Medicinal Cannabis, its not Brain Surgery…..

hemisphere
Just a a quick post today. I have heard second hand anecdotal stories from a NZ Refugee to Colorado, that CBD rich Cannabis oil has worked on children for seizures where a much more drastic (and rare) procedure has failed.

I present to you the most radical and invasive treatment for seizures generated by only part of the brain, the Hemispherectomy.  Judging from this picture, it is as bad as it sounds.  Despite being so drastic, it actually has good results on average, with a close to 75% success rate.  Almost the entire Hemisphere of the brain that has unusual activity leading to seizures is removed…..

The brain has a significant ability to recover from this procedure, (neuroplasticity) and generally, the younger the procedure is preformed, the better the results. It actually doesn’t effect cognition as such when done young, in the happier cases, kids can obtain above average academically. Most are left with physical symptoms similar to a stroke, blindness or vision issues in one eye, and motor impairments down one side of the body, though these side effects pale into comparison to the risks for children on the medical equivalent of death row.

Although not part of the Hippocratic Oath, a key principle guiding modern medicine is  “first, do no harm” which is where the preference for Conservative or Non-invasive treatments stems from. So we have a dilemma, the use of an experimental medicine with scant but positive scientific research and attached legal baggage, versus a rare, but extreme, and on average effective treatment for those children with life threatening seizures.

As a parent, how would you feel if you agreed to lop off a chunk of your child’s brain, and the procedure fails…… desperate?

Desperate enough to move to Colorado to try something new? How would you then feel if you reduced the frequency, duration and severity of seizures by over 75% with a fairly basic plant derived preparation??

pretty good? how about only trying it after already having lopped out a sizeable chunk of you child’s brain?
Guilty in hindsight, though to be fair, this is new ground.

Going forward I would lay the blame at the surgeons feet, as the evidence continues to stack up in favor of Medicinal Cannabis, there is no excuse to not try a moderate risk drug over such a radical procedure…..

Out

Pot and Pain, Part 2.

This follows on from Pot and Pain Part 1, where we discussed the efficacy of Cannabis for Neuropathic pain, and also the undesirable effects of Opiates versus Cannabis

pain

In Part 2 I will cover

  • Synergestic effect with Opiates.
  • Hyperalgesia.
  • Anti Inflammatory effects.

The first nugget of knowledge is about synergy. Cannabis, when combined with Opiates such as Morphine, has a synergestic effect on Chronic pain, meaning the relief is greater than the sum of its parts, 2 + 2 = 6 on the relief scale if you will.  It does this without increasing the amount of Opiate soaked up by the body, meaning it isn’t increasing the risk of death. This means more of what Chronic Pain patients are after, relief…  The positive side effect is, that patients can get the same level of relief with less Opiate, reducing the chance of accidental overdose and death.  This effect has been linked to a huge reduction in deaths from accidental overdose in the states, as users switch from Opiates to Cannabis as the preferred pain relief, in this scenario, Cannabis really does save lives….

The second  thing to touch on is the side effect of long term use of Opiates, Hyperalgesia. This is the perverse side effect and polar opposite of what Opiates are supposed to do, basically if you take pain killers long enough, the do the opposite and exacerbate the pain. The only opiate that is not prone to causing Hyperalgesia is Methadone, a Class B Drug that many GPs refuse to prescribe due to misinformed perceptions. Methadone would actually be the preferred Opiate for chronic pain, as the tolerance build up is months or years, and Hyperalgesia is virtually eliminated as a risk, It also has a long duration of effect, allowing the patient to sleep through the night, rather than wake at 3am to pop more pills as the others have worn off, counter to that, its long half life makes it dangerous and easier to overdose on, and the public perception of it being only used for addicts has a significant effect on its use in NZ.

The final thing that Cannabis is reported to be effective for, (though I am less familiar with it)  is inflammation, particularly related to Rheumatoid Arthritis (RA).  The latest trend in the USA is the swelling ranks of retirement age people using Cannabis for pain relief,  there is a smaller body of evidence suggesting CBD  the non psychoactive ingredient of Cannabis, directly interferes with disease progression in Arthritis, in addition to providing pain relief.  The most desired side effect by this subset of the MMJ community is the improved sleep, which makes it 1 drug for 3 effects, pain, inflammation/disease progression, and sleep. The explosion in elderly patients is partly because MMJ dispensaries, those that take the medical part seriously at least, have worked on alternative methods of administration, including, skin creams.  Which anecdotally, have No psychoactivity while offering localized pain relief. It is these unique qualities that have made it a go to solution for the elderly, who often have extra side effects from regular medications and need extra monitoring, due to dodgy livers, kidneys and metabolism.

