Friday, March 10, 2017

Petition: Requesting The Inclusion Of A New Medical Condition: Substance Abuse Disorder

Jason Barker - Medical Cannabis Patient & Organizer with LECUA Patient’s Coalition Of New Mexico LECUA_thc_cbd.png

LECUAPatientsCoalitionNM@gmail.com
dukecitywellness.blogspot.com

Tuesday, February 28th 2017

New Mexico State Department of Health
Medical Cannabis Advisory Board
Medical Cannabis Program
PO Box 26110
Santa Fe, NM, 87502-6110




Petition: Requesting The Inclusion Of A New Medical Condition: Substance Abuse Disorder
Table of Contents
Pg.  1 Cover Page
Pg.  2 Petition Introduction
Pg.  3 Petition Purpose and Background
Pg.  23 Relief Requested In Petition
Pg. (Noted) References
Pg.  23 - 34 Appendix A & B

 

Printing Provided By:




Petition Introduction: Requesting The Inclusion Of A New Medical Condition: Substance Abuse Disorder

New Mexico’s medical cannabis history started in 1978, after public hearings the legislature enacted H.B. 329, the nation’s first law recognizing the medical value of cannabis. The New Mexico’s medical cannabis program (MCP)  is the only program in the U.S. that places sole responsibility for regulation on the state’s Department of Health. Doctors must comply with state requirements for patients to be considered for applying to the medical cannabis program.

In the Lynn and Erin Compassionate Use Act, (2007) the law states; The Secretary of Health shall establish an advisory board consisting of eight practitioners representing the fields of neurology, pain management, medical oncology, psychiatry, infectious disease, family medicine and gynecology. The practitioners shall be nationally board-certified in their area of specialty and knowledgeable about the medical use of cannabis. The members shall be chosen for appointment by the Secretary from a list proposed by the New Mexico Medical Society. A quorum of the advisory board shall consist of three members. The advisory board shall:
A. review and recommend to the department for approval additional debilitating medical conditions that would benefit from the medical use of cannabis;
B. accept and review petitions to add medical conditions, medical treatments or diseases to the list of debilitating medical conditions that qualify for the medical use of cannabis;
C. convene at least twice per year to conduct public hearings and to evaluate petitions, which shall be maintained as confidential personal health information, to add medical conditions, medical treatments or diseases to the list of debilitating medical conditions that qualify for the medical use of cannabis;
D. issue recommendations concerning rules to be promulgated for the issuance of the registry identification cards; and
E. recommend quantities of cannabis that are necessary to constitute an adequate supply for qualified patients and primary caregivers.

First, do no harm.  As an important step in becoming a doctor, medical students must take the Hippocratic Oath. And one of the promises within that oath is “first, do no harm”.  

We have a sound law in the Lynn and Erin Compassionate Use Act, as Section 2 reads; PURPOSE OF ACT.--The purpose of the Lynn and Erin Compassionate Use Act is to allow the beneficial use of medical cannabis in a regulated system for alleviating symptoms caused by debilitating medical conditions and their medical treatments.
“ARTICLE 2B. LYNN AND ERIN COMPASSIONATE USE ACT
N.M. Stat. Ann. § 26-2B-2 (2009)
    § 26-2B-2. Purpose of act
The purpose of the Lynn and Erin Compassionate Use Act [26-2B-1 NMSA 1978] is to allow the beneficial use of medical cannabis in a regulated system for alleviating symptoms caused by debilitating medical conditions and their medical treatments.
HISTORY: Laws 2007, ch. 210, § 2.
EFFECTIVE DATES. --Laws 2007, ch. 210, § 12 makes the act effective July 1, 2007.”

Mosby’s Medical Dictionary states that “medical treatment” means; the management and care of a patient to combat disease or disorder. Medical treatment includes: Using prescription medications, or use of a non-prescription drug at prescription strength; and or treatment of disease by hygienic and pharmacologic remedies, as distinguished from invasive surgical procedures. Treatment may be pharmacologic, using drugs; surgical, involving operative procedures; or supportive, building the patient's strength. It may be specific for the disorder, or symptomatic to relieve symptoms without effecting a cure.(Mosby's Medical Dictionary, 9th edition.)

What is a chronic medical condition?
A chronic disease is one lasting 3 months or more, by the definition of the U.S. National Center for Health Statistics. Chronic diseases generally cannot be prevented by vaccines or cured by medication, nor do they just disappear. Harvard Medical Dictionary defines chronic as: Any condition that lasts a long time or recurs over time; chronic pain as: Pain that persists after an injury has healed or a disease is over; and chronic pain syndrome as : Long-term, severe pain that doesn't spring from an injury or illness, that interferes with daily life, and is often accompanied by other problems, such as depression, irritability, and anxiety.
What is the meaning of debilitating?
Something that's debilitating seriously affects someone or something's strength or ability to carry on with regular activities, like a debilitating illness. Debilitating comes from the Latin word debilis, meaning "weak." That's why you'll often see the adjective used to describe illness, despite the negative reference.
Petition Purpose and Background

The purpose of this petition is; Requesting The Inclusion Of A New Medical Condition: Substance Abuse Disorder. (substance use disorder, for which the applicant or qualified patient is currently undergoing treatment for the applicant's or qualified patient's condition)

This petition for the Medical Treatment that pertains to: Requesting The Inclusion Of A New Medical Condition: Substance Abuse Disorder, is being provided to the state Department of Health Medical Cannabis Program so the advisory board can review and recommend to the department for approval additional debilitating medical conditions that would benefit from the medical use of cannabis with the Lynn and Erin Compassionate Use Act.

Who Should Qualify for Medical Cannabis Use?
According to Americans For Safe Access Policy Studies & Research:
Background: The most fundamental aspect of medical cannabis laws is the relationship between a patient and their physician. It is often only the physician and the patient that possess information about a patient’s health condition. However, many public officials and others who oppose medical cannabis laws often make assumptions about people’s health. The media have even fomented such inappropriate assumptions by naming a category of patients “Young Able Bodied Males,” condemning certain patients by visual assessment alone.

Findings: The health care information discussed between a patient and physician is considered private and protected under federal HIPAA laws. It is typically the purview of state medical boards to assess whether a physician has inappropriately recommended cannabis to someone who should not be qualified. Studies have shown in some medical cannabis states that the majority of patients suffer from chronic pain, an ailment that is not obviously detectable by another person. Nevertheless, police will often harass and arrest patients based on the assumption that someone is faking their illness.

Position: Medical professionals should have an unrestricted ability to recommend cannabis therapeutics and that should not be impacted by law enforcement’s perceptions.

Americans For Safe Access policy further states:
“Qualifying medical condition” shall mean any condition for which treatment with medical cannabis would be beneficial, as determined by a patient's qualified medical professional, including but not limited to cancer, glaucoma, positive status for human immunodeficiency virus, acquired immune deficiency syndrome (AIDS), hepatitis C, amyotrophic lateral sclerosis (ALS), Crohn’s disease, Parkinson’s disease, post-traumatic stress disorder, arthritis, chronic pain, neuropathic and other intractable chronic pain, and multiple sclerosis.
“Qualifying patient” shall mean a person who has a written recommendation from a qualified medical professional for the medical use of cannabis.


Substance Use Disorder

Substance Use Disorder is a complex brain disease and includes such diseases as alcoholism and drug addiction. Substance Use Disorders occur when a person has a dependence on alcohol and or drugs that is accompanied by intense and sometimes uncontrollable cravings and compulsive behaviors to obtain the substance.

The DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th Edition: DSM-5) establishes these types of Substance-Related Disorders: Alcohol, Caffeine, Hallucinogens, Inhalant, Opioid (e.g., heroin), Sedatives, Hypnotics, or Anxiolytics (e.g., valium, "qualudes"), Stimulants (cocaine, methamphetamine), Tobacco
*Substance use disorder does not apply to caffeine. Regardless of the particular substance, the diagnosis of a substance use disorder is based upon a pathological set of behaviors related to the use of that substance. These behaviors fall into four main categories: 1. Impaired control 2. Social impairment 3. Risky use 4. Pharmacological indicators (tolerance and withdrawal)
The Proof Medical Cannabis Works: A neuroscientist who studies the molecular and neurochemical effects of both cannabinoids and opioids argues that the area of medical cannabis research is largely neglected, in a recently-published Trends of Neuroscience report. Yasmin L. Hurd, PhD, and the Ward-Coleman Chair of Translational Neuroscience at the Icahn School of Medicine at Mount Sinai and Director of the Center for Addictive Disorders for the Mount Sinai Behavioral System addresses the benefits of cannabidiol found in several animal studies and a small human pilot study.
Preclinical animal studies demonstrated evidence that the substance reduces rewarding properties of opioid drugs and withdrawal symptoms, and directly reduces heroin-seeking behavior. These results mirrored those of the human study led by Dr. Hurd, which revealed that the drug decreased cravings and anxiety induced by heroin cues.
The review indicates that both cannabinoids and opioids have pain-relieving properties, but opioids particularly target acute pain, while cannabinoids have a primary effect on alleviating inflammation based chronic pain. Both drugs affect separate areas of the brain, and cannabinoids’ low potential for lethality reduces concerns about overdoses. Cannabinoids even retain their safe profile when combined with a strong opioid agonist, and have demonstrated therapeutic value in children with epilepsy.
A previous retrospective, cross-sectional survey of patients with chronic pain underscored an association between cannabis use and lower opioid use. Overall, cannabis use was associated with 64% lower opioid use in the patients who completed the survey. Patients also reported better quality of life and fewer medication adverse effects.
As the cannabis movement continues to cultivate itself in New Mexico, awareness of cannabis grows specifically for lawmakers at the Roundhouse in 2017. Legislation being debated ranges from; Medical Cannabis Program improvements & research for patients, Hemp legislation, and three proposals for the legalization of cannabis for adult use.  Yes, there is a lot of amazing progress being made and people are becoming more educated on the positive qualities of cannabis. As New Mexico works to define a model for cannabis legalization that protects and improves the state’s medical cannabis program and puts patients first as well, lawmakers have a lot of history to contend with. New Mexico’s medical cannabis history started in 1978 (After public hearings the legislature enacted H.B. 329, the nation’s first law recognizing the medical value of cannabis). However, frustrations persist due to some basic misconceptions about cannabis and the medical cannabis program...below are some highlights that will make some rethink their theory that cannabis is bad for a person’s health.

