We hope you enjoy the August 2015 AAMC newsletter.
Cannabis Is Medicine - David Bearman, M.D.
"Scant evidence that medical pot helps" read the recent headlines. With 5,000 years of known human medical use and 20,000 studies on cannabis and cannabinoids in the past twenty years, this statement is absurd on its face. A closer look at the studies find that only 2 of the 14 studies even used whole plant cannabis.
The U.S. government stands in the way of any studies that are designed to show benefits from cannabis, studies designed to show such benefit are few and far between. Studies on marijuana showing beneficial results are almost invariably blocked by the USPHS, and/or the FDA, and/or NIDA, and/or the DEA. And why not? Congress has limited NIDA's task to study the so-called dangers of drugs not the benefits.
This JAMA article reviews but a snippet of studies done since 1995. It would have us believe that the FDA, who approved THC (Marinol) in 1985, doesn't get it. Or possibly the JAMA article is saying that the favorable findings from several of the 18 FDA approved studies at four University of California Medical Schools from 2001-2010 on the medical utility of cannabis are wrong.
• Examples
Obviously space does not allow a review of all 20,000 studies. Here are just a few examples that the JAMA article appears to ignore:
Nausea
Apparently the studies done in the 80s in NM, TN, NY, IL, FL and CA are wrong about cannabis being an anti-nauseant and appetite stimulant. There are two indications approved for THC (Marinol) by the FDA.
HIV
The article ignores the work of UCSF oncologist Dr. Donald Abrams whose studies which proved cannabis was better at promoting weight gain on HIV than Marinol (THC).
Multiple Sclerosis
The findings of this meta-analysis of a mere 14 studies only two of which used actual marijuana, is out of touch with much of the research of the last 25 years. It seems to completely overlook the tincture of cannabis studies done by GW Pharmaceuticals in England since 1999. These studies by GW were sufficiently convincing to get 20 countries in the world to approve Nabiximol (tincture of cannabis) for treating pain related to MS, muscle spasm and intractable pain.
Epilepsy
I guess the authors missed the studies on the high CBD tincture of cannabis medicine (Epidiolox) reducing seizure frequency in subjects by 50%. This finding comes as no surprise. In 1947 a study by Drs. Ramsey and Davis showed that cannabis stopped completely or almost stopped the intractable seizures of 5 of 7 children with Cerebral Palsy. They recommended further study, which we finally got in 2014.
Neuropathic pain
Researchers at the University of California, Davis, reported in The Journal of Pain that patients with neuropathy (nerve pain) who used cannabis (the word scientists prefer to the slang "marijuana") were more likely to have significant relief than those taking a placebo. The chemical compounds in cannabis affect cell receptors in the brain, reducing pain and making it an alternative for patients who are unresponsive to standard drug therapies.
Deaths due to opiate overdoses have decreased 30% in states with legal MMJ as opposed to those where its illegal, means nothing. Beneficial results of cannabis on treating PTSD have been shown in Israel.
Crohn's Disease
Researchers at Tel Aviv University recently reported that 21 of 30 Crohn's patients who used cannabis had less pain and were able to reduce their use of other medications. They also were less likely to require surgery. The chemical compounds in cannabis reduce not only pain but also inflammation that causes ongoing tissue damage in the intestinal tract.
Cancer
We've known as long ago as 1974, from research done at the Medical College of Virginia (acting at the behest of the federal government) that cannabis inhibits malignant tumor
cell growth in culture and in mice. An August 18, 1974 Washington Post newspaper feature, reported that THC, "slowed the growth of lung cancers, breast cancers and a virus-induced leukemia in laboratory mice, and prolonged their lives by as much as 36 percent” This study was published in the Journal of the National Cancer Institute in 1975.
In January 2008 investigators at the University of Wisconsin School of Medicine and Public Health reported that the administration of cannabinoids halts the spread of a wide range of cancers, including brain cancer, prostate cancer, breast cancer, lung cancer, skin cancer, pancreatic cancer, colorectal cancer and lymphoma. The report noted that cannabis offers significant advantages over standard chemotherapy treatments because the cannabinoids in cannabis are both non-toxic and can uniquely target malignant cells
while ignoring healthy ones.
IND Program
Starting in 1978 the United States government enrolled 15 patients in the Investigational New Drug (IND) program. This program provides cannabis to people for whom the U.S. government has found it provides benefits. There are still 4, and the U.S. government sends these patients 7-9 lbs. of cannabis per year and has for over 25 years. Why? Because the government determined that it works.
I could go on and on but why bother. Dr. Donald Abrams, an oncologist at UCSFG, puts it "except for the period from 1942-1997 cannabis has been a medicine for 5,000 years". The petrochemical industry brought us the Marijuana Tax Act and the Pharmaceutical companies and good old fashioned racism is preventing us from realizing the full potential of cannabis as an analgesic, anxiolytic, anti-proliferative, anti-depressant, appetite stimulant, sleep aid, treatment for ADD, PTSD, bipolar disorder, migraine, auto immune disease, arthritis, IBS and Crohn's Disease.
