CBD efficacy on nonmotor symptoms of Parkinson Disease anxiety & psychosis

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This is the last section of a review article Managing Psychosis in Parkinson Disease

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Results from preclinical and preliminary studies also suggest that cannabidiol (CBD) has therapeutic potential for nonmotor symptoms of PD.¹⁴ The multifaceted mechanism of action as an agonist of 5-HT1A, partial agonist of CB1 and CB2 receptors, and antagonist of the G-protein–coupled receptor GPR55 reverses the iron-induced epigenetic modification of mitochondrial DNA and the reduction of succinate dehydrogenase activity and decreases the levels of the pro-inflammatory cytokines IL-1β, TNF-α, IFN-β, IFN-γ, IL-17, and IL-6—all of which decrease pro-inflammatory mediators resulting in neuroprotective, anxiolytic, and antipsychotic effects.¹⁴

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“Several in vitro experiments have demonstrated promising neuro- protective effects of CBD in PD models. In one of these models, using PC12 and SH-SY5Y cells treated with MPP+ [1-methyl-4-phenylpyridinium], CBD increased cell viability, differentiation, and the expression of axonal [GAP-43] and synaptic [synaptophysin and synapsin I] proteins,” Ferreria-Junior and colleagues wrote,¹⁵ while acknowledging the paucity of studies that have addressed the biological bases for the purported effects of CBD on PD. “Double-blind, placebo-controlled, randomized trials with larger samples of patients with PD are needed to elucidate the possible effectiveness and mechanisms involved in the therapeutic potential of CBD in this movement disorder. This will also include the putative effects of CBD in preventing L-dopa–induced severe [adverse] effects and preventing PD progression.”

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The endocannabinoid system serves as an important filter of excitatory, inhibitory, and modulatory inputs that act at the midbrain and terminal regions to orchestrate DA neurotransmission by controlling DA cell body firing patterns, terminal release, and effects on postsynaptic sites in the striatum.¹⁶ Beneficial effects of CBD administration have been observed prior to or immediately after induction of PD-like symptoms in animal studies, which may suggest a preventive role rather than a therapeutic one.¹⁴ In an early open-label pilot study to evaluate the efficacy of CBD on nonmotor symptoms of PD in 6 patients with PDP, psychotic symptoms significantly decreased under CBD treatment, as evaluated by the brief psychiatric rating scale and the Parkinson psychosis questionnaire.¹⁷

 

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Psychiatric comorbidities prevalent in the majority of patients with PD are associated with more disease severity, impaired QOL, and increased use of healthcare resources, with longer hospital stays and re-hospitalizations adding to the total cost burden.

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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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For My Home Page, click here:  

Welcome to my Weblog on Pain Management!

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CBD Anti-inflammatory, does not make you “high”

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CBD from CV SCIENCES Las Vegas, NV, is top rated by Consumer Labs. They sell CBD spray, oil, capsules, and softgels. The soft gels contain 5mg of hemp-derived CBDA/CBD oil per serving that includes terpenes, phytocannabinoids, fatty acids. Capsules contain 10 or 15 mg CBD are “made using our Total Plant Complex” that includes terpenes, phytocannabinoids, plant sterols, fatty acids.

One patient says the softgel is small, easy to swallow. “PlusCBD Oil Raw Softgels offer the fullest spectrum of naturally occurring hemp co-factors and contain 5mg of hemp-derived CBDA/CBD oil per serving.” [6.2 mg consumers labs say, tho bottle says 10 mg]

CWHemp in Boulder, CO, sells CBD oil and capsules. One patient who had 3 different pain conditions, each one disabling, severe, found it far better than CBD tried in 3 different states.

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One patient, A, has several conditions responding to CBD, discussed below.

TINNITUS:

She has suffered many years of tinnitus.

Soon after starting CBD, the tinnitus is now down to where she is just barely able to hear it. “It was driving me crazy: clicking, grinding, hissing, whiny, scraping like pieces of sandpaper being scraped together. I thought I’m going to go crazy. Now I can barely hear a hiss at all on left, and on the right very very low hardly discernible hiss. It’s like a miracle.”  Taking 1 twice daily, maybe have been taking them for 2 weeks, it’s amazing to me.”

