Vol. 8, Number 7
cheryl riley, James Freire,
Dr. David Bearman,
Gradi Jordan, Ed Glick,
Paul Armentano, Keith Stroup
Sunil Aggarwal, Julie Godard
Al Byrne, Amanda Reiman,
Jim Greig, Chip Whitley,
Sandee Burbank, Joan Bello
Dr. Ethan Russo, Bryan Krumm
Richard Miller, Arthur Livermore
AAMC Rhode Island
The Great Debate Is Almost Over - David Bearman, M.D.
Medicinal Cannabis Rising
The medical marijuana movement has had its fair share of critics. The majority of them do not have a medical background. The critics tend to be of the belief that the medicinal use of cannabis is a hoax, and has more to do with legalizing cannabis for recreational purposes than to relieve the symptoms of people who are ill. This is in the face of over 75 years of unrelenting propaganda.
If something (say Valium or morphine) has medicinal value and people want to utilize it therapeutically, that does not mean that society is also sanctioning its recreational use. Medicinal and recreational use are two different issues when it comes to regulation and the law. This effort to conflate the two is unfortunate because while related, conflating the two actually can interfere with needed policy change for both.
Support for Medicinal Cannabis
It is important to remember that notwithstanding wide recreational use that cannabis has significant medicinal value. Fortunately, we are in the midst of a new change in better public and medical opinion. Over 75% of Americans favor legalization for medicinal purposes. It is rumored that before the summer is out the DEA will reschedule cannabis, Sativex and Epidiolex. This has been a long time in coming. The pressure for this change has been ramping up for over 50 years. Over 100 medical organizations, including the American Medical Association (AMA), American College of Physicians (ACP), American Nurses Association (ANA) and the American Public Health Association (APHA) support cannabis being rescheduled so it can be integrated into mainstream medicine.
The former Surgeon General of the United States, Dr. Jocelyn Elders, said that there is an overwhelming amount of evidence to show that cannabis can relive certain types of pain. A 1997 editorial published in the New England Journal of Medicine, said that they thought that the federal policy of preventing physicians from prescribing marijuana for ill patients was "misguided, heavy-handed, and inhumane." Furthermore, the government funded Institute of Medicine report into the medicinal use of marijuana concluded that cannabis does indeed have medicinal properties.
Dr. Andrea Barthwell, who served as Deputy Director for Demand Reduction in the Office of National Drug Control Policy (ONDCP), between 2002 and 2005 has had an interesting change of position. During her time at the ONDCP she was highly critical of medical marijuana. However, after leaving that post, she became a paid lobbyist for GW Pharmaceuticals, the company that makes Sativex®, which is tincture of cannabis.
Another person who dramatically changed his opinion on medical marijuana is Bob Barr, a former member of the United States House of Representatives. Barr was a vigorous opponent of marijuana and a strong supporter of the War on Drugs. However, since joining the Libertarian party, Barr has seemingly reversed his previous opinions. He became a paid lobbyist for the Marijuana Policy Project, whose goal is to legalize the recreational use of marijuana. He bases this change on solid Libertarian philosophy - that after 9/11 the federal government accrued too much power to itself at the expense of the states.
No doubt the most dramatic change of heart was by Dr. Sanjay Gupta, CNN's medical reporter. He has come out with at least three documentaries championing the medical value of cannabis. He began the very first one by apologizing for his previous position critical and questioning cannabis’ medical value.
Change May Be Just Around the Corner
Every day it becomes clearer and clearer that cannabis is becoming restored to its historical position as an extremely useful and safe medication. Places like Australia, Uruguay, and Israel are ahead of the U.S. in this drug policy reform. As we proceed, we cannot let the government over-regulate cannabis. We must not let them underfund medical education on the endocannabinoid system (ECS), cannabis and cannabinoids. We must press for government funding of research on cannabis, cannabinoids and the ECS. Lastly we must watch for bait and switch so that efforts to legalize medical use do not throw medical use under the bus.
Administering Medical Marijuana - David Bearman, M.D.
As medicinal cannabis becomes more mainstream the options for various cannabis products as well as routes of administration has expanded. Essentially there are four or five different routes of administration: respiratory, oral, sublingual and topical. Oral can be by capsules, tablets, tinctures, edibles, and tea. Respiratory can be by cannabis cigarette (joint) and vaporizer.
The most well known method of taking cannabis for recreational use is the respiratory route, via smoking. However, in recent years vaporization, another type of respiratory delivery has become more and more popular. Vaporization involves heating up the cannabis to a temperature which releases into the air the volatile cannabinoids containing oils that are in the plant. Its benefits are the same rapid onset as a joint but without the carcinogens, other irritants and heat.
The respiratory route of administration is generally the best because the therapeutic effects of cannabis are almost instantaneous when taken in via the lungs. The respiratory route also allows for easy dose titration. The respiratory route can be via smoking or vaporizing. Vaporizing provides about 70% less irritants than smoking.
