palmspringsbum

by **palmspringsbum** » Sat Jul 01, 2006 1:20 pm

Chronogram wrote:Your Inner Cannabis

Marijuana as Medicine Through The Endocannabinoid System

Chronogram
By Lorrie Klosterman
July 2006

Marijuana-like chemicls are part of our physiology; usurping their cellular pathways for medical research and treatment is decades old.

<table class=posttable align=right width=300><tr><td class=postcell><img class=postimg width=300 src=bin/chronogram.bmp></td></tr></table>In the early 1980s, Steven J. Gould, Professor of Zoology at Harvard and curator of its Museum of Comparative Zoology, explained publicly how smoking marijuana was the only thing that made his cancer chemotherapy tolerable. Gould was one of last century's landmark thinkers in evolutionary biology and paleontology. He penned hundreds of essays for the layperson in Natural History magazine, and collected his entertaining musings in The Panda's Thumb, Ever Since Darwin, The Mismeasure of Man, and many other books.

Gould's revelation impressed me, partly because he was admitting to a federal crime, but mostly because one wouldn't mess with a cerebrum like his lightly. Indeed, it is said he shunned drugs, including alcohol, for that reason. Gould won his cancer battle back then, which bought him two more decades; he succumbed to another onslaught in 2002.

Thousands of people have used marijuana to alleviate symptoms of grave illnesses or to quell side effects of treatments, inspiring several panels of medical experts over the years to scrutinize existing clinical trials and testimony of patients and doctors to discern any promise for marijuana or its components as medicine. In 1999, the Institute of Medicine, a part of the revered US National Academy of Sciences, explained its findings in a 250-page document (an exceptionally educational read for lay people about many aspects of health and medicine). The report concluded that marijuana and its most-studied component, THC, were moderately effective for some conditions and in some patients—enough so that more studies were warranted. Further, the suite of drug effects offered multiple benefits that existing drugs did not.

Also in the late 1990s were reports from the American Medical Association, British Medical Association, US National Institutes of Health, World Health Organization, and the British House of Lords Science and Technology Committee; all echoed the Institute's conclusions, noted a dearth of studies, and encouraged more.

But earlier this year, the FDA reiterated its position in response to discussions in Congress about medical marijuana. An April 20 interagency advisory and press release cited a "past evaluation by several Department of Health and Human Services agencies" (including the FDA, Substance Abuse and Mental Health Services Administration, and National Institute for Drug Abuse), which concluded that "no sound scientific studies supported medical use of marijuana for treatment in the United States, and no animal or human data supported the safety or efficacy of marijuana for general medical use." The statement is the second of two recent federal-level punches to the notion of legalization of marijuana for medical use. The first was a 2005 decision by the Supreme Court that marijuana use for any purpose would remain a federal crime, including in those eleven states that allow medical exemptions.

The Institute of Medicine agrees that "there is little future in smoked marijuana as a medically approved medication [emphasis added]," faulting it as "a crude THC delivery system that also delivers harmful substances," meaning the abundant toxins and carcinogens in marijuana smoke. But it clarifies: "The argument against the future of smoked marijuana for treating any condition is not that there is no reason to predict efficacy but that there is risk. That risk could be overcome by the development of a nonsmoked rapid-onset delivery system for cannabinoid drugs." Specifically, an inhaler would be a good idea. Since that could be years and hundreds of millions of research dollars away with our drug approval system, says the report, "there is no clear alternative for people suffering from chronic conditions that might be relieved by smoking marijuana, such as pain or AIDS wasting."

Meet Your Endocannabinoids

There is ample evidence that marijuana and THC (delta-9-tetrahydrocannabinol) influence the body in ways that, for some patients, nothing else can. But how? Does it offer a mellow resignation, perhaps a lethargy that makes it hard to care too much about one's horrific physical state? To some degree, yes. But that's just a preface to a fascinating story that doesn't get much popular press.

Just as studies of heroin's effects on the brain led to the discovery of our own opioid system—the endorphins and cousins—so has marijuana revealed the endocannabinoids. That tongue twister of a name refers to naturally occurring chemicals now suspected to play along with the brain's neurotransmitter elite—dopamine, serotonin, GABA, and epinephrine—in essential brain functions such as mood, cognition, memory, appetite, pain awareness, and emotions. Endocannabinoids are widespread outside the brain as well. They are made from a hairpin-shaped lipid, arachidonic acid, an essential omega-6 fatty acid in the membranes of all cells, and which serves as a precursor to several molecules with diverse activities. This is not to say that all our cells make cannabinoids, but their building blocks are nothing exotic.

Endocannabinoid history begins in the late 1980s, with clear evidence that people (as well as laboratory animals) have special proteins to which THC and related chemicals bind. These proteins were dubbed cannabinoid receptors (CB1) after Cannabis, the marijuana plant's botanical name. By the early 1990s cannabinoid receptor proteins had been purified and their presence in many regions of the brain and other tissues established. Two years later a naturally occurring chemical—the first endogenous cannabinoid—was identified. It was named anandamide, after the Sanskrit word ananda, bliss (the chemical's formal name is arachidonyl ethanolamide). It is about half as potent as THC. Then a second type of receptor (CB2) was located, mostly on immune cells. Other endogenous cannabinoids have since been discovered, with varying degrees of biological activity (most without the psychogenic properties of anandamide). For instance, 2-arachidonyl glycerol (2-AG) is more abundant but less psychoactive than anandamide and binds to both the CB1 and CB2 receptors; cannabidiol attaches most readily to CB2 receptors, and in doing so seems to relieve convulsions, inflammation, anxiety, and nausea.

Medicinal Value of Cannabinoids

The endocannabinoid system is how THC and similar chemicals are presumed to exert their impacts on physiology. Smoked marijuana typically induces relaxation, sleepiness, euphoria, and an increase in appetite. It temporarily impairs memory formation and clear thinking, and can produce visual distortions, dizziness, and even anxiety, panic, or psychotic reactions in rare cases. (The last effects can be too disruptive for some patients to continue.) But there is more to this drug. Accounts exist for nearly two dozen medical conditions for which marijuana (or purified THC) has improved symptoms. Here are the most established:

Pain suppression. While opioid-based pain relievers (e.g., morphine) work well for many kinds of pain, they don't touch others, and people develop drug tolerance that requires ever-higher doses for the same effect. Also, opioids create dependency and, for some people, insurmountable adverse reactions, especially at the high doses required to alleviate their pain. Several clinical trials show cannabinoids offer pain relief while also inducing calm, sleep, and improved appetite. In addition, they can be added to opioids for better pain relief, such as for "breakthrough" pain that eludes ongoing opioid analgesia. Alleviating pain is no small issue; the medical community has long acknowledged that undertreatment of pain is a serious problem. Studies suggest marijuana or THC helps with migraine headaches, for which existing medications don't always work.

Nausea and Vomiting. Nausea and/or vomiting are nearly guaranteed side effects of cancer chemotherapy. More than just unpleasant, vomiting (emesis, medically speaking) can be so debilitating that people forego anything resembling a normal daily existence or choose to stop chemotherapy. Marijuana has helped many of those people (including in Dr. Gould's time), before antiemetic drugs were as effective as they are today. And while only a third or a fourth of patients find marijuana and THC effective, they are an alternative for patients for whom the standard drugs are insufficient or intolerable due to side effects.

Food Intake. Clinical trials demonstrate that marijuana and THC improve appetite and weight gain in AIDS patients, for whom as little as five percent weight loss decreases survival, and in cancer patients with cachexia (tumor-mediated tissue breakdown and weight loss, common in later stage cancer). In fact, it was a study in the early 1990s showing that THC increased body weight in many people with AIDS wasting, that won FDA approval for pharmaceutical THC (called dronabinol, trade name Marinol) in that patient population.

Muscle Spasm Control. People with multiple sclerosis, spinal cord injury, epilepsy, and movement disorders such as Parkinson's disease, Huntington's disease, and Tourette's syndrome have spontaneous muscle contractions that can be extremely debilitating. Marijuana or THC reduces muscle spasms (most studies are for multiple sclerosis), presumably through brain regions related to muscle control that are known to have cannabinoid receptors.

Anti-inflammatory. Ongoing studies in laboratory animals and people show promise for the cannabinoids in treating diseases of the digestive tract, especially those that involve inflammation, such as ulcers, irritable bowel syndrome, Crohn's disease, and gastroesophageal reflux (heartburn). Another application is neuroprotection—sparing brain cells from death after head injury, oxygen deprivation, and inflammation or immune-mediated nerve cell damage.

