Accurate Education – Marijuana (Cannabis): Legislative Update

Marijuana (Cannabis)

Legislative Update

The use of marijuana for recreational or medical purposes remains highly controversial. While Louisiana has recently passed new legislation legalizing medical marijuana (cannabis), it is likely to not be fully implemented until late 2018.

 

See below for more information about Medical Marijuana in LA

 

The guidelines previously establishd by the LA State Board of Medical Examiners dictated that the use of illicit marijuana could not be allowed in my opioid pain management program. Due to recent legislation, the growing knowledge regarding the combined use of opioids and medical marijuana, and changing attitutudes to the use of marijauan, it may be possible in the near future that it may not be necessary to forbid the use of illicit marijuana in patients who are prescribedo opioids. Nevertheless, the legal ramifications remain unclear and until these are resolved, patients in the Accurate Clinic opioid pain management program are  still advised they must discontinue use of illicit cannabis or be terminated from opioid management. Discontinuing chronic use of cannabis products may be difficult and may be associated with withdrawal symptoms (see below).

 

See also:

Marijuana – Discontinuing Use

Marijuana Addiction – Cannabis Use Disorder

 

 

Key to Links:

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Red text – another page on this website

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Medical Marijuana (Cannabis) in Louisiana

While Louisiana has recently passed new legislation legalizing medical marijuana (cannabis), it is likely to not be fully implemented until late 2018. Amongst other hurdles,  the state boards of pharmacy annd medical examiners must determine the specific products to be made available, including quantities and strengths and the combination ratios of different constituent components including THC and cannabadiol (CBD) . Furthermore, they must determine what constitutes a month’s supply for prescribing purposes. Contrary to the previous stance by the LA Board of Medical Examiners, it appears that medical marijuana will be allowed to be prescribed in conjunction with opioids.

 

As of the most recent legislation, House Bill 579 signed by the governor and due to become law on 8/1/18,  the current form of legislation dictates that medical marijuana may be used for treatment of the following conditions, although this list may change in the future:

 

  1. Intractable Pain
  2. Severe muscle spasm
  3. PTSD
  4. Crohns
  5. Spasticity such as Spastic Quadriplegia
  6. Chemotherapy in the treatment of cancer
  7. Certain seizure disorders
  8. HIV/AIDS complications such as cachexia or wasting syndrome
  9. Debilitating medical conditions such as Paarkinsons and Muscular Dystrophy
  10. Multiple Sclerosis

 

Caveats to the above include the definition of intractable pain which legislation defines as “A pain state in which the cause of pain cannot be removed or otherwise treated with the consent of the patient and which in the generally accepted course of medical practice , no relief or cure of the cause of the pain is possible, or none has been found after reasonable efforts. It is pain so chronic and severe as to warrant an opioid prscritpion.”

 

Furthermore it should be understood that like the prescribing of opioids, medical marijuana is not the first “go-to” treatment for the above conditions. A patient must first be trialed and failed conservative therapy. While not specified, it is likely that medical marijuana can be prescribed without establishing a failed course of opioid therapy first.

 

Resources:

www.Healer.com

This website appears to be good resource for exploring medical marijuana. It lists the following references in support of the advice and information provided:

 

1Russo, Ethan B., Alice P. Mead, and Dustin Sulak. “Current Status and Future of Cannabis Research.” The Clinical Researcher 29:2 (2015): 58-64.

 

2Thompson, George R., et al. “Oral and intravenous toxicity of Δ 9-tetrahydrocannabinol in rhesus monkeys.” Toxicology and applied pharmacology 27.3 (1974): 648-665.

 

3Grotenhermen, Franjo. “Pharmacology of cannabinoids.” Neuroendocrinology Letters 25.1/2 (2004): 14-23. 4Mittleman, Murray A., et al. “Triggering myocardial infarction by marijuana.” Circulation 103.23 (2001): 2805-2809.

 

5Stout, Stephen M., and Nina M. Cimino. “Exogenous cannabinoids as substrates, inhibitors, and inducers of human drug metabolizing enzymes: a systematic review.” Drug metabolism reviews 46.1 (2013): 86-95.

 

6Cichewicz, Diana L. “Synergistic interactions between cannabinoid and opioid analgesics.” Life sciences 74.11 (2004): 1317-1324. 7Abrams, D. I., et al. “Cannabinoid–opioid interaction in chronic pain.” Clinical Pharmacology &Therapeutics 90.6 (2011): 844-851.

 

8Cooper, Ziva D., et al. “Impact of co-administration of oxycodone and smoked cannabis on analgesia and abuse liability.” Neuropsychopharmacology (2018): 1.

 

9Grotenhermen, Franjo. “Pharmacokinetics and pharmacodynamics of cannabinoids.” Clinical pharmacokinetics 42.4 (2003): 327-360. 10Perez-Reyes, Mario, et al. “Antagonism of marihuana e ects by indomethacin in humans.” Life sciences 48.6 (1991): 507-515.

 

11McPartland, John M., Dan J. Blanchon, and Richard E. Musty. “CLINICAL STUDY: Cannabimimetic e ects modulated by cholinergic compounds.” Addiction biology 13.3-4 (2008): 411-415.

 

12Joy JE, Watson SJ, Benson JA, editors. Marijuana and medicine: Assessing the science base. Washington DC: Institute of Medicine, National Academy Press; 1999.

