Wednesday, September 27, 2017

Petition: Substance Abuse Disorder

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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: Substance Abuse Disorder
(To Include: Alcohol Use Disorder (AUD), Tobacco Use Disorder, Stimulant Use Disorder, Hallucinogen Use Disorder, and Opioid Use Disorder)

Table of Contents
Pg.  1 Cover Page
Pg.  2 Petition Introduction
Pg.  3 Petition Purpose and Background
Pg.  43 Relief Requested In Petition
Pg. (Noted) References
Pg.  43-54 Appendix A & B

 


“I have to make sure I don't engage in conversations with people who don't abide by the rules of evidence.” ― Dr. Carl Hart


Petition: Requesting The Inclusion Of A New Medical Condition: Substance Abuse Disorder
(To Include: Alcohol Use Disorder (AUD), Tobacco Use Disorder, Stimulant Use Disorder, Hallucinogen Use Disorder, and Opioid Use 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: Requesting The Inclusion Of A New Medical Condition: Substance Abuse Disorder; To Include: Alcohol Use Disorder (AUD), Tobacco Use Disorder, Stimulant Use Disorder, Hallucinogen Use Disorder, and Opioid Use Disorder (substance use disorder, for which the applicant or qualified patient is currently undergoing treatment for the applicant's or qualified patient's condition).

The purpose of this Petition: Requesting The Inclusion Of A New Medical Condition: Substance Abuse Disorder; To Include: Alcohol Use Disorder (AUD), Tobacco Use Disorder, Stimulant Use Disorder, Hallucinogen Use Disorder, and Opioid Use 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
To Include: Alcohol Use Disorder (AUD), Tobacco Use Disorder, Stimulant Use Disorder, Hallucinogen Use Disorder, and Opioid 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)

Criteria for Substance Use Disorders

Substance use disorders span a wide variety of problems arising from substance use, and cover 11 different criteria:
  1. Taking the substance in larger amounts or for longer than you're meant to
  2. Wanting to cut down or stop using the substance but not managing to
  3. Spending a lot of time getting, using, or recovering from use of the substance
  4. Cravings and urges to use the substance
  5. Not managing to do what you should at work, home, or school because of substance use
  6. Continuing to use, even when it causes problems in relationships
  7. Giving up important social, occupational, or recreational activities because of substance use
  8. Using substances again and again, even when it puts you in danger
  9. Continuing to use, even when you know you have a physical or psychological problem that could have been caused or made worse by the substance
  10. Needing more of the substance to get the effect you want (tolerance)
  11. Development of withdrawal symptoms, which can be relieved by taking more of the substance

Background and Types of Substance Use Disorders

The following is a list with descriptions of the most common substance use disorders in the United States.

Alcohol Use Disorder (AUD)

Excessive alcohol use can increase a person’s risk of developing serious health problems in addition to those issues associated with intoxication behaviors and alcohol withdrawal symptoms. According to the Centers for Disease Control and Prevention (CDC), excessive alcohol use causes 88,000 deaths a year.
Data from the National Survey on Drug Use and Health (NSDUH) — 2014 (PDF | 3.4 MB) show that in 2014, slightly more than half (52.7%) of Americans ages 12 and up reported being current drinkers of alcohol. Most people drink alcohol in moderation. However, of those 176.6 million alcohol users, an estimated 17 million have an AUD.
Many Americans begin drinking at an early age. In 2012, about 24% of eighth graders and 64% of twelfth graders used alcohol in the past year.
The definitions for the different levels of drinking include the following:
  • Moderate Drinking—According to the Dietary Guidelines for Americans, moderate drinking is up to 1 drink per day for women and up to 2 drinks per day for men.
  • Binge Drinking—SAMHSA defines binge drinking as drinking 5 or more alcoholic drinks on the same occasion on at least 1 day in the past 30 days. The National Institute on Alcohol Abuse and Alcoholism (NIAAA) defines binge drinking as a pattern of drinking that produces blood alcohol concentrations (BAC) of greater than 0.08 g/dL. This usually occurs after 4 drinks for women and 5 drinks for men over a 2 hour period.
  • Heavy Drinking—SAMHSA defines heavy drinking as drinking 5 or more drinks on the same occasion on each of 5 or more days in the past 30 days.
Excessive drinking can put you at risk of developing an alcohol use disorder in addition to other health and safety problems. Genetics have also been shown to be a risk factor for the development of an AUD.
To be diagnosed with an AUD, individuals must meet certain diagnostic criteria. Some of these criteria include problems controlling intake of alcohol, continued use of alcohol despite problems resulting from drinking, development of a tolerance, drinking that leads to risky situations, or the development of withdrawal symptoms. The severity of an AUD—mild, moderate, or severe—is based on the number of criteria met.
Learn more about the treatments for AUD. Find more information at the NIAAA website.

Tobacco Use Disorder

According to the CDC, more than 480,000 deaths each year are caused by cigarette smoking. Tobacco use and smoking do damage to nearly every organ in the human body, often leading to lung cancer, respiratory disorders, heart disease, stroke, and other illnesses.
In 2014, an estimated 66.9 million Americans aged 12 or older were current users of a tobacco product (25.2%). Young adults aged 18 to 25 had the highest rate of current use of a tobacco product (35%), followed by adults aged 26 or older (25.8%), and by youths aged 12 to 17 (7%).
In 2014, the prevalence of current use of a tobacco product was 37.8% for American Indians or Alaska Natives, 27.6% for whites, 26.6% for blacks, 30.6% for Native Hawaiians or other Pacific Islanders, 18.8% for Hispanics, and 10.2% for Asians.
For information and strategies to help you or a loved one stop smoking or using tobacco, visit SAMHSA’s Treatments for Substance Use Disorders page. To find out more about smoking and tobacco, visit the CDC website.

