cannabisnews.com: Cannabis and Pain Management 










  Cannabis and Pain Management 

Posted by CN Staff on August 26, 2003 at 14:58:03 PT
Feature Story By Ethan Russo M.D. 
Source: Cannabis Health  

The following article is an edited composite of a Policy Paper on Cannabis in Pain Treatment presented to the American Academy of Pain Management by Dr Ethan Russo, M.D.Effective treatment of acute, chronic and intractable pain is a critically important public health concern in the world today. Despite a vast array of analgesic medicines including anti-inflammatory and opioid analgesics, countless patients continue to suffer the burden of unrelieved pain.
Opiate addiction, and the recent OxyContin® controversy underline the importance of newer effective and safe alternatives. For over a century, international commissions have studied the issue of cannabis, and virtually uniformly recommended its decriminalization and provision for medical applications, specifically including the treatment of pain.Cannabis has been employed as an analgesic for thousands of years, and was utilized in this country as well, particularly for neuropathic pain, prior to its effective removal from the American market 65 years ago. Historical cannabis supporters have included such physicians and scientists as Galen, Dioscorides, Parkinson, Linnaeus, Gowers, Weir Mitchell, Osler, Solomon Snyder, and many others. Cannabis remains a frequently employed ethno-botanical agent in pain management among indigenous peoples of the world.Modern research on endogenous cannabinoids and the cannabinoid receptor system has demonstrated a scientific basis for the efficacy of synthetic and phytocannabinoids in pain management based on serotonergic, dopaminergic, Substance P, and glutamatergic mechanisms, interactions with the endogenous opioid system, as well as antioxidant and anti-inflammatory effects. These mechanisms have been demonstrated in both central and peripheral systems. Adjunctive effects of cannabis and cannabinoids on depression, anxiety, spasticity, tremor, nausea and anorexia also contribute to treatment benefits in chronic pain patients. Whole cannabis and its extracts provide an entourage of cannabinoids, terpenoids, and flavonoids that combine to create a synergy of benefits in holistic treatment of chronic and intractable pain. Systematic examination of the toxicology and side effect profile of cannabis and cannabinoids on long-term cognitive, other nervous system, endocrine, hematological, and immunological function demonstrate little documentation of significant detrimental effects, and suggest a safety margin well within that of most prescription medicines. The sole area of demonstrable concern surrounds chronic pulmonary issues attendant with smoked cannabis. These problems are possibly avoidable with harm reduction techniques such as vaporization, and are totally so with alternative delivery methods such as sublingual or nebulized cannabis-based medicine extracts. Fears of cannabis-induced psychosis, addiction, and cognitive impairment and deterioration have been largely exaggerated. Oral synthetic THC (Marinol®), a synthetically derived THC dissolved in sesame oil, was developed by Unimed Pharmaceuticals. It is available in capsules of 2.5, 5 and 10 mg and is marketed in the USA, Canada, Australia, and some areas in Europe, and has proven quite disappointing as a pain management tool. Cannabis proper, and a variety of synthetic agents are in various stages of clinical investigation. Development and FDA approval of synthetic cannabinoids will require many years. In contrast, cannabis-based medicine extracts have proven safe and effective in a large variety of pain conditions, and are expected to attain governmental regulatory approval in the UK, Western Europe and Canada within a very short time. The History of Cannabis in Pain Management Traditional knowledge of cannabis in China may span 5000 years, dating to the legendary emperor, Shen-Nung. Julien (1849) wrote of the physician Hoa-tho in the early 2nd century and his use of a cannabis extract in anesthesia for major surgical procedures. The Atharva Veda of India (dating to between 1400 and 2000 BCE) mentions a sacred grass for anxiety, bhang, which remains a modern term for cannabis. Medical references to cannabis date to Susruta in the sixth to seventh centuries BCE. Dwarakanath (1965), described a series of Ayurvedic and Arabic traditional preparations containing the herb indicated for migraine, neuralgic and visceral pains. Similar proof of the medicinal use of cannabis exists in records and artifacts from ancient Egypt, Assyria, Israel/Palestine/Judea, and the Greek and Roman Empires. In common use throughout the Medieval world and Renaissance Europe, the medical use of cannabis, or "Indian hemp" was reintroduced to the West by O'Shaughnessy (1838-1840). His treatise on the subject dealt with the apparent utility of a plant extract administered to patients suffering from rabies, cholera, tetanus, infantile convulsions, but also a series of painful rheumatological conditions. Of particular note, even patients that succumbed to their illnesses were greatly relieved by cannabis with convincing palliative benefits.Shortly thereafter in England, Clendinning (1843) described his results of treatment of 18 patients: 3 with headaches, one with abdominal pain secondary to tumor, one with pain secondary to a laceration, two with rheumatic joint pain, and one with gout. In each case, the tincture of Indian hemp provided relief, even in cases of morphine withdrawal symptoms.In Ireland, Donovan (1845) extensively described his own extensive trials with small doses of cannabis resin, mainly in patients with various types of neuropathic and musculoskeletal pain. Effects were almost uniformly impressive, with few side effects. He also described the benefits of local application of hemp leaf oil on hemorrhoids and neuralgic pains.Over the next decades, numerous authorities recognized cannabis as helpful for painful conditions. Sir John Russell Reynolds was eventually to become Queen Victoria's personal physician. He successfully treated her dysmenorrhea with a cannabis extract throughout her adult life (Reynolds 1868) and used it extensively to treat migraine and neuropathic pain. Hobart Hare (1887): I have found the efficient dose of a pure extract of hemp to be as powerful in relieving pain as the corresponding dose of the same preparation of opium... During the time that this remarkable drug is relieving pain a very curious psychical condition sometimes manifests itself; namely, that the diminution of the pain seems to be due to its fading away in the distance, so that the pain becomes less and less, just as the pain in a delicate ear would grow less and less as a beaten drum was carried farther and farther out of the range of hearing.In the French literature, See (1890) submitted a detailed report on use of cannabis in the treatment of various disorders producing gastric and intestinal pain, and found it preferable in efficacy and side effects to opiates and bismuth.Suckling (1891) noted the ability of cannabis to allow migraine sufferers to return to work. An American drug handbook stated the following: (Lilly, 1898) "Antispasmodic, analgesic, anesthetic, narcotic, aphrodisiac. Specially recommended in spasmodic and painful affections."Hare (1922) still advocated use of cannabis noting "For the relief of pain, particularly that depending on nerve disturbance, hemp is very valuable."An editor of the Journal of the American Medical Association, as late as 1930 noted the ability of cannabis to achieve a labor with pain burden substantially reduced or eliminated, followed by a tranquil sleep (Anonymous 1930) without sequelae. Despite its political disenfranchisement, Fishbein (1942) still advocated oral preparations of cannabis in treatment of menstrual (catamenial) migraine. Cannabis remained in the British armamentarium somewhat longer, and was extolled above opiates and barbiturates in the treatment of the pain of hospitalized patients with duodenal ulcers (Douthwaite, 1947). In Tashkent in the 1930's, cannabis or nasha was employed medicinally, despite Soviet prohibition (Benet 1975) for headache and pain of defloration. In Southeast Asia, cannabis remains useful (Martin 1975). Everywhere it is considered to be of analgesic value, comparable to the opium derivatives. Moreover, it can be added to any relaxant to reinforce its action. Cooked leaves, which have been dried in the sun, are used in quantities of several grams per bowl of water. This decoction helps especially to combat migraines and stiffness. In a book about medicinal plants of India (Dastur, 1962) Charas [hashish] --- is a valuable narcotic, especially in cases where opium cannot be administered; it is of great value in malarial and periodical headaches, migraine, acute mania, whooping cough, cough of phthisis, asthma, anaemia of brain, nervous vomiting, tetanus, convulsion, insanity, delirium, dysuria, and nervous exhaustion; it is also used as an anaesthetic in dysmenorrhea, as an appetizer and aphrodisiac, as an anodyne in itching of eczema, neuralgia, severe pains of various kinds of corns, etc.In Colombia the analgesic effects of a cannabis tincture were lauded (Partridge 1975) "the knowledge that cannabis can be used for treatment of pain is widespread." Rubin documented extensive usage of cannabis in Jamaica for a variety of conditions (Rubin, 1976; Rubin and Comitas, 1972), including headache. In Brazil, Hutchinson (1975) "Such an infusion [of leaves] is taken to relieve rheumatism, "female troubles", colic and other common complaints. For toothache, marijuana is frequently packed into and around the aching tooth and left for a period of time, during which it supposedly performs an analgesic function".  