Trumpvirus Death Count Saturday, 10 October 2020

This death count brought to you by:
The once Grand Old Party, who reminds you, Vote for Biden!

The GOP reminds you:
VOTE FOR BIDEN!

There are at least 214, 367 reasons to NOT vote for Trump.
Those are dead reasons.
There are 7,717,392 living reasons to NOT vote for the Liar in Chief.

Remember: TAKE OUT THE TRASH IN NOVEMBER!

You KNOW things are serious when a majority of physicians, scientists, researchers and others come out against a political leader, especially and particularly the President… when they’ve NEVER DONE IT BEFORE.

America has NOT been made “great again” by our feckless misleader, the Liar in Chief, Donald John Trump.

It’s time to TAKE OUT THE TRASH IN NOVEMBER!

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In an uncharacteristic move, The New England Journal of Medicine recently took a step which they have not since their 1812 founding.

 

A scathing editorial signed by all 34 editors of the publication – physicians, scientists, health researchers, and medical experts – acknowledged that in response to the COVID-19 pandemic, the President and his administration have “taken a crisis and turned it into a tragedy.”

The group minced no words in their scorching criticism of the President and his administration for their abysmal, still-ongoing failures which have claimed at least 212,466 lives, and counting, by writing that “Instead of relying on expertise, the administration has turned to uninformed ‘opinion leaders’ and charlatans who obscure the truth and facilitate the promulgation of outright lies.”

Solution being carefully poured into a petri dish that sits under a micro scope. A medical scientist wearing glasses can be seen concentrating as he pours from the glass flask. Selective focus.

Noting that physicians and other healthcare professionals face the possibility of lawsuits, and loss of license for such malpractice, they acknowledged that the nation’s solitary recourse for political malfeasance is to vote him out of office, and wrote that, “Anyone else who recklessly squandered lives and money in this way would be suffering legal consequences. Our leaders have largely claimed immunity for their actions. But this election gives us the power to render judgment.”

They cited America’s Trump-led failures and wrote that in comparison to other nations, “We have failed at almost every step. We had ample warning, but when the disease first arrived, we were incapable of testing effectively and

Walking Into The Promised Land With COVID-19

I have maintained from Day One of the emergence of this pandemic back in late December 2019, early January 2020, that there will be a “golden thread” running through it all, and that being, is that we are unwittingly marching into the veritable “promised land” of health, which is longevity, through improved well-being. The lessons learned in this coronavirus pandemic are teaching us, by experience, what we need to know to improve human health, and by extension, longevity.

Dr. Anthony S. Fauci, MD, Director, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland

It will, of course, emerge as a secondary by-product of treatment, and prevention, at the tertiary level. And for that, we can all be grateful.

So, while at present, we (at least the wise ones) are taking every conceivable precaution to prevent contracting the disease, there remain stubbornly stupid individuals whom insist on ignoring science (like the President and many Republicans) and the expert recommendations of those whose life work has revolved around studying infectious disease, the most notable among which is Dr. Anthony Fauci, MD, Director of the National Institute of Allergy and Infectious Diseases at the National Institutes of Health, in Bethesda, Maryland.

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Why Do Some People Weather Coronavirus Infection Unscathed?

August 24, 2020 by Emily Laber-Warren

One of the reasons Covid-19 has spread so swiftly around the globe is that for the first days after infection, people feel healthy. Instead of staying home in bed, they may be out and about, unknowingly passing the virus along. But in addition to these pre-symptomatic patients, the relentless silent spread of this pandemic is also facilitated by a more mysterious group of people: the so-called asymptomatics.

According to various estimates, between 20 and 45 percent of the people who get Covid-19 — and possibly more, according to a recent study from the Centers for Disease Control and Prevention — sail through a coronavirus infection without realizing they ever had it. No fever or chills. No loss of smell or taste. No breathing difficulties. They don’t feel a thing.

Asymptomatic cases are not unique to Covid-19. They occur with the regular flu, and probably also featured in the 1918 pandemic, according to epidemiologist Neil Ferguson of Imperial College London. But scientists aren’t sure why certain people weather Covid-19 unscathed. “That is a tremendous mystery at this point,” says Donald Thea, an infectious disease expert at Boston University’s School of Public Health.

The prevailing theory is that

What If Democrats Win… And So Does Trump?

The year 2020 has been one of black swans, to be certain.

Some would say 2016 was the precursor, when Hillary won the Popular Vote, and Trump was elected.

Who saw it coming, eh?

Certainly not the pollsters.

One man did, however, and since 1984 he has CORRECTLY predicted every Presidential Election’s outcome… including Trump’s impeachment.

More on that in a moment.

But just so we’ll understand one another, the term “black swan” in this and other such contexts (not necessarily politically related, however), is the moniker given to events that are outside the context of normalcy, or the normally-expected, are exceedingly rare, difficult to predict, may often have severe consequences, and in hindsight, often have broad acceptance that the event(s) in question were characterized as obvious.

In fact, I would suggest that many who supported the Current White House Occupant now, and then, would also consider him a “black swan” president.

Consider these actual events:

As candidate Trump, on his website, he wrote in part “It’s Time To Drain The Swamp In Washington, D.C.” Interestingly, that page (https://www.donaldjtrump.com/press-releases/donald-j.-trumps-five-point-plan-for-ethics-reform) is NO LONGER ACTIVE, and must be accessed via the Internet Archive (as linked above).

His promises were fairly straight-forward (though neither drastic, nor sweeping, and have been done previously):

First: I am going to re-institute a 5-year ban on all executive branch officials lobbying the government for 5 years after they leave government service. I am going to ask Congress to pass this ban into law so that it cannot be lifted by executive order.

Second: I am going to ask Congress to institute its own 5-year ban on lobbying by former members of Congress and their staffs.

Third: I am going to expand the definition of lobbyist so we close all the loopholes that former government officials use by labeling themselves consultants and advisors when we all know they are lobbyists.

Fourth: I am going to issue a lifetime ban against senior executive branch officials lobbying on behalf of a foreign government.

Fifth: I am going to ask Congress to pass a campaign finance reform that prevents registered foreign lobbyists from raising money in American elections.

Not only will we end our government corruption, but we will end the economic stagnation.

The promise is one thing. However… the reality is much different.

Consider these ACTUAL EVENTS of his administration which call into question the veracity of his claims, and the integrity of his administration:

• His former-Environmental Protection Agency (EPA) Administrator, Scott Pruitt, was living in super-cheap housing courtesy of the wife of a man who was lobbying the EPA, and the administrator Scott Pruitt.

• Trump opened the door for 281 lobbyists to work for his administration in his first three years. Former lobbyists now run four agencies, including the departments of Defense and Energy.

• A former coal lobbyist was put in charge of regulating air pollution.

• Trump fired the State Department Inspector General at the request of the Secretary of State, Mike Pompeo, because the IG was investigating how Pompeo used staff from the Department of State to run personal errands for him, such as picking up takeout food orders, and the family dry cleaning.

• Pompeo spoke at the Republican National Convention, live from Jerusalem, while on a taxpayer-funded trip.

• The Secretary of the Department of Homeland Security used the White House to stage a naturalization ceremony starring the president, which became a video segment for the GOP convention.

• Trump’s White House Press Office recently announced they have compiled a “very large dossier” on Washington Post writer David Fahrenthold, after he reported that “taxpayers have paid Trump’s businesses more than $900,000 since he took office.” (Remember Nixon’s “Enemies List”?)

• Former Florida Attorney General, Pam Bondi, a Republican, attacked

Russia Announces WORLD’S FIRST COVID-19 Vaccine!

Well… they did it!

Russian coronavirus vaccine – A coronavirus vaccine developed in Russia shows safety, nad causes an antibody response in small human trials, according to research published in Lancet Friday, September 4, 2020.

Sputnik V has won!

So much for Trump’s “Operation Warp Speed.”

Russia has just handed Trump’s hat to him.

Twice.

They have developed TWO different versions of the vaccine.

Here are pertinent excerpts from the research published in The Lancet, the world’s leading, and among the oldest, scientific and medical journal.

“We developed a heterologous COVID-19 vaccine consisting of two components, a recombinant adenovirus type 26 (rAd26) vector and a recombinant adenovirus type 5 (rAd5) vector, both carrying the gene for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spike glycoprotein (rAd26-S and rAd5-S). We aimed to assess the safety and immunogenicity of two formulations (frozen and lyophilised) of this vaccine.”

Note the first two words – “We developed.”

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31866-3/fulltext#seccestitle10

“In conclusion, these data collectively show that the heterologous vaccine based on rAd26-S and rAd5-S is safe, well tolerated, and does not cause serious adverse events in healthy adult volunteers. The vaccine is highly immunogenic and induces strong humoral and cellular immune responses in 100% of healthy adult volunteers, with antibody titres in vaccinated participants higher than those in convalescent plasma. Unprecedented measures have been taken to develop a COVID-19 vaccine in Russia. Based on our own experience in developing vaccines against Ebola virus disease and MERS, the COVID-19 vaccine has been developed in a short time. Preclinical and clinical studies have been done, which has made it possible to provisionally approve the vaccine under the current

Common Sense: An Endangered Species?

Perhaps it’s been said before – “common sense isn’t so common anymore.”

Maybe even, at one time, or another, you’ve said as much.

Common sense, of course, is a thought process that implies a.) one is thinking, and b.) one is using process of reasoning.

And, without exception, EVERYONE thinks. Not everyone exercises good judgment.

Some take common sense for granted, while others do not.

Common sense may arise from experience, and/or education, and sometimes, experience is a harsh taskmaster – lessons learned aren’t always learned the easiest, or best way. But, it’s education nevertheless.

Point being, is that when we think, we use our highest and best faculties, which separates us and makes us unique in the animal kingdom.

So let’s quickly talk about common sense and politics – an area in which many seem to disagree, some even vehemently, and unfortunately, sometimes violently.

When we fight, we often “lose our mind,” and are motivated and actuated by feelings… which can often betray us. Yet, even in structured fighting, such as war, we employ our faculties of reason to win the victory. War, its strategies and tactics, is studied, and taught. So that very act itself demonstrates that our thinking faculties are a higher order than feeling.

Note that instead of saying “I think,” many people say, “I feel.”

That, I think, is a mistake to say that one “feels” rather than “thinks” when expressing an opinion, for it – the feeling – is something which rationally, one cannot argue against. Feelings may be pleasant, or unpleasant. And if one feels this way, or that way, it is a merely a feeling – and may be, and often is, fleeting, or passing – it is temporal, and lasts only briefly. Consider the feeling of being sad, bloated, or even gassy.

This too, shall pass.

But let’s not delve too deeply into the matter, not to become too philosophical or analytical, per se, and suffice it to say that we want to share some common sensical thoughts – ones that many, if not most, or, even all, could agree upon – in the realm of politics.

It is, after all, political season, and we human beings are political animals.

Poll: Americans Think Wall Keeps Out Coronavirus

Today’s NPR leading headline “Americans Back Trump On Immigration — But Only To Stop COVID-19, Poll Finds” took me by surprise.

Why?

Because frankly, it’s practically too late for any of that.

That is to say, it’s too late for any effort to prevent the spread of COVID-19 by limiting travel, or immigration.

We’ve had our opportunity, and like many other opportunities, it was handed to us on a proverbial silver platter.

Now, we’ve the POTUS and his minions have squandered it.

Consider that as much as President Trump blows his own horn on the matter (as he does on almost everything, which according to him, he’s the best, the smartest, the greatest, the _insert_your_superlative_of_choice_here_ on anything and everything), claiming that his actions to limit its spread to the United States by limiting travelers from certain nations were effective, and helped prevent further spread of the infection, in light of what has happened in the days since as we all watched in horror at what unfolded.

They were not!

On January 22, while attending the World Economic Forum in Davos, Switzerland, POTUS was asked by CNBC Squawk Box host Joe Kernan if he was worried about a pandemic. Here’s the pertinent exchange.

JOE KERNEN: It was a couple of years ago. Before we get started– with- we’re going talk about the economy and a lot of other things–the CDC– has identified a case of coronavirus– in Washington state. The Wuhan strain of this. If you remember SARS, that affected GDP. Travel-related effects. Do you– have you been briefed by the CDC? And–

PRESIDENT TRUMP: I have, and–

JOE KERNEN: –are there worries about a pandemic at this point?

PRESIDENT TRUMP: No. Not at all. And– we’re– we have it totally under control. It’s one person coming in from China, and we have it under control. It’s—going to be just fine.
ref: https://www.cnbc.com/2020/01/22/davos-2020-cnbcs-full-interview-with-president-trump.html

But let’s go back even further, to November 2019.

In a secret intelligence report prepared (yet denied) by the Army’s National Center for Medical Intelligence (NCMI) located on Fort Detrick, in Frederick, Maryland, which was based upon analysis of wire and computer intercepts, and satellite images, concerns that

Trump Flu Killed Herman Cain Today – U.S. Death Toll Now Over 150,000

The Trump Flu, which was caused by the Trump administration’s President’s careless and reckless disregard of science, has now killed well over 150,000 people in the United States.

