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There Is Value In This Drug Debate

Herb Fellow

New Member
KALAMAZOO - The chief medical officer of Kalamazoo County might use marijuana to alleviate the pain of his glaucoma -- if it were legal. In 2000, Richard Tooker, 54, was diagnosed with pigmentary glaucoma, a rare eye disease where fluid buildup inside the eye can lead to intense pain. Blindness is also possible.

"I would consider taking it, if it were legal, for medical use,'' he said. "I want to keep my vision.'' Studies have shown marijuana can lessen pressure in the eyes of those with glaucoma.

Tooker said he would have to consult with legal counsel before he used the drug. That's because, even if Michigan voters in November decide to allow medical marijuana use by seriously ill patients, it still would be illegal under federal law.

Users of medical marijuana, as well as others who support its use, say the drug offers relief to those suffering debilitating conditions. They also say it would be cheaper than buying the drug off the street and that use and production can be controlled if properly regulated.

How would the appropriate dose be established for those who are deemed eligible users? Are there possible negative health effects from using the drug for medical reasons? Do alternatives to medical marijuana already exist?

"On the balance, it's a good thing,'' Tooker said of medical marijuana. "And if we're going to legalize marijuana for medical use in Michigan, let's legalize it across the country. It's a dicey, difficult issue.''

State Sen. Tom George, R-Texas Township, worked for Hospice of Greater Kalamazoo and sometimes prescribed a synthetic -- and legal -- form of marijuana called Marinol. But the drug is not cheap. Ninety Marinol pills at the middle dosage strength of 5 milligrams cost $1,140 at drugstore.com Online Pharmacy - Prescription Drugs, Health and Beauty, plus more, an online pharmacy. The amount and strength of Marinol taken by a patient depends on their needs. The average cost of an ounce of marijuana on the street is between $125 and $150, said Joseph Taylor, commander of the Kalamazoo Valley Enforcement Team, which targets illegal drug use in Kalamazoo County.

Smoking risks

George, an anesthesiologist, opposes the ballot initiative because of the availability of Marinol and the possible health risks of medical marijuana. "Marinol is better than smokeable marijuana because Marinol does not contain the additional chemicals, impurities and hazards associated with smoke,'' George said in a statement this month to the Senate. "Also, the resulting THC (tetrahydrocannabinol) blood levels and hence, the effects, are more predictable with Marinol than smokeable marijuana.''

George said other drugs being developed would include THC, the main active component of marijuana. One drug is called Sativex, which if approved by the U.S. Food and Drug Administration, could be used as a treatment for patients with advanced cancers. Approved in November by the FDA for clinical testing, the drug would be administered as an oral spray.

"I'm telling you, as a former hospice physician, it is of no benefit to legalize smokeable marijuana,'' George said.

The FDA agrees.

"There are alternative FDA-approved medications in existence for treatment of many of the proposed uses of smoked marijuana,'' the agency said in a statement in 2006.

But Marinol, available since 1986, has its problems, said Ruth Hoppe, head of the Michigan chapter of the American College of Physicians, the nation's second largest physicians group.

Marinol is absorbed slowly into the body, she said, and a patient experiencing extreme nausea might not be able to use it because the pill must be swallowed to be effective. "We need to look at other routes of delivery,'' Hoppe said.

Potential for abuse?

Smoking anything is harmful to one's health, Hoppe said. But that doesn't mean marijuana doesn't have its place as a legitimate medical treatment or supplement to other medications. The American College of Physicians recently released a position paper on medical marijuana. It concluded that, although more research needs to be done, "reports suggest numerous potential medical uses for marijuana.''

"For patients with AIDS or those undergoing chemotherapy, who suffer severe pain, nausea and appetite loss, cannabinoid drugs may provide symptom relief not found in any other medication,'' the position paper said.

The federal government, however, puts marijuana in the same class as LSD, heroin, mescaline, psychedelic mushrooms and ecstasy. "Marijuana has a high potential for abuse, has no currently accepted medical use in treatment in the United States, and has a lack of accepted safety for use under medical supervision,'' the 2006 FDA report said.

