Don't Get High….. Get Well

Archive for the ‘cannabis’ Category

GreenBridge Med, is a primary care and Cannabis Specialty Medical practice with Dr. Allan Frankel and Dr. Christine Paoletti.

Green Bridge Medical Center, Inc as a 501C3 dedicated to providing guidance and education to physicians, patients, collectives as well as consultation in the political arena.

We are working with Health Care Facilities, growers and genetic specialists while doing other consultative work regarding true Whole Plant AND Dosable cannabis medications. We often suggest CBD rich strains and help make the genetics available to growers generally at no charge.

As the collectives grow their own CBD Rich healing plants, the plants are monitored and tested at several times during their flowering cycle. So, there is a closed loop between the “owner” of the plant, the collective, and the final certified cannabis medicine, fully Sherman Act Compliant labelled, etc available for that collective’s patients.

This is working fine, but I see a much bigger picture. I have a very difficult time supporting most of the stores and I know I will take flack for saying this, but I personally wouldn’t miss most of them.

Think of the morning after pill, as Plan B. Well, here is Plan B. This is starting right now and can operate alongside the entire storefront model. It is nothing new. It is very old.

We, Green Bridge Medical Center, GBMC, are consulting with a Delivery/Grow Collective in Los Angeles. We have been working with them for many months and have chosen for them and secured: statewidecollective.org. The Site will be up soon.

The “motto” for SWC is “Tested and Dosable Medications”. In the beginning, this will be restricted to dosable medications. i.e. tinctures, capsules and CBD based topicals for local pain.

SWC will soon be delivering to it’s members, a 3 foot by 3 foot very elegant grow box. Made for the living room. Clones, ready to flower are delivered, six at a time and then inspected both online as well as weekly by the “pool guy”. The patient in return receives Certified Medicines for no charge. Each of these small, but very respectable small patient “grows”, will produce 100′s of bottles of tincture each year. Enough for it to be both very inexpensive to it’s members and very possible to have excess to share.

The same technology is applied to larger grows, but always with modest numbers of plants. There would be single genetic strains being grown at each “Certified Phyto Laboratory”. Then as SWC grows in size, it MAY begin providing reasonably priced “flowers” for it’s members, in addition to dosed medications. After all, social cannabis is something I love very much. For example, it is quite possible that while operating as a TRUE collective; great indoor flowers on a cost plus basis cost around $1000/pound, including full time employee. Even with some extra fees, we are talking about $100 ounces; or medication priced where it should be priced.

As SWC grows, and we suggest all collectives suggest joining SWC. as there is no harm in joining a second collective or even third collective. I am not certain about 50 collectives, but I leave that up to the 18 y/o kids. Anyway, SWC should become huge; it should morph into a true co-op, 1960′s style, with membership and membership benefits; perhaps token monthly fees that go to credit medication purchases.

There are approximately 1.2 million patients in the sate. It is not impossible to have 100,000 patients in this collective. By then charging $5/patient, a war chest is developed AND MONITORED VERY CLOSELY, I PROMISE, to fight every case needing to be fought.

It is not too much of a leap to take this co-op and obtain health insurance. I have met with three actuaries. Even at 100 patients, a group such as this could have great coverage. With 10,000 or more, we would have first dollar coverage. In fact, two insurance companies had already looked at the Cannabis patient group; we are very, very low risk as we are often/mostly medicine adverse. Great to insure.

Then comes the politics. We now have a super pak and I believe we would soon add more and more members both state wide as well as nationally, but this would be a “chapter”;not a collective, as that would obviously be illegal – at least for now. :)

This can be done. It is my dream. It is a way to build a patient and plant wall around us. The money would go towards keeping our medicine inexpensive and available. This size organization can defend itself from any local, state or federal attack better than legislation. If nothing else, we have sort of walled ourselves in and this MIGHT allow the feds to ignore a totally legally running non-profit, that is non-profit and dosed medication based. This might be a tough fight for them and we should easily have the resources to prevail. Can you imagine ANY jury ruling against this? No, of course not. You can’t find a jury without a few cannabis patients on it. There is no jury with no cannabis users – anywhere – I mean anywhere.

In addition, this fight would, by nature, be between a huge “legal” co-sop using mostly dosed medications, against the pharmaceutical industry. What jury would convict SWC, IF it is truly state wide.??

