Cannabis, a few things you need to know


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PainWeek 2018 has a series of conferences in different cities. This weekend 10/13-10/14, it was in San Diego teaching pain management. 

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There was a talk on cannabis by a nurse practitioner from Stanford. I would add or highlight a few things.

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There are two species:

–Indica often said to help pain, sleep.

–Sativa more activating, for daytime use.

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Most are hybrids. Some people have opposite responses. It may be contraindicated for those with bipolar disorder. Those with multiple sclerosis may use it for spasticity. It can help depression but may cause anxiety, depression, paranoia, etc.

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The plant has 400 chemicals. More than 90 are cannabinoids. Two best known cannabinoids:

–THC is psychoactive.

–CBD has no psychoactive properties and does not make you high. In recent years, it has been found to help certain forms of epilepsy in children who are resistant to all known epilepsy medication.

–THCV has been said to prevent the munchies. Only one strain I know of has this cannabinoid, Durban Poison.

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It is not necessary to have THC for pain relief. Pain in some patients may respond to CBD alone.

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Tolerance does develop. It becomes less and less effective with use.

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Side Effects: the very worst is the munchies – deadly weight gain. Dry eyes and dry mouth can affect all, but for those with Sjogren’s Syndrome, it increases the risk of corneal transplants and loss of teeth that already exists and can be a serious problem. It can increase heart rate and blood pressure especially in those who have never used cannabis.

 

Update 10/19/18, cannabis may boost risk of stroke. The drug has system-wide effects therefor not limited to smoking it. Note that we have known it does increase heart rate and blood pressure, at least initially when starting use, but may develop tolerance to side effect with regular use – or not. The new study does not indicate how much cannabis these patients were using, their ages and blood pressure baseline and during use. Was their use conservative or were they overdosing, couch locked, less active than usual?

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  • Stroke increased by 15% among marijuana users between 2010 and 2014
  • Rates of stroke in non-cannabis users stayed constant over that time
  • Compounds in cannabis may cause blood vessels in the brain to narrow

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Rates of stroke among non-cannabis users didn’t change. However, rates among recreational users jumped by 15 per cent.

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“Avalon University researchers…analysed 2.3 million people between the ages of 18 an 84 who used cannabis recreationally and spent time in hospital from 2010-to-2014.

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Of these, 32,231 – 1.4 per cent – had a stroke.

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And 19,452 had an acute ischemic stroke (AIS), which occurs when blood supply to an area of the brain is suddenly cut off, leading to a loss of cognitive function.

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Over the four years, the rate of all strokes among marijuana users rose from 1.3 per cent to 1.5 per cent. And AIS increased from 0.7 per cent to 0.9 per cent.

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The research was presented today at the World Stroke Congress in Montreal.

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They scientists believe their findings ‘warrant further prospective studies to evaluate the marijuana-stroke association amidst legalisation of recreational use’.

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But the study contradicts previous research that suggests smoking cannabis can actually reduce the risk of stroke by boosting blood flow to the brain.

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Marijuana has also been linked to faster recovery post stroke.

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Stroke is the second leading cause of death and disability globally, with one person passing away from the condition every six seconds.

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Around 140,000 people die from stroke in the US and 32,000 in the UK every year.

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Leafly.com is a nationwide resource for locations where cannabis is legal, listing strains and dispensaries by zip code. For each local strain it shows a bar graph of EffectsMedical, Negatives. Negatives may include dry eyes, dry mouth, sleep, anxiety, paranoia, headache, etc. rated by buyers. For example, one strain may be rated 100% dry eyes, but only 50% dry mouth. Each strain is different. But dry eyes, dry mouth are the most common, always highly prevalent, whereas paranoia, dizziness, anxiety may be rated only 3%.

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FDA has approved 2 THC compounds available for medical use:

–Dronabinol (Marinol), schedule III drug. I have never seen a single person with cancer pain, HIV AIDS pain or chronic pain benefit. Instead they complain about it, including those who heavily used cannabis.

–Nabilone (Cesamet), a schedule II drug. I had it diluted 10 times for a healthy senior with intractable pain. He hallucinated for 12 hours after a tiny dose. I’ve never seen a plant do this.

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More research is greatly needed. It has primary effect on the immune system in brain and body including neuro-inflammation in the central nervous system and the skeletal cannabinoid system. It is anti-inflammatory. In the brain, the microglia makes and reabsorbs one of the endogenous cannabinoids made by the brain. Studies show cannabis can help pain but almost all of my patients who tried many many strains reported that it failed to help intractable pain. Others stopped due to side effects. But I have seen patients with intractable pain and treatment resistant migraine who responded to CBD alone.

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Use the search function top left above photo for previous posts on cannabis.

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Beware the munchies and weight gain. It can be deadly. That effect can be life-saving in cancer patients and end of life care.

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Urine drug testing does not always include cannabis. It may be present in urine for up to 2 months. Don’t even think about getting on a plane with cannabis.

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The material on this site is for informational purposes only.

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It is not legal for me to provide medical advice without an examination.

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

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Comments are welcome.

This site is not for email, not for medical questions, and not for appointments.

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

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Please IGNORE THE ADS BELOW. They are not from me.

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Cannabidiol (CBD) FDA Approved for Epilepsy – May Help Pain, Mood – Costs Review


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Epidiolex from GW Pharmaceuticals, is a cannabidiol (CBD) recently approved by FDA for treatment of epilepsy. Others have found CBD helpful for pain, migraine, and mood disorders. CBD is one of the more than 80 known cannabinoids in the cannabis plant, the marijuana plant. It has no psychoactive effect, that means it does not make anyone “high”. But urine drug tests will be positive for marijuana and anyone may risk losing their job if their employer checks – some drug tests do not specify marijuana.

