The three betrayals of the medical cannabis growing activist: From multiple victimhood to reconstruction, redemption and activism

Classical cannabinoid receptors as target in cancer-induced bone pain: a systematic review, meta-analysis and bioinformatics validation

To test the hypothesis that genetic and pharmacological modulation of the classical cannabinoid type 1 (CB1) and 2 (CB2) receptors attenuate cancer-induced bone pain, we searched Medline, Web of Science and Scopus for relevant skeletal and non-skeletal cancer studies from inception to July 28, 2022. We identified 29 animal and 35 human studies. In mice, a meta-analysis of pooled studies showed that treatment of osteolysis-bearing males with the endocannabinoids AEA and 2-AG (mean difference [MD] - 24.83, 95% confidence interval [95%CI] - 34.89, - 14.76, p < 0.00001) or the synthetic cannabinoid (CB) agonists ACPA, WIN55,212-2, CP55,940 (CB1/2-non-selective) and AM1241 (CB2-selective) (MD - 28.73, 95%CI - 45.43, - 12.02, p = 0.0008) are associated with significant reduction in paw withdrawal frequency. Consistently, the synthetic agonists AM1241 and JWH015 (CB2-selective) increased paw withdrawal threshold (MD 0.89, 95%CI 0.79, 0.99, p < 0.00001), and ACEA (CB1-selective), AM1241 and JWH015 (CB2-selective) reduced spontaneous flinches (MD - 4.85, 95%CI - 6.74, - 2.96, p < 0. 00001) in osteolysis-bearing male mice. In rats, significant increase in paw withdrawal threshold is associated with the administration of ACEA and WIN55,212-2 (CB1/2-non-selective), JWH015 and AM1241 (CB2-selective) in osteolysis-bearing females (MD 8.18, 95%CI 6.14, 10.21, p < 0.00001), and treatment with AM1241 (CB2-selective) increased paw withdrawal thermal latency in males (mean difference [MD]: 3.94, 95%CI 2.13, 5.75, p < 0.0001), confirming the analgesic capabilities of CB1/2 ligands in rodents. In human, treatment of cancer patients with medical cannabis (standardized MD - 0.19, 95%CI - 0.35, - 0.02, p = 0.03) and the plant-derived delta-9-THC (20 mg) (MD 3.29, CI 2.24, 4.33, p < 0.00001) or its synthetic derivative NIB (4 mg) (MD 2.55, 95%CI 1.58, 3.51, p < 0.00001) are associated with reduction in pain intensity. Bioinformatics validation of KEGG, GO and MPO pathway, function and process enrichment analysis of mouse, rat and human data revealed that CB1 and CB2 receptors are enriched in a cocktail of nociceptive and sensory perception, inflammatory, immune-modulatory, and cancer pathways. Thus, we cautiously conclude that pharmacological modulators of CB1/2 receptors show promise in the treatment of cancer-induced bone pain, however further assessment of their effects on bone pain in genetically engineered animal models and cancer patients is warranted.

Conflict and social control among cannabis growers

AIMS

Illegal drug markets are often assumed to be violent and predatory due to the absence of third-party enforcement. While cannabis markets are generally considered to be relatively more peaceful, there has been little investigation of the levels of conflict and victimization among small-scale cannabis growers, particularly under different cannabis policy and enforcement settings. This paper explores prevalence and predictors of conflict and social control among small-scale cannabis growers.

METHODS

The data were obtained from an online convenience survey of small-scale cannabis growers from 13 countries (Austria, Canada, Denmark, Finland, France, Germany, Israel, New Zealand, Portugal, Switzerland, United Kingdom, United States, and Uruguay) from August 2020 to September 2021 (N = 5667). Key measures collected included the types of victimization due to cannabis growing, the perpetrators of these predatory actions, reasons for the conflict, and the grower's response to being victimized. Multivariate logistic regression models were used to identify predictors of different types of victimization and social control responses among cannabis cultivators.

