November 28, 2014 Enigami Newsletter

Enigami Medical Cannabis, LLC (a subsidiary for Enigami Systems, Inc.)

Enigami continues to entertain “R & D” proposals for entities interested in developing condition specific medical cannabis medications.

Enigami is interested in partnering with a limited number of Dispensaries and Clinics who wish to be national treatment models for medical cannabis. As the medical cannabis field moves toward medical legitimacy we want to be in the mix.

For folks who are in the process of submitting clinic and dispensary applications for the various medical cannabis states Enigami will consider LOI’s to accompany the applications. In some cases Enigami can offer generous advertising allowances for new businesses establishing themselves as clinics and dispensaries seeking a significant difference in treatment resources – those that help patients determine the appropriate medications(s) for their treatment.

On some Enigami sites you will soon notice a “How to Register” video which also serves as a comprehensive FAQ resource. We’re always improving our products, generating meaningful patents, and trademarks.

Clif Croan spoke on the Dr. Diane Dike Radio Show, “Picking the Right Medical Cannabis For Your Medical Treatment”, joined the Board at the National Association of Cannabis Based Medicine , and was elected Chair (as a gubernatorial appointee) of the (Colorado) Disability Benefit Support Contract Committee . Most of the Enigami staff are heavily involved in community service as is the company itself. A nice lead in for our pro bono Veterans study…

“Do Veterans with PTSD Benefit from Medical Cannabis?” – an ongoing National Study

Kudos to Dr. Gary Miller, one of the study principals, for the Exclusive Ben Swann Video Interview: Dr. Gary Miller Says Veterans With PTSD Need Access To Cannabis Dr. Miller, always meaningfully contributing to the community, was elected to his local school board. Congratulations !

Bill Graf and Clif Croan manned a booth, for the study, at the November 8 Denver Veterans Day Festival at Denver’s Civic Center Park, near the State Capitol. It was a huge event and there were about 5-10,000 veterans. ttp://www.denverveteransday.com/ Bill Graf is constantly reaching out to various Vet advocacy organizations and is heavily committed to the worldwide community by his “hands on” philanthropic work in Haiti, several African nations, and southeast Asia.

Thank you ! to ML Mathre and Al Byrne, study members, for having made innumerable pitches for the study at more events than can be listed. What dedicated Vets they are ! Dr. Uma Dhanabalan, the study PI, continues her advocacy and has made numerous presentations at national conferences for the Vet study. She’s a Diamond !

Due to hosting problems on our website (2nd time) we were off line twice this month for a few hours. We no longer host our site with that organization. Problem solved.

A new informational brochure is available on the study website: http://www.vetptsdstudy.org/

Please contact the VA to support new legislation enabling them to look at medical cannabis treatment for PTSD. A call to Colorado’s Rep. Polis office wouldn’t hurt either. Ask for Stuart Feinhor.

As always please “spread the word” about the study…the VA and mainstream media sure won’t ! And for all the organizations disseminating information about the Vet study…Thank You !

Have a Happy, Safe, and Joyful Holiday Season !

September 22, 2014, Enigami Newsletter

Our development team at Crank211, LLC have evolved into close friends and co-workers. Despite their best efforts to avoid service disruption Microsoft ‘s “Azure” had a severe hiccup in service the past few weeks. If you encountered difficulties in your web services MIcrosoft may be the culprit.

The “Marijuana for Medical Professionals” conference on Sept. 9-11, 2014, in Denver, was a HUGE success. Many thanks to Ms. Montemayor, of Healthy Choices Unlimited for putting on the most professional medical cannabis conference to date. We can’t wait to attend next year.

Clif Croan, of Enigami, will be doing a radio interview with Dr. Diane Dike, Oct. 10, 2014, about the importance of patients being able to understand the medical cannabis products contents and how they relate to the conditions they’re treating: www.DianeDike.org.

Enigami Medical Cannabis, LLC (EMC) will be “tossing it’s hat into the ring” at the Marijuana Tech Start Up Competition, in Denver, the weekend of Sept. 26. EMC will only be accepting proposals on the future of the database which defines the relationships between the cannabinoid combinations and the qualifying conditions.

“EMC” has entered into a limited number of agreements to serve as R&D to large grow operations both domestically and abroad. EMC will furnish the information for product specifications to a very small number of growers/manufacturers.

“Brownie Points” – we all love ‘em, right ? A number of Dispensary and Evaluation clinics have signed LOI’s to provide EMC patient medication/symptom tracking (to determine the appropriate medications for treatment) in applications for state licenses to open. Good luck with the applications folks ! EMC looks forward to working with you !

