The recommendation by the Institute of Medicine that studies be conducted ‘to test the hypothesis that cannabinoids play an important role in movement disorders’ is justified by a significant body of experimental and clinical evidence. Preclinical studies have focused on the possible application of CB1 receptor agonists in the management of dyskinesias that accompany the treatment of Parkinson’s disease with L-dihydroxyphenylalanine. Clinical investigations have been primarly concerned with the ability of CB1 receptor agonists to alleviate spasticity in various conditions and tics in Tourette’s syndrome. In particular, a recent double-blind trial has demonstrated significant improvements in tics and obsessive compulsive behaviors following administration of the oral constituent D9-tetrahydrocannabinol to Tourette patients . However, these improvements were accompanied in five patients by mild side-effects that included fatigue, dizziness and euphoria.There is a general consensus that heavy cannabis abuse can precipitate psychotic episodes in individuals with an underlying schizophrenic condition. This idea, which is supported by substantial epidemiological evidence, instigated an ongoing clinical trial of the CB1 receptor antagonist SR141716A in schizophrenic patients. Yet, on examining the basis of cannabis-precipitated psychosis, consideration should also be given to CB1 receptor desensitization and to the fact that this process can have repercussions that go beyond behavioral tolerance. One such repercussion is an exacerbated response to the psychostimulant, D-amphetamine. In animals, D-amphetamine increases motor activity and stereotypies, an effect that depends on dopamine receptor activation and is blocked by D2 receptor antagonists. Because D-amphetamine can also trigger psychotic episodes in schizophrenics,rolling bench the behavioral response to D-amphetamine in animals is often used as a screening test for antipsychotic medications.

The stimulation of stereotyped movements elicited by D-amphetamine is blocked by acute administration of D9-THC, but this same stimulation is increased in animals that have been made tolerant to cannabinoids by repeated injections of D9-THC . Thus, CB1 receptor activation might counterbalance stimulation of dopamine-containing neurons, whereas CB1 receptor inactivation might enhance such stimulation. In this framework, cannabis use by schizophrenics might be interpreted as a misguided attempt to obtain relief from psychotic symptoms, which might in turn facilitate a psychotic episode when CB1 receptors become desensitized. The ability of D9-THC to reduce tics in Tourette’s syndrome and to inhibit D-amphetamine-induced stereotypy suggests that CB1 receptor agonists might be therapeutically useful to alleviate the symptoms of dopamine hyperactivity associated with many neuropsychiatric conditions. However, the psychotropic effects produced even by low doses of D 9-THC in Tourette patients and the possible impact of CB1 receptor desensitization underscore the need to investigate a wider variety of cannabinoid agents in animal models of motor disorders and psychosis. For example, evidence suggests that the anandamide transport inhibitor AM404 can normalize motor activity in genetically hyperactive rats without causing overt cannabimimetic effects.Proposition was really focused on the criminal justice aspects of cannabis prohibition — on [addressing] the negative impact of criminalization, primarily on people of color. It also focused on what happens to consumer safety and protection in the absence of regulation. It didn’t really prescribe regulation for the commercial sale of cannabis. The Legislature had already come up with a framework for regulating medical cannabis prior to Proposition passing, and we didn’t have any reason to think that [the Legislature’s framework] would change drastically just because the criminal code had changed. We were right. California regulates cannabis with a strong hand and high taxes. You have to interface with a lot of agencies to be compliant. Those agencies are often overburdened and understaffed.

Cannabis farmers and the cannabis industry in general have to navigate the same pitfalls that we see [elsewhere] in the California regulatory landscape. But when you add in [the cannabis industry’s] lack of access to banking, and [its] inability to transfer product across state lines — it makes it even more difficult for folks involved in this industry.I would probably say rethinking our tax structure. In the current regulatory environment, taxes are assessed at a flat rate for each pound of cannabis flower and trim that’s sold to a distributor. What we’d really like to see is cannabis [taxed the way] they currently tax alcohol, based on production level. If you are an alcohol producer, you get quite a substantial tax break up until a certain amount that you produce. That way, smaller players pay less taxes and their work is actually subsidized by the folks that are making a lot more product and are able to keep costs down. I think that the state is a little reluctant to look at the tax structure, primarily because — and rightfully so — they have something to prove in terms of tax revenue. To start messing with the tax structure now, before they feel they’ve really proven that they can make the revenue — they’re very reluctant to [do] that. But moving forward, the smaller producers will always need that extra support.We only have about 17 localities in the state — counties or cities — that allow sun grown cultivation [cultivation without supplemental light]. We’re not doing enough to educate localities and regulators about the energy impacts of high-intensity lighting, or [the drawbacks] of setting up systems where the only way you can cultivate cannabis commercially is through very energy-intensive methods — which go very much against California’s goals [for reducing] carbon emissions. I think the California Department of Food and Agriculture could talk more about sustainable cultivation — about implementing [incentive programs similar to those developed for] other industries — so that, from the get go, we’re establishing sustainable systems, rather than going back 10 or 15 years later to do a greening of the cannabis industry.