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Medications can be prescribed off-label by your doctor for conditions other than the FDA approved epilepsy in this case, and hopefully covered by healthcare insurance. Below are costs of the Epidiolex brand reviewed by O’Shaughnessy’s newsletter, the newsletter originally for California cannabis doctors.

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FDA approval means CBD now has accepted medical use and should be no longer classified as Schedule I, though the ruse will likely be continued by congress.

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GW Pharmaceuticals PLC said it plans to charge about $32,500 per patient annually in the U.S. for its new treatment for rare forms of epilepsy, the first prescription drug derived from the marijuana plant.

Chief Executive Justin Gover said in an interview Wednesday that the company set the price to be in line with other brand-name epilepsy drugs, such as H. Lundbeck A/S’s Onfi. He noted that the FDA designated the product an “orphan drug,” meaning it treats rare conditions, and that some other orphan drugs carry higher prices.

Out-of-pocket costs for patients taking Epidiolex could range from $5 to $10 a month for those in state Medicaid programs to as high as $200 a month for some private insurance plans, Julian Gangolli, president of the company’s North America unit, said on a conference call with analysts Tuesday. Uninsured patients may qualify for receiving the drug free.

Dr. Jacqueline French, chief scientific officer of the Epilepsy Foundation, said there are low-cost generic epilepsy drugs on the market, but many patients with the rare forms of the disease have already tried them and the drugs didn’t help much.

Dr. French said Epidiolex improved symptoms for many children in clinical trials, and she is happy the price isn’t significantly higher.

The company expects to make the drug available after the U.S. Drug Enforcement Administration assigns it a controlled-substance classification, a decision expected by late September. GW Pharmaceuticals will distribute the drug through specialty pharmacies that ship directly to patients and caregivers.

FDA approval of a CBD extract means that cannabidiol now has an acknowledged medical use and therefore doesn’t fit a key criterion of Schedule I status. DEA rescheduling is supposed to follow as day follows night. Logically, the DEA resked should apply to cannabidiol, the molecule. But fixisin.com says CBD will remain on Sked I, with an exception created for CBD in an FDA-approved pharmaceutical.”

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The material on this site is for informational purposes only.

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It is not legal for me to provide medical advice without an examination.

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

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Comments are welcome.

This site is not for email, not for medical questions, and not for appointments.

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

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Please IGNORE THE ADS BELOW. They are not from me.

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Cannabis Overwhelmingly Preferred over Opioids for Pain – UC Berkeley / HelloMD Opioid Study


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Congratulations and thanks to HelloMD’s email, posted below, that describes a new study. They are doing important work for people who can be helped by cannabis. We need help in the treatment of chronic pain.

I’ve seen pharma pressure pain specialists to refuse to treat patients who also use cannabis. For Pete’s sake it helps relax deep muscle like nothing else, helps anorexia, can bring up extremely low energy a tiny bit, helps depression, and pain. Shock and awe. What an awful thing to pressure doctors to do just to punish the plant based industry and extinguish the competition. I’m sure TV ads brainwash even more. Professionals in healthcare and politics need our help to know good studies already exist and even without that rigorous proof, our dispensaries can recreate what the world has safely used for thousands of years.

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HelloMD is a trusted source of information. 

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The HelloMD Advisor

Opinions from Industry Experts


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Hi Nancy,

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Yesterday we announced the results of our landmark study examining the use of cannabis as a substitute for opioid and non-opioid based pain medication. Performed in collaboration with University of California Berkeley, HelloMD surveyed 3,000 participants from our patient database….[– click on below link to article]

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[They showed the]

overwhelming majority of cannabis patients (92%) prefer using cannabis to opioids when managing their chronic pain.”

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Your participation in HelloMD studies is invaluable as it takes us one big step closer to showing healthcare professionals, elected officials and the public at large the potential for cannabis to alleviate the opioid crisis our nation is experiencing.

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HelloMD also recently launched in New York state offering patients the ability to get their medical marijuana certification online. This week we highlight PharmaCannis, a shining example of the eastern US cannabis scene, with five dispensaries statewide, professionals from the pharmaceutical industry, and an eye towards making cannabis a part of the future of healthcare.

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Finally, we highlight Dr. Gary Richter, the ‘Cannabis Pet Vet’, who has made it his mission to help animals and their owners lead happy, healthy lives.

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Be happy & healthy,

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Pamela Hadfield – Co Founder

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This is an important study for people to learn about and to help our legislators understand we need help to use this plant for billions who are needlessly suffering. We all need help. And simple is best. This medication has been safely used by grandmothers for thousands of years. Silly to think we cannot begin. Silly to deny millennia of use. We need help:

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  1. Low cost medication is essential.

  2. Healthcare insurers must reimburse patients for the cost of medical marijuana. This is done in New Mexico and should be in every state.

  3. We must all stop weaponizing a simple healing plant that can be effective. Truth beats fear. Every study helps to open minds.

  4. Support the work of good groups like HelloMD, NORML

  5. Get politics out of science and healthcare

  6. Teach our doctors – require 1 hour CME for all who see patients.

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I have so many senior patients terrified to try cannabis, and one who just had a once-in-a-lifetime result with a few cannabis drops under the tongue. She worked with a dispensary that mixed a personalized ratio of THC:CBD. It Worked! Nothing else had, her life spent in years of constant headache. It’s gone! yet she is still terrified of cannabis.

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Such has been the insanity about the American gung-ho opioid boosters vs the shoot ’em dead plant loving criminals and addicts – that’s what these little old ladies think they have become. Criminals and addicts. This sweet woman’s intractable migraine has taken her life every day for years, failing to respond to the best care in the nation, is now gone with cannabis! Yet she’s going to have a heart attack because for decades the GOP has trained her to think she’s a criminal addict. She was referred by one of the foremost migraine experts whose final suggestion was to try cannabis. A few weeks later when she came to her first visit with me, she was headache free.