Cannabis and Cannabinoids as Medicine Cannabis Proper Cannabis is traditionally employed therapeutically by smoking or ingestion. Grotenhermen has produced an excellent summary of "Practical Hints" (Grotenhermen, 2002), as have Brazis and Matthre (1997) and Russo (2002). Dosing of therapeutic cannabis must be titrated to the patient's need. In general, 5 mg of THC content represents a threshold dose for noticeable effects in the average adult (Grotenhermen 2002). Whereas tolerance to cardiovascular effects (tachycardia) and psychoactive effects ("high") are achieved after some days to weeks of chronic usage, observed clinical and "anecdotal" reports support retention of analgesic efficacy over the long term. Occasionally, upwards dose titration is necessary, as is true for any agent.Allergies to cannabis are rare, although some may experience rhinitis symptoms, particularly when exposed to the smoke of the unrefined product. People employing cannabis therapeutically must be warned of the usual caveats assigned to any potentially sedative drug: due care with operation of machinery, motor vehicles, etc., which are analogous to the industry warnings for Marinol® (synthetic THC).Acute over-dosages of cannabis are self-limited, and most frequently consist of panic reactions. These are uniquely sensitive to reassurance ("talking down") and are quite unusual once a patient becomes familiar with the drug. Cannabis has a unique distinction of safety over four millennia of analgesic usage: No deaths due to direct toxicity of cannabis have ever been documented in the medical literature. Some cannabis-drug interactions are apparent, but are few in number. Additive sedative effects with other agents, including alcohol, may be observed. Similarly however, additive or synergistic anti-emetic and analgesic benefits may accrue when combining dopamine agonist neuroleptics and cannabis (Carta, Gessa, and Nava 1999). Cannabis may accelerate metabolism of theophylline, while slowing that of barbiturates. Anticholinergic-induced tachycardia may be accentuated by cannabis, while this effect is countered by beta-blockers (Grotenhermen 2002). Indomethacin seems to reduce slightly the psychoactive and tachycardic effects of cannabis (Perez-Reyes et al. 1991). As discussed above, synergistic analgesic benefits may accrue with concomitant usage of cannabis and opioids (Cichewicz et al. 1999; Hare 1887). CBD is a powerful inhibitor of cytochrome P450 isozymes 3A4, 2C19, and 2D6 (Bornheim et al. 1994; Bornheim and Grillo 1998) indicating the need for caution in cannabis patients taking that component in conjunction with fentanyl, sildenafil (Viagra®), tricyclic antidepressants and anti-arrhythmic drugs. Crude cannabis contains most of its THC in the form of delta-9-THC acids that must be decarboxylated by heating to be activated. This occurs automatically when cannabis is smoked, whereas cannabis that is employed orally should be heated to 200-210šC. for 5 minutes prior to ingestion (Brenneisen 1984). Contrary to disseminated propaganda in the USA, average cannabis potency has varied little over the last 3 decades (ElSohly et al. 2000; Mikuriya and Aldrich 1988). It is true that the maximum potency has increased through applied genetics, cultivation and harvesting techniques. This goal is achieved through production of clonal cultivation of the preferred female plants and maximization of the yield of unsterilized flowering tops known as sinsemilla (Spanish for "without seed"). In this manner a concentration of glandular trichomes where THC and therapeutic terpenoids are produced is effected. Resultant yields of THC may exceed 20% by weight. This is potentially advantageous, particularly when smoked, because a therapeutic dosage of THC is obtained with fewer inhalations, thereby decreasing lung exposure to tars and carcinogens. As noted by Professor Wayne Hall (Lords 1998).Indeed, it is conceivable that increased potency may have little or no adverse effect if users are able to titrate their dose to achieve the desired state of intoxication. If users do titrate their dose, the use of more potent cannabis products would reduce the amount of cannabis material that was smoked, thereby marginally reducing the respiratory risks of cannabis smoking. A considerable concentration of THC, other cannabinoids and terpenoids may also be achieved through some simple processing of crude dried cannabis. Techniques for sieving or washing of cannabis to isolate the trichomes to produce hashish are well described (Clarke 1998; Rosenthal, Gieringer, and Mikuriya 1997), and may produce potential yields of 40-60% THC. Clarke demonstrates a simple method of rolling the resultant powdery material into a joint of pure hashish, termed "smoking the snake" (Clarke 1998), providing a relatively pure product for inhalation. Cultivation techniques are beyond the scope of this review, but emphasis should focus on potent medicinal strains, scrupulous organic cultivation of female plants, clonal selection and augmentation, and appropriate processing with a high degree of quality control throughout the process. It deserves emphasis that clinical cannabis patients benefit from consistent quality and dosing. This is extremely difficult to achieve on a practical basis, unless cloned cannabis strains or standardized extracts are employed. Additionally, although cannabis is often touted as relatively "pest-free," it is subject to predation by a number of insects, bacteria, viruses, fungi, etc. (McPartland, Clarke and Watson 2000). Cannabis strains in the USA are THC predominant, almost uniformly devoid of CBD content (Gieringer 1999). While this may be appropriate for certain medical conditions, patients with concomitant muscle spasm, anxiety, seizure disorders, or susceptibility to psychoactive effects may not achieve optimal results. The labor required to manage cannabis genetics, culture, maintenance of "organic" technique without contamination, processing and quality control are likely beyond the ken and capabilities of most patients, particularly those with chronic pain.It remains the case that smoked cannabis is a crude delivery system with some inherent respiratory risk. This fact, taken with the inability to develop smoked cannabis into an FDA-approved medicine in the USA, makes the development of alternative rapid-delivery cannabis-based systems mandatory. Oral Use of Cannabis A variety of issues attend oral cannabis administration. The most important concerns bioavailability. Oral absorption of cannabinoids is slow and erratic at best, often requiring 30-120 minutes. In HIV positive or chemotherapy patients and in acute migraine, nausea and emesis may preclude oral usage altogether. Additionally, oral THC is subject to the "first pass effect" of hepatic metabolism yielding 11-hydroxy-THC, considerably more psychoactive than THC itself. Thus, some patients become ³too high² even on low doses of medicine, such as 2.5 mg of THC as dronabinol. Advantages of oral usage are its avoidance of lung exposure in those who are immunosuppressed or have impaired pulmonary function, and its prolonged half-life. This may be of advantage for nocturnal complaints where sedation is less of an issue.Grotenhermen suggests dose titration beginning with the equivalent of 2.5 mg of oral THC bid with increases as needed and tolerated (Grotenhermen 2002). Most painful clinical conditions require tid dosing of cannabis. THC, CBD and terpenoids are all highly lipophilic. Gastrointestinal absorption is markedly enhanced by inclusion of lipids in the cooked preparations. Therapeutic tincture extraction in alcohol is also possible. Smoked Cannabis Techniques of smoking cannabis are legion. Pharmacodynamically, smoking would be an ideal method of application of clinical cannabis, but for the attendant pulmonary issues. Clinical effects are noted within seconds to minutes after smoking. Inhalation avoids the first pass effect that hampers oral use, and allows effective dosage titration. When symptoms return, repeat dosage is achieved quickly and easily. Overdosage is frequently avoidable.Traditional smoking techniques in the USA make prolonged holding of a marijuana "toke" de rigueur. From a dose-response standpoint, this is unnecessary. Inhaled THC is well absorbed after a very brief interval, and subjective high and serum THC levels do not increase beyond a maximum 10-second inhalation. Furthermore, prolonged breath holding under pressure increases the potential for hypoxia or pneumothorax. Contamination of herbal cannabis by pesticides, herbicides, and bacterial or fungal agents is possible, and may represent a threat to the smoker, especially immunosuppressed patients. Scrupulous cultivation techniques avoid some of these issues. McPartland recommends pasteurization of herbal cannabis by heating in an oven of 150C. for 5 minutes (McPartland 2001). Waterpipes and bongs are popular techniques for cooling smoke. While they may reduce particulate matter as well, THC content and pharmaceutical efficiency also seem to be compromised. Surprisingly, the unfiltered ³joint² seems to represent the most efficient means for conventional smoking, although use of hashish in a pipe (without tobacco) was not examined.  