Medical Cannabis: Safe, Effective

May 31, 2013

Where did you receive your school­ing and train­ing? I have been a med­ical physi­cian for more than 29 years since grad­u­at­ing from the Uni­ver­sity of Utah School Of Med­i­cine.  I com­pleted train­ing in gen­eral surgery in Los Ange­les and plas­tic surgery in Utah.  Dur­ing my gen­eral surgery train­ing I com­pleted a one-year plas­tic surgery research fel­low­ship at the Uni­ver­sity of South­ern Cal­i­for­nia.  I fin­ished my board cer­ti­fi­ca­tions in both gen­eral surgery and plas­tic surgery, and set up pri­vate plas­tic surgery prac­tice in Las Vegas.  I prac­ticed plas­tic and recon­struc­tive surgery for six years until I under­went cer­vi­cal spine surgery for her­ni­ated discs in the neck.  The surgery left me with neck pain and bod­ily mus­cle pain that pre­vented me from return­ing to the prac­tice of surgery. After five years, I was well enough to re-train in pain med­i­cine at the Uni­ver­sity of Utah under a group of renowned pain-medicine physi­cians, who have served as cur­rent and past pres­i­dents of promi­nent pain acad­e­mies and soci­eties in the United States.  I hold mem­ber­ships in the Amer­i­can Acad­emy of Pain Med­i­cine, the Inter­na­tional Cannabi­noid Research Soci­ety and the Amer­i­can Telemed­i­cine Asso­ci­a­tion. What is your cur­rent prac­tice? I am a board-certified pain-medicine physi­cian and owner of Hawaiian-Pacific Pain and Pal­lia­tive Care ( med​ical​mar​i​jua​naofhawaii​.org ).  The focus of my prac­tice is the care of patients with chronic pain.  In addi­tion, I have a strong inter­est in hos­pice and end-of-life care.  This prac­tice is done on a vol­un­tary basis and is based in Waimanalo at the Native Hawai­ian Model Agri­cul­tural Vil­lage called Pu’uhonua O Waimanalo.  Nearly all fees gen­er­ated by the advo­cacy and clin­i­cal prac­tice for med­ical cannabis ther­a­pies are used for expenses and Native Hawai­ian pro­grams. Malama First Health­care is a non­profit ini­tia­tive based in the vil­lage, and its goals are to improve the health care of Native Hawai­ians world­wide.  I serve as their chief med­ical offi­cer on a vol­un­tary basis. How long have you been an advo­cate for med­ical mar­i­juana? I have been an advo­cate for the use of med­ical cannabis since 2008, when I was first exposed to a group of chronic pain patients on the Big Island who were using cannabis as their sole pain med­ica­tion, or some­times in com­bi­na­tion with pain pills. Hav­ing no per­sonal expe­ri­ence with mar­i­juana use, I found it quite fas­ci­nat­ing that so many peo­ple found ben­e­fit and relief to their chronic pain con­di­tions using cannabis. From there, my pro­fes­sional opin­ion evolved to the point of full polit­i­cal and med­ical advo­cacy. My for­mal train­ing taught me that mar­i­juana was a gate­way drug and had no med­ical use, which I have since learned to be com­pletely false.  Dur­ing my train­ing, patients using cannabis often were denied opi­oid ther­a­pies and viewed as drug seek­ers and addicts. Dur­ing my train­ing, no one explained to me how cannabis helped with pain, except one young man who suf­fered a severe neck injury in the Indone­sia tsunami. Our addic­tion psy­chi­a­trists were forc­ing him to quit the use of cannabis before the group would pre­scribe opi­oids.  Thank­fully, this is an out-of-date notion. These restric­tions should never be forced upon any patients who suf­fer severe, dis­abling pain.  As I inter­viewed more peo­ple, I became more con­vinced of the use­ful­ness of med­ical cannabis. I thought to myself that thou­sands of Hawaii res­i­dents can’t be wrong. Patients were find­ing sig­nif­i­cant relief from chronic pain con­di­tions and syn­dromes that oth­er­wise have poor or no effec­tive treat­ments. I then set off on an exten­sive endeavor to under­stand the med­ical sci­ence of cannabis, cannabi­noid recep­tors, cannabi­noid phys­i­ol­ogy and cannabi­noid ther­a­pies. At first I was shocked by the sup­pres­sion of these safe and effec­tive ther­a­pies because of irra­tional prej­u­dices and polit­i­cal machi­na­tions.  