Mary's Prime Time Issue #3

Prime Time Coverage and Commentary on the Top Cannabis Conferences • Issue 3 • 2018

CANNABIS CONFERENCES MULTIPLY Spring and early summer increasingly bring a stunning array of cannabis conferences. It wasn’t always this way.

Even as recently as ten years ago, cannabis conferences were few and far between. Patients Out of Time and the International Cannabinoid Research Society (ICRS) are the granddaddies of cannabis conferences and both are still given each year in the spring.

For this issue of Mary’s Prime Time we have chosen two conferences a half-a-globe apart: a multi-disciplinary meeting, ICR in Colorado (April 27-28), and a discipline-targeted meeting in Vienna (June 25-26) which was geared towards physicians. They were as different in content as they were in geographic locale.

The sheer size of the ICR meeting makes it impossible to cover all presentations. With close to 100 sessions in two days, attendees are forced to choose and this writer was no different. In the end I focused on three presentations and included a selection of the abstracts that appeared in the program. To its credit, ICR is making recordings from its meetings available on the internet. You will find the links to these sessions in this issue of MPT. Medical Cannabis 2018 was just the opposite of ICR. There was one meeting room in which all the speakers appeared. And there was a theme, “Controversies on Cannabis-Based Medicines.” This allowed more detailed coverage although space restrictions do cause some curtailment.

We hope this issue of Mary’s Prime Time expands your knowledge of cannabis. Thanks for reading.

Alice O’Leary Randall

CONFERENCE FACTS & FIGURE S Sponsor: Institute of Cannabis Research (ICR) Dates: April 26-28, 2018 Venue: Pueblo, Colorado, USA Attendees: 400 Sponsor: BioEvents - Medical Cannabis 2018 Dates: June 25-26, 2018 Venue: Vienna, Austria Attendees: 225

PUEBLO’S PRIDE - A TOP-NOTCH CANNABIS CONFERENCE Today’s cannabis conferences seem to fall into three categories: scientific/clinician, business trends/developments, and the consumer oriented “expos” with their vast array of exhibits. This segregation is natural but unfortunate in some ways. The re-introduction of cannabis onto the modern scene is a dynamic and expansive process with exciting results.

The trend towards “silo” meetings fails to give attendees a comprehensive view of this issue.

For those seeking exposure to the many facets of cannabis without the blunt commercialism of a cannabis expo, Colorado’s Institute of Cannabis Research (ICR) is the place to go. April 2018 marked the second annual conference of the ICR which is headquartered at Colorado State University campus in Pueblo. The fledgling institute (it was founded in 2016) managed for a second year to pull together an informative and at times impressive, multi-disciplinary conference that was aptly named “Exploring All Things Cannabis.”

The ICR meeting is unique among U.S. based cannabis conferences because it is multi-disciplinary in its approach.

While most conferences tend to be theme-based, the ICR conferences thus far have been eclectic and broad-based owing to the Institute’s reaching out to the colleges and MARY’S PRIME TIME

Published periodically by Mary’s Medicinals Editor-in-Chief and Writer: Alice O’Leary Randall alice@marysmedicinals.com Design: Jesica Clark

MarysMedicinals.com MarysPubs.com

Published by Mary’s Medicinals, Denver, CO Copyright (c) 2018 - All rights reserved This publication is solely for educational purposes and is not intended to substitute for the medical advice of a treating physician. Medicine and cannabis research is an ever-changing science. Therefore, the editor, contributors and publisher do not accept responsibility in the event of negative consequences incurred as a result of the information presented in Mary’s Prime Time. We do not claim this information is necessarily accurate by rigid scientific and regulatory standards applied for medical treatment.

No warranty, expressed or implied, is furnished with respect to the material contained in this publication. Readers are encouraged to consult with personal physicians with respect to treatment of any medical condition.

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Mary’s Prime Time | Issue 3 | 2018

universities, most particularly in Colorado, where ongoing cannabis research is becoming the norm. States with legal cannabis —for medical and/or adult use—offer tremendous research opportunities for a vast array of studies. This is particularly true of the social sciences which can incorporate studies in anthropology, archaeology, economics, history, human geography, jurisprudence, linguistics, political science, psychology, public health and sociology. So, in addition to the important cannabis research that is being conducted in medical laboratories and clinical trials, there are now ongoing studies that look beyond the molecular structure of cannabis and outward to the plant’s impact on society in more than statistical queries about use. Topics at ICR 2018 included presentations on cannabis use among the homeless, the impact of legal cannabis on child welfare systems, occupational safety among marijuana workers, and the effects of legalization on Colorado’s tourism. Researchers from twenty universities were present.

The downside to the ICR meetings is the extraordinary range of presentations that occur concurrently. The keynote and the Mechoulam Lecture are the only plenary sessions during the two full-days of the conference. At all other times the attendees had to choose from an array of intriguing topics and were forced to make painful choices. This was true for everyone, including this writer. I will confess to being a bit stumped as to how to convey just how much information is available from the nearly 100 sessions presented in two days.

The answer: there is no way. So this issue of Mary’s Prime Time provides a partial listing of the sessions with extracts taken from the program abstracts as well as three reports on topics that are of interest to this writer … call it a perk of the job.

The ICR has already uploaded the two keynotes from this year and several programs (more are promised). You can also view presentations from the inaugural conference in 2017. This sharing of such valuable material is to be commended.

But if you are a serious cannabis activist, entrepreneur or scientist (or if you just want to learn more about cannabis) my advice is to visit this conference next year (April 25-27, 2019).

The registration fees are affordable (a disappearing aspect in the growing number of cannabis conferences), Pueblo has a wide-array of housing options, and the conference will bring you in touch with a tremendous selection on current research and trending thought. Oh, and the networking is astonishing!

The annual ICR is really a must for any one engaged in the cannabis industry or issue.  Pueblo’s Pride - A top-notch

Highlights from ICR 2018 MARIJUANA RESEARCH AT THE NATIONAL INSTITUTE ON DRUG ABUSE PRESENTER: HEATHER L. KIMMEL, PH.D., DIVISION OF EPIDEMIOLOGY, SERVICES AND PREVENTION RESEARCH Therapeutic Cannabinoid Research

