Tantamount to Freedom

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Tantamount to Freedom

© Michelle Sexton ND 2013

Thus far in my lifetime, I have become involved in two different movements that I realized have several common threads.  The first movement for me was the becoming a midwife and participating in homebirth. This “becoming” was partially as a result of my own hospital surgical birth and the desire to be more self-empowered, and partially to help other women realize the same.  (Later it had nothing to do with this for me, but was solely about nonviolence for the new arrivals!)The second movement was natural health and herbal medicine (which has gone hand-in-hand with homebirth) and subsequently led me to become a naturopathic doctor and researcher of Cannabis as medicine.  One thing common to both of these interests is that they used to be considered “hippy”, counterculture phenomenon and today they have both become more mainstream.  And in the end, both of these choices are tantamount to freedom!  

Here are what I see to be a few elemental similarities between homebirth and Cannabis as medicine:

1) Affordability- there is a relative lowcost for both homebirth and Cannabis as medicine compared to hopsital/pharmaceuticals and this applies whether or not one has access to healthcare insurance. 

2) Risk/benefit ratio- there is a relative measure of safety at a homebirth that is due to the lace of hospital intervention.  Likewise, there can be a risk reduction when discountinuing a number of pharmaceutical drugs in favor of using Cannabis.  The effects of a treatment that produce a negative outcome are called “iatrogenic”, so in alignment with the idea of “not messing with Mother Nature” both homebirth and Cannabis and medicine are more aligned with this value;  

3) Effectiveness- if measured by empowerment, quality of life and outcome, both homebirth and Cannabis as medicine have these in common.

To describe a couple of other abstruse analogies between these two movements, consider both of these practices from a more anthropological perspective.  The first method common to both homebirth and medical Cannabis is the attempt to dismantle hegemonic authority. What does this mean??  This means that people are questioning what the perceived “authorities” attempt at domination over others by forcing certain prescribed rituals or medicine.

The medicalization of childbirth and the medicalization of health have parallels in the emergence of “Western” medicine.  Both homebirth and alternative health and healing could be considered as ethical challenges to the status quo.  However, contemporary homebirthers and medical Cannabis users (or adult users) are no longer necessarily “radicals” or “extremists” rather just educated and empowered people living their lives as they see fit.  

Second, both groups could be considered to be engaged in a more ritualistic form of living, of bringing meaning to and carefully considering how to engage: the body, the spirit, the soul.

Third, the acts of ‘giving’ birth and choosing/preparing/titrating/ one’s own medicine bring meaning and empowerment to the individual.  In this  sense, they could both be considered to be “manipulated rituals of technocratic subversion”.

levi baby

The real common thread between these two involvements of mine is the people!  Both movements are filled with folks that may have at one time been considered ‘counterculture’.  But wait, just because wanting to participate fully in the birth of your child, you’re not counterculture anymore!   And wait, if you think you are going to be all culturally deviant by using Cannabis for pain relief, or to treat irritable bowel syndrome, or depression or just to alter your consciousness, you’re not!  The dominant values and behavior of society are changing!  If you think you could have either homebirth or medical Cannabis (or other natural medicine) in a system of collaboration and mutual respect, you can!

You are now just a member of the emerging culture, deliberately peeling away at the fiction of the medicalization of LIFE.   Our health and our life, how we live and how we die, do not need legitimacy in political and medical theaters.  To territorialize how we are born, how we die, and how we live the ‘dash’ in between our date of birth and date of death inscribed on a tombstone (or urn!) is tantamount to freedom!

CASP public comments to the Working Group

Dear Washington State Liquor Control Board (WSLCB):          November 12, 2013

Please accept the following as my contribution to public comments concerning the DRAFT recommendations to the legislature of the Medical Marijuana Working Group, constituted by representatives from the WSLCB, the Department of Revenue (DOR), and the Department of Health (DOH), and presented by the WSLCB on October 21, 2013.  Our Washington State nonprofit organization, the Center for the Study of Cannabis and Social Policy, is dedicated to the promotion of reality-based cannabis policies, significantly made possible by the legalization of cannabis under Initiative 502.  We are concerned that these draft recommendations are based more in the production of political theater than in the realities of currently existing patient access, on the one hand, and a lack of understanding about Washington State cannabis markets on the other.  We do, however, understand that the legislature is responding to an absence of regulatory frameworks around medical cannabis, and that there is a compelling need to do so.  We propose a simple, pragmatic two-step solution that would minimize cost to taxpayers and preserve patient access, while hardly affecting potential state revenues.  We propose that the legislature re-visit a bill they already approved, but was then substantively section-vetoed by the governor’s office in 2011.  And we propose that the state establish a scientific commission to study the realities of patient access to medical cannabis.

The perceived lack of medical cannabis regulation in Washington State is the direct result of former Governor Christine Gregoire’s 2011 section veto of key regulatory provisions in 69.51A.045.    This is illustrated by the following quote from a Seattle Times article dated April 29, 2011:

The governor took a combative posture in vetoing most of the bill, which would have licensed and regulated medical-marijuana dispensaries and grow operations, and given patients broader arrest protection … Recent letters from U.S. Attorneys around the country, including Washington’s two federal prosecutors, threatening more aggressive action against medical-marijuana programs and state workers enforcing them show a “changed landscape,” she said.

