Essentials in the Time of COVID-19

"This is Prohibition 2.0."
"It's a time of uncertainty and  high stress on the consumer side, and on the government side, there are economic issues."
Ben Kovler, Green Thumb Industries Inc.

"When you're quarantining along with your children you need a break."
"We have a whole persona of micro-dosing mamas. They need cannabis to get through it."
"You would think in the midst of a global respiratory pandemic, inhalables would decline, but it's only a small percent of customers shifting their behaviour."
Bethany Gomez, managing director, Brightfield Group

"A lot of the users coming into the sector now are people who never used before."
"[Many of them are over 60] and asking for pain relief, sleep aids, anxiety relief -- and it's mostly not smoking."
Boris Jordan, chairman, Curaleaf Holdings Inc.

Sales are continuing at California cannabis stores such as Harborside’s Oakland dispensary, photographed on March 23.   Bloomberg News/Landov

In 2019, according to Arcview Market Research and BDS Analytics, Americans spent $12.4 billion on legal recreational and medical cannabis. This year that number is expected to grow to $16.3 billion, representing an increase of 31 percent. According to the Tax Policy Center, revenue for various states from marijuana sales varied, with governments wary of taxing too heavily and consequentially driving consumers to the black market.

Pot taxes in Nevada, Colorado and Washington earned them about one percent each of own-source general revenue, to less than one percent for Alaska and Oregon, while California has profited by roughly $1 billion in its first two years of legalization. Curaleaf Holdings expects federal legalization to increase employment in the industry from about 250,000 at the present time to a million in an overnight response.

Scientific advisers and advice from the health community warns the public that smoking can have the effect of greater susceptibility to COVID-19 infection appearing in a more severe form. That may or may not have persuaded Americans to switch over to baked goods, leading them to bake marijuana relief-treats in greater numbers, more frequently.

Getty

Millennials appear to lead the greater-user demographic. Data from the Brightfield Group which tracks social-media posts analyzing trends in cannabis use, shows that regular users are primarily responsible for  much of the increase in use. In late March, 34 percent of those who used cannabis in the last year agreed they have become more frequent users, while 15 percent state they use higher doses or are doing longer sessions, with 41 percent of millennials using more frequently, and 20 percent using higher doses.

Seven percent, according to Brightfield's survey were using fewer inhalables, while 11 percent wee using greater numbers of edibles. Next-generation products are already being ramped up by the industry. Some companies announced at May's virtual Canaccord Genuity Group conference that they anticipate greater numbers of edible products to be market-available.                                          

Curaleaf, operating 53 dispensaries in 17 states, has seen greater interest in lozenges, tinctures and gummies. Moncton, New Brunswick-based Organigram Holdings Inc., a producer of products including pods for vaping, announced a line of chocolates, a new investment in recognition of edibles being viewed as "highly desirable" at the present time.

The Apothecarium, San Francisco. Credit...Jeff Chiu/Associated Press

The trend in higher cannabis use has been spurred by the lockdown on people's lives under the grim shadow of SARS-CoV-2 threatening COVID-19. That dark threat has made people feel vulnerable and uncertain, with something needed to lift their state of ongoing depression. The upturning of people's lives, unemployment and financial distress has its consequences.

Nine in ten Americans now approve of either medicinal or recreational use of marijuana and reflecting that popular opinion, over twenty states formally deem medical or recreational sales to represent "essential" businesses during the pandemic shutdown. Leaving Americans to begin the trend of using more weed than usual in quarantine. The crisis that caused that attitudinal change according to cannabis advocates will influence the federal government to follow the 33 states' lead and legalize cannabis in an accelerated move.

Revenue-poor governments are anxious after months of lockdown to tap available resources for tax revenues. The growing popularity of cannabis presents as an answer to a fiscal dilemma.One that will open the market to increased employment opportunities and allow governments to tax a profitable and popular self-medication for anxiety and stress.

Proceed with Caution and Awareness

"This perception of risk [surrounding the use of cannabis] is decreasing more rapidly among those with depression. Those with depression who perceive little or no risk associated with use [of cannabis] have a much higher prevalence of cannabis use, relative to those who perceive higher associated risks."
"There is some thinking that drug use is a form of self-medication of depression, or attempted self=medication of depressive symptoms."
"The prevalence of cannabis use among those with depression who perceived no risk associated with regular use was much higher than among those who perceived significant risk associated with use -- 39 percent versus 1.6 percent, respectively."
"With increasing legalization in the U.S., previous studies have shown that perception of risk associated with use is declining overall. The results of this study show that this decline is even more rapid among this vulnerable population: those with depression." 
"There is no evidence to suggest that cannabis use will ease depression symptoms, except temporarily, and there are data to suggest that cannabis use may worsen or prolong depression."
"Historically, patients in treatment/recovery from depression are advised to avoid cannabis use."
Dr.Renee Goodwin, psychiatric epidemiologist and clinical psychologist, Columbia University, New York city

Bustle

A new study had researchers examining data collected from almost 729,000 people between the ages of 12 and older from the period 2005 to 2017. Prior-month use of cannabis and depression that may have been experienced over the previous year were absorbed into the study. When it reached the final year, some 19 percent of those with depression reported some cannabis use in comparison with 8.7 percent of individuals with no recent history of depression.

