Marijuana addiction is real: Forget about \’gateway drug\’ fears – 4 million Americans are hooked on cannabis itself and there is NO treatment

• Marijuana is now legal in 31 states, either for medical or recreational purposes
• Growers are making strains as much as 10-times stronger than they were 40 years ago
• Though it can be used safely, many are under the misconception that marijuana is non-addictive
• The National Institutes of Health estimate that four million Americans are addicted to marijuana

For complete article http://www.dailymail.co.uk/health/article-5883793/Marijuana-addiction-real-Forget-gateway-drug-fears-4-million-Americans-hooked-weed.html (June 2018)

Court rules CBD is Schedule 1 controlled substance, cannabidiol sales only where pot legal

KRISTEN NICHOLS, Hemp Industry Daily May 4, 2018

On Thursday, Feb. 1, 2018, the Cosmic Grind Coffee Shop on Church Street in Burlington, Vermont, started offering CBD hemp oil shots in their drinks. But don\’t worry, CBD is a \’non-psychoactive\’ extract, not to be confused with THC in marijuana. RYAN MERCER/FREE PRESS

DENVER (AP) – A federal appeals court sided with the Drug Enforcement Administration and upheld its decision that CBD is a Schedule 1 controlled substance – a major setback for the American hemp industry.

The decision, issued Monday by a three-judge panel of the 9th Circuit in San Francisco, means that hemp producers can only sell cannabidiol where it is allowed under state law.

It also means that states that allow CBD – even if they don\’t allow the sale of high-THC marijuana – are violating federal law, the same as states that allow recreational cannabis.

CBD producers who brought the case vowed to appeal.

\”We will be appealing, and we will be funding that appeal,\” said Michael Brubeck, CEO of Centuria Natural Foods and a plaintiff in the case.

Based in Las Vegas, Centuria grows hemp and produces CBD products for sale in all 50 states. Centuria was joined in its challenge by the Hemp Industries Association.

CBD case history

The case started in 2016, when the DEA issued a \”clarifying rule\” stating that CBD is an illegal drug, because it is extracted from marijuana flowers.

Hemp producers cried foul, arguing that CBD can also be extracted from legal hemp flowers, and there is no way to tell whether extracted CBD came from marijuana or from hemp.

Brubeck and the HIA argued that the DEA was attempting to add a new substance to the Controlled Substances Act, something it cannot do.

The DEA said the extract rule was simply a clarification of existing law and that it \”makes no substantive change to the government\’s control of any substance.\”

The agency also scoffed at the suggestion that CBD is being made from anything but flowering parts of the cannabis plant because cannabinoids \”are found in the parts of the cannabis plant that fall within the . definition of marijuana, such as the flowering tops, resin and leaves.\”

The three-judge panel of the 9th Circuit agreed. Their decision means that the DEA was within its authority to clarify CBD as a \”marijuana extract.\”

For complete article: https://www.statesmanjournal.com/story/news/2018/05/04/court-rules-cbd-cannabidiol-schedule-1-controlled-substance-marijuana-pot/580835002/

FDA approves the first non-opioid treatment for management of opioid withdrawal symptoms in adults:

Encouraging more widespread innovation and development of safe and effective treatments for opioid use disorder remains top agency priority.

The U.S. Food and Drug Administration today approved Lucemyra (lofexidine hydrochloride) for the mitigation of withdrawal symptoms to facilitate abrupt discontinuation of opioids in adults. While Lucemyra may lessen the severity of withdrawal symptoms, it may not completely prevent them and is only approved for treatment for up to 14 days. Lucemyra is not a treatment for opioid use disorder (OUD), but can be used as part of a broader, long-term treatment plan for managing OUD.

“As part of our commitment to support patients struggling with addiction, we’re dedicated to encouraging innovative approaches to help mitigate the physiological challenges presented when patients discontinue opioids,” said FDA Commissioner Scott Gottlieb, M.D. “We’re developing new guidance to help accelerate the development of better treatments, including those that help manage opioid withdrawal symptoms. We know that the physical symptoms of opioid withdrawal can be one of the biggest barriers for patients seeking help and ultimately overcoming addiction. The fear of experiencing withdrawal symptoms often prevents those suffering from opioid addiction from seeking help. And those who seek assistance may relapse due to continued withdrawal symptoms. The FDA will continue to encourage the innovation and development of therapies to help those suffering from opioid addiction transition to lives of sobriety, as well as address the unfortunate stigma that’s sometimes associated with the use of medication-assisted treatments.”

Opioid withdrawal includes symptoms – such as anxiety, agitation, sleep problems, muscle aches, runny nose, sweating, nausea, vomiting, diarrhea and drug craving – that occur after stopping or reducing the use of opioids in anyone with physical dependence on opioids. Physical dependence to opioids is an expected physiological response to opioid use. These symptoms of opioid withdrawal occur both in patients who have been using opioids appropriately as prescribed and in patients with OUD.

