Don't Get High….. Get Well

Posts Tagged ‘cannabis’

There is a new drug indicated for “weight loss” – Rimonabant. It made it through trials but ultimately was not released.

The purpose of this drug is to block the effects of certain cannabinoids upon specific cannabinoid brain receptors, the CB1 receptors. Our bodies create natural or “endogenous” cannabinoids which stimulate hunger. Rimonabant was developed to do the opposite by inhibiting the “appetite stimulation” of cannabinoids. Many of us are familiar with getting the “munchies” – I guess you could say, Rimonabant is the ultimate “anti-munchy”.

We all also know that that cannabinoids improve our mood.

As the makers of Rimonabant discovered, while the drug blocks appetite as an inhibitor of the CB1 receptor, the blocking of these neurotransmitter functions also affects one’s mood. In fact, two of the hallmark clinical signs of Depression are the loss of appetite and severe drops in mood. Administering Rimonabant to patients resulted in numerous suicides and nervous breakdowns. You’ll be happy to learn that the trials on this drug have been suspended and it will not make it to market.

However, the failure of Rimonabant has resulted in a sort of “Tail Wagging The Dog” Clinical Trial scenario. This debacle has ended up confirming that Cannabis and Cannabis receptors play a major role in mood and appetite regulation. The Cannabinoids clearly increase both our appetite and mood. So, if a pill blocks these receptors both our appetite and mood are influenced.

This is more evidence that the Endo Cannabinoid system, or ECS plays a major role in how we all feel. Cannabis clearly effects mood and in my opinion is a very sophisticated and powerful mood enhancer.

In many of my appointments, I tell patients, “Imagine the room you are currently in, represents ‘how you are feeling’. The floor represents the most depressed moments of your life and the ceiling represents the highest and most out of control state you can imagine. Would you agree we are all somewhere approximately 1/3 of the way up the wall?”

When they see my point of view, ALL want to increase where they are on the wall by 25% or so. So often, everything patients do in their lives is to get this bump in how they feel. When they are feeling a bit better, they are aware of the change and often do not know even why they are doing better.

I go on to explain to my patients that many Sativa strains of Cannabis are very helpful with anxiety and depression. I caution, however, that there are many instances where Cannabis alone is inadequate to control psychosis, but this is to be decided between the patient and physician. Regardless, Sativa strains make most people feel more awake, alert and happy while remaining focused – all characteristics that patients report ‘moves them up the wall that extra amount’.

Once I have educated patients that their symptoms will be addressed using cannabis, I explain that it is the THC and Sativa Cannabinoids working on our Cannabinoid receptors in addition to increasing the production and decreasing the destruction of Serotonin that makes us feel so much better. So, are we all a little depressed? Does the Endo Cannabinoids Deficiency Syndrome really exist and we are medicating to normalize our internally low levels of Cannabinoids? Perhaps the mood changing effects of Cannabinoids to varying degrees function in a combined state as both direct and indirect neurotransmitters? This is what I believe is the most likely scenerio.

I don’t often just give out “links”, but the link on NORMAL is just too fantastic not to share. Do yourself or your friends a favor and check out:

Diseases treated with Cannabis.

September 8, 2008

The Honorable Arnold Schwarzenegger
Governor
State of California
State Capitol
Sacramento, CA 95814

Re: AB2279 (Leno) Medical Cannabis Employment Non-Discrimination

Dear Governor Schwarzenegger,

Assembly Bill 2279 sponsored by Assemblyman Mark Leno will soon be on your desk for a signature. AB 2279 is in response to the California State Supreme Court decision that allows employers to fire medical marijuana patients who test positive for medical cannabis. As a California Board certified physician since 1979 and a graduate of the UC medical system, I felt compelled to write you. I urge you to support AB 2279 and help my patients receive their medication and keep their jobs. Patients are being unfairly discriminated against simply as a result of the medications their physicians chose to recommend for them as the best treatment for their symptoms. AB 2279 will erase unjustified discrimination in the workplace while benefiting employers, medical marijuana patients and society as a whole.