Plant and Pharm

While virtually every existing drug product was born out of Mother Nature's botanical warehouse, the Institute of Medicine noted in their report that those based on marijuana are "considered to be especially risky, to judge by the paucity of products in development and the small size of the pharmaceutical firms sponsoring them." Still, the work to "pharm" marijuana has been underway for some time. The first synthetic cannabinoids were created in the 1980s (and key in the discovery of the receptors). Today, there are half a dozen agonists (drugs that mimic the effects of THC or endogenous cannabinoids in various ways) and a few antagonists (which block cannabinoid action). Some agonists are many times more potent than THC; certain forms are more specific for one receptor type, aiding the design of drugs to zero in on certain symptoms with the fewest side effects. The antagonist rimonabant is a potential appetite suppressant/weight-loss drug that also improves blood lipid profiles in such a way that would reduce risk of heart disease.

In the US, two oral cannabinoids are available by prescription. Marinol is synthetic THC, approved by the FDA in 1985 specifically to stimulate appetite in AIDS patients who are losing weight, and in 1992 to reduce nausea and vomiting in people undergoing cancer chemotherapy. Nabilone, a THC-like synthetic, was approved just over a month ago to treat nausea and vomiting in cancer patients when other drugs have failed.

There are pros and cons to both smoked marijuana and the pharmaceuticals. The former carries risk of airway irritation in the short term and airway disease and cancer in the long term (though the largest study to date of lung cancer among long-term heavy marijuana smokers found no increase compared to nonsmokers). And of course, it's a criminal act to grow, buy, possess, or use it. Some medical users find it makes them too sleepy, but many learn to adjust their intake to balance benefit of symptom relief with side effects—something easily done because effects are rapid when inhaled. The pharmaceuticals have their own—and many people would argue, worse—problems. Expense is one, though the makers of Marinol have financial programs for reduced cost to qualified patients. The oral delivery mode means it takes two to four hours for maximum effect (and is useless for patients who are vomiting), yet as additional doses are given to reach effect, overdose is possible. Marinol's packaging warns "overdose may occur either with therapeutic doses or with higher, nontherapeutic doses" and "caution should be exercised in dose escalation because the incidence of psychiatric symptoms increases significantly at maximum doses." Overdose symptoms can include blood pressure drop and unconsiousness, extreme agitation, and psychotic or hallucinatory reactions (these are rarely reported by marijuana smokers). Another consideration is that the dried plant contains many other potentially active compounds; this has been argued as a benefit both of using the plant and of using a single-drug pharmaceutical.

Coming Down the Pipe—er, Pike

Other marijuana-inspired drugs are out there. Sativex is an oral spray developed in the UK and recently approved in Canada and Spain to treat pain and muscle spasms of multiple sclerosis. It is billed as the first Cannabis-based drug in the world available by prescription (in the sense that it has THC and cannabinol from the plant, rather than being synthetics). Sativex got the nod in January by the FDA for a two-to-three year clinical trial in the US beginning later this year for pain relief in advanced cancer patients; at least two other studies are underway to test marijuana and THC for neuropathic pain relief in HIV and AIDS patients.

There is also the federal "compassionate use" program, which grants individual people with life-threatening conditions the opportunity to take a drug not yet approved by the FDA as safe or effective. These "n-of-1" (single-person) clinical trials allow a patient who qualifies and complies with requirements to take an "experimental" drug, including marijuana, while under a doctor's supervision.

So while debates on legalization of marijuana continue and opponents fume, scientists have moved on, as best they can, to capitalize on the plant—monetarily and medically. Research into what marijuana's cannabinoids and our endocannabinoids do, in sickness and in health, is forging ahead.

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RESOURCES

The Institute of Medicine's Marijuana and Medicine: Assessing the Science Base, at http://fermat.nap.edu/html/marimed

"The Brain's Own Marijuana" about endocannabinoids, in Scientific American (December 2004), online at www.sciam.com

Online audio slide show about cannabinoids, by the makers of Marinol,at www.marinol.com/slides.html

by **palmspringsbum** » Sat Nov 04, 2006 5:41 pm

ucsftoday wrote:Wednesday, 18 October '06

On the Spot: Dr. Abrams Responds

ucsftoday

As part of our new On the Spot web feature, Dr. Donald Abrams, the new director of clinical programs at the Osher Center for Integrative Medicine and an expert in complementary therapies, agreed to answer your questions.

Below we’ve published some of the questions you’ve asked of Dr. Abrams, along with his responses. As questions and comments continue to come in, this story will be updated with Dr. Abrams’s additional responses.

If you’d like to submit a question of your own to Dr. Abrams, you may do so here.

Faculty in other disciplines also are "On the Spot" to answer your questions.

Please remember that we may not be able to answer all questions or address all comments. Nor can we or the participating faculty member offer specific medical advice. For medical advice, you should always contact your personal physician.

Medicinal Marijuana

Q. In regard to medicinal marijuana, does marijuana smoke or secondhand exposure affect the lungs or throat like cigarette smoke or secondhand exposure?

A. With regards to secondhand marijuana smoke, I do not believe that such studies have been done. In general, inhalation of products of combustion is not the ideal way to deliver a medicine.

Donald Tashkin at UCLA has spent nearly 40 years investigating the harmful effects of inhaled marijuana on the lungs—from the electron microscopy level to airway responsiveness to the development of cancer. He has made some interesting observations. Chronic marijuana use seems to be associated with an increased risk of chronic bronchitis. Tobacco smokers who also smoke marijuana, however, seem to have less of a risk to develop emphysema. Most recently he has done a case control study of over 1,300 lung cancer patients in Los Angeles and has found that regular marijuana smoking does not lead to an increase in lung cancer, and may actually be associated with a decreased risk of lung cancer.

How is that possible, you may ask? Well, actually this seems to support an animal study and a previous epidemiologic cohort study which suggests the same. It may be that the anti-inflammatory and anti-oxidant effects of some of the components of marijuana are coming into play to explain this finding. There was one study that suggested that chronic marijuana smoking could be associated with an increased risk of head and neck cancers; however, that study was flawed by not controlling for the impact of tobacco smoking, which is a known risk.

More and more basic science studies are demonstrating that cannabinoids–the active ingredients in marijuana—may actually be worth investigating as anti-cancer agents! So that is a whole new line of interesting research that may be bearing fruit in years to come!

Q. Is it illegal for clinicans to prescribe marijuana? 

A. To actually “prescribe” marijuana one needs to have a Schedule 1 license from the Drug Enforcement Administration and even then it is only being “prescribed” for research studies. I have a Schedule 1 license to be able to “prescribe” the marijuana that I get from the National Institute on Drug Abuse (NIDA) to participants in my research trials.

Since 1996, California physicians have had the right to discuss and recommend the use of medicinal marijuana with their patients. Generally, for their patients to be able to access marijuana from a dispensary (of course you cannot go to a pharmacy and get marijuana in this country), the doctors need to write a letter or sign a form saying that it is ok with them if their patients seek and utilize medicinal marijuana, and that they will continue to follow and care for the patient. So that is not exactly prescribing. And again, there is no official place patients can go to get their “prescription” filled except the local dispensaries, which the Federal Government is not necessarily happy about so they keep shutting them down! Not an ideal situation.

Q. I know that marijuana is advised for AIDS/HIV and Cancer patients. Could it be useful in treating things like severe headaches, high blood pressure, low back pain and stress? If not, why not? 

A. All of those conditions you listed have been found to be helped by cannabis. If one looks at the law in California, Proposition 215, it allows for the recommendation of medical marijuana where use has been deemed appropriate and recommended by a physician for use in “treatment of cancer, anorexia, AIDS, spasticity, glaucoma, arthritis, migraine or any other illness for which marijuana provides relief.”

Are there clinical trials that have generated the evidence that marijuana is beneficial in all these conditions? No, largely because it has been virtually impossible to do such studies until recently. The creation of the UC Center for Medicinal Cannabis Research provided really the first mechanism for investigators to look at marijuana as a possible therapeutic agent. Before the CMCR was established, there was no easy way to obtain cannabis to study, other than as a substance of abuse. As you can see if you visit the site, CMCR has funded a number of studies investigating pain and spasticity uses of medical marijuana.