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Had her family doctor been able to recommend someone who works with cannabis patients many years ago, she would not have wasted her life and fortune. It can be simple and life-saving to try, and always nice to have a helpful hand from the dispensary to show you how.  Again HelloMD helps with that.

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I am very grateful for HelloMD. For their great organization, a smoothly developed, simple, cost effective model that is affordable and convenient for my patients who are too ill to travel or simply too uncomfortable at the thought of hanging with a waiting room crowd so far from their better healed comfort zone.

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After all, they don’t look disabled, but I see disabled kids as young as 8 through 90’s.

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Do not judge disability by how someone looks. Young disabled veterans wearing artificial legs, have been attacked for not looking disabled when they park in disability spaces.

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Bring peace and healing to all whenever you can. Learn to use the plant and to enjoy the plant too. To be able to let off the weight of the world…. that alone is healing. Nothing is working right. Well, so what? Let go. We have to let go, let peace, breathe. You know you do the best you can as always, so now do the best and let go. Bring peace.

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Cannabis is a sacred plant. Treat it with respect. Fear is ignorance. Teach the truth. 

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“Democracy dies in darkness.”

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Bring peace and healing

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The material on this site is for informational purposes only.

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It is not legal for me to provide medical advice without an examination.

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

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This site is not for email and not for appointments.

If you wish an appointment, please telephone the office to schedule.

~~~~~

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

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Please IGNORE THE ADS BELOW. They are not from me.

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Cannabis risk, death from fungal infection, demanding peer reviewed science. Not even billions can buy CBD if it is classed as Schedule I


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“IMPROVING MICROBIAL DETECTION STANDARDS FOR CANNABIS”

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The full article in O’Shaunessy’s is recommended. I’ve extracted a few parts.

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“If the government is going to tax us, in return they’ve got to provide us with needed services. And that means well-equipped analytic test labs run by disinterested technicians.” [emphasis mine]

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“Let’s make measured changes before another patient is harmed while demanding peer reviewed science is used to guide the regulatory process. In an era of fake news, science by press release with “beliefs” derived from companies that have a vested interest in seeing more cannabis safety testing should be hyper scrutinized.”

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“I think the cannabis-testing labs should be operated by the Department of Public Health, overseen by Commissioner Raber (and equally proficient chemists in every city and state) and staffed by well trained and well paid technicians whose pensions are secure.”

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The importance is that many patients who are immunosuppressed use medical marijuana, and need to use it safely because nothing else helps as well, including those who are immunosuppressed and don’t know it. For example, many do not know that diabetics are immunosuppressed. Those with autoimmune diseases, chronic renal disease, may be using medical cannabis and should demand testing be done with their taxed dollars as should we all. This has been one of the most useful herbs in history, for thousands of years, and can give balm and relief even to shattered nerves, especially now that healthcare insurers are denying to pay for pharma’s gobsmacking overnight billious costs.

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gobsmacking billious costs

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getting up to speed on legal cannabis &

 research on endocannabinoid systems

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This is a timely issue. Discuss with your doctor, get your representatives to help to legalize it nationwide. It may be the only thing that can help, or the only one that doesn’t constipate or cause erectile dysfunction or interact with other drugs. We don’t want our medication infected, even if we want to use cannabis for relaxation and pleasure. The Xanax’s and Ativan’s could be improved upon if only the right science is funded.

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“On February 7, the Daily Mail reported a cancer patient in northern California died from a fungal infection that authorities suspect was caused by the inhalation of contaminated medical cannabis.”

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snip

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“Furthermore, molecular techniques can be used to assess whether this cancer patient’s infection was actually cannabis derived. This is possible by using PCR and sequencing as performed by Remington et al. on the cannabis material and on the patient to confirm such an event.”

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“Rather than jumping to conclusions from a news story about cannabis contamination (which may in fact be the case), officials should confirm, via molecular methods, that a fatal infection occurred from the consumption of contaminated Cannabis or from another source, such as a hospital acquired infection. Once confirmed, the scientific data can help drive the appropriate regulations forward to ensure patient safety.  Unfortunately, most regulations passed to date for microbial detection do not appropriately address patient safety and often suggest the use of antiquated, inaccurate technologies.  For instance, we have peer-reviewed evidence that the currently accepted 48-hour Petrifilm-based method currently in use fails to detect some of the most harmful microbes found on cannabis. The State of Colorado has recently come to similar conclusions and has moved their Petrifilm detection times from 48 hours to 60-72 hours while referencing a paper suggesting 120 hours may be required.  And even with these adjustments to the regulations, Petrifilms will never give as accurate results as PCR.” [emphasis mine]

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“All technologies used to ensure product quality and patient safety should be peer reviewed. DNA-based methods are imperative to patient safety, as they are accepted, peer reviewed, and have been used for decades in other industries for similar purposes.”

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Kits to perform qPCR-based microbial testing on cannabis are commercially available at medicinalgenomics.com. We hold the largest sequence database of microbes found on cannabis and have kits that perform these tests in hours as opposed to days.”
[emphasis mine]

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“The technology exists to ensure safer cannabis for patients. Let’s make measured changes before another patient is harmed while demanding peer reviewed science is used to guide the regulatory process. In an era of fake news, science by press release with “beliefs” derived from companies that have a vested interest in seeing more cannabis safety testing should be hyper scrutinized. This extends to our own work at Medicinal Genomics and underscores our publication history in this space.”

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snip

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O’Shaughnessy’s retro message:

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Medicinal Genomics’s qPCR technology is undoubtedly superior and would have picked up the aspergillus that may have been fatal to the California  patient. But how widespread is the danger, really? In San Francisco in the ’90s, many thousands of AIDS patients whose immune systems were beyond “compromised” smoked untested crude herb, and I only heard of one rumored instance in which aspergillus may have been involved in a death. Donald Abrams, MD, might be able to confirm or correct my reassuring recollection.”

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“That said, of course the labs testing cannabis should employ the best available technology. The question, is who should pick up the tab?” [emphasis mine]

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“When I was working for the San Francisco District Attorney in ’01 or ’02 I called on Josh Bamberger at the city health department on Grove Street and asked if their lab would take on the testing of cannabis being sold at dispensaries. He said he didn’t have the budget or the personnel.  In the years ahead I was surprised that nobody from the movement/industry ever made the demand —not even the request— that a government agency take responsibility for testing medical cannabis. No patient advocate declared, “If the government is going to tax us, in return they’ve got to provide us with needed services. And that means well-equipped analytic test labs run by disinterested technicians.” [emphasis mine]

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“All around the world, PRIVATIZATION is the overwhelming socioeconomic trend of our time.  The Power Elite have done such a thorough job of selling off the commons and undermining the public sector that everybody now simply assumes that for-profit labs can and should take on the responsibility of protecting public health. “

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“I think the cannabis-testing labs should be operated by the Department of Public Health, overseen by Commissioner Raber (and equally proficient chemists in every city and state) and staffed by well trained and well paid technicians whose pensions are secure. And while we’re at it, how about free public education and single-payer medical care?”

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I keep getting the suspicion billions are being funneled rapidly down new rabbit holes using fear to prevent science. We must be able to do more than just prescribe  opioids for severe pain. Opioids cause inflammation which causes more pain. Cannabis is anti-inflammatory, analgesic, etc etc etc, and not allowed in hospitals, SNFs, or in facilities that seniors can only dream of retiring to when they can no longer manage at home. We need medical better choices.

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Medicinal cannabis is a healing plant with cannabinoids like ones that your body makes that helps you feel healthy and somehow influences the immune system more than any other system, while also lifting mood. Wouldn’t it be nice to know? It has 400 chemicals, not just two synthetic ones pharma makes. An exciting new cosmos in the body’s realm of more than just neuroscience. We have more cannabinoid receptors than any other kind in our body. We need to learn.
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Stop this Schedule I nonsense. Legalize cannabis. Privatize and regulate it like big alcohol, but keep it apart from big pharma, and endow strong university ties. For pete’s sake, fund the research immediately. We need it. The immune system needs it. The pain matrix needs it. Why should we allow euthanasia when we can treat pain and symptoms. Grandmothers used to know how. We are living in the dark ages with cannabinoid systems science. It is in starving infancy, Israel’s Mechoulam lab pioneering this blossoming for decades.
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Don’t forget to tell your representatives that you hear you may benefit from medical marijuana. Cannabis, marijuana, just may help, as it helped so many little children having hundreds of seizures each day, helped by just one of the cannabinoids in the plant: CBD.  It has been reported to almost completely stop the hundreds of daily seizures in possibly 50% —wouldn’t it be important to do research on it?

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CBD  has no psychoactive power. There is no high, no hallucinations. It actually blocks the psychoactive power of THC. It should be legal. The plant should be legal. It helps many medical conditions. I have posted an astonishing case months ago 100% relief with CBD. Instead it, just the other day, CBD got clearly classified as Schedule I. This must go to the courts. This insanity about a healing plant can be sanely managed, just like alcohol is managed. Without privatized prison systems that waste taxpayer dollars.

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We see new funnels of big money going down the rabbit hole. The urgency to privatize. We have a lot of people who cannot afford the American medical system, cannot afford doctors, who may get some relief even as a muscle relaxant or for sleep or anxiety.

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How can anyone respect a legal system that does not even allow research on a healing plant so important to the immune system?

 

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No amount of billions can buy CBD if it is classed as Schedule I.

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The material on this site is for informational purposes only.
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It is not legal for me to provide medical advice without an examination.
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It is not a substitute for medical advice, diagnosis or treatment provided by a qualified health care provider.
~~
This site is not for email and not for appointments.
If you wish an appointment, please telephone the office to schedule.
~~~~~
For My Home Page, click here:  Welcome to my Weblog on Pain Management!

