It’s Past Time to Remove False Claims About Cannabis

In 2017, the United States (US) Drug Enforcement Administration (DEA) removed some false claims about Cannabis from their website. The nonprofit advocacy group, Americans for Safe Access, used government policy against the DEA, filing a petition that stated they had violated the Information Quality Act (Data Quality Act), meant to ensure objective, fact-based information is supplied on government websites and literature meant to educate the public. The group cited at least 25 misleading statements found on the DEA’s website and in a report from the agency titled, “The Dangers and Consequences of Marijuana Abuse”, that not only contradicted commonly accepted facts about Cannabis backed by science and research, but also the DEA’s own statements from 2016 when then-US Attorney General Loretta Lynch said Cannabis is not, in fact, a gateway drug’. “We usually … are talking about individuals that started out with a prescription drug problem”, she said.

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Image result for ban the deaAmong the other misinformation the DEA was passing off as purported fact was that marijuana’ induces psychosis and causes long-term brain damage. “We are pleased that in the face of our request the DEA withdrew some of the damaging misinformation from its website”,  said Vickie Feeman of law firm Orrick, Herrington & Sutcliffe“We are hopeful the DEA will also remove the remaining statements rather than continue to mislead the public in the face of the scientifically proven benefits of ‘medical Cannabis’”, she said. “However, the DEA continues to disseminate many damaging facts about the health risks of ‘medical Cannabis’, and patients across the country face ongoing harm as a result of these alternative facts’”. In 2019, there are still concerning statements on the DEA website that contradict accepted facts about Cannabis.

The Australian Government’s Department of Health (DoH) website states the following:

… ‘drugs’ can be categorised by the way in which they affect our bodies;

  • depressants — slow down the function of the central nervous system
  • hallucinogens — affect your senses and change the way you see, hear, taste, smell or feel things
  • stimulants — speed up the function of the central nervous system

Some ‘drugs’ affect the body in many ways and can fall into more than one category. For example, Cannabis appears in all three categories.

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The links to individual substances listed on the DoH website lead you to the Australian Alcohol and Drug Foundation (ADF) website for the purported facts (to use the term, facts, extremely loosely). On Cannabis it notes the effects include anxiety, blurred vision, clumsiness, dry mouth, excitement, fast heart rate, feeling sleepy, increased appetite, low blood pressure, paranoia, quiet mood, reflective mood, relaxation, slower reflexes, spontaneous laughter … and calls it a cannabinoid drug’, contradicting the DoH, using an adapted Drug Wheel (from the United Kingdom).

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Checking the references of the ADF article on Cannabis there are no surprises as to the misinformation, on the short list of names there are several of the usual culprits; high-profile Australian prohibitionists who profit from pushing propaganda with scant regard for actual science or the truth (many ‘brought to us’ by the pharmaceutical industry, among others with vested interests).


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Australians Nationally

34.8%, 14 years and over, have used Cannabis once or more in their life,
10.4%, 14 years and over have used Cannabis in the previous 12 months,
Young People in Australia
• Most do not use Cannabis – 68.7% of 12-17 year olds have never tried it.


Image result for Cannabis and those pernicious substances, the drugs, are wholly unalikeThe therapeutic index (larger the TI, the safer) of Cannabis is estimated to be between 4,000:1 to 40,000:1. Nobody really knows because no one has ever died from an overdose of natural Cannabis. This is because there are few or no CB1 receptors in the brain stem so there is NO respiratory depression from cannabinoids. Respiratory depression can be caused by many psychoactive drugs such as benzodiazepines, alcohol, anti-depressants and opiates. As most people who have tried Cannabis (estimated to be more than one-hundred million US citizens alone) know, the effects can often be quite pleasant and the side effects, such as they are, are mild and less often seen in people with serious medical conditions. Like all therapeutic agents, Cannabis can cause side effects for some, which may include anxiety, paranoia, dysphoria and cognitive impairment. These side effects appear to be dose related, tend to occur in naïve users and are entirely temporary. Due to this (in 1988), US Judge Francis Young, DEA’s Chief Administrative Law Judge, after a two-year rescheduling hearing, recommended rescheduling Cannabis to Schedule II, adding,  “Cannabis was one of the safest therapeutic agents known to man”.cannapharmaco

 


The reality is clear: Cannabis and those pernicious substances, the drugs, are wholly unalike. As the word ‘drug’ is wrong and inapplicable to Cannabis, it is necessary to establish a correct word, veracious vocabulary, which is fitting. “Because Cannabis has been loosely, widely and incorrectly referred to in the past as a ‘drug’ does not mean that this basic untruth can become acceptable. On the contrary, since the introduction of Prohibition the legal situation compels veracity and clarity more than ever, for not to articulate the truth accurately involves perjury. Yet truthful language, the truth, exposes the mendacious basis to the crime that is this prohibition of Cannabis”. 

From The Report of the Family Council on Drug Awareness (FCDA) (Europe, 2000)


Anti-weed activists say violent crimes have increased in states like Colorado. Picture: AP Photo/Dave Zalubowski

Image result for addiction to cannabis less than coffeeThe US Federal Government’s Independent New Drug (IND) program, instituted in 1978,  showed there are no troubling chronic effects from regular long-term use of Cannabis. A 2004 study by Dr Ethan Russo and Mary Lynn Mathre, RN, performed a battery of tests and physical exams on several IND patients supplied with government-grown Cannabis for over 25 years. They found these Cannabis patients to have had no adverse health effects from decades-long respiratory consumption of 7.5-9 lbs (3.4-4+kg) per year. There is plenty of data to demonstrate the safety of Cannabis. Not only the US Government’s IND program but also epidemiology studies demonstrate there are no proven long­-term adverse effects of Cannabis use. Prohibitionistic propagandists will say Cannabis is addictive. However, Cannabis addiction does not exist (except as an oxymoron). It is a misunderstanding of the definition of addiction alongside a lack of knowledge of the action of cannabinoids on the human Endocannabinoid System (ECS). Of course there is a dependency risk to Cannabis, one shared with other medications and/or recreational substances. As substance abuse experts Drs Hennigfield and Benowitz pointed out decades ago, the dependency risk of Cannabis is less than coffee. The 1972 report of the Nixon Marijuana Commission also debunked the idea that Cannabis is addictive.

