EDITORIAL & ADVISORY BOARD
ANNE BOLDUC Group Publisher & President EDITOR IN CHIEF Guy J. Jonkman
ROBERT M. GOLDMAN, MD, PhD, DO, FAASP World Chairman-International Medical Commission Co-Founder & Chairman of the Board-A4M Founder & Chairman-International Sports Hall of Fame Co-Founder & Chairman-World Academy of Anti-Aging Medicine President Emeritus-National Academy of Sports Medicine (NASM) DR. RONALD KLATZ, MD, DO, is the physician founder and President of the American Academy of Anti-Aging Medicine. In 1984, Dr. Klatz was a pioneer in the clinical specialty of preventative medicine: as a principal founder of the National Academy of Sports Medicine and researcher into cannabis medicine elite human performance and physiology. Dr. Klatz is a best-selling author, and is columnist or Senior Medical Editor to several international medical journals. He is the inventor, developer, or administrator of 100-plus scientific patents, including those for technologies for brain resuscitation, trauma and emergency medicine, organ transplant and blood preservation. DR. ADAM ABODEELY MD, MBA, FACS, FASCRS is the founder/CEO of ReserveMD™ and is a Board Certified Surgeon specializing in gastrointestinal diseases and cancer. Realizing the benefits of cannabis for patients with such ailments, Dr. Abodeely expanded his medical cannabis practice to include patients with a variety of medical ailments. He is an active member in numerous international cannabinoid societies and he serves as Chairman of the Dispensary Review Committee for the Association of Cannabis Specialists. Dedicated to advancing the science and education of cannabinoid-based therapies, he has a special interest in formulating products which capture the unique benefits of cannabinoids.
DAVID B. MANDELL, JD, MBA, is a former attorney and author of ten books for clients, including For Doctors Only: A Guide to Working Less & Building More, as well a number of state books. He is a principal of the financial consulting firm OJM Group. He has co-authored the Category I CME Monograph Risk Management for the Practicing Physician which has gone through 5 editions since 1998 & is certified for 5-hour business of medicine CME.
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SAHAR SWIDAN, Pharm. D., BCPS, ABAAHP currently serves as the Executive Director of Professional Development and Compliance at Slyngshot Health and CEO of Pharmacy Solutions. Dr. Swidan has over 25 years of experience in Personalized Medicine and Pharmacogenomics and serves as adjunct faculty at George Washington University, Wayne State University, and Chicago State University. Dr. Swidan is Board Certified and is an Advanced Fellow in Anti-Aging and Regenerative Medicine. She has authored several chapters, articles, and education materials in Pain Management and Personalized Medicine.
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STARTING MEDICAL CANNABIS PRACTICE CAN BE TERRIFYING & EXCITING
Developing Your Practice’s Medical Cannabis Strategy: A Check list for Success By DR. LUIS ENRIQUE WEYBACK, MD
The concept of starting a new medical cannabis practice can be equally terrifying and exciting. While opportunities for success and ubiquitous positive care are certainly within reach, the path to achieving those can be arduous without proper preparation. Having overcome the trials of medical cannabis implementation within my own practice, I offer my extensive experience and advice to those considering the exploration of this growing industry. These are my thoughts, warnings, and strategies for success in operating a medical cannabis practice. www.cannaMEDbusiness.com
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DR. LUIS ENRIQUE WEYBACK, MD is Founder & President of Doctor Jane A United States Navy veteran, Dr. Weyback is passionate about ensuring that first responders and veterans have access to the benefits of medical cannabis they can use to manage the psychological and physical conditions that disproportionately affect them. Dr. Weyback holds a Bachelor of Science in Chemistry and Biology and a Post-Baccalaureate in Medical Sciences from the University of Pennsylvania. He obtained his MD from Eastern Virginia Medical School in 2014 and is a member of the Congress of Neurological Surgeons, American Association of Neurological Surgeons, North American Spine Society, and the Florida Medical Association. www.doctorjane.net
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THOUGHTS, WARNING & STRATEGIES TO SUCCEED IN CANNAMED
Derivations of the cannabis plant were used in just about everything: beverages, medications, food products and more were routinely injected with cannabis as common knowledge dictated that physical and mental healing could be expected from ingestion. However, regardless of efficacy, American popularity nearly died with the Tax Act and the subsequent Reefer Madness.
