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Title: Should patients in chronic pain be allowed whatever pain remediation possible including the use of the strongest opioids such as heroin? (Algology)


1
Should patients in chronic pain be allowed
whatever pain remediation possible including the
use of the strongest opioids such as heroin?
(Algology)
  • Elizabeth Liu
  • Duy Tran
  • BINF705

2
Definition of Chronic Pain
  • Originally defined as pain that has lasted 6
    months or longer.
  • Pain that persists longer than the temporal
    course of natural healing that is associated with
    a particular type of injury or disease process
  • An unpleasant sensory and affective experience
    induced by the exposure to noxious stimuli i.e.
    injury incipient or substantive in nature. (The
    International Association for the Study of pain)

3
Management
  • It is rare to completely achieve absolute and
    sustained relief of pain. Thus, the clinical goal
    is pain management. Pain management covers the
    spectrum of medications, injections, infusions as
    well as neuroablative procedures. Therefore, pain
    management is often multidisciplinary in nature.
  • Medications
  • Opioids and non opioids
  • Antidepressants and Antiepileptic Drugs
  • Injection, Neuromodulation and Neuroablative
    Therapy
  • Rehabilitation

4
Medication
  • The drugs used in pain management may be broadly
    categorized as opioid and nonopioid medications.
  • Opioids are derived from opium, modestly
    effective analgesics in chronic pain management.
    However, they are associated with adverse
    effects, especially during the commencement or
    change in dosing and administration.
  • When opioids are used for prolonged periods drug
    tolerance, chemical dependency and addiction may
    occur.
  • The other major group of analgesics are
    nonsteroidal anti-inflammatory drugs. This class
    of medications has limited benefit in chronic
    pain disorders and with long term use is
    associated with significant adverse effects
  • OxyContin and Medical Marijuana are the two
    interventions for pain have been in the news
    recently

5
Controlled Substances Act (CSA)
  • Enacted into law by the Congress of the United
    States as Title II of the Comprehensive Drug
    Abuse Prevention and Control Act of 1970.
  • The CSA is the legal basis by which the
    manufacture, importation, possession, and
    distribution of certain drugs are regulated by
    the federal government of the United States. The
    Act also served as the national implementing
    legislation for the Single Convention on Narcotic
    Drugs.
  • The legislation created five Schedules
    (classifications), with varying qualifications
    for a drug to be included in each.
  • Two federal departments, the Department of
    Justice and the Department of Health and Human
    Services (which includes the Food and Drug
    Administration) determine which drugs are added
    or removed from the various schedules, though the
    statute passed by Congress created the initial
    listing. Classification decisions are required to
    be made on the criteria of potential for abuse,
    accepted medical use in the United States, and
    potential for addiction.
  • The Department of Justice is also the executive
    agency in charge of federal law enforcement.
    State governments also regulate certain drugs not
    controlled at the federal level.

6
Schedule I Drugs
  • Findings required
  • (A) The drug or other substance has a high
    potential for abuse.
  • (B) The drug or other substance has no currently
    accepted medical use in treatment in the United
    States.
  • (C) There is a lack of accepted safety for use of
    the drug or other substance under medical
    supervision.
  • No prescriptions may be written for Schedule I
    substances, and such substances are subject to
    production quotas by the DEA.

7
Schedule I Drugs Include
  • GHB (Gamma-hydroxybutyrate), which has been used
    as a general anesthetic with minimal side-effects
    and controlled action but a limited safe dosage
    range. It was placed in Schedule I in March 2000
    after widespread recreational use
  • 12-Methoxyibogamine (Ibogaine)
  • Cannabis (includes tetrahydrocannibinols found in
    marijuana, hashish, and hashish oil). Cannabis
    has legal medical uses in some countries and the
    U.S. Consequently, extreme controversy exists
    about its placement in Schedule I. Main article
    Cannabis rescheduling in the United States.
  • Dimethyltryptamine (DMT)
  • Heroin (Diacetylmorphine), which is used in much
    of Europe as a potent pain reliever in terminal
    cancer patients. (It is about twice as potent, by
    weight, as morphine.)
  • MDMA (3,4-methylenedioxymethamphetamine,Ecstasy),
    which continues to be used medically, notably in
    the treatment of post-traumatic stress disorder
    (PTSD).The medical community originally agreed
    upon placing it as a Schedule 3 substance. The
    government denied this suggestion from the
    medical community, without any discussion. The
    FDA approved this PTSD use in 2001.
  • Psilocybin, the active ingredient in psychedelic
    mushrooms

