The vagueness of laws governing the use of medical marijuana in California has resulted in a patchwork of local regulations and tensions with federal regulators. The confusion has prompted activists to search for a way to improve California medical cannabis regulations. Medical marijuana attorney Chris Van Hook proposes using 3 existing frameworks for regulating marijuana, depending on its intended use: pharmaceutical, herbal, or food/industrial.

Van Hook, founder of the Clean Green Certified medical marijuana inspection program, points out medical cannabis is used in a few distinct ways. Cannabis-based drugs like Sativex are prescribed by doctors in Europe and Canada as an actual medicine, and although they are not available in the US at this time, Van Hook believes there is a large potential market here. Patients also use cannabis as an herbal remedy to relieve various ailments by inhaling, vaporizing, eating or using cannabis tinctures. Finally, cannabis is taken as a dietary supplement/food/fiber crop.

“Each of these methods of use is legitimate and the uses are not exclusionary; in fact, they should be recognized and further developed,” says Van Hook.

The California medical cannabis compliance lawyer says pharmaceutical cannabis will most likely always be grown indoors. There will be very specific patentable strains producing patentable compounds that will help in the very specific manner for which they have been tested and developed. Regulatory standards for cleanliness, dosage standardization labeling and prescribing will be thoroughly developed, as they should be for that particular market.

“The expansion of this market will increase the number of people who will become more comfortable with cannabis. This in turn will increase the number of patients who will become comfortable with the other regulatory categories of cannabis—herbal remedies and food/fiber crops,” he explains.

Cannabis used in herbal remedies will come from both the indoor- and outdoor-grown cannabis production models. The regulatory constraints of herbal remedies are much less burdensome than the pharmaceutical regulations, and their use need not be prescribed by a doctor. Examples of this type of use include edibles, falling under existing food regulations; in pill form, similar to garlic pills or fish oil pills; in tincture form, like Echinacea; or inhaled in a manner similar to aromatherapy, where herbs and plants that are burned and the smoke is inhaled to clear nasal systems or to break up colds. The smoke may be inhaled or the plant matter vaporized to reduce the smoke intake.

“Under this regulatory framework there need not be any medical proof that it is working; there only need be the patient determining that it is helping them,” notes Van Hook. He says this largest category of use does not require the strict regulations applied to pharmaceuticals. The agricultural standards for the production, field handling, and manufacturing/processing of herbal remedy crops are already in place and successfully used to regulate the multi-billion dollar herbal products industry.

Cannabis as a food and fiber agricultural crop will almost exclusively come from outdoor cannabis production, which can support the larger volumes of cannabis required for the developing juicing methods, hemp fiber and dietary oils from seed production. Existing agricultural production, field handling and food processing regulations are already in place to produce and market raw fresh wheatgrass juice to consumers, and these regulations could easily be adapted for cannabis juicing, says Van Hook.

He says by properly placing the different ways that medical cannabis is used into the appropriate existing regulatory frameworks of: pharmaceutical, herbal remedy, and food and fiber crops, California will 1) widen and expand the market for all cannabis uses 2) help assure that the agricultural and small farm component of the industry is not overburdened by pharmacological standards and regulations, and 3) more accurately describe the regulatory frameworks each use of cannabis should be in.

“By expanding the regulatory categories cannabis can operate under, each category’s growth would enhance and support the other two. Each developing use would have clear regulatory guidelines that are already in place. Each category of participant could then be buoyed by the success of the other two categories and friction between the different types of uses would be minimized,” Van Hook concludes.

About Clean Green Certified

Clean Green Certified, an independent third-party medical cannabis certification program created by attorney Chris Van Hook, is an agricultural process review and certification program based on the non-use of synthetic chemical fertilizers and sprays, and the building of consumer confidence that their agricultural products are produced in manner that is both healthy and safe for the environment. Their California medical marijuana quality control programs also include Best Practices certification, which allows the limited and responsible use of synthetic chemical fertilizers, and compliance with Mendocino County Code 9.31 (the medical cannabis cultivation regulation ordinance).

