How Much Do Researchers Really Know About Medical Marijuana You Ask? As of last December, more than 30% of Americans live in states that have voted to legalize recreational marijuana use. A majority live in states that allow access to medical marijuana. In many states, cannabis consumers can attend dinners, where multiple varieties of weed are paired with chef-prepared gourmet meals. In New York — a state with a relatively strict medical marijuana law — 98-year-olds like Ruth rely on cannabis oil to soothe the debilitating pains of neuropathy. Weed’s more legally accessible now than it has been since the Reefer as well as others. The varieties available now, created with the aid of modern botany and chemistry, are unparalleled in history. With that in mind you might think that scientific researchers would have a pretty good handle on exactly how regular or casual marijuana use affects humans, how medical marijuana should be best used, and what potential risks there may be to cannabis use. But if you thought that the recent warming towards marijuana is fully backed by scientific understanding, you might be surprised. “There are so many basic questions that need to be addressed,” says Ryan, an associate professor of psychiatry who researches marijuana at Johns Hopkins Medicine. “The practical use and legalization of these things is happening faster than the science can keep up.” A number of other experts say that even though we know far more about marijuana than we did just a few decades ago, there are important topics — ranging from questions about how marijuana affects the brains of different users to questions about how to make use of medical cannabis — where the legal policy has far outpaced the science. It’s not about being anti- or pro-marijuana industry, it’s simply that scientists want to know more — especially now, when it’s such an important topic because of the wave of legalization. The Drug Enforcement Agency (DEA) considers marijuana a drug with no medical value, so it’s hard to get approval to research it and impossible to study the cannabis products most people use, since researchers can only give study participants cannabis grown at DEA-approved facilities. “It’s pretty amazing” that we have so many unanswered questions, says Staci, an associate professor of psychiatry at Medical School and director of the Marijuana Investigations for Neuroscientific Discovery program. “Its not new, it’s been around for thousands and thousands of years, it’s not like we just made this in a lab.”  Many of the most common inquiries fit into three categories: questions about how recreational marijuana will affect users both young and old; questions about how medical marijuana affects patients; and questions about the marijuana plant itself. And while marijuana is still distressingly hard to research, there are a number of ongoing studies that should help answer some of the most pressing questions. Here’s what we’re learning from that research and what we still need to know. The cannabis plant itself is a fascinating organism, one that humanity has used for thousands of years for reasons ranging from religious rituals to performance enhancement to just plain partying. But within that plant there are somewhere around 400 chemical compounds, more than 60 of which are special compounds known as cannabinoids. These bond with a relatively recently discovered system in our brain that interacts with naturally-produced cannabinoids which is now being used by marijuana doctors in florida and other states around the country. In every animal, these natural (endogenous) cannabinoids play multiple roles, affecting mood, appetite, memory, consciousness, pain response, blood pressure, and more. The cannabinoids from marijuana tap into that same system, which is why the plant has such wide-ranging effects. We’re pretty far from fully understanding how that system works and even further from understanding all the compounds in marijuana. The most famous cannabinoid, THC, is largely responsible for marijuana’s ability to get users high. Cannabidiol, CBD, is the next best known — it seems to be important for Florida marijuana doctors and many medical uses of marijuana. But those are still just two components of the plant. “We know a lot about THC and we’re starting to learn about CBD. “Out of about 400 compounds we know a decent amount about two.” That means there’s a lot to learn about which compounds might contribute to psychoactive effects and which might potentially have medical uses. Further complicating this question is the fact that growers create numerous strains of cannabis with different characteristics. We see this most frequently now with high THC strains of marijuana. The data on this isn’t perfect, but it is true you can get stronger pot now than ever before, largely because of innovations in growing practices. About 20 years ago, a high THC concentration might have been 10 or 12%. In legal shops in Colorado and Washington now, it’s not hard to find concentrations of 18, 24, or even 30% THC. Every tweak is going to change the health effects of the plant. High THC plants tend to have low CBD, for example, according to an associate professor of psychology and director of the Brain Imaging and Neuropsychology Lab. In general, THC potency keeps going up. Shesays this could be worrisome, since there is some research indicating that some of the brain changes seen in heavy marijuana smokers are not present in smokers who smoke higher CBD, lower THC strains. This could make the trend away from CBD a negative for some medical users. Many wonder what will happen when THC concentration “goes up to 40,50, 60%.” People consume THC at those levels in some concentrated forms of cannabis, but we don’t know if that sort of consumption carries additional health risks or not. On the one hand, high potency stuff may be worse for cognition, but on the other, He says she’s had people tell her they smoke less when they use more concentrated products. When it comes to marijuana, millions of people are using different types of cannabis products for supposedly therapeutic purposes. Different, strains, different concentrations, all consumed in different ways. He is studying the how different ways of consuming marijuana — orally, smoking, vaping — all affect the body. And while he says that not all of his work can be talked about yet, we do know that the mode of ingestion makes a big difference for how people feel the effects and how they manifest themselves. Many substances might fall under the medical cannabis umbrella, but depending on their specific cannabinoid content and the means through which they are ingested, they’re going to have different effects. All those people using products for therapeutic purposes are “lacking information about which types of products to choose, what doses to use, and how cannabis compares to other medications,” according to Vandrey. We do know that marijuana has legitimate medical uses — a recent report by the National Academies of Science, Engineering, and Medicine found a number of ways in which marijuana seems to be medically effective. But the report also noted that a lot more information about how marijuana and its various components affect users is needed. At present, that’s hard to study. The marijuana that researchers can give people for experiments has to come from approved facilities and tends to be far weaker than what people actually use. A researcher in Colorado can walk into a store and buy marijuana but they can’t get approval to give that product to participants in a study. Partially because of that, it’s even hard to measure what’s in these products. There’s no one approved system for testing cannabis products, so people running two different tests on marijuana samples might get different results. Those results might vary even more if they use a test meant for conventional marijuana (flower) on an edible. For those who really want to better understand the plant and to see how to use it most effectively to help people in a medical context, that’s a real problem. Onething that’s absolutely critical is the development of standards around product manufacturing and labeling. Some states have started to require that marijuana products be tested for potency and to make sure they are free of contaminants-Colorado, Nevada, Washington and Florida Medical Marijuana have rules that recreational and medical products be tested and Washington started to require testing after approving recreational marijuana, for example. However, it’s not clear that a fully accurate means of testing cannabis products exists yet.