8
Schedule I Drugs Include Cont.
  • 5-MeO-DIPT (Foxy / Foxy Methoxy /
    5-methoxy-n,n-diisopropyltryptamine)
  • Lysergic acid diethylamide (LSD / Acid), which
    has historically been used to treat alcoholism
    and other addictions, helped to stop cluster
    headaches, and has been shown to be useful in
    treating schizophrenia, bi-polar, and other
    psychological disorders.
  • Peyote, one of the few plants specifically
    scheduled, which has a narrow exception to its
    illegal status for religious use by members of
    the Native American Church
  • Mescaline, the main psychoactive ingredients of
    the peyote cactus
  • Methaqualone (Quaalude, Sopor, Mandrax) It was
    previously used for similar purposes as used for
    barbiturates, until it was scheduled up.
  • 2,5-dimethoxy-4-methylamphetamine (STP / DOM)
  • 2C-T-7 (Blue Mystic / T7)
  • 2C-B (Nexus / Bees / Venus / Bromo Mescaline)
  • Cathinone (ß-ketoamphetamine) is a monoamine
    alkaloid found in the shrub Catha edulis (Khat).
  • AMT (alpha-methyltryptamine)

9
Schedule II Drugs
  • Findings required
  • (A) The drug or other substance has a high
    potential for abuse.
  • (B) The drug or other substance has a currently
    accepted medical use in treatment in the United
    States or a currently accepted medical use with
    severe restrictions.
  • (C) Abuse of the drug or other substances may
    lead to severe psychological or physical
    dependence.
  • These drugs are only available by prescription,
    and distribution is carefully controlled and
    monitored by the DEA. Oral prescriptions are
    allowed, except that the prescription is limited
    to 30 doses, although exceptions are made for
    cancer patients, burn victims, etc. No refills
    are allowed. Also, Schedule II drugs are subject
    to production quotas set by the DEA.

10
Schedule II Drugs Include
  • Cocaine (used as a topical anesthetic)
  • Methylphenidate (Ritalin)
  • Morphine
  • Phencyclidine (PCP)
  • Most pure opioid agonists meperidine, fentanyl,
    hydromorphone, opium, oxycodone (main ingredient
    in Percocet and OxyContin), or oxymorphone
  • Short-acting barbiturates, such as secobarbital
  • Amphetamines were originally placed in Schedule
    III, but was moved to Schedule II in 1971.
    Injectable methamphetamine has always been in
    Schedule II

11
Schedule III Drugs
  • Findings required
  • (A) The drug or other substance has a potential
    for abuse less than the drugs or other substances
    in schedules I and II.
  • (B) The drug or other substance has a currently
    accepted medical use in treatment in the United
    States.
  • (C) Abuse of the drug or other substance may lead
    to moderate or low physical dependence or high
    psychological dependence.
  • These drugs are available only by prescription,
    though control of wholesale distribution is
    somewhat less stringent than Schedule II drugs.
    Prescriptions for Schedule III drugs may be
    refilled up to five times within a six month
    period.

12
Schedule III Drugs Include
  • Anabolic steroids (including prohormones such as
    androstenedione and androstenediol)
  • Intermediate-acting barbiturates, such as
    talbutal or butalbital
  • Buprenorphine
  • Dradorn
  • Ketamine, a drug originally developed as a milder
    substitute for PCP (mainly to use as a human
    anesthetic) but has since become popular as a
    veterinary anesthetic
  • Xyrem, a preparation of GHB used to treat
    narcolepsy. Xyrem is in Schedule III but with a
    restricted distribution system
  • Hydrocodone / codeine, when compounded with an
    NSAID (e.g. Vicoprofen, when compounded with
    ibuprofen) or with acetaminophen (paracetamol)
    (e.g. Vicodin / Tylenol 3)
  • Marinol, a synthetic form of Tetrahydrocannabinol
    (THC) used to treat nausea and vomiting caused by
    chemotherapy, as well as appetite loss caused by
    AIDS
  • Paregoric
  • Phloemate

13
Schedule IV Drugs
  • Findings required
  • (A) The drug or other substance has a low
    potential for abuse relative to the drugs or
    other substances in schedule III.
  • (B) The drug or other substance has a currently
    accepted medical use in treatment in the United
    States.
  • (C) Abuse of the drug or other substance may lead
    to limited physical dependence or psychological
    dependence relative to the drugs or other
    substances in schedule III.
  • Control measures are similar to Schedule III.
    Prescriptions for Schedule IV drugs may be
    refilled up to five times within a six month
    period.

