Ansia e Sclerosi Multipla

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Cari amici,
oggi torniamo a parlare di disturbi psicologici e sclerosi multipla. In particolare oggi vorrei trattare un argomento di cui si parla tanto: l’ansia.
Rispetto alla depressione, l’ansia associata alla sclerosi multipla, è stata oggetto di un minore numero di ricerche, nonostante anch’essa rappresenti un importante problema per i malati SM. La sua frequenza varia moltissimo a seconda della casistica che viene considerata, ma i dati presenti nella letteratura scientifica, che vanno da un 19 ad un 90%, amplificano probabilmente tale variabilità, forse perché gli studi che li hanno raccolti hanno impiegato metodi diversi per individuare il problema. Prendendo in considerazione il momento della diagnosi, molto critico nella vita delle persone con sclerosi multipla, alcune ricerche hanno dimostrato la presenza dell’ansia nel 34% dei malati e nel 40% dei loro coniugi. Seguendo per due anni persone alle quali è stata comunicata una diagnosi di sclerosi…

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Can marijuana treat MS symptoms? One Colorado researcher makes it his mission to find out

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If these studies can demonstrate that cannabis effectively relieves and treats MS symptoms, they could help establish the medicinal value of cannabis

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PUBLISHED: JAN 18, 2017, 8:00 AM
By Thorsten Rudroff, Colorado State University

Story via The Conversation

An estimated 400,000 Americans are currently living with multiple sclerosis, an autoimmune disease where the body’s immune cells attack a fatty substance called myelin in the nerves. Common symptoms are gait and balance disorders, cognitive dysfunction, fatigue, pain and muscle spasticity.

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Colorado has the highest proportion of people living with MS in the United States. It is estimated that one in 550 people living in the state has MS, compared to one in 750 nationally. The reason for this is unknown, but could be related to several factors, such as vitamin D deficiency or environment.

Currently available therapies do not sufficiently relieve MS symptoms. As a result many people with the condition are trying alternative therapies, like cannabis. Based on several studies, the American Association of Neurology states that there is strong evidence that cannabis is effective for treatment of pain and spasticity.

Although there are many anecdotal reports indicating cannabis’ beneficial effects for treatment of MS symptoms such as fatigue, muscle weakness, anxiety and sleep deprivation, they have not been scientifically verified. This is because clinical trials – where patients are given cannabis – are difficult to do because of how the substance is regulated at the federal level.

To learn more, Integrative Neurophysiology Laboratory at Colorado State University is studying people with MS in the state who are already using medical cannabis as a treatment to investigate what MS symptoms the drug can effectively treat.

Medical marijuana isn’t a prescription drug. Marijuana, or cannabis, contains over 100 compounds, but THC (Tetrahydrocannabinol) and CBD (Cannabidiol) are believed to have the most medical relevance.

However, there is currently no information about the most effective ratio of THC and CBD, which form of ingestion (smoking or eating, for instance) is best, or how often people with MS should use cannabis products.

The main reason for the limited scientific evidence about how well cannabis can treat MS symptoms is because it is a Schedule 1 substance. This means that it has “no currently accepted medical use and a high potential for abuse.” This classification makes it very difficult to study cannabis in clinical trials.

Because cannabis is on Schedule 1, doctors can’t prescribe it, even in the states with medical marijuana laws, like Colorado. In those states doctors can provide patients with a “permission slip” for cannabis, which has to be approved by a state agency.

Because of the lack of scientific evidence, doctors can’t recommend a specific strain and dosage of cannabis to patients. Patients are left to choose on their own. Moreover, a recent study in the Journal of the American Medical Association showed that out of 75 cannabis products, only 17 percent were accurately labeled. And 23 percent contained significantly more THC than labeled, possibly placing patients at risk of experiencing adverse effects.

How we are studying cannabis and MSMy lab’s long-term goal is to determine whether cannabis can safely and effectively treat MS symptoms. But because of current federal regulations our lab can conduct only observational studies at this time. To conduct clinical trials with a Schedule 1 substance, investigators much have a special license, which my lab is in the process of applying for. At the moment, this means we study only people who are or are about to use cannabis and we do not provide cannabis to anyone for our studies.

