PEA (palmitoylethanolamide) made in America – like PeaPure


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Vitalitus

now sells PEA

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Palmitoylethanolamide is now sold in the US as PEA by Vitalitus. It should be very comparable with the product PeaPure from the Netherlands. Since a Nobel Prize winner rediscovered it in 1993, over 400 scientific papers have been published on it. It is a food supplement, your brain makes it, plants make it. It is nontoxic, a glial modulator that works on the innate immune system, inflammation and mast cells, among many functions.

 

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Remember, you need to take PEA capsules with something a little fatty, like milk, or peanut butter, or buttered toast. Otherwise, it will not absorb. Because it is lipophilic, i.e. likes fat, it does not dissolve in water. Only oil.

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Dosage – use the search functions on left column for PEA or palmitoylethanolamide or PeaPure. You will find where I previously imported the instructions from the Netherlands website.

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PeaPure has helped intractable nerve pain. We published in 2014 the case of a woman in remission after 8 years of vulvodynia, treated with PeaPure.

 

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I have been very pleased with PeaPure (palmitoylethanolamide) for neuropathic pain. It is available in a capsule as a food supplement called PEA, without prescription.

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[Edited 12-13-16 for repetitious comments. Link added.]

 

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The material on this site is for informational purposes only.

It is not a substitute for medical advice, diagnosis or treatment provided by a qualified health care provider.

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For My Home Page, click here:  Welcome to my Weblog on Pain Management!

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Cannabis Politics, Science and Healing – O’Shaunessy’s


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O’Shaughnessy’s | The Journal of Cannabis in Clinical Practice

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Medicine is an endlessly evolving field. My patients deserve better. We have such limited tools.

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One medication has been excluded from study and from native use and understanding for decades. Libraries, seeds, plants, doctors, and lives have been destroyed. Cannabinoid receptors have been found in creatures as old as algae. You have more in your body than any other type. Think immune system and cardiovascular system and bone. Bone. Too bad we know nothing about it.

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I will give you several examples, below, why this journal is important. Laws are being written behind closed doors. Lawmakers are blocking enormous cost effective progress in medicine, not least of which is the ability to use a plant for stress and relaxation that your body has never been able to do without its help. What they are doing.

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Disclaimer: I have written recommendations for cannabis for fewer than 10 patients in 41 years of medicine. Cannabis is one of the world’s oldest and most valuable medications. There are people who should not use cannabis, especially a risk for those with mood disorder, cardiac arrhythmias, heart attack, stroke.

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O’Shaunessy’s is not a fluff journal for medicine or politics. It’s been a brutal fight for people who want to or need to use cannabis for its many benefits. Brutal for many doctors, for hospice patients, for anyone with medical needs who want a choice to use a plant rather than synthetic drugs, and those who want a different way to relax and enjoy time away from work without having to use alcohol. And for those who cannot afford more. Heaven forbid you should not grow to help others, even if they are too old or disabled to do it themselves.

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O’Shaunessy’s has several new articles on CBD, including how Senator Mitch McConnell got DEA to allow Kentucky farmers to grow hemp [high CBD].

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As lawmakers prepare the latest restrictions on use of medical cannabis behind closed doors, restrictions may prevent the best known California cannabis doctors from practicing. Those are the ones with most to teach after  years of clinical experience caring for patients with this ancient medication that has been used as well for spiritual purposes, creativity and relaxation.

270-member Society of Cannabis Clinicians protests aspects of the guidelines

Fred Gardner’s journal O’Shaughnessy’s has carried in-depth coverage of the most important issues for years.

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Fred reports on the laws and lawmakers who look at high volume cannabis practices. They should also look at high volume psychiatry. It’s required of psychiatrists at university clinics to dispense 2 to 5 or more antipsychotic drugs to psychotic patients —-one complex patient every 10 minutes.  Volume psychiatry mills. That is the standard for disabled patients who cannot afford more, a place to monitor and refill pills. Psychiatrists who have no choice or just starting in practice work there, high volume with the most dangerous drugs to the most dangerous unstable population we have. Toxic drugs in complex combinations on unstable patients. Next patient every 10 minutes.

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Why should a person who has anxiety not be able to choose – with a physician of their choice, especially a physician who is familiar with or at least not close minded – to test if cannabis helps better than Xanax . Especially when Xanax is known to cause Alzheimer’s disease, depression, addiction, and potential  overdose.

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Consider, if pain causes anxiety, is it better for a patient who is prescribed an opioid for chronic pain to add Xanax that increases risk of overdose? or cannabis that is also anti-inflammatory and can be used to help sleep when pain is too severe?

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Which would be better after major surgery: an opioid that causes inflammation and suppresses respiration or cannabis that reduces inflammation and pain? Don’t worry, we will never be allowed to test it in hospital, but people are known to sneak in canisters of tea or milk and patients need less opioid so their lungs and brains are not sedated, they can breathe, breathe much more deeply thus lower risk of pneumonia.

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Conundrum

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Consider, if you had failed spine surgery and cannabis gave some relief from spasm and pain and insomnia but nothing else had helped. It took years of hard work every month with pain specialists, nothing else worked. Genetic testing confirms. One patient had double mastectomy and later surgery for oophorectomy with no opioids — they simply didn’t work. What if, in your case, there’s a bad history of alcoholism that destroyed your family. You don’t want to risk opioid addiction but you need big surgery. You cannot get pre-operative clearance for cannabis from your cardiologist even though it is the only thing that helps you. Families risk cardiovascular problems when they sneak it in to hospital — we’ve all heard those stories for decades.

