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FDA says marijuana has a legitimate medicinal purpose (abcactionnews.com)
175 points by DocFeind on March 21, 2024 | hide | past | favorite | 163 comments



I can only speak anecdotally, but recreational cannabis product has all but cured my insomnia sleep issues. While off prescribed medication, I will stay up all night exhaustedly writing code and watching TV. While on prescribed medication, I will stay up all night exhaustedly watching TV without the bare minimum amount of focus to write code. If I take some edibles around 8PM, I'm out like a light by 11PM.

The final straw for me was being awake for 2 days straight a few years ago. I would lay down and close my eyes and just be exhausted while doing nothing.


Weed does miracles for people truly suffering from insomnia. (At least for me)

However, there is still a risk/reward equation. If I take too much, there’s a noticeable difference in next day cognitive performance. Like anything, weed is only an effective medical tool when used in extreme moderation. The same as diphenhydramine, ambien, etc.


THC interferes with the REM cycle. This is why when heavy smokers quit, they have crazy dreams for a few weeks. That's probably why you feel so groggy the next day when you take higher doses. You were asleep, but not getting good sleep.

Pot helps you fall asleep, but it does not help you get good quality sleep.


I feel the cannabinoid and terpene profiles determine these REM cycle disruptions and grogginess just the same as they affect the onset of being sleepy. I sleep great on indica based land races, but terrible on most modern strains that have a higher THC percentage or hybrids of sativa strains. Hopefully in the future we can break down these differences in the profiles of each strain rather than having blanket studies and opinions that might be neglecting that these profiles can be significantly different in their effects, especially regarding sleep and medical use.


Before I started on MMJ I slept in 2 hour shifts, every 12 hours or so, due to neuropathic pain. Now I sleep for 8 hours - once I get to sleep. It seems that daily use does make it a bit harder to fall asleep (racing mind?) but at least I'm not just getting the bare minimum anymore.

Note that taking CBD reduces the negative effects of THC use, at the cost of less stoned. If using for medical reasons that's not a big deal. If recreational use it probably is.


I'm sure to someone getting little to no sleep, not-great sleep would sound like a huge improvement.


Correct. I understand it is "less good", but as someone with Restless Leg Syndrome THC is the only "medication" I have found that stops the electric feelings in my legs almost immediately. Luckily RLS does not flare up every day any more, and my ADHD medication I take right before bed helps a ton. I recall the worst ever period I had of RLS was 36 hours of no sleep when I finally just blew a fuse over the issue.


Thanks for this, that was exactly my experience, https://news.ycombinator.com/item?id=39786167. In the long run I think THC made my insomnia issues worse, or at least prevented me from addressing the root cause sooner.


I would bet that was strain related as mentioned in this thread, it took me going through 30 strain’s before realizing this for myself.


Weirdly, since I started using low doses of THC + CBD flower before bed it has increased my dreaming (or at least recall of it) substantially. For many many years now I would always wake up in the middle of the night out of breath, sweaty and sore whenever I'd have intense dreams, possibly due to trauma. Now I stay asleep through the most vivid and intense dreams, and wake up reasonably relaxed and well rested at normal times. Has been going on for several months now ever since I started using tiny amounts of cannabis intermittently again (no more than 4x per week, often less, and below 0.05g per "dose").


Agree about the moderation. The downside of the edibles is that after a month or two, I start needing more. When this happens I abstain and go back to my prescribed medicine for 2-3 weeks, and then continue back with the dosage that I allow myself. It's a bit of a cycle to watch over and maintain, but at least for me, the miracle of decent sleep far outweighs the cons.


What sort of edibles and how much does such a regimen cost? I assume it’s not covered by insurance? Is your prescribed med one of the z drugs (ambien, lunesta, sonata)?


I take an edible that advertises it came from an Indica strain, where I take it in a dose of 20mg of THC and 10mg CBN. It costs me around $150/month, which I suppose it depends if you consider that a large amount of money. It's not as cheap (from the perspective of my wallet) as my prescribed medicine, granted, but works much better. And correct, I just buy it at a local dispensary, no prescription.

My prescription drug is Trazodone, which so far has worked better than nothing. But it's a bit more involved of a process of winding down, for me. I have to make a conscious decision to stop everything I'm doing with it, and concentrate on just getting sleepy. Which is both maddening and a horrible waste of my waking time, in my opinion. And then every moment that I lay in bed, I have to make sure my mind is calm, or it's like I instinctively fight the drug and end up awake. On the edibles I just AM calm, I don't have to try to be anything.


Thank you very much for the data point. I don’t think $150 is very much given the impact of chronic insomnia. And most of that is going to back into taxes anyway, so it’s socially beneficial.

Have you worried about dependence— an issue with any sleep med? I’ve been told daily use of edibles isn’t viable without taking days off to reset tolerance. I don’t think 20mg is very much, so maybe keeping the dose moderate and sub-recreational is key.


>My prescription drug is Trazodone, which so far has worked better than nothing

Someone I know tried Trazodone but it had similar problems as well as other minor side effects. They switched to Quetiapine in extremely low dose and it worked great, however they are concerned to use it long term as it's not the main reason that drug is usually prescribed. Out of curiosity, I am wondering if you have tried that and can compare it to the current edible that is working for you?