With this information, I hope you the reader are more equipped to know the ins and outs of how cannabis works, (lots of research links!!) why it is safer than conventional Opiate pain killers, and even that it improves the pain relief from Opiates, and that it is available in skin creams that have no psychoactive effects, suitable for arthritic joints.

Out.

Pot and Pain, Part 1

It seems there are still some misconceptions about pain being an “excuse” for Medicinal Marijuana (MMJ), I have overheard on talk back radio old folks complaining that it didn’t work for them etc. There are several reasons why Cannabis is useful, and preferred by patients, it is to much for 1 post,  I got to 1200 words on the first attempt, so I will break it down,

  • Neuropathic Pain vs Nociceptive pain.  Part 1
  • Side effect profile vs Opiates.   Part 1
  • Synergestic effect with Opiates.  Part 2
  • Hyperalgesia.   Part 2
  • Anti Inflammatory effects.  Part 2

 

First of all, MMJ will not work for Nociceptive pain  It is well established in the scientific literature that is is effective for Neuropathic pain.  In Laymans terms, this means that it wont work if you break  a bone,  but if you happened to crush a nerve…….. then it offers good results. The Germans managed to compile a list of high quality cannabis studies in 2012, and show those with postive vs negative results.  There tallies were 26 studies for chronic/neuropathic pain, with 23 having positive results in favor of MMJ. There are also many other studies since 2012 supporting the benefits, and even getting measurable results out of tiny doses.  Some of these studies also go into secondary benefits, such as improved sleep, which anecdotally, is what a lot of older MMJ users in the USA find, it relieves some pain from sciatica or similar, and allows them to sleep through the night better.

The second nugget of knowledge is in regards to the conventional alternatives.  Many of the members of my chronic pain group have debilitating diseases, it is not a case of a bunch a people with a dodgy knee, we have 10+ people with Complex Regional Pain Syndrome (CRPS),  which is widely considered the most painful condition in existence. We also have a young woman who has been on Morphine since age 12 for Juvenile Arthritis that had so much inflammation the nerves were damaged,  several failed back surgeries, people with Lupus, MS, and Allodynia,  which is when the nerves a basically fried in a permanent state of over excitement, where even the lightest touch is severely painful.  Because this group is at the extreme end of the scale, Doctors feel the urge to “do something” and this invariably involves the Morphine family of drugs (Opiates) and the Valium class of drugs (Benzodiazepines, “Benzos”) Both classes are addictive, and while they work short term, or as a rescue medication for flares, there is actually little evidence that opiates work long term.   Many of the community have had to battle the label of addiction, when taking the medications exactly as prescribed by the GPs and specialists. I myself have seen it first hand with the 40+ Emergency Department visits my wife has made, in the cities, the doctors treat you as a junkie, as seeking relief from excruciating pain looks very similar to seeking a “fix” that the substance abusers seek.  I would go so far as to say Christchurch hospital was disgusting in that regard, yet the St Johns crew could make an estimate of a patients pain based on blood pressure and heart rate, and showed nothing but compassion, Gold Star for them!

Opiates are widely over prescribed, although it is not as bad as in the USA, where estimates are 17k people die from prescription overdoses per anum, we still have problems with it here, I have an OIA request in to get some harder numbers on deaths and near misses in NZ.  The side effects often experienced with Opiates and or Benzos are….

  • Constipation, (who doesn’t love a fleet enema )
  • Depression, (as if people in chronic pain aren’t depressed enough already)
  • Respiratory depression, (that is how it kills, you stop breathing, even if your mind is completely aware, as my wife’s was when St Johns overdosed her)
  • Aggression
  • Dizzyness, prone to falling over, causing more pain..
  • Cognitive impairment, unable to spell 5 letter words, delayed reactions, patients often feel unsafe to drive, especially at night and more so when Opiates and Benzos are combined
  • Tolerance build up, after a few weeks or months, you will need to double it
  • Nausea, though generally this side effect fades over a week or so, in some cases it is a violent reaction and the medication cannot be tolerated
  • In extreme cases heart issues, I’m aware of 1 patient on 120 mg of Methadone morning and night, and his Heart rhythm/QT Intervals went out of whack leaving him unable to walk to his letterbox.
  • Hyperalgesia – more on that later..