Stimulant Use Disorder

Stimulants increase alertness, attention, and energy, as well as elevate blood pressure, heart rate, and respiration. They include a wide range of drugs that have historically been used to treat conditions, such as obesity, attention deficit hyperactivity disorder and, occasionally, depression. Like other prescription medications, stimulants can be diverted for illegal use. The most commonly abused stimulants are amphetamines, methamphetamine, and cocaine. Stimulants can be synthetic (such as amphetamines) or can be plant-derived (such as cocaine). They are usually taken orally, snorted, or intravenously.
In 2014, an estimated 913,000 people ages 12 and older had a stimulant use disorder because of cocaine use, and an estimated 476,000 people had a stimulant use disorder as a result of using other stimulants besides methamphetamines. In 2014, almost 569,000 people in the United States ages 12 and up reported using methamphetamines in the past month.
Symptoms of stimulant use disorders include craving for stimulants, failure to control use when attempted, continued use despite interference with major obligations or social functioning, use of larger amounts over time, development of tolerance, spending a great deal of time to obtain and use stimulants, and withdrawal symptoms that occur after stopping or reducing use, including fatigue, vivid and unpleasant dreams, sleep problems, increased appetite, or irregular problems in controlling movement.
Learn more about stimulants from the Alcohol, Tobacco, and Other Drugs topic. For information about the treatment of stimulant use disorder, visit SAMHSA’s Treatments for Substance Use Disorders page.

Hallucinogen Use Disorder

Hallucinogens can be chemically synthesized (as with lysergic acid diethylamide or LSD) or may occur naturally (as with psilocybin mushrooms, peyote). These drugs can produce visual and auditory hallucinations, feelings of detachment from one’s environment and oneself, and distortions in time and perception.
In 2014, approximately 246,000 Americans had a hallucinogen use disorder. Symptoms of hallucinogen use disorder include craving for hallucinogens, failure to control use when attempted, continued use despite interference with major obligations or social functioning, use of larger amounts over time, use in risky situations like driving, development of tolerance, and spending a great deal of time to obtain and use hallucinogens.

Opioid Use Disorder

Opioids reduce the perception of pain but can also produce drowsiness, mental confusion, euphoria, nausea, constipation, and, depending upon the amount of drug taken, can depress respiration. Illegal opioid drugs, such as heroin and legally available pain relievers such as oxycodone and hydrocodone can cause serious health effects in those who misuse them. Some people experience a euphoric response to opioid medications, and it is common that people misusing opioids try to intensify their experience by snorting or injecting them. These methods increase their risk for serious medical complications, including overdose. Other users have switched from prescription opiates to heroin as a result of availability and lower price. Because of variable purity and other chemicals and drugs mixed with heroin on the black market, this also increases risk of overdose. Overdoses with opioid pharmaceuticals led to almost 17,000 deaths in 2011. Since 1999, opiate overdose deaths have increased 265% among men and 400% among women.
In 2014, an estimated 1.9 million people had an opioid use disorder related to prescription pain relievers and an estimated 586,000 had an opioid use disorder related to heroin use.
Symptoms of opioid use disorders include strong desire for opioids, inability to control or reduce use, continued use despite interference with major obligations or social functioning, use of larger amounts over time, development of tolerance, spending a great deal of time to obtain and use opioids, and withdrawal symptoms that occur after stopping or reducing use, such as negative mood, nausea or vomiting, muscle aches, diarrhea, fever, and insomnia.
For information about the treatment of opioid use disorder, visit SAMHSA’s Treatments for Substance Use Disorders page.

The Science And Research:
“How Medical Cannabis Can Cure the Opioid Epidemic with Dr. Jacob Vigil”    
Drs. Jacob Vigil, Anthony Reeve, and Sarah Stith talk about how medical cannabis can treat chronic pain and stop the opioid epidemic.
Visit the University of New Mexico Medical Cannabis Research Fund at: mcrf.unm.edu https://www.youtube.com/watch?v=u368htFsZOo