Identifying Opportunities and Roadblocks The long and complex history of medical cannabis in The American Medical Association (AMA) actually the United States has been quite noticeably plagued fervently opposed the Tax Act due simply to the fact with obstacles and oppositions. For doctors and that inhibitory taxes would be assigned to those industry professionals flirting with entering medical producing, prescribing and selling medical cannabis cannabis, these regular uncertainties can be products. disquieting. As evidenced by the innumerable successful practices that incorporate cannabis in its many forms, the rewards can be well worth the time if efforts are dedicated to the promotion of positive, effective treatment. Prior to the self-explanatory Marihuana Tax Act of 1937, cannabis use was nearly as ubiquitous as, say, ibuprofen is today.
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CANNAMED PRACTICE MUST BE DEDICATED TO THE PROMOTION OF POSITIVE EFFECTIVE TREATMENT
The AMA insisted that marijuana and subsequent derivations be added to the Harrison Narcotics Tax Act1, which would have regulated and taxed production, importation, and distribution in accordance with other common
medications.
Regardless,
the
Marihuana Tax Act quickly became both the death of cannabis’ public popularity and the flame that lit the war against it. 1 Terry CE. THE HARRISON ANTI-NARCOTIC ACT. Am J Public Health (N Y) . 1915;5(6):518.doi:10.2105/ajph.5.6.518
Race and cultural freedom is, unsurprisingly, an enormous factor in the drug war’s inception. Under President Nixon’s leadership, which coincided directly with Harry Anslinger's rule over the Federal Narcotics
What’s worse, much of the United States’ war against cannabis can be attributed to a man characterized by racist and hateful intentions. Harry Anslinger, 2
Bureau, the country’s fight against marijuana and other substances took flight in extremely negative ways.
thirty-year overlord of the Federal Narcotics Bureau before its 1973 transition into the DEA, used the Narcotics Bureau’s stringent anti-drug platform (created by Anslinger himself) as a way to “squelch the radical freedom of the Jazz Age for people of color”. 2 Harry Anslinger, in many ways the sole creator of the “drug war,” was a “xenophobe with no capacity for intellectual nuance, and his racist views informed his work to devastating effect.” 2
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INSTALL A SUCCESSFUL CANNAMED PRACTICE WITHIN YOUR EXISTING CLINIC
“The Nixon campaign in 1968, and the Nixon White PRACTICAL IMPLEMENTATION CHECKLIST House after that, had two enemies: the antiwar left and Installation of a successful medical cannabis extension black people. You understand what I’m saying. We within a new or existing practice can be quite difficult knew we couldn’t make it illegal to be either against without prior consideration for certain key factors. the war or black, but by getting the public to associate the hippies with marijuana and blacks with heroin, 1. Knowledge Base Establishment and then criminalizing both heavily, we could disrupt Unfortunately, the number of legitimate physicians those communities. We could arrest their leaders, raid who lack any functional knowledge of cannabis’ their homes, break up their meetings, and vilify them medical applications is staggering. Statistics show that night after night on the evening news. Did we know we due to the fundamental lack of knowledge, doctors are were lying about the drugs? Of course we did.”
avoiding
medical cannabis recommendations altogether.3 This can be seen in a positive light; doctors are not recommending that which they do not understand at an appreciable level. In doing so, however, a large body of legitimate, effective medication is being altogether ignored. These options, which could potentially solve significant problems for those suffering from a variety of conditions, are disregarded in favor of more common and often more harmful prescription medications.
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NUMBER OF PHYSICIANS LACKING KNOWLEDGE OF CANNABIS MEDICAL APPLICATION IS STAGGERING
Developing a working understanding of these cannabis derivations and their usabilities may both increase business and offer healing to those that may otherwise find it unavailable. 2 Smith L.“How a racist hate-monger masterminded America’s War on Drugs”. https://timeline.com/harry-anslinger-racist-war-on-drugs-prisonindustrial-complex-fb5cbc281189 . Updated Feb 27, 2018. Accessed 25 May 2019.
2. Physician Certification Physicians seeking certification within their legal
3
Legraien L. “Doctors not prescribing medical cannabis due to
jurisdictions will meet several levels of steps and
lack of knowledge”.
requirements, though none are significantly restricting.
http://www.pulsetoday.co.uk/news/commissioning/commissioning-
First and foremost, obtaining licensure involves fees
topics/prescribing/doctors-not-prescribing-medical-cannabis-due-
specific to the state in which the business will operate in.
to-lack-of-knowledge/20038489.article . Updated Apr 2, 2019. Accessed 25 May 2019.
www.cannaMEDbusiness.com
These fees will vary by region and will require renewal after each year.