Lastly, EMC has submitted two research applications to the State of Colorado Medical Marijuana Research Grant Program (RFA #1353). EMC and Healthy Choices (HCU Education LLC) teamed together for a study entitled: “Use of urine neurotransmitter markers in determining appropriateness of cannabis for chronic pain patients”. In the second instance EMC has teamed with the Colorado Cross Disability Coalition to research: “A Correlational Study of Medical Cannabis Cannabinoids Efficacy in the Treatment of the Colorado Qualifying Conditions”. Our advocacy position for the Colorado disability community is to assess the community’s needs in relation to the Colorado Department of Health and Environment’s Medical Marijuana Registry. Tragically the State has failed to allow representation of the Colorado disability community in the various Boards relating to the use of Medical Cannabis in Colorado. EMC is also exploring research needs in Uruguay and Europe.

“Veterans, PTSD, and Medical Cannabis” – the national study inviting 10,000 participants is cruising along and we would appreciate the advocacy of anyone involved in advancing Veterans treatment options through the findings of this valuable study.
Not a word in answer to our communications from the Veterans Health Administration.

Dr. Gary Miller, a senior account specialist with Enigami based in Arizona, will be doing a radio interview on Liberty Radio, catch up to Dr. Miller and his comments about the need for Veterans advocacy: http://benswann.com/

August, 14, 2014, Enigami Newsletter

Thanks to everyone who has signed up for Enigami Medical Cannabis subscriptions ! The first month has been fantastic.

It has been a delight to hear from everyone across the Nation. We wish you good health ! Here are a few notes about what we are up to in the next month or so.

Conferences Scheduled:

September 9, 10, 11, Enigami Medical Cannabis, LLC will be exhibiting at the Denver Medical Marijuana Professionals Conference.

Sept. 11, 2014, Enigami Medical Cannabis, LLC will be present in Minneapolis, Minnesota for a stakeholders conference at the Thompson Hall law firm offices.

Sept. 26th, Enigami Medical Cannabis, LLC will be attending and presenting at the Marijuana Tech Start Up Competition the weekend of September 26th, in Denver.

We’ll also be in attendance at the (Colorado) Marijuana Scientific Advisory Council meetings scheduled through the next few months. If you are in Denver – drop in and watch the process as Colorado decides how to research medical cannabis. Another state with an outstanding approach to medical cannabis treatment is Minnesota. Here is a link to the Minnesota regs: http://www.health.state.mn.us/topics/cannabis/faq.html#track . Minnesota’s inclusion of: “How will the state track the effectiveness and safety of medical cannabis?” and “What are the obligations of patients and health care providers participating in the state’s medical cannabis program?”… are great enhancements to the legitimacy of Dr/Pt relationships, clinical care, and serious Medical Cannabis treatment. They have good thoughts for all the state’s supporting innovations in medical cannabis treatment.

Enigami has opened up a “Ben & Jerry’s” type of competition. We are interested in proposals concerning our knowledge base which is defining the relationships between the cannabinoid combinations (or products) and the various conditions. This knowledge is largely absent from medical cannabis AND the medical field. In the future such knowledge will help educate physicians about recommending, or prescribing, medical cannabis products. It will empower Consumers. This knowledge could be used to guide product development by savvy medical cannabis product developers. It could be used to guide Federal policy, specifically the Veterans Health Administration, and State policy. Should this de-identified aggregate information be published on a Bhutanese mile marker so it may be discovered by an intrepid traveler ? Should a group of medical cannabis stakeholders decide how to disseminate the information ? Should a note be placed in a bottle and thrown out to the dark blue sea ? We’ll accept any creative proposals – even in crayon !

Sign up for the Veterans study is going gangbusters too !!! Some of you persevered through an obscure website glitch dealing with website security…THANK YOU !!!

There are downloadable Posters and Brochures available on the website: http://www.vetptsdstudy.org/ please feel free to use to “get the word out”.

Please submit any support tickets or questions to:
support@enigamisystemsinc.zendesk.com

Have you noticed the news blackout of this study – even in the medical cannabis and Veterans communities ? We’d appreciate hearing your comments on why some folk are trying to suppress medical cannabis research for Veterans with PTSD. Drop a note to us at: info@enigamisystems.com

Please “spread the word” about the Veterans study. We want to finish up the research 10,000 strong.

Scientific Study Factoid for the Day – Observational studies: going beyond the boundaries of randomized controlled trials

– Wenying Yang, Alexey Zilov, Pradana Soewondo, Ole Molskov Bech, Fawzia Sekkal, Philip D. Home (http://www.sciencedirect.com/science/article/pii/S0168822710700024)

Abstract: The term observational study describes a wide range of study designs including prospective and retrospective cohort studies, case-control studies, and cross-sectional studies, a defining feature of which is that any intervention studied is determined by clinical practice and not the protocol. Data from large, prospective observational studies provide information about the safety and efficacy of medicines in daily clinical use. Such observational studies are generally carried out once a medicine has received approval from regulatory agencies. Observational trials have inherent limitations in terms of their susceptibility to bias and confounding, restricting their ability to define causality. However, their strengths include that they reflect daily clinical practice more closely than randomized controlled trials (RCTs), both in terms of the heterogeneous patient populations that are included, and the medical interventions that they receive. Therefore, observational trials can provide clinically relevant information that is not necessarily provided by RCTs. Given the limitations of an observational study approach, it is important to optimize their study design to maximize their validity, and thus, in particular, known causes of bias and confounding should be measured. Medical investigators, health authorities, and the pharmaceutical industry all have important roles to play in designing, approving, and performing observational studies.

