Maryland, home to the FDA, is one of 38 US states, along with three territories and the District of Columbia, that have legalized cannabis for medical purposes. This legal sea change has generated increasing interest in and use of cannabis and cannabis products, yet most health care practitioners and students feel underprepared to counsel patients on medical cannabis, according to a new paper co-authored by a University of Maryland School of Medicine (UMSOM) faculty member and published in JAMA Network Open.

The paper suggests key content that should be incorporated into medical school curricula so that students will have the tools they need to serve patients in a landscape of increasing legal medical cannabis use, according to study co-author David Gorelick, MD, PhD, Clinical Professor of Psychiatry at the Maryland Psychiatric Research Center.

“This paper outlines the core competencies that physicians should possess to deal appropriately with their patients regarding medical cannabis,” Dr. Gorelick said. “The goal is to spur medical schools and residency programs to incorporate these competencies into their curricula.”

When I interviewed Dr. Raphael Mechoulam in the past, and also Dr. Alan Shackelford, both medical cannabis pioneers in their right, they both understood that dosing is key. How to find it may depend on the individual’s response to finely tuned concentrations of CBD and THC and other cannabis active compounds.

The core competencies could also help clinicians address a concurrently increasing amount of legal non-medical cannabis use, Dr. Gorelick added, as 24 states, including Maryland, now allow for adult recreational sale and use of cannabis products.

In collaboration with more than 20 co-authors across 26 institutions, Dr. Gorelick and his colleagues characterized the gap between patient and clinician needs and the current medical school curriculum. They cited past studies showing that only 8 percent of medical school curricula mentioned medical cannabis in the 2015-2016 academic year, and that 66.7 percent of surveyed medical school curriculum deans felt their students graduated without adequate preparation for prescribing medical cannabis.

At the same time, the need for cannabis-informed physicians is increasing as more people are using cannabis with or without medical supervision — UMSOM researchers studying cannabis use among pregnant women found that use increased 170 percent between 2009 and 2016, for instance.

When I asked cancer researchers at Princess Margaret Hospital in Toronto, treating my dad for cancer, and one of the leading cancer clinical hospitals in the world, they were stumped and said I couldn’t access any treatments inside the hospital. The concept was out of bounds.

To better meet the needs of patients and clinicians, the authors assembled 23 clinical and scientific experts with varied backgrounds to achieve a consensus on what medical students need to know about cannabis before entering practice. The process resulted in a recommendation of six core competencies addressing the clinical utility, risks, legal landscape, and scientific evidence around medical cannabis.

The six core competencies are:

1. Understand the basics of the endocannabinoid system.
2. Describe the main components of the cannabis plant and their biological effects.
3. Review the legal and regulatory landscape of cannabis in the US.
4. Describe the evidence base for health conditions that are commonly managed with cannabis.
5. Understand the potential risks of medical cannabis use.
6. Understand basic clinical management with medical cannabis.

”It’s important that medical students be exposed to this information, and we currently provide lectures that cover cannabis fairly robustly in our pre-clerkship curriculum in the first two years of medical school,” said Dr. Joseph Martinez, MD, UMSOM Professor of Emergency Medicine and the school’s Associate Dean for Medical Education and Student Experience.

Students also gain hands-on experience in caring for patients using cannabis, as well as any other medications and illicit substances, after they begin their clinical rotations, he added.

“I’m pleased to say that the UMSOM medical student curriculum appears to incorporate most of the topics recommended in the JAMA Network Open article,” Dr. Gorelick said. “I hope that further progress will be made in including cannabis-related material in the curricula for clinical clerkships and residencies. This will help ensure that future physicians have the knowledge and expertise they need to work with patients who are using or considering using cannabis products.”

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The medical cannabis boom felt in Israel may show signs of a giant cooldown. Syqe was one of the darlings of the medical cannabis pharma space, as a doseable drug. This is an industry I helped spark into life when I started the Canna Tech Conference in Jaffa about 10 years ago. Much has changed and a lot of the hype has died down, mainly due to loosened restrictions on access to cannabis, making it easy for people to self medicate in the United States and Canada.