That logic, that explicit regulation might expose state employees to Federal sanction, was rendered irrelevant by U.S. Attorney General Cole’s Department of Justice memo dated August 29, 2013 (“Cole 2”).  As you well know, the Cole 2 memo explicitly states that as long as state regulatory frameworks meet eight conditions, the Federal government will allow state experiments with legalization.  There is nothing in the memo that bans state medical marijuana regulation, as long as those regulations are clear, substantive, and do not violate any of the eight conditions.  Washington State’s absence of clear regulatory frameworks for medical marijuana is clearly the result of Gregoire’s 2011 section vetoes.  If they had not happened, Washington State would be in Colorado’s position and there would be no need for your Working Group’s recommendations.

Therefore, the WSLCB should recommend a clear course of action to the legislature: establish a commission to study what was vetoed; modify to reflect the current landscape; and re-submit for executive signature, given the opening created by Cole 2.

I-502 said nothing about medical cannabis when the voters passed it, and it is a perversion of public initiative process for the state legislature, or any public stakeholder including the governor’s office and the Department of Revenue, to use it to dismantle the existing system of patient access.  The WSLCB was tasked with creating a workable legal system, not with destroying what is currently working for patient access.  Despite the Working Groups’ affirmation that patients now have a safe, legal alternative, the fact is that not one license has been given and the legal market will have a lot of kinks to work out.  No honest stakeholder disputes this.  It should be given space to work out these kinks without dragging patient access into the messiness.  Any recommendation that is based on asserting the viability of something that does not exist, has never been attempted, and/or is an optimistic projection, cannot be put forward to the legislature as a foundation for sound policy making.

As a result: each recommendation for which I-502 does not explicitly have a correlating mandate (designated “N/A” in the recommendations) should be withdrawn or amended to explicitly mandate credible, substantive studies of their potential effects on patients and patient access before being revisited at a later date.  That includes Section 2, establishing a mandatory patient registry; 3, regulations regarding health care professionals; and 4, eliminate collective gardens.  Sections 1, 5, and 6 are also problematic, but given the severity of our organization’s recommendation to completely eliminate sections 2, 3, and 4, our comments will focus on these.

We assert that the central problem with the Working Group’s competence and credibility is that it is comprised of state agencies with zero expertise in medical cannabis.  The secondary problems are corollaries: the DOR has no expertise in how licit cannabis markets are affected by quasi-licit medical markets and illicit markets that constitute the main competitors to legal cannabis markets; the DOH has no expertise in medical cannabis; and the LCB’s recently acquired field of knowledge is bounded by licit market regulation, not medical market regulation.  The problem is a profound lack of formal knowledge, in the absence of which politics rule the day over common sense.

The DOR bases its precise calculations on BOTEC’s work.  The acronym “BOTEC” stands for “back of the envelope calculations.”  Another acronym would have worked: SWAG, for scientific wild-ass guess.  The state’s contractor’s numbers are precise but accuracy is not the same as precision, and those numbers are suspect for a number of reasons but most of all, because BOTEC was mostly an outsider organization with no prior knowledge of Washington cannabis markets, much less knowledge about medical cannabis markets in the big picture, which includes a much more significant illicit cannabis markets.  BOTEC did come to the realization that medical markets are a tiny fraction of the overall cannabis markets in Washington State, relative to illicit markets.  This should mean, to you and to the legislature, that the State does not have a substantive economic interest in protecting licit state cannabis markets from quasi-licit medical cannabis markets, and that expensive and detailed regulation can only cost more than it would save.  It makes no economic sense, and the only way to explain this obsession is that it makes political capital for certain stakeholders.

This applies especially to the recommendation to ban “collective gardens,” which are quite different from commercial store fronts.  The true collective garden can be identified by its social relations of production: I recommend that the Working Group read a book titled “Dying to Get High, Dr. Wendy Chapkiss’ outstanding ethnography of the Wo/man’s Alliance for Medical Marijuana.  Patient participation in collective gardens can be important as cannabis consumption when it comes to palliative care.  Banning collective gardens hurts existing and potential patient access, and is therefore a human rights violation.  There is no reason, at all, to believe that collective gardens pose any sort of threat to the as-yet nonexistent legal cannabis market, because they are completely different from commercial relations of production.  If the recommendation to ban collective gardens comes from an urge to ban storefront dispensaries, an alternative might be to ban commercial storefronts.  But if these are illegal anyway, as US attorney Jenny Durkan has asserted, then the recommendation should be to enforce existing law.  There is no need to create additional regulatory work for which taxpayers would foot the bill without receiving any social benefits.  This can only be about political theater, and I urge you to refrain from participating.

The DOH, in these recommendations, would be tasked with overseeing doctor-patient relationships in a manner that deviates substantially from current regulations regarding the sanctity of the doctor-patient relationship.  We note that if the legislature is concerned about fraudulent authorizations, then that is an indication that the DOH is not doing its job or that what is being recommended is a system of physician oversight for which there is no licit precedent.  If the DOH is not currently applying the regulatory power it does have, how can it be expected to fulfill the oversight function for which it has been recommended?  Also of great concern is the absence of any expertise regarding medical cannabis in the DOH itself – how is a licit bureaucracy going to know more about a field of medicine that is only now opening up, where research is advancing at a rapid rate, and due to its illicit nature the people who know the most about cannabis as an herbal medicine are the patients themselves; and brave health care workers who have treated patients despite legal risks, because public health should not be sacrificed to political policy.