July 4, 2014, Enigami Newsletter

Hello Friends and Family,

Enigami Medical Cannabis, LLC (a subsidiary of Enigami Systems, Inc) is proud to be a part of the research outlined in the press release, below.

“Do Veterans, with PTSD, Receive Benefit from Medical Cannabis?” – Questions a National Study of 10,000 Veterans. According to Enigami Systems, Inc. media relations department a national study to determine the effects of medical cannabis treatment for Veterans’ PTSD begins July 4, 2014. The study is eighteen months long and holds great promise for determining effective treatment of Post-traumatic Stress Disorder.

Denver, Colorado (PRWEB) July 04, 2014

It is the opinion of the study group* that when the Veterans Health Administration (the “VA”) re-establishes effective medical programs, the United States will begin, as a Nation, to honor its commitment to the Veteran community. And further it is the opinion of the study group that currently, the V.A. is failing the Veterans as evidenced by the hourly rate of Veteran suicides. (CNN, November 14, 2013, 12:08 p.m., http://www.cnn.com/2013/09/21/us/22-veteran-suicides-a-day/index.html)

Acting Secretary Sloan D. Gibson has stepped into an alarming situation where the Administration has failed (according to the study group) to provide adequate oversight of, or solutions to, the debacle the V.A. is calling a premier healthcare system – especially for those suffering from Post-Traumatic Stress Disorder (PTSD). (White House, Office of the Press Secretary, June 27, 2014, http://www.whitehouse.gov/the-press-office/2014/06/27/readout-president-s-meeting-acting-veterans-affairs-secretary-sloan-gi-0 )

Accompanying the “appointment book cooking,” which is so prominent in the news these days (Time, June 9, 2014, http://time.com/2850879/va-appointment-delays-keep-getting-worse/), the VA has re-instituted failed treatment programs for PTSD (NBC News, June 20, 2014, 9:00 a.m., http://www.nbcnews.com/health/health-news/dod-va-cant-prove-their-ptsd-care-working-study-claims-n136371 ). In the 1990’s, the V.A. learned their specialized inpatient programs were ineffective, and closed them down only to reinstitute them in the last decade (NBC News, June 20, 2014, 9:00 a.m., http://www.nbcnews.com/health/health-news/dod-va-cant-prove-their-ptsd-care-working-study-claims-n136371 ) and according to the study group it may have been to appease the public outcry for effective treatment. That doesn’t make sense. The study group asks, “Why are we funding ineffective programs?”

And so, in the study group’s opinion, a suffering Veteran, maybe one in anyone’s family, commits suicide about every hour because the V.A., and the U.S. as a Nation, has failed to keep their part of the deal – to care for Veteran’s wounds. Some Americans cannot tolerate this situation.

The Departments of Defense and Veterans Affairs spend unbelievably large sums every year to treat post-traumatic stress disorder (NBC News, June 20, 2014, 9:00 a.m., http://www.nbcnews.com/health/health-news/dod-va-cant-prove-their-ptsd-care-working-study-claims-n136371). Collectively they spent $3.294 billion in 2012. But does the treatment help? According to a mandated Congressional report neither the Pentagon nor the VA have a clue about the situation. ( NBC News, June 20, 2014, 9:00 a.m., http://www.nbcnews.com/health/health-news/dod-va-cant-prove-their-ptsd-care-working-study-claims-n136371 )

Adding to the distress and hopelessness Veterans are experiencing, research is impeded or disallowed by the Administration’s bureaucracy. There is a well- established public outcry over a history of “paid for study outcomes” (for “marijuana” research) that are academic nonsense ( Business Insider, August 12, 2013, 4:01 p.m., http://www.businessinsider.com/sanjay-gupta-changed-his-mind-on-weed-2014-4). As recently as this week another promising study, for Veterans suffering from PTSD utilizing Medical Cannabis for treatment, by Dr. Sue Sisley, of the University of Arizona, was blocked by her school administration for advocating research about Medical Cannabis. Dr. Sisley, a heroic academic pioneer, lost her position at the University for advocating the research of a promising treatment option. (Arizona Capitol Times, July 1, 2014, 1:31 p.m., http://azcapitoltimes.com/news/2014/07/01/uofa-medical-marijuana-researcher-sue-sisley-fired-claims-political-motivation/)

Enter Enigami Systems, Inc. owner of a number of patent pending technologies they intend to use to address this through a subsidiary, Enigami Medical Cannabis, LLC.