In comparison,  the most reported side effects, when used medcinally for Cannabis use are,

  • Dry eyes
  • Improved mood
  • Improved Sleep
  • Cognitive impairment (mild in comparison to Opiates and Benzos)

From personal experience with the wife, the cognitive deficit from Opiates and Benzos can be huge, there is an entire year of her life she barely remembers, which is just as well, as that year had the most pain and hospital visits as ACC tried to shirk their responsibilities. The aggression she displayed that year at points was enough for a social worker to become involved during one hospital visit. I also had a neighbor with a failed back surgery that would have a family intervention due to aggression after less than a week on Morphine.  I also have a contact from who had a respectable job, and on being prescribed Methadone,  “lost the plot”  and resulted in 2 Tresspass orders, of which he can barely remember the events.

More to follow,  in part 2 next week!

 

 

National’s Stance, another Rebuttal on Medicinal Cannabis

Below is the templated response that my friendly local National Party MP  sends to the constituents with regards to Medical Cannabis in NZ, the first mistake of the National Party is to not separate Medical Cannabis from  more broad issue of Cannabis Law reform, which doesn’t seem a hard concept to understand considering Australia  has made that breakthrough with the Greens, Labor, Liberal, Nationals and Democratic Liberal parties, as well as their Prime Minister all being in support of a bill going before parliament..

So anyway here is the MPs response letter

Thank you for contacting me regarding cannabis legislation in New Zealand.
This Government has no plans to change the legal status of cannabis.
We do not think that there are any benefits for decriminalising or legalising cannabis, for medicinal purposes or otherwise,
which outweigh the harm it causes to society.
I have seen too much harm caused by this drug to have any tolerance for its broad decriminalisation.
Government policy over successive governments has been to not support the decriminalisation of cannabis for medicinal use.
In terms of medical use, such as for pain relief, there are already pharmaceutical forms of cannabis that provide measured doses and quality control.

Since 2008, a mouth spray called Sativex, which contains extracts from cannabis,
has been able to be prescribed by medical professionals.
It is used by multiple sclerosis patients and those with chronic pain, and it use requires ministerial approval (delegated to the Ministry of Health).

The Government’s position has always been, and will always be; NOT using any psychoactive substances is
the safest and best option for any individual, whether they are synthetic or natural. This Government has passed
legislation removing from sale all remaining so-called ‘legal highs’ until they can be reasonably proven to be low-risk.

Yours sincerely

 

I would like to post a public Rebuttal to this templated response from my Local MP on the case for Medical Cannabis,
The first point Minister, in what capacity have seen “too much harm” caused by cannabis? In poverty stricken families? people on benefits? in the mental health system?  what is your professional area of expertise again?

Causation is not correlation Minister, I have first hand experience of substance abuse, My biological Father had problems with Cannabis and Alcohol, I can assure you it was not Cannabis that provoked the domestic violence in my childhood home, including an assault on my Mother while pregnant with my younger brother.

“In terms of medical use, such as for pain relief, there are already pharmaceutical forms of cannabis that provide measured doses and quality control”

Sativex is simply not good enough, it is neither ideal nor cost effective. For Pain relief it is off label and nigh on impossible to get due to the lack of doctors familiar with it, and it is also apparent that there is a disproportionate amount of Specialists from overseas who prescribe Sativex, using it  as a place holder for Raw Cannabis that they do have experience of but can not prescribe in NZ, suggesting a lack of education in the NZ Medical community on the subject of Cannabinoid “receptors” or therapeutic targets.

It also less than optimal in costs, Methadone, a Class B opiate costs less than 19 cents for a 5mg tablet, for one patient with Complex Regional pain syndrome the cost of Sativex was estimated at 30 dollars PER DAY. Also you point out the virtues of measured doses, Unfortunately, we are stuck with one ratio of 1:1 THC:CBD  for the 2 primary ingredients of Cannabis that are contained in Sativex.

Paige Gallien, a child with intractable and disabling epilepsy, and also the only child in NZ to try Sativex has had good results so far in significantly reducing the occurrence and severity of her seizures.  She has, on the balance of probabilities, the ability to be “functionally cured” or virtually seizure free, if she was able to ingest more Cannabidiol (CBD).
Unfortunately, to escalate her dose of CBD, the main drug attributed to relief from epilepsy, would go hand in hand with an escalated dose of THC, which is the drug that causes the high, and is much more likely to have detrimental effects.

Epidiolex is on the horizon and is a high CBD extract from the makers of Sativex, but it is likely to have a similar cost to Sativex, of 10-30k per year.  This young girl has room for improvement, if not total remission with a more concentrated CBD product. The most cost effective method of doing this, is to grow it, specifically a “clone” or cutting from a plant with a known CBD:THC ratio, such as the headline grabbing strain Hippies Disappointment” AKA “charlottes web” although there are other varieties too.