Cannabis Research NIH

# of Projects

FY2017 Investment

Percentage

NCATS

1

$442,958

0.31%

NCCIH

4

$2,254,745

1.60%

NCI

3

$1,672,397

1.20%

NEI

2

$740,337

0.53%

NHLBI

7

$4,668,601

3.34%

NIA

6

$2,307,509

1.65%

NIAAA

37

$21,542,490

15.40%

NIAID

1

$209,375

0.15%

NIBIB

1

$180,341

0.13%

NICHD

4

$1,659,294

1.19%

NIDA

NIH IC

# of Projects

FY2017 Investment

NCATS

1

$442,958

Percentage 1.22%

NCCIH

2

$1,147,231

3.16%

NCI

3

$1,672,397

4.61%

NEI

2

$740,337

2.04%

NHLBI

5

$3,528,741

9.72%

NIA

2

$1,237,000

3.41%

NIAAA

10

$6,543,372

18.03%

NIDA

30

$16,337,519

45.02%

NIDDK

1

$448,433

1.24%

NIMH

5

$1,180,283

NINDS

7

$1,998,161

3.25% 5.51%

OD

2

$1,014,266

2.79%

Grand Total

70

$36,290,698

100.00%

209

$88,171,781

63.02%

NIDCD

1

$309,750

0.22%

NIDCR

1

$1

0.00%

NIH IC

# of Projects

FY2017 Investment

NIDDK

11

$3,398,310

2.43%

NCCIH

1

$695,709

4.62%

NIGMS

3

$714,974

4

$809,827

5.38%

NIMH

21

$6,460,023

0.51% 4.62%

NCI NHLBI

1

$538,692

3.58%

NINDS

12

$3,556,637

2.54%

NIAAA

4

$1,032,058

6.85%

OD

6

$1,613,930

1.15%

NIDA

15

$11,041,161

NINDS

3

$817,562

73.32% 5.43%

OD

1

$124,121

Grand Total

26

$15,059,130

Grand Total

330

$139,903,453

100.00%

CBD Research Percentage

0.82% 100.00%

The National Institute on Drug Abuse (NIDA) is among a triumvirate of federal agencies that control marijuana policy and it has always seemed a bit of a red-headed stepchild. Its two big siblings — DEA and FDA — are more independent than NIDA, which is tucked away in the hierarchy (some might say labyrinth) of the National Institutes of Health (NIH) which oversees 27 institutes and centers. NIDA has been a primary player in the marijuana issue for decades (established in 1974) and at times it has seemed confused about its role in this longstanding cultural question, especially with respect to medical cannabis.

abuse research. This position was bolstered by the Nancy Reagan, Just Say No Campaign. Specific disease-oriented institutes, such as the National Cancer Institute or National Eye Institute were told that they should do therapeutic cannabis research. Politically speaking it was a good move and it did take some of the pressure off the tiny fiefdom of NIDA. As the years rolled on, NIDA dug in its heels and would staunchly defend its lack of therapeutic cannabis research even while the only legal cultivation of cannabis in the country was under NIDA contract and employees of that contract were filing patents on cannabinoids that NIDA allowed them to explore.

In the late 1970s and into the 1980s, NIDA was frequently perceived as THE go-to agency for help with thirty-four state-wide medical cannabis research programs that were legislatively authorized between 1978 and 1981. But NIDA realized the medical cannabis movement could potentially drain its supply of legally produced cannabis (the longstanding contract at the University of Mississippi) with no real gain from NIDA’s perspective since, at that time, the cannabis was provided free of charge to federally approved research projects. It was a no-win situation for NIDA, so the agency began, rather forcefully, to insist that NIDA wasn’t responsible for medical cannabis research, it was only interested in drug

Time moved on and NIDA continued to obfuscate with respect to medical cannabis. In 2003 it got a new director, Nora Volkow, an addiction specialist who supported the theory of marijuana addiction and had little good to say about potential medical use of cannabis. But in 2015 there was a fundamental shift at NIDA…sort of. Dr. Volkow seemed to embrace the therapeutic promise of cannabis, in particular the cannabinoid known as CBD. And DEA, in 2017, announced it would allow more cultivation of legal cannabis, presumably breaking the monopoly enjoyed by U of Miss for decades.

Mary’s Prime Time | Issue 3 | 2018

But here we are in 2018 and it seems the more things change Marijuana Research at the National

3

the more they stay the same. Dr. Heather Kimmel of NIDA dazzled the ICR crowd with a slide showing the purported spending by NIH on cannabis research. The FY2016 data was quite interesting and Dr. Kimmel was helpful in pointing this writer towards more recent data at the NIH website. The figures were quite hopeful showing a 21% increase in overall funding of “cannabinoid research” between FY 2016 and FY2017. But the allocations remain well entrenched in drug abuse, not therapeutic use. (http://m.aryspub.com/categb2a71) NIDA, in Dr. Kimmel’s words, gets “the lion’s share,” a whopping 63% of the $139 million allocated for cannabis research -- $88.2 million. Second on the list is the National Institute of Alcohol Abuse and Alcoholism (NIAAA) receiving $21.5 million or 15%. Thus roughly 78% of the federal government’s expenditure on cannabis research is going to agencies that look only at addiction and “cannabis use disorders.”

NIH categorizes cannabis research expenditures into four categories — or, as Dr. Kimmel phrased it, “silos of research”

— cannabinoid research, endocannabinoid system research, cannabidiol (CBD) research, and therapeutic cannabinoid research. But these categories are misleading.

For example, one would believe that the silo labeled “therapeutic cannabinoid research” is solely focused on disease-specific applications, receiving $36 million in FY 2017. But drill a little deeper and you find $22 million of that amount was given to NIDA and NIAA which, as we know, both focus on cannabis abuse and dependence. The other ten institutes shared roughly $14 million.

This shell-game is not uncommon in the federal government, but it is disheartening when one considers the promise of therapeutic cannabis. Dr. Kimmel encouraged anyone in the audience wishing to fund a cannabis research project to contact NIDA. A nice enough sentiment but, honestly, after more than four decades of pouring millions of dollars into the “abuse” of marijuana doesn’t it seem that someone in the federal hierarchy might say, “Perhaps we should re-focus our attention and funding?” 

EDUCATING THE CANNABIS CHEMISTS OF COLORADO PRESENTER VANESSA FISHBACK, PH.D., DEPARTMENT OF CHEMISTRY, COLORADO UNIVERSITY As previously mentioned, the ICR Conference can be a little frustrating because there is so much from which to choose.

But that can also be a blessing and it gives attendees a chance to leave their comfort zone behind and learn something new and different about the cannabis issue. This writer had several opportunities in which to do that and not all were successful but Dr. Vanessa Fishback’s session was among the positive experiences I had at Pueblo. I am not a chemist and high school chemistry was long ago. But if you have delved into the cannabis issue at all in the past ten years you can’t help but be impressed with the number of young chemists who have entered this field. The majority of companies that produce cannabis products have chemists on staff and it is quite remarkable what they have been able to accomplish.

Dr. Fishback, it seems, agrees. She recognized that a collegelevel, cannabis chemistry class could not only train tomorrow’s cannabis chemists but could also be a useful class for, pardon the pun, budding physicians, pharmacists and other healthcare practitioners. Additionally, since the class has gotten up and running, Dr. Fishback has noticed that many undergraduates take the class in order to round out their resume for future employment, although the pre-requisites, as Dr. Fishback put it, are “pretty heavy” including basic biochemistry and organic chemistry classes.