“Marijuana, in its natural form, is one of the safest therapeutically active substances known to man.”
— DEA Administrative Law Judge Francis Young
Docket No. 86-22. 1988.

Drug Addiction
Cannabis therapy has been used in addiction recovery for more than 100 years.
From “Marijuana in Medicine” by Tod H. Mikuriya M.D. (1969):
“Because cannabis did not lead to physical dependence, it was found to be superior to the opiates for a number of therapeutic purposes. Birch, in 1889, reported success in treating opiate and chloral addiction with cannabis, and Mattison in 1891 recommended its use to the young physician, comparing it favorably with the opiates.”
Recent science:
~
Source Pain is the number one reason people seek medical attention, and patients seeking pain relief are the most prevalent group employing cannabis medicines. Chronic pain seriously interferes with the quality of life for many patients. For some, strong prescription pain medications (opioids) have provided them relief. Unfortunately several problems can follow with the use of opioids on a long term basis. Patients may soon develop a tolerance to the analgesic effects, thus requiring ever increasing doses. Chronic use of opioids also causes unwanted side effects that include such problems as constipation, feeling drugged, nauseated, and depressed.
Countless self-reports from chronic pain patients who use cannabis for pain management show a common theme. These patients report that they are able to either significantly decrease their dose of opioids or discontinue opioid use completely. They also report the benefit of no longer having to deal with opioid side effects such as constipation, nausea or depression.
A typical observation by patients is that their use of cannabis doesn’t necessarily take away the pain, but that they are no longer preoccupied with the pain; they are able to ignore it. Research is beginning to show that there is a synergy between cannabinoids and opioids and thus, a patient could decrease the amount of opioids necessary to manage pain due to the opioid sparing effect of cannabis. Since opioids carry the risk of overdose along with other unwanted side effects, adding cannabis to their treatment regime allows patients to achieve more comfort with a lower amount or no opioid medication. Source
Non Habit Forming
Mikurya found Cannabis to be non habit forming as well…
“.. . there is positively no evidence to indicate the abuse of cannabis as a medicinal agent or to show that its medicinal use is leading to the development of cannabis addiction. Cannabis at the present time is slightly used for medicinal purposes, but it would seem worthwhile to maintain its status as a medicinal agent for such purposes as it now has. There is a possibility that a re-study of the drug by modern means may show other advantages to be derived from its medicinal use.”
From TIME magazine – 1931:
“…in spite of the legends, no case of physical, mental or moral degeneration has ever been traced exclusively to marijuana… Because of its non-habit-forming character, doctors have recently been experimenting with the drug as an aid in curing opium addiction.”
More studies have uncovered similar results, finding only scant evidence of physical dependence and withdrawal in humans:
When human subjects were administered daily oral doses of 180-210 mg of THC – the equivalent of 15-20 joints per day – abrupt cessation produced adverse symptoms, including disturbed sleep, restlessness, nausea, decreased appetite, and sweating. The authors interpreted these symptoms as evidence of physical dependence. However, they noted the syndrome’s relatively mild nature and remained skeptical of its occurrence when marijuana is consumed in usual doses and situations. 1 Indeed, when humans are allowed to control consumption, even high doses are not followed by adverse withdrawal symptoms. 2
Signs of withdrawal have been created in laboratory animals following the administration of very high doses. 3 Recently, at a NIDA-sponsored conference, a researcher described unpublished observations involving rats pretreated with THC and then dosed with a cannabinoid receptor-blocker. 4 Not surprisingly, this provoked sudden withdrawal, by stripping receptors of the drug. This finding has no relevance to human users who, upon ceasing use, experience a very gradual removal of THC from receptors.
~ So, why do we hear so much about the increasing number of “marijuana addicts? ~
The most avid publicizers of marijuana’s addictive nature are treatment providers who, in recent years, have increasingly admitted insured marijuana users to their programs. 5 The increasing use of drug-detection technologies in the workplace, schools and elsewhere has also produced a group of marijuana users who identify themselves as “addicts” in order to receive treatment instead of punishment. 6
Less addictive than caffeine
Source Dr. Jack E. Henningfield of the National Institute on Drug Abuse and Dr. Neal L. Benowitz of the University of California at San Francisco ranked six psychoactive substances on five criteria.
  • Withdrawal — The severity of withdrawal symptoms produced by stopping the use of the drug.
  • Reinforcement — The drug’s tendency to induce users to take it again and again.
  • Tolerance — The user’s need to have ever-increasing doses to get the same effect.
  • Dependence — The difficulty in quitting, or staying off the drug, the number of users who eventually become dependent
  • Intoxication — The degree of intoxication produced by the drug in typical use.
The tables listed below show the rankings given for each of the drugs. Overall, their evaluations for the drugs are very consistent. It is notable that marijuana ranks below caffeine in most addictive criteria, while alcohol and tobacco are near the top of the scale in many areas.
Alcoholism
In December 2009 new findings emerged as to the benefit of cannabis as a treatment for alcoholism:
Substituting cannabis in place of more harmful drugs may be a winning strategy in the fight against substance misuse. Research published in BioMed Central’ open access Harm Reduction Journal features a poll of 350 cannabis users, finding that 40% used cannabis to control their alcohol cravings, 66% as a replacement for prescription drugs and 26% for other, more potent, illegal drugs.
Amanda Reiman, from the University of California, Berkeley, USA, carried out the study at Berkeley Patient’s Group, a medical cannabis dispensary. She said, “Substituting cannabis for alcohol has been described as a radical alcohol treatment protocol. This approach could be used to address heavy alcohol use in the British Isles – people might substitute cannabis, a potentially safer drug than alcohol with less negative side-effects, if it were socially acceptable and available”.
Reiman found that 65% of people reported using cannabis as a substitute because it has less adverse side effects than alcohol, illicit or prescription drugs, 34% because it has less withdrawal potential and 57.4% because cannabis provides better symptom management. She said, “This brings up two important points. First, self-determination, the right of an individual to decide which treatment or substance is most effective and least harmful for them. Secondly, the recognition that substitution might be a viable alternative to abstinence for those who can’t or won’t completely stop using psychoactive substances”.
Speaking about legalization of cannabis, Reiman added,
“The economic hardship of The Great Depression helped bring about the end of alcohol prohibition. Now, as we are again faced with economic struggles, the US is looking to marijuana as a potential revenue generator. Public support is rising for the legalization of recreational use and remains high for the use of marijuana as a medicine. The hope is that this interest will translate into increased research support and the removal of current barriers to conducting such research, such as the Schedule I/Class B status of marijuana”.
See Also
Harm Reduction Journal – full text study
Marijuana protects from alcohol-induced brain damage
Too much alcohol can lead to permanent brain damage, but a new study suggests marijuana may be able to prevent this.
Published…in the journal Pharmacology Biochemistry and Behavior, scientists from the University of Kentucky and University of Maryland concluded that a chemical in marijuana called cannabidiol (CBD) could be used to ward off alcohol-induced brain damage. (Source)
Marijuana found to discourage use of hard drugs
A ground-breaking study of 4117 marijuana smokers in California reveals that the ‘Gateway Theory’ probably had it backwards. Instead of enticing young people to use other drugs, this study suggests that marijuana may have the opposite effect.
This first-ever clinical examination of a large number of medical marijuana applicants depicts a population that is remarkably normal. The percentages earning bachelors’ degrees and doctorates are nearly identical to the national numbers. They are, in the main, productive citizens with jobs, homes and families who smoke marijuana weekly or daily – and have in some cases for decades.
For the vast majority of these applicants, their use of cannabis ultimately led to a decrease in the use of tobacco, alcohol, and hard drugs. Asked to compare their current alcohol consumption with their lifetime peak, over 10% claimed to be abstinent and nearly 90% claimed to have cut their drinking in half.
They also report using cannabis as self medication for stress and anxiety – with fewer side effects than the legal pharmaceutical alternatives.
As children, a significant percentage of the male applicants had been treated for ADHD (Attention Deficit Hyperactivity Disorder). Today their routine morning use of minimal amounts of cannabis strongly suggests that it enhances their ability to concentrate by allowing them to focus on one problem at a time.
As one construction company estimator said, “After two hits and my morning coffee, I’m the best estimator in the company.” Source / study
See also: Twin study fails to prove ‘gateway’ hypothesis
Study shows role of Endocannabinoid system in curing people of addiction to hard drugs
Source According to a new study by the National Institute of Health, cannabis may be an effective treatment in curing people of addiction from hard drugs such as cocaine and amphetamines.
According to researchers, this study “presents an up-to-date review with deep insights into the pivotal role of the ECBS [endocannabinod system] in the neurobiology of stimulant addiction and the effects of its modulation on addictive behaviors. They state that; “A growing number of studies support a critical role of the ECBS and its modulation by synthetic or natural cannabinoids in various neurobiological and behavioral aspects of stimulants addiction.”
For the study, researchers found that “cannabinoids modulate brain reward systems closely involved in stimulants addiction, and provide further evidence that the cannabinoid system could be explored as a potential drug discovery target for treating addiction across different classes of stimulants.”
The study, which was conducted at the Psychiatry Research Unit at Centre Hospitalier de l’UniversitĂ© de MontrĂ©al in Canada, can be viewed by clicking here.
History and case studies
Cannabis has been used by doctors to treat opiate dependence since at least 124 years, according to documentation from multiple doctors dating anywhere from 1889 to 2009. One such doctor was E. A. Birch, M.D. who recorded success in treating not only opiate dependence with cannabis, but also Chloral addiction.
In 1887, while in Calcutta, India, Birch came upon a man who confided in him that he suffered from an opiate addiction. After the man’s wife reportedly died of the same addiction, the man’s use of the drug became so heavy that he was fully addicted. He couldn’t sleep without the drug, couldn’t eat at all and often contemplated suicide. After analyzing the patient, Birch prescribed a tincture containing 10 minims cannabis indica and strophanth. Birch then instructed the patient to take the tincture medicine daily as prescribed and report back in 6 weeks. After 6 weeks, the patient returned. He reported that at first his use of the drug had greatly improved, but over time he stopped taking his medication regularly and slipped back into the full intensity of his addiction. After hearing this, Birch then prescribed his patient a pill containing cannabis indica. Amazingly, in just 24 hours the cravings for the opiates were gone, the man took the pill (which lasted longer and was stronger than the tincture) as prescribed and returned to living a healthy and productive life. He never used opiates again.
Much more recently, in 2009 ScienceDaily published a report by Valerie Dauge of the Laboratory for Physiopathology of Diseases of the Central Nervous System. In this report, she and her team concluded that, when given 10 mg injections of THC (the main active ingredient found in marijuana), lab rats who were previously addicted to morphine and/or heroin gradually reduced their dependence on the drug, finally being cured. It’s hypothesized then, that opiate addiction could soon become a reason for a prospective patient to obtain a medical marijuana prescription.
Cannabis hasn’t just been used to treat those addicted to opiates either. It can also help reduce the need for opiate-based drugs in patients with chronic pain and severe pain. In several cases, patients who lived a life that would be full of pain if it weren’t for heavy-duty painkillers such as Oxycodone, Oxycontin, morphine, etc, were given a prescription a 2 – 4 “puffs” of marijuana periodically throughout the day. In these cases, the patients pain medications were reduced by up to half the amount they normally had to take to be pain-free. This, in turn, caused them to be less-dependent on the drugs.
Some may then raise the question of whether or not those who use cannabis to treat opiate dependence would then become dependent of cannabis. However zero – I repeat, zero – research has found that cannabis a physically addicting drug. It’s not addictive, but if someone were to use cannabis to treat opiate dependence, it would still be recommended to continue use of cannabis. Some findings conclude the reason for marijuana helping opiate addicts is that the sedative feeling of strong indicas is somewhat comparable to the high from opiates. This is why it would be recommended to continue usage of marijuana, even after months or years of sobriety from heroin, morphine or any of those drugs.
UNM study suggests medical marijuana could decrease prescription opiate abuse
By Cathy Cook  Published 03/05/17 6:40pm [http://www.dailylobo.com/article/2017/03/medical-cannabis-research]
Medical cannabis use is highly under-researched, according to UNM professors Jacob Vigil and Sara Stith — and their recent findings suggest that it could actually help to battle addiction.
The pair, along with pain specialist Dr. Anthony Reeve, presented their research on how enrollment in the New Mexico Medical Cannabis Program has affected prescription opioid use in patients with chronic pain on Friday at UNM.
Vigil said the Medical Cannabis Program is unprecedented because patients manage their own care, since doctors can’t prescribe doses of cannabis, only authorize patients to obtain it.
He said it’s difficult to obtain federal funding for research on medical cannabis use and New Mexico is a great place to do research on it now, because recreational use is not currently legal.
The study compared prescription opioid use in Reeve’s patients who were enrolled in the medical cannabis program and his patients who were not enrolled over an 18 month period, Stith said.
New Mexico keeps track of prescription opioid use, allowing them to check whether patients who reported a reduction in opioid use were telling the truth, she said.
Their research found a 31 percent reduction in opioid use after 18 months in the medical cannabis patients and a slight increase in opioid use in the control group, she said.
The trend for cannabis users was clear, while the control group’s trend was less definite. But their research defies the popular gateway hypothesis, that cannabis use will lead to the use of more dangerous drugs, Vigil said.
Stith said it was difficult to even begin the study as Vigil spent two years getting the “little pilot study” approved through the institutional review board.
“I don’t have tenure yet. I wouldn’t have been able to spend those two years,” Stith said. “Basically (Vigil) got tenure and was able to invest the time and so it really is restrictive, especially when you don’t have tenure to even begin to start on these types of studies because it’s just too long of a timeline.”
One of the other challenges is quality assurance, Stith said.
“You can go to one dispensary and buy something called “purple firefly” or something and you go to another dispensary, it’s called the same thing but it’s actually a totally different plant,” she said. “There’s a lot of inconsistencies and that makes it hard to study in a medical sense.”
Stith said the biggest challenge to doing research is cannabis’ status as a Schedule 1 drug.
“We cannot give patients cannabis or we’re drug dealers — so we have to figure out how to observe them in a way so that we’re not intervening with them,” she said. “We couldn’t say, ‘take this before you go to bed and tell us how it works.’ We can’t do that. So that’s the biggest hurdle, the Schedule 1 aspect of it, and Schedule 1 means literally no therapeutic potential for the medication or substance.”
But despite all of the challenges, they are excited to continue in this “really exciting” area of research, she said.
“One benefit of the fact they haven’t allowed us to do research for so long, is there’s a lot of questions waiting to be answered,” Stith said. “It’s not hard to find research to do in this area — especially now that we’ve been able to develop this more observational approach as opposed to an interventionist approach.”
The two plan to continue their research on medical cannabis use and expand the scope of their research, she said.
“We want to look across different states. Different types of cannabis programs, how those work,” Stith said, adding that one of the next things they will look at is the indirect effect of cannibis on sedatives.
“It appears that these patients are not just reducing their opioid use, they’re also reducing their sedative use,” she said. “We’re going to look at some of the polypharmaceutical aspects. We want to get into some of the economic questions, cost effectiveness.”
Now that they have completed the pilot study, Stith said she believes future studies will be easier to begin, especially after going “back and forth and back and forth” with the IRB to get everything approved.
“So all that’s been worked out,” she said. “How the patients consent, when they consent, all that stuff. So a lot of legwork’s been done on that.”
Medical cannabis patient and community advocate Jason Barker said he thought the presentation was excellent and is excited to see research being done on medical cannabis.
“This is research that should have started back in 2014 when they first initially tried to do this,” he said. “Now they’ve got it under way, this is exciting because opioids kill more people in the state than any other thing we have.”
Cathy Cook is a news reporter at the Daily Lobo. She can be reached at news@dailylobo.com or on Twitter @Cathy_Daily.