In patients using opioid analgesics appropriately as prescribed, opioid withdrawal is typically managed by slow taper of the medication, which is intended to avoid or lessen the effects of withdrawal while allowing the body to adapt to not having the opioid. In patients with OUD, withdrawal is typically managed by substitution of another opioid medicine, followed by gradual reduction or transition to maintenance therapy with FDA-approved medication-assisted treatment drugs such as methadone, buprenorphine or naltrexone; or by various medications aimed at specific symptoms, such as over-the-counter remedies for upset stomach or aches and pains. Other treatments may also be prescribed by a patient’s health care provider.

“Today’s approval represents the first FDA-approved non-opioid treatment for the management of opioid withdrawal symptoms and provides a new option that allows providers to work with patients to select the treatment best suited to an individual’s needs,” said Sharon Hertz, M.D., director of the Division of Anesthesia, Analgesia and Addiction Products in the FDA’s Center for Drug Evaluation and Research

For complete story .https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm607884.htm

Why marijuana remains a highly risky habit that can ravage young people\’s lives

Kathy Donaghy June 10 2018

Any debate around the legalisation of cannabis must take into account the harm it causes, one of the country\’s leading psychiatrists has warned.

Consultant psychiatrist Dr Matthew Sadlier is calling for a public health campaign to educate people about the dangers of cannabis use.

As attitudes to cannabis use become more relaxed and tolerance increases in society in general, Dr Sadlier says many young people\’s lives are being wrecked by habitual use of the drug – and that this side of the story is not being heard.

In his work as a general adult psychiatrist in north Dublin over the last five years, he says he could comfortably say that a third of all his patients had been referred because of cannabis.

\”There are people out there who have developed long-term psychotic illnesses from smoking cannabis. If they\’d never smoked it, they would never have developed it. We know that acute usage causes neurological conditions. The question is does it have a long-term effect?

\”We know that the younger you start smoking it, the more likely it is to have a lasting, damaging effect. What gets my blood boiling is that it\’s also carcinogenic. We have spent 40 years getting cigarette smoking down, but smoking cannabis has the same negative effects as cigarette smoking,\” says Dr Sadlier.

\”I think there has to be a public health campaign because the information out there for young people is very confused. We have people speaking up for the medicinal effects. Street cannabis is a very different thing and it\’s very dangerous,\” he says.

\”I have seen families ripped apart by cannabis use. I\’ve seen people with good futures ahead of them fall into apathy due to chronic cannabis use. People need to be educated about this. In my opinion, it\’s much more dangerous than alcohol,\” says Dr Sadlier.

For complete article https://www.independent.ie/irish-news/why-marijuana-remains-a-highly-risky-habit-that-can-ravage-young-peoples-lives-36987969.html

Dr. Sanjay Gupta misleads: No evidence marijuana helps curb opioid addiction

by Kenneth Finn, M.D. | May 08, 2018

I have been practicing pain medicine in Colorado for 24 years and I have seen patients referred to me on very high-dose opioids, reporting very high levels of pain, and using marijuana for pain control. In discussions with these patients, and overall, more than 95 percent report that their use of marijuana does not help with their presenting pain symptoms.

In my clinical practice in Colorado, patients openly report sharing their medical marijuana and growing their own marijuana after their marijuana card expires. Now, with a legal layer of marijuana, people are self-diagnosing and treating their medical conditions without physician supervision.

Among drug-testing patients who are on chronic opioid therapy, it’s been my experience that those who independently (and without my knowledge) co-treat with marijuana tend to be positive for other illicit substances, which is consistent with the literature.

As it relates to the use of marijuana for pain, there is some evidence that there are components of the plant that may help in different pain conditions. It is important to understand the current evidence on pain involves only about 2,500 patients – few studies of short duration and not placebo-controlled. A National Academies of Science, Engineering and Medicine report misleadingly stated that “there is substantial evidence that cannabis is an effective treatment for chronic pain in adults.” But pain is a broad diagnosis and different types of pain will respond to different kinds of medications..

Currently there is no available accepted medical literature showing any benefit with dispensary cannabis in common pain conditions. This was noted in the Annals of Internal Medicine in August 2017.

As it relates to curbing the opioid epidemic, marijuana simply isn\’t doing any such thing. The Colorado Department of Public Health and Environment has been monitoring this data over time, and 2017 was a record year for opioid deaths. The Journal of Public Health reported that opioid overdose deaths were on the decline, but did not take several things into consideration, such as lives saved through the newly widespread use of Narcan, physicians less likely to prescribe opioids, and patients becoming more reluctant to accept opioids. This also took place during a period of time when prescriptions were moving to long acting agents and abuse deterrent formulation.

Over time, opioid overdoses have continued to climb in Colorado, despite its 17-year-old medical marijuana program. Of greater concern in Colorado, the opioid epidemic has been morphing into a more widespread problem even as methamphetamine and cocaine are making a comeback. All together, this is increasing drug deaths in Colorado. I would be brave enough to suggest that yes, marijuana is a companion drug rather than a substitute, and it might even be contributing to the opioid epidemic in Colorado.