Clean Green’s expert legal team also provides services that include: medical cannabis expert witness testimony; on-site inspections; medical cannabis compliance for growers and for handlers/processors/dispensaries; formation of grower collectives and nonprofit corporations; commercial leases; product licensing; contracts and real property issues; administrative law; and permit assistance and acquisition.

For more information about the Clean Green Certified program, call Chris Van Hook at (707) 218-6979 or visit http://www.cleangreencert.com.

To learn more about becoming a legal medical marijuana patient, please visit http://www.thecannabisdoctors.com or call Roger A. Barnes, MD for a confidential Pasadena Medical Marijuana Evaluation at 626-344-7596

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• About those State of California medical marijuana ID cards (pasadenamarijuanaevaluations.com)

Everyone knows that drinking and driving is never a good idea. Well, according to a new study by the British Medical Journal, using medical marijuana and driving is also a bad idea. The study concludes that people who smoke marijuana within a few hours of getting behind a wheel, may be almost twice as likely to cause an accident compared with someone who was not using medical marijuana.

There was a review of nine studies done on marijuana smoking and car crashes. The researchers were from Dalhousie University in Nova Scotia, Canada.

Conclusions: Acute cannabis consumption is associated with an increased risk of a motor vehicle crash, especially for fatal collisions. This information could be used as the basis for campaigns against drug impaired driving, developing regional or national policies to control acute drug use while driving, and raising public awareness.

The entire study can be read here http://www.bmj.com/content/344/bmj.e536

If you or someone you know is suffering from a chronic condition, and would like to learn more about using medical marijuana, legally as a medicine, please contact Roger A. Barnes, MD at 626-344-7596 or visit http://www.TheCannabisDoctors.com to schedule a confidential medical marijuana evaluation in Pasadena, California

.

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• California Medical Association Calls For Legalization Of Marijuana (pasadenamarijuanaevaluations.com)
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You might have noticed that every time President Obama takes to the series of interactive intertubes, the unwashed masses want to talk, not taxes and not turkey, but the good herb. Last year, the POTUS employed YouTube and Twitter to walk amongst the people, and on Monday, Obama connected with his fellow Americans using “Hangout” on Google +.

Just like the last two times, viewers/voters submitted questions to the president for consideration via YouTube. And just like the last two times, a question about marijuana legalization was the top draw.

And, just like the last time, the question from a retired cop about failed drug policy and a reexamination of law enforcement priorities was not forwarded to the president.

Yet again, Obama is blameless: The White House says Google + moderators selected the questions.

Some 133,000 questions were sent in to the president, according to Reuters. Two questions received top billing: A video question about marijuana, and a texted question about copyright infringement.

The video question came from former Los Angeles Police Department Deputy Chief Stephen Downing, who noted a recent Gallup Poll showed more Americans in favor of legalization than not. “What do you say to this growing voter constituency that wants more changes to drug policy than you have delivered in your first term?” Downing asked.

It’s anyone’s guess, as the president was too busy doing a dance in front of camera, taking questions about his 20th wedding anniversary and those silly little things called drones in the Middle East.

White House Press Secretary Jay Carney noted that it was out of the White House’s hands. Google + moderators picked the questions to feed to the president, whose answers were interspersed between give-and-take with five “typical” Americans in the Google + “hangout.”

It’s unclear why Silicon Valley-based Google opted not to test the president — perhaps it’s the mutual flow of money and influence between the two?

“It’s worse than silly that YouTube and Google would waste the time of the president and of the American people discussing things like midnight snacks and playing tennis when there is a much more pressing question on the minds of the people who took the time to participate in voting on submissions,” said Downing, a board member of Law Enforcement Against Prohibition, a coterie of cops and former cops who speak out against the Drug War.

“The time to discuss this issue is now. We’re tired of this serious public policy crisis being pushed aside or laughed off.”