One of the challenges in cannabis as medicine is dosing (read this article on half of all medical cannabis drugs being mislabled). What’s written as THC or CBD concentration may be far from what’s inside the plant or how it affects your body, and how it’s delivered. Syqe, an inhaler dosing system in Israel promises to make dosing a pharmaceutical science, but in waiting for the coveted US FDA approval, Syqe says it needs to lay off 50 of its staff of about 150 based in Tel Aviv. If their product works they may be actually a solution to the mislabeling.

The company grew into medical marijuana stardom when Philip Morris / PMI, the cigarette company invested $20 million in 2016 and later entered into an agreement to acquire the company for ~$650 million, contingent on regulatory success. In that acquisition plan, PMI committed $120 million to push Syqe’s inhaler device through U.S. FDA regulatory hurdles. Is the money running out without results?

This backing gave Syqe financial muscle and strategic reach—but also raises reputation and strategic risks, given tobacco’s fraught public perception in the health space. Imagine if McDonald’s bought into a regenerative kale farm. The cash infusion could scale production, but people would always wonder if the lettuce was being served with a side of fries.

According to recent news Syqe Medical recently cut 50 employees, about 32% of its workforce, with the majority coming from its development (R&D) department. If the company succeeds or not, is only an insider’s guess. The inhaler uses a unique cartridge containing dozens of “VaporChips,” each holding a measured dose of cannabis flower, allowing accurate administration according to a doctor’s prescription. The question is does it work in dosing, can it work? Sometimes funds run out before the right tests can be checked and confirmed by the FDA.

On the general issue of cannabis, if you are traveling to Dubai or Abu Dhabi, take note: medical cannabis, even if only in your blood, and self-medicated can land you in jail according to the law in the United Arab Emirates. Even CBD oil is a risk.

Read more on medical cannabis and medical marijuana on Green Prophet:

• Study: Medical cannabis eases chronic pain without hurting mental clarity
• Grassland: When growing cannabis lands you in jail—after legalization
• Portugal aims to be Europe’s medical-cannabis hub
• Israel trial: CBD drug tested for children with autism
• Greece legalizes medical cannabis, eyes EU grow-hub status
• Philip Morris to acquire Syqe, Israel’s dose-controlled cannabis inhaler
• Scientists boost THC in cannabis using a plant virus
• Medical cannabis & children: Hebrew University unit opens
• Cannabis for COVID-19: Israeli medical trial launches
• Throwback: Syqe’s 3D-printed, dose-controlled cannabis inhaler

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Medical cannabis can be a life saver for children and adults with epilepsy. It helps alleviate cancer pain and it’s been shown to help certain people with PTSD. But not all cannabis plants have the same potency of medically active ingredients such as THC and CBD. And a new study has shown that even though there are measures in place to estimate potencies and doses in actual practice the labels are wildly inaccurate.

Researchers weigh in and report that nearly half of cannabis flower products are inaccurately labeled when it comes to potency, with most showing they contain more THC than they really do. Meanwhile, labels on cannabis concentrates tend to be accurate, with 96% shown to match what’s inside.

Related: Charlotte’s web and cannabis 

That’s the takeaway from a new analysis of products sold at dispensaries across Colorado—the first state to legalize recreational marijuana. The study, published this month in the journal Scientific Reports, is the first comprehensive label audit of legal market cannabis to date.

“Cannabis use has complex and wide-ranging effects, and we are working hard to better understand them,” said senior author Cinnamon Bidwell, associate professor of psychology and neuroscience at CU Boulder. “While that research plays out, we should, at the very least, be providing accurate information about the amount of THC in these products.”

The study was funded by the Institute of Cannabis Research, the state’s official cannabis research institute, and conducted in collaboration with MedPharm Research, LLC, a licensed cannabis testing facility, manufacturer and retailer. Under federal law, university scientists are not allowed to handle legal market cannabis for research, so collaborating with industry is critical.