It is likely that this is the nation’s first college level cannabis chemistry course and among the problems Dr. Fishback encountered was one of textbooks. Undoubtedly books are being prepared that will make excellent future textbooks for 4

Mary’s Prime Time | Issue 3 | 2018

cannabis-specific classes. But for Dr. Fishback the pickings were scarce. However she did locate the 1971 classic, Marijuana Botany written by Robert C. Clarke. More recently she was able to add the report from the National Academies of Sciences, Engineering and Medicine, The Health Effects of Cannabis and Cannabinoids (published in 2017).

Considerable time is spent on plant structure, of course, with what sounded like a heavy emphasis on terpenes. Cultivars, genetics, drug types, the impact of growing conditions…all are covered in the classes. In the addition to looking at the plant, the class also takes a look at synthetic products like marinol and nabilone. Additionally Dr. Fishback delves into patents and federal controls, including the classification of cannabis as Schedule I. And there was more. A section of the class looks at pesticides and how to test for them. The ability of cannabis (mainly hemp) to extract pollutants from the ground was touched on. And Dr. Fishback shared with the audience her plans to expand the classes and possibly move towards an undergraduate degree in cannabis chemistry.

As I said, I am not a chemist and some of this was over my head but it proved, once again, how deep into the fabric of society the re-introduction of cannabis has gone. Within a few years college level classes relating to cannabis will be commonplace and Dr. Vanessa Fishback will be among pioneers who made that possible. 

Educating the Cannabis Chemists of

CARDIAC EFFECTS OF CANNABIS IN POST-HEART ATTACK SUBJECTS PRESENTER: LORI WALKER, PH.D. DEPARTMENT OF MEDICINE, DIVISION OF CARDIOLOGY, UNIVERSITY OF COLORADO - DENVER

This paucity of data, coupled with conflicting interpretations,

THE DIGESTIVE SYSTEM

CBD

reduces contractions in the small intestines

CBD & THC-V

reduces seizures & convulsions

However, Dr. Walker concluded with a heartfelt statement.

“We’re not making the strides that we have to because our hands are really tied behind our backs,” she said, “So anytime you have a chance to be an advocate for more studies…it is very good because in a certain population there [may be risks].” 

Sharing the wealth!

THC-V

CBN

aids in sleep

CBD

tranquilizes & relieves anxiety

The U.S. federal government has spent a spectacular amount of money on cannabis research (see “Marijuana Research at NIDA,” page 3) without answering some of the basic facts that would be helpful. Its effect on the cardiovascular system is a prime example. There has been some research on the cardiovascular effects of cannabis use but it involved a small number of young males aged 21-33 years and was conducted in 1969 and 1971! It demonstrated that cannabis causes tachycardia — increased heart rate — but not much else. Jumping forward to 2001, Walker noted two studies with conflicting outcomes: one seemed to demonstrate that cannabis caused myocardial infarction (heart attack) while another study seemed to demonstrate a positive outcome from the use of cannabis on rats with cardiac arrhythmia.

As noted, the study is still ongoing. But from the data collected thus far, Dr. Walker was able to report that in post-MI subjects there was a higher incidence of cardiac arrhythmia compared with those with no history of heart disease. Her preliminary conclusion was that individuals with a history of heart attack should exercise caution in using cannabis but she was quick to add the lament of every cannabis scientist, “we need more research.” She noted that the subjects thus far have been frequent cannabis users and there is a definite tolerance that develops with regular cannabis use but whether the tolerance is beneficial is just one more question that needs to be answered. Dr. Walker had not anticipated “the frequency of use” and is wanting to add to the study the effects of “good periods of non use” to compare.

THC

With such a large population of adults using cannabis and also potentially suffering from cardiac disease, Dr. Walker found herself wondering, “Is cannabis safe for the aging population?”

And, as with so many areas of cannabis knowledge, she found the answers lacking.

Study subjects who had a history of MI were fitted with an ambulatory cardiac monitor (the ZioPatch) for two weeks. All subjects were asked to record their cannabis use, the specific cultivar, and an estimate of dose. Researchers then compared cardiac performance for one hour prior to using cannabis and up to four hours after.

appetite stimulant

There was another stunning, non-cannabis related statistic that Dr. Walker had to share: After age 40, adults have about a 50% chance of developing some kind of cardiovascular disease. It is an aging disease that is hard to escape.

led Dr. Walker to conduct her own observational study, one of a growing number of studies in states that have legalized cannabis. At the time of her presentation at the ICR Conference the study was still ongoing with a total number of subjects about equal to that of the US federal studies in 1969 and 1971. The big difference is that Walker is looking at older users and comparing them with similar cohorts who have a history of myocardial infraction (MI).

appetite suppressant

In the U.S. today, more than half of all adults acknowledge they have used cannabis at some time. And, while we tend to think of adolescents as the primary users of cannabis, the statistics show the opposite. Indeed, according to recent federal data gathered between 2002 and 2014 there was a stunning 455% increase in marijuana consumption among adults aged 55-64 years and 333% in ages greater than 64 years! As the presenter, Lori Walker, noted, “2014 was the first year that parents were more likely to use cannabis than their children.”

The Institute of Cannabis Research has uploaded many of the presentations from its 2017 and 2018 conferences.

The two Mechoulam Lectures and the keynote address from 2018 are available and in some cases the PowerPoint presentations from this year’s meeting are available as well. http://m.aryspub.com/thepa40b83

Mary’s Prime Time | Issue 3 | 2018

Cardiac Effects of Cannabis in

5

SO MUCH TO SEE, SO LITTLE TIME ...

With over 100 sessions conducted in two days, the ICR 2018 conference was a smorgasbord of cannabis delights ranging from clinical research to discussions of banking, chemistry, the cannabis genome and more. The following descriptions are taken directly from the abstracts in the conference program. Where possible the entire abstract is reproduced but some were too lengthy and a break in the text is noted.

MULTIPLE SCLEROSIS, CANNABIS, AND CLINICAL DISABILITY: A MOLECULAR IMAGING STUDY WITH 18F-FDG POSITRON EMISSION TOMOGRAPHY Thorsten Rudroff, Colorado State University Summary: Lower brain glucose uptake has been observed in people with multiple sclerosis (PwMS) compared to healthy controls and has been negatively associated with disease symptoms such as fatigue and impaired cognitive function.

The primary aim of this study was to examine resting brain glucose uptake in people with multiple sclerosis currently using (n=8) and not using (n=8) cannabis.

