Cannabis Nurse Truths

Did you know that every cannabis plant sold legally in the United States is tracked from the time it is planted to the moment it reaches the consumers’ hands?  This is a mandated process called Seed-to-Sale, and while the intention of these regulations is to keep legal cannabis off the illegal market while ensuring transparency in the supply chain, there is a growing concern about how Seed-to-Sale data is used and the burdens related to this process.
In this episode of Cannabis Nurse Truths, we look at the complexity and concerns related to Seed-to-Sale processes, where currently, cannabis is the only industry that must follow these over-reaching regulatory and mysterious processes. And by the way, if you have purchased legal cannabis in a state-run dispensary, your personal identifying data is also part of this tracking system. So if you are thinking about buying a bunch of 'flowers' for your Valentine sweetheart, cannabis buyers beware!  
 
 
EPISODE RESOURCES
CannabisLifeNetwork.com. (2021, April 6). All About Seed-to-Sale Tracking: The Good, The Bad, And The Ugly. https://cannabislifenetwork.com/all-about-seed-to-sale-tracking-the-good-the-bad-and-the-ugly/
Caulkins, J.P., Davenport, S., Doanvo, A., Furlong, K., Siddique, A., Turner, M., & Kilmer, B. (2019). Triangulating web & general population surveys: Do results match legal cannabis market sales? International Journal of Drug Policy, 73, 293–300. https://doi.org/10.1016/j.drugpo.2019.06.010
Costantino, A., Maiese, A., Lazzari, J., Casula, C., Turillazzi, E., Frati, P., & Fineschi, V. (2023). The dark side of energy drinks: A comprehensive review of their impact on the human body. Nutrients, 15(18), 3922. https://doi.org/10.3390/nu15183922
FlowHub. (n.d.). 2025 Marijuana Industry Statistics & Data Insights: How The Industry Is Performing And Where It's Headed. https://flowhub.com/cannabis-industry-statistics
Goldsberry, D. (2018, August 13). Is Seed-to-Sale Tracking Helping Or Hurting The Industry? Cannabis Business Times. https://www.cannabisbusinesstimes.com/interviews-opinion/news/15696437/is-seed-to-sale-tracking-helping-or-hurting-the-industry
IndicaOnline. (2025, January 16). Industry Statistics 2024 And What We Learned. https://indicaonline.com/blog/industry-statistics-2024/
Lintilhac, P. (2019, October 5). The Fatal Flaws of Seed-to-Sale. Medium. https://medium.com/pauls-blockchain-blog/how-did-we-get-here-d80d169359e8
MJ Freeway. (n.d.). Cannabis Seed To Sale Software: What is Cannabis Seed To Sale Software? https://mjplatform.com/what-is-cannabis-seed-to-sale-software/
Pacula, R.L., Pessar, S.C., Zhu, J., Kritikos, A., & Smart, R. (n.d.). Federal Regulation of Cannabis for Public Health in the United States. https://healthpolicy.usc.edu/wp-content/uploads/2022/07/USC-Schaeffer-Center-white-paper_Federal-Regulation-of-Cannabis-for-Public-Health-in-the-United-States.pdf
Perdomo, C. (2024, September). Industrial Hemp Production in the US - Market Research Report (2014-2029). IBIS World. https://www.ibisworld.com/united-states/industry/industrial-hemp-production/3315/
Sobie, R. (2024, November 12). 10 Things to Know about the Drug Supply Chain Security Act. Pharma Manufacturing. https://www.pharmamanufacturing.com/compliance/article/55242138/10-things-you-need-to-know-about-the-drug-supply-chain-security-act
Statista. (n.d.). Total number of medical prescriptions dispensed in the U.S. from 2009 to 2022. https://www.statista.com/statistics/238702/us-total-medical-prescriptions-issued/#:~:text=Total%20drug%20prescriptions%20dispensed%20in%20the%20U.S.%202009%2D2022&text=In%202009%20the%20number%20of,dispensed%20was%20around%206.7%20billion.
Vaders, M.J. (2021, October 20). Seed To Sale: The Buzz On Understanding the FDA Regulatory Landscape For Cannabis. https://www.womblebonddickinson.com/us/insights/articles-and-briefings/seed-sale-buzz-understanding-fda-regulatory-landscape-cannabis
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Stoner. Pothead. Loser. Couch potato.  These are just a few of the choice names for individuals who choose to use a plant to self-medicate or relax.  The stereotypes related to the cannabis enthusiast have been crafted over decades of lies and deceit, and in the public eye, cannabis is promoted as a harmful gateway drug only used by the lowest elements of our society.
That stereotype is changing fast, as numerous high-profile individuals, like Elon Musk and Robert F. Kennedy Jr., have come out in support of cannabis legalization and appropriate use.  To further the conversation, new evidence is indicating that yes, indeed, there are numerous benefits to using cannabis for health and well-being.  And within our own culture, we see it every day as high-functioning stoners operate multi-million dollar businesses, participate in physical activity, and perform their daily adult responsibilities without incident. In this episode of Cannabis Nurse Truths, we consider the high-functioning stoner, a mythical creature that is gaining in population as the US continues to move toward cannabis legalization. 
 