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Another common fallacy is the possibility Cannabis use is linked to adverse cognitive effects. Studies that purport to show these effects are poorly done. A prime example is they do not control for important variables such as use of drugs, traumatic brain injury, PTSD, other medical conditions, growing up in a dysfunctional family, and/or environmental factors. One study cited to support the bogus claim found a reduction in IQ of 8 points in long-time users. This has not been replicated. Several studies including a twin study done by University of California, Los Angeles (UCLA) and University of Minnesota showed this adverse IQ was not true. In fact, Cannabis has helped many with ADD and ADHD pay better attention and raise their academic scores from C’s and D’s to A’s and B’s. One of the most egregious allegations is that Cannabis can change brain structure. Those trying to make the case point to effects in the hippocampus, amygdala and prefrontal cortex. Of course, there are effects on this part of the brain, because it is where many CBl receptors are located. This is why Cannabis has such beneficial effects on treating anxiety, depression and impulse control.

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Another canard (unfounded rumour or story) is that regular Cannabis use is linked to an increased risk of psychotic symptoms. This too is untrue. If it were true, epidemiology would show an increased incidence of psychotic behaviour in the 1970’s or 1980’s because of the pervasive use of Cannabis. There was no such increase. Over the past 60 years the incidence of psychosis has stayed flat or slightly declined. Instead, Cannabis has been shown to be beneficial in the treatment of bipolar disorder and schizophrenia.  Then there are those who insist Cannabis is linked to lower educational attainment. This too is untrue. The work of Dr Melanie Dreher with children exposed to Cannabis in utero and in breastmilk demonstrated that these children did better in school and reached their developmental landmarks sooner than those children whose mothers did not use Cannabis in pregnancy. And the lies continue to percolate wherever it is politically and economically advantageous to those in power in so many jurisdictions, worldwide.

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The International Drug Policy Consortium (IDPC) recommended that, beyond 2019, United Nations (UN) member states should end punitive ‘drug’ control approaches and put people and communities first. The IDPC’s Shadow Report, ‘Taking stock: A decade of drug policy’ evaluates the impacts of policies implemented across the world over the past decade, using UN data, complemented with peer-reviewed academic research and grey literature reports from civil society. Image result for IDPC LOGOThe important role of civil society in the design, implementation, monitoring and evaluation of global policies is recognised in the 2009 Political Declaration and Plan of Action on drugs, as well as in the Outcome Document of the 2016 United Nations General Assembly Special Session (UNGASS). It is in this spirit the IDPC produced the Shadow Report, to contribute constructively to high-level discussions on the next decade in global drug policy. The Shadow Report concluded that member states should identify more meaningful policy goals and targets in line with the 2030 Agenda for Sustainable Development, the UNGASS Outcome Document and international human rights commitments.


IDPC’s Shadow Report, ‘Taking stock: A decade of drug policy’ – Key Conclusions

• Data from the Shadow Report show targets and commitments made in the 2009 Political Declaration and Plan of Action have not been achieved, and in many cases have resulted in counterproductive policies.
• The Shadow Report highlights the urgent need to conduct more comprehensive and balanced research and evaluations on the impacts of drug policies worldwide, taking into account government data, but also academic research and civil society findings.
• The Shadow Report concludes member states should identify more meaningful drug policy goals and targets in line with the 2030 Agenda for Sustainable Development, UNGASS Outcome Document and international human rights commitments.


Crossing out Lies and writing Truth on a blackboard.Image result for cannabis is not a drug

 

 

 

 

 

 

The right to the truth is a human right. Cannabis is a herb, not a drug, and should be removed from all the various drug conventions, worldwide; then it could be provided to all in need, just as ‘Mother Nature’ intended. In the interim, how about the whole, organic truth about the Cannabis sativa plant; it might just set us all free.

 

Adapted from DEA Removes False Claims About Cannabis from Their WebsiteDEA Finally Removes Misinformation about Pot from WebsiteLIES USED TO JUSTIFY RESTRICTIVE CANNABIS POLICIES, Illegally HealedDEA Drops Inaccurate Cannabis Claims From WebsiteWhat You Should Know About MARIJUANAGranny Storm Crow’s List and CANNABIS IS NOT A DRUG.

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Cannabis is a Significant Non-Toxic Substitute for Dangerously Addictive Pharmaceuticals

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Giving patients legal access to Cannabis will influence a significant portion of them to use Cannabis as an alternative to traditional pharmaceuticals, two 2019 studies found. In the first, published in the Journal of Pain, researchers analysed data from online surveys submitted by 1,321 adult Cannabis consumers in legalised states throughout the United States. It found that +80% of respondents had used Cannabis as a substitute for pharmaceuticals, primarily opioid painkillers. Seventy-two percent of those who reported substitution said they had completely ceased opioid use, 68% stopped taking benzodiazepines and 80% eliminated SSRI anti-depression medication. The participants were asked why they chose Cannabis over pharmaceuticals. The top reasons given included that Cannabis had fewer adverse side effects and was more successful in managing symptoms. Almost 90% of respondents said their pain improved after using Cannabis and 71% said their health improved overall. “The current study and the consistent nature of the observational findings provide additional nuance to the ongoing debate about Cannabis’ analgesic value for chronic pain, as well as a potential substitute for opioids or other drugs”, researchers wrote. The second study, published in the Harm Reduction Journal in January 2019 surveyed  +2,000 Canadian adult medical Cannabis patients registered with federally authorised manufacturer Tilray. They completed online questionnaires about why they use Cannabis and whether they’ve used it as a substitute for other medications and substances. The exhaustive survey included 239 questions.