Approximately 10.2 percent of those living with depression, and 5.7 percent of individuals not impacted by depression made use of cannabis, at the same time that the proportion of people with depression perceiving risky behaviour with the use of cannabis fell from 41 percent to 17 percent during the study period. A decline from 52 percent to 33 percent among those with no depression counterbalanced the results, according to the report published in the journal Addiction.

Among people aged 18 to 25 with depression, who were unmarried, male or black, usage was common with each of those groups coming in at around 23 percent. There was no focus in the study to determine how or whether depression could influence the frequency with which people used cannabis, nor their thoughts of the risk inherent in regular use of the drug.

Researchers relied throughout the study on participants truthfully reporting their cannabis use or symptoms of depression; there were no laboratory tests for drug use and nor were medical records examined to confirm the diagnosis of mental health. The study team noted as well that researchers were unable to link whether cannabis legalization could have impacted the number of those using the drug, or thoughts about its safety.

"As brain development is ongoing until at least age 25, and young persons with depression are especially vulnerable, this is a group who may need attention in terms of prevention and intervention."
"Depression is not generally a condition for which medicinal cannabis is prescribed, and it is not clear why recreational use would occur disproportionately among those with depression."
"It is conceivable that cannabis may be increasingly used in an attempt to self-medicate depression in states where it is legal for recreational use."

Storm of Assurances Heading Your Way

"Although it's going to be critical for us to ensure that we look at all of our input materials and we get specific analysis to make sure there are no additional contaminants in the product, we must remember we are in a highly regulated environment in Canada where consumer safety comes first."
Greg Engel, CEO, Organigram Inc. licensed producer

"Legal extract product will be stringently tested for contaminants like heavy metals and solvents, which is not a process done with black market product."
HEXO Corp., licensed producer

"While the FDA does not have enough data to presently conclude that vitamin E acetate is the cause of the lung injury, the agency believes it is prudent to avoid inhaling this substance."
U.S. Food and Drug Administration

An e-cigarette store, in Wilkesboro, N.C., 2016. George Etheredge/The New York Times

"There is still insufficient information to comment specifically on the media reports coming out of the United States, but we believe that the mix of information underscores how important it is for governments to create regulated frameworks for cannabis vape products. None of Canopy Growth's vape devices will use vitamin E acetate."                                                                                                                      Jordan Sinclair, Canopy Growth Corp.

"I think what we are seeing now is one of the first real debates around the formulation of vape products and whether, even legal products are actually safe for public consumption."
"I think it's still much too early to see the impact of this health scare on consumer demand, but there is an optic of safety in vaping where consumers believe it is a safer option to combustion. That may change."
"Vape pens, both cannabis and nicotine, became popular so quickly and it was hard for governments to say, 'No, we're not going to legalize that', when they were seen as an alternative to cigarettes."
"Because it is such a new product class and because the environment has been evolving so quickly, the adoption rate of these products moved faster than the science did, to help us understand what the different compositions of these vape products could mean for the health of consumers."
John Kagia, executive vice-presdent, industry analytics, New Frontier Data, cannabis research firm

A man uses a vape as he walks on Broadway in New York City.   Reuters/Andrew Kelly/File Photo

Just when cannabis vape products are on the cusp of becoming legal in Canada, comes news from the United States of issues no one might ever imagine would eventuate, with lung illnesses presenting at hospitals and diagnoses linking them with vaping. Six people have died, and altogether close to five hundred people in 33 American states have been affected. This is a serious turnaround from the euphoria people experienced with the relaxing of state laws, making marijuana possession legal, and Canada's federal legalization of cannabis.

The mysterious lung condition presenting in the U.S. has completely mystified investigators. What is known is that one of the deaths linked to cannabis oil was purchased in Oregon from a legal pot shop. While no one can definitively point to the exact cause of the development of respiratory problems in hundreds of vapers, the U.S. Food and Drug administration has singled out vitamin E acetate as a culprit. Its use is that of a suspension fluid in cannabis vape pens.

So for producers of vaping devices it seems abundantly clear that vitamin E acetate is not to be used. The use of "vitamins and colouring agents" in vaping products is banned by Health Canada through its Tobacco and Vaping Products Act. Any ingredients in a vape pen besides flavouring agents, according to Health Canada, should reflect pharmaceutical quality. All this, despite that there is no proof as yet that vitamin E acetate is responsible for the adverse health condition flare-ups.

Alexander Mitchell’s lungs had stopped working and he was in intensive care on two different life support systems for about a week — he escaped death, but two others did not. Mitchell Family / Washington Post - supplied

What is certain, however, is that health authorities at the state and federal levels in both countries respectively have seen fit to issue warnings on the effects of nicotine- and cannabis-infused vape devices. That, since 2015 when vaping was first introduced and became a popular trend, it has been embraced by teens, and that truly has the health community concerned; neither nicotine nor the psychoactive ingredient in pot bodes well for the future health of the young, impacting the lungs and the still-developing brain.

Data collection in Canada is in its early stages in determining whether an emerging problem similar to what the United States is experiencing has visited Canada as well. Nor whether the problem has links to the illegal vape pen market. And nor is there any data yet available on the long-term use of vaping pens for either product -- for irrespective of the promises of safety by licensed producers, no reliable longitudinal data exists, suggesting vaping as a safe form of consuming cannabis.