Finally, the LCB itself.  With the exception of the secrecy around this working group, the LCB has done a terrific job seeking and listening to public input.  You have learned much in the last 11 months or so, but your learning has been focused – rightly – on how to write rules for implementing a legal cannabis market.  This is what the voters asked you to do, and it is not your fault that the legislature made this extra request.  It seems to me that most of you in the LCB have wanted nothing to do with this, and this is reflected by the dominance of one stakeholder in these recommendations: the Department of Revenue.  But I ask you to take what you have learned in the last eleven months and tell the legislature the truth:  all recommendations that might impact a single patient’s access to cannabis as medicine have to be studied at length before being made, much less implemented.  The problematic assumption that many medical cannabis patients game the system has to be compared with the totally unproblematic assumption that many real patients exist and they should not be sacrificed on the twin altars of politics and revenue.  The WSLCB knows this because it has met those patients, heard from them, at public hearings across the state.  That is only half the picture, however: the WSLCB has not, to my knowledge, made a systematic effort to listen to clinical researchers, physicians, and naturopaths regarding the study of cannabis as medicine.  And why would you?  You were not tasked or funded to do so.

In sum, the Center for the Study of Cannabis and Social Policy asserts that Washington State public health policy would be adversely affected by the Working Group’s recommendations as they now stand.  Further, there is no social benefit that would be created that could offset the fact that these recommendations constitute bad public health policy.  Legal cannabis policy must be constructed to work with with other kinds of social policy, grounded in reality rather than fearful political maneuvering.  It should not create new problems that are totally unnecessary and counterproductive in the long term.  We are committed to making legal cannabis work, and convinced that Washington State has a historic opportunity to serve as a positive model for making things work instead of making a mess that other states and even nations would look at as a cautionary tale.

Thank you                                                                                                              Dr. Dominic Corva                                                                                          Executive Director                                                                                                Center for the Study of Cannabis and Social Policy

 

Partner Project Vashon Island/VIMEA

CASP is overjoyed to announce our first sustainable livelihood partner project, a collaboration with Shango Los’ nonprofit Vashon Island Marijuana Entrepreneurs Alliance!  While the Grange has yet to find a dedicated partner, VIMEA is a perfect example of our organization’s Action-Research mission to find, support and collaborate with people who are already organizing their communities to inform the public and assist with adjusting to the post-502 landscape.

The following press release describes well how VIMEA and CASP missions and activities will complement each other going forward.

#Press Release#
VIMEA and CASP form Partnership for implementation of legal marijuana in rural Washington State
October 18th, 2014
Vashon Island, WA

The Vashon Island Marijuana Entrepreneurs Alliance (VIMEA) announces their partnership with The Center for the Study of Cannabis and Social Policy (CASP).  Through this partnership, VIMEA will gain access to valuable research, marijuana industry contacts and increased funding opportunities.  The Center will gain first person reports, photos and legal marijuana implementation best practices from VIMEA.  Both groups see this partnership as an opportunity to widen the understanding of marijuana as business and medicine.

Director of VIMEA, Shango Los stated, “We are very pleased to to form this partnership with CASP.  Securing access to the center’s vast resources and marijuana policy experience will assist greatly to VIMEA’s success in rural Washington.  CASP Director Dominic Corva’s in-depth understanding of global approaches to marijuana production and policy supports our goal to implement I-502 in a way that sustains our local food security while also integrating legal marijuana farming in ways consistent with our local community standards.”
CASP Director, Dominic Corva stated, “VIMEA is providing the local community organizing necessary to implement legal marijuana in a way that respects the Vashon Island community.  We are grateful to secure first hand accounts to inform our policy research.  We look forward to studying the VIMEA approach and help disseminate their best practices throughout the country.”

The Vashon Island Marijuana Entrepreneurs Alliance is an advocacy and trade organization for legal marijuana produced on Vashon Island in Washington State.  VIMEA’s goals are to create an environment welcoming to local marijuana farmers, assist marijuana entrepreneurs in setting up their businesses, re-establish the Vashon Island marijuana brand and encourage successful farmers to reinvest a portion of their profits into the community.  VIMEA is based on Vashon Island, WA.www.vimea.org and www.Facebook.com/vimea
The Center for the Study of Cannabis and Social Policy (CASP) produces, reviews, and disseminates objective research and opinions about the relationship between Cannabis Policy and other forms of Social Policy including but not limited to environmental policy, agricultural policy, public health policy, policing, foreign policy, and economic policy.  CASP is based in Seattle, WA.www.cannabisandsocialpolicy.org
For more information, contact Shango Los at 206-595-9006 or Shango@vimea.org

 

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Shango Los
Vashon Island Marijuana Entrepreneurs Alliance
www.vimea.org coming soon
PO Box 2327
Vashon Island, WA 98070

 

 

Whither medical cannabis in Washington state?

As the Liquor Control Board works to finalize its rules for implementing Initiative 502, it turns to a key piece of unfinished business: making recommendations to the state legislature regarding the much less regulated medical cannabis industry.  To do this, they have enlisted the help of the Departments of Health and Revenue, forming a joint committee that has been meeting since July.