For the study, a secret shopper from MedPharm traveled the state to obtain 277 products from 52 dispensaries across 19 counties. The sampling included 178 flower products and 99 smokable concentrates. No edibles were included in this phase of the study.

The shopper shared label photos with Bidwell’s team. Then the samples, marked only with a number, were tested by MedPharm chemists who hadn’t seen the labels. Data analysis showed that flower products contained on average about 21% THC, or tetrahydrocannabinol—the main psychoactive ingredient in cannabis. Concentrates contained 71% THC on average, with some containing as much as 84%. In the 1980s, the typical THC content in marijuana was around 8%.

“THC content has increased significantly, and we know that greater THC exposure is likely associated with greater risks, including risk of cannabis use disorder and some mental health issues,” notes Bidwell.

Products were considered “accurately labeled” if they contained within 15% of the THC amount shown on the label—the same threshold the state uses. About 44% percent of flower products failed to meet that standard, with 54 of those products inflating their THC content and 23 containing more THC than the label indicated. Only four concentrate products were labeled inaccurately.

“When it comes to concentrates, I would say Colorado gets a good grade for labeling accuracy, but there are some real issues with flower,” said Bidwell.

The study also looked at several other cannabinoids, including cannabidiol (CBD), cannabigerol (CBG), and cannabigerolic acid (CBGA). Notably, CBG and CBGA, which have been associated with anti-inflammatory and anti-anxiety properties, were more abundant than CBD in products across categories. But Colorado law only requires that companies put CBD levels on the label.

“Focusing on THC on the label can actually do a disservice for consumers, because it creates an environment in which people buy based solely on THC content,” said Bidwell. “Our data suggests that multiple other cannabinoids should also be reported.”

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A growing number of chronic pain patients are turning to medical cannabis—and finding relief without the mental fog that often comes with traditional painkillers, according to a new peer-reviewed study published in Cureus.

The research, conducted by the Rothman Institute Foundation for Opioid Research & Education, examined how people living with chronic musculoskeletal pain are using cannabis, what benefits they’re experiencing, and whether long-term use affects cognitive function.

“Over 80% of participants reported that medical cannabis helped manage their pain,” said Dr. Mohammad Khak, co-author of the study and researcher at the Rothman Institute. “Many also noted improvements in sleep and anxiety, indicating cannabis could provide broader symptom relief than typical pain medications.”

Importantly, 40% of those surveyed reduced their use of traditional analgesics after starting cannabis—some even scaled back their opioid use.

“This suggests cannabis might be a safer alternative or complement to conventional pain management, especially in light of the ongoing opioid epidemic,” said Dr. Ari Greis, senior author of the study and assistant professor at Drexel University College of Medicine.

Patients used cannabis in a variety of forms, including oils, vaporizers, and smoked flower. Most had tried conventional treatments without success, turning to cannabis as a last resort when pain became unmanageable. Still, only about 25% of users received a physician’s recommendation, pointing to ongoing challenges in medical cannabis access and acceptance.

“This study underscores barriers such as a lack of physician training, complex regulations, and persistent stigma,” added Dr. Khak.

The study also explored concerns over cognitive side effects. While some patients experienced mild symptoms like dry mouth or fatigue, most reported no serious cognitive impairment—suggesting that medical cannabis can often be used without affecting mental sharpness.

Researchers stressed that while patient-reported outcomes are promising, larger clinical trials are essential to confirm the long-term safety and effectiveness of medical cannabis for chronic musculoskeletal pain. They also called for improved education for healthcare providers and more streamlined regulations to help guide responsible cannabis use in pain treatment.

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Legalized, medical cannabis has changed lives in Canada, America and Israel where it is easy to access and research is developed. It is prescribed by doctors and used by children to treat extreme cases of epilepsy, and it also helps adults with PTSD, pain from cancer, and it’s byproducts like CBD is used as a neutraceutical.

Now that’s it’s legal in more than half of all US states, what should be done with the people incarcerated when it was outlawed?

