MEDICAL MARIJUANA

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MEDICAL MARIJUANA

• David Peters
• SOC 5810 Fall, 2012

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Michigan Medical Marijuana

• Research and Legal Issues
• Past Problems and Future Directions

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• Five Topics
• 1. History of marijuana and medical marijuana
• Legal Issues The Dispensary Question
• Medical Marijuana research
• The War on Marijuana Research
• My research
• -PhD Dissertation- interviews of patients and
  caregivers.
• -Multi-Center study surveying perceived effects
  of different strains of medical marijuana.

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I. History of Hemp.
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The use of marijuana likely predates humanity
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Marijuana is eaten by practically every mammal
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Mammals have the cannabinoid receptor
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• About 28,000 years ago we finally got good at
  growing Marijuana.
• Which means.Marijuana was probably the first
  plant cultivated.

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• 26,000 B.C.- One of the earliest pieces of
  agricultural evidence ever discovered includes a
  28,000 year old Hemp cord imprint on a pottery
  shard in pre-historic Taiwan village

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So the first use of marijuana was about the same
time Paleolithic cave art developed around
28,000-30,000 years ago.
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Is there a connection? You be the judge.
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• It would be wryly interesting if in human
  history the cultivation of marihuana led
  generally to the invention of agriculture, and
  thereby to civilization.

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• Which came first
• The weed or the imagination?

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It would not be the last time marijuana sparked
up a creative renaissance
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Egyptian hieroglyphic showing Pharaoh smoking a
strange plant from 3,000 B.C.
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Marijuana as medicine in History

• 2737 B.C.- Chinese text recommends marijuana for
  gout, malaria, eye problems, pain, and arthritis.
• 1600 B.C.- Hebrew text recommends marijuana as a
  pain killer in child birth.

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Herodotus in 480 B.C. reported on the Scythians
communal use of marijuana.

• They place select tops into a container over the
  fire and creep beneath felt booths. Immediately
  it releases a vapor such as no Grecian bath can
  comparewhich causes the Scyths to howl with joy.

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Marijuana as medicine in the U.S.

• Over one hundred articles recommending cannabis
  were published between 1840 and 1900 alone
  (Herer, 2000).
• Early 1900s Ban as a Mexican Immigration Foil.
• Before the 1937 Marijuana Stamp Act Marijuana
  was commonly recommended by U.S. doctors
• --as a painkiller during childbirth
• --for treatment of asthma
• --as a palliative for gonorrhea symptoms
• --anxiety
• --hysteria
• among other conditions (Earleywine, 2006).

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Later uses of medical marijuana in the U.S.

• --glaucoma,
• --chemotherapy induced nausea,
• --spastic disorders,
• --AIDS wasting syndrome,
• --other less severe illnesses such as chronic
  pain were later claimed to be helped by the
  therapeutic use of marijuana (Chapkis, 2008).

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The Michigan Medical Marijuana Act

• Chronic Pain
• AIDS
• ALS (Lou Gehrig's Disease)
• Severe Nausea
• Glaucoma (Impaired Eyesight)
• Hepatitis C
• Nail Patella
• Cachexia or Wasting syndrome
• Crohn's Disease
• Multiple Sclerosis
• Muscle Spasms Epilepsy or Brain Seizures
• Cancer

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II. Legal Questions
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Dispensaries

• Not mentioned in the referendum because the issue
  was not polling well
• A caregiver can register up to 5 patients and
  grow and possess 12 plants and 2.5 ounces per
  patient to whom he is connected through the
  caregiver registry system

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• Attorney General Bill Schuette claims that
  caregivers and patients are supposed to become
  independent and grow their own completely
  within the caregiver registry system.

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But, but, but what about.

• Starting the garden (clones)
• Overages
• Temporary loss of supply
• Bad crop
• Bad harvest
• Bad genetics
• Unreliable caregiver

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Even the most competent Caregiver cannot by
himself offer

• varieties of marijuana
• counseling
• chemical testing
• massage oils, tinctures, baked goods, suckers,
  etc.

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• State of Michigan
• In the Court of Public Opinion
• Non-Profit Dispensary
• vs.
• Farmers Market
• Compassion Clubs
• Compassion Network
• Delivery Service

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• Appellate courts have ruled that Patient to
  Patient transfers are NOT allowed under the MMMA
  (for ).
• However at least one Circuit Court judge has
  ruled that patient to patient transfers that do
  not involve the exchange of money are allowed.