Image analysis revealed that regular cannabis users did not demonstrate lower brain glucose uptake. In fact, cannabis users demonstrated greater glucose uptake in small areas throughout the frontal and temporal lobes, e.g., inferior frontal gyms, temporal pole, and frontal pole… Our findings indicate that regular cannabis use does not appear to negatively affect brain glucose uptake or physical function in PwMS. However, cannabis should be used under medical supervision with a focus on possible negative cognitive effects. • RESULTS OF THE CANNABIS USERS SURVEY ON HEALTH 2016 Elyse Contreras, Colorado Department of Public Health and Environment, Marijuana Health Monitoring and Research Program Background: Patterns of cannabis consumption have not been explored in detail among regular cannabis users within a legalized environment. We aimed to conduct a survey among regular cannabis users to collect detailed information on frequency of use, methods of use, amounts consumed, and adverse health effects experienced.

Conclusion: The Cannabis Users Survey on Health provided much needed data to inform ongoing public health surveillance on patterns of cannabis use in Colorado postlegalization. A high prevalence of daily use coupled with a high prevalence of smoking cannabis is concerning due to the potential for long term health effects. The prevalence of acute adverse effects from cannabis use demonstrated in this survey also underscores the need for more detailed surveillance to assess the severity of these effects. Continued data collection will allow public health to better assess the effects of increased cannabis product availability on use patterns and health. • 6

Mary’s Prime Time | Issue 3 | 2018

A COMMUNITY-DRIVEN RESEARCH APPROACH TO DEVELOPING CANNABIS APPELLATIONS OF ORIGIN Genine Coleman, Mendocino Appellations Project The Mendocino Appellations Project (MAP) is a non-profit organization devoted to the research and development of legal appellation of origin protections for cannabis. Appellation of origin (AO) is a type of regional intellectual property right within geographical indication systems. Implemented correctly, AO protects the ecology, economic strength, and agricultural heritage of rural farming communities. The qualifying standards of an AO certification are derived from research of the unique environmental, cultural, and botanical aspects of the region’s agriculture, which ensures an authentic provincial product of superior quality and enhanced market value.

MAP’s objective is that a researched, standards-based AO system be adopted for cannabis in the United States, in order to most effectively protect our heritage cannabis farming communities and drive the further development of AO systems for all American agriculture.

The aim is to increase knowledge and understanding of our rural cannabis farming communities and integrate the knowledge gained within policy and social change in order to secure the legacy of heritage cannabis agriculture in America.• FAST TRACK CREATION OF FDA COMPLIANT CANNABIS TRANSLATIONAL MEDICAL PRODUCTS: IDEATION THROUGH R/D TO CLINICAL RESULTS TRACKED TO QUALITATIVE/ QUANTITATIVE CANNABINOID CONTENT Stephen Goldner, Pure Green, John Althaus, and Debra Kimless We describe the methodology and clinical results obtained from sublingual tablets that disintegrate in 10 seconds with onset of effects in 90 seconds, lasting 4 to 8 hours. The tablets are consistent, reliable, convenient, portable, discreet to use and transport, patent-pending, organoleptically advantageous, and water soluble. This technology stack creates quantitative and qualitative cannabis clinical trial formulations directly linked to marketplace products with rigorous statistical analysis of human clinical trial data, resulting in superior marketplace outcomes. • So much to see, so

CANNABIS AS A THERAPEUTIC OPTION FOR CHRONIC PAIN MANAGEMENT, CURTAILING THE OPIOID ADDICTION AND OVERDOSE CRISIS: A PATIENT AND MEDICAL PERSPECTIVE Kyle Dijon Hill, Fight Opioid Addiction and Overdose with Medical Cannabis Project … Chronic pain remains the leading condition for which opioids are prescribed. Despite opioid therapy being a mainstay approach for pain management, the usage remains controversial due to increasing concerns regarding side effects, efficacy, outcomes and high potential for abuse and addiction.

One of the largest components of curtailing the opioid crisis is finding an alternative first-line treatment option for chronic pain; one that does not progress to dependence or overdose.

Medical cannabis needs to be acknowledged as such an alternative.

After a car accident left me with fractured vertebrae among other injuries and severe chronic pain, I slowly became a victim to the unacknowledged devastation of opiates. As a medical student and a researcher within the realm of cannabinoid science, I provide a unique perspective of America’s current situation of over prescribed and poorly monitored opiate pharmaceuticals. With the malignant nature of the opioid overdose crisis resulting in more than ninety Americans dying each day, it is due time we understand the reason fueling this crisis as well as generate viable solutions to curtail the destruction. By way of statistics, article reviews, comparative analyses, and a glimpse into countries and cities with established medical cannabis programs; a clear perspective is constructed and presented. • SPATIAL DISTRIBUTION OF CANNABINOIDS , TERPENES, AND OTHERS WITHIN AGRICULTURAL CANNABIS PRODUCTS Joseph Diverdi, Xtr Systems, LLC, Colorado State University, and Twinkle Paryani Agricultural products are, by their very nature, inhomogeneous in many ways and on many size scales. Some products destined for human use and consumption are used in their entirety and others are blended. Cannabis is no different in this regard, yet it appears that common systems of production, processing, analysis and final use do not take this heterogeneity fully into account and may be impacted by this failure. The work presented here exposes a fundamental characteristic of cannabis in this light: the initial agricultural product at the beginning of this supply, production, consumption and treatment chain (“flower” or “bud”) is intrinsically and significantly inhomogeneous in important characteristics and this can materially affect our models, quantitative evidence of benefit and harm and elsewhere. •

Mary’s Prime Time | Issue 3 | 2018

INTERPRETATIONS OF THE FARM BILL: THE DIFFERENCES BETWEEN STATES AND HOW THAT IMPACTS AN EMERGING INDUSTRY Duane Sinning, Colorado Department of Agriculture Since the passage of the Agricultural Act of 2014 or the 2014 Farm Bill, at least 34 states have passed legislation related to industrial hemp. The Farm Bill defined industrial hemp, laid the groundwork for who could cultivate industrial hemp, and provided guidance on what could be done with the material grown. So why are the regulations so different between states?

This talk will touch upon how states came to develop such different regulations, all with the belief that their programs were Farm Bill compliant. It will touch on the lack of uniform information states receive from their federal partners and how not all federal agencies are uniformly applying their own regulations to industrial hemp. And the talk will take a look at what impact the lack of standardization in regulations has on this emerging industry as it looks for legitimacy. •

2017 TO 2018: WHAT’S NEW WITH THE “LEGAL” STATUS OF CANNABIS? A REVIEW OF CHANGES AT THE FEDERAL LEVEL Linda Schutjer, Colorado State University Since last year’s conference there has been significant changes in the legal landscape with respect to industrial hemp and high THC cannabis. Attorney General Sessions appointment to head the Department of Justice has lead to a withdrawal of the “Cole memo” which had previously guided the DOJ in its application of the Controlled Substances Act to marijuana users and those in the medical marijuana and hemp industries.