Medical Cannabis vs Prescriptions.

Prescription Pills: Each year, about 4.5 million Americans visit their doctor’s office or the emergency room because of adverse prescription drug side effects. A startling 2 million other patients who are already hospitalized suffer the ill effects of prescription medications annually, and this when they should be under the watchful eye of medical professionals. The most common non-severe or mild side effects from taking drugs include (there are many more, these are the most common): Constipation, Dermatitis, Diarrhea,  Dizziness, Drowsiness, Dry mouth, Headache, and Insomnia.
What are the short and long term effects of prescription drugs? Short-term effects: Alertness, focus, sleeplessness, loss of appetite, increased blood pressure and heart rate, high body temperature.
Long-term effects: Addiction, paranoia and long-term insomnia, extreme weight change.
What are the effects of prescription drugs? Physical symptoms: Increased or decreased need for sleep, Appearing unusually energetic, or overly fatigued, Increased or decreased appetite.

These drugs come with side effects that range from birth defects and liver damage to suicidal behavior, blood clots, bladder cancer, Crohn’s disease, heart attacks, strokes, uncontrollable bleeding, heart failure and death: Chronic Pain Treatment drug Fentanyl (opioid). Type 2 diabetes drugs Avandia and Actos. Antidepressants Paxil, Prozac, Effexor, Zoloft and Lexapro. Mood stabilizer Depakote. Birth control pills Yaz and Yasmin. Acne medication Accutane. Blood thinners Pradaxa and Xarelto Osteoporosis treatment Fosamax. GranuFlo and NaturaLyte, which are used in dialysis.
Hair loss pill Propecia. Stop smoking cigarettes drug Chantix.

In article in American-Statesman staff writer Jeremy Schwartz in 2012 noted that in 2011, “the Pentagon spent more on pills, injections and vaccines than it did on Black Hawk helicopters, Abrams tanks, Hercules C-130 cargo planes and Patriot missiles — combined.” The military spent at least $2.7 billion on antidepressants and more than $1.6 billion on opioid painkillers such as Oxycontin and hydrocodone over the past decade. More than $507 million was spent on the sleeping pill Ambien and its generic equivalents.”  the pharmaceutical industry spent about $1.7 million for more than 1,400 trips for Defense Department doctors and pharmacists to places such as Paris, Las Vegas and New Orleans between 1998 and 2007.  All those Pills killed a lot of Veterans, Cannabis has a 5000 year history with zero deaths associated with it.

“Its margin of safety is immense and underscores the lack of any meaningful danger in using not only daily doses in the 3.5 – 9 gram range, but also considerably higher doses.”
Physician, researcher, court-qualified cannabis expert

Cannabis Is Safe & The Federal Government Has A Patent For It.  

The U.S. Patent Office issued patent #6630507 to the U.S.Health and Human Services filed on 2/2/2001. The patent lists the use of cannabinoids found within the plant cannabis sativa plant as useful in certain neurodegenerative diseases such as Alzheimer's, Parkinson's, and HIV dementia. Since cannabis sativa (marijuana) contains compounds recognized and endorsed by an agency of the U.S. government- Why is it that cannabis remains on the Federal Schedule One list of drugs? The issuance of patent #6630507 is a direct contradiction of the Government’s own definition for classification of a Schedule 1 drug. The U.S. government’s own National Institutes of Health researchers even concluded: “Based on evidence currently available the Schedule I classification is not tenable; it is not accurate that cannabis has no medical value, or that Information on safety is lacking.”

"The American Medical Association has no objection to any reasonable regulation of the medicinal use of cannabis and its preparations and derivatives. It does pretest, however, against being called upon to pay a special tax, to use special order forms in order to procure the drug, to keep special records concerning its professional use and to make special returns to the Treasury Department officials, as a condition precedent to the use of cannabis in the practice of medicine."                     
~Wm. C. Woodward, Legislative Counsel - 11:37 AM Monday, July 12, 1937

For over 5000 years, various strains of the green herb Cannabis sativa, or true hemp, have been among the most widely used of medicinal plants. This includes civilizations in China, India, Europe, Africa and the Middle East. Cannabis was used in the US from 1800’s to 1937 to treat more than 100 distinct diseases or conditions.

Cannabis is a NON-TOXIC substance. No one has ever died from taking cannabis.  One hundred per cent of the scores of studies by American universities and research facilities show that toxicity does not exist in cannabis. (U.C.L.A, Harvard, Temple, etc.) All the in-depth medico-scientific clinical studies conducted (for example, US-Jamaican, US-Costa Rican, LaGuardia Report, etc) have revealed that cannabis contains no addictive properties in any part of the plant or its smoke, so, unlike and in contrast to tobacco, alcohol, and all the legal or illegal 'recreational' substances cannabis is both non-habit-forming and non-toxic.