Vaporizers for Cannabis AdministrationVaporization of herbal cannabis may allow delivery of THC and terpenoid components below the flash point of the leaf, thereby reducing exposure to smoke, tar and carcinogens. The technology has been hampered in its development by paraphernalia laws. Initial investigations of available devices had disappointing results, but further studies have demonstrated promising benefits on avoidance of carcinogenic components from smoking (Gieringer 2001). Research continues. Sublingual Tincture of Cannabis This method of administration is under investigation by GW Pharmaceuticals in the United Kingdom employing combinations of specific strains of cannabis that are rich in THC or CBD. Terpenoids and other minor components that are important to therapeutic effects of cannabis are retained. Dose-metered sublingual sprays are currently in Phase 2 and 3 clinical trials for a variety of indications. Initial results indicate good bioavailability and excellent patient tolerance and clinical effects. Painful conditions have been of particular note in this research.  Aerosol THC Preparations Cannabis has a long history of use in asthma, even as a smoked preparation. A pure THC aerosol has been attempted numerous times in the past. Physical and delivery issues have been challenging, but more interestingly, pure THC seems to have an irritating and even bronchoconstrictive effect when employed in isolation (Tashkin et al. 1977). Some authors believe that anti-inflammatory effects of concomitant terpenoid and flavonoid administration are necessary for full effects and tolerance in pursuit of the pulmonary route. Further research is underway by GW Pharmaceuticals, Inhale Therapeutic Systems, and possibly others. Marinol® (dronabinol, synthetic THC) Marinol® is a synthetically derived THC dissolved in sesame oil, developed by Unimed Pharmaceuticals. It is available in capsules of 2.5, 5 and 10 mg and is marketed in the USA, Canada, Australia, and some areas in Europe. Until 1999, Marinol® was a Schedule II drug in the USA with close scrutiny to its usage, which was restricted to indications of AIDS-associated anorexia and cancer chemotherapy. After safety studies revealed a low potential for abuse or diversion, dronabinol was "down-scheduled" to Schedule III in 1999, allowing refill prescriptions for up to 6 months, and its "off-label" administration for any indication. Clinicians have utilized Marinol® to only a limited degree. Its bioavailability is only 25-30% of an equivalent smoked dose of THC (Association 1997). Additional problems include the first pass effect of hepatic metabolism, which results in the production of a more psychoactive metabolite 11-hydroxy-THC, and its considerable cost, which may exceed US $600 per month for the lowest dosage of 2.5 mg tid. Considerable anecdotal data supports preference by patients of smoked cannabis over dronabinol.  NabiloneNabilone is a synthetic cannabinoid said to be pharmacologically similar to THC, but more potent, less apt to produce euphoria, and possessing lower "abuse potential" (Association 1997). It is produced by Eli Lilly Company as Cesamet® and is available in the UK, Canada, Australia and certain countries in Europe as an agent for nausea in chemotherapy. Some scattered reports have noted benefit on spasticity in MS, and effects on dyskinesias. A group in the UK assessed analgesic effects of nabilone in patients including some with neuropathic pain (Notcutt, Price, and Chapman 1997). Side effects of drowsiness and dysphoria were troubling. Several patients claimed improved pain relief and fewer side effects with smoked cannabis and preferred it to this legal alternative. Nabilone's cost was also estimated to be 10 times higher than cannabis even at black market rates. Future Directions and Needs Future directions for research on cannabis and cannabinoids will be primarily determined by political factors. Studies with smoked cannabis in the USA will continue under constraints imposed by NIDA: limited access to low potency smoked marijuana with rigorous oversight. Such studies may have limited applicability to the actual potential of true medical-grade cannabis or cannabis-based medicine extracts. Herbal cannabis as a smoked medicine will never fulfill FDA guidelines to become a prescription medicine. Such a process requires absolute standardization of constituents, rigorous quality control, bacteriological purity, safety, reliability, reproducibility, and uniform dose titration. In contrast cannabis-based medicine extracts, whether employed sublingually or via aerosol, can easily meet this burden and will likely achieve market approval in Europe and Canada within months. Sidebar: Dr. Russo's Findings and Policy Recommendations 1) Cannabis has a long and documented history in the treatment of neuropathic, musculoskeletal, spasmodic, and inflammatory pain conditions. Cannabis has a historical role as a palliative agent in terminal patients2) Additional adjunctive antidepressant and anti-anxiety properties of cannabis, as well as its anti-spasticity, and appetite stimulatory effects offer important therapeutic value in pain management patients. 3) Modern pharmacological and receptor studies of cannabis and cannabinoids support therapeutic claims.4) Cannabinoids represent an important parallel system to the endogenous opioid system of pain modulation, and administration of cannabinoids can effectively synergize opioid responses while mitigating side effects. Cannabinoids show unique promise in treatment of neuropathic pain.5) Historically, governmental commissions have almost uniformly recommended allowance or provision of cannabis for medical indications including pain.6) Financial investment in research into cannabis and cannabinoid strategies for pain management are deserving of support by medical and governmental organizations. 7) Current research supports the contention that no single agent will ever possess the spectrum of synergistic activity of whole cannabis.8) Alternative delivery systems for whole cannabis and especially its standardized extracts represent the logical methods for administering this medicine to pain patients.9) These practical and effective methods of cannabis administration (sublingual and inhaled CBME) in painful conditions are available now in other countries with imminent licensure. Government agencies should expedite efforts to provide comparable access to rapid onset alternative methods of delivery of standardized cannabis-based medicine extracts to deserving patients, or, alternatively until their approval, re-open the Compassionate Use IND, with the availability of potent, well manicured sterilized cannabis. I believe that the USA should provide expedited access to cannabis-based medicine extracts and appropriate synthetic cannabinoids by patients with pain conditions, or, re-open the Compassionate Use Investigational New Drug (IND) program to provide potent, well-manicured medicinal-grade cannabis to chronic pain patients.URL: http://cannabishealth.com/issue06/index.html Source: Cannabis Health (Canada)Author: Ethan Russo M.D.Published: August 2003Copyright: 2003 Cannabis Health MagazineContact: editor cannabishealth.comWebsite: http://www.cannabishealth.comRelated Articles:The Missoula Study - Austin Chroniclehttp://cannabisnews.com/news/thread16656.shtmlTranscripts: Ethan Russo MD: CNews Chat http://cannabisnews.com/news/thread15220.shtmlAsk Dr. Ethan: Canadian Medical Marijuana Journalhttp://cannabisnews.com/news/thread14326.shtmlStudy Shows Therapeutic Benefits http://cannabisnews.com/news/thread10581.shtml