Enigami Systems, Inc. commercial products help Patients determine the appropriate medical products for effective treatment. Their online application helps a patient determine the relationship of “mainstream medications”, medical cannabis products, and “over the counter products” – and the conditions they are seeking relief from. Currently the knowledge of how effective these interventions are, alone, or in unison, is absent from the medical field.

So, Enigami Medical Cannabis, LLC was formed with an eye to support the Veterans and the PTSD issue. Enigami’s commercial product was tailored to a national study, “Veterans, Post-Traumatic Stress, and Medical Cannabis”, put together by a number of clinicians and Veterans advocates.

Harborside Health Center, the largest Medical Cannabis dispensary in the U.S., located in California, and seen on television’s “Weed Wars”, is listed as an Advisor to promote the study. Though Enigami is providing over $300,000.00 in technology services the study still seeks minimal administrative funding.

The introductory website is: http://www.vetptsdstudy.org and the Study Login/Signup is: https://study.vetptsdstudy.org

The study is free for qualified Veterans who will notice only the absolute minimum of personally identifying information being requested for their personal health records. These records constitute the database for the eighteen (18) month long study. In this study, a Veteran registers, then notes the symptoms of PTSD he/she wishes to track, and decides how often email notices are to be sent as a reminder to record symptom status and medication. This information is translated into an easy to read graph showing treatment progress so that the study participant may determine the best medication approach for his or her care. The record is the personal property of the Veteran study participant with the exception of the aggregate de-identified information which will serve as the answer to the study question, “Do Veterans, with PTSD, derive any treatment benefit from the use of Medical Cannabis?” These personal health records are HIPAA compliant. HIPAA Privacy Rules are the national standards to protect individual’s privacy. The study group has taken additional security measures, as noted on the website security notices. As in all legitimate scientific studies, the project underwent, and will undergo, review by an Institutional Review Board.

The study begins registration and participation on July 4th in honor of the Veterans. At the conclusion of the study the aggregate results will be interpreted and submitted to a professional journal for publication.

The Veterans Health Administration, Congressional leadership, and the Administration will be notified of the de-identified study findings.

*The principals in the study are Patients Out of Time, a national Veteran advocacy organization (Mary Lynn Mathre, RN, MSN, former Lt. in U.S. Navy Nurse Corps, President Al Byrne, LtCdr, retired, U.S. Navy, COO), Enigami Medical Cannabis, LLC (Clifton D. Croan, MA, LPC, DAPA, FAPA, BCPC, DMAPA, William F. Graf, JD), Health Solutions of Arizona, Inc. (Gary D. Miller, DBH, LMSW, CEO), and Global Health & Hygiene Solutions, LLC (Uma Dhanabalan, MD MPH FAAFP, Founder and CEO).

“Do Veterans, with PTSD, Receive Benefit from Medical Cannabis?” – Questions a National Study of 10,000 Veterans

According to Enigami Systems, Inc. media relations department a national study to determine the effects of medical cannabis treatment for Veterans’ PTSD begins July 4, 2014. The study is eighteen months long and holds great promise for determining effective treatment of Post-traumatic Stress Disorder.

Denver, Colorado (PRWEB) July 04, 2014

It is the opinion of the study group* that when the Veterans Health Administration (the “VA”) re-establishes effective medical programs, the United States will begin, as a Nation, to honor its commitment to the Veteran community. And further it is the opinion of the study group that currently, the V.A. is failing the Veterans as evidenced by the hourly rate of Veteran suicides.
(CNN, November 14, 2013, 12:08 p.m., http://www.cnn.com/2013/09/21/us/22-veteran-suicides-a-day/index.html)

Acting Secretary Sloan D. Gibson has stepped into an alarming situation where the Administration has failed (according to the study group) to provide adequate oversight of, or solutions to, the debacle the V.A. is calling a premier healthcare system – especially for those suffering from Post-Traumatic Stress Disorder (PTSD). (White House, Office of the Press Secretary, June 27, 2014, http://www.whitehouse.gov/the-press-office/2014/06/27/readout-president-s-meeting-acting-veterans-affairs-secretary-sloan-gi-0 )

Accompanying the “appointment book cooking,” which is so prominent in the news these days (Time, June 9, 2014, http://time.com/2850879/va-appointment-delays-keep-getting-worse/), the VA has re-instituted failed treatment programs for PTSD (NBC News, June 20, 2014, 9:00 a.m., http://www.nbcnews.com/health/health-news/dod-va-cant-prove-their-ptsd-care-working-study-claims-n136371 ). In the 1990’s, the V.A. learned their specialized inpatient programs were ineffective, and closed them down only to reinstitute them in the last decade (NBC News, June 20, 2014, 9:00 a.m., http://www.nbcnews.com/health/health-news/dod-va-cant-prove-their-ptsd-care-working-study-claims-n136371 ) and according to the study group it may have been to appease the public outcry for effective treatment. That doesn’t make sense. The study group asks, “Why are we funding ineffective programs?”