I would also point out that for chronic pain. a 1:1 THC/CBD ratio is not ideal either, A journal reference Hyperalgesia: New Insights for the Healthcare Professional: 2013 Edition, states that the ideal ratio is 24:1 CBD to THC. Which is in the realm of such Medical Cannabis strains as “Hippies Disappointment” AKA “Charlottes web”

Because of the huge differences in effect for high CBD strains, none of which are available in NZ, we could also suggest your witnessing of “harm”  caused by this drug is invalid, the name “hippies disappointment” should be a clue to its value for abuse.

I would also counter your governments position of not using Psychoactive substances is the safest option. I by no means regard Cannabis as a first line treatment for nausea or pain in lieu of Ondansetron or Codeine etc, although there are those on the far left fringe who do, but I would like to demonstrate the problems with your broad statement in the field chronic pain.
This is a list of the Psychoactive substances prescribed for a close family member so far following a back injury with unreasonable delays to treatment imposed by ACC.

  • Codeine
  • Tramadol
  • Morhpine
  • Oxynorm
  • Oxycontin
  • Pethidiene
  • Fentanyl
  • Methadone
  • Temazapam
  • Diazepam, including suppository….
  • Clonozapam
  • Lorazepam
  • Quetiapine
  • Gabapentin
  • Ketamine
  • Baclofen
  • Amytryptelene
  • Nortryptylene
  • Venlafaxine
  • Fluoxetine
  • Citalopram
  • Escitalopram
  • Pregabalin, – To be tried in the new year.

Minister, do you really believe that raw Cannabis,  a Class C drug is too harmful or dangerous to be used in a medical setting?   on what grounds is Fentanyl, or Clonozapam  safer?  Do I have to count the Class B drugs administered so far?  Are you aware of the cognitive deficits caused by regular medications for chronic pain?

I urge you to reconsider your stance.

Complex Regional Pain Syndrome, another case for Medicinal Cannabis

This week’s story is from someone I know personally, who has Complex Regional Pain Syndrome, widely regarded as the worst pain disorder in existence,  the only thing worse is when the disease progresses, and the R for regional no longer applies,  in advanced stages even the senses are rewired to pain, so loud noises bright lights etc also trigger this cascade effect.  It can also trigger bowel and other organ issues etc in advanced stages which can come across as chemical sensitivities.

Below is a chart of comparison pain levels, the pain vs child birth can be confirmed by those who develop the condition later in life, just as my wife can confirm that Flare ups of her back pain easily surpass the pain of her child birth. CRPS if picked up early can be reversed with intensive management, however once it has progressed to a certain point, there is no cure, and it normally it will gradually deteriorate.  This condition is a poster child for both compassionate use of Medicinal Cannabis, but also Euthanasia, as there are many with advanced CRPS who seriously consider suicide, if not act upon it.

painscale

What is Medical Marijuana to me. Its being able to have a better quality of life – to function – to laugh – to enjoy the small things in life & medical marijuana helps me achieve that. I have lived (survived) 15yrs with CRPS Complex Regional Pain Syndrome the highest rated pain condition above unmedicated labour even amputation of a digit. An accident / injury / surgery caused a switch in my nervous system causing inflammation.

What does that mean. Everything that my nervous system controls touch, sound, vibration, sight, hormones, stress, any normal stimuli that is harmless has now become so sensitive its harmful. It also controls, hair growth, skin colouration, blood flow, heart rate, swelling. The pain of course also affects sleep which then affects mood control & coping skills.

I have been on every mediation thrown at me, making me feel like a lab rat as I suffer side effect after side effect. I also tried every alternative help that I could find, but the only thing Iv found to help is medical marijuana. Before I became chronically ill I did not approve of marijuana & looked down on those that used, until I was in so much pain begging for death, as I felt I tried everything else to help end the pain. The relief was instant, their was light at the end of the tunnel. One should not be made to feel a criminal for seeking a better quality of life.

Yes it is still a drug & will not be for all but its made a world of difference for me, it helps by blocking, distracting the pain receptors in the spinal cord helping reduce, distract from the pain, but thats not all, it can also be used as a sleep aid, an anti depressant, help stop reduce muscle spasm & tension, & most of all that horrid nausea, your’ll be able to eat again, though that is also a side effect so watch what you eat & how much.

For me this medical plant has helped me so much I no longer need any prescription drugs which crps has made me chemically sensitive too causing horrid side effects on top of the many evil things crps does. More education is needed & give help to those suffering, included in the education is that New Zealand can still be smoke free, New Yorks Medical Marijuana laws have shown us the way.  The education should include different applications of the medicine to get the best help from symptoms, vape, butter, oil,  and creams, all still help without the need to smoke, this is why we need education.