 
EPISODE RESOURCES
Anderson, D.M., Fe, H.T., Liang, Y., & Sabia, J.J. (2024). Recreational marijuana laws and teen marijuana use, 1993-2021. JAMA Psychiatry, 81(8), 840–842. https://doi.org/10.1001/jamapsychiatry.2024.0698
Bradford, A.C., Lozano-Rojas, F., Shone, H.B., Bradford, W.D., & Abraham, A.J. (2024). Cannabis laws and utilization of medications for the treatment of mental health disorders. JAMA Network Open, 7(9), e2432021. https://doi.org/10.1001/jamanetworkopen.2024.32021
Brenan, M. (2022, August 5). More in U.S. Say Alcohol Adversely Affects Drinkers, Society. Gallup. https://news.gallup.com/poll/395867/say-alcohol-adversely-affects-drinkers-society.aspx
Brown, D. (2025, January 14). Canada's Medical Cannabis Market Remains Steady, Exports Continue to Increase. StratCann. https://stratcann.com/news/canada-medical-cannabis-market-exports-increase/
Caulkins, J.P. (2024). Changes in self-reported cannabis use in the United States from 1979 to 2022. Addiction, 119(9), 1648–1652. https://doi.org/10.1111/add.16519
Cavalli, J.M., Cuttler, C., & Cservenka, A. (2025). A naturalistic examination of the acute effects of high-potency cannabis on emotion regulation among young adults: A Pilot study. Human Psychopharmacology: Clinical and Experimental, 40(1), e2915. https://doi.org/10.1002/hup.2915
Centers for Disease Control and Prevention. (2024, August 6). CDC Data Show Improvements in Youth Mental Health but Need for Safer and More Supportive Schools.https://www.cdc.gov/media/releases/2024/p0806-youth-mental-health.html
Choo, E.K., Trent, S.A., Nishijima, D.K., Eichelberger, A., Kazmierczak, S., Ye, Y., Brasel, K.J., Audett, A., & Cherpitel, C.J. (2024). Risk of motor vehicle collision associated with cannabis and alcohol use among patients presenting for emergency care. Accident Analysis & Prevention, 198, 107459. https://doi.org/10.1016/j.aap.2024.107459
Coley, R.L., Carey, N., Kruzik, C., Hawkins, S.S., & Baum, C.F. (2024). Recreational cannabis legalization, retail sales, and adolescent substance use through 2021. JAMA Pediatrics, 178(6), 622–625. https://doi.org/10.1001/jamapediatrics.2024.0555
Colorado Department of Public Health & Environment. (2022, June 15). CDPHE releases latest Healthy Kids Colorado Survey data. https://cdphe.colorado.gov/press-release/cdphe-releases-latest-healthy-kids-colorado-survey-data-0
De La Torre, I.D., Hébert, E.T., Kezbers, K.M., Walters, D., Pope, Z.C., Mao, B., Benson, L., Shi, D., Stanley, N., & Businelle, M.S. (2025). Associations between cannabis use and same-day health and substance use behaviors. Addictive Behaviors, 163, 108239. https://doi.org/10.1016/j.addbeh.2024.108239
English, F., & Whitehill, J.M. (2023). Risk factors for adolescent cannabis use in a state with legal recreational cannabis: The role of parents, siblings, and friends. Clinical Therapeutics, 45(6), 589–598. https://doi.org/10.1016/j.clinthera.2023.04.002
Grimm, B. (2017, April 20). 50 Most Successful Marijuana Enthusiasts You Should Know. Rolling Stone. https://www.rollingstone.com/culture/culture-lists/50-most-successful-marijuana-enthusiasts-you-should-know-114790/zayn-malik-3-112209/ 
Karmakar, B., Mukherjee, G., & Kar, W. (2024). Using penalized synthetic controls on truncated data: A case study on effect of marijuana legalization on direct payments to physicians by opioid manufacturers. Journal of the American Statistical Association, 1–16. https://doi.org/10.1080/01621459.2024.2406583
Marijuana Policy Project. (2025, January 9). New Data Shows Adult-Use Cannabis Legalization Corresponds with Drops in Teen Use. https://www.mpp.org/news/press/new-data-shows-adult-use-cannabis-legalization-corresponds-with-drops-in-teen-use/
McCarthy, J. (2024, August 10). Fully Half of Americans Have Tried Marijuana. Gallup. https://news.gallup.com/poll/509399/fully-half-americans-tried-marijuana.aspx
Merrill, R.M., Ashton-Hwang, K., & Gallegos, L. (2024). Association between cannabis use and physical activity in the United States based on legalization and health status. Journal of Cannabis Research, 6(1), 39. https://doi.org/10.1186/s42238-024-00248-6
Miech, R.A., Johnston, L.D., Patrick, M.E., & O’Malley, P.M. (2024). Overview and key findings for secondary school students. National Institute on Drug Abuse National Institutes of Health. https://monitoringthefuture.org/wp-content/uploads/2024/12/mtf2025.pdf
Mital, S., Bishop, L., Bugden, S., Grootendorst, P., & Nguyen, H.V. (2024). Association between non-medical cannabis legalization and alcohol sales: Quasi-experimental evidence from Canada. Drug and Alcohol Dependence, 257, 111137. https://doi.org/10.1016/j.drugalcdep.2024.111137
Patrick, M.E. (n.d.). Daily or near-daily cannabis and alcohol use by adults in the United States: A comparison across age groups. Addiction, 1-4. https://doi.org/10.1111/add.16748 
Rosen, E.M., Kerr, W.C., Patterson, D., Greenfield, T.K., Ramos, S., & Karriker-Jaffe, K.J. (2024). Prevalence and correlates of alcohol and drug harms to others: Findings from the 2020 U.S. National Alcohol Survey. Journal of Studies on Alcohol and Drugs, 85(6), 794–803. https://doi.org/10.15288/jsad.23-00387 
Sargent, M. (2025, January 13). What Is a High-Functioning Stoner? Royal Queen Seeds. https://www.royalqueenseeds.com/blog-what-is-a-high-functioning-stoner-n1726
Younis, M. (2023, August 17). More Americans View Moderate Drinking as Unhealthy. Gallup. https://news.gallup.com/poll/509588/americans-view-moderate-drinking-unhealthy.aspx 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

In 1998, a group of researchers proposed a hypothesis known as the Entourage Effect, in which a multitude of the compounds found in cannabis can synergistically work together based on the fact that these effects were also seen in the synergism properties associated with our own endocannabinoids. However, after 26 years, this hypothesis has never been supported clinically, meaning that while we have a lot of proposals and a lot of research suggesting interactions, we've never actually applied it to a patient population in a real-life setting.
In this episode of Cannabis Nurse Truths, we examine this hypothesis known as the Entourage Effect, because while there is a lot of research suggesting this phenomenon is occurring, meaning that something is happening - we just don't know what it is - critics state that there is not enough evidence to support this in science. Their claim is that it is really just a marketing tool to help promote cannabis products. So which is it - an actual phenomenon that explains why cannabis compounds work together to heal the body, or is it just a gimmick to sell more weed? Bottom line; cannabis contains over 500 compounds that all have beneficial physiological effects, so does it really matter which is true?
EPISODE RESOURCES
Al-Khazaleh, A.K., Zhou, X., Bhuyan, D.J., Münch, G.W., Al-Dalabeeh, E.A., Jaye, K., & Chang, D. (2024). The neurotherapeutic arsenal in Cannabis sativa: Insights into anti-neuroinflammatory and neuroprotective activity and potential entourage effects. Molecules, 29(2), Article 2. https://doi.org/10.3390/molecules29020410
Ben-Shabat, S., Fride, E., Sheskin, T., Tamiri, T., Rhee, M.-H., Vogel, Z., Bisogno, T., De Petrocellis, L., Di Marzo, V., & Mechoulam, R. (1998). An entourage effect: Inactive endogenous fatty acid glycerol esters enhance 2-arachidonoyl-glycerol cannabinoid activity. European Journal of Pharmacology, 353(1), 23–31. https://doi.org/10.1016/S0014-2999(98)00392-6
Blasco-Benito, S., Seijo-Vila, M., Caro-Villalobos, M., Tundidor, I., Andradas, C., García-Taboada, E., Wade, J., Smith, S., Guzmán, M., Pérez-Gómez, E., Gordon, M., & Sánchez, C. (2018). Appraising the “entourage effect”: Antitumor action of a pure cannabinoid versus a botanical drug preparation in preclinical models of breast cancer. Biochemical Pharmacology, 157, 285–293. https://doi.org/10.1016/j.bcp.2018.06.025
Boggs, D.L., Nguyen, J.D., Morgenson, D., Taffe, M.A., & Ranganathan, M. (2018). Clinical and preclinical evidence for functional interactions of cannabidiol and Δ9-tetrahydrocannabinol. Neuropsychopharmacology: Official Publication of the American College of Neuropsychopharmacology, 43(1), 142–154. https://doi.org/10.1038/npp.2017.209
Christensen, C., Rose, M., Cornett, C., & Allesø, M. (2023). Decoding the postulated entourage effect of medicinal cannabis: What it is and what it isn’t. Biomedicines, 11(8), 2323. https://doi.org/10.3390/biomedicines11082323
Cogan, P.S. (2020). The “entourage effect” or “hodge-podge hashish”: The questionable rebranding, marketing, and expectations of cannabis polypharmacy. Expert Review of Clinical Pharmacology, 13(8), 835–845. https://doi.org/10.1080/17512433.2020.1721281
Cunha, J.M., Carlini, E.A., Pereira, A.E., Ramos, O.L., Pimentel, C., Gagliardi, R., Sanvito, W.L., Lander, N., & Mechoulam, R. (1980). Chronic administration of cannabidiol to healthy volunteers and epileptic patients. Pharmacology, 21(3), 175–185. https://doi.org/10.1159/000137430
Fowler, C.J. (2003). Plant-derived, synthetic and endogenous cannabinoids as neuroprotective agents non-psychoactive cannabinoids, ‘entourage’ compounds and inhibitors of N-acyl ethanolamine breakdown as therapeutic strategies to avoid psychotropic effects. Brain Research Reviews, 18. https://pubmed.ncbi.nlm.nih.gov/12505646/
Gallily, R., Yekhtin, Z., & Hanuš, L.O. (2015). Overcoming the bell‐shaped   dose‐response of cannabidiol by using cannabis extract enriched   in cannabidiol. Pharmacology & Pharmacy, 6(02), 75–85. https://doi.org/10.4236/pp.2015.62010
Namdar, D., Anis, O., Poulin, P., & Koltai, H. (2020). Chronological review and rational and future prospects of cannabis-based drug development. Molecules, 25(20), Article 20. https://doi.org/10.3390/molecules25204821 
Pamplona, F.A., da Silva, L.R., & Coan, A.C. (2018). Potential clinical benefits of CBD-rich cannabis extracts over purified CBD in treatment-resistant epilepsy: Observational data meta-analysis. Frontiers in Neurology, 9, 759. https://doi.org/10.3389/fneur.2018.00759
Russo, E.B. (2011). Taming THC: Potential cannabis synergy and phytocannabinoid-terpenoid entourage effects: Phytocannabinoid-terpenoid entourage effects. British Journal of Pharmacology, 163(7), 1344–1364. https://doi.org/10.1111/j.1476-5381.2011.01238.x
Russo, E.B. (2016). Beyond cannabis: Plants and the endocannabinoid system. Trends in Pharmacological Sciences, 37(7), 594–605. https://doi.org/10.1016/j.tips.2016.04.005
Russo, E.B. (2019). The case for the entourage effect and conventional breeding of clinical cannabis: No “strain,” no gain. Frontiers in Plant Science, 9, 1969. https://doi.org/10.3389/fpls.2018.01969
Simei, J.L.Q., Souza, J.D.R., Lisboa, J.R., Campos, A.C., Guimarães, F.S., Zuardi, A., & Crippa, J.A.S. (2024). Does the “entourage effect” in cannabinoids exist? A narrative scoping review. Cannabis and Cannabinoid Research, 9(5), 1202–1216. https://doi.org/10.1089/can.2023.0052
Spindle, T.R., Zamarripa, C.A., Russo, E., Pollak, L., Bigelow, G., Ward, A.M., Tompson, B., Sempio, C., Shokati, T., Klawitter, J., Christians, U., & Vandrey, R. (2024). Vaporized D-limonene selectively mitigates the acute anxiogenic effects of Δ9-tetrahydrocannabinol in healthy adults who intermittently use cannabis. Drug and Alcohol Dependence, 257, 111267. https://doi.org/10.1016/j.drugalcdep.2024.111267
Svendsen, K., Sharkey, K.A., & Altier, C. (2024). Non-intoxicating cannabinoids in visceral pain. Cannabis and Cannabinoid Research, 9(1), 3–11. https://doi.org/10.1089/can.2023.0113