Pains are 80% better:

Stiffness in hands, osteoarthritis arthritis pain in knuckles

 
70% relief left shoulder had been barely able to pick up the shoulder due to bone on bone osteoarthritis. Not frozen shoulder but the pain mimicked frozen shoulder, pseudo-frozen. Markedly better.

Anxiety:

Lifelong anxiety disorder has been helped to a degree, allowed drop in Xanax down to 3.0 mg/day from 3.5 mg total daily dose of Xanax she was taking since 1990. And dropped dose within the first week on 12 mg CBD dose, able to leave out the 2 pm Xanax. 

Had been using 2  of the 12 mg capsules from Leafly initially.

Vertigo due to BPPV, very severe:

25% improved, can roll over in bed now without feeling like flying off the bed. Helped balance related to the vertigo. The tinnitus had made the vertigo worse, so lessening of tinnitus has lessened the vertigo. Helped the balance, not a lot, but since vertigo is diminished, balance is better. 

“THC gives me more trouble than the CBD because I know I am not going to have a paranoid attack on CBD.  I’ve now lost my desire to smoke marijuana for relief. There is no change yet in depression, but during SAD [Seasonal Affective Disorder] and weeks of grey weather, I can’t tell.”

BAM, the devastating bile acid malabsorption:

No change yet. I have been manipulating diet to get results I need, now fairly good control by taking more water. Not having the horrible bile burn in lower abdomen, none in days. I’m not sure why yet. Water intake, I can’t even tell because I’m so sporadic. If I could get into me minimum 4 full glasses a day, I probably could control the constipation part. I’d rather deal with that than the diarrhea which is debilitating.” 

Ear Pressure:

JG no longer needs to be taking ibuprofen to treat PRESSURE in ear. It felt like the tubes were full of fluid and that pressure from the tubes was having a vacuum type effect on the eardrum itself.  He’s been to every ENT at Rush Memorial, next will see ENT at Loyola. It was distracting and uncomfortable, made him miserable, frustrated and did not want to take the medication because he was concerned about NSAID adverse effect on the heart. Was taking Ibuprofen every few hours, now no longer needed. This pressure has been disabling for years.

 
He is taking CBD 12mg/day, now will start taking 18-19 mg.
This is profound. 

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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.

~~~~~

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, 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 Effects, Medical, 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.

~~~~~

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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Soothamide (PEA) Cream Helps Psoriasis & Seborrheic Dermatitis

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I have posted on PEA (palmitoylethanolamide) for several years on this site – use the search function top left above photo and type in PEA. No prescription is needed. Before it was available in the US, patients ordered it from the Netherlands where it is sold as PeaPure. One whose neuropathic pain was finally relieved by it, ran out, flew to the Netherlands just to pick up an emergency supply and flew back immediately. Thankfully Vitalitus began offering PEA capsules in the US a few years ago, and then made the 2% cream called Soothamide, which I have also posted on this site. It may even relieve the neuropathic pain of Complex Regional Pain  Syndrome (CRPS).

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Palmitoylethanolamide (PEA, or PeaPure in Netherlands) is nontoxic, anti-inflammatory, analgesic, and has no side effects. Your body makes it; plants make it. Years ago the publications on it were extensive. A Nobel Prize winner published on it in the early 90’s. When taken in capsule form for CRPS, I have seen it take 6 or 8 weeks to be effective, but when it relieved pain, it lowered pain from very severe to mild in a patient bedridden for 6 years. I have seen the cream relieve neuropathic pain instantly in a couple minutes in some with CRPS. I have seen the cream fail to relieve CRPS pain in one patient, who then wiped the remainder of the cream along the lumbar spine of her dad who had been groaning with pain, who had instant relief. And I have published on its use for vulvodynia, discussing its autocoid mechanism.

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Skin conditions can be their own constant day and night torment. A patient reports almost complete immediate relief from the itch of psoriasis and seborrhea (around eyes and all over scalp). Itch can be a form of neuropathic pain besides more common causes such as allergy. The rash, the bleeding crusted itchy skin of those two conditions is treated by prescription steroid creams that can thin the skin, and thin skin itself can predispose to bleeding, further discomfort, and frankly did not help this patient. If you use steroid creams, it must be applied 3 or 4 times a day and use gloves or caution where you rub your fingers — risk thinning the delicate skin near eyes and nether regions as weeks and weeks drag on. Soothamide worked quickly, not needing 3 or 4 applications per day.