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Please IGNORE THE ADS BELOW. They are not from me.
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Medical Marijuana – Cannabis for Pain


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These references include links to peer reviewed journal articles on cannabinoids. They are taken from the Reference Library of the outstanding RSD Association in Connecticut, whose mission is to help relieve pain. They have grouped the articles in helpful folders by subject, and this is one of many folders on the immense subject of pain. Please donate to them as their research helps everyone with pain, not just nerve pain or CRPS. May the references help enrich your lives and help support congress and regulators in legalizing cannabis across the country — the attorney general just now voted in by congress opposes medical marijuana.

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Be aware that states should monitor the plant for bacteria, fungus, pesticides, and heavy metals as discussed in this Smithsonian article:

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“Washington, the second state to legalize recreational marijuana, does require such testing for microbial agents like E. coli, salmonella and yeast mold, and officials there rejected about 13 percent of the marijuana products offered for sale in 2014.”

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Concentrates may be made with toxic butane or heptane. If you have cancer or are immunosuppressed – cancer and autoimmune diseases fall into that category – it is safer not to inhale. Cannabis can be used on the skin or swallowed but be aware when swallowed, it takes 60 to 90 minutes before you feel the effect. It is easy to overdose when swallowed. Check your blood pressure and pulse before use and again while you feel its effect.

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The article also points out that on testing, many of the plants have high THC but no longer have CBD, one of the 86 known cannabinoids, the one that blocks the psychoactive side effects of THC. On its own, CBD has many medical benefits.

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For those who have allodynia, the most intense form of nerve pain, pain that is triggered by a light touch or breath of air:

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Keep in mind that chronic pain is much harder to treat than cancer pain and acute pain. Chronic nerve pain is the hardest of all to treat. We need to be able to prescribe anything that helps. Pain can lead to suicide in these extreme pain conditions.

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Watch out for the munchies – do not get fat.