We are not pot heads, we are people where there is no cure. and the medical system is failing us, and will continue to fail us for the forseeable future.

We demand the right for a better quality of life, and a mere class C Drug helps in so many ways.

Medicinal Cannabis and the return to work.

Of a particular frustration to the chronic pain community, is those that are able to return to part time work, but have so many flare ups and days off sick that they are not able to work to a schedule, and unreliable workers in that sense.  This is a personal issue I have with the ACC system, as most employers balk at the idea of an employee who can’t reliably manage a few short shifts per week, as there is no guarantee when the flare ups of the pain will occur. Below is a story by another sufferer of a chronic pain syndrome, that evolved from an excruciating event with a kidney stone. In this patients case  moderated Cannabis use has saved the Govt thousands in hospital admissions, another few hundred in prescriptions, and with the patient actively trying to return to the workforce thanks to the relief obtained with Cannabis, one would anticipate a 5 figures  per year or so saving  in sickness benefits would be paid out in future.

The night before my 20th birthday I was watching TV and I started getting what I thought were period pains. They kept on getting worse and worse until I rang Healthline and told them what was happening. They told me to go into A&E and there I was told I had a kidney stone.

That passed on its own no problems, then a few months later I had the pain again, went in and they said the same thing it’s a stone, don’t stress you’ll be sweet as, here have some more morphine.

The pain started coming more and more often until I was going into A&E a couple of times a month with pain that was out of control in my lower left abdomen.

Eventually I was diagnosed with a Chronic Pain Syndrome, a neurological condition where my wiring in my nerves send out pain signals for no reason. My GP referred me to Burwood Pain Clinic and there I saw Dr Alchin and the pain team. There I was put on gabapentin in combination with an anti-depressant called Venlafaxine. Apparently these 2 drugs work well together when it comes to relieving chronic pain. I also was referred to a psychiatrist and physiotherapist.

Nothing worked and the side effects of the venlafaxine were making me SO unwell. I was also prescribed Morphine, Tramadol, Codiene, pretty much every painkiller they have which all help the pain slightly for a little bit of time but cause horrible side effects like nausea, vomiting, BAD temper, bad dreams, bad memory, dizziness, stopping in the middle of a conversation and forgetting what we were talking about, leaving stuff behind ALL the time and a whole lot of other crap.

Then after awhile they said there wasn’t any more they could do and that I was just going to have to do my best to live with it.

Before all this started I was working as a nanny in Auckland and I had to quit as I was so unreliable, I had no idea when the pain would hit and when it did all I could do is ring 111 and ask for an ambulance. I tried working part time in a supermarket deli, was fired from that too because I was 2 unreliable and took 2 much time off sick.

For 3 years since my 20th I had been going to A&E about 2-3 times a month with very strong 10/10 uncontrollable pain. More than a few times I was told GO HOME YOU’RE NOTHING BUT A DRUG SEEKER. This is one of the worst things I think, as the pain was neurological, there was no other symptoms other than pain and raised pulse/BP, so they couldn’t find a source for the pain so obviously I was faking it for attention/to get opiates. When you are in that much pain and you get told you’re faking it, you do not usually react very well, your reaction is noted in your records and the next time you go to A&E in pain the exact same thing will happen.

I started reading up on a support group for people with chronic pain which is mostly based in the US and Canada. The people on the page had such amazing stories about how MMJ helped them with their chronic pain and I had to try it.

I researched methods of using it, as I was in this for the long haul, I didn’t want to smoke it and ruin my lungs.  I discovered many people were using vaporizers, the good ones have been tested and found to remove 90-95% of the extra crap that ends up in the lungs. Basically they work just be applying heat without flame to the material, and the active ingredients boil off and are inhaled, without burning the material. I have a portable one that allows me to discreetly get pain relief while out and about, allowing me to get more active without fear of being disabled by my pain while in the middle of town.

I started as soon as I could find some and I noticed my whole body relaxing as I was “vaping” it. My pain which was sitting at about 6/10 at the time went away almost completely.  I thought “nah surely it wouldn’t work that fast” but it really did.

After around 2 months, one day I realized OMG I haven’t been in a&e this month!! And I didn’t go back in for about 6 months. I was amazed and I’ve never looked back.

I’m turning 26 in March and I’ve been vaping regularly for 2 years, I am about to start looking for part time work!  I haven’t been into A&E for (around about) the last 6 months with the pain and the gaps between flares are getting bigger and bigger.

I personally don’t think it’s fair that someone who doesn’t even know me, has the authority to tell me “you can’t smoke that its illegal/bad for you” when it’s the only thing keeping me going!

 

 

 

 

 

 

 

Amy Adams, Does she even science?

