Mixing up the Medicine: CBD in cocktails?

I’ve said it before and I’ll say it again: In my opinion, is WAY safer than alcohol. But what happens when the two are combined? I’m not talking about getting crossfaded after you decide to take a puff or two after a night of drinking — I’m talking canna-beverages.

Weed beer and wine have been on the horizon for a while, but as someone who has had the exciting experience of trying beer brewed with THC-laden cannabis (shout out to good friends who brew excellent beers!) I will be the first to say that THC + alcohol, at least within the same beverage, can be a dangerous proposition. And by “dangerous” I don’t mean that there is inherent physical risk (besides falling asleep); moreso that drinks of that nature, if/when they do appear on the market, will need to be highly regulated to ensure a safe and proper dosage. Most people just won’t be able to crush a six pack of THC beer (or a bottle of weed wine) like they may be able to do with their alcohol of choice sans cannabis.

So far, every legal state has prohibited combining THC and alcohol in the same beverage, thus makers of weed beverages like beer and wine often remove the alcohol before the cannabis is added, or they are offered in non-smoking, edibles-only social gatherings.

But what about CBD? THC’s softer sister compound, increasingly popular for it’s non-psychoactive healing effects for just about everyone, could have great potential as a companion to alcohol. In fact, breweries and bars in legal states are already serving up CBD-infused beers and cocktails (see recipe below), and with the recent legalization of nationwide, there seems to be an influx of CBD-infused everything popping up in every corner store. But what happens when you combine CBD with alcohol? More research is needed, as always seems to be the case with cannabis (and will be until we have federal legalization), but what we do know so far might surprise you.

Unlike mixing THC and alcohol, which can increase the effect of THC in the bloodstream and lead to a less-than-ideal level of intoxication, scientists are discovering that CBD may actually help to temper the effect of alcohol in one’s system. Even as early as 1979, a study published in the journal Psychopharmacology reported that participants who were given a mix of CBD and alcohol had lower blood alcohol levels than participants who had just been given alcohol, though there weren’t any notable differences in impairment of motor skills.” (So don’t go thinking you can use CBD to sober up and drive, folks!) Since then, multiple studies have shown that CBD acts as a neuroprotective antioxidant, and can actually help to protect the body and brain from alcohol-induced neurodegeneration and oxidative damage to the liver, as well as reduce alcohol consumption and withdrawal symptoms. Further, a recent review awaiting publication in the journal Frontiers in Pharmacology found that “because of its impact on various aspects of the disease (including ‘intake, motivation, relapse, anxiety and impulsivity’), CBD ‘could have a significant action on drinking levels in human subjects with [alcohol use disorder].'”

Unfortunately, because the FDA has yet to approve the use of CBD in food and beverages, even hemp- derived CBD-infused drinks are still considered unlawful, and the Alcohol and Tobacco Trade Bureau is unlikely to approve of CBD in alcoholic beverages until the FDA changes its tune. So for now, those looking to experiment with mixing cannabis and alcohol will have to administer the substances separately, or make their own cocktail at home (hot toddy, anyone?). Because there are so many variables and every body is different, no matter which method you choose (or if you’re drinking CBD, THC or both), remember to start low and go slow. It’s a good idea to start with non-alcoholic drinks, choose a safe environment (like your home) for the experimental experience, and wait at least 30 minutes between beverages. Drink responsibly!

CBD Hot Toddy:

1. Heat 1-2 cups of hot liquid cider (add whiskey if you’re feeling frisky) 2. Add 1/4 ounce honey and 1 pull of tincture (preferably alcohol-based) to the mix 3. Garnish with 1 cinnamon stick, 1 lemon wedge, and serve

On Cloud Nine-One-One?: Vaping safety

Unless you’ve been avoiding the news (which is honestly understandable these days), you’ve probably heard recently about the dangers of vaping. This week we saw the sixth confirmed death from the mysterious vape-related illness that seems to be sweeping the nation. Although we have yet to see any cases in RI, the RI Department of Health reports that 1 in 5 RI teens use “e-cigs” like the popular Juul, which resembles a USB-device. Likewise, there has been an increase in demand both in the legal and underground marijuana markets for vape pens, which offer a discreet and convenient method for vaping cannabis concentrates. Even if you don’t partake yourself, chances are that you or your kids know someone who vapes regularly, and the news reports can be pretty alarmist (shocker, I know). So what do we actually know about vaping, and why is it making people sick?

