Fifth National Clinical Conference on Cannabis

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"Donald Tashkin, M.D. from the Pulmonary/Critical Care department at UCLA School of Medicine presented his paper, “Does Regular Marijuana Smoking Lead to Pulmonary Disease (COPD, Lung Cancer, Pneumonia)?” His hypothesis was that heavy or long term use of smoked marijuana would increase lung, upper airway and throat cancers. He enlisted 1200 lung and UAT cancer patients and 1000 control patients. His study include MJ smokers, tobacco smokers, and smokers who used both. He found that habitual marijuana smoking is associated with symptoms of acute and chronic bronchitis, and evidence of microscopic injury to bronchial lining cells. He found inconsistent evidence of mild airflow obstruction in the airways of marijuana smokers. He did not find an accelerated decline in lung function that is normally associated with the onset of chronic obstructive pulmonary disease (COPD). He did not observe a positive association of marijuana smoking - even heavy long-term use - with either lung or UAT cancer, if there was no concomitant use of tobacco. Additionally, he did not find in a large group of gay men who smoked marijuana, increased progression of AIDS or the development of opportunistic infection.

Steve Hosea, M.D., an internal medicine and infectious disease specialist from Santa Barbara gave a talk called “Cannabis from a Physician’s Perspective”. He spoke about Western medicine’s focus on treating symptoms and diseases using drugs, radiation, or surgery and that treatment recommendations are the result of evidence based studies. This derived from the suspicion that modern physicians have concerning the 19th century “snake oil” approach, where allegedly medicinal products were marketed as cures for almost everything. This legacy made modern physicians suspicious of any medicine that was touted as effective based only on testimonial recommendation by “patients”. The credibility of Western medicine is the result of many research and clinical studies that prove the efficacy of various drugs in treating medical conditions. As pharmaceuticals began to be manufactured, the use of herbal remedies by physicians began to decline. By the mid 1930’s, the US government began to accuse cannabis of being a “killer weed” and had it removed from the US Pharmacopeia. Cannabis was accused of leading people to “sexual excess”, addiction, and was a “stepping stone” to harder drugs. Dr. Hosea then outlined what constitutes “evidence-based medicine”, which categorizes different types of clinical evidence and ranks them according to the strength of their freedom from the various biases that beset medical research. He then cited Donald Abrams’ study of the effectiveness of cannabis in treating the neuropathic pain associated with HIV as an excellent example of a medical study that used state-of-the-art “evidence-based” research to show cannabis’ effectiveness as a medicine. He cited a quote from Dr. Lester Grinspoon of Harvard Medical School, “A new study in the Journal, “Neurology” is being hailed as unassailable proof that marijuana is a valuable medicine. It is a sad commentary on the state of modern medicine that we still need “proof” of something that medicine has known for 5,000 years.” Dr. Hosea listed a few of the problems with non-evidence based medicine as providing “proof”. These problems included the placebo effect, the biases inherent in simple observation, the accuracy of reporting medical cases, and the difficulties in ascertaining who is an actual expert and qualified to establish a real cause and effect relationship between a purported medicine and the illness it purports to treat. However, he countered this with the consistent “non-evidence’ based reports that marijuana is effective for treating certain symptoms associated with AIDS, asthma, arthritis, auto-immune conditions, cancer, chronic pain, depression, mood disorders, epilepsy, glaucoma, menstrual cramps, labor pains, MS, spasm and spasticity, migraine, pruitus, insomnia and its aphrodisiac effects… Dr. Hosea then slammed the Controlled Substances Act Schedule I classification of marijuana as having no medicinal value, high potential for abuse and lack of accepted safety. Dr. Hosea asked why modern physicians don’t embrace cannabis as a medicine… He said that it’s because physicians fear prosecution by the Feds, fear of addiction, lack of education regarding cannabis’ medicinal benefits, lack of confidence in anything not produced by a pharmaceutical company and the suspicion that “getting high” is the primary motivation for patients. In contrast, Dr. Hosea then cited the American College of Physicians Position Paper of Marijuana released in Jan. 2008… that supports research into cannabis as a medicine, encourages the development of non-smoked forms of cannabinoids, supports federal research-grade marijuana, supports the rescheduling of marijuana from a Class I drug, and supports exemption from federal prosecution for marijuana researchers. To change attitudes of physicians, he concluded, we need evidence-based studies of cannabis, education about medicinal cannabis at the local, state and federal level for both lawmakers and physicians and ultimately the legalization of science as it pertains to marijuana.

