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MJ News for 06/09/14

7greeneyes

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http://www.denverpost.com/marijuana...cal+(Denver+Post:+News:+Local:+All+Local+News)




2016 RNC bid: Is legal marijuana Denver's elephant in the room?


There's no escaping Colorado's status as the poster child for legal recreational marijuana when visitors come to town, even — or especially — when Denver is trying to sell itself as the perfect site for a national political convention.

Take the initial site visit by Republican National Committee staffers in April, a precursor to a larger three-day scouting mission that starts Monday.

Over lunch, the topic turned to marijuana. The GOP visitors had plenty to ask.

But the questions didn't leave bid boosters worried that legal pot might hurt Denver's chances, even if Republicans are least likely to support such laws.

"They're more curious about how this is going to play out in other places around the country," said Pete Coors, chairman of the Denver bid committee. "We're the first state, and we're learning how to do it."

Still, Colorado's marijuana reputation isn't the kind of international exposure Republican officials are hyping as they seek the party's convention in 2016. Also in the running are Cleveland and Kansas City, Mo., which RNC officials and the Site Selection Committee visited last week, and Dallas, where they'll head Wednesday after Denver.

Two years from now, it remains to be seen whether marijuana will be such a big issue. Would Jimmy Fallon or Stephen Colbert make jokes on late-night TV about wayward or lost Republicans wandering into pot shops on the 16th Street Mall?

But interest from RNC scouts has been inescapable, even if Denver boosters, echoed by a national political analyst, think cannabis won't play much of a factor in the RNC's host city decision, to be made later this summer or fall.

"You can't run from it, and we haven't," said Angela Lieurance, the bid committee's executive director. "You cannot pretend that it's not an issue or challenge for us."

Their message: It's the will of the people, and "we have very thoughtful, smart people dealing with this."

Besides, other states are lining up to try the legal pot experiment. Washington state's voter-legalized recreational marijuana sales start July 1.

"In 2014, it'll probably be on the ballot in Oregon again and in Alaska," said Sam Kamin, a University of Denver law professor who has tracked marijuana laws for years. "In 2016, it'll probably be on the ballot in California and Nevada, and possibly other states."

Meanwhile, even some conservative-leaning states have been taking a look at medical marijuana, which is legal in states where more than half of Americans live. Last week, 49 Republicans joined a bipartisan majority in the U.S. House to protect state-licensed medical marijuana businesses from federal busts.

Full legalization "is definitely moving a lot nationally, and it's moving a lot generationally," Kamin said, with only people in their 50s and older hesitating to support it.

National polls for the first time recently put overall support for the idea at more than 50 percent.

Still, among Republicans, a CNN poll in January found only 36 percent supported legalization, compared with 62 percent of Democrats and 59 percent of independents.

As the national GOP considers where to nominate its next presidential ticket, "I'm sure (marijuana is) going to be a topic for discussion," said Jennifer Duffy, senior editor of The Cook Political Report, which analyzes politics across the country.

That said, she pointed out that some Republican delegates may view it as a feather in Denver's cap

"When you're talking about convention delegates," she said, "they tend to be party activists. So you've got a fairly decent libertarian contingent who will be fine with it." And party leaders, she said, likely realize that marijuana's hot-button status diminishes every year.

Even so, most states that advocates see as offering the best chances at legalization via voter initiative may not put it on the ballot until 2016, a prospect that could force the issue to the forefront of national politics that year.

That's not a concern for Denver boosters.

And, asked about the effect of Colorado's legal marijuana on bid considerations, RNC spokesman Ryan Mahoney said, "This is not something the committee is focused on at this time."
 

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http://www.freep.com/article/20140608/NEWS07/306080143/jamaica-legal-marijuana




Jamaica mulls legal marijuana (no, it's not already legal)


KINGSTON, JAMAICA — This tourist mecca may soon be known as the Colorado of the Caribbean.

Given the ready availability of "ganja" as the locals call it, many outsiders assume marijuana is already legal in Jamaica, but it's not ... yet.

Encouraged by legalized marijuana in Colorado, Washington state and Uruguay — the first country to legalize and regulate the weed — Jamaican farmers and some politicians want to capitalize on what already is a homegrown industry with an international brand.