Therefore cannabis is uniquely safe when compared to modern FDA approved prescriptions.

Cannabis stimulate CB1 and CB2 endocannabinoid receptors on the brain and other tissues that affect body systems, triggering a chain of temporary psychological and physiological effects. Initially it has a stimulant effect, followed by relaxation and overall reduction in stress. Analgesic effect. Blocks migraine or seizures. Helps mitigate or control symptoms of multiple sclerosis (MS), spinal injury, epilepsy. Lifts mood and enhances sense of well-being. Relieves chronic and neuropathic pain. Has synergistic effects with opiates and other drugs. Not all cannabis has the same potency or effect. May cause drowsiness, distraction, paranoia or anxiety (due to type of cannabis strain)  and dry mouth - that”s it.

Myth that “Stoned” driving is as bad as drunk driving. Drunk driving kills 28 people a day in America, according to Mothers Against Drunk Driving. Studies have not found similar results for driving “while high”, and it’s not even clear that cannabis even increases the number of traffic accidents. That’s not to say that cannabis doesn’t affect driving ability—for many people it does. However, cannabis use is as likely as anything to make people more cautious than usual, which is an asset while driving. This same cautiousness makes some high people opt not to drive at all. Furthermore, as Dr. Sanjay Gupta explains in his medical documentary “Weed”, daily cannabis smokers seem to be less impaired on the road after smoking than occasional users.
Cannabinoid Therapies for the Treatment of Alcohol Dependence

Alcohol Abuse, Dependence, Tolerance, and Withdrawal

Alcoholism is an addiction one has to the consumption of alcoholic liquor or the mental illness and compulsive behavior resulting from alcohol dependency.
Alcohol dependence (i.e. alcoholism) may result from alcohol abuse (i.e. use of alcohol in a way that negatively impacts one’s actions/life), and is characterized by a feeling that one needs to consume alcohol in order to function normally, with a decreased ability to stop drinking even if the desire to do so exists. Those with alcohol dependence develop tolerance to alcohol, meaning that they need to consume more and more over time in order to feel the same effect they experienced the first time they drank. If alcohol consumption then stops, especially abruptly, individuals with alcohol dependence will experience symptoms of alcohol withdrawal.
Mild alcohol withdrawal is characterized by signs and symptoms including anxiety, development of tremors/shakiness, depression, irritability, fatigue, palpitations, etc., while severe alcohol withdrawal is characterized by more serious events, such as the onset of seizures and delirium tremens (with symptoms including a confused state, fever, tremors/shakiness, seizures, changes in mental functioning, irritability, hallucinations), which can lead to death in 1-5% of cases.
Even if a person who is alcohol-dependent wants to stop drinking, the negative impact of withdrawal will often prevent them from doing so (i.e. they may continue to drink to avoid the associated undesirable feelings).
Of the 38 million adults in the United states who drink too much, approximately 17 million of them have alcohol abuse disorders. Alcohol abuse is the 3rd leading cause of preventable death and results in costs totaling over $200 billion each year. Due to the huge impact alcohol abuse has on people, their families, and society, and to the fact that alcohol withdrawal is a major impediment to stopping alcohol abuse/overuse, its management is paramount to helping people overcome alcohol dependence.

Study Results

Using PET scans (which help us to visualize the functioning of organs and tissues) to measure activity/availability of CB1 receptors (a cannabinoid receptor found most commonly in the brain and spinal cord), authors of a study published in The Journal of Neuroscience in February 2014 found that cannabinoid signaling varies in the brains of alcohol non-users, non-dependent alcohol users, and dependent alcohol users.
Researchers found that in the brains of social, non-dependent drinkers (i.e. “non-alcoholic” drinkers, n=20), activity/availability of CB1 receptors was significantly increased after administration of ethanol (i.e. alcohol) into the bloodstream.
On the other hand, activity/availability of CB1 receptors was significantly decreased in dependent users (i.e. “alcoholics”, n=26) after long-term, heavy use of alcohol, even after 1 month of abstinence (no alcohol use). After long-term, heavy use, activity/availability was especially decreased in the areas of the cerebellum (part of the brain involved in coordinating movements, producing fine movements, maintaining posture and balance, etc.) and the parieto-occipital cortex (area of the brain which may be involved in planning processes). After abstinence, additional areas of decreased activity/availability of CB1 receptors were the ventral striatum (a part of the brain activated when a reward/pleasurable feeling is perceived) and the mesiotemporal lobe (an area whose damage is sometimes associated with epileptic seizures).

Conclusion

CB1 receptor stimulation is involved with subjectively feeling reward/pleasure. However, if the receptors are overstimulated, as by long-term, heavy use of alcohol, their activity/availability will decrease. During a period of abstinence from alcohol, this decreased stimulation may lead to an increased craving for alcohol, in order to re-establish the positive feelings associated with its use. Additionally, during the early phases of abstinence, neurons become hyperexcitable (i.e. overactivated), which can lead to their damage and death.
Therefore, for alcohol-dependent individuals attempting to reduce or eliminate their alcohol use, treatments aimed at increasing signaling of cannabinoid receptors in the brain [e.g. (1) cannabinoid therapies (such as targeted, isolated/synthetic CB1 receptor “stimulators”, or potentially whole-plant use if deemed appropriate by and closely monitored by a healthcare provider) or (2) therapies that upregulate CB1 receptors], may be useful for the following reasons:
  • Since cannabinoids may act as neuroprotective agents (with the potential to reduce hyperexcitability and prevent brain cell damage), cannabinoid therapies may directly prevent harm to the brain caused by withdrawal.
  • Cannabinoid therapy use, in combination with alcohol abstinence, may be helpful in the treatment of alcohol dependence and withdrawal by assisting in the prevention of alcohol cravings.

Study: Cannabidiol (CBD) Helps Prevent Alcohol-Induced Liver Damage
It is no secret that alcohol consumption can negatively affect one’s liver. This is because it can cause an excess of fats and lipids and additional oxidative stress (i.e. damage caused by free radicals).
With that said, a recent study published in Free Radical Biology and Medicine offers an interesting preventive measure. Funded by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) and the National Institutes of Health (NIH), it suggests that cannabidiol (CBD) could help protect the liver from alcohol-induced damage.

Researchers Prevent Alcohol-Induced Liver Damage With CBD

As we know, cannabidol (CBD) may have anti-oxidant effects. Couple that with the constituent’s lack of psychoactivity, and it makes sense why the team of researchers from China and Mount Sinai School of Medicine in New York chose to investigate its ability to counter alcohol-induced oxidative stress in the liver.
In doing so, they injected mice with ethanol twice a day for five days. This was intended to model the impact of binge drinking on one’s liver. Prior to this, a group of the mice were administered cannabidiol (CBD) as a preventive measure.
“The study’s results seem to confirm that cannabidiol (CBD) protects the liver from steatosis – the accumulation of fats and lipids.”
Sure enough, the study’s results showed that cannabidiol (CBD) may protect the liver from steatosis – the accumulation of fats and lipids. The researchers suggested that this was potentially the result of cannabidiol’s inhibition of oxidative stress and activation of pathways associated with fat accumulation.
The accumulation of fat in the liver can lead to much more serious problems like cirrhosis of the liver (i.e. scarring of the liver that may lead to liver failure) if it gets out of hand. With that said, there is no easy way to go about “curing” the disease once it occurs, so taking a preventive approach is best. Although increased research may strengthen the theory that cannabidiol (CBD) administration helps to prevent alcohol-induced liver damage, cannabidiol is not an approved or definitively effective preventive treatment at the present time.
Study: CBD-Based Topicals May Aid In Alcoholism Treatment

What Is CBD’s Effect On Brain Degradation?

According to the National Institute of Alcohol Abuse and Alcoholism (NIAAA), alcohol can be linked to neurodegradation(i.e. breakdown of neurons, which are brain cells that communicate with each other to transmit signals) among other effects. Due to the fact that cannabidiol (CBD) has been found to potentially have neuroprotectiveeffects, a study published last week in Pharmocology Biochemisty & Behavior aimed to explore the effect of cannabidiol topicals on alcohol-induced brain degradation.
It is important to understand the causes of, and ways to prevent, degradation associated with excessive alcohol use, because some believe that the behavioral and cognitive deficits it causes may be linked to alcoholism’s high relapse rate (i.e. many people with alcohol dependence who stop drinking eventually start drinking again). The researchers, who were from the University of Kentucky, AllTranz Inc., and the University of Maryland, hoped to compare cannabidiol topicals with a direct injection of CBD.

Cannabidiol (CBD) Topicals May Be Equally As Effective

Fluoro-Jade B (FJB) is a “degenerative stain” that is used to signify cell degradation in the central nervous system. In looking at the levels of FJB in the brain, researchers were able to determine the effects of 3 different cannabidiol gels (5% CBD, 2.5% CBD, and 1% CBD), and evaluate their neuroprotective properties.
“Cannabidiol (CBD) based topicals may represent a future aid for the treatment of alcoholism.”
The initial results inspired the researchers to create a second generation of 2.5% gel, and they compared it with a direct injection of cannabidiol. Rats who were not treated topically were injected with 40mg/kg of CBD every day, and the results were comparable. In fact, the topical CBD treatment had better results in terms of protecting the brain from degradation.
The American study suggests that topical cannabis extracts may be an equally effective method of introducing cannabinoids to the bloodstream. This is particularly interesting, because cannabidiol topicals would eliminate the cancer-causing compounds associated with smoking cannabis flowers, similar to vaporizing (which reduces, but does not eliminate, the amount of cancer-causing compounds in cannabis smoke) and medicated edibles.
More studies are surely needed, but researchers believe that these results could be the beginning of a new aid for the treatment of alcoholism. Cannabis has been investigated for its reduction of opiate withdrawal symptoms, and it seems like it may expand it’s rehabilitation repertoire in the form of cannabidiol topicals.