What Is Vaping?

Vaping refers to the practice of using a device that vaporizes a liquid containing either nicotine or cannabis extracts (usually not both), often blended with other solvents that help to dissolve and deliver the drug through inhalation. Although scientists haven’t yet pinpointed a key ingredient common to all of the current cases of illness, many believe that these carrier oils may be the culprit. Among the various oils, cutting agents and chemicals found in vaping liquid, there have also been reports of pesticides, carcinogens and heavy metals. It doesn’t help that there are no meaningful regulations of these products, and that none of the e-cigs currently on the market have been systematically reviewed by the FDA.

Vaping was invented decades ago, but emerged in its modern form in the mid-2000s as a safer alternative to combusting and inhaling tobacco or cannabis products. “E-cigarettes” have been marketed as a way for smokers to transition away from cigarettes altogether, while some cannabis users prefer vaping flower or concentrates as a gentler and more therapeutic alternative to smoking traditionally. What Are the Risks?

The mysterious pulmonary illness popping up around the country appears to be an inhalation injury, likely resulting from the body reacting to a specific ingredient in the vape liquid. The symptoms, including shortness of breath, fatigue, chest pain and vomiting, have been associated with an illness known as lipoid pneumonia and are caused when carrier oils are vaporized at high temperatures and then recondensed in the lung tissue, damaging cells and affecting the lungs’ ability to exchange gases. That can decrease the amount of oxygen that gets to a person’s bloodstream, and cause their lungs to fill with fluid. One such oil has been identified by an FDA investigation as vitamin E acetate, an oil derived from vitamin E that has been found to be a common ingredient in many of the victims’ cases. Commonly used as a vitamin supplement and in topical skin treatments, vitamin E acetate is safe to swallow, but turns out to be dangerous when vaporized, as it coats the lungs with oil and leads to the pneumonia-like illness.

What Can I Do to Protect Myself?

Because of a lack of oversight, there is always a risk in consuming an unregulated product. Most of the recent victims had been using THC vape cartridges purchased on the underground market, but many reported using both cannabis and nicotine vapes. According to Dr. Scott Gottlieb, the former commissioner of the Food and Drug Administration, “This is probably going to be associated with illegal products. It’s not like the major manufacturers have suddenly changed their ingredients,” he said. “It’s probably something new that has been introduced into the market by an illegal manufacturer, either a new flavor or a new way to emulsify THC that is causing these injuries.” Until we have more information on the dangers posed by certain vape ingredients, or stricter regulations on their production, consumers should use vapes at their own risk. The FDA and the CDC have issued a common sense warning: “If you are concerned about these specific health risks, consider refraining from the use of e- cigarette products.”

In the most recent news, the Trump administration and the FDA would like to ban flavored e-cigarettes, leaving only tobacco-flavored vape juice available for purchase in stores or online. Flavors like mint, mango and other fruits make up 80% of the $9 billion total sales of Juuls in the US, and many believe that these flavors are deliberately marketed toward young people, although they are enjoyed by vapers of all ages. A Juul spokesman recently said that the company strongly agrees with “aggressive category- wide action on flavored products. We will fully comply with the final FDA policy when effective.” In any case, we already know that 8 million adults and 5 million children, or more than 25% of high school students in the US, have reported using e-cigs regularly. The time is now to start researching and regulating these popular devices so that accurate information can be made available to healthcare professionals and the public, and proper harm reduction practices can be put in place. So, is vaping dangerous? While evidence points to vaping as a safer alternative to smoking, until we have all of the information, the long-term risks of vaping remain to be seen. 4/20: Do its origins appear in Lovecraft’s writings?

H.P. Lovecraft wrote these words in 1936, describing a psychoactive plant that may sound familiar to some readers:

“I had encountered at last one of those curious mirage-plants about which so many of our men told stories. Anderson had warned me of them, and described their appearance very closely – the shaggy stalk, the spiky leaves, and the mottled blossoms whose gaseous, dream-breeding exhalations penetrate every existing make of mask.”

“In The Walls of Eryx” was published in Weird Tales Magazine in 1939, and includes a scene that some Lovecraft fans believe to be the true origin story of 4/20. In the story, the main character has a somewhat psychedelic experience while navigating a maze on the planet Venus, and it all goes down at a strangely specific time of day:

“Although everything was spinning perilously, I tried to start in the right direction and hack my way ahead. My route must have been far from straight, for it seemed hours before I was free of the mirage- plant’s pervasive influence. Gradually the dancing lights began to disappear, and the shimmering spectral scenery began to assume the aspect of solidity. When I did get wholly clear, I looked at my watch and was astonished to find the time was only 4:20. Though eternities had seemed to pass, the whole experience could have consumed little more than a half-hour.”