The government's classification of marijuana hinders study of the drug for medical use, Hoppe said. The American College of Physicians is recommending reclassifying the drug to allow for more study. "I can see a day when marijuana is seen as a legitimate medical treatment, especially in conjunction with other medications,'' Hoppe said. "There is value in this drug.''

`Trial and error' doses

Marinol comes in doses of 2.5 milligrams, 5 milligrams and 10 milligrams. Determining the proper dose of marijuana from plants is less scientific because it can be smoked, drunk, eaten or inhaled through a vaporizer.

Tooker, who is open to the medical uses for marijuana, said he opposes smoking it. He said ``trial and error'' would be the only way to determine what the appropriate dose of marijuana would be for a patient.

Dianne Byrum, a former state legislator and spokeswoman for the Michigan Coalition for Compassionate Care, said the dose level would depend on the patient's needs and symptoms. "This would be a recommendation, not a prescription,'' she said. She also said smoking marijuana would not be harmful, especially for patients with terminal conditions.

Drug of choice

For about 40 years, Eva Myrick, 62, has had multiple sclerosis, a disease that sometimes has made it difficult for her to speak, see and walk. Shortly after her diagnosis, she used marijuana to ease her symptoms. "It makes it so you can live with what you've got,'' she said. "It's like a cushion.''

Myrick, of Kalamazoo, takes four other prescription drugs, many of which have side effects like constipation. Marijuana, she said, would help make the side effects more tolerable. "If marijuana was legal (for medical use), I'd definitely try to get rid of some of my pills,'' she said.

Myrick said her husband, Bruce, also used marijuana prior to dying of cancer in 1997.

"Now it's a risk to try to find it,'' she said. "I don't (understand) it, though, because we're not hurting anybody.''

Source: Kalamazoo Gazette
Copyright: 2008, Kalamazoo Gazette
Contact: CHRIS KILLIAN, Special to the Gazette
Website: `There is value in this drug'Debate continues whether risks of medical marijuana outweigh the benefits- mlive.com
 
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sicntired

Member
I read an article recently in which a British Big Pharmacy rep was raving about his company's new drug which was a derivative of cannabis .He was lobbying for the rights to North American distribution.These people have zero objection to marijuana.Their only objection is to the fact that it can be grown any where by any one.Thusly,we have prohibition,which has never been about the banning of drugs but is all about the monopoly on the sale of these drugs and complete product control by big pharmacy.The end of big oil's grasp on the production of fibres and the need to save what few trees we have left will soon end all arguements against the growing of hemp.Now it's just the ideologues that forsee drugs as the end of the world.I still remember friends of mine who thought as soon as the old farts died marijuana would finally be legal.Now some of my old friends are the old farts and nothing has changed.At one time I was dumb enough to think it was a war of ideology but it's so clear now that it's all about money and who can get the most of it.The prohibition people just don't care how many lives they destroy to make their point.:11::31::adore:
 

Boss

Well-Known Member
As long as the media keeps portraying Cannabis users as second class citizens by telling everyone how much better they are then Cannabis users, we are in for an uphill battle.

I would be willing to bet some of the most beautiful art and music was done with the aid of Cannabis. But we rarely hear any of the positives. I mean look, they just proved in 2 major studies that Cannabis can stop cancer tumors and how much did you hear in the news?
 

Noel McC

New Member
Hello everyone.
It's late now, I'll keep it short.
First of all, I really like this site you have over the water there stateside.
I shall not speak on the legal ins and outs of the situation over there -- that's primarily for 'the people' to decide and moreover while I read from time to time the dreadful items in the press, I am not famaliar enough to comment. I was very pleased with the ACP report FEB 2008.
The American College of Physicians publishes the journal of internal medicine: so a statement position from an organisation as internationally renouned and prestigeous as the American CP is no small thing on this side of the water either!
What I do know is how things are organised here: in short, cannabis is illegal in this jurisdiction, but there is a Directive from the Public Prosecutor to the Minister of Binnenlandse Zaken (Police) NOT to prosecute individuals for less than .... Im not sure what it is exactly but it's a lot.
To regulate supply (for the illicit, street kind) of cannabis, the state literally 'look the other way' form so-called 'coffeeshops'. BUT the Local Municipality run a very strict form of licencing criteria for the premises that may operate under these (strict) conditions and legal stipulations (age limit, quality control, TAXES, etc).

