Marijuana (Cannabis)

 

The medical information on this site is provided as a resource for information only, and is not to be used or relied upon for any diagnostic or treatment purposes and is not intended to create any patient-physician relationship.  Readers are advised to seek professional guidance regarding the diagnosis and treatment of their medical concerns.

 

Legislative Update

The use of marijuana for recreational or medical purposes remains highly controversial. While Louisiana has passed new legislation legalizing marijuana (cannabis) for medical use, it is now available (as tinctures only for now).

 

Availability of Medical Marijuana Update

Update:

  1. Medical cannabis is now available.
  2. The doctor will print medical cannabis “recommendations” and they will be faxed directly to the designated cannabis-certified pharmacy.
  3. Medical cannabis is available in tincture form and cartridges with metered dose inhalers to allow for vaping.
  4. The tinctures are provided in the following ratios: a 1:1 CBD to THC ratio, a 20:1 CBD to THC ratio, and a 100% THC formulation.
  5. Up to 3 bottles of tincture can be dispensed at a time.
  6. Topical formulations are available in different strengths
  7. Under the new legislation taking effect 1/1/2022, pharmacies can dispense up to two and a half ounces of raw or crude cannabis every 14 days for therapeutic use to patients 21 years and older.

 

Hemp Farming Act 2018

  1. Removed hemp for the US list of scheduled substances.
  2. Did not remove hemp derived cannabinoids from the list of scheduled I substances.
  3. Amended the definition of marijuana by including an exemption for hemp, defined as “any part” of the Cannabis sativa L. plant containing no more than 0.3% THC.

 

Previously reported:

The law allows only the LSU and Southern University agricultural centers, with business partners, to cultivate and produce medical pot. Both of these institutions have been hampered by multiple delays in getting started in production.

 

LSU’s first legal crop of medical marijuana was just planted Friday August 17, 2018 due to regulatory delays lasting months. The joint effort between LSU AgCenter  and its business partners, GB Sciences, won’t harvest their first crop until November, 2018, about two months later than originally anticipated. It takes a crop about three months to mature. It is unclear how long it will then take for the products to be manufactured from the plants into the pills and oils that will make up the “medical marijuana” available in Louisiana.

 

Southern University has been delayed by legal challenges with its chosen grower and their production has been delayed. Southern University planted its first seeds for medical marijuana in Louisiana in July, 2019. They do not anticipate medical products to be available until sometime in 2020.

 

See:

News Story – August 16, 2018

News Story – July 25, 2019

 

Terminology

Prescription Cannabinoids

The term “prescription cannabinoid” refers to products containing one or more marijuana plant-derived or synthetically manufactured cannabinoids that are available by prescription only. Currently in the U.S. only three prescription cannabinoids are FDA-approved and legal to be prescribed in all states. These include:

 

  1. Cesamet (nabilone, a synthetic cannabinoid similar to THC) – Available in the U.S.
  2. Epidiolex (a plant-derived CBD) – Available in the U.S.
  3. Marinol (dronabinol, a synthetic THC) – Available in the U.S.

 

Sativex (a combination of THC and CBD in a 1:1 ratio) is a prescription cannabinoid available in Canada and Europe but not yet FDA-approved or available in the U.S.  Some of the most informative research into medical uses of marijuana has come from studies evaluating Sativex because it is plant-base and contains both THC and CBD as well as other pharmacologicaly significant cannabis plant constituents including some terpenes.

Medical Marijuana:

This term is in popular use but it is imprecise.  It generally refers broadly to dried cannabis dispensed or otherwise obtained and used either for supervised medical purposes or for self-medication. In a more accurate context, the term “cannabis” or “dried cannabis” is preferred when describing the plant form.

 

Cannabis/Dried Cannabis:

The terms “cannabis” or “dried cannabis” refer to the marijuana in its plant form.

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Pharmaceutical Cannabinoids:

The term “pharmaceutical cannabinoid” refers to cannabinoids that may be available without a prescription that  are generally derived from the marijuana plant and manufactured under controlled commercial conditions. Which of these products are available without a prescription varies state by state and the quality of manufacturing may also vary significantly from one product to another, with little to no regulatory oversight over the manufacturing process.