At present, there are many different brands and models of vaporizers on the market. The vaporization point for the various chemicals in cannabis is 190 to 340 degrees Fahrenheit and the combustion point is 451 degrees Fahrenheit. The smoke produced by vaporization is both cooler and contains about 70% fewer irritants than smoking marijuana cigarettes (aka joints).
Cannabis can also be consumed sublingually. That is the way that Sativex®, an under the tongue metered spray, tincture of cannabis product is administered. The benefit is that the onset is more rapid than swallowing, fifteen minutes compared to an hour. This is beneficial for chronic conditions like arthritis.
Cannabis can be ingested orally. This route goes back several thousand years to the use in bhang, a tea like drink in India for over 3,000 years. Oral administration is how the prescription drug Marinol® (synthetic THC) is administered. The oral route lasts longer than the respiratory (3-8 hours compared to 1 ½ - 2 ½ hours). New York Times columnist Maureen Dowed didn’t do her homework and ate over 100 mg. cannabis at one sitting she was miserable. The drawback is the possibility of dysphoria from too high a dose of THC.
It is also possible to use cannabis topically. Topical application of tincture of cannabis is an effective route of administration for people with arthritis of the hands, wrists, and feet. The tincture can provide pain relief and diminish swelling in the small joints of the fingers, wrists, and even ankles and toes of a patient whose small joints are afflicted by arthritis.
Historically the use of leaves or roots to make tea goes back at least to 1100 BCE in Ayervedic medicine. It is still used in India and is called bhang. It must be made with milk or cream because the cannabinoids are not water soluble. Many dispensaries carry flavored drinks spiked with cannabis. If the product is tested and labeled it is easier to get the right dose.
Use caution with dosing in so called edibles, like Aunt Suzie’s Brownies. Who knows how many Aunt Suzie’s there are, how many growers she buys from and what recipe she is using. Know the THC content of edibles you consume.
The problem with taking cannabis orally is that absorption rates vary, depending on motility and contents of the gastrointestinal tract. Unless you are using Marinol the dose may vary. If it is too much it can cause dysphoria, which can last for a couple of hours.
Know Your Dose
Particularly if you are using cannabis medicinally, you should purchase your medicine from a dispensary that tests and labels all its edible and drinkable products. Remember cannabis is medicine. So long as you treat it as such you should reap the therapeutic benefits with minimal side effects.
Alabama: Considering a medical marijuana law.
Arkansas: Considering a medical marijuana law.
Idaho: Considering a medical marijuana law.
Indiana: Considering a medical marijuana law.
Iowa: Considering a medical marijuana law.
Missouri: Considering a medical marijuana law.
North Carolina: Considering a medical marijuana law.
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.
Featured Recipe - Coma Cookies by Jay R. Cavanaugh, PhD.
Medical relief from the Canny Bus Trip Kit
There’s a dilemma in making medical cannabis edibles. In general, the stronger they are the worse they taste. Who wants a bitter tasting cookie? Who wants a great tasting cookie that doesn’t work? Compounding the dilemma is the fact that the stronger the cannabutter used in baking, the more the butter acts like oil which dramatically alters the baking properties.
Nurse Nancy Wife co-cook and I have come up with a modified cookie recipe that seems to solve the dilemma. WARNING: These cookies are not called “Coma” for nothing. They are very strong potent medicine used to treat severe muscle pain and cramping and insomnia related to chronic pain. Do not drive for at least 8 hours after ingestion.
First, we made Black Out Butter from high grade trim. This is nasty tasting stuff but has the needed potency. It is estimated that each cookie made from this recipe has from 0.7 grams to 1.5 grams of cannabis. Second, we didn’t combine our cannabutter with dairy butter as we usually do in our recipes. We used pure cannabutter. Third, we reduced the amount of additional ingredients to further increase the relative amounts of cannabinoids in the cookie and to keep the cookies moist.
2 cups all purpose flour
Sift together the dry ingredients (except the steel cut oats) and set aside. Cream the cannabutter and sugars then add the vanilla and mix in the eggs. Don’t overwork the butter and sugar or it will break down. Mix (we used an electric mixer) the set aside dry ingredients into the creamed butter. Mix in the oats with a heavy spoon and blend. Fold in the currants, cranberries, and pecans. Chill the batter (we made two portions and froze them). With the batter still cold roll the dough into balls about golf ball size.
Place the cookie balls on a greased baking pan and bake at 300 degrees for 15-17 minutes.
Hint: The cookies will flatten out and not rise as usual. They will be chewy and crispy at the same time. Keep the cookies in an airtight container (they should stay fresh a month that way).
Options: You may use raisins instead of currants. You may also want to add a teaspoon of lemon zest and/or some allspice or ground cloves.
Recommended beverage: Guatemalan Antigua coffee
Final note: Eat one whole cookie, sip coffee, and relax. You are now on a pain free vacation.
April 14-16, 2016
Baltimore, Maryland USA
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