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Instantly the itch was markedly better. And overnight! the rash was markedly improved. The patient had had some mild relief from the bleeding itchy scabs on scalp with T/Sal shampoo but not great, for weeks and weeks. Before that, DHS Zinc shampoo helped only mild “dandruff”, did not touch the crusts and itch. Aloe Vera helped the itch for a few hours. Steroid creams were no help for itch, for 4 months scratching the delicate skin around eyes with hard scratchy cloth almost like a dry loofah sponge. Soothamide 2% took away the itch around eyes immediately though it can easily get into eyes when washed or when rubbing the eyes, it does not burn. It is truly very soothing.

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It’s also a remarkable moisturizer, absorbs very quickly, is not greasy, and for those whose other skin conditions are unusually thickened, it would likely be worth a try.

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I see Vitalitus now also sells CBD, that is cannabidiol, the cannabinoid from the marijuana plant that has no psychotomimetic properties – does not make you “high”. GW Pharmaceuticals’s “Epidiolex”, their CBD, recently received FDA approved for epilepsy. Imagine! a Schedule I drug received FDA approval! hmmm, must not be deadly after all. Wait til the DEA kills that idea. Does congress make sense when they dictate medicine?

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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.

~~~~~

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 has announced its pricing stategy for Epidiolex, the CBD extract recently approved by FDA. In a Wall St. Journal interview, GW’s Justin Gover emphasized that the cost will be similar to other anti-epileptic drugs such as Onfi —$32,500/year. An officer of the Epilepsy Society expresses gratitude that GW didn’t set a much higher price.

Here’s Dale Gieringer’s back-of-the-envelope comparison of Epidiolex and a homegrown equivalent:

At $32,500 per year, Epidiolex, the new FDA-approved CBD drug, is a costly medication.  The standard dosage of Epidiolex is from 5 to 25 mg of CBD per kg bodyweight per day, which works out to 250 – 1,250 mg of CBD per day for a 100-pound patient (on the heavy side for pediatric cases).   Using high-potency flowers of 15% CBD, this works out to 1.67 to 8.33 grams of cannabis per day, or 1.2 – 6 pounds of cannabis per year.    At a price of $150/ounce, an equivalent amount of 15% CBD cannabis flowers would cost $2880 – $14,400 per year.   Another example of the high cost of FDA-regulated medication.   – D.G.

Here’s Peter Loftus in the August 8 Wall St. Journal:

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.

“We wanted to make sure we were pricing Epidiolex in such a way where the means to access this medication would be consistent with branded epilepsy drugs these patients already use,” he said.

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.

~~

Comments are welcome.

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

~~~~~

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 That Can Stop the Munchies? What is THCV?

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MEDICAL MARIJUANA

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Cannabis is legal in California for adult use as of January 1, 2018. This may be helpful to someone you know. It is a most important drug. Below you can find a few pointers that are basic to understanding what strains to try. Distributors are swamped with ten times as many buyers as last week, prices are doubled, taxes are very high, it is very expensive and you will need to test many strains before you find what works for you without making you stupid with euphoria that lasts 12 hours. Do be warned of turning the body into sofa-size obesity overnight. Munchies occur with high THC strains. To discuss below how to avoid that torture and still relieve pain or muscle spasm.

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Horvath et al at Yale in 2015 found cannabis stimulates hunger and arousal in hypothalamic neurons. Here’s the YaleNews on the multi-authored work.

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Horvath is the Jean and David W. Wallace Professor of Neurobiology and of Obstetrics, Gynecology, and Reproductive Sciences, director of the Yale Program in Cell Signaling and Neurobiology of Metabolism, and chair of the Section of Comparative Medicine.

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To orient you in the quote below, cannabinoid receptor 1 (CB₁R) is one of the two known cannabinoid receptors in the brain. Others are located outside brain, throughout the body.

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“The Pomc gene encodes both the anorexigenic peptide α-melanocyte-stimulating hormone, and the opioid peptide β-endorphin. Hypothalamic pro-opiomelanocortin (POMC) neurons promote satiety. Cannabinoid receptor 1 (CB₁R) is critical for the central regulation of food intake. CB₁R activation selectively increases β-endorphin but not α-melanocyte-stimulating hormone release in the hypothalamus, and systemic or hypothalamic administration of the opioid receptor antagonist naloxone blocks acute CB₁R-induced feeding.