While there are many theories as to the origin of the 4/20 as a symbol for cannabis, this one may certainly be the oldest written version, and that’s not the only mention of cannabis in Lovecraft’s work. In the well-known story “The Call of Cthulhu” (1926), Lovecraft reveals that Abdul Alhazred, who wrote the Necronomicon, (known as Al Azif in Arabic), was actually an avid user of and opium. In the Necronomicon, Lovecraft refers to a “strange grass,” or “that grass that gives the mind great power to travel tremendous distances into the heavens, as also into the hells.” Even Lovecraft’s god-like Ancient Ones were known to partake: “And they burn unlawful grasses and herbs, and raise tremendous Evils, and their Words are never written down, it is said.”

Writers, artists and scientists have used cannabis to enhance creativity and cultivate new ideas for centuries, and the so-called “Lovecraft Circle” was no exception. Fellow writers and friends of Lovecraft, including Clark Ashton Smith and Robert E Howard, also wrote about hashish.

In some of his writings, Lovecraft appears quite anti-intoxication, citing his fear of disturbing the delicate balance that fueled his imagination. But even though he likely avoided intoxicating substances himself, he definitely seemed curious about the experience of those who didn’t. It’s Festival Season! Your guide to safe, secure and sensible cannabis use this summer

Let’s face it, smoking weed at music festivals is nothing new — 50 years ago Woodstock became the earth mother of the modern music festival experience, and you better believe people were sparking up in the fields at Yasgur’s farm. And they weren’t the first ones, either — marijuana and music have been a match made in heaven for pretty much as long as humans have been performing and enjoying live music. Cannabis heightens the senses, relaxes the body and activates the brain’s pleasure center. It’s safer than alcohol, doesn’t cause rowdiness or violence, and doesn’t impair your ability to drive home in the same way that drinking does. Today, as cannabis legalization sweeps the nation and more concert attendees may prefer to enjoy some cannabis during the show, it is important to keep in mind that music festivals are not all tie dye and peace signs. Here are some tips and tricks for the cannabis-loving music fan (and everyone else!) to ensure a safe and enjoyable festival season.

Pack wisely. Whether or not you are a cannabis enthusiast, packing for a music festival is crucial to having a good time. Prepare a checklist before you leave home (look online for examples), and ensure that your tickets are accessible! Essentials include cash, an ID, reusable water bottle, sunscreen, bug spray, comfortable shoes and a method of charging your phone. Keep in mind that many festivals won’t allow any glass inside, so be sure your alcohol and snacks are in plastic or cans, and leave your dab rig and blow torch at home. If you are planning on bringing anything that could be perceived as drugs or paraphernalia, it’s a good idea to pack it away securely in the trunk of the vehicle, and consider using a travel lock for your tent or backpack.

Know your rights (and local laws). Lucky for those of us in the Northeastern US, all seven New England states have some form of cannabis legalization or decriminalization/medical law in place, so the odds of getting in legal trouble for traveling with marijuana are lower than in other, less progressive parts of the country. That being said, it remains illegal in most places to consume cannabis in public, operate a vehicle after consuming and sell cannabis to others. Before heading to a festival, educate yourself on the local cannabis laws, as well as your rights in the case of a police/security encounter (eg, never consent to a search of your property). If you do find yourself answering law enforcement inquiries, remember to ask if you are being detained, exercise your right to remain silent and have a friend record the encounter just in case. If you’re a medical patient, it might be a good idea to keep your patient card on you, although it won’t do much to protect you if you’ve broken the law.

Be aware of your surroundings. Although consumption of cannabis is technically illegal at most public events, it is often tolerated in the setting of a music festival or concert. Discretion is key to getting your cannabis into the venue, as well as enjoying it once you’re inside. First, choose the form of cannabis that fits the bill — vape pens and edibles are both super discreet, but it can be easy to take too much, while a glass piece and grinder might be a little bulky in your fanny pack. My favorite is a classic (or a few), rolled up before the show and tucked safely into a cigarette pack, wallet or undergarment. Whatever your preferred method, remember to “start low and go slow” when it comes to dosage, and use your best judgement about where/when is the best time to light up.

