Apparently people are having complicated and heated discussions regarding how much marijuana a medical marijuana patient should be allowed to possess.
I find it difficult to get very interested in that debate, although I understand that it’s important for the patients.
Here’s what I do think, however.
- Law enforcement does not have a dog in this race. The patient can have a valid opinion. So can the doctor. But not the cop.
- It seems to me that the amount that a patient is allowed to have should be at least the amount that the patient needs. Since that varies for each patient, there should be no set limit.
- If you really have to set a limit, then I’d decide it based on safety and place it just under the amount that would cause a fatal overdose*. That way, you wouldn’t have to worry about anyone getting hurt.
Best wishes for Ted Kennedy and his family.
In response to recent questions from The Chronicle about medical marijuana, Obama’s campaign – the only one of the three contenders to reply – endorsed a hands-off federal policy.
“Voters and legislators in the states – from California to Nevada to Maine – have decided to provide their residents suffering from chronic diseases and serious illnesses like AIDS and cancer with medical marijuana to relieve their pain and suffering,” said campaign spokesman Ben LaBolt.
“Obama supports the rights of states and local governments to make this choice – though he believes medical marijuana should be subject to (U.S. Food and Drug Administration) regulation like other drugs,” LaBolt said. He said the FDA should consider how marijuana is regulated under federal law, while leaving states free to chart their own course
LaBolt also said Obama would end U.S. Drug Enforcement Administration raids on medical marijuana suppliers in states with their own laws.
Abstract: We found marijuana addicts showed a varied profile of dangerous and potentially lethal withdrawal symptoms. 82% of them went from being psychologically healthy to showing clear clinical signs of anxiety, depression, post traumatic stress, or obsessive compulsive disorder. These varied psychological withdrawal effects were less responsive to conventional treatment. Patients whose marijuana addiction was concurrent with cancer additionally suffered nausea, vomiting, an increase in pain sensitivity, increased growth rates of tumors and increased morbidity. Marijuana addicted AIDS patients showed a severe reaction that included nausea, vomiting, loss of appetite, wasting, and an inability to comply with medication regimes, which was worse than heroin withdrawal. In addition, marijuana withdrawal caused more subtle effects on music perception and brain function, with many of the musicians and music lovers moving from various abstract, creative genres, to smooth jazz and pop-country, and a decreased tendency to notice and ability to play polyrhythmic music. These withdrawal effects clearly and conclusively show the dangers of marijuana, and demonstrate a particular concern for marijuana in cancer and AIDS patients.
If you are feeling severely depressed, consider a dose of Aurum metallicum, 30C.
NTodd is wicked smart.
At potencies above 12C, no atoms of the original substance remain. At 30C, yet there is potency.
Hypothesis: A psychedelic remedy with physical effects caused by psychosomatic transference.
Thanks to whoever it was that sent this article to me.
Dosing Medical Marijuana: Rational Guidelines on Trial in Washington State
Sunil K. Aggarwal, MS III, PhC, BS, BA; Muraco Kyashna-Tocha, PhD; Gregory T. Carter, MD, MS
The medicinal value of cannabis is well documented in the medical literature.[1,2] Cannabinoids, the active ingredients, are found in the resin-producing pistillate inflorescences of the Cannabis sativa plant. Since the early 1900s, cannabis has been referred to as mari(h/j)uana, a pejorative term derived from Mexican Spanish-Portuguese colloquial slang. Cannabinoids have many distinct pharmacologic properties. These include analgesic, antiemetic, antioxidative, neuroprotective, and anti-inflammatory activity, as well as modulation of glial cells and tumor growth regulation. We now know that there is an endogenous molecular signaling system in our bodies that is run by cannabinoids. The discovery of this endogenous cannabinoid system with specific receptors and ligands has led to the progression of our understanding of the therapeutic actions of cannabis from folklore to valid science. It now appears that the cannabinoid system evolved with our species and is intricately involved in normal human physiology, specifically in the control of movement, pain, appetite, memory, immunity, and inflammation, among others. The detection of widespread cannabinoid receptors in the brain and peripheral tissues suggests that the cannabinoid system represents a previously unrecognized, ubiquitous network in the nervous system. On that basis, exogenous cannabinoids appear to have tremendous potential in treating neurodegenerative disorders.[5,6] For example, in amyotrophic lateral sclerosis (ALS), there is animal model evidence that exogenous cannabinoids have disease-modifying potential.[7-12] Further, in a large survey, ALS patients reported that marijuana relieved the major symptoms of the disease better than prescription medications. The most common reason cited by ALS patients for not considering using cannabis to treat their symptoms was lack of access.