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CERTIFYING PATIENTS FOR MEDICAL CANNABIS REQUIRE CREDENTIALING, TRAINING & EXPERIENCE DOCUMENTATION
Physicians seeking to certify patients for medical Physicians are capable of providing medical cannabis cannabis use are required to provide credentialing, certifications to those dealing with a wide range of training, and experience documentation along with ailments. Conditions like cancer, epilepsy, glaucoma, physician license information. Doctors must be in Parkinson's Disease, multiple sclerosis, certain other good standing with their respective Boards of
neurodegenerative disorders, inflammation, anxiety
Medicine, maintain a valid medical license, and be and stress disorders, seizures, and many more fall capable of providing serious judgments about a within the range of medical cannabis’ ability to ease patient’s legitimate need for medical cannabis suffering. It is the responsibility of the doctor to treatments. Legal restrictions exist and vary by state, determine whether medical cannabis will be the best though certain standards permeate the United States treatment option for the specific patient, and if as a whole; for example, doctors nationwide are never another medication could achieve better results, the allowed to certify themselves or family members for doctor is obligated to not recommend cannabis medical cannabis, make false statements on treatment. certification forms, and so on. 3. Current Practice Environment Perhaps one of the most exciting benefits of starting a medical cannabis practice is the fact that the environment for consultations can be chosen almost entirely by the physician. Everything from location to population should be considered to the finest detail; will the practice operate within a hospital or academic location?
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CANNAMED ENVIRONMENT FOR CONSULTATIONS CAN BE CHOSEN ENTIRELY BY THE PHYSICIAN
Will consultations occur individually or in groups?
4. Current Patient Base Composition
These details may depend on whether parent
As with any medical practice, balancing the loyalty and
organizations allow such opportunities, whether
wellbeing of both current and forthcoming patients
partners support the decisions, and upon partners
should be the highest priority. Implementing a medical
allowing for segmentation of business for the
cannabis program can be time-consuming and may
practice. Discussing these details upfront will
threaten to shift attention away from those existing
eliminate uncertainty and provide jumping off
patients. Identifying whether the practice can handle
points for the practice’s initial stages.
additional patients is as crucial as it often is difficult. When becoming dedicated to starting your medical
Telemedicine is another popular form of
cannabis practice, it may be necessary to shift or
consultation, though medical cannabis’ current
off-load existing patients toward partners so that more
status does not allow for fully visit-free certification
time can be devoted to the new venture while care is not
in most states. Certain forms may be required to be
lessened for those individuals.
completed in-person, and doctors may be unable to recommend substances in medical cannabis’ category in particular jurisdictions at this time. This may change fairly quickly as legal uncertainty surrounding the plant dissipates, but for now, telemedicine is quite restricted.
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MEDICAL MALPRACTICE INSURANCE CARRIERS ARE STILL DIFFICULT TO FIND
It may be tempting to assume that all existing patients Practiced medical professionals will understand the would be excellent candidates for the new medical importance of medical malpractice coverage as cannabis certification practice. However, as mentioned something that’s better to have and not need than need previously, it is the responsibility of the physician to and not have. When preparing to incorporate medical only recommend the treatment for those who would cannabis into a practice, this is simply another element seriously benefit from it. When the practice starts that requires consideration. Finding coverage may be taking shape, it may be in the physician’s and patients’ more difficult than it typically is for those using more best interest to recommend those who would not fit common, regulated treatments. the medical cannabis practice toward partner physicians.
