A new multi-million dollar study at Johns Hopkins University aims to analyze how patients nationwide respond to medical cannabis treatments. 

Johns Hopkins University, which championed one of the largest and most widely referenced studies on medical applications of psilocybin mushrooms, announced the launch of a medical cannabis study in the winter edition of their Brainwise newsletter. 

According to the newsletter, the study will take a nationally representative sample of about 10,000 medical cannabis patients in an attempt to “fill [the] information gap” that exists when comparing medical cannabis knowledge to other elements of modern medicine. In other words, they are attempting to learn just as much about cannabis and how it can be used to treat medical maladies as other potential treatments which have all typically undergone extensive peer-reviewed scrutiny before ever being used in a medical setting. Cannabis is already used nationwide to treat a range of ailments like pain management, anxiety and ADHD but little is certain about long-term practical efficacy of such treatments other than anecdotal information from people who say it helps them. 

“We have the availability of cannabis as a therapeutic, but we’re lacking the quality of data that we have with other medicines,” said a written statement by Ryan Vandrey, one of the initiative’s creators and a professor of psychiatry and behavioral sciences at the Johns Hopkins University School of Medicine. “Our mission with this research is to understand the health impacts of therapeutic cannabis use,”Vandrey said. “We hope to provide some starting points for understanding what types of products may or may not be helpful and what types of products may be more risky for use in certain populations or for certain therapeutic purposes.”

The initiative is supported by a five-year, $10 million grant from the National Institute on Drug Abuse and plans to collect data from patients such as methods of ingestion (smoking, edibles, vaping etc.), dosage, interactions with other medications and the chemical composition of different products. 

 “We’re tracking them with multiple assessments over the course of their first year with more tightly spaced assessments toward the beginning because our assumption is that as people are starting their medical cannabis journey, they’re likely going to try different products until they find the products that best help them with their symptoms,” said Johannes Thrul, associate professor of mental health at the Johns Hopkins Bloomberg School of Public Health who is collaborating on this project with Vandrey. 

One of the issues with quantifying, analyzing or studying cannabis in general is that it’s such a versatile plant that can be ingested and used in so many different fashions that it has somewhat puzzled medical and pharmaceutical professionals in the past who tend to rely on cut-and-dry medications which can be easily patented. This is not the case with cannabis products or cannabis users which tend to vary greatly. How does one compare the experience of dabbing to combustion of flower or distillate gummies to hash gummies without extensive study that, up until recently, was ineligible for any form of federal funding. The new Johns Hopkins study aims to put a dent in that research deficit. 

“Under the umbrella term of cannabis exist hundreds of products that are all different in very important and significant ways,” Vandrey said. “We’re trying to narrow the scope a little bit, find areas of real promise and focus the science on those.”

Vandrey said that the data from this study could have practical applications across the board from guiding decisions made in clinical settings, to legislative policy decisions, to providing regulations for additional clinical trials. This is even more evident based on the policy and clinical decisions which have already been made from the aforementioned psilocybin study which paved the way for decriminalization in several cities across the country as well as additional clinical trials and direct legalization for medical use in states like Oregon. 

The researchers at Johns Hopkins will be working closely with the National Institute on Drug Abuse as well as Realm of Caring, a Colorado-based nonprofit that provides information about cannabinoid therapies. The researchers will analyze and track data from patients over a year or more of their own respective cannabis-based treatments.

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Brightly colored fentanyl pressed into pills or in a chalky form—called rainbow fentanyl—was found in 18 states, a press release from the Drug Enforcement Administration (DEA) warns, and drug dealers getting “kids and young adults” hooked early on.

It was only a matter of time until fentanyl and other deadly drugs were marketed the way designer drugs are, as colorfully branded pills and in other forms.

“Rainbow fentanyl—fentanyl pills and powder that come in a variety of bright colors, shapes, and sizes—is a deliberate effort by drug traffickers to drive addiction amongst kids and young adults,” said DEA Administrator Anne Milgram. “The men and women of the DEA are relentlessly working to stop the trafficking of rainbow fentanyl and defeat the Mexican drug cartels that are responsible for the vast majority of the fentanyl that is being trafficked in the United States.”

While even the National Institute on Drug Abuse (NIDA) admits there has never been a fatal overdose recorded from cannabis alone—fentanyl is a completely different story, as it has a knack for stopping breathing.

There’s no other way to look at what’s happening in the United States with opioids as anything other than an epidemic. In fact, according to NIDA’s data, deaths involving synthetic opioids other than methadone—primarily fentanyl—continued their steady death march with 56,516 overdose deaths reported in 2020.

That number, 56,526 deaths, is in the ballpark of total U.S. military casualties during the Vietnam War recorded in the Defense Casualty Analysis System. Similarly, the Centers for Disease Control and Prevention (CDC) recorded 107,622 total drug overdoses in 2021, and say that the majority, or 66% of those deaths, are related to synthetic opioids like fentanyl. (The CDC also says an overdose from cannabis is “unlikely.”)

An overdose from accidentally taking a bit too much fentanyl, however, is likely. The DEA’s announcement reminds us that fentanyl is 50 times more potent than heroin and 100 times more potent than morphine. In other words, 2 mg of fentanyl, equal to 10-15 grains of table salt, can kill you. Obviously, street drugs don’t provide lab testing results—and the margin for error is as slim as 2 mg.