Music Festival Discretion – Dos and Don’ts Do wait for the right moment (hint: during the show is better than before or after). Do go toward the center of the crowd, and blow smoke downward. Do have a buddy (and a meeting spot in case you are separated). Do keep your phone on you. Do take a break if you over-consume or feel overwhelmed — drink water, seek shade and find a place to sit down away from crowds.

Don’t consume near families/kids. Don’t accept cannabis, alcohol or any substances from strangers. Don’t be afraid to tell security if someone makes you feel uncomfortable in any way, or seek medical attention if you or one of your friends is in need.

Most of all, don’t be a dick. The magic of the music festival experience relies on the kindness and compassion of all who attend, and looking out for each other is part of the peace, love and positive vibes, man. RI is home to some incredible music festivals, so I hope you get the chance to get out there this summer, and maybe you’ll even find yourself moving and grooving while sharing a toke among friends.

Just Be Patient: Our expert offers step by step instructions on procuring a medical marijuana license

Friends, family and complete strangers often express to me their interest in the benefits of medical marijuana, but hesitate when I ask them if they have considered becoming a medical marijuana patient. Their hesitation often has to do with the doctor approval process, navigating the application or their fear of being placed on some government blacklist. All of which are totally understandable — between the paperwork, annual cost and legal gray area of federal prohibition versus state law, it’s easy to see how anyone could be intimidated by the process. So here is a simple guide to help those interested take the first steps toward obtaining a medical marijuana patient card.

Check with a doctor

If you have a good relationship with your primary care doctor or a specialist, they are probably aware of your health issues and previous treatments and may be more willing than you think to approve your use of medical marijuana. Still, it is important for patients, especially those with more serious health issues, to have an in-depth conversation with a doctor before embarking on their medical marijuana journey, as some delivery methods or medicated products may not be suitable for everyone.

Some people might not have the established patient/doctor relationship — or even the health insurance — necessary to consult with a primary care or specialist about their desire to try medical marijuana, or the doctor may not feel comfortable approving it based on their limited relationship with a young patient (versus an older patient who may have many years of documented health issues). If that is the case for you, you still have options. There are several practitioners in Rhode Island and Massachusetts who specialize in medical marijuana and are qualified to approve your use of cannabis following a consultation appointment. These services are offered by CannaCare Docs, True Herbal Consults and B&B Consulting.

Keep in mind that you must have one of the state-approved qualifying debilitating medical conditions in order to apply for a medical marijuana license; chronic pain is commonly cited and PTSD has been recently added to the list in RI (check out the full list on the Department of Health website at health.ri.gov).

Application

If you use one of the aforementioned consulting services, you will be able to fill out the application in the office during your appointment, and the staff on site can answer questions. You will decide whether you would like to appoint an authorized buyer to visit the dispensaries on your behalf or choose a caregiver who will grow your medicine for you. You also have the option to grow your own medicine at home, but you will need to indicate your desire to do so on your application.

Send money, receive letter, obtain photo ID

Finally, send your application (including practitioner form) and $50 to the RI Department of Health, and you will receive a return letter instructing you to have your ID photo taken at the Department of Health building on Capitol Hill. The medical marijuana office is only open for photos from 1 – 3pm, but they will print out your card in minutes and you will officially be a Rhode Island medical marijuana patient.

Shop, grow, medicate!

Now, all you have to do is decide where to get your medicine. If you are growing your own or relying on a caregiver, the process is a little more complicated, but you can always just walk into one of our three medical dispensaries — GreenLeaf in Portsmouth, Summit in Warwick or The Slater Center in Providence — to purchase flower, concentrates, edibles and more.

It is important to remember that changes in laws and regulations could affect patients. As the state moves to add more dispensary licenses (or not), protect a patient’s right to home grow (or not) and eventually create an adult-use system that will operate alongside our medical program, it is everyone’s responsibility to pay attention and stand up for our fellow patients and caregivers. Munchies: CBD in food remains a gray area

The distinctions between food, drugs and medicine can be unclear and overlapping, and the lines separating them are often contrived by human institutions. One such entity is the Food and Drug Administration (FDA), which is now becoming tangled up in the regulation of the CBD products that are the fastest-growing new health food craze. Industrial hemp is now federally legal to grow and process, and we have all seen the resulting influx of CBD products being sold in gas stations, liquor stores and grocery stores, but when it comes to CBD in food products, the regulatory roll-out has been more complicated.