"Sure, many of those who have reported breathing problems might have bought vape devices from the illegal market, and you really don't know what goes into them, but at the same time you just don't know the long-term effects of vaping cannabis consistently. If the industry is saying it is safe, they actually don't know that themselves", pointed out Jacob Borodovsky, epidemiologist at the Washington University School of Medicine in St.Louis.

Since November enforcement action has been taken against some 130 students in regards to vaping on school grounds. These are just some of the vapes and vape products confiscated by schools and turned over to By-law. Postmedia

The situation can also be useful to the legitimate industry in cautioning consumers that the only way to be absolutely safe is to purchase products solely from legal sources. This has presented licensed producers with the opportunity to tout the safety and reliability of their highly regulated products as a safe choice for anyone concerned with avoiding the possibility of unknowingly compromising their health by frequenting the illegal market.

"I think it's too early for us to comment on whether this concern over vaping is going to affect sales. But I can tell you that for us, the biggest priority is to ensure safe, consistent access for the consumer and you will get that from the legal market."
"Vapes are becoming the preferred method of consumption, and it would be disingenuous of us to do anything except fully understand the regulations and try to abide by them."
Tim Pellerin, general manager, PAX Labs for Canada

In this Aug. 28, 2019 photo a man exhales while smoking an e-cigarette in Portland, Maine. Health Canada says people who vape should get medical attention right away if they're worried their electronic cigarettes are harming them. Robert F. Bukaty / THE ASSOCIATED PRESS

Cannabis Bashful? Acquisition from Illegal Sources?

"Over the past two years, Statistics Canada has been working to update its statistical programs to better capture the social and economic impacts related to the legalization of cannabis, which took place on October 17, 2018, and to the misuse of opioids and other drugs with higher risk of being abused. Accurate measures of total societal use of cannabis and misused drugs are difficult to obtain." "The stigma associated with use and reluctance to disclose purchases from non-regulated suppliers are two factors that could contribute to some under-reporting on surveys. To support the survey-based data, Statistics Canada is exploring the use of a technique called wastewater-based epidemiology (WBE), which has been used in Europe since 2007 to report on the consumption of different types of drugs in large cities (European Monitoring Centre for Drugs and Drug Addiction, 2016)."
"In March 2018, the agency implemented a pilot project to collect and test municipal wastewater samples for traces of cannabis, and a dozen other drugs to examine if the resulting data could be used to make estimates of the extent of drug use in different cities across Canada and change in use over time. The pilot test is the largest ever conducted in North America in terms of population covered. The advantages of this technique include its low cost, timeliness, the ability to monitor change over time at the city level, and importantly, the potential to determine the total amount of a drug consumed, whether legally or illegally acquired. One limitation of this approach is that it does not provide information on the number or characteristics of individuals who consumed or how the drugs were consumed, but Statistics Canada uses other surveys to help determine these more detailed data."
"The pilot project covered 14 wastewater treatment plants in five large urban centres across the country, and serving close to 8.4 million people, which is over 20% of the Canadian population (Table 1). Wastewater from each site was sampled at least every 30 minutes for seven consecutive days starting on the second Monday of each month, from March 2018 to February 2019."
"It is possible that the consumption per user could be greater. It is also possible that cannabis use in Montreal is measurably higher than for the rest of Quebec."
Statistics Canada, Wastewater report

Wastewater Pilot-Test Design Table summary
This table displays the results of Wastewater Pilot-Test Design. The information is grouped by Test Site (appearing as row headers), Wastewater Treatment Plants and 2018 Population
(millions of people) (appearing as column headers).

Test Site	Wastewater Treatment Plants	2018 Population (millions of people)
Central Halifax	3	0.2
Montreal Island	1	2.0
Toronto City	4	2.8
Edmonton City	1	1.0
Vancouver metro area	5	2.5
Total	14	8.4
Source: Statistics Canada 2019

Wastewater samples have been collected from five cities in Canada to search for traces of cannabis in an effort to gauge the actual use of the drug through collecting, and testing the evidence in wastewater. The results were found to be somewhat unexpected; on the one hand they were the opposite of other data collected by Statistics Canada on pot use. On the other hand, it became clear that the size of the black market access to drugs appeared to be higher than anticipated.

The human body converts THC into THC-COOH, when cannabis is consumed. The resulting chemical can be measured in wastewater, otherwise known as sewage. Halifax, as it turned out, had the highest average load of THC-COOH per capita of the five cities that were measured between March 2018 and February 2019. Then came Montreal, followed by Toronto, Vancouver and Edmonton.

Statisticians were not surprised to find that residents of Halifax excrete more cannabis residue than users of any other Canadian city, given that the National Cannabis Survey associated with Statistics Canada found 24 percent of Nova Scotians self-reported the use of pot in the second quarter, representing the highest use of any province.

What was unexpected however, is the high level of the chemical residue in Montreal's wastewater since  a mere ten percent of Quebecers felt free to report cannabis use in the second quarter, representing the lowest score of any province. The low wastewater results for Edmonton also appear perplexing, since Alberta had the third-highest reported cannabis use at 20 percent.