We recently completed an online survey of 139 MS patients currently using cannabis to learn what types of products they used, how often they used those products and for how long.

Our results, which have not yet been published, found that 91 of our respondents (66 percent) reported that they currently use cannabis, and 56 percent of the cannabis users reported using either smoked or edible products. Seventy-eight percent of the cannabis users also indicated that they reduced or even stopped other medications as a result of their cannabis use.

The survey respondents who are using cannabis reported lower disability scores on the Guy’s Neurological Disability Scale, a clinical scale used to evaluate neurological disability in people with MS, and they seem less likely to be obese. However, these data are self-reported, which means objective longer clinical trials are required to confirm these results.

We are also conducting an ongoing observational study, set to be completed in mid-2017, on the effects of regular cannabis use on physical function and activity levels in people with MS. There are many studies on the influence of cannabis on cognitive function in healthy and diseased populations. However, no study to date has used objective measures of motor function in people with MS who are using cannabis, such as muscle strength and fatigue tasks, walking performance and postural stability tests.

Our preliminary results indicate that people with MS using cannabis have greater physical activity levels, leg strength and walking speed, while also having less spasticity, fatigue and a lower perceived risk of falling. It is of note that these individuals are rarely using only cannabis to help control their symptoms. They are often using cannabis alongside traditional medications.

Importantly, cannabis users did not perform worse than nonusers on any of our measurements. These are very promising results, and we are expecting significant positive effects of cannabis at the end of this observational study.

Randomized control trials are neededThe outcomes of these observational studies will be the foundation for larger randomized clinical trials, where some patients are treated with cannabis and others aren’t. These types are studies are needed to truly show the benefits and risks of consequences of cannabis use in this population.

Applying for the special license that investigators must have to conduct clinical research with a Schedule 1 substance is a lengthy process. Once granted, the DEA requires on-site inspections of the investigator’s facilities. Furthermore, it is also very difficult for these types of experiments to be approved and performed. These policies make conducting research on the medical benefits and side effects of cannabis in the United States extremely hard. As a sad result, top researchers are looking to export their ideas outside the country.

Assessing the scientific evidence: What is known about cannabis and health effects

We want to conduct clinical research to understand what cannabis products MS patients should use, in what dosage and in what form of ingestion. We also want to find out whether long-term cannabis use is safe, and if the effectiveness changes overtime due to increased tolerance. Fortunately, our first intervention study, which will investigate the effects of different marijuana strains on motor and cognitive function in people with MS, has been approved by the CSU Institutional Review Board. This means that my lab can begin this research once our license is approved.

The answers to these questions will provide guidelines for health care providers and people with MS on cannabis use. If these studies can demonstrate that cannabis effectively relieves and treats MS symptoms, they could help establish the medicinal value of cannabis. That could make a case for rescheduling cannabis, making it easier for physicians and researchers to establish cannabis’ true benefits and risks.

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This article was originally published on The Conversation. Read the original article.

http://www.thecannabist.co/2017/01/18/marijuana-treat-multiple-sclerosis/71515/

Assessing the scientific evidence: What is known about cannabis and health effects

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Conclusions in ‘Health Effects of Cannabis and Cannabinoids’ report
PUBLISHED: JAN 12, 2017, 6:38 PM 
By Alicia Wallace, The Cannabist Staff

 

A sweeping assessment on marijuana research by the National Academies of Sciences, Engineering and Medicine published Jan. 12 analyzed 10,000 studies conducted since 1999. A team of researchers for the U.S. scientific academy quantified the weight of current scientific evidence, with recommendations for future study. The report made the following conclusions about what is known about cannabis:

Conclusive evidence
Defined as: Many supportive findings from good-quality studies with no credible opposing findings. A firm conclusion can be made, and the limitations to the evidence, including chance, bias, and confounding factors, can be ruled out with reasonable confidence. Therapeutic effects: Strong evidence from randomized controlled trials to support the conclusion that cannabis/cannabinoids are an effective or ineffective treatment. Other health effects: Strong evidence from randomized controlled trials to support or refute a statistical association between cannabis/cannabinoid use and the health endpoint.