Quetiapine isn’t typically on the menu for mere insomnia. At least that’s what I’ve been told when I’ve asked various doctors about it. Trazodone acts an antihistamine at lower dosages as I’ve been told. My experience is that it’s much more than that, and that modern medical science is woefully unaware of what they’re doing when prescribing such drugs.


I have not tried it, sorry. Unfortunately I only started trying to do something about my sleep issues recently, and so Trazadone was the first thing my doctor prescribed so far. Previously I just worked around them by getting night shift jobs and blaming that for my lack of sleep, heh.


This happens to me with my prescription meds too. Always have to go back to the doctor and get a higher dose. Then the higher dose causes side effects, it sucks.


Reading this, I’m wrestling with why I can conform to “prescribed” dosages of potentially abusable pharmaceutical like stimulants, but I find it so hard to just have a little weed I force my wife to keep hers in a safe and opt for sleeping pills for my insomnia.

Only answer I can come up with is societal norms. Taking more prescriptions than prescribed makes you an addict, smoking more weed is just normal.


> Like anything, weed is only an effective medical tool when used in extreme moderation.

and I just wish it would be subject to the same per ailment clinical trials that other substances are. so that for each specific thing people claim it helps with, there are specific side effects listed and studied.

zero of these state level efforts have that and we are still stuck in the medieval age of anecdotes, its embarrassing


We are missing the science due to prohibition. This is the kind of change that is needed to foster more science.


I'm aware

The anecdotes masquerading as enlightenment are frustrating.


Do you get the impression that anyone here is masquerading anecdotes in this conversation, or are you speaking generally? Because I disclaimed my whole parent comment with, "I can only speak anecdotally..."


Its not a pejorative statement about the people here

Its a pejorative statement about how thats all we have to work with


I think this is a balanced approach --for just about any addictive drug with undesirable side effects from overconsumption.

Unfortunately, we tend to be in the extremes rather than the middle. We've either criminalized it, or have it wide open. Maybe after a decade or so of studies that are enabled by the legalization, we can get better guidance on usage and control.


Counter anecdote - THC basically ruined my sleep for a while. Granted, it was mostly my own fault, but I've just become wary because I've seen so many advertisements promoting CBD and THC as cures for basically everything that I think it's important to be wary of the risks.

In my case, I just ended up doing way too much THC in the evenings and at night so I would essentially pass out. I would sleep, but my sleep quality was really bad and I felt "groggy and foggy" the next day. When I tried to go off it, for a long time I would wake up every night around 3 AM and couldn't get back to sleep.

To be clear, I totally agree THC does have medicinal uses, but lots of medicines can cause a host of side effects and other problems (and sleep medicines in particular are a notorious bunch for dependency issues). If you go the THC route to help sleep, just be more careful than I was.


> I've just become wary because I've seen so many advertisements promoting CBD and THC as cures for basically everything that I think it's important to be wary of the risks.

I've been part of interviews of various doctors in relation to cannabis. Some are so gung-ho it comes across that you should take no other medicine other than cannabis. Others come across from the point of view as it's just one more tool in the tool chest of treatment options. So even in the medical community, there's no consensus. I'm hopeful that the rate of current research will start revealing something closer to fact, and hoping bigPharma doesn't come along and ruin it


It’s going to be such a relief when medical professionals can speak to specific “strains” (is this a problematic term here?) of people instead of trying to speak about all humans as though they all fit in one homogenous bucket.

Internally we are wildly different and surprisingly varied.


My guess would be once all of the individual molecules have been studied, they'll be able to prescribe a cocktail of cannabinoids as needed. Provided of course it is as beneficial to health treatments as hoped


dosis sola facit venenum, 'only the dose makes the poison' -Paracelsus


> all but cured

I'm confused - doesn't that mean it has done anything, but cured - so it didn't cure?


“All but X” is an idiom in (at least American) English which means essentially “99%”. So in this case it didn’t literally cure his insomnia, but is so close to having done so that it may as well have.


It just sounds somehow so wrong to me, I'm not a native speaker though.


Native speaker here, this has kept me distracted on a couple long drives.

  “X is all but Y”

  Interpretation 1: X has moved so close to Y that it may as well be Y  
  -> X loosely equals Y   
  (I think this is the colloquial understanding)

  Interpretation 2: In the set that represents X, Y has been removed  
  -> X is not Y
Excuse the poor notation, I hope this is clear! The tldr is this confuses me too sometimes


Yeaaah. But it feels like "all" could be everything that is positive OR negative, so if you have all the positive and all the negative, and you take the one positive away (or the most positive), it is slightly negative (or very negative)?


Yea! I thought along the same lines, but I wasn't sure how to write it out. If X is on a spectrum, and Y is removed, it's closer to not-Y.

Edit, eh your explanation probably explains it better anyway :)


I really appreciate your positive responses to my off-topic out-of-blue observations.


It throws me off because it sounds sarcastic depending on which parts you emphasize. "The fire department all but put out the fire".


In this context it typically means it treats the symptoms almost completely. But if you stop treating it, the underlying problem is still there.