 

13Wang, Tongtong, et al. “Adverse e ects of medical cannabinoids: a systematic review.” Canadian Medical Association Journal 178.13 (2008): 1669-1678. 14Hall W, Pacula R. Cannabis Use and dependence: Public Health and Public Policy. Cambridge University Press, 2003.

 

15D’Souza D, et al. Blunted psychotomimetic and amnestic e ects of Δ-9- tetrahydrocannabinol in frequent users of cannabis. Neuropsychopharmacol 2008;33(10):2505-16.

 

16Pertwee, Roger G. “Pharmacological and therapeutic targets for Δ9 tetrahydrocannabinol and cannabidiol.” Euphytica 140.1-2 (2004): 73-82.

 

17De Vry, J., et al. “Behavioral e ects of cannabinoids show di erential sensitivity to cannabinoid receptor blockade and tolerance development.” Behavioural pharmacology 15.1 (2004): 1-12.

 

18Tait, Robert J., Andrew Mackinnon, and Helen Christensen. “Cannabis use and cognitive function: 8-year trajectory in a young adult cohort.” Addiction 106.12 (2011): 2195-2203.

 

19Hashibe, Mia, et al. “Marijuana use and the risk of lung and upper aerodigestive tract cancers: results of a population-based case-control study.” Cancer Epidemiology Biomarkers & Prevention 15.10 (2006): 1829-1834.

 

20Tetrault, Jeanette M., et al. “E ects of marijuana smoking on pulmonary function and respiratory complications: a systematic review.” Archives of Internal Medicine 167.3 (2007): 221-228.

 

21Pacher, Pál, Sándor Bátkai, and George Kunos. “The endocannabinoid system as an emerging target of pharmacotherapy.” Pharmacological reviews 58.3 (2006): 389-462.

 

22Grotenhermen, Franjo, and Kirsten Müller-Vahl. “The therapeutic potential of cannabis and cannabinoids.” Deutsches Ärzteblatt International 109.29-30 (2012): 495.

 

23Russo, Ethan. “ Clinical Endocannabinoid De ciency (CECD): Can this Concept Explain Therapeutic Bene ts of Cannabis in Migraine, Fibromyalgia, Irritable Bowel Syndrome and other Treatment-Resistant Conditions?” Neuroendocrinology Letters 25.1/2 (2004): 31-39.

 

24National Academies of Sciences, Engineering, and Medicine. The health e ects of cannabis and cannabinoids: The current state of evidence and recommendations for research. National Academies Press, 2017.

 

25Sulak, Dustin, Russell Saneto, and Bonni Goldstein. “The current status of artisanal cannabis for the treatment of epilepsy in the United States.” Epilepsy & Behavior 70 (2017): 328-333.

 

26Abi-Jaoude, Elia, et al. “Preliminary evidence on cannabis e ectiveness and tolerability for adults with Tourette syndrome.” The Journal of neuropsychiatry and clinical neurosciences 29.4 (2017): 391-400.

 

27Abuhasira, Ran, et al. “Epidemiological characteristics, safety and e cacy of medical cannabis in the elderly.” European journal of internal medicine 49 (2018): 44-50.

 

28Walsh, Zach, et al. “Medical cannabis and mental health: A guided systematic review.” Clinical psychology review 51 (2017): 15-29.

 
29McPartland, John M., and Ethan B. Russo. “Cannabis and cannabis extracts: greater than the sum of their parts?.” Journal of Cannabis Therapeutics 1.3-4 (2001): 103-132.

 

30Russo E, Guy GW. A Tale Of Two Cannabinoids: The Therapeutic Rationale For Combining Tetrahydrocannabinol And Cannabidiol. Med Hypotheses 2006;66:234-46.

 

References:

Medical Marijuana – Louisiana

  1. louisiana-medical-marijuana-expansion-bill-signed-into-law-may-20-2016
  2. louisiana-2016-sb180-chaptered
  3. medical-marijuana-in-louisiana-who-will-get-access-june-2015
  4. now-in-effect-louisiana-medical-marijuana-law-shields-patients-and-caregivers-from-prosecution-aug-5-2016
  5. La house committee passes bill to allow medical marijuana prescription 4-5 2018

 

Medical Marijuana – Colorado

  1. The Clinical Conundrum of Medical Marijuana – 2017

Medical Marijuana –Pain

  1. Use-of-Prescription-Pain-Medications-Among-Medical-Cannabis-Patients

Emphasis on Education

 

Accurate Clinic promotes patient education as the foundation of it’s medical care. In Dr. Ehlenberger’s integrative approach to patient care, including conventional and complementary and alternative medical (CAM) treatments, he may encourage or provide advice about the use of supplements. However, the specifics of choice of supplement, dosing and duration of treatment should be individualized through discussion with Dr. Ehlenberger. The following information and reference articles are presented to provide the reader with some of the latest research to facilitate evidence-based, informed decisions regarding the use of conventional as well as CAM treatments.

 

For medical-legal reasons, access to these links is limited to patients enrolled in an Accurate Clinic medical program.

 

Should you wish more information regarding any of the subjects listed – or not listed –  here, please contact Dr. Ehlenberger. He has literally thousands of published articles to share on hundreds of topics associated with pain management, weight loss, nutrition, addiction recovery and emergency medicine. It would take years for you to read them, as it did him.

 

For more information, please contact Accurate Clinic.

 

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