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Progressive Politics in Minnesota, the Nation, and the World

Let's Get Past The Marijuana Stereotypes And Use It For Pain

Category: Medical Marijuana
Posted: 09/06/16 14:14, Edited: 09/07/16 12:27

by Dave Mindeman

OK. I am going to ask for a huge mental exercise right now.

Let's pretend that you have not been conditioned by the "drug war" mentality. Let's ignore the 50 years of negative reinforcement from law enforcement about the drug culture. Let's pretend that you have never seen a Cheech and Chong movie or think of street purchases as your context to marijuana.

Assume all of that (a lot to ask) and take an unbiased look at marijuana as a treatment venue.

In today's Star Tribune there is an article about medical marijuana being allowed as a pain treatment...starting August 1st. There has been a lot of sign-ups - much more initial sign-ups than for any of the indicated medical reasons already in the program.

Here are some relevant points to consider on marijuana - and remember we are trying to start without a biased viewpoint.

As the article states, "a recent survey of patients in Minnesota's program found that 90 percent reported some relief from the drug." That is hard to correlate to a placebo effect...or wishful thinking. That is real results.

A medical marijuana patient (Cassie Traun)...."told the lawmakers, patients, law enforcement and medical experts who make up the task force that it would cost her thousands of dollars a month to buy her medicine legally, so she has returned to buying it off the street." A legal program has much higher cost than street purchases? That is just messed up.

Medical marijuana has been legalized in half the states now, and in most of them, it's a booming industry. Legal medical and recreational marijuana sales topped $5.4 billion in 2015, according to an analysis by ArcView Group, which tracks the cannabis industry. In most states with cannabis programs, pain patients make up the bulk of the customer base.


So let's get back at our initial premise. What if we take an open eyes look at marijuana.

Look at it without a DEA that refuses to take marijuana off the restricted list and states the ridiculous reason "because it's illegal".

Let's look at it without a law enforcement history that encourages marijuana use stereotypes and only deals with the criminal elements that have the access and means to sell it on an illegal basis.

Let's look at it with the knowledge that for generations, marijuana has been in private, illegal use and few deaths have occurred from overdose or medical side effects. It would be nice to study that as a way to know for sure, but DEA restrictions won't allow for proper scientific experimentation.

Let's look at the data in Colorado...where legalization has resulted in no increase in teen marijuana use - and that since the move to legal recreational use, prices have dropped considerably and continue to do so.

When you look at all of this information, marijuana should, at the very least be no different than alcohol in societal use. And from a medical standpoint, medical marijuana needs to be readily available - and physicians need to be educated in use and benefits.

Why is this so important? In two words really - opioid deaths.

This problem is getting increased attention. Several states put it in the epidemic category. And it is not just about illegal opioids - too many deaths come at the hands of simple prescription painkillers.

We hear people say we need to do something about this - and the answer is right there - on the street and potentially in the garden. Marijuana is a less dangerous and sometimes more effective answer to that opioid problem. There is a good chance that marijuana is much less dangerous and probably less addictive.

Yeah, it probably should be heavily regulated - but Minnesota's medical marijuana is too restrictive, too timid, and too costly.

Get beyond the Doritos joke or the 60's image of bongs and headbands and stoners.

Marijuana is a real potential solution to a troubling societal problem.

Get over those Cheech and Chong movies - please.
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Marijuana And The Drug Czar

Category: Medical Marijuana
Posted: 06/06/16 01:31

by Dave Mindeman

On 60 minutes they repeated a story they did with Michael Botticelli, Obama's appointment as Drug "Czar". Now Botticelli is doing a great job. He has moved the conversation from drug incarceration to drug treatment. And this is absolutely the best change in drug policy that we can have. He is a recovering alcoholic who has had a wide range of experience in dealing with drug treatment issues and government drug policy at the state and Federal level.

But there is one segment of this 60 minutes interview which I have to take issue with....and it is in regards to marijuana. Here is Botticelli's response about marijuana as a legal drug:

"I'm not a fan. What we've seen quite honestly is a dramatic decrease in the perception of risk among youth around occasional marijuana use. And they are getting the message that because it's legal, that it is, there's no harm associated with it. So, we know that about one in nine people who use marijuana become addicted to marijuana. It's been associated with poor academic performance, in exacerbating mental health conditions linked to lower IQ."

Now although Botticelli is doing great things and his focus on treatment is a vast improvement in our drug policy, he is not an expert in the science of this field. His education consists of a Bachelor of Arts degree from Siena College and a Master of Education degree from St. Lawrence University.

His background is essential for educating the public about drug policy but he does not have any background in the science of medicinal pharmacology.

So let's look at some factual errors in the above statement. First, he says that one in nine marijuana users become addicted. It is disappointing that Botticelli would use the wrong terminology in this regard. Here is the science of the matter:

Estimates of the number of people addicted to marijuana are controversial, in part because epidemiological studies of substance use often use dependence as a proxy for addiction even though it is possible to be dependent without being addicted. Those studies suggest that 9 percent of people who use marijuana will become dependent on it, rising to about 17 percent in those who start using young (in their teens).