The Cole guidance has provided some comfort to users and growers that as long as they acted in compliance with applicable state laws, the risk of arrest and prosecution was low. While congress has included a measure blocking use of government funds to prosecute those otherwise in compliance with their state medical marijuana and hemp laws in each budget since 2014, it is unclear that the administration will honor it. Other regulatory actions have suggested that even medical use of CBDs could face DOJ action, even where it would seem that such use is permissible under Farm Bill provisions. Given these and other actions and statements from Washington DC, an update on the legal status of hemp and high THC cannabiswhat we know, don’t know and suspect or expect would be timely and useful information. •

So much to see, so

7

CBG

reduces blood sugar levels & treats psoriasis

ENDOCRINE & IMMUNE RESPONSE

treats fungal infections

CBG

CBD, CBC, CBN & THC

reduces or eliminates pain

kills or slows bacteria growth

CBD & CBG

inhibit cell growth & cancer cells

CBD, CBG, CBC & THC

WHOLE BODY RELIEF & PROTECTION

CBD & THC

increases cerebral blood flow

THE NERVOUS SYSTEM

CIRCULATORY SYSTEM

CBD

reduces risk of artery blockage & anti-ischemic

CANNABIS MAN

suppress muscle spasms

CBD, CBC & THC

reduce inflammation

CBD, CBN & THC

promote bone health

CBD, CBG, CBC & THC-V

MUSCULAR & SKELETAL

CBD & THC-V

CBD

tranquilizes & relieves anxiety

CBD

THE DIGESTIVE SYSTEM

appetite stimulant

THC

reduces seizures & convulsions

reduces contractions in the small intestines

appetite suppressant

THC-V

CBN

aids in sleep

Each year the Institute of Cannabis Research has a Mechoulam Lecture as part of the ICR’s annual conference.

The lecture is named in honor of the pioneering chemist, Rafael Mechoulam, who gave the First Mechoulam Lecture in April 2017. Dr. Mechoulam’s address was entitled “The endocannabinoid system: a look back and ahead.” It can be viewed here: http://m.aryspub.com/theene1275

EXPLORING FARMWORKERS’ SAFETY AND HEALTH ISSUES WORKING IN CANNABIS INDUSTRY Farzaneh Khorsandi, University of California, Davis, Marc B. Schenker, Western Center for Agricultural Health and Safety, and Diane Mitchell, Western Center for Agricultural Health and Safety Cannabis is the unspoken number one agricultural product in California, with an estimated $23.3 billion in cash farm recipient. About 100,000 farmers and farmworkers work in the cannabis industry in California. Unfortunately, due to the illegal nature of most cannabis production in the California, very little research specifically addresses the health and safety issues of farmworkers in this area.

NBC

So much to see, so

peels ni sdia

10 Mary’s Prime Time | Issue 3 | 2018

V-CHT

The 2018 Mechoulam Lecture was presented by Vincenzo Di Marzo, Canada Excellence Research Chair on the MicrobiomeEndocannabinoidome Axis in Metabolic Health at Université Laval, Quebec City, Canada and Research Director and Coordinator of the Endocannabinoid Research Group, Institute of Biomolecular Chemistry, Consiglio Nazionale delle Ricerche, Pozzuoli, Naples, Italy. Dr. Di Mazo’s 2018 lecture can be seen here: http://m.aryspub.com/phyto59229

DBC

& seziliuqnart yteixna seveiler

V-CHT & DBC

DBC

snoitcartnoc secuder senitsetni llams eht ni

tnasserppus etiteppa

EVITSEGID EHT METSYS

The first aim of this project is to conduct an assessment to explore the health and safety issues working in the cannabis industry. The health and safety hazards in cannabis production include biological, chemical, and physical hazards. Among physical hazards, we explore repetitive motion, inserted force, and awkward posture. We also seek to develop an outreach program to educate workers and supervisors about potential hazards and accidents in this field, and appropriate prevention methods and protective equipment. •

Americans 55 to 64 years old are the fastest growing segment of marijuana users. Although marijuana use has increased among all age groups, use by 55 to 64 year olds increased by 455%, from 1.1% in 2002 to 6.1 % in 2014. In comparison, use by 26 to 34 year olds increased by 65%, from 17.3% to 19.6%, during this same timeframe. Factors that have contributed to increased marijuana use in the 55-64 age group include changes in state marijuana laws and local policies, increased use of marijuana as an alternative treatment for health related problems, greater social acceptance of marijuana, and the continued use by lifetime marijuana users as they age into the age group. Information regarding the patterns and correlates of use among this age group may be useful to researchers, practitioners and policy makers responsible for designing outreach, and prevention and treatment programs. Little is known about the role played by, for example, gender , age of onset of use, geographical region, race, or socioeconomic factors such as education and employment status in the use of marijuana and the development of marijuana use disorders among 55-64 year olds. In this study, we use National Survey on Drug Use and Health (NSDUH) data (2002-2015) to examine the gender differences in marijuana use over time in the 5564 year old age group. Among this population, we examine the age of when marijuana was first used by gender, identify patterns of marijuana use over time, and the development of marijuana use disorder within the past year. • snoisluvnoc & seruzies secuder

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In California, commercial cannabis producers require a license which will be issued beginning in January 2018. A new bill also requires cannabis producers to train employees in worker safety within one year of receiving their license.

The sharp increase in the number of cannabis employees combined with the lack of research and demand for trained workers intensifies the need for an assessment to detect the health and safety hazards of working in this industry and the development of a health and safety outreach program.

GENDER DIFFERENCES IN PATTERNS OF MARIJUANA USE OVER TIME IN THE 55-64 YEAR OLD POPULATION Kasia O’Connell, Westat, and Jessica Taylor

WORKER HEALTH AND SAFETY IN THE CANNABIS INDUSTRY Roberta Smith, Colorado Department of Public Health ond Environment

IMPACT OF LEGAL CANNABIS ON THE CHILD WELFARE SYSTEM Arlene Reilly-Sandoval, Colorado State UniversityPueblo

Background: In 2014, the use of recreational marijuana was legalized in the state of Colorado. Prior to this legalization, medical marijuana had been legalized in the November 2000 election. The legalization of recreational marijuana started a new industry in Colorado involving the cultivation and selling of an agricultural product that is not recognized as a legal agricultural product at a federal level. The emergence of a new industry-led occupational health and safety professionals to find ways in which they could begin understand what health and safety risks might exist for employees in the marijuana cultivation business. Currently, there are not many studies that describe these risks that have been published. It was also recognized that employers themselves may not be aware of the OSHA and other regulations needed to make sure their employees were protected on the job.

In the past five years, laws centered on the possession, sale, and transfer of medicinal and recreational cannabis have changed drastically. Penalties for cannabis possession can include mandatory prison sentences, fines, and loss of government family aid, drastically altering the lives of those caught with cannabis, and leaving a secondary impact on their families. When a parent is charged with a drug offense, the consequences they face tend to trickle down to their children and Child Protective Service ( CPS) involvement is common.