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And no, absolutely do not think I am advising you to take cannabis. That is likely against the law, just like it is against the law to tell a patient where to purchase cannabis safely, at respected sources in ratios of CBD to THC. I do not advise you to take cannabis to hospital, just because that was legal in Israel years ago, as long as conditions were met. Some people choose not to take opioids for hospice or near death.

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Would you rather live in an ICU doped up on opioids and Valium on a respirator or surreptiously taking cannabis when cardiologists do not know what is causing the cardiac arrhythmia —- cardiovascular potential, think THC.

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O’Shaunessy’s covers new dangers that lie ahead for doctors who prescribe. Story from O’Shaughnessy’s, below, on behind the scenes maneuvering of lawmakers.

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And rays of hope, like CBD for epilepsy in children, Fred interviews the team from GW Pharmaceuticals, UCSF, NYU Medical School, and presents the data from neurology meetings.

From the CBD article:

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proved beneficial in animal studies —and
for which Epidiolex [GW Pharmacuetical’s CBD] has been given orphan
drug status— is Neonatal Hypoxic-
Ischemic Encephatopathy, or NHIE (brain
damage caused by oxygen deprivation during
delivery).

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“In neonatal hypoxic-ischemia,” says
GW chairman Geoffrey Guy, MD, “you’ve
got an underlying inflammatory process
which is massively exaggerated by excitotoxicity
after each seizure, which is setting
up the next seizure in a way. It’s not enough
to treat just the seizures without treating
the underlying inflammatory encephalitis
and the damage to neuroplasticity.
“Children’s brains are very plastic and
can usually work around issues, but if
you’re having continuing seizures and
continuing inflammation, that ability will
be dampened. We’re hoping from the preclinical
work that cannabidiol will address
a number of these different issues, not just

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“There is evidence that the Federation of State Medical Boards is a shill for Big PhRMA. Starting in the 1990s, the FSMB, with funding from opioid manufacturers, pushed less restrictive prescribing guidelines that contributed to the current epidemic of addiction and death by overdose.”

Story from O’Shaughnessy’s, below

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How Senator Mitch McConnell got DEA to allow Kentucky farmers to grow hemp [high CBD]. They now lead the nation in producing CBD yet in California, DEA was allowed to raid and destroy the entire production of CBD capsules from California, one day after showing its high standards to city officials. CBD can stop one type of epileptic seizures in some children who have hundreds of seizures per day: Charlotte’s Web. Story from O’Shaughnessy’s.

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The little I know of cannabis, I owe to the instantly helpful, amazing Fred Gardner, who founded O’Shaughnessy’s. Thank you for your help, your investigative work, your connections, your life’s work, Fred. Wikipedia forgot to mention he was in medical school.

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Wikipedia says

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Fred Gardner is an American political organizer and author best known for his opposition to the Vietnam War and his writings about the medical mariijuana movement in the United States.

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Gardner received his bachelor’s degree from Harvard in 1963. He has been an editor at Scientific American, a private detective, a songwriter, an author, a freelance journalist, one of the credited screenwriters for Zabriskie Point directed by Michelangelo Antonioni, the owner of Variety Home Video, the editor of Synapse (the UCSF Medical Center student newspaper), and Public Information Officer for the San Francisco District Attorney’s office under Terence Hallinan.

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In the fall of 1967 Gardner, with Donna Mickleson and Deborah Rossman, started a coffeehouse in Columbia, South Carolina, that became a hang-out for GIs, an alternative USO called the UFO (United Freedom Organization). Gardner covered the court martial of 27 GIs charged with mutiny at the Presidio of San Francisco in October 1968 and wrote a book about the case, The Unlawful Concert, published by Viking in 1970 and reissued by Gryphon Press in 2005.

In April 1970, Gardner worked as a stage manager for Free The Army (FTA) with actors Jane Fonda and Donald Sutherland. This travelling road show for soldiers was meant to counter USO shows put on by Bob Hope. Gardner is a frequent contributor to CounterPunch. He is a long-time contributor to the Anderson Valley Advertiser.

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In 2003, Gardner launched O’Shaughnessy’s Journal of Cannabis in Clinical Practice, a journal in which doctors of the Society of Cannabis Clinicians, monitoring cannabis use by patients could share their findings and observations, and be kept abreast of relevant scientific and political developments. Martin A. Lee has been associate editor since 2009.

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Gardner currently lives in Alameda, California with his wife Marci. He has six sons and a daughter.

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The journal is doing important investigative journalism, to name just a few from :

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O’Shaunessy’s Winter 2015/2016 Print Edition

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CBDiaryHow we broke the cannabidiol story —and the ongoing ramifications.

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Off-Topic is the context in which marijuana prohibition exists —a vast terrain full of contradictions and treacherous peaks and canyons where “Cannabis activists” are told by “Reform leaders” not to stray.

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Going digital is still new for O’Shaunessy’s:

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A Work in Progress

Building this site
in plain sight
we cite Bertolt Brecht—

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“And please make
my curtain half-height, don’t cut the stage off.
Let the spectators leaning back
notice the busy preparations being made
so ingeniously for them, a metallic moon
comes swinging down, a shingle roof
is carried in; don’t show them too much
but show them something. And let them observe
that this is not magic but
work, my friends.”