Today, it killed Herman Cain, former CEO of Godfather’s Pizza, and one-time GOP presidential candidate.

So much for “fake news,” eh?

How much longer must we

How Can I Keep From Getting COVID-19 ?

Preventing COVID-19 Infection

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Of necessity, the introduction is somewhat wordy, simply because it’s necessary for the purposes of clarification, and understanding the topic, which can be complex to the average layperson. While it is outside the scope of this blog to treat patients, per se, the purpose in sharing this and other information, is to inform of the latest valid scientific findings. Those who read are free to treat themselves as they see fit, as is everyone. Again, the purpose in sharing these findings is to inform. –Ed.

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Among professional scientific, medical, and research cadre the novel coronavirus is properly known as, and is called SARS-CoV-2. Colloquially, it’s known as COVID-19. SARS is the abbreviation for Severe Acute Respiratory Syndrome, while CoV is the abbreviation for coronavirus, thus COVID is shorthand for COronaVIrus Disease, while the number 19 refers to the year in which is was first discovered. If you’re froggy enough, here’s a great read on the nomenclature.

But the point of this entry is not about the name, but about the disease, and more specifically, about preventing the disease.

And suffice it to say, that while there are naysayers who (in some cases) loudly proclaim that COVID-19 is no worse than the flu or (insert your choice of disease here _X_), or that it doesn’t affect (_X_ – insert your choice of category people group(s), young, old, middle-aged, people who live in the tropics, in Scandinavia, etc.), none of the bizarre comments or nonsensical off-the-wall “justifications” such naysayers use, none of it’s true.

Remember: Despite the unambiguously incontrovertible and overwhelming evidence that the Earth is shaped like a ball, there are some who insist that the Earth is flat.

Point being, is that there will likely always be nut cases in the world, and practically nothing that anyone says or does will change their warped, demented minds… which are like concrete – thoroughly mixed, and permanently set.

When used in the scientific medical sense, the word “novel” means new. So this coronavirus is a new type of coronavirus, meaning one which has never been seen before.

Again, not to go off the deep end (for there are plenty of people who do), but simply because a virus is new, doesn’t mean that it was “man-made” or that it was an existing virus which became “weaponized.” To make such preposterously absurd claims is not only ignorantly stupid, it is false, simply because humanity does not know everything about anything, much less everything about everything. There are plenty of things in the world that we do not know about, and there are principles in the world about which we do not now know. And in fact, there are more things about which we know little, or nothing, than there are things about which we do know.

Again, point being, is that humans aren’t “know-it-alls,” and to claim that we know practically anything the novel coronavirus is false, because we do not. Hell… we don’t even know how to treat it! The only thing we’re doing now is treating symptoms. We do the exact same thing with the common cold, for which we also have no cure, and no vaccine to prevent it.

And as regarding prevention – an ounce of which is worth a pound of cure (as the saying goes) – the only thing we can do now with the coronavirus is to MECHANICALLY prevent its spread, simply because (that we now know of) we have no ability to prevent it with a vaccine. And to be certain, when we say “mechanically” prevent its spread, we mean by physical means, by actions, not by medicine.

And that is precisely why the World Health Organization (WHO), the Centers for Disease Control and Prevention (CDC), and other public health groups have recommended maintaining a distance of 6 feet from others while in public (aka “social distancing”), wearing a face & nose covering (mask), disposable gloves, avoiding groups of people, minimizing public outings to as great an extent as possible, along with increased hand-washing, surface cleanings (disinfecting), etc.

Because we have learned that people infected with the novel coronavirus are at least 30-50% asymptomatic (meaning that they show NO signs or symptoms of infection, not even one – which also means temperature checks at certain public places are therefore effectively USELESS at preventing spread), it is critically important to maintain the physical (mechanical) precautions (preventions) at all times when out in public.

And, because 30-50% of all persons infected with COVID-19 are asymptomatic (they do NOT show even one sign or symptom of infection), that is why 100% testing of ALL people (aka “universal testing”) is critically important.

Again, EVERYONE is on a “learning curve” with the novel coronavirus, and that means EVERYONE – all scientists, all physicians, all nurses, all researchers… EVERYONE. So no one knows it all.

Now, let’s move along toward treatment.

We’re working our way toward the topic – unlike some, or even many articles, which say nothing of any value about anything. Such articles are like saying “how to lower the death rate – prevent drowning in bath tubs,” and then talking about building and installing tubs, why you should take a shower, and how expensive it is to operate swimming pools. Utter nonsense.

So, as we know, the only thing that we can do now is treat the symptoms of COVID-19 infection. And when it comes to treating the symptoms, if the symptoms are severe enough, someone will likely be in hospital, rather than at home. Thus, they’re pretty sick. And if they’re in an ICU (Intensive Care Unit), they’re really sick. And if they’re on a ventilator, they’re seriously critically sick. So there are levels of sickness with this, and other diseases, and the severity of sickness is determined by several factors, including how many signs and symptoms are being experienced (exhibited), and how much those symptoms are interfering with their ability to maintain homeostasis – our bodies’ innate ability to maintain proper function (circulate oxygenated blood, maintain proper operating temperature, utilize nutrients in food, and excrete waste by-products from digestion).

The human body is a series of complex mechanisms, all of which work together in harmony with other body systems to continue and maintain life (homeostasis).

What we do know about the more severe cases of COVID-19, is that it affects the lungs. We’re learning also that it quite likely affects other body systems, and may also have long-term implications, but the most notable, and most immediately life-threatening, is the damage done to the lungs.

We know also that COVID-19 is characterized by inflammation of the lungs, which is, in effect, a proper response mechanism of the body gone haywire. Imagine, if you will, a huge firetruck – even the whole Fire Department – responding to a small backyard barbecue fire which is nothing more than a flare-up, and easily (and most often) extinguished by you, the cook, or someone else. No drastic measures are required.

But, imagine if, in response to

Readily Available Vaccine Shows Ability To Prevent COVID-19

There Are NOW Positive Findings In COVID-19 Prevention!

While it has been reported, it has not been reported widely enough, per se, insofar as it hasn’t been picked up and reported widely enough by the MSM (MainStream Media).

And what might that good news be?

The MMR (Measles Mumps Rubella) vaccine seems to confer some ability to prevent COVID-19 infection.

Read the scientific data for yourself as follows.

And there are a couple stories about the findings (also listed below), through again, they were not widely reported.

MMR Vaccine Appears to Confer Strong Protection from COVID-19: Few Deaths from SARS-CoV-2 in Highly Vaccinated Populations

COVID-19 is MUCH MORE HARMFUL than we imagined.

Based upon the peculiarities which we were observing – a high rate of asymptomatic infected carriers, loss of senses of taste and smell, etc. – I STRONGLY suspected that this virus was a VERY BAD “player,” and NOT one to be trifled with.

Turns out, my suspicions were warranted.

I have ALSO said that, when we find a treatment and/or cure and/or vaccination, and have emerged on the “other side” of this universal, global health crisis, we will have unknowingly embarked upon a journey into healthcare’s “holy grail” and begun to journey into the “promised land” of longevity and a greater understanding of life itself – at the “granular” molecular level.

Yesterday also, I was considering the peculiar, and characteristic, identifying hallmark of the associated phenomenon of loss of senses of taste and smell.

Where does that occur?

On Old Olympus’ Towering Tops A Finn And German Viewed Some Hops

Remind me again, please…

Where do viruses reside?

Varicella, herpes (zoster, etc.), and other select viruses – including HIV – DO NOT “go away.” They’re the gifts that keep on giving… REGARDLESS of the ability to detect viral load, or not.

It’s in the nerve root.

Chicken pox, when it “goes away” really doesn’t “go away.”
It just takes up residence in the nerve root.
And, when it decides to show up again (express itself), we call it “shingles,” for which we also have a vaccination.

I’m putting money on this one, that it’s much the same way. That it’s a permanent “gift.”

There’s no other rational explanation for WHY the loss of senses of taste and smell occur, is there?

Why not?

Is it not self-evident?

Senses occur though nerves.

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https://www.latimes.com/science/story/2020-06-26/inside-the-body-the-coronavirus-is-even-more-sinister-than-scientists-had-realized

Inside the body, the coronavirus is even more sinister than scientists had realized

An electron microscopy image of a cell infected by the coronavirus that causes COVID-19. (UC San Francisco)

By Melissa Healy, Staff Writer
Friday, June 26, 2020

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The new coronavirus’ reputation for messing with scientists’ assumptions has taken a truly creepy turn.

Researchers exploring the interaction between the coronavirus and its hosts have discovered that when the SARS-CoV-2 virus infects a human cell, it sets off a ghoulish transformation. Obeying instructions from the virus, the newly infected cell sprouts multi-pronged tentacles studded with viral particles.

These disfigured zombie cells appear to be using those streaming filaments, or filopodia, to reach still-healthy neighboring cells. The protuberances appear to bore into the cells’ bodies and inject their viral venom directly into those cells’ genetic command centers — thus creating another zombie.

The authors of the new study, an international team led by researchers at UC San Francisco, say the coronavirus appears to be using these newly sprouted dendrites to boost its efficiency in capturing new cells and establishing infection in its human victims.

Their research was published Friday in the journal Cell.

The scientists also

COVID-19 Deaths in America Compared

Some have wondered how other diseases’ mortality (death statistics) compares with COVID-19.

To illustrate, their questions can be stated somewhat like “on an annualized basis, how many deaths have historically occurred because of “X” disease when compared to COVID-19?”

Such a comparison examines ONLY death.

It does not examine risk.

“Death as a Strangler”; “Death playing the violin at a Masquerade during a cholera outbreak in Paris in 1831.” 1845, by Alfred Rethel (1816-1859)

It’s akin to asking “who will die?”

Answer: Your death is a 100% certainty.

Or, if you prefer, we know for a hard, cold fact, that you will die. The corollary operative Latin phrase is “memento mori,” translated literally “remember die,” and which translates functionally as “remember death,” or loosely as “remember that you must die.”

Death rates do NOT examine how quickly hospital or healthcare systems have been or could be overwhelmed with “X” disease.

In some localities, New York City most notably, COVID-19 has overwhelmed the healthcare resources of America’s most populous city.

Death rates do NOT examine the disease’s ease of transmissibility.

COVID-19 is spread by breathing. Cancer is not. Heart disease is not. Accidents are not. Cerebrovascular disease is not. Alzheimer’s is not.

Cancer, diabetes, heart disease, kidney disease, etc., are typically chronic (long-term) conditions.

COVID-19 is not, and has often killed in a matter of days.

Death rates do not consider the insidious nature of COVID-19, i.e., that it hides in the body, often not even making its presence known (at least 30-50% of those infected are asymptomatic, i.e., show no signs of infection – not even one, including fever), even after an incubation period that ranges from 2-14 days.

Death rates do NOT examine

DJ Trump Plays Americans For Fools

So… the Bullshitter in Chief went to Allentown, PA today – to Owens & Minor, a PPE (Personal Protective Equipment) manufacturer’s distribution facility, no less – and REFUSED to wear that Made in America product, and had the audacity to say in part, that:

“You know, we’ve been doing testing at a level that nobody has ever done it before. We cannot get any, and we cannot get the press to write about it or write fairly about it. And nobody has ever done. We’ve done double what anyone else — if you add up all of the countries in the world, we’ve done more testing than all of the countries in the world added up together. Nobody has ever done anything like that. And we have the best tests.”

Look, Americans aren’t dummies.

And he’s just blowing smoke. Purely.

Just because someone doesn’t have a university degree doesn’t make them a complete blithering idiot.

Seriously.

And you don’t have to be a brainiac to know that America (330,000,000) has MANY MORE people than Spain (46,752,506).
And the UK

French Scientists Discover COVID-19 In December 2019 BEFORE The China Outbreak

This information, which was reported just yesterday (Monday, 4 May 2020), is turning the entire understanding of this disease on its ear.

Previously thought to have originated in China, COVID-19 is now thought to have been spreading globally long before the outbreak in Wuhan, China ever occurred.

An interesting observation:
This individual –and– “Patient Zero” in Wuhan were BOTH fishmongers.

A germane question:
Could this virus be related to, or capable of being transmitted in aquatic wildlife?

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Who: 42 year old man born in Algeria, lived in France for many years, worked as fishmonger

What: retrospective investigation for SARS-COV2 (novel coronavirus, aka COVID-19) in respiratory samples collected

Where: intensive care units (ICUs) of hospital north of Paris, France

When: December 27, 2019

Why: Presented to emergency ward with hemoptysis (coughing up blood/bloody sputum), cough, headache and fever, evolving for 4 days

How: RT-PCR test (reverse transcription-polymerase chain reaction) the most sensitive technique for mRNA (genetic) detection and quantitation currently available

Additional Facts: Last trip was in Algeria during August 2019. One of his children presented with ILI (influenza-like illness) prior to the onset of his symptoms. His medical history included asthma, type II diabetes mellitus. Had not visited China.

