Vol. 6, Number 5
May 2014
cheryl riley, editor & writer
Dr. David Bearman,
Gradi Jordan, Ed Glick,
Paul Armentano,
Sunil K Aggarwal,
Amanda Reiman,
Jim Greig, Joan Bello,
Arthur Livermore
Who's Who
What's New
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Cannabis Therapeutics Conference in Portland, Oregon - Arthur Livermore

The Eighth National Clinical Conference on Cannabis Therapeutics was a popular event. It was attended by hundreds of doctors, nurses, lawyers, pharmacists, students and the general public. There were workshops for doctors, nurses and lawyers on the day before the conference in Portland, Oregon. Speakers presented the latest information about the Endocannabinoid System and how to use Cannabis to treat age-related illness.

Donald Abrams, MD presented information about the clinical use of Cannabis in cancer patients. Cannabinoids stimulate appetite and control nausea and vomiting caused by chemotherapy. Smoked Cannabis was superior to oral administration in treating these symptoms. He also described how Cannabis works in the treatment of pain and neuropathy. Cannabis can be used with opiate medications to safely treat pain using lower doses of opioids. Cannabinoids also induce cancer cell death.

David Allen, MD presented information about the repression of scientific knowledge about the endocannabinoid system. A survey of 157 accredited American medical schools showed that only 13% of the medical schools surveyed teach endocannabinoid science to our future doctors.

Mark Ware, MD talked about the educational needs of health care professionals. In a survey of 426 clinicians he found that the majority of clinicians do not have information about the risks and benefits of medical marijuana or the appropriate use of marijuana for medical purposes.

Michelle Sexton, MD talked about Cannabis as an adaptogenic herb. It has a normalizing effect so that it stimulates in depression and sedates when there is irritation. Cannabis has a biphasic action and will stimulate the Endocannabinoid System in low doses while inhibiting in high doses.

Cecilia Hillard, PhD presented information about endocannabinoids and mood disorders. Anxiety, depression and post-traumatic stress disorder (PTSD) are the result of endocannabinoid deficiency. This deficiency creates a poor ability to buffer stress.

Perry Fine, MD talked about cannabinoids and pain. There are multiple types of pain and traditional treatments target neural circuits using anticonvulsants, opioids, antidepressants and analgesics. In the future cannabinoids will become part of the analgesic formulary.

Julian Romero, PhD talked about the endocannabinoid system and Alzheimer’s disease. Cannabinoids improved agitation and aggressiveness in patients with Alzheimer’s disease. Cannabinoids also show promise in slowing the progression of Alzheimer’s disease.

Gregory Carter, MD presented information about the use of Cannabis in the management of neuromuscular disorders. Cannabinoids are useful as analgesics, sedatives, anti-inflammatory, antispasmodic, anticonvulsant, antiemetic, appetite stimulants, and neuroprotective agents.

Reem Smoum-Jaouni, PhD discussed the use of cannabinoids in cardiovascular problems. Acute use of marijuana may increase the heart rate and chronic use may slow the heart rate. Cannabinoids produce dilation of blood vessels and reduce blood pressure. Cannabinoids also reduce inflammation.

Dustin Sulak, DO talked about the art of cannabinoid medicine. In his Maine medical practice he uses Cannabis in place of conventional medicines that are more dangerous and less effective, especially opioids and benzodiazepines. The effects of Cannabis are holistic and affect multiple body systems. It empowers the homeostatic capacity of the body.

Sunil Aggarwal, MD, PhD discussed the therapeutic use of Cannabis in hospice and palliative care. The focus of care in palliative medicine is on individual choice, patient autonomy, empowerment, comfort and quality of life. Prolonged use of Cannabis produced significant improvement in all aspects of supportive and palliative care in cancer patients.

Many more speakers discussed the progress of medical marijuana laws and standards for Cannabis products. Patients Out of Time continues to educate health care professionals and the public. This conference was part of ongoing efforts to return Cannabis to medical practice. The Ninth National Clinical Conference on Cannabis Therapeutics will be in April 2015 at the Florida State University Conference Center, Tallahassee, Florida. Raphael Mechoulam PhD., Professor of Medical Chemistry at Hebrew University in Jerusalem, Israel will be the keynote speaker.

SCC/AACM Report on Certification Prep Symposium Prior to the Patients Out of Time Conference
On May 8, 2014 the Society of Cannabis Clinicians/American Academy of Cannabinoid Medicine (SCC/AACM) put on our third certification preparation course in Portland, Oregon the day before the start of the Patients Out of Time seventh conference.

Those of you who follow the professional side of the cannabinoid medicine movement may already be aware that the two largest and most prestigious health care professional cannabinoid medicine groups (SCC and AACM) have merged. This has created a more powerful voice for the clinical application of cannabis. We will soon have twelve one-hour category I CME course on line. This will allow more clinicians to familiarize themselves with cannabis, cannabinoids and the endocannabinoid system. Prior to the course Drs. Jeff Hergenrather and David Bearman discussed the mechanics and importance of the AACM/SCC merger.

The course was well attended with over 80 health care professionals and cannabinoid medicine industry representatives in attendance. The enthusiasm was palpable. This was a big increase over the 17 who attended our pre-P.O.T. conference course two years ago in Tucson. Over 70% of the attendees were MDs DOs and NPs.