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About 70% said they used Cannabis as a substitute for prescription drugs, 35% for opioids, 11% for anti-depressants, 8% for anti-seizure medications, 4% for sleeping pills and muscle relaxants and 4% for benzodiazepines. A significant fraction of those who used Cannabis as an opioid substitute reported complete cessation: 59%. About 20% said they reduced their opioid usage by at least 75%. Like the US survey, the researchers asked the Canadian patients about the reasons behind their decision to substitute. Fifty-one percent said it was because they felt Cannabis was safer than pharmaceuticals they were prescribed, 40% said Cannabis had fewer adverse side effects and 20% reported better symptom management with Cannabis. Additionally, 44% of respondents said they used Cannabis to partially or completely stop using alcohol and 31% cut out tobacco. “This study offers a unique perspective by focusing on the use of a standardised, government-regulated source of medical Cannabis by patients registered in Canada’s federal medical cannabis program”, researchers wrote. “The findings provide a granular view of patient patterns of medical Cannabis use, and the subsequent self-reported impacts on the use of opioids, alcohol, and other substances, adding to a growing body of academic research suggesting that increased regulated access to medical and recreational Cannabis can result in a reduction in the use of and subsequent harms associated with opioids, alcohol, tobacco, and other substances”. Nearly half of patients using Cannabis to help with their respective medical conditions stopped taking prescribed benzodiazepines, another study, published in the journal Cannabis and Cannabinoid Research, reported.

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“Within a cohort of 146 patients initiated on medical Cannabis therapy, 45.2% successfully discontinued their pre-existing benzodiazepine therapy”, authors wrote. “This observation merits further investigation into the risks and benefits of the therapeutic use of medical Cannabis and its role relating to benzodiazepine use”. While much research has been dedicated to understanding how medical Cannabis could potentially replace opioids for patients who deal with chronic pain and other ailments, the study suggests patients who take Valium, Xanax and other popular tranquilisers for neurological conditions (anxiety, insomnia, seizures etc) may find relief through Cannabis. Researchers in Canada conducted a retrospective analysis of data collected from a group of patients who had been referred to the Canabo Medical Clinic for medical Cannabis to treat a variety of conditions. They identified 146 patients who reported taking benzodiazepines regularly at the start of their Cannabis therapy. According to their findings, 44 patients (30%) had discontinued benzodiazepines by their first follow-up visit. Another 21 had stopped by their second follow-up visit and one more person reported doing so at the third visit. Sixty-six patients, or 45%, stopped taking benzodiazepines after starting a medical Cannabis regimen. “Patients initiated on medical Cannabis therapy showed significant benzodiazepine discontinuation rates after their first follow-up visit to their medical Cannabis prescriber, and continued to show significant discontinuation rates thereafter” the study stated. “Discontinuation was not associated with any measured demographic characteristic. Patients also reported decreased daily distress due to their medical condition(s) following prescription cannabinoids”.

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The amount of CBD and THC content did not appear to play a role in who continued to discontinue taking the tranquilisers. “The study results are encouraging and this work is concurrent with growing public interest in a rapidly developing Canadian Cannabis market”, said the lead author, Chad Purcell. The study also served as an opportunity to draw more attention to the potential risks associated with benzodiazepines, Purcell said. “I was interested in this project because it presented an opportunity to address benzodiazepines and Cannabis use, both of which are becoming increasingly socially relevant. Benzodiazepines can be effective in treating many medical conditions but unlike opioids, there seems to be little public awareness of the risks associated with these commonly used prescription medications”. According to the US Centres for Disease Control and Prevention, overdose deaths related to benzodiazepines rose 830% between 1999 and 2017. Another study (August 2018) showed how Cannabis could be an effective treatment option for both pain relief and insomnia, for those looking to avoid prescription and over-the-counter pain and sleep medications – including opioids. The study, published in the Journal of Psychoactive Drugs, looked at 1,000 people taking legalised Cannabis in an American state and found among the 65% taking Cannabis for pain, 80% found it was very or extremely helpful. This led to 82% of these people being able to reduce, or stop taking over-the-counter pain medications and 88% being able to stop taking opioid painkillers. 74% of the 1,000 bought it to help them sleep – 84% of whom said Cannabis had helped and over 83% said they had since reduced or stopped taking over-the-counter or prescription sleep aids.

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The study suggests Cannabis could lower opioid use. However, researchers caution more needs to be done to understand potential therapeutic benefits of Cannabis. “Twenty percent of American adults suffer from chronic pain, and one in three adults do not get enough sleep”, said Dr Gwen Wurm, Assistant Professor, University of Miami Miller School of Medicine. Traditional over-the-counter medications and painkillers can help, however they may have serious side effects. Opioids depress the respiratory system, meaning that overdoses may be fatal. “People develop tolerance to opioids, which means they require higher doses to achieve the same effect”, said Dr Julia Arnsten, Professor of Medicine, Albert Einstein College of Medicine. “This means that chronic pain patients often increase their dose of opioid medications over time, which in turn increases their risk of overdose”. Although less common, sleeping pills can lead to dependence and cause grogginess the next day, interfering with people’s work and social lives. As a consequence, some people are looking to Cannabis to help. To find out more about these users, Wurm and her colleagues used survey data from people who purchased Cannabis from two retail stores in Colorado, US, where it is legal for both medical and recreational use – meaning any adult over 21 with a valid government ID may purchase product. “In states where adult use of Cannabis is legal, our research suggests that many individuals bypass the medical Cannabis route (which requires registering with the state) and are instead opting for the privacy of a legal adult use dispensary”, said Wurm.