• Effective in treating chronic pain in adults

• Effective as antiemetic properties to prevent and treat chemotherapy-induced nausea and vomiting

• Effective in improving multiple sclerosis spasticity symptoms

Substantial evidence
Defined as: Several findings from good- to fair-quality studies with very few or no credible opposing findings. A general conclusion can be made, but limitations, including chance, bias, and confounding factors, cannot be ruled out with reasonable confidence. Therapeutic effects: Some evidence to support the conclusion that cannabis/cannabinoids are an effective or ineffective treatment. Other health effects: There is some evidence to support or refute a statistical association between cannabis/cannabinoid use and the health endpoint.

• Long-term cannabis smoking and worse respiratory symptoms and frequent chronic bronchitis episodes (statistical association)

• Increased risk of motor vehicle crashes (statistical association)

• Maternal cannabis smoking contributes to lower birth weight of the offspring (statistical association)

• Development of schizophrenia or other psychoses, with the highest risk among the most-frequent users (statistical association)

• Stimulant treatment of attention deficit hyperactivity disorder in adolescence is not a risk factor for problem cannabis use

• Being male and being a smoker are risk factors for cannabis use to progress to problem cannabis use

• Cannabis use at an earlier age is a risk factor for the development of problem cannabis use

Moderate evidence
Defined as: Several findings from good- to fair-quality studies with very few or no credible opposing findings. A general conclusion can be made, but limitations, including chance, bias, and confounding factors, cannot be ruled out with reasonable confidence. Therapeutic effects: Some evidence to support the conclusion that cannabis/cannabinoids are an effective or ineffective treatment. Other health effects: Some evidence to support or refute a statistical association between cannabis/cannabinoid use and the health endpoint.

• Effective in improving short-term sleep outcomes in people with sleep apnea, fibromyalgia, chronic pain and multiple sclerosis

• No statistical association between cannabis use and incidence of lung, head and neck cancers

• Improved respiratory airway dynamics among cessation from acute cannabis smokers but not chronic use (statistical association)

• Cannabis smoking leads to higher forced vital capacity (statistical association)

• Cannabis use has increased risk of overdose injuries — including respiratory distress — among pediatric population in U.S. states where cannabis is legal (statistical association)

• Acute cannabis use impairs cognitive functions such as learning, memory and attention (statistical association)

• Individuals with psychotic disorders and a history of cannabis use have better cognitive performance (statistical association)

• Cannabis use and increased symptoms of mania and hypomania in individuals with bipolar disorders (statistical association)

• Small increased risk for development of depressive disorders (statistical association)

• Increased incidence of suicidal thoughts and attempts with higher incidence among heavier users (statistical association)

• Increased incidence of suicidal completion (statistical association)

• Increased incidence of social anxiety disorder (statistical association)

• No statistical association between cannabis use and worsening of negative symptoms of schizophrenia among individuals with psychotic disorders.

• Anxiety, personality disorders, bipolar disorders, ADHD are not risk factors for the development of problem cannabis use

• Individually, major depressive disorder, being male, having exposure to combined use of abused drugs are risk factors for the development of problem cannabis use

• On their own, alcohol and nicotine dependence are not risk factors for the progression of cannabis use to problem cannabis use.

• In adolesence, the frequency of cannabis use, oppositional behaviors, a younger age of first alcohol use, nicotine use, parental substance use, poor school performance, anti-social behaviors and childhood sexual behaviors are risk factors for the development of problem cannabis use.

• Persistence of problem cannabis use and history of psychiatric treatment (statistical association)

• Problem cannabis use and increased severity of post-traumatic stress disorder symptoms (statistical association)

Former U.S. Marine Sgt. Ryan Begin smokes medical marijuana at his home in Belfast, Maine on November 21, 2014. (Robert F. Bukaty, The Associated Press)
Former U.S. Marine Sgt. Ryan Begin smokes medical marijuana at his home in Belfast, Maine on November 21, 2014. (Robert F. Bukaty, The Associated Press)
Limited evidence
Defined as: Supportive findings from fair-quality studies, or mixed findings with most favoring one conclusion. A conclusion can be made, but there is significant uncertainty due to chance, bias, and confounding factors. Therapeutic effects: Weak evidence to support the conclusion that cannabis or cannabinoids are an effective or ineffective treatment. For other health effects: Weak evidence to support or refute a statistical association between cannabis or cannabinoid use and the health endpoint.