Dreadlocked Rastafarians and farmers gathered in downtown Kingston in April to launch Jamaica's Ganja Future Growers and Producers Association. The only thing missing was the smoke. They listened to speakers from Jamaica, the United States and Canada about the benefits of the drug and the need to get on the bandwagon for the marijuana industry.

The push isn't to outdo Colorado since Jamaica's link to ganja is already well known, largely because of the popularity of the late reggae superstar Bob Marley.

"The time has come to provide an opportunity for Jamaicans to benefit from the marijuana industry," said Angela Brown Burke, Kingston's mayor and a Parliament senator. Her husband, Paul Burke, is program director of the recently launched ganja association and is general secretary of the PNP, the government's ruling party.

Phillip Paulwell, the leader of government business in the House of Representatives, declared that ganja will be decriminalized this year for possession of small amounts of the drug.

Among the speakers at the launch of the ganja association was Josh Stanley, a Colorado producer of the Charlotte's Web strain of medicinal marijuana and a cannabis activist. He encouraged Jamaica to become a leader in the ganja industry and cited many economic and social benefits that the drug has brought to Colorado.

The motivation behind the legal pot drive is largely economic. Jamaica's economy has suffered from slow growth, high unemployment (now 13.4%) and high debt for the last two decades, according to the World Bank.

Jamaica, where an estimated 37,066 acres grow marijuana, is the largest Caribbean supplier of pot to the U.S. and other Caribbean islands, according to the State Department's 2014 International Narcotics Control Strategy Report.

Most Jamaicans are not against ganja. According to a national survey last year, 66% claim to have smoked it, and 85% strongly favor the creation of medicinal products extracted from it.

Buoyed by the survey, Medicanja, Jamaica's first medicinal marijuana company, was launched in December.

Dayton Campbell, a physician and member of Parliament, does not oppose the medicinal use of marijuana, but he is against smoking it "because of the harmful effects on the body (such as) alterations in mental capacity, especially on the developing brain.

"I do believe it may boost our economy, but I don't think we should sacrifice our human capital to gain the marijuana dollar," Campbell said.

If ganja is decriminalized, "the impact (on) tourist arrivals would be enormous," Archibald McDonald, head of the Cannabis Commercial and Medicinal Research Task Force in Kingston, told USA TODAY, adding he was not speaking for the task force. "This will provide the growth in GDP that we need so badly."

The Jamaica Cannabis Conference, organized by the task force and held in late May, released a statement declaring "there is no plausible reason" why industry regulations cannot be in place by the end of September, warning: "Wake up Jamaica, our opportunities are slipping away."

But not everyone thinks ganja is the way to go.

"We can do other stuff without marijuana to increase our tourist arrivals" such as build water parks, said Owayne Bolton, a manager at the Hilton in Montego Bay.

Others, such as farmer Clinel Robinson, 69, a small-crop ganja grower, think legalization would boost tourism.

"Thousands — if they know they can come into a ganja field and police wouldn't arrest them — they would come," he said. "Hotels would be full of people. Everybody would benefit."
 

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http://www.usatoday.com/story/money/cars/2014/06/09/marijuana-accidents/10219119/




Marijuana playing larger role in fatal crashes


As more states are poised to legalize medicinal marijuana, it's looking like dope is playing a larger role as a cause of fatal traffic accidents.

Columbia University researchers performing a toxicology examination of nearly 24,000 driving fatalities concluded that marijuana contributed to 12% of traffic deaths in 2010, tripled from a decade earlier.

NHTSA studies have found drugged driving to be particularly prevalent among younger motorists. One in eight high school seniors responding to a 2010 survey admitted to driving after smoking marijuana. Nearly a quarter of drivers killed in drug-related car crashes were younger than 25. Likewise, nearly half of fatally injured drivers who tested positive for marijuana were younger than 25.

A National Highway Traffic Safety Administration study found that 4% of drivers were high during the day and more than 6% at night, and that nighttime figure more than doubled on weekends.

Colorado has seen a spike in driving fatalities in which marijuana alone was involved, according to Insurance.com. The trend started in 2009 — the year medical marijuana dispensaries were effectively legalized at the state level.

NHTSA and the National Institute on Drug Abuse are now in the final months of a three-year, half-million-dollar cooperative study to determine the impact of inhaled marijuana on driving performance. Tests observe participants who ingest a low dose of THC, the active ingredient in marijuana, a high dose and a placebo to assess the effects on performance, decision-making, motor control, risk-taking behavior and divided-attention tasks.