If I had to rank the type of cultivator that licensed cultivators are okay seeing law enforcement go after, number one would be people that are doing environmental degradation on public land. Folks in the forest or the national park who are harming the environment — I would say that almost no one would ever disagree [with enforcement against them]. The attitude changes when we talk about people on private land. Because even though nobody wants folks to be diverting from streams, there is a sense that “It’s their land,” and maybe they’re trying to do better. That’s part of the culture up here [in the Emerald Triangle]. A lot of folks came up here to buy big pieces of land [partly because] they wanted privacy, and to be themselves on their land. No one wants to see environmental degradation, but when it comes to private land, they may say “Is there a way you can go in and try to help [non-compliant growers] before law enforcement comes in? Can you go and give them a warning?” In terms of people on private land who are not harming the environment, there is a strong belief that law enforcement should not be involved. Maybe these individuals want to become compliant but can’t afford to become compliant. So instead of law enforcement prioritizing them, we should instead offer support and say, “What can we do to support you in transitioning to the regulated market?” It’s not an all-or-nothing thing. There are definitely people cultivating without a license who are way more egregious than others.Over the next decade, I do. I think that there are probably two main components that have to happen before we can start thinking about dry rack cannabis like other industries — one, of course, being banking. We cannot be treated like any other industry when we cannot bank. Until banking is allowed and we can get small business loans, we will not be like any other industry. The second thing is being able to ship across state lines. You can’t ship wine to every state, but you can ship it to most states, and the ability of states like California and Oregon, or California and Washington, to enter into an agreement so cannabis can flow across the borders — that’s another way that we will be able to be treated like every other industry. Until then, you have to cap production [at the level] your state can consume. Do we say, “Florida, you can only grow so many oranges because [your oranges] all have to stay in Florida?” That doesn’t make sense. I’m hoping that both [banking and interstate shipments] will happen in the next 10 years. I think banking will happen this year — the SAFE Banking Act [a cannabis banking bill] was introduced in Congress this year with over 100 sponsors from both sides of the aisle.People with HIV or at risk for HIV are potentially more susceptible to the adverse effects of alcohol due to high prevalence of mental health disorders, poor physical health and chronic conditions, and risk-taking behaviors . Epidemiological evidence consistently shows the relationship between hazardous alcohol use and emergency department visits, increased sexual transmission risk behavior, and worse HIV related outcomes in this population . A cross-sectional survey of people with HIV/hepatitis C virus co-infection after the start of the COVID-19 pandemic showed 26% of respondents used both alcohol and other drugs . Sanchez et al. surveyed men who have sex with men and found the prevalence of drug use increased 10% and alcohol use increased 25% among respondents compared to prior to COVID-19. People often consume higher levels of alcohol during times of stress, and alcohol use often stays elevated after the stressful event has resolved . Alcohol consumption during the COVID-19 pandemic has increased in the general population and resulted in a rise of hospitalizations related to withdrawal management and alcohol-related conditions . Among the population of people with HIV and those at risk of HIV, hazardous alcohol use during this period may compound the existing burden of health and social vulnerabilities leading to worse health outcomes. At the same time the drug supply has become increasingly saturated with illicitly manufactured fentanyl directly contributing to 100,000 drug overdoses in 12-month period in the U.S. .

Yet less is known about the intersection of alcohol and drug use among people with HIV or at risk for HIV during the COVID-19 pandemic. Given the high burden of alcohol and other drug use among people with HIV or at risk for HIV, there is an urgent need to identify the patterns of multiple substance use to initiate harm reduction and treatment strategies and direct future research. Lesko and Bengtson highlighted the relationship of alcohol and drug use consequences among vulnerable populations like those people with HIV or at risk for HIV. However, studies thus far are either limited to a single geographic area or the methods limit the generalizability . The Collaborating Consortium of Cohorts Producing NIDA Opportunities organized surveys which provided a new opportunity to understand alcohol and other drug use in a diverse population of people with or at risk for HIV during the COVID-19 pandemic. Herein, we report the results from the initial surveys describing the 1) prevalence of low-risk and hazardous alcohol use and 2) exploring the association of other drug use and psycho-social factors with alcohol use among a population of people with HIV or at risk for HIV enrolled in diverse cohorts. The Collaborating Consortium of Cohorts Producing NIDA Opportunities was established in 2017 by the National Institute on Drug Abuse to enhance data sharing opportunities and mechanisms to facilitate collaborative research efforts among NIDA-supported cohorts that examine HIV/AIDS in the context of substance use. Details of the participating cohorts and other methodology have been previously described , but briefly, the C3PNO Consortium is comprised of nine NIDA cohorts located in major cities in the United States and Canada with a combined sample size of up to 12,000 active participants. Between May 2020 and February 2021, a subset of participants in each cohort was recruited to respond to a survey about their experiences during the COVID-19 pandemic. Of the nine C3PNO cohorts, six reported information on participant alcohol use: The AIDS Linked to the Intravenous Experience ; the Healthy Young Men’s Study ; the Johns Hopkins HIV Clinical Cohort ; the Miami Adult Studies on HIV ; mSTUDY ; and the Multilevel Influences on HIV and Substance Use in YMSM Cohort .