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Although the survey was conducted among customers willing to participate (meaning the results may not reflect the overall population of dispensary customers) other national survey data and data from medical patients at medical Cannabis dispensaries, demonstrates that people who use Cannabis to treat symptoms both decrease and stop their use of prescription medications. The study adds weight to the theory that widening access to Cannabis for medicinal purposes could lower the use of prescription painkillers, allowing more people to manage and treat pain without relying on opioid prescription drugs that have dangerous side effects. This is backed up with other research that shows US states with medical Cannabis laws have a 6.38% lower rate of opioid prescribing and that Colorado’s adult-use Cannabis law is associated with a relative reduction in opioid overdose death rate from 1999 to 2010. Wurm added, “Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen cause GI bleeding or kidney damage with chronic use. Paracetamol (Acetaminophen) toxicity is the second most common cause of liver transplantation worldwide and is responsible for 56,000 ER visits, 2,600 hospitalisations, and 500 deaths per year in the US”. Again, however, researchers caution more research is needed to understand the health benefits and side effects of Cannabis. “The challenge is that health providers are far behind in knowing which Cannabis products work and which do not. Until there is more research into which Cannabis products work for which symptoms, patients will do their own ‘trial and error’, experiments, getting advice from friends, social media and dispensary employees”, said Wurm.

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Adapted from Patients Are Substituting Marijuana For Addictive Pharmaceutical Drugs, Two New Studies ShowA ‘Significant’ Number Of Patients Stopped Taking Benzodiazepines After Starting Medical MarijuanaCould marijuana be an effective pain alternative to prescription medications?

Cannabis to Treat Opioid Addiction

Medical Cannabis

In the United States in 2011, the Centers for Disease Control and Prevention declared an ‘opioid epidemic’. This announcement came on the heels of two decades of medical over-prescribing practices, leading to opioid misuse and abuse, resulting in soaring rates of overdoses across the US. Too little, too late? Addiction isn’t a new problem. The human body is inherently vulnerable to addiction through the action of dopamine in the brain. Dopamine, a prominent chemical messenger, is released in response to rewarding and pleasurable events. Its role is to reinforce biologically relevant and necessary behaviours, including eating, sleeping and sex.

However, humans and other animals are at risk of becoming dependent on the dopamine ‘rush’ and can, therefore, develop an addiction to these behaviours whereby their body becomes dependent on the increased dopamine to function at baseline. Just like food or sex, substances like alcohol and opioids can lead to dopamine release. Opioids are derived from the poppy plant and are a key component of illicit drugs (like heroin) and pain medications (like oxycodone). While opioid medications have been used for many years to treat pain, a few crucial factors converged in the late 1990’s and early 2000’s that led to an opioid-addicted US.

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In 1996, healthcare professionals were urged to pay closer attention to the pain reported by their patients – a recommendation bordering on being a requirement, prompting recognition of pain as the ‘fifth vital sign’. The Joint Commission on Accreditation of Healthcare Organisation heightened the urgency to treat pain in their published guidelines and US Congress declared the first decade of the 21st century to be the “Decade of Pain Control and Research”. These events and associated policy changes sent a jolting ripple effect through the medical community that resulted in greatly increased prescriptions for pain medications.

Concurrently, Purdue Pharmaceuticals, the manufacturer of OxyContin®, began aggressively marketing their prescription opioids, spending $200 million on advertising. Their tactics included down-playing the potential risk of addiction and dependency caused by opioid medications. As a result, OxyContin® sales soared from $48 million in 1996 to almost $1.1 billion in 2000. While Purdue eventually faced criminal and civil charges, by then, the damage to America had already been done. In 2017 there were 47,600 opioid-related deaths in the US. While prescription opioids certainly contributed to these statistics, many of these deaths involved heroin; those who take opioid medications are at significantly higher risk of using heroin, due to its lower cost and easier access.

In fact, the nature of the opioid epidemic fundamentally shifted the way addiction is viewed in the US. Government initiatives have invested in strategies to reduce access to prescription opioid medications but this does nothing to help patients with chronic pain who need treatment, nor those recovering from addiction. Fortunately, there is an overwhelming amount of data supporting Cannabis as both an effective agent for pain relief and an aide in helping people recover from opioid addiction. The idea of using Cannabis to treat pain is not new – in fact, ancient Chinese civilisations used Cannabis for joint pain and inflammation before it came to the West (Cannabis is one of the ancient Chinese ‘50 Fundamental Herbs’).

Opioids, derived from the poppy plant, have also been historically used for pain control; however, unlike Cannabis, those who used opioids quickly learned of the risk of addiction. Cannabis shares some physiological similarities to opioids, as short-term use increases dopamine to relieve pain. However, Cannabis increases dopamine via cannabinoid receptors, while opioids increase it via opioid receptors. Additionally, the increase in dopamine levels from Cannabis does not persist over time and, therefore, the risk of possible dependence is significantly lower.

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The effects of Cannabis on pain have been demonstrated across many studies. A meta-analysis of 28 clinical trials conducted on Cannabis and pain ranging from 1948-2015 reported positive findings, concluding Cannabis is effective in treating pain with a reasonable safety profile. Cannabis has therefore been approved to treat chronic pain in the majority of US states where its use is legalised. But, what about treating opioid addiction and not just pain? US states with legalised medical’ Cannabis have significantly lower levels of opioid use and opioid-related deaths.

A study in 2016 found a 64% reduction in opioid use in American patients who used Cannabis for their chronic pain. Studies have shown Cannabis may be effective in reducing craving for opioids and easing withdrawal symptoms. Based on this evidence and the unrelenting opioid crisis, New Jersey and Pennsylvania added opioid addiction as a qualifying condition for ‘medical’ Cannabis and other states like New Mexico, Maryland, Connecticut and Ohio are drafting similar policies. New York and Illinois allow patients prescribed opioids to receive ‘medical’ Cannabis instead.

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These policies certainly represent tremendous progress toward helping patients use ‘medical’ Cannabis to treat their pain and potentially aid them in recovery as they transition off opioids. However, Cannabis still remains a Schedule I substance at the federal level in the US, which restricts patients’ access to it and continues to slow critical research. Despite growing awareness and recognition of the potential for Cannabis in alleviating the epidemic caused by opioid addiction, ending prohibition entirely is the only way to further progress and alleviate the opioid crisis in the United States.

