Author: Fred Gardner

Protected: Letter to a Chief Probation Officer

By Philip A. Denney, MD I have recently had a number of requests for information about my patients who use medicinal cannabis while under court supervision. My discussions with your deputy probation officers reveal a great deal of confusion and misunderstanding about this issue. As you know, a majority of California voters approved the Compassionate Use Act in November 1996 which became codified as Health and Safety code 11362.5. The Act allows the use of cannabis as medicine “upon the written or oral recommendation or approval of a physician.” The use of medicinal cannabis has been addressed by the California Supreme Court in People v. Mower (2002), and its use while under court supervision has been addressed by the California Appellate Courts in People v. Tilehkooh (2003) and People v. Spark (2004). The Mower Court stated “as a result of the enactment of section 11362.5(d), the possession and cultivation of marijuana is no more criminal —so long as its conditions are satisfied— than the possession and acquisition of any prescription drug…” In Tilehkooh, the Court held that a trial court erred in refusing to allow a defendant to present a compassionate-use defense at a probation revocation hearing where one of the trial court’s reasons for finding the defense inapplicable was that the defendant was not ‘seriously’ ill.’” Lastly, the Spark court found “the question of whether the medical use...

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FDA Approval as a Botanical

By an FDA Consultant (O’S Spring 2005) I’ve never heard anyone at a drug company or FDA talk about medical marijuana, but there’s a lot of useful experience with other botanicals. The first step in qualifying a product for medicinal purposes, here or in any other developed country, is to have a well-defined product, and this is where most botanicals have difficulty. Even a botanical with a strong claim for homogeneity (e.g., one made in huge, well-mixed batches, with some sort of convincing standards to control batch-to-batch variation) would be suspect; it must contain many chemical species, and it’s...

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Reduced Use of Pharmaceuticals —a Recurring Theme

By Jeffrey Hergenrather, MD Despite the many advances in medical science in elucidating the causes and treatments for many diseases there remain many conditions that fall into the category of “etiology unknown.” For these, physicians continue to offer the best treatments that are available to alleviate the pain and suffering where there is little hope for cure. In many cases the conventional treatments are as problematic as the diseases themselves. Patients who have chosen cannabis as an alternative treatment for these conditions often confide to cannabis specialists that they have been able to quit or reduce their use of pharmaceutical drugs. It is a recurring theme, and a significant one. Brief reports on two such cases follow. Systemic lupus erythematosus Patient AG is a 34-year-old woman who has had systemic lupus for over 10 years. Her lab findings include positive ANA, positive RNP antibody, positive platelet antibodies, and hypocomp-lementemia. Her abnormalities include low grade fevers, fatigue, arthritis, arthralgias, cutaneous manifestations, persistent leukopenia and thrombocytopenia. Evaluation and treatment by two rheumatologists resulted in the repeated advice to use immunosuppressive drugs including Plaquenil and prednisone to modify her immune system disease. She did this for many years with multiple adverse effects. Subsequently, she discovered the medicinal use of cannabis, initially for pain control and depression, then later as an immune system modulating medication. Over the past two years she has discontinued...

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Protected: Conditions Treatable With Cannabis

The historic medical marijuana initiative passed by California voters in 1996 authorizes physicians to approve the use of cannabis  “in the treatment of cancer, anorexia, AIDS, chronic pain, spasticity, glaucoma, arthritis, migraine, or any other illness for which marijuana provides relief.” Californians’ understanding that cannabis is a remarkably versatile medicine has been confirmed in recent years by researchers throughout the world. GW Pharmaceuticals, the British company that is developing cannabis-plant extracts to be marketed by Bayer, identifies the following conditions as likely targets for its products. Which conditions treatable spring...