This inexact science of having people self-report is obviously behind the failure of people's admissions of use not matching the actual tested samples in the various cities' wastewater pools. It would seem that, factors beyond simple cannabis use per capita could be skewing the results, allowing for the fact that people are notoriously reluctant to divulge their use of a mind-altering drug which, though now legal, still has a social stigma attached to its devoted  use.

Cannabis? Best to Avoid During Pregnancy

"Unfortunately, it would seem that health-care professionals are not good sources of information for pregnant women. One study found that only half provided counselling when informed of marijuana use during pregnancy and this often focused on the legal rather than the medical consequences. In fact, women reported that it was difficult to find reliable information on cannabis use during pregnancy and often relied on anecdotal advice from friends or family."
"Clearly, how we as a society view cannabis has changed drastically in the past decade and has led to its general acceptance and legalization. But we should not forget that there are potential risks to its use, and regardless or whether you support its legalization or not, probably best to avoid it while pregnant."
Dr. Christopher Labos, McGill Office for Science and Society, Montreal

Obstetrician-gynecologists in Canada are seeing an increasing number of pregnant women who think that using marijuana through their pregnancy is fine, that there are no risks associated with doing so. It has also been agreed that cannabis  represents the most commonly used drug during pregnancy. Women appear to be cognizant that to protect their growing foetus it is best to avoid alcohol and smoking  and the use of those two potential health risks are steadily reducing. Daily use of cannabis on the other hand during the first trimester of pregnancy appears to be on the increase.


That is of particular concern to the health community given the reality that the drug has become more potent than it once was. Cannabis use does come with risks, aside from risks associated with its use during pregnancy. Heavy use of marijuana by teens is fraught with a particular danger to the maturing brain. Its potential effect on mental health in the young represents yet another concern, which is why the medical community recommends it not be used until maturity, around 22 years of age. CBD has properties that may also be considered to be problematical for health.

All this aside from its recognized use for health benefits for people suffering from some chronic conditions finding relief with cannabis use. For pregnant women the general consensus among the medical community is that women be advised to avoid its use. The American Academy of Obstetricians and Gynecologists has warned against cannabis use in pregnancy. It was clearly found in a matched cohort analysis using Ontario health data that cannabis use is associated with an increase in preterm births (10.2 percent as opposed to 7.2 percent).

Babies whose mothers use cannabis while pregnant are likelier to be transferred to the neonatal ICU because they're born smaller. In addition to which an increase in stillbirths has been noted. However, not all studies support these conclusions. A different 2016 meta-analysis found no increased risk of preterm births. When expectant mothers smoke tobacco it is difficult to separate that issue from the harms seen in smoking marijuana. The debate becomes how much of an increased risk is attributable to smoking, as opposed to marijuana use.

Long-term effects that cannabis can have on the developing brain of the foetus represents yet another concern. If it is seen -- and it is -- to affect the brain development of teens, it makes sense that the drug would cross the placenta to affect the brain of the developing foetus. There may be some confusion resulting in society linked to the issue of legalization leading to the increasing popularity of cannabis use. People tend to think that something that is legal is also safe, thus making it more socially acceptable.

Data from the U.S. National Survey on Drug Use and Health database reveal the proportion of women believing marijuana use to hold no risks during pregnancy rose from 4.6 percent to 19 percent between the years 2005 and 2015. Women appear to rely sometimes on advice they solicit from cannabis dispensaries. One study indicated that 70 percent of Colorado dispensaries recommend marijuana as a morning sickness treatment, an actual misrepresentation.

Vox

Risks to a child’s brain development

Use of cannabis during pregnancy may affect a child’s brain development, behaviour and mental health into adolescence and early adulthood. The effects may be permanent. If a mother uses cannabis daily, some of the risks for the child may be:
Age 0 – 3 years:

• Difficulty calming down
• Exaggerated startles
• Sleep problems

Age 3 – 6 years:

• Poorer memory
• More impulsive
• Less attentive
• Less able to understand and follow instructions

Age 6 – 10 years:

• More hyperactive and impulsive
• More difficulty learning
• Symptoms of depression and anxiety
• More difficulty making decisions
• Less attentive

Age 14 – 18 years:

• Poorer school performance
• Delinquency problems
• May try and/or use cannabis earlier
• Continue to be hyperactive, impulsive and less attentive

Government of Canada Website

Trends in self-reported and biochemically tested marijuana use among pregnant Females in California From 2009 to 2016.

JAMA

Everything Old is New Again

"We've known that cannabis is one of the oldest cultivated plants in East Asia, primarily for making oil and hemp."
"Now we know the ancients also valued the plant for its psychoactive properties."
"[The plant was placed there] to probably allow this man to use this to go into the spirit world."
"There is a very deep history of a relationship between cannabis and humans for many uses -- fibre, seed, oil, food, medicine and psychoactive or spiritual or other uses."
Mark Merlin, botany professor, University of Hawaii, Manoa 

"[The location of those artifacts suggests cannabis smoke was] being used during funeral rituals, possibly to communicate with nature or spirits or deceased people, accompanied by music."
"[The findings are consistent with what's known about cannabis use across Central Eurasia], possibly reflecting some kind of community of shared beliefs in the Eurasian mountain foothills."
Yimin Yang, archaeologist, University of Chinese Academy of Sciences 

Scientists exhumed 10 wooden braziers from eight tombs at the ancient Jirzankal Cemetery in what is now western China. Many of the braziers held stones that were apparently heated and used to burn cannabis plants.

