Jason Barker - Medical Cannabis Patient & Organizer with LECUA Patient’s Coalition Of New Mexico 
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
Medical Cannabis Program
PO Box 26110
Santa Fe, NM, 87502-6110
Petition: Requesting The Inclusion Of A New Medical Condition: Sleep Disorders
Table of Contents
Pg. 1 Cover Page
Pg. 2 Petition Introduction
Pg. 3 Petition Purpose and Background
Pg. 10 Relief Requested In Petition
Pg. 10-11 References
Printing Provided By:
Petition Introduction: Requesting The Inclusion Of A New Medical Condition: Sleep Disorders
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”.
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.
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.
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 Medical Treatment Petition is: Requesting The Inclusion Of A New Medical Condition: Sleep Disorders.
This petition for the Medical Treatment that pertains to: Requesting The Inclusion Of A New Medical Condition: Sleep Disorders 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.
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.
“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.
There is a wealth of new scientific understanding regarding how medical marijuana or cannabis can be beneficial for treating Sleep Disorders.
The most common kinds of sleep disorders are
- Insomnia – a hard time falling or staying asleep
- Sleep apnea – breathing interruptions during sleep
- Restless legs syndrome – a tingling or prickly sensation in the legs
- Narcolepsy – daytime “sleep attacks”
Nightmares, night terrors, sleepwalking, sleep talking, head banging, wetting the bed and grinding your teeth are kinds of sleep problems called parasomnias. There are treatments for most sleep disorders. Sometimes just having regular sleep habits can help.
Clinical Information Related to Sleep Disorders and How Medical Cannabis Helps
Insomnia
Insomnia, a clinical sleep disorder, is characterized by the sufferer’s inability to fall asleep and or stay asleep. The disorder comes in two forms: Primary Insomnia where the individual’s sleep problems are not the result of another ailment or disorder, and Secondary Insomnia where the sleep problems are the result of another ailment, disease, or disability - examples include chronic pain conditions such as arthritis or fibromyalgia; anxiety and or depression; epilepsy; recovery from chemotherapy; HIV/AIDS; recovery from addiction; psychological issues; stress, and even some side effects from medication can result in Insomnia.
Insomnia can be very debilitating and can lead to drastically lowered energy levels and tiredness throughout the day, difficulties concentrating, problems with memory, irritability, and it can even cause and or exacerbate depression. At the worst, chronic lack of sleep or sleep deprivation can cause neurological problems in the brain.
There are a number of medications and treatments that help tackle insomnia, and it is relieving to know that some cases of insomnia may not even need medical intervention.
Using Cannabis to Treat Insomnia
Cannabis is a complex medicinal plant that may actually be used to treat a variety of debilitating symptoms caused by a surprisingly large number of ailments. Its usefulness as a non-lethal medicine cannot be overstated and its versatility in terms of how it can be consumed and as to how it can be useful for so many illnesses is something to be excited about. However, it is important to remember that consulting with your primary care physician should be your first priority when considering incorporating cannabis into one’s medical regiment and that cannabis is to be used as an adjunct therapy and not a replacement. It is also your responsibility to communicate with your doctor as to how your use of cannabis has affected your health and of your progress with utilizing medical cannabis.
Much of the recent research surrounding cannabis and its usefulness in treating insomnia is focused on the sedative effects of both Cannabidiol (CBD), Cannabinol (CBN), and even Tetrahydrocannabinol (THC). It is important to note, however, that the sedative effects often associated with THC are due to the synergistic terpenoids that work with it to provide a therapeutic effect useful for insomnia.
Overall, exciting studies have shown that cannabis may be quite useful for treating individuals suffering from Insomnia for the following reasons: assisting with falling asleep and overall quality of sleep; helping to manage possible anxiety and or depression; and with protecting the brain from possible damage and degeneration.
Cannabinol (CBN): The Cannabinoid That Makes You Sleepy
What Is Cannabinol (CBN)?
When we look at the construction of cannabis, we find that it has over 80 cannabinoids. Until recently, tetrahydrocannbinol (THC) was the only cannabinoid anyone seemed to care about. Thankfully recent research, particularly about cannabidiol (CBD), has brought about an intense interest in all the cannabinoids.