• Increasing appetite and decreasing weight loss associated with HIV/AIDS

• Improving clinician-measured multiple slcerosis spasticity symptoms

• THC capsules improve Tourette syndrome symptoms

• Cannabidiol improves anxiety symptoms, as assessed by public speaking test, in people with social anxiety disorders

• Improves symptoms of PTSD (nabilone, one single, small fair-quality trial)

• Better outcomes after a traumatic brain injury or intracranial hemorrhage (statistical association)

• Cannabinoids are ineffective for improving symptoms associated with dementia

• Cannabinoids are ineffective in improving intraocular pressure associated with glaucoma

• Cannabinoids are ineffective in reducing depressive symptoms in individuals with chronic pain or multiple sclerosis

• Cannabis smoking and non-seminoma-type germ cell tumors (statistical association)

• Cannabis smoking triggers acute myocardial infarction (statistical association)

• Ischemic stroke or subarachnoid hemorrhage (statistical association)

• Decreased risk of metabolic syndrome and diabetes (statistical association)

• Increased risk of pre-diabetes (statistical association)

• Occassiaonal annabis smoking and an increased risk of developing chronic obstructive pulmonary disease (statistical association)

• Decrease in the production of several inflammatory cytokines in healthy individuals(statistical association)

• No statistical association between daily cannabis use and the progression of liver fibrosis or hepatic disease in individuals with Hepatitis C

• Maternal cannabis smoking and pregnancy complications (statistical association)

• Maternal cannabis smoking and admission of the infant to the neonatal intensive care unit (statistical association)

• Impaired academic achievement and education outcomes (statistical association)

• Increased rates of unemployment or low incomes (statistical association)

• Impaired social functioning and engagement (statistical association)

• Sustained abstinence from cannabis use and impairments in learning, memory and attention (statistical association)

• Increase in schizophrenia symptoms such as hallucinations among individuals with psychotic disorders (statistical association)

• Likelihood of developing bipolar disorder, especially among regular or daily users (statistical association)

• Development of any type of anxiety disorder except social anxiety disorder (statistical association)

• Increased symptoms of anxiety among near daily users of cannabis (statistical association)

• Increased severity of PTSD symptoms (statistical association)

• Childhood anxiety and childhood depression are risk factors for the development of problem cannabis use

• Initiation of tobacco use (statistical association)

• Changes in the rates and use patterns of other licit and illicit substances (statistical association)

No or insufficient evidence to support or refute
• Effective treatment for cancers, including glioma

• Effective treatment for cancer-associated anorexia cachexia syndrome and anorexia nervosa

• Effective treatment for symptoms of irritable bowel syndrome

• Effective treatment for epilepsy

• Effective treatment for spasticity in patients with paralysis due to spinal cord injury

• Effective treatment for symptoms associated with amyotrophic lateral sclerosis

• Effective treatment for chorea and certain neuropsychiatric symptoms associated with Huntington’s disease

• Effective treatment for motor system symptoms associated with Parkinson’s disease

• Effective treatment for Dystonia

• Effective treatment for achieving abstinence in the use of addictive substances

• Effective treatment for mental health outcomes in individuals with schizophrenia or schizophreniform psychosis

• Incidence of esophageal cancer from cannabis smoking (statistical association)

• Incidence of prostate cancer, cervical cancer, malignant gliomas, non-Hodgkin lymphoma, penile cancer, anal cancer, Kaposi’s sarcoma or bladder cancer (statistical association)

• Subsequent risk of developing acute myeloid leukemia/acute non-lympoblastic leukemia, acute lymphoblastic leukemia, rhabdomyosarcoma, astrocytoma, or neuroblastoma in offspring (statistical association)

• Increased risk of acute myocardial infarction (statistical association)

• Hospital admissions for COPD (statistical association)

