Wednesday, September 27, 2017

Petition: Diabetes mellitus

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Saturday, September 16th 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: Diabetes mellitus


Table of Contents
Pg.  1 Cover Page
Pg.  2 Petition Introduction
Pg.  3 Petition Purpose and Background
Pg.  23 Relief Requested In Petition
Pg.  24 References
Pg.  27-28 Appendix A

 




Petition Introduction:Requesting The Inclusion Of A New Medical Condition: Diabetes mellitus

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: Requesting The Inclusion Of A New Medical Condition: Diabetes mellitus.

This Petition: Requesting The Inclusion Of A New Medical Condition: Diabetes mellitus 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.

Petition: Diabetes mellitus
(New Research Material Added Starts Here)
Diabetes mellitus is a metabolic disease that prevents the body from properly utilizing glucose. Studies have shown medical cannabis reduces the risk of diabetes, can help treat diabetes once its developed, and assists in the management of pain associated with the disease.

OVERVIEW OF DIABETES

Diabetes mellitus, also commonly simply referred to as diabetes, is a group of diseases that influences how the body uses glucose. Glucose, or blood sugar, is an important source of fuel for the body’s cells and is the main source of energy for the brain. In diabetes, there is too much glucose in the bloodstream. Glucose builds up because of an issue with insulin, a hormone made by the pancreas that allows your body to process and use glucose. There are two types of diabetes. Type 1 diabetes, or insulin-dependent diabetes, commonly affects children and teenagers and occurs when the pancreas doesn’t produce enough insulin. Type 2 diabetes, which accounts for 90 to 95% of all diabetes cases, occurs when the pancreas doesn’t produce enough insulin or the body’s cells fail to respond to insulin properly. Having too much glucose in the blood can lead to serious health problems, including cardiovascular disease, nerve damage, kidney damage, eye damage, foot damage, skin conditions and hearing impairment. The symptoms associated with diabetes include increased thirst and frequent urination, unexplained weight loss, fatigue, extreme hunger, irritability, blurred vision, presence of ketones in urine, dry and itchy skin, and frequent infections. The case of type 1 diabetes continues to be unknown. The body’s immune system accidentally attacks and destroys the cells within the pancreas that produce insulin. Type 2 diabetes is linked to being overweight and a lack of exercise. Treatments for diabetes commonly include the encouragement of healthy eating and regular exercise to lower body weight. In addition, regularly monitoring blood sugar is important for those with type 1 and type 2 diabetes. Insulin injections may be needed to adjust blood glucose levels.

FINDINGS: EFFECTS OF CANNABIS ON DIABETES

Cannabis use has been found to have an inverse association with diabetes (Alshaarawy & Anthony, 2015). Those who use cannabis have a lower incidence of the disease. This inverse relationship has been seen both in animal and human studies. In animal trials, one of the cannabinoids found in cannabis, cannabidiol (CBD), was shown to significantly reduce both pro-inflammatory cytokines in the bloodstream and the incidence of diabetes in non-obese mice (Weiss, et al., 2006). Later, those same researchers followed up with a similar study, but with rodents that were either in a latent diabetes stage or with initial symptoms of diabetes and found that CBD was effective at curtailing the manifestations of the disease. Only 30% of the CBD-treated mice ended up developing diabetes (Weiss, et al., 2008). Research has also found that CBD treatments in rats for one to four weeks received significant protection from diabetic retinopathy (El-Remessy, et al., 2006). Another cannabinoid found in cannabis, tetrahydrocannabinol (THC), produced several beneficial effects reducing the risk of diabetes in obese mice, including reducing glucose intolerance, improving glucose tolerance and increasing insulin sensitivity (Wargent, et al., 2013). Cannabinoids have also shown to elicit anti-inflammatory effects that effectively treat Type 1 diabetes in mice (Acharya, et al., 2017). In human studies, cannabis use has been correlated to a lower prevalence of diabetes (Rajavashisth, et al., 2012). An observational trial found that individuals that had used cannabis within the last 30 days experienced both lower fasting insulin levels and insulin resistance (Penner, Buettner & Mittleman, 2013). Other researchers found that those who consumed cannabis in the past year were more likely to possess a lower body mass index, lower fasting insulin and lower insulin resistance compared to non-users (Ngueta, Belanger, Laouan-Sidi & Lucas, 2015). In HIV-HCV infected patients, in which the risk of diabetes is higher, cannabis has been shown to be associated with a lower insulin resistance risk, thus demonstrating its potential as a therapeutic option (Carrieri, et al., 2015). Cannabinoids have also shown they can play a role in the regulation of glucose metabolism, suggesting that they’re beneficial for regulating fat tissue in humans that are obese (Pagano, et al., 2007). CBD and THC act upon the cannabinoid receptors (CB1 and CB2) of the endocannabinoid system, which stimulates anti-inflammatory and analgesic responses (Bermudez-Silva, et al., 2008) (Di Marzo, 2008) (Horváth, Mukhopadhyay, Haskó & Pacher, 2012). Because of cannabis’ anti-inflammatory effects, researchers have concluded that it can serve as a viable therapeutic option in the treatment of inflammatory diseases, like diabetes (Croxford & Yamamura, 2005). One study found that administering CBD weakened oxidative stress, inflammation, cell death and fibrosis, suggesting that it possesses great therapeutic potential (Rajesh, et al., 2010). An animal study found that action on the CB1 receptor decreased non-fasting plasma glucose, improved glycemic response to glucose and enhanced insulin sensitivity (Irwin, Hunter, Frizzell & Flatt, 2008). When combined with a hypocaloric diet, blocking the CB1 receptor over one year was shown to cause a significant decrease in bodyweight and waist circumference and cause an improvement in cardiovascular risk factors (Van Gaal, et al., 2005). Another study found cannabinoids to be effective at reducing β-cell destruction, which leads to insulin deficiency and cause of type 1 diabetes (Kim, et al., 2016). Cannabis can also assist in the management of pain associated with diabetes. In numerous studies, administering cannabis in mice reduced diabetic-related tactile allodynia, or pain resulting from a non-injurious stimulus to the skin (Dogrul, et al., 2004) (Ulugol, et al., 2004). One placebo-controlled study found that inhaled cannabis was effective at reducing diabetic peripheral neuropathy pain that had otherwise proven refractory to treatment (Wallace, et al., 2015).