As is the case in many of the known cannabinoids, cannabinol (CBN) stems from cannabigerolic acid (CBGA) in cannabis. The plant naturally produces enzymes (aka synthases) that convert the CBGA to one of 3 major cannabinoids: cannabichromene carboxylic acid (CBCA), cannabidiol carboxylic acid (CBDA), and tetrahydrocannabinol carboxylic acid (THCA).
When the plant develops THCA, it usually will be converted to THC as a result of heat or UV light. That being said, THCA can be converted to CBNA over time as well. Prolonged exposure to air causes the THCA to lose hydrogen molecules and oxidize; now we have CBNA. Just like the rest of the acidic cannabinoids, CBNA will convert to cannabinol (CBN) when exposed to heat or UV light.
What Are The Benefits Of Cannabinol (CBN)?
Cannabis is widely used as a sleep-aid for those who suffer from insomnia and cannabinol is the reason why. By all accounts, CBN is the cannabinoid responsible for the sedative effects of cannabis. Because of this, I tend to reserve high-CBN strains for night use.
Another use for cannabinol as an anti-bacterial. According to a Italian study from 2008, cannabinol “showed potent activity against MRSA” when applied as a topical. Topical uses also have shown promise in treating burns and psoriasis.
The research on cannabinol (CBN) is still lacking, but some early studies have suggested it could stimulate bone growth. If that’s the case, it would be helpful in treating osteoporosis. It could also help those with broken bones to recover more quickly.
Cannabinol Can Reflect The Age Of Your Cannabis
When searching for the perfect strain, it’s important to know what you’re getting. This is why lab-testing should never be overlooked. Testing facilities like Steep Hill Lab in California give patients a complete cannabinoid profile of their medicine. It’s always a good idea to check a strains profile before making a decision.
Because cannabinol is a production of degradation, it’s not usually found in high concentrations (in a collective). High levels of CBN are usually related to poor storage methods. If cannabis is stored in an airtight container of some sort, it’s unlikely that a lot of THC would convert to CBN.
Luckily, not all is lost if you’re searching your collective for a sleep-aid. The simple solution would be to allow your medicine to age a bit. When exposed to the air, the THC will begin to degrade and convert to CBN, a great way to fight insomnia.
Study: Cannabinoids Help Treat Obstructive Sleep Apnea
What Is Obstructive Sleep Apnea?
Obstructive sleep apnea(OSA) is the most common of form of sleep apnea. The literal definition of apnea is, “cessation of breath.” With that said, OSA causes a complete or partial blockage of the upper airway, and the diaphragm and chest muscles must work harder to pull air into the lungs.
According to WedMD, breathing often resumes with a loud gasp, snort, or body jerk, all of which can be detrimental to sleep quality. Additionally, obstructive sleep apnea can reduce the flow of oxygen to vital organs and negatively impact heart health. In fact, the disease has been tied to an increased risk of heart attack.
As it stands, the most common form of sleep apnea treatment is the use of a continuous positive airway pressure (CPAP) machine. A CPAP, which typically comes in the form of a mask, increases air pressure in your throat so that the air way does not collapse while inhaling.
Understandably, a number of people are not keen on the idea of sleeping with a mask and adherence to treatment can be difficult to maintain. It is clear that a more convenient method of treatment would be warranted so long as side effects are minimal.
Cannabinoids Offer Natural Sleep Apnea Treatment
A team of researchers from the University of Illinois at Chicago published a study this month in the journal Respitory Physiology & Neurobiologythat investigated the efficacy of cannabinoid treatments for obstructive sleep apnea. In doing so, they investigated the effects of dronabinol – a synthetic cannabinoid with similar effects to tetrahydrocannabinol (THC).
Prior to the experiment, the research team, led by Michael Calik, PhD, hypothesized that an injection of cannabinoids would help keep sleep apnea at bay. They first injected dronabinol into a portion of the vagus nerve, which reports sensory information to the brain, in rats.
According to their results, the cannabinoid injections were able to attenuate serotonin-induced apnea. Additionally, the researchers found that dronabinol seemed to increase phasic activation of the genioglossus – a muscle that runs from the chin to the tongue and is responsible for sticking out your tongue. Relaxation off the genioglossus has been implicated as a potential cause of obstructive sleep apnea in the past.