Chris Conrad spoke on “Cannabis Yields and Dosage”. Chris is a recognized courtroom expert in this field. The levels of dosage that he characterized as medicinally appropriate might surprise most CRC patients. Chris based his work on the experiences of the US government’s own IND (Investigational New Drug) patients whom have been receiving, every month for the last thirty years, a large can of pre-rolled marijuana cigarettes grown by the government in Mississippi. This federally provided marijuana is of notoriously low quality, filled with stems, sticks and seeds. Only four patients in the IND program participated in Chris’ survey, of the six patients that are still alive. The average IND patient uses over a quarter-ounce of federal cannabis per day. He used this data, from the government’s own patients, to characterize what all medicinal cannabis patients should be legally allowed to possess and grow for medical use. He extrapolated this data to define six categories of medicinal use: occasional (1-4 oz. per year), daily (12 oz per year), several times per day (3 - 3.5 lbs. per year), throughout the day (6 lbs. per year), constant smoking (9-12 lbs. per year), and finally…eaten and smoked constantly (24 lbs. a year.). To put this in perspective, in Tashkin’s study, the heaviest marijuana user in the study estimated that they’d smoked 30 lbs in their entire life. So, Chris went on to show how these consumption rates would translate into plant canopy in a marijuana grow for one patient, based on the government’s own cultivation yield statistics of _ oz of processed cannabis per square foot grown at their Mississippi facility. To yield the average IND patient’s supply would require a 200 sq. foot garden… according to the government’s own figures. So, by the federal government’s own measures, California law would not even allow the average patient to produce one month supply per year at IND patient consumption levels… Interesting argument.

Dr. Arno Hazekamp, one of the world’s leading cannabis and cannabinoid researchers, also spoke at the conference. He gave a talk, “Cannabis Tea Revisited”. Making cannabis tea is one of the two recommended methods of medicinal cannabis consumption by the Dutch government (the other method is vaporization). He examined the Dutch govt.’s own recipe for cannabis tea. Here’s the recipe: boil one gram of cannabis in one liter of water for fifteen minutes in a covered saucepan. Strain tea. Makes five cups. Can be stored in a thermos for one day. Can be stored in refrigerator for five days. The cannabis used by Dutch patients for this recipe comes from their pharmacies. Their pharmaceutical cannabis varieties contain either 11% or 18% THC by dry weight. Hazekamp noted several problems with this recipe. First, raw cannabis contains its THC in an acid form that is not easily digested. More heat is required to convert THC-A to THC than can be achieved by boiling cannabis in water. Second, the THC quickly precipitates out of the tea onto the walls of the container. All of the major cannabinoids were detected in the tea, except for CBD… even though the cannabis contained a little bit of CBD. He said that one surprising result of his investigation is that apparently THC-A has more medicinal value than originally thought, even though it is not as psychoactive as THC. He also found that the THC will stay in solution for days if you add a little powdered creamer to the tea after straining the cannabis from it. He said that cannabis tea might be an entirely different cannabinoid delivery method, because of its THC-A content. Very interesting talk.

Perhaps my favorite talk happened to be the one for which I took the least number of notes… Dr. Natalya Kogan from Hebrew University in Jerusalem has been conducting a massive amount of research studies with her team on the effects of CBD (cannabidiol). Her team is conducting clinical and laboratory research on CBD use with a variety of illnesses and conditions. Their results are very promising. They have found that CBD has a cardioprotective effect, functions to protect the pancreas from developing diabetes, increases dopamine production during sleep, combats nausea in post-traumatic stress disorder, restores some cognitive function and working memory in senile dementia, and protects the brain from amyloid protein accumulation and protects spatial memory in Alzheimer’s disease. After her talk, the audience was a bit subdued, as the mass of material she presented seemed nothing short of astonishing.

Mark Ware, M.D. from McGill University presented his study, “Effects of Smoked Cannabis on Chronic Neuropathic Pain”. Neuropathic pain is a specific type associated with nerve damage caused by disease. These days neuropathic pain is often treated with anticonvulsants and antidepressants, though neither class of drug is particularly effective. Ware’s study was very well designed and his protocols were strict. His subjects were screened to eliminate patients with liver function, cardiac and psychiatric issues. He selected patients that did not regularly use cannabis. He employed three different strengths of marijuana (2.5%THC, 6% THC and 9%THC) to the patients along with one placebo version of cannabis that contained no cannabinoids. Each patient got to use each of the four types for one week over the course of the study, but they didn’t know which type they were smoking at any time. The purpose of the study was to assess the effects of smoked cannabis on the patients’ pain, mood, sleep and quality of life. Twenty-one patients completed the study. Average age of the participants was 45. The placebo, the 2.5% THC, and the 6% THC cannabis provided no benefit to the participants. Only the 9% THC cannabis was effective at reducing pain and increasing quality of sleep. Few side effects were reported, but reported side effects included headache, dizziness, mild cough, and a burning sensation in the throat. There were no cardiac side effects reported in any of the patients.