See also: COVID-19 in France since December, hospital test suggests
Researchers testing old samples found COVID-19 in a man treated a month before France confirmed its first cases.
(https://www.aljazeera.com/news/2020/05/covid-19-france-december-hospital-test-suggests-200504154024084.html)

See also: French hospital discovers Covid-19 case from December
Man found to have had virus a month before government confirmed first cases
(https://www.theguardian.com/world/2020/may/04/french-hospital-discovers-covid-19-case-december-retested)

See also: After retesting samples, French hospital discovers COVID-19 case from December
(https://www.reuters.com/article/us-health-coronavirus-france/after-retesting-samples-french-hospital-discovers-covid-19-case-from-december-idUSKBN22G20L)

See also: French hospital discovers country’s first known Covid-19 case, from December
A French hospital which has retested old samples from pneumonia patients discovered that it treated a man who had Covid-19 as early as Dec. 27, nearly a month before the French government confirmed its first cases.
(https://www.france24.com/en/20200505-france-s-first-known-covid-19-case-was-in-december)

See also: After Retesting Samples, French Hospital Discovers COVID-19 Case From December
(https://www.nytimes.com/reuters/2020/05/04/world/europe/04reuters-health-coronavirus-france.html)

See also: Genetic Study Shows COVID-19 Was in France Weeks Before The First Case Was Reported
(https://www.sciencealert.com/genetic-investigation-reveals-covid-19-was-circulating-in-europe-before-cases-were-reported)

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International Journal of Antimicrobial Agents

Available online 3 May 2020, 106006

In Press, Journal Pre-proof
https://doi.org/10.1016/j.ijantimicag.2020.106006
https://www.sciencedirect.com/science/article/pii/S0924857920301643#fig0002

Highlights

• Covid-19 was already spreading in France in late December 2019, a month before the official first cases in the country.

• Early community spreading changes our knowledge of covid-19 epidemic.

• This new case changes our understanding of the epidemic and modeling studies should adjust to this new data.

Abstract

The COVID-19 epidemic is believed to have started in late January 2020 in France. We report here a case of a patient hospitalized in December 2019 in our intensive care, of our hospital in the north of Paris, for hemoptysis with no etiological diagnosis and for which RT-PCR was performed retrospectively on the stored respiratory sample which confirmed the diagnosis of COVID-19 infection. Based on this result, it appears that the COVID-19 epidemic started much earlier.

SARS-COV-2 was already spreading in France in late December 2019

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Introduction

After its onset in December 2019 in China, the new coronavirus (SARS-COV-2) spreads widely in several countries, causing COVID-19 illness.¹ World Health Organization (WHO) declared COVID-19 a pandemic on March 11, 2020.³ France reported the first cases of SARS-COV-2 related infection on January 24, 2020.⁵ Both cases had a history of travel to Wuhan.⁶ To the best of our knowledge, these 2 cases are believed to be the first confirmed cases in France. COVID-19 most commonly present with influenza-like illness (ILI).⁷ While China was facing COVID-19 outbreak, European countries were struggling with seasonal influenza.⁸ Clinical symptomatology between COVID-19 and ILIis similar,we therefore decided retrospectively to look for SARS-COV2 in respiratory samples collected in the intensive care units (ICUs) of our hospital near Paris.

Methods – Retrospective analysis

Selected records

We reviewed medical record of ICUs patients admitted for ILI between December 2, 2019 and January 16, 2020, with a negative RT-PCR performed at admission. Every respiratory sample collected in our hospital are

Which is more deadly? War, or COVID-19?

American COVID-19 Deaths
WILL SURPASS
the
TOTAL Number of Deaths
in the
Vietnam and Korean Wars
COMBINED.

33,686 + 47,424 =81,110

81,110 – 68,387 = 12,723

Remember those numbers.

What are they?

The first figure – 33,686 – represents the number of deaths in the Korean War.

The second figure – 47,424 – represents the number of deaths in the Vietnam War.

The third figure is the sum (total) of the two numbers.

The fourth figure – 68,387 – represents the number of COVID-19 deaths in the United States, as of 0450 UTC (Universal Coordinated Time), Monday, 4 May 2020.

The fifth figure – 12,723 – represents the difference between the current number of COVID-19 American Deaths and the Total number of Deaths in the Korean and Vietnam Wars combined.

Sadly, that fifth figure WILL surpass the the third figure in a matter of days.

Already, the TOTAL number of American COVID-19 deaths has SURPASSED the number of deaths in Vietnam (47,424), Iraq (3836), Afghanistan (1833), Gulf War (149), and the Beirut Deployment (256) COMBINED – 53,498.

But here’s the sad, startling fact:

This has all happened in the space of a couple months – since 20 January – a mere 106 days. On the other hand, those wars lasted far, far longer.

So, you tell me

Shocking Findings: 96% of Prison Inmates Infected with COVID-19 HAVE NO SYMPTOMS

We have been told that the MINIMUM asymptomatic (without symptoms) range was 30-50% for the general public, which means that the number of POSITIVE cases is very likely UNDER–COUNTED by that amount, and therefore at LEAST 30-50% HIGHER than tests show, precisely because without symptoms, few, if any, are being tested.

The rationale such individuals have is, ‘I don’t have symptoms, so why should I get tested?’

And that is the classic “Typhoid Mary” Mallon case of the early 20th Century in which Mary Mallon infected many with Typhoid Fever (some of whom died), and NEVER – not even once – EVER showed any signs or symptoms of disease – not even on her deathbed.

And she did NOT die of Typhoid Fever.

And what you’re about to read is PRECISELY what needs to happen to EVERYONE in America.

That is,

EVERYONE

SHOULD BE TESTED,

EVEN IF

THEY HAVE

NO SYMPTOMS!

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In four U.S. state prisons, nearly 3,300 inmates test positive for coronavirus — 96% without symptoms

By Linda So and Grant Smith

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Sun Apr 26, 2020 / 7:59 AM EDT

(Reuters) – When the first cases of the new coronavirus surfaced in Ohio’s prisons, the director in charge felt like she was fighting a ghost.

“We weren’t always able to pinpoint where all the cases were coming from,” said Annette Chambers-Smith, director of the Ohio Department of Rehabilitation and Correction. As the virus spread, they began mass testing.

They started with the Marion Correctional Institution, which houses 2,500 prisoners in north central Ohio, many of them older with pre-existing health conditions. After testing 2,300 inmates for the coronavirus, they were shocked. Of the 2,028 who tested positive, close to 95% had no symptoms.

“It was very surprising,” said Chambers-Smith, who oversees the state’s 28 correctional facilities.

As mass coronavirus testing expands in prisons, large numbers of inmates are showing no symptoms. In four state prison systems — Arkansas, North Carolina, Ohio and Virginia — 96% of 3,277 inmates who tested positive for the coronavirus were asymptomatic, according to interviews with officials and records reviewed by Reuters. That’s out of 4,693 tests that included results on symptoms.

The numbers are the latest evidence to suggest that people who are asymptomatic — contagious but not physically sick — may be driving the spread of the virus, not only in state prisons that house 1.3 million inmates across the country, but also in communities across the globe. The figures also reinforce questions over whether testing of just people suspected of being infected is actually capturing the spread of the virus.

“It adds to the understanding that we have a severe undercount of cases in the U.S.,” said Dr. Leana Wen, adjunct associate professor of emergency medicine at George Washington University, said of the Reuters findings. “The case count is likely much, much higher than we currently know because of the lack of testing and surveillance.”

Some people diagnosed as asymptomatic when tested for the coronavirus, however, may go on to develop symptoms later, according to researchers.

The United States has more people behind bars than any other nation, a total incarcerated population of nearly 2.3 million as of 2017 — nearly half of which is in state prisons. Smaller numbers are locked in federal prisons and local jails, which typically hold people for relatively short periods as they await trial.

State prison systems in Michigan, Tennessee and California have also begun mass testing — checking for coronavirus infections in large numbers of inmates even if they show no sign of illness — but have not provided specific counts of asymptomatic prisoners.

Tennessee said a majority of its positive cases didn’t show symptoms. In Michigan, state authorities said

Are There Common Factors With Spread Of COVID-19 Disease?

Much of the media has focused upon the raw numbers for COVID-19 infection cases in the United States, and, that’s just one way of examining data. Of course, it doesn’t look good, and some may try and put a “spin” on the information as they whistle past the proverbial graveyard – it’s a type of denial… which is not just a river in Egypt.

So in that sense, I sought to examine population, population density, global population comparison, national area (in square miles) in psuedo-randomly selected nations throughout the world, and THEN to post their Infection Rates. By so doing, it gives a more clear understanding of the nature of the problem, at least in some sense.

Copper engraving of Doctor Schnabel [i.e Dr. Beak], a plague doctor in seventeenth-century Rome, with a satirical macaronic poem (‘Vos Creditis, als eine Fabel, / quod scribitur vom Doctor Schnabel’) in octosyllabic rhyming couplets.

For example, consider India.

With 1,361,462,965 people, it is the 2nd most populous nation in the world, with 17.5% of the global population. Its population density is 1,051.3 people per square mile, and it has 27,890 COVID-19 cases, with an infection rate of 2 per 100,000 people.

But, some may protest saying that the population dilutes the figures. So, let’s examine another nation.

Mozambique, an African nation on the south eastern coastal horn of that continent, has 30,066,648 inhabitants, with a population density of 74.3 people per square mile. It comprises only 0.386% of the global population. And with only 76 confirmed COVID-19 cases, its infection rate is 0.2527 per 100,000.

Again, some may protest and say that heat and sunshine are the primary reason why that nation’s infection rate is so low. So again, let’s examine another nation.

With 34,218,169 people, Saudi Arabia has 0.440% of the world’s population, is largely a

America’s COVID-19 Infection Rate Likely at Least TWICE the Reported Number

According to publicly available information compiled by Johns Hopkins University, as of 2100 GMT/UCT Wednesday, 22 April 2020, in the United States, there were:

• 842,319 Confirmed COVID-19 cases

• 46,399 COVID-19 deaths

• 4,171,896 Total COVID-19 Tests Conducted

• United States population is very nearly 330,000,000

• COVID-19’s incubation time ranges between 2 to 14 days.

• 4,466,559 have been tested

• At least 30%–50% of COVID-19 cases are asymptomatic carriers (show no signs or symptoms of infection, i.e., no fever, no chills, no loss of taste, no loss of smell, no muscle aches, no nausea, no vomiting, no upset stomach, no loss of appetite, no diarrhea, no cough, no runny nose, no sore/scratchy throat, no headache, no tiredness, no shortness of breath, no difficulty breathing, no feeling of hotness {subjective fever}, etc.)

Extrapolating, what that means is:

• Only 1.3535% of the American population has been tested for COVID-19.

• 120,932 Total have been Hospitalized

• Potentially 421,160 MORE, or AT LEAST 1,263,479 people could be infected – 50% more than have been diagnosed

• The U.S. COVID-19 Death Rate is 5.5084%

Globally, there are:

• 2,623,231 Total Confirmed COVID-19 cases

• 182,740 Total COVID-19 Deaths

The COVID-19 Global Death Rate is 6.9662%.

At this juncture, there are 707,331 known Total Recovered COVID-19 cases globally.

These figures are by no means final; they are merely preliminary good estimates, because the scenario is changing daily, and more diagnoses are being made, and autopsies which are showing COVID-19 infection as a cause of death.

The Santa Clara County California Medical Examiner’s Office recently reported that following autopsy results, TWO deaths occurred in that county February 6, and 17, both related to COVID-19, which put the dates of the first known deaths in the United States back by at least two weeks, instead of the case in Kirkland, Washington on February 29 which to date, was thought to be the first COVID-19 related death in the United States.

Essentially, the implications are precisely in keeping with what we know about COVID-19, that it is insidious – progressing inconspicuously, but harmfully – stealthily and seriously damaging before it makes its presence known with symptoms.

The experts (not the POTUS) from the CDC, including Dr. Anthony Fauci, MD, Director of the National Institute of Allergy and Infectious Diseases since 1984, tell us that

A More Thoroughly Comprehensive COVID-19 Timeline

Editor’s Note: The timeline will be updated as information becomes available, and events occur.

BACKGROUND: In the 1970’s, amidst a national famine in which millions died, the Chinese Communist government allowed and encouraged private farming in 1978, and 10 years later legalized the private industrialization of wildlife farming, in which wildlife animals were farmed, and sold in so-called “wet markets,” where live animals were slaughtered, butchered and sold alongside other foods.

This recent outbreak of coronavirus of SARS-CoV (Sudden Acute Respiratory Syndrome), a coronavirus known as COVID-19, appears to have originated in a particular live-animal wet market in the Hubei province city of Wuhan, China, which population is estimated between 8.9 to 11 million – and by some estimates, the 6th most populous city in China. Of the first 41 people infected with the virus, 27 had gone to the Huanan live market in Wuhan.