The Hemp Business Journal estimates that the market for hemp-based CBD products will grow from $390 million in 2018 to $1.3 billion by 2022. The majority of CBD products that we see being sold are derived from industrial hemp, which is why there is a difference between the CBD oil you buy in a gas station and the one you purchase at one of our three state medical marijuana dispensaries. Both have little-to-no THC (the psychoactive compound in cannabis), but because hemp-derived CBD products are largely unregulated, there aren’t the same requirements for purity testing and quality control. The federal government permits the transportation of hemp products across state lines as long as they meet a standard of 99.3% purity, meaning there is less than 0.3% THC in the product. However, a 2017 University of Pennsylvania study found that nearly 70% of CBD products sold online either contain more or less of the compound than their labels say. Even though CBD is extremely safe, accurate labeling and dosing is still important, especially for new consumers.

Most hemp-derived CBD products sold in RI were grown and processed elsewhere, but local CBD producers are now starting to hit the ground running. Most notably, SODCO is entering the industrial hemp space, and as experienced growers of potatoes, corn and turf for generations, I think we can expect to see a positive impact on the RI CBD market in the next year or so. As with anything, consumers and businesses should prioritize purchasing CBD products from local producers whenever possible.

So when it comes to food, drugs and medicine, where does CBD land? It depends on who you ask. CBD enthusiasts and those producing and selling it will probably agree that it can be all three – CBD is widely touted for its health benefits, from relieving anxiety and stress to helping with sleep problems and joint pain. It helps bring balance to our endocannabinoid system, which basically just makes us feel better, and it is known to be the safest and most accessible form of cannabis medicine available. So why not ingest it in any form you like, including food and drink?

According to the FDA, which has approved a CBD-derived pharmaceutical for treating seizures called Epidiolex, the distinction between food and drug is clear. The Food, Drugs and Cosmetics Act of 1938 prohibits the introduction of approved active ingredients into dietary supplements or food products, so the legality of CBD food and beverage products, or even selling CBD products as health and wellness supplements, remains a gray area where the federal government is concerned. Additionally, state health departments generally have rules prohibiting introducing additives into food and drinks, and there have been several cases where the Health Department has attempted to interfere with local juice bars and coffee shops that are advertising CBD shots as a healthy addition to your favorite beverage.

Despite these uncertainties, you can find CBD-infused beverages at Crazy Burger Cafe & Juice Bar in Narragansett, Kwench Juice Cafe in PVD, and Raw Bob’s Juicery in East Greenwich. Former URI basketball player-turned-CBD entrepreneur Ibn Bakari of Harmless Health has been teaming up with local businesses to bring CBD into the mainstream of food and beverages in Rhode Island through education. One of his partners is the TwoTen Oyster Bar & Grill, which now features CBD-infused cocktails on its menu.

As is typical with cannabis-related regulations, state policies vary widely, and some states, like Rhode Island, are still figuring out how to deal with CBD when it comes to food. Some states (NY, CA and ME) have chosen to ban the use of CBD in food products, while in Colorado all parts of the hemp plant can be added to food. Either way, if local businesses are interested in marketing CBD products, they need to be careful of the language they use, as the FDA has sent numerous warning letters to companies for making health claims without federal approval. We also need to make sure that our state regulations are crafted in a way that benefits consumers, producers and businesses alike. The governor’s recent budget article proposes limiting CBD product sales to only those over 21, and also imposes an 80% wholesale tax on CBD, which would surely have a negative impact on small local businesses interested in earning their share of the CBD pie. Just some food for thought…

Equity Now: Cannabis Coalition demands justice through legalization Most of us understand that the time to legalize cannabis for adult use in RI was like, yesterday. Year after year, activists have been told that the legislature prefers to “wait and see” how other states (especially Massachusetts) roll out regulations so that RI can legalize “the right way” when the time comes. Now it appears that the governor is on board to legalize this year, but Article 20 of her recent budget proposal has left most of us scratching our heads, wondering if those tasked with drafting regulations have been paying attention at all.

Besides the prohibition of home grow, undue financial and logistical burdens on patients, and the abhorrent distribution of cannabis industry revenue [See also: “Governor’s Proposal to Legalize Recreational Cannabis – A Self-Inflicted Wound” motifri.com/recr-cann-legal-opinion], to me, the most glaring error in Article 20 is the complete omission of any kind of social justice provision to address the harms caused by the war on marijuana.