This article was originally available at http://blogs.sfweekly.com/thesnitch/2012/01/medical_marijuana_obama_google.php

If you, or someone you know, is suffering, and would like to learn more about using marijuana as medicine, please call Roger A. Barnes, MD at the Pasadena Medical Marijuana Evaluation Clinic at 626-344-7596 or visit his website at http://www.thecannabisdoctors.com

A quarter-century after the U.S. Food and Drug Administration approved the first prescription drugs based on the main psychoactive ingredient in medical marijuana, additional medicines derived from or inspired by the cannabis plant itself could soon be making their way to pharmacy shelves, according to drug companies, small biotech firms and university scientists.

A British company, GW Pharma, is in advanced clinical trials for the world’s first pharmaceutical developed from raw marijuana instead of synthetic equivalents — a mouth spray it hopes to market in the U.S. as a treatment for cancer pain. And it hopes to see FDA approval by the end of 2013.

Sativex contains marijuana’s two best known components — delta 9-THC and cannabidiol — and already has been approved in Canada, New Zealand and eight European countries for a different usage, relieving muscle spasms associated with multiple sclerosis.

FDA approval would represent an important milestone in the nation’s often uneasy relationship with marijuana, which 16 states and the District of Columbia already allow residents to use legally with doctors’ recommendations. The U.S. Drug Enforcement Administration categorizes pot as a dangerous drug with no medical value, but the availability of a chemically similar prescription drug could increase pressure on the federal government to revisit its position and encourage other drug companies to follow in GW Pharma’s footsteps.

“There is a real disconnect between what the public seems to be demanding and what the states have pushed for and what the market is providing,” said Aron Lichtman, a Virginia Commonwealth University pharmacology professor and president of the International Cannabinoid Research Society. “It seems to me a company with a great deal of vision would say, ‘If there is this demand and need, we could develop a drug that will help people and we will make a lot of money.’”

Possessing marijuana still is illegal in the United Kingdom, but about a decade ago GW Pharma’s founder, Dr. Geoffrey Guy, received permission to grow it to develop a prescription drug. Guy proposed the idea at a scientific conference that heard anecdotal evidence that pot provides relief to multiple sclerosis patients, and the British government welcomed it as a potential way “to draw a clear line between recreational and medicinal use,” company spokesman Mark Rogerson said.

In addition to exploring new applications for Sativex, the company is developing drugs with different cannabis formulations.

“We were the first ones to charge forward and a lot of people were watching to see what happened to us,” Rogerson said. “I think we are clearly past that stage.”

In 1985, the FDA approved two drug capsules containing synthetic THC, Marinol and Cesamet, to ease side-effects of chemotherapy in cancer patients. The agency eventually allowed Marinol to be prescribed to stimulate the appetites of AIDS patients. The drug’s patent expired last year, and other U.S. companies have been developing formulations that could be administered through dissolving pills, creams and skin patches and perhaps be used for other ailments.

Doctors and multiple sclerosis patients are cautiously optimistic about Sativex. The National Multiple Sclerosis Society has not endorsed marijuana use by patients, but the organization is sponsoring a study by a University of California, Davis neurologist to determine how smoking marijuana compares to Marinol in addressing painful muscle spasms.

“The cannabinoids and marijuana will, eventually, likely be part of the clinician’s armamentarium, if they are shown to be clinically beneficial,” said Timothy Coetzee, the society’s chief research officer. “The big unknown in my mind is whether they are clearly beneficial.”

Opponents and supporters of crude marijuana’s effectiveness generally agree that more research is needed. And marijuana advocates fear that the government will use any new prescription products to justify a continued prohibition on marijuana use. .

“To the extent that companies can produce effective medication that utilizes the components of the plant, that’s great. But that should not be the exclusive access for people who want to be able to use medical marijuana,” Americans for Safe Access spokesman Kris Hermes said. “That’s the race against time, in terms of how quickly can we put pressure on the federal government to recognize the plant has medical use versus the government coming out with the magic bullet pharmaceutical pill.”

Interest in new and better marijuana-based medicines has been building since the discovery in the late 1980s and 1990s that mammals have receptors in their central nervous systems, several organs and immune systems for the chemicals in botanical cannabis and that their bodies also produce natural cannabinoids that work on the same receptors.