Medical Cannabis as Treatment for Alcoholism & Addiction
Medical marijuana is frequently in the news, and hopefully the growing awareness of the benefits of medical marijuana will lead to more sensible regulations and deeper research into why cannabis is so helpful in treating so many different conditions. Among the conditions that medical marijuana can treat is addiction, whether to drugs or alcohol.
Marijuana as a recovery treatment is controversial, not least because there is conflicting research about whether medical marijuana is or is not addictive. However, many studies have found that medical marijuana is not addictive, or as harmful, as other drugs such as alcohol and opiates. Additionally, several studies have shown that marijuana can be an effective treatment for recovery from other substances.
Medical Marijuana as a Recovery Treatment
Since marijuana has earned an undeserved negative reputation in many quarters, it is often difficult to determine what is fact and what is politics when talking about medical marijuana. However, the following three studies pointed to definite possibilities of using cannabis to overcome dependence on more harmful drugs and alcoholism:
  • A 2009 study performed by the Laboratory for Physiopathology of Diseases of the Central Nervous System found that injections of THC, the primary active chemical in cannabis, helped eliminate dependence on opiates such as morphine and heroin in test animals.
  • A survey compiling self-reported addiction treatment and relapse rates among substance users, “Cannabis as a Substitute for Alcohol and Other Drugs” that was published in the Harm Reduction Journal, found that respondents used cannabis to curb their alcohol cravings, as an alternative to previous use of prescription drugs, and even as a substitute for more potent drugs such as cocaine. Tellingly, 57.4% of respondents chose to use cannabis because it provided better symptom management as well.
  • Another study published in the Harm Reduction Journal, “Long term cannabis users seeking medical cannabis in California,” found that medical cannabis users were much less likely to use more potent drugs, and even reported less tobacco use than non-cannabis users.
Why Use Cannabis as a Recovery Treatment?
It’s clear that more effective addiction recovery treatment is needed in our country. According to the National Institute on Drug Abuse, depending on the addiction, up to half of individuals who begin an addiction treatment program relapse within six months. As more states move to legalize medical marijuana, it is becoming easier for scientists, doctors, and researchers to point to the benefits of marijuana as a treatment for pain relief and symptom management for many diseases. Benefits now known to the scientific community include:
  • Medical marijuana patients are able to function more fully in daily activities and work, unlike with many prescription opiates for symptom relief.
  • Medical marijuana patients report fewer unpleasant side effects with marijuana than with many traditional and stronger drug treatments.
  • Medical marijuana patients achieve more effective symptom relief using marijuana than with other alternatives.
Since withdrawal from alcohol and serious drug use often prompts the same symptoms as other medical conditions that marijuana is used to treat (anxiety, depression, pain, nausea, and sleeplessness,) it is logical that responsible use of marijuana could also help with addiction recovery.
Cannabis Shown To Ease Symptoms During Opiate Withdrawal
According to a recent study, cannabis use may help relieve withdrawal symptoms during Methadone treatment. The study that was performed at Thomas Jefferson University and recently published online shows the cannabinoid system may have a place in future substance abuse treatment. This Pennsylvania-based university was the home for observing 91 patients undergoing Methadone treatment.
Methadone is common form of treatment for opiate dependence. It can be effective, but it has a number of negative side effects.
There are quite a few reported side effects of Methadone treatment, such as: anxiety, insomnia, nausea, loss of appetite, and even psychological dependence.
These are only a few of the reported side effects and there are likely more that go unreported. Perhaps the scariest side effect is the psychological dependence. An opiate-dependent patient is putting their trust into a treat to break their vicious dependence. Sadly, instead of curing the patient of their dependence they start to need the treatment as much as they did the original opiates.

Cannabis Use Reduced Opiate Withdrawal Symptoms

According to the Thomas Jefferson University study, cannabis use before and during treatment decreased the patients score on the Clinical Opiate Withdrawal Scale (COWS). This is a scale used to objectively determine withdrawal symptoms in opiate-dependent patients. The lower scores indicate that cannabis plays a role in reducing the symptoms of opiate withdrawal.
“The present findings may point to novel interventions to be employed during treatment for opiate dependence that specifically target cannabinoid-opioid system interactions” – Thomas Jefferson University, Philadelphia.
This study suggests that cannabis may play a role in increasing the success of Methadone treatment. The reason for this is that is lowers the amount of withdrawal symptoms patients experience.
As discussed earlier, common symptoms of opiate withdrawal include anxiety, muscle aches, insomnia, abdominal cramps, and nausea. Medical cannabis is already being used to successfully treat each of these symptoms with little to no known side effects. “Marijuana does not have the physical addictive components that opiates do,” says Shelley Stormo, a clinical psychologist at Gosnold. “It does not have the propensity, as opiates do, for overdoses. There’s no documented death by overdose of marijuana.


DSM-5 definition

Cannabis and Opioids

We are in the throes of an opioid abuse crisis and are desperately searching for an answer. It’s time we acknowledge the solution that’s right in front of us and make this life-saving treatment available for those dependent on opioids. Cannabis has been proven to relieve chronic pain while reducing and replacing the use of opioids. It also relieves the symptoms of opioid withdrawal and decreases opioid craving. There is no toxic or lethal overdose of cannabis, and thousands of patients are already effectively using cannabis to replace opioids and other addictive substances.

http://healer.com/cannabis-and-opioids-video-guide-the-science/

Click here to watch the recorded broadcast – 2hrs
Dr. Dustin Sulak, regarded as one of the world’s leading practicing experts on medical cannabis, will be presenting a free public seminar on how medical cannabis can provide a major solution to the opioid addiction epidemic.
As part of the presentation, Dr. Sulak will talk about how cannabis has helped many of his own patients with opioid addiction and the latest findings from scientific studies worldwide on this subject.
“We are in the throes of an opioid abuse crisis and are desperately searching for an answer.  It’s time we acknowledge the solution that’s right in front of us and make this life-saving treatment available for those dependent on opioids.  Cannabis has been proven to relieve chronic pain while reducing and replacing the use of opioids.  It also relieves the symptoms of opioid withdrawal and decreases opioid craving.  There is no toxic or lethal overdose of cannabis, and thousands of patients in Maine are already effectively using cannabis to replace opioids and other addictive substances. “  Dr. Dustin Sulak
He will discuss how medical cannabis, like any other legalized medicine, requires proper dosing procedures along with patient and provider education. Dr. Sulak will introduce www.Healer.com, a free comprehensive medical cannabis education resource for patients, the public and medical professionals, to learn how to best use cannabis, find your correct dosage, and achieve optimal therapeutic results.
Presented by VPR Media and Marketing.

Part 1 of this video series discusses the science behind the claims that cannabis can relieve chronic pain and reduce and replace the use of opioids.
Addiction & Alcoholism

Rules, Regulations, & Policy Solution Requesting The Inclusion Of A New Medical Condition: Substance Abuse Disorder
The approval of this petition that pertains to: Requesting The Inclusion Of A New Medical Condition: Substance Abuse Disorder, that is being provided to the state Department of Health Medical Cannabis Program so the advisory board can review and recommend to the department for approval additional debilitating medical conditions that would benefit from the medical use of cannabis with the Lynn and Erin Compassionate Use Act. The approval of this petition would bring the Department of Health in compliance with the intent of the law and uphold the spirit of the Lynn and Erin Compassionate Use Act, 2007. Fulfilling both;“ Section 2. PURPOSE OF ACT.--The purpose of the Lynn and Erin Compassionate Use Act is to allow the beneficial use of medical cannabis in a regulated system for alleviating symptoms caused by debilitating medical conditions and their medical treatments” And  Section 6. ADVISORY BOARD CREATED--DUTIES: The advisory board shall: A. review and recommend to the department for approval additional debilitating medical conditions that would benefit from the medical use of cannabis.” New Mexico’s medical cannabis history started in 1978.  After public hearings the legislature enacted H.B. 329, the nation’s first law recognizing the medical value of cannabis...the first law.

Appendix A:
Cannabis Cure For Opioid Addiction
Several new scientific studies and one in particular from Columbia University's Mailman School of Public Health just introduced a new science based angle.
According to The Washington Post, researchers tracked fatal car crashes over 14 years in 18 states. They analyzed the drugs found in the systems of those killed- being either cannabis or opioids. In states with legal medical cannabis programs there was lower rates of crash victims with opioids in their systems.  Especially among victims ages 21 to 40 or, the age group most likely to use cannabis. As the study authors cited the new found evidence: "In states with medical cannabis laws, fewer individuals are using opioids and dying."
The opioid epidemic in America began hitting crisis levels in 2013 and now has cost to many Americans their life since the epidemic starting ramping up in 2001.  Addiction is a chronic disease characterized by drug seeking and use that is compulsive, despite harmful consequences. As with most other chronic diseases, such as diabetes, asthma, or heart disease, treatment for drug addiction generally isn’t a cure. However, addiction is treatable and can be successfully managed according the National Institute on Drug Abuse.

It's Life or Death For New Mexico
In New Mexico, according to the Department of Health, the drug overdose rate in 2014 was still twice that of the national average. It was the #1 cause of unintentional injury or death in New Mexico. Seventy-five percent of those drug overdose deaths involving opioids or heroin. During the time period of 2001 - 2014, medical prescription sales of opioids increased 236% in New Mexico.  That's lead to and average of 10 New Mexicans dying per week. New Mexico saw a statistically significant increase from 2013-2014 in overdose deaths caused by opioids. According to CDC state data, a increase of 20.8% in opioid overdose deaths was reported.

Medical cannabis could be used in addiction treatment for this current opioid crisis New Mexico faces along with other states. Though opioids and cannabis have vastly different effects on a user's body and vastly different consequences as they both ease pain. Opioids were responsible for 28,000 overdoses in 2014 nationwide. Cannabis has never been responsible for any deaths.

Medical Cannabis As An Exit Drug for Addiction
"Research suggests that people are using cannabis as an exit drug to reduce the use of substances that are potentially more harmful, such as opioid pain medication." Says a lead investigator on addiction, Zach Walsh, a professor of psychology at University of British Columbia.
Medical cannabis is legal in 28 states and the District of Columbia. Still, the DEA classifies cannabis as a Schedule I controlled substance, the same category as heroin. US Patent No. 6630507, is held by the United States Department of Health and Human Services. The Patent covers the use of cannabinoids for treating a wide range of diseases. Yet under U.S. federal law, cannabis is defined as having no medical use. So it might come as a surprise to hear that the government owns a patent on cannabis as a medicine. The patent (US6630507) is titled “Cannabinoids as antioxidants and neuroprotectants". It was awarded to the Department of Health and Human Services (HHS) in October 2003. It was filed in 1999, by a group of scientists from the National Institute of Mental Health (NIMH), also part of the National Institutes of Health.