Welcome back to our Cannabis Nurse Truths podcast!  Lee and I took some much-needed time off for the holidaze but we are back to share more truths about cannabis as we move into a new year.
2024 was a crazy year for the cannabis industry, and in the United States, we anticipate more changes as federal, state, and even global perceptions of cannabis shift dramatically.  In this episode, we reflect on some of the major events that happened in the cannabis industry that saw both successes and failures for everyone involved in cannabis - both businesses and users.  But from my perspective as a cannabis nurse, I recognize the underlying trend across the US - cannabis is being used by so many individuals that it can no longer be denied - cannabis is medicine. Welcome to Cannabis Nurse Truths in 2025!
 
EPISODE RESOURCES
Bailey, J.A., Tiberio, S.S., Kerr, D.C.R., Epstein, M., Henry, K.L., & Capaldi, D.M. (2023). Effects of cannabis legalization on adolescent cannabis use across 3 studies. American Journal of Preventive Medicine, 64(3), 361–367. https://doi.org/10.1016/j.amepre.2022.09.019
Ballard, J. (2024, July 17). Marijuana Leads Alcohol For Daily Usage. Alcohol Is Well Ahead For Monthly Usage. YouGov. https://today.yougov.com/health/articles/50106-marijuana-leads-alcohol-daily-usage-alcohol-ahead-monthly-usage
Bradford, A.C., Lozano-Rojas, F., Shone, H.B., Bradford, W.D., & Abraham, A.J. (2024). Cannabis laws and utilization of medications for the treatment of mental health disorders. JAMA Network Open, 7(9), e2432021. https://doi.org/10.1001/jamanetworkopen.2024.32021
Business Wire. (2025, January 16). The Two Largest Cannabis Industry Groups Combine Policy Advocacy Efforts To Form Singular, Leading Authority Representing Industry In Washington. https://www.businesswire.com/news/home/20250116788639/en/The-Two-Largest-Cannabis-Industry-Groups-Combine-Policy-Advocacy-Efforts-to-Form-Singular-Leading-Authority-Representing-Industry-in-Washington
Carrión, R.E., Auther, A.M., McLaughlin, D., Adelsheim, S., Burton, C.Z., Carter, C.S., Niendam, T., Ragland, J.D., Sale, T.G., Taylor, S.F., Tso, I.F., McFarlane, W.R., & Cornblatt, B.A. (2023). Recreational cannabis use over time in individuals at clinical high risk for psychosis: Lack of associations with symptom, neurocognitive, functioning, and treatment patterns. Psychiatry Research, 328, 115420. https://doi.org/10.1016/j.psychres.2023.115420
Caulkins, J. P. (2024). Changes in self-reported cannabis use in the United States from 1979 to 2022. Addiction, 119(9), 1648–1652. https://doi.org/10.1111/add.16519
Cavendish, V. (2025, January 9). New Data Shows Adult-Use Cannabis Legalization Corresponds with Drops in Teen Use. Marijuana Policy Project. https://www.mpp.org/news/press/new-data-shows-adult-use-cannabis-legalization-corresponds-with-drops-in-teen-use/
Centers for Disease Control and Prevention. (n.d.). Youth Risk Behavior Survey: Data Summary & Trends Report 2013-2023. U.S. Department of Health and Human Services. https://www.cdc.gov/yrbs/dstr/pdf/YRBS-2023-Data-Summary-Trend-Report.pdf
Colorado Department of Public Health & Environment. (2022, June 15). CDPHE Releases Latest Healthy Kids Colorado Survey Data. https://cdphe.colorado.gov/press-release/cdphe-releases-latest-healthy-kids-colorado-survey-data-0
Darakjian, L., Glassman, H., Lo, C.Y., & Russo, F. (2024). Exploring the interaction between cannabis, hearing, and music. OSF. https://doi.org/10.31234/osf.io/pmuhx
Evoy, R., & Victoroff, T. (2024). Prevalence of cannabis use among US workers in 15 states, 2016–2020. American Journal of Public Health, 114(S8), S645–S653. https://doi.org/10.2105/AJPH.2024.307788
Halman, A., Chenhall, R., & Perkins, D. (2024). Changes in pain and mental health symptoms associated with prescribed medicinal cannabis use: A one-year longitudinal study. Journal of Pain & Palliative Care Pharmacotherapy, 1–13. https://doi.org/10.1080/15360288.2024.2414898
Herrington, A.J. (2025, January 13). DEA Judge Cancels Marijuana Rescheduling Hearing Set For Next Week. Forbes. https://www.forbes.com/sites/ajherrington/2025/01/13/dea-judge-cancels-marijuana-rescheduling-hearing-set-for-next-week/
Jaeger, K. (2025, January 8). New York Marijuana Consumption Lounges Could Sell Food And Drinks While Hosting Live Concerts Under New Bill. Marijuana Moment. https://www.marijuanamoment.net/new-york-marijuana-consumption-lounges-could-sell-food-and-drinks-while-hosting-live-concerts-under-new-bill/
Karmakar, B., Mukherjee, G., & Kar, W. (2024). Using penalized synthetic controls on truncated data: A case study on effect of marijuana legalization on direct payments to physicians by opioid manufacturers. Journal of the American Statistical Association, 0(0), 1–16. https://doi.org/10.1080/01621459.2024.2406583
Leatherdale, S.T., Amores, A., Bélanger, R.E., Battista, K., Patte, K.A., & Jiang, Y. (2023). Youth perception of difficulty accessing cannabis following cannabis legalization and during the early and ongoing stages of the COVID-19 pandemic: Repeat cross-sectional and longitudinal data from the COMPASS study. Archives of Public Health, 81(1), 214. https://doi.org/10.1186/s13690-023-01224-x
Martinelli, A. (2025, January 5). Maryland Lawmakers File Legislation To Allow On-Site Marijuana Consumption Establishments And Events. The Marijuana Herald. https://themarijuanaherald.com/2025/01/maryland-lawmakers-file-legislation-to-allow-on-site-marijuana-consumption-establishments-and-events/
Mirshahi, D. (2024, December 2024). Va. Democrats To Press Cannabis Market Bills in 2025. VPM News. https://www.vpm.org/news/2024-12-16/paul-krizek-aaron-rouse-glenn-youngkin-virginia-cannabis-market-bill
National Rifle Association Institute for Legislative Action. (2025, January 13). U.S. Appellate Court Issues Case On Marijuana Use And Firearm Possession. https://www.nraila.org/articles/20250113/us-appellate-court-issues-case-on-marijuana-use-and-firearm-possession
Roberts, C. (2025, January 13). Marijuana Rescheduling Process Paused Indefinitely After Judge Cancels Hearing. MJ Biz Daily. https://mjbizdaily.com/judge-cancels-marijuana-rescheduling-hearing/
Rosen, E.M., Kerr, W.C., Patterson, D., Greenfield, T.K., Ramos, S., & Karriker-Jaffe, K.J. (2024). Prevalence and correlates of alcohol and drug harms to others: Findings from the 2020 U.S. National Alcohol Survey. Journal of Studies on Alcohol and Drugs, 85(6), 794–803. https://doi.org/10.15288/jsad.23-00387
Skodzinkski, N. (2024, November 22). Trump Is In: Will Pro-Cannabis Reform Be In Or Out? Cannabis Business Times. https://www.cannabisbusinesstimes.com/home/news/15708936/trump-is-in-will-procannabis-reform-be-in-or-out
Substance Abuse and Mental Health Services Administration. (2024). Key substance use and mental health indicators in the United States: Results from the 2023 National Survey on Drug Use and Health (HHS Publication No. PEP24-07-021, NSDUH Series H-59). Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration. https://www.samhsa.gov/data/report/2023-nsduh-annual-national-report
Yang, J., Mejia, M.C., Sacca, L., Hennekens, C.H., & Kitsantas, P. (2024). Trends in marijuana use among adolescents in the United States. Pediatric Reports, 16(4), Article 4. https://doi.org/10.3390/pediatric16040074
Younis, M. (2023, August 17). More Americans View Moderate Drinking As Unhealthy. Gallup. https://news.gallup.com/poll/509588/americans-view-moderate-drinking-unhealthy.aspx
 