Xinhua Wu/Science Advances

Cannabis is no relatively recent plant known for its mind-bending properties as well as for pain relief. The use of this plant as a substance whose properties lend to mind-altering experiences is assumed to be at least 2,500 years old in human experience and  use. A new study just published in the journal Science Advances whose conclusions are based on the chemical analysis of residues discovered in a western China burial site by archaeologists identify a substance whose charred remains were found in wooden braziers, as cannabis.

In the 5th Century B.C., the Greek historian Herodotus wrote of people in Central Asia who burned the plant, inhaling the resulting smoke within tent-like structures as ceremonial procedures during burial ceremonies. He appeared to find the ritual he described similar to what he had witnessed in Greek bathhouses. Evidently the cannabis plant was used back in ancient times just as incense is used now in many Asian ceremonies, the smoke meant to be inhaled, part of a tradition of spiritual practices.

Cannabis residue the archaeologists found at the western China site was located in wood containers or braziers holding stones that conceivably were heated to create smoke from plant material which laboratory tests identified to be cannabis with higher levels of the psychoactive ingredient THC than most wild varieties of the plant naturally contain. Which led to conjecture whether people of the time cultivated the plants to breed them for their higher THC properties or had simply come across rare varieties of the plant containing greater amounts of the chemical.

According to Robert Spengler, a scientist at the Max Planck Institute for the Study of Human History in Jena, Germany, and a co-author of the paper, "a solid, unequivocal data point for actual use of this plant as a drug" was derived from the research. That this was ceremonially conducted during a burial led the researchers to believe the ceremony participants made use of cannabis "to communicate with nature, or spirits or deceased people", concluded Yimin Yang, the paper's senior author.

Much further away in northern China at yet another burial site, a kilogram of chopped cannabis was discovered adjacent to the head of a man buried in a cemetery which dated to roughly the same period. According to Dr. Spengler, there were two phases of cannabis domestication; first it was cultivated in eastern China some 3,500 years ago, valued as a source of fibre, oil and food, the wild plant having very low THC content. No evidence exists that the earlier domestication was linked to inhalation of the smoke.

The site in Western China, however, indicates that people had by then discovered and valued yet another feature of cannabis; the presence of tetrahydrocannabinol (THC). Archaeologists had excavated eight tombs in a burial site called Jirzankal Cemetery, in the Pamir Mountains of western China in 2013, where four stones were found with burn markings. When the material was examined through a chemical analysis known as gas chromatography -- mass spectrometry (GC-MS) the presence of cannabis with relatively high levels of THC was revealed.

Tomb M12, where the wooden burner was found   Photo: Xinhua Wu

Grooming With Care

"Kids are smart and they're watching everything and everyone."
"The conversations should be about authenticity and honesty."
"There is a difference between discretion and hiding. Hiding encourages stigma because it is something that you keep from people. Having discretion is about responsible use."
"It's maybe not that I don't trust my own kids. I keep it [cannabis] locked and away from them so that they understand that it's an adult-use product."
"My job is to be a responsible user and store it [cannabis] responsibly and have these conversations. I want to have a dialogue with my kids about this."
Ashleigh Brown, founder, SheCann

"I just asked myself, 'I know my adult children are smoking it, so why am I the one hiding it?"
"We're all adults here."
Sabine Dolby, 56, Toronto

"There are downsides to [cannabis use], but if we don't talk about it, how are we really going to know?"
April Pride, founder, Van der Pop, cannabis lifestyle, Seattle

In this post-legalization world of cannabis access beyond medical use and into the recreational sphere parents of teens find themselves suddenly faced with the need to discuss the use of pot with their adventurous children, adolescents forever attracted to the exotic and 'forbidden'. It's good strategy. Just as good strategy and very badly needed, as when parents begin to discuss with their children the ins and outs of intimate sexual relations, how babies are born and how best to deal with one's hormonal cravings to experiment and learn first-hand what all the fuss is about.

In the Toronto of recreational marijuana legality, a recent event titled Women & Weed took place, where a number of speakers addressed the audience interested to hear first-hand from those upon whom they look as 'experts' to guide them in their own perplexing search how best to handle the sensitive issue of parent-child discussions revolving around the use of cannabis. Uppermost in mind of these parents is the certain knowledge that young people will and do extend themselves to discover first-hand what's happening.

That, linked to the medical community warning of the deleterious effects of marijuana use for young people whose brains are still developing and who, with the use of pot, can expose themselves to harm, makes the issue of primary importance. At that event, the founder of SheCann, an online portal enabling women in Canada to share their own use of medical cannabis experiences, emphasized the importance she places personally on making these discussions a continuous dialogue.



Ashleigh Brown of SheCann spoke of her own experience with medical cannabis begun in 2016, using it medicinally giving her children the decided impression that pot was a medicine, nothing more. Then she initiated discussions with her 14- and ten-year-old daughters about cannabis used by different people for a host of reasons; not necessarily confined to health. Both she and April Pride stressed the importance of conversations with children, to prepare them for the inevitability of being knowledgeable to a degree about weed they'll come across in future on the street and at parties.