As described extensively in the American Bar Association’s Malpractice Liability and Medical
5. Medical Malpractice Awareness
Marijuana by Douglas B. Marlowe, J.D., Ph.D.,
It should be extremely clear by now that initializing a “Physicians who wade into the terrain of medical medical cannabis program can and will come with marijuana must understand that although their certain risks, some of which can be legal in nature. One actions may not be criminally culpable in legalizing such concern involves medical malpractice coverage; states, they are nonetheless recommending or most large medical malpractice insurance carriers certifying a non-FDA-approved treatment that is not actively avoid underwriting or even addressing supported or recognized by the large majority of their medical cannabis malpractice policies or concerns, a professional colleagues. Doing so may expose them to fact that causes medical cannabis doctors to either malpractice liability no differently than if they search extensively for distant, and often difficult to prescribed any other potentially hazardous and find, carriers that offer coverage or risk a gap in scientifically controversial experimental treatment.”4 coverage altogether. CANNA MED
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THE STATES ARE LEADING ON THE SAFE BANKING ACT OF 2019 AND NEED CLARITY FROM FEDERAL LAW
6. Banking and Fee Collection Extensively preparing for any and all financial details will serve a practice greatly in the long run. Included within this is insurance, which can be difficult at times for medical cannabis practitioners. For example, unless the practice operates in the state of New York, no insurance carriers will process claims
Changes like those present in the
that have anything to do with cannabis. In these
SAFE Banking Act of 2019 will
instances, patients will be required to self-pay the full
allow for more normalized
amount.
financial operations within the cannabis industry. This Bill, which is pending further
The sad truth is that banks still consider all cannabis
consideration in the House and Senate, will allow for
activity, either directly or indirectly related to the
proper banking with credit cards, deposits, and
trafficking, sale, or distribution of marijuana, to be
checking for legitimate cannabis-related businesses.
enablement. Doing so removes responsibility from
This will add further validity to cannabis transactions,
the individual, and this is precisely where the
which are currently cash-only for most businesses. With
dangers of enablement manifest.
credit card processing being such a challenge for medical cannabis professionals, such change will be
By tying cannabis activity to enablement, banks are
much welcomed and rapidly implemented.
associating medical cannabis with dangerous substances like opioids and prescription medications
4 Marlowe, D.B. “Malpractice liability and medical marijuana.”
while actively ignoring the documented lack of
The Health Lawyer - American Bar Association Health Law Section.
harm. It should be noted that financial institutions
Volume 29. Number 2. Pages 2-17. December 2016.
take such a stance without consideration for moral ground but rather from a federal liability standpoint - until the Federal Government provides clearer and
5 Secure and Fair Enforcement Banking Act or “SAFE” Banking Act of 2019. (H.R. 1595). 116th Congress. 2019.
more secure regulations, no financial institution can reasonably open itself to potential liabilities such as cannabis trafficking. www.cannaMEDbusiness.com
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PROPER PLANNING & ROADMAPPING LAY THE GROUNDWORK FOR A SUCCESSFUL CANNAMED IMPLEMENTATION
As there are risks involved, that word - sustainable - can be enormously
inspiring
when
preparing your practice’s medical cannabis operation. Whether the ultimate goal is widespread healing, advocacy for a substance that has long been mischaracterized, or business growth to allow for care of more patients, sustainability lies at the foundation as a key component in longevity. SUSTAINABILITY IS NOT A MYTH The list of details requiring careful attention is
Of all factors involved in medical cannabis
admittedly long; proper planning and roadmapping, implementation, entry timing should be of little to no however, will consistently lay the groundwork for a
concern. This may actually be the best possible time to
successful
implementation.
develop a medical cannabis plan, in fact; according to
In fact, this exact list of considerations follows the
the Institute of Medicine, chronic pain affects around
steps that took my medical cannabis practice from a
100 million American adults yearly. This large
simple concept to fully-adaptable reality within
estimate does not even include significantly populated
months. My business, now providing regular one-on-
groups like children, individuals in long-term care
one consultations with patients presenting wide
facilities, military personnel, or prison inmates.
varieties of concerns, is successful, sustainable, and prepared for any unforeseen obstacle that may come as
What’s more, a University of Michigan Health Lab report 6 shows that chronic pain is one of the most
a result of the United States’ ever-changing cannabis
common factors that lead patients to medical
climate.
cannabis use.
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RESEARCH REPORTS CORROBORATE SAFE & EFFECTIVE USABILITY OF CANNABIS APPLICATIONS
As public perception continues shifting toward cannabis acceptance, more of these chronic pain sufferers will be seeking treatment; a reputable local practice will be the first place they go.