Counter-anecdotally, doesn't work at all for insomnia, at anything short of heroic doses. (Or some there some variable I'm possibly overlooking? I got this prescribed for insomnia a couple months ago and have largely given up—it didn't seem effective).


I originally started smoking to help with my insomnia, and it was effective for quite some time. However, I also learned that I just generally enjoy being high, and am reasonably functional on it, so I started smoking for general relaxation purposes. Now that I am a frequent smoker, my tolerance has grown, so it is more of a mixed bag when it comes to putting me to sleep. Heroic doses don't help, at least when smoking (even when using high purity concentrates, etc.) (though edibles are more consistent in this regard,) even though I stick to the general "wisdom" of only using indica strains. There's mixed science on how impactful the terpene makeup is, though some are considered psychoactive or at least modulating on the uptake of cannabinoids via the entourage effect, so it's possible that terpene content could impact how useful you find it for sleeping. Or you might just respond to it more similarly to how I do now that I am a regular smoker, and not see significant impact on your ability to sleep.


I don't know what you were prescribed, but for me, smoking and vaping doesn't have the same effect. Edibles, and in particular I take ones that use Indica strains with some CBD, do the magic for me.

And it took me a bit of experimentation to figure out the correct dosage in milligrams for my body. An interesting thing about cannabis is that you don't really risk a ton from over-indulging besides maybe just having a bad time with some uncomfortable mental state (paranoia and dizziness.) I'm a fairly small person and 20mg is what does it for me. But you might try 10mg or 30mg. I know people that take 50mg, or have (perhaps irresponsibly) taken 100mg. It's mostly up to you to figure out your dosage, and in most cases I'd say listening to your doctor for dose is the right call; for this I'd say maybe take it a bit more as a suggestion than a rule, until you find a sweet spot. If you find a sweet spot. Wish you the best!


> Indica strains with some CBD

what does this mean? any cannabis plant with THC will have CBD. the amount of the minor cannabinoids differ depending on the cultivar. recreational weed has been cultivated to spike the THC so it is way out of balance to the other cannabinoids, and in my current understanding seems to drastically reduce its use for medicinal purposes. the popular phrase is "entourage effect" of all of the cannabinoids working together.


Many strains out there are below 0.05% CBD, but you can find much higher if you look for it. In my legal state every cannabis dispensary has at least one 1:1 or 2:1 CBD to THC strain, often several. It's not that hard to find.

Worst case, you can order hemp flower (very high CBD with trace amounts of THC) legally in many places and just combine that with a high THC strain at whatever ratio you desire. You can pretty easily make edibles yourself this way with an online guide, it's basically just following a recipe.


This is actually ended up working pretty well for me! The HN replies I got provoked me to go out and obtain a high-CBD hemp strain (22%), which turned out to be the key variable. I had often before tried combining THC + CBD strains, as you describe—but with more conventional, lower-strength CBD. It just turned out the "correct" CBD dosage for me a lot higher than I had explored!

Appreciate all the technical advice in this thread.


Thank you!


Not sure where you are located, but if available and you're willing to try again, look for gummies with CBN in them. There are various ratios, 2:1, 4:1, 5:1, 10:3. The 5:1 work really really well for me.


CBN or CBD? Does cannabidiene have an effect other than giving you a headache? Cannabidiol is what my medical provider provides with THC.


In the recent past few years since the stigma of the cannabis plant has calmed down, many more molecules have been identified and isolated.

https://www.health.harvard.edu/blog/beyond-cbd-here-come-the...

https://www.nccih.nih.gov/health/cannabis-marijuana-and-cann...


I maybe indulge once a year or so in a legal state, although I smoked a bit more in my teens-early 20's.

I have found that if you look for a strain that has a high concentration of THC-V, it will typically be the more fun/giggly/silly experience with a lot of highdeas and almost no munchies.

Durban Poison or Tansie are my recommendations based upon my very light experience, of course, ymmv.


To add another anecdote, I have found that these in particular https://aproperhigh.com/products/edible/plus/lychee-sleep-1-... are noticeably more effective and have less grogginess than other stuff I've tried, and they're the only thing I've found locally with CBN


CBN. Some brands I've tried in the past are Camino, Wyld, and Lights Out.

For me, a THC:CBN combo works wonders for sleep.


I have chronic insomnia and weed definitely keeps me up


That’s how I fixed my insomnia also, but this doesn’t work for every case. The cause of my insomnia was that I just couldn’t turn off my brain - I’d lay in bed and think about stuff until like 5 am. With an edible, once THC kicks in, I could turn off my thoughts at will and fall asleep nearly instantly. And the best part is, after about a month and a half of daily consumption I just quit the edibles and was able to sleep normally without any withdrawal or other side effects. I do not take THC now.

I’ve read however that for some people THC can have detrimental effect on sleep. But that wasn’t the case for me, and in any event THC is better than either the typical sleeping pills or sleeping like 4 hours per day.


Did you work out why you have the insomnia? I just got a referral to a psych that I haven't booked yet, and I believe mine is low-level anxiety based. I can be incredibly tired but my brain keeps turning around what-if scenarios in my head. Sometimes to the point my mind says screw it, I'm sleeping without you, and I start to hallucinate a little as though dreaming has started (which often wakes me up via adrenaline, phantom spiders do that).