All things considered, future studies could find a more direct link between cannabis and obstructive sleep apnea. If that scenario comes to fruition, then cannabis extracts, likely in the form of capsules, could offer a natural alternative to CPAP machines in the treatment of sleep apnea.
Beneficial Cannabinoids and terpenoids Useful for Treating Insomnia
The cannabis plant offers a plethora of therapeutic benefits and contains numerous cannabinoids and terpenoid compounds that are useful for managing insomnia.
The following chart denotes which cannabinoids and terpenoids work synergistically with each other for possible therapeutic benefit. It may be beneficial to seek out strains that contain these cannabinoids and terpenoids.
Sleep Disorders
In the United States, approximately 70 million people suffer from insomnia, insufficient sleep or another sleep disorder. CBD has been mistakenly described as sedating. In modest doses, CBD is mildly alerting. Cannabidiol activates the same adenosine receptors as caffeine, a stimulant. But several patients with sleep issues report that ingesting a CBD-rich tincture or extract a few hours before bedtime has a balancing effect that facilitates a good night’s sleep.
- The nonpsychoactive Cannabis constituent cannabidiol is a wake-inducing agent [http://www.ncbi.nlm.nih.gov/pubmed/19045957]
- Cannabis, pain, and sleep: Lessons from therapeutic clinical trials of Sativex [http://www.ncbi.nlm.nih.gov/pubmed/?term=Cannabis%2C+pain%2C+and+sleep%3A+lessons+from+therapeutic+clinical+trials+of+Sativex%2C+a+cannabis-based+medicine]
- Endocannabinoid modulation of cortical up-states and NREM sleep [http://www.ncbi.nlm.nih.gov/pubmed/24520411]
- Intranodose ganglion injections of dronabinol attenuate serotonin-induced apnea in Sprague-Dawley rat [http://www.ncbi.nlm.nih.gov/pubmed/24121138]
Rules, Regulations, & Policy Solution For This Petition Requesting The Inclusion Of A New Medical Condition: Sleep Disorders
The approval of this petition: Requesting The Inclusion Of A New Medical Condition: Sleep Disorders, 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.
References
Understanding medical cannabis.Elemental Wellness Center, 2014 Jul.
Cannabis and insomnia.Tringale, Rolando, et al.
O’Shaughnessy’s, 2011 Apr, 31-32.
The modulatory role of endocannabinoids and sleep.Murillo-Rodriguez, Eric.
Revisita de Neurologia, 2008, 46(3): 160-166.
The role of the CB1 receptor in the regulation of sleep.Murillo-Rodriguez, Eric.
Progress in Neuro-Psycopharmacology and Biological Psychiatry, 2008 Aug 1, 32(6): 1420-1427.
Cannabis, pain, and sleep: lessons from therapeutic clinical trials of Sativex, a cannabis-based medicine.Russo, Ethan B., et al.
Chemistry & Biodiversity, 2007 Aug 21, 4(8): 1729-1743.
Cannabidiol, a constituent of cannabis sativa, modulates sleep in rats.Murillo-Rodriguez, Eric, et al.
FEBS Letters, 2006 Aug 7, 581(18): 4337-4345.
Effects of Δ-9 tetrahydrocannabinol and cannabidiol on nocturnal sleep and early-morning behavior in young adults.Nicholson, Anthony N., et al.
Journal of Clinical Psychopharmacology, 2004 Jun, 24(3): 305-313.
Pharmacology of cannabinoids.Grotenhermen, Franjo.
Neuroendocrinology Letters, 2004 Apr, 1-2: 15-23.
Anandamide enhances extracellular levels of adenosine and induces sleep: an in vivo microdialysis study.Murillo-Rodriguez, Eric, et al.
Sleep, 2003 Aug, 26(8): 943-947.
Established and potential therapeutic applications of cannabinoids in oncology.Walsh, Declan, et al.
Supportive Care in Cancer, 2003 Mar, 11(3): 137-143.
Functional role for cannabinoids in respiratory stability during sleep.Carley, DW, et al.
Sleep, 2002, 25(4): 391-398.
Lynn & Erin Compassionate Use Act Patient’s Coalition of New Mexico ~ A GrassRoots Movement!
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(All Rights Reserved 04/20/2016)
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