Vox produced a brief video of the scenario surrounding the emergence of the novel coronavirus on March 6. (https://www.youtube.com/watch?v=TPpoJGYlW54)

This illustration reveals ultrastructural morphology exhibited by the COVID-19 coronavirus. Note the spikes that adorn the outer surface of the virus, which impart the look of a corona surrounding the virion, when viewed electron microscopically. Image credit: CDC.

One particularly fascinating aspect of the market where farm-raised wildlife is sold, is that the exceeding majority of Chinese nationals do not eat wildlife, and rather, it is the well-to-do and wealthy – who are an extremely small minority of the 1.389 billion-plus Chinese population – which consume such fare.

“Animal husbandry” is the term given to describe the agricultural practice of tending to, caring for, raising, breeding, and rearing animals, particularly and especially livestock, meaning domesticated animals typically raised for human use, either as use for production of dairy, meat, fiber, clothing, etc. Typically again, those animals are hogs, cattle, goat, sheep, poultry and fowl, including animals used for labor such as donkeys, mules, horses, oxen, etc. While there are examples of farm-raised wildlife in Western nations such as with alligators, mink, etc., such animals are infrequently or rarely used for human consumption, but in China, that practice is allowed, and even encouraged.

While China has made great strides in acknowledging that animal health is important for the animals intrinsically, and in relationship to humans’ interaction with them as well, there remain many more significant advancements to be made, because the health of animals and humans are inextricably intertwined. Specifically, laws, regulations, and governmental agencies, standards and practices in veterinarian medicine, and in animal husbandry and health should be more jointly unified, widespread, and enforced.

––––––––––––––––––––––––––––––––––––––––––––––––––––

2017
January

10 – Dr. Anthony Fauci, MD, Director of the National Institute of Allergy and Infectious Diseases since 1984, delivered keynote address at a Harvard Global Health Institute conference in conjunction with peer-reviewed healthcare journal Health Affairs, held at Georgetown University entitled “Pandemic Preparedness for the Next Administration” which “focused on priorities for the next U.S. presidential administration and potential agenda items for pandemic preparedness.”
(https://globalhealth.harvard.edu/news/pandemic-preparedness-priorities-next-administration)

––––––––––––––––––––––––––––––––––––––––––––––––––––
2018
April

White House National Security Advisor John Bolton pressured White House Homeland Security Advisor, Tom Bossert, to resign along with his team. Neither the NSC nor DHS epidemic teams were replaced.
(https://www.washingtonpost.com/politics/white-house-homeland-security-adviser-resigns-amid-continued-turnover-in-trump-administration/2018/04/10/15db518a-3ccb-11e8-a7d1-e4efec6389f0_story.html)

May

POTUS ordered the National Security Council’s entire Global Health Security unit shut down, and called for Senior Director for Global Health Security and Biothreats Rear Admiral Timothy Ziemer to be reassigned, and dissolved his team inside the agency.
(https://www.washingtonpost.com/news/to-your-health/wp/2018/05/10/top-white-house-official-in-charge-of-pandemic-response-exits-abruptly/)

7 – POTUS called for cutting $252 million of unused funds remaining from the 2014-2015 Ebola epidemic in West Africa that killed more than 11,000 people, far exceeding the combined total cases reported in about 20 previous outbreaks since the 1970s.
(https://www.washingtonpost.com/news/to-your-health/wp/2018/05/10/top-white-house-official-in-charge-of-pandemic-response-exits-abruptly/)

––––––––––––––––––––––––––––––––––––––––––––––––––––
2019
November

In a secret intelligence report by the military’s National Center for Medical Intelligence (NCMI), based upon analysis of wire and computer intercepts, and satellite images, concerns that an out-of-control disease sweeping through China’s Wuhan region could pose a serious threat to U.S. Armed Forces in Asia, that

Mayo Clinic to have COVID-19 Antibody Test by Monday

“How can I know if I’m FULLY recovered from COVID-19 novel coronavirus?” is a question that gets asked by many, particularly by those who have been infected by COVID-19.

Unfortunately – to this point, at least – the answer to that question has been “We don’t know.”

Fortunately, however, researchers have rapidly doubled-down on their research, intensified their efforts, and are becoming fruitful.

Here’s a brief story about one such effort.

MPRNews.org

Mayo Clinic expects COVID-19 antibody test to be ready Monday

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Mayo Clinic Expects COVID-19 Antibody Test To Be Ready Monday

Pedestrians cross the street as they leave Mayo Clinic’s Gonda Building in Rochester, Minn., in 2016. Mayo researchers say they’re close to releasing tests that would tell whether a person has had and recovered from COVID-19.Alex Kolyer for MPR News file (Minnesota Public Radio)

Researchers at Mayo Clinic expect to release a test that would tell whether a person has had and recovered from COVID-19 on Monday. The Minneapolis Star Tribune reports the University of Minnesota is also narrowing in on an antibody test.

The tests would help public health officials understand the scope of the outbreak and identify people who could safely be in public to help with relief efforts. They would also help in an effort to treat critical COVID-19 patients with plasma from individuals who have recovered.

Elitza Theel is director of the Mayo Clinic lab testing COVID-19 antibody tests. She spoke with MPR News host Tom Crann Wednesday.

You can listen to the interview by clicking on the audio player above, or read the transcript below, which has been edited lightly for clarity and length.

Q: Tell us first, what is an antibody?

A: Antibodies essentially recognize the virus and can help inactivate and kill it.

It’s important to know that these types of tests are different than all of the molecular tests that are being done off of nasal swabs or throat swabs. Those tests detect viral genetic material [to show whether the coronavirus has infected that person].

These [blood serum] antibody tests are detecting a person’s immune response to that virus. It takes, in some cases, 10 to 11 days for a person to mount an immune response and produce these antibodies, so these tests aren’t going to be used as a diagnostic in patients that are presenting with two or three days of symptoms.

Q: Tell us how soon they’ll be ready

A: At Mayo, we hope to have it available as early as next week. We will be doing kind of a slow roll out because, similar to the situation with molecular tests, there’s a limited supply of these tests. We’re hoping that commercial manufacturers will ramp up here in the next few weeks so that we can make it available much more widely.

Q: Then it can go straight to to doctors, public health departments, or is FDA approval needed? How does that work?

A: FDA approval is not needed at this time. However, laboratories that are offering these tests have to go through a very rigorous verification process to make sure that the tests they’re offering provide the right results.

Clinicians will be able to order this in individuals who they think having are a result for would be helpful to either guide return to work [decisions] or further quarantining.

Also, you may have heard about the convalescent plasma treatment trials. As we wait for antivirals and vaccines to be developed and deployed, we need some sort of bridging therapy. So, the idea here is to identify individuals who have recovered from COVID-19, collect their plasma, make sure that it has the antibodies, and then use that plasma to treat acutely ill patients. We’re basically providing somebody else’s antibodies to ill patients who maybe don’t have an immune response mounted yet, and these antibodies would essentially help to fight off the virus.

Q: How close are we on plasma treatment?

A: Clinical trials are starting very soon, both here at Mayo Clinic as well as many other locations across the U.S.

Q: Why is it important to have this information about how many people have been infected, even if they are recovered?

A: There’s a couple of reasons. One, we know there’s a significant number of individuals who have been infected without symptoms. So, knowing the true number, the true denominator of individuals who have been infected with COVID-19, would allow us to determine the true case fatality rate. And then the other reason this is important is identifying when, as a community, as a region, as a nation, we’ve reached herd immunity status.

Cytokine Storm

Cytokine storm.

Wot zat?

Glad you asked.

Imagine having a very minor kitchen fire – as in ’some grease/oil in a small 6-inch skillet flamed up’ while cooking breakfast one morning.

It’s easily put out by placing a lid on the pan.

Stop the air from getting to it, and VOILA!

Out goes the light.

More’n likely, anyone who’s ever cooked has experienced one.

Not a big deal, right?

So, what if, in response to that minor emergency – and yes, it is an emergency, and yes, it is minor – a fleet of 747 jumbo jets all filled with water (for forest fire-fighting purposes, they’re called “Super Tankers”) flew over your place and dumped it all atop your house?

That’d be pretty extreme, wouldn’t it?

Of course it would!

But

Questions & Answers About Cannabis

NOTE: The more frequently updated version of this entry is found on the front page of this blog, which is linked here: https://warmsouthernbreeze.wordpress.com/questions-answers-about-cannabis/

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Updated Friday, 18 September 2020

While the intended audience for these Qs & As is meant primarily for medical, and healthcare science professionals, they may still be of some interest, or use, by others –– particularly for those who do not know that there is legitimate science behind the use, and recommendation of cannabis in various therapies.

From Franz Eugen Köhler’s Medizinal-Pflantzen. Published and copyrighted by Gera-Untermhaus, FE Köhler in 1887 (1883–1914).
Hemp plant.
A–flowering male and B–seed-bearing female plant, actual size; 1-male flower, enlarged detail; 2&3-pollen sac of same from various angles; 4-pollen grain of same; 5-female flower with cover petal; 6-female flower, cover petal removed; 7-female fruit cluster, longitudinal section; 8-fruit with cover petal; 9-same without cover petal; 10-same; 11-same in cross-section; 12-same in longitudinal section; 13-seed without hull.

So in that sense, enjoy!

––//––

QUESTION: What is the pharmacological profile of buccally administered cannabinoids?

ANSWER: With buccal administration, a mix of cannabinoids can be sprayed on to the oral mucosa and the medicine is absorbed through the mucous membranes. Peak plasma concentrations usually occur within 2-4 hrs after administration. When compared to inhalation of cannabinoids, buccal administration of cannabinoids is associated with lower blood levels of cannabinoids because absorption is slower, redistribution into fatty acids occurs rapidly and some of the cannabinoids undergo first pass metabolism.

–––

QUESTION: Nabiximols (a cannabinoid medicine containing THC and CBD) is approved in many European countries for the treatment of neuropathic pain, spasticity and bladder dysfunction in patients suffering from multiple sclerosis. What are the potential drug interactions between nabiximols and analgesic medications?

ANSWER: The nabiximols product monograph cautions prescribers against combining nabiximols with amitriptyline or fentanyl because these drugs are metabolized by the same enzymes as nabiximols. Potential drug interactions with other opioids (oxycodone, tramadol and methadone) also exist.

–––

QUESTION: What is the purpose of urine drug testing?

ANSWER: Urine drug tests typically screen for the patient’s prescribed opioids and the commonly abused drugs: cocaine, amphetamines, alcohol, barbiturates, opiates and benzodiazepines. Although a urine drug test can confirm if the patient is taking the prescribed opioid, it cannot determine if the patient is taking the prescribed dose.

–––

QUESTION: What are the drugs that are inhibitors to cytochrome P450 and therefore decrease the metabolism of cannabinoids?

ANSWER: THC is oxidized by the cytochrome P450 (CYP) mixed-function oxidases 2C9, 2C19 and 3A4 1. Therefore, substances that inhibit these CYP isoenzymes (e.g. fluoxetine, cimetidine, clarithromycin, ketoconazole, verapamil, indinavir, among others) can potentially increase the bioavailability of THC, and thus increase the chance of experiencing THC-related side effects.

–––

QUESTION: Why do NSAIDS relieve pain?

ANSWER: NSAIDs reduce the production of prostaglandin E2 (PGE2) and prostacyclin (PGI2), which mediate pain and inflammation.

–––

QUESTION: Describe the process of vaporization of cannabis.

ANSWER: Vaporization is a smokeless delivery system in which warm air or heat of 180°C to 200°C, rather than a flame, is used to convert cannabinoids and other compounds into a fine mist that can be inhaled. Due to their volatility, cannabinoids will vaporize at temperatures of 180°C to 200°C, but will not combust and therefore few combustion by-products such as soot or polycyclic aromatic hydrocarbons are produced. As temperatures increase, the amount of cannabinoids released increases, and the amount of combustion by-products increases, too.

–––

QUESTION: The pharmacological properties of cannabigerol have been investigated. What have the studies shown?

ANSWER: Cannabigerol (CBG) is the phytocannabinoid precursor molecule, and demonstrates weak partial agonism at CB1 and CB2. In in vitro studies, CBG displays analgesic and anti-erythemic effects. CBG also displays anti-hypertensive activity.

–––

QUESTION: The pharmacological properties of tetrahydrocannabivarin have been investigated. What have the studies shown?

ANSWER: Tetrahydrocannabivarin (THCV) is a CB1 antagonist at low doses, but displays weak agonistic effects at high doses. In obese mice models, THCV reduced appetite, produced weight loss and decreased body fat and leptin concentration.

–––

QUESTION: What is the pharmacologic profile of cannabis when it is vaporized?

ANSWER: The pharmacologic profile of cannabis when it is vaporized is similar to the profile when it is smoked. Psychoactive effects appear within 90 seconds, reach a maximum after 15-30 minutes, and taper off within 2-3 hours.