Side Effects
The comments on side effects fly in the face of 1937 House testimony by the AMA, that they knew of no dangers from the medicinal use of cannabis and 2009 position of AMA that cannabis should not be schedule I; the 2005 position of FDA, that tincture of cannabis was safe for human study; the U.S. Dept. of HHS which has a patent for CBD; the FDA, who in 1988 approved of prescription THC (Marinol); and the 2005 FDA approval of a phase III study of tincture of cannabis. The FDA's Chief Administrative Law Judge considered that cannabis was one of the safest therapeutic agents known to man.
Conclusion
The JAMA article methodology doesn't hold up to scrutiny. There have been 20,000 studies done on cannabis and cannabinoids in the last 20 years, why were the 14 selected. Or why didn't they look at the research done at UC Davis, UC Irvine, UCSD, and UCSF under the auspices of the California Cannabis Research Center. At least five of these studies had to do with relief of pain and at least two were published in peer reviewed medical journals.
It is way past time to recognize (1) that cannabis and cannabinoids have legitimate medical value and (2) that the best preventive to substance abuse is not hysterical, inaccurate scare tactics, but stable supportive families who can give a child the love, care and time that that child requires to build self-esteem and develop personal responsibility and good decision making skills. This was the basis for a very successful federally
funded drug abuse intervention and prevention program run by the Santa Barbara County Schools over 30 years ago, for which I was but one of its many consultants.
There are 20 countries where tincture of cannabis is legal. Could it be that it is the JAMA article that is out of step?
Study: Scant Evidence That Medical Pot Helps Many Illnesses
By THE ASSOCIATED PRESS JUNE 23, 2015, 11:52 A.M. E.D.T.
Daniel... the untold story of an American soldier - Al Byrne
I never have met Dan's mother but we have talked on the phone a good bit and by email. It was in one of those first written notes that she got my attention. I was riveted on her words.
"Al, I gave the Marine Corps a fine young man, eager to serve his fellow Marines and his country and look what they gave me back".
His mom has a full length cardboard cutout of her son in his full dress blues. It is a picture of the poster Marine, the one chosen to visually exemplify the rest. Sergeant stripes and combat action awards proudly worn. A newer cardboard cutout would show a demoted and fined corporal, racked by prescription drugs.
Pain drives his day from an explosion in Iraq. He is consumed by it. He's a smart guy I judge from the many phone calls we have shared. He wants badly to work, to share his future life as an equal partner. His wife he credits with helping him adjust to living with PTS(d) and dealing with the non supportive KY facility. They were married in July of 2011 in a simple ceremony and, with his black Labrador Retriever, work together toward their goals.
When the State of Oregon first opened their cannabis door for approved patients 70% of those initially applying wanted cannabis for pain. Trauma pain, arthritis, phantom pain, joint pain such as fibromyalgia, rheumatism, more. Now it hovers near 80%.
His physical pain is in his back. It will be there for his life. The explosion also caused traumatic brain injury (TBI), and as has become increasingly known from studying the history of multiple traumas, Dan has been diagnosed with Post Traumatic Stress (PTS).
During the recovery period from his physical wounds he found cannabis, used cannabis and it helped him – a lot. He was an active duty Marine, subject at any time to a urine test not because he was deficient or had a negative attitude, or that he was acting abnormally for the uptight group, but because.
I do not know what else to write about this test on Dan. Just - because - that's what our country does now. Clinics, test labs, technicians, trucking companies, governments, multiple levels of business, national and international now spend billions of years of labor and dollars checking urine to prove only that the person in question did or did not use some prohibited substance recently. Other than the money flowing through that spigot the whole activity is illogical but it sure does let the worker know he or she is owned, controlled. Pretty close to military life.
He was doing well. Sure he hurt but it was bearable and he had hope- then- that prescription drugs and physical therapy and his youth would bring him to a functioning level or better. A urine test was announced and he told the Marines to save some money because he smoked pot and it helped him. Please help me he said.
He was “written up” for using an illegal substance, fined and demoted. He was placed on chemical drugs all while at a wounded warrior battalion in NC. Here he turned into a chemically induced zombie. Anger, confusion, terror, unconsciousness became his norm. The wounded with him did what you would expect, they protected and watched their buddy closely. They know that world of terror, wanting, needing it all to just go away. They saw the signs. He attempted to shoot himself in the head. The Marines stated that there were no suicides or attempted suicides that year at that command. His mother in KY was called and she and her husband were on the road. They drove straight through the night. Dawn saw them and the Officer in Charge of the wounded arrive.
By noon Dan and his parents were gone from the Marine base, going home to KY. He was not discharged but placed in the care of his family.
Nothing is ever over when you hurt day and night, and the terror inhabits your head. It's worse when your two tours in Iraq as a rifleman are dismissed as irrelevant to your emotional health by demoting you from earned rank and fining you as though you brought this nightmare upon yourself and you should pay for getting ordered to the wrong place at the wrong time.
Twenty years ago as a Vietnam Vet and combat counselor I lectured in meetings with health care professionals in Virginia where I was educating them about post traumatic stress. I stressed dropping the "D".