From the WSLCB listser announcement:”Section 141 of the state operating budget directs the Liquor Control Board to work with the departments of Revenue and Health to develop recommendations to the Legislature regarding the interaction of medical marijuana and the emerging recreational marijuana system. The workgroup, which includes senior staff from each agency, has been meeting since July.”

The timetable:

October 21
Provide draft recommendations to stakeholders for comment
November 8
Deadline for written comments
November 21-22
Present draft recommendations to appropriate House and Senate committees at Legislative Assembly Days
January 1, 2014
Deadline for delivering final recommendations to the Legislature

Note that the process is a speeded-up version of what they did for 502 draft rulemaking; and that while the Department of Health makes sense, the Department of Revenue is trickier business and undoubtedly related to the differential taxation structure from 502, which adds an excise tax of 25% at each stage of the process: producer to processor, processor to retailer, and retailer to consumer.

The announcement of this process and its timeline has caught many of us by surprise — it arrived to my inbox while I was at a group meeting to hammer out a legislative proposal for regulating medical cannabis producers, processors, and retailers after 502 kicks in, presumably in January.

It should be interesting to see what the joint committee comes up with.  I can’t report on what our grassroots committee is deliberating, but I would like to offer my thoughts on what can work, politically and economically.

First, it’s my understanding that the joint committee will settle on a timeline for phasing out the medical cannabis supply chain as it exists.  I’ve been quoted anywhere from 6 months to 2 years, during which medical producers, processors, and distributors may continue to operate under existing medical cannabis (largely self-) regulation.  Now, whether such operators will be subject to US Attorney prosecution is another question: I suggest that at the very least some low-hanging fruit will be plucked, but most likely it will be gray market participants that shade towards black.  In any case, the legal field will get very messy, but remember that a messy legal field favors defendants.

Second, it is very hard for me to imagine that new medical cannabis frameworks will include producers and processors.  Simply put: 502 licenses for producers and processors will be much more easily obtained than retail licenses, and their product(s) are exactly the same as medical products — in fact much more regulated.  I don’t see any scenario in which the legislature carves out exceptions to 502 producing and processing rules.

The extent to which the legislature may be amenable to continue medical cannabis in some form hinges on the question of patient access, which is an end-use question rather than a producing and processing question.  This is more complicated than it seems, since retail stores (a) won’t be very convenient to access for most and (b) aren’t allowed to have any mention of “medical” use associated with packaging and labeling, per I-502 language.

That leaves the possibility that the state may carve out a retail exception to 502, with a much more tightly regulated system for authorizing and patient database registration — probably a different list of conditions, as well, on which I presume the Department of Health will be weighing in.  One exception that will have to be made is the age-limit for purchasing medical cannabis.  Post-Sanjay Gupta, I can’t imagine that medical cannabis for children won’t be permitted.

To be clear, this is my analysis of what will be possible to secure for medical cannabis patients and industry in the coming year.  A broader range of existing allowances, in my opinion, should be allowed but are unlikely to attract political support in the legislature (whose primary interest is producing revenue, not protecting patients).  These include: collective gardens, home grow provisions, and more than an ounce to purchase at a time.

I’ll update you on the progress of this process, but leave you with this thought:  every state that already has medical cannabis regulations is going to have to go through this process after passing legalization initiatives or legislation.  It’s a very messy process — states are already divergent with respect to qualifiying conditions and authorizers.  It’s also another reminder that legalization is only the beginning of a process, and that continuous organizing must happen to shape outcomes.  Beyond that, though, is the question of moving beyond highly regulated legalization to total Federal de-scheduling.  I believe that the current steps that are being taken are familiarizing the rest of the US with cannabis and to their surprise, cannabis is not the bogeyman they’ve been led to believe.  There is absolutely no non-political need, in my opinion, for cannabis regulation to be as strict as it is.

 

 

 

A Tale of Two Zoning Maps

 

by Dominic Corva, Executive Director

NOTE: Zoning maps are estimates and not final, at this point — except the second map, which was viable about a week.

Estimated Area for I502 Licensed MAP Marijuana under City and State Restrictions

Estimated Area for I502 Licensed MAP Marijuana under City and State Restrictionscommonpatch

Map of Common Path of Travel Analysis

Last week, the Washington State Liquor Control Board (LCB) had to take back a proposed zoning language revision for the 1000-foot rule.  This revision would have defined 1000 feet from “as the crow flies” to “common path of travel,” a change that gave the second map of possible cannabis industrial location above some breathing room compared with the first map.  Take a look.

The re-revision gives us some idea of just how restrictive the zoning regulations will be for Washington’s most cannabis-friendly polity.  This regulatory “barrier to entry” will drive differential land prices in the City, raising alarm bells for the Port of Seattle whose summer efforts to exclude cannabis-related businesses from industrial Port spaces has culminated, for now, in a compromise whereby IG1 (the part closest to downtown, including much of SoDo) is scheduled to zone 10,000 square feet instead of 50,000 originally planned.  IG2 is also revised down to 20,000 square feet.

Under the current rules, the rest of the state may permit up to 30,000 square feet.  Whether they do so or not, increasing urban land prices and restricted producer space (processor space is not necessarily a problem) make it more cost-effective, once political zoning regs are relaxed in the rest of the state, to locate in rural areas.  The future of cannabis agriculture, in terms of production cost, is rural hybrid greenhouses that use supplemental lighting.  That model, in Israel, is currently producing 4-5 cycles per year at 50 cents a gram.

