FDA To Evaluate Marijuana For Potential Reclassification As Less Dangerous Drug

From The Huffington Post:

“The feds could actually soften their stance a little when it comes to weed.

The Food and Drug Administration is reviewing the medical evidence surrounding the safety and effectiveness of marijuana, a process that could lead to the agency downgrading the drug’s current status as a Schedule I drug, the most dangerous classification.”

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Marijuana Might Make You a Worse Driver Than Alcohol Does

From The New Republic:

“Supporters of legal marijuana, medical or otherwise, are fond of pointing out that marijuana is less deadly than alcohol. Even President Obama’s deputy drug czar admitted as much in February. That doesn’t mean pot is harmless: USA Today reported Tuesday that marijuana’s role in traffic fatalities tripled between 2000 and 2010, according to Columbia University researchers. But driving stoned is still safer than driving drunk, right? Don’t be so sure.”

With some calling for legalization of marijuana for recreational purposes like Colorado and Washington, I’m especially concerned with impaired driving when both alcohol and marijuana are used together. As the article points out:

“The researchers concluded that the percentage of TOL [time out of lane] was not significantly affected by either alcohol or marijuana alone, but that it was much higher when both substances were used together.”

Will drivers under the legal limit for blood alcohol level (BAC) but also under the influence of marijuana perceive themselves as too impaired to drive, and result in more potentially fatal traffic accidents? Time and data will tell.

Poster: Cannabis May Exacerbate Depression-Attributable Functional Impairment Among Recently Active Depression Cases

Next week (June 17th) I will be presenting a poster based on my PhD dissertation work at the College on Problems of Drug Dependence (CPDD) conference in San Juan, Puerto Rico. I will be in San Juan for the CPDD conference from June 14th to 19th.

Poster Session: July 17, 2014
Poster #: 203
CANNABIS SMOKING MAY EXACERBATE DEPRESSION-ATTRIBUTABLE
FUNCTIONAL IMPAIRMENT AMONG RECENTLY ACTIVE DEPRESSED CASES.
Brian J Fairman, James C Anthony; Epidemiology and Biostatistics, Michigan
State University, East Lansing, MI

Aims: Among the suspected health hazards of prolonged cannabis smoking is an increase in the occurrence of a depression syndrome. Clinically significant occupational and social impairments are known to be attributed to depression. We surmise that co-occurring cannabis problems might affect these impairment levels. The aim is to estimate this hypothesized cannabis effect on this facet of the lives of depression cases. 

Methods: After nationally representative sampling and recruitment, computerized self-interviews of the U.S. National Surveys of Drug Use and Health identified depression cases with recent episodes (n=13,743). Depression-related impairment was measured using a modified Sheehan Disability Scale (SDS). Features of CP were items tapping DSM-IV criteria for cannabis use disorders. Latent variable analysis was conducted in Mplus to regress a continuous depression impairment trait on a CP trait, with covariate adjustments.
Results: One-fourth of these depression cases attributed severe to very severe functional impairments to their mood disturbances, with more pronounced impairments in relationships and social life domains. At higher levels of CP there was greater depression-related impairment (beta=0.2; 95% CI= 0.1,0.3). Findings could not be accounted for by model covariates or by depression occurring prior to cannabis onset (i.e., self-medication hypothesis).
Conclusions: Our evidence points to a more impairment-laden depression with impairments in work, home-life, and social relationships when depression co-occurs with problematic cannabis smoking. Randomized clinical trials with cannabis cessation outcomes may be required to produce more definitive evidence of this possible effect of cannabis problems on depression severity.
Financial Support: NIDA T32DA021129 (BJF); K05DA015799 (JCA).
Click on the link below to download a copy of the poster in PDF format:

Download CPDD 2014 Poster

Hear my commentary for this poster on YouTube:

Starting Post-Doc Position @ John Hopkins in July 2014

I am pleased to announce that I recently accepted a post-doctoral fellowship position in the Drug Dependence Epidemiology Training (DDET) program at the John Hopkins Bloomberg School of Public Health in Baltimore, MD.

http://web.jhu.edu/dde

I am very excited about this opportunity, which will begin June 30th with plans for relocation to the Baltimore area in early to mid-July.

Absence (of cannabis) makes the heart grow fonder?

A recently published study in Journal of the American Heart Association by Jouanjus et al. (2014) concludes cannabis is a possible risk factor for cardiovascular-related events:

Cannabis use: signal of increasing risk of serious cardiovascular disorders

However, it should be noted that this study from France is based on only 35 cases of cannabis-related cardiovascular events out of a total of 1979 cannabis-related reports. Here, using the total cannabis-related reports as the denominator, the authors report an increase in the proportion of cardiovascular-related events from 2006-2010 (1.1% to 3.6%). Yet, considering the number of regular cannabis users reported by the authors (1.2 million), 35 cases does not seem to be strong evidence of a cardiovascular risk.

Why is there concern over cannabis smoking and adverse cardiovascular outcomes? Smoking marijuana causes an increase in heart rate and dilates (widens) blood vessels (Ashton, 2001). The widening of blood vessels in the conjunctiva of the eye is what produces the characteristic reddening seen in intoxicated smokers. The dilation of blood vessels may also cause a drop in blood pressure (hypotension, the opposite of high blood pressure, i.e., hypertension), and this may cause dizziness or fainting (Jones, 2002). By contrast, blood vessels in the fingers and toes may constrict, causing tingles or cold sensation in the extremities. After repeated marijuana use tolerance to these effects occur, which can also be lost rapidly after marijuana cessation (typically after 48 hours). Nevertheless, THC is fat-soluble (meaning it can be stored in fat cells), and THC can continue to be released into the bloodstream in detectable levels for up to a month (Ashton, 2001).

Does smoking marijuana cause cardiovascular-related harms? One important distinction for this question is the main cardiovascular-related harm studied. The events of main interest are those that disrupt or block blood flow to the heart (i.e., a heart attack, also called a myocardial infarction) or brain (i.e., a stroke), and abnormal changes to heart rhythm (i.e., palpitations, also called arrhythmias). Another important distinction is whether these cardiovascular-related events can be caused by the immediate use of marijuana, and/or the result of an accumulation of cardiovascular insults over time due to chronic marijuana consumption.

Several reviews have looked at the subject (Jones, 2002; Sidney, 2002; Aryana and Williams, 2007; Debois and Cacoub, 2013). These reviews concluded that marijuana poses a risk to older individuals, especially those with cardiovascular disease or at risk for such cardiovascular-related events. However, much of the evidence comes from case reports or clinical samples of patients where a cardiovascular event has already occurred (Mittleman et al., 2001; Mukamal et al., 2008; Wolff et al., 2011). These types of studies may not be representative of the risk in the overall population.