And so, in the study group’s opinion, a suffering Veteran, maybe one in anyone’s family, commits suicide about every hour because the V.A., and the U.S. as a Nation, has failed to keep their part of the deal – to care for Veteran’s wounds. Some Americans cannot tolerate this situation.

The Departments of Defense and Veterans Affairs spend unbelievably large sums every year to treat post-traumatic stress disorder (NBC News, June 20, 2014, 9:00 a.m., http://www.nbcnews.com/health/health-news/dod-va-cant-prove-their-ptsd-care-working-study-claims-n136371). Collectively they spent $3.294 billion in 2012. But does the treatment help? According to a mandated Congressional report neither the Pentagon nor the VA have a clue about the situation. ( NBC News, June 20, 2014, 9:00 a.m., http://www.nbcnews.com/health/health-news/dod-va-cant-prove-their-ptsd-care-working-study-claims-n136371 )

Adding to the distress and hopelessness Veterans are experiencing, research is impeded or disallowed by the Administration’s bureaucracy. There is a well- established public outcry over a history of “paid for study outcomes” (for “marijuana” research) that are academic nonsense ( Business Insider, August 12, 2013, 4:01 p.m., http://www.businessinsider.com/sanjay-gupta-changed-his-mind-on-weed-2014-4). As recently as this week another promising study, for Veterans suffering from PTSD utilizing Medical Cannabis for treatment, by Dr. Sue Sisley, of the University of Arizona, was blocked by her school administration for advocating research about Medical Cannabis. Dr. Sisley, a heroic academic pioneer, lost her position at the University for advocating the research of a promising treatment option
(Arizona Capitol Times, July 1, 2014, 1:31 p.m., http://azcapitoltimes.com/news/2014/07/01/uofa-medical-marijuana-researcher-sue-sisley-fired-claims-political-motivation/)

Enter Enigami Systems, Inc. owner of a number of patent pending technologies they intend to use to address this through a subsidiary, Enigami Medical Cannabis, LLC.

Enigami Systems, Inc. commercial products help Patients determine the appropriate medical products for effective treatment. Their online application helps a patient determine the relationship of “mainstream medications”, medical cannabis products, and “over the counter products” – and the conditions they are seeking relief from. Currently the knowledge of how effective these interventions are, alone, or in unison, is absent from the medical field.

So, Enigami Medical Cannabis, LLC was formed with an eye to support the Veterans and the PTSD issue. Enigami’s commercial product was tailored to a national study, “Veterans, Post-Traumatic Stress, and Medical Cannabis”, put together by a number of clinicians and Veterans advocates.

Harborside Health Center, the largest Medical Cannabis dispensary in the U.S., located in California, and seen on television’s “Weed Wars”, is listed as an Advisor to promote the study. Though Enigami is providing over $300,000.00 in technology services the study still seeks minimal administrative funding.

The introductory website is: http://www.vetptsdstudy.org and the Study Login/Signup is: https://study.vetptsdstudy.org

The study is free for qualified Veterans who will notice only the absolute minimum of personally identifying information being requested for their personal health records. These records constitute the database for the eighteen (18) month long study. In this study, a Veteran registers, then notes the symptoms of PTSD he/she wishes to track, and decides how often email notices are to be sent as a reminder to record symptom status and medication. This information is translated into an easy to read graph showing treatment progress so that the study participant may determine the best medication approach for his or her care. The record is the personal property of the Veteran study participant with the exception of the aggregate de-identified information which will serve as the answer to the study question, “Do Veterans, with PTSD, derive any treatment benefit from the use of Medical Cannabis?” These personal health records are HIPAA compliant. HIPAA Privacy Rules are the national standards to protect individual’s privacy. The study group has taken additional security measures, as noted on the website security notices. As in all legitimate scientific studies, the project underwent, and will undergo, review by an Institutional Review Board.

The study begins registration and participation on July 4th in honor of the Veterans. At the conclusion of the study the aggregate results will be interpreted and submitted to a professional journal for publication.

The Veterans Health Administration, Congressional leadership, and the Administration will be notified of the de-identified study findings.

*The principals in the study are Patients Out of Time, a national Veteran advocacy organization (Mary Lynn Mathre, RN, MSN, former Lt. in U.S. Navy Nurse Corps, President Al Byrne, LCdr, retired, U.S. Navy, COO), Enigami Medical Cannabis, LLC (Clifton D. Croan, MA, LPC, DAPA, FAPA, BCPC, DMAPA, William F. Graf, JD), Health Solutions of Arizona, Inc. (Gary D. Miller, DBH, LMSW, CEO), and Global Health & Hygiene Solutions, LLC (Uma Dhanabalan, MD MPH FAAFP, Founder and CEO).

Euphoria for Recreational Marijuana / Medical Cannabis Not So Much

The marijuana/cannabis field is so interesting in its present development. Let’s take a look at one of the topsy-turvy parts. And you will excuse me as I do so while I use “marijuana” for recreational and “cannabis” for medical.