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Comment #57 posted by SoberStoner on August 28, 2003 at 18:36:05 PT
Here's what I dont understand
The FDA has no authority over many dietary or herbal supplements, many of which are incredibly harmful. The very fact that the agency is supposed to be for pharmacetical drugs would seem to dicate it has no authority to make any classification on the cannabis plant as it is a naturally occuring substance.Dr Russo, I've always admired your work and I wish you luck with whatever you do, I hope you will continue to grace us with your knowledge.While I think that all of us that visit here want cannabis rescheduled as fast as possible, I do think Dr. Russo has a point. The FDA is de facto owned by the pharma-tech pushers. They will NEVER declassify cannabis as doing so will cost the pharm corporations quite literally billions of dollars a year.The government is not on our side, thinking the government will do something to help us is not only wrong, it could very well be suicidal for our cause. SS
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Comment #56 posted by FoM on August 27, 2003 at 21:18:26 PT
ekim 
Tom and Rollie have been on my mind a lot lately. If you see an article please post it. I will start checking out the South Bend Tribune. I remember as clear as day when I heard that Rainbow Farm was under attack by the Feds. I emailed a frantic note in Map Staff and said someone will die. I know it. I felt it and it was a horrible feeling. We know the end. 
Tom & Rollie Memorial Page
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Comment #55 posted by ekim on August 27, 2003 at 21:06:03 PT
yes a film on the farm would be good
man when i think of all the wonderfull time and nice people i have met at the farm i dont know what to do. how can you explain something like that to someone who has never known real freedom. --on Mon morning those most touched will be walking from the farm to the courthouse. i take that back those who can make it will be walking cause i know many more that have been deeply touched can not make it. long live RAINBOW
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Comment #54 posted by Motavation on August 27, 2003 at 20:19:39 PT:
*****LAMBORGINI DIABLO*****
E J, I think its more like a LamborginiDiablo........
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Comment #53 posted by FoM on August 27, 2003 at 16:48:03 PT
Handbook of Psychotropic Herbs
In Doctor Russo's book on page 21, Chapter 2 it explains about the regulations of botanicals in the U.S. I'm going to read it. It has a lot of detail. It might help explain about the FDA.
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Comment #52 posted by Jose Melendez on August 27, 2003 at 16:27:53 PT
reason prevails
http://www.reason.com/links/links082703.shtml
Like Red Wine for Chocolate
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Comment #51 posted by E_Johnson on August 27, 2003 at 15:49:34 PT
Postmodernists validated by GW
Back in the nineties, a lot of people in science were very outraged by the postmodernist critiques of science being published in journals like Social Text.Science is not about truth, the pomos said. Science is inherently an economic activity and as such also a political activity, scientific objectivity can't even be defined in that context, let alone defended, the pomos said.No, science is about TRUTH the defenders of science said.And as an example the put forward Galileo, victimized for understanding the solar system and being honest about it in front of the Church.Science is about speaking the truth to power. That was supposed to be the lesson taught about science by the saga of Galileo.But back in the nineties there was also an article in Scientific American where scientists from GW discussed medical marijuana and the problem of it being illegal.The article concluded that the "scientific solution" to this problem was to develop patentable cannabinoid products, as they are doing now.Postmodern critics of science should find the Scientific American article by GW scientists very validating, because GW also defines science as an economic activity whose inherent value does not lie in producing the truth, but rather in making new products to expand the modern consumer economy. I don't think that's what Galileo had in mind when he put his own life at risk.
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Comment #50 posted by FoM on August 27, 2003 at 13:48:04 PT
I've Never Understood Why Cannabis Isn't an Herb
The A to Z Guide to Healing Herbal Remedies by Jason Elias and Shelagh Ryan Masline, 1995, gives an insightful explanation about why the FDA has not approved herbs for medicinal use: "An herb, unlike a drug cannot be patented by any one company in the United States--which means that manufacturers of these remedies have little incentive to brave the costly and lenghty gauntlet of the FDA's approval process...therefore, the FDA cannot allow the packager of herbal products to make any healing claims on the labels of their products...the FDA does not permit warning of any possible side effects of herbs." http://asiarecipe.com/herb.html#4
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Comment #49 posted by FoM on August 27, 2003 at 13:34:35 PT
BGreen
Herbs are not approved by th FDA but can be discussed with a Doctor I believe. I was trying to find what the laws in the U.S. are concerning herbs in general last night but couldn't find what I was looking for.
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Comment #48 posted by BGreen on August 27, 2003 at 13:29:41 PT
Cannabis is like Ginkgo
The FDA doesn't have to approve cannabis as medicine for me to be able to glean the positive herbal effects. Ginkgo was recommended by my optometrist for the circulation in my eyes and Ginkgo isn't approved by the FDA. My optometrist also recommended cannabis because of a family history of glaucoma. I consider the recommendation of cannabis NO different than the recommendation of Ginkgo.The work by Dr. Russo helps to bolster our argument that CANNABIS IS AS SAFE AS ANY SUBSTANCE COULD POSSIBLY BE! Every single prohibitionist argument is being disproved by the research into the synthetic cannabinoids and whole plant extracts.Every time I read that the synthetic or extract "works as well as cannabis" or that "cannabis shows no more effective than codeine in pain reduction" these are validations of our plant.The FDA approves chemicals even though they may cause death in a "statistically insignificant" number of people. The families of those "statistically insignificant" people may disagree that their loved one wasn't important, so FDA approval means NOTHING!Cannabis is HERBAL MEDICINE! Let the research continue and the expensive synthetics be produced because all of the comparisons will still be with the cannabis plant, and about the only way we can get scientists to study cannabis is to let them use it to compare their synthetics to.The study on the AIDS patients released last week showed SMOKED CANNABIS to be MORE EFFECTIVE than the synthetic alternative with no major side effects. This is the kind of research that helps bolster our position. If we can discredit the prohibitionist's lies about cannabis it will force them to change their party line (lies) more often than they do now and it will be easier for the masses to detect the stench of BS coming from walters and his evil puppet brigade.The Rev. Bud Green
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Comment #47 posted by FoM on August 27, 2003 at 13:22:12 PT
Swampie
It's good to see you posting. Hopefully soon you will be able to be on line more. Glad you like what's happening here. I like it too. We're having very stormy weather. Hope all is well up north. We lost power for almost 4 hours last night. Interesting time listening to the woods. So full of life.
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Comment #46 posted by E_Johnson on August 27, 2003 at 12:38:52 PT
Clarification
Science does more than JUST serve the needs of the status quo but I differentiate scientific knowledge from the science community.Scientific knowledge serves all humanity for eternity, but at the same time, the scientific community ends up serving the needs of the status quo in their own time.I've seen this happen so many times.One professor at caltech has a brother who needs medical marijuana. Bill Clinton came to visit Caltech, and this prominent scientist was in the group allowed to meet with him.Did he mention medical marijuana?No, his mission in that meeting was to sercure funding for his own research, and standing up for medical marijuana would have put the damper on that, for sure.He told me, "Sometimes you just have to make compromises to get funding."My reply was, "When you sell yourself, be careful that you don't sell things that you can never buy back."
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Comment #45 posted by E_Johnson on August 27, 2003 at 12:30:58 PT
We need to involve the humanities now
I'm sorry if I was hard on Dr. Russo as a person. I know that one well-intentioned scientist cannot change the collective behavior of science as a social activity. Having been educated at a major science school, I have learned to be deeply skeptical about the potential of science to do anything but serve the needs and interests of the status quo.I'm 100% serious when I say that we should all be enrolling in writing workshops to bring our own personal truths and journeys into the realm of the humanities.There ought to be a movie about the Rainbow Farm tragedy, for one thing.We have so much excrutiating and ironic and outrageous tragedy going on in our community now that we have enough material for many many many dramatically comelling and heart wrenching novels and films.
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Comment #44 posted by Richard Paul Zuckerm on August 27, 2003 at 12:18:38 PT:
PEACE WITH HEMP FUEL; NOT FOSSIL FUEL WARS!!
The September 11, 2001, airplane crashes, the war in Iraq, and the concealment of the truth by the newspapers and television from the American sheeple, are part of the plan of the Bush/Rockefeller/Vatican Illuminati, for global control of our fuel, IRAQI COMMANDER SWEARS HE SAW USAF FLY SADDAM OUT OF BAGHDAD, by Bill Dash, www.100megsfree4.com/farshores/sc04bd.htm, as part of the Pentagon's War against Dissent, HORRIFYING US SECRET WEAPON UNLEASHED IN BAGHDAD, by Bill Dash, www.100megsfree4.com/farshores/sc04bd.htm; to prevent us from living free from government control, which would easily be done thru the use of Hemp for fuel. See, e.g.:
www.hempcar.org; Shadow of the Swastika, www.sumeria.net/politics/shadv3.html.Why shouldn't be believe it was state-sponsored terrorism? The Bush and Rockefellers financed Adolph Hitler. See, e.g., www.tarpley.net; Shadow of the Swastika, supra. These government supremacists have lied their way to power since they coaxed the colonies to sign the Constitution with the promise of a Bill of Rights, which, by the way, was put together after the people rose up in arms as Congress wanted to instead revise the tax laws. See, e.g.: Hologram Of Liberty, www.javelinpress.com.Richard Paul Zuckerman, Box 159, Metuchen, N.J., 08840-0159, richardzuckerman2002 yahoo.com, (Cell telephone number)(908) 403-6990; Member of: www.normlnj.org; www.norml.org; www.cannabisculture.com; www.hightimes.com; www.aclu-nj.org; www.greenparty.org; www.njlp.org; www.jpfo.org; www.njmilitia.org; www.dav.org; www.fija.org;
Diploma in Paralegal, New York University, 2003;
Diploma in Truck Driving, Smith & Solomon School of Truck Driving, Edison, N.J., 1995;
B.A. in Political Science, Kean College of New Jersey [presently named Kean University], Union, N.J., 1987.
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Comment #43 posted by SWAMPIE on August 27, 2003 at 12:12:47 PT
Pain is no fun....
I had alot of pain when I had my lung punctured in Feb,and I give cannabis and Observer and the people at the chats doing cybertokes alot of credit from keeping my lung from collapsing.It helped with the pain that opioid pain killers didn't relieve,and also kept my lung inflated.If it wasn't for the good work you all do,I may not be here to write this comment.FoM,and all,we are still around,just not everyday.I have been copying to disc and reading at home til we get the phone back.So far,I like what I am reading,and will comment further as I have some reading to do.Take care.. ONWARD THROUGH THE FOGGGG!!!!!  KEN