14
Schedule IV Drugs Include
  • Benzodiazepines, such as alprazolam (Xanax),
    chlordiazepoxide (Librium), diazepam (Valium),
    flunitrazepam (Rohypnol) (Note that Rohypnol is
    not used medically in the United States, and some
    states have placed it in Schedule I under state
    law.)
  • Zolpidem (sold in the U.S. as Ambien)
  • Dextropropoxyphene (sold in the U.S. as Darvocet)
  • Long-acting barbiturates such as phenobarbital
  • Some partial agonist opioid analgesics, such as
    pentazocine (Talwin)
  • Certain non-amphetamine stimulants, including
    pemoline and the pseudostimulant modafinil.

15
Schedule V Drugs
  • Findings required
  • (A) The drug or other substance has a low
    potential for abuse relative to the drugs or
    other substances in schedule IV.
  • (B) The drug or other substance has a currently
    accepted medical use in treatment in the United
    States.
  • (C) Abuse of the drug or other substance may lead
    to limited physical dependence or psychological
    dependence relative to the drugs or other
    substances in schedule IV.
  • Schedule V drugs are sometimes available without
    a prescription.

16
Schedule V drugs Include
  • Cough suppressants containing small amounts of
    codeine
  • Preparations containing small amounts of opium or
    diphenoxylate (used to treat diarrhea)
  • Pregabalin, an anticonvulsant and pain modulator.

17
Opioid
  • The main use is for pain relief. These agents
    work by binding to opioid receptors, which are
    found principally in the central nervous system
    and the gastrointestinal tract. The receptors in
    these two organ systems mediate both the
    beneficial effects, and the undesirable side
    effects.
  • There are four broad classes of opioids
  • endogenous opioid peptides (opioids produced
    naturally in the body)
  • opium alkaloids, such as morphine and codeine
  • semi-synthetic opioids, such as heroin and
    oxycodone
  • Fully synthetic opioids, such as pethidine and
    methadone.

18
History of Opioids
  • 1817, Friedrich Wilhelm Adam Sertürner reported
    the isolation of pure morphine from opium after
    at least thirteen years of research and a nearly
    disastrous trial on himself and three boys.
  • Morphine was the first pharmaceutical isolated
    from a natural product, and this success
    encouraged the isolation of other alkaloids
  • 1820, isolations of narcotine, strychnine,
    veratrine, colchicine, caffeine, and quinine were
    reported.
  • Morphine sales began in 1827, by Heinrich Emanuel
    Merck of Darmstadt, and helped him expand his
    family pharmacy into the massive Merck KGaA
    pharmaceutical company.
  • Codeine was isolated in 1832 by Robiquet.
  • Heroin, the first semi-synthetic opiate, was
    first synthesized in 1874, but was not pursued
    until its rediscovery in 1897 by Felix Hoffmann
    at the Bayer pharmaceutical company in Elberfeld,
    Germany.

19
History of OpioidsCont.
  • From 1898 through to 1910 heroin was marketed as
    a non-addictive morphine substitute and cough
    medicine for children.
  • By 1902, sales made up 5 of the company's
    profits, and "heroinism" had attracted media
    attention.
  • Oxycodone, a thebaine derivative similar to
    codeine, was introduced by Bayer in 1916 and
    promoted as a less-addictive analgesic.
    Preparations of the drug such as Percocet and
    Oxycontin remain popular to this day.
  • A range of synthetic opioids such as methadone
    (1937), pethidine (1939), fentanyl (late 1950s),
    and derivatives have been introduced, and each is
    preferred for certain specialized applications.
  • No drug has yet been found that can match the
    painkilling effect of opium without also
    duplicating much of its addictive potential.

