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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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Stop the Stereotyping Fears and Approve Med Marijuana for Pain

Category: Medical Marijuana
Posted: 11/05/15 00:08

by Dave Mindeman

Minnesota's Medical Marijuana law has some deep flaws. We have the heaviest restrictions on the use of medical marijuana in the nation. Whether it is because of being overly cautious, lack of knowledge, or law enforcement objections, we need to find a better way forward....especially when it comes to people in chronic pain.

Here is the current problem...

A state panel that spent months studying whether to expand Minnesota's medical marijuana program to pain patients came out in opposition to the idea Wednesday.

Some of the panel's objections stem from this....

"Panel members expressed concern that patients eligible to use medical cannabis for pain have expectations that it would provide total relief and that such a perception may leave patients to abandon other proven pain management methods, such as physical therapy," the recommendation noted. "Panel members agreed that medical cannabis should not be the first line of therapy in treating intractable pain, but that it could be an option after exhausting other standard treatments."

Here is the problem with that. Standard treatment of pain involves opioid prescription pain killers. They are not meant to be used in chronic situations because they are highly addictive and have many long term side effects.

In fact, a recent study that noticed the alarming increase in middle age caucasian death rates cited opioid overdose as one of the factors.

People in chronic pain may have high expectations for a new therapy but that is not a reason not to try it. Marijuana is less addictive with less side effects when compared to opioids. Doctors have been looking for an alternative to these types of pain killers for years.

Well, cannabis is a very viable alternative. Sure, it is not going to work for everyone who uses it. No medication ever does. One of the problems with drugs like Vicodin and Percocet is that the pain can break through the dose therapy (tolerance) and cause the patient to use more and more of the drug to attain the same level of relief. And chronic pain users will often do anything to seek that relief.

Now this panel does not have the final say on adding this indication for the use of cannabis....the final decision is in the hands of Minnesota Health Commissioner Ed Ehlinger. I would hope that Mr. Ehlinger takes more into account than patient expectations when making this decision.

Chronic pain sufferers deserve an opportunity for an alternative therapy. Even if it only works in 30% of the patients treated, it will save lives.

Let's get beyond the stereotypical fears of marijuana's history and get back to the real science of its use.

A lot of people will be grateful for the opportunity.
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Christie On Marijuana - Wrong Stand; Wrong Time

Category: Medical Marijuana
Posted: 04/15/15 11:30

by Dave Mindeman

In an obvious attempt to maintain relevancy in the GOP presidential primary, Chris Christie is going to "get tough" on marijuana.

When asked by Hewitt if he would enforce federal drug laws in those states that have legalized and regulated cannabis, Christie responded unequivocally.

"Absolutely," Christie said. "I will crack down and not permit it."

Citing an "enormous addiction problem" in the U.S., Christie, who has not yet announced a presidential run but has launched a political action committee, said that a very clear message needs to be sent "from the White House on down through federal law enforcement."

"States should not be permitted to sell it and profit" from legalizing marijuana, he said.


Guess this is another one of those Republican conflicts on states rights. States have the rights to do what they want, except when they don't.

But Christie's position would be a complicated one and put the Federal government and state laws in the courts for years. Besides, Christie is just wrong about the issue and on the wrong side of history.

When I was in pharmacy school (many moons ago), marijuana was given only a cursory examination. It was classified, and still is Federally, as a Schedule I drug - the same class as heroin, LSD, and cocaine. With that type of classification, the medicinal value of cannabis had limited research. The complications of trying to bring it to market were just not financially feasible to big Pharma. But even then, its medicinal value in nausea and chemotherapy side effects were well considered.

We have progressed since then - well, sort of progressed. Medical marijuana is legal in several states and available for recreational use in a few others. And yes, there is that inherent conflict with Federal law.

But when Christie uses this country's "enormous addiction problem" as his excuse for some gigantic Federal crackdown, he is wrong.

I'm not saying that marijuana is not addictive - the research is conflicted, but most believe that it does have some addictive properties. But we have far bigger addiction problems with "legal" drugs in that regard. Alcohol has the most obvious issue. And nicotine in cigarettes is highly addictive as well.

And then there is our prescription drug problems. Vicodin, Codeine, and amphetamine addictions are rampant. We have a country addicted to sleeping pills like Ambien. We even have chronic problems with Afrin nasal spray.

Almost any medication can be turned into an abuse problem. So when Christie cites marijuana as some kind of straw that breaks the camel's back, he is just plain wrong.

I find it somewhat ironic that Christie believes that states should not allow marijuana to be sold and profit from it. I say ironic because as marijuana grows into a "cash" crop and agribusiness begins to adopt it, there will be no turning back. Watch the business lobby move on that one in a hurry.

Eventually, marijuana will move into broader legal status. It needs to be regulated to be sure. It will impair driving and laws need to reflect that. It will have long term side effects, which we need to research. And it will be abused in marketing, which needs to be watched. But if we are unwilling to go backward on alcohol and nicotine in a legal sense, then going forward on marijuana, which has more positive uses than either alcohol or nicotine, will have much more value added benefit.

Chris Christie's tough guy image on this is out of sync with the times. He may get some traction among GOP primary voters (although that is shifting as well), but Pew research says that 53% of all Americans are ready for full legalization - even higher percentages want medicinal marijuana to be available.

Christie may be searching for a way to get back some relevancy, but on the subject of marijuana, he is going in the wrong direction.
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