The course started at 11:00 a.m. and went to 5:15 p.m. The agenda was:
  • Course Introduction/Hx of cannabis in medicine - David Bearman, M.D.
  • Endocannabinoid System, Retrograde Inhibition - Dustin Sulak, D.O.
  • Cannabis as an Herbal Medicine - Michelle Sexton, Naturopath Doctor
  • Dosing and Methods of delivery - Deborah Malka, M.D.
  • Topicals - Jake Felice, Naturopathic Doctor
  • Analgesia - Deborah Malka, M.D., Ph.D. & David Bearman, M.D.
  • Cannabinoid Medicine Practice Standards - Frank Lucido, M.D.
  • Crohn’s Disease and GI issues/nausea - Jeff Hergenrather, M.D.
  • Cannabis and Cancer Treatment - Jeff Hergenrather, M.D.
  • Psychiatric Issues/PTSD - Chris Fichtner, M.D.

The audience was eager to learn and asked numerous relevant questions. It is hard to say which presentation was the most well-received since the presentations were universally informative and responsive to the needs of practicing cannabinoid medicine specialists. We look forward to having a presentation next April before the anticipated 2015 Patients Out of Time Conference in Tallahassee at Florida State University.

In the evening at the P.O.T. opening reception I ran into Dr. Mark Ware of McGill who gave me some feedback that he had heard that our course was very well received.

At this time SCC/AACM is working on an on-line course of 12 one hour units each worth one credit hour of Category I CME. This should be coming out in the fall.

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What's New

Alabama: Considering a medical marijuana law.
   HB642 - The Michael Phillips Compassionate Care Act of Alabama

Arkansas: Considering a medical marijuana law.

Florida: Medical marijuana petition drive underway.

Idaho: Considering a medical marijuana law.

Indiana: Considering a medical marijuana law.

Iowa: Considering a medical marijuana law.

Kansas: Medical marijuana petition drive underway.
   Marijuana Bill Reaches House
   Cannabis Compassion and Care Act

Minnesota: Considering a medical marijuana law.

Missouri: Considering a medical marijuana law.
   HOUSE BILL NO. 1670 - An Act relating to the use of marijuana for medicinal purposes
   Cottleville Mayor Don Yarber hopes Missouri legislature passes medical marijuana law

New York: Considering a medical marijuana law.
   Medical Marijuana Bills Introduced

North Carolina: Considering a medical marijuana law.
   North Carolina Medical Cannabis Act

Ohio: Considering a medical marijuana law.
   HB 214

Pennsylvania: Considering a medical marijuana law.
   HB 1393

South Carolina: Considering a medical marijuana law.

South Dakota: Medical marijuana petition drive underway.

Tennessee: Considering a medical marijuana law.

Texas: Considering a medical marijuana law.

Wisconsin: Considering a medical marijuana law.
   The Jacki Rickert Medical Marijuana Act

Featured Recipe - Better Bud Butter

We’ve received numerous inquiries about just how one goes about making butter for all of these recipes. Well, folks have been making butter from cannabis for as long as I can remember which unfortunately is quite long. In the 60’s butter was not widely used as cannabis was in short supply and many folks smoked the leaves as well as any flowers (bud) they might acquire.

Even before the widespread use of medical cannabis in the 80’s and 90’s, increasing numbers of folks who had access to significant quantities of leaf, began to use basic recipes to make cooking products including butter and oil. All of these basic recipes involved slow and low cooking of dairy butter (or oil) and chopped leaf (in roughly equal proportions) to produce a deep green butter. This butter could be very potent but tastes pretty terrible. The problem is that butter made from the whole leaf will include both the chlorophyll and terpenes (as in turpentine) from the plant.

The use of Cannabis for medical purposes has spurred innovation and variety in Cannabis products. Many patients cannot or will not smoke. Of course there are vaporizers and tincture (the subject of a future recipe) but butter is the easiest to cook with and food products are not only well tolerated but can be very tasty and add much needed nutrition. The better the butter the greater the application is in recipes ranging from baked goods to soups to stews, to a wide variety of sauces.

This author relies on the "experts" for the following butter recipes. There are a few basic principles to good butter:

  1. Use very low heat as to not lower the potency or alter the biochemical characteristics of the Cannabis.
  2. Use high quality sweet unsalted dairy butter.
  3. Use a roughly 50/50 ratio (by weight) of plant product and dairy butter. With potent strains or flowers instead of trim the ratio can be easily changed to 10/1 (butter to plant). The resulting butter will have lighter color and better taste.

Bud Butter and Trim Butter: Manicure and dry flowers and/or bud trimmings. Grind to a powder with an electric coffee grinder. Melt the unsalted dairy butter first in a crock pot set on low. Gradually add the trim or flower powder with constant stirring. Cook in crock pot covered on the lowest setting with frequent stirring for two to four hours. Before the dark green butter cools, pour through a cheese cloth and squeeze into plastic tubs. Once the butter cools you can cover the tubs and place them in the refrigerator to finish cooling.

Potency: Potency of butter can vary tremendously depending upon the strain and which portions of the plant are used. Adding four to six ounces of powdered bud trim to two pounds of dairy butter will produce extremely powerful butter. Adding 2-4 tablespoons of such butter to a recipe that serves 10 means that each portion is receiving approximately 1-3 grams of Cannabis. Cookies and brownies made with this butter can be even stronger. Most of the good cookie recipes call for as much as 16 tablespoons of butter to three dozen cookies. These cookies are strong. Although patient dose requirements for orally delivered Cannabis are 4-10X higher than when smoked, one can see a portion can be quite potent. Unlike smoked Cannabis, the effects of the butter will appear more slowly and have much longer duration.

Storage: Butter can be kept in the freezer in airtight containers. Butter kept in this fashion can last many months. One should frequently inspect the butter to insure mold has not spoiled it. If mold has developed or the butter has been exposed and become rancid then it is best to toss it. When in doubt, throw it out.

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8th National Clinical Conference on Cannabis Therapeutics
May 8, 9, 10, 2014
Portland, Oregon USA

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