Today a brave woman, of a slightly conservative background, a Christian Farmer and wife from the ‘Naki made the Taranaki daily paper putting her hand up as a user of Cannabis for pain relief.  She suffers from a condition called Fibromyalgia, which  causes sore muscles, general stiffness and fatigue, and tender painful points over the much of the body. In and of itself it isn’t the worst chronic pain condition to have, but it is not a “pissing contest” on who suffers the most, the secondary effects from Chronic Pain on mood, sleep, family life and love life are all the same.

In response to this the minister of Justice, Amy Adams responded

I have seen no evidence that supports the benefits for decriminalizing or legalizing cannabis, for medicinal purposes or otherwise, outweighing the harm it causes to society.

“The potential harms from smoking cannabis are well documented and I have no plans to soften the Government’s stance on what is commonly considered a gateway drug to more harmful substances such as P.

I am writing a letter to her in response, but I think some of this nonsense needs to be cleared up publicly.

The first benefit of Legalizing cannabis for medicinal purposes, is in the overdose rates from Opiates (morphine class of drugs)  In the USA,  overdose rates are huge due to the way the doctors are lobbied by the pharmaceutical companies,  in every state that enabled Medicnal Marijauna law (MMJ), the rate of death from overdose dropped, this effect occurred over many states at many points in time as the dominoes fell, and is hard to refute.  In NZ I have an OIA request in to get some hard numbers on how many die, and how many nearly die from the use of Opiates in a clinical setting.  Would a reduction in deaths from Opiates of 1/3rd not be enough to justify the Medicinal Cannabis,  or would saving lives not be in the public interest.  Is it worth while and in the public interest to deny chronic pain sufferers a safer alternative, out of  fear that the likes of Dakta Green might acquire some medical product?  News flash minister, they already have it!

In the public benefit, there are thousands of New Zealanders suffering from chronic pain, and there is strong evidence for the use of Cannabis in treating that pain.  A German compilation of high quality studies conducted found of 26 good studies, 23 had favorable results in treating Chronic Pain.  Again, would a Politician deny the improved quality of life of thousands, for fear of recreational users? this stinks of either ignorance, or a lack of moral courage to do the right thing by the people.

The one thing I agree with that Amy Adams said is that smoking cannabis is harmful, which is why we have had an explosion of vaporizer devices, which coincided with the explosion in medical use in the USA, the quality vaporizers can remove 90-95% of the harmful byproduct that would otherwise be inhaled. In fact New York is implementing a no Smoking  MMJ policy.

The gateway drug theory is well and truly debunked,  studies suggest that it is early access to alcohol,  or race/social economic groups, that are stronger predictors of illicit drug use.

I look forward to the Minister trying to conjure up evidence supporting her stance from within recent history, her stance is a copy paste description that every National MP replies with, and is a Tory hangover from the Reefer madness years.  I have only attacked her stance from the Chronic Pain angle, as that is the one I am most familiar with, but others with more experience in the treatment of Nausea from Cancer and HIV treatments, or the Epilepsy and Tourretes side of the equation could certainly add even more “public interest” to alleviating suffering.

Cannabis and Chronic Pain, a Canadian story.

Below is a story from a person within the chronic pain community, who has had the good fortune to be on the receiving end of a more progressive cannabis policy in Canada.  In a short space of time, he used Cannabis, a class C drug, to withdraw from Clonozepam, an addictive class C drug (similar to but generally stronger than Valium) and significantly reduce his usage of Fentanyl patches, (an even more addictive class B drug, much stronger than morphine), all the while receiving much more pain relief.  Even the specialist couldn’t argue with such results when he came back to NZ, and so he began the process of obtaining Sativex, a mouth spray of Cannabis oil, and the only Cannabis preparation available in NZ

I am a man in my mid 30s,  who use to work as a mid level manager for a medical organisation,  my Journey to MMJ began in May 2012….

A car pulled in front of my scooter without looking, rather than collide I put the bike down and shattered my tibia and broke my thumb.

They put a K wire in my thumb.  I was then flown to Auckland to put an External fixator (holes drilled into your bones to hold them in place) in my leg to wait for the swelling  to  go down, which it never did, and eventually they put 2 titanium plates and 13 pins in. But my knee is still crooked and heavily scarred. … They also said there was almost no soft tissue damage………..

I couldn’t even wipe myself or shower for at least 2 months following the accident.

At the hospital they didn’t believe my extreme pain after the first operation (which I started waking up during, suggesting either they didn’t use enough gas, or I have a high natural tolerance for opiates and certain sedatives).

This became my first flare up of what was eventually diagnosed as CRPS (complex Regional Pain Syndrome).