 
 
 
 
 

Several years ago, a medical case appeared that took the scientific and medical community by storm. A patient appeared for surgery who reported never feeling anxiety, depression, or pain, despite numerous injuries and surgeries for which she required treatment.  As scientists analyzed her genetic profile, they discovered something amazing - Joanne Cameron lacked the genetic code that was responsible for transmitting pain and creating anxiety and depression.
In this episode of Cannabis Nurse Truths, we examine the curious case of Joanne Cameron that has led to some very surprising research that targets this important physiological phenomenon, and drug companies are furiously developing drugs to capitalize on this incredible potential to decrease pain, anxiety, depression, and treat a number of psychological and physical disorders. One of the most incredible findings linked to this case: cannabinoids, like CBD, also enhance the natural physiological activities of the body linked to the FAAH-OUT gene, where inflammation is halted (reducing pain), while also reducing or eliminating anxiety and depression.  
 
EPISODE RESOURCES
Ahn, K., Johnson, D. S., & Cravatt, B. F. (2009). Fatty acid amide hydrolase as a potential therapeutic target for the treatment of pain and CNS disorders. Expert Opinion on Drug Discovery, 4(7), 763–784. https://pmc.ncbi.nlm.nih.gov/articles/PMC2882713/pdf/nihms-116402.pdf  
Bartel, S. J., Sherry, S. B., & Stewart, S. H. (2020). Self-isolation: A significant contributor to cannabis use during the COVID-19 pandemic. Substance Abuse, 41(4), 409–412. https://pubmed.ncbi.nlm.nih.gov/33044893/ 
Bisogno, T., & Maccarrone, M. (2013). Latest advances in the discovery of fatty acid amide hydrolase inhibitors. Expert Opinion on Drug Discovery. https://www.researchgate.net/publication/236044861_Latest_advances_in_the_discovery_of_fatty_acid_amide_hydrolase_inhibitors 
Boileau, I., Mansouri, E., Williams, B., Le Foll, B., Rusjan, P., Mizrahi, R., Tyndale, R. F., Huestis, M. A., Payer, D. E., Wilson, A. A., Houle, S., Kish, S. J., & Tong, J. (2016). Fatty acid amide hydrolase binding in brain of cannabis users: Imaging with the novel radiotracer [11C]CURB. Biological Psychiatry, 80(9), 691–701. https://pubmed.ncbi.nlm.nih.gov/27345297/  
Bornscheuer, L., Lundin, A., Forsell, Y., Lavebratt, C., & Melas, P. A. (2023). Functional variation in the FAAH gene is directly associated with subjective well-being and indirectly associated with problematic alcohol use. Genes, 14(9), 1826. https://pubmed.ncbi.nlm.nih.gov/37761966/ 
Cravatt, B.F., & Lichtman, A.H. (2003). Fatty acid amide hydrolase: An emerging therapeutic target in the endocannabinoid system. Current Opinion in Chemical Biology, 7(4), 469–475. https://pubmed.ncbi.nlm.nih.gov/12941421/ 
Di Marzo, V., & Petrosino, S. (2007). Endocannabinoids and the regulation of their levels in health and disease. Current Opinion in Lipidology, 18(2), 129–140. https://pubmed.ncbi.nlm.nih.gov/17353660/ 
D’Souza, D. C., Cortes-Briones, J., Creatura, G., Bluez, G., Thurnauer, H., Deaso, E., Bielen, K., Surti, T., Radhakrishnan, R., Gupta, A., Gupta, S., Cahill, J., Sherif, M. A., Makriyannis, A., Morgan, P. T., Ranganathan, M., & Skosnik, P. D. (2019). Efficacy and safety of a fatty acid amide hydrolase inhibitor (PF-04457845) in the treatment of cannabis withdrawal and dependence in men: A double-blind, placebo-controlled, parallel group, phase 2a single-site randomised controlled trial. Lancet Psychiatry, 6(1), 35–45. https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(18)30427-9/abstract 
Girella, A., Di Bartolomeo, M., Dainese, E., Buzzelli, V., Trezza, V., & D’Addario, C. (2024). Fatty acid amide hydrolase and cannabinoid receptor type 1 genes regulation is modulated by social isolation in rats. Neurochemical Research, 49(5),1278-1290. http://www.ncbi.nlm.nih.gov/pubmed/38368587 
Giuffrida, A., Leweke, F. M., Gerth, C. W., Schreiber, D., Koethe, D., Faulhaber, J., Klosterkötter, J., & Piomelli, D. (2004). Cerebrospinal anandamide levels are elevated in acute schizophrenia and are inversely correlated with psychotic symptoms. Neuropsychopharmacology, 29(11), 2108–2114. https://www.nature.com/articles/1300558 
Habib, A. M., Okorokov, A. L., Hill, M. N., Bras, J. T., Lee, M.-C., Li, S., Gossage, S. J., van Drimmelen, M., Morena, M.,Houlden, H., Ramirez, J. D., Bennett, D. L. H., Srivastava, D., & Cox, J. J. (2019). Microdeletion in a FAAH pseudogene identified in a patient with high anandamide concentrations and pain insensitivity. British Journal of Anaesthesia, 123(2), e249–e253. https://europepmc.org/backend/ptpmcrender.fcgi?accid=PMC6676009&blobtype=pdf  
Haseltine, W.A., (2023). No pain, FAAH-OUT. Forbes.https://www.forbes.com/sites/williamhaseltine/2023/06/19/no-pain-faah-out/ 
Huggins, J. P., Smart, T. S., Langman, S., Taylor, L., & Young, T. (2012). An efficient randomised, placebo-controlled clinical trial with the irreversible fatty acid amide hydrolase-1 inhibitor PF-04457845, which modulates endocannabinoids but fails to induce effective analgesia in patients with pain due to osteoarthritis of the knee. Pain, 153(9), 1837–1846. https://pubmed.ncbi.nlm.nih.gov/22727500/  
Jacobson, M. R., Watts, J. J., Silva, T. D., Tyndale, R. F., Rusjan, P. M., Houle, S., Wilson, A. A., Ross, R. A., Boileau, I., & Mizrahi, R. (2020). Fatty acid amide hydrolase is lower in young cannabis users. Addiction Biology, 26(1), e12872. https://pmc.ncbi.nlm.nih.gov/articles/PMC7944390/ 
Lever, I. J., Robinson, M., Cibelli, M., Paule, C., Santha, P., Yee, L., Hunt, S. P., Cravatt, B. F., Elphick, M. R., Nagy, I., & Rice, A. S. C. (2009). Localization of the endocannabinoid-degrading enzyme fatty acid amide hydrolase in rat dorsal root ganglion cells and its regulation after peripheral nerve injury. Journal of Neuroscience, 29(12), 3766–3780. https://doi.org/10.1523/JNEUROSCI.4071-08.2009 
Leweke, F. M., Giuffrida, A., Wurster, U., Emrich, H. M., & Piomelli, D. (1999). Elevated endogenous cannabinoids in schizophrenia. Neuroreport, 10(8), 1665–1669. https://pubmed.ncbi.nlm.nih.gov/10501554/ 
Leweke, F. M., Piomelli, D., Pahlisch, F., Muhl, D., Gerth, C. W., Hoyer, C., Klosterkötter, J., Hellmich, M., & Koethe, D. (2012). Cannabidiol enhances anandamide signaling and alleviates psychotic symptoms of schizophrenia. Translational Psychiatry, 2(3), e94–e94.  https://www.nature.com/articles/tp201215 
Machado-Vieira, R, & Haseeb, A. (2024). A trial of the fatty acid amide hydrolase inhibitor palmitoylethanolamide in bipolar depression. Identifier NCT06229977. https://clinicaltrials.gov/study/NCT06229977?cond=DEPRESSION%20&term=FAAH&rank=1&a=1  
Mikaeili, H., Habib, A. M., Yeung, C. W.-L., Santana-Varela, S., Luiz, A. P., Panteleeva, K., Zuberi, S., Athanasiou-Fragkouli, A., Houlden, H., Wood, J. N., Okorokov, A. L., & Cox, J. J. (2023). Molecular basis of FAAH-OUT-associated human pain insensitivity. Brain: A Journal of Neurology, 146(9), 3851–3865. https://pubmed.ncbi.nlm.nih.gov/37222214/ 
Minkkila, A. M., Saario, S., & Nevalainen, T. (2010). Discovery and development of endocannabinoid-hydrolyzing enzyme inhibitors. Current Topics in Medicinal Chemistry, 10(8), 828–858. https://doi.org/10.2174/156802610791164238 
Patel, S., Hill, M. N., Cheer, J. F., Wotjak, C. T., & Holmes, A. (2017). The endocannabinoid system as a target for novel anxiolytic drugs. Neuroscience and Biobehavioral Reviews, 76(Pt A), 56–66. https://pmc.ncbi.nlm.nih.gov/articles/PMC5407316/pdf/nihms843439.pdf 
Pfizer. (2009). A multiple dose trial evaluating the safety, tolerability, pharmacokinetics and pharmacodynamics of PF-04457845 in healthy volunteers. Identifier NCT00836082. https://clinicaltrials.gov/study/NCT00836082?term=pf%2004457845&checkSpell=&rank=1&tab=table 
Pfizer. (2010). A study to establish the effects of PF-04457845 on sleep in healthy volunteers. Identifier NCT01092845. https://clinicaltrials.gov/study/NCT01092845?term=pf%2004457845&checkSpell=&rank=7&a=7  
Pfizer. (2019). A study to investigate whether PF-04457845 is effective in treating pain, is safe and tolerable in patients with osteoarthritis of the knee. Identifier NCT00981357.https://clinicaltrials.gov/study/NCT00981357?cond=osteoarthritis%20&term=FAAH&rank=1  
Sanofi-Aventis. (2013). An eight-week study of SSR411298 as treatment for major depressive disorder in elderly patients (FIDELIO). Identifier NCT00822744. https://clinicaltrials.gov/study/NCT00822744?term=SSR-411298&rank=1&a=9  
Schlosburg, J. E., Kinsey, S. G., & Lichtman, A. H. (2009). Targeting fatty acid amide hydrolase (FAAH) to treat pain and inflammation. AAPS Journal, 11(1), 39. https://pmc.ncbi.nlm.nih.gov/articles/PMC2664876/pdf/12248_2008_Article_9075.pdf  
Tripathi, R. K. P. (2020). A perspective review on fatty acid amide hydrolase (FAAH) inhibitors as potential therapeutic agents. European Journal of Medicinal Chemistry, 188, 111953. https://pubmed.ncbi.nlm.nih.gov/31945644/  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

In the schizophrenic United States of Cannabis, Americans have been denied fundamental Constitutional Rights because of their choice to use a plant. Long after court requirements are satisfied from a marijuana charge, many Americans are denied basic rights like employment, voting, housing, property, child custody, and college loans that keep them from Life, Liberty, and the Pursuit of Happiness. As the laws and regulations regarding cannabis undergo extreme transformations, Americans are still subjected to discrimination, but now, there could be a light on the horizon.
In this episode of Cannabis Nurse Truths, we are excited to host our first poTcast guest, Tamara Lyn Netzel, a nationally-recognized cannabis advocate and author, who has just published her second book, Humans of Cannabis in a Renaissance of Hope, highlighting the struggles and successes of normal everyday Americans who have decided that cannabis is their drug - or medicine - of choice.  Tamara is the founder of the non-profit 501c3 Cruel Consequences: Portraits of Misguided Law after becoming a medical cannabis advocate for treatment of her multiple sclerosis symptoms and in this episode of CNT, we discuss her journey to cannabis as medicine and her passion for cannabis advocacy.
 
EPIDSODE RESOURCES
Cruel Consequences: Portraits of Misguided Law https://cruelconsequences.org/  
Amazon: Humans of Cannabis in a Renaissance of Hopehttps://www.amazon.com/Humans-Cannabis-Tamara-Lyn-Netzel/dp/B0DHJH9HJV?sr=8-1  
Portraits of Misguided Law: The Human Cost of Marijuana Prohibitionhttps://checkout.square.site/buy/RLKFXWPJQ5N4K6HDMBMBEVSL  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

In order to understand how we ended up in the schizophrenic United States of Cannabis, we have to travel back in time to when cannabis was part of the American experience.  For nearly 150 years after the first colony was established in Jamestown, Virginia, cannabis was utilized for spiritual rituals, rope, fibers, textiles, bird seed, oils and medicine, both for humans and pets. Until one day, a bunch of men in business suits decided that they needed a lot of money to start a war on drugs. 
In this episode of Cannabis Nurse Truths, we take a look at the very mixed-up and unfair hijinks used by the Federal government agencies that would later also benefit from its prohibition.  It is all too apparent that our federal government is seriously flawed and even worse, those government entities who created this national psychosis are still benefiting from the effects of prohibition over 80 years later.
 