Something like Restavit (available OTC here, doxylamine succinate) makes me feel "tired" but does not seem to help me get to sleep. It does reduce wake-ups during the night and makes me feel like a zombie until noon the next day though.


I assume it's legal where you live? Because where I live, you get dragged through the courts and get a criminal record for even small amounts. Also since it's illegal, you have to have contacts in the criminal underworld, and fund criminal enterprises. Not to mention you don't know the quality of what you're getting. It could be laced with contaminants or simply low quality crap. If it's legal where you live, relish that and see it as an enormous privilege.


In the USA, marijuana is functionally legal through most of the country due to the hemp bill and the existence of things like THCA and Delta-8 THC. Because of how a product is defined as marijuana vs. hemp, products high in THCA but below the Delta-9 THC limit are considered hemp, even though when decarbed (smoked, vaporized, cooked into edibles) THCA turns into regular old THC and Delta-8 THC is functionally a less potent form of Delta-9 THC.

Some states have enacted provisions around some or all of the Delta-9 THC analogs, but most have not.

I regularly have THCA products shipped to me via USPS in a box with marijuana leaves on it in a state where Delta-9 THC is still illegal for recreational use.


The THC-A exceptions really have not been tested against state laws where weed is still illegal. I understand that THC-A weed is openly sold in a lot of illegal states and enforcement is low. But if local/county/parish officers wanted to test using GCMS instead of LCMS, it would still show that the weed had too much D9-THC.

Maybe people could get this overturned in court in some of those states, but maybe not. I understand that there's some arguments that the federal law supersedes state law due to being on a USDA farm bill or something, but I really, really don't think any of the THC-A stuff has been tested in court.

Even at a purely federal level, I don't think I can just hop on a plane with a pound of THC-A weed and tell the TSA "oh this is just hemp."


https://www.tsa.gov/travel/security-screening/whatcanibring/...

TSA is supposed to let it through if it's below 0.3 D9-THC

GCMS will detect THCA if derivatized - https://www.cannabissciencetech.com/view/a-brief-review-of-d... - I find it hard to believe that you couldn't get a non-derivatized GCMS thrown out in court when it's known that GCMS will cause THCA to decarboxolate into THC.

I suppose I should stipulate I'm not a lawyer and there are obvious risks to possessing something that looks exactly like an illegal product.


Oh it is absolutely a privilege! Though it should not be, in the sense that it should be legal everywhere. Here in Oakland CA I can walk down the street and buy all the weed I want at the corner store. We have also decriminalized psilocybin mushrooms and other plant based substances including DMT. I had a very meaningful and healing experience aided by mushrooms with some close friends a few weeks ago, which involved opening up about some past shared trauma that a friend had been holding in, and led to a breakthrough in communication and togetherness.

California is looking at incremental steps towards broader legalization in therapeutic contexts, which is a step in the right direction: https://www.latimes.com/california/story/2024-01-14/decrimin...


It is legal where I am, and I do relish the privilege. I truly hope decision makers pay attention and make it universally legal.


Growing it is also fairly straightforward and most growers are hardly the criminal underground.


Benzos also work but are very dangerous if you get hooked on them


Anecdotally, it had no impact for me. I normally stay up way too late and really want to sleep earlier. While taking an edible will make me very tired, I will still fight to stay awake as long as possible. When I do finally sleep, it seems less restful.

I’ve stayed up for 2 days straight more times than I can count. I actually find that easier than making the decision to go to bed. That’s my issue, it’s not the act of sleeping, it’s the act of deciding that today is over.


Just watch your phases a bit:

"Several studies of PSG-measured sleep report increased SWS [25, 75], decreased REM sleep [74, 75, 160], and decreased REM density (e.g., number of eye movements during REM sleep) [74, 75]. However, this pattern is not always replicated [150]."[0]

(SWS =slow wave sleep)

[0] https://link.springer.com/article/10.1186/s13722-016-0056-7


Not sure how accurate my apple watch is, but I see minimal variance in my REM sleep between nights when I smoke and when I don't.

Alcohol very much screws up with my sleep though, and my total sleep score plummets if I go to bed drunk.


> Not sure how accurate my apple watch is

From what I understand, not very


It’s wild, I’ve had the complete opposite experience. The smallest bit of weed for me is like a cup of coffee. If I have any after 6pm, my mind will race all night and I won’t sleep.


It basically destroyed long bouts of jet lag for me. I fly into LA, get some edibles and get straight off to sleep, wake up at a reasonable hour the next day no side effects.


Yeah but the next day is a slow foggy mess. If you keep doing it for a long time, you’ll eventually get “the fear”, which is mild agoraphobia and paranoia.


THC edibles or CBD ones?


"marijuana is currently in the same category as some of the hardest drugs, like heroin and LSD"

Drugs should not be illegal period, but "some of the hardest drugs, like heroin and LSD" is a very funny (dark) sentence to me.