“Study Finds Medical Cannabis May Reduce Use Of Dangerous Prescription Drugs” http://www.cannabisnewsjournal.co/2017/09/study-finds-medical-cannabis-may-reduce.html                          The United States is in the midst of a major drug epidemic. Stories continue to roll in daily about the lives claimed by prescription and non-prescription drug overdoses. The numbers are staggering. Opioids alone (including prescription pain killers and street heroin) killed more than 33,000 people in 2015, 90+ Americans every single day, and more than any year on record according to the Center for Disease Control (CDC). From 2000 to 2015, half a million people died from prescription drug overdoses.
The opioid epidemic is the leading preventable form of death in the United States.
“The potential for addiction and health risks associated with using multiple scheduled drugs places additional direct monetary and health costs on patients and healthcare systems due to an increased number of side effects, risky drug interactions, dependency, and overdose” stated University of New Mexico researchers Jacob Miguel Vigil and Sarah See Stith, of a new study titled, Effects of Legal Access to Cannabis on Scheduled II-V Drug Prescriptions, which will be soon released in an upcoming issue of the Journal of American Medical Directors Association.
The study resulted from insights provided by co-investigator Dr. Anthony Reeve, a pain specialist from the Industrial Rehabilitation Pain Clinics, Albuquerque, N.M. and also one of the first physicians to authorize the use of cannabis for patients with chronic pain in the state of New Mexico.
Reeve observed a number of his patients coming back to see him, not only less frequently after enrolling in the New Mexico Medical Cannabis Program (MCP), but anecdotally, they would often claim that they were not only reducing their pain medications, but other types of prescription medications as well.
In their historical cohort study the researchers compared individuals that enrolled in the medical cannabis program to individuals with a similar diagnosis that chose not to enroll in the medical cannabis program but were offered the same authorization, to measure the effect of enrollment in a state-authorized United States’ MCP on Scheduled II-V drug prescription patterns.
They compared 83 chronic pain patients, who enrolled in the New Mexico Medical Cannabis Program during a five+ year period from April 2010 to October 2015, to 42 non-enrolled patients over a 24 month period (starting 6 months prior to enrollment for the MCP patients) using the Prescription Monitoring Program.
Using outcome variables including baseline levels and pre- and post-enrollment monthly trends in the numbers of drug prescriptions, distinct drug classes, dates prescription drugs were filled, and prescribing providers, the researchers found that 28 cannabis program enrollees (34 percent) and one comparison group patient (2 percent) ceased the use of all scheduled prescription medications by the last six months of the observation period.
Age and gender-adjusted regressions show that, although no statistically significant differences existed in pre-enrollment levels and trends, the post-enrollment trend among MCP patients is statistically significantly negative for all four measures of scheduled drug medication usage, while the post-enrollment trend is zero among the comparison group. The cannabis program enrollees showed statistically significantly lower levels across all four measures in comparison to the non-enrollees by 10 months post-enrollment. The researchers hypothesize that legal access to cannabis may reduce the use of multiple classes of dangerous prescription medications in certain patient populations.
“Our current opioid epidemic is the leading preventable form of death in the United States, killing more people than car accidents and gun violence,” said Vigil, the senior author and Associate Professor in the Department of Psychology. “No one has ever died from smoking too much cannabis. Therefore, the relative safety and efficacy of using cannabis in comparison to that of the other scheduled medications should be taken by the health providers and legislators, and may very well to have been considered by the patients in our study.”
The authors state that increased patient access to MCPs could impact prescription drug activity in numerous ways. “Potentially, MCPs might drive increased prescribing of medications as a result of side effects of cannabis use, including agitation or somnolence. Alternatively, access to cannabis could lead to a reduction in scheduled prescription drug use, if it treats patients’ underlying condition(s) more effectively than scheduled drugs requiring a prescription.”
The researchers are currently employing naturalistic studies to identify how older patients use and are affected by opioids, benzodiazepines, and medical cannabis for treating significant and societally expensive health conditions.
To support this and related research on the safety and effectiveness of Cannabis sativa as a pharmacological agent, you can do so by donating to The University of New Mexico Medical Cannabis Research Fund.  This News first broke by By Steve Carr on September 08, 2017 with the UNM Newsroom.



“New potential for marijuana: Treating drug addiction”
By Susan Scutti, CNN
Updated 7:21 PM ET, Wed May 17, 2017
(CNN) Harm reduction is a strategy for treating addiction that begins with acceptance. A friendlier, less disciplined sister of abstinence, this philosophy aims to reduce the overall level of drug use among people who are unable or simply unwilling to stop. What should naturally follow is a decrease in the many negative consequences of drug use.
In other words: progress, not perfection, as advocates of Alcoholics Anonymous often say.
Most European countries and Canada have embraced the idea of harm reduction, designing policies that help people with drug problems to live better, healthier lives rather than to punish them.
On the front lines of addiction in the United States, some addiction specialists have also begun to work toward this end.
Joe Schrank, program director and founder of High Sobriety, is one of them. He says his Los Angeles-based treatment center uses medicinal cannabis as a detox and maintenance protocol for people who have more severe addictions, although it's effectiveness is not scientifically proven.
"So it's a harm-reduction theory," he said. "With cannabis, there is no known lethal dose; it can be helpful for certain conditions."
Still, harm reduction is gaining acceptance in the wider field of addiction specialists in the U.S.
"In principle, what we have aimed for many years is to find interventions that would lead to complete abstinence," said Dr. Nora Volkow, director of the National Institute on Drug Abuse. Practically, though, that has been very difficult to achieve with relapsing addictions.
"One of the things is, we don't have any evidence-based medication that has proven to be efficacious for the treatment of cocaine addiction," Volkow said. "So we currently have no medicine to intervene, and it can be a very severe addiction and actually quite dangerous."
Dangerous because it gives users a high that literally alters the brain. Medical consequences of cocaine addiction include seizure, stroke and bleeding within the brain.
"We have started to explore the extent to which interventions that can decrease the amount of drug consumed can have benefits to the individual," Volkow said, adding that she'd make this same argument for opioids and heroin. "It would be valuable to decrease the amount of drug consumed."
Schrank is clear on the value of simply reducing drug use.
"We think of addiction as this light switch you can turn on and off," he said. "What we're learning is that for some people, it's similar to scuba diving: You can only come up 20 feet so often or you get very, very sick. When people stop immediately and that abruptly, it really makes them vulnerable."
Schrank, who readily concedes there are possible health and addiction risks with marijuana, says he offers his cannabis detox and maintenance protocol to people addicted to crack cocaine as well as those trying to kick opioids. Through the years, he says, he's treated about 50 people with this technique and expects to see "more people wanting to try to have a voice in their recovery rather than just plug into systems telling them what to do."
Marijuana "can really help people with pain management and other health issues, or it can help them be safer," Schrank said.