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O’Shaunessy’s today published articles that may be useful for your Senators, healthcare insurers and states:

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“some additional articles published by cannabis clinicians in O’Shaughnessy’s showing the strength of aggregated case reports. We hope the MBC Marijuana Task Force will give them serious consideration.”

 

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Cannabinoids

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Marijuana: Adverse Effects on Vascular System – Heart Attacks, Strokes, TIA’s, Peripheral Vascular Effects


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Studies were recently published on the lifesaving value of cannabis, marijuana. For many intractable conditions, it may be all that works.

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Yet cannabis, if it is mentioned at all in medical conferences, is treated like a novelty by physician lecturers who may retell its colorful history while largely ignoring its serious potential for harm as well as its remarkable potential for relief so little known to doctors in the Western world.

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Of foremost concern is the vascular system where we do not yet know the function of cannabinoid receptors. For example, in a search a few years ago, I found the youngest person who died after use of cannabis was a healthy 17 year old boy.

 

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Fortunately, this recent publication is available as a PDF:

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Adverse Cardiovascular, Cerebrovascular, and Peripheral Vascular Effects of Marijuana Inhalation: What Cardiologists Need to Know (pdf)

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by Grace Thomas, MD, Robert A. Kloner, MD, and Shereif Rezkalla, MD

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Published by the American Journal of Cardiology 2014 by cardiologists from Marshfield Clinic Wisconsin, Good Samaritan Hospital and University of Southern California in Los Angeles.

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“Marijuana is the most widely used illicit drug, with approximately 200 million users worldwide…. Temporal associations between marijuana use and serious adverse events, including myocardial infarction, sudden cardiac death, cardiomyopathy, stroke, transient ischemic attack, and cannabis arteritis have been described. In conclusion, the potential for increased use of marijuana in the changing legal landscape suggests the need for the community to intensify research regarding the safety of marijuana use and for cardiologists to maintain an awareness of the potential for adverse effects.”

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Am J Cardiol 2014;113:187e190

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More research is needed.

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We have more cannabinoid receptors in our body than any other type. The plant has 400 chemicals, of which there are 86 known cannabinoids such as THC and CBD, and there are 100 or 200 terpenes that have medicinal value. It can be inhaled (smoked or vaporized), swallowed or used topically. Mechanism of action primarily involves the immune system – one of the endogenous cannabinoids in the brain is made and reabsorbed by the microglia that is the mast cell of the brain. But we don’t have a clue what all those cannabinoid receptors are doing in bone.

 

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The material on this site is for informational purposes only.
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It is not legal for me to provide medical advice without an examination.

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

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This site is not for email and not for appointments.