They told me to ignore it and watch TV and gave me a strong Antipsychotic to shut me up, – Halperidol, usually used for Schizophrenia etc.

It took 3 hours of extreme pain and yelling in the emergency department and my wife pleading before they finally got an anaesthetist to administer fentanyl.

Over the next year there were lots of physios. When my leg swelled nice and red they’d put ice on it. It just got worse and worse even though they had me biking hundreds of kms they never took note of it, this is a failure on there part to diagnose my CRPS sooner as the semi-permanent swelling and discoloration is a tell tale sign of CRPS.

13 months later after being treated like a drug seeker they finally sent me for an ultrasound. All those physios and orthopedics had me biking and walking on a snapped LCL, a missing meniscus and a torn PCL and damaged ACL.  (google meniscus for a knee diagram…)

They sent me to what ACC called a pain specialist, who I recently found out is not a pain specialist but a rehab specialist, nevertheless he wasn’t an “ACC Hitman” and he diagnosed the CRPS.

Since then I have tried the tricylcic anti depressants, Nortriptyline and Amitriptyline, I am hyper sensitive to them and even the smallest dose put me in a state similar to a half doz of beer all day every day.  I have been on all the anti depressants under the sun,  I have tried fairly experimental treatments such as Bisphosonate infusions that made my arm swell like a watermelon and made me feel like I had a horrible flu for a week.

The standard medication for dulling nerve pain, Gabapentin, was tried twice to no effect, but I did have temporary success with Fentanyl patches,  Fentanyl is a very strong opiate, somewhere in strength between morphine and the weaponised gas version used in the Moscow Theatre Siege of the early 2000s.  It was originally intended for palliative care where patients couldn’t swallow pills etc, and is a 3 day slow release patch,

The patches would take 1 or 2 points out of 10 off the pain, however tolerance built quickly, and I escalated to the largest patch, of 100mcg,  which is the equivalent of 300-400mg of morphine a day,  usually reserved for cancer pain and palliative care, etc.   With pain and opiates, the answer seemed to be “not working, you need MORE!”

I was a zombie. Stuck at home. In pain.  Incredibly short tempered, and not always  coherent, memory patchy at best, prone to feeling nauseated and vomiting during pain flares, and I slowly lost weight.

I couldn’t drive, reactions were too slow, balance wasnt great either, I was prone to bouts of dizzyness, and made dumb decisions.

So I made a life changing decision, you see, I am originally from Canada, a place where MMJ is fully legal,  I made a 2 month trip to visit family. While there, my family acquired a Vaporizer,  (Vaporizing  can remove 95% of the unwanted residues etc from smoking). While there I used vaporised cannabis from a compassion club, after getting 2 hits out of a small portion of cannabis, the leftovers would then get boiled down to cannabutter, to extract any last cannabinoids, for use on toast.  (cannabinoids are fat soluble, so there are lots of recipes to soak them in olive oil, butter etc)  While there I made huge gains, within 10mins of Vaping my pain would have  a 5/10 reduction to just 2 or 3 out of 10,  so over the 2 months, I almost felt normal, a side effect of course was a lift in my mood,  and any nausea was smashed out of the park by the Vaporiser, and I began to put on weight again.  I came off several medications, Including Clonozepam, a drug with significant cognitive side effects, and had a significant reduction in my opiate requirements, Im sure with another 2 months, I could have become opiate free, which is a holy grail for people with Chronic pain.

After 2 months it was time to come back to NZ, and my improvements impressed the ACC specialist, so much so, that he agreed to try Sativex, the Cannabis oil based mouth spray, which is used off label for neuropathic pain, and the only option in NZ.

At this stage I was trialed on methadone while waiting for Sativex which sent me backward fast. I don’t remember much except when I woke up nearly blind at one stage. I did call the  ACC specialist after hours at some stage and apparently mentioned his wife/secretary had bad phone manners and would never let me get in touch with him.  He gave me a trespass order for that.  It was probably because I was on the surly side, (again opiates can in rare cases make people aggressive, depression is usually the main one exacerbated by them)

I also received another from ACC when I was mentioning Cannabis in reference to getting Sativex,  immediately after the Ashburton shootings, so in hindsight ACC staff may have been a little on the jumpy side…..

It was obvious after 2 tresspass orders that methadone doesn’t agree with me, so I switched back to Fentanyl patches. The Specialist did sign the papers before all of this so I could get a Sativex script. But ACC wouldn’t fund it. I am having them do a review in the new year.