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QUESTION: What is the pharmacologic profile of cannabis when it is smoked?

ANSWER: When herbal cannabis is smoked, the active ingredients in cannabis are vaporized by the heat of combustion and inhaled. Inhaled constituents quickly pass from alveoli into the bloodstream and readily cross the blood-brain barrier. Psychoactive effects appear within 90 seconds, reach a maximum after 15-30 minutes, and taper off within 2-3 hours. This short onset of action makes dose titration possible, by spacing inhalations at 90-second intervals.

–––

QUESTION: The pharmacological properties of cannabichromene have been investigated. What have the studies shown?

ANSWER: Cannabichromene (CBC) is a potent anadamide uptake inhibitor and thus may modulate the endocannabinoid system similarly to CBD. In mice studies, it has been shown that CBC has anti-inflammatory properties and analgesic activity. CBC has other pharmacological properties, as well.

–––

QUESTION: The pharmacological properties of cannabinol have been investigated. What have the studies shown?

ANSWER: Cannabinol (CBN) is the oxidative by-product of THC and appears after long storage. It is a weaker partial agonist at CB1 and CB2 as compared to THC. In in vitro studies, it has been found that cannabinol is anticonvulsant and anti-inflammatory, and stimulates bone formation.

–––

QUESTION: It is the mixture of phytocannabinoids, terpenes and other active components present in a cannabis product that ultimately determines the therapeutic effects and side effects. Does CBD affect THC absorption and tolerance?

ANSWER: CBD has long been thought to influence the effects of THC. This thinking was extended to consider that CBD potentiates some of the beneficial effects of THC, as it reduces the psychoactive effects of THC and thus could improve tolerability. CBD may counteract some of the functional consequences of CB1 receptor activation in the brain. This effect has been used to explain why high CBD:THC cannabis use is less associated with the development of psychotic symptoms compared to low CBD:THC cannabis. Also, CBD is thought to interact with the cytochrome p450 enzymes that metabolize THC and thus may alter the metabolism and influence the effects of the THC consumed. It has been proposed that THC and CBD act synergistically in therapeutic use.

–––

QUESTION: Does methadone alter cardiac conduction?

ANSWER: Yes. Methadone is known to prolong QTc intervals in up to 16% of patients. Studies have shown a linear dose response curve, with higher doses leading to a higher propensity for QTc prolongation. This has led to an FDA “black box” warning for methadone and the recommendation for routine ECG monitoring.

–––

QUESTION: How have medical advances altered opioid use in cancer patients?

ANSWER: Cancer is no longer considered a “terminal disease.” Because of significant advances in surgical, radiation, and chemotherapeutic treatments, more than 50% of cancer patients are living greater than 2 years after the diagnosis of cancer. This allows for more cancer patients to develop chronic pain. All of these factors have led to more cancer patients taking opioids long-term.

–––

QUESTION: What are terpenes (or terpenoids)?

ANSWER: Terpenes are aromatic components produced in the glandular part of the cannabis plant’s flower bud. Terpenes are manufactured by many plants (not just the cannabis plant) and can be found in many food products, including coffee beans, ginger and cinnamon. Often, it is the terpenes that are responsible for a plant’s odor.

–––

QUESTION: Does smoking marijuana impact the metabolism of theophylline?

ANSWER: It may. Reports have indicated that smoking marijuana may increase the clearance of theophylline. Note: this effect appears to be a direct result of the hydrocarbons found in marijuana smoke rather than the cannabis-based products, as there is a lack of evidence for enzyme induction when cannabis-based drugs are consumed via oral ingestion.

–––

QUESTION: Do the hydrocarbons in marijuana smoke impact drug metabolism?

ANSWER: Possibly. Similar to cigarette smoke, the hydrocarbons in marijuana smoke appear to induce the activity of some cytochromes, including CYP1A2.

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QUESTION: What criteria should be used when selecting a CBD hemp product?

ANSWER: According to a 2019 Mayo Clinic publication, the following 4 questions should be asked, and the answers to each of the questions should be “yes” :
1. Does the hemp product meet the quality standards of the Current Good Manufacturing Practices Certification from the FDA, or the European Union, Australian or Canadian organic certification, or the National Science Foundation International Certification?
2. Does the manufacturer have an independent review adverse event reporting system?
3. Is the product certified organic or ecofarmed?
4. Have the company’s products been lab tested to confirm THC levels to be < 0.3% and to confirm that no pesticides or heavy metals are present?

–––

QUESTION: Is full spectrum CBD the same as whole plant CBD?

ANSWER: No. Whole plant CBD contains fats, waxes and fibrous materials not found in full spectrum CBD.

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QUESTION: Is the plasma concentration of Epidiolex (CBD) affected by co-administration of high fat/high calorie food?

ANSWER: Yes. It has been that if CBD is co-administered with a high fat/high calorie meal, the plasma concentration of CBD may increase by as much as 5-fold.

–––

QUESTION: Describe the exact mechanism of action of Epidiolex.

ANSWER: According to the Epidiolex FDA Approved Package Insert, (Greenwich Biosciences, Inc.), the precise mechanism(s) by which Epidiolex exerts its anticonvulsant effects in humans are unknown. It does not appear to be through cannabidiol receptors.

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QUESTION: Epidiolex has been approved for the treatment of seizures associated with two rare and severe forms of epilepsy, Lennox-Gastaut syndrome (LGS) and Dravet syndrome (DS). Has the FDA approved Epidiolex for any other conditions?

ANSWER: Yes. On July 31, 2020, the U.S. Food and Drug Administration approved Epidiolex (cannabidiol or CBD) oral solution for the treatment of seizures associated with tuberous sclerosis complex (TSC) in patients one year of age and older.

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QUESTION: The International Association for the Study of Pain (IASP) has updated the definition of pain. What is their new definition of pain?

ANSWER: After 40+ years, the IASP has revised their definition of pain to reflect advances in our understanding of pain. The revised definition emphasizes that tissue damage is not required. The updated definition of pain is: “An unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage.” The revised definition also includes 6 notes:

1.) Pain is always a personal experience that is influenced to varying degrees by biological, psychological, and social factors

2.) Pain and nociception are different phenomena, and pain cannot be inferred solely from activity in sensory neurons

3.) Through life experiences, people learn the concept of pain

4.) A person’s report of an experience as pain should be respected

5.) Although pain usually serves an adaptive role, it may have adverse effects on function and social and psychological well-being

6.) Verbal description is only one of several behaviors to express pain, and an inability to communicate does not negate the possibility that a human or a nonhuman animal experiences pain

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QUESTION: What is oliceridine (Olinvyk)? Is it a new FDA-approved opioid?

ANSWER: According to an August 7, 2020 FDA news release, “the FDA approved Olinvyk (oliceridine), an opioid agonist for the management of moderate to severe acute pain in adults, where the pain is severe enough to require an intravenous opioid and for whom alternative treatments are inadequate. Olinvyk is indicated for short-term intravenous use in hospitals or other controlled clinical settings, such as during inpatient and outpatient procedures. It is not indicated for at-home use.” https://www.fda.gov/news-events/press-announcements/fda-approves-new-opioid-intravenous-use-hospitals-other-controlled-clinical-settings

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QUESTION: What is the safety profile of Olinvyk?

ANSWER: According to an August 7, 2020 FDA news release, “The safety profile of Olinvyk is similar to other opioids. As with other opioids, the most common side effects of Olinvyk are nausea, vomiting, dizziness, headache and constipation. Olinvyk should not be given to patients with significant respiratory depression; acute or severe bronchial asthma in an unmonitored setting or in the absence of resuscitative equipment; known or suspected gastrointestinal obstruction; or known hypersensitivity to the drug. Prolonged use of opioid analgesics during pregnancy can result in neonatal opioid withdrawal syndrome.” “Olinvyk carries a boxed warning about addiction, abuse and misuse; life-threatening respiratory depression; neonatal opioid withdrawal syndrome; and risks from concomitant use with benzodiazepines or other central nervous system depressants. Unlike other opioids for intravenous administration, Olinvyk has a maximum recommended daily dose limit of 27 milligrams.” https://www.fda.gov/news-events/press-announcements/fda-approves-new-opioid-intravenous-use-hospitals-other-controlled-clinical-settings

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QUESTION: Changes in fetal growth have been described in some epidemiological studies examining the impact of maternal use of marijuana. Do the long‐term patterns of physical growth appear to be affected?

ANSWER: No, long-term physical growth does not appear to be affected. In contrast, long‐term impacts on psychological health have been noted and include increased rates of depressive symptoms and anxiety as well as delinquency.

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QUESTION: Does the use of cannabinoid-based products impact female sexual function?

ANSWER: According to a study published in the journal Sexual Medicine, an increased frequency of marijuana use is associated with improved sexual function among females. Interestingly, it was noted that chemovar type and method of consumption did not impact outcomes, though.

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QUESTION: CBD and medical marijuana are legal in Florida and California. Do the major amusement parks in these states and other legal marijuana states allow medical marijuana patients to carry CBD and medical marijuana into the amusement parks?

ANSWER: With a few exceptions, the answer is no. Medical marijuana and CBD products are not allowed in Disney parks and resorts (including hotels, shopping and restaurants). Six Flags, Universal, and Cedar Fair also prohibit all forms of legal cannabinoid products, including CBD. In contrast, Sea World properties (which include all Busch Gardens and Sea World parks) allow visitors to carry CBD—but no forms of medical marijuana with significant amounts of THC.

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QUESTION: According to an estimate by the United Nations, what percentage of the world’s population used cannabis products in 2016?

ANSWER: The UN estimated that in 2016, 3.9% of the world’s population used cannabis products. (3.9% of the world population is equivalent to ~ 192.2million people)—The UN’s data suggest that there was an increase of 16% compared with estimates of the previous decade.

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QUESTION: Does the Food and Drug Administration (FDA) currently certify the levels of THC contained within CBD products?

ANSWER: Actually, no. The FDA does not regulate the CBD products sold in convenience stores, grocery stores and on line. Although they are labeled as containing no THC, some may actually contain a small amount of THC. (Note: The FDA does monitor the CBD product called Epidiolex.)

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QUESTION: Has the FDA approved any drugs that contain a purified drug substance derived from cannabis?

ANSWER: Yes. Epidiolex oral solution contains purified cannabidiol that has been extracted from the cannabis plant, and this drug has been approved by the FDA. The FDA has also approved medications, such as marinol, that contain synthetic THC.

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QUESTION: Do cannabinoids induce clinical remission or affect inflammation in inflammatory bowel disease patients?

ANSWER: According to a systematic review with meta-analysis of the efficacy of cannabis and cannabinoids for inflammatory bowel disease, cannabis/cannabinoids do not induce clinical remission or affect inflammation in IBD patients. (No effect on inflammatory biomarkers was observed.) However, in this systematic review it was found that cannabis/cannabinoids significantly improved patient-reported symptoms and quality of life. (Clinical symptoms (abdominal pain, general well-being, nausea, diarrhea, and poor appetite) all improved with cannabis/cannabinoids on Likert-scales.) This systematic review involved 15 nonrandomized studies and 5 randomized controlled trials.

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QUESTION: In July of 2020, the FDA announced that labeling for opioid analgesics and medicine to treat opioid use disorder (OUD) must be updated. What do the updates entail?

ANSWER: The updates include that naloxone availability be routinely discussed as part of prescribing opioid analgesics and OUD medicines. The labelling changes also recommend that health care professionals consider prescribing naloxone when they prescribe medicines to treat OUD. Additionally, the labeling changes recommend “that health care professionals consider prescribing naloxone to patients being prescribed opioid pain medicines who are at increased risk of opioid overdose… A naloxone prescription should also be considered for patients prescribed opioids who have household members, including children, or other close contacts at risk for accidental ingestion or opioid overdose.”

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QUESTION: Do cannabinoid-based medicines impact the deposition of Amyloid β peptide in Alzheimer’s disease?

ANSWER: According to the results of a systematic review, the findings of 9 animal studies indicated that cannabis-based medicines might modulate Amyloid β modifications and inhibit the progression of Alzheimer’s disease. (The maximum and minimum cannabinoid dosages, mostly CBD and THC in animal studies, were 0.75 and 50 mg/kg, respectively. The cannabinoids (CBD and THC) were injected for 10 to 21 days.)

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QUESTION: What is the most common mode of CBD administration?

ANSWER: According to a 2017–2018 online survey evaluating modes of CBD administration, the most common method of CBD administration was sublingual, followed by vaping, oral ingestion of capsules and liquids, smoking, edibles, and topical administration.

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QUESTION: In what dosage forms are pharmaceutical fentanyl products supplied?

ANSWER: Pharmaceutical fentanyl products are currently available in the following dosage forms: oral transmucosal lozenges (AKA fentanyl “lollipops”), buccal tablets and sublingual tablets, sublingual sprays, nasal sprays, transdermal patches, and injectable formulations.