The chief problem with the marijuana industry boils down to a states’ rights issue. While numerous states have legalized marijuana, either for medical or recreational use, the drug remains illegal at the federal level, leaving many companies vulnerable to investigations.

The federal Controlled Substances Act classifies marijuana as a Schedule I drug, defined as a substance or chemical with no accepted medical use and a high potential for abuse. On the other hand though, four states have already legalized recreational marijuana — Colorado, Washington, Alaska, and Oregon— and almost half permit medical marijuana.

“If they say states can do this, the federal government just needs to get out of the way and let states do this. “But frankly, I don’t think it’s a priority for too many federal politicians.”

The Department of Justice “will continue to exercise its discretion in deciding where and how to enforce the Controlled Substances Act.

To start, federal law 280E on the Internal Revenue Code prevents both medical and recreational marijuana doctors in florida as well as businesses from certain benefits given to other legal businesses. Because of the law, The Daily Beast reported, marijuana businesses may pay as much as 70% in federal taxes.

Under 280E, any business that engages in the distribution of Schedule I or II controlled substances is barred from tax deductions, like for leasing property or paying salaries, that other legal businesses are allowed to take. The provision was originally set up as a punitive measure against cocaine and heroin dealers, according to Herzberg.

In addition to 280E, banks must comply with federal regulations and often won’t take on clients in the marijuana industry for fear of legal repercussions. A federal court even refused access to a master account for The Fourth Corner, a credit union set up by Colorado’s state government to help dispensaries access banks.

That shuts many marijuana business out of financial institutions and forces them to operate on an all-cash basis, which makes tasks like paying taxes and keeping track of revenue difficult.

Much of Poseidon’s investments come from high-net-worth individuals or family offices that have higher risk tolerance than institutional investors like banks, according to Paxhia.

“Partners at venture-capital or private-equity firms are using their own capital, rather than firm assets,” he said. “They’re not waiting for the federal government. They’re participating in any way they can.”

There are a lot of people — and there is a lot of money — waiting on the sidelines to jump into the burgeoning industry. But as long as these banking issues persist and health from marijuana remains classified as a Schedule I drug, the industry will face immense challenges from the federal government.

Now the country now looks to California as the next battleground. State residents will likely have a chance to vote on full legalization on November 8. What happens could serve as a model for other states.

The vote continues what started in September 2015 with California’s Medical Marijuana Regulatory Safety Act (MMRSA). MMRSA allows medical-marijuana businesses in California and florida medical marijauna to operate as for-profit businesses in the state and set up various requirements and systems for operation.

Prior to MMRSA, medical-marijuana businesses operated on legal foundations, leaving an open door for the DOJ to build a case against Harborside. While the Compassionate Use Act of 1996 allowed for medical-marijuana use, the law did not specifically permit medical-marijuana providers to profit from the sale of marijuana and marijuana products, like edibles and synthetics.

 

After November 8, 20% of Americans now live in states that have voted to allow recreational marijuana use. 

Florida, Massachusetts, Nevada, and California have now joined Colorado, Washington, Oregon, Alaska, and the District of Columbia in voting for initiatives that make it legal for adults to consume cannabis authorized by florida marijuana doctors. Votes are still being counted, but it looks like Maine will most likely join that group. And several states joined the 25 that already allow for medical use of marijuana — the most notable addition being Florida, with a broad medical marijuana law that will allow doctors to recommend cannabis for a wide variety of conditions.