Adapted from Medical Cannabis for Opioid Addiction: A Two-Pronged Approach, Part 1 and Medical Cannabis for Opioid Addiction: A Two-Pronged Approach, Part 2

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Cannabis Tinctures

In many states of the United States and across Canada, dispensaries and health food stores have shelves lined with little amber or blue glass dropper bottles. Easy to purchase and use, tinctures offer a tried-and-true mode of Cannabis consumption that has been around since long before the days of legalisation. A dropper or two of a liquid tincture placed under the tongue is a solid sub-lingual delivery mechanism that can lead to quick absorption and lasting effects. But what exactly is in a tincture? Tinctures have been used in ancient and modern herbalism for centuries and are, at a basic level, an alcohol extract of an herb.

The two necessary ingredients to any tincture are thus alcohol and an amount of the botanical from which to derive an extract. In the case of Cannabis tinctures, this means the most basic ingredients are alcohol and Cannabis. Ethanol, or grain alcohol, is the most common base for a tincture, but the extract can also be done by soaking plant material in oil or in vegetable glycerine under normal ambient conditions. A saturated MCT oil, such as coconut oil, is a common carrier for this type of tincture. A vegetable glycerine tincture is the least common due to the availability of glycerine and the fact it can lead to a less potent tincture.

cannabis-tinctures

Cannabis tinctures are made by soaking Cannabis flowers (buds) in alcohol (leaf trim, hash and kief can also be used). The alcohol extracts the terpenes, cannabinoids and other compounds from the Cannabis (for the full ‘Entourage Effect’), into a liquid that contains a high concentration of active compounds. Alcohol preserves the compounds, which is important since it takes longer to consume tinctures as opposed to other forms of Cannabis. A DIY or homemade tincture would involve soaking raw Cannabis in a strong grain-derived alcohol and leaving it to soak in a dark glass container for several weeks.

Tinctures are often darker than post-processed concentrates which have undergone clean-up steps like winterisation to remove undesirable plant molecules like waxes, lipids and chlorophyll that are soluble in the alcohol. A commercial application would involve a similar process while using laboratory equipment to adhere to standards and regulations for cleanliness and quantity. Cannabis should be decarboxylated prior to being placed in the alcohol (or oil/glycerine) solution if the intent is to consume the activated THC instead of the inactive THC-A. While a strict tincture only consists of the carrier liquid and herb base, many tinctures available for public consumption in North America contain other ingredients.

grapefruit-oil

Many additions are based on flavour and/or recipe desires and are not essential in the creation of a tincture. Honey, Mint, Lavender and many other herbs can be added to a Cannabis tincture and are often included to make a more proprietary blend that brands can use to distinguish themselves in the marketplace. Cannabis tinctures are usually stored in glass dropper bottles, which help preserve the tincture for longer by blocking out sunlight. One of the benefits of using tinctures is the alcohol allows the body to absorb the medicine faster. Most tinctures are taken by placing a few drops under the tongue, known as sublingual administration.

When you take a tincture sublingually, the cannabinoids are absorbed rapidly by the blood vessels lining the inner tissues of the mouth, resulting in a quick onset of effects. Tinctures can also be ingested orally, such as by swallowing or mixing it with food. If you consume a tincture orally, the cannabinoids must be absorbed through the stomach and gastrointestinal tract and through the liver (in particular) and take significantly longer to enter the bloodstream. Depending on whether the Cannabis is decarboxylated first, tinctures may contain tetrahydrocannabinol (THC) in its active form or non-active form (THCa). Most people choose to decarboxylate their Cannabis before making a tincture, allowing them to take full advantage of the medical benefits of THC. 

thcWhile medical uses of THC are still being researched, there is evidence it can be helpful in treating a wide range of conditions and disorders, including nausea, vomiting, poor appetite, pain, multiple sclerosis, cancer, Crohn’s disease, PTSD, anxiety, depression, Parkinson’s disease, Alzheimer’s disease, sleep apnoea, glaucoma, diabetes, cardiovascular disease and many others. However, if you do not decarboxylate your Cannabis, you will receive the benefits of tetrahydrocannabinolic acid, THC acid or THCa, found in the flowers, leaves and stems of young Cannabis plants.

Biosynthesised by the trichomes, THCa plays a critical role in protecting the trichomes, and thus the plants themselves, from insects and other predators. Furthermore, THCa is no more ‘psychoactive’ than CBD, thus allaying parental concerns about getting their children ‘high’ (an unfounded, prohibitionist-driven fear). THCa is one of the cannabinoids primarily found in fresh Cannabis, although in variable amounts, according to CannLabs. Once the Cannabis plant is exposed to heat, such as vaporising, THCa decarboxylates to THC. What happens on a molecular level is that the carbon dioxide in the Cannabis is released; as a carbon atom in the acid is lost, THCa is converted to neuro-active THC. THCa acts as a cannabinoid receptor agonist and in so doing, also provides neuro-protective (brain protection) effects.

North American Recipes

Australian Recipes (Nimbin HEMP Embassy)

(including Cold and Hot Methods, Glycerine and Oil-based Methods)Effects of Cannabis Tinctures

Tinctures can be felt as quickly as 15 minutes after dosing and the effects last for a shorter period of time compared to edibles. Tincture efficacy usually peaks about 90 minutes after consumption and can last 4 to 8 hours, depending on the dose. Because the effects can be felt so quickly, dosing with a tincture is easier than dosing with an edible. As with any form of Cannabis, you should start with a small dose to gauge your tolerance and to avoid any possible, initial, unwanted effects of ‘over-consuming’. If you’re taking a Cannabis tincture for the first time, start off with about 1 ml and adjust (upwards or downwards) as necessary. CBD-min-1-800x445

There are three ways to consume Cannabis tinctures: sublingually, orally or with food. To take a tincture sublingually, drop desired dose under the tongue and hold for 30 seconds before swallowing. This method will produce quicker, stronger effects because the tincture is absorbed into the bloodstream through the inner lining of the mouth. You can take Cannabis tinctures orally by adding a few drops to a beverage such as a smoothie, juice or even a ‘mocktail’. Alternatively, you can swallow the tincture on its own like any liquid medicine. When you take a tincture orally rather than sublingually, it must be absorbed through the digestive system, so it will take longer to feel the effects.