• Asthma development or asthma exacerbation (statistical association)

• Other adverse immune cell responses in healthy individuals from cannabis smoking (statistical association)

• Adverse effects on immune status in individuals with HIV (statistical association)

• Increased incidence of oral human papilloma virus (statistical association)

• All-cause mortality (statistical association)

• Occupational accidents or injuries (statistical association)

• Death due to cannabis overdose (statistical association)

• Changes in the course or symptoms of depressive disorders (statistical association)

• Development of PTSD (statistical association)

This Sept. 15, 2015 file photo shows marijuana plants with their buds covered in white crystals at a medical marijuana cultivation center in Albion, Ill. (Associated Press file)
This Sept. 15, 2015 file photo shows marijuana plants with their buds covered in white crystals at a medical marijuana cultivation center in Albion, Ill. (Associated Press file)
Challenges and barriers in conducting cannabis and cannabinoid research
• Regulatory barriers, including the classification of cannabis as a Schedule I substance, that impede the advancement of cannabis and cannabinoid research

• Difficulty for researchers to gain access to the quantity, quality and type of cannabis product necessary to address specific research questions on the health effects

• Lack of a diverse network of funders to support research that explores the beneficial and harmful effects of cannabis use.

• Lack of conclusive evidence for the effects of cannabis use on short- and long-term health outcomes, improvements and standardization in research methodology.

http://www.thecannabist.co/2017/01/12/marijuana-research-review-10000-studies-analyzed/71215/

Ind. Veteran Pushing For Legalization Of Medical Marijuana

U.S. Marijuana Party of Kentucky

By Barbara Brosher
Posted January 13, 2017

The American Legion of Indiana could consider a resolution this weekend that would encourage state lawmakers to develop a medical marijuana program.

The proposal comes from a Kokomo veteran who hopes medical marijuana could help veterans struggling with opioid addiction.

But, similar proposals have failed to gain traction at the statehouse.

Veteran Hopes Medical Marijuana Could Help Treat Physical, Emotional Pain

Veterans gather on a daily basis at the bar or around tables at the American Legion post in Martinsville to catch up with each other. The talk revolves around their families, politics and, lately, a proposal from another veteran to make medical marijuana legal in Indiana.

“People don’t know what kind of pain old men have. You can explain it to them, but nobody knows”

—James Ritter, Veteran

“If marijuana is medically available for older veterans that have a need for pain…

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Just eight individuals, all men, own as much wealth as the poorest half of the world’s population, Oxfam said on Monday in a report calling for action to curtail rewards for those at the top. As decision makers and many of the super-rich gather for this week’s World Economic Forum (WEF) annual meeting in Davos,…

via The World’s 8 Richest Men Are Now as Wealthy as Half the World’s Population — Fortune

Scoperto un nuovo modo di manipolare i canali del Calcio per la formazione di mielina

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Cari lettori,
ieri sera un altro interessante articolo è giunto alla mia attenzione e voglio condividerlo con voi nel consueto post di approfondimento scientifico.
Secondo un team di ricercatori americani, sarebbe necessaria una specifica tipologia di canale che facilita il flusso di calcio, per il normale sviluppo delle cellule che producono lo scudo, chiamato mielina, intorno alle fibre nervose. Una scoperta questa, che potrebbe aprire nuovi approcci per rigenerare le cellule produttrici di mielina (chiamate oligodendrociti) che vengono perse nei pazienti con Sclerosi Multipla.

I ricercatori ora sperano di trovare il modo di manipolare i canali del calcio dopo che un problema porta ad una disfunzione degli oligodendrociti in modo da rigenerare queste cellule. Dal momento che un sacco di farmaci destinati ai canali del calcio già esiste per altre malattie, il team spera che la conoscenza proveniente da altri campi della medicina aiuterà ad avanzare la loro ricerca.