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QUESTION: Chronic pelvic pain affects up to 15% of women in the United States. Cannabinoid receptors are expressed on reproductive tissues (including the uterus) and non-reproductive pelvic tissues. Do patients with chronic pelvic pain use cannabinoid-based products to ameliorate their symptoms?

ANSWER: The conclusions of a survey of 122 chronic pelvic pain female patients indicated that up to 23% report using cannabinoid-based products as an adjunct to their prescribed therapies. The patients use a variety of formulations and doses of cannabinoid-based products, and most report daily or weekly use. Most users report improvement in symptoms, but did acknowledge that side effects are common.

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QUESTION: Describe the chemical makeup of endocannabinoids.

ANSWER: Endocannabinoids are ester, ether, and amide derivatives of long chain polyunsaturated fatty acids. Arachidonic acid is an example of a polyunsaturated fatty acid in endocannabinoids.

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QUESTION: How is the endocannabinoid system linked to the opioid system?

ANSWER: Opioid receptors and CB receptors are located within the same neurons within the CNS. In addition, cannabinoids activate kappa and delta receptors to initiate a release of endogenous opioids.

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QUESTION: Does the co-administration of THC and alcohol impact serum THC levels?

ANSWER: Yes. According to a study by Hartman in 2015, alcohol may increase serum THC levels.

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QUESTION: Some producers of cannabinoid products will provide a certificate of analysis (CoA) from an independent and certified testing laboratory. What information is typically displayed on a CoA?

ANSWER: CoAs typically indicate the amount and concentration of major cannabinoids and terpenes present, and data regarding the presence of microbial/ fungal contaminants, levels of heavy metals, and presence and concentration of pesticide and solvent residues.

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QUESTION: Drug screens are sometimes done in the pre-operative. Is it clinically useful to do a drug screen for the presence of cannabinoids or cannabinoid metabolites?

ANSWER: Drug screens for the presence of cannabinoids and metabolites of cannabinoids will not inform the healthcare provider of the recency of marijuana use, as cannabinoids can remain in the body for several weeks.

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QUESTION: Does CBD isolate contain any other cannabinoids or terpenes?

ANSWER: CBD isolate is CBD in its molecular form, and is typically sold as 99+% pure. Unless indicated on the label, products made with CBD isolate do not contain any other cannabinoids or terpenes.

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QUESTION: What does “broad spectrum” mean?

ANSWER: Broad spectrum and full spectrum are not synonymous. Broad-spectrum products are processed in such a manner as to ensure that the final product does NOT contain THC.

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QUESTION: What does “full spectrum” marijuana product mean?

ANSWER: Full spectrum means that the product contains all of the original compounds found in the flower of the cannabis plant (cannabinoids, terpenes and flavonoids).

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QUESTION: Have the results of studies conducted between 2003-2017 indicated that cannabinoids are effective at treating chronic non-cancer pain?

ANSWER: Yes. Lynch and Ware published 2 systematic reviews (SR). One SR evaluated trials from 2003 to 2010 and the other SR evaluated trials from 2010 to 2014. Of the 29 RCTs evaluated in the 2 SRs, 22 of them demonstrated that cannabinoids have a modest analgesic effect and are safe in the management of chronic pain. The modes of administration explored in these 29 SRs included: smoking, oromucosal and oral. All 6 smoked cannabis trials showed a positive analgesic response.

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QUESTION: Epidemiological studies indicate that as many as 15% of inflammatory bowel disease (IBD) patients may use cannabinoids to ameliorate some of their symptoms, including improvement in diarrhea, abdominal pain and appetite. Do the studies show that cannabinoids are effective?

ANSWER: There are few studies evaluating cannabinoid use in IBD, and those studies are small. In Crohn’s disease, it has been demonstrated that THC reduces the Crohn’s disease activity index by >100 points (on a scale of 0–450). Also, two small studies involving ulcerative colitis patients showed a marginal benefit. However, no improvement in inflammatory markers or in endoscopic score in either disease was detected.

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QUESTION: The findings of multiple RCTs indicate that cannabinoids effectively treat chronic pain. Do cannabinoids effectively treat the chronic pain associated with fibromyalgia?

ANSWER: No. According to a Cochrane systematic review published in 2016 on the use of cannabinoids to treat fibromyalgia, there is no convincing, unbiased, high-quality evidence suggesting that a cannabinoid-based medicine (nabilone) is of value in treating people with fibromyalgia. Furthermore, the tolerability of nabilone was low in people with fibromyalgia. Also, the results of a 2019 study where 4 varieties of pharmaceutical grade marijuana were administered by single shot vapor to fibromyalgia patients indicated that none of the 4 marijuana varieties had an effect greater than placebo. (Note: The data from the 2019 study could not be used to extrapolate the long-term effects of cannabinoids on fibromyalgia-associated pain.)

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QUESTION: Some cancer patients use medical marijuana to treat various cancer-associated ailments. What are some of the ailments ameliorated by medical marijuana?

ANSWER: According to one study involving 96 cancer patients receiving supportive cancer care, the data support the safety and effectiveness of medical marijuana as a complementary option for improving pain control, appetite and quality of life for cancer patients. The top three adverse events of this study included drowsiness, low energy and nausea, and were reported in 28% of patients, with 9% having to stop using the medical marijuana. (Note: other studies indicate that chemotherapy-induced N/V and anxiety are ameliorated by medical marijuana.)

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QUESTION: Side effects of short-term cannabinoid-based therapy may differ from person to person, and the same person may experience different side effects at different times. What factors influence the probability and the severity of adverse events?

ANSWER: Many factors influence the likelihood and the severity of adverse events, including the type of cannabinoid preparation; the mode of administration; the patient’s expectations, the patient’s prior experience with cannabinoid-based therapies, and the age of the patient. Drug–drug interactions may also lead to adverse events.

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QUESTION: According to the results of a survey of breast cancer patients’ use of cannabinoid products before, during, and after treatment, 42% of survey participants had used medical cannabinoid products to relieve symptoms. What symptoms were treated with the cannabinoid products?

ANSWER: Members of the Breastcancer.org and Healthline communities were asked to participate in a survey during the period of 12/16/2019 – 1/19/2020. Among the 832 respondents who completed screening, 725 met the eligibility criteria, and 612 (84%) completed the survey. According to the results, the symptoms for which cannabinoids were used included insomnia (70%), pain (59%), anxiety (57%), stress (51%), and nausea/vomiting (46%). The results also indicated that cannabinoids were used prior to treatment in 24%, during treatment in 79%, and after treatment in 54%. Of subjects reporting cannabis use during treatment: 86% used it during chemotherapy, 71% during HER2 therapy, 65% during hormonal therapy, 49% during breast radiation, and 47% during radiation for metastatic sites. Post-surgical use was reported in 51% after mastectomy alone, 40% after lumpectomy, and 38% after mastectomy/reconstruction.

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QUESTION: Other than feeling “high” what are some of the reported psychological CNS-related side effects associated with cannabinoid use?

ANSWER: Psychological side effects associated with cannabinoid use include: restless/anxiety/nervousness, depressed mood, dysphoria, confusion, dissociation, hallucinations, hyperactivity, weird dreams, paranoia and psychosis.

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QUESTION: Are cannabinoids an effective analgesic agent in the chronic pain setting?

ANSWER: In contrast to the lack of efficacy in the acute pain setting, cannabinoids are effective analgesic agents in the chronic pain setting. According to 2 systematic reviews involving a total of 29 RCTs, 22 of the 29 RCTs demonstrated that cannabinoids have a modest analgesic effect in the management of chronic pain. The following modes of administration were examined in the RCTs: smoked cannabis (6 trials), oromucosal and oral cannabis extract (11 trials), nabilone (8 trials), dronabinol (2 trials), THC-11 acid analogue (2 trials), and fatty acid amide hydrolase inhibitor (1 trial).

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ANSWER: Are cannabinoids an effective analgesic agent in the acute pain setting?

ANSWER: No. According to the results of multiple RCT examining the efficacy of cannabinoids to treat acute pain, THC, nabilone and other cannabinoid-based products were not associated with a reduction in pain, but were associated with adverse side effects, including sedation.

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QUESTION: What are the common modes of administration of medical marijuana used by cancer patients?

ANSWER: According to a survey completed by 183 cancer patients of an oncology clinic at Sutter Medical Center in Sacramento, California, over 50% reported use of oils and tinctures and 44% used edibles. A smaller percentage consumed cannabis-based products via vaping (26%) or smoking (30%). Topical use was preferred by fewer patients (17%). Over 58% of patients stated they used more than one method.

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QUESTION: It has been estimated that a significant proportion of cancer patients (18.3-40.0%) in the United States use cannabis or cannabinoid-based products. Does the evidence indicate that cannabinoid-based products are effective in treating cancer-related pain? chemotherapy-induced n/v? cancer-related cachexia?

ANSWER: According to a study published in the Journal of Clinical Oncology, there is substantial evidence for the effectiveness of cannabis and cannabinoids in treating cancer-related pain; specifically, oromucosal THC/CBD spray. Also, there is conclusive evidence that cannabis and cannabinoids effectively relieve chemotherapy-induced nausea and vomiting; (specifically, oral THC). However, there is inconclusive evidence about the effectiveness of cannabinoid-based products in treating cancer-related cachexia.

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QUESTION: Does the administration of marijuana affect insulin levels in humans?
Answer

ANSWER: In a DBRCT involving 20 participants, it was found that marijuana consumed via oral, smoked, or vaporized routes affected blood concentrations of some metabolic hormones, including insulin. In fact, the results of this study indicate that acute marijuana use blunted the insulin spike associated with the consumption of a brownie.

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QUESTION: Are there any special considerations for patients who consume cannabinoid-based products and are undergoing plastic surgery?
Answer

ANSWER: Yes. On occasion, plastic surgeons administer atropine and/or epinephrine during a procedure. Both of these medications can increase heart rate, and cannabinoids may potentiate the increase in heart rate.

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QUESTION: A common adverse effect of chronic recreational marijuana use is cannabinoid hyperemesis syndrome. In fact, cannabinoid hyperemesis syndrome is a near daily diagnosis in many Canadian emergency departments. Anecdotal evidence supports the use of haloperidol. Is haloperidol more effective than odansetron for the treatment of the nausea and vomiting associated with cannabinoid hyperemesis syndrome?

ANSWER: According to the results of a randomized controlled trial involving 33 patients with cannabinoid hyperemesis syndrome, haloperidol (0.05 mg/kg or 0.1 mg/kg) was superior to odansetron 8mg for average reduction from baseline in abdominal pain and nausea at 2 hours, and was associated with the need for fewer rescue antiemetics and shorter time to ED departure. In this study, there were 2 haloperidol and 6 ondansetron return ED visits for ongoing nausea/vomiting, as well as 2 return visits for acute dystonia, both in the higher dose haloperidol group.

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QUESTION: Cannabinoid receptors have been located in the central nervous system and the peripheral nervous system, as well as on immune cells. Have cannabinoid receptors been isolated in reproductive tissues/cells?

ANSWER: In addition to cannabinoid receptors being identified in the hypothalamus and the pituitary gland, cannabinoid receptors have also been identified on ovary, endometrial tissue, testes, and spermatozoa. In fact, research suggests that marijuana may alter the release of FSH and LH, ovulation, sperm motility, fertilization, as well as placentation.

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QUESTION: What are K2 and Spice?

ANSWER: K2 and Spice are synthetic cannabinoid “designer drugs” that are intended to mimic the effects of THC. These synthetic cannabinoids are sold as “herbal incense” at convenience stores/gas stations, smoke shops and via the internet. They are produced in powder form, and then often dissolved in solvents, so they can be applied to dry plant material to make the “herbal incense” products.

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QUESTION: Heroin is processed from morphine, an extract from the poppy plant. Heroin is often depicted as a white powder. Is heroin sold in forms other than white powder?

ANSWER: In addition to white powder, heroin is sold as a brownish powder, or as a black sticky/tar-like substance (AKA black tar heroin). Heroin is either sold in pure form or is “cut” with other drugs (quinine, for example) or with other white powdery substances, including sugar, starch or powdered milk.

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QUESTION: Respiratory depression is associated with the overdose of opioids or benzodiazepines. Is respiratory depression associated with an overdose of cannabinoids? Why or why not?

ANSWER: Respiratory depression is not associated with cannabinoid use because CB1 receptors are not located in the midbrain, the part of the brain responsible for respiratory drive.

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QUESTION: As of January 2020, how many Americans were using marijuana-based products for medicinal purposes?

ANSWER: It has been estimated that more than 2 million Americans use marijuana for medical reasons. Some of the many ailments being treated with marijuana include: chronic pain, PTSD, depression, sleep disorders, multiple sclerosis (MS), cancer-related ailments, and GI disorders. Some indications are supported by good scientific evidence, but many are not.

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QUESTION: Rohypnol® is the trade name for the benzodiazepine called unitrazepam. Has this drug ever been approved by the Food and Drug Administration for medical use in the United States?