Many of the other purported benefits have come from anecdote. Like any other medication, people who are using cannabis for medicinal purposes should do so under the supervision of a physician and be aware that side effects and drug-herb interactions are possible.

Herbal

Q. What herbal/botanical alternatives are available for treatment of high blood pressure (herbal/botanical)?

A. Although my integrative medicine practice is largely focused on people living with and beyond cancer, we did get extensive training in the Program in Integrative Medicine on interventions that may be useful in the control of blood pressure. Obviously there are many different causes of and types of hypertension, so definitely there is not one intervention that will work for all.

I like to think of diet and exercise interventions that may be useful prior to herbs. Many people who are overweight or obese have elevated blood pressure. By watching caloric intake and increasing energy output through exercise, people are taking important steps in controlling their blood pressure. Keeping added salt to a minimum and eating a plant-based diet with lower levels of animal fat (particularly red meat and dairy products) are ways to drop some extra pounds.

Garlic–which has many healthful properties—has been suggested to be useful in lowering blood pressure as well as cholesterol levels. Again, 30-60 minutes of exercise 5 days of the week will go a long way towards weight reduction and improving tone.

Before turning to herbal interventions, I would consider some mind-body work to assist with decreasing stress that may be contributing to elevated blood pressure. Breath work, meditation, mindfulness-based stress reduction, yoga, tai chi, even self-hypnosis could be very useful in stress reduction that may assist with lowering blood pressure. I send most of my patients to one of our Traditional Chinese Medicine practitioners at the Osher Center, as I feel that TCM has a long and rich history of caring for people and maintaining their wellness. So I would consider a visit to a TCM practitioner as well.

Related Links:

Osher Center for Integrative Medicine

The UCSF Guide to Integrative Medicine, 2006 edition (pdf)

University of California Center for Medicinal Cannabis Research

by **palmspringsbum** » Sat Nov 04, 2006 8:16 pm

CounterPunch wrote:October 23, 2006

An Interview with Jeffrey Hergenrather, MD

What Have California Doctors Learned About Cannabis?

By FRED GARDNER
CounterPunch

It has been 10 years since California voters enacted Proposition 215, making it legal to grow and use cannabis, with a doctor's approval, for medical purposes. Prop 215 didn't create a record-keeping system because the authors didn't trust the government and didn't want to generate a master list of cannabis users. So, over the course of the past decade, a vast public health experiment has been conducted in California but no state agency has been tracking doctors who approve cannabis use or patients who medicate with it.

To assess the results in the absence of government-garnered data, I surveyed doctors associated with the Society of Cannabis Clinicians. The SCC was founded by Tod Mikuriya, MD, in 2000 so that doctors monitoring their patients' use of cannabis could share data for research purposes (and, alas, respond to threats from federal and state authorities). More than 20 doctors have attended SCC meetings, which are held quarterly. Philip A. Denney, MD, is the current president.

Some responses to the survey have not yet been received, but it appears that the specialists have approved cannabis use by more than 140,000 patients. "Approve," not "recommend," is the apt term, since more than 95 percent of the patients consulting specialists had been self-medicating previously.

The specialists account for approximately 40% of the letters of authorization on file with an agency that issues ID cards on behalf of cannabis dispensaries (to spare them having to confirm the validity of each customer's letter of approval). Extrapolating from this ratio, I estimate the number of Californians who have used and/or provided medicinal cannabis legally under Prop 215 to be about 350,000.

The complete survey will appear in the Fall issue of O'Shaughnessy's, a journal I produce for the SCC. What follows are excerpts from the response of Jeffrey Hergenrather, MD, a former family practitioner who has been conducting cannabis consultations in Sebastopol since 1999.

Q. How many patients will have received your approval to use cannabis through October 2006?

A. 1,430

Q. What percentage had been self-medicating with cannabis prior to consulting you?

A. 99%

Q. With what medical conditions have they presented? List top five and approximate percentage (total can exceed 100%).

Chronic pain (62%), Depression and other mental disorders (30%), Intestinal disorders (12%), Harmful dependence (10%), Migraine (9%) are the most common conditions being treated.

Q. What results do patients report? How does cannabis appear to work in treating their symptoms?

A cannabis specialist soon becomes aware of two remarkable facts. The range of conditions that patients are treating successfully with cannabis is extremely wide; and patients get relief with the use of cannabis that they cannot achieve with any other pharmaceuticals.

The testimonies that I hear on a daily basis from people with serious medical conditions are moving and illuminating. From many people with cancer and AIDS come reports that cannabis has saved their lives by giving them an appetite, the ability to keep down their medications, and mental ease. No other drug works like cannabis to reduce or eliminate pain without significant adverse effects. It evidently works on parts of the brain involving short-term memory and pain centers, enabling the patient to stop dwelling on pain. Cannabis helps with muscle relaxation, and it has an anti-inflammatory action. Patients with rheumatoid arthritis stabilize with fewer and less destructive flare-ups with the regular use of cannabis.

Other rheumatic diseases similarly show remissions. Spasticity cannot be treated any more quickly or efficiently than with cannabis, and, again, without significant adverse effects.

Patients who suffer from migraines can reduce or omit conventional medications as their headaches become less frequent and less severe.

About half of the patients with mood disorders find that they are adequately treated with cannabis alone while others reduce their need for other pharmaceuticals. In my opinion, there is no better drug for the treatment of anxiety disorders, brain trauma and post concussion syndrome, ADD and ADHD, obsessive compulsive disorder, and post-traumatic stress disorder. Patients with Crohn's disease and ulcerative colitis are stabilized, usually with comfort and weight gain, while most are able to avoid use of steroids and other potent immunomodulator drugs.

People who were formerly dependent on alcohol, opiates, amphetamines and other addictive drugs have had their lives changed when substituting with cannabis. Patients with end-stage renal disease on dialysis and those with transplanted kidneys show mental ease, comfort, and lack of significant graft-versus-host incompatibility reactions in my small series.

Diabetics report slightly lower and easier-to-control blood sugar levels, yet to be studied and explained.

Sleep patterns are typically improved, with longer and deeper sleep without any hangover or significant adverse effects.

Many patients with multiple sclerosis report that their condition has not worsened for many years while they have been using cannabis regularly. MS and other neurodegenerative diseases share the common benefits of reduced pain and muscle spasms, improved appetite, improved mood and fewer incontinence problems. Many patients with epilepsy are adequately treated with or without the use of other anticonvulsants.

Patients with skin conditions associated with systemic disease such as psoriasis, lupus, dermatitis herpetiformis, and eczema all report easement and less itching when using cannabis regularly.

Airway diseases such as asthma, sleep apnea, COPD, and chronic sinusitis deserve special mention because I encourage the use of cannabis vapor or ingested forms rather than smoking to reduce airway irritation. Finally, most obese and morbidly obese patients respond with weight loss and improved self esteem. I believe that cannabis and psychotherapy work well together in fostering behavioral changes.

Q. Have you compiled demographic data or can you estimate the breakdown with respect to your patients' age, gender, race, economic status?

Gender: 62% male, 38% female. Ages range from 14 to 86 years old. The male mean age is 45.9 years with a median age of 46. The female mean age is 47.4 with a median age of 48 years. The graphs of the age and gender distribution are similar with the exception that there is a bump in the leading edge of my male patient population as compared to the females, which I account for by young men's work injuries, sports injuries, motor vehicle accidents, and problems stemming from military service, including injuries and post-traumatic stress disorder. The vast majority of patients in my practice are of Caucasian / Indo-European descent, with only about 1% African-American, 2% Native American, 1% Pacific Islanders, and 2% Asian.

Q. Have you observed or had reports of adverse effects from cannabis? If so, please describe.

Is there a downside to the use of cannabis? The sense of intoxication rarely lasts longer than an hour and tends to be more troubling to the novice than to the experienced user. For some people cannabis can induce dry mouth, red eyes, unsteady gait, mild in-coordination, and short-term memory loss, all of which are transient. These effects are reportedly trivial compared to those brought on by pharmaceutical alternatives.

Cannabis use is steadily finding acceptance in society. Still, for many it remains awkward if not totally impractical in the workplace. People whose jobs require multi-tasking such as pilots, drivers, dispatchers, switchboard operators, and many professionals find the intoxicating effects of cannabis inappropriate in the workplace, and therefore reserve their use for after work. Strains

Q. What have you learned re strains and dosage?

Cannabis is a complex, un-patentable plant with vast pharmacologic potential. Different strains contain different mixes of cannabinoids and terpenes that give them distinct qualities. Some strains energize you; others put you to sleep. Many patients, when they find a strain that suits their needs, try to obtain it on a regular basis. Unless they are growing their own from cuttings, however, they have to rely on growers and distributors to reproduce and make available the preferred strain from year to year.