There is a correlation, they stressed, between advising and discussing with children the effects of recreational alcohol, and no less so with cannabis. And one of the critical issues in such discussions is to explain why it is that marijuana is meant to be used only by adults, and until such time as young people join that category of maturity, its use can present a future health danger. Both women explained that they lock their pot away from their children. Despite which they feel that avoidance of conversation about cannabis use creates an aura of stigma, unhelpful in persuading kids to make considered decisions.


They recommend using resources as for example from Canadian Students for Sensible Drug Policy which views problematic drug use as a distinct issue of health, not an issue for the criminal justice system, advocating instead for harm reduction support. Talking to children about why and how people make use of cannabis is a start. Sabine Dolby who uses cannabis by prescription hid it from her children when they were young. Now, aged 24 and 30, she smokes with her children as a regular user and with legalization, feels relieved not to have to hide her use any longer.

The Canadian Centre on Substance Use and Addiction's position is that consuming cannabis on a regular basis during adolescence has the potential to cause loss of concentration and memory, and reduce thinking to incoherence. In a 2015 report, the Centre stated that regular use of cannabis is associated with experiencing psychotic symptoms and the development of schizophrenia, particularly among those with a family history of the condition.

There is a caveat that connection between cannabis use and mental illnesses, particularly acute anxiety, is not clear entirely, requiring additional research. The general consensus remains, however, that the effect of cannabis on not-yet-fully developed brains -- up to age 21 to 25 -- makes it imperative that such discussions do take place.

Maren Caruso/Offset (leaves); Kichigin/Shutterstock (head); Sergejs Makarovs/Shutterstock (leaf)

Manipulating Cannabis Genetics

"You can only manipulate a gene when you know where it is located. And you also need to know something about the rest of the sequencing in the genome so that you can uniquely target the gene of interest and not be side-tracked by --- other things that look similar."
Harm van Bakel, genomic expert, Icahn School of Medicine, Mount Sinai Hospital, New York

"Humans, plants, virtually all organisms have something like this [embedded retroviruse DNA].
"[The machinery] that's normally responsible for keeping things tidy and organized gets confused when it sees multiple copies of the same thing, and it makes mistakes."
"That is almost certainly what has happened [with the THC and CBD genes in cannabis]."
"Until the last couple of years, it's been extremely difficult to work with it [cannabis] legally. The repercussions of being caught with a huge number of marijuana strains in order to do genetic experiments -- nobody would risk that."
Tim Hughes, molecular geneticist, Donnelly Centre for Cellular and Biomolecular Research, University of Toronto

Cannabis sativa plant (photo by michael fischer)

Now, however, since the October 17 recreational cannabis legalization legislation has taken effect in Canada, research can commence on a grand scale. Dr. van Bakel foresees Canada becoming the go-to place for marijuana research into the plant and its hallucinogenic as well as medicinal effects. The latest-generation scanners for example are capable of capturing tens of thousands of the base pairs that produce the twisting DNA molecul which older technology could sequence only excruciatingly slowly, making advances in research far more possible.

As was done when the research team comprised of Canadian and U.S. scientists were enabled to locate the genes responsible for the kick that cannabis produces when they located the THC and CBD genes on the plant's sixth chromosome, owing to the aid given them by improved genetic scanning technology. One of the intriguing points of interest for research is to understand what the genes producing THC and CBD effect for the plant itself, even while it is well enough understood how THC and CBD affect humans.

The study in question was released this month b the online journal Genome Research, which concluded:

• Definitively that THC and CBC are produced by separate genes;
• The existence of another active gene that produces a product known as cannabichromone (CBC) which can have both medicinal and slightly intoxicating effects in humans;
• The location of a gene that helps to determine the potency of different cannabis strains.

Although it was well enough known for decades what the chemical makeup of the genes producing THC and CBD were  -- the two main cannabinoids found in marijuana -- what was not known was where they could be found. Cannabis's 10-chromosome genome had been sequenced in 2011, but the location of these genes remained a mystery; unknown was where they were in a maze of viral DNA. It may seem strange to speak of viral DNA but all species, including humans can be infested with DNA from viruses.

Marijuana and hemp plants, sharing a common ancestor, see 70 to 75 percent of their DNA derived from retrovirus sources, explains Dr. Hughes. The research's success in discovering just where the genes responsible for the cannabinoids were to be found, hidden among "junk" DNA left in the plant's genome by viruses during its evolutionary phase will make it infinitely more efficient to manipulate levels of intoxicating THC and medicinal CBD.

That will be done with a view to producing a product amenable to variations reflecting preferences in the legalized Canadian market. The scientists have concluded that the viral DNA in cannabis played a key role in creating random genetic rearrangements to produce the active forms of THC and CBD in an inert plant. Had the viral DNA not been present, that transformation and presence of those genes would in all likelihood never have occurred. Cellular mechanisms that normally maintain genetic order can be circumvented by lengthy and repeated sequences of the surrounding viral DNA.

The faulty mechanisms that result would rearrange their sequencing to produce the genetic configurations seen today rather than presenting the genes in their original form. Now research can continue apace in the new political climate of legalization along with the use of more technically advanced instruments, scanners capable of capturing tens of thousands of base pairs as opposed to the technology they have replaced which could sequence a mere several hundred at a time.