This was fol­lowed by pro­fes­sional and polit­i­cal dis­dain at gov­ern­ment, politi­cians, enti­ties and cor­po­ra­tions with ulte­rior motives who are will­fully caus­ing mil­lions of peo­ple to endure greater suf­fer­ing because of their direct inter­fer­ence in the prac­tice of med­i­cine and med­ical research, and their sup­pres­sion and denial of these ther­a­pies.  Thank­fully, the Hawaii State Leg­is­la­ture took a bold stand more than a decade ago, in the face of great polit­i­cal pres­sure, which still exists, and allowed for legal use by chron­i­cally ill and dis­abled peo­ple. Chronic pain is the No.  1 med­ical con­di­tion in the United States, with an esti­mated 75 mil­lion to 100 mil­lion Amer­i­cans liv­ing with it.  At least 20 mil­lion to 25 mil­lion Amer­i­cans live with severe pain.  In Hawaii, it is con­ser­v­a­tively esti­mated that more than 100,000 live with mod­er­ate to severe pain from all causes, includ­ing arthritic degen­er­a­tion, trauma, meta­bolic con­di­tions such as dia­betes, and can­cer or its treat­ment. Where do things stand right now in the leg­isla­tive arena? This year, two bills out of many were vet­ted in com­mit­tee and passed by both the Hawaii State Sen­ate and House of Rep­re­sen­ta­tives and are expected to be signed by Gov.  Aber­crom­bie.  The first and most impor­tant bill calls for the trans­fer of the med­ical cannabis pro­gram to the Depart­ment of Health.  Patients and physi­cians have requested this trans­fer for many years. It is more appro­pri­ate that a pro­gram for the health and med­ical wel­fare of patients be under the aus­pices of a health depart­ment and not law enforce­ment.  The sec­ond bill attempts to improve sig­nif­i­cant short­com­ings in the pro­gram itself.  Safe access is our No.  1problem and con­cern. The state allows for the use of cannabis as a med­i­cine but does not allow the access to a safe source of that med­i­cine. From a med­ical point of view this is uncon­scionable.  You would not make a dia­betic grow and pro­duce their own insulin or dia­betes pills. Cur­rently, patients must obtain seeds, grow the plants, over­come the hos­til­i­ties of grow­ing by mold and bugs and then develop the yield that becomes their med­i­cine. The major­ity of patients are not in a posi­tion to even get started. They don’t know how to grow.  They don’t feel well enough to grow.  They don’t have a place to grow.  And there’s no guar­an­tee that these efforts will result in an ade­quate med­ica­tion sup­ply. The use of cannabis is not an alter­na­tive to the use of tra­di­tional med­ica­tions it is a unique med­ica­tion with unique med­ical effects. It is not replace­able with any­thing else in exis­tence. Imme­di­ate access can only be solved by a dis­pen­sary or retail out­let. A state-run sys­tem would be ideal.  The other main issue is the fail­ure to increase the qual­i­fy­ing diag­noses list, since cannabi­noid ther­apy is uniquely help­ful to a myr­iad of con­di­tions.  A large pro­por­tion of Hawaii’s cannabis users do it for med­ical pur­poses, but the law does not respect that and allow them to be legal because they are using it for con­di­tions not allowed by law.  Our com­bat sol­diers are denied its legal use for PTSD after a decade of mul­ti­ple deploy­ments to war zones, and are thereby denied an effec­tive and safe treat­ment for this difficult-to-treat con­di­tion.  