One of the first drugs to build on those breakthroughs was an anti-obesity medication that blocked the same chemical receptors that trigger the munchies in pot smokers. Under the name Acomplia, it was approved throughout Europe and heralded as a possible new treatment for smoking cessation and metabolic disorders that can lead to heart attacks.

The FDA was reviewing its safety as a diet drug when follow-up studies showed that people taking the drug were at heightened risk of suicide and other psychiatric disorders. French manufacturer Sanofi-Aventis, pulled it from the market in late 2008.

Given that drug companies already were reluctant “to touch anything that is THC-like with a 10-foot- pole,” the setback had a chilling effect on cannabinoid drug development, according to Lichtman.

“Big companies like Merck and Pfizer were developing their own versions (of Acomplia), so all of those programs they spent millions and millions on just went away…” he said.

But scientists and drug companies that are exploring pot’s promise predict the path will ultimately be successful, if long and littered with setbacks.

One is Alexandros Makriyannis, director of the Center for Drug Discovery at Northeastern University and founder of a small Boston company that hopes to market synthetic pain products that are chemically unrelated to marijuana, but work similarly on the body or inhibit the cannabinoid receptors. He also has been working on a compound that functions like the failed Acomplia but without the depressive effects.

“I think within five to 10 years, we should get something,” Makriyannis said.

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If you, or someone you know, is suffering and would like to learn more about using marijuana as medicine, please call Roger A. Barnes, MD at 626-344-7596 or visit http://www.thecannabisdoctors.com

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Harm Reduction Journal 2012, 9:1 doi:10.1186/1477-7517-9-1

Mark Collen
PainExhibit.com, 9008 El Cajon Way, #4, Sacramento, CA, 95826, USA
Email: Mark@PainExhibit.com

Abstract
Neuropathic pain affects between 5% and 10% of the US population and can be refractory
to treatment. Opioids may be recommended as a second-line pharmacotherapy but have
risks including overdose and death. Cannabis has been shown to be effective for treating
nerve pain without the risk of fatal poisoning. The author suggests that physicians who
treat neuropathic pain with opioids should evaluate their patients for a trial of cannabis and
prescribe it when appropriate prior to using opioids. This harm reduction strategy may
reduce the morbidity and mortality rates associated with prescription pain medications.

Keywords: cannabis, cannabinoids, opioids, neuropathic pain, chronic pain, harm
reduction, ethics

Neuropathic pain (NP) is defined as pain caused by a lesion or disease of the central or
peripheral somatosensory nervous system.[1] NP affects between 5% and 10% of the US
population [2] and examples include diabetic neuropathy, complex regional pain syndrome,
radiculopathy, phantom limb pain, HIV sensory neuropathy, multiple sclerosis-related pain,
and poststroke pain.[3] Neuropathic pain is difficult to treat and opioid analgesics are often
prescribed.[4] Recent science has demonstrated efficacy in treating NP with cannabis,[5,
6, 7] a safer drug than opioids.[8] This paper suggests that physicians who treat
neuropathic pain should prescribe cannabis prior to using opioids as a harm reduction
(HR) strategy. Topics covered include how harm reduction applies to prescription opioid
substitution, the legality of medicinal cannabis, a comparison of cannabis to opioids, the
science on treating NP with cannabis and cannabinoids, and the ethics of prescribing a
drug which is deemed illegal on the federal but not the state level.
Medicine relies upon the principle of, “First, do no harm,” and one might supplement the
axiom to read – “First, do no harm, and second, reduce all the harm you can.” “Harm
reduction” or “harm minimization” can be defined in the broadest sense as strategies
designed to reduce risk or harm.[9] Those harmed may include the individual, others
impacted by the harmed person, and society.[9] The substitution of a safer drug for one
that is more dangerous is considered harm reduction.[10] Specific examples of HR include
prescribing methadone or buprenorphine to replace heroin,[11] prescribing nicotine
patches to be used instead of smoking tobacco,[12] and prescribing intranasal naloxone to
patients on opioid therapy to be utilized in case of overdose.[13] Substituting cannabis for
prescribed opioids may be considered a harm reduction strategy.
Under the Federal Controlled Substance Act “marihuana” is illegal and classified as a
schedule I substance – meaning it has a high potential for abuse and no accepted medical
use.[14 ] However, sixteen states and the District of Columbia have legalized cannabis for
medicinal use and these include Alaska, Arizona, California, Colorado, Delaware, Hawaii,
Maine, Michigan, Montana, Nevada, New Jersey, New Mexico, Oregon, Rhode Island,
Vermont, and Washington.[15] Each state law differs but all allow physicians to “authorize”
or “recommend” cannabis for specific ailments.[16] This “recommendation” affords legal
protections for patients to obtain and use medicinal cannabis, and may be considered the
“prescription.”
Cannabis (Cannabis sativa) and the opium poppy (Papaver somniferum) are both ancient
plants that have been used medicinally for thousands of years.[17, 18] The natural and
synthetic derivatives of opium, including morphine, are called “opioids.”[19]
“Cannabinoids” is the term for a class of compounds within cannabis of which delta-9-
tetrahydrocannabinol (THC) is the most familiar.[20] Besides THC, approximately 100
other cannabinoids have been identified [21, 22] including one of special scientific interest
called “cannabidiol” (CBD).[23] The human body produces both endogenous
cannabinoids (endocannabinoids) and opioids (endorphins) and contains specific
receptors for these substances.[24, 25] There is an extensive literature on opioids but far
less on cannabis/cannabinoids (CC).
Adverse effects from opioids include respiratory depression, sedation, sleep disturbance,
cognitive and psychomotor impairment, delirium, hallucinations, seizures, hyperalgesia,
constipation, nausea, and vomiting.[26-28] Adverse events from cannabis/cannabinoids