Due to Prohibition, California growers have been denied the tools of analytical chemistry to test the cannabinoid contents of their plants. This has impeded the development of strains aimed at treating various conditions. Nevertheless, patients continue to educate themselves about cannabis as medicine and how best to use it. Over the years that I have specialized in cannabis therapeutics, health benefits reported by patients have been substantiated and explained by findings from research centers around the world.

Vaya Con Dios

The great Freddy Fender died last week -lung cancer at age 69. From his Associated Press obit: "his career was put on hold [in 1960] when he and his bass player ended up spending almost three years in prison in Angola, LA., for marijuana possession." He was born Baldemar Huerta and took the name Fender in honor of his electric guitar when he signed with Imperial Records in 1959. He took "Freddy" because he thought it sounded good with Fender. I never stopped giving my vinyl "Best of Freddy Fender" a spin.

Look at how America treats its artists, its national treasures! Clifford Antone, founder of Austin's famous blues club, died in May of this year. He served two prison terms, according to his obit in the New York Times, "one in the 1980's for possessing marijuana and another from 2000 to 2002 for dealing more than 9,000 pounds of the drug and laundering money Mr. Antone was known for his generosity to musicians. He organized a series of benefits for victims of Hurricane Katrina and recently he helped arrange an apartment and nursing care for the 92-year-old pianist Pinetop Perkins."

Paul Armentano of NORML has analyzed a new U.S. Department of Justice report for 2004 and concludes that U.S. taxpayers are now spending more than a billion dollars annually to incarcerate citizens for pot. Armentano estimates that 33,655 state inmates and 10,785 federal inmates are locked up on marijuana charges. The DOJ report didn't provide stats for county jails.
<blockquote>Thousands behind bars cannot see the stars
Shining o'er the land of the free
They could be at home if they could grow their own
Or get it from the local pharmacy.</blockquote>

Fred Gardner can be reached at fred@plebesite.com

by **palmspringsbum** » Tue Nov 07, 2006 6:00 pm

CounterPunch wrote:Weekend Edition
November 4 / 5, 2006

Dr. Mikuriya's Observations

10 Years of Legalized Medical Marijuana in California

By FRED GARDNER
CounterPunch

Tod Mikuriya, MD (Berkeley), was the first California doctor to monitor patients' use of cannabis systematically. In the early 1990s his interviews with members of the San Francisco Cannabis Buyers Club documented Dennis Peron's observation that people were self-medicating for an extremely wide range of problems.

The broad range of applications confirmed what Mikuriya had learned from his study of the pre-prohibition medical literature on cannabis, and so when Prop 215 was being drafted, he urged that it apply not only to people with a list of named conditions, but to those treating " ... any other illness for which marijuana provides relief."

No sooner had Prop 215 passed than top California law enforcement agents colluded with Clinton Administration officials and Prohibitionist strategists from the private sector to plan its disimplementation. On Dec. 30, 1996, Drug Czar Barry McCaffrey, Attorney General Janet Reno, Health & Human Services Secretary Donna Shalala, and the director of the National Institute of Drug Abuse, Alan Leshner, held a press conference to threaten California doctors with loss of their licenses, i.e., their livelihoods, if they approved marijuana use by their patients. McCaffrey stood alongside a large chart headed "Dr. Tod Mikuriya's, (215 Medical Advisor) Medical Uses of Marijuana." Twenty-six conditions were listed in two columns. ("Migranes" was misspelled.) "This isn't medicine, this is a Cheech and Chong show," he said. Reno said prosecutors would focus on doctors who were "egregious" in approving marijuana use by patients.

Dr. Mikuriya watched the press conference on CNN at his home in the Berkeley Hills. "As doctors become more fearful," he says. "I'll obviously get more and more patients who are using cannabis or are considering it. Will that make it seem that there's something 'egregious' about my practice? You bet it will!"

>From the Attorney General's office in Sacramento a memo went out from Senior Deputy AG John Gordnier to district attorneys in all 58 counties asking them to forward any cases involving Mikuriya. In due course, on the basis of complaints from sheriffs, cops, and DAs, Mikuriya was investigated by the medical board and found to have committed "extreme departures from standard practice." He was placed on probation and ordered to pay $75,000 for his own prosecution.

Over the years the number of cannabis specialists among California doctors has risen slowly but steadily. In 2000 Mikuriya organized a group, now known as the Society of Cannabis Clinicians, to share data for research purposes. More than 20 doctors have become involved with the SCC. Collectively they have approved cannabis use by an estimated 350,000 patients. This summer, with the 10th anniversary of Prop 215's passage approaching, I surveyed the SCC doctors get their basic findings. Here are Dr. Mikuriya's responses to the survey he inspired.

<table class=posttable align=right width=200><tr><td class=postcap colspan=2>Approvals issued to date:</td><td class=postcell align=right>8,684.</td></tr><tr><td class=postcap colspan=2>Previously self-medicating:</td><td class=postcell align=right>>99%</td></tr><tr><td class=postcap colspan=3>Category of use:</td></tr><tr><td class=postcell></td><td class=postcell>Analgesic/immunomodulator</td><td class=postcell align=right>41%</td></tr><td class=postcell></td><td class=postcell>Antispasmodic/anticonvulsant</td><td class=postcell align=right>29%</td></tr><tr><td class=postcell></td><td class=postcell>Antidepresssant/Anxiolytic</td><td class=postcell align=right>27% </td></tr><td class=postcell></td><td class=postcell>Harm reduction substitute:</td><td class=postcell align=right>4%</td></tr></table>Results reported are dependent on the conditions and symptoms being treated. The primary benefit is control without toxicity for chronic pain and a wide array of chronic conditions. Control represents freedom from fear and oppression. Control -or lack thereof- is a major element in self-esteem.

With exertion of control, with freedom from fear of incapacity, quality of life is improved. The ability to abort an incapacitating attack of migraine, asthma, anxiety, or depression empowers.

Relief from the burden of criminality through medical protection enhances a salutary self-perception.

Alteration in the perception of and reaction to pain and muscle spasticity is a unique property of cannabis therapy.

Patient reports are diverse yet contain common elements. 100% report that cannabis is safe and effective. Return for follow-up and renewal of recommendation and approval confirms safety and efficacy.

Cannabis seems to work by promoting homeostasis in various systems of the body. Its salient effects are multiple and concurrent. They include- <ul class=postlist><li> Restoration of normal functioning of the gastrointestinal tract with normalization of peristalsis and restoration of appetite.</li>

<li> Normalizing circadian rhythm, which relieves insomnia. Sleep is therapeutic in itself and synergistically helps with pain control.</li>

<li> Easement of pain, depression, and anxiety. Cannabis as an anxiolytic and antidepressant modulates emotional reactivity and is especially useful in treating post-traumatic stress disorders.</li></ul>

Patients treated for ADHD: 92

Patients using cannabis as a substitute for alcohol: 683. The slow poisoning by alcohol with its sickening effects on the body, psyche, and family can be relieved by cannabis.

Medications no longer needed? Opioids, sedatives, NSAIDS (non-steroidal anti-inflammatories), and SSRI anti-depressants are commonly used in smaller amounts or discontinued. These are all drugs with serious adverse effects. Opioids and sedatives produce depression, demotivation, and diminished mobility. Weight gain and diminished functionality are common effects. Cognitive and emotional impairment and depression are comorbid conditions. Opioids adversely effect vegetative functioning with constipation, dyspepsia, and gastric irritation. Pruritus is also an issue for some. Circadian rhythms are disrupted with sleep disorders and chronic sedation caused by these agents. Dependence and withdrawal symptoms are more serious than with sedatives.

Opioids are undoubtedly the analgesic of choice in treating acute pain. For chronic pain, however, I recommend the protocol proposed by a doctor named Fronmueller2 to the Ohio Medical Society in 1859: primary use of cannabis, resorting to opiates for episodic worsening of the condition. Efficacy is maximized, tolerance and adverse effects are minimized. (Neither cannabis nor human physiology has changed since 1859.)