The study is being performed using what NHTSA calls "the world's most advanced driving simulator," the University of Iowa's National Advanced Driving Simulator, which was previously used to study the effects of alcohol on driving.
 

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http://lasvegas.cbslocal.com/2014/06/08/judge-rules-medical-marijuana-can-be-used-to-treat-ptsd/




(Arizona) Judge Rules Medical Marijuana Can Be Used To Treat PTSD


PHOENIX (AP) — A court ruling filed this week has added post-traumatic stress disorder to the list of debilitating conditions that qualify for medical marijuana treatment.

State Department of Health Services Director Will Humble has until July 9 to accept, modify or reject an administrative law judge’s ruling that PTSD sufferers are eligible for a medical marijuana registration card.

Humble said Friday that he would study the order before making a decision.

The Arizona Cannabis Nurses Association appealed Humble’s denial last December to classify PTSD as an ailment that could be treated with pot.

Humble said he initially denied the group’s petition, citing a lack of scientific evidence showing marijuana helps patients with the disorder.

Judge Thomas Shedden, however, said in his opinion that there was substantial evidence that those with PTSD receive a “palliative benefit from marijuana use.” Shedden said medical professionals often rely on patients’ input for when making off-label prescriptions.

Ricardo Pereyda was among those who testified at the hearing on how marijuana can help with post-traumatic stress. The Iraq War veteran said prescription drugs for his anger, depression and other issues only gave him adverse side effects. It wasn’t until he started using cannabis in 2010 that he felt happier and more focused.

Pereyda said he doesn’t understand why Humble would take a month to make a decision.

“What is it that you need to wait and see before that day that you haven’t seen in the past four days? Get it done. People are dying. And that’s not just veterans,” Pereyda said.

Having a medical marijuana card would also let veterans and other PTSD
victims feel protected legally while seeking treatment.

“What if I got caught with an ounce or something like that? Under the Arizona Medical Marijuana Act, I would have had a card and it would have been perfectly legal,” Pereyda said.

If Humble rejects the judge’s ruling, the group can appeal to the Maricopa County Superior Court.

Eleven states currently approve medicinal marijuana for treating PTSD.

In April, veterans lobbied lawmakers to pay for a clinical study at the University of Arizona that looks at the health benefits of medical marijuana.

Advocates say that pot needs to be studied to learn how it might be able to
remedy post-traumatic stress disorder. They say legislation that would have enabled the state to use part of the fund it receives from sales of medical-marijuana permits was unfairly killed in the legislature.

The University of Arizona received approval from the U.S. Department of Health and Human Services to conduct long-delayed marijuana research that has been in the works for more than two decades. The approval was an important milestone for the project, but it still needs money from the state of Arizona to carry out the research, along with approval from the federal Drug Enforcement Administration.
 

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http://www.cbsnews.com/news/colorado-agrees-to-cannabis-credit-co-ops/




Colorado agrees to cannabis "credit co-ops"


Colorado's pioneering marijuana industry continues to break new ground, especially when it comes to confronting financial and legislative issues surrounding cannabis.

Colorado Governor John Hickenlooper on Friday signed into law HB 1398, a bill that allows legal marijuana businesses in the state to create what the measure calls "marijuana financial services cooperatives," referred to in the statute as "cannabis credit co-ops."

Twenty-two states and the District of Columbia have legalized the use of medical marijuana, and earlier this year Washington state and Colorado legalized the recreational use of cannabis for adults.

A big challenge for Colorado's burgeoning marijuana industry is that most of its transactions are on a cash-only basis. That's because cannabis remains illegal on a federal level and most banks and financial institutions won't do business with marijuana-related businesses out of fear of federal prosecution.

In February, however, the U.S. Treasury Department's Financial Crimes Enforcement Network, working with the Justice Department, issued guidance for financial institutions seeking to provide services to cannabis-related businesses. The goal? To promote "greater financial transparency in the marijuana industry and mitigate the dangers associated with conducting an all-cash business."

Those dangers are real. CBS station KCNC-TV, quoting data from the Denver police, says there were 40 burglaries and one robbery at marijuana businesses in the city during the first four months of this year.