20
Heroin
  • A semi-synthetic opioid.
  • It mimics endorphins and creates a sense of
    well-being upon entering the bloodstream It is
    thus used both as a pain-killer and a
    recreational drug.
  • The body responds to heroin in the brain by
    reducing (and sometimes stopping) production of
    the endogenous opioids when heroin is present.
    Endorphins are regularly released in the brain
    and nerves and attenuate pain. Their other
    functions are still obscure, but are probably
    related to the effects produced by heroin besides
    analgesia
  • Internationally, heroin is controlled under
    Schedules I and IV of the Single Convention on
    Narcotic Drugs.
  • It is illegal to manufacture, possess, or sell
    heroin in the United States however, under the
    name diamorphine, heroin is a legal prescription
    drug in the United Kingdom

21
Diamorphine (Heroin)
  • The UK Department of Health's Rolleston Committee
    report in 1926 established the British approach
    to heroin prescription to users, which was
    maintained for the next forty years dealers were
    prosecuted, but doctors could prescribe heroin to
    users when withdrawing it would cause harm or
    severe distress to the patient.
  • This "policing and prescribing" policy
    effectively controlled the perceived heroin
    problem in the UK until the 1960s.
  • 1964 only specialized clinics and selected
    approved doctors were allowed to prescribe heroin
    to users.
  • By 1970s, the emphasis shifted to abstinence and
    the prescription of methadone, until now only a
    small number of users in the UK are prescribed
    heroin.

22
Oxycodone
  • Oxycodone is a semi-synthetic opioid derived from
    the alkaloid thebaine, unlike most early
    opium-derived drugs which instead used the
    morphine or codeine alkaloids also found in the
    plant.
  • Oxycodone was first synthesized in a German
    laboratory in 1916, a few years after the German
    pharmaceutical company Bayer had stopped the mass
    production of heroin due to addiction and abuse
    by both patients and physicians. It was hoped
    that a thebaine-derived drug would retain the
    analgesic effects of morphine and heroin with
    less of the euphoric effect which led to
    addiction and over-use.
  • To some extent this was achieved, as oxycodone
    does not "hit" the central nervous system with
    the same immediate punch as heroin or morphine do
    and it does not last as long. The subjective
    experience of a "high" was still reported for
    oxycodone, however, and it made its way into
    medical usage in small increments in most Western
    countries until the introduction of the OxyContin
    preparation radically boosted oxycodone use.

23
OxyContin
  • OxyContin is a medically prescribed pill that
    contains Oxycodone,
  • A synthetic opioid with analgesic properties
    similar to opium-derived painkillers like
    morphine or codeine.
  • OxyContin is a Schedule II drug under the
    Controlled Substances Act (CSA), which includes
    legal drugs that are subject to the maximum
    amount of government control and regulation. The
    FDA approved OxyContin in 1995 and Purdue Pharma
    introduced the drug in 1996.
  • Unlike Percocet, whose potential for abuse is
    limited by the presence of paracetamol, OxyContin
    contains only oxycodone and inert filler

24
OxyContin Cont.
  • In 2001, OxyContin was the number one opioid
    painkiller sold and in 2000 over 6.5 million
    prescriptions were written.
  • OxyContin is prescribed for patients with
    moderate or severe pain who need extended relief
    from treatment of terminal cancer and severe
    injuries.
  • Addiction to OxyContin is rare for those who use
    the drug as recommended, however, due to pharmacy
    break-ins, growing levels of recreational use,
    and increased media reports of Oxycontin abuse,
    the DEA heavily regulates prescriptions.
  • Some pharmacies now no longer stock the drug and
    many doctors are afraid to prescribe OxyContin
    and other legitimate pain medications out of fear
    of government sanctions.
  • This stigmatizes patients in need of pain
    medication and makes it more difficult for them
    to obtain relief.

25
The Need For Pain Management
  • Natural opiate and synthetic derivatives have
    been lauded as excellent painkillers, while at
    the same time criticized as highly addictive
    substances.
  • Over the last two decades, the medical community
    has been more attentive to pain and pain
    management. As a result, the use of opioid
    medicine has increased, especially among cancer
    patients who were previously under treated.
  • According to the American Medical Association
    (AMA) and the National Institutes of Health
    (NIH), approximately 17 million Americans suffer
    from unyielding pain. A 1997 report by the AMA
    stated that a major problem in American medicine
    was inadequate treatment of pain. In addition,
    The American Pain Foundation estimates that 50
    million U.S. citizens suffer from significant
    pain daily.