NSAIDs can be particularly insidious for those who do not immediately react with gastric irritation and discontinue the drug. Chronic irritation with bleeding may produce serious morbidity. Most often, the dyspepsia produced is suppressed with antacids or other medications. Many patients tolerate acute intermittent use but not chronic use. SSRIs, if tolerated, coexist without adverse interaction with cannabis. Some SSRI users say cannabis is synergistic in that it treats side effects of jitteriness or gastrointestinal problems.

Many patients report pressure exerted by the Veterans Administration, HMOs such as Kaiser Permanente, and workers' compensation program contractors to remain on pharmaceutical regimens. A significant number describe their prescribed drugs as ineffectual and having undesirable effects. "Mainstream" doctors frequently respond to reports of adverse effects by prescribing additional drugs. Instead of negating the problem, they often complicate it. Prevailing practice standards encourage polypharmacy -the use of multiple drugs, usually five or more.

Out of the ordinary conditions? While all pain reflects localized immunologic activity secondary to trauma or injury, the following atraumatic autoimmune disorders comprise a group of interest: Crohn's disease Atrophie blanche, Melorheostosis, Porphyria, Thallasemia, Sickle cell anemia, Amyloidosis Mastocytosis, Lupus, Scleroderma, Eosinophilia myalgia syndrome. These are all clearly of autoimmune etiology, difficult to treat. Specific metabolic errors such as amyloidosis and certain anemias warrant further study and may elucidate the underlying mechanisms of the illnesses and the therapeutic effects of cannabis. Multiple sclerosis with its range of severity varies in therapeutic response to cannabis.

Demographics: male patients, 72; female, 28%. Women are more likely than men to use cannabis for psychotherapeutic purposes (32% to 18%). Men are more likely to use for harm reduction (4% to 1%). A roughly bell-shaped curve describes the age of my patients. 0-18 years, 1%; 19-30, 19%; 31-45, 36%; 45-60, 37%; older than 61, 7%.

Additional Observations:

Proactive structuralism works. Meaning: people can create something and by doing so, set a precedent.

Medical cannabis users are typically treating chronic illnesses -not rapidly debilitating acute illnesses.

The cash economy works better than the bureaucratic alternative. Word of mouth builds a movement.

The private sector is handling marijuana distribution because the government has defaulted.

Cannabis was once on the market and regulated, then it was removed from the market and nearly forgotten.

Not all that we've learned in the past 10 years is new.

Once upon a time the California Compassionate Use Act of 1996 became the law of the state. We had the mistaken belief that civil servants, sworn to uphold the law, would set about implementing the new section of the Health & Safety Code. Hardly... Twenty California doctors have been investigated by the Medical Board for approving cannabis use by their patients. Limited immunity from prosecution for physicians was either proclaimed invalid or, more commonly, evaded by the Board and the Attorney General. They dissimulate, pretending that it is not the physician's approval of marijuana at issue, but his or her standard of practice. They then hold cannabis consultants to a standard that most HMO doctors violate constantly.

The fix is in. The state criminal justice entities share information and operate in concert with the DEA. There has been a total end run around the injunctive protection of the Conant ruling. [In Conant, a federal court enjoined the government from threatening doctors who discuss cannabis as a treatment option with patients.] General media indifference enables this RICO under color of authority and the continuing defiance of the will of Californians who spoke ten years ago.

This is counterbalanced by the rewards of helping patients with serious chronic aliments who have adverse experience utilizing so-called main stream medicines.

Fred Gardner can be reached at fred@plebesite.com

by **palmspringsbum** » Mon Nov 13, 2006 6:13 pm

CounterPunch wrote:Weekend Edition
November 11 / 12, 2006

Pot Shots
Marijuana, the Anti-Drug

By FRED GARDNER
CounterPunch

The extent to which medical cannabis users discontinue or reduce their use of pharmaceutical and over-the-counter drugs is a recurring theme in a recent survey of pro-cannabis (PC) California doctors. The drug-reduction phenomenon has obvious scientific implications. Medicating with cannabis enables people to lay off stimulants as well as sedatives -suggesting that the herb's active ingredients restore homeostasis to various bodily systems. (Lab studies confirm that cannabinoids normalize the tempo of many other neurotransmission systems.) The political implications are equally obvious. Legalizing herbal cannabis would devastate the pharmaceutical manufacturers and allied corporations in the chemicals, oil, "food," and banking sectors. Put simply, the synthetic drug makers stand to lose half their sales if and when the American people get legal access to cannabis.

In the 10 years since Proposition 215 made it legal for California doctors to approve cannabis use by patients, the PC docs did not adopt a common intake questionnaire, and, with one exception, did not collect systematic data on which pharmaceutical drugs their patients had chosen to stop taking. However, the consistency with which the doctors describe this phenomenon has a force as impressive as any slickly presented "hard" data.

This summer I surveyed 19 PC doctors who, between them, had approved and monitored cannabis use by more than 140,000 patients. Herewith some replies to a question about patients reporting reduced reliance on pharmaceuticals.

Frank Lucido, MD: "Chronic pain patients report reduced use of opioids, NSAIDs, muscle relaxants, sleeping pills. Psychiatric and insomnia patients reduce use of tranquilizers, SSRI antidepressants, and sleeping pills. Neurologic patients reduce use of opioids, muscle relaxants, NSAIDS, triptans and other migraine headache remedies."

Marian Fry, MD: "Medications discontinued or reduced include Oxycontin, Norco, Percoset, Vicodin, Flexerol, Soma, Valium, SSRI antidepressants, and blood-pressure medications Norvasic and Hydrochlorothiazide. Approximately 1% of my patients report reduced reliance or discontinuation of seizure medication by substituting Cannabis for Dilantin and remaining seizure free. Many of my Glaucoma patients no longer require their Timoptic drops and are able to maintain normal pressures with the use of Cannabis. Many of my patients who have lost hope in conventional pharmaceutical treatments report enhanced health, decreased pain, decrease depression and an overall sense of well being despite chronic illness."

Helen Nunberg, MD is medical director of MediCann, a statewide chain of clinics through which 53,000 patients have received approvals. Nunberg reviewed records of 1,800 patients seen at nine clinics. "Prescription drug substitution is very significant," she writes. "51% of the 1,800 patients report using cannabis as a substitute for prescription medications; 48% report using cannabis to prevent prescription medication side effects; 67% report using cannabis to reduce dosage of prescription medication; 49% of patients using cannabis for chronic pain were previously prescribed an opioid (such as hydrocodone) by their personal physician."

Philip Denney, MD: "Cannabis allows significant decreased use or elimination of many prescription medications, particularly narcotics. Patients usually report decreases of 50% or better."

Tom O'Connell, MD: "Vicodin and other opioids; lithium; Klonopin; various sleep aids; and the whole gamut of psychotropic medications from Prozac to Xanax. I don't tell patients to stop taking anything, but I will suggest they discuss it with the prescribing doctor. I have the feeling that most don't."

Robert Sullivan, MD: "Opiates, muscle relaxants, antidepressants, hypnotics (for sleep), anxiolytics, neurontin, anti-inflammatories, anti-migraine drugs, GI meds, prednisone (for asthma, arthritis)."

William Eidelman, MD: "Opioids, sleeping pills, anxiolytics, SSRI anti-depressants."

Hanya Barth, MD: "Approximately 90% of my patients have at one time or another tried traditional medications for their symptoms and found that they produced significant side effects. With cannabis most patients report either being able to manage their symptoms without any other medications, or using less than they would ordinarily have to. It is not unusual to have patients come for a recommendation, bringing a whole bag of medications that they are taking. They might then return the following year saying that they no longer needed many of them and had cut back on many others.

"It is also true that most patients who were using alcohol to manage their symptoms or who were abusing alcohol or speed or opiates, etc. find that they can stop these drugs when they have marijuana. Many also report that they were using those drugs to manage certain symptoms such as pain or anxiety and then became addicted. This is especially true of certain populations, mainly the homeless and the mentally ill. Even cigarette smokers often state that they can substitute cannabis for nicotine.

"What amazes me overall is the efficacy and lack of side effects. It is not that the pain stops but that the mind doesn't fixate on the pain in the same way. In addition, the muscles that become tense around an area of pain can cause secondary symptoms, which then are relieved with cannabis. If someone is in pain and/or anxious, he or she often has a hard time sleeping. With cannabis, patients report that they are able to sleep better, wake up more refreshed, have less secondary depression and are able to function more efficiently the following day. Many hypnotics can only be taken at a certain time (not at 4 a.m., for example). However, having a puff of cannabis at that time will help them fall back asleep without a morning hangover."