If you have ever studied, or taught, the history of “drugs” you will recall how some medications were developed in strength but the side effects were so strong the development of the drug went BACKWARDS in terms of its strength (amphetamines were too strong so they were “watered down”. The logical developmental end of heroin was methadone – again too strong. Cocaine became crack – too strong. Wine became brandy etc. ETOH became Everclear etc.)

Currently many people are operating under the belief that “medical grade” should be “the good stuff” meaning it should be more euphoric (“stronger” or “more potent”) in nature. I’ll predict this is not at all what we will wind up with. Medical products aren’t meant to be euphoric in nature – they’re supposed to address ailments. The “high” effect is a sideline in some medications it is not the intent. The ideas we have around CBD are an example. You don’t get high you get medical relief. The idea is to address medical symptoms. I’ll extend the prediction to say many cannabinoid combinations used for medical purposes won’t have an intoxicant effect at all.

If you are involved in producing medical cannabis products pay attention here. “Find a method of identifying what the important cannabinoid combinations are so you may market an effective medical cannabis product!” (the same with recreational marijuana)

Recreational marijuana is supposed to be fun, an intoxicant, a euphoric. What’s wrong with that ? Think about a good scotch (personally not a favorite of mine). Or to take a step further… brandy. Brandy is a spirit produced by distilling wine. Brandy generally contains 35–60% alcohol by volume. So, in a sense, brandy may be construed as “super spirit”. Recreational marijuana will follow this same path. Instead of being less euphoric in nature (than medical cannabis) the public will demand higher grades of intoxication from recreational marijuana.

I think we can anticipate some interesting developments for medical cannabis and recreational marijuana. If you don’t join in early innovation or early adoption… what will happen to your competitive edge ? Can Ford still market it’s outmoded original products ? No. Not many folk are in the market for a Model A when they want a Porsche performance.

Enigami Systems, Inc. through it’s subsidiary, Enigami Medical Cannabis, LLC, is a big enough believer in this prediction to have taken a patent out on how to discern the cannabinoids use in medical cannabis and recreational marijuana.

At some point in the future we’ll provide the public with the relationships between the cannabinoids and their recreational and medical uses. Stay tuned !

“THE CURRENT MEDICAL MARIJUANA TREATMENT MODEL DOES NOT WORK”

“The future of MMJ treatment is dependent on several issues: physicians must establish legitimate, bona fide, physician/patient relationships, patients must have a method of determining the best medication for their unique symptoms, and clinical outcomes for ongoing treatment must be obtained to validate the field of medical marijuana. These are the three areas our company focuses on.” (C. Croan)

The anti-medical marijuana lobby is effective so let’s recognize how they are effectively undermining the medical marijuana industry:

 They have raised the issue of whether MMJ dr/pt relationships are valid, legitimate or even professional.
 The MMJ “evaluation” does not employ “MMJ care” it only uses “MMJ evaluation” in other words “care” or “treatment” is missing in the MMJ treatment model.
 Anti-mmj legislators have adroitly maneuvered MMJ physicians into performing evaluations only – with no follow up care. The MMJ docs thought they were winning a major point and they would cash in on evaluations. This robs the MMJ industry from obtaining positive clinical outcomes.
 Currently there is no vehicle to use aggregate data to indicate whether MMJ actually works as a treatment. “Pharma” trials do that but MMJ has entered the market essentially untested.

The current MMJ care model dooms the field.

In regard to physician/patient relationships the state legislators the author is familiar with intended only for a physician to perform the MMJ evaluation. It is clearly specified that a physician’s assistant or other professional may not perform the evaluation and have the doctor sign off – it’s flirting with disaster to operate against the legislative intent and administrative policy. We don’t need people in the field who cut corners. But they won’t be around long without licenses or clinics as we are seeing.

If a clinic takes your money for an evaluation…shouldn’t they reimburse your money if they dropped the ball about an aspect of their compliance and you were NOT provided a legitimate evaluation? Should you have received a refund from the clinic? This makes some clinics, or organizations look, pretty…mercenary.

Oh, and to the physician who related to the author, “Since PTSD is psychic pain I’m going to recommend that condition for MMJ because technically it’s chronic pain and PTSD isn’t authorized”. Bullshit, that’s dishonest.

Anyone cutting legal corners in the MMJ field is doing EVERYONE a disservice.

Failure to follow up in medicine is contradictory to the mainstream medical care model which is called “evidence based medicine”. After all – who would recommend a Schedule I substance and not follow up on the effect for treatment?

In every Medical Practice Act, in every state where MMJ is authorized, there lies the seed of one of the next regulations. Ever physician is actually required, now, to follow up with the patient about the medical intervention (the MMJ recommendation). Our prediction at Enigami is that legitimate follow up will be increasingly enforced by the regulatory agencies. At the time of this writing four states mandate follow up.