Tinctures taken orally have a similar effect to edibles and can take up to an hour to start Cannabis tinctureworking. Tinctures can also be combined with food to make a tincture edible. The difference between a tincture edible and a fat-based edible is the latter is harder to dose and can produce a longer, more intense effect (including euphoria). If you consume a tincture mixed with food, it will take the digestive system more time to absorb than if you took the tincture sublingually. Cannabis tinctures may be added to a variety of foods such as puddings, ice creams, dressings and sauces.

There are many advantages to taking Cannabis tinctures, with a major one being how easy they are to make at home. You can make your own Cannabis tincture (links above) and, while there are many different recipes, these are some of the most popular. When preparing a Cannabis tincture, you usually must decarboxylate (or ‘decarb’) your plant material. Decarboxylation is the process of heating Cannabis to activate the compounds in the plant. Specifically, this will convert THCa into THC and allow you to experience all the effects of whole-plant Cannabis. If you choose to skip this step, your tincture will mostly contain THCa.

Epsilon Apothecaries, (California, US) has a downloadable Extraction Basics Guide (pdf), the Epsilon Essentials Guide Series, comprises a novice approach to the creation of three special supplements: tincture extract of Cannabis, essential extract of Cannabis and supplemental extract of Cannabis. Readers can learn how to create therapeutic grade supplements at home, following in the footsteps of Epsilon’s decade-long track record of success in a variety of cases. The Epsilon Essentials Guide is free of charge, the company’s website says, “All we ask is your respect in return”.

Adapted from What’s in a Tincture? and Cannabis Tinctures: Uses, Effects and Recipes

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Cannabis Topicals and How They Work

 

Tens of millions of Americans are afflicted with chronic pain and many are seeking safe, non-addictive solutions to ease their suffering. So too in Australia, where 67% or 11.1 million people aged 15 years and over reported experiencing bodily pain in the previous month (2012). Around one in ten (9%) experienced severe or very severe pain, and many adults experienced chronic pain. Research suggests Cannabis topicals could provide relief for sufferers of ailments ranging from sports injuries and migraines to skin conditions such as acne, eczema and psoriasis. Image result for cannabis topicals

Topicals represent one of the fastest-growing segments of the legal Cannabis marketplace in the United States. Scientific bodies confirm Cannabis has pain-relieving properties. But to fully understand how topicals can relieve pain and other ailments, we need to take a quick tour of the human Endocannabinoid System (ECS). The ECS is a vast network of receptors throughout the body. It’s responsible for modulating many physiological systems involving the brain, endocrine, immune and nervous systems. Researchers have found the ECS is essential for maintaining homoeostasis, or balance, in these various systems.

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There are two main types of receptors or ‘message receivers’ in the ECS, classified as CB1 and CB2 receptors. CB1 receptors are predominantly located in the brain and central nervous system; CB2 receptors are primarily in the peripheral nervous system. The messages these receptors receive are actually chemicals that bind to the receptor and either activate it or shut it down, producing a corresponding effect within the body. 

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The chemical compounds in Cannabis that interact with the ECS are called cannabinoids, with the most well-known being neuroactive delta-9-Tetrahydrocannabinol (THC), which activates CB1 receptors in the brain to create euphoria. More than 100 cannabinoids have been identified in the Cannabis plant including cannabidiol (CBD) and others like cannabinol (CBN), cannabigerol (CBG) and tetrahydrocannabivarin (THCv), whose various medicinal properties are under escalating scrutiny.

When you apply a Cannabis topical to your skin, the cannabinoids interact with CB2 receptors in your epidermis and muscles. In a 2016 report in Cellular and Molecular Life Sciences, researchers found when CB2 receptors were the targets, the result was reduced inflammation, an immune response that plays a role in many ailments including skin conditions and chronic pain. Unlike anti-inflammatory medications, Cannabis topicals can be used without risking unpleasant potential side effects or overdose. Image result for cannabis topicals

Some Cannabis topicals contain THC, but when applied to the skin, the cannabinoids don’t actually enter the bloodstream. Instead, THC interacts with the ECS receptors outside the blood-brain barrier. A research review in Molecular Pharmacology concluded, “activation of CB2 receptors does not appear to produce … psychotropic effects”. Topicals allow consumers to localise and directly target an afflicted area to reduce inflammation. People can and do ingest Cannabis via smoking, vaping or edibles for generalised pain relief, but many prefer to single out that aching knee or sore neck by applying a topical directly. Image result for cannabis topicals

Some research even indicates cannabinoids may accelerate our bodies’ natural healing process. A 2005 study on CB1 and CB2 receptors in the gastrointestinal system found that cannabinoids can promote the healing of epithelial wounds. Our skin is composed of epithelial cells, which also line the surfaces of our organs and blood vessels. So, Cannabis topicals may also promote a quicker healing response for skin conditions and injuries. Perhaps best of all, Cannabis topicals offer consumers a simple, safe and low-stakes entryway into exploring the wellness benefits of Cannabis.

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Many people still harbour fears about Cannabis, but topicals are approachable and in many ways, the best ambassador for the Cannabis plant’s pain-relieving and healing capabilities. The emerging research is clear in showing the tangible ways Cannabis topicals work with our bodies. Just let that knowledge soak in.

Adapted from How Cannabis Topicals Actually Work: A Deep Dive into Your Body’s CB1 / CB2 Receptors (Author Dahlia Mertens is the founder and CEO of Mary Jane’s Medicinals)

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Cannabis for Seizures

A cutting edge paper published in early 2017, from three American physicians, Dustin Sulak, Russel Saneto and Bonni Goldstein, outlined case reports and the applications of Cannabis medicines for epilepsy and seizure disorders.

Highlights: 

  • Physicians have documented the efficacy of artisanal whole plant Cannabis preparations for seizure reduction.
  • In a study of 272 patients, 86% had some degree of seizure reduction while using artisanal Cannabis.
  • A combination of cannabinoids and terpenes, not just CBD, may be most effective for seizures.
  • These clinical findings challenge Big Pharma assumptions that favour single-molecule medications.