For legal medical users, the state (via the Ministry of Health Wellbeing and Sport's regulator in this matter of legal implementation) regulate the 'legal' 'labatory production' of cannabis to some 20,000 patients, resident in the Netherlands. The Regulation is required because of the UN conventions on Narcotics and Psytrophic substances 1971, (NY). Lately the Italian, Candian & many others attempted to have cannabis rescheduled at UN Treaty level. If this were done, the legal basis for prohibition may remain, but it would be decriminalised drug, with medical purpose just like the really strong drugs that doctors have access to all of the time: medi cocaine and morphine....! After all, these prescription drugs can bring about an overdose, but as the government here have researched throughly: it is not possible to suffer a fatality because of overdose on cannabis. Many have tried, perseviered & tried again on this one: and all the medical evidence is that it just is not medically possible.
Medically-speaking [and please remember we are discussing the Public Health here], on a level medical playing-field with, let's say, 10 needle-injection doses of morphiate-codine cocktail on the one hand, and a fired up and ready-to-go Vapourizer II with 15 grams (0.529109429 ounces) on the other hand.......where does the real threat to public health lie?
My point being that YES there need to be regulations for the medical uses and so forth, but the world of medicine is far better equiped to manage that (as they do already for countless other prescription drugs) than the Ministry of the Interior (ie the police).
I base that opinion on the fact that they are the relevant experts.
As written here earlier, that all takes place on a (individual) prescription-basis : however with somewhat more accuracy than one would assume.
There are various medical varieties available: and because these are produced for the State under state licence (and regulator) in labatory conditions using specific strains: the medical pharmacists who produce the cannabis can indicate precisely how much active ingredient is contained in the 5gram [0.17636981 ounces] container that the pharmacist sells (with sales tax) to patients and only on prescription from the physician.
Just like with morphine!

I've said enough! Here's the information from the federal government itself [comes with the meds each time you purchase them, just like any other medicine you would get from the drugs store on prescription:

all the best,
Slan
Noel

Ministry of Health, Welfare and Sports
Office of Medicinal Cannabis

P.O. Box 16144
NL-2500 BC The Hague
The Netherlands
Medicinal Cannabis


Information for Health Care Professionals version date: 15 November 2007

1. Name of drug
Cannabis, dried flowers (Cannabis flos)
Cannabis is supplied in three varieties:
Variety Dronabinol /THC Cannabidiol/CBD
Bedrocan approx. 18% <1%
Bedrobinol approx. 11% <1%
Bediol (granulate) approx. 6% approx. 7.5%
2. Qualitative and quantitative composition
Cannabis is made up of the dried inflorescences of the female Cannabis sativa L. plant, and is cultivated and processed under standardised conditions in order to obtain a consistent product. Cannabis contains several constituents including substances that belong to the cannabinoids, such as dronabinol (delta-9-tetrahydrocannabinol, THC) and cannabidiol (CBD). The content of cannabinoids depends on the type of cannabis.
3. Pharmaceutical form
Dried female flowers (gamma-irradiated)
4. Clinical information
4.1 Therapeutic indications
The efficacy of cannabis-components has been examined in various small and large scale clinical studies. Results from these studies indicate that medicinal cannabis may have a positive therapeutic effect on the symptomatic treatment of:
- disorders that involve slight spasticity with pain (multiple sclerosis, spinal chord injuries)
- nausea and vomiting (resulting from chemotherapy, radiotherapy and HIV combination therapy)
- chronic pain (in particular neurogenic pain)
- Gilles de la Tourette syndrome
- palliative treatment of cancer and AIDS
The use of cannabis is indicated only when the results with current treatment protocols are unsatisfactory or when too many side-effects occur.
Medical literature also mentions a significant number of other indications. However, the scientific basis for application in the case of these indications is still small, and more research is needed.
Ministry of Health, Welfare and Sports Office of Medicinal Cannabis
Page 2 Version date 15 November 2007