"We are all having nightmares about this issue," Michael Elliott, executive director of the Denver-based Marijuana Industry Group, told KCNC.

In a statement issued last month, Elliot said the lack of basic banking services was causing "serious public safety and accountability issues" in the cash-dominant marijuana industry.

"HB 1398 is likely not a solution to the banking problem," he added, "but an opportunity to move the conversation forward. It will allow cannabis credit co=ops to form, and seek permission from the [Federal Reserve] to access merchant services and checking."

Financial experts acknowledge the new measure will probably not solve the marijuana industry's inability to use banks and other financial services.

"We don't think it will do anything other than allow the state to say, 'We've tried everything we can think of and it won't work, so Congress it's now up to you'," Don Childears, president and CEO of the Colorado Bankers Association, told the Denver Business Journal on Friday.

"They'll never get access to the Federal Reserve System," he continued, "and if they can't do that, the co-ops will never be formed."

Meanwhile, one group benefiting from the current cash-only basis of Colorado's marijuana industry are private security firms. Ted Daniels of Blue Line Security told KCNC he can't hire armed guards fast enough to protect the cash-filled dispensaries.

"If you ask me to grow marijuana, I wouldn't know the first thing," Daniels said in an interview. "But I know how to protect it."
 

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http://www.cnbc.com/id/101732379




Pot for pets? Cannabis now helping dogs and cats


Georgia, a 5-year-old Cavalier King Charles Spaniel, is a medical marijuana patient. Kelly Conway, Georgia's owner, takes some heat when she tells friends about the unorthodox treatment.

"People will say they can't believe I'm letting her get high, but she's not getting high," Conway said.

No, Georgia is not ingesting the same kind of pot that Snoop Dogg smokes. (Or New York Times columnist Maureen Dowd eats.) Georgia, along with a growing number of pets, eats hemp-based capsules that contain only trace amounts of tetrahydrocannabinol—or THC—the psychoactive ingredient that provides the cannabis high.

Georgia suffered from syringomyelia, a serious neurological disease, and traditional medicine wasn't working. So earlier this year, Conway took her to Dr. Cynthia Graves, who practices alternative veterinary care in Philadelphia. Graves started Georgia on acupuncture, which seemed to help, and then she recommended Canna-Pet, a supplement made from hemp, for Georgia's pain and anxiety.

Conway was skeptical, but to her surprise, it worked.

"It has truly been a miracle and I don't say that lightly," Conway told CNBC. "I feel like I have a whole new dog. Georgia's happy and relaxed. She's not in pain. It's amazing."

Colorado and Washington have legalized and regulated cannabis for human recreational use—and 22 states allow for some form of medical marijuana. But no federal or state agency has made any provisions for the largely unregulated pet supplement industry.

To further complicate matters, the Drug Enforcement Agency still considers industrial hemp a controlled substance even though it is not psychoactive.

But times are changing. On Thursday, the Senate Appropriations Committee voted 22-8 on a plan that would block the DEA—or any federal agency—from spending funds to enforce anti-hemp laws in any state that has received permission to grow it. The full House OK'd the measure the previous week.

Congress' action emerged after the DEA in May seized a shipment of hemp seeds from Italy headed to Kentucky. The state filed a lawsuit against the federal government to get its hemp seeds and now Kentucky, long known for its tobacco fields, has hemp in the ground.

As the nation grapples with this knotty issue, farmers, business owners, patients—and pets—are moving ahead while lawmakers hash it out.

Helping with pain and anxiety

Graves has recommended hemp-based supplements for other dogs experiencing anxiety or pain. She's also used Canna-Pet in conjunction with cancer treatments and to boost appetite in dogs that won't eat.

"There's no question that it's a benefit to some patients," she said.

Two companies in the Seattle area, Canna-Pet and Canna Companion, are leading the charge into this new and uncharted field of hemp-based veterinary medicine.

Dr. Sarah Brandon and Dr. Greg Copas, husband and wife veterinarians, launched Canna Companion in March. They've been exploring medical cannabis for about eight years now.

They started with their pets and then those of family and friends, to find the right dosage.

"We took information from the human world and combined that with our knowledge of dogs and cats and slowly whittled away until we got something that was safe for them and that worked," she explained.

They grind up the whole hemp plant to make their Canna Companion capsules—roots, seeds, leaves and stem—to preserve all the ingredients. They want just a little THC along with the cannabidiol (CBD), one of the main medical components.

