Current Therapeutic Cannabis Controversies and Clinical Trial Design Issues

Pesticide Contamination in the Legal Cannabis Market
Pesticide Contamination in the Legal Cannabis Market
By on September 16, 2016

ABSTRACT: This overview covers a wide range of cannabis topics, initially examining issues indispensaries and self-administration, plus regulatory requirements for production of cannabis-based medicines, particularly the Food and Drug Administration “Botanical Guidance.” The remainder pertains to various cannabis controversies that certainly require closer examination if the scientific, consumer, and governmental stakeholders are ever to reach consensus on safety issues, specifically: whether botanical cannabis displays herbal synergy of its components, pharmacokinetics of cannabisand dose titration, whether cannabis medicines produce cyclo-oxygenase inhibition, cannabis-drug interactions, and cytochrome P450 issues, whether cannabis randomized clinical trials are properly blinded, combatting the placebo effect in those trials via new approaches, the drug abuse liability (DAL) of cannabis-based medicines and their regulatory scheduling, their effects on cognitive function and psychiatric sequelae, immunological effects, cannabis and driving safety, youth usage, issues related to cannabis smoking and vaporization, cannabis concentrates and vape-pens, and laboratory analysis for contamination with bacteria and heavy metals. Finally, the issue of pesticide usage on cannabis crops is addressed. New and disturbing data on pesticide residues in legal cannabis products in Washington State are presented with the observation of an 84.6% contamination rate including potentially neurotoxic and carcinogenic agents. With ongoing developments in legalization of cannabis in medical and recreational settings, numerous scientific, safety, and public health issues remain.

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When Bob Dylan Turned the Beatles On To Marijuana

dylan beatles marijuana
By on August 25, 2016

Move over 420. August 28th should be a national cannabis holiday.

On that day in 1964, folk legend Bob Dylan ascended the elevator of the Delmonico Hotel on Park Avenue in Manhattan for a momentous first meeting with the Beatles, who were touring the United States. Beatlemania was then at its peak, and twenty police stood guard in the corridor as Dylan and his entourage entered the Beatles’ sixth-floor hotel suite.

After an exchange of courtesies, Dylan suggested that they all smoke some grass. He was surprised to learn that the Beatles were marijuana virgins. Dylan had a bag of weed with him and he tried to roll a joint. But Bob was all thumbs, so his driver and close friend Victor Maymudes did the deed. Blinds were drawn and towels carefully placed before locked doors to hide the smell. Dylan lit a reefer and a few minutes later everyone was laughing uproariously.

“We were kind of proud to have been introduced to pot by Dylan,” Paul McCartney later remarked. “That was rather a coup.”

Cannabis was quite different from the purple hearts and other uppers that the Beatles had taken to keep pace with the rigors of the late-night club circuit in Germany and the UK. Marijuana eased them into a soft yet lively space, a cushioned reprieve from the bizarre fishbowl sensation—the hysterical fans, the constant media attention—that accompanied their vertiginous rise to rock stardom. From that day forward, the Beatles would consume cannabis on a regular basis. And whenever John Lennon felt like getting stoned, he would say, “Let’s ’ave a larf!”

Cannabis opened the door to new dimensions of popular music, and the Beatles carried the youth of the world with them across the psychoactive threshold.

After the Beatles got into grass, they began to think of themselves as artists, not just performers. The herb triggered a creative surge that altered their approach to writing and recording songs. (“We were smoking marijuana for breakfast,” Lennon jibed.) Cannabis opened the door to new dimensions of popular music, and the Beatles carried the youth of the world with them across the psychoactive threshold.

Numerous Beatle songs contained subtle and not-so-subtle allusions to cannabis. “Got to Get You into My Life,” one of several weed-inspired tunes on the Beatles’ Revolver album, was “entirely about pot,” according to McCartney, who acknowledged that marijuana had a huge impact on the Fab Four in the mid-Sixties.

Drug references on the Beatles next album, Sgt. Pepper’s Lonely Hearts Club Band, were more explicit. Ringo Starr rhapsodized about “getting high with a little help” from his friends. McCartney “had a smoke” and “went into a dream.” And Lennon cooed: “I’d love to turn you on.”

“Do you know what caused Pepper?” McCartney told a reporter. “In one word, drugs. Pot.”

“But you weren’t on it all the time.”

“Yes, we were. Sgt. Pepper was a drug album,” McCartney insisted.

The BBC proceeded to ban several of the songs from its playlist, including “Lucy in the Sky with Diamonds,” on the grounds that they promoted the use of illegal drugs. This ungainly attempt to censor the Beatles, who were at the zenith of their influence, underscored Britain’s befuddled — some might say schizoid —attitude toward marijuana and its most influential proponents. The Beatles, after all, had recently been honored by the Queen of England. Lennon would later say they smoked bud in the bathroom at Buckingham Palace.

Cannabis had been banned in Great Britain since 1928, and recreational reefer remained on the margins, confined mainly to Caribbean migrants, until flower power blossomed in Merry Olde England. The Beatles were at the forefront of efforts legalize cannabis. In 1967, they paid for a controversial, full-page advertisement in The Times of London, which criticized Britain’s marijuana laws as “immoral in principle and unworkable in practice.”

Specifically, the ad called upon the British government to:

  • allow scientific research into cannabis
  • remove cannabis from the list of dangerous drugs and make possession punishable by a fine
  • permit the use of cannabis in private premises
  • and release everyone imprisoned for marijuana possession.