CPS involvement can stem from the drug use itself or occur from abuse or neglect issues that arise from the ingestion of substances that affect cognition or physical health.

Results: The result of the collaboration was the publishing of a health and safety guide accessible to the marijuana industry.

This document is the foundation of health and safety training programs for the marijuana industry in the state and a model of practice for other states that are facing this new industry.

Although this guide is directly focused on the potential hazards in the marijuana industry, the collaborative process used and the resulting guide can be used as a model of outreach to emerging industries. • IMPAIRED DRIVING AND CANNABIS: MEDIA REPORTING FROM HEALTH STUDIES AND ACADEMIC RESEARCH Lloyd Covens, West420 News Weekly Driving under the influence of medical or adult-use cannabis continues to be a concern for marijuana policy in North America. News reporting on the impairment measurements around blood, saliva or breath tests has entered the mass media, and is also critical in the science and health problems of expanded cannabis access. This paper will examine the social, science and individual dimensions of impaired cannabis driving behaviors, as reported by select major media, and compares news reports of both academic research and government studies.

The analysis will shed light on varied approaches to public communications, comparative detection techniques, and reporting on law enforcement goals for safe driving in the age of greater cannabis use. •

Mary’s Prime Time | Issue 3 | 2018

This study looked at the impact of cannabis legalization within the CPS system in Pueblo County, Colorado. The number of Child Welfare (CW) referrals and amount of Core dollars spent on substance abuse treatment were collected for the years 2012-2017, and four CW workers were interviewed regarding their experience with families who use cannabis as compared to families who do not, and the challenges experienced when working with families who are cannabisinvolved. Each CW worker came from a different unit within the Department of Social Services (i.e., intake, adolescent services, foster care, truancy) in order to include the largest client population possible.

Initial results showed a surge in referrals and core dollars spent on substance abuse treatment programs immediately after cannabis legalization, but a decrease in the number of children removed from a home for parental drug or alcohol abuse. Interviews from CW workers indicated that parents were more likely to disclose cannabis use than use of any other drug. Interviews also revealed an anecdotal belief among CW workers that homeless families have increased in Pueblo and revealed a lack of guidance for caseworkers regarding when to remove children or reunify families when cannabis is the only substance involved.

The subject of cannabis legalization and child welfare is multi-faceted, and further complicated by issues such as poverty, citizenship status, unemployment, homelessness, availability of safety net benefits, and mental health challenges that are experienced by families referred to Pueblo County Department of Social Services. This poster presentation will describe the data collected and provide recommendations for policy changes and suggestions for future research. •

So much to see, so 11

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12 Mary’s Prime Time | Issue 3 | 2018

suppress muscle spasms

CBD, CBN & THC

CBD, CBC & THC

Cannabis is the most widely used illicit substance in the United States and liberalization of state cannabis laws has been associated with greater usage, refined cultivation methods , increased THC potency, and diverse modes of ingestion. Taken together these shifts create challenges and opportunities for public health professionals. Inadequate product labeling and inconsistent dosage control during manufacturing resulted in a spike of reported cannabis overdoses shortly after some U.S. cannabis markets became legal in 2014. Such episodes have more commonly been associated with edible use. This study examined user experiences with edibles in order to identify factors contributing to the onset of a negative edible experience, coping strategies reported, and the influence of such experiences on subsequent cannabis or edible use.

Open-ended in-depth interviews were conducted with a nonrandom sample of medical and recreational cannabis users in California and Colorado. Interviewees were asked to describe their prior cannabis experience with cannabis and introduction to cannabis edibles as well as share the story of their negative edible experience. Interview transcripts were analyzed for emergent themes and lessons for product labeling and public health campaigns are discussed. •

Results: Of physician certifiers, oncologists and primary care clinicians certified the majority of cancer patients in this cohort ( 46% and 30%, respectively). All symptoms showed a significant decrease in score distributions between baseline and the overall four month period following their first purchase indicating that symptoms had diminished over time (p<0.001 for all symptoms). The symptoms with the greatest reduction in median score (baseline vs. four month average) included anxiety (7 to 4.2), lack of appetite (7 to 4.8), and nausea (6 to 3.8). Proportion of patients who achieved 30% symptom reduction ranged from 27% (fatigue) to 50% (vomiting). A smaller percentage of patients were able to achieve a 30% reduction in symptom intensity and maintain that degree of improvement for at least four additional months (range 11% to 28% across all symptoms). Only 10.5% of the patient cohort reported any side effects within four months of their first medical cannabis purchase, and over 90% of these reports were rated as mild or moderate. Top three side effects reported were drowsiness/somnolence/sedation (24%), dry mouth (21%), and fatigue (18%). reduce inflammation

“I ATE HOW MUCH!?” USER EXPERIENCES WITH CANNABIS EDIBLES Josh Meisel , Humboldt State University, Sue Sisley, Scottsdale Research Institute, and Jane Fraser, Colorado State University-Pueblo

Background: More than half of all states have legalized medical cannabis, yet there is very little systematic data collection occurring within state medical cannabis programs to assess patient benefits over time. Minnesota’s program routinely collects patient-reported scores for eight symptoms (anxiety, appetite lack, depression, disturbed sleep, fatigue, nausea, pain, and vomiting).

Conclusion: Systematic data collection through Minnesota’s medical cannabis program suggests that cancer patients are experiencing symptom improvements within a few months of program participation, with some attaining clinically meaningful and lasting levels of improvement. Side effects appeared infrequently and were generally mild or moderate in severity. • romote bone health

Sundie Seefried is CEO and president of Partner Colorado Credit Union, located in Denver, Colorado. She has served in the credit union industry since 1983 and as CEO since 2001. Poised to retire in 2014, Seefried instead embarked on what has been the biggest challenge of her eventful career: designing and building “Safe Harbor Private Banking,” a fullscope cannabis banking program. The program she devised, tested and launched has not only withstood the scrutiny of federal and state regulators, it has succeeded financially. Just as important, by backing an industry that once had little choice but to execute all of its transactions in cash, Seefried and her Partner Colorado team have made communities all over Colorado safer. •

IMPACT OF MEDICAL CANNABIS ON PATIENTREPORTED SYMPTOMS FOR CANCER PATIENTS ENROLLED IN MINNESOTA’S MEDICAL CANNABIS PROGRAM Susan Anderson, Minnesota Department of Health Office of Medical Cannabis

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SAFE HARBOR: LEGAL BANKING FOR LEGAL CANNABIS Sundie Seefried, Parmer Colorado Credit Union