Brandon readily acknowledges that she does not have any scientific tests to prove the medicinal value of hemp-based supplements. She hopes that by "pushing the envelope" a bit, researchers will be encouraged to study it.

"It's experimental and we tell people that," Brandon noted. "It's not a miracle drug. This is truly a supplement designed to help conditions and help ongoing therapies, not the sole treatment of anything."

Are testimonials good enough?

Both Canna Companion and Canna-Pet have heartwarming testimonials on their websites.

There's Kerry Churchill from Virginia. Her dog Ginger has neurological problems that cause uncontrolled muscle twitching. The twitching hasn't stopped, but Churchill says after taking Canna Companion, Ginger's energy level is greatly increased and her playfulness is back.

"She just seems happier overall, which is great to see," Churchill told CNBC. "This is not wishful thinking. Her quality of life has definitely improved."

Annabelle is a 14-year-old Persian cat featured on the Canna-Pet website. Owner Rose Easterling, a self-described "doubting Thomas," was very apprehensive about using the product. She gave it to Annabelle because she didn't like giving her the pain medication the vet prescribed.

"I don't think it has cured anything. She still has arthritis, but it's making her feel better," Easterling said.

Does it work?

CNBC contacted a number of veterinary experts about the use of cannabis-related products to treat dogs and cats. All of them saw the potential for benefits for some conditions, such as anxiety and pain management. But they also pointed out that testimonials are not scientific evidence.

"We don't have any data to go on to indicate whether it's going to have a therapeutic effect or whether it's potentially problematic," said Patricia Talcott, a professor in the College of Veterinary Medicine at Washington State University. "It's probably low risk, but we simply don't know."

Dr. Robin Downing, a pain management expert and hospital director at the Downing Center for Animal Pain Management in Windsor, Colorado, agrees. She sees a lot of potential—and a lot of red flags.

"There's a whole host of hoo-ha out there when it comes to how this product can and should be used," she said. "We have no information that is reliable, valid or useful about the true applications for cannabinoids. What we don't know far exceeds what we know."

Downing does not use cannabis-based products in her practice because she believes the opportunity to cause harm "far exceeds" the opportunity to help.

"We have no efficacy data in animals. We have zero safety data in animals. We have no dosing data in animals," she said.

Downing also points out that this new industry has virtually no regulations in terms of manufacturing practices or verifying and standardizing the contents.

"There's a huge amount of research that needs to be done," said Narda Robinson, director of the Center for Comparative and Integrative Medicine at Colorado State University's Veterinary Teaching Hospital. "I expect there is some effect, but we need rigorous studies. We need to know more about safety and dosing and proper applications."

Robinson hopes to start clinical trials next year, but first she wants to gather information from people who have given cannabinoid products to their pets. She set up a special email just for this purpose: AnimalMMJ@gmail.com.

Pet owners need to be cautious

While pet-lovers wait for the research, it's clear that sales are getting ahead of the science.

Canna-Pet has only been selling to the public for about eight months and it's already shipping its products throughout the U.S. and 23 foreign countries. Dan Goldfarb, president of Canna-Pet, calls it "an exploding market" that will grow exponentially in the years ahead.

"There is no risk. There's no harm," Goldfarb said. "Hemp is incredibly safe. We want people to try it."

Despite companies' safety assurances, veterinary experts advise caution. The best advice for now: Never give any cannabis-based product to your dog or cat without consulting your vet.
 

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http://www.theweedblog.com/cannabis-lab-testing-in-washington-shows-inconsistencies/




Cannabis Lab Testing In Washington Shows Inconsistencies


Lab testing in the cannabis industry has been an evolving thing. The first time I heard of lab testing was when my uncle went to Amsterdam, and he purchased cannabis. The retailer claimed he had multiple strains testing at 35% THC or higher. It wasn’t until I talked to a testing lab in Colorado years later that I was able to confirm that those levels in Amsterdam were false.

The testing lab in Colorado explained that testing technology previously used was very inaccurate, and that current technology is getting results closer to the correct amounts. They were quick to say that even today’s technology isn’t always 100% accurate. The issue of inaccurate results is compounded by the fact that not all testing labs are created equal. Many testing labs are run by non-qualified people that just bought a low quality spectrometer and set up shop. there’s a big difference between simply testing cannabis, and testing it correctly with quality equipment.