We know that laws surrounding the criminalization of cannabis have always been disproportionately enforced on communities of color and that black Americans are almost four times as likely to be arrested for a marijuana offense than whites, despite similar usage rates. So where do we begin when it comes to addressing social justice through cannabis legalization? Community Reinvestment Fund to support communities harmed by the prohibition of marijuana by providing grant support to Rhode Island non-profits and state agencies for socially beneficial services, such as public health initiatives and re-entry programs for formerly incarcerated individuals — all funded by a portion of the revenue from legal cannabis. Social Equity Program that provides interest-free loans and technical assistance to marijuana businesses that are owned by folks from historically disadvantaged backgrounds. Automatic expungement for all prior low-level marijuana offenses, including cultivation and distribution.

These are just starting points, and the road to sensible cannabis policy is certainly long and evolving, but the good news is that we don’t have to reinvent the wheel here. In neighboring Massachusetts — the same place legislators have been so eager to keep an eye on — the Cannabis Control Commission has shown admirable commitment to their social equity program and has set a new standard for what state regulations should do as a bare minimum to address some of the harms of prohibition.

The lack of any kind of language addressing social justice in Article 20 shows that ensuring a just and accessible cannabis industry is not important to the powers-that-be in RI. Whether ignorance or arrogance is to blame, it is unacceptable that RI legislators aren’t having these conversations at the state house. Rep. Marcia Ranglin-Vassell’s Rhode Island Cannabis Equity Act (HB 5795) is a direct response to the governor’s proposal and provides a great start to get the discussion moving forward.

In its current iteration, the governor’s budget proposal will not eliminate the illicit market for cannabis, protect our youth or help Rhode Island patients access safe medicine. Furthermore, it will continue to perpetuate the harms of cannabis prohibition by failing to acknowledge that they even exist. If we are going to move forward with legalization this year (which we should!), then it is our responsibility to ensure that the communities most impacted by marijuana prohibition aren’t left behind in the process.

If it weren’t so disappointing, it would almost be comical that RI state leadership actually managed to propose a legalization measure that almost no one feels comfortable supporting. Even long-time legalization proponents like myself are struggling to get behind Article 20, despite it being our best chance at legalization yet. But rather than thinking “too little, too late,” we should see this attempt as a rude awakening that the RI legislators have a lot to learn when it comes to legalizing “the right way,” and it’s up to us to educate them.

A coalition of concerned citizens, community organizers and public servants will be meeting Monday, May 6 at 6pm at United Way of Rhode Island (50 Valley St, Providence) to discuss HB 5795, Article 20, and how to move forward.

The Answer?: Medical marijuana could help solve the opioid addiction crisis

Despite having only 20% of the world’s population, the United States ingests 99% of the world supply of hydrocodone, a commonly used opioid medication. Opioid overdose has now surpassed car accidents as the leading cause of accidental death in the United States, and many of those deaths originated with prescribed medication. Forty-nine percent of pain patients leave their doctor’s office with an opioid prescription, and there’s been a four-fold increase in prescriptions since 1999.

Sixty percent of overdose victims have an opioid prescription, and most of those prescriptions are for treating pain. In addition to being treated with opioids, chronic pain is one of most commonly cited qualifying conditions for obtaining a medical marijuana patient card. Both medicines work by blocking pain signals in the nervous system, but as medical marijuana becomes more prevalent, we are learning more about how they differ, how they interact and how cannabis could be part of the solution to the ongoing opioid epidemic.

Evidence shows that patients dealing with pain can find greater relief from combining opioid treatment with medical marijuana, due to the synergistic effect of the two drugs in the human body. In fact, studies have shown that THC, when combined with opioids, works to reduce pain even in extremely low doses that wouldn’t be effective when used alone. Cannabis enhances the efficacy of opioids by preserving and potentiating the function of the medication, which can reduce the harms associated with using opioids by lowering the effective dose. The therapeutic index is widened as the effective dose is lowered, while the lethal dose remains the same. Using opioids alone, patients can develop a high tolerance, leading to a higher effective dose for treating their pain. Put simply, higher doses are linked to higher risks of overdose, and by lowering one’s effective dose, cannabis can help some patients move away from relying on opioids for pain management. [Note: Because everyone responds to cannabis medicine differently, it remains important to choose strains and consumption methods carefully, to “start low and go slow” when it comes to dosing and to always consult a doctor before drastically altering one’s treatment plan.]