Grassland, a timely social justice narrative film highlighting the perils of cannabis incarceration, is now available for streaming on Apple TV, Amazon, Roku, and more.

The story follows Leo (Cabot-Conyers), a curious and sensitive young boy whose world is turned upside down when he befriends his new neighbors—an inquisitive young white boy and his police officer grandfather (Kober). Unknowingly, Leo’s friendship places his single mother (Maestro), who is secretly running an illegal cannabis business, at risk.

Grammy, Emmy, and Oscar-winning artist Common serves as an Executive Producer. The film stars Mía Maestro (The Motorcycle Diaries), Quincy Isaiah (Winning Time), Jeff Kober (Sons of Anarchy), Ravi Cabot-Conyers (Star Wars: Skeleton Crew), and Sean Convery. Rounding out the cast are Rachel Ticotin, Armando Riesco, Claudia Robinson, and newcomer Elizabeth Cuzzupoli. Set in 2008, amidst the economic recession, Grassland explores the stark realities of racial inequality in the criminal justice system.

The Grassland team launched a robust impact and advocacy campaign aimed to target relevant federal, state-level criminal justice reform and the estimated 40,000+ Americans still in prison on low-level cannabis possession charges, despite the legal cannabis industry reaching over $30 Billion in 2024 in the U.S.

The film partnered with Common’s organization, Free to Dream, as well as lifestyle brand Shinola and Last Prisoner Project in its impact campaign. As part of their partnership with Shinola, the film’s team launched a multi-city screening tour featuring panels with activists in the cannabis equity space.

Executive Produced by Common and Directed by William Bermudez and Sam Friedman, Grassland offers an intimate portrayal of race, justice, and family, telling a story of friendship, courage, and sacrifice. As Leo’s desire to protect his family unknowingly jeopardizes their safety, the film powerfully illustrates the devastating cost of systemic injustice.

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CBD, a component from medical cannabis, may hold promise as a tool to help people reduce problem drinking, according to a new study published in Alcohol: Clinical and Experimental Research.

Cannabidiol, commonly known as CBD, modifies the activity of the parasympathetic nervous system and reduces physical signs of anxiety and self-reported craving for alcohol in people with alcohol use disorder. No adverse side effects, such as drowsiness or cognitive issues, were observed during the short-term regimen.

The authors of the study recommend more research to determine whether CBD could be an effective treatment to help people recover from alcohol use disorder.

CBD is non-psychotropic chemical found naturally in cannabis. It can be isolated from other molecules such as THC so that you don’t experience the high when you use it. CBD can be found in drinks, vitamins and even coffee products in the US.

The latest study sought to examine whether CBD could modify craving and dysregulated responses to alcohol cues in people with alcohol use disorder. CBD is a natural component of the cannabis plant that does not produce psychoactive effects.

Australian researchers administered 800 milligrams of CBD per day or a placebo for three days to adults with alcohol use disorder. Participants’ craving and mood were assessed periodically using questionnaires, and physiologic responses were measured using electrodes on the skin, including while the participants were in the presence of alcohol, and audio and visual cues related to drinking.

CBD was found on several measures to have beneficial effects on anxiety and craving, compared to placebo. Participants who had been administered CBD showed elevated high-frequency heart rate variability, indicating increased activity in the parasympathetic nervous system, which helps the body relax during times of stress and may reduce the feeling of needing a drink.

Participants in the CBD sessions also reported reductions in anxiety from baseline to exposure to alcohol cues, while the placebo group reported increases in anxiety. During exposure to alcohol cues, activity in the parasympathetic nervous system did lessen somewhat, but after the alcohol cue task, the CBD group reported reduced craving for alcohol, whereas the placebo group did not.

The study also found that participants tolerated CBD well; no significant side effects were reported. There were no significant differences between the CBD and placebo groups on any measures of cognitive functioning, including visual attention, processing speed, and basic motor function. Participants did not report significantly higher sedation following CBD administration compared to placebo.