STATES THAT HAVE APPROVED MEDICAL CANNABIS FOR DIABETES

No states have specifically approved medical cannabis for the treatment of diabetes. However, a number of other states will consider allowing medical cannabis to be used for the treatment of diabetes with the recommendation from a physician. These states include: California (any debilitating illness where the medical use of marijuana has been recommended by a physician), Connecticut (other medical conditions may be approved by the Department of Consumer Protection), Massachusetts (other conditions as determined in writing by a qualifying patient’s physician), Nevada (other conditions subject to approval), Oregon (other conditions subject to approval), Rhode Island (other conditions subject to approval), and Washington (any “terminal or debilitating condition”). In Washington D.C., any condition can be approved for medical marijuana as long as a DC-licensed physician recommends the treatment. In addition, Illinois has approved medical cannabis for the treatment of diabetic neuropathy, which can occur in those with diabetes. Several states have approved medical specifically to treat “chronic pain.” These states include: Alaska, Arizona, California, Colorado, Delaware, Hawaii, Maine, Maryland, Michigan, Montana, New Mexico, Ohio, Oregon, Pennsylvania, Rhode Island, Vermont, and West Virginia. The states of Nevada, New Hampshire, North Dakota, Montana, Ohio and Vermont allow medical marijuana to treat “severe pain.” The states of Arkansas, Minnesota, Ohio, Pennsylvania, Washington, and West Virginia have approved cannabis for the treatment of “intractable pain.”

 

 

RECENT STUDIES ON CANNABIS’ EFFECT ON DIABETES

  • Individuals that used marijuana within the last 30 days experienced lower fasting insulin levels and lower insulin resistance. The impact of marijuana use on glucose, insulin, and insulin resistance among US adults. (http://www.amjmed.com/article/S0002-9343(13)00200-3/pdf)
  • Marijuana users found to have a lower prevalence of diabetes compared to non-marijuana users. Decreased prevalence of diabetes in marijuana users: cross-sectional data from the National Health and Nutrition Examination Survey (NHANES) III.(http://bmjopen.bmj.com/content/2/1/e000494.full)

Findings in a new study indicate that the endocannabinoid system plays an instrumental role in maintaining the immunological health of the gut.

A new study from researchers at the University of Connecticut School of Medicine has found that cannabinoids are involved in maintaining the health of the digestive tract. The study, published last month in the Proceedings of the National Academy of Sciences, discovered that an endocannabinoid naturally produced by the body, anandamide, effectively reduces inflammation and cures Type 1 diabetes in mice.
In the study, the mice were given capsaicin, a key ingredient found in chili peppers. The capsaicin, once ingested, bound with the TRPV1 receptor, which in turn stimulated the production of anandamide. It was the anandamide that calmed down the immune system. The researchers discovered the same gut-calming results when feeding the mice anandamide directly.
Anandamide is a neuromodulatory lipid and one of the major endocannabinoids involved in ensuring the proper functioning of the endocannabinoid system. The endocannabinoid system is responsible for regulating an array of physiological processes, including immune response.
The researchers found that once the anandamide was produced or administered, it interacted with the endocannabinoid system’s receptors in the digestive tract to stimulate the production of a white blood cell called a macrophage to elicit an anti-inflammatory response. This inflammation-limiting effect cured the mice of Type 1 diabetes, suggesting it could also be beneficial for treating colitis, Crohn’s disease, and other inflammatory-related diseases.
One of the study’s researchers suggested that consuming cannabis, which contains phytocannabinoids that are chemically analogous to endocannabinoids like anandamide, would likely deliver the same result.
“I’m hoping to work with the public health authority in Colorado to see if there has been an effect on the severity of colitis among regular users of edible weed,” said Pramod Srivastava, senior author and Professor of Immunology and Medicine at UConn School of Medicine.
Srivastava plans to investigate whether the prevalence of inflammatory-related stomach diseases in Colorado has dropped since the state ended prohibition on recreational marijuana.
“If the epidemiological data shows a significant change [since adult use marijuana was legalized in 2012], that would make a testable case that anandamide or other cannabinoids could be used as therapeutic drugs to treat certain disorders of the stomach, pancreas, intestines and colon,” he said.
Previous studies have found the endocannabinoid system responsible for regulating the immune system. Others indicate that modulating the endocannabinoid system through the administering of cannabis and its cannabinoids returns the immune system to homeostasis and effectively reduces inflammation. Two major cannabinoids found in cannabis – tetrahydrocannabinol (THC) and cannabidiol (CBD) – have shown to interact with the cannabinoid receptors that are located in the brain to regulate inflammation.
“This allows you to imagine ways the immune system and the brain might talk to each other. They share a common language,” said Srivastava.
You can read the entire study, “Endocannabinoid system acts as a regulator of homeostasis in the gut,” via the journal Proceedings of the National Academy of Sciences of the United States of America (PNAS). (Abstract is below)
“Significance