ANSWER: No, but outside the US, Rohypnol® is prescribed to treat insomnia. Rohypnol® has been referred to as a date rape drug or roofies. Before 1997, Rohypnol® was manufactured as a white tablet, and when mixed in liquids, it was colorless, tasteless, and odorless. In 1997, the manufacturer responded to concerns about the drug’s role in sexual assaults, and reformulated the drug. Now, Rohypnol® is produced as an olive green tablet with a speckled blue core that when dissolved in light-colored drinks will change the color of the liquid to blue. Of note, generic versions of the drug may not contain the blue dye.

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QUESTION: What is the Chemical Diversion and Trafficking Act (CDTA) of 1988?

ANSWER: The CDTA is an Act that regulated 12 (drug manufacturing) precursor chemicals, eight essential chemicals, tableting machines, and encapsulating machines. The Act imposed recordkeeping and import/export reporting requirements on transactions involving these regulated products. One of the goals of this Act was to reduce the supply of methamphetamine. As of 2020, the DEA regulates more than 40 chemicals that are often used in the production of illicit drugs.

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QUESTION: Cannabinoids are metabolized by many of the same cytochrome P450 enzymes as warfarin, including CYP3A4, CYP2C9, and CYP2C19. THC, CBD and CBN can inhibit the CYP2C9-mediated hydroxylation of warfarin, and thus lead to an increase in INR. Do cannabinoids also affect the metabolism of heparin? Is the metabolism of direct oral anticoagulants (DOACs), including rivaroxaban, edoxaban, and apixaban, impacted by cannabinoids?

ANSWER: While cannabinoids do not alter the metabolism of heparin, cannabinoids may impact the metabolism of DOACs. DOACs are substrates of P-gp and are absorbed by the gut through the P-gp efflux transporter. Cannabinoids may bind to P-gp membrane transporters and alter DOAC metabolism. DOAC levels may increase, leading to an increased risk of bleeding.

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QUESTION: CBD is a CB1 antagonist and a negative allosteric modulator at CB2. Does CBD interact with receptors other than CB1 or CB2?

ANSWER: Yes. CBD has cannabinoid receptor-independent properties. For example, CBD is an agonist at the TRPV1 receptor and has agonist properties at the 5-HT1A/2A/3A serotonergic receptors. CBD is also a capsaicin analog. CBD has antagonist activity on alpha-1 adrenergic and μ-opioid receptors, too. In addition, CBD has been found to inhibit synaptosomal uptake of noradrenaline, dopamine, serotonin, and gamma-amino butyric acid. CBD also inhibits anandamide uptake.

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QUESTION: Cannabinoid receptors are located throughout various parts of the CNS, including the basal ganglia, hippocampus, cerebellum and cerebral cortex, and in the peripheral nervous system. Do these receptors have effects on neurotransmitters such as serotonin?

ANSWER: Yes. CB receptor activity not only impacts serotonin, but it also affects acetylcholine, dopamine, glutamate, and GABA, as well as NMDA and opioid receptor systems.

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QUESTION: The Controlled Substances Act (CSA) regulates five classes of drugs. What are they?

ANSWER: The Controlled Substances Act (CSA) regulates five classes of drugs, including narcotics, depressants, stimulants, hallucinogens and anabolic steroids. All controlled substances have abuse potential or they are immediate precursors to substances that have abuse potential. Note: Alcohol and tobacco are specifically exempt from
control by the CSA.

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QUESTION: Methamphetamine is a Schedule II highly addictive stimulant. What is methamphetamine’s mechanism of action that leads to the “rush” and “high”?

ANSWER: It is believed that the “rush” and the “high” associated with amphetamine use result from the release of very high levels of dopamine into areas of the brain that regulate feelings of pleasure.

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QUESTION: Methadone, morphine and heroin are all narcotics. Do they all have a similar chemical structure?

ANSWER: No. Morphine and heroin (which is derived from morphine) have a similar structure. Methadone, which is a synthetic narcotic, does not have a similar structure to morphine.

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QUESTION: Methamphetamine is a controlled substance and is classified as a Schedule II drug. Schedule II drugs have a high potential for abuse and have an accepted medical use. What medical use(s) does methamphetamine have?

ANSWER: As of April 2020, there is only one legal “meth” product, and it is sold under the name Desoxyn®. It has very limited use in the treatment of obesity and ADHD.

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QUESTION: Is the analgesic potency of hydromorphone more or less than the potency of morphine?

ANSWER: Hydromorphone is (2 to 8 times) more potent than morphine but not as potent as fentanyl.

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QUESTION: Chronic pelvic pain affects up to 15% of women in the United States. Cannabinoid receptors are expressed on reproductive tissues (including the uterus) and non-reproductive pelvic tissues. Do patients with chronic pelvic pain use cannabinoid-based products to ameliorate their symptoms?

ANSWER: The conclusions of a survey of 122 chronic pelvic pain female patients indicated that up to 23% report using cannabinoid-based products as an adjunct to their prescribed therapies. The patients use a variety of formulations and doses of cannabinoid-based products, and most report daily or weekly use. Most users report improvement in symptoms, but did acknowledge that side effects are common.

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QUESTION: In what dosage forms are pharmaceutical fentanyl products supplied?

ANSWER: Fentanyl pharmaceutical products are currently available in the following dosage forms: oral transmucosal lozenges (AKA fentanyl “lollipops”), buccal tablets and sublingual tablets, sublingual sprays, nasal sprays, transdermal patches, and injectable formulations.

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QUESTION: Fentanyl, morphine and heroin are all analgesics. Which one of the three is the most potent analgesic?

ANSWER: Fentanyl is the most potent analgesic of the three. It is about 100 times more potent than morphine and 50 times more potent than heroin, as an analgesic agent.

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QUESTION: What are common street names for marijuana?

ANSWER: Often, marijuana concentrates look similar to honey with either a brown or gold color, and many of the street names refer to the golden brown color. The terms wax, ear wax, honey oil, budder, butane hash oil, butane honey oil (BHO), shatter, dabs (dabbing), black glass, and errl have all been used to refer to marijuana concentrates.

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QUESTION: What is hashish?

ANSWER: Hashish (AKA hash) is a THC-rich resin from the cannabis plant. This resin is collected and processed into various forms, including balls, cakes or cookies. Pieces of hashish can be broken off, and placed in pipes or cigarettes for smoking. Some individuals mix hashish with tobacco. Hashish products are considered to be Schedule I substances.

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QUESTION: What is the most common route of administration for the synthetic cannabinoids K2 or Spice?

ANSWER: K2 and Spice are used for recreational purposes, and smoking is the most common route of administration. Spraying or mixing the synthetic cannabinoids on dried plant material allows one to smoke it (using a pipe, a water pipe, or rolling the drug-laced plant material in cigarette papers). Also, liquid synthetic cannabinoids have been designed to be vaporized via e-cigarettes.

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QUESTION: Does marijuana use alter the sexual intercourse experience?

ANSWER: An online survey posed questions regarding various aspects of sexual experience and how those aspects were impacted by marijuana use. The results indicated that marijuana helped individuals relax, heightened their sensitivity to touch, and increased intensity of feelings, thus enhancing their sexual experience, while others found that marijuana interfered by making them sleepy and less focused or had no effect on their sexual experience.

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QUESTION: CB1 receptors are located on neurons in the CNS and PNS. Are CB1 receptors also located on cardiomyocytes?

ANSWER: Yes. CB1 receptors are located in cardiomyocytes, vascular endothelial cells as well as smooth muscle cells. Activation of these CB1 receptors may lead to oxidative stress, inflammation, fibrosis, vasodilation, and negative inotropy.

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QUESTION: Some cannabinoid-based medicines are used to treat chemotherapy-induced n/v. Have cannabinoid-based medicines been shown to be effective in the treatment of post-op n/v?

ANSWER: The results of studies indicate that neither nabilone or intravenous THC is effective for post-op n/v. Even premedication with nabilone was ineffective at treating post-op n/v.

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QUESTION: Does ketamine interact with the endocannabinoid system?

ANSWER: Yes. Ketamine induces the release of endocannabinoids.

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QUESTION: Do CB1 and CB2 agonists facilitate endogenous opioid signaling?

ANSWER: Yes. In fact, CB1 and CB2 agonists increase the concentrations of endogenous opioids.

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QUESTION: Is the endocannabinoid system linked to the opioid system?

ANSWER: Yes. Opioid receptors and CB receptors are located within the same neurons within the CNS. In addition, cannabinoids activate kappa and delta receptors to initiate a release of endogenous opioids.

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QUESTION: How do cannabinoids modulate pain sensation? In other words, describe the mechanism of action of cannabinoids.

ANSWER: Endocannabinoids are synthesized in the postsynaptic neuron in response to stimuli such as pain, stress and inflammation. Endocannabinoids travel in a retrograde fashion and activate the presynaptic CB receptors. Antinociceptive effects occur when either endocannabinoids or phytocannabinoids activate presynaptic inhibitory CB1 receptors. Stimulation of CB1 receptors (G protein coupled receptors (Gi,Go)) leads to a reduction of cAMP production via the inhibition of adenylyl cyclase. This results in an action on voltage gated calcium and potassium channels – there is a depression of neuronal excitability and a reduction of neurotransmitter release.

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QUESTION: A study by Jamal et al. published in the European Journal of Anaesthesiology reported that marijuana users required a higher dose of morphine s/p abdominal surgery. They estimated that there was a 23% increased opioid dose requirement. Have the results of studies examining the opioid requirements s/p orthopedic surgery also shown that marijuana users require more opioids than patients who do not use marijuana?

ANSWER: In a retrospective study including 3793 patients, patient-reported postoperative outcomes of 155 marijuana users were compared with those of 155 non-users. The results indicate that pre-operative marijuana users had higher pain scores at rest and on movement but did not consume more post-operative opioid analgesics. The cannabinoid users also reported a greater incidence of post-operative sleep impairment.

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QUESTION: CBD is a negative allosteric modulator. What does that mean?

ANSWER: A negative allosteric modulator changes the shape of the receptor and, as a result, reduces the binding ability of components that typically bind to the receptor. In the case of cannabinoids, CBD alters the shape of CB1 receptors, and THC along with endogenous cannabinoids do not bind to the CB1 receptor to the same degree as they do when CBD is not present.

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QUESTION: Some producers of cannabinoid products will provide a Certificate Of Analysis (CoA) from an independent certified testing laboratory. What information is typically displayed on a CoA?

ANSWER: CoAs typically indicate the amount and concentration of major cannabinoids and terpenes present, and data regarding the presence of microbial/ fungal contaminants, levels of heavy metals, and presence and concentration of pesticide and solvent residues.

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QUESTION: What medications alleviate the symptoms of marijuana withdrawal?

ANSWER: There are no general guidelines to treat the symptoms of marijuana withdrawal, but it has been reported that benzodiazepines and synthetic THC products used for the treatment of chemotherapy induced N/V may help alleviate some of the symptoms.

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QUESTION: What does “broad spectrum” mean?

ANSWER: Broad-spectrum products are processed in such a manner as to ensure that the final product does NOT contain THC.

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QUESTION: What does “full spectrum” marijuana product mean?

ANSWER: Full spectrum means that the product contains all of the original compounds found in the flower of the cannabis plant (cannabinoids, terpenes and flavonoids).

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QUESTION: Over 2 million Americans with cardiovascular disease use marijuana. Warfarin interacts with marijuana. Do statins interact with cannabinoids?

ANSWER: Yes. Statins and cannabinoids are metabolized by the same liver enzymes. The co-administration of cannabinoids and statins can lead to a decrease in statin metabolism. As a result, the potency of the statins may increase, and lead to hypotension.

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QUESTION: Although Illinois and Nevada have both legalized the use of medical and recreational marijuana, it is illegal to take marijuana on a flight from Chicago to Las Vegas. The reason – airspace is regulated by the federal government and marijuana is illegal under federal law. Do any US airports have “marijuana amnesty boxes” for the disposal of marijuana?

ANSWER: Yes. In addition to 2 airports in Chicago, Mc Carran International Airport in Las Vegas and the Colorado Springs Airport have installed amnesty boxes for passengers who need to surrender their marijuana before boarding a flight.

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QUESTION: What are the precursors for the most commonly naturally occurring phytocannabinoids?

ANSWER: The precursors for THC, CBD and CBC are olivetolic acid and geranyl pyrophosphate. These precursors undergo a condensation reaction which results in the formation of cannabigerolic acid (CBGA). A cyclase enzyme converts CBGA into either tetrahydrocannabinolic acid (THCA) or cannabidiolic acid (CBDA) or cannabichromenic acid (CBCA). Then, heat decarboxylates these cannabinoids into THC, CBD or CBC, respectively.

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QUESTION: True or false? Cannabinoids impact NMDA, opioid AND gamma amino butyric acid (GABA) receptors.