EPISODE RESOURCES
Adams, E. S. (2024). Just don’t do it: Why cannabis regulations are the reason cannabis businesses are failing. Nevada Law Journal, 24(349). https://scholars.law.unlv.edu/cgi/viewcontent.cgi?article=1935&context=nlj0 
Galliher, J. F., & Walker, A. (1977). The puzzle of the social origins of the Marihuana Tax Act of 1937. Social Problems, 24(3), 367–376. https://doi.org/10.2307/800089  
Griffith, R. C. (2021). A breath of fresh air: A Constitutional amendment legalizing marijuana through an Article V Convention of the States. University of Massachusetts Law Review, 16(200), Article 2.https://scholarship.law.umassd.edu/umlr/vol16/iss2/2  
LaGuardia, F. (1944). The Laguardia Committee Report New York, USA (1944).https://rodneybarnett.net/PDF/Laguardia%20Report%201944.pdf  
Last Prisoner Project. (n.d.). Exactly how many people are locked up for weed? https://www.lastprisonerproject.org/cannabis-prisoner-scale 
National Conference of State Legislatures. (n.d.). State Medical Cannabis Laws.  https://www.ncsl.org/health/state-medical-cannabis-laws?__cf_chl_tk=jj5C1HNOjfrPgfuAOfFuEtsRvbrl0ufw5tdRo54kBBk-1730819983-1.0.1.1-3WmtBp1aGo4X66bWfielCviKdPcDqEI.k1hG1LmOiH4  
National Institute on Alcohol Abuse and Alcoholism. (2024). Alcohol Use in the United States: Age Groups and Demographic Characteristics.  National Institutes of Health. https://www.niaaa.nih.gov/alcohols-effects-health/alcohol-topics/alcohol-facts-and-statistics/alcohol-use-united-states-age-groups-and-demographic-characteristics
Musto, D. F. (1972). The 1937 Marijuana Tax Act. Archives of General Psychiatry, 26, 101-108. https://static1.squarespace.com/static/54b9fbd9e4b0b6737df63e5d/t/627af393d870030771a32aa1/1652224915619/The+1937+Marijuana+Tax+Stamp+Act-Musto-1972.pdf  
Patton, D. V. (n.d.). A history of United States cannabis law. Journal of Law & Health, 34(1). https://engagedscholarship.csuohio.edu/cgi/viewcontent.cgi?article=1567&context=jlh  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Previous research has indicated that driving impaired while under the influence of cannabis can increase safety concerns for both driver and passengers, and that cannabis users are more likely to drive while impaired because of the perception that drugged driving is not as risky as drunk driving.
However, prior driving research studies focused mainly on healthy individuals using intoxicating levels of THC, which do not provide real-world evidence of how new paradigms, such as medical cannabis, influence driving while high. In this episode of Cannabis Nurse Truths, we examine the safety concerns and current attitudes related to driving while high, and we emphasize an immediate need for more reliable drug testing methods and public education campaigns. 
 