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 From O’Shaunessy’s Winter 2015/16 issue on CBD

CBD is the non psychoactive cannabinoid in the plant that has at least 86 cannabinoids. It blocks THC

“Many farmers are doing ‘dual harvest,’Boucher explained. “If you’re growing for fiber, are you going to throw that CBD in
the flowers away? If you grow hemp for
seeds, why throw that CBD away? That’s
money for the farmer.”
Boucher credits Senators Mitch McConnell
and Rand Paul and Kentucky Ag Commissioner
James Comer for intervening
in 2014 when the Drug Enforcement Administration
confiscated seeds before they
could reach hemp farmers. David Bronner,
head of Dr. Bronner’s Magic Soap Company,
paid for the lawyers who got the crucial
injunction that ended the confiscation.
“McConnell made them back down last
year and this year the DEA didn’t interfere
at all,” says Boucher. “They were helpful,
in fact.”

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It was politically shrewd of McConnell,
the Senate Republican leader (and faithful
shill for the mine owners) to support the
hemp industry because he was facing a
serious challenge from a Democrat in November
2014. According to an observer of
Kentucky politics, “He would go to town
meetings and rallies, and the first question
—the first three questions— would always
be about hemp. And he’s like, ‘Wait a second,
this is a litmus test for the farmers.
If this is what they want, I’ve got to get behind this.”

behind this.’ And it was funny,
after about the second or third
rally he would say ‘Watch this,
I bet you the first question is
going to be about hemp.’ And
of course it always was.”
Kentucky farmers made
three times more per acre
growing hemp in 2015 than
growing tobacco (which used
to be government-subsidized),
according to Boucher; and 10
times more than they would
have growing corn.

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He said hemp companies were paying
“anywhere from $1,800 a ton, dry
weight—that’s barrel-bottom price—for
the top 2.5 feet of their plants.”
Companies purchasing hemp stalks plan
to make a wide range of products, from
horse bedding to fine textiles. CannaVest
donated seeds to the Growing Warriors, a
veterans group that is making American
flags from hemp. “They process it the oldtime
way,” Boucher says. “They watered
down the fibers, use an old hemp brake,
take the fiber to hand weavers.”
Boucher expects to be scaling up in the
period ahead. He foresees a market of 40
to 50 million Americans for cannabis, and
a large subset looking for CBD. CannaVest
will make tinctures and capsules marketed
as nutritional products, depending on directives
(or signals) from the DEA. “That’s
where everything’s kind of in limbo,” he
adds.

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Boucher says there are misconceptions
about the warnings sent by the FDA earlier
this year to companies that made claims attributing
curative properties to CBD, and
lied on their labels about how much CBD
their products contained. The warning was
not a blanket injunction against distribution
of CBD-rich oil, according to Boucher,
but an outing of companies making false
claims. And CannaVest was blameless.

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We sell to hundreds of different companies,
and some of those third parties were
making claims. When we sell to people, we
specifically tell them in the sales agreement
that you cannot make claims and we

 

The war on cannabis clinicians

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By Fred Gardner  July 22, 2016   The low-intensity war on cannabis clinicians —part of a long-range containment and rollback effort planned by top industry and government strategists after California voters legalized marijuana for medical use in 1996— has been heating up..

 

The Federation of State Medical Boards (FSMB) is now pushing guidelines that could result in cannabis clinicians being investigated based on the number of patients they’ve approved and/or number of plants authorized. The FSMB guidelines, when adopted by state boards, could also result in physicians who medicate with cannabis losing their licenses based on an assumption of impairment! [O’Shaunessy’s covered past cases of doctors who won cases brought against them by the Medical Board of California.]

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Some state medical boards and departments of public health already have adopted guidelines restricting cannabis approvals. Colorado suspended the licenses of four physicians alleged to have authorized too many patients to grow too many plants. Here is John Ingold’s report in the Denver Post.

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Next week the Medical Board of California (MBC) meets in San Francisco and one agenda item has Executive Director Kimberly Kirchmeyer leading a “Discussion on the Process to Revise the Statement on Marijuana for Medical Purposes, Marijuana Recommendations Guidelines, and a Policy on Physician Use of Marijuana.” Linked to the agenda item on the MBC’s website is the state board’s existing policy statement on “Marijuana for Medical Purposes” and the more restrictive “Model Guidelines for the Recommendation of Marijuana in Patient Care” proposed by the FSMB.

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Steve Robinson, MD, has drafted a letter to the FSMB in which the 270-member Society of Cannabis Clinicians protests aspects of the guidelines. The letter will also go to JAMA, which ran an op-ed setting forth the FSMB guidelines. Dr. Robinson thinks the Medical Board of California is on the verge of adopting the FSMB guidelines at its upcoming meeting. Kirchmeyer reassured me in an interview that next week’s procedure is just one small step towards that goal.

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The Federation of State Medical Boards is a non-profit organization consisting of one physician —Humayun Chaudhry, president and CEO — plus a staff of 180 headquartered in Euless, Texas, plus a small  Washington, DC office for their lobbyists.

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There is evidence that the Federation of State Medical Boards is a shill for Big PhRMA. Starting in the 1990s, the FSMB, with funding from opioid manufacturers, pushed less restrictive prescribing guidelines that contributed to the current epidemic of addiction and death by overdose.

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As of the 1990s, the prevailing wisdom was that opioids are highly addictive and should be prescribed only for cancer pain and short-term severe pain. But the makers of synthetic opioids such as Oxycontin (Purdue Pharma), Duragesic (Johnson & Johnson) and Percocet (Endo) had begun funding studies that minimized the risk of addiction when their drugs were used to treat longterm, non-cancer pain such as back and neck pain.