If you wish an appointment, please telephone the office to schedule.

~~~~~

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

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Please ignore the ads below. They are not from me.

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Medical Marijuana – Open Letter to Jeff Sessions, Nominee for Attorney General


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My patients with serious intractable health issues would be unable to function without the use of medical marijuana. They are deeply concerned that the nominee for next Attorney General may act against legalization thus eliminating their own personal gains made using this plant for medical purposes. I have recently posted studies from Science November 4 that report significant drop in prescription medications for pain, nausea and sleep, and lives saved from opioid overdose, in states where medical marijuana has been legal.

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Many others view marijuana as important for recreational use, nontoxic and healthier than alcohol or drugs, allowing deep relaxation and joy.

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Therefore in support of an effective marijuana policy, from HelloMD is an open letter to Senator Jeff Sessions, nominated to become our next Attorney General.

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HelloMD is the leading digital healthcare platform for the cannabis industry. It is the largest community of patients using medical marijuana for health & wellness in the country.

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Dear Senator Sessions,

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Congratulations on your nomination for Attorney General. As the nations’ most senior law enforcement official, you have a big job ahead of you.

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When it comes to marijuana, the fact is that previous administrations have left you with a pickle of a problem. One that has put millions of Americans and about half the state’s laws out of sync with the policies of the federal government, and the law of the land.
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As Attorney General, you will oversee the DEA. You won’t need any assistance in destroying the medical cannabis industry if you so choose. The laws are in place and the resources lined up for you already. You simply need to unleash the DEA and they will go about arresting and charging people from California, to Oregon, to Colorado and in 25 other states. Federal law breakers all of them, and so easy to find since they are doing business openly, even paying taxes on their illegal activities. Can you believe that?
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Let’s review what some of the consequences of DEA action might be:
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  • Destroying the cannabis industry would be hugely unpopular, likely generating widespread protests across the country. 89% of Americans now support the use of cannabis for medical purposes with a small majority (54%) supporting complete legalization. Young people in particular would feel very passionate about this issue causing further disenchantment with the new Trump administration.
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  • Prosecution would drive thousands of (otherwise law abiding) business people underground, where they would once again sell on the black market.
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  • People who rely on cannabis would once again be meeting dealers in cars, in their homes and on street corners. Associated petty crime would flourish with all this new illegal activity.
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  • Millions of people with anxiety, PTSD, migraines, chronic pain, insomnia and about 18 other medical conditions would find it much harder to get the products that they have come to rely on over the past few years. There are millions with serious medical conditions, including children with epilepsy and seizure disorders, that depend on medical marijuana.
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  • Fewer people would use to cannabis get off opioids and end their opioid addiction. This is currently one of the biggest health issues in America.
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  • Tax revenue for schools, drug treatment programs, education, law enforcement, medical research and lots of other programs would dwindle.
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  • Growers would continue growing, but doing so once again out of sight. Their products would no longer be tested for pesticides or harmful chemicals putting people at risk.
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  • Thousands of businesses owners would close their doors, lay off their employees and stop paying taxes.
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  • People would still use marijuana, just as they have done for thousands of years.
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  • All of this would be hugely unpopular within the electorate, at a time when the Trump administration desperately needs to unite the country around its agenda.

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Mr. Sessions, I know that you are no fan of marijuana, but let me propose a way that you might navigate this huckleberry, while remaining true to your core beliefs as a conservative, as well as showing support for the ‘jobs first’ agenda of our new President.

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  1. State publicly, even though you don’t support the marijuana movement, that you strongly believe in the conservative principles of states’ rights and federalism, and therefore marijuana policy should be up to the states to decide. The federal government has no business involving itself in this issue.
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  2. Instruct the DEA to continue following the Cole Memo which said that the federal government should not expend its resources pursuing people that are observing state and local laws.
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  3. Recognize that more than 60 percent of Americans now live in states where voters have approved either medical marijuana, recreational marijuana, or both. Allowing states to get further out of alignment with the federal government is problematic. To solve this problem once and for all, simply instruct the DEA to remove marijuana from the list of controlled substances, where it can be regulated and taxed like alcohol or tobacco (two far more harmful substances).
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  4. Recognize that cannabis is the fastest growing industry in the US, and with $100B industry forecast by 2029, it’s a massive job creator (something every conservative should be able to get behind).

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Mr. Sessions, if you have any remaining doubts, have your people give me a call. I would be happy to connect you with tens of thousands of everyday Americans, who are finding incredible relief for their serious medical issues, by using a harmless weed that grows just about anywhere. I would also be happy to put you in touch with countless medical professionals who have advised these patients, and are equally convinced of the healing benefits of medical cannabis.

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At HelloMD, we see this first-hand every day of the week. I know things look different in Alabama, but perhaps you should pay a visit to California?

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Your Sincerely,

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Mark Hadfield

 

 

 

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The material on this site is for informational purposes only.
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It is not legal for me to provide medical advice without an examination.

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

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This site is not for email and not for appointments.

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

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Medical Marijuana Proven to Save Lives, Science Issue on Pain, November 4, 2016


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The entire issue is devoted to Pain 

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From “Pot and Pain” page 566:

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Analyzing Medicare drug prescription data from 2010 to 2015 in states where medical marijuana is legal, David and Ashley Bradford at University of Georgia in Athens found significant differences in prescription of medications for anxiety and nausea. “But one condition stood out from the rest: ‘The effect for pain was 3 to 4 times larger than all of the others.'”

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“In medical marijuana states, each physician prescribed 1826 fewer doses of conventional pain medicines each year.” The reduction in pain prescriptions is even more dramatic in the younger Medicare Group.  [presumably disabled by pain]

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Marcus Buchhuber, previously at the Veterans Affairs Medical Center in Philadelphia, examined death certificates in all 50 states between 1999 and 2010. In states that permitted marijuana, there were nearly 25% fewer deaths from opioid drug overdose.

In 2010 alone, “that translated into 1729 fewer deaths” from overdose. And the effects grew stronger in the 5 to 6 years after medical marijuana was approved.

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Further information on Marijuana here.