EPISODE RESOURCES
Boicu, B., Al-Hakim, D., Yuan, Y., & Brubacher R. J. (2024). Attitudes toward driving after cannabis use: A systematic review and meta-analysis. Transportation Research Part F: Traffic Psychology and Behaviour, 106, 418–430. https://doi.org/10.1016/j.trf.2024.08.005 
Brooks-Russell, A., Brown, T., Rapp-Olsson, A. M., Friedman, K., & Kosnett, M. (2019). Driving after cannabis use and compensatory driving behaviors among current cannabis users in Colorado. Traffic Injury Prevention, 20(sup2), S199–S201. https://www.tandfonline.com/doi/full/10.1080/15389588.2019.1665424
Brown, T., Banz, B., Schmitt, R., Gaffney, G., Milavetz, G., Camenga, D., Li, K., Brooks-Russell, A., & Vaca, F. (2022). A study of self-reported personal cannabis use and state legal status and associations with engagement in and perceptions of cannabis-impaired driving. Traffic Injury Prevention, 23(sup1), S183–S186. https://www.tandfonline.com/doi/full/10.1080/15389588.2022.2124803 
Colizzi, M., & Bhattacharyya, S. (2018). Cannabis use and the development of tolerance: A systematic review of human evidence. Neuroscience and Biobehavioral Reviews, 93, 1-25. https://pubmed.ncbi.nlm.nih.gov/30056176/ 
Cuttler, C., Sexton, M., & Mischley, L. K. (2018). Driving under the influence of cannabis: An examination of driving beliefs and practices of medical and recreational cannabis users across the United States. Cannabis, 1(2), Article 2. https://publications.sciences.ucf.edu/cannabis/index.php/Cannabis/article/view/cannabis.2018.02.001 
Di Ciano, P., Rajji, T. K., Hong, L., Zhao, S., Byrne, P., Elzohairy, Y., Brubacher, J. R., McGrath, M., Brands, B., Chen, S., Wang, W., Hasan, O. S. M., Wickens, C. M., Kaduri, P., & Le Foll, B. (2024). Cannabis and driving in older adults. JAMA Network Open, 7(1), e2352233. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2814053 
Dutra, L. M., Gourdet, C., Farrelly, M. C., & Bradfield, B. (2023). Perceived safety, not perceived legality, mediates the relationship between cannabis legalization and drugged driving. Health Education & Behavior: The Official Publication of the Society for Public Health Education, 50(6), 718–727. https://pubmed.ncbi.nlm.nih.gov/35822623/ 
Jones, C., Donnelly, N., Swift, W., & Weatherburn, D. (2006). Preventing cannabis users from driving under the influence of cannabis. Accident; Analysis and Prevention, 38(5), 854–861. https://pubmed.ncbi.nlm.nih.gov/16574046/ 
Kraemer, M., Madea, B., & Hess, C. (2019). Detectability of various cannabinoids in plasma samples of cannabis users: Indicators of recent cannabis use? Drug Testing and Analysis, 11(10), 1498–1506. https://pubmed.ncbi.nlm.nih.gov/31407526/ 
Manning, B., Arkell, T. R., Hayley, A. C., & Downey, L. A. (2024). A semi-naturalistic open-label study examining the effect of prescribed medical cannabis use on simulated driving performance. Journal of Psychopharmacology, 38(3), 247–257. https://journals.sagepub.com/doi/10.1177/02698811241229524
McDonald, A. J., Hamilton, H. A., Wickens, C. M., Watson, T. M., Elton-Marshall, T., Wardell, J. D., Rueda, S., Roerecke, M., Stoduto, G., & Mann, R. E. (2021). Driving under the influence of cannabis risk perceptions and behaviour: A population-based study in Ontario, Canada. Preventive Medicine, 153, 106793. https://www.sciencedirect.com/science/article/pii/S0091743521003625 
Miller, R., Brown, T., Schmitt, R., Gaffney, G., & Milavetz, G. (2024). Predicting changes in driving performance in individuals who use cannabis following acute use based on self-reported readiness to drive. Accident Analysis & Prevention, 195, 107376. https://www.sciencedirect.com/science/article/abs/pii/S0001457523004232?via%3Dihub  
National Center for Statistics and Analysis. (2022). Alcohol-Impaired Driving: 2020 Data(Traffic Safety Facts. DOT HS 813 294) https://www.nhtsa.gov/data 
National Survey on Drug Use and Health (NSDUH). Results from the 2021 NationalSurvey on Drug Use and Health: Detailed Tables. 2022; https://www.samhsa.gov/data/sites/default/files/reports/rpt39441/NSDUHDetailedTabs2021/NSDUHDetailedTabs2021/NSDUHDetailedTabsTOC2021.htm#toc 
Ramaekers, J. G., Kauert, G., Theunissen, E. L., Toennes, S. W., & Moeller, M. R. (2009). Neurocognitive performance during acute THC intoxication in heavy and occasional cannabis users. Journal of Psychopharmacology, 23(3), 266–277.  https://pubmed.ncbi.nlm.nih.gov/18719045/ 
Terry, P., & Wright, K. A. (2005). Self-reported driving behaviour and attitudes towards driving under the influence of cannabis among three different user groups in England. Addictive Behaviors, 30(3), 619–626. https://pubmed.ncbi.nlm.nih.gov/15718082/ 
Thomas, F. D., Berning, A., Darrah, J., Graham, L. A., Blomberg, R. D., Griggs, C., Crandall, M., Schulman, C., Kozar, R., Neavyn, M., Cunningham, K. W., Ehsani, J., Fell, J.C., Whitehill, J., Babu, K., Lai, J. S., Rayner, M., & Dunlap and Associates, Inc. (2020). Drug and alcohol prevalence in seriously and fatally injured road users before and during the COVID-19 public health emergency (DOT HS 813 013). https://rosap.ntl.bts.gov/view/dot/50941 
Watson, T., Mann, R., Wickens, C., & Brands, B. (2019). “Just a habit”: Driving under the influence of cannabis as ordinary, convenient, and controllable experiences according to drivers in a remedial program. Journal of Drug Issues, 49.  https://www.researchgate.net/publication/332427583_Just_a_Habit_Driving_Under_the_Influence_of_Cannabis_as_Ordinary_Convenient_and_Controllable_Experiences_According_to_Drivers_in_a_Remedial_Program  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Previous research has indicated that driving impaired while under the influence of cannabis can increase safety concerns for both driver and passengers, and that cannabis users are more likely to drive while impaired because of the perception that drugged driving is not as risky as drunk driving.