The opioid epidemic is a multifaceted problem, however. On the flip side of the opioid epidemic, there are also people with high-level pain who complain that they are denied opioids and falsely labeled addicts.

The DEA announcement blames cartels for the rise in rainbow fentanyl, explaining that the fentanyl available in the United States is primarily supplied by two criminal drug networks: the Sinaloa Cartel and the Jalisco New Generation Cartel (CJNG).

Uttam Dhillon, former acting administrator of the DEA, told Yahoo! News on September 1 that the Sinaloa cartel has ramped up pill production big time, and that DEA agents are now seizing millions of fentanyl pills in places such as Los Angeles.

“Even seeing just one lab in Mexico pressing pills was something unique that we were seeing. And this was only a few years ago,” Dhillon told Yahoo! News. “Now we’re seeing literally a million pills being seized in Los Angeles, for example, just a few months ago. So the growth has been massive.”

The DEA is fighting back with public awareness campaigns and FAQ sheets.

Launched in September 2021, the ”One Pill Can Kill” Public Awareness Campaign was launched by the DEA with a goal to educate Americans about the dangers of fake pills, which can be disguised as a less dangerous pill or in other ways. The DEA also provides more resources for parents that can be found on DEA’s Fentanyl Awareness page.

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More than 100,000 people succumbed to overdose deaths in the United States in the span of a year, a record death toll that underscores the continuing failure of the War on Drugs to keep the nation safe.

During the 12-month period ending April 2021, 100,306 Americans died of drug overdoses, according to provisional data released by the U.S. Centers for Disease Control and Prevention on Wednesday. Federal officials point to the coronavirus pandemic and the proliferation of powerful synthetic opioids including fentanyl as major contributors to the spike in overdose deaths over the past two years.

“These are numbers we have never seen before,” Dr. Nora Volkow, director of the National Institute on Drug Abuse, told the New York Times. Commenting on the human toll behind the statistics, Volkow noted that a majority of the deaths occurred among people aged 25 to 55.

“They leave behind friends, family and children, if they have children, so there are a lot of downstream consequences,” Dr. Volkow said. “This is a major challenge to our society.”

Overdose Deaths Add to Covid-19’s Toll

During the same time period, approximately 509,000 died from Covid-19 in the United States, according to figures from Johns Hopkins University, while millions were left isolated due to quarantines and business closures. Volkow noted that the pandemic also led to border shutdowns that made powerful synthetic opioids including fentanyl easier to smuggle into the country than naturally produced but less potent and thus more bulky drugs including morphine and heroin.

“What we’re seeing are the effects of these patterns of crisis and the appearance of more dangerous drugs at much lower prices,” Volkow said to CNN. “In a crisis of this magnitude, those already taking drugs may take higher amounts and those in recovery may relapse. It’s a phenomenon we’ve seen and perhaps could have predicted.”

The new data, representing deaths from May 2020 through April 2021, reflects a 28.5 percent increase in the number of fatal overdoses in the United States compared to the same time period one year earlier and the first time deaths have exceeded 100,000 in one year. Synthetic opioids including fentanyl were up 49 percent over the year before, contributing to the vast majority (64 percent) of overdose deaths. Stimulants including methamphetamines were involved in about a quarter of overdose deaths, a jump of 48 percent over the previous year. The data also show more modest increases in the number of overdose deaths caused by natural opioids, cocaine and prescription medications.

Dr. Volkow said that while some drug users intentionally seek out fentanyl, others “may not have wanted to take it. But that is what is being sold, and the risk of overdose is very high.”

The pandemic also decreased the availability and access to treatment for substance use disorders. As the country reopens and life begins to return to normal, overdose deaths are likely to remain high if access to drug treatment and other interventions is not improved, experts says.

“Even if Covid went away tomorrow, we’d still have a problem. What will have an impact is dramatic improvement to access to treatment,” said Dr. Andrew Kolodny, medical director of opioid policy research at the Brandeis University Heller School for Social Policy and Management.

“These are deaths in people with a preventable, treatable condition. The United States continues to fail on both fronts, both on preventing opioid addiction and treating addiction,” he continued, adding that President Joe Biden should act on his campaign promises to address the continuing opioid crisis.

Access to Treatment Saves Lives

The White House Office of National Drug Control Policy on Wednesday released model legislation to serve as a guideline for states to pass laws that increase access to naloxone, a life-saving drug that can reverse opioid overdoses. Other medications including buprenorphine can be prescribed to help those with opioid use disorder, but access to the drugs is also often limited. In October, the U.S. Department of Health and Human Services issued a plan to combat drug overdoses, including federal support for harm reduction and recovery services and provisions that lessen barriers to substance abuse treatment.

“If we really want to turn the corner, we have to get to a point where treatment for opioid addiction is easier to access than fentanyl, heroin, or prescription opioids are,” Kolodny said.

Beth Connolly, director of the Pew Charitable Trusts substance use prevention and treatment initiative, said that improving access to drug treatment and emergency interventions can help bring down the spike in overdose deaths.

“The evidence is really clear that using medications to treat opioid addiction disorders saves lives,” said Connolly. “As we see more and more evidence that (medication) does save lives, that will hopefully reduce stigmatizing and categorizing in favor of supporting individuals.”

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