But what is it the regulatory agencies are going to require? Evidence based medicine. Wikipedia defines it like this: “Evidence based medicine aims to apply the best available evidence gained from the scientific method to clinical decision making.” In other words there needs to be some type of legitimate method to “follow up” or to monitor whether the medical intervention actually works. Okay, that’s just good medicine and good for the consumer.

Currently, in those states where there is no follow up care – we obtain no clinical evidence of whether MMJ actually is effective. Grrrrr.

The Colorado Medical Practice Act is pretty typical of the different States and partially relies on case law. Colorado’s Act quotes case law defining medical practice as not being a discrete single event. Yet in the MMJ care model it stops at a single event – evaluation. It’s true that in many areas of medicine consumers may go to a specialist who evaluates us and refers us on for ongoing needs – and therein is the key – MMJ evaluators have no viable follow up referrals because they don’t exist. How many primary care doctors will perform the follow up? There are a few MMJ doctors who perform minimal follow up and still more physicians who are concerned about the question of having a legitimate physician/patient relationship. Follow up care would go a long way to enhancing the MMJ care model. In fact performing follow up care, “evidence based medicine”, will help patients determine the best medication.

But there’s another great benefit to follow up care besides just practicing legitimate medicine. It can provide clinical outcomes which legitimize the entire field of medical marijuana. The “evaluation only model” was considered a win by physicians in legislation. So I say, “Congratulations, you’ve robbed the field of MMJ from establishing itself as legitimate by not being able to show hard research outcomes!”

Help is on the way though. Pioneering MMJ legislators are making legitimate follow up mandatory. It’ll be a short step to collecting those outcomes and being able to quote hard data instead of relying on anecdotal success stories. Instead of saying, “it MIGHT shrink tumors” we’ll get to say, “in an multi-year study involving 350,000 MMJ patients – those with such and such tumors showed reduction in size (etc.)”

The lack of a legitimate medical marijuana care model concerns us so here is what we did.

We created Enigami Systems, Inc., to uses outbound email inquiries (or other methods of media communication) to follow up and inquire about a client’s unique symptoms and how they are responding to a specific MMJ medication which we also track. The information, helps determine which medication is the best used to diminish, or contain, distressing symptoms. The outbound inquiries come from our online portal where the individual’s personal health record exists. We can monitor with whatever frequency is desired which makes a heckuva medical record but after all is said and done it beats the pants off of ANY mainstream medicine follow up.

Oh, our aggregate “outcomes” legitimize the MMJ field’s effectiveness

Medical Marijuana Is Becoming All About the Money …Less About the Care.

Let me share how I came to see the present medical marijuana business as “…all about the money”.

I’m a clinician and very interested in health information technology and how it may assist patients to improve care so I began to look at medical marijuana (MMJ) care with an eye to contributing to that care method. I also have to say I’m a sixties child and still full of that Love, Peace, and “people are basically good” approach to the world (thus my career as a caregiver).  I’m with a little IT company that helps patients track symptoms and the medical marijuana field seems to be an ideal place to help people in this regard. My company and I are unimportant to this article but where the field is going in respect to patients managing their treatment is important. My personal interests and background have helped me to frame an understanding of the cannabis care model. Here’s what we see…

In the medical marijuana field a patient has an evaluation (and if recommended) then purchases medication. In order to keep getting medication a person has to have an annual certification renewal. The docs get a buck, the dispensaries get a buck, and even the state gets a buck on the certification. So you got a condition and a medication – how is a patient supposed to manage treatment? Where’s that part of the care model fit in? Wasn’t someone supposed to have said something about that along the way?

In “mainstream medicine” an individual gets an evaluation (and if recommended) may get a medical intervention (like medication) but the patient will undergo some type of assessment of the interventions success later. If you’re in the medical field you would say, “that’s practicing real medicine”. That leaves it to reason that the cannabis care model is not considered legitimate medical practice by many. If you’ve been around medicine the last few decades you know that “evidence based medicine” (looking at the interventions results) is the norm and ethical practitioners ALWAYS assess their interventions. This makes MMJ look kind of, well funny.

In the medical marijuana care model there are three distinct, mutually exclusive, areas of involvement:

  • physicians manage evaluations
  • patients manage ongoing treatment or “follow up care”
  • dispensaries manage selling medication 

Why should patients needing help with multiple sclerosis, cancer, glaucoma,  pain management, or other illnesses be told, “we got ours…you’re on your own !”. Don’t the physicians and dispensaries feel any sense of partnership in the care model? Don’t the professionals owe it to the patient to get involved in the overall care model instead of concentrating solely on the profit side?

Should cannabis care be defined as more than the product, the physician, or the dispensary and more about the actual process of care? What sector is going to step up and help the sufferer find a way to manage treatment (right medication, right dose, right method of administration, strain, THC/CBD/CBN count, etc.). When you’re flopping around on a floor having a seizure or throwing your guts up these are a bit more important than just a recreational feature. You’re care is not a cookie cutter deal and you’re an individual with unique needs.

