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 !

Medicines Abdication to a Cannabis Conspiracy

             It’s true enough what the US federal wordsmiths of spin roll out about there being a conspiracy to make cannabis available to the sick in the United States. There is such a cabal of cannabis crusaders working to undermine the US governments role in determining what medicine(s) they can use, and when, and how. I know most of these people and let me assure you that they are serious about their goal. (1). I’m one of the conspirators.

Some are half crazy about the wide reach of all governments into their lives, negative as they see it, like Libertarians and the Tea Party stalwarts. Many are politically active, seeing the election of selected politicians the key to a change in the rules of cannabis prohibition regardless of whether they sport a red or blue tie. 21 states their goal, believing just like their adversaries that medical decisions about cannabis are best made by non-medical professionals by opting for constitutional amendments instead of science. The Capitalists have moved into the cabal after surrounding the gathering with a multitude of products to infuse, to eat, to vaporize, to chew, to suck, to rub, to inhale. Their money now challenges the federal governments’ investment in a long running cannabis annihilation project defined by the knowing citizen as a failure.

Some, including me have gone to the courts and demanded a change to the prohibited scheduling of cannabis under the rubric of “The Coalition to Reschedule Cannabis.” It took ten years for this Petition to move through the process, designed to delay and obfuscate a reasonable request. This Petition is part of the conspiracy to bring the ill and dying a better, non-toxic, method of restoring their endocannabinoid deficiency. I admit that.

Ten years of delay seems like another conspiracy at work I also admit. (2).

Patients are in the forefront of the plot to free the cannabis plant from its murderers. Some government accounts list “patients” as the real source of the fire that burns joints to relieve pain in other joints and sustains the blow-back of heat that 18 states and DC have brought to the Keepers of Prohibition in the freest country on earth. Others will claim the patients’ best friend, the nurse, with the leadership role in the rediscovery of the plant and its magic clinical ways with humans. It is the American Nurses Association (ANA), representing the most revered profession – nurses – that has charged all US nurses to become educated about the therapeutic, nutritional and clinical uses of cannabis.

A series of accredited clinical cannabis conferences is part of the plot to undermine the cannabis cops. It’s simple really. All you have to do is take the best cannabis researchers and clinicians from around the world, put them in a room and let them speak to their astonishing discoveries of cannabis receptors in all human organs; the endocannabinoid system; of marvelous healing compounds such as THC and CBD and their acids found in the plant; of the cancer killing; pain deadening; spasticity calming; anti-emetic properties and emotional peace cannabis may provide the ill. There’s been seven of these historic forums each sanctioned by the ANA and the American Medical Association (AMA) as worthy clinical courses meriting attendees coveted CME and CEU credits for professional development. MD’s and RN’s can find the same education on-line and so can you. (3).

I’m writing as a leader of the cannabis conspiracy to brag up my involvement in the plan to “overgrow the government.” I think that honest therapeutic information about cannabis has been around now for at least 20 years, the time frame of the discovery of cannabis receptors becoming known.

What has happened within the US medical community over the two decades has been an abdication of responsibility concerning clinical cannabis use.

While I am pleased that the AMA has “accredited” Patients Out of Time’s clinical cannabis forums for medical doctors to learn of the science that discredits the federal spin, the lack of AMA leadership in this controversy is alarming. As a start at this critique I offer the fact that to my knowledge as I write in November 2012 no medical school or nursing school in the US offers a course on medicinal cannabis uses, it’s nutritional value, its clinical potential and the interface between cannabis plant compounds and our endocannabinoid system.

Considering that all living creatures on earth, canines and sponges, birds and snakes share the common system of endocannabinoid production I used to wonder if some doc somewhere would notice. Then one did. His name is Petzel and he is the leader, a medical doctor, of the Veterans Health Administration. In July 2010 a Directive, VHA 2010-035, was issued under his signature that said clearly – cannabis is a medicine.

Now there is a federal conundrum. The largest health care system in the US, a federal agency run by medical professionals says cannabis is medicine, in writing. The drug czar, a cop, says cannabis is poison.

The news made the first page of the NY Times! All VA facilities began treating Vets that used cannabis legally under state law without a problem. Suicides dropped! (4). Where are the VA doctors in this issue? Is it medicine or not? If it’s medicine for Sgt. Black why isn’t it medicine for Sgt. White?

Answer: Sgt. White lives in Virginia, Sgt. Black lives in Maine.

So where are the VA docs, why are they silent about practicing medical treatment protocols based on geography? “First do no harm” does not apply if you are an MD working for the US federal system? Why is the AMA mute? If it’s medicine for a wounded Vet in Arizona why not in Idaho? Idaho Vets did not measure up? Idaho Vets don’t hurt like guys from other states? Idaho Vets are like Nam Vets so let’s screw them over like we did those guys?

Why is the media such shills for national indecency? Unethical medical practice is ok?  Medicine is doled out based on where the Vet lives not the Vets wounds? This is not news? I know I’m an old guy in a new world but shit what happened? Where are all those young and old journalists that used to give a damn about the world they “report” about?

Why did the docs let cops and lawyers steal their work? When did we start issuing lawyers medical and nursing degrees? When did the law change about who gets to make medical judgments to folks with no knowledge, no license, only the ability to “make laws” and pretend they know what they do? Why does law enforcement sit at a table discussing what type of symptom cannabis can be used for as though some county sheriff is medically enlightened?  Why not put drilling teeth into a Senator’s job description?

As a member of the VFW I was told the VFW has at this point no position on some Vets getting cannabis to treat TBI, PTS, other wounds, pain, while other Vets are denied, prohibited from receiving the same medical protocol.  As a member I could begin a resolution process to see if the VFW would actually speak up about such callous mistreatment of Veterans of foreign war. An estimated three year process. I reminded the VFW representative that while we spoke a Vet blew her head off, and would again and again every 80 minutes. I was told a supervisor would call to help me find another way for the VFW National Commander to reset the balls he left somewhere. That was twelve days ago. No call.

As a member of the American Legion I have written the Legion leadership multiple times requesting the organizations aid in seeking an end to this medical debauchery being practiced on wounded Vets. Never has any staffer ever answered up. They did send a request for dues though. The Legion might have a great baseball program for kids but when they grow up and become soldiers, make that wounded soldiers, the Legion has no program at all to insure equal medical treatment for those they claim to represent.

But dear readers do not be too concerned. Veterans Day is behind us for another year, your plastic yellow ribbon will survive the days to the next, the Virginia Governor an Army Vet will ignore the 800,000 Vets in his state that are denied cannabis a medicine. He wants to be the President you see. Many other governors will as well. Congresswomen, male Representatives and thousands of political staffers will find other more meaningful tasks than unethical Vet care to banter about like fiscal cliffs and hem lines and the demise of Twinkies, but not the death by own hand of the troop that died while you read my essay.

The AMA, the media, the VA, MD’s – what about you?

Al Byrne for Patients Out of Time

 

1 www.medicalcannabis.com

2 www.drugscience.org

3 www.medicalcannabis.com  has a direct link to the University of California’s School of Medicine, San Francisco and a series of on-line accredited courses on the nutritional, holistic, clinical uses of cannabis and the state of the art science concerning the Endocannabinoid System (ECS) found in all living creatures excepting insects.

4 Institute of the Study of Labor, Bonn Germany, February 2012. WSJ, Shea. (Medical cannabis states in the US report an overall 5% lower rate of suicide, the Bonn study was a range of 5-11% dependent on age group of the deceased).

“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