26
What To Do About OxyContin
  • The National Foundation for the Treatment of Pain
    has concluded that OxyContin abuse is a minor
    problem compared to the millions of untreated,
    under treated, mistreated, and abandoned
    patients.
  • The FDA has stated that, "Although abuse, misuse,
    and diversion are potential problems for all
    opioids, including OxyContin, opioids are a very
    important part of the medical armamentarium for
    the management of pain when used appropriately
    under the careful supervision of a physician."
    The agencies will "help to ensure that these
    important drugs remain available to appropriate
    patients."

27
Medical Marijuana (Medical Cannabis)
  • Medical cannabis refers to the use of the drug
    Cannabis as a physician recommended herbal
    therapy, most notably as an antiemetic.
  • Cannabis has been used for medicinal purposes for
    over 4,800 years.
  • Surviving texts from Ancient India confirm that
    its psychoactive properties were recognized, and
    doctors used it for a variety of illnesses and
    ailments. (gastrointestinal disorders, insomnia,
    headaches and as a pain reliever)
  • Cannabis as a medicine was common throughout most
    of the world in the 1800s, It was used as the
    primary pain reliever until the invention of
    aspirin.
  • The term medical marijuana post-dates the U.S.
    Marijuana Tax Act of 1937, the effect of which
    made cannabis prescriptions illegal in the United
    States.
  • Later in the century, researchers investigating
    methods of detecting cannabis intoxication
    discovered that smoking the drug reduced
    intraocular pressure. (High intraocular pressure
    causes blindness in glaucoma patients)
  • In the 1970s, a synthetic version of THC, the
    primary active ingredient in cannabis, was
    synthesized to make the drug Marinol.
  • Users reported several problems with Marinol,
    however, that led many to abandon the pill and
    resume smoking the plant.
  • Patients complained that the violent nausea
    associated with chemotherapy made swallowing
    pills difficult. The effects of smoked cannabis
    are felt almost immediately, and is therefore
    easily dosed.
  • Marinol (Dronibanol), like ingested cannabis, is
    very psychoactive, and is harder to titrate than
    smoked cannabis.
  • Marinol has also consistently been more expensive
    than herbal cannabis. Some studies have indicated
    that other chemicals in the plant may have a
    synergistic effect with THC.

28
Medical Marijuana
  • Marijuana is the most commonly abused illicit
    drug in the United States. A dry, shredded
    green/brown mix of flowers, stems, seeds, and
    leaves of the plant Cannabis sativa, it usually
    is smoked as a cigarette (joint, nail), or in a
    pipe (bong). It also is smoked in blunts, which
    are cigars that have been emptied of tobacco and
    refilled with marijuana, often in combination
    with another drug. It might also be mixed in food
    or brewed as a tea. As a more concentrated,
    resinous form it is called hashish and, as a
    sticky black liquid, hash oil. Marijuana smoke
    has a pungent and distinctive, usually
    sweet-and-sour odor.
  • Marijuana is a Schedule I substance under the
    Controlled Substances Act (CSA). Schedule I drugs
    are classified as having a high potential for
    abuse, no currently accepted medical use in
    treatment in the United States, and a lack of
    accepted safety for use of the drug or other
    substance under medical supervision.

29
Medical Marijuana
  • It is illegal to possess cannabis under federal
    law in all fifty states.
  • While federal law does trump state law, most law
    enforcement regarding cannabis is handled at the
    state and local law enforcement level.
  • Currently, there are twelve states with effective
    medical marijuana laws on the books Alaska,
    California, Colorado, Hawaii, Maine, Maryland,
    Montana, Nevada, Oregon, Rhode Island, Vermont,
    and Washington. It should be noted that
    Maryland's law does not legalize possession of
    medical cannabis, but rather makes it
    unobtainable legally, the offense of which is a
    maximum penalty of a 100 fine.
  • Twenty Additional US States have resolutions on
    their books affirming the medicinal value of
    marijuana. (Alabama, Arizona, Arkansas,
    Connecticut, Georgia, Illinois, Louisiana,
    Michigan, Minnesota, New Hampshire, New Jersey,
    New Mexico, New York, North Carolina, Oklahoma,
    South Carolina, Tennessee, Texas, Virginia, and
    Massachusetts. Florida and Ohio formerly had
    medicinal marijuana resolutions that have since
    been repealed)
  • Eighteen US States do not recognize the medicinal
    value of marijuana.(Delaware, Florida, Idaho,
    Indiana, Iowa, Kansas, Kentucky, Mississippi,
    Missouri, Nebraska, North Dakota, Ohio,
    Pennsylvania, South Dakota, Utah, West Virginia,
    Wisconsin, and Wyoming. )