Back to reality, as this dream unfolds, patients would of course obtain most of their medication from their current places. Again, it can start with a modest number of patients, a large number of members and the ability to grow very quickly if the need arises.

So, I say “Let’s be prepared”. If our initial set of rules somehow fails us, let be ready the next morning, with “Plan B”; perhaps not the ideal solution, but it works. :)

Well, that is the first time I have put all this down in one place.

What do folks out there think??

Certified Cannabis Tinctures assure the patient that:

1. The cannabis plants used in the making of the tincture are organic

2. The entire plant is used in the making of the tincture other than fan/water leaves

3. The cannabis plant as well as the tincture is chemically tested for cannabinoids and 35 Terpenes

4. Carbon Dioxide in liquid form is pressurized to separate the plant material from the lipid soluble medicating molecules

5. No alcohol is used

6. The labels will be Sherman Act compliant and state cannabinoid/terpene content in mg/cc

7. Each tincture is clinically evaluated for its degree of psychoactivity – altered thinking/mind altering

HOW TO SELECT THE RIGHT TINCTURE FOR YOU?

Strain type is not the best predictor of which tinctures may work the best for you. Strain type as well, does not predict efficacy. So, a psychoactive clinical scale is used, as below, to help the patient select a tincture that is likely to be best for them without causing excessive psycho activity, or how mind altering the tincture may be for you.

The scale goes from 0 to 10, with 0 being no psycho activity and 10 being extremely psychoactive.

Not Psychoactive<–0  1  2  3  4  5  6  7  8  9  10 –>Very Psychoactive

In general, the greater the ratio of CBD(cannabidiol / THC the less psychoactive a tincture will tend to be. However, for many patients even with a relatively high level of  THC, even a small amount of CBD can virtually eliminate the psychoactivity. Also, as with everything in medicine, patients and conditions vary. We will be asking your help in determining what works best for various conditions in different groups of patients.

If you are using a tincture with CBD, please take the Project CBD survey. It is one of the main pages of this site.

As a physician, my only “agenda” must be my patients health and comfort. This involves preventive issues as well as “disease” issues. None of us would minimize preventive health care.

I do not know how much gay marriage restricts extra-marital affairs, but it does a reasonable job among heterosexuals. I would imagine, that gay marriage must decrease multiple partner exposure therefore leading to decreased exposure to HIV.

How many lives might be saved? How much money would be saved? I don’t know. At this point in time we can’t lose lives and money to politics.

Does anyone know about studies regarding this issue? Perhaps this is another way to help pursuade powers that be?

Consider two facts:

1. The city of LA is broke

2. The city of LA is not always on the best terms with the Medical Cannabis Community regarding “standards”

So, how about if we setup a committee to consider the following:

Standards for the dispensing of Medical Cannabis are jointly (pun intended) determined in a non “partisan” manner. To help ensure this, a city cannabis tax might be introduced within the dispensary system. A portion of this money would be to create standards which might become national standards. The balance and the lion’s share would go directly to the city of LA.

Thoughts?

Peanut Butter   9 and counting

Marijuana           0

Please refer back to my recent post on “Open Source Cannabis” for background on this concept.

One of the most challenging issues facing cannabis research is where to begin to understand how or even which chemicals in cannabis cause an effect on symptoms. Unfortunately, at least at this point in time, medical cannabis for clinical trials is just not available. I can only hope this will change, but in the meantime, I believe we can get started with an intermediate survey type study – Open Source Cannabis.

The idea is to create a database of information that crosses patient testimonials on how strains treat their symptoms with the chemical breakdown of that strain from a Gas Chromatography machine.  Regrettably, it takes weeks to get the results from a Gas Chromatography machine.  During this time, the strain usually is distributed from the dispensary resulting in patients being unable to use the GC analysis information. Perhaps in the future, the market will require all growers to perform their own analysis on their strains or send them in for analysis, but as with research into this subject, that will not soon happen.

So, as to a solution for the time delay, what if when any strain is delivered to the dispensary, it is assigned a random ID by a database program. With this database, the dispensaries can logon to the system and get the ID for the strain and send it off for GC analysis.