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Also recommended is the ICR keynote address from the 2018

by Dr. Audra Stinchcomb, a Pueblo native who describes twenty years of cannabis based drug delivery research in less than an hour in her talk entitled: “Cannabis-based drug delivery: university lab to medical trials.” You can see it here: http://m.aryspub.com/cannab9138

So much to see, so

Medical Cannabis 2018

25-26 June | Vienna, Austria

The International Annual Congress on

Controversies on Cannabis-Based Medicines

INTRODUCTION The Vienna conference theme -- “Controversies on Cannabis-Based Medicines” -- suggested a multitude of different directions the conference could go and I was pleasantly surprised to learn the controversy of whether cannabis has medical value was not one of them. That battle is clearly over. The 210 attendees and 25 speakers seemed uniformly comfortable with accepting the medical utility of cannabis. For these conference goers, the constant refrain was dosing—how much, how often and what product? In that regard, these medical practitioners are remarkably similar to their holistic brethren. Last July, I attended a meeting at the National University of Natural Medicine in Portland (see Mary’s Prime Time, Issue #1) and heard many of the same refrains from naturopathic doctors. Where the two disciplines part company is with the refinement of the plant.

Homeopaths are content with cannabis-based products—tinctures, salves, patches and other products. Many of the physicians in Vienna were looking for pharma-produced preparations with Western prescribing instructions. For those who are less rigid, the conference offered new ways of thinking and some remarkable insights from practitioners — mainly from Canada and Israel — who have been on the frontlines of medical cannabis practice.

The attendees came from 32 different countries with the “traveled-the-greatest-distance-award” going to two women from Pakistan. The inclusion of so many nationalities clearly demonstrates the global acceptance of medical cannabis and it is hard to believe that global reform with respect to cannabis regulations has not yet occurred. But these international meetings do give insight into levels of control that are seldom considered by U.S. activists. The bottom line: more research —human or in vivo research — is desperately needed and regulatory bodies MUST start cooperating in the medical cannabis revolution and, to put it bluntly, get out of the way. Alice O’Leary Randall

CONTROVERSIES ON CANNABIS-BASED MEDICINES - DAY 1 THERE WERE FOUR SESSIONS ON THE FIRST DAY. THIS REPORT COVERS THREE OF THOSE SESSIONS.

Basic Science — Cannabis a Treasure Chest?

With any presentation — whether a theatrical production or scientific conference — it is always best to start on an upbeat.

Call it a warm up, if you will, but the goal is simply to capture the audience focus for the following action. In that regard Rafael Maldonado, MD, Ph.D. (professor of pharmacology at the University Pompeu Fabra in Barcelona, Spain) was a perfect choice. Dr. Maldonado is clearly intrigued with cannabis. His session was entitled “Basic Science — Cannabis a Treasure Chest?” and Dr. Maldonado gave a very animated talk about the ECS and its promise in developing therapeutic products.

At one point, he stated that CB1 receptors are the most abundant receptors in the human brain and enthusiastically, if simplistically, concluded “they must be very important, for sure!”

Dr. Maldonado’s positive overview was a good lead-in to the next presentation by Dr. David Meiri of Israel. A biologist, Dr. Meiri has been studying the anti-cancer properties of cannabis and he is a frequent presenter at these conferences where he generates a lot of excitement. But Meiri is cautious about his work, stating, “we are very, very, very far” from developing anti-cancer cannabis medications.

Mary’s Prime Time | Issue 3 | 2018

It was interesting to this writer that within the first hour of this conference there were two notable researchers who gave widely different information about the cannabis plant. Dr. Maldonado stated there are 60-65 cannabinoids in cannabis.

Less than a half hour later Dr. Meiri stated he had identified 144 cannabinoids! (As a side-note, Wikipedia states there are 113.) This disparity highlights just one of the problems with today’s cannabis science. And while Dr. Maldonado (and most other researchers) spoke of two receptors (CB1 and CB2), Dr. Meiri claims to have identified 32 receptors.

Dr. Meiri’s research is taking place at a sub-molecular level and even the smallest amount of a different cannabinoid can make a huge difference. For example, he has already demonstrated the cancer toxicity of some cannabinoids on certain types of breast cancer but when those specific cannabinoids are used on other types of cancer, e.g. prostate, there is no anti-cancer effect. Even more daunting is that Dr. Meiri’s is working with 90-100 different cultivars from eight cannabis farms in Israel.

In cooperation with Israeli oncologists he has assisted in the treatment of 8,000 patients, encountering some success but many more failures. Still, one has the feeling that Meiri will keep at it because the promise is enticing and, as he noted, “The problem with this plant is that it works.”

Introduction 13

The Situation in Europe The second session of the day moved away from research and into the area of regulation and control. Four presentations provided information on the control of cannabinoids in European countries, Canada and Israel. It was here that participants began to see the dichotomy of the current situation relative to medical cannabis use.

Nevenka Krcevski Skvarc, from Slovenia, reported on a survey of the 37 chapters in the European Pain Federation (EFIC).

Quoting from the published results: Thirty-one out of 37 contacted councillors responded.

Plant-derived tetrahydrocannabinol/cannabidiol (THC/ CBD) oromucosal spray is approved for spasticity in multiple sclerosis refractory to conventional treatment in 21 EFIC chapters. Plant-derived THC (dronabinol) is approved for some palliative care conditions in four EFIC chapters. Synthetic THC analogue (nabilone) is approved for chemotherapy-associated nausea and vomiting refractory to conventional treatment in four EFIC chapters’. Eight EFIC chapters’ countries have an exceptional and six chapters an expanded access programme for medical cannabis. German and Israeli pain societies recommend the use of cannabis-based medicines as third-line drug therapies for chronic pain within a multicomponent approach. Conversely, the German medical association and a team of finish [sic] experts and officials do not recommend the prescription of medical cannabis due to the lack of high-quality evidence of efficacy and the potential harms.

This paragraph demonstrates the confused state of European countries with respect to medical cannabis, confusion that was not lost on a later speaker in the same session, Tamir Gedo of Breath Of Life (BOL) in Israel, who would declare, “There is no need to reinvent the wheel. The wheel is turning very well in Israel.”

The final session on the first day was entitled “Study Design— Beyond RCTs?” Randomized controlled trials (RCTs) have been the “gold standard” for scientists since the 18th century.

With cannabis, however, there are definite problems in attempting to conduct an RCT, particularly with inhaled cannabis. Additionally, there has never been a medicine quite like cannabis. Lacking a pharmaceutical sponsor, there has been no one to organize RCTs. And perhaps most importantly, cannabis has been available to the public (albeit illegally) for decades with word-of-mouth instruction substituting for pharmaceutical directions. While this is frustrating to many clinicians who want cannabis to fit into the nice box labeled “western medicine” the fact is quite simple: it doesn’t.