The American Journal of Psychiatry released a paper September 2017 following 33,000 people and showed that cannabis use \”appears to increase rather than decrease the risk of developing nonmedical prescription opioid use and opioid use disorder.\” Regarding the association between cannabis use and aberrant behavior during chronic opioid therapy for chronic pain, it has been shown that patients using cannabis and opioid concurrently have a higher risk of opioid misuse.

Additionally, Evidence Based Practice found and published in January 2017 a piece showing that people using cannabis for pain were more likely – not less – to meet criteria for substance use disorders, and more likely to be noncompliant with their prescription opioids. Even patients in with chronic pain in an interdisciplinary pain rehabilitation program may be at higher risk for substance-related negative outcomes and are more likely to report a past history of illicit substance use, alcohol use, and tobacco use.

The upshot? There is no scientific evidence at all that marijuana use is helping the opioid epidemic, and quite a bit of evidence that it is actually contributing to the opioid epidemic.

Dr. Kenneth Finn is board certified in physical medicine and rehabilitation, pain medicine and pain management. He is a member of the American Academy of Physical Medicine and Rehabilitation, the American Academy of Pain Medicine, and the American Board of Pain Medicine, and an exam council member of the American Board of Pain Medicine.

https://www.washingtonexaminer.com/opinion/op-eds/dr-sanjay-gupta-misleads-no-evidence-marijuana-helps-curb-opioid-addiction

The FDA and the Next Wave of Drug Abuse – Proactive Pharmacovigilance

In response to the opioid crisis, the Food and Drug Administration (FDA) has taken action on multiple fronts. We have approved better measures for treating opioid use disorder and preventing deaths from overdose, have launched efforts to inform more appropriate prescribing as a way to limit clinical exposure to opioids, have taken actions to reduce the excess opioids available for abuse, and are working to facilitate development of new therapeutics that can effectively and safely help patients suffering from pain. Going forward, the FDA needs to remain vigilant to recognize shifting trends in the addiction landscape. Taking a systematic approach to monitoring such trends should allow us to intervene promptly and appropriately and protect the public from associated risks.

Meanwhile, we must be aware that any decisive actions taken to reduce prescription opioid abuse and stem the tide of overdose and death can have unintended consequences, including prompting people to turn to alternative, potentially dangerous substances. In addition, as clinicians seek to help patients with pain, new prescribing patterns will emerge. Deciding on a course of action that will sustain appropriate use of prescription drugs while curtailing drug abuse is essential. Our assessment of changing patterns in drug use and abuse must be informed by an understanding of the complex social environment in which changing patterns of drug consumption occur. The FDA is committed to using a multicomponent system of pharmacovigilance so that we can intervene proactively and effectively, in anticipation of changes in drug abuse. Three recent examples illustrate the necessary elements of this system, which draws on clinical, epidemiologic, basic science, and social science expertise.

To begin with, an effective system of pharmacovigilance for drugs such as opioids must include the capacity to determine the reasons behind changing patterns of prescription-drug use and to elucidate the dynamics of misuse, abuse, and appropriate changes in prescribing. For example, the gabapentinoids (gabapentin and pregabalin) are approved for the treatment of seizures and certain forms of neuropathic pain. But U.S. rates of gabapentinoid use tripled between 2002 and 2015,¹ and pregabalin ranked as one of the 10 best-selling drugs in 2017.²Increased prescription rates have raised concerns about possible abuse of gabapentinoids,³although their appropriate use for pain, alone or in combination with opioids and other medicines, complicates the matter.

To understand why usage patterns are shifting, the FDA used a social media “listening platform” to set up a dashboard to track traditional social media sites (such as Twitter, Facebook, Instagram, blogs, and forums) that we monitor for conversations about opioids. When we find mention of additional substances on social media or elsewhere, we conduct more specific searches for relevant, publicly available conversations through our listening platform, as well as through Reddit, Google, and various online forums that don’t require registration or subscription. These may include forums associated with drug misuse or abuse, such as Bluelight.org and talk.drugabuse.com. A preliminary appraisal of social media topics revealed a shift between 2013 and 2017 from a discussion of legitimate gabapentinoid use for pain and seizures to a focus on misuse and abuse of these drugs.

We are also exploring health care databases to assess the consequences of using gabapentinoids in combination with opioids. For example, the FDA Adverse Event Reporting System allows us to explore reports of respiratory depression (sometimes fatal) that may occur in association with use of these products in combination with other central nervous system depressants, including opioids. Additional epidemiologic data will help us understand the potential risks associated with the use of gabapentinoids concomitantly with opioids, benzodiazepines, and other drug products. Our preliminary epidemiologic assessments suggest that the number of patients to whom gabapentinoids are dispensed concurrently with opioid analgesics or benzodiazepines has increased in recent years, with more than half of patients, according to some analyses, concurrently receiving an opioid analgesic. Our continued investigations may underpin future regulatory action to address any harmful trends, and our experience with the opioid crisis has instructed us to act with speed and vigilance when potential new addiction trends emerge. For complete article go to N.E.J.M https://www.nejm.org/doi/full/10.1056/NEJMp1806486?query=psychiatry