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 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!

 

 

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………