Lo studio dal titolo

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I disturbi psicologici nella SM

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Cari lettori,
da tempo sentivo l’esigenza di dedicare uno dei miei articoli settimanali ad uno dei tanti aspetti problematici correlati alla Sclerosi Multipla, quello psicologico. Un argomento delicato e complesso di cui non si parla abbastanza e quando se ne parla, lo si fa con una sorta di freddezza, con una mancanza di empatia e un distacco emotivo, tipico di quando si descrivono quelle cose remote, lontane da noi come se mai ci interessassero davvero, nel profondo. Ed invece eccomi qui a parlarvi oggi dei tanti sintomi psichiatrici che purtroppo sono presenti nella maggior parte dei pazienti con sclerosi multipla e che contribuiscono in modo significativo a determinare un progressivo peggioramento della sintomatologia neurologica, aggravando la disabilità e rendendo ancora più complicate le nostre vite.

Secondo  Feinstein (2011) i disturbi psicologici interferiscono in maniera significativa con il funzionamento familiare, sociale e lavorativo dei pazienti SM. La prima descrizione ad un coinvolgimento delle funzioni sottese alla convessità cerebrale si deve a Charcot che, nella sua…

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Trump’s Cabinet Not Cannabis-Friendly, But Don’t Panic Yet

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Trump selecting Sen. Jeff Sessions for Attorney General and Rep. Tom Price for Health Secretary does not bode well for federal cannabis regulation.

 

President-elect Donald Trump nominated Sen. Jeff Sessions from Alabama for Attorney General and Rep. Tom Price from Georgia as the new Health Secretary. Those appointments still require Senate approval before they are officially members of the cabinet. Neither of the picks to head the Department of Justice (DoJ) and the Department of Health & Human Services (HHS) is friendly to cannabis.

What’s the bad news?

Both of those agencies are at the center of any federal regulation of cannabis, including access for research. As Attorney General, Jeff Sessions would essentially have the ability to block any rescheduling efforts, as outlined in the Controlled Substances Act.

Gage Skidmore, Flickr
Sessions has made inflammatory, racist remarks and showed his disdain for cannabis users on multiple occasions. He disgracefully said at a Senate hearing in April, “Good people don’t smoke marijuana.” When he was a federal prosecutor, Sessions was a prominent advocate for the War on Drugs, and perhaps even still is.

Rep. Tom Price (R-GA) Photo: Gage Skidmore, Flickr
Tom Price, a Republican Congressman from Georgia, has voted repeatedly against pro-cannabis legalization bills, including twice against the Veterans Equal Access Amendment as well as the Rohrabacher/Farr Amendment, which “prohibits the use of funds in the bill to supersede State law in those States that have legalized the use of medical marijuana.” NORML’s Georgia Scorecard gave Tom Price a D grade for his previously voting against pro-cannabis bills.

What’s the good news?

While Sen. Jeff Sessions is certainly no friend to legal cannabis, I believe he is not a serious danger to the cannabis industry. This op-ed on CNN does a terrific job at summing up Sessions’ potential threat to the cannabis industry, but also why it may not be cause for a total panic. The author mentions a laundry list of DoJ priorities over cannabis, but I think the larger issue at hand is states’ rights.

Republicans are historically passionate when it comes to keeping states’ rights sovereign. With cannabis’ big wins on Election Day, a majority of the country’s population now lives in states where cannabis is legal.

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There is too much momentum behind legal cannabis for a new administration to waste precious resources and time on trying to disrupt it. States are getting too much tax revenue from regulating cannabis to just let the DoJ interfere with their economies. “Voters in 28 states have chosen programs that shift cannabis from the criminal market to highly regulated, tax-paying businesses,” says Aaron Smith, executive director of the National Cannabis Industry Association (NCIA). “Senator Sessions has long advocated for state sovereignty, and we look forward to working with him to ensure that states’ rights and voter choices on cannabis are respected.” Smith’s words in the NCIA statement are pointed and clear: this is a states’ rights issue at heart and they must respect that.

By forcing the states’ rights issue to the front, it is possible to put legal cannabis in a bipartisan lens, thus eliminating the possibility of a few old drug war stalwarts disrupting the industry. While rescheduling efforts could be thwarted for the coming years, I have faith that the federal government will not interfere with states that legalize cannabis.

 

 

https://www.cannabisindustryjournal.com/column/trumps-cabinet-not-cannabis-friendly-but-dont-panic-yet/