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By 2004 the Federation of State Medical Boards was pushing guidelines that encouraged a more lenient approach to opioid prescribing.  In 2012 John Fauber blew the whistle on the FSMB in the Milwaukee Journal Sentinel/MedPage. The relevance of   Fauber’s expose to the current campaign against cannabis clinicians is striking. He wrote:

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The Federation of State Medical Boards, often develops guidelines that serve as the basis for model policies with the stated goal of improving medical practice —but after its guideline for the use of opioids to treat chronic pain patients was adopted as a model policy, it asked Purdue Pharmaceuticals for $100,000 to help pay for printing and distribution that policy to 700,000 practicing doctors.

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That $100,000 was just a small downpayment on the $3.1 million that the Federation’s foundation estimated it would cost for its campaign to get out the word about “safe” use of opioid analgesics in treatment of chronic pain…

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Why the FSMB would turn to a pharmaceutical company to underwrite the cost of producing and distributing a book about its opioid prescribing policy — and why the FSMB undertook developing such a policy in the first place — is part of a much larger story that has unfolded over the last decade, culminating with the Centers for Disease Control and Prevention’s stark warning about spiraling risk of death from prescription painkillers.

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An FSMB spokesperson said there were many reasons for it to codify a position on the prescribing of opioids, and among those reasons was a project supported by the Robert Wood Johnson Foundation to seek some common ground in the treatment of chronic pain.

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[Fauber had previously reported on the University of Wisconsin Pain & Policy Studies Group receiving $2.5 million from opioid manufacturers between 1999 and 2010, starting with a $693,000 grant from the Robert Wood Johnson Foundation in ’99.]

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    •    The RWJ-funded project started with an advisory committee that recruited several pain experts who had ties to makers of opioids — a core group that included J. David Hadd

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snip

 

continued

 

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The material on this site is for informational purposes only.

It is not a substitute for medical advice, diagnosis or treatment

provided by a qualified health care provider.

Relevant comments are welcome.

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For My Home Page, click here:

Welcome to my Weblog on Pain Management!

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Please be aware any advertising on this free educational website is

NOT advocated by me and NOT approved by me.

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Insys Pharma fighting legal cannabis. Research shows big drop in opioid use with cannabis, & first proof large scale healing properties. LEGALIZE & watch pain get better


 

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Legalize Marijuana like Alcohol

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Stop blocking people who need it in order to work. Make it legal there too in reasonable circumstances. NFL players need access to Cannabis, not just to opioids made by Insys that has the ear of Congress. Insys has effectively torn a big breach in plans for healthcare needs that can be supplemented with cannabis, not just opioids, and with none of the overdoses especially with fentanyl, the most sought after high, preferred by addicts because 50 times more potent than heroin. The killer drug. Kills insurance companies too: $$$ x 6 per day.

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Case

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My patient got progressively worse and was unable to work for two years until seeing me recently. Opioids initially were a big relief, but high dose and not worth the cludgy brain feeling. Brain and body finally now free of pain, but not until she got off opioids. With cannabis, the depression due to pain and disability lifted, pain literally dropped to zero for 8 hours or more with just a tiny drop under tongue.

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Enormous disabling pain, low back, both shoulders, both hands, old body heavily used with joy in work. After one drop under tongue, zero pain, old body no more, able to take teams of people on strenuous adventures with no problem. Life back. No high. No brain effect. One drop under tongue. Eight hours free of any pain or side effect, young body back.

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So congress, deny access to cannabis so people with pain don’t even get educated on it, and doctors don’t learn. CDC now chops opioids with their guidelines, so where do people turn? Insys wants to stop American medicine from evolving with this plant, yet we have more cannabinoid receptors in our body than any other kind. Far more than opioid receptors that kill the immune system.

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For my patient, it is illegal to fly among homes in 3 states in order to work, but it is now sold at a local nutrition store — not a cannabis dispensary. It is not but must be available for use in hospitals and ICU’s.

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CASE

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Patient Friday, polymyalgia rheumatica, aged 20 years overnight from high dose prednisone. Arms and legs stained heavily with bruises it brings on. Heavy edema in legs making it difficult to get around. Started cannabis on the skin and overnight all of the massive edema was gone, and the nonhealing area on the ankle had healed. No more Scripps Wound Clinic that had worried so much about it.

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For Pete’s sake, the stupidity when anyone’s eyes can see how congress is pushing opioids, how this benefits addiction to opioids, the entry drug for heroin abuse, benefits a militarized police state and the racist overpriced and violent industrial police-prison complex. That’s the policy of this congress, perpetuate opioid addiction, remain blind to cannabis’ medical uses unless their pockets are lined, anti-science until their own healthcare is concerned. Opioid overdoses 130 a day, the size of a Boeing 737, I just posted on this, two days ago.

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Tell me how this is a Schedule I drug that our injured veterans must not use or they will be kicked out of pain clinics. Who set that up, the opioid pharma league with congressional oversight against those addicts who have pain or they would not be seeing help from drugs? Who warned doctors at pain meetings they must never treat a patient with opioids if they also use cannabis for pain and spasm and sleep.

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Could the influence of pharma money be causing your aging grandparents to suffer without being able to afford medication? A medicine anyone could grow in their home and bring up children with the knowledge that plants with 400 healing chemicals we will learn to use are better than any synthetic that has only one ingredient. I don’t want to risk addicting 10% of the population at age 10 when they get their wisdom teeth pulled or break their leg in soccer. Teach our children when they break a leg, plants heal .

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My valued and talented senior finds such joy in work which has brought a lifetime of awesome experiences, but it had looked like life was over, forever. 

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We need to learn new medicine using some or all of the 400 healing chemicals in the plant. Surely we cannot let a pharmaceutical company influence Congress and regulators to plant themselves firmly against valued medical research and healing medications.