However, prior driving research studies focused mainly on healthy individuals using intoxicating levels of THC, which do not provide real-world evidence of how new paradigms, such as medical cannabis, influence driving while high. In this episode of Cannabis Nurse Truths, we examine the safety concerns and current attitudes related to driving while high, and we emphasize an immediate need for more reliable drug testing methods and public education campaigns. 
EPISODE RESOURCES
Boicu, B., Al-Hakim, D., Yuan, Y., & Brubacher R.J. (2024). Attitudes toward driving after cannabis use: A systematic review and meta-analysis. Transportation Research Part F: Traffic Psychology and Behaviour, 106, 418–430. https://doi.org/10.1016/j.trf.2024.08.005  
Brooks-Russell, A., Brown, T., Rapp-Olsson, A.M., Friedman, K., & Kosnett, M. (2019). Driving after cannabis use and compensatory driving behaviors among current cannabis users in Colorado. Traffic Injury Prevention, 20(sup2), S199–S201. https://www.tandfonline.com/doi/full/10.1080/15389588.2019.1665424  
Brown, T., Banz, B., Schmitt, R., Gaffney, G., Milavetz, G., Camenga, D., Li, K., Brooks-Russell, A., & Vaca, F. (2022). A study of self-reported personal cannabis use and state legal status and associations with engagement in and perceptions of cannabis-impaired driving. Traffic Injury Prevention, 23(sup1), S183–S186. https://www.tandfonline.com/doi/full/10.1080/15389588.2022.2124803   
Colizzi, M., & Bhattacharyya, S. (2018). Cannabis use and the development of tolerance: A systematic review of human evidence. Neuroscience and Biobehavioral Reviews, 93, 1-25.https://pubmed.ncbi.nlm.nih.gov/30056176/  
Cuttler, C., Sexton, M., & Mischley, L.K. (2018). Driving under the influence of cannabis: An examination of driving beliefs and practices of medical and recreational cannabis users across the United States. Cannabis, 1(2), Article 2. https://publications.sciences.ucf.edu/cannabis/index.php/Cannabis/article/view/cannabis.2018.02.001  
Di Ciano, P., Rajji, T.K., Hong, L., Zhao, S., Byrne, P., Elzohairy, Y., Brubacher, J.R., McGrath, M., Brands, B., Chen, S., Wang, W., Hasan, O.S.M., Wickens, C.M., Kaduri, P., & Le Foll, B. (2024). Cannabis and driving in older adults. JAMA Network Open, 7(1), e2352233. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2814053  
Dutra, L.M., Gourdet, C., Farrelly, M.C., & Bradfield, B. (2023). Perceived safety, not perceived legality, mediates the relationship between cannabis legalization and drugged driving. Health Education & Behavior: The Official Publication of the Society for Public Health Education, 50(6), 718–727. https://pubmed.ncbi.nlm.nih.gov/35822623/  
Jones, C., Donnelly, N., Swift, W., & Weatherburn, D. (2006). Preventing cannabis users from driving under the influence of cannabis. Accident; Analysis and Prevention, 38(5), 854–861. https://pubmed.ncbi.nlm.nih.gov/16574046/  
Kraemer, M., Madea, B., & Hess, C. (2019). Detectability of various cannabinoids in plasma samples of cannabis users: Indicators of recent cannabis use? Drug Testing and Analysis, 11(10), 1498–1506. https://pubmed.ncbi.nlm.nih.gov/31407526/  
Manning, B., Arkell, T.R., Hayley, A.C., & Downey, L.A. (2024). A semi-naturalistic open-label study examining the effect of prescribed medical cannabis use on simulated driving performance. Journal of Psychopharmacology, 38(3), 247–257. https://journals.sagepub.com/doi/10.1177/02698811241229524 
McDonald, A.J., Hamilton, H.A., Wickens, C.M., Watson, T.M., Elton-Marshall, T., Wardell, J.D., Rueda, S., Roerecke, M., Stoduto, G., & Mann, R.E. (2021). Driving under the influence of cannabis risk perceptions and behaviour: A population-based study in Ontario, Canada. Preventive Medicine, 153, 106793. https://www.sciencedirect.com/science/article/pii/S0091743521003625  
Miller, R., Brown, T., Schmitt, R., Gaffney, G., & Milavetz, G. (2024). Predicting changes in driving performance in individuals who use cannabis following acute use based on self-reported readiness to drive. Accident Analysis & Prevention, 195, 107376. https://www.sciencedirect.com/science/article/abs/pii/S0001457523004232?via%3Dihub  
National Center for Statistics and Analysis. (2022). Alcohol-Impaired Driving: 2020 Data(Traffic Safety Facts. DOT HS 813 294). National Highway Traffic Safety Administration. Office of Behavioral Safety Research. Available at https://www.nhtsa.gov/data  
National Survey on Drug Use and Health (NSDUH). (2022). Results from the 2021 NationalSurvey on Drug Use and Health: Detailed Tables. 2022. Available at  https://www.samhsa.gov/data/sites/default/files/reports/rpt39441/NSDUHDetailedTabs2021/NSDUHDetailedTabs2021/NSDUHDetailedTabsTOC2021.htm#toc  
Ramaekers, J.G., Kauert, G., Theunissen, E.L., Toennes, S.W., & Moeller, M.R. (2009). Neurocognitive performance during acute THC intoxication in heavy and occasional cannabis users. Journal of Psychopharmacology, 23(3), 266–277. https://pubmed.ncbi.nlm.nih.gov/18719045/   
Terry, P., & Wright, K.A. (2005). Self-reported driving behaviour and attitudes towards driving under the influence of cannabis among three different user groups in England. Addictive Behaviors, 30(3), 619–626. https://pubmed.ncbi.nlm.nih.gov/15718082/  
Thomas, F.D., Berning, A., Darrah, J., Graham, L.A., Blomberg, R.D., Griggs, C., Crandall, M., Schulman, C., Kozar, R., Neavyn, M., Cunningham, K.W., Ehsani, J., Fell, J.C., Whitehill, J., Babu, K., Lai, J.S., Rayner, M., & Dunlap and Associates, Inc. (2020). Drug and alcohol prevalence in seriously and fatally injured road users before and during the COVID-19 public health emergency (DOT HS 813 013). National Highway Traffic Safety Administration. Office of Behavioral Safety Research. Available at https://rosap.ntl.bts.gov/view/dot/50941  
Watson, T., Mann, R., Wickens, C., & Brands, B. (2019). “Just a habit”: Driving under the influence of cannabis as ordinary, convenient, and controllable experiences according to drivers in a remedial program. Journal of Drug Issues, 49. https://www.researchgate.net/publication/332427583_Just_a_Habit_Driving_Under_the_Influence_of_Cannabis_as_Ordinary_Convenient_and_Controllable_Experiences_According_to_Drivers_in_a_Remedial_Program  
 