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Three Consecutive Patients

Three Consecutive Patients in a Therapeutic Cannabis Medical Practice By Philip A. Denney, MD R.C., a 53-year-old insurance attorney, sustained a cervical spine fracture at C-4 and C-5 in a surfing accident in a surfing accident in 1991. The injury required surgical fusion with bone grafting and internal fixation, resulting in chronic pain. He has used cannabis successfully for pain mangement over the last eight years at a stable dose of 1/4 ounce per week. He weaned himself completely from narcotics and benzodiapenes (Valium). “That stuff was killing me.” He denies any adverse effects of cannabis use. Comment: This is a very typical patient in my practice. Chronic pain is the presenting complaint for as many as 1/2 my patients. -PAD B.M., a 20-year-old student, presents with a diagnosis of Crohn’s Disease discovered at age 15. He gives a history of chronic abdominal pain, severe weight loss and rectal bleeding, poorly controlled with multiple medications. He was introduced to cannabis by another Crohn’s Disease patient two years ago and noted immediate improvement. He has had significant weight gain, marked reduction in abdominal symptoms including rectal bleeding and has had no hospitalizations since beginning therapeutic cannabis. He uses 1/2 ounce per week and has stopped all pain medications. He continues to use Asacol to treat his underlying disease. Comment: Chronic gastrointestinal diseases, particularly those with painful cramping, nausea or anorexia,...

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Protected: Lucido & Mangini

Implementation of the Compassionate Use Act In a Family Medical Practice: Seven Years’ Clinical Experience By Frank H. Lucido, MD, with Mariavittoria Mangini, PhD, FNP Clinical medicine, as I have experienced it during a quarter century of practice, is a constantly evolving system. Every practitioner has a different approach to gathering clinical information, diagnostic reasoning and therapeutic decision making. There is rarely a single correct way to care for patients. Instead, there is usually a wide variety of acceptable approaches, any of which may be appropriate in a given situation1. (Goldberg, 2002b). Particularly for the student, but also for...

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Cannabis Specialists Agree on Health History Questionnaire

From O’Shaughnessy’s Spring 2004 Drs. Jeff Hergenrather, Tod Mikuriya and Frank Lucido of the California Cannabis Research Medical Group have developed a questionnaire for patients that elicits extensive information about cannabis use.  The three physicians have submitted an abstract to the International Cannabinoid Research Society and hope to make a presentation at the ICRS meeting to be held this summer in Naples, Italy.  Here is the abstract, as drafted by Hergenrather. [“ICD” stands for “International Classification of Disease.”] Pre-1937 citations in the medical literature for cannabis treated conditions include 28 codeable diagnoses among them chronic pain, neurodegenerative diseases, seizure...

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Cannabis in the Curriculum (USC Keck School of Medicine Takes the Lead)

By Fred Gardner —O’Shaughnessy’s Spring 2004 “Any pain-management training that does not have information about cannabis is committing malpractice.”  —Claudia Jensen, MD On Feb. 13 students and faculty from the University of Southern California Keck School of Medicine put on a half-day program devoted to the clinical uses of cannabis and the relevant pharmacology. Some 30 first- and second-year medical students attended the history-making event in McKibben Hall, which was organized by Rolando Tringale, a second-year medical student, and Claudia Jensen, MD, a Ventura pediatrician who is an Instructor in the Department of Family Medicine. Jensen teaches “Introduction to...

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Denney and Sullivan Lift the Orange County Curtain

By Fred Gardner —O’Shaughnessy’s Spring 2004 Since November 1996, California law has authorized physicians to recommend cannabis in the treatment of a wide range of serious medical conditions. As of Spring 2004, by O’Shaughnessy’s’s estimate, at least 100,000 patients have obtained physician approvals to do so. We extrapolated from the number of Oregonians —more than 10,000— who had obtained physician approval as of Jan. 1, 2004.  (The state of Oregon maintains a registry of medical marijuana users and physicians who authorize its use; California does not.) Twelve doctors associated with the California Cannabis Research Medical Group—all but one from the northern part of the state— have issued approximately half of those approval letters. Proprietors of dispensaries in Oakland and San Francisco report a marked increase in approvals issued by non-CCRMG doctors following a recent  decision by the U.S. Supreme Court in the Conant v. Walters case. Philip A. Denney, MD, calls the Conant decision “a key factor” in his decision to open an office in Orange County. The background In December 1996 Drug Czar Barry McCaffrey and other federal officials threatened to revoke the prescription-writing licenses of California doctors who discuss cannabis as a treatment option with their patients. UCSF AIDS specialist Marcus Conant, MD, and co-plaintiffs immediately sought an injunction to prevent the government from carrying out the threat. “The war on drugs has become the war on physicians,” ...

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