Currently, however, uncertainty about local municipal authority politics limiting 502 production outside of Seattle/King County will drive a real estate bubble centered in the most contiguous yellow space shown in the first map, south of downtown.  This uncertainty, in my opinion, is easily managed by access to policymaker education and interest in getting a piece of the cannabusiness pie.

If you are a rural farmer/grower, right now is a good time to get ahead of the curve.  Your land costs are way cheaper and your cost of production, with the right guidance, are way lower.  The first thing to do, however, is to reach out to local authorities — policymakers and police — to discuss their attitudes towards 502.  Get to know your neighbors, be a good citizen, do everything by the books, give back to your communities, and you’ll find that this is the best no-cost way to mitigate risk.

 

How is Cannabis Traditional Medicine?

by Dr. Michelle Sexton                       IMG_2380

Traditional medicine (TM) is the generational and societal healing wisdom that has developed sequentially by cultures, prior to the genesis of modern medicine.  The World Health Organization defines TM as “the health practices, approaches, knowledge and beliefs incorporating plant, animal and mineral-based medicines, spiritual therapies, manual techniques and exercises, applied singularly or in combination to treat, diagnose and prevent illnesses or maintain well-being.”

The contemporary exploitation of plant compounds, via the chemical revolution and the genesis of synthetic compounds, has culminated in modern chemically-based medicine that is unsustainable, and in many cases with questionable risk:benefit ratios. The United States is in a minority compared to 80% of countries that still primarily use traditional medicine to treat the whole person.   Some examples of these ancient approaches include Ayurveda, Siddha medicine, Unani, ancient Iranian medicine, Islamic medicine, traditional Vietnamese medicine, traditional Chinese medicine, traditional Korean medicine, and traditional African medicine systems such as Multi and Ifá.

The earliest written records of plant-based medicine or herbal/botanical medicine (sometimes known as “herbals”) from Egyptian, Chinese, Indian and Arabic texts all included Cannabis in their repertory. An Egyptian manuscript known as “Fayyum Medical Book” compiled knowledge dating from 6 BCE and discussed using topical application of an herbal mixture that included Cannabis (sometimes heated) for “curing” of tumors. It appears that Cannabis was often used topically also as  “a treatment for the eyes” (Papyrus Ramesseum III, A 26, ca. 1700 BCE.). There are records indicating that it taken internally to treat diarrhea, urinary problems, pain, spasticity, as a vermicide, as a love potion, for impotence, pulmonary congestion, anxiety, as an anti-inflammatory, and possibly to “cure anger and sorrow” (C. H. Oldfather, Diodorus Siculus, Harvard University Press, Cambridge, MA, 1933, p. 470).  The ancient Greek physician, pharmacologist and botanist Pedanius Dioscordes referenced hemp in his medical/botanical book “De Materia Medica” (50-70 CE) which is the primary source of historical information on Greek, Roman and other medicines of antiquity. Of hemp, he wrote:  “being juiced when it is green is good for the pains of the ears”. Pliny the Elder, who was a Roman naturalist, included hemp in a volume he wrote, Naturalis Historia, (77 CE). Skipping ahead to more modern times, the French writer M. Marcandier reported in 1778 that hemp was reported to be useful in thetreatment of “tumors”.  The term “tumor” may have been used to describe any kind of “abscess, sores, ulcers or swelling” but it is unclear if these tumors included what we consider today to be cancerous tumors.  Based on these documentations, Cannabis has clearly been an element of TM from the earliest recorded history to more contemporary times.

Dr. William Brooke O’Shaughnessy introduced Cannabis to contemporary western or “modern” medicine, around 1839 when he described successfully treated cases of rheumatism, hydrophobia, cholera, tetanus, and epilepsy he observed at the Medical College of Calcutta. Upon his return to England in 1843, he introduced “Indian Hemp” as “an anti-convulsive remedy of the greatest value.”  Western medicine reacted promptly as a wave of cholera was in motion and in France, Dr. Louis Aubert-Roche, successfully used it in treating “the plague”. Hemp had also found its way into Hahnemann’s  and otherhomoepathic “material medica” from 1811, where it remains today.

The American Eclectic physicians, an early branch of American medicine that peaked around 1890, relied heavily on botanical use that they drew from the Native Americans. The Eclectics included Cannabis in their materia medicas (the contemporary “herbal” texts) at the turn of the 20th century.  The American Materia Medica (1919) by Finley Ellingwood (a major Eclectic practitioner) classified Cannabis as a narcotic. Roberts Bartholow was a more “conventional” American doctor at this time who did the first experiments with electrical stimulation of the brain. He dared to investigate the Eclectic’s claims and  classed Cannabis as a “cerebral excitant” (From the Eclectic Medical Gleamer, March 1912 vol.8,2). These opposite effects of being sedative and excitant may demonstrate what modern science would consider biphasic actions of cannabinoids at their receptors. Ellingwood’s text continues: “its mode of