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However..The Supreme Court of Michigan has not
ruled on this issue or on CG to Patient transfers

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Section 4(e)

• A registered primary caregiver may receive
  compensation for costs associated with assisting
  a registered qualifying patient in the medical
  use of marihuana. Any such compensation shall not
  constitute the sale of controlled substances.

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People vs. Kolanek and King

• Section 4 and section 8 BOTH provide protections.
• Section 4 requires compliance with 2.5 Oz limit
  per patient.
• Section 8 ONLY requires The patient and the
  patient's primary caregiver, if any, were
  collectively in possession of a quantity of
  marihuana that was not more than was reasonably
  necessary to ensure the uninterrupted
  availability of marihuana for the purpose of
  treating or alleviating the patient's serious or
  debilitating medical condition.
• Limited to the patient OR his primary caregiver
  and does not appear to protect dispensary
  operators or bud-tenders.

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III. Medical Marijuana Research
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• No placebo controlled clinical research has EVER
  been done using medical marijuana
• One recent clinical (but not placebo controlled)
  study (Morgan, 2010) used volunteers who provided
  their own cannabis for the study
• They investigated whether higher CBD marijuana
  could decrease the effects of higher THC
  marijuana (as a way to decrease the effects of
  marijuana addiction)
• Note how the research questions are characterized

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A few scattered MM findings

• Weight and BMI gain for AIDS patients using
  medical cannabis (Abrams, 2003).
• Mixed results on reduced spasticity for M.S.
  patients using synthetic THC (Only 14 total
  studies on M.S. patients).
• 97 of M.S. patients claim they perceive reduced
  spasticity and pain when using smoked cannabis
  (Consrue, 1997).

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Marijuana as effective as codeine in reducing
pain (Campbell, 2001).

• These authors conclude- incredibly- their
  results show that marijuana
• -Is not useful for post-operative pain
• -----and-----
• -needs more research before use for other
  types of chronic pain.

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This does not need more research
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Studies in the 1980s on the medicinal benefits
of marijuana
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1970s era studies using NIDA cannabis

• Inconclusive on Glaucoma pressure.
• Some suggestion of analgesia (reduced pain
  sensitivity) in healthy subjects (Milsein, 1975).

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Federal Prohibition on medical research

• Research focuses almost exclusively on the
  harmful effects of marijuana
• 95 of research uses synthetic cannibinoids
  rather than marijuana (Nabilone, Cesemet,
  Dronabinol, Levanatrodol etc.)

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A marijuana clinical study requires
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• Food and Drug Administration approval on the
  safety vs. risk benefits of the study.

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• Drug Enforcement Administration Schedule I
  Controlled Substances License (one of several
  contemporary marijuana stamps.)
• Drug Enforcement Administration approval for the
  study

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• National Institute of Drug Abuse approval to
  supply the research marijuana.
• NIDA will only study the harmful effects of
  drugs.

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NIDA Research Marijuana 1.5 - 8.3 THC

• SCHWAG

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• I have not found any study that uses 8.3 (a
  Canadian study used 9.5).
• Almost all marijuana studies have used 1.5.
• Dr. Abrams in the 1990s was the first scientist
  to get research marijuana since the early 1980s.
• I am not sure how many others have been supplied
  research marijuana since the early 1980s- If
  there are any I am sure all of them studied the
  harmful effects of marijuana, not the medicinal
  effects.

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V. My research
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• When there is smoke there is fire.
• The government is hiding something.
• They are deliberately and aggressively blocking
  scientific research into the efficacy of medical
  marijuana.
• I want to know what they are hiding.

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My PhD Dissertation

• Interviews of Medical Marijuana Patients and
  Caregivers
• --8 page interview guide- more than 50 topics.
• --1-2 hour interviews

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Preliminary Findings 1 of 2

• Average medical marijuana patient is much older
  than the common characterization of teenagers
  hanging out at the marijuana club over a
  hangnail.
• Patients with chronic pain claim the analgesic
  effects of marijuana is less than morphine, more
  than tylenol, and about the same as codeine or
  vicodin.

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Preliminary Findings 2 of 2

• Patients consistently claim they are able to
  dramatically reduce prescription drug intake of
  many types as a result of access to potent
  medical marijuana.
• Most patients began using marijuana at a young
  age and have used regularly most of their life.

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Quasi-Clinical Study

• My great idea was to research the perceived
  effects of Indica and Sativas using a survey.
• Of course the ancient Sanskrit words Indica-
  Night and Sativa- Day are well known.