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Interesting. Low dose naltrexone, which is essentially long acting naloxone, may block munchies in humans? At what dose? Please comment if you take naltrexone 4.5 mg or 15 mg (anti-inflammatory doses) or 28 mg (weight loss dose) or 50 mg and above doses of naltrexone (high doses for addiction).

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One strain that is better at stopping or reducing the munchies, and that is believed due to a cannabinoid in the strain called THCV. You can always do a search for THCV.

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Cannabis is one of the few medications that can relieve some of the worst side effects of opioid withdrawal. Many patients find they need to use fewer opioid pills for pain or can stop them altogether; they need to use fewer muscle relaxants; and they can eat or sleep better if they use cannabis. Once cannabis became legal, many alcoholics were able to give up alcohol because their first preference is cannabis.

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Get a low cost recommendation for medical marijuana in minutes at home from your mobile phone. The best source for recommendation is : HelloMD.

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Cannabis may be legal in all states once tobacco companies toss some money at Congress. Could cannabis be related to the vow of Phillip Morris and a wave of big tobacco companies to stop selling cigarettes this year?

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It is dreadfully expensive and heavily taxed. All states should adopt New Mexico’s law that allows healthcare insurers to reimburse patients who have paid for medicinal cannabis. Voters…

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Cannabis is made by the body and the brain makes two of the endogenous cannabinoids. If is highly anti-inflammatory, and profoundly important mainly in the immune system but also in bone turnover. You have more cannabinoid receptors in your body than any other kind. It is as old as sponges, an ancient medicine.

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A WORTHY READ

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Mr. X – by Carl Sagan who describes his experience with marijuana at length and used it creatively for decades opening his brain to experiences he was otherwise not oriented to at all.

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MUNCHIES

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Fear the munchies. Cannabis, medical marijuana, can cause the munchies, an overwhelming desire to eat nonstop, usually all the most high calorie things your desperately fevered brain can dream of cramming in.

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Certain strains of cannabis can be life saving for those who have loss of appetite from conditions such as cancer, HIV/AIDS, depression, inflammatory conditions, etc. But the munchies can be disastrous when you cannot afford to gain weight due to pain or disability or simply wish to develop an important standard to maintain best health which means good lean body weight. The best way to reduce inflammation is to avoid obesity, avoid sugar, avoid diabetes, heart attacks, strokes. Remember inflammation is the root cause of 90% of the conditions we die of: diabetes, cancers, Alzheimer’s, Parkinson’s, autoimmune disease, atherosclerosis, etc.

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Those with an eating disorder should scrupulously avoid those strains that are highly rated for helping anorexia, loss of appetite.

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CHOOSE STRAINS THAT STOP THE MUNCHIES

STRAINS WITH HIGH THCV  OR HIGH CBD 

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If needing high THC for pain or appetite, for example, then a strain with high THC and high THCV is Durban Poison. Read in detail about strains on leafy.com using the search function and it will find dispensaries in your area.

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If low THC is all you need, then Leafly discusses high CBD strains with low THC currently available. Google it or ask the dispensary.

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I am not going to do more than mention these three cannabinoids: THC, CBD, THCV. You can google them but do glance at my outdated 2009 cannabis website – CBD has vastly changed since then, available even at farmer’s markets and nutrition departments of groceries.

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The cannabis plant has 400 chemicals of which about 86 are known cannabinoids but we focus on just a few and hybrids have been bred to display many qualities and various percentages of cannabinoids.

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THC

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THC, tetrahydrocannabinol, can cause euphoria and is the principal psychoactive ingredient useful for pain, depression, appetite, multiple sclerosis, fatigue, stress, and many conditions including just to have fun, be giggly or creative. For the California Medical Board, a strain with 18% THC is considered high, but some strains such as Holy Grail have 27% or more THC. Some strains are noted for causing more anxiety or paranoia due to THC content. It is widely said THC is necessary for pain relief but… see CBD below.