“Please drop the D. I know it is a medical term but it is inappropriate, it's insulting. These men and women are reacting normally to a completely abnormal set of traumatic experiences. Theirs is a normal reaction and you all must accept that as reality.” Call it a “response syndrome” to trauma. Change the medical terminology so that words “do no harm”.
I also found in those years it was normal for a Vet to use cannabis to calm him, to sleep, to eat, to give up hard drugs, to reduce or end alcohol use. Twenty years have passed and yesterday I spoke briefly with a man, now a senior law enforcement official in NC, who had in the past worked for 5 years in a VA hospital.
“It was everywhere in the hospital. We all knew what they were smoking and why. It was OK with everybody.”
It has not been OK for Dan. The VA hospital in Lexington, KY has refused to prescribe opiate based pain killers to him because of his past cannabis use as an active duty Marine and his continued use. The half dozen, non-opiate based chemicals they did try on him failed.
My call is that the VA system and the Marines failed Dan not the other way around.
It is flat unethical to deny pain medication for anybody let alone someone known to be a severely injured US warrior. That is what has been done without excuse. It's the hospital policy to deny opiates to known drug addicts an ER MD told Dan two weeks ago. Addict? It's right here in your Marine record that you used cannabis and are therefore an addict. I cannot help you.
I co-founded a Veterans service organization, Veterans for Medical Cannabis Access for exactly the behavior exhibited by this VA facility. Behavior, aberrant, illogical and demonstratively damaging to another human being I always thought was worth worrying about. Urine testing for such action could be justified but is not in this case. The Commanding Officer who allows this type of judgment, actually a lack thereof to prevail needs the test not a “grunt” in pain.
I have a letter in my possession written by the Undersecretary for Health, Department of Veterans Affairs, dated July 06, 2010 addressed to my co founder of VMCA, in part it reads...
“This is a follow-up response to your letter requesting clarification of the Veterans Health Administration's (VHA) policy regarding the practice of prescribing opioid therapy for pain management for Veterans who provide documentation of the use of medical marijuana in accordance with state law.” (State law is an important factor now in treatment for all Veterans regardless of duty period or medical problem. I call it treatment by geography. A completely new medical concept, never tried before in human history, being experimented with on the wounded.)
He continues, “If a Veteran obtains and uses medical marijuana in a manner consistent with state law, testing positive for marijuana would not preclude the Veteran from receiving opioids for pain management in a Department of Veterans Affairs (VA) facility.”
Dan did not in the Marines and does not obtain cannabis legally now in KY. If KY were to allow cannabis used clinically Dan would be ok.
Who or what do you want to blame for this travesty? The CO for being a bureaucrat instead of a doctor. Kentucky politicians for being feckless cowards. The ER physician for sending a man in pain out on the street. His case worker at the VA for being a lemming instead of a real advocate. The entire Congress of the United Sates for sending the youth off to war and then abandoning them because they smoked a joint? They all could be stand up humans but are not. Dan stood up and they could treat him as a role model instead they don't treat him at all.
Dan did two tours in Iraq. He did them both with Larry. The first tour for them physically was a pass. Men died around them, the smell of rot filled their senses, doubt filled their soul, heat, boredom and sudden terror filled their days but they were physically ok. During the second tour the world as they knew it ended forever for Dan and Larry, Marines.
Each was blown up by an IED, what we called in Nam a mine, built out of unexploded bombs from aircraft, or scavenged containers, and scraps of wire and filled with nails and glass and metal pieces and exploded with stolen C4 or old ordinance buried until needed.
They were both returned to duty and continued to patrol as before, but this was before TBI and the resulting potential for PTS was considered a wound. After returning to the US Dan was treated for PTS and cannabis use at a six week inpatient facility under Marine care. Months later there was a “failed” urine test, cannabis use, at the VA hospital and without an explosion, instead a mendacious, illogical “policy”, a myth according to the Undersecretary, changed Dan's life again and again for the worse. No pain control for a Marine in pain. “Support the Troops.” Picture all the yellow ribbons.
Larry was a California guy and returned to his home state after his discharge. He was and is treated in a VA hospital in that state. In California, its citizens voted to allow all residents to use cannabis therapeutically under medical supervision. The VA Undersecretary for Health as you have read has directed that opiate treatment be provided in VA facilities in “legal” states at the discretion and based on the judgment of the individual patients' needs and the attending physician, NP or PA. Larry is a registered cannabis patient and is treated for his pain with opiates. He is attending college.
On the phone Dan said to me, “Al, Larry and I were shot at by the same people. We shot at the same people. We got blown up by the same kind of bomb. The shrapnel I carry in me is the same shit that Larry carries in his body. Why won't they help me?”
Riveting.
Medical Cannabis - Healing with an herbal medicine
We are raising funds for a project that will produce educational videos about how marijuana is used in the treatment of various medical conditions. We need to raise at least $20,000 to get this project started. We will produce professional quality videos with medical cannabis experts and patients describing how they use marijuana to treat their condition.