Cannabis is supe­rior to all other modal­i­ties in exis­tence such as anti-depressants and anti-psychotics, which have ques­tion­able effec­tive­ness and many adverse side effects. How effec­tive is med­ical mar­i­juana com­pared with other painkillers? At the most recent meet­ing of the Amer­i­can Acad­emy of Pain Med­i­cine, Dr.  M.  Moskowitz stated that “pre­clin­i­cal stud­ies, sur­veys, case stud­ies and ran­dom­ized double-blind placebo-controlled tri­als with cannabis have all shown its effec­tive­ness in chronic pain con­di­tions .  Cannabis works to set­tle down the pro­cess­ing of wind-up ( or expanded pain pro­cess­ing in the brain ) and is the only drug known to do so.  It reduces inflam­ma­tory pain in the periph­eral nerves, and has a unique mech­a­nism for pain reduc­tion unlike any other med­i­cine.” Stud­ies have shown that med­ical cannabis is as effec­tive as opi­oid ther­a­pies.  By using med­ical cannabis, many peo­ple are able to com­pletely elim­i­nate or sig­nif­i­cantly reduce their use of opi­oid pain pills.  This elim­i­nates or sig­nif­i­cantly reduces the numer­ous adverse side effects that opi­oids inflict. The major med­ical ben­e­fit to the with­drawal of opi­oids is the removal of phys­i­cal depen­dency.  Most impor­tantly, the mor­tal safety of a patient on an opi­oid reg­i­men is dra­mat­i­cally improved with the addi­tion of med­ical cannabis and a reduc­tion in opi­oid dosage. Every day, Amer­i­cans are dying from the mis­use and over­dos­ing of opi­oid med­ica­tions.  There is an epi­demic of pre­scribed opi­oid pill diver­sions, which can lead to death or ongo­ing drug addic­tion. The use of cannabis in chronic pain also reduces the num­ber of other types of med­ica­tions needed for coex­ist­ing sleep and mood dis­or­ders, and myofas­cial spasms ( within tis­sue sur­round­ing the mus­cles ) found in nearly all chronic pain patients. There are no other sin­gle med­ica­tions in exis­tence that can treat all of these coex­ist­ing prob­lems in addi­tion to treat­ing the pain.  The removal of these other med­ica­tions also removes their inher­ent adverse side effects and any med­ica­tions needed for adverse side effects, such as drowsi­ness, con­sti­pa­tion or nau­sea. Any­thing you would like to add? Med­ical cannabis is an effec­tive and safe ther­apy that should not be denied to any human being. Gov­ern­ment poli­cies are directly inter­fer­ing with med­ical sci­ence and research, along with clin­i­cal care. The pro­hi­bi­tion of safe access is an ongo­ing major prob­lem for patients in Hawaii and needs to be cor­rected by dynamic and outside-the-box think­ing. There are solu­tions to these issues. The con­cerns of cannabis habit­u­a­tion, depen­dency and addic­tion, along with recre­ational or mis­use in young peo­ple, are not valid rea­sons for the denial and sup­pres­sion of these ther­a­pies for legit­i­mate patients; oth­er­wise, no con­trolled sub­stances would be allowed in clin­i­cal prac­tice. I hear com­pelling, life-changing sto­ries from patients almost daily.  Just today, a mother expressed her grat­i­tude to us for help­ing her son, who was prac­ti­cally bedrid­den for two years, get his life back.  She cried when he tried cannabis and was able to get up and out of bed and start run­ning around. These are not iso­lated and rare occur­rences. The addi­tion of med­ical cannabis as a replace­ment or adju­vant med­ica­tion to the chronic pain patient’s med­ica­tion reg­i­men will greatly improve patient well-being and care, and pro­vide increased patient safety. Source: Mid­Week (HI) Col­umn: Doc­tor in the House Copy­right: 2013 RFD Pub­li­ca­tions, Inc. Con­tact: kberry@​midweek.​com Web­site: http://​www​.mid​week​.com/ Author: Rasa Fournier

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Med­ical Cannabis: Safe, Effective

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