include psychotic episodes, anxiety or panic reactions, memory impairment, reduced
concentration, disorientation, lowered blood pressure and increased heart rate.[7, 29, 30,
31] In a systematic review Wang and colleagues found most adverse events for short term
cannabis use were not serious, and there was a lack of evidence to determine
adverse effects for long-term use.[32] Opioids and cannabis share issues of addiction,
physical dependence, tolerance and withdrawal.[5, 33, 34]
Between 1999 and 2006 approximately 65,000 people died from opioid analgesic
overdose.[35] Regarding fatal overdose from cannabis, Carter and colleagues write, “…
this well documented fact: no one has ever died from an overdose of cannabis.”[8] In
addition, there is insufficient data to demonstrate smoking cannabis causes lung cancer
[36] but long-term use is associated with an increased risk of respiratory problems.[37]
Although, eating cannabis [38] avoids the respiratory issues. In 2001 the total cost of
prescription opioid abuse was estimated at $8.6 billion.[39] Unfortunately, there are no
comprehensive studies on the total cost of cannabis abuse. However, enforcing the
prohibition on cannabis costs an estimated $7.7 billion per year.[40] Since the federal and
most state governments view any use of cannabis as abuse – including medicinal use –
one might include this cost. According to a report from the Substance Abuse and Mental
Health Services Administration between 1999 and 2009 admissions for treatment of
nonheroin opioid abuse increased approximately 516% while admissions for cannabis saw
a 53% rise.[41]
Nerve pain can be refractory to treatment [42] and opioids are often used as a second-line
therapy while antidepressants and anticonvulsants are commonly used first.[4, 43]
Moreover, opioids may provide only limited pain relief and as Henry McQuay writes, “…you
may be able to decrease neuropathic pain with strong opioids, but the decrease is often
slight and is achieved with an adverse effect burden that will not be tolerable over weeks
to months.”[44] Cannabis and cannabinoid research is in its relative infancy and many
studies are of short duration and with small sample sizes.[6] However, a number of review
articles suggest that treating neuropathic pain with cannabis/cannabinoids is efficacious
and with moderate adverse effects.[5-7] The most thorough of the systematic reviews was
of randomized controlled trials (RCTs) of CC therapy [6] which looked at nine studies [45-
53] whose focus was on treating different types of neuropathic pain with either smoked
cannabis,[45-48] a synthetic cannabinoid similar to THC,[49, 50] or a whole plant extract of
THC and CBD in a 1:1 ratio.[51-53] CBD may moderate the psychoactive effect of THC
and have analgesic properties.[24] Seven of the nine studies demonstrated efficacy for
using CC for neuropathic pain [45-49, 52, 53] while two had mixed results,[50, 51] and
eight of the nine studies found no serious adverse events.[45-51, 53]
A closer look at the four RCTs which evaluated smoked cannabis for neuropathic pain [45-
48] reveals some common and contrasting elements (Table 1). Two of the studies, Ware
et al. [45] and Wilsey et al., [47] examined cannabis in treating a variety of NP conditions;
while the other two, Ellis et al. [46] and Abrams et al., [48] explored the effects of cannabis