Indian Cannabisaction is sedative, narcotic, anodyne and anti-spasmodic.  It acts upon disturbed function of the nervous system”.  The monograph goes on to describe therapy for “pain, insomnia, melancholia, hypochondria of the menopause, epilepsy, heart disturbance, functional disorder of the stomach, neuralgic dysmenorrhea, menorrhagia and metorrhagia, gonorrhea, arresting priapism, for genito-urinary infection and impotence, coughs, and laryngeal spasm”.  These are some of the documentations of the traditional use of Cannabis as a therapeutic agent.                                                                                                                   This brief, and in no way comprehensive, historical background is intended to demonstrate the documented ancient history of Cannabis as a TM. These documentations illustrate the efficacy and relative safety of this plant medicine and serve as the historical analog to western medicine’s drug approval process.  It is improvident to assign plants to reductionistic scrutiny that single-agent synthetic drugs should be subjected to, as the historical records speak for themselves. Also, the complex and synergistic way that herbs or herbal formulas work alongside other natural and traditional approaches to restore health, are too elaborate to reduce to the current gold standard of randomized controlled trials (RCTs), the defining feature of

Cannatolechemically-based medicine.  However, cannabis in inhaled and oral forms has been subjected to rigorous large RCTs for specific indications such as pain and spasm and has prevailed. There are adequate records to show that humans have known which plants are toxic and deadly, and which are helpful and healing by trial and error over centuries. Plants and human beings are biologically too intertwined for solely viewing their relationship through the impoverished current models that were designed for single agents and a more reductionistic approach to medical treatment and healing.

The trial-and-error method, or what might be viewed as “uncontrolled” clinical trials, continue today with a host of plant medicines, while increasingly “We the People” are turning to them for their greater safety profile and history of efficacy. Combine this movement with a return to nurturing our bodies, relationships, communities, societies, cultures and our planet, and there is room for hope of a healthy future. Indeed, there are lessons to be learned from the current phenomenon of cultivating and using Cannabis as a botanical medicine, such as how organic gardens, growing our own medicine, locally, cooperatively, and responsibly is a means to sustainable health.  According to the UN Universal Declaration of Human Rights (1948)  “Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family including, food, clothing, housing and medical care . . .” (Art. 25 Sec.1).  May our right to pursue traditional medicine and natural health not be overcome by municipalities, higher governments, capital gain, healthcare plans or other forces that have high social costs and mitigate our larger freedoms to pursue the time-honored means of healing ourselves with plants.

DSCN4040

The current awakening to herbs, and specifically Cannabis, for medicine is a portal “back to the garden” of botanical and sustainable medicine that is misconstrued as “alternative” when it is in fact universal and time-honored. Animals and plants are made for each other.  We have co-existed from the beginning of time, with plants the servants that provide us food, shelter, clothing and medicine, thus sustaining our survival.  Cannabis: the gateway herb.  DSCN4038

 

Needless Suffering of Medical Marijuana Patient Embodies Federal-State Conflict: A Prison Extraction

Sunil Kumar Aggarwal at Huffington Post – Associate Member of the New York Academy of Medicine, Senior Resident Physician at Large Academic Medical Center in New York City

When I was in the graduate school portion of the Medical Scientist Training Program at the University of Washington in the Department of Geography, I had an opportunity to work with an intrepid defense attorney by the name of Douglas Hiatt, who brought me face-to-face with major health and human rights cases of persecuted, ill and disabled patients who were caught up in the federal-state conflict on medical marijuana. While the story I share below is from 2005, and was covered by the AP wire, it seems it is only in this age of majority support for ending the federal war on marijuana, when there is still doubt being expressed about the severity of marijuana prohibition enforcement, that people may be able to read and appreciate the full medical details of the following case. I did try to submit the write-up below to medical journals several years ago, but it seems like they were not yet willing to listen. Please lend me your ears and consider the consequences of a federal health policy built on denial of scientific fact of the medical utility of herbal cannabis.

Read the story here

Cannabis and the Medical Community

by Will Duffield

The past few weeks I have been attending classes at my local ambulance station, working toward getting my EMT certification. I think it is important to look at how new EMTs are taught to deal with cannabis, as protocols surrounding the substance are often influenced more by dogmatic  legal speculation than science, even within the medical field.

Our textbook contains a brief paragraph about cannabis in the toxicology section, terming it marijuana. According to the book, smoking marijuana produces “euphoria, relaxation, and drowsiness”, and also impairs “short term memory and the capacity to complex thinking and work”. While the validity of some of these observations can be questioned, the data available to those researching behavioral trends among cannabis users has been limited. Government prohibition of cannabis use, as well as social discrimination, leads many users to lie about their use. The textbook goes on to estimate that 20 million americans smoke cannabis every day. Most cannabis related emergency calls come not from the desired effects of cannabis, but from unwanted “anxiety and panic” that sometimes occurs.

I would have liked to see a discussion of the THC to CBD ratios present in most smoked cannabis, and how they might affect the user’s experience, particularly with regard to the possibility for anxiety and panic. The textbook notes that “A person who has been using marijuana rarely needs transport to the hospital”. When a marijuana user is in such distress that they wish to go to the hospital (EMTs cannot refuse to transport a patient) the textbook advises the EMT to “reassure the patient and transport the patient with a minimum amount of excitement”. In essence, we understand that you’re freaking out, man, and we will try to keep you calm and comfortable in our alien vehicle. This is a remarkably progressive approach, particularly when juxtaposed with police procedures which treat cannabis users as potential threats. In fact, the book draws strong connections between alcohol and murder, traffic injuries, and suicide, while making no mention of a similar connection between cannabis and mayhem. It does warn that marijuana may be laced with other drugs, and a call for marijuana intoxication may turn out to be something far more dangerous. This is a symptom of the current black market and its lack of nonviolent methods of contract enforcement.

