Don't Get High….. Get Well

Posts Tagged ‘evaluation’

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

There has been some international uproar of late regarding the closure of some “coffee shops” in Amsterdam as well as the closure by local authorities of dispensaries allowing communal “medicating”.

Don’t get me wrong. I like the idea and freedom of being able to smoke in private clubs with a group of like-minded individuals. Perhaps in the future this will be the direction to head; however, it would have to be at a time when the political climate accepts the use of Cannabis for purely recreational reasons. Under today’s laws, using Cannabis for recreational reasons is clearly illegal, if only a misdemeanor in some states.

My problem with cafes, at least in the US, is that we are struggling to simply get Medical Cannabis accepted legally at regional levels as well as hopefully ultimately nationally. As a physician, I just can’t see the medical benefit of medicating as a group in a public setting. Until a lot more education and enlightenment occurs, It is just too hard to justify in the current setting and as far as I can see, for some time to come.

Alcohol is very different, and as far as I know, it is the only drug we use socially in public groups that are legal. At the same time, I just don’t know many – if any – physicians, including myself, who would be drawn into “prescribing” alcohol for a patient. Even in the waning years of alcohol prohibition nobody was pushing for Medical Alcohol!

So, I would prefer to keep Cannabis in the medical arena and out of the café world. Many of us need this medication for help with serious issues. Let’s all please be careful not to become insensitive to the big picture.

Open Source, the concept of sharing information, not for one individual’s benefit, but for the benefit of all should be applied to Medical Cannabis.  There is one critical piece of information patients and physicians are entirely missing with the current state of Medical Cannabis; we don’t know what we are medicating with.  Cannabis doesn’t come with a chemical breakdown – “a list of ingredients”.

When we purchase cannabis from a knowledgeable source such as a reputable dispensary, we are able to feel comfortable that we know if we are using a Sativa or Indica strain (my prior blogs explain why).

We know, however, that all Sativa strains are not the same. The same is true for Indica strains. What are the differences? There are differences in THC content, CBD content as well as dozens of other Cannabinoids. We are all unique as human beings, and so our needs are unique. It stands to reason that certain strains will work better than others for different people. This is common in medicating with all treatment modalities in medicine – from the current Western model of medicine to the Alternative and Eastern type models of medicine.

How about if we had a listing of the most important Cannabinoids on the bottle of Cannabis? That would allow each of us to evaluate over time which of the various Cannabinoids work best for us. At that point, we could be much more certain to obtain the correct strain as well as potentially the “perfect” tincture or “concentrate”. The Cannabis plants are extremely complex botanicals with over 400 ingredients including over 50 Cannabinoids.

I envision a genetic research center that would breed cannabis to genetically alter the strains IN THE GARDEN. The goal would be to obtain varied but known and reproducible strains of Cannabis.  We could all then share this strain information in centralized databases, much as we have learned how to share information in the world of Open Source Code; hence Open Source Cannabis.

So, would you patent something that currently has no value but is considered more dangerous than cocaine and heroin? Oh, and on top of that, it’s illegal.

I always encourage my patients to find Sativa/Indica tinctures. These generally come in some sort of spray mechanism or sublingual preparation.

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.