When patients find a particular strain that really works very well for them, they logon to the database and enter basic symptom questions as well as the strain ID that would be stamped on the label.

Over time, as the GC results come back, they are tied back to the strain IDs.

This will enable two things:

1.As individuals have entered data on strains that work very well for them, they can see what combination of Cannabinoids and Terpenoids work best for them. Over time, they would select their medications based upon this information and not just a name such as “bubble gum kush” – which can mean anything.
2.The patient community data should yield interesting results as well. As patients give feedback on strains analyzed by a GC, I suspect we will begin to see some trends of cannabinoid and terpenoid benefits that we cannot even currently imagine.

I would really appreciate feedback on this one.

I don’t know how I missed this letter from Congress to the DEA. I generally don’t cross the “political” boundaries as a physician, but I really thought this would put a smile on your face. As you will find in the article below, Congress has sent a very tough letter to the DEA. Congress is waiting for a response from the DEA, but will be holding hearings regardless. It seems that our Congress is not very pleased with how the DEA has been handling itself in California.

I am very hopeful.

http://www.greenbridgemed.com/wp-content/uploads/2009/01/Conyers_DEA_Letter-1.pdf

Although not the first such study, researchers in Milano, Italy, recently presented a study on whole plant extracts of Cannabis formulations to treat neuropathic pain. If you’d like to read the study, please see the reference at the end of this blog.

After reading the results, researchers learned that extracting a single active ingredient from cannabis does not produce the ends desired. This is one more well designed, although “rat-based”, study encouraging us to realize that including all genetic variations of the whole plant in medications will probably produce better and safer drugs than extracting one cannabinoid at a time.

Researchers might not be achieving the effects they desire, but this might be the result of ignorance in the knowledge of manipulating cannabinoids, or it might be that the whole plant is in fact “the medicine”.  Certainly the ratio of the various cannabinoids in different strains will greatly vary, but at the very least we can say that overall, cannabis is an extremely safe medication.

http://www.ncbi.nlm.nih.gov/pubmed/18618522

I recently saw a 70 y/o male as a new patient. He appeared in all ways to be a street person and seemed a bit out of place. However there was something in his eyes that got my attention. His body seemed much older than his stated age, but his eyes reflected something still very much alive and I escorted him to my exam room.

He was arrested 33 years ago in the State of Georgia for possession of 1 gram of marijuana. He showed me his prison admission form as well as discharge papers. He spent 32 years in prison and was beatup on so many occasions that he had become crippled. We discussed his options with medical cannabis and he left.

He returned last week just to say thanks and show me how much better he was feeling. He didn’t say that this new freedom made up for his lost 32 years, but he did say it took a bit of the sting out of it.

I am pleased to hear that, at least in California, non-violent criminals are going to be released in larger number for financial incentives. Whatever the reason, I am grateful. Often very good things happen for the wrong reasons, but this is an acceptable compromise. :)

Most patients are reluctant to be open regarding how much and how often they use Cannabis. I always encourage my patients to be as honest as possible, as this is the best starting point in any doctor-patient visit.

Further more, if we are discussing treatment for anxiety, depression or ADD……..we are talking about Sativa strains during the daytime hours. In my opinion, the most significant issue with daytime medicating is related to the smoking. If patients are using sativa tinctures, which are ideal for daytime mood disorders, they are no different than any other patient using xanax, valium or vicodan out of a pill bottle during the day.

The smoking and smell during the daytime are generally just not acceptable. I encourage everyone to learn more about the daytime use of sativa tinctures/concentrates. They just seem so much more like “real medicines”.

A recent interest of mine has been to research ingestion methods of cannabis.  In reviewing a few articles regarding the various means we all use at times to medicate, the following list results: to smoke in one form or another, vaporize, eat edibles or tinctures.

Since edibles and tinctures are generally not inhaled and have no tar issues, I will place them aside for this blog’s discussion.

What I found most interesting, however, is that BONGS actually absorb substantial amounts of THC – up to 30%, (!), while allowing tar products through.  In other words, water is NOT a good filtration system for smoking Cannabis.

Joints, surprisingly, were better than any other smoking methods – other than vaporizing. Even placing a true “filter” on a joint, has similar effects to water. So, other than vaporizing, a loose joint without any filter, is next best.