It is important to understand how various segments of the medical community currently view cannabis, and why these views are held. To the extent that they are shaped by legal prohibition, they may change as cannabis is legalized, however, the “how” of legalization may influence, and be influenced by, the medical community.

The advent of legal cannabis in Colorado has lead to an increase in the number of THC infused edible products available to consumers. While adults will rarely mistake commercially sold  marijuana edibles for normal baked goods, young children cannot often distinguish between the products, as both often have brightly colored, easily opened packaging. Michael Kosnett, a toxicologist and associate clinical professor at the University of Colorado School of Medicine has recommended that THC infused products be sold in childproof containers, as many modern medicines are. The problem could also be solved by more responsible parenting, and perhaps more respectful treatment of what is undoubtedly a mind altering substance.

While it is politically simple to treat cannabis like alcohol, in reality, the substances are incredibly different, both in effect and in how they are consumed. Children do not enjoy drinking vodka, and people do not die from smoking large amounts of cannabis. The medical community has accepted this to a far greater degree than our legislators and law enforcement officers, and has been quicker to address the unique specifics of cannabis.

*Textbook citation – Gulli, B., Ciatolla, J. A., Barnes, L., & American Academy of Orthopaedic Surgeons. (2011). Emergency Care and Transportation of the Sick and Injured. Sudbury, Mass.: Jones and Bartlett.

Operation Medical Access Transition

by Dominic Corva, Executive Director

The passage of I-502 meant that its Legal Landscape would operate in conjunction with current Washington State Medical Marijuana legislation, until or unless the legislature acted to clarify the situation.  This is quite significant, since current Medical Marijuana statutes are much more liberal than I-502, despite offering less formal protection as affirmative defense.  Many current Medical Marijuana patients are justifiably concerned that if the Medical regime is subsumed under the Legal, more restrictive regulations regarding production, distribution, and retail will translate into lack of access to the medical care.  For instance, under I-502 no home grows will be legally permitted and consumers may only buy one ounce at a time at retail stores, if they can get to retail locations given restrictive zoning rules.

No matter what one thinks about the broad set of conditions for which one may become a medical marijuana patient in Washington State, a significant percentage of these are seriously ill and debilitated patients — patients that no reasonable person could accuse of “hiding” behind medical to get high.  Further, these patients often get free cannabis from their access points or from their caretakers, in the existing black- and grey-market industry.  For them, I-502 may take away their de facto (socially conferred) and de jure (legally conferred) right to affordable and accessible medicine.

This Project asks how Initiative 502’s relationship with current Medical Marijuana Policy in Washington State affects catastrophic patient access to medicine.  We will partner with existing medical dispensaries to select and track a sample population over time.

 

State-sanctioned Knowledge about Cannabis: Willfull Ignorance

Posted: 04/15/2013 2:40 pm

After a 40-year battle over the placement of marijuana in Schedule I, the U.S. Court of Appeals, DC Circuit, ruled in January on the most recent petition to reschedule marijuana in the case of AMERICANS FOR SAFE ACCESS (ASA) v. DRUG ENFORCEMENT ADMINISTRATION (DEA). The court ruled that the DEA had notacted arbitrarily and capriciously when it denied ASA’s petition filed 9 years earlier to remove marijuana from Schedule I. Schedule I drugs have “no currently accepted medical use in treatment in the United States” and “a lack of accepted safety for use under medical supervision” — a classification that holds marijuana more dangerous than cocaine, morphine, or methamphetamine, all listed in Schedule II with accepted medical uses. The court ruled that the research needed to move marijuana out of Schedule I does not exist. We respectfully beg to differ.

The DEA’s argument, stated in a 2006 report from the US Department of Health and Human Services (HHS), is that there are no “adequate and well-controlled studies” proving marijuana’s efficacy. Though they noted a number of U.S.-based small-to-medium sized randomized, double-blind, placebo-controlled studies of inhaled marijuana for severe pain, spasticity, and wasting syndromes, all showing valid medical benefits, they felt these were not big enough. What DEA wants to see are akin to Phase III clinical trials — large studies, involving hundreds of subjects, comparing marijuana to placebo in a double-blind, randomized fashion for a specific indication — exactly what the Food and Drug Administration (FDA) wants when evaluating interstate drug marketing applications. Here’s the rub: those kinds of studies have been done and are published in the peer-reviewed scientific literature and yet neither the DEA, nor the HHS, nor the Court took notice. Large, multicenter, randomized, double-blind, placebo-controlled studies involving hundreds of patients in America and abroad that are in some cases a year in duration have been published in U.S. National Library of Medicine indexed journals showing that marijuana, orally administered in extract form, can treat intractable pain in cancer and improve mobility and symptom control in multiple sclerosis. What is arbitrary and capricious is federal agencies have chosen to ignore these studies because they have been done mainly in the private pharmaceutical drug development sector where marijuana-infused products are produced, tested, and sometimes strategically renamed. This hide and seek game has resulted in rigorous research having little to no bearing on public scientific understanding of the medical use of marijuana.