One RCT alternative is the use of patient registries. In the U.S. “registries” initially had a bad connotation with patients worried about personal health information falling into the wrong hands or being singled out by law enforcement. But registries are accepted in the scientific community as a valid means of amassing data on a particular drug and/or medical condition. Google the term and you will find many positive web sites extolling patient registries including the National Institutes of Health (NIH) which has an entire page dedicated to registries. It states: Many registries collect information about people who have a specific disease or condition, while others seek participants of varying health status who may be willing to participate in research about a particular disease.

Individuals provide information about themselves to these registries on a voluntary basis. Registries can be sponsored by a government agency, nonprofit organization, health care facility, or private company.

In 2015, Dr. Mark Ware of McGill University in Canada

THERE IS NO NEED TO REINVENT THE WHEEL. THE WHEEL IS TURNING - Tamir Gedo, CEO, BOL, Israel VERY WELL IN ISRAEL.

“

“

Patient Registries - one way to solve the “no evidence” problem?

This confusion and, at times, downright silliness, is reminiscent of the U.S. It seems that European states, like American states, are trying to outdo each other with tough control measures. In Italy, for example, the country’s military is in charge of growing cannabis for medical purposes (and it was reported there is a shortage of supply). In Germany there is discussion of growing cannabis in bunkers! This got a good laugh from the audience but demonstrates how far astray the question of regulation is taking the issue. As one speaker noted, regulation is impeding standardization and the product price is becoming enormous. Little wonder that Mr. Gedo, the Israeli from BOL, reminded attendees that Israel is already up and running with eight farms and more are planned. Israel, he reminded us, “has plenty of sunlight to grow cannabis.”

14 Mary’s Prime Time | Issue 3 | 2018

launched the Quebec Cannabis Registry. Its purpose was to allow physicians to better manage [cannabis’] use and monitor patient safety. This innovative project represents the world’s first research database on the use of cannabis for medical purposes and places the province at the forefront of research in the field of medical cannabis.” (http://m.aryspub.com/world4b440) Dr. Ware has been a passionate advocate for the use of patient registries and his particular database is unique since it “has established a mechanism through which patients who received medical marijuana can be registered in a database on the use of dried cannabis for medical research.” (http://m.aryspub.com/infor872c4) Dr. Andrew Moore, noted pain researcher from the

Introduction

University of Oxford, followed Ware’s presentation and was supportive of the idea. “Good quality registries,” he said, “may be the answer” to the paucity of evidencebased research relative to cannabis.

Listening to these discussions, which included audience questions and comments, it seemed to this writer that the idea

of patient registries struck a particular chord with conference goers. There was almost a “buzz” that developed, a sense that perhaps this could be the way. It is clear to most clinicians that cannabis is not going to disappear and they are desperate for data they can trust. In this current state of affairs, many clinicians feel as though they are flying blind. 

CONTROVERSIES ON CANNABIS-BASED MEDICINES - DAY 2 It was on the second day of the conference that the true “controversy” referenced in the conference title began to emerge. Almost the entire day was devoted to questions about using cannabis for pain management and, indirectly, reduction of opioid use.

Most speakers were supportive of cannabis use but all were frustrated by the lack of research. The first session focused on using cannabis to treat the rheumatic pain and had two presenters, one pro and one con. Dr. Jacob Ablin from Israel, represented the pro side. He was a particularly thoughtful speaker and managed to work in a quote from American politician Donald Rumsfield, something you don’t hear too often at a cannabis conference.

Dr. Ablin knows cannabis is being used by his patients and he compassionately noted, “we must not hesitate to consider cannabis an option [for patient use] when more well-studied options have failed our patients.”

For those seeking the Holy Grail of double-blind, placebo controlled studies, Dr. Ablin referenced a tongue-in-cheek article from a 2003 issue of the British Medical Journal entitled “Parachute use to prevent death and major trauma related to gravitational challenge: systematic review of randomised controlled trials,” which concluded: As with many interventions intended to prevent ill health, the effectiveness of parachutes has not been subjected to rigorous evaluation by using randomised controlled trials. Advocates of evidence based medicine have criticised the adoption of interventions evaluated by using only observational data. We think that everyone might benefit if the most radical protagonists of evidence based medicine organised and participated in a double blind, randomised, placebo controlled, crossover trial of the parachute.

Dr. Ablin’s counterpart was Dr. Mary-Ann Fitzcharles of Canada. Coming from an addiction background, her opinions are firmly rooted in the “Gateway Drug School” of cannabis thought. She was condescending and alarmist all at the same time and her presentation was packed with emotional terms like “poor little ones” and “granny, wobbly on her sticks.”

She had barely finished before her Canadian colleague Dr. Mark Ware was on his feet and at the audience microphone to challenge a number of her statements, most notably her statement that Canada only spends $1.4 million on cannabis research. Ware said the actual figure is $24 million.

Mary’s Prime Time | Issue 3 | 2018

Saving the most provocative for last, the closing topic was “Medical Cannabis: Is Cannabis a Solution to the Opioid Epidemic or Another Epidemic?” No surprise that Dr. Fitzcharles was back and much more aggressive. Perhaps realizing that her argument was not going down well among attendees, she repeated a position that is frequently heard these days by anti-cannabis individuals and groups — she was pro-cannabinoid but anti-cannabis. Her partner on the panel was Hans-Georg Kress of the Medical University of Vienna who was, rather disappointingly, of similar thinking as Dr. Fitzcharles. Both panelists speculated that a release of medical cannabis will only be substituting one problem (opioids) for another (cannabis). This did not make for a very stimulating presentation. Audience responses, on the other hand, were most definitely pro-cannabis and provided the counterpoint.

The sophistication of knowledge that was evident in the questioners was particularly striking to this writer. For many years those opposed to cannabis have been able to give presentations about the purported harms of cannabis, citing studies and methods that were questionable at best. Reefer Madness has been a difficult beast to kill. But in today’s climate there is a new sophistication and a basic understanding that not all cannabis use is the same. An example of this knowledge came during a presentation by event co-chair Silviu Brill on Cannabis and Driving. Dr. Brill used statistics from the U.S. that seemed to imply medical cannabis users were posing a threat on the highway. Criteria was needed, he said, to make sure that medical cannabis users were safe drivers and we need to move more slowly with making cannabis medically available until we knew the answers to these questions. I have been to enough conferences over the years to not be surprised by this kind of talk. But I was surprised by the response from the audience. Dr. Caroline MacCallum of the University of British Columbia called Dr. Brill to task for using data from studies of recreational users, noting that recreational cannabis users typically use more cannabis and at higher potencies.

It is this critical thinking that I find so refreshing in the recent conferences that I have been attending. The cannabis issue has come a long, long ways and the emerging class of researchers and clinicians gives one considerable hope for the future. The topic is now actually being discussed, not just debated.  Alice O’Leary Randall Controversies on Cannabis-Based Medicines 15

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