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The material on this site is for informational purposes only.
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It is not legal for me to provide medical advice without an examination.

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

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This site is not for email and not for appointments.

If you wish an appointment, please telephone the office to schedule.

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

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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

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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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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Cannabis: CBD may help pain when rectal suppository morphine is a problem


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Marijuana, cannabis, is overlooked for pain control

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CBD – cannabidiol — is the immune/glial suppressor

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It is anti-inflammatory in brain and spinal cord

 

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Correction 3/28/16:

It is not legal to transport CBD to states where marijuana is illegal, though it has no psychoactive properties. This is explained in detail by two doctors who wrote in drugpolicy.org, March 2015. I recommend reading the article as it makes several important points.

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The cannabis plant, and everything in it, is illegal under federal law. And even in states where it is legal, it is not legal to ship cannabis products from state to state, or to leave the state with such a product.

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A recent study from Israel showed that CBD in its natural form as a whole plant extract is superior over a single, synthetic CBD compound for treating illness. The plant has continually outperformed synthetic versions in research studies.

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…There are many support groups for children with epilepsy whose parents are using medical cannabis, such as this forum run through the Epilepsy Foundation. Connecting with them can be a great resource for staying on top of the developments with CBD and the other therapeutic cannabinoids in the cannabis plant.

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Dr. Malik Burnett is a former surgeon and physician advocate. He also served as executive director of a medical marijuana nonprofit organization. Amanda Reiman, PhD, holds a doctorate in Social Welfare and teaches classes on drug policy at the University of California-Berkeley.

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Cannabis has been used for thousands of years. It has been in the U.S. pharmacopoeia since 1850. A medical textbook from the 1920’s lists medical uses for cannabis. A Mexican American grandfather on hospice in 1995, explained how cannabis had helped his arthritic joints decades before.

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When alcohol prohibition failed and was repealed in 1933, Harry J. Anslinger, head of the Federal Bureau of Narcotics from 1930 to 1962, created the word marihuana claiming it led to addiction, violence, overdosage. Anslinger used racist propaganda to instill fear in Americans that only Mexicans and Negros use cannabis which led to creation of the Marijuana Tax Act passed by congress in 1937. Not unlike the CDC Opioid Guideliness of March 2016, it was passed over the objections of the AMA.

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The American Medical Association (AMA) opposed the act because the tax was imposed on physicians prescribing cannabis, retail pharmacists selling cannabis, and medical cannabis cultivation/manufacturing. The AMA proposed that cannabis instead be added to the Harrison Narcotics Tax Act. The bill was passed over the last-minute objections of the American Medical Association. Dr. William Creighton Woodward, legislative counsel for the AMA objected to the bill on the grounds that the bill had been prepared in secret without giving proper time to prepare their opposition to the bill. He doubted their claims about marijuana addiction, violence, and overdosage; he further asserted that because the word Marijuana was largely unknown at the time, the medical profession did not realize they were losing cannabis. “Marijuana is not the correct term… Yet the burden of this bill is placed heavily on the doctors and pharmacists of this country.”

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Israel’s Professor Rafael Mechoulam is widely recognized for his work on cannabis over more than 40 years. He and his lab isolated and identified THC, CBD, cannabinoid receptors, endogenous cannabinoids – your brain makes two of them! Your body has more cannabinoid receptors than any other type. It was he who published 40 years ago that CBD controls certain types of epilepsy in children – and it was ignored until Dr. Sanjay Gupta publicized this in the last one or two years.

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Professor Mechoulam says CBD from the plant (the plant is illegal in the United States) outperforms synthetic CBD.

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However, standards for CBD products do not exist, assays may be unreliable, it may be extracted with harsh chemicals that are harmful to those who are ill, and FDA has warned against false claims of efficacy. 

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Nevertheless, there are indications CBD may help pain. It has no psychoactive properties. It does not cause intoxication. There is no THC in it.

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CBD, Cannabidiol, is one of the 86 known cannabinoids in the cannabis plant that has 400 chemicals. In addition, the plant has perhaps 100 or 200 unique terpenes, also said to help symptoms. 

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Topical CBD may help – keep that in mind when Blue Shield’s formulary offers only rectal suppository morphine (unless you wait days and hope they will approve a prior authorization).

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I received a note today about Colorado Hemp Farmers:

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a woman in her sixties suffering from sciatica who is having her nurse rub her back with a coconut oil extract of a specific strain of industrial hemp rich in CBD, but without significant THC. She reports that the pain alleviation is remarkable with the soothing extract, which she judged to be superior to when commercially available CBD oil was used. 

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Have any readers have tried CBD for pain?

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Your feedback would help to inform researchers to add an additional arm to the tests now being done in rats.

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I have heard from one man with severe pain today. He uses CBD in many forms. It helps pain a little, and also it is calming. He describes it like you know pain is better after you take ibuprofen. Similar with CBD. He does not feel at all drugged.

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This site is not for email.

If any questions, please schedule an appointment with my office.

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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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Rectal Suppository Morphine, part 3 – cannabis


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Let’s all now avoid the topic of cannabis.

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How am I and other physicians, without research, supposed to help someone with insomnia caused by pain that takes the blood pressure to 220/110, with intense nausea.

That kind of pain.

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CDC suggests Tylenol and aspirin. That’s it folks.

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There is only one politician discussing cannabis.

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And please, don’t force researchers to use that stale dry brown stuff that NIDA sends to researchers.

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If any questions, please schedule an appointment with my office.

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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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Vitamins and Herbs – Risks and Benefits


Most doctors have little if any training in vitamins and supplements

except as they relate to their specialty.

My field of neurology concerns itself with metabolic and nutritional diseases more than most areas of expertise, and I have an interest in several vitamins because of research related to major causes of mortality in the United States.

During the period I taught at a cancer center, I was concerned that research protocols may be misleading as these supplements were not accounted for, however since that time in the mid 90’s, I’m glad that public interest has pushed this field into the fore.  Major cancer centers now have active research in Complementary and Integrative Medicine (CAM) because there are risks and benefits, and some have significant herb-drug interactions as discussed below.

Check your vitamins and supplements for toxicity

Because of the growing science on toxicity, usefulness, and drug interactions, if you use vitamins, review each one carefully with your physician and with the websites listed in the column on your right. Some “vitamins” are simply brand names that have over 20 different vitamins, minerals and various ingredients.  This means you must review each one for current research benefits and risks.