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Must our pain patients in particular be denied care, be treated with such contempt as to have their opioid doses suddenly taken down, and see opioid use conflating them with addicts. Must our addicts be given felony jail rather than treatment for their deadly medical condition.

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Without legalizing use of cannabis for medical conditions, you will be forced to go monthly or at regular intervals to your doctor for a prescription of one synthetic chemical in the healing plant that has 400 different rich chemicals we need to learn about and harvest.

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Tell your congress persons that Kentucky farmers influenced their senior Senator running to save his seat, they can make 10 times more growing hemp than they can growing corn, and 3 times more than tobacco. Hemp is cannabis that has almost no THC—there is no high, but can it stop children from having 100 seizures a day? Let’s grow one that can. Their university agriculture departments are now hot on the science of Kentucky strains. Patent them.

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Let’s get this country hot on the science of healing medical conditions without running up costs such as frequent doctors visits. And lets stop forbidding hospital use for relief nothing else can provide.

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I presume the unnamed pharmaceutical company may be Insys Pharmaceuticals. They market a rapid acting opioid called, a fentanyl spray, and already market THC and got approval to test CBD. THC and CBD are only 2 or 400 chemicals in the plant. Insys is being accused of trying to ruin the market for patient access to naturally grown plants that are medicinal and actually healing.

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Hot research just published, see below, releases data showing that in states where cannabis is legal, proof that cannabis is actually healing and not used just used in place of pain medication.

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Well if that’s true, and opioids make people violent, then cannabis makes people relax and feel less stressed, less violent, able to relax so deeply, my patients have said it’s like those decades of fight-flight response instantly vanished and they were finally able to feel a deep calm. The kind that makes you want to listen to music. To find peace. Not shoot up heroin in dark corners, away from family, hiding addiction. To deny our pain patients is simply astonishing they get away with the lunacy.

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Everyone knows the only reason pain was recognized for the first time was with the discovery of pain receptors and endogenous opioids. And that was not funded because congress and consciousness cares about your pain, it was addiction research on addicts that legitimized pain for the first time in history, early 1970’s. Well, we have a powerful endogenous cannabinoid system with amazing healing mysteries to unlock.

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True healing.

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Like the patient with barely one drop on the skin, and severe edema in BOTH legs was gone overnight. and the nonhealing skin healed.

 

It seems Insys wants the market for a single synthetic cannabinoid and argues we mus prevent GW Pharmaceuticals from gaining legal market protections and FDA approval of plant based cannabis. You should prefer seeing your doctor for prescription of Insys’ synthetic THC or CBD and hospitals should never allow you to use what you have proven works for you. CBD and THC are only two of 400 chemicals in this healing plant that we must learn to use as soon as possible. Pharma costs are staggering. Farmers can grow cannabis hybrids for different medical uses. We need research, not 1920’s style attacks on cannabis and alcohol. Look where Prohibition led them. How many doctors were thrown in in jail in that era for trying to treat pain.

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Medicine and brain research would lose a critical opportunity to study the cannabinoid system in our body.

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We have more cannabinoid receptors in our body than any other type. What are those receptors doing in bone all over the body, while my body slowly dissolves from osteoporosis and my brain just read research showing cannabis helps Alzheimers plaques.

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GW Pharmaceuticals for decades has led the field of medical research in cannabis. They have been valued highly as a business and our patients need no avenues closed.

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It is brilliant timing for new research reported in the Washington Post. I trust you will consider how to use this work to sway the election campaign to help our patients and forward medical research. Many are not getting the help they need, especially as their opioids were slashed and we have no tools to help pain. We need a clinical pain research institute with all the science, research and tools to help people in extreme pain to continue functioning, at least enough to allow them to bend, stretch, bathe and dress themselves. To allow them to be able to relax deeply and let go of monstrous pain at the end of the day. Nerve pain is always worse at night. Cannabis is an essential plant requiring the best research minds.

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One striking chart shows why pharma companies are fighting legal marijuana

 

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There’s a body of research showing that painkiller abuse and overdose are lower in states with medical marijuana laws. These studies have generally assumed that when medical marijuana is available, pain patients are increasingly choosing pot over powerful and deadly prescription narcotics. But that’s always been just an assumption.

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Now a new study, released in the journal Health Affairs, validates these findings by providing clear evidence of a missing link in the causal chain running from medical marijuana to falling overdoses. Ashley and W. David Bradford, a daughter-father pair of researchers at the University of Georgia, scoured the database of all prescription drugs paid for under Medicare Part D from 2010 to 2013.

They found that, in the 17 states with a medical-marijuana law in place by 2013, prescriptions for painkillers and other classes of drugs fell sharply compared with states that did not have a medical-marijuana law. The drops were quite significant: In medical-marijuana states, the average doctor prescribed 265 fewer doses of antidepressants each year, 486 fewer doses of seizure medication, 541 fewer anti-nausea doses and 562 fewer doses of anti-anxiety medication.

But most strikingly, the typical physician in a medical-marijuana state prescribed 1,826 fewer doses of painkillers in a given year.

 

The tanking numbers for painkiller prescriptions in medical marijuana states are likely to cause some concern among pharmaceutical companies. These companies have long been at the forefront of opposition to marijuana reform, funding research by anti-pot academics and funneling dollars to groups, such as the Community Anti-Drug Coalitions of America, that oppose marijuana legalization.