6
Malcom, Kelly. “What Drives Patients to Use Medical Marijuana:
Mostly Chronic Pain.” Health News, Medical Breakthroughs & Research
SAFETY FIRST
for Health Professionals,
Safety will naturally be a major concern for doctor
labblog.uofmhealth.org/lab-report/what-drives-patients-to-use-
and patient alike when it comes to this alternative
medical-marijuanamostly-chronic-pain.
and largely misunderstood treatment. Having been so thoroughly vilified for several decades, this initial
Existing studies regularly show positive and often
caution is completely valid. However, large amounts
comparatively healthier effects resulting from medical
of research support corroborate the safe and effective
cannabis use as opposed to prescription medications
usability of cannabis applications. Additionally, with
and over-the-counter drugs. Published information
the increasing speed with which laws and
confirming the near-nonexistent lethality of cannabis
amendments are passed to allow for further research
treatments confirm what advocates have long known;
into the plant, this database is seeing exponential
the substance’s “extraordinarily high estimated lethal
growth with much more yet to come.
dose,” according to Americans For Safe Access, is “equivalent to smoking approximately 1,500 pounds in 15 minutes, a physical impossibility”.
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PATIENT CONCERNS ABOUT CANNAMED FALL WITHIN THE RESPONSIBILITY OF THE CLINICIAN EXPLORING ITS USE
Furthermore, some of the uncertainty surrounding 7 Addressing any and all patient concerns about medical cannabis may be due to our inability to identify serious cannabis fall immediately within the responsibility of dangers that may or may not even exist - “Scientists the medical practitioner exploring its use. Before have had to estimate the LD50, or Lethal Dose for 50% installing a medical cannabis program within a of the human population, because it has never been practice, answers to questions about its safety and demonstrated. This puts cannabis in a class of its own, efficacy should be prepared thoroughly. This is since even relatively safe medications such as aspirin something that the Doctor Jane team has been working have a lethal dose.”
hard to do; answering questions, promoting understanding, and abolishing negative stigma will
It must, of course, be stated that despite a lack of help to both grow your practice and assist the danger within the substance itself, safety concerns may movement toward acceptance of this highly effective
still exist due to the nature of its current metamorphic treatment. n status in the United States. Issues like “no quality control, little to no guidance by a healthcare provider, 7
Information on Cannabis Safety. Americans for Safe Access.
and the potential legal consequences as a result of
https://www.safeaccessnow.org/cannabis_safety .
growing, possessing or distributing this plant” exist
Accessed May 25, 2019.
and can complicate many of the steps in increasing 8 Safety Profile of Medical Cannabis. MedicalCannabis.com. popularity among patients.8
https://www.medicalcannabis.com/cannabis-science/safety-profile/.
Accessed May 25, 2019.
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Legal
PROFITS OF CANNA PRODUCERS & TAX REVENUES ARE SQUARELY PITCHED AGAINST THE HEALTH OF USERS
WATCHING CANADA’S EXPERIMENT WITH LEGAL CANNABIS
By DIANE KELSALL
Given the known and unknown health hazards of cannabis,2,3 any increase in use of recreational cannabis after legalization, whether by adults or youth, should be viewed as a failure of this legislation. The government of Canada should commit to amending the act if cannabis use rises.
Predictably, given the federal government’s stated commitment to pushing this legislation through, investment in cannabis firms has risen substantially over
O
n Oct. 17, 2018, the government of Canada have
the past year in anticipation, and new producers, large
launched a national, uncontrolled experiment in
and small, have been popping up across the country.
which the profits of cannabis producers and tax
Their goal is profit, and profit comes from sales — sales
revenues are squarely pitched against the health of
of a drug that, according to Health Canada, will cause a
Canadians. When Bill C-45 came into force in
problem in nearly 1 in 3 adult users and an addiction in
mid-October, access to recreational marijuana has been be
close to 1 in 10, with higher risks in youth.2
legal,1 making Canada one of a handful of countries to legalize recreational use of the drug. CANNA MED
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CANNABIS PRODUCERS WILL BEHAVE EXACTLY LIKE TOBACCO PRODUCERS
We cannot expect cannabis firms to restrict their growth
Although the act prohibits promotion to young people and
ambitions or to have use reduction as a goal. Cannabis
marketing may not evoke a way of life that includes
companies may initially focus on attracting current
“glamour, recreation, excitement, vitality, risk or daring,”
consumers from black-market sources, but eventually, to
among other restrictions,1 there is plenty of leeway for
maintain or increase profits, new markets will be developed
cannabis companies to attract users. Promoting brand
as is consistent with the usual behaviour of a for-profit
preference and providing “informational” materials are
company.4 Marketing efforts may include encouraging
allowed in places where young people are not permitted by
current users to increase their use or enticing a younger
law, for example. And the decision by the federal
demographic. The track record for tobacco producers has
government to legalize cannabis sends a clear message to
not been encouraging in this regard, and it is unlikely that
Canadians that its use is acceptable.