The Final Say

The evidence is clear on how medical cannabis can help substance abuse & addiction. The New Mexico Department of Health should approve this petition. Making Substance Abuse Disorder- a qualifying health condition to be included into the state’s medical cannabis program. This would allow that program to continue to help even more New Mexicans, medical cannabis could be a new way to combat opiate addiction. It could also place the Land of Enchantment to the forefront in the harm reduction model of addiction treatment in the United States.

An Americans for Safe Access (ASA) national report was released on December 8th, 2016 and calls for an end to contradictions between federal and state guidelines with regard to medical cannabis policies. The Americans for Safe Access briefing book, “Medical Cannabis in America”, showing that not only do opiate related deaths drop an average of 24.8% in states with medical cannabis laws, the report also notes that the Department of Justice has spent an estimated $592 million to date in arrests, investigations, enforcement raids, pretrial services, incarceration, and probation.

WHEREAS cannabis (marijuana) has been used as a medicine for at least 5,000 years and can be effective for serious medical conditions for which conventional medications fail to provide relief;

WHEREAS modern medical research has shown that cannabis can slow the progression of such serious diseases as Alzheimer’s and Parkinson’s and stop HIV and cancer cells from spreading; has both anti-inflammatory and pain-relieving properties; can alleviate the symptoms of epilepsy, PTSD and multiple sclerosis; is useful in the treatment of depression, anxiety and other mental disorders; and can help reverse neurological damage from brain injuries and stroke;

WHEREAS the World Health Organization has acknowledged the therapeutic effects of cannabinoids, the primary active compounds found in cannabis, including as an anti-depressant, appetite stimulant, anticonvulsant and anti-spasmodic, and identified cannabinoids as beneficial in the treatment of asthma, glaucoma, and nausea and vomiting related to illnesses such as cancer and AIDS;

WHEREAS the American Medical Association has called for the review of the classification of cannabis as a Schedule I controlled substance to allow for clinical research and the development of cannabinoid-based medicines;

WHEREAS the National Cancer Institute has concluded that cannabis has antiemetic effects and is beneficial for appetite stimulation, pain relief, and improved sleep among cancer patients;

WHEREAS the American Herbal Pharmacopoeia and the American Herbal Products Association have developed qualitative standards for the use of cannabis as a botanical medicine;

WHEREAS the U.S. Supreme Court has long noted that states may operate as “laboratories of democracy” in the development of innovative public policies;

WHEREAS twenty-eight states and the District of Columbia have enacted laws that allow for the medical use of cannabis;

WHEREAS seventeen additional states have enacted laws authorizing the medical use of therapeutic compounds extracted from the cannabis plant;

WHEREAS more than 17 years of state-level experimentation provides a guide for state and federal law and policy related to the medical use of cannabis;

WHEREAS accredited educational curricula concerning the medical use of cannabis have been established that meets Continuing Medical Education requirements for practicing physicians;

WHEREAS Congress has prohibited the federal Department of Justice from using funds to interfere with and prosecute those acting in compliance with their state medical cannabis laws, and the Department of Justice has issued guidance to U.S. Attorneys indicating that enforcement of the Controlled Substances Act is not a priority when individual patients and their care providers are in compliance with state law, and that federal prosecutors should defer to state and local enforcement so long as a viable state regulatory scheme is in place.