Per MMJ Business Daily:

“Lab owners and policymakers believe that the inconsistencies will be eliminated by the state’s recreational market, since rules will require mandatory testing. But developing regulations and standards for cannabis testing is a complicated task, and it’s unclear how it will all play out.

Cannabis experts blamed the inconsistencies on several factors, including the genetics and age of the plants. Human error could have also played a factor, they said, as could have mislabeling and fraudulent marketing.”


when you purchase cannabis, take the test results with a grain of salt. Just because it’s been tested doesn’t mean it’s been tested properly. Because legit testing companies are poor at branding, there is no ‘top testing company’ in most areas that customers can demand when they walk into a dispensary or retail store. Hopefully that changes soon.
 

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http://www.medicaljane.com/2014/06/...-for-patients-living-with-multiple-sclerosis/




Cannabis Classroom: Cannabis-Based Medicine For Patients Living With Multiple Sclerosis


What Is Multiple Sclerosis (MS)?

MS is an autoimmune, inflammatory condition which is caused by an attack from the body’s immune system on the myelin sheath that surrounds nerve cells in the central nervous system (CNS). The myelin sheath provides insulation to these cells to allow for fast conduction of signals throughout the body; destruction slows the speed of signals from the CNS to the body’s peripheral nervous system (PNS). This condition can also lead to destruction of the nerves themselves, which is irreversible.

Due to the fact that the CNS is the “command center” for the body, MS can cause problems in numerous body systems. MS (and the current treatments available for its treatment) can cause bladder infection and dysfunction, bowel dysfunction, depression, fatigue, itching, emotional changes, pain, sexual problems, tremors, dizziness and vertigo, gait (walking) difficulties, sleep disturbance, and more.

One major symptom of MS is referred to as spasticity. It can cause overactive reflexes, involuntary movements, difficulty with care and hygiene, abnormal posture, contractures, pain, bone and joint deformities, and more. Needless to say, MS causes a severely decreased quality of life for patients. There is currently no cure for MS, which is why research for new treatments for symptom relief and disease progression is imperative.

Results From The Largest Study On Cannabis, MS To Date

One of the largest studies gauging the effect of medical cannabis on patients with MS was one of 630 participants conducted by Zajicek et al. in 2003 at 33 centers. Results showed that participants who used whole-plant cannabis-based medicine (CBM) extracts did not experience an improvement in objective measurements of spasticity measured by the Ashworth scale – a tool used to assess objective measures of spasticity, including tone, resistance, and rigidity in body extremities.

However, in self-reports, patients in the CBM extract or ∆-9-tetrahydrocannabinol (THC) CBM groups reported improvements in “pain, sleep quality, spasms, and spasticity,… though no effect was noted with respect to irritability, depression, tiredness, tremor or energy.”
In comparing the lack of efficacy for spasticity as measured by the Ashworth Scale to other treatment options available for MS, Zajicek et al. importantly note the following:

“When assessing our results, it should be acknowledged that the degree of evidence for many of the commonly used drugs to combat [MS] symptoms is weak… One study [of a commonly used medication for MS] noted a difference in Ashworth scores comparing active treatment with placebo, whereas the other showed no effect. Neither of these studies detailed any difference in walking times [, another measure of disability caused by MS], and even when a significant effect was obtained in the Ashworth score, there was no different in pain measures or sleep quality on active medication.”

In contrast, medical cannabis did show efficacy in improvement of pain and sleep quality. Additionally and importantly, at the 12-month follow-up, “muscle spasticity measured by the Ashworth scale was significantly improved in the THC-treated [CBM] group. The Rivermead Mobility Index [a test of functional mobility] was also improved, indicative of reduced disability.”

Using Objective Reporting Measures When Treating MS

So if medical cannabis did not show immediate efficacy on the Ashworth Scale in such as large study, this treatment option is not effective a good treatment option for MS, right? The answer to this question is a strong and resounding “no”; comprehension of the reasoning for this requires a basic understanding of tools used in research.

Validity tests (those that gauge whether or not a tool is accurate/whether it measures what it is designed to measure) and reliability tests (those that gauge the ability of a tool to produce the same results when administered multiple times in the same conditions) are performed on tools like the Ashworth Scale, in order to help us to understand their real-world or clinical utility.