In my office, I have the forms to order traditional and non-traditional therapies, including medical marijuana – tragically one of these can result in the loss of jobs for my patients. The result of allowing employers to fire medical marijuana patients for their physician recommended course of treatment interferes with my ability to prescribe the best course of medical relief for my patients – in essence forcing me to violate the Hippocratic Oath. Of course, whatever medication I choose to prescribe should not interfere with my patient’s ability to execute their responsibilities. Yet, it is my personal experience with thousands of patients that medical cannabis allows patients to function at their best – and I have to ask, what employer wouldn’t want that from his employees?

In my practice the average age of my patients is 50. I have examined the demographics and find most of my patients’ function well in society and hold respectable jobs. I find that by the time patients have come to me they have tried many standard pharmaceuticals as well as other alternative health options to deal with their disease. They tell me stories about how these therapies have caused them to function at a sub-standard level. They come to me looking for relief and a better quality of life. For those whom I have recommended cannabis, I know they have benefited, because nearly all return for renewals on an annual basis with the same comment, “I’ve never had a better year.”

As I collect more clinical evidence, I am finding that medical cannabis patients’ function at least as well at work than the thousands of patients for whom I have prescribed standard pharmaceuticals over 25 years.
I understand that the California Supreme Court is trying to interpret the law as currently written, however, testing for cannabis doesn’t prove patients are less effective at work.

• Testing only proves that the patient used cannabis sometime in the past several months.
• Effects of cannabis only last about 90 minutes compared to four hours or more for pharmaceuticals.
• Testing doesn’t gauge the “hang over” effects such as those that can seen in patients who use alcohol the night before or come to work groggy because of their prescription medications.

It is difficult to justify the discrimination of firing a medical marijuana patient who uses cannabis during their off hours and then has no impairment at work versus patients who are truly disabled at work, (i.e., hung over or pharmaceutically medicated patients), being allowed to continue employment while cannabis patients are fired. There is no justification for allowing impairment at work for some doctor recommended medications and prohibiting any use, even at home, of another.

Once a medication is legal under state law, it should be legal in the eyes of all state governmental functions. The state should not allow medical marijuana use on one hand and then endorse discrimination against a patient on the other. Limiting the options of job seekers because of unfair and unjustified discrimination makes no sense. Upon completion of an exam, I explain to my patients the details of any medications I might prescribe or recommend. I believe that my patients use their medications responsibly. So whether I pick up a prescription pad and write a traditional prescription for the patient or write a medical marijuana recommendation is a decision between the patient and me as their doctor. Without AB 2279, some of my patients will be discriminated against in their workplace, will lose their jobs, and may find themselves on public assistance and state supported Medi-Cal. This serves no public good and hurts us all.

Please sign AB 2279 into law.

Sincerely,

Allan I. Frankel, M.D.
3007 Washington Blvd. Suite 110
Marina Del Rey, CA 90292
310-821-9600

As I have discussed in prior blogs, Cannabis can be a potent anti-depressant. It has this “happy” factor, regardless of whether the patient is medicating for pain, low appetite or nausea.

As a doctor, I am justifiably concerned about the side affects of medications. So, you’d think I’d be concerned when a patient calls me explaining that their nausea is much improved “but” they notice that they feel happier and just “better”. In fact, this doesn’t worry me at all.

When I hear about their concern over “feeling better”, truthfully, it puts a smile on my face. I wish more of the medications I have prescribed over the many years I have practiced had the same side effect profile: “Warning! May include increased feelings of well being”.

All of this begs the question; under what circumstances is happiness or feeling at ease a problem? It is a problem when the good feelings lead to poor or no focus and interferes with one’s life. The mood elevating “side-effects”, (particularly from Sativa Strains), are packed with increased focus – and this is what is so very different and so very wonderful.

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