Notice the word dependent. There is a clinical difference between dependency and addiction. As Botticelli pointed out in the 60 minutes segment, addiction changes the brain chemistry and the ability to stop using the drug. That is a disease which only responds to medical treatment and counseling. Dependency is different. A coffee drinker can become dependent on caffeine. Those people who say they can't do anything until they have had their cup of coffee are stating a dependency symptom. Our bodies get used to this state of being and feels more normal when an infusion of caffeine happens. But outside of some minor withdrawal symptoms (in the case of caffeine - irritability and a headache), we can stop our infusion of caffeine. It might take a few days to reacquaint our bodies to a caffeine free state, but we will soon function normally.

Marijuana can create a similar dependency.

Now marijuana can also move into an addiction phase if doses become too high for too long a period of time. Abuse like that can happen with almost any drug, but to classify marijuana as narcotic is just as ridiculous as classifying alcohol in the same manner.

And Botticelli repeats another oft cited marijuana issue - links to lower IQ.

There was a classic study published last January which used sound scientific research involving twins and marijuana use. The conclusion?

After taking environmental factors into account, the scientists found no measurable link between marijuana use and lower IQ.

It was a strong conclusion and published in reputable science journals.

Now, nobody is saying that marijuana doesn't have risks and usage issues. I have little doubt that we will have our share of marijuana abusers developing in states that allow cannabis for recreational use. It needs to be dealt with in the same manner as any mood altering drug. But the evidence continues to grow that marijuana has less addictive properties and more medicinal potential than anything already in legal use.

Mr. Botticelli has concerns that, because marijuana has been legalized in some states, that young people are going to assume that it is harmless. That is certainly a possible outcome and we need to be sure to address that with proper education. Cannabis needs to be regulated and people who use it should be made aware of their risks and responsibilities.

But education on the product is the key - not making incorrect claims about its properties or its effects.

And one of the places that needs the most education is the law enforcement community. They are still locked into the "war on drugs" mentality and have convinced themselves that marijuana is some kind of gateway drug to harder narcotics. And as I keep trying to point out, it is not a gateway drug, but its Schedule I classification puts it into the hands of dealers and smugglers that expose users to other addictive drugs.

I hope that Michael Botticelli continues his effective work. That he continues to push forward drug policies that makes treatment our main weapon against addiction - and that legal penalties and incarceration can be reduced and made more fair.

The science of marijuana is out of Botticelli's purview and he needs to let the science determine how we classify marijuana. And, at the same time, maybe we can make the penalties in regards to marijuana more reasonable and fitting for the ramifications of the drug itself.

More education is the key - for everyone.
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Please Doctors - Use Medical Marijuana In Pain Management

Category: Medical Marijuana
Posted: 06/03/16 17:06

by Dave Mindeman

There is a policy area in which I think Bernie Sanders has the most forward thinking, and correct plan for this country. And that is in regards to marijuana. Bernie has a simple solution. Legalize it. Nationally. Get rid of the stigma. Get rid of the penalties.

A lot of people think this goes too far. That not enough studies on marijuana have been done. That it is still a dangerous, addictive drug.

Well, yes, it has addictive properties. I think that those properties are less than alcohol, but it is still something that needs to be addressed in any marijuana policy.

It is difficult to properly study marijuana, primarily because of its classification as a Schedule I drug. It is scheduled the same as heroin and cocaine...and I think most rational thinking people do not believe that it belongs there.

But there HAVE been studies on marijuana for a variety of medical purposes. One group has done a comprehensive search to find all of the studies on marijuana since 1990 - the summation can be found here.

They have found 60 different studies related to marijuana and their scorecard reads like this:

Positive results for condition treated: 41
Negative results for condition treated: 5
Mixed results for condition treated: 14

I especially want to talk about the pain studies. We just learned that Prince died from an accidental overdose of Fentanyl - an opioid pain medication. This is a familiar story for a lot of families. Chronic pain is an ongoing medical issue and in a lot of cases, we cannot cure it, we can only manage it. But that management gravitates over time into an addictive situation that can make pain management devolve into a whole new problem. One which can destroy quality of life, relationships, and even death.

There were 7 peer reviewed studies of marijuana in regards to pain. Six of them had positive results. One was mixed. But none of the studies were negative. None.

We already know from recreational users that overdoses of marijuana are rare. And controlled legal medical usage would be rarer still.

A lot of the potential negative issues with marijuana follow a similar pattern to alcohol use - and I would even say that alcohol problems are worse than marijuana.

To stigmatize marijuana as a "hard" drug in our current lexicon is just plain wrong with the knowledge base we have now. Yes, it still needs regulation, but classifying it as a narcotic is really over the top.

Our laws on marijuana are changing and right now, they are terribly confusing. Some states completely legalize it, some states allow limited medical use, and others restrict it the way it has always been. And hovering over all of it is the specter of a Federal intervention crackdown from a "war on drugs" mentality....at the discretion of those put in charge of enforcement.

Which is why, in Minnesota, we have very few doctors willing to participate in the state sanctioned authorization to use medical marijuana for pain. I feel strongly that this needs to change.

As a pharmacist, I have followed the progression of marijuana acceptance. I, personally, believe that full recreational use will eventually be the norm. But, at the present time, we cannot ignore the rationale to use marijuana for chronic pain management. Especially in an era where opioid addiction is running rampant and at dangerous levels.

So, I fully agree with Bernie on this one. Get rid of this decades old stigma that is the cornerstone of failed drug policy. And, at the bare minimum, the medical profession should take advantage of this new tool in the complex problem of pain management.

The authority is already there. Please use it.
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