Dense cannabinoid receptor concentrations have been found in the cerebellum, basal ganglia, and hippocampus, accounting for the effects of cannabis on motor tone, coordination, and mood state. Low concentrations are found in the brainstem, accounting for the remarkably low toxicity of cannabis. Of note, lethal doses for cannabis in humans have not been described. So far, we know of at least 2 molecular receptor proteins (CB1 and CB2) and 2 endogenously produced lipid cannabinoids (anandamide and 2-acylglycerol) found in numerous tissues throughout the body, including neural and immune tissues, which comprise the endogenous cannabinoid system.[1,3,4] The cannabinoid system helps regulate the function of other systems in the body, making it an integral part of the central homeostatic modulatory system — the check-and-balance molecular signaling network in our bodies that keeps us at a healthy “98.6.” Despite all of the advances in understanding the physiology and pharmacology of cannabis and cannabinoids, there remains a strong need for developing rational guidelines for dosing cannabis. We (Gregory T. Carter [GTC] and Muraco Kyashna-Tocha [MKT]) have previously attempted to address this issue, deriving a dosing scheme with the available known chemistry and pharmacology of cannabis. However, it would appear that there is still considerable controversy over this issue. Read the rest of this entry »
MANCHESTER, NEW HAMPSHIRE — In his first public statement on the subject, Democratic presidential candidate Barack Obama pledged to end medical marijuana raids in the 12 states that have medical marijuana laws Tuesday at a campaign event during a Nashua Pride minor league baseball game.
The Illinois senator’s statement means all eight Democratic candidates have now voiced support for the 12 states with medical marijuana laws. Republican candidates Rep. Ron Paul (Texas), Rep. Tom Tancredo (Colo.) and former Wisconsin Gov. Tommy Thompson have all vowed to end medical marijuana raids as well.
On Friday, New Mexico Gov. Bill Richardson, who signed legislation in April making his the 12th medical marijuana state, wrote to President Bush asking him to end federal raids in medical marijuana states.
“Respected physicians and government officials should not fear going to jail for acting compassionately and caring for our most vulnerable citizens,” Richardson wrote. “Nor should those most vulnerable of citizens fear their government because they take the medicine they need.”
Obama’s pledge came as a response to a question from Nashua resident and Granite Staters for Medical Marijuana volunteer Scott Turner, who asked the senator what he would do to stop the federal government from putting seriously ill people like Turner in prison in states where medical marijuana is legal.
“I would not have the Justice Department prosecuting and raiding medical marijuana users,” Obama said. “It’s not a good use of our resources.”
“For the first time in history, the leaders of one of our nation’s major parties have unanimously called for an end to the federal prosecution of medical marijuana patients,” GSMM campaign manager Stuart Cooper, from Manchester, said. “New Hampshire voters and medical professionals effectively sent a clear message that we would not support a candidate who would arrest – rather than protect – our nation’s most seriously ill citizens. Compassion and reason are finally overcoming politics and propaganda.”
Federal intrusion into medical marijuana states has been on the rise this summer, with DEA raids taking place in several counties in California and Oregon. Recently, the DEA also began threatening landlords who lease space to medical marijuana dispensaries – legal under state law – with seizure of their property, a move condemned in a Los Angeles Times editorial as “a deplorable new bullying tactic.”
Based in Manchester, New Hampshire, Granite Staters for Medical Marijuana is a grassroots coalition of New Hampshire patients, medical professionals and activists. GSMM is organizing during the New Hampshire presidential primary campaign to raise awareness of the need for federal action to protect medical marijuana patients. For further information, please see: http://www.GraniteStaters.com
Hey, contact lens wearers, according to a CDC survey, more than half of you have no clue that Advanced Medical Optics recalled their Complete MoisturePlus lens cleaner. The multipurpose solution fails to protect users from an amoeba that can cause acanthamoeba keratitis. Over 25% of users who contracted the infection required a corneal transplant, and if that doesn’t scare you, consider this quote from the CDC:
“This is just as serious as the fusarium outbreak,” said Lola Russell, a spokeswoman for the Centers for Disease Control and Prevention, referring to an outbreak of fungal eye infections last year that was linked to Bausch & Lomb’s ReNu with MoistureLoc lens cleaners.