Exogenous cannabinoids such as marijuana exert their influence through cannabinoid receptors. Endogenous cannabinoids such as anandamide (AEA) function through the same receptors, and their physiological roles are a subject of intense study. Here, we show that AEA plays a pivotal role in maintaining immunological health in the gut. The immune system in the gut actively tolerates the foreign antigens present in the gut through mechanisms that are only partially understood. We show that AEA contributes to this critical process by promoting the presence of CX3CR1hi macrophages, which are immunosuppressive. These results uncover a major conversation between the immune and nervous systems. In addition, with the increasing prevalence of ingestion of exogenous marijuana, our study has significant implications for public health.

Abstract
Endogenous cannabinoids (endocannabinoids) are small molecules biosynthesized from membrane glycerophospholipid. Anandamide (AEA) is an endogenous intestinal cannabinoid that controls appetite and energy balance by engagement of the enteric nervous system through cannabinoid receptors. Here, we uncover a role for AEA and its receptor, cannabinoid receptor 2 (CB2), in the regulation of immune tolerance in the gut and the pancreas. This work demonstrates a major immunological role for an endocannabinoid. The pungent molecule capsaicin (CP) has a similar effect as AEA; however, CP acts by engagement of the vanilloid receptor TRPV1, causing local production of AEA, which acts through CB2. We show that the engagement of the cannabinoid/vanilloid receptors augments the number and immune suppressive function of the regulatory CX3CR1hi macrophages (Mϕ), which express the highest levels of such receptors among the gut immune cells. Additionally, TRPV1−/− or CB2−/− mice have fewer CX3CR1hi Mϕ in the gut. Treatment of mice with CP also leads to differentiation of a regulatory subset of CD4+ cells, the Tr1 cells, in an IL-27–dependent manner in vitro and in vivo. In a functional demonstration, tolerance elicited by engagement of TRPV1 can be transferred to naïve nonobese diabetic (NOD) mice [model of type 1 diabetes (T1D)] by transfer of CD4+ T cells. Further, oral administration of AEA to NOD mice provides protection from T1D. Our study unveils a role for the endocannabinoid system in maintaining immune homeostasis in the gut/pancreas and reveals a conversation between the nervous and immune systems using distinct receptors.”
Full Text Available Here : http://www.pnas.org/content/114/19/5005.full


