail sales. MethodsData come from US respondents who participated in Wave 1 of the International Cannabis Policy Study (ICPS), conducted in August-October 2018. Respondents were aged 16–65 years who had used cannabis in the past 12 months (n = 4320). Respondents were recruited using the Nielsen Consumer Insights Global Panel. Binary logistic regression models examined likelihood of any out-of-state cannabis purchases in the prior year, including differences by cannabis regulations, and time since recreational cannabis retail sales began. ResultsOverall, 15.0 % of US cannabis users had made any out-of-state cannabis purchases in the past 12 months. Respondents in states where recreational cannabis was legal were less likely to make any out-of-state purchases than respondents in states where only medical cannabis was legal (AOR = 0.45, 95 % CI: 0.34-0.60, p < 0.001) and where all cannabis was prohibited (AOR = 0.36, 95 % CI: 0.26-0.50, p < 0.001). Among respondents in ‘legal’ states, a longer history of legal sales was associated with a lower likelihood of out-of-state cannabis purchases (AOR = 0.82, 95 % CI: 0.72-0.93, p = 0.002). ConclusionThe findings demonstrate that consumers in states where recreational cannabis is legal were less likely to purchase cannabis out-of-state than consumers in states where recreational cannabis is not legal. Future research should examine which states people travel to purchase cannabis and why.

A Tobacco Control Framework for Regulating Public Consumption of Cannabis: Multistate Analysis and Policy Implications.

Eleven US states and Washington, DC, legalized recreational (adult use) cannabis. Seven states-Alaska, California, Colorado, Massachusetts, Nevada, Oregon, and Washington-allow cannabis sales. A public health concern is that exemptions in state or local smoke-free laws for public cannabis smoking or vaping will weaken smoke-free laws, expose the public to secondhand cannabis, and renormalize smoking.We describe the experience of the seven states and challenges faced in maintaining smoke-free laws. Using elements of a tobacco control framework, we identify best practices in cannabis regulation by comparing each state's smoke-free laws and allowances for public cannabis use. All states prohibit public cannabis use; two lack 100% smoke-free protections; one lacks vaping devices in its smoke-free law; three allow cannabis use in retailers; two allow cannabis use in social consumption lounges; and two allow cannabis use in tourism venues.States should close gaps in smoke-free laws and not expand where cannabis use is permitted to ensure public health.

Arkansas community’s attitudes toward the regulation of medical cannabis and the pharmacist’s involvement in Arkansas medical cannabis

ObjectivesThis study explored the attitudes of the Arkansas community toward medical cannabis (MC) regulation and the role of pharmacists in dispensing MC before the product became available and examined whether participants’ demographics (e.g., age, gender) and characteristics (e.g., history of cannabis use) were associated with these attitudes. DesignCross-sectional survey. Setting and participantsUsing social media, a university research registry, and posted flyers, we invited residents of Arkansas to participate in the self-administered online survey study during a 3-month period, February to April, in 2018. Outcome measuresFive questions that inquired about participants’ attitudes toward MC regulation and pharmacists’ roles regarding MC use. ResultsParticipants (n = 1343) who completed at least 1 of the 5 questions were included. The majority were aged 40-64 years (52.2%), female (69.1%), and white (88.7%). Most participants reported a history of cannabis use (81.8%) and possession or intention to apply for an MC card (52.9%). Among the conditions approved for MC use, pain (20.3%), arthritis (15.4%), and posttraumatic stress disorder (14.5%) were reported frequently. Likewise, prescription use for mood disorders (46.1%) and pain (37.4%) were also reported. In multivariable regression analyses, participants’ history of cannabis use was associated with a preference for lesser oversight of MC, disagreement with MC being available through a pharmacy only, and disagreement on whether MC should be regulated before it is legalized for recreational use (all P < 0.001). It was also associated with a decrease in agreement that pharmacists are well-trained to improve patient safety (P < 0.001) and counsel patients regarding appropriate MC use (P = 0.032). ConclusionParticipants who had previously used cannabis were in favor of fewer restrictions and negatively perceived pharmacists’ involvement in ensuring appropriate dispensing and MC use. The findings may highlight the need for Arkansas pharmacists to explore alternative ways to promote the safe and proper MC use.

The Interplay between the Endocannabinoid System, Epilepsy and Cannabinoids.

Epilepsy is a neurological disorder that affects approximately 50 million people worldwide. There is currently no definitive epilepsy cure. However, in recent years, medicinal cannabis has been successfully trialed as an effective treatment for managing epileptic symptoms, but whose mechanisms of action are largely unknown. Lately, there has been a focus on neuroinflammation as an important factor in the pathology of many epileptic disorders. In this literature review, we consider the links that have been identified between epilepsy, neuroinflammation, the endocannabinoid system (ECS), and how cannabinoids may be potent alternatives to more conventional pharmacological therapies. We review the research that demonstrates how the ECS can contribute to neuroinflammation, and could therefore be modulated by cannabinoids to potentially reduce the incidence and severity of seizures. In particular, the cannabinoid cannabidiol has been reported to have anti-convulsant and anti-inflammatory properties, and it shows promise for epilepsy treatment. There are a multitude of signaling pathways that involve endocannabinoids, eicosanoids, and associated receptors by which cannabinoids could potentially exert their therapeutic effects. Further research is needed to better characterize these pathways, and consequently improve the application and regulation of medicinal cannabis.