Reversing heroin's damage

Yasmin Hurd, director of the Addiction Institute at Mount Sinai School of Medicine, says generally, cannabidiol is the more important compound when it comes to marijuana as a treatment for addiction. It is one of the two primary cannabinoids, along with Δ9-tetrahydrocannabinol (THC), found in the cannabis plant. In terms of the wider scope of medical marijuana research, this is the "same cannabidiol being looked at for the kids with epilepsy," Hurd said.
THC, she says, binds to cannabinoid receptors in our brains (as do the natural cannabinoids our bodies produce), and it is the stimulation of those receptors that brings a "high." By comparison, cannabidiol has very weak effects in this regard and negatively modulates that receptor, instead.
Yet cannabidiol reverses some of the brain changes that occur with heroin use, Hurd says, based on her own studies of the compound.
For instance, heroin harms the glutamate transmitter system, which is important for decision-making, cognition and even reward, explains Hurd.
"We found that (cannabidiol) reversed the impairments caused by heroin, for example, on the glutamatergic receptors," Hurd said. Similarly, cannabidiol reversed damage to the cannabinoid receptors themselves caused by heroin, while activating the serotonin system: the neurotransmitter system believed to affect mood and a common target for makers of anti-anxiety and antidepressant medications.
More generally, cannabidiol positively influences our biological systems that are linked to the negative components of addiction, such as anxiety and inhibitory control, Hurd suggests.
"We still haven't figured out how it works," Hurd said. She notes that although cannabidiol is believed to be a "treatment to consider for opioid addiction and other drugs," there aren't a lot of data, especially with regard to its potential effects for cocaine addiction.
Adding to the data is a recent study, funded in part by a company applying to the Canadian government for a license to produce medical cannabis, exploring one possible harm reduction plan: swapping crack cocaine for marijuana.
Source and Full Article: http://www.cnn.com/2017/05/17/health/addiction-cannabis-harm-reduction/index.html
“High Sobriety: A Path Toward Life and Choice.”
(From the California Program Currently Treating Addiction with Medical Cannabis) https://highsobrietytreatment.com/about-us/
“High Sobriety supports a spectrum of recovery alternatives for individuals who have been previously unable to stop using alcohol and/or other drugs after attending traditional abstinence-based settings. The sheer number of people that fall into this category is astounding. For example, if you examine statistics from SAMHSA (Substance Abuse & Mental Health Services Administration), approximately 25% of individuals who undergo abstinence-based treatment, do not relapse. Although any measure of success is encouraging, we at High Sobriety are committed to supporting the remaining 75%, who incidentally, rank in the millions.
Tradition Vs. Change

The majority of other recovery programs are staffed with “recovering” addicts and alcoholics. Most of these individuals participate (hopefully) in a 12-Step Program, which they believe, is the one path that helped them get clean and sober. Therefore, when a client questions the concept of total abstinence, the staff member will shut it down, citing no real data, except for their own personal experience in 12-Step Meetings.  

Herein lies the crux of the problem; individuals that don’t adhere to the concept of total abstinence, but have improved their lives, do not attend 12-Step Meetings. They are not welcome there, unless of course, they want to stop doing what has worked for them, and adhere to a confusing set of internally known but publicly unsung standards about which types of drugs are acceptable in the 12-Step Program and when they can be used. For example, a benzodiazepine prescribed by a Psychiatrist for the treatment of anxiety is probably reasonable, but cannabis prescribed for Crohn’s Disease or a Sleep Disorder is definitely not!  

Although these standards may make sense to most traditional practitioners working in traditional treatment settings, they don’t make a lot of sense when considering the needs of the 75% who don’t understand the concept of abstinence, and more importantly, have probably demonstrated an inherent inability to abide by that philosophy in the past.
We support our residents’ cannabis replacement approach, where it is in full compliance with law and under medical supervision. Cannabis is used for a variety of medical conditions for treating and aiding symptomatic care. Cannabis can aid in the cleansing process, helping with discomfort, insomnia, and flu-like symptoms associated with the withdrawal process, reducing or eliminating the need for other drugs. After the initial cleansing process, a doctor of the residents’ choice provides a comprehensive and collaborative evaluation to determine an individual’s goals for recovery. The determination of how cannabis is used is ultimately made by the doctor, like any other medication.
Post cleansing, cannabis continues to be an option under medical supervision. When someone has been using for a prolonged period of time, moving into total abstinence within 30 days may not be a realistic undertaking, it may not even be the best strategy. It certainly raises the question: if total abstinence is the best course of action, why are the results so poor?”
Article: ‘How Cannabis Can Combat the Opioid Epidemic: An Interview With Philippe Lucas’