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Comment #42 posted by E_Johnson on August 27, 2003 at 12:10:40 PT
If the Volcano were a car
If the Volcano were a car, it would be a Porsche that gets 100 mpg and produces emission-free exhaust.
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Comment #41 posted by E_Johnson on August 27, 2003 at 12:02:47 PT
Lehder, it's beyond their control
Individual scientists can disagree with prohibition all they want, but science as an organized human activity is designed to support and affirm the values of the status quo, and right now the status quo supports prohibition.Science can never describe the pain of seeing good people go to prison for no good reason. Science cannot respond to that pain, either, or do anything at all about stopping it.As for myself, I am working on a novel. I think that's a better way to express the truth about this situation.
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Comment #40 posted by FoM on August 27, 2003 at 11:41:10 PT
My Thoughts 
I'm thinking about this topic and have mixed feelings. I am a person who shuns pharmaceutical drugs. I've seen harm done by legal drugs. I believe that all good medicine will come from plants. Pills haven't been around long at all compared to plants. Just these last two weeks I had to give antibiotics for 10 days to my dog. I didn't want to. Every night crushing the pills made me agitated. I wanted something natural to use but the antibiotics helped him. He is better now. I had 5 major surgeries over the years and I don't know how I would have been able to get thru the pain without narcotics. We need good medicine now more then ever. 
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Comment #39 posted by Sam Adams on August 27, 2003 at 11:19:10 PT
Pick-an-organ!
EJ, very sorry to hear that you have to take Prednisone. I totally sympathize with you, I nearly died from severe bleeding ulcers from taking NSAIDS meds. They had to cauterize the inside of my stomach & duodenum with a laser to save me.  It's awfully hard to tolerate the arrogant physician community telling us that medical cannabis is a joke because it's smoked, when their meds nearly killed me. In fact, about 16,000 Americans die per year from NSAID-caused bleeding ulcers. Most are elderly patients taking NSAIDs for arthritis. Of course cannabis is a totally safe and effective pain killer AND anti-inflammatory.I think it's an interesting metaphor for the hypocrisy of modern American society. It's A-OK to destroy the inside of your body with a nice, pretty pill. But don't blow your smoke this way! It might make us doctors look like a bunch of 19th century snake-oil salesmen, god forbid. Image is everything in our strange Orwellian society. It's sickening to me. Don't tee off too badly on Dr. Russo though. This article is not a rah-rah piece for GW, the paragraph for sub-lingual tincture is the same size as the vaporizer one. I think it's horrible that GW's research and products will be ransomed to us for thousands of dollars. But who knows, maybe this will help our cause. Maybe when studies of GW's effectiveness in Canada and Europe come out, the US medical community will realize what a lying bastard the drug czar is (I'm assuming he's going to fight to keep GW's products OUT of the US).
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Comment #38 posted by Lehder on August 27, 2003 at 09:50:28 PT
those questions
are properly asked of GW Pharmaceuticals, and I was impulsive to rather unfairly direct them to Ethan. Myapologies for personalizing them.But answers should be demanded of the company. I've looked, and they are difficult to find because GWP is listed on European exchanges but not U.S. - no surprise there.One must ask: Does the activity of this company subvert or support the drug war, whatever the intention, if any, of its founders. As apublic corporation whose shareholders demand a profit, its effect on society will be determined by profits.Does this company offer only incremental improvements over the natural herb, and do its potential profits then depend on the maintenance of prohibition?Or does it envision a capability to deliver truly significant and life-giving advantages over the herb so that its profits can coexist with a free and legal market in the herb?Perhaps I will send for an annual report and see what can be gleaned from that. My expectation: probably nothing. We know for certain these days that many companies maintain powerful social agendas in the pursuit of profit, but they are mendacious or remain mute when questioned about their treatment, for example, of the environment.Many physicists, infamously moreso than physicians, have been torn within when questions of responsibility, morality and the welfare of humankind are personalized, and their record is hardly, overall, laudable. I'm glad there's such a nice discussion, and no one owes any personalized explanation to me, who for a time traded the comforts of an old car as home for the lucre of weapons and a questionalble young conscience. Yes, they're easy questions - I'm against aggressive war - but they have some difficult aspects. But I know who are, fundamentally, thefriends and the foes of humanity; I'm not so sure about GWP.
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Comment #37 posted by E_Johnson on August 27, 2003 at 09:45:18 PT
We should start some writers' workshops
Writing about the human cost of cannabis prohibition could be very therapeutic.And most people form their opinions of the world through fiction rather than science, actually.How many great compelling dramatic stories do we have within ourselves?The treasure of knowledge in cannabinoid science is something we can all appreciate, despite this controversy over whether cannabinoid science will ever keep anyone out of prison.But there are treasures of art in our experience that are even more valuable than anything they will find in sicnece.Fiction is something even prisoners can take part in.Writing Down Prohibition -- how's that for a catchy title?Now if only we had some qualified writer to teach a writing workshop....
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Comment #36 posted by Motavation on August 27, 2003 at 09:22:33 PT:
*****VOLCANO*****
I remember the first time I ever tried the VOLCANO. It was in Amsterdam for the 14th annual Cannabis Cup, at DeKals coffee shop. The Volcano is the way of the future. This piece of machinery is the best invention since the automobile. The Volcano is the Lamborgini of automobiles.I think the reason people don't take Vaporizer's seriously is becuase of all the low quality Vaporizers. Those Vaporizers that sell for 100 bucks are the Ford pintos of Vaporizers. Quality costs Money, The Volcano Rocks
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Comment #35 posted by E_Johnson on August 27, 2003 at 09:17:47 PT
Actually we need fiction even more than science
ACtually I think that what most of us shoud be doing right now is not relying on science but on the humanities. Not to say that cannabinoid science is not revolutionary and important. But there are the facts of cannabinoid science, and then there are the facts of scientific culture.Whereas cannabis science in terms of facts undermines prohibition, and individual cannabinoid scientists may themselves be against prohibition, scientific culture has ALWAYS been friendly to prohibition and will ALWAYS continue to be friendly to prohibition, no matter how individual scientists feel or what the truth itself dictates.Here is proof:Almost every single physicist I know is against marijuana prohibition. Why don't they speak up? Because in order to get money to do physics, they have to sign agreements with the government to support drug prohibition.So we have hundreds of individuals who individually are against prohibition, but as a group they actually serve the interests of prohibition quite well. And that's because of the way scientific culture is, and that will NEVER change.What we should all be doing is writing novels and memoirs about prohibition and its costs. SCreenplays, soap operas, whatever. Our human story is not going to be told by science. That's why we still have humanities departments in universities, because of all the things science cannot and will not do.So people -- start writing your novels and memoirs and plays and movies TODAY!
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Comment #34 posted by FoM on August 27, 2003 at 09:08:52 PT
EJ I'm Not Sure
I wanted to answer you but I don't know what to say. I'll keep thinking.
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Comment #33 posted by Jose Melendez on August 27, 2003 at 08:38:41 PT
E_J
We all have our demons. We probably all have conflicts of interest. I recognized long ago that vaporizers are probably the safest and easiest way to consume cannabis. Perhaps I'm addicted to the toluene or the carbon monoxide created as part of the combustion process. I know better than to pretend it's the cost, I could make one, if that was the case. Surely folks could steep their own pot in vodka and spray it under their tongues. By their substantial investment of resorces, GW Pharm is proof that you should be able to use your generic ganja, by whatever method makes you feel better. In today's climate, it must take incredible resolve to diplomatically jump through the hoops and over the hurdles it took to acheive what they have done, and I argue that those efforts have helped you, and all of us. Maybe the path they chose is not the only way. This is a similar issue to the Cowan/Kampia disagreement. We need this discourse, to flesh out ways to leverage prohibitionism into sustainable legal use, if that involves commerce, there will always be such issues. Keep writing, and try to keep in mind that others here are striving for the same goal. Dissent is fine, just remember that your enemies are the ones who would have you locked up, not those putting their livelihoods on the line . . .
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Comment #32 posted by E_Johnson on August 27, 2003 at 08:36:07 PT
FoM, good research needs to be objective
Research is great but FoM, it is not objective science to report that vaporizer technology is dismissable with a wave of the hand.I am not against research, I am against biased research that is biased to serve the economic interests of the party that funds the research.The section of Dr. Russo's report that dealt with vaporizers was deficient compared to what is known on the subject now, it was scientifically deficient. Vaporizers were dismissed with a wave of the hand.And this deficiency in objectivity very handily plays into the conclusion that only the products being developed by GW can really help people.But what if that is not the actual truth?Isn't science supposed to be about the actual truth?Science as they teach it in school is supposed to be about the ACTUAL truth, not the economically and politically possible truth.
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Comment #31 posted by FoM on August 27, 2003 at 08:11:34 PT
Just a Comment
I don't know what to say. I understand everyones issues. What I do know is Dr. Russo is the first Doctor that I felt even cares about our issue and that means so much to me. I loved a movie called The Medicine Man. Sean Connery was the star of the movie. I think of Dr. Russo as our Medicine Man. What if there could be a cure for cancer in one of the compounds of the Cannabis plant? We just don't know how much benefit we could gain from more dedicated research.Medicine Man: http://w1.860.telia.com/~u86014447/medicine.html
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Comment #30 posted by goneposthole on August 27, 2003 at 07:38:55 PT
laughable