I like Barack Obama, and I wish he would agree with his colleagues Hillary Clinton and John Edwards that the federal raids on California medical marijuana providers, dispensaries and patients must end.
Hat-tip Corpus Juris @ Watching Those We Chose for the video.
Recipe edited July 21, 2007. This originally called for twice as much cassia, but I found it to be excessive. Black pepper is a very good addition with turmeric.
1 tsp turmeric powder
1/4 tsp cassia powder
twist of black pepper
1 tsp raw honey
8 oz cool water
Stir and enjoy.
A California judge is likely to order a Berkeley city initiative back on the ballot because of local officials’ mishandling of electronic voting machine data, a public-interest lawyer arguing the case said Friday.
In a preliminary ruling Thursday, Judge Winifred Smith of the Alameda County Superior Court indicated she would nullify the defeat of a medical marijuana proposal in Berkeley in 2004 and order the measure put back on the ballot in a later election. A hearing on Friday morning in advance of a final ruling brought out nothing that indicated Smith would deviate from her preliminary decision, said attorney Gregory Luke, who is representing Americans for Safe Access. The medical-marijuana advocacy group is suing the county, assisted by the technology rights group Electronic Frontier Foundation.
The case points to the dangers of electronic voting systems, which make it harder to ensure fair elections, Luke said. Electronic voting machines have been widely adopted in the U.S. since the disputed presidential election of 2000. Laws in California and some other states now require paper records of all votes, but the California law wasn’t in place for the Berkeley election.
WASHINGTON, D.C. — With a vote on medical marijuana looming in the U.S. House of Representatives, the Leukemia and Lymphoma Society has adopted a formal policy position calling for removal of criminal and civil penalties for seriously ill patients using marijuana with their doctor’s recommendation. The Leukemia and Lymphoma Society is the second largest cancer charity in the U.S., and the world’s largest voluntary health organization dedicated to funding blood cancer research, education and patient services.
New York, NY: Inhaling cannabis significantly increases daily caloric intake and body weight in HIV-positive patients, is well tolerated, and does not impair subjects’ cognitive performance, according to clinical trial data to be published in the Journal of Acquired Immune Deficiency Syndromes (JAIDS).
Investigators at Columbia University in New York assessed the efficacy of inhaled cannabis and oral THC (Marinol) in a group of ten HIV-positive patients in a double-blind, placebo-controlled trial. All of the subjects participating in the study had prior experience using marijuana therapeutically and were taking at least two antiretroviral medications.
Researchers reported that smoking cannabis (2.0 or 3.9 percent THC) four times daily “produced substantial … increases in food intake … with little evidence of discomfort and no impairment of cognitive performance.”
On average, patients who smoked higher-grade cannabis (3.9 percent) increased their body weight by 1.1 kg over a four-day period. Researchers reported that inhaling cannabis increased the number of times subjects ate during the study, but did not alter the average number of calories consumed during each meal.
Investigators said that the administration of oral THC produced similar weight gains in patients, but only at doses that were “eight times current recommendations.” The US Food and Drug Administration approved the prescription use of Marinol (a gelatin capsule containing synthetic THC in sesame oil) to treat HIV/AIDS-related cachexia in 1992.
Subjects in the study reported feeling intoxicated after using either cannabis or oral THC, but remarked that these effects were “positive” and “well tolerated.”
Although not a primary outcome measure of the trial, authors reported that patients made far fewer requests for over-the-counter medications while taking either cannabis or oral THC than they did when administered placebo. Most of these requests were to treat patients’ gastrointestinal complaints (nausea, diarrhea, and upset stomach), investigators said.
Patients in the study also reported that smoking higher-strength marijuana subjectively improved their sleep better than oral THC.