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Pharmaceutical companies have also lobbied federal agencies directly to prevent the liberalization of marijuana laws. In one case, recently uncovered by the office of Sen. Kirsten Gillibrand (D-N.Y.), the Department of Health and Human Services recommended that naturally derived THC, the main psychoactive component of marijuana, be moved from Schedule 1 to Schedule 3 of the Controlled Substances Act — a less restrictive category that would acknowledge the drug’s medical use and make it easier to research and prescribe. Several months after HHS submitted its recommendation, at least one drug company that manufactures a synthetic version of THC — which would presumably have to compete with any natural derivatives — wrote to the Drug Enforcement Administration to express opposition to rescheduling natural THC, citing “the abuse potential in terms of the need to grow and cultivate substantial crops of marijuana in the United States.”

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The DEA ultimately rejected the HHS recommendation without explanation.

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In what may be the most concerning finding for the pharmaceutical industry, the Bradfords took their analysis a step further by estimating the cost savings to Medicare from the decreased prescribing. They found that about $165 million was saved in the 17 medical marijuana states in 2013. In a back-of-the-envelope calculation, the estimated annual Medicare prescription savings would be nearly half a billion dollars if all 50 states were to implement similar programs.

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“That amount would have represented just under 0.5 percent of all Medicare Part D spending in 2013,” they calculate.

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Cost-savings alone are not a sufficient justification for implementing a medical-marijuana program. The bottom line is better health, and the Bradfords’ research shows promising evidence that medical-marijuana users are finding plant-based relief for conditions that otherwise would have required a pill to treat.
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“Our findings and existing clinical literature imply that patients respond to medical marijuana legislation as if there are clinical benefits to the drug, which adds to the growing body of evidence suggesting that the Schedule 1 status of marijuana is outdated,” the study concludes.

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.One limitation of the study is that it only looks at Medicare Part D spending, which applies only to seniors. Previous studies have shown that seniors are among the most reluctant medical-marijuana users, so the net effect of medical marijuana for all prescription patients may be even greater.

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The material on this site is for informational purposes only.

It is not a substitute for medical advice, diagnosis or treatment

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Relevant comments are welcome.

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For My Home Page, click here: 

Welcome to my Weblog on Pain Management!

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Veterans Suicides 20 per day – MD not paid in 12 months for 5 approved visits


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VA Conducts Nation’s Largest Analysis of Veteran Suicide

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Read the report all you want, but for 12 months I’m not reimbursed. And no explanation why. No wonder they can’t get doctors.

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Yet another call just now from TriWest asking me to treat a veteran. VA crisis lines leave vets in limbo. Calls go to voice mail. Veterans have killed themselves just after calls to crisis lines. A lot of these suicides are due to PTSD. Veterans cannot get the help they need.

 

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I believe it is TriWest who won the contract to schedule suicidal veterans who have Treatment Resistant Depression or PTSD or Bipolar Depression. I treat that. It works except in the most extreme cases, in minutes to just a couple days. It’s simple and safe for outpatient use. It has been tested at NIMH and Yale since 1991. The VA-UCSD psychiatrist referred him and then continued care.

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I will not see one more veteran until I am reimbursed for the 5 pre-approved visits for a veteran I treated 12 months ago. He was better in a few days, the first time in decades he had relief of depression. If you cannot pay me who can relieve treatment resistant Major Depression in 2 days, then honey, no wonder you can’t find docs to help. They limited me to their chosen codes for billing. I spoke to psychiatrists who work with veterans and they have never heard of those codes. I guess they just mean loud and clear: NO PAY. Fine. It was a pay cut to offer and took weeks of paper forms, months of approval – you have to really want to do it. With frequent help from a very experienced clerk and a doggedly informed veteran who knew all the ropes, it took months for paperwork to get rushed through. Plenty of doctors just graduating this month don’t know how many months paperwork takes and they won’t get paid.

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San Diego VA has the worst reputation in the nation. I understand it is the San Diego VA that has the worst lag time delays of several months before veterans can even be seen. Worst in the country. Correct me if I’m wrong. And we have a lot more veterans because warm sunny weather is easier on their bones. Is that any excuse to dis-incentivise any doctor by not paying for services?

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The new veterans suicide hotline does not even return all calls. Public Radio just had an expose’ on this one or two weeks ago.

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Twenty veterans take their life daily.

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Only 30% of people with depression respond to antidepressants.

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Based on publications from major academic centers, treatment resistant depression, it seems, is diagnosed after failing as few as 3 or 4 antidepressants.

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Compare any antidepressant to ketamine with potential relief in hours to a couple days.

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It’s not like this is new. In 1991 ketamine was first studied at NIH for depression. Yale has carried the work forward with them. But people live at home and it has to be cost effective. It is unnecessary and/or unaffordable for most people including taxparers to be paying for IV infusions when many or most patients do well on sublingual or nasal use. It is the #1 drug of abuse in China, so don’t just offer it to any person who needs it. Make sure you understand how important glial modulators are in depression. See Yale with NIMH publication on inflammation in depression, I posted on these pages about 3 or 4 years ago when it came out.

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Yale with NIMH had published that ketamine rapidly creates synapses.

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And Yale has published:


Activation of a ventral hippocampus–medial prefrontal cortex pathway is both necessary and sufficient for an antidepressant response to ketamine

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In January 2012, I posted detailed information:

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Depression PTSD – Ketamine Rapid Relief

 

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  • PTSD has a more direct link to suicide than previously thought, a current Texas A&M University study concludes – references below.

  • A high lifetime risk of suicide occurs in women who have been sexually and physically abused as young girls.

  • More than 300,000 veterans have been diagnosed with PTSD or major depression – many not yet diagnosed.

  • Risk of suicide is the highest during the first month of standard antidepressant therapy, and a significant number of patients do not have adequate improvement even after months, resulting in harm to personal and professional lives.