Stop picking on Dr. Russo. Come on. Lighten up, and light up. Make it a good one.Module 44.1 Pharmaceuticals and drugs in the past- If you can find a copy of Bertha Dodge's Plants that changed the world in your library, skim over it, especially chapters 4 and 9. My copy was printed in 1962, and may be hard to find, so look around Dewey 581.61 for other similar titles.- Try reading any translation of Pliny the Elder's Natural History -- he is also known more formally as Gaius Plinius Secundus, and he may need to be looked up under that name. You won't learn a great deal of science or technology, but you will be gently amused.- Getting down to serious business, look for a library copy of D. J. Collins et al., Plants for Medicines, published by the CSIRO, and listed at $80 in their catalogue. This gives the details of alkaloid and anti-tumour screening by the CSIRO of nearly 2000 species, and is a specialist work which could be dipped into by an interested student.- "Aspirin", Scientific American, January 1991, 58-64.** Now for some addiction: three articles in , New Scientist, 1/10/1994: "Prisoners of pleasure": 26-31, "How to heal the body's craving":32-37, "The highs and lows of prohobition": 38-41.----------------------- For an unusual sidelight on antibiotics, see "Ants and antibiotics", Ecos 61, 27-28. Some ants use antibiotics to control the growth of bacteria in their "fungus gardens", deep down, inside their nest. http://www.powernet.nsw.gov.au/aplstrdl/ap_mod03.html
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Comment #29 posted by E_Johnson on August 27, 2003 at 07:33:23 PT
IT's self-serving to write off vaporizers
Dr. Russo, I'm sorry to have to say this, but I think you stepped away from the ideal of scientific objectivity when you so deftly disposed of vaporizers as a safer delivery tool than smoking.If everyone had a Volcano, who would want or need a spray that irritates the mouth?Your rapid dismissal of vaporizer technology was very disturbing to me.I have a Volcano right here, I am using it, and it delivers a wonderful clean and very effective vapor.Your report was deficient in this respect.And it would have been so EASY to include a GOOD and THOROUGH discussion of the Volcano that really I must wonder why you chose to disniss vaporizers as you did.Dismissal of vaporization serves the economic interests of Geoffrey Guy but it does not serve the interests of the TRUTH.The TRUTH is that the Volcano works so well it would put Geoffrey Guy out of business if it were legal.
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Comment #28 posted by E_Johnson on August 27, 2003 at 07:10:06 PT
Prednisone irritates EVERYTHING
One reason why I feel angry about this GW-serving dismissal of smoked marijuana as an approvable medicine is that I have to take prednisone, which irritates my digestive tract far more and with much worse implications for my future survival than marijuana irritates the lungs.This struggle is nopt a struggle for the possible Dr. Russo.It is a struggle for truth and dignity.It is not serving the cause of truth to dismiss smnoked marijuana as a medicine when every single day, people are being prescribed prednisone, which irritates amnd eventually destroys every single body membrane that it touches.NOT FAIRNOT OBJECTIVENOT TRUEI used to believe that scientists were supposed to fight for what is true.It is true that smoked marijuana is no more harmful to my lungs than prednisone is to my stomach and colon.Fight for the TRUTH DR. Russo, not for "what is possible" for us to accomplish by making Geoffy Guy a rich(er) man.
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Comment #27 posted by Sam Adams on August 27, 2003 at 06:51:54 PT
Don't forget, "operate in reality"-G.Johnson
One of Gov. Gary Johnson's 7 rules for living is "operate in reality". The reality is that most Prohibition stakeholders will NEVER accept any use of cannabis, medical or otherwise. This includes most government regulatory agencies.This article is aimed at medical doctors who may be on the fence regarding medical cannabis. The right-wing doctors will never come around, but if we can convince the more reasonable ones with practical arguments and facts couched in the terminology of "modern medicine", then maybe we'll get enough support to change the laws. Personally, I think our "modern medicine" system is rotten to the core. But, it's easier to change the system for one thing, the cannabis plant, than it is to overthrow the entire fascist governmental/medical paradigm.If Dr. Russo took an absolutist stance with this article, arguing in favor of radical political changes, the article would immediately be discounted by the medical community. If Dr. Russo could wave a magic wand and remove all cannabis laws from the books, I'm sure he would do it in a second. Instead he's taking all his experience in the medical community and deciding that this moderate approach is the most effective. I trust his judgement. Of course he thinks cannabis should be moved out of Schedule I. This purpose of the article is to cite all the evidence that cannabis has medical usage and is not addictive, these are the exact qualifications to move it out of Schedule I.
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Comment #26 posted by Ethan Russo MD on August 27, 2003 at 06:41:35 PT
Last Meant Last
I stand by what I have said, and what I have done. Take a look at the public record. I have never supported prohibition.No one should be criminalized for their use of an herb. I have no further explanations, nor apologies to offer.Should anyone like to call me a sellout, let them, but they will be wrong. There is nothing I can say or do that will change anyone's mind who believes that. The path I have taken has been difficult. Tomorrow is my last day in practice. I will be working full-time now in the area of phytopharmaceutical research and development with the aim that as many people around world will have access to cannabis medicines and other plant-based remedies. That is my sole motivation.The "movement" has a choice. It can continue to bicker and engage in internecine warfare, or it can seek common ground and move forward rationally to change a sorry chapter in the world's history.
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Comment #25 posted by goneposthole on August 27, 2003 at 06:38:17 PT
fish swim the oceans
Geese fly north in the spring, south in the fall. You can have the vaporizers, dronabinol, nabilone (could it be from a clam), I'll take my kind bud. It tastes the best of all. If you can snatch the draft.
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Comment #24 posted by Lehder on August 27, 2003 at 06:36:04 PT
i'll take some of that back
there's no reason that marijuana cannot be both prescribed and also generally legal. a physician can prescribe aspirin, for example. that's how it should be with marijuana too, and i'm sure that's ethan's attitude, unstated, as he indicates.
but we must be careful to not let a new source of profits become more ammunition for the drug wars. we are grateful to you, dr. russo, for your long and expert alliance. please don't forget in the world of big business who your friends are or your vow not to hurt.that's my last word.
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Comment #23 posted by Lehder on August 27, 2003 at 06:18:09 PT
mj for the people
"Rather, it is that they will not. A prescribed cannabis
   medicine that meets regulatory requirements will necessarily be consistent, reproducible,
   and having the lowest possible side-effect profile. It is only then that physicians will employ
   it for adults, children and elderly...."We all agree. But you skirt the question, and I'll put it to you bluntly: Do you not think that marijuana can be grown and safely used by the public without restrictive and expensive medical supervision?Do you imagine that only physicians are cool enough and intelligent enough to handle marijuana? It's not as if we are the Weather Underground asking you to drop acid to prove your veracity. We are gentle people. The questions are easy questions. Unless there's a conflict of interest.Have you become a marijuana elitist?If the above are your "last words" then they are hollow.
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Comment #22 posted by Ethan Russo MD on August 27, 2003 at 05:37:56 PT
My Last Word on this Subject
To all who have commented, I will say simply that in this business there is frequently a severe mismatch between what we think or desire, and what is possible to occur. Do you catch my drift at all?I have said what I believe to be true, and described the reality on the ground (as of January 2002 when the work on which this is based was originally submitted). It does not mean that I condone or defend the political status quo that surrounds cannabis.As I have stated repeatedly in every possible forum, the dangers of cannabis in any form have been scandalously and criminally misrepresented. It is not that the FDA cannot reschedule smoked cannabis. Rather, it is that they will not. A prescribed cannabis medicine that meets regulatory requirements will necessarily be consistent, reproducible, and having the lowest possible side-effect profile. It is only then that physicians will employ it for adults, children and elderly, and the government and third party payors will approve its use. This will take a very long time. Of that, I am certain.
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Comment #21 posted by Lehder on August 27, 2003 at 04:59:24 PT
footnote
I had to sleep on this paper before commenting, slightly cowed by the revelry, and made my remarks before reading EJ's. She's right. there's more than a loophole here, more than a threat - there are footsteps at our doors. Ethan?
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Comment #20 posted by Lehder on August 27, 2003 at 04:48:18 PT
2.9 Loud Cheers for Ethan Russo!
how refreshing to encounter this straigtforward paper that gently and credibly informs its readers of the long history of medicinal marijuana, one well documented fact after another, 
without brow beatings over what we MUST BELIEVE, whom we MUST IMPRISON, and how we MUST SACRIFICE all that we hold dear to SAVE THE CHILDEREN.the history of medicinal marijuana is presented here in a low-key voice that documents the herb's efficacy century after century, ailment after ailment. as the progression of the medicine's marvels is revealed seemingly without bound, the sheer weight of historical fact confronts thereader with the unspoken dilemma: how can this herb have been banned? how can this herb's curative and palliative wonders call for imprisonment of its beneficiaries?it is at once an informative history of marijuana as medicine and an artfully crafted implicit indictment of the war on marijuana that readers will perceive without coaxing. Whether it be the successes of its applications in 1400 BC or the 1800's of our own era, for asthma or migraine, tetanus or cramps, there comes a point for every reader when the question cannot be avoided: Where is the crime, who is the criminal?Nevertheless, there is a threat to our cause here in the last paragraph:>>Herbal cannabis as a smoked medicine will never fulfill FDA guidelines to become a
   prescription medicine. Such a process requires absolute standardization of constituents,
   rigorous quality control, bacteriological purity, safety, reliability, reproducibility, and
   uniform dose titration. There's a danger here that the good properties of marijuana will be usurped and monopolized by the pharmaceutical industry, while the millions of casual smokers who find their lives enhanced by marijuana will remain imprisoned and reviled. Let's not leave open this loophole for the continuing genocide of our people.
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Comment #19 posted by Rev Jonathan Adler on August 26, 2003 at 23:23:50 PT:
Dr. Russo Rocks! You go Boy!
Aloha Ethan. Excellent reference paper and the most information available for the lay person currently. All interested parties should bone up on the truth about pot.
It seems all of the arguments against it were BS and incomplete research has always been used to stigmatize God's greatest plant gift. Let's follow Ethan's lead and use scientific fact and study the true effects of good cannabis legally. I am still hoping to be his best source in the long run. Peace Out and keep planting the truth flower.
Hawaii Medical Marijuana Institute
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Comment #18 posted by E_Johnson on August 26, 2003 at 21:44:41 PT