References:
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  2. Alshaarawy, O., and Anthony, J.C. (2015, July). Cannabis Smoking and Diabetes Mellitus: Results from Meta-analysis with Eight Independent Replication Samples. Epidemiology, 26(4), 597-600. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4801109/.
  3. Bermudez-Silva, F.J., Suarez, J., Baixeras, E., Cobo, N., Bautista, D., Cuesta-Munoz, A.L., Fuentes, E., Juan-Pico, P., Castro, M.J., Milman, G., MEchoulam, R., Nadal, A., and Rodriguez de Fonseca, F. (2008, March). Presence of functional cannabinoid receptors in human endocrine pancreas. Diabetologia, 51(3), 476-87. Retrieved from http://link.springer.com/article/10.1007%2Fs00125-007-0890-y.
  4. Carrieri, M.P., Serfaty, L., Vilotitch, A., Winnock, M., Poizot-Martin, I., Loko, M., Lions, C., Lascoux-Combe, C., Roux, P., Salmon-Ceron, D., Spire, B., and Dabis, F. (2015, March 16). Cannabis use and reduced risk of insulin resistance in HIV-HCV infected patients: a longitudinal analysis (ANRS CO13 HEPAVIH). Clinical Infectious Diseases, 61(1), 40-48. Retrieved from https://academic.oup.com/cid/article-lookup/doi/10.1093/cid/civ217.
  5. Croxford, J.L., and Yamamura, T. (2005, September). Cannabinoids and the immune system: potential for the treatment of inflammatory diseases? Journal of Neuroimmunology, 166(1-2), 3-18. Retrieved from http://www.jni-journal.com/article/S0165-5728(05)00160-8/fulltext.
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  8. Dogrul, A., Gul, H., Yildiz, O., Bilgin, F., and Guzeldemir, M.E. (2004, September 16). Cannabinoids blocks tactile allodynia in diabetic mice without attentuation of its antinociceptivee effect. Neuroscience Letters, 368(1), 82-6. Retrieved from http://www.sciencedirect.com/science/article/pii/S0304394004007980.
  9. El-Remessy, A.B., Al-Shabrawey, M., Khalifa, Y., Tsai, N.T., Caldwell, R.B., and Liou, G.I. (2006, January). Neuroprotective and blood-retinal barrier-preserving effects of cannabidiol in experimental diabetes. American Journal of Pathology, 168(1), 235-44. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1592672/.
  10. Horváth, B., Mukhopadhyay, P., Haskó, G., & Pacher, P. (2012). The Endocannabinoid System and Plant-Derived Cannabinoids in Diabetes and Diabetic Complications. The American Journal of Pathology, 180(2), 432–442. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3349875/.
  11. Irwin, N., Hunter, K., Frizzell, N., and Flatt, P.R. (2008, February 26). Antidiabetic effects of sub-chronic administration of the cannabinoid receptor (CB1) antagonist, AM251, in obese diabetic (ob/ob) mice. European Journal of Pharmacology, 581(1-2), 226-33. Retrieved from http://www.sciencedirect.com/science/article/pii/S0014299907013209.
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This study, published in 2013 in the American Journal of Medicine, looked at over 4500 patients over a five year period and found that cannabis use was associated with lower levels of fasting insulin and smaller waist circumference. “The most important finding is that current users of marijuana appeared to have better carbohydrate metabolism than nonusers,” says Murray Mittleman, an associate professor of medicine at Harvard Medical School and the lead author of the study. “Their fasting insulin levels were lower, and they appeared to be less resistant to the insulin produced by their body to maintain a normal blood-sugar level.”

The British Medical Journal hypothesised that the prevalence of DM would be reduced in cannabis users due to the presence of one or more cannabinoids because of their immunomodulatory and anti-inflammatory properties. In this article published in February, 2011, they found that cannabis use was independently associated with a lower prevalence of DM.

The years 2003 – 2008 showed a remarkable increase in publications on cannabidiol mainly stimulated by the discovery of its anti-inflammatory, anti-oxidative and neuroprotective effects. These studies have suggested a wide range of possible therapeutic effects of cannabidiol on several conditions, including Parkinson’s disease, Alzheimer’s disease, cerebral ischemia, diabetes, rheumatoid arthritis, other inflammatory diseases, nausea and cancer.

Israeli medical cannabis is flying high
Article At: http://www.jpost.com/HEALTH-SCIENCE/Israeli-medical-cannabis-is-flying-high-502905
“Four decades ago, we did research on cannabidiol on mice; it stopped their epileptic attacks and also was shown to be effective in humans.

Neurologists were not interested in it, but we know that it can be used to treat children with epilepsy. But giving too much of it can actually cause an epileptic attack. I don’t know why it took so long to give it to them.”

The chemical was also given to mice with type 1 (autoimmune) diabetes whose pancreatic cells were under attack. There has not been a single clinical study on the substance or type 1 diabetics. I can’t explain why.”

It can also be effective against graft vs. host disease, a complication after bone-marrow transplants.

“But because cannabis cannot be patented, companies are not very interested in producing products.

Schizophrenia patients can benefit from CBD, but not from THC. There are many brain regions in which cannabinoid receptors are abundant.”

Cannabis derivatives can be used to improve osteoporosis in menopausal women, reduce withdrawal symptoms from opiates and have been shown even to block nicotine addiction in mice and possibly in humans addicted to tobacco, Mechoulam said.” (Prof. Raphael Mechoulam, the 87-year-old world pioneer in cannabis research at the Hebrew University of Jerusalem)
(End of New Research Material Presented)