Juan Sanchez-Ramos, PhD, M.D., Director of Movement Disorders at the University of South Florida presented a talk on “Cannabinoids and Movement Disorders”. He is a major heavyweight in Parkinson’s and Huntington’s disease research. Dr. Sanchez-Ramos is an exceptional speaker and presented an entire overview of cannabinoid research on movement disorders in 30 minutes. I couldn’t begin to summarize the wealth of information he presented, but here goes… The brain is filled with CB1 receptors that interact with anandamide, a cannabinoid produced within the human body. One of the primary functions of our own cannabinoids within the brain is to regulate and modulate other neurotransmitters such as dopamine and GABA. The symptoms of movement disorders such as Parkinson’s and Huntington’s result from the inability to produce or regulate these neurotransmitters. Many of these CB1 receptors are located in the deep gray structures of the brain (the basal ganglia). The basal ganglia play a critical role in controlling movement. It is where our learned motor behaviors such as walking or rolling over are initiated. In the 1880’s cannabis extracts were the most common treatment for movement disorders such as Parkinson’s disease. Cannabis extracts modulate the release of dopamine. With low dopamine levels, the body’s movement slows down and the body stiffens. With a low dopamine levels, the body relaxes and the stiff movement disappears. At a higher dopamine levels, the body can begin to move too much or tremor. Cannabinoids even out or modulate dopamine release in the basal ganglia. Cannabinoids increase GABA neurotransmission, which means that they can reduce the frequency of seizure disorders and even anxiety disorders. GABA seems to be synergistic with both THC and CBD. Phytocannabinoids such as THC and CBD exhibit a neuroprotective effect that someday might be used to prevent the onset of neurotransmitter-related disorders. CBD looks like it may be especially useful for its antioxidant and neuroprotective effects that may prevent the onset of certain neurological diseases or conditions.

Donald Abrams, M.D. is Chief of Hematology-Oncology at San Francisco General Hospital and Professor of Clinical Medicine at UCSF. He was one of the true clinical pioneers in the use of cannabis for treating the side effects of HIV therapies. He gave a brief overview in the use of “Cannabis in Pain and Palliative Care.” He feels that conventional medicine has relied too heavily on opiates for pain treatment. Currently, opiates are falling out of favor for specific types of pain and are already considered ineffective for neuropathic pain. He is very interested in ongoing research concerning the use of CBD for its effects on reducing both pain and inflammation. He showed the state of medicine in 2000 BC, “Here, eat this plant,” then showed the state of medicine in 1950, “Here, eat this pill,” then the state of medicine today, “Here, eat this plant.”

Rik Musty, PhD is Professor Emeritus of Psychology at University of Vermont. He is one of the pioneers in bringing cannabis back into the mainstream of medicine. He gave a talk on “CBD and Mental Health”. Musty feels CBD, a non-psychoactive cannabinoid, will produce some significant anti-anxiety and antidepressants without many of the side effects of the medicines currently used to combat these mental health issues. The problem with CBD-based medicines is that they aren’t easily delivered orally or through injection. They can be delivered via vaporization, but not as easily as by smoking, which present a problem…

Melanie Dreyer, PhD, RN presented the results of her study conducted in Jamaica on “Prenatal Cannabis Exposure and Children’s Abilities at Age 5″. The sample size for her study was small: 59 children completed the study, while 132 dropped out, but her results were interesting… Her major finding was that there were higher cognitive and verbal abilities among the children with prenatal exposure than the unexposed group. This was confirmed by extensive testing. This finding contradicts previous studies that indicated that prenatal cannabis exposure had negative effects on the cognitive development of children.

Rick Doblin, PhD is the director of the Multi-Disciplinary Association for Psychedelic Studies (MAPS). MAPS has been at the forefront of the struggle to get the federal government to allow studies on a variety of Schedule 1 drugs including marijuana. Rick gave a presentation entitled, “DEA/NIDA and the Obstruction of Privately Funded Research.” MAPS has enjoyed breakthroughs and setbacks in their battle with the government. Among their victories are getting the FDA to approve vaporizers for medical cannabis studies and breaking the NIDA monopoly on research-grade marijuana for use in studies. Rick was heartened by the FDA’s shift to give science precedence over politics in the investigation of the potential medical uses of Schedule 1 drugs. The big setback has been the NIDA’s refusal to provide their research-grade marijuana (the only marijuana that could be used in US research) to studies that have been approved by the FDA. In other words, the FDA says yes, but NIDA says no (with the backing of the DEA). At every step the NIDA/DEA has blocked research into the medicinal uses of cannabis."
 
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