RESULTS

Most growers (76 %) never directly experienced violence or other victimization related to their cannabis cultivation. However, about one-quarter of growers had been victimized at some point, mostly involving theft, with physical violence rare. Growing outdoors, growing with others, growing more plants, and being a more seasoned grower increased the risk of victimization. Growers who were motivated by profit were more susceptible to theft. Surprisingly, growers in legal recreational jurisdictions experienced greater levels of theft and violent victimization than growers in illegal jurisdictions. Nonviolent social control responses predominated among the growers, mostly characterized by toleration but also avoidance and negotiation.

CONCLUSION

While most growers reported no victimization, a substantial minority did so, largely theft rather than violence, and typically did not report employing retaliatory violence. Social control responses were mostly nonviolent. These findings varied under different cannabis policy and enforcement environments. Cannabis legalization does not eliminate opportunities for theft and violence related to cannabis cultivation.

"It's a big added stress on top of being so ill": The challenges facing people prescribed cannabis in the UK

BACKGROUND

This paper reports on the first qualitative study to interview people prescribed cannabis in the UK. Cannabis is a class B controlled substance under the 1971 Misuse of Drugs (MoD) Act, but a 2018 change to UK regulations provided for the prescription of cannabis for medical purposes. Relatively few people have been able to access a prescription, despite this policy change. This paper examines their experiences.

METHODS

Qualitative, semi-structured interviews were conducted with 24 people with a prescription for cannabis, or their carers. Data was analysed using a reflextive thematic analysis approach. The findings are discussed using a zemiology (social harms) perspective which provides a language for critical reflection on the current cannabis policy context.

RESULTS

All participants reported that cannabis had significantly improved their mental and/or physical health, across a broad range of conditions. Many had been able to reduce their use of conventional medicines and reported that cannabis had relatively few side effects. Despite the potentially life-enhancing benefits of cannabis medicine, patients in the UK face multiple barriers to access. These include a lack of funding streams, bureaucratic supply problems, and a lack of training for doctors and police. Even for the few people able to obtain a prescription, the ongoing criminalisation of cannabis in the UK contributed to their experiences of stigmatisation. This often made it difficult and anxiety-inducing to take their medicine in public spaces.

CONCLUSION

The UK government's lack of implementation of medical cannabis legalisation, combined with their ongoing prohibition position, is producing multiple harms to people who need cannabis medicine. The policy context is perpetuating stigmatising attitudes to cannabis which, as we demonstrate, contribute to social harms. We make recommendations on equality of patient access, and highlight the importance of education and policy change as means of combatting stigma.

More harm than good? Cannabis, harm and the misuse of drugs act

Purpose

This paper aims to consider the nature of cannabis-related harms under the UK’s Misuse of Drugs Act (MDA). Written for the specific context of this four-paper special section on 50 years of the MDA, it argues that the MDA may cause more harm than it prevents.

Design/methodology/approach

An opinion piece offering a structured overview of cannabis-related harms under prohibition. It summarises existing evidence of the ways in which prohibition may exacerbate existing – and create new – harms related to the production, distribution, use and control of cannabis.

Findings

The paper argues that prohibition of cannabis under the MDA may cause more harm than it prevents.

Originality/value

It has long been argued that the MDA does not accurately or fairly reflect the harms of the substances it prohibits, and much existing research points to different ways in which drug prohibition can itself be harmful. The originality of this paper lies in bringing together these arguments and developing a framework for analysing the contribution of prohibition to drug-related harm.

Association of cannabinoid receptor modulation with normal and abnormal skeletal remodelling: A systematic review and meta-analysis of in vitro, in vivo and human studies