Diabetes Mellitus
Diabetes mellitus, or simply diabetes, is a chronic, lifelong condition that affects a person’s ability to healthily manage and produce insulin; in other words, it severely hinders the body’s ability to use the energy found in food. If left unmanaged, the ailment can cause blindness, heart disease, kidney failure, nerve damage, stroke, and ultimately death.
There are 2 primary types of diabetes: the more serious type 1 diabetes (juvenile diabetes which is also an autoimmune disease) where the body is incapable of producing insulin on it’s own, and the less severe type 2 diabetes (adult-onset diabetes) where the body produces inadequate amounts of insulin. The former requires consistent supplemental insulin, often in the form of syringes and insulin pens, while the latter can be better controlled with good diet and nutrition, but may still require medication. Although diabetes can be healthily managed, there is currently no known cure.
Using Cannabis to Treat Diabetes
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. It’s usefulness as a non-lethal medicine (you cannot die from an overdose of cannabis) cannot be overstated and it’s 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.
Those suffering from Diabetes will be pleased to hear that recent scientific medical studies show that cannabis can be useful in the treatment of the disease. One exciting study published in the American Journal of Medicine (Penner, E, et al., May 16, 2013), concludes, “We found that marijuana use was associated with lower levels of fasting insulin and HOMA-IR, and smaller waist circumference.”
Even more medical studies have shown that cannabis may be quite useful for treating individuals with Diabetes for the following reasons: slowing disease progression; protecting from eye disease caused by diabetes; significantly reducing neuropathic (nerve) pain; reducing the symptoms of heart-muscle disease (cardiomyopathy); controlling blood pressure caused by silent myocardial ischemia; aiding in healthy weight loss; controlling and reducing glucose and insulin levels.

Medical Cannabis: Keeping Your Insulin Levels Down
Research published in the current issue of The American Journal of Medicine concluded that regular cannabis users have a lower chance of obesity and diabetes mellitus than people who have never used cannabis.
The study was done by the Beth Israel Deaconess Medical Center (BIDMC) in Boston, where the 4657 men and women in the study were assessed after a 9-hour fast. Glucose and fasting insulin were tested for by way of blood samples, and a Homeostasis Model Assessment (HOMA) of insulin resistance (IR) was calculated to evaluate insulin resistance.
Their tests found that, “Current marijuana use was associated with 16% lower fasting insulin levels and 17% lower HOMA-IR.”
Researchers concluded that regular cannabis users (reported using marijuana in past month) have lower fasting insulin levels, and a lower risk of insulin resistance compared to those who have never used cannabis.
“Researchers concluded that regular cannabis users have lower fasting insulin levels, and a lower risk of insulin resistance compared to those who have never used cannabis.”
They also found a relationship between frequent marijuana use and smaller waist sizes. These findings were scarce in people who had reported smoking marijuana at least once, but not within the past 30 days, suggesting the effects of cannabis on insulin exists only during periods of recent use.
The study suggested that this is due to cannabinoids affecting peripheral metabolic processes via cannabinoid receptors in your body. However, it has not been made clear what exactly causes the effects on body mass index (BMI).
Cannabis Consumers Eat More & Weigh Less
It is a commonly accepted fact that cannabis users eat more. But did you know that it’s actually been shown in a study that they do? That’s right, an extra 600 calories per day more at that.
Yet marijuana smokers still have been found to have a reduced prevalence of obesity and lower incidence of diabetes (obesity is a precursor to diabetes). Regardless, the ramification of these discoveries could be monumental, considering the fact that nearly 40% of U.S. adults are considered obese and are costing the U.S. trillions in healthcare costs. It seems like something that most definitely deserves some recognition.

Study: Cannabis Associated With Lower Diabetes Risk
Adults with a history of marijuana use have a lower prevalence of type 2 diabetes and possess a lower risk of contracting the disease than those with no history of cannabis consumption, according to clinical trial data published in the British Medical Journal.
Investigators at the University of California, Los Angeles assessed the association between diabetes mellitus (DM) and marijuana use among adults aged 20 to 59 in a nationally representative sample of the US population of 10,896 adults. The study included four groups: non-marijuana users (61.0%), past marijuana users (30.7%), light (one to four times/month) (5.0%) and heavy (more than five times/month) current marijuana users (3.3%). Diabetes was defined based on self-report or abnormal glycaemic parameters.
Researchers hypothesized that the prevalence of type 2 diabetes would be reduced in marijuana users because of the presence of various cannabinoids that possess immunomodulatory and anti-inflammatory properties.
Investigators reported that past and present cannabis consumers possessed a lower prevalence of adult onset diabetes, even after authors adjusted for social variables (ethnicity, level of physical activity, etc.), despite all groups possessing a similar family history of DM. Researchers did not find an association between cannabis use and other chronic diseases, including hypertension, stroke, myocradial infarction, or heart failure compared to nonusers.
Past and current cannabis users did report engaging in more frequent physical activity than nonusers, but also possessed higher overall levels of total cholesterol and triglycerides. By contrast, the highest prevalence of marijuana consumers were found among those with the lowest glucose levels.
Investigators concluded, “Our analysis of adults aged 20-59 years … Showed that participants who used marijuana had a lower prevalence of DM and lower odds of DM relative to non-marijuana users.” They caution, however: “Prospective studies in rodents and humans are needed to determine a potential causal relationship between cannabinoid receptor activation and DM. Until those studies are performed, we do not advocate the use of marijuana in patients at risk for DM.”
Previous studies in animals have indicated that certain cannabinoids possess anti-diabetic properties. In particular, a preclinical trial published in the journal Autoimmunity reported that injections of 5 mg per day of the non-psychoactive cannabinoid CBD significantly reduced the incidence of diabetes in mice compared to placebo. Investigators reported that control mice all developed adult onset diabetes at a median of 17 weeks (range 15-20 weeks), while a majority (60 percent) of CBD-treated mice remained diabetes-free at 26 weeks.
Full text of the study, “Decreased prevalence of diabetes in marijuana users: cross-sectional data from the National Health and Nutrition Examination Survey (NHANES) III,” appears online here. [http://bmjopen.bmj.com/content/2/1/e000494.full ]
The Impact of Marijuana Use on Glucose, Insulin, and Insulin Resistance among US Adults by Elizabeth A. Penner, MD, MPH; Hannah Buettner, BA; Murray A. Mittleman, MD, DrPH
Abstract
Background
There are limited data regarding the relationship between cannabinoids and metabolic processes. Epidemiologic studies have found lower prevalence rates of obesity and diabetes mellitus in marijuana users compared with people who have never used marijuana, suggesting a relationship between cannabinoids and peripheral metabolic processes. To date, no study has investigated the relationship between marijuana use and fasting insulin, glucose, and insulin resistance.