 

In Louisiana, the only pharmaceutical cannabinoid currently legal and available is cannabidiol if it is 100% pure and manufactured from cannabis stems or seeds, not leaves or flowers. Louisiama has now legalized other cannabinoids including THC, likely in the forms of capsules and tinctures only, expected to become available in the fall of 2018.

 

Tinctures

Tinctures are produced by steeping cannabis flowers in alcohol while applying low heat which allows the active compounds in cannabis to infuse into the alcohol. This infusion is then concentrated, resulting is a potent liquid that contains various cannabinoids and other constituents. Manufacturers often add carrier oils and other complementary ingredients, such as an orange oil to improve the taste of a tincture. Tinctures can be taken orally or sublingually (under the tongue).

 

 

Prescription Opioids and Medical Marijuana

The guidelines previously establishd by the LA State Board of Medical Examiners dictated that the use of illicit marijuana could not be allowed in an opioid pain management program. Due to recent legislation, the growing knowledge regarding the combined use of opioids and medical marijuana, and changing attitudes towards the use of marijuana, it may be possible in the future that it would not be necessary to forbid the use of illicit marijuana in patients who are prescribed 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 and cannabis-based products containing >0.3% THC or be terminated from opioid management. Discontinuing chronic use of cannabis products may be difficult and may be associated with withdrawal symptoms (see Marijuana – Discontinuing Use).

 

However, use of physician-recommended “Medical Marijuana” cannabis-based products will be allowed in the Accurate Clinic opioid pain management program. However, unless certain conditions apply, patients at Accurate Clinic who receive written recommendations for “Medical Marijuana” cannabis-based products when prescribed opioids must have both their opioids and “Medical Marijuana” prescribed/recommended at Accurate Clinic.

 

See:

Marijuana vs. Hemp

Marijuana – Legislative Update for Louisiana

Marijuana – Medical Use Overview

“Medical Marijuana” – Getting Started

 

Cannabinoid-Based Medications:

Over-the-Counter Cannabinoid Medications:

Marijuana – Cannabidiol (CBD)

 

Prescription Cannabis-Based Medications:

FDA-Approved Prescription Cannabis-Based Medications

Louisiana Prescription Cannabis-Based Products – “Medical Marijuana”

 

 

Clinical Applications of Cannabis:

Cannabis – Anxiety (coming soon)

Cannabis – Fibromyalgia

Cannabis – Headaches (coming soon)

Cannabis – Inflammatory Bowel Disease (coming soon)

Cannabis – Neuroinflammation (coming soon)

Cannabis – Pain (coming soon)

Cannabis – Sleep (coming soon)

 

The Medical Science of Cannabis:

The Endocannabinoid System

Marijuana – Botanical

Marijuana – Pharmacokinetics

Marijuana – Inhaled (Smoked and Vaporized)

Marijuana – Cannabinoids and Opioids

 

Cannabinoids and Terpenes:

Cannabinoids & Terpenes – An Overview (coming soon)

Cannabinoids:

Marijuana – Cannabidiol (CBD)

 

Terpenes:

Terpenes – An Overview (coming soon)

 

See also:

Marijuana – Discontinuing Use

Marijuana Addiction – Cannabis Use Disorder (CUD)

 

Key to Links:

Grey text – handout

Red text – another page on this website

Blue text – Journal publication

 

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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.

 

The most recent legislation, House Bills 579 & 672, were signed by the governor and became 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 Parkinsons and Muscular Dystrophy
  10. Multiple Sclerosis
  11. Autism: Any of the following conditions associated with autism spectrum disorder:

 Repetitive or self-stimulatory behavior of such severity that the physical health of the person with autism is jeopardized

 Avoidance of others or inability to communicate of such severity that the physical health of the person with autism is jeopardized

 Self-injuring behavior

 Physically aggressive or destructive behavior

Note: (In recommending medical marijuana for a patient under the age of 18 years old with an autism  spectrum disorder, a physician must first consult with a pediatrician)

 

A caveat to the above is 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 prescription.”