30
Facts On Medical Marijuana
  • University of Mississippi has grown marijuana
    since 1968 funded by Nature Institution on Drug
    Abuse (NIDA), then later by National Institution
    Health (NIH). Grow 1.5 to 6.5 acres of marijuana.
  • Every state residence voted for medical marijuana
    except South Dakota which is 48 to 52
  • According to the US government marijuana alone
    has never cause a death from overdose.
  • The British Lung Foundation reports that
    3-4 marijuana cigarettes a day are as dangerous
    to the lungs as 20 or more tobacco cigarettes a
    day.
  • A UCLA study found no association between
    marijuana and lung cancer.
  • In 1978 the U.S. government started the
    Compassionate Investigational New Drug (IND)
    program, which supplies about 300 marijuana
    cigarettes per month to seriously ill patients
    approved for the program. The program was shut
    down in 1991, but seven of those patients (as of
    7/31/06), continue to receive the free government
    marijuana.
  • Marijuana extracts were one of the top three most
    prescribed medicines in the United States each
    year from 1842 until the 1890s.

31
Four Categories of Pharmaceutical Drugs Based on
Marijuana
  • Drugs that contain chemical taken directly from
    the Marijuana Plat (1)

32
Four Categories of Pharmaceutical Drugs Based on
Marijuana
  • Drugs that contain synthetic versions of
    chemicals naturally found in marijuana (2)

33
Four Categories of Pharmaceutical Drugs Based on
Marijuana
  • Drugs that contain chemicals similar to those in
    marijuana but not found in the plant (6)

34
Four Categories of Pharmaceutical Drugs Based on
Marijuana
  • Drugs that do not work like marijuana but use the
    same brain pathways (4)

35
Pros of Medical Marijuana
  •  
  • Overwhelming that marijuana can relieve certain
    types of pain, nausea, vomiting and other
    symptoms caused by such illnesses as multiple
    sclerosis, cancer and AIDS. Compared with
    cigarettes and alcohol, the health risks and
    societal costs associated with even chronic
    marijuana use are mild. Yet we don't ban those
    items, while we deny marijuana to seriously ill
    people who could get a lot of relief from it.
    This is misguided and cruel.
  • Prohibition of marijuana doesn't work. It has
    only spawned an enormous black market, eroded our
    civil rights and corrupted our justice system.
  • No one overdoses on marijuana because it has a
    negligible therapeutic ratio that is, you don't
    have to use much to get the desired effect.
  • Prohibition of marijuana over the past decades
    has not diminished the demand in the US

36
Cons of Medical Marijuana
  • The government has an obligation to protect
    public health
  • The 'Gateway' Thesis Pot smokers are much more
    likely than non-users to graduate to harder drugs
    like cocaine and heroin
  • No hardcore evidence that prove marijuana is a
    effective drug as medicine, 20 year research have
    produce no reliable scientific proof
  • Legalization of drug, crime will increase due to
    a higher increase of pot users which will
    eventually become addicts and will steal or kill
    in order to get their drugs

37
Case 1
  • Woman Denied Right to Use Marijuana as
    Life-saving Medication
  •  
  • Angel Raich, 41yr old mother from Oakland
    California, suffer from inoperable brain tumour,
    a weight-loss disorder, seizures, chronic nausea
    and scoliosis.  Doctor has claim that marijuana
    is the only drug keeping her alive.  She takes
    marijuana every few hours, under her doctors
    advice to control pain and give her an appetite
    otherwise she would starve to death.