Methods
We included 4657 adult men and women from the National Health and Nutrition Examination Survey from 2005 to 2010. Marijuana use was assessed by self-report in a private room. Fasting insulin and glucose were measured via blood samples after a 9-hour fast, and homeostasis model assessment of insulin resistance (HOMA-IR) was calculated to evaluate insulin resistance. Associations were estimated using multiple linear regression, accounting for survey design and adjusting for potential confounders.

Results
Of the participants in our study sample, 579 were current marijuana users and 1975 were past users. In multivariable adjusted models, current marijuana use was associated with 16% lower fasting insulin levels (95% confidence interval [CI], −26, −6) and 17% lower HOMA-IR (95% CI, −27, −6). We found significant associations between marijuana use and smaller waist circumferences. Among current users, we found no significant dose-response.

Conclusions
We found that marijuana use was associated with lower levels of fasting insulin and HOMA-IR, and smaller waist circumference.
The endocannabinoid system in obesity and type 2 diabetes.
Di Marzo V1.
Abstract
Endocannabinoids (ECs) are defined as endogenous agonists of cannabinoid receptors type 1 and 2 (CB1 and CB2). ECs, EC anabolic and catabolic enzymes and cannabinoid receptors constitute the EC signalling system. This system participates in the control of lipid and glucose metabolism at several levels, with the possible endpoint of the accumulation of energy as fat. Following unbalanced energy intake, however, the EC system becomes dysregulated, and in most cases overactive, in several organs participating in energy homeostasis, particularly, in intra-abdominal adipose tissue. This dysregulation might contribute to excessive visceral fat accumulation and reduced adiponectin release from this tissue, and to the onset of several cardiometabolic risk factors that are associated with obesity and type 2 diabetes. This phenomenon might form the basis of the mechanism of action of CB1 antagonists/inverse agonists, recently developed by several pharmaceutical companies as adjuvants to lifestyle modification for weight reduction, glycaemic control and dyslipidaemia in obese and type 2 diabetes patients. It also helps to explain why some of the beneficial actions of these new therapeutics appear to be partly independent from weight loss.

Cannabis and Lower Diabetes Incidence

Marijuana use is very well known for the unstoppable ‘Munchies’ it induces, thus why it is so appealing to chemo patients. One would think that an increased caloric intake would result in a larger BMI.
Surprisingly, this doesn’t seem to apply to marijuana users and this is exactly where we do not yet understand the implications of marijuana in metabolic functions.
In an effort to determine if there could be a positive correlation between marijuana and diabetes, one study examined the effects of marijuana use on glucose and insulin levels.
579 participants out of the 4657 were current marijuana users and showed a lower prevalence of diabetes than non-users. Current users showed 16 % lower levels of fasting insulin as well as 17 % lower insulin resistance, both with a confidence interval of 95%.
Marijuana users in this study were also found to have lower waist circumference than non-users and increased levels of high-density lipoprotein cholesterol (HDL-C), commonly called ‘good cholesterol’.
Marijuana and diabetes can be better studied in mice models mainly because the action of cannabis derivatives can directly be examined. The natural derivatives of the plant seem a lot more promising than the casual smoking.
This was the aim of a study conducted on diabetic mice which examined the effects of cannabidiol (CBD), a non-psychoactive component of marijuana, on the incidence of the disease.
The researchers demonstrated the potential of (CBD) to reduce the occurrence and delay the onset of Type 1 diabetes. It was found that CBD shows anti-autoimmune properties which needed further examination.
While some non-specific immunosuppressive drugs have shown to be successful in preventing diabetes, they are not an ideal alternative. Suppressing the immune system in a general fashion for a long period of time would present a high-risk treatment. Moreover, these drugs showed to be working only temporarily in the clinic until resistance was acquired.
The marijuana and diabetes research is a lot more promising. While CBD is also a non-specific immunosuppressant, it was found to promote a protective immune response in diabetic mice by the means of immunomodulation. Immunomodulation would allow the use of CBD in early-onset patients only long enough to deviate the destructive autoimmune response to a protective one.
Insulin forming Beta cells showed to be saved from destruction, allowing for proper metabolism to occur. Once the immune response is reversed, patients would no longer need to use the cannabis derivatives.This mechanism of action and would prevent the long-term resistance and immunosuppressive effects of continued use.