Although the plant’s genome had been sequenced in 2011, the location of some genes remained hidden in a sea of viral DNA.  (Steven Senne / The Associated Press)

Canada's Big Day in "Progressive" Legislation

"I have been hearing more and more about it over the past few months. Physicians have been seeing more of it in emergency departments."
"They [Ontario doctors] are watching Wednesday [October 17, legalization date for recreational cannabis in Canada] approach and wondering what will happen."
"We want the government to spend more time researching, tracking and understanding usage patterns."
"Decriminalization is associated with healthier, safer communities. It brings it out of the shadows so it can be treated like any other substance. [The OMA uses a] harm reduction [view of the legalization of cannabis]."
"[The work of the Ontario Medical Association and physicians] is to educate the public so they make safe decisions]."
Dr. Nadia Alam, head, Ontario Medical Association

CHS sufferers feel compelled to take hot baths  Project CBD

"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."
"[Any increase in cannabis use as a result of its legalization] should be viewed as a failure."
Canadian Medical Association Journal editorial

"While cannabis may be legal as of October 17, driving high is not."
"If you are charged with driving impaired by drugs, you face the same consequences as driving impaired by alcohol, which is a 90-day driver's licence suspension, a seven-day vehicle impoundment and criminal charges."
"If you plan on getting high and/or drunk, plan your ride home so we do not have to plan it for you."
Ottawa Police Service

 

Cannabinoid hyperemesis syndrome, which includes symptoms like vomiting and abdominal pain, can affect chronic users of marijuana. Source: Shutterstock.com

Just as physicians who are practising members of the Ontario Medical Association are becoming familiar with a newly-revealed syndrome resulting from excess and prolonged use of marijuana, they are also being informed of their professional duty to ensure that they do their utmost to inform the public of this new health menace relating to the new federal law legislating the de-criminalization of recreational marijuana, joining the years'-old freeing up of marijuana for medicinal purposes in a new atmosphere of freedom to indulge.

A notable new phenomenon of rising numbers of people appearing at hospital emergency departments in Ontario of recent months with a hitherto unseen condition related to heavy, chronic cannabis use has become a matter of some consternation in the medical community. And it is this syndrome which has compelled the Ontario Medical Association head, to alert both the professional community she serves and to put on notice the governments involved in this new public territory of normalizing cannabis use while setting up commonsense restrictions.

The syndrome is called Cannabinoid hyperemesis, identified by nausea of a severe nature and vomiting, alarming symptoms that obviously all is not well with a patient. First to be reported in 2004, according to the British Columbia Pharmacy Association, it is a frequent visitor to users who have accustomed themselves to one to five years of daily or even weekly use. Waves of severe vomiting ensues which hot showers appear to provide relief from.

It is this very visible and concerning syndrome, along with all manner of other potential imponderables that has the medical community in Canada concerned with the introduction of legal cannabis for recreational purposes. According to Dr. Alam, one of the more acute concerns is that improved access to marijuana will invariably increase its use, most particularly with young adults, and that THC -- the active chemical ingredient in cannabis responsible for achieving those highs -- is now present in higher concentrations than once was the case.

According to one study on the matter, the cannabis now being produced has been altered to contain about three times more THC than was present 40 years earlier. And since it is well known that young people up to age 25 are at risk when using cannabis while their brain function is not yet fully mature, still in its later development stages, the effect on that age group is particularly concerning. Add to that the awareness of doctors that a connection exists between marijuana use in youth and mental-health issues inclusive of psychosis, then add in impaired driving and there is a perfect storm warning.

Public health education logically requires that the government of Ontario track the impact trajectory of legalization in an effort to understand its import for the future. Aside from these concerns, Dr. Alam recognizes the advantage of positive outcomes through legalization; more public information and discussion relating to the use of cannabis. People would be more encouraged to speak to their doctors about usage, critical to ensuring that as much helpful information is relayed as possible.

Furthermore, as an anesthesiologist herself, Dr. Alam is aware of the importance of a patient conveying to doctors their regular cannabis use to ensure that during surgery proper dosages of anesthetic are applied, since patients who are users could have a higher tolerance for sedatives and the possibility they could launch into withdrawal while anesthetized during surgery would be in no one's best interests, to say the very least.

Cannabis is an antiemetic — but paradoxically, chronic use can cause intermittent debilitating vomiting known as cannabis (or cannabinoid) hyperemesis syndrome (CHS). Since the legalization of cannabis in several states in the U.S., hospital visits for persistent or cyclic vomiting have increased. With cannabis use in Canada increasing, pharmacists should be aware of CHS in order to help patients and other health-care professionals avoid delay in diagnosis and effective treatment.
Cannabinoid hyperemesis syndrome (CHS) is similar to cyclic vomiting syndrome. The association of CHS with chronic cannabis use was first reported in 2004, although the authors had noticed cases of hyperemesis with cannabis use for years. CHS typically occurs in younger patients who began using cannabis at an early age. It manifests after one to five years (though the range can be between four months to 27 years) of daily or at least weekly use. Between episodes, patients with CHS may be relatively symptom-free or experience morning nausea and occasional vomiting, anorexia and abdominal pain lasting for weeks to months. Then severe vomiting and retching begin suddenly.
Hot showers or baths provide temporary relief. A history of compulsive bathing or showering suggests the diagnosis of CHS. Vomiting may last hours to days (typically 48 hours) and then stops.
Complications include acute dehydration, renal failure, erosive esophagitis, weight loss, and scalding from hot showers. Patients may also experience social distress, impaired job performance and absenteeism. CHS may go undiagnosed for years, resulting in repeated hospital and physician visits, fruitless  investigations and ineffective treatment.