What about Schedule I?
Dr. Russo, this article makes it appear that you do not believe that cannabis needs to be rescheduled. Do you believe that it needs to be rescheduled? If you believe so then why not mention it here?
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Comment #17 posted by E_Johnson on August 26, 2003 at 21:37:47 PT

Look don't get your hopes up
The war against the plant is a powerful political lobby. I don't see anything in this report that they will find to be a challenge to waging their brutal vendetta.In fact it says the plant itself will never be approvable by the FDA.That to me means only one thing -- more people going to prison for growing the plant.More guns, more seizures, more prisoners.I guess other people find this document hopeful.To me it actually sounds like it brings the sound of heavy boots closer to my doorstep.I hope we all survive all of this wonderful science. Personally I'm beginning to doubt it.
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Comment #16 posted by 420eh on August 26, 2003 at 20:10:34 PT

Does Ann have a copy????
it seems here in canada our health minister keeps telling reporters etc that there has never been a study on cannabis's medical benefits. she has told us she will stop selling it to sick people if the goverment wins an appeal on a court challenge...this lady really needs to read this article and get her facts straight.420eh
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Comment #14 posted by ekim on August 26, 2003 at 19:54:13 PT

good going Doc you make us proud
would you concider calling in to our cable access program, Aug 22 here in MI. we will have the Rep. of MI. Norml and the cop cowboy Howard will be calling in from somewhere on his 3000 mile trip. Detroit and Ann Arbor will be puting Med Cannabis issues on the ballot next fall. Maybe you could call in and say a little about your study. The show is one hour with 15 for intro for Norml and 15 for call from Howard and if you call around 7;30 pm we could do a little on Med. use and give a few references for people to get info.
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Comment #13 posted by Patrick on August 26, 2003 at 18:17:38 PT