Cannabidiol (CBD), in addition to its anti-inflammatory and pain-reducing properties, has been shown to reduce the rewarding effects of opioids by binding to the brain’s serotonin receptors, curbing cravings and even diminishing the symptoms associated with withdrawal (eg, nausea, vomiting, insomnia and muscle spasms). A 2016 University of Michigan study of 244 patients using both cannabis and opioids found decreased side effects from other medications, improved quality of life in 45% of participants and a 64% average reduction in opioid use overall. In the same year, an Israeli study of 176 patients showed that 44% were able to discontinue opioid use entirely after 7 months of cannabis treatment.

This is not to say that cannabis can replace opioid use for all pain patients; rather, some patients may be able to choose cannabis as a safer, less addictive option for pain management, which can be effective both for weaning them off of opioid medication and for treating their chronic pain issues. The Drug Policy Alliance states that one recent study found “80% of medical marijuana patients reported substituting marijuana for prescribed medications, particularly among patients with pain-related conditions.” Cannabis has been proven to have an extremely low risk of dependence and diversion, especially compared with the side effects and risks associated with long-term opioid use.

To this end, researchers also have seen measurable results on a larger scale. In states that have some form of legalized cannabis, there has been an average of a 25% reduction in opioid overdoses, with overdose rates continuing to decrease each year after medical marijuana laws were passed, according to the Journal of American Medical Association. In 13 states, opiate-related deaths decreased by 33% in the following six years after medical marijuana was passed. In 2018, a study found that “states with medical dispensaries saw 3.7 million fewer daily doses of prescription opioids and states that allowed for home cultivation of marijuana saw 1.7 million fewer daily doses” and that “legal access to medical marijuana has been associated with a 23% reduction in opioid dependence or abuse-related hospitalizations and 15% fewer opioid treatment admissions” (Drug Policy Alliance).

The bottom line is that when it comes to the opioid epidemic, all possible pieces of the solution need to be considered, especially ones with as low of a risk-to-reward ratio as medical marijuana. Ninety-eight percent of Americans live in states with some form of legal access to marijuana, but state policies can differ greatly, and until broader legalization opens up access to more people, we rely on state medical marijuana programs to meet the needs of pain patients. Currently, only four states (NY, IL, PA and NJ) consider opioid dependence to be a legitimate qualifying condition for medical marijuana, and although patient advocates in RI have been pushing to add opioid use disorder to the qualifying conditions list, it will not be an easy victory. A hearing was held at the Department of Health on the topic in February, but was opposed by several community “health experts.”

Baked!: Try these healthy cannabis-infused recipes for spring

Whether you are slimming down for summer or just enjoy want to fresh seasonal produce, try these simple recipes (with or without the cannabis) to bring more health and happiness to your home this spring!

CBD Smoothie

Combine in a blender until smooth:

2 cups fresh spinach or kale (stems removed) 1 frozen banana 1 cup frozen fruit of choice (try strawberries, pineapple, or mango) 1 Tbsp hemp hearts 1 tsp full-spectrum CBD oil ¼ cup almond milk or coconut water (add more while blending until desired smoothie thickness is reached)

Optional additions include 1/4 cup Greek yogurt, 2 Tbsp hemp protein powder, 1/4 cup nut butter, 1 Tbsp chia seeds, 1 tsp turmeric and/or 1 tsp spirulina. You could also add cannabis-infused coconut oil or decarboxylated flower or for more medicinal benefits!

“Green Goddess” Spring Salad

For the dressing:

Blend two scallions and half a jalapeño pepper in a blender. Add 2/3 cup Greek yogurt, 1/3 cup cannabis-infused oil, 1/2 cup lightly packed cilantro, 2 Tbsp lime juice, 1 Tbsp maple syrup or honey and 1/2 tsp kosher salt, and blend until smooth.

Drizzle over local seasonal produce like butter lettuce, radishes and snap peas, or just dip carrots in the dressing for a healthy snack!