Appendix A Cannabis as a Substitute for Alcohol: A Harm-Reduction Approach
Tod H. Mikuriya
ABSTRACT. Ninety-two Northern Californians who use cannabis as an alternative to alcohol obtained letters of approval from the author. Their records were reviewed to determine characteristics of the cohort and efficacy of the treatment, which was defined as reduced harm to the patient. All patients reported benefit, indicating that for at least a subset of alcoholics, cannabis use is associated with reduced drinking. The cost of alcoholism to individual patients and society at large warrants testing of the cannabis-substitution approach and study of the drug-of-choice phenomenon. [http://www.cannabiscure.info/wp-content/uploads/2016/07/marijuana-and-alcohol.pdf  All rights reserved.]
KEYWORDS. Addiction, alcohol, alcoholism, cannabis, depression, drug-of-choice, harm reduction, marijuana, pain
INTRODUCTION Physicians who treat alcoholics are familiar with the cycle from drunkenness and disinhibition to withdrawal, drying out, and apology for behavioral lapses, accompanied over time by illness and debility as the patient careens from one crisis to another. “Harm reduction” is a treatment approach that seeks to minimize the occurrence of drug/alcohol addiction and its impacts on the addict/alcoholic and society at large. A harm-reduction approach to alcoholism adopted by 92 of my patients in Northern California utilizes the substitution of cannabis, with its relatively benign side-effect profile, as the intoxicant of choice. No clinical trials of the efficacy of cannabis as a substitute for alcohol are reported in the literature, and there are no papers directly on point prior to my own account (Mikuriya 1970) of a patient who used cannabis consciously and successfully to discontinue her problematic drinking. There are ample references, however, to the use of cannabis as a substitute for opiates (Birch 1889) and as a treatment for delirium tremens (Clendinning 1843; Moreau 1845), which were among the first uses by European physicians. The 1873 Indian Government Finance Department Resolution recommended against suppressing cannabis use for fear that people (p. 1395) “would in all probability have recourse to some other stimulant such as alcohol.” The Indian Hemp Drugs Commission Report of (1893-1894) articulated the same concern (p. 359): “. . . driving the consumers to have recourse to other stimulants or narcotics which may be more deleterious.” Birch (1889) described a patient weaned off alcohol by use of opiates who then became addicted and was weaned off opiates by use of cannabis. He noted (p. 625), “Ability to take food returned. He began to sleep well; his pulse exhibited some volume; and after three weeks he was able to take a turn on the verandah with the aid of a stick. After six weeks he spoke of returning to his post, and I never saw him again.” Birch feared that cannabis itself might be addictive, and recommended against revealing to patients the effective ingredient in their elixir (p. 625), “Upon one point I would insist–the necessity of concealing the name of the remedial drug from the patient, lest in his endeavor to escape from one form of vice he should fall into another, which can be indulged with facility in any Indian bazaar.” This stern warning may have undercut interest in the apparently successful two-stage treatment he was describing. At the turn of the 19th century in the United States, cannabis was listed as a treatment for delirium tremens in standard medical texts (Edes 1887; Potter 1895) and manuals (Lilly 1898; Merck 1899; Parke Davis 1909). Since delirium tremens is associated with advanced alcoholism, we can adduce that patients who were prescribed cannabis and used it on a long term basis were making a successful substitution.
By 1941, due to its prohibition, cannabis was no longer a treatment option, but attempts to identify and synthesize its active ingredients continued (Loewe 1950). A synthetic THC called pyrahexyl was made available to clinical researchers, and one paper from the postwar period reports its successful use in easing the withdrawal symptoms of 59 out of 70 alcoholics (Thompson and Proctor 1953). In 1970 the author reported (Mikuriya 1970) on Mrs. A., a 49-yearold female patient whose drinking had become problematic. The patient had observed that when she smoked marijuana socially on weekends she decreased her alcoholic intake. She was instructed to substitute cannabis any time she felt the urge to drink. This regimen helped her to reduce her alcohol intake to zero. The paper concluded (p. 175), “It would appear that for selected alcoholics the substitution of smoked cannabis for alcohol may be of marked rehabilitative value. Certainly cannabis is not a panacea, but it warrants further clinical trial in selected cases of alcoholism.” The warranted research could not be carried out under conditions of prohibition in the USA, but in private practice and communications with colleagues I encountered more patients like Mrs. A. and generalized that somewhere in the experience of certain alcoholics, cannabis use is discovered to overcome pain and depression, target conditions for which alcohol is originally used, but without the disinhibited emotions or the physiologic damage. By substituting cannabis for alcohol, patients were able to reduce the harm their intoxication caused themselves and others. Although the increasing use of marijuana starting in the late ’60s had renewed interest in its medical properties, including possible use as an alternative to alcohol (Scher 1971), meaningful research was prevented until the 1990s, when the establishment of “buyers clubs” in California created a potential database of patients who were using cannabis to treat a wide range of conditions. The medical marijuana initiative passed by voters in 1996 mandated that prospective patients obtain a doctor’s approval in order to treat a given condition with cannabis, resulting in an estimated 30,000 physician approvals as of May 2002 (Gieringer 2003). In a review of my records in the spring of 2002, 92 patients were identified as using cannabis to treat alcohol abuse and related problems. This paper describes characteristics of that cohort and the results of their efforts to substitute cannabis for alcohol. Tod H. Mikuriya
METHODOLOGY Identifying Alcoholism The initial consultation (20 minutes) provided multiple opportunities to identify alcoholism as a problem for which treatment with cannabis might be appropriate. The intake form asked patients to state their reason for contacting the doctor, and enabled them to prioritize their present illnesses and describe the course of treatment to date. The form also asked patients to identify any non-prescribed psychoactive drugs they were taking (including alcohol), and invited remarks. A specific question concerned injuries incurred “while or after consuming alcohol.” Examination of medical records provided an additional opportunity to identify alcohol abuse, as did the taking of a verbal history. Evaluating Efficacy At follow-up visits (typically at 12-month intervals), patients were asked to list the conditions they had been treating with cannabis and to evaluate their status as “stable,” “improved,” or “worse.” Patients were asked to evaluate the efficacy of cannabis (five choices from “very effective to “ineffectual”) and to describe any adverse events. Patients were also asked to describe any changes in their “living and employment situation,” and if so, to elaborate. The question about use of non-prescribed psychoactive drugs, including alcohol, was repeated. Comparison of responses in a given patient’s initial and follow-up questionnaires enabled assessment of the utility of cannabis as an alternative to alcohol.
Patient Background Gieringer (2003) notes that (p. 55), “Many patients who find marijuana helpful for otherwise intractable complaints report that their physicians are fearful of recommending it, either because of ignorance about medical cannabis, or because they fear federal punishment or other sanctions. This is especially true in regions where the use of marijuana is less familiar and accepted.” The patients whose records form the basis for this study were all seen in ad hoc settings arranged by local cannabis clubs, 88 in rural counties of Northern California, four in the San Francisco Bay Area. They form a special but not unique subset, having intentionally sought out a physician whose clinical use of cannabis and confidence in its versatility and relative safety was extensive and well known in their communities. A majority of the patients identified themselves as blue-collar workers: carpenter (5), construction (3), laborer (3), waitress (3), truck driver (3), fisherman (3), heavy equipment operator (3), painter (2), contractor (2), cook (2), welder (2), logger (2), timber faller, seaman, hardwood floor installer, bartender, building supplies, house caretaker, ranch hand, concrete pump operator, cable installer, silversmith, stone mason, boatwright, auto detailer, tree service-handyman-cashier, nurseryman, glazier, gold miner, carpet layer, carpenter’s apprentice, landscaper, river guide, screenprinter, and glassblower. Eleven were unemployed or did not list an occupation; four were disabled, two retired, and two patients defined themselves as mothers. Others were in sales (5), musicians (5), clerical workers (3), paralegal, teacher, actor, actress, artist, sound engineer, and computer technician.
Eighty-two of the patients were male. Patients’ ages ranged from 20 to 69. Twenty-nine were in their twenties; 16 in their thirties; 24 in their forties; 20 in their fifties; and three in their sixties. Exactly half (46 patients) had taken some college courses, but only four had college degrees. Five did not complete high school. Thirteen were veterans, all branches of the Armed Forces being represented. All but six (five native-Americans, one African-American) were Caucasian. Slightly more than half (49) reported being raised by at least one addict/alcoholic parent. Prioritizing Alcoholism Fifty-nine of the patients identified alcoholism or cirrhosis of the liver as their primary medical problem. Secondary and tertiary problems reported by this group were depression (19), pain (17), insomnia (15), arthritis (8), anxiety/stress (8), PTSD (3), cramps (4), hepatitis C (4), gastritis (2), ADHD (2), cramps/PMS (3), scoliosis, irritable bowel syndrome, glaucoma, and anorexia. Thirty-three patients identified themselves as alcohol abusers, but reported other problems as more significant: pain (12), depression (7), anxiety/stress (6), headache/migraines (5), insomnia (5), head injuries (3), bipolar disorder (3), arthritis (2), asthma (2), spinal cord injury/disease (2), gastritis (2), paraplegia, ADHD, multiple broken bones, Parkinson’s, and cramps. Nineteen patients reported having been injured while or after drinking heavily.
Fourteen had incurred legal problems or been ordered into rehab programs. Cannabis Use/Awareness of Medicinal Effect Patients were asked when they started using cannabis and when they realized it exerted a medicinal effect. Three reported first using at age 9 or younger; 61 between ages 10 and 19; nine began using in their 20s; three in their 30s; six in their 40s; two at age 50; and one at age 65. Twenty-four patients reported realizing immediately upon using cannabis that it exerted a beneficial medical effect. Some of their responses still seem to reflect their relief at the time: • “In 1980 I had quit drinking for a month. My niece asked me if I ever tried marijuana to calm me down. So I tried it and it worked like a miracle.” • “Helped pain very much! Helped sleep–excellent.” Thirty-five patients answered ambiguously with respect to time: “When realized preferred to alcohol,” for example, or, “when I smoked when suffering.” Seven reported becoming aware of medical effect within a year of using cannabis. Ten became aware within one to five years. Three became aware of medical effect 12-15 years after first using. Ten became aware between 20 and 30 years after first using. All but one of these patients had resumed using cannabis after years of abstinence. Use of OTC and Prescription Drugs Patients were asked to list other drugs (prescribed, over-the-counter, and herbal) that they were currently using or had used in the past to treat their illnesses. Most common of the prescription drugs were SSRIs (31), opiates (23), NSAIDs (18), disulfuram (15), and Ritalin® (methylphenidate) (8). Delivery Systems Seventy-eight patients smoked joints, the average amount being one joint a day (assuming 3.5 joints per 1/8 ounce of high-quality marijuana).
Twelve patients reported using a pipe, and three owned vaporizers. All were strongly advised that smoking involves an assault on the lungs, and that vaporization is a safer method of inhaling cannabinoids.
OBSERVATIONS Alcoholic Parents A slight majority of patients (51) reported being raised by at least one alcoholic parent. This is not surprising. The children of alcoholics enter adulthood with two strikes. They have endured direct emotional abuse and/or abandonment by parent(s), and they lack role models for coping with uncomfortable feelings other than by inebriation. It is to be expected that many, when encountering problems early in life, are treated with, or seek out, mind-altering drugs. Reported Efficacy As could be expected among patients seeking physician approval to treat alcoholism with cannabis, all reported that they’d found it “very effective” (45) or “effective” (38). Efficacy was inferred from other responses on seven questionnaires. Two patients did not make follow-up visits but had reported efficacy at the initial interview. Nine patients reported that they had practiced total abstinence from alcohol for more than a year and attributed their success to cannabis. Their years in sobriety: 19, 18, 16, 10, 7, 6, 4 (2), and 2. Patients who reported a return of symptoms when cannabis was discontinued (19), ranged from succinct to dramatic: • “I started drinking a lot more.” • “More anxiety, less happiness.” • “Use alcohol when cannabis isn’t available.” • “If I don’t have anything to smoke, I usually drink a lot more.” • “I quit using cannabis while I was in the army and my drinking doubled. I was also involved in several violent incidents due to alcohol. • “My caretaker got arrested and I lived too far from the city to purchase at a club, and I started doing heroin again and almost killed myself and some of my friends.”
• “Stress level becomes higher, become more uptight. Went back to drinking in the 1970s.”–A female patient with 19 years of sobriety. Several patients specifically noted that cannabis use reduced the craving for alcohol: • “I crave alcohol when I can’t smoke marijuana.” • “Had to quit drinking at 48 yrs. old. Found cannabis helped stop the urge to drink.”–A 69-year-old commercial fisherman. Three patients reported a sad irony: they had “fallen off the wagon” when they had to stop using cannabis in anticipation of drug tests. Patient S., a 27-year-old cable installer, had six alcohol-related arrests by age 21, “. . . after not smoking herb (for probation drug test) and blacking out on alcohol, I found my drinking getting out of hand and I began getting into more trouble.” He later relapsed when denied use of cannabis at a residential treatment facility. Cannabis for Analgesia The large number of patients using cannabis for pain relief (29) reflects the high percentage of blue-collar workers who suffer musculoskeletal injury during their careers. As expressed by a carpenter, “Nobody gets to age 40 in my business without a bad back.” Nurses who must lift gurneys, farm workers, desk-bound clerical workers, and many others are also prone to chronic back and neck pain. Fights and accidents (vehicular, sports- and job-related) also create chronic pain patients, many of whom self-medicate with alcohol. Eighteen patients reported having been injured while or after drinking heavily. This comment by a 26-year-old truck driver describes a typical chain-reaction of alcohol-induced trouble: “Injured in a fight after consuming alcohol, resulted in staph infection of right knuckle, minor surgery and four days in hospital.” Injuries suffered while drunk add to pain and the need for relief by alcohol, or a less destructive alternative. A total of 29 patients reported using cannabis for both pain relief and as an alternative to alcohol. A 47-year-old landscaper was run over by a vehicle at age 5, requiring multiple surgeries and leaving him with pins in his right ankle: “Given pain pills for my right ankle, I got too drowsy. Smoked herb to relieve pain.” After he had to discontinue cannabis use, he reported, “was unable to ease pain in ankle without herb, and drink when unable to have cannabis to smoke.”
Cannabis for Mood Disorders Twenty-six patients reported using cannabis to treat depression (44 if the category is expanded to include anxiety, stress, and PTSD), and their comments frequently touched on the negative synergies between mood disorders and alcoholism. A 44-year-old paralegal, suffering from depression, alcoholism, and PMS, noted simply, “Alcohol causes more depression.” When she did not have access to cannabis, she noted, “Alcohol consumption increases and so does depression.” At her initial visit she reported consuming 5-10 drinks/day. At a follow-up visit (after 16 months) she had confined her consumption to weekend usage. A 33-year-old river guide (and decorated Army vet) put it this way: “I have had a problem with violence and alcohol for a long time and I have a rap sheet to prove it. None of the problems occurred while using cannabis. Not only does cannabis prevent my violent tendencies, but it also helps keep me from drinking.” On his follow-up visit (12 months) this patient reported improved communication with family members and fewer problems relating to other people. His alcohol consumption had decreased from 36 drinks/week to zero (one month of sobriety). Patient L.G. presented initially at age 35 as homeless and unemployed, suffering “severe depression. Anxiety. Pain.” Her problem with alcohol was inferred from her response concerning non-medical-psychoactive drug use: “I drink and smoke too much–started when I couldn’t get marijuana.” L.G. had requested a recommendation for cannabis from a Humboldt County physician but, as she recounted, “I’m paranoid and local doctors are scared, too. They gave me Paxil® [paroxetine] and stop smoking pamphlet.” At a follow-up visit (14 months), L.G. reported a change in circumstance: “Now have a room. But am on G.R. [General Relief] and am paying too much.” She was still using alcohol “a little. I’m doing good dealing with not drinking. Being able to medicate with cannabis has helped a lot.” Eighteen months later the pattern hadn’t changed: “Alcohol several times/week. Depends on if I have cannabis, stress still triggers.” Fewer Adverse Side-Effects Compared with NSAIDs, steroids, SSRIs, opioids, and benzodiazepines, cannabis has a benign side-effect profile. In acute conditions Tod H. Mikuriya 87 these other drugs may be tolerable, but taking them to treat chronic conditions may be worse than the illness. Patients’ comments on their prescribed analgesics and anti-depressants tended to be negative with respect to efficacy (22), side-effects (26) and cost (15), not surprising, perhaps, in a cohort seeking an herbal alternative. Patient R.B. presented as a 41-year-old alcoholic also suffering from arthritis, pain from knee and ankle surgeries, and depression, for which he had been prescribed Librium® (chlordiazepoxide), Valium® (diazepam), Buspar® (buspirone), Welbutrin® (bupropion), Effexor® (venlafaxine), Zoloft® (sertraline), and Depakote® (valproate) over the years; “No help!” he wrote bluntly. On his return visit (one year) he reported “few relapses” and was able to take some classes. The dulling effects of Vicodin® (hydrocodone) and other opiates were mentioned by seven patients. As patient P.B. put it, “When I can get Vicodin it helps the pain but I don’t like being that dopey.” Patient S.F., whose skull was badly damaged in an accident, also appreciated the pain relief but asserted that opiates (obtained through the Veterans’ Administration) “made me paranoid and mean.” Patient C.A., who was diagnosed with attention-deficit hyperactivity disorder (ADHD) in ninth grade, touches on some recurring themes in describing the treatment of his primary illness: “I was prescribed Ritalin and Zoloft. The Ritalin helped me concentrate slightly but caused me to be up all night. The Zoloft made me sick to my stomach and never relieved my stress or depression. I have never been prescribed anything for my insomnia but I usually have to drink some liquor to get to sleep. I think that is a bad thing as I have now begun to drink excessive amounts of whisky, which has really started to affect my stomach.” C.A. first used cannabis at age 19 and became aware of benefits immediately. “I found myself running to the refrigerator and then sleeping better than I had for years.” At age 21 he fears permanent damage. “From drinking (I believe) my stomach has been altered, along with my appetite...I cannot really eat that much and feel malnourished and weaker than a 21-year-old should. My joints ache constantly and I am not as strong as I used to be. I also fear that I will become or am an alcoholic and I do not want to see myself turn into my dad.” At his follow-up visit (12 months), C.A. reported cannabis to be “very effective.” He was employed, “not partying,” doing well socially, and trying to give up cigarettes.
Interactions, Positive and/or Negative Several patients (3) indicated that cannabis had a welcome amplifying effect on the efficacy of other medications. As cannabis comes into wider use in California and elsewhere, it is important that its interactions with other medications be studied and publicized.
DEFINING SUCCESS The harm-reduction approach to alcoholism is based on the recognition that for some patients, total abstinence has been an unattainable goal. Success is not defined as the achievement of perpetual sobriety. A treatment may be deemed helpful if it enables a patient to reduce the frequency and quantity of alcohol consumption; if drunken episodes and/ or blackouts are reduced; and if success in the workplace can be achieved; if specific problems induced by alcohol (suspended driver’s license, for example) can be resolved; and if ineffective or toxic drugs can be avoided. As noted, all of the patients in this study were seeking physician’s approval to use cannabis medicinally, a built-in bias that explains the very high level of efficacy reported. However, the vast majority presented with comorbid conditions, and would have qualified for physician’s approval to use cannabis whether or not they reported efficacy with respect to alcoholism. Although medicinal use of cannabis by alcoholics can be dismissed as “just one drug replacing another,” lives mediated by cannabis and alcohol tend to run very different courses. Even if use is daily, cannabis replacing alcohol (or other addictive, toxic drugs) reduces harm because of its relatively benign side-effect profile. Cannabis-only usage is not associated with car crashes; it does not damage the liver, the esophagus, the spleen or the digestive tract. The chronic alcohol-inebriation-withdrawal cycle ceases with successful cannabis substitution. Sleep and appetite are restored, ability to focus and concentrate is enhanced, energy and activity levels are improved, and pain and muscle spasms are relieved. Family and social relationships can be sustained as pursuit of long-term goals ends the cycle of crisis and apology. Patient M.S., a 42-year-old journeyman carpenter, is a success story from a harm-reduction perspective. At his initial visit he defined his problem as “intermittent explosive disorder,” for which he had been prescribed Lithium. Although drinking eight beers a day, he reported Tod H. Mikuriya 89 “Cannabis has allowed me to just drink beer when I used to blackout drink vodka and tequila.” By the time of a follow-up visit (12 months), Mark had been sober for four months. He also reported, “anger outbreaks less severe, able to complete projects,” and, poignantly, “paranoia is now mostly realism.” He plans to put his technical skill to use in designing a vaporizer. THE DOCTOR-PATIENT RELATIONSHIP As a certified addictionologist, I have supervised both inpatient and outpatient treatment for thousands of patients since 1969. In the traditional alcoholism medical-treatment model, the physician is an authority figure to a patient whose life has spun out of control. The patient enters under coercive circumstances, frequently under court order, with physiologies in toxic disarray. Transference dynamics cast the physician into a parental role, producing the usual parent-child conflicts. After detoxification when cognition has returned from the confusional state of withdrawal, the patient leaves, usually with powers of denial intact. Follow-up outpatient treatment is oriented to Alcoholics Anonymous (AA) and/or pharmacological substitutes. Treating alcoholism by cannabis substitution creates a different doctor-patient relationship. Patients seek out the physician to confer legitimacy on what they are doing or are about to do. My most important service is to end their criminal status, Aeschalapian protection from the criminal justice system, which often brings an expression of relief. An alliance is created that promotes candor and trust. The physician is permitted to act as a coach or an enabler in a positive sense. As enumerated by patients, the benefits can be profound: self-respect is enhanced; family and community relationships improve; a sense of social alienation diminishes. A recurrent theme at follow-up visits is the developing sense of freedom as cannabis use replaces the intoxication-withdrawal-recovery cycle, freedom to look into the future and plan instead of being mired in a dysfunctional past and present; and freedom from crisis and distraction, making possible pursuit of longterm goals that include family and community.
RE: ALCOHOLICS ANONYMOUS Although nine patients made voluntary reference to attending AA meetings (three presently, six in the past), it is likely that many more actually tried the 12-step program, but the question was not posed on the intake form. A future study should examine the relationship between cannabis-only users and Alcoholics Anonymous. At AA meetings, cannabis use is considered a violation of sobriety. This puts cannabis-only users in a bind. Those who attend meetings can’t practice the “rigorous honesty” that AA considers essential to recovery; and those who avoid meetings are denied support and encouragement that might help them to stay sober. Support-group meetings at which cannabis-only users are welcome would be a positive development. Patient T.H., first seen at age 29, was diagnosed as an alcoholic in 1987 and began attending AA meetings, which he found helpful although he could not achieve sustained sobriety. In 1998, after realizing that cannabis reduced his cravings for alcohol, he received approval to use it. At a follow-up in November ’99, he reported, “Have stopped drinking for the first time in many years. I have not taken a drink of alcohol in 14 months. I attribute some credit for this to daily use of cannabis. My life has improved with this treatment.” T.H. was seen again in April 2001 and reported, “I continue to maintain sobriety regarding alcohol. Have not had a drink for 2 1/2 years. I drank alcohol heavy for about 10 years, and had difficulty stopping drinking and staying stopped until I began this treatment. Pain symptoms from back spasms/scoliosis also better.”
FACTORS IN DRUG OF CHOICE Experimentation with drugs and alcohol typically begins in adolescence and participants in the present study fit the well established pattern. It is also in adolescence that most individuals select a drug-of-choice. Factors in the process have not been thoroughly studied, but drugof-choice is not simply a function of an individual’s brain chemistry; social group plays a key role (Carstairs 1951). Carstairs spent a year in a large village in northern India where the two highest castes, Rajputs and Brahmins, consumed alcohol and cannabis, respectively. The Rajputs were the warriors and governors; they viewed the alcohol-inspired release of emotions, notably sexual and aggressive impulses, as admirable. The Brahmins were the religious leaders whose emphasis on self-denial included (p. 79.), “the avoidance of anger and or any other unseemly expression of personal feelings; abstinence from meat and alcohol is a prime essential.” Tod H. Mikuriya 91 Carstairs’ goal was to understand how the Brahmins could rationalize intoxicant use. He concluded (p. 79): There are alternative ways of dealing with sexual and aggressive impulses besides repressing them and then ‘blowing them off’ in abreactive drinking bouts in which the superego is temporarily dissolved in alcohol. The way which the Brahmins have selected consists in a playing down of all interpersonal relationships in obedience to a common, impersonal set of rules of Right Behavior . . . Whereas the Rajput in his drinking bout knows that he is taking a holiday from his sober concerns, the Brahmin thinks of his intoxication with bhang as a flight not from but toward a more profound contact with reality. Two aspects of Carstairs’ report resonate strongly with my own observations: 1. The disinhibition achieved via alcohol is the Rajput kind, a flight from reality, becoming “blotto,” whereas the disinhibition achieved via cannabis is the result of focused or amplified contemplation. 2. “Drug of choice” tends to be–perhaps invariably is–determined by social factors, and, once determined, becomes a defining element of individual self-image, i.e., possible but not easy to change in adulthood. Undoubtedly, alcohol’s status as a legal drug that is widely advertised and can be purchased virtually anywhere influences the number of college students and other young adults who make it their initial drug of choice. Perhaps the firmer implementation of California’s medical marijuana law will make it possible to study whether young adults with a family history of alcoholism, given no legal obstacle to using cannabis as an alternative to alcohol, would do so, with positive results.
REFERENCES