Philippe Lucas has deep roots in Canada’s cannabis culture. After co-founding the Vancouver Island Compassion Society medical dispensary in 1999, Lucas applied himself to cannabis science, working as a graduate researcher with the Center for Addictions Research of British Columbia and serving as founding board member of both the Multidisciplinary Association of Psychedelic Studies Canada and the Canadian Drug Policy Coalition. In 2013, he received the Queen Elizabeth II Diamond Jubilee Medal for his research on medical cannabis.
(Full disclosure/fun fact: He’s also Vice President of Patient Advocacy at Tilray, the cannabis production company owned by Privateer Holdings, which also owns Leafly.)
Most recently, Lucas is the author of a new study: “Rationale for cannabis-based interventions in the opioid overdose crisis,” published last month in the Harm Reduction Journal. In the study, Lucas lays out a variety of roles that cannabis might play in combatting the opioid epidemic, which currently kills 38,000 people in the U.S. and Canada each year and ranks as the leading cause of death among Americans under 50.
His study added an important perspective to the growing body of evidence supporting the notion of cannabis as healing tool in the opioid crisis. That idea is quickly moving into mainstream thought, as we’ve seen recently with the public pronouncements of Utah Sen. Orrin Hatch and, just this week, Dr. Oz.
Over the phone from his office in Nanaimo, Lucas let me interrogate him about specifics of the study.
Dave Schmader: What inspired you to undertake this study?
Philippe Lucas: Whether it’s medical use or recreational use, cannabis appears to be having an impact on the rates of opioid abuse. This study is a summation of the evidence, and I’ve taken that summation to suggest three opportunities for cannabis to intervene in the opioid crisis.
And those are…?
First is introduction—if physicians start recommending the use of medical cannabis prior to introducing patients to opioids, those patients that find cannabis to be a successful treatment for their chronic pain might never have to walk down the very tricky path of opioid use that all too often leads to abuse or overuse or overdose.
“Patients that find cannabis to be a successful treatment for their chronic pain might never have to walk down the very tricky path of opioid use.”
The second opportunity is reduction, for those patients who are successfully using opioids in the treatment of their chronic pain or other conditions but are worried about increasing their use of opioids over time. The evidence suggests you can introduce cannabis as an adjunct treatment and reduce the cravings for opioids, therefore potentially steering people away and reducing the risk of opioid overdose and opioid dependence.
The third part is cessation. Once individuals have become dependent on opioids and they recognize that dependence and are seeking treatment for it through opioid replacement therapy like methadone and suboxone, you can potentially introduce cannabis as an adjunct treatment to increase the success rate of the methadone or suboxone treatment. The reason this point is so important is that when people with an opioid dependence fail out of treatment, that’s the period where they become the most vulnerable to potential overdose. Replacement therapy has failed, they’re at their most vulnerable, and they go back to the illicit drug market, potentially risking overdose.
A key concept in the study is the “substitution effect.”
Yes. The substitution effect is an economic concept that suggests that the use of one substance never stands alone. In fact, the use of one substance can affect the use of another. When it comes to psychoactive substances, the use of a substance can be affected by changes in price, changes in legality or regulatory access, or changes in the product itself in terms of potency. And that can really affect the use of another drug.
“In medical cannabis states, there was a 25 percent reduction in opioid overdose deaths.”
A 2014 study showed that in medical cannabis states, there was a 25 percent reduction in opioid overdose deaths compared to neighboring states that didn’t have medical cannabis programs. There’s a growing body of research showing that simply making medical cannabis available in a number of US states and in Canada has reduced rates of not just opioid use, but also the use of alcohol, tobacco, and illicit substances,
often leading to total abstinence of those substances. So we’re looking at cannabis as a potential therapeutic agent, but also as a harm reduction agent when it comes to problematic substance use. This evidence suggests cannabis could be an exit drug to problematic substance use and addiction.
In the study you write, “Cannabis augments the pain-relieving potential of opioids and can re-potentiate their effects.” Tell me about re-potentiation.
Research suggests that when you use cannabis alongside opioids in the treatment of chronic pain, you seem to get a synergistic effect—a greater effect than you might have if each was taken individually. People who have been using opioids for some time sometimes have to increase their dose, and cannabis presents another option for physicians, so instead of increasing the dose of opioids they can instead prescribe medical cannabis as an adjunct treatment in order to keep the patient at a lower dose of opioids, thereby reducing the risk of overdose.
Another study quote: “[I]t would seem logical to seek to develop policies and associated education strategies to increase physician support for cannabis for therapeutic purposes in the treatment of chronic pain.” This does seem logical. What are the chances of it happening?
Right now we’re facing this tremendous public-health threat around the opioid overdose crisis. Opioid overdose is the most common cause of accidental death in Canada and the US right now. The over-prescription of opioids seems to be leading the way, in that four out of five people currently injecting opioids say that they started by using prescription opioids. There’s an oversaturation of the market and an over-availability on the black market.
I think that if we can shift prescription patterns by physicians—so that instead of first prescribing opioids and then, if those opioids fail, moving on to medical cannabis—we can modernize those policies and instead focus on introducing medical cannabis first. That’s based on all the available evidence, which indicates that it’s far less harmful than prescription opioids in terms of dependence and risk of overdose.
Right now in Canada and in US states with medical marijuana, physicians are encouraged to prescribe opioids first and if those don’t work, cannabis is considered as a third- or fourth-line treatment option. We need to flip that around and make cannabis the second-line treatment option and move opioids to third or fourth options if indeed cannabinoids are not successful.
Source: https://www.leafly.com/news/health/how-cannabis-can-combat-the-opioid-epidemic-an-interview-with-philippe-lucas
Supporting Research- Studies, References and Findings
Figure 1: When THC and prescription opioids are co-administered, the same level of pain relief is achieved with lower opioid dosage. This can prevent some of the negative side effects of opioid treatment and allow patients to reduce opioid use. (Photo credit: Amy Phung/Leafly)