The variety of cannabis to be used must be established by experience. So far, no scientific evidence exists which point towards preference of one of the varieties for a certain indication. Recent data indicate that DRONABINOL and CBD in combination improve pain and spasm in MS-patients. Inhaling cannabis with a high content of dronabinol increases the risk of psychological side-effects. This can be avoided when using cannabis for the first few times, by choosing a variety with a low content of dronabinol or through oral administration in tea.
4.2 Dosage and method of administration
The required amount of cannabis per day should be determined on an individual basis. The initial dosage should be low and can be increased slowly as symptoms indicate. The dosage needed to achieve the desired effects is often different/ lower than the dosage at which psychological side-effects occur (become high).
Two methods of administration are recommended: orally or via inhalation. Inhaling cannabis exhibits a stronger and faster therapeutic effect compared to oral administration.
Oral (tea): (see also 6.6)
drink 1 cup (0.2 litre) of tea in the evening, hot or cold
When using this method, keep in mind that it takes an average of two weeks before the maximum effect is achieved; if after roughly two weeks the result is too limited or unsatisfactory, drink one extra cup (0.2 litre) in the morning.
Inhalation (vaporizer): (see also 6.6.)
1-2 times a day, inhale a few times until the desired effect is reached or until psychological side-effects occur. Wait 5-15 minutes after the first inhalation and between inhalations.
When using the inhalation method, the strength of the cannabis must be kept in mind. Be careful about the dosage when switching from one variety of cannabis to another, especially if cannabis with a lower content of dronabinol was used earlier.
With repeated administration of cannabis, it takes 2 weeks to arrive at steady-state concentrations of dronabinol. This must be kept in mind when evaluating the activity of the drug.
4.3 Contra-indications
The use of cannabis is not recommended for patients predisposed to psychotic disorders. Use cautiously in patients with underlying psychological problems.
4.4 Special warnings and precautions when using cannabis
Patients with heart diseases (heart arrhythmias, angina pectoris) should avoid high doses of cannabis because of the cardiovascular side-effects (in particular tachycardia). Tolerance to these effects develops within a few days to weeks. The dosage may only be increased slowly as indicated by the effects on the heart and only after consultation with the physician.
The psychological effects of cannabis can be disturbing for inexperienced users. It is advised to administer cannabis for the first time in a quiet and familiar setting, and in the presence of another person who can calm down the patient if necessary.
Smoking is not recommended. Cannabis smoke contains harmful combustion products, including carcinogens and carbon monoxide. As a result, frequent use of smoked cannabis over a long period of time presumably exposes users to health risks associated with smoking. Smoking cannabis can impair pulmonary function (histopathological changes in the mucous membranes) and reduce resistance to infection. Regular cannabis smokers can develop pharyngitis, rhinitis
Ministry of Health, Welfare and Sports Office of Medicinal Cannabis
Page 3 Version date 15 November 2007

and COPD (Chronic Obstructive Pulmonary Disease). To limit the damage caused by combustion products, cannabis can be inhaled by a vaporizer.
4.5 Interactions with other drugs and other forms of interaction
There are known cumulative effects when cannabis is used at the same time with other tranquillizing substances such as alcohol, benzodiazepines and opiates. Basically there is only one research into interactions with other drugs. Finding was that there were no potential effects of medicinal cannabis on the pharmacokinetics of concomitantly administerd irinotecan and docetaxel, or other (anticancer) drugs.
The effective dosage of opiates was found to be significantly decreased in the case of combination of opiates with cannabis in animal studies.
Because of the high first-pass effect in the liver, particularly in the case of oral administration of cannabis, it is possible that pharmacokinetic interactions could occur with drugs, which are broken down by the isoenzymes CYP2C9 and CYP3A4 in the cytochrome P450 system. Drugs that inhibit these isoenzymes are macrolides (in particular claritromycin and erythromycin), antimycotics (itraconazole, fluconazole, ketoconazole and miconazole), calcium antagonists (in particular diltiazem and verapamil), HIV protease inhibitors (in particular ritonavir), amiodarone and isoniazid. Simultaneous use of the enzyme inhibitors mentioned above can increase the bioavailability of dronabinol and with that, the possibility of additional side-effects.
Drugs that accelerate the breakdown of dronabinol via the isoenzymes mentioned are rifampicin, carbamazepine, phenobarbital, phenytoin, primidone, rifabutin, troglitazone and Saint John’s Wort. When a patient stops taking these drugs, an increase in the bioavailability of dronabinol may be expected.
Interactions are also possible with drugs which (like dronabinol) are strongly bound to plasma proteins.
4.6 Pregnancy and breastfeeding
Use of cannabis during pregnancy should be avoided. Dronabinol is known to reach the fetus via the umbilical cord. There are no indications that the use of cannabis during pregnancy causes deformities. Research has not shown any unequivocal effect on growth parameters. School-aged children who were exposed to cannabis while in utero have a normal overall IQ but score lower on certain aspects (in particular, in their ability for abstract-visual reasoning, memory function, and the executive function, which is the ability to demonstrate flexible, purposeful behaviour). Hyperactivity, concentration problems and impulsivity are also reported in 10-year olds.
Dronabinol has been detected in breast milk. Therefore, the use of cannabis while breastfeeding is not recommended.
4.7 Effect on ability to drive and operate equipment
The use of cannabis can reduce reaction-time and lower concentration. This may create problems in carrying out everyday activities. Participating in traffic is forbidden in the Netherlands and operating equipment is not recommended.
Ministry of Health, Welfare and Sports Office of Medicinal Cannabis
Page 4 Version date 15 November 2007