Cannabis and the Reversal of Neuropathy

One of the harshest complications of diabetes is Diabetic Neuropathy. Clinically it is defined as “the presence of symptoms and/or signs of peripheral nerve dysfunction in people with diabetes after the exclusion of other causes”, and affects 20% of the diabetic population.
Currently, several treatments are available, but none of them are sufficient in preventing neuropathy. Opioids and anticonvulsants have plateaued at a 50% efficacy in pain reduction and are associated with severe side effects.
While the association of cannabis receptors with the nervous system has been increasingly documented, some have brought their focus on marijuana and diabetes.
Two main cannabinoid receptors are responsible with pain modulation: CB1 and CB2. CB1 has been found to be more closely associated with the nervous system while CB2 can be found in the tissues of the immune system. Both synthetic and natural cannabinoids, such as CBD, have shown to be effective in treating pain associated with neuropathy.
One research focusing on marijuana and diabetes succeeded in showing such benefits in diabetic mice. First, the mice were chemically rendered diabetic by pancreatic impairment ( I know it sounds horrible) and tested for thermal and mechanical responsiveness.
After 30 days, the rats showed a significant decrease in responsiveness to stimuli due to the loss of neural sensation. eCBD, a mixture of CBD and THC, was then administered orally. Pain assessment was recorded 7 days after administration and the animals were killed in order to further examine their nerves and liver.
The correlation found between marijuana and diabetes were groundbreaking. eCBD has shown to restore the thermal pain perception in the paws of the rats and significantly increase their impaired mechanical force.
Diabetes has been documented to increase tissue damage in the liver by destroying the antioxidant scavenger system of the organism. Close examination of the eCBD treated rat livers revealed a reversal of the oxidative stress-induced damage by restoring the defense mechanism of the organism. Diabetic retinopathy, just as neuropathy, is considered to be mainly triggered by oxidative stress. Recent advancement in the study of marijuana and glaucoma may be able to shine new light on this problem.

Cannabis and Cardiovascular Complications

Another focus of the marijuana and diabetes research is to address the cardiovascular complication associated with the disease. Diabetic patients tend to show symptoms of defective clot dissolution and thrombosis leading to macrovascular disease.
Insulin resistance has been found to disturb coagulation and platelet aggregation as well as to increase a series of coagulants in the blood, such as thrombin. Such impairment of the procoagulant state often leads to hypertension and dangerous blood clots.
In order to examine the effects of cannabis extracts (THC, CBD, CBN) on blood coagulation, one study used obese rat models.
Obese rats were found  to have a 1.7 fold lower clotting time than lean rats in the laboratory. Both lean and obese rats were injected with cannabis extract for 28 days, after which blood was drawn and compared to the initial sample.
They found that CBD alone did not have any effects on thrombin activity, but that THC in combination with CBN had inhibitory effects. In both lean and obese rats, clotting time was 1.5 and 2 folds greater, respectively, than initial measurements. This finding is another important milestone in the study of marijuana and diabetes.
animals) showing that cannabis can have a number of positive effects on diabetes.
It begins with that original 2005 research paper that we highlighted from the American Alliance for Medical Cannabis (AAMC), which purported that cannabis can have the following benefits for PWDs (people with diabetes):
  • stabilizing blood sugars (confirmed via "a large body of anecdotal evidence building among diabetes sufferers")
  • anti-inflammatory action that may help quell some of the arterial inflammation common in diabetes
  • "neuroprotective" effects that help thwart inflammation of nerves and reduce the pain of neuropathy by activating receptors in the body and brain
  • "anti-spasmodic agents" help relieve muscle cramps and the pain of gastrointestinal (GI) disorders
  • acts as a "vasodilator" to help keep blood vessels open and improve circulation
  • contributes to lower blood pressure over time, which is vital for diabetics
  • substituting cannabis butter and oil in foods "benefits cardiac and arterial health in general"
  • it can also be used to make topical creams to relieve neuropathic pain and tingling in hands and feet
  • helps calm diabetic "restless leg syndrome" (RLS), so the patient can sleep better: "it is recommended that patients use a vaporizer or smoked cannabis to aid in falling asleep"
Evidence for all of this still stands, and has in fact been corroborated and built upon in the past decade. Here’s more:

Why Cannabis is Healthful

When most illegal substances are frowned upon, why is there so much talk about marijuana as medicine, that can actually be good for you?  
The linchpin seems to be something called the endogenous cannabinoid system, named after the plant that led to its discovery, which is “perhaps the most important physiologic system involved in establishing and maintaining human health,” according to NORML, the National Organization for the Reform of Marijuana Laws, based in Washington DC.
They explain:
“Endocannabinoids and their receptors are found throughout the body: in the brain, organs, connective tissues, glands, and immune cells. In each tissue, the cannabinoid system performs different tasks, but the goal is always the same: homeostasis, the maintenance of a stable internal environment despite fluctuations in the external environment… Cannabinoids promote homeostasis at every level of biological life, from the sub-cellular, to the organism, and perhaps to the community and beyond.”
Therefore NORML and other marijuana advocates and supporters “…believe that small, regular doses of cannabis might act as a tonic to our most central physiologic healing system.”