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Putting it together

• Jamie and Kevin operate nonprofit medical
  marijuana dispensaries.
• Ken tests marijuana for the dispensaries.
• They were already collecting far superior data
  using precise concentrations of THC, CBD, CBN and
  more than a dozen others.
• A quantum leap beyond broad categorizations of
  indica and sativa!!!

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• So forget about Indica and Sativa- go right to
  comparing the actual chemical constituents of the
  marijuana
• ---vs----
• Perceived effects of marijuana

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Study Procedure

1. Patients procure MM in the same way they would
   normally.
2. Testing Authority picks a sample of the week for
   each dispensary.
3. Samples are double blinded- only Ken and the
   director know what is in sample.
4. Patient consumes the product at home.
5. Patient fills out online survey on perceived
   effects 1-2 hours later.

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Certification of Medical Cannabis
Administrable by
We certify that this cannabis sample has been
Med Joint
prescreened by MTAKB007 on Wednesday, February 01,
2012
for safe medical administration. Our
prescreening results
assist in the administration of this cannabis by
insuring it is safe from harmful
and possibly deadly contaminants. Our state of
the art equipment tests parts
per billion to detect chemical compounds that
enable this cannabis to be
administered for specific illnesses and serious
conditions.
Wayne State Study
Identification Certificate
IDM101
Genetic Fingerprint I.D. Card
Bacteria Analysis
Potency Analysis
Mold
Pass
CBD
1.0
Fungus
Pass
THC
9.8
Mildew
Pass
CBN
0.2
Chemical Analysis!
Pesticide Pass
Captured above is this cannabis samples unique
Chemical Signature drafted by its genome,
environment and farming practices.
Pharmacological Effects Analysis
Qualitative Scale of Effects (1-10) Ten being
one of the best.
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10
8
6
4
2
0
Pain
Diet
Sleep
Focus
Awake
Hunger
Nausea
Alzhiem
Immune
Anti-spasm
Inflamation
Anti-Cancer
Anti-Anxiety
THCV, Delta 8 and other minor
Pleasure
Cannabinoids are added to provide
a total count.
Affects of the detected Medical Compounds found
in this sample of cannabis.
MTA uses portable state of the art G.C.- S.A.W.
Surface Acoustic Wave technology, along with a
scientific low pressure vapor testing
method to detect the terpinoids, flavinoids, and
cannabinoids in parts per billion. Our on site
testing produces accurate test results in
almost real time, so it can be utilized as a tool
in selecting quality medication. Please feel
free to call 1-855-751-2500 with any questions .
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• Please rate the potency or effectiveness of the
  test sample on the OVERALL SEDATING OR "DOWN"
  EFFECTS.
• 0 No Effect
• 1 Very Small Effect
• 2 Medium Effect
• 3 Large Effect
• 4 Very Large Effect
• One of the strongest I have experienced
• --------------------------------------------------
  ---------------------------------------------
• Please rate the potency or effectiveness of the
  test sample on the OVERALL EUPHORIA OR "UP"
  EFFECTS.
• 0 No Effect
• 1 Very Small Effect
• 2 Medium Effect
• 3 Large Effect
• 4 Very Large Effect
• 5 One of the strongest I have experienced

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Hypothetical Data
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More Hypothetical Data
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1400 Data points and counting!!

• Once enough data points are collected with enough
  samples we should be able to regress multiple
  chemical components

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Sociology Research Statistics

• Often use THOUSANDS of participants (General
  Social Survey)
• Can isolate specific components of behavior and
  environment to predict
• For example Predict- Educational Level
• Race
• Parents Income
• Parents Profession
• 2 parent stable family
• Religion
• Gender etc. etc.

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• This means we will be able to calculate the
  contribution to uplifting (or sedating or
  pain relief etc) from each component in the
  medical marijuana.

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• We are also comparing the perceptions of samples
  high in one or more components with the
  perceptions of samples high in other components.
• -The sample sizes are to small to compare
  individual samples but we can group them by
  category (example)
• --Samples 1, 9, and 15 high CBD
• --Samples 2, 3, and 12 low CBD
• Then compare pain relief or sedation.

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Why do we care?

• Informing genetics for growers, patients and
  breeders.
• Should we propagate that mutant with the high
  Limonene??

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Can we develop strains for

• Pain
• Depression
• Anxiety
• Nausea
• Inflammation
• I think it is possible we could develop strains
  full of anti-cancer ingredients for general
  prophylactic (prevention of cancer) use.

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A couple dozen companies have been given patents
to isolate medicines from whole cannabis extracts.
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Future Directions With this Research

• Supervised use and testing in a clinical lab.