  • Patients are at suicide risk upon discharge from psychiatric hospitals.

  • Significant predictors of both suicide attempts and preoccupation with suicide are guilt and anger and impulsive behaviors.

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  • Ketamine is the most important breakthrough in treatment of major depression with rapid and lasting effects.

  • Ketmine can help immediately, unlike all other antidepressants that may require weeks or months to work, if they help at all. See NPR report here – that appeared soon after I posted this (skip to their last section). It is FDA approved and legal. NPR again reports ketamine’s rapid relief of depression.

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    • The medical literature on ketamine use is profoundly important. There are over 6,800 medical publications. Ketamine has potent healing powers. Karl Jansen, psychiatrist in London, believes that “ketamine has potent healing powers when used as an adjunct to psychotherapy.” There is nothing like it; however, treatment for serious depression still requires team support, not medication only.

    •  The World Health Organization reports that disability to due depression is second only to heart disease.

    • Suicide is a catastrophic medical emergency. I cannot stress this enough. Depression is treatable.

    • Your death is unnecessary. It would be a terrible loss to all who love you.

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Please read that entire post January 2012 before you call to ask questions. The calls are very time consuming.

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There is no reason to restrict life and death matters to one drug, and then make it dependent upon only IV infusions. What kind of life is vegetating in depression for decades? It is a short acting drug. I have posted on why ketamine should never be used alone, but must be used with other glial modulators.

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Most troubling:

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Compounded Medications are Not Covered by Any Insurance

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Most people cannot afford compounded medications, especially if disabled due to Major Depression or PTSD or pain – same medications work on mood and pain.

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TAKE ACTION

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Healthy people can get back their lives. These simple steps can be taught across the nation. Millions are needlessly disabled, especially our young adults who are most vulnerable to these disorders, and several hundred thousand of our young veterans.

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An entire nation can get and breathe relief.

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DO THIS:

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Call your favorite politician and relevant organizations who care about healthcare and veterans to STOP the collusion and restraint of trade since all insurers began refusing to cover compounded medications. All these new $100,000 per year medications are paid for by the taxpayers and your insurance deductible that goes up every year. How long will you be able to afford medical care? How long can this restraint of trade be practiced under our noses unless we take action?

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Get this on the Democratic platform this presidential year. It’s a scam perpetuated by multibillion dollar pharma and their mighty rich contributions to congress who are killing affordable medical care.

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Affordable medical care

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These medications must be compounded. How many can afford $200 to $300 or more cash out of pocket just for medications? Or will this become another safe old drug that is bought by a financier, patented, and now they charge $100,000 a year? You know who pays for everything and it ain’t the 1%.

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Opioid Overdoses ~130 every day, the capacity of a Boeing 737 – naloxone $4,500, up from $690 in 2014. You pay


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LA Times reports

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As need grows for painkiller overdose treatment, companies raise prices

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$4,500

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$4,500.

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$4,500 for naloxone manufactured by Kaleo, Richmond Virginia. Naloxone reverses opioid overdose.

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That seems to be their Evzio two-pack, two single-use injectors of naloxone in a hard case handy to carry in a pocket for someone who has an opioid overdose.

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Each has a 0.4 mg injection that last 2 or 3 minutes each, just long enough to call an ambulance.

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A drug that costs pennies, sold as a 2-pack for $690 in 2014, then $900, now $4,500 as of Feb. 1.

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“…Columbus, Ohio, said the city’s firefighters last year used 2,250 naloxone doses, or about 6 doses a day — at a cost of $147,000. Recently, Columbus also stocked the drug in 115 police cruisers….”

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FDA approved Evzio in April 2014 after granting fast-track status. Fast track now means gold mine status. 

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Naloxone was first approved in 1971.

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“In July 2005 its average wholesale price for a vial of the injectible drug was $1.10, according to Truven Health Analytics.

By 2014, the price was almost $19 a vial.” 

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Medical costs are astronomical, insurance premiums are up, insurance deductibles are $5,000 to $10,000 for many. Police, fire department and EMT’s are using naltrexone to save lives and lower ER visits.

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Taxes are high. Where is the initiative and innovation among EMT’s, police, fire? How many hours per day do they get paid full salary to work out at the gym and stay fit while they sit and wait for the next call to rescue an addict who overdosed. Then retire on double pensions if they hold two city jobs. While they wait for next calls, could they not fill syringes from a vial of naloxone? How much do taxpayers pay for these overpriced robotic filled syringes at factories.

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Pharma is raking it in. Pharma’s blood sucking 1% are overdosing on costs. Many of my patients with intractable pain who are on opioids were not able to afford $690. They are not addicts but any dose of opioid can kill. Your tax dollar pays for naloxone for addicts found dead, unresponsive.

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We are all paying a fortune for inexcusable pharma costs. Costs for millions of drug addicts all over the country. Costs for prescription medications. Congress unwilling to address anything that would cut the flow of donations to their coffers from pharma.

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Just remember, in Israel, it is illegal for corporate lobbyists to contact any politician.

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“Late last year, Adapt introduced a naloxone nasal spray named Narcan for a average wholesale price of $150 for two units, according to Truven.”

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That is a BD syringe fitted with a flared BD adapter at the tip to fit the nostril. It requires the user be capable of pushing the 1 mL syringe so the liquid is sprayed into nostril.

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For Pete’s sake. I’ve been prescribing medicine in these BD syringes with nasal adapter for years. Is there no EMT smart enough to make and stock their own supply to use for emergencies?