cannabis producers will behave differently. We are already seeing the rise of cannabis brands and can The provisions regarding promotion of cannabis were the
expect cannabis firms to promote their products to the full
subject of much debate as the bill wended its way through
extent allowed under law — and possibly beyond. This
the legislative process.
summer, cannabis companies were promoting their wares at music festivals and similar venues to ensure brandawareness of the legislation.5
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WINDFALL OF TAX REVENUE SHOULD BE FUND RESEARCH ON HARMS RELATED TO CANNABIS RECREATIONNAL USE But fundamentally, the federal government needs to take responsibility for the consequences of this controversial legislation. To that end, it must provide adequate funding for robust monitoring of cannabis use among all segments of society, especially among youth and other populations at particular risk. The anticipated windfall of tax revenue should fund research on harms related to use, as there are many unanswered questions about the shortand long-term implications of cannabis use.3 And finally, Even the food and beverage industry is joining in with plans
if use of cannabis increases, the federal government
to augment their products with cannabis.
should have the courage to admit the legislation is flawed and amend the act. Canadians — and the world — are
Legislated bill C-45 explicitly states that its purpose is to
watching. n
protect public health and safety, by keeping cannabis out of the hands of youth and enhancing public awareness of
References
health risks associated with cannabis use.1 To achieve this
1. An Act respecting cannabis and to amend the Controlled Drugs and Substances Act, the Criminal Code and other Acts. 42nd Parliament, 1st sess, 2018 June 21. Available: www. parl.ca/Content/Bills/421/Government/C-45/C-45_4/C-45_4.PDF (accessed 2018 Sept. 27).
will require a concerted effort by government at all levels. Analyzing the experiences of other jurisdictions that have legalized recreational cannabis should prove helpful,4 as will thoughtful reflection on Canada’s successes — or lack thereof — in tobacco and alcohol control.
Many local and provincial governments have put regulations in place to restrict the use and distribution of cannabis, beyond the broad provisions in the federal legislation. And health authorities are now having on campaigns to raise awareness of health and other risks, such as impaired driving, associated with cannabis use.
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2. What you need to know about cannabis. Ottawa: Health Canada; (modified 2018 Sept. 6). Available: www. canada.ca/en/services/health/campaigns/cannabis/canadians.htm l#a2 (accessed 2018 Sept. 27). 3. Memedovich KM, Dowsett LE, Spackman E, et al. The adverse health effects and harms related to marijuana use: an overview review. CMAJ Open 2018;6:E339–46. 4. Vogel L. What really happened after Colorado legalized marijuana? [news]. CMAJ 2018 Sept. 26. Available: https:// cmajnews.com/2018/09/26/what-really-happened-after-coloradolegalized-marijuana-cmaj-109-5665/ (accessed 2018 Sept. 27). 5. Buckner D. Cannabis marketers enjoy summer of schmooze ahead of legislative crackdown. CBC News 2018 July 11. Available: www.cbc.ca/news/business/cannabis-promotion-despite-cominglaw-1.4740933 (accessed 2018 Sept. 27).
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CANNA MED Business Review
FIRST STUDY INVESTIGATE CHANGES IN CANNABIS ACROSS EUROPE
IN EUROPE, HERBAL CANNABIS THC CONCENTRATIONS INCREASED 10% HASH CANNABIS THC CONCENTRATIONS INCREASED 17%
A significAnt new study shows thAt
cAnnAbis potency hAs doubled Across europe in the pAst 11 yeArs.