Previous research has found that heavy drinking is associated with heightened levels of anxiety and stress and contributes to relapse. Animal studies have found CBD to have neuroprotective effects and reduce anxiety and craving. The current study’s findings that CBD may reduce symptoms of anxiety and craving without negatively affecting executive function or alertness signify that it may have therapeutic potential for people with alcohol use disorder. The study’s generalizability is limited by its small sample size, particularly of male participants, but it provides guidance for larger and longer human therapeutic efficacy studies.

CBD has been found to reduce seizures in children with epilepsy, and it can help autism and with pain management. Green Prophet’s exclusive work with medical doctor Alan Shackelford in the US has helped us understand the limitless medical possibilities with CBD.

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Portugal became the new Costa Rica during the Covid epidemic. Lax lockdowns and no need for vaccine certificates, combined with plenty of nature and freedom for global nomads made Portugal the go-to place for people around the globe. Full of entrepreneurial spirit that other countries may have lost Portugal now aims to be a medical cannabis hub of Europe and the world. America’s complicated relationships with Federal cannabis laws make doing business there complicated. Canada’s market is saturated with so many products and companies. Can the climate of Portugal do it better?

Canadian-founded and American headquartered Tilray is one of the companies doing business in Portugal. Tilray (Nasdaq: TLRY; TSX: TLRY) receives its second approval for a new medical cannabis extract in Portugal: Tilray Oral Solution THC10:CBD10. It’s a product that is built with half and half, CBD and THC.

Denise Faltischek, Chief Strategy Officer and Head of International at Tilray said: “This is a significant step towards meeting the critical needs of patient care and providing high-quality cannabis products and therapeutic options to those with specific medical conditions. The approval of this oral cannabis solution in Portugal is a testament to Tilray’s global commitment to increasing safe and regulated access to medical cannabis products for patients in need.”

Related: How Alan Shackelford changed cannabis into medicine

Tilray Medical continues to be a global leader in the medical cannabis industry, offering a diverse portfolio of EU-GMP certified medicinal cannabis products. With operations extending over 20 countries, Tilray Medical is dedicated to supporting medical cannabis patient care worldwide through quality products accessible via healthcare practitioners. Its business in Portugal is a stepping stone to the rest of the EU.

Tilray Medical grew from being one of the first companies to become an approved licensed producer of medical cannabis in Canada to building the first GMP-certified cannabis production facilities in Europe, first in Portugal and later in Germany. Today, Tilray Medical is one of the biggest suppliers of medical cannabis brands to patients, physicians, hospitals, pharmacies, researchers, and governments, in over 20 countries and across five continents.

After we published this article, we feel a reader inquiry warrants an update. A cannabis grower with a nationally registered brand tells Green Prophet: “But what you don’t hear in your story is how littered with clandestine growers are in the police services.”

People planning on starting a cannabis business in Portugal beware

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The king of Morocco has decided to pardon 5,000 farmers convicted of illegal cannabis cultivation, the justice ministry said in a statement on Monday.

Morocco is now a major cannabis producer and has legislated the cultivation, export and use of the drug for medicine or in industry since 2021, but it does not allow it to be used for recreational purposes. Cannabis extracts such as CBD has been found to be helpful to treat autism and epilepsy.

The latest pardon by King Mohammed VI would encourage farmers “to engage in the legal process of cannabis cultivation to improve their revenue and living conditions,” Mohammed El Guerrouj, the head of Moroccan cannabis regulator ANRAC, told Reuters.

Morocco’s first legal cannabis harvest weighed 294 metric tons back in 2023, according to officials.

This year it is expected to be higher as the number of farming permits increases officials allow farmers to cultivate a local strain called Beldia.

About a million people live in northern Morocco where cannabis is now the main economic activity. People have been growing and smoking it for generations, along with tobacco in long-stemmed pipes.

Legalization was meant to stop trafficking and improve the farmers’ income. It has awarded 54 export permits last year. Here is a great research article on the history and challenges of cannabis and medical marijuana in Morocco from 2017.