Great article Dr. Russo!
I think every politician should be mailed a personal copy.At the same time I can picture them all commenting, after actually reading your article, something like... "I still do not see any medical value in marijuana. Until our scientists and doctors can show some degree of medical value, we will have to enforce Schedule 1 and continue to incarcerate any citizen having the nerve to grow this illegal plant in clear violation of our existing laws against it. The law must be enforced. Even to the point of lethal force and confisication of private property. Until medical value can be shown we will enforce current drug laws. In fact, a vote for me in the next election is a vote to protect your children from the scourge of illegal drugs. Ad nausem, yada yada, blah blah...."
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Comment #12 posted by E_Johnson on August 26, 2003 at 17:43:31 PT

Try the Volcano Dr. Russo
The Volcano is not disappointing at all. The Volcano rocks. You can run the same bit of bud through over and over again and get every last bit of cannabinoids out of it. This thing is pays for itself rapidly if you're fairly chronic and can't grow your own.http://www.vapormed.comEvery day I break off a little bit of bud and say to myself, that can't possibly last me all day long, it's barely enough for a Dionne Warwick joint. But with the Volcano, it really does last me all day.
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Comment #11 posted by OverwhelmSam on August 26, 2003 at 17:41:21 PT:

Great Article
I try to gage the ebb and flow of the war against marijuana based on the number and quality of the articles throughout the week. This was a well produced documentation of everything we know about marijuana now. Every member of Congress should get a copy. Facts will win the war.
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Comment #10 posted by Petard on August 26, 2003 at 17:08:44 PT

Bankrupting HMO's
Would be one way of achieving HMO reform. I'm the type that likes to force politicians and others hand. Cut out the hemming and hawing, end the stonewalling, and act. Debate is fine and dandy for things like speed limits, trade policies, taxes and such, but when people's lives and health are at stake, actions are required.Plus economically speaking, an increase in demand for a synthetic product could produce expanded supply and thus lower the price through economies of scale. Marinol should be coming up for generic status soon too, so an increase in demand might stimulate other marketers into increasing the supply. But, yeah, $6/pill is pretty stiff for about a joint's worth of synthetic THC. Still less expensive than some of the FDA approved products though.
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Comment #9 posted by Ethan Russo MD on August 26, 2003 at 16:39:03 PT

Comments Appreciated
Thanks for your comments.Marinol seekers should be aware that costs for the capsules range from $6 apiece for the 2.5 mg up to $17.25 for the 10 mg. As I said at NORML in 2001, going ahead with a prescription could bankrupt your HMO.
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Comment #8 posted by BGreen on August 26, 2003 at 16:31:01 PT

Petard
You don't even have to see your doctor in person. A schedule III prescription can be phoned into the pharmacy.Can you actually afford a prescription of marinol? A year's supply costs as much as my brand new house did 14 years ago.The Rev. Bud Green
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Comment #7 posted by phil_debowl on August 26, 2003 at 15:57:27 PT

2nd that thank you
thank you again Dr. Russo. You are a great contributer to the movement.
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Comment #6 posted by FoM on August 26, 2003 at 15:57:14 PT

BGreen
That's ok. My heart beat has returned to norml! LOL! I know what you mean about expecting reports that aren't true. I had a interesting conversation yesterday with a satellite technician. We were trying to find the source of my satellite not working yesterday. We changed a few things but he thought after going thru everything that my web page might not be working right. He asked me the name of it and I just told him. He was silent. I thought oh my what did I say. We talked about the Internet and it is our only life line to the truth in the news. I said we can't depend on the news on tv because it will be guided by whoever sponsors the channel. He said the work I was doing was admirable and necessary. He asked me if I ever went to a web site called the voice of america. http://www.voanews.com/index.cfm I said I did when the war was big news. Maybe with the Internet we will win. It's our only hope.
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Comment #5 posted by Petard on August 26, 2003 at 15:48:02 PT

Excellent work as always
and quite readable too, overall presentation was excellent.I find this particular portion very interesting: "dronabinol was "down-scheduled" to Schedule III in 1999, allowing refill prescriptions for up to 6 months, and its "off-label" administration for any indication."So in other words, I can go to my doctor and say "I've got migraines and want Marinol" and the doc can write me a 6 month scrip I can then take home, and use as I please as long as I don't re-distribute? Or I could claim any soft tissue chronic pain and request Marinol and get a 6 month supply of THC? Where's the commercials on TV imploring, "Ask your Doctor about Marinol" then? I'd damn sure want that over Rogaine (Hey, I've got THC who cares about hair loss), Lamisil (Hey, I've got THC who cares if I have athlete's foot), Celebrex (talk about celebrate, I got THC pills), all sorts of stuff.Plus the whiz test industry would be shot down. "Sure I'll fill your jar. By the way, here's my scrip for THC pills for my _____ condition."
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Comment #4 posted by BGreen on August 26, 2003 at 15:30:50 PT

Sorry, FoM
I'm so conditioned to expect lie after lie in anything I read about cannabis it was actually euphoric reading this article. I just felt happy and silly.The Rev. Bud Green
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Comment #3 posted by FoM on August 26, 2003 at 15:21:02 PT

Oh BGreen!
I was just folding clothes and listening to Greendale and saw your comment and my poor little heart sunk! I'm so glad your kidding! LOL!
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Comment #2 posted by BGreen on August 26, 2003 at 15:18:48 PT

Science?
How can this be science? Dr. Russo doesn't have one single quote from the DEAth or walters et al., joyce nalepka isn't screaming about the kids, nor is there any quote from the millions of "concerned" law enforcement agents.OK, this has been a total joke, just in case people aren't familiar with my writing and might somehow think I'm seriously attacking our beloved Dr. Russo.We're winning! Great work, Dr. Russo!The Rev. Bud Green
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Comment #1 posted by FoM on August 26, 2003 at 15:04:13 PT

Thank You Dr. Russo
I appreciate all your hard work. 
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