All while clearly the most dangerous drugs like fentanyl are schedule 2. (╯°□°)╯︵ ┻━┻


this isn't how things are defined, though. these days, heroin is not necessarily the best opiate against opioids. we have more selective drugs that are better at targeting analgesia over euphoria. fentanyl and more euphoric options are generally used for high levels of pain, not routinely. and so diacetylmorphine has very few medical uses besides treating withdrawal, where methadone is a better option.

because it doesn't really have a legit medical use, it's schedule 1. marijuana, lsd, and psilocybin obviously no longer really fit these criteria, but heroin probably does.

with all that said, i'm generally against scheduling and think pharmaceutical and recreational drugs should be available over-the-counter.


> because it doesn't really have a legit medical use

UK seems to think otherwise

https://en.wikipedia.org/wiki/Heroin#Medical_uses


sure, that's one alternative opinion. i am one of the biggest fda-haters you'll find but, in a vacuum, this call isn't really wrong. it can theoretically be used medically - but i'd be hard-pressed to think of why a doctor would use it now over other options. perhaps one can give some examples of cases where it was truly the only option.


I mean Fentanyl should be schedule 2, it has legitimate medical uses. That's why Cocaine and Methamphetamine are also schedule 2. Marijuana should probably be schedule 4 or 5, if not completely de-scheduled and regulated the same way Alcohol is, which is what a lot of recreational legalization states have done.


I used to think this, but now am not as sure. The experience that Portugal and the Pacific Northwest have had has caused me to question this.

I legitimately don’t know.


Blanket legalization without any supporting infrastructure seems dicey. Portugal had fairly promising results early on when they had funding for all of the assistance programs, etc., but this money ran out and the taxes raised as part of the change did not provide enough funding to support them. The PNW implementations are scattershot messes, so no surprise things are going poorly there. (Though I don't think as poorly of harm reduction practices as many do)

I think there are quite a few things we could broadly legalize, like marijuana, lsd, shrooms, dmt, etc., and have little cause for concern. Opioids, amphetamines, cocaine, etc. have enough abuse potential that we do probably need real programs to help people get clean and away from the situation that led them to begin abusing in the first place before we make them broadly legal.

Though, at the same time there are legitimate arguments that we would see significant benefits in some areas by legalizing, if only because we could bundle naloxone with opioids and ensure consistent dosages and purity, which would save a lot of lives.


Fentanyl has changed everything. The only "old" drug comparable with it is heroin, and it has always been pretty expensive and required "dedication" (intravenous use) from abusers.

Fentanyl is cheap, so a daily dose even for a heavy user is apparently less than $30 now ( https://sfstandard.com/2024/01/22/cheap-street-fentanyl-san-... ). It's also easy to get into, you just smoke it off a foil, no need for scary syringes.

And once you get addicted, you're a walking dead. The success rate for fentanyl addiction treatment is apparently less than 1%. ONE PERCENT. Even for heroin, it's around 5%.

So yeah, drugs are just different. Europe has not yet been hit with fentanyl, but it's starting to appear ( https://www.economist.com/europe/2023/11/16/fentanyl-kills-t... ). We'll see what happens.


I agree for the most part. I used to be more pro legalization of everything. It definitely seems like if you do the cost benefit analysis for individual cases it is better to not punish people for ingesting a substance voluntarily.

That said, I've lost two friends to heroin overdoses (one intentional, one not). They were both relatively successful. I find the call for better programs a bit empty - would these programs be voluntary if you are on decriminalized drugs? If so, do they have any chance of success? My friends were both financially fine so they could have opted for rehab and (as far as I know) did not.

Perhaps if legal there'd be better harm reduction practices, though I'm still skeptical this would overcome the increase in ubiquity.

The data also makes things hard. California and Oregon have far few overdoses than West Virginia. But Texas and North Dakota beat the west coast states by a lot.


I've also lost a friend to a heroin overdose, and as best we can tell it was unintentional and the result of a significant difference in purity/dose from what he was expecting. It's the sort of thing legalization and regulation would go a long way to fixing. Naloxone being readily available and using with others capable of dosing you with it to stop an OD would also be a huge deal.

But yes, I imagine any rehabilitation programs would be voluntary, though I think it would be reasonable to force them in situations where people are doing other illegal things while on the drug - DWI, the sort of public abuse you see in some cities (though lots of this is tied to a larger homelessness issue), etc. Bundle it up with programs for the homeless and you probably take care of a lot of the worst situations for people.

I don't think we'll ever get to perfect, but I hope everyone believes we can get to a better spot than we're at today.


If they're legalized it's possible it would be easier to track usage, and stage interventions if someone's demonstrating dangerous patterns.

If it's illegal than maybe fewer people are exposed, but it can be harder to know when it's a problem.


I am skeptical that libertarians who want legalized drugs would be okay with tracking. For progressive-minded people I'm skeptical too, most harm reduction programs I see emphasize anonymity.

The link below is framework for harm reduction policies which seems pretty clear that tracking usage is not part of the practice

"Participation in services is always voluntary, confidential (or anonymous), self-directed, and free from threats, force, and the concept of compliance. Any data collection requires informed consent and participants should not be denied services for not providing information. This means using low-threshold evaluation and data collection systems to measure the effectiveness of harm reduction programs."

https://www.samhsa.gov/sites/default/files/harm-reduction-fr...


I’d caution taking too many lessons from what’s happened in Oregon so far.

Measure 110 was advanced by ballot initiative, and there was little planning around how supportive services/infrastructure would be built. As a result, the rollout has gone extremely poorly.