In the case of GW Pharma Ltd (GWP) of Wiltshire, England, it is a mouth spray directly extracted with liquid carbon dioxide from the flowers of two strains of marijuana plants grown in UK-licensed company greenhouses from a worldwide marijuana seed collection that resided in the Netherlands until the late 1990s. In the case of the non-profit Institute of Clinical Research (IKR) of Berlin, Germany, it is a capsulated alcohol extract made from marijuana flowers grown in Switzerland and extracted in Germany. Marijuana extracts have been produced for millennia for consumption, and the public has an overriding interest and right to know that these marijuana studies exist and that their results should logically have bearing on how we as a society understand, utilize, value, and ultimately classify marijuana.

So why do the feds not include marijuana resin extract studies when weighing marijuana’s evidence base? Sometimes it is as simple as a name game. Congress’s definition of marijuana — unchanged since 1937 — has always included any compound, extract, or manufactured mixture containing a detectable amount of marijuana resin. If marijuana resin has been extracted and dissolved into a solvent or otherwise concentrated, that new substance is still called marijuana, hash, or hash oil, and this form of marijuana often carries stricter penalties, such as the life sentence penalty recently adopted by Oklahoma in 2011 for first-offense hash production. Millions have been punished under this full definition of marijuana via their possession or distribution of marijuana-infused edibles such as brownies or hash oil. Marijuana medicines made by GWP and IKR are concentrated forms of the marijuana plant with marijuana resin as a base. GWP’s lead product, imported for U.S. trials under DEA license, was named “nabiximols” (Sativex®) and not marijuana by the United States Adopted Names Council, a body composed of organized medicine and pharmacy with FDA backing. In IKR’s case, the company chose the name Cannador® for their marijuana extract seemingly without any regulatory oversight.

Cannabis, marijuana’s proper name, is a commonwealth medicinal plant belonging to no government or private entity. Licensed producers of marijuana extracts in the private sector have a rare and coveted wide latitude of scientific freedom to explore and discover, in a rigorous way, many of the medicinal benefits inherent to cannabis. Does the government have the right to ignore rigorous peer-reviewed published evidence about marijuana’s medical utility accumulated in the pharmaceutical sector which enjoys privileged access to marijuana for research and development? Does private industry have the right to demand, as GWP once did, that marijuana not be rescheduled based in part on their collected data, which they recently achieved in the UK, presumably to protect company market share and pricing by avoiding competition from future marijuana producers who would be empowered by a rational reclassification of marijuana in federal law? Cannabis should not be cordoned off for the sake of private patents, monopolies, or FDA drug marketing applications.

In the U.S., federal agencies have set-up onerous roadblocks that limit researchers’ abilities to access marijuana — the very impetus for private marijuana research to get started overseas, licensed by friendlier governments. A DEA judge actually ruled that the U.S. marijuana supply monopoly was not in the public interest in 2007, but this decision has been ignored. Many major medical societies want marijuana rescheduled or are urging a scheduling review be undertaken, including theAmerican Medical Association, the American College of Physicians, and theMassachusetts Medical Society, publishers of the New England Journal of Medicine. In fact, there has been ongoing resistance to marijuana’s placement in Schedule I ever since Congress first attempted it in 1970. When drafting the law, Congress sought input from Dr. Roger Egeberg, Assistant Secretary of Health at HHS and former personal physician to General MacArthur. He testified that “our recommendation is that marihuana be retained within schedule I at least until the completion of certain studies now underway to resolve the issue”, referring to the comprehensive “National Commission on Marihuana and Drug Abuse” study being undertaken at that time. His recommendations were echoed in a Congressional Committee report which stated “the recommendations of this Commission” would be “of aid” in determining “the appropriate location of marihuana within the schedules of the bill.” When the Commission reported in 1972 that the public threat of marijuana had been greatly exaggerated and recommended that its classification be lowered so that it was no longer on par with heroin, no one took responsibility and marijuana was left in Schedule I. Immediately afterwards, citizens filed the first of several petitions to reschedule marijuana. After 16 years, the first petition was favorably viewed by a DEA judge who concluded after an extensive, two-year evidentiary hearing, that “marijuana, in its natural form, is one of the safest therapeutically active substances known to man. By any measure of rational analysis marijuana can be safely used within a supervised routine of medical care.” He ruled that marijuana be rescheduled to Schedule II, with painkillers and anesthetics, and that to not do so would be “unreasonable, arbitrary, and capricious.” His decision was overruled by the politically appointed DEA head who said that data were inadequate.

Forty years later, the ASA v. DEA case, now on appeal, is the latest major legal challenge to marijuana’s schedule I status, and new rescheduling bills have been filed in Congress. We cannot let the federal government play fast-and-loose with science on marijuana research any longer–cannabis in all forms must be down-scheduled and de-scheduled. The public health justice imperative to stop curtailment of scientific inquiry and free medical professionals to explore alternative treatments like marijuana with patients is paramount. There are too many lives at stake, not to mention scientific integrity and a burgeoning field of medical discovery requiring much freer access to the marijuana plant.
Sunil Aggarwal, M.D., Ph.D. and Amanda Reiman, Ph.D., M.S.W.

Dr. Aggarwal is a board member of Americans for Safe Access Foundation and a resident physician at a large academic medical center in New York City. Dr. Reiman is a California policy manager for the Drug Policy Alliance and a Lecturer in the School of Social Welfare at the University of California, Berkeley.