“The data demonstrate that over four days of administration, smoked marijuana and oral [THC] produced a similar range of positive effects: increasing food intake and body weight and producing a ‘good [drug] effect’ without producing uncomfortable levels of intoxication or impairing cognitive function,” authors wrote.
They added, “Smoked marijuana … has a clear medical benefit in HIV-positive [subjects] by increasing food intake and improving mood and objective and subjective sleep measures.”
A previous preliminary trial by Columbia investigators published in the journal Psychopharmacology in 2005 also reported that inhaling cannabis “produce[s] substantial … increases in food intake [in HIV+ positive patients] without producing adverse effects.”
Survey data indicates that an estimated one out of three HIV/AIDS patients in North America use cannabis therapeutically to combat symptoms of the disease or the side-effects of antiretroviral medications.
Clinical trial data published in the Annals of Internal Medicine in 2003 reported that cannabis use by HIV patients is associated with increased CD4/T-cell counts compared to non-users. A separate study published in JAIDS in 2005 found that HIV/AIDS patients who report using medical marijuana are 3.3 times more likely to adhere to their antiretroviral therapy regimens than non-cannabis users.
Most recently, investigators at San Francisco General Hospital and the University of California’s Pain Clinical Research Center reported this year in the journal Neurology that inhaling cannabis significantly reduced HIV-associated neuropathy (nerve pain) compared to placebo.
The Columbia University study is one of the first US-led clinical trials to evaluate the efficacy of smoked cannabis to take place in nearly two decades, and it is the first to compare the tolerability and efficacy of smoked marijuana and oral THC in HIV patients.
Planet X, if you count Pluto. And she has a moon.
Hat-tip Doug Stych, who has a number of interesting stories to report, as he often does.
Video by Demetrius, Renee’s husband (in Ohio).
In November 2004 the American Psychiatric Association (APA) published Practice Guidelines for the treatment of PTSD (1). The three psychotherapeutic interventions recommended for established PTSD are:
Although the APA endorses the above therapies in their Practice Guidelines, it is noteworthy that they also imply the need for research into more effective treatment techniques, with their statement that “there is a paucity of high-quality evidence-based studies of interventions for patients with treatment-resistant PTSD….” (1). The APA practice guidelines state that the goals of PTSD treatment “include reducing the severity of … symptoms…(by) improving adaptive functioning and restoring a psychological sense of safety and trust, limiting the generalization of the danger experienced as a result of the traumatic situation(s) and protecting against relapse.” It goes on to say that “…factors that may need to be addressed in patients who are not responding to treatment include problems in the therapeutic alliance; the presence of psychosocial or environmental difficulties; the effect of earlier life experiences such as childhood abuse or previous trauma exposures…” (1) Despite significant differences between these types of therapy, including MDMA-assisted therapy, they all share some important theoretical underpinnings. Moreover, some of the therapeutic experiences that occur with any of these approaches are very similar. This is not surprising, since each approach, in its particular way, is stimulating universal, innate healing mechanisms. For instance, the nondirective approach of MDMA-assisted therapy often leads to the spontaneous occurrence of many of the kinds of experiences that are more directly elicited and thought to be therapeutically important in these other approaches. As noted previously in this treatment manual, the therapists’ role is first to prepare participants for this likelihood by encouraging a non-controlling and open attitude toward experiences that arise and then to support the unfolding and the subsequent integration of these experiences. MDMA can act as an important catalyst to this process.
Table 1 briefly compares the major therapeutic approaches for treating PTSD, including the therapeutic elements discussed in the APA guidelines, in Dr. Edna Foa’s excellent manual of cognitive-behavioral therapy for PTSD (2), and in the protocol outlined in this treatment manual.