Add to that, despite what people will viciously argue to the contrary, the distribution caused to society by COVID. Across the entire US there was a significant increase in crime, followed by a subsequent reduction. Further, significant numbers of people were let out of the jail system and shelters to reduce crowding.

There are realistically several currents that are leading to people’s anecdotal experiences, which are challenging to disentangle. All I would argue is that it is folly to think that just throwing the doors open without careful planning and consideration is a bad idea (shocking, I know).


Well, legalizing drugs won't solve other social problems. That takes completely unrelated reforms. But at least people won't end up senselessly put in prison for what they choose to put in their own body.


People usually don't get thrown in jail for getting high, they get thrown in jail for things that they do either in order to get high, or because they got high. Am I wrong?


It might work if you divert all of the funds to recovery programs. But Oregon did not do that and now they are backpedaling.


We also didn't require you to enter recovery programs.


Non-opiois drugs should generally be legal imo. Opioids specifically are tricky.


The PNW isn't a monolithic legal environment. Oregon state has dabbled in legalization much more than Washington.


you realize that "decriminalization" is the same as 1800s snake oil salesmen at the world's fair right? the exact reason the FDA was created

these substances need to go through the FDA with per ailment clinical trials and side effects listed just like other substances

reach parity with other approved drugs, alongside licensed distribution (like other drugs), treatment programs and education

make options for consumers - like we're already doing at the state level with marijuana - but better options so they don't chose the black market supply


A few things to mention here. First, the government actually paid a university to grow cannabis and they gave it to glaucoma patients for decades without any interesting results (in my opinion probably because the grantees were more interested in getting repeated funding from NIDA than to publish things NIDA didn't want to see). Second, there have been a number of clinical trials on marijuana for quite some time with a wide range of results (it's a tricky drug to study for a number of reasons). For a long time, NIDA made it hard to get funding for this- and also constrained the supply- probably with the goal of preventing studies that would find efficacy. Third, I think the FDA system is really poor at evaluating a wide range of drugs (of which cannabis is an example). They have a really limiting mechanism that doesn't work well in "compassionate use" where we already have a good understanding of the risks from widespread use. Fourth, the FDA wasn't created to do this- it was created mainly to reduce consumer fear of drugs in response to absolutely horrific side effects. The drug that led to this, thalidomide, is approved by the FDA and used in the US as a highly effective medicine.

I think in retrospect, it took the FDA so long to get here for political reasons, not scientific or medical ones.


The product made by that university was whole plant, ground. It might have been paid to grow it, but it wasn't any good at it.

https://www.reddit.com/r/trees/comments/epeb6k/the_universit...


Only artificially concentrated drugs should be heavily regulated and tracked. Everything that is a plant should be legal like tobacco. The main danger is the dosage of the drug, and using chemicals and other ways to concentrate the active ingredients, which is what makes them so dangerous.


Hemlock?

If drugs are to be outlawed based on their level of harm to society, tobacco shouldn’t be legal. It kills 7x as many as opioids every day.


That's just because more people are using. Imagine if just as many used heroine. Additionally, tobacco companies add more than just tobacco, which I believe is the most harmful and addictive part of cigarettes. I'm not saying it should all be banned, but the restrictions should align with how transformed and concentrated the product is.


Also, tobacco typically kills after 20-30+ years of use. The people it kills are mostly older people in their 60s. Heroin kills people in the prime of their life.

Imagine if nicotine was banned and people had to get it from dealers who make it in liquid form in huge vats in their basement. There would be a lot more dead from nicotine overdose for sure.


Tobacco frankly probably shouldn't be legal.


That would be like banning sugar. Sugar probably kills more people.


Sugar doesn't deal AOE damage to everyone in the vicinity.


I dunno, ever bring a box of donuts to a party?


Fun quip, but I'll do you the favor of assuming you understand why this isn't the same, explaining it to someone that most likely already understands would feel a bit patronizing


That’s because the article is wrong. Scheduling is not based on the dangerousness of the drug. It’s based on the potential for abuse and the medicinal value.


Yeah what the heck is “hard”. Destructive on the human body? Acid and heroin have about as much in common as beer and psilocybin


I think it's like one of two criteria: 1. Damaging to your body and highly addictive. This is most opioids, arguably tobacco (which is kind of grandfathered into being legal), meth, cocaine etc. 2. Can cause significant, unpredictable shifts in behavior in otherwise stable people, to the point of endangering themselves or others. This is (also) cocaine and meth, arguably alcohol (also grandfathered in), ecstasy, and why LSD is so highly scheduled. There's probably a world in which there're responsible, safe ways to experiment with LSD, but it's not something you necessarily want your given random guy on the street to be taking, lest he walk or drive into traffic or start swinging a 2x4 at people.


Ease of addiction combined with difficulty of quitting.


If that is the criteria, it is clearly wrong to include LSD in that bucket.


Oh, for sure. "Hard drugs" classification makes sense for cocaine, heroin, fentanyl, but not for psychedelics.


degree of effect. marijuana and ecstacy are "soft" because, in common recreational doses, they have less radical effects on one's personality and coherence. heroin, acid, and psilocybin all have more significant effects, microdoses aside.