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Scientists in Haifa, Israel have developed a new path for understanding how cannabis-extracted CBD helps children with autism. They have found that preparations of CBD-rich cannabis products or extracts reduce anxiety and other autistic symptoms in children, according to data published in the journal Cannabis and Cannabinoid Research. Ayelet David and Eynat Gal led the study out of Haifa University.

Israeli scientists assessed the efficacy of CBD-dominant cannabis extracts in a cohort of 65 children (ages 5-12 years) with autism. Study participants consumed customized doses of cannabis extracts for six months.

Related: A look at cannabis and autism

“We observed significant differences in the autistic children’s overall anxiety and in some anxiety subtypes. Significant improvements were observed in RRBI [restricted and repetitive behaviors and interests], including the total score, and specifically in compulsive, ritualistic, and sameness behaviors,” reported the researchers who concluded that “Our study suggests positive implications for CBD-rich cannabis treatment in alleviating anxiety and RRBI symptoms in autistic children.

“We strongly recommend further double-blind, placebo-controlled studies using standardized assessments to validate these findings.”

The findings are consistent with other studies which find that cannabinoid (or CBD) treatment provides symptom improvements in children with autism. We have consulted with Dr. Alan Shackleford, a leading physician in medical cannabis in the United States and Israel, who has also said to us in personal communication that he believes some amount of THC is needed to see an effect.

Observational studies have also shown that the use of cannabis can provide benefits to adults with autism. In 2023, a randomized trial from Israel compared CBD-enriched extract (20:1 CBD:THC) and purified cannabinoids in the same ratio to placebo in a three-arm crossover design in 150 patients with autism aged 5 to 21 years.

The authors reported tolerability with improvements in disruptive behaviours and core autism symptoms.

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If you walk the streets of Tel Aviv and Jaffa, the smell of cannabis burning isn’t something unusual. While countries like Canada have decided to fully legalize medical marijuana and recreational cannabis, Israelis may have felt that that was the path for the nation who was the first to study and classify the molecular compounds in cannabis and hashish. Professor Raphael Mechoulam, who I have interviewed and who died in 2023, was a chemist who was given a pile of hashish from the Israeli police and took it upon himself to study the medical applications of the illicit substance.

He had all sorts of fanciful nicknames for the plant, such as Ananda from Sanskrit which means “supreme joy” and he believed that there are more than 100 molecules in the cannabis plant that play a role in its medication. He told me that the human body has special receptors for accepting these molecules, making for an interesting match between plant and man.

So in 2015 when I founded the CannaTech conference and hundreds of people came out for the event on last minute’s notice (it featured Israeli-American physician Alan Shackelford) it felt that cannabis use as medicine, but also recreationally would be accepted on the streets of Tel Aviv. Until then police turned a blind eye to smoking on the street, but selling or growing it could get you in jail.

Still, there was always people who believed they were above the law and that full legalization was around the corner. One of those people was the founder of a Telegram group called Telegrass. Join, say you want and it would be delivered. Finding cannabis was never so easy. Who needed to bother going through the hassle of getting a medical permit?

According to Israeli media Telegrass founder Amos Dov Silver was sentenced to eight years of jail this week following a plea agreement. Telegrass connected an estimated 3,000 drug dealers to more than 200,000 clients.

Meanwhile cannabis companies from Israel expand to Greece to supply medical cannabis to Europe. And companies like Tipa make compostable packaging for edibles in America – see Wyld Edibles.

Silver was arrested in 2022 already. In the years before his arrest, Silver was an activist for cannabis legalization, including organizing The Big Bong Night in 2014. Israel has taken steps in recent years to make medical cannabis available and is poised to become a major exporter of the crop. Recreational use of the drug remains illegal, however. The Public Security Ministry partially decriminalized it in 2017, setting fines and treatment for initial offenders instead of criminal procedures.

Are you interested in sustainable investment and generational wealth? Green Prophet is working with 36North, an investment advisory in Canada on how to teach you how to build generational wealth. Email 36north@greenprophet.com for an introduction.

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