To address the inconsistent findings from studies that used different models to explore the role of classical cannabinoid type 1 (CB1) and 2 (CB2) receptors in skeletal remodelling, we searched Medline, Web of Science and Embase for relevant studies from inception to June 23, 2020. We identified 38 in vitro, 34 in vivo and 9 human studies. A meta-analysis of in vitro studies showed that exposure to the inverse-agonists AM251 (mean difference [MD]:-26.75, 95% confidence interval [CI]:-45.36,-8.14, p = 0.005), AM630 (standardised[std.] MD:-3.11, CI:-5.26,-0.97, p = 0.004; SR144528, std.MD:-4.88, CI -7.58,-2.18, p = 0.0004) and CBD (std.MD:-1.39, CI -2.64,-0.14, p = 0.03) is associated with reduced osteoclastogenesis, whereas the endocannabinoid 2-AG (std.MD:2.00, CI:0.11-3.89, p = 0.04) and CB2-selective agonist HU308 (MD:19.38, CI:11.75-27.01, p < 0.00001) were stimulatory. HU308 also enhanced osteoblast differentiation (std.MD:2.22, CI:0.95-3.50, p = 0.0006) and activity (std.MD:2.97, CI:1.22-4.71, p = 0.0008). In models of bone loss, CB1/2 deficiency enhanced peak bone volume (std.MD:3.70, CI:1.77-5.63, p = 0.0002) but reduced bone formation (std.MD:-0.54, CI:-0.90,-0.17, p = 0.004) in female mice. In male rats, CB1/2 deficiency (std.MD:2.31, CI:0.30-4.33, p = 0.02) and AM251 or CBD treatments (std.MD:2.19, CI:0.46-3.93, p = 0.01) enhanced bone volume. CB1/2 deficiency (std.MD:9.78, CI:4.96-14.61, p < 0.0001) and AM251 or AM630 treatments (std.MD:28.19, CI:19.13-37.25, p < 0.0001) were associated with osteoprotection. The CB2-selective agonists JWH133 and 4Q3C enhanced bone volume in arthritic rodents (std.MD:14.45, CI:2.08-26.81, p = 0.02). In human, CB2 SNPs (AA:rs2501431, MD:-0.28, CI:-0.55,-0.01, p = 0.04; CC:rs2501432, MD:-0.29, CI:-0.56,-0.02, p = 0.03) were associated with reduced bone mineral density, however the association of Marijuana use remains unclear. Thus, CB1/2 modulation is associated with altered bone metabolism, however findings are confounded by low study number and heterogenicity of models.

Hidden and uninterested populations: Methodological insights and unresolved issues from the study of Cannabis Social Clubs

Cannabis Social Clubs are typically non-profit associations established by adult users of cannabis, which produce and distribute cannabis among their members. Such associations can be found in several European countries and beyond, but with exception of Uruguay, they are illegal or otherwise operate at the margins of domestic drug control legislation, at risk for law enforcement detection. We have conducted several individual and collaborative studies on Cannabis Social Clubs and their key actors (e.g. Cannabis Social Clubs leaders, users affiliated as members, cannabis growers, other stakeholders), primarily drawing on qualitative methods (e.g. ethnographic fieldwork, interviews, qualitative media analyses) but also employing a quantitative approach (e.g. online surveys). In this article, we reflect on the research experiences of the authors in studying Cannabis Social Clubs, providing insights for future research in this area and within criminology and socio-legal studies. In particular, we aim to examine our approaches with regard to the recruitment of participants and research design, identifying good practices, but also discussing what the less successful strategies were. We draw on research conducted since 2014 in different countries, with different legal frameworks, which provides an opportunity for a comparative and more in-depth critical consideration of what might be helpful ways of reaching and researching hard-to-reach populations.

Introduction: cultivation, medication, activism and cannabis policy

Purpose

The purpose of this paper is to introduce the special issue on Illicit Cannabis Cultivation in a Time of Policy Change.

Design/methodology/approach

The paper reviews some of the different adaptations made by cannabis growers in countries where cannabis has not been legalised.

Findings

Cannabis growers are adjusting to different legal settings by focusing on home production. Participation in cultivation is a crime, but can also be activism: an effort to change the law. Medical use of cannabis is a particularly important driver here. Having to break the law to alleviate symptoms and treat illnesses provides both a greater sense of urgency and a level of sympathy not usually granted to illicit drug users.

Practical implications

Grass-roots advocacy may drive policy change.

Originality/value

This is an original assessment of current state of knowledge on cannabis cultivation in countries where cannabis cultivation remains restricted.