I would argue that MDMA in common recreational doses has about the same level of radical effects as psilocybin. Different effects, but similar "level" or intensity of effect. And MDMA is much more dangerous for your body.


Opioids including heroin have moderate effects at moderate doses, much like marijuana or alcohol.


I've been hunting for the related source for this (and similar) article today. I cannot find any FDA press releases[1] which point to any documents like this being released. From a YouTube video from the same source as this article, there is a brief image of a document, which is the August 29, 2023 letter from HHS to the FDA [3-redacted].

Has anyone found a more definitive source that the FDA has recently released a "report" with this content? I wonder if this is just slow news day recap of old information.

[1] https://www.fda.gov/news-events/fda-newsroom/press-announcem... [2] https://www.youtube.com/watch?v=0VULoaz3E7o&t=20s [3-redacted] https://www.hhs.gov/sites/default/files/signed-ash-to-dea-le...



Maybe wait a day or two to see if the report appears on their website before assuming that the article is wrong?


Instead, I will assume that the FDA has not reversed a decades-long policy without evidence stronger than a local news station which uses a local weed doctor as their quotable source.

The change in _stated_ FDA policy is a huge shift. This explainable-by-a-simple-mistake news article seems much more likely to me. This article header says "Posted at 5:43 AM, Mar 21, 2024 and last updated 2024-03-21 20:13:30-04". That's a 100% full business day where _no other mainstream media_ picked up the story? Possible, but not likely.


Agreed, this looks like fake news. Good reminder to me to not take headlines at face value.


I turned 65 this year. I've been using weed for over 50 years now. I have never had any serious health issues at all. My hips are started to tell me I'm getting old but otherwise I'm still doing pretty good.

It's not for everyone but it has certainly been good for me.


I did a deep literature dive about it in the spring of 1986 and was amazed about how little negatives there was at that time. The biggest positive was that THC protected neurons from hypoxia, almost the opposite of damage. The other interesting finding was the Jamaican study, near zero negative effect for the heaviest use cohort. 5 or more fat joints per day for 35 or more years had basically zero negative vs the other groups. No real positives but zero negatives beyond a slightly larger percent of phlegmy lungs, like a few percent more.


1986? I am guessing even the heavy users were light -- perhaps even by an order or more of magnitude! -- compared to what today's concentrate user can easily get into with stuff bought at the state legal store.

Maybe the same findings would still hold to a great degree, but I wonder and worry, if we are going to find out in 20 years that this ultraconcentrated high dose cannabis that never existed before is going to cause long term effects that were unanticipated by generations who were familiar with the proverbial weak 1970s "ditch weed."

After all, it happened with alcohol in the 19th century, when cheap distilled spirits were introduced, wreaking havoc on society accustomed to coping with the mild intoxication of beer, not yet accustomed to how to treat something radically different in concenctration. See https://en.wikipedia.org/wiki/Beer_Street_and_Gin_Lane


Curious if any users here have had experience with Cannabinoid Hyperemesis Syndrome [1]. I enjoy partaking but after several years of consistent use I believe I started suffering from constant nausea and had to stop.

1: https://www.cedars-sinai.org/health-library/diseases-and-con...


I miss weed but I miss it less than the nausea and extreme gastric reflux that started after more 20 years of heavy use. It was a part of my identity I was a Pothead an a Nerd, now I am just an old nerd...


This hopefully is the precursor the DEA needs (plus a political push) to reschedule cannabis.


The DEA is a law enforcement agency of the US government. I wouldn't get my hopes up.


Now that the FDA has recommended it there's a good chance the DEA will reschedule it as Schedule 3, but I think that would only make medical marijuana legal on the federal level so it won't actually have that much effect.

None of these agencies are going to want to push for it to be fully descheduled.


Can anybody explain me (or recommend any resources that explains) what benefit does it have to make it illegal to have these substances?

From my point of view, it does not fix the problem of having people consume them, and it does harm the time it takes for us to have serious scientific tests that assess if they have any good benefits at all.


It’s very profitable for gangs such as DEA.


And the gangs that manufacture the patentable alternative pharmaceuticals.


If the FDA truly believed this (like, followed science, did studies, etc), they would have pushed for rescheduling decades ago. Instead, they've finally bowed to political pressure that has built up in the country over the last 10 years.

Thats all it is to them, politics. This FDA does not believe in true science.

It will also likely be politics that moves them to start banning food products that contain high levels of plastics, pesticides, etc. It won't be the science (thats already known), it will be politics again, but not until it's really bothered enough people again.


I don't really care if it has medicinal purpose or not, but it shouldn't be a crime to grow or possess it. Neither alcohol nor tobacco is held to this standard. Nor hyper-palatable foods.


Well, of course. It's an election year and the incumbent is polling poorly with young people.


So elected officials are actually following the will of the people? Isn't that their job? Last I checked, cannabis legalization had over 70% approval in this country. Hardly a grand conspiracy.


Cue the student loan headlines as well… quite the theatre


The future smells bad


> As a Schedule 1 drug, marijuana is in the same category as some of the hardest drugs like heroin and LSD, which means it’s classified as being more dangerous than fentanyl and methamphetamine.