on HIV-related neuropathic pain. Both Wilsey et al. [47] and Abrams et al.[48] required
participants to have previously used cannabis in order to reduce the risk of adverse
reactions from psychoactive effects. The RCTs used cannabis with a variety of THC
strengths ranging from 0% for placebo [45-48] to 9.4% in Ware et al.[45] Each study required participants to continue taking their regular medications during the cannabis trials
and all found a significant decrease in pain compared to placebo.[45-48] In addition,
adverse events were tolerable for the vast majority of participants.[45-48]
Commentators have suggested that patients should use whole plant cannabis, as opposed
to chemical derivatives, because of other potentially beneficial compounds.[8, 19] In
addition, a number of articles have reported on interactions between cannabinoid and
opioid receptors which may result in enhanced analgesia and a synergistic effect when CC
is added to opioids.[54, 55] This may translate into patients being able to reduce their
opioid intake with adjuvant cannabinoid therapy.[5,29]
Although prescribing cannabis is legal in 16 states and the District of Columbia, it remains
illegal at the federal level. Portions of the American Medical Association’s Code of Medical
Ethics, Opinion 1.02 – The Relation of Law and Ethics reads, “Ethical values and legal
principles are usually closely related, but ethical obligations typically exceed legal duties.
In some cases, the law mandates unethical conduct.” “In exceptional circumstances of
unjust laws, ethical responsibilities should supersede legal obligations.”[56] An
“exceptional circumstance of unjust laws” may be interpreted as the federal ban on
cannabis for medical use. Sixteen states and the District of Columbia found the federal
government’s prohibition on prescribing and using medicinal cannabis so unjust as to
create laws in direct violation of federal statute. Therefore, one could surmise that
prescribing cannabis for the purpose of harm reduction is ethical even though it violates
federal law. In addition, Hayry suggests that the idea of “freedom” also provides an ethical
reason for prescribing cannabis and he writes, “… whatever the legal situation, respect for
the freedom of the individual would imply that requests like this (for medicinal cannabis)
should be granted, either by health professionals, or by society as a whole.”[57]
In states where medicinal cannabis is legal, physicians who treat neuropathic pain with
opioids should evaluate their patients for a trial of cannabis and prescribe it when
appropriate prior to using opioids. There is sufficient evidence of safety and efficacy for
the use of CC in the treatment of nerve pain relative to opioids and as Carter et al write,
“From a pharmacological prospective, cannabinoids are considerably safer than
opioids…”[8] Prescribing cannabis in place of opioids for neuropathic pain may reduce the
morbidity and mortality rates associated with prescription pain medications and may be an
effective harm reduction strategy.
[The subject of cannabis dosing is beyond the scope of this paper but those interested
should consider reading Carter GT, Weydt P, Kyashna-Tocha M, Abrams DI. Medicinal
cannabis: rational guidelines for dosing. IDrugs 2004;7:464-70.]