CANNABIS RESIN AND HERBAL CANNABIS HAVE SIGNIFICANTLY INCREASED IN POTENCY AND IN PRICE, ACCORDING TO THE FIRST STUDY TO INVESTIGATE CHANGES IN CANNABIS ACROSS EUROPE. A recent study, published in the journal Addiction by researchers from the University of Bath and King's College London, draws on data collected from across 28 EU Member states, as well as Norway and Turkey by the European Monitoring Centre for Drugs and Drug Addiction. The findings show that for herbal cannabis, concentrations of delta-9-tetrahydrocannabinol ('THC' -- the main psychoactive constituent of cannabis) increased by a similar amount each year, from 5% in 2006 to 10% in 2016. www.cannaMEDbusiness.com
For cannabis resin (or hash), THC concentrations were relatively stable from 2006 to 2011 (from 8% to 10%) but then increased rapidly from 2011 to 2016 (from 10% to 17%). The price of cannabis resin also increased, but to a lesser extent than for herbal cannabis. Lead author Dr Tom Freeman from the Addiction and Mental Health Group within the Department of Psychology at the University of Bath, said: "These findings show that cannabis resin has changed rapidly across Europe, resulting in a more potent and better value product." Unlike herbal cannabis, cannabis resin typically contains cannabidiol (CBD) in addition to THC. CBD has recently attracted considerable interest due to its potential to treat several medical conditions including childhood epilepsy syndromes, psychosis and anxiety. •
CANNA MED
BUSINESS Review
Canna Study
CANNA MED Business Review
Canna Study
IN EUROPE, THERE IS AN INCREASE OF THC AND A DECREASE OF CBD
What we are seeing in Europe is an increase in THC and either stable or decreasing levels of CBD, potentially making cannabis more harmful. These changes in the illicit market are largely hidden from scientific investigation and are difficult to target by policy-makers. An alternative option could be to attempt to control THC and CBD content through regulation." When present in cannabis, CBD may offset some of the harmful effects of THC such as paranoia and memory impairment. Cannabis containing higher levels of THC and / or lower levels of CBD has been linked to greater long-term harms such as the development of cannabis dependence, and an increased risk of psychotic illness. New resin production techniques in Morocco and Europe have increased levels of THC, but not CBD. Dr Freeman added: "CBD has the potential to make cannabis safer, without limiting the positive effects users seek. CANNA MED
BUSINESS Review •
It is estimated that 24 million people (or 7.2%) of European adults used cannabis in the last year. Across the globe 192 million people use the drug in a variety of markets, ranging from heavily sanctioned prohibition to commercialised legal sale. Cannabis policies are rapidly changing across the globe. Recreational use is now legalised in Canada and several US states, and medical use is permitted in many more countries, including very recently in the UK.
www.cannaMEDbusiness.com
CANNABIS Journal of Medicine
THE MOST IMPORTANT CHANGES IN EUROPEAN CANNABIS PRODUCTS IN RECENT YEARS HAVE OCCURRED IN CANNABIS RESIN
An important feature of European cannabis markets is the presence of resin (also referred to as hashish or hash): compressed blocks of extracted plant matter that are typically brown in colour. Arguably, the most important changes in European cannabis products in recent years have occurred in cannabis resin. Resin is primarily imported to Europe from Morocco; however, it is also imported from Lebanon and Afghanistan and produced domestically within Europe. Resin found in European markets has been reported to contain significant levels of cannabidiol (CBD), a non-intoxicating cannabinoid that may offset THC harms, and is typically absent from herbal cannabis. Traditional resin production methods often include a mixture of three plant chemotypes (THC-dominant, CBD-dominant, THC and CBD) found in landrace crops, such as Moroccan ‘kif ’. As THC and CBD are synthesized from a common precursor, the mixture of chemotypes used in traditional resin production methods can result in modest levels of THC, with balanced (roughly equal) levels of CBD. By contrast, THC-dominant plants can produce higher levels of THC with little or no CBD and are often used to cultivate herbal cannabis, higher-potency forms of resin and concentrated extracts. Recent data suggest that Moroccan resin production has shifted away from traditional landrace ‘kif ’ crops to THC-dominant strains, resulting in marked increases in THC concentrations. The effects of these changes appear to be evident in the French cannabis market, as documented by a 25-year study of police seizures. The authors reported a substantial increase in resin potency starting in 2011, driven by the emergence of a new type of resin exceeding 20% THC. Increases in THC concentrations were also detected in resin samples collected from police seizures in the United Kingdom from 2004–05 to 2015–16 and in Italy from 2010 to 2013. By contrast, THC concentrations in imported resin samples purchased from coffee shops in the Netherlands were largely stable in potency, from 2005 to 2015. However, the extent to which new higher-potency resin samples have penetrated cannabis markets at the European level is currently unknown.