38
Case 1 Cont.
  • Raich v. Ashcroft, 2003 U.S.Summary The Ninth
    Circuit held that the federal Department of
    Justice should be temporarily enjoined from
    enforcing the Controlled Substances Act with
    respect to medical marijuana users in California
    pending trial of the case. The plaintiffs, a
    patient and two unnamed growers who supply her
    with the drug and another patient who grows her
    own marijuana, filed suit after a series of DEA
    raids against medical marijuana patients and
    suppliers in California, which allows medical
    marijuana use. The plaintiffs argued that because
    the medical use of marijuana by California
    residents does not cross state lines and is not
    commerce, Congress is without power to regulate
    it under the Commerce Clause. The three-judge
    panel of the Ninth Circuit found that the
    plaintiffs argument that the federal law is
    unconstitutional as applied to them was likely to
    succeed. The court found that the appellants
    class of activities - the intrastate,
    noncommercial cultivation, possession and use of
    marijuana for personal medical purposes on the
    advice of a physician - is, in fact, different in
    kind from drug trafficking. The appellate panel
    remanded the case to the district judge and
    ordered him to enjoin raids by federal officials
    pending trial of the case. The ruling may be
    appealed by the Justice Department to a larger
    panel of the circuit court or to the U.S. Supreme
    Court.

39
Case 2
  • Jenks v. State, Fla. Dist1991Summary Jenks and
    his wife, who both suffered from AIDS, were
    convicted of manufacturing cannabis which they
    used to control nausea. This opinion acquits
    appellants, noting that they met the elements of
    the medical necessity defense and that
    marijuanas presence on Schedule I did not
    preclude the use of that defense because these
    drugs are subject to limited medical uses.

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Case 3
  • Seeley v. State  Wash.1997Summary This
    challenge to a Washington law, which names
    marijuana as a Schedule I controlled substance,
    was brought by a patient with terminal bone
    cancer who claimed therapeutic benefits from
    smoking marijuana. The Washington Supreme Court
    held that the law did not violate the Washington
    Constitution and that the right to smoke
    marijuana also fails federal equal protection
    analysis because it is not a fundamental right
    and is not within a zone of privacy.

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Case 4
  • Allen v. Purdue Pharma L.P. (Stamford, CT 2002)
  • Plaintiff alleges that Mrs. Allen took OxyContin
    and, as a direct and proximate cause there from
    suffered addiction to the drug and other related
    damages, which caused her to inject the pill in
    her vein, which resulted in her death.   
  • Judge Rowe's ruled when you ignore safety
    warnings and take an otherwise safe and effective
    product in an irresponsible and illegal manner,
    no personal injury lawyer will be able to help
    you cash in on your own misconduct by suing the
    product's maker.

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Case 5
  • Doctor Guilty in OxyContin case (FL, 2002)
  • Dr. James Graves ,Florida's top OxyContin
    prescriber, was convicted of manslaughter for
    prescribing the drug to 4 patients who overdosed
    and died.  He was making 500,000 a year from his
    pain management practice.

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References
  • http//www.soyouwanna.com/site/pros_cons/pot/pot.h
    tml
  • http//www.painandthelaw.org/palliative/marijuana_
    cases.php
  • http//www.medicalmarijuanaprocon.org/pop/cannabis
    drugs.htm
  • http//www.medicalmarijuanaprocon.org/pop/testing.
    htm
  • http//www.nida.nih.gov/about/organization/nacda/m
    arijuanastatement.html
  • http//www.usdoj.gov/dea/pubs/csa.html
  • http//www.law.cornell.edu/uscode/21/usc_sec_21_00
    000812----000-.html
  • http//www.wikipedia.com
  • http//stopthedrugwar.org/chronicle/467/support_fo
    r_marijuana_legalization_low_in_europe
  • http//www.ninds.nih.gov/disorders/chronic_pain/ch
    ronic_pain.htmWhat_is
  • http//www.ampainsoc.org/advocacy/opioids.htm
  • http//www.medscape.com/viewarticle/549294
  • http//www.painreliefnetwork.org/prn/how-expert-te
    stimony-distorts-the-standard-preemptive-analgesia
    -ethics-an-underlying-principle.php
  • http//www.jhu.edu/jhumag/0699web/pain.html
  • http//jama.ama-assn.org/cgi/content/full/292/11/1
    394
  • http//en.wikipedia.org/wiki/Controlled_Substances
    _Act
  • http//www.medicalmarijuanaprocon.org/
  • http//www.sptimes.com/2002/02/20/State/Doctor_gui
    lty_in_OxyC.shtml

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