High Times magazine’s Cannabis Cup, the world’s most prestigious (only?) marijuana judging competition is finally coming to Los Angeles after decades in Amsterdam and years in San Francisco.

What took them so long?

We asked associate publisher Rick Cusick:

The first one in the U.S. was a coin flip between Los Angeles or San Francisco. We always had our sights on L.A. The Cannabis Cup and L.A. is like soup and a sandwich.

The Cup and its related marijuana expo commeth to the downtown-area’s L.A.s Center Studios Feb. 11 and 12. (Strangely, the Studios pulled out of hosting a rave last year following bad press).

High Times states that the expo will feature a “medicating section available that will accommodate the needs of medical marijuana patients.”

Irie.

The event will also have …

​

… California’s best indicas, sativas, hybrids, concentrates and edibles will be judged, the winners awarded prizes and afterwards be known as the top in their fields.

Samples will include entries from L.A.’s own array of 500 or so dispensaries (and beyond, considering the outlets outside the city limits).

We always wondered, with no wine-tasting-style spitting available, how the hell judges for these things don’t end up passing out after an hour of sampling the finest bud in the land.

Cusick explained that judges will be allowed to live with the weed for a week, take notes according to a questionnaire, and compare notes at the event.

Marijuana entered for competition is judged first and foremost for potency and flavor, High Times‘ Nico Escondido told the Weekly. Other factors include aroma, taste, visual aesthetics and “burnability.” Lab results for THC and Cannabidiol also weigh on the strain’s potency score.

The cup has been held twice in San Francisco, once in Denver, and once in Detroit, where police gave organizers a hard time. Last year’s Amsterdam event saw a police raid.

High Times is heading back to Amsterdam this year for the 25th anniversary of its Cup there.

Organizers expect no problems in L.A., the medical marijuana capital of the nation, although the municipality’s top prosecutor, City Attorney Carment Trutanich, is no fan of medical marijuana culture.

“We’re trying to be as transparent and upfront wih the authorities as we can be,” says Cusick.

Tickets start at $30 a day. Patrons must be 18. Cusick:

We’ve been waiting to come to L.A. for a long time. It’s probably going to be the best one.

Related articles

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Abstract

1. Mark J. Pletcher, MD, MPH;

   

2. Eric Vittinghoff, PhD;
3. Ravi Kalhan, MD, MS;
4. Joshua Richman, MD, PhD;
5. Monika Safford, MD;
6. Stephen Sidney, MD, MPH;
7. Feng Lin, MS;
8. Stefan Kertesz, MD

Context Marijuana smoke contains many of the same constituents as tobacco smoke, but whether it has similar adverse effects on pulmonary function is unclear.

Objective To analyze associations between marijuana (both current and lifetime exposure) and pulmonary function.

Design, Setting, and Participants The Coronary Artery Risk Development in Young Adults (CARDIA) study, a longitudinal study collecting repeated measurements of pulmonary function and smoking over 20 years (March 26, 1985-August 19, 2006) in a cohort of 5115 men and women in 4 US cities. Mixed linear modeling was used to account for individual age-based trajectories of pulmonary function and other covariates including tobacco use, which was analyzed in parallel as a positive control. Lifetime exposure to marijuana joints was expressed in joint-years, with 1 joint-year of exposure equivalent to smoking 365 joints or filled pipe bowls.

Main Outcome Measures Forced expiratory volume in the first second of expiration (FEV₁) and forced vital capacity (FVC).

Results Marijuana exposure was nearly as common as tobacco exposure but was mostly light (median, 2-3 episodes per month). Tobacco exposure, both current and lifetime, was linearly associated with lower FEV₁ and FVC. In contrast, the association between marijuana exposure and pulmonary function was nonlinear (P < .001): at low levels of exposure, FEV₁ increased by 13 mL/joint-year (95% CI, 6.4 to 20; P < .001) and FVC by 20 mL/joint-year (95% CI, 12 to 27; P < .001), but at higher levels of exposure, these associations leveled or even reversed. The slope for FEV₁ was −2.2 mL/joint-year (95% CI, −4.6 to 0.3; P = .08) at more than 10 joint-years and −3.2 mL per marijuana smoking episode/mo (95% CI, −5.8 to −0.6; P = .02) at more than 20 episodes/mo. With very heavy marijuana use, the net association with FEV₁ was not significantly different from baseline, and the net association with FVC remained significantly greater than baseline (eg, at 20 joint-years, 76 mL [95% CI, 34 to 117]; P < .001).

Conclusion Occasional and low cumulative marijuana use was not associated with adverse effects on pulmonary function.

Originally available at http://jama.ama-assn.org/content/307/2/173