The ad was signed by sixty-five British dignitaries, including two members of Parliament, a dozen prominent physicians and clergymen, numerous writers and artists, a Nobel laureate scientist, and the four Beatles.

The following year, the British Parliament’s Advisory Committee on Drug Dependence released a comprehensive study, known as the Wootton Report, which sparked a heated public debate by giving cannabis something very close to a clean bill of health. Headed by Baroness Wootton of Abinger, a social scientist of great repute, the advisory committee concluded that “the long-term consumption of cannabis in moderate doses has no harmful effects” and “the law is socially damaging, if not unworkable.”

Marijuana is “very much less dangerous than opiates, amphetamines, and barbiturates, and also less dangerous than alcohol [and] it is the personality of the user, rather than the properties of the drug, that is likely to cause progression to other drugs,” the Wootton Report asserted.

Those who had become habituated to viewing marijuana as a beastly menace were mortified by the report. As soon as Baroness Wootton presented her study, stodgy British officials denounced its findings. For the Beatles and millions of their pot-smoking fans, it was just another day in the life.

This article is adapted from Smoke Signals: A Social History of Marijuana -- Medical, Recreational and Scientific by Martin A. Lee, director of Project CBD.

Copyright, Project CBD. May not be reprinted without permission.

Survey: Cannabis Better Than Big Pharma Meds for PTSD

cannabis better for PTSD
By on March 08, 2016
Survey: Cannabis Better Than Big Pharma Meds for PTSD

Between seven and eight percent of people will develop PTSD (Post-Traumatic Stress Disorder) in their lifetime. Among military veterans, the rates are higher.

Care By Design recently surveyed 300 patients on their use of cannabis and other medications to treat PTSD. The survey asked what medications patients had been prescribed for their PTSD-related symptoms and what impact these medications—and cannabis—had on five telltale symptoms of PTSD: anxiety, depression, pain, anger or irritability, and sleep problems.

Among the findings of the survey:

  • Respondents reported that cannabis was the most likely to improve PTSD symptoms and the least likely to make symptoms worse.
  • Veterans reported being prescribed more pharmaceutical medications than civilians. They were also more likely to be prescribed medications that generally worsened their symptoms, including anti-psychotics, narcotic pain meds, and so-called mood stabilizers.
  • The most common medication prescribed for the treatment of PTSD among survey respondents was anti-depressants. Yet, few report these were effective. Only 18% of respondents said their depression got better on anti-depressants. Half reported that their depression got worse on anti-depressants.
  • Roughly half of respondents reported they had been prescribed narcotics for PTSD, and a majority of them reported that their anger and irritability, depression, and sleep problems got worse while they were on narcotics.
  • Half of the respondents reported using CBD-rich cannabis to treat their PTSD symptoms.
  • 80% of respondents reported that they consume less alcohol when using cannabis.

While largely anecdotal and limited in scope, this survey offers hope for PTSD sufferers. A growing body of research suggests that there is a strong connection between the endocannabinoid system and PTSD, and that cannabis therapy may help address the root causes of PTSD, including impaired fear extinction, poor memory consolidation, and chronic stress.

Cannabis & Cancer: A Parable

Cannabis & cancer
By on January 11, 2016

Adapted from the forthcoming book, The Thinking Patient’s Guide to Cannabis & Cancer (vol. I)  by Jonathan Treasure, which Project CBD highly recommends. A free download of the complete 2nd chapter (partially excerpted below) is available here.

The Mechanic and the Gardener

Seeing herbs as either poison or panacea is unhelpful, but so is vilifying either modern mainstream or traditional herbal medicine. A more useful way to illustrate the differences between the two would be by comparing the approaches of a gardener and a mechanic.

Mainstream medicine tends to see the body as a machine—albeit a complex one. A machine is understood in terms of basic principles of engineering design, where the assembly of component parts follow predictable rules of organization and behavior; a malfunction can usually be fixed by logical fault-finding (diagnosis) and mending or replacing the defective part—a mechanical approach.

For herbal medicine, the body is more like a garden—an ecosystem unto itself, a complex network of inter-relating and interdependent systems in which the whole is more than the sum of its parts. Malfunction can arise from stressors or perturbances which, if uncorrected, lead to imbalances that, over time, manifest as patterns of disease. Fixing problems therefore involves adjustments to the terrain or ground . . . much like the job of a gardener.

Put another way, when things go wrong, mainstream medicine tends to focus on the problem in terms of the pathology and the disease, whereas herbal medicine tends to look at the person who has the disease.

In terms of cancer, this is classically described as the polarity between tumor and host, the latter being the terrain or ground in which the tumor develops. Extending our horticultural theme, cancer could be likened to an invasive weed. Weeds thrive in disturbed and neglected ground, so amending the soil (checking its pH, mineral content and feeding it with appropriate micronutrients) can prevent invasive weeds from taking root. Similarly, creating an internal "anti-cancer" garden or terrain within the body is one of the more important ways in which herbs can be used to prevent cancer and inhibit its progression. And, as is the case with chemotherapy and other heroic cancer treatments, killing weeds with poisons and herbicides that cause collateral damage to the surroundings is not necessarily the best way to clear them from a garden—although at times it may be the only way.

In any event, there will always be gardeners who have a mechanical approach, and mechanics who can be as artistic as gardeners. In practice, especially with cancer where the situation is rarely simple, the smart patient will seek out gardeners who understand mechanics and mechanics who are gardeners.