Zajicek et al. noted in their large 2003 study, “The limitations of the Ashworth scale in measuring the highly complex symptom of spasticity are well known, and there is a need to develop new patient-oriented scales to enable measurement of what matters to them.”

Due to the fact that the Ashworth scale is not a fully valid measure of spasticity, performance on it should not be used in the assessment of treatment efficacy. Whether medical cannabis is able to produce significant change in the Ashworth Scale therefore does not properly measure the efficacy of medical cannabis on spasticity.

Additionally, there are many other symptoms experienced by patients with MS than just spasticity (such as pain, weakness, etc.), and treatment efficacy should not be gauged solely on changes in that one symptom.
According to Vaney et al., “…it must be questioned if disturbance of muscle tone by strong anti-spastic agents is in every case clinically meaningful as disability in MS patients seems more clearly related to weakness than to spasticity.”

In a study using CBM capsules with 2.5 mg THC and 0.9 mg cannabidiol (CBD), these same researchers found that “there were no statistically significant differences associated with active treatment [i.e. medical cannabis] compared to placebo, but trends in favor of active treatment were seen for spasm frequency, mobility and getting to sleep.”

Further, studies have shown improvement in objective ratings of spasticity. Using the modified Ashworth Scale (MAS), a study conducted in 2012 by Corey-Bloom et al. found that “treatment with smoked cannabis resulted in a significant reduction in patient scores… In addition, treatment reduced pain scores on a visual analogue scale [a self-report measure].”

No difference was found between medical cannabis and placebo groups on a timed walk test. However, scores on a test of cognitive function showed lower scores for participants on active treatment compared to the placebo group.

Using Subjective Reporting Measures When Treating MS

So what tools should researchers utilize to measure improvements in spasticity symptoms for patients with MS? In a 2010 meta-analysis of the efficacy of oromucosal CBM and MS, Wade et al. stated the following:

“The 0-10 Numerical Rating Scale is recommended as a preferred outcome measure in the assessment of interventions in chronic pain, but has not been widely used in studies of anti-spasticity medications. It has the benefit of allowing the patient to express their own daily experience of spasticity and has recently been validated… it is a suitable assessment tool and possibly an alternative to the Ashworth Scale which several research groups have criticized.

The researchers “found that global impression of change (GIC) was significantly improved for patients on active treatment [i.e. medical cannabis]. Participants on active treatments were significantly less likely to experience spasticity compared to placebo participants, based on self-reports of Visual Analogue Scale and Numerical Rating Scale.”

In scientific study, self-report measures are considered unreliable because humans possess bias by nature, often unintentionally. Scientists understandably desire facts and not opinions, which is the reason why objective measures and double-blinding are used as elements of the gold-standard for determining treatment efficacy.

However, a study by Collin et al. (2007), which found efficacy of CBM using self-report measures addresses this issue in relation to CBM treatment and MS. The researchers mention in the “Discussion” section of their study that although their work was criticized for the utilization of a self-report measure, it may actually be superior to observer-rated measures.

One reason for this is the lack of “clinical relevance” that objective measurements provide; when “real world” patients with spasticity go to see their physician, the physician often merely asks either the patient or their caregiver how the patient has been feeling about their spasticity. Very rarely are objective measures like the Ashworth Scale utilized.

Additionally, utilization of the 11-point Numeric Rating Scale is meant to provide a broader view of the patient’s experience of their spasticity. It does so by measuring spasticity over 24 hours, not at only one point in time, thereby gaining a better idea of the patient’s quality of life.

As noted by Collin et al., “there is increasing acceptance that a patient reported outcome measure is appropriate for spasticity.” The NRS is frequently used for pain assessment in the clinic, with at least a 30% reduction in pain after treatment signifying that the treatment provided a “clinically meaningful reduction in pain”.

While it is unclear whether or not the same gauge is appropriate to assess whether or not the NRS can be used to accurately measure spasticity with reliabilty, 40% of the original CBM group in this study experienced a >30% improvement in their spasticity. This improvement was found in addition to those already provided by the participants’ prescribed medications for anti-spasticity, which they were required to continue throughout the trial.

The researchers note, ”Small improvements in the patients[’] experience may lead to large changes in quality of life… The ideal objective measure of spasticity does not exist. Using the NRS [for spasticity research] as in pain research appears to be a reasonable compromise.”