|Therapeutic Element||Cognitive Behavioral Therapy||EMDR||Psychodynamic Psychotherapy||MDMA-Assisted Psychotherapy|
|Prolonged exposure (either in vivo exposure or trauma reliving in therapy)||For in vivo exposure, develop a hierarchy list of situations, and assign specific homework involving exposure to these situations. For imaginal exposure, ask the patient to describe the trauma in detail in the present tense. This is done repeatedly over a number of visits.||A target image related to the trauma is used as a starting point, with a non−directive approach to what follows. Patient is encouraged to “let whatever happens happen.” Discussions with the therapist are intermittent.||The traumatic events are discussed, but the specific approach of prolonged exposure is not included. (In practice psychodynamic psychotherapy and cognitive behavioral therapy are often combined.)||Non−directive approach to the way trauma comes up and is processed, with encouragement to stay present rather than distracting from difficult memories and emotions. Discussions with the therapists are intermittent. (Note that a contract is made before the session that if the trauma does not come up spontaneously the therapist will bring it up, but thus far trauma has always come up spontaneously; in effect, prolonged exposure happens spontaneously.|
|Cognitive restructuring||− Identify “negative thoughts and beliefs/cognitive distortions. − Challenge them using Socratic method. − Modify them by arriving at rational response.||Cognitive restructuring often occurs spontaneously and may be catalyzed by therapist’s adding “cognitive interweave,” if needed.||Focus on the “meaning of the trauma for the individual in terms of prior psychological conflicts and developmental experience and relationships…” (1)||Cognitive restructuring often occurs spontaneously, with minimal therapist intervention in this regard. Elements of both cognitive-behavioral and psychodynamic approaches may be used in follow-up integration sessions, but always in response to the way the experience is continuing to develop for the subject rather than according to a predetermined structure.|
|Anxiety management training (AMT), including stress inoculation training (SIT)||Relaxation skills are often taught at outset of treatment, such as breathing exercises, deep muscle relaxation, imagery.||EMDR protocol includes establishing an effective relaxation method at outset — often guided visualization.||Not a specific element of psychodynamic therapy, but clinically is often combined.||Subjects are taught relaxation, often using diaphragmatic breathing.|
|Increased awareness of positive experiences, including present safety||May be part of cognitive restructuring, or may occur spontaneously after prolonged exposure.||Often occurs spontaneously, most often toward end of session.||May occur as a result of examining present and past relationships and experiences. Typically happens later in therapy.||Usually occurs spontaneously, often early in the first MDMA session. May provide a sense of safety and well-being that provide a platform for deeper processing of painful experiences later in the session or in a subsequent session.|
|Clearing of tension in body and other somatic symptoms||Therapist directs attention to the body.||Therapist directs attention to the body.||Not generally considered as part of psychodynamic psychotherapy.||Mentioned in preparatory sessions and treated as an important therapeutic component that may be inadequately addressed in usual talking therapies. MDMA-assisted psychotherapy tends to bring this somatic component to awareness and allows for its release, often spontaneously and sometimes by: the therapist directing attention to body symptoms (as is done in Dr. Foa’s examples of imaginal exposure p.167), or by using the kind of focused body work described in Appendix B.|
|Transference and countertransference issues||Not a focus, but therapists should be aware of them.||Not a focus, but therapists should be aware of them.||Interpretation of transference may be important part of the intervention.||Not a focus, but therapists should be aware of them and the fact that they can be heightened in non-ordinary states such as that induced by MDMA. Should be addressed openly and honestly and inquired about if there seems to be a significant unspoken dynamic. Therapists are self disclosing and collaborative. Transference is addressed early rather than letting it build, as can happen in psychodynamic therapy.|
|Difficulties with therapeutic alliance − a possible obstacle to successful treatment||Time and attention are given to developing alliance, with some limitations in time- limited therapeutic protocols (Dr. Foa recommends 9 sessions with the possibility of 3 more and mentions that, “there is a point of diminishing returns” with patients who have not responded to that course of treatment.)||Time and attention are given to developing alliance.||Time and attention are given to developing alliance.||Time and attention to are given to developing alliance. Both the set and setting of the treatment model and the effects of MDMA promote a sense of trust and therefore development of a therapeutic alliance in a relatively short time.|
|“The effect of earlier life experiences such as childhood abuse or previous trauma exposures…” (1) as complicating factors that may cause treatment resistance||May be addressed in cognitive restructuring.||May come up spontaneously in EMDR sessions.||Discussing this may be a focus of psychodynamic psychotherapy.||Early experience of abuse or lack of support often comes up spontaneously in MDMA sessions, typically with insight about connections between this early experience and PTSD. This insight and the concomitant emotional connection and processing often occur with little or no intervention from the therapists.|