www.cannabisjournalofmedicine.com
Regarding herbal cannabis in Europe, a small number of country-specific studies have reported changes in potency. In the Netherlands, domestic herbal cannabis showed a marked increase in THC from 2000 to 2004, followed by a marginal decrease from 2005 to 2015. In the United Kingdom, the potency of herbal cannabis was broadly similar in 2004–05 compared to 2015–16, but increased each year from 2010 to 2013, in Italy and from 1992 to 2016 in France. A meta-analysis of herbal cannabis potency world-wide reported annual increases (mean = 0.21% THC per year) from 1970 to 2009. However, the extent to which European herbal cannabis potency has changed in recent years is currently unclear. n
Story Source: Materials provided by University of Bath. Note: Content may be edited for style and length. Journal Reference: Tom P. Freeman, Teodora Groshkova, Andrew Cunningham, Roumen Sedefov, Paul Griffiths, Michael T. Lynksey. Increasing potency and price of cannabis in Europe, 2006-2016. Addiction, 2018; DOI: 10.1111/add.14525 University of Bath. "Increased risk of harm from cannabis across Europe." ScienceDaily. ScienceDaily, 31 December 2018. <www.sciencedaily.com/releases/2018/12/181231103957.htm>.
• CANNABIS Journal of Medicine
Canna Study
INTRODUCING A NEW, NON-OPIOID PAIN SOLUTION:
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The report “World Analgesics Market - Opportunities and Forecasts, 2015-2022” projects that the world analgesics market would reach $26.4 billion by 20221. Pain sufferers have long regarded plant botanicals as a source of healing; there are more than 100 plants known to have pain relieving properties2. Consumers have sought retail brands of topical pain relief with menthol as an active ingredient3. There is a “new” botanical that consumers need to be aware of for pain relief: cannabidiol. In a study published by the National Institutes of Health4, it is stated that, “The nonpsychoactive cannabinoid, cannabidiol (CBD), has great potential for the treatment of chronic and 'breakthrough’ pain.” The study also states, “Chronic pain relief can be best achieved through the transdermal route.” Today, the United States faces a health epidemic: prescription opioid addiction. To address this problem, manufacturers are producing a new topical combination of CBD with menthol. These non-habit forming ingredients are a welcome solution for consumers who do not wish to pursue prescription opioid pain medications or are looking for an alternative to prescription pain medicine. The irony is that CBD is anything but “new”. CBD is a naturally occurring component of the hemp plant. Hemp is from the cannabis genus and cannabis for medicinal use dates back to the ancient Chinese emperor, Shen-Nung (c.2700 B.C.). Having compiled the medical encyclopedia called, Pen Ts'ao,5 Shen-Nung is regarded as the Father of Chinese Medicine. Cannabis or “Ma”was used by the Chinese to treat weaknesses (menstruation), gout, rheumatism, malaria, beri-beri, constipation, and absentmindedness. During the second century A.D., the Chinese surgeon, Hua T'o, began to use cannabis as an anesthesia. CBD is activated in the body through CB2 receptors located in the skin. CB2 receptors play a role in antinociception, or the relief of pain.6 Menthol is a known active ingredient with cooling properties. Working similar to ice, menthol binds with temperature-sensitive receptors in the skin and is thought to modulate pain signals within the body’s natural pain relieving systems. CBD, known to be hydrophobic and lipophilic, does not dissolve or emulsify readily in water, but will dissolve in fat. Bioavailability of CBD depends on the way that the cannabinoid is delivered into the human body. Today, science has enabled CBD to be water soluble as well as time-release. The new topical pain cream, RapidCBD™, delivers a powerful combination of micro-encapsulated time-released CBD called Cebidiol™. In Cebidiol™, consumers will benefit from menthol plus eight additional homeopathic ingredients including lavender and rosemary essential oils to relieve pain. The RapidCBD™ Cooling Pain Cream is ideal after strenuous activity and has been proven to be as effective and work as fast as an FDA approved OTC topical pain relief solution. The immediate availability of RapidCBD™ is welcome news for consumers who are seeking a non-opioid solution for muscle aches, strains and joint pain. 1 -http://www.prnewswire.com/news-releases/analgesics-market-is-expected-to-reach-264-billion-globally-by-2022-575688921.html 2 -http://www.motherearthliving.com/health-and-wellness/the-best-herbs-for-pain-relief.aspx 3 -http://health.usnews.com/health-products/top-rec-topical-analgesics-arthritis-joint-pain-135 4 -http://www.ncbi.nlm.nih.gov/pubmed/20545522 5 -https://www.psychologytoday.com/blog/the-teenage-mind/201105/history-cannabis-in-ancient-china 6 -https://en.wikipedia.org/wiki/Cannabinoid_receptor
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