Perhaps it is time to “sell short” on bongs??

More to come on Tinctures next week.

My Director of Education, Michele Nelson, answers this question:

Prior to 1937, cannabis and hemp in America was used as medicine and material for various industrial needs. One of the plant’s greatest industrial benefits to early American’s was that it did not rot in seawater, therefore enabling sails and rigging. This made hemp essential to the new American country – without it; America could not have a navy.  John Adams felt hemp was so vital to the creation of the new country that it was one of the first items on his to do list when riding to the Continental Congress.  He wrote, “Encourage the cultivation of hemp.” Every farmer was required to dedicate a portion of his or her farm to hemp production. As a medicine, cannabis was used from children’s pain remedies to relieving adult’s depression, anxiety, and pain. During the mid-1800’s, there were over 600 tinctures of cannabis available on the market from pharmaceutical companies well known today – Pfizer and Merck for example.

However, in the 1930’s two things happened that made hemp/cannabis illegal. One, a machine was invented that processed the hemp/cannabis without using the heavy manual labor needed in the past. Some called it a “hemp gin” like the cotton gin. Suddenly, hemp was not such an expensive fiber. At the time, Popular Mechanics magazine ran an article calling hemp “America’s billion dollar crop”. Industrialists began experimenting with hemp and discovered that it could be used to create plastics, was an excellent bio-fuel and was a strong fiber for paper.

At the same time hemp was being touted as a new raw material, the petrol chemical industry was emerging. The Dupont’s were at the center of this industry, discovering other uses for petroleum such as plastics and nylon. Also during this time, William Randolph Hearst the newspaper tycoon, needed to secure paper for his news empire, so he invested in forests for paper. Because hemp could replace both petrol chemicals and trees to make products cheaper, easier, (and it’s a renewable resource that many could profit from producing) these two families joined forces with former Alcohol Prohibitionist, Harry Anslinger to create and pass the Marijuana Tax Stamp Act in Congress.

Many consider the Marijuana Tax Stamp Act as “industrial espionage”.   At the time, marijuana was not a recognized name for hemp or cannabis and so the act was passed without the medical or farm community’s awareness. The tax stamp act gave the US government control over what farmers could plant and destroyed the cannabis pharmaceutical business. If farmers didn’t apply and receive a tax stamp, they were subject to fines and possible imprisonment for growing the plant. Cannabis/hemp production plummeted. Doctors begged Congress to allow cannabis to be used as a medicine, but they failed to overturn or even modify the Marijuana Tax Stamp Act.

Marijuana prohibition started because two families needed to have a monopoly on business. However, in today’s economic and environmental climate the prohibition that resulted from that decision might not be viable any longer.  Cannabis and hemp might be needed soon.

Michele Nelson, GreenBridge Director of Education

Over my thirty years practicing Internal Medicine, I have greatly changed my opinion regarding what I consider “excessive” use of medications. I now include Cannabis in my assessment as well. So, when patients ask me, when is “too much” Cannabis really too much? I respond that as with all drugs, too much is when the drug is controlling the patient.

It might not be apparent to the patient they are controlled by cannabis, but it becomes obvious to most people who know them. Those who know the patient can see the affects on the patient’s life – they can tell if the Cannabis is interfering with work, or an issue at home with kids or family or is causing responsibilities to be neglected.

If so, it is a problem that must be addressed. However, (and you might be surprised by this), the problem is NOT directly related to the amount of Cannabis being used. Consider this: just as with pharmaceuticals and alcohol, everyone is very different in their response and sensitivity to drugs. The various strains of Cannabis have a similar effect: a lot for one person can be trivial to another.

If the patient is using Cannabis and is acting responsibly, then what better result could anyone hope for? If friends and family continue to believe cannabis is adversely affecting the patient when there is no evidence, I think a good look at personal biases against Cannabis are in order.

Allan I Frankel, MD

In the practice of Cannabis Medicine, I am often asked by patients if they will be placed on a “list”.

The only “list” that I am aware of, is the list compiled by the State of California. This list is generated when patients purchase a “State ID Card”. This card is NOT MANDATORY and in Southern California, is seldom recognized at the “Dispensaries”. The Physician letter, which all patients receive at the end of an approved and legitimate visit, is the only required ID.

Allan Frankel, MD