I am contemplating paying for it myself and it cost me about $1000 a month. I am sure that’s why they denied me.  Methadone costs less than 20 cents for a 5mg tablet i’m told, Sativex would be $30 a day… Fentanyl didn’t work as effectively as it should, I had a personality transplant on Methadone and lost the ability to form coherent memories, and I don’t miss Clonozepam, So of the Class B Drugs,  Cannabis preparation were the most relief from pain, and also controlled my Nausea and mood, removing the need for even more drugs…

With the truly positive experience I have in my homeland, I can’t understand how anyone can deny MMJ with a straight face, the night and day difference it provided to me overseas was a revelation for my specialist.

The 2 main active ingredients, CBD and THC are both listed as medicines. That’s why Sativex is legal. Why not import a cheaper alternative from the US or somewhere. Make a market not a monopoly…..  ACC is denying me the only variety available of the most effective and sustainable family of treatments/medicines based on cost,  in Canada the Compassion clubs have given me better relief than ACCs top pain specialists, which is why I believe that domestically grown must be a part of the debate going forward to keep prices in check. I cannot just “live like its legal” and grow my own, as my wife has a medical career herself that would be put in jeopardy.  Something has to change, and I still cry about it. If I could find a grower I would quit all the drugs and go all natural. But alas it’s illegal, with no political will to change it…..

Introducing a new Author – Shane Le Brun

Hello everyone, I’d like to formally introduce myself to the Blog, as I will be writing on an issue that effects me personally, Medicinal Cannabis, over the next few months.

For a little background on me,  I joined the Army fresh out of high school and spent just over 8 years “In Green” most of which was spent as an Ammunition Technician, blowing stuff up as a perk, between more mundane parts of the role. After things went to custard for the wife  I studied IT in Christchurch, and moved to Nelson for a Job opportunity.

In the past year I have been gradually becoming more vocal on the Medical Marijuana (MMJ) scene in NZ, following a string of near misses my wife has had with Opiates (Morphine class of Drugs) in a hospital setting. Then the astounding level of pain relief obtained on the first attempt with MMJ.  I have been selected as a board member for Green Cross, mainly due to my knowledge and first hand experience as an “Amateur Aneasthetist” with regards to the pros, cons, and side effects of various pain medications, the experience derived from caring for my wife and being over involved in her ACC process.   I have also been working closely with Karen Jeffries and a few others who have been advocating for longer from the more recent development in MMJ, the treatment of Pediatric or intractable epilepsy.

Much of the MMJ community, (or at least the most vocal parts) in NZ is very left wing, having been on the receiving end of what they see as an unjust govt policy from both the Labour and National Governments that have knowingly ignored their plight.  Any right wing or moderate professionals in favor are generally of the silent type, further skewing the perception.  Anecdotally , the amount of people suffering who mention their cannabis use and receive a smile and a wink from the medical fraternity, who then stay silent on the issue is also incredibly frustrating to the patient, further pushing people politically left against “the system”.

It is also important to note that United Future, a minnow in parliament,  polled less than ALCP during the last election on the party vote, and has been a steadfast opponent of Medical Marijuana since inception, and due to a faux pas dating back a decade, has been the target of some fairly harsh and unconstructive  criticism and derision from within the MMJ community.

There is also a strong movement internationally to tout Medicinal Cannabis as a panacea for all sort of ailments, including people who genuinely believe that it is a cure for ALL types of cancer. There is promising research in vitro, (the lab dish) but that has yet to be followed up by useful human trials. I see those making such boastful claims publicly as hindering the entry of MMJ  into the mainstream in NZ.  – More on that another time.

What I hope to contribute, is from a slightly  right wing, (or at least less radical left wing) background, rational argument and debate from a politically neutral standpoint, about applying Medicinal Cannabis to treatments where there is well established evidence in NZ. This includes for HIV or Cancer related Nausea and weight loss, MS related spasticity and pain and  long term Chronic Pain management where the Morphine and Valium families of drugs, with all their risks, side effects and required dose escalations are undesirable. I feel it should also be at least a last resort for the very promising new fields of research as they crop up. Pediatric Epilepsy is all the rage at the moment, with an NZ child Jade Guest having a 90% seizure reduction after moving to Colorado but research is suggesting Arthritis, Osteoporosis and Crohns disease may be breakthrough areas in the near future, so it shouldn’t be pigeon holed to individual conditions as is the case in Many US States,

My personal vision of implementation is that a Prescription for Cannabis goes through  2 medical professionals before approval, effectively a specialist only medicine,  such as your GP recommending use, then the relevant specialist, such as an Oncologist, or Anaesthetist etc giving the final approval.

Seeing as Pete posted an index of his political orientation I will share mine….

8x22  Social moderate………