LSD is another drug where it is absurd it is on Schedule 1, and reporters likening it specifically to heroin as one of the hardest drugs is equally absurd. Psilocybin/Psilocin also fall in this category.

Obviously not to the extent that marijuana does, but we are seeing real medical research showing promising results around mushrooms, lsd, and similar substances in treating depression, ptsd, alcohol dependency, etc. as well as just general mental wellbeing. Plainly, these do not match the criteria of 'having no recognized medical use.'

Fix our drug laws.


It's because taking these drugs give people "other ideas" about their life which don't sit well with maintaining the status quo in society we have today.

People might start to become radicalized, see themselves as more connected to things like "the natural world" and then start to demand spooky changes which aren't all about economics.

It's far too much of a risky experiment to run, so it's easier to put it all on some type of banned substances list.


Felonies disenfranchise voters. That's the root of a lot of this stuff, social control is mostly irrelevant by comparison.


And are disproportionately given to minorities to keep the white man (or orange man, or skeleton man) in office preventing them from voting. It’s systemic.


Drugs aren't classified schedule 1 based on the idea that these drugs are more dangerous than schedule 2. Both schedule 1 and schedule 2 are considered to be drugs with high abuse potential. What delineates the two is the notion that schedule 1 have no accepted medical use, while schedule 2 are accepted to have a medical use. Schedule 3, 4 and 5 are also considered to have medical use. If it is concluded that marijuana should be reclassified as having a medical use, then it could be put in category 3,4 or 5. I doubt it would be reclassified as schedule 2.


An absurd classification system that exempts alcohol and tobacco for no particular reason. I think the classification system should be consistent in a way that includes alcohol and tobacco under the same regime.


I think that it may be kept as it is to allow the ATF to continue enforcing the law for alcohol and tobacco. The DEA is responsible for enforcing the law for the substances in the Controlled Substances Act. If alcohol and tobacco were added, that would greatly widen the scope of the DEA. To add to this, the drugs classified under schedule 2-5 are produced by pharmaceutical companies, while producers of consumer alcohol and tobacco are not.


Then you need a schedule 6, "controlled substances that are dual food/drink and medical use".


I think this would still lead to the DEA being responsible for the enforcement of alcohol and tobacco, which I don't think is a desired outcome by the public.


Legalize.


[flagged]


We could just follow the lead from Central Asia where only older people are free to do whatever in terms of drugs but it's very much frowned upon if younger productive people do so. 'Course that is changing with western influence and people just getting addicted with very addictive substances.


We need to envelope the planet in weed smoke and put shrooms into the water supply instead of whatever they’re putting in right now!!.!!!! Whose with me


Not me. I hate cannabis smoke.

PSA: please make sure your second hand smoke does not affect others.


Good, but not good enough. Marijuana should be treated like kratom, kava, and salvia.


> Kava: Mild giddiness and relaxation > Salvia: Extremely intense delirium and mind-blowing hallucinations

How have you placed two in the same category????


I think basically the category is "things that aren't DEA scheduled."


Kratom is not similar or in the same category. It may not be classified as an opioid but it has similar addictive and side effects. It's an easy way to see if a head shop is honest or out to make quick money off the poorly thought out legalization measures.

The reason THC should be generally legal is because evidence shows it generally has minimal harm and other significant benefits. Kratom needs more research and is best used if all in a clinical setting.


> Kratom is not similar or in the same category.

Not only is it an opioid, but it has SSRI-like effects [1][2][3] (similar to tramadol). If you get addicted to it (like I did) for years, you could have protracted withdrawals resembling SSRI post-acute withdrawal syndrome. The actual opioid withdrawals were a walk in the park (lasting only two weeks for me), but I spent 6 months unable to function with extreme, extreme anhedonia. I just watched TV on the couch for 6 months, feeling nothing.

[1]: https://pubmed.ncbi.nlm.nih.gov/35840540/

[2]: https://journals.lww.com/ccmjournal/citation/2024/01001/1342...

[3]: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7309668/


That sounds awful and I had no idea. I've used kratom off and on over the past 20 years, but never more than a few times a year.


Incidentally, I started using kratom after quitting Prozac cold-turkey so I was probably serotonin-starved or something. It felt like the lights were finally turned on. My code, social life, discipline, etc. was 10x better. But that wore off after 4 months or so and 2 years later I had to pay the price.


Weird. I tried it once not knowing what it was and it did nothing to me.


Kratom has worked well for me, against work burnout/anxiety, while Weed I always have horrible, anxious response to.

I haven't done Kratom for 2 years now, but I'm on Concerta now which helps a bit as well.

I'm using Concerta, because I got into legal trouble due to Kratom usage... Despite just trying to handle my work and life - being a corporate drone, I was almost deemed a criminal.


It's not really like those


It should be treated the same legally as those other plants. I'm not saying the effects of consuming any of those plants are similar to each other.


Then I have truly no idea by what method you categorize drugs


Kava, kratom, salvia are all federally legal and basically unregulated.some states have laws about these plants. I think marijuana should fall into the same category as these other plants in regards to how the government is involved. What is hard to understand about that?


> salvia

you couldn't pay me enough to touch a deleriant


Maybe you're thinking of datura?


even worse. not a hard anticholinergic but salvia has some deleriant effects




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