Cannabis clinicians treating epileptic patients in three American states, California, Washington and Maine, reported their findings in a peer-reviewed article that underscores the complex challenges and unique therapeutic potential of Cannabis oil concentrates. In this uncontrolled observational study involving 272 patients, some degree of seizure reduction was noted in 86% of cases; 10% (26 patients) experienced complete seizure remission. In addition to documenting the efficacy of “artisanal” (meaning not FDA-approved) Cannabis preparations for seizure reduction, the article highlights the need for flexible treatment protocols involving different cannabinoid ratios, an approach that implicitly calls into question single-molecule strategies favoured by Big Pharma. What follows are excerpts from “The current status of artisanal cannabis for the treatment of epilepsy in the United States” by Dustin Sulak, Russell Saneto and Bonni Goldstein in the journal, Epilepsy & Behavior:

“Of 272 combined patients from Washington state and California, 37 (14%) found Cannabis ineffective at reducing seizures, 29 (17%) experienced a 1-25% reduction in seizures, 60 (18%) experienced a 26-50% reduction in seizures, 45 (17%) experienced a 51-75% reduction in seizures, 75 (28%) experienced a 76-99% reduction in seizures and 26 (10%) experienced a complete clinical response. Overall, adverse effects were mild and infrequent and beneficial side effects such as increased alertness were reported. The majority of patients used cannabidiol (CBD)-enriched artisanal formulas, some with the addition of delta-9-tetrahydrocannabinol (THC) and tetrahydrocannabinolic acid (THCA)”.

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The authors maintain that artisanal Cannabis products should be considered for patients with refractory epilepsy that have a low likelihood of responding to FDA-approved anti-epileptic drugs (AEDs). Moreover, a combination of cannabinoid compounds, not just CBD, may be more effective for seizure reduction.

“The patient population that considers herbal Cannabis as a treatment for epilepsy is heterogeneous in etiology, currently predominantly paediatric and has seizures that are usually refractory to multiple conventional treatments. The cannabinoids may reduce seizures via numerous mechanisms of action that warrant further investigation including THC’s reduction of glutamate exotoxicity via the CB1 receptor, CBD’s modulation of numerous non-cannabinoid receptors and several proposed targets of THCA. Objective measurement of treatment response can be challenging and subjective reports of the efficacy of artisanal Cannabis can be strongly influenced by the placebo effect, especially in patients that have invested significant resources into securing access to these formulas”.

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Several other challenges are cited by the authors:

“Availability of a consistent supply of the medication is frequently interrupted due to horticultural, manufacturing and economic factors. Current market prices for artisanal Cannabis preparations observed in Maine, California and online range from 5 to 50 cents per milligram. Higher dosing ranges are financially unfeasible for many patients unless they grow and produce their own medicine, a complex process that presents many potential interruptions in treatment. Sudden loss of access to cannabinoids may result in rebound seizures. The potential for disruption of medical treatment or family structure related to child protective services and other legal agencies, even when the patient and medical provider operate within state laws, must also be carefully considered on a case-by-case basis”.

There are also serious issues of quality control with respect to artisanal Cannabis preparations used by epilepsy patients.

“Inaccurate product labelling is pervasive in this new and often-unregulated industry. A 2015 study of edible Cannabis products available in Seattle, San Francisco and Los Angeles found that of 75 products examined, 17% were accurately labelled for cannabinoid content, 23% were inaccurate with higher than labelled concentrations and 60% contained lower than labelled concentrations. Many patients purchase and use purportedly CBD-dominant “hemp” formulas that are sold online and shipped across state and international borders. Patients are led to believe that such products are legal, even in states without medical Cannabis laws, despite the fact that CBD remains classified as Schedule One. In 2015 and again in 2016, the FDA published analytical results of several commercial CBD products and issued warning letters to their manufacturers. Many products were under-labelled for  CBD content, contained no CBD, or contained significant amounts of THC”.

Image result for inaccurate product labelling california cannabisThe authors referenced the clinical trials of Epidiolex, a CBD isolate developed by GW Pharmaceuticals, evaluated at a dosing range of 2-50 mg/kg/day. Artisanal Cannabis preparations have a wider therapeutic window than Epidiolex (which has caused other drug poisoning) and are safe and effective at various dosages in clinical practice.  One of the authors, Dustin Sulak, observed anti-convulsive effects in patients at doses as low as 0.02 mg cannabinoids per kilogram per day. Ultra-low doses of cannabinoids have been shown to be physiologically active in pre-clinical models: a single application of 0.002 milligrams per kilogram of THC to mice induced long lasting activation of protective signalling in molecules in the brain. Cannabinoids trigger biphasic responses depending on dosage.

Low doses and high doses can elicit opposite effects and this should not be unexpected in clinical practice. The authors comment on the clinical implications of potential biphasic dose-response trends in the anticonvulsant of activity of THCCBD and other modulators of the endocannabinoid system. The extraordinarily wide dosing range of Cannabis is complicated by non-linear dose-response relationships. Clinicians are cautioned to avoid making the simple assumption that higher doses of cannabinoids will yield stronger therapeutic effects. If previous clinical improvements begin to diminish, especially after a dosage increase, clinicians may consider dosage reduction as a potential strategy to improve efficacy. The authors also discuss the use of tetrahydrocannabinol acid (THCA) for seizure reduction.main-cannabinoids

“Delta-9-THC acid is becoming a popular treatment approach for patients with epilepsy in legal states and is sometimes more readily available and/or affordable than CBDTHCA does not produce psychoactive effects in animals at relatively high doses and psychoactivity has not been observed in humans. Though most THCA-dominant preparations will contain at least trace amounts of THCTHCA does not convert into THC in vivo.

In one case, THCA-rich therapy proved effective when treatment with CBD and THC  failed to deliver satisfactory results. Specific terpenes, such as linalool (present in lavender and various Cannabis cultivars), may also confer anticonvulsant effects.