ANSWER: True. Not only do cannabinoids act at NMDA, opioid AND gamma amino butyric acid (GABA) receptors, but they also have activity at receptors such as adenosine, serotonergic, adrenergic, nicotinic acetylcholine, glycine, and PPAR receptors, and ion channels such as TRPV.

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QUESTION: Are pupillary responses to light affected by marijuana?

ANSWER: Yes – marijuana may impair pupillary responses.

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QUESTION: Is the legalization of medical marijuana associated with an increase in sexual activity?

ANSWER: Yes, according to researchers from the University of Connecticut and Georgia State University, the legalization of medical marijuana is associated with an increase in sexual activity. Of note, the study also determined that there’s a decrease in the use of contraceptives and an increase in the number of births following the enactment of medical marijuana policies. This study was published in the Journal of Health Economics.

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QUESTION: What is the definition of drug diversion?

ANSWER: In the National Academies of Sciences, Engineering & Medicine’s Framing Opioid Prescribing Guidelines for Acute Pain: Developing the Evidence (2020), drug diversion is defined as the transfer of regulated prescription drugs from the legal market to illegal markets. The sharing of drugs with other individuals for medical or nonmedical purposes is NOT considered to be drug diversion. (The sharing of drugs is drug misuse.)

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QUESTION: Is it legal to carry marijuana on a Greyhound bus?

ANSWER: No. Greyhound Lines bans alcohol and drugs (including marijuana) “anywhere on the bus (including in your checked baggage).”

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QUESTION: Animal research studies on CBD’s potential therapeutic effects often employ rodents. Is CBD administered to rodents the same way CBD is administered to humans?

ANSWER: No. CBD is commonly administered to rodents either via intraperitoneal injection or via the oral route. In contrast, CBD has been studied in humans using oral administration or inhalation, but not via intraperitoneal. The pharmacokinetics of these various routes of administration differ and therefore the blood concentrations of CBD may differ.

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QUESTION: Has the use of CBD been evaluated for the treatment of heroin addiction?

ANSWER: Yes. Dr. Yasmin Hurd, director of the Addiction Institute of Mount Sinai in NYC led a double-blind study of 42 recovering heroin addicts and found that CBD reduced both cravings and cue-based anxiety, both of which can cycle people back into using heroin.

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QUESTION: Does CBD modulate 5-HT1A receptor activity?

ANSWER: Yes, and this modulation may directly improve hyperarousal/insomnia symptoms in PTSD patients.

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QUESTION: Is the US VA Office of research and Development conducting any clinical trials that evaluate the use of CBD for the treatment of PTSD?

ANSWER: Yes. A RCT evaluating the efficacy of using CBD as an adjunctive to prolonged exposure therapy (PE therapy)) was started in March 2019 and will conclude on September 30,2023. The trial will compare PE + CBD to PE + placebo in a sample of 136 military Veterans with PTSD at the VA San Diego Medical Center.

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QUESTION: Is it legal to transport marijuana on Amtrak’s railway?

ANSWER: Amtrak has a strict policy: “The use or transportation of marijuana in any form for any purpose is prohibited, even in states or countries where recreational use is legal or permitted medically.”

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QUESTION: Do any medical marijuana legal states accept out-of-state medical marijuana authorizations?

ANSWER: Yes. About twenty states accept out-of-state medical marijuana authorizations, BUT reciprocity laws vary from state to state. In some states, visitors are required to sign up for the medical marijuana program 30 days in advance and pay a $50 nonrefundable fee. The state’s purchasing limit may differ for permanent vs. temporary residents. In Oregon, for example, residents can possess up to 24 ounces, while visitors are allowed only one ounce.

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QUESTION: Does the CBD molecule contain an aromatic ring?

ANSWER: Yes, it does. The CBD molecule contains a cyclohexene ring and an aromatic ring (a phenolic ring). Of interest, the rings are located in planes that are almost perpendicular to each other.

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QUESTION: Describe the chemical makeup of endocannabinoids.

ANSWER: Endocannabinoids are ester, ether, and amide derivatives of long chain polyunsaturated fatty acids. Arachidonic acid is an example of a polyunsaturated fatty acid in endocannabinoids.

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QUESTION: Does chronic use of THC and/or CBD by individuals with multiple sclerosis impact cerebral glucose metabolism?

ANSWER: The results of “The Effects of Chronic Δ-9-Tetrahydrocannabinol (THC) and Cannabidiol (CBD) use on Cerebral Glucose Metabolism in Multiple Sclerosis: A Pilot Study” published in 2019 in ‘Applied Physiology, Nutrition and Metabolism‘ indicate that “Compared to non-users, THC-users had hypermetabolism of three regions (p < 0.039, d >1.17) in left temporal areas, while CBD-users had hypometabolism of five regions (p < 0.032, d > 1.31) in left temporal areas.”

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QUESTION: True or False? According to the results of a survey conducted by the FDA, about 90% of US adults understand that FDA-approved prescription drugs may cause harm.

ANSWER: False. The results of the survey indicate that 42.9% of consumers were not able to accurately report that FDA‐approved prescription drugs may cause harm.

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QUESTION: The FDA approves the language used on package inserts of prescription drugs. Does the FDA also approve the language of “direct-to -consumer” ads?

ANSWER: Actually, no. The language, including the risk or benefit statements, used in “direct to consumer” ads is not FDA-approved.

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QUESTION: Based on data from the 2016 to 2017 National Survey on Drug Use and Health and the U.S. Department of Health and Human Services, do more people in the US smoke marijuana or tobacco cigarettes”

ANSWER: According to the 2016 to 2017 National Survey on Drug Use and Health, more than 39 million people smoke marijuana, and according to data from the U.S. Department of Health and Human Services, 34.3 million people smoke tobacco cigarettes. Recent trends show that the number of marijuana smokers is rising while the number of cigarette smokers is declining.

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QUESTION: CB1 receptors are located on neurons in the CNS and PNS. Are CB1 receptors also located on cardiomyocytes?

ANSWER: Yes. CB1 receptors are located in cardiomyocytes, vascular endothelial cells as well as smooth muscle cells. Activation of these CB1 receptors may lead to oxidative stress, inflammation, fibrosis, vasodilation, and negative inotropy.

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QUESTION: Smoking and vaporizing marijuana may induce an increase in heart rate. Is smoking marijuana associated with other cardiac electrical effects?

ANSWER: Yes. THC may increase catecholamine levels and therefore may theoretically increase the likelihood of arrhythmias. Various cardiac electrical effects have been described in observational studies. Atrial fibrillation was one of the more commonly reported arrhythmias. Other marijuana-associated arrhythmias reported include atrial flutter, atrioventricular block/asystole, sick sinus syndrome, ventricular tachycardia, and Brugada pattern.

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QUESTION: Some cannabinoid-based medicines are used to treat chemotherapy-induced n/v. Have cannabinoid-based medicines been shown to be effective in the treatment of post-op n/v?

ANSWER: The results of studies indicate that neither nabilone or intravenous THC is effective for post-op n/v. Even premedication with nabilone was ineffective at treating post-op n/v.

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QUESTION: Do cannabinoid-based medicines have a higher NNT (number needed to treat) than opioids for pain relief? Than pregabalin? Than tricyclic antidepressant (TCA) agents?

ANSWER: According to recent systematic reviews and meta-analyses (from 2016-2018), cannabinoid -based medicines have a higher NNT than opioids, pregabalin and TCAs. It was also noted that there was a higher risk of adverse events associated with cannabinoid-based medicines compared to opioids, pregabalin and TCAs.

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QUESTION: The 2017 National Academies of Sciences, Engineering and Medicine’s (NASEM)review on the health effects of cannabinoid-based medicines concluded that there was conclusive or substantial evidence for the use cannabis or cannabinoids for the treatment of pain in adults. Do other national regulatory bodies have similar conclusions to the NASEM’s conclusion?

ANSWER: Actually, no. The Health Products Regulatory Authority of Ireland does not support the use of cannabinoid-based medicines for the treatment of chronic pain. Also, the European Pain Federation’s recent position paper recommended cannabinoid-based medicines be considered for chronic neuropathic pain only as a third line agent. Furthermore, the European Pain Federation found that the results of the studies examining chronic non-cancer pain indicated that there was insufficient evidence for the use of cannabinoid-based medicines for the treatment of non-neuropathic chronic non-cancer pain.

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QUESTION: Does ketamine interact with the endocannabinoid system?

ANSWER: Yes. Ketamine induces the release of endocannabinoids.

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QUESTION: Do CB1 and CB2 agonists facilitate endogenous opioid signaling?

ANSWER: Yes. In fact, CB1 and CB2 agonists increase the concentrations of endogenous opioids.

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QUESTION: Do opioid antagonists impact the effects of cannabinoids?

ANSWER: Yes. For example, it has been shown that the administration of opioid antagonists block some of the effects of THC.

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QUESTION: Is the endocannabinoid system linked to the opioid system?

ANSWER: Yes. Opioid receptors and CB receptors are located within the same neurons within the CNS. In addition, cannabinoids activate kappa and delta receptors to initiate a release of endogenous opioids.

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QUESTION: True or false? Cannabinoids impact NMDA, opioid AND gamma amino butyric acid (GABA) receptors.

ANSWER: True. Not only do cannabinoids act at NMDA, opioid AND gamma amino butyric acid (GABA) receptors, but they also have activity at receptors such as adenosine, serotonergic, adrenergic, nicotinic acetylcholine, glycine, and PPAR receptors, and ion channels such as TPRV.

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QUESTION: How do cannabinoids modulate pain sensation? In other words, describe the mode of action of cannabinoids.

ANSWER: The endocannabinoid system, consisting of the cannabinoid₁ receptor (CB₁R) and cannabinoid₂ receptor (CB₂R), endogenous cannabinoid ligands (endocannabinoids), and metabolizing enzymes, is present throughout the pain pathways. Endocannabinoids, phytocannabinoids, and synthetic cannabinoid receptor agonists have antinociceptive effects in animal models of acute, inflammatory, and neuropathic pain. CB₁R and CB₂R located at peripheral, spinal, or supraspinal sites are important targets mediating these antinociceptive effects. The mechanisms underlying the analgesic effects of cannabinoids likely include inhibition of presynaptic neurotransmitter and neuropeptide release, modulation of postsynaptic neuronal excitability, activation of the descending inhibitory pain pathway, and reductions in neuroinflammatory signaling. The large body of preclinical evidence in support of cannabinoids as potential analgesic agents is supported by clinical studies demonstrating their efficacy across a variety of pain disorders.

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QUESTION: EXPERIMENTAL pain studies indicate that cannabinoids may be an effective therapy for acute and chronic pain. Have the results of CLINICAL studies also shown that cannabinoids are effective at alleviating acute and chronic pain?

ANSWER: In contrast to experimental studies, the results of clinical trials with cannabinoids provide only moderate-quality evidence for the relief of chronic pain. Also, the analgesic effects of cannabinoids have not been found to be superior to placebo in acute pain. In addition, pre-operative and peri-operative marijuana use may increase post-operative perceived pain.

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QUESTION: A study published in the European Journal of Anaesthesiology, by Jamal et al. reported that marijuana users required a higher dose of morphine s/p abdominal surgery. They estimated that there was a 23% increased opioid dose requirement. Have the results of studies examining the opioid requirements s/p orthopedic surgery also shown that marijuana users require more opioids than patients who do not use marijuana?

ANSWER: In a retrospective study including 3793 patients, patient-reported postoperative outcomes of 155 marijuana users were compared with those of 155 non-users. The results indicate that pre-operative marijuana users had higher pain scores at rest and on movement but did NOT consume more post-operative opioid analgesics. The cannabinoid users also reported a greater incidence of post-operative sleep impairment.

16-Year Study: Medical Marijuana Laws Decrease Underage Use

Results of a large-scale, 16-year anonymized research project found that states with Medical Marijuana Laws (MMLs) and decriminalization statutes, underage cannabis consumption declines, especially among minority youth.

One concern some have regarding legalization of cannabis – whether for Medical (MMJ), or Adult Recreational Use (ARU) – is whether or not it will adversely affect youth. Specifically, a question often asked is, “will legalizing cannabis increase underage consumption?”

Lead Researcher Dr Rebekah Levine Coley said that, “Some people have argued that decriminalizing or legalizing medical marijuana could increase cannabis use amongst young people, either by making it easier for them to access, or by making it seem less harmful.”

“However, we saw the opposite effect,” said Dr Coley, and noted that results of the 16-year-long study show that in states where MMJ is legal, rates of underage consumption of cannabis have declined.

Those findings occurred even after accounting for other variables, including policies on

Ever feel like cattle in a feedlot? High Fructose Corn Syrup works wonders!

Researchers at Princeton University have discovered what farmers have known for many years.

Corn will make you fat.

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Sure you do.

Just read the ingredients labels of the foods you purchase.

Many, if not most, foods contain “High Fructose Corn Syrup,” which can be found in most unlikely of foods.

Ingredients are listed in order of concentration, from highest to lowest. Often, High Fructose Corn Syrup is