Dr. A: "Narcotics, including heavy narcotics such as Fentanyl."

William Courtney, MD: "While the percentage of patients in my practice using cannabis for management of ADHD is small, those who have discovered its benefits are pleased that they can achieve control without having to continue to use Ritalin, etc."

Tod Mikuriya, MD: "Opioids, sedatives, non-steroidal anti-inflammatories, and SSRI anti-depressants are commonly used in smaller amounts or discontinued. These are all drugs with serious adverse effects."

Jeffrey Hergenrather, MD: "A cannabis specialist soon becomes aware of two remarkable facts. The range of conditions that patients are treating successfully with cannabis is extremely wide; and patients get relief with the use of cannabis that they cannot achieve with any other pharmaceuticals.

"The testimonies that I hear on a daily basis from people with serious medical conditions are moving and illuminating. From many people with cancer and AIDS come reports that cannabis has saved their lives by giving them an appetite, the ability to keep down their medications, and mental ease. "No other drug works like cannabis to reduce or eliminate pain without significant adverse effects. It evidently works on parts of the brain involving short-term memory and pain centers, enabling the patient to stop dwelling on pain. Cannabis helps with muscle relaxation, and it has an anti-inflammatory action. Patients with rheumatoid arthritis stabilize with fewer and less destructive flare-ups with the regular use of cannabis.

"Other rheumatic diseases similarly show remissions. Spasticity cannot be treated any more quickly or efficiently than with cannabis, and, again, without significant adverse effects.

"Patients who suffer from migraines can reduce or omit conventional medications as their headaches become less frequent and less severe.

"About half of the patients with mood disorders find that they are adequately treated with cannabis alone while others reduce their need for other pharmaceuticals. In my opinion, there is no better drug for the treatment of anxiety disorders, brain trauma and post-concussion syndrome, ADD and ADHD, obsessive compulsive disorder, and post-traumatic stress disorder.

"Patients with Crohn's disease and ulcerative colitis are stabilized, usually with comfort and weight gain, while most are able to avoid use of steroids and other potent immunomodulator drugs.

"People who were formerly dependent on alcohol, opiates, amphetamines and other addictive drugs have had their lives changed when substituting with cannabis.

"Patients with end-stage renal disease on dialysis and those with transplanted kidneys show mental ease, comfort, and lack of significant graft-versus-host incompatibility reactions in my small series. "Diabetics report slightly lower and easier-to-control blood sugar levels, yet to be studied and explained.

"Sleep patterns are typically improved, with longer and deeper sleep without any hangover or significant adverse effects.

"Many patients with multiple sclerosis report that their condition has not worsened for many years while they have been using cannabis regularly. MS and other neurodegenerative diseases share the common benefits of reduced pain and muscle spasms, improved appetite, improved mood and fewer incontinence problems. Many patients with epilepsy are adequately treated with or without the use of other anticonvulsants.

"Patients with skin conditions associated with systemic disease such as psoriasis, lupus, dermatitis herpetiformis, and eczema all report easement and less itching when using cannabis regularly.

"Airway diseases such as asthma, sleep apnea, COPD, and chronic sinusitis deserve special mention because I encourage the use of cannabis vapor or ingested forms rather than smoking to reduce airway irritation."

All these clinical reports jibe perfectly with lab studies showing that synthetic THC enables rodents to achieve pain relief with half the amount of opioids. (Under the rules of evidence established by corporate Science, rodents are considered more trustworthy witnesses than we, the people, are.)

<hr class=postrule>
Fred Gardner is the editor of O'Shaughnessy's Journal of the California Cannabis Research Medical Group. He can be reached at: fred@plebesite.com

by **palmspringsbum** » Sun Nov 19, 2006 1:09 pm

CounterPunch wrote:Weekend Edition
November 18 / 19, 2006

California Medical Survey

The Adverse Effects of Marijuana

By FRED GARDNER
CounterPunch

In the past 10 years, California doctors have authorized cannabis use by at least 350,000 patients. What have they learned about its adverse effects?

According to a survey of 19 doctors associated with the Society of Cannabis Clinicians, side-effects are relatively rare, mild, and transient. There have been no deaths, no major adverse events attributed to cannabis -with one exception involving a claim by an establishment psychiatrist that cannabis induced and exacerbated psychosis in an 18-year old whom she had on a regimen of Lexapro and Zyprexa.

Comments by the SCC doctors follow.

Frank Lucido, MD: Reported adverse effects are rare, in part because the patient coming to a medical cannabis consultation has already found cannabis to be of benefit. (I have had perhaps 10 patients in 10 years who had never tried cannabis or who hadn't used it in many years and were uncertain if it would effectively treat their current illness or symptoms.) Two patients have discontinued use in response to decreased productivity. The overwhelming majority report that they are MORE productive when their symptoms are controlled with cannabis.

Robert Sullivan, MD: None common (c. 1%), none "serious." Weight gain, tolerance, anxiety (related to potential theft from an outdoor garden), dry mouth, short-term memory decrease, anxiety, red eyes. All described in response to my inquiry (not spontaneous). None resulted in stopping cannabis use.

Marian Fry, MD: The most significant negative reactions are due to fear of incarceration and the results of abuse by officers unwilling to honor California law.

William Toy, MD: The most important adverse effects are respiratory problems caused by smoking. Most patients who have respiratory problems use vaporizers or edible forms of cannabis. We go out of our way to get patients on vaporizers and we now have only a small percentage of smokers -mostly people who have been smoking marijuana for 30-40 years. Most in this group use very little, maybe one or two doses a day.

Philip A. Denney, MD: Virtually none reported by patients except contacts with the legal system. Patients are able to stop using easily in order to pass drug tests or when traveling. Overdose from edible cannabis -an unpleasant drowsiness lasting six to eight hours- is rare and transient.

David Bearman, MD: Occasional complaints of cough. Many more complaints about Marinol than cannabis -dysphoria, ineffective, costs too much.

Tom O'Connell, MD: The most common is the "paranoid" reaction, in which, characteristically, a user who is "high" develops the uncomfortable feeling that everyone he/she sees KNOWS they are high and is critical of them for it. It almost always occurs in a situation where the person may be forced to deal unexpectedly with the public. It certainly needs further study. In any event, patients deterred from using pot aren't lining up for approvals to do so.

William Courtney, MD: A significant number of my middle-aged patients are no longer enamored of the psychoactive effects that previously were the highlight of their cannabis use. For them, what was euphoric has now become dysphoric. Such patients tolerate the anxiogenic properties in order to enjoy the anti-spasmodic or analgesic effects -much as a patient on chemotherapy reluctantly accepts the nausea in exchange for the anti-tumor effects. While a few patients have discovered that there are strains that provide relief without dysphoria, others are excited by the possibility of daytime CBD analgesia or autoimmune modulation without alteration of their sensorium.

Dr. A.: We've had several reports of hypotensive reaction -a sudden drop in blood pressure, which results in fainting. It's very rare and, as reported by my patients, is a one-time thing. It typically happens after a big meal, when the GI tract is opened up and absorbing a lot of blood.

Jeffrey Hergenrather, MD: Is there a downside to the use of cannabis? The sense of intoxication rarely lasts longer than an hour and tends to be more troubling to the novice than to the experienced user. For some people cannabis can induce dry mouth, red eyes, unsteady gait, mild in-coordination, and short-term memory loss, all of which are transient. These effects are reportedly trivial compared to those brought on by pharmaceutical alternatives.

Cannabis use is steadily finding acceptance in society. Still, for many it remains awkward if not totally impractical in the workplace. People whose jobs require multi-tasking such as pilots, drivers, dispatchers, switchboard operators, and many professionals find the intoxicating effects of cannabis inappropriate in the workplace, and therefore reserve their use for after work.

The survey, conducted by your correspondent for the upcoming issue of O'Shaughnessy's (and previewed exclusively on CounterPunch), does not pretend to be rigorous. It involves the patient population least likely to experience adverse events and a setting in which adverse events might be downplayed (examinations in which the patient is seeking the doctor's approval to use). As Dr. Lucido and others point out, in the first 10 years of legality created by Prop 215, almost all the patients seeking physician approval to use cannabis had been self-medicating previously with positive results. Truly naïve patients have been rare -and those experiencing unwanted side-effects would be unlikely to return to the doctor for a renewal, i.e., their complaints would go unreported.