“Low-dose CBD at 0.05 mg/kg/day reportedly improved cognition, but higher doses of CBD caused an increase in myoclonic seizures. THC at 1 mg/kg/day reportedly produced a 4-day seizure-free episode, followed by recurrence of seizures. At 2 mg/kg/ day, THCA resulted in a reported overall 90% seizure reduction and improved tolerance to temperature fluctuations. At one point a new formula of THCA at the same dosage resulted in notably decreased efficacy. A terpenoid analysis of the previous formula demonstrated the presence of high levels of alpha-linalool, absent in the less effective formula. Returning to a THCA formula based on the linalool-dominant chemovar improved her response.

Whereas pharmaceutical companies focus on single-molecule compounds, clinical practice indicates that patients with seizure disorders are more likely to benefit if they have access to a range of whole plant artisanal Cannabis preparations, not just CBD. The authors concluded that despite the inherent challenges in the clinical use of artisanal Cannabis preparations, patients with refractory epilepsy do benefit. To avoid issues related to the variability of artisanal preparations, clinicians can measure serum cannabinoids levels and patients or their families should be advised not to rely on product labels, but to test every batch of medicine for cannabinoid potencies and potential contaminants at analytic laboratories using industry-standard methods. Clinicians can navigate the cannabinoid dosing nuances by providing patients with individualised, methodical titration instructions.

Read the entire paper, “The current status of artisanal cannabis for the treatment of epilepsy in the United States” (six page pdf)

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Adapted from Medical Marijuana for Seizures

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Higher Cannabis Education – Bridging the Clinical Gap

Cannabis and its role as a medicine is gaining prevalence, despite a distinct lack of governmental recognition of its true medicinal value. Isn’t it about time doctors, all those professionals with their knowledge purportedly rooted in science and reality, gain an adequate Cannabis education? How else can doctors possibly give their patients guidance? Every health expert should know about the Endocannabinoid System (ECS) and that almost every living creature with vertebrae has one. Named after the plant that led to its discovery, Cannabis, the Endocannabinoid System is one of the most widespread and powerful physiological control systems in the human body. It helps balance nearly every metabolic process in the body, from fertility to pain perception to emotion and so much more.
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Pointedly, several different chronic diseases and conditions are thought to be a direct result of an ECS imbalance or dysfunction. Understanding how the ECS works with respect to both our endogenous (from within) cannabinoids (endocannabinoids) and those exogenously (externally) produced, like in the Cannabis plant (phytocannabinoids), is undeniably vital to human physiology. Given its significance, most conventional health professionals know very little about Cannabis and ECS science. An independent survey by Dr David Allen, an American 30-year veteran heart and general surgeon, showed only 13.3% of the 157 accredited US medical schools taught or offered any type of endocannabinoid and/or Cannabis education. Dr Allen himself claims the ECS is the “single most important discovery in modern medicine since the recognition of sterile surgical technique”.Image result for ECS is the single most important discovery in modern medicineWith such little Cannabis education, it’s no wonder most doctors are so ill-equipped to effectively treat patients with Cannabis. The inability of physicians to guide patients in regard to Cannabis is essentially creating a “clinical gap” between patient and provider.  Cannabis is a versatile yet relatively safe and sophisticated living medicine. Millions worldwide turn to it for relief for numerous ailments every single day. Cannabis breaks the boundaries and limitations of single-molecule synthetic drugs and trumps other plant species with its intra-species diversity and vast clinical applications. For many patients however, navigating the waters of Cannabis therapy can be frustrating and difficult without expert, educated medical guidance on how to approach Cannabis treatment. While knowing that “CBD is good for inflammation” for example, educated Cannabis physicians will understand the lipophilic (“fat-loving”) nature of cannabinoids like CBD, and how they must be used consistently to allow for its “accumulation” in one’s body. The truth is, Cannabis is a complex and tricky plant.

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Sceptics continue to decry, “there isn’t enough research!” Yes, we do need more research around Cannabis. Yet, we already know more about it than most realise. Go to PubMed.gov (US repository for medical literature) and you’ll find over 28,000 studies published on Cannabis, whilst the likes of Ritalin will give over 8,600 results. Aside from this, Cannabis has been recognised as a medicine for thousands of years. Prohibition is fairly recent compared to that and is backed by zero science.  Prohibition also fails to account for the body’s own Endocannabinoid System and how Cannabis has proven to be an excellent supplement for this system, relieving many different types of ailments and conditions. Countries like Israel are light years ahead in their Cannabis research and clinical experience. Image result for israel cannabis researchCannabis has a lot of catching up to do when it comes to large-scale, double-blind, placebo-controlled trials. However, we know enough about the plant and the Endocannabinoid System that this shouldn’t prevent us from embracing it now. The only way we can begin to optimise cannabinoid therapy for patients is by breaking the mould and integrating Endocannabinoid and Cannabis education into the medical curriculum, as well as those in other sectors of healthcare (e.g. nurses etc). In the US, while the DEA continues to stonewall research attempts due to federally restrictive scheduling of Cannabis, there is absolutely nothing stopping allopathic medical schools from teaching future doctors what we do know about the Endocannabinoid System (which is a lot). American Osteopathic and Naturopathic medical schools have already begun, putting them at a clear advantage over their allopathic counterparts.    0000ECSandBodilySystems

The Endocannabinoid System is arguably involved in almost every physiological and biological process involving who we are and the status of our health. We can either pretend this incredibly significant element of the human body doesn’t exist (not recommended), or we can do something about it and start implementing evidence-based Cannabis education into healthcare curriculums around the world. Patients deserve the best, safest and most effective care medicine has to offer. Humanity deserves the opportunity to continue its pursuit of knowledge of the biomechanical and physiological workings of the human body. The mainstream medical community can no longer stand on the sidelines as they do in the US, simply authorising patients for a ‘medical cannabis’ card is not enough. The time to bridge this clinical gap is now; not just for the sake of the patients and physicians, but for all of us.

Adapted from Higher Education: Bridging the Clinical Gap in Medical Cannabis

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