 

Similar to the prescribing of opioids, medical marijuana is not the first “go-to” treatment for the above conditions. A patient must first trial and fail conventional, conservative therapy. While not specified, it is likely that medical marijuana may be prescribed without first establishing a failed course of opioid therapy.

 

For more information regarding approved medical conditions for the use of medical marijuana products in Louisiana and a brief list of medical journal publications that support their use, please download:

Approved Medical Conditions in Louisiana – May 16, 2019 Articles Supporting Recommendations

 

Cannabidiol (CBD)

CBD – Legal Status

There exists a great deal of confusion for researchers, practitioners and patients with regard to CBD products. This confusion arised from conflict between federal and state laws on the medical use of cannabis products, the lack of consistency among state laws and the availability of many artisanal cannabis and CBD products.

See: Marijuana vs. Hemp

 

Federal Law

The DEA’s most recent denial of two marijuana rescheduling petitions means that marijuana and its constituent cannabinoids, including CBD from any source (including hemp), will remain Schedule I.  Based on federal law, all Schedule I drugs are illegal in all states. This conclusion is based on a recent legal review article published in 2017.  However, while the DEA maintains that CBD is definitely still illegal, in November 2017 a spokesperson for the agency stated that while those who violat
e federal drug laws could run the “risk of arrest and prosecution,”  the DEA is not “going after” individuals who benefit from CBD oil.

 

Louisiana Law

Currently, cannabidiol products are legal in Louisiana but only if derived from industrial hemp seeds and/stalks but not flowers or leaves, not synthetic, and they must be 100% free of THC (See: House Bill 225 – 2017). 

 

Availability of Medical Marijuana Products

There are only two medical marijuana growers licensed in LA, Southern University and LSU. Each of these growers are using different resources to produce the products that will be available to LA residents who qualify for prescriptions. Reportedly, LSU will have products available by October, or November.  Southern University will reportedly have products available in February, 2019.  However, these predictions do not appear reliable.

 

Currently, there will only be nine licensed pharmacies allowed to dispense medical marijuana. The exact products to be made available are unknown but the law allows medical marijuana to only be in the form of a pill or tincture. Dried plant is not to be included and no product that is intended to be smoked or vaped will be legal.

 

The Ten Pharmacies:

New Orleans Region

H&W Drug Store is located at 4718 Paris Ave. in Gentilly.

Central Louisiana – Alexandria

The Medicine Cabinet Pharmacy ise located at 403 Bolton Ave.

Southeastern Louisiana – Madisonville

Willow Pharmacy is at 1519 W. Highway 22 in Madisonville.

Shreveport Region – Shreveport

Hope Pharmacy is located at 1410 E. Kings Highway in Shreveport.

Monroe Region – West Monroe

Delta Medmar is located at 111 McMillan Road in West Monroe.

Acadiana – Lafayette

The Apothecary Shoppe is located at 620 Guilbeau Road in Lafayette.

Capitol Region – Baton Rouge

Capitol Wellness Solutions ise located at 7941 Picardy Ave in Baton Rouge.

Teche Region – Houma

Green Leaf Dispensary is located 6048 W. Park Ave. in Houma.

Southwestern Louisiana Region – Lake Charles

Medicis is located at 1727 Imperial Blvd. in Lake Charles.

? Region – ?

Geaux Green Pharmacy is located at

 

Resources:

www.Healer.com

This website appears to be good resource for exploring medical marijuana.

 

References:

Medical Marijuana – Federal

  1. The legal status of cannabis (marijuana) and cannabidiol (CBD) under U.S. law – 2017

 

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
  6. HOUSE BILL NO. 225 – 2017 Regular Session
  7. Approved Medical Conditions in Louisiana – May 16, 2019 Articles Supporting Recommendations
  8. GB Sciences Louisiana Product Guide (07.23.2019)

 

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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