 
 
 
 
 
 
 
 
 
 
 
 

Cannabis users are both considered criminals and protected under federal laws.  What a mess.  One of the most significant issues surrounding cannabis use, especially in states where medical marijuana is legal, is the ability to use state-sanctioned medical marijuana, which is typically protected under disability laws, but yet can also be punitive as employers are allowed to terminate employees for cannabis use. Another pressing concern is how workers’ compensation activities will be affected by an employee’s medical marijuana use. 
In this episode of Cannabis Nurse Truths,  we continue to review how privacy laws, medical freedom, and workers’ compensation issues all have a significant impact on employers’ workplace policies, and we offer recommendations that employers should begin to consider as cannabis legalization is likely implemented in the near future. 
EPISODE RESOURCES
Anderson, D. M., Hansen, B., & Rees, D.I. (2013). Medical marijuana laws, traffic fatalities, and alcohol consumption. Journal of Law and Economics, 56(2), 333–369. https://docs.iza.org/dp6112.pdf 
Barnett, G. (2023, July 31). A growing number of companies are dropping marijuana drug testing. WTOP News. https://wtop.com/business-finance/2023/07/a-growing-number-of-companies-drop-marijuana-drug-testing/#:~:text=But%20some%20businesses%20have%20done,looking%20to%20hire%2C%20Clayton%20said   
Carnide, N., Lee, H., Frone, M.R., Furlan, A.D., & Smith, P.M. (2021). Patterns and correlates of workplace and non-workplace cannabis use among Canadian workers before the legalization of non-medical cannabis. Drug and Alcohol Dependence, 218, 108386. https://oem.bmj.com/content/oemed/79/12/824.full.pdf  
Chakraborty, A., Doremus, J., & Stith, S. (2020). The effects of recreational cannabis access on labor markets: Evidence from Colorado. IZA Journal of Labor Economics, 10(1). https://sciendo.com/pdf/10.2478/izajole-2021-0005  
Dylan, D., & Soltys, J. (2020). Accommodating the unknown: Balancing employee human rights with the employer duty to ensure safety: A Dialogue on Stewart v Elk Valley and the Cannabis Act.  Canadian Journal of Human Rights, 9(1), 57. https://heinonline.org/HOL/LandingPage?handle=hein.journals/canajo9&div=6&id=&page=  
Hazle, M.C., Hill, K.P., & Westreich, L.M. (2022). Workplace cannabis policies: A moving target. Cannabis and Cannabinoid Research, 7(1), 16-23. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8864412/  
Hire Right. (2023, June). Employers Guide to Legalized Marijuana (Medical & Adult Use/Recreational).  E-book retrieved from https://www.hireright.com/resources/employers-guide-to-legalized-medical-and-recreational-marijuana  
Howard, J., Wurzelbacher, S., Osborne, J., Wolf, J., Ruser, J., & Chadarevian, R. (2021). Review of cannabis reimbursement by workers’ compensation insurance in the US and Canada. American Journal of Industrial Medicine, 64(12), 989-1001. https://onlinelibrary.wiley.com/doi/abs/10.1002/ajim.23294  
Green, C.P, & Paniagua, M.N. (2016). Play hard, shirk hard? The effect of bar hours regulation on worker absence. Oxford Bulletin of Economics and Statistics, Department of Economics, 78(2), 248-264. https://conference.iza.org/conference_files/riskonomics2012/green_c3422.pdf  
Kelly, J. (2024, June 14). Why workplace absenteeism is on the rise. Forbes. https://www.forbes.com/sites/jackkelly/2024/06/14/why-workplace-absenteeism-is-on-the-rise/  
Marmot, M.G., North, F., Feeney, A., & Head, J. (1993). Alcohol consumption and sickness absence: From the Whitehall II study. Addiction, 88(3), 369–382. https://doi.org/10.1111/j.1360-0443.1993.tb00824.x  
Martinez, A. (2024, April 29). 2024 Marijuana Legalization Review: A Guide for Employers In A Complex Legal Landscape. Available at https://www.hireright.com/blog/2024-marijuana-legalization-review-a-guide-for-employers-in-a-complex-legal  
Nicholas, L.H., & Maclean, J.C. (2016). The effect of medical marijuana laws on the health and labor supply of older adults: Evidence from the Health and Retirement Study. NBER Working Paper No. 22688. JEL No. I10,I18,J20. https://www.nber.org/system/files/working_papers/w22688/w22688.pdf  
Nissen, J. (2023, September 24). Michigan dropping marijuana drug testing for some new-hires on Oct.1. https://www.fox2detroit.com/news/michigan-dropping-marijuana-drug-testing-for-some-new-hires-on-oct-1  
Otañez, M. (2021). A labor studies approach to cannabis. In The Routledge Handbook of Post-Prohibition Cannabis Research (pp. 174-182). Routledge. https://cannalib.eu/wp-content/uploads/2022/03/The-Routledge-Handbook-of-Post-Prohibition-Cannabis-Research-2021.pdf#page=195  
Paychex. (2019, June 19). More than one-third of business owners not prepared to manage legalized marijuana in the workplace.  https://www.paychex.com/newsroom/news-releases/business-owners-not-prepared-to-manage-legalized-marijuana  
Pearlman, S. (2019, August 15). Illinois' hazy new law legalizing recreational use of marijuana. https://www.forbes.com/sites/stevenpearlman/2019/08/15/illinois-hazy-new-law-legalizing-recreational-use-of-marijuana/  
Perlman, A.I., McLeod, H.M., Ventresca, E.C., Salinas, M.G., Post, P.J., & Schuh, M.J. (2021, October). Medical cannabis state and federal regulations: Implications for United States health care entities. In Mayo Clinic Proceedings, 96(10), 2671-2681. https://www.mayoclinicproceedings.org/article/S0025-6196(21)00399-2/fulltext  
Ullman, D.F. (2017). The effect of medical marijuana on sickness absence. Health Economics, 26(10),1322-1327. doi:10.1002/hec.3390. https://pubmed.ncbi.nlm.nih.gov/27416978/  
U.S. Bureau of Labor and Statistics. (n.d.). Injuries, Illnesses, and Fatalities. Available at https://www.bls.gov/iif/home.htm  
West, B. (2020). The grass is greener somewhere: Protecting privacy rights of medical cannabis patients in the workplace. Chicago-Kent Law Review, 95, 751. https://scholarship.kentlaw.iit.edu/cgi/viewcontent.cgi?article=4334&context=cklawreview  
Worthy, S.L., & Kulkarni, S.R. (2021). Dazed and confused: Making sense of employers' risks from mandated coverage of non-FDA-approved cannabis products. Seton Hall Legislative Journal, 45, 379. https://scholarship.shu.edu/cgi/viewcontent.cgi?article=1187&context=shlj