Source: acouplecooks.com/healthy-green-goddess-dressing

Cannabis Carrot Cake

This healthy cannabis carrot cake is a great way to upgrade your spring baking game — just remember to always keep cannabis infusions and baked goods safely away from children. Wet Ingredients:

1 banana, mashed 2 large eggs 1/4 cup nonfat Greek yogurt 2 Tbsp cannabis-infused coconut oil 1 tsp vanilla extract 1 cup unsweetened almond milk 1/2 cup maple syrup or honey 1 cup grated carrots

Dry Ingredients:

1 1/2 cups whole wheat flour 1/2 tsp baking powder 1/2 tsp baking soda 1 1/2 tsp ground cinnamon 1/8 teaspoon salt

For the Frosting:

1/2 cup fat-free cream cheese 1/2 cup vanilla Greek yogurt 2 Tbsp maple syrup

Instructions:

Preheat oven to 350 degrees F and spray a 9×9 inch pan with coconut oil cooking spray. Set aside. In a large bowl, mix together wet ingredients minus the coconut oil. In a medium bowl, mix together dry ingredients. Set aside. Finely grate 2 to 3 carrots. Use a paper towel to squeeze as much of the moisture out as possible. Add carrots to wet ingredients and mix. Then, add in dry ingredients and mix. Finally add in melted coconut oil and mix. Transfer batter into a 9×9 inch pan and into the oven. Bake at 350ºF for 35-40 minutes. Let cool for at least an hour before frosting.

Source: fitfoodiefinds.com/lightened-carrot-cake

Acting Up: Our expert provides a primer on cannabis activism

Cannabis legalization is not inevitable, and recent progress is in large part thanks to the hard work of drug policy activists and advocates for medical marijuana who for decades haven’t stopped fighting for the rights of cannabis users in the face of victories and defeats alike.

I became involved in cannabis activism back in college when I joined Students for Sensible Drug Policy (see my November column for more on the work they do at motifri.com/ssdp). I was, and continue to be, blown away by the level of critical thought, coordination and energy that it takes to organize around drug policy reform. I quickly realized that the War on Drugs is one of the most important and intersectional issues facing our country, and that legalizing cannabis is not just about protecting the rights of individuals to get high. It’s the first step on the path toward more science-based and compassionate drug policies for everyone.

The cannabis industry, which is relatively new and grounded in grassroots activism, has both the opportunity and the responsibility to be a more equitable, diverse and inclusive industry than its white- male-dominated predecessors. As of now, the industry is more gender-diverse than other mature industries, but it continues to fall short when it comes to racial diversity (Source: New Frontier Data). Activism is absolutely necessary for the cannabis industry to continue on the journey toward equity that was started so many years ago, and it’s now easier than ever to be an activist.

Cannabis Activism 101

Educate yourself on the history, science and policies surrounding cannabis prohibition, health benefits and legalization status in your area. Check out Michael Bilow’s recent columns on Motif’s website for the latest on RI legalization efforts (motifri.com/recr-cann-legal-opinion).

Engage with other like-minded individuals, or have a conversation with someone unfamiliar with the issue. Online resources like social media, podcasts and email newsletters make it easier than ever to stay on top of ever-changing news and policy updates. For more information, NORML, , Marijuana Today and Marijuana Majority are all worth a follow.

Advocate for yourself and your community, either in writing or in person. Call or write to your representatives in the State House or write a letter to the editor of your local newspaper if you really want to speak your mind. But the best way to show up for cannabis reform is to show up! Many of the details of cannabis regulation will be decided at the municipal level, so one of the best things you can do is to become a familiar face at your local government meetings and hearings; agendas are often posted online (check to see if cannabis will be discussed), and there is almost always time allotted for public comment. There are also an increasing number of events hosted by organizations like Elevate Northeast and NECANN, as well as public rallies like the Boston Freedom Rally, where you can be among other citizen-activists.

Donate to organizations that know how to get the job done! Students for Sensible Drug Policy, Americans for Safe Access and the Drug Policy Alliance are all excellent organizations that are worthy of your donation dollars, especially if you are still feeling a little shy about sharing your activist voice with the world.

Vote! Unfortunately, the Rhode Island constitution does not allow for the legalization of cannabis through a ballot measure, but there is always a chance that a referendum on cannabis could come up that will need your vote. It’s also important to vote for representatives who will stand up for what you believe in!

Activism is a great way to learn, meet people and engage in meaningful conversations about important issues. Just remember to do what fits your schedule and lifestyle, always meet people where they’re at and don’t be too hard on yourself. Stay focused on what you are fighting for and why — and don’t settle for less! The cannabis community is thriving and growing all the time, so whether you get involved because you care about social justice, public policy or individual freedom, or just because you are an enthusiastic consumer, you’re in good company!