Research on Diabetes & Cannabis Says…

While there’s some conflicting evidence on marijuana’s role in delaying the risk of developing type 2 diabetes, research shows it is beneficial indeed for those already diagnosed with either type 1 or 2, and especially for those who suffer complications.
  • cannabis compounds may help control blood sugar
  • marijuana users are less likely to be obese, and have lower body mass index (BMI) measurements -- despite the fact that they seemed to take in more calories
  • cannabis smokers also had higher levels of "good cholesterol" and smaller waistlines
"The most important finding is that current users of marijuana appeared to have better carbohydrate metabolism than non-users. Their fasting insulin levels were lower, and they appeared to be less resistant to the insulin produced by their body to maintain a normal blood-sugar level,” Murray Mittleman, associate professor of medicine at Harvard Medical School and the lead researcher told TIME magazine.
In 2014, a “summary of the promising epidemiological evidence” on marijuana in the management of diabetes published in the Natural Medicine Journal also concluded that in thousands of subjects, past and current marijuana use was associated with lower levels of fasting insulin, blood glucose, insulin resistance, BMI, and waist circumference.
And in 2015, Israeli researchers at the Hebrew University of Jerusalem released a study showing that the anti-inflammatory properties of cannabidiol (CBD), a compound found in cannabis, could effectively be used to treat different illnesses including type 2 diabetes.
There’s also compelling scientific evidence that cannabis can aid in treating diabetes complications, for example eye disease; cannabis reduces the intraocular pressure (fluid pressure in the eye) considerably in people with glaucoma, which is caused by conditions that severely restrict blood flow to the eye, like diabetic retinopathy.

How Can Medical Cannabis Help With Diabetes?

So let’s say you were using marijuana, or wanted to try it. What would the effect be on your diabetes?
A number of PWDs report that with regular use, they see lower blood sugar levels and reduced A1c results over time. The existing scientific evidence shows that marijuana has an effect on improving insulin resistance [http://www.healthline.com/diabetesmine/treating_diabet#1 ]
Beneficial Cannabinoids and Terpenoids Useful for Treating Diabetes
Very recent studies have shown that Cannabidiol (CBD) was useful for lowering incidents of diabetes in animal models; that CBD has protective properties against both the vision impairing symptoms of diabetes and against cardiomyopathy (complications of the heart) is also important to note. Additionally, Tetrahydrocannabinol (THC) has been shown to reduce artificially elevated glucose levels in mouse models - human trials are definitely in need.
Other studies also show that Tetrahydrocannabivarin (THCV) may be useful for controlling unhealthy weight in the obese individual, which may help in controlling the symptoms of diabetes. Two major characteristics of cannabis may also benefit those suffering from diabetes: 1) cannabis has vasodilator properties and that it helps to improve blood flow, and 2) cannabis may help to significantly reduce blood pressure over time.
Last but not least, the following chart denotes which cannabinoids and terpenoids work synergistically with each other for possible therapeutic benefit:


Additional Research on How Medical Cannabis Benefits Diabetes


Rules, Regulations, & Policy Solution For Requesting The Inclusion Of A New Medical Condition: Diabetes mellitus
The approval of this petition: Requesting The Inclusion Of A New Medical Condition: Diabetes mellitus, 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.
Healthline News, 2013 July 23.
The American Journal of Medicine, 2013 Jul 23, 126(7): 583-589.
Nutrition & Diabetes, 2013 May 27, 3(5): 68.
Elsevier, 2013 May 15.
BMJ Open: Diabetes and endocrinology, 2012 Feb, 2(1).
The British Journal of Diabetes & Vascular Disease, 2010 Dec, 10(6): 267-273.
Journal of the American College of Cardiology, 2010 Dec, 56(25): 2115-2125.
Diabetes Care, American Diabetes Association website, 2010 Jan, 33(1): 128-130.
Phytotherapy Research, 2009 Dec, 23(12): 1678-1684.
Phytomedicine: International Journal of Phytotherapy and Phytopharmacology, 2009 July 24, 16(10): 942-949.
The American Journal of Pathology: Cellular and Molecular Biology of Disease, 2006 Jan, 168(1): 235-244.
Autoimmunity, 2006, 39(2): 143-151.
Journal of Neuroimmunology, 2005 Sep, 166(1-2): 3-18.
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Appendix A:
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.

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