The charge that cannabis use caused and then increased the severity of a psychotic break in an 18-year-old was made by a Stanford University psychiatrist, Dr. P., who filed a complaint with the state medical board against the doctor who had approved it. "I believe THC caused his depression to worsen, interferes with antidepressant meds, and clearly caused his psychosis," Dr. P advised the board. "He is also psychologically and physically dependent on the substance. He refuses to quit. He even admitted to seeking the medical marijuana justification in order to use regularly 'legally.'"

The assumption that marijuana causes physical dependence is without scientific foundation. Dr. P.'s use of the term "even admitted" reveals a prosecutorial frame of mind. She seems appalled to learn what all cannabis consultants know and what should come as no surprise to any person with common sense: feeling legitimate relieves anxiety! Dr. P.'s treatment of the mutual patient involved anti-marijuana exhortations and the pushing of her preferred corporate drugs. Lexapro is an SSRI antidepressant made by Forest Pharmaceuticals. Like all SSRIs it is slowly but surely being linked to suicide in the medical literature (while the drug companies and their paid researchers in the psychiatric establishment challenge each piece of evidence).

Dr. P.'s allegation that marijuana use precipitated and aggravated the patient's break with reality can't be proved or disproved. Some published studies indicate an "association" between marijuana use and schizophrenia, but not necessarily a causal relationship. (A person seeing demons or hearing voices may use cannabis because he finds that it quiets them.) Schizophrenia occurs in about 1% of adult populations in all countries and cultures, regardless of the prevalence of cannabis use. The use of Marinol (synthetic THC) by teenage cancer patients has not resulted in an increased incidence of schizophrenia.

Ironically, the component of the cannabis plant thought to have sedative and anti-psychotic properties -Cannabidiol (CBD)- is present only in trace amounts in the strains available to California patients. As indicated by Dr. Courtney, the SCC doctors are frustrated that they don't know the cannabinoid contents of the herbs their patients are using. They all wish a high-CBD strain was available. They would have learned a lot in 10 years about how it differs from high-THC cannabis. Prohibition sabotages research.

Fred Gardner is the editor of O'Shaughnessy's Journal of the California Cannabis Research Medical Group. He can be reached at: fred@plebesite.com

by **palmspringsbum** » Sat Dec 15, 2007 12:22 am

The Hawaii Reporter wrote:Research Leaves No Cloud In Medical Pot Debate

by Paul Armentano, Hawaii Reporter
October 18th, 2007

As the author of the recent publication, “Emerging Clinical Applications for Cannabis and Cannabinoids: A Review of the Scientific Literature,” I take umbrage with those politicians and law enforcement officials who argue, "Smoked marijuana is not medicine." This allegation -- most recently asserted on the DEA's new website - http://www.JustThinkTwice.com -- is false, plain and simple.

While writing the abovementioned booklet, I reviewed over 150 clinical and preclinical studies assessing the therapeutic value of cannabis and its active compounds to treat symptoms -- and in some cases moderate disease progression -- in a variety of illness, including multiple sclerosis, Alzheimer’s, osteoporosis, diabetes, and Lou Gehrig’s disease. Nearly all of the studies cited in my work were published within the past six years.

Additional scientific studies are being published in peer-reviewed journals everyday. For example, a recent review by investigators at the National Institutes of Health (“The endocannabinoid system as an emerging target of pharmacotherapy,” Pharmacology Today) reported that compounds in pot “hold therapeutic promise in a wide range of disparate diseases and pathological conditions,” including movement disorders, mental disorders, and cardiovascular disorders.

This February, investigators at San Francisco General Hospital and the University of California’s Pain Clinical Research Center assessed the efficacy of inhaled cannabis as a treatment for HIV-associated sensory neuropathy. (Neuropathic pain – colloquially known as ‘nerve pain’ – affects an estimated one percent of the world’s population and is typically unresponsive to both opioids and non-steroidal anti-inflammatory medications.)

Writing in the journal Neurology, researchers reported that patients who smoked low-grade cannabis three times daily experienced, on average, a 34 percent reduction in pain.

Investigators at Columbia University in New York published clinical trial data in the Journal of Acquired Immune Deficiency Syndromes this summer that concluded, “Smoked marijuana ... has a clear medical benefit in HIV-positive [patients] by increasing food intake and improving mood and objective and subjective sleep measures.”

Researchers in the study compared the efficacy of inhaled cannabis to the Marinol -- a synthetic THC pill lauded by the DEA and many critics of medical marijuana -- but reported that the prescription pill was far less effective. In fact, patients in the study required eight times the daily recommended dose of Marinol to achieve the same therapeutic benefits provided by just a few puffs of weed, researchers reported.

Finally, last month an investigative team from Trinity College in Ireland proclaimed in the British Journal of Pharamcology that pot-based therapies may offer greater hopes for staving off Alzheimer’s disease than do existing pharmaceutical therapies (“Alzheimer’s disease: taking the edge off with cannabinoids?”).

Researchers wrote, “Cannabinoids offer a multi-faceted approach for the treatment of Alzheimer's disease by providing neuroprotection and reducing neuroinflammation, whilst simultaneously supporting the brain's intrinsic repair mechanisms by augmenting neurotrophin expression and enhancing neurogenesis (the formation of new brain cells).”

Can the Drug Enforcement Administration please name another plant with the power to achieve all this?

Finally, unlike most politicians and law enforcement officials, I frequently interact with medical marijuana patients. Many of them write to me daily, as do their physicians. Often they tell me stories like this:

"I was recently diagnosed with a malignant brain tumor inside the left the temporal lobe of my brain. I had surgery, and I've just started chemotherapy and radiation. The surgeon actually apologized for the fact that he could not write me a prescription for marijuana, but he told me it was safe to smoke. My prescriptions make me very dizzy and nauseous and I have ever-present headaches that top any of the worst hangover headaches anyone could possibly have. My brain is still so badly swollen. The swelling has actually gotten worse and is exacerbated by the radiation. Marijuana is saving my life right now; it has helped to kill my seizures, nausea, dizziness, and calm my headaches. If marijuana can help me with all my other problems in addition to possibly reducing the size of my tumor and extending my life, then why on earth would our government not allow me to have it?"

Why indeed? Perhaps it's time for the DEA to "just think twice."

<hr class=postrule>
Paul Armentano is the senior policy analyst for NORML and the NORML Foundation in Washington, DC. He is the author of “Emerging Clinical Applications for Cannabis and Cannabinoids: A Review of the Scientific Literature” (2007, NORML Foundation), which may be accessed online at:www.norml.org/index.cfm?Group_ID=7002.He may be contacted via email atpaul@norml.org

by **palmspringsbum** » Wed Feb 27, 2008 7:34 pm

The Salem News wrote:Feb-21-2008 17:51

Medical Marijuana

Dr. Phillip Leveque
Salem-News.com

Phillip Leveque has spent his life as a Combat Infantryman, Physician, Toxicologist and Pharmacologist. He has experience with 4,000 medical marijuana patients.

<table class=posttable align=right width=300><tr><td class=postcell><img class=postimg src=bin/leveque_phillip.jpg width=300></td></tr></table>(MOLALLA, Ore.) - Cannabis as useful medicine was first brought to Western Europe by Dr. W.B. O'Shaunessy about 1840. He had served in India where he was introduced to the medical use by local physicians. He found it to be efficacious for analgesia, rabies, cholera, tetanus and convulsions and soon published his findings in England. This was followed by many physicians using it (successfully) for many medical conditions.

The American College of Physicians (ACP) via their journal the Annals of Internal Medicine as of January 2008, has published the best but unfortunately limited article about the benefits of marijuana/cannabis as medicine.

Unfortunately positive articles on the subject have rarely been printed in medical journals for the past thirty years. Only 10 of their 41 references are dated after 2005 and much of the most critical and acceptable medical information has been published since 2001 at which time physicians had enough clinical experience but could rarely get their research published.

Their article only refers to a few of the medical conditions for which marijuana/cannabis has been found to be highly beneficial. This article will indicate some 25 or more diseases for which it is efficacious.

More History

Dr. John Russel Reynolds became the personal physician for Queen Victoria around 1868, who used it for menstrual cramps, nausea and vomiting of pregnancy and obstetric analgesia. She had eleven children.

About 1860 the Ohio State Medical Society published a therapeutics report on cannabis use. They recommended it for fourteen medical conditions for which cannabis is still used today.