Critics of legalization claim that legalization is bad for public health. “When states legalize recreational marijuana, fatalities increase and the lives of children and teenagers are put at stake, president and CEO of Spectrum Health Systems, a substance abuse and mental health treatment provider, recently wrote in an opinion piece for Stat News. 

But the data on how both recreational and medical legalization of marijuana tells a different story.

It’s still early — marijuana hasn’t been legal for long, even in these states — but so far, legalization hasn’t had a negative impact on public health, according to a report recently published by the Drug Policy Alliance (DPA). That report and other recent studies help show how marijuana legalization for medical or recreational purposes in these states has changed things. 

Nationally, the number of students who used marijuana in the past 30 days leveled out in 2010 after rising for several years, according to the DPA report. State surveys of kids in Colorado, Washington, Oregon, Fort Lauderdale and Alaska show that after legalization, the number of students who used or who had ever tried marijuana stayed stable (depending on the state, surveys looked at kids in grades 6, 8, 9, 10, 11, and 12) or decreased slightly.

In his opinion piece, rep says that Colorado youth use marijuana at higher rates than any other kids in the country. But as other notes at The Washington Post, experts say that trend existed before legalization, too.

A 2015 article in the New England Journal of Medicine states that legalizing florida medical marijuana in Colorado doesn’t seem to have increased the prevalence of youth usage. While the percentage of kids who described marijuana as “highly risky” decreased after legalization, the percentage of students who reported ever trying decreased slightly as well.

There’s some debate about the effect that cannabis legalization has had on traffic deaths. Rep says that data from Washington and Colorado shows that an increased percentage of the people involved in traffic fatalities have had marijuana in their systems since legalization. 

However, traffic death rates since legalization have not increased in Colorado or Washington and are lower than the national average, according to National Highway Transportation Safety Administration data analyzed in the DPA report. At the same time, DUI rates seem to have decreased since legalization, potentially an overall benefit, since the risks of driving under the influence of alcohol are much more obvious than the risks of driving under the influence of cannabis (people who combine the substances perform the worst on driving tests, however). 

The DPA report says that more people may test positive for cannabis now since officials are now more likely to test for it in the first place. Also, since people can test positive for cannabis long after they’ve stopped feeling the effects, the report says the “data only illuminate that tested drivers consumed hours, days, or weeks prior to the test” — not that cannabis was involved.

As Stat News pointed out in another story, there are several studies that show that states that allow medical marijuana have fewer opioid deaths. This effect seems to stack over time, with states who pass these laws seeing a “20 percent lower rate of opioid deaths in the laws’ first year, 24 percent in the third, and 33 percent in the sixth.”

If people are substituting marijuana for opioids for medical purposes, that seems to have a strong positive effect. 

Isaacson says that doctors at Denver’s Children’s Hospital have reported treating an increased number of children who have accidentally ingested marijuana edibles since legalization. The overall numbers are small — in the JAMA Pediatrics study documenting these cases, doctors say that the rate of these visits has gone from 1.2 per 100,000 population 2 years prior to legalization to 2.3 per 100,000 population 2 years after legalization. As Ingraham has pointed out in the Post previously, parents are far more likely to call poison control centers because of kids ingesting diaper cream, toothpaste, tobacco, or crayons.

Adults tourists who have overdone it have also increased the number of marijuana-related ER visits slightly. 

If you’ve ever seen someone who has been surprised by the strength of a marijuana edible, you know these moments aren’t fun (just ask Maureen Dowd), but luckily, people recover from these events and no one has ever died from a marijuana overdose.

The DPA report notes that “[b]y no longer arresting and prosecuting possession and other low-level marijuana offenses, states are saving hundreds of millions of dollars,” based on the fact that Washington spent $200 million enforcing marijuana laws between 2000 and 2010. Arrest rates in these states for marijuana offenses have plummeted (you can still be arrested for certain offenses), though the report notes that people of color are still twice as likely to be arrested despite using marijuana at similar rates to white people.

Financially, the DPA report says taxing and selling marijuana in Colorado and Washington has been “overwhelmingly successful in generating revenue,” with revenues exceeding projections in both states. Colorado brought in $129 million in the second year of legalization and Washington $220 million — significant amounts of money, though as Ingraham notes, still only a tiny fraction of the overall state budgets.

There are still plenty of questions about how legalized marijuana doctors in florida will affect states in the future. Some people have expressed concerns that powerful THC-loaded varieties available today could potentially have more of an impact than we know, especially if used by young people with developing brains. On the other hand, if people are using marijuana instead of more dangerous substances like alcohol, there could be some benefit to public health there, though so far, it’s hard to say whether legalization makes people drink more or less.

Now, we’ll be able to see the effects in several additional states. Hopefully, that will encourage study into marijuana’s effects, something that scientists say is still incredibly difficult to research because of federal regulations. In the meantime, the DPA report argues that the lessons from states like Colorado and Washington indicate that the public health effects are “so far, so good.”