Are We Becoming Concerned Yet?

"We are witnessing the beginning of a real debate around the wider legally regulated availability of drugs in Canada. The legalization of cannabis has opened peoples' minds to the idea of responsible regulation, whilst the opioid crisis has forced the debate into new territory. The window of opportunity is now wide open."
"Which drugs would be available, to whom, and where? These are tricky questions, but once we are able to answer under a legally regulated model where government has taken back control, rather than abdicating all responsibility to criminal market forces. More risky substances could be available only via a medical prescription model with supervised use, like heroin in Switzerland. Certain medium-risk drugs, including certain stimulants and party drugs, could be available on a rationed basis to adults from pharmacies, perhaps with a licensed buyer model, once they have proven they understand the risks. Other lower-risk drugs could be more available through appropriate licensed retailing, as we are about to do with cannabis."
David-Martin Milot, medical specialist in public health and preventive medicine, Canada
Steve Rolles, Senior Policy Analyst, Transform Drug Policy Foundation, United Kingdom

One in seven cannabis users with a driver's licence said they had got behind the wheel at least once within two hours of using the drug in the past three months. (Shutterstock)

So, open our minds a little further, beyond merely legalizing marijuana, so that criminal charges would not apply to anyone using once-forbidden drugs. Serious 'substances' needing a medical prescription and supervised use; medium-risk drugs available on a rationed track from pharmacies after an educational interrogation, and low-risk drugs obtained through licensed retailing. To some people with an independent streak this might seem like the same old interfering government auspices that so irritates those who feel they should be empowered to just get the stuff and get on with it.

The result being that the kind of black market activities with freely available drugs of all descriptions whose prices are becoming more 'affordable' increasingly, will remain in force, due to popular demand. Complete with the sociopathic compulsion to maximize profitability by 'cutting' drugs with cheaper, more powerful alternatives. People being people, are psychologically driven to resistance against imposing rules for anything they feel is their right to engage in without interference from any source.

As for imposing rules and expecting that law-abiding citizens will adhere to them for everyone's benefit, it ain't necessarily so.

Not until November, two months' hence will pot be entirely legalized in Canada, with a few provisos that edible forms will remain illegal, and only government-appointed sources will be mandated under license to sell those forms of the drug that are permitted, leaving the system in place for medical marijuana to its own devices. And one can only wonder what the end result will be; do government authorities really believe that cannabis will be kept out of the hands of vulnerable youth whose brains, still in their formative stage science has shown can be deleteriously affected with its use?

This appeal to legalize all drugs is an interesting one, reflecting in large part desperation on the part of government agencies and the medical community in the emergency efforts to deal with a rising tide of opioid overdoses leading to death. Aligned with the recognition that up to the present, laws that have criminalized non-medical drug use have failed dismally, in lock-step with the reality of criminal gangs from street corner operations to national syndicates having flourished -- and their scruples end where profits begin.

A new Statistics Canada survey reveals an "alarming" number of Canadians have driven a vehicle while high on cannabis or have been passengers in such vehicles.     CKWS

Statistics Canada has just released its second quarterly national cannabis survey, and according to the results an "alarming" number of Canadians evidently don't think twice about driving while high on cannabis. Admittedly, nowhere near all cannabis users flout common sense, yet 14 percent with a driver's licence revealed that within two hours of consuming cannabis they decided to get behind the wheel of a vehicle ... and this, while cannabis use yet remains illegal.

Five percent of Canadians over age 14 have been a passenger in a vehicle being driven by someone who had used cannabis in the preceding two hours. Public danger? You bet. These quarterly surveys being conducted by Statistics Canada represent an effort meant to measure social and economic impacts involved in the legalization of cannabis. It's one thing to discourage people from driving while high but the issue of cannabis strength and individual users' reaction to pot, certainly complicates the matter.

This second quarter data revealed that roughly 4.6 million Canadians, representing about 16 percent of Canadians age 15 and over, reported the use of cannabis in the three-month period before the survey was undertaken. Men, close to two times likelier than women to drive while high on marijuana. On the national scene, cannabis use was higher in Nova Scotia at 21 percent than the national average, with Ontario at 18 percent -- Whitehorse 23 percent, Yellowknife 27 percent and Iqaluit 33 percent.

"I think if you compare it to alcohol, they're shocking [statistics that the rate of Canadians who drive after using using pot is triple the number of those consuming alcohol in the preceding two hours before driving]."
"I think [however, that] once people get the idea that police do have the tools, that they can detect drug-impaired drivers, especially cannabis, then I think like alcohol with the breathalyzer it'll start to lower those rates."
Andrew Murie, CEO, MADD Canada

You think?

According to Statistics Canada’s latest cannabis survey, 14 per cent of users are driving within two hours of consumption.  (Sean Kilpatrick / The Canadian Press)