4.8 Side-effects
The psychological side-effects of cannabis can vary widely, and depend on several factors: the amount of cannabis used, the method of administration, the user’s experience with cannabis and personal constitution, such as the person’s state of mind at the time of use and how open the user is to experiencing the effects. A person can become “high” after using cannabis. This is a feeling of euphoria that slowly changes into a pleasant sensation of calm and rest. Users can also experience other effects while “high”, such as sedation, cheerfulness with fits of laughter, hunger, a heightened sensitivity to perceptions of colour and music, a disrupted sense of time and space, and lethargy. This altered perception can give rise to a sense of anxiety, panic and confusion. Restlessness and insomnia are also reported. Cannabis can sometimes provoke a psychotic reaction, characterized by delusions and hallucinations. A genetic relationship between cannabis use and schizophrenia has been established, although it is not clear whether the relationshop is causal.
Physical side-effects of cannabis are:
- tachycardia
- orthostatic hypotension
- headache
- dizzyness
- sense of hot or cold in hands and feet
- red burning eyes
- muscle weakness
- dry mouth
- in cannabis smokers (and after inhaling): irritation of the airways
These effects are temporary and disappear a few hours after use.
Long-standing, intensive use of cannabis is presumed to have an effect on cognition, but this is reversible. In some cases, cannabis use results in dependence and abuse. Chronic users who stop can experience physical withdrawal symptoms such as mild forms of restlessness, irritability, insomnia and nausea.
4.9 Overdose
An overdose of cannabis may cause depression or feelings of fear, to the point of panic and fainting. The symptoms should spontaneously disappear in a few hours. In case of overdose, benzodiazepines (diazepam IV) can be administered if needed. Tachycardia can be treated with a beta blocker (propranolol IV).
Ministry of Health, Welfare and Sports Office of Medicinal Cannabis
Page 5 Version date 15 November 2007