Figure 2: CBD treatment can reduce the chance of relapse for those struggling with drug addiction by altering the withdrawal and drug abstinence phases. Symptoms of withdrawal will be treated, decreasing pain, anxiety, and mood symptoms. CBD can promote drug abstinence by reducing drug craving through suppression of the reward system of the brain. (Photo credit: Amy Phung/Leafly)
“Dr. Mehmet Oz said medical cannabis could be an "exit drug" that helps reduce opioid addiction.”
https://www.forbes.com/sites/tomangell/2017/09/19/dr-oz-says-medical-marijuana-could-help-solve-opioid-addiction/
“Cannabis as a Substitute for Opioid-Based Pain Medication: Patient Self-Report”
INTRODUCTION:
Prescription drug overdoses are the leading cause of accidental death in the United States. Alternatives to opioids for the treatment of pain are necessary to address the issue. Cannabis can be an effective treatment of pain, greatly reduces the chance of dependence, and eliminates the risk of fatal overdose compared to opioid-based medications. Medical cannabis patients report that cannabis is just as effective, if not more, than opioid-based medications for pain.
MATERIALS AND METHODS:
The current study examined the use of cannabis as a substitute for opioid-based pain medication by collecting survey data from 2897 medical cannabis patients.
CONCLUSION:
Future research should track clinical outcomes where cannabis is offered as a viable substitute for pain treatment examine the outcomes of using cannabis as a medication assisted treatment for opioid dependence.
© Cannabis and Cannabinoid Research.
Volume 2.1, 2017 DOI: 10.1089/can.2017.0012
Amanda Reiman,1,* Mark Welty,2 and Perry Solomon 3  View complete study here

“Medicinal cannabis and mental health: A guided systematic review”
HIGHLIGHTS:
• Mental health conditions are prominent among the reasons for medical cannabis use.

• Cannabis has potential for treatment of PTSD and substance abuse disorders.

• Cannabis use may influence cognitive assessment, particularly with regard to memory.

• Cannabis use does not appear to increase the risk of harm to self or others.

• More research is needed to characterize the mental health impact of medical cannabis.
 
© Clinical Psychology Review, Volume 51, February 2017, Pages 15-29.
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“Impact of cannabis use during stabilization on methadone maintenance treatment”
BACKGROUND AND OBJECTIVES:
Illicit drug use, particularly of cannabis, is common among opiate-dependent individuals and has the potential to impact treatment in a negative manner.
METHODS:
To examine this, patterns of cannabis use prior to and during methadone maintenance treatment (MMT) were examined to assess possible cannabis-related effects on MMT, particularly during methadone stabilization. Retrospective chart analysis was used to examine outpatient records of patients undergoing MMT (n = 91), focusing specifically on past and present cannabis use and its association with opiate abstinence, methadone dose stabilization, and treatment compliance.
RESULTS:
Objective rates of cannabis use were high during methadone induction, dropping significantly following dose stabilization. History of cannabis use correlated with cannabis use during MMT but did not negatively impact the methadone induction process. Pilot data also suggested that objective ratings of opiate withdrawal decrease in MMT patients using cannabis during stabilization.
CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE:
The present findings may point to novel interventions to be employed during treatment for opiate dependence that specifically target cannabinoid-opioid system interactions.
Copyright © American Academy of Addiction Psychiatry.
Am J Addict. 2013 Jul-Aug;22(4):344-51. doi: 10.1111/j.1521-0391.2013.12044.x.

“Cannabidiol inhibits the reward-facilitating effect of morphine: involvement of 5-HT1A receptors in the dorsal raphe nucleus”
Unlike hospice, long-term drug safety is an important issue in palliative medicine. Opioids may produce significant morbidity. Cannabis is a safer alternative with broad applicability for palliative care. Yet the Drug Enforcement Agency (DEA) classifies cannabis as Schedule I (dangerous, without medical uses). Dronabinol, a Schedule III prescription drug, is 100% tetrahydrocannabinol (THC), the most psychoactive ingredient in cannabis. Cannabis contains 20% THC or less but has other therapeutic cannabinoids, all working together to produce therapeutic effects. As palliative medicine grows, so does the need to reclassify cannabis. This article provides an evidence-based overview and comparison of cannabis and opioids. Using this foundation, an argument is made for reclassifying cannabis in the context of improving palliative care and reducing opioid-related morbidity.
Am J Hosp Palliat Care. 2011 Aug;28(5):297-303. doi: 10.1177/1049909111402318. Epub 2011 Mar 28.