Evidence For Efficacy Of Cannabis-Based Medicine On MS

Multiple studies have shown the benefits of medical cannabis for patients with MS experiencing a wide range of symptoms. Novotna et al. (2011) conducted a Phase III placebo-controlled trial on cannabis-based medicine (CBM) as an add-on therapy for MS symptoms. The CBM add-on produced a “highly significant” difference in the Numeric Rating Scale, as well as improvements in self-reports of spasm frequency, sleep disturbance, and perspective of the caregiver and clinical regarding global impression of change for the patient.

In 2007, Collin et al. conducted a study on the effects of CBM on patients with MS and found that oromucosal CBM significantly improved daily subject-recorded Numerical Rating Scale of spasticity. However, there was no significant difference between placebo and active treatment [i.e. medical cannabis] on Ashworth Score and the Motricity Index [an objective measure of muscle power]. 57% of participants on active treatment vs. 48% of control participants experienced an improved global impression of change of symptoms.

Numerous studies have also shown the efficacy of medical cannabis in treating neuropathic pain, which is the most common pain type experienced by patients with MS. These include “A Randomized, Placebo-Controlled, Crossover Trial of Cannabis Cigarettes in Neuropathic Pain” by Wilsey et al. (2008) and “Smoked cannabis for chronic neuropathic pain: a randomized controlled trial” by Ware et al. (2010), which also showed improvements in ability to fall asleep, improved quality of sleep, and well-tolerated and minimal adverse events.

Additionally, “A Preliminary Controlled Study to Determine Whether Whole-Plant Cannabis Extracts Can Improve Intractable Neurogenic Symptoms” by Wade et al. (2003), which used oromucosal CBM, found improvements in pain, impaired bladder control, muscle spasms and spasticity with medical cannabis treatment.

CBM As Treatment Of The Disease, Not Just The Symptoms

There is some evidence that suggests that medical cannabis may be useful beyond symptom control for patients with MS, and may be able to act as direct treatment of the disease.

A study by Pertwee et al. (2007) conducted a review on cannabinoids and their effect on MS, found that there is evidence to suggest that cannabinoids may work not only as a treatment for MS symptoms, but also the direct treatment of the disease.

This is believed to occur through activation of cannabinoid receptors which “may suppress some of the pathological changes that give rise to these signs and symptoms”.

The researchers note, “signs and symptoms of this disease can be ameliorated by cannabinoid receptor agonists at doses that do not provoke unacceptably severe adverse events. Preclinical evidence has emerged supporting the hypothesis that activation of CB2 receptors expressed by T cells within the central nervous system will decrease inflammation in MS and possibly also slow progression of the disease.”

Cognitive Effects Of Cannabis On People With MS

To date, some of the evidence that suggests that medical cannabis is a harmful treatment option for patients with MS points to the fact that on cognitive tests, MS patients who use medical cannabis may perform worse in comparison to MS patients who did not use medical cannabis.

Given that the disease itself can cause cognitive declines, these results represent an understandable concern. However, when discussing conditions like MS with debilitating symptoms, maintenance of optimal cognition is not the most important issue.

A patient using medical cannabis with decreased pain, greater ease in sleeping, decreased self-reports of spasticity, and/or an increase in global perception of their health, is a medical success.

CBM Is A Safe, Effective Treatment Option For Patients With MS

Given its low risk of negative side effects and low risk of dependence, CBM may be an effective treatment option to be used in conjunction with other efficacious treatments for patients with both typical and intractable MS symptoms. However, medical cannabis is not an optimal treatment option for everyone.

To gain a better understanding of the CBM and its effects on MS, more research needs to be conducted using proper tools in order to assess its effects.

With that said, increased research for any medication is always warranted – even for those that have been legal and commonly used for decades. Thus, this is not a strong enough reason to maintain prohibition on medical cannabis for patients with MS.

The evidenced overall safety of medical cannabis in various forms, along with its shown efficacy for various symptoms of MS, seems to support its use for patients who are suffering. This is especially true of those with intractable symptoms which cannot be ameliorated by other therapies.
In turn, it would be beneficial for patients with multiple sclerosis to have safe, legal access to various forms of medical cannabis, with use authorized and monitored by their healthcare provider.
 

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