<img class=postimg src=bin/uses-1860.jpg>

Physicians in California, Oregon and elsewhere where it is medically legal have found it effective for a very broad list of medical conditions.

Ms. Tia Taylor MPH indicates that cannabis/marijuana has been used for numerous (potential) uses. The conditions specified in the present communication indicate a very broad list of medical conditions. In fact the U.S. Pharmacopoeia up to 1937 listed one hundred successfully treated medical conditions.

<img src=bin/uses-current.jpg>

At the present time eleven U.S. states have legalized medical marijuana for at least 400 thousand patients with the numbers increasing rapidly as physicians can review records and sign applications or recommended forms.

There are no standard or optimal doses. The U.S. government has prevented any standardization of quantity or quality and medical users of Marinol, a synthetic THC, have found the natural substance far superior.

Inhalation of the medicinal compounds through a vaporizer as with asthma inhalers (not smoked as cigarettes or through a pipe) is the optimal means of titrating to optimal relief. Oral administering and absorption is fraught with difficulties and few patients use it even with Marinol.

Cannabis/marijuana is the safest medication ever discovered. The worst adverse effect is sleeping many hours with a very high "overdose" though Marinol causes panic attacks.

This author has had over 4,000 patients with all of the medical conditions mentioned. They all say "cannabis/marijuana is better than any and all of the standard prescriptions taken!"

by **palmspringsbum** » Sat Mar 22, 2008 6:37 pm

The Salem News wrote:Salem-News.com (Mar-20-2008 00:20)

Marijuana

Dr. Phillip Leveque Salem-News.com

Pharmacology and Therapeutics Part One.

<table class=posttable align=right width=300><tr><td class=postcell><img class=postimg width=300 src=bin/marijuana_daily-med.jpg></td></tr><tr><td class=postcell>Marijuana is daily medication for some patients. Photo: CAY</td></tr></table>(MOLALLA, Ore.) - Marijuana/Cannabis at one time was the most prescribed medicine in the United States. It was prescribed for more than one hundred medical conditions. Why it was made illegal is still not understood.

It was resurrected as legal medicine in 1998 in California and has been legalized in eleven other states. About 400,000 patients have permits to grow and use marijuana/cannabis now and the number of permits for use seem to increase at least 10 percent per year.

In the meantime, the US government estimates at least 10 million people are using it daily. About 750,000 people are arrested each year for using it.

IT HAS BECOME THE MOST VERSATILE DRUG OF THE 21ST CENTURY.

I have stated above that it has been and is now effectively used for about 100 medical conditions. The top three are pain, spasm and nausea/vomiting. It will require at least three more articles to cover this subject adequately.

The next goes to the table of medical conditions.

TABLE ONE

Medical Conditions Relieved by Marijuana/Cannabis as allowed under Oregon state law:

1. ALZHEIMER'S RAGE (agitation related to Alzheimer's disease)

2. CACHEXIA

3. CANCER

4. GLAUCOMA

5. HIV+/AIDS

6. NAUSEA

7. SEVERE PAIN

8. SEIZURES (including but not limited to epilepsy)

9. Persistent muscle spasms, including but not limited to those caused by multiple sclerosis

TABLE TWO

Medical Conditions Found by California Medical Marijuana Doctors

MENTAL ILLNESS - SCHIZOPHRENIA (pro and con articles have been reported)

OBSTETRIC PROBLEMS (dysmenorrheal, morning sickness, uterine bleeding, and antimiscarriage)

ARTHRITIS, OSTEO- and RHEUMATOID ASTHMA (while not burning cannabis)

ADDICTION, CHLORAL HYDRATE ADDICTION, ETC. (and probably tobacco addiction).

TUMORS (blockade of a carcinogenesis enzyme)

WITHDRAWAL SYMPTOMS OF ALCOHOLISM, MORPHINISM, COCAINE

CROHN'S DISEASE/INFLAMMATORY BOWEL DISEASE

AIDS WASTING SYNDROME

DEPRESSION

DEGENERATIVE NEURAL DISEASES

EATING DISORDERS/ANOREXIA

EPILEPSY/SEIZURES

GLAUCOMA

INTRACTABLE BREATHLESSNESS

MIGRAINE

MULTIPLE SCLEROSIS

NAUSEA AND VOMITING

PAIN, of all types

PHANTOM LIMB PAIN

Explanations of the pharmacologic action of marijuana/cannabis will be presented in subsequent articles.

by **palmspringsbum** » Thu Mar 12, 2009 11:12 am

An Historical Introduction to the Endocannabinoid and Endovanilloid Systems - Istvan Nagy, John P.M. White, Cleoper C. Paule, and Attila Köfalvi

by **palmspringsbum** » Fri Mar 20, 2009 7:12 pm

The National Institute of Health wrote:
Study Helps Unravel Mysteries of Brain’s Endocannabinoid System

NIDA research could lead to better treatment for pain and marijuana addiction

The National Institute of Health
March 16, 2009

New research funded by the National Institute on Drug Abuse (NIDA), part of the National Institutes of Health, has identified a new mechanism for the processing of endocannabinoids, natural brain compounds similar to THC, the active ingredient in marijuana. The results of this study, led by researchers from Stony Brook University, were published March 16 in the Proceedings of the National Academy of Sciences.

Endocannabinoids are known to play a role in numerous physiological processes including appetite, memory, and pain. Researchers had long suspected that endocannabinoids needed a specific transporter that would ferry them to the location where they are broken down. This study successfully identified a couple of previously known fatty acid binding proteins (FABPs) as capable of carrying the endocannabinoid anandamide (also known as AEA) from the cell membrane, through the cell interior, to the location where it is destroyed.

"This finding is important because it significantly expands the range of potential targets for developing medications that could help fight pain, addiction, and other disorders," said NIDA Director Dr. Nora D. Volkow. "For example, the manipulation of the endocannabinoid system has the potential to provide sorely needed therapeutics for the management of severe pain that are devoid of the side effects of opiate analgesics."

The breakdown of AEA requires two factors. First, because AEA is a fatty compound and thus unable to move inside the watery cellular environment, there needs to be a mechanism for transporting AEA to the location where it is inactivated. Second, the cell must express an enzyme called FAAH, which is responsible for breaking down and inactivating AEA. In the laboratory, the researchers coaxed a non-neuronal cell type (Cos-7) to express FAAH. These FAAH-expressing Cos7 cells were able to break down AEA efficiently, indicating that the intracellular AEA transport mechanism was already present and operational in these cells. The researchers identified these carriers as two different, previously known fatty-acid binding proteins (FABPs). By specifically inhibiting FABPs, they were able to decrease the breakdown of AEA by about 50 percent.

"Inhibiting FABPs could potentially raise the levels of AEA in the brain’s synapses," said Dr. Dale Deutsch, lead author of the study. "Naturally occurring AEA levels have been shown to curb pain without the negative side effects, such as motor coordination problems, of molecules like THC that can also bind the cannabinoid receptor. So it’s advantageous to try and target AEA for therapeutic purpose."

"From a theoretical viewpoint, this approach could be used for treating marijuana addiction," said Dr. Volkow. "Compounds that inhibit FABPs could produce an effect similar to nicotine patches for smokers or methadone for opiate replacement. This line of research may also be important for other types of addiction, such as chronic alcohol abuse, which also affects AEA levels," she explained.

In addition to pain control, researchers are also examining manipulation of the endocannabinoid system for treating anxiety, obsessive-compulsive disorder, traumatic brain injury, and other substance abuse disorders.

The National Institute on Drug Abuse is a component of the National Institutes of Health, U.S. Department of Health and Human Services. NIDA supports most of the world’s research on the health aspects of drug abuse and addiction. The Institute carries out a large variety of programs to inform policy and improve practice. Fact sheets on the health effects of drugs of abuse and information on NIDA research and other activities can be found on the NIDA home page at www.drugabuse.gov. To order publications in English or Spanish, call NIDA’s new DrugPubs research dissemination center at 1-877-NIDA-NIH or 240-645-0228 (TDD) or fax or email requests to 240-645-0227 or drugpubs@nida.nih.gov. Online ordering is available at http://drugpubs.drugabuse.gov.

The National Institutes of Health (NIH) — The Nation's Medical Research Agency — includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. It is the primary federal agency for conducting and supporting basic, clinical and translational medical research, and it investigates the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.

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