“The Effect of Medicinal Cannabis on Pain and Quality of Life Outcomes in Chronic Pain: A Prospective Open-label Study”
OBJECTIVES
The objective of this prospective, open-label study was to determine the long-term effect of medicinal cannabis treatment on pain and functional outcomes in subjects with treatment-resistant chronic pain.  

METHODS
The primary outcome was change in pain symptom score on the S-TOPS (Treatment Outcomes in Pain Survey – Short Form) questionnaire at 6 months follow-up in intent-to-treat (ITT) population. The secondary outcomes included change in S-TOPS physical, social and emotional disability scales, pain severity and pain interference on brief pain inventory (BPI), sleep problems, and change in opioid consumption.  

RESULTS
274 subjects were approved for treatment; complete baseline data were available for 206 (ITT), and complete follow-up data for 176 subjects. At follow-up, pain symptom score improved from median 83.3 (95% CI 79.2-87.5) to 75.0 (95% CI 70.8-79.2), P<0.001. Pain severity score (7.50 [95% CI 6.75-7.75] to 6.25 [95% CI 5.75-6.75] and pain interference score (8.14 [95% CI 7.28-8.43] to 6.71 [95% CI 6.14-7.14]) improved (both P<0.001), together with most social and emotional disability scores. Opioid consumption at follow-up decreased by 44% (P<0.001). Serious adverse effects led to treatment discontinuation in two subjects.

DISCUSSION
The treatment of chronic pain with medicinal cannabis in this open-label, prospective cohort resulted in improved pain and functional outcomes, and significant reduction in opioid use. The results suggest long-term benefit of cannabis treatment in this group of patients, but the study’s non-controlled nature should be  considered when extrapolating the results.
Am J Hosp Palliat Care. 2011 Aug;28(5):297-303. doi: 10.1177/1049909111402318. Epub 2011 Mar 28.

“Medical cannabis laws and opioid analgesic overdose mortality in the United States, 1999-2010”
IMPORTANCE
Opioid analgesic overdose mortality continues to rise in the United States, driven by increases in prescribing for chronic pain. Because chronic pain is a major indication for medical cannabis, laws that establish access to medical cannabis may change overdose mortality related to opioid analgesics in states that have enacted them.
OBJECTIVE
To determine the association between the presence of state medical cannabis laws and opioid analgesic overdose mortality.
DESIGN, SETTINGS AND PARTICIPANTS
A time-series analysis was conducted of medical cannabis laws and state-level death certificate data in the United States from 1999 to 2010; all 50 states were included.
EXPOSURES
Presence of a law establishing a medical cannabis program in the state.
MAIN OUTCOMES AND MEASURES
Age-adjusted opioid analgesic overdose death rate per 100 000 population in each state. Regression models were developed including state and year fixed effects, the presence of 3 different policies regarding opioid analgesics, and the state-specific unemployment rate.
RESULTS
Three states (California, Oregon, and Washington) had medical cannabis laws effective prior to 1999. Ten states (Alaska, Colorado, Hawaii, Maine, Michigan, Montana, Nevada, New Mexico, Rhode Island, and Vermont) enacted medical cannabis laws between 1999 and 2010. States with medical cannabis laws had a 24.8% lower mean annual opioid overdose mortality rate (95% CI, −37.5% to −9.5%; P = .003) compared with states without medical cannabis laws. Examination of the association between medical cannabis laws and opioid analgesic overdose mortality in each year after implementation of the law showed that such laws were associated with a lower rate of overdose mortality that generally strengthened over time: year 1 (−19.9%; 95% CI, −30.6% to −7.7%; P = .002), year 2 (−25.2%; 95% CI, −40.6% to −5.9%; P = .01), year 3 (−23.6%; 95% CI, −41.1% to −1.0%; P = .04), year 4 (−20.2%; 95% CI, −33.6% to −4.0%; P = .02), year 5 (−33.7%; 95% CI, −50.9% to −10.4%; P = .008), and year 6 (−33.3%; 95% CI, −44.7% to −19.6%; P < .001). In secondary analyses, the findings remained similar.
CONCLUSIONS AND RELEVANCE
Medical cannabis laws are associated with significantly lower state-level opioid overdose mortality rates. Further investigation is required to determine how medical cannabis laws may interact with policies aimed at preventing opioid analgesic overdose.
Bachhuber, Marcus A., Brendan Saloner, Chinazo O. Cunningham, and Colleen L. Barry.
JAMA internal medicine 174, no. 10 (2014): 1668-1673.

“Medical Cannabis Use Is Associated With Decreased Opiate Medication Use in a Retrospective Cross-Sectional Survey of Patients With Chronic Pain”
FINDINGS
•Cannabis use was associated with 64% lower opioid use in patients with chronic pain.
•Cannabis use was associated with better quality of life in patients with chronic pain.
•Cannabis use was associated with fewer medication side effects and medications used.

Opioids are commonly used to treat patients with chronic pain (CP), though there is little evidence that they are effective for long term CP treatment. Previous studies reported strong associations between passage of medical cannabis laws and decrease in opioid overdose statewide. Our aim was to examine whether using medical cannabis for CP changed individual patterns of opioid use. Using an online questionnaire, we conducted a cross-sectional retrospective survey of 244 medical cannabis patients with CP who patronized a medical cannabis dispensary in Michigan between November 2013 and February 2015. Data collected included demographic information, changes in opioid use, quality of life, medication classes used, and medication side effects before and after initiation of cannabis usage. Among study participants, medical cannabis use was associated with a 64% decrease in opioid use (n = 118), decreased number and side effects of medications, and an improved quality of life (45%). This study suggests that many CP patients are essentially substituting medical cannabis for opioids and other medications for CP treatment, and finding the benefit and side effect profile of cannabis to be greater than these other classes of medications. More research is needed to validate this finding.

PERSPECTIVE
This article suggests that using medical cannabis for CP treatment may benefit some CP patients. The reported improvement in quality of life, better side effect profile, and decreased opioid use should be confirmed by rigorous, longitudinal studies that also assess how CP patients use medical cannabis for pain management.
Kevin F. Boehnke, Evangelos Litinas, Daniel J. Clauw
Front Psychiatry. 2013 Sep 23;4:109. doi: 10.3389/fpsyt.2013.00109.

Scholarly Article Links - Scientific reportings on medical marijuana and addiction treatment
Amanda Reiman, PhD MSW

Clinical Psychology Review

“Medical Cannabis A Viable Strategy to Address the Opioid Crisis”

Advocates Hope Lawmakers Consider Cannabis as Strategy

August 09, 2016 |  By Melissa Wilcox with Americans For Safe Access http://www.safeaccessnow.org/medical_cannabis_a_viable_strategy_to_address_the_opioid_crisis
Today, Americans for Safe Access (ASA) released the Medical Cannabis Access for Pain Treatment: A Viable Strategy to Address the Opioid Crisis report to educate legislators and health practitioners on the benefits of medical cannabis as a treatment option for the millions of patients suffering from chronic pain. Prescription opioid use has increased dramatically over the last two decades, and in the same period the number of deaths attributed to opioid overdose have quadrupled, creating a national crisis.   
In a briefing released earlier this year, President Obama proposed $1.1B in new funding for a multi-pronged approach to address the opioid overdose epidemic. In July, Obama signed the  Comprehensive Addiction and Recovery Act (CARA) into law. Many of the provisions in CARA focus on post-addiction strategies for treating drug abuse, heroin use, and overdose prevention strategies. Provisions that focus upstream, including addiction prevention strategies and ways to reduce the amount of opioids prescribed while still ensuring patients receive effective treatment, are underrepresented in the plan. While increasing funding for treatment programs is critical, it is equally important to utilize less harmful, treatment options.
ASA’s report outlines research and data supporting cannabis as an effective treatment option and provides three recommendations:
“We know that patients across the US are successfully utilizing cannabis to treat pain”  said ASA’s Executive Director Steph Sherer.  “ It is not a coincidence that opiate deaths are down nearly 25% in the states that allow medical professionals and their patients to utilize cannabis therapies as a treatment option. The Medical Cannabis Access for Pain Treatment: A Viable Strategy to Address the Opioid Crisis report shows that access to medical cannabis for pain treatment would help address two major components of the opiate crisis; accidental overdoses and addiction.”
In February, Senator Elizabeth Warren (D-MA) called on the CDC to collaborate with states and other federal agencies on the exploration of “alternative pain relief options” including medical cannabis. Additionally, she requested that the CDC evaluate the impact of medical and recreational cannabis on opioid overdose deaths in states where it is legal. Data gathered from states that have medical cannabis programs has shown a 24.8% reduction in deaths attributed to opioid related overdose compared to states without programs.
Some states have already taken action to include cannabis as an alternative treatment for chronic pain.  In June 2016, Vermont Governor Pat Shumlin signed legislation that added chronic pain to the state’s list of qualifying health conditions for medical cannabis treatment saying, “At a time when opioid addiction is ravaging our state and drug companies continue to urge our doctors to pass out painkillers like candy, we need to find a more practical solution to pain management.” Of the 26 states with full medical cannabis programs, only about three quarters currently include chronic pain as a qualifying condition.
ASA delivered the report to all members of Congress and is encouraging its members to discuss the report with their Representatives at their home offices. The report will also be sent to states that have medical cannabis programs that that do not include chronic pain as a qualifying condition.
More info:

“Women and Opioids: Inside the Deadliest Drug Epidemic in American History”

September 19, 2017 |  Marissa Valeri with Americans For Safe Access
Thirty-one women will lose their lives to opioids today. This special report details how the crisis is impacting all of us—and what it will take to end it.

“We must tackle opioid problem before it leads to an AIDS epidemic”

September 19, 2017 |  Marissa Valeri
A stitch in time saves nine. This may not be the reality we want or a society we court but we are in a crisis mode as far as opioids use is concerned. How did we get here? Who is to blame? Could it be our government or the physicians prescribing opioids? Some have argued culpability for civil society and of course who would forget the drug companies?

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’Université de Montréal 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.



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 for this Petition: Requesting The Inclusion Of A New Medical Condition: Substance Abuse Disorder; To Include: Alcohol Use Disorder (AUD), Tobacco Use Disorder, Stimulant Use Disorder, Hallucinogen Use Disorder, and Opioid Use Disorder

The approval of this The purpose of this Petition: Requesting The Inclusion Of A New Medical Condition: Substance Abuse Disorder; To Include: Alcohol Use Disorder (AUD), Tobacco Use Disorder, Stimulant Use Disorder, Hallucinogen Use Disorder, and Opioid Use 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.

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