Birch, E.A. 1889. The use of Indian hemp in the treatment of chronic chloral and chronic opium poisoning. Lancet 1(March 30):625. Carstairs, G.M. 1951. Bhang and alcohol: Cultural factors in the choice of intoxicants, from Marihuana Papers, Ed. Solomon, D. Bobbs Merrill: New York. Clendinning, J. 1843. Observation on the medicinal properties of Cannabis sativa of India. Medical-Chiurgical Transactions 26:188-210. Edes, R.T. 1887. Textbook of therapeutics and materia mmedica. Lea Bros. Philadelphia. Gieringer, D. 2003. The acceptance of medical marijuana in the U.S. J Cannabis Therapeutics 3(1):53-65. Government of India Financial Department. (1873). Effects of the use of ganja and other preparations of the hemp plant. Resolution No. 3773 Supplement to the Gazette of India, December 27, 1395-9. Indian Hemp Drugs Commission. (1893-1894). Report. Government Central Printing Office, Simla I:XVIII 359. Lilly’s, E. 1898. Hand book of pharmacy & therapeutics. Fifth revision. Indianapolis. Merck Manual. 1899. New York. Mikuriya, T.H. 1970. Cannabis substitution: An adjunctive therapeutic tool in the treatment of alcoholism. Medical Times 98(4):187-91. Moreau, J.-J. 1845. Hashish and Mental Illness. Raven Press, New York, 1973. Parke-Davis. 1909. Manual of therapeutics. Detroit, MI. Potter, S.O.L. 1895. Materia medica, pharmacy and therapeutics. Blakiston & Son: Philadelphia. Scher, M.S. 1971. Marijuana as an agent in rehabilitating alcoholics. Amer J Psychiat 127:7. Thompson, L.J. and R.C. Proctor. 1953. The use of pyrahexyl in the treatment of alcoholic and drug withdrawal conditions. N Carolina Med J 14:520-3.

Lynn & Erin Compassionate Use Act Patient’s Coalition of New Mexico ~ A GrassRoots Movement!
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