At special risk for vitamin deficiencies are those who have highly restricted diets, abdominal resection, intestinal conditions, colitis, Celiac Disease, gastric bypass, HIV, or the elderly.

Pregnant women have special needs that are essential not only for their own health but to reduce the risk of neurological defects in the fetus.  It is essential in their case to work closely with their obstetrician, especially if morning sickness prevents them from taking their daily supplement.

Resources

One of the best resources I have found is Memorial Sloan Kettering Cancer Center’s Herbs and Botanicals, also linked on the column at right.  Their website is updated frequently with an excellent review of the literature.  It is hosted by a senior physician who has specialized in the field for decades and is actively involved in research at their center as well as NIH.

MD Anderson Cancer Center’s Complementary/Integrative Medicine Education Resources website andColumbia University’s Rosenthal Center for Complementary and Alternative Medicine are two others, but there are other resources on the web and books that are excellent.

Recipe for Rum Soaked Salmon with Apple Ginger Puree is found here.

VITAMINS & SUPPLEMENTS

Vitamin D has become a major research topic in recent years.  It may play a more important role than any listed below.   I have written separately on it and its controversy in greater detail.  Please refer to the last post by scrolling down.

Fish Oil

Omega 3 Fish Oils are polyunsaturated fatty acids that are essential for health yet cannot be made by the body.  Unless you eat several servings per week of fatty fish or wild salmon, not farmed salmon, it is one of the most important supplements that any adult of any age can take.  They are needed for building cell membranes in the brain but our body does not make them.   Fish oil helps your lipid profile by reducing triglycerides as much as 45%.  It reduces platelet clotting, lowers risk of heart attack and cardiac arrhythmia, and is an important anti-inflammatory reducing pain for many particularly those with arthritis.  One of thebest references on Omega 3 Fatty Acids is by  Dr. Frank Sacks, Professor of Cardiovascular Disease Prevention, Department of Nutrition, Harvard School of Public Health.   He mentions high doses “are used to treat depression. New studies are identifying potential benefits for a wide range of conditions including cancer, inflammatory bowel disease, and other autoimmune diseases such as lupus and rheumatoid arthritis.”

One high quality fish oil, Lovaza, has been approved by the FDA and is prescription only.  Fish oil and cod liver oil available over the counter should be checked for adequate dosages of EPA and DHA that will vary with your needs as determined by your lipid profile, and should be purified to remove cholesterol, dioxin, PCB’s and other pesticides.

Co-Enzyme Q10 is also called CoQ10.  CoQ10 is present in every cell of the body which is why it is also called ubiquinone.  It is important in the electron transport chain to produce intracellular energy.

Statins deplete CoQ10. Vitaline’s CoQ10 product has been used in NIH funded trials for cardiovascular, neurological and brain disorders. Two mitochondrial disorders have been shown to benefit from Co-Q10: migraine and Parkinsons Disease.

My preferred manufacturer is Vitaline because of their research with NIH which requires that they validate and verify dosages.  Their website discusses other advantages and gives guidance on dosages that have shown benefit for various conditions. They offer a discount of 25% if you request scheduled delivery every 3 months.  Use the code code DEF25.  Their product is in the form of wafers that are about the size of a quarter and are very easy to break into 2 or 4 with your hands.

Vitamin B supplements in the elderly may help reduce the risk of dementia and B12 deficiency may result in neurological conditions such as peripheral neuropathy, dementia, hematologic and psychiatric disorders, Subacute Combined Degeneration of spinal cord & brain, increased fracture risk, and may increase the risk of cardiovascular diseases.  A good B complex vitamin is not likely to harm and may benefit.    The best source of all is food:  leafy green vegetables, beans and peas.

Thiamine (Vitamin B1) in high doses of 300 mg per day may reduce kidney disease in type 2 diabetes and may prevent early diabetic cardiomyopathy (heart disease).  As many as 70% to 90% of people with diabetes, both type 1 and type 2, are thiamine deficient.  The research is still a little early to draw firm conclusions.  It is being done by Charity Diabetes UK which finds that thiamine works by helping protect cells against the harmful effects of the high blood sugar levels.”

Vitamin A is associated with a 45% risk of hip fracture.  There are four major adverse effects of high levels: birth defects, liver abnormalities, reduced bone mineral density that may result in osteoporosis, and central nervous system disorders.

Vitamin E may actually increase mortality and there are significant risks to its use including increased risk of some cancers.  Several studies were reviewed by one of the foremost science writers, Jane Brody, in the New York Times on March 23, 2009.  It does not reduce the risk of cardiovascular disease, stroke, dementia, mild cognitive impairment, and there is no evidence that it slows the progression of macular degeneration.  In thePhysicians’ Health Study II it has been shown to actually increase the risk of hemorrhagic stroke since it decreases the clotting tendency of blood.

Vitamin C was recently shown to markedly increase the growth of cancers. It’s healthy for them too.  It blunts the effect of cancer drugs by as much as 30 to 70% depending upon the drug tested.

Zinc may prevent the absorption of copper which is necessary for the brain and spinal cord thus resulting in progressive neurological conditions.  Herb-drug interaction reduces the bioavailability of some antibiotics, tetracycline and fluoroquinolones.  Intake of 100-300 mg/day may result in chronic toxicity including copper deficiency, depressed immune function, headache, chills, fever, and fatigue.  It concentrates in the prostate and consumption of more than 100 mg per day may increase risk of prostate cancer.

It may be useful for tinnitus and for short term use to reduce symptoms of the common cold when used topically or in lozenges

HERBS & BOTANICALS

Don’t forget seeds, beans and whole grains that help digestion and keep the system moving!

This is a very brief summary of a few of the more commonly used herbs.  Please refer to Memorial Sloan Kettering Herbs and Botanicals website for detailed information on risks and benefits.

Arnica – a topical anti-inflammatory may help sprains and osteoarthritis.

Aloe Vera – apply immediately after sunburn or burning the skin to prevent blister formation

Chamomile – calming sedative, may use for intestinal colic or gas

Cat’s Claw – anti-inflammatory activity may be caused by the inhibition of TNF-alpha production.  It may be useful for refractory oral ulcers of unknown etiology in persons with HIV/AIDS that have not responded to other known remedies.

Echinacea may shorten the duration of common cold, useful in sinusitis, and respiratory infections.  Because of the lack of standardization of various products, I recommend a high quality organic liquid product by HerbPharm. Avoid use in autoimmune conditions, Multiple Sclerosis, HIV/AIDS.  “Echinacea was shown to stimulate phagocytosis, enhance mobility of leukocytes, stimulate TNF and interleukin 1 secretion from macrophages and lymphocytes, and improve respiratory activity… both in vitro and in vivo.”

Goldenseal is anti-inflammatory, antimicrobial with activity against pathogens such enterotoxigenic E. coli and V. cholera that may be useful for bacterial sinusitis and respiratory infections.   Warning it may prolong the QTc interval in persons with heart disease or those on methadone and it is contraindicated in persons with hypertension.  A high quality organic liquid product is made by HerbPharm.

Medicinal Marijuana is a vast subject. I would be happy to schedule time to discuss its medical use with you. Refer here for some of the known research and patient information.

Red Yeast Rice, a naturally occurring statin, the same as Lovastatin, often used in China.   Make sure your doctor knows this and monitors liver function.  Statins may cause severe muscle and joint pain that may potentially lead to rhabdomyolysis (sudden death of muscles), kidney failure, vasculitis, lupus-like syndrome, and many other symptoms, however most people tolerate them without side effects and they have dramatically reduced the incidence of heart attacks and stroke.  They may also reduce the risk of dementia including Alzheimer’s type dementia.

Turmuric (Curcumin) – may alleviate irritable bowel syndrome and ulcerative colitis.  There is a suggestion of improved cognitive performance from epidemiology studies but studies show no benefit for Alzheimer’s Disease.  Avoid use if you have gallstones.  It may inhibit the action of some chemotherapy drugs, such as used for breast cancer, but may be beneficial for certain cancers and other chemotherapy drugs.

Wheat grass– a natural source of vitamins and minerals (Chlorophyll, Vitamins A, C, E, K and B-complex, Iron, Calcium, Magnesium,  Selenium,  Amino acids); may have antioxidant effects.

Willow Bark – contains salicin, the precursor of aspirin.

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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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