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“…as the demand for naloxone has risen — overdose deaths now total 130 every day, or roughly the capacity of a Boeing 737 — the drug’s price has soared.
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…Increased access to naloxone is among the measures included in federal legislation that Congress passed last week in response to the painkiller deaths. The White House has said that President Obama plans to sign the bill.
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Last month, U.S. Sens. Susan Collins (R-Maine.) and Claire McCaskill (D-Mo.) wrote to Kaleo, Rancho Cucamonga’s Amphastar Pharmaceuticals and three other drug makers, asking why they had hiked prices for naloxone during a public health crisis.
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“At the same time this epidemic is killing tens of thousands of Americans a year,” said McCaskill, “we’re seeing the price of naloxone go up by 1,000% or more.

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 …Mylan, which sells a vial [how many doses per vial?] for an average wholesale price of $23.70, according to Truven and Adapt Pharma of Dublin, Ireland.”

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The material on this site is for informational purposes only.

It is not a substitute for medical advice, diagnosis or treatment

provided by a qualified health care provider.

Relevant comments are welcome.

~~~~~

For My Home Page, click here: 

Welcome to my Weblog on Pain Management!

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Please be aware any advertising on this free educational website is

NOT advocated by me and NOT approved by me.

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Ketamine Survey for MD’s from RSDSA – Please Help


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Jim Broatch, Executive Director of RSDSA requests help from doctors giving IV Ketamine to treat CRPS. Please ask your doctor to do the survey. 

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 https://www.surveymonkey.com/r/ZPP9BXY

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And remember, if you shop Amazon, you can direct Amazon to contribute a portion to RSDS.org —- many thanks! 

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This site is educational, not for email.

Relevant comments are welcome.

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Advertising on this free website, below, is not endorsed or sanctioned by me.

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Oxycontin Investigation – A Pulitzer for LA Times?


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A TIMES INVESTIGATION

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Inside an L.A. OxyContin ring that pushed more than 1 million pills. What the drugmaker knew

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By HARRIET RYAN, LISA GIRION AND SCOTT GLOVER

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JULY 10, 2016

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This LA Times investigative report by Ryan, Girion and Glover is now a contender for Pulitzer Award. They expose years of passively tracking extreme volume sales by leaders at the top of Purdue Pharma, the maker of OxyContin. While they racked up billions in sales, they tracked the surge in prescriptions from pill clinics in LA to gangs trafficking in Washington State for sale on the street. 80 mg tablets, deaths, crime, gangs, heroin – waves of heroin related crime and overdoses in cities all over the world.

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Purdue could track suspicious high volume sales of their pill:

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Until a decade ago, Purdue, like most drug manufacturers, didn’t monitor pharmacies for criminal activity. The DEA has held wholesalers, not drugmakers, responsible for identifying and reporting suspicious orders from their customer pharmacies.

In 2007, the DEA pressured drug manufacturers to do more to stem the prescription drug crisis and warned that it would be looking at every step in the supply chain. In response, Purdue decided to gather detailed information about pharmacies, Crowley said.

The company approached wholesalers and struck agreements allowing the company access to their sales reports. With the new data, the security team in Stamford could see all wholesalers’ OxyContin sales to individual pharmacies, down to the pill.

“I can look at something and say, ‘Geez, that stinks’ without me even visiting the place,” Crowley recalled.

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……What Purdue knew

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More than 194,000 people have died since 1999 from overdoses involving opioid painkillers, including OxyContin. Nearly 4,000 people start abusing those drugs every day, according to government statistics. The prescription drug epidemic is fueling a heroin crisis, shattering communities and taxing law enforcement officers who say they would benefit from having information such as that collected by Purdue.

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A private, family-owned corporation, Purdue has earned more than $31 billion from OxyContin, the nation’s bestselling painkiller.

 

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In 2015, the Week published:

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How the American opiate epidemic was started by one pharmaceutical company

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From Pacific Standard

Mike Mariani

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OxyContin’s ball-of-lightning emergence in the health care marketplace was close to unprecedented for a new painkiller in an age where synthetic opiates like Vicodin, Percocet, and Fentanyl had already been competing for decades in doctors’ offices and pharmacies for their piece of the market share of pain-relieving drugs.

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These reports must demand a Congressional investigation into Oxycontin (before and after the 2010 abuse deterrent version) and all potentially addicting drugs currently on the market, not just pain killers.

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Congress needs to address pharma’s drug trafficking, data collection, and,duty to report.

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Pharma needs to be tracking distribution not just for sales and profit, but for common sense to interrupt drug trafficking. Obviously there is no law.  Profit always wins.

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Business ethics is not good enough to justify the explosion of opioid abuse that stems from years of Oxycontin pills. Profiteering at the cost of deaths and drug abuse. Vote with your stock holdings.

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Cannabis for pain and symptom relief

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Congress has lost the average person’s respect for scheduling cannabis as Schedule 1. It is an essential medication that has been used medically, safely for thousands of years. Patients are arriving in office with the discovery that CBD, simply CBD, works for their intractable pain. That’s not exactly correct, but there is a topical cannabis mixture that can relieve malignant pain – I mean disabling, not cancer.

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Reschedule cannabis as Schedule 3 immediately. It needs to be legalized, studied and taught. When MD’s are not taught about the cardiovascular potential with THC and when patients arrive in the ER without knowing what was in the marijuana they used, our hands are tied.

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Congress owes a release to the millions jailed simply for felony cannabis possession.

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Cannabis  “to date has been responsible for the arrest of about 20 million US citizens,” written in 2010 by Emeritus Professor of Psychiatry Lester Grinspoon.

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This website is for educational purposes only, not for medical advice or treatment. It is not for email.

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