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CBD

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CBD, cannabidiol, a non-psychoactive cannabidiol that blocks the psychoactive component of THC so that you may be able to mix with THC in order to use a stronger dose of THC for the underlying condition —  find your best ratio of CBD to THC. Or use 100% CBD. Among strains of flower sold at dispensary, I’m not sure what % CBD

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Some people are highly sensitive to THC (paranoia, panic attacks, anxiety) and cannot use any THC or only very tiny amounts of THC with higher percentage CBD.

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Some use pure 100% CBD which is said to be useful for Crohn’s Disease, PTSD, multiple sclerosis and certain seizure disorders, the severe childhood Dravet Syndrome. There is a recent single report of an adult who failed all anticonvulsants and responded to CBD alone. I have seen a patient with depression after 2 years of severe disability from 4 major chronic pain conditions, surprisingly all pain 100% relieved by CBD. It is widely said that THC is essential for pain relief but for this case not needed.

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Some dispensaries will mix liquid CBD:THC in ratios of 15mg/mL CBD to 0.1 mg/mL CBD all the way up to ratio of 15:15 or more. Use topically, under tongue or swallow. One patient dilutes and uses topically. Very expensive!!! It is the only thing helping his extremely painful autoimmune neuropathy.

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THCV

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Leafly discusses ten strains that will not make you (as) hungry. 

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After discussing high CBD strains, then turn to high THCV:

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High THCV Sativa Strains

“By now you know what THC and CBD is, but you may not be familiar with the less ubiquitous THCV, a related chemical that suppresses appetite. While most strains on the market today tend to test anywhere between 10-20% THC, what’s considered a high THCV content might only hit a high-water mark of 5%. THCV tends to be more abundant in sativa strains, and it’s possible you’ve noticed that sativas tend to provoke hunger less than indica strains. The unique metabolic effects of THCV even have researchers considering its utility in treating obesity and diabetes.”

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Durban Poison is the name of the strain with highest THC and THCV, and a good profile detailed on Leafly: Maximal effect is Energetic > happy > uplifted >> focused >> euphoric. Not everyone may have all these effects.

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Always check Leafly’s negatives for each strain and look at the bar graphs — how severe are the side effects? Note that always worst is dry mouth. Half as bad are dry eyes for this strain – at least not as bad as dry mouth; and much lower in incidence is dizzy, anxious, paranoid. Overall a very good profile for a high THC strain.

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RISKS

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Note, those with Sjogren’s Syndrome who have dry eyes are at risk for corneal transplants and who have dry mouth are at risk for all teeth crumbling, so choose and treat accordingly.

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Cannabis can increase pulse and blood pressure which can be a risk of heart attack and stroke for any age. It is especially likely if you are naive to the drug, i.e. have never used it or have not introduced it to your system for decades. Check blood pressure and pulse before use and after you feel the peak effect.

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The youngest person I found on the internet who died of heart attack caused by cannabis was a healthy 17 year old male, possibly a false report, but cardiac arrhythmias can be fatal and there are undiagnosed cardiac conditions in young athletes who may be likely to use cannabis.

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Cannabis can interfere with memory.

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The adolescent developing brain may be vulnerable to harmful effects.

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HOW TO USE IT

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Vaporize it. Avoid 4 toxins. Rapid onset, short duration of effect.

If smoking, you will inhale 4 major toxins.

Use under tongue or topically on skin.

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If you swallow cannabis, you will not feel effect for 90 to 120 minutes so allow 2 hours before you add more or you may seriously overdose. Duration of effect may be 4 to 12 hours or more – overdosing can last days.

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5 mg oral THC may be too much for a starter dose for some people, but may be average for many, and some may need 10 mg. But heavy users need far, far more: TOLERANCE DEVELOPS!!! Money down the drain. Use only as much as you need or you will develop tolerance and require more frequent and higher and higher doses to reach same effect. That can be unaffordable for the average middle class person. 

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And yes, it may appear in urine for 30 to 60 days, possibly more.

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Cannabis is still a schedule I drug. The Emperor has no clothes. Do not take it onto planes or attempt to mail it.

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Do read more about it on my cannabis website linked above. It is a drug. You will benefit from learning how to use it.

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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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Best wishes to all!

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Please ignore the Advertising – has nothing to do with me.

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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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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CBDiary: How 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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Retinitis Pigmentosa progression may be slowed by cannabis

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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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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.

~~~~~

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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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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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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