5. Pharmacological properties
5.1 Pharmacodynamic properties
Cannabinoids act on the cannabinoid receptors. At least two different receptors (G-protein coupled receptors) have been identified: CB1 and CB2 receptors. CB1 receptors are found particularly in the central nervous system, while the CB2 type are peripheral and located mainly in the immune system and gastrointestinal tract.
5.2 Pharmacokinetic properties
Absorption
The absorption of cannabinoids in the body is determined by the method of administration. When cannabis is inhaled, the cannabinoids are absorbed into the blood within minutes via the lungs and transported to the brain. The concentration of cannabinoids in the brain reaches a maximum within 15 minutes, which coincides with the peak of the psychological and physiological effects.
Absorption varies greatly per individual and depends on various factors, including the heating of the cannabis, the number of inhalations, the waiting time between inhalations, the inhalation time and lung capacity.
When cannabis is taken orally, absorption of cannabinoids in the blood is slow and more unpredictable. This results in the psychoactive effect being delayed 30 to 90 minutes with the maximum effect being experienced two or three hours later, and then lasting four to eight hours. Dronabinol concentrations in the blood with oral intake are 25-30% of those seen after inhalation. This is caused, in part, by the large first-pass effect in the liver.
Distribution
After being absorbed, the cannabis constituents are distributed through-out the body. The concentration of cannabinoids rises most quickly in the tissues with the largest blood supply: the brain, lungs, liver and kidneys. A substantial portion of the dronabinol is stored in fatty tissue. Dronabinol and its metabolites are strongly bound to plasma proteins. The distribution volume of dronabinol is 10 liter per kilogram of body weight.
Elimination
In the liver, isoenzymes CYP2C9 and CYP3A4 of the cytochrome P450 system initially convert dronabinol to 11-hydroxy-THC (11-OH-THC), a metabolite that is biologically active. This connection probably contributes to some of the effects of cannabis. The metabolite 11-OH-THC is further converted to 9-carboxy-THC (THC-COOH), which is biologically inactive. A range of other inactive metabolites are also formed. The elimination half-time of dronabinol and 11-OH-THC is 25-36 hours. Dronabinol metabolites can be detected in the urine up to several weeks after the last use of cannabis.
Ministry of Health, Welfare and Sports Office of Medicinal Cannabis
Page 6 Version date 15 November 2007

6 Pharmaceutical information
6.1 List of excipients
Not applicable.
6.2 Cases of incompatibility
None.
6.3 Shelf life
Cannabis can decompose under the influence of light and moisture. Cannabis can be stored in the original packaging until the expiry date indicated on the package.
6.4 Special precautions for storage
The cannabis should be stored in the original packaging at room temperature (15-25oC).
6.5 Type and content of the packaging
Cannabis is available for pharmacies in 5-gram packages.
6.6 Instructions for use and processing
In cannabis, the cannabinoids are primarily present as pharmacologically inactive acids (for example, THC acid). Heating gives rise to free molecules through decarboxylation. For this reason, a heating step must always be carried out before administration.
Use of vaporizer
See instructions for use enclosed with the device. The cannabis is heated, causing the active ingredients to evaporate. Subsequently, they can be inhaled without combustion. The right temperature has been reached when a vapour is just visible (a light mist) but no smoke has formed (thick clouds). For vaporizers with a thermostat, the temperature should be set at 180-195 oC. It is possible to re-use the same cannabis 2-3 times in the inhaler.
Making the tea
Boil half a gram of cannabis for 15 minutes in half a liter of water in a covered pan. Before using, strain the solid ingredients from the tea. Sweeten the tea as desired with honey or sugar.
The leftover tea can be kept in a thermosflask when consumed the same day.
When the tea is made for several days it is possible to store it in the refrigerator for up to 5 days. A fatty substance such as milkpowder should be added to the tea in order to keep the active ingredients in solution.
7. Particulars
Import
Import of medicinal cannabis from the Netherlands by an foreign company/ pharmacy is possible through the OMC.
Ministry of Health, Welfare and Sports Office of Medicinal Cannabis
Page 7 Version date 15 November 2007

For this, the following documents are needed:
• 2 original duplicates of an import licence from the requesting country
• A letter with the amount of medicinal cannabis needed, and the indication of the patient.
After we have received those documents we will apply for an export licence with the Netherlands Health Care Inspectorate. Subsequently, we will draw up a contract and send this together with an invoice. When we have received the signed contract in return and the invoice is paid we can send the medicinal cannabis.
 

Jim Finnel

Fallen Cannabis Warrior & Ex News Moderator
Very good post. Welcome to the boards. I look forward to your future posts.

"Unless we put medical freedom into the Constitution, the time will come when medicine will organize into an undercover dictatorship...To restrict the art of healing to one class of men and deny equal privileges to others will constitute the Bastille of medical science. All such laws are un-American and despotic..., and have no place in a republic...The Constitution of this Republic should make special provisions for medical freedom as well as religious freedom." - Dr. Benjamin Rush, signer of Declaration of Independence; member, Continental Congress; B.S. Princeton U.
 
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