Why are these “mutually distinct groups” the care model for cannabis? Maybe it’s simply because the patients need for managing their care simply isn’t an area of interest to the other parties. Maybe it really is about the Almighty Dollar but maybe there’s more to it than that.

Physicians

Docs like to specialize – when they do they make more money. In MMJ this is very true. Is there anything wrong with wanting to operate in a specialty area of medicine? No. Is it a bad thing to be a diagnostician and not involved in subsequent care? No, again.  Do most cannabis physicians operate only in the MMJ field? Yes.

Regulatory authorities are struggling with the idea of treatment management and questioning whether it should be tied to the evaluating physician. This obligation hasn’t panned out because physicians in other areas of medicine are allowed to specialize in the same manner that cannabis physicians do. If physicians don’t help manage care are patients qualified to manage their own treatment? On a limited basis patients can manage their care but that’s not to say they don’t need meaningful consults from professionals like the cannabis physicians and “professionals” like the dispensary staffs are trying to be. Certainly no one expects a patient to travel too far into the “practicing medicine” area but to a limited degree patients can manage their well being reasonably well.

Is there a bit of trickery going on in the various state regulations when it comes to indicating the cannabis physicians should operate in a manner consistent with other areas of medicine and provide ongoing care? In my opinion I believe this may be the case because it takes us back to the “normal” way of practicing medicine “evidence based medical care” and I believe we’ll see a number of test cases where evaluating physicians are being prompted to provide ongoing care. (In some states follow up care is now mandated.) But this just takes us back to the “specializing in areas of medicine” paradigm and it’s really just an attempt to tie care to the evaluating physician. If a physician doesn’t really want to provide ongoing care he won’t.

If you want to know the answer to the question, “Does the doc really care about my well being?”…ask yourself this…did he REALLY steer you in the direction of specific, meaningful, and ongoing, care…or was it “try some acupuncture or yoga – and see you next year for the re-cert !”

But the docs aren’t the bad guys here. They’re just doing a job.

Dispensaries

Does your dispensary truly offer an array of ancillary services focused on your well being? Or, does the dispensary really just offer that one high dollar product? Check out Harborside Health Center in Oakland and see their commitment to their patients well being. They offer all kinds of ancillary services focused on patient’s well being. That’s a good model but it can be improved.

Dispensaries remind me of the plethora (yes, I actually used that word) of clothing boutiques which sprung up in the 1960’s (okay, I’m an old guy). Everyone just had to have a boutique, they were so cool, and so very hip. But most owners lost their businesses because they weren’t good business people – so perhaps we can forgive the dispensaries a bit because like the clothing boutiques they have a business to run and for many it’s new territory. For them the business is truly a bread and butter proposition and it’s not as if they took some kind of pledge to heal people or reduce people’s suffering.

A few months ago there were about 1285 dispensaries in Colorado now there are approximately 950. Do you think a few big money interests are getting together and forming chain dispensaries like in California? It’s just business folks.

And just trying to make a decent living doesn’t make you a bad guy either so the dispensaries are off the hook too.

Patients

Can consumers manage their care? Hasn’t that always been the bottom line reality anyway? Aren’t we forced to become our own advocates when we face our doctors in those 10-15 minute sessions? If you don’t speak up, you’re screwed. But where is the line for our competency as consumers?

Final rag, options for patients to manage their care will not appeal to businesses that are predominately concerned with helping people “score” legally. People who want to “get high” are NOT concerned about their well being or ongoing treatment. Businesses that wish to serve this type of customer will have no interest in legitimate treatment management options.  We all know the score on this issue.

So how do we create a workable cannabis care model?

Medical marijuana is a new, promising, and legitimate area of medicine. As a clinician I heartily believe it. As a human being I’m sold. It scared the pants off me to take a pipe and pot to my father in Texas when he was dying. Nauseated, and vomiting, the great man could have had some relief if only he could have gotten past the stigma and lit up. I was married to a wonderful woman who died of disabling asthma. I wish we’d known before the last year of her life that cannabis helped her breathe. She died when she was 44. They both deserved better medical options.

We need cannabis in the medical market and we need a decent model of care. We need the players to step up to the plate and do the right thing – get involved. Not because they have to, they don’t, but because it’s the right thing to do.

Ultimately it comes back to us, it’s our responsibility to look after ourselves. I hate to get all existential but you’re the one in charge – not just of your life but of your well being.

Now, go find the tools to take care of yourself. Look for good people to guide you. And along the way nag your doc and dispensary about helping you to manage your care. Try the guilt trip but remember to take your cash when you visit them.

Maybe Gordon Gecko was right, “It’s all about the money and the